凡伤于寒则为病热热虽甚不死（内经曰风寒客于人使人毫毛毕直皮肤闭而为热是伤寒为病热也针经曰多热者易已多
寒者难已是热虽甚不死内经热论甚详宜熟玩之）若两感于寒而病者必死（表里俱病谓之两感）尺寸俱浮者太阳受病也当
一二日发以其脉上连风府故头项痛腰脊强（太阳多血少气为三阳之长其气浮于外故尺寸俱浮是邪气初入皮肤外在表也当
一二日发风府穴名也项中央太阳之脉从巅入络脑还出别下项是以上连风府其经循肩膊内侠脊抵腰中故病头项痛腰脊
强）尺寸俱长者阳明受病也当二三日发以其脉侠鼻络于目故身热目疼鼻干不得卧（阳明血气俱多尺寸俱长者邪并阳明而
血气淖溢也太阳受邪不已传于阳明是当二三日发其脉侠鼻者阳明脉起于鼻交额中络于目阳明之脉正上 还出系目系
身热者阳明主身之肌肉针经曰阳明气盛则身以前皆热目疼鼻干者经中客邪也不得卧者胃气逆不得从其道也内经曰胃不
和则卧不安）尺寸俱弦者少阳受病也当三四日发以其脉循胁络于耳故胸胁痛而耳聋（内经曰阳中之少阳通于春气少血多
气春脉弦尺寸俱弦者知少阳受邪也二三日阳明之邪不已传于少阳是当三四日发胸胁痛而耳聋者经壅而不利也高文庄本
作脉从巅入络肾还出别下项夹脊抵腰中凡太阳传至厥阴自表至里其汗下必因次第有不经三阳便自少阴太阴厥阴者详后
则各根据本经治之）此三经皆受病未入于府者可汗而已（三阳受邪为病在表法当汗解然三阳亦有便入腑者入腑则宜下故云
未入于府者可汗而已按府字素问作藏字理胜盖府为阳藏为阴也又况传阳明者非入腑而何）
尺寸俱沉细者太阴受病也当四五日发以其脉布胃中络于嗌故腹满而嗌干（阳极则阴受之邪传三阳既遍次乃传于阴经
在阳为在表在阴为在里邪在表则见阳脉邪在里则见阴脉阳邪传阴邪气内陷故太阴受病而脉尺寸俱沉细也自三阳传于太
阴是当四五日发也邪入于阴则渐成热腹满而嗌干者脾经壅而成热也）尺寸俱沉者少阴受病也当五六日发以其脉贯肾络于
肺系舌本故口燥舌干而渴（少阴肾水也性趋下少阴受病脉尺寸俱沉也五日太阴之邪不已至五六日则传于少阴也是少阴病
当五六日发人伤于寒则为病热谓始为寒而终成热也少阴病口燥舌干而渴邪气入里热气渐深也活人云经云一二日少阴者
谓国中病时便入少阴不经三阳也大抵伤寒发于阳则太阳也发于阴则少阴也凡病一日至十二三日太阳证不能罢者俱治太
阳有初得病便见少阴证者宜攻少阴不必先自巨阳盖寒入太阳即发热而恶寒入少阴即恶寒而不热）尺寸俱微缓者厥阴受病
也当六七日发以其脉循阴器络于肝故烦满而囊缩（缓者风脉也厥阴脉微缓者邪传厥阴热气已剧近于风也六七日发以少阴
邪传于厥阴烦满而囊缩者热气聚于内也〔娄〕烦满谓少腹烦满也下文云十二日厥阴病衰囊纵少腹微下谓向者囊之缩者今
复病少腹之烦满故令微下也）此三经皆受病已入于府可下而已（三阴受邪为病在里于法当下然三阴亦有在经者在经则宜
汗故云已入于府者可下而已经曰临病之工宜须两审按已入于府二句恐是阳明经条下之错简盖素问不如此说但曰三阴三
阳五脏六腑皆受病荣卫不行五脏不通则死矣盖三阴经汗下温三法俱有不特可下而已也）若两感于寒者一日太阳受之即与
少阴俱病则头痛口干烦满而渴二日阳明受之即与太阴俱病则腹满身热不欲食谵语三日少阳受之即与厥阴俱病则耳聋囊
缩而厥水浆不入不知人者六日死若三阴三阳五脏六腑皆受病则荣卫不行腑脏不通而死矣（阴阳俱病表里俱伤者为两感以
其阴阳两感病则两证俱见至于传经则亦阴阳两经俱传也始得一日头痛者太阳口干烦满而渴者少阴至二日则太阳传于阳
明而少阴亦传于太阴身热谵语者阳明腹满不欲食者太阴至三日阳明传于少阳而太阴又传于厥阴耳聋者少阳囊缩而厥者
厥阴水浆不入不知人者胃气不通也内经曰五脏已伤六腑不通荣卫不行如是之后三日乃死何也岐伯曰阳明者十二经脉之
长也其血气盛故云不知人三日其气已尽故死矣谓三日六经俱病荣卫之气不得行于内外腑脏之气不得通于上下至六日腑
脏之气俱尽荣卫之气俱绝则死矣按太阴可传于少阴少阴不可传于太阴逆故也此说未善盖太阳为膀胱少阴为肾肾与膀胱
为合太阴为脾阳明为胃胃与脾合少阳为胆厥阴为肝肝与胆合阴道从阳譬之妯娌但以夫年为次不以己齿为序也）伤寒一日
太阳受之脉若静者为不传颇欲吐若躁烦脉数急者为传也（太阳主表一日则太阳受邪至二日当传阳明若脉气微则不传阳明
胃经受邪则喜吐寒邪传里者则变热若颇欲吐若烦躁脉急数者为太阳寒邪变热传于阳明也）伤寒二三日阳明少阳证不见者
为不传也（伤寒二三日无阳明少阳证知邪不传止在太阳经中也）
伤寒三日三阳为尽三阴当受邪其人反能食而不呕此为三阴不受邪也（四日表邪传里里不和则不能食而呕今反之故知
不传阴但在阳也）
问曰伤寒三日脉浮数而微病患身凉和者何也答曰此为欲解也解以夜半脉浮而解者 然汗出也脉数而解
者必能食也脉微而解者必大汗出也三日少阳脉小欲已也（论见口苦舌干）
其不两感于寒更不传经不加异气者至七日太阳病衰头痛少愈也八日阳明病衰身热少歇也九日少阳病衰耳聋微闻也
十日太阴病衰腹减如故则思饮食十一日少阴病衰渴止舌干已而嚏也十二日厥阴病衰囊纵少腹微下大气皆去病患精神爽
慧也太阳病头痛至七日以上自愈者行其经尽故也若欲再传经者针足阳明使不传则愈
六七日脉至皆大烦而口噤不言躁扰者必欲解也伤寒六七日无大热其人躁烦此为阳去入阴故也若过十三日以上不间
（间谓病已）尺寸陷者大危
若更感异气变为他病者当依旧坏证而治之若脉阴阳俱盛重感于寒者变为温疟（尺寸俱盛先热后寒宜小柴胡先寒后热
宜加桂但寒柴胡加桂姜汤但热白虎加桂汤有汗多烦渴小便赤涩素有瘴气及不服水土呕吐甚者五苓散）阳脉浮滑阴脉濡弱
者更遇于风变为风温（风温主四肢不收头痛身热常自汗出不解气喘尺寸俱浮嘿嘿欲睡治在少阴厥阴不可发汗）阳脉洪数
阴脉实大者遇温热变为温毒为病最重也（温毒必发斑）阳脉濡弱阴脉弦紧者更遇温气变为温疫以冬伤于寒发为温病脉之
变症方治如后说（见后条）
戴 伤寒先犯太阳以次而传此特言其概耳然其中变证不一有发于阳即少阴受之者有夹食伤寒食动脾脾太阴之经一
得病即腹满痛者亦有不循经而入如初得病径犯阳明之类不皆始于太阳也亦有首尾止在一经不传他经亦有止传一二经而
止者不必尽得诸经也至如病之逾越不可泥于次序当随证施治所以伤寒得外证为多仲景云日数虽多有表证者犹宜汗日数
虽少有里证者即宜下
海 阳中之阳水太阳是也为三阳之首能循经传亦能越经传阳中之阳土阳明是也阳明为中州之主主纳而不出如太阳
传至此名曰循经传也阳中之阳木少阳是也上传阳明下传太阴如太阳传至此为越经传阴中之阴土太阴是也上传少阳为顺
下传少阴为逆如传少阴为上下传也如太阳传太阴为误下传也阴中之阴水少阴是也上传太阴为顺下传厥阴为逆如太阳传
至此乃表传里也阴中之阴木厥阴是也上传少阴为实再传太阴为自安
海 太阳者巨阳也为诸阳之首膀胱经病若渴者自入于本也名曰传本太阳传阳明胃土者名曰循经传为发汗不彻利小
便余邪不尽透入于里也太阳传少阳胆木者名曰越经传也为元受病脉浮无汗宜用麻黄汤而不用故也太阳传太阴脾土者名
曰误下传为元受病脉缓有汗当用桂枝而反下之所致也当病腹痛四肢沉重太阳传少阴肾水名曰表传里为病急当发汗而反
下汗不发所以传里也太阳传厥阴肝木者为阴不至于首惟厥阴与督脉上行与太阳相接名循经得度传
吴 夫伤寒六经为病阴阳虚实或冷或热者无非客邪之所为也内经言人伤于寒则为病热者言常而不言变也仲景谓或
寒或热而不一者备常与变而弗遗也盖阳邪传者常也阴邪传者变也且夫阳邪以日数次第而传者一二日太阳二三日阳明三
四日少阳四五日太阴五六日少阴六七日厥阴也七日经尽当汗出而解七日不解谓之再经二七日不解谓之过经过经不解则
为坏病华佗云伤寒一日在皮二日在肤三日在肌四日在胸五日在腹六日在胃乃传里也其治例曰在皮肤者汗之在肌肉者和
之在胸者吐之在腹入里者下之也伤寒赋曰一二日可发表而散三四日可和解而痊五六日便实方可议下其例颇同也殊不知
此皆大约之法言常而不言变也盖寒之伤人初无定规或中于阴或中于阳也经言一二日发热脉沉者少阴病也又一二日口中
和背恶寒者少阴病也此皆直中阴经之寒非常而为变也活人书曰凡寒邪自背而入者或中太阳或中少阴自面而入者则中阳
明之类亦不专主于太阳也又曰寒邪首尾只在一经而不传者有之有间传一二经者有传过一经而不再传者亦有足经冤热而
传入手经者有误服药而致传变者多矣故经曰一日太阳受之脉静者为不传也若脉数躁急烦欲吐者传也又曰二三日阳明少
阳病不见者为不传又曰太阳病脉浮紧身疼痛发热七八日不解此表证仍在当发其汗又少阴病得之二三日口燥咽干者急下
之宜大承气汤此皆不以日数而言也守真曰谁敢二三日便以大承气下之盖圣人书不尽言言不尽意说其大概而已盖太阳为
诸经之首传变居多且热邪乘虚入经则传也若经实则不受邪而不传也且夫太阳水传阳明土乃妻传夫谓之微邪阳明土传少
阳木亦曰妻传夫乃微邪也少阳木传太阴土乃夫传妻谓之贼邪太阴土传少阴水亦曰夫传妻乃贼邪也少阴水传厥阴木母传
子谓之虚邪太阳水间传少阳木乃母传子亦曰虚邪也太阳水越经而传太阴土谓之微邪又曰误下传也太阳水传少阴水此乃
阴阳双传即两感也太阳水传厥阴木乃母传子谓之虚邪又曰首尾传也夫伤寒传至厥阴肝经为尾盖厥者尽也正气将复而邪
气将解水升火降寒热作而大汗解也若正气不复邪无从解阴气胜极则四肢厥冷舌卷耳聋囊缩不知人而死矣赵氏曰大抵邪
在阳经则易治传入阴经则危殆盖阳微而阴盛正虚而邪实也况误下内陷汗虚别经则坏异倾危可立而待凡治伤寒之要须读
仲景之书求其立法之意不然则疑信相杂未免通此而碍彼也熟读详玩其例自见则治法不差矣若不得其例而执论专方胶柱
鼓瑟谬误其可免哉许氏有曰读仲景书用仲景法未尝守仲景方可谓得古人心矣学人可不于片言只字玩索其意与幸相与勉
之陶氏曰伤寒传足不传手经者俗医之谬论也夫人之气自平旦会于膻中朝行手太阴肺以次分布诸经所以一脉愆和则百脉
皆病彼云传足不传手者何所据乎盖伤寒者乃冬时感寒即病之名也在时则足太阳少阴正司其令触冒之者则二经受病其次
则少阳厥阴继冬而司春令而亦受伤何也盖风木之令起于大寒节正当十二月中至春分后方行温令故风寒亦能伤之足阳明
太阴中土也与冬时无预而亦伤之何也紫阳朱子曰土无定位无成名无专气寄旺于四季能终始万物则四时寒热温凉之气皆
能伤之也况表邪传里必归于脾胃而成燥粪用承气汤以除去之胃气和矣手之六经主于夏秋故不伤之足之六经盖受伤之方
分境界也若言伤足不伤手则可以为传足不传手则不可也况风寒之中人先入荣卫昼夜循环无所不至岂间断于手经哉发明
曰伤寒受病之由皆出热论一篇而已何独传足而不传手何也盖伤寒病冬月得之足太阳膀胱为首次至足厥阴肝经为尾此病
惟伤北方及东方与戊土上有足阳明胃湿之专位兼丑上有足太阴脾土之专位盖足之六经皆在东北之方经云冬伤于寒即发
者为伤寒春发于温病夏发于温疫为病最重此之谓也仲景云无奇经则无伤寒缘奇经皆附足六经不附手经是以寒邪只伤足
经也长夏为大热病者夏火既旺火之方与秋之分皆手经居之水方与春之分皆足经不足及夏火旺客邪助于手经则不足者愈
不足矣故所用之药皆泄有余而非足经药何者泄有余则不足者补矣此伤寒先言足经而不言手经也大意如此至于传手经者
亦有之矣此事难知曰伤寒传至五六日间渐变神昏不语或睡中独语一二句目赤唇焦舌干不饮水稀粥与之则咽终日不与则
不思六脉细数而不洪大心下不痞腹中不满大小便如常或传十日以来形貌如醉人医见神昏不已多用承气汤下之误矣盖不
知此热传手少阴心经也然又未知自何经而来答曰本太阳经伤风风为阳邪阳邪伤卫阴血自燥热蓄膀胱壬病逆传于丙丙丁
兄妹由是传心心火自上迫而熏肺所以神昏也谓肺为清虚之脏内有火邪致令神昏宜栀子黄芩黄连汤若脉在丙者导赤散脉
在心者泻心汤若误用凉膈散乃气中之血药也如左手寸脉沉滑有力者则可用之或用犀角地黄汤近于是也本方所说若无犀
角以升麻代之是阳明经药也此解阳明经血中热药若脉浮沉俱有力者是丙丁中俱有热也可以导赤泻心各半服之则宜矣此
证膀胱传丙足传手经也下传上也丙传丁也表传里也壬传丁者坎传离也越经传也又谓腑传脏也活人云伤寒传足不传手此
言不尽意也有从足经而传手经者何以知之经云伤寒或止传一经或间传一二经不可拘以始太阳终厥阴也但凭脉与外证治
凡是感受寒邪就会发生热病，即使热势很盛也不会死亡（《内经》说：风寒侵袭人体，使人毫毛竖立，皮肤闭塞而发热，这就是伤寒导致发热的道理。《针经》说：热证多的容易痊愈，寒证多的难治，所以热势虽盛也不会死亡。《素问·热论》对此论述得很详细，应当仔细研读）。如果是两感于寒而发病的，必定死亡（表里两经同时受邪称为两感）。
脉象尺寸部都浮的，是太阳经受病，应当在第一、二天发作，因为它的经脉上连风府穴，所以会出现头痛、项强、腰脊僵硬的症状（太阳经多血少气，是三阳经之首，其气浮越于外，所以脉象尺寸俱浮，这是邪气初入皮肤，在体表的表现，应当在第一、二天发作。风府是穴位名。足太阳膀胱经从头顶入络于脑，复出别下行至项部，所以上连风府；其经脉循行经过肩膊内侧，夹脊柱抵腰部，所以病见头痛、项强、腰脊僵硬）。
脉象尺寸部都长的，是阳明经受病，应当在第二、三天发作，因为它的经脉夹鼻络于目，所以会出现身热、目痛、鼻干、不得安卧的症状（阳明经气血俱多，脉象尺寸俱长，说明邪气并入阳明，气血充盛溢满。太阳受邪不愈传于阳明，应当在第二、三天发作。其脉夹鼻者，是因为阳明脉起于鼻，交于额中，络于目。阳明之脉正上行，复出系目系。身热是因为阳明主司肌肉，《针经》说阳明气盛则身体前部皆热。目痛、鼻干是经中有客邪。不得安卧是因为胃气逆乱，不能顺行其道。《内经》说胃不和则卧不安）。
脉象尺寸部都弦的，是少阳经受病，应当在第三、四天发作，因为它的经脉循胁肋络于耳，所以会出现胸胁痛和耳聋的症状（《内经》说：阳中之少阳通应春气，少血多气，春脉弦。脉象尺寸俱弦，可知是少阳受邪。第二、三天阳明之邪不愈传于少阳，应当在第三、四天发作。胸胁痛和耳聋是因为经络壅滞而不通畅。高文庄本作“脉从巅入络肾还出别下项夹脊抵腰中”。凡太阳经传至厥阴经，自表入里，其汗法、下法必须依照次第进行。有不经过三阳经就直接传入少阴、太阴、厥阴的，详见后文，治疗时各根据本经病症施治）。
这三条经（太阳、阳明、少阳）都受了病，但邪气尚未入腑的，可以通过发汗治愈（三阳受邪为病在表，依法当用汗法解表。然而三阳经也有直接入腑的情况，入腑则宜用下法，所以说“未入于府的可以发汗治愈”。按“府”字，《素问》作“藏”字，道理更胜，盖府属阳，藏属阴。况且传于阳明的，难道不是入腑吗？）。
脉象尺寸部都沉细的，是太阴经受病，应当在第四、五天发作，因为它的经脉布散于胃中，络于咽喉，所以会出现腹满和咽喉干燥的症状（阳极则阴受之，邪气传遍三阳之后，接着才传于阴经。在阳经为在表，在阴经为在里。邪在表则见阳脉，邪在里则见阴脉。阳邪传入阴经，邪气内陷，所以太阴受病而脉象尺寸俱沉细。自三阳传于太阴，应当在第四、五天发作。邪入阴经则逐渐化热。腹满和咽喉干燥是因为脾经壅滞而成热）。
脉象尺寸部都沉的，是少阴经受病，应当在第五、六天发作，因为它的经脉贯穿肾脏，络于肺，系于舌根，所以会出现口燥、舌干而渴的症状（少阴属肾水，性趋下，少阴受病脉象尺寸俱沉。第五天太阴之邪不愈，至第五、六天则传于少阴。这也是少阴病应当在第五、六天发作的原因。人伤于寒则为病热，是说起初受寒，最终化为热。少阴病出现口燥、舌干而渴，是因为邪气入里，热气渐深。《活人书》说：经文说“一二日少阴”，是指国人患病时邪气便入少阴，不经过三阳经。大抵伤寒发于阳经则是太阳病，发于阴经则是少阴病。凡病从一日至十二三日，太阳证不能罢休的，都治太阳。有初得病就见到少阴证的，宜攻治少阴，不必先从巨阳（太阳）治起。盖寒邪入太阳即发热而恶寒，入少阴即恶寒而不发热）。
脉象尺寸部都微缓的，是厥阴经受病，应当在第六、七天发作，因为它的经脉循行于阴器，络于肝，所以会出现烦闷和阴囊收缩的症状（缓脉是风脉。厥阴脉微缓，说明邪气传至厥阴，热气已剧，近于风邪。第六、七天发作，是因为少阴邪气传于厥阴。烦闷和阴囊收缩是因为热气聚于体内。〔娄〕说：烦满指少腹烦满。下文说“十二日厥阴病衰，囊纵，少腹微下”，是说先前阴囊收缩的，现在复病少腹烦满，所以令其微下也）。
这三条经（太阴、少阴、厥阴）都受了病，且邪气已入腑的，可以通过泻下治愈（三阴受邪为病在里，依法当下。然而三阴经也有在经的情况，在经则宜用汗法，所以说“已入于腑的可以泻下治愈”。《经》曰：临病之工，宜须两审。按“已入于腑”这两句，恐怕是阳明经条下的错简，因为《素问》不是这样说的，只说“三阴三阳、五脏六腑皆受病，营卫不行，五脏不通则死矣”。盖三阴经的汗、下、温三种方法都有，不只是可下而已）。
如果是两感于寒的，第一天太阳经受病，随即少阴经也受病，则出现头痛、口干、烦满而渴；第二天阳明经受病，随即太阴经也受病，则出现腹满、身热、不欲食、谵语；第三天少阳经受病，随即厥阴经也受病，则出现耳聋、阴囊收缩和四肢厥冷，水浆不入、神志昏迷的，第六天死亡。如果三阴三阳、五脏六腑都受病，则营卫不行，脏腑不通而死（阴阳两经同时受病，表里俱伤的称为两感。因为阴阳两感，所以两经症状俱见。至于传经，也是阴阳两经俱传。始得病一日头痛，是太阳经病；口干、烦满而渴，是少阴经病。至二日，太阳传于阳明，而少阴亦传于太阴。身热、谵语，是阳明经病；腹满、不欲食，是太阴经病。至三日，阳明传于少阳，而太阴又传于厥阴。耳聋，是少阳经病；阴囊收缩和四肢厥冷，是厥阴经病。水浆不入、不知人，是胃气不通。《内经》说：五脏已伤，六腑不通，营卫不行，如是之后三日乃死。为什么呢？岐伯说：阳明经是十二经脉之长，其血气盛，所以说不知人。三日其气已尽，所以死亡。谓三日六经俱病，营卫之气不得行于内外，脏腑之气不得通于上下。至六日，脏腑之气俱尽，营卫之气俱绝，则死亡。按太阴可传于少阴，少阴不可传于太阴，这是逆传，所以这种说法并不完善。盖太阳为膀胱，少阴为肾，肾与膀胱为合；太阴为脾，阳明为胃，胃与脾合；少阳为胆，厥阴为肝，肝与胆合。阴道从阳，譬如妯娌，但以丈夫年龄为次，不以自己齿序为序）。
伤寒第一天，太阳经受病，脉象若静定不变，说明不传经；如果颇欲呕吐，或者烦躁，脉数急的，说明传经了（太阳主表，第一天太阳受邪，至第二天当传阳明。若脉气微弱，则不传阳明。胃经受邪则喜吐。寒邪传里则变热。如果颇欲吐、烦躁、脉急数，是太阳寒邪变热，传于阳明）。
伤寒第二、三天，不见阳明、少阳证的，说明不传经了（伤寒第二、三天，没有阳明、少阳证，知道邪气不传，止在太阳经中）。
伤寒第三天，三阳经的病已尽，三阴经应当受邪。如果其人反而能食且不呕吐，这说明三阴经不受邪（第四天表邪传里，里不和则不能食而呕。现在反能食不呕，故知不传阴，但在阳经）。
问：伤寒三天，脉浮数而微，病人身体凉爽平和，这是什么原因？答：这是病将要解除的表现。解除的时间多在夜半。脉浮而解的，必然濈然汗出；脉数而解的，必定能进食；脉微而解的，必定大汗出。第三天少阳脉小，说明病欲已（此条论述见于口苦舌干条下）。
那些不属于两感于寒，又不传经，不加杂气的，到第七天太阳病衰退，头痛稍减；第八天阳明病衰退，身热稍歇；第九天少阳病衰退，耳聋稍能听到声音；第十天太阴病衰退，腹部胀满减轻如常，开始想饮食；第十一天少阴病衰退，口渴止，舌干已除，并且打喷嚏；第十二天厥阴病衰退，阴囊松弛，少腹微下，大气皆去，病人精神清爽聪慧。太阳病头痛，至七日以上自愈的，是因为行其经尽的缘故。如果想要再传经，针刺足阳明经，使不传经则愈。
六七天脉象盛大，大烦而口噤不言，躁扰的，必定要解病。伤寒六七天，无大热，其人躁烦，这是因为阳邪入阴的缘故。如果过十三日以上病未间（间谓病已），尺寸脉陷下的，是大危之候。
如果再次感受异气，变为其他病的，应当依旧按照坏证治疗。如果脉象阴阳俱盛，重感于寒的，变为温疟（尺寸俱盛，先热后寒，宜用小柴胡汤；先寒后热，宜加桂枝，即柴胡加桂姜汤；但热，宜白虎加桂枝汤；有汗多、烦渴、小便赤涩，素有瘴气及不服水土、呕吐甚者的，用五苓散）。阳脉浮滑，阴脉濡弱的，更遇风邪，变为风温（风温主症为四肢不收，头痛身热，常自汗出不解，气喘，尺寸俱浮，嘿嘿欲睡，治在少阴、厥阴，不可发汗）。阳脉洪数，阴脉实大的，遇温热变为温毒，为病最重（温毒必发斑）。阳脉濡弱，阴脉弦紧的，更遇温气，变为温疫，以冬伤于寒发为温病，脉的变症方治如后说（见后条）。
戴氏说：伤寒先犯太阳，依次而传，这只是言其大概。然而其中变证不一，有发于阳即少阴受之的；有夹食伤寒，食动脾，脾属太阴之经，一得病即腹满痛的；也有不循经而入，如初得病径犯阳明之类的，不皆始于太阳。也有首尾止在一经，不传他经的；也有止传一二经而止的，不必尽得诸经。至于病之逾越，不可泥于次序，当随证施治。所以伤寒得外证为多，仲景云：日数虽多，有表证者犹宜汗；日数虽少，有里证者即宜下。
海氏说：阳中之阳水，太阳是也，为三阳之首，能循经传，亦能越经传。阳中之阳土，阳明是也，阳明为中州之主，主纳而不出。如太阳传至此，名曰循经传。阳中之阳木，少阳是也，上传阳明，下传太阴。如太阳传至此，为越经传。阴中之阴土，太阴是也，上传少阳为顺，下传少阴为逆。如传少阴，为上下传。如太阳传太阴，为误下传。阴中之阴水，少阴是也，上传太阴为顺，下传厥阴为逆。如太阳传至此，乃表传里。阴中之阴木，厥阴是也，上传少阴为实，再传太阴为自安。
海氏又说：太阳者，巨阳也，为诸阳之首。膀胱经病，若渴者，是自入于本，名曰传本。太阳传阳明胃土者，名曰循经传，为发汗不彻，利小便，余邪不尽透入于里也。太阳传少阳胆木者，名曰越经传，为元受病脉浮无汗，宜用麻黄汤而不用所致。太阳传太阴脾土者，名曰误下传，为元受病脉缓有汗，当用桂枝而反下之所致。当病腹痛，四肢沉重。太阳传少阴肾水，名曰表传里，为病急当发汗而反下之，汗不发，所以传里。太阳传厥阴肝木，者为阴不至于首，惟厥阴与督脉上行，与太阳相接，名循经得度传。
吴氏说：夫伤寒六经为病，阴阳虚实，或冷或热，无非客邪之所为。《内经》言人伤于寒则为病热，是言常而不言变。仲景谓或寒或热而不一，是备常与变而弗遗。盖阳邪传者常也，阴邪传者变也。且夫阳邪以日数次第而传者：一二日太阳，二三日阳明，三四日少阳，四五日太阴，五六日少阴，六七日厥阴。七日经尽，当汗出而解。七日不解，谓之再经。二七日不解，谓之过经。过经不解，则为坏病。华佗云：伤寒一日在皮，二日在肤，三日在肌，四日在胸，五日在腹，六日在胃，乃传里也。其治例曰：在皮肤者汗之，在肌肉者和之，在胸者吐之，在腹入里者下之。《伤寒赋》曰：一二日可发表而散，三四日可和解而痊，五六日便实方可议下。其例颇同。殊不知此皆大约之法，言常而不言变。盖寒之伤人，初无定规，或中于阴，或中于阳。经言一二日发热脉沉者，少阴病也。又一二日口中平和背恶寒者，少阴病也。此皆直中阴经之寒，非常而为变。《活人书》曰：凡寒邪自背而入者，或中太阳，或中少阴；自面而入者，则中阳明之类，亦不专主于太阳。又曰：寒邪首尾只在一经而不传者，有之；有间传一二经者；有传过一经而不再传者；亦有足经冤热而传入手经者；有误服药而致传变者，多矣。故经曰：一日太阳受之，脉静者为不传。若脉数躁急，烦欲吐者，传也。又曰：二三日阳明少阳病不见者为不传。又曰：太阳病脉浮紧，身疼痛，发热七八日不解，此表证仍在，当发其汗。又少阴病得之二三日，口燥咽干者，急下之，宜大承气汤。此皆不以日数而言。守真曰：谁敢二三日便以大承气下之？盖圣人书不尽言，言不尽意，说其大概而已。盖太阳为诸经之首，传变居多。且热邪乘虚入经则传也，若经实则不受邪而不传。且夫太阳水传阳明土，乃妻传夫，谓之微邪。阳明土传少阳木，亦曰妻传夫，乃微邪。少阳木传太阴土，乃夫传妻，谓之贼邪。太阴土传少阴水，亦曰夫传妻，乃贼邪。少阴水传厥阴木，母传子，谓之虚邪。太阳水间传少阳木，乃母传子，亦曰虚邪。太阳水越经而传太阴土，谓之微邪，又曰误下传。太阳水传少阴水，此乃阴阳双传，即两感。太阳水传厥阴木，乃母传子，谓之虚邪，又曰首尾传。夫伤寒传至厥阴肝经为尾，盖厥者尽也。正气将复而邪气将解，水升火降，寒热作而大汗解。若正气不复，邪无从解，阴气胜极，则四肢厥冷，舌卷耳聋，囊缩不知人而死。赵氏曰：大抵邪在阳经则易治，传入阴经则危殆。盖阳微而阴盛，正虚而邪实。况误下内陷，汗虚别经，则坏异倾危，可立而待。凡治伤寒之要，须读仲景之书，求其立法之意，不然则疑信相杂，未免通此而碍彼。熟读详玩其例自见，则治法不差。若不得其例而执论专方，胶柱鼓瑟，谬误其可免哉？许氏有曰：读仲景书，用仲景法，未尝守仲景方，可谓得古人心矣。学人可不于片言只字玩索其意，与幸相与勉之。陶氏曰：伤寒传足不传手经者，俗医之谬论。夫人之气自平旦会于膻中，朝行手太阴肺，以次分布诸经，所以一脉愆和则百脉皆病。彼云传足不传手者，何所据乎？盖伤寒者，乃冬时感寒即病之名。在时则足太阳、少阴正司其令，触冒之者则二经受病。其次则少阳、厥阴继冬而司春令，而亦受伤。何也？盖风木之令起于大寒节，正当十二月中，至春分后方行温令，故风寒亦能伤之。足阳明、太阴中土，也与冬时无预，而亦伤之。何也？紫阳朱子曰：土无定位，无名，无专气，寄旺于四季，能终始万物，则四时寒热温凉之气皆能伤之。况表邪传里，必归于脾胃而成燥粪，用承气汤以除去之，胃气和矣。手之六经主于夏秋，故不伤之。足之六经，盖受伤之方分境界也。若言伤足不伤手，则可以传足不传手，则不可。况风寒之中人，先入荣卫，昼夜循环，无所不至，岂间断于手经哉？发明曰：伤寒受病之由，皆出《热论》一篇而已。何独传足而不传手？何也？盖伤寒病冬月得之，足太阳膀胱为首，次至足厥阴肝经为尾。此病惟伤北方及东方，与戊土上有足阳明胃湿之专位，兼丑上有足太阴脾土之专位。盖足之六经皆在东北之方。经云：冬伤于寒即发者为伤寒，春发于温病，夏发于温疫，为病最重，此之谓。仲景云：无奇经则无伤寒，缘奇经皆附足六经，不附手经，是以寒邪只伤足经。长夏为大热病者，夏火既旺，火之方与秋之分皆手经居之，水方与春之分皆足经不足。及夏火旺，客邪助于手经，则不足者愈不足矣。故所用之药皆泄有余，而非足经药。何者？泄有余则不足者补矣。此伤寒先言足经而不言手经。大意如此。至于传手经者，亦有之。此事难知曰：伤寒传至五六日间，渐变神昏不语，或睡中独语一二句，目赤唇焦，舌干不饮水，稀粥与之则咽，终日不与则不思，六脉细数而不洪大，心下不痞，腹中不满，大小便如常。或传十日以来，形貌如醉人。医见神昏不已，多用承气汤下之，误矣。盖不知此热传手少阴心经。然又未知自何经而来？答曰：本太阳经伤风，风为阳邪，阳邪伤卫，阴血自燥，热蓄膀胱，壬病逆传于丙，丙丁兄妹，由是传心。心火自上迫而熏肺，所以神昏。谓肺为清虚之脏，内有火邪，致令神昏。宜栀子黄芩黄连汤。若脉在丙者，导赤散；脉在心者，泻心汤。若误用凉膈散，乃气中之血药。如左手寸脉沉滑有力者，则可用之。或用犀角地黄汤，近于是。本方所说若无犀角，以升麻代之，是阳明经药。此解阳明经血中热药。若脉浮沉俱有力，是丙丁中俱有热，也可以导赤泻心各半服之，则宜矣。此证膀胱传丙，足传手经，下传上也，丙传丁也，表传里也，壬传丁者，坎传离也，越经传，又谓腑传脏。《活人》云：伤寒传足不传手，此言不尽意。也有从足经而传手经者。何以知之？经云：伤寒或止传一经，或间传一二经，不可拘以始太阳终厥阴。但凭脉与外证治。
Whenever one is injured by cold, a heat disease occurs. Even if the heat is severe, death will not ensue (The *Neijing* states: "When wind and cold invade humans, causing all body hairs to stand erect and skin pores to close, heat results; this is why cold injury causes heat." The *Zhenjing* states: "Those with much heat are easy to cure; those with much cold are difficult to cure." Thus, even severe heat does not lead to death. This is discussed in detail in the *Suwen: Re Lun*, and should be studied carefully.) However, if one suffers from "Liang Gan" (simultaneous involvement of exterior and interior meridians) due to cold, death is inevitable (Simultaneous involvement of exterior and interior is called Liang Gan).
If the pulse at both Cun and Chi positions is floating, it indicates Taiyang meridian disease. It typically manifests on the first or second day because its vessel connects to the Fengfu acupoint, leading to headache, stiffness of the neck and spine, and rigidity of the lower back (Taiyang has abundant blood but scarce Qi and is the head of the three Yang meridians; its Qi floats outward, hence the floating pulse at Cun and Chi, indicating pathogenic factors have just entered the skin and are at the exterior. It manifests on days 1-2. Fengfu is an acupoint name. The Foot-Taiyang Bladder Meridian enters the brain from the vertex, emerges separately, and descends to the nape, thus connecting to Fengfu. Its course runs along the shoulders, inside the paravertebral muscles, reaching the waist; therefore, pathology presents as headache, neck stiffness, and spinal rigidity).
If the pulse at both Cun and Chi positions is long, it indicates Yangming meridian disease. It typically manifests on the second or third day because its vessel surrounds the nose and connects to the eyes, leading to fever, eye pain, nasal dryness, and inability to sleep (Yangming has abundant Qi and Blood; a long pulse at Cun and Chi indicates pathogens merging into Yangming with overflowing Qi and Blood. If Taiyang pathology persists and transmits to Yangming, it manifests on days 2-3. The vessel surrounding the nose refers to the Yangming Meridian of Hand-Yangming starting at the nose, crossing the forehead, and connecting to the eyes. The Yangming Meridian ascends to the vertex, emerges, and connects to the eye system. Fever occurs because Yangming governs the muscles; the *Zhenjing* states that excess Yangming Qi causes heat in the anterior body. Eye pain and nasal dryness result from pathogenic factors lodging in the vessel. Inability to sleep occurs because Stomach Qi rebels and fails to follow its normal course; the *Neijing* states, "When the Stomach is disharmonious, sleep is disturbed.")
If the pulse at both Cun and Chi positions is wiry (Xian), it indicates Shaoyang meridian disease. It typically manifests on the third or fourth day because its vessel follows the hypochondrium and connects to the ears, leading to hypochondriac pain and deafness (The *Neijing* states: "Shaoyang within Yang corresponds to Spring Qi; it has less blood and more Qi, and the Spring pulse is wiry." A wiry pulse at Cun and Chi indicates Shaoyang invasion. If Yangming pathology persists from days 2-3 and transmits to Shaoyang, it manifests on days 3-4. Hypochondriac pain and deafness result from vessel congestion and obstruction. Gao Wenzhuang's edition reads: "The vessel enters the kidney from the vertex, emerges separately, descends alongside the spine to the waist." Generally, transmission from Taiyang to Jueyin proceeds from exterior to interior, requiring sequential use of sweating and purging methods. Some cases bypass the three Yang meridians and directly involve Taiyin, Shaoyin, or Jueyin; see later sections for treatment based on the specific meridian involved).
For these three meridians (Taiyang, Yangming, Shaoyang), if the pathogens have not yet entered the Fu organs, they can be cured by inducing sweating (Pathogens in the three Yang meridians affect the exterior, so the method should be sweating. However, the three Yang meridians can also directly enter the Fu organs; if they do, purging is indicated. Hence, "those not yet entering the Fu organs can be cured by sweating." Note: In the *Suwen*, the character "Fu" (Organ) is written as "Zang" (Viscera); this reasoning is superior, as Fu belongs to Yang and Zang to Yin. Moreover, transmission to Yangming implies entering the Fu organ?).
If the pulse at both Cun and Chi positions is deep and fine, it indicates Taiyin meridian disease. It typically manifests on the fourth or fifth day because its vessel spreads through the Stomach and connects to the throat, leading to abdominal fullness and dryness of the throat (When Yang reaches its extreme, Yin is affected. After pathogens traverse the three Yang meridians, they subsequently transmit to the Yin meridians. Involvement of Yang meridians is considered exterior; involvement of Yin meridians is considered interior. Exterior pathogens present with Yang pulses; interior pathogens present with Yin pulses. Yang pathogens transmitting to Yin cause internal sinking of pathogens, resulting in Taiyin disease with deep and fine pulses at Cun and Chi. Transmission from the three Yang to Taiyin occurs on days 4-5. Pathogens entering Yin gradually generate heat. Abdominal fullness and throat dryness result from Spleen meridian congestion generating heat).
If the pulse at both Cun and Chi positions is deep, it indicates Shaoyin meridian disease. It typically manifests on the fifth or sixth day because its vessel penetrates the Kidney, connects to the Lung, and attaches to the root of the tongue, leading to dry mouth, dry tongue, and thirst (Shaoyin corresponds to Kidney Water, which tends downward; thus, Shaoyin disease presents with deep pulses at Cun and Chi. On the fifth day, if Taiyin pathogens persist, they transmit to Shaoyin by days 5-6. This explains why Shaoyin disease manifests on days 5-6. Humans injured by cold develop heat diseases; initially cold, it eventually transforms into heat. Dry mouth, dry tongue, and thirst in Shaoyin disease indicate pathogens entering the interior and heat intensifying. The *Huoren Shu* states: "The text mentions 'Shaoyin on days 1-2' referring to cases where pathogens enter Shaoyin immediately upon illness, bypassing the three Yang meridians." Generally, Shanghan originating in Yang meridians involves Taiyang; originating in Yin meridians involves Shaoyin. For illnesses lasting 1 to 12-13 days where Taiyang symptoms persist, treat Taiyang. If Shaoyin symptoms appear immediately upon onset, treat Shaoyin directly without first treating Juyang (Taiyang). Cold invading Taiyang causes fever and aversion to cold; invading Shaoyin causes aversion to cold without fever).
If the pulse at both Cun and Chi positions is slightly slow (Huan), it indicates Jueyin meridian disease. It typically manifests on the sixth or seventh day because its vessel follows the genitalia and connects to the Liver, leading to irritability, fullness, and retraction of the scrotum (A slow pulse is associated with Wind. A slightly slow Jueyin pulse indicates transmission to Jueyin with intense heat resembling Wind. Manifestation on days 6-7 occurs because Shaoyin pathogens transmit to Jueyin. Irritability, fullness, and scrotal retraction result from heat gathering internally. [Lou] states: "Fanman" refers to irritability and fullness in the lower abdomen. The following text says, "On the twelfth day, Jueyin disease declines, the scrotum relaxes, and there is slight lower abdominal depression," meaning the previous scrotal retraction is now accompanied by lower abdominal irritability/fullness, causing slight depression).
For these three meridians (Taiyin, Shaoyin, Jueyin), if the pathogens have already entered the Fu organs, they can be cured by purging (Pathogens in the three Yin meridians affect the interior, so the method should be purging. However, the three Yin meridians can also remain in the Jing (vessel) level; if in the vessel, sweating is appropriate. Hence, "those having entered the Fu organs can be cured by purging." The Classics state: "Physicians facing illness must examine carefully." Regarding the phrase "having entered the Fu organs," this may be a misplaced slip from the Yangming section, as the *Suwen* states only: "If all three Yin and three Yang meridians, five Zang and six Fu organs are diseased, Ying and Wei circulation stops, and the five Zang become blocked, death ensues." The three Yin meridians utilize sweating, purging, and warming methods, not merely purging).
If suffering from Liang Gan (simultaneous exterior-interior cold injury): On day one, Taiyang is affected, simultaneously involving Shaoyin, presenting with headache, dry mouth, irritability, fullness, and thirst. On day two, Yangming is affected, simultaneously involving Taiyin, presenting with abdominal fullness, fever, anorexia, and delirious speech. On day three, Shaoyang is affected, simultaneously involving Jueyin, presenting with deafness, scrotal retraction, and cold limbs. If water and grain cannot be taken and consciousness is lost, death occurs on day six. If all three Yin and three Yang meridians, five Zang and six Fu organs are affected, Ying and Wei circulation ceases, and Zang-Fu communication is blocked, leading to death (Simultaneous disease of Yin and Yang, with damage to both exterior and interior, is called Liang Gan. Because both Yin and Yang meridians are affected, symptoms of both appear. During transmission, Yin and Yang meridians transmit together. Day one headache is Taiyang; dry mouth, irritability, and thirst are Shaoyin. By day two, Taiyang transmits to Yangming, and Shaoyin transmits to Taiyin. Fever and delirium are Yangming; abdominal fullness and anorexia are Taiyin. By day three, Yangming transmits to Shaoyang, and Taiyin transmits to Jueyin. Deafness is Shaoyang; scrotal retraction and cold limbs are Jueyin. Inability to take fluids and loss of consciousness indicate Stomach Qi blockage. The *Neijing* states: "After the five Zang are damaged and six Fu organs blocked, with Ying and Wei stopped, death occurs three days later." Why? Qibo answers: "Yangming is the leader of the twelve meridians, with abundant Qi and Blood; thus, loss of consciousness occurs. After three days, its Qi is exhausted, leading to death." This means after three days, all six meridians are diseased, Ying and Wei cannot circulate internally and externally, and Zang-Fu Qi cannot communicate vertically and horizontally. By day six, Zang-Fu Qi is exhausted, and Ying and Wei are severed, leading to death. Note: Taiyin can transmit to Shaoyin, but Shaoyin cannot transmit to Taiyin (this is reverse transmission, so this explanation is flawed). Taiyang (Bladder) and Shaoyin (Kidney) are paired; Taiyin (Spleen) and Yangming (Stomach) are paired; Shaoyang (Gallbladder) and Jueyin (Liver) are paired. Yin follows Yang, like sisters-in-law who rank by husband's age, not their own.
On the first day of Shanghan, Taiyang is affected. If the pulse remains quiet, transmission does not occur. If there is a strong desire to vomit, or if there is restlessness and the pulse is rapid and urgent, transmission has occurred (Taiyang governs the exterior. On day one, Taiyang is invaded; by day two, it should transmit to Yangming. If the pulse is weak, it does not transmit to Yangming. Stomach channel invasion causes vomiting. Cold pathogens transmitting inward transform into heat. Strong desire to vomit, restlessness, and rapid/urgent pulses indicate Taiyang cold transforming into heat and transmitting to Yangming).
On the second and third days of Shanghan, if Yangming and Shaoyang symptoms are absent, transmission has not occurred (Absence of Yangming and Shaoyang symptoms on days 2-3 indicates pathogens have not transmitted and remain in the Taiyang channel).
On the third day of Shanghan, the three Yang meridians' pathology is exhausted, and the three Yin meridians should be affected. If the patient can eat and does not vomit, it indicates the three Yin meridians are not affected (On day four, exterior pathogens transmit inward; if the interior is disharmonious, eating and vomiting occur. Since the patient eats and does not vomit, transmission to Yin is ruled out; the pathogen remains in Yang).
Question: On the third day of Shanghan, the pulse is floating, rapid, and faint, and the patient's body is cool and harmonious. What is this? Answer: This indicates the disease is about to resolve. Resolution often occurs at midnight. If the pulse resolves while floating, there will be continuous sweating. If the pulse resolves while rapid, the patient will be able to eat. If the pulse resolves while faint, there will be profuse sweating. On the third day, if the Shaoyang pulse becomes small, the disease is about to end (See discussion on bitter taste and dry tongue).
For those not suffering from Liang Gan, without further transmission or mixed pathogens, by the seventh day, Taiyang disease declines, and headaches subside. By the eighth day, Yangming disease declines, and fever subsides. By the ninth day, Shaoyang disease declines, and hearing slightly improves. By the tenth day, Taiyin disease declines, abdominal fullness reduces to normal, and appetite returns. By the eleventh day, Shaoyin disease declines, thirst stops, tongue dryness resolves, and sneezing occurs. By the twelfth day, Jueyin disease declines, the scrotum relaxes, lower abdominal depression subsides, vital Qi disperses, and the patient regains mental clarity. Taiyang headache resolving after seven days occurs because the meridian cycle is complete. To prevent further transmission, needle the Foot-Yangming meridian to stop transmission and ensure recovery.
If, on the sixth or seventh day, the pulse becomes large, accompanied by severe irritability, locked jaw, and inability to speak, restlessness indicates impending resolution. If Shanghan lasts six to seven days without high fever but with restlessness, this indicates Yang pathogens entering Yin. If the condition persists beyond thirteen days without improvement (improvement means cessation of disease), and the Cun and Chi pulses are depressed, it is a critical danger.
If additional pathogenic factors are contracted, transforming into other diseases, treat according to the existing compromised patterns. If both Yin and Yang pulses are excessive, and cold is re-contracted, it transforms into Wen Nue (Warm Malaria) (Excessive Cun and Chi pulses with initial heat followed by cold suggest Xiaochaihu Tang; initial cold followed by heat suggests adding Cinnamon Twig, i.e., Chaihu Jia Guizhi Jiang Tang; heat only suggests Baihu Jia Guizhi Tang. With sweating, thirst, red scanty urine, pre-existing miasma, or intolerance to local conditions with severe vomiting, use Wuling San). If Yang pulses are floating and slippery, and Yin pulses are soft and weak, exposure to wind transforms it into Feng Wen (Wind-Warmth) (Feng Wen features flaccid limbs, headache, fever, spontaneous sweating without relief, panting, floating pulses at Cun and Chi, lethargy, and drowsiness. Treat Shaoyin and Jueyin; do not induce sweating). If Yang pulses are surging and rapid, and Yin pulses are solid and large, exposure to warmth transforms it into Wendu (Warm-Toxin), the most severe condition (Wendu invariably causes macules/rash). If Yang pulses are soft and weak, and Yin pulses are wiry and tight, exposure to warm Qi transforms it into Wen Yi (Warm Epidemic), originating from winter cold injuring leading to Warm Disease; see subsequent sections for pulse variations and treatments.
Dai states: Shanghan initially attacks Taiyang and transmits sequentially; this is a generalization. However, variations exist: some originate in Yang and immediately affect Shaoyin; some involve food stagnation affecting the Spleen (Taiyin), causing immediate abdominal fullness and pain; some do not follow the meridian sequence, such as directly attacking Yangming upon onset, not always starting with Taiyang. Some remain confined to one meridian; some transmit to only one or two meridians, not necessarily involving all. One must not rigidly adhere to sequence but treat according to symptoms. Thus, Shanghan often presents with exterior signs; Zhang Zhongjing stated: "Even if many days have passed, if exterior signs exist, sweating is appropriate; even if few days have passed, if interior signs exist, purging is appropriate."
Hai states: Taiyang (Water of Yang within Yang) is the head of the three Yang meridians; it can transmit via the meridian sequence or skip meridians. Yangming (Earth of Yang within Yang) is the master of the Central Earth, governing intake but not output. Transmission from Taiyang to Yangming is called "Sequential Transmission." Shaoyang (Wood of Yang within Yang) transmits upward to Yangming and downward to Taiyin. Transmission from Taiyang to Shaoyang is called "Skipping Transmission." Taiyin (Earth of Yin within Yin) transmits upward to Shaoyang (smooth) or downward to Shaoyin (reverse). Transmission from Taiyang to Taiyin is called "Misguided Purging Transmission." Shaoyin (Water of Yin within Yin) transmits upward to Taiyin (smooth) or downward to Jueyin (reverse). Transmission from Taiyang to Shaoyin is "Exterior to Interior Transmission." Jueyin (Wood of Yin within Yin) transmits upward to Shaoyin (excess) or again to Taiyin (self-recovery).
Hai further states: Taiyang (Juyang) is the head of all Yang meridians. Bladder meridian disease with thirst indicates transmission to its root (Chuan Ben). Transmission from Taiyang to Yangming (Stomach Earth) is Sequential Transmission, caused by incomplete sweating, diuresis, and residual pathogens penetrating inward. Transmission from Taiyang to Shaoyang (Gallbladder Wood) is Skipping Transmission, caused by failing to use Mahuang Tang when the initial presentation was floating pulse and no sweat. Transmission from Taiyang to Taiyin (Spleen Earth) is Misguided Purging Transmission, caused by using purgatives instead of Guizhi Tang when the initial presentation was slow pulse and sweating, leading to abdominal pain and heavy limbs. Transmission from Taiyang to Shaoyin (Kidney Water) is Exterior-to-Interior Transmission, caused by urgent need for sweating but mistakenly using purgatives, preventing sweating and driving pathogens inward. Transmission from Taiyang to Jueyin (Liver Wood) is rare because Yin does not reach the head; only Jueyin ascends with the Du Mai to connect with Taiyang, termed "Following the Degree of Transmission."
Wu states: The six meridians in Shanghan involve Yin/Yang, Deficiency/Excess, Cold/Heat, all caused by exogenous pathogens. The *Neijing* states "Cold injury leads to heat," describing the norm, not variations. Zhang Zhongjing describes varying cold/heat to cover both norms and variations. Transmission of Yang pathogens is the norm; transmission of Yin pathogens is variation. Normative sequential transmission of Yang pathogens: Days 1-2 Taiyang, 2-3 Yangming, 3-4 Shaoyang, 4-5 Taiyin, 5-6 Shaoyin, 6-7 Jueyin. By day seven, the meridian cycle completes, and sweating should resolve the disease. If unresolved by day seven, it is "Re-transmission"; by fourteen days, it is "Over-passing the Meridian." Unresolved over-passing leads to "Bad Disease" (Huai Bing). Hua Tuo stated: Day 1 Skin, Day 2 Flesh, Day 3 Muscle, Day 4 Chest, Day 5 Abdomen, Day 6 Stomach, then interior. Treatment: Sweat for skin, harmonize for muscle, emetic for chest, purge for abdomen/interior. The *Shanghan Fu* states: Days 1-2 release exterior, 3-4 harmonize, 5-6 purge if solid. These are approximate rules for norms, not variations. Cold injury has no fixed pattern; it may strike Yin or Yang. Texts mention Day 1-2 fever with deep pulse as Shaoyin disease, or Day 1-2 clear mouth with back aversion to cold as Shaoyin disease. These are direct strikes to Yin meridians, variations not the norm. The *Huoren Shu* states: Cold entering from the back may strike Taiyang or Shaoyin; entering from the face may strike Yangming, etc., not exclusively Taiyang. Also, cold may stay in one meridian, skip meridians, transmit past one meridian without further transmission, transmit from foot to hand meridians due to heat, or change due to incorrect medication. Thus, texts say: Day 1 Taiyang, quiet pulse means no transmission; rapid/irritable pulse with vomiting desire means transmission. Days 2-3 absence of Yangming/Shaoyang symptoms means no transmission. Taiyang disease with floating/tight pulse, body pain, fever for 7-8 days unresolved still requires sweating. Shaoyin disease with dry mouth/throat on days 2-3 requires urgent purging with Dachengqi Tang. These do not rely solely on days. Shouzhen asked: "Who dares to purge with Dachengqi Tang on days 2-3?" The sages spoke generally. Taiyang is the head of meridians with frequent transmission. Heat pathogens transmit when deficiency exists; they do not transmit if the meridian is solid. Taiyang Water transmitting to Yangming Earth is "Wife transmitting to Husband" (Minor Evil). Yangming Earth transmitting to Shaoyang Wood is also "Wife to Husband" (Minor Evil). Shaoyang Wood transmitting to Taiyin Earth is "Husband transmitting to Wife" (Robbing Evil). Taiyin Earth transmitting to Shaoyin Water is also "Husband to Wife" (Robbing Evil). Shaoyin Water transmitting to Jueyin Wood is "Mother transmitting to Son" (Deficient Evil). Taiyang Water skipping to Shaoyang Wood is "Mother to Son" (Deficient Evil). Taiyang Water skipping to Taiyin Earth is Minor Evil/Misguided Purging. Taiyang Water transmitting to Shaoyin Water is Dual Yin-Yang Transmission (Liang Gan). Taiyang Water transmitting to Jueyin Wood is "Mother to Son" (Deficient Evil/Head-to-Tail Transmission). Transmission to Jueyin Liver is the tail ("Jue" means exhaustion). When righteous Qi recovers and pathogens resolve, Water rises, Fire descends, chills/fevers occur, and profuse sweating resolves the disease. If righteous Qi does not recover, pathogens cannot resolve; extreme Yin leads to cold limbs, curled tongue, deafness, scrotal retraction, unconsciousness, and death. Zhao states: Pathogens in Yang meridians are easier to treat; entering Yin meridians is critical. Yang is weak, Yin is strong; Righteous Qi is deficient, Pathogens are excess. Misguided purging/sweating leads to critical collapse. To treat Shanghan, one must study Zhang Zhongjing’s works to understand his principles; otherwise, confusion arises. Careful study reveals correct methods. Relying on fixed formulas without understanding principles leads to error. Xu stated: "Read Zhang Zhongjing’s books, use his methods, but do not rigidly stick to his formulas; this is truly understanding the ancients." Scholars should ponder every word. Tao stated: "Shanghan transmits only to foot meridians, not hand meridians" is a vulgar misconception. Qi converges at Danzhong at dawn, circulating through Hand-Taiyin Lung first, then distributing. If one meridian is discordant, all are affected. Why claim only foot meridians? Shanghan is winter cold injury. Winter governs Foot-Taiyang and Foot-Shaoyin. Spring governs Shaoyang and Jueyin, which are also affected because Wind-Wood begins at Dahan solar term (mid-12th lunar month) and warms after Chunfen, so Wind-Cold affects them. Foot-Yangming and Foot-Taiyin (Central Earth) are not specifically linked to winter but are affected. Zhu Xi stated: Earth has no fixed position/name/Qi, prospering in all four seasons, ending/beginning all things; thus, all seasonal temperatures affect it. Exterior pathogens transmitting inward return to Spleen/Stomach to form dry feces, treated with Chengqi Tang to harmonize Stomach Qi. Hand meridians govern Summer/Autumn and are less affected. Foot meridians are the primary realm of injury. Claiming "foot injured, not hand" allows claiming "transmits to foot, not hand," which is false. Wind-Cold enters Ying-Wei, circulating day and night everywhere, not stopping at hand meridians. Commentary: Shanghan origins are in the *Re Lun*. Why only foot meridians? Winter Shanghan starts at Foot-Taiyang Bladder and ends at Foot-Jueyin Liver. This disease mainly affects North/East directions and Earth positions associated with Foot-Yangming Stomach and Foot-Taiyin Spleen. Foot meridians are in the Northeast. Texts say: Winter cold manifesting immediately is Shanghan; Spring manifestation is Wenbing; Summer manifestation is Wenyi (most severe). Zhang Zhongjing said: "Without Extraordinary Vessels, there is no Shanghan," as extraordinary vessels attach to foot meridians, not hand, so cold injures only foot meridians. Long Summer is hot; Summer Fire is strong. Fire direction and Autumn Equinox are Hand meridians; Water direction and Spring Equinox are Foot meridians (deficient). When Summer Fire is strong, pathogens assist Hand meridians, making deficiency worse. Thus, medicines used drain excess, not tonify foot meridians. Draining excess tonifies deficiency. This is why Shanghan discusses foot meridians first. However, transmission to hand meridians does occur. *Cishi Nan Zhi* states: Shanghan days 5-6 may gradually cause confusion, muteness, or sleep-talking, red eyes, scorched lips, dry tongue, no thirst, swallowing porridge but refusing food, fine/rapid but not surging pulses, no epigastric fullness, no abdominal distension, normal bowels/bladder. After ten days, appearance resembles drunkenness. Doctors seeing confusion often purge with Chengqi Tang, which is wrong. They fail to recognize heat transmitting to Hand-Shaoyin Heart. Origin? Originally Taiyang Wind Strike. Wind is Yang pathogen, damaging Wei, drying Yin Blood. Heat accumulates in Bladder (Ren/Water), reverses to Bing/Fire (Small Intestine), siblings Bing/Ding, transmitting to Heart. Heart Fire steams Lung from above, causing confusion. Lung is pure/empty; internal fire causes confusion. Use Zhizi Huangqin Huanglian Tang. If pulse relates to Bing, use Daochi San; if relating to Heart, use Xiexin Tang. Lianpo San is Qi-moving/Blood-draining; use only if Left Cun pulse is deep/slipping/strong, or Xijiao Dihuang Tang. If no Xijiao, use Shengma (Yangming Blood-heat herb). If pulses are strong superficially and deeply, Bing/Ding both have heat; use half Daochi, half Xiexin. This case: Bladder transmits to Bing, Foot to Hand, Downward, Bing to Ding, Exterior to Interior, Ren (Kan/Water) to Ding (Li/Fire), Skipping Transmission, Fu to Zang. *Huoren* says "Shanghan transmits foot not hand" is incomplete. Transmission from foot to hand exists. How to know? Texts say: Shanghan may stay in one meridian, skip one or two, not bound by start Taiyang/end Jueyin. Treat based on pulse and signs.