详《伤寒论》、《百问百证歌》、《活人书》、《活人大全》及今陶氏《六书》、王氏《家宝》与各名家,
惟陆氏伤寒未睹其书。
尝闻病皆起于伤寒,治莫精于仲景。一百一十三方,如水有源;(不过汗吐下渗和解温补,总方以变化以也)
三百九十七法,如衣有领。(不过阴阳表里虚实而已)惜乎!全书亡而后益支离,记性拙而聊从简省,姑以六
经而言之。
太阳则头疼身热脊强,
此太阳正病也。以后凡言太阳证,即头疼身热脊强也。凡言表证者,亦即太阳证也,各经仿此。阳从下起,
三阳之长曰太阳。脉尺寸俱浮,浮紧伤寒,浮缓伤风。太阳受病,当一二日发。以其脉上连风府,故头项背腰
脊强。头者,诸阳之会,气病则麻,血病则痛。身热者,
寒客皮毛,郁闭其阳,而后发热,阳虽人身正气,郁则为邪、为热。热虽甚不死,盖伤寒始于寒而终成于热也。
惟不发热而但恶寒者,邪发于阴也。或热多寒少、或不大便而泉清频数、或热结膀胱溺涩、或汗多溺难、或汗
后不解、或汗漏不止、或过经不解、或蓄血发黄、或喘、或呕,皆太阳所主。
阳明则目痛鼻干不眠。
阳为明,夹于二阳之中,阳气盛极,故曰阳明。脉尺寸俱长。长而微洪经病,长而沉数腑病。太阳脉静则
不传,如脉数急欲吐者,此寒邪变热,传于阳明,当二三日发。以其经中客邪,故目痛鼻干。身热者,阳明
主肌肉,邪甚则身前皆热。不眠者,烦盛津干,胃气不和也。太阳未罢者,发热恶寒。太阳已罢者,不恶寒而反
恶热,烦渴作呕,津干便硬,或即狂言,谓之正阳明。少阳阳明,胁满不大便而呕。或瘀血发黄,或下血谵语,
或胸烦懊 ,皆此经所主。然亦有里寒下利,或寒气结积而为痼瘕者,不可不知。
少阳耳聋胁痛,寒热呕而口为之苦;
少,初也。阳气初嫩,亚于阳明,故曰少阳。脉尺寸俱弦,弦而滑数者,阳极发厥;弦而和者,病欲散。
少阳受病,当三四日发。以其脉循胁络于耳,故风热上壅不利,则耳聋胁痛、寒热往来、不食、呕而口苦干、
目眩。若不呕吐而能食者,为三阴不受邪也。若身无大热燥闷者,阳去入阴无疑矣。似疟,妇人血结,皆此经
所主。
太阴腹满自利,尺寸沉而津不到咽。
阴从天降,首曰太阴。在阳为表,在阴为里,邪在表则见阳脉,邪在里则见阴脉,故尺寸俱沉,沉实有力
当下,沉细无力当温。太阴受病,当四五日发。以其脉布胃中,络于咽溢,故腹满或痛,而嗌喉下干燥。或大
便不通,小便如常;或自利,手足温而渴者,为传经腑热。或自利不渴,手足冷者,为直中阴证。或因内伤饮
食,冷气入脾,必腹痛胸膈不快。然太阴乃三阳之终,三阴之始,阳经表证未尽宜汗,半表里胸满多痰宜吐,
传经里热宜下,直中阴经宜温。调脾胜邪,正在此关。
少阴舌干口燥,
次于太阴,故曰少阴。脉尺寸俱沉,沉实有力当下,沉微无力当温。少阴受病,当五六日发。以其脉起
于足心,贯肾络于肺系,故舌干口燥而渴。或自利清水,心痛腹胀;或大便闭硬,不欲浓衣者,皆热入里之深
也。苦厥逆畏寒,欲吐不吐,腹痛自利,小便白色,或干呕,亡阳咽痛,脉微欲寐者,乃阴毒入脏之深也。或
下利体痛,咳呕者,水气也。或饭食入口则吐,脉弦迟,厥逆,心下实者,不可下也,宜吐之。或脉沉发热者,
汗之。盖有初得病直攻少阴,不先自太阳传次而入也。
厥阴烦满囊拳。
厥阴者,阴尽则变而厥逆生。盖传经至此已尽,无复可传,再传则逆于手经矣。脉尺寸俱沉,沉实有力当
下,沉迟无力当温,浮缓者病自愈。厥阴受病,当六七日发。以其脉循阴器,络于肝,故唇青舌卷。或烦满者,
胸中气满急也;或囊拳者,阴囊缩也;在女子则阴户急痛引小腹,此传经厥阴,风热毒深于内也。肝木移热克
脾,脾受贼邪,五脏六腑皆困,荣卫不通,耳聋囊缩而厥,水浆不入,不知人则死,速下以救,五死一生。
或下利谵语者,内有燥屎也,仍宜下之;或呕而发热者和之;或发热恶寒如疟,囊不缩,脉微浮微缓,胃之脉,
脾气既全,不受贼邪,荣卫将复,水升火降,寒热作而大汗解矣;或下利腹胀,身疼者,当先救表,而后温里;
若下利清谷,大汗出而厥,四肢疼,小腹拘急;或干呕吐沫,或气冲心痛,发热消渴吐蛔,皆厥阴寒证也,宜
温之。以上正文六言,乃万病之祖,非得之《内经》,不能六言包括无遗如此。凡言六经所见之证,即此三阳
三阴经证也,杂病亦然。
经络难拘日数,
经曰∶一日足太阳膀胱之经,二日足阳明
胃之经,三日足少阳胆之经,四日足太阴脾之经,五日足少阴肾之经,六日足厥阴肝之经。又云∶伤寒不加异
气,不传经者,七日足太阳病衰,手太阳受之,头痛少愈;八日足阳明病衰,手阳明受之,身热少歇;九日足
少阳病衰,手少阳受之,耳聋微闻;十日足太阴病衰,手太阴受之,腹减如故,则思饮食;十一日足少阴病衰,
手少阴受之,渴止,舌干已而嚏;十二日足厥阴病衰,手厥阴受之,囊纵少腹微下,大气乃止。病再传六经,
有自安者。《活人》云∶一二日,可发表而散∶三四日,宜和解而痊;五六日不解,便实方可议下,此皆论其
常耳。《解惑论》云∶病患有虚实,邪气有迟速,岂可拘于日数?日虽多,尚有表证而脉浮数,犹当发汗;日
虽少,已有里证而脉沉细,即当下之,但随证虚实与脉而汗、下之。陶节庵云∶但见太阳证,即用麻、桂汗太
阳;见少阴证,即用四逆温少阴;见阳明证,即用承气下阳明;见真寒证,直入阴经,即救真寒,此最活法。
有循次传者,天运主气者,初气厥阴风木、二气少阳相火、三气少阴君火、四气太阴湿土、五气阳明燥金、六
气太阳寒水。人生顺受其气,病则逆其气而传变,自下而上,自外而内。究其所以然者,阳主动而位外,阴主
静而位内,人身膀胱气血之会,自头背至足,无所不主,故风寒每先犯之;其次,胃气流行无息,自鼻腹至足,
皆其所主,故太阳行督而交任,必及于阳明也;又其次,少阳清气,主行荣卫胁肋身侧,皆其所主,故胃邪必
移于胆部。此三阳皆身之外而动者,故为表。至于太阴,人身五脏,脾为死阴,至静不动,其所消食者,全赖
胃气升降,故自少阳胁肋下肚腹,宜乎先入太阴也;其次,肾主受米谷之精而至静,惟子时浊气一动而已,故
自中腹移至脐腹,必及于肾也;又其次,肝惟主散血藏血,而极其凝静者,故入里之深至于小腹,而下行已极,
乃复上行于手经。此天然之序,不可乱者如此。若夫太阳自传于本者,作渴溺涩,因误渗也;太阳并传阳明者,
当用麻黄,而反用葛根以引之也;太阳越经传少阳者,当用麻黄,而反用柴胡以引之也;太阳传少阴者,当用
桂、麻,而反下以陷之也;太阳传太阴者,当用桂枝,而反下以入之也。此医之误而乱其传之序也。又有太阳
即传厥阴,头顶痛甚,二经脉络相接,同督脉而上行也。有太阳伤风以致阴血自燥,热蓄膀胱,逆传小肠与心,
谓之冤热。有风寒自背入者,直中太阳、少阳;自面入者,直中阳明;有首尾只在太阳经而不传诸经者;有间
传一二经者;有不传而罢者,有不罢再传者;有不自阳经,直中阴经者,此邪无定体,不可拘于日数也。《活
人》云∶六气之邪,乘虚之经得之。
标本须明后先。
标者,梢末;本者,根本。以主言之,各经络为标,各腑脏为本,如太阳经为标,膀胱为本。余仿此。以
客邪言之,先受病为本,次受病为标。标为相传,治其急者,请详言之。太阳膀胱为本,故头疼脊强,小肠为
标,与心为表里,故发热,冬月麻黄、桂枝,余月九味羌活汤。阳明大肠为标,与肺为表里,故微恶寒发热为
经病,葛根解肌汤;渴而有汗不解者,白虎汤;胃为本,目痛鼻干,潮汗闭涩,满渴狂谵为腑病,调胃承气汤。
少阳三焦相火为本,游行一身,故微热;胆为标,耳聋、胁痛,寒热、呕而口苦,缘三焦无形,胆无出入之路,
故从中治,标本俱小柴胡汤。太阴肺为标,咽干身目黄;脾为本,腹满痛,谓之腑热,咽干、腹满、手中温者,
桂枝加大黄汤,或大柴胡汤;身目黄者,茵陈汤;胸满者,瓜蒂散;如自利不渴,或呕吐者,属脏病,理中汤、
丸。少阴心为本,故舌干口燥,或绕脐硬痛,或心下硬痛,或下利纯清水,或谵语便闭,小承气汤;肾为标,
面寒如刀刮,唇青不渴,吐利,胸腹绞痛,四肢厥逆,指甲黑,蜷卧,身如被杖,古姜附汤。厥阴心包络为标,
故舌卷、厥逆、冷过肘膝、吐沫呕逆、不渴、小腹绞痛者,为寒,三味参萸汤、四顺汤;肝为
本,主男子囊缩,女子阴挺乳缩,或手足乍冷乍温,大便实,消渴烦满者,属热,大承气汤;似疟不呕、二便
自调者,必自愈;不愈脉迟,有汗者,小建中汤;脉涩无汗者,桂麻各半汤。其囊,乳缩证,寒证亦有之。此万
法之祖也,学人于此而一悟焉,则病机到手矣!自非仲景《玉函》内秘,其孰能与于斯乎!此后汗、吐、下、温、
和解诸方,不甚详载,止言宜汗、宜吐、宜下、宜和,悟之。
寒伤荣而风伤卫,太阳为之首尔;
荣行脉中,在血脉,其病深;卫行脉外,在皮肤,其病浅。荣血阴也,阴主闭藏,故寒喜伤荣而无汗;
卫气阳也,阳主开泄,故风喜伤卫而有汗。然岂独太阳为荣卫之会而有风寒之别乎?阳明善饥为伤风,不食为
伤寒。少阳耳聋胸满而烦为伤风,口苦咽干目眩为伤寒。三阴伤风,但四肢烦疼耳。太阳为之先者,伤寒因肾
水亏损,至春木无生意,故发为温病;至夏绝生化之原,发为热病。所以太阳。少阴二经,受病最多最先。
经可解可腑可下,阳明为之主焉。
表多里少为在经,宜清肌解表∶里多表少为在腑,宜和肌通里。盖阳明标虽主肌,而其本则胃也。然岂
独阳明为十二经之长而有经腑之异乎?仲景曰∶三阳受病,未入于腑,可汗而已;三阴受病,已入于腑,可下而
已。则三阴有在经者,仍宜微汗之。盖荣卫属太阳,主皮毛;胃腑属阳明,主皮肤之下,肌肉之上及肠胃也;
胸胁属少阳,主血,荣百节,流行三部;脏属三阴,主筋骨并两足。故太阳为阳证之表,胃为阳证之里。若但
以脏腑而分表里,则腑为表,脏为里。若合荣卫脏腑而分表里,则表者荣卫之所行,里者胃腑之所主,而脏则
又深于里。但病入胃,则亦不更传,不可不知。
少阳原从乎中治,禁汗禁下;
少阳居太阳阳明之中,半表半里,禁汗,恐犯太阳;禁下,恐犯阳明;禁渗,恐生发之气陷入阴中,只
宜和之以小柴胡汤。犯三禁,则变不可胜。他如∶太阳经禁下与渗,犯之则动血,热入里,而难解;阳明经禁
汗与渗,犯之则竭津,血蓄下而如狂,益津液者,连须葱白汤是也。又下症中治见合病。
三阴利用乎变法,有中有传。
三阴最不可执,有宜下者,有宜温者。自三阳气分传入三阴,谓之传经阴证。传,非传入脾肾肝也,
乃入三阴血分,胃与大小肠之腑也,故仲景谓已入于腑可下者是也。若不自阳经传来,直中三阴之经,初起厥
逆腹痛,自利不渴,太阴自受寒也;上证加之呕吐,少阴自受寒也;又加之小便清利,厥阴自受寒也。热药温
之,犹恐或迟,阴阳一差,生死立判。虽然传经直中,先贤发之尽矣,然岂无传变者乎?假如传经之际,轻生
者或被生冷,或犯房欲,或粗工猛施汗下,真气衰弱,阳证变为阴证,如俗所谓阳证归阴,仍宜直中寒证法治。
故《内经》止言传变而不言直中者,盖言变则包直中。今《局方》言传阴、传阳则不是,当言传阳变阴。庶乎
传经为里热,直中与变为里寒,临证参脉,直中三阳、传经三阳,病在于表,脉浮长弦;传经三阴,病在于里,
脉沉数实;直中三阴,病在于经,脉沉微缓,此表里虚实大分,非专以阳为热,阴为寒也。
谓伤足而不伤手则可,以寒为足之所司;
手之六经,主于春夏,足太阳、少阳,正司冬令,触冒之者,则二经受病。其次则少阳、厥阴继冬而司春
令,至春分后,方行温令,故风寒亦能伤之。足阳明与冬本无与,然寄旺四季,寒热温凉之气皆能伤之。况表
邪传里,必归脾胃,而为燥粪,用汤药下之,而胃和矣。
谓传足而不传手不可,盖热为手之所冤。
人身之气,每日周行三百六十五骨节,以应周天三百六十五度。血亦随气营运腠理,以为一身动静云为
之主。所以一脉愆和,百脉皆
病。况风寒中人,先入荣卫,昼夜循环,无所不至,岂间断于手经哉!七日不愈而再传者,乃足经移热传于手
经,如冤家之相摭也,虽然手冤亦推本言耳。上古止分三阴三阳,而不分手足,其意甚深。况手足三阳,同手
走头至足,手足三阴,同足走胸腹与手,岂有经络同,而受病又有不同者哉!即如喘咳发热,分明手太阴、太
详细考察《伤寒论》、《百问百证歌》、《活人书》、《活人大全》以及当今陶华氏的《六书》、王肯堂的《家宝》和各名家著作,唯独没有看到陆氏关于伤寒的书籍。
曾经听说疾病都起因于伤寒,治疗没有比张仲景更精妙的了。一百一十三首方剂,就像水有源头;(不过是汗法、吐法、下法、渗利法、和解法、温法、补法这几种总治法来变化运用罢了)三百九十七种治法,就像衣服有衣领。(不过是阴、阳、表、里、虚、实这六种辨证纲领而已)可惜啊!全书失传后内容更加支离破碎,因为记忆力笨拙所以姑且从简省略,姑且以六经来论述。
太阳病则头痛、身体发热、项背强直,这是太阳病的正证。此后凡是说太阳证,就是指头痛、身体发热、项背强直。凡是说表证,也就是指太阳证,其他各经仿照此例。阳气从下部升起,三阳经中为首的是太阳经。脉象寸关尺三部都浮,浮紧是伤寒,浮缓是伤风。太阳经受邪,应当在发病一二天出现症状。因为它的经脉上连风府穴,所以头项背腰脊部强直。头部是诸阳经汇聚的地方,气病则麻木,血病则疼痛。身体发热,是因为寒邪客居皮毛,郁闭了阳气,然后才发热,阳气虽然是人身正气,但被郁结就会变成邪气、变成热。热虽然很严重也不会死,因为伤寒始于寒邪最终转化为热证。只有不发热而只是怕冷的,是邪气发于阴分。或者热多寒少、或者不大便但小便清长频数、或者热结膀胱导致小便涩痛、或者出汗多导致小便困难、或者发汗后病不解、或者汗漏不止、或者过了经界病仍不解、或者蓄血发黄、或者喘、或者呕吐,这些都是太阳经所主的症状。
阳明病则眼睛痛、鼻子干、失眠。阳为明,夹在二阳之间,阳气盛极,所以叫阳明。脉象寸关尺三部都长。长而微洪是经病,长而沉数是腑病。太阳脉静则不传变,如果脉数急想呕吐的,这是寒邪变热,传到了阳明,应当在发病二三天出现。因为邪气客居在经脉中,所以眼睛痛、鼻子干。身体发热,因为阳明主肌肉,邪气重则身体前面都热。失眠,是因为烦热旺盛津液干枯,胃气不和。太阳病未罢的,发热恶寒。太阳病已罢的,不怕冷反而怕热,烦渴作呕,津液干枯大便硬,或者立即胡言乱语,这叫正阳明。少阳兼阳明,胁肋胀满、不大便且呕吐。或者瘀血发黄,或者便血谵语,或者胸中烦闷懊恼,都是此经所主。然而也有里有寒而下利的,或者寒气凝结积聚形成癥瘕的,不可不知道。
少阳病耳聋、胁痛,忽冷忽热、呕吐且口苦;
少,就是初的意思。阳气初生嫩弱,次于阳明,所以叫少阳。脉象寸关尺三部都弦,弦而滑数的,是阳极发生厥逆;弦而柔和的,是病将要消散。少阳受邪,应当在发病三四天出现。因为它的经脉循行胁肋联络耳朵,所以风热上壅不利,就出现耳聋胁痛、寒热往来、不想吃东西、呕吐且口苦干、目眩。如果不呕吐且能吃东西的,是三阴经不受邪气。如果身体没有大热燥闷的,阳气离去进入阴分无疑了。像疟疾,妇女血结,都是此经所主。
太阴病腹部胀满、自发性腹泻,脉象寸关尺都沉且津液不能上达咽喉。
阴从天降,首先说是太阴。在阳分称为表,在阴分称为里,邪气在表则见阳脉,邪气在里则见阴脉,所以寸关尺都沉,沉实有力应当用下法,沉细无力应当用温法。太阴受邪,应当在发病四五天出现。因为它的经脉布散在胃中,联络于咽部,所以腹部胀满或疼痛,且咽喉干燥。或者大便秘结,小便正常;或者自发性腹泻,手足温暖且口渴的,是传经的腑热。或者自发性腹泻不口渴,手脚冰冷的,是直中阴证。或者因为内伤饮食,冷气入脾,必定腹痛胸膈不快。然而太阴是三阳的终结,三阴的开始,阳经表证未尽适宜发汗,半表里胸满多痰适宜催吐,传经里热适宜攻下,直中阴经适宜温补。调理脾胃战胜邪气,关键就在这里。
少阴病舌干口燥,
次于太阴,所以叫少阴。脉象寸关尺都沉,沉实有力应当用下法,沉微无力应当用温法。少阴受邪,应当在发病五六天出现。因为它的经脉起于足心,贯穿肾脏联络肺系,所以舌干口燥且渴。或者自发性腹泻清水,心痛腹胀;或者大便秘结硬,不想穿厚衣服的,都是热邪深入里的表现。苦于四肢厥冷畏寒,想吐吐不出,腹痛自发性腹泻,小便颜色白,或者干呕,亡阳咽痛,脉微欲睡的,是阴毒深入脏的表现。或者下利身体疼痛,咳嗽呕吐的,是水气病。或者饭食入口就吐,脉弦迟,四肢厥冷,心下痞硬的,不可用下法,适宜用吐法。或者脉沉发热的,用发汗法。大概有病初得直接攻击少阴,不先从太阳传次而入的情况。
厥阴病烦闷、阴囊收缩。
厥阴,阴尽则变而生成厥逆。因为传经到这里已经尽了,没有再可传的,再传就逆传到手经了。脉象寸关尺都沉,沉实有力应当用下法,沉迟无力应当用温法,浮缓的病会自愈。厥阴受邪,应当在发病六七天的出现。因为它的经脉循行阴器,联络肝脏,所以嘴唇青紫舌头卷曲。或者烦闷的,是胸中气满急迫;或者阴囊收缩的,是阴囊缩进;在女子则是阴户急痛牵引小腹,这是传经厥阴,风热毒邪深在于内。肝木移热克制脾土,脾受贼邪,五脏六腑都困顿,营卫不通,耳聋阴囊收缩而厥逆,水浆不进,不知人事就会死,速用下法来抢救,五死一生。或者下利谵语的,内有燥屎,仍然适宜用下法;或者呕吐且发热的,用和解法;或者发热恶寒像疟疾,阴囊不收缩,脉微浮微缓,是胃的脉象,脾气既全,不受贼邪,营卫将恢复,水升火降,寒热发作而大汗解除了;或者下利腹胀,身体疼痛的,应当先救表,而后温里;如果下利完谷不化,大汗出且厥逆,四肢疼痛,小腹拘急;或者干呕吐沫,或者气冲心痛,发热消渴吐蛔虫,都是厥阴寒证,适宜用温法。以上正文六句话,是万病的祖源,不是得自《内经》,不能用六句话包括无遗如此。凡是说六经所见到的证候,就是这三阳三阴经证候,杂病也是这样。
经络难以拘泥于日数,
经文说:第一天足太阳膀胱经,第二天足阳明胃经,第三天足少阳胆经,第四天足太阴脾经,第五天足少阴肾经,第六天足厥阴肝经。又说:伤寒不夹杂异气,不传经的,第七天足太阳病衰,手太阳受之,头痛稍减;第八天足阳明病衰,手阳明受之,身热稍歇;第九天足少阳病衰,手少阳受之,耳聋微闻;第十天足太阴病衰,手太阴受之,腹减如故,则思饮食;第十一天足少阴病衰,手少阴受之,渴止,舌干已而打喷嚏;第十二天足厥阴病衰,手厥阴受之,阴囊松弛小腹微下,大气乃止。病再传六经,有自己痊愈的。《活人书》说:一两天,可以发表发散;三四天,宜和解而痊愈;五七天病不解,大便结实才可以讨论用下法,这都是论述常理。《解惑论》说:患者有虚实,邪气有迟速,怎么能拘泥于日数?日数虽多,还有表证且脉浮数,还应当发汗;日数虽少,已有里证且脉沉细,就当下之,只随证虚实与脉象而决定汗、下之法。陶节庵说:只见太阳证,就用麻黄汤、桂枝汤发太阳之汗;见少阴证,就用四逆汤温少阴;见阳明证,就用承气汤下阳明;见真寒证,直入阴经,就救真寒,这是最灵活的方法。有按次序传的,有天运主气的,初气厥阴风木、二气少阳相火、三气少阴君火、四气太阴湿土、五气阳明燥金、六气太阳寒水。人生顺受其气,生病则逆其气而传变,自下而上,自外而内。探究其所以然的原因,阳主动而位在外,阴主静而位在内,人身膀胱气血汇聚之处,从头背至足,无所不主,所以风寒每每先侵犯它;其次,胃气流行不息,自鼻腹至足,都是它所主,所以太阳行督脉而交任脉,必波及到阳明;又其次,少阳清气,主行营卫胁肋身侧,都是它所主,所以胃邪必移于胆部。这三阳都是身体外部且动的,所以为表。至于太阴,人身五脏,脾为死阴,至静不动,它所消化的食物,全靠胃气升降,所以自少阳胁肋下肚腹,适宜先入太阴;其次,肾主受纳米谷的精气而至静,只有子时浊气一动而已,所以自中腹移至脐腹,必波及到肾;又其次,肝惟主散血藏血,而极其凝静的,所以入里之深至于小腹,而下行已极,乃复上行于手经。这是天然的顺序,不可打乱如此。如果太阳自传于本经,出现口渴小便涩,是因为误用渗利药;太阳并传阳明,应当用麻黄汤,而反用葛根来引之;太阳越经传少阳,应当用麻黄汤,而反用柴胡来引之;太阳传少阴,应当用桂枝汤、麻黄汤,而反用下法以陷之;太阳传太阴,应当用桂枝汤,而反用下法以入之。这是医生的错误而打乱了传变的顺序。又有太阳即传厥阴,头顶痛甚,二经脉络相接,同督脉而上行。有太阳伤风以致阴血自燥,热蓄膀胱,逆传小肠与心,叫做冤热。有风寒自背入者,直中太阳、少阳;自面入者,直中阳明;有首尾只在太阳经而不传诸经的;有间传一二经的;有不传而罢的,有不罢再传的;有不自阳经,直中阴经的,这是邪气没有定体,不可拘泥于日数。《活人书》说:六气之邪,乘虚之经得之。
标本必须明白先后。
标,就是梢末;本,就是根本。以主而言,各经络为标,各腑脏为本,如太阳经为标,膀胱为本。其余仿照此例。以客邪而言,先受病为本,次受病为标。标为相传,治疗其急者,请详细论述。太阳膀胱为本,所以头疼脊强,小肠为标,与心为表里,所以发热,冬月用麻黄汤、桂枝汤,余月用九味羌活汤。阳明大肠为标,与肺为表里,所以微恶寒发热为经病,用葛根解肌汤;渴而有汗不解的,用白虎汤;胃为本,目痛鼻干,潮汗闭涩,满渴狂谵为腑病,用调胃承气汤。少阳三焦相火为本,游行一身,所以微热;胆为标,耳聋、胁痛,寒热、呕而口苦,缘三焦无形,胆无出入之路,所以从中治,标本俱用小柴胡汤。太阴肺为标,咽干身目黄;脾为本,腹满痛,谓之腑热,咽干、腹满、手中温的,用桂枝加大黄汤,或大柴胡汤;身目黄的,用茵陈汤;胸满的,用瓜蒂散;如自利不渴,或呕吐的,属脏病,用理中汤、丸。少阴心为本,所以舌干口燥,或绕脐硬痛,或心下硬痛,或下利纯清水,或谵语便闭,用小承气汤;肾为标,面寒如刀刮,唇青不渴,吐利,胸腹绞痛,四肢厥逆,指甲黑,蜷卧,身如被杖,用古姜附汤。厥阴心包络为标,所以舌卷、厥逆、冷过肘膝、吐沫呕逆、不渴、小腹绞痛的,为寒,用三味参萸汤、四顺汤;肝为本,主男子阴囊收缩,女子阴挺乳缩,或手足乍冷乍温,大便实,消渴烦满的,属热,用大承气汤;像疟疾不呕、二便自调的,必自愈;不愈脉迟,有汗的,用小建中汤;脉涩无汗的,用桂麻各半汤。其阴囊、乳缩证,寒证也有。这是万法的祖源,学人于此而一旦领悟,则病机到手了!如果不是张仲景《玉函经》的内秘,谁能参与于此呢!此后汗、吐、下、温、和解诸方,不甚详细记载,只说宜汗、宜吐、宜下、宜和,悟之。
寒伤荣而风伤卫,太阳为之首领;
荣行脉中,在血脉,其病深;卫行脉外,在皮肤,其病浅。荣血阴也,阴主闭藏,所以寒喜伤荣而无汗;卫气阳也,阳主开泄,所以风喜伤卫而有汗。然而岂独太阳为荣卫之会而有风寒之别吗?阳明善饥为伤风,不食为伤寒。少阳耳聋胸满而烦为伤风,口苦咽干目眩为伤寒。三阴伤风,只是四肢烦疼罢了。太阳为之先的,伤寒因肾水亏损,至春木无生意,所以发为温病;至夏绝生化之原,发为热病。所以太阳、少阴二经,受病最多最先。
经可解可腑可下,阳明为之主宰。
表多里少为在经,宜清肌解表;里多表少为在腑,宜和肌通里。盖阳明标虽主肌,而其本则胃也。然而岂独阳明为十二经之长而有经腑之异吗?张仲景说:三阳受病,未入于腑,可汗而已;三阴受病,已入于腑,可下而已。则三阴有在经的,仍宜微汗之。盖荣卫属太阳,主皮毛;胃腑属阳明,主皮肤之下,肌肉之上及肠胃也;胸胁属少阳,主血,荣百节,流行三部;脏属三阴,主筋骨并两足。所以太阳为阳证之表,胃为阳证之里。若但以脏腑而分表里,则腑为表,脏为里。若合荣卫脏腑而分表里,则表者荣卫之所行,里者胃腑之所主,而脏则又深于里。但病入胃,则亦不更传,不可不知道。
少阳原从乎中治,禁汗禁下;
少阳居太阳阳明之中,半表半里,禁汗,恐犯太阳;禁下,恐犯阳明;禁渗,恐生发之气陷入阴中,只宜和之以小柴胡汤。犯三禁,则变不可胜。他如:太阳经禁下与渗,犯之则动血,热入里,而难解;阳明经禁汗与渗,犯之则竭津,血蓄下而如狂,益津液的,连须葱白汤是也。又下症中治见合病。
三阴利用乎变法,有中有传。
三阴最不可执,有宜下的,有宜温的。自三阳气分传入三阴,谓之传经阴证。传,非传入脾肾肝也,乃入三阴血分,胃与大小肠之腑也,所以张仲景谓已入于腑可下者是也。若不自阳经传来,直中三阴之经,初起厥逆腹痛,自利不渴,太阴自受寒也;上证加之呕吐,少阴自受寒也;又加之小便清利,厥阴自受寒也。热药温之,犹恐或迟,阴阳一差,生死立判。虽然传经直中,先贤发之尽矣,然岂无传变者乎?假如传经之际,轻生者或被生冷,或犯房欲,或粗工猛施汗下,真气衰弱,阳证变为阴证,如俗所谓阳证归阴,仍宜直中寒证法治。所以《内经》只言传变而不言直中的,盖言变则包直中。今《局方》言传阴、传阳则不是,当言传阳变阴。庶乎传经为里热,直中与变为里寒,临证参脉,直中三阳、传经三阳,病在于表,脉浮长弦;传经三阴,病在于里,脉沉数实;直中三阴,病在于经,脉沉微缓,此表里虚实大分,非专以阳为热,阴为寒也。
谓伤足而不伤手则可以,以寒为足之所司;
手的六经,主于春夏,足太阳、少阳,正司冬令,触冒之者,则二经受病。其次则少阳、厥阴继冬而司春令,至春分后,方行温令,所以风寒也能伤之。足阳明与冬本无与,然寄旺四季,寒热温凉之气都能伤之。况且表邪传里,必归脾胃,而为燥粪,用汤药下之,而胃和矣。
谓传足而不传手不可以,盖热为手之所冤。
人身之气,每日周行三百六十五骨节,以应周天三百六十五度。血亦随气营运腠理,以为一身动静云为主。所以一脉愆和,百脉皆病。况且风寒中人,先入荣卫,昼夜循环,无所不至,岂间断于手经哉!七日不愈而再传的,乃是足经移热传于手经,如冤家之相摭也,虽然手冤也是推本而言耳。上古只分三阴三阳,而不分手足,其意很深。况手足三阳,同手走头至足,手足三阴,同足走胸腹与手,岂有经络同,而受病又有不同者哉!即如喘咳发热,分明手太阴、太
Detailed examination of the *Treatise on Cold Damage* (Shanghan Lun), *Song of Hundred Questions and Hundred Symptoms*, *Book of Huore Ren*, *Complete Book of Huo Ren*, as well as Tao Hua's *Six Books*, Wang Kentang's *Family Treasure*, and works by various masters, reveals that Lu's book on cold damage has not been seen.
It is heard that diseases all originate from cold damage, and no treatment is more exquisite than that of Zhang Zhongjing. The one hundred and thirteen formulas are like water with a source; (they are merely variations of the general methods of sweating, vomiting, purging, draining, harmonizing, warming, and tonifying). The three hundred and ninety-seven methods are like the collar of clothing; (they are merely Yin, Yang, Exterior, Interior, Deficiency, and Excess). Alas! After the complete text was lost, the content became increasingly fragmented. Due to poor memory, I shall briefly summarize it, discussing it in terms of the Six Channels.
Taiyang disease presents with headache, fever, and stiffness of the neck and back. This is the proper syndrome of Taiyang. Henceforth, whenever "Taiyang syndrome" is mentioned, it refers to headache, fever, and stiffness of the neck and back. Whenever "Exterior syndrome" is mentioned, it also refers to Taiyang syndrome; other channels follow this pattern. Yang Qi rises from the lower part, and among the Three Yang channels, Taiyang is the head. The pulse is floating at all three positions (Cun, Guan, Chi). Floating-tight indicates cold damage (Shanghan), while floating-slow indicates wind injury (Shangfeng). When the Taiyang channel is affected, symptoms should appear within one or two days. Because its vessel connects to the Fengfu point (GV16), there is stiffness in the head, neck, back, waist, and spine. The head is the gathering place of all Yang channels; Qi pathology causes numbness, while Blood pathology causes pain. Body heat occurs because cold pathogens lodge in the skin and hair, obstructing Yang Qi, which then generates heat. Although Yang Qi is the body's righteous Qi, when obstructed, it becomes pathogenic and hot. Even severe heat will not cause death, as cold damage begins with cold but ultimately transforms into heat. Only cases without fever but with aversion to cold indicate pathogens originating in the Yin aspect. Other manifestations include more heat than cold, constipation with frequent clear urination, heat binding in the bladder causing difficult urination, excessive sweating leading to difficulty in urination, unresolved illness after sweating, continuous leakage of sweat, illness persisting beyond the expected period, blood stasis with jaundice, wheezing, or vomiting—all are governed by the Taiyang channel.
Yangming disease presents with eye pain, dry nose, and insomnia. Yang is bright; situated between the Two Yangs, its Yang Qi is extremely abundant, hence named Yangming. The pulse is long at all three positions. Long and slightly surging indicates channel disease; long, deep, and rapid indicates fu-organ disease. If the Taiyang pulse is quiet, transmission does not occur. If the pulse is rapid and urgent with nausea, this indicates cold transforming into heat and transmitting to Yangming, appearing on the second or third day. Because pathogens lodge in the channel, there is eye pain and dry nose. Body heat occurs because Yangming governs muscles; when pathogens are severe, the anterior body becomes hot. Insomnia results from intense irritability, dried fluids, and disharmony of Stomach Qi. If Taiyang symptoms have not resolved, there is fever and aversion to cold. If Taiyang symptoms have resolved, there is aversion to heat rather than cold, irritability, thirst, vomiting, dried fluids, hard stool, or even delirious speech; this is termed proper Yangming. Shaoyang-Yangming presents with fullness in the hypochondrium, constipation, and vomiting. It may also present with blood stasis jaundice, hematochezia with delirium, or chest irritability and restlessness—all governed by this channel. However, one must know that interior cold with diarrhea, or cold qi condensing into masses, can also occur.
Shaoyang disease presents with deafness, flank pain, alternating chills and fever, vomiting, and bitter taste in the mouth. "Shao" means beginning. Yang Qi is initially tender and secondary to Yangming, hence named Shaoyang. The pulse is wiry at all three positions. Wiry, slippery, and rapid indicates extreme Yang leading to reversal; wiry and harmonious indicates the disease is dissipating. When the Shaoyang channel is affected, symptoms appear on the third or fourth day. Because its vessel circulates along the flanks and connects to the ears, wind-heat congestion causes deafness, flank pain, alternating chills and fever, anorexia, vomiting, bitter and dry mouth, and dizziness. If there is no vomiting and appetite is preserved, the Three Yin channels are not affected. If there is no significant fever or dryness/distress, Yang has definitely entered Yin. Malaria-like symptoms and blood stagnation in women are governed by this channel.
Taiyin disease presents with abdominal fullness and spontaneous diarrhea; the pulse is sunken at all three positions, and fluids fail to reach the throat. Yin descends from Heaven, starting with Taiyin. In Yang, it is Exterior; in Yin, it is Interior. Pathogens in the Exterior show Yang pulses; pathogens in the Interior show Yin pulses. Thus, the pulse is sunken at all positions. Sunken and forceful requires purging; sunken, fine, and weak requires warming. When the Taiyin channel is affected, symptoms appear on the fourth or fifth day. Because its vessel spreads in the stomach and connects to the throat, there is abdominal fullness or pain, and dryness in the pharynx. There may be constipation with normal urination, or spontaneous diarrhea with warm hands and feet and thirst, indicating transmitted channel-heat. Or spontaneous diarrhea without thirst and cold limbs, indicating direct invasion of Yin syndromes. Internal injury from diet causing cold qi to enter the spleen leads to abdominal pain and chest discomfort. Taiyin is the end of Three Yang and the beginning of Three Yin. If exterior symptoms of Yang channels remain, sweating is appropriate; if half-exterior/half-interior with chest fullness and phlegm, vomiting is appropriate; if transmitted interior heat, purging is appropriate; if direct invasion of Yin channels, warming is appropriate. Regulating the Spleen to overcome pathogens is key here.
Shaoyin disease presents with dry tongue and mouth. Secondary to Taiyin, it is named Shaoyin. The pulse is sunken at all positions. Sunken and forceful requires purging; sunken, minute, and weak requires warming. When the Shaoyin channel is affected, symptoms appear on the fifth or sixth day. Because its vessel originates at the sole, passes through the Kidney, and connects to the Lung system, there is dry tongue and mouth with thirst. There may be spontaneous diarrhea of clear water, heart pain, and abdominal distension; or constipation with hard stool and aversion to heavy clothing, all indicating deep penetration of heat into the Interior. Severe cold limbs, aversion to cold, desire to vomit but unable to, abdominal pain with spontaneous diarrhea, white urine, dry retching, Yang exhaustion with sore throat, and a minute pulse with drowsiness indicate deep penetration of Yin toxicity into the Zang organs. Diarrhea with body pain, cough, and vomiting indicates water qi. Vomiting immediately after eating, wiry-slow pulse, cold limbs, and epigastric fullness contraindicate purging; vomiting is appropriate. A sunken pulse with fever indicates sweating is appropriate. Some cases attack Shaoyin directly upon onset, without transmitting from Taiyang.
Jueyin disease presents with irritability, fullness, and retraction of the testicles. Jueyin represents the end of Yin, where reversal occurs. Transmission ends here; further transmission reverses to the Hand channels. The pulse is sunken at all positions. Sunken and forceful requires purging; sunken, slow, and weak requires warming; floating-slow indicates spontaneous recovery. When the Jueyin channel is affected, symptoms appear on the sixth or seventh day. Because its vessel circulates around the genitalia and connects to the Liver, there is cyanotic lips and curled tongue. Irritability indicates chest Qi fullness and urgency; testicular retraction indicates shrinking of the scrotum. In women, it manifests as acute pain in the vagina radiating to the lower abdomen, indicating deep internal wind-heat toxicity in transmitted Jueyin. Liver Wood transferring heat to Spleen Earth damages the Spleen, distressing all Zang-Fu, blocking Ying and Wei, leading to deafness, testicular retraction, and reversal. If food and drink are refused and consciousness is lost, death ensues; rapid purging is needed for survival (one in five survives). Diarrhea with delirium indicates dry feces inside; purging is still appropriate. Vomiting with fever requires harmonizing. Fever and chills like malaria, without testicular retraction, with a slightly floating/slow pulse (Stomach pulse), indicates Spleen Qi is restored, rejecting pathogens, Ying and Wei recovering, Water rising and Fire descending, resolving with profuse sweating. Diarrhea with abdominal distension and body pain requires treating the Exterior first, then warming the Interior. Diarrhea with undigested food, profuse sweating, reversal, limb pain, and lower abdominal cramping; dry retching with froth; Qi rushing causing heart pain; fever, thirst, and vomiting roundworms—all are Jueyin cold syndromes requiring warming. The above six statements are the ancestor of all diseases; without the *Neijing*, such comprehensive summary would be impossible. Any syndrome described in the Six Channels refers to these Three Yang and Three Yin channel syndromes, applicable to miscellaneous diseases as well.
Channels cannot be rigidly bound by days.
The classic states: Day 1, Foot-Taiyang Bladder channel; Day 2, Foot-Yangming Stomach channel; Day 3, Foot-Shaoyang Gallbladder channel; Day 4, Foot-Taiyin Spleen channel; Day 5, Foot-Shaoyin Kidney channel; Day 6, Foot-Jueyin Liver channel. It also states: If cold damage does not involve mixed pathogens and does not transmit, on Day 7, Foot-Taiyang disease declines, Hand-Taiyang takes over, headache lessens; Day 8, Foot-Yangming declines, Hand-Yangming takes over, body heat subsides; Day 9, Foot-Shaoyang declines, Hand-Shaoyang takes over, hearing slightly recovers; Day 10, Foot-Taiyin declines, Hand-Taiyin takes over, abdominal distension resolves, appetite returns; Day 11, Foot-Shaoyin declines, Hand-Shaoyin takes over, thirst stops, dry tongue heals, sneezing occurs; Day 12, Foot-Jueyin declines, Hand-Jueyin takes over, scrotum relaxes, lower abdomen feels better, vital Qi stops. Disease transmitting twice through the Six Channels may resolve spontaneously. *Huo Ren Shu* says: Days 1-2, release the Exterior; Days 3-4, harmonize to cure; Days 5-7 unresolved, if stool is solid, consider purging. These discuss normal patterns. *Huohuo Lun* says: Patients vary in deficiency/excess, pathogens vary in speed; how can days be rigidly applied? Many days with Exterior signs and floating-rapid pulse still require sweating; few days with Interior signs and sunken-fine pulse require purging. Treatment depends on syndrome, deficiency/excess, and pulse. Tao Jian'an says: If Taiyang signs appear, use Ephedra Decoction or Cinnamon Twig Decoction to sweat Taiyang; if Shaoyin signs appear, use Four Reversal Decoction to warm Shaoyin; if Yangming signs appear, use Chengqi Decoction to purge Yangming; if true cold signs appear entering Yin channels, rescue true cold. This is the most flexible method. Transmission follows order or heavenly Qi. Initial Qi is Jueyin Wind-Wood; Second is Shaoyang Ministerial-Fire; Third is Shaoyin Sovereign-Fire; Fourth is Taiyin Damp-Earth; Fifth is Yangming Dry-Metal; Sixth is Taiyang Cold-Water. Humans accept Qi normally; disease arises from opposing Qi, transmitting from lower to upper, outside to inside. Yang moves and is external; Yin is still and internal. The Bladder gathers Qi and Blood, governing from head/back to feet, so wind-cold attacks it first. Next, Stomach Qi flows endlessly from nose/abdomen to feet, so Taiyang connecting Du and Ren vessels affects Yangming. Next, Shaoyang Clear Qi governs Ying/Wei, flanks, and sides, so Stomach pathogens move to Gallbladder. These Three Yang are external and moving, thus Exterior. Taiyin: Spleen is Dead Yin, very still; digestion relies on Stomach Qi ascending/descending, so pathogens from Shaoyang flanks enter Taiyin abdomen. Next, Kidneys receive grain essence and are still, moving only at midnight, so pathogens from middle abdomen reach Kidneys. Next, Liver disperses/stores Blood and is very still, so deep interior pathogens reach lower abdomen, then ascend to Hand channels. This is natural order. Errors disrupt this: Taiyang self-transmission with thirst/difficult urination is due to mistaken draining; Taiyang-Yangming combined requires Ephedra but uses Pueraria; Taiyang jumping to Shaoyang requires Ephedra but uses Bupleurum; Taiyang to Shaoyin requires Cinnamon/Ephedra but uses purgatives; Taiyang to Taiyin requires Cinnamon Twig but uses purgatives. These are medical errors disrupting transmission order. Taiyang may jump to Jueyin (severe vertex headache) due to connected meridians ascending via Du. Taiyang wind injury causing dry Yin blood, heat in Bladder, reversing to Small Intestine/Heart is called "Injustice Heat". Wind-cold from back directly invades Taiyang/Shaoyang; from face directly invades Yangming. Some stay in Taiyang without transmitting; some skip channels; some stop; some repeat; some bypass Yang to invade Yin directly. Pathogens have no fixed form; days cannot be rigidly applied. *Huo Ren Shu* says: Six Qi pathogens attack deficient channels.
Biao and Ben must be understood regarding priority.
Biao (Branch) is the tip/end; Ben (Root) is the foundation. Regarding the host, channels are Biao, Zang-Fu are Ben (e.g., Taiyang Channel is Biao, Bladder is Ben). Regarding guest pathogens, primary infection is Ben, secondary is Biao. Biao involves transmission; treat the urgent. Detailed explanation: Taiyang Bladder is Ben (headache, stiff back); Small Intestine is Biao (interior-exterior with Heart), causing fever. Winter: Ephedra Decoction/Cinnamon Twig Decoction; Other months: Nine-Ingredient Qianghuo Decoction. Yangming Large Intestine is Biao (interior-exterior with Lung), mild chills/fever is channel disease, use Pueraria Muscle-Releasing Decoction; Thirst with sweat unrelieved: White Tiger Decoction. Stomach is Ben (eye pain, dry nose, tidal sweat, constipation, fullness, thirst, mania, delirium) is Fu disease, use Harmonizing Stomach Chengqi Decoction. Shaoyang Sanjiao Ministerial Fire is Ben (circulates whole body, mild heat); Gallbladder is Biao (deafness, flank pain, chills/fever, vomiting, bitter taste). Since Sanjiao is formless and Gallbladder has no exit, treat from the center; both Biao/Ben use Minor Bupleurum Decoction. Taiyin Lung is Biao (dry throat, yellow body/eyes); Spleen is Ben (abdominal fullness/pain, Fu heat). Dry throat, fullness, warm palms: Cinnamon Twig Plus Rhubarb Decoction or Major Bupleurum Decoction. Yellow body/eyes: Yinchen Decoction. Chest fullness: Melon Sepal Powder. Spontaneous diarrhea without thirst or vomiting: Zang disease, use Lizhong Decoction/Pills. Shaoyin Heart is Ben (dry tongue/mouth, periumbilical hardness/pain, epigastric hardness/pain, pure water diarrhea, delirium/constipation): Minor Chengqi Decoction. Kidney is Biao (face cold as if scraped, cyanotic lips, no thirst, vomiting/diarrhea, chest/abdominal colic, cold limbs, black nails, curling up, body feels beaten): Ancient Ginger-Attis Decoction. Juexin Pericardium is Biao (curled tongue, reversal, cold past elbows/knees, frothy vomiting, no thirst, lower abdominal colic) is Cold: Three-Ingredient Ginseng-Cornus Decoction or Four-Smooth Decoction. Liver is Ben (male testicular retraction, female vaginal prolapse/breast retraction, alternating cold/warm limbs, solid stool, thirst/irritability) is Heat: Major Chengqi Decoction. Malaria-like, no vomiting, normal urination/defecation: Self-healing. Unhealed, slow pulse, sweating: Minor Construct Middle Decoction. Unhealed, choppy pulse, no sweating: Half-Cinnamon-Half-Ephedra Decoction. Testicular/breast retraction can also be Cold. This is the ancestor of all methods; understanding this grasps disease mechanisms! Without Zhongjing's *Yukan* secrets, who could achieve this? Subsequent sweating, vomiting, purging, warming, harmonizing formulas are not detailed, only stating indications; understand them.
Cold injures Ying, Wind injures Wei, Taiyang is the leader.
Ying circulates in vessels, deep pathology; Wei circulates outside vessels, superficial pathology. Ying Blood is Yin, Yin governs closure/storage, so Cold injures Ying causing no sweat. Wei Qi is Yang, Yang governs opening/release, so Wind injures Wei causing sweat. Is Taiyang unique as the meeting of Ying/Wei with Cold/Wind distinction? Yangming hunger is Wind injury, anorexia is Cold damage. Shaoyang deafness/chest fullness/irritability is Wind injury; bitter mouth/dry throat/dizziness is Cold damage. Three Yin Wind injury causes only limb irritability/pain. Taiyang is first because Cold damage stems from Kidney Water deficiency; Spring Wood lacks life force, causing Warm Disease; Summer loses generation source, causing Heat Disease. Thus, Taiyang and Shaoyin suffer most and earliest.
Channels can be resolved, Fu treated, or purged; Yangming is the master.
More Exterior than Interior means in Channel, clear muscle/release Exterior; More Interior than Exterior means in Fu, harmonize muscle/unblock Interior. Yangming Biao governs muscle, but Ben is Stomach. Is Yangming unique among Twelve Channels with Channel/Fu differences? Zhongjing said: Three Yang disease not yet in Fu can be sweated; Three Yin disease already in Fu can be purged. Thus, Three Yin in Channel still needs mild sweating. Ying/Wei belong to Taiyang, govern skin/hair; Stomach Fu belongs to Yangming, governs below skin, above muscle, and intestines; Chest/flanks belong to Shaoyang, govern Blood, nourish joints, circulate three parts; Zang belong to Three Yin, govern sinews/bones and feet. Taiyang is Exterior of Yang syndromes; Stomach is Interior of Yang syndromes. If dividing by Zang-Fu, Fu is Exterior, Zang is Interior. If combining Ying/Wei/Zang-Fu, Exterior is Ying/Wei pathway, Interior is Stomach Fu domain, Zang is deeper Interior. Once disease enters Stomach, it stops transmitting.
Shaoyang originally treated from Center, contraindicates sweating and purging.
Shaoyang is between Taiyang/Yangming, half-exterior/half-interior. Contraindicate sweating (fear offending Taiyang); contraindicate purging (fear offending Yangming); contraindicate draining (fear generating Qi sinking into Yin). Only harmonize with Minor Bupleurum Decoction. Violating three prohibitions leads to uncontrollable changes. Taiyang channel contraindicates purging/draining (violating moves Blood, heat enters Interior, hard to resolve); Yangming channel contraindicates sweating/draining (violating exhausts fluids, blood stasis in lower body causing mania; replenish fluids with Scallion White Decoction). See combined diseases in purging treatments.
Three Yin utilize variable methods, with direct invasion and transmission.
Three Yin must not be rigid; some need purging, some warming. Transmission from Three Yang Qi level to Three Yin is called Transmitted Yin Syndrome. "Transmission" does not mean entering Spleen/Kidney/Liver, but entering Three Yin Blood level, Stomach, Large/Small Intestine Fu organs—hence Zhongjing says "entered Fu, can purge." If not transmitted from Yang, direct invasion of Three Yin channels: initial reversal, abdominal pain, spontaneous diarrhea without thirst is Taiyin direct cold; adding vomiting is Shaoyin direct cold; adding clear urination is Jueyin direct cold. Hot herbs to warm, fearing delay; Yin/Yang error determines life/death. Although ancients explained transmission/direct invasion fully, what about transformation? During transmission, if patients eat raw/cold, engage in sex, or are aggressively treated by incompetent doctors, True Qi weakens, Yang syndrome transforms to Yin (commonly "Yang returning to Yin"), treat as direct cold. *Neijing* mentions transformation but not direct invasion, implying transformation covers direct invasion. *Ju Fang* mentioning "transmitting Yin/Yang" is incorrect; should be "Yang transforming to Yin." Generally, transmitted is Interior Heat; direct/transformation is Interior Cold. Pulse diagnosis: Direct/Transmitted Three Yang, Exterior disease, floating-long-wiry pulse; Transmitted Three Yin, Interior disease, sunken-rapid-solid pulse; Direct Three Yin, Channel disease, sunken-micro-slow pulse. This distinguishes Exterior/Interior/Deficiency/Excess; do not simply equate Yang with Heat and Yin with Cold.
Saying Feet are injured but not Hands is acceptable, as Cold is governed by Feet.
Hand Six Channels govern Spring/Summer; Foot-Taiyang/Shaoyang govern Winter. Touching these causes disease in these two. Next, Shaoyang/Jueyin succeed Winter governing Spring; after Spring Equinox, Warmth governs, so Wind-Cold can also injure them. Foot-Yangming has no relation to Winter but thrives in Four Seasons, so Cold/Heat/Warm/Cool can injure it. Moreover, Exterior pathogens transmitting to Interior return to Spleen/Stomach, forming dry feces, resolved by purging decoctions, harmonizing Stomach.
Saying Feet transmit but not Hands is unacceptable, as Heat is the injustice of Hands.
Body Qi circulates daily through 365 joints, corresponding to 365 degrees of heaven. Blood follows Qi circulating in collaterals, governing body movement/action. One meridian disharmony causes all meridions to sicken. Wind-Cold enters Ying/Wei, circulating day/night everywhere, how could it stop at Hand channels? If not healed in seven days and transmitting again, Heat transfers from Foot to Hand channels, like enemies retaliating. Though "Hand Injustice" traces back to origin. Ancients divided only Three Yin/Yang, not Hand/Foot, implying deep meaning. Hand/Foot Three Yang all go Head to Foot; Hand/Foot Three Yin all go Chest/Abdomen to Hand. How can same meridians have different diseases? Wheezing/cough/fever clearly involves Hand-Taiyin...