《伤寒》一书,专明表里,以寒邪之入也,表里以次,故分六经以列其次之后先。寒病
之呈
也,表里恒兼,故又分六经六篇,以辨其兼之多少,于是属词比事,不得不起一例。其例纯
表者入表部,兼里者亦入表部,必纯里者乃在里部。假如六经症具,必在太阳篇,以太阳为
表之表也。太阳症罢,乃入阳明,阳明罢乃入少阳,少阳罢乃入太阴、入少阴、入厥阴,各
取最外一层隶之,故于太阳着论最多,而厥阴独少。非略也,他经之兼太阳者,例不得入于
他经,而厥阴之兼他经而已分入各部者,例不得入于厥阴,则第纪其经症及解时愈候而已。
其自诸四逆以下,古另为一篇,《玉函》题曰平呕哕厥利脉症并治,成本误并之。或据成本
而犹以为少,不得其故,乃曰此仲景未成之书也,否则曰此王叔和之所乱也。
余论《伤寒》六经为纪表里,屡矣。究何所证?曰∶证诸华佗。《千金》引其说云∶凡
伤寒
一日在皮,二日在肤,三日在肌,四日在胸,五日在腹,六日入胃,是分六层以纪表里之次
者由佗始。所云入胃,即阳明病胃家实也;在皮、在肤、在肌,即太阳及阳明经病也;在胸
,
即少阳及太阴病吐食不下也;在腹,
即太阴腹满痛及
少阴、厥阴病也。特措词有文质,分次有赢缩,以此不同耳!其纪表里之义则同,仲景既存
《素问》六日六经之文于例,而又取华氏六日六层之义润饰之,而易其目以着篇,乃主药法
而略针法之意。巢元方能知之,故《病源》存华说于总
论,复次《素问》六日六经根据脉生病之文于
后,与仲景若合符节,是又得一证矣。夫又奚疑?
《伤寒论》一书,专门阐明表证与里证。因为寒邪侵入人体,是按照由表及里的次序进行的,所以分为六经来排列其先后顺序。寒病发作时,表证和里证常常同时存在,因此又分为六经六篇,以辨别兼夹证候的多少。于是,在组织语言和叙述事件时,不得不确立一个统一的体例。凡是纯表证的归入表部,兼有里证的也归入表部,只有纯里证的才归入里部。假如六经症状都具备,必然记载在太阳篇中,因为太阳是表中之表。太阳病症解除后,病邪传入阳明;阳明病症解除后,传入少阳;少阳病症解除后,传入太阴、少阴、厥阴。各经病症都取最外一层的特征归属相应篇章,所以在太阳篇论述最多,而厥阴篇最少。这并不是疏略,而是因为其他经病如果兼有太阳证,按照体例不得归入他经单独论述;而厥阴病如果兼有其他经病,已经分别归入各部了,那么在厥阴篇中就只记录其本经症状以及解愈的时间规律罢了。
从四逆汤类方以下的内容,古代原本另为一篇,《玉函经》将其题为“平呕哕厥利脉症并治”,宋成本(成无己注本)错误地合并了进去。有人依据宋成本认为内容仍然太少,不明白其中的缘故,就说这是张仲景未完成的著作,否则就说这是王叔和整理时搞乱了。
我论述《伤寒论》六经是用来记录表里关系的,已经多次提及。究竟有什么证据呢?回答说:用华佗的理论来证明。《千金方》引用华佗的说法说:“大凡伤寒,第一天在皮,第二天在肤,第三天在肌,第四天在胸,第五天在腹,第六天入胃。”这是分六层来记录表里次序的,是从华佗开始的。所说的“入胃”,就是阳明病的胃家实(胃肠燥热实证);所说的“在皮、在肤、在肌”,就是太阳病及阳明经病;所说的“在胸”,就是少阳病及太阴病出现的呕吐、饮食不下;所说的“在腹”,就是太阴病的腹满痛以及少阴病、厥阴病。只是措辞有文雅与质朴的区别,分次有详略的不同,因此有所不同!但记录表里关系的意义则是相同的。张仲景既然保留了《素问》中关于六日传变六经的文字作为体例,又采纳华氏六日六层的意义加以润色修饰,并更改标题以设立篇章,这主要是侧重药物疗法而简略针灸疗法的意图。巢元方能理解这一点,所以《诸病源候论》在总论中保存了华佗的说法,又在后面依次排列了《素问》中根据脉象生病的六日六经文字,这与张仲景的观点若合符节,这又是一个证据。对此还有什么可怀疑的呢?
The *Shanghan Lun* (Treatise on Cold Damage) is a work dedicated to elucidating exterior and interior patterns. Since cold pathogenic factors invade the body in a sequential manner from exterior to interior, the text divides the disease process into six meridians (Six Channels) to delineate their chronological order. In the manifestation of cold damage diseases, exterior and interior patterns often coexist; therefore, the text is further divided into six chapters corresponding to the six meridians to distinguish the degree of such concurrent involvement. Consequently, in organizing terminology and narrating clinical events, it becomes necessary to establish a unified methodological principle. Cases presenting with pure exterior patterns are classified into the exterior section; those with concurrent interior patterns are also included in the exterior section; only cases presenting with pure interior patterns are placed in the interior section. For instance, if symptoms of all six meridians are present, they must be recorded in the Taiyang chapter, because Taiyang represents the most superficial layer of the exterior. Once Taiyang patterns resolve, the disease enters Yangming; once Yangming patterns resolve, it enters Shaoyang; once Shaoyang patterns resolve, it enters Jueyin, Shaoyin, and Taiyin. Each meridian’s presentation is categorized based on its most superficial layer. Thus, there are the most discussions regarding Taiyang, while Jueyin has the fewest. This is not due to negligence. Rather, according to the established principle, if other meridians’ patterns involve Taiyang, they cannot be discussed under their respective headings but rather under Taiyang. Conversely, if Jueyin patterns involve other meridians, they have already been distributed into their respective sections; thus, the Jueyin chapter merely records its specific meridian symptoms and the prognosis for resolution.
Regarding the content starting from the Sini Tang (Four Reversal Decoction) and subsequent formulas, ancient editions treated this as a separate chapter. The *Yuyuan Jing* (Jade Box Classic) titled it "Comprehensive Treatment of Vomiting, Hiccups, Cold Limbs, Diarrhea, Pulse, and Symptoms." The Song Benben (Song Dynasty Edition annotated by Cheng Wuji) erroneously merged it. Some scholars, relying on the Song edition, still found the content insufficient and, failing to understand the reason, claimed this was an unfinished work by Zhang Zhongjing, or alternatively, that it was disrupted by Wang Shuhe during compilation.
I have frequently argued that the Six Meridians in the *Shanghan Lun* serve to record the progression of exterior and interior patterns. What is the evidence? The answer lies in the theories of Hua Tuo. The *Qianjin Yaofang* (Essential Prescriptions Worth a Thousand Gold) cites his view: "Generally, in cold damage, on the first day the pathogen is in the skin, on the second day in the flesh/subcutaneous tissue, on the third day in the muscles, on the fourth day in the chest, on the fifth day in the abdomen, and on the sixth day it enters the Stomach." This classification into six layers to record the sequence of exterior and interior originated with Hua Tuo. What he termed "entering the Stomach" corresponds to Yangming disease characterized by Wei Jia Shi (Stomach House Excess/Intestinal Dryness-Heat Excess); "in the skin, flesh, and muscles" corresponds to Taiyang and Yangming meridian diseases; "in the chest" corresponds to Shaoyang and Taiyin diseases manifesting as vomiting and inability to ingest food; "in the abdomen" corresponds to Taiyin disease with abdominal fullness and pain, as well as Shaoyin and Jueyin diseases. The differences lie merely in the style of expression (literary vs. plain) and the granularity of the stages (detailed vs. condensed). However, the underlying meaning of recording the exterior-interior progression remains identical. Zhang Zhongjing retained the text from the *Suwen* (Basic Questions) regarding the transmission through six meridians over six days as a foundational principle, and further enriched it with Hua Tuo’s concept of six days and six layers, modifying the titles to establish the chapters. This reflects an intention to prioritize herbal therapy while simplifying acupuncture methods. Chao Yuanfang understood this, which is why the *Bingyuan* (Source of Diseases) preserved Hua Tuo’s theory in its general discussion and subsequently arranged the *Suwen*’s text on disease generation via pulses across six days and six meridians. This aligns perfectly with Zhang Zhongjing’s approach, providing further confirmation. What, then, is there to doubt?