此一卷论经络。治伤寒先须识经络。不识经络。触途冥行。不知邪气之所在。往往病在太阳。反
攻少阴。证是厥阴。乃和少阳。寒邪未除。真气受毙。又况伤寒看外证为多。未诊先问。最为有准。
孙真人云。问而知之。别病浅深。名为巧医。病家云。发热恶寒。头项痛。腰脊强。则知病在太阳经
也。身热目疼。鼻干不得卧。则知病在阳明经也。胸胁痛耳聋。口苦舌干。往来寒热而呕。则知病在少
阳经也。腹满咽干。手足自温。或自利不渴。或腹满时痛。则知病在太阴经也。引饮恶寒。或口燥舌
干。则知病在少阴经也。烦满囊缩。则知病在厥阴经也。然后切脉以辩其在表在里。若虚若实。以汗
下之。古人所以云问而知之为中工。切而知之为下工。若经隧支络懵然不分。按寸握尺。妄意疾证。
岂知坐授明堂。藏室金兰者耶。
\r足太阳经\pt51a1.bmp\r
风府穴∶两旁各一从此分为四道
膀胱∶重九两二铢纵广九寸盛溺九升九合
∶ 谓膝后曲脚之中委中穴也
足太阳膀胱之经。（肾与膀胱为合。故足少阴与足太阳为表里）从目内 上头连于风府。分为
四道。下项并正别脉上下六道以行于背。与身为经。太阳之经为诸阳主气。或中寒邪。必发热而恶寒。
缘头项腰脊。是太阳经所过处。今头项痛。身体疼。腰脊强。其脉尺寸俱浮者。故知太阳经受病也。
（灵枢经云。足太阳之脉起于目内 。上额交巅。其支者。从巅至耳上角。其直者。从巅入络脑，还
出别下项。循肩 。内挟脊。抵腰中。入循膂。络肾。属膀胱。其支者。从腰中，下挟脊贯臀入
中，其支者，从 内左右别下贯胛。挟脊内。过髀枢。循髀。从廉下合 中。以下贯 内。出外踝之后。
循京骨。至小趾外侧）
\r足阳明经\pt51a2.bmp\r
大迎穴∶在曲颔前一寸一分骨陷中动脉又以口下当两肩者得之是
承浆穴∶在唇下陷者中是
人迎穴∶在结喉旁一寸五分动脉应手者是
缺盆穴∶一名天盖在肩下横骨陷者中是
胃∶重二斤十四两盛谷二斗水一斗五升为水谷之海
脾∶络脾
伏兔穴∶在膝上六寸起内是一云是膝盖上七寸是
髀关穴∶在膝上伏兔后交分中是
气冲穴∶在归来下鼠鼷上一寸动脉又云在阴毛两旁
下膝∶三寸者正白三里穴而下也三里穴在膝下三寸是
足阳明胃之经。（脾与胃为合。故足太阴与足阳明为表里）从鼻起挟于鼻。络于目。下咽分为
四道。并正别脉六道上下行腹纲维于身。盖诸阳在表。阳明主肌肉。络于鼻。故病患身热目疼鼻干不
得卧。其脉尺寸俱长者。知阳明经受病也。
（灵枢经云。足阳明之脉。起于鼻交 中。旁约太阳之脉。下循鼻外。入上齿中。还出挟口。环唇。
下交承浆。却循颐后下廉。出大迎。循颊车。上耳前。过客主人。循发际，至额颅。其支者。从大迎
前下人迎。循喉咙。入缺盆。下膈属胃络脾。其直者从缺盆下乳内廉。下挟脐。入气冲中。其支者。起
胃口下循腹里。下至气冲中而合。以下髀关。抵伏兔。下膝膑中。下循胫外廉。下足跗。入中趾内间。
其支者。下廉三寸而别。以下入中趾外间。其支者。别跗上。入大趾间。出其端）
\r足少阳经\pt51a3.bmp\r
气冲穴∶在阴毛两旁动脉应手
胆∶在肝之短叶间重三两三铢盛精汁三合
足少阳胆之经。（肝与胆为合。故足厥阴与足少阳为表里）起目外 。络于耳。遂分为四道。
下缺盆。循于胁并正别脉六道上下主经营百节流气三部。故病患胸胁痛而耳聋。（黄帝针经曰。邪在
肝则两胁痛。又曰。胆胀者胁下痛。口中苦。善太息）或口苦咽干。或往来寒热而呕。其脉尺寸俱
弦者。知少阳经受病也。
（灵枢经云。足经少阳之脉。起于目锐 。上抵头角下耳后。循颈。行手少阳之前。至肩上。却交
出手少阳之后。入缺盆。其支者。从耳下入耳中。出走耳前。至目锐 后。其支者。别锐 。下大迎。
合手少阳抵于 下。加颊车下颈。合缺盆以下胸中。贯膈络肝属胆。循胁里。出气冲。绕毛际。入髀
厌中。其直者。从缺盆下腋。循胸中。过季胁。下合髀厌中。以下循髀阳出膝之廉下。外辅骨之前。
直下抵绝骨之端。下出外踝之前。循足跗上。出小趾次趾之端。其支别者。从跗上。入大趾。循岐骨
内出其端）
\r足太阴经\pt51a4.bmp\r
舌本∶舌本者舌根也
咽门∶重十两为胃之系
胃∶络胃
脾∶重二斤三两象马蹄内色胃脘象土形也经络之气交归于中以营运真灵之气意之舍也
上循膝∶股内前廉
足太阴脾之经。为三阴之首。其脉布于脾胃。络于嗌喉。故病患腹满而嗌干。尺寸俱沉细者。知
太阴经受病也。
灵枢经云。足太阴之脉。起于大趾之端。循趾内侧白肉际。过核骨后。上内踝前廉。上 （示
兖切）内循胫骨后。交出厥阴之前。上循膝股内前廉。入腹属脾络胃。上膈。挟咽。连舌本。散舌下。
其支者。复从胃别上膈。注心中。
\r足少阴经\pt51a5.bmp\r
肾脏∶有二形如红豆相并而曲附于膂筋外有脂裹里白表黑主藏精。
足少阴肾之经。其脉起于小趾之下。斜趣足心。别行者。入跟中。上至股内后廉。贯肾络膀胱。
直行者。从肾上贯肝膈。入肺中。系舌本。伤寒热气入于脏。流于少阴之经。少阴主肾。肾恶燥。故
渴而引饮。又经发汗吐下以后。脏腑空虚。津液枯竭。肾有余热亦渴。故病患口燥舌干而渴。其脉尺
寸俱沉者。知少阴经受病也。
灵枢经云。足少阴之脉起于小趾之下。斜趣足心。出于然骨之下。循内踝之后。别入跟中。以
上（时兖切）内。出 内廉。上股内后廉。贯脊属肾络膀胱。其直者。从肾上贯肝膈。入肺中。循
喉咙。挟舌本。其支者。从肺出络心。注胸中。
\r足厥阴经\pt51a6.bmp\r
上 ∶内廉。
循足跗∶上廉。
巅∶顶上曰巅。
颃颡者:悬雍两旁肉也又灵枢经曰颃颡者分气之泄。
肝∶重四斤四两有七布叶一叶小如木甲拆之象也各有支络脉进中以宦发阳和之气魏之宫也
足厥阴肝之经。厥者。尽也。灵枢曰。亥为左足之厥阴。戌为右足之厥阴。两阴俱尽。故曰厥阴。
夫阴尽为晦。阴出为朔。厥阴者。以阴尽为义也。其脉循阴器而脉络于舌本也。脉弗营则筋急。筋急
则引舌与卵。故唇青舌卷而卵缩。凡病患烦满而囊缩。其尺寸俱微缓者。知厥阴经受病也。
（灵枢经云。足厥阴之脉。起于大趾丛毛之际。上循足跗上廉。去内踝一寸。上踝八寸。交出太
阴之后。上 内廉。循股阴。入毛中。环阴器。抵小腹。挟胃属肝络胆。上贯膈。布胁肋。循喉咙之
后。上入颃颡。连目系。上
出额。与督脉会于巅。其支者。从目系下颊里。环唇内。其支者。复从肝别贯膈。上注肺中）
（一）问伤寒一二日。发热恶寒。头项痛。腰脊强。尺寸脉俱浮。
此足太阳膀胱经受病也。（仲景云。太阳病欲解时。从巳至未上）太阳病头疼发热。汗出恶风。
宜桂枝汤。（正一）轻者。只与柴胡桂枝汤（正方三十一）太阳病头痛发热无汗恶寒。宜麻黄汤。
（正二十）轻者只与桂枝麻黄各半汤。（正二）麻黄汤桂枝汤。二者均为解散。正分阴阳。不可不慎
也。仲景所谓无汗不得服桂枝。有汗不得服麻黄。常须识此。勿令误也。今人才见身热头痛。便发汗。
不知汗孔闭而用麻黄。汗孔疏而用桂枝。伤寒伤风。其治不同。古人有汗者当解肌。无汗者可发汗。
（二）问伤寒二三日。身热目疼鼻干。不得卧。尺寸脉俱长。
此足阳明胃经受病也。（仲景云。阳明病欲解时。从申至戌上）伤寒二日。阳明经受病。可发
其汗。非正阳明也。（正阳明者。身热汗出不恶寒。反恶热。故可下也）今言一二日传阳明经。身
热目疼。鼻干不得卧。其脉俱长者。是太阳阳明可表而已。若无汗尚恶寒。宜升麻汤。（杂方）有汗
微恶寒者。表未解也。宜桂枝汤。（正方一）无汗脉浮。其人喘者。与麻黄汤。（正二十）○又问十
二经皆一。而阳明有三。何也。有太阳阳明。有少阳阳明。有正阳阳明也。太阳阳明者。本太阳病。
若发汗若下若利小便。此亡津液。胃中干燥。因转属阳明也。（太阳阳明。脾约是也。大便坚。小便
利。其脾为约）少阳阳明者。本传到少阳。因发汗利小便已。胃中燥实。大便难也。正阳阳明者。病
人本风盛气实也。三阳明俱宜下。唯恶寒乃中寒为病在经。与太阳合病。属表。可发其汗。盖太阳与
阳明合病。脉必浮大而长。外证必头疼
腰痛肌热目痛鼻干也。脉浮大者。太阳也。长者。阳明也。头疼腰痛者。太阳也。肌热目痛鼻干者。
阳明也。尚恶寒者。可升麻汤（杂方一）汗之。若不恶寒反恶热。大便不秘者。可白虎汤（正方六十
四）解利之。不恶寒反恶热。大便秘。或谵语者。属胃家实也。可调胃承气汤下之。（正四十三）○
又问三阳有合病。有并病。何也。脉浮大而长。头疼腰痛肌热目疼鼻干者。合病也。太阳初得病时。
发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒者。并病也。三阳皆有合病。唯三阴无合病。
不可不知也。太阳证罢。但发潮热。手足 汗出。大便难而谵语者下之愈。宜大承气汤。（正四十
一）若太阳证不罢。不可下。宜用桂枝麻黄各半汤（正方二）小发汗。设面赤色者。阳气怫郁在表。
当解之熏之。若发汗不大彻。则阳气怫郁。不得越散。当汗不汗。烦躁不知痛处。其人短气但坐。盖
以汗出不彻故也。更以麻黄汤发其汗则愈。何以知汗出不彻。以脉涩故知之。
（三）问伤寒三四日。胸胁痛而耳聋。或口苦舌干。或往来寒热而呕。其尺寸脉俱弦。
此足少阳胆经受病也。（仲景云。少阳病欲解时。从寅至辰上）太阳病不解。转入少阳。胁下
硬满。干呕不能食。往来寒热。尚未可吐下。诊其脉弦紧者。小柴胡汤主之。（正方二十九）盖脉弦
细头疼发热属少阳。少阳受病。口苦咽干目眩。宜小柴胡汤以解表。不可发汗。（仲景少阳证唯小柴
胡为解表药耳）发汗则谵语。谵语属胃。胃和则愈。不和则烦而燥。宜调胃承气汤（正四三）此属
少阳阳明也。
（四）问伤寒四五日。腹满咽干。手足自温。或自利不渴。或腹满时痛。尺寸俱沉细。
此足太阴脾经受病也。（仲景云。太阴病欲解时。从亥至丑上）伤寒手足必微冷。若手足自温
者。系太阴也。自利不渴。属太阴也。腹满时痛。属太阴也。自利不渴者脏寒也。当温之。宜四逆汤、
（正方七十五）理中汤也。（正方七十四）腹满脉浮者。可桂枝（正方一）微发汗。腹痛者。桂枝加
芍药汤。（正十二）痛甚者。桂枝加大黄汤。（正十三）○古人以四日太阴证病在胸膈。可吐而愈何
也。答曰。不然。有太阴证脉大胸满多痰者。可吐之。脉大而无吐证者。可汗而已。大抵在表者汗之。
在里者下之。在上者涌之。在下者泄之。瓜蒂（正百十一）栀豉（杂十九）随证施用。不可拘以日数
也。
（五）问伤寒五六日。尺寸脉俱沉。或口燥舌干而渴。或口中和而恶寒。
此足少阴肾经受病也。（仲景云。少阴病欲解时。从子至寅上）少阴病口燥舌干者。急下之。
宜大承气汤。（正四十一）若不渴。不口燥舌干而脉沉者。急温之。宜四逆汤。（正方七十五）太阴
厥阴皆不恶寒只有少阴有恶寒之证。不可不知也。少阴病得之一二日。口中和。其背恶寒者。宜着灸
并附子汤也。大抵伤寒阳明证宜下。少阴证宜温。然仲景于少阴证口燥咽干即云急下之。盖少阴主肾。
系舌本。伤寒热气入于脏。流于少阴之经。肾汁干。咽路焦。故口燥咽干而渴。须宜急下之。非若阳
明证宜下而可缓也。虽然。阳明亦有一证。发热汗出多。急下之。阳明属胃。汗多则胃汁干。亦须急
下也。
（六）问伤寒六七日。烦满囊缩。其脉尺寸俱微缓。
此足厥阴肝经受病也。（仲景云。厥阴病欲解时。从丑至卯上）厥阴病其脉微浮为欲愈。不浮
为未愈。宜小建中汤。（正三十七）
脉浮缓者。必囊不缩。外证必发热恶寒似疟。为欲愈。宜桂枝麻黄各半汤。（正方二）若尺寸脉俱沉
短者。必是囊缩毒瓦斯入脏。宜承气汤下之。（正方四十二）○大抵伤寒病脏腑传变。阳经先受病。故
次第传入阴经。以阳主生。故太阳水传足阳明土。土传足少阳木。为微邪也。阴主杀。故木传足太阴
土。土传足少阴水。水传足厥阴木。至六七日当传厥阴肝木。必移气克于脾土。脾再受贼邪。则五脏
六腑皆困而危殆。营卫不通。耳聋囊缩。不知人而死矣。速用承气汤下之。可保五死一生。古人云。
脾热病则五脏危。又云。土败木贼则死。若第六七日传厥阴。脉得微缓微浮。为脾胃脉也。故知脾气
全。不再受克。邪无所容。痞极泰来。营卫将复。水升火降。则寒热作而大汗解矣。
这一卷论述经络。治疗伤寒必须先认识经络。如果不认识经络，就会像盲人走路一样，不知道邪气所在的部位。往往病在太阳经，反而去攻治少阴经；证候属于厥阴经，却去调和少阳经。这样寒邪未能去除，真气反而受到损害。况且伤寒多观察外部证候，未诊脉先询问病情，最为准确。孙真人说：通过询问而得知病情，辨别疾病的深浅，这称为巧医。病人说：发热恶寒，头项痛，腰脊强直，就知道病在太阳经。身体发热，眼睛疼痛，鼻子干燥，不能安卧，就知道病在阳明经。胸胁痛，耳聋，口苦，舌干，忽冷忽热并且呕吐，就知道病在少阳经。腹部胀满，咽喉干燥，手脚自然温暖，或者自行腹泻且不口渴，或者腹部胀满且有时疼痛，就知道病在太阴经。想喝水但怕冷，或者口燥舌干，就知道病在少阴经。心烦腹满，生殖器收缩，就知道病在厥阴经。然后切脉以辨别病在表还是在里，是虚还是实，从而决定用发汗或泻下的方法。古人所以说，通过询问而知晓的是中等水平的医生，通过切脉而知晓的是低水平的医生。如果对经络支络茫然不分，按寸口尺口，随意猜测疾病，哪里懂得那些坐在明堂、收藏金兰秘籍的人呢？
足太阳膀胱经
风府穴：两旁各一，从此分为四道
膀胱：重九两二铢，纵长广九寸，盛尿九升九合
委中穴：即膝盖后方弯曲处的穴位
足太阳膀胱经。（肾与膀胱相合，所以足少阴肾经与足太阳膀胱经互为表里）从目内眦上行至头部连接于风府穴，分为四道，下行至颈部并正别脉上下六道行于背部，与身体构成经脉。太阳经为诸阳主气。如果中受寒邪，必定发热且恶寒。因为头项腰脊是太阳经经过的地方。现在头项痛，身体疼，腰脊强直，其脉尺寸俱浮，所以知道是太阳经受病。（《灵枢经》说：足太阳脉起于目内眦，上额交巅，其支者，从巅至耳上角，其直者，从巅入络脑，还出别下项，循肩髆内挟脊，抵腰中，入循膂，络肾，属膀胱。其支者，从腰中，下挟脊贯臀入腘中，其支者，从腘内左右别下贯胛，挟脊内，过髀枢，循髀外廉，从膝下合腘中，以下贯腨内，出外踝之后，循京骨，至小趾外侧）
足阳明胃经
大迎穴：在曲颔前一寸一分骨陷中的动脉处，又以口下当两肩的位置取之
承浆穴：在下唇下方的凹陷处
人迎穴：在结喉旁一寸五分，动脉应手处
缺盆穴：一名天盖，在肩下横骨凹陷处
胃：重二斤十四两，盛谷二斗，水一斗五升，为水谷之海
脾：络脾
伏兔穴：在膝上六寸起内侧，一说是在膝盖上七寸
髀关穴：在膝上伏兔后方的交分处
气冲穴：在归来穴下鼠鼷上一寸的动脉处，又说在阴毛两旁
下膝三寸处正是足三里穴的下部，三里穴在膝下三寸
足阳明胃经。（脾与胃相合，所以足太阴脾经与足阳明胃经互为表里）从鼻起挟于鼻，络于目，下咽分为四道，并正别脉六道上下行于腹部纲维于身。盖诸阳在表，阳明主肌肉，络于鼻，所以病患身体发热，眼睛疼痛，鼻子干燥，不能安卧，其脉尺寸俱长，知道是阳明经受病。
（《灵枢经》说：足阳明之脉，起于鼻交頞中，旁约太阳之脉，下循鼻外，入上齿中，还出挟口，环唇，下交承浆，却循颐后下廉，出大迎，循颊车，上耳前，过客主人，循发际，至额颅。其支者，从大迎前下人迎，循喉咙，入缺盆，下膈属胃络脾。其直者从缺盆下乳内廉，下挟脐，入气冲中。其支者，起胃口下循腹里，下至气冲中而合，以下髀关，抵伏兔，下膝膑中，下循胫外廉，下足跗，入中趾内间。其支者，下廉三寸而别，以下入中趾外间。其支者，别跗上，入大趾间，出其端）
足少阳胆经
气冲穴：在阴毛两旁，动脉应手处
胆：在肝之短叶间，重三两三铢，盛精汁三合
足少阳胆经。（肝与胆相合，所以足厥阴肝经与足少阳胆经互为表里）起于目外眦，络于耳，遂分为四道，下缺盆，循于胁并正别脉六道上下主经营百节流气三部。所以病患胸胁痛而耳聋。（《黄帝针经》说：邪在肝则两胁痛，又说：胆胀者胁下痛，口中苦，善太息）或者口苦咽干，或者忽冷忽热而呕吐，其脉尺寸俱弦，知道是少阳经受病。
（《灵枢经》说：足经少阳之脉，起于目锐眦，上抵头角下耳后，循颈，行手少阳之前，至肩上，却交出手少阳之后，入缺盆。其支者，从耳下入耳中，出走耳前，至目锐眦后。其支者，别锐眦，下大迎，合手少阳抵于䪼下，加颊车下颈，合缺盆以下胸中，贯膈络肝属胆，循胁里，出气冲，绕毛际，入髀厌中。其直者，从缺盆下腋，循胸中，过季胁，下合髀厌中，以下循髀阳出膝之廉下，外辅骨之前，直下抵绝骨之端，下出外踝之前，循足跗上，出小趾次趾之端。其支别者，从跗上，入大趾，循岐骨内出其端）
足太阴脾经
舌本：舌根也
咽门：重十两，为胃之系
胃：络胃
脾：重二斤三两，象马蹄，内色白，胃脘象土形也，经络之气交归于中以营运真灵之气，意之舍也
上循膝股内前廉
足太阴脾经，为三阴之首，其脉布于脾胃，络于嗌喉，所以病患腹部胀满而咽喉干燥，尺寸脉俱沉细，知道是太阴经受病。
《灵枢经》说：足太阴之脉，起于大趾之端，循趾内侧白肉际，过核骨后，上内踝前廉，上腨内循胫骨后，交出厥阴之前，上循膝股内前廉，入腹属脾络胃，上膈，挟咽，连舌本，散舌下。其支者，复从胃别上膈，注心中。
足少阴肾经
肾脏：有二形如红豆相并而曲，附于膂筋外，有脂裹，里白表黑，主藏精。
足少阴肾经，其脉起于小趾之下，斜趣足心，别行者，入跟中，上至股内后廉，贯肾络膀胱。直行者，从肾上贯肝膈，入肺中，系舌本。伤寒热气入于脏，流于少阴之经，少阴主肾，肾恶燥，所以渴而引饮。又经发汗吐下以后，脏腑空虚，津液枯竭，肾有余热亦渴，所以病患口燥舌干而渴，其脉尺寸俱沉，知道是少阴经受病。
《灵枢经》说：足少阴之脉起于小趾之下，斜趣足心，出于然骨之下，循内踝之后，别入跟中，以上腨内，出内廉，上股内后廉，贯脊属肾络膀胱。其直者，从肾上贯肝膈，入肺中，循喉咙，挟舌本。其支者，从肺出络心，注胸中。
足厥阴肝经
上腨内廉。
循足跗上廉。
巅：顶上曰巅。
颃颡者：悬雍两旁肉也，又《灵枢经》曰颃颡者分气之泄。
肝：重四斤四两有七，布叶一叶小如木甲拆之象也，各有支络脉进中以宦发阳和之气，魏之宫也
足厥阴肝经，厥者，尽也。《灵枢》说：亥为左足之厥阴，戌为右足之厥阴，两阴俱尽，故曰厥阴。夫阴尽为晦，阴出为朔，厥阴者，以阴尽为义也。其脉循阴器而脉络于舌本也。脉弗营则筋急，筋急则引舌与卵，所以唇青舌卷而卵缩。凡病患烦满而囊缩，其尺寸俱微缓，知道是厥阴经受病。
（《灵枢经》说：足厥阴之脉，起于大趾丛毛之际，上循足跗上廉，去内踝一寸，上踝八寸，交出太阴之后，上腨内廉，循股阴，入毛中，环阴器，抵小腹，挟胃属肝络胆，上贯膈，布胁肋，循喉咙之后，上入颃颡，连目系，上出额，与督脉会于巅。其支者，从目系下颊里，环唇内。其支者，复从肝别贯膈，上注肺中）
（一）问：患伤寒一二日，发热恶寒，头项痛，腰脊强，尺寸脉俱浮。
这是足太阳膀胱经受病。（张仲景说：太阳病欲解时，从巳至未上）太阳病头疼发热，汗出恶风，宜用桂枝汤。（正方一）轻症，只给柴胡桂枝汤（正方三十一）。太阳病头痛发热无汗恶寒，宜用麻黄汤。（正方二十）轻症只给桂枝麻黄各半汤。（正方二）麻黄汤、桂枝汤，二者均为解散之法，正分阴阳，不可不慎。张仲景所谓无汗不得服桂枝，有汗不得服麻黄，常须识此，勿令误也。现在的人一见身热头痛，就发汗，不知道汗孔闭而用麻黄，汗孔疏而用桂枝。伤寒伤风，其治不同。古人说有汗者当解肌，无汗者可发汗。
（二）问：患伤寒二三日，身热目疼鼻干，不得卧，尺寸脉俱长。
这是足阳明胃经受病。（张仲景说：阳明病欲解时，从申至戌上）伤寒二日，阳明经受病，可发其汗，非正阳明也。（正阳明者，身热汗出不恶寒，反恶热，故可下也）现在说一二日传阳明经，身热目疼，鼻干不得卧，其脉俱长者，是太阳阳明可表而已。若无汗尚恶寒，宜用升麻汤。（杂方）有汗微恶寒者，表未解也，宜用桂枝汤。（正方一）无汗脉浮，其人喘者，与麻黄汤。（正方二十）○又问十二经皆一，而阳明有三，何也？有太阳阳明，有少阳阳明，有正阳阳明也。太阳阳明者，本太阳病，若发汗若下若利小便，此亡津液，胃中干燥，因转属阳明也。（太阳阳明，脾约是也，大便坚，小便利，其脾为约）少阳阳明者，本传到少阳，因发汗利小便已，胃中燥实，大便难也。正阳阳明者，病人本风盛气实也。三阳明俱宜下，唯恶寒乃中寒为病在经，与太阳合病，属表，可发其汗。盖太阳与阳明合病，脉必浮大而长，外证必头疼腰痛肌热目痛鼻干也。脉浮大者，太阳也。长者，阳明也。头疼腰痛者，太阳也。肌热目痛鼻干者，阳明也。尚恶寒者，可升麻汤（杂方一）汗之。若不恶寒反恶热，大便不秘者，可白虎汤（正方六十四）解利之。不恶寒反恶热，大便秘，或谵语者，属胃家实也，可调胃承气汤下之。（正四十三）○又问三阳有合病，有并病，何也？脉浮大而长，头疼腰痛肌热目疼鼻干者，合病也。太阳初得病时，发其汗，汗先出不彻，因转属阳明，续自微汗出，不恶寒者，并病也。三阳皆有合病，唯三阴无合病，不可不知也。太阳证罢，但发潮热，手足濈然汗出，大便难而谵语者下之愈，宜大承气汤。（正四十一）若太阳证不罢，不可下，宜用桂枝麻黄各半汤（正方二）小发汗。设面赤色者，阳气怫郁在表，当解之熏之。若发汗不大彻，则阳气怫郁，不得越散，当汗不汗，烦躁不知痛处，其人短气但坐，盖以汗出不彻故也。更以麻黄汤发其汗则愈。何以知汗出不彻，以脉涩故知之。
（三）问：患伤寒三四日，胸胁痛而耳聋，或口苦舌干，或往来寒热而呕，其尺寸脉俱弦。
这是足少阳胆经受病。（张仲景说：少阳病欲解时，从寅至辰上）太阳病不解，转入少阳，胁下硬满，干呕不能食，往来寒热，尚未可吐下，诊其脉弦紧者，小柴胡汤主之。（正方二十九）盖脉弦细头疼发热属少阳，少阳受病，口苦咽干目眩，宜小柴胡汤以解表，不可发汗。（张仲景少阳证唯小柴胡为解表药耳）发汗则谵语，谵语属胃，胃和则愈，不和则烦而燥，宜调胃承气汤（正四三），此属少阳阳明也。
（四）问：患伤寒四五日，腹满咽干，手足自温，或自利不渴，或腹满时痛，尺寸俱沉细。
这是足太阴脾经受病。（张仲景说：太阴病欲解时，从亥至丑上）伤寒手足必微冷，若手足自温者，系太阴也。自利不渴，属太阴也。腹满时痛，属太阴也。自利不渴者脏寒也，当温之，宜四逆汤、（正方七十五）理中汤也。（正方七十四）腹满脉浮者，可桂枝（正方一）微发汗。腹痛者，桂枝加芍药汤。（正十二）痛甚者，桂枝加大黄汤。（正十三）○古人以四日太阴证病在胸膈，可吐而愈何也？答曰：不然。有太阴证脉大胸满多痰者，可吐之。脉大而无吐证者，可汗而已。大抵在表者汗之，在里者下之，在上者涌之，在下者泄之。瓜蒂（正百十一）、栀豉（杂十九）随证施用，不可拘以日数也。
（五）问：患伤寒五六日，尺寸脉俱沉，或口燥舌干而渴，或口中和而恶寒。
这是足少阴肾经受病。（张仲景说：少阴病欲解时，从子至寅上）少阴病口燥舌干者，急下之，宜大承气汤。（正四十一）若不渴，不口燥舌干而脉沉者，急温之，宜四逆汤。（正方七十五）太阴厥阴皆不恶寒只有少阴有恶寒之证，不可不知也。少阴病得之一二日，口中和，其背恶寒者，宜着灸并附子汤也。大抵伤寒阳明证宜下，少阴证宜温。然张仲景于少阴证口燥咽干即云急下之，盖少阴主肾，系舌本，伤寒热气入于脏，流于少阴之经，肾汁干，咽路焦，故口燥咽干而渴，须宜急下之，非若阳明证宜下而可缓也。虽然，阳明亦有一证，发热汗出多，急下之。阳明属胃，汗多则胃汁干，亦须急下也。
（六）问：患伤寒六七日，烦满囊缩，其脉尺寸俱微缓。
这是足厥阴肝经受病。（张仲景说：厥阴病欲解时，从丑至卯上）厥阴病其脉微浮为欲愈，不浮为未愈，宜小建中汤。（正三十七）
脉浮缓者，必囊不缩，外证必发热恶寒似疟，为欲愈，宜桂枝麻黄各半汤。（正方二）若尺寸脉俱沉短者，必是囊缩毒瓦斯入脏，宜承气汤下之。（正方四十二）○大抵伤寒病脏腑传变，阳经先受病，故次第传入阴经，以阳主生，故太阳水传足阳明土，土传足少阳木，为微邪也。阴主杀，故木传足太阴土，土传足少阴水，水传足厥阴木，至六七日当传厥阴肝木，必移气克于脾土，脾再受贼邪，则五脏六腑皆困而危殆，营卫不通，耳聋囊缩，不知人而死矣。速用承气汤下之，可保五死一生。古人云：脾热病则五脏危，又云：土败木贼则死。若第六七日传厥阴，脉得微缓微浮，为脾胃脉也，故知脾气全，不再受克，邪无所容，痞极泰来，营卫将复，水升火降，则寒热作而大汗解矣。
This volume discusses the meridians. In treating cold damage (Shanghan), one must first understand the meridians. Without understanding the meridians, one wanders blindly without knowing where the pathogenic qi resides. Often, when the disease is in the Taiyang meridian, treatment is mistakenly directed at the Shaoyin meridian; when the syndrome belongs to the Jueyin meridian, treatment is wrongly applied to harmonize the Shaoyang meridian. The cold pathogen remains unremoved, and the true qi suffers damage. Moreover, cold damage diagnosis relies heavily on external signs; questioning the patient before pulse-taking is the most accurate method. Sun Simiao said, "Diagnosing through inquiry and distinguishing the depth of the disease is called a skillful physician." If patients report fever and aversion to cold, headache and stiffness of the head and neck, and stiffness of the lower back and spine, we know the disease is in the Taiyang meridian. If they report body heat, eye pain, nasal dryness, and inability to lie down, we know the disease is in the Yangming meridian. If they report hypochondriac pain, deafness, bitter taste in the mouth, dry tongue, alternating chills and fever, and vomiting, we know the disease is in the Shaoyang meridian. If they report abdominal fullness, dry throat, naturally warm hands and feet, or spontaneous diarrhea without thirst, or abdominal fullness with intermittent pain, we know the disease is in the Taiyin meridian. If they report desire to drink but aversion to cold, or dry mouth and tongue, we know the disease is in the Shaoyin meridian. If they report irritability, abdominal fullness, and retraction of the genitals, we know the disease is in the Jueyin meridian. Then, by taking the pulse, we distinguish whether the disease is in the exterior or interior, whether it is deficiency or excess, and decide whether to use sweating or purging methods. The ancients said that diagnosing through inquiry makes one an average practitioner, while diagnosing through pulse-taking makes one a lower-level practitioner. If one is ignorant of the branching collaterals of the meridians, arbitrarily guessing diseases by pressing the Cun and Chi positions, how could one understand those who sit in the bright hall and guard the golden orchid secrets?
Foot-Taiyang Bladder Meridian
Fengfu (DU16) Acupoint: One on each side, dividing into four channels from here.
Bladder: Weighs nine taels and two zhu, nine cun long and wide, holds nine sheng and nine he of urine.
Weizhong (BL40) Acupoint: Refers to the acupoint in the center of the popliteal crease behind the knee.
Foot-Taiyang Bladder Meridian. (The Kidney and Bladder are internally-externally related, so the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian are paired as interior-exterior.) It starts from the inner canthus of the eye, ascends to the head, connects to the Fengfu point, and divides into four channels. It descends to the nape of the neck and runs along the back via six main and branch channels. The Taiyang meridian governs the qi of all yang meridians. If struck by cold pathogen, it inevitably causes fever and aversion to cold. This is because the head, neck, waist, and spine are areas traversed by the Taiyang meridian. Now, with headache, body ache, stiff spine, and floating pulses at both Cun and Chi positions, we know the Taiyang meridian is affected. (*Ling Shu* states: The Foot-Taiyang meridian originates at the inner canthus, crosses the vertex, its branch goes from the vertex to the supraorbital ridge; its straight branch enters the brain from the vertex, emerges, descends separately to the nape, follows the shoulder blade, runs inside the paraspinal muscles to the waist, enters to connect with the intestines, and attaches to the bladder. Its branch from the waist descends alongside the spine through the buttocks into the popliteal fossa; another branch separates inside the popliteal fossa, passes through the scapula, runs inside the spine, crosses the hip joint, follows the lateral aspect of the thigh, meets in the popliteal fossa, descends through the calf muscle, exits behind the lateral malleolus, follows the Jinggu point, to the lateral side of the little toe.)
Foot-Yangming Stomach Meridian
Daying (ST5) Acupoint: Located one cun and one fen anterior to the angle of the jaw in the bony depression where the artery beats; also found below the mouth opposite the shoulders.
Chengjiang (CV24) Acupoint: Located in the depression below the lower lip.
Renying (ST9) Acupoint: Located one cun and five fen lateral to the laryngeal prominence, where the arterial pulse is palpable.
Quepen (ST12) Acupoint: Also known as Tiangai, located in the depression below the clavicle.
Stomach: Weighs two jin and fourteen liang, holds two dou of grain and one dou five sheng of water; it is the sea of water and grain.
Spleen: Connects to the spleen.
Futu (ST32) Acupoint: Located six cun above the knee on the medial side; some say seven cun above the knee.
Biguan (ST31) Acupoint: Located in the junction posterior to Futu above the knee.
Qichong (ST30) Acupoint: Located one cun above the inguinal ligament (Shuxi) under Guilai, where the artery beats; also described as on both sides of the pubic hair.
Below the knee, three cun down is the location of Zusanli (ST36); Zusanli is three cun below the knee.
Foot-Yangming Stomach Meridian. (The Spleen and Stomach are internally-externally related, so the Foot-Taiyin Spleen Meridian and Foot-Yangming Stomach Meridian are paired as interior-exterior.) It starts from the nose, flanks the nose, connects to the eyes, descends to the pharynx, and divides into four channels. Along with six main and branch channels, it runs up and down the abdomen, governing the body. Since all yang meridians are in the exterior, and Yangming governs the muscles and connects to the nose, patients present with body heat, eye pain, nasal dryness, and inability to lie down. With long pulses at both Cun and Chi positions, we know the Yangming meridian is affected.
(*Ling Shu* states: The Foot-Yangming meridian originates at the nose, crossing the bridge of the nose, adjacent to the Taiyang meridian, descending along the lateral nose, entering the upper gums, emerging to flank the mouth, encircling the lips, crossing Chengjiang, following the mandible behind the chin, exiting Daying, following Jiache, ascending anterior to the ear, passing Guest Master, following the hairline to the forehead. Its branch from Daying descends to Renying, follows the throat, enters Quepen, descends through the diaphragm, attaches to the stomach, and connects to the spleen. Its straight branch from Quepen descends along the medial breast, flanks the umbilicus, enters Qichong. Its branch starts from the stomach, descends inside the abdomen, meets Qichong, then descends to Biguan, reaches Futu, goes below the kneecap, follows the lateral tibia, descends to the dorsum of the foot, and enters between the toes of the second digit. Another branch separates three cun below the knee, enters between the toes of the second digit. Another branch separates on the dorsum of the foot, enters between the big toes, and emerges at their ends.)
Foot-Shaoyang Gallbladder Meridian
Qichong (ST30) Acupoint: On both sides of the pubic hair, where the arterial pulse is palpable.
Gallbladder: Located between the short lobes of the liver, weighs three taels and three zhu, holds three he of bile juice.
Foot-Shaoyang Gallbladder Meridian. (The Liver and Gallbladder are internally-externally related, so the Foot-Jueyin Liver Meridian and Foot-Shaoyang Gallbladder Meridian are paired as interior-exterior.) It originates at the outer canthus of the eye, connects to the ear, and divides into four channels. It descends to Quepen, follows the hypochondrium, and with six main and branch channels, manages the flow of qi in the three jiao. Thus, patients present with hypochondriac pain and deafness. (*Huang Di Zhen Jing* states: Pathogens in the liver cause pain in both hypochondria; also: Gallbladder distension causes pain under the hypochondrium, bitter taste in the mouth, and frequent sighing.) Or there may be bitter taste and dry throat, or alternating chills and fever with vomiting. With wiry pulses at both Cun and Chi positions, we know the Shaoyang meridian is affected.
(*Ling Shu* states: The Foot-Shaoyang meridian originates at the outer canthus, ascends to the corner of the head, descends behind the ear, follows the neck, runs anterior to the Hand-Shaoyang meridian, reaches the shoulder, crosses behind the Hand-Shaoyang meridian, enters Quepen. Its branch descends from behind the ear into the ear, emerges anterior to the ear, and reaches the outer canthus. Another branch separates from the outer canthus, descends to Daying, merges with the Hand-Shaoyang at the cheekbone, descends the neck, merges with Quepen, descends into the chest, pierces the diaphragm, connects to the liver, attaches to the gallbladder, follows the hypochondrium, exits Qichong, surrounds the pubic region, and enters the hip joint. Its straight branch from Quepen descends into the axilla, follows the chest, passes the costal margin, merges with the hip joint, follows the lateral thigh, exits the lateral knee, runs anterior to the fibula, descends to the end of the fibula, exits anterior to the lateral malleolus, follows the dorsum of the foot, and emerges at the tip of the fourth toe. A separate branch from the dorsum of the foot enters the big toe, follows the interosseous space, and emerges at its end.)
Foot-Taiyin Spleen Meridian
Root of the Tongue: Refers to the base of the tongue.
Gate of the Pharynx: Weighs ten liang, serves as the connection to the stomach.
Stomach: Connects to the stomach.
Spleen: Weighs two jin and three liang, shaped like a horse's hoof, white inside; the stomach cavity resembles earth. The qi of the meridians converges in the center to circulate the vital spirit qi; it is the residence of intention.
Ascends along the anterior medial aspect of the thigh.
Foot-Taiyin Spleen Meridian is the chief of the three yin meridians. Its vessels distribute to the spleen and stomach and connect to the pharynx. Thus, patients present with abdominal fullness and dry throat. With deep and fine pulses at both Cun and Chi positions, we know the Taiyin meridian is affected.
*Ling Shu* states: The Foot-Taiyin meridian originates at the tip of the great toe, follows the medial white skin margin of the toe, passes behind the metatarsophalangeal joint, ascends anterior to the medial malleolus, ascends along the medial calf bone, crosses anterior to the Jueyin meridian, ascends along the anterior medial thigh, enters the abdomen, attaches to the spleen, connects to the stomach, pierces the diaphragm, flanks the pharynx, connects to the root of the tongue, and spreads under the tongue. Its branch separates from the stomach, ascends through the diaphragm, and pours into the heart.
Foot-Shaoyin Kidney Meridian
Kidneys: Two in number, resembling red beans joined and curved, attached outside the spinal muscles, wrapped in fat, white inside and black outside, responsible for storing essence.
Foot-Shaoyin Kidney Meridian. Its vessel originates below the little toe, slants towards the sole of the foot. The divergent branch enters the heel, ascends to the posterior medial thigh, pierces the kidney, and connects to the bladder. The straight branch ascends from the kidney through the liver and diaphragm, enters the lungs, and connects to the root of the tongue. When heat pathogens enter the zang organs and flow into the Shaoyin meridian, since Shaoyin governs the kidney, and the kidney dislikes dryness, thirst and desire to drink occur. Furthermore, after sweating, vomiting, or purging, the zang-fu become empty and fluids depleted; residual heat in the kidney also causes thirst. Thus, patients present with dry mouth and tongue and thirst. With deep pulses at both Cun and Chi positions, we know the Shaoyin meridian is affected.
*Ling Shu* states: The Foot-Shaoyin meridian originates below the little toe, slants towards the sole, emerges below RanGu, follows posterior to the medial malleolus, diverges into the heel, ascends along the medial calf, emerges at the medial leg, ascends the posterior medial thigh, pierces the spine, attaches to the kidney, and connects to the bladder. Its straight branch ascends from the kidney through the liver and diaphragm, enters the lungs, follows the throat, and flanks the root of the tongue. Its branch emerges from the lungs, connects to the heart, and pours into the chest.
Foot-Jueyin Liver Meridian
Ascends along the medial calf.
Follows the lateral dorsum of the foot.
Dian: The top of the head is called Dian.
Hangsang: The fleshy parts on both sides of the uvula. *Ling Shu* states: Hangsang is the outlet for distributing qi.
Liver: Weighs four jin, four liang, and seven qian, with lobes resembling split wooden armor; each has branch vessels advancing inward to emit yang-harmonizing qi; it is the palace of Wei.
Foot-Jueyin Liver Meridian. Jue means "end." *Ling Shu* states: Hai corresponds to the left Foot-Jueyin, Xu to the right Foot-Jueyin. When both yins end, it is called Jueyin. The end of yin is darkness (Hui), and the emergence of yin is the new moon (Shuo). Jueyin signifies the end of yin. Its vessel circles the genitalia and connects to the root of the tongue. If the vessel does not nourish, tendons become tight; tight tendons pull the tongue and testicles, causing blue lips, curled tongue, and retracted genitals. Whenever patients present with irritability, abdominal fullness, and retracted scrotum, with slightly slow pulses at both Cun and Chi positions, we know the Jueyin meridian is affected.
(*Ling Shu* states: The Foot-Jueyin meridian originates at the pubic hair on the great toe, ascends along the lateral dorsum of the foot, one cun from the medial malleolus, eight cun above the ankle, crosses posterior to the Taiyin meridian, ascends the medial calf, follows the medial thigh, enters the pubic region, circles the genitalia, reaches the lower abdomen, flanks the stomach, attaches to the liver, connects to the gallbladder, pierces the diaphragm, distributes in the hypochondrium, follows the posterior throat, enters Hangsang, connects to the eye system, ascends to the forehead, and meets the Du meridian at the vertex. Its branch from the eye system descends into the cheek, circles inside the lips. Another branch separates from the liver, pierces the diaphragm, and pours into the lungs.)
(1) Inquiry: On the first or second day of cold damage, with fever, aversion to cold, headache, stiff neck and spine, and floating pulses at both Cun and Chi positions.
This is disease of the Foot-Taiyang Bladder Meridian. (Zhang Zhongjing stated: The time for Taiyang disease to resolve is from Si to Wei hours.) For Taiyang disease with headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is indicated. (Formula 1) For mild cases, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is given alone. (Formula 31) For Taiyang disease with headache, fever, no sweating, and aversion to cold, Mahuang Tang (Ephedra Decoction) is indicated. (Formula 20) For mild cases, Guizhi Mahuang Ge Ban Tang (Equal Half Dose of Cinnamon Twig and Ephedra Decoction) is given alone. (Formula 2) Both Mahuang Tang and Guizhi Tang are dispersing formulas, correctly distinguishing yin and yang; caution is essential. Zhang Zhongjing said, "Those without sweat should not take Guizhi Tang; those with sweat should not take Mahuang Tang." Always remember this to avoid errors. Nowadays, people see fever and headache and immediately induce sweating, failing to recognize that closed pores require Mahuang, while open pores require Guizhi. The treatments for cold damage and wind strike differ. The ancients said: For those with sweat, release the muscles; for those without sweat, induce sweating.
(2) Inquiry: On the second or third day of cold damage, with body heat, eye pain, nasal dryness, inability to lie down, and long pulses at both Cun and Chi positions.
This is disease of the Foot-Yangming Stomach Meridian. (Zhang Zhongjing stated: The time for Yangming disease to resolve is from Shen to Xu hours.) On the second day of cold damage, if the Yangming meridian is affected, sweating may be induced, but this is not Zheng Yangming (True Yangming). (Zheng Yangming presents with body heat, sweating, aversion to heat rather than cold, thus purging is appropriate.) Now, stating that transmission to the Yangming meridian occurs on days one or two, with body heat, eye pain, nasal dryness, and inability to lie down, and long pulses, this is Taiyang-Yangming which can be treated by releasing the exterior. If there is no sweat and aversion to cold persists, Shengma Tang (Cimicifuga Decoction) is indicated. (Miscellaneous Formula) If there is sweat and slight aversion to cold, the exterior is unresolved, and Guizhi Tang is indicated. (Formula 1) If there is no sweat, floating pulse, and wheezing, Mahuang Tang is given. (Formula 20) ○ Further inquiry: Why are there three types of Yangming among the twelve meridians? There is Taiyang-Yangming, Shaoyang-Yangming, and Zheng Yangming. Taiyang-Yangming arises when a primary Taiyang disease, due to sweating, purging, or diuresis, depletes fluids, causing dryness in the stomach, leading to transmission to Yangming. (Taiyang-Yangming involves constipation with easy urination, termed "Spleen Confinement.") Shaoyang-Yangming arises when transmission to Shaoyang is followed by sweating and diuresis, causing dryness and excess in the stomach and difficulty in defecation. Zheng Yangming arises when the patient originally has abundant wind and strong qi. All three Yangming types generally require purging, except when aversion to cold indicates cold pathogen in the meridian combined with Taiyang, which belongs to the exterior and requires sweating. Generally, Taiyang-Yangming combination presents with large and long pulses, and external signs of headache, backache, muscle heat, eye pain, and nasal dryness. Large pulses indicate Taiyang; long pulses indicate Yangming. Headache and backache indicate Taiyang; muscle heat, eye pain, and nasal dryness indicate Yangming. If aversion to cold persists, Shengma Tang induces sweating. If there is no aversion to cold but aversion to heat, and stool is not constipated, Baihu Tang (White Tiger Decoction) resolves and benefits. If there is no aversion to cold but aversion to heat, constipation, or delirium, it belongs to Stomach Excess, and Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Magnolia Bark Decoction) is used to purge. (Formula 43) ○ Further inquiry: What is the difference between He Bing (Combined Disease) and Bing Bing (Concurrent Disease) in the three yang meridians? Pulse large and long, with headache, backache, muscle heat, eye pain, and nasal dryness constitutes He Bing. When Taiyang disease is first acquired, sweating is induced, but the sweat is incomplete, leading to transmission to Yangming, followed by slight spontaneous sweating and absence of aversion to cold, this is Bing Bing. All three yang meridians have He Bing, but the three yin meridians do not; this must be known. When Taiyang symptoms cease, only tidal fever, continuous sweating on hands and feet, difficult defecation, and delirium remain, purging cures it; Dachengqi Tang (Major Order the Qi Decoction) is indicated. (Formula 41) If Taiyang symptoms persist, purging is contraindicated; instead, Guizhi Mahuang Ge Ban Tang induces slight sweating. If the face is red, yang qi is constrained in the exterior; it should be resolved using fumigation. If sweating is incomplete, yang qi is constrained and cannot disperse; failure to sweat causes restlessness, unknown pain locations, shortness of breath, and sitting posture, due to incomplete sweating. Re-administering Mahuang Tang to induce sweating cures it. How do we know sweating was incomplete? By the choppy pulse.
(3) Inquiry: On the third or fourth day of cold damage, with hypochondriac pain and deafness, or bitter taste and dry tongue, or alternating chills and fever with vomiting, and wiry pulses at both Cun and Chi positions.
This is disease of the Foot-Shaoyang Gallbladder Meridian. (Zhang Zhongjing stated: The time for Shaoyang disease to resolve is from Yin to Chen hours.) If Taiyang disease does not resolve and transfers to Shaoyang, with hardness and fullness under the hypochondrium, dry retching, inability to eat, and alternating chills and fever, emesis and purging are not yet appropriate. If the pulse is wiry and tight, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula. (Formula 29) Wiry-thin pulse, headache, and fever belong to Shaoyang. When Shaoyang is affected, with bitter taste, dry throat, and vertigo, Xiaochaihu Tang releases the exterior; sweating is contraindicated. (Among Zhang Zhongjing's Shaoyang formulas, only Xiaochaihu Tang releases the exterior.) Inducing sweating causes delirium; delirium belongs to the stomach. If the stomach harmonizes, recovery occurs; if not, irritability and restlessness ensue, and Tiaowei Chengqi Tang is indicated. This belongs to Shaoyang-Yangming.
(4) Inquiry: On the fourth or fifth day of cold damage, with abdominal fullness, dry throat, naturally warm hands and feet, or spontaneous diarrhea without thirst, or abdominal fullness with intermittent pain, and deep, fine pulses at both Cun and Chi positions.
This is disease of the Foot-Taiyin Spleen Meridian. (Zhang Zhongjing stated: The time for Taiyin disease to resolve is from Hai to Chou hours.) In cold damage, hands and feet are usually slightly cold; if naturally warm, it relates to Taiyin. Spontaneous diarrhea without thirst belongs to Taiyin. Abdominal fullness with intermittent pain belongs to Taiyin. Spontaneous diarrhea without thirst indicates cold in the zang organs; warming is required. Sini Tang (Frigid Extremities Decoction) and Lizhong Tang (Regulate the Middle Decoction) are indicated. (Formulas 75 and 74) If abdominal fullness is accompanied by a floating pulse, Guizhi Tang induces slight sweating. (Formula 1) For abdominal pain, Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony) is indicated. (Formula 12) For severe pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb) is indicated. (Formula 13) ○ The ancients asked why Taiyin disease on the fourth day, located in the chest and diaphragm, could be cured by emesis. The answer is: Not so. For Taiyin syndrome with large pulse, chest fullness, and much phlegm, emesis is appropriate. For large pulse without emesis indications, sweating suffices. Generally, exterior conditions are treated by sweating, interior by purging, upper by inducing vomiting, and lower by draining. Genti (Thistle Fruit) and Zhichi (Gardenia and Fermented Soybean Decoction) are used according to the syndrome, not restricted by days.
(5) Inquiry: On the fifth or sixth day of cold damage, with deep pulses at both Cun and Chi positions, or dry mouth and tongue with thirst, or neutral taste in the mouth with aversion to cold.
This is disease of the Foot-Shaoyin Kidney Meridian. (Zhang Zhongjing stated: The time for Shaoyin disease to resolve is from Zi to Yin hours.) For Shaoyin disease with dry mouth and tongue, urgent purging is required; Dachengqi Tang is indicated. (Formula 41) If there is no thirst, no dry mouth and tongue, but a deep pulse, urgent warming is required; Sini Tang is indicated. (Formula 75) Taiyin and Jueyin do not present with aversion to cold; only Shaoyin does. This must be known. For Shaoyin disease acquired within one or two days, with neutral taste in the mouth and aversion to cold on the back, moxibustion and Fuzi Tang (Aconite Decoction) are indicated. Generally, Yangming cold damage requires purging, while Shaoyin requires warming. However, Zhang Zhongjing stated that for Shaoyin disease with dry mouth and throat, urgent purging is needed. This is because Shaoyin governs the kidney and connects to the root of the tongue; when heat pathogens enter the zang and flow into the Shaoyin meridian, kidney fluids dry up, and the throat scorches, causing dry mouth, throat, and thirst. Urgent purging is necessary, unlike Yangming where purging can be delayed. Although, Yangming also has a condition: fever with profuse sweating requires urgent purging. Yangming belongs to the stomach; profuse sweating dries stomach fluids, requiring urgent purging.
(6) Inquiry: On the sixth or seventh day of cold damage, with irritability, abdominal fullness, and retracted genitals, with slightly slow pulses at both Cun and Chi positions.
This is disease of the Foot-Jueyin Liver Meridian. (Zhang Zhongjing stated: The time for Jueyin disease to resolve is from Chou to Mao hours.) For Jueyin disease, a slightly floating pulse indicates impending recovery; non-floating indicates no recovery. Xiaojianzhong Tang (Minor Construct the Middle Decoction) is indicated. (Formula 37)
If the pulse is floating and slow, the genitals will not retract; external signs include fever and aversion to cold resembling malaria, indicating impending recovery. Guizhi Mahuang Ge Ban Tang is indicated. (Formula 2) If both Cun and Chi pulses are deep and short, the retracted genitals indicate toxin entering the zang organs; Chengqi Tang is used to purge. (Formula 42) ○ Generally, in cold damage, the zang-fu transmit sequentially; yang meridians are affected first, then transmitted to yin meridians. Since yang governs life, Taiyang Water transmits to Foot-Yangming Earth, and Earth transmits to Foot-Shaoyang Wood, representing minor pathogens. Yin governs killing; thus Wood transmits to Foot-Taiyin Earth, Earth to Foot-Shaoyin Water, and Water to Foot-Jueyin Wood. By the sixth or seventh day, transmission reaches Jueyin Liver Wood, whose qi necessarily overacts on Spleen Earth. If the spleen receives this thief pathogen again, the five zang and six fu become exhausted and critical, Ying and Wei circulation stops, deafness and genital retraction occur, loss of consciousness leads to death. Rapid purging with Chengqi Tang can save one in five deaths. The ancients said: Heat disease in the spleen endangers the five zang; also: Earth failure and Wood attack lead to death. If transmission to Jueyin occurs on the sixth or seventh day, and the pulse becomes slightly slow and floating, indicating Spleen-Stomach pulse, we know the spleen qi is intact and no longer subjected to overacting. The pathogen has no place to reside; extreme stagnation turns to prosperity, Ying and Wei will recover, water rises and fire descends, chills and fever arise, and recovery comes with profuse sweating.