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，即使热势很严重也不会死亡（《内经》说：风寒侵入人体，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，所以热势虽重也不致死。《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，应当在一两天内发作。风府是穴位名，位于项部中央。太阳经脉从头顶入络于脑，复出别行下项，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，因为它的经脉挟鼻络于目，所以出现身热、目痛、鼻干、不能安卧的症状（阳明经气血都很旺盛，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，应当在两三天内发作。其脉挟鼻者，阳明脉起于鼻，交于额中，络于目。阳明经主司身体的肌肉，《针经》说：阳明气盛则身体前部皆热。目痛、鼻干是因为经络中有客邪。不能安卧是因为胃气上逆，不能顺从其正常通路。《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，因为它的经脉循行胁肋络于耳，所以出现胸胁疼痛和耳聋的症状（《内经》说：阳中的少阳通应于春气，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，应当在三、四天内发作。胸胁痛和耳聋是因为经络壅塞而不通畅。高文庄本作“脉从巅入络肾还出别下项夹脊抵腰中”，凡是从太阳传至厥阴，自表入里，其汗法、下法必须依照次第。有不经过三阳而直接从少阴、太阴、厥阴发病的，详见后文，各根据本经治疗）。
这三条经都受了病，但尚未入腑的，可以通过发汗治愈（三阳受邪为病在表，依法当用汗法解表。然而三阳也有直接入腑的情况，入腑则宜用下法，所以说未入腑的可汗而解。按，“府”字在《素问》中作“藏”字，理更胜，盖府为阳，藏为阴。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，应当在四、五天内发作。邪入于阴则逐渐化热。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，所以出现口燥、舌干而渴的症状（少阴属肾水，性质趋下，少阴受病脉象尺寸俱沉。第五天太阴之邪不愈，至五、六天则传于少阴，这是少阴病应当在五、六天发作。人感受寒邪则发生热病，是说开始为寒邪，最终化为热。少阴病见口燥、舌干而渴，是邪气入里，热气渐深。《活人书》说：经文说“一二日少阴者”，是指国人患病时邪气便入少阴，不经过三阳。大抵伤寒发于阳经则是太阳，发于阴经则是少阴。凡病从一天到十二、三天，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，因为它的经脉循行阴器，络于肝，所以出现烦闷和阴囊收缩的症状（缓是风脉。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〕注：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）。
这三条经都受了病，且已入腑的，可以通过泻下治愈（三阴受邪为病在里，依法当下。然而三阴也有在经的情况，在经则宜汗，所以说已入腑的可下而解。《内经》说：临病的医生应当仔细审察。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，第一天太阳受病，随即与少阴同时发病，则出现头痛、口干、烦满而渴；第二天阳明受病，随即与太阴同时发病，则出现腹满、身热、不欲食、谵语；第三天少阳受病，随即与厥阴同时发病，则出现耳聋、阴囊收缩和四肢厥冷，水浆不进、神志昏迷的，第六天死亡。如果三阴三阳、五脏六腑都受了病，则营卫不行，脏腑不通而死（阴阳两经同时受邪，表里俱伤称为两感。因为阴阳两感，所以两证俱见。至于传经，也是阴阳两经俱传。始得病一日头痛，是太阳经；口干、烦满而渴，是少阴经。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，腹满、不欲食是太阴经。至三日，阳明传于少阳，而太阴又传于厥阴，耳聋是少阳经，阴囊收缩和四肢厥冷是厥阴经，水浆不进、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。谓三日六经俱病，营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，营卫之气俱绝，则死。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，不以自己齿序为序也）。
伤寒第一天，太阳经受病，如果脉象平静，说明不传变；如果颇欲吐，或者烦躁，脉数急，说明要传变（太阳主表，第一天则太阳受邪，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）。
伤寒二、三天，不见阳明、少阳证的，说明不传变（伤寒二、三天无阳明、少阳证，知邪不传，止在太阳经中）。
伤寒三天，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。现在反之，故知不传阴，但在阳也）。
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。解除的时间是在半夜。脉浮而解的，必然微微汗出；脉数而解的，一定能进食；脉微而解的，必然大汗出。三天后少阳脉小，说明病欲愈（论见口苦舌干）。
如果不两感于寒，且不传经、不加异气的，至第七天太阳病衰退，头痛减轻；第八天阳明病衰退，身热稍歇；第九天少阳病衰退，耳聋稍闻声音；第十天太阴病衰退，腹部胀满消退如常，则思饮食；第十一天少阴病衰退，口渴止，舌干已，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，病人精神爽慧。
太阳病头痛，至七日以上自愈的，是因为行其经尽的缘故。如果想再传经，针刺足阳明经，使不传则愈。
六、七天脉象大而大烦，口噤不言，躁扰的，必定要解病。
伤寒六、七天，没有大热，其人躁烦，这是阳去入阴的缘故。
如果过十三日以上病不间（间谓病已），尺寸脉陷下的，是大危之候。
如果更感异气，变为他病的，应当依旧坏证而治之。如果脉阴阳俱盛，重感于寒的，变为温疟（尺寸俱盛，先热后寒宜小柴胡汤，先寒后热宜加桂枝，但寒宜柴胡加桂姜汤，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，更遇于风的，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，阴脉实大的，遇温热变的，变为温毒，为病最重（温毒必发斑）。阳脉濡弱，阴脉弦紧的，更遇温气的，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，这特言其概略耳。然而其中变证不一，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。
海氏又说：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，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。
吴氏说：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。又一二日口中不和，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。
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 the human body, causing all hair follicles 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 easily cured; 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: Relun* chapter and should be studied carefully.) However, if one suffers from "Lianggan" (simultaneous infection of exterior and interior meridians) due to cold, death is inevitable (Simultaneous involvement of exterior and interior is called Lianggan).
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 channel connects to the Fengfu acupoint, leading to headache, neck stiffness, and lower back/spine rigidity (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 surface. It manifests within one or two days. Fengfu is an acupoint name located in the center of the nape. The Taiyang channel enters the brain from the vertex, emerges, descends separately along the nape, thus connecting to Fengfu. Its course runs through the shoulders and arms, parallel to the spine, 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 channel flanks the nose and connects to the eyes, leading to fever, eye pain, nasal dryness, and inability to sleep (Yangming has abundant blood and Qi; a long pulse at Cun and Chi indicates pathogens merging into Yangming with overflowing blood and Qi. If Taiyang pathology persists and transmits to Yangming, it manifests on the second or third day. The channel flanking the nose refers to the Yangming channel originating at the nose, crossing the forehead, and connecting to the eyes. Yangming governs the muscles of the body; the *Zhenjing* states: "When Yangming Qi is excessive, the anterior part of the body becomes hot." Eye pain and nasal dryness result from pathogens lodging in the channels. Inability to sleep occurs because Stomach Qi rebels and fails to follow its normal pathway. 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 channel follows the hypochondrium and connects to the ears, leading to chest and 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. Chest/hypochondriac pain and deafness result from channel obstruction and stagnation. Gao Wenzhuang's edition reads: "The pulse enters the brain from the vertex, connects to the Kidney, emerges, descends separately along 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 and directly involve Taiyin, Shaoyin, or Jueyin; see later sections for treatment based on the specific meridian).
For diseases involving these three meridians that have not yet entered the Fu organs, they can be resolved by inducing sweating (Pathogens in the Three Yang affect the exterior, so the method is sweating. However, the Three Yang can also directly enter the Fu organs; if they do, purging is indicated. Hence, "not yet entering the Fu organs" implies sweating. Note: The character "Fu" (Organ) in the *Suwen* is written as "Zang" (Viscera); this is logically superior as Fu is Yang and Zang is 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 channel spreads in the Stomach and connects to the throat, leading to abdominal fullness and dry throat (When Yang reaches its extreme, Yin is affected. After pathogens traverse the Three Yang, they transmit to the Yin meridians. Exterior involvement shows Yang pulses; interior involvement shows Yin pulses. Yang pathogens transmitting to Yin cause internal sinking, resulting in Taiyin disease with deep/fine pulses. Transmission from Three Yang to Taiyin occurs on days 4-5. Pathogens entering Yin gradually generate heat. Abdominal fullness and dry throat result from Spleen channel stagnation 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 channel penetrates the Kidney, connects to the Lung, and attaches to the root of the tongue, leading to dry mouth, dry tongue, and thirst (Shaoyin belongs to Kidney Water, which tends downward; Shaoyin disease presents with deep pulses at Cun and Chi. On day 5, if Taiyin pathogens persist, they transmit to Shaoyin by days 5-6. Humans injured by cold develop heat diseases, meaning cold initially transforms into heat. Dry mouth/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 without passing through the Three Yang." Generally, Shanghan manifesting in Yang meridians involves Taiyang; manifesting in Yin meridians involves Shaoyin. For illnesses lasting 1 to 12-13 days where Taiyang symptoms persist, treat Taiyang. If Shaoyin symptoms appear at onset, treat Shaoyin directly rather than starting with 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 channel follows the genitalia and connects to the Liver, leading to irritability/fullness and contraction of the scrotum (Slow is the Wind pulse. A slightly slow Jueyin pulse indicates pathogens have transmitted to Jueyin with intense heat approaching Wind characteristics. Manifestation on days 6-7 occurs because Shaoyin pathogens transmit to Jueyin. Irritation/fullness and scrotal contraction result from heat gathering internally. [Lou] notes: "Fanman" refers to lower abdominal irritation. The following text says "On day 12, Jueyin disease declines, scrotum relaxes, lower abdomen slightly descends," meaning the previous scrotal contraction now allows slight descent due to lower abdominal irritation).
For diseases involving these three meridians that have already entered the Fu organs, they can be resolved by purging (Pathogens in the Three Yin affect the interior, so the method is purging. However, Three Yin can also remain in the Jing (channels); if in the channel, sweating is indicated. Hence, "already entered the Fu organs" implies purging. The *Neijing* states: "Physicians must examine carefully." These two sentences regarding "entering Fu organs" may be misplaced from the Yangming section, as the *Suwen* states: "If all Three Yin and Three Yang, Five Zang and Six Fu are diseased, Ying and Wei cease to circulate, and Five Zang become blocked, death ensues." The Three Yin meridians utilize sweating, purging, and warming methods, not just purging).
If suffering from Lianggan (simultaneous exterior-interior cold infection):
Day 1: Taiyang is affected, simultaneously with Shaoyin, causing headache, dry mouth, irritability, fullness, and thirst.
Day 2: Yangming is affected, simultaneously with Taiyin, causing abdominal fullness, fever, anorexia, and delirious speech.
Day 3: Shaoyang is affected, simultaneously with Jueyin, causing deafness, scrotal contraction, and cold limbs. If the patient cannot ingest fluids/water and loses consciousness, death occurs on day 6.
If all Three Yin and Three Yang, Five Zang and Six Fu are affected, Ying and Wei cease to circulate, and Zang-Fu communication stops, leading to death (Simultaneous Yin-Yang disease and exterior-interior damage is called Lianggan. Both syndromes appear together. Regarding transmission, both Yin and Yang meridians transmit simultaneously. Day 1 headache is Taiyang; dry mouth/irritability/thirst is Shaoyin. By day 2, Taiyang transmits to Yangming, and Shaoyin transmits to Taiyin; fever/delirium is Yangming; abdominal fullness/anorexia is Taiyin. By day 3, Yangming transmits to Shaoyang, and Taiyin transmits to Jueyin; deafness is Shaoyang; scrotal contraction/cold limbs is Jueyin; inability to ingest fluids/unconsciousness is Stomach Qi blockage. The *Neijing* states: "After five Zang are damaged and six Fu are blocked, with Ying/Wei ceasing to circulate, death occurs three days later." Why? Qibo answers: "Yangming is the leader of the twelve meridians, with abundant blood and Qi. Unconsciousness persists for three days until its Qi is exhausted, then death occurs." By day 3, all six meridians are diseased, blocking Ying/Wei externally/internally and Zang/Fu vertically/horizontally. By day 6, Zang/Fu Qi and Ying/Wei Qi are exhausted, leading to death. Note: Taiyin can transmit to Shaoyin, but Shaoyin cannot transmit to Taiyin (reverse transmission); thus, this theory 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 ranking by husband's age, not their own).
Shanghan on Day 1: Taiyang is affected. If the pulse is quiet, transmission does not occur. If there is a desire to vomit, or restlessness/irritability with a rapid/urgent pulse, transmission occurs (Taiyang governs the exterior; Day 1 affects Taiyang, expected to transmit to Yangming on Day 2. If pulse Qi is weak, it does not transmit. Stomach channel invasion causes vomiting. Cold pathogens transmitting inward transform into heat. Desire to vomit, irritability, and rapid/urgent pulses indicate Taiyang cold transforming into heat and transmitting to Yangming).
Shanghan on Days 2-3: If Yangming and Shaoyang symptoms are absent, transmission does not occur (Absence of Yangming/Shaoyang symptoms on days 2-3 indicates pathogens remain in Taiyang).
Shanghan on Day 3: The Three Yang meridians' disease 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 4, exterior pathogens transmit inward; disharmony prevents eating/vomiting. Since the opposite occurs, transmission to Yin is ruled out; pathology remains in Yang).
Q: Shanghan on Day 3, pulse is floating, rapid, and slight; the patient's body is cool and peaceful. What is this?
A: This indicates the disease is resolving. Resolution occurs at midnight. Floating pulse resolving implies slight sweating; rapid pulse resolving implies appetite returns; slight pulse resolving implies profuse sweating. On Day 3, if the Shaoyang pulse becomes small, the disease is about to resolve (See discussion on bitter taste and dry tongue).
If not Lianggan, no transmission, and no additional pathogenic factors:
Day 7: Taiyang disease declines; headache lessens.
Day 8: Yangming disease declines; fever subsides slightly.
Day 9: Shaoyang disease declines; hearing improves slightly.
Day 10: Taiyin disease declines; abdominal distension resolves, appetite returns.
Day 11: Shaoyin disease declines; thirst stops, tongue dryness resolves, sneezing occurs.
Day 12: Jueyin disease declines; scrotum relaxes, lower abdomen descends slightly, vital Qi disperses, patient regains mental clarity.
Taiyang headache resolving after 7+ days occurs because the meridian cycle is complete. To prevent further transmission, needle the Foot-Yangming meridian to stop transmission and promote recovery.
On days 6-7, if the pulse is large, accompanied by great irritability, locked jaw, silence, and restlessness, resolution is imminent.
Shanghan on days 6-7 with no significant fever but irritability/restlessness indicates Yang departing to enter Yin.
If illness persists beyond 13 days without improvement (Jian means recovered), and Cun/Chi pulses sink, it is a critical danger.
If re-infected with different pathogens causing other diseases, treat according to the original compromised syndrome patterns. If both Yin and Yang pulses are full/excessive, and re-infected with cold, it transforms into Wenre (Warm Malaria) (Full/Cun-Chi pulses: alternating hot/cold favors Xiao Chai Hu Tang; cold-first favors adding Guizhi; cold-only favors Chai Hu Jia Gui Jiang Tang; heat-only favors Bai Hu Jia Guizhi Tang. With sweating, thirst, red urine, miasma history, or水土不服 (acclimatization issues)/vomiting, use Wu Ling San). If Yang pulse is floating/slipping and Yin pulse is soft/weak, and exposed to wind, it transforms into Fengwen (Wind-Warmth) (Fengwen features limb flaccidity, headache, fever, spontaneous sweating, unresolved state, panting, floating Cun-Chi pulses, lethargy/sleepiness; treat Shaoyin/Jueyin, avoid sweating). If Yang pulse is洪数 (Surging/Rapid) and Yin pulse is solid/large, exposure to warmth transforms it into Wendu (Warm-Toxin), the most severe disease (Wendu causes macules/rash). If Yang pulse is soft/weak and Yin pulse is wiry/tight, exposure to warm Qi transforms it into Wenyi (Warm Plague), originating from winter cold injuring leading to Warm Disease; pulse variations and treatments follow (see later sections).
Dai Shi says: Shanghan first attacks Taiyang and transmits sequentially; this is a generalization. Variations exist: some attack Yang and immediately affect Shaoyin; some involve food stagnation affecting Spleen/Taiyin causing immediate abdominal fullness/pain; some do not follow channels, e.g., directly attacking Yangming at onset. Not all start with Taiyang. Some remain in one meridian; some transmit only 1-2 meridians. Do not rigidly adhere to sequence; treat according to symptoms. Most Shanghan present with exterior signs. Zhang Zhongjing said: Many days with exterior signs still require sweating; few days with interior signs require purging.
Hai Shi says: Taiyang (Water of Yang within Yang) is the head of Three Yang, capable of sequential and skipping transmission. Yangming (Earth of Yang within Yang) is the master of Central Earth, receiving but not expelling. Transmission from Taiyang to Yangming is sequential. Shaoyang (Wood of Yang within Yang) transmits up to Yangming and down to Taiyin; transmission from Taiyang to Shaoyang is skipping transmission. Taiyin (Earth of Yin within Yin) transmits up to Shaoyang (smooth) or down to Shaoyin (reverse). Transmission from Taiyang to Taiyin is erroneous purging transmission. Shaoyin (Water of Yin within Yin) transmits up to Taiyin (smooth) or down to Jueyin (reverse); transmission from Taiyang to Shaoyin is exterior-to-interior transmission. Jueyin (Wood of Yin within Yin) transmits up to Shaoyin (excess) or again to Taiyin (self-recovery).
Hai Shi further states: Taiyang (Juyang) is the head of all Yang. Bladder channel disease with thirst indicates transmission to its home meridian (Chuanben). Transmission to Yangming (Stomach Earth) is sequential, caused by incomplete sweating, diuresis, and residual pathogens penetrating inward. Transmission to Shaoyang (Gallbladder Wood) is skipping, caused by failing to use Mahuang Tang for initial floating/no-sweat presentation. Transmission to Taiyin (Spleen Earth) is erroneous purging, caused by using purgatives instead of Guizhi Tang for initial slow/sweating presentation, leading to abdominal pain/heavy limbs. Transmission to Shaoyin (Kidney Water) is exterior-to-interior, caused by urgent need for sweating but using purgatives instead, preventing sweat release. Transmission to Jueyin (Liver Wood) is sequential degree transmission, as Jueyin ascends via Du Mai to connect with Taiyang.
Wu Shi says: Shanghan Six Meridian diseases, whether Yin/Yang, deficiency/excess, cold/heat, are all due to exogenous pathogens. The *Neijing* states "Cold injury causes heat" describing the norm, not variation. Zhang Zhongjing covers both norm and variation. Yang pathogen transmission is normal; Yin pathogen transmission is variation. Normal Yang transmission sequence: Day 1-2 Taiyang, Day 2-3 Yangming, Day 3-4 Shaoyang, Day 4-5 Taiyin, Day 5-6 Shaoyin, Day 6-7 Jueyin. Day 7 completes the cycle, resolving with sweat. No resolution by Day 7 is "Re-Jing"; Day 14 is "Guo-Jing". Unresolved Guo-Jing leads to Huai Bing (Complicated Disease). Hua Tuo stated: Day 1 Skin, Day 2 Flesh, Day 3 Muscle, Day 4 Chest, Day 5 Abdomen, Day 6 Stomach (Interior). Treatments: Sweat for Skin, Harmonize for Muscle, Emetic for Chest, Purge for Interior/Abdomen. *Shanghan Fu* agrees: Days 1-2 Release Exterior, Days 3-4 Harmonize, Days 5-6 Purge if solid. These are general rules for norms, not variations. Cold injury has no fixed rule; it can strike Yin or Yang. Texts mention Day 1-2 fever/deep pulse as Shaoyin; Day 1-2 mouth discomfort/back aversion to cold as Shaoyin. These are direct strikes to Yin meridians, variations. *Huoren Shu* states: Cold entering from back strikes Taiyang or Shaoyin; from face strikes Yangming, etc., not exclusively Taiyang. Also, pathogens may stay in one meridian, skip meridians, transmit once then stop, or move from Foot to Hand meridians, or change due to medication errors. Thus, texts say: Day 1 Taiyang, quiet pulse = no transmission; rapid/restless pulse = transmission. Days 2-3 absence of Yangming/Shaoyang symptoms = no transmission. Taiyang with floating/tight pulse, pain, fever, unresolved after 7-8 days = exterior remains, sweat it. Shaoyin with dry mouth/throat after 2-3 days = purge urgently with Dachengqi Tang. These ignore day counts. Shouzhen asked: Who dares purge with Dachengqi on Day 2-3? Sages speak generally. Taiyang has most transmissions. Heat pathogens transmit when deficiency exists; strong channels resist. Taiyang (Water) to Yangming (Earth) is Wife to Husband (Minor Evil). Yangming (Earth) to Shaoyang (Wood) is Wife to Husband (Minor Evil). Shaoyang (Wood) to Taiyin (Earth) is Husband to Wife (Tiger Evil). Taiyin (Earth) to Shaoyin (Water) is Husband to Wife (Tiger Evil). Shaoyin (Water) to Jueyin (Wood) is Mother to Son (Deficiency Evil). Taiyang (Water) skipping to Shaoyang (Wood) is Mother to Son (Deficiency Evil). Taiyang (Water) skipping to Taiyin (Earth) is Minor Evil/Erroneous Purging. Taiyang (Water) to Shaoyin (Water) is Dual Yin-Yang transmission (Lianggan). Taiyang (Water) to Jueyin (Wood) is Mother to Son (Deficiency Evil/Head-to-Tail Transmission). Shanghan ending at Jueyin Liver is "Tail" (Jue means end). Righteous Qi recovers, pathogens resolve, Water rises/Fire descends, chills/fevers occur, profuse sweat resolves. If Righteous Qi fails, pathogens persist, Yin excess causes cold limbs, curled tongue, deafness, scrotal contraction, unconsciousness, and death. Zhao Shi says: Yang meridian pathogens are easier to treat; Yin meridian transmission is dangerous due to Yang deficiency/Yin excess and Righteous deficiency/Pathogen excess. Erroneous purging/internal sinking, sweating deficiency, or cross-meridian complications lead to critical states. Essential to read Zhang Zhongjing to understand legislative intent; otherwise, confusion arises. Study examples thoroughly to avoid errors. Relying on fixed formulas without understanding principles leads to mistakes. Xu Shi said: Read Zhongjing's book, use his methods, but do not rigidly stick to his formulas. Scholars should ponder every word. Tao Shi refutes the vulgar theory that "Shanghan transmits only Foot meridians, not Hand meridians." Qi gathers at Danzhong at dawn, flows through Hand-Taiyin Lung, then distributes. One meridian imbalance affects all. Foot meridians dominate Winter (Taiyang/Shaoyin), followed by Spring (Shaoyang/Jueyin) due to Wind-Wood. Earth (Yangming/Taiyin) is affected by all seasons. Exterior pathogens transmitting inward return to Spleen/Stomach, forming dry feces treated with Chengqi Tang. Hand meridians govern Summer/Autumn, so they are less affected in Winter. Foot meridians cover specific directions (Northeast). *Relun* states: Winter cold injury manifests as Shanghan; Spring as Wenbing; Summer as Wenyi (most severe). Zhang Zhongjing said: Without Extraordinary Vessels, there is no Shanghan, as they attach to Foot meridians, not Hand. Thus, cold injures Foot meridians. Long Summer heat diseases involve Hand meridians due to Fire/Water balance. Medications often drain excess rather than tonify Foot meridions, balancing the system. General principle: Foot meridians mentioned first. However, Hand meridian transmission exists. *Cishi Nan Zhi* describes: Days 5-6, confusion, mutism, sleeping speech, red eyes, dry lips/tongue, no thirst, swallowing porridge but refusing water, fine/rapid non-surging pulses, no epigastric fullness/abdominal distension, normal bowels/bladder, or appearing drunk after 10 days. Physicians mistakenly purge with Chengqi Tang. This is heat transmitting to Hand-Shaoyin Heart. Origin: Taiyang Wind-Strike. Wind (Yang) injures Wei, drying Yin Blood. Heat accumulates in Bladder (Ren), reverses to Bing (Small Intestine), siblings Bing/Ding transmit to Heart. Heart fire scorches Lung (clear/vacuous), causing confusion. Treat with Zhizi Huangqin Huanglian Tang. If pulse in Bing, use Daochi San; if in Heart, use Xiexin Tang. Avoid Liangge San (Qi/Blood herb). If Left Cun pulse is deep/sliding/forceful, use Xijiao Dihuang Tang. If no Xijiao, substitute Shengma (Yangming blood-heat herb). If pulse forceful superficial/deep, both Bing/Ding have heat; use half Daochi, half Xiexin. This case: Bladder transmits to Bing, Foot to Hand, Down to Up, Bing to Ding, Exterior to Interior, Ren (Kan) to Ding (Li), Skipping transmission, Fu to Zang. *Huoren* says "Foot not Hand" is incomplete. Follow pulse and symptoms, not rigid sequences.