以六经钤百病。为确定之总诀。以三焦赅疫证。为变通之捷诀。
【秀按】病变无常。不出六经之外。《伤寒论》之六经。乃百病之六经。非伤寒所独也。惟疫邪分布弃斥。无复
六经可辨。故喻嘉言创立三焦以施治。上焦升逐。中焦疏逐。下焦决逐。而无不注重解毒。确得治疫之要。
【廉勘】俞东扶曰。《内经》云、热病者皆伤寒之类也。是指诸凡骤热之病。皆当从类伤寒观。盖不同者但在太
阳。其余则无不同。温热病只究三焦。不讲六经。此属妄言。仲景之六经。百病不出其范围。岂以伤寒之类。
反与伤寒截然两途乎。叶案云。温邪吸自口鼻。此亦未确。仲景明云伏气之发。李明之王安道俱言冬伤于寒。伏
邪自口内而发。奈何以吴又可《温疫论》牵混耶。惟伤寒则足经为主。温热则手经病多耳。要诀在辨明虚实。辨得
真方可下手。平素精研仲景《伤寒论》者。庶有妙旨。此与杨栗山所云。温病与伤寒。初病散表。前一节治法虽曰
不同。而或清或攻。后一节治法原无大异。其言适合。由此观之。定六经以治百病。乃古来历圣相传之定法。
从三焦以治时证。为后贤别开生面之活法。其实六经三焦。皆创自《内经》。姑述发明三焦者。《内经》云。伤于风者
上先受。伤于湿者下先受。又曰、燥热在上。湿气居中。风寒在下。火游行其间。又曰、病在上。取之下。病
在中。旁取之。病在下。取之上。是《内经》论病施治。亦不执定六经也。厥后喻西昌从疫证创立三焦治法。叶长
洲从《内经》六元发明三焦治法。分出卫气营血浅深辨法。吴淮阴乃演其说曰。治上焦如羽。治中焦如恒。治下焦
如权。又曰、补上焦如鉴之空。补中焦如衡之平。补下焦如水之注。廉臣细参吴氏条辨峙立三焦。远不逮俞氏
发明六经之精详。包括三焦而一无遗憾。噫、《通俗伤寒论》。真堪为后学师范。
【荣斋按】《伤寒论》的六经，以证候为骨干，以治疗为主题；历来注家，只有唐容川标出六经病的提纲，比较
合理。但他解释六经涵义，仍不能超出诸家牵强模糊的范畴。恽铁樵先生对于六经的见解，是很突出的。他
说∶“六经者，就人体所有之病状，为之界说者也。是故病然后有六经可言，不病直无其物。”言简意赅，可以
说是一个定义。陆渊雷先生在《伤寒今释》里，帮助∶六经是病理上的一个分野，它的里面，包括若干病证。如∶
太阳病、则包括太阳经证，太阳腑证，太阳变证；阳明病、则包括阳明经证，阳明腑证；少阳病、则包括少阳
经证，少阳腑证；太阴病、则包括太阴纯阴证，太阴纯阳证；少阴病、则包括少阴协火证，少阴协水证；厥阴
病、则包括厥多热少证、厥少热多证；每证之下又分为若干细目。这样有条不紊，纲举目张的理论，在发扬祖
国医学之今日，实占重要地位。
凡勘外感病。必先能治伤寒。凡勘伤寒病。必先能治阳明。阳明之为病。实证多属于火。虚证多属于水。暴病多属
于食。久病多属于血。
【秀按】伤寒六经并重。而俞氏独注重阳明者。以风寒、暑湿、湿温、温热。一经传到阳明。皆成燥火重
病。其生其死。不过浃辰之间。即日用对病真方。尚恐不及。若仅视同他病。力求轻稳。缓缓延之。而病多有
迫不及待者。俞氏善用凉泻。故能善治阳明。而名医之名。亦由此得。其实临证审病。火化水化。伤食蓄血。
分析极清。即所用方法。轻重合度。非率尔操觚者比。
【廉勘】陆九芝曰。病在阳明之经。虽大不大。一用芩连膏知。即能化大为小。病到阳明之腑。不危亦危。
非用硝黄枳朴。不能转危为安。病应下。下之安。乃为稳当。勿专认不敢下而致危者为稳当也。语最精审。
凡伤寒证。恶寒自罢。汗出而热仍不解。即转属阳明之候。当此之时。无论风寒暑湿。所感不同。而同归火化。
【秀按】风寒暑湿。悉能化火。故火病独多。火必就燥。阳明专主燥气。故久必归阳明。
伤寒本无定体。中阳溜经。中阴溜腑。惟入阳经气分。则太阳为首。入阴经血分。则少阴为先。
【秀按】《灵枢》病形篇曰。中于面则下阳明。中于项则下太阳。中于颊则下少阳。其中于膺背两胁亦中其经。
又曰中于阴者常从 臂始。柯韵伯注《伤寒论》云。本论太阳受邪。有中项中背之别。中项则头项强痛。中背则背
强KT KT 也。阳明有中面中膺之别。中面则目痛鼻干。中膺则胸中痞硬也。少阳有中颊中胁之别。中颊则口苦咽
干。中胁则胁下痞硬也。此岐伯中阳溜经之义。其云邪中于阴。从 臂始者。谓自经及脏。脏气实而不能容。
则邪还于腑。故本论三阴。皆有自利证。是寒邪还腑也。三阴皆有可下证。是热邪还腑也。此岐伯中阴溜腑之
义。至于太阳主通体毫毛。为肤表之第一层。故风寒必首伤太阳。然亦有不从太阳。而竟至手太阴肺经者。以
肺主皮毛。《内经》所谓风寒客于人。病入舍于肺是也。手少阴经属心。心主血。病入阴经血分。自当先传少阴。
然亦有不先传少阴。而竟至足厥阴肝经者。以肝主藏血。《内经》所谓风气通于肝。入则发惊骇是也。又云风寒虽
入舍于肺。弗治。病即传而行之肝也。此皆扩充伤寒本无定体之义。故伤寒有循经传。越经传。并经传。逆经
传。首尾传。各种传变之不同。
凡勘伤寒。先明六气。风寒在下。燥热在上。湿气居中，火游行其间。不病则为六元。病即为六淫。
【秀按】热指暑言。四时之序。春为风。夏为暑。长夏为湿。秋为燥。冬为寒。皆有外因。火则本无外因。
然《内经》言百病之生。皆生于风寒暑湿燥火。则并及于火而为六。病则名曰六淫。盖以风暑湿燥寒感于外。火即
应之于内。则在内之火。即此在外之五气有以致之。故火但曰游行其间。后贤所以有五气皆从火化之说也。
【廉勘】气交之病。未有不因此六者。六气之病。前哲王秉衡皆主外因。爰述其说曰。伤寒为外感之总名。
仲景《伤寒论》。统论外感之祖书。风暑湿燥寒。乃天地之气行于四时者也。惟夏令属火。日光最烈。《内经》云。岁
火太过。炎暑流行。明指烈日之火而言。然春秋冬三时之暖燠。无非离照之光热。因皆不可以暑称。故轩歧于
五气之下。赘一火字。且其言暑。明曰在天为热。在地为火。其性为暑。是暑赅热与火二者而言。经旨已深切
着明矣。而人之火病独多者。以风寒暑湿。悉能化火。五志过动。无不生火。则又天气与人性交合化火之大源也。
【荣斋按】六气来从四时，四时有温、凉、寒、暑，万物以生长收藏。人处四时之中，每一时期有一时期特
殊的感觉。春夏和煦，秋冬凛冽，此其常也。反常则病。恽铁樵先生对六气有卓越的理解，他说∶“风非空气
鼓动之风，寒非直觉之寒，火非燃烧物质之火。《内经》曰∶风胜则动，寒胜则痛，暑胜则浮，燥胜则干，湿胜则
濡泻。风寒燥湿乃气候之名词，动、痛、濡泻，乃人体所标着；此必天人相合而后见者。所以六气者，是人体
感气候之变化而着之病状也。”
凡勘伤寒。首辨六气。次辨阴阳虚实。阴证必目瞑嗜卧。声低息短。少气懒言。身重恶寒。阳证必张目不
眠。声音响亮。口臭气粗。身轻恶热。虚证必脉细。皮寒。气少。泄利前后。饮食不入。实证必脉盛。皮热。腹
胀。闷瞀。前后不通。
【秀按】此辨阴阳虚实之总诀。
伤寒新感。自太阳递入三阴。温热伏邪。自三阴发出三阳。惟疫邪吸自口鼻。直行中道。流布三焦。一经杂见二三
经证者多。一日骤传一二经。或二三经者尤多。
【秀按】伤寒之邪。自表传里。里证皆表证所侵人。温热之邪。自里达表。表证皆里证所浮越。惟疫邪由膜
原中道。随表里虚实乘隙而发。不循经络传次。亦不能一发便尽。吴又可发明九传。及热结旁流。胶闭而非燥
结。皆为特识。
凡病伤寒而成温者。阳经之寒变为热。则归于气。或归于血。阴经之寒变为热。则归于血。不归于气。
【秀按】伤寒由气分陷入血分。温热由血分转出气分。故伤寒多始自太阳。温热多始自阳明。或始自少阴。
此即热归于气或归于血之明辨也。
病无伏气。虽感风寒暑湿之邪。病尚不重。重病皆新邪引发伏邪者也。惟所伏之邪。在膜原则水与火互结。病多
湿温。在营分则血与热互结。病多温热。邪气内伏。往往屡夺屡发。因而殒命者。总由邪热炽盛。郁火薰蒸。血液胶
凝。脉络窒塞。营卫不通。内闭外脱而死。
【秀按】伏气有二。伤寒伏气。即春温夏热病也。伤暑伏气。即秋温冬温病也。所伏之气不同。而受病之体
质各异。故治法与伤寒伤暑正法亦异。且邪伏既久。气血亦钝而不灵。灵其气机。清其血热。为治伏邪第一要
义。但人之脏性有阴阳。体质有强弱。故就中又有轻重虚实之分焉。
【廉勘】伏气温病。有兼风、兼寒、兼湿、兼毒之不同。伏气热病。有兼气、兼湿、兼燥之不同。惟伏暑之
邪。古无是说。至深秋而发者。始见于华氏《指南》。霜未降者轻。霜既降者重。冬至尤重。然竟有伏至来春始发
者。由于秋暑过酷。冬令仍温。收藏之令不行。中气因太泄而伤。邪热因中虚而伏。其绵延淹滞。较《指南》所论
更甚。调治之法则尤难。非参 所能托。非芩连所能清。惟藉轻清灵通之品。缓缓拨醒其气机。疏透其血络。
始可十救一二。若稍一呆钝。则非火闭。即气脱矣。临证者不可不细审也。
六经实热。总清阳明。六经虚寒。总温太阴。六经实寒。总散太阳。六经虚热。总滋厥阴。
【秀按】此治六经寒热虚实之总诀。非博历知病者不能道。
外风宜散。内风宜熄。表寒宜汗。里寒宜温。伤暑宜清。中暑宜开。伏暑宜下。风湿寒湿。宜汗宜温。暑湿芳淡。
湿火苦泄。寒燥温润。热燥凉润。上燥救津。中燥增液。下燥滋血。久必增精。郁火宜发。实火宜泻。暑火宜补。阴火宜引。
【秀按】此治四时六淫之总诀。风无定性。视寒热燥湿为转移。故风寒温散。风热凉散。风燥辛润。风湿辛
燥。寒与暑为对待。燥与湿为对待。各宜对证发药。惟火证独多。如风寒湿闭郁表气。郁而化火者。治宜辛温
发散。内伤饮食生冷。遏而化火者。治宜辛热消导。此二者。皆为郁火。《内经》所谓火郁发之也。外感温暑燥
热。增助内热成火者。治宜辛凉甘润。内伤饮食辛热。致火得热愈炽者。治宜苦寒消导。此二者。皆为实火。
丹溪所谓气有余便是火。《内经》所谓实者泻之是也。气不足。致令脾阳郁而成火者。李东垣所谓阳虚发
热也。治宜
甘温以补中气。少佐甘凉以泻浮火。肾水虚。致令肝火冲而上炎者。朱丹溪所谓阴虚发热也。治宜甘平以滋真
水。少佐酸辛以泄相火。此二者。皆为虚火。《内经》所谓精气气夺则虚。虚者补之是也。若夫郁火实火虚火之外。
别有一种阴火者。此即阴盛格阳之火。亦即阴极似阳之火。《木华海赋》所谓阳冰不治。阴火潜然者也。其于病也。
虽见种种火象。如面赤戴阳。除中能食。手足躁扰。欲入泥水中坐。而用药则惟大辛大热。直破其阴以回阳。
少佐甘咸。以引火归元。惟温热伏邪。最多假阴火证。如热壅于上。气不下行。而见热深厥深。两足如冰。或
两手亦冷。确似下寒上热之证者。切不可误认为阴火。辄用桂附。而曰迎阳破阴。导龙归海。以致酷烈胃液。
烁涸肾阴。祸不旋踵。吾辈其审慎之。
伤寒一发汗而表寒即解。温热一发汗而里热愈炽。故伤寒以发表为先。温热以清里为主。伤寒多伤阳。故末路
以扶阳为急务。温热多伤阴。故末路以滋阴为要法。扶阳滋阴。均宜侧重阳明。
【秀按】伤寒注重寒水。表分实寒。自宜发汗。里气虚寒。自宜扶阳。温热归重燥火。初治清里。末治滋
阴。前哲确定之成法。如伏热发于上焦。虚烦懊 。与栀豉汤。伏热发于中焦。干燥烦渴。与白虎汤。伏热发
于下焦。小便赤热。与猪苓汤。上焦清宣。中焦清降。下焦清利。此皆清里之法也。惟滋阴一法。其先后缓急
之间。最宜分际清析。但俞氏独重阳明者。以胃为十二经之海。五脏六腑之大源也。以余所验。未经汗下和解
者。为阳盛致燥之阳明。以清火泻阳为急。已经汗下和解者。为阴枯致燥之阳明。以润燥滋阴为主。滋阴药之
先后宜否。当以此为标准。
邪留气分。每易疏透。轻则自汗而解。重则解以战汗狂汗。邪留血分。恒多胶滞。轻则发疹而解。重则解
以发 发疮。
【秀按】气、轻清也。正虚邪实。邪气与正气争。则发战汗出而解。正不虚。邪已甚。正气欲逼邪外出。与
邪气竞争。则发狂汗出而解。邪正俱衰。阴阳自和。则不战不狂。汗自出而解。邪之从自汗战汗狂汗而解者以
此。至于血、重浊也。邪留血分。则邪气遏伏甚重。急则从疹 解。稍缓则从疮疡解。皆为外解。若邪不从外
解而传里。则根据附胃肠糟粕。必从大便解。伤寒重病然。温热伏邪然。时行疫病亦然。
用六经来统摄百病，是确定的总纲口诀。用三焦来概括疫病证候，是变通的快捷口诀。
【秀按】病变没有常规，但不超出六经的范围。《伤寒论》中的六经，是百病的六经，并非仅仅针对伤寒。只有疫邪分布排斥，不再符合六经的辨证规律，所以喻嘉言创立了三焦治法来施治。上焦升散驱逐，中焦疏泄驱逐，下焦决渎驱逐，而无不注重解毒，确实掌握了治疗疫病的要领。
【廉勘】俞东扶说：《内经》讲：“热病者皆伤寒之类也。”这是指凡是突然发热的病，都应当从类伤寒的角度观察。大概不同的地方只在太阳经，其余则没有不同。温热病只研究三焦，不讲六经，这属于妄言。仲景的六经，百病都不出其范围，难道因为属于伤寒一类，反而与伤寒截然分为两途吗？叶天士医案中说：“温邪吸自口鼻”，这也不确切。仲景明确说是伏气发作，李东垣、王安道都说冬天感受寒邪，伏邪从口内发出，怎么能把吴又可的《温疫论》牵强混淆呢？只有伤寒以足经为主，温热病则以手经病多罢了。关键诀窍在于辨明虚实，辨得真切才能下手。平时精研仲景《伤寒论》的人，才能有妙旨。这与杨栗山所说的“温病与伤寒，初病散表，前一节治法虽然不同，而后一节治法原无大异”的说法相吻合。由此看来，定六经以治百病，是古来历圣相传的定法；从三焦以治时行证候，是后贤别开生面的活法。其实六经和三焦，都创始于《内经》。姑且阐述发明三焦的道理，《内经》说：“伤于风者上先受，伤于湿者下先受。”又说：“燥热在上，湿气居中，风寒在下，火游行其间。”又说：“病在上，取之下；病在中，旁取之；病在下，取之上。”这说明《内经》论病施治，也不拘泥于六经。后来喻昌（字西昌）从疫病证候创立三焦治法，叶桂（字天士，号香岩，长洲人）从《内经》六元理论发明三焦治法，分出卫气营血浅深辨法，吴鞠通（名瑗，淮阴人）于是演绎其学说说：“治上焦如羽（非轻不举），治中焦如衡（非平不安），治下焦如权（非重不沉）。”又说：“补上焦如鉴之空，补中焦如衡之平，补下焦如水之注。”廉臣仔细参详吴氏的条辨，峙立三焦体系，远远不如俞氏发明六经的精详，包括三焦而毫无遗憾。唉！《通俗伤寒论》，真可以作为后学的师范。
【荣斋按】《伤寒论》的六经，以证候为骨干，以治疗为主题；历来注家，只有唐容川标出六经病的提纲，比较合理。但他解释六经涵义，仍不能超出诸家牵强模糊的范畴。恽铁樵先生对于六经的见解，是很突出的。他说：“六经者，就人体所有之病状，为之界说者也。是故病然后有六经可言，不病直无其物。”言简意赅，可以说是一个定义。陆渊雷先生在《伤寒今释》里帮助补充：六经是病理上的一个分野，它的里面，包括若干病证。如：太阳病，则包括太阳经证，太阳腑证，太阳变证；阳明病，则包括阳明经证，阳明腑证；少阳病，则包括少阳经证，少阳腑证；太阴病，则包括太阴纯阴证，太阴纯阳证；少阴病，则包括少阴协火证，少阴协水证；厥阴病，则包括厥多热少证、厥少热多证；每证之下又分为若干细目。这样有条不紊，纲举目张的理论，在发扬祖国医学之今日，实占重要地位。
凡是诊察外感病，必须先能治疗伤寒。凡是诊察伤寒病，必须先能治疗阳明病。阳明病这个病，实证多属于火，虚证多属于水，暴病多属于食积，久病多属于瘀血。
【秀按】伤寒六经并重，而俞氏独注重阳明者，是因为风寒、暑湿、湿温、温热，一经传到阳明，都成为燥火重病。其生其死，不过几天之间，即使日常使用对症的真方，还恐怕来不及。如果仅把它看作其他病，力求轻稳，缓缓拖延，而病多有迫不及待的。俞氏善用凉泻法，所以能善治阳明，而名医之名，也由此得来。其实临证审病，火化水化，伤食蓄血，分析极清，即所用的方法，轻重合度，不是草率行事的人能比的。
【廉勘】陆九芝说：病在阳明之经，虽然大不大，一用黄芩、黄连、石膏、知母，就能化大为小。病到阳明之腑，不危亦危，非用芒硝、大黄、枳实、厚朴，不能转危为安。病应下，下之安，乃为稳当，不要专门认定不敢下而导致危险的人才算稳当。这话最精审。
凡是伤寒证，恶寒自然停止，汗出而热仍不解，就是转属阳明之候。当此之时，无论风寒暑湿，所感不同，而同归火化。
【秀按】风寒暑湿，都能化火，所以火病独多。火必就燥，阳明专主燥气，所以久必归阳明。
伤寒本无固定形体，中于阳经溜入经络，中于阴经溜入脏腑。只有进入阳经气分，则太阳为首；进入阴经血分，则少阴为先。
【秀按】《灵枢·病形篇》说：“中于面则下阳明，中于项则下太阳，中于颊则下少阳。其中于膺背两胁亦中其经。”又说：“中于阴者常从臂始。”柯韵伯注《伤寒论》说：“本论太阳受邪，有中项中背之别。中项则头项强痛，中背则背强僵硬也。阳明有中面中膺之别。中面则目痛鼻干，中膺则胸中痞硬也。少阳有中颊中胁之别。中颊则口苦咽干，中胁则胁下痞硬也。”这是岐伯中阳溜经的意思。其说邪中于阴，从臂始者，谓自经及脏，脏气实而不能容，则邪还于腑。所以本论三阴，皆有自利证，是寒邪还腑也。三阴皆有可下证，是热邪还腑也。这是岐伯中阴溜腑的意思。至于太阳主通体毫毛，为肤表之第一层，故风寒必首伤太阳。然亦有不从太阳，而竟至手太阴肺经者，以肺主皮毛，《内经》所谓风寒客于人，病入舍于肺是也。手少阴经属心，心主血，病入阴经血分，自当先传少阴。然亦有不先传少阴，而竟至足厥阴肝经者，以肝主藏血，《内经》所谓风气通于肝，入则发惊骇是也。又云风寒虽入舍于肺，弗治，病即传而行之肝也。此皆扩充伤寒本无定体之义。故伤寒有循经传，越经传，并经传，逆经传，首尾传，各种传变之不同。
凡是诊察伤寒，先明六气。风寒在下，燥热在上，湿气居中，火游行其间。不病则为六元，病即为六淫。
【秀按】热指暑言。四时之序，春为风，夏为暑，长夏为湿，秋为燥，冬为寒，皆有外因。火则本无外因。然《内经》言百病之生，皆生于风寒暑湿燥火，则并及于火而为六。病则名曰六淫。盖以风暑湿燥寒感于外，火即应之于内，则在内之火，即此在外之五气有以致之。故火但曰游行其间，后贤所以有五气皆从火化之说也。
【廉勘】气交之病，未有不因此六者。六气之病，前哲王秉衡皆主外因。爰述其说曰：伤寒为外感之总名，仲景《伤寒论》，统论外感之祖书。风暑湿燥寒，乃天地之气行于四时者也。惟夏令属火，日光最烈，《内经》云：“岁火太过，炎暑流行”，明指烈日之火而言。然春秋冬三时之暖燠，无非离照之光热，因皆不可以暑称。故轩歧于五气之下，赘一火字。且其言暑，明曰在天为热，在地为火，其性为暑，是暑赅热与火二者而言，经旨已深切着明矣。而人之火病独多者，以风寒暑湿，悉能化火，五志过动，无不生火，则又天气与人性交合化火之大源也。
【荣斋按】六气来从四时，四时有温、凉、寒、暑，万物以生长收藏。人处四时之中，每一时期有一时期特殊的感觉。春夏和煦，秋冬凛冽，此其常也。反常则病。恽铁樵先生对六气有卓越的理解，他说：“风非空气鼓动之风，寒非直觉之寒，火非燃烧物质之火。《内经》曰：‘风胜则动，寒胜则痛，暑胜则浮，燥胜则干，湿胜则濡泻。’风寒燥湿乃气候之名词，动、痛、濡泻，乃人体所标着；此必天人相合而后见者。所以六气者，是人体感气候之变化而着之病状也。”
凡是诊察伤寒，首辨六气，次辨阴阳虚实。阴证必目瞑嗜卧，声低息短，少气懒言，身重恶寒。阳证必张目不眠，声音响亮，口臭气粗，身轻恶热。虚证必脉细，皮寒，气少，泄利前后，饮食不入。实证必脉盛，皮热，腹胀，闷瞀，前后不通。
【秀按】这是辨阴阳虚实之总诀。
伤寒新感，自太阳递入三阴。温热伏邪，自三阴发出三阳。惟疫邪吸自口鼻，直行中道，流布三焦。一经杂见二三经证者多，一日骤传一二经，或二三经者尤多。
【秀按】伤寒之邪，自表传里，里证皆表证所侵人。温热之邪，自里达表，表证皆里证所浮越。惟疫邪由膜原中道，随表里虚实乘隙而发，不循经络传次，亦不能一发便尽。吴又可发明九传，及热结旁流，胶闭而非燥结，皆为特识。
凡是病伤寒而成温者，阳经之寒变为热，则归于气，或归于血。阴经之寒变为热，则归于血，不归于气。
【秀按】伤寒由气分陷入血分，温热由血分转出气分。故伤寒多始自太阳，温热多始自阳明，或始自少阴。此即热归于气或归于血之明辨也。
病无伏气，虽感风寒暑湿之邪，病尚不重。重病皆新邪引发伏邪者也。惟所伏之邪，在膜原则水与火互结，病多湿温。在营分则血与热互结，病多温热。邪气内伏，往往屡夺屡发，因而殒命者，总由邪热炽盛，郁火薰蒸，血液胶凝，脉络窒塞，营卫不通，内闭外脱而死。
【秀按】伏气有二。伤寒伏气，即春温夏热病也。伤暑伏气，即秋温冬温病也。所伏之气不同，而受病之体质各异，故治法与伤寒伤暑正法亦异。且邪伏既久，气血亦钝而不灵。灵其气机，清其血热，为治伏邪第一要义。但人之脏性有阴阳，体质有强弱，故就中又有轻重虚实之分焉。
【廉勘】伏气温病，有兼风、兼寒、兼湿、兼毒之不同。伏气热病，有兼气、兼湿、兼燥之不同。惟伏暑之邪，古无是说，至深秋而发者，始见于华氏《指南》。霜未降者轻，霜既降者重，冬至尤重。然竟有伏至来春始发者，由于秋暑过酷，冬令仍温，收藏之令不行，中气因太泄而伤，邪热因中虚而伏。其绵延淹滞，较《指南》所论更甚，调治之法则尤难。非人参所能托，非黄芩、黄连所能清。惟藉轻清灵通之品，缓缓拨醒其气机，疏透其血络，始可十救一二。若稍一呆钝，则非火闭，即气脱矣。临证者不可不细审也。
六经实热，总清阳明。六经虚寒，总温太阴。六经实寒，总散太阳。六经虚热，总滋厥阴。
【秀按】这是治六经寒热虚实之总诀。非博历知病者不能道。
外风宜散，内风宜熄。表寒宜汗，里寒宜温。伤暑宜清，中暑宜开。伏暑宜下。风湿寒湿，宜汗宜温。暑湿芳淡，湿火苦泄。寒燥温润，热燥凉润。上燥救津，中燥增液，下燥滋血，久必增精。郁火宜发，实火宜泻。暑火宜补，阴火宜引。
【秀按】这是治四时六淫之总诀。风无定性，视寒热燥湿为转移。故风寒温散，风热凉散，风燥辛润，风湿辛燥。寒与暑为对待，燥与湿为对待，各宜对证发药。惟火证独多，如风寒湿闭郁表气，郁而化火者，治宜辛温发散。内伤饮食生冷，遏而化火者，治宜辛热消导。此二者，皆为郁火，《内经》所谓火郁发之也。外感温暑燥热，增助内热成火者，治宜辛凉甘润。内伤饮食辛热，致火得热愈炽者，治宜苦寒消导。此二者，皆为实火。丹溪所谓气有余便是火，《内经》所谓实者泻之是也。气不足，致令脾阳郁而成火者，李东垣所谓阳虚发热也。治宜甘温以补中气，少佐甘凉以泻浮火。肾水虚，致令肝火冲而上炎者，朱丹溪所谓阴虚发热也。治宜甘平以滋真水，少佐酸辛以泄相火。此二者，皆为虚火，《内经》所谓精气气夺则虚，虚者补之是也。若夫郁火实火虚火之外，别有一种阴火者，此即阴盛格阳之火，亦即阴极似阳之火。《木华海赋》所谓阳冰不治，阴火潜然者也。其于病也，虽见种种火象，如面赤戴阳，除中能食，手足躁扰，欲入泥水中坐，而用药则惟大辛大热，直破其阴以回阳，少佐甘咸，以引火归元。惟温热伏邪，最多假阴火证，如热壅于上，气不下行，而见热深厥深，两足如冰，或两手亦冷，确似下寒上热之证者，切不可误认为阴火，辄用桂附，而曰迎阳破阴，导龙归海，以致酷烈胃液，烁涸肾阴，祸不旋踵。吾辈其审慎之。
伤寒一发汗而表寒即解，温热一发汗而里热愈炽。故伤寒以发表为先，温热以清里为主。伤寒多伤阳，故末路以扶阳为急务。温热多伤阴，故末路以滋阴为要法。扶阳滋阴，均宜侧重阳明。
【秀按】伤寒注重寒水，表分实寒，自宜发汗。里气虚寒，自宜扶阳。温热归重燥火，初治清里，末治滋阴。前哲确定之成法，如伏热发于上焦，虚烦懊憹，与栀子豉汤。伏热发于中焦，干燥烦渴，与白虎汤。伏热发于下焦，小便赤热，与猪苓汤。上焦清宣，中焦清降，下焦清利，此皆清里之法也。惟滋阴一法，其先后缓急之间，最宜分际清析。但俞氏独重阳明者，以胃为十二经之海，五脏六腑之大源也。以余所验，未经汗下和解者，为阳盛致燥之阳明，以清火泻阳为急。已经汗下和解者，为阴枯致燥之阳明，以润燥滋阴为主。滋阴药之先后宜否，当以此为标准。
邪留气分，每易疏透。轻则自汗而解，重则解以战汗狂汗。邪留血分，恒多胶滞。轻则发疹而解，重则解以发痈发疮。
【秀按】气，轻清也。正虚邪实，邪气与正气争，则发战汗出而解。正不虚，邪已甚，正气欲逼邪外出，与邪气竞争，则发狂汗出而解。邪正俱衰，阴阳自和，则不战不狂，汗自出而解。邪之从自汗战汗狂汗而解者以此。至于血，重浊也。邪留血分，则邪气遏伏甚重，急则从疹痱解，稍缓则从疮疡解，皆为外解。若邪不从外解而传里，则根据附胃肠糟粕，必从大便解。伤寒重病然，温热伏邪然，时行疫病亦然。
Using the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) to encompass all diseases constitutes the definitive general principle. Using the Triple Burner (Sanjiao) to summarize epidemic syndromes constitutes the expedient principle for adaptation.
[Commentary by Xiu] Pathological changes are unpredictable but do not exceed the scope of the Six Channels. The Six Channels in *Shanghan Lun* (Treatise on Cold Damage) are the Six Channels for all diseases, not exclusive to cold damage. Only when epidemic pathogens distribute and repel such that they no longer conform to the differentiation of the Six Channels did Yu Jiayan establish the treatment method based on the Triple Burner. The Upper Burner lifts and expels, the Middle Burner disperses and expels, and the Lower Burner drains and expels, with an emphasis on detoxification in all cases, truly grasping the essence of treating epidemics.
[Commentary by Lian] Yu Dongfu stated: *Neijing* (The Inner Canon) says, "All heat diseases belong to the category of cold damage." This refers to the fact that any sudden feverish disease should be viewed from the perspective of cold-damage-like conditions. The difference lies primarily in the Taiyang channel; otherwise, there is no difference. To study warm-heat diseases only through the Triple Burner and ignore the Six Channels is erroneous talk. Zhang Zhongjing's Six Channels encompass all diseases; how could diseases similar to cold damage be completely separated into a different path? Ye Tianshi's medical records state, "Warm pathogens enter via the mouth and nose," which is also inaccurate. Zhongjing clearly states that this is the manifestation of latent qi. Li Dongyuan and Wang Andao both stated that winter cold damage leads to latent pathogens emerging from the mouth. How can Wu Keyi's *Wenyi Lun* (Treatise on Epidemic Diseases) be confusedly applied? Generally, cold damage primarily affects the Foot channels, while warm-heat diseases more frequently affect the Hand channels. The key lies in distinguishing deficiency and excess; only with true discernment can one begin treatment. Those who have meticulously studied Zhang Zhongjing's *Shanghan Lun* will grasp its profound principles. This aligns with Yang Lisshan's statement that although the initial treatment methods for warm diseases and cold damage differ in dispersing the exterior, the subsequent treatments involving clearing or purging are largely similar. Thus, establishing the Six Channels to treat all diseases is the established method passed down from ancient sages, while using the Triple Burner to treat seasonal disorders is the flexible method opened up by later scholars. In fact, both the Six Channels and the Triple Burner originated from *Neijing*. Let us elaborate on the invention of the Triple Burner theory. *Neijing* states, "Those injured by wind are first affected above; those injured by dampness are first affected below." It also says, "Dryness and heat are above; dampness is in the middle; cold and wind are below; fire travels between them." Furthermore, "For diseases above, treat below; for diseases in the middle, treat laterally; for diseases below, treat above." This shows that *Neijing*'s approach to disease and treatment was not rigidly confined to the Six Channels. Later, Yu Chang (courtesy name Xichang) established the Triple Burner treatment method for epidemic diseases. Ye Tianshi (Ye Gui), from Changzhou, developed the Triple Burner treatment method based on the *Neijing*'s theory of the Six Yuan, distinguishing the depth of Wei, Qi, Ying, and Blood levels. Wu Jutong (Wu Yuan) further elaborated: "Treating the Upper Burner is like feathers (lightness is essential); treating the Middle Burner is like a balance (equilibrium is essential); treating the Lower Burner is like weights (heaviness is essential)." He also said, "Tonifying the Upper Burner is like an empty mirror; tonifying the Middle Burner is like a balanced scale; tonifying the Lower Burner is like flowing water." Lianchen carefully examined Wu's systematic differentiation of the Triple Burner and found it far inferior to Yu's detailed exposition of the Six Channels, which encompasses the Triple Burner without flaw. Alas! *Putong Shanghan Lun* (Popularized Treatise on Cold Damage) is truly worthy of being a model for future students.
[Commentary by Rongzhai] The Six Channels in *Shanghan Lun* take syndromes as the backbone and treatment as the theme. Among past commentators, only Tang Rongchuan provided outlines for the Six Channel diseases, which is relatively reasonable. However, his explanation of the connotation of the Six Channels still falls within the realm of forced and vague interpretations of previous scholars. Mr. Yun Tieqiao's understanding of the Six Channels is outstanding. He stated: "The Six Channels are definitions based on all pathological manifestations of the human body. Therefore, only when there is disease can the Six Channels be discussed; without disease, they do not exist." This is concise and comprehensive, serving as a definition. In *Shanghan Jinshi* (Modern Interpretation of Shanghan Lun), Mr. Lu Yuanlei assisted by stating: The Six Channels are a division in pathology, encompassing various syndromes within them. For example, Taiyang disease includes Taiyang Meridian syndrome, Taiyang Fu-organ syndrome, and Taiyang transformed syndrome; Yangming disease includes Yangming Meridian syndrome and Yangming Fu-organ syndrome; Shaoyang disease includes Shaoyang Meridian syndrome and Shaoyang Fu-organ syndrome; Taiyin disease includes pure Yin Taiyin syndrome and pure Yang Taiyin syndrome; Shaoyin disease includes Shaoyin assisting Fire syndrome and Shaoyin assisting Water syndrome; Jueyin disease includes Jueyin with more cold and less heat syndrome, and Jueyin with less cold and more heat syndrome. Each syndrome is further divided into several sub-items. Such an orderly, systematic theory holds an important position in the development of traditional Chinese medicine today.
In examining exogenous diseases, one must first master the treatment of cold damage. In examining cold damage, one must first master the treatment of Yangming disease. Yangming disease: Excess syndromes mostly belong to Fire; Deficiency syndromes mostly belong to Water; Acute diseases mostly belong to Food Stagnation; Chronic diseases mostly belong to Blood Stasis.
[Commentary by Xiu] Although cold damage treats the Six Channels equally, Mr. Yu emphasizes Yangming because Wind-Cold, Summerheat-Dampness, Damp-Warmth, and Warm-Heat, once transmitted to Yangming, all become severe Dryness-Fire diseases. Life and death hang in the balance within a few days. Even with the correct formula for the specific condition, time may be insufficient. If treated lightly and cautiously like other diseases, delaying progress, many patients cannot wait. Mr. Yu excels in using cooling purgatives, thus mastering the treatment of Yangming, earning his reputation as a famous physician. In clinical practice, he analyzes Fire transformation, Water transformation, food injury, and blood stasis with great clarity, and his methods are appropriately graded, unlike rash practitioners.
[Commentary by Lian] Lu Jiuzhi said: When disease is in the Yangming Meridian, although it appears severe, using Huang Qin, Huang Lian, Shi Gao, and Zhi Mu can reduce severity. When disease reaches the Yangming Fu-organs, it is critical even if not yet life-threatening; only using Mang Xiao, Da Huang, Zhi Shi, and Hou Po can turn danger into safety. Purging when indicated ensures safety; do not mistakenly consider those who dare not purge as safe. This statement is most precise.
In cold damage syndromes, when aversion to cold ceases naturally and sweating occurs but fever persists, it indicates transmission to Yangming. At this time, regardless of whether the pathogen is Wind, Cold, Summerheat, or Dampness, they all transform into Fire.
[Commentary by Xiu] Wind, Cold, Summerheat, and Dampness can all transform into Fire, hence Fire diseases are numerous. Fire adheres to Dryness, and Yangming governs Dryness, so eventually, diseases return to Yangming.
Cold damage has no fixed form. Pathogens entering Yang channels flow into the meridians; pathogens entering Yin channels flow into the zang-fu organs. Upon entering the Qi level of Yang channels, Taiyang is primary; upon entering the Blood level of Yin channels, Shaoyin is primary.
[Commentary by Xiu] *Lingshu · Bingxing Pian* states: "Striking the face descends to Yangming; striking the nape descends to Taiyang; striking the cheek descends to Shaoyang. Striking the chest, back, or flanks also strikes their respective meridians." It also states: "Pathogens striking Yin often start from the arm." Ke Yunbo, commenting on *Shanghan Lun*, noted: "In this treatise, Taiyang receives pathogens, differing between striking the nape and the back. Striking the nape causes stiffness and pain of the head and neck; striking the back causes back stiffness. Yangming differs between striking the face and the chest. Striking the face causes eye pain and dry nose; striking the chest causes fullness and hardness in the chest. Shaoyang differs between striking the cheek and the flanks. Striking the cheek causes bitter taste and dry throat; striking the flanks causes fullness and hardness under the ribs." This is Qibo's meaning of pathogens entering Yang channels flowing into meridians. Regarding pathogens striking Yin starting from the arm, it means moving from meridians to zang organs. Since zang Qi is solid and cannot contain the pathogen, the pathogen returns to the fu organs. Thus, all three Yin channels in this treatise show spontaneous diarrhea, indicating cold pathogens returning to fu organs. All three Yin channels have indications for purging, indicating heat pathogens returning to fu organs. This is Qibo's meaning of pathogens entering Yin channels flowing into fu organs. Taiyang governs the whole body's hair follicles and is the first layer of the skin surface, so Wind-Cold always injures Taiyang first. However, some do not start from Taiyang but directly affect the Hand-Taiyin Lung meridian, as the Lung governs skin and hair, consistent with *Neijing*: "When Wind-Cold invades humans, the disease enters and resides in the Lung." The Hand-Shaoyin meridian belongs to the Heart, and the Heart governs Blood. When disease enters the Yin channels' Blood level, it should naturally transmit to Shaoyin first. However, some do not transmit to Shaoyin first but directly affect the Foot-Jueyin Liver meridian, as the Liver stores Blood, consistent with *Neijing*: "Wind Qi communicates with the Liver; entering causes fright and palpitations." It is also said that although Wind-Cold resides in the Lung, if untreated, the disease transmits to and moves through the Liver. These expand the meaning that cold damage has no fixed form. Thus, cold damage has various transmissions: following the meridians, skipping meridians, concurrent meridians, reverse meridians, and head-to-tail transmission.
In examining cold damage, first clarify the Six Qi. Cold and Wind are below; Dryness and Heat are above; Dampness is in the middle; Fire travels between them. When healthy, they are the Six Primals; when diseased, they are the Six Evils.
[Commentary by Xiu] "Heat" here refers to Summerheat. The order of four seasons: Spring is Wind, Summer is Summerheat, Late Summer is Dampness, Autumn is Dryness, Winter is Cold; all have external causes. Fire originally has no external cause. However, *Neijing* states that all diseases arise from Wind, Cold, Summerheat, Dampness, Dryness, and Fire, including Fire to make six. When diseased, they are named the Six Evils. Because Wind, Summerheat, Dampness, Dryness, and Cold are felt externally, Fire responds internally. Thus, internal Fire is caused by these five external Qi. Hence, Fire is described as traveling between them, leading later scholars to propose that all five Qi can transform into Fire.
[Commentary by Lian] Diseases of Qi interaction are invariably caused by these six. Regarding diseases of the Six Qi, the former sage Wang Bingheng emphasized external causes. He stated: Cold damage is the general term for exogenous diseases. Zhang Zhongjing's *Shanghan Lun* is the ancestral book discussing exogenous diseases comprehensively. Wind, Summerheat, Dampness, Dryness, and Cold are the Qi of Heaven and Earth moving through the four seasons. Only Summer belongs to Fire, with the most intense sunlight. *Neijing* says, "Excessive Yearly Fire leads to widespread hot summer weather," clearly referring to the fire of the scorching sun. However, the warmth in Spring, Autumn, and Winter is none other than the light and heat of the sun, so they cannot be called Summerheat. Thus, Xuanyuan and Qibo added the character "Fire" after the Five Qi. Moreover, regarding Summerheat, it explicitly states: "In Heaven it is Heat, on Earth it is Fire, its nature is Summerheat." Thus, Summerheat encompasses both Heat and Fire, making the canonical intent clear. The reason why people suffer predominantly from Fire diseases is that Wind, Cold, Summerheat, and Dampness can all transform into Fire, and excessive movement of the Five Emotions generates Fire. This is the major source of Fire transformation resulting from the interaction of heavenly climate and human nature.
[Commentary by Rongzhai] The Six Qi originate from the four seasons. The four seasons have Warmth, Coolness, Cold, and Summerheat, allowing all things to grow, flourish, harvest, and store. Humans living within the four seasons have special sensations in each period. Spring and Summer are mild; Autumn and Winter are biting cold; this is normal. Deviation causes disease. Mr. Yun Tieqiao had an excellent understanding of the Six Qi, stating: "Wind is not air-driven wind; Cold is not intuitively felt cold; Fire is not burning substance fire. *Neijing* says: 'Excess Wind causes movement; Excess Cold causes pain; Excess Summerheat causes floating/swelling; Excess Dryness causes dryness; Excess Dampness causes loose stools.' Wind, Cold, Dryness, and Dampness are climatic terms; movement, pain, and loose stools are bodily manifestations; these appear only when Heaven and Man combine. Therefore, the Six Qi are pathological manifestations arising from the human body sensing climatic changes."
In examining cold damage, first distinguish the Six Qi, then distinguish Yin/Yang and Deficiency/Excess. Yin syndromes必定 feature closed eyes, drowsiness, low voice, short breath, reluctance to speak, heavy body, and aversion to cold. Yang syndromes必定 feature open eyes, insomnia, loud voice, bad breath, coarse respiration, light body, and aversion to heat. Deficiency syndromes必定 feature fine pulse, cold skin, shortness of breath, diarrhea/incontinence, and inability to eat/drink. Excess syndromes必定 feature surging pulse, hot skin, abdominal distension, oppression/confusion, and blockage of urination/defecation.
[Commentary by Xiu] This is the general principle for distinguishing Yin/Yang and Deficiency/Excess.
Newly contracted cold damage transmits sequentially from Taiyang to the Three Yin. Latent warm-heat pathogens emerge from the Three Yin to the Three Yang. Epidemic pathogens, however, enter via the mouth and nose, travel directly through the central pathway, and spread throughout the Triple Burner. It is common to see mixed syndromes of two or three channels in one stage, and rapid transmission to one, two, or three channels within a day is even more common.
[Commentary by Xiu] Cold damage pathogens transmit from Exterior to Interior; interior syndromes are invaded by exterior syndromes. Warm-heat pathogens move from Interior to Exterior; exterior syndromes float out from interior syndromes. Epidemic pathogens, however, originate from the Mo-Yuan (interstitial space) central pathway, taking advantage of deficiencies in the Exterior/Interior and Deficiency/Excess to erupt, without following meridian transmission sequences, and cannot be exhausted in one eruption. Wu Keyi invented the concept of Nine Transmissions, as well as "Heat Accumulation with Side Flow" (sticky blockage rather than dry accumulation), demonstrating unique insights.
When cold damage transforms into warm disease: Cold transforming into Heat in Yang channels returns to Qi or Blood. Cold transforming into Heat in Yin channels returns to Blood, not Qi.
[Commentary by Xiu] Cold damage sinks from Qi level to Blood level; warm-heat emerges from Blood level to Qi level. Therefore, cold damage usually starts in Taiyang, while warm-heat usually starts in Yangming or Shaoyin. This is a clear distinction between heat returning to Qi or Blood.
Diseases without latent pathogens, even if contracting Wind, Cold, Summerheat, or Dampness, are not severe. Severe diseases are all triggered by new pathogens activating latent pathogens. Where latent pathogens reside in the Mo-Yuan, Water and Fire bind mutually, causing Damp-Warmth. Where they reside in the Ying (Nutritive) level, Blood and Heat bind mutually, causing Warm-Heat. Internal latent pathogens often recur and erupt repeatedly, leading to death. This is due to blazing pathogenic heat, stifling fire steaming, coagulating blood, blocking collaterals, obstructing Ying and Wei circulation, resulting in internal closure and external collapse.
[Commentary by Xiu] There are two types of latent qi. Cold damage latent qi refers to Spring-Warmth and Summer-Heat diseases. Summerheat latent qi refers to Autumn-Warmth and Winter-Warmth diseases. The latent qi differs, and the constitution of the affected individual varies, so treatment methods differ from standard cold damage or summerheat treatments. Furthermore, long-standing latent pathogens dull Qi and Blood. Revitalizing Qi mechanism and clearing Blood heat are the primary principles for treating latent pathogens. However, organ nature has Yin/Yang, and constitution has strength/weakness, leading to variations in severity and deficiency/excess.
[Commentary by Lian] Latent warm diseases may combine Wind, Cold, Dampness, or Toxicity. Latent heat diseases may combine Qi stagnation, Dampness, or Dryness. The concept of "Latent Summerheat" is absent in ancient texts; it first appeared in Hua's *Zhinan* when manifesting in late autumn. Manifesting before frost is mild; manifesting after frost is severe; especially severe at Winter Solstice. However, some remain latent until next spring due to excessively hot autumns and warm winters, preventing proper storage, damaging Middle Qi through excessive leakage, and allowing pathogenic heat to lie latent due to Middle Deficiency. Its lingering and sluggish nature is worse than described in *Zhinan*, and treatment is particularly difficult. Not supported by Ren Shen (Ginseng), not cleared by Huang Qin/Huang Lian (Scutellaria/Phellodendron). Only with light, clear, and unblocking agents can one slowly awaken the Qi mechanism and vent the Blood collaterals, saving one or two out of ten. Any rigidity leads to Fire closure or Qi collapse. Clinicians must examine carefully.
Six Channel Excess Heat: Clear Yangming generally. Six Channel Deficiency Cold: Warm Taiyin generally. Six Channel Excess Cold: Disperse Taiyang generally. Six Channel Deficiency Heat: Nourish Jueyin generally.
[Commentary by Xiu] This is the general principle for treating Six Channel Cold/Heat and Deficiency/Excess. Only those experienced in pathology can articulate this.
External Wind: Disperse. Internal Wind: Extinguish. Exterior Cold: Sweat. Interior Cold: Warm. Summerheat Injury: Clear. Summerheat Stroke: Open. Latent Summerheat: Purge. Wind-Damp/Cold-Damp: Sweat/Warm. Summerheat-Damp: Aromatic/Diuretic. Damp-Fire: Bitter/Purge. Cold-Dry: Warm/Moisten. Heat-Dry: Cool/Moisten. Upper Dryness: Rescue Fluids. Middle Dryness: Increase Liquids. Lower Dryness: Nourish Blood. Long-term: Increase Essence. Stifled Fire: Vent. Excess Fire: Purge. Summerheat Fire: Tonify. Yin Fire: Guide.
[Commentary by Xiu] This is the general principle for treating Four Seasons' Six Evils. Wind has no fixed nature, shifting with Cold/Heat and Dryness/Dampness. Thus, Wind-Cold requires warm dispersion; Wind-Heat requires cool dispersion; Wind-Dryness requires pungent/moistening; Wind-Dampness requires pungent/drying. Cold and Summerheat are opposites; Dryness and Dampness are opposites. Medications must match the syndrome. Fire diseases are numerous. For example, Wind-Cold-Damp closing/stifling Exterior Qi, transforming into Fire due to stagnation: treat with Pungent-Warm dispersion. Internal injury from raw/cold food, suppressing and transforming into Fire: treat with Pungent-Hot digestion. These two are Stifled Fire, as *Neijing* states: "Stifled Fire should be vented." External contraction of Warm/Summerheat/Dryness/Heat, augmenting internal heat to become Fire: treat with Pungent-Cool/Sweet-Moistening. Internal injury from pungent/hot food, causing Fire to blaze with heat: treat with Bitter-Cold digestion. These two are Excess Fire. Danxi said: "Excess Qi is Fire"; *Neijing* said: "Excess should be purged." Insufficient Qi causing Spleen Yang stagnation to become Fire: Li Dongyuan called this "Yang Deficiency Fever." Treat with Sweet-Warm to tonify Middle Qi, adding slightly Sweet-Cool to drain floating Fire. Kidney Water deficiency causing Liver Fire rushing upward: Zhu Danxi called this "Yin Deficiency Fever." Treat with Sweet-Pour to nourish True Water, adding slightly Sour/Pungent to drain Ministerial Fire. These two are Deficiency Fire, as *Neijing* states: "When Essence/Qi is depleted, it is Deficiency; Deficiency should be tonified." Besides Stifled, Excess, and Deficiency Fire, there is another type: Yin Fire. This is Fire repelled by Yin Excess (False Heat), or Fire resembling Yang at Yin Extreme. As *Mu Hua Hai Fu* states: "When Yang Ice does not melt, Yin Fire burns secretly." Clinically, despite various Fire signs like red face (floating Yang), ability to eat in epigastrium, restlessness, desire to sit in mud/water, medication must use Great Pungent/Great Hot agents to break Yin and restore Yang, adding slightly Sweet/Salty to guide Fire back to its source. However, warm-heat latent pathogens most often present as False Yin Fire syndromes. For example, Heat congested above, Qi failing to descend, presenting with deep heat and deep cold limbs (feet like ice, or hands cold), seemingly lower Cold/upper Heat: Do not mistake this for Yin Fire and use Gui Zhi/Fu Zi claiming to "break Yin to welcome Yang" or "guide Dragon to sea," which would harshly consume Stomach fluids and parch Kidney Yin, bringing disaster swiftly. We must be cautious.
One sweat resolves Exterior Cold in cold damage; one sweat intensifies Interior Heat in warm-heat. Thus, cold damage prioritizes releasing the Exterior; warm-heat prioritizes clearing the Interior. Cold damage mostly injures Yang, so restoring Yang is urgent at the end. Warm-heat mostly injures Yin, so nourishing Yin is essential at the end. Restoring Yang and nourishing Yin both should focus on Yangming.
[Commentary by Xiu] Cold damage focuses on Cold/Water; Exterior Excess Cold requires sweating. Interior Deficiency Cold requires restoring Yang. Warm-heat focuses on Dryness/Fire; initial treatment clears Interior; final treatment nourishes Yin. Established methods of past sages: If latent heat erupts in Upper Burner, causing vexation/regret, use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). If latent heat erupts in Middle Burner, causing dryness/thirst, use Bai Hu Tang (White Tiger Decoction). If latent heat erupts in Lower Burner, causing red/hot urine, use Zhu Ling Tang (Polyporus Decoction). Upper Burner: Clear and disperse; Middle Burner: Clear and descend; Lower Burner: Clear and drain. These are all methods of clearing the Interior. The method of nourishing Yin requires careful distinction of sequence and urgency. Mr. Yu emphasizes Yangming because the Stomach is the Sea of Twelve Channels and the Great Source of Five Zang and Six Fu Organs. Based on my experience: Those not yet sweated/purgated/reconciled are Yangming due to Yang Excess causing Dryness; clearing Fire and purging Yang is urgent. Those already sweated/purgated/reconciled are Yangming due to Yin Withering causing Dryness; moistening Dryness and nourishing Yin is primary. The appropriateness of nourishing Yin agents should be judged by this standard.
Pathogens remaining in Qi level are easily dispersed and vented. Mild cases resolve with spontaneous sweating; severe cases resolve with battle-sweat or maniacal-sweat. Pathogens remaining in Blood level are often sticky and stagnant. Mild cases resolve with rashes; severe cases resolve with abscesses/carbuncles.
[Commentary by Xiu] Qi is light and clear. When Zheng Qi is deficient and Pathogen is excess, Pathogen and Zheng Qi contend, causing battle-sweat resolution. When Zheng Qi is not deficient but Pathogen is extreme, Zheng Qi attempts to force Pathogen out, contending with it, causing maniacal-sweat resolution. When both Pathogen and Zheng Qi decline, Yin/Yang harmonize spontaneously, causing non-battle/non-maniacal spontaneous sweating. This explains resolution via spontaneous, battle, or maniacal sweat. Blood is heavy and turbid. When pathogens remain in Blood level, Pathogen suppression is severe. Urgently, it resolves via rashes; slightly slower, via carbuncles. Both are exterior resolutions. If pathogens do not resolve externally but transmit inward, they attach to intestinal/fecal waste and must resolve via defecation. This applies to severe cold damage, latent warm-heat, and seasonal epidemics.