伤寒二三日阳明少阳证不见者为不传也
伤寒一日太阳二日阳明三日少阳此定法也二日三日无不传阳明少阳之理若阳明少阳之里证不见者是但传三阳之经而
不传阳明之腑也 阳明病皆腑病非经病故曰阳明之为病胃家实也胃家一实则病邪归腑终始不迁虽未尝不传三阴之经而不
复入三阴之脏所谓阳明中土万物所归无所复传以其阳尽而阴退也至于葛根汤证则腑病之连经而胃热之未实者即其桂枝麻
黄二证亦阳明之经病未成阳实之腑病者也二三日中不见阳明胃家实证此为不传阳明之腑也少阳病小柴胡证皆脏腑病之连
经亦非但是经病缘脏腑经络表里郁迫故柴胡诸证久而不罢有至八九日以及十三日且有过经十余日者若不连脏腑但在经络
则三日少阳四日已见太阴经病证五日已见少阴经病证六日经尽而汗解何得少阳一经之证如此久远而不退乎即其麻黄一证
亦少阳之经病未成内连脏腑之证者也二三日中不见少阳柴胡证此亦为不传阳明之腑也
伤寒一日太阳受之脉若静者为不传颇欲吐若烦躁脉急数者为传也
浮紧之脉断不能静设脉若安静者为不内传若经邪郁迫阳明少阳之经胃气上逆颇欲作吐与夫烦躁不宁脉候急数者是其
表邪束迫之重与经气郁遏之极此为必将内传也 太阳经病里气和平阳不偏盛则不内传于腑阴不偏盛则不内传于脏伤寒一
日太阳受之脉若安静者为不传谓不传于脏腑非谓不传于六经也程氏以为温病传经伤寒不传经果不传经是伤寒一日病在太
阳若脉候安静则一日而汗解也既是伤寒安有一日即解之理若不经汗解六经部次相连安有太阳既病但在此经绝不挨经而内
传者乎其谓数日仍在太阳数日方过阳明支离不通矣又言或从太阳而阳明或从太阳而少阳阳明在太阳少阳之间既过阳明而
传少阳阳明何以不病若不过阳明何由而及少阳后世庸妄旧有直中阴经之说未知三阳在表何由超越三阳而内及阴经也此皆
下愚之胡谈不足深辨也
伤寒发病二三日,若未见阳明病和少阳病的证候,说明病邪没有传变。
伤寒第一天太阳经受邪,第二天阳明经受邪,第三天少阳经受邪,这是固定的规律。到了第二、三天,按理说病邪应当传入阳明或少阳;如果此时没有出现阳明或少阳的里证,说明病邪只是传入了三阳经的经脉,而没有传入阳明腑(胃与大肠)。
阳明病都是腑病,而不是经病,所以说“阳明之为病,胃家实也”。“胃家”一旦实证,病邪归入腑中,始终停留在此处不再移动。虽然病邪可能经过三阴经,但不会再进入三阴之脏,这就是所谓的“阳明中土,万物所归,无所复传”,因为阳气极盛而阴气退却的缘故。至于葛根汤证,则是腑病牵连到经,且胃热尚未成实的阶段;即使是桂枝汤证和麻黄汤证,也属于阳明经病,尚未形成阳实性质的腑病。在第二、三天中,如果没有出现阳明“胃家实”的证候,这就叫做没有传入阳明之腑。
少阳病的小柴胡汤证,都是脏腑病变牵连到经脉,也不仅仅是经病。这是因为脏腑经络表里之间郁结逼迫所致,所以小柴胡汤的各种证候如果久不痊愈,有的长达八九天甚至十三天,甚至有超过经尽十余天的情况。如果病邪仅仅停留在经络而不牵连脏腑,那么到第三天出现少阳经病证,第四天应该见到太阴经病证,第五天见到少阴经病证,第六天经气运行完毕就会汗出而解,怎么会有少阳一经的证候如此长久不退呢?即使是麻黄汤证,也是少阳的经病,尚未形成内连脏腑的证候。在第二、三天中,如果没有出现少阳小柴胡汤证,这也算是没有传入阳明之腑(注:此处原文逻辑似有笔误或特定语境,通常指未传少阳之腑/半表半里,但依文意翻译为未传相应重证)。
伤寒第一天,太阳经受邪,如果脉象平静,说明病邪没有传变;如果病人频频想吐,或者烦躁不安,脉象急数,说明病邪正在传变。
浮紧的脉象绝对不能说是平静的。假设脉象安静,说明病邪不会向内传变。如果是经邪郁结逼迫阳明、少阳之经,导致胃气上逆频频作呕,以及烦躁不宁、脉象急数,这是表邪束缚逼迫严重,经气郁遏至极的表现,这必定会向内传变。
太阳经病时,如果里气平和,阳气不偏盛,就不会内传于腑;阴气不偏盛,就不会内传于脏。伤寒第一天太阳受邪,如果脉象安静,说明没有传变,这里指的是不传于脏腑,并非指不传于六经。程氏认为温病传经而伤寒不传经,如果真的不传经,那么伤寒第一天病在太阳,如果脉象安静,就应该一天就汗解了。既然是伤寒,哪有第一天就自愈的道理?如果不通过发汗解表,六经部位次序相连,哪里有太阳既已患病,只停留在这一经,绝不挨着其他经向内传变的道理?那些说几天仍在太阳、几天才过阳明的说法,支离破碎,不通顺。又说有的从太阳传到阳明,有的从太阳传到少阳。阳明位于太阳和少阳之间,既然已经过了阳明再传少阳,那阳明怎么会不生病呢?如果不过阳明,又怎么能到达少阳?后世庸俗狂妄之人旧有的“直中阴经”的说法,不知道三阳经都在体表,怎么可能超越三阳经直接内及阴经呢?这些都是愚昧无知的胡说八道,不值得深入辩驳。
Taiyang disease (disease of the Taiyang channel) occurring on the second or third day, if no Yangming (disease of the Yangming channel/fu-organ) or Shaoyang (disease of the Shaoyang channel/gallbladder) syndromes are observed, indicates that the pathogen has not transmitted.
In the first day of Taiyang disease, the Taiyang channel is affected; on the second day, the Yangming channel; and on the third day, the Shaoyang channel. This is a fixed rule. By the second and third days, logic dictates the pathogen should transmit to Yangming or Shaoyang. If there are no interior syndromes of Yangming or Shaoyang at this time, it means the pathogen has only transmitted to the meridians of the Three Yang channels but has not entered the Fu-organs of Yangming.
Yangming diseases are all Fu-organ diseases, not Meridian diseases. Therefore, it is stated: "The essence of Yangming disease is the excess condition of the Stomach family" (Wei Jia Shi). Once the "Stomach family" becomes excessive, the pathogen resides in the Fu-organ and remains there without shifting. Although the pathogen may pass through the Three Yin channels, it will not re-enter the Zang-organs of the Three Yin. This is referred to as "Yangming, the central earth, is the destination for all things, with nowhere else to transmit," because Yang energy reaches its peak while Yin recedes. As for the Ge Gen Tang (Kudzu Decoction) syndrome, it represents a Fu-organ disease affecting the meridian, where Stomach heat has not yet become excessive. Even the Gui Zhi Tang (Cinnamon Twig Decoction) and Ma Huang Tang (Ephedra Decoction) syndromes belong to Yangming Meridian diseases and have not yet formed the excessive Fu-organ disease characterized by Yang excess. In the second and third days, the absence of the "excess condition of the Stomach family" in Yangming indicates that transmission to the Yangming Fu-organ has not occurred.
Shaoyang diseases, such as those treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction), involve organ-pathology affecting the meridians and are not merely meridian diseases. This is due to the constraint and pressure between the interior and exterior of the organs and meridians. Consequently, syndromes associated with Chai Hu (Bupleuri Radix) may persist for eight or nine days, or even thirteen days, sometimes exceeding ten days after the completion of the meridian cycle. If the pathogen were confined solely to the meridians without involving the organs, one would expect Shaoyang meridian symptoms on the third day, Taiyin meridian symptoms on the fourth day, Shaoyin meridian symptoms on the fifth day, and resolution through sweating by the sixth day when the meridian cycle completes. How could Shaoyang syndromes persist so long without receding? Even the Ma Huang Tang syndrome is a Shaoyang meridian disease that has not yet formed an interior syndrome connecting to the organs. The absence of Xiao Chai Hu Tang syndromes in the second and third days also signifies that transmission to the relevant deep-seated pathology has not occurred.
On the first day of Taiyang disease, if the pulse is calm, it indicates no transmission. However, if the patient frequently desires to vomit, experiences irritability, and the pulse is rapid and urgent, it indicates transmission.
A floating and tight pulse cannot be considered calm. If the pulse were calm, it would indicate that the pathogen will not transmit inward. If meridian pathogens cause constraint upon the Yangming and Shaoyang meridians, leading to rebellious Stomach Qi and frequent vomiting, along with irritability and a rapid, urgent pulse, this signifies severe external pathogen constraint and extreme stagnation of meridian Qi. Such conditions inevitably lead to internal transmission.
When Taiyang meridian disease occurs, if the interior Qi is harmonious and Yang does not prevail excessively, it will not transmit internally to the Fu-organs; if Yin does not prevail excessively, it will not transmit internally to the Zang-organs. On the first day of Taiyang disease, a calm pulse indicates no transmission, specifically meaning no transmission to the Zang and Fu-organs, not that there is no transmission among the Six Channels. Master Cheng argued that Warm Diseases transmit through channels while Cold Damage does not. If Cold Damage truly did not transmit, then on the first day, with the pathogen in Taiyang and a calm pulse, the disease would resolve via sweating on the same day. Since it is Cold Damage, how could it resolve on the first day? Without resolving through sweating, given that the Six Channels are sequentially connected, how could Taiyang disease remain isolated in one channel without transmitting to adjacent ones? Claims that the disease stays in Taiyang for several days before passing Yangming are disjointed and illogical. Others suggest transmission from Taiyang to Yangming or from Taiyang to Shaoyang. Since Yangming lies between Taiyang and Shaoyang, if transmission passes Yangming to reach Shaoyang, why would Yangming not manifest disease? If Yangming is bypassed, how can the pathogen reach Shaoyang? The later theory of "Direct Invasion into the Yin Channels" proposed by ignorant and presumptuous individuals ignores that the Three Yang channels are superficial; thus, it is impossible to bypass the Three Yang channels to directly invade the Yin channels. These are mere nonsensical ramblings of the foolish and do not warrant serious refutation.