太阳病。或已发热。或未发热。必恶寒体痛呕逆。脉阴阳俱紧者。名曰伤寒。
前总脉总证中。已先并举中风伤寒所同有之脉证矣。而尚未分其何以为中风。何以为伤寒也。此篇即于篇首脉
浮头项强痛之总脉证中。又增入已发热未发热。恶寒头痛呕逆。及脉之阴阳俱紧。以别其为伤寒所现之脉证。有
如此也。伤寒者。寒伤营也。营在卫内而属阴。寒本阴邪。其性锋锐。故深入而伤营也。寒邪入腠。玄府紧闭。阳气不
得
发泄。未有不郁而为热者。此言或已发热。或未发热者。言其发热之候。虽有或早或迟。而皆必恶寒体痛呕逆也。称
恶寒而不言恶风者。以寒伤营而言也。下文虽有恶风无汗之条。盖以营卫表里相连。寒邪由卫入营。营伤则卫必
先伤。是以亦恶风也。体痛者。寒伤营分也。营者血中精专之气也。血在脉中。随营气而流贯。滋养
夫一身者也。生气通天论云。圣人陈阴阳而筋脉和同。气血皆从。此因寒邪入于血脉之分。营气涩而不快
于流行。故身体骨节皆痛也。呕逆。气逆而呕也。胸膈为太阳之区界。邪在胸膈。故气逆而为呕也。
然各经之呕不一。唯恶寒发热脉紧无汗之呕。则为太阳之本证也。当以各经之兼证别之。则自分矣。如伤寒呕多。
虽有阳明证。不可攻之。盖以太阳表证未去。亦属太阳之呕也。若发热无汗之伤寒。呕不能食。而反
汗出 然者。是转属阳明之呕也。又如食谷欲呕者。属阳明也。又若呕而往来寒热者。属少阳之类是也。脉紧
者如索之紧绞也。脉经谓紧与弦相类。辨脉篇云。弦者状如弓弦。按之不移也。紧者如转索无常也。脉阴阳俱
紧者。言取之浮候固紧。而按之沉候亦紧也。前中风为阳邪。所以仅伤卫分之阳。故阳浮而阴弱。此以寒邪锋锐。
深入营分。寒邪由卫入营。营卫俱受伤。故脉之阴阳俱紧也。病机十九条云。诸寒收引。皆属于肾。肾与膀胱相
为表里。故寒在太阳而脉紧也。紧则为寒气所伤。故名之曰伤寒也。然非独冬令为然也。六气之变。四时皆有之。
特以冬月为多耳。以下凡称伤寒而用麻黄汤者。皆同此脉证也。以寒伤营为第二层。故以之为太阳中篇也。
辨误 夫寒虽六气之一。实冬令严寒肃杀之藏气也。天地之阳气。自春令上升。出地而发生万物。至夏令而畅茂
盛长矣。盛极当衰。故行秋令以收敛成实。是为西成。既成则有冬气以藏之。又为来春发生之根本。故冬藏之寒气。
乃天地万物成始成终之正气。所以不可伤。伤之则为病矣。然何以伤之即病乎。盖天地之阳气。至十月则阴气已
极。卦属纯坤。十一月而一阳生于盛阴之中。在卦为复。其象为坎。一阳居于二阴之中。以寒水为之
胞胎。涵藏深固。潜养初阳。所谓潜龙勿用也。待渐长出地。而为东震发生之主。故其卦为泰。乃立春
之候也。至二月而阳气始壮。透地上腾而为风矣。由此天造草昧之时。而雷霆风雨。万物化生。草木
条达矣。若伤其寒水之胞胎。则藏阳损泄。至春而不能畅达。则六气不时。旱涝不均。饥荒荐至矣。
人身以肾为冬脏。命门之真阳。藏于两肾之中。即坎卦之象。乃大极中涵藏之元气也。为生气之本。三
焦之原。一阳藏于两肾寒水之中。潜养固密。则元阳充足。然后清阳之气。升越上腾。蒸谷气而外达。
则为卫气。游一身而布化。则为三焦。若此火损伤。则三焦无以布其阳气。上焦无此。则耳目失其聪明。
中焦无此。则水谷不能运化。下焦无此。则气化不得流行。二阴之窍不利。况不能蒸腾其 悍滑疾之谷气。
以外卫皮肤。致腠理不密。而风寒温暑之邪。乘虚而中之矣。故曰冬伤于寒。春必温病。此内经言未病之前。
先伤于寒也。所谓冬伤于寒者。言伤其冬脏主蛰封藏之本。寒水不能固养其元阳。以致三焦肝胆之阳气不旺。
不能敷布其阳春生发之卫气。使腠理不密。玄府空疏。外邪得以袭之而成温也。至若此篇之所谓伤寒者。
乃仲景专指寒邪侵入营卫。郁于腠理之间。阳气不得发泄。恶寒发热之外邪。已病之伤寒也。叔和不晓阴阳。
未达至理。轩岐之旨罔窥。仲景之玄未悟。妄以内经之冬伤于寒。认为仲景之伤寒。不分已病未病。不辨
先天后天。遂引内经冬伤于寒。以证仲景论中伤寒二字。究不能解冬伤于寒。因何直待春令而始温病。又不
能解热论所云。凡病伤寒而成温者。先夏至日者为病温。后夏至日者为病暑。以既感之寒邪。何故肯遥隔
半年三月。然后发动。想其下笔之际。必大为扼腕。不得已而强为一说曰。不即病者。寒毒藏于肌肤。至春变
为温病。至夏变为暑病。若寒邪果肯安然久处于肌肤。
则素问玉机真藏论中之风寒客于人。使人毫毛毕直。皮肤闭而为热之说。岂反为虚语耶。自有叔和之说。
而千古之惑。从此始矣。不意唐启玄子王冰亦不察其误谬。遂于素问阴阳应象论中冬伤于寒句下。引此数语。
以作注脚。又因此而使天下后世之人。皆认为经文之本意如此。莫识其为叔和之谬语。视之不啻若鼎钟
铭勒之文。金石不磨之论。悉崇信之而不疑。动辄引之以为证据。无论智愚。鲜有不陷溺其说。而入其
彀中者矣。余四气之旨。详载在素问生气通天论及阴阳应象论注中。此篇不及俱载。仅略举其一端。以辨
伤寒二字之疑似。为千古之讹耳。
太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风无汗而喘者。麻黄汤主之。
上条虽具脉证。以正伤寒之名。而伤寒之证。犹未备也。故于此条补出诸证。并出其主治之法也。
其于两条中互见者。盖示人以伤寒之见证。非必悉具。亦或有不齐也。邪在太阳必头痛。前虽见之总证。
而本条犹未见也。故仍补出。曰身疼腰痛。骨节疼痛者。所以分疏上文体痛之义。至真要大论云。诸
寒收引。皆属于肾。腰者肾之府也。骨者肾之所主也。肾与膀胱一脏一腑。相为表里。且足太阳膀胱之经。
挟背脊而行于两旁。邪在太阳。故腰痛骨节疼也。恶风虽或可与恶寒互言。然终是营伤卫亦伤也。何则。
卫病则恶风。营居卫内。寒已入营。岂有不从卫分而入者乎。故亦恶风也。无汗而喘者。肺主皮毛。寒
邪在表。内通于肺。邪气不得发泄。肺气不宣通。故无汗而喘也。寒邪非汗泄不解。故以麻黄汤主之。
麻黄汤方
麻黄（三两去节） 桂枝（二两） 甘草（一两） 杏仁（七十个去皮研）
上四味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取二升半。去滓。温服八合。覆取微似汗。
不须啜粥。余如桂枝法将息。
麻黄气味轻薄。辛温发散。肺经开鬼门之专药也。杏仁苦辛。滑利肺气之要药也。仲景治太阳伤寒。皆用手
太阴药者。以肺主皮毛故也。用甘草者。经云寒淫所胜。平以辛热。佐以苦甘是也。一剂之中。唯桂
枝为卫分解肌之药。而能与麻黄同发营分之汗者。以卫居营外。寒邪由卫入营。故脉阴阳俱紧。阳脉
紧则卫分受伤。阴脉紧则邪伤营分。所以欲发营内之寒邪。先开卫间之出路。方能引邪由营达卫。汗出
而解也。故李时珍本草发明下云。麻黄乃肺经专药。故治肺病多用之。张仲景治伤寒无汗用麻黄。有汗用桂枝。
历代名医解释。皆随文附会。未有究其精微者。时珍尝思之。似有一得。与昔人所解不同。夫津液为汗。汗
即血也。在营则为血。出卫则为汗。大寒伤营。营血内涩。不能外通于卫。卫气闭固。津液不行。故无汗发热
而憎寒。夫风伤卫。卫气受邪。不能内护于营。营气虚弱。津液不固。故有汗发热而恶风。然风寒之邪。皆
由皮毛而入。皮毛者肺之合也。肺主卫气。包罗一身。天之象也。证虽属乎太阳。而肺实受邪气。其证时兼
面赤怫郁。咳嗽痰喘胸满诸证者。非肺病乎。盖皮毛外闭。则邪热内攻。而肺气 郁。故麻黄甘草同桂枝
引出营分之邪。达之肌表。佐以杏仁。泄肺而利气。是则麻黄汤虽太阳发汗重剂。实为发散肺经火郁之药
也。濒湖此论。诚千古未发之秘。奈何前辈见仲景用之以发太阳之汗。遂以为足太阳药。又以麻黄为发汗之药。桂
枝为固卫止汗之药。若桂枝果能止汗。仲景岂反用之以助麻黄而发汗耶。后人有用麻黄而监之以桂枝。见节制
之妙。更有驭六马而执辔唯谨。恒虞其泛轶之说。岂理也哉。
脉浮者。病在表。可发汗。宜麻黄汤。
脉浮而数者。可发汗。宜麻黄汤。
此二条。所申脉浮及浮数者。亦可发汗。不必皆紧脉也。按脉法。浮则为风。紧则为寒。脉浮恶风自汗者。
当用桂枝汤解之。脉紧恶寒无汗者。当以麻黄汤汗之。中风用麻黄汤。则为误汗。伤寒用桂枝汤。尤为禁剂。
此条以脉但浮。而曰可发汗。宜麻黄汤。岂仲景之误耶。以理测之。脉虽浮数而不紧。必有恶寒体痛无汗之见症。
故以麻黄汤发汗也。若脉浮而数者。尤似乎脉浮而动数之太阳中风矣。不知已发热之伤寒。其脉亦可浮数也。
但察其所见之证。有恶寒无汗等证。则仍是寒伤营也。然脉既浮数。则郁热之邪犹在表。经云。可汗而已也。
故曰可发汗。宜麻黄汤。
辨误 寒邪在表则脉浮。已发热者则脉数。此其常也。因上文有阴阳俱紧之脉法。然寒邪在表。亦可浮紧。
恐人拘泥。故又申此二条。以明伤寒脉浮及浮数者。亦可用麻黄汤。但以有汗无汗别之可也。注家俱因仲景有
脉数急者为欲传句。遂谓乘其欲散而拓出之。散其数而不令其至于传。后人因之又巧为之说曰。乘其势正欲传。
用麻黄击其半渡。而驱之使出。以理推之。恐不必作如是解。
伤寒一日太阳受之。脉若静者。为不传。颇欲吐。若燥烦脉数急者。为传也。
伤寒一日太阳受之者。即内经热论所谓一日巨阳受之。二日阳明受之之义也。因太阳主表。总统营卫。故先受邪
也。然寒伤营之证。其脉阴阳俱紧。或见浮紧之脉。若一日之后。脉安静恬退。则邪轻而自解。不至传入他经矣。倘见
证颇觉欲吐。则伤寒呕逆之证。犹未除也。况吐则邪入胃。乃内入之机。若口燥而烦热。脉数急者。为邪气已郁为热。
其气正盛。势未欲解。故为传经之候也。
伤寒二三日。阳明少阳证不见者。为不传也。
二三日。热论所谓二日阳明受之。三日少阳受之也。然未必太阳之邪必先传阳明。而后传少阳也。或入阳明。或入
少阳。未可定也。若以常法论之。则二日当传阳明。三日当传少阳。若二三日阳明少阳证不见者。是邪气止在
一经。故为不传也。
太阳病。或者已经发热，或者尚未发热，必定伴有恶寒、身体疼痛、呕吐逆气。如果脉象寸关尺三部都呈现紧象的，称为伤寒。
在前面总论脉证中，已经先并列举出了中风和伤寒所共有的脉证了，但还没有区分究竟什么是中风，什么是伤寒。这一篇就在篇首“脉浮、头项强痛”的总脉证中，又增加了“已发热、未发热”、“恶寒、头痛、呕吐逆气”，以及脉象“阴阳俱紧”的内容，以此来区别这是伤寒所表现出的脉证，情况就是这样。所谓伤寒，就是寒邪损伤营分。营气在卫气之内而属于阴，寒邪本是阴邪，其性质锋锐，所以深入而损伤营分。寒邪侵入腠理，玄府（汗孔）紧闭，阳气不能发泄，没有不郁结而产生热的。这里说“或已发热，或未发热”，是说发热的时机，虽然有或早或迟的区别，但都必定伴有恶寒、身体疼痛、呕吐逆气。称恶寒而不称恶风，是因为从寒伤营的角度来说的。下文虽然有恶风无汗的条文，大概是因为营卫表里相连，寒邪由卫分进入营分，营分受伤则卫分必定先受伤，所以也出现恶风。身体疼痛，是寒邪损伤营分。营气是血中精专之气。血液在脉管中，随着营气流动贯通，滋养全身。《生气通天论》说：“圣人调和阴阳使筋脉平和，气血顺从。”这是因为寒邪侵入血脉之分，营气涩滞而不能流畅流行，所以身体骨节都疼痛。呕吐逆气，是气逆而上导致的呕吐。胸膈是太阳经的区域界限，邪气在胸膈，所以气逆而为呕吐。
然而各经的呕吐不止一种，只有恶寒、发热、脉紧、无汗的呕吐，才是太阳病的本证。应当根据各经的兼证来辨别，自然就能分清。比如伤寒呕吐多，即使有阳明病的证候，也不可攻下。这是因为太阳表证未去，也属于太阳的呕吐。如果是发热无汗的伤寒，呕吐不能进食，反而出汗淋漓的，这是转属阳明的呕吐。又如进食就想呕吐的，属于阳明病。再如呕吐且往来寒热的，属于少阳病之类。脉紧，像绳索一样紧绷绞转。《脉经》说紧脉与弦脉相似，《辨脉篇》说：弦脉像弓弦一样，按之不移位；紧脉像转动的绳索一样无常。脉阴阳俱紧，是说轻取浮候确实紧，重按沉候也紧。前面的中风是阳邪，所以只损伤卫分之阳，因此阳脉浮而阴脉弱。这里因为寒邪锋锐，深入营分，寒邪由卫入营，营卫都受伤，所以脉象阴阳俱紧。《病机十九条》说：“各种寒性收引的症状，都归属于肾。”肾与膀胱互为表里，所以寒在太阳经而脉紧。紧脉则是寒气所伤，所以命名为伤寒。然而并不只是冬季才这样，六气的变化，四季都有，只是冬季比较多罢了。以下凡是提到伤寒而使用麻黄汤的，都是同样的脉证。因为以寒伤营为第二层，所以将其作为太阳病的中篇。
【辨误】 寒虽然是六气之一，实际上是冬季严寒肃杀的收藏之气。天地的阳气，从春季开始上升，出地而发生长万物，到了夏季就茂盛生长了。盛极必衰，所以施行秋季的命令来收敛成果实，这叫做西成。既已成就，则有冬气来收藏它，又成为来年春天发生的根本。所以冬季收藏的寒气，乃是天地万物成始成终的正气。所以不可受伤害，受了伤害就会生病。然而为什么受了寒立刻就会生病呢？大概天地的阳气，到了十月阴气已经极盛，卦象属于纯坤。十一月一阳生于盛阴之中，在卦象为复卦，其形象为坎卦。一阳居于二阴之中，以寒水为胞胎，涵藏深固，潜养初生的阳气，这就是所说的“潜龙勿用”。等到逐渐长出地面，成为东方震卦发生的主宰，所以其卦象为泰卦，这是立春的时候。到了二月阳气始壮，透地上腾而变为风了。由此天造草昧之时，雷霆风雨，万物化生，草木条达舒展。如果损伤了寒水的胞胎，则藏阳损泄，到了春天就不能畅达，那么六气就不按时令，旱涝不均，饥荒接连而至。
人体以肾为冬季之脏，命门的真阳，藏在两肾之中，即坎卦的形象，是大极中涵藏的元气。它是生气的根本，三焦的原动力。一阳藏于两肾寒水之中，潜养固密，则元阳充足，然后清阳之气，升越上腾，蒸腾谷气而外达，就成为卫气，游走一身而布化，就成为三焦。如果此火受到损伤，则三焦无法布散其阳气。上焦没有此火，则耳目失去聪明；中焦没有此火，则水谷不能运化；下焦没有此火，则气化不得流行，二阴之窍不利。况且不能蒸腾其慓悍滑疾的谷气，以外卫皮肤，导致腠理不紧密，而风寒温暑等邪气，乘虚而入。所以说“冬伤于寒，春必温病”。这是《内经》说的在未病之前，先伤了寒邪。所谓“冬伤于寒”，是说损伤了冬季主蛰封藏的根本，寒水不能固养其元阳，以致三焦肝胆的阳气不旺，不能敷布其阳春生发的卫气，使腠理不密，玄府空疏，外邪得以侵袭而成温病。至于这篇所说的伤寒，乃是张仲景专门指寒邪侵入营卫，郁于腠理之间，阳气不得发泄，出现恶寒发热之外邪，是已经发病的伤寒。王叔和不晓阴阳，未通达至理，轩岐（黄帝、岐伯）的宗旨未曾窥见，仲景的玄妙未能领悟，妄将《内经》的“冬伤于寒”认为是仲景的“伤寒”，不分已病未病，不辨先天后天，于是引用《内经》“冬伤于寒”来证明仲景《论》中“伤寒”二字，终究不能解释“冬伤于寒”为何要直待春令才开始温病，也不能解释《热论》所说：“凡病伤寒而成温者，先夏至日者为病温，后夏至日者为病暑。”既然感到的寒邪，为何肯遥隔半年三月，然后才发动？想他下笔之际，必定大为扼腕，不得已而强行解释说：“不即病者，寒毒藏于肌肤，至春变为温病，至夏变为暑病。”如果寒邪果真肯安然久处于肌肤，那么《素问·玉机真藏论》中说的“风寒客于人，使人毫毛毕直，皮肤闭而为热”的说法，岂不是反成了虚语吗？自从有了王叔和的说法，千古的疑惑，从此开始了。没想到唐代王冰也不察其谬误，于是在《素问·阴阳应象大论》中“冬伤于寒”句下，引用这几句话，作为注脚。又因此使天下后世的人，都认为经文的本意如此，不知道那是王叔和的谬语，看待它不像鼎钟铭刻的文字、金石不磨的言论那样完全崇信而不怀疑，动辄引用它作为证据，无论智愚，很少有不被其学说陷溺而落入其圈套的。我关于四气的旨意，详细记载在《素问·生气通天论》及《阴阳应象论》注中，本篇不及全部载录，仅略举其一端，以辨明“伤寒”二字的疑似，纠正千古的讹误罢了。
太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘的，用麻黄汤主治。
上一条虽然具备了脉证，用以确立伤寒的名称，但伤寒的证候，还不完备。所以在此条补充出各种证候，并给出主治的方法。这两条中互相见到的内容，大概是告诉人们伤寒的见证，不一定全部具备，也可能有不齐备的情况。邪气在太阳经必定头痛，前面虽然在总证中见到，但本条还未见到，所以仍补充出来。说“身疼腰痛，骨节疼痛”，是用来分别说明上文“体痛”的含义。《至真要大论》说：“诸寒收引，皆属于肾。”腰是肾之府，骨是肾所主的。肾与膀胱一脏一腑，互为表里，而且足太阳膀胱经，挟背脊而行于两旁，邪气在太阳经，所以腰痛骨节疼。恶风虽然有时可与恶寒互言，但最终是营伤卫也伤。为什么呢？卫病则恶风，营居卫内，寒已入营，岂有不从卫分而入的呢？所以也恶风。无汗而喘，肺主皮毛，寒邪在表，内通于肺，邪气不得发泄，肺气不宣通，所以无汗而喘。寒邪非通过汗泄不能解除，所以用麻黄汤主治。
麻黄汤方
麻黄（三两，去节） 桂枝（二两） 甘草（一两） 杏仁（七十个，去皮尖，研）
以上四味药，用水九升，先煮麻黄，减少二升，去掉上面的浮沫，加入其他药物，煮取二升半，去渣，温服八合，覆盖衣被取微似汗。不需要喝粥，其余调养方法如同桂枝汤法。
麻黄气味轻薄，辛温发散，是肺经开启鬼门（汗孔）的专用药。杏仁苦辛，滑利肺气的重要药物。张仲景治疗太阳伤寒，都用入手太阴肺经的药，是因为肺主皮毛。用甘草，经云：“寒淫所胜，平以辛热，佐以苦甘。”在一剂药中，只有桂枝是解肌发表的药物，却能配合麻黄同发营分之汗，是因为卫居营外，寒邪由卫入营，所以脉阴阳俱紧。阳脉紧则卫分受伤，阴脉紧则邪伤营分。所以想要发散营内的寒邪，必须先开通卫间的出路，才能引导邪气由营达卫，汗出而解。所以李时珍在《本草纲目·发明》下说：“麻黄乃肺经专药，故治肺病多用之。”张仲景治伤寒无汗用麻黄，有汗用桂枝。历代名医的解释，都随文附会，未有探究其精微的。李时珍曾思考过，似乎有一得之见，与昔人所解不同。津液为汗，汗即血也，在营则为血，出卫则为汗。大寒伤营，营血内涩，不能外通于卫，卫气闭固，津液不行，所以无汗发热而憎寒。风伤卫，卫气受邪，不能内护于营，营气虚弱，津液不固，所以有汗发热而恶风。然而风寒之邪，皆由皮毛而入，皮毛者是肺之合，肺主卫气，包罗一身，天之象也。证候虽属太阳，而肺实际受邪气，其证时常兼见面赤怫郁、咳嗽痰喘胸满诸证，这不是肺病吗？大概皮毛外闭，则邪热内攻，而肺气郁结，所以麻黄、甘草同桂枝引出营分之邪，达之肌表，佐以杏仁，泄肺而利气。这样看来，麻黄汤虽然是太阳发汗的重剂，实为发散肺经火郁的药物。李时珍（濒湖）此论，确实是千古未发的秘密。奈何前辈见仲景用之以发太阳之汗，遂以为它是足太阳经的药，又以麻黄为发汗之药，桂枝为固卫止汗之药。如果桂枝果能止汗，仲景岂反用之以助麻黄而发汗耶？后人有用麻黄而监制以桂枝的，见节制之妙，更有驾驭六匹马而执辔唯谨，常担心其泛轶（失控）的说法，这难道是道理吗？
这两条，所申述的是脉浮及浮数的，也可以发汗，不必都是紧脉。按脉法，浮则为风，紧则为寒。脉浮、恶风、自汗的，当用桂枝汤解之。脉紧、恶寒、无汗的，当以麻黄汤汗之。中风用麻黄汤，则为误汗；伤寒用桂枝汤，尤为禁忌。此条说脉但浮，而曰可发汗，宜麻黄汤，难道是仲景的错误吗？以理推测，脉虽浮数而不紧，必定伴有恶寒、体痛、无汗的见症，所以用麻黄汤发汗。若脉浮而数者，尤其似乎脉浮而动数的太阳中风了。不知已发热的伤寒，其脉也可浮数。只要察其所见的证候，有恶寒、无汗等证，则仍是寒伤营。然脉既浮数，则郁热之邪犹在表，经云：“可汗而已也。”所以说可发汗，宜麻黄汤。
【辨误】 寒邪在表则脉浮，已发热者则脉数，这是常理。因上文有阴阳俱紧的脉法，然而寒邪在表，亦可浮紧。恐人拘泥，所以又申述此两条，以明伤寒脉浮及浮数的，也可用麻黄汤，但以有汗无汗来辨别即可。注家都因仲景有“脉数急者为欲传”的句子，遂谓乘其欲散而拓出之，散其数而不令其至于传。后人因此又巧为之说曰：乘其势正欲传，用麻黄击其半渡，而驱之使出。以理推之，恐怕不必作如是解。
伤寒一日，太阳受之，脉若静的，为不传。颇欲吐，若躁烦，脉数急者，为传也。
“伤寒一日，太阳受之”，即《内经·热论》所谓“一日巨阳受之，二日阳明受之”的意思。因为太阳主表，总统营卫，所以先受邪。然而寒伤营的证候，其脉阴阳俱紧，或见浮紧之脉。若一日之后，脉安静恬退，则邪轻而自解，不至传入他经了。倘见症颇觉欲吐，则伤寒呕逆的证候，仍未除。况且吐则邪入胃，乃内入之机。若口燥而烦热，脉数急者，为邪气已郁为热，其气正盛，势未欲解，故为传经的征候。
伤寒二三日，阳明少阳证不见的，为不传也。
二三日，是《热论》所谓“二日阳明受之，三日少阳受之”。然而未必太阳之邪必先传阳明，而后传少阳。或入阳明，或入少阳，未可定也。若以常法论之，则二日当传阳明，三日当传少阳。若二三日阳明少阳证不见的，是邪气止在一经，故为不传。
Taiyang disease (Disease of the Taiyang/Bladder channel). There may be fever already, or there may be no fever yet. There will invariably be aversion to cold (aversion to cold), body pain, and vomiting with a sensation of qi rushing upward. If the pulse is tight at both the cun (distal) and chi (proximal) positions on both hands, it is named Shanghan (Cold Damage).
In the previous general discussion of pulses and syndromes, the pulses and syndromes common to Fengzhong (Wind Strike) and Shanghan were already listed together, but it was not yet distinguished which constitutes Fengzhong and which constitutes Shanghan. This chapter, starting from the general pulse and syndrome of "floating pulse, stiffness and pain in the head and neck," adds "fever present or absent," "aversion to cold, headache, vomiting," and the "tightness of the pulse at yin and yang positions" to differentiate these as the pulses and syndromes manifested by Shanghan. Such is the situation. Shanghan refers to cold pathogen damaging the Ying (Nutrient) level. The Ying level resides within the Wei (Defensive) level and belongs to Yin. Cold is originally a Yin pathogen, with a sharp nature, thus penetrating deeply to damage the Ying level. When the cold pathogen enters the Couli (interstices/skin pores), the Xuanfu (pores) become tightly closed, preventing Yang Qi from venting. It is inevitable that stagnation will generate heat. The statement "either fever has already appeared or has not yet appeared" indicates that although the timing of fever onset may vary (early or late), aversion to cold, body pain, and vomiting are invariably present. The term "aversion to cold" is used rather than "aversion to wind" because the focus is on cold damaging the Ying level. Although subsequent texts mention aversion to wind and absence of sweating, this is likely because the Ying and Wei levels are interconnected internally and externally; as the cold pathogen moves from the Wei to the Ying, damage to the Ying implies prior damage to the Wei, hence aversion to wind also occurs. Body pain results from cold damaging the Ying division. Ying Qi is the refined and concentrated Qi within the blood. Blood flows within the vessels, circulating with Ying Qi to nourish the entire body. The *Suwen: Shengqi Tongtian Lun* states, "The sage harmonizes Yin and Yang so that sinews and vessels are peaceful, and Qi and blood follow smoothly." This is because when the cold pathogen enters the blood vessels, Ying Qi becomes sluggish and fails to circulate freely, causing pain throughout the body and joints. Vomiting and upward rushing of Qi result from rebellious Qi. The chest and diaphragm constitute the boundary area of the Taiyang channel; when pathogens reside here, Qi rebels upward causing vomiting.
However, vomiting occurs in various channels. Only vomiting accompanied by aversion to cold, fever, tight pulse, and absence of sweating constitutes the primary syndrome of Taiyang. One must distinguish it based on accompanying syndromes of other channels to clarify the diagnosis. For instance, if vomiting is frequent in Shanghan, even if Yangming syndromes are present, purgation should not be used. This is because the Taiyang exterior syndrome has not resolved, so it still belongs to Taiyang vomiting. If, in Shanghan characterized by fever and absence of sweating, there is vomiting, inability to eat, and profuse sweating, this indicates a transformation into Yangming vomiting. Similarly, desire to vomit after eating belongs to Yangming. Furthermore, vomiting accompanied by alternating chills and fever belongs to Shaoyang, and so forth. A "tight" pulse feels like a twisted rope. The *Maijing* states that the tight pulse resembles the wiry pulse. The *Bianmai Pian* says: "The wiry pulse resembles a bowstring, firm and unyielding upon pressure; the tight pulse resembles a turning rope, shifting constantly." "Tightness at yin and yang positions" means that upon superficial palpation (floating position), the pulse is indeed tight, and upon deep palpation (sinking position), it is also tight. In the case of Fengzhong, the pathogen is Yang, thus only damaging the Yang of the Wei level, resulting in a floating Yang pulse and weak Yin pulse. Here, due to the sharp nature of the cold pathogen penetrating deeply into the Ying level, and moving from Wei to Ying, both Ying and Wei are damaged, resulting in a tight pulse at both yin and yang positions. The *Jingji Jiuyao* states, "All conditions of contraction and pulling due to cold belong to the Kidney." Since the Kidney and Bladder are interior-exteriorly related, cold in the Taiyang channel manifests as a tight pulse. Tightness indicates injury by cold Qi, hence the name Shanghan. However, this is not exclusive to winter; changes in the Six Qi occur in all four seasons, though they are more prevalent in winter. Henceforth, whenever Shanghan is mentioned with the use of Mahuang Tang, it refers to this specific pulse and syndrome pattern. As damaging the Ying level by cold constitutes the second layer, this section is placed as the middle chapter of Taiyang diseases.
[Correction of Errors] Although Cold is one of the Six Qi, it is essentially the storing energy of severe winter cold and desolation. Heaven and Earth's Yang Qi rises in spring, emerging from the earth to generate all things, reaching full flourishing and growth in summer. At its peak, it declines, thus enacting autumn's command to converge and mature. This is called "Western Completion." Once completed, winter energy stores it, serving as the root for next spring's generation. Therefore, the cold energy stored in winter is the righteous energy for the beginning and end of all things in heaven and earth. It must not be injured; injury leads to disease. Why does injury cause immediate illness? By the tenth lunar month, Yin Qi is at its extreme, corresponding to the hexagram Kun (Pure Yin). In the eleventh month, one Yang arises amidst extreme Yin, corresponding to the hexagram Fu (Return), with the image of Kan (Water). One Yang resides between two Yin lines, using cold water as its womb, deeply hidden and firmly nurtured, cultivating the initial Yang—this is what is meant by "Hidden Dragon, do not act." Waiting until it gradually emerges above ground to become the master of generation in East Zhen (Thunder), its hexagram becomes Tai (Peace), marking the time of Lichun (Start of Spring). By the second lunar month, Yang Qi strengthens, rising above ground becoming Wind. From this primordial time, thunder, rain, and wind generate all things, allowing plants to grow vigorously. If the womb of cold water is injured, the stored Yang leaks and depletes. By spring, it cannot flourish freely, causing the Six Qi to be out of season, leading to droughts and floods, and successive famines.
In the human body, the Kidney is the organ of winter. The True Yang of the Mingmen (Gate of Life) resides within the two kidneys, mirroring the image of the Kan hexagram. It is the Yuan Qi (Original Qi) contained within the Great Ultimate. It is the root of generating Qi and the source of the Sanjiao (Triple Burner). One Yang hides within the cold water of the two kidneys, nurtured securely and densely. When Yuan Yang is sufficient, clear Yang Qi rises and ascends, steaming grain Qi to reach the exterior, becoming Wei Qi. It roams the body and distributes via the Sanjiao. If this Fire is damaged, the Sanjiao cannot distribute Yang Qi. Without it in the Upper Jiao, hearing and vision lose clarity; without it in the Middle Jiao, food and drink cannot be transformed; without it in the Lower Jiao, Qi transformation fails, and the openings of the Yin organs are obstructed. Moreover, it cannot steam the pungent, slippery, and rapid grain Qi to defend the skin externally, leading to loose Couli, allowing wind, cold, warmth, and summer-heat pathogens to invade through deficiency. Thus, it is said, "If one is injured by cold in winter, one will suffer from Warm Disease in spring." This refers to injury by cold before the manifestation of disease. "Winter injury by cold" means injuring the root of hibernation and storage governed by the Winter organ. Cold water fails to secure and nurture Yuan Yang, causing the Yang Qi of the Sanjiao, Liver, and Gallbladder to be weak, unable to distribute the spring-like generating Wei Qi. This leaves Couli loose and Xuanfu open, allowing external pathogens to invade and cause Warmth. However, the "Shanghan" discussed in this chapter specifically refers to Zhang Zhongjing's designation of cold pathogen invading Ying and Wei, stagnating in the Couli, preventing Yang Qi from venting, manifesting as aversion to cold and fever—an already manifested Shanghan. Wang Shuhe failed to understand Yin and Yang and did not grasp the profound principles. He did not perceive the teachings of Xuanyuan and Qibo, nor comprehend the mysteries of Zhongjing. He erroneously equated the *Neijing*'s "winter injury by cold" with Zhongjing's "Shanghan," failing to distinguish between pre-disease and post-disease states, or congenital and acquired factors. He cited the *Neijing* to justify the term "Shanghan" in Zhongjing's treatise, yet could not explain why "winter injury by cold" leads to Warm Disease only in spring, nor could he explain the *Relun* passage: "All diseases transforming from Shanghan into Warmth are called Wen if occurring before the Summer Solstice, and Shu if occurring after." How could an acquired cold pathogen remain dormant for half a year or three months before activating? Presumably, upon writing, he must have been greatly frustrated, forcing an explanation: "Those who do not immediately fall ill harbor cold toxicity in the skin and muscles, transforming into Warm Disease in spring and Heat Disease in summer." If cold pathogen could indeed remain peacefully in the skin and muscles for long, would the statement in *Suwen: Yuji Zhenzang Lun*—"When wind and cold invade humans, causing all hair to stand erect and skin pores to close, generating heat"—be false? Since Wang Shuhe's theory,千古 (eternal) confusion began. Unexpectedly, Wang Bing of the Tang Dynasty also failed to notice this error. He cited these sentences under "Winter injury by cold" in the *Suwen: Yin-Yang Yingxiang Lun* as commentary. Consequently, future generations believed this was the original intent of the scripture, unaware it was Wang Shuhe's error. They revered it as inscriptions on bronze tripods and carvings on stone, unhesitatingly believing and frequently citing it as evidence. Whether wise or foolish, few escaped falling into his trap. My exposition on the principles of the Four Qi is detailed in the annotations of *Suwen: Shengqi Tongtian Lun* and *Yin-Yang Yingxiang Lun*. This chapter does not reproduce them fully but briefly mentions one aspect to clarify the ambiguity of the term "Shanghan" and correct eternal errors.
Taiyang disease, characterized by headache, fever, body ache, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, is treated primarily with Mahuang Tang.
Although the previous clause provided pulses and syndromes to define the name Shanghan, the symptoms of Shanghan were not fully enumerated. Therefore, this clause supplements various symptoms and provides the primary treatment method. The overlapping information between these two clauses serves to show that the manifestations of Shanghan need not be complete and may vary. Pathogens in the Taiyang channel inevitably cause headache. Although seen in the general syndrome earlier, it is reiterated here. "Body ache, lower back pain, joint pain" clarifies the meaning of "body pain" mentioned previously. The *Zhizheng Dayao Lun* states, "All conditions of contraction and pulling due to cold belong to the Kidney." The waist is the mansion of the Kidney, and bones are governed by the Kidney. The Kidney and Bladder are a zang-fu pair, interior-exteriorly related. The Foot-Taiyang Bladder Channel runs along both sides of the spine. With pathogens in the Taiyang channel, lower back and joint pain occur. Aversion to wind can sometimes be used interchangeably with aversion to cold, but ultimately indicates damage to both Ying and Wei. Why? Wei pathology causes aversion to wind. Ying resides within Wei; if cold has entered Ying, it must have passed through the Wei level. Hence, aversion to wind also occurs. Absence of sweating and wheezing occur because the Lung governs the skin and hair. Cold pathogens in the exterior connect internally to the Lung. Unable to vent, Lung Qi fails to diffuse, causing absence of sweating and wheezing. Cold pathogens cannot be resolved without sweating; thus, Mahuang Tang is used.
Mahuang Tang Formula
Ephedrae Herba (Mahuang, 麻黄) 3 liang, remove nodes
Cinnamomi Ramulus (Guizhi, 桂枝) 2 liang
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 1 liang
Pruni Semen Armeniacae Amarum (Xingren, 杏仁) 70 seeds, remove skins and tips, grind
These four ingredients. Use 9 sheng of water. First boil Ephedrae Herba, reduce by 2 sheng, remove the foam on top. Add the remaining herbs. Boil to obtain 2.5 sheng. Remove dregs. Take 8 ge warm. Cover to induce a slight sweat. Do not consume porridge. Rest and care follow the method of Guizhi Tang.
Ephedrae Herba has a light and thin flavor, acrid and warm, dispersing. It is the specialized herb for opening the "Ghost Gates" (sweat pores) of the Lung Meridian. Pruni Semen Armeniacae Amarum is bitter and acrid, essential for smoothing Lung Qi. Zhang Zhongjing treats Taiyang Shanghan using herbs entering the Hand-Taiyin Lung Meridian because the Lung governs the skin and hair. Gancao is used because the classics state: "For excess cold, soothe with acrid-hot, assist with bitter-sweet." Among these herbs, only Cinnamomi Ramulus is a muscle-relaxing and exterior-releasing agent, yet it works with Ephedrae Herba to induce sweating from the Ying level. This is because Wei resides outside Ying; cold moves from Wei to Ying, causing tightness at yin and yang pulses. Tightness at the Yang pulse indicates Wei damage; tightness at the Yin pulse indicates Ying damage. To release cold pathogens from within Ying, one must first open the exit in Wei, guiding pathogens from Ying to Wei, resolving through sweating. Li Shizhen stated in the *Bencao Gangmu*: "Ephedrae Herba is the specialized herb of the Lung Meridian, hence often used for Lung diseases." Zhang Zhongjing used Ephedrae Herba for Shanghan with no sweat, and Cinnamomi Ramulus for those with sweat. Past physicians explained this merely by following the text, rarely exploring the essence. Li Shizhen pondered this, finding insight different from predecessors. Body fluids become sweat; sweat is blood. Within Ying, it is blood; exiting Wei, it is sweat. Severe cold damages Ying, causing Ying blood to stagnate internally, unable to communicate externally with Wei. Wei Qi closes and secures, body fluids fail to move, resulting in no sweat, fever, and aversion to cold. Wind damages Wei; Wei Qi receives pathogens, unable to protect Ying internally. Ying Qi becomes weak, body fluids insecure, resulting in sweat, fever, and aversion to wind. However, wind and cold pathogens enter via skin and hair, which are the exterior of the Lung. The Lung governs Wei Qi, encompassing the body, representing Heaven. Although the syndrome belongs to Taiyang, the Lung actually receives the pathogen. Symptoms often include red face, oppression, cough, phlegm, wheezing, and chest fullness—are these not Lung diseases? When skin and hair close externally, pathogenic heat attacks internally, causing Lung Qi stagnation. Thus, Ephedrae Herba and Gancao, assisted by Cinnamomi Ramulus, draw out Ying-level pathogens to the muscle surface. Pruni Semen Armeniacae Amarum assists in draining Lung Qi and promoting movement. Therefore, although Mahuang Tang is a heavy sweating formula for Taiyang, it is实质上 (substantially) a formula for dispersing Fire Stagnation in the Lung Meridian. Binhu (Li Shizhen)'s theory reveals a secret unknown for millennia. Regrettably, predecessors saw Zhongjing use it to induce sweating in Taiyang and assumed it was a Foot-Taiyang herb, viewing Ephedrae Herba as a sweating agent and Cinnamomi Ramulus as a stabilizing-Wei and stopping-sweat agent. If Cinnamomi Ramulus truly stopped sweat, why would Zhongjing use it to assist Ephedrae Herba in inducing sweat? Later practitioners used Ephedrae Herba monitored by Cinnamomi Ramulus, marveling at the moderation, comparing it to controlling six horses with reins, fearing loss of control. Is this logical?
A floating pulse indicates disease in the exterior; sweating may be induced, preferably with Mahuang Tang.
A floating and rapid pulse allows for sweating; preferably with Mahuang Tang.
These two clauses reiterate that floating and floating-rapid pulses can also be treated with sweating, not necessarily requiring a tight pulse. According to pulse methodology, floating indicates Wind, tight indicates Cold. Floating pulse with aversion to wind and spontaneous sweating requires Guizhi Tang. Tight pulse with aversion to cold and absence of sweating requires Mahuang Tang. Using Mahuang Tang for Fengzhong is erroneous sweating; using Guizhi Tang for Shanghan is strictly contraindicated. This clause states that a merely floating pulse allows for sweating with Mahuang Tang. Is this Zhongjing's error? Reasoning logically, although the pulse is floating and rapid without tightness, there must be accompanying symptoms of aversion to cold, body pain, and absence of sweating, justifying Mahuang Tang. A floating and rapid pulse resembles the floating and active-rapid pulse of Taiyang Fengzhong. However, Shanghan with existing fever can also present a floating-rapid pulse. Observing symptoms such as aversion to cold and absence of sweating confirms cold damaging Ying. Since the pulse is floating and rapid, the stagnant heat pathogen remains in the exterior. The classics state, "It can be resolved by sweating." Hence, "Sweating may be induced, preferably with Mahuang Tang."
[Correction of Errors] Cold pathogens in the exterior cause a floating pulse; existing fever causes a rapid pulse. This is the norm. Given the previous mention of tight yin-yang pulses, cold in the exterior can also be floating-tight. To prevent rigid adherence, these two clauses clarify that floating and floating-rapid pulses in Shanghan can also use Mahuang Tang, distinguished by presence or absence of sweat. Commentators, citing Zhongjing's "rapid and urgent pulse indicates transmission," argue that Mahuang Tang is used while the pathogen is about to disperse, scattering the rapidness to prevent transmission. Later scholars further speculated: "While the momentum is transmitting, strike it halfway with Mahuang Tang to drive it out." Logically, such interpretation is unnecessary.
On the first day of Shanghan, the Taiyang channel is affected. If the pulse is quiet, transmission has not occurred. If there is strong desire to vomit, restlessness, irritability, and a rapid-urgent pulse, transmission has occurred.
"First day of Shanghan, Taiyang affected" corresponds to the *Neijing: Relun* concept: "Day 1, Juyang (Taiyang) is affected; Day 2, Yangming is affected." Since Taiyang governs the exterior and commands Ying and Wei, it is affected first. In cold damaging Ying, the pulse is tight at yin and yang, or floating-tight. If after one day the pulse becomes calm and retreating, the pathogen is mild and resolves spontaneously, without transmitting to other channels. If symptoms include strong desire to vomit, the Shanghan vomiting syndrome persists. Vomiting implies pathogen entering the Stomach, a sign of internal invasion. Dry mouth, irritability, fever, and rapid-urgent pulse indicate pathogen has stagnated into heat, Qi is vigorous, and resolution is unlikely, signaling transmission.
On the second or third day of Shanghan, if Yangming and Shaoyang syndromes are absent, transmission has not occurred.
Days 2 and 3 correspond to "Day 2 Yangming affected, Day 3 Shaoyang affected" in the *Relun*. However, Taiyang pathogens do not necessarily transmit to Yangming first, then Shaoyang. They may enter Yangming or Shaoyang directly. By standard progression, Day 2 transmits to Yangming, Day 3 to Shaoyang. If on days 2-3, Yangming and Shaoyang syndromes are absent, the pathogen remains in one channel, hence no transmission.