此承上文而言。霍乱下利后。亡津液而当便硬。硬则能食者愈。属阳明胃气和也。今反不能食。传
入后一经中。颇能食。
是复过一经能食矣。如属阳明气和。则其过之一日当愈。不愈者。暴热使之能食。非阳明气和也。
此泛言过经者也。何尝有再传经谓之过经之旨哉。况邪传六经。岂有三度之理哉。成氏释仲景书。
阐明奥旨。惠及后世多矣。独于传经少达。乃致穿凿之甚。蕴要祖成氏之注。其过经不解例曰。
经言伤寒十三日不解。谓之过经。仲景焉有此语。是以成注为经矣。其六经传变论又曰。过经不解。则
为坏病矣。夫仲景所谓坏病者。言为犯逆所坏也。蕴要之说。讹上之讹矣。陶尚文曰。伤寒汗不愈
而过经。其症尚在而不除者。亦温病也。此说更不可晓。
魏荔彤曰。闵氏传经之说。亦能独发微旨。其六经尽传不再传之说。实本于内经。病邪递传
一脏不两伤。两伤则死之理。其切要之语。谓伤寒病传经。凡言日者。概不可以日数拘也。尤为破
的。但亦有应申明者。经云。一日太阳受之。不过云太阳病始于此一日耳。在太阳数十日不罢。皆
可谓之在太阳一日分内也。故有始终生死于太阳者矣。此伤寒论仲师设有过经不解专篇。乃为伤寒
论不传经言也。二日阳明受之者。亦以太阳传阳明之始为二日。在太阳者暂。即曰传阳明。固阳明
之二日也。在太阳者久。七八日始传阳明。亦为阳明之二日也。其余各经递言三四五六日。概如是
矣。必言七日者。自太阳始受病。计至七日太阳愈。藉日以明其递传之次耳。如人自此起行至某处。
七日之程。其行之迟速。至之先后。则不可计也。此七日太阳病当愈之义也。闵氏以为七少阳之数。仍
似执论。余谓太阳病愈之日。即为七日。更觉明爽耳。是凡阳明受邪之日。皆为二日也。不过太阳始
传于阳明之次耳。然则在阳明为久为暂。得愈之日。皆八日也。亦不必谓七日合少阳之数也。诸经
得愈之日。亦皆如此。似不合经文。而深合于经旨也。何也。经文示天下万世以成宪。或不得不藉
日以明其次第。使人知六经受病及愈日之纪也。其实病邪变迁。倏忽无常。加甚得愈。且无定时。
诸病皆然。伤寒尤甚。何可以日计乎。所以仲师又设合病专篇。是两三经同感。则一日已满三阳之
分。又乌从计日乎。即直中阴经之寒邪。亦尝初起即遍三阴。何必一日中太阴。二日方及少阴。三
日
方及厥阴耶。寒邪常易中少阴。以阴起于下。肾经在下体也。直中少阴。常并及三阴。少阴厥阴并
中者更多。岂以日可计乎。(鳌按。不但直中少阴厥阴者为更多。即传经至少阴者。亦往往即传厥阴。
而此二经之症。一半日间即已俱见。以肝肾同部。故易相连而及也。)知计日以言经。却不计日
以察病。斯可与言遵经治病矣。及病邪已入厥阴。重言复传太阳。则合内经灵素搜求。再考仲师之
论。并无此说。稍知医理者。可明其妄。盖人身内而腑脏。外而经络。邪无自厥阴得入太阳之道路
也。如邪已透表。则升散矣。焉有自里透表复从表入里者哉。试问古今来自厥阴复入太阳者。何人
曾治此伤寒病乎。以余观之。今人患伤寒病。在三阳经。或生或死即决矣。直中阴经者反有之。传
经至阴经者已少。况六经遍传乎。以今人气禀虚弱者多。世医操术不明者更多。不俟传遍已死矣。
所以见治六经传遍之伤寒病者。竟无有也。(鳌按。此论更精更快。可以提醒世医。)况伤寒病
虽如是分别六经。而病此者。未必尽分疆画界。如此井井。初得之时。两经皆病者。三经皆病者甚多。
此未病。而彼已传者。亦复不少。阳经未尽。亦有入于阴经者。至阴经矣。又尝见太少两经俱病
也。又尝见三阴经俱病也。所以仲景未尝不设合病篇以论病。并病篇以论治也。合病并病。虽独有
三阳。乃举一隅也。宁不可推之三隅乎。若不能推。则虽有书充栋。亦无用矣。如能神明。必于斯言
有会耳。
鳌按。自仲景论著传经之说。后来聚讼纷纷。终不合经旨。以总皆拘于日数。故说来往往支碍也。
自有闵氏辨其理于前。复有魏氏畅其说于后。合二篇观之。而传经一款。千古遂有定案。诚伤
寒科之秘笈也。
这是承接上文来说的。霍乱和下利之后,津液耗伤导致大便干硬。如果大便干硬但能进食,说明病要好了,这属于阳明胃气调和的表现。现在反而不能进食,说明病邪传入了后一经(下一经)。如果后来又能进食了,那是又经过了一经才恢复能食的状态。如果属于阳明胃气调和,那么经过这一日应当痊愈;如果不痊愈,是因为突然发热使得病人能进食,这并不是阳明胃气调和。这是泛指病邪经过一经的情况。哪里有什么“再次传经”叫做“过经”的宗旨呢?况且邪气传入六经,哪有传了三次的道理呢?成无己注释张仲景的书,阐明了深奥的宗旨,惠及后世很多。唯独在解释传经方面理解不够透彻,以至于穿凿附会得很厉害。《医宗金鉴·伤寒蕴要》沿袭了成无己的注解,其中关于“过经不解”的例子说:“经文说伤寒十三天不愈,叫做过经。张仲景哪里有这样的话?因此把成注当作经典。”他在《六经传变论》中又说:“过经不愈,就成为坏病了。”所谓张仲景所说的坏病,是指因为误治而导致的病变。《蕴要》的说法,是在错误的基础上更加错误。陶尚文说:“伤寒发汗后不愈而过经,症状还在而没有消除的,也是温病。”这种说法更让人难以理解。
魏荔彤说:闵氏关于传经的说法,也能独自发掘微妙的旨意。他提出的“六经传遍不再传”的理论,实际上源于《内经》中“病邪依次传变一脏而不两伤,两伤则死”的道理。他那句切中要害的话是说,伤寒病传经,凡是提到“日”的,一概不可以用具体的天数来拘泥。这尤为破的放矢。但也有一些需要申明的地方。经文说:“一日太阳受之”,不过是说太阳病开始于这一天罢了。如果在太阳经受病几十天不好,都可以说是处于太阳病的初始阶段内。所以有始终在太阳经发生生死变化的情况。这是张仲景设立“过经不解”专篇的原因,是为了说明伤寒论中不传经的情况。“二日阳明受之”,也是以从太阳传向阳明作为第二天。如果在太阳经的时间短,就说传阳明,固然是阳明的第二天;如果在太阳经的时间长,七八天才传阳明,也称之为阳明的第二天。其余各经依次说的三四五六天,都是这样的道理。一定要说七天,是从太阳开始受病算起,到第七天太阳病愈,借天数来明确其递传的次序罢了。就像人从这里走到某处,七天的路程,行走的快慢、到达的先后,是不能计算的。这就是“七日太阳病当愈”的含义。闵氏认为这是少阳之数,仍然似乎执着于理论。我认为太阳病痊愈的日子就是第七天,这样想更加明白清爽。凡是阳明受邪的日子,都称为第二天,不过是太阳开始传给阳明的次序而已。那么在阳明经时间长还是时间短,得到痊愈的日子,都是第八天。也不必说七天符合少阳之数。其他各经得到痊愈的日子,也都是如此。这似乎不合经文表面意思,而深层符合经旨。为什么呢?经文向天下万世展示固定的法则,或许不得不借天数来明确其次第,使人知道六经受病及痊愈日期的记录。其实病邪的变化,瞬息无常,加重或痊愈都没有固定时间。各种病都是这样,伤寒尤其严重。怎么能用天数来计算呢?所以张仲景又设立了合病专篇,如果是两三经同时感受邪气,那么一天就已经满了三阳的分界,又怎么从天数计算呢?即使是直中阴经的寒邪,也曾经初起就遍及三阴,何必第一天太阴,第二天才及少阴,第三天才及厥阴呢?寒邪常容易中少阴,因为阴气起于下部,肾经在下体。直中少阴,常常并及三阴,少阴厥阴同时中邪的更多,难道可以用天数计算吗?(沈金鳌按:不但直中少阴厥阴的情况更多,就是传经到少阴的,也往往立即传到厥阴,而且这两经的症状,半天白天就已经全部出现,因为肝肾同部,所以容易相连波及。)知道用天数来谈论传经,却不拘泥于天数来诊察疾病,才可以跟他谈论遵循经文治病。等到病邪已经入厥阴,又说重新传回太阳,那就去搜求《内经·灵枢》和《素问》,再考察张仲景的论述,并没有这种说法。稍微懂点医理的人,可以明白这是荒谬的。大概人身内连脏腑,外连经络,邪气没有从厥阴进入太阳的道路。如果邪气已经透达体表,就会升散发散,哪有从里透表又重新从表入里的道理呢?试问古今以来,有没有从厥阴重新进入太阳的人,谁曾治疗过这种伤寒病呢?在我看来,现在人患伤寒病,在三阳经,或者生或者死立刻就决定了。直中阴经的反而有这种情况。传经到阴经的已经很少,何况六经遍传呢?因为现在人气血禀赋虚弱的多,世间医生医术不明朗的更多,不等传遍就已经死了。所以见到治疗六经遍传的伤寒病的人,竟然没有。(沈金鳌按:这个论述更加精辟快速,可以提醒世间的医生。)况且伤寒病虽然这样分别六经,但患这种病的人,未必完全分疆画界,像这样井井有条。刚得病的时候,两经同时病的,三经同时病的很多。这里还没病,那里已经传变的,也不少。阳经没完,也有进入阴经的。到了阴经,又常见太少两经同时病。又常见三阴经同时病。所以张仲景未曾不设立合病篇来讨论病情,并病篇来讨论治疗。合病并病,虽然独有涉及三阳,但这只是举一个角落为例,难道不能推知其他三个角落吗?如果不能推知,那么即使书堆满屋子,也没有用处。如果能神妙领悟,一定会对这些话有所领会。
沈金鳌按:自从张仲景论述传经之说,后来争论纷纷,最终不符合经旨,因为全都拘泥于天数,所以说起来往往支离碍理。自从闵氏在前面辨明其理,又有魏氏在后面畅述其说,合看这两篇,关于传经这一项,千古遂有了定案,确实是伤寒科的秘笈啊。
This follows the preceding text. After Huoluan (cholera-like syndrome with vomiting and diarrhea) and purging, the loss of body fluids leads to dry stool. If the stool is dry but the patient can eat, it indicates recovery; this belongs to the harmonization of Stomach Qi in the Yangming stage. Now, conversely, if the patient cannot eat, it means the pathogen has transmitted to the subsequent channel. If the ability to eat returns later, it implies that another channel cycle has passed before eating resumed. If this belonged to the harmonization of Yangming Stomach Qi, it should have healed after passing one day. If it does not heal, the sudden fever enabling eating is not due to the harmonization of Yangming Stomach Qi. This generally refers to the concept of "passing a channel" (Guojing). Where is there any principle that "transmitting again through a channel" is called "passing a channel"? Moreover, how could pathogenic factors transmit through the Six Channels three times? Cheng Wuji's commentary on Zhang Zhongjing's works elucidates profound principles and benefits future generations greatly. However, his understanding of channel transmission is insufficient, leading to forced interpretations. *Yizong Jinjian: Summary of Essential Principles* follows Cheng's commentary. In the example of "pathogen remaining after passing a channel," it states: "The classic says 'Shanghan for thirteen days without resolution is called Guojing.' Does Zhang Zhongjing say this? Therefore, Cheng's commentary is treated as canonical." In his "Discussion on Six-Channel Transmission," he further states: "If Guojing is not resolved, it becomes a damaged disease (Huai Bing)." The so-called "damaged disease" mentioned by Zhang Zhongjing refers to damage caused by improper treatment. The view in *Yiyao* is an error compounded by error. Tao Shangwen said: "Shanghan that does not resolve after sweating and passes a channel, with symptoms persisting, is also a Warm Disease (Wenbing)." This explanation is even more incomprehensible.
Wei Litong said: Min's theory on channel transmission can independently reveal subtle meanings. His theory that "after transmitting through all six channels, it does not transmit again" is actually based on the *Neijing*, specifically the principle that "pathogens transmit sequentially to one Zang organ and do not injure two; injuring two leads to death." His crucial point is that when discussing Shanghan channel transmission, the mention of "days" should not be rigidly confined to specific numbers. This is particularly incisive. However, some points need clarification. The classic says, "On the first day, the Taiyang receives the pathogen," merely indicating that Taiyang disease begins on that day. Even if Taiyang disease persists for dozens of days, it can still be considered within the initial phase of Taiyang. Thus, there are cases where life and death are determined entirely within the Taiyang stage. Zhang Zhongjing established the special chapter on "pathogen remaining after passing a channel" precisely to explain cases where Shanghan does not transmit. "On the second day, the Yangming receives the pathogen" simply marks the beginning of transmission from Taiyang to Yangming. If the stay in Taiyang is short, we call it transmission to Yangming, which is naturally the second day of Yangming. If the stay in Taiyang is long, taking seven or eight days to transmit to Yangming, it is still referred to as the second day of Yangming. The same logic applies to the sequential mentions of the third, fourth, fifth, and sixth days for other channels. The mention of "seven days" serves to calculate from the initial reception in Taiyang until its resolution on the seventh day, using days to clarify the sequence of transmission. It is like traveling from here to a destination: a seven-day journey's duration depends on speed and arrival time, which cannot be fixed. This is the meaning behind "Taiyang disease should resolve on the seventh day." Min regarded this as referring to Shaoyang, which seems too literal. I believe considering the day of Taiyang resolution as the seventh day is clearer. Any day Yangming receives the pathogen is called the second day, marking the sequence of initial transmission from Taiyang. Whether the stay in Yangming is long or short, the day of resolution is the eighth day. There is no need to associate seven days with Shaoyang numerology. The resolution days for other channels follow this pattern. Although this seems inconsistent with the literal text, it deeply aligns with the essence of the classic. Why? The classic presents eternal laws to the world, perhaps necessitating the use of days to clarify sequence, allowing people to understand the chronology of Six-Channel disease and resolution. In reality, pathogenic changes are sudden and unpredictable; aggravation or resolution has no fixed timing. This applies to all diseases, especially Shanghan. How can they be calculated by days? Therefore, Zhang Zhongjing established chapters on Combined Diseases (He Bing), where if two or three channels are affected simultaneously, the division of the Three Yang channels is filled in one day, making daily calculation irrelevant. Even Cold pathogens directly invading the Yin channels may affect all Three Yin channels at onset. Why must Taiyang be affected on day one, Shaoyin on day two, and Jueyin on day three? Cold pathogens often directly invade Shaoyin because Yin originates from below, and the Kidney meridian is in the lower body. Direct invasion of Shaoyin often involves all Three Yin channels, with simultaneous Shaoyin and Jueyin involvement being common. Can this be calculated by days? (Shen Jin'ao notes: Not only is direct invasion of Shaoyin and Jueyin common, but transmission to Shaoyin often immediately proceeds to Jueyin. Symptoms of these two channels often appear within half a day because Liver and Kidney share the same region and easily influence each other.) Knowing to discuss channels by days, yet examining disease without being bound by days, allows one to truly discuss treating according to the classics. When pathogenic factors enter Jueyin and it is claimed they re-transmit to Taiyang, searching the *Lingshu* and *Suwen* and examining Zhang Zhongjing's discussions reveals no such statement. Anyone with basic medical knowledge can see this as absurd. Physically, internally connecting Zang-Fu organs and externally connecting meridians, there is no pathway for pathogens to enter Taiyang from Jueyin. If pathogens have penetrated the exterior, they ascend and dissipate; how could they move from interior to exterior and then back to interior? Ask yourself: throughout history, who has treated Shanghan where pathogens moved from Jueyin back to Taiyang? In my observation, modern patients with Shanghan in the Three Yang channels decide life or death quickly. Direct invasion of Yin channels occurs. Transmission to Yin channels is rare. Transmission through all six channels is even rarer. Since most people today have weak constitutions and many physicians lack clear skills, patients die before transmission completes. Thus, seeing Shanghan that has transmitted through all six channels is non-existent. (Shen Jin'ao notes: This argument is precise and rapid, serving as a reminder to contemporary physicians.) Moreover, although Shanghan is distinguished into six channels, patients do not always present with strict boundaries. At onset, simultaneous involvement of two or three channels is common. Transmission from one area to another while unaffected areas remain intact is frequent. Yang channel diseases may enter Yin channels. Simultaneous Taiyang and Shaoyang involvement is seen. Simultaneous involvement of all Three Yin channels is also observed. Therefore, Zhang Zhongjing established chapters on Combined Diseases (He Bing) to discuss pathology and Concurrent Diseases (Bing Bing) to discuss treatment. Although Combined and Concurrent diseases are discussed primarily regarding the Three Yang, this is merely an example; one should infer the rest. Without such inference, books piled high would be useless. With spiritual comprehension, one will find resonance in these words.
Shen Jin'ao notes: Since Zhang Zhongjing discussed channel transmission, debates have been endless, ultimately failing to align with the classic's intent because everyone was bound by day counts, leading to fragmented arguments. Since Min clarified the logic beforehand and Wei elaborated afterwards, combining these two perspectives provides a definitive case for channel transmission for eternity. It is indeed a secret manual for the Shanghan specialty.