一阳子曰∶伤寒传足不传手，非穷理之言也。草窗刘子，指足经所属水土木，以水
遇寒而涸冰，土遇寒而坼裂，木遇寒而调枯，故寒喜伤之。手经所属金与火，金遇寒
而愈坚，大体极热，寒不能袭，故寒不能伤。昧者奇之，竟将人身荣卫经络上下截
断，不相联系矣。夫寒邪袭人，必先皮毛灼热，鼻塞气粗，肺主皮毛，是手太阴肺辛金
先受病矣。故先贤有桂黄等汤。然汗法舍皮毛何自而解？迨至热邪入里，大便闭结，手
阳明大肠庚金病矣。故先贤有硝黄朴实之用。然下法舍大肠何自而通？刘子谓金遇寒
而愈坚之言可信乎？阳气怫郁，舌苔言妄，手少阴心下火病矣。先贤所以有泻心数法，
亢极动血，上下烦蒸，手厥阴心胞火，手少阳三焦火病矣。治有三黄柴芩数条，小便癃
秘，手太阳小肠内火病矣，治有五苓导赤之例，刘子谓大热寒不能伤之一言信乎？《经》
云∶伤寒则为病热。既云病热，则无水冰土裂木枯之象，而有金烁火亢之征矣。刘子之
言，不亦谬甚。
伤寒下早，邪流注而为结胸。若心下胀满，按之如石硬而痛，手不可近，燥渴谵
语，大便实秘，脉来沉实有力者，名曰大结胸。然滞在胸膈，未可即下，尚宜消导俟。
邪热壅盛于里，糟粕结实于下，乃攻而去之，邪热得解，元气无伤，所谓下药宜迟者
此也。如按之而心胸不痛，惟胸高气粗者，名曰小结胸，是邪气填于胸中，未尽入腑，
但宜小柴胡汤加入枳、桔，未可下也。若头有微汗，身不甚热，时时噫气，胸亦微滞，
名曰水结胸，由水饮过多，停聚心下也，治宜利之。如利而小水不通，头汗出者，乃阳
脱也，不治。若时时懊 ，躁闷舌干，手足大热，酷喜饮冷，此为热实结胸。如无狂
躁，手足微冷，胸痞噫气者，此名寒实结胸。更有脏结与结胸不异，但结胸在阳分而
不欲食，脏结在阴分而饮食如故，兼必时时下利也。凡病在二三日间，卧则心下烦满，
起则微觉稍爽者，须知心下必有结矣。盖卧则气壅上逆而为烦，起则气降散而觉爽，但
此尚未结实。若一下之，则邪因虚而更结，或为旁流下痢矣。复有阳明病，时谵语潮
热，然果内有实热而当消谷引食矣。若反不欲食，而小腹绕脐硬痛，小水短赤而渴者，
是胃有燥屎也，可即下之。若频频欲食，食而不多者，是胃有虚热，虽硬亦非燥屎，不
可下也。若小腹痛而大便黑，小水自利，身黄谵语，燥渴脉沉实者为蓄血，宜桃仁顺气
汤，下尽黑物则愈。若按之而小腹胀满不硬痛，小水不利者，乃溺涩也。宜利之，但勿
过利，以耗竭津液耳。大凡下后神清气爽，身凉思食者，邪气退而正气复也。如反身热
烦躁者，是正气散乱于内。邪气纵横于中也。并发紫黑斑点者，并为死候。其脉动而
中止，少能自还，更来小数者，名曰结阴。结阴者，主内邪气恣，结也。如动而不还，
即来而微动者，名曰代阴。代阴者，主内正气衰极欲绝也。故曰结脉可生，代脉必死也。
一阳子说：伤寒病只传足经而不传手经，这不是探究事理的说法。草窗的刘子，依据足经所属的水、土、木五行属性，认为水遇到寒冷就会结冰干涸，土遇到寒冷就会开裂，木遇到寒冷就会凋枯，所以寒邪喜欢伤害它们。而手经所属的金与火，金遇到寒冷反而更加坚固，大体上极热，寒邪不能侵袭，所以寒邪不能伤害手经。愚昧的人对此感到奇怪，竟然将人身上的营卫经络上下截断，互不联系。其实寒邪侵袭人体，必定先出现皮毛灼热、鼻塞气粗的症状，肺主皮毛，这是手太阴肺经的辛金首先受病了。所以先贤有使用桂枝、大黄等汤剂的方法。然而发汗法如果不从皮毛入手，从哪里解除病邪呢？等到热邪进入体内，大便闭结不通，这是手阳明大肠经的庚金受病了。所以先贤有使用硝石、大黄、厚朴、枳实等药物的用法。然而攻下法如果不从大肠入手，从哪里使腑气通畅呢？刘子说金遇到寒冷反而更加坚固的话，能相信吗？阳气郁结，舌苔异常言语狂妄，这是手少阴心经的下火受病了。先贤因此有泻心汤等多种治法。火势亢盛到极点导致动血，上下烦闷蒸热，这是手厥阴心包经之火和手少阳三焦经之火受病了。治疗有三黄、柴胡、黄芩等方剂。小便癃闭不通，这是手太阳小肠经的内火受病了，治疗有五苓散、导赤散的先例。刘子说大热时寒邪不能伤害的一句话，能相信吗？《内经》说：伤寒就会变成热病。既然说是热病，就没有水结冰、土开裂、木凋枯的现象，而有金被烧灼、火气亢盛的征象了。刘子的话，不是太荒谬了吗？
伤寒如果过早使用攻下法，邪气流注而形成结胸证。如果心下部胀满，按压像石头一样坚硬且疼痛，手不能靠近，伴有燥渴、说胡话，大便坚实秘结，脉象沉实有力，这叫做“大结胸”。但是病邪停滞在胸膈，不可以立即攻下，还应当先用消导之法等待时机。只有当邪热壅盛于体内，糟粕结实于肠道下部时，才进行攻下以去除病邪，这样邪热得以解除，元气不受损伤，这就是所说的“攻下药应当慎用（不宜过早）”的意思。如果按压时心胸部位不痛，只是呼吸急促气粗的，叫做“小结胸”，这是邪气填塞在胸中，尚未完全进入脏腑，只适宜用小柴胡汤加入枳壳、桔梗，不可攻下。如果头部有微汗，身体不太热，经常打嗝，胸部也有轻微阻滞感，这叫“水结胸”，是由于水饮过多，停聚在心下部所致，治疗应当利水。如果利水后小便仍然不通，头部出汗，这是阳气外脱，属于不治之症。如果经常心中懊恼烦躁，胸闷舌干，手足很热，非常想喝冷水，这是“热实结胸”。如果没有狂躁表现，手足微微发冷，胸脘痞闷打嗝的，这叫“寒实结胸”。更有“脏结”与“结胸”相似但不完全相同，区别在于结胸在阳分而食欲不振，脏结在阴分而饮食如常，并且必然经常腹泻。凡是患病在两三天之间，躺下时心下部烦闷胀满，站起来时稍微感觉舒畅的，要知道心下部一定有结滞。因为躺下时气机壅逆向上导致烦闷，站起来时气机下降消散所以感觉舒畅，但这还没有结成坚硬的实证。如果此时一旦攻下，邪气会因正气虚弱而更加凝结，或者形成旁流下痢。又有阳明病，时常说胡话、潮热，但如果内部确实有实热，本来应该消化食物并想吃东西。如果反而不想吃东西，小腹绕脐部硬痛，小便短赤且口渴，这是胃中有燥屎，可以立即攻下。如果频频想吃东西，但吃得不多，这是胃中有虚热，虽然腹部硬也不是燥屎，不可攻下。如果小腹痛且大便黑色，小便自利，身体发黄、说胡话、燥渴、脉象沉实的，这是蓄血证，适宜用桃仁顺气汤，排出黑色瘀血物则痊愈。如果按压时小腹胀满但不硬痛，小便不利的，这是尿涩，适宜利小便，但不要过度利水，以免耗竭津液。一般来说，攻下之后神志清爽、身体凉爽、想要进食的，是邪气退去而正气恢复的表现。如果反而身体发热、烦躁不安，这是正气散乱于内，邪气纵横于中。如果出现紫黑色的斑点，都是死证。脉跳动时有中止，很少能自行恢复，再次来时脉象稍快细小的，叫做“结阴”。结阴，主内部邪气恣肆凝结。如果脉跳动后不能恢复，再次来时脉象微弱跳动的，叫做“代阴”。代阴，主内部正气衰败至极，即将断绝。所以说结脉还有生机，代脉必死。
Mr. Yiyang said: The notion that Taiyang (Cold Damage) disease transmits only through the Foot meridians and not the Hand meridians is not a statement derived from thorough investigation of principles. Mr. Liu of Caowang, referring to the Water, Earth, and Wood elements associated with the Foot meridians, argued that Water freezes and dries up when encountering cold, Earth cracks when encountering cold, and Wood withers and dies when encountering cold; therefore, Cold pathogens favor injuring them. In contrast, the Metal and Fire elements associated with the Hand meridals become harder when encountering cold. Generally, they are extremely hot, so Cold cannot invade them, and thus Cold cannot injure them. Ignorant people found this strange and actually severed the Ying (Nutrient) and Wei (Defensive) Qi and the meridians above and below the human body, disconnecting them from each other.
In fact, when a Cold pathogen invades the human body, it must first cause burning heat in the skin and hair, nasal congestion, and coarse breathing. Since the Lung governs the skin and hair, this indicates that the Xin Metal of the Hand Taiyin Lung Meridian is the first to be diseased. Therefore, the sages used decoctions such as Guizhi Tang (Cinnamon Twig Decoction) and Huanglian Tang (Coptis Decoction). However, if the sweating method does not start from the skin and hair, from where would the pathogen be resolved? When the Heat pathogen enters the interior and causes constipation, the Geng Metal of the Hand Yangming Large Intestine Meridian is diseased. Therefore, the sages used substances like Xiaoshi (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Zhishi (Aurantii Fructus). However, if the purgative method does not act on the Large Intestine, from where would the fu-organs be unblocked? Can one believe Mr. Liu's statement that Metal becomes harder when encountering cold?
When Yang Qi is constrained, leading to abnormal tongue coating and delirious speech, the Xia Fire of the Hand Shaoyin Heart Meridian is diseased. This is why the sages employed several methods for Xiexin Tang (Drain the Epigastrium Decoction). When Fire reaches its extreme and causes bleeding, accompanied by vexation and steaming heat throughout the upper and lower body, the Huo Fire of the Hand Jueyin Pericardium Meridian and the Huo Fire of the Hand Shaoyang Sanjiao Meridian are diseased. Treatments include formulas containing Sanhuang (Three Yellows) or Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix). When there is strangury and urinary retention, the Neihuo (Internal Fire) of the Hand Taiyang Small Intestine Meridian is diseased. Treatments follow the examples of Wuling San (Five-Ingredient Powder with Poria) and Daochi San (Guide Out Redness Powder). Can one believe Mr. Liu's statement that great heat prevents Cold from causing injury?
The Classics state: "Taiyang disease transforms into Heat disease." If it is called a Heat disease, there should be no signs of Water freezing, Earth cracking, or Wood withering, but rather signs of Metal being scorched and Fire being hyperactive. Is Mr. Liu's statement not extremely absurd?
If Taiyang disease is treated with purgatives too early, the pathogen flows and accumulates, forming Jie Xiong (Chest Binding). If the epigastrium is distended and full, feels hard as stone upon pressure, is painful to touch, and is accompanied by dry thirst, delirium, solid constipation, and a deep, forceful pulse, it is named Da Jie Xiong (Major Chest Binding). However, if the pathogen stagnates in the chest and diaphragm, immediate purgation is not appropriate; one should use resolving and guiding methods and wait. Only when the pathogenic heat is abundant in the interior and the waste products are firmly accumulated in the lower part should one attack and remove them. Thus, the pathogenic heat is resolved without injuring the Yuan Qi (Primal Qi). This is what is meant by saying that purgative drugs should be used cautiously (late).
If pressing the area reveals no pain in the chest and heart, but only rapid and coarse breathing, it is named Xiao Jie Xiong (Minor Chest Binding). This indicates pathogenic qi filling the chest, not yet fully entering the fu-organs. One should only use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhike (Aurantii Fructus Immaturus) and Jiegeng (Platycodonis Radix); purgation is not indicated. If there is slight sweating on the head, the body is not very hot, there is frequent belching, and mild chest stagnation, it is named Shui Jie Xiong (Water Chest Binding). This is caused by excessive water-fluid accumulation stagnating in the epigastrium. Treatment should involve promoting urination. If after promoting urination, urine remains blocked and sweating occurs on the head, this is Yang collapse, which is untreatable.
If there is frequent mental restlessness (Ao Nu), oppression, dry tongue, very hot hands and feet, and a strong desire to drink cold liquids, this is Re Shi Jie Xiong (Heat-Excess Chest Binding). If there is no mania, but slightly cold hands and feet, with chest stuffiness and belching, this is Han Shi Jie Xiong (Cold-Excess Chest Binding). There is also Zang Jie (Zang Binding), which is similar to Jie Xiong but different. Jie Xiong is in the Yang aspect and involves loss of appetite, whereas Zang Jie is in the Yin aspect with normal appetite, and is always accompanied by frequent diarrhea.
Generally, in diseases lasting two to three days, if lying down causes epigastric vexation and fullness, but standing up brings slight relief, one must know that there is binding in the epigastrium. Lying down causes Qi to obstruct and rebel upward, leading to vexation; standing up allows Qi to descend and dissipate, bringing relief. However, this has not yet formed a solid excess pattern. If purged at this stage, the pathogen will bind more tightly due to deficiency, potentially leading to paralytic diarrhea.
There is also Yangming disease characterized by occasional delirium and tidal fever. If there is truly excess heat inside, digestion should be accelerated, and the patient should desire food. If instead there is no desire to eat, hardness and pain around the umbilicus in the lower abdomen, short and red urine, and thirst, this indicates Dry Stool (Zao Shi) in the stomach. Immediate purgation is indicated. If the patient frequently desires food but eats little, this indicates Deficient Heat in the stomach; although the abdomen may be hard, it is not Dry Stool, and purgation is contraindicated. If there is lower abdominal pain, black stool, free urination, jaundice, delirium, dry thirst, and a deep, forceful pulse, this is Xu Xue (Blood Accumulation/Stasis). Tao Ren Shun Qi Tang (Peach Kernel Regulate Qi Decoction) is indicated. Recovery occurs when black material is excreted. If pressing causes lower abdominal distension without hardness or pain, and urination is difficult, this is Niao Se (Urinary Difficulty). Promoting urination is indicated, but do not overdo it to avoid exhausting body fluids.
Generally, after purgation, if the spirit is clear, the body is cool, and the patient desires food, it indicates the pathogen has retreated and Zheng Qi (Upright Qi) has recovered. If conversely there is fever and irritability, it indicates Zheng Qi is scattered internally and the pathogen is rampant in the middle. The simultaneous appearance of purple-black spots indicates a fatal prognosis.
If the pulse beats and then stops, rarely recovering on its own, and when it returns again it is slightly rapid and small, it is named Jie Yin (Knotted Yin). Jie Yin indicates internal pathogenic qi acting recklessly and binding. If the pulse beats and does not recover, returning only with a weak beat, it is named Dai Yin (Intermittent Yin). Dai Yin indicates internal Zheng Qi is extremely deficient and about to cease. Therefore, it is said that a Jie (Knotted) pulse can survive, but a Dai (Intermittent) pulse implies death.