柯氏云∶仲景之书，撰同《素问》。《皮部论》云∶阳主外，阴主内。故仲景以三阳主
外，
三阴主内。又曰∶在阳者主内，在阴者主出，以渗于内。故仲景又以阳明主内。少阴亦有反
发热者，故仲景于表剂中用附子，是因其渗也。又曰∶少阴之阴，名曰枢儒，其入于经也
，从
阳部注于经；其出者，从阴内注于骨。故仲景制麻黄附子汤，治发热，脉沉，无里症者，是
从阳部注经之意也；制附子汤，治身体骨节痛，手足寒，背恶寒，脉沉者，是从阴内注于骨
之义也。按《内经》所谓阳主外，阴主内者，是言阳明之阳，以阳明为阳之阖，故出则从阳
而
主外，入则从阴而主内也。所谓在阳者主内，在阴者主外，以渗于内者，是言少阳之阳，以
少阳为枢为机之地，故在阳者其用反从阴而主内，在阴者其用反从阳而主出，以渗于内。渗
于内，如便液之属，盖从内出外之意也。少
阴亦枢机之地，故其入者反从阳而注于经，其出者反从阴内注于骨也。此《皮部论》之义，
柯氏似此援引，未尽的确。
柯氏援地理兵法，喻病邪之浅深，方药之大小，可谓深切着明。而于兵法又多精义，非
好为夸大者可比。张千秋口陈乌桓兵事，了如指掌，非达识经事，不能如此。
柯氏因阴阳十脉，而立对待正看六法，曲尽其变，几无遁形矣。
太阳膀胱之经，起于足小趾，循股上行，至头，为三阳之表。而寒邪伤人，多自表入，
故太
阳得先受邪，有头项强痛、背疼等症。而柯氏云∶心为太阳，故得外统一身之气血，内行脏
腑之经隧；若膀胱位列下焦，为州都之官，所藏津液，必待上焦之气化而后出，何能外司营
卫，为诸阳主气哉？又曰∶伤寒最多心病，以心当太阳之位也。心为君主，寒为阴邪，君火
不足，寒气得以伤之，所以名为大病。按少阴心经，起于手小指，循臂上行，入缺盆，注心
中。今伤寒初病，不闻有是经所生症者，而邪入心经，变不复见头项强痛等症。夫心以为太
阳之位，则不应无太阳之症，以心为一身之主，不得易膀胱之位；况仲景所谓太阳者，只就
经脉而言，自表邪传经入里，热结膀胱，乃始及于腑。柯氏但知其位卑在下，不得为都会之
地，而不思其经络所过，实为一身之表邪！徇尊卑之名，忘经野之实，亦何取焉？且伤寒虽曰
大病，未必便是死症。若寒邪犯心，水来克火之说，自是寒邪直入心脏之病，而非大概伤寒
在表之病矣。必如其说，则伤寒之病，十无一生，虽救疗之不及，而何有延至十数日之久哉
？
且以心当太阳之位，则太阳随经入里之邪，将直犯君主，而何以仍归膀胱，为小便不利，为
结血不行？炫新说而变旧章，智者之过也，道其不明矣夫！
膀胱有下口而无上口，处大肠、小肠交接之间，即阑门也。阑门者，泌别水谷之处，气
通命
门。人之水谷入胃，以次传入小肠，斯时虽已熟腐，而清浊犹未分也；至于阑门，而得命门
之火，薰蒸分布，于是水液渗入膀胱，糟粕下入大肠。入大肠者，以渐而下；入膀胱者，满
而后泻。柯氏乃谓膀胱有上口而无下口，能入而不能出，必待太阳气化，而溺始出。非也。
果尔，则胞中之水，其渗已多，而犹未溺之时，更于何处可蓄耶？且《内经》所谓气化则能
出者，亦非太阳之气化，乃肺经之气化也。肺经之气化，则膀胱之气亦化，满而后出，虚而
复受；不然，虽满不能出也。是以膀胱虽主津液，而非命门之火蒸之，则不能入；非肺金之
气化，则不能出。不入，则溏泻之病生；不出，则癃闭之病作矣。
柯氏说：张仲景的著作，体例仿效《素问》。《素问·皮部论》中说：“阳主外，阴主内。”所以张仲景以三阳经主表（外部），三阴经主里（内部）。又说：“在阳者主内，在阴者主出，以渗于内。”所以张仲景又以阳明经主里。少阴病也有出现反常发热的情况，所以张仲景在解表剂中使用附子，是顺应其“渗”的特性。又说：“少阴之阴，名为枢儒，邪气进入经脉时，从阳部注入经脉；邪气外出时，从阴内部注入骨骼。”所以张仲景制定麻黄附子汤，治疗发热、脉沉、没有里证的患者，这是体现“从阳部注经”的意思；制定附子汤，治疗身体骨节疼痛、手足寒冷、背部恶寒、脉沉的患者，这是体现“从阴内注于骨”的含义。
按照《内经》所说“阳主外，阴主内”，是指阳明之阳，因为阳明是阳气之“阖”（闭合/收敛），所以外出时从阳而主表，入内时从阴而主里。所谓“在阳者主内，在阴者主外，以渗于内”，是指少阳之阳，因为少阳是“枢机”所在之地，所以在阳的部位，其作用反而从阴而主里；在阴的部位，其作用反而从阳而主出，从而渗入体内。“渗于内”，像二便之类的排泄物，大概是从内向外排出的意思。少阴也是枢机之地，所以它进入的时候反而从阳而注入经脉，它外出的时候反而从阴内部注入骨骼。柯氏引用《皮部论》的这些义理，似乎并不完全确切。
柯氏借用地理和兵法来比喻病邪的深浅、方药的大小，可以说深刻且明白。而且他对兵法的理解多有精妙之处，不是那些喜欢夸大其词的人能比的。就像张千秋口中讲述乌桓的军事事务，了如指掌，如果不是通达见识、熟悉世事的人，不能做到这样。
柯氏根据阴阳十脉，确立了对待正看的六种方法，穷尽了各种变化，几乎让病邪无处遁形。
太阳膀胱经，起于足小趾外侧，沿大腿上行至头部，是三阳经的表层。寒邪伤人，多从体表侵入，所以太阳经最先受邪，出现头项强痛、背痛等症状。但柯氏却说：心属于太阳，所以能外统一身的营卫气血，内行脏腑的经络；如果膀胱位于下焦，作为“州都之官”（储藏津液的器官），所藏的津液必须等待上焦的气化作用才能排出，怎么能外司营卫，成为诸阳之主气呢？他又说：伤寒病中最多见的是心病，因为心处于太阳的位置。心为君主，寒为阴邪，君火不足，寒气得以伤害它，所以称为大病。按少阴心经，起于手小指，沿手臂上行，进入缺盆，注入心中。现在伤寒初起，没听说有这条经脉产生的症状，而邪气进入心经后，病变不再出现头项强痛等症状。如果把心当作太阳之位，就不应该没有太阳的症状；把心当作一身之主，就不能随意改变膀胱的位置；况且张仲景所说的太阳，只是就经脉而言，直到表邪传经入里，热结膀胱，才涉及到腑。柯氏只知道膀胱位置卑下，不能作为都会之地，却不思考它的经络经过之处，实际上是一身之表邪！拘泥于尊卑的名分，忘记了经络运行的实际，这有什么可取的呢？况且伤寒虽然称为大病，未必就是死症。如果寒邪侵犯心脏，用“水来克火”的说法，这自然是寒邪直入心脏的病，而不是一般伤寒在表的病了。如果像他的说法，那么患伤寒病的人，十个没有一个能活下来，即使救治不及，怎么会有拖延到十几天的情况呢？
如果用心的位置来对应太阳，那么太阳随经入里的邪气，将直接侵犯君主（心），为什么仍然归于膀胱，表现为小便不利、瘀血不行？炫耀新说而改变旧章，这是智者的过失，道理因此变得不明白了啊！
膀胱只有下口而没有上口，位于大肠和小肠交接之间，即阑门处。阑门，是分别清浊水谷的地方，气通命门。人的水谷进入胃后，依次传入小肠，这时虽然已经熟腐，但清浊还没有分开；到了阑门，得到命门之火的薰蒸分布，于是水液渗入膀胱，糟粕下入大肠。进入大肠的，逐渐下行；进入膀胱的，满了之后才排出。柯氏却认为膀胱有上口而无下口，只能进不能出，必须等待太阳气化，尿液才能排出。这是不对的。果真如此，那么胞宫中的水，渗透进来的已经很多，而在尚未排尿的时候，多余的水蓄积在哪里呢？况且《内经》所说“气化则能出”，也不是太阳的气化，而是肺经的气化。肺经的气化，使得膀胱之气也发生气化，满了之后才排出，空虚了再接受新的；不然的话，即使满了也不能排出。所以膀胱虽然主管津液，但如果没有命门之火的蒸腾，就不能进入；如果没有肺金的气化，就不能排出。不能进入，就会产生溏泻的病；不能排出，就会产生癃闭的病。
Ke stated: Zhang Zhongjing's writings emulate the structure of the *Suwen* (Plain Questions). The *Pibu Lun* (Treatise on Cutaneous Regions) states: "Yang governs the exterior, Yin governs the interior." Therefore, Zhang Zhongjing assigns the Three Yang meridians to govern the exterior and the Three Yin meridians to govern the interior. He further states: "That which is in Yang governs the interior; that which is in Yin exits, seeping into the interior." Thus, Zhang Zhongjing also assigns the Yangming meridian to govern the interior. Shaoyin diseases may also present with fever, so Zhang Zhongjing uses Fuzi (Aconite Lateralis Radix Preparata) in exterior-releasing formulas, adapting to its property of "seeping." He further states: "The Yin of Shaoyin is named Shuru; when pathogens enter the meridians, they flow from the Yang aspect into the meridians; when they exit, they seep from the Yin interior into the bones." Therefore, Zhang Zhongjing formulated Mahuang Fuzi Tang (Ephedra and Aconite Decoction) to treat fever, deep pulse, and absence of interior syndromes, reflecting the meaning of "flowing from the Yang aspect into the meridians"; he formulated Fuzi Tang (Aconite Decoction) to treat body and joint pain, cold hands and feet, aversion to cold in the back, and deep pulse, reflecting the meaning of "seeping from the Yin interior into the bones."
According to the *Neijing*, "Yang governs the exterior, Yin governs the interior" refers to Yangming Yang. Since Yangming is the "He" (closing/consolidating) of Yang, it governs the exterior when exiting via Yang and governs the interior when entering via Yin. The statement "That which is in Yang governs the interior, that which is in Yin exits, seeping into the interior" refers to Shaoyang Yang. Since Shaoyang is the site of the "Shu" (pivot), its function in the Yang aspect tends toward Yin to govern the interior, while its function in the Yin aspect tends toward Yang to exit, thereby seeping into the interior. "Seeping into the interior" refers to substances like urine and feces, implying a direction from inside out. Shaoyin is also a site of pivot mechanism; thus, its entry tends from Yang into the meridians, and its exit tends from the Yin interior into the bones. Ke's citation of these principles from the *Pibu Lun* seems not entirely accurate.
Ke’s use of geography and military strategy to metaphorize the depth of pathogens and the magnitude of prescriptions can be described as profound and clear. His insights into military strategy are particularly refined, unlike those who merely exaggerate. Just as Zhang Qian could recount the military affairs of the Wuhuan people with perfect clarity, only one with broad vision and practical experience could achieve such understanding.
Based on the ten pulses of Yin and Yang, Ke established six methods of dialectical analysis (treating opposites and direct observation), exhaustively detailing variations, leaving no pathogen concealed.
The Bladder Meridian of Taiyang originates at the lateral side of the little toe, ascends along the thigh to the head, and serves as the exterior of the Three Yang meridians. Cold pathogens usually invade from the exterior, so the Taiyang meridian is often the first to be affected, presenting with stiffness and pain in the head and neck, and back pain. However, Ke claims: The Heart belongs to Taiyang, thus it can externally unify the Qi and Blood of Ying and Wei throughout the body, and internally traverse the meridians of the Zang-Fu organs. If the Bladder is located in the Lower Jiao and acts as the "Official of the Metropolis" (storing fluids), its stored fluids must await the Qi transformation of the Upper Jiao before being excreted. How can it externally govern Ying and Wei and serve as the master Qi of all Yang meridians? He further states: Heart disease is most common in Shanghan (Cold Damage) because the Heart occupies the position of Taiyang. The Heart is the Monarch; Cold is a Yin pathogen. When the Minister Fire (Heart Fire) is insufficient, Cold Qi can damage it, hence it is called a major disease. According to the Shaoyin Heart Meridian, it originates at the tip of the little finger, ascends along the arm, enters the supraclavicular fossa, and flows into the heart. In early-stage Shanghan, symptoms generated by this meridian are rarely heard of. When pathogens enter the Heart meridian, symptoms such as stiffness and pain in the head and neck cease to appear. If the Heart were the position of Taiyang, it should not lack Taiyang symptoms. As the master of the body, the Heart cannot arbitrarily assume the position of the Bladder. Moreover, what Zhang Zhongjing calls "Taiyang" refers strictly to the meridian; only after exterior pathogens transmit through the meridians into the interior and heat binds in the Bladder does it involve the Fu organ. Ke only recognizes that the Bladder's low position prevents it from being a capital city, failing to consider that its meridian pathway actually covers the exterior of the body. Clinging to hierarchical names while ignoring the reality of meridian pathways—what value is there in this? Furthermore, although Shanghan is termed a major disease, it is not necessarily fatal. If Cold pathogens attack the Heart, invoking the theory of "Water overcoming Fire," this would describe Cold pathogens directly invading the Heart, not the general exterior syndrome of Shanghan. If his theory held, nearly all Shanghan patients would die; even if treatment were delayed, how could the disease persist for ten or more days?
If the Heart corresponds to the position of Taiyang, then pathogens transmitting from Taiyang into the interior should directly attack the Monarch (Heart). Why do they still return to the Bladder, manifesting as difficult urination and blood stasis? Displaying new theories while altering established chapters is an error of the wise, rendering the Dao obscure!
The Bladder has a lower orifice but no upper orifice, situated between the junction of the Large Intestine and Small Intestine, known as the Lanmen (Gate of Separation). The Lanmen is where water and grain are separated; its Qi connects to the Mingmen (Gate of Life). Food and drink enter the Stomach and pass sequentially into the Small Intestine. Although digested, clear and turbid parts are not yet separated. Upon reaching the Lanmen, aided by the fire of the Mingmen steaming and distributing, fluid seeps into the Bladder, while dregs descend into the Large Intestine. What enters the Large Intestine moves downward gradually; what enters the Bladder is excreted only when full. Ke claimed that the Bladder has an upper orifice but no lower orifice, capable of receiving but not discharging, requiring Taiyang Qi transformation for urine to exit. This is incorrect. If true, where would excess fluid accumulate in the Baozhong (Uterus/Bladder region) before urination occurs? Moreover, the *Neijing*'s statement "Qi transformation enables exit" refers not to Taiyang Qi transformation, but to Lung Qi transformation. Lung Qi transformation facilitates Bladder Qi transformation, allowing excretion when full and reception when empty; otherwise, even a full Bladder cannot discharge. Thus, although the Bladder governs fluids, without the steaming of Mingmen Fire, fluids cannot enter; without Lung Metal Qi transformation, fluids cannot exit. Failure to enter leads to loose stools; failure to exit leads to strangury (difficulty urinating).