则阴已先尽，何阳可回耶？故见厥除热，存津液元气于什一，已失之晚，况敢助阳劫阴乎？（喻嘉言）
直中之伤寒，阴液未伤，急宜救阳，故有真武、四逆诸方；热病之伤寒，烁伤阴液，只宜救阴，故姜、
附不可犯。（许宣治）
伤寒邪传入里，胃气实，则大便闭结；胃气虚，则大便泄泻。夫胃气实，何以便闭？缘病患胃气本实，
邪热入胃，熏蒸激搏，津液
干枯，是以便硬而闭结矣。譬之以火烧土，自然坚硬，宜以承气汤下之。胃气虚，何以泄泻？缘病患胃气本虚，
邪气入胃，邪正相搏，邪胜正负，于是正气下陷而泄泻矣。譬之淤泥泞淖，益以雨淋，则流荡涣散。宜以理中
汤温补之。此因病患元气虚实，而兼以外邪参之，一定不移之法。（俞傅山）
余历试伤寒病，本是热证，治以寒药，延绵数日，忽然变为寒证，此中气大虚不堪寒凉，改用温剂获效。
又或阳证当下，医下太过，亦变为寒，此为坏证，改用热剂方愈。谚谓官打见在，吏打当该是也。故治伤寒活
法，今日见热证，即用凉药；明日见寒证，即用热药；又明日复见热证，仍复用凉药。全在变通，不可拘执。（吴篁池）
问曰∶如何是入阴者可下？答曰∶阳入于阴者可下，非入太阴、少阴、厥阴，乃入三阳也。三阳者，非太
阳、少阳、阳明之三阳，乃胃与大、小二肠之三阳也。三阳皆为腑，以其受盛水谷，传导有形，故曰入于阴也。
仲景云∶已入腑者可下。此之谓也。○汗本亡阴，以其汗多，阳亦随阴而走；下本泻阳，以其下多，阴亦随阳
而走。故曰∶汗多亡阳，下多亡阴也。○《评热论》藏字，此藏物之藏，非五脏之脏也。三阳经入藏，物之藏，
是可泄也。帝问治，岐伯对以治之各通其藏脉，病日衰已矣。复言其未满三日可汗而已，其满三日可泄而已。
三阳受病，未入藏者可汗；已入藏者可泄。若认藏字为五脏之脏，则前后颠倒不通；若认藏字作藏物之藏，则
前后辞理皆顺矣。仲景曰∶已入于腑者可下。《校正》云∶腑字当作藏字。何疑之有？（《此事难知》）
凡治伤寒之诀，起先惟恐传经，传经则变生；其后惟恐不传经，不传经则势笃。（《尚论篇》）
表证当汗，脉浮急汗之，脉沉缓汗之。里证当下，脉浮缓下之，脉沉急下之。三阳汗当急，而下当缓；三
阴汗当缓，而下当急。汗有大汗解表、微汗解肌之殊，下有急下少与、微和渗利之
别。（王好古）
五法大旨
仲景治有表里证，有两解表里者，有只解表而里自和者，有只和里而表自解者，与先救里后救表，先解表
后攻里，遂成五法。（柯韵伯）
一曰发，药用辛甘。盖表中之表，腠理致密，非辛甘不能发散，故曰发。发者正表也。○二曰解，解则轻
于发，药用辛凉。盖腠理既疏，恶寒已罢，邪将化热，非辛不能解肌，非凉不能解热，故曰解。解者解肌肉也。
○三曰和，和又轻于解，药用辛者轻，而凉者重。盖表邪将罢，欲入于里而未深入于里，曰表不可，曰里又不
可，半表半里，发解两难，故曰和。和者和其表里也。○四曰攻，攻则重于和，药用苦寒。为表已罢，邪入于腑，
结于肠胃，非苦寒不能攻，故曰攻。攻者攻实热也。○五曰救，救则与攻不同，热则攻而寒则救，药用温热。盖
邪不由阳经而入，径中三阴，名曰直中，内寒盛极，阳气衰危，故曰救。救者救阳危也。○五法之中，所谓表
者汗也，攻者下也。然仲景治伤寒有汗、吐、下三法，今独去吐法者何也？盖三法皆为逐邪，而设邪在表则汗
之，邪在胃之上脘则吐之，邪在里则下之。汗之、吐之、下之，皆逐邪也可知。吐之一字，原为邪在胃之上脘
而设也。夫邪在表禁吐，邪在里亦禁吐，至于半表半里，汗、吐、下三法皆禁。今世方书，皆以吐为邪在半表
半里，使后人受害者多矣。吐法取效者，十无一、二，受害者十常八、九，医者口能言之，而实不敢轻用也，
故不列于五法中。（陈养晦）
按∶吐药不止栀子也，诸药皆可为之。惟要确审胸胃之邪是寒、是热、是食、是水、是痰、是气？因何阻
滞，使胸胃阳气不伸？遂以当用之药而吐涌之，自可愈也。如欲吐寒，则以干姜、桂皮之类；吐热，则以栀子、
苦茶之类；吐食，平胃、食盐之类；吐水，五苓、生姜之类；吐痰，稀涎、橘皮之类；吐气，流气、
枳、朴之类。但形气弱者，药宜少，仍当佐以补中益气等升药为妥；形气壮者，药宜多，更佐以瓜蒂、藜芦等
猛药更效。凡煎吐药汤及调散，或用酸米汤，或用白汤，或用稀米粥，须备十余钟，令病者顿服一钟，即用指
探吐，药出再服一钟，亦随用指探吐，药出再服再吐，以顺溜快吐为度，则头额、身上自有微汗，所有病证轻
减，即为中病，不必尽服余药。若过吐之，即使病尽除，恐损胸中阳气也。近世之医，以吐为古法不可用久矣，
皆因仲景之道不彰，其法失传，无怪乎其不敢用也。夫不知其妙，而不敢用，犹之可也。若竟委之曰古法不
可用，则不可也。盖邪之在上者，非吐不愈。若如俗工所云，使病者畏不敢服，因循生变，致轻者重，重者死，
夫谁之咎与？抑知汗、吐、下三法，用之诚当，其证无不立时取效，后之业医者，又安可只言汗、下两法，
而置吐法于不用，致使古法沦亡也？（《医宗金鉴》）
六经禁例
足太阳膀胱经禁下，若下之太早，必变证百出。足阳明胃经禁发汗、禁利小便，犯之则重损津液，脉必代
结。足少阳胆经禁汗、禁下、禁利小便，汗则犯阳明，下则犯太阳，利小便则使生发之气陷入阴中。太阳经一
禁，阳明经二禁，少阳经三禁，此定禁也。至三阴经则无定禁，但非胃实仍禁下耳。（喻嘉言）
六经正义
仲景于诸病之表里阴阳，分为六经，清理脉证之异同，寒热之虚实，使治病只在六经。夫一身之病，俱
受六经范围者，犹周礼分六官以总百职也。若伤寒，不过是六经中一证，叔和不知仲景之六经，是经略之经，
而非经络之经，妄引《内经》热病论作序例，以冠仲景之书，而混其六经之证治。夫热病之六经，专主经脉为
病，但有表里之实热，并无表里之虚寒，虽因于伤寒，已变成热病，即温病之互名，但有可汗可泄之法，并无
可温可补之例。夫仲景之六经，是分区地面，所该者广，凡风寒湿热，内伤
外感，自表及里，寒热虚实，无所不包。所以六经提纲，各立一局，不为经络所拘，勿为风寒画定也。太阳为
开，故以之主表，而以脉浮、恶寒、头项强痛为提纲。阳明为阖，故以之主里，而以胃实为提纲。少阳为枢，
少阴亦为枢，故皆有半表半里证。少阳为阳枢，归重在半表，故以口苦、咽干、目眩为提纲；少阴为阴枢，故
其欲寐不寐，欲吐不吐，亦半表半里证，归重在半里也。岂惟阳明主里，三阴亦皆主里，而阴阳异位，故所主
各不同。阳明主里证之阳，阳道实，故以胃实属阳明；太阴主里证之阴，阴道虚，故以自利属太阴。太阴为开，
又为阴中之至阴，故主里寒而自利，厥阴为阖，又为阴中之阳，故主里热而气逆；少阴为阴中之枢，故所主或
寒或热之不同，或表或里之无定，与少阳相似也。请以地理喻，六经犹列国也。腰以上为三阳地面，三阳主外，
而本乎里。心者三阳夹界之地也，内由心胸，外自巅顶，前至额颅，后至肩背，下及乎足，内合膀胱，是太阳
地面。此经统理营卫，主一身之表证，犹近边御敌之国也。内自心胸，至胃及肠，外自头颅，由面及腹，下及
于足，是阳明地面。由心至咽，退场门颊，上耳目，斜至巅外，至胁内属胆，是少阳地面，犹畿甸矣。腰以下为
三阴地面，三阴主里，而不及外。腹者，三阴夹界之地也。自腹由脾及二肠魄门，为太阴地面；自腹至两肾及
膀胱溺道，为少阴地面；自腹由肝上膈至心，从胁肋下及于小肠宗筋，为厥阴地面。此经通三焦，主一身之里
证，犹畿辅之国矣。太阴、阳明同居异治，犹周召分政之义也。六经之有正邪、客邪、合病、并病、属脾、属
胃者，犹寇盗充斥，或在本境，或及邻国义之也。太阳地面最大，内邻少阴，外邻阳明，故病有相关。如小便
不利，本膀胱病，少阴病而小便不利者，邪入太阳之界也。腰痛本肾病，太阳病而腰痛者，是邪及少阴之界也。
六、七日不大便，反头痛身热者，是阳明热邪侵入太阳之界也。头项强痛兼鼻鸣、干呕者，是太阳风邪侵入
阳明之界也。心胸是阳明地面，而为太
阳之通衢，因太阳主营卫，心胸是营卫之本，营卫环周不休，犹边邑之吏民、士卒会于邦畿，往来不绝也。如
喘而胸满者，是太阳外邪入阳明地面而骚扰，故称为太阳阳明合病。若头不痛，项不强，胸中痞硬，气冲咽喉
不得息者，此邪不自太阳来，乃阳明热邪结于胸中，犹乱民聚于本境为患也。心为六经之主，故六经皆有心烦
之证。如不头项强痛，则烦不属太阳；不往来寒热，则烦不属少阳；不见三阴证者，则烦不属三阴矣。故心愦
愦，心惕惕，心中懊 ，一切虚烦，皆属阳明，以心居阳明地面也。阳明犹邦畿，故心腹皆居其地，邪在心为
虚烦，在腹为实热。心为阳而属无形，腹为阴而属有形也。夫人身之病，动关心腹，阳邪聚于心，阴邪聚于腹。
肝为阴中之阳，故能使阴邪上撞于心，阳明为在里之阳，故能使阳邪入聚于腹耳。更以兵法喻，兵法之要，在
明地形，必先明六经之路，才知贼寇之所从来，知某方是某府来路，某方是某府去路。来路犹边关，三阳是也；
去路是内境，三阴是也。六经来路各不同，太阳是大路，少阳是僻路，阳明是直路，太阴近路也，少阴后路也，
厥阴邪路也。客邪多由三阳来，正邪多由三阴起，犹外寇自边关至，乱民自内地生也。明六经之地形，始得握
百病之枢机；详六经之来路，乃能操治病之规则。如以证论，伤寒大寇也，病从外来；中风流寇也，病因旁及；
杂病乱民也，病由中起。既认为何等之贼，又知为何地所起，发于其境，便御之本境，移祸邻郡，即两路夹攻。
如邪入太阳地面，即汗而散之，犹陈利兵于要害，乘其未定而击之也。邪之轻者在卫，重者在营，尤重者在胸
膈，犹寇之浅者在关外，深者在关上，尤深者在关内也。麻黄为关外之师，桂枝、葛根为关上之师，大青龙为
关内之师。凡外寇不靖，内贼必起而应之，因立而解法，故有大、小青龙及桂枝、麻黄加减诸方。如前军无纪，
致内乱蜂起，当重内轻外，因有五苓、十枣、陷胸、泻心、抵当等汤。邪入少阳地位，宜杂用表里寒热攻补之
品，为防御解利之
法。如偏僻小路，利于短兵，不利于矛戟；利于守备，不利于战争也。邪之轻者入腠理，重者入膜原，尤重者
入脾胃。小柴胡，腠理之剂也；大柴胡，膜原之剂也；小建中、半夏泻心、黄芩、黄连四方，少阳之脾剂也；
柴胡加芒硝、加牡蛎二方，少阳之胃剂也。如太阳少阳有合并病，是一军犯太阳，一军犯少阳矣；用柴胡桂枝
汤，是两路分击之师也。甚至三阳合病，是三面受敌矣，法在独取阳明。阳明之地面清肃，则太、少两路之阳
邪不攻自解，但得内寇平而外患自息，此白虎所由奏捷耳。若阳邪不戢于内，用大承气以急下之，是攻邪以护
主；若阴邪直入于中，用四逆汤以急救其里，是强主以逐寇也。阳明为内地，阳明界上，即太阳、少阳地面，
邪入阳明之界，虽不犯太阳，太阳之师不得坐视而不救，故阳明之营卫病，即假麻、桂等方以汗之。邪近少
阳地面，少阳之师不得高垒而不战，故阳明之腠理病，即假柴胡以解之。是知阳明之失守，非太阳不固，即少
阳无备，所以每每两阳相合而为病也。若邪已在阳明地面，必出师奋击，以大逐其邪，不使稍留，故用瓜蒂、
栀豉之吐法以迅扫之。若深入内地，不可复驱，则当清野千里，使无所剽掠，是又白虎得力处也。若邪在门庭，
又当清宫除道，此三承气所由取胜。如茵陈、猪苓辈，又为失纪之师立法矣。太阴亦内地，少阴、厥阴为夹界，
太阴居中州，虽外通三阳，而阴阳既以殊途，心腹更有膈膜之藩蔽。故寒水之邪，从太阳外属者轻，由少阴内
授者重；风木之邪，自少阳来侵者轻，因厥阴上袭者重。如本经正邪，转属阳明而为实，犹师老势穷，可下之
而愈。如阳明实邪，转属本经而成虚，则邪盛正虚，温补挽回者甚难。盖太阴、阳明，地面虽分，并无阻隔，
元气有余，则邪入阳明，元气不足，则邪入太阴。但在阳明，则陈师鞠旅，可背城一战，取胜须臾；在太阴，
则焚劫积蓄，仓廪空虚，无能御敌耳。厥阴之地，相火游行之区也，其本气则为少火。若风、寒、燥、湿之邪
一入其境，悉化为热，即是壮火。其
少火为一身之生机，而壮火为心腹之大患。且其地面通三焦，邪犯上焦，则气上撞心，心中疼热，消渴口烂，
咽痛喉痹；逼于中焦，即手足厥冷，脉微欲绝，饥不欲食，食即吐蛔；移祸下焦，则热利下重，或便脓血，为
那么阴气已经先耗竭了，阳气又怎么能够回复呢？所以见到四肢厥冷而除去热邪，想要保存十分之一二的津液和元气，为时已晚，何况还敢用助阳的方法去劫夺阴液吗？（喻嘉言）
直中（寒邪直接侵犯脏腑）的伤寒，阴液没有受损，急需救阳，所以有真武汤、四逆汤等方剂；热病性质的伤寒，火热灼伤阴液，只宜救阴，所以姜、附子不可使用。（许宣治）
伤寒邪气传入体内，如果胃气实，则大便闭结不通；如果胃气虚，则大便泄泻。胃气实，为什么会导致便秘？因为患者原本胃气就实，邪热进入胃中，熏蒸激荡，导致津液干枯，所以大便坚硬而闭结。这就好比用火烤土，泥土自然会变硬，适宜用承气汤攻下。胃气虚，为什么会泄泻？因为患者原本胃气就虚，邪气进入胃中，邪正相争，邪胜正负，于是正气下陷而导致泄泻。这就好比淤泥泥泞，再加上雨淋，就会流荡涣散。适宜用理中汤温补。这是根据患者元气的虚实，兼以外邪的情况，所确定的不变法则。（俞傅山）
我历次诊治伤寒病，发现它本是热证，医生用寒凉药物治疗，拖延数日后，突然变为寒证，这是因为中气大虚，不能耐受寒凉，改用温热药剂才见效。又或者阳证应当用下法，医生攻下太过，也变成了寒证，这属于坏证，改用热剂才能痊愈。谚语说“官打见在，吏打当该”就是这个道理。所以治疗伤寒的灵活方法，今天见到热证，就用凉药；明天见到寒证，就用热药；后天又见到热证，仍然复用凉药。全在于变通，不可拘泥固执。（吴篁池）
问：什么是入阴者可下？答：阳入于阴者可下，并非指进入太阴、少阴、厥阴，而是指进入三阳。这里的三阳，并非指太阳、少阳、阳明这三条经络的三阳，而是指胃与大肠、小肠这三腑之三阳。三阳都是腑，因为它们受盛水谷，传导有形之物，所以称为入于阴（此处阴指里/腑）。仲景说：已入腑者可下。说的就是这个意思。○发汗本会亡阴，但因为汗出过多，阳也会随着阴一起流失；攻下本会泻阳，但因为泻下过多，阴也会随着阳一起流失。所以说：汗多亡阳，下多亡阴。○《评热论》中的“藏”字，这里指储藏食物的“藏”，而非五脏之“脏”。三阳经的病入藏（指入腑），是储藏食物之所，是可以泄下的。黄帝问治疗，岐伯回答说治疗要通调各藏的脉气，病就会日渐衰退痊愈。又说未满三日可发汗而愈，满三日可泄下而愈。三阳受病，未入藏（腑）的可发汗；已入藏（腑）的可泄下。如果把“藏”字理解为五脏之脏，那么前后文意颠倒不通；如果把“藏”字理解为储藏食物的藏，那么前后文理都顺了。仲景说：已入于腑者可下。《校正》说：腑字应当作藏字。有什么可疑的呢？（《此事难知》）
凡是治疗伤寒的关键，起初惟恐病邪传经，传经则变化丛生；后来惟恐不传经，不传经则病情深重。（《尚论篇》）
表证应当发汗，脉浮急的发汗，脉沉缓的发汗。里证应当攻下，脉浮缓的下法，脉沉急的下法。三阳病的发汗应当急，而下法应当缓；三阴病的发汗应当缓，而下法应当急。发汗有大汗解表和微汗解肌的区别，攻下有急下少与和微和渗利的不同。（王好古）
五法大旨
仲景治疗有表里证的疾病，有两种方法同时解表里的，有只解表而里自和的，有只和里而表自解的，以及先救里后救表、先解表后攻里，从而形成了五种治法。（柯韵伯）
第一种叫“发”，药物用辛甘味。因为表中之表，腠理致密，非辛甘不能发散，所以叫发。发是指正表。○第二种叫“解”，解比发轻，药物用辛凉。因为腠理已疏，恶寒已罢，邪气将要化热，非辛不能解肌，非凉不能解热，所以叫解。解是指解除肌肉层面的邪气。○第三种叫“和”，和又比解轻，药物辛味轻而凉味重。因为表邪将罢，欲入里但未深入，曰表不可，曰里亦不可，处于半表半里，发法和解法都难以单独奏效，所以叫和。和是指调和表里。○第四种叫“攻”，攻比和重，药物用苦寒。因为表邪已罢，邪气入腑，结于肠胃，非苦寒不能攻，所以叫攻。攻是指攻逐实热。○第五种叫“救”，救与攻不同，热证用攻，寒证用救，药物用温热。因为邪气不由阳经而入，直接中于三阴，名叫直中，内寒极盛，阳气衰危，所以叫救。救是指挽救阳气之危。○在五法之中，所谓的表就是汗法，攻就是下法。然而仲景治疗伤寒有汗、吐、下三法，现在唯独去掉吐法是什么原因呢？因为三法都是为了驱逐邪气，邪在表则汗之，邪在胃之上脘则吐之，邪在里则下之。汗之、吐之、下之，都是驱逐邪气。吐这一字，原本是为邪在胃之上脘而设的。邪在表禁吐，邪在里亦禁吐，至于半表半里，汗、吐、下三法皆禁。现在的方书，都把吐法当作邪在半表半里的治法，使后人受害很多。吐法取效的，十无一二，受害的十常八九，医者嘴上能说，但实际上不敢轻易使用，所以不列在五法中。（陈养晦）
按语：吐药不止栀子一种，诸药皆可用来催吐。只要确切审察胸胃之邪是寒、是热、是食积、是水饮、是痰、是气滞？因何阻滞，使胸胃阳气不得伸展？遂用相应的药物涌吐，自然可以痊愈。如欲吐寒邪，则用干姜、桂皮之类；吐热邪，则用栀子、苦茶之类；吐食积，用平胃散、食盐之类；吐水饮，用五苓散、生姜之类；吐痰，用稀涎散、橘皮之类；吐气滞，用流气饮、枳实、厚朴之类。但形体气弱的人，药量宜少，仍应佐以补中益气等升提药为妥；形体气壮的人，药量宜多，更佐以瓜蒂、藜芦等猛药更有效。凡煎煮吐药汤剂及调配散剂，或用酸米汤，或用白开水，或用稀米粥，须准备十余钟，让病人顿服一钟，随即用手指探喉催吐，药吐出后再服一钟，也随即用手指探喉催吐，药出再服再吐，以顺畅快速地呕吐为度，此时头额、身上自然会有微汗，所有病症减轻，即为中病，不必服完剩余的药物。如果过度催吐，即使病邪尽除，恐怕会损伤胸中阳气。近世的医生，认为吐法是古法不可用已久，都是因为仲景之道不显，其法失传，难怪他们不敢用。不知道其妙处而不敢用，还可以理解。如果竟推委说古法不可用，那就不对了。因为邪气在上焦的，不用吐法不能痊愈。如果像庸医所说，使病人畏惧不敢服药，因循拖延产生变故，致使轻者变重，重者致死，这是谁的过错呢？况且知道汗、吐、下三法，用得恰当，病症无不立即见效，后来的业医者，又怎能只说汗、下两法，而置吐法于不用，致使古法沦亡呢？（《医宗金鉴》）
六经禁例
足太阳膀胱经禁用下法，如果下得太早，必然变证百出。足阳明胃经禁发汗、禁利小便，犯之则会严重损伤津液，脉象必定出现代脉或结脉。足少阳胆经禁汗、禁下、禁利小便，发汗则犯阳明，攻下则犯太阳，利小便则使生发之气陷入阴中。太阳经一禁，阳明经二禁，少阳经三禁，这是固定的禁忌。至于三阴经则没有固定禁忌，只是如果不是胃实证，仍禁止攻下。（喻嘉言）
六经正义
仲景将各种疾病的表里阴阳分为六经，理清脉证的异同，寒热的虚实，使治病只在六经范围内进行。全身的病症，都受六经范围统摄，就像周礼分设六官来总管百职一样。如果说是伤寒，不过是六经中的一种证候，王叔和不懂仲景的六经是经略之经，而非经络之经，妄引《内经》热病论作为序例，冠于仲景之书，从而混淆了其六经的证治。热病的六经，专门主经脉为病，只有表里的实热，没有表里的虚寒，虽然起因于伤寒，但已变成热病，也就是温病的互称，只有可汗可泄的方法，没有可温可补的例子。仲景的六经，是划分区域地面，所涵盖的范围很广，凡风寒湿热，内伤外感，自表及里，寒热虚实，无所不包。所以六经提纲，各立一局，不被经络所拘束，不为风寒画定界限。太阳为开，所以以它主表，以脉浮、恶寒、头项强痛为提纲。阳明为阖，所以以它主里，以胃实为提纲。少阳为枢，少阴也为枢，所以都有半表半里证。少阳为阳枢，归重在半表，所以以口苦、咽干、目眩为提纲；少阴为阴枢，所以其欲寐不寐，欲吐不吐，也是半表半里证，归重在半里。岂止阳明主里，三阴也都主里，而阴阳位置不同，所以所主各不相同。阳明主里证之阳，阳道实，所以以胃实属阳明；太阴主里证之阴，阴道虚，所以以自利属太阴。太阴为开，又为阴中之至阴，所以主里寒而自利；厥阴为阖，又为阴中之阳，所以主里热而气逆；少阴为阴中之枢，所以所主或寒或热不同，或表或里无定，与少阳相似。请用地理来比喻，六经就像列国。腰以上为三阳地面，三阳主外，而本乎里。心是三阳夹界之地，内由心胸，外自巅顶，前至额颅，后至肩背，下及于足，内合膀胱，这是太阳地面。此经统理营卫，主一身之表证，犹如靠近边境抵御敌寇的国家。内自心胸，至胃及肠，外自头颅，由面及腹，下及于足，这是阳明地面。由心至咽，退至脸颊，上耳目，斜至巅外，至胁内属胆，这是少阳地面，犹如京畿附近。腰以下为三阴地面，三阴主里，而不及外。腹是三阴夹界之地。自腹由脾及二肠魄门，为太阴地面；自腹至两肾及膀胱溺道，为少阴地面；自腹由肝上膈至心，从胁肋下及于小肠宗筋，为厥阴地面。此经通三焦，主一身之里证，犹如京辅之国。太阴、阳明同居异治，犹如周公召公分政之义。六经有正邪、客邪、合病、并病、属脾、属胃的情况，犹如寇盗充斥，或在本境，或波及邻国。太阳地面最大，内邻少阴，外邻阳明，所以病有关联。如小便不利，本是膀胱病，少阴病而小便不利的，是邪气进入太阳的边界。腰痛本是肾病，太阳病而腰痛的，是邪气波及少阴的边界。六、七日不大便，反头痛身热的，是阳明热邪侵入太阳的边界。头项强痛兼鼻鸣、干呕的，是太阳风邪侵入阳明的边界。心胸是阳明地面，而为太阳的通衢，因为太阳主营卫，心胸是营卫之本，营卫环周不休，犹如边邑的吏民、士卒会于邦畿，往来不绝。如喘而胸满的，是太阳外邪入阳明地面而骚扰，所以称为太阳阳明合病。若头不痛，项不强，胸中痞硬，气冲咽喉不得息的，此邪气不自太阳来，乃阳明热邪结于胸中，犹如乱民聚于本境为患。心为六经之主，所以六经都有心烦的证候。如不头项强痛，则烦不属太阳；不往来寒热，则烦不属少阳；不见三阴证者，则烦不属三阴。故心愦愦，心惕惕，心中懊憹，一切虚烦，皆属阳明，因为心居阳明地面。阳明犹如邦畿，所以心腹皆居其地，邪在心为虚烦，在腹为实热。心为阳而属无形，腹为阴而属有形。人身之病，动关心腹，阳邪聚于心，阴邪聚于腹。肝为阴中之阳，所以能使阴邪上撞于心；阳明为在里之阳，所以能使阳邪入聚于腹。再用兵法比喻，兵法的要领，在于明地形，必先明六经之路，才知道贼寇从哪里来，知道某方是某府的来路，某方是某府的去路。来路犹边关，三阳是也；去路是内境，三阴是也。六经来路各不相同，太阳是大路，少阳是僻路，阳明是直路，太阴是近路，少阴是后路，厥阴是邪路。客邪多由三阳来，正邪多由三阴起，犹如外寇自边关至，乱民自内地生。明六经的地形，始得握百病之枢机；详六经的来路，乃能操治病之规则。如以证论，伤寒是大寇，病从外来；中风是流寇，病因旁及；杂病是乱民，病由中起。既认为是何等之贼，又知为何地所起，发于其境，便御之本境，移祸邻郡，即两路夹攻。如邪入太阳地面，即汗而散之，犹如陈列利兵于要害，乘其未定而击之。邪之轻者在卫，重者在营，尤重者在胸膈，犹如寇之浅者在关外，深者在关上，尤深者在关内。麻黄为关外之师，桂枝、葛根为关上之师，大青龙为关内之师。凡外寇不靖，内贼必起而应之，因此设立解法，故有大、小青龙及桂枝、麻黄加减诸方。如前军无纪，致内乱蜂起，当重内轻外，因此有五苓、十枣、陷胸、泻心、抵当等汤。邪入少阳地位，宜杂用表里寒热攻补之品，为防御解利之法。如偏僻小路，利于短兵，不利于矛戟；利于守备，不利于战争。邪之轻者入腠理，重者入膜原，尤重者入脾胃。小柴胡，是腠理之剂；大柴胡，是膜原之剂；小建中、半夏泻心、黄芩、黄连四方，是少阳之脾剂；柴胡加芒硝、加牡蛎二方，是少阳之胃剂。如太阳少阳有合并病，是一军犯太阳，一军犯少阳矣；用柴胡桂枝汤，是两路分击之师。甚至三阳合病，是三面受敌矣，法在独取阳明。阳明之地面清肃，则太、少两路之阳邪不攻自解，但得内寇平而外患自息，此白虎汤所以奏捷的原因。若阳邪不戢于内，用大承气汤以急下之，是攻邪以护主；若阴邪直入于中，用四逆汤以急救其里，是强主以逐寇。阳明为内地，阳明界上，即太阳、少阳地面，邪入阳明之界，虽不犯太阳，太阳之师不得坐视而不救，故阳明之营卫病，即假借麻黄、桂枝等方以汗之。邪近少阳地面，少阳之师不得高垒而不战，故阳明之腠理病，即假借柴胡以解之。是知阳明之失守，非太阳不固，即少阳无备，所以每每两阳相合而为病。若邪已在阳明地面，必出师奋击，以大逐其邪，不使稍留，故用瓜蒂、栀豉之吐法以迅扫之。若深入内地，不可复驱，则当清野千里，使无所剽掠，这又是白虎汤得力之处。若邪在门庭，又当清宫除道，这是三承气汤所以取胜的原因。如茵陈、猪苓辈，又是为失纪之师立法。太阴也是内地，少阴、厥阴为夹界，太阴居中州，虽外通三阳，而阴阳既以殊途，心腹更有膈膜之藩蔽。所以寒水之邪，从太阳外属者轻，由少阴内授者重；风木之邪，自少阳来侵者轻，因厥阴上袭者重。如本经正邪，转属阳明而为实，犹如师老势穷，可下之而愈。如阳明实邪，转属本经而成虚，则邪盛正虚，温补挽回者甚难。盖太阴、阳明，地面虽分，并无阻隔，元气有余，则邪入阳明，元气不足，则邪入太阴。但在阳明，则陈师鞠旅，可背城一战，取胜须臾；在太阴，则焚劫积蓄，仓廪空虚，无能御敌耳。厥阴之地，是相火游行之区，其本气则为少火。若风、寒、燥、湿之邪一入其境，悉化为热，即是壮火。其少火为一身之生机，而壮火为心腹之大患。且其地面通三焦，邪犯上焦，则气上撞心，心中疼热，消渴口烂，咽痛喉痹；逼于中焦，即手足厥冷，脉微欲绝，饥不欲食，食即吐蛔；移祸下焦，则热利下重，或便脓血，为
Then Yin has already been exhausted first, how can Yang be restored? Therefore, seeing cold extremities and removing heat, to preserve one-tenth or one-hundredth of the body fluids and Yuan Qi (Original Qi), is already too late; how much more dare one assist Yang by robbing Yin? (Yu Jiayan)
In "Zhi Zhong" (Direct Invasion) Shanghan (Cold Damage), the Yin fluids are not damaged, so urgent rescue of Yang is required; thus formulas such as Zhenwu Tang (True Warrior Decoction) and Sini Tang (Reverse the Extremities Decoction) are used. In Shanghan characterized by Heat Disease, where scorching heat damages the Yin fluids, only rescuing Yin is appropriate; therefore, Ginger (Sheng Jiang, 生姜) and Aconite (Fu Zi, 附子) must not be used. (Xu Xuanzhi)
When Shanghan pathogens transmit inward: if Stomach Qi is Excess, there will be constipation; if Stomach Qi is Deficient, there will be diarrhea. Why does Excess Stomach Qi lead to constipation? Because the patient's Stomach Qi was originally Excess, and when pathogenic heat enters the Stomach, it steams and agitates, drying up the body fluids, leading to hard and constipated stools. This is like firing clay in a kiln; naturally, it becomes hard. It is appropriate to use Chengqi Tang (Major/Minor Order the Qi Decoction) to purge it. Why does Deficient Stomach Qi lead to diarrhea? Because the patient's Stomach Qi was originally Deficient, and when pathogenic factors enter the Stomach, the pathogen and righteous Qi contend; the pathogen wins and righteous Qi loses, causing righteous Qi to sink downward and resulting in diarrhea. This is like mud becoming slushy; adding rain causes it to flow and scatter. It is appropriate to use Lizhong Tang (Regulate the Middle Decoction) to warm and tonify. This is a fixed method based on the Excess or Deficiency of the patient's Yuan Qi combined with external pathogens. (Yu Fushan)
I have repeatedly treated Shanghan diseases, which are essentially Heat patterns. When treated with Cold medicines for several days, they suddenly transform into Cold patterns. This is because the Middle Jiao Qi is severely deficient and cannot tolerate cold and cool substances; switching to warm agents yields results. Alternatively, in a Yang pattern that requires purgation, if the physician purges too excessively, it also transforms into a Cold pattern. This is a "Huai Zheng" (Damaged Pattern). Switching to hot agents is necessary for recovery. The proverb says, "An official beats you for being present; a clerk beats you for being liable." Thus, the flexible method for treating Shanghan is: today, if a Heat pattern is seen, use cool medicines; tomorrow, if a Cold pattern is seen, use hot medicines; the day after, if a Heat pattern appears again, reuse cool medicines. It all lies in adaptability; one must not be rigid or dogmatic. (Wu Huangchi)
Question: What does it mean that "entering Yin allows for purgation"? Answer: When Yang enters Yin, purgation is allowed. This does not refer to entering Taiyin, Shaoyin, or Jueyin, but rather entering the Three Yang. Here, "Three Yang" does not refer to the Taiyang, Shaoyang, and Yangming meridians, but to the Stomach, Large Intestine, and Small Intestine. These three Yang organs are Fu (Hollow Organs); because they receive and hold food and drink, and conduct有形 (form/substance), they are called "entering Yin" (here Yin refers to the interior/Fu organs). Zhang Zhongjing said: "Once entered the Fu, purgation is allowed." This is what is meant. ○ Sweating inherently causes loss of Yin; because excessive sweating causes Yang to follow Yin and leave. Purging inherently drains Yang; because excessive purging causes Yin to follow Yang and leave. Therefore it is said: Excessive sweating leads to loss of Yang; excessive purging leads to loss of Yin. ○ In *Ping Re Lun* (Discussion on Fever), the character "Zang" (Storehouse/Organ) here refers to the storehouse of food, not the Five Zang (Solid Organs). When disease of the Three Yang meridians enters the "Zang" (storehouse/Fu), which stores food, it can be drained/purged. The Yellow Emperor asked about treatment; Qibo replied that treatment should unblock the pulses of each Zang, and the disease will decline daily. He further stated that if less than three days have passed, sweating can cure it; if more than three days have passed, purging can cure it. For disease affecting the Three Yang, if it has not entered the Zang (Fu), sweating is appropriate; if it has entered the Zang (Fu), purging is appropriate. If one interprets "Zang" as the Five Solid Organs, the preceding and following text becomes contradictory and illogical; if one interprets "Zang" as the storehouse of food, the logic flows smoothly throughout. Zhang Zhongjing said: "Once entered the Fu, purgation is allowed." The *Jiaozheng* (Correction) states: The character "Fu" should be read as "Zang". What is there to doubt? (*Ci Shi Nan Zhi*)
The key to treating Shanghan initially is fearing transmission through the meridians; transmission brings changes. Later, one fears non-transmission; non-transmission means the condition becomes severe. (*Shanglun Pian*)
For Exterior patterns, sweating is indicated: if the pulse is floating and rapid, sweat; if floating and slow, sweat. For Interior patterns, purging is indicated: if floating and slow, purge; if deep and rapid, purge. For the Three Yang, sweating should be urgent, while purging should be slow; for the Three Yin, sweating should be slow, while purging should be urgent. Sweating differs between profuse sweating to release the exterior and mild sweating to resolve the muscle layer. Purging differs between urgent purging with small doses and mild harmonizing with moistening/diuresis. (Wang Haogu)
General Principles of the Five Methods
Zhang Zhongjing treats diseases with both Exterior and Interior patterns using methods that simultaneously resolve both; methods that only resolve the Exterior allowing the Interior to harmonize itself; methods that only harmonize the Interior allowing the Exterior to resolve itself; and methods of rescuing the Interior first then the Exterior, or resolving the Exterior first then attacking the Interior. Thus, five methods are formed. (Ke Yunbo)
1. Fa (Elicit/Disperse): Medicines use Pungent and Sweet flavors. Because the outermost layer of the Exterior, the Cou Li (interstices/skin pores), is dense, only Pungent and Sweet can disperse it; hence it is called "Fa". "Fa" refers to the true Exterior. ○ 2. Jie (Resolve): Resolution is lighter than elicitation; medicines use Pungent and Cool flavors. Because the Cou Li is already open and aversion to cold has ceased, and pathogens are transforming into heat, only Pungent can resolve the muscle layer, and only Cool can resolve heat; hence it is called "Jie". "Jie" refers to resolving the muscles. ○ 3. He (Harmonize): Harmonizing is lighter than resolving; medicines use light Pungent and heavy Cool flavors. Because the Exterior pathogen is fading but wants to enter the Interior without deeply penetrating, it is neither purely Exterior nor purely Interior, but Semi-Exterior/Semi-Interior, making both Fa and Jie difficult; hence it is called "He". "He" refers to harmonizing the Exterior and Interior. ○ 4. Gong (Attack): Attacking is heavier than harmonizing; medicines use Bitter and Cold flavors. Because the Exterior pathogen has ceased, and pathogens have entered the Fu, knotting in the intestines and stomach, only Bitter and Cold can attack; hence it is called "Gong". "Gong" refers to attacking Excess Heat. ○ 5. Jiu (Rescue): Rescue is different from attack; Heat is attacked, Cold is rescued; medicines use Warm and Hot flavors. Because pathogens do not enter via the Yang meridians but directly strike the Three Yin, named "Zhi Zhong" (Direct Strike), internal Cold is extremely severe, and Yang Qi is critically deficient; hence it is called "Jiu". "Jiu" refers to rescuing critical Yang. ○ Among the five methods, the so-called "Exterior" is sweating, and "Attack" is purging. However, Zhang Zhongjing’s treatment of Shanghan includes Sweating, Vomiting, and Purging methods. Why is Vomiting excluded now? Because all three methods expel pathogens: if pathogens are in the Exterior, sweat them; if in the upper epigastrium of the Stomach, vomit them; if in the Interior, purge them. Sweating, vomiting, and purging all expel pathogens. The term "Vomit" was originally set for pathogens in the upper epigastrium. Pathogens in the Exterior prohibit vomiting; pathogens in the Interior prohibit vomiting; at Semi-Exterior/Semi-Interior, all three methods are prohibited. Modern formularies treat vomiting as the method for Semi-Exterior/Semi-Interior, causing much harm to later generations. Vomiting succeeds in one or two cases out of ten, and harms in eight or nine. Physicians can speak of it but dare not use it lightly, so it is not listed among the five methods. (Chen Yanghui)
Note: Emetic drugs are not limited to Gardenia (Zhi Zi); various drugs can induce vomiting. One must accurately diagnose whether the pathogen in the chest and stomach is Cold, Heat, Food retention, Water retention, Phlegm, or Qi stagnation? What obstruction prevents the Chest-Stomach Yang Qi from extending? Then use the appropriate drug to induce vomiting, and recovery will naturally occur. To vomit Cold, use Dried Ginger (Gan Jiang, 干姜) and Cinnamon Bark (Gui Pi, 桂皮); to vomit Heat, use Gardenia (Zhi Zi, 栀子) and bitter tea; to vomit Food, use Pingwei San (Calm the Stomach Powder) and salt; to vomit Water, use Wuling San (Five Ling Powder) and fresh ginger; to vomit Phlegm, use Xixian San (Slippery Saliva Powder) and tangerine peel; to vomit Qi, use Liuqi Yin (Flowing Qi Decoction), Zhi Shi (Immature Bitter Orange, 枳实), and Hou Po (Magnolia Bark, 厚朴). For those with weak constitution, the dose should be small, supplemented with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and other ascending drugs for safety; for those with strong constitution, the dose should be larger, supplemented with potent drugs like Melon Sprout (Gua Di, 瓜蒂) and Veratrum (Li Lu, 藜芦) for better effect. When decocting emetic soups or mixing powders, use sour rice soup, plain water, or thin rice gruel. Prepare over ten cups. Have the patient gulp down one cup, then stimulate the throat with a finger to induce vomiting. After vomiting, take another cup, stimulate again, and repeat until vomiting is smooth and rapid. At this point, slight sweat will appear on the forehead and body, symptoms will lessen, indicating the medicine has hit the mark. There is no need to finish the remaining medicine. Over-vomiting may damage Chest Yang even if the disease is cured. Modern physicians have long considered vomiting an obsolete ancient method. This is because Zhang Zhongjing’s principles are obscure and the method lost, so no wonder they dare not use it. Not knowing its efficacy and daring not to use it is understandable. But dismissing it as "ancient methods are unusable" is wrong. Pathogens in the Upper Jiao cannot be cured without vomiting. If, as vulgar practitioners claim, patients fear taking the medicine, leading to delay and complications, turning mild cases severe and severe cases fatal, whose fault is it? Moreover, if Sweating, Vomiting, and Purging are used appropriately, effects are immediate. How can future physicians only discuss Sweating and Purging, leaving Vomiting unused, causing ancient methods to perish? (*Yizong Jinjian*)
Contraindications of the Six Meridians
Foot-Taiyang Bladder Meridian prohibits purging. If purged too early, myriad transformation patterns will emerge. Foot-Yangming Stomach Meridian prohibits sweating and diuresis. Violating this severely damages body fluids, and the pulse will likely show intermittent (Dai, 代) or knotted (Jie, 结) qualities. Foot-Shaoyang Gallbladder Meridian prohibits sweating, purging, and diuresis. Sweating violates Yangming; purging violates Taiyang; diuresis traps the generating Qi in Yin. Taiyang has one prohibition, Yangming has two, Shaoyang has three; these are fixed prohibitions. As for the Three Yin meridians, there are no fixed prohibitions, except that purging is still prohibited unless there is Stomach Excess. (Yu Jiayan)
Correct Interpretation of the Six Meridians
Zhang Zhongjing divides the Exterior/Interior and Yin/Yang of various diseases into Six Meridians, clarifying differences in pulses and symptoms, and Excess/Deficiency of Cold/Heat, so that treatment focuses solely on the Six Meridians. Diseases of the whole body are encompassed by the Six Meridians, just as the Rites of Zhou divided six offices to manage all duties. If speaking of Shanghan, it is merely one pattern within the Six Meridians. Wang Shuhe did not understand that Zhang Zhongjing’s Six Meridians refer to strategic regions, not meridian pathways. He wrongly cited the *Neijing*'s *Re Bing Lun* (Treatise on Fever Diseases) as a preface, confusing the diagnosis and treatment of the Six Meridians. The Six Meridians of Fever Diseases focus specifically on meridian pathology, involving only Excess Heat in the Exterior/Interior, with no Deficient Cold. Although originating from Shanghan, it has transformed into a Fever Disease (also known as Warm Disease), possessing only methods for sweating and purging, with no examples of warming or tonifying. Zhang Zhongjing’s Six Meridians divide geographical regions, covering a wide range: Wind-Cold-Damp-Heat, Internal Injury, External Contraction, from Exterior to Interior, Cold-Heat, Excess-Deficiency, all included. Thus, the Six Meridians outlines stand independently, not constrained by meridians, nor defined strictly by Wind-Cold. Taiyang is Opening, thus governing the Exterior, with floating pulse, aversion to cold, and stiffness/pain of the head and neck as the outline. Yangming is Closing, thus governing the Interior, with Stomach Excess as the outline. Shaoyang is Pivot, and Shaoyin is also Pivot, so both have Semi-Exterior/Semi-Interior patterns. Shaoyang is the Yang Pivot, focusing on Semi-Exterior, with bitter taste, dry throat, and vertigo as the outline; Shaoyin is the Yin Pivot, with desire to sleep but inability, desire to vomit but inability, also Semi-Exterior/Semi-Interior, focusing on Semi-Interior. Does only Yangming govern the Interior? The Three Yin also govern the Interior, but due to different Yin/Yang positions, their governance differs. Yangming governs the Yang aspect of Interior patterns; the Yang pathway is Excess, so Stomach Excess belongs to Yangming. Taiyin governs the Yin aspect of Interior patterns; the Yin pathway is Deficient, so spontaneous diarrhea belongs to Taiyin. Taiyin is Opening and the Ultimate Yin within Yin, thus governing Interior Cold and spontaneous diarrhea. Jueyin is Closing and Yang within Yin, thus governing Interior Heat and rebellious Qi. Shaoyin is the Pivot within Yin, so its governance varies between Cold/Heat and Exterior/Interior, similar to Shaoyang. Let us use geography as a metaphor: the Six Meridians are like feudal states. Above the waist is the Three Yang region; Three Yang govern the Exterior but originate from the Interior. The Heart is the borderland of the Three Yang. Internally from the chest/heart, externally from the vertex, anteriorly to the forehead, posteriorly to the shoulders/back, inferiorly to the feet, internally connecting to the Bladder—this is the Taiyang region. This meridian manages Ying and Wei Qi, governing Exterior patterns of the whole body, like a border state defending against enemies. Internally from the chest/heart to the Stomach/intestines, externally from the head to the face/abdomen, inferiorly to the feet—this is the Yangming region. From the heart to the throat, back to the cheeks, up to the eyes/ears, diagonally to the vertex exterior, internally to the hypochondrium connecting to the Gallbladder—this is the Shaoyang region, like the capital vicinity. Below the waist is the Three Yin region; Three Yin govern the Interior and do not extend to the Exterior. The abdomen is the borderland of the Three Yin. From the abdomen via the Spleen to the intestines/anus—Taiyin region; from the abdomen to the kidneys/bladder urinary tract—Shaoyin region; from the abdomen via the Liver up through the diaphragm to the heart, from the hypochondrium down to the small intestine/genitals—Jueyin region. This meridian connects the San Jiao, governing Interior patterns of the whole body, like a vassal state near the capital. Taiyin and Yangming reside together but are treated differently, like the shared governance of Zhou and Shao. The presence of Correct Pathogens, Guest Pathogens, Combined Diseases, Concurrent Diseases, and involvement of Spleen/Stomach in the Six Meridians is like bandits filling the land, either in their own territory or spreading to neighbors. The Taiyang region is largest, adjacent internally to Shaoyin and externally to Yangming, so diseases are related. For example, difficulty urinating is originally a Bladder disease; if Shaoyin disease presents with difficulty urinating, the pathogen has entered the Taiyang boundary. Lower back pain is originally a Kidney disease; if Taiyang disease presents with lower back pain, the pathogen has reached the Shaoyin boundary. Constipation for 6-7 days with headache and fever indicates Yangming Heat pathogen invading the Taiyang boundary. Head/neck stiffness with nasal congestion and dry retching indicates Taiyang Wind pathogen invading the Yangming boundary. The chest/heart is the Yangming region but serves as the thoroughfare for Taiyang, because Taiyang manages Ying and Wei Qi, and the chest/heart is the root of Ying and Wei. Ying and Wei circulate endlessly, like border officials/citizens/soldiers gathering in the capital, coming and going constantly. Wheezing with chest fullness indicates Taiyang external pathogen entering the Yangming region and causing disturbance, hence called Taiyang-Yangming Combined Disease. If no headache/stiffness, but chest oppression/hardness, Qi rushing to the throat preventing breathing, this pathogen does not come from Taiyang but is Yangming Heat knotting in the chest, like rebels causing trouble in their own territory. The Heart is the master of the Six Meridians, so all Six Meridians have irritability. If no head/neck stiffness, irritability does not belong to Taiyang; if no alternating chills/fever, irritability does not belong to Shaoyang; if no Three Yin signs, irritability does not belong to the Three Yin. Thus, mental confusion, palpitations, inner restlessness, and all deficiency irritability belong to Yangming, because the Heart resides in the Yangming region. Yangming is like the capital, so Heart and Abdomen are in its territory. Pathogen in the Heart causes deficiency irritability; in the Abdomen causes Excess Heat. The Heart is Yang and formless; the Abdomen is Yin and substantial. Diseases of the human body often involve the Heart and Abdomen; Yang pathogens gather in the Heart, Yin pathogens gather in the Abdomen. The Liver is Yang within Yin, so it can cause Yin pathogens to rush upward to the Heart; Yangming is Yang within the Interior, so it can cause Yang pathogens to gather in the Abdomen. Using military strategy as a metaphor, the key to strategy is understanding terrain. One must first understand the paths of the Six Meridians to know where the enemy comes from, which direction is the approach to which prefecture, and which is the retreat. The approach is like the border pass (Three Yang); the retreat is the interior (Three Yin). The approaches of the Six Meridians differ: Taiyang is the main road, Shaoyang is the remote path, Yangming is the direct road, Taiyin is the nearby road, Shaoyin is the rear road, Jueyin is the irregular path. Guest pathogens mostly come from the Three Yang; Correct pathogens (internal imbalances) mostly arise from the Three Yin, like external invaders coming from borders and rebels rising from the interior. Understanding the terrain of the Six Meridians allows one to grasp the pivot of all diseases; detailing the approaches allows one to control the rules of treatment. Regarding patterns: Shanghan is a great invader, disease from outside; Stroke is a roaming bandit, disease from side involvement; Miscellaneous diseases are chaotic locals, disease arising from within. Once identified as what kind of enemy and known where it originates, if it arises in its territory, defend there; if it shifts disaster to neighboring counties, attack from two routes. If pathogen enters Taiyang region, sweat and disperse it, like deploying elite troops at key points to strike before they settle. Light pathogens are in Wei (Defensive Qi), heavy in Ying (Nutritive Qi), especially heavy in Chest/Diaphragm, like enemies shallow outside the pass, deep inside the pass, especially deep within. Mahuang (Ephedra) is the army outside the pass; Guizhi (Cinnamon Twig) and Gegen (Kudzu Root) are the army at the pass; Da Qinglong Tang (Major Green Dragon Decoction) is the army within the pass. Whenever external unrest occurs, internal thieves rise to respond; thus solutions are established, leading to Da/Xiao Qinglong Tang and modified Guizhi/Mahuang formulas. If the vanguard lacks discipline causing internal chaos, prioritize the interior over the exterior, hence Wuling San, Shizao Tang, Xiongxiong Tang, Xiexin Tang, Didang Tang. If pathogen enters Shaoyang region, mix Exterior/Interior, Cold/Heat, Attack/Tonify agents for defense and resolution. Like a remote path, suitable for short weapons, not spears; suitable for defense, not war. Light pathogens enter Cou Li, heavy enter Mo Yuan (Membrane Source), especially heavy enter Spleen/Stomach. Xiao Chaihu Tang (Minor Bupleurum Decoction) is the Cou Li agent; Da Chaihu Tang (Major Bupleurum Decoction) is the Mo Yuan agent; Xiaojianzhong Tang, Banxia Xiexin Tang, Huangqin, Huanglian are the Shaoyang Spleen agents; Chaihu Jia Mangxiao Tang, Chaihu Jia Muli Tang are the Shaoyang Stomach agents. If Taiyang-Shaoyang combined disease, one army attacks Taiyang, one attacks Shaoyang; Chaihu Guizhi Tang is the two-route dividing force. Even San Yang Combined Disease, facing enemies on three sides, the method is to exclusively target Yangming. If the Yangming region is clear and orderly, the Yang pathogens of Tai/Shaoyang resolve without attack; once internal rebels are pacified, external threats cease. This is why Baihu Tang achieves victory. If Yang pathogens are not contained internally, use Dachengqi Tang for urgent purging to attack pathogens and protect the host; if Yin pathogens strike directly inward, use Sini Tang to urgently rescue the interior to strengthen the host and drive out invaders. Yangming is the interior; its boundaries are the Taiyang/Shaoyang regions. If pathogen enters Yangming boundary, even if not violating Taiyang, Taiyang forces cannot ignore it; thus Yangming Ying/Wei diseases borrow Guizhi/Mahuang formulas to sweat. If pathogen nears Shaoyang region, Shaoyang forces cannot hide behind walls without fighting; thus Yangming Cou Li diseases borrow Chaihu to resolve. Knowing Yangming’s failure to hold implies either Taiyang is not solid or Shaoyang is unprepared, so often Two Yangs combine to cause disease. If pathogen is already in Yangming region, must send out troops to vigorously chase pathogens, leaving none, hence using Goudi/Zhichi emetic method to sweep quickly. If penetrating deep into the interior, cannot be driven out, then practice scorched earth policy, denying plunder; this is where Baihu Tang excels. If pathogen is at the gate, must clean the palace and roads; this is why the three Chengqi formulas succeed. Drugs like Yinchen and Zhuling legislate for undisciplined armies. Taiyin is also interior; Shaoyin/Jueyin are borderlands. Taiyin occupies the Central State; though externally connected to Three Yang, Yin and Yang take different paths, and Heart/Abdomen have diaphragmatic barriers. Thus, Cold-Water pathogens attaching externally from Taiyang are light; those internally transmitted from Shaoyin are heavy. Wind-Wood pathogens invading from Shaoyang are light; those襲 (attacking) from Jueyin are heavy. If the primary pathogen of the meridian transfers to Yangming becoming Excess, like an old army with exhausted momentum, it can be purged to heal. If Yangming Excess pathogen transfers to the primary meridian becoming Deficient, then Excess pathogen and Deficient righteous Qi make warm-tonifying recovery very difficult. Although Taiyin and Yangming regions are distinct, there is no barrier. If Yuan Qi is sufficient, pathogen enters Yangming; if insufficient, pathogen enters Taiyin. In Yangming, one can deploy troops and fight behind the city walls, winning quickly; in Taiyin, supplies are burned and granaries empty, unable to resist enemies. Jueyin region is the area where Minister Fire wanders; its original Qi is Minor Fire. If Wind/Cold/Dryness/Dampness pathogens enter, they all transform into Heat, becoming Major Fire. Minor Fire is the life force of the body; Major Fire is the great disaster of Heart/Abdomen. Its region connects the San Jiao. Pathogen attacking Upper Jiao causes Qi rushing to the Heart, burning pain in the Heart, thirst, mouth ulcers, sore throat, throat obstruction. Pressing on Middle Jiao causes cold extremities, faint/almost imperceptible pulse, hunger but no desire to eat, vomiting roundworms upon eating. Shifting disaster to Lower Jiao causes dysentery with heaviness, or pus/blood in stool, leading to...