素盛，或有宿食，太阳之邪一传阳明，遂入胃腑，致大便不通者，所谓胃家实是也；有少阳阳明，谓病已到少
阳，法当和解，而反发汗、利小便，亡其津液，胃中燥热复转属阳明，致大便结燥者，所谓大便难是也。其治
阳明经病，则以葛根汤或桂枝加葛根汤发之，或以白虎汤清之，或以柴胡白虎汤和之，随其证而施之可也。其
治阳明腑病，虽均为可下，然不无轻重之分，故或以三承气汤下之，或麻仁丸通之，或蜜煎胆汁导之，量
其病而治之可也。此阳明病之大略也。兹以在经在腑二者，详疏于篇，俾读者易为分别，则临证施治自不紊矣。
（《医宗金鉴》）
少阳提纲
少阳处半表半里，司三焦相火之游行。仲景特揭口苦、咽干、目眩为提纲，是取病机立法也。夫口、
咽、目三者，脏腑精气之总窍，与天地之气相通者也，不可为表，不可为里，是表入里、里出表之路，所谓半
表半里也。三者能开能阖，开之可见，阖之不见，为枢之象。苦干眩者，相火上走空窍而为病，风寒杂病咸
有之，所以为少阳一经总纲也。○少阳之表有二∶脉弦细、头痛、发热、或呕而发热者，少阳伤寒也；耳聋、
目眩、胸满而烦者，少阳中风也。此少阳风寒之表，而非少阳之表。阳明风寒之表，亦有麻、桂证；少阳风
寒之表，不得用麻、桂之汗，亦不得用瓜蒂、栀豉之吐。发汗则谵语，吐下则惊悸，是少阳之和解，不特
在半表而始宜也。少阳始感风寒，恶寒发热与太阳同，不得为半表。所以为半表者，寒热不齐，各相回避，一
往一来，势若两分，为半表耳。○寒热往来，病情见于外；苦喜不欲，病情得于内。看苦、喜、欲三字，非真
呕真满，不能饮食也。看往、来二字，即见有不寒热时。寒热往来，胸胁苦满，是无形之表；心烦喜呕，默默
不欲饮食，是无形之里。其或胸中烦而不呕，或渴，或腹中痛，或胁下痞硬，或心下悸，或小便不利，或咳
者，此七证皆偏于里。惟微热为在表，皆属于无形。惟胁痛痞硬为有形，皆风寒通证。惟胁下痞硬属少阳，总
是气分为病。非有热实可据，故从半表半里之治法。○按∶呕、渴虽六经俱有，而少阳阳明之病机，在呕、渴中
分。渴则转属阳明，呕则仍在少阳。如伤寒呕多，虽有阳明证，不可攻，因三焦之气不通，病未离少阳也。服
柴胡汤已渴者，属阳明也。此两阳之并合病，已过少阳也。○东垣有少阳不可汗、吐、下、利小便四禁，然柴
胡证中，口不渴，身有微热者，仍加桂枝以取汗；下后胸胁满微结，小便不利，渴而不呕，头汗出，往来寒热
者，用柴胡桂枝干姜汤汗之；下后胸满烦惊，小便不利，谵语身重者，柴胡龙骨牡蛎汤中用大黄、茯苓以利二
便；柴胡证具，而反下之，心下满而硬痛者，用大陷胸下之；医以丸药下之而不得利，已而微利，胸胁满而呕，
日晡潮热者，用小柴胡加芒硝下之。是仲景于少阳经中已备汗、下、利小便法也。（柯韵伯）
少阳之里，即三阴也，故其位居半表里焉。半表则不当下，半里则不当汗、吐，故治有三禁，而法主和
解。凡方中用栝蒌者，为其热也；用干姜者，为其寒也；用桂枝者，为其兼太阳也；用大黄者，为其兼阳明也；
用芍药者，为其兼太阴也。学人当细绎其加减之法。（程扶生）
太阴提纲
按∶太阴脉，布胃中，络于嗌，故腹满、嗌干，此热伤太阴之
标，自阳部注经，非太阴本病也。仲景立本病为提纲，因太阴主内，又为阴中至阴，故不及嗌干之证。太阴为
开，又阴道虚，太阴主脾，脾主湿，故提纲主腹满时痛、吐利，皆是里虚不固，湿胜外溢之证也。脾虚则胃亦
虚，食不下者，胃不主内也。要知胃家不实，便是太阴病。○脾胃同处腹中，故腹满为太阴、阳明俱有之证。在
阳明是热实为患，在太阴是寒湿为眚。阳明腹满不敢轻下者，恐胃家不实，即转属太阴耳。世拘阳明传少阳之
谬，反昧传太阴之义。○热病腹满，是热郁太阴之经，病在表也；寒湿腹满，是寒生至阴之义，病在本也。脾
热则阴精不输于肺，故嗌干；脾寒则不为胃行其津液，故下利。○太阴脉浮为在表，当见四肢烦疼等证；沉为在
里，当见腹满吐利等证。表有风邪可发汗，宜桂枝汤；里有寒邪当温之，宜四逆辈。太阳而脉沉者；因于寒，
寒为阴邪，沉为阴脉也；太阴而脉浮者，因于风，风为阳邪，浮为阳脉也。当知脉从病变，不拘于经，故阳经
有阴脉，阴经有阳脉也。世谓脉至三阴则俱沉，阴经不当发汗者，不审此耳。○手足自温句，暗对身不发热言，
非言太阴伤寒必当手足温也。夫病在三阳，尚有手足冷者，何况太阴？陶氏分太阴手足温，少阴手足寒，厥阴
手足厥冷，是大背太阴手足烦疼，少阴一身手足尽热之义矣。凡伤于寒，则为病热。寒为阴，太阴为至阴，两
阴相合，无热可发，惟四肢为阴阳之会，故尚温耳。○太阳以阴为根，而太阴则以阳为本。太阳不敢妄汗，恐
亡少阴之津也；太阴不敢轻下，恐伤阳明之气也。（柯韵伯）
太阴为病，《经》文止十数条耳，而温、清、散、下、和、补，法无不备，后人可以引伸类长矣。然太阴
一经，多是寒邪入里，而热证为少，以热病皆发于少阴，而不发于太阴也。（程扶生）
六气之邪，感人虽同，人受之而生病各异者何也？盖以人之形有浓薄，气有盛衰，脏有寒热，所受之邪，
每从其人之脏气而化，故生病各异也。是以或从虚化，或从实化，或从寒化，或从
热化。譬诸水火，水盛则火灭，火盛则水耗，物盛从化，理固然也。诚知乎此，又何疑乎？阳邪传阴，变寒化
热，而遂以为奇耶？自后汉迄今，千载以来，皆谓三阴寒邪不传，且以伤寒传经，阴邪谓为直中，抑知直中乃
中寒之证，非传经之邪耶？是皆未曾熟读仲景之书，故有此误耳。如《论》中下利，腹胀满，身体疼痛者，先
温其里，乃攻其表。温里宜四逆汤，攻表宜桂枝汤。此三阳阳邪传入太阴，邪从阴化之寒证也。如少阴病下利，
白通汤主之。此太阴寒邪，传少阴之寒证也。如下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。此少阴
寒邪，传厥阴之寒证也。皆历历可据，岂得谓伤寒阴不相传，无阳从阴化之理乎？（《医宗金鉴》）
少阴提纲
少阴一经，兼水火二气，寒热杂居。其寒也，证类太阴；其热也，证似太阳。故仲景以微细之病脉，欲
寐之病情为提纲，立法于象外，使人求法于病中。凡病之寒热，与寒热之真假，仿此义以推之，真阴之虚实见
矣。○少阳为阳枢，少阴为阴枢。弦为木象，弦而细者，阳之少也；微为水象，微而细者，阴之少也。少阴病
则枢机不利，故欲寐也，与少阳喜呕同。呕者主出，阳主外也；寐者主入，阴主内也。喜呕是不得呕，欲寐是
不得寐，皆在病患意中，得枢机之象如此。○但欲寐，即是不得眠。然但欲寐是病情，乃问而知之；不得眠是
病形，可望而知之。欲寐是阴虚，不眠是烦躁，故治法不同。○太阴是阳明之里，阳明不恶寒，故太阴虽吐利腹
满，而无恶寒证。少阴是太阳之里，太阳恶寒，故少阴吐利必恶寒，阴从阳也。○太阳是少阴之标，太阴是少
阴之本。少阴阴虚，则移热于膀胱，故一身手足尽热而便血，从标也；少阴阳虚，则移寒于脾土而吐利，从本
也。○太阳、少阴，皆有身痛、骨痛之表，水气为患之里。太阳则脉浮紧而身发热，用麻黄发汗，是振营卫之
阳以和阴也；少阴则脉沉而手足寒，用附子温补，是扶坎宫之阳以配阴也。太阳之水，属上焦，小青龙汗而发
之，阳水
当从外散也；少阴之水，属下焦，真武温而利之，阴水当从下泄也。○同是恶寒蜷卧，利止手足温者可治；利
不止手足逆冷者不治。时自烦，欲去衣被者可治；不烦而躁，四逆而脉不至者死。同是吐利，手足不逆冷，反
发热者不死；烦躁四逆者死。同是呕吐，汗出大便数少者可治；自利，烦躁不得卧者死。盖阴阳互为其根，阴
中无阳则死，独阴不生也。○三阳，惟少阳无承气证；三阴，惟少阴有承气证。盖少阳为阳枢，阳稍虚，邪
便入于阴，故不可妄下以虚其阳；少阳为阴枢，阳有余，邪便伤其阴，故宜急下以存其阴。且少阳属木，邪
在少阳，惟畏其克土，故无下证；少阴主水，邪在少阴，更畏有土制，故当紧下。盖真阴不可虚，强阳不可
纵也。（柯韵伯）
肾中有真水，有真火。肾中真火，即坎内一画之阳伏藏于二耦之中者也。火弱则水泛，而阴邪所入，皆
得凭肾中之寒水作滔天之势，故为咳、为呕、为下利、为四肢沉重、为背寒、为逆冷。仲景绝不虑夫外邪而妄用
汗、下以伤其阳，惟以真武、四逆、附子诸汤，回肾中之真阳，使之坐镇北方，此即王冰所谓益火之原，以消
阴翳法也。若肾中之真火不能自存，则必烦躁、多汗、面赤，证反似阳而死矣。肾中真水，即坎外二画之耦，
周回于一奇之外者也。水弱则火炽，而热邪所入，悉得根据肾中之阳火作蕴隆之患，故为心烦、为口燥、为咽痛、
为不眠。仲景亦绝不虑夫外邪而妄施汗、下以伤其阴，惟以黄连阿胶、猪肤、猪苓诸汤，滋肾中之真阴，使之
坐制南方，此即王冰所谓壮水之主，以制阳光法也。若肾中之真水不能营养，则必传入厥阴，热深厥深，咽痛
者转为喉痹，呕咳者转吐痈脓，下利者转便脓血，甚者躁热、厥逆、昏不知人，肾气先绝而死也。故知仲景温
经散寒之法与清热润燥之法，如四时日月，并行不悖也。（程扶生）
凡中阴之证，必先入少阴，一用表散，则孤阳飞越，乘汗而出，是以烦躁不安，妄见妄闻，谵言乱语。
若误认为火证，而加
以寒凉，立刻毙矣。若任其汗出不休，元阳不返窟宅，则阳气腾散，亦将毙矣。急宜驱阴回阳之法，又宜敛阳
归根之法，如八味地黄汤加人参之属。愚意谓中阴之证，必先入少阴者，盖少阴属肾，与太阳膀胱经相为表里。
因其人肾脏素虚，封藏不固，遂致太阳疏漏，寒邪易侵，表不固则邪直入于里，表里交虚，同声相应。肾为水
脏，膀胱又为藏水之经，故中阴必先入肾者此耳。又曰∶伤寒偏死肾虚人。良非虚语。（吴天士）
少阴肾经，水火之脏。邪伤其经，随人虚实，或从水化以为寒，或从火化以为热。水化为阴寒之邪，是
其本也，火化为阳热之邪，是其标也。阴邪其脉沉细而微，阳邪其脉沉细而数。至其见证，亦各有别。阴邪但
欲寐，身无热；阳邪虽欲寐，则多心烦。阴邪背恶寒，口中和；阳邪背恶寒，则口中燥。阴邪咽痛不肿；阳邪
咽痛则肿。阴邪腹痛，下利清谷；阳邪腹痛，下利清水，或便脓血也。阴邪外热面色赤，里寒大便利，小便白；
阳邪外寒手足厥，里热大便秘，小便赤。此少阴标本寒热之脉证也。凡从本之治，均宜温寒回阳；从标之治，均
宜攻热救阴。回阳救阴，其机甚微，总在临证详究，辨别标本寒热，以急施其治，庶克有济，稍缓则不及矣。
（《医宗金鉴》）
厥阴提纲
太阴厥阴，皆以里证为提纲。太阴为阴中之阴而主寒，故不渴；厥阴为阴中之阳而主热，故消渴也。太
阴主湿土，土病则气陷下，湿邪入胃，故腹痛自利；厥阴主相火，火病则气上逆，火邪入心，故心中疼热也。
太阴腹满而吐，食不下；厥阴饥不欲食，食即吐蛔。同是食不下，太阴则满，厥阴则饥；同是一吐，太阴则吐
食，厥阴则吐蛔。此又属土、属木之别也。太阴为开，本自利，而下之则开拆。胸下痞硬者，开拆反阖也。厥
阴为阖，气上逆，而下之则阖拆。利不止者，阖拆反开也。○两阴交尽，名曰厥阴，又名阴之绝阳，是厥阴宜
无热矣。然厥阴主肝，而胆藏肝
内，则厥阴热证，皆少阳相火内发也。要知少阳、厥阴，同一相火，相火郁于内，是厥阴病出于表，为少阳病。
少阳咽干，即厥阴消渴之机；胸胁气满，即气上撞心之兆；心烦即疼热之初；不欲食是饥不欲食之根；喜呕即
吐蛔之渐。故少阳不解，转属厥阴而病危；厥阴病衰，转属少阳而欲愈。○厥者必发热，热与厥相应，厥深热
亦深，厥微热亦微，此四证，是厥阴伤寒之定局。先热后厥，厥热往来，厥多热少，热多厥少，此四证，是
厥阴伤寒之变局。○厥阴有晦朔具合之理，阴极阳生，故厥阴伤寒反以阳为主。厥少热多，是为生阳，故病当
愈；厥多热少，是为死阴，故病为进。其热气有余者，或便脓血，或发痈脓，与《内经》煎厥不同。○手足
厥冷，脉微欲绝，是厥阴伤寒之外证；当归四逆，是厥阴伤寒之表药。夫阴寒如此而不用姜、附者，以相火寄
于肝胆，外虽寒而脏不寒，故先厥者后必发热，手足愈冷，肝胆愈热，故厥深热亦深。所以伤寒初起，脉证如
此者，不得遂认为虚寒，妄投姜、附以遗患也。○本篇云∶诸四逆厥者不可下。又曰∶厥应下之，而反发汗者，
必口伤烂赤。二义不同。诸四逆不可下，是指伤寒脉微欲绝，此时外寒切迫，内热未起。此当发汗，是指虚寒证
【背景信息】
书名：医述 作者：程杏轩 朝代：元 章节：伤寒(6/11) 类别：医论
【待处理原文】
素盛，或有宿食，太阳之邪一传阳明，遂入胃腑，致大便不通者，所谓胃家实是也；有少阳阳明，谓病已到少阳，法当和解，而反发汗、利小便，亡其津液，胃中燥热复转属阳明，致大便结燥者，所谓大便难是也。其治阳明经病，则以葛根汤或桂枝加葛根汤发之，或以白虎汤清之，或以柴胡白虎汤和之，随其证而施之可也。其治阳明腑病，虽均为可下，然不无轻重之分，故或以三承气汤下之，或麻仁丸通之，或蜜煎胆汁导之，量其病而治之可也。此阳明病之大略也。兹以在经在腑二者，详疏于篇，俾读者易为分别，则临证施治自不紊矣。
（《医宗金鉴》）
少阳提纲
少阳处半表半里，司三焦相火之游行。仲景特揭口苦、咽干、目眩为提纲，是取病机立法也。夫口、咽、目三者，脏腑精气之总窍，与天地之气相通者也，不可为表，不可为里，是表入里、里出表之路，所谓半表半里也。三者能开能阖，开之可见，阖之不见，为枢之象。苦干眩者，相火上走空窍而为病，风寒杂病咸有之，所以为少阳一经总纲也。○少阳之表有二∶脉弦细、头痛、发热、或呕而发热者，少阳伤寒也；耳聋、目眩、胸满而烦者，少阳中风也。此少阳风寒之表，而非少阳之表。阳明风寒之表，亦有麻、桂证；少阳风寒之表，不得用麻、桂之汗，亦不得用瓜蒂、栀豉之吐。发汗则谵语，吐下则惊悸，是少阳之和解，不特在半表而始宜也。少阳始感风寒，恶寒发热与太阳同，不得为半表。所以为半表者，寒热不齐，各相回避，一往一来，势若两分，为半表耳。○寒热往来，病情见于外；苦喜不欲，病情得于内。看苦、喜、欲三字，非真呕真满，不能饮食也。看往、来二字，即见有不寒热时。寒热往来，胸胁苦满，是无形之表；心烦喜呕，默默不欲饮食，是无形之里。其或胸中烦而不呕，或渴，或腹中痛，或胁下痞硬，或心下悸，或小便不利，或咳者，此七证皆偏于里。惟微热为在表，皆属于无形。惟胁痛痞硬为有形，皆风寒通证。惟胁下痞硬属少阳，总是气分为病。非有热实可据，故从半表半里之治法。○按∶呕、渴虽六经俱有，而少阳阳明之病机，在呕、渴中分。渴则转属阳明，呕则仍在少阳。如伤寒呕多，虽有阳明证，不可攻，因三焦之气不通，病未离少阳也。服柴胡汤已渴者，属阳明也。此两阳之并合病，已过少阳也。○东垣有少阳不可汗、吐、下、利小便四禁，然柴胡证中，口不渴，身有微热者，仍加桂枝以取汗；下后胸胁满微结，小便不利，渴而不呕，头汗出，往来寒热者，用柴胡桂枝干姜汤汗之；下后胸满烦惊，小便不利，谵语身重者，柴胡龙骨牡蛎汤中用大黄、茯苓以利二便；柴胡证具，而反下之，心下满而硬痛者，用大陷胸下之；医以丸药下之而不得利，已而微利，胸胁满而呕，日晡潮热者，用小柴胡加芒硝下之。是仲景于少阳经中已备汗、下、利小便法也。（柯韵伯）
少阳之里，即三阴也，故其位居半表里焉。半表则不当下，半里则不当汗、吐，故治有三禁，而法主和解。凡方中用栝蒌者，为其热也；用干姜者，为其寒也；用桂枝者，为其兼太阳也；用大黄者，为其兼阳明也；用芍药者，为其兼太阴也。学人当细绎其加减之法。（程扶生）
太阴提纲
按∶太阴脉，布胃中，络于嗌，故腹满、嗌干，此热伤太阴之标，自阳部注经，非太阴本病也。仲景立本病为提纲，因太阴主内，又为阴中至阴，故不及嗌干之证。太阴为开，又阴道虚，太阴主脾，脾主湿，故提纲主腹满时痛、吐利，皆是里虚不固，湿胜外溢之证也。脾虚则胃亦虚，食不下者，胃不主内也。要知胃家不实，便是太阴病。○脾胃同处腹中，故腹满为太阴、阳明俱有之证。在阳明是热实为患，在太阴是寒湿为眚。阳明腹满不敢轻下者，恐胃家不实，即转属太阴耳。世拘阳明传少阳之谬，反昧传太阴之义。○热病腹满，是热郁太阴之经，病在表也；寒湿腹满，是寒生至阴之义，病在本也。脾热则阴精不输于肺，故嗌干；脾寒则不为胃行其津液，故下利。○太阴脉浮为在表，当见四肢烦疼等证；沉为在里，当见腹满吐利等证。表有风邪可发汗，宜桂枝汤；里有寒邪当温之，宜四逆辈。太阳而脉沉者；因于寒，寒为阴邪，沉为阴脉也；太阴而脉浮者，因于风，风为阳邪，浮为阳脉也。当知脉从病变，不拘于经，故阳经有阴脉，阴经有阳脉也。世谓脉至三阴则俱沉，阴经不当发汗者，不审此耳。○手足自温句，暗对身不发热言，非言太阴伤寒必当手足温也。夫病在三阳，尚有手足冷者，何况太阴？陶氏分太阴手足温，少阴手足寒，厥阴手足厥冷，是大背太阴手足烦疼，少阴一身手足尽热之义矣。凡伤于寒，则为病热。寒为阴，太阴为至阴，两阴相合，无热可发，惟四肢为阴阳之会，故尚温耳。○太阳以阴为根，而太阴则以阳为本。太阳不敢妄汗，恐亡少阴之津也；太阴不敢轻下，恐伤阳明之气也。（柯韵伯）
太阴为病，《经》文止十数条耳，而温、清、散、下、和、补，法无不备，后人可以引伸类长矣。然太阴一经，多是寒邪入里，而热证为少，以热病皆发于少阴，而不发于太阴也。（程扶生）
六气之邪，感人虽同，人受之而生病各异者何也？盖以人之形有浓薄，气有盛衰，脏有寒热，所受之邪，每从其人之脏气而化，故生病各异也。是以或从虚化，或从实化，或从寒化，或从热化。譬诸水火，水盛则火灭，火盛则水耗，物盛从化，理固然也。诚知乎此，又何疑乎？阳邪传阴，变寒化热，而遂以为奇耶？自后汉迄今，千载以来，皆谓三阴寒邪不传，且以伤寒传经，阴邪谓为直中，抑知直中乃中寒之证，非传经之邪耶？是皆未曾熟读仲景之书，故有此误耳。如《论》中下利，腹胀满，身体疼痛者，先温其里，乃攻其表。温里宜四逆汤，攻表宜桂枝汤。此三阳阳邪传入太阴，邪从阴化之寒证也。如少阴病下利，白通汤主之。此太阴寒邪，传少阴之寒证也。如下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。此少阴寒邪，传厥阴之寒证也。皆历历可据，岂得谓伤寒阴不相传，无阳从阴化之理乎？（《医宗金鉴》）
少阴提纲
少阴一经，兼水火二气，寒热杂居。其寒也，证类太阴；其热也，证似太阳。故仲景以微细之病脉，欲寐之病情为提纲，立法于象外，使人求法于病中。凡病之寒热，与寒热之真假，仿此义以推之，真阴之虚实见矣。○少阳为阳枢，少阴为阴枢。弦为木象，弦而细者，阳之少也；微为水象，微而细者，阴之少也。少阴病则枢机不利，故欲寐也，与少阳喜呕同。呕者主出，阳主外也；寐者主入，阴主内也。喜呕是不得呕，欲寐是不得寐，皆在病患意中，得枢机之象如此。○但欲寐，即是不得眠。然但欲寐是病情，乃问而知之；不得眠是病形，可望而知之。欲寐是阴虚，不眠是烦躁，故治法不同。○太阴是阳明之里，阳明不恶寒，故太阴虽吐利腹满，而无恶寒证。少阴是太阳之里，太阳恶寒，故少阴吐利必恶寒，阴从阳也。○太阳是少阴之标，太阴是少阴之本。少阴阴虚，则移热于膀胱，故一身手足尽热而便血，从标也；少阴阳虚，则移寒于脾土而吐利，从本也。○太阳、少阴，皆有身痛、骨痛之表，水气为患之里。太阳则脉浮紧而身发热，用麻黄发汗，是振营卫之阳以和阴也；少阴则脉沉而手足寒，用附子温补，是扶坎宫之阳以配阴也。太阳之水，属上焦，小青龙汗而发之，阳水当从外散也；少阴之水，属下焦，真武温而利之，阴水当从下泄也。○同是恶寒蜷卧，利止手足温者可治；利不止手足逆冷者不治。时自烦，欲去衣被者可治；不烦而躁，四逆而脉不至者死。同是吐利，手足不逆冷，反发热者不死；烦躁四逆者死。同是呕吐，汗出大便数少者可治；自利，烦躁不得卧者死。盖阴阳互为其根，阴中无阳则死，独阴不生也。○三阳，惟少阳无承气证；三阴，惟少阴有承气证。盖少阳为阳枢，阳稍虚，邪便入于阴，故不可妄下以虚其阳；少阳为阴枢，阳有余，邪便伤其阴，故宜急下以存其阴。且少阳属木，邪在少阳，惟畏其克土，故无下证；少阴主水，邪在少阴，更畏有土制，故当紧下。盖真阴不可虚，强阳不可纵也。（柯韵伯）
肾中有真水，有真火。肾中真火，即坎内一画之阳伏藏于二耦之中者也。火弱则水泛，而阴邪所入，皆得凭肾中之寒水作滔天之势，故为咳、为呕、为下利、为四肢沉重、为背寒、为逆冷。仲景绝不虑夫外邪而妄用汗、下以伤其阳，惟以真武、四逆、附子诸汤，回肾中之真阳，使之坐镇北方，此即王冰所谓益火之原，以消阴翳法也。若肾中之真火不能自存，则必烦躁、多汗、面赤，证反似阳而死矣。肾中真水，即坎外二画之耦，周回于一奇之外者也。水弱则火炽，而热邪所入，悉得根据肾中之阳火作蕴隆之患，故为心烦、为口燥、为咽痛、为不眠。仲景亦绝不虑夫外邪而妄施汗、下以伤其阴，惟以黄连阿胶、猪肤、猪苓诸汤，滋肾中之真阴，使之坐制南方，此即王冰所谓壮水之主，以制阳光法也。若肾中之真水不能营养，则必传入厥阴，热深厥深，咽痛者转为喉痹，呕咳者转吐痈脓，下利者转便脓血，甚者躁热、厥逆、昏不知人，肾气先绝而死也。故知仲景温经散寒之法与清热润燥之法，如四时日月，并行不悖也。（程扶生）
凡中阴之证，必先入少阴，一用表散，则孤阳飞越，乘汗而出，是以烦躁不安，妄见妄闻，谵言乱语。若误认为火证，而加以寒凉，立刻毙矣。若任其汗出不休，元阳不返窟宅，则阳气腾散，亦将毙矣。急宜驱阴回阳之法，又宜敛阳归根之法，如八味地黄汤加人参之属。愚意谓中阴之证，必先入少阴者，盖少阴属肾，与太阳膀胱经相为表里。因其人肾脏素虚，封藏不固，遂致太阳疏漏，寒邪易侵，表不固则邪直入于里，表里交虚，同声相应。肾为水脏，膀胱又为藏水之经，故中阴必先入肾者此耳。又曰∶伤寒偏死肾虚人。良非虚语。（吴天士）
少阴肾经，水火之脏。邪伤其经，随人虚实，或从水化以为寒，或从火化以为热。水化为阴寒之邪，是其本也，火化为阳热之邪，是其标也。阴邪其脉沉细而微，阳邪其脉沉细而数。至其见证，亦各有别。阴邪但欲寐，身无热；阳邪虽欲寐，则多心烦。阴邪背恶寒，口中和；阳邪背恶寒，则口中燥。阴邪咽痛不肿；阳邪咽痛则肿。阴邪腹痛，下利清谷；阳邪腹痛，下利清水，或便脓血也。阴邪外热面色赤，里寒大便利，小便白；阳邪外寒手足厥，里热大便秘，小便赤。此少阴标本寒热之脉证也。凡从本之治，均宜温寒回阳；从标之治，均宜攻热救阴。回阳救阴，其机甚微，总在临证详究，辨别标本寒热，以急施其治，庶克有济，稍缓则不及矣。（《医宗金鉴》）
厥阴提纲
太阴厥阴，皆以里证为提纲。太阴为阴中之阴而主寒，故不渴；厥阴为阴中之阳而主热，故消渴也。太阴主湿土，土病则气陷下，湿邪入胃，故腹痛自利；厥阴主相火，火病则气上逆，火邪入心，故心中疼热也。太阴腹满而吐，食不下；厥阴饥不欲食，食即吐蛔。同是食不下，太阴则满，厥阴则饥；同是一吐，太阴则吐食，厥阴则吐蛔。此又属土、属木之别也。太阴为开，本自利，而下之则开拆。胸下痞硬者，开拆反阖也。厥阴为阖，气上逆，而下之则阖拆。利不止者，阖拆反开也。○两阴交尽，名曰厥阴，又名阴之绝阳，是厥阴宜无热矣。然厥阴主肝，而胆藏肝内，则厥阴热证，皆少阳相火内发也。要知少阳、厥阴，同一相火，相火郁于内，是厥阴病出于表，为少阳病。少阳咽干，即厥阴消渴之机；胸胁气满，即气上撞心之兆；心烦即疼热之初；不欲食是饥不欲食之根；喜呕即吐蛔之渐。故少阳不解，转属厥阴而病危；厥阴病衰，转属少阳而欲愈。○厥者必发热，热与厥相应，厥深热亦深，厥微热亦微，此四证，是厥阴伤寒之定局。先热后厥，厥热往来，厥多热少，热多厥少，此四证，是厥阴伤寒之变局。○厥阴有晦朔具合之理，阴极阳生，故厥阴伤寒反以阳为主。厥少热多，是为生阳，故病当愈；厥多热少，是为死阴，故病为进。其热气有余者，或便脓血，或发痈脓，与《内经》煎厥不同。○手足厥冷，脉微欲绝，是厥阴伤寒之外证；当归四逆，是厥阴伤寒之表药。夫阴寒如此而不用姜、附者，以相火寄于肝胆，外虽寒而脏不寒，故先厥者后必发热，手足愈冷，肝胆愈热，故厥深热亦深。所以伤寒初起，脉证如此者，不得遂认为虚寒，妄投姜、附以遗患也。○本篇云∶诸四逆厥者不可下。又曰∶厥应下之，而反发汗者，必口伤烂赤。二义不同。诸四逆不可下，是指伤寒脉微欲绝，此时外寒切迫，内热未起。此当发汗，是指虚寒证
[Background Information]
Book: Yi Shu (Medical Discourse) Author: Cheng Xingxuan Dynasty: Yuan Chapter: Shanghan (Cold Damage) (6/11) Category: Medical Theory
[Original Text Processing]
Generally robust constitution, or with retained food, when the pathogenic factor of Taiyang (Taiyang Meridian Syndrome) transmits to Yangming (Yangming Meridian Syndrome), it enters the Stomach Fu-organ, causing constipation; this is what is referred to as "Stomach Fullness and Excess" (Wei Jia Shi). There is also Shaoyang-Yangming, meaning the disease has reached Shaoyang (Shaoyang Meridian Syndrome), where the method should be harmonization. However, if sweating or promoting urination is mistakenly used, body fluids are depleted, dryness and heat in the Stomach re-transmit to Yangming, causing hard and dry stools; this is what is referred to as "Difficulty in Defecation" (Da Bian Nan). For treating Yangming Jing (Meridian) disease, one may use Gegen Tang (Kudzu Decoction) or Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) to induce sweating, or Baihu Tang (White Tiger Decoction) to clear heat, or Chaihu Baihu Tang (Bupleurum and White Tiger Decoction) to harmonize, applying treatment according to the syndrome. For treating Yangming Fu (Organ) disease, although purgation is generally applicable, there are degrees of severity. Thus, one may use San Chengqi Tang (Three Da Huang Purgative Decoctions) to purge, or Mahuang Wan (Ephedra Pill) to unblock, or honey suppositories mixed with bile to guide out the stool, measuring the disease to apply treatment. This is a general overview of Yangming disease. Herein, the differences between Jing (Meridian) and Fu (Organ) involvement are detailed in this chapter, enabling readers to distinguish them easily, so that clinical treatment will naturally proceed without confusion.
*(From "Yi Zong Jin Jian")*
Shaoyang Outline
Shaoyang resides at the half-exterior and half-interior level, governing the circulation of Ministerial Fire (Xiang Huo) of the Sanjiao (Triple Burner). Zhang Zhongjing specifically highlights bitter taste in the mouth, dry throat, and dizziness as the outline, establishing laws based on the pathogenesis. The mouth, throat, and eyes are the orifices where the essence and qi of the Zang-Fu organs converge, connecting with the Qi of Heaven and Earth. They cannot be considered exterior, nor interior; they are the pathway from exterior to interior and from interior to exterior, known as the half-exterior and half-interior. These three orifices can open and close; opening reveals visibility, closing hides it, representing the image of the pivot (Shu). Bitter taste and dizziness occur when Ministerial Fire ascends to the empty orifices causing disease; this occurs in various wind-cold and miscellaneous diseases, thus serving as the general outline for the Shaoyang meridian. ○ There are two types of Shaoyang Exterior: Pulse wiry and fine, headache, fever, or vomiting with fever indicate Shaoyang Cold Damage (Shanghan); deafness, dizziness, chest fullness, and vexation indicate Shaoyang Wind Strike (Zhongfeng). This is the exterior of Shaoyang wind-cold, not the true Shaoyang Exterior. The exterior of Yangming wind-cold also presents with Ma (Ephedra) and Gui (Cinnamon Twig) syndromes; however, for Shaoyang wind-cold exterior, Ma and Gui sweating methods must not be used, nor must Geng Ti (Melon Seed) and Zhi Chi (Gardenia and Fermented Soybean) emetic methods be used. Inducing sweating leads to delirium; emesis and purgation lead to palpitations and fright. Therefore, harmonization for Shaoyang is suitable not only at the half-exterior stage. When Shaoyang initially contracts wind-cold, aversion to cold and fever are the same as Taiyang, so it cannot be considered half-exterior. What makes it half-exterior is that chills and fever are uneven, avoiding each other, coming and going alternately, appearing as if divided into two, which constitutes the half-exterior. ○ Alternating chills and fever manifest the condition externally; bitterness, preference, and lack of desire manifest the condition internally. Examining the characters 'bitter', 'preference', and 'lack of desire' indicates it is not true vomiting or true fullness, but rather an inability to eat. Examining 'alternating' and 'coming/going' shows periods without chills or fever. Alternating chills and fever with chest and hypochondriac distress represent the Formless Exterior; mental vexation, frequent vomiting, silence, and lack of appetite represent the Formless Interior. If there is vexation in the chest without vomiting, thirst, abdominal pain, hardness and fullness under the ribs, palpitations, difficult urination, or coughing, these seven syndromes all lean towards the Interior. Only slight fever indicates the Exterior, belonging to the Formless. Only rib-side pain and hardness/fullness are Formful, representing common wind-cold syndromes. Only hardness and fullness under the ribs belong to Shaoyang, always being a disorder of the Qi Division. Since there is no evidence of Heat Excess, the treatment follows the half-exterior and half-interior method. ○ Note: Although vomiting and thirst occur in all Six Channels, the pathogenesis of Shaoyang and Yangming is distinguished by them. Thirst indicates transmission to Yangming; vomiting indicates the disease remains in Shaoyang. For example, in Cold Damage with frequent vomiting, even if Yangming symptoms exist, purgation must not be used because the Qi of the Sanjiao is blocked, and the disease has not left Shaoyang. If thirst appears after taking Chaihu Tang, it belongs to Yangming. This is a combined disease of the two Yang channels, having passed Shaoyang. ○ Dong Yuan stated four prohibitions for Shaoyang: no sweating, no emesis, no purgation, no promoting urination. However, in Chaihu syndromes, if the mouth is not thirsty and the body has slight fever, Cinnamon Twig (Guizhi) is still added to induce sweating; after purgation, if there is chest and hypochondriac fullness with slight knotting, difficult urination, thirst without vomiting, head sweating, and alternating chills and fever, Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is used to sweat; after purgation, if there is chest fullness, vexation, fright, difficult urination, delirium, and heaviness of the body, Dahuang (Rhubarb) and Fuling (Poria) are used in Chaihu Longgu Muli Tang (Bupleurum, Dragon Bone, and Oyster Shell Decoction) to promote urination and defecation; if Chaihu syndrome is present but purgation is mistakenly used, resulting in fullness and hard pain below the heart, Da Xianxiong Tang (Major Chest-Trapping Decoction) is used to purge; if a physician uses pill-based purgatives leading to no bowel movement, followed by slight diarrhea, chest and hypochondriac fullness, vomiting, and tidal fever in the afternoon, Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Mangxiao (Mirabilite) is used to purge. Thus, Zhang Zhongjing already prepared sweating, purging, and promoting urination methods within the Shaoyang channel. (Ke Yunbo)
The Interior of Shaoyang is the Three Yin channels, hence its position is half-exterior and half-interior. Half-exterior should not be purged; half-interior should not be sweated or emetized. Therefore, there are three prohibitions in treatment, and the method primarily focuses on harmonization. Whenever Trichosanthes Fruit (Gualou) is used in a formula, it is for Heat; Dried Ginger (Ganjiang) is for Cold; Cinnamon Twig (Guizhi) is for concurrent Taiyang involvement; Rhubarb (Dahuang) is for concurrent Yangming involvement; White Peony Root (Shaoyao) is for concurrent Taiyin involvement. Students should carefully analyze its modification methods. (Cheng Fusheng)
Taiyin Outline
Note: The Taiyin pulse spreads through the Stomach and connects to the pharynx. Therefore, abdominal fullness and dry pharynx result from Heat damaging the Taiyin Branch (Biao), flowing from the Yang portion into the meridian; this is not the Taiyin Root (Ben) disease. Zhang Zhongjing established the Root disease as the outline because Taiyin governs the interior and is the most Yin among Yins, thus omitting the dry pharynx symptom. Taiyin acts as the Opening, and the Yin path is deficient. Taiyin governs the Spleen, and the Spleen governs Dampness. Therefore, the outline focuses on abdominal fullness, occasional pain, vomiting, and diarrhea, all signs of interior deficiency and instability, with excessive Dampness overflowing outward. Spleen deficiency leads to Stomach deficiency; inability to eat indicates the Stomach fails to govern the interior. It must be known that if the Stomach is not Excess, it is Taiyin disease. ○ The Spleen and Stomach reside together in the abdomen, so abdominal fullness is a symptom shared by both Taiyin and Yangming. In Yangming, it is caused by Heat Excess; in Taiyin, it is caused by Cold-Dampness. One dares not lightly purge Yangming abdominal fullness for fear that if the Stomach is not Excess, it will transmit to Taiyin. The world clings to the fallacy of Yangming transmitting to Shaoyang, while ignoring the meaning of transmission to Taiyin. ○ Abdominal fullness in Heat diseases is due to Heat stagnating in the Taiyin meridian, with the disease at the Exterior; abdominal fullness from Cold-Dampness is due to Cold generating in the Extreme Yin, with the disease at the Root. If the Spleen is hot, Yin Essence is not transported to the Lungs, causing dry pharynx; if the Spleen is cold, it does not transport fluids for the Stomach, causing diarrhea. ○ A floating Taiyin pulse indicates the Exterior, presenting with symptoms like limb discomfort and pain; a sinking pulse indicates the Interior, presenting with abdominal fullness, vomiting, and diarrhea. If there is Wind Pathogen at the Exterior, sweating is appropriate, using Guizhi Tang (Cinnamon Twig Decoction); if there is Cold Pathogen at the Interior, warming is appropriate, using Si Ni Tang (Frigid Extremities Decoction) and similar formulas. For Taiyang with a sinking pulse, it is due to Cold; Cold is a Yin Pathogen, and sinking is a Yin Pulse. For Taiyin with a floating pulse, it is due to Wind; Wind is a Yang Pathogen, and floating is a Yang Pulse. One must know that pulses follow pathological changes and are not confined to meridians; thus, Yang meridians can have Yin pulses, and Yin meridians can have Yang pulses. The world claims that when the pulse reaches the Three Yin channels, it is always sinking, and Yin meridians should not be sweated, failing to examine this principle. ○ The phrase "hands and feet are self-warm" implicitly contrasts with "body has no fever," not stating that Taiyin Cold Damage must present with warm hands and feet. Even in diseases of the Three Yang channels, there are cases of cold hands and feet, let alone Taiyin? Mr. Tao distinguished Taiyin with warm hands and feet, Shaoyin with cold hands and feet, and Jueyin with cold extremities, which greatly contradicts the meaning of Taiyin limb discomfort/pain and Shaoyin whole-body and limb heat. Generally, injury by Cold results in Heat disease. Cold is Yin, Taiyin is Extreme Yin; the combination of two Yins produces no heat to emit. Only the limbs are the meeting point of Yin and Yang, so they remain warm. ○ Taiyang takes Yin as its root, while Taiyin takes Yang as its basis. Taiyang dares not sweat recklessly for fear of depleting Shaoyin fluids; Taiyin dares not purge lightly for fear of damaging Yangming Qi. (Ke Yunbo)
For Taiyin disease, the Classic texts contain only a dozen clauses, yet methods of warming, clearing, dispersing, purging, harmonizing, and tonifying are all complete, allowing later generations to extend and expand upon them. However, Taiyin channel diseases mostly involve Cold Pathogens entering the interior, with few Heat syndromes, because Heat diseases all originate from Shaoyin, not Taiyin. (Cheng Fusheng)
Why do pathogens of the Six Qi affect people similarly, yet cause different diseases? It is because people's constitutions vary in thickness, Qi varies in abundance or deficiency, and Zang organs vary in Cold or Heat. The received pathogen often transforms according to the person's Zang Qi, hence diseases vary. Thus, transformation may follow Deficiency, Excess, Cold, or Heat. Like water and fire, abundant water extinguishes fire, abundant fire consumes water; things transform according to their abundance, which is natural law. Knowing this, what doubt remains? When Yang Pathogens transmit to Yin, transforming from Cold to Heat, why consider it strange? From the Later Han dynasty until now, for a thousand years, it has been said that Cold Pathogens of the Three Yin do not transmit, and in Cold Damage transmission, Yin Pathogens are called "Direct Invasion" (Zhi Zhong). Do they know that Direct Invasion is a syndrome of contracting Cold directly, not a transmitted pathogen? These errors arise from not reading Zhang Zhongjing's books thoroughly. For example, in the Treatise, regarding diarrhea, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Warming the interior suits Si Ni Tang (Frigid Extremities Decoction); attacking the exterior suits Guizhi Tang (Cinnamon Twig Decoction). This is a Cold syndrome where Yang Pathogens from the Three Yang channels transmit to Taiyin, and the pathogen transforms to Cold following Yin. Regarding Shaoyin disease with diarrhea, Botong Tang (White Connective Decoction) is the main treatment. This is a Cold syndrome where Taiyin Cold Pathogen transmits to Shaoyin. Regarding diarrhea with undigested food, interior Cold with exterior Heat, sweating, and cold extremities, Tongmai Si Ni Tang (Unblocking the Vessels Frigid Extremities Decoction) is the main treatment. This is a Cold syndrome where Shaoyin Cold Pathogen transmits to Jueyin. All these are clearly documented; how can one say that Yin does not transmit in Cold Damage, or that there is no principle of Yang transforming from Yin? (From "Yi Zong Jin Jian")
Shaoyin Outline
The Shaoyin channel combines Water and Fire Qi, housing Cold and Heat mixed. Its Cold resembles Taiyin; its Heat resembles Taiyang. Therefore, Zhang Zhongjing uses the subtle and fine pulse and the desire to sleep as the outline, establishing laws beyond images, prompting people to seek laws within the disease. By imitating this principle, one can deduce the Cold and Heat of diseases, and the truth or falsity of Cold and Heat, revealing the Deficiency and Excess of True Yin. ○ Shaoyang is the Pivot of Yang, Shaoyin is the Pivot of Yin. Wiry represents Wood; wiry and fine represents little Yang; subtle represents Water; subtle and fine represents little Yin. In Shaoyin disease, the pivot mechanism is obstructed, hence the desire to sleep, similar to Shaoyang's frequent vomiting. Vomiting governs exit, Yang governs exterior; sleeping governs entry, Yin governs interior. Frequent vomiting means unable to vomit; desire to sleep means unable to sleep. Both exist in the patient's mind, obtaining the image of the pivot mechanism. ○ Desire to sleep is essentially inability to sleep. However, desire to sleep is the disease condition, known through inquiry; inability to sleep is the disease form, known through observation. Desire to sleep indicates Yin Deficiency; insomnia indicates vexation/restlessness, hence treatments differ. ○ Taiyin is the Interior of Yangming; Yangming does not have aversion to cold, so although Taiyin has vomiting, diarrhea, and abdominal fullness, it lacks aversion to cold. Shaoyin is the Interior of Taiyang; Taiyang has aversion to cold, so Shaoyin vomiting and diarrhea must include aversion to cold, as Yin follows Yang. ○ Taiyang is the Branch (Biao) of Shaoyin, Taiyin is the Root (Ben) of Shaoyin. If Shaoyin Yin is deficient, Heat transfers to the Bladder, causing whole-body and limb heat and blood in urine, following the Branch; if Shaoyin Yang is deficient, Cold transfers to Spleen and Earth, causing vomiting and diarrhea, following the Root. ○ Taiyang and Shaoyin both have Exterior symptoms of body and bone pain, and Interior disorders of Water Qi. Taiyang has a floating-tight pulse and body fever, using Ephedra (Mahuang) to sweat, stirring Ying and Wei Yang to harmonize Yin; Shaoyin has a sinking pulse and cold hands and feet, using Aconite (Fuzi) to warm and tonify, supporting the Yang of Kan Palace to match Yin. Water of Taiyang belongs to Upper Jiao; Xiao Qinglong Tang (Minor Green Dragon Decoction) sweats and releases it, Yang Water should dissipate from the exterior; Water of Shaoyin belongs to Lower Jiao; Zhenwu Tang (True Warrior Decoction) warms and promotes urination, Yin Water should drain from below. ○ Same aversion to cold and curling up: if diarrhea stops and hands/feet are warm, it is treatable; if diarrhea continues and hands/feet are cold, it is untreatable. Occasional spontaneous vexation, wanting to remove clothes/quilts, is treatable; no vexation but restlessness, cold extremities, and absent pulse indicate death. Same vomiting and diarrhea: if hands/feet are not cold and instead there is fever, survival is possible; vexation, restlessness, and cold extremities indicate death. Same vomiting: if sweating occurs and bowel movements are infrequent, it is treatable; spontaneous diarrhea, vexation, and inability to lie down indicate death. Yin and Yang are roots of each other; without Yang in Yin, there is death, for solitary Yin cannot generate life. ○ Among the Three Yang, only Shaoyang lacks Chengqi (Purgative) syndromes; among the Three Yin, only Shaoyin has Chengqi syndromes. Shaoyang is the Pivot of Yang; if Yang is slightly deficient, pathogens enter Yin, so reckless purging should not be used to further weaken Yang. Shaoyin is the Pivot of Yin; if Yang is excessive, pathogens damage Yin, so urgent purging is needed to preserve Yin. Moreover, Shaoyang belongs to Wood; with pathogens in Shaoyang, one fears Wood overcoming Earth, hence no purgation syndrome. Shaoyin governs Water; with pathogens in Shaoyin, one fears Earth controlling Water, hence urgent purging is required. True Yin must not be deficient, and Strong Yang must not be indulged. (Ke Yunbo)
In the Kidney there is True Water and True Fire. The True Fire in the Kidney is the Yang line hidden within the two Yin lines of Kan. If Fire is weak, Water overflows, and invading Yin Pathogens rely on the Cold Water in the Kidney to create a devastating force, causing cough, vomiting, diarrhea, heavy limbs, back cold, and cold extremities. Zhang Zhongjing never worries about external pathogens and recklessly uses sweating or purging to damage Yang; he only uses Zhenwu Tang (True Warrior Decoction), Si Ni Tang (Frigid Extremities Decoction), and Fuzi (Aconite) decoctions to restore True Yang in the Kidney, making it guard the North. This is what Wang Bing called "Benefiting the source of Fire to eliminate Yin shadows." If True Fire in the Kidney cannot sustain itself, there will be vexation, profuse sweating, red face, and the syndrome will resemble Yang, leading to death. True Water in the Kidney is the two Yin lines outside the single Yang line of Kan, surrounding the odd line. If Water is weak, Fire blazes, and invading Heat Pathogens rely on the Yang Fire in the Kidney to cause accumulation and swelling, causing mental vexation, dry mouth, sore throat, and insomnia. Zhang Zhongjing never worries about external pathogens and recklessly uses sweating or purging to damage Yin; he only uses Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction), Zhufu Tang (Pig Skin Decoction), and Zhuling Tang (Polyporus Decoction) to nourish True Yin in the Kidney, making it control the South. This is what Wang Bing called "Strengthening the master of Water to control Solar brilliance." If True Water in the Kidney cannot nourish, it will transmit to Jueyin, deep heat causes deep cold, sore throat turns into throat obstruction, vomiting/cough turns into spitting pus, diarrhea turns into bloody pus, and severely, restlessness, heat, cold extremities, and unconsciousness occur, with Kidney Qi failing first, leading to death. Thus, one knows that Zhang Zhongjing's methods of warming meridians and dispersing cold, and clearing heat and moistening dryness, operate simultaneously like the four seasons and sun/moon, without contradiction. (Cheng Fusheng)
Any syndrome contracting Yin must first enter Shaoyin. Once surface-dispersing methods are used, lone Yang flies away, exiting with sweat, causing restlessness, hallucinations, delirium, and confused speech. If mistakenly identified as a Fire syndrome and treated with Cold/Cooling herbs, death ensues immediately. If allowed to sweat continuously, Primordial Yang does not return to its residence, Qi scatters, and death also ensues. Urgently, methods to drive out Yin and return Yang are needed, along with methods to gather Yang and return it to its root, such as Bawei Dihuang Tang (Eight-Ingredient Rehmannia Pill) plus Ren Shen (Ginseng). My opinion is that syndromes contracting Yin must first enter Shaoyin because Shaoyin belongs to the Kidney, which is exterior-interior related to the Taiyang Bladder Channel. Because the person's Kidneys are inherently deficient, with insecure sealing and storing, Taiyang becomes leaky, allowing Cold Pathogens to invade easily. If the exterior is not secure, pathogens enter directly to the interior, with both exterior and interior deficient, resonating together. The Kidney is a Water Organ, and the Bladder is a Water-storing channel; thus, contracting Yin must first enter the Kidney. It is also said: "Cold Damage tends to kill those with Kidney Deficiency." This is certainly not an empty statement. (Wu Tianshi)
The Shaoyin Kidney Channel is an organ of Water and Fire. When pathogens injure the channel, depending on the person's Deficiency or Excess, it may transform via Water into Cold, or via Fire into Heat. Transformation via Water into Yin-Cold Pathogen is its Root (Ben); transformation via Fire into Yang-Heat Pathogen is its Branch (Biao). Yin Pathogens present with sinking, fine, and subtle pulses; Yang Pathogens present with sinking, fine, and rapid pulses. Their manifested symptoms also differ. Yin Pathogens: desire to sleep, no body heat. Yang Pathogens: though desiring to sleep, often have mental vexation. Yin Pathogens: aversion to cold on the back, neutral mouth sensation. Yang Pathogens: aversion to cold on the back, dry mouth. Yin Pathogens: sore throat without swelling. Yang Pathogens: sore throat with swelling. Yin Pathogens: abdominal pain, diarrhea with undigested food. Yang Pathogens: abdominal pain, diarrhea with clear water, or bloody pus in stool. Yin Pathogens: exterior heat, red face, interior cold, loose stools, white urine. Yang Pathogens: exterior cold, cold extremities, interior heat, constipation, red urine. These are the pulse and symptom patterns of Shaoyin Root and Branch Cold and Heat. For treatments following the Root, warming Cold and returning Yang are appropriate; for treatments following the Branch, clearing Heat and saving Yin are appropriate. Returning Yang and saving Yin involves subtle mechanisms, always requiring careful clinical investigation to distinguish Root/Branch and Cold/Heat, applying urgent treatment to achieve success; any delay renders it ineffective. (From "Yi Zong Jin Jian")
Jueyin Outline
Both Taiyin and Jueyin use Interior syndromes as their outline. Taiyin is Yin within Yin and governs Cold, hence no thirst. Jueyin is Yang within Yin and governs Heat, hence excessive thirst. Taiyin governs Wet Earth; Earth disease causes Qi to sink downward, Damp Pathogen enters the Stomach, causing abdominal pain and spontaneous diarrhea. Jueyin governs Ministerial Fire; Fire disease causes Qi to rebel upward, Fire Pathogen enters the Heart, causing pain and heat in the heart region. Taiyin: abdominal fullness and vomiting, inability to eat. Jueyin: hunger but no desire to eat, vomiting roundworms upon eating. Both involve inability to eat: Taiyin presents with fullness, Jueyin with hunger. Both involve vomiting: Taiyin vomits food, Jueyin vomits roundworms. This distinguishes Earth from Wood. Taiyin is the Opening; originally spontaneous diarrhea, purging causes the Opening to collapse. Hardness and fullness below the chest represent the Opening collapsing turning into Closing. Jueyin is the Closing; Qi rebels upward, purging causes the Closing to collapse. Unstopping diarrhea represents the Closing collapsing turning into Opening. ○ Two Yins intersect and end, named Jueyin, also called the Absolute Yang of Yin, suggesting Jueyin should have no Heat. However, Jueyin governs the Liver, and Gallbladder is stored within the Liver. Thus, Jueyin Heat syndromes all originate from internal Ministerial Fire of Shaoyang. It must be known that Shaoyang and Jueyin share the same Ministerial Fire. When Ministerial Fire is stagnant internally, Jueyin disease emerges at the Exterior, becoming Shaoyang disease. Shaoyang dry throat is the mechanism of Jueyin excessive thirst; chest and hypochondriac Qi fullness is the sign of Qi hitting the heart; mental vexation is the beginning of pain and heat; lack of desire to eat is the root of hunger without desire to eat; frequent vomiting is the gradual stage of vomiting roundworms. Thus, if Shaoyang is not resolved, it transmits to Jueyin and the disease becomes critical; if Jueyin disease declines, it transmits to Shaoyang and recovery is desired. ○ Cold extremities must be accompanied by fever; Heat and Cold correspond. Deep cold implies deep heat, slight cold implies slight heat. These four syndromes are the fixed pattern of Jueyin Cold Damage. Heat first, then cold; alternating cold and heat; more cold than heat; more heat than cold. These four syndromes are the variable pattern of Jueyin Cold Damage. ○ Jueyin follows the principle of new moon and full moon intersection; Yin extreme generates Yang, so Jueyin Cold Damage actually prioritizes Yang. Less cold, more heat is Generating Yang, so the disease should heal; more cold, less heat is Dead Yin, so the disease progresses. Those with excess Heat Qi may have bloody pus in stool or develop carbuncles/pus, differing from "Jian Jue" (Frying Cold) in the Neijing. ○ Cold hands and feet, pulse subtle and near extinction are external signs of Jueyin Cold Damage; Danggui Sini Tang (Angelica Sini Decoction) is the exterior medicine for Jueyin Cold Damage. Why are Ginger and Aconite not used despite such Yin-Cold? Because Ministerial Fire resides in Liver and Gallbladder; although the exterior is cold, the Zang organs are not cold. Thus, those with initial cold will later have fever; the colder the hands and feet, the hotter the Liver and Gallbladder, hence deep cold implies deep heat. Therefore, at the onset of Cold Damage, if pulses and symptoms are like this, one must not immediately consider it Deficiency-Cold and recklessly administer Ginger and Aconite to leave trouble behind. ○ The chapter states: "All cases of cold extremities and Jue should not be purged." It also says: "Jue should be purged, but if sweating is used instead, the mouth will surely become injured and red." The meanings differ. "All cases of cold extremities should not be purged" refers to Cold Damage with subtle/near-extinct pulse, where external Cold is pressing and internal Heat has not risen. "This should be sweated" refers to Deficiency-Cold syndromes.