凡阴病见阳脉者生，阳病见阴脉者死。
起口用凡字，是开讲法，不是承接法。此与上文阴阳脉，文同而义则异也。阳脉指胃气言，所谓二十五
阳者是也。五脏之阳和发见，故生。阴脉指真脏言，胃脘之阳，不至于手太阴，五脏
之真阴发见，故死。要知上文沉、涩、弱、弦、迟是病脉，不是死脉，其见于阳病最多。若真脏脉至，如肝脉
中外急，心脉坚而搏，肺脉大而浮，肾脉之如弹石，脾脉之如喙距，反见有余之象，岂可以阳脉名之？若以胃
脉为迟，真阴为数，能不误人耶？（柯韵伯）
伤寒一日，太阳受之。脉若静者，为不传；颇欲吐，若躁烦，脉数急者，为传也。
《经》云一日太阳受之，二日阳明受之，三日少阳受之；四、五、六日三阴受之。与《洪范》一曰寿，
二曰富，三曰康宁，四曰攸好德，五曰考终命，文法符同。实为标出六经证据，以为治疗张本。何尝教人以
日数为拘也！后人以曰作日，自然如同暗镜，从古无人道及。或言日字不必看实。夫日实字也，安可作虚
字用耶？（《医补》）
传者，即《内经》人伤于寒而传为热之传。乃太阳之气生热，而传于表，即发于阳者传七日之谓。非太阳
与阳明、少阳经络相传之谓也。（柯韵伯）
伤寒二三日，阳明、少阳证不见者，为不传也。
伤寒一日太阳、二日阳明、三日少阳者，是言见证之期，非传经之日也。岐伯曰∶邪中于面，则下阳明；
中于项，则下太阳；中于颊，则下少阳；其中膺背两胁，亦中其经。盖太阳经部位最高，故一日发；阳明经
部位次之，故二日发；少阳经部位又次之，故三日发。是气有高下，病有远近，适其至所为故也。夫三阳各
受寒邪，不必自太阳始，诸家言三阳必自太阳传来者，未审斯义耳。（柯韵伯）
伤寒三日，三阳为尽，三阴当受邪。其人反能食而不呕，此为三阴不受邪也。
受寒三日，不见三阳表证，是其人阳气冲和，不与寒争，邪不得入，故三阳尽不受邪也。若阴虚而不能支，
则三阴自受邪气。岐伯曰∶中于阴者，从臂 始。故三阴各自受邪，不必阳经传
授。所谓太阴四日、少阴五日、厥阴六日者，亦以阴经之高下为见证之期，非六经以次相传之日也。（柯韵伯）
伤寒六七日，无大热，其人烦躁者，此为阳去入阴故也。
阴者指里而言，非指三阴也。或入太阳之本而热结膀胱，或入阳明之本而胃中干燥，或入少阳之本而
胁下硬满，或入太阴而暴烦下利，或入少阴而口燥舌干，或入厥阴而心中疼热，皆入阴之谓。（柯韵伯）
太阳病，头痛，至七日以上自愈者，以行其经尽故也。若欲作再经者，针足阳明，使经不传则愈。
旧说伤寒日传一经，六日至厥阴，七日再传太阳，八日再传阳明，谓之再经。自此说行，而仲景之堂无
门可入矣。夫仲景未尝有日传一经之说，亦未有传至三阴而尚头痛者。曰头痛者，是未离太阳可知。曰行，
则与传不同。曰其经，是指本经而非他经矣。发于阳者七日愈，是七日乃太阳一经行尽之期，不是六经传
变之日。岐伯曰∶七日太阳病衰，头痛少愈，有明证也。故不曰传足阳明，而曰欲作再经，是太阳过经不解，
复病阳明而为并病也。针足阳明之交，截其传路，使邪气不得再入阳明之经，则太阳之余邪亦散，非归并阳明，
使不犯少阳之谓也。（柯韵伯）
发汗后，水药不得入口为逆；若更发汗，必吐下不止。
此条从来诸家错会，扯入桂枝四禁，谓已用桂枝致逆，若更用桂枝，则其变愈大，粗疏极矣！盖为逆是
言水逆，未尝说为凶逆也。且原文不云更与桂枝，而云更发汗者，见水药俱不得入，则中满已极，凡是表药，
皆可令吐、下不止，不独桂枝当禁也。所以仲景于太阳水逆之证，全不用表药，惟用五苓以导水，服后随溉热
汤以取汗，正与此条互相发明；设只单禁桂枝，将麻黄、葛根、柴胡等类在所不禁，而误用以致吐下不止，
恬不知为犯禁矣。（《尚论篇》）
太阳病，发汗，汗出不解，其人仍发热，心下悸，头眩，身
动，振振欲擗地者，真武汤主之。
振振欲擗地五字，形容亡阳之状如绘。诸家不加细绎，妄取《诗经》注擗拊心貌为解，仲景论中心下悸欲
得人按，与夫叉手自冒心，且与拊心之义不协，何得妄指耶？盖擗者，辟也，避也。汗出过多，卫气解散，
其人似乎全无外廓，故振振然四顾彷徨，无可置身，思欲辟地而避处其内也。阴证似阳者，欲坐井中，避热
就冷也。汗多亡阳者，欲入土中，避虚就实也。试观婴孩出汗过多，神虚畏怯，常合面偎入母怀者，岂非振
振欲擗地之一验乎？（喻嘉言）
太阳病中风，以火劫发汗，邪风被火热，血气流溢，失其常度，两阳相熏灼，其身发黄。阳盛则欲衄，阴
虚则小便难，阴阳俱虚竭，身体则枯燥，但头汗出，剂颈而还，腹满而喘，口干咽烂，或不大便，久则谵语，
甚者至哕、手足躁扰、捻衣摸床。小便利者，其人可治。
按∶此证乃阳邪挟火，扰乱阴分而亡其阴，与亡阳之证，天渊悬绝。观阳盛欲衄，身体枯燥等语，
明是失汗所致。失汗则阳必内入，何反外亡耶？注家泥于阴阳俱虚竭一语，遂谓小便利者，阴未甚虚，则阳犹
可回，是认可治为回阳，大失《经》旨。不知此证急驱其阳以存阴气之一线，尚恐不得，况可回阳以更劫
其阴乎？且头汗乃阳邪上壅，不下通于阴，所以剂颈以下不能得汗。设见衄血，则邪从衄解，头间且无汗矣；
设有汗，则邪从汗解，又不衄矣。后条火邪深入必圊血一证，亦谓身体枯燥而不得汗者，必致圊血。设有汗，
更不圊血矣。读古人书，全要会意，岂有得汗而加衄血圊血之理哉！又岂有遍身无汗，而头汗为亡阳之理哉！
（喻嘉言）
太阳病下之，其脉促，不结胸者，此为欲解也。脉浮者，必结胸也；脉紧者，必咽痛；脉弦者，必两胁
拘急；脉细数者，头痛未止；脉沉紧者，必欲呕；脉沉滑者，协热利；脉浮滑者；必
下血。
脉促，为阳邪上盛，反不结聚于胸，则阳邪未陷，可勃勃从表出矣，故为欲解也。脉浮者必结胸，即指
促脉而申之，见脉促而加之以浮，邪气弥满于阳位，故必结胸也。浮字贯下四句，见浮而促必结胸，浮而紧
必咽痛，浮而弦必两胁拘急，浮而细数必头痛未止，皆太阳本病之脉，故主病亦在太阳之本位。设脉见沉紧，
则阳邪已入阴分，但入而未深，仍欲上冲作呕，其无结胸咽痛等证，从可知矣。只因《论》中省用一个促字、
三个浮字，后之读者遂眩，谓紧为下焦，属在少阴，惑之甚矣！观本文下句即指出沉紧者必欲呕一语，正见
前之紧字，是指浮紧而言也。沉紧方是阳邪入阴，上逆作呕，岂有浮紧咽痛，反为少阴寒邪上冲之理！明明
太阳误下之脉证，何缘插入少阴，烁乱后人耶？至于滑脉居浮沉之间，亦与紧脉同推，故沉滑则阳邪入阴而
主下利，浮滑则阳邪正在营分，扰动其血，而主下血也。夫太阳误下之脉，主病皆在阳、在表，即有沉紧、
沉滑之殊，亦不得以里阴名之。仲景辨析之精，讵可杂以赘庞哉！（喻嘉言）
病发于阳，而反下之，热入因作结胸；病发于阴，而反下之，因作痞。所以成结胸者，以下之太早故也。
发阳发阴，二千年来未知其解。果如原注谓无热恶寒为阴，则中寒矣，下之有不立毙者乎？如《尚
论》以寒伤营血为阴，则仲景痞结篇中，中风、中寒每每互言，未尝分属也。不知发于阴者，虽是阴证，但是
阳经传入之邪，非直中阴经之谓。阳经传入。原为热证，至于阴经，未有不热深于内者。此所以去热入二字，
而成千古之疑也。热证由阴传府，乃为可下；若在经而下，仍为误下，与三阳在经无异。故曰阳邪结于阳位，
则结在胸，阴邪结于阴位，则结在心下，或偏旁也。阴经误下，何止成痞？以所结只在阴位，不若阳邪势盛，
所结必在阳位也。（周禹载）
阳者指外而言，形躯是也。阴者指内而言，胸中、心下是也。
此指人身之外为阳内为阴，非指阴经之阴，亦非指阴证之阴。发阴、发阳，俱指发热；结胸与痞，俱是热证；
作痞不言热入者，热原发于里也。误下而热不得散，因而痞硬，不可以发阴作无热解。若作痞谓非热证，泻心
汤不得用芩、连、大黄矣。若栀子豉之心中懊 ，瓜蒂散之心中温温欲吐，与心下满而烦，黄连汤之胸中有热，
皆是病发于阴。（柯韵伯）
伤寒发汗，若吐、若下解后，心下痞硬，噫气不除者，旋复代赭石汤主之。
此条后贤不解，谓噫气为伏饮作逆，方注倡之，二家即和，不知何所据也？盖伏饮作逆之吐，有形之邪也；
今噫而不吐，为无形之虚气上逆，何可混言哉！（魏荔彤）
伤寒六七日，发热，微恶寒，肢节烦疼，微呕，心下支结，外证未去者，柴胡桂枝汤主之。
心下支结者，邪结于心下之偏旁，不正中也。比小结胸之正在心下又较轻矣。伤寒至六七日宜经传已遍，
乃发热、微恶寒、肢节烦疼、微呕，则邪尚在三阳之界，未入于里，虽心下支结，而外证未除，即不可用大
陷胸汤，以大陷胸汤主里而不主表也；亦不可用小陷胸汤，以小陷胸汤主饮而不主表也。夫支结之邪，其在
外者方盛，其陷入者原少，故但合用柴胡、桂枝和解二法，以治其表，表邪去而支结自开矣。后人谓支结乃支饮
结于心下，梦语喃喃，吾不识支饮为何物也！（喻嘉言）
太阳病，项背强KT KT 。
KT KT ，鸟之短羽者，动则引颈。KT KT 然，形容病患之颈项俱病，俯仰不能自如之貌。（方中行）
《诗》云∶赤舄KT KT 。注∶KT KT ，安重貌。谓取自拘持，使低目不妄顾视。按此可以想见项背拘强之状，
若作鸟羽释，则KT 当音殊，而于拘强之义，反不切矣。（《证治准绳》）
太阳病，三日，已发汗，若吐、若下、若温针，仍不解者，
此为坏病，桂枝不中与也。观其脉证，知犯何逆，随证治之。
相传伤寒过经日久，二三十日不痊者，谓之坏病。遂与过经不解之病无辨，此古今大误也。仲景止说病
三日，即五、六日亦未说到；且此条止说太阳病，连少阳亦未说到，故谓桂枝偏表之法不可用。观太阳转入少
阳之坏证，有柴胡证罢四字，可见此为桂枝证罢，故不可复用也。设桂枝证仍在，即不得谓之坏病，与《少
阳篇》内柴胡证仍在者，此虽已下之不为逆，复与柴胡汤必蒸蒸而振，却发热汗出而解之文，又互相绾照也。
岂有桂枝、柴胡之证尚未罢，而得指为坏病之理哉！故必细察其脉为何脉，证为何证，从前所误，今犯何逆，
然后随其证而治之，始为当耳。（喻嘉言）
本太阳病不解，转入少阳者，胁下硬满，干呕，不能食，往来寒热，尚未吐下，脉沉紧者，与小柴胡汤。若
已吐、下、发汗、温针，谵语，柴胡证罢，此为坏病。知犯何逆，以法治之。
按∶上条太阳经之坏病也，此条少阳经之坏病也。两条文意互发，其旨甚明。叔和分汇，致滋疑惑。兹
合而观之，乃知上条云桂枝汤不中与，则其所犯，要不离于太阳一经之误吐、误下、误发汗、误烧针之诸逆
也。此条云柴胡汤不中与，则其所犯，要不离于少阳一经之误吐、误下、误发汗、误烧针之诸逆也。后人
拟议何逆四治，见为创获，由兹观之，真呓语矣！（喻嘉言）
脉阳微而汗出少者，为自和也，汗出多者为太过。阳脉实，因发其汗，出多者，亦为太过；太过为阳绝于
里，亡津液，大便因硬也。
阳绝，即亡津液之互辞。仲景每于亡津液者悉名无阳，本文阳绝于里，亡津液，大便因硬甚明。注家认
作汗多而阳亡于外，大谬！（喻嘉言）
无阳与亡阳不同。亡阳者，发散之过，阳气随汗液而亡失也；无阳者，真阳亏少，而无汗液之可散也。（程扶生）
阳明病，脉浮而紧者，必潮热发作有时，但浮者，必盗汗出。
阳明脉之浮紧，即太阳寒伤营之脉也；单浮，即太阳风伤卫之脉也。但传至阳明，仲景不欲以营卫辨证，而
姑变其文耳。至于太阳证有未罢，各条虽悉，尚恐未明，再举潮热及盗汗，阳明之必至者辨之，确然无疑矣。
从前注解皆是断章取义，而不会其大意，不知脉紧与潮热，脉浮与盗汗，非的对之证也，不过借以辨阳明八、
九，太阳一、二之候耳。至谓浮为阳盛，阳盛则阴虚，阴虚则盗汗出，节外生枝，几于说梦矣！（喻嘉言）
阳明病，若中寒，不能食，小便不利，手足 然汗出，此欲作固瘕，必大便初硬后溏。所以然者，以胃中冷，
水谷不别故也。
注谓固为坚固，瘕为积聚，大谬。盖大便初硬后溏，因成瘕泄，瘕泄即溏泄，久而不止，则曰固瘕也。（喻嘉言）
固瘕即初硬后溏之谓，肛门虽固结，而肠中不全干也。溏即水谷不别之象，以症瘕作解者谬矣。（柯韵伯）
病患无表里证，发热七八日，虽脉浮数者，可下之。假令已下，脉数不解，合热则消谷善饥，至六七日不大
凡是阴证出现阳脉的，预后良好；凡是阳证出现阴脉的，预后不良。
柯韵伯注：起首用“凡”字，是开启论述的方法，不是承接上文的意思。这里的阴阳脉，文字与上文相同，但含义却不同。所谓阳脉，是指胃气而言，也就是前文所说的“二十五阳”。五脏的阳气调和显露，所以能生；所谓阴脉，是指真脏脉而言，如果胃脘的阳气不能通达到手太阴肺经，五脏的真阴显露，所以会死。要知道，前文提到的沉、涩、弱、弦、迟是病脉，并不是死脉，它们出现在阳病中最为常见。如果是真脏脉出现，比如肝脉中外紧急，心脉坚硬搏指，肺脉大而浮，肾脉像弹石一样坚硬，脾脉像鸟嘴一样尖锐，反而出现有余的征象，怎么可以称为阳脉呢？如果把胃脉当作迟脉，把真阴当作数脉，难道不会误人吗？
《医补》注：伤寒第一天，太阳经受邪。如果脉象平静，说明病邪没有传变；如果病人想吐，或者烦躁不安，脉象数而急促，说明病邪已经传变。
《医补》注：经典说第一天太阳受邪，第二天阳明受邪，第三天少阳受邪；第四、五、六天三阴经受邪。这与《洪范》篇中“一曰寿，二曰富，三曰康宁，四曰攸好德，五曰考终命”的文法相符。这实际上是标出六经的证据，作为治疗的基础。哪里是教人以日数为拘束呢！后人把“日”字当作虚数理解，自然如同盲人摸象，从古以来没有人这样说过。有人说“日”字不必看作实数。其实“日”是实数，怎么能当作虚数使用呢？
柯韵伯注：所谓的“传”，就是《内经》中说的“人伤于寒而传为热”的传变。这是太阳之气产生热邪，并传于体表，也就是“发于阳者七日愈”的说法。这并不是指太阳经与阳明经、少阳经经络之间的相互传变。
柯韵伯注：伤寒二三天后，如果没有出现阳明和少阳的症状，说明病邪没有传变。
柯韵伯注：伤寒第一天太阳受邪、第二天阳明受邪、第三天少阳受邪，这是指症状出现的时期，而不是病邪传经的日子。岐伯说：邪气中于面部，则传入阳明经；中于项部，则传入太阳经；中于颊部，则传入少阳经；中于胸膺、背部及两胁，也传入相应的经脉。大概太阳经部位最高，所以第一天发病；阳明经部位次之，所以第二天发病；少阳经部位又次之，所以第三天发病。这是因为气有高下之分，病有远近之别，邪气到达的部位决定了发病的时间。三阳经各自感受寒邪，不一定非要从太阳经开始，各家说三阳经必定从太阳经传来，是没有审察清楚这个道理。
柯韵伯注：伤寒三天，三阳经的病邪已尽，三阴经应当受邪。如果病人反而能吃饭且不呕吐，这说明三阴经没有受邪。
柯韵伯注：感受寒邪三天，没有出现三阳经的表证，是因为此人阳气冲和，不与寒邪抗争，邪气不得侵入，所以三阳经都不受邪。如果阴虚而不能支撑，那么三阴经自然会受邪气侵袭。岐伯说：邪气中于阴经，从手臂开始。所以三阴经各自受邪，不一定非要由阳经传过来。所谓太阴经第四天、少阴经第五天、厥阴经第六天发病，也是以阴经部位的高下来决定症状出现的时期，而不是六经依次相传的日子。
柯韵伯注：伤寒六七天，身体没有大热，但病人烦躁，这是阳邪入里进入阴分的缘故。
柯韵伯注：这里的“阴”是指里而言，并不是指三阴经。或者是邪气进入太阳之本而热结膀胱，或者是进入阳明之本而胃中干燥，或者是进入少阳之本而胁下硬满，或者是进入太阴经而出现暴烦下利，或者是进入少阴经而出现口燥舌干，或者是进入厥阴经而出现心中疼热，这些都叫作入阴。
柯韵伯注：太阳病，头痛，到了七天以上自愈的，是因为病邪在本经行尽的缘故。如果想要进入下一经（再经），针刺足阳明经的穴位，使病邪不再传变，就能痊愈。
柯韵伯注：旧的说法定伤寒每天传一经，六天传到厥阴，七天再传太阳，八天再传阳明，这叫作再经。自从这种说法流行后，张仲景的医学殿堂就无人能入了。张仲景从来没有每天传一经的说法，也没有说过病邪传到三阴经还会头痛。说头痛，可知病邪未离开太阳经。说“行”，则与“传”不同。说“其经”，是指本经而不是他经。“发于阳者七日愈”，是七天乃太阳一经病邪行尽的时期，不是六经传变的日期。岐伯说：第七天太阳病衰退，头痛稍减，这是明确的证据。所以不说“传足阳明”，而说“欲作再经”，意思是太阳经过经不解，复病阳明经而为并病。针刺足阳明经的原穴，截断其传变之路，使邪气不得再次进入阳明经，那么太阳经的余邪也会消散，并不是归并到阳明经，使其不侵犯少阳经的意思。
《尚论篇》注：发汗后，水药无法入口，这叫逆证；如果再次发汗，必然导致上吐下泻不止。
《尚论篇》注：这一条历来各家都误解了，牵强地扯入桂枝汤的四禁，认为已经用了桂枝导致逆证，如果再使用桂枝，那么变化会更大，真是粗疏至极！所谓“逆”是说水饮之逆，并没有说是凶险之逆。而且原文没说“更与桂枝”，而是说“更发汗”，可见水药俱不得入，说明中焦胀满已到极点，凡是解表药，都可以导致吐、下不止，不仅仅是桂枝当禁。所以张仲景对于太阳水逆之证，完全不用解表药，只用五苓散来导水，服药后喝热粥来取汗，正与此条互相发明；如果只禁止桂枝，那么麻黄、葛根、柴胡等类药就在所不禁之列，而误用这些药导致吐下不止，还恬不知耻地认为没有犯禁。
喻嘉言注：太阳病，发汗后，汗出而病不解，病人仍然发热，心悸，头晕，身体动摇，震颤得好像要跌倒在地，用真武汤主治。
喻嘉言注：“振振欲擗地”五个字，形容亡阳的状态如绘画般逼真。各家不加细细推敲，妄取《诗经》注中“擗拊心貌”来解释，张仲景论述中心下悸想要人按压，以及叉手自冒心，都与“拊心”的意义不协调，怎么能妄加指点呢？大概“擗”通“辟”，是躲避的意思。出汗过多，卫气解散，病人似乎完全没有外在的保护，所以震颤四顾彷徨，无处容身，想要避开地面而躲藏在内侧。阴证似阳的人，想要坐在井中，是为了避热就冷。汗多亡阳的人，想要进入土中，是为了避虚就实。试看婴儿出汗过多，神气虚弱畏怯，常常脸朝里偎依在母亲怀里的样子，难道不是“振振欲擗地”的一个验证吗？
喻嘉言注：太阳病中风，用火法劫迫发汗，邪风被火热所迫，气血流溢，失去常度，两阳相熏灼，身体发黄。阳盛则想流鼻血，阴虚则小便困难，阴阳俱虚竭，身体就会枯燥，只有头部出汗，齐颈而止，腹部胀满而喘，口干咽烂，或者不大便，时间久了会出现谵语，严重的甚至出现呃逆、手足躁扰、捻衣摸床。如果小便利，这个人还可以治。
喻嘉言注：按：此证乃是阳邪挟火，扰乱阴分而亡其阴，与亡阳之证，有天壤之别。看“阳盛欲衄，身体枯燥”等语，明显是失汗所致。失汗则阳必内入，怎么会反而外亡呢？注家拘泥于“阴阳俱虚竭”一句话，于是认为小便利，说明阴未甚虚，则阳犹可回，认为认可可治是为了回阳，大大失掉了经典的旨意。不知道此证急驱其阳以存阴气之一线，还恐怕做不到，何况可以回阳以更劫其阴呢？而且头汗是阳邪上壅，不能向下通达于阴，所以颈部以下不能得汗。假使见衄血，则邪从衄解，头部也就无汗了；假使有汗，则邪从汗解，也就不衄血了。后条火邪深入必致便血一证，也说身体枯燥而不得汗者，必致便血。假使有汗，更不会便血了。读古人书，全要领会意思，哪有得汗而又加衄血便血的道理呢！又哪有遍身无汗，而头汗是亡阳的道理呢！
喻嘉言注：太阳病误用下法，脉象促，不形成结胸的，这是病欲解的表现。脉浮的，必形成结胸；脉紧的，必咽痛；脉弦的，必两胁拘急；脉细数的，头痛未止；脉沉紧的，必想呕吐；脉沉滑的，协热下利；脉浮滑的，必下血。
喻嘉言注：脉促，是阳邪上盛，反而不结聚于胸，说明阳邪未陷，可以勃勃地从表而出，所以是病欲解。脉浮者必结胸，即针对促脉进一步说明，见脉促而加上浮，邪气弥满于阳位，所以必结胸。“浮”字贯穿下面四句，见浮而促必结胸，浮而紧必咽痛，浮而弦必两胁拘急，浮而细数必头痛未止，都是太阳本病的脉象，所以主病也在太阳的本位。假如脉见沉紧，则阳邪已入阴分，只是入而未深，仍想上冲作呕，其没有结胸咽痛等证，从这一点就可以知道了。只因《伤寒论》中省去了一个“促”字、三个“浮”字，后世的读者就感到眩惑，说紧脉属下焦，属少阴，迷惑得很啊！看本文下句即指出“沉紧者必欲呕”一句话，正见前面的“紧”字，是指浮紧而言。沉紧才是阳邪入阴，上逆作呕，哪有浮紧咽痛，反为少阴寒邪上冲的道理！明明是太阳误下的脉证，何缘插入少阴，扰乱后人呢？至于滑脉居浮沉之间，也与紧脉同样推论，所以沉滑则阳邪入阴而主下利，浮滑则阳邪正在营分，扰动其血，而主下血。夫太阳误下的脉，主病皆在阳、在表，即使有沉紧、沉滑的不同，也不能以里阴名之。张仲景辨析之精，岂可杂以赘余庞杂之说呢！
周禹载注：病发于阳，而反用下法，热邪内入因而形成结胸；病发于阴，而反用下法，因而形成痞证。之所以形成结胸，是因为下得太早的缘故。
周禹载注：发阳发阴，两千年来没有人知道它的解释。果真如原注所说无热恶寒为阴，那就是中寒了，下法下去有不立即死亡的么？如《尚论篇》以寒伤营血为阴，那么张仲景痞结篇中，中风、中寒每每互言，未曾分别归属。不知道发于阴者，虽然是阴证，但是阳经传入的邪气，并非直中阴经的意思。阳经传入，原为热证，至于阴经，没有不热深于内的。这就是去掉“热入”二字，而成千古之谜的原因。热证由阴传腑，才可以下；如果在经而下，仍然是误下，与三阳在经无异。所以说阳邪结于阳位，则结在胸；阴邪结于阴位，则结在心下，或偏旁处。阴经误下，何止成痞？因为所结只在阴位，不像阳邪势盛，所结必在阳位。
柯韵伯注：阳是指外而言，形躯是。阴是指内而言，胸中、心下是。
柯韵伯注：这里指人身之外为阳内为阴，不是指阴经之阴，也不是指阴证之阴。发阴、发阳，都指发热；结胸与痞，都是热证；作痞不言热入，是因为热原发于里。误下而热不得散，因而痞硬，不可以把发阴解释为无热。如果把痞认为是非热证，那么泻心汤就不能用黄芩、黄连、大黄了。如果栀子豉汤的心懊憹，瓜蒂散的心中温温欲吐，与心下满而烦，黄连汤的胸中有热，都是病发于阴。
魏荔彤注：伤寒发汗，如果用吐法、下法后病解，但心下痞硬，嗳气不除的，用旋复代赭石汤主治。
魏荔彤注：这一条后世贤者不理解，说嗳气是伏饮作逆，方注倡导这种说法，两家随即附和，不知道有什么依据呢？大概伏饮作逆的吐，是有形的邪气；现在嗳气而不吐，是无形的虚气上逆，怎么能混为一谈呢！
喻嘉言注：伤寒六七天，发热，微恶寒，肢节烦疼，微呕，心下支结，外证未去的，用柴胡桂枝汤主治。
喻嘉言注：心下支结，是邪结于心下的偏旁，不在正中。比小结胸之正在心下又轻了。伤寒到了六七天应该传经已遍，现在发热、微恶寒、肢节烦疼、微呕，说明邪气还在三阳之界，未入于里，虽然心下支结，而外证未除，即不可用大陷胸汤，因为大陷胸汤主里而不主表；也不可用小陷胸汤，因为小陷胸汤主饮而不主表。夫支结之邪，其在外的方盛，其陷入的原本很少，所以只合用柴胡、桂枝和解二法，以治其表，表邪去而支结自开矣。后人说支结是支饮结于心下，梦话喃喃，我不认识支饮是什么东西！
方中行注：几几，是鸟之短羽者，动则引颈。几几然，形容病患之颈项俱病，俯仰不能自如之貌。
《证治准绳》注：《诗经》说：赤舄几几。注：几几，安重貌。谓取自拘持，使低目不妄顾视。按：这可以想见项背拘强之状，如果解释为鸟羽，则“几”应当音殊，而对于拘强之义，反而不切合了。
喻嘉言注：太阳病，三日，已发汗，如果用吐法、下法、温针，仍不解的，这叫坏病，桂枝汤不再适用。观察其脉证，知道犯了什么逆乱，随证治之。
喻嘉言注：相传伤寒过经日久，二三十日不痊的，叫做坏病。于是与过经不解的病没有区别，这是古今的大错误。张仲景只说病三日，即使是五、六日也未说到；而且此条只说太阳病，连少阳也未说到，所以说桂枝偏表之法不可用。看太阳转入少阳的坏证，有“柴胡证罢”四字，可见这是桂枝证罢，所以不可再用。假设桂枝证仍在，即不得称之为坏病，与《少阳篇》内“柴胡证仍在者，此虽已下之不为逆，复与柴胡汤必蒸蒸而振，却发热汗出而解”的文字，又互相呼应。哪有桂枝、柴胡之证尚未罢，而得指为坏病的道理呢！所以必须细察其脉为何脉，证为何证，从前所误，今犯何逆，然后随其证而治，才恰当。
喻嘉言注：本太阳病不解，转入少阳者，胁下硬满，干呕，不能食，往来寒热，尚未吐下，脉沉紧的，与小柴胡汤。如果已吐、下、发汗、温针，谵语，柴胡证罢，此为坏病。知道犯了什么逆，以法治之。
喻嘉言注：按：上条是太阳经的坏病，此条是少阳经的坏病。两条文意互相发明，主旨很明确。王叔和分类汇编，致使滋生疑惑。现在合而观之，才知道上条说桂枝汤不中与，则其所犯，总不离于太阳一经的误吐、误下、误发汗、误烧针之诸逆也。此条说柴胡汤不中与，则其所犯，总不离于少阳一经的误吐、误下、误发汗、误烧针之诸逆也。后人拟议“何逆四治”，见为创获，由此看来，真是呓语了！
喻嘉言注：脉阳微而汗出少的，是自和，汗出多的为太过。阳脉实，因发其汗，出多的，也为太过；太过为阳绝于里，亡津液，大便因此硬结。
喻嘉言注：阳绝，即亡津液的互辞。张仲景每当遇到亡津液者都名为无阳，本文“阳绝于里，亡津液，大便因硬”非常明确。注家认作汗多而阳亡于外，大错！
程扶生注：无阳与亡阳不同。亡阳者，发散之过，阳气随汗液而亡失也；无阳者，真阳亏少，而无汗液之可散也。
喻嘉言注：阳明病，脉浮而紧的，必潮热发作有时，单浮的，必盗汗出。
喻嘉言注：阳明脉之浮紧，即太阳寒伤营之脉也；单浮，即太阳风伤卫之脉也。但传至阳明，张仲景不欲以营卫辨证，而姑变其文耳。至于太阳证有未罢，各条虽悉，尚恐未明，再举潮热及盗汗，阳明之必至者辨之，确然无疑矣。从前注解皆是断章取义，而不会其大意，不知脉紧与潮热，脉浮与盗汗，非的对之证也，不过借以辨阳明八、九，太阳一、二之候耳。至谓浮为阳盛，阳盛则阴虚，阴虚则盗汗出，节外生枝，几于说梦矣！
喻嘉言注：阳明病，若中寒，不能食，小便不利，手足濈然汗出，此欲作固瘕，必大便初硬后溏。之所以如此，是因为胃中冷，水谷不别故也。
喻嘉言注：注家谓固为坚固，瘕为积聚，大谬。盖大便初硬后溏，因成瘕泄，瘕泄即溏泄，久而不止，则曰固瘕也。
In general, if a Yin disease presents with Yang pulses, the prognosis is good; if a Yang disease presents with Yin pulses, the prognosis is poor.
Ke Yunbo's Commentary: The use of the word "fan" (generally/all) at the beginning is a method to initiate discourse, not to connect with the preceding text. The Yin and Yang pulses here have the same wording as above but different meanings. By "Yang pulse," it refers to Stomach Qi (Wei Qi), which is what was previously called the "Twenty-Five Yangs." When the Yang Qi of the Five Zang Organs harmonizes and manifests, life is sustained. By "Yin pulse," it refers to the True Visceral Pulse (Zhen Zang Mai). If the Yang Qi of the Stomach House does not reach the Hand Taiyin Lung Meridian, and the True Yin of the Five Zang Organs manifests, death ensues. One must understand that the sinking (Chen), choppy (Se), weak (Ruo), string-taut (Xian), and slow (Chi) pulses mentioned earlier are pathological pulses, not necessarily fatal pulses; they appear most frequently in Yang diseases. If the True Visceral Pulses appear, such as the Liver pulse being tense inside and out, the Heart pulse being firm and forceful, the Lung pulse being large and floating, the Kidney pulse feeling like bouncing stones, and the Spleen pulse being sharp like a bird's beak, showing signs of excess, how can these be called Yang pulses? If one mistakes the Stomach pulse for a slow pulse and the True Yin for a rapid pulse, would this not lead to error?
Yi Bu Commentary: On the first day of Cold Damage (Shang Han), the Taiyang Meridian is affected. If the pulse remains calm, the disease has not transmitted; if the patient desires to vomit or is restless/agitated, and the pulse is rapid and urgent, transmission has occurred.
Yi Bu Commentary: The Classics state that on the first day, Taiyang is affected; on the second day, Yangming is affected; on the third day, Shaoyang is affected; and on the fourth, fifth, and sixth days, the Three Yin meridians are affected. This corresponds in structure to the *Hong Fan* chapter: "First longevity, second wealth, third peace and health, fourth love of virtue, fifth dying a natural death." This actually highlights the evidence of the Six Meridians to serve as the basis for treatment. How could it possibly teach people to be bound by the number of days! Later scholars interpreted "day" as an abstract concept rather than a literal count, which is like groping in the dark; no one from ancient times spoke of this. Some say the character "day" need not be taken literally. But "day" is a concrete term; how can it be used as an abstract one?
Ke Yunbo's Commentary: The so-called "transmission" refers to the transmission mentioned in the *Neijing*: "When humans are injured by cold, it transmits into heat." This means the Qi of Taiyang generates heat and transmits to the exterior, which is what is meant by "those originating in Yang recover in seven days." It does not refer to the meridian-to-meridian transmission between Taiyang, Yangming, and Shaoyang.
Ke Yunbo's Commentary: Two or three days after Cold Damage, if symptoms of Yangming and Shaoyang do not appear, it indicates that transmission has not occurred.
Ke Yunbo's Commentary: Saying Taiyang is affected on day one, Yangming on day two, and Shaoyang on day three refers to the period when symptoms manifest, not the days of meridian transmission. Qibo said: "If evil strikes the face, it descends to Yangming; if it strikes the nape, it descends to Taiyang; if it strikes the cheek, it descends to Shaoyang; if it strikes the chest, back, or flanks, it also affects their respective meridians." Since the Taiyang Meridian is located highest, it manifests on the first day; Yangming is next, manifesting on the second day; Shaoyang is lower still, manifesting on the third day. This is because Qi has high and low positions, and diseases have distant and near origins; the manifestation depends on where the pathogen arrives. Each of the Three Yang meridians can independently contract cold pathogens; they do not necessarily start from Taiyang. The assertion by various schools that the Three Yang meridians must transmit from Taiyang fails to examine this principle.
Ke Yunbo's Commentary: After three days of Cold Damage, the pathogenic factors in the Three Yang meridians should be exhausted, and the Three Yin meridians should be affected. However, if the patient can eat and does not vomit, this indicates that the Three Yin meridians are not affected.
Ke Yunbo's Commentary: After contracting cold for three days, if there are no exterior symptoms of the Three Yang meridians, it is because the person's Yang Qi is harmonious and does not contend with the cold; thus, the pathogen cannot enter, and the Three Yang meridians remain unaffected. If Yin deficiency prevents support, then the Three Yin meridians will naturally accept the pathogenic factor. Qibo said: "Evil striking Yin meridians starts from the arms." Therefore, the Three Yin meridians accept pathogens independently, without needing transmission from Yang meridians. The statements that Taiyin manifests on day four, Shaoyin on day five, and Jueyin on day six also refer to the timing of symptom manifestation based on the anatomical position of the Yin meridians, not the days of sequential transmission through the Six Meridians.
Ke Yunbo's Commentary: Six or seven days into Cold Damage, if there is no significant fever but the patient is irritable/restless, this is because Yang pathogenic factors have entered and moved into Yin (interior).
Ke Yunbo's Commentary: Here, "Yin" refers to the interior, not specifically the Three Yin meridians. It may involve entering the root of Taiyang with heat binding in the Bladder, entering the root of Yangming with dryness in the Stomach, entering the root of Shaoyang with hardness and fullness under the ribs, entering Taiyin with sudden irritability and diarrhea, entering Shaoyin with dry mouth and tongue, or entering Jueyin with pain and heat in the heart. All these constitute "entering Yin."
Ke Yunbo's Commentary: In Taiyang disease, headache persists; if it resolves spontaneously after seven days or more, it is because the pathogen has completed its course within its own meridian. If it is about to enter the next stage ("re-entering the meridian"), needling the Foot-Yangming meridian can prevent transmission and lead to recovery.
Ke Yunbo's Commentary: Old theories claimed Cold Damage transmits one meridian per day, reaching Jueyin on day six, re-transmitting to Taiyang on day seven, and Yangming on day eight, calling this "re-entering the meridian." Since this theory spread, Zhang Zhongjing's medical teachings became inaccessible. Zhang Zhongjing never proposed daily meridian transmission, nor did he mention headaches persisting after transmission to the Three Yin. The presence of headache indicates the pathogen has not left Taiyang. The term "xing" (travel/complete) differs from "chuan" (transmit). "Its meridian" refers to the primary meridian, not another. "Those originating in Yang recover in seven days" means seven days is the period for the completion of the Taiyang meridian's cycle, not the timeline for Six Meridian transmission. Qibo stated: "On the seventh day, Taiyang disease declines, and headache lessens," providing clear evidence. Thus, it says "about to re-enter the meridian" rather than "transmitting to Foot-Yangming," meaning Taiyang has passed its course without resolving, and Yangming becomes involved as a concurrent disease. Needling the Yuan-Source point of Foot-Yangming intercepts the transmission route, preventing the pathogen from re-entering Yangming, thereby dispersing residual Taiyang pathogen; it does not mean merging into Yangming to avoid Shaoyang.
Shanglun Pian Commentary: After sweating, if water and medicine cannot be swallowed, it is considered adverse ("ni"); if sweating is induced again, it will certainly result in incessant vomiting and diarrhea.
Shanglun Pian Commentary: This clause has always been misunderstood by various schools, incorrectly linked to the Four Contraindications of Guizhi Tang, claiming that using Guizhi caused the adverse reaction, and using it again would worsen it, which is extremely crude. The term "adverse" here refers to Water Adversity (Shui Ni), not a dire/fatal condition. Moreover, the original text does not say "give Guizhi again," but "induce sweating again," indicating that since both water and medicine are rejected, middle-jiao fullness is extreme. Any exterior-releasing drug could cause incessant vomiting and diarrhea, not just Guizhi. Therefore, for Taiyang Water Adversity, Zhang Zhongjing uses no exterior-releasing drugs, only Wuling San to guide out water, followed by hot porridge to induce sweat, which aligns with this clause. If only Guizhi were prohibited, drugs like Ephedrae Herba (Mahuang), Puerariae Radix (Gegen), and Bupleuri Radix (Chaihu) would remain permissible, and their misuse leading to vomiting and diarrhea would go unnoticed as violations.
Yu Jiayan's Commentary: In Taiyang disease, after inducing sweating, if the disease does not resolve despite sweating, and the patient still has fever, palpitations in the epigastrium, dizziness, body tremors, and feels as though trembling and wanting to fall to the ground, Zhenwu Tang should be administered.
Yu Jiayan's Commentary: The phrase "trembling and wanting to fall to the ground" vividly describes the state of Yang exhaustion. Various schools failed to analyze this carefully, wrongly citing the commentary on the *Classic of Poetry* regarding "striking the chest" to explain it. Zhang Zhongjing discusses palpitations in the epigastrium desiring pressure, and crossing hands over the heart, which do not align with "striking the chest." How can one arbitrarily interpret it? "Pi" means to push away or avoid. Excessive sweating disperses Defensive Qi (Wei Qi); the patient seems to lack external protection, trembling and looking around helplessly, having nowhere to stay, wishing to avoid the ground and hide inward. In Yin patterns resembling Yang, patients wish to sit in wells to avoid heat and seek cold. In cases of Yang loss due to excessive sweating, patients wish to enter the earth to avoid emptiness and seek solidity. Observe infants who sweat excessively, becoming spiritually weak and timid, often burying their faces into their mother's embrace; is this not a verification of "trembling and wanting to fall to the ground"?
Yu Jiayan's Commentary: In Taiyang Wind Strike, if fire therapy is used to forcibly induce sweating, the wind pathogen combined with fire causes blood and Qi to overflow, losing their normal regulation. The interaction of two Yangs scorching the body leads to jaundice. Excess Yang leads to nasal bleeding; Yin deficiency leads to difficult urination. If both Yin and Yang are depleted, the body becomes dry and withered. There is only sweating on the head up to the neck, abdominal fullness and wheezing, dry mouth and sore throat, or constipation. Over time, delirium occurs; severely, there may be hiccups, restlessness of hands and feet, and picking at clothes or beds. If urination is free, the patient can be treated.
Yu Jiayan's Commentary: Note: This pattern involves Yang pathogen combining with fire, disturbing the Yin aspect and depleting Yin, which is vastly different from Yang exhaustion. Observing phrases like "excess Yang desires nasal bleeding" and "body dry and withered," it is clearly caused by failure to sweat properly. Failure to sweat means Yang enters internally; why would it escape externally? Commentators stuck on the phrase "both Yin and Yang are depleted" argue that free urination indicates Yin is not severely deficient, so Yang can be restored, interpreting "can be treated" as restoring Yang. This greatly misses the Classic's intent. One should urgently drive out the Yang pathogen to preserve a thread of Yin Qi; fearing this might fail, how can one restore Yang to further劫 (rob) Yin? Head sweating is due to Yang pathogen obstructing upward, unable to descend to Yin, hence no sweat below the neck. If nasal bleeding occurs, the pathogen resolves through bleeding, and there would be no head sweat; if sweating occurs, the pathogen resolves through sweat, and there would be no bleeding. The later clause on deep-seated fire pathogen causing bloody stool states that those with dry bodies and no sweat will definitely have bloody stool. If there is sweat, there will be no bloody stool. Reading ancient texts requires grasping the meaning; how can there be sweating accompanied by nasal or rectal bleeding? And how can widespread absence of sweat with only head sweat indicate Yang exhaustion?
Yu Jiayan's Commentary: In Taiyang disease, if purgation is mistakenly used, and the pulse is hurried (Cu) without forming Chest Binding (Jie Xiong), this indicates the disease is about to resolve. If the pulse is floating, Chest Binding will definitely form; if tight, throat pain will occur; if wiry, bilateral hypochondriac stiffness will occur; if fine and rapid, headache will persist; if deep and tight, desire to vomit will occur; if deep and slippery, heat-coupled diarrhea will occur; if floating and slippery, bloody stool will occur.
Yu Jiayan's Commentary: A hurried pulse indicates excess Yang pathogen ascending; if it does not bind in the chest, the Yang pathogen has not sunk and can emerge vigorously from the exterior, hence indicating resolution. "Floating pulse leads to Chest Binding" elaborates on the hurried pulse: if the pulse is hurried and floating, pathogenic factors fill the Yang position, leading to Chest Binding. The character "floating" applies to the following four clauses: floating and hurried leads to Chest Binding; floating and tight leads to throat pain; floating and wiry leads to hypochondriac stiffness; floating and fine-rapid leads to persistent headache. These are all pulses of the primary Taiyang disease, so the pathology remains in the Taiyang domain. If the pulse is deep and tight, the Yang pathogen has entered the Yin aspect but is not yet deep, still attempting to rush upward causing vomiting. The absence of Chest Binding or throat pain is evident. Because the *Treatise* omitted one "hurried" and three "floating" characters, later readers were confused, claiming tightness belongs to the Lower Jiao and Shaoyin, which is highly misleading. The subsequent sentence explicitly states "deep and tight leads to vomiting," confirming the previous "tight" referred to "floating and tight." Deep and tight signifies Yang pathogen entering Yin and rushing upward to cause vomiting; how could floating and tight throat pain be Shaoyin cold pathogen rushing upward? These are clearly Taiyang errors after purgation; why insert Shaoyin to confuse later generations? As for the slippery pulse, situated between floating and deep, it follows similar logic: deep and slippery means Yang pathogen enters Yin causing diarrhea; floating and slippery means Yang pathogen is in the Ying level, disturbing blood, causing bloody stool. The pulses in Taiyang errors primarily relate to Yang and Exterior; even with deep/tight or deep/slippery variations, they cannot be named as Interior Yin. Zhang Zhongjing's precise differentiation should not be mixed with redundant complexities.
Zhou Yuzai's Commentary: Disease originating in Yang, if mistakenly purged, heat enters and forms Chest Binding; disease originating in Yin, if mistakenly purged, forms Epigastric Fullness/Stagnation (Pi). The reason Chest Binding forms is that purgation was done too early.
Zhou Yuzai's Commentary: The origin of Yang and Yin has been unknown for two millennia. If, as the original note suggests, "no heat and aversion to cold" defines Yin, then it is Cold Injury; purging would lead to immediate death. If *Shanglun* defines "cold injuring Ying and Blood" as Yin, then in Zhang Zhongjing's Pi and Binding chapters, Wind Strike and Cold Injury are interchanged without distinction. The truth is, "originating in Yin" refers to a Yin pattern, but the pathogen comes from Yang meridians, not direct invasion of Yin meridians. Pathogens entering via Yang meridians are originally Heat patterns; upon entering Yin meridians, internal heat deepens. This omission of "heat enters" creates a millennium-long mystery. Heat patterns transmitting from Yin to Fu organs allow for purgation; if purged while in the Meridians, it is still erroneous, similar to Three Yang in the Meridians. Thus, Yang pathogen binding in Yang positions binds in the Chest; Yin pathogen binding in Yin positions binds in the Epigastrium or sides. Mistaken purgation of Yin meridians causes more than just Pi; because the binding is only in Yin positions, unlike the vigorous Yang pathogen binding in Yang positions.
Ke Yunbo's Commentary: Yang refers to the exterior, i.e., the形体 (physical body). Yin refers to the interior, i.e., the Chest and Epigastrium.
Ke Yunbo's Commentary: This refers to the exterior of the human body as Yang and interior as Yin, not to Yin meridians or Yin patterns. "Originating in Yin/Yang" both refer to fever; Chest Binding and Pi are both Heat patterns. Pi is described without "heat entering" because the heat originates internally. Mistaken purgation prevents heat dispersion, leading to Pi and hardness; one cannot interpret "originating in Yin" as "no heat." If Pi were non-heat, Xiexin Tang would not contain Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Rhei Radix et Rhizoma (Dahuang). Cases like Zhizi Chihui Tang's mental agitation, Genti Powder's warm desire to vomit in the heart, epigastric fullness with irritability, and Huanglian Tang's heat in the chest are all diseases originating in Yin.
Wei Litong's Commentary: After Cold Damage sweating, or if resolved by vomiting/purgation, if there is epigastric hardness/stagnation and unrelenting belching, Xuanshi Daizheshi Tang should be administered.
Wei Litong's Commentary: Later scholars misunderstand this, claiming belching is due to latent fluid retention reversing upward, a view promoted by formula commentaries and echoed by others without basis. Latent fluid retention causing vomiting involves有形 (substantial) pathogen; current belching without vomiting involves无形 (insubstantial) deficient Qi rushing upward. How can they be conflated?
Yu Jiayan's Commentary: Six or seven days into Cold Damage, with fever, slight aversion to cold, limb joint discomfort, slight vomiting, subcostal stagnation (Zhi Jie), and unresolved exterior symptoms, Chaihu Guizhi Tang should be administered.
Yu Jiayan's Commentary: "Subcostal stagnation" means pathogen binds at the side of the epigastrium, not centrally. It is milder than the central binding of Xiaojie Xiong Tang. By day six or seven, transmission should be complete. However, fever, slight aversion to cold, limb pain, slight vomiting indicate the pathogen remains at the boundary of the Three Yang, not yet in the interior. Despite subcostal stagnation, since exterior symptoms persist, Daxie Xiong Tang cannot be used, as it treats Interior, not Exterior; nor can Xiaojie Xiong Tang be used, as it treats Fluid Retention, not Exterior. The subcostal pathogen is predominantly exterior with minimal interior penetration; thus, combining Chaihu and Guizhi to harmonize both methods treats the exterior. Once exterior pathogen is removed, subcostal stagnation resolves. Later scholars claim "Zhi Jie" is Zhi Yin (branch fluid) binding in the epigastrium with muttering dreamspeak; I do not know what "Zhi Yin" is!
Fang Zhongxing's Commentary: Taiyang disease, stiff and rigid neck and back (Jing Jing).
Fang Zhongxing's Commentary: "Jing Jing" refers to birds with short wings, stretching their necks when moving. "Jing Jing ran" describes the patient's neck and back illness, unable to bend or extend freely.
Zhengzhi Zhunsheng Commentary: The *Classic of Poetry* says: "Red shoes, jing jing." Commentary: "Jing jing" means steady and heavy posture, implying self-restraint, keeping eyes down and avoiding wandering glances. Note: This helps visualize neck/back stiffness. If interpreted as bird feathers, "Jing" should sound different, and the meaning of stiffness would be less accurate.
Yu Jiayan's Commentary: Taiyang disease, after three days, if sweating, vomiting, purgation, or warm needle therapy fails to resolve it, this is called a "Ruined Disease" (Huai Bing); Guizhi Tang is no longer applicable. Observe the pulse and symptoms, determine what error was made, and treat according to the pattern.
Yu Jiayan's Commentary: It is traditionally said that Cold Damage lingering past its course for 20-30 days is a "Ruined Disease," confusing it with unresolved post-course disease, a major ancient and modern error. Zhang Zhongjing only mentions three days, even five or six are not specified; and this clause only mentions Taiyang, excluding Shaoyang. Thus, Guizhi's exterior-focused method is inapplicable. Looking at Ruined Diseases transitioning from Taiyang to Shaoyang, the phrase "Chaihu syndrome has ceased" implies "Guizhi syndrome has ceased," hence it cannot be reused. If Guizhi syndrome persists, it cannot be called a Ruined Disease, echoing the Shaoyang chapter: "If Chaihu syndrome persists, although purged, it is not adverse; giving Chaihu Tang again will cause shivering, then fever and sweating for resolution." How can Guizhi or Chaihu syndromes persist yet be labeled Ruined? One must carefully inspect the pulse and symptoms, identify prior errors and current reversals, then treat accordingly.
Yu Jiayan's Commentary: Primary Taiyang disease unresolved, transferring to Shaoyang: hardness/fullness under ribs, dry retching, inability to eat, alternating chills and fever. If not yet vomited/purged/sweated/warm-needled, and pulse is deep and tight, give Xiaochaihu Tang. If already vomited, purged, sweated, or warm-needled, resulting in delirium and cessation of Chaihu syndrome, this is a Ruined Disease. Determine the reversal and treat accordingly.
Yu Jiayan's Commentary: Note: The previous clause is a Ruined Disease of the Taiyang Meridian; this clause is a Ruined Disease of the Shaoyang Meridian. Their meanings complement each other clearly. Wang Shuhe's compilation caused confusion. Viewing them together, the first clause states Guizhi Tang is inapplicable, implying errors limited to Taiyang (mistaken vomiting, purgation, sweating, burning needle). This clause states Chaihu Tang is inapplicable, implying errors limited to Shaoyang (same mistaken treatments). Later scholars praising the "determine reversal, treat accordingly" approach miss the obvious point; it is merely babbling!
Yu Jiayan's Commentary: If the Yang pulse is faint and sweating is scant, it is self-harmonizing; excessive sweating is excessive. If the Yang pulse is solid, and sweating is induced excessively, this is also excessive; excess leads to Yang extinction in the interior, loss of Body Fluids (Jin Ye), and hard stool.
Yu Jiayan's Commentary: "Yang extinction" is synonymous with "loss of Body Fluids." Zhang Zhongjing often names loss of fluids as "No Yang." The text "Yang extinction in the interior, loss of fluids, hard stool" is clear. Commentators mistake this for Yang escaping externally due to sweating, which is a major error!
Cheng Fusheng's Commentary: "No Yang" differs from "Yang Loss." Yang Loss results from excessive dispersion, where Yang Qi escapes with sweat. No Yang refers to deficiency of True Yang, lacking sufficient fluids to disperse.
Yu Jiayan's Commentary: In Yangming disease, if the pulse is floating and tight, tidal fever occurring at specific times is expected; if only floating, night sweats are expected.
Yu Jiayan's Commentary: The floating and tight pulse in Yangming is the same as the pulse for Cold injuring Ying in Taiyang; floating alone is the pulse for Wind injuring Wei in Taiyang. Upon transmission to Yangming, Zhang Zhongjing avoids using Ying/Wei differentiation, altering the terminology instead. Regarding unresolved Taiyang symptoms, despite detailed clauses, clarity is sought by highlighting tidal fever and night sweats as inevitable in Yangming, leaving no doubt. Previous annotations took fragments out of context, missing the main idea. They failed to realize that tight pulse/tidal fever and floating pulse/night sweats are not direct correspondences but references to distinguish Yangming (days 8-9) from Taiyang (days 1-2). Claiming floating indicates Yang excess, leading to Yin deficiency and night sweats, is superfluous and dream-like!
Yu Jiayan's Commentary: In Yangming disease, if mid-Cold (Zhong Han) occurs, inability to eat, difficult urination, and continuous sweating on hands and feet suggest impending Gu Jia (Solid Mass),必然 (inevitably) presenting with hard stool initially followed by loose stool. This is because the Stomach is cold, failing to separate Water and Grain.
Yu Jiayan's Commentary: Annotations defining "Gu" as solid and "Jia" as accumulation are grossly wrong. Hard stool initially followed by loose stool forms "Jia Diarrhea"; Jia Diarrhea is loose diarrhea. If prolonged and unceasing, it is called Gu Jia.
Ke Yunbo's Commentary: Gu Jia refers to hard stool initially followed by loose stool. Although the anus may feel constricted, the intestines are not completely dry. Loose stool represents the separation of Water and Grain; interpreting it as Symptom-Mass (Zheng Jia) is erroneous.
The patient has neither exterior nor interior symptoms, with fever for seven or eight days. Even if the pulse is floating and rapid, purgation may be indicated. Suppose purgation has been performed, but the rapid pulse persists. Combined heat causes efficient digestion and frequent hunger. By the sixth or seventh day, there is no bowel movement...