（《素问·热论篇》 附∶传经说及伤寒治法）
黄帝问曰∶今夫热病者，皆伤寒之类也，或愈或死，其死皆以六七日之间，其愈皆以十日以上者何也？不知其解，
愿闻其故。（伤寒者，中阴寒杀厉之气也。寒盛于冬，中而即病者，是为伤寒。其不即病者，至春则名为温病，至夏则名
为暑病。然有四时不正之气，随感随发者，亦曰伤寒。寒邪束于肌表，则玄府闭，阳气不得散越，乃郁而为热，故凡系
外感发热者，皆伤寒之类。）岐伯对曰∶巨阳者，诸阳之属也。（巨，大也。太阳为六经之长，统摄阳分，故诸阳皆其所
属。）其脉连于风府，故为诸阳主气也。（风府，督脉穴。太阳经脉，复于巅背之表，故主诸阳之气分。）人之伤于寒也，
则为病热，热虽甚不死；（人伤于寒而传为热者，寒盛则生热也。寒散则热退，故虽甚不致死。）其两感于寒而病者，必
不免于死。（表里俱受，是谓两感，义详后章。）帝曰∶愿闻其状。岐伯曰∶伤寒一日，巨阳受之，故头项痛，腰脊强。（巨
阳，足太阳也，为三阳之表，而脉连风府，故凡病伤寒者多从太阳始。太阳之经从头项下肩 ，挟脊抵腰中，故其为病
如此。仲景曰∶太阳之为病，脉浮，头项强痛而恶寒。按∶人身经络，三阳为表，三阴为里。三阳之序，则太阳为三阳，
阳中之阳也；阳明为二阳，居太阳之次；少阳为一阳，居阳明之次，此三阳为表也。三阴之序，则太阴为三阴，居少阳
之次，少阴为二阴，居太阴之次；厥阴为一阴，居少阴之次，此三阴为里也。其次序之数，则自内而外，故各有一二三
之先后者如此。又如邪之中人，必自外而内，如《皮部论》等篇曰∶邪客于皮则腠理开，开则邪入客于络脉，络脉满则
注于经脉，经脉满则入舍于腑脏。此所以邪必先于皮毛，经必始于太阳，而后三阴三阳五脏六腑皆受病，如下文之谓也。）
二日阳明受之，阳明主肉，其脉挟鼻络于目，故身热目疼而鼻干，不得卧也。（伤寒多发热，而独此云身热者，盖阳明主
肌肉，身热尤甚也。邪热在胃则烦，故不得卧。余证皆本经之所及。仲景曰∶阳明之为病，胃家实也。）三日少阳受之，
少阳主胆，其脉循胁络于耳，故胸胁痛而耳聋。（邪在少阳者，三阳已尽，将入太阴，故为半表半里之经。其经脉出耳前
后，下循胸胁，故为胁痛耳聋等证。仲景曰∶伤寒脉弦细，头痛发热者，属少阳。少阳之为病，口苦咽干目眩也。又曰∶
太阳病不解，转入少阳者，胁下硬满，干呕不能食，往来寒热。盖邪在阴则寒，邪在阳则热，邪在表则无呕满等证，邪
在里则胸满干呕不能食。故成无己曰∶少阳之邪，在半表半里之间。）三阳经络皆受其病，而未入于脏者，故可汗而已。
（三阳为表属腑，邪在表而未入于三阴之脏者，皆可汗而散也。）四日太阴受之，太阴脉布胃中，络于嗌，故腹满而嗌干。
（邪在三阳，失于汗解，则入三阴，自太阴始也。仲景曰∶伤寒脉浮而缓，手足自温者，系在太阴。太阴之为病，腹满
而吐，食不下、自利益甚，时腹自痛也。）五日少阴受之，少阴脉贯肾络于肺，系舌本，故口燥舌干而渴。（肾经属水而
邪热涸之，故口舌为之干渴。仲景曰∶少阴之为病，脉微细，但欲寐也。）六日厥阴受之，厥阴脉循阴器而络于肝，故烦
满而囊缩。（六经传遍，乃至厥阴，邪热甚于阴分，故为烦满。仲景曰∶厥阴之为病，气上撞心，心中疼热，饥而不欲食，
食则吐蛔，下之利不止。按∶伤寒传变，先自三阳之表，后入三阴之里，此阴阳先后之序也。然观东垣曰∶太阳者，巨
阳也。膀胱经病，若渴者，自入于本也，名曰传本。太阳传阳明胃土者，名曰巡经传。太阳传少阳胆木者，名曰越经传。
太阳传少阴肾水者，名曰表里传。太阳传太阴脾土者，名曰误下传。太阳传厥阴肝木者，名曰巡经得度传。又陶节庵曰∶
风寒之国中人也无常，或入于阴，或入于阳，皆无定体，非但始太阳，终厥阴也。或自太阳始，日传一经，六日至厥阴，
邪气衰，不传而愈者；亦有不罢再传者；或有间经而传者；或有传至二三经而止者；或有终始只在一经者；或有越经而
传者；或有初入太阳，不作郁热，便入少阴而成真阴证者；或有直中阴经而成寒证者。缘《经》无明文，后人有妄治之
失。若夫自三阳传次三阴之阴证，外虽有厥逆，内则热邪耳。若不发热，四肢便厥冷而恶寒者，此则直中阴经之寒证也。
自叔和立说之混，使后人蒙害者多矣。又有合病并病之症∶曰合病者，两经或三经齐病不传者为合病；并病者，一经先
病未尽，又过一经之传者为并病。所以有太阳阳明合病，有太阳少阳合病，有少阳阳明合病，有三阳合病。三阳若与三
阴合病，即是两感，所以三阴无合并例也。此皆经文所未及，而二子言之，其义多出于仲景，皆理所必然者也。然经所
言者，言传经之常；二子所言者，言传经之变。学人俱当详察，不可执一，庶乎随机应变，不致有胶柱之误矣。）三阴三
阳、五脏六腑皆受病，荣卫不行，五脏不通，则死矣。（伤寒邪在经络，本为表证，经尽气复，自当渐解；若六经传遍而
邪不退，则深入于腑，腑不退则深至于脏，故五脏六腑皆受病矣。邪盛于外则营卫不行，气竭于内则五脏不通，故六七
日间致死也。善治此者，必不使其邪入内，亦必不使其脏气竭，知斯二者，近于神矣。愚按∶伤寒传变，止言足经，不
言手经，其义本出此篇，如上文六节是也。奈何草窗刘氏不明其理，遂谬创伤寒传足不传手之说，谓足经所属皆水木土，
水寒则冰，木寒则雕，土寒则坼，是皆不胜其寒也。手经所属，皆金与火，金得寒则愈坚，火体极热而寒不能袭。所以
伤寒只传足经，不传手经，巧言要誉，昧者称奇，妄诞欺人，莫此为甚。夫人之金火两脏，不过以五行之气各有所属耳，
岂即真金真火，不能毁伤者耶？斯言一出，遂起人疑，致有谓足经在下，手经在上，寒本阴邪，故传足也。有谓足之六
经皆东北方及四隅之气，手之六经皆西南方之气，寒气中人，必在冬春，同气相求，故先自水经以及木土，而金火则无
犯也。有谓无奇经则无伤寒，奇经惟附于足也。纷纷议论，争辨不明，其说皆谬。夫人之血气营运周身，流注不息，岂
传遇手经而邪有不入者哉？且寒之中人，必先皮毛，皮毛者肺之合，故在外则有寒栗鼻塞等证，在内则有咳喘短气等证，
谓不传于肺乎？其入手少阴、厥阴也，则有舌苔怫郁，神昏错乱等证，谓不传于心主包络乎？其入手阳明也，则有泄泻
秘结等证，谓不传于大肠乎？其入手太阳也，则有癃闭不化等证，谓不传于小肠乎？其入手少阳也，则有上下不通，五
官失职，痞满燥实俱全等证，谓不传于三焦乎？再观本节云三阴三阳、五脏六腑皆受病，岂手经不在内乎？所以仲景有
肺心肝脾肾五脏绝症，义又可知。然本经之不言手者何也？盖伤寒者表邪也，欲求外证，但当察于周身，而周身上下脉
络，惟足六经则尽之矣，手经无能遍也。且手经所至，足经无不至者，故但言足经，则其左右前后阴阳诸证，无不可按
而得，而手经亦在其中，不必言矣。此本经所以止言足者，为察周身之表证也。义本易见，而疑辩至今，皆惑于刘氏之
妄言耳。井蛙蠹道之评，孰为评之过也。）其不两感于寒者，七日巨阳病衰，头痛少愈；（邪气渐退，则正气渐复，如下
文也。）八日阳明病衰，身热少愈；九日少阳病衰，耳聋微闻；十日太阴病衰，腹减如故，则思饮食；十一日少阴病衰，
渴止不满，舌干已而嚏；十二日厥阴病衰，囊纵少腹微下，大气皆去，病日已矣。（所谓其愈皆十日以上者如此。嚏音帝。）
帝曰∶治之奈何？岐伯曰∶治之各通其脏脉，病日衰已矣。其未满三日者，可汗而已；其满三日者，可泄而已。（各通其
脏脉，谓当随经分治也。凡传经之邪，未满三日者，其邪在表，故可以汗已。满三日者，其邪传里，故可以下。然此言
表里之大体耳。按《正理伤寒论》曰∶脉大浮数，病为在表，可发其汗；脉实沉数，病为在里，可下之。故日数虽多，
但有表证而脉浮大者，犹宜发汗；日数虽少，但有里证而脉沉实者，即当下之。此汗下之法，但当以表里为据，有不可
以执一也。愚按∶伤寒一证，感天地阴厉之气，变态不测，最为凶候，治一有差，死生反掌。在古人垂训之多，何止百
家千卷，其中立法之善，无出仲景，用药之善，须逊节庵，凡于曲折精微，靡不详尽，余复何言；然尤有不能已者，在
苦于条目之浩繁，而后学求之不易也。观陶氏家秘的本曰∶伤寒治法，得其纲领如拾芥，若求之多岐，则支离破碎，如
涉海问津矣，盖脉证与理而已。斯言也，予殊佩之。然求其所谓纲领者，谓操其枢要，切于时用者是也。所谓多岐者，
谓检遍方书，无方可用者是也。所谓脉证者，谓表里阴阳寒热虚实之辨也。所谓理者，谓见之真、法之要也，得其理则
治无一失矣。是以法必贵详，用当知约，详而不约，徒详何益？诚若望洋，无所用之地矣。予请约之曰∶凡治伤寒，其
法有六，曰吐汗下温清补也。盖吐中有发散之意，可去胸中之实，可举陷下之气，若无实邪在上，不可用之，所用既少，
法亦无多，故舍吐之外而切于用者，惟汗下温清补五法而已。所谓汗者，治表证也，寒邪在表，不汗何从而解？然汗法
有三∶曰温散，曰凉解，曰平解。温散者，如以寒胜之时，阴胜之脏，阳气不充，则表不易解。虽身有大热，亦必用辛
温，勿以寒凉为佐，此即寒无犯寒之谓也。凉解者，如炎热炽盛，表里枯涸，则阴气不营，亦不能汗，宜用辛凉，勿以
温热为佐，此即热无犯热之谓也。若病在阴阳之间，既不可温，又不可凉，则但宜平用，求其解表而已也。然无表证者
不可汗，似表非表者不可汗，咽中闭塞者不可汗，诸动气者不可汗，淋家不可汗，诸亡血者不可汗，脉微弱者无阳也不
可汗，脉微恶寒者阴阳俱虚不可汗吐下。其可汗者，如仲景曰∶凡发汗温服汤药，其方虽言日三服，若病剧不解，当促
之于半日中尽三服。又曰∶凡作汤药，不可避晨夜，觉病须臾，即宜便治，不等早晚，则易愈矣。此所以汗不嫌早也。
所谓下者，攻其内也，实邪内结，不下何从而去？然表邪未解者不可下，诸虚者不可下，阳微者不可下，诸外实者不可
下，咽中闭塞者不可下，诸动气者不可下，脉弱者不可下，脉浮而大者不可下，病呕吐者不可下，大便先硬后溏者不可
下，非有大满燥实坚者不可下，此所以下不嫌迟也。所谓温者，温其中也，脏有寒气，不温之何自而除？有客寒者，寒
自外入者也。有主寒者，气虚者也。盖气为阳，气不足则寒生于中，寒即阴证之属，温即兼乎补也。所谓清者，清其热
也，有热无结，本非大实，不清之何由而散？表热者宜于清解，里热者宜于清降，热即阳证之属，清即类乎泻也。若此
四者，古人发明已尽，余不过述其要耳，学人仍当由博而约，勿谓止于是也。惟补之一字，则所系尤切，而人多不知之。
夫用补之法，岂止因于中气，盖实兼乎表里。如表邪不解，屡散之而汗不出者，中虚无力，阴气不能达也。盖汗即水也，
水既不足，汗自何来？人知汗属阳分，升阳可以解表，而不知汗生于阴，补阴最能发汗，今有饮水而汗出者，即其义也。
又如内热不解，屡清之而火不退者，阴不足也。人知惟寒可以去热，而不知壮水方能息火也。又如正气不足，邪气有余，
正不胜邪，病必留连不解。有如是者，不可攻邪，但当实其中气，使正气内强，则根本无害，逼邪外出，则营卫渐平，
所谓温中自有散寒之意，此不散表而表自解，不攻邪而邪自退，不治之治，尤非人之所知也。惟是用补之法，则脏有阴
阳，药有宜否，宜阳者必先于气，宜阴者必先乎精。阳以人参为主，而 术升柴之类可佐之；阴以熟地为主，而茱萸山
药归杞之类可佐之。然人参随熟地，则直入三阴；熟地随 术，亦上归阳分。但用药当如盘珠，勿若刻舟求剑。且人伤
于寒而传为热，则阳胜伤阴者多，故利于补阴者十之七八，利于补阳者十之二三。然阴中非无阳气，佐以桂附，则真阳
复于命门；佐以姜草，则元气达于脾胃。药不及病，与不药同。故当随病重轻以为增减，此余之百战百胜者，所活已多，
非谬说也。或曰∶古人之治伤寒，皆重在汗吐下三法而后于补，今子所言，则似谆谆在补而后于攻者何也？曰∶三法已
悉，无待再言，独于用补，殊未尽善，故不得不详明其义，以补古人之未备。试以《伤寒论》观之，曰∶阴证得阳脉者
生，阳证得阴脉者死。迄今说者，无不为然。愚谓阳证阳脉、阴证阳脉者，本为顺证，可以无虑；惟阳证阴脉，则逆候
也，为伤寒之最难，故古人直谓之死，则其无及于此也可知矣，余所谓切于补者，正在此也。今以余所经验，凡正气虚
（《素问·热论篇》 附：传经说及伤寒治法）
黄帝问道：现在的热病，都属于伤寒这一类。有的痊愈，有的死亡，死亡的往往在六七天之间，痊愈的都在十日以上，这是为什么呢？我不明白其中的道理，希望听听原因。（所谓伤寒，是指感受阴寒杀厉之气。寒气盛于冬季，感受后随即发病的，称为伤寒。如果不随即发病，到了春天就称为温病，到了夏天就称为暑病。然而也有四时不正之气，随感随发的，也叫做伤寒。寒邪束缚肌表，导致玄府闭塞，阳气不能发散，于是郁结而化热，所以凡是外感发热者，都属于伤寒一类。）
岐伯回答说：巨阳（即太阳经），是诸阳经所属的主管经脉。（巨，就是大的意思。太阳经为六经之长，统摄阳分，所以诸阳经都是它所主管的。）它的脉气连于风府穴，所以它是诸阳经主气的经脉。（风府是督脉的穴位。太阳经脉，又上行至头顶背部体表，所以主管诸阳经的气分。）人受到寒邪侵袭，就会发生热病，热势虽然严重也不会致死；（人受寒邪而转化为热证的，是因为寒盛则生热。寒邪散去则热退，所以即使热势严重也不致死。）如果是两感于寒而发病的，就一定难免于死亡。（表里两经同时受邪，称为两感，含义详见后文。）
黄帝说：希望听听它的症状表现。岐伯说：伤寒第一天，太阳经受邪，所以出现头项疼痛，腰脊僵硬。（巨阳，指足太阳膀胱经，是三阳经的表层，且脉气连于风府，所以凡患伤寒的人多从太阳经开始。太阳经脉从头项下行至肩部，夹脊柱抵腰部，所以患病会出现上述症状。张仲景说：太阳病的特征是脉浮，头项强痛且恶寒。按：人身经络，三阳经属表，三阴经属里。三阳经的次序，太阳为三阳，是阳中之阳；阳明为二阳，居太阳之后；少阳为一阳，居阳明之后，这三阳经属于表。三阴经的次序，太阴为三阴，居少阳之后；少阴为二阴，居太阴之后；厥阴为一阴，居少阴之后，这三阴经属于里。其次序的数字，是从内向外排列的，所以各有第一、第二、第三的先后顺序如此。又如邪气侵犯人体，必定由外向内，如《皮部论》等篇所说：邪气客于皮肤则腠理开泄，开泄则邪气进入络脉，络脉满溢则注入经脉，经脉满溢则进入脏腑。这就是为什么邪气必先侵犯皮毛，经脉病变必始于太阳，然后三阴三阳五脏六腑才会都受病，如下文所述。）
第二天阳明经受邪，阳明经主管肌肉，其脉气夹鼻络于目，所以出现身体发热、眼睛疼痛、鼻子干燥，无法安卧。（伤寒多发热，唯独这里说身热，是因为阳明经主管肌肉，身上的热势尤其严重。邪热在胃则烦躁，所以无法安卧。其余症状都是本经所影响的。张仲景说：阳明病的特征是胃家实。）
第三天少阳经受邪，少阳经主管胆，其脉气循行胁肋络于耳，所以出现胸胁疼痛和耳聋。（邪气在少阳，三阳经的病已尽，将要传入太阴，所以少阳是经处于半表半里的位置。其经脉出于耳前后，向下循行胸胁，所以出现胁痛、耳聋等症状。张仲景说：伤寒脉弦细，头痛发热的，属于少阳。少阳病的特征是口苦、咽干、目眩。又说：太阳病不解，转入少阳的，胁下硬满，干呕不能食，往来寒热。邪气在阴分则寒，在阳分则热，在表则无呕吐胀满等症状，在里则有胸满、干呕、不能食。所以成无己说：少阳的邪气，在半表半里之间。）
三阳经的经络都受了病，但邪气未传入脏的，所以可以通过发汗的方法治愈。（三阳经属表属腑，邪气在表而未传入三阴之脏的，都可以用发汗的方法解散。）
第四天太阴经受邪，太阴经脉气布散于胃中，络于咽喉，所以出现腹部胀满和咽喉干燥。（邪气在三阳经，如果失于发汗解表，就会传入三阴经，从太阴经开始。张仲景说：伤寒脉浮而缓，手足自温的，病系在太阴。太阴病的特征是腹满而吐，饮食不下，自利日益加重，时常腹痛。）
第五天少阴经受邪，少阴经脉气贯穿肾脏络于肺，联系舌根，所以出现口燥、舌干而渴。（肾经属水，被邪热耗伤，所以口舌为之干渴。张仲景说：少阴病的特征是脉微细，只想睡觉。）
第六天厥阴经受邪，厥阴经脉气循行阴器络于肝，所以出现烦闷和阴囊收缩。（六经传遍，到了厥阴，邪热在阴分很盛，所以出现烦闷。张仲景说：厥阴病的特征是气上撞心，心中疼热，饥饿但不想吃东西，吃了会吐蛔虫，如果用下法会导致腹泻不止。按：伤寒传变，先自三阳之表，后入三阴之里，这是阴阳先后次序。然而看李东垣说：太阳，就是巨阳。膀胱经生病，如果有口渴症状，是自入于本经，名叫传本。太阳传阳明胃土，名叫巡经传。太阳传少阳胆木，名叫越经传。太阳传少阴肾水，名叫表里传。太阳传太阴脾土，名叫误下传。太阳传厥阴肝木，名叫巡经得度传。还有陶节庵说：风寒等人侵没有固定规律，或入于阴，或入于阳，都没有定体，不是一定始于太阳终于厥阴。有的自太阳始，日传一经，六天到厥阴，邪气衰，不传而愈；也有不罢再传的；有隔经而传的；有传到二三经而止的；有始终只在一经的；有越经而传的；有初入太阳，不作郁热，便入少阴而成真阴证的；有直中阴经而成寒证的。因为《内经》没有明文规定，后人就有妄治的错误。至于自三阳传次三阴的阴证，外虽有四肢厥冷，内则是热邪。如果不发热，四肢就厥冷且恶寒的，这才是直中阴经的寒证。自从王叔和立说混乱，使后人蒙受危害很多。又有合病并病的症状：所谓合病，是两经或三经同时发病不传变的叫合病；并病，是一经先病未尽，又过一经传变的叫并病。所以有太阳阳明合病，有太阳少阳合病，有少阳阳明合病，有三阳合病。三阳若与三阴合病，就是两感，所以三阴没有合并的例子。这些经文都没提到，而是这两位先生说的，他们的义理多出于张仲景，都是理所当然的。然而经文说的是传经的常法；两位先生说的是传经的变法。学医的人都应当详细考察，不可固执一端，这样才能随机应变，不至于有胶柱鼓瑟的错误。）
三阴三阳、五脏六腑都受了病，营卫运行停止，五脏气机不通，就会死亡。（伤寒邪气在经络，本来是表证，经络之气恢复，自然应当逐渐缓解；如果六经传遍而邪气不退，就会深入于腑，腑病不退则深至于脏，所以五脏六腑都受病了。邪气盛于外则营卫不行，气竭于内则五脏不通，所以在六七日间致死。善于治疗此病的人，一定不让邪气入内，也一定不让脏气衰竭，懂得这两点，就近乎神明了。我按：伤寒传变，只说足经，不说手经，这个义理本出自本篇，如上文六节就是。奈何草窗刘氏不明白这个道理，于是谬创伤寒传足不传手的说法，认为足经所属都是水木土，水冷则冰，木寒则凋零，土寒则裂开，这些都是不胜受寒。手经所属，都是金与火，金得寒则更坚固，火体极热而寒不能侵袭。所以伤寒只传足经，不传手经，巧言取誉，愚昧的人称奇，荒诞欺人，没有比这更严重的了。人的金火两脏，不过是五行之气各有所属罢了，难道就是真金真火，不能被毁伤吗？这话一出，就引起人们疑惑，导致有人说足经在下，手经在上，寒本是阴邪，所以传足。有人说足的六经都是东北方及四隅之气，手的六经都是西南方之气，寒气中人，必在冬春，同气相求，所以先从水经以及木土，而金火则不犯。有人说无奇经则无伤寒，奇经惟附于足。纷纷议论，争辩不明，这些说法都是错误的。人的血气营运周身，流注不息，难道传遇手经邪气就不入吗？况且寒邪中人，必先侵犯皮毛，皮毛是肺的合应部位，所以在外则有寒栗鼻塞等症状，在内则有咳喘短气等症状，能说是不传肺吗？其入手少阴、厥阴，则有舌苔怫郁、神昏错乱等症状，能说是不传心主包络吗？其入手阳明，则有泄泻秘结等症状，能说是不传大肠吗？其入手太阳，则有癃闭不化等症状，能说是不传小肠吗？其入手少阳，则有上下不通、五官失职、痞满燥实俱全等症状，能说是不传三焦吗？再看本节说三阴三阳、五脏六腑皆受病，难道手经不在其中吗？所以张仲景有肺心肝脾肾五脏绝症的说法，义理也就可知了。然而本经为什么不提手经呢？大概伤寒是表邪，想要寻求外证，只当观察周身，而周身上下脉络，只有足六经能涵盖全部，手经不能遍及。而且手经所到的地方，足经没有不到的，所以只说足经，那么左右前后阴阳各种症状，没有不可以按图索骥得到的，手经也在其中，不必说了。这就是本经之所以只说足经的原因，是为了观察周身的表证。义理本来容易看见，而疑惑辩论至今，都是被刘氏的妄言所迷惑。井底之蛙蠹书之虫的评价，是谁评判错了呢？）
那些不是两感于寒的，第七天太阳病衰退，头痛减轻；（邪气逐渐消退，正气逐渐恢复，如下文所述。）第八天阳明病衰退，身热减轻；第九天少阳病衰退，耳聋稍微能听见声音；第十天太阴病衰退，腹部胀满消除像往常一样，就开始想吃饭；第十一天少阴病衰退，口渴停止，腹部不再胀满，舌干已好并且打喷嚏；第十二天厥阴病衰退，阴囊松弛，小腹轻微舒缓，大气（邪气）都已去除，病一天天好了。（所谓痊愈都在十日以上，就是这样。嚏音帝。）
黄帝说：怎么治疗呢？岐伯说：治疗要分别疏通各经的脉气，病就会一天天衰退痊愈。病程未满三天的，可以通过发汗治愈；病程已满三天的，可以通过攻下治愈。（分别疏通各经脉气，意思是应当随经分治。凡是传经的邪气，未满三天的，邪气在表，所以可以用发汗法。满三天的，邪气传里，所以可以用下法。然而这是说表里的大概情况。按《正理伤寒论》说：脉大浮数，病在表，可以发汗；脉实沉数，病在里，可以攻下。所以天数虽多，只要有表证而脉浮大的，仍然适宜发汗；天数虽少，只要有里证而脉沉实的，就应当攻下。这汗下之法，只应当以表里为依据，不可以固执一端。我按：伤寒一证，感受天地阴厉之气，变化莫测，最为凶险，治疗稍有差错，生死反掌。古人流传下来的训诫很多，何止百家千卷，其中立法之善，没有超过张仲景的，用药之善，须逊陶节庵，凡是曲折精微之处，无不详尽，我还有什么可说的；然而尤其不能停止的是，苦于条目浩繁，而后学者难以求得。看陶氏家秘的本说：伤寒治法，得其纲领如拾芥，若求之多歧，则支离破碎，如涉海问津矣，盖脉证与理而已。这句话，我非常佩服。然而寻求所谓的纲领，是指掌握枢要，切合时用的。所谓多歧，是指检遍方书，无方可用。所谓脉证，是指表里阴阳寒热虚实的辨别。所谓理，是指见识真切、方法关键，得到理则治疗无一失误。所以法必须详细，应用应当简约，详细而不简约，徒然详细有什么用？就像望洋兴叹，无处施展。我请概括一下：凡是治疗伤寒，其法有六种，即吐、汗、下、温、清、补。吐中有发散之意，可去胸中之实，可举陷下之气，若无实邪在上，不可用之，所用既少，法亦无多，所以舍吐之外而切于用的，只有汗、下、温、清、补五法而已。所谓汗，是治表证，寒邪在表，不汗从哪里解除？然而汗法有三种：曰温散，曰凉解，曰平解。温散，如在寒冷之时，阴胜之脏，阳气不充，则表不易解。虽然身有大热，也必须用辛温，不要用寒凉为佐，这就是“寒无犯寒”的意思。凉解，如在炎热炽盛，表里枯涸，则阴气不营，也不能汗，宜用辛凉，不要用温热为佐，这就是“热无犯热”的意思。若病在阴阳之间，既不可温，又不可凉，则只宜平用，以求解表而已。然而无表证者不可汗，似表非表者不可汗，咽中闭塞者不可汗，诸动气者不可汗，淋家不可汗，诸亡血者不可汗，脉微弱者无阳也不可汗，脉微恶寒者阴阳俱虚不可汗吐下。可汗的情况，如张仲景说：凡发汗温服汤药，其方虽言日三服，若病剧不解，当促之于半日中尽三服。又说：凡作汤药，不可避晨夜，觉病须臾，即宜便治，不等早晚，则易愈矣。这就是汗不嫌早的原因。
所谓下，是攻其内，实邪内结，不下从哪里去除？然而表邪未解者不可下，诸虚者不可下，阳微者不可下，诸外实者不可下，咽中闭塞者不可下，诸动气者不可下，脉弱者不可下，脉浮而大者不可下，病呕吐者不可下，大便先硬后溏者不可下，非有大满燥实坚者不可下，所以下不嫌迟。
所谓温，是温其中，脏有寒气，不温它从哪里除去？有客寒，是寒自外入。有主寒，是气虚。气为阳，气不足则寒生于中，寒即阴证之类，温即兼乎补。所谓清，是清其热，有热无结，本非大实，不清它从哪里散？表热者宜于清解，里热者宜于清降，热即阳证之类，清即类乎泻。如果这四者，古人已经发明殆尽，我不过陈述其要点罢了，学医者仍应当由博而约，不要说只到这里为止。唯有补之一字，关系尤为密切，而很多人不知道。用补的方法，岂止因于中气，其实兼乎表里。如表邪不解，屡散之而汗不出者，是中虚无力，阴气不能达。汗即水，水既不足，汗从哪里来？人知道汗属阳分，升阳可以解表，却不知道汗生于阴，补阴最能发汗，现在有饮水而汗出的，就是这个道理。又如内热不解，屡清之而火不退者，是阴不足。人只知道惟寒可以去热，却不知道壮水方能息火。又如正气不足，邪气有余，正不胜邪，病必留连不解。有这种情况的，不可攻邪，只当实其中气，使正气内强，则根本无害，逼邪外出，则营卫渐平，所谓温中自有散寒之意，此不散表而表自解，不攻邪而邪自退，不治之治，尤其不是人所知道的。唯是用补之法，则脏有阴阳，药有宜否，宜阳者必先于气，宜阴者必先乎精。阳以人参为主，而白术、升麻、柴胡之类可佐之；阴以熟地为主，而茱萸、山药、当归、枸杞之类可佐之。然而人参随熟地，则直入三阴；熟地随白术，亦上归阳分。但用药当如盘珠，勿若刻舟求剑。且人伤于寒而传为热，则阳胜伤阴者多，故利于补阴者十之七八，利于补阳者十之二三。然而阴中非无阳气，佐以桂枝、附子，则真阳复于命门；佐以生姜、甘草，则元气达于脾胃。药不及病，与不药同。所以当随病重轻以为增减，这是我百战百胜的经验，救活的人很多，不是谬说。有人说：古人之治伤寒，皆重在汗吐下三法而后于补，今你所说的，则似乎谆谆在补而后于攻，为什么呢？回答说：三法已悉，无待再言，独于用补，殊未尽善，故不得不详明其义，以补古人之未备。试以《伤寒论》观之，说：阴证得阳脉者生，阳证得阴脉者死。迄今说者，无不为然。我认为阳证阳脉、阴证阳脉者，本为顺证，可以无虑；惟阳证阴脉，则逆候也，为伤寒之最难，所以古人直谓之死，则其无及于此也可知矣，我所谓切于补者，正在此也。如今以我所经验，凡正气虚
(From *Suwen: Re Lun Pian* [Plain Questions: Discussion on Heat], Appendix: Theory of Meridian Transmission and Treatment Methods for Cold Damage)
Huangdi asked: "Currently, febrile diseases are all of the category of Shanghan (Cold Damage). Some recover, while some die; those who die usually do so within six or seven days, while those who recover usually take ten days or more. What is the reason? I do not understand the explanation. I wish to hear the cause." (Shanghan refers to contracting Yin-cold pathogenic qi that is severe and lethal. Cold is most prevalent in winter; if one contracts it and falls ill immediately, it is called Shanghan. If one does not fall ill immediately, but develops illness in spring, it is called Wenbing (Warm Disease); if in summer, it is called Shubing (Summerheat Disease). However, there are also irregular pathogenic qi of the four seasons that cause immediate onset upon contraction, which are also termed Shanghan. When cold pathogenic qi binds the muscle surface, the acupores close, and Yang Qi cannot dissipate, thus stagnating and transforming into heat. Therefore, all external-contracted febrile diseases belong to the category of Shanghan.)
Qibo replied: "Juyang (Giant Yang, i.e., Taiyang/Sun) is the leader of all Yang meridians." (Ju means great. The Taiyang meridian is the head of the Six Meridians, commanding the Yang divisions, therefore all Yang meridians belong to it.) Its vessels connect to the Fengfu point, thus serving as the master Qi of all Yang meridians." (Fengfu is an acupoint of the Du Mai [Governing Vessel]. The Taiyang meridian channels ascend to the vertex and back surface, thus governing the Qi division of all Yang meridians.) When humans are injured by cold, they develop febrile disease; even if the fever is severe, it will not be fatal;" (When humans contract cold and transform into heat, it is because extreme cold generates heat. When cold disperses, heat recedes, so even if severe, it is not fatal.) "but those who suffer from Lianggan (Simultaneous Contraction of Exterior and Interior) due to cold will inevitably die." (Exterior and Interior meridians are simultaneously affected, this is called Lianggan; the meaning is detailed in subsequent chapters.)
The Emperor said: "I wish to hear the symptoms." Qibo said: "On the first day of Shanghan, Juyang receives the pathogen, hence headache, stiff neck, and stiffness of the lumbar spine." (Juyang refers to the Foot-Taiyang Bladder Meridian, which is the exterior of the Three Yang meridians, and its vessels connect to Fengfu; therefore, most Shanghan cases begin from the Taiyang meridian. The Taiyang meridian runs from the head and neck down to the shoulders, flanking the spine to the waist, hence its symptoms manifest thus. Zhang Zhongjing stated: 'The characteristic of Taiyang disease is floating pulse, headache, stiff neck, and aversion to cold.' Note: In the human body's meridians, the Three Yang meridians are exterior, and the Three Yin meridians are interior. The order of the Three Yang meridians is: Taiyang is the Third Yang (Yang within Yang); Yangming is the Second Yang, following Taiyang; Shaoyang is the First Yang, following Yangming. These Three Yang meridians constitute the exterior. The order of the Three Yin meridians is: Taiyin is the Third Yin, following Shaoyang; Shaoyin is the Second Yin, following Taiyin; Jueyin is the First Yin, following Shaoyin. These Three Yin meridians constitute the interior. Their numerical sequence proceeds from interior to exterior, hence the priority of First, Second, and Third as described above. Furthermore, when pathogens enter the human body, they must move from exterior to interior. As stated in chapters like *Pi Bu Lun*: 'When pathogens reside in the skin, the interstices open; when open, pathogens enter the Luo vessels; when Luo vessels are full, they inject into the Jing meridians; when Jing meridians are full, they enter and settle in the Zang-Fu organs.' This is why pathogens first invade the hair and skin, meridian pathology begins with Taiyang, and subsequently the Three Yin and Three Yang, Five Zang, and Six Fu organs all become diseased, as mentioned below.)
"On the second day, Yangming receives the pathogen. Yangming governs the flesh; its vessels flank the nose and connect to the eyes. Hence, there is body heat, eye pain, dry nose, and inability to sleep." (Shanghan often involves fever, but here specifically mentioning body heat is because Yangming governs muscles, making body heat particularly severe. Pathogenic heat in the Stomach causes irritability, hence the inability to sleep. Other symptoms are derived from this meridian's influence. Zhang Zhongjing stated: 'The characteristic of Yangming disease is excess in the Stomach-Fu.')
"On the third day, Shaoyang receives the pathogen. Shaoyang governs the Gallbladder; its vessels follow the hypochondrium and connect to the ears. Hence, there is chest and hypochondriac pain and deafness." (When pathogens are in the Shaoyang meridian, the Three Yang diseases have exhausted, and it is about to enter Taiyin; thus, it is a Half-Exterior Half-Interior meridian. Its meridian channels emerge around the ears and descend along the chest and hypochondrium, hence symptoms such as hypochondriac pain and deafness. Zhang Zhongjing stated: 'In Shanghan, if the pulse is wiry and fine, with headache and fever, it belongs to Shaoyang. The characteristic of Shaoyang disease is bitter taste, dry throat, and vertigo.' He also said: 'If Taiyang disease is not resolved and transfers to Shaoyang, there will be hardness and fullness under the ribs, dry retching, inability to eat, and alternating chills and fever.' Pathogens in Yin cause chills; in Yang cause heat; in Exterior cause no vomiting or fullness; in Interior cause chest fullness, dry retching, and inability to eat. Thus, Cheng Wuji stated: 'Shaoyang pathogens exist between Half-Exterior and Half-Interior.')
"If the meridians of the Three Yang are all affected, but the pathogens have not entered the Zang organs, they can be cured by sweating." (The Three Yang meridians belong to the Exterior and Fu organs. If pathogens are in the Exterior and have not entered the Three Yin Zang organs, they can all be dispersed by inducing sweating.)
"On the fourth day, Taiyin receives the pathogen. The Taiyin vessels distribute in the stomach and connect to the pharynx. Hence, there is abdominal fullness and dry pharynx." (If pathogens in the Three Yang fail to be resolved by sweating, they enter the Three Yin, starting with Taiyin. Zhang Zhongjing stated: 'In Shanghan, if the pulse is floating and slow, and hands and feet are naturally warm, the disease is related to Taiyin. The characteristic of Taiyin disease is abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain.')
"On the fifth day, Shaoyin receives the pathogen. The Shaoyin vessels penetrate the Kidney, connect to the Lung, and tie to the root of the tongue. Hence, there is dry mouth, dry tongue, and thirst." (The Kidney meridian belongs to Water, which is depleted by pathogenic heat, causing dryness and thirst in the mouth and tongue. Zhang Zhongjing stated: 'The characteristic of Shaoyin disease is faint and fine pulse, and only desiring to sleep.')
"On the sixth day, Jueyin receives the pathogen. The Jueyin vessels follow the genitalia and connect to the Liver. Hence, there is irritability, fullness, and retraction of the scrotum." (After transmitting through all six meridians, reaching Jueyin, pathogenic heat is very intense in the Yin division, causing irritability and fullness. Zhang Zhongjing stated: 'The characteristic of Jueyin disease is Qi rushing up to strike the heart, pain and heat in the heart, hunger without desire to eat, vomiting roundworms after eating, and unceasing diarrhea if purged.' Note: Shanghan transmission first occurs from the Exterior of the Three Yang, then enters the Interior of the Three Yin; this is the order of Yin and Yang precedence. However, observing Li Dongyuan: Taiyang is Juyang. If the Bladder meridian is diseased and there is thirst, it has entered its own meridian, named Chuanben (Transmission to Root). Taiyang transmitting to Yangming Stomach Earth is named Xunjingchuan (Following Meridian Transmission). Taiyang transmitting to Shaoyang Gallbladder Wood is named Yuejingchuan (Crossing Meridian Transmission). Taiyang transmitting to Shaoyin Kidney Water is named Biaolichuan (Exterior-Interior Transmission). Taiyang transmitting to Taiyin Spleen Earth is named Wuxiachuan (Error-Purge Transmission). Taiyang transmitting to Jueyin Liver Wood is named Xunjingdeduchuan (Following Meridian Within Limits Transmission). Additionally, Tao Jian'an stated: Wind-cold pathogens entering humans have no constant pattern; they may enter Yin or Yang, with no fixed form, not necessarily starting at Taiyang and ending at Jueyin. Some start at Taiyang, transmitting one meridian per day, reaching Jueyin on the sixth day; if pathogenic qi declines, it stops transmitting and heals. Others may transmit again after stopping. Some transmit skipping meridians; some stop after two or three meridians; some remain in one meridian throughout; some skip meridians in transmission; some, upon initial entry into Taiyang, do not generate stagnant heat but immediately enter Shaoyin forming True Yin syndrome; some directly strike the Yin meridians forming Cold syndromes. Because the Classics lack explicit text, later practitioners made errors in reckless treatment. Regarding Yin syndromes transmitted from Three Yang to Three Yin: although there may be extremity reversal externally, internally there is pathogenic heat. If there is no fever, and extremities are reversed and cold with aversion to cold, this is a direct strike to Yin meridians forming a Cold syndrome. Since Wang Shuhe established confused theories, many later generations have suffered. There are also Hebing (Combined Disease) and Bingbing (Concurrent Disease) syndromes: Hebing refers to two or three meridians being diseased simultaneously without transmission; Bingbing refers to one meridian's disease not yet resolving before transmitting to another. Thus, there is Taiyang-Yangming Hebing, Taiyang-Shaoyang Hebing, Shaoyang-Yangming Hebing, and San Yang Hebing. If Three Yang combine with Three Yin, it is Lianggan; thus, there are no combination examples for Three Yin. These were not covered in the Classic texts but elaborated by these two scholars; their meanings largely derive from Zhang Zhongjing and are logically necessary. However, the Classic discusses the normal transmission, while these two discuss variations. Students must examine both carefully and not adhere rigidly to one view, thereby adapting to changes and avoiding the error of rigidity.)
"If the Three Yin and Three Yang, Five Zang and Six Fu organs are all diseased, and Ying and Wei circulation cease, and the Five Zang mechanisms are blocked, death ensues." (Shanghan pathogens in the meridians originally present as Exterior syndromes; after meridian transmission completes and Qi recovers, resolution should gradually occur. If pathogens persist after passing through all six meridians, they deepen into the Fu organs; if Fu organs remain affected, they deepen into the Zang organs, hence all Five Zang and Six Fu become diseased. Excess pathogens externally block Ying and Wei circulation; exhaustion of Qi internally blocks the Five Zang, leading to death within six or seven days. A skilled practitioner ensures pathogens do not enter inward and organ Qi does not exhaust. Understanding these two aspects approaches divine skill. My note: Shanghan transmission mentions only Foot meridians, not Hand meridians. This principle originates from this chapter, as seen in the previous six sections. Regrettably, Liu Congzhou failed to understand this logic, erroneously creating the theory that Shanghan transmits only to Foot meridians and not Hand meridians, claiming Foot meridians belong to Water, Wood, and Earth; Water freezes in cold, Wood withers in cold, Earth cracks in cold—all unable to withstand cold. Hand meridians belong to Metal and Fire; Metal becomes harder in cold, Fire is extremely hot and immune to cold invasion. Thus, Shanghan only transmits to Foot meridians. This is clever rhetoric for reputation, astonishing the ignorant, and grossly deceptive. Human Metal and Fire organs merely possess Five Element Qi attributes; are they true Metal and Fire that cannot be damaged? This statement caused doubt, leading to claims that Foot meridians are lower and Hand meridians upper; since cold is Yin pathogen, it transmits to Foot. Or that Foot Six Meridians correspond to Northeastern and corner Qi, while Hand Six Meridians correspond to Southwestern Qi; cold invades in Winter/Spring, seeking similar Qi, thus affecting Water/Wood/Earth first, sparing Metal/Fire. Or that without Extraordinary Vessels there is no Shanghan, and Extraordinary Vessels attach only to Foot meridians. These debates are futile and incorrect. Human Blood and Qi circulate endlessly throughout the body; how could pathogens avoid Hand meridians? Cold invading humans first affects the skin/hair, which corresponds to the Lung; thus, externally there are chills and nasal congestion, internally cough and shortness of breath—can we say it does not transmit to the Lung? Entering Hand Shaoyin/Jueyin causes coated tongue, confusion, and delirium—can we say it does not transmit to the Heart Master and Pericardium? Entering Hand Yangming causes diarrhea or constipation—can we say it does not transmit to the Large Intestine? Entering Hand Taiyang causes urinary retention—can we say it does not transmit to the Small Intestine? Entering Hand Shaoyang causes obstruction of upper/lower passages, dysfunction of five senses, and fullness/dryness/excess—can we say it does not transmit to the Sanjiao? Re-reading this section stating all Three Yin/Yang and Five Zang/Six Fu are diseased, surely Hand meridians are included? Thus, Zhang Zhongjing’s descriptions of terminal syndromes of Lung, Heart, Liver, Spleen, and Kidney make sense. Why does this Classic omit Hand meridians? Because Shanghan is an Exterior pathogen; to observe exterior signs, one examines the whole body. The meridians covering the entire body are primarily the Foot Six Meridians; Hand meridians cannot cover them all. Moreover, wherever Hand meridians reach, Foot meridians also reach. Therefore, discussing only Foot meridians allows deduction of all left/right/front/back Yin/Yang symptoms, encompassing Hand meridians implicitly. This is why the Classic mentions only Foot meridians: to observe exterior syndromes of the whole body. The principle is obvious, yet debated until now due to Liu’s false statements. Who is wrong in judging the frog in the well and the bookworm?"
"For those not suffering from Lianggan, on the seventh day, Taiyang disease declines, and headache lessens;" (Pathogenic qi gradually retreats, and healthy Qi gradually recovers, as described below.) "on the eighth day, Yangming disease declines, and body heat lessens; on the ninth day, Shaoyang disease declines, and hearing slightly returns; on the tenth day, Taiyin disease declines, abdominal fullness subsides to normal, and appetite returns; on the eleventh day, Shaoyin disease declines, thirst stops, distension resolves, tongue dryness improves, and sneezing occurs; on the twelfth day, Jueyin disease declines, scrotum relaxes, lower abdomen soothes, and major pathogenic qi departs, with the illness daily improving." (This is what is meant by recovery taking ten days or more. Sneeze pronunciation: Di.)
The Emperor asked: "How should it be treated?" Qibo said: "Treatment requires unblocking the meridians of each respective Zang; the disease will decline daily. If the duration is less than three days, it can be cured by sweating; if three days or more, it can be cured by purging." (Unblocking each Zang's meridian means treating according to specific meridians. For transmitted pathogens, if less than three days, the pathogen is in the Exterior, so sweating is appropriate. If three days or more, the pathogen has transmitted to the Interior, so purging is appropriate. However, this describes the general rule of Exterior/Interior. According to *Zhengli Shanghan Lun*: Floating, large, rapid pulses indicate Exterior disease, suitable for sweating; deep, solid, rapid pulses indicate Interior disease, suitable for purging. Thus, even if many days have passed, if Exterior signs and floating/large pulse exist, sweating is still indicated; even if few days have passed, if Interior signs and deep/solid pulse exist, purging is required. Sweating and purging methods depend on Exterior/Interior status, not rigid adherence to days. My note: Shanghan, contracted from Heaven and Earth’s Yin lethal Qi, is unpredictable and highly dangerous; a slight treatment error leads to life or death instantly. Ancients provided extensive teachings, exceeding hundreds of schools and thousands of volumes. In establishing principles, none surpass Zhang Zhongjing; in medication, Tao Jian’an excels. They detailed every nuance; what more can I add? Yet, I cannot remain silent regarding the overwhelming complexity burdening students. Tao’s *Jiami Benbo* states: Grasping the outline of Shanghan treatment makes it easy as picking mustard seeds; pursuing details fragments it like searching for a ford in the sea—it is merely Pulse-Signs and Principle. I deeply admire this. The 'outline' refers to grasping the pivot and practical application. 'Details' refer to checking formularies with no applicable prescriptions. 'Pulse-Signs' refer to distinguishing Exterior/Interior, Yin/Yang, Cold/Heat, Deficiency/Excess. 'Principle' refers to true insight and essential methods; mastering principle ensures no treatment failure. Therefore, methods must be detailed, but application concise. Detailed without conciseness is useless, like gazing at the ocean. I summarize: Shanghan treatment has six methods: Vomiting, Sweating, Purging, Warming, Clearing, and Tonifying. Vomiting contains dispersing intent, removing Upper Jiao excess, and raising sunken Qi. Without Upper excess, it is contraindicated; thus, rarely used. Excluding Vomiting, the practical methods are Sweating, Purging, Warming, Clearing, and Tonifying.
Sweating treats Exterior syndromes. Cold in the Exterior cannot resolve without sweating. Sweating has three types: Warm Dispersal, Cool Resolution, and Neutral Resolution. Warm Dispersal applies when cold weather dominates, Yin excess weakens organs, and Yang Qi is insufficient, making Exterior difficult to resolve. Even with high fever, Acrid-Warm herbs must be used without Cold-Cool auxiliaries ('Do not violate Cold with Cold'). Cool Resolution applies when heat is intense, Exterior/Interior are dried, Yin Qi fails to nourish, preventing sweating. Acrid-Cool herbs are used without Warm-Hot auxiliaries ('Do not violate Heat with Heat'). If the disease is between Yin and Yang, neither Warm nor Cool is suitable; use Neutral methods to resolve the Exterior. Contraindications for sweating: No Exterior syndrome, pseudo-Exterior syndrome, pharyngeal obstruction, Qi movement disorders, chronic strangury patients, blood-loss patients, faint pulse indicating Yang deficiency, and faint pulse with aversion to cold indicating dual Yin/Yang deficiency. Indications for sweating: As Zhang Zhongjing stated, administer warm decoctions; if severe illness persists, accelerate administration to complete three doses within half a day. Treat immediately upon detection, regardless of time, for faster recovery. Hence, sweating should not be delayed.
Purging attacks the Interior. Internal excess accumulation cannot resolve without purging. Contraindications for purging: Unresolved Exterior pathogens, all Deficiency patterns, Yang deficiency, apparent Exterior excess, pharyngeal obstruction, Qi movement disorders, weak pulse, floating-large pulse, vomiting, hard-then-loose stool, and absence of Fullness/Dryness/Excess/Hardness. Hence, purging should not be rushed.
Warming warms the Interior. Internal Cold cannot resolve without warming. External Cold enters from outside; Internal Cold arises from Qi deficiency. Qi is Yang; insufficiency generates internal Cold, classified as Yin syndrome. Warming includes Tonification.
Clearing removes Heat. Heat without accumulation is not severe excess; it must be cleared. Exterior Heat requires clearing/dispersing; Interior Heat requires clearing/descending. Heat belongs to Yang syndrome; Clearing resembles Purging. Ancients explained these thoroughly; I merely state essentials. Students should move from broad to concise.
Tonification is crucial yet misunderstood. Tonification addresses not just Middle Jiao but also Exterior/Interior. If Exterior pathogens persist despite repeated dispersal without sweating, it indicates Middle Deficiency and insufficient Yin Qi to produce sweat (Sweat is Water; insufficient Water yields no Sweat). People know Sweat relates to Yang and ascending Yang resolves Exterior, but forget Sweat is born from Yin; Tonifying Yin promotes sweating (e.g., drinking water induces sweating). If Internal Heat persists despite clearing, it indicates Yin deficiency. People know Cold removes Heat, but forget Strengthening Water extinguishes Fire. If Healthy Qi is insufficient and Pathogenic Qi excessive, illness lingers. Attack is contraindicated; instead, strengthen Middle Qi. Strong Healthy Qi expels pathogens, balancing Ying/Wei. Warming Middle disperses Cold without direct Exterior attack; this is 'treating by not treating.'
Tonification depends on Zang Yin/Yang and herb suitability. For Yang Tonification, Ginseng (*Ren Shen*) is primary, assisted by Atractylodes (*Bai Zhu*), Cimicifuga (*Sheng Ma*), Bupleurum (*Chai Hu*). For Yin Tonification, Prepared Rehmannia (*Shu Di Huang*) is primary, assisted by Cornus (*Shan Zhu Yu), Dioscorea (*Shan Yao*), Angelica (*Dang Gui*), Lycium (*Gou Qi*). Ginseng with Rehmannia enters Three Yin; Rehmannia with Atractylodes ascends to Yang divisions. Medication should be flexible, not rigid. Since Cold transforms to Heat, damaging Yin, Yin Tonification suits 70-80% of cases, Yang Tonification 20-30%. However, Yin contains Yang; assisting with Cinnamon Twig (*Gui Zhi*) and Aconite (*Fu Zi*) restores Mingmen True Yang; assisting with Ginger (*Sheng Jiang*) and Licorice (*Gan Cao*) reaches Spleen/Stomacy Yuan Qi. Insufficient dosage equals no treatment. Dosage must adjust to severity. This is my proven experience, saving many lives, not mere theory.
Some ask: Ancients prioritized Sweating/Vomiting/Purging over Tonification; you emphasize Tonification first. Why? Answer: The three methods are known; Tonification was inadequately addressed, requiring clarification. *Shanghan Lun* states: Yin syndrome with Yang pulse survives; Yang syndrome with Yin pulse dies. Most agree. I believe Yang syndrome/Yang pulse and Yin syndrome/Yang pulse are favorable. Yang syndrome/Yin pulse is adverse and difficult, often deemed fatal by ancients. My emphasis on Tonification addresses this. Based on my experience, whenever Healthy Qi is deficient..."