吴云。解。释也。释阳明脉为病之义。
主肉 甲乙作肌肉。简按新校正云。脉。作肌。误。
惋 甲乙。作闷。释音。惋。乌贯切。简按集韵。惋。愠。宛。 同。音郁。心所郁积也。即与王注
符。若乌贯切。则为骇恨惊叹之义。志云。惊恐貌。高云。惊顾也。并乖经旨。
阳盛 甲乙。作邪盛。
骂詈 韵会。正斥曰骂。旁及曰詈。一切经音义云。詈。亦骂也。今解。恶言及之曰骂。诽谤咒诅曰詈。
不欲食不欲食故妄走 吴本。十字改为歌二字。简按问语乃然。当从吴。
马云。首言热病者皆伤寒之类。故即以热论名篇。
今夫热病 甲乙。外台。无今字。
伤寒之类也 张云。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。阳气不散越。乃郁而为热。故凡系外感发热者。皆伤寒之类。马云。水热穴论。帝问。人伤于寒。而传为
热。何也。岐伯曰。夫寒盛则生热也。又此处王注。以伤寒论中。至夏变为热病之热病强解。甚非。盖未有伤
于寒而不成热者也。非但至夏之热病为然也。简按王引伤寒例文。暑病。作热病。五十八难云。伤寒有几。其
脉有变否。然。伤寒有五。有中风。有伤寒。有湿温。有热病。有温病。其所苦各不同。知是中风伤寒湿温热
病温病。古总称之伤寒。则王注不可废。
巨阳者诸阳之属也其脉连于风府故为诸阳主气也 巨。甲乙作太。下同。张云。太阳为六经之长。统
摄阳分。故诸阳皆其所属。太阳经脉。覆于巅背之表。故主诸阳之气分。志云。属。会也。谓太阳为诸阳之会。
滑本。此二十字。移于伤寒一日巨阳受之之下。徐本同。文义顺承。为胜。（资生经。风府下。引此节云。然
则风府者。固伤寒所自起也。北人皆以毛裹之。南人怯弱者。亦以帛护其项。俗谓三角。是也。凡怯弱者。须
护项后可也。）
伤寒一日巨阳受之 张云。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。是三阴为里也。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。简按吴。此下。补以其脉经头项循腰脊九字。不可从。
头项痛腰脊强 张云。凡病伤寒者。多从太阳始。太阳之经云云。（与王注同）故其为病如此。仲景
曰。太阳之为病。脉浮头项强痛而恶寒。新校正云。甲乙。太素。作头项与腰皆强。简按今甲乙。作腰背强。
身热 张云。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。仲景曰。阳明之为病。胃家实也。
不得卧 调经论云。阳明者。胃脉也。其气下行。阳明逆不得从其道。故不得卧也。
少阳主胆 新校正。引全元起。太素。甲乙。并作主骨。简按病源。亦作主骨。只外台作胆。外台
引本篇文云。出第九卷中。考新校正。此篇。全本在第五卷。盖王氏改骨作胆。而宋人根据以改外台也。且灵经
脉篇云。胆主骨。如阳明。不云主胃。而云主肉。则理宜于少阳亦云主骨。盖太阳主皮肤。阳明主肉。少阳主
骨。从外而内。殆是半表半里之部分。故改胆作骨。于义为长。张云。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。
未入于脏者 简按据新校正。全本。太素。脏。作腑。甲乙。伤寒例。亦作腑。只外台作脏。恐是
亦宋人所校改也。考下文未满三日者。可汗而已。其满三日者。可泄而已。此言邪在三阳之表者。可发汗。在
三阴之脏者。可下之。若推仲景之例。则当作腑。然本经治法表里只有汗下二法。故王改腑作脏。义甚明显。
而东垣李氏云。藏。非谓五脏之脏。乃是藏物之藏。（出此事难知）三阳王氏演而作热论脏字说。（出伤寒纲
目）并属强解。志云。藏者。里也。阴也。言三阳之经络。皆受三阳邪热之病。然在形身之外。而未入于里阴。
可发汗而解也。此解为胜。
四日太阴受之 张云。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。简按本经所论三阴病者。
即仲景所谓阳明胃家实证。故下文云。其满三日者。可泄而已。仲景所论三阴病者。乃阴寒之证。此本经所未
言及。张引彼注此。殆不免乖谬。下少阴厥阴亦同。
络于肺 甲乙。病源。外台。无于字。
六日厥阴受之 简按方氏伤寒条辨云。一日二日三四五六日。犹言第一第二第三四五六之次第也。
大要譬如计程。如此立个前程的期式约模耳。非计日以限病之谓。张云。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。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。为周身之表证也。
烦满而囊缩 简按满。懑同。说文。懑。烦也。盖烦懑。乃烦闷也。（详见生气通天论喘满注。）缪
氏伤寒撮要云。妇人亦有囊缩可辨。但其乳头缩者。即是也。李氏入门云。在女子。则阴户急痛引小腹。吴。
囊缩下。补三阴经络者。皆受病已入于腑。可下而已十六字。此推三阳之例。则经文似脱此等十余字。然以三
阴称腑。尤为无谓。若改作脏字。仅通。
五脏不通则死矣 高云。则。犹即也。结上文三阴受病。非必四日太阴。五日少阴。六日厥阴。故内
之三阴。外之三阳。内之五脏。外之六腑。一日皆受其病。致荣卫不行。五脏不通。即死矣。较之两感于寒。
不免于死者。更甚也。
渴止不满 甲乙。伤寒例。并无不满二字。简按上文。不言腹满。此必衍文。
而嚏 口问篇云。阳气和则嚏。
大气皆去病日已矣 调经论云。泻实者。开其门而出。大气乃屈。五色篇云。大气入脏腑者。不病
而卒死。简按俱谓大邪之气。高云。其不两感于寒。属经脉之热病。皆以七日环复。病衰而愈。由此观之。则
上文所云。一日受二日受者。乃循次言之。非一定不移之期日也。会悟圣经。当勿以辞害志。
通其脏脉 张云。谓当随经分治也。志云。谓手足三阴
三阳之经脉。高云。脏脉。如上文太阴脾脏之脉。少阴肾脏之脉。厥阴肝脏之脉也。
可泄而已 张云。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。吴。此下补若其寒邪。传不以次。与夫专经不传。表里变易。则随证脉处治。吐下汗和。蚤暮异法。三十
二字。云。欲人通变云尔。简按王引伤寒论。义颇明显。若欲人通变。则有仲景伤寒论在焉。岂三十二字所包
括乎。不啻添足。殆亦 妄。薛氏原旨云。按伤寒一证。传变无穷。此不过言传经之常。而未及于变。自仲景
而后诸大家。俱有名言可法。学人所当尽读而精思之。然义多出于仲景。于仲景书。又当闭户深求者也。
遗 志云。伤寒论曰。大病瘥后劳复者。枳实栀子汤主之。若有宿食者。加大黄如博棋子五六枚。盖
因伤寒热甚之时而强食其食。故有宿食之所遗也。简按遗。是礼乐记。遗音遗味之遗。郑玄注。遗。犹余也。
盖与此同义。童氏活人指掌辨疑云。遗字注解多不同。活人书注。谓便不禁也。或云。遗。亡也。其人必利不
禁也。此皆非是。余谓遗者。如以物遗人之遗。即司马公所谓积德以遗后人之遗。是也。言当少愈之时。邪气
未尽去。胃气未尽复。肉食者。其后复病。多食者。其后遗病。将痊而不得痊矣。
强食之 甲乙。无之字。仲景云。病患脉已解。而日暮微烦者。以病新瘥。人强与谷。脾胃气尚弱。
不能消谷。故令微烦。损谷则愈。又曰。吐利发汗。脉平小烦者。以新瘥不胜谷气故也。
调其逆从 志云。脉浮者。以汗解之。脉沉者。以下解之。此之谓调其逆从也。高云。视其经脉之虚
实。调其阴阳之逆从。
食肉则复 马云。肉本性热而难化。所以热病复生。志云。肉。谓豕肉。豕乃水畜。其性寒冷。是以
多食则遗。简按当从马注。
谵言 甲乙。外台。作谵语。简按谵。又作 。并之廉切。音詹。考之字书。义少异。集韵。谵。多
言也。 。疾而寐语也。然医书则互用。刘奎说疫为二义。甚误。
不知人六日死 外台。作不知人则六日而死。滑云。六日。当作三日。下文可见。徐同。简按下文云。
如是之后。三日乃死。则作六日者。非字之误。谓至三日。则少阳与厥阴俱病云云。三阴三阳俱受病。水浆不
入。昏不知人。如是者三日。凡于六日之际当死也。
三日乃死 吴云。故不知人三日。六字为句。张云。如是之后。三日乃死。谓两感传遍之后。复三日
而死也。盖即六日之义。高云。乃死。非即死矣。简按朱氏活人书云。两感。仲景无治法。但云两感病俱作。
治有先后。伤寒下之后。复下利不止。身疼痛者。急当救里。宜四逆汤。复身体疼痛。清便自调者。急当救表。
宜桂枝汤。盖本经三阴证。并是仲景所谓胃家实。不宜以彼而例此。当考伤寒论。
病温 生气通天论曰。冬伤于寒。春必病温。金匮真言论曰。夫精者。身之本也。故冬藏于精者。春
不病温。仲景云。太阳病。发热而渴。不恶寒者。为温病。（详见金匮真言论。）
病暑 滑云。此病暑。与病 不同。病暑。即热病也。宜发汗。病 则不宜汗矣。张云。寒邪中人。
而成温病暑病者。其在时则以夏至前后言。在病则以热之微甚言。故凡温病暑病。皆伤寒也。简按温病暑病。
皆是热病。以时异其名耳。考灵论疾诊尺篇云。冬伤于寒。春生瘅热。张云。即温热之病。其义可概见也。为
热之微甚者。恐非。
与汗 简按与。予也。玉函经总例云。仲景曰。不须汗而强与汗之者。夺其津液。又须汗而不与汗之
者。使诸毛孔闭塞。
吴云：解，即解释。此处旨在阐释阳明脉发生病变的道理。
（原文）主肉。甲乙经作“肌肉”。简按：新校正说，“脉”字当作“肌”，是误字。
（白话）经脉主管肌肉。《甲乙经》中写作“肌肉”。简注：根据新校正的考证，“脉”字应当改为“肌”，这是传抄中的错误。
（原文）惋。甲乙经作“闷”。释音：惋，乌贯切。简按：《集韵》说，惋、愠、宛，同义，音郁，指心中郁积之气。这与王冰的注释相符。如果读作乌贯切，则是惊骇、怨恨、惊叹的意思。张志聪说，是惊恐的样子。高世栻说，是惊慌顾视。这些都违背了经文的本意。
（白话）“惋”字，《甲乙经》中写作“闷”。读音解释：“惋”字读作“乌贯切”。简注：根据《集韵》记载，“惋”、“愠”、“宛”意思相同，读音为“郁”，指的是心中郁结积聚的气机。这与王冰的注解相符合。如果按照“乌贯切”来解读，则变成了惊骇、怨恨或惊叹的含义。张志聪认为是指惊恐的神态，高世栻认为是惊慌四顾的样子，这些理解都偏离了经文的宗旨。
（原文）阳盛。甲乙经作“邪盛”。
（白话）阳气亢盛。《甲乙经》中写作“邪气亢盛”。
（原文）骂詈。《韵会》说：正斥曰骂，旁及曰詈。《一切经音义》说：詈，也是骂的意思。现在的解释是：恶言相加叫骂，诽谤咒诅叫詈。
（白话）“骂詈”。《韵会》解释说：当面斥责叫“骂”，牵连他人叫“詈”。《一切经音义》解释说：“詈”也是骂的意思。目前的解释是：用恶毒的语言攻击称为“骂”，进行诽谤和诅咒称为“詈”。
（原文）不欲食不欲食故妄走。吴本将“十”字改为“歌”二字。简按：问语原本如此，应当遵从吴本。
（白话）不想吃东西，因为不想吃东西所以胡乱奔跑。吴崑版本中将“十”字改为了“歌”字。简注：询问的语气原本就是这样，应当遵循吴崑的版本。
马云：开头说热病都属于伤寒一类，所以就用“热论”来命名这篇。
（白话）马莳说：文章开头指出热病都属于伤寒的范畴，因此以“热论”作为篇名。
（原文）今夫热病。甲乙经、外台秘要无“今”字。
（白话）现在的热病。《甲乙经》和《外台秘要》中没有“今”字。
（原文）伤寒之类也。张云：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，阳气不散越，乃郁而为热。故凡系外感发热者，皆伤寒之类。马云：《水热穴论》中，黄帝问：人伤于寒，而传变为热，为什么呢？岐伯说：寒气盛就会产生热。另外此处王冰的注释，引用《伤寒论》中到夏天变为热病的说法来强行解释，非常不妥。大概没有受了寒邪而不转化为热的。不仅仅是夏天的热病是这样。简按：王冰引用《伤寒例》的文字，将暑病写作热病。《难经·五十八难》说：伤寒有几类？脉象有变化吗？回答说：伤寒有五，有中风，有伤寒，有湿温，有热病，有温病。它们痛苦的症状各不相同。由此可知，中风、伤寒、湿温、热病、温病，古代统称为伤寒。那么王冰的注释也不能废弃。
（白话）属于伤寒的一类。张景岳说：所谓伤寒，是感受了阴寒酷烈之气。冬季寒气最盛，感受后立即发病的，称为伤寒。如果不立即发病，到了春天就称为温病，到了夏天就称为暑病。然而，如果有四季中不正之气，感之即发的，也称为伤寒。寒邪束缚在肌表，导致毛孔闭塞，阳气不能发散，从而郁结化为热。所以凡是外感引起的发热，都属于伤寒的范畴。马莳说：在《素问·水热穴论》中，黄帝问道：人受寒邪侵袭，却传变为热证，为什么呢？岐伯回答：寒气极盛就会化热。此外，王冰在此处的注释，引用《伤寒论》中关于夏季变为热病的观点来强行解释，非常不当。大抵没有受了寒邪却不化热的道理，不只是夏天的热病如此。简注：王冰引用《伤寒例》的内容，把暑病写成热病。《难经·五十八难》中提到：伤寒有哪几种？脉象有变化吗？回答是：伤寒分为五种，包括中风、伤寒、湿温、热病、温病。它们的症状各不相同。由此可见，中风、伤寒、湿温、热病、温病在古代都被统称为伤寒。因此，王冰的注释也不能完全否定。
（原文）巨阳者诸阳之属也，其脉连于风府，故为诸阳主气也。巨。甲乙经作“太”，下同。张云：太阳为六经之长，统摄阳分，故诸阳皆其所属。太阳经脉，覆于巅背之表，故主诸阳之气分。志云：属，会也。谓太阳为诸阳之会。滑寿本将此二十字移至“伤寒一日巨阳受之”之下，徐灵胎本相同，文义顺承，更为优越。（《资生经》在风府穴下引用此节说：既然这样，那么风府穴，确实是伤寒起始的地方。北方人都用毛皮包裹头部，南方体弱的人也用布带保护颈部，俗称三角巾。凡是体弱的人，必须保护颈部才可以。）
（白话）足太阳膀胱经是各阳经的统领，它的经脉连接风府穴，所以它是各阳经的主气经脉。“巨”字，《甲乙经》中写作“太”，以下相同。张景岳说：太阳经是六经之首，统摄所有的阳分，所以所有阳经都属于它。太阳经脉覆盖在头顶和背部体表，所以主宰各阳经的气机。张志聪说：“属”意为汇聚，指太阳经是各阳经汇聚之处。滑寿版本将这二十个字移到了“伤寒第一天足太阳经受邪”这一句下面，徐灵胎版本也相同，这样文意连贯，更加合理。（《资生经》在风府穴条目下引用这段话时说：既然如此，风府穴确实是伤寒发作的起点。北方人常用毛皮裹头，南方体质虚弱的人也用布带护颈，这就是俗话说的三角巾。凡是身体虚弱的人，都必须保护好颈部。）
（原文）伤寒一日巨阳受之。张云：按人身经络，三阳为表，三阴为里。三阳的顺序，则太阳为三阳，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。这三阳属于表。三阴的顺序，则太阴为三阴，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。这三阴属于里。其次序的数字，是从内向外排的，所以各有初一、初二、初三的先后顺序如此。又如邪气侵入人体，必定从外向内，如《皮部论》等篇所说：邪气客于皮肤，则腠理开，开了则邪气进入络脉，络脉满了则注入经脉，经脉满了则进入脏腑。这就是为什么邪气一定先侵犯皮毛，经脉一定始于太阳，然后三阴三阳、五脏六腑都会受病，如下文所说的那样。简按：吴崑在此处补上了“以其脉经头项循腰脊”九个字，不可从。
（白话）伤寒第一天，足太阳经受邪。张景岳说：考察人体的经络，三阳经主表，三阴经主里。三阳经的顺序中，太阳经排第三，是阳中之阳；阳明经排第二，位于太阳经之后；少阳经排第一，位于阳明经之后。这三阳经属于表证。三阴经的顺序中，太阴经排第三，位于少阳经之后；少阴经排第二，位于太阴经之后；厥阴经排第一，位于少阴经之后。这三阴经属于里证。这个次序的数字排列，是由内向外的，所以各自有初、二、三的先后顺序，就像这样。再比如邪气侵入人体，一定是从外向内，正如《皮部论》等篇章所说：邪气停留在皮肤，腠理就会开放，开放后邪气进入络脉，络脉充盈后传入经脉，经脉充盈后进入脏腑。这就是为什么邪气必然先侵犯皮毛，经脉病变必然始于太阳经，随后三阴三阳、五脏六腑才会相继受病，就像下文描述的那样。简注：吴崑在这里补充了“因为其经脉经过头项并沿着腰脊”这九个字，这种改动不可取。
（原文）头项痛，腰脊强。张云：凡患伤寒的人，多从太阳经开始。太阳经……（与王冰注释相同）所以它的病症表现为这样。仲景说：太阳病，脉浮，头项强痛而恶寒。新校正说：《甲乙经》、《太素》作“头项与腰皆强”。简按：现在的《甲乙经》作“腰背强”。
（白话）头痛，脖子僵硬，腰部脊柱拘紧疼痛。张景岳说：凡是患伤寒的病人，大多从太阳经开始发病。太阳经……（与王冰的注释一致）所以它的病症表现就是这样的。张仲景说：太阳病的特征是脉象浮，头项部僵硬疼痛并且怕冷。新校正指出：《甲乙经》和《太素》中写作“头项和腰部都僵硬”。简注：现存的《甲乙经》版本写作“腰背部僵硬”。
（原文）身热。张云：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。仲景曰：阳明之为病，胃家实也。
（白话）身体发热。张景岳说：伤寒病大多会发热，但这里特别提到“身热”，是因为阳明经主管肌肉，所以身体发热尤其严重。邪热在胃中会导致烦躁，所以无法躺卧。张仲景说：阳明病的特征，是胃肠燥实内结。
（原文）不得卧。《调经论》说：阳明经是胃的经脉，它的氣下行，如果阳明经气逆乱，不能顺着正常通道下行，就会导致无法躺卧。
（白话）无法安卧。《素问·调经论》说：足阳明胃经的经脉之气应该向下运行，如果阳明经气上逆，不能遵循正常的生理路径下行，就会导致失眠或无法平卧。
（原文）少阳主胆。新校正引用全元起、《太素》、《甲乙经》，都作“主骨”。简按：《诸病源候论》也作“主骨”，只有《外台秘要》作“胆”。《外台秘要》引用本篇文字说出自第九卷。考据新校正，本篇全本在第五卷。大概是王冰将“骨”改为“胆”，宋人据此修改了《外台秘要》。而且《灵枢·经脉》篇说：胆主骨。就像阳明经不说“主胃”而说“主肉”一样，按理说少阳也应该说“主骨”。大概太阳主皮肤，阳明主肌肉，少阳主骨骼，由外而内，这大概是半表半里的部位。所以将“胆”改为“骨”，在义理上更通顺。张云：邪气在少阳经，三阳经的病已经走完，将要进入太阴经，所以是半表半里的经脉。它的经脉出于耳前后，向下沿着胸胁，所以会出现胁痛、耳聋等症状。仲景说：伤寒，脉象弦细，头痛发热的，属于少阳病。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，干呕不能进食，往来寒热。大概邪气在阴分则寒，在阳分则热，在表则没有呕吐胀满等症状，在里则有胸满、干呕、不能进食。所以成无己说：少阳的邪气，在半表半里之间。
（白话）少阳经主司胆。新校正引用全元起的观点以及《太素》、《甲乙经》，均写作“主骨”。简注：《诸病源候论》中也写作“主骨”，只有《外台秘要》写作“胆”。《外台秘要》引用本篇文字称其出自第九卷。经查证新校正，本篇的全本位于第五卷。大概是王冰将“骨”字改成了“胆”字，宋代校勘者据此修改了《外台秘要》。此外，《灵枢·经脉》篇中说：胆主骨。正如阳明经不讲“主胃”而讲“主肉”一样，逻辑上少阳经也应讲“主骨”。大致而言，太阳经主皮肤，阳明经主肌肉，少阳经主骨骼，由外向内，这对应的是半表半里的层次。因此，将“胆”改为“骨”，在医理上更为恰当。张景岳说：邪气停留在少阳经，说明三阳经的病邪已尽，即将传入太阴经，因此少阳经属于半表半里的经脉。其经脉循行出于耳前耳后，向下沿胸胁走行，所以会出现胁痛、耳聋等证候。张仲景说：伤寒病，脉象弦细，伴有头痛发热的，归属于少阳病。少阳病的典型症状是口苦、咽干、眼睛昏花。他又说：太阳病未愈，转入少阳的，会出现胁下痞硬胀满，干呕，不能进食，寒热往来。大抵邪气在阴分则表现为寒，在阳分则表现为热，在表证阶段则没有呕吐、胀满等症状，在里证阶段则有胸满、干呕、不能进食。所以成无己说：少阳病的邪气，处于半表半里的位置。
（原文）未入于脏者。简按据新校正，全本、《太素》中，“脏”作“腑”。《甲乙经》、《伤寒例》也作“腑”，只有《外台秘要》作“脏”。恐怕这也是宋代人校改的。考据下文“未满三日者，可汗而已；其满三日者，可泄而已”。这里说的是邪气在三阳之表，可以发汗；在三阴之脏，可以攻下。如果推演张仲景的体例，则应当作“腑”。但是本经的治疗法则，表里只有汗、下两法，所以王冰将“腑”改为“脏”，用意非常明显。而李东垣说：藏，不是指五脏之脏，而是指藏物之藏。（出自《此事难知》）张景岳演绎王冰关于《热论》中“脏”字的说法。（出自《伤寒纲目》），都属于牵强附会的解释。张志聪说：藏，就是里，就是阴。意思是三阳的经络，都受到三阳邪热的病邪，但在形体之外，尚未进入里的阴分，可以通过发汗来解除。这个解释更好。
（白话）邪气尚未进入内脏。简注：根据新校正的考证，全本和《太素》中，“脏”字写作“腑”。《甲乙经》和《伤寒例》中也写作“腑”，只有《外台秘要》写作“脏”。这恐怕也是宋代学者校订时改动的。参考下文所说的“病程未满三天，可以用发汗法治愈；病程已满三天，可以用泻下法治愈”。这里讲的是邪气在三阳经的表层，可以采用发汗法；如果在三阴经的内脏，可以采用攻下法。如果参照张仲景的诊疗体系，这里应当写作“腑”。然而，《内经》此处的治疗原则，针对表里只有发汗和攻下两种方法，所以王冰将“腑”改为“脏”，意图十分明显。李东垣曾说：这里的“藏”，并非指五脏之脏，而是指容纳事物的“藏”（出自《此事难知》）。张景岳对王冰在《热论》中关于“脏”字的论述进行了发挥（出自《伤寒纲目》），这些都属于牵强附会的解读。张志聪认为：藏，意指里，意指阴。意思是三阳经的经络虽然受到了三阳邪热的影响，但病位仍在形体表面，尚未深入体内的阴分，因此可以通过发汗的方法使病邪解散。这种解释更为精当。
（原文）四日太阴受之。张云：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。简按：本经所论三阴病者，即仲景所谓阳明胃家实证，所以下文说“其满三日者，可泄而已”。张仲景所论的三阴病，乃是阴寒之证，这是本经所未曾提及的。张景岳引用彼处注释此处，难免有误。下面少阴、厥阴的情况也相同。
（白话）第四天，足太阴脾经受邪。张景岳说：邪气在三阳经，如果未能及时通过发汗解除，就会传入三阴经，从太阴经开始。张仲景说：伤寒病，脉象浮而缓，手脚自然温暖的，病位在太阴。太阴病的特征是腹部胀满且呕吐，饮食难进，腹泻逐渐加重，时常腹痛。简注：《内经》此处讨论的三阴病，实际上对应张仲景所说的阳明胃家实证，所以下文说“病程满三天，可用泻下法”。而张仲景论述的三阴病，属于阴寒性质的证候，这是《内经》本篇没有涉及的内容。张景岳引用张仲景的理论来解释此处，恐怕有所偏差。后续关于少阴、厥阴的描述也是如此。
（原文）络于肺。甲乙经、《诸病源候论》、《外台秘要》无“于”字。
（白话）联络于肺脏。《甲乙经》、《诸病源候论》和《外台秘要》中没有“于”字。
（原文）六日厥阴受之。简按方有执《伤寒条辨》说：一日、二日、三日、四日、五日、六日，犹言第一、第二、第三、第四、第五、第六的次第罢了。大体上就像计算路程一样，设立一个预期的期限模子而已。并不是用天数来限制疾病的意思。张云：我考察伤寒的传变，只提足经，不提手经，这个意义原本出自本篇，如上文第六节所述。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。大概伤寒是表邪，想要观察外证，只需察看周身，而周身上下脉络，只有足六经能够涵盖全部。手经无法遍达全身。而且手经到达的地方，足经没有不到的。所以只说足经，那么左右前后、阴阳的各种证候，没有不可以按图索骥得到的，手经也就包含在其中，不必再说了。这就是本经之所以只提足经的原因，是为了阐述周身表证。
（白话）第六天，足厥阴肝经受邪。简注：方有执在《伤寒条辨》中指出：一日、二日、三日、四日、五日、六日，只是表示第一、第二、第三、第四、第五、第六的次序而已。大体上如同估算行程距离，设定一个大致的时间框架罢了，并非是用具体的天数来限定疾病的发展。张景岳说：我研究伤寒的传变规律，只提及足经，而未提及手经，这一观点本源于本篇，如上文第六节所述。然而刘完素（草窗）不明此理，竟然谬造出“伤寒只传足经不传手经”的说法。大抵伤寒属于表邪，若要观察外在证候，只需审视周身，而周身上下经络，唯有足六经足以概括。手经无法遍及全身各处。况且手经所到的部位，足经无不抵达。因此，仅论述足经，即可推知左右前后、阴阳各类证候，手经的情形自然包含在内，无需赘述。这正是本篇只论述足经的原因，旨在阐明周身表证的规律。
（原文）烦满而囊缩。简按满，同懑。《说文》：懑，烦也。盖烦懑，乃烦闷也。（详见《生气通天论》喘满注。）缪希雍《伤寒撮要》说：妇人也有囊缩，可以辨别，但如果是乳头收缩，那就是了。李梴《医学入门》说：在女子身上，则是阴户急痛牵引小腹。吴崑在“囊缩”下补上了“三阴经络者，皆受病已入于腑，可下而已”十六个字。这是推演三阳经的例子，经文似乎脱漏了这十余字。然而用“腑”来称呼三阴，尤为荒谬。如果改为“脏”字，勉强说得通。
（白话）心烦胀满，阴囊收缩。简注：“满”通“懑”。《说文解字》解释：“懑”就是烦。所谓烦懑，就是烦闷的意思。（详见《生气通天论》中关于喘满的注释。）缪希雍在《伤寒撮要》中说：女性患者也会出现类似囊缩的症状，可以通过乳头收缩来辨别。李梴在《医学入门》中指出：对于女性患者，表现为阴部急痛并牵引小腹部。吴崑在“囊缩”之后补充了“三阴经络都已受病，邪气已进入腑，可以用泻下法治疗”这十六个字。这是类比三阳经的条文，经文可能脱漏了这十几个字。但是用“腑”来指代三阴经，是非常不恰当的。如果改为“脏”字，尚能讲得通。
（原文）五脏不通则死矣。高云：则，犹即也。总结上文三阴受病，不一定非要是第四天太阴、第五天少阴、第六天厥阴。所以内的三阴，外的三阳，内的五脏，外的六腑，一天之内都会受病，导致营卫不行，五脏不通，随即死亡。比之两感于寒，不免于死的，更为严重。
（白话）五脏气机闭塞不通就会死亡。高世栻说：“则”字相当于“即”字。这是对上文三阴经受邪的总结，病情不一定非要等到第四天太阴、第五天少阴、第六天厥阴才出现。因此，体内的三阴、体表的三阳，体内的五脏、体外的六腑，可能在一天之内同时受病，导致营卫气血运行停滞，五脏功能闭塞不通，随即死亡。这种情况比“两感于寒”（表里两经同时受邪）导致的死亡，还要严重。
（原文）渴止不满。甲乙经、《伤寒例》并无“不满”二字。简按：上文未提及腹满，此处必是衍文。
（白话）口渴停止，腹部不胀满。《甲乙经》和《伤寒例》中并没有“不满”这两个字。简注：上文没有提到腹部胀满，这里出现的“不满”二字必然是多余衍生的文字。
（原文）而嚏。《口问》篇说：阳气调和就会打喷嚏。
（白话）并且会打喷嚏。《素问·口问》篇说：当体内阳气调和通畅时，就会发生喷嚏。
（原文）大气皆去，病日已矣。《调经论》说：泻除实邪，打开门户使其外出，大气（大邪之气）就会受挫。《五色》篇说：大邪之气进入脏腑，人不生病却突然死亡。简按：都指大邪之气。高云：那些没有两感于寒的，属于经脉的热病，都以七天为一个循环周期，病势衰退而痊愈。由此看来，上文所说的一日受邪、二日受邪，是依次而言的，并非固定不变的日期。领悟圣经，应当不要因辞害意。
（白话）大邪之气全部散去，疾病的日子也就结束了。《素问·调经论》说：治疗实证，是通过打开邪气外出的门户，使大邪之气受挫。《素问·五色》篇说：如果大邪之气深入脏腑，人虽无明显病症却会突然死亡。简注：这两处提到的“大气”均指大邪之气。高世栻说：那些没有发生“两感于寒”的经脉热病，通常以七天为一个周期，随着病势衰退而痊愈。由此可见，上文所说的第一天受邪、第二天受邪，是按顺序描述的，并非绝对固定的天数。研读经典，应当领会精神实质，不要拘泥于字面意思而误解原意。
（原文）通其脏脉。张云：谓当随经分治也。志云：谓手足三阴三阳之经脉。高云：脏脉，如上文太阴脾脏之脉，少阴肾脏之脉，厥阴肝脏之脉也。
（白话）疏通其内脏的经脉。张景岳说：意思是应当根据经络分别进行治疗。张志聪说：指的是手足三阴和三阳的经脉。高世栻说：脏脉，就像上文提到的足太阴脾经之脉、足少阴肾经之脉、足厥阴肝经之脉。
（原文）可泄而已。张云：凡是传经的邪气，未满三天的，邪气在表，所以可以用发汗法；已满三天的，邪气传入里，所以可以用泻下法。吴崑在此处补上了“若其寒邪，传不以次，与夫专经不传，表里变易，则随证脉处治，吐下汗和，蚤暮异法”三十二个字，说是希望人们能够通权达变。简按：王冰引用《伤寒论》，意义颇为明显。如果想要人们通权达变，那就有张仲景的《伤寒论》在那里，岂是这三十二个字所能概括的？这不啻是画蛇添足，大概是妄加。薛雪《原旨》说：考察伤寒一证，传变无穷无尽，这里不过讲述传经的常法，而未涉及变法。自张仲景以后，各位大家都有名言可供效法，学人应当尽读并深思。然而义理多出于张仲景，对于张仲景的书，又应当闭门深求。
（白话）可以使用泻下法治愈。张景岳说：凡是经过传变的邪气，病程未满三天的，邪气还在体表，因此可以使用发汗法；病程已满三天的，邪气已传入体内，因此可以使用泻下法。吴崑在此处补充了“如果寒邪传变没有固定次序，或者只在某一经不传变，表里发生变化，则应根据证候和脉象进行治疗，运用催吐、泻下、发汗、和解等方法，早晚用药亦有不同”这三十二个字，声称这是希望医者能够灵活变通。简注：王冰引用《伤寒论》的观点，意义已经很明确了。如果意在强调灵活变通，张仲景的《伤寒论》早已详述，哪里是这三十二个字就能涵盖的呢？这简直是画蛇添足，可能是后人妄加的。薛雪在《医原》中说：考察伤寒病，传变情况无穷无尽，本文此处仅讲述传经的一般规律，并未涉及特殊情况。自张仲景之后，众多医家都有值得学习的精辟见解，学习者应当广泛阅读并深入思考。然而大部分医理源自张仲景，对于《伤寒论》这部著作，更应当潜心钻研。
（原文）遗。志云：《伤寒论》说：大病痊愈后劳复的，用枳实栀子汤主治。如果有宿食的，加大黄如博棋子五六枚。这是因为伤寒热盛的时候勉强进食，所以留有宿食。简按：遗，是《礼记·乐记》中“遗音遗味”的遗。郑玄注：遗，犹余也。大概与此义相同。童涵春《活人指掌辨疑》说：遗字的注解有很多不同。《活人书》注解说，是指大便不禁。或者说，遗，是亡失的意思。其人必定是大便不禁。这些都不对。我认为遗，就像把东西送给人的“遗”（wèi），也就是司马光所说的“积德以遗后人”的遗。意思是当病情稍有好转时，邪气未尽去除，胃气尚未恢复，吃肉的人，后来会复发；多吃的人，后来会遗留病根，即将痊愈却好不了。
（白话）遗留（宿食/病根）。张志聪说：《伤寒论》中提到：大病初愈后因劳累而复发的，主治方剂是枳实栀子汤。如果体内有积滞的宿食，则加入大黄，用量约为五六枚博棋大小。这是因为在伤寒高热期间勉强进食，导致食物停滞成为宿食。简注：“遗”字，取自《礼记·乐记》中“遗音遗味”的用法。郑玄注释说：“遗”意思是剩余。此处含义与此相同。童涵春在《活人指掌辨疑》中指出：关于“遗”字的解释众说纷纭。《南阳活人书》的注解认为是指大小便失禁。另一种说法认为，“遗”通“亡”，指人必定会出现大便失禁的症状。这些解释都是错误的。我认为，“遗”应理解为动词“赠送”（音wèi），如同司马光所言“积德以遗后人”中的“遗”。其含义是：在病情刚刚好转之际，邪气尚未完全清除，胃气也未完全恢复，此时若食用肉类，日后容易复发；若进食过多，日后会遗留病根，导致疾病迁延不愈，难以彻底康复。
（原文）强食之。甲乙经无“之”字。仲景说：病人脉象已经平和，但傍晚时分轻微心烦的，是因为病刚痊愈，别人强迫他进食，脾胃之气还很虚弱，不能消化食物，所以导致轻微心烦。减少饮食就会痊愈。又说：吐利发汗后，脉象平静但有轻微心烦的，是因为病刚痊愈，不胜谷气所致。
（白话）勉强进食。《甲乙经》中没有“之”字。张仲景说：如果病人的脉象已经恢复正常，但在傍晚时分感到轻微心烦，这是因为病刚好转，旁人强迫其进食，而脾胃之气依然虚弱，无法运化食物，从而导致轻微的心烦。只要减少饮食摄入，症状就会痊愈。他又说：经过呕吐、腹泻或发汗治疗后，脉象虽已平稳但仍感轻微心烦，这是因为病后初愈，身体还不能适应食物的营养（谷气）。
（原文）调其逆从。志云：脉浮的，用发汗法解除；脉沉的，用泻下法解除。这就叫做调其逆从。高云：观察其经脉的虚实，调节其阴阳的逆从。
（白话）调理气机的逆乱与顺从。张志聪说：脉象浮的，采用发汗法治疗；脉象沉的，采用泻下法治疗。这就叫做调理气机的逆顺。高世栻说：审视经脉的虚实状况，调节阴阳气血的逆乱与顺承。
（原文）食肉则复。马云：肉本性热且难消化，所以热病复发。志云：肉，指猪肉。猪是水畜，性寒冷，所以多吃则会遗留病根。简按：应当遵从马注。
（白话）吃肉类会导致疾病复发。马莳说：肉类性质偏热且难以消化，因此会导致热病复发。张志聪说：这里的“肉”特指猪肉。猪属于水性动物，性质寒凉，所以多吃会导致病邪遗留。简注：应当采纳马莳的注释。
（原文）谵言。甲乙经、《外台秘要》作“谵语”。简按：谵，又作“譫”，并读“之廉切”，音詹。考证字书，意义略有不同。《集韵》：谵，多言也。譫，疾而寐语也。然而医书中两者互用。刘奎将二者分为两个意义，非常错误。
（白话）胡言乱语。《甲乙经》和《外台秘要》中写作“谵语”。简注：“谵”字，又写作“譫”，读音均为“之廉切”，音同“詹”。查阅字书，两者的意义略有差异。《集韵》解释：“谵”指多说话；“譫”指病重时胡言乱语。但在医籍中，这两个字经常通用。刘奎将二者严格区分开来，认为是两种不同的含义，这是非常错误的。
（原文）不知人，六日死。《外台秘要》作“不知人则六日而死”。滑寿说：六日，应当作三日。下文可见。徐灵胎相同。简按：下文说“如是之后，三日乃死”，那么作“六日”的不是字形错误。意思是到了第三天，少阳与厥阴同时发病……三阴三阳全部受病，水浆不进，昏迷不知人，像这样的情况持续三天，总共在第六天左右就会死亡。
（白话）神志不清，六天后死亡。《外台秘要》中写作“神志不清则六天后死亡”。滑寿说：这里的“六日”，应当理解为“三日”。可以从下文得到验证。徐灵胎持相同观点。简注：查看下文提到“像这种情况之后，再过三天就会死亡”，因此原文作“六日”并非笔误。其含义是：到了第三天，少阳经和厥阴经同时发病……此时三阴三阳全部受病，患者无法进水进食，昏迷不醒，像这样的状态持续三天，总计在第六天左右便会死亡。
（原文）三日乃死。吴云：故“不知人三日”六字为一句。张云：如是之后，三日乃死，意思是两感传遍之后，再过三天才死。大概就是六日的含义。高云：乃死，不是立即死亡。简按：朱肱《活人书》说：两感病，张仲景没有治疗方法，只说两感病同时发作，治疗有先后顺序。伤寒攻下后，又腹泻不止，身体疼痛的，紧急应当救里，宜用四逆汤。如果身体疼痛缓解，大小便正常，紧急应当救表，宜用桂枝汤。大概本经的三阴证，并是张仲景所谓的胃家实证，不应用彼处理论来类比此处。应当考证《伤寒论》。
（白话）再过三天才会死亡。吴崑说：因此“不知人三日”这六个字构成一个句子。张景岳说：上述情况之后，再过三天才会死亡，意思是表里两经的病邪传遍之后，又过了三天才去世。这其实就是六日死亡的总括。高世栻说：“乃死”并不意味着立刻死亡。简注：朱肱在《南阳活人书》中指出：对于两感于寒的病证，张仲景未提供具体治法，仅指出两感病同时发作，治疗需分先后。若伤寒误下后，出现腹泻不止且身体疼痛，应紧急温里，适宜使用四逆汤；若身体疼痛消失，二便调畅，则应紧急解表，适宜使用桂枝汤。大抵《内经》本篇所述的三阴证，实质上对应张仲景所说的“胃家实”证，不应简单套用其他理论来类比此处。研究者应当仔细考证《伤寒论》。
（原文）病温。《生气通天论》说：冬天伤害于寒邪，春天必定发生温病。《金匮真言论》说：精，是身体的根本。所以冬天能固藏精气的人，春天就不会得温病。仲景说：太阳病，发热且口渴，不怕冷的，称为温病。（详见《金匮真言论》。）
（白话）发生温病。《素问·生气通天论》说：如果在冬季感受了寒邪，到了春季必然会患上温病。《素问·金匮真言论》说：精气是生命的根本。因此，冬季善于保养精气的人，春季就不会罹患温病。张仲景说：太阳病中，如果出现发热、口渴且不恶寒的症状，就诊断为温病。（详见《素问·金匮真言论》。）
（原文）病暑。滑寿说：此处的“病暑”，与“病瘅”不同。“病暑”就是热病，适宜发汗。“病瘅”则不宜发汗。张云：寒邪中人，而成温病、暑病的，在时令上是以夏至前后来说的，在病症上是以热的轻重来说的。所以凡是温病、暑病，都属于伤寒。简按：温病、暑病，都是热病，只是因季节不同而名称各异。考据《灵枢·论疾诊尺》篇说：冬伤于寒，春生瘅热。张云：即温热之病，其义可以概见。至于说是因为热的轻重不同，恐怕不对。
（白话）发生暑病。滑寿说：这里的“病暑”，与“病瘅”不同。“病暑”就是指热病，适合采用发汗法治疗。“病瘅”则不适合发汗。张景岳说：寒邪侵入人体，进而发展为温病或暑病，从时令角度看，是以夏至前后为界；从病情角度看，是以热势的轻重来区分。因此，所有的温病和暑病，本质上都属于伤寒范畴。简注：温病和暑病，本质上都是热病，仅仅是因为发生的季节不同而得名。查阅《灵枢·论疾诊尺》篇记载：冬季感受寒邪，春季会产生瘅热。张景岳认为：这就是温热类的疾病，其中的道理可以由此推知。至于将其区别归结为热势的轻重程度，恐怕并不准确。
（原文）与汗。简按：与，给予也。《玉函经总例》说：仲景说：不需要发汗却强行发汗的，会耗夺津液；需要发汗却不给发汗的，会使毛孔闭塞。
（白话）给予发汗法。简注：“与”字意为给予、施用。《伤寒论·玉函经总例》中说：张仲景指出：如果不需要发汗却强行使用发汗法，会耗损人体的津液；如果需要发汗却没有及时给予发汗治疗，会导致毛孔闭塞，邪气无法排出。
Wu Yun: "Jie" (Explain) means to interpret. This section aims to explain the pathology of the Yangming meridian.
(Text) Zhu Rou (Governs flesh/muscle). Jia Yi Jing (Classic of A-Bio Acupuncture and Moxibustion) reads "Ji Rou" (Muscle). Jian An: Xin Zheng Xiao (New Corrections) states that "Mai" (Pulse/Meridian) should be "Ji" (Flesh/Muscle), which is a textual error.
(Vernacular Translation): The meridian governs the muscles. In the *Jia Yi Jing*, it is written as "muscles." Note: According to the *Xin Zheng Xiao* corrections, the character "Mai" (Meridian) is an error for "Ji" (Flesh/Muscle).
(Text) Wan (Depression/Gloom). Jia Yi Jing reads "Men" (Oppression/Stuffy). Pronunciation explanation: "Wan" is pronounced "Wu Guan Qie." Jian An: *Ji Yun* (Collection of Rhymes) states that "Wan," "Yun" (Resentment), and "Wan" (Curve/Lie) are synonymous, pronounced "Yu" (Depressed), referring to the accumulation of qi in the heart. This aligns with Wang Bing's commentary. If read as "Wu Guan Qie," it implies shock, hatred, or astonishment. Zhang Zhicong says it refers to a look of fear and panic. Gao Shixi says it refers to startled looking around. Both interpretations deviate from the original intent of the classic.
(Vernacular Translation): The character "Wan" is written as "Men" in the *Jia Yi Jing*. Regarding pronunciation: "Wan" corresponds to the phonetic spelling "Wu Guan Qie." Note: According to the *Ji Yun*, "Wan," "Yun," and "Wan" share the same meaning and pronunciation "Yu," denoting mental depression or stagnation of qi. This matches Wang Bing's annotation. Reading it as "Wu Guan Qie" would imply meanings of shock, resentment, or amazement. Zhang Zhicong interprets it as a fearful expression, while Gao Shixi interprets it as startled glancing; both diverge from the classical meaning.
(Text) Yang Sheng (Yang Excess). Jia Yi Jing reads "Xie Sheng" (Pathogenic Excess).
(Vernacular Translation): Yang excess. The *Jia Yi Jing* version reads "pathogenic excess."
(Text) Ma Li (Cursing/Scolding). *Yun Hui* (Rhyme Compilation) states: Directly rebuking is called "Ma"; implicating others is called "Li." *Yi Qie Jing Yin Yi* (Sound and Meaning of All Sutras) states: "Li" also means scolding. Current interpretation: Using abusive language is "Ma"; slander and cursing is "Li."
(Vernacular Translation): "Ma Li" (Cursing and Scolding). The *Yun Hui* distinguishes them: direct verbal abuse is "Ma," while indirect slander or cursing is "Li." The *Yi Qie Jing Yin Yi* notes that "Li" is synonymous with scolding. Modern interpretation defines "Ma" as using foul language and "Li" as slandering or casting spells/curses.
(Text) Bu Yu Shi (No desire to eat), Bu Yu Shi Gu Wang Zou (Due to no desire to eat, one wanders aimlessly). Wu Ben (Wu Kun's edition) changes the character "Shi" (Ten) to "Ge" (Sing). Jian An: The interrogative context supports this; one should follow Wu Ben.
(Vernacular Translation): Lack of appetite leads to aimless wandering. Wu Kun's edition alters the character "ten" to "sing." Note: The grammatical structure of the question supports Wu Kun's reading; therefore, his version should be adopted.
Ma Yun: The chapter begins by stating that heat diseases belong to the category of Shanghan (Cold Damage), hence it is named "Re Lun" (Treatise on Heat).
(Vernacular Translation): Ma Shi explains that since the chapter opens by categorizing heat diseases under Shanghan, it is titled "Treatise on Heat."
(Text) Jin Fu Re Bing (Now, regarding heat disease). Jia Yi Jing and Wai Tai Mi Yao (Essential Prescriptions of the Imperial Library) omit the character "Jin" (Now).
(Vernacular Translation): Concerning current heat diseases. The characters "Jin" (Now) are absent in the *Jia Yi Jing* and *Wai Tai Mi Yao*.
(Text) Shanghan Zhi Lei Ye (They are of the Shanghan category). Zhang Yun: Shanghan refers to contracting the severe yin-cold pathogenic qi. Cold is prevalent in winter; contracting it and falling ill immediately is Shanghan. If not ill immediately, it becomes Wenbing (Warm Disease) in spring and Shubing (Summerheat Disease) in summer. However, pathogenic qi from any season that causes immediate illness is also called Shanghan. When cold pathogen binds the muscle surface, the Xu Fu (pores/sweat glands) close, yang qi cannot disperse, and thus stagnates into heat. Therefore, all external contraction fevers belong to the Shanghan category. Ma Yun: In the *Shui Re Xue Lun* (Treatise on Water and Heat Acupoints), the Yellow Emperor asks: Why does cold injury transmit into heat? Qibo answers: Severe cold generates heat. Furthermore, Wang Bing’s commentary here forcibly interprets this using the concept from the *Shanghan Lun* that cold transforms into heat disease in summer, which is inappropriate. Generally, cold injury does not fail to transform into heat. This applies not only to summer heat diseases. Jian An: Wang Bing cites the *Shanghan Li* (Example of Cold Damage), writing "Shubing" as "Re Bing." The *Nan Jing* (Classic of Difficult Issues) Chapter 58 asks: How many types of Shanghan are there? Does the pulse change? It answers: There are five types of Shanghan: Fengzhong (Wind Strike), Shanghan, Shiwen (Damp-Warmth), Re Bing, and Wenbing. Their symptoms differ. Thus, Fengzhong, Shanghan, Shiwen, Re Bing, and Wenbing were collectively termed Shanghan in antiquity. Therefore, Wang Bing’s commentary cannot be discarded.
(Vernacular Translation): They fall under the category of Shanghan. Zhang Jingyue states: Shanghan involves contracting severe yin-cold pathogens. Winter is the season of extreme cold; immediate illness upon exposure is Shanghan. Delayed onset manifests as Warm Disease in spring and Summerheat Disease in summer. Additionally, pathogens from irregular seasonal conditions causing immediate illness are also classified as Shanghan. Cold binding the exterior closes the pores, trapping yang qi which stagnates and transforms into heat. Thus, all exogenous febrile diseases are categorized under Shanghan. Ma Shi references the *Shui Re Xue Lun*: The Yellow Emperor asks why cold transforms into heat; Qibo replies that extreme cold generates heat. Wang Bing’s interpretation here, linking it to summer heat transformation in the *Shanghan Lun*, is forced. Fundamentally, cold injuries invariably transform into heat. This principle extends beyond just summer heat diseases. Note: Wang Bing’s citation of the *Shanghan Li* equates Summerheat Disease with Heat Disease. The *Nan Jing* classifies five types of Shanghan: Wind Strike, Cold Damage, Damp-Warmth, Heat Disease, and Warm Disease. Historically, these were collectively referred to as Shanghan. Thus, Wang Bing’s commentary retains validity.
(Text) Ju Yang Zhe Zhu Yang Zhi Shu Ye, Qi Mai Lian Yu Feng Fu, Gu Wei Zhu Yang Zhu Qi Ye (The Greater Yang is the leader of all yang meridians; its vessels connect to the Fengfu point, thus it governs the qi of all yang). Ju. Jia Yi Jing reads "Tai" (Great), same below. Zhang Yun: Taiyang is the head of the six meridians, commanding the yang divisions, so all yang meridians belong to it. The Taiyang meridian covers the vertex and back exterior, thus governing the qi of all yang. Zhi Yun: "Shu" means convergence, implying Taiyang is the convergence of all yang. Hua Shou’s edition moves these twenty characters to below "Shanghan Day One: Taiyang Receives It," aligning better with the text flow. (*Zisheng Jing* quotes this section under Fengfu: Thus, Fengfu is indeed where Shanghan originates. Northerners wrap their heads in fur; southerners with weak constitutions use cloth to protect the neck, known as the triangular scarf. Weak individuals must protect the neck.)
(Vernacular Translation): The Foot-Taiyang Bladder Meridian is the chief of all yang meridians; its pathway connects to the Fengfu acupoint, making it the master of yang qi. "Ju" is written as "Tai" in the *Jia Yi Jing*. Zhang Jingyue explains: Taiyang leads the six meridians and controls the yang aspect, so all yang meridians are subordinate to it. Its pathway covers the head and back, governing yang qi. Zhang Zhicong notes "Shu" means meeting, signifying Taiyang as the hub of yang. Hua Shou rearranges this passage for better logical flow. Note: The *Zisheng Jing* cites this under the Fengfu acupoint, emphasizing its role as the entry point for cold pathogens and the importance of protecting the neck in vulnerable populations.
(Text) Shanghan Yi Ri Ju Yang Shou Zhi (On the first day of Shanghan, Taiyang receives the pathogen). Zhang Yun: Examining the meridians, three yang are exterior, three yin are interior. Order of three yang: 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 are exterior. Order of three yin: Taiyin is the third yin, following Shaoyang; Shaoyin is the second yin, following Taiyin; Jueyin is the first yin, following Shaoyin. These three yin are interior. The numbering proceeds from inside out. Similarly, pathogens enter from outside in: skin -> collaterals -> main vessels -> zang-fu. Hence, pathology starts at Taiyang. Jian An: Wu Kun adds "because its vessel passes through the head, neck, and along the spine" (nine characters); this addition is inadvisable.
(Vernacular Translation): On the first day of Cold Damage, the Taiyang meridian is affected. Zhang Jingyue outlines the sequence: Taiyang (3rd Yang), Yangming (2nd Yang), Shaoyang (1st Yang) constitute the exterior; Taiyin (3rd Yin), Shaoyin (2nd Yin), Jueyin (1st Yin) constitute the interior. Pathogens invade from exterior to interior, starting with the skin and Taiyang meridian before affecting deeper organs. Note: Wu Kun’s interpolation regarding the meridian pathway is considered unnecessary by the annotator.
(Text) Tou Xiang Tong, Yao Ji Qiang (Head and nape pain, stiffness of waist and spine). Zhang Yun: Shanghan usually begins with Taiyang... (Same as Wang Bing). Thus, symptoms present this way. Zhongjing says: Taiyang disease features floating pulse, stiff/painful head and nape, and aversion to cold. Xin Zheng Xiao: Jia Yi Jing and Tai Su read "Head, nape, and waist are all stiff." Jian An: Current Jia Yi Jing reads "Waist and back stiff."
(Vernacular Translation): Headache, nuchal rigidity, and stiffness of the lower back and spine. Zhang Jingyue notes that Shanghan typically initiates in the Taiyang channel. Zhang Zhongjing describes Taiyang syndrome as presenting with a floating pulse, stiffness and pain in the head and neck, and aversion to cold. Textual variants exist, with some editions specifying stiffness in the waist and back.
(Text) Shen Re (Body heat). Zhang Yun: Shanghan often involves fever, but specifically mentioning "body heat" here is because Yangming governs the muscles, making body heat particularly intense. Pathogenic heat in the stomach causes irritability, leading to inability to sleep. Zhongjing says: Yangming disease is characterized by "Stomach House Excess" (Fu organ excess).
(Vernacular Translation): Generalized body heat. Zhang Jingyue explains that while fever is common in Shanghan, the specific mention of "body heat" highlights Yangming’s association with the muscles, resulting in prominent heat. Stomach heat causes restlessness and insomnia. Zhongjing defines Yangming disease as an excess condition of the fu organs.
(Text) Bu De Wo (Inability to lie down/rest). *Tiao Jing Lun* says: Yangming is the stomach meridian; its qi descends. If Yangming qi rebels and fails to descend, one cannot lie down.
(Vernacular Translation): Insomnia or inability to assume a supine position. The *Tiao Jing Lun* attributes this to rebellious Yangming qi failing to descend normally.
(Text) Shao Yang Zhu Dan (Shaoyang governs the Gallbladder). Xin Zheng Xiao cites Quan Yuanqi, Tai Su, and Jia Yi Jing reading "Zhu Gu" (Governs Bone). Jian An: *Bing Yuan* also reads "Governs Bone"; only *Wai Tai Mi Yao* reads "Gallbladder." *Wai Tai Mi Yao* cites this from Volume 9. New Corrections note the full text is in Volume 5. Likely Wang Bing changed "Bone" to "Gallbladder," and Song editors followed suit. *Ling Shu* states "Gallbladder governs bone." Just as Yangming is said to govern flesh rather than stomach, Shaoyang should govern bone. Exterior to Interior: Skin (Taiyang) -> Flesh (Yangming) -> Bone (Shaoyang). This fits the Half-Exterior/Half-Interior classification. Changing "Gallbladder" to "Bone" makes more sense. Zhang Yun: Shaoyang is Half-Exterior/Half-Interior. Pathology includes hypochondriac pain and deafness. Zhongjing: Shaoyang disease features sour taste, dry throat, vertigo, alternating chills and fever. Cheng Wuji: Shaoyang pathogen resides between exterior and interior.
(Vernacular Translation): Shaoyang governs the Gallbladder. However, earlier texts like *Tai Su* read "Governs Bone." The annotator argues that "Bone" is likely the original term, consistent with the *Ling Shu* and the progression from Skin (Taiyang) to Flesh (Yangming) to Bone (Shaoyang). This structural view supports Shaoyang as the Half-Exterior/Half-Interior stage. Symptoms include hypochondriac fullness, deafness, bitter taste, dry throat, and vertigo.
(Text) Wei Ru Yu Zang Zhe (Not yet entered the Zang organs). Jian An: Based on Xin Zheng Xiao, Full Text and Tai Su read "Fu" (Fu organs). Jia Yi Jing and Shanghan Li also read "Fu." Only Wai Tai Mi Yao reads "Zang." Likely a Song dynasty correction. Context: "Less than 3 days, sweat; more than 3 days, purge." Exterior (Yang/Fu) treated by sweating; Interior (Yin/Zang) treated by purging. If following Zhongjing, it should be "Fu." But Wang Bing changed it to "Zang" to fit the simple Sweat/Purge dichotomy. Li Dongyuan argues "Zang" means storage, not the five zang organs. Zhang Zhicong argues "Zang" means interior/yin. He states yang meridians are affected by yang heat but remain in the exterior/form, treatable by sweating. This interpretation is superior.
(Vernacular Translation): The pathogen has not yet entered the Zang organs. Textual evidence suggests the original word was "Fu" (organs). Wang Bing likely changed it to "Zang" (organs) to emphasize the distinction between exterior (treatable by sweating) and interior (treatable by purging). Zhang Zhicong interprets "Zang" broadly as the interior/yin aspect, arguing that while yang meridians are affected, the pathogen remains superficial enough to be resolved via sweating.
(Text) Si Ri Tai Yin Shou Zhi (On the fourth day, Taiyin receives it). Zhang Yun: If exterior pathogen is not resolved by sweating, it enters the interior, starting with Taiyin. Zhongjing: Taiyin disease features abdominal fullness, vomiting, poor appetite, diarrhea, and abdominal pain. Jian An: The Nei Jing’s discussion of Three Yin diseases corresponds to Zhongjing’s Yangming excess (purgeable). Zhongjing’s Three Yin diseases are cold-deficiency patterns, not discussed here. Zhang’s comparison is flawed. Same for Shaoyin and Jueyin.
(Vernacular Translation): On the fourth day, the Taiyin meridian is affected. Zhang Jingyue links this to the transmission from exterior to interior. Zhongjing describes Taiyin syndrome with digestive symptoms. The annotator notes a discrepancy: the *Nei Jing* focuses on excess heat patterns (similar to Yangming), whereas Zhongjing’s Taiyin syndrome is typically a cold-deficiency pattern.
(Text) Luo Yu Fei (Connects to the Lung). Jia Yi Jing, Bing Yuan, Wai Tai Mi Yao omit "Yu".
(Vernacular Translation): The meridian connects to the Lung. Some editions omit the preposition "to."
(Text) Liu Ri Jue Yin Shou Zhi (On the sixth day, Jueyin receives it). Jian An: Fang Youzhi argues days represent sequence, not fixed duration. Zhang Yun: Shanghan transmission discusses only Foot meridians. Hand meridians are omitted because Foot meridians cover the whole body. Liu Wansu’s theory of "Foot only" is criticized by Zhang as incomplete, but Zhang admits the text focuses on Foot meridians to describe systemic exterior signs.
(Vernacular Translation): On the sixth day, the Jueyin meridian is affected. Fang Youzhi interprets the days as a sequential order rather than a strict timeline. Zhang Jingyue explains that the text focuses on the Foot meridians as they encompass the systemic circulation, rendering explicit mention of Hand meridians redundant for describing exterior syndromes.
(Text) Fan Man Er Nang Suo (Irritability, fullness, and retraction of the scrotum). Jian An: "Man" equals "Men" (oppression). Miao Xizhong notes women may have nipple retraction instead. Li Chan notes women may have vaginal pain pulling to the lower abdomen. Wu Kun adds "Three Yin meridians affected, entered Fu, can purge." Annotator rejects "Fu" for Three Yin, prefers "Zang."
(Vernacular Translation): Mental agitation, chest/abdominal fullness, and retraction of the genitalia. The annotator clarifies that "fullness" implies oppression. Clinical manifestations in females may differ (e.g., nipple retraction or pelvic pain). Wu Kun’s addition suggesting purification therapy for Three Yin is rejected as anatomically inconsistent; "Zang" is preferred over "Fu."
(Text) Wu Zang Bu Tong Ze Si Yi (If the Five Zang do not communicate, death ensues). Gao Yun: "Ze" means "then/immediately." Summarizes Three Yin disease. Not necessarily Day 4-6. All Yin/Yang, Zang/Fu can be affected simultaneously, stopping Ying-Wei circulation, leading to death. Worse than "Liang Gan" (Double Exposure).
(Vernacular Translation): Blockage of the Five Zang organs leads to death. Gao Shixi interprets this as a critical summary where multiple systems fail simultaneously, halting vital circulation (Ying and Wei), resulting in mortality more severe than standard double-exposure cases.
(Text) Ke Zhi Bu Man (Thirst stops, no fullness). Jia Yi Jing and Shanghan Li omit "Bu Man". Jian An: Previous text didn't mention abdominal fullness; "Bu Man" is likely a scribal error.
(Vernacular Translation): Thirst ceases, and abdominal distension resolves. The phrase "no fullness" appears to be a textual corruption, as abdominal fullness was not previously mentioned.
(Text) Er Ti (And sneezing). *Kou Wen* says: Harmonious yang qi causes sneezing.
(Vernacular Translation): Sneezing occurs when yang qi becomes harmonious and unobstructed.
(Text) Da Qi Jie Qu, Bing Ri Yi Yi (The great pathogen departs, the disease days end). *Tiao Jing Lun*: Purging excess opens the door, defeating the great pathogen. *Se Wu Pian*: Great pathogen entering Zang-Fu causes sudden death without prior illness. Gao Yun: Non-Liang Gan heat diseases resolve in 7-day cycles. Days 1-6 are sequential, not fixed deadlines. Do not let words obscure the meaning.
(Vernacular Translation): Once the major pathogen is expelled, the disease resolves. The seven-day cycle indicates a pattern of decline rather than a rigid deadline. Interpretation should focus on the underlying principles rather than literal day counts.
(Text) Tong Qi Zang Mai (Unblock the Zang pulses). Zhang Yun: Treat according to the specific meridian. Zhi Yun: Hand and Foot Yin/Yang meridians. Gao Yun: Refers to pulses of Spleen, Kidney, Liver.
(Vernacular Translation): Unblock the pulses of the Zang organs. This implies treating the specific meridians involved, such as those of the Spleen, Kidney, and Liver.
(Text) Ke Xie Er Yi (Can be resolved by purging). Zhang Yun: <3 days, exterior, sweat; >3 days, interior, purge. Wu Kun adds 32 characters about flexible treatment (vomiting, purging, sweating, harmonizing) based on pulse/symptoms. Jian An: Wang Bing’s reference to *Shanghan Lun* is clear. Adding Wu Kun’s text is superfluous. Xue Yue: Transmission is infinite; this text describes normal transmission. Study Zhongjing’s works deeply.
(Vernacular Translation): Purging is indicated. Zhang Jingyue distinguishes treatment based on duration (<3 days exterior/sweat, >3 days interior/purge). Wu Kun’s addition emphasizes clinical flexibility. The annotator criticizes this addition as redundant, urging reliance on Zhongjing’s comprehensive framework.
(Text) Yi (Leftover/Remnant). Zhi Yun: Cites *Shanghan Lun* regarding recurrence after illness due to forced eating (remnant food). Jian An: "Yi" means remainder (from *Li Ji*). Tong Hanchun: "Yi" means leaving behind pathology. When recovering, if qi is weak, eating meat causes recurrence; overeating leaves residual disease.
(Vernacular Translation): Residual pathogen or dietary retention. The term "Yi" denotes remnants. Tong Hanchun explains that improper diet during recovery can leave residual pathogens or cause relapse.
(Text) Qiang Shi Zhi (Forcefully eating). Jia Yi Jing omits "Zhi". Zhongjing: Post-illness mild vexation at dusk is due to forcing food on a weak spleen/stomach. Reduce intake to heal. Also, post-vomit/purge mild vexation is due to inability to handle grain qi.
(Vernacular Translation): Forcing food intake. Zhongjing advises that post-illness discomfort arises from overwhelming a weakened digestive system; reducing food intake promotes recovery.
(Text) Tiao Qi Ni Cong (Regulate rebellion and compliance). Zhi Yun: Floating pulse -> sweat; Deep pulse -> purge. This is regulating rebellion/compliance. Gao Yun: Observe deficiency/excess, regulate yin/yin rebellion.
(Vernacular Translation): Regulate the flow of qi, addressing both rebellious (ascending/excess) and compliant (descending/deficient) states through appropriate therapies like sweating or purging.
(Text) Shi Rou Ze Fu (Eating meat causes recurrence). Ma Yun: Meat is hot and hard to digest, causing heat disease recurrence. Zhi Yun: Pork is cold/water-associated, causing residual disease if overeaten. Jian An: Follow Ma Yun.
(Vernacular Translation): Consuming meat may trigger relapse. Ma Shi attributes this to meat’s heating nature and difficulty in digestion.
(Text) Zhan Yan (Delirious speech). Jia Yi Jing/Wai Tai Mi Yao read "Zhan Yu". Jian An: "Zhan" means talking much; "Zhan" (variant) means sleeping talk. Medical texts use them interchangeably. Liu Kui’s distinction is erroneous.
(Vernacular Translation): Delirious speech. The terms are used interchangeably in medical literature to describe incoherent speech associated with high fever or altered consciousness.
(Text) Bu Zhi Ren, Liu Ri Si (Unconscious, dies on the 6th day). Wai Tai Mi Yao: "Unconscious, then dies on the 6th day." Hua Shou: "Six" should be "Three." Jian An: Text says "After this, three days then dies." So "Six" is not a typo. It means Day 3 (Shaoyang/Jueyin involvement) + 3 days = Day 6 total death.
(Vernacular Translation): Loss of consciousness leading to death on the sixth day. The timeline accounts for the initial three days of transmission plus three additional days of critical decline.
(Text) San Ri Nai Si (Three days later, then dies). Wu Yun: "Bu Zhi Ren San Ri" is one sentence. Zhang Yun: After transmission completes, three more days pass before death. Equivalent to six days. Gao Yun: "Nai Si" means eventually dies, not instantly. Zhu Gong: Zhongjing lacks treatment for Liang Gan. Prioritize interior/exterior. Nei Jing’s Three Yin resembles Zhongjing’s Yangming Excess. Consult *Shanghan Lun*.
(Vernacular Translation): Death occurs three days after the onset of unconsciousness. This confirms the six-day total timeline. Treatment strategies for such critical stages require careful differentiation, as referenced in the *Shanghan Lun*.
(Text) Bing Wen (Contracting Warm Disease). *Sheng Qi Tong Tian Lun*: Winter cold injury leads to Spring Warm Disease. *Jin Gui Zhen Yan Lun*: Essence is root; storing essence in winter prevents Spring Warm Disease. Zhongjing: Taiyang disease with fever, thirst, no aversion to cold is Warm Disease.
(Vernacular Translation): Contracting Warm Disease. Etiology links winter cold injury to spring warmth. Preservation of essence in winter is preventive. Clinically, Warm Disease presents with fever, thirst, and absence of aversion to cold.
(Text) Bing Shu (Contracting Summerheat). Hua Shou: "Bing Shu" differs from "Bing Dan." "Bing Shu" is Heat Disease, treatable by sweating. "Bing Dan" is not. Zhang Yun: Timing (around Summer Solstice) and severity define Shu vs. Wen. Both are Shanghan. Jian An: Wen and Shu are Heat Diseases, named by season. *Ling Shu*: Winter cold -> Spring Dan Heat. Zhang: Means Warm-Heat disease. Severity distinction is doubtful.
(Vernacular Translation): Contracting Summerheat Disease. Distinctions are made based on seasonal timing and symptom severity. Both Warm and Summerheat diseases are subtypes of heat pathology originating from cold injury.
(Text) Yu Han (Give sweating). Jian An: "Yu" means give/administer. *Yu Han Jing*: Zhongjing warns against forced sweating (depletes fluids) or withheld sweating (closes pores).
(Vernacular Translation): Administering sweating therapy. Caution is advised against inappropriate use, which can either deplete fluids or trap pathogens.