伤寒。外感百病之总名也。有小证。有大证。有新感证。有伏气证。有兼证。有夹证。有坏证。有复证。
传变不测。死生反掌。非杂病比。奈扁鹊难经但言伤寒有五。一曰中风。二曰伤寒。三曰湿温。四曰热病。
五曰温病。仅载脉候之异同。并无证治之陈列。语焉不详。后学何所根据。惟中风自是中风。伤寒自是伤寒。
湿温自是湿温。温热自是温热。已可概见。然皆列入伤寒门中者。因后汉张仲景。着《伤寒杂病论》。当时不传于世。
至晋王叔和。以断简残编。补方造论。混名曰《伤寒论》。而不名曰四时感证论。从此一切感证。通称伤寒。从
古亦从俗也。予亦从俗。名曰《通俗伤寒论》。
人皆谓百病莫难于伤寒。予谓治伤寒何难。治伤寒兼证稍难。治伤寒夹证较难。治伤寒复证更难。治伤寒坏证
最难。盖其间寒热杂感。湿燥互见。虚实混淆。阴阳疑似。非富于经验。而手敏心灵。随机应变者。决不足
当此重任。日与伤寒证战。谚云熟读王叔和。不如临证多。非谓临证多者不必读书也。亦谓临证多者乃为
读书耳。国初喻嘉言尝云、读书无眼。病患无命。旨哉言乎。予业伤寒专科。四十余年矣。姑以心得者。历言其要。
太阳经主皮毛。阳明经主肌肉。少阳经主腠理。太阴经主肢末。少阴经主血脉。厥阴经主筋膜。
【荣斋按】“六经形层”这个名词，是根据周学海“与友条论读伤寒论法”第五、九、十一条而产生的。
“六经”在伤寒论学说上，是一个根深蒂固的道统术语。本节把六经假定作机体方面的六个层次，虽然说不出
充分理由，但在病理上的某一分野里用它暂作“代号”，是应该的。恽铁樵先生曾这样说∶“六经者，就人体
所着之病状为之界说者也。”日人鹤冲元逸在“医断”里也说∶“伤寒六经，非谓病在六经也，假以为纪也
已；及其施治也，皆从证而不拘焉。”藤本廉更明确地说∶“三阴三阳之目，何为而设焉？凡病有六等之差，
而地位脉证不同也，概述诸说，皆以六经为病位之假称，而不取于经络之义。”总的来说，伤寒六经，不过就
病变上分作六个阶段；但人体机能之亢盛衰减，中间的动态尚多，不是这样可以肯定划分的。第三节六经病证
中，所以详列了错综复杂的证候群。
太阳内部主胸中。少阳内部主膈中。阳明内部主脘中。太阴内部主大腹。少阴内部主小腹。厥阴内部主少腹。
【秀按】此即六经分主三焦之部分也。《内经》云。上焦心肺主之。中焦脾胃主之。下焦肝肾主之。乃略言三焦
五内之部分。合而观之。六经为感证传变之路径。三焦为感证传变之归宿也。尝读张仲景《伤寒论》。一则曰胸
中。再则曰心中。又次曰心下。曰胸胁下。曰胃中。曰腹中。曰少腹。虽未明言三焦。较讲三焦者尤为详明。
【廉勘】张长沙治伤寒法。虽分六经。亦不外三焦。言六经者。明邪所从入之门。经行之径。病之所由起所由
传也。不外三焦者。以有形之痰涎水饮瘀血渣滓。为邪所搏结。病之所由成所由变也。窃谓病在躯壳。当分六
经形层。病入五内。当辨三焦部分。详审其所夹何邪。分际清析。庶免颟顸之弊。其分析法。首辨三焦部分。
膈膜以上。清气主之。肺与心也。膈膜以下。浊气主之。脾胃二肠内肾膀胱也。界乎清浊之间者为膈膜。乃肝
胆部分也。从膈下而上。上至胸。旁至胁。皆清气与津液往来之所。其病不外痰涎水饮。为邪所击搏。与气互
结。由胃中脘。及腹中。下抵少腹。乃有渣滓瘀浊之物。邪气得以根据附之而成下证。此上中下三焦之大要也。
伤寒，是外感各类疾病的总称。它有小证、大证、新感证、伏气证、兼证、夹证、坏证和复证之分。其传变莫测，生死往往在顷刻之间，这与普通杂病不同。然而，《难经》（扁鹊所著）仅提到“伤寒有五”：一是中风，二是伤寒，三是湿温，四是热病，五是温病。书中只记载了脉象的异同，并没有详细陈列症状和治疗方法，语焉不详，后学者依据什么来学习呢？况且，中风自是中风，伤寒自是伤寒，湿温自是湿温，温热自是温热，这一点已经可以概见。但是，这些病症都被列入伤寒门类中，是因为东汉张仲景撰写了《伤寒杂病论》，当时此书未在世间流传。到了晋代王叔和，利用断简残编，补充方剂并创作论述，将其混名为《伤寒论》，而不命名为《四时感证论》。从此，一切外感疾病都通称为伤寒，这是从古至今顺应习俗的结果。我也顺应习俗，将书名定为《通俗伤寒论》。
人们都说百病之中没有比伤寒更难治的，我认为治疗伤寒并不难，难的是治疗伤寒的兼证，较难的是治疗夹证，更难的是治疗复证，最难的是治疗坏证。因为其中寒热混杂感受，湿燥相互显现，虚实混淆不清，阴阳疑似难辨，如果不是经验丰富、手敏心灵、能随机应变的人，绝对不足以承担此重任。我日日与伤寒证候作战，谚语说：“熟读王叔和，不如临证多。”这并不是说临证多就不必读书，而是说只有经过大量临床实践，才能真正读懂书本知识。清朝初年喻嘉言曾说：“读书无眼，病患无命。”这话真是有深意啊！我从事伤寒专科已有四十多年，姑且将我心得的要领逐一陈述出来。
太阳经主管皮毛，阳明经主管肌肉，少阳经主管腠理，太阴经主管四肢末端，少阴经主管血脉，厥阴经主管筋膜。
【荣斋按】：“六经形层”这个名词，是根据周学海《与友条论读伤寒论法》中的第五、九、十一条而产生的。“六经”在《伤寒论》学说中，是一个根深蒂固的道统术语。本节将六经假定为机体方面的六个层次，虽然说不出充分的理由，但在病理上的某一分野里用它暂作“代号”，是应该的。恽铁樵先生曾这样说：“六经者，就人体所着之病状为之界说者也。”日本人鹤冲元逸在《医断》里也说：“伤寒六经，非谓病在六经也，假以为纪也已；及其施治也，皆从证而不拘焉。”藤本廉更明确地说：“三阴三阳之目，何为而设焉？凡病有六等之差，而地位脉证不同也，概述诸说，皆以六经为病位之假称，而不取于经络之义。”总的来说，伤寒六经，不过是就病变上分作六个阶段；但人体机能之亢盛衰减，中间的动态尚多，不是这样可以肯定划分的。第三节六经病证中，所以详列了错综复杂的证候群。
太阳经内部主管胸中，少阳经内部主管膈中，阳明经内部主管脘中，太阴经内部主管大腹，少阴经内部主管小腹，厥阴经内部主管少腹。
【秀按】：这就是六经分主三焦的部分内容。《内经》说：上焦由心肺主管，中焦由脾胃主管，下焦由肝肾主管。这只是粗略地讲了三焦和五脏六腑的部分归属。合起来看，六经是外感疾病传变的路径，三焦是外感疾病传变的归宿。我曾研读张仲景的《伤寒论》，文中多次提到胸中、心中、心下、胸胁下、胃中、腹中、少腹等部位，虽然没有明言三焦，但比起专门讲三焦的著作更为详尽明白。
【廉勘】：张长沙（张仲景）治疗伤寒的方法，虽然分为六经，但也不外乎三焦。言六经，是为了说明邪气入侵的门径、经络运行的路径、疾病发生和传变的由来。不外乎三焦，是因为有形的痰涎、水饮、瘀血、渣滓等，被邪气搏结，导致疾病形成和变化。我私下认为，病在躯壳，应当区分六经形层；病入五脏六腑，应当辨别三焦部分。详细审察其所夹杂的是什么邪气，分际清晰分析，才能避免糊涂粗疏的弊病。其分析方法，首先辨别三焦部分。膈膜以上，由清气主管，即肺与心。膈膜以下，由浊气主管，即脾胃、大肠、小肠、肾、膀胱。介于清浊之间的是膈膜，乃肝胆部分。从膈下而上，上至胸部，旁至胁部，都是清气与津液往来的场所。其病不外乎痰涎水饮，被邪气击搏，与气互相结聚，由胃中脘，及腹中，下抵少腹，于是有了渣滓瘀浊之物，邪气得以依附而成下焦证。这就是上、中、下三焦的大要。
Shanghan (Cold Damage), is the general term for all exogenous diseases. It includes minor syndromes, major syndromes, newly acquired syndromes, latent qi syndromes, combined syndromes, complicated syndromes, deteriorated syndromes, and recurrent syndromes. Its transmission is unpredictable, and life or death can be decided in an instant; it differs from miscellaneous diseases. However, *Nan Jing* (Classic of Difficult Issues, attributed to Bian Que) only mentions that "Shanghan comprises five types": one is Zhongfeng (Wind Strike), two is Shanghan (Cold Damage), three is Shiwen (Damp-Warmth), four is Rebing (Heat Disease), and five is Wenbing (Warm Disease). It only records the similarities and differences in pulse presentations, without detailing the symptomatology and treatment protocols. The explanation is vague, leaving students with no basis for study. Moreover, Zhongfeng is inherently Zhongfeng, Shanghan is inherently Shanghan, Shiwen is inherently Shiwen, and Wenre (Warm-Heat) is inherently Wenre; this distinction is already evident. Nevertheless, these conditions were all categorized under the Shanghan section because Zhang Zhongjing of the Eastern Han Dynasty authored *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases), which was not circulated during his lifetime. Later, Wang Shuhe of the Jin Dynasty used fragmented manuscripts to supplement prescriptions and compose treatises, confusingly naming the work *Shanghan Lun* (Treatise on Cold Damage), rather than *Sishi Gan Zheng Lun* (Treatise on Seasonal Exogenous Syndromes). From then on, all exogenous diseases were collectively referred to as Shanghan, following ancient custom and popular usage. I also follow this custom, titling my work *Putong Shanghan Lun* (Popularized Treatise on Cold Damage).
People claim that among all diseases, none is more difficult to treat than Shanghan. I argue that treating Shanghan itself is not difficult; treating the combined syndromes of Shanghan is slightly more difficult; treating the complicated syndromes is relatively more difficult; treating the recurrent syndromes is even more difficult; and treating the deteriorated syndromes is the most difficult. This is because cold and heat may mix, dampness and dryness may intermingle, deficiency and excess may be confused, and yin and yang may be suspected and indistinguishable. Without rich clinical experience, agile hands and mind, and the ability to adapt flexibly to changing circumstances, one is certainly inadequate for such a heavy responsibility. I engage daily with Shanghan syndromes. As the proverb says, "Familiarity with Wang Shuhe's text is inferior to extensive clinical practice." This does not mean that those with extensive clinical practice need not read books; rather, it implies that only through extensive clinical practice can one truly understand the books. Yu Jiayan of the early Qing Dynasty once said, "Reading without insight leads to patients losing their lives." How profound these words are! I have specialized in Shanghan for over forty years. Here, I shall briefly state the essentials derived from my personal insights.
The Taiyang Meridian (Taiyang Channel) governs the skin and hair; the Yangming Meridian (Yangming Channel) governs the muscles; the Shaoyang Meridian (Shaoyang Channel) governs the interstices (Couli); the Taiyin Meridian (Taiyin Channel) governs the extremities; the Shaoyin Meridian (Shaoyin Channel) governs the blood vessels; and the Jueyin Meridian (Jueyin Channel) governs the tendons and membranes.
[Rongzhai's Note]: The term "Six Meridian Morphological Layers" originates from Zhou Xuehai's "Five, Nine, and Eleven Points Discussed with Friends on Reading Shanghan Lun." "Six Meridians" is a deeply entrenched orthodox terminology within the theory of *Shanghan Lun*. In this section, the Six Meridians are hypothetically assumed to represent six layers of the organism. Although sufficient justification cannot be fully provided, using them as provisional "codes" in specific pathological divisions is appropriate. Mr. Yun Tieqiao once stated: "The Six Meridians define the boundaries based on the disease manifestations presented by the human body." The Japanese scholar Tsuruoka Gen'i also wrote in *Yidan*: "The Six Meridians of Shanghan do not imply that the disease resides in the Six Meridians; they are merely used as markers for recording; when treatment is applied, one follows the syndrome without being rigidly bound by them." Fujimoto Ren stated more explicitly: "For what purpose were the names of Three Yin and Three Yang established? All diseases have six levels of difference, with distinct locations, pulses, and symptoms. Summarizing various theories, all regard the Six Meridians as hypothetical designations for disease location, rejecting the literal meaning of meridians." Generally speaking, the Six Meridians of Shanghan simply divide the pathological changes into six stages. However, there are many dynamic processes between the hyperactivity and decline of human physiological functions, making definitive division impossible. Therefore, Section 3 details the complex and intertwined syndrome clusters of the Six Meridian diseases.
Internally, the Taiyang Meridian governs the chest center; the Shaoyang Meridian governs the diaphragm center; the Yangming Meridian governs the epigastric region; the Taiyin Meridian governs the great abdomen; the Shaoyin Meridian governs the lower abdomen; and the Jueyin Meridian governs the hypogastric region.
[Xiu's Note]: This refers to the partial governance of the Sanjiao (Triple Burner) by the Six Meridians. *Nei Jing* (Inner Canon) states: The Upper Jiao is governed by the Heart and Lungs; the Middle Jiao by the Spleen and Stomach; the Lower Jiao by the Liver and Kidneys. This is a brief mention of the regional distribution of the Sanjiao and Zang-Fu organs. Viewing them together, the Six Meridians serve as the pathway for the transmission of exogenous syndromes, while the Sanjiao serves as their destination. Having studied Zhang Zhongjing's *Shanghan Lun*, I note frequent mentions of the chest center, heart center, below the heart, hypochondrium, stomach center, abdominal center, and hypogastric region. Although the Sanjiao is not explicitly named, it is described more clearly than in works specifically discussing the Sanjiao.
[Lian's Commentary]: Zhang Changsha's (Zhang Zhongjing's) method of treating Shanghan, although divided into Six Meridians, essentially encompasses the Sanjiao. Discussing the Six Meridians clarifies the gateways for pathogenic invasion, the pathways of meridian circulation, and the origins and transmission of disease. Encompassing the Sanjiao addresses the formation and transformation of disease due to the binding of tangible pathogens such as phlegm-fluids, water retention, blood stasis, and residues. I privately believe that when disease is in the body shell, one should distinguish the Six Meridian morphological layers; when disease enters the internal organs, one should differentiate the Sanjiao regions. One must carefully examine what pathogenic factors are involved and analyze the distinctions clearly to avoid confusion and negligence. The analytical method begins by distinguishing the Sanjiao regions. Above the diaphragm, clear Qi governs, corresponding to the Lungs and Heart. Below the diaphragm, turbid Qi governs, corresponding to the Spleen, Stomach, Large Intestine, Small Intestine, Kidneys, and Bladder. Between clear and turbid lies the diaphragm, which corresponds to the Liver and Gallbladder. From below the diaphragm upwards to the chest and laterally to the hypochondrium is the area where clear Qi and Body Fluids circulate. Diseases here are primarily due to phlegm-fluids and water retention being attacked by pathogens and binding with Qi. From the epigastrium and abdomen down to the hypogastric region, residues and turbid substances accumulate, allowing pathogens to attach and form Lower Jiao syndromes. This constitutes the main principles of the Upper, Middle, and Lower Sanjiao.