五十八难曰∶伤寒有几，其脉有变不？
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。
《素问》于风论、热论言之甚详，岂得独遗寒论一门。而热论首言今夫热病者，皆伤寒之类
也。既云类伤寒，则有伤寒专论可知，惜乎第七一卷亡于兵火，亦以见古医经以伤寒为外感之
统名。越人恐后世寒温莫辨，故作伤寒有五之论，以分别其脉证，滑氏以变当作辨是矣。
中风之脉，阳浮而滑，阴濡而弱。
中风者，风寒直伤肌腠也。风无定体，偏寒即从寒化，风寒之邪，直入肌肉而伤其营，营血
伤则血脉弱，而其脉动必缓。阳寸浮者，乃卫阳外越也。阴尺弱者，乃营血受伤也。然必见热
自发，汗自出，恶寒恶风，鼻鸣干呕等证，方是风寒中肌腠之的证的脉也。谓风伤卫，寒伤营
者非也。其实寒伤卫，风伤营耳。或问许学士发微论言风伤卫，寒伤营，成无己以降俱宗之，
而子独谓寒伤卫，风伤营者何耶？曰∶寒者，太阳之本气也。太阳之阳。发于至阴，而充于皮
毛，是皮毛一层，卫所居也，卫阳虚，招外寒。致皮毛闭塞而无汗，故曰寒伤卫也。风在六气，
属厥阴肝木，厥阴主营血，血虚则招外风。夫营血虽与卫气偕行，而究之皮毛一层，为卫所司，
肌肉一层，为营所宅，风入肌肉中，而营不守卫，是以卫气泄而自汗出，故曰风伤营也。况仲
景无汗用麻黄，明是治卫气之药，有汗用桂枝，明是和营血之药，安得淆混哉？或问麻黄治寒
伤卫，桂枝治风伤营，已明其义，何以仲景辨脉篇曰∶寸口脉浮而紧，浮则为风，紧则为寒，
风则伤卫，寒则伤营，营卫俱病，骨节烦疼，当发其汗也，此非风伤卫，寒伤营之明证耶？曰∶
此章本《内经》寒伤形，热伤气，阳邪伤阳，阴邪伤阴，统该阴阳二气而言，非谓桂枝主风伤
卫，麻黄主寒伤营也。读书贵乎融贯，不可拘泥。此所谓风伤营者，言风寒之邪，直中营中，
逼其卫气外泄，风寒则伤营也。若风温之邪，首先犯卫，卫主气，盖热则伤气矣。所谓寒伤卫
者，非不伤营，盖寒闭卫外之气则无汗，然亦由敛其营血而然，此《内经》热伤气，寒伤形之
旨也。设寒热莫辨，执风为阳邪而伤卫一语，以温里和营之桂枝汤治风温，则谬之甚矣。可不
慎哉。
按∶此论中风为风寒入肌腠，外感也。若《金匮》所论中风，有中腑、中脏、中血脉之分，
与此不同，不可误也。中腑之脉多浮，五色必显于面，恶风恶寒，拘急不仁，或中身之前，或
中身之后，或中身之侧，其病在表，多着四肢，虽见半身不遂，手足不随，痰涎壅盛，气喘如
雷，然目犹能视，口犹能言，且外有六经形证也。中脏其病在里，多滞九窍，故唇缓二便闭者，
脾中也；不能言者，心中也；耳聋者，肾中也；鼻塞者，肺中也；目瞀者，肝中也。中血脉者，
病在半表半里，外无六经之证，内无二便之闭，但见口眼 斜，半身作痛而已。至若体纵不收，
耳聋无闻，目瞀不见，口开眼合，撒手遗溺，失音鼾睡，乃本实先拨，阴阳枢纽不交，为难治
之脱证矣。此名同而证异者，不可不辨也。
伤寒之脉，阴阳俱盛而紧涩。
伤寒者，寒伤太阳之肤表也。华元化曰∶伤寒一日在皮，二日在肤，三日在肌，四日在胸，
五日在腹，六日入胃。是风寒初感之邪，由皮肤毛窍而入，抑遏营气，束于经脉，故脉阴阳俱
浮盛紧涩而无汗也。然必见头项强痛，发热身疼，腰痛骨节疼痛，恶风恶寒而喘诸形证，方是
寒伤肤表之的证的脉也。夫太阳膀胱中所化之气，由气海循冲任，过膈入肺，出之于鼻，为呼
出气。膀胱所化之气，又有内从三焦脂膜，出诸气街，循肌肉，达于皮毛，为卫外之气。人知
口鼻出气，而不知周身毛窍，亦无不出气，鼻气一出，则周身毛窍之气皆张，鼻气一入，则周
身毛窍皆敛。若毛窍之气不得外出，则反入于内，壅塞于肺，上退场门鼻而为喘，故寒伤肤表，
皮毛之卫气不得外出，则返于内而上壅为喘，皮毛之内是肌肉，寒邪内犯肌肉，故周身疼痛。
邪犯太阳之经脉，故头项腰痛。人身皮内之肌，俗名肥肉；肥肉内夹缝中有纹理，名曰腠理，
又内为瘦肉，瘦肉两头即生筋，筋与瘦肉为一体，皆附骨之物也，故邪犯瘦肉，则入筋而骨节
疼痛。《内经》曰∶诸筋皆属于节者是也。但发其表，则寒邪由内及外，从毛窍而汗解矣，故仲
景以麻黄汤治之。
湿温之脉，阳濡而弱，阴小而急。
湿温者，暑与湿交合之温病也，其因有三。先受暑，后受湿，热为湿遏者，则其脉阳濡而弱，
阴小而急，濡弱见于阳部，湿气搏暑也，小急见于阴部，暑气蒸湿也，此本经所谓之湿温也。
若其人常伤于湿，因而中 ，湿热相搏，则发为湿温，证见两胫冷，腹满叉胸，头目痛苦妄言，
治在足太阴，不可发汗，此叔和《脉经》所谓之湿温也。有触时令郁蒸之气者，春分后，秋分
前，少阴君火，少阳相火，太阴湿土，三气合行其事，是天本热也，而益以日之暑，日本烈也，
而载以地之湿，三气交动，时分时合。其分也，风动于中，胜湿解蒸，不觉其苦。其合也，天
之热气下降，地之湿气上腾，人在气交中，受其炎蒸，无隙可避，口鼻受邪，着于脾胃，脉濡
弱，舌苔白，或绛底，呕逆口干而不能汤饮，胸次软而满闷，身潮热，汗出稍凉，少顷又热，
此喻西昌所谓三气合而为病之湿温也。然其因虽有不同，而其病多属足阳明足太阴，盖湿土之
邪，同气相感也。病在二经之表，多兼手少阳三焦，病在二经之里，多兼手厥阴包络，以少阳
厥阴，同司相火故也。识此，庶几知所从治矣。
热病之脉，阴阳俱浮，浮之而滑，沉之散涩。
热病者，温热病概伏气外感而言也。脉阴阳俱浮者，《金匮要略》云∶浮脉则热，阳气盛故
也。浮之而滑，沉之散涩者，滑则阳盛于外，涩则阴衰于内也。夫温者热之渐，热者温之甚，
其实一而已矣，然内外微甚间，不可不辨也。伏气温病者，乃冬日之阳热，被严寒杀厉之气所
折伏，藏于肌骨之间，至春感春阳之气而触发，热邪内发，阴液已伤，即仲景《伤寒论》所谓
发热而渴，不恶寒之温病是也。外感风温者，或冬暖不藏，或春日气温，其风偏热，即从热化，
其证脉浮恶风，发热咳嗽者是也。若内有伏气，外为风热逗引，两阳相合，卫气先伤，误以辛
温表散，致成灼热，身重多眠，鼻鼾自汗，直视失溲螈 诸逆证者，即《伤寒论》所谓误汗被
下被火，一逆尚引日，再逆促命期之风温，是外感而兼伏气者也。王安道曰∶温热病之脉，多
在肌肉之分，而不甚浮，且右手反盛于左手者，良由怫热在内也。或左手盛或浮者，必有重感
之风寒，否则非温病热病，是暴感风寒之病耳。此温热病脉，一定不移之论也。何以言之？《素
问·阴阳应象大论》曰∶左右者，阴阳之道路也。水火者，阴阳之征兆也。血，阴也，水亦阴也；
气，阳也，火亦阳也。以脉体言，左属血，阴也；右属气，阳也。此即血气之左右，水火之征
兆也。风热属阳邪，先伤无形之气，风寒乃阴邪，首犯有形之血，亦即《内经》寒伤形，热伤
气之旨也。识此，当知风热伤卫，风寒伤营，可不致执许学士风伤卫一语，而以桂枝治温热，遗
人夭札矣。
按∶伏气之理，未有阐发其义者，请试明之。《素问·阴阳应象大论》曰∶重阴必阳，重阳
必阴。故曰∶冬伤于寒，春必病温；春伤于风，夏生飧泄，夏伤于暑，秋必 疟；秋伤于湿；
冬生咳嗽。此章经文，尤重在重阴必阳，重阳必阴两句。亦以见天地阴阳之邪，随人身之气化
感召，而非寒能变热，热可变寒也。其冬伤于寒，春必病温者，冬至一阳渐生，人身之阳气内
盛，冬日严寒，杀厉之气，时中于人，入于肤腠，其内伏之阳热，被寒毒所折，深浃于骨髓之
间，至春阳气盛长，伏邪浅者，亦可随春阳之气渐散，伏邪深者，或遇风寒所遏，或因嗜欲所
伤，内伏郁结之阳气，为外邪触发，伏气既得发泄，遇天气之阳热，两热相干，发为温病，温
之甚者，即为热病，此重阴必阳也。夏伤于暑，秋必 疟者，夏至一阴渐生，人身之阴气内盛，
暑乃阳邪，阳气外炽，则里气虚寒，加以贪凉饮冷，损其真阳，至秋阴气盛长之时，内伏阴邪
欲出，外袭阳暑欲入，阴阳相持，故发为往来寒热之 疟，此重阳必阴也。春伤于风，夏生飧
泄，秋伤于湿，冬生咳嗽者，乃阴阳上下之相乘也。夫喉主天气。咽主地气。阳受风气，阴受
湿气。伤于风者，上先受之，伤于湿者，下先受之。阳病者，上行极而下，是以春伤于风者，
夏生飧泄，风为阳邪，泄乃阴病、此重阳必阴也。阴病者，下行极而上，是以秋伤于湿，上逆
而咳，湿乃阴邪，咳为阳病，此重阴必阳也。然邪之所凑，其气必虚，人身之神气血脉，皆生
于精，能藏其精，则血气内固，外邪何由内侵。金匮真言论曰∶精者，身之本也，故藏于精者，
春不病温。摄生者可不慎诸。
温病之脉，行在诸经，不知何经之动也，各随其经所在而取之。
温病者，瘟，疫病也，古无瘟字，温与瘟通故也。疫者，役也，犹徭役之谓。多见于兵燹之
余，或水旱偏灾之后，大则一城，小则一镇一村，遍相传染者是也。乃天地 厉之气，不可以
常理测，不可以常法治也。故《素问》遗篇有五疫之刺，庞安常有青筋索，赤脉KT ，黄肉随，
白气狸，黑骨温，五色之治。疫之为病，偏温偏热者多，偏寒者少，然间亦有之。如《病源》
所载，从春分以后，秋分节前，天有暴寒，皆为时行寒疫也。寒疫初病，寒热无汗，面赤头痛
项强，盖得之毛窍开，而寒气闭之也，与伤寒异处，惟传染耳。其证多见于金水之年，是金水
不能敛藏，人物应之而为寒疫也。若东坡治疫之圣散子，又寒而兼乎湿者也。近世吴又可之论
疫，乃温热夹湿者、故其气臭如尸，色蒸晦垢，舌本深绛，苔如积粉，神情昏扰而惊悸，脉右
盛而至数模糊，皆湿热相搏之征，故宜达原饮以达募原之伏邪也。至余师愚之清瘟败毒散，重
用石膏，又专治暑热之成疫者也。越人早鉴于此，故曰∶温病之脉，行在诸经，不知何经之动
也。各随其经之所在而取之，其旨深矣。若黄坤载以《素问·热论》之一日太阳，二日阳明，
三日少阳，四日太阴，五日少阴，六日厥阴，经随日传，六日而尽，须逐日诊之，难以预定为
解。不知传经者，乃正气以次相传，七日来复，周而复始，一定不移，非病气之传也，病气之传，
本太阳不解，或入于阳，或入于阴。不拘时日，无分次第。如传于阳明，则见阳明证，传于少
阳，则见少阳证，传三阴，则见三阴证。故《伤寒论》曰∶伤寒二三日，阳明少阳证不见者，
为不传也。况病邪随经气之虚而传陷，中风伤寒热病皆然。何以越人于各证之下，皆有专脉，
独于温病，而云不知何经之动，各随所在而取之，分明指天地 厉之气，不可以常理测治而言，
何黄氏之不察妄议，谬之甚矣。
伤寒有汗出而愈，下之而死者，有汗出而死，下之而愈者，何也？
然∶阳虚阴盛，汗出而愈，
下之即死；阳盛阴虚，汗出而死，下之而愈。
伤寒，为此五病之通称。但伤寒有汗出而愈，下之则死者；有下之而愈，汗之则死者，其故
何欤？盖寒邪外袭为阴盛，可汗而不可下；热邪内炽为阳盛，可下而不可汗。王叔和伤寒序例曰∶
桂枝下咽，阳盛则毙，承气入胃，阴盛以亡，即此义也。
寒热之病，候之如何也？
然∶皮寒热者，皮不可近席，毛发焦，鼻槁，不得汗；肌寒热者，皮
肤痛，唇舌槁，无汗；骨寒热者，病无所安，汗注不休，齿本槁痛。
寒热病候之如何者，言忽寒忽热之病，当候病之所在也。皮寒热者，言寒热在皮，邪之中人
最浅者。肺主皮毛，开窍于鼻，故邪在皮毛，则皮不能着物，毛发焦干，而鼻枯槁不泽也。不
得汗，营卫不和也。肌寒热者，皮内即肌肉，肌肉之邪，由皮肤而入，故皮肤痛也。脾主肌肉，
开窍于口，故肌有邪，则唇舌皆受病也。骨寒热者，肌肉之内骨也，骨受邪，其病最深，故一
身之中，无所得安也。肾主骨，又主液，齿为骨之余，故骨病则肾液泄而为汗，齿枯槁而痛也。
按∶此节乃《灵枢·寒热篇》文，而与以上五种伤寒有间，然皆经气之为病，宜取三阳少阴
之络以去邪，虽与伤寒各异，而皮肤肌肉骨髓之层次经气则一是。越人列此一节于五种伤寒之
后者，正示人以内伤杂病，与外感之形证不同，不可误治耳。
第五十八难问道：伤寒有几类，其脉象是否有变化？
回答说：伤寒有五类，有中风，有伤寒，有湿温，有热病，有温病，它们所痛苦的症状各不相同。
《素问》在风论、热论中论述得非常详细，怎么能唯独遗漏了寒论这一门呢？而《热论》开头说“如今的热病，都属于伤寒之类”。既然说是“类伤寒”，那么就有专门论述伤寒的文章可知，可惜第七卷在战火中亡佚了，这也说明古代医经将“伤寒”作为外感病的统称。越人（秦越人/扁鹊）恐怕后世混淆寒与温的区别，所以作了“伤寒有五”的论述，以区分它们的脉象和证候，滑寿认为这里的“变”字应当作“辨”解，是正确的。
中风的脉象，阳部（寸口）浮而滑，阴部（尺部）濡而弱。
所谓中风，是风寒直接损伤肌腠。风没有固定的形体，偏于寒则从寒化，风寒之邪直入肌肉损伤营血，营血受伤则血脉虚弱，脉搏跳动必然缓慢。寸口脉浮，是卫阳外越的表现；尺部脉弱，是营血受伤的表现。但是必须见到发热自出、汗自出、恶寒恶风、鼻鸣干呕等症状，这才是风寒中伤肌的确切的证候和脉象。说“风伤卫，寒伤营”是不对的。其实是寒伤卫，风伤营。有人问许叔微在《发微论》中说风伤卫，寒伤营，成无己以下的人都遵从它，为什么您偏偏说寒伤卫，风伤营呢？回答说：寒，是太阳的本气。太阳的阳气，发源于至阴，充盛于皮毛，这皮毛一层，是卫气居住的地方，卫阳虚，招致外寒，导致皮毛闭塞而无汗，所以说寒伤卫。风在六气中，属厥阴肝木，厥阴主营血，血虚则招致外风。虽然营血与卫气偕行，但究其根本，皮毛一层由卫气主管，肌肉一层由营血宅居，风进入肌肉中，营不守卫，导致卫气泄出而自汗出，所以说风伤营。况且张仲景无汗用麻黄，明明是治疗卫气的药，有汗用桂枝，明明是调和营血的药，怎能混淆呢？又有人问：麻黄治寒伤卫，桂枝治风伤营，已经明白了其中的道理，为什么张仲景在《辨脉篇》中说：“寸口脉浮而紧，浮则为风，紧则为寒，风则伤卫，寒则伤营，营卫俱病，骨节烦疼，应当发汗”，这不是风伤卫、寒伤营的明证吗？回答说：这一章本于《内经》的“寒伤形，热伤气，阳邪伤阳，阴邪伤阴”，统括阴阳二气而言，并不是说桂枝主治风伤卫，麻黄主治寒伤营。读书贵在融会贯通，不可拘泥。这里所说的“风伤营”，是指风寒之邪直中营分，逼迫卫气外泄，风寒因此伤及营血。如果是风温之邪，首先侵犯卫分，卫主气，热则伤气。所谓“寒伤卫”，并非不伤营，而是寒闭阻卫外之气导致无汗，这也是收敛营血的结果，这正是《内经》“热伤气，寒伤形”的宗旨。如果寒热不能辨别，执着于“风为阳邪而伤卫”这句话，用温里和营的桂枝汤去治疗风温，那就大错特错了。能不谨慎吗？
按语：此论中风为风寒侵入肌腠，属于外感病。若《金匮要略》所论述的中风，有中腑、中脏、中血脉之分，与此不同，不可误认。中腑的脉象多浮，五色必显现在面部，恶风恶寒，拘急麻木，或中身之前，或中身之后，或中身之侧，病在表，多着于四肢，即使出现半身不遂，手足不能随意运动，痰涎壅盛，气喘如雷，但眼睛还能看，口还能说话，且外部有六经的形证。中脏的病在里，多阻滞九窍，所以口唇松弛、大小便闭塞的是脾中；不能说话的是心中；耳聋的是肾中；鼻塞的是肺中；视物昏花的是肝中。中血脉者，病在半表半里，外部没有六经的证候，内部没有大小便的闭塞，只见口眼歪斜，半身疼痛罢了。至于身体瘫软不收，耳聋听不见，视物不见，口开眼合，撒手遗尿，失音打鼾睡，这是根本已拔除，阴阳枢纽不交，为难治的脱证。这是同名而证候不同的情况，不可不辨别。
伤寒的脉象，阴阳两部都盛大而紧涩。
所谓伤寒，是寒邪损伤太阳肤表。华佗说：伤寒第一天在皮，第二天在肤，第三天在肌，第四天在胸，第五天在腹，第六天入胃。这是风寒初感之邪，由皮肤毛孔而入，抑遏营气，束缚于经脉，所以脉象阴阳俱浮盛紧涩且无汗。但是必须见到头项强痛，发热身疼，腰痛骨节疼痛，恶风恶寒而喘等各种证候，才是寒伤肤表的确实证候和脉象。太阳膀胱中所化生的气，由气海循冲任脉，过膈入肺，出于鼻，为呼出的气。膀胱所化生的气，又有内从三焦脂膜，出于气街，循肌肉，达于皮毛，为卫外的气。人们只知道口鼻出气，而不知道周身毛孔也没有不出气的，鼻气一出，则周身毛孔的气都张开，鼻气一入，则周身毛孔都收敛。如果毛孔的气不得外出，则反而入于内，壅塞于肺，上退场门鼻而为喘，所以寒伤肤表，皮毛的卫气不得外出，则返于内而上壅为喘，皮毛之内是肌肉，寒邪内犯肌肉，所以周身疼痛。邪气侵犯太阳的经脉，所以头项腰痛。人身皮内的肌肉，俗名肥肉；肥肉内夹缝中有纹理，名叫腠理，再内为瘦肉，瘦肉两头即生筋，筋与瘦肉为一体，都附着于骨骼，所以邪气侵犯瘦肉，则入筋而骨节疼痛。《内经》说：“诸筋皆属于节”就是这个意思。只要发散其表，则寒邪由内及外，从毛孔随汗而解，所以张仲景用麻黄汤治疗它。
湿温的脉象，阳部濡而弱，阴部小而急。
所谓湿温，是暑与湿交合的温病，其原因有三。先受暑，后受湿，热被湿遏制，则其脉阳部濡而弱，阴部小而急，濡弱见于阳部，是湿气搏结暑气；小急见于阴部，是暑气蒸腾湿气，这就是本经所说的湿温。如果其人常伤于湿，因而中脘痞闷，湿热相搏，则发为湿温，证见两小腿冷，腹部胀满叉胸，头目痛苦妄言，治疗在足太阴脾经，不可发汗，这是王叔和《脉经》所说的湿温。有触犯时令郁蒸之气的，春分后，秋分前，少阴君火，少阳相火，太阴湿土，三气合行其事，是天本热，而加上日之暑，日本烈，而承载以地之湿，三气交动，时分时合。其分散时，风动于中，胜湿解蒸，不觉其苦。其合拢时，天之热气下降，地之湿气上腾，人在气交之中，受其炎蒸，无隙可避，口鼻受邪，着于脾胃，脉濡弱，舌苔白，或绛底，呕逆口干而不能饮水，胸次软而满闷，身潮热，汗出稍凉，一会儿又热，这是喻嘉言所说的三气合而为病的湿温。然而其病因虽有不同，但其病多属于足阳明、足太阴，因为湿土之邪，同气相感。病在二经之表，多兼手少阳三焦；病在二经之里，多兼手厥阴心包络，因为少阳、厥阴，同司相火。认识这一点，差不多就知道如何治疗了。
热病的脉象，阴阳两部都浮，轻取而滑，重取而散涩。
所谓热病，是温热病概指伏气和外感而言。脉象阴阳俱浮，《金匮要略》说：浮脉则热，是因为阳气盛。轻取而滑，重取而散涩，滑则阳盛于外，涩则阴衰于内。温是热的渐进，热是温的极甚，其实是一回事，但在内外、微甚之间，不可不辨别。伏气温病，是冬天的阳热，被严寒杀厉之气所折伏，藏于肌骨之间，到春天感受春阳之气而触发，热邪内发，阴液已伤，就是张仲景《伤寒论》所说的“发热而渴，不恶寒”的温病。外感风温者，或者冬天温暖不藏精，或者春日气温，其风偏热，即从热化，其证脉浮恶风，发热咳嗽等。如果内有伏气，外为风热逗引，两阳相合，卫气先伤，误用辛温表散，导致灼热，身重多眠，鼻鼾自汗，直视失溲抽搐等各种逆证，就是《伤寒论》所说的误汗被下被火，一逆尚引日，再逆促命期的风温，这是外感而兼伏气的。王安道说：温热病的脉，多在肌肉之分，而不甚浮，且右手反盛于左手，良由怫热在内。或者左手盛或浮，必有重感的风寒，否则就不是温病热病，是暴感风寒的病罢了。这是温热病脉一定不移的理论。为什么说这样呢？《素问·阴阳应象大论》说：左右，是阴阳的道路。水火，是阴阳的征兆。血，是阴，水也是阴；气，是阳，火也是阳。从脉体来说，左属血，阴；右属气，阳。这就是血气的左右，水火的征兆。风热属阳邪，先伤无形之气；风寒乃阴邪，首犯有形之血，也就是《内经》“寒伤形，热伤气”的宗旨。认识这一点，应当知道风热伤卫，风寒伤营，可不致执着许学士“风伤卫”一句话，而用桂枝治疗温热，给人带来夭折。
按语：伏气的理论，没有人阐发其义，请试着阐明它。《素问·阴阳应象大论》说：重阴必阳，重阳必阴。所以说：冬伤于寒，春必病温；春伤于风，夏生飧泄，夏伤于暑，秋必疟疾；秋伤于湿，冬生咳嗽。这一章经文，尤其重在“重阴必阳，重阳必阴”两句。也可见天地阴阳之邪，随人身之气化感召，而不是寒能变热，热能变寒。那“冬伤于寒，春必病温”，冬至一阳渐生，人身之阳气内盛，冬日严寒，杀厉之气，时常中人，入于肤腠，其内伏之阳热，被寒毒所折，深透于骨髓之间，到春天阳气盛长，伏邪浅的，也可随春阳之气渐散，伏邪深的，或者遇风寒所遏，或因嗜欲所伤，内伏郁结之阳气，为外邪触发，伏气既得发泄，遇天气之阳热，两热相干，发为温病，温之甚的，即为热病，这就是重阴必阳。“夏伤于暑，秋必疟疾”，夏至一阴渐生，人身之阴气内盛，暑乃阳邪，阳气外炽，则里气虚寒，加以贪凉饮冷，损其真阳，到秋天阴气盛长之时，内伏阴邪欲出，外袭阳暑欲入，阴阳相持，故发为往来寒热的疟疾，这就是重阳必阴。“春伤于风，夏生飧泄，秋伤于湿，冬生咳嗽”，是阴阳上下之相乘。喉主天气，咽主地气。阳受风气，阴受湿气。伤于风者，上先受之，伤于湿者，下先受之。阳病者，上行极而下，所以春伤于风者，夏生飧泄，风为阳邪，泄乃阴病，此重阳必阴。阴病者，下行极而上，所以秋伤于湿，上逆而咳，湿乃阴邪，咳为阳病，此重阴必阳。然而邪之所凑，其气必虚，人身的神气血脉，皆生于精，能藏其精，则血气内固，外邪何由内侵。《金匮真言论》说：精者，身之本也，所以藏精的人，春天不病温。养生的人能不谨慎吗？
温病的脉象，运行在各经，不知道哪一经发动，各随其经所在而诊察。
所谓温病，瘟，就是疫病，古时无瘟字，温与瘟通。疫者，役也，如同徭役一样。多见于兵火之余，或水旱偏灾之后，大的一个城，小的一个镇一村，遍相传染的就是。这是天地疠厉之气，不可以常理测度，不可以常法治疗。所以《素问》遗篇有五疫的刺法，庞安常有青筋索，赤脉KT，黄肉随，白气狸，黑骨温，五色的治法。疫之为病，偏温偏热的多，偏寒的少，然而间也有。如《病源》所载，从春分以后，秋分节前，天有暴寒，都是时行寒疫。寒疫初病，寒热无汗，面赤头痛项强，盖得之毛窍开，而寒气闭之，与伤寒不同之处，只有传染性。其证多见于金水之年，是金水不能敛藏，人物应之而为寒疫。如果东坡治疗的圣散子，又是寒而兼乎湿的。近世吴又可论疫，是温热夹湿的，所以其气臭如尸，色蒸晦垢，舌本深绛，苔如积粉，神情昏扰而惊悸，脉右盛而至数模糊，都是湿热相搏的征象，所以宜用达原饮以达募原的伏邪。至于余师愚的清瘟败毒散，重用石膏，又专治暑热成疫的。越人早鉴于此，所以说：温病的脉，行在诸经，不知道哪一经发动。各随其经所在而取之，其旨意深远了。如果黄坤载以《素问·热论》的一日太阳，二日阳明，三日少阳，四日太阴，五日少阴，六日厥阴，经随日传，六日而尽，须逐日诊之，难以预定来解释。不知道传经者，乃正气以次相传，七日来复，周而复始，一定不移，不是病气的传。病气的传，本太阳不解，或入于阳，或入于阴。不拘时日，无分次第。如传于阳明，则见阳明证，传于少阳，则见少阳证，传三阴，则见三阴证。所以《伤寒论》说：伤寒二三日，阳明少阳证不见者，为不传也。何况病邪随经气之虚而传陷，中风伤寒热病都一样。为什么越人在各证之下，都有专脉，唯独于温病，而说不知道哪一经发动，各随所在而取之，分明指天地疠厉之气，不可以常理测治而言，为什么黄氏的不察妄议，谬误得很。
伤寒有汗出而愈，下之而死的，有汗出而死，下之而愈的，为什么呢？
回答说：阳虚阴盛，汗出而愈，下之即死；阳盛阴虚，汗出而死，下之而愈。
伤寒，是为此五种病的通称。但伤寒有汗出而愈，下之则死的；有下之而愈，汗之则死的，原因是什么呢？大概寒邪外袭为阴盛，可汗而不可下；热邪内炽为阳盛，可下而不可汗。王叔和《伤寒序例》说：桂枝下咽，阳盛则毙，承气入胃，阴盛以亡，就是这个意思。
寒热病，怎么候察呢？
回答说：皮寒热者，皮不可近席，毛发焦，鼻槁，不得汗；肌寒热者，皮肤痛，唇舌槁，无汗；骨寒热者，病无所安，汗注不休，齿本槁痛。
寒热病怎么候察，是说忽寒忽热的病，应当候察病所在的部位。皮寒热者，是说寒热在皮，邪气中人最浅的。肺主皮毛，开窍于鼻，所以邪在皮毛，则皮不能着物，毛发焦干，而鼻枯槁不泽。不得汗，是营卫不和。肌寒热者，皮内即肌肉，肌肉的邪，由皮肤而入，所以皮肤痛。脾主肌肉，开窍于口，所以肌有邪，则唇舌皆受病。骨寒热者，肌肉之内骨也，骨受邪，其病最深，所以一身之中，无所得安。肾主骨，又主液，齿为骨之余，所以骨病则肾液泄而为汗，齿枯槁而痛。
按语：这一节是《灵枢·寒热篇》的文字，而与以上五种伤寒有间隔，然而都是经气之为病，宜取三阳少阴之络以去邪，虽然与伤寒各异，而皮肤肌肉骨髓的层次经气则是一致的。越人列这一节于五种伤寒之后，正是示人以內伤杂病，与外感的形证不同，不可误治罢了。
Chapter 58 asks: How many types are there of Shanghan (Cold Damage), and do their pulses change?
The response states: There are five types of Shanghan: Zhongfeng (Wind Strike), Shanghan, Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing (Warm Disease); the suffering symptoms of each differ.
Suwen discusses wind and heat extensively in its chapters on Wind and Heat, so how could it omit a chapter on Cold? The opening of the Chapter on Heat states that all current heat diseases belong to the category of Shanghan. Since it is called "category of Shanghan," it implies the existence of a specific treatise on Shanghan; unfortunately, Volume 7 was lost in war, which also shows that ancient medical classics used "Shanghan" as a general term for exogenous diseases. Yue Ren (Qin Yueren/Bian Que) feared that future generations would confuse Cold and Warmth, so he proposed the theory of "Five Types of Shanghan" to distinguish their pulse and syndrome characteristics. Hua Shi's interpretation that "bian" (change) should be read as "bian" (distinguish) is correct.
The pulse of Zhongfeng is floating and slippery at the Yang position (Cun) and soggy and weak at the Yin position (Chi).
Zhongfeng refers to Wind-Cold directly injuring the muscle-cou li (interstitial spaces). Wind has no fixed form; if biased towards cold, it transforms into cold. The pathogenic factors of Wind-Cold enter the muscles directly and injure Ying Blood. When Ying Blood is injured, the blood vessels become weak, and the pulse movement must be slow. Floating at the Cun position indicates Wei Yang escaping outward; weakness at the Chi position indicates injury to Ying Blood. However, only when fever spontaneously arises, sweat flows out, aversion to cold and wind, nasal congestion with roaring, and dry retching occur, can these be considered the definitive syndromes and pulses of Wind-Cold invading the cou li. The statement "Wind injures Wei, Cold injures Ying" is incorrect. In reality, Cold injures Wei, and Wind injures Ying. One might ask: Xu Xueshi stated in his Fabi Lun that Wind injures Wei and Cold injures Ying, and Cheng Wuji and subsequent scholars followed this. Why do you alone assert that Cold injures Wei and Wind injures Ying? I reply: Cold is the primary qi of the Taiyang channel. Taiyang Yang originates from Zhiyin and fills the skin and hair. This layer of skin and hair is where Wei Qi resides. If Wei Yang is deficient, it attracts external Cold, causing the pores to close without sweat; thus, we say Cold injures Wei. Wind belongs to Jueyin Liver Wood among the Six Qi; Jueyin governs Ying Blood. If Blood is deficient, it attracts external Wind. Although Ying Blood travels with Wei Qi, fundamentally, the skin-hair layer is governed by Wei, while the muscle layer is the dwelling of Ying. When Wind enters the muscles, Ying fails to guard Wei, causing Wei Qi to leak out resulting in spontaneous sweating; thus, we say Wind injures Ying. Moreover, Zhang Zhongjing uses Mahuang Tang when there is no sweat, clearly indicating it treats Wei Qi; he uses Guizhi Tang when there is sweat, clearly indicating it harmonizes Ying Blood. How can they be confused? Another question arises: Having clarified that Mahuang treats Cold injuring Wei and Guizhi treats Wind injuring Ying, why does Zhang Zhongjing state in the Bian Mai Pian: "If the Cun position pulse is floating and tight, floating indicates Wind, tight indicates Cold; Wind injures Wei, Cold injures Ying; both Ying and Wei are diseased, causing severe pain in bones and joints, requiring diaphoresis." Is this not clear evidence of Wind injuring Wei and Cold injuring Ying? I reply: This chapter derives from Neijing's principle that "Cold injures the form, Heat injures Qi; Yang pathogens injure Yang, Yin pathogens injure Yin," speaking generally of Yin and Yang Qi, not implying that Guizhi specifically treats Wind injuring Wei or Mahuang specifically treats Cold injuring Ying. Reading requires integration, not rigidity. Here, "Wind injuring Ying" means the Wind-Cold pathogen strikes directly into the Ying level, forcing Wei Qi to escape outward, thereby injuring Ying. If it were Fengwen (Wind-Warmth) pathogen, it first attacks the Wei level; Wei governs Qi, and Heat injures Qi. Regarding "Cold injuring Wei," it does not mean it doesn't injure Ying; rather, Cold blocks the exterior Wei Qi causing anhidrosis, which also involves constricting Ying Blood. This aligns with the Neijing principle that "Heat injures Qi, Cold injures Form." If one cannot distinguish Cold from Heat and clings to the phrase "Wind is a Yang pathogen injuring Wei," using the warming and harmonizing Guizhi Tang to treat Fengwen would be a grave error. One must be cautious.
Note: This discussion defines Zhongfeng as Wind-Cold entering the cou li, belonging to exogenous diseases. However, the Zhongfeng discussed in Jingui Yaolue includes differentiation into Zhong Fu (Invasion of the Viscera), Zhong Zang (Invasion of the Organs), and Zhong Xue Mai (Invasion of the Collaterals), which differs from the above and must not be confused. The pulse for Zhong Fu is often floating, with five colors manifesting on the face, accompanied by aversion to wind and cold, stiffness, and numbness. It may affect the front, back, or sides of the body. The disease is in the exterior, often affecting the four limbs. Even if hemiplegia occurs with immobile limbs, copious phlegm-saliva, and thunderous breathing, the eyes can still see, and the mouth can speak, and there are exterior Six Channel manifestations. For Zhong Zang, the disease is interior, often obstructing the nine orifices. Thus, flaccid lips with urinary/fecal retention indicate Spleen involvement; inability to speak indicates Heart involvement; deafness indicates Kidney involvement; nasal congestion indicates Lung involvement; and blurred vision indicates Liver involvement. For Zhong Xue Mai, the disease is at the half-exterior/half-interior level, lacking Six Channel exterior signs and internal obstruction of bowels/bladder, presenting only with facial deviation and unilateral pain. If the body collapses and cannot be controlled, deafness, blindness, open mouth and closed eyes, hand release with incontinence, aphonia, and snoring sleep occur, this represents the collapse syndrome where the root is uprooted and the pivot of Yin and Yang fails to interact, making it difficult to treat. These share the same name but differ in presentation, requiring distinction.
The pulse of Shanghan is full and tight-choppy in both Yin and Yang positions.
Shanghan refers to Cold injuring the Taiyang superficial surface. Hua Yuanhua stated: On the first day of Shanghan, the pathogen is in the skin; on the second day, in the flesh; on the third day, in the muscle; on the fourth day, in the chest; on the fifth day, in the abdomen; on the sixth day, it enters the Stomach. This indicates that the initial Wind-Cold pathogen enters through the skin and pores, suppressing Ying Qi and binding it within the meridians, resulting in a pulse that is full, floating, tight, and choppy in both Yin and Yang positions, accompanied by anhidrosis. Definitive signs include stiff neck and head, fever, body ache, lower back pain, joint pain, aversion to wind and cold, and wheezing. The Qi transformed in the Taiyang Bladder circulates from the Qi Sea along the Chong and Ren channels, crosses the diaphragm into the Lungs, and exits via the nose as exhaled air. Another portion of this Qi moves internally through the Sanjiao fatty membranes, exits via the Qi Streets, follows the muscles, reaches the skin and hair, serving as the defensive exterior Qi. People know about breath exiting the nose but ignore that Qi also exits through every pore. When nasal breath exits, all pore Qi expands; when nasal breath enters, all pore Qi contracts. If pore Qi cannot exit externally, it turns inward, obstructing the Lungs, leading to wheezing via the nose and throat. Thus, when Cold injures the superficial surface, the defensive Qi of the skin and hair cannot exit, turning inward and obstructing upwards to cause wheezing. Inside the skin and hair are muscles; when Cold invades the muscles, the whole body aches. When the pathogen invades the Taiyang meridians, head, neck, and lower back pain occur. The muscle inside the skin is commonly called subcutaneous fat; between layers of fat are textures called cou li; deeper inside is lean meat. Tendons grow at both ends of the lean meat, connecting with the bone. Thus, when the pathogen invades the lean meat, it enters the tendons, causing joint pain, as stated in Neijing: "All tendons attach to the joints." By releasing the exterior, the Cold pathogen moves from inside to outside and resolves through sweat; hence, Zhang Zhongjing uses Mahuang Tang.
The pulse of Shiwen is soggy and weak at the Yang position and small and rapid at the Yin position.
Shiwen is a Warm Disease caused by the combination of Summerheat and Dampness. There are three causes. First, contracting Summerheat then Dampness, where Heat is suppressed by Dampness, results in a pulse that is soggy and weak at the Yang position (Dampness contending with Summerheat) and small and rapid at the Yin position (Summerheat steaming Dampness). This is the Shiwen mentioned in this chapter. Second, if a person is chronically injured by Dampness, leading to epigastric fullness, and Damp-Heat contend, Shiwen develops with symptoms of cold calves, abdominal distension with chest pressing, headache, eye pain, and delirium. Treatment focuses on the Foot-Taiyin Spleen channel, and diaphoresis is contraindicated. This is the Shiwen described in Wang Shuhe's Maiching. Third, encountering the stagnant Qi of the season between Spring Equinox and Autumn Equinox, when Shaoyin Ministerial Fire, Shaoyang Ministerial Fire, and Taiyin Damp Earth act together. Heaven is naturally hot, enhanced by solar Summerheat; Earth is naturally damp, carrying terrestrial moisture. These three Qi interact intermittently. When dispersed, Wind moves within, overcoming Dampness and resolving stagnation, causing no distress. When combined, Heavenly Heat descends and Earthly Moisture ascends. Humans in this Qi intersection suffer from inflammation and steaming with no escape. Pathogens enter via nose and mouth, settling in the Spleen and Stomach. Symptoms include soggy-weak pulse, white or crimson-based tongue coating, vomiting, dry mouth unable to drink, soft yet full chest, tidal fever, sweating with slight cooling followed by recurrent heat. This is Yu Chang's description of Shiwen caused by the convergence of three Qi. Although causes differ, the disease mostly affects Foot-Yangming Stomach and Foot-Taiyin Spleen due to resonance of Damp-Earth Qi. Exterior diseases of these two channels often involve Hand-Shaoyang Sanjiao; interior diseases often involve Hand-Jueyin Pericardium, because Shaoyang and Jueyin both govern Ministerial Fire. Understanding this guides treatment.
The pulse of Rebing is floating in both Yin and Yang positions; floating and slippery upon light pressure, scattered and choppy upon deep pressure.
Rebing generally refers to Warm-Heat diseases involving latent pathogens and exogenous factors. A pulse floating in both Yin and Yang indicates heat due to excess Yang, as per Jin Gui Yao Lue. Slippery upon light pressure indicates Yang excess externally; scattered and choppy upon deep pressure indicates Yin deficiency internally. Warmth is the gradual onset of Heat; Heat is the extreme of Warmth; essentially they are one, but differences in interior/exterior and mild/severe must be distinguished. Latent Warm Disease involves Winter Yang Heat being suppressed by severe Cold, hiding between muscle and bone. In Spring, triggered by Spring Yang Qi, the Heat pathogen emerges internally, damaging Yin fluids. This corresponds to Zhang Zhongjing's description in Shanghan Lun of "fever with thirst and no aversion to cold" as Warm Disease. Exogenous Wind-Warmth occurs due to winter warmth failing to store essence or spring warmth causing Wind to transform into Heat, presenting with floating pulse, aversion to wind, fever, and cough. If latent Qi exists internally and is stimulated by external Wind-Heat, the two Yangs combine, injuring Wei Qi first. Mistaken use of acrid-warm dispersants leads to burning heat, heaviness, excessive sleepiness, snoring, spontaneous sweating, staring gaze, incontinence, and convulsions. This corresponds to the Wind-Warmth in Shanghan Lun caused by mistaken sweating, purging, or fire therapy, representing exogenous disease combined with latent Qi. Wang Andao stated that Warm-Heat disease pulses are mostly in the muscle layer, not very floating, and often stronger on the right than left due to trapped heat internally. If stronger or floating on the left, it indicates concurrent Wind-Cold; otherwise, it is not Warm-Heat disease but acute Wind-Cold. This is a fixed theory. Why? Suwen Yin Yang Ying Xiang Da Lun states: Left and Right are the pathways of Yin and Yang; Water and Fire are the signs of Yin and Yang. Blood is Yin, Water is Yin; Qi is Yang, Fire is Yang. From the pulse body perspective, Left belongs to Blood (Yin); Right belongs to Qi (Yang). This reflects the left-right nature of Blood and Qi, and the signs of Water and Fire. Wind-Heat is a Yang pathogen, first injuring formless Qi; Wind-Cold is a Yin pathogen, first attacking formed Blood. This aligns with Neijing's "Cold injures Form, Heat injures Qi." Recognizing this, one knows Wind-Heat injures Wei and Wind-Cold injures Ying, avoiding the error of using Guizhi for Warm-Heat based solely on Xu Xueshi's "Wind injures Wei," which could lead to premature death.
Note: No one has elucidated the theory of latent Qi; let me attempt to explain. Suwen Yin Yang Ying Xiang Da Lun states: Extreme Yin transforms into Yang; extreme Yang transforms into Yin. Thus: Injury to Cold in Winter leads to Warm Disease in Spring; Injury to Wind in Spring leads to undigested stool diarrhea in Summer; Injury to Summerheat in Summer leads to Malaria in Autumn; Injury to Dampness in Autumn leads to Cough in Winter. This passage emphasizes "Extreme Yin transforms into Yang; extreme Yang transforms into Yin." It shows that Heaven and Earth Yin-Yang pathogens resonate with human Qi transformation, not that Cold changes to Heat or vice versa. "Winter injury to Cold, Spring Warm Disease": At Winter Solstice, Yang begins to generate, and human Yang Qi becomes abundant internally. Severe Winter Cold kills life force, entering skin and cou li. Internal latent Yang Heat is suppressed by Cold toxins, penetrating deep into marrow. In Spring, as Yang Qi grows, shallow latent pathogens dissipate with Spring Yang; deep latent pathogens, if blocked by Wind-Cold or damaged by desires, have their internal stagnant Yang triggered by external pathogens. Once released, interacting with Heavenly Yang Heat, two heats interfere, causing Warm Disease; extreme Warmth becomes Heat Disease. This is Extreme Yin transforming into Yang. "Summer injury to Summerheat, Autumn Malaria": At Summer Solstice, Yin begins to generate, and human Yin Qi becomes abundant internally. Summerheat is a Yang pathogen; external Yang flare-up makes internal Qi deficient and cold. Combined with greed for coolness and cold drinks damaging True Yang, in Autumn when Yin Qi grows, internal latent Yin pathogen wants to exit while external Yang Summerheat wants to enter. Yin and Yang contend, causing alternating chills and fever Malaria. This is Extreme Yang transforming into Yin. "Spring injury to Wind, Summer diarrhea; Autumn injury to Dampness, Winter cough" relates to mutual overacting of Yin and Yang above and below. Throat governs Heavenly Qi; Pharynx governs Earthly Qi. Yang receives Wind; Yin receives Dampness. Those injured by Wind are affected upward first; those injured by Dampness downward first. Yang diseases move up to extreme then down; thus Spring Wind injury leads to Summer diarrhea. Wind is Yang pathogen, diarrhea is Yin disease; this is Extreme Yang transforming into Yin. Yin diseases move down to extreme then up; thus Autumn Dampness injury leads to upward counterflow cough. Dampness is Yin pathogen, cough is Yang disease; this is Extreme Yin transforming into Yang. Wherever pathogens gather, Qi must be deficient. Divine Qi, Blood, and Meridians originate from Essence. Preserving Essence secures Blood and Qi internally, preventing external invasion. Jingui Zhen Yan Lun states: Essence is the root of the body. Therefore, those who preserve Essence do not get Warm Disease in Spring. Health preservers must be cautious.
The pulse of Wenbing runs through various meridians; one does not know which meridian is activated, so diagnose according to the affected meridian.
Wenbing refers to Plague/Epidemic diseases. Ancient texts lacked the character "Wen," using it interchangeably with "Wen" (Warmth). Yi (Plague) means service/corvee, spreading like labor duties. It is common after wars or natural disasters, infecting cities, towns, or villages. It is caused by Heaven and Earth pestilential Qi, unmeasurable by normal logic and untreatable by standard methods. Suwen lost chapters mention acupuncture for five plagues. Pang Anchang described treatments for Green Tendon Cord, Red Vein KT, Yellow Flesh Follow, White Qi狸, Black Bone Warmth, and Five Colors. Plague diseases are mostly warm-heat biased, rarely cold-biased. However, Bingyuan records that after Spring Equinox before Autumn Equinox, sudden cold causes seasonal Cold Plague. Initial Cold Plague presents with chills, fever, anhidrosis, red face, headache, and stiff neck, caused by open pores closed by Cold. Unlike Shanghan, it is contagious. It appears more in Metal-Water years when Metal and Water fail to store, causing humans and objects to respond with Cold Plague. Dongpo's Shengsanzi treats Cold Plague combined with Dampness. Modern Wu Keyang discussed Plague as Warm-Heat combined with Dampness, characterized by corpse-like odor, dull greasy complexion, deep crimson tongue base, powder-like coating, mental confusion, palpitations, strong right pulse with vague rate, all signs of Damp-Heat contention, treated with Dayuan Yin to reach the募原 (Mu Yuan/Cribriform Form). Yu Shiyu's Qingwen Baidu San uses heavy Gypsum to treat Plague caused by Summerheat. Yue Ren anticipated this, stating Wenbing pulses run through various meridians, unknown which is activated, diagnosing by location. This intent is profound. Huang Kunzai's interpretation using Suwen Relun's daily transmission (Day 1 Taiyang... Day 6 Jueyin) requiring daily diagnosis is flawed. Transmission of meridians refers to healthy Qi transmitting sequentially, returning in seven days, a fixed cycle, not pathogen transmission. Pathogen transmission depends on Taiyang unresolved, entering Yang or Yin, regardless of time or sequence. Transmission to Yangming shows Yangming signs; to Shaoyang shows Shaoyang signs; to Three Yin shows Three Yin signs. Shanghan Lun states: If Yangming and Shaoyang signs are absent on days 2-3 of Shanghan, it has not transmitted. Pathogens transmit based on meridian Qi deficiency, applying to Zhongfeng, Shanghan, and Rebing. Why does Yue Ren specify unique pulses for other conditions but for Wenbing say "unknown which meridian activated, diagnose by location"? Clearly referring to Heaven and Earth pestilential Qi unmeasurable by normal logic. Huang's reckless discussion is highly erroneous.
Regarding Shanghan: Some recover with sweating and die with purging; some die with sweating and recover with purging. Why?
Response: In Yang deficiency and Yin excess, sweating leads to recovery, purging leads to death. In Yang excess and Yin deficiency, sweating leads to death, purging leads to recovery.
Shanghan is a general term for these five diseases. But why does Shanghan sometimes recover with sweating and die with purging, or recover with purging and die with sweating? Generally, external Cold attack is Yin excess, treatable by sweating but not purging; internal blazing Heat is Yang excess, treatable by purging but not sweating. Wang Shuhe's Preface to Shanghan states: "Guizhi swallowed, Yang excess leads to death; Chengqi entering stomach, Yin excess leads to demise," illustrating this principle.
How to observe Hanre (Cold-Heat) diseases?
Response: Pi Hanre (Skin Cold-Heat): Skin cannot touch the mat, hair burns, nose dries, no sweat. Ji Hanre (Muscle Cold-Heat): Skin hurts, lips and tongue dry, no sweat. Gu Hanre (Bone Cold-Heat): Body finds no rest, sweat pours continuously, tooth roots dry and painful.
Observing Hanre means identifying the location of alternating chills and fever. Pi Hanre indicates pathogen is shallowest, in the skin. Lung governs skin and hair, opens to the nose. Thus, pathogen in skin prevents contact with objects, hair becomes dry and brittle, nose withers. Lack of sweat indicates disharmony of Ying and Wei. Ji Hanre: Muscle lies beneath skin. Pathogen enters muscle via skin, causing skin pain. Spleen governs muscle, opens to the mouth. Thus, muscle pathology affects lips and tongue. Gu Hanre: Bone lies within muscle. Pathogen in bone is deepest, causing global discomfort. Kidney governs bone and fluids; teeth are surplus of bone. Thus, bone disease causes Kidney fluid leakage as sweat, and teeth become dry and painful.
Note: This section is from Linghu Hanre Pian, distinct from the previous five Shanghan types, yet all involve meridian Qi pathology. Treating with collaterals of Three Yang and Shaoyin expels pathogens. Though different from Shanghan, the hierarchy of skin, muscle, and bone meridian Qi is consistent. Yue Ren placed this after the five Shanghan types to show that internal injury miscellaneous diseases differ from exogenous presentations and must not be mistreated.