（４）五种治法：关于合病、并病的治法，后人有合病重在一经，并病数经兼顾之说，自得其要，但不全面。实则合病治法亦有兼顾其次者，如葛根汤、黄芩汤因呕则加半夏、生姜等是。并病亦有独取一经者，如２２０条之用大承气汤是也。李氏拟对于合病并病治法，混合归纳，约为下列五种：一为突出治其主证而不问其余。如主证既除，则所伴是次要之证，亦得悉解。上面所举阳明病主用小柴胡汤两例，及合病条用麻黄汤、白虎汤等是。二为治其主证而宜兼顾其次者，如桂枝人参汤证，用理中以温中为主，而加一味桂枝后下以解表。三为合并之病，权衡其轻重相等，则同治之法，自无孰轻孰重之殊。如柴胡桂枝汤双解太少之邪，麻黄附子甘草汤温阳解表，以治少阴阳虚而兼表证皆是。四是合并病有轻重缓急之分，则治法自有先后缓急之异。
如“先与四逆汤，后与桂枝汤”（参见９１条，３７２条）等条，可体会其意。五为合并之病，一般有先治原发病，后治续发病者，如“阳明病，脉迟，……若汗多，微发热恶寒者，外未解也……”（２０８条）。此与下“宜桂枝汤”（２３４条）脉证相同，有“其外不解者，尚未可攻，当先解其外……”（１０６条）之义，亦是合病并病治法之一种。
合并并病之说，大论创之，柯氏启之。李氏拟掇拾其大义，阐发其幽微，以其六经学说，广为世用。
６标本学说之应用标本之说，首先见于《素问·标本病传论》及《灵枢·病本篇》（下引《内经》原文均见此二篇），对于抓疾病证候之主次，定治疗方法之先后，用于临床实际中自有一定价值。《伤寒论》六经证治大法：如病在太阳之表者汗之；病入阳明之里，热者清之，实者泻之；病在少阳，则以和解为主。若病入三阴，太阴脾虚脏寒，治法直当温中；少阴虚寒，宜用扶阳抑阴，如属虚热，则宜育阴清热法等等。对于标本，似无明文可稽。但在病机复杂、证候多变的情况下，其总的治疗原则，又有先治、后治、缓治、急治、并治、独治等种种不同。试为探索其义理，则与《内经》标本之说，有相符合者。今特阐述于次，以明仲景撰用《素问》之旨，以供深入研究仲景学说者之参考。
（１）先病为本，后病为标：关于《内经》标本的涵义，自王启玄以下，如姚止庵、马玄台诸家皆未确指，惟谓“标者病之后生，本者病之先成，此乃病体之不同也”，盖即“先病为本，后病为标”之义。独钱塘张志聪、高士宗师弟，据三阴三阳之六气以释标本，而其说又互有小异。今考《内经》原文中有“先寒”、“先热”之词，是六气自寓其中。又载有“先泄”、“先中满”等病，则推究标第三卷１８５本所含之义，似又不仅局限于此。且《内经》固谓：“夫阴阳逆从标本之道也，小而大，言一而知百病之害。少而多，浅而博，可以言一而知百也。……言标与本，易而勿及”。则标本学说，当为探讨多种疾病证治的一般规律与共同规律的总的概括，今仍本诸先病为本后病为标之义，以着重研究在《伤寒论》中的具体应用。
（２）先治其本，后治其标：《内经》云：“先病而后逆者治其本，先逆而后病者治其本，先寒而后生病者治其本，先病而后生寒者治其本，先热而后生病者治其本……”等，据先病为本后病为标之义，治疗法则一般是先治其本，后治其标。《伤寒论》运用标本学说于具体六经病候中，如“本发汗，而复下之，此为逆也。若先发汗，治不为逆。本先下之，而反汗之为逆。若先下之，治不为逆”（宋本９０条）。因六经病证，多由初犯太阳之表，而后及其里。故其治疗大法，则是先治其表，后治其里。此与先治其本的意义类似。但在疾病特殊的情况下，亦有先里后表的治法，是与急则治标的治则略同。此条用汗下而说明表里先后缓急的治疗原则，自与《内经》的标本大义，正相合拍。此外，如“伤寒大下后，复发汗，心下痞，恶寒者，表未解也。不可攻痞，当先解表，表解乃可攻痞。解表宜桂枝汤，攻痞宜大黄黄连泻心汤”（１６４条）。此是伤寒大下后邪热内聚心下而为痞，但恶寒发热等表证仍在。治法先解表，后攻痞，是与“先寒而后生病者治其本”略同。又如“太阳病，过经十余日，反二三下之，后四五日，柴胡证仍在者，先与小柴胡。呕不止，心下急，郁郁微烦者，为未解也，与大柴胡汤下之则愈”（１０３条）。此是太阳表病过经而传为少阳病，因误下津液受伤，火燥相合，而有热实证象。但少阳病仍在，故先与小柴胡汤。如不愈，后与大柴胡汤，以和解少阳兼通下结热为治。另有“伤寒阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤。不差者，小柴胡汤主之”（１００条）。此条患者当是素有中焦虚寒又患有伤寒少阳病。治法侧重先宜建立中气，温养气血，以培中虚之本；如病不愈，后用和解法以治少阳之标。以上三者都是先治其本后治其标之范例。
（３）急则治标，缓则治本：《内经》云：“先热而后生中满者治其标”，“先病而后生中满者治其标”，“小大便不利治其标，小大便利治其本”。盖病候有标本之分，病势有缓急之殊，则治法自有先后之异。考病势最为严重而急，无过于中满、大小便不利数者而已。故列举此类证候，以明治法，当急其所急，而应缓其所缓者。后人循此义理，推究治则，而衍为急则治标缓则治本之说。六经病中，不仅有此类似病例，而且所举证候如中满，大小便不利，亦与《内经》有相切合者。如“少阴病，六七日，腹胀不大便者，急下之，宜大承气汤”（３２２条）。“少阴病，自利清水，色纯青，心下必痛，口干燥者，急下之，宜大承气汤”（３２１条）。少阴津液干涸，本不应下，但因腑实证急，故又宜急下。又如“伤寒，哕而腹满，视其前后，知何部不利，利之则愈”（３８０条）。
此条腹满是实热积于中，哕逆是胃气逆于上。如大便不通，当用通下结热法。如小便不利，则用导火通利法，皆是实热重证治法。以上所举为实热重证，若虚寒危急之证，亦有不乏其例。
如“下利腹胀满，……先温其里，……温里宜四逆汤”（３７１条）。此与“下利清谷，不可攻表，汗出必胀满”（３６３条），皆属三阴虚寒脾肾阳微危重之证，虽有表证，当以救里为急。凡此据后病为标之义，皆可属于急则治其标之例。
（４）本而标之，标而本之：《内经》云：“病发而有余，本而标之，先治其本，后治其标。病发而不足，标而本之，先治其标，后治其本”。此处所举标本，自寓先病后病之义。说明如病发而病邪势盛，属于实证，当以祛邪为主，一般可采取“本而标之”的治法。六经病中，如“太阳不解，热结膀胱，其人如狂，……其外不解者，尚未可攻，当先解其外；外解已，但少腹急结者，乃可攻第三卷１８６之，宜桃核承气汤”（１０６条）。此是实热有余之证，故可采用本而标之的治法。《伤寒论》中此类病例甚多。如前段所举先解表，后攻痞；解表宜桂枝汤，攻痞宜大黄黄连泻心汤及“阳明病，脉迟，……若汗多，微发热恶寒者，外未解也，其热不潮，未可与承气汤”（２０８条）等等皆是。反之，如病发而正气不足，属于虚证，则应以扶正为主，宜采用“标而本之”的治法。如“伤寒，医下之，续得下利清谷不止，身疼痛者，急当救里；后身疼痛，清便自调者，急当救表。救里，宜四逆汤；救表，宜桂枝汤”（９１条）。此条伤寒表证身疼痛是原发病，是本病；下利清谷不止，是误下后续发病，是标病。下利清谷是脾肾阳气衰微，不能腐熟水谷，运化精微，病势急危而重，故当采取病发而不足，标而本之的治法。按此段说明当详审病体之有余不足以决定治法。与上两段先本后标、急则治标之义，既有联系，又有区别。应当灵活掌握，互相参用。举例言之，如蓄血重证，“表证仍在”（１２４条），近似病发有余，亦当用抵当汤以破血去瘀，仍是急则治标的治法。又如“太阳病，外证未除，而数下之，遂协热而利，利下不止，心下痞硬，表里不解者，桂枝人参汤主之”（１６３条）。本条治法虽偏重于里，略同于病发不足，但温里解表，义取双解，毕竟是标本同治之法。
（５）谨察间甚，以意调之：《内经》云：“谨察间甚，以意调之，间者并行，甚者独行”。此在申述疾病标本之先后，察病势之轻重缓急，审病体有余不足之后，缀此数句，似含总结上文之义。
王冰注：“间，谓多也，甚，谓少也”，甚是。所谓“以意调之，自当赅有治法，亦即间者并行或甚者独行之谓”。但在先病后病错综复杂的证候中，多与少只是相对而言。例如在六经合并病中，审其证候之寒热，邪正之虚实等，有明显倾向于主要的一种，即突出使用一种治法，治其独盛之病。如合病中用麻黄汤、葛根汤之解表发汗，白虎汤独清阳明经热，并病中如用大承气汤以峻下热结，推而广之，有表证而用四逆汤以回阳救逆等数条，均略同于“甚者独行”之治法。再者，六经之病，在病机复杂的情况下，多出现有虚实相兼寒热夹杂之证，则治法自宜全面兼顾：如附子、半夏、生姜、甘草四泻心汤及黄连汤等之寒温并用。小柴胡加芒硝汤、柴胡加龙牡汤之攻补兼施。柴胡桂枝汤治少阳兼表不解，治法采取和营卫以解太阳，利枢机以治少阳。麻黄附子细辛甘草汤温阳解表，治少阴病反发热等等，都与“间者并行”之义略同。惟王注又谓：“多，谓多形证而轻易。少，谓少形证而重难也。”此说似觉欠妥。盖间杂之证，有重而难者；较为独盛之证，亦有轻而易者。如太阳伤寒大青龙证之重于麻黄汤证，而少阳小柴胡证自较大柴胡为轻也。
《内经》标本学说，得到《伤寒论》进一步推衍和具体运用，掌握病有标本治有先后等规律，对待病机之千变万化，充分运用于临床之中，是有重要实际意义的。
７析六经证候传与不传六经分证，其病机变化是错综复杂的，其证候表现形式是多种多样的。在复杂的病变之中，《伤寒论》根据证候交替此起彼伏之特点，有“传”与“不传”、“转属”、“过经”、“转系”、“转入”等等说法。李氏之意不拟由说法上找问题，而应从证候中寻症结。故今只取“传与不传”为标题，以试探六经证候变化之规律。这对疾病的诊断与治疗，具有重要实际意义。
（１）传与不传：《伤寒论》在太阳病提纲及中风、伤寒之后，紧接着提出：“伤寒一日，太阳受之，脉若静者，为不传；颇欲吐，若躁烦，脉数急者，为传也”（４条）。“伤寒二三日，阳明少阳证不见者，为不传也”（５条）。此是申述太阳表病有传与不传之别，并以辨明《素问·热论》一日巨阳、二日阳明等之非。盖表病传与不传，当凭现有的脉证，不可拘泥于日数。且疾病之传变与第三卷１８７否，从病因机理综合分析，实取决于病邪（致病因素）的微甚，正气（体质及抗病能力等）的盛衰，治疗当否，以及护理是否适宜，患者有无宿疾等等。如患者正气较旺，病邪轻微，虽得表病，亦不内传。故曰：“伤寒三日，三阳为尽，三阴当受邪，其人反能食而不呕，此为三阴不受邪也”（２７０条）。若在疾病发生发展过程中，治疗失当，则证候多变，病势易于内传。故太阳中下二篇，误用汗吐下后转为变证条文，实占绝大多数。又有服桂枝汤，“服已须臾，啜热稀粥一升余，以助药力。温复令一时许，遍身，微似有汗者益佳”。若护理失宜，汗出如水流漓，此在阳虚之体，则易漏汗亡阳，如桂枝加附子汤证；若属阳盛之体，汗出过多，又能形成热盛伤津，如白虎加人参汤证。又如阳明蓄血证，病因“本有久瘀血”（２３７条）。阳明燥屎证，以“本有宿疾有关”。是某种疾病之形成，又与宿疾有关。综上所述，是知疾病传与不传，实决定于多方面。太阳表病不传的类型约有两种：一则如“太阳病，头痛，至七日以上自愈者，以行其经尽故也”（８条）。此是表病多日，正气渐复，病邪势衰，证候减轻，已属自愈之象。亦有病势虽不内传，而始终仍稽留于太阳之表者。如“太阳病，脉浮紧，无汗发热，身疼痛，八九日不解，表证仍在，此当发其汗，……麻黄汤主之”（４６条）者是。又如“太阳病，十日以去，脉浮细而嗜卧者，外已解也。
设胸满胁痛者，与小柴胡汤；脉但浮者，与麻黄汤”（３７条）。此条当分三小段解释：首段述外已解的脉证，当是病势已退正气未复之象，与上述自愈条的病理机制略同。末段“脉但浮者，与麻黄汤”，则与４６条中心大意类似。说明表病多日，邪病多留连于表，病势并未内传。但因表寒实证确实存在，故仍用解表发汗之法。次段“设胸满胁痛者，与小柴胡汤”，则是表病内传入里，由太阳而转入少阳，故可用和解枢机之法。详情并在以下项目范围内讨论。
（4）五种治法：关于合病、并病的治法，后世医家有“合病重在单一经，并病需兼顾多经”的说法，这虽然抓住了要点，但并不全面。实际上，合病的治法也有兼顾次要证候的情况，例如葛根汤、黄芩汤因出现呕吐则加入半夏、生姜等药物就是例子。并病也有只针对一经治疗的情况，如第220条使用大承气汤就是例子。李氏拟将合病和并病的治法混合归纳，大致分为以下五种：一是突出治疗主要证候而不顾及其他。如果主要证候消除，那么伴随的次要证候也会随之解除。上面所举阳明病主用小柴胡汤的两个例子，以及合病条文中用麻黄汤、白虎汤等就是这种情况。二是治疗主要证候而适宜兼顾次要证候，例如桂枝人参汤证，以理中汤温中为主，再加一味后下的桂枝来解表。三是合并的疾病，权衡其轻重相等，则采用同时治疗的办法，自然没有孰轻孰重的区别。例如柴胡桂枝汤双解太阳、少阳之邪，麻黄附子甘草汤温阳解表，以治疗少阴阳虚兼有表证等都是如此。四是合并的病有轻重缓急之分，则治法自然有先后缓急的不同。如“先给予四逆汤，后给予桂枝汤”（参见第91条，第372条）等条文，可以体会其中的意思。五是合并的病，一般先治疗原发病，后治疗续发病，如“阳明病，脉迟，……如果汗多，微发热恶寒者，说明表证未解……”（第208条）。这与下文“宜用桂枝汤”（第234条）的脉证相同，有“表证未解，尚不可攻下，应当先解表……”（第106条）的含义，这也是合病并病治法的一种。
关于合并病和并病的说法，由《伤寒论》创立，柯琴等人加以阐发。李氏拟摘录其大义，阐发其深奥细微之处，结合其六经学说，广泛供世人应用。
6. 标本学说的应用：标本之说，首先见于《素问·标本病传论》及《灵枢·病本篇》（下文引用的《内经》原文均出自这两篇），对于抓住疾病证候的主次，确定治疗方法的前后顺序，用于临床实际中自有一定的价值。《伤寒论》六经证治的大法：如病在太阳之表，则用发汗法；病入阳明之里，热者用清热法，实者用泻下法；病在少阳，则以和解为主。若病入三阴，太阴脾虚脏寒，治法直接应当温中；少阴虚寒，宜用扶阳抑阴法，如果属于虚热，则宜用育阴清热法等。对于标本，似乎没有明文可查考。但在病机复杂、证候多变的情况下，其总的治疗原则，又有先治、后治、缓治、急治、并治、独治等种种不同。试探索其义理，则与《内经》的标本之说，有相符合的地方。现在特别阐述如下，以阐明张仲景撰写《伤寒论》运用《素问》的宗旨，以供深入研究张仲景学说者参考。
（1）先病为本，后病为标：关于《内经》标本的含义，自王启玄以下，如姚止庵、马玄台各家都没有确切指出，只说“标是病之后生，本是病之先成，这是病体的不同”，大概即“先病为本，后病为标”的意思。只有钱塘张志聪、高士宗师徒二人，依据三阴三阳的六气来解释标本，而他们的说法又互有小异。现在考证《内经》原文中有“先寒”、“先热”的词句，这说明六气自寓其中。又记载有“先泄”、“先中满”等疾病，那么推究标本所含的意义，似乎又不局限于此。而且《内经》确实说：“夫阴阳逆从标本之道也，小而大，言一而知百病之害。少而多，浅而博，可以言一而知百也。……言标与本，易而勿及”。那么标本学说，应当是探讨多种疾病证治的一般规律与共同规律的总的概括，现在仍本着先病为本后病为标的意义，以着重研究在《伤寒论》中的具体应用。
（2）先治其本，后治其标：《内经》说：“先病而后逆者治其本，先逆而后病者治其本，先寒而后生病者治其本，先病而后生寒者治其本，先热而后生病者治其本……”等，根据先病为本后病为标的意义，治疗法则一般是先治其本，后治其标。《伤寒论》运用标本学说于具体六经病候中，如“本应发汗，反而用下法，这是逆治。如果先发汗，治疗就不为逆。本应先下之，反而发汗是为逆。如果先下之，治疗就不为逆”（宋本第90条）。因为六经病证，多由初犯太阳之表，而后波及其里。所以其治疗大法，则是先治其表，后治其里。这与先治其本的意义类似。但在疾病特殊的情况下，亦有先里后表的治法，这与急则治标的治则大致相同。此条用汗法和下法来说明表里先后缓急的治疗原则，自然与《内经》的标本大义，正相吻合。此外，如“伤寒大下后，复发汗，心下痞，恶寒者，说明表证未解。不可攻痞，应当先解表，表解后方可攻痞。解表宜用桂枝汤，攻痞宜用大黄黄连泻心汤”（第164条）。这是伤寒大下后邪热内聚心下而成痞，但恶寒发热等表证仍在。治法先解表，后攻痞，这与“先寒而后生病者治其本”大致相同。又如“太阳病，过经十余日，反二三下之，后四五日，柴胡证仍在者，先给予小柴胡汤。呕不止，心下急，郁郁微烦者，说明病未解，给予大柴胡汤下之则愈”（第103条）。这是太阳表病过经而传为少阳病，因误下津液受伤，火燥相合，而有热实证象。但少阳病仍在，故先给予小柴胡汤。如不愈，后给予大柴胡汤，以和解少阳兼通下结热为治。另有“伤寒阳脉涩，阴脉弦，法当腹中急痛，先给予小建中汤。不差者，以小柴胡汤主治”（第100条）。此条患者应当是素有中焦虚寒又患有伤寒少阳病。治法侧重先宜建立中气，温养气血，以培补中虚之本；如病不愈，后用和解法以治少阳之标。以上三者都是先治其本后治其标的范例。
（3）急则治标，缓则治本：《内经》说：“先热而后生中满者治其标”，“先病而后生中满者治其标”，“小大便不利治其标，小大便利治其本”。盖病候有标本之分，病势有缓急之殊，则治法自有先后之异。考察病势最为严重而急，无过于中满、大小便不利这几项而已。所以列举此类证候，以明确治法，应当急其所急，而应缓其所缓者。后人遵循此义理，推究治则，而衍化为急则治标缓则治本的说法。六经病中，不仅有此类似病例，而且所举证候如中满，大小便不利，也与《内经》有相切合的地方。如“少阴病，六七日，腹胀不大便者，急下之，宜用大承气汤”（第322条）。“少阴病，自利清水，色纯青，心下必痛，口干燥者，急下之，宜用大承气汤”（第321条）。少阴津液干涸，本不应下，但因腑实证急，故又宜急下。又如“伤寒，哕而腹满，视其前后，知何部不利，利之则愈”（第380条）。此条腹满是实热积于中，哕逆是胃气逆于上。如大便不通，当用通下结热法。如小便不利，则用导火通利法，皆是实热重证的治法。以上所举为实热重证，若虚寒危急之证，亦不乏其例。如“下利腹胀满，……先温其里，……温里宜用四逆汤”（第371条）。这与“下利清谷，不可攻表，汗出必胀满”（第363条），皆属三阴虚寒脾肾阳微危重之证，虽有表证，当以救里为急。凡此根据后病为标的意义，皆可属于急则治其标的例子。
（4）本而标之，标而本之：《内经》说：“病发而有余，本而标之，先治其本，后治其标。病发而不足，标而本之，先治其标，后治其本”。此处所举标本，自寓先病后病之义。说明如病发而病邪势盛，属于实证，当以祛邪为主，一般可采取“本而标之”的治法。六经病中，如“太阳不解，热结膀胱，其人如狂，……其外不解者，尚未可攻，当先解其外；外解已，但少腹急结者，乃可攻之，宜用桃核承气汤”（第106条）。这是实热有余之证，故可采用本而标之的治法。《伤寒论》中此类病例甚多。如前段所举先解表，后攻痞；解表宜用桂枝汤，攻痞宜用大黄黄连泻心汤及“阳明病，脉迟，……如果汗多，微发热恶寒者，说明表证未解，其热不潮，未可与承气汤”（第208条）等等皆是。反之，如病发而正气不足，属于虚证，则应以扶正为主，宜采用“标而本之”的治法。如“伤寒，医下之，续得下利清谷不止，身疼痛者，急当救里；后身疼痛，清便自调者，急当救表。救里，宜用四逆汤；救表，宜用桂枝汤”（第91条）。此条伤寒表证身疼痛是原发病，是本病；下利清谷不止，是误下后续发病，是标病。下利清谷是脾肾阳气衰微，不能腐熟水谷，运化精微，病势急危而重，故当采取病发而不足，标而本之的治法。按此段说明应当详审病体之有余不足以决定治法。与上两段先本后标、急则治标的意义，既有联系，又有区别。应当灵活掌握，互相参用。举例言之，如蓄血重证，“表证仍在”（第124条），近似病发有余，亦当用抵当汤以破血去瘀，仍是急则治标的治法。又如“太阳病，外证未除，而数下之，遂协热而利，利下不止，心下痞硬，表里不解者，桂枝人参汤主之”（第163条）。本条治法虽偏重于里，略同于病发不足，但温里解表，义取双解，毕竟是标本同治之法。
（5）谨察间甚，以意调之：《内经》说：“谨察间甚，以意调之，间者并行，甚者独行”。这是在申述疾病标本之先后，察病势之轻重缓急，审病体有余不足之后，缀此数句，似含总结上文之义。王冰注：“间，谓多也，甚，谓少也”，甚是。所谓“以意调之，自当赅有治法，亦即间者并行或甚者独行之谓”。但在先病后病错综复杂的证候中，多与少只是相对而言。例如在六经合并病中，审其证候之寒热，邪正之虚实等，有明显倾向于主要的一种，即突出使用一种治法，治其独盛之病。如合病中用麻黄汤、葛根汤之解表发汗，白虎汤独清阳明经热，并病中如用大承气汤以峻下热结，推而广之，有表证而用四逆汤以回阳救逆等数条，均略同于“甚者独行”之治法。再者，六经之病，在病机复杂的情况下，多出现有虚实相兼寒热夹杂之证，则治法自宜全面兼顾：如附子、半夏、生姜、甘草四泻心汤及黄连汤等之寒温并用。小柴胡加芒硝汤、柴胡加龙牡汤之攻补兼施。柴胡桂枝汤治少阳兼表不解，治法采取和营卫以解太阳，利枢机以治少阳。麻黄附子细辛甘草汤温阳解表，治少阴病反发热等等，都与“间者并行”之义略同。惟王注又谓：“多，谓多形证而轻易。少，谓少形证而重难也。”此说似觉欠妥。盖间杂之证，有重而难者；较为独盛之证，亦有轻而易者。如太阳伤寒大青龙证之重于麻黄汤证，而少阳小柴胡证自较大柴胡为轻也。
《内经》标本学说，得到《伤寒论》进一步推衍和具体运用，掌握病有标本治有先后等规律，对待病机之千变万化，充分运用于临床之中，是有重要实际意义的。
7. 析六经证候传与不传：六经分证，其病机变化是错综复杂的，其证候表现形式是多种多样的。在复杂的病变之中，《伤寒论》根据证候交替此起彼伏之特点，有“传”与“不传”、“转属”、“过经”、“转系”、“转入”等等说法。李氏之意不拟由说法上找问题，而应从证候中寻症结。故今只取“传与不传”为标题，以试探六经证候变化之规律。这对疾病的诊断与治疗，具有重要实际意义。
（1）传与不传：《伤寒论》在太阳病提纲及中风、伤寒之后，紧接着提出：“伤寒一日，太阳受之，脉若静者，为不传；颇欲吐，若躁烦，脉数急者，为传也”（第4条）。“伤寒二三日，阳明少阳证不见者，为不传也”（第5条）。这是申述太阳表病有传与不传之别，并以辨明《素问·热论》一日巨阳、二日阳明等的错误。盖表病传与不传，当凭现有的脉证，不可拘泥于日数。且疾病之传变与否，从病因机理综合分析，实取决于病邪（致病因素）的微甚，正气（体质及抗病能力等）的盛衰，治疗当否，以及护理是否适宜，患者有无宿疾等等。如患者正气较旺，病邪轻微，虽得表病，亦不内传。故曰：“伤寒三日，三阳为尽，三阴当受邪，其人反能食而不呕，此为三阴不受邪也”（第270条）。若在疾病发生发展过程中，治疗失当，则证候多变，病势易于内传。故太阳中下二篇，误用汗吐下后转为变证条文，实占绝大多数。又有服桂枝汤，“服已须臾，啜热稀粥一升余，以助药力。温复令一时许，遍身，微似有汗者益佳”。若护理失宜，汗出如水流漓，此在阳虚之体，则易漏汗亡阳，如桂枝加附子汤证；若属阳盛之体，汗出过多，又能形成热盛伤津，如白虎加人参汤证。又如阳明蓄血证，病因“本有久瘀血”（第237条）。阳明燥屎证，以“本有宿疾有关”。是某种疾病之形成，又与宿疾有关。综上所述，是知疾病传与不传，实决定于多方面。太阳表病不传的类型约有两种：一则如“太阳病，头痛，至七日以上自愈者，以行其经尽故也”（第8条）。这是表病多日，正气渐复，病邪势衰，证候减轻，已属自愈之象。亦有病势虽不内传，而始终仍稽留于太阳之表者。如“太阳病，脉浮紧，无汗发热，身疼痛，八九日不解，表证仍在，此当发其汗，……麻黄汤主之”（第46条）者是。又如“太阳病，十日以去，脉浮细而嗜卧者，外已解也。设胸满胁痛者，与小柴胡汤；脉但浮者，与麻黄汤”（第37条）。此条当分三小段解释：首段述外已解的脉证，当是病势已退正气未复之象，与上述自愈条的病理机制略同。末段“脉但浮者，与麻黄汤”，则与46条中心大意类似。说明表病多日，邪病多留连于表，病势并未内传。但因表寒实证确实存在，故仍用解表发汗之法。次段“设胸满胁痛者，与小柴胡汤”，则是表病内传入里，由太阳而转入少阳，故可用和解枢机之法。详情并在以下项目范围内讨论。
(4) Five Treatment Methods: Regarding the treatment methods for concurrent diseases (He Bing, simultaneous involvement of two or more meridians) and combined diseases (Bing Bing, sequential progression from one meridian to another), later physicians proposed that "concurrent diseases focus on a single meridian, while combined diseases require consideration of multiple meridians." This captures the essence but is not comprehensive. In fact, the treatment of concurrent diseases also involves addressing secondary manifestations; for example, Ge Gen Tang (Kudzu Root Decoction) and Huang Qin Tang (Scutellaria Decoction) add Ban Xia (Pinellia Rhizome) and Sheng Jiang (Fresh Ginger) when vomiting occurs. Similarly, combined diseases may sometimes be treated by targeting only one meridian, such as the use of Da Cheng Qi Tang (Major Order the Golden Cabinet Decoction) in clause 220. Mr. Li proposes synthesizing and categorizing the treatment methods for concurrent and combined diseases into five types: First, highlight the treatment of the primary syndrome without regard for others. Once the primary syndrome is resolved, the accompanying secondary syndromes will also be cleared. The two examples mentioned above where Yangming disease primarily uses Xiao Chai Hu Tang (Minor Order the Golden Cabinet Decoction), and the use of Ma Huang Tang (Ephedra Decoction) and Bai Hu Tang (White Tiger Decoction) in concurrent disease clauses are instances of this. Second, treat the primary syndrome while appropriately addressing secondary ones. For instance, in Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction), Li Zhong Tang (Regulate the Middle Decoction) is used as the main treatment to warm the middle, with the addition of Gui Zhi (Cinnamon Twig) added last to release the exterior. Third, when merged diseases are judged to have equal severity, they are treated simultaneously, leaving no distinction in priority. Examples include Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) resolving pathogens in both Taiyang and Shaoyang, and Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) warming yang and releasing the exterior to treat Shaoyin yang deficiency with concurrent exterior syndrome. Fourth, when merged diseases differ in severity and urgency, treatment methods naturally vary in sequence and pace. Clauses such as "first administer Si Ni Tang (Four Reversal Decoction), then administer Gui Zhi Tang" (see clauses 91 and 372) illustrate this principle. Fifth, in merged diseases, it is generally standard to treat the primary disease first and the secondary disease later. For example, "Yangming disease, pulse slow... if there is much sweating, slight fever and aversion to cold, the exterior has not yet resolved..." (clause 208). This aligns with the pulse and symptoms described in "suitable for Gui Zhi Tang" (clause 234) and carries the meaning of "if the exterior is not resolved, attack is not yet permissible; one must first resolve the exterior..." (clause 106). This is also a type of treatment method for concurrent and combined diseases.
The concepts of merged and combined diseases were created by the *Treatise on Cold Damage* (*Shang Han Lun*) and elucidated by Ke Qin. Mr. Li intends to extract their major principles, expound upon their subtle depths, and apply them widely through his Six Meridian theory for general use.
6. Application of the Theory of Root and Branch: The theory of Root (Ben) and Branch (Biao) first appears in *Su Wen: Chapter on Root and Branch Disease Transmission* and *Ling Shu: Chapter on Disease Origin* (all subsequent citations from *Nei Jing* are from these two chapters). It holds certain value in clinical practice for grasping the主次 (primary and secondary aspects) of disease manifestations and determining the sequence of treatment methods. The general principles of Six Meridian syndrome differentiation and treatment in the *Treatise on Cold Damage* are as follows: If the disease is at the exterior of Taiyang, use diaphoresis (sweating); if it enters the interior of Yangming, clear heat if hot, purge excess if solid; if in Shaoyang, prioritize harmonization. If the disease enters the Three Yin meridians, for Taiyin spleen deficiency and internal cold, the treatment should directly warm the middle; for Shaoyin deficiency-cold, use methods to support yang and suppress yin; if it belongs to deficiency-heat, use methods to nourish yin and clear heat. There seems to be no explicit text discussing Root and Branch in this context. However, under conditions of complex pathogenesis and variable syndromes, the overall treatment principles include treating first or later, slowly or urgently, concurrently or exclusively. Exploring their rationale reveals consistency with the Root and Branch theory in *Nei Jing*. This is elaborated below to clarify Zhang Zhongjing's intent in utilizing *Su Wen*, providing reference for those studying his theories deeply.
(1) Primary disease is Root, Secondary disease is Branch: Regarding the meaning of Root and Branch in *Nei Jing*, scholars from Wang Qixuan onwards, such as Yao Zhi'an and Ma Xuantai, did not specify it precisely, stating only that "Branch is what arises later in the disease, Root is what formed earlier; this refers to differences in the disease body," which essentially means "Primary disease is Root, Secondary disease is Branch." Only Zhang Zhicong and Gao Shizong from Qiantang, based on the Six Qi of the Three Yin and Three Yang, explained Root and Branch, though their views differed slightly. Examining the original text of *Nei Jing*, terms like "first cold" and "first heat" imply the presence of Six Qi. Records of diseases like "first diarrhea" and "first abdominal fullness" suggest that the meaning of Root and Branch extends beyond just these. Furthermore, *Nei Jing* states: "The way of Yin-Yang reversal and conformity, Root and Branch, is small yet great, speaking of one to know the harm of a hundred diseases. Few yet many, shallow yet broad, speaking of one to know a hundred... Speaking of Root and Branch is easy but difficult to reach." Thus, the Root and Branch theory should be viewed as a general summary of the common laws governing the diagnosis and treatment of various diseases. Here, we adhere to the meaning of "Primary disease is Root, Secondary disease is Branch" to focus on its specific application in the *Treatise on Cold Damage*.
(2) Treat the Root first, then the Branch: *Nei Jing* states: "If disease arises first followed by rebellion, treat the Root; if rebellion arises first followed by disease, treat the Root; if cold arises first followed by disease, treat the Root; if disease arises first followed by cold, treat the Root; if heat arises first followed by disease, treat the Root..." Based on the principle that Primary disease is Root and Secondary disease is Branch, the general therapeutic rule is to treat the Root first and the Branch later. The *Treatise on Cold Damage* applies this theory to specific Six Meridian syndromes, such as: "Originally should have been treated with diaphoresis, but purgation was used instead; this is contrary. If diaphoresis is performed first, the treatment is not contrary. Originally should have been purged, but diaphoresis was used instead; this is contrary. If purgation is performed first, the treatment is not contrary" (Song Edition, Clause 90). Since Six Meridian diseases often start with an invasion of the Taiyang exterior and subsequently affect the interior, the general treatment principle is to treat the exterior first and the interior later. This is similar to treating the Root first. However, in special circumstances, treating the interior before the exterior is possible, which aligns roughly with the principle of "Urgent cases treat the Branch." This clause uses diaphoresis and purgation to illustrate the principles of sequence and urgency in treating exterior and interior, perfectly matching the major doctrine of Root and Branch in *Nei Jing*. Additionally, "After severe purgation and subsequent diaphoresis in cold damage, epigastric fullness (Pi) occurs, and aversion to cold indicates the exterior is unresolved. Do not attack the Pi; first resolve the exterior. After the exterior is resolved, attack the Pi. Resolve exterior with Gui Zhi Tang (Cinnamon Twig Decoction); attack Pi with Da Huang Huang Lian Xie Xin Tang (Rhubarb, Scutellaria, and Coptis Heart-Purging Decoction)" (Clause 164). This describes heat accumulating in the epigastrium after severe purgation, yet exterior signs like aversion to cold remain. The treatment resolves the exterior first, then attacks the Pi, similar to "cold arises first followed by disease, treat the Root." Another example: "Taiyang disease, passing beyond the stage for over ten days, subjected to repeated purgation, after four or five days, if Chai Hu syndrome persists, first give Xiao Chai Hu Tang (Minor Order the Golden Cabinet Decoction). If vomiting continues, epigastric tension, and mild vexation persist, indicating unresolved disease, give Da Chai Hu Tang (Major Order the Golden Cabinet Decoction) to purge, and recovery ensues" (Clause 103). This is Taiyang exterior disease progressing to Shaoyang due to fluid injury from erroneous purgation, leading to heat-excess signs. Since Shaoyang disease persists, Xiao Chai Hu Tang is given first. If ineffective, Da Chai Hu Tang is given to harmonize Shaoyang and purge accumulated heat. Another case: "Cold damage, Yang pulse choppy, Yin pulse string-like, law dictates acute abdominal pain; first give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). If not improved, Xiao Chai Hu Tang (Minor Order the Golden Cabinet Decoction) is the primary treatment" (Clause 100). The patient likely has chronic Middle Jiao deficiency-cold alongside cold damage Shaoyang disease. The treatment focuses on establishing Middle Qi and nourishing blood and qi to address the root of Middle deficiency; if unresolved, harmonization is used to treat the Shaoyang branch. These three cases are examples of treating the Root first and the Branch later.
(3) Urgent cases treat the Branch, Slow cases treat the Root: *Nei Jing* states: "If heat arises first followed by abdominal fullness, treat the Branch"; "If disease arises first followed by abdominal fullness, treat the Branch"; "If urination and defecation are obstructed, treat the Branch; if normal, treat the Root." Since syndromes have Root and Branch distinctions, and disease momentum varies in urgency, treatment sequences differ. The most severe and urgent conditions are abdominal fullness and obstruction of urination/defecation. Listing these syndromes clarifies that treatment should address the urgent aspect urgently and the slow aspect slowly. Later scholars derived the principle of "Urgent cases treat the Branch, Slow cases treat the Root" from this reasoning. In Six Meridian diseases, not only are there similar cases, but syndromes like abdominal fullness and urinary/defecatory obstruction also align with *Nei Jing*. For example, "Shaoyin disease, six or seven days, abdominal distension and inability to defecate; urgent purgation is required, suitable for Da Cheng Qi Tang (Major Order the Golden Cabinet Decoction)" (Clause 322). "Shaoyin disease, spontaneous diarrhea of clear water, pure green color,必定 pain in the epigastrium, dry mouth and throat; urgent purgation is required, suitable for Da Cheng Qi Tang (Major Order the Golden Cabinet Decoction)" (Clause 321). Although Shaoyin fluid depletion usually contraindicates purgation, the urgency of the fu-organ excess necessitates urgent purgation. Another example: "Cold damage, hiccups and abdominal fullness; examine the anterior and posterior orifices to determine which is obstructed; unblocking it leads to cure" (Clause 380). Abdominal fullness here is excess-heat accumulation in the middle; hiccups are stomach qi rebelling upward. If stool is blocked, purge accumulated heat; if urination is obstructed, guide fire and promote diuresis. These are treatments for severe excess-heat syndromes. For critical deficiency-cold syndromes, examples exist as well. "Diarrhea with abdominal fullness... first warm the interior... warming interior is suitable for Si Ni Tang (Four Reversal Decoction)" (Clause 371). This, along with "Diarrhea of undigested food, do not attack the exterior; sweating will cause abdominal fullness" (Clause 363), belongs to critical Three Yin deficiency-cold with failing Spleen-Kidney yang. Even with exterior signs, saving the interior is urgent. Following the logic that secondary disease is Branch, these fall under "Urgent cases treat the Branch."
(4) Root then Branch, Branch then Root: *Nei Jing* states: "When disease manifests with excess, treat Root then Branch (treat Root first, Branch later). When disease manifests with deficiency, treat Branch then Root (treat Branch first, Root later)." Here, Root and Branch imply primary and secondary disease. If disease onset involves strong pathogenic factors (excess syndrome), the focus is on eliminating pathogens, generally adopting "Root then Branch" treatment. In Six Meridian diseases, "Taiyang unresolved, heat binds to Bladder, person acts like mad... if exterior is unresolved, attack is not yet permissible; first resolve exterior; once exterior is resolved, if only lower abdomen is tense and knotted, then attack, suitable for Tao He Cheng Qi Tang (Peach Pit Order the Golden Cabinet Decoction)" (Clause 106). This is an excess-heat syndrome, so "Root then Branch" treatment is applicable. Many such cases exist in the *Treatise on Cold Damage*, such as resolving exterior first then attacking Pi, using Gui Zhi Tang for exterior and Da Huang Huang Lian Xie Xin Tang for Pi, and "Yangming disease, pulse slow... if much sweating, slight fever and aversion to cold, exterior unresolved, heat not tidal, do not give Cheng Qi Tang" (Clause 208). Conversely, if disease onset involves deficient righteous qi (deficiency syndrome), the focus is on supporting righteousness, adopting "Branch then Root" treatment. For example, "Cold damage, physician purged, continuing diarrhea of undigested food, body pain; urgently save interior; later, if body pain persists and stool/urine normalize, urgently save exterior. Save interior with Si Ni Tang (Four Reversal Decoction); save exterior with Gui Zhi Tang (Cinnamon Twig Decoction)" (Clause 91). Here, body pain from Taiyang exterior disease is the primary disease (Root); continuous diarrhea of undigested food from erroneous purgation is the secondary disease (Branch). Diarrhea indicates衰竭 of Spleen-Kidney yang, unable to digest food and transform nutrients, a critical and heavy condition, thus requiring "Branch then Root" treatment for deficiency. This passage explains that treatment decisions depend on assessing excess versus deficiency. While connected to the previous sections on treating Root first and urgent Branch treatment, there are distinctions. Flexibility and mutual application are required. For instance, in severe blood stasis cases, "exterior signs still present" (Clause 124), resembling excess, Dang Gui Tang (Dangui Decoction) is used to break blood and remove stasis, still following the urgent Branch treatment principle. Another case: "Taiyang disease, exterior signs unresolved, subjected to repeated purgation, resulting in協热 diarrhea, continuous diarrhea, epigastric hardness, exterior and interior unresolved; Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) is the primary treatment" (Clause 163). Although this treatment leans towards the interior, similar to deficiency, warming interior and releasing exterior aims at dual resolution, ultimately being a method of treating Root and Branch concurrently.
(5) Carefully observe mildness and severity, adjust according to judgment: *Nei Jing* states: "Carefully observe mildness and severity, adjust according to judgment; mild cases treat concurrently, severe cases treat exclusively." This sentence, placed after discussing the sequence of Root and Branch, observing disease momentum, and assessing excess/deficiency, seems to summarize the preceding text. Wang Bing noted: "Mild (Jian) means many, Severe (Shen) means few," which is correct. "Adjust according to judgment" encompasses all treatment methods, meaning either concurrent treatment for mild cases or exclusive treatment for severe cases. However, in complex primary-secondary disease scenarios, "many" and "few" are relative. For example, in Six Meridian concurrent diseases, assessing cold/heat and deficiency/excess may reveal a clear tendency toward one primary aspect, warranting a single dominant treatment method. Using Ma Huang Tang or Ge Gen Tang to release exterior and induce sweat in concurrent diseases, Bai Hu Tang (White Tiger Decoction) exclusively clearing Yangming channel heat, or Da Cheng Qi Tang (Major Order the Golden Cabinet Decoction) vigorously purging heat accumulation in combined diseases, and even using Si Ni Tang (Four Reversal Decoction) to restore yang and rescue from collapse in the presence of exterior signs, all approximate the "Severe cases treat exclusively" principle. Furthermore, in complex Six Meridian pathogenesis, mixed deficiency-excess and cold-heat syndromes often occur, requiring comprehensive treatment. Examples include the Four Xi Xin Decoctions (containing Fu Zi, Ban Xia, Sheng Jiang, Gan Cao) and Huang Lian Tang (Coptis Decoction) combining cold and warm herbs; Xiao Chai Hu Tang plus Mang Xiao (Mirabilite) and Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Turtle Shell Decoction) combining attack and tonification; Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) treating Shaoyang with unresolved exterior by harmonizing Ying-Wei to resolve Taiyang and benefiting pivot function to treat Shaoyang; and Ma Huang Fu Zi Xi Xin Gan Cao Tang (Ephedra, Aconite, Asarum, and Licorice Decoction) warming yang and releasing exterior for Shaoyin disease with counter-flushing heat. These align with the meaning of "Mild cases treat concurrently." Wang Bing further stated: "Many means many forms of syndrome but light difficulty; Few means few forms of syndrome but heavy difficulty." This view seems inappropriate. Mixed syndromes can be heavy and difficult; dominant syndromes can be light and easy. For example, Taiyang cold damage Da Qing Long Zheng (Major Green Dragon Syndrome) is heavier than Ma Huang Tang syndrome, while Shaoyang Xiao Chai Hu Zheng (Minor Order the Golden Cabinet Syndrome) is lighter than Da Chai Hu Zheng.
The Root and Branch theory of *Nei Jing* was further extended and specifically applied in the *Treatise on Cold Damage*. Mastering laws such as "disease has Root and Branch, treatment has sequence" and applying them flexibly to the ever-changing pathogenesis in clinical practice holds significant practical importance.
7. Analysis of Six Meridian Syndrome Transmission and Non-Transmission: Six Meridian differentiation involves complex pathogenetic changes and diverse symptom manifestations. Within complex pathological changes, the *Treatise on Cold Damage* uses terms like "transmission" and "non-transmission," "transfer to," "passing beyond the stage," "transfer system," and "entering" based on the alternating characteristics of syndromes. Mr. Li does not intend to find problems in terminology but seeks key issues within syndromes. Therefore, the title "Transmission and Non-Transmission" is chosen to explore the laws of Six Meridian syndrome changes. This has important practical significance for disease diagnosis and treatment.
(1) Transmission and Non-Transmission: Following the Taiyang disease outline and Wind Strike/Cold Damage descriptions, the *Treatise on Cold Damage* immediately states: "On the first day of cold damage, Taiyang receives it; if the pulse is quiet, it is non-transmission; if there is much desire to vomit, restlessness, and rapid/urgent pulse, it is transmission" (Clause 4). "On the second or third day of cold damage, if Yangming and Shaoyang syndromes are not seen, it is non-transmission" (Clause 5). This elaborates on the difference between transmission and non-transmission in Taiyang exterior disease, refuting the *Su Wen: Heat Discussion* claim of "Day 1 Ju Yang, Day 2 Yangming," etc. Whether exterior disease transmits depends on current pulse and symptoms, not rigidly on days. From a comprehensive etiological and pathogenic analysis, disease transmission depends on the intensity of pathogenic factors, the strength of righteous qi (constitution and resistance), appropriateness of treatment, suitability of nursing care, and presence of pre-existing diseases. If righteous qi is strong and pathogens weak, even with exterior disease, internal transmission does not occur. Hence: "On the third day of cold damage, Three Yang are exhausted, Three Yin should receive pathogens; if the person can eat and not vomit, this means Three Yin does not receive pathogens" (Clause 270). Conversely, improper treatment during disease development leads to variable syndromes and easy internal transmission. Most clauses in the middle and lower sections of Taiyang describe transformation into altered syndromes due to erroneous sweating, vomiting, or purgation. Regarding Gui Zhi Tang (Cinnamon Twig Decoction), "after taking it, drink hot thin porridge to assist medicinal power. Cover warmly for about an hour until slight sweating over the whole body is ideal." Improper nursing causing profuse sweating can lead to leakage of sweat and loss of yang in yang-deficient bodies (Gui Zhi Jia Fu Zi Tang syndrome) or excessive sweating damaging fluids and generating intense heat in yang-excess bodies (Bai Hu Jia Ren Shen Tang syndrome). Also, Yangming blood stasis syndrome originates from "long-standing blood stasis" (Clause 237). Yangming dry feces syndrome is related to "pre-existing chronic disease." Thus, disease formation is linked to pre-existing conditions. In summary, transmission depends on multiple factors. There are approximately two types of non-transmitting Taiyang exterior diseases: One is like "Taiyang disease, headache, self-heals after seven days or more because the meridian cycle is completed" (Clause 8). This shows prolonged exterior disease, gradual recovery of righteous qi, weakening of pathogens, and alleviation of symptoms, indicating self-healing. Another type remains stuck in the Taiyang exterior without internal transmission, such as "Taiyang disease, floating-tight pulse, no sweat, fever, body pain, unresolved after eight or nine days, exterior signs still present, this requires diaphoresis... Ma Huang Tang (Ephedra Decoction) is the primary treatment" (Clause 46). Another example: "Taiyang disease, ten days gone, floating-thin pulse and desire to lie down indicate exterior is resolved. If chest fullness and hypochondriac pain occur, give Xiao Chai Hu Tang (Minor Order the Golden Cabinet Decoction); if only floating pulse, give Ma Huang Tang (Ephedra Decoction)" (Clause 37). This clause should be explained in three parts: The first part describes pulse/symptoms of resolved exterior, indicating declining disease momentum and unrecovered righteous qi, similar to the self-healing mechanism. The last part, "only floating pulse, give Ma Huang Tang," resembles Clause 46, indicating prolonged exterior disease lingering on the surface without internal transmission, but since exterior cold-excess exists, diaphoresis is still used. The middle part, "if chest fullness and hypochondriac pain occur, give Xiao Chai Hu Tang," indicates interior transmission from Taiyang to Shaoyang, allowing for harmonizing pivot treatment. Details are discussed in subsequent items.