此篇相传谓为叔和述仲景金匮之文。虽远不可考。观其揭首之辞。信有之也。然既曰以为与
伤寒相似而致辨焉。则亦述所当述者。是故后人称之为仲景之徒云。
伤寒所致太阳痉湿 三种。宜应别论。以为与伤寒相似。故此见之。
痉。见太阳上编。 。音谒。下同。痉见下。素问诸痉项强。是也。湿。沾润不干也。天之
雨露。上湿也。地之水潦。下湿也。人之汗液。身中之湿也。凡着沾润。经久不干。皆能致病。
伤湿之谓也。 。伤暑也。史记羽扇 。淮南子武王荫 人于樾下。左拥而右扇之。是也。叔和
之意。盖谓三者皆风寒之变证。既成变证。则当别为立论。然自风寒变来。本属太阳。犹有风寒
涉似之疑。须当并为辨论。故揭己意而述之如下。
太阳病。发热。脉沉而细。名曰痉。
此揭痉之状。发热。太阳未除也。沉。寒也。细。湿也。中风伤寒。病犹在太阳。而脉变如此
者。则是重感寒湿而变痉。不可仍以中风伤寒称也。详见下。
太阳病。发汗太多。因致痉。
此承上条撤消变痉之由。千金曰。太阳中风。重感寒湿则变痉。然则发汗太多者。重感寒湿
而变痉之原因也。盖中风自汗。伤寒发汗。汗出过多。衣被必湿。湿胜寒生。过时不更。汗后新
虚。易于感受。湿渍寒侵。渗注关节。所以有痉之变也。
不然。则太阳病而发汗。安得别有所谓寒湿而可以为重感哉。
太阳病。发热。汗出。不恶寒者。名曰柔痉。
此以中风而致变言。汗出不恶寒。风伤卫也。柔。风性软缓也。
太阳病。发热。无汗。反恶寒者。名曰刚痉。
此以伤寒而致变言。无汗。反恶寒。寒伤荣也。刚。寒性劲急也。
病。身热。足寒。颈项强急。恶寒。时头热。面赤。目脉赤。独头面摇。卒口噤。背反张者。
痉病也。
卒。清勿切。噤。郡轸切。此以痉之具证言。身热头热。面赤。目脉赤。阳邪发于阳也。足寒。
阴邪逆于阴也。独头面摇者。风行阳而动于上也。卒。忽然也。噤。寒而口闭也。盖口者脾之窍。
胃为脾之合。而脉挟口。环唇。脾虚胃寒。故忽然唇口吻合。噤急而饮食不通也。背反张者。太
阳之脉挟背。故寒则筋急而拘挛。热则筋缓而纵弛也。然刚柔二痉。则各见证之一偏。惟风寒俱
有而致变者。则具见也。痉止此。详见痉书。
湿家之为病。一身尽疼。发热。身色如似熏黄。
一身尽疼者。人身之土。内则主脾胃。外则主肌肉。土恶湿。湿自外入。肌肉先伤也。发热。
湿郁而蒸也。熏黄者。土本黄色。湿则昏滞。故黧暗而不明也。
湿家病。身上疼痛。发热。面黄而喘。头痛。鼻塞而烦。其脉大。自能饮食。腹中和无病。病
在头中寒湿。故鼻塞。内药鼻中则愈。
塞。心勿切。内。音纳。此以上湿言。亦风湿也。身上疼痛。与上条互词。面黄。喘。烦。脉大者。
风为阳。而阳受之也。能饮食者。阳能化谷。所以胃和而里无病也。病在头以下。申上文之意。
寒以湿之性言。鼻气通于天。故邪独甚而专主治也。
湿家。其人但头汗出。背强。欲得被覆向火。若下之早。则哕。胸满。小便不利。舌上如苔
者。以丹田有热。胸中有寒。渴欲得水而不能饮。则口燥烦也。
强。上声。此以下湿言。亦寒湿也。但头汗出者。寒为阴。阴邪客于阴。阳上越而不通于下
也。背强欲得被覆向火者。太阳之脉挟背。背居北。最为畏寒。寒湿之阴邪。注经络。渗骨髓。
所以筋脉牵急。而恶寒甚也。哕。胸满者。凡在太阳下早皆然也。丹田。下焦也。胸中。上焦也。
热在下而寒在上。所以渴欲得水。反逆而不能饮。且又亡津液。所以口干燥而内作烦 也。
太阳病。关节疼痛而烦。脉沉而细者。此名湿痹之候。其人小便不利。大便反快。但当利其
小便。
此以湿之入里者言。关节疼痛者。寒湿之气。走注内渗。所以脉沉而细也。痹以疼痛言。小
便不利。大便反快者。湿即水。甚则横流。不遵故道。妄逆而暴乱也。利其小便者。导其遵故道
而行。禹之治功也。
病者一身尽疼。发热日晡所剧者。此名风湿。此病伤于汗出当风。或久伤取冷所致也。
发热。日晡所剧者。阳明主胃而属土。土主湿。所以热甚于阳明之王时也。然汗出当风而为
风湿。则是以身中之湿言。此其所以阳明王而热则剧。与久伤取冷。与夏月伤于冷水之意同。
问曰。风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不止。医云。此可发汗。汗之病不
愈者。何也。答曰。发
其汗。汗大出者。但风气去。湿气在。是故不愈也。若治风湿者。发其汗。但微微似欲汗出者。
风湿俱去也。
此承上条复设问答而喻治。阴雨不止。则湿不除。所以益当发汗也。然风湿本由汗出当风而
得。则汗之大出者。必反湿转加甚可知也。微微似欲汗出而不见出。则湿消而风散矣。此固发汗
之微机。后之动辄以大汗为言者。其去道奚啻寻常而已哉。
湿家下之。额上汗出。微喘。小便利者。死。若下利不止者。亦死。
额上汗出微喘者。阳亡于上也。小便利与下利不止者。阴脱于下也。然治湿当利其小便。而
以小便利主死。何也。误治而阴阳散亡也。湿止此。
太阳中热者。 是也。其人汗出恶寒。身热而渴也。
蒸热谓之暑。伤暑谓之 。汗出恶寒者。太阳表不固也。身热者。暑邪伤阳也。渴者。亡津
液而内燥也。然渴为内证。太阳主表而有渴。何也。炎暑之时。阳浮外越。人之津液本少。渴为
常事。况更汗出而重亡津液乎。且太阳温病已有渴。又况 乎。
太阳中 者。身热。疼重而脉微弱。此以夏月伤冷水。水行皮中所致也。
身热疼重。而曰夏月伤冷水。水行皮中所致者。土主肌肉而恶湿。水渗土而蒸发也。脉微弱
者。热则血干而气耗也。然夏日则饮水。故人之常事。而曰伤。何哉。良由暑迫。饮之过多。或
得之澡洗。暑反内入也。然则庸俗以当盛暑时濯流饮泉。而得身热疼重。遽谓为闭水伤寒者。水
其暑之讹。而伤寒则浮谣之谬也。
太阳中 者。发热。恶寒。身重而疼痛。其脉弦细而芤迟。小便已。洒洒然毛耸。手足逆冷。
小有劳身即热。口开。前板齿燥。若发汗。则恶寒甚。加温针。则发热甚。数下之。则淋甚。
数。音速。发热。恶寒。身重而疼痛。总上文具证而言。下乃申其详而致戒也。弦细芤迟。
亦详微弱之意。小便已。洒洒然毛耸者。阴虚而寒内作也。手足逆冷者。阳热内陷也。小有劳身
即热者。阳虚气怯。不胜力任之甚也。口开者热甚也。故反则噤是也。前板齿燥者。阳明热甚而
津液干也。恶寒甚者。以虚其表也。发热甚者。以扰其阳而损其阴也。淋甚者。损其阴而津液竭
也。言三法皆不可也。然则治之奈何。金匮治 以白虎加人参汤。白虎有啸则生风之能。荐凉解
秋之义。人参有益阳补虚之用。生津止渴之功。是故通寒暑而妙应。神矣哉。所谓方而世为万病
祖者。此之谓也。
This chapter is traditionally believed to be text from Zhang Zhongjing's *Jingui Yaolue* narrated by Wang Shuhe. Although it is too distant in time to verify, observing the opening remarks confirms this belief. Since it states that these conditions are similar to Shanghan (Cold Damage) and thus differentiated, it indeed narrates what should be narrated. Therefore, later generations referred to it as being authored by a disciple of Zhang Zhongjing.
The three types of diseases caused by Shanghan affecting the Taiyang channel—Jing disease (Spasm), Shi disease (Dampness), and Ye disease (Heatstroke)—should be discussed separately because they resemble Shanghan, hence their appearance here.
Jing disease is described in the upper volume of the Taiyang chapter. "Jing" is pronounced *ye*, same as below. Jing disease is seen in the lower volume. The various jing diseases with neck stiffness mentioned in *Suwen* refer to this. Shi (Dampness) refers to moisture that does not dry. Rain and dew from heaven constitute upper dampness; water accumulation on earth constitutes lower dampness; sweat from the human body constitutes internal dampness. Anything that becomes moist and remains undried for a long time can cause disease; this is called injury by dampness. "Ye" (*yē*) refers to injury by summerheat. The *Shiji* records Yu Fan fanning people, and *Huainanzi* records King Wu shading people under trees, fanning them left and right; this refers to such practices. Wang Shuhe's intention was likely that these three conditions are all transformed patterns of Wind-Cold. Once transformed patterns arise, separate discussions are warranted. However, since they originate from Wind-Cold and belong originally to the Taiyang channel, there remains doubt regarding their similarity to Wind-Cold, necessitating combined differentiation and discussion. Thus, his own views are revealed and narrated as follows.
Taiyang disease, with fever, deep and fine pulse, is named Jing disease.
This reveals the manifestation of Jing disease. Fever indicates the Taiyang exterior pattern has not resolved. A deep pulse indicates Cold; a fine pulse indicates Dampness. In Wind-stroke or Shanghan, if the pathogen remains in the Taiyang channel but the pulse changes thus, it is due to secondary contraction of Cold-Damp leading to Jing disease, and cannot simply be called Wind-stroke or Shanghan anymore. See details below.
Taiyang disease, resulting from excessive sweating, leads to Jing disease.
This continues the previous clause to explain the cause of transformation into Jing disease. *Qianjin Fang* states: Taiyang Wind-stroke, when secondarily affected by Cold-Damp, transforms into Jing disease. Thus, excessive sweating is the cause of secondary Cold-Damp contraction leading to Jing disease. Generally, Wind-stroke involves spontaneous sweating, Shanghan involves induced sweating. Excessive sweating makes clothing and bedding wet; excess dampness generates cold. If not changed over time, after sweating, the new deficiency makes one susceptible to external pathogens. Dampness infiltrates and Cold invades, seeping into joints, thus causing transformation into Jing disease.
Otherwise, how could Taiyang disease treated with sweating involve another so-called Cold-Damp as a secondary contraction?
Taiyang disease, with fever, sweating, and aversion to cold absent, is named Rou-Jing (Soft Spasm).
This discusses change caused by Wind-stroke. Sweating without aversion to cold indicates Wind injuring the Wei (Defensive) Qi. "Rou" (Soft) refers to the soft and slack nature of Wind.
Taiyang disease, with fever, no sweating, and contrary aversion to cold, is named Gang-Jing (Hard Spasm).
This discusses change caused by Shanghan. No sweating and contrary aversion to cold indicate Cold injuring the Ying (Nutritive) Blood. "Gang" (Hard) refers to the stiff and urgent nature of Cold.
In patients, with body heat, cold feet, neck and back stiffness and rigidity, aversion to cold, occasional head heat, red face, red eye vessels, only head and face shaking, sudden lockjaw, and opisthotonos, this is Jing disease.
"Cu" is pronounced *qingwu qie*; "Jin" is pronounced *junzhen qie*. This details the full symptoms of Jing disease. Body heat, head heat, red face, red eye vessels indicate Yang pathogen manifesting in Yang aspects. Cold feet indicate Yin pathogen counterflowing in Yin aspects. Only head and face shaking occurs because Wind moves in Yang and acts upward. "Cu" means suddenly. "Jin" means mouth closed due to Cold. The mouth is the orifice of the Spleen; the Stomach is the interior-exterior pair of the Spleen, and meridians surround the lips. Spleen deficiency and Stomach Cold cause sudden lip closure, jaw urgency, and inability to eat or drink. Opisthotonos occurs because the Taiyang meridian runs along the back; thus, Cold causes tendon stiffness and spasms, while Heat causes tendon relaxation and flaccidity. However, Gang-Jing and Rou-Jing each present only one aspect of the syndrome. Only when both Wind and Cold are present causing transformation do all these symptoms appear fully. Jing disease discussion ends here; see *Jing Shu* for details.
Patients with Shi disease suffer from whole-body pain, fever, and skin color resembling smoked yellow.
Whole-body pain occurs because Earth governs the Spleen and Stomach internally and muscles externally. Earth dislikes Dampness; when Dampness enters from outside, muscles are injured first. Fever results from Dampness stagnation and steaming. Smoked yellow occurs because Earth is naturally yellow; Dampness causes dullness and turbidity, making the complexion dark and obscure.
Shi disease patients experience body pain, fever, yellow face, wheezing, headache, nasal congestion with irritability, and a large pulse. They can eat normally, and the abdomen is harmonious with no illness. The pathology lies in Cold-Damp affecting the head, causing nasal congestion; inserting medicine into the nose will cure it.
"Sai" is pronounced *xinwu qie*; "Nei" is pronounced *na*. This discusses upper Jiao Dampness, also Wind-Damp. Body pain complements the previous clause. Yellow face, wheezing, irritability, and large pulse occur because Wind is Yang pathogen affecting Yang channels. Ability to eat indicates Yang can transform grain, so Stomach Qi is harmonious and interior is healthy. Pathology is below the head, elaborating on the previous point. Cold is described by the nature of Dampness. Nasal qi connects to Heaven, so pathogenic factors are particularly severe and require specific treatment of the head.
Shi disease patients exhibit only head sweating, back stiffness, and desire to cover themselves with blankets near fire. If purgatives are used prematurely, hiccups, chest fullness, difficult urination, and tongue coating resembling moss will occur. This is because Heat resides in the Dantian (Lower Jiao) while Cold resides in the Chest (Upper Jiao). Thirst for water but inability to drink leads to dry mouth and irritability.
"Qiang" is pronounced *shang sheng*. This discusses lower Jiao Dampness, also Cold-Damp. Head-only sweating occurs because Cold is Yin pathogen lodging in Yin, causing Yang to float upward without communicating downward. Back stiffness and desire for warmth occur because the Taiyang meridian runs along the back; the back faces North and fears Cold most. Cold-Damp Yin pathogen penetrates meridians and marrow, causing tendon and vessel tension and severe aversion to cold. Hiccups and chest fullness result from premature purgation in Taiyang disease. Dantian refers to Lower Jiao; Chest refers to Upper Jiao. Heat below and Cold above cause thirst for water but reverse flow preventing drinking, plus fluid depletion, leading to dry mouth and internal irritability.
Taiyang disease with joint pain and irritability, deep and fine pulse, is named Shi-Bi (Damp Bi) syndrome. Patients have difficult urination and loose stools. Treatment should focus on promoting urination.
This discusses Dampness entering the interior. Joint pain results from Cold-Damp Qi wandering and penetrating inward, causing deep and fine pulses. Bi refers to pain. Difficult urination and loose stools occur because Dampness is Water; when excessive, it flows horizontally, deviating from normal pathways, acting recklessly. Promoting urination guides it back to normal pathways, akin to Yu the Great controlling floods.
Patients with whole-body pain and fever worsening at dusk are named Feng-Shi (Wind-Damp). This disease results from sweating exposed to wind or prolonged exposure to cold.
Fever worsening at dusk occurs because Yangming governs the Stomach and belongs to Earth, which governs Dampness. Thus, heat intensifies during Yangming's prosperous time. However, Wind-Damp from sweating exposed to wind relates to internal Dampness. This explains why heat worsens when Yangming is prosperous, consistent with prolonged cold exposure or summer injury from cold water.
Question: When Wind and Damp contend, causing whole-body pain, perspiration should resolve it. Why did perspiration fail when rain continued incessantly? Answer: Profuse sweating expels only Wind, leaving Damp behind, hence failure. To treat Wind-Damp, induce slight perspiration ("slightly desiring sweat"); then both Wind and Damp are expelled.
This continues the previous clause with Q&A to illustrate treatment. Incessant rain prevents Damp removal, necessitating perspiration. However, Wind-Damp originates from sweating exposed to wind; profuse sweating would exacerbate Damp. Slight perspiration eliminates Damp and disperses Wind. This is the subtle mechanism of perspiration; those advocating profuse sweating deviate greatly from the Dao.
Purgation in Shi disease patients causing forehead sweating, slight wheezing, and free urination leads to death. If diarrhea persists, it also leads to death.
Forehead sweating and wheezing indicate Yang collapse upward. Free urination or persistent diarrhea indicates Yin exhaustion downward. Treating Damp requires promoting urination, yet free urination signifies death here due to mismanagement causing Yin-Yang dispersion. Shi disease discussion ends.
Taiyang Heatstroke (Ye) involves sweating, aversion to cold, body heat, and thirst.
Steaming heat is called Summerheat; injury by Summerheat is called Ye. Sweating and aversion to cold indicate insecure Taiyang exterior. Body heat indicates Summerheat injuring Yang. Thirst indicates fluid depletion and internal dryness. Thirst is an interior sign, yet Taiyang is exterior; why thirst? During hot summers, Yang floats outward, fluids are scarce, and thirst is common. Especially with sweating causing further fluid loss. Moreover, Taiyang Warm Disease already presents thirst, let alone Ye disease.
Taiyang Ye disease presents body heat, heavy pain, and weak pulse. This results from summer cold water injury, with water qi circulating in the skin.
Body heat and heavy pain from summer cold water injury relate to Earth governing muscles and disliking Dampness; water permeates Earth and evaporates. Weak pulse indicates heat drying blood and consuming Qi. Drinking water in summer is normal, yet termed "injury"? Due to oppressive heat, excessive drinking, or bathing/washing, Summerheat pathogen may enter internally. Vulgar beliefs attributing summer heat and heavy pain from swimming/drinking cold spring water to "Closed Water Shanghan" are errors confusing "Summerheat" with "Water" and spreading false rumors about Shanghan.
Taiyang Ye disease presents fever, aversion to cold, heaviness and pain, string-taut thin hollow slow pulse. After urination, chills with hair standing erect, cold extremities. Slight exertion causes body heat, open mouth, and dry anterior teeth. Perspiration worsens aversion to cold; moxibustion worsens fever; repeated purgation worsens strangury.
"Shuo" is pronounced *su*. Fever, aversion to cold, heaviness, and pain summarize previous symptoms; the following details warnings. String-taut, thin, hollow, slow pulses elaborate on weak meanings. Chills after urination indicate Yin deficiency generating internal Cold. Cold extremities indicate internal sinking of Yang Heat. Exertion-induced heat indicates Yang deficiency and Qi timidity, unable to bear effort. Open mouth indicates severe Heat (contrary to lockjaw). Dry anterior teeth indicate Yangming Heat exhausting fluids. Worsened aversion to cold indicates exterior deficiency. Worsened fever indicates disturbing Yang and damaging Yin. Worsened strangury indicates damaging Yin and exhausting fluids. These three methods are contraindicated. How to treat? *Jingui Yaolue* treats Ye with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). Baihu has the ability to generate wind upon roaring, symbolizing cooling autumn air. Renshen benefits Yang, tonifies deficiency, generates fluids, and stops thirst. Thus, it harmonizes Cold and Heat miraculously. Truly divine! As said, formulas are ancestors of treating myriad diseases; this is what is meant.