【纲】仲景曰。伤寒若吐若下后。心下逆满。气上冲心。起则头眩。脉沉紧。发汗则动经。身
为振振摇者。茯苓桂枝白术甘草汤主之。太阳病发汗。汗出不解。其人仍发热。心下悸。头眩。身
动。振振欲擗地者。真武汤主之。
【目】成无己曰。振者。森然若寒。耸然振动者是也。伤寒而振。皆由虚寒。盖以欲汗之时。
其人必虚。必蒸蒸而振。却发热汗出而解。振近战。而轻者为振矣。战为正与邪争。争则为鼓栗而
战。振但虚而不至争。故惟耸动而振也。下后复发汗振寒者。为其表里俱虚也。亡血家发汗。则寒
栗而振者。谓其气血俱虚也。诸如此者。止于振耸耳。其身为振振摇。振振欲擗地。二者皆发汗
过多。亡阳经虚。不能自主持。故身为振摇也。又非若振栗之比矣。
此二汤。皆温经益阳滋血助气之剂。经虚阳弱得之。未有不获全济之功者。
【纲】仲景曰。问曰。病有战而汗出。因得解者。何也。答曰。脉浮而紧。按之反芤。此为本
虚。故当战而汗出也。其人本虚。是以发汗。以脉浮。故当汗出而解。若脉浮而数。按之不芤。此
人本不虚。若欲自解。但汗出耳。不发战也。
【目】韩祗和曰。汗下后战者。与救逆汤。微减。与羊肉汤。再投而战解。若阴气内盛。正气
大虚。心栗鼓颔。身不战者。遂
成寒逆。宜灸之。或用大建中汤。仲景治尸厥战而栗者。刺期门巨阙。
吴绶曰。凡战者。大抵气血俱虚。不能荣养筋骨。故为之振摇而不能主持也。须大补气血。予
曾用人参养荣汤得效。
又一人身摇不得眠者。以十味温胆汤倍加人参而愈。内经曰。寒之伤人。使人毛发毕直。鼓颔
战栗而无汗。按此表寒而战栗也。此言病有战而汗出。因得解。其脉浮而紧。按之反芤。此为本虚。
故当战而汗出也。又曰。脉阴阳俱停。以三部浮沉迟数脉同等。必先振栗汗出而解。若脉浮数。
按之不芤。其人本不虚者。则汗出解不战也。若不战而心栗。此阴中于邪。必内栗也。凡正气怯弱。
寒邪在内。必为栗也。宜详究焉。
【纲】仲景曰。太阳病未解。脉阴阳俱停。必先振栗。汗出而解。但阳脉微者。先汗出而解。
但阴脉微者。下之而解。若欲下之。宜调胃承气汤。
【目】成无己曰。战与栗二者。形相类而实非一。有内外之别焉。战者。身为之摇。栗者。心
战是也。经曰。胃无谷气。脾涩不通。口急不能言。战而栗。即此观之。战之与振。振轻而战重也。
战之与栗。战外而栗内也。战栗者。皆阴阳之争。伤寒欲解将汗之时。正气内实。邪不能与之争。
则便汗出而不发战。邪气欲出。其人本虚。邪与正争。微者为振。甚者则战。战退正胜而解矣。其
战而汗。因得解者。其人本虚。是以发战。邪气外与正气争。则为战。乃其愈者也。邪气内与正气
争。则为栗。是为甚者也。经曰。阴中于邪。必内栗也。表气虚微。里气不守。故使邪中于阴也。
方其里气不守。而为邪中乎中气。正气怯弱。故成栗也。战者。正气胜。栗者。邪气胜也。伤寒六
七日欲解之时。当战而汗出。其有但心栗而鼓颔。身不战者。已而遂成寒逆。似此症多不得解。何者。
以阴气内盛。正气大虚。不能胜邪。反为邪所胜也。非大热剂与灼灸。又焉得而御之。
张介宾曰。战与栗异。战由外。栗由内也。凡伤寒欲解将汗之时。若其人正气内实。邪不能争。
则但汗出。不作战。所谓
不战。应知体不虚也。若其人本虚。邪与正争。微则振。甚则战。正胜邪则战而汗解矣。夫战则
正气将复。栗则邪气肆强。故伤寒六七日。有但栗不战竟成寒逆者。多不可救。此以正气中虚。阴邪内
盛。正不盛邪。而反为邪胜。凡遇此症。非大温热不可。
柯琴曰。阳脉微二句。承上之辞。不得作三段看。太阳病。阳浮而阴弱。是阳强也。今阳脉微。
即是阴阳俱停。病虽不解。已是调和之脉。其解可知矣。脉但浮者为阳盛。必先烦而有汗。阳脉
微者为阳虚。必先振栗而汗出。振栗。是阴津内发之兆。汗出。是阳气外越之征。此阴阳自和而愈
也。
[General Principle] Zhang Zhongjing stated: In Shaoyang disease (Shaoyang syndrome), if purgation or emesis has been performed, and the patient experiences fullness and rebellious qi in the epigastrium, qi rushing upward to the heart region, dizziness upon rising, and a deep, tight pulse. If sweating is induced at this stage, it will disturb the meridians, causing the body to tremble and shake. This condition should be treated with Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction). In Taiyang disease (Taiyang syndrome), if after inducing sweating the disease does not resolve, and the patient still has fever, palpitations in the heart region, dizziness, body movement, and trembling so severe that they wish to fall to the ground, this condition should be treated with Zhenwu Tang (True Warrior Decoction).
[Detailed Commentary] Cheng Wuji stated: "Zhen" (trembling/shivering) refers to a sensation of coldness accompanied by耸动 (upright shaking) and vibration. Trembling in Shaoyang disease is always due to deficiency-cold. Generally, when the body attempts to sweat, the person's righteous qi (Zheng Qi) must be deficient. There will inevitably be a steaming sensation followed by trembling, after which fever subsides, sweat appears, and the disease resolves. "Zhen" is close to "Zhan" (rigors/chills), but the milder form is called "Zhen". "Zhan" occurs when righteous qi struggles against pathogenic factors; this struggle manifests as rigors and chattering teeth. "Zhen" merely results from deficiency without such struggle, hence only upright shaking occurs. If chills and trembling occur after purgation followed by sweating, it is because both the exterior and interior are deficient. If sweating is induced in a person who has lost blood, resulting in cold rigors and trembling, it is because both qi and blood are deficient. Cases like these result only in trembling. However, when the body trembles and shakes, or trembles so severely one wishes to collapse, these are caused by excessive sweating leading to the loss of yang qi and meridian deficiency, resulting in an inability to control the body. This differs from rigors and chattering teeth. Both of these two formulas (Fuling Guizhi Baizhu Gancao Tang and Zhenwu Tang) are agents that warm the meridians, benefit yang, nourish blood, and assist qi. For those with meridian deficiency and weak yang, there is no case where complete recovery is not achieved.
[General Principle] Zhang Zhongjing asked: Why do some diseases resolve through sweating following rigors? The answer is: If the pulse is floating and tight, but feels hollow (Kou pulse) upon pressure, this indicates underlying deficiency. Therefore, rigors followed by sweating and resolution should occur. Because the person is inherently deficient, sweating was induced; since the pulse is floating, sweating leads to resolution. If the pulse is floating and rapid, and does not feel hollow upon pressure, the person is not inherently deficient. If the disease is to resolve spontaneously, it will simply involve sweating without rigors.
[Detailed Commentary] Han Zhihe stated: For rigors occurring after sweating or purgation, Jiuni Tang (Rescue Against Deviation Decoction) should be given. When symptoms slightly decrease, Yangrou Tang (Mutton Decoction) should be administered. After another dose, rigors cease and the disease resolves. If internal yin qi is abundant and righteous qi is greatly deficient, causing mental trembling and jaw chattering without body rigors, this may develop into cold reversal. Moxibustion is appropriate, or Dajianzhong Tang (Greatly Build the Middle Decoction) may be used. Zhang Zhongjing treated Shijue (Corpse-like Coma) with rigors by needling Qimen (LR14) and Juxue (CV14).
Wu Shou stated: Rigors generally indicate deficiency of both qi and blood, failing to nourish muscles and bones, leading to trembling and lack of self-control. Great tonification of qi and blood is required. I have seen effective results using Renshen Yangrong Tang (Ginseng and Nutrient-Ying Decoction). Another patient with body shaking and insomnia was cured by Shibai Wendan Tang (Ten-Ingredient Gallbladder-Warming Decoction) with doubled Ginseng. The Neijing states: Cold injuring the body causes hair to stand erect, jaw chattering, rigors, and absence of sweat. This describes exterior cold causing rigors. The text mentions disease resolving via sweating after rigors. With a floating-tight pulse feeling hollow on pressure, it indicates underlying deficiency, necessitating rigors and sweating for resolution. It also states: If the pulse at Yin and Yang positions is "stopped" (meaning balanced/equalized or temporarily hidden), i.e., floating/sinking, slow/rapid pulses are equal across all three positions, rigors and sweating will precede resolution. If the pulse is floating and rapid and not hollow, and the person is not deficient, resolution occurs via sweating without rigors. If there is no rigors but mental trembling, this indicates evil invading the yin, causing internal trembling. Whenever righteous qi is weak and cold evil is internal, trembling occurs. This requires careful investigation.
[General Principle] Zhang Zhongjing stated: In Taiyang disease unresolved, if the pulse at Yin and Yang positions is "stopped" (balanced/hidden), rigors will precede sweating and resolution. If only the Yang pulse is slight (weak on superficial pressure), resolution comes via sweating. If only the Yin pulse is slight (weak on deep pressure), resolution comes via purgation. If purgation is desired, Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) is appropriate.
[Detailed Commentary] Cheng Wuji stated: "Zhan" (rigors) and "Li" (internal trembling) are similar in appearance but distinct, differing in location. "Zhan" involves body shaking; "Li" involves mental/internal trembling. The Classics state: Without grain qi in the stomach and sluggish spleen transport, leading to oral stiffness and inability to speak, rigors and trembling occur. Thus, "Zhan" is heavier than "Zhen"; "Zhan" is external while "Li" is internal. Both "Zhan" and "Li" represent the struggle between yin and yang. When Shaoyang disease is about to resolve and sweat, if righteous qi is internally solid, pathogenic factors cannot struggle, and sweating occurs without rigors. If pathogenic factors attempt to exit but the person is deficient, the struggle between pathogen and righteous qi manifests as mild "Zhen" or severe "Zhan". After rigors subside, righteous qi prevails, and resolution occurs. Resolution via sweating after rigors happens because the person is deficient, leading to rigors. External struggle between pathogen and righteous qi causes "Zhan", indicating healing. Internal struggle causes "Li", indicating severity. The Classics state: Evil invading yin causes internal trembling. Exterior qi deficiency and failure of interior qi to guard allow evil to invade yin. When interior qi fails and evil invades the middle jiao, weak righteous qi leads to "Li". "Zhan" signifies righteous qi victory; "Li" signifies pathogenic victory. During the 6th-7th day of Shaoyang disease, when resolution is expected, rigors and sweating should occur. If there is only mental trembling and jaw chattering without body rigors, cold reversal ensues. Such cases rarely resolve because internal yin abundance and great righteous qi deficiency prevent overcoming the pathogen, which instead overcomes the righteous qi. Only strong hot agents and moxibustion can counter this.
Zhang Jiebin stated: "Zhan" and "Li" differ; "Zhan" is external, "Li" is internal. When Shaoyang disease is about to resolve and sweat, if righteous qi is internally solid, the pathogen cannot struggle, resulting in sweating without rigors. Absence of rigors indicates non-deficient constitution. If the person is deficient, pathogen-righteous qi struggle causes mild "Zhen" or severe "Zhan". Righteous qi victory leads to resolution via sweating after rigors. "Zhan" indicates recovering righteous qi; "Li" indicates肆强 (unrestrained strength) of pathogenic qi. Thus, during the 6th-7th day, cases with only "Li" without "Zhan" often lead to cold reversal and are incurable. This is due to central righteous qi deficiency and internal excess of yin-pathogen, where righteous qi fails to overcome the pathogen. Such cases require strong warming-hot herbs.
Ke Qin stated: The phrases regarding "slight Yang pulse" continue the previous discussion and should not be viewed as three separate sections. In Taiyang disease, a floating Yang pulse and weak Yin pulse indicate Yang excess. A slight Yang pulse now indicates "Yin-Yang stopped" (balanced pulse). Although the disease is unresolved, the pulse is harmonizing, indicating impending resolution. A purely floating pulse indicates Yang excess, leading to irritability then sweating. A slight Yang pulse indicates Yang deficiency, leading to rigors/trembling then sweating. Rigors/trembling signal the emergence of internal yin fluids; sweating signals the outward expansion of yang qi. This represents self-harmonization of yin and yang leading to recovery.