【纲】仲景曰。太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。伤寒六七日。发热。微恶寒。肢节烦疼。微呕。
心下支结。外
症未去者。柴胡加桂枝汤主之。太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风。无汗而喘者。麻
黄汤主之。风湿相搏。骨节烦疼。掣痛。不得屈伸。近之则痛剧。汗出短气。小便不利。恶风。不欲去衣。
或身微肿者。甘草附子汤主之。
【目】张兼善曰。脉沉而细。本少阴脉。今太阳病而见此脉。太阳与少阴为表里。故相似。乃
太阳之变脉也。湿流关节。故疼痛。太阳气不宣。故烦。湿气痹闭而不行。故脉应其象而沉细。太
阳之脉。从风则缓。从寒则紧。从湿则细。伤上则浮。伤下则沉。当因症而合脉。
魏荔彤曰。伤寒六七日。宜传里矣。乃有半未离太阳之表。而半已微入少阳之里者。惟不离太
阳。故结胸之结。变而结于心下。复不正结而偏出。微入少阳两侧之界。因谓之支结。虽云带少阳。
实皆太阳表里之症也。故用少阳柴胡之治。仍加太阳之桂枝。本条何以见太阳多少阳少也。如正
文发热微恶寒支节烦疼微呕。太阳之症有四。独心下支结一症。侵入少阳。其实又系大小结胸
之流派。惟以部位在少阳。故治少阳。正所以治太阳也。用柴胡加入桂枝者。犹如太阳之贼。侵少
阳之界。用太阳之兵捕。协同少阳之兵捕。方可治太阳少阳两界之贼寇也。
【纲】仲景曰。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。骨肉
烦疼。当发其汗也。
【目】柯琴曰。风寒本相因。必风先开腠理。寒得入经络。紧者急也。即数也。紧以形象言。
数以至数言。紧则为寒。指伤寒也。数则为热。指发热也。辞异而义同。故脉浮数浮紧者。皆是麻黄
症。骨肉烦疼。即是风寒两伤。营卫俱病。要之冬月风寒。本同一体。故中风伤寒。皆恶风恶寒。
营病卫必病。中风之重者。便是伤寒。伤寒之浅者。便是中风。不必在风寒上细分。须当在有汗无
汗上着眼耳。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), if there is joint pain accompanied by vexation, and the pulse is deep and fine, this is termed Shi Bi (Bi syndrome caused by dampness obstruction). After six or seven days of Shanghan disease (cold damage disease), if fever, slight aversion to cold, vexing pain in the limbs and joints, slight vomiting, and a sensation of support and accumulation in the epigastrium occur, while the exterior syndrome has not yet resolved, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) should be administered. In Taiyang disease, if there is headache, fever, body pain, lower back pain, bone and joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, Mahuang Tang (Ephedra Decoction) should be administered. When Wind-Dampness pathogens contend with each other, causing vexing pain in the bones and joints, pulling pain, inability to flex and extend, severe pain upon touch, sweating, shortness of breath, dysuria, aversion to wind, reluctance to remove clothing, or slight bodily edema, Gancao Fuzi Tang (Licorice and Aconite Decoction) should be administered.
[Commentary] Zhang Jianshan said: A deep and fine pulse is originally characteristic of Shaoyin pulse (pulse pattern common in Shaoyin channel pathology). Its appearance in Taiyang disease occurs because Taiyang and Shaoyin are interior-exteriorly related, hence their similarity; this is a variant pulse of Taiyang disease. Dampness flowing into the joints causes pain. The non-circulation of Taiyang Qi causes vexation. The obstruction and stagnation of dampness cause the pulse to manifest as deep and fine correspondingly. The Taiyang pulse becomes slow when affected by Wind, tight when affected by Cold, and fine when affected by Dampness; it floats when injured above and sinks when injured below. One must diagnose by combining symptoms with pulse characteristics.
Wei Litong said: By the sixth or seventh day of Shanghan disease, transmission to the interior is expected. However, at this stage, half remains on the Taiyang exterior, and half has slightly entered the Shaoyang interior. Because it has not completely left the Taiyang, the "accumulation" of the Jie Xiong syndrome (Chest Binding Syndrome) transforms into accumulation in the epigastrium. It does not accumulate centrally but deviates outward, slightly invading the boundaries of both sides of Shaoyang, thus termed "Zhi Jie" (Supporting Accumulation). Although described as involving Shaoyang, these are essentially Taiyang exterior-interior syndromes. Therefore, Bupleurum (Chai Hu), used for treating Shaoyang, is combined with Cinnamon Twig (Gui Zhi), used for treating Taiyang. How can one determine the proportion of Taiyang versus Shaoyang involvement? As seen in the main text—fever, slight aversion to cold, vexing limb/joint pain, slight vomiting—these are four Taiyang symptoms. Only the single symptom of "epigastric supporting accumulation" invades the Shaoyang domain. In fact, it is a variation of Da Jie Xiong (Major Chest Binding) and Xiao Jie Xiong (Minor Chest Binding). Since the location is in Shaoyang, treating Shaoyang is precisely treating Taiyang. Using Chai Hu added with Gui Zhi is like Taiyang soldiers pursuing bandits who have invaded Shaoyang borders, cooperating with Shaoyang soldiers to pacify the bandits in both Taiyang and Shaoyang territories.
[General Principle] Zhang Zhongjing stated: If the Cun Kou pulse (radial artery pulse) is floating and tight, floating indicates Wind, and tight indicates Cold. Wind injures Wei Qi (Defensive Qi), and Cold injures Ying Blood (Nutritive Blood). When both Ying and Wei are diseased, causing vexing pain in the bones and flesh, diaphoresis (sweating therapy) should be employed.
[Commentary] Ke Qin said: Wind and Cold pathogens naturally accompany each other; typically, Wind first opens the Cou Li (skin pores and interstices), allowing Cold to enter the meridians. "Tight" implies urgency or speed. "Tight" describes the shape/form, while "Rapid" (Shu) describes the frequency/rate. A tight pulse indicates Cold, referring to Shanghan; a rapid pulse indicates Heat, referring to fever. The terminology differs, but the meaning is the same. Thus, floating-rapid or floating-tight pulses both indicate Mahuang Tang syndrome. Vexing pain in bones and flesh signifies injury by both Wind and Cold, with both Ying and Wei being diseased. Essentially, Wind and Cold in winter constitute a unified entity; therefore, both Feng Zhong (Wind Strike/Exogenous Wind) and Shang Han (Cold Damage) present with aversion to wind and cold. If Ying is diseased, Wei must also be diseased. Severe Feng Zhong is equivalent to Shang Han, and mild Shang Han is equivalent to Feng Zhong. There is no need to overly distinguish between Wind and Cold; rather, one must focus on the presence or absence of sweating.