【纲】仲景曰。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。若脉微弱。汗出恶风者。不可服。服之则厥逆。筋惕肉 。此为逆也。太阳病。医发汗。仍发
热恶寒。复下之。心下痞。表里俱虚。阴阳气并竭。无阳则阴独。复加烧针。因胸烦。面色青黄。
肤者。难治。今色微黄。手足温者。易愈。
【目】朱肱曰。大凡发汗过多。即身 动振摇。虚羸之人。微发汗。便有此症。宜服真武汤。
羸甚者。去芍药。或少用之。有热症。恶热药者。去附子。
杨士瀛曰。伤寒筋惕身 。发汗太过所致也。古人以真武汤主之。然真武汤能止其汗。而不能
定其 。 者。动也。盖汗多则伤血。血虚无以荣筋。筋愈急而四体百骸俱为之 。宜以四物去地黄加人参、半夏、茯
苓、甘草作剂。以五灵脂为佐。入生姜、乌梅煎服。自有神效。此专主生血。生血乃以收汗也。
陶华曰。筋惕肉 者。非常常有之。内经曰。阳气者。精则养神。柔则养筋。发汗过多。津液
枯少。阳气偏虚。筋肉失所养。故惕惕然跳。 然动。非温经助阳不能愈。仲景特设真武汤救之。
或因发汗吐下后。表里俱虚而有此状者。此又逆之甚矣。
柯琴曰。此条用真武汤。全在降火利水。重在发热心下悸。头眩身 。因心下悸所致。脉微弱
而自汗出。是无阳也。是桂枝症。不可与大青龙。以中有麻黄、石膏也。服之则血气不周于身。必
筋惕肉 。因汗下后加烧针。以致虚烦。多汗伤血。故经脉动惕。烧针伤肉。故面青肤 。此亦半
夏泻心汤症也。
【纲】仲景曰。动气在左。不可发汗。发汗则头眩。汗不止。筋惕肉 。
【目】魏荔彤曰。脐左属肝。故肝虚风动为头眩。肝藏血之脏。风动扰阴。故汗出不止也。筋
惕肉 者。肝主筋。血主肉。俱因气虚而振振惕 也。
陶华曰。此候最逆。先宜防风白术牡蛎汤。次服小建中汤。十救一二。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel), after sweating therapy, if the condition remains unresolved despite perspiration, and the patient still has fever, palpitations in the epigastrium (sensation of beating in the stomach area), dizziness, body tremors, and a sensation of trembling instability as if wanting to fall to the ground, Zhenwu Tang (True Warrior Decoction) should be administered. However, if the pulse is faint and there is spontaneous sweating with aversion to wind, Zhenwu Tang must not be used. If mistakenly administered, it will lead to cold limbs (coldness of the extremities) and muscle twitching; this constitutes a therapeutic error (adverse reaction).
In Taiyang disease, if the physician induces sweating, yet fever and aversion to cold persist, and subsequently applies purgation (downward-draining method), resulting in epigastric fullness (stagnation in the chest/epigastrium), both exterior and interior qi are depleted, and yin and yang qi are exhausted. The absence of yang leads to the predominance of yin. If moxibustion via burning needles is then applied, causing chest irritability, a greenish-yellow complexion, and dry, shriveled skin, the prognosis is difficult. Conversely, if the complexion is slightly yellow and the hands and feet are warm, recovery is likely.
[Commentary] Zhu Gong said: Generally, excessive sweating leads to body tremors and shaking. In frail and emaciated individuals, even mild sweating can induce these symptoms, for which Zhenwu Tang is appropriate. For those severely emaciated, remove Paeoniae Radix Alba (Shaoyao) or use it in small quantities. If heat syndromes are present and the patient dislikes warm-hot herbs, remove Aconiti Lateralis Radix Praeparata (Fuzi).
Yang Shiy ing stated: Muscle twitching and body tremors in Shanghan (Cold Damage) are caused by excessive sweating. Ancients treated this with Zhenwu Tang. However, while Zhenwu Tang can stop sweating, it cannot stabilize the twitching. 'Ti' refers to jumping/twitching; 'Shun' refers to trembling. Since excessive sweating damages blood, blood deficiency fails to nourish the sinews, leading to increased tension in the sinews and trembling of all four limbs and bones. One should use Siwu Tang (Four Substance Decoction) minus Rehmanniae Radix (Dihuang), adding Ginseng Radix (Renshen), Pinelliae Rhizoma (Banxia), Poria (Fuling), and Glycyrrhizae Radix et Rhizoma (Gancao) as the main formula, with Psoraleae Fructus (Wulingzhi) as an assistant, decocted with Zingiberis Rhizoma Recens (Shengjiang) and Vitis Vinifera Fructus (Wumei). This yields miraculous effects. This approach specifically focuses on generating blood, thereby consolidating sweat.
Tao Hua stated: Muscle twitching and body tremors are not common occurrences. The *Neijing* states: "Yang qi, when refined, nourishes the spirit; when soft, it nourishes the sinews." Excessive sweating depletes body fluids, causing relative deficiency of yang qi, leaving muscles and sinews without nourishment, resulting in fearful twitching and trembling. Without warming the channels and assisting yang, recovery is impossible. Zhang Zhongjing specifically established Zhenwu Tang to rescue such cases. This may also occur after sweating, vomiting, or purging, where both exterior and interior are deficient, representing a severe adverse outcome.
Ke Qin stated: The use of Zhenwu Tang in this clause focuses on descending fire and promoting diuresis, emphasizing fever, epigastric palpitations, dizziness, and body tremors caused by the epigastric palpitations. A faint pulse with spontaneous sweating indicates deficiency of yang. This is a Guizhi Tang (Cinnamon Twig Decoction) pattern; Da Qing Long Tang (Major Green Dragon Decoction) is contraindicated because it contains Ephedrae Herba (Mahuang) and Gypsum Fibrosum (Shigao). Misuse would prevent qi and blood from circulating throughout the body, inevitably causing muscle twitching. The addition of burning needles after sweating and purging leads to deficiency-irritability; excessive sweating damages blood, causing vessel twitching. Burning needles damage flesh, causing a blue face and shriveled skin. This is also a Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction) pattern.
[General Principle] Zhang Zhongjing stated: If there is pulsation (moving qi) on the left side of the umbilicus, sweating therapy is contraindicated. If sweating is induced, it will cause dizziness, incessant sweating, muscle twitching, and body tremors.
[Commentary] Wei Litong stated: The area to the left of the umbilicus belongs to the Liver. Thus, Liver deficiency with internal wind causes dizziness. As the Liver stores blood, wind disturbing the yin leads to incessant sweating. Muscle twitching and body tremors occur because the Liver governs the sinews and blood governs the flesh; both tremble due to qi deficiency.
Tao Hua stated: This syndrome is extremely adverse. Initially, Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes Macrocephala, and Oyster Shell Decoction) should be administered, followed by Xiaojianzhong Tang (Minor Construct the Middle Decoction). Only one or two out of ten patients may be saved.