【纲】仲景曰。太阳病。脉阴阳俱浮。自汗。身重。多眠。鼻鼾。语言难出。不可下。不可火。
若被火者。微则发黄。剧则惊痫螈 。
【目】吴绶曰。夫螈 者。一伸一缩。手足相引。搐搦不已。大抵与婴儿发搐相似。古人以此
症多属于风。风主动摇也。骆龙吉言心主脉。肝主筋。心属火。肝属木。火主热。木主风。风火相
扇。则为螈 也。若不因汗下所生者。当平肝木。降心火。佐以和血脉之剂。如羌、防、柴、芍、
芎、归、芩、连、生地、天麻之类。若兼有痰。必加竹沥、星、夏。如风邪内煽。加全蝎、僵蚕。
若伤寒曾经汗下后。多所传变而得。为病势已过。多难治也。盖因虚极生风所致。须用小续命汤或
大建中汤加减一二味主之。凡伤寒汗出露风。则汗不通流。遂变筋脉挛急。手足搐搦。宜牛蒡根。
如本条。由风温被火。宜葳蕤汤。若螈 戴眼反折。绝汗乃出。大如贯珠。着身不流者。此太阳终
也。不可治。又有四肢 习。动而不止。似螈 而无力抽搐者。此为肝绝。盖汗下后变生此症者多
死。
凡用小续命汤。有汗去麻黄。无汗去黄芩。要在通变而已。
【纲】仲景曰。风湿为病。脉阴阳俱浮。自汗出。身重。多眠睡。鼻息必鼾。语言难出。若被
下者。小便不利。直视失溲。若被火者。微发黄色。剧则如惊痫。时螈 。
【目】成无己曰。螈者筋脉急也。 者筋脉缓也。急则引而缩。缓则纵而伸。或缩或伸。动而
不止者。名曰螈 。俗谓之搐搦是也。内经以螈为契合之契。 为放纵之纵。以急为螈。以缓为 。
理至明矣。螈 者。风疾也。而癫痫则螈 焉。伤寒螈 者。邪实气极也。热盛则风抟并经络。
风主动。故四肢螈 而不宁也。风湿被火而螈 。言热气之剧盛
也。伤寒至于发螈 。病势已过矣。内经曰。太阳终者。戴眼反折螈 。绝汗乃出。大如贯珠。着
身不流。是见其螈 为已过之疾也。螈 之症虽剧。若能以祛风涤热之剂折其大势。则亦有生者。若妄灼灸。或与发表
之药。必死。经曰。一逆尚引日。再逆促命期。
鳌按。此乃风热甚之病。宜祛风散热为主。然或有一二可生耳。非谓其必生也。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang channel), the pulse is floating at all three positions (cun, guan, chi). There is spontaneous sweating, heaviness of the body, somnolence, snoring, and difficulty in speaking. Purging methods should not be used, nor should fire therapy be applied.
If fire therapy is mistakenly applied, mild cases may result in jaundice, while severe cases may lead to fright, epilepsy, and chi-zong (alternating contraction and relaxation of tendons and sinews).
[Annotation] Wu Shou said: Chi-zong refers to a condition where the limbs extend and contract alternately, pulling against each other, with continuous spasms. It is generally similar to convulsions seen in infants. Ancient physicians attributed this syndrome mostly to Wind, as Wind is characterized by movement and tremor. Luo Longji stated: The Heart governs the blood vessels, and the Liver governs the sinews. The Heart belongs to Fire, and the Liver belongs to Wood. Fire corresponds to Heat, and Wood corresponds to Wind. When Wind and Fan stir each other, chi-zong occurs. If this condition does not arise from sweating or purging therapies, one should soothe the Liver Wood, descend Heart Fire, and assist with agents that harmonize the blood vessels, such as Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Chai Hu (Bupleuri Radix), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Huang Qin (Scutellariae Radix), Lian Zi (Coptidis Rhizoma), Sheng Di Huang (Rehmanniae Radix), and Tian Ma (Gastrodiae Rhizoma). If phlegm is also present, Zhu Li (Bambusae Succus) and Nan Xing (Arisaematis Tuber), Ban Xia (Pinelliae Rhizoma) must be added. If internal Wind pathogen is stirring vigorously, Quan Xie (Scorpio) and Jiang Can (Bombyx Batryticatus) should be added. If this arises after sweating or purging in a Shanghan (Cold Damage) case, it indicates that the disease has progressed through many transformations; the pathological process is largely exhausted, and it is difficult to treat. This is caused by extreme deficiency generating internal Wind. One should use Xiao Xu Ming Tang (Minor Continuation of Life Decoction) or Da Jian Zhong Tang (Major Construct the Middle Decoction) with minor modifications. Whenever sweating occurs in Shanghan followed by exposure to wind, sweat flow becomes obstructed, leading to tendon and vessel spasm and limb convulsions; Niu Bang Gen (Arctii Radix) is suitable. As in this specific clause, if caused by Wind-Wen (Wind-Heat) mistaken for fire therapy, Zhe Yu Tang (Zhe Yu Tang, Reed Rhizome Decoction) is suitable. If chi-zong is accompanied by Dai Yan (upward deviation of the eyes), Fan Zhe (opisthotonos), and Jue Han (collapse sweat) flowing out like beads strung together that do not flow away upon touching the body, this signifies the termination of the Taiyang channel; it is incurable. There is also a condition where the four limbs tremble continuously, resembling chi-zong but without forceful spasms; this indicates the exhaustion of the Liver Qi. Generally, when this syndrome arises after sweating or purging, death is likely.
When using Xiao Xu Ming Tang, remove Ma Huang (Ephedrae Herba) if there is sweating, and remove Huang Qin if there is no sweating; the key lies in flexible adaptation.
[General Principle] Zhang Zhongjing stated: In diseases caused by Wind-Dampness, the pulse is floating at all three positions. There is spontaneous sweating, heaviness of the body, somnolence, snoring, and difficulty in speaking. If mistakenly treated with purging, it leads to dysuria, fixed gaze, and incontinence of urine and feces. If mistakenly treated with fire therapy, mild cases result in slight yellowing of the skin, while severe cases resemble fright and epilepsy, with intermittent chi-zong.
[Annotation] Cheng Wuji said: "Chi" refers to the tension of tendons and sinews, while "Zong" refers to their relaxation. Tension causes contraction, and relaxation causes extension. Alternating contraction and extension with continuous movement is called chi-zong, commonly known as spasms. The Nei Jing interprets "chi" as fitting together tightly (contraction) and "zong" as letting go loosely (relaxation). Considering tension as chi and relaxation as zong makes the principle very clear. Chi-zong is a Wind disease, and epilepsy also involves chi-zong. Chi-zong in Shanghan indicates excess pathogen and extreme depletion of healthy qi. When heat is excessive, Wind pathogen binds to the meridians. Since Wind is active, the four limbs undergo chi-zong and restlessness. Wind-Dampness triggered by fire therapy leading to chi-zong indicates extreme abundance of Heat. When Shanghan progresses to cause chi-zong, the disease momentum has passed its peak. The Nei Jing states: When the Taiyang channel terminates, symptoms include Dai Yan, Fan Zhe, and chi-zong, along with Jue Han flowing out like beads that do not flow away. This shows that the appearance of chi-zong indicates a disease in its terminal stage. Although the symptoms of chi-zong are severe, if one can suppress the major trend using agents that dispel Wind and purge Heat, survival is possible. However, if cauterization is wrongly applied, or diaphoretic drugs are given, death is inevitable. The Classic says: One error may prolong life for a time, but two errors will hasten death.
Shen Jin'ao commented: This is a disease of severe Wind-Heat, primarily requiring treatment to dispel Wind and dissipate Heat. However, perhaps only one or two cases might survive; it does not mean they will definitely survive.