【纲】仲景曰。病患身热足寒。颈项强急。恶寒。时头热。面赤。目脉赤。独头摇。卒口噤。
背反张者。此太阳中风。重感寒湿而为痉也。湿家下之。额上汗出。微喘。小便利者死。若下利不
止者亦死。
【目】朱肱曰。风寒湿杂至合而为痹。身重汗出恶风。痛如历节状。防己黄 汤。
张兼善曰。错杂之邪合至。当论其先后多少分治可也。
成无己曰。额上汗出而喘。阳气上逆也。小便自利。或下利。阴气下流也。阴阳相离。故云死。内经曰。
阴阳离缺。精气乃绝。此之谓也。
鳌按。下条乃言湿家死症也。湿病本不至死。今由误下以至不救。仍是医杀之耳。
李 曰。阴脉紧者。雾露浊邪。中于下焦少阴之分。故曰浑。因表虚里微。遂使邪中于阴。为
栗。令人足胫逆冷。便溺妄出。或腹痛下利。宜理中汤、四逆汤热药以散其邪。阳脉紧或带涩者。
雾露消邪。中于上焦太阳之分。故曰洁。令人发热。头疼项强。筋挛。腰痛胫酸。宜九味羌活汤加
本。或恶寒欲吐者。藿香正气散、五积散。仍量加 本。阴阳脉俱紧者。上下二焦俱中邪也。必
吐利后脉不紧。手足温则愈。若吐利后脉迟不食者。脾胃虚而内停水饮也。若脉阴阳俱紧。口中气
出。唇口干燥。蜷卧足冷。鼻涕出。舌上苔滑。勿妄治也。又有阳病上行极而下。阴病下行极而上。
上下必于中焦。于是三焦溷乱。内外气塞。以致口糜 嚏。下为小便黄。大便血。凝如猪肝。
热气腾而脾胃不运。营卫凝滞。则生疮痈。虚寒甚者。脾胃独弱。下焦不约。清便下重。脐筑湫痛
而死。盖脐为生气之源。筑痛乃生气已绝。
[General Principles] Zhang Zhongjing stated: When a patient presents with fever in the body and coldness in the feet, stiffness and rigidity of the neck and nape, aversion to cold, occasional heat in the head, redness of the face, congestion of the eye vessels, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (backward arching of the back), this is Taiyang Wind Strike syndrome complicated by Cold-Dampness, resulting in Spasm disease. If a patient suffering from Dampness is treated with purgation, leading to sweating on the forehead, slight wheezing, and free urination, the prognosis is fatal. Similarly, if persistent diarrhea occurs, it is also fatal.
[Specific Discussions] Zhu Gong stated: When Wind, Cold, and Dampness mix and combine to form Bi syndrome, symptoms include heaviness of the body, sweating, aversion to wind, and pain resembling Lijie disease (painful obstruction similar to rheumatoid arthritis). Fangji Huangqi Tang (Astragalus and Stephania Decoction) should be used.
Zhang Jianshan stated: When mixed pathogenic factors attack simultaneously, treatment should be differentiated based on the sequence and proportion of the pathogens.
Cheng Wuji stated: Sweating on the forehead accompanied by wheezing indicates the reversal of Yang Qi upwards. Free urination or diarrhea indicates the flow of Yin Qi downwards. The separation of Yin and Yang leads to death. The *Neijing* states: "When Yin and Yang separate, essence and Qi are exhausted." This refers to that situation.
Shen Jin'ao commented: The following clause describes the fatal cases of Dampness disease. Dampness disease itself does not typically lead to death; however, due to erroneous purgation, it becomes incurable. This is essentially iatrogenic death caused by the physician.
Li Shi stated: A tight pulse in the Yin position indicates that turbid pathogens from fog and dew have invaded the Shaoyin region of the Lower Jiao, hence termed "Hun" (turbid). Due to exterior deficiency and interior weakness, pathogens invade the Yin aspect, causing shivering, coldness in the calves, involuntary urination and defecation, or abdominal pain with diarrhea. Li Zhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction) and other warming herbs should be used to disperse the pathogens. A tight or choppy pulse in the Yang position indicates that clear pathogens from fog and dew have invaded the Taiyang region of the Upper Jiao, hence termed "Jie" (clear). Symptoms include fever, headache, neck stiffness, tendon spasms, lower back pain, and soreness in the calves. Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) added with Gaoben (Ligusticum sinense Rhizome) is appropriate. If there is aversion to cold and nausea, Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi) or Wuji San (Five Accumulations Powder) may be used, still adding Gaoben as needed. If both Yin and Yang pulses are tight, it indicates invasion of pathogens in both the Upper and Lower Jiao. Recovery depends on the pulse no longer being tight after vomiting and diarrhea, and the hands and feet becoming warm. If the pulse is slow and the patient cannot eat after vomiting and diarrhea, it indicates Spleen-Stomach deficiency with internal retention of fluid-dampness. If both Yin and Yang pulses are tight, with hot breath from the mouth, dry lips and tongue, curled-up posture, cold feet, runny nose, and a slippery coating on the tongue, do not treat rashly. Furthermore, Yang diseases rising to the extreme descend downward, and Yin diseases descending to the extreme ascend upward; both must involve the Middle Jiao. Consequently, the Three Jiaos become chaotic, and Qi blockage occurs internally and externally, leading to oral ulcers, sneezing, yellow urine, and bloody stools coagulated like duck liver. Rising heat impairs Spleen-Stomach transportation, stagnation of Ying and Wei fluids leads to sores and carbuncles. In severe deficiency-cold, the Spleen-Stomach is particularly weak, the Lower Jiao loses its restraining function, leading to tenesmus in urination and defecation, and colicky pain at the umbilicus, resulting in death. The umbilicus is the source of vital Qi; colicky pain here signifies the exhaustion of vital Qi.