太阳病有身痒阳明病有身如虫行俱为荣卫气虚微邪在表无从而出故有为痒如虫行之状也悉宜各半汤太阳病得之八
九日如疟状发热恶寒热多寒少其人不呕清便欲自可一日二三度发脉微缓者为欲愈也脉微而恶寒者此阴阳俱虚不可更发
汗更下更吐也面色反有热色者未欲解也以其不能得小汗出身必痒宜桂枝麻黄各半汤
阳明病法多汗反无汗其身如虫行皮中状者此久虚故也(宜桂枝麻黄各半汤活人用术附汤黄 建中汤)
赵 虫行皮中
状者即经言身痒是也久虚者以表气不足津液不充于皮肤使腠理枯涩汗难出也若谓虚则当补毕竟阳明受邪为病邪可补乎
如用术附黄 辈皆收汗药则荣卫郁闭邪无从出内热发矣何况其病又无吐利胃虚等证病不在里但皮肤中表气虚之理宜和
解可也莫若除中借用各半汤或有热者柴胡桂枝汤庶乎甘辛之剂可以和其荣卫通行津液而解未审当否
成 除中者藏寒应不能食今反能食者是也有二证悉属厥阴藏寒其一证由误服黄芩汤凉药而致期以必死其一则热少
厥多胃气在者必愈恐暴来出而复去者死其热续在者生此不因药故也
伤寒脉迟六七日而反与黄芩汤彻其热脉迟为寒今与黄芩汤复除其热腹中应冷当不能食今反能食此名除中必死眼睛
不慧语言不出而谷食反多者此为除中口虽欲言舌不能言凡手足厥冷而利不当食而食者恐为除中试与索饼食之发热者除
中不发热者非也(详见厥门)
Taiyang disease presenting with body itching, and Yangming disease presenting with a sensation of insects crawling on the skin, both result from deficiency of Ying and Wei Qi (Nutritive and Defensive Qi), where slight pathogenic factors remain in the exterior without an outlet. Thus, symptoms resembling insect crawling or itching occur. In all such cases, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Combined Decoction) is appropriate.
When Taiyang disease persists for eight to nine days, resembling malaria with alternating fever and chills, where heat predominates over cold, the patient does not vomit, and bowel/bladder functions are relatively normal, occurring two or three times a day: if the pulse is slightly slow and relaxed (Huan), recovery is imminent; if the pulse is faint and aversion to cold worsens, this indicates simultaneous deficiency of Yin and Yang, and methods such as sweating, purging, or vomiting must not be used. If the face appears flushed, the disease has not yet resolved because slight sweating has not occurred to expel pathogens, leading to body itching; Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Combined Decoction) is indicated.
Yangming disease typically involves profuse sweating; if there is no sweating and the sensation of insects crawling under the skin occurs, it is due to chronic deficiency (Guizhi Mahuang Ge Ban Tang [Cinnamon Twig and Ephedra Half-Combined Decoction] is indicated; *Ren Shu* suggests Baizhu Fuzi Tang [Atractylodes Macrocephala and Aconite Decoction] or Huangqi Jianzhong Tang [Astragalus Middle-Jianzhong Decoction]).
Zhao states: The sensation of insects crawling under the skin is what the classics refer to as body itching. "Chronic deficiency" here refers to insufficiency of Exterior Qi and lack of Jin Ye (Body Fluids) nourishing the skin, causing dryness of Cou Li (Skin Pores) and difficulty in sweating. If one argues that deficiency requires tonification, since Yangming is affected by pathogenic factors, can pathogens be eliminated by tonification? Using herbs like Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), and Huangqi (Astragali Radix), which are astringent/sweat-retaining, would cause Ying and Wei stagnation, preventing pathogen expulsion and generating internal heat. Moreover, there are no signs of Stomach deficiency such as vomiting or diarrhea; the pathology is not in the interior but involves deficiency of Exterior Qi at the skin level. The principle should be harmonization. It is advisable to borrow Ge Ban Tang (Half-Combined Decoction); if heat is present, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) may be used. Such sweet-acrid formulas can harmonize Ying and Wei, circulate Jin Ye, and resolve the exterior. Whether this is correct remains open to discussion.
Cheng states: Chu Zhong (Elimination of the Center) refers to a condition where internal Cold should prevent eating, yet the patient suddenly desires food. There are two presentations, both belonging to Jueyin disease with Zang Cold. One results from the erroneous administration of cooling medicines like Huangqin Tang (Scutellaria Decoction) and carries a fatal prognosis. The other presents with less heat and more cold limbs; if Stomach Qi remains, recovery is certain. However, one must fear sudden, transient appetite followed by death (a sign of impending Yang collapse); if heat persists, survival is likely. This is not caused by medication error.
In Shanghan (Cold Damage), if the pulse is Chi (Slow) and after six or seven days, Huangqin Tang (Scutellaria Decoction) is erroneously given to clear heat: since a Slow pulse indicates Cold, using Huangqin Tang further removes warmth, causing abdominal coldness and inability to eat. If the patient suddenly eats, this is Chu Zhong (Elimination of the Center), indicating certain death. Symptoms include blurred vision, inability to speak, yet increased grain intake. Although the mouth wishes to speak, the tongue cannot move. Whenever cold limbs and diarrhea are present, and the patient eats despite indications not to, suspect Chu Zhong. Offer Suobing (noodles/dough strips); if fever ensues after eating, it is Chu Zhong; if no fever occurs, it is not. (See detailed discussion in the Jueyin chapter).