麻黄 芍药 黄耆各三两 甘草 川乌（□咀，以蜜二升，煎取一升，即出乌头）五
枚
右五味，□咀四味，以水三升，煮取一升，去滓，内蜜煎中，更煎之，服七合；不知
，尽服之。
@@@
诸肢节疼痛，身体尪羸，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之。
【按】
温温当是「嗢嗢」。
【注】
历节之证，诸肢节疼痛也。身体尪羸，即上条身体羸瘦，甚言其瘦之甚也。脚肿如脱
，即上条独足肿大，甚言其肿之甚也。头眩短气，阳气虚也。嗢嗢欲吐，寒邪盛也。
而不用乌头汤者，因无黄汗之湿胜也。用桂枝芍药知母汤者，以壮阳气，散寒湿为急
也。故方中桂枝芍药倍于麻黄、防风，大加白术、附子，其意专在温行阳气，次在散
寒湿也。多用生姜，因其欲吐；更佐知母、甘草者，以其剂过辛热，监制之也。
【集注】
李□曰：此历节病，由气血两虚而致者也。风湿相搏，四肢节节皆痛，即历节病也。
身体尪羸，邪胜正衰也。脚肿如脱，气绝于下也。头眩短气，气虚于上也。温温欲吐
，气逆于中也。此三焦气血两虚，故是汤主祛风湿而温气血。
桂枝四两 芍药三两 甘草二两 麻黄二两 生姜五两 白术五两 知母四两 防风
二两附子（炮）二枚
右九味，以水七升，煮取二升，温服七合，日三服。
@@@
趺阳脉浮而滑，滑则谷气实，浮则汗自出。
【注】
趺阳胃脉也，谷气，胃气也，浮则为风外薄，滑则为胃实热，风热蒸于肌腠之间，故
汗自出。此发明黄汗，亦有因风热之义也。
@@@
少阴脉浮而弱，弱则血不足，浮则为风，风血相抟，即疼痛如掣。
【注】
少阴心脉也，心主血，心脉浮而弱，弱则为血虚，浮则为风邪，风血相抟，而交争于
经络之间，故疼痛牵引如掣也。此发明历节亦有因血虚之义也。
【集注】
李□曰：风在血中，则栗悍劲切，无所不至，为风血相搏。盖血主荣养筋骨者也，若
风以燥之，则血愈耗而筋骨失其所养，故疼痛如掣。昔人曰：治风先养血，血生风自
灭，此其治也。
@@@
盛人脉涩小，短气，自汗出，历节疼，不可屈伸，此皆饮酒汗出当风所致。
【注】
盛人脉盛，不应涩小；盛人气长，不应气短。令盛人脉涩小，短气，是形气脉息不合
也。审其证，自汗出，历节疼不可屈伸，询其由，得之于饮酒汗出当风也。此又发明
历节不止一端之义也。
【集注】
徐彬曰：盛人，肥人也。肥人湿多，脉得涩小，此痹像也。于是气为湿所搏而短，因
风作使而自汗，气血为邪所痹而疼痛不可屈伸。然肥人固多湿，何以脉骤涩小，岂非
酒湿困之乎？何以疼痛有加而汗出不已，岂非湿而挟风乎？脉证不同，因风则一，故
曰：此皆饮酒汗出当风所致。
Ephedrae Herba (Mahuang, 麻黄), Paeoniae Radix Alba (Baishao, 芍药), and Astragali Radix (Huangqi, 黄芪) each three liang; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) and Aconiti Kusnezoffii Radix (Chuanwu, 川乌) [cut into pieces, decocted with two sheng of honey until one sheng remains, then remove the Aconite root] five pieces.
The above five herbs: cut the four herbs excluding the Aconite root into pieces, decoct with three sheng of water until one sheng remains, strain to remove the dregs, add this liquid to the previously decocted honey mixture, and decoct again. Take seven he as a dose; if the condition does not improve after taking this amount, take the entire remaining decoction.
@@@
Pain in all joints of the limbs, emaciation and weakness of the body, swelling of the feet as if they were detached, vertigo, shortness of breath, and a sensation of nausea wanting to vomit are primarily treated with Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, White Peony, and Anemarrhena Decoction).
[Note]
"Wenwen" should be read as "Wawa" (a term describing the sensation of nausea).
[Commentary]
Lijie disease (a condition characterized by severe joint pain) manifests as pain in all joints. "Wanglei" refers to deformity of the limbs accompanied by emaciation, which was mentioned in the previous section as general emaciation, here emphasizing the severity of the wasting. "Swelling of the feet as if detached" refers to the isolated swelling of the foot mentioned earlier, here emphasizing the severity of the edema. Vertigo and shortness of breath indicate deficiency of Yang Qi. The sensation of nausea indicates an excess of Cold Evil. Utou Tang (Aconite Decoction) is not used because there is no dampness predominance associated with Huanghan (Yellow Sweat). Guizhi Shaoyao Zhimu Tang is used to strengthen Yang Qi and urgently dispel Cold-Dampness. Therefore, the dosage of Guizhi (Cinnamon Twig) and Baishao (White Peony) is doubled compared to Mahuang (Ephedra) and Fangfeng (Saposhnikovia Root); large amounts of Baizhu (Atractylodes Macrocephala Rhizome) and Fuzi (Prepared Aconite Lateral Root) are added. The intent is specifically to warm and circulate Yang Qi, secondarily to dispel Cold-Dampness. More Shengjiang (Fresh Ginger) is used because of the patient's desire to vomit; Zhimu (Anemarrhena Rhizome) and Gancao (Licorice Root) are added as assistants because the formula is excessively acrid and hot, serving to restrain its dryness and heat.
[Collected Notes]
Li [Name] stated: This Lijie disease is caused by deficiency of both Qi and Blood. Wind-Dampness combats each other, causing pain in every joint of the four limbs, which constitutes Lijie disease. Wanglei (emaciation/deformity) indicates that evil is excessive while healthy Qi is deficient. Swelling of the feet as if detached indicates the severance of Qi in the lower part. Vertigo and shortness of breath indicate Qi deficiency in the upper part. Nausea indicates reversal of Qi in the middle part. This represents deficiency of Qi and Blood in the Upper, Middle, and Lower Jiao; thus, this decoction mainly dispels Wind-Dampness and warms Qi and Blood.
Guizhi (Cinnamon Twig) four liang, Baishao (White Peony Root) three liang, Gancao (Licorice Root) two liang, Mahuang (Ephedra Herb) two liang, Shengjiang (Fresh Ginger) five liang, Baizhu (Atractylodes Macrocephala Rhizome) five liang, Zhimu (Anemarrhena Rhizome) four liang, Fangfeng (Saposhnikovia Root) two liang, Fuzi (Prepared Aconite Lateral Root, processed) two pieces.
The above nine herbs: decoct with seven sheng of water until two sheng remain. Take seven he warm, three times a day.
@@@
The Duyang pulse (located at the dorsum pedis, reflecting Stomach Qi) is floating and slippery. Slippery indicates substantial Grain Qi (Stomach Qi); floating indicates spontaneous sweating.
[Commentary]
Duyang is the Stomach pulse. Grain Qi refers to Stomach Qi. A floating pulse indicates external invasion by Wind; a slippery pulse indicates Excess Heat in the Stomach. Wind-Heat steaming between the muscle layers causes spontaneous sweating. This elucidates that Huanghan (Yellow Sweat) can also arise from Wind-Heat.
@@@
The Shaoyin pulse (located at Taixi, reflecting Kidney/Heart Qi) is floating and weak. Weak indicates insufficient Blood; floating indicates Wind. Wind and Blood combat each other, resulting in pulling pain.
[Commentary]
Shaoyin is the Heart pulse. The Heart governs Blood. A floating and weak Heart pulse indicates Blood deficiency (weak) and Wind pathogen (floating). Wind and Blood combat each other, contending within the meridians, hence the pulling pain. This elucidates that Lijie disease can also arise from Blood deficiency.
[Collected Notes]
Li [Name] stated: When Wind resides in the Blood, it becomes fierce and penetrating, reaching everywhere, termed Wind-Blood combat. Blood is responsible for nourishing sinews and bones. If Wind dries and consumes the Blood, the Blood becomes more depleted, and sinews and bones lose their nourishment, causing severe pulling pain. Ancients said: To treat Wind, first nourish the Blood; when Blood is generated, Wind extinguishes itself. This is the treatment principle.
@@@
In robust individuals, if the pulse is choppy and small, accompanied by shortness of breath and spontaneous sweating, suffering from Lijie pain where flexion and extension are impossible, this is all caused by sweating after drinking alcohol and being exposed to wind.
[Commentary]
Robust individuals should have a strong pulse, not choppy and small; they should have long breath, not short. Now, a robust individual having a choppy/small pulse and shortness of breath indicates a mismatch between form, Qi, and pulse. Examining the symptoms: spontaneous sweating and Lijie pain preventing movement. Inquiring into the cause: it results from sweating after drinking alcohol and exposure to wind. This further elucidates that Lijie disease has multiple etiologies.
[Collected Notes]
Xu Bin stated: "Shengren" refers to obese people. Obese people have much Dampness. A choppy and small pulse is a sign of Bi syndrome. Thus, Qi is obstructed by Dampness leading to shortness of breath; Wind acts as the agent causing spontaneous sweating; Qi and Blood are bi-blocked by pathogens causing pain and immobility. Although obese people naturally have much Dampness, why is the pulse suddenly choppy and small? Is it not due to obstruction by Wine-Dampness? Why is pain aggravated and sweating unceasing? Is it not Dampness combined with Wind? Although the pulse and symptoms differ, the presence of Wind is consistent; therefore, it is said: This is all caused by sweating after drinking alcohol and exposure to wind.