桂枝6克 白芍6克大枣10克生姜10克厚朴4克杏仁6克紫菀6克 防风3克法夏9克炙甘草3克云苓12克陈皮5克三剂
(三诊]服三剂后，咳喘大减，时咳清稀痰涎。拟小半夏汤加味，温中化饮，祛风止咳治之。
处方：
云苓12克法夏6克干姜3克炙甘草5克旋覆花6克紫菀6克苏叶3克防风3克[四诊]服四剂，咳喘平。因久病伤正，宜温中益气，健脾除湿，以理中汤加味善其后。
处方：
党参10克 白术6克干姜3克炙甘草3克黄芪6克 法夏6克砂仁5克云苓6克六剂
服六剂后停药，身体恢复正常。 1979年7月26日追访，患儿已成年，体质健壮，哮喘未复发。
[按语]此例太阳表虚，桂枝汤证具。复因风痰交争，新感引动宿疾，气机阻滞，发为哮喘。正如《伤寒论》所说： “喘家作，桂枝汤，加厚朴、杏子佳。”验之临床，对太阳伤寒之表虚兼有喘逆之证，不论老幼皆宜。
太阳证刚痉
(临产麻疹)
郭××，女，20岁。成都某厂工人。
(病史]1951年春，因临产入××产院。次日晨，自觉身倦、头昏、发热、恶寒，双眼流泪，鼻流清涕，脸上出现红疹，当即诊断为麻疹。因怕传染，通知其转传染病院。由于即将分娩，两院相距又远，家属不同意，最后回到家中，复感风寒，病情急剧恶化，昏迷失语。遂请范老去家急诊。按太阳证麻疹寒闭论治，服药两剂，转危为安。
[诊治]面部耳后麻疹出而复收，疹色转为淡紫微暗，疹点下陷。额头微热无汗，恶风寒，胸闷气紧上逆。项背强痛，两手抽搐，口噤无声，人已昏迷。面色灰暗，唇淡微乌，撬开牙关，视舌质淡红偏暗，苔黄夹白微腻，脉浮紧。此当临产疹出未透而重感风寒，麻毒内陷，并致刚痉之危证。法宜驱风散寒，解痉透疹，以葛根汤加减主之。
处方：
葛根10克麻黄10克桂枝6克 白芍10克甘草3克 生姜lO克升麻10克服药后，逐渐清醒，声渐出而语清，手足抽动停止。头项强痛明显减轻，疹点重新现出。此为寒邪衰，郁闭开，刚痉主证已解，转为正常疹出，遂即顺产。后继以清热解毒、甘寒养阴之剂，调治而愈。
[辨证]一般说来，麻疹属温病范围，切忌辛温发汗。为什么本例竞从太阳经病风寒表实兼证入手?
《金匮要略》云： “太阳病，发热无汗，反恶寒者，名日刚痉”， “太阳病，无汗而小便反少，气上冲胸，口噤不得语，欲作刚痉，葛根汤主之。”
临床所见，患者突然项背强痛，胸闷气紧上逆，口噤不得语，以及牙关紧闭等，皆为寒气盛而痉在表。同时疹出即没，疹点下陷，昏迷失语，牙关紧闭，显系麻疹中途隐没之闭证。此病例病机，究属热闭寒闭?细察之，额头虽微热，但非全身灼热；虽昏沉失语，但无烦渴谵妄；疹点虽下陷，仅淡紫微暗。参之唇色，暗淡不红；苔黄而不燥，脉浮紧而不洪数。显然，应属麻疹寒闭之逆证。不可泥于“痧喜清凉，痘喜温暖”之说。故投葛根汤发表透疹以除寒闭，从经输达邪外出，以解刚痉。
[按语]产褥期中，由于失血伤津，产道创伤，感染毒邪而引起“产后发痉”，颇不乏人。本例麻疹，发生于成年，且临产发病，并转为寒闭刚痉，在临床中颇为罕见。此证对产妇而言，生死反掌。其致命之危，首在麻疹寒闭而引起之抽搐昏迷。故临证之要点，必须拨开云雾，辨析其症结。综观患者麻疹寒闭诸证，按伤寒六经，归根到底，则为寒气盛而致痉，应属寒，属表，属实，病在太阳之经，葛根汤实为对症之良方。
太阳证柔痉
史××，男，37岁。北京市某局汽车驾驶员。
[病史]1977年秋开始，头痛、眩晕、眼胀、后项强直胀痛及背，牵连双肩酸楚，难以俯仰转侧。驾驶车辆时，头项活动受限，严重影响工作。夜间卧床，必须垫上三个高枕；病重时闭眼则觉眩晕，甚而被迫睁目不眠。西医查无明显指征，仅血压稍偏高。经常服用镇痛、安眠剂，无明显效果。 1978年9月来诊，按太阳证柔痉论治，半月痊愈。
[诊治]头痛、项背强痛。常自汗出，头项部特别恶风。躺下则头晕，夜卧不宁。一年来逐渐加重，驾驶汽车日感困难。舌质淡红，苔白滑润，脉浮濡。此系风湿外伤筋脉之“项背强几几”，属太阳病“柔痉”。法宜解肌祛风，濡润经脉。以桂枝加葛根汤主之。
处方：
葛根12克桂枝9克白芍9克炙甘草9克生姜15克大枣20克二剂
上方服两剂，诸证悉减。损益再进数剂，嘱其注意冷暖。半月左右病遂告愈。 1979年5月17日随访，患者说：经范老治愈后，一直未再犯病。去年11月，驱车万里，远至东北，至今头项再无不适之感。
[辨证]本例头痛项强，舌淡红润，苔薄白滑，脉浮，显系太阳痉病。虽病已年余，但无里证，无传经之候，病仍属太阳经证。
初诊时，项背强几几为时已久，究其病因，为风寒之邪壅阻脉络，气血运行不畅，以致筋脉失养。舌质正常、苔白滑，脉浮濡，为太阳表证之象；再参之汗出而恶风，此为表虚之证。
《伤寒论》明确指出： “太阳病，项背强几儿，反汗出恶风者，桂枝加葛根汤主之。”与本例对照，主证相符，故投原方。
[按语]本例桂枝加葛根汤之柔痉，与上例葛根汤之刚痉，皆以桂枝汤为基本方，均重用葛根为君。所不同者，麻黄一味之差，有汗无汗一字之异，其理法方药，则随之不同。但历来《伤寒论》若干版本，刊载之桂枝加葛根汤多有麻黄。后人如林亿等提出，此恐非仲景之本意。今验之临床，亦确实如此。
太阳证风湿
田××，女，70岁。北京中直机关家属。
[病史]左下肢疼痛，以小腿与膝关节为重，步履艰难，一年有余。××医院按风湿性关节炎治疗。经理疗、针灸、中药治疗无效。1978年11月28日来诊，按太阳证风湿论治，两诊而愈。
(初诊]经人搀扶前来。左腿痛甚，难以着地，并有畏风及沉重感，入夜常剧痛难寐。关节不红肿。舌质淡红，苔白滑。此为太阳证风湿，法宜祛风胜湿，解肌通络，以桂枝汤加味主之。
处方：
桂枝3克 白芍10克 生姜15克 大枣15克牛膝10克炙甘草10克威灵仙6克木瓜10克二剂
[复诊]上方服两剂，腿痛消失。可下地自由走动。为巩固疗效，清除余邪，原方加减，再服。
处方：桂枝6克白芍10克生姜10克牛膝lO克炙甘草10克木瓜10克紫苏叶10克防风10克法夏10克服两剂病愈。1979年5月15日追访，因家中无人，邻居介绍：1977年患者腿痛，多处治疗，不见好转，痛甚时，背着儿女在家哭泣。范老几剂药治愈，现回乡探亲去了。
[按语]《伤寒论》中，论述杂病颇多。而风湿痹痛之阐述，又以《太阳篇》最详。盖太阳主一身之表，为六经之藩篱。风寒外邪袭人，太阳首当其冲。或由表及里，引起整体反应；或具备太阳病之特征，不必拘于时日，皆可从实际出发，按太阳病“脉证并治”。
本例之关节疼痛，其病变为风湿之邪，由表及里，留注腠理，滞于下肢，使局部气血运行不畅，邪阻益甚，故痛剧难忍。用桂枝汤者，取其通阳解肌，祛风邪，调营卫之效。重用芍药、甘草，酸甘化阴，凋血养筋，缓急止痛；加牛膝，性善下行，活血通经；再加木瓜、威灵仙，舒筋活络，祛风除湿，以共奏解表驱邪之功。
此篇置于风湿痹痛诸案之第一篇，拟通过现代之实践检验，举一反三，进一步证实，伤寒之中有万病，仲景约法能合诸病也。
太阳证风湿
杨××，女，60岁。四川省温江县永宁乡， 农民。
[病史]既往有风湿痛史。1974年8月初， 身觉不适，畏寒，头昏，身痛。某日正弯腰时，忽感腰部剧烈疼痛，不能伸直，头上直冒冷汗，遂倒床不起。邀范老诊治，按太阳证风湿论治，十余日痊愈。
(诊治]腰痛如割，不能转侧，身觉阵阵畏寒发热，手脚麻木。面色青暗，唇乌，舌质微红，苔白滑腻，触双手背微凉，脉浮虚。此为太阳证，风湿相搏，卫阳已虚。法宜温经散寒，祛风除湿。以桂枝附子汤主之。
处方：
桂枝15克制附片60克(久煎，一个半小时)
生姜30克炙甘草10克红枣30克四剂
上方连眼四剂后，诸证悉减。再服四剂，基本痊愈。从此行走、劳动如常。1979年6月追访， 患者谈及五年前病愈以后，未再复发。
[按语]《伤寒论》指出： “伤寒八九日，风湿相搏，身体疼烦，不能自转侧，不呕不渴，脉浮虚而涩者，桂枝附子汤主之。”本例诸证与上条基本吻合，故按原方投之，仅药量斟酌变化。加重桂枝，发散在表之风寒，通阳化气；配以生姜，使风邪从皮毛而出；加重附子，温经逐寒止痛，助肾阳，而立卫阳之基；佐以草、枣，益中洲、和营卫，则三气除而搏自解。
太阳证风寒湿痹
(风湿)
汤××，女，37岁。成都市棕垫生产组工人。
[病史]1964年自觉经常头晕，乏力，周身关节疼痛。1965年10月30日晚，突觉肢体沉重疼痛，不能转侧，手不能握物，足不能移步，衣食往行均需他人料理。次日急送××医院，诊断为“风湿”。经针灸治疗十余日，效果不显，遂来求诊。按太阳证论治，三个月基本治愈。
[初诊]由两人搀扶前来就诊。全身关节剧痛似鸡啄，游串不定。头晕，耳鸣，四肢不温，畏寒恶风，口干少津，不欲饮。舌质偏淡，舌体胖大，边缘有齿痕，苔薄白。寸关脉浮虚，尺微沉。此为太阳证，风寒湿邪郁久成痹，法宜温经逐寒，除湿止痛，以甘草附子汤加味主之。
处方：炙甘草30克制附片60克(久煎)
白术12克桂枝18克生姜30克二剂
附片先煎一个半小时，再加其它味药同煎约半小时(以下汤剂中，凡有附片者，均以此法煎煮)；日三服，忌食生冷。
[辨证]此证风寒湿邪兼而有之，蕴积已久，郁阻成痹。虽有畏寒恶风脉浮之表证，但不可单用发表；虽有头晕耳鸣，四肢不温，口干不欲饮，舌质偏淡而尺脉沉之里证，又不宜径投回逆。参之舌脉诸证，乃为风寒湿相搏，属太阳类似证。 《伤寒论》曰： “风湿相搏，骨节疼烦，掣痛不得屈伸，近之则痛剧……甘草附子汤主之。”此方用治本例风寒湿痹，颇相吻合。甘草益气和中，附子温经散寒止痛，白术燥湿健脾，桂枝祛风固卫，通阳化气，加生姜以助温散之力。
[复诊]上方服两剂后，关节疼痛减轻，稍可转侧行动。上方加麻黄、辽细辛，以增强驱风散寒、开闭止痛之效，续进五剂。
[再诊] 自拄拐杖前来就诊。关节疼痛及全身串痛著减。头晕，耳鸣，畏寒，恶风亦明显好转。上方加茯苓以渗湿，续服五剂。
[又诊]全身活动已较自如，精神好转，但腰腿尚觉疼痛、重着。今虽见初效，毕竟一时难收全功。须培补脾肾，通窍除湿，以清余邪，拟理中丸加味续服。
处方：
潞党参60克干姜片120克炒白术60克 炙甘草60克制附片120克云苓60克 上肉桂30克川桂枝15克宁枸杞60克 真琥珀60克五剂 共研细末，水打丸，如黄豆大。日服二次，每次3克。
连服三个月，基本痊愈，恢复正常工作。1979年追访，十余年来，虽关节偶有轻微疼痛，但行动自如，一切较好。
(按语]甘草附子汤之“骨节疼烦，掣痛不得屈伸”，与桂枝附子汤之“身体疼烦，不能自转侧”，皆为风寒湿相搏之太阳证；其疼痛不能自已者，均为筋胀之故，病理相同。所异者，本例甘草附子证，风湿留于关节，邪深入里；而桂附证，风寒湿留着肌肉，有表无里。故汤证不同。
上述两方原义，桂附证因属风湿，留着肌表，当以速去为宜，故附子用量较大；而甘草附子证，已病久入里，减其附子用量者意在缓行。但本例虽属久病入里，又暴发于一旦，且脉沉而细；故兼采两方之义，加大附子并生姜，既速去标，又开筋骨之痹也。
太阳证历节病
(风湿性关节炎)
柴××，男，13岁。四川省郫县团结乡，学生。
[病史]1975年11月，在校义务劳动中遇雨，全身湿透，身觉不适。翌日，感周身骨节烦疼，服药效不显。一月后，双膝关节逐渐肿大，骨节变形，膝关节周围出现硬结。1976年1月初，下肢屈伸不利， 行动困难。经××医院诊断为“风湿性关节炎”。同年2月初来诊，按历节病论治，月余病愈。
[初诊]患者已卧床不起，由其父背来就诊。全身关节疼痛，尤以四肢为甚。双膝关节肿大，膝面有多处硬结，双手掌脱皮，双脚边缘红肿麻木。晚间自汗出，食欲不振。舌质较红，苔白微腻，脉浮紧数。此为太阳证历节病。法宜驱风解热，化湿散寒，以桂枝芍药知母汤加减主之。
处方：
桂枝12克赤芍12克知母12克麻黄10克生姜10克 白术15克 甘草6克 防风12克苡仁20克三剂
[辨证]本例劳动中大汗出，风寒湿邪留注关节。正如仲景所云： “汗出入水中，如水伤心。历节黄汗出，故日历节。”又云： “诸肢节疼痛，身体廷赢，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之。”此例主证突出，风寒湿邪致痹，病属太阳类似证。但已有风从热化之象，故去附子，加苡仁以增强渗湿利痹，止痹痛拘挛之效。
Cinnamon Twig (Guizhi) 6g, White Peony Root (Baishao) 6g, Jujube (Dazao) 10g, Fresh Ginger (Shengjiang) 10g, Magnolia Bark (Houpo) 4g, Apricot Seed (Xingren) 6g, Aster Root (Ziwan) 6g, Saposhnikovia Root (Fangfeng) 3g, Pinellia Rhizome (Faxia) 9g, Roasted Licorice Root (Zhigancao) 3g, Poria (Yunling) 12g, Tangerine Peel (Chenpi) 5g. Three doses.
(Third Visit) After taking three doses, cough and wheezing decreased significantly, with occasional expectoration of clear, thin phlegm. The formula Xiaobanxia Tang (Minor Pinellia Decoction) was modified to warm the middle and transform fluid retention, dispel wind, and stop coughing.
Prescription:
Poria (Yunling) 12g, Pinellia Rhizome (Faxia) 6g, Dried Ginger (Ganjiang) 3g, Roasted Licorice Root (Zhigancao) 5g, Inula Flower (Xuanfuhua) 6g, Aster Root (Ziwan) 6g, Perilla Leaf (Suye) 3g, Saposhnikovia Root (Fangfeng) 3g.
(Fourth Visit) After taking four doses, cough and wheezing subsided. Due to prolonged illness damaging healthy qi, it is appropriate to warm the middle, boost qi, strengthen the spleen, and remove dampness. Lizhong Tang (Regulate the Middle Decoction) was modified for follow-up treatment.
Prescription:
Codonopsis Root (Dangshen) 10g, Atractylodes Macrocephala Rhizome (Baizhu) 6g, Dried Ginger (Ganjiang) 3g, Roasted Licorice Root (Zhigancao) 3g, Astragalus Root (Huangqi) 6g, Pinellia Rhizome (Faxia) 6g, Amomum Fruit (Sharen) 5g, Poria (Yunling) 6g. Six doses.
After taking six doses, medication was stopped, and the body returned to normal. Follow-up on July 26, 1979, showed that the child had grown into an adult with robust constitution, and asthma had not recurred.
[Commentary] This case belongs to Exterior Deficiency Syndrome of the Taiyang (Greater Yang) channel, presenting characteristics of Guizhi Tang (Cinnamon Twig Decoction) syndrome. Additionally, due to the struggle between wind and phlegm, a new pathogenic factor triggered a latent disease, causing obstruction of qi mechanism and resulting in asthma. As stated in Shanghan Lun (Treatise on Cold Pathogenic Diseases): "For those with chronic asthma who suffer an attack, use Guizhi Tang (Cinnamon Twig Decoction), adding Magnolia Bark (Houpo) and Apricot Seed (Xingzi) is beneficial." Clinical verification confirms that for Exterior Deficiency accompanied by wheezing in Taiyang Cold Damage, this approach is suitable regardless of age.
Taiyang Gang Spasm Syndrome
(Measles during Labor)
Guo XX, Female, 20 years old. Worker at a factory in Chengdu.
(Medical History) In the spring of 1951, she was admitted to a maternity hospital due to impending labor. The next morning, she felt fatigued, dizzy, feverish, and aversive to cold, with tearing eyes and runny nose. Red rashes appeared on her face, leading to an immediate diagnosis of measles. Fearing contagion, she was advised to transfer to an infectious disease hospital. Due to imminent delivery and the distance between hospitals, the family refused, and she returned home. There, she contracted wind-cold, causing her condition to deteriorate rapidly into coma and aphasia. Dr. Fan was called for emergency home treatment. Treated as Taiyang Measles Cold Closure, two doses of medicine led to stabilization.
[Diagnosis and Treatment] Rashes on the face and behind the ears emerged and then retracted; rash color turned pale purple and slightly dark, with lesions sinking inward. Forehead slightly hot without sweat, aversion to wind and cold, chest tightness with rebellious qi. Stiffness and pain in the neck and back, convulsions of both hands, locked jaw without sound, and coma. Complexion grayish-dark, lips pale with slight cyanosis. Upon opening the mouth, tongue body was pale red leaning towards dark, coating yellow mixed with white and slightly greasy, pulse floating and tight. This indicates measles during labor that failed to fully erupt, compounded by severe wind-cold contraction, causing measles toxin to sink inward and leading to the critical condition of Gang Spasm. The treatment method should be to disperse wind and scatter cold, relieve spasm and promote eruption of rashes, using Gegen Tang (Kudzu Root Decoction) modified as the main formula.
Prescription:
Kudzu Root (Gegen) 10g, Ephedra Herb (Mahuang) 10g, Cinnamon Twig (Guizhi) 6g, White Peony Root (Baishao) 10g, Licorice Root (Gancao) 3g, Fresh Ginger (Shengjiang) 10g, Cimicifuga Rhizome (Shengma) 10g.
After taking the medicine, the patient gradually regained consciousness, speech became clear, and hand-foot convulsions ceased. Neck and back stiffness significantly reduced, and rashes re-emerged. This indicated the decline of cold pathogens, opening of closure, and resolution of the main symptoms of Gang Spasm, transitioning to normal rash eruption, followed by spontaneous delivery. Subsequently treated with heat-clearing, detoxifying, and sweet-cold nourishing yin agents, she recovered.
[Differentiation] Generally, measles falls within the scope of Warm Diseases, where pungent-warm sweating methods are strictly contraindicated. Why did this case start from the Taiyang channel disease involving Wind-Cold Exterior Excess with accompanying symptoms?
Jingui Yaolue (Essential Prescriptions of the Golden Cabinet) states: "Taiyang disease, fever without sweat, and contrary aversion to cold is named Gang Spasm," "Taiyang disease, no sweat but urine volume is unusually low, qi rushes up to the chest, locked jaw preventing speech, intending to develop Gang Spasm, Gegen Tang (Kudzu Root Decoction) governs it."
Clinically observed, the patient's sudden stiffness and pain in the neck and back, chest tightness with rebellious qi, locked jaw preventing speech, and clenched teeth all indicate excessive cold and spasm in the exterior. Simultaneously, the rash appearing and disappearing, sinking lesions, coma, aphasia, and clenched teeth clearly indicate a closure syndrome where measles retreats midway. Regarding the pathology of this case, is it Heat Closure or Cold Closure? Careful observation reveals: although the forehead is slightly hot, it is not burning hot throughout the body; although comatose and aphasic, there is no irritability, thirst, or delirium; although lesions sank, they were only pale purple and slightly dark. Considering lip color, it was dull and not red; coating was yellow but not dry, pulse was floating and tight but not surging and rapid. Clearly, this belongs to the adverse syndrome of Measles Cold Closure. One must not stick rigidly to the saying "rash prefers coolness, pustule prefers warmth." Therefore, Gegen Tang (Kudzu Root Decoction) was administered to release the exterior, promote eruption, and remove cold closure, allowing pathogens to exit via the meridians to resolve Gang Spasm.
[Commentary] During the puerperium, "postpartum spasms" caused by blood loss injuring fluids, trauma to the birth canal, and infection with toxic pathogens are not uncommon. This case of measles occurring in an adult, specifically during labor, and transforming into Cold Closure Gang Spasm is quite rare clinically. For the parturient, this condition determines life or death. Its fatal danger lies primarily in convulsions and coma caused by measles cold closure. Thus, the key point in clinical practice is to pierce through the confusion and analyze the crux of the symptoms. Summarizing the various signs of measles cold closure, according to the Six Channels of Shanghan, ultimately, it is spasm caused by excessive cold, belonging to Cold, Exterior, Excess, located in the Taiyang channel. Gegen Tang (Kudzu Root Decoction) is indeed an excellent对症 prescription.
Taiyang Rou Spasm Syndrome
Shi XX, Male, 37 years old. Bus driver for a bureau in Beijing.
[Medical History] Starting in autumn 1977, he experienced headache, dizziness, eye distension, stiff and painful tension in the posterior neck extending to the back, radiating to sore shoulders, making flexion, extension, and rotation difficult. Driving restricted head and neck movement, severely affecting work. At night, lying down required three high pillows; when ill, closing eyes caused dizziness, forcing him to keep eyes open to avoid sleep. Western medical examination showed no obvious indicators, only slightly elevated blood pressure. Frequent use of analgesics and sedatives yielded no obvious effect. He consulted Dr. Fan in September 1978. Treated as Taiyang Rou Spasm Syndrome, he recovered in half a month.
[Diagnosis and Treatment] Headache, stiffness and pain in the neck and back. Frequent spontaneous sweating, especially aversion to wind in the head and neck area. Lying down causes dizziness, restless sleep. Condition worsened gradually over a year, making driving increasingly difficult. Tongue body pale red, coating white and slippery, pulse floating and soft. This is "stiffness and discomfort in the neck and back" caused by wind-dampness injuring the sinews, belonging to "Rou Spasm" of Taiyang disease. The treatment method should be to resolve the muscle layer, dispel wind, and moisten/nourish the meridians. Use Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root) as the main formula.
Prescription:
Kudzu Root (Gegen) 12g, Cinnamon Twig (Guizhi) 9g, White Peony Root (Baishao) 9g, Roasted Licorice Root (Zhigancao) 9g, Fresh Ginger (Shengjiang) 15g, Jujube (Dazao) 20g. Two doses.
After taking two doses of the above prescription, all symptoms decreased significantly. Adjustments were made, and several more doses were taken, with advice to pay attention to temperature changes. The illness was resolved in about half a month. Follow-up on May 17, 1979, the patient reported: After being cured by Dr. Fan, he never relapsed. Last November, he drove ten thousand li to the Northeast, and since then, his head and neck have felt completely comfortable.
[Differentiation] This case of headache and neck stiffness, pale red tongue, thin white slippery coating, and floating pulse clearly indicates Taiyang Spasm Disease. Although the illness has lasted over a year, there are no Interior syndromes or signs of transmission, so the disease still belongs to the Taiyang channel syndrome.
At the first visit, the stiffness in the neck and back had persisted for a long time. Investigating the etiology, it was caused by wind-cold pathogens obstructing the collaterals, poor circulation of qi and blood, leading to malnourishment of the sinews. Normal tongue quality, white slippery coating, and floating soft pulse are signs of Taiyang Exterior syndrome; combined with sweating and aversion to wind, this indicates an Exterior Deficiency syndrome.
Shanghan Lun explicitly states: "Taiyang disease, stiffness and discomfort in the neck and back, with contrary sweating and aversion to wind, is governed by Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root)." Comparing with this case, the main symptoms match, so the original formula was administered.
[Commentary] The Rou Spasm treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root) in this case, and the Gang Spasm treated with Gegen Tang (Kudzu Root Decoction) in the previous case, both use Guizhi Tang (Cinnamon Twig Decoction) as the base formula and heavily emphasize Kudzu Root (Gegen) as the sovereign herb. The difference lies merely in the presence or absence of one herb, Ephedra (Mahuang), and the distinction between sweating and no sweating. Consequently, the principles, methods, formulas, and herbs differ accordingly. However, many versions of Shanghan Lun historically published Guizhi Jia Gegen Tang containing Ephedra. Later scholars like Lin Yi suggested this might not reflect Zhongjing's original intent. Clinical verification today confirms this is indeed the case.
Taiyang Wind-Damp Syndrome
Tian XX, Female, 70 years old. Family member of a central government organ in Beijing.
[Medical History] Pain in the left lower limb, severe in the calf and knee joint, difficulty walking, lasting over a year. Treated at a certain hospital for rheumatoid arthritis. Physiotherapy, acupuncture, and Chinese herbal medicine treatments were ineffective. She consulted Dr. Fan on November 28, 1978. Treated as Taiyang Wind-Damp Syndrome, she was cured in two visits.
(First Visit) Supported by others to come. Severe pain in the left leg, difficult to put foot on the ground, with fear of wind and heaviness. Often unbearable pain at night preventing sleep. Joints were not red or swollen. Tongue body pale red, coating white and slippery. This is Taiyang Wind-Damp Syndrome. The treatment method should be to dispel wind and overcome dampness, resolve the muscle layer, and unblock collaterals. Use Guizhi Tang (Cinnamon Twig Decoction) modified as the main formula.
Prescription:
Cinnamon Twig (Guizhi) 3g, White Peony Root (Baishao) 10g, Fresh Ginger (Shengjiang) 15g, Jujube (Dazao) 15g, Achyranthes Root (Niuxi) 10g, Roasted Licorice Root (Zhigancao) 10g, Clematis Root (Weilingxian) 6g, Quince Fruit (Mugua) 10g. Two doses.
[Second Visit] After taking two doses of the above prescription, leg pain disappeared. Able to walk freely on the ground. To consolidate efficacy and eliminate residual pathogens, the original formula was modified and continued.
Prescription: Cinnamon Twig (Guizhi) 6g, White Peony Root (Baishao) 10g, Fresh Ginger (Shengjiang) 10g, Achyranthes Root (Niuxi) 10g, Roasted Licorice Root (Zhigancao) 10g, Quince Fruit (Mugua) 10g, Perilla Leaf (Zisuye) 10g, Saposhnikovia Root (Fangfeng) 10g, Pinellia Rhizome (Faxia) 10g. Cured after two doses. Follow-up on May 15, 1979, neighbors reported: In 1977, the patient suffered leg pain, multiple treatments showed no improvement, crying while carrying children at home due to severe pain. Dr. Fan cured her with a few doses; she is now visiting relatives in her hometown.
[Commentary] Shanghan Lun discusses many miscellaneous diseases. Among them, the exposition on wind-damp bi-pain is most detailed in the Taiyang Chapter. Taiyang governs the exterior of the whole body and serves as the barrier of the Six Channels. When wind-cold external pathogens attack, Taiyang bears the brunt. It may move from exterior to interior, causing systemic reactions; or if it possesses characteristics of Taiyang disease, regardless of time duration, one can proceed practically, treating according to "pulse and symptom combination" of Taiyang disease.
The joint pain in this case involves wind-damp pathogens moving from exterior to interior, lodging in the interstices, stagnating in the lower limbs, causing poor local circulation of qi and blood, worsening obstruction, hence severe pain. Guizhi Tang (Cinnamon Twig Decoction) is used for its ability to unblock yang, resolve the muscle layer, dispel wind pathogens, and regulate Ying and Wei. Heavy use of Peony and Licorice creates Yin through Sour-Sweet transformation, regulating blood, nourishing sinews, and relieving urgency/pain; adding Achyranthes (Niuxi), which descends well, invigorates blood and unblocks meridians; adding Quince (Mugua) and Clematis (Weilingxian) to relax sinews, activate collaterals, dispel wind, and remove dampness, jointly achieving the goal of releasing the exterior and driving out pathogens.
Placing this chapter as the first case of wind-damp bi-pain aims to verify through modern practice, drawing inferences, further confirming that within Shanghan there are myriad diseases, and Zhongjing's concise laws can accommodate various diseases.
Taiyang Wind-Damp Syndrome
Yang XX, Female, 60 years old. Farmer from Yongning Township, Wenjiang County, Sichuan Province.
[Medical History] Previous history of rheumatic pain. In early August 1974, felt unwell, aversion to cold, dizziness, body pain. One day while bending over, suddenly felt severe waist pain, unable to straighten, breaking out in cold sweat, collapsing onto the bed. Invited Dr. Fan for treatment. Treated as Taiyang Wind-Damp Syndrome, recovered in over ten days.
[Diagnosis and Treatment] Waist pain like cutting, unable to turn sides, feeling periodic chills and fever, numbness in hands and feet. Complexion greenish-dark, lips cyanotic, tongue body slightly red, coating white slippery and greasy, backs of hands slightly cool to touch, pulse floating and deficient. This is Taiyang syndrome, wind-damp struggling together, Defensive Yang already deficient. The treatment method should be to warm meridians, scatter cold, dispel wind, and remove dampness. Use Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) as the main formula.
Prescription:
Cinnamon Twig (Guizhi) 15g, Processed Aconite Slice (Zhi Fupian) 60g (Decoct for a long time, 1.5 hours), Fresh Ginger (Shengjiang) 30g, Roasted Licorice Root (Zhigancao) 10g, Red Date (Hongzao) 30g. Four doses.
After taking four consecutive doses of the above prescription, all symptoms decreased significantly. Taking another four doses led to basic recovery. Walking and labor returned to normal thereafter. Follow-up in June 1979, the patient mentioned that after recovering five years ago, there was no recurrence.
[Commentary] Shanghan Lun points out: "Cold damage for eight or nine days, wind-damp struggling together, body pain and vexation, unable to turn sides, no vomiting or thirst, pulse floating, deficient, and choppy, is governed by Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction)." The symptoms in this case basically match the above clause, so the original formula was administered, with only dosage adjustments. Increasing Cinnamon Twig disperses wind-cold in the exterior, unblocks yang and transforms qi; pairing with Fresh Ginger allows wind pathogens to exit through skin and hair; increasing Aconite warms meridians, drives out cold, stops pain, assists Kidney Yang, and establishes the foundation of Defensive Yang; assisting with Licorice and Dates benefits the Middle Jiao, harmonizes Ying and Wei, thus removing the three pathogens and resolving the struggle.
Taiyang Wind-Cold-Damp Bi Syndrome
(Rheumatism)
Tang XX, Female, 37 years old. Worker at Chengdu Brown Mat Production Group.
[Medical History] Since 1964, frequently felt dizzy, fatigued, and painful joints throughout the body. On the evening of October 30, 1965, suddenly felt heavy and painful limbs, unable to turn sides, hands unable to grasp objects, feet unable to step, requiring others for daily care. Sent to a certain hospital the next day, diagnosed with "rheumatism." Acupuncture treatment for over ten days showed little effect, so she sought consultation. Treated as Taiyang syndrome, basically cured in three months.
(First Visit) Brought in supported by two people. Severe pain in all joints like chicken pecking, wandering and不定. Dizziness, tinnitus, cold limbs, aversion to cold and wind, dry mouth with little saliva, no desire to drink. Tongue body pale, tongue body enlarged with tooth marks on edges, coating thin white. Cun and Guan pulses floating and deficient, Chi pulse slightly sunken. This is Taiyang syndrome, wind-cold-damp pathogens stagnating for a long time forming Bi. The treatment method should be to warm meridians, drive out cold, remove dampness, and stop pain. Use Gancao Fuzi Tang (Licorice and Aconite Decoction) modified as the main formula.
Prescription: Roasted Licorice Root (Zhigancao) 30g, Processed Aconite Slice (Zhi Fupian) 60g (Decoct for a long time), Atractylodes Rhizome (Baizhu) 12g, Cinnamon Twig (Guizhi) 18g, Fresh Ginger (Shengjiang) 30g. Two doses.
Aconite slices are decocted first for 1.5 hours, then other herbs are added and decocted for about half an hour (for all subsequent decoctions containing Aconite slices, this method is used); taken three times a day, avoiding raw and cold foods.
[Differentiation] This syndrome involves both wind-cold and damp pathogens, accumulating for a long time, stagnating and forming Bi. Although there are Exterior signs like aversion to cold, wind, and floating pulse, one cannot solely use releasing methods; although there are Interior signs like dizziness, tinnitus, cold limbs, dry mouth without desire to drink, pale tongue, and sunken Chi pulse, one should not directly administer rescue methods. Considering tongue and pulse signs, it is wind-cold-damp struggling together, belonging to Taiyang-like syndrome. Shanghan Lun says: "Wind-damp struggling together, bone and joint pain and vexation, pulling pain preventing flexion and extension, touching causes severe pain... Gancao Fuzi Tang (Licorice and Aconite Decoction) governs it." This formula fits well for treating this case of wind-cold-damp Bi. Licorice boosts qi and harmonizes the middle, Aconite warms meridians, scatters cold, and stops pain, Atractylodes dries dampness and strengthens the spleen, Cinnamon Twig dispels wind, secures defense, unblocks yang, and transforms qi, adding Fresh Ginger to assist warming and dispersing power.
[Second Visit] After taking two doses of the above prescription, joint pain decreased, able to turn and move slightly. Ephedra (Mahuang) and Thoroughwort Rhizome (Liaoxixin) were added to enhance dispelling wind, scattering cold, opening closure, and stopping pain effects, continuing for five doses.
[Third Visit] Came supporting a cane. Joint pain and whole-body wandering pain significantly reduced. Dizziness, tinnitus, aversion to cold, and wind also improved obviously. Poria (Fuling) was added to drain dampness, continuing for five doses.
[Fourth Visit] Whole-body movement became relatively free, spirit improved, but waist and legs still felt painful and heavy. Although initial efficacy is seen, full results are hard to achieve quickly. Must tonify Spleen and Kidney, unblock orifices, remove dampness, and clear residual pathogens. Li Zhong Wan (Regulate the Middle Pill) modified was planned for continued use.
Prescription:
Codonopsis Root (Luoshen) 60g, Dried Ginger Slice (Ganjiang Pian) 120g, Stir-fried Atractylodes Rhizome (Chaobaizhu) 60g, Roasted Licorice Root (Zhigancao) 60g, Processed Aconite Slice (Zhi Fupian) 120g, Poria (Yunling) 60g, Upper Cinnamon Bark (Shang Rougui) 30g, Cinnamon Twig (Chuanguizhi) 15g, Ningxia Goji Berry (Ninggouqi) 60g, True Amber (Zhen Hupo) 60g. Five doses. Ground into fine powder, made into pills with water, size of soybeans. Taken twice daily, 3g each time.
Taken continuously for three months, basically recovered, returning to normal work. Follow-up in 1979, over ten years later, although joints occasionally had slight pain, movement was free, and everything was good.
[Commentary] "Bone and joint pain and vexation, pulling pain preventing flexion and extension" in Gancao Fuzi Tang (Licorice and Aconite Decoction), and "body pain and vexation, unable to turn sides" in Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), both belong to Taiyang syndrome of wind-cold-damp struggling together; their inability to control pain is due to sinus swelling, sharing the same pathology. The difference is that in this Gancao Fuzi Tang case, wind-damp remains in joints, pathogens deeply entering the interior; whereas in Guizhi-Fuzi cases, wind-cold-damp lingers in muscles, having exterior but no interior involvement. Hence, the decoction indications differ.
In the original meaning of these two formulas, Guizhi-Fuzi cases, belonging to wind-damp lingering on the muscular exterior, should be removed quickly, hence larger dosage of Aconite; while Gancao Fuzi cases, having been ill for a long time entering the interior, reducing Aconite dosage intends slow action. But this case, although belonging to long-term illness entering the interior, also erupted suddenly, and pulse was deep and fine; thus combining the meanings of both formulas, increasing Aconite and Fresh Ginger, both quickly removes the branch symptoms and opens the bi-stagnation of bones and sinews.
Taiyang Lijie Disease
(Rheumatoid Arthritis)
Chai XX, Male, 13 years old. Student from Tuanjie Township, Pixian County, Sichuan Province.
[Medical History] In November 1975, caught in rain during school volunteer labor, soaked thoroughly, feeling unwell. The next day, felt painful joints throughout the body, medication showed little effect. After one month, bilateral knee joints gradually swelled, joints deformed, hard nodules appeared around knees. In early January 1976, lower limbs difficult to flex and extend, difficulty walking. Diagnosed with "rheumatoid arthritis" at a certain hospital. Consulted Dr. Fan in early February of the same year. Treated as Lijie Disease, recovered in over a month.
(First Visit) Patient bedridden, carried by father to consult. Pain in all joints, especially severe in limbs. Bilateral knee joints swollen, multiple hard nodules on knee surfaces, palms peeling, edges of feet red, swollen, and numb. Spontaneous sweating at night, poor appetite. Tongue body redder, coating white slightly greasy, pulse floating, tight, and rapid. This is Taiyang Lijie Disease. The treatment method should be to dispel wind, clear heat, transform dampness, and scatter cold. Use Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) modified as the main formula.
Prescription:
Cinnamon Twig (Guizhi) 12g, Red Peony Root (Chishaoyao) 12g, Anemarrhena Rhizome (Zhimu) 12g, Ephedra Herb (Mahuang) 10g, Fresh Ginger (Shengjiang) 10g, Atractylodes Rhizome (Baizhu) 15g, Licorice Root (Gancao) 6g, Saposhnikovia Root (Fangfeng) 12g, Coix Seed (Yiren) 20g. Three doses.
[Differentiation] In this case, profuse sweating during labor allowed wind-cold-damp pathogens to lodge in joints. As Zhongjing said: "Sweating and entering water, as if water harms the heart. Lijie with yellow sweat, therefore named Lijie." Also: "Pain in all limb joints, emaciated body, feet swollen as if detached, dizziness, shortness of breath, nausea, Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) governs it." The main symptoms of this case are prominent, wind-cold-damp pathogens causing Bi, belonging to Taiyang-like syndrome. However, there are signs of wind transforming into heat, so Aconite was removed, and Coix Seed (Yiren) added to enhance draining dampness, benefiting Bi, and stopping Bi pain and spasms.