痛，可与麻黄汤加术同义。
程应旄曰∶湿家不惟不可误下，即汗亦不可误汗。风湿相抟一证，一身尽疼痛，虽是微挟表邪，然其脉
不浮，终是汗难大汗，治风兼治湿，但使微微似欲汗出者，是其法也。
伤寒八九日，风湿相抟，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。若其人大便硬，小便自利者，去桂枝加白术汤主之。
【注】此承上条，详申脉证，以明其治也。伤寒八九日，不呕不渴，是无伤寒里病之证也；脉浮虚涩，是
无伤寒表病之脉也。脉浮虚，主在表，虚风也；涩者主在经，寒湿也。身体疼烦属风也，不能转侧属湿也，乃
风湿相抟之证，非伤寒也，与桂枝附子汤温散其风湿，使从表而解也。若脉浮实者，则又当以麻黄加术汤，大
发其风湿也。如其人有是证，虽大便硬，小便自利，而不议下者，以其非邪热入里之硬，乃风燥湿去之硬，故
仍以桂枝附子汤去桂枝，以大便硬，小便自利，不欲其发汗，再夺津液也；加白术，以身重着，湿在肉分，用
以佐附子逐湿气于肌也。
【集注】成无己曰∶烦者，风也。身疼不能自转侧者，湿也。经曰∶风则浮虚。《脉经》曰∶脉来涩者，
为病寒湿也。
桂枝附子去桂枝加白术汤方
附子（炮，去皮，破，三枚） 白术（四两） 生姜（切，三两） 大枣（擘，十二枚） 甘草（炙，二两）
上五味，以水六升，煮取二升，去滓，分温三服。初一服，其人身如痹，半日许，复服之，三服都尽，其
人如冒状，勿怪。此以附子、术，并走皮内，逐水气未得除，故使之耳。法当加桂四两。此本一方二法，以大
便硬、小便自利去桂也。以大便不硬、小便不利，当加桂。附子三枚，恐多也，虚弱家及产妇，宜减服之。
风湿相抟，骨节疼烦，掣痛不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不欲去衣，或身微肿者，
甘草附子汤主之。
【注】风湿相抟，骨节疼烦，重着不能转侧，湿胜风也。掣痛不可屈伸，风胜湿也。今掣痛不可屈伸，近
之则痛剧，汗出、短气，恶风不欲去衣，皆风邪壅盛，伤肌表也。小便不利，湿内蓄也。身微肿者，湿外薄也。
以甘草附子汤微汗之，祛风为主，除湿次之也。以上二条，皆详风湿之义，以明风湿之治也。
【集注】方有执曰∶抟，捏聚也。言风与湿捏合抟聚，共为一家之病也。烦，风也。痛，湿也。风淫则
掣，湿淫则痛，风湿之邪注经络，流关节，渗骨髓，身体所以烦痛、掣痛而不利也。近之则痛剧者，外邪客于
内，迕之则逆也。短气者，汗多亡阳而气伤也。恶风不欲去衣者，以重伤，故恶甚也。甘草益气和中，附子温
经散湿，术能胜湿燥脾，桂枝祛风固卫，此四物者，所以为风湿相抟之的药也。
吴人驹曰∶必脉之沉而细者，若浮大而盛，则风多而湿少，附子须在审之。
甘草附子汤方
甘草（炙，二两） 附子（炮，去皮，破，二枚） 桂枝（四两） 白术（二两）
上四味，以水六升，煮取三升，去滓，温服一升，日三服。初服得微汗则解，能食。汗止复烦者，服五
合。恐一升多者，宜服六七合为妙。
【方解】风湿之治，用甘草附子汤，即桂枝附子汤去姜、枣加白术也。去姜、枣者，畏助汗也。加白术
者，燥中湿也。日三服，初服一升，不得汗解，则仍服一升。若微得汗则解，解则能食，是解已彻也，可止再
服。若汗出而复烦者，是解未彻也，仍当服之，但不可更服一升，恐已经汗，多服而过汗也，服五合可也。如
不解，再服六七合为妙。似此服法，总是示人不可尽剂之意，学人于理有未解处，即于本文中求之自得矣。
太阳中热者， 是也。其人汗出恶寒，身热而渴也。
【注】中暑热病，亦由太阳表入，故曰∶太阳中热者， 是也。其人汗出恶寒，身热而渴，颇似太阳温
热之病。但温热无恶寒，以
热从内发，故虽汗出而不恶寒；中 恶寒者，以暑由外入，故汗出而恶寒也。究之于脉，温热之浮，必浮而实；
中之浮，必浮而虚，以暑热伤气也。究之于渴，温热之渴，初病不过欲饮水；中 之渴，一病即大渴引饮也。温
热则传经，变病不一，中 则不传，不愈即死也。虽同为太阳经中之病，而虚实施治不同，宜以人参白虎汤主治之。
【集注】方有执曰∶蒸热谓之暑，伤暑谓之 。汗出恶寒者，太阳表不固也。身热者，暑邪伤阳也。渴
者，亡津液而内燥也。
程知曰∶此辨暑热脉证也。太阳中热者，谓是太阳表证而属中热也。均是太阳表病，汗出恶寒，身热而
不渴者，为中风；汗出身热而渴，不恶寒者，为温病。今汗出恶寒，身热而渴，则是中 。 者，暑热之气也。
不言 而言热，以其胃热为独重也。里有热，故身热而渴，暑伤气，故汗出恶寒。
吴人驹曰∶不可因恶寒而用辛温，又不可因汗出而固表，惟宜甘寒以解其暑热可也。
太阳中 者，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已，洒洒然毛耸，手足逆冷，小有劳身即热，
口开，前板齿燥。若发汗则恶寒甚，加温针则发热甚，数下之则淋甚。
【注】此申上条，详出证脉，戒人不可妄行汗、下温针也。太阳中 ，无汗身重疼痛者，似伤寒也，但
脉弦细芤迟，非伤寒脉也。且有小便已，而洒洒然恶寒毛耸之证，乃太阳膀胱表气为暑所伤而然也。手足逆冷
者，乃暑伤气，气伤不能达四肢，则寒也。小有劳身即发热，口开前板齿燥者，乃劳则动热，暑热益烈，伤阴
液也，此皆中 危证。若以发热无汗，恶寒身痛，误为伤寒之表，妄行发汗，则表气愈虚，恶寒更甚也。若以
手足逆冷，误为阳虚，妄加温针，则暑邪愈盛，发热更炽也。若以壮热齿干，误为胃火而数下，则水源竭涩，尿
淋窘甚也。凡此之证，皆中 妄行汗、下、温针致变，惟宜以白虎加人参汤主之。或人参汤调辰砂六一散亦可也。
【集注】成无己曰∶经云∶因于暑汗，烦则喘喝。口开，谓喘喝也，喘喝不止，故前板齿燥。
程知曰∶人身之阳，以汗而外泄；人身之阴，以热而内竭。故 证禁用汗、下、温针，谓汗则伤阳，下
则伤阴，温针则引火内入也。
张锡驹曰∶洒洒者，恶寒之象也。毛耸者，毫毛竖起也。
太阳中 者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。
【注】太阳中 之证，身热疼重者，暑伤形也；脉微弱者，暑伤气也。以此证脉揆之，亦其人夏月盛暑
喜贪风凉，过饮冷水，水气输行于皮中，表为邪束，不得汗泄所致也。此时即以香薷饮、大顺散汗之，可立愈
也。若因循不治，则水气既不得外泄于表而作肿，势必内攻于里而喘胀矣，是又当以葶苈大枣汤或瓜蒂一物散
下之也。上条戒人不可汗下，此条示人宜当汗下。仲景之法，多是如此，盖恐人固执失宜也。
【集注】方有执曰∶身热疼重，而曰夏月伤冷水，水行皮中所致者，土主肌肉而恶湿，水渗土而蒸发也。
脉微弱者，热则血干而气耗也。然夏月饮水，人之常事，而曰伤何哉？良由暑迫饮之过多，或得之冷水澡洗，
暑反内入也。
张璐曰∶按论 三条，首言动而得之之病，谓中 ，属外因；次言静而得之之病，虽曰中 ，实暑病也，
属内因；末言因热伤冷之病，乃中 之变证，属不内外因，不得以三者混称也。
程应旄曰∶可见中 之病，大都阳气在表，而胃中虚冷，所以身热疼重，而脉微弱。夏月饮冷水，里阴
郁住表阳，水气不得宣泄，而行于皮中，多有此证。此则开郁宣阳，又为 证中增一义也。
Pain, which is consistent in principle with Mahuang Tang (Ephedra Decoction) plus Baizhu (Atractylodis Macrocephalae Rhizoma).
Cheng Yingmao stated: For patients with dampness disorders, not only should purgation be avoided as a mistake, but also diaphoresis must not be misapplied. In the syndrome of wind-dampness intermingling, where there is generalized body pain, although it slightly involves exterior pathogens, the pulse is not floating, and profuse sweating is ultimately difficult to achieve. The treatment for wind should simultaneously address dampness; the method is to induce slight perspiration, resembling a desire to sweat.
After eight or nine days of Shanghan (Cold Damage), if wind-dampness intermingles, causing severe bodily pain and restlessness, inability to turn over independently, absence of vomiting and thirst, and a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is the primary prescription. If the patient presents with hard stools and spontaneous urination, remove Guizhi (Cinnamomi Ramulus) and add Baizhu (Atractylodis Macrocephalae Rhizoma); Baizhu Tang (Atractylodis Macrocephalae Rhizoma Decoction) is the primary prescription.
[Annotation] This follows the previous clause, detailing the pulse and symptoms to clarify the treatment. After eight or nine days of Shanghan, the absence of vomiting and thirst indicates no interior pathology of Shanghan; a floating, deficient, and choppy pulse indicates no exterior pathology of Shanghan. A floating and deficient pulse signifies pathogen in the exterior due to deficient wind; a choppy pulse signifies cold-dampness in the meridians. Severe bodily pain belongs to wind; inability to turn over belongs to dampness. This is a syndrome of wind-dampness intermingling, not Shanghan. Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is used to warm and disperse wind-dampness, allowing resolution from the exterior. If the pulse is floating and excess, Mahuang Jia Zhu Tang (Ephedra Plus Atractylodis Macrocephalae Rhizoma Decoction) should be used to vigorously disperse wind-dampness. If the patient has these symptoms, despite hard stools and spontaneous urination, purgation is not considered because the hardness is not due to heat pathogens entering the interior, but rather dryness from wind and removal of dampness. Therefore, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is still used, removing Guizhi (Cinnamomi Ramulus) because hard stools and spontaneous urination suggest avoiding further diaphoresis that would deplete fluids; Baizhu (Atractylodis Macrocephalae Rhizoma) is added because heavy sensation and dampness in the muscle layer require assisting Fuzi (Aconiti Lateralis Radix Preparata) to expel dampness from the skin and muscles.
[Collected Annotations] Cheng Wuji stated: Restlessness indicates wind. Bodily pain and inability to turn over indicate dampness. The Classics state: Wind results in a floating and deficient pulse. The Mai Jing (Pulse Classic) states: A choppy pulse indicates cold-dampness disease.
Formula for Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) with Guizhi Removed and Baizhu Added
Fuzi (Prepared, peeled, broken, three pieces), Baizhu (Four liang), Shengjiang (Sliced, three liang), Dazao (Broken open, twelve pieces), Gancao (Honey-fried, two liang).
The above five ingredients are boiled in six sheng of water until two sheng remain. Strain and divide into three warm doses. After the first dose, the patient may feel numbness; after about half a day, administer the second dose. After all three doses are consumed, the patient may experience a sensation of dizziness or confusion; do not be alarmed. This occurs because Fuzi (Aconiti Lateralis Radix Preparata) and Baizhu (Atractylodis Macrocephalae Rhizoma) move within the skin, expelling water qi that has not yet been eliminated. According to the method, Guizhi (Cinnamomi Ramulus) four liang should be added. This was originally one formula with two methods: remove Guizhi (Cinnamomi Ramulus) for hard stools and spontaneous urination; add Guizhi (Cinnamomi Ramulus) for non-hard stools and inhibited urination. Three pieces of Fuzi (Aconiti Lateralis Radix Preparata) may be excessive; for weak individuals and postpartum women, the dosage should be reduced.
If wind-dampness intermingles, causing painful and restless bone joints, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, inhibited urination, aversion to wind with reluctance to remove clothing, or slight edema, Gancao Fuzi Tang (Licorice and Aconite Root Decoction) is the primary prescription.
[Annotation] Wind-dampness intermingling causes painful and restless bone joints, heaviness, and inability to turn over; this is dampness prevailing over wind. Pulling pain preventing flexion and extension is wind prevailing over dampness. Now, pulling pain prevents flexion and extension, pain worsens upon touch, sweating and shortness of breath occur, and there is aversion to wind with reluctance to remove clothing; all these indicate excess wind pathogens damaging the muscle and exterior. Inhibited urination indicates internal accumulation of dampness. Slight edema indicates external pressure of dampness. Gancao Fuzi Tang (Licorice and Aconite Root Decoction) is used to induce slight sweating, primarily dispelling wind and secondarily removing dampness. The above two clauses detail the meaning of wind-dampness to clarify its treatment.
[Collected Annotations] Fang Youzhi stated: "Tuan" means kneading together. It refers to wind and dampness combining to form a single pathological entity. "Fan" (restlessness) is wind; "Tong" (pain) is dampness. Excess wind causes pulling sensations; excess dampness causes pain. Wind-dampness pathogens enter the meridians, flow into the joints, and seep into the marrow, causing the body to suffer from restlessness, pain, pulling pain, and dysfunction. Pain worsening upon touch occurs because external pathogens lodge internally, and opposing them causes rebellion. Shortness of breath results from excessive sweating leading to loss of Yang qi and damage to Qi. Aversion to wind with reluctance to remove clothing indicates severe injury, hence severe aversion. Gancao (Glycyrrhizae Radix et Rhizoma) tonifies Qi and harmonizes the middle; Fuzi (Aconiti Lateralis Radix Preparata) warms the meridians and disperses dampness; Baizhu (Atractylodis Macrocephalae Rhizoma) overcomes dampness and dries the Spleen; Guizhi (Cinnamomi Ramulus) dispels wind and secures the Wei. These four herbs are the specific medicines for wind-dampness intermingling.
Wu Renju stated: The pulse must be deep and fine. If it is large and floating and vigorous, wind is abundant and dampness is scarce; the use of Fuzi (Aconiti Lateralis Radix Preparata) requires careful consideration.
Formula for Gancao Fuzi Tang (Licorice and Aconite Root Decoction)
Gancao (Honey-fried, two liang), Fuzi (Prepared, peeled, broken, two pieces), Guizhi (Four liang), Baizhu (Two liang).
The above four ingredients are boiled in six sheng of water until three sheng remain. Strain and take one sheng warm, three times daily. Initial administration inducing slight sweating resolves the condition and restores appetite. If sweating stops and restlessness recurs, take five he. If one sheng is feared to be too much, taking six or seven he is optimal.
[Formula Analysis] The treatment for wind-dampness uses Gancao Fuzi Tang (Licorice and Aconite Root Decoction), which is Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) minus Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) plus Baizhu (Atractylodis Macrocephalae Rhizoma). Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) are removed to avoid aiding diaphoresis. Baizhu (Atractylodis Macrocephalae Rhizoma) is added to dry dampness in the middle. Taking three doses daily, starting with one sheng: if sweating does not resolve the condition, continue with one sheng. If slight sweating resolves the condition and appetite returns, the resolution is complete, and further dosing can stop. If sweating recurs with restlessness, resolution is incomplete, and dosing should continue, but not another full sheng, to avoid excessive sweating after prior diaphoresis; five he is appropriate. If unresolved, taking six or seven he is optimal. Such dosing instructions always demonstrate the principle of not consuming the entire dose. Scholars who do not understand the rationale can find answers within the text itself.
Taiyang Zhongre (Heat Stroke in Taiyang Meridian), also known as Ye (Summerheat), is characterized by sweating, aversion to cold, fever, and thirst.
[Annotation] Summerheat diseases also enter via the Taiyang exterior, hence it is said: Taiyang Zhongre (Heat Stroke in Taiyang Meridian) is Ye (Summerheat). The patient exhibits sweating, aversion to cold, fever, and thirst, resembling Taiyang Warmth Disease. However, Warmth Disease lacks aversion to cold because heat originates internally; thus, despite sweating, there is no aversion to cold. Ye (Summerheat) involves aversion to cold because summerheat enters from the exterior; thus, sweating accompanies aversion to cold. Regarding the pulse, the floating pulse of Warmth Disease is floating and excess; the floating pulse of Ye (Summerheat) is floating and deficient because summerheat damages Qi. Regarding thirst, in Warmth Disease, early-stage thirst only desires drinking water; in Ye (Summerheat), thirst is intense immediately upon onset. Warmth Disease transmits through the meridians with varied transformations; Ye (Summerheat) does not transmit, and if unhealed, leads to death. Although both are diseases of the Taiyang meridian, their deficiency and excess require different treatments; Renshen Baihu Tang (Ginseng and White Tiger Decoction) is indicated.
[Collected Annotations] Fang Youzhi stated: Steaming heat is called Shu (Summerheat); injuring Shu is called Ye (Summerheat). Sweating and aversion to cold indicate insecure Taiyang exterior. Fever indicates Shu pathogen damaging Yang. Thirst indicates loss of Jin-Ye (Body Fluids) and internal dryness.
Cheng Zhi stated: This distinguishes the pulse and symptoms of summerheat. Taiyang Zhongre (Heat Stroke in Taiyang Meridian) refers to a Taiyang exterior syndrome belonging to middle heat. All are Taiyang exterior diseases: sweating, aversion to cold, fever without thirst is Fengzhong (Wind Strike); sweating, fever, and thirst without aversion to cold is Wenbing (Warm Disease). Now, sweating, aversion to cold, fever, and thirst indicate Zhongye (Summerheat). Ye (Summerheat) is the Qi of summerheat. Referring to "Re" (Heat) instead of "Ye" emphasizes the severity of Stomach heat. Internal heat causes fever and thirst; summerheat damages Qi, causing sweating and aversion to cold.
Wu Renju stated: Do not use acrid-warm herbs due to aversion to cold, nor secure the exterior due to sweating; only sweet-cold herbs should be used to resolve summerheat.
In Taiyang Zhongye (Summerheat in Taiyang Meridian), there is fever, aversion to cold, heaviness, and pain. The pulse is string-taut, fine, knotted, and slow. After urination, there is chills and piloerection. The extremities are cold. Slight exertion causes immediate fever. The mouth opens, and the anterior teeth are dry. If diaphoresis is induced, aversion to cold becomes severe. If moxibustion needles are applied, fever becomes severe. If purgation is repeated, strangury becomes severe.
[Annotation] This elaborates on the previous clause, detailing symptoms and pulse, warning against reckless diaphoresis, purgation, or moxibustion. Taiyang Zhongye (Summerheat in Taiyang Meridian) with no sweating, heaviness, and pain resembles Shanghan (Cold Damage), but the string-taut, fine, knotted, and slow pulse is not characteristic of Shanghan. Additionally, chills and piloerection after urination indicate the Taiyang Bladder exterior Qi is damaged by summerheat. Cold extremities indicate summerheat damaging Qi, which fails to reach the limbs, causing cold. Immediate fever upon slight exertion, opening the mouth, and dry anterior teeth indicate that exertion stirs heat, intensifying summerheat and damaging Yin fluids. These are critical signs of Zhongye (Summerheat). Mistaking fever, no sweating, aversion to cold, and body pain for an exterior Shanghan syndrome and inducing diaphoresis will further weaken exterior Qi, worsening aversion to cold. Mistaking cold extremities for Yang deficiency and applying moxibustion needles will intensify summerheat pathogens, worsening fever. Mistaking high fever and dry teeth for Stomach fire and repeatedly purging will deplete the water source, causing severe strangury. All these conditions result from mishandling Zhongye (Summerheat) with diaphoresis, purgation, or moxibustion. Only Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is suitable. Alternatively, Renshen Tang (Ginseng Decoction) mixed with Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) may be used.
[Collected Annotations] Cheng Wuji stated: The Classics say: Due to summerheat sweating, restlessness leads to panting and drinking. Opening the mouth refers to panting and drinking; continuous panting and drinking cause dry anterior teeth.
Cheng Zhi stated: Human Yang escapes via sweat; human Yin is depleted internally by heat. Therefore, Ye (Summerheat) contraindicates diaphoresis, purgation, and moxibustion: diaphoresis damages Yang, purgation damages Yin, and moxibustion draws fire inward.
Zhang Xiju stated: "Sasha" describes the sensation of aversion to cold. "Mao Song" refers to piloerection.
In Taiyang Zhongye (Summerheat in Taiyang Meridian), there is fever, heaviness, pain, and a weak or faint pulse. This is also caused by injuring cold water in summer, with water qi circulating in the skin.
[Annotation] In Taiyang Zhongye (Summerheat in Taiyang Meridian), fever, heaviness, and pain indicate summerheat damaging the形体 (Form/Body); a weak or faint pulse indicates summerheat damaging Qi. Based on these symptoms and pulse, this condition arises when a person, during summer heat, enjoys cool breezes and drinks excessive cold water. Water qi circulates in the skin, the exterior is constrained by pathogens, and sweating is inhibited. At this time, Xiangru Yin (Elsholtzia Decoction) or Da Shun San (Great Harmony Powder) should be administered to induce sweating for immediate recovery. If neglected, water qi cannot escape externally, leading to edema, and inevitably attacks internally, causing wheezing and distension. Then, Tingli Dazao Tang (Lepidii Seed and Jujube Decoction) or Goudi Yi Wu San (Melon Trichosanthes Single-Ingredient Powder) should be used to purge. The previous clause warns against diaphoresis and purgation; this clause indicates when they are appropriate. Zhang Zhongjing's methods often follow this pattern, fearing rigid adherence leads to error.
[Collected Annotations] Fang Youzhi stated: Fever, heaviness, and pain, attributed to summer cold water injury with water qi in the skin, occur because Earth governs muscles and dislikes dampness; water infiltrates Earth and evaporates. A weak or faint pulse indicates heat drying blood and depleting Qi. Drinking water in summer is normal; why is it termed injury? Because summer heat forces excessive drinking, or bathing in cold water causes summerheat to enter internally.
Zhang Lu stated: Regarding the three clauses on Ye (Summerheat): The first describes illness acquired through movement, Zhongye (Summerheat), belonging to external causes; the second describes illness acquired through stillness, also called Zhongye (Summerheat) but actually a Summerheat disease, belonging to internal causes; the third describes illness from heat injuring cold, a variant of Zhongye (Summerheat), belonging to neither internal nor external causes. They should not be conflated.
Cheng Yingmao stated: This shows that Zhongye (Summerheat) diseases generally have Yang Qi at the exterior while the Stomach is deficient and cold, causing fever, heaviness, pain, and a weak or faint pulse. Drinking cold water in summer causes interior Yin to stagnate exterior Yang, preventing water qi from venting and causing it to circulate in the skin, resulting in many such cases. This represents opening stagnation and promoting Yang, adding another dimension to the understanding of Ye (Summerheat).