损其津液。故致哕而胸满小便不利。下后里虚。上焦阳气因虚而陷于下焦。为
丹田有热。表中寒乘。而入于胸中。胸中有寒。故使舌上生白苔滑。藏燥则欲饮
水。以胸中客寒湿故不能饮。而但口燥烦也。
湿家下之。额上汗出。微喘。小便利（一云不利）者死。若下利不止者亦死。
〔衍义〕伤寒论注曰。本是后条湿家身烦疼。可与麻黄加术四两发其汗。妄下之。
因致此逆。盖逆则真阳自上越。阴自下脱。其额上汗出微喘者。阳之越。小便利
与下利不止者。阴之脱也。阴阳离决。必死之兆也。自此而推之。下之虽额上汗
出微喘。若大小便不利者。是阴气不退。而阳之根犹在也。下之虽大小便利。若
额上无汗出与喘。是阳气不越。而阴之根犹在也。则非离决。可以随其虚而救
之。
风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不止。医云。此可发汗。汗之病不
愈者。何也。盖发其汗。汗大出者。但风气去。湿气在。是故不愈也。若治风湿者。发其
汗。但微微似欲汗出者。风湿俱去也。
〔衍义〕按伤寒论注是条。曰。值天阴雨不止。明其湿胜也。内经曰。阳受风寒。阴受
湿气。又云。伤于风者。上先受之。伤于湿者。下先受之。风湿相搏。则风在外而湿
在内。汗大出者。其气暴。暴则外邪出而里邪不能出。故风去而湿在。汗微微而
出者。其气缓。缓则内外之邪皆出。故风湿俱去也。
湿家病。身疼。发热。面黄而喘。头痛。鼻塞而烦。其脉大。自能饮食。腹中和无病。病在
头中寒湿。故鼻塞。内药鼻中则愈。（脉经云病患喘而无湿家病以下至而喘十三字）
〔衍义〕按伤寒论是条。注曰。病有浅深。症有内外。此则湿气浅者也。何以言之。湿
家不云关节烦疼。而云身上疼痛。是湿气不流关节。而外客肌表也。不云发热
身似熏黄。复云发热面黄而喘。是湿不干于脾。而薄于上焦也。阴受湿气。则湿
邪为深。今头痛鼻塞而烦。是湿邪客于阳而不客于阴也。湿家之脉沉细。为湿
内流。今脉大者。是湿不内流而在表也。又以自能饮食。胸腹别无满痞。为腹中
和无病。知其湿气微。但内药鼻中。以宣通头中寒湿。是注其理明且尽矣。若夫
脉经之无身上疼痛十三字。岂无其说乎。头痛鼻塞。其痛在头。身上疼痛发热。
其病在经脉。内药鼻中者。为去头中寒湿。故减十三字尔。然则三阳经皆上于
头。太阳与阳明。俱到鼻 。今头上寒湿。而鼻为之塞也。则二经脉皆不通。郁而
发热。身无疼痛。内药鼻中。头上之湿散。则二阳之经脉行。而病可尽愈矣。
湿家身烦疼。可与麻黄加术汤发其汗。慎不可以火攻之。
麻黄加术汤方
麻黄（二两去节） 桂枝（二两去皮） 甘草（一两炙） 杏仁（七十个去皮尖） 白术（四两）
上五味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取二升半。去滓。温服八合。覆取微似汗。
〔衍义〕此为气湿之邪。盖邪者湿与寒合。故令人身疼。大法。表实成热。则可发汗。
无热是阳气尚微。汗之恐虚其表。今是症虽不云发热。而烦已生。烦由热也。所
以服药不敢大发其汗。且湿亦非暴汗可散。故用麻黄汤治寒。加术去湿。使其
微汗尔。然湿邪在表者。惟可汗之。不可火攻。火攻则增其热。必有发痉之变。所以戒人慎之。
病者一身尽疼。发热。日晡所剧者。名风湿。此病伤于汗出当风。或久伤取冷水所
致也。可与麻黄杏仁薏苡甘草汤。
麻黄杏仁薏苡甘草汤方
麻黄（去节半两汤泡） 甘草（一两炙） 薏苡仁（半两） 杏仁（十个去皮尖炒）
上锉麻豆大。每服四钱。水一盏半。煮八分。去滓。温服。有微汗避风。
〔衍义〕按伤寒论注曰。身尽疼痛。湿也。发热日晡所剧者。风也。若汗出当风而得
之者。则先客热而后感风。若久伤取冷得之者。则先伤风而后中湿。注文若是。
其谓日晡所剧为风者。则义未了。予按内经太阴阳明论曰。太阴阳明为表里。
脾胃脉也。外合肌肉。故阳受风气。阴受湿气。所以风湿客之。则一身肌内尽痛。
夫阳气者。一日而主外。平旦阳气生。属少阳。日中阳气隆。属太阳。日西气门内
闭。属阳明。是故阳明之气。主乎申酉。所以日晡所剧也。方用麻黄治寒湿取汗
为主。杏仁利气。薏苡仁除风热湿痹为臣。甘草和脾胃解肌肉为使。
风湿。脉浮身重。汗出恶风者。防己黄 汤主之。
防己黄 汤方
防己（一两） 甘草（半两炒） 白术（七钱五分） 黄 （一两一分去芦）
上锉麻豆大。每抄五钱匕。生姜四片。大枣一枚。水盏半。煎八分。去滓。温服。良久
再服。喘者加麻黄半两。胃中不和者。加芍药三分。气上冲者。加桂枝三
分。下有陈寒者。加细辛三分。服后当如虫行皮中。从腰下如冰。后坐被上。
又以一被绕腰下。温令微汗瘥。
〔衍义〕此症风湿。皆从表受之。其病在外。故脉浮汗出。凡身重有肌肉痿而重者。
有骨痿而重者。此之身重。乃风湿在表。故不作疼。虚其卫气而湿着为身重。由
是以黄 实卫。甘草佐之。防己去湿。白术佐之。然则风湿二邪。独无散风之药
何耶。盖汗多知其风已不留。以表虚而风出入乎其间。因之恶风尔。惟实其卫。
正气壮则风自退。此不治而治者也。若其有喘者。湿中兼寒也。则加麻黄以散
之。若风内应肝木。伤其胃中不和者。则加芍药以泻之。芍药味酸。能自土中泻
木。若气上冲者。则加桂枝以散其逆。若下有陈寒者。谓下焦肝肾之分。则加细
辛以温之。细辛散里之表药也。服后云云者。方中令作一段。然考之当在下有
陈寒加细辛之后。连为一段。何则细辛佐防己去寒湿。黄 实表。表尚全实。则
湿不退。所以皮中如虫行。表实未全。则阳气未周。于是从腰以下。其陈寒者犹
得如冰。必以被令温。助接其阳。使之微汗。
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。若大便坚。小便自利者。去桂加白术汤主之。
桂枝附子汤方
桂枝（四两去皮） 生姜（三两切） 附子（三枚炮去皮破八片） 甘草（二两炙） 大枣（十二枚擘）
上五味以水三升。煮取一升。去渣分温三服。
白术附子汤方
白术（二两） 附子（一枚半炮去皮） 甘草（一两炙） 生姜（一两半切） 大枣（六枚）
上五味。以水三升。煮取一升。去滓。分温三服。一服觉身痹。半日许再服。三服都
尽。其人如 状。勿怪。即是术附并走皮中。逐水气未得除故尔。
〔衍义〕按是症亦出伤寒论。其注曰。伤寒与中风。至八九日。邪气多在里。必不苦
疼痛。今日数多。复身体疼烦不能自转侧者。风湿相搏也。烦者风也。身疼不能
自转侧者湿也。脉浮虚为风。涩为寒湿也。不渴不呕。里无邪也。风湿俱在经也。
与桂枝附子汤。以桂枝散表之风。附子逐经中之湿。小便利。大便坚。为津液之
不足。桂枝发汗。走津液。故去之而加白术。虽然。自病而察药。自药而察病。因知
身之不能自转侧者。非惟湿邪所致也。亦为阳气不充。筋脉无养。故动之不能
也。欲去阳气不充之湿者。必以辛热气味之药。则可补其阳而逐其湿。与治伤
寒同法。是症之用附子者殆此欤。于是虽大便坚而不为微结者亦用之。如后
条身疼不能屈伸。用附子甘草汤治者。亦此意。不然身疼脉浮。为病在经。又不
言其有汗。必取汗而解。乃云其服药如 者。得非阳虚不胜夫邪药之相逐而然欤。
〔补注〕伤寒至八九日。亦云久矣。既不传经。复不入腑者。因风湿持之也。所显外
症烦疼者。风也。不能转侧者。湿也。不呕不渴者。无里症也。其脉浮虚而涩。正与
相应。然后知风湿之邪在肌肉。而不在筋节。故以桂枝表之。不发热为阳气素
虚。故以附子逐湿。两相绾合。自不能留矣。然在经曰。伤于湿者。必小便不利。大
便反快。今其人与此相反者。知膀胱之气化无伤。而胃腑之津液已耗也。又安
取于桂枝之散布乎。加白术者。所以安胃也。然白术性燥。仲景何以复燥其结
耶。殊不知内已结者。邪入必易。况外无热症。必湿多风少可知矣。设湿气内入。
将有初硬后溏之虑。故用术草以和中气。仍姜附以驱外邪。略转易间。便是因
人而施之大道也。然则人病何常。精神不等。仲景又何能逐一以相告耶。
风湿相搏。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。
甘草附子汤方
甘草（二两炙） 附子（二枚炮去皮） 白术（二两） 桂枝（四两去皮）
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。食。汗
出复烦者。服五合。恐一升多者。服六七合为妙。
〔衍义〕此亦出伤寒论。其注曰。风则伤卫。湿流关节。风湿相搏。而邪乱经。故骨节
疼烦掣痛。不得屈伸。近之则痛剧也。风胜则卫气不固。汗出短气。恶风不欲去
衣为在表。湿胜则水气不行。小便不利。或身微肿。为湿外薄也。此汤散湿温经
固卫。观夫此方与前意同。但此不用姜枣。为汗出更不发之。白术以去湿取汗。益短气也。
〔补注〕此条方是风行于皮毛关节之间。湿流于腠理筋骨之际。阻遏正气。不令
宣通。遂致痛不可近。不得屈伸。此其征也。汗出短气。恶风不欲去衣。邪风袭入
而中卫之正气俱虚也。小便不利。身微肿者。中外为湿所持。而膀胱之化不行
也。安得不以甘术和中。桂附去邪耶。然此症较前条更重。且里已受伤。曷为反
减去附子耶。前条风湿尚在外。在外者利其速去。此条风湿半入里。入里者妙
在缓攻。仲景正恐附子多则性猛且急。骨节之窍未必骤开。风湿之邪岂能托
出。徒使汗大出而邪不尽尔。君甘草者。欲其缓也。和中之力短。恋药之用长也。
此仲景所以前条用附子三枚者。分三服。此条只二枚者。初服五合。恐一升为
多。宜服六七合。全是不欲尽剂之意。学人于仲景书有未解。即于本文中求之。自得矣。
太阳中 。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。若发其汗。则恶寒甚。加温针。则发热甚。数下之。则淋甚。
〔衍义〕按是症亦出伤寒论。其注曰。病有在表。有在里。有表里俱病者。发热恶寒
身重疼痛者。表中 也。脉弦细芤迟者。中暑脉虚也。小便已。洒洒毛耸。手足逆
冷者。太阳经气不足也。小有劳。身即热者。谓劳其阳气而 即发也。口开前板
齿燥者。里有湿也。口开为喘喝也。以喘喝不止。故前板齿干燥。若发汗以去表
邪。则外虚阳气。故恶寒甚。若以温针助阳。则火热内攻。故发热甚。若下之以除
里热。则内虚而膀胱燥。故淋甚。注虽已解过治之失。于当救之道则未明。予尝
思之。此症属阴阳俱虚。脉弦细者。阳虚也。芤迟者。阴虚也。所以温针复损其阴
汗之复伤其阳。此症惟宜甘药补正。以解其热尔。即灵枢所谓阴阳俱不足。补
阳则阴竭。补阴则阳脱。可将以甘药。不可饮以刚剂。
太阳中热者。 是也。汗出恶寒。身热而渴。白虎加人参汤主之。
白虎加人参汤方
知母（六两） 石膏（一斤碎） 甘草（一两） 粳米（六合） 人参（三两）
上五味。以水一斗。煮米熟汤成。去滓。温服一升。日三服。
〔衍义〕此症亦出伤寒论。其注云。汗出恶寒身热而不渴者。中风也。汗出恶寒而
渴者。中 也。然而未有明其至理者。盖此但言中风初得表症。与自汗出身热
恶寒相似。独以渴不渴为辨尔。吁岂谓中风终无渴者耶。若伤寒中风。则皆有
背微寒。与时时恶风而渴者矣。亦以白虎人参汤治之乎。夫此症汗出恶寒。身
热而渴。岂不与彼证所同者哉。盖此证为令火之气酷其金。肺主气者也。肺伤
则卫气虚。然太阳膀胱。属水主表。肺金之子也。母虚而子亦不足。卫虚表不足。
由是汗出身热恶寒。内经曰。心移热于肺。传为膈消。膈消则渴也。皆相火伤脉之所
致。此可知其要在救肺也。石膏虽能除三焦火热。然仲景名白虎者。为石
膏功独多于清肺。退肺中之火。是用为君。知母亦就肺中泻心火。滋水之源。人
参生津。益所伤之气而为臣。粳米、甘草补土。以资金为佐也。
太阳中 。身热疼重。而脉微弱。此以夏月伤冷水。水行皮中所致也。一物瓜蒂汤主之。
一物瓜蒂汤方
瓜蒂（二十个）
上锉。以水一升。煮取五合。去滓。顿服。
〔衍义〕此证尝见伤寒注云。脉虚身热。得之伤暑。身热脉微弱者。 也。身体疼痛者。
水也。夏得暑热。以水灌洗而得之。一物瓜蒂散服之。尝观仲景 病。惟出三
证。岂偶然哉。举其端。将为后世准绳。一者明其表里俱虚。一者言其 中表之
Damage to body fluids leads to hiccups, chest fullness, and difficulty in urination. After purgation, the interior becomes deficient; the Yang Qi of the Upper Jiao sinks into the Lower Jiao due to deficiency, creating heat in the Dantian (lower abdomen). Meanwhile, cold from the exterior takes advantage of this weakness and enters the chest, causing cold in the chest. Consequently, a white, slippery coating appears on the tongue. Dryness in the Zang organs creates thirst, but because of the pathogenic cold-dampness lodged in the chest, drinking is impossible, resulting only in dry mouth and irritability.
If a patient with dampness is incorrectly treated with purgation, and symptoms such as sweating on the forehead, slight shortness of breath, and free urination (or alternatively, difficulty in urination) appear, it indicates a fatal condition. If diarrhea persists without stopping, it is also fatal.
[Commentary] The commentary on the *Treatise on Cold Damage* states: Originally, in a later section regarding "a person with dampness suffering from painful restlessness," Mahuang Jia Zhu Tang (Cinnamon Twig and Atractylodes Decoction) should be used to induce sweating. Incorrect purgation here leads to these adverse reactions. This is because purgation causes the True Yang to escape from above and Yin fluids to leak from below. Sweating on the forehead with slight shortness of breath indicates the escaping of Yang; free urination and persistent diarrhea indicate the depletion of Yin. Separation of Yin and Yang is a sign of certain death. From this, we can infer: although purgation leads to sweating on the forehead and slight shortness of breath, if both stool and urine are difficult to pass, it means Yin has not retreated and the root of Yang remains. Although purgation leads to free urination and stool, if there is no sweating on the forehead or shortness of breath, it means Yang has not escaped and the root of Yin remains. In such cases, it is not separation of Yin and Yang, and treatment can be administered according to the specific deficiency.
When Wind-Dampness combats each other, the whole body aches. According to the principles, sweating should resolve the condition. However, if it rains continuously, and the physician says, "Sweating can be induced," but the disease does not improve after sweating, why is this? Because excessive sweating expels only the Wind pathogen while Dampness remains, hence the lack of improvement. To treat Wind-Dampness, sweating should be mild, with a slight moisture appearing on the skin, so that both Wind and Dampness are expelled together.
[Commentary] The commentary on the *Treatise on Cold Damage* notes: Continuous rain indicates an excess of Dampness. The *Nei Jing* states: "Yang is affected by Wind and Cold; Yin is affected by Dampness." It also says: "Those injured by Wind are first affected above; those injured by Dampness are first affected below." When Wind-Dampness combats, Wind is at the exterior and Dampness is at the interior. Excessive sweating is violent; violence allows external pathogens to exit but prevents internal pathogens from exiting, so Wind leaves while Dampness remains. Mild sweating is gentle; gentleness allows both internal and external pathogens to exit, so both Wind and Dampness are expelled.
A person with dampness suffers from body ache, fever, yellowish complexion, and wheezing; headache, nasal congestion, and irritability; with a large pulse. They can eat normally, and the abdomen is harmonious and free of disease. The pathology lies in Cold-Dampness in the head, causing nasal congestion. Administering medicine into the nose will cure it. (*Mai Jing* records patient wheezing but omits the thirteen characters from "person with dampness" to "wheezing").
[Commentary] The commentary on this section of the *Treatise on Cold Damage* explains: Diseases have depth, and symptoms have location. This is a case of shallow Dampness. Why? Because it mentions body ache rather than joint pain, indicating Dampness has not flowed into joints but resides on the muscle surface. It mentions fever, yellow face, and wheezing rather than fever and yellow like smoked pigment, indicating Dampness does not affect the Spleen but presses upon the Upper Jiao. Yin is affected by Dampness, making Dampness deep. Here, headache, nasal congestion, and irritability show Dampness affects Yang channels, not Yin. Dampness typically presents with a deep, fine pulse due to internal flow; a large pulse indicates Dampness is not internal but at the exterior. Normal diet and absence of chest/abdominal distension confirm abdominal harmony and light Dampness. Thus, administering medicine into the nose to ventilate Cold-Dampness in the head is clear and thorough reasoning. Regarding the omission of "body ache" in *Mai Jing*: Headache and nasal congestion indicate pain in the head; body ache and fever indicate pathology in the meridians. Nasal administration targets Cold-Dampness in the head, explaining the omission. Since all three Yang meridians ascend to the head, and Taiyang and Yangming reach the nose, Cold-Dampness in the head blocks these meridians, causing stagnation, fever, and nasal congestion. Nasal medication disperses head Dampness, allowing the two Yang meridians to flow freely, curing the disease.
For a person with dampness suffering from painful restlessness, Mahuang Jia Zhu Tang (Ephedra, Cinnamon Twig, and Atractylodes Decoction) may be used to induce sweating. Fire therapy must be strictly avoided.
Mahuang Jia Zhu Tang Formula
Ephedrae Herba (Mahuang, 麻黄) - 2 liang, nodes removed
Cinnamomi Ramulus (Guizhi, 桂枝) - 2 liang, bark removed
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang, honey-fried
Pruni Semen (Xingren, 杏仁) - 70 seeds, skin and tips removed
Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) - 4 liang
Combine the five ingredients. Boil in 9 sheng of water, first boiling Ephedra until reduced by 2 sheng, skimming off foam. Add remaining herbs, boil to obtain 2.5 sheng, strain, and take 8 ge warm. Cover to induce slight sweating.
[Commentary] This involves Qi-Dampness pathogen. Pathogens combine Dampness and Cold, causing body ache. Generally, if exterior excess generates heat, sweating is indicated. Without heat, Yang is weak, and sweating risks further deficiency. Although fever isn't mentioned, irritability implies heat. Thus, heavy sweating is avoided. Dampness cannot be scattered by profuse sweating. Therefore, Mahuang Tang treats Cold, adding Atractylodes to remove Dampness, inducing mild sweating. Exterior Dampness requires sweating, not fire therapy. Fire therapy increases heat and risks spasms (Jing), so caution is advised.
A patient suffers from whole-body pain, fever, worsening in the late afternoon (Ri Wu), named Wind-Dampness. This results from sweating and exposure to wind, or prolonged injury from cold water. Mahuang Xingyi Gancao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) is indicated.
Mahuang Xingyi Gancao Tang Formula
Ephedrae Herba (Mahuang, 麻黄) - 0.5 liang, nodes removed, soaked in hot water
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang, honey-fried
Coicis Semen (Yiyiren, 薏苡仁) - 0.5 liang
Pruni Semen (Xingren, 杏仁) - 10 seeds, skin and tips removed, stir-fried
Crush to size of hemp seeds. Take 4 qian per dose. Boil in 1.5 chong of water until reduced to 0.8 chong. Strain and take warm. Ensure mild sweating and avoid wind.
[Commentary] The commentary states: Whole-body pain is Dampness; fever worsening in the late afternoon is Wind. If caused by sweating and wind, Heat arrives first, then Wind. If caused by cold water, Wind arrives first, then Dampness. The idea that late-afternoon worsening indicates Wind is incomplete. The *Nei Jing* states: Taiyin and Yangming are interior-exterior pairs, governing Spleen and Stomach, associated with muscles. Yang receives Wind, Yin receives Dampness. Wind-Dampness invasion causes whole-body muscle pain. Yang Qi governs the exterior daily: Shao Yang at dawn, Taiyang at noon, Yangming at dusk (Shen-You hours). Thus, worsening in the late afternoon relates to Yangming. Ephedra is sovereign for inducing sweat to treat Cold-Dampness; Apricot Kernel is minister for moving Qi and removing Wind-Heat-Dampness Bi; Licorice is envoy for harmonizing Spleen/Stomach and relieving muscle tension.
In Wind-Dampness, with floating pulse, heavy body, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is the primary treatment.
Fangji Huangqi Tang Formula
Stephaniae Tetrandrae Radix (Fangji, 防己) - 1 liang
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 0.5 liang, stir-fried
Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) - 0.75 liang
Astragali Radix (Huangqi, 黄芪) - 1.1 liang, radix tips removed
Crush to size of hemp seeds. Take 5 qian bi per dose with 4 slices of fresh ginger and one jujube. Boil in 1.5 chong of water until reduced to 0.8 chong. Strain and take warm. Repeat after some time. For wheezing, add 0.5 liang Ephedra. For stomach disharmony, add 0.3 liang Paeoniae Radix Alba. For rebellious Qi, add 0.3 liang Cinnamomi Ramulus. For chronic cold in the lower part, add 0.3 liang Asari Radix et Rhizoma. After taking, sensation of insects crawling under skin is expected. Waist-down feeling cold like ice is normal. Sit on blankets and wrap another around the waist to keep warm until slight sweating occurs, then recover.
[Commentary] This Wind-Dampness originates from the exterior. Floating pulse and sweating indicate exterior involvement. Heavy body without pain suggests Wind-Dampness at the exterior, not affecting joints. Deficiency of Wei Qi with Dampness sticking causes heaviness. Astragalus consolidates Wei Qi, assisted by Licorice; Stephania removes Dampness, assisted by Atractylodes. Why no Wind-dispersing herb? Profuse sweating indicates Wind has left; aversion to wind is due to exterior deficiency. Consolidating Wei Qi strengthens Zheng Qi, causing Wind to retreat spontaneously. For wheezing (Damp-Cold), add Ephedra. If Wind affects Liver Wood causing stomach disharmony, add Paeoniae Radix Alba to drain Wood via Earth. For rebellious Qi, add Cinnamomi Ramulus. For chronic cold in Lower Jiao (Liver/Kidney), add Asari Radix et Rhizoma to warm. Asari disperses interior-exterior Cold. The description of post-medication sensations follows the addition of Asari. Stephania and Asari remove Cold-Dampness; Astragalus consolidates exterior. If exterior is fully solid, Dampness doesn't retreat, causing crawling sensation. If exterior solidity is incomplete, Yang Qi doesn't circulate fully, causing coldness below the waist. Blankets assist Yang Qi to induce mild sweating.
After eight or nine days of Cold Damage, Wind-Dampness combats, causing painful restlessness, inability to turn over, no vomiting, no thirst, floating, deficient, and choppy pulse. Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is indicated. If stool is hard and urination is free, remove Cinnamon Twig and add Atractylodes (Baizhu Fuzi Tang).
Guizhi Fuzi Tang Formula
Cinnamomi Ramulus (Guizhi, 桂枝) - 4 liang, bark removed
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 3 liang, sliced
Aconiti Lateralis Radix Praeparata (Fuzi, 附子) - 3 pieces, processed, peeled, cut into eight pieces
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Ziziphi Jujubae Fructus (Dazao, 大枣) - 12 pieces, split
Boil five ingredients in 3 sheng of water until reduced to 1 sheng. Strain and divide into three warm doses.
Baizhu Fuzi Tang Formula
Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) - 2 liang
Aconiti Lateralis Radix Praeparata (Fuzi, 附子) - 1.5 pieces, processed, peeled
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang, honey-fried
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1.5 liang, sliced
Ziziphi Jujubae Fructus (Dazao, 大枣) - 6 pieces
Boil five ingredients in 3 sheng of water until reduced to 1 sheng. Strain and divide into three warm doses. After the first dose, numbness may occur. Take the second dose after half a day. Finish all three doses. The patient may feel like having wind-stroke; do not be alarmed. This is Baizhu and Fuzi moving in the skin, expelling Water Qi which has not yet been fully removed.
[Commentary] This symptom also appears in the *Treatise on Cold Damage*. Commentary notes: By day 8-9, pathogens usually enter the interior, so pain shouldn't be severe. Persistent pain and inability to turn indicate Wind-Dampness combat. Restlessness is Wind; pain/inability to move is Dampness. Floating-deficient pulse indicates Wind; choppy indicates Cold-Dampness. No thirst/vomiting means no interior pathogen; Wind-Dampness is in the meridians. Guizhi Fuzi Tang uses Cinnamon Twig to disperse exterior Wind and Aconite to expel interior Dampness. Hard stool and free urination indicate fluid deficiency. Cinnamon Twig induces sweating and consumes fluids, so it is removed and replaced with Atractylodes. Observing the pathology and prescription reveals that inability to move is not just Dampness, but also insufficient Yang Qi failing to nourish sinews. To treat Dampness caused by Yang deficiency, acrid-hot herbs are needed to tonify Yang and expel Dampness, similar to Cold Damage treatment. Aconite is used here for this purpose. Even with hard stool, it's not considered constipation requiring harsh purgation. Similarly, in later cases of pain and immobility, Aconite Licorice Decoction is used for the same reason. The sensation of numbness after taking the medicine suggests Yang deficiency struggling against the strong herbs, driving out pathogens.
[Supplementary Note] Eight or nine days of Cold Damage is long. No transmission or fu-organ involvement indicates Wind-Dampness retention. Pain/restlessness is Wind; immobility is Dampness. No vomiting/thirst confirms no interior syndrome. Floating-deficient-choppy pulse matches this. Wind-Dampness is in muscles, not sinews/joints. Cinnamon Twig releases the exterior. Lack of fever indicates inherent Yang deficiency, so Aconite expels Dampness. Their combination prevents retention. The *Nei Jing* states dampness causes difficult urination and loose stools. Here, the opposite occurs, indicating Bladder Qi transformation is intact but Stomach fluids are depleted. Cinnamon Twig's spreading action is unnecessary. Atractylodes stabilizes the Stomach. Although Atractylodes is drying, it prevents internal binding of pathogens. External lack of heat confirms more Dampness than Wind. If Dampness enters internally, initial hard then loose stools might occur. Atractylodes and Licorice harmonize Qi; Ginger and Aconite drive out exterior pathogens. This illustrates individualized treatment. Disease varies by constitution; Zhang Zhongjing could not detail every case.
Wind-Dampness combats, causing joint pain, restlessness, pulling pain, inability to flex/extend, severe pain on touch, sweating, shortness of breath, difficult urination, aversion to wind with desire to keep clothes on, or slight swelling. Gancao Fuzi Tang (Licorice and Aconite Decoction) is indicated.
Gancao Fuzi Tang Formula
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Aconiti Lateralis Radix Praeparata (Fuzi, 附子) - 2 pieces, processed, peeled
Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) - 2 liang
Cinnamomi Ramulus (Guizhi, 桂枝) - 4 liang, bark removed
Boil four ingredients in 6 sheng of water until reduced to 3 sheng. Strain and take 1 sheng warm, three times daily. Initial dose inducing mild sweating resolves the condition. If eating causes sweating and renewed irritability, take 0.5 sheng. If 1 sheng is too much, 0.6-0.7 sheng is optimal.
[Commentary] Also from the *Treatise on Cold Damage*. Commentary: Wind injures Wei Qi; Dampness flows into joints. Combat disrupts meridians, causing joint pain, pulling pain, immobility, and tenderness. Wind excess causes insecure Wei Qi, sweating, shortness of breath, and aversion to wind (exterior). Damp excess causes stagnant Water Qi, difficult urination, and slight swelling (exterior Dampness). This formula disperses Dampness, warms meridians, and consolidates Wei Qi. Unlike previous formulas, it lacks Ginger and Jujube to avoid further sweating. Atractylodes removes Dampness and induces sweating to help shortness of breath.
[Supplementary Note] Wind moves in skin/hair/joints; Dampness flows in interstices/sinews/bones, obstructing Zheng Qi, causing severe pain and immobility. Sweating, shortness of breath, and aversion to wind indicate Wei Qi deficiency from Wind invasion. Difficult urination and swelling indicate Dampness blocking Bladder transformation. Licorice and Atractylodes harmonize the middle; Cinnamon and Aconite expel pathogens. This case is heavier than the previous one, with interior involvement. Why reduce Aconite? Previous case was exterior, favoring rapid expulsion. This case is half-interior, favoring slow attack. Zhang Zhongjing feared excessive Aconite would be too fierce, failing to open joint pores and expel pathogens, causing profuse sweating without full recovery. Licorice slows the action. Harmonizing power is short; retaining medicinal effect is long. Previous case used 3 Aconite pieces divided into 3 doses; this case uses 2 pieces, starting with 0.5 sheng, max 0.7 sheng, avoiding complete dosage. Students should seek understanding within the text itself.
Taiyang Zhongshu (Heatstroke), with fever, aversion to cold, heavy body, and pain; pulse is string-taut, fine, hollow, and slow. After urination, chills with hair standing on end, cold hands and feet. Slight exertion causes fever. Mouth open, front teeth dry. If sweating is induced, aversion to cold worsens. If moxibustion/warm needle is added, fever worsens. If purged repeatedly, strangury worsens.
[Commentary] Also from the *Treatise on Cold Damage*. Commentary: Diseases can be exterior, interior, or both. Fever, aversion to cold, heavy pain indicate exterior Zhongshu. String-taut/fine/hollow/slow pulse indicates deficient pulse of Summerheat. Chills after urination and cold limbs indicate Taiyang channel Qi deficiency. Exertion triggering fever indicates damaging Yang Qi triggers Zhongshu. Open mouth and dry teeth indicate interior Dampness. Open mouth signifies panting; continuous panting dries front teeth. Sweating damages exterior Yang, worsening cold aversion. Warm needle adds fire, worsening fever. Purging damages interior, drying Bladder, worsening strangury. While commentary explains errors of mistreatment, it misses the correct rescue method. I believe this is simultaneous deficiency of Yin and Yang. String-taut/fine indicates Yang deficiency; hollow/slow indicates Yin deficiency. Warm needle damages Yin; sweating damages Yang. Only sweet-natured herbs should tonify Zheng Qi and resolve heat. As stated in *Ling Shu*: When Yin and Yang are both deficient, tonifying Yang exhausts Yin, tonifying Yin escapes Yang. Use sweet herbs, not rigid/pungent ones.
Taiyang Zhongre (Summerheat) is Zhongshu. Sweating, aversion to cold, fever, and thirst are present. Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is indicated.
Baihu Jia Renshen Tang Formula
Anemarrhenae Rhizoma (Zhimu, 知母) - 6 liang
Gypsum Fibrosum (Shigao, 石膏) - 1 jin, crushed
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang
Oryzae Fructus (Jingmi, 粳米) - 6 he
Panax Ginseng (Renshen, 人参) - 3 liang
Boil five ingredients in 1 dou of water until rice is cooked and soup is ready. Strain and take 1 sheng warm, three times daily.
[Commentary] Also from the *Treatise on Cold Damage*. Commentary: Sweating, aversion to cold, fever without thirst is Windstroke; with thirst is Zhongshu. However, the underlying principle is often unclear. It seems to distinguish early Windstroke exterior symptoms (similar to spontaneous sweating, fever, aversion to cold) solely by thirst. But does Windstroke never cause thirst? In Cold Damage/Windstroke, back chill and intermittent aversion to wind with thirst occur. Would White Tiger plus Ginseng Decoction be used? This case shares symptoms. The key is that seasonal Fire attacks Metal (Lung). Lung governs Qi; damage leads to Wei Qi deficiency. Taiyang Bladder (Water) is the child of Lung (Metal) and governs the exterior. Mother deficiency leads to child deficiency; Wei deficiency leads to exterior insufficiency, causing sweating, fever, and aversion to cold. *Nei Jing* states: Heart transferring heat to Lung causes Ge Xiao (Diaphragmatic Consumption), leading to thirst. This results from Minister Fire damaging vessels. The key is saving the Lung. Gypsum clears Sanjiao heat but specifically excels in clearing Lung heat, serving as Sovereign. Anemarrhena drains Heart Fire in the Lung and nourishes Water source. Ginseng generates fluids and benefits damaged Qi as Minister. Oryza and Licorice tonify Earth to support Metal as Assistants.
Taiyang Zhongshu, with fever, heavy pain, and weak pulse. This is caused by injuring cold water in summer, with water circulating in the skin. Yi Wu Gua Di Tang (Single Ingredient Trichosanthes Fruit Decoction) is indicated.
Yi Wu Gua Di Tang Formula
Trichosanthis Fructus (Gua Di, 瓜蒂) - 20 pieces
Crush. Boil in 1 sheng of water until reduced to 0.5 sheng. Strain and take in one dose.
[Commentary] Seen in *Cold Damage Commentary*: Deficient pulse and fever result from Summerheat injury. Fever with weak pulse is Zhongshu. Body pain is Water. Summer heat combined with cold washing causes this. Single ingredient Gua Di powder is taken. Zhang Zhongjing only presented three types of Zhongshu cases intentionally, setting standards for future generations. One clarifies exterior-interior deficiency; the other discusses...