（俞本。证下。有治字。是。）
论一首 脉证十二条（当作十六条。） 方十一首
太阳病。发热无汗。
太阳病。发热汗出。
按反恶寒。钱注竟属牵强。盖反。是而字讹。千金翼可以征焉。（千金翼。作而反恶寒。窃想反字。后人从本
经所补入。）不恶寒。诸注亦不确。巢源无不字。林亿等校伤寒论。及总病论。并既引证之。为是。要之此二证俱
有恶寒。惟须以无汗与汗出。为表实表虚之分。不系恶寒不恶寒也。栝蒌桂枝汤条曰。太阳病其证备。亦可以征。
又按赵氏曰。所谓柔痉者。非不强也。但刚痉强而有力。柔痉强而无力为异尔。此金鉴所本。又圣惠方曰。阳
痉即易瘥。阴痉即难瘥。又曰。柴胡散。治伤寒阴痉。闭目仰面。石膏散。治伤寒阳痉。通身热仰目。此解惑论所
本。先兄曰。曲礼刚日柔日。即阴阳之义。
太阳病。发热脉沉而细者。
按脉沉而细。徐钱以为痉病正脉。（然则细是紧细之细。非微细之细。）而痉之必难治。程鉴等以为痉见此脉者。
气少之候。故难治。
夫风病。下之则 。
按风病。犹言风家。不过与前条均言太阳病。
疮家。虽身疼痛。不可发汗。
按疮家。谓金疮家。（疮。古作创。说详于伤寒论述义中。）盖身疼痛。本麻黄汤所主。如金疮家。躯壳血乏。
纵得伤寒。倘发其汗。则筋脉益燥。遂为痉病也。此与破伤风之邪入自疮口者。其机稍异。
又按以上三条。言痉病所由。医通每处一方。非是。
病者。身热足寒。颈项强急。（原注 字。赵本不复。）
张锡驹曰。颈项强急。则不能转舒而动摇。故独头面摇也。成氏曰。卒口噤。皆不常噤也。有时而缓。
按此条诸证。皆是系于邪着筋脉。风热上扇之所致。诸注强为解事。不必然。又轩村宁熙曰。若发其汗以下十
七字。盖湿病中之文。今错在此也。此说似是。
暴腹胀大者。为欲解。
〔徐〕 家之脉。总不离于沉紧。今之伏弦。亦沉紧类耳。
按如故二字难解。王肯堂曰。此痉字。恐当作死字。非是。
夫 脉。按之紧如弦。
按转筋篇。转筋之为病。其人臂脚直。脉上下行微弦。
太阳病其证备。身体强KT KT 然。
〔徐〕太阳病其证备者。身热头痛汗出也。〔程〕太阳病其证备。言头痛项强。发热恶风寒具见也。
按太阳证备。尤引赵氏。其说近迂。徐程为稳。脉反沉迟者。与桂枝加芍药生姜人参新加汤证。殆同其辙。
又按栝蒌桂枝汤。为柔痉初治之方。先教谕别有痉病论。曰。刚痉表证。与葛根汤。入胃者。承气汤。柔痉表
证。与栝蒌桂枝汤。倘里气亦虚者。桂枝加附子汤。芍药甘草附子汤。真武汤。活人附术散。圣济附子散之属。理
所宜然。亡血产后。阳盛阴虚。或有不中与附子者。乃参归汤。人参建中汤。及景岳滋补数方。当采择而用焉。
又沈氏曰。有竹叶汤加附子。以治产后颈项强。乃阳虚湿盛之痉。此言不核。然其方可借为柔痉里虚之治。
栝蒌桂枝汤方（按三升下。似脱去滓二字。）
太阳病。无汗而小便反少。
按无汗则津液内多。小盒饭利。而反少者。以其人津燥之故。尤注谬矣。
为病。胸满口噤。卧不着席。
按千金方曰。诸反张。大人脊下容侧手。小儿容三指者。不可复治也。此庞氏所据。沈氏曰。大承气汤。或见
内实。原有疏解。非为攻下而设。尤氏曰。此痉病之属阳明瘀热者。然无燥实见证。自宜涤热。而勿荡实。乃不用
调胃。而用大承气者。岂病深热极。非此不能治欤。然曰可与。则犹有斟酌之意。用者慎之。朱氏曰。急与大承气。
以下其热实。则枳朴硝黄。未始非涤热生津除热之神品也。并与金鉴相发。
又按汪机医学原理曰。痉病。方书皆谓感受风湿而致。多用风药。予细详之。恐仍未备。当作气血内虚。外邪
干之所致。盖人百骸九窍。必本气血荣养。始能运动。观内经云。足得血而能步。掌得血而能握。目得血而能视等
文可见。盖筋脉无血荣养。则强直不能运动。痉病之证是也。但因有数者不同。是以有气虚不能引导津血。以养筋
脉而致者。有津血不足。无以荣养筋脉而致者。有因痰火塞窒经隧。以致津血不荣者。有因真元本虚。六淫之邪乘
袭。致血不荣养者。虽有数因不同。其于津血有亏。无以滋荣经脉则一。详先哲谓汗下过多。及病后产后。与大耗
精耗血之病。皆能作痉。其意可见。学人不可力执局方。专用风药而疗。在乎分因用药可也。以上汪说。盖辨痉之
非湿。此为蓝本。其见甚卓。惜强分头绪。稍属多事。如张介宾。专以内因论。似不熟绎经文者。则又逊于汪氏一
等矣。
又按柯氏曰。夫 之始也。本非正病。必夹杂于他病之中。此说殆佳。盖其人本有某故。而营血内乏。或外感
误治。而亡其津液。俱使邪火就燥。以着筋脉。遂为劲急也。太阳病发汗太多。风病误汗下。疮家过汗。皆是痉之
所因。而并产后发痉观之。则其非径得之者。可以见矣。其证必备表候。而冠以太阳病。则外邪所触而致者。亦可
以知矣。
太阳病。关节疼痛而烦。（玉函。脉经。细。作缓。活人书注曰。脉细者。非也。此名以下。徐。沈。朱。作
此名中湿。亦曰湿痹。其候云云。非是。）
按湿病有挟风寒者。今此证则纯于湿者。故举为湿病之首。先后篇所谓湿流关节。是也。（成氏既引此句以为
解。）此条。尤氏注甚核。盖湿邪不藉风寒。则更易濡滞。势必趣里。是以治法不事驱表。但利其小便。则外湿亦
随消除也。烦字。钱注为当。或以为心烦者误矣。大便反快句。诸注未妥。愚意快者。快调和平之谓。言小便不利
者。津液偏渗大肠。法当濡泻。而今湿邪壅闭。水气内郁。不敢漏泄。故使大便反如平也。（注家多以濡泻解快字。
然泻利数行。岂得云之快。且小便不利者。势必泻利。则不宜下反字。故知前注之非。）顾如此证。绸缪失治。必
变遍身浮肿。
又按成氏曰。痹。痛也。因其关节烦疼。而名曰湿痹。非香港脚之痹也。此说本于许氏说文。又魏氏曰。湿气不
孤行。必附于别气。非风则寒。今感人而关节疼痛。知附于寒者多。而为病于太阳者同也。非是。又黄仲理于此证
拟方曰。甘草附子汤。麻黄连翘赤小豆汤。并不确。
湿家之为病。一身尽疼。
〔尤〕湿外盛者。其阳必内郁。湿外盛为身疼。阳内郁则发热。热与湿合。交蒸互郁。则身色如熏黄。熏者。
如烟之熏。色黄而晦。湿气沉滞故也。若热黄则黄而明。所谓身黄如橘子色也。
按此证亦纯于湿者。郭氏补亡论曰。宜五苓散。然其病属外。殆是麻黄连轺赤小豆汤所宜也。（宜以伤寒论述
义湿热条相参。）
巢源风黄候曰。凡人先患风湿。复遇冷气相搏。则举身疼痛。发热而体黄也。又有风黄胆候。并是别证。
湿家。其人但头汗出。（胸上。赵。作胸中。）
〔尤〕寒湿居表。阳气不得外通。而但上越。为头汗出。〔朱〕背强恶寒者。以背皆阳经所主。为湿所痹也。〔魏〕
欲得被覆向火。恶寒之甚矣。
按此湿郁之甚者。医者误下。以为坏证。哕与小便不利。亦为下冷之验。胸满亦为上热之征。舌上如胎。注家
多于如字费解。然胎本苔字。以气液蒸酿。积于舌上。恰如苔藓之布铺地面。故云如苔。或省云舌上苔。后人改从
肉旁。而注家不知其本义。遂至牵凑为说。特成氏曰。使舌上生白苔滑也。其意可见焉。（或曰。说文。 。水衣
也。舌苔之苔。为 煤之 看。却觉衬着。说文。炱。灰炱煤也。段氏曰。通俗文云。积烟曰炱煤。玉篇云。炱煤。
烟尘也。盖舌苔自薄而浓。自白而黄而黑。有积烟之象。故以名之。一说。谓舌苔多因热而生。故从火为正者。凿
矣。）甲乙经。石门。一名丹田。在脐下二寸。任脉气所发。盖此所云。泛称下焦。与关元同例。（关元。见厥阴篇。
水气篇。妇人杂病篇。）太阳下编五苓散条曰。其人渴而口燥。烦。亦同语例。
湿家下之。额上汗出。
〔徐〕虽仲景有下之早则哕句。似乎太早不可。而后则可下也。不知此为头汗而表未解者。虑其有内入之事。
表邪内入。则可下矣。非言治湿可下也。
风湿相搏。一身尽疼痛。
按朱氏曰。以见此证宜桂枝加术汤。而非麻黄汤之任。值天阴两句。更示人因时变通意。此说不必。盖此条示
风湿取汗之例。不宜拟定一方。
此事难知曰。服解药而去沉困。只头痛目闷。是知湿去而风不去。则欲解也。若风去而湿不去则不解。何以然。
风则高。湿则下而入里也。按此说不了。
湿家病。身疼发热。面黄而喘。
成氏曰。病有浅深。证有中外。此则湿邪浅者也。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。是湿客于阳。而不客于阴也。湿家之脉当沉细。为湿气内流。脉大者阳也。则湿不内流。
而外在表也。又以自能饮食。胸腹别无满痞。为腹中和无病。知其湿气微浅。内药鼻中。以宣泄头中寒湿。
按本事方。载有本证治验二则。并用瓜蒂散。宜参。
湿家身烦疼。可与麻黄加术汤。
按此条。乃证以方略者也。今就其方考之。是风湿之属表实者。发热恶寒无汗。其脉浮紧。可推而知矣。故以
麻黄汤。发散郁邪。加术以驱表湿。此方之术。宜用苍术。非逐里湿也。盖仲景分风湿太阳病。以为三等。亦犹风
寒之例。又黎居士简易方。以此证为寒湿。恐不然。
麻黄加术汤方（类聚。甘草一两。）
病者一身尽疼。发热日晡所剧者。
按发热日晡所剧者。以湿为阴邪。故得阴时而加甚也。盖此证。湿邪滞着稍深。而其表则实。故于麻黄汤中。
增损以治之。亦犹伤寒有葛根汤之例。
风湿。脉浮身重。汗出恶风者。
按此风湿之表虚者。亦犹桂枝汤之例。故嫌麻黄之峻。其不用阳旦者。岂以芍药之涩乎。防己黄 汤。注家以
为实卫渗湿之剂。此殊不然。防己。皮水有防己茯苓汤。而陶隐居曰。是疗风水家要药尔。然则亦是系逐表湿之品。
黄。但黄 建中汤治里虚。其他如黄 桂枝五物汤。乌头汤。 芍桂酒汤。桂枝加黄 汤。皆用治湿着。盖托阳
排结。于濡滞之邪。适然相对矣。术之驱外湿。既如前述。况方后曰。服后当如虫行皮中。曰。令微汗瘥。则知此
方为风湿家解肌之治。而非渗利之剂也明矣。
防己黄 汤方（方后如冰。赵原刻。作犹冰。）
伤寒八九日。风湿相搏。
〔周〕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。
按风湿相搏句。当与八九日字易位看。金鉴本于沈氏。以为风湿之病。得之伤寒八九日。非是。
白术附子汤方
〔朱〕如冒状者。正气鼓动。水气亦随而动。正邪相搏。未得遽胜之象。所谓与术附并走也。
按此方亦系于发表。既详之伤寒论述义中。兹不复赘。
风湿相搏。骨节疼烦。
〔鉴〕汗出短气。恶风不欲去衣。皆风邪壅盛也。小便不利。湿内蓄也。〔尤〕此亦湿胜阳微之证。其治亦不
出助阳散湿之法。云得微汗则解者。非正发汗也。阳复而阴自解耳。
按伤寒表证。大端有二。曰太阳病。曰少阴病直中。顾湿家亦不过如此。盖其太阳证治。麻黄加术汤等条。是
已。如前条及此条。俱系表虚寒证。虽湿邪持久。犹是少阴直中之类。而桂枝附子汤。术附汤。甘草附子汤。亦犹
麻黄附子细辛甘草二汤。及附子汤之例矣。尤氏于治湿诸方有总义。殊欠核当。仍不录。
甘草附子汤方
圣济。附子汤。治中风四肢挛急。身体沉重。骨节烦疼。
即本方。姜枣同煎。
百一选方。史氏白术散。治腰痛。
于本方。去甘草。加芍药。
太阳中 。发热恶寒。（按数下之数字。非误即衍。）
〔赵〕注虽已解过治之失。于当救之道则未明。（按注。言成氏。）予尝思之。此证属阴阳俱虚。脉弦细者。阳
虚也。芤迟者。阴虚也。所以温针复损其阴。汗之复损其阳。此证惟宜甘药补正。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。
按柯氏曰。弦细芤迟。不得连读。言中暑夹寒之脉。或微弱。或弦细。或芤迟。皆是虚脉。盖细与芤不并见。
柯说为是。然此证虽阴阳俱虚。而暑邪 缘。津液乏燥。且热证亦见迟脉。则谓之夹寒。恐不为当。
活人书曰。问中暑何故洒然毛耸恶寒。答曰。经云。四时八风之中人也。因有寒暑。寒则皮肤急腠理闭。暑则
皮肤缓腠理开。开则洒然寒。闭则热而闷。近人多不明中暑。或作热病法治之。复用温热药。必致发黄斑出。更为
蓄血。尤宜戒之。
按先兄曰。郑玄易通卦验注。太阳脉。起足少指端。至前两板齿。云岐子伤寒保命集曰。口开前板齿干燥者。
(Shu's edition has the character "Zhi" (treatment) under "Zheng" (symptom), which is correct.)
One Treatise, Twelve Pulse and Symptom Sections (should be sixteen), Eleven Formulas.
Taiyang disease, fever, absence of sweating.
Taiyang disease, fever, with sweating.
Commentary: If read as "contrary aversion to cold," Qian Tianlai's annotation appears forced. Likely, "Fan" (contrary) is a corruption of "Er" (and). This can be verified by *Qianjin Yi Fang* (Supplement to the Thousand Golden Prescriptions). (*Qianjin Yi Fang* reads "Er Fan Ai Han" [and contrary aversion to cold]. I speculate that "Fan" was inserted later by someone following the text of *Shanghan Lun*. The reading "No aversion to cold" is also inaccurate according to various annotations. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* does not have the character "Bu" (no). Lin Yi and others, when collating *Shanghan Lun*, and *Zong Bing Lun*, both cited this proof, considering it correct. In summary, both these syndromes involve aversion to cold; the distinction between exterior excess and exterior deficiency lies solely in the presence or absence of sweating, not in the presence or absence of aversion to cold. The section on Gualou Guizhi Tang states: "Taiyang disease with all its symptoms present," which serves as further evidence.
Furthermore, Zhao stated that so-called Rou Jing (Soft Tetanus) is not without stiffness; the difference is that Gang Jing (Hard Tetanus) is stiff and forceful, whereas Rou Jing is stiff but weak. This is the basis for Wu Qian's *Yi Zong Jin Jian*. Also, *Shenghui Fang* states: Yang Jing is easy to cure, Yin Jing is difficult to cure. It also says: Chaihu San treats Shanghan Yin Jing, with symptoms of closed eyes and head tilted back; Shigao San treats Shanghan Yang Jing, with symptoms of whole-body heat and upward-looking eyes. This is the basis for the discussion resolving doubts. My elder brother said: "Gang days" and "Rou days" in *Qu Li* refer to the meaning of Yin and Yang.
Taiyang disease, fever, with pulse deep and fine.
Commentary: A deep and fine pulse, Xu Lingtai and Qian Huang consider to be the typical pulse for Jing disease. (However, here "fine" refers to tight-fine, not faint-fine.) And Jing disease presenting with this pulse is difficult to treat. Cheng Zhi et al. believe that seeing this pulse in Jing indicates a deficiency of Qi, hence it is difficult to treat.
In cases of Wind disease, if purgation is applied incorrectly, then...
Commentary: "Wind disease" here refers to "Wind family," merely stating Taiyang disease as in the previous section.
A patient with chronic sores (Chuang Jia), although experiencing body pain, must not undergo sweating therapy.
Commentary: "Chuang Jia" refers to patients with metal wounds. ("Chuang" anciently written as "Chuang," detailed in *Shanghan Lun Shuyi*). Body pain is primarily indicated for Mahuang Tang. For a patient with metal wounds, blood in the body shell is already depleted. Even if they contract Shanghan, inducing sweating would dry the sinews and vessels further, leading to Jing disease. This differs slightly in mechanism from wind entering through an open wound (Poshang Feng).
Furthermore, the above three sections discuss the causes of Jing disease. *YiTong*'s approach of prescribing one formula for each is incorrect.
The patient has body heat, cold feet, and stiffness/tightness in the neck and nape. (Original note: The character here is omitted in Zhao's edition.)
Zhang Xiju said: Stiffness in the neck and nape prevents turning and relaxing, causing only the head and face to tremble. Cheng Wuji said: Sudden jaw clenching (Kou Jin) means it is not constant; there are times of relaxation.
Commentary: All symptoms in this section result from pathogenic factors attaching to the sinews and vessels, caused by wind-heat rising. Various annotations force explanations unnecessarily. Xuan Cun Ningxi suggested that the seventeen characters starting with "If sweating is induced..." belong to the text on Dampness disease and were misplaced here. This view seems plausible.
Sudden abdominal distension indicates impending resolution.
[Xu] The pulse of Jing disease generally does not depart from deep-tight. The current hidden-stringy pulse is also a type of deep-tight.
Commentary: The phrase "as before" is hard to interpret. Wang Kentang said: This "Jing" character might be a corruption of "Si" (death), which is incorrect.
Regarding ... pulse, pressing it feels tight like a string.
Commentary: In the "Tendon Cramping" section, it is stated: In tendon cramping disease, the person's arms and legs are straight, and the pulse runs up and down, slightly stringy.
Taiyang disease with all symptoms present, body stiffness, feeling rigid/uncomfortable.
[Xu] Taiyang disease with all symptoms present refers to body heat, headache, and sweating. [Cheng] Taiyang disease with all symptoms present means headache, neck stiffness, fever, and aversion to wind-cold are all present.
Commentary: Regarding Taiyang symptoms being complete, Zhao's interpretation is somewhat pedantic; Xu and Cheng are more steady. A pulse that is contrary deep and slow corresponds closely to the syndrome treated by Guizhi Ji Shaoyao Shengjiang Renshen Xinjia Tang.
Furthermore, Gualou Guizhi Tang is the initial treatment formula for Soft Jing. My former tutor had a separate treatise on Jing disease, stating: For Gang Jing exterior syndrome, give Gegen Tang; if it enters the stomach, give Chengqi Tang. For Rou Jing exterior syndrome, give Gualou Guizhi Tang. If interior Qi is also deficient, give Guizhi Jia Fuzi Tang, Shaoyao Gancao Fuzi Tang, Zhenwu Tang, Huoren Fushu San, Shengji Fuzi San, etc., which is reasonable. For those with blood loss or postpartum, where Yang is excess and Yin is deficient, or where Fuzi is contraindicated, use Shenguui Tang, Renshen Jianzhong Tang, and several tonifying formulas from Zhang Jingyue, selecting as appropriate.
Also, Shen said: There is Zhuye Tang plus Fuzi used to treat postpartum neck stiffness, which is Jing due to Yang deficiency and dampness excess. This statement is not accurate. However, the formula can be borrowed for treating interior deficiency in Rou Jing.
Formula: Gualou Guizhi Tang (Note: Under "three sheng," the characters "Zi" [dregs] seem missing.)
Taiyang disease, no sweating, yet urine output is surprisingly low.
Commentary: No sweating implies fluids remain internally, so urination should be normal. The fact that it is low is due to the patient's fluid dryness. You's annotation is erroneous.
Developing Jing disease, chest fullness, jaw clenching, unable to lie flat (back arching off the bed).
Commentary: *Qianjin Fang* states: For all cases of opisthotonos, if an adult's back can accommodate a sideways hand, or a child's three fingers, it is incurable. This is what Pang Anshi relied upon. Shen said: Dachengqi Tang might see internal excess; originally intended for relief, not specifically for purgation. You said: This belongs to Yangming stagnant heat in Jing disease. However, without signs of dryness and excess, one should clear heat rather than purge excess. Why use Dachengqi Tang instead of Tiaoweichengqi Tang? Is it because the disease is deep and heat extreme, requiring this treatment? However, saying "may give" implies caution; users should be careful. Zhu said: Urgently give Dachengqi Tang to purge heat-excess; thus Zhishi, Houpo, Mangxiao, and Dahuang are indeed divine items for clearing heat, generating fluids, and removing heat. This complements *Yi Zong Jin Jian*.
Furthermore, Wang Ji in *Yixue Yuanli* stated: Jing disease is attributed to wind-dampness in medical books, often using wind-dispelling drugs. Upon careful examination, I fear this is incomplete. It should be considered as caused by internal deficiency of Qi and Blood, invaded by external pathogens. The hundred bones and nine orifices rely on Qi and Blood nourishment for movement. As seen in *Neijing*: "Feet walk when nourished by blood, palms grasp when nourished by blood, eyes see when nourished by blood." Without blood nourishment, sinews and vessels become stiff and immobile, which is Jing disease. However, causes vary: some due to Qi deficiency failing to guide fluids and blood to nourish sinews; some due to insufficient fluids and blood; some due to phlegm-fire blocking meridians preventing nourishment; some due to original deficiency allowing six excesses to invade, preventing blood nourishment. Despite different causes, the lack of fluids and blood to nourish meridians is consistent. Detailed examination of ancient sages' words shows that excessive sweating/purgation, post-illness/postpartum states, and diseases causing massive essence/blood loss can all induce Jing. Scholars must not rigidly adhere to standard formulas using only wind-dispelling drugs, but must differentiate causes and prescribe accordingly. Wang's theory distinguishes Jing from dampness, serving as a foundation with high insight, though overly segmented. Zhang Jiebin's exclusive focus on internal causes seems less familiar with textual analysis, ranking below Wang.
Furthermore, Ke Qin said: The onset of Jing is not a primary disease but always mixed with others. This is a good point. The person likely had prior conditions causing internal deficiency of Ying-Blood, or mistreatment of external contraction leading to fluid loss, causing pathogenic fire to attach to dryness and stiffen the sinews. Excessive sweating in Taiyang disease, mistaken sweating/purgation in Wind disease, excessive sweating in Chuang Jia are all causes of Jing. Observing postpartum Jing confirms it is not directly contracted. The presence of exterior symptoms labeled as Taiyang disease indicates it is triggered by external pathogens.
Taiyang disease, joint pain and vexation. (*Yuhan Jing*, *Maijing* read "Xi" (fine) as "Huan" (slow). *Huoren Shu* commentary says: Fine pulse is incorrect. Below this name, Xu, Shen, Zhu write "This name is Zhong Shi" [Contracting Dampness], also called Shi Bi, describing symptoms... Incorrect.)
Commentary: Dampness disease may involve wind-cold, but this case is purely dampness, hence listed first in Dampness disease. This corresponds to "Dampness flowing into joints" mentioned in earlier/later chapters. (Cheng Wuji cites this sentence for explanation.) You's annotation here is very accurate. Dampness, without wind-cold, becomes more stagnant and tends inward. Thus, treatment does not focus on dispersing exterior, but on promoting urination, eliminating exterior dampness along with it. Qian's annotation for "Vexation" is appropriate. Interpreting it as mental vexation is wrong. Regarding "Stool is surprisingly loose," annotations are unsatisfactory. My view: "Loose" means smooth/normal regulation. When urination is impaired, fluids leak into the large intestine, normally causing loose stools. But now dampness blocks and water qi stagnates internally, preventing leakage, so stool remains normal. (Annotators often explain "loose" as damp diarrhea, but frequent diarrhea cannot be called "loose/normal." Moreover, if urination is blocked, diarrhea is inevitable, making "surprisingly" inappropriate, proving previous notes wrong.) If neglected, this condition will lead to generalized edema.
Furthermore, Cheng Wuji said: Bi means pain. Named Shi Bi due to painful joints, not podagra-type Bi. Based on Xu Shen's *Shuowen*. Wei said: Dampness does not travel alone, attaching to other Qi, either wind or cold. Joint pain suggests attachment to cold, similar to Taiyang pathology. Incorrect. Huang Zhongli proposed formulas for this: Gancao Fuzi Tang, Mahuang Lianqiao Chixiaodou Tang, neither of which is accurate.
For Dampness patients, the disease manifests as whole-body pain.
[You] When dampness is abundant externally, Yang must be constrained internally. External damp abundance causes body pain; internal Yang constraint causes fever. Heat and dampness combine, steaming and郁stagnating, resulting in a yellowish complexion like smoked tobacco—yellow and dull, due to dampness heaviness. If heat-yellow, it is bright yellow, described as "body yellow like an orange peel."
Commentary: This is also purely dampness. Guo Yong's *Buwang Lun* suggests Wuling San. However, since the disease is exterior, Mahuang Lianyao Chixiaodou Tang is more suitable. (Refer to *Shanghan Lun Shuyi* Heat-Damp section.)
Chao Yuanfang's *Feng Huang Hou* (Wind Yellow Syndrome) states: Those who first suffer wind-damp, then encounter cold qi struggling against it, experience whole-body pain, fever, and yellowing. There is also Feng Huang Dan Hou, distinct syndromes.
Dampness patients, only sweating from the head. ("Chest upper," Zhao reads "Chest middle.")
[You] Cold-damp residing in exterior, Yang Qi cannot circulate outward, only rises upward, causing head sweating. [Zhu] Back stiffness and aversion to cold occur because the back is governed by Yang meridians, obstructed by dampness. [Wei] Desiring blankets and facing fire indicates severe aversion to cold.
Commentary: This is severe dampness constraint. Mistaken purgation by physicians leads to misdiagnosis of damaged syndrome. Hiccups and urinary difficulty are signs of cold from purgation. Chest fullness is a sign of upper heat. "Tongue coating like mold": Annotators struggle with "like." "Tai" originally meant "Tai" (moss/fungus). Due to vaporization of Qi and fluids accumulating on the tongue, resembling moss spreading on ground, hence "like moss" or shortened to "tongue moss." Later versions changed the radical to meat, and annotators, unaware of the original meaning, forced interpretations. Cheng Wuji said: Causing white slippery moss on the tongue. His intent is visible. (Some say: *Shuowen*, , is water clothing. Tongue moss comes from coal smoke imagery, fitting well. *Shuowen*, Tai, is ash/soot. Duan Yucai says: *Tongsu Wen* says accumulated smoke is Tai Mei. *Yupian* says Tai Mei is smoke dust. Tongue coating thickens from thin, turns white to yellow to black, resembling accumulated smoke, hence the name. Another view: Tongue coating arises mostly from heat, so the fire radical is correct—this is forced.) *Jiayi Jing*: Shimen, also named Dantian, two cun below umbilicus, origin of Ren Mai Qi. Here, "lower jiao" is used generally, analogous to Guanyuan. (Guanyuan seen in Jueyin, Shuiqi, Furen Zabing chapters.) *Shanghan Lun* Taiyang chapter Wuling San section: "Patient thirsty, dry mouth, vexed," uses similar linguistic examples.
Dampness patients subjected to purgation, sweating on forehead.
[Xu] Although Zhang Zhongjing said premature purgation causes hiccups, implying too early is bad, later purgation might be okay. Not realizing this is head sweating with unresolved exterior, worrying about internal invasion. Once exterior pathogen invades internally, purgation may be applicable. This does not mean dampness should be purged.
Wind and Dampness battling, whole-body pain.
Commentary: Zhu said: Gui Zhi Jia Zhu Tang is suitable, not Mahuang Tang. The lines about cloudy weather show flexibility according to time. This view is unnecessary. This section illustrates sweating for wind-damp, not prescribing a fixed formula.
*Cishi Nanzhi* states: After taking resolving medicine, heavy fatigue leaves, only headache and stuffy eyes remain, indicating dampness gone but wind remains, approaching resolution. If wind goes but dampness remains, no resolution. Why? Wind is high, dampness sinks and enters interior. Commentary: This explanation is unclear.
Dampness disease, body pain, fever, yellow face, and wheezing.
Cheng Wuji said: Diseases have depth, symptoms have interior/exterior. This is shallow dampness. Why? Dampness patients don't mention joint pain/vexation, but body pain, meaning dampness doesn't flow into joints but attacks muscle-surface. Don't mention fever/smoke-yellow, but fever/yellow face/wheezing, meaning dampness doesn't affect spleen but affects upper jiao. Yin receiving dampness makes it deep. Now headache, nasal congestion, vexation means dampness attacks Yang, not Yin. Dampness pulse should be deep-fine for internal flow. Large pulse is Yang, meaning dampness stays exterior. Ability to eat, no chest/abdominal fullness/stuffiness indicates harmonious abdomen, knowing dampness is slight/shallow. Administer medicine via nose to vent cold-damp in head.
Commentary: *Benshi Fang* records two treatments for this syndrome, both using Gouti San. Refer.
Dampness patients with body pain and vexation, may give Mahuang Jia Zhu Tang.
Commentary: This section matches syndrome with formula. Examining the formula, it suits wind-damp exterior excess: fever, aversion to cold, no sweating, floating-tight pulse. Thus, Mahuang Tang disperses trapped evil, adding Zhu to drive exterior dampness. Zhu in this formula should be Cang Zhu, not for driving interior dampness. Zhang Zhongjing classified wind-damp Taiyang disease into three levels, similar to wind-cold. Li Jushi's *Jianyi Fang* considers this cold-damp, likely incorrect.
Formula: Mahuang Jia Zhu Tang (*Leiju*: Gancao one liang.)
Patient with whole-body pain, fever worsening at dusk (Ri Bu Suo).
Commentary: Fever worsening at dusk occurs because dampness is Yin evil, exacerbating during Yin hours. This syndrome has slightly deeper dampness stagnation but exterior excess. Thus, modified Mahuang Tang treats it, similar to Gegen Tang in Shanghan.
Wind-damp, floating pulse, heavy body, sweating, aversion to wind.
Commentary: This is wind-damp exterior deficiency, analogous to Guizhi Tang. Hence, avoiding harsh Mahuang. Why not Yangdan Tang? Perhaps due to sour/astringent Shaoyao? Fangji Huangqi Tang, annotated as securing exterior and leaching dampness, is quite wrong. Fangji: Pi Shui has Fangji Fuling Tang. Tao Hongjing said: It is a key drug for Feng Shui families. Thus, it drives exterior dampness. Huangqi: Huangqi Jianzhong Tang treats interior deficiency. Others like Huangqi Guizhi Wuwu Tang, Wutou Tang, Shaoyao Guijiu Tang, Guizhi Jia Huangqi Tang all treat dampness adherence. They support Yang and resolve blockage, opposing stagnant pathogens. Zhu drives exterior dampness as previously stated. Furthermore, post-formula instructions say: After taking, feel like insects crawling in skin, indicating slight sweating resolves. Thus, this formula treats wind-damp by resolving muscle layer, clearly not a diuretic.
Formula: Fangji Huangqi Tang (Post-formula: Like ice. Zhao original print: Still like ice.)
Shanghan for eight or nine days, wind and dampness battling.
[Zhou] Eight or nine days of Shanghan is long. Not transmitting channels, not entering fu organs, due to persistent wind-damp.
Commentary: "Wind and dampness battling" should be read with "eight or nine days." *Yi Zong Jin Jian*, based on Shen, believes wind-damp disease results from Shanghan for eight or nine days. Incorrect.
Formula: Baizhu Fuzi Tang
[Zhu] Feeling like dizziness indicates Zheng Qi stirring, Water Qi moving with it, Zheng and Xie battling, not yet decisively won. So-called "moving together with Zhu and Fuzi."
Commentary: This formula also focuses on releasing exterior, detailed in *Shanghan Lun Shuyi*, not repeated here.
Wind and dampness battling, bone-joint pain and vexation.
[Jian] Sweating, shortness of breath, aversion to wind, unwillingness to remove clothes, all indicate abundant Wind Evil. Urinary difficulty indicates internal dampness accumulation. [You] This is also a syndrome of dampness excess and Yang micro-deficiency. Treatment involves assisting Yang and scattering dampness. Saying "slight sweating resolves" does not mean proper sweating; Yang recovers and Yin resolves naturally.
Commentary: Shanghan exterior syndromes mainly include Taiyang disease and Shaoyin direct transmission. Dampness patients are no exception. Taiyang treatments are covered in Mahuang Jia Zhu Tang etc. Previous and current sections are exterior deficiency-cold syndromes. Though dampness persists, akin to Shaoyin direct transmission. Guizhi Fuzi Tang, Shufu Tang, Gancao Fuzi Tang correspond to Mahuang Fuxi Xixin Gancao Two Decoctions and Fuzi Tang. You's general principles for dampness formulas lack accuracy, not recorded.
Formula: Gancao Fuzi Tang
*Shengji Zonglu*: Fuzi Tang treats stroke limb cramping, heavy body, bone-joint vexation.
Same formula, decocted with ginger and jujube.
*Bai Yi Xuan Fang*: Shi's Baizhu San treats lower back pain.
From this formula, remove Gancao, add Shaoyao.
Taiyang Zhong Yue (Heatstroke), fever and aversion to cold. (Note: Numbers below "Shu" are likely errors or interpolations.)
[Zhao] Annotation explains treatment errors but doesn't clarify rescue methods. (Note refers to Cheng.) I ponder: This syndrome involves dual deficiency of Yin and Yang. String-fine pulse indicates Yang deficiency. Hollow-slow pulse indicates Yin deficiency. Thus, warm needle damages Yin, sweating damages Yang. Only sweet-tonic drugs should be used to supplement Zheng and resolve heat. As *Ling Shu* states: When Yin and Yang are both insufficient, tonifying Yang exhausts Yin, tonifying Yang depletes Yin. Sweet drugs may be used, not harsh agents.
Commentary: Ke Qin said: String-fine, hollow-slow should not be read continuously. Pulse of heatstroke with cold may be weak, string-fine, or hollow-slow, all deficiency pulses. Fine and hollow do not appear together. Ke is correct. However, although dual deficiency exists, summerheat flares, fluids dry, and heat syndromes can show slow pulse. Calling it "with cold" is questionable.
*Huoren Shu* asks: Why does heatstroke cause sudden chills and hair standing? Answer: Classics state four seasons and eight winds enter humans due to cold and heat. Cold makes skin tight and pores close; heat makes skin loose and pores open. Open pores cause sudden chill; closed pores cause heat and stuffiness. Modern people misunderstand heatstroke, treating as heat disease with warm-hot drugs, inevitably causing yellow spots and blood stasis. Especially beware.
Commentary: Elder brother said: Zheng Xuan's *YiTong Gua Yan* annotation: Taiyang pulse starts at little toe end, reaches front two incisors. Yunqizi *Shanghan Baoming Ji* says: Mouth open, front incisors dry...