太阳病。发热无汗。反恶寒者。名曰刚痉。太阳病。发热汗出而不恶寒。名曰柔痉。
成氏曰。千金云。太阳中风。重感寒湿则变痉。太阳病。发热无汗为表实。则不当恶寒。今反恶
寒者。则太阳中风。重感于寒。为痉病也。以其表实有寒。故曰刚痉。太阳病。发热汗出为表虚。则
当恶寒。今不恶寒
者。风邪变热。外伤筋脉为痉病也。以其表虚无寒。故曰柔痉。然痉者强也。其病在筋。故必兼有颈
项强急。头热足寒。目赤头摇。口噤背反等证。仲景不言者。以痉字该之也。活人书亦云。痉证发热
恶寒。与伤寒相似。但其脉沉迟弦细。而项背反张为异耳。
太阳病。发热。脉沉而细者。名曰痉。为难治。
太阳脉本浮。今反沉者。风得湿而伏。故为痉。痉脉本紧弦。今反细者。阴气适不足。故难治。
太阳病。发汗太多。因致痉。夫风病下之则痉。复发汗。必拘急。疮家虽身疼痛。不可发汗。汗
出则痉。此原痉病之由。有此三者之异。其为脱液伤津则一也。盖病有太阳风寒不解。重感寒湿而成
痉者。亦有亡血竭气。损伤阴阳。而病变成痉者。经云。气主 之。血主濡之。又云。阳气者。精则
养神。柔则养筋。阴阳既衰。筋脉失其濡养。而强直不柔矣。此痉病标本虚实之异。不可不辨也。
病者身热足寒。颈项强急。恶寒。时头热面赤目赤。独头动摇。卒口噤。背反张者。痉病也。若
发其汗者。寒湿相得。其表益虚。即恶寒甚。发其汗已。其脉如蛇。
痉病不离乎表。故身热恶寒。痉为风强病。而筋脉受之。故口噤、头项强、背反张、脉强直。经
云。诸暴强直。皆属于风也。头热足寒。面目赤。头动摇者。风为阳邪。其气上行而又主动也。寒湿
相得者。汗液之湿。与外寒之气。相得不解。而表气以汗而益虚。寒气得湿而转增。则恶寒甚也。其脉
如蛇者。脉伏而曲。如蛇行也。痉脉本直。汗之则风去而湿存。故脉不直而曲也。
暴腹胀大者为欲解。脉如故。反伏弦者痉。
此即上文风去湿存之变证。魏氏云。风去不与湿相丽。则湿邪无所依着。必顺其下坠之性。而入
腹作胀矣。风寒外解。而湿下行。所以为欲解也。如是诊之。其脉必浮而不沉。缓而不弦矣。乃其脉
如故。而反加伏弦。知其邪内连太阴。里病转增。而表病不除。乃痉病诸证中之一变也。
夫痉脉按之紧如弦。直上下行。
紧如弦。即坚直之象。李氏曰。上下行者。自寸至尺。皆见紧直之脉也。脉经亦云。痉病脉坚伏。
直上下行。痉病有灸疮。难治。
有灸疮者。脓血久溃。穴俞不闭。娄全善云。即破伤风之意。盖阴伤而不胜风热。阳伤而不任攻
伐也。故曰难治。
太阳病。其证备。身体强。KT KT 然。脉反沉迟。此为痉。栝蒌桂枝汤主之。
太阳证备者。赵氏谓太阳之脉。自足上行。循背至头项。此其所过之部。而为之状者。皆是其证
是也。KT KT 。背强连颈之貌。沉本痉之脉。迟非内寒。乃津液少而营卫之行不利也。伤寒项背强KT KT 。汗
出恶风者。脉必浮数。为邪风盛于表。此证身体强KT KT 然。脉反沉迟者。为风淫于外。而津伤于内。
故用桂枝则同。而一加葛根以助其散。一加栝蒌根兼滋其内。则不同也。
栝蒌桂枝汤方
栝蒌根（二两） 桂枝（三两） 芍药（三两） 甘草（二两） 生姜（三两） 大枣（十二枚）
上六味。以水九升。煮取三升。分温三服。微汗。汗不出。食顷。啜热粥发。
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。
无汗而小便反少者。风寒湿甚。与气相持。不得外达。亦并不下行也。不外达。不下行。势必逆
而上冲。为胸满。为口噤不得语。驯至面赤头摇。项背强直。所不待言。故曰欲作刚痉。葛根汤。即桂
枝汤加麻黄、葛根。乃刚痉无汗者之正法也。
按痉病多在太阳、阳明之交。身体强。口噤不得语。皆其验也。故加麻黄以发太阳之邪。加葛根
兼疏阳明之经。而阳明外主肌肉。内主津液。用葛根者。所以通隧谷而逐风湿。加栝蒌者。所以生津
液而濡经脉也。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂枝 甘草（炙） 芍药（各二两） 生姜（三两） 大枣
（十二枚）
上七味。以水一斗。先煮麻黄、葛根。减二升。去沫。内诸药。煮取三升。去滓。温服一升。覆
取微似汗。不须啜粥。余如桂枝汤法将息及禁忌。
痉为病。胸满口噤。卧不着席。脚挛急。必 齿。可与大承气汤。
此痉病之属阳明瘀热者。阳明之筋起于足。结于跗。其直者上结于髀。阳明之脉。入齿中。挟口
环唇。其支者。循喉咙。入缺盆下膈。故为是诸证。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。
大承气汤方
大黄（四两酒洗） 浓朴（半斤炙去皮） 枳实（五枚炙） 芒硝（三合）
上四味。以水一斗。先煮枳、朴取五升。去滓。内大黄。煮二升。去滓。内芒硝。更上微火一两
沸。分温再服。得下。余勿服。
太阳病。关节疼痛而烦。脉沉而细者。此名中湿。亦名湿痹。湿痹之候。小便不利。大便反快。但
当利其小便。湿为六淫之一。故其感人。亦如风寒之先在太阳。但风寒伤于肌腠。而湿则流入关节。
风脉浮。寒脉紧。而湿脉则沉而细。湿性濡滞。而气重着。故亦名痹。痹者闭也。然中风者。必先有
内风而后召外风。中湿者。亦必先有内湿而后感外湿。故其人平日土德不及而湿动于中。由是气化不
速。而湿侵于外。外内合邪。为关节疼烦。为小便不利。大便反快。治之者必先逐内湿。而后可以除
外湿。故曰当利其小便。东垣亦云。治湿不利小便。非其治也。然此为脉沉而小便不利者设耳。若风
寒在表。与湿相搏。脉浮恶风。身重疼痛者。则必以麻黄、白术、薏苡、杏仁、桂枝、附子等。发其
汗为宜矣。详见后条。湿家之为病。一身尽疼。发热。身色如熏黄也。
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。
熏黄者。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。
湿家其人但头汗出。背强。欲得被覆向火。若下之早则哕。或胸满。小便不利。舌上如苔者。以
丹田有热。胸上有寒。渴欲得饮而不能饮。则口燥烦也。
寒湿居表。阳气不得外通而但上越。为头汗出。为背强。欲得被覆向火。是宜驱寒湿以通其阳。乃
反下之。则阳更被抑。而哕乃作矣。或上焦之阳不布。而胸中满。或下焦之阳不化。而小便不利。随
其所伤之处而为病也。舌上如苔者。本非胃热。而舌上津液燥聚。如苔之状。实非苔也。盖下后阳气
反陷于下。而寒湿仍聚于上。于是丹田有热而渴欲得饮。胸上有寒而复不能饮。则口舌燥烦。而津液
乃聚耳。
湿家下之。额上汗出。微喘。小便利者死。若下利不止者亦死。
湿病在表者宜汗。在里者宜利小便。苟非湿热蕴积成实。未可遽用下法。额汗出微喘。阳已离而
上行。小便利。下利不止。阴复决而下走。阴阳离决。故死。一作小便不利者死。谓阳上游而阴不下济也。
亦通。风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不止。医云。此可发其汗。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。但微微似欲汗出者。风湿
俱去也。
风湿虽并为六淫之一。然风无形而湿有形。风气迅而湿气滞。值此雨淫湿胜之时。自有风易却而
湿难除之势。而又发之速而驱之过。宜其风去而湿不与俱去也。故欲湿之去者。但使阳气内蒸而不骤
泄。肌肉关节之间充满流行。而湿邪自无地可容矣。此发其汗。但微微似欲汗出之旨欤。
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。
寒湿在上。则清阳被郁。身疼头痛。鼻塞者。湿上甚也。发热面黄烦喘者。阳上郁也。而脉大。
则非沉细之比。腹和无病。则非小便不利。大便反快之比。是其病不在腹中而在头。疗之者宜但治其
头。而毋犯其腹。内药鼻中。如瓜蒂散之属。使黄水出则寒湿去而愈。不必服药以伤其和也。
湿家身烦疼。可与麻黄加术汤。发其汗为宜。慎不可以火攻之。
身烦疼者。湿兼寒而在表也。用麻黄汤以散寒。用白术以除湿。喻氏曰。麻黄得术。则虽发汗。不
至多汗。而术得麻黄。并可以行表里之湿。不可以火攻者。恐湿与热合而反增发热也。
麻黄加术汤方
麻黄（三两去节） 桂枝（二两） 甘草（一两炙） 白术（四两） 杏仁（七十个去皮尖）
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
微汗。
病者一身尽疼。发热。日晡所剧者。此名风湿。此病伤于汗出当风。或久伤取冷所致也。可与麻
黄杏仁薏苡甘草汤。
此亦散寒除湿之法。日晡所剧。不必泥定肺与阳明。但以湿无来去。而风有休作。故曰此名风湿。
然虽言风而寒亦在其中。观下文云。汗出当风。又曰久伤取冷。意可知矣。盖痉病非风不成。湿痹无寒不
作。故以麻黄散寒。薏苡除湿。杏仁利气。助通泄之用。甘草补中。予胜湿之权也。
麻黄杏仁薏苡甘草汤方
麻黄（半两） 杏仁（十个去皮尖） 薏苡（半两） 甘草（一两炙）
上锉麻豆大。每服四钱匕。水一盏半。煎八分。去滓温服。有微汗。避风。
风湿。脉浮身重。汗出恶风者。防己黄 汤主之。
风湿在表。法当从汗而解。乃汗不待发而自出。表尚未解而已虚。汗解之法。不可守矣。故不用
麻黄出之皮毛之表。而用防己驱之肌肤之里。服后如虫行皮中。及从腰下如冰。皆湿下行之征也。然
非、术、甘草。焉能使卫阳复振。而驱湿下行哉。
防己黄 汤方
防己（一两） 甘草（半两炙） 白术（七钱半） 黄 （一两一分）
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。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。
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。去桂枝加白术汤主之。
身体疼烦不能自转侧者。邪在表也。不呕不渴。里无热也。脉浮虚而涩。知其风湿外持。而卫阳
不正。故以桂枝汤去芍药之酸收。加附子之辛温。以振阳气而敌阴邪。若大便坚。小便自利。知其在
表之阳虽弱。而在里之气犹治。则皮中之湿。自可驱之于里。使从水道而出。不必更发其表。以危久
弱之阳矣。故于前方去桂枝之辛散。加白术之苦燥。合附子之大力健行者。于以并走皮中而逐水气。亦
因势利导之法也。
桂枝附子汤方
桂枝（四两） 附子（三枚炮去皮破八片） 生姜（三两切） 甘草（二两炙） 大枣（十二枚擘）
上五味。以水六升。煮取二升。去滓。分温三服。
白术附子汤方
白术（一两） 附子（一枚炮去皮） 甘草（二两炙） 生姜（一两半） 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
冒状。勿怪。即是术、附并走皮中。逐水气未得除故耳。
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。
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。
夫风湿在表。本当从汗而解。麻黄加术汤、麻黄杏仁薏苡甘草汤。其正法也。而汗出表虚者。不宜重
发其汗。则有防己黄 实表行湿之法。而白术附子。则又补阳以为行者也。表虚无热者。不可遽发其
阳。则有桂枝附子温经散湿之法。而甘草附子。则兼补中以为散者也。即此数方。而仲景审病之微。用
法之变。盖可见矣。
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）
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。汗出复烦者。
服五合。恐一升多者。宜服六七合为妙。
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。
中 即中暑。暑亦六淫之一。故先伤太阳而为寒热也。然暑、阳邪也。乃其证反身重疼痛。其脉
Taiyang disease (disease of the Taiyang channel), characterized by fever and absence of sweating, with an aversion to cold, is named Gang Jing (Stiff Spasm). Taiyang disease, characterized by fever and presence of sweating, without an aversion to cold, is named Rou Jing (Soft Spasm).
Cheng Wuji stated: The *Qianjin Fang* records that in Taiyang Wind-Strike syndrome, if one is additionally affected by Cold-Dampness, it transforms into Jing disease. In Taiyang disease, fever with absence of sweating indicates Exterior Excess, which should not involve an aversion to cold; the current presence of an aversion to cold indicates that Taiyang Wind-Strike has been additionally affected by Cold, resulting in Jing disease. Because the exterior is excess and Cold is present, it is called Gang Jing. In Taiyang disease, fever with sweating indicates Exterior Deficiency, which should involve an aversion to cold; the current absence of an aversion to cold indicates that Wind pathogen has transformed into Heat, injuring the sinews and vessels externally to form Jing disease. Because the exterior is deficient and Cold is absent, it is called Rou Jing. However, "Jing" means stiffness; the pathology lies in the sinews, so there must be accompanying symptoms such as stiffness and tension of the neck and nape, heat in the head and cold in the feet, red eyes, head shaking, trismus (lockjaw), and opisthotonos. Zhang Zhongjing did not list these separately because the term "Jing" encompasses them. The *Huo Ren Shu* also states that the fever and aversion to cold of Jing syndrome are similar to Shang Han (Cold Damage), but the pulse is deep, slow, wiry, and thin, and the opisthotonos is different.
In Taiyang disease, if there is fever and the pulse is deep and thin, it is named Jing, which is difficult to treat.
The Taiyang pulse should originally be floating; the current deepness indicates that Wind has sunk due to Dampness, thus causing Jing. The Jing pulse should originally be tight and wiry; the current thinness indicates that Yin Qi is insufficient, hence it is difficult to treat.
In Taiyang disease, excessive sweating leads to Jing. If a Wind disease is treated with purgation, it leads to Jing; if sweating is induced again, rigidity and cramping will certainly occur. Patients with chronic sores, even if they have body pain, should not undergo sweating therapy; if sweating occurs, Jing will result. These describe the causes of Jing disease. Although there are differences among these three scenarios, they all share the commonality of depleting fluids and damaging Yin. Generally, diseases may transform into Jing due to unresolved Taiyang Wind-Cold combined with additional Cold-Dampness; or they may transform into Jing due to blood loss and Qi exhaustion, damaging Yin and Yang. The Classics state: "Qi primarily provides warming, Blood primarily provides nourishment." It also states: "Yang Qi, when refined, nourishes the Spirit; when soft, it nourishes the sinews." Since both Yin and Yang are declining, the sinews and vessels lose their nourishment, becoming stiff and inflexible. This highlights the differences in root and branch, deficiency and excess in Jing disease, which must be distinguished.
When a patient presents with body heat, cold feet, stiffness and tension of the neck and nape, aversion to cold, occasional head heat, red face and eyes, isolated head shaking, sudden trismus, and opisthotonos, it is Jing disease. If sweating is induced, Cold and Dampness combine, further weakening the exterior, leading to severe aversion to cold. After sweating, the pulse becomes winding like a snake.
Jing disease remains at the Exterior level, hence body heat and aversion to cold. Jing is a Wind-Stiffness disease affecting the sinews and vessels, hence trismus, head and neck stiffness, opisthotonos, and strong, straight pulses. The Classics state: "All sudden stiffness belongs to Wind." Head heat, foot cold, red face and eyes, and head shaking occur because Wind is a Yang pathogen whose Qi ascends and moves actively. When Cold and Dampness combine, it refers to the moisture from sweat combining with external Cold Qi, failing to resolve, thereby further weakening the Exterior Qi due to sweating, while Cold strengthens with Dampness, causing severe aversion to cold. A pulse "like a snake" refers to a pulse that is hidden and curved, resembling a snake's movement. The Jing pulse is originally straight; after sweating, Wind leaves but Dampness remains, so the pulse becomes curved rather than straight.
Sudden abdominal distension indicates the condition is about to resolve. If the pulse remains unchanged but becomes hidden and wiry, it is still Jing.
This is a variation of the previously mentioned scenario where Wind leaves but Dampness remains. Mr. Wei stated: When Wind leaves and no longer adheres to Dampness, the Dampness pathogen has no basis and must follow its downward nature, entering the abdomen to cause distension. With Wind-Cold resolving externally and Dampness moving downward, it is considered a sign of resolution. In such cases, the pulse should be floating rather than deep, and slow rather than wiry. However, if the pulse remains unchanged and adds hidden wiriness, it indicates the pathogen has connected internally to the Taiyin, worsening the Interior condition while the Exterior condition persists. This is one variation among Jing syndromes.
The Jing pulse, when pressed, feels tight and wiry, running straight up and down.
"Tight and wiry" signifies a stiff and straight quality. Mr. Li stated: "Running up and down" means that from the Cun (inch) position to the Chi (cubit) position, a tight and straight pulse is seen. The *Mai Jing* also states: "The Jing disease pulse is hard and hidden, running straight up and down." If a Jing patient has moxibustion sores, it is difficult to treat.
Patients with moxibustion sores have long-standing suppuration and ulceration, leaving acupoints open. Lou Quanshan stated: This is equivalent to broken wind (tetanus). Essentially, Yin injury cannot withstand Wind-Heat, and Yang injury cannot withstand attack and depletion. Hence, it is said to be difficult to treat.
In Taiyang disease, with full manifestation of symptoms, body stiffness, and back stiffness extending to the neck (KT KT describes the appearance of back stiffness connecting to the neck), but the pulse is unexpectedly deep and slow, this is Jing. It is treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction).
Mr. Zhao explained that the Taiyang pulse travels upward from the foot, along the back to the head and neck; symptoms appearing in these areas constitute the Taiyang syndrome. KT KT describes the stiffness of the back connecting to the neck. A deep pulse is typical for Jing; a slow pulse here does not indicate Interior Cold, but rather insufficient fluids leading to impaired circulation of Ying and Wei. In Shang Han, if there is neck and back stiffness, sweating, and aversion to wind, the pulse is typically floating and rapid, indicating abundant Wind-Cold at the Exterior. Here, with body stiffness and an unexpectedly deep and slow pulse, it indicates Wind invading the Exterior while fluids are damaged internally. Thus, using Guizhi (Cinnamon Twig) is the same, but adding Gegen (Kudzu Root) aids dispersion, whereas adding Gualougen (Trichosanthes Root) nourishes the interior, making them different.
Gualou Guizhi Tang Formula
Gualougen (Trichosanthes Radix) (2 liang) Guizhi (Cinnamomi Ramulus) (3 liang) Shaoyao (Paeoniae Radix Alba) (3 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang) Shengjiang (Zingiberis Rhizoma Recens) (3 liang) Dazao (Ziziphi Jujubae Fructus) (12 pieces)
These six ingredients are boiled in 9 sheng of water to yield 3 sheng. Divide into three warm doses. Induce slight sweating. If sweating does not occur, after a meal interval, drink hot porridge to promote sweating.
In Taiyang disease, with absence of sweating and unexpectedly decreased urination, Qi rushing upward to the chest, trismus, and inability to speak, indicating impending Gang Jing, Gegen Tang (Kudzu Decoction) is indicated.
Absence of sweating and decreased urination indicate that Wind-Cold-Dampness is abundant, conflicting with Zheng Qi, preventing outward release or downward drainage. Unable to go out or down, it must rush upward, causing chest fullness and trismus with inability to speak. Gradually, facial flushing, head shaking, and neck/back stiffness will ensue. Hence, it is termed "impending Gang Jing." Gegen Tang is essentially Guizhi Tang plus Mahuang (Ephedrae Herba) and Gegen. It is the standard treatment for Gang Jing without sweating.
Note: Jing disease often occurs at the junction of Taiyang and Yangming channels. Body stiffness and trismus with inability to speak are confirmations. Therefore, Mahuang is added to disperse Taiyang pathogens, and Gegen is added to soothe Yangming channels. Yangming governs muscles externally and fluids internally. Gegen is used to unblock collaterals and expel Wind-Dampness; Gualou is used to generate fluids and moisten sinews.
Gegen Tang Formula
Gegen (Puerariae Lobatae Radix) (4 liang) Mahuang (Ephedrae Herba) (3 liang, tips removed) Guizhi (Cinnamomi Ramulus) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Shaoyao (Paeoniae Radix Alba) (2 liang) Shengjiang (Zingiberis Rhizoma Recens) (3 liang) Dazao (Ziziphi Jujubae Fructus) (12 pieces)
These seven ingredients are boiled in 10 sheng of water. First boil Mahuang and Gegen, reduce by 2 sheng, remove foam. Add remaining herbs, boil to yield 3 sheng. Remove dregs. Warm dose of 1 sheng. Cover to induce slight sweating. No need to drink porridge. Rest and dietary restrictions follow Guizhi Tang methods.
For Jing disease presenting with chest fullness, trismus, inability to lie flat with legs touching the mat, leg cramps, and teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be given.
This represents Jing disease belonging to Yangming Stagnant Heat. The Yangming sinews originate at the foot, knot at the dorsum, and ascend to the thigh. The Yangming meridian enters the teeth, surrounds the mouth and lips, and its branch follows the throat to the clavicle and diaphragm, explaining these symptoms. However, without signs of dryness and excess, one should clear heat without purging excess. Why use Da Chengqi Tang instead of Tiaoweichengqi Tang? Perhaps the disease is deep and heat extreme, requiring this potent formula. The phrase "may be given" implies caution; practitioners should exercise care.
Da Chengqi Tang Formula
Dahuang (Rhei Radix et Rhizoma) (4 liang, wine-washed) Houpo (Magnoliae Officinalis Cortex) (0.5 jin, skin removed, honey-fried) Zhishi (Aurantii Fructus Immaturus) (5 pieces, honey-fried) Mangxiao (Natrii Sulfas) (3 he)
These four ingredients are boiled in 10 sheng of water. First boil Zhishi and Houpo to yield 5 sheng, remove dregs. Add Dahuang, boil to yield 2 sheng, remove dregs. Add Mangxiao, boil briefly over low fire. Divide into two warm doses. If bowel movement occurs, stop taking the remainder.
In Taiyang disease, joint pain accompanied by vexation, with a deep and thin pulse, is named Zhong Shi (Struck by Dampness) or Shi Bi (Dampness Bi Syndrome). Symptoms of Shi Bi include difficulty in urination and loose stools. Treatment should focus on promoting urination. Dampness is one of the Six Evils; like Wind and Cold, it initially affects Taiyang. However, Wind-Cold injures muscle interstices, while Dampness flows into joints. Wind pulse is floating, Cold pulse is tight, but Dampness pulse is deep and thin. Dampness is sticky and stagnant, causing heaviness, hence named Bi (Obstruction). Bi means closure. Just as Wind Strike requires internal Wind to attract external Wind, Zhong Shi requires internal Dampness to attract external Dampness. Thus, individuals with Spleen deficiency (Earth virtue lacking) have internal Dampness moving, leading to sluggish Qi transformation and external Dampness invasion. Internal and external pathogens combine, causing joint pain and vexation, urinary difficulty, and loose stools. Treatment must first eliminate internal Dampness before removing external Dampness. Hence, "promote urination." Dong Yuan also stated: Treating Dampness without promoting urination is incorrect. However, this applies to cases with deep pulse and urinary difficulty. If Wind-Cold is at the exterior combing with Dampness, with floating pulse, aversion to wind, heaviness, and pain, then sweating with Mahuang, Baizhu (Atractylodis Macrocephalae Rhizoma), Yiyiren (Coicis Semen), Xingren (Armeniacae Semen Amarum), Guizhi, and Fuzi (Aconiti Lateralis Radix Praeparata) is appropriate. See later sections.
Patients with chronic Dampness suffer from generalized body pain, fever, and a sallow complexion resembling smoked yellow.
Excessive external Dampness causes internal stagnation of Yang. External Dampness causes body pain; internal Yang stagnation causes fever. Heat and Dampness mix and ferment, causing the skin to appear smoked-yellow. Smoked-yellow is dull and dark yellow due to the heavy and stagnant nature of Dampness. In contrast, Heat-Yellow is bright yellow, described as "yellow like an orange peel."
Patients with chronic Dampness may only sweat on the head, have back stiffness, and desire to cover themselves near fire. If purged prematurely, hiccups, chest fullness, urinary difficulty, and a tongue coating resembling moss may occur. This is due to Heat in the Lower Dan Tian and Cold in the Upper Chest. Thirst with desire to drink but inability to do so causes dry mouth and vexation.
Cold-Dampness residing at the exterior prevents Yang from circulating outward, causing it to rise, leading to head sweating and back stiffness. Desire for warmth indicates the need to dispel Cold-Dampness to unblock Yang. Instead, using purgation suppresses Yang further, causing hiccups. Or, Upper Jiao Yang fails to distribute, causing chest fullness; or Lower Jiao Yang fails to transform, causing urinary difficulty. Pathology arises where damage occurs. A tongue coating resembling moss is not Stomach Heat, but dried fluid aggregating on the tongue like moss. After purgation, Yang sinks to the Lower, while Cold-Dampness remains in the Upper. Thus, Heat in the Lower Dan Tian causes thirst, while Cold in the Upper Chest prevents drinking, leading to oral dryness and vexation, causing fluid aggregation.
If a Dampness patient is purged, leading to sweating on the forehead, slight panting, and free urination, it is a death sign. If diarrhea persists uncontrollably, it is also fatal.
Dampness at the exterior should be treated with sweating; Dampness at the interior with promoting urination. Unless Damp-Heat accumulates into excess, purgation should not be used hastily. Sweating on the forehead and panting indicate Yang separating and ascending; free urination and persistent diarrhea indicate Yin separating and descending. Separation of Yin and Yang leads to death. Another interpretation suggests urinary difficulty is fatal, meaning Yang ascends but Yin does not descend, which is also valid.
When Wind and Dampness combat, causing generalized pain, sweating should resolve it. If rain continues and the physician prescribes sweating, but the disease does not improve, why? Profuse sweating removes Wind but leaves Dampness behind, hence no improvement. To treat Wind-Dampness, one should induce only slight, continuous sweating, allowing both Wind and Dampness to leave together.
Although Wind and Dampness are both among the Six Evils, Wind is formless and Dampness is tangible; Wind is swift and Dampness is stagnant. During damp seasons, Wind is easier to expel than Dampness to remove. Rapid and excessive sweating expels Wind but fails to expel Dampness. To remove Dampness, Yang Qi must steam internally without sudden leakage, filling the muscles and joints, leaving no room for Dampness. This explains the principle of inducing only slight sweating.
Patients with chronic Dampness suffering from body pain, fever, yellow face, wheezing, headache, nasal congestion, and vexation, with a large pulse, normal appetite, and harmonious abdomen, have Cold-Dampness in the head causing nasal congestion. Administering medicine nasally will cure it.
Cold-Dampness above obstructs Clear Yang, causing body/head pain. Nasal congestion indicates severe Dampness above. Fever, yellow face, vexation, and wheezing indicate Yang stagnation above. A large pulse differs from deep/thin pulses. A harmonious abdomen differs from urinary difficulty/loose stools. The pathology is in the head, not the abdomen. Treatment should focus on the head without disturbing the abdomen. Nasal administration, such as Gouti San (Melon Dispersant Powder), expels yellow fluid, removing Cold-Dampness. Medication should not be ingested to avoid harming the interior harmony.
For patients with chronic Dampness suffering from painful body aches, Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction) to induce sweating is appropriate. Fire therapy must be avoided.
Painful body aches indicate Dampness combined with Cold at the exterior. Mahuang Tang disperses Cold; Baizhu eliminates Dampness. Yu Jia stated: Mahuang with Baizhu induces sweating without excessive loss; Baizhu with Mahuang treats both exterior and interior Dampness. Fire therapy is contraindicated to prevent Dampness combining with Heat, increasing fever.
Mahuang Jia Zhu Tang Formula
Mahuang (Ephedrae Herba) (3 liang, tips removed) Guizhi (Cinnamomi Ramulus) (2 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (1 liang, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma) (4 liang) Xingren (Armeniacae Semen Amarum) (70 seeds, skin and tips removed)
These five ingredients are boiled in 9 sheng of water. First boil Mahuang, reduce by 2 sheng, remove foam. Add other herbs, boil to yield 2.5 sheng. Remove dregs. Warm dose of 8 ge. Cover to induce slight sweating.
When a patient suffers from generalized body pain, fever, worsening in the late afternoon (Shi hour), it is named Feng Shi (Wind-Dampness). This results from sweating exposed to wind or prolonged exposure to cold. Mahuang Xingren Yiyi Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) is indicated.
This is another method to disperse Cold and eliminate Dampness. Worsening in the late afternoon need not be strictly attributed to Lung or Yangming; it is named Wind-Dampness because Dampness is constant while Wind comes and goes. Although termed Wind, Cold is included, as indicated by "sweating exposed to wind" and "prolonged cold exposure." Jing disease requires Wind; Shi Bi requires Cold. Thus, Mahuang disperses Cold, Yiyiren eliminates Dampness, Xingren regulates Qi to assist drainage, and Gancao tonifies the Middle to empower overcoming Dampness.
Mahuang Xingren Yiyi Gancao Tang Formula
Mahuang (Ephedrae Herba) (0.5 liang) Xingren (Armeniacae Semen Amarum) (10 seeds, skin and tips removed) Yiyi (Coicis Semen) (0.5 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (1 liang, honey-fried)
Crush to size of hemp seeds. Take 4 qian bi per dose with 1.5 sheng of water, decoct to 0.8 sheng. Remove dregs and take warm. Induce slight sweating; avoid wind.
For Wind-Dampness with floating pulse, heaviness, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is indicated.
Wind-Dampness at the exterior should be resolved via sweating. However, spontaneous sweating indicates the exterior is already deficient despite unresolved pathology. Standard sweating methods are unsuitable. Thus, Mahuang is not used to expel from the skin surface, but Fangji is used to drive Dampness from the muscle layer. Post-administration sensations of insects crawling under the skin or ice-cold feeling below the waist indicate Dampness descending. Without Baizhu and Gancao, Wei Yang cannot recover to drive Dampness downward.
Fangji Huangqi Tang Formula
Fangji (Stephaniae Tetrandrae Radix) (1 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (0.5 liang, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma) (0.75 liang) Huangqi (Astragali Radix) (1.1 liang)
Crush to size of hemp seeds. Take 5 qian bi per dose with 4 slices of Shengjiang and 1 Dazao in 1.5 sheng of water, decoct to 0.8 sheng. Remove dregs and take warm. For wheezing, add 0.5 liang Mahuang. For stomach disharmony, add 0.3 liang Shaoyao. For Qi rushing upward, add 0.3 liang Guizhi. For old Cold below, add 0.3 liang Xixin (Asari Radix et Rhizoma). After taking, expect sensation of insects crawling under skin and ice-cold feeling below waist. Sit on blankets and wrap another around the waist to maintain warmth until slight sweating occurs and condition improves.
After eight or nine days of Shang Han, Wind-Dampness combats, causing severe body pain, inability to turn over, no vomiting or thirst, and a floating, empty, and choppy pulse. Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is indicated. If stool is hard and urination is free, remove Guizhi and add Baizhu; Baizhu Fuzi Tang is indicated.
Severe body pain and inability to turn indicate Exterior pathogen. No vomiting or thirst indicates no Interior Heat. Floating, empty, choppy pulse indicates Wind-Dampness holding the exterior and improper Wei Yang. Thus, Guizhi Tang removes sour-astringent Shaoyao and adds pungent-warm Fuzi to boost Yang against Yin. If stool is hard and urination is free, Interior Qi is functional despite weak Exterior Yang. Dampness in the skin can be driven inward to exit via urine, avoiding further sweating that might endanger weak Yang. Thus, remove pungent-dispersing Guizhi and add bitter-drying Baizhu, combined with powerful Fuziu, to move through the skin and expel water-Qi. This is guiding according to momentum.
Guizhi Fuzi Tang Formula
Guizhi (Cinnamomi Ramulus) (4 liang) Fuzi (Aconiti Lateralis Radix Praeparata) (3 pieces, peeled, split into 8) Shengjiang (Zingiberis Rhizoma Recens) (3 liang, sliced) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Dazao (Ziziphi Jujubae Fructus) (12 pieces, split)
These five ingredients are boiled in 6 sheng of water to yield 2 sheng. Remove dregs. Divide into three warm doses.
Baizhu Fuzi Tang Formula
Baizhu (Atractylodis Macrocephalae Rhizoma) (1 liang) Fuzi (Aconiti Lateralis Radix Praeparata) (1 piece, peeled) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Shengjiang (Zingiberis Rhizoma Recens) (1.5 liang) Dazao (Ziziphi Jujubae Fructus) (6 pieces)
These five ingredients are boiled in 3 sheng of water to yield 1 sheng. Remove dregs. Divide into three warm doses. After the first dose, if numbness is felt, repeat after half a day. Finish all three doses. A sensation of dizziness is expected; do not be alarmed. This is due to Baizhu and Fuzi moving through the skin to expel water-Qi.
When Wind-Dampness combats, causing joint pain, tenderness, pulling pain, inability to flex or extend, exacerbation upon touch, sweating, shortness of breath, urinary difficulty, aversion to wind with desire to keep clothes on, or slight edema, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated.
This is a syndrome of Dampness overwhelming weak Yang. Treatment involves boosting Yang and dispersing Dampness. "Resolving with slight sweating" is not true sweating, but Yang recovery leading to Yin resolution. While Wind-Dampness at the exterior usually resolves via sweating (standard methods being Mahuang Jia Zhu Tang and Mahuang Xingren Yiyi Gancao Tang), patients with sweating and deficient exterior should not be heavily sweated. Fangji Huangqi Tang solidifies the exterior and moves Dampness. Baizhu Fuzi Tang boosts Yang to facilitate movement. For deficient exterior without Heat, Guizhi Fuzi Tang warms meridians and disperses Dampness. Gancao Fuzi Tang supplements the Middle while dispersing. These formulas demonstrate Zhang Zhongjing’s subtle diagnosis and flexible application.
Gancao Fuzi Tang Formula
Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Fuzi (Aconiti Lateralis Radix Praeparata) (2 pieces, peeled) Baizhu (Atractylodis Macrocephalae Rhizoma) (2 liang) Guizhi (Cinnamomi Ramulus) (4 liang)
These four ingredients are boiled in 6 sheng of water to yield 3 sheng. Remove dregs. Warm dose of 1 sheng, three times daily. Initial dose inducing slight sweating resolves symptoms and restores appetite. If sweating recurs with vexation, take 0.5 sheng. If 1 sheng is too much, 0.6–0.7 sheng is optimal.
Taiyang Zhong Shu (Summerheat Strike) presents with fever, aversion to cold, heaviness, and pain. The pulse is wiry, thin, hollow, and slow. After urination, chills and piloerection occur. Hands and feet are cold. Minor exertion causes body heat. Mouth opens, and anterior teeth are dry. If sweating is induced, aversion to cold worsens. If moxibustion is applied, fever worsens. If purged repeatedly, strangury worsens.
Zhong Shu is Summerheat. Summerheat is one of the Six Evils, initially injuring Taiyang causing chills and fever. However, Summerheat is a Yang pathogen, yet symptoms include heaviness and pain, and the pulse is...