身痛亦太阳表证。欲发其表。宜以汗解。然阴阳表里。互有出入。在权其轻重而善治之
。不能执一也。
其宜汗解者。如经云。太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风无汗而喘者。麻
黄汤
主之。又云。太阳中风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁者。以大青龙汤发之。
此发汗之正法也。至于太阳之邪。连及少阳。则如经云。伤寒六七日。发热。微恶寒。支节
烦疼。微呕。心下支结。外证未去者。柴胡桂枝汤主之。此专用少阳和解之法。而兼桂枝以
和太阳之表。则又不纯用汗法矣。而脉必以浮为断。若脉沉者即不得治表。如经云。病发热
头疼。脉反沉。若不瘥。身体疼痛。当救其里。宜四逆汤。又云。发汗后。身疼痛。脉沉迟
者。桂枝芍药生姜人参新加汤主之。又云。少阴病。身体疼。手足寒。骨节痛。脉沉者。附
子汤主之。其间治法天渊。在相其缓急。以分别先后。如伤寒医下之。续得下利。清谷不止
。
身疼痛者。急当救里。后身疼痛。清便自调者。急当救表。救里宜四逆汤。救表宜桂枝汤
。仲景论中本身昭晰。不得以身痛属表证。概与发表。致召亡阳之变也。
身痛同为表证。然湿家之为病。一身尽疼。此邪着于里。外舍于肌肉之间。要当温经。
使自
作汗而解。无径行发表之理。如经云。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。又曰。风湿相搏。骨节烦疼。掣痛不得屈伸。近之则痛剧。汗出
短气。恶风不欲去衣。或身微肿者。甘草附子汤主之。此二者。当温经则其汗自透。若大发
其汗。病反不除。不呕不渴。方可温经。由此推之。则呕而且渴。又属湿热壅滞。汗法尤
忌矣。故仲景又曰。太阳中 者。发热恶寒。身重而疼痛。要之湿淫与热淫。皆能使身疼痛
。虽宜得汗而解。而汗法不可一例施也。
霍乱下利。本属阴病。阴病转阳。往往见身疼痛之证。治宜先温其里。乃攻其表。如理
中四
逆辈是也。至吐利止而身痛不休。当消息和解其外。宜桂枝汤小和之。此在仲景论中。有法
有方。可以遵循。其有寒尽化热。转成阳明燥渴证者。则又当别论矣。
凡用汗法。宜相其人之津液。经云。脉浮紧者。法当身疼痛。宜以汗解之。假令尺中迟
者。
不可发汗。何以知之然。以荣气不足血少故也。又疮家虽身疼痛。不可发汗。汗出则痉。凡
用汗法者其慎诸。
有身疼痛而兼体重者。有但体重而身不疼者。有身疼痛而体不重者。如伤寒脉浮紧。一
身尽
疼痛。必恶寒体重呕逆。又伤寒脉浮缓。身不疼但重乍有轻时。无少阴证者。此均当大发其
汗也。至少阴病。四肢沉重。其脉则沉而不浮矣。他如风温为病。自汗出。身重多眠。三阳合
病。腹满身重。难以转侧。与夫太阳中 者身重而疼痛。皆申发汗之禁。总之体重亦有宜汗
不宜汗之辨。可与身痛参看。
腰痛一证。其由头疼身痛而牵连及之者。同属太阳表证。表解则痛自已矣。兼湿者当察
其兼证
。分别寒湿与湿热。根据法施治。但太阳病与少阴相为表里。腰痛又须防肾虚之候。不可不察
。
四肢痉痛者。同属太阳经脉之郁。与身痛参看。痛在周身者。邪之分布也。痛在一处者
。邪
之专注也。专注之邪。其血脉必别有凝泣之处。须于解表药加一二引经药。方验其风寒暑湿
之辨。尤必察其兼证。分别施治。庶无差忒。
身体疼痛也是太阳经表证的表现。想要解除表邪，应当采用发汗的方法治疗。然而阴阳、表里之间，相互关联且有变化，关键在于权衡病情的轻重而妥善治疗，不能拘泥于一种固定的方法。
适合用发汗法治疗的，如《伤寒论》经文所说：太阳病，头痛发热，身体疼痛，腰痛，骨节疼痛，恶风无汗且气喘的，用麻黄汤主治。又说：太阳中风，脉象浮紧，发热恶寒，身体疼痛，无汗且烦躁的，用大青龙汤发汗解表。这是发汗的正法。至于太阳经的邪气，牵连到少阳经，则如经文所说：伤寒六七天，发热，轻微恶寒，四肢关节烦疼，轻微呕吐，心下部位支撑胀满，外感表证未去的，用柴胡桂枝汤主治。这是专门使用少阳经和解的方法，同时兼用桂枝来调和太阳经的表邪，这就不是单纯使用发汗法了。此时脉象必须以浮脉为判断标准。如果脉象沉，就不得治疗表证。如经文所说：病人发热头疼，脉象反而沉，如果病情不愈，身体疼痛，应当先救其里证，宜用四逆汤。又说：发汗后，身体疼痛，脉象沉迟的，用桂枝芍药生姜人参新加汤主治。又说：少阴病，身体疼，手足寒冷，骨节痛，脉象沉的，用附子汤主治。其中的治疗方法天差地别，在于观察病情的缓急，以分别治疗的先后顺序。例如伤寒医生误用下法，接着出现腹泻，完谷不化不止，身体疼痛的，应当紧急救治里证；后来身体疼痛，大小便正常的，应当紧急救治表证。救治里证宜用四逆汤，救治表证宜用桂枝汤。张仲景的论述中本身已经清晰明了，不能因为身体疼痛就归属于表证，一概给予发表（发汗）治疗，从而导致亡阳的变证。
身体疼痛虽然同为表证，但湿病患者所患的病，是一身尽痛，这是邪气附着在里，外部停留在肌肉之间，应当温通经脉，使其自然出汗而病解，没有直接强行发表的道理。如经文所说：风湿相搏，身体疼痛剧烈，不能自行转侧，不呕不渴，脉象浮虚而涩的，用桂枝附子汤主治。又说：风湿相搏，骨节烦疼，牵掣作痛不能屈伸，靠近就疼痛加剧，出汗短气，恶风不想脱衣，或者身体微肿的，用甘草附子汤主治。这两种情况，应当温通经脉，那么汗液自然透出。如果大发其汗，病情反而不除。只有不呕不渴，才可以温通经脉。由此推断，如果又呕又渴，又属于湿热壅滞，发汗法尤其禁忌。所以张仲景又说：太阳中暍（中暑），发热恶寒，身体沉重而疼痛。总之，湿淫与热淫，都能导致身体疼痛，虽然适宜通过出汗而解，但发汗法不可一概施用。
霍乱下利，本属于阴病。阴病转阳，往往会出现身体疼痛的证候。治疗应当先温补其里，然后再攻治其表，如理中汤、四逆汤之类的方剂。等到吐利停止而身体疼痛不休，应当斟酌情况调和其外，宜用小剂量的桂枝汤调和。这在张仲景的论述中，有法有方，可以遵循。如果有寒气完全化为热邪，转变成阳明经燥渴证的，那就另外讨论。
凡是使用发汗法，应当观察病人的津液状况。经文说：脉象浮紧的，法当身体疼痛，宜用发汗法治疗。假如尺部脉迟的，不可发汗。为什么知道呢？因为营气不足，血少的缘故。又有疮家（久患疮疡的人）虽然身体疼痛，也不可以发汗，发汗会导致痉病。凡是使用发汗法的人，一定要谨慎啊。
有身体疼痛而兼身体沉重的，有仅身体沉重而身体不痛的，有身体疼痛而身体不沉重的。例如伤寒脉浮紧，一身尽痛，必定恶寒、身体沉重、呕吐逆气；又比如伤寒脉浮缓，身体不痛但沉重，偶尔有减轻的时候，没有少阴病的证候，这些都属于应当大发其汗的情况。到了少阴病，四肢沉重，其脉象则是沉而不浮了。其他如风温为病，自汗出，身体沉重多眠睡；三阳合病，腹部胀满身体沉重，难以转侧；以及太阳中暍者身体沉重而疼痛，都阐发了发汗的禁忌。总之，身体沉重也有适宜发汗和不适宜发汗的区别，可以与身体疼痛参看。
腰痛这一证候，由头疼身痛牵连及到的，同属太阳经表证，表邪解除则疼痛自然停止。兼夹湿气的应当观察其兼夹证候，分别寒湿与湿热，根据法则施治。但是太阳病与少阴经互为表里，腰痛又须防备肾虚的征候，不可不仔细考察。
四肢痉挛疼痛的，同属太阳经脉之气郁滞，可与身体疼痛参看。疼痛遍布周身，是邪气分布广泛；疼痛固定在一处，是邪气专注一处。专注一处的邪气，其血脉必然另有凝滞之处，必须在解表药中加入一两味引经药，才能验证风寒暑湿的辨别。尤其必须观察其兼夹证候，分别施治，这样才不会有差错。
Body pain is also a manifestation of the Taiyang exterior syndrome. To release the exterior pathogen, one should employ the sweating method for treatment. However, Yin and Yang, interior and exterior are interconnected and subject to change; the key lies in weighing the severity of the condition and treating it appropriately, rather than adhering rigidly to a single fixed method.
For cases suitable for the sweating method, as stated in the classic text: In Taiyang disease, if there is headache, fever, body pain, lower back pain, joint pain, aversion to wind, absence of sweat, and wheezing, Ma Huang Tang (Ephedra Decoction) is the primary prescription. It further states: In Taiyang Wind Strike, with a floating and tight pulse, fever, aversion to cold, body pain, absence of sweat, and irritability, Da Qing Long Tang (Major Blue Green Dragon Decoction) should be used to induce sweating. This is the orthodox method of inducing sweating. When the pathogen of the Taiyang channel extends to the Shaoyang channel, as stated in the classic: After six or seven days of Shanghan (Cold Damage), with fever, slight aversion to cold, discomfort and pain in the limbs and joints, slight vomiting, subcostal fullness and obstruction, and the exterior syndrome not yet resolved, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is the primary prescription. This employs the harmonizing method specific to the Shaoyang channel while simultaneously using Gui Zhi (Cinnamon Twig) to harmonize the Taiyang exterior, thus not purely relying on the sweating method. In such cases, the pulse must be judged by its floating quality. If the pulse is deep, the exterior should not be treated. As stated in the classic: If a patient has fever and headache, but the pulse is unexpectedly deep, and if the condition does not improve, accompanied by body pain, one should first rescue the interior, preferably using Si Ni Tang (Frigid Extremities Decoction). It further states: After inducing sweating, if body pain persists and the pulse is deep and slow, Gui Zhi Shao Yao Sheng Jiang Ren Shen Xin Jia Tang (Modified Cinnamon Twig, Peony, Ginger, and Ginseng Decoction) is the primary prescription. It also states: In Shaoyin disease, with body pain, cold hands and feet, joint pain, and a deep pulse, Fu Zi Tang (Aconite Decoction) is the primary prescription. The treatment methods here differ vastly; one must observe the urgency of the condition to determine the sequence of treatment. For instance, if a Shanghan patient was mistakenly purged, leading to continuous diarrhea with undigested food and body pain, one must urgently rescue the interior; later, if body pain persists but bowel movements normalize, one must urgently rescue the exterior. Rescuing the interior requires Si Ni Tang, while rescuing the exterior requires Gui Zhi Tang. Zhang Zhongjing's discussions are clear: one must not attribute body pain solely to the exterior syndrome and indiscriminately apply exterior-releasing methods, which could lead to the collapse of Yang Qi.
Although body pain is often an exterior syndrome, in patients with dampness, the entire body may ache. This indicates the pathogen attaching to the interior and residing externally between the muscles. One should warm the meridians to allow natural sweating for resolution, rather than directly forcing the exterior to release. As stated in the classic: When Wind-Dampness combats, causing severe body pain preventing self-turning, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is the primary prescription. It further says: When Wind-Dampness combats, causing vexing pain in bone joints, pulling pain preventing flexion and extension, exacerbated by touch, with sweating, shortness of breath, aversion to wind preferring to keep clothes on, or slight body swelling, Gan Cao Fu Zi Tang (Licorice and Aconite Decoction) is the primary prescription. In these two cases, warming the meridians will naturally allow sweat to penetrate. If one induces heavy sweating, the disease will not resolve. Only when there is no vomiting or thirst can one warm the meridians. From this, we infer that if there is vomiting and thirst, it belongs to Damp-Heat stagnation, where the sweating method is particularly contraindicated. Thus, Zhang Zhongjing also states: In Taiyang Zhong Yue (Summerheat Stroke), with fever, aversion to cold, heavy body, and pain. Essentially, both excessive Dampness and Heat can cause body pain. Although resolution through sweating is appropriate, the sweating method cannot be applied uniformly.
Huoluan (Huo-loan/Cholera-like disorder) with diarrhea originally belongs to Yin diseases. When a Yin disease transforms into Yang, body pain often appears. Treatment should first warm the interior, then attack the exterior, using formulas like Li Zhong Tang (Regulate the Middle Decoction) or Si Ni Tang. When vomiting and diarrhea cease but body pain continues, one should carefully harmonize the exterior, preferably using a small dose of Gui Zhi Tang. These methods and prescriptions are clearly outlined in Zhang Zhongjing's works for guidance. If cold completely transforms into heat, evolving into Yangming dryness and thirst syndrome, it requires separate discussion.
Whenever using the sweating method, one must assess the patient's Jin Ye (Body Fluids). The classic states: With a floating and tight pulse, body pain is expected, and sweating is indicated. However, if the Chi position (cun-guan-chi pulse positions) pulse is slow, sweating is contraindicated. Why? Because Ying Qi (Nutritive Qi) is insufficient and blood is scant. Furthermore, patients with chronic sores (Chuang Jia) who have body pain should not be sweated, as sweating may lead to Jing (Spasm). Those using the sweating method must be extremely cautious.
There are cases of body pain accompanied by heaviness, cases of only heaviness without pain, and cases of pain without heaviness. For example, in Shanghan with a floating and tight pulse, whole-body pain, accompanied by aversion to cold, heaviness, and vomiting/reversal of Qi; or in Shanghan with a floating and slow pulse, no pain but heaviness that occasionally lightens, without Shaoyin signs, these all require heavy sweating. In Shaoyin disease, the limbs are heavy, and the pulse is deep rather than floating. Other conditions like Feng Wen (Wind-Warmth) presenting with spontaneous sweating, heavy body, and excessive sleepiness; San Yang He Bing (Combined Disease of Three Yangs) presenting with abdominal fullness, heaviness, and difficulty turning; and Taiyang Zhong Yue presenting with heavy body and pain—all illustrate contraindications to sweating. Ultimately, body heaviness also has distinctions regarding whether sweating is appropriate or not, which should be considered alongside body pain.
Lower back pain, when radiating from headache and body pain, belongs to the Taiyang exterior syndrome; resolving the exterior stops the pain. If complicated by Dampness, one must observe accompanying signs, distinguishing between Cold-Damp and Damp-Heat, and treat according to principles. Since Taiyang and Shaoyin are interior-exterior paired, one must also guard against signs of Kidney deficiency.
Spasmodic pain in the four limbs belongs to the stagnation of Taiyang channel Qi and should be referenced alongside body pain. Pain distributed throughout the body indicates widespread pathogen distribution; pain localized in one area indicates focused pathogen concentration. Focused pathogens likely cause local blood stasis; therefore, one or two guiding herbs should be added to exterior-releasing formulas to verify the differentiation of Wind-Cold, Summerheat, or Dampness. One must carefully observe accompanying signs and treat accordingly to avoid errors.