（风寒湿暑燥热）
六气为病。皆能发热。然寒与热相因。暑与热相继。独燥与湿相反。风寒温暑皆因天气。而湿病多得之地气。燥病
多得
之内因。此病因之殊同也。内经病机十九条。其分属六气者。火居其人。风寒湿者居其一。燥症独无。若诸 项强。皆
属于湿。愚尝疑其属燥。今本论有 湿之分。又曰太阳病。发汗太多因致 。则 之属燥可知也。夫 以状名。因血虚
而筋急耳。六气为患。皆足以致 。然不热则不燥。不燥则不成矣。六经皆有 病。须审部位以别之。身以后属太阳。
则凡头项强急。头背KT KT 。脊强反张。腰似折。髀不可以曲。HT 如结。皆其症也。身之前者属阳明。头项摇动。
口禁齿
。缺盆纽痛。脚挛急。皆其症也。身之侧属少阳。口眼 斜。手足牵引。两胁拘急。半身不遂。皆其症也。若腹内拘
急。因吐利而四肢拘急。是太阴 。恶寒蜷卧。尻以代踵。脊以代头。俯而不能仰者。是少阴 。睾丸上升。宗筋下注。
小腹里急。阴中拘牵。膝胫拘急者。厥阴 也。若 之挟风寒者。其症发热无汗而恶寒。气上撞胸。而小便少。其脉必
坚紧。其状必强直而口噤。此得天之气。内经所云诸暴强直。皆属于风者是。其势勇猛。故曰刚 。病自外来。当逐
邪而解外。 有夹本邪而为外患者。其邪从内出。故发热汗出而不恶寒。其脉沉迟。其状则项背强。KT KT 。此得之
地气。
内经所云。诸 项强。皆属于湿者是也。其势 弱。故名柔 。病因于内也当滋阴以和内。治湿君栝蒌根者。非以治风。
实以生津。非以治湿。实以润燥耳。夫 之始也。本非正病。必夹杂于他病之中。人之病此者。世医悉指为风。所以
不明其理。善医者。必于他症中审察而预防之。如头项强痛。即 之一端。是太阳之血虚。故筋急也。今人但知风寒。
不恤津液。所以发汗太多。因致痉者多矣。夫 本有由来。一经妄治。即奇形必见。项背强KT KT 。是 之征兆。
故用葛
根。身体强。是 状已着。故用栝蒌根。卧不着席。脚挛急。口禁齿 。是 之极甚。故用大黄芒硝。无非用多津多液
之品。以滋养阴血。不得与当汗当下者同例也。观伤寒脉浮自汗。心烦恶寒。而见脚挛急。是 势已成。须当滋阴存液。
不得仍作伤寒主治。故与桂枝汤则厥。与芍药甘草汤。其脚即伸。此明验矣。第以表症未除。不得用承气。若 语者少
与调胃承气。是又与不着席者与大承气。同一机彀也。凡 之为病。因外邪伤筋者少。因血虚筋急者多。如误作风治。
用辛散以助阳。则真阴愈虚。因燥剂以驱风。则血液愈涸。故 得之暴起者少。妄治而致者多。虚而不补。不死何待。
非参苓归地。调和荣卫。未易奏捷也。内经曰。诸湿肿满。皆属于脾。又曰湿胜则濡泄。此指湿伤于内者言也。又曰地
之湿气。感则害人皮肉筋骨。又曰因于湿。首如裹。此指湿伤于外者言也。若湿而兼热。则大筋 短而为拘。小筋弛
长而为痿即柔 之变见矣。阳明篇有湿热发黄之症。叔和不为别论。独取太阳之风湿相传者。尚遗数条。亦搜采之疏失
也。内经曰。身半以上者。风中之也。身半以下者。湿中之也。中阳则溜于经。中阴则溜于腑。又曰阳受风气。阴受湿
气。故伤于风者。上先受之。伤于湿者。下先受之。皆风湿对言。本论则风湿合言也。风湿相合。则阴阳相传。上下内
外反病矣。所以身体烦疼。不能转侧。骨节掣痛。不能屈伸。小便不利。大便反快也。内经曰。风湿之伤人也血气与邪
并。客与分腠之间。其势坚大。故曰实。寒湿之中人也。皮肤不收。肌肉坚紧。营血涩。卫气去。故曰虚。此又以血家
虚
实。因风寒而分也。本论伤寒发汗。寒湿在里不解。身目为黄。与阳明之热不得越瘀热在里。身体发黄者。当下不当下。
亦以寒湿湿热分虚实矣。内经以风寒湿三气合而为痹。本论又合风寒湿热四气。而名湿痹。当知痹与 。皆由湿变矣。
夫同一湿也。湿去燥极则为 。久留而着则为痹。痹为实。 为虚。 痹异形。虚实亦殊。固不得妄以 属风。亦不得
因于湿。而竟视 为湿矣。 湿余义。详内经注。及本论注中。
风寒、湿、暑、燥、热这六种外感邪气致病，都能引起发热。然而，寒与热相互关联，暑与热相继发生，唯独燥与湿性质相反。风、寒、温、暑多因天气变化而致病，而湿病多因地气潮湿所致，燥病多因体内津液亏损等内因而致。这就是病因的异同之处。《内经》病机十九条中，归属于六气的条目里，火占据两条（君火、相火），风、寒、湿各占一条，唯独没有燥症的专门条目。如果说“诸项强”（各种颈项僵硬）都归属于湿，我过去曾怀疑它应归属于燥。如今《伤寒论》中有刚痉、柔痉的区别，又提到太阳病发汗过多导致痉病，那么痉病属于燥证是可以知道的。所谓“痉”，是以症状命名，是因为血虚导致筋脉拘急罢了。六气为患，都能导致痉病。然而，不热就不会燥，不燥就不会形成痉病。六经都有痉病，必须审查病变部位来加以区分。身体后部属太阳经，所以凡是头项僵硬紧急，头背部拘挛不舒，脊柱强直反张，腰部像折断一样疼痛，大腿不能弯曲，阴部收缩如结状，都是其症状。身体前部属阳明经，头项摇动，牙关紧闭，牙齿格格作响，缺盆穴处纽痛，脚部挛急，都是其症状。身体侧面属少阳经，口眼歪斜，手足牵引抽搐，两胁拘急，半身不遂，都是其症状。如果是腹部拘急，因呕吐腹泻导致四肢拘急，这是太阴痉病；恶寒蜷缩而卧，臀部着地代替脚跟，脊背弯曲代替头部，俯身而不能仰起，这是少阴痉病；睾丸上缩，宗筋下垂汇聚，小腹部内部急迫，阴部拘牵不适，膝胫部拘急，这是厥阴痉病。如果痉病兼夹风寒，其症状是发热无汗且恶寒，气逆冲撞胸部，小便量少，脉象必然坚紧，状态必然是强直且牙关紧闭。这是感受天之邪气，《内经》所说“诸暴强直，皆属于风”就是这种情况。其病势勇猛，所以称为刚痉。病自外来，应当驱散外邪而解表。如果有夹杂本经邪气而受外邪侵害的，其邪气从内出，所以发热汗出而不恶寒，脉象沉迟，症状则是项背强直，头背部拘挛不舒。这是感受地之邪气，《内经》所说“诸项强，皆属于湿”就是这种情况。其病势较弱，所以称为柔痉。病因在于内，应当滋阴以调和内在。治疗湿病以栝蒌根为主药，并非为了治风，实在是为了生津；并非为了治湿，实在是为了润燥罢了。痉病的开始，本来不是正病，必定夹杂在其他疾病之中。患此病的人，世俗医生都指认为风邪致病，所以不明白其中的道理。善于治病的医生，必定在其他症状中审察并预防它。比如头项强痛，就是痉病的一个端绪，这是因为太阳经血虚，所以筋脉拘急。现在的人只知道风寒，不顾惜津液，所以发汗太多，导致痉病的很多。痉病本有由来，一经误治，就会出现奇异的形态。项背强直拘挛，是痉病的征兆，所以用葛根；身体强直，是痉病的症状已经明显，所以用栝蒌根；卧床时背部不着席面，脚部挛急，牙关紧闭，牙齿格格作响，是痉病极其严重的表现，所以用大黄、芒硝。无非是用多津多液的药物，来滋养阴血，不能与应当发汗或应当攻下的情况同等看待。观察伤寒脉浮自汗，心烦恶寒，而出现脚部挛急，说明痉病的趋势已经形成，应当滋阴存液，不能仍然按照伤寒主治。所以给予桂枝汤会导致四肢厥冷，给予芍药甘草汤，脚部就能伸直，这是明确的验证。只是由于表症未除，不能使用承气汤。如果有谵语的情况，少量给予调胃承气汤，这与给背部不着席者使用大承气汤，机理是一样的。凡痉病这种病，因外邪损伤筋脉的少，因血虚筋脉拘急的多。如果误作风邪治疗，用辛散药物助长阳气，则真阴更加虚弱；因用燥剂驱风，则血液更加枯竭。所以痉病突然发作的少，因误治导致的居多。虚证如果不补，不死还等什么？如果不是人参、茯苓、当归、地黄等调和营卫的药物，不容易取得迅速疗效。《内经》说：“诸湿肿满，皆属于脾。”又说：“湿胜则濡泄。”这是指湿邪伤于体内的说法。又说：“地之湿气，感则害人皮肉筋骨。”又说：“因于湿，首如裹。”这是指湿邪伤于体外的说法。如果湿邪兼夹热邪，则大筋缩短而导致拘挛，小筋弛长而导致痿软，这就是柔痉的变证了。《伤寒论》阳明篇有湿热发黄的症状，王叔和不为这些单独论述，只选取太阳风湿相传的条文，还遗漏了几条，这也是搜集采录时的疏失。《内经》说：“身半以上者，风中中也。身半以下者，湿中也。”中于阳经则流注于经，中于阴经则流注于腑。又说：“阳受风气，阴受湿气。”所以伤于风邪的，上部先受病；伤于湿邪的，下部先受病。这都是风湿对举而言。《伤寒论》则是风湿合言。风湿相合，则阴阳相传，上下内外反而生病。所以身体烦疼，不能转侧，骨节掣痛，不能屈伸，小便不利，大便反而通畅。《内经》说：“风湿之伤人也，血气与邪并，客于分腠之间，其势坚大，故曰实。”寒湿之中人也，皮肤松弛不收，肌肉坚紧，营血涩滞，卫气离去，故曰虚。这又是以血家的虚实，因风寒而区分的。《伤寒论》中伤寒发汗后，寒湿在里不解，身目发黄，与阳明之热不得越、瘀热在里导致身体发黄的病症，该下不该下，也是以寒湿、湿热来分虚实了。《内经》认为风寒湿三气合而为痹，《伤寒论》又合风寒湿热四气，命名为湿痹。应当知道痹与痉，都是由湿变化而来的。同样是湿，湿去燥极则成为痉，久留附着则成为痹。痹是实证，痉是虚证，痹与痉形态不同，虚实也殊异。固然不能妄将痉归属于风，也不能因为源于湿，就竟将痉视为湿。关于痉与湿的其他含义，详见《内经》注及《伤寒论》注中。
Wind, cold, dampness, summerheat, dryness, and heat—these six qi (pathogenic factors) causing disease can all lead to fever. However, cold and heat are interrelated, and summerheat follows heat; only dryness and dampness are opposite in nature. Wind, cold, warmth, and summerheat are often caused by changes in the heavenly qi (weather), whereas dampness diseases are mostly due to earthly qi (damp environment), and dryness diseases are mostly due to internal factors such as fluid deficiency. This is the difference and similarity in etiology. In the Nineteen Pathomechanisms of the *Neijing* (*Huangdi Neijing*), among those attributed to the six qi, fire occupies two positions (Ministerial Fire and Sovereign Fire), while wind, cold, and dampness each occupy one, with no specific entry for dryness syndromes. If it is stated that "all stiffness of the neck and back belongs to dampness," I have previously suspected it should belong to dryness. Now, with the distinction between Gang Jing (Stiff Spasm) and Rou Jing (Soft Spasm) in this treatise, and the statement that excessive sweating in Taiyang disease leads to Jing, it is evident that Jing belongs to dryness. The term "Jing" is named after its symptoms, which arise from blood deficiency causing tendon tension. All six qi pathologies can cause Jing. However, without heat, there is no dryness; without dryness, Jing does not form. Jing diseases occur in all six meridians; one must examine the location to differentiate them. The posterior body belongs to the Taiyang meridian; thus, any stiffness and tightness of the head and neck, rigidity of the head and back, opisthotonos (spinal arching), waist pain as if broken, inability to flex the thighs, and contraction of the genitalia are its symptoms. The anterior body belongs to the Yangming meridian; thus, shaking of the head and neck, trismus (lockjaw), grinding of teeth, pain in the supraclavicular fossa, and leg cramps are its symptoms. The lateral body belongs to the Shaoyang meridian; thus, facial paralysis (deviation of mouth and eyes), traction of hands and feet, hypochondriac tension, and hemiplegia are its symptoms. If there is abdominal tension, or limb tension due to vomiting and diarrhea, this is Taiyin Jing. Aversion to cold, curling up to sleep, sitting on the buttocks instead of using heels, bending the spine forward instead of holding the head upright, and inability to extend the trunk backward indicate Shaoyin Jing. Retraction of the testes, sinking of the Zongjin (major tendons), urgency in the lower abdomen, pulling sensation in the yin region, and tension in the knees and shins indicate Jueyin Jing. If Jing is complicated by wind and cold, symptoms include fever, absence of sweating, aversion to cold, Qi rushing up to the chest, scanty urination, a firm and tight pulse, and rigid posture with lockjaw. This results from heavenly pathogens, consistent with the *Neijing* saying, "All sudden stiffness belongs to wind." Its momentum is fierce, hence called Gang Jing (Stiff Spasm). Since the pathogen comes from outside, one should dispel the external pathogen to resolve the exterior. If there is an internal pathogen combined with external invasion, the pathogen emerges from within, resulting in fever, sweating, absence of aversion to cold, a deep and slow pulse, and stiffness of the neck and back with rigidity of the head and back. This results from earthly pathogens, consistent with the *Neijing* saying, "All stiffness of the neck and back belongs to dampness." Its momentum is weaker, hence called Rou Jing (Soft Spasm). Since the etiology is internal, one should nourish Yin to harmonize the interior. Treating dampness with Gualougen (Trichosanthis Radix) is not primarily to treat wind, but to generate fluids; not primarily to treat dampness, but to moisten dryness. At its onset, Jing is not a primary disease but is always mixed with other diseases. Physicians of the world often attribute it to wind, failing to understand the principle. Skilled physicians must examine and prevent it amidst other symptoms. For instance, stiffness and pain of the head and neck are an early sign of Jing, caused by Taiyang blood deficiency leading to tendon tension. Nowadays, people only consider wind and cold, neglecting body fluids; thus, excessive sweating frequently leads to Jing. Jing has its origins; improper treatment of even one stage will reveal bizarre forms. Stiffness and rigidity of the neck and back are signs of Jing, so Gegen (Puerariae Radix) is used. Generalized body stiffness indicates established Jing, so Gualougen is used. Inability to lie flat on the bed, leg cramps, and severe lockjaw with tooth grinding indicate extreme Jing, so Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) are used. These are all agents rich in fluids to nourish Yin and blood; they cannot be treated like cases requiring diaphoresis or purgation. Observing Taiyang disease with floating pulse, spontaneous sweating, irritability, aversion to cold, and leg cramps indicates that Jing is developing; one must nourish Yin and preserve fluids, not treat it merely as Taiyang disease. Therefore, giving Guizhi Tang (Cinnamon Twig Decoction) would cause cold limbs, while Shaoyao Gancao Tang (Peony and Licorice Decoction) would relieve the leg cramps, which is clear evidence. However, since exterior symptoms remain, Chengqi formulas should not be used. If delirium occurs, a small dose of Tiaowei Chengqi Tang (Regulate the Stomach and Order the Bowels Decoction) may be given, which shares the same mechanism as using Dachengqi Tang (Major Order the Bowels Decoction) for those unable to lie flat. Generally, Jing is rarely caused by external pathogens damaging tendons but mostly by blood deficiency causing tendon tension. If mistakenly treated as wind, using acrid-dispersing herbs to boost Yang will further deplete True Yin; using drying herbs to expel wind will further desiccate the blood. Thus, acute onset of Jing is rare, while that caused by mis-treatment is common. Deficiency without tonification leads to death; without herbs like Renshen (Ginseng Radix), Renchen (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Shudihuang (Rehmanniae Radix Praeparata) to harmonize Ying and Wei, quick recovery is unlikely. The *Neijing* states: "All dampness, swelling, and fullness belong to the Spleen." It also says: "Excess dampness leads to loose stools." This refers to dampness injuring the interior. It also says: "Earthly dampness, when contracted, harms skin, flesh, sinews, and bones." And: "Due to dampness, the head feels wrapped." This refers to dampness injuring the exterior. If dampness combines with heat, large tendons shorten causing spasm, and small tendons relax causing flaccidity; this is a variation of Rou Jing. The Yangming chapter mentions yellowing due to damp-heat; Wang Shuhe did not discuss this separately but only selected Taiyang wind-damp transmission, missing several clauses, which is a lapse in compilation. The *Neijing* states: "The upper half of the body is struck by wind; the lower half by dampness." Striking Yang channels flows into the meridians; striking Yin channels flows into the fu organs. It also says: "Yang receives wind qi; Yin receives damp qi." Thus, wind injuries affect the upper part first; damp injuries affect the lower part first. These are mentioned in opposition. This treatise mentions wind and damp together. When wind and damp combine, Yin and Yang transmit to each other, causing illness in upper/lower and interior/exterior. Symptoms include bodily restlessness and pain, inability to turn over, joint pulling pain, inability to flex or extend, dysuria, and loose stools. The *Neijing* states: "When wind and damp injure humans, Qi and Blood merge with the pathogen, lodging between the fenli (muscle intervals); its momentum is firm and large, hence termed Excess (Shi)." When cold and damp injure humans, the skin becomes lax, muscles become firm and tight, Ying blood becomes stagnant, and Wei Qi departs; hence termed Deficiency (Xu). This differentiates based on the excess or deficiency of the blood system due to wind and cold. In this treatise, after sweating for Taiyang cold, if cold-damp remains unresolved internally, causing jaundice of the body and eyes, this differs from Yangming heat trapped inside causing jaundice, which requires purgation. This again distinguishes excess and deficiency based on cold-damp versus damp-heat. The *Neijing* holds that wind, cold, and dampness combine to form Bi (Obstruction) syndrome; this treatise adds heat to form Wet-Bi. One must know that both Bi and Jing transform from dampness. The same dampness, when dried out excessively, becomes Jing; when lingering and attaching, it becomes Bi. Bi is Excess; Jing is Deficiency. Bi and Jing differ in form and excess/deficiency status. One must not rashly attribute Jing to wind, nor, because it originates from dampness, simply view Jing as dampness. Other meanings regarding Jing and dampness are detailed in the annotations of the *Neijing* and this treatise.