伤寒所致。太阳痉湿 三种。宜应别论。以为与伤寒相似。故此见之。（痉俗作 ）
太阳病发热无汗。反恶寒者。名曰刚痉。
本寒伤寒。故发热无汗病至痉邪入深矣。而犹恶寒者。经中故也。寒伤营血。则经脉不利。故身强直。而为刚痉也。
○金匮又有太阳病无汗。而小便反少。气上冲胸。口噤不能言。欲作刚痉。葛根汤主之。一条即是申明此条之义。而补
其治法也。无汗而小便少者。以太阳阳明二经之热聚于胸中。延伤肺金清肃之气。内外不能宣通故也。
太阳病。发热汗出不恶寒者。名曰柔痉。
本风伤卫。故发热汗出不恶寒。以风伤卫气腠理疏。故汗出身柔但汗出太过。则经脉空虚。虽似稍缓。而较之刚痉
尤甚。以其本虚故也盖刚痉属阳为邪。胜柔痉属阴为血虚。故治法有不同耳。○金匮又有太阳病。其证备。身体强KT
KT然。脉反沉迟。此为痉栝蒌桂枝汤主之。即桂枝汤加栝蒌根二两。其证备。则发热汗出等证。不必赘矣。○伤寒方
中用桂枝加葛根汤矣。此以脉之沉迟。知在表之邪。为内湿所持不解。即系湿热二邪交合。不当从风寒之表法起见。故
不用葛根。而改用栝蒌根变。表法为利法也。
太阳病发热脉沉而细者。名曰痉。
脉沉细者。湿胜而致痉也。病发热脉当浮数。而反沉细知邪。风为湿气所着。所以身虽发热而脉不能浮数。是阳证
见阴脉。故金匮指为难治也。治此者。急宜麻黄附子细辛汤。温经祛湿。勿以沉细为湿证之本脉而忽之也。
太阳病发汗太多因致痉。
发汗太多。则经虚风袭虽曰属风而实经虚邪盛之候。非真武汤必难救疗也。
病身热足寒。颈项强忽恶寒。时头热无汗。目脉赤独头面摇。卒口噤背反张者。痉病也。
身热足寒者。伤湿而中风也。其下病证皆风虚湿搏之候。盖风主动摇。湿主拘急风主阳。本乎天者亲上。是以独头
面摇。湿主阴本乎地者亲下。是以足胫。寒逆也。金匮此条下。又多若发汗者。寒湿由搏其表益虚。即恶寒甚发其汗已
其脉如蛇六句。发汗反恶寒者。以但用表药而不加术故也。汗后其脉如蛇者。汗出之时。阳气发外。其脉必洪盛。汗后
气门乃闭。阳气退潜。寒湿之邪。得汗药引之于外。所以其脉复见浮素。而指下。迟滞不。前有似蛇行之状耳。○按金
匮此后复有五条。其一云。夫风病下之则痉。发汗必拘急盖风病。而热者其邪已应于筋脉。若更下之则伤其营血。筋无
养而成痉。汗之则伤其卫气。脉无养而拘急矣。其一云。暴腹胀大为欲愈。脉如故反伏弦者。痉盖脾。土得木火而为暴
胀。知火之郁于肝者。已出之脾木火气行则脉当浮大。今不浮大而如故。知风犹郁在肝。则筋病而成痉矣。然此必暴胀
之先已见欲解之证。故云其一云。夫痉脉紧如弦直上下行。盖紧直如弦肝脉也。而直上下行。则又属督脉为病。所以皆
强而厥也。与脉经痉家其脉伏坚直。上下同义。其一云。痉病有灸疮者难治。盖痉病风热燥急不当。复灸以火。深入助
阳风热。得之愈固而不散也。其一云。痉为病。胸满口噤。卧不有席脚挛急必 齿可与大承气汤。盖热传阳明风。热极
深所以有如上诸证。非苦寒大下。不足以除其热救其阴也。夫伤寒病螈 以。热生风而搐。尚为难治。况此甚于搐者。
至若齿 足挛。而无内实下证。大便自行者必不可治。灵枢云。热而痉者死。腰折螈 齿 也。
以上痉病例。
太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。湿痹之候。其人小便不利。大便反快。但当利其小便。
关节疼痛而烦者。言湿气留着筋骨。绊结之间。而发热烦疼也。脉沉而细明系湿证。虽疼处烦热。必非风寒。是当
利水为要也。○大抵此证。当利小便以通阳气。今为湿气内胜。故小便不利。利之则阳气行。虽在关节之湿。亦得宣泄
矣。设小便利已而关节之痹不去。又当从表治之。
湿家之为病。一身尽疼发热。身色如以熏黄。
湿证发黄。须分寒热表里。湿热在里茵陈蒿汤。在表栀子柏皮汤。寒湿在里。白术附子汤。在表麻黄加术汤。此寒
湿在表而发黄也。金匮有云。湿家身烦疼。可与麻黄加术汤。发其汗为宜。慎不可以火攻之。盖湿与寒合。故令身疼。
以湿着在表。表间阳气不盛。故不可大发其汗。是以用麻黄汤。必加白术以助脾。祛湿也。麻黄得术。则汗不致于骤发。
术得麻黄。而湿滞得以宣通。然湿邪在表。惟可汗之。不可火攻。火攻则增其热。必有发黄之变。故戒之。
湿家其人但头汗出。背强欲得被覆。向火若下之。早则哕胸满小便不利舌上如苔者。以丹田有热胸中有寒。渴欲得
水。而不能饮。则口燥烦也。
此寒湿相搏也。太阳寒气在经。故令人欲得被覆向火。皆强头汗。若认作里有实热。上蒸头汗。而误下之。必致于
哕。而胸满小便不利也。下后阳气下陷。故丹田有热。而胸中反有寒饮结聚。妨碍津液。是以口燥烦渴不能饮也。何以
见其胸中有寒。以舌上如苔白滑故知之。治宜黄连汤。和其上下寒热之邪。则诸证逸然分解矣。
湿家病之额上汗出微喘。小便利者死。若下利不止者亦死。
此本湿家身烦痛。可与麻黄加术汤发其汗之例。因误下之致有此逆额上汗出微喘者。阳之越也。小便利与下利不止
者。阴之脱也。阴阳离决必死之兆自此而推之虽额上汗出微喘。若大小便不利者是阴气未脱而阳之根犹在也。下之虽大
小便利。若额上无汗不喘。是阳气不越。而阴之根犹在也。则非离火可以随其虚实而救之。至于下利不止。虽无头汗喘
逆阳气上脱之候亦死。又有下利不止小便反秘而额上汗出者。谓之关经云关格不通头无汗者。可治有汗者死。
问曰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。何也答曰发其汗汗大出者。
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。
风湿相搏法当汗出而解合用桂枝加术。使微微蒸发表里。气和风湿俱去。正如湿家身烦痛。可与麻黄加术汤同义。
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。
日晡所剧者。阳明之气旺于申酉也。金匮云可与麻黄杏仁薏苡甘草汤。盖麻黄加术汤是主寒湿。防己黄 汤。是主
风湿。此则寒湿风湿合病也。所以此条之后。金匮则继之以风湿。脉浮身重汗出恶风。防己黄 汤主之一条。盖风湿皆
从阳受其病在外。故脉浮。汗出身重。由是以黄 实卫。甘草佐之防己去湿。白术佐之。然治风湿二邪。独无去风之药。
以汗多知风已不留。表虚任风出入乎其间。因之恶风惟客其卫。正气旺则风自退也。至服后当如虫行皮中腰下如水。后
坐被上。又以一被绕腰下。温令微汗。瘥等语。皆有精义。不可忽也。
湿家病。身上疼痛发热。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。
湿家必脉沉细。饮食减小。今脉大能食。但头痛鼻塞。正内经所谓因于湿。首如裹是也。与瓜蒂散内鼻中。取下黄
水则愈。
以上中湿例。
太阳中热者。 是也。其人汗出恶寒。身热而渴也。
成注谓汗出恶风。身热不渴者中风也。汗出恶寒而渴者。中 也。然未明其至理。盖此证为时火之气。烁其肺金。
肺伤则卫气虚。由是汗出身热恶寒。即内经所谓膈消。皆相火伤肺之所致。金匮主以白虎加人参汤救肺为主也。
太阳中 者。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。合小有劳。身即热口开前板齿燥。
若发汗则恶寒甚。加温针则发热甚。数下之则淋甚。
发热恶寒身重而疼。太阳中 表证也。表证脉当浮。今不能浮。而反弦细芤迟者。明系元气不足。不能鼓动。其脉
于外。盖弦细者。阳虚也。芤迟者阴虚也。阴阳俱虚。故不胜劳。小便已洒然毛耸者。太阳经火气内伏也。手足逆冷。
太阴气弱。不胜时火也。口开前板齿燥者。阳明中 之本证。亦津液内伤之确微。所以发汗复虚其卫。则恶寒甚。温
针复损其营。则发热甚。下之复伤其胃则淋甚。以夏月阴气在内故也。灵机所谓阴阳俱不足。补阳则阴竭。补阴则阳亡。
惟宜甘药补正以解其热。东垣制清暑益气汤。深得其旨。然仲景俱言太阳。而不言脾肺者。以热邪炽甚。则寒水必致受
困耳。
太阳中 者。身热疼重。而脉微弱。此以夏月伤冷水。水行皮中所致也。
成注谓脉虚身热得之伤暑。然脉微者 也。身体疼重者水也。夏月暑热以水灌洗而致病一物瓜蒂汤主之。观仲景论
惟出三证。岂偶然哉。举其端。将为后世准绳。一者明其 中。表热。一者言其表里俱虚。此则外邪郁时火而成中 。
若是邪郁时火。比类而推其因殆有不可胜言。如取凉风者。感雾露者。食生冷者。素有积热者。阴血素虚不胜。大热者。
宿邪感动者。处阴湿地者。凡是之类。皆足以郁其时火。为中 之病。或轻或重。或表或里。或虚或实。随证发见。若
论其治邪退热。较量权衡。岂一言而尽哉。○按仲景论 三条。首言动而得之之病谓中 。属外因。次言静而得之之病。
虽曰中 。实暑病也。属内因。未言因热伤冷之病。乃中 之变证。属不内外因。不得以三者混称也。
以上中 例。
病加桂枝证头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉不得息者。此为胸中有寒也。当吐之宜瓜蒂散。诸
亡血虚家不可与瓜蒂散。
痰饮内动身必有汗加以发热恶寒。全似中风。但头不痛项不强。此非外入之风邪。乃内蕴之寒痰窒塞胸间。宜用瓜
蒂散之苦寒。合小豆之利水。香豉之散邪。以快涌膈上之实痰。内经所谓其高者。因而越之也。诸失血虚家禁用者。亡
血而复用吐。则气亦虚。虚家而复用吐。则损其阴。所以为禁也。
病患手足厥冷。脉乍紧者。邪结在胸中。心下满而烦饥不能食者。病在胸中。当须吐之。宜瓜蒂散。
手足厥冷。与厥阴之厥深热深相似。其脉乍紧则有时不紧。殊不似矣。可见痰结在胸中。随气上下。故脉时紧时缓。
而烦满不能食也。○此条旧在厥阴。而辨不可吐下。复有一条云病患手足厥冷。脉乍结以客气在胸中心下满而烦欲食不
能食者。病在胸中。当吐之与此无异。但此云脉乍紧。彼云脉乍结。紧则寒。饮结聚。结则痰饮伏匿之脉。皆属瓜蒂散
证。不必两存也。然此手足厥逆。亦属寒饮宿病与厥阴病证何预哉。
病胸上诸实。胸中郁郁而痛不能食欲传人。按之而反有涎唾。下利日十余行。其脉反迟寸口脉微滑此可吐之。吐之
利则止。
痛不得食按之反有涎唾者。知有寒痰在胸中也。下利脉迟寸口微滑者。为膈上实。故吐之则利自止也。○合三条但
见痰证可吐不可汗。合食积虚烦香港脚四证论之。勿指为类伤寒。但指为不可发汗。则其理甚精。盖食积已是胸中阳气不
布更发汗则阳外越不团。阴气用事。愈成危候。虚烦则胃中津液已竭。更发汗则津液尽耗矣。香港脚即地气之湿。邪从足
先受。正湿家不可发汗之义耳。
以上痰证例。
问曰人病有宿食何以别之。师曰。寸口脉浮而大。按之反涩尺中亦微。而涩故知有宿食当下之宜大承气汤。
寸口即气口。灵枢经脉对代人迎而言也气口脉浮取之大而按之反涩尺中亦微而涩。此以胃中营气受伤。所以气口脉
虽浮大。而不能滑实。重按反涩也尺中亦微而涩。以其腐秽已归大肠肺与大肠为表里。故其脉自应涩也。所谓亦微而涩
亦字从上贯下言浮大。而按之略涩。非涩弱无力之谓见浮大。中按之略涩方可用大承气下之。设纯又当从枳实理中助胃
消导之药矣岂复为大承气证乎。○此条下金匮有脉数而滑者实也。此有宿食下之愈宜大承气汤。数为在腑滑则流利。如
珠此为实也盖宿食在腑。有诸中形之外也。
下利不欲食者以有宿食。故也当下之与大承气汤。
不欲食非不能食乃伤食恶食之明征也。
下利脉反滑当有所去下之乃愈。宜大承气汤。
下利恐为阴寒。及肠胃虚冷滑脱不止。今脉见滑实。知为热邪内结。当有所去不可止遏宜与大承气攻其实热。腐秽
去而利自止耳。
下利三部脉皆平。按之心下硬者。急下之宜大承气汤。
下利三部脉皆平。其人元气本强也。且按之心下硬者。为食滞中宫无疑。
下利脉迟而滑者。内实也。利未欲止当下之。宜大承气汤。
脉迟为阳明结滞之候。迟而不滑为结未定硬不可攻也。今迟而滑实虽自利亦须下之。下后里气得通则脉自不滑亦不
迟耳。
病腹中满痛者。此为实也。当下之宜大承气汤。
腹中痛而不满者。为阴寒满。平不痛者。为虚气。此既满且痛。为实结无疑急须下之。
宿食在上脘者当吐之。
宿食本不当吐。以其人素多痰饮。载宿食于上脘。故宜用吐法。其高者固宜越之也。○此条金匮多宜瓜蒂散。四字
伤寒病所致的痉、湿、热（暑）三种病证，应当分别论述。因为它们与伤寒症状相似，所以在此一并列出。（“痉”字俗写为“痓”。）
太阳病表现为发热、无汗，反而恶寒的，称为刚痉。
这是因为感受寒邪而患伤寒，所以发热无汗。病情发展到痉挛阶段，邪气已深入，但仍然恶寒，这是经脉受寒的缘故。寒邪损伤营血，导致经脉运行不畅，所以身体强直，形成刚痉。
○《金匮要略》中还有关于太阳病无汗，小便反而减少，气上冲胸，口噤不能说话，即将发生刚痉的记载，用葛根汤主治。这一条就是阐明上述条文的意义，并补充其治疗方法。无汗且小便少，是因为太阳、阳明两经的热邪聚集于胸中，进而损伤肺金清肃下降的气机，导致内外之气不能宣通。
太阳病表现为发热、出汗、不恶寒的，称为柔痉。
这是因为风邪损伤卫气，所以发热出汗且不恶寒。由于风邪伤及卫气，腠理疏松，所以出汗。如果出汗过多，经脉就会空虚，虽然症状看起来比刚痉稍缓，但实际上比刚痉更严重，因为本质是虚证。大概刚痉属于阳证，由邪气盛实所致；柔痉属于阴证，由血虚所致，所以治疗方法有所不同。○《金匮要略》中还有太阳病，症状具备，身体强直拘挛，脉象反而沉迟的，这是痉病，用栝蒌桂枝汤主治。即桂枝汤加栝蒌根二两。既然说“症状具备”，那么发热出汗等症状就不必赘述了。○在伤寒方剂中已经使用了桂枝加葛根汤，这里因为脉象沉迟，知道在表的邪气被内湿束缚而不能解除，即是湿热两种邪气交合，不应当从风寒表证的方法考虑，所以不用葛根，而改用栝蒌根，将解表法变为利湿法。
太阳病发热，脉象沉而细的，称为痉。
脉象沉细，是湿气胜而致痉。患病发热，脉象应当浮数，反而沉细，可知邪气被风夹带，被湿气附着，所以身体虽然发热，脉象却不能浮数。这是阳证见到阴脉，所以《金匮要略》指出难以治疗。治疗此证，急宜用麻黄附子细辛汤，温经祛湿，不要因为脉象沉细认为是湿证的本脉而忽视它。
太阳病发汗太多，因此导致痉病。
发汗太多，则经脉空虚，风邪乘袭。虽然说是属风，实际上是经脉虚而邪气盛的证候，不用真武汤很难救治。
病人身体发热，脚冷，颈项强直，突然恶寒，有时头部发热无汗，眼睛血脉红赤，只有头面部摇动，突然口噤，背反张的，是痉病。
身体发热脚冷，是伤湿又中风。其下部病症都是风虚与湿邪搏结的表现。大概风主动摇，湿主拘急。风属阳，本乎天者亲上，所以只有头面部摇动；湿属阴，本乎地者亲下，所以足胫寒冷逆乱。《金匮要略》在这条下面，又多出若发汗者，寒湿因搏结于体表更加虚弱，于是恶寒很厉害，发汗后其脉如蛇行等六句。发汗后反而恶寒的，是因为只用解表药而不加白术的缘故。发汗后脉象如蛇行，是在出汗的时候，阳气发散于外，脉象必然洪盛；汗后毛孔关闭，阳气退潜，寒湿之邪，被汗药引至体外，所以脉象再次出现浮涩，而在指下感觉迟滞不畅，前面有类似蛇爬行的样子。○按《金匮要略》此后又有五条。其一说：风病如果用下法就会变成痉，发汗必定拘急。大概风病而有热的，邪气已经应于筋脉，如果再下之，就会损伤营血，筋脉失去滋养而成痉；发汗就会损伤卫气，脉道失去滋养而拘急。其一说：突然腹胀大是想要痊愈，脉象如故反而伏弦的，是痉。大概脾土得木火之气而突然腹胀，知道火郁在肝者，已经出于脾，木火气行则脉应当浮大，现在不浮大而如故，知道风仍然郁在肝，则筋病而成痉。然而这必须在突然腹胀之前已经见到想要解除的证候，所以说。其一说：痉病的脉紧如弦，直上下行。大概紧直如弦是肝脉，而直上下行，则又属于督脉为病，所以都出现强直和厥逆。这与《脉经》中痉家其脉伏坚直上下同义。其一说：痉病有灸疮的难治。大概痉病风热燥急，不应当再用火灸，火深入助长阳和风热，得到它就更坚固而不散。其一说：痉病，胸满口噤，卧时没有席子（形容角弓反张），脚挛急，必齘齿（磨牙），可与大承气汤。大概热传阳明，风热极深，所以有如上诸证，非苦寒大下，不足以清除其热，救其阴液。夫伤寒病出现抽搐，因为热生风而抽搐，尚且难治，何况这比抽搐更严重的呢？至于到牙齿咬合、脚挛急，而没有内实下证的，大便自行通畅的，必不可治。《灵枢》说：热而痉的会死，腰折抽搐，牙齿咬合。
以上是痉病的病例。
太阳病，关节疼痛而且烦扰，脉象沉而细的，这名叫湿痹。湿痹的证候，其人小便不利，大便反而快利，只应当利小便。
关节疼痛而烦扰，是说湿气留着在筋骨之间，绊结在那里，而发热烦疼。脉象沉细明确是湿证，虽然疼痛处烦热，必定不是风寒，应当以利水为主要治法。○大抵此证，应当利小便以通阳气，现在因为湿气内盛，所以小便不利，利小便则阳气运行，即使在关节的湿气，也能宣泄。假如小便通利后关节的痹症不去除，又应当从表证治疗。
湿病患者生病，全身都疼痛，发热，身体颜色像被烟熏过的黄色。
湿证发黄，必须区分寒热表里。湿热在里用茵陈蒿汤，在表用栀子柏皮汤；寒湿在里用白术附子汤，在表用麻黄加术汤。这是寒湿在表而发黄。《金匮要略》说：湿病患者身体烦痛，可用麻黄加术汤，发其汗为宜。千万不要用火攻法。大概湿与寒结合，所以令身体疼痛，因为湿着在体表，表间阳气不盛，所以不可以大发其汗。因此用麻黄汤，必须加白术以助脾祛湿。麻黄得到白术，则汗不至于骤发；白术得到麻黄，而湿滞得以宣通。然而湿邪在表，只可汗之，不可火攻，火攻则会增加其热，必有发黄的变证，所以告诫。
湿病患者，其人只是头部出汗，背部强直，想要盖被子，靠近火源。如果过早使用下法，轻则呃逆，胸满，小便不利，舌上像有苔一样，这是因为丹田有热，胸中有寒，口渴想喝水，但不能喝，所以口燥烦。
这是寒湿相搏。太阳寒气在经脉，所以令人想要盖被子靠近火源，背部强直，头部出汗。如果误认为里有实热，热气上蒸头部出汗，而误用下法，必定导致呃逆，胸满，小便不利。下法后阳气下陷，所以丹田有热，而胸中反而有寒饮结聚，妨碍津液，所以口燥烦渴不能喝。怎么知道胸中有寒？因为舌上像苔白滑，所以知道。治疗适宜用黄连汤，调和上下寒热之邪，则诸证自然分解。
湿病患者，额头出汗，微喘，小便利的死。如果下利不止的也死。
这本是湿病患者身体烦痛，可用麻黄加术汤发其汗的例子，因为误用下法导致有此逆证。额头出汗微喘，是阳气外越。小便利与下利不止，是阴气脱失。阴阳离决，是必死的征兆。由此推之，虽然额头出汗微喘，如果大小便不利，是阴气未脱而阳之根犹在；如果下法后大小便利，如果额头无汗不喘，是阳气不外越而阴之根犹在，则不是离绝之火，可以随其虚实而救治。至于下利不止，虽然没有头汗喘逆，阳气上脱的证候，也死。又有下利不止，小便反而秘结而额头出汗的，叫做关格。《内经》云：关格不通，头无汗的，可治；有汗的死。
问曰：风湿相搏，全身都疼痛，方法应当汗出而解。正值天下雨不停，医生说此病可发汗，发汗后病不愈，为什么呢？答曰：发其汗，汗出太多的，但风气去，湿气在，所以不愈。如果治疗风湿，发其汗，只要微微似欲出汗的，风湿俱去。
风湿相搏，法当汗出而解，合用桂枝加术汤，使微微蒸发表里，气和，风湿俱去。正如湿病患者身体烦痛，可用麻黄加术汤，意义相同。
病人全身都疼痛，发热，日晡时分加剧的，这名叫风湿。此病是由于出汗当风，或久伤取冷所导致的。
日晡时分加剧，是因为阳明之气旺于申酉时。《金匮要略》说可与麻黄杏仁薏苡甘草汤。大概麻黄加术汤是主治寒湿，防己黄芪汤是主治风湿，此则是寒湿风湿合病。所以此条之后，《金匮要略》继之以风湿，脉浮身重汗出恶风，防己黄芪汤主治的一条。大概风湿皆从阳受其病在外，所以脉浮，汗出身重，因此用黄芪固护卫气，甘草佐之，防己去湿，白术佐之。然而治疗风湿二邪，唯独没有去风的药，因为汗多知道风已不留，表虚任风出入乎其间，因此恶风，只有客于卫分，正气旺则风自退。至于服药后应当如虫行皮中，腰下如水，后坐在被子上，又以一被绕腰下，温令微汗，病愈等语，都有精义，不可忽视。
湿病患者生病，身上疼痛，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，所以鼻塞，内药鼻中则愈。
湿病患者必定脉沉细，饮食减小，现在脉大能食，只是头痛鼻塞，正是《内经》所谓因于湿，首如裹。用瓜蒂散纳入鼻中，取下黄水则愈。
以上是中湿的病例。
太阳中热者，就是暍（暑）病。其人汗出恶寒，身热而渴。
成无己注解说：汗出恶风，身热不渴的是中风；汗出恶寒而渴的是中暍。然而没有阐明其中的道理。大概此证为时令火热之气，灼烁肺金，肺伤则卫气虚，由此汗出，身热恶寒，即《内经》所谓膈消，都是相火伤肺所导致。《金匮要略》主张用白虎加人参汤救肺为主。
太阳中暍者，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，稍有劳作，身即热，口开前板齿燥。如果发汗则恶寒甚，加温针则发热甚，多次下之则淋甚。
发热恶寒身重而疼，是太阳中暍的表证。表证脉应当浮，现在不能浮，反而弦细芤迟，明确是元气不足，不能鼓动脉气于外。大概弦细是阳虚，芤迟是阴虚，阴阳俱虚，所以不胜劳。小便已洒然毛耸，是太阳经火气内伏。手足逆冷，是太阴气弱，不胜时令火热。口开前板齿燥，是阳明中暍的本证，也是津液内伤的确实征象。所以发汗复虚其卫，则恶寒甚；温针复损其营，则发热甚；下之复伤其胃，则淋甚，因为夏月阴气在内。灵枢所谓阴阳俱不足，补阳则阴竭，补阴则阳亡，只适宜甘药补正以解其热。东垣制清暑益气汤，深得其中旨意。然而仲景都说太阳，而不说脾肺，是因为热邪炽盛，则寒水必致受困。
太阳中暍者，身热疼重，而脉微弱，这是夏月伤冷水，水行皮中所导致的。
成无己注解说：脉虚身热，得之于伤暑。然而脉微是暍，身体疼重是水。夏月暑热用水灌洗而致病，用一物瓜蒂汤主治。看仲景论述只有三条，难道是偶然的吗？举其端绪，将为后世准绳。一是说明其暍中表热，一是言其表里俱虚，此则是外邪郁积时令火热而成中暍。如果是邪郁时令火热，类比推究其病因，大概有说不完的，如取凉风者，感雾露者，食生冷者，素有积热者，阴血素虚不胜大热者，宿邪感动者，处阴湿地者，凡是之类，都足以郁其时令火热，成为中暍的病。或轻或重，或表或里，或虚或实，随证发见。如果论其治邪退热，较量权衡，岂是一句话能说尽的？○按仲景论暍三条，首言动而得之的病谓之中暍，属外因；次言静而得之的病，虽曰中暍，实暑病也，属内因；未言因热伤冷的病，乃中暍之变证，属不内外因。不得以三者混称。
以上是中暍的病例。
病加上桂枝证，头不痛，项不强，寸脉微浮，胸中痞硬，气上冲咽喉不得息者，此为胸中有寒也，当吐之，宜瓜蒂散。各种亡血虚家不可与瓜蒂散。
痰饮内动，身体必定有汗，加上发热恶寒，全似中风。但头不痛项不强，这不是外入的风邪，乃是内蕴的寒痰窒塞胸间，适宜用瓜蒂散之苦寒，合小豆之利水，香豉之散邪，以快涌膈上之实痰。《内经》所谓其高者，因而越之。各种失血虚家禁用，是因为亡血再用吐，则气亦虚，虚家再用吐，则损其阴，所以为禁。
病患手足厥冷，脉乍紧的，邪结在胸中，心下满而烦饥不能食者，病在胸中，当须吐之，宜瓜蒂散。
手足厥冷，与厥阴之厥深热深相似。其脉乍紧则有时不紧，殊不相同。可见痰结在胸中，随气上下，所以脉时紧时缓，而烦满不能食。○此条旧在厥阴篇，而辨不可吐下，另有一条说：病患手足厥冷，脉乍结，以客气在胸中，心下满而烦欲食不能食者，病在胸中，当吐之与此无异。但这说脉乍紧，那说脉乍结，紧则寒饮结聚，结则痰饮伏匿之脉，都属于瓜蒂散证，不必两存。然而此手足厥逆，也属寒饮宿病，与厥阴病证有什么关系呢？
病胸上诸实，胸中郁郁而痛，不能食欲传人，按之而反有涎唾，下利日十余行，其脉反迟，寸口脉微滑，此可吐之，吐之利则止。
痛不得食，按之反有涎唾，知道有寒痰在胸中。下利脉迟，寸口微滑，为膈上实，所以吐之则利自止。○综合三条，只见痰证可吐不可汗，合食积虚烦香港脚四证论之，勿指为类伤寒，只指为不可发汗，则其理甚精。大概食积已是胸中阳气不布，更发汗则阳外越不固，阴气用事，愈成危候。虚烦则胃中津液已竭，更发汗则津液尽耗。香港脚即地气之湿，邪从足先受，正是湿家不可发汗之义。
以上是痰证的病例。
问曰：人病有宿食，何以别之？师曰：寸口脉浮而大，按之反涩，尺中亦微而涩，故知有宿食，当下之，宜大承气汤。
寸口即气口，《灵枢》经脉对代人迎而言。气口脉浮取之大而按之反涩，尺中亦微而涩，这是以胃中营气受伤，所以气口脉虽浮大，而不能滑实，重按反涩。尺中亦微而涩，以其腐秽已归大肠，肺与大肠为表里，故其脉自应涩。所谓“亦微而涩”，“亦”字从上贯下，言浮大而按之略涩，非涩弱无力之谓。见浮大中按之略涩方可用大承气下之。设纯涩，又当从枳实理中助胃消导之药矣，岂复为大承气证乎？○此条下《金匮》有脉数而滑者实也，此有宿食，下之愈，宜大承气汤。数为在腑，滑则流利，如珠，此为实也。大概宿食在腑，有诸中形之外也。
下利不欲食者，以有宿食故也，当下之，与大承气汤。
不欲食非不能食，乃伤食恶食的明证。
下利脉反滑，当有所去，下之乃愈，宜大承气汤。
下利恐为阴寒，及肠胃虚冷滑脱不止，今脉见滑实，知为热邪内结，当有所去，不可止遏，宜与大承气攻其实热，腐秽去而利自止耳。
下利三部脉皆平，按之心下硬者，急下之，宜大承气汤。
下利三部脉皆平，其人元气本强。且按之心下硬者，为食滞中宫无疑。
下利脉迟而滑者，内实也，利未欲止，当下之，宜大承气汤。
脉迟为阳明结滞之候，迟而不滑为结未定硬，不可攻也。今迟而滑实，虽自利亦须下之，下后里气得通则脉自不滑亦不迟耳。
病腹中满痛者，此为实也，当下之，宜大承气汤。
腹中痛而不满者，为阴寒；满不痛者，为虚气。此既满且痛，为实结无疑，急须下之。
宿食在上脘者当吐之。
宿食本不当吐，以其人素多痰饮，载宿食于上脘，故宜用吐法。其高者固宜越之。○此条《金匮》多“宜瓜蒂散”四字。
The three types of conditions—Jing (spasm), Shi (dampness), and Re/Shu (heat/summerheat)—caused by Shanghan (cold damage) should be discussed separately. Because their symptoms are similar to those of Shanghan, they are presented here together. ("Jing" is commonly written as "Chi".)
In Taiyang disease, if there is fever, anhidrosis (absence of sweating), and aversion to cold, it is named Gang Jing (rigid spasm).
This occurs because one contracted Shanghan due to cold pathogen, resulting in fever and anhidrosis. When the condition progresses to spasm, the pathogen has penetrated deeply, yet aversion to cold persists; this is due to the meridians being affected by cold. Cold damaging the Ying (nutritive) blood causes obstruction in the meridian circulation, leading to stiffness and rigidity of the body, thus forming Gang Jing.
○ The *Jin Gui Yao Lue* also states: In Taiyang disease, if there is no sweating, but urination is unexpectedly scanty, with Qi rushing upward to the chest, inability to speak due to trismus (lockjaw), and impending rigid spasm, Ge Gen Tang (Kudzu Decoction) should be administered. This clause elucidates the meaning of the previous clause and supplements its treatment method. The combination of anhidrosis and scanty urination results from heat pathogens gathering in the chest from both the Taiyang and Yangming meridians, thereby injuring the Lung Metal's descending and purifying Qi, preventing the free communication between the interior and exterior.
In Taiyang disease, if there is fever, diaphoresis (sweating), and absence of aversion to cold, it is named Rou Jing (soft spasm).
This occurs because Wind pathogen damages the Wei (defensive) Qi, leading to fever, sweating, and absence of aversion to cold. Since Wind damages the Wei Qi, causing the pores to open, sweating occurs. If sweating is excessive, the meridians become empty. Although the symptoms appear slightly less tense than in Gang Jing, the condition is actually more severe because the root deficiency is present. Generally, Gang Jing belongs to Yang patterns caused by excess pathogens, whereas Rou Jing belongs to Yin patterns caused by Blood deficiency; hence, their treatment methods differ. ○ The *Jin Gui Yao Lue* also states: In Taiyang disease, if the symptoms are complete, the body is stiff and spasmodic, and the pulse is unexpectedly deep and slow, indicating Jing disease, Gua Lou Gui Zhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used. This is Gui Zhi Tang (Cinnamon Twig Decoction) plus two liang of Gua Lou Gen (Trichosanthes Root). Since the symptoms are described as "complete," details such as fever and sweating need not be repeated. ○ In Shanghan formulas, Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudtu) has already been used. Here, because the pulse is deep and slow, it is known that the exterior pathogen is constrained by internal dampness, representing a combination of Damp-Heat pathogens. It should not be treated using methods for Wind-Cold exterior syndromes; therefore, Ge Gen is not used, but replaced with Gua Lou Gen (Trichosanthes Root), changing the exterior-releasing method to a method of draining dampness.
In Taiyang disease, if there is fever and the pulse is deep and thin, it is named Jing.
A deep and thin pulse indicates that Dampness is prevailing, causing spasm. In febrile diseases, the pulse should typically be floating and rapid; however, a deep and thin pulse suggests that the pathogen is carried by Wind and adhered to by Dampness. Thus, although the body is hot, the pulse does not float or rapid. This represents a Yang syndrome presenting with a Yin pulse, which is why the *Jin Gui Yao Lue* points out that it is difficult to treat. For treating this condition, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) should be urgently administered to warm the meridians and dispel dampness. One must not ignore the deep and thin pulse merely because it is considered the characteristic pulse of Dampness syndromes.
If Taiyang disease involves excessive sweating, it may lead to Jing disease.
Excessive sweating leads to emptiness in the meridians, allowing Wind pathogen to invade. Although it is attributed to Wind, it is essentially a pattern of meridian deficiency with strong pathogenic factors. Without Zhen Wu Tang (True Warrior Decoction), it would be difficult to save the patient.
If a patient presents with fever in the body but cold feet, stiffness in the neck and nape, sudden aversion to cold, occasional fever in the head without sweating, redness in the eye vessels, only shaking of the head and face, sudden trismus (lockjaw), and opisthotonos (arching of the back), this is Jing disease.
Fever in the body with cold feet indicates injury from Dampness combined with Wind. The lower-body symptoms are signs of Wind deficiency and Dampness binding. Generally, Wind governs movement and shaking, while Dampness governs contraction and urgency. Wind belongs to Yang and follows Heaven, tending toward the upper part; thus, only the head and face shake. Dampness belongs to Yin and follows Earth, tending toward the lower part; thus, the calves and shins are cold and rebellious. Following this clause in the *Jin Gui Yao Lue*, there are additional sentences regarding sweating: if sweating is induced, Cold-Damp binds to the exterior, causing greater weakness and severe aversion to cold; after sweating, the pulse resembles a snake's movement. If sweating induces severe aversion to cold, it is because only exterior-releasing herbs were used without adding Bai Zhu (Atractylodes Macrocephala Rhizome). After sweating, when the pulse resembles a snake, it is because during sweating, Yang Qi disperses outward, making the pulse surging and full; after sweating, the pores close, Yang Qi retreats inward, and the Cold-Damp pathogen, drawn outward by the sweating-inducing herbs, causes the pulse to reappear as floating and choppy, feeling sluggish under the fingers, resembling the slithering motion of a snake previously. ○ According to the *Jin Gui Yao Lue*, five more clauses follow. One states: If Wind disease is treated with purgatives, it becomes Jing; if treated with sweating, it results in stiffness. Generally, in Wind disease with heat, the pathogen has already affected the sinews; further purgation injures the Ying Blood, causing the sinews to lose nourishment and develop spasm; sweating injures the Wei Qi, causing the pulses to lose nourishment and become stiff. Another states: Sudden abdominal distension indicates impending recovery; if the pulse remains unchanged but becomes hidden and wiry, it is Jing. Generally, Spleen Earth experiencing Wood-Fire energy causes sudden distension; knowing that Fire stagnating in the Liver has moved to the Spleen, Wood-Fire Qi moving should result in a floating and large pulse. Now, since the pulse is not floating and large but unchanged, it indicates Wind still stagnates in the Liver, causing sinew pathology and spasm. However, this must occur after signs of resolution have appeared prior to the sudden distension. Another states: The pulse in Jing disease is tight like a string, running straight up and down. Tightness like a string is the Liver pulse, while running straight up and down indicates disease of the Du Mai (Governing Vessel), resulting in stiffness and厥 (reversal/collapse). This aligns with the *Mai Jing* stating that patients with Jing have a hidden, firm, and straight-up-and-down pulse. Another states: Jing disease with moxibustion sores is difficult to treat. Generally, Jing disease involves Wind-Heat and dryness/urgency; applying fire moxibustion allows Heat to penetrate deeper, assisting Yang and Wind-Heat, making them more entrenched and dispersed. Another states: In Jing disease, with chest fullness, trismus, inability to lie flat on a mat (due to opisthotonos), leg cramps, and teeth grinding (bruxism), Da Cheng Qi Tang (Major Order the Qi Decoction) can be given. Generally, Heat transmitting to the Yangming channel and extreme Wind-Heat cause these symptoms; only bitter-cold purgation is sufficient to clear the Heat and rescue the Yin fluids. Even in Shanghan, convulsions caused by Heat generating Wind are difficult to treat; how much more so for conditions worse than convulsions? As for bruxism and leg cramps without internal excess or lower fu organ symptoms, and with spontaneous bowel movements, it is incurable. The *Ling Shu* states: Death occurs in Heat-induced Jing, characterized by spinal rigidity, convulsions, and bruxism.
These are cases of Jing disease.
In Taiyang disease, if joint pain is accompanied by vexation and the pulse is deep and thin, this is named Shi Bi (Damp Bi). The manifestation of Shi Bi includes difficulty in urination and loose stools. The primary treatment should be to promote urination.
Joint pain with vexation indicates Dampness lingering in the bones and joints, causing heat and painful vexation. A deep and thin pulse clearly indicates a Dampness syndrome. Although the painful area feels hot and vexed, it is certainly not Wind-Cold; thus, promoting water metabolism is essential. ○ Generally, this condition requires promoting urination to unblock Yang Qi. Currently, internal excess of Dampness causes difficulty in urination; promoting urination allows Yang Qi to circulate, even dissipating Dampness in the joints. If, after urination becomes normal, the joint Bi syndrome persists, treatment should then focus on the exterior.
When a person suffering from Dampness experiences generalized body pain, fever, and a yellowish skin color resembling smoke staining,
Yellowing in Dampness syndromes must be differentiated into Cold-Heat and Interior-Exterior. For Damp-Heat in the interior, Yin Chen Hao Tang (Artemisia Capillaris Decoction) is used; for Damp-Heat in the exterior, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) is used. For Cold-Damp in the interior, Bai Zhu Fu Zi Tang (Atractylodes and Prepared Aconite Decoction) is used; for Cold-Damp in the exterior, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) is used. This case describes Cold-Damp in the exterior causing yellowing. The *Jin Gui Yao Lue* states: For Dampness patients with painful vexation, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) can be used to induce mild sweating. Fire therapy must strictly be avoided. Generally, the combination of Dampness and Cold causes body pain; because Dampness adheres to the exterior and Yang Qi in the exterior is insufficient, heavy sweating should not be induced. Therefore, Ma Huang Tang (Ephedra Decoction) is used with added Bai Zhu (Atractylodes Macrocephala Rhizome) to assist the Spleen in dispelling Dampness. With Bai Zhu, Ma Huang prevents sudden profuse sweating; with Ma Huang, Bai Zhu helps disseminate stagnant Dampness. However, for exterior Dampness, only sweating is appropriate, not fire therapy; fire therapy increases Heat and may lead to yellowing, hence the warning.
If a Dampness patient sweats only on the head, has a stiff back, desires to cover themselves with blankets, and seeks warmth from fire, premature use of purgatives will lead to hiccups, chest fullness, and difficulty in urination. The tongue may appear coated, indicating Heat in the Dan Tian (lower abdomen) and Cold in the chest. The patient may feel thirsty and desire water but be unable to drink, resulting in dry mouth and vexation.
This is a struggle between Cold and Dampness. Taiyang Cold Qi in the meridians causes the desire for blankets and warmth, back stiffness, and head sweating. Mistaking this for interior Excess Heat steaming upward and using purgatives incorrectly will inevitably cause hiccups, chest fullness, and urinary difficulty. Purgation causes Yang Qi to sink, creating Heat in the Dan Tian while Cold fluid accumulates in the chest, obstructing Jin Ye (body fluids), leading to dry mouth, vexation, thirst, and inability to drink. How do we know there is Cold in the chest? The white and slippery coating on the tongue indicates it. Treatment should utilize Huang Lian Tang (Coptis Decoction) to harmonize the Cold and Heat in the upper and lower jiao, resolving all symptoms.
If a Dampness patient sweats only on the forehead, has slight panting, and urinates freely, death ensues. Similarly, if diarrhea continues incessantly, death ensues.
This originally followed the example of Dampness patients with painful vexation, where Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) was indicated for sweating. Due to incorrect purgation, adverse reactions occurred. Sweating on the forehead with slight panting indicates the escape of Yang Qi. Free urination or incessant diarrhea indicates the depletion of Yin Qi. The separation of Yin and Yang is a sign of inevitable death. From this, we can infer: even if there is forehead sweating and slight panting, if urination and defecation are obstructed, Yin Qi is not depleted, and the root of Yang remains; if, after purgation, urination and defecation are free, but there is no forehead sweating or panting, Yang Qi does not escape, and the root of Yin remains; in such cases, it is not a separated state, and treatment can follow deficiency or excess to rescue the patient. However, if diarrhea continues incessantly, even without forehead sweating or panting (signs of Yang escaping upward), death still occurs. There is also a case of incessant diarrhea with constipation and forehead sweating, called Guan Ge (Obstruction and Reversal). The *Nei Jing* states: In Guan Ge obstruction, if there is no forehead sweating, it is treatable; if there is sweating, it is fatal.
Question: When Wind-Dampness binds, causing generalized body pain, the method dictates relief through sweating. If it rains continuously and the physician prescribes sweating, but the illness does not resolve, why? Answer: If sweating induces profuse perspiration, only the Wind pathogen is expelled, while Dampness remains; therefore, it does not resolve. To treat Wind-Dampness, inducing only a slight, continuous moisture-like sweat ensures both Wind and Dampness are expelled.
For Wind-Dampness binding, relief comes through sweating. Using Gui Zhi Jia Zhu Tang (Cinnamon Twig plus Atractylodes Decoction) allows gentle steaming of the interior and exterior, harmonizing Qi so that both Wind and Dampness are expelled. This is consistent with the principle for Dampness patients with painful vexation using Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction).
If a patient has generalized body pain and fever that worsens at dusk (Shen and You hours), this is named Feng Shi (Wind-Dampness). This condition arises from sweating while exposed to wind or prolonged exposure to cold environments.
Worsening at dusk corresponds to the peak activity of Yangming Qi during the Shen and You hours. The *Jin Gui Yao Lue* suggests Ma Huang Xing Yi Gan Cao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction). Generally, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) treats Cold-Dampness, and Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction) treats Wind-Dampness. This case involves a combination of Cold-Dampness and Wind-Dampness. Consequently, the *Jin Gui Yao Lue* follows this with a clause on Wind-Dampness featuring a floating pulse, heaviness, sweating, and aversion to wind, treated with Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction). Generally, Wind-Dampness affects the exterior via Yang channels, resulting in a floating pulse, sweating, and heaviness. Astragalus consolidates the Wei Qi, assisted by Licorice; Stephania dispels Dampness, assisted by Atractylodes. Notably, there are no specific herbs for expelling Wind in this formula because profuse sweating indicates Wind has already dissipated; the exterior deficiency allows Wind to enter and exit, causing aversion to wind, lodging only in the Wei layer. When Zheng Qi (Upright Qi) is robust, Wind recedes naturally. After administration, sensations of insects crawling under the skin and water flowing below the waist may occur. Sitting on a blanket and wrapping another around the waist to induce mild sweating aids recovery. These details hold profound significance and should not be overlooked.
If a Dampness patient suffers from body pain, fever, yellow complexion, panting, headache, nasal congestion, and vexation, with a large pulse, normal appetite, and no abdominal discomfort, the pathology lies in Cold-Dampness in the head causing nasal congestion. Administering medicine intranasally will cure it.
Dampness patients typically present with deep, thin pulses and reduced appetite. Here, the pulse is large and appetite is normal, with only headache and nasal congestion, exactly as described in the *Nei Jing*: "Affected by Dampness, the head feels wrapped." Using Gua Di San (Thistle Powder) inserted into the nose to drain yellow fluid cures the condition.
These are examples of Zhong Shi (Internal Dampness).
Taiyang Zhong Re (Summerheat) is also known as Ye (Heatstroke). Patients exhibit sweating, aversion to cold, fever, and thirst.
Cheng Wuji notes that sweating with aversion to wind, fever, and no thirst indicates Wind strike; sweating with aversion to cold and thirst indicates Zhong Ye (Summerheat). However, he did not fully explain the underlying mechanism. This condition results from seasonal Fire Qi scorching Lung Metal. Lung injury leads to Wei Qi deficiency, causing sweating, fever, and aversion to cold, akin to the *Nei Jing*'s description of Ge Xiao (Diaphragmatic Consumption), both caused by Ministerial Fire injuring the Lung. The *Jin Gui Yao Lue* advocates using Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) to rescue the Lung.
In Taiyang Zhong Ye (Summerheat), there is fever, aversion to cold, heaviness, and body pain. The pulse is wiry, thin, hollow, and slow. After urination, there is chills and piloerection, and cold extremities. Slight exertion causes immediate fever, open mouth, and dryness of the anterior teeth. If sweating is induced, aversion to cold worsens; if moxibustion is applied, fever worsens; if purgatives are used repeatedly, strangury worsens.
Fever, aversion to cold, heaviness, and pain are exterior symptoms of Taiyang Zhong Ye. Exterior syndromes typically present with a floating pulse; however, a wiry, thin, hollow, and slow pulse indicates insufficient Yuan Qi (Primordial Qi) failing to propel the pulse outward. Wiry and thin indicate Yang deficiency; hollow and slow indicate Yin deficiency. With both Yin and Yang deficient, the patient cannot tolerate exertion. Chills and piloerection after urination indicate latent Fire Qi in the Taiyang meridian. Cold extremities indicate weak Taiyin Qi unable to withstand seasonal Heat. An open mouth and dry anterior teeth are intrinsic symptoms of Yangming Zhong Ye and confirm internal injury to Jin Ye (Body Fluids). Thus, sweating further depletes Wei Qi, worsening aversion to cold; moxibustion damages Ying Blood, worsening fever; purgation injures the Stomach, worsening strangury, especially since Yin Qi resides internally during summer. The *Ling Shu* states: When both Yin and Yang are insufficient, tonifying Yang exhausts Yin, and tonifying Yin destroys Yang. Only sweet medicines should be used to tonify Zheng Qi and resolve Heat. Dong Yuan's Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) captures this essence well. Although Zhang Zhongjing refers only to Taiyang and not Spleen or Lung, it is because intense Heat pathogens inevitably constrain Han Shui (Cold Water/Kidney Water).
In Taiyang Zhong Ye, if there is fever, body pain, and heaviness with a faint pulse, this is caused by consuming cold water in summer, with water circulating within the skin.
Cheng Wuji notes that a void pulse with fever indicates injury from Summerheat. However, a faint pulse indicates Ye (Heatstroke), and body pain/heaviness indicates Water. In summer, bathing in cold water while hot causes this disease, treated with Yi Wu Gua Di Tang (Single Herb Thistle Decoction). Observing that Zhang Zhongjing discusses only three clauses regarding Ye, it is not accidental. He sets the standard for future generations: one clarifies exterior Heat in Ye; another addresses interior-exterior deficiency; this third addresses external pathogens郁 (stagnating) seasonal Heat to form Zhong Ye. If pathogen stagnates with seasonal Heat, analogies reveal countless causes: seeking cool breezes, exposure to fog/dew, eating raw/cold foods, pre-existing accumulated Heat, inherent Yin Blood deficiency unable to withstand great Heat, activation of old pathogens, or residing in damp places. All these can stagnate seasonal Heat, causing Zhong Ye of varying severity, location, and nature. Discussing treatments to eliminate pathogens and reduce heat involves complex weighing of factors, impossible to summarize in one statement. ○ Regarding Zhang Zhongjing's three clauses on Ye: the first describes "obtained through movement," termed Zhong Ye, belonging to external causes; the second describes "obtained through stillness," technically Zhong Ye but actually Shu Bing (Summerheat disease), belonging to internal causes; the third describes injury from Cold due to Heat, a variant of Zhong Ye, belonging to neither internal nor external causes. They should not be conflated.
These are examples of Zhong Ye.
If a patient presents with Gui Zhi syndrome symptoms but without headache or neck stiffness, with a slightly floating Cun pulse, chest oppression and hardness, and Qi rushing to the throat causing breathing difficulty, this indicates Cold in the chest. Vomiting therapy is indicated, using Gua Di San (Thistle Powder). Patients who have lost blood or are deficient should not receive Gua Di San.
Internal movement of Phlegm-Fluid often presents with sweating, fever, and aversion to cold, mimicking Wind strike. However, the absence of headache and neck stiffness indicates this is not external Wind, but internal Cold-Phlegm obstructing the chest. Gua Di San (Thistle Powder), utilizing bitter-cold properties, combined with Xia Dou (Adzuki Bean) to promote urination and Chi Xiao Dou (Red Bean) to disperse pathogens, effectively vomits solid Phlegm from above the diaphragm, following the *Nei Jing* principle: "Where pathology is high, induce vomiting." Patients with blood loss or deficiency are contraindicated because vomiting further depletes Qi in blood-loss patients and damages Yin in deficient patients.
If a patient has cold extremities and a pulse that suddenly becomes tight, with pathogen knotting in the chest, epigastric fullness, vexation, hunger but inability to eat, the disease is in the chest. Vomiting therapy is indicated, using Gua Di San.
Cold extremities resemble the deep Heat/deep Cold of Jue Yin reversal. However, the pulse being suddenly tight (and sometimes not tight) differs significantly. This indicates Phlegm knotting in the chest, moving with Qi, causing the pulse to fluctuate between tight and loose, along with vexation, fullness, and inability to eat. ○ This clause was traditionally placed in the Jue Yin chapter, discussing contraindications for vomiting and purgation. Another clause states: If a patient has cold extremities and a pulse that suddenly knots, with pathogenic Qi in the chest, epigastric fullness, vexation, desire to eat but inability to do so, the disease is in the chest, requiring vomiting. This is identical to the current clause, except one mentions a "suddenly tight" pulse and the other a "suddenly knotted" pulse. Tightness indicates Cold-Fluid accumulation; knotting indicates hidden Phlegm-Fluid. Both belong to Gua Di San indications, so both need not be retained separately. However, these cold extremities belong to chronic Cold-Fluid diseases and have little relation to Jue Yin pathology.
If there are various Excess conditions in the upper chest, with oppressive distress and pain in the chest, inability to eat, sensation of food sticking, salivation upon palpation, and diarrhea occurring over ten times a day, with a surprisingly slow pulse and a slightly slippery Cun pulse, vomiting is indicated. Vomiting will stop the diarrhea.
Pain, inability to eat, and salivation upon palpation indicate Cold-Phlegm in the chest. Diarrhea with a slow pulse and a slightly slippery Cun pulse indicates Excess above the diaphragm; thus, vomiting stops the diarrhea. ○ Combining these three clauses, if Phlegm symptoms are present, vomiting is indicated rather than sweating. Considering Food Retention, Empty Vexation, and Hong Jiao (Podagra/Gout), none should be classified as Shanghan-like syndromes contraindicating sweating. Food retention implies failure of Yang Qi distribution in the chest; sweating causes Yang to escape externally, leaving Yin to dominate, worsening the critical condition. Empty vexation implies exhaustion of Stomach Jin Ye; sweating consumes remaining fluids. Hong Jiao (Podagra) stems from Earth Dampness entering through the feet, consistent with the principle that Dampness patients should not sweat.
These are examples of Phlegm syndromes.
Question: How can one distinguish Food Retention in a patient? Master says: If the Cun Kou pulse is floating and large, but feels choppy upon pressing, and the Chi position is also faint and choppy, one knows there is Food Retention. Purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Cun Kou (Radial Pulse) is discussed in the *Ling Shu* relative to the Dai Ying pulse. A floating and large Cun Kou pulse that feels choppy upon pressure indicates injury to Ying Qi in the Stomach. Thus, although the pulse is floating and large, it lacks the slippery solidity of a healthy pulse and feels choppy upon deep pressure. The Chi position being faint and choppy indicates that putrid waste has moved to the Large Intestine. Since Lung and Large Intestine are exterior-interior pairs, the pulse reflects this choppy quality. The term "also faint and choppy" implies continuity from the upper description: floating and large with slight choppieness upon pressure, not necessarily weak and powerless. If floating and large with slight choppieness, Da Cheng Qi Tang can be used. If purely choppy, one should use Zhi Shi Li Zhong Wan (Immortelle and Magnolia Fruit Regulating Middle Pill) to aid digestion and strengthen the Stomach, rather than using Da Cheng Qi Tang. ○ Following this clause, the *Jin Gui Yao Lue* states: A rapid and slippery pulse indicates Excess. If there is Food Retention, purging resolves it, using Da Cheng Qi Tang. Rapid indicates pathology in the Fu organs; slippery indicates smooth flow, like pearls rolling. This signifies Excess. Generally, Food Retention in the Fu organs manifests externally.
If there is diarrhea with lack of appetite, it is due to Food Retention. Purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Lack of appetite, rather than inability to eat, is a clear sign of food injury and aversion to food.
If diarrhea presents with a surprisingly slippery pulse, there is something to be removed. Purging brings cure, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Diarrhea is often feared to be Yin-Cold or intestinal deficiency-cold with sliding incontinence. However, a slippery and solid pulse indicates internal Heat binding. Something must be removed; stopping it is inappropriate. Da Cheng Qi Tang should be used to attack the Excess Heat. Once putrid waste is eliminated, diarrhea stops spontaneously.
If the pulses in all three positions are normal in a patient with diarrhea, but palpation reveals hardness in the epigastrium, urgent purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Normal pulses in all three positions indicate the patient has strong Yuan Qi. Hardness in the epigastrium upon palpation confirms Food Stagnation in the Middle Jiao.
If diarrhea presents with a slow and slippery pulse, there is internal Excess. Diarrhea has not ceased; purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
A slow pulse indicates Yangming stagnation. Slow without slipperiness indicates indeterminate hardness, unsuitable for purging. Now, with slow and slippery-solid qualities, purging is necessary even with spontaneous diarrhea. After purging, once interior Qi flows freely, the pulse will no longer be slippery or slow.
If there is abdominal fullness and pain, this is Excess. Purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Abdominal pain without fullness indicates Yin-Cold; fullness without pain indicates Deficient Qi. Here, both fullness and pain indicate definite Excess binding, requiring urgent purging.
If Food Retention is in the Upper Jiao, vomiting is indicated.
Food Retention generally should not be treated with vomiting. However, if the patient habitually has Phlegm-Fluid carrying Food Retention to the Upper Jiao, vomiting is appropriate. "Where pathology is high, induce vomiting." ○ The *Jin Gui Yao Lue* adds the phrase "Yong Gua Di San" (Use Thistle Powder) to this clause.