太阳病痉湿暑三症，宜应别论。以伤寒所致，与伤寒相似，故此见之。
太阳主表，六气皆得而伤之，三种故与伤寒不同。然亦有因于伤寒而见，症与伤寒相似，故论及之耳。
太阳病，发汗太多，因致痉。脉沉而细，身热足寒，头项强急，恶寒，时头热面赤，目脉赤，独头面摇，卒
口噤，背反张者，痉病也。
阳气者，精则养神，柔则养筋。发汗太多，则无液养筋，筋伤则挛急而反张矣。太阳主筋，所生病矣。要
知痉之一症，非无因而至，因于伤寒发汗不如法所致耳。太阳脉本浮，今反沉者，营气微也。细者，阳气少也。
身热而足寒者，下焦虚也。头痛虽止，而颈项强急恶寒之症未罢，更时见面赤目赤，是将转属于阳明。然诸症皆
与伤寒相似而非痉。独有头面动摇，卒然口噤，背反如张弓者，与伤寒不相似，故名之曰痉耳。此汗多亡液，
不转属阳明而成痉者。以发汗太骤，形身之津液暴脱，而胃家津液未干，故变见者仍是太阳表症，而治法当滋阴
以急和其里，勿得以沉细为可温也。炙甘草汤主之。《金匮》用桂枝汤加栝蒌根，恐不胜其任。
太阳病，发热无汗，反恶寒者，名曰刚痉；太阳病，发热汗出，不恶寒者，名曰柔痉。
此以表气虚实分刚柔，原其本而名之也。亦可以知其人初病之轻重，禀气之强弱而施治矣。《金匮》用葛
根汤则谬。
上论痉症。
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，或久伤寒冷所致也。
汗出当风，寒则汗不越。久留骨节，故一身尽疼。玄府反闭，故
发热。日晡为阳明主时，太阴湿土郁而不伸，故剧。此虽伤于湿，而实因于风寒也。《金匮》用麻黄杏仁薏苡
甘草汤。
风湿为病，脉阴阳俱浮，自汗出，身重，多眠睡，鼻息必鼾，语言难出。若被下者，小便不利，直视失溲。
若被火者，微发黄色，剧则如惊痫，时螈 。
脉浮为风，阴阳俱浮，自汗出者，风湿相搏于内也。湿流骨节，故身重。湿胜则卫气行阴，不得行阳，故好
眠也。睡则气从鼻出，风出而湿留之，呼吸不利，故鼻息必鼾。湿留会厌，则重而难发声，如从室中言，是中气
之湿矣。法当汗解而反下之，大便利则小便必不利。心肺之气化不宣，胃家之关门不利，脾土之承制不行，故直
视失溲也。若以火劫之，受火气之轻者，湿不得越，因热而发黄；受火气之重者，必亡阳而如惊痫状，液脱而时
见螈 之形矣。
问曰∶“值天阴雨不止，风湿相搏，一身尽疼，法当汗出而解。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。”
上条备言风湿诸症，未及身疼。要知风湿与伤寒之身疼不同，伤寒身疼无止时，风湿相搏而痛，多在日晡时
发。若更值阴雨，是风湿与天气合，故疼痛更甚，不必在日晡时也。阴雨不止，疼痛亦不止，法当汗解。汗大出，
湿反不去者，风为阳邪，其入浅，湿为阴邪，其入深。又风伤于上，湿伤于下，浅者上者易去，而深者下者难出。
故微汗之，令遍身 乃佳耳。
伤寒八九日，风湿相搏，身体烦疼，不能自转侧，不呕不渴，脉浮虚而涩者，桂枝附子汤主之。若其人大便
硬，小便自利者，去桂加白术汤主之。
脉浮为在表，虚为风，涩为湿，身体烦疼，表症表脉也。不呕不渴，是里无热，故于桂枝汤加桂以治风寒，
去芍药之酸寒，易附子之辛热以除寒湿。若其人大便硬、小便自利者，表症未除，病仍在表，不是因
于胃家实，而因于脾气虚矣。盖脾家实，腐秽当自去，脾家虚，湿土失职不能制水，湿气留于皮肤，故大便反见
燥化。不呕不渴，是上焦之化源清，故小便自利。濡湿之地，风气常在，故风湿相搏不解也。病本在脾，法当君
以白术，代桂枝以治脾，培土以胜湿，土旺则风自平矣。前条风胜湿轻，故脉阴阳俱浮，有内热，故汗自出，宜
桂枝汤。此湿胜风微，故脉浮虚而涩，内无热而不呕不渴，故可加附子、桂枝理上焦。大便硬，小便利，是中焦不
治，故去桂。大便不硬，小便不利，是下焦不治，故仍须桂枝。
桂枝附子汤∶
桂枝（四两） 附子（三枚，炮） 大枣（十二枚） 生姜（三两） 甘草（二两）
上五味，以水六升，煮取二升，去滓，分温三服。
桂枝附子去桂加白术汤∶
前方去桂枝，加白术（四两）。余同前法。
初服，其人身如痹。半日许，复服之。三服都尽，其人如冒状，勿怪。以术、附并走皮肉逐水气，未得除，
故使然耳。法当加桂四两。此本一方二法，以大便硬小便自利去桂也。以大便不通小便不利当加桂，附子三枚恐
多也，虚弱家及产妇宜减之。
风湿相搏，骨节烦疼，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。
身肿痛剧，不得屈伸，湿盛于外也。恶风不欲去衣，风淫于外也。汗出短气，小便不利，化源不清也。君桂
枝以理上焦而散风邪，佐术、附、甘草以除湿而调气。
甘草附子汤∶
甘草（炙） 白术（各二两） 桂枝（四两） 附子（二枚）
上四味，水六升，煮取三升，去滓，温服一升，日三。初服得微汗则解，能食；汗复烦者，服三合。
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。
《内经》曰∶“风寒湿三气合而为痹。”痛者，寒气多也；烦者，阳遭阴也。夫脉浮为风，细为湿。太阳
脉本浮，风湿为病，脉阴阳俱浮，或浮虚而涩。今关节烦疼，脉反沉细者，是发汗不如法，但风气去，湿流骨节
为着痹也。湿气留着于身形，脾气不能上输，肺气不能下达。膀胱之液不藏，胃家之关不启，故小便不利。脾土
上应湿化不能制水，故大便反快。但利其小便，安能聚水而为患哉？风湿相搏者当发汗，风去湿在者当利小便，
此两大法。吐下火攻，非其治矣。
湿家之为病，一身尽疼，发热，身色如熏黄。
凡湿不得泄，热不得越，则身黄。若伤寒发黄时，身疼已解。此湿流关节，故不解也，须五苓以除其湿。
湿家但头汗出，背强，欲得被覆向火。若下之则哕，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，口燥烦也。
但头汗，若小便利，则不发黄。背强恶寒，尚是太阳寒湿，法当汗解。若下之，阳气扰于胸中故满，中伤胃
气故哕，下焦虚不能制水，故小便不利也。如舌上有苔，不是心家热，以上焦之湿不除，胸中之寒不解，惟丹田
之有热不安于下焦，而上走空窍，故口燥烦而舌上苔耳。不能饮水，可见湿犹在中，又当从五苓去桂枝易肉桂
之法矣。
湿家下之，额上汗出，微喘，小便利者死，下利不止者亦死。
湿痹本无死症，皆因妄治而死。火逆则惊痫螈 ，下之则直视失溲舌苔而哕，皆死兆也。夫额上汗出而小
便不利，是痹不得泄，故发黄。此更微喘，是水气入肺。当不能通调水道，而小便反利者，是膀胱不藏，水泉
不止也。若下利不止，是仓廪不藏，门户不要也，失守者死矣。
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。
种种皆是表症。鼻塞而不鸣，脉大而不浮，不关风矣，脉不沉细，非湿痹矣。腹初不满，则非瘀热在里。重
干头痛，是头中寒湿可知。寒湿从鼻而入，故鼻塞，亦当从鼻而出。内药鼻中，塞因塞用法也。
上论湿症。
太阳中暑者，身热疼重而恶寒，脉微弱，此以夏月伤冷水，水行皮中所致也。
中暑与伤寒迥殊，而亦有因于伤寒者。太阳之气，在天为寒，在地为水。冬月之伤寒，伤于天之寒风；夏
月之伤寒，伤于地之寒水也。脉微亡阳，脉弱发热。此身热脉微，本是暑伤于气。而疼重恶寒，实由于寒水沐浴，
留在皮肤而然，亦是伤寒所致耳。《金匮》用瓜蒂汤非是，宜五苓散、藿香饮之类。
太阳中暑者，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，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，下之则淋。
弦细芤迟，不得连讲。言中暑夹寒之脉，或微弱，或弦细，或芤迟，皆是虚脉。如脉浮而紧者，名曰弦，
弦而细则为虚矣。脉弦而大则为芤，芤固为虚，芤而迟，更为寒矣。以此脉而见发热恶寒身重疼痛等症，虽当炎
夏而虚寒可知。更当审其小便，小便者，寒水之气化也。寒水留在皮肤，不得下行，故小便已而洒然毛耸，其短
涩可知。手足为诸阳之本，小便已而逆冷，其寒水留于四肢可知。夏行冬令，不可谓非伤寒所致耳。仍以中暑名
之者，以其人阴气素虚，因小有劳，身即发热，内热更炽，见其开口以出之板齿枯燥，故知其本乎中暑耳。若
汗之表阳愈虚，恶寒反甚。火攻则阴津愈虚，发热反甚。下之，水行谷道，小便更短涩而成淋矣。此东垣补中益
气，深合仲景心也。
太阳中暑，其人汗出恶寒身热而渴也。
中暑夹寒，有不因乎浴水，而因乎乘凉者。或因露风，或因旷宇，或因夜气阴寒，先着于肌肤，而暑气内伤
于心脉，故恶寒身热汗
出而渴也。清暑益气汤，东垣得之矣。
上论暑症。
三症皆本于伤寒，故恶寒发热身疼，皆与伤寒相似。痉者脉同湿家，中暑则大同小异，三脉迥殊于伤寒。
治之者当以脉别症，更当从脉施治耳。
太阳病中的痉、湿、暑三种病症，应当单独论述。因为它们是由伤寒引发的，症状与伤寒相似，所以在此一并讨论。
太阳主司体表，六淫邪气都能侵袭它，这三种病症因此与典型的伤寒有所不同。然而也有因伤寒而出现的，症状与伤寒相似，所以在这里加以论述。
太阳病中，如果发汗过多，就会导致痉病。脉象沉细，身体发热但脚部发凉，头项强直拘急，恶寒，有时头部发热、面色发红，眼结膜充血，只有头面部摇动，突然牙关紧闭，背部反张如弓形，这就是痉病。
阳气，精微的部分滋养精神，柔和的部分滋养筋脉。发汗过多，导致津液枯竭无法滋养筋脉，筋脉受损就会发生挛急和角弓反张。太阳经主管筋脉，所以产生这些病变。要知道痉病这一症状，并非无端发生，而是由于伤寒治疗时发汗不当所致。太阳病的脉象本应浮，现在反而沉，说明营气微弱。脉细，说明阳气不足。身体发热而脚部发凉，说明下焦虚寒。头痛虽然停止，但颈项强直、恶寒等症状未消，再加上时而见面赤、目赤，这是病情即将转属阳明经的表现。然而各种症状都与伤寒相似而非痉病特有的表现。唯独头面动摇，突然牙关紧闭，背部反张像拉满的弓一样，这与伤寒不相似，所以命名为痉病。这是因为发汗过多导致津液亡失，没有转属阳明经而是形成了痉病。由于发汗太急骤，体表的津液暴脱，但胃中的津液尚未完全干枯，所以变生的症状仍然属于太阳表证。治疗方法应当滋阴以紧急调和里气，不要认为脉沉细就可以使用温法。主治方剂为炙甘草汤。《金匮要略》中使用桂枝汤加栝蒌根，恐怕难以胜任。
太阳病，发热且无汗，反而恶寒的，称为刚痉；太阳病，发热且有汗出，不恶寒的，称为柔痉。
这是根据表气的虚实来区分刚柔，探究其本源而命名的。也可以据此判断病人初病时的轻重程度以及禀赋体质的强弱，从而实施治疗。《金匮要略》中使用葛根汤则是错误的。
以上论述了痉症。
病人全身疼痛，发热，在下午申酉时（日晡）加剧的，这叫做风湿。这种病是由于出汗时受风，或长期遭受寒冷侵袭所致。
出汗时受风，寒气使汗液不能正常发散，久留于骨节之间，所以全身疼痛。玄府（汗孔）反而闭塞，所以发热。日晡时是阳明经主令的时间，太阴湿土之气郁滞不得舒展，所以疼痛加剧。这虽然是因为伤湿，但实际上是由于风寒引起的。《金匮要略》中使用麻黄杏仁薏苡甘草汤。
风湿作为疾病，脉象寸关尺三部都浮，自汗出，身体沉重，嗜睡，鼻息一定伴有鼾声，说话困难。如果被误用攻下法，会导致小便不利，两眼直视，大小便失禁。如果被误用火疗，轻则面色微黄，重则像惊痫发作，时而出现抽搐。
脉浮表示有风，寸关尺三部皆浮且自汗出，是风湿在体内相搏结。湿气流注于骨节，所以身体沉重。湿邪偏胜则卫气行于阴分，不能行于阳分，所以喜欢睡觉。睡着时气息从鼻中呼出，风随气出而湿邪滞留，呼吸不畅，所以鼻息一定有鼾声。湿气停留在会厌部位，导致声音沉重难发，就像在室内说话一样，这是中焦湿邪的表现。治法应当通过发汗解表，却反而用了攻下法，导致大便通利则小便必然不利。心肺的气化功能不能宣通，胃的关门功能失调，脾土的制约功能不行，所以出现直视、大小便失禁。如果用火劫法治疗，受火气较轻的，湿邪不能外越，因热而发黄；受火气较重的，必然亡阳而出现像惊痫一样的症状，津液耗脱而时常出现抽搐的形态。
问曰：“正值阴雨连绵不止，风湿相搏，全身疼痛，按理应当发汗而解。医生说可以发汗，但发汗后病没好，为什么呢？”
答曰：“发汗时，如果汗出太多，只是风气去了，湿气还在，所以病不好。如果要治疗风湿，发汗时只要微微似有汗出的样子，风湿就能一起去除。”
上一条详细论述了风湿的各种症状，没有提到身疼。要知道风湿的身疼与伤寒的身疼不同，伤寒的身疼没有休止时间，风湿相搏引起的疼痛，多在日晡时发作。如果再遇到阴雨天气，这是风湿与天气相应合，所以疼痛更严重，不一定非要在日晡时才发作。阴雨不停止，疼痛也不停止，治法应当发汗解表。如果大汗出，湿气反而不去，这是因为风为阳邪，侵入浅表；湿为阴邪，侵入深里。而且风伤于上部，湿伤于下部，浅表和上部的容易去除，深部和下部的难以排出。所以要用微汗法，让全身微微湿润才是好的。
伤寒经过八九天，风湿相搏，身体烦痛，不能自行翻身转动，不呕吐不口渴，脉象浮虚而涩的，主治方剂为桂枝附子汤。如果病人大便硬，小便自利的，去掉桂枝加上白术汤主治。
脉浮表示病在表，虚表示有风，涩表示有湿，身体烦痛，是表证表脉。不呕吐不口渴，说明里没有热，所以在桂枝汤基础上加桂枝以治疗风寒，去掉芍药的酸寒之性，改用附子的辛热之性以祛除寒湿。如果病人大便硬、小便自利，表证未除，病仍在表，不是因为胃家实热，而是因为脾气虚弱。大概脾家实，腐秽之物自然会去除；脾家虚，湿土失职不能制水，湿气留在皮肤，所以大便反而显得干燥。不呕吐不口渴，说明上焦的气化源头清肃，所以小便自利。潮湿之地，风气常在，所以风湿相搏不解。病本在脾，治法应当以白术为君药，代替桂枝来治疗脾脏，培补脾土以战胜湿气，土旺则风气自然平息。前一条风胜湿轻，所以脉象寸关尺俱浮，内有热，所以自汗出，适宜用桂枝汤。这里湿胜风微，所以脉象浮虚而涩，内无热且不呕不渴，所以可以加附子、桂枝调理上焦。大便硬，小便利，是中焦不治，所以去掉桂枝。大便不硬，小便不利，是下焦不治，所以仍须用桂枝。
桂枝附子汤：
桂枝（四两） 附子（三枚，炮制） 大枣（十二枚） 生姜（三两） 甘草（二两）
以上五味药，用水六升，煮取二升，去渣，分三次温服。
桂枝附子去桂加白术汤：
前方去掉桂枝，加入白术（四两）。其余同前法。
初次服用，病人身体感觉麻木痹阻。约半日后，再服用。三次药服完，病人如有头晕昏蒙的感觉，不要奇怪。因为白术、附子并走皮肉驱逐水气，尚未完全排除，所以会有这种现象。治法应当加桂枝四两。这本来是一个方子两种用法，因为大便硬、小便自利而去掉桂枝。因为大便不通、小便不利应当加桂枝，附子三枚恐怕剂量过大，体质虚弱的人及产妇应当减量。
风湿相搏，骨节剧烈疼痛，牵引作痛，不能屈伸，靠近就疼痛加剧，汗出短气，小便不利，怕风不想穿衣，或者身体轻微浮肿的，主治方剂为甘草附子汤。
身体肿痛剧烈，不能屈伸，是湿邪盛于体表。怕风不想穿衣，是风邪淫溢于体表。汗出短气，小便不利，是气化源头不清。用桂枝为君药调理上焦而疏散风邪，佐以白术、附子、甘草以除湿而调气。
甘草附子汤：
甘草（炙） 白术（各二两） 桂枝（四两） 附子（二枚）
以上四味药，用水六升，煮取三升，去渣，温服一升，每日三次。初次服用得到微微汗出则病解，能进食；如果出汗后又感到烦躁，服用三合。
太阳病，关节疼痛且烦扰，脉象沉而细的，这叫做湿痹。湿痹的症状，病人小便不利，大便反而快利，只应当通利小便。
《内经》说：“风寒湿三气合而为痹。”疼痛，是因为寒气多；烦扰，是因为阳气被阴邪所困。脉浮为风，脉细为湿。太阳脉本应浮，风湿为病，脉象寸关尺俱浮，或浮虚而涩。现在关节烦痛，脉反而沉细，这是发汗不当，只去除了风气，湿气流注骨节成为着痹。湿气留着于身形，脾气不能上输，肺气不能下达。膀胱的津液不藏，胃的关门不开启，所以小便不利。脾土上应湿化但不能制水，所以大便反而快利。只通利小便，怎么能聚水为患呢？风湿相搏者应当发汗，风去湿在者应当利小便，这是两大治法。吐法、下法、火攻法，都不是正确的治法。
凡是湿气不得宣泄，热气不得外越，就会身黄。如果是伤寒发黄时，身疼已经解除。这里是湿气流注关节，所以身疼不解，需要用五苓散来祛除湿气。
湿病患者只有头部出汗，背部强直，想要盖被子靠近火源取暖。如果误用攻下法，会出现呃逆，胸满、小便不利，舌苔像铺了一层苔藓，这是因为丹田有热，胸中有寒，想喝水却不能喝，口燥烦躁。
只有头部出汗，如果小便利，就不会发黄。背强恶寒，还是太阳寒湿，治法应当发汗解表。如果误用攻下法，阳气扰动于胸中所以胸满，中伤胃气所以呃逆，下焦虚不能制水，所以小便不利。如果舌上有苔，不是心家热，而是因为上焦的湿邪不除，胸中的寒邪不解，只有丹田的热不安于下焦，而上走空窍，所以口燥烦躁且舌上有苔。不能饮水，可见湿气仍在中焦，又应当采用五苓散去掉桂枝换成肉桂的方法。
湿病患者误用攻下法，额头出汗，微喘，小便利的是死证，腹泻不止的也是死证。
湿痹本来没有死证，都是因为误治而死。火逆则惊痫抽搐，误下则直视失溲舌苔而呃逆，都是死兆。额头出汗而小便不利，是痹证不得宣泄，所以发黄。这里又有微喘，是水气入肺。当不能通调水道，而小便反而利，是膀胱不藏，水泉不止。如果腹泻不止，是仓廪不藏，门户不固，失守者死。
湿病患者，身上疼痛，发热，面黄而喘，头痛、鼻塞且烦，脉大，能饮食，腹部平和无病，病在头中寒湿，所以鼻塞，将药物纳入鼻中则痊愈。
种种症状都是表证。鼻塞但不鸣响，脉大而不浮，不关乎风；脉不沉细，不是湿痹。腹部起初不满，则不是瘀热在里。重点在于头痛，可知是头中寒湿。寒湿从鼻而入，所以鼻塞，也应当从鼻而出。将药物纳入鼻中，是用塞因塞用的方法。
以上论述了湿症。
太阳中暑，身体发热、疼痛沉重且恶寒，脉微弱，这是因为夏天伤了冷水，水气行于皮中所致。
中暑与伤寒截然不同，但也有因伤寒引发的。太阳之气，在天为寒，在地为水。冬天的伤寒，伤于天之寒风；夏天的伤寒，伤于地之寒水。脉微表示亡阳，脉弱发热。这身热脉微，本是暑气伤于气。而疼痛沉重恶寒，实际上是由于寒水沐浴，留在皮肤所致，这也是伤寒引发的。《金匮要略》用瓜蒂汤是不对的，适宜用五苓散、藿香饮之类。
太阳中暑，发热恶寒，身体沉重且疼痛，脉象弦细芤迟。小便结束后，洒洒然毛发耸立，手足逆冷，稍微劳动，身体即发热，张口呼吸，前板齿干燥。如果发汗则恶寒更甚，加温针则发热更甚，攻下则导致淋证。
弦细芤迟，不能连在一起讲。意思是中暑夹寒的脉象，或微弱，或弦细，或芤迟，都是虚脉。如脉浮而紧，名叫弦，弦而细则为虚。脉弦而大则为芤，芤固然是虚，芤而迟，更是寒。以此脉象见到发热恶寒身重疼痛等症状，虽然在炎夏，但虚寒可知。更应当审查其小便，小便，是寒水之气化的表现。寒水留在皮肤，不得下行，所以小便结束后洒然毛耸，其短涩可知。手足是诸阳之本，小便结束后逆冷，可知寒水留于四肢。夏天行冬天的命令，不可谓不是伤寒引发。仍以中暑命名，是因为此人阴气素虚，因为稍微劳动，身体即发热，内热更炽盛，见其张口以散热，板齿枯燥，所以知道根本在于中暑。如果发汗，表阳更虚，恶寒反而更甚。火攻则阴津更虚，发热反而更甚。攻下，水行谷道，小便更短涩而成淋证。这是李东垣的补中益气汤，深得仲景的心意。
中暑夹寒，有不因洗澡水，而因乘凉引起的。或因露风，或因空旷之处，或因夜间阴寒之气，先附着于肌肤，而暑气内伤心脉，所以恶寒、身热、汗出且口渴。清暑益气汤，李东垣对此有所领悟。
以上论述了暑症。
这三种病症都本源于伤寒，所以恶寒、发热、身疼，都与伤寒相似。痉病的脉象同湿家，中暑则大同小异，三种脉象迥异于伤寒。治疗者应当以脉象辨别症状，更应当依据脉象施治。
The three syndromes of JING (Spasm), SHI (Dampness), and SHU (Summerheat) in Taiyang disease should be discussed separately. Since they are caused by Shanghan (Cold Damage) and their symptoms resemble those of Shanghan, they are discussed here together.
Taiyang governs the exterior, and all six climatic pathogens can damage it; thus, these three syndromes differ from typical Shanghan. However, some arise due to Shanghan with symptoms similar to it, which is why they are included in this discussion.
In Taiyang disease, if sweating is induced excessively, JING (Spasm) may result. The pulse is deep and fine, the body is hot while the feet are cold, there is stiffness and tightness of the head and neck, aversion to cold, occasional heat in the head and redness of the face, congestion of the eye vessels, isolated shaking of the head and face, sudden locking of the jaw (Jin Kou), and opisthotonos (back arching like a bow). This is JING disease.
Yang Qi, when refined, nourishes the Shen (Spirit); when soft, it nourishes the Jin Mai (Sinew Vessels). Excessive sweating depletes fluids, failing to nourish the sinews; damaged sinews become spasmodic and lead to opisthotonos. Taiyang governs the sinews, hence these pathologies arise. It must be understood that JING does not occur without cause; it results from improper sweating therapy during Shanghan. The Taiyang pulse should normally be floating; a deep pulse indicates weak Ying Qi (Nutritive Qi). A fine pulse indicates insufficient Yang Qi. Body heat with cold feet indicates deficiency in the Lower Jiao (Lower Burner). Although the headache has ceased, symptoms such as neck stiffness and aversion to cold persist, accompanied by intermittent facial redness and eye congestion, suggesting a potential transition to Yangming disease. However, most symptoms resemble Shanghan rather than specific signs of JING. Only the shaking of the head and face, sudden jaw locking, and opisthotonos resembling a drawn bow distinguish it from Shanghan, hence the name JING. This occurs because excessive sweating led to fluid loss without transitioning to Yangming, but forming JING instead. Due to abrupt and excessive sweating, surface fluids were suddenly depleted, while stomach fluids remained relatively intact; thus, the resulting symptoms still belong to Taiyang exterior syndrome. The treatment should focus on nourishing Yin to urgently harmonize the interior, avoiding warming methods simply because the pulse is deep and fine. The primary formula is Zhigancao Tang (Honey-Processed Licorice Decoction). Guizhi Tang plus Gualou Gen (Trichosanthes Root) used in *Jinkui Yaolue* is likely insufficient.
In Taiyang disease, fever with no sweat and paradoxical aversion to cold is called Gang JING (Rigid Spasm); fever with sweating and no aversion to cold is called Rou JING (Flexible Spasm).
This distinction between Rigid and Flexible is based on the deficiency or excess of Exterior Qi, naming them according to their root causes. This also helps assess the severity of initial illness and the patient's constitutional strength for appropriate treatment. Using Gegen Tang (Kudzu Decoction) as suggested in *Jinkui Yaolue* is erroneous.
The above discusses JING syndromes.
When a patient suffers from generalized body pain, fever, and exacerbation in the late afternoon (Ri Wu), this is named Feng Shi (Wind-Dampness). This condition arises from sweating followed by exposure to wind, or prolonged exposure to cold.
Sweating with wind exposure causes cold to prevent normal perspiration, leading to stagnation in the joints and generalized pain. Closure of the Xuan Fu (pores) causes fever. Late afternoon corresponds to the Yangming meridian's time of dominance; stagnation of Taiyin Damp Earth prevents free flow, causing exacerbation. Although caused by Dampness, it is fundamentally due to Wind-Cold. *Jinkui Yaolue* recommends Mahuang Xingren Yiyi Ren Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction).
In Wind-Dampness disease, the pulse is floating at all positions (Yin and Yang), with spontaneous sweating, heavy body, somnolence, snoring nasal breathing, and difficulty speaking. If mistakenly treated with purgatives, it leads to difficult urination, fixed gaze, and incontinence. If treated with fire therapy, mild cases show slight yellow discoloration, while severe cases present like convulsive epilepsy with periodic clonic spasms.
A floating pulse indicates Wind; floating pulses at all positions with spontaneous sweating indicate Wind and Dampness battling internally. Dampness flowing into joints causes heaviness. When Dampness prevails, Wei Qi (Defensive Qi) moves within the Yin and cannot reach the Yang, causing sleepiness. During sleep, breath exits through the nose; Wind exits while Dampness remains, obstructing respiration and causing snoring. Dampness lodging in the epiglottis makes speech heavy and muffled, like speaking from inside a room, indicating Middle Jiao Dampness. The method should be diaphoresis, but purgation was used instead. Profuse stool leads to difficult urination. The Qi transformation of the Heart and Lung fails to circulate, the Gate of the Stomach fails to function, and the Spleen Earth fails to control, resulting in fixed gaze and incontinence. Fire therapy: mild heat retention causes Dampness to fail to vent, leading to jaundice via Heat; severe heat causes Yang collapse and symptoms resembling epilepsy, with fluid depletion causing periodic spasms.
Question: "During continuous rainy weather, Wind and Dampness battle, causing generalized pain. Theoretically, diaphoresis should resolve it. The doctor says sweating is indicated, yet the patient does not recover. Why?"
Answer: "If sweating induces profuse perspiration, only the Wind is expelled while Dampness remains, hence no recovery. To treat Wind-Dampness, induce only slight, continuous perspiration ('like wanting to sweat'), so both Wind and Dampness are eliminated."
The previous section detailed Wind-Dampness symptoms but omitted body pain. Note that Wind-Dampness body pain differs from Shanghan body pain; Shanghan pain is constant, whereas Wind-Dampness pain often peaks in the late afternoon. If combined with rainy weather, Wind and Dampness resonate with the climate, worsening pain regardless of the time. Continuous rain means continuous pain; diaphoresis is the method. Profuse sweating fails to remove Dampness because Wind is a Yang pathogen entering superficially, while Dampness is a Yin pathogen entering deeply. Wind damages the upper body, Dampness the lower; superficial/upper pathogens are easier to expel than deep/lower ones. Thus, mild diaphoresis to moisten the entire body is ideal.
After eight or nine days of Shanghan, if Wind and Dampness battle causing severe body pain, inability to turn over, no vomiting, no thirst, and a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is indicated. If the patient has hard stool and spontaneous urination, remove Cinnamon Twig and add Baizhu (Atractylodes Macrocephala Rhizome) decoction.
A floating pulse indicates exterior location; deficiency indicates Wind; choppy indicates Dampness. Severe body pain reflects exterior syndrome and pulse. No vomiting or thirst indicates no interior Heat. Therefore, add Cinnamon Twig to Guizhi Tang to treat Wind-Cold, remove Sour-Cold Shaoyao (Peony Root), and replace it with Pungent-Warm Fuzi (Prepared Aconite Root) to dispel Cold-Dampness. If stool is hard and urination is spontaneous, the exterior syndrome persists, and the pathology is not Stomach Excess but Spleen Deficiency. When Spleen is Excess, turbid matter clears naturally; when Spleen is Deficient, Damp Earth fails to control Water, leaving Dampness in the skin, causing apparent dryness in stool. No vomiting/thirst indicates clear Upper Jiao transformation, allowing spontaneous urination. In damp places, Wind lingers, preventing resolution of Wind-Dampness. The root is in the Spleen; Baizhu should be the sovereign herb, replacing Cinnamon Twig to tonify Spleen Earth and overcome Dampness. When Earth is robust, Wind calms. In the previous case, Wind prevailed over light Dampness, pulses were floating at all positions, interior Heat caused sweating, so Guizhi Tang was suitable. Here, Dampness prevails over weak Wind, pulses are floating, deficient, and choppy, no interior Heat, no vomiting/thirst, so Fuzi and Cinnamon Twig can regulate the Upper Jiao. Hard stool and free urination indicate Middle Jiao dysfunction, requiring removal of Cinnamon Twig. Normal stool and difficult urination indicate Lower Jiao dysfunction, requiring Cinnamon Twig.
Guizhi Fuzi Tang:
Guizhi (Cinnamomi Ramulus) (4 liang), Fuzi (Aconiti Lateralis Radix Praeparata) (3 pieces, processed), Dazao (Ziziphi Jujubae Fructus) (12 pieces), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang).
These five ingredients, boiled in 6 sheng of water, reduce to 2 sheng. Remove dregs, divide into three warm doses.
Guizhi Fuzi Qu Guizi Jia Baizhu Tang (Cinnamon Twig and Prepared Aconite Decoction minus Cinnamon Twig plus Atractylodes Macrocephala Rhizome):
Remove Guizhi from the previous formula, add Baizhu (4 liang). Rest follows the same method.
Upon first dose, the patient may feel numbness. After half a day, administer again. After three doses, the patient may feel dizzy; do not be alarmed. This is because Baizhu and Fuzi move through skin and flesh to drive out water qi, which has not yet been fully expelled. The method should add 4 liang of Guizhi. This is one formula with two applications: remove Guizhi for hard stool/free urination; add Guizhi for constipation/difficult urination. Three pieces of Fuzi may be too much; reduce dosage for frail patients and postpartum women.
If Wind and Dampness battle causing severe joint pain, pulling pain, inability to flex/extend, exacerbated by touch, sweating, shortness of breath, difficult urination, aversion to wind with desire to keep clothes on, or slight edema, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated.
Severe swelling/pain and immobility indicate Dampness prevailing externally. Aversion to wind indicates Wind invading externally. Sweating, shortness of breath, and difficult urination indicate unclear Qi transformation. Use Guizhi as sovereign to regulate Upper Jiao and disperse Wind; assist with Baizhu, Fuzi, and Gancao to drain Dampness and harmonize Qi.
Gancao Fuzi Tang:
Gancao (Processed) (2 liang), Baizhu (Atractylodis Macrocephalae Rhizoma) (2 liang), Guizhi (Cinnamomi Ramulus) (4 liang), Fuzi (Aconiti Lateralis Radix Praeparata) (2 pieces).
These four ingredients, boiled in 6 sheng of water, reduce to 3 sheng. Remove dregs, take 1 sheng warm, three times daily. Initial dose yielding slight sweat resolves symptoms and restores appetite; if restlessness recurs after sweating, take 3 he.
In Taiyang disease, painful and vexing joints with a deep, fine pulse is named Shi Bi (Damp Bi). Symptoms of Shi Bi include difficult urination and loose stools; the treatment is to promote urination.
*Neijing* states: "Combination of Wind, Cold, and Dampness forms Bi." Pain indicates excess Cold; vexation indicates Yang encountering Yin. Floating pulse is Wind, fine pulse is Damp. Taiyang pulse should be floating; in Wind-Dampness, pulses are floating at all positions or floating/deficient/choppy. Now, joint pain with deep/fine pulse indicates improper sweating, expelling only Wind while Dampness lodges in joints, forming Zhuo Bi (Fixed Bi). Dampness lingering in the body prevents Spleen Qi from ascending and Lung Qi from descending. Bladder fluid storage fails, Stomach gate fails to open, causing difficult urination. Spleen Earth fails to transform Dampness and control Water, causing loose stools. Promoting urination prevents water accumulation. For Wind-Dampness battle, use diaphoresis; for Wind gone/Damp remaining, use diuresis. These are the two major methods. Vomiting, purging, and fire therapy are incorrect.
Patients with chronic Dampness suffer generalized pain, fever, and sallow-yellow complexion (Xun Huang).
When Dampness cannot vent and Heat cannot escape, jaundice occurs. In Shanghan jaundice, body pain resolves. Here, Dampness flows into joints, so pain persists; Wuling San (Five-Ingredient Powder with Poria) is needed to drain Dampness.
Chronic Dampness patients may have only head sweating, back stiffness, and desire to cover up near fire. Purging causes hiccups, chest fullness, difficult urination, and tongue coating resembling moss, due to Heat in the Dantian and Cold in the Chest. Thirst with inability to drink and oral dryness/vexation occur.
Head-only sweating with free urination prevents jaundice. Back stiffness and aversion to cold indicate Taiyang Cold-Dampness, treated by diaphoresis. Purbing disturbs Yang in the Chest (fullness), damages Stomach Qi (hiccups), and fails to control Water in the Lower Jiao (difficult urination). Tongue coating is not Heart Heat, but unresolved Upper Jiao Dampness and Chest Cold, with Dantian Heat rising to orifices, causing dry mouth/vexation/coating. Inability to drink indicates Dampness in the Middle Jiao; use Wuling San minus Guizhi, substituting Rougui (Cinnamon Bark).
Purging chronic Dampness patients causing forehead sweating, slight wheezing, and free urination is fatal; persistent diarrhea is also fatal.
Shi Bi has no fatal outcomes unless mistreated. Fire reversal causes epilepsy/spasms; purging causes fixed gaze/incontinence/hiccups, all death omens. Forehead sweating with difficult urination indicates Bi obstruction leading to jaundice. With slight wheezing, Water Qi enters the Lung. Failure to regulate water passages with free urination indicates Bladder failure. Persistent diarrhea indicates Spleen/Stomach failure to contain, leading to death.
Chronic Dampness patients with body pain, fever, yellow face, wheezing, headache, nasal congestion, vexation, large pulse, normal appetite, and peaceful abdomen have Cold-Dampness in the Head causing nasal congestion. Medication inserted into the nose cures it.
All symptoms are exterior. Nasal congestion without rhonchi, large but not floating pulse, rules out Wind; non-deep/fine pulse rules out Shi Bi. Abdominal softness rules out interior Stasis-Heat. Headache confirms Cold-Dampness in the Head. Cold-Dampness enters via the nose and should exit via the nose. Intranasal medication uses the "treat obstruction with obstruction" method.
The above discusses Dampness syndromes.
Taiyang Summerheat presents with body heat, heavy pain, aversion to cold, and weak pulse. This results from drinking cold water in summer, causing water qi to remain in the skin.
Summerheat differs significantly from Shanghan, though some cases stem from it. Taiyang Qi is Cold in Heaven and Water in Earth. Winter Shanghan is injured by Heavenly Cold Wind; Summer Shanghan is injured by Earthly Cold Water. Weak pulse indicates Yang loss; weak pulse with fever indicates this case. Body heat with weak pulse is Summerheat injuring Qi. Heavy pain and aversion to cold result from cold water bathing, lingering in the skin, also caused by Shanghan. Genti Tang in *Jinkui Yaolue* is incorrect; Wuling San or Huoxiang Yin (Agastache Drink) are suitable.
Taiyang Summerheat presents with fever, aversion to cold, heavy pain, and string-taut, fine, hollow, or slow pulse. After urination, chills and piloerection occur; hands/feet are cold; slight exertion causes fever; mouth opens, and anterior teeth are dry. String-taut, fine, hollow, slow pulses cannot be read continuously; they represent deficiency pulses in Summerheat with Cold. Floating/tight is string-taut; string-taut/fine is deficiency; string-taut/large is hollow; hollow/slow is Cold. Fever/aversion to cold/heavy pain in summer indicates deficiency-cold. Urination reflects Cold Water Qi transformation. Cold water lingering in skin fails to descend, causing chills after urination. Hands/feet are roots of Yang; coldness after urination indicates Cold Water in limbs. Summer acting like Winter is Shanghan-induced. Named Summerheat because the patient has inherent Yin deficiency; slight exertion causes fever, intense internal Heat, open mouth, and dry teeth. Diaphoresis worsens exterior Yang deficiency and aversion to cold. Fire therapy worsens Yin fluid deficiency and fever. Purging causes Water to flow through the intestines, worsening urination into strangury. Li Dongyuan's Buzhong Yiqi Tang aligns with Zhang Zhongjing's principles.
Taiyang Summerheat presents with sweating, aversion to cold, body heat, and thirst.
Summerheat with Cold, not from bathing but from cooling off (exposure to wind, open spaces, or night chill), affects the skin first, then Summerheat injures the Heart vessel internally, causing aversion to cold, body heat, sweating, and thirst. Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction) reflects Li Dongyuan's understanding.
The above discusses Summerheat syndromes.
All three syndromes originate from Shanghan; thus, aversion to cold, fever, and body pain resemble Shanghan. JING pulse resembles Dampness patients; Summerheat is largely similar but slightly different. The three pulses differ distinctly from Shanghan. Treaters must differentiate symptoms by pulse and treat according to the pulse.