【纲】仲景曰。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。
【目】朱肱曰。伤寒有连服汤剂而汗不出者。死。如中风法蒸之。温热之气。于外迎之。无不
得汗也。其法。用薪火烧地。良久。扫去火。可以水洒之。取蚕砂、柏叶、桃叶、糠麸皆可用。相
和铺烧地上。可侧手浓。上加席。令病患卧。温覆之。夏月只布单覆之。汗移时立至。俟周身至脚
心皆汗 。乃用温粉扑止。移上床。最得力者。蚕砂、柏桃叶也。无蚕砂、单桃叶亦可。用糠麸
乃助添令多耳。不用亦可。伤气亦有气虚不能作汗者。
刘完素曰。腠理者。津液腠泄之所为腠。文理缝会之中为理。寒邪中经。腠理致密。内渗则无
汗。无汗之由有数种。如伤寒在表。及邪行于里。或水饮内蓄。与亡阳久虚。皆令无汗。其伤寒无汗。
则腠理致密也。风中卫。则腠理开而自汗。寒中营。则无汗。腠理闭也。本条与太阳病脉浮紧无
汗麻黄汤症。太阳中风脉浮紧大青龙症。及阳明病反无汗而小便利。二三日呕而咳。手足厥。若头
痛鼻干不得汗。脉浮无汗而喘。与刚痉无汗。是数者。皆寒邪在表而无汗者也。其邪行于里而无
汗者。邪气内传。不外熏发。经所谓阳明病无汗身发黄。及发热无汗渴欲饮水无表症者。与夫三阴
为病不得有汗。是数者皆邪行于里而无汗者也。
杨士瀛曰。太阳主一身之表。风寒客于表。则皮毛闭密。故无汗。
【纲】仲景曰。太阳病。脉浮紧。无汗。发热身疼痛。八九日不解。表症仍在。此当发其汗。麻
黄汤主之。服药已。微除。其人发烦。目瞑。剧者必衄。衄乃解。所以然者。阳气重故也。太阳中
风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。
【目】柯琴曰。此两条脉症相同。而异者。上条外不恶寒。内不烦躁耳。发于阳者七日愈。八九日
不解。阳气重可知。脉紧无汗。发热身疼。麻黄症未解。仍与麻黄。只微除在表之风寒。而不解内
扰之阳气。发烦目瞑。可知阳络受伤。必逼血上行而衄。不得汗解。必从衄解。太阳中风汗出脉缓
者。中于鼓动之阳风。此汗不出而脉紧者。中于凛冽之阴风。风令脉浮。浮紧而沉不紧。与伤寒阴
阳俱紧之脉有别。
【纲】仲景曰。伤寒脉浮紧者。麻黄汤主之。不发汗。因致衄。太阳病。脉浮紧。发热身无汗。
自衄者愈。衄家不可发汗。汗出必额上陷。脉紧急。目直视。不能 。不得眠。
【目】鳌按。脉紧无汗。本当发汗。以泄阳气。若不发汗。致阳气内扰。而阳络受伤。因而成衄。
则阳邪即从汗解矣。故既衄即不当用麻黄再发汗。故仲景既于他条言已服麻黄微除而仍致衄。此
又恐人衄后再汗。故特提明以见衄家不可再发汗也。若身无汗而自衄者愈。正言阳从衄泄之故。脉
急紧四句。正言既衄复汗之变。其变见于额与目者。以太阳脉起目内 上额故也。
【纲】仲景曰。太阳病。项背强KT KT 。无汗恶风者。葛根汤主之。
【目】鳌按。风伤卫分者。皮毛闭而无汗。不得以本条之无汗为伤寒也。盖以太阳脉自络脑而
还出下项。挟脊背。本条风邪。乃自风池入。不上干于脑。故不言头疼。而下行脊背。故但见项背强
KTKT 也。
【纲】仲景曰。伤寒脉浮缓。发热恶寒。无汗烦躁。身不疼。但重。乍有轻时。无少阴症者。
大青龙汤主之。
【目】张从正曰。寒有重轻。伤重。脉阴阳俱紧而身疼。伤轻。脉浮缓而身重。亦有初时脉紧
渐缓。初时身疼渐不疼者。当用活看。然脉浮紧者。身必疼。脉浮缓者。身不疼。中风伤寒皆然。
无少阴症者。仲景正因少阴亦有发热恶寒无汗烦躁之症。虽与大青龙症同。然彼则法当温补。不得
与麻黄。必细审其所不用。然后不失其所当用也。
【纲】仲景曰。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。
【目】张兼善曰。此以虚实分别刚柔也。
【纲】仲景曰。脉浮而迟。迟为无阳。不能作汗。其身必痒。
【目】刘完素曰。阳为津液之主。阳虚则津液虚少。故无汗。若阳明病反无汗。其身如虫行皮肤
之状。则又久虚矣。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），出现头痛、发热、身体疼痛、腰痛、骨节疼痛、怕风、无汗且气喘的症状，应当用麻黄汤主治。
【目】朱肱说：伤寒病患者如果连续服用汤药却仍然不出汗的，属于死证。治疗方法如同治疗中风那样进行熏蒸。用温热之气从外部迎导，没有不能出汗的。具体方法是：用柴火烧热地面，过一段时间后，扫去灰烬，可以用水喷洒地面。取蚕砂、柏树叶、桃树叶、米糠麸皮都可以使用，混合铺在烧热的地面上，厚度约为一只手的手掌厚度。上面加上席子，让病人躺卧，并用衣物温暖覆盖。夏季只需铺单被覆盖。不久汗水就会立刻出来。等到全身直到脚心都出汗后，再用温粉扑在身上以停止出汗。然后将病人移上床休息。其中效果最显著的是蚕砂和柏叶、桃叶。如果没有蚕砂，单用桃叶也可以。使用米糠麸皮只是为了辅助增加湿气，不用也可以。气虚的人也有因为气虚而不能出汗的情况。
刘完素说：腠理（皮肤纹理及皮下组织间隙）是津液排泄的通道称为“腠”，纹理缝隙汇合之处称为“理”。寒邪侵入经脉，导致腠理致密，津液内渗则无汗。无汗的原因有几种情况：如伤寒在表，以及邪气传入里部；或者水饮内停蓄积，以及亡阳后的长期虚弱，都会导致无汗。伤寒导致的无汗，是因为腠理致密。风邪侵袭卫分，则腠理开泄而自汗；寒邪侵袭营分，则无汗，因为腠理闭塞。本条所述与太阳病脉浮紧、无汗、麻黄汤证，太阳中风脉浮紧、大青龙汤证，以及阳明病反而无汗且小便通利，两三天后呕吐咳嗽，手足厥冷，若头痛鼻干不得汗，脉浮无汗且气喘，还有刚痉无汗等情况，这些都是寒邪在表而无汗的表现。邪气传入里部而无汗的情况，是邪气内传，不外散熏蒸。经文中所说的阳明病无汗身体发黄，以及发热无汗口渴想喝水但没有表证的，还有三阴经发病不得有汗的情况，这些都是邪气在里而无汗的表现。
杨士瀛说：太阳经主管一身之表，风寒客居于体表，则皮毛闭合致密，所以无汗。
【纲】张仲景说：太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九天仍未解除，表证依然存在，这应当发汗治疗，用麻黄汤主治。服药后，症状轻微缓解，病人感到心烦，眼睛闭着不愿睁开，病情严重的必定会出现鼻出血，鼻出血后病邪才能解除。之所以这样，是因为阳气郁重所致。太阳中风，脉象浮紧，发热恶寒，身体疼痛，不出汗且烦躁的，用大青龙汤主治。
【目】柯琴说：这两条的脉症相同，不同之处在于：上一条外不恶寒，内不烦躁。病发于阳经者七日痊愈，过了八九天未解，可知阳气郁重。脉紧无汗，发热身疼，是麻黄汤证未解，仍给予麻黄汤，只能轻微驱散在表的风寒，而不能解除内扰的阳气，因此出现心烦、眼睛闭着，可知阳络受伤，必然逼迫血液上行而出血（衄血）。不能通过汗解，必然通过衄血来解除。太阳中风汗出脉缓的，是中了鼓动之性的阳风；此条汗不出而脉紧的，是中了凛冽之性的阴风。风邪使脉浮，浮紧而沉取不紧，与伤寒阴阳俱紧的脉象有别。
【纲】张仲景说：伤寒脉象浮紧的，用麻黄汤主治。如果不发汗，会导致鼻出血。太阳病，脉象浮紧，发热身体无汗，自然鼻出血的，病会自愈。经常鼻出血的人（衄家）不可发汗，如果发汗，必然导致额部凹陷，脉象紧急，两眼直视，不能转动，无法入睡。
【目】沈金鳌按：脉紧无汗，本当发汗，以宣泄阳气。如果不发汗，导致阳气内扰，阳络受伤，因而造成鼻出血，那么阳邪就会随着出血而解除。所以既然已经鼻出血，就不应当再用麻黄汤发汗。因此张仲景在其他条文说已服麻黄汤轻微缓解后仍致鼻出血，这里又是担心人们在鼻出血后再发汗，所以特别提出明确说明衄家不可再发汗。如果身体无汗而自然鼻出血的病会自愈，正是说明阳气随鼻出血而泄出的缘故。脉急紧四句，正是说明既鼻出血又发汗的变证。其变证见于额头和眼睛，是因为太阳经脉起于目内眦上行至额部的缘故。
【纲】张仲景说：太阳病，项背部强直拘急不舒（KT KT 形容僵硬不适的样子），无汗怕风的，用葛根汤主治。
【目】沈金鳌按：风邪伤及卫分，皮毛闭合而无汗，不能把本条的无汗当作伤寒来看待。因为太阳经脉从脑部络属返回下行至项部，挟持脊背。本条的风邪，是从风池穴进入，不上犯于脑，所以不说头痛，而是下行至脊背，所以只见到项背部强直拘急不舒。
【纲】张仲景说：伤寒脉象浮缓，发热恶寒，无汗烦躁，身体不疼，只是沉重，偶尔有减轻的时候，没有少阴病的症状，用大青龙汤主治。
【目】张从正说：寒邪有轻重之分。伤重者，脉象寸关尺三部皆紧且身体疼痛；伤轻者，脉象浮缓且身体沉重。也有初时脉紧后来渐缓，初时身体疼痛后来不疼的，应当灵活看待。然而脉浮紧的，身体必然疼痛；脉浮缓的，身体不疼痛，中风和伤寒都是如此。没有少阴病的症状，张仲景正是因为少阴病也有发热恶寒无汗烦躁的症状，虽然与大青龙汤证相同，但是少阴病法当温补，不能用麻黄汤，必须仔细审察那些不适用（麻黄汤）的情况，然后才不会误用该用的方剂。
【纲】张仲景说：太阳病，发热无汗，反而怕冷的，名叫刚痉。太阳病，发热汗出，不怕冷的，名叫柔痉。
【纲】张仲景说：脉象浮而迟，迟脉代表无阳（阳气不足），不能作汗，身体必然瘙痒。
【目】刘完素说：阳气是津液的主宰，阳虚则津液虚少，所以无汗。如果是阳明病反而无汗，身体像虫子在皮肤上爬行的感觉，那就是久虚了。
[Outline] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), characterized by headache, fever, body pain, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) should be primarily administered.
[Commentary] Zhu Gong stated: If a patient with Shanghan (Cold Damage) continues to take herbal decoctions but still fails to sweat, it is a fatal condition. The treatment method is similar to that for Fengzhong (Wind Strike): perform steaming therapy. By guiding warm Qi from the exterior, sweating can invariably be induced. The specific method involves heating the ground with firewood, waiting until hot, then sweeping away the ashes. Water may be sprinkled on the ground. Mulberry sand (Cicadae Alumen), cypress leaves, peach leaves, and bran are all usable. These materials are mixed and spread over the heated ground to a thickness of approximately one hand's palm width. A mat is placed on top, and the patient lies upon it, covered warmly with blankets. In summer, only a single sheet is needed. Sweating will occur immediately after a short while. Once sweating extends to the soles of the feet, apply warm powder to stop the sweating. Then move the patient to bed. Among these materials, mulberry sand, cypress leaves, and peach leaves are most effective. If mulberry sand is unavailable, peach leaves alone suffice. Bran serves merely to augment moisture and is optional. There are also cases of Qi deficiency where patients cannot sweat due to insufficient Qi.
Liu Wansu stated: "Couli" refers to the pores through which body fluids excrete, while "Li" refers to the interstices where tissue textures converge. When Cold Evil invades the meridians, the Couli become dense, causing fluids to seep inward, resulting in an absence of sweating. Causes of anhidrosis include several types: such as Shanghan remaining at the exterior, or pathogens moving inward; internal accumulation of fluid retention; or prolonged deficiency following Yang collapse. In Shanghan-induced anhidrosis, the Couli are dense. Wind attacking the Wei (Defensive) level causes the Couli to open, leading to spontaneous sweating. Cold attacking the Ying (Nutritive) level results in anhidrosis because the Couli are closed. This outline corresponds to Taiyang disease with floating-tight pulse, anhidrosis, and Mahuang Tang syndrome; Taiyang Fengzhong with floating-tight pulse and Da Qinglong Tang syndrome; Yangming disease presenting with anhidrosis yet clear urination; vomiting and coughing after two to three days; cold extremities; headache, nasal dryness, inability to sweat, floating pulse, anhidrosis, and wheezing; as well as Gang Jing (Stiff Spasm) with anhidrosis. All these represent Cold Evil at the exterior causing anhidrosis. Regarding anhidrosis due to pathogens moving inward: when pathogens transmit internally without external dispersal, as described in the classics regarding Yangming disease with anhidrosis and jaundice, or fever with anhidrosis, thirst, desire to drink water, but no exterior signs, nor sweating in San Yin diseases—all these represent anhidrosis due to pathogens residing within.
Yang Shiyin stated: The Taiyang meridian governs the exterior of the body. When Wind-Cold resides at the exterior, the skin and hair follicles close tightly, resulting in anhidrosis.
[Outline] Zhang Zhongjing stated: In Taiyang disease, with a floating-tight pulse, anhidrosis, fever, and body pain persisting for eight or nine days without resolution, if exterior signs remain, diaphoresis (inducing sweating) is indicated. Mahuang Tang (Ephedra Decoction) should be primarily administered. After taking the medicine, symptoms may slightly alleviate, but the patient may experience irritability and closed eyes. In severe cases, epistaxis (nosebleed) will occur, and the disease resolves upon bleeding. This occurs because Yang Qi is heavily constrained. In Taiyang Fengzhong, with a floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and restlessness, Da Qinglong Tang (Great Blue Dragon Decoction) should be primarily administered.
[Commentary] Ke Qin stated: The pulse and symptoms in these two clauses are identical, differing only in that the former lacks aversion to cold externally and irritability internally. Diseases originating in Yang typically resolve in seven days; persistence beyond eight or nine days indicates heavy Yang constraint. With a tight pulse, anhidrosis, fever, and body pain, the Mahuang Tang syndrome remains unresolved, so Mahuang Tang is given again. It only slightly disperses Wind-Cold at the exterior but does not resolve the internally disturbed Yang, leading to irritability and closed eyes. This indicates injury to the Yang collaterals, forcing blood upward into epistaxis. Since resolution via sweating is impossible, resolution must occur via epistaxis. In Taiyang Fengzhong with sweating and a slow pulse, the patient was struck by the stirring Yang Wind. Here, with anhidrosis and a tight pulse, the patient was struck by the biting Yin Wind. Wind causes the pulse to float; a floating-tight pulse that is not tight upon deep pressing differs from the pulse of both Yin and Yang being tight in Shanghan.
[Outline] Zhang Zhongjing stated: In Shanghan with a floating-tight pulse, Mahuang Tang (Ephedra Decoction) should be primarily administered. Failure to induce sweating may lead to epistaxis. In Taiyang disease, with a floating-tight pulse, fever, body pain, and anhidrosis, spontaneous epistaxis leads to recovery. Patients prone to epistaxis (Nujia) should not undergo diaphoresis; if sweating is induced, it will cause depression of the forehead, an urgent and tight pulse, fixed staring gaze, inability to move the eyes, and insomnia.
[Commentary] Shen Jin'ao noted: A tight pulse with anhidrosis warrants diaphoresis to vent Yang Qi. If sweating is not induced, Yang Qi becomes internally disturbed, injuring the Yang collaterals and causing epistaxis. Thus, the Yang pathogen resolves through bleeding. Therefore, once epistaxis has occurred, Mahuang Tang should not be used again to induce sweating. Zhang Zhongjing mentioned in other clauses that slight relief followed by epistaxis after taking Mahuang Tang; here, he emphasizes this to warn against inducing sweating after epistaxis, stating clearly that Nujia should not be sweated again. If anhidrosis is accompanied by spontaneous epistaxis, recovery occurs naturally, illustrating the principle that Yang vents through bleeding. The four sentences regarding urgent/tight pulse describe the complications of sweating after epistaxis. These complications manifest in the forehead and eyes because the Taiyang meridian originates from the inner canthus and ascends to the forehead.
[Outline] Zhang Zhongjing stated: In Taiyang disease, with stiffness and discomfort in the nape and back, anhidrosis, and aversion to wind, Gegen Tang (Kudzu Root Decoction) should be primarily administered.
[Commentary] Shen Jin'ao noted: When Wind injures the Wei level, the skin and hair follicles close, causing anhidrosis; thus, the anhidrosis in this clause should not be mistaken for Shanghan. The Taiyang meridian connects to the brain, returns, descends to the nape, and flanks the spine. The Wind Evil in this clause enters via the Fengchi point, does not ascend to disturb the brain (hence no headache), but descends along the spine, resulting only in stiffness and discomfort in the nape and back.
[Outline] Zhang Zhongjing stated: In Shanghan with a floating-slow pulse, fever, aversion to cold, anhidrosis, restlessness, lack of body pain but heaviness, which occasionally alleviates, and absence of Shaoyin disease signs, Da Qinglong Tang (Great Blue Dragon Decoction) should be primarily administered.
[Commentary] Zhang Congzheng stated: Cold pathogens vary in severity. Severe injury presents with a tight pulse in all positions and body pain; mild injury presents with a floating-slow pulse and body heaviness. Some cases start with a tight pulse that gradually slows, or initial body pain that subsides; these must be viewed flexibly. However, a floating-tight pulse implies body pain, while a floating-slow pulse implies no body pain, applicable to both Fengzhong and Shanghan. The absence of Shaoyin signs is crucial because Shaoyin disease also presents with fever, aversion to cold, anhidrosis, and restlessness, resembling Da Qinglong Tang syndrome. However, Shaoyin requires warming and tonification, not Mahuang Tang. One must carefully examine contraindications to avoid misusing appropriate treatments.
[Outline] Zhang Zhongjing stated: In Taiyang disease, fever with anhidrosis and aversion to cold is called Gang Jing (Stiff Spasm). Fever with sweating and no aversion to cold is called Rou Jing (Soft Spasm).
[Commentary] Zhang Jianshan stated: This distinguishes Gang Jing and Rou Jing based on excess and deficiency.
[Outline] Zhang Zhongjing stated: A floating and slow pulse indicates "No Yang" (insufficient Yang), inability to produce sweat, and inevitable body itching.
[Commentary] Liu Wansu stated: Yang governs body fluids. Yang deficiency leads to scanty fluids, resulting in anhidrosis. If Yangming disease presents with anhidrosis and a sensation like insects crawling on the skin, it indicates prolonged deficiency.