【纲】仲景曰。病患身热足寒。颈项强急。恶寒。时头热。面赤。目脉赤。独头摇。卒口噤。
背反张者。此太阳中风。重感寒湿而为痉也。湿家下之。额上汗出。微喘。小便利者死。若下利不
止者亦死。
【目】朱肱曰。风寒湿杂至合而为痹。身重汗出恶风。痛如历节状。防己黄 汤。
张兼善曰。错杂之邪合至。当论其先后多少分治可也。
成无己曰。额上汗出而喘。阳气上逆也。小便自利。或下利。阴气下流也。阴阳相离。故云死。内经曰。
阴阳离缺。精气乃绝。此之谓也。
鳌按。下条乃言湿家死症也。湿病本不至死。今由误下以至不救。仍是医杀之耳。
李 曰。阴脉紧者。雾露浊邪。中于下焦少阴之分。故曰浑。因表虚里微。遂使邪中于阴。为
栗。令人足胫逆冷。便溺妄出。或腹痛下利。宜理中汤、四逆汤热药以散其邪。阳脉紧或带涩者。
雾露消邪。中于上焦太阳之分。故曰洁。令人发热。头疼项强。筋挛。腰痛胫酸。宜九味羌活汤加
本。或恶寒欲吐者。藿香正气散、五积散。仍量加 本。阴阳脉俱紧者。上下二焦俱中邪也。必
吐利后脉不紧。手足温则愈。若吐利后脉迟不食者。脾胃虚而内停水饮也。若脉阴阳俱紧。口中气
出。唇口干燥。蜷卧足冷。鼻涕出。舌上苔滑。勿妄治也。又有阳病上行极而下。阴病下行极而上。
上下必于中焦。于是三焦溷乱。内外气塞。以致口糜 嚏。下为小便黄。大便血。凝如猪肝。
热气腾而脾胃不运。营卫凝滞。则生疮痈。虚寒甚者。脾胃独弱。下焦不约。清便下重。脐筑湫痛
而死。盖脐为生气之源。筑痛乃生气已绝。
【纲】张仲景说：病人身体发热，双脚发凉，颈项僵硬拘急，怕冷，有时头部发热，面色发红，眼睛血脉充血，只有头部摇动，突然牙关紧闭，背部向后反折（角弓反张），这是太阳中风证，又重感寒湿之邪而形成的痉病。患湿病的人被误用泻下法治疗后，出现额头出汗，轻微气喘，小便通利的，预后不良致死；如果腹泻不止的，也预后不良致死。
【目】朱肱说：风、寒、湿三种邪气混杂而至，合而为痹证。表现为身体沉重，出汗，怕风，疼痛像历节病一样剧烈，可用防己黄芪汤治疗。
张兼善说：错杂的邪气同时侵袭人体，应当根据邪气的先后和多少分别进行治疗。
成无己说：额头出汗且气喘，是阳气上逆的表现；小便自利，或者腹泻，是阴气下流的表现。阴阳之气相互分离，所以说会死亡。《内经》说：阴阳离决，精气就会断绝。说的就是这种情况。
沈金鳌按语：下一条条文说的是湿病患者的死症。湿病本来不至于致死，现在因为误用泻下法导致无法救治，这实际上是医生治死了病人。
李氏说：阴脉紧实的，是雾露浊邪，侵入下焦少阴经的分野，所以称为“浑”。因为表虚里微，致使邪气侵入阴分，引起战栗，使人小腿逆冷，大小便失禁，或者腹痛腹泻，适宜用理中汤、四逆汤等热性药物来驱散邪气。阳脉紧实或带涩象的，是雾露清邪，侵入上焦太阳经的分野，所以称为“洁”。使人发热，头痛，颈项强直，筋脉拘挛，腰痛，小腿酸楚，适宜用九味羌活汤加藁本；或者如果有怕冷想吐的症状，用藿香正气散、五积散，仍酌情加入藁本。如果阴阳脉都紧实，说明上下二焦都中了邪气。必须在呕吐腹泻后脉象不再紧实，手足温暖才能痊愈。如果在呕吐腹泻后脉象迟缓且不能进食的，是脾胃虚弱且体内停聚水饮。如果脉象阴阳俱紧，口中呼出热气，嘴唇口舌干燥，蜷缩而卧，脚冷，流鼻涕，舌苔滑润，不要妄加治疗。又有阳病上行到极点则向下传变，阴病下行到极点则向上逆行，上下病变必然涉及中焦，于是三焦混乱，内外气机阻塞，导致口腔糜烂、打喷嚏，下部出现小便黄赤，大便出血，凝结如猪肝状。热气蒸腾而脾胃运化失常，营卫凝滞，则生疮痈。虚寒严重的，脾胃特别虚弱，下焦约束无力，大小便排出不畅且有坠重感，脐部筑痛（阵发性绞痛）而死。因为脐部是生气之源，脐部筑痛意味着生气已经断绝。
[General Principles] Zhang Zhongjing stated: When a patient presents with fever in the body and coldness in the feet, stiffness and rigidity of the neck and nape, aversion to cold, occasional heat in the head, redness of the face, congestion of the eye vessels, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (backward arching of the back), this is Taiyang Wind Strike syndrome complicated by Cold-Dampness, resulting in Spasm disease. If a patient suffering from Dampness is treated with purgation, leading to sweating on the forehead, slight wheezing, and free urination, the prognosis is fatal. Similarly, if persistent diarrhea occurs, it is also fatal.
[Specific Discussions] Zhu Gong stated: When Wind, Cold, and Dampness mix and combine to form Bi syndrome, symptoms include heaviness of the body, sweating, aversion to wind, and pain resembling Lijie disease (painful obstruction similar to rheumatoid arthritis). Fangji Huangqi Tang (Astragalus and Stephania Decoction) should be used.
Zhang Jianshan stated: When mixed pathogenic factors attack simultaneously, treatment should be differentiated based on the sequence and proportion of the pathogens.
Cheng Wuji stated: Sweating on the forehead accompanied by wheezing indicates the reversal of Yang Qi upwards. Free urination or diarrhea indicates the flow of Yin Qi downwards. The separation of Yin and Yang leads to death. The *Neijing* states: "When Yin and Yang separate, essence and Qi are exhausted." This refers to that situation.
Shen Jin'ao commented: The following clause describes the fatal cases of Dampness disease. Dampness disease itself does not typically lead to death; however, due to erroneous purgation, it becomes incurable. This is essentially iatrogenic death caused by the physician.
Li Shi stated: A tight pulse in the Yin position indicates that turbid pathogens from fog and dew have invaded the Shaoyin region of the Lower Jiao, hence termed "Hun" (turbid). Due to exterior deficiency and interior weakness, pathogens invade the Yin aspect, causing shivering, coldness in the calves, involuntary urination and defecation, or abdominal pain with diarrhea. Li Zhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction) and other warming herbs should be used to disperse the pathogens. A tight or choppy pulse in the Yang position indicates that clear pathogens from fog and dew have invaded the Taiyang region of the Upper Jiao, hence termed "Jie" (clear). Symptoms include fever, headache, neck stiffness, tendon spasms, lower back pain, and soreness in the calves. Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) added with Gaoben (Ligusticum sinense Rhizome) is appropriate. If there is aversion to cold and nausea, Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi) or Wuji San (Five Accumulations Powder) may be used, still adding Gaoben as needed. If both Yin and Yang pulses are tight, it indicates invasion of pathogens in both the Upper and Lower Jiao. Recovery depends on the pulse no longer being tight after vomiting and diarrhea, and the hands and feet becoming warm. If the pulse is slow and the patient cannot eat after vomiting and diarrhea, it indicates Spleen-Stomach deficiency with internal retention of fluid-dampness. If both Yin and Yang pulses are tight, with hot breath from the mouth, dry lips and tongue, curled-up posture, cold feet, runny nose, and a slippery coating on the tongue, do not treat rashly. Furthermore, Yang diseases rising to the extreme descend downward, and Yin diseases descending to the extreme ascend upward; both must involve the Middle Jiao. Consequently, the Three Jiaos become chaotic, and Qi blockage occurs internally and externally, leading to oral ulcers, sneezing, yellow urine, and bloody stools coagulated like duck liver. Rising heat impairs Spleen-Stomach transportation, stagnation of Ying and Wei fluids leads to sores and carbuncles. In severe deficiency-cold, the Spleen-Stomach is particularly weak, the Lower Jiao loses its restraining function, leading to tenesmus in urination and defecation, and colicky pain at the umbilicus, resulting in death. The umbilicus is the source of vital Qi; colicky pain here signifies the exhaustion of vital Qi.