〔《活》〕大抵太阳病必发热而恶寒,不可过覆衣被,及近火气,恐寒热相搏,脉道沉伏,愈令病患寒不可
遏。但去被彻火,兼饮以和表之药,自然不恶寒矣。若妇人恶寒,尤不可近火,恐寒气入腹,血室结聚,针药
所不能治矣。
发热恶风为表虚,属太阳病。(方论见发热太阳病条。)发汗后,遂汗漏不止,其症似风湿相搏症,背
恶风,汗出,小便不利,四肢难屈伸,但心下不满者,身不痛,用桂枝加附子汤。(方见自汗。)
风湿相搏者,骨节烦疼,掣痛,用甘草附子汤。(方见体痛。)身热恶风,项强胁满,手足温而渴者,
用小柴胡汤。
(方论见胁痛。)
〔成〕恶风者,见风至则恶矣。必居密室之内,帏帐之中,则坦然自舒。恶寒者,则不待风而自寒,虽身
大热而不欲去衣者是也。《活人》云∶恶寒者,不当风而自憎寒。恶风者,当风而憎寒也。
发热头痛恶风者,属太阳。(方论见发热太阳病。)大便不利六七日,头痛身热,小便赤者,宜承气汤。
若小便利者,知不在里仍在表也,宜桂枝汤。(论见胃实。)头痛发热,脉弦细者,属少阳,宜小柴胡汤。(论见口苦。)
若脉反沉者,当救里,宜四逆汤。(论见发热。)头痛兼心下痞硬满痛,苦眩冒,时如结胸者,刺大椎第
一间肺俞、肝俞。(论见项强。)若下后仍发热无汗,小便不利者,桂枝去桂加茯苓白术汤。(方论见项强。)若表解汗出,
胁痛
干呕者,宜十枣汤。(方论见胁痛。)头痛,干呕吐涎沫者,用吴茱萸汤。(方论见吐。)若表解汗出,
心下硬,引胁痛者,用十枣汤。若阳明胃实,反无汗而小便利,呕咳,手足厥者,为寒邪。(方论见胃实。)头痛
发热,吐利者,为霍乱。(方论见吐利。)湿家,病身痛发热,面黄而喘,头痛鼻塞而烦,其脉大能食者,
纳药鼻中则愈。(方论见身痛湿痹条。)
太阳病下之复脉细数者,头痛未止。
〔《活人书》〕大抵太阳病(太阳经受邪所致的病证)必定出现发热而恶寒的症状,不可过度覆盖衣被,也不应靠近火源取暖,恐怕寒热之气相互搏结,导致脉道沉伏不起,反而使患者感到寒冷难以抑制。只需撤去被褥、远离火源,同时服用调和表证的药物,自然就不会再恶寒了。如果是女性患者出现恶寒,尤其不能靠近火源,恐怕寒气侵入腹部,导致血室(子宫及冲任二脉)气血凝结,届时针灸和药物都难以治愈了。
发热且怕风属于表虚证,归属于太阳病。(方剂论述见“发热·太阳病”条目。)发汗治疗后,如果汗出淋漓不止,症状类似风湿相搏证,表现为背部怕风、出汗、小便不利、四肢难以屈伸,但心下没有胀满感的,身体不疼痛的,使用桂枝加附子汤。(方剂见“自汗”条目。)
若是风湿相搏证,骨节剧烈疼痛、牵掣作痛,使用甘草附子汤。(方剂见“体痛”条目。)身体发热、怕风、项部僵硬、胁肋胀满,手足温暖且口渴的,使用小柴胡汤。
(方剂论述见“胁痛”条目。)
〔成无己〕所谓恶风,是指见到风就觉得难受厌恶。必须居住在密闭的房间内,帷帐之中,才能感到坦然舒适。所谓恶寒,则是不需要风吹就自觉寒冷,即使身体高热也不想脱去衣服,就是这种情况。《活人书》说:恶寒的人,不吹风也自己憎恨寒冷;恶风的人,吹风才憎恨寒冷。
发热、头痛、怕风的,归属于太阳经。(方剂论述见“发热·太阳病”。)大便不通六七天,头痛身热,小便颜色赤红的,适宜用承气汤。如果小便通利的,知道病邪不在里而在表,适宜用桂枝汤。(论述见“胃实”条目。)头痛发热,脉象弦细的,归属于少阳经,适宜用小柴胡汤。(论述见“口苦”条目。)
如果脉象反而沉的,应当急救里证,适宜用四逆汤。(论述见“发热”条目。)头痛兼有心下痞塞、坚硬、胀满疼痛,苦于眩晕昏冒,有时像结胸证的,针刺大椎穴第一间、肺俞穴、肝俞穴。(论述见“项强”条目。)如果经过攻下后仍然发热无汗,小便不利的,用桂枝去桂加茯苓白术汤。(方剂论述见“项强”条目。)如果表证已解且出汗,伴有胁痛、干呕的,适宜用十枣汤。(方剂论述见“胁痛”条目。)头痛,干呕吐涎沫的,用吴茱萸汤。(方剂论述见“吐”条目。)如果表证已解且出汗,心下硬满,牵引胁肋疼痛的,用十枣汤。如果是阳明胃实证,反而无汗且小便通利,伴有呕吐咳嗽,手足厥冷的,这是寒邪所致。(方剂论述见“胃实”条目。)头痛发热,伴有呕吐腹泻的,是霍乱。(方剂论述见“吐利”条目。)患有湿痹的病人,身体疼痛发热,面色发黄且气喘,头痛鼻塞且烦躁,脉象大且能进食的,将药物纳入鼻中即可痊愈。(方剂论述见“身痛湿痹”条目。)
太阳病经过攻下后,脉象变得细数,头痛仍未停止。
[From *Huo Ren Shu*] Generally, Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel) is characterized by fever and aversion to cold. One should not cover the patient excessively with blankets or place them near fire sources, lest the cold and heat qi clash, causing the pulse to sink and become imperceptible, thereby exacerbating the patient's uncontrollable sensation of cold. Simply remove the blankets, keep away from fire, and administer herbs that harmonize the exterior; the aversion to cold will naturally cease. If a female patient suffers from aversion to cold, she must especially avoid fire, as this may allow cold qi to enter the abdomen, causing stagnation in the Blood Chamber (referring to the uterus and Chong and Ren vessels), a condition beyond the reach of acupuncture and herbal medicine.
Fever accompanied by wind aversion indicates exterior deficiency and belongs to Taiyang disease. (Formula discussion see "Fever · Taiyang Disease" section.) After sweating therapy, if perspiration continues unceasingly, presenting symptoms similar to Wind-Dampness clashing—such as wind aversion on the back, sweating, difficulty in urination, and inability to flex or extend the limbs—but without fullness in the epigastrium and without body pain, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root) should be used. (Formula see "Spontaneous Sweating" section.)
In cases of Wind-Dampness clashing, where there is severe pain and pulling pain in the bone joints, Gancao Fuzi Tang (Licorice Root and Aconite Root Decoction) should be used. (Formula see "Body Pain" section.) For those with body heat, wind aversion, stiffness in the neck and nape, distension in the hypochondrium, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
(Formula discussion see "Hypochondriac Pain" section.)
[Cheng Wuji] "Wind aversion" refers to feeling discomfort and aversion upon encountering wind. The patient must reside in a tightly sealed room within curtains to feel at ease and comfortable. "Cold aversion," however, involves feeling cold even without wind exposure; even if the body is highly febrile, the patient does not wish to remove clothing. This is the definition of cold aversion. *Huo Ren Shu* states: Those with cold aversion hate the cold spontaneously without wind; those with wind aversion hate the cold only when exposed to wind.
Fever, headache, and wind aversion belong to the Taiyang stage. (Formula discussion see "Fever · Taiyang Disease".) If constipation persists for six or seven days, accompanied by headache, body heat, and reddish urine, Chengqi Tang (Purgative Decoction) is appropriate. If urination is free, it indicates the pathogen remains in the exterior rather than the interior, so Guizhi Tang (Cinnamon Twig Decoction) is suitable. (Discussion see "Stomach Excess" section.) Headache and fever with a wiry and fine pulse belong to the Shaoyang stage, indicating Xiaochaihu Tang (Minor Bupleurum Decoction). (Discussion see "Bitter Taste in Mouth" section.)
If the pulse is unexpectedly deep, the interior must be rescued urgently, using Sini Tang (Recovery Decoction). (Discussion see "Fever" section.) For headache accompanied by epigastric stuffiness, hardness, fullness, and pain, suffering from vertigo and dizziness, resembling Chest Binding Syndrome at times, needle the first interspace of Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). (Discussion see "Neck Stiffness" section.) If after purgation there is still fever, no sweat, and difficulty in urination, Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractodes Rhizome Decoction) should be used. (Formula discussion see "Neck Stiffness" section.) If the exterior is resolved with sweating, accompanied by hypochondriac pain and dry retching, Shizao Tang (Ten Jujubes Decoction) is indicated. (Formula discussion see "Hypochondriac Pain" section.) For headache with dry retching and vomiting of clear saliva, Wuzhuyu Tang (Evodia Fruit Decoction) is used. (Formula discussion see "Vomiting" section.) If the exterior is resolved with sweating, and there is epigastric hardness radiating to the hypochondrium with pain, use Shizao Tang (Ten Jujubes Decoction). In cases of Yangming Stomach Excess, if there is paradoxically no sweat, free urination, vomiting, coughing, and cold extremities, this is due to Cold Pathogens. (Formula discussion see "Stomach Excess" section.) Headache and fever accompanied by vomiting and diarrhea indicate Huoluan (Cholera-like disorder). (Formula discussion see "Vomiting and Diarrhea" section.) Patients suffering from Dampness Bi syndrome, presenting with body pain, fever, yellow complexion, wheezing, headache, nasal congestion, and irritability, with a large pulse and ability to eat, can be cured by insufflating medicine into the nose. (Formula discussion see "Body Pain and Dampness Bi" section.)
After purgation in Taiyang disease, if the pulse becomes fine and rapid, the headache has not yet ceased.