麻黄 芍药 黄耆各三两 甘草 川乌（□咀，以蜜二升，煎取一升，即出乌头）五
枚
右五味，□咀四味，以水三升，煮取一升，去滓，内蜜煎中，更煎之，服七合；不知
，尽服之。
@@@
诸肢节疼痛，身体尪羸，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之。
【按】
温温当是「嗢嗢」。
【注】
历节之证，诸肢节疼痛也。身体尪羸，即上条身体羸瘦，甚言其瘦之甚也。脚肿如脱
，即上条独足肿大，甚言其肿之甚也。头眩短气，阳气虚也。嗢嗢欲吐，寒邪盛也。
而不用乌头汤者，因无黄汗之湿胜也。用桂枝芍药知母汤者，以壮阳气，散寒湿为急
也。故方中桂枝芍药倍于麻黄、防风，大加白术、附子，其意专在温行阳气，次在散
寒湿也。多用生姜，因其欲吐；更佐知母、甘草者，以其剂过辛热，监制之也。
【集注】
李□曰：此历节病，由气血两虚而致者也。风湿相搏，四肢节节皆痛，即历节病也。
身体尪羸，邪胜正衰也。脚肿如脱，气绝于下也。头眩短气，气虚于上也。温温欲吐
，气逆于中也。此三焦气血两虚，故是汤主祛风湿而温气血。
桂枝四两 芍药三两 甘草二两 麻黄二两 生姜五两 白术五两 知母四两 防风
二两附子（炮）二枚
右九味，以水七升，煮取二升，温服七合，日三服。
@@@
趺阳脉浮而滑，滑则谷气实，浮则汗自出。
【注】
趺阳胃脉也，谷气，胃气也，浮则为风外薄，滑则为胃实热，风热蒸于肌腠之间，故
汗自出。此发明黄汗，亦有因风热之义也。
@@@
少阴脉浮而弱，弱则血不足，浮则为风，风血相抟，即疼痛如掣。
【注】
少阴心脉也，心主血，心脉浮而弱，弱则为血虚，浮则为风邪，风血相抟，而交争于
经络之间，故疼痛牵引如掣也。此发明历节亦有因血虚之义也。
【集注】
李□曰：风在血中，则栗悍劲切，无所不至，为风血相搏。盖血主荣养筋骨者也，若
风以燥之，则血愈耗而筋骨失其所养，故疼痛如掣。昔人曰：治风先养血，血生风自
灭，此其治也。
@@@
盛人脉涩小，短气，自汗出，历节疼，不可屈伸，此皆饮酒汗出当风所致。
【注】
盛人脉盛，不应涩小；盛人气长，不应气短。令盛人脉涩小，短气，是形气脉息不合
也。审其证，自汗出，历节疼不可屈伸，询其由，得之于饮酒汗出当风也。此又发明
历节不止一端之义也。
【集注】
徐彬曰：盛人，肥人也。肥人湿多，脉得涩小，此痹像也。于是气为湿所搏而短，因
风作使而自汗，气血为邪所痹而疼痛不可屈伸。然肥人固多湿，何以脉骤涩小，岂非
酒湿困之乎？何以疼痛有加而汗出不已，岂非湿而挟风乎？脉证不同，因风则一，故
曰：此皆饮酒汗出当风所致。
麻黄、芍药、黄芪各三两，甘草、川乌（切碎，用蜂蜜二升，煎取一升，此时取出川乌）五枚。
以上五味药，将除川乌外的四味药切碎，用水三升，煎煮取一升，滤去药渣，加入之前煎好的蜂蜜中，再一起煎煮，服用七合；若服药后病证未缓解，则全部服下。
@@@
全身各个关节疼痛，身体消瘦虚弱，脚部肿胀如同脱落之感，头晕目眩，呼吸短促，心中泛恶欲吐，宜用桂枝芍药知母汤主治。
【按语】
“温温”应当是“嗢嗢”（wà wà，形容恶心欲吐的样子）。
【注释】
历节病（一种以关节剧烈疼痛为主症的疾病），表现为各个关节疼痛。身体尪羸（wāng léi，指肢体弯曲变形且消瘦），即上一条文中提到的身体羸瘦，这里是极力形容其消瘦的程度。脚肿如脱，即上一条文中提到的独足肿大，这里是极力形容其肿胀的程度。头晕目眩、呼吸短促，是因为阳气虚衰。嗢嗢欲吐，是因为寒邪炽盛。之所以不用乌头汤，是因为没有黄汗那种湿邪偏盛的病机。使用桂枝芍药知母汤，是为了壮盛阳气，急散寒湿。所以方中桂枝、芍药的用量倍于麻黄、防风，大量加入白术、附子，其用意专门在于温通运行阳气，其次才是散寒湿。多用生姜，是因为患者有欲吐的症状；另外佐使知母、甘草，是因为方剂过于辛热，用以制约其燥烈之性。
【集注】
李□说：这种历节病，是由气血两虚导致的。风湿相互搏结，四肢各个关节都疼痛，这就是历节病。身体尪羸，是邪气盛而正气衰的表现。脚肿如脱，是下部气绝的表现。头晕目眩、呼吸短促，是上部气虚的表现。嗢嗢欲吐，是中焦气逆的表现。这是上、中、下三焦气血两虚，所以此汤主要作用是祛风湿并温补气血。
桂枝四两、芍药三两、甘草二两、麻黄二两、生姜五两、白术五两、知母四两、防风二两、附子（炮制）二枚。
以上九味药，用水七升，煎煮取二升，温服七合，每日服用三次。
@@@
趺阳脉（位于足背动脉处，候胃气）浮而滑，滑脉代表谷气实（胃气充实），浮脉代表汗液自出。
【注释】
趺阳脉是胃脉，谷气即胃气，浮脉表示风邪外袭，滑脉表示胃中有实热，风热熏蒸于肌腠之间，所以汗液自出。此处阐明了黄汗病也有因风热引起的含义。
@@@
少阴脉（位于太溪穴处，候肾气/心气）浮而弱，弱脉代表血不足，浮脉代表风邪，风邪与血相互搏结，就会出现牵引样疼痛。
【注释】
少阴脉是心脉，心主血脉，心脉浮而弱，弱脉表示血虚，浮脉表示风邪，风邪与血相互搏结，在经络之间交争，所以出现牵引样疼痛。此处阐明了历节病也有因血虚引起的含义。
【集注】
李□说：风邪在血中，则性质慓悍劲切，无处不到，称为风血相搏。血液主要负责荣养筋骨，如果风邪使其干燥耗损，则血液更加枯竭，筋骨失去滋养，所以疼痛如牵引般剧烈。古人说：治疗风病先养血，血生则风自灭，这就是治疗方法。
@@@
形体壮盛之人脉象却涩小，呼吸短促，自汗出，患历节疼痛，关节不可屈伸，这都是因为饮酒后出汗当风受邪所致。
【注释】
形体壮盛之人脉象应该盛大，不应该是涩小；壮盛之人气息应该长，不应该是短促。现在壮盛之人脉象涩小、气短，这是形气脉息不相符合。仔细审查症状，有自汗出、历节疼痛不可屈伸，询问病因，得知是由于饮酒后出汗当风受邪所致。此处又阐明了历节病不止一种成因的含义。
【集注】
徐彬说：盛人，指肥人。肥人多湿，脉象出现涩小，这是痹证的征象。于是气被湿邪阻滞而短促，因风邪作祟而自汗，气血被邪气痹阻而疼痛不可屈伸。然而肥人固然多湿，为什么脉象突然涩小？难道不是酒湿困阻吗？为什么疼痛加重且汗出不止？难道不是湿邪夹杂风邪吗？脉证虽然不同，但致病因素都有风邪，所以说：这都是饮酒后出汗当风受邪所致。
Ephedrae Herba (Mahuang, 麻黄), Paeoniae Radix Alba (Baishao, 芍药), and Astragali Radix (Huangqi, 黄芪) each three liang; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) and Aconiti Kusnezoffii Radix (Chuanwu, 川乌) [cut into pieces, decocted with two sheng of honey until one sheng remains, then remove the Aconite root] five pieces.
The above five herbs: cut the four herbs excluding the Aconite root into pieces, decoct with three sheng of water until one sheng remains, strain to remove the dregs, add this liquid to the previously decocted honey mixture, and decoct again. Take seven he as a dose; if the condition does not improve after taking this amount, take the entire remaining decoction.
@@@
Pain in all joints of the limbs, emaciation and weakness of the body, swelling of the feet as if they were detached, vertigo, shortness of breath, and a sensation of nausea wanting to vomit are primarily treated with Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, White Peony, and Anemarrhena Decoction).
[Note]
"Wenwen" should be read as "Wawa" (a term describing the sensation of nausea).
[Commentary]
Lijie disease (a condition characterized by severe joint pain) manifests as pain in all joints. "Wanglei" refers to deformity of the limbs accompanied by emaciation, which was mentioned in the previous section as general emaciation, here emphasizing the severity of the wasting. "Swelling of the feet as if detached" refers to the isolated swelling of the foot mentioned earlier, here emphasizing the severity of the edema. Vertigo and shortness of breath indicate deficiency of Yang Qi. The sensation of nausea indicates an excess of Cold Evil. Utou Tang (Aconite Decoction) is not used because there is no dampness predominance associated with Huanghan (Yellow Sweat). Guizhi Shaoyao Zhimu Tang is used to strengthen Yang Qi and urgently dispel Cold-Dampness. Therefore, the dosage of Guizhi (Cinnamon Twig) and Baishao (White Peony) is doubled compared to Mahuang (Ephedra) and Fangfeng (Saposhnikovia Root); large amounts of Baizhu (Atractylodes Macrocephala Rhizome) and Fuzi (Prepared Aconite Lateral Root) are added. The intent is specifically to warm and circulate Yang Qi, secondarily to dispel Cold-Dampness. More Shengjiang (Fresh Ginger) is used because of the patient's desire to vomit; Zhimu (Anemarrhena Rhizome) and Gancao (Licorice Root) are added as assistants because the formula is excessively acrid and hot, serving to restrain its dryness and heat.
[Collected Notes]
Li [Name] stated: This Lijie disease is caused by deficiency of both Qi and Blood. Wind-Dampness combats each other, causing pain in every joint of the four limbs, which constitutes Lijie disease. Wanglei (emaciation/deformity) indicates that evil is excessive while healthy Qi is deficient. Swelling of the feet as if detached indicates the severance of Qi in the lower part. Vertigo and shortness of breath indicate Qi deficiency in the upper part. Nausea indicates reversal of Qi in the middle part. This represents deficiency of Qi and Blood in the Upper, Middle, and Lower Jiao; thus, this decoction mainly dispels Wind-Dampness and warms Qi and Blood.
Guizhi (Cinnamon Twig) four liang, Baishao (White Peony Root) three liang, Gancao (Licorice Root) two liang, Mahuang (Ephedra Herb) two liang, Shengjiang (Fresh Ginger) five liang, Baizhu (Atractylodes Macrocephala Rhizome) five liang, Zhimu (Anemarrhena Rhizome) four liang, Fangfeng (Saposhnikovia Root) two liang, Fuzi (Prepared Aconite Lateral Root, processed) two pieces.
The above nine herbs: decoct with seven sheng of water until two sheng remain. Take seven he warm, three times a day.
@@@
The Duyang pulse (located at the dorsum pedis, reflecting Stomach Qi) is floating and slippery. Slippery indicates substantial Grain Qi (Stomach Qi); floating indicates spontaneous sweating.
[Commentary]
Duyang is the Stomach pulse. Grain Qi refers to Stomach Qi. A floating pulse indicates external invasion by Wind; a slippery pulse indicates Excess Heat in the Stomach. Wind-Heat steaming between the muscle layers causes spontaneous sweating. This elucidates that Huanghan (Yellow Sweat) can also arise from Wind-Heat.
@@@
The Shaoyin pulse (located at Taixi, reflecting Kidney/Heart Qi) is floating and weak. Weak indicates insufficient Blood; floating indicates Wind. Wind and Blood combat each other, resulting in pulling pain.
[Commentary]
Shaoyin is the Heart pulse. The Heart governs Blood. A floating and weak Heart pulse indicates Blood deficiency (weak) and Wind pathogen (floating). Wind and Blood combat each other, contending within the meridians, hence the pulling pain. This elucidates that Lijie disease can also arise from Blood deficiency.
[Collected Notes]
Li [Name] stated: When Wind resides in the Blood, it becomes fierce and penetrating, reaching everywhere, termed Wind-Blood combat. Blood is responsible for nourishing sinews and bones. If Wind dries and consumes the Blood, the Blood becomes more depleted, and sinews and bones lose their nourishment, causing severe pulling pain. Ancients said: To treat Wind, first nourish the Blood; when Blood is generated, Wind extinguishes itself. This is the treatment principle.
@@@
In robust individuals, if the pulse is choppy and small, accompanied by shortness of breath and spontaneous sweating, suffering from Lijie pain where flexion and extension are impossible, this is all caused by sweating after drinking alcohol and being exposed to wind.
[Commentary]
Robust individuals should have a strong pulse, not choppy and small; they should have long breath, not short. Now, a robust individual having a choppy/small pulse and shortness of breath indicates a mismatch between form, Qi, and pulse. Examining the symptoms: spontaneous sweating and Lijie pain preventing movement. Inquiring into the cause: it results from sweating after drinking alcohol and exposure to wind. This further elucidates that Lijie disease has multiple etiologies.
[Collected Notes]
Xu Bin stated: "Shengren" refers to obese people. Obese people have much Dampness. A choppy and small pulse is a sign of Bi syndrome. Thus, Qi is obstructed by Dampness leading to shortness of breath; Wind acts as the agent causing spontaneous sweating; Qi and Blood are bi-blocked by pathogens causing pain and immobility. Although obese people naturally have much Dampness, why is the pulse suddenly choppy and small? Is it not due to obstruction by Wine-Dampness? Why is pain aggravated and sweating unceasing? Is it not Dampness combined with Wind? Although the pulse and symptoms differ, the presence of Wind is consistent; therefore, it is said: This is all caused by sweating after drinking alcohol and exposure to wind.