5.项背几几强太阳, 脉浮无汗葛根汤, 有汗桂枝添葛入 , 脉沉栝蒌
桂枝方. 结胸项强如柔痉, 大陷胸丸下必康, 但见少阳休汗下, 柴胡
去半入蒌良.
【注】项强, 太阳病也. 项背强, 太阳、阳明病也. 几几, 拘强而甚
之貌也. 脉浮属二阳之表脉也. 若无汗是从伤寒传来, 宜葛根汤；有
汗是从中风传来, 宜桂枝加葛根汤. 脉沉, 谓邪已入胸里也, 宜栝蒌
桂枝汤. 结胸, 谓结胸病也, 项强如柔痉, 谓项强背反张, 有汗如柔
痉之状也, 宜大陷胸丸. 但见少阳, 谓太阳、少阳并病之项强. 休汗
下,谓邪入少阳, 不可更汗下也, 宜柴胡汤去半夏加栝蒌主之. 良,
好也. 栝蒌桂枝汤方在『金匮要略』.
6.身痛未汗表实证, 汗后身疼属表虚, 桂加生姜参芍药, 尺迟血少
建中耆, 少阴沉厥附子治 , 厥阴汗痢四逆医, 风湿尽痛难转侧, 掣
引烦疼桂附宜.
【注】身痛, 未汗属表实证, 宜麻黄汤. 汗后身疼, 属表虚证, 宜桂
枝新加汤, 即桂枝汤倍生姜, 芍药加人参也. 曰桂加, 即桂枝汤加此
也.尺迟血少建中耆, 谓身痛尺中脉迟, 是血少营气不足也, 虽未经
汗,不可发汗, 直建中汤加黄耆以补营血也. 少阴, 谓身痛见少阴沉
脉,四肢厥冷也. 附子治, 谓宜附子汤治也. 厥阴, 谓身痛见厥阴厥
逆,汗出不止, 下痢清谷也. 四逆医, 谓以四逆汤医也. 风湿, 谓风
湿身痛也. 尽痛难转侧, 是湿则令人一身尽痛不能转侧. 掣引烦疼,
是风则令人筋脉牵引, 烦疼不宁也. 桂附宜, 谓宜以桂枝附子汤也.
5. 项背强直拘急如“几几”之状，属太阳病；脉象浮，无汗者用葛根汤；有汗者用桂枝汤加葛根；若脉沉，则用栝蒌桂枝汤。结胸病见项强，症状类似柔痉（以汗出、项背强直为特征），宜用大陷胸丸攻下必愈；若仅见少阳病证，严禁使用发汗或攻下法，宜用小柴胡汤去半夏加栝蒌根。
【注】项部强直，是太阳病的表现。项背部强直，是太阳与阳明合病的表现。“几几”，形容拘紧强直的样子。脉浮属于二阳（太阳、阳明）的表证脉象。若无汗，是从伤寒传变而来，适宜用葛根汤；若有汗，是从中风传变而来，适宜用桂枝加葛根汤。脉沉，说明邪气已入胸中，适宜用栝蒌桂枝汤。结胸，指结胸病；项强如柔痉，指项强且背部反张，伴有汗出，类似柔痉的症状，适宜用大陷胸丸。仅见少阳病，指太阳与少阳并病引起的项强。休汗下，指邪气进入少阳，不可再使用发汗或攻下法，适宜用小柴胡汤去掉半夏加入栝蒌根主治。“良”，意为好。栝蒌桂枝汤的方剂在《金匮要略》中已有记载。
6. 身体疼痛且未发汗，属表实证；发汗后身体仍痛，属表虚证；可用桂枝新加汤（即桂枝汤倍用生姜、芍药，加入人参）。若尺脉迟且血虚，宜用建中汤加黄芪。少阴病见四肢厥冷，用附子汤治疗；厥阴病见汗出不止、下利清谷，用四逆汤治疗。风湿痹阻致全身尽痛且难以转侧，牵引作痛且心烦不安，宜用桂枝附子汤。
【注】身体疼痛，若未经发汗，属表实证，适宜用麻黄汤。发汗后身体疼痛，属表虚证，适宜用桂枝新加汤，也就是桂枝汤加倍生姜和芍药的用量，再加入人参。所谓“桂加”，即指桂枝汤加入上述药物。尺脉迟且血少建中加黄芪，指身体疼痛且尺中脉迟，这是血少营气不足的表现，即使未经发汗，也不可再发汗，应直接用建中汤加黄芪来补益营血。少阴，指身体疼痛且见少阴病沉脉、四肢厥冷的情况。附子治，指适宜用附子汤治疗。厥阴，指身体疼痛且见厥阴病厥逆、汗出不止、下利完谷不化的情况。四逆医，指用四逆汤来医治。风湿，指风湿邪气导致的身体疼痛。全身尽痛难以转侧，是因为湿邪使人全身疼痛不能转动侧身。牵引烦疼，是因为风邪使人筋脉牵引，疼痛烦躁不安。桂附宜，指适宜用桂枝附子汤。
5. Stiffness and rigidity of the neck and back, resembling the posture of a bird stretching its neck (Ji Ji), indicates Taiyang disease (disease of the Taiyang channel). If the pulse is floating and there is no sweating, Gegen Tang (Kudzu Root Decoction) should be used; if there is sweating, Guizhi Tang (Cinnamon Twig Decoction) with added Gegen (Kudzu Root) should be used. If the pulse is deep, Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) is indicated. In Jie Xiong (Chest Binding) syndrome presenting with neck stiffness resembling Rou Jing (Soft Spasm, characterized by sweating and stiffness), Daxiexiong Wan (Major Draining the Chest Pill) for purging will lead to recovery. If Shaoyang (Lesser Yang) symptoms are present, sweating or purging methods must not be used; instead, Xiaochaihu Tang (Minor Bupleurum Decoction) with Banxia (Pinellia Rhizome) removed and Gualou Gen (Trichosanthes Root) added is appropriate.
[Annotation] Neck stiffness is a manifestation of Taiyang disease. Stiffness of the neck and back involves both Taiyang and Yangming diseases. "Ji Ji" describes a state of severe stiffness and rigidity. A floating pulse belongs to the exterior patterns of the two Yang channels (Taiyang and Yangming). If there is no sweating, it indicates transmission from Shang Han (Cold Damage), and Gegen Tang is suitable. If there is sweating, it indicates transmission from Feng Zhong (Wind Strike), and Guizhi Jia Gegen Tang (Guizhi Tang plus Kudzu Root) is suitable. A deep pulse indicates that the pathogen has entered the chest interior, and Gualou Guizhi Tang is indicated. Jie Xiong refers to Chest Binding syndrome; neck stiffness resembling Rou Jing implies neck stiffness with opisthotonos (back arching) and sweating, similar to the presentation of Rou Jing, for which Daxiexiong Wan is indicated. "Only seeing Shaoyang" refers to neck stiffness caused by concurrent Taiyang and Shaoyang disease. "Do not sweat or purge" means that once the pathogen enters Shaoyang, sweating and purging methods are contraindicated; Xiaochaihu Tang with Banxia removed and Gualou Gen added is the primary treatment. "Liang" means good or effective. The formula Gualou Guizhi Tang is recorded in Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet).
6. Body pain without prior sweating indicates an Exterior Excess pattern; body pain after sweating indicates an Exterior Deficiency pattern. For the latter, Guizhi Xinjia Tang (Guizhi Decoction with Added Ingredients) is used, which consists of Guizhi Tang with doubled Shengjiang (Fresh Ginger) and Shaoyao (Peony Root), plus Renshen (Ginseng Root). If the Chi position of the pulse is slow indicating blood deficiency, Jianzhong Tang (Establish the Middle Decoction) with Huangqi (Astragalus Root) should be used. Shaoyin disease presenting with cold limbs is treated with Fuzi Tang (Aconite Decoction). Jueyin disease presenting with incessant sweating and diarrhea of undigested food is treated with Sini Tang (Recover the Pulse Decoction). Rheumatism causing generalized body pain and difficulty in turning the body, accompanied by pulling pain and restlessness, is treated with Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction).
[Annotation] Body pain without prior sweating belongs to an Exterior Excess pattern, for which Mahuang Tang (Ephedra Decoction) is suitable. Body pain after sweating belongs to an Exterior Deficiency pattern, for which Guizhi Xinjia Tang is suitable. This formula is Guizhi Tang with increased amounts of Shengjiang and Shaoyao, plus Renshen. "Gui Jia" refers to adding these ingredients to Guizhi Tang. "Chi chi xue shao Jianzhong Qi" means that body pain with a slow pulse at the Chi position indicates insufficient blood and Ying Qi (Nutritive Qi); even without prior sweating, diaphoresis is contraindicated, and one should directly use Jianzhong Tang with Huangqi to tonify Ying and Blood. "Shaoyin" refers to body pain accompanied by a deep pulse and cold limbs characteristic of Shaoyin disease. "Fuzi Zhi" means treating with Fuzi Tang. "Jueyin" refers to body pain accompanied by Jue Ni (cold extremities), incessant sweating, and diarrhea of undigested food characteristic of Jueyin disease. "Sini Yi" means treating with Sini Tang. "Feng Shi" refers to body pain caused by Wind-Dampness. "Jin tong nan zhuan ce" means that Dampness causes generalized body pain making it difficult to turn the body. "Che yin fan teng" means that Wind causes pulling sensations in the sinews and vessels, resulting in painful restlessness. "Gui Fu Yi" means using Guizhi Fuzi Tang is appropriate.