麻黄（去节）三两 桂枝（去皮）二两 甘草（炙）二两 杏仁（去皮、尖）七十个
白术四两
右五味，以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取二升半，去滓，温服
八合，覆取微似汗。
【按】
桂枝气味辛甘，全在于皮，若去皮是枯木矣。如何有解肌发汗之功？宜删此二字，后
仿此。
@@@
太阳病，关节疼痛而烦，脉沉而细者，此名湿痹，湿痹之候，小便不利，大便反快，
但当利其小便。
【注】
此承上条互详其义，谓湿家身痛不可发汗，当有利小便之法也。太阳病，一身关节烦
疼，若脉浮细者，湿在外也，当汗之；小便不利，大便反快，脉沉细者，湿在内也，
当利之。。今湿气淫于内外，故关节烦疼，□而不行，小便不利，大便反快，此名湿
痹。虽有身痛，其脉不浮细，故不可发汗。设脉沉细，故但当利小便，若小便利，濡
泻止，痹不愈，身仍疼痛，汗之可也。
【集注】
赵良曰：痹痛也，因其关节烦疼，脉沉而细，则名曰湿痹也。经云：湿胜则濡泻，小
便不利，大便反快者，是湿气内胜地，但当先利小便，以泻腹中湿气，故云治湿不利
小便，非其治也。设小便利已，而关节之痹不去 ，又必自表治之。
李□曰：太阳经行身之表，外邪皆得伤之，故亦受湿气也。关节疼痛者，湿留关节也
，湿气郁蒸而生热，故烦也。经云：沉潜水蓄，沉细为内湿脉。痹者，闭塞不通之谓
，即『内经』湿气胜者为□痹之意，今小便不利，是湿盛于内也。即『内经』湿胜则
濡泄也。利小便则湿去，而泻烦止矣。
@@@
湿家，其人但头汗出，背强，欲得被覆向火，若下之蚤则哕，或胸满，小便不利，舌
上如胎者，以丹田有热，胸中有寒，渴欲得水，而不能饮，则口燥烦也。
【注】
湿家头汗出者，乃上湿下热，蒸而使然，非阳明内实之热，蒸而上越之汗也。背强者
，乃湿邪重□之强，非风湿拘急之强也。欲覆被向火者。乃一时湿盛生寒，非伤寒之
恶寒也。若误以阳明内湿之热，上越之头汗而遂下之，则湿从寒化，即乘虚入于上，
则肺气逆而胸满，入于中，则胃不和而为哕，入于下，则膀胱气化不行，为小便不利
。舌上白滑如胎者，盖以误下热陷，丹田有热也。寒聚于上，胸中有寒也，所以渴欲
得水，而不能饮。由下有热而生口燥烦，由上有寒而不化生津液，虽口燥舌干，而不
能多饮也。
@@@
湿家下之，额上汗出，微喘，小便利者，死；下利不止者，亦死。
【注】
此承上条互详误下，以明湿家头汗之死证也。夫误下，额汗微喘，若小便不利，是湿
家额汗之喘，未可言死也。今小便反利，则知非湿气上溢，乃上脱额汗之喘，故曰死
。若下利不止，亦知非湿去之利，乃中脱直下之利，故曰亦死。
【集注】
赵良曰：此妄下之，因而致逆，逆则阳自上越，阴自下脱，其额上汗出微喘者，阳之
越，小便利与下利不止者，阴之脱也，阴阳离决，必死之兆也。自此而推之，下之虽
额上汗出微喘，若大小便不利者。是阴气不脱，而阳之根犹在也；下之虽大小便利，
设额上无汗与喘，是阳气不越，而阴之根犹在也，则非离决，可以随其证而治之。
李玮西曰：前云湿家当利小便，以湿气内瘀，小便原自不利，宜用药利之。此下后里
虚，小便自利，液脱而死，不可一例概也。
@@@
病者一身尽疼，发热，日晡所剧者，名风湿。此病伤于汗出当风，或久伤取冷所致也
，可与麻黄杏仁薏苡甘草汤。
【注】
病者，谓一身尽痛之病人也。湿家一身尽痛，风湿亦一身尽痛，然湿家痛，则重□不
能转侧；风湿痛，则轻掣不可屈伸，此痛之有别者也。湿家发热，早暮不分微甚；风
湿之热，日晡所必剧，盖以湿无来去，而风有休作，故名风湿。原其由来，或为汗出
当风，或为久伤取冷，相合而致，则麻黄杏仁薏苡甘草汤，发散风湿，可与也明矣。
【集注】
程林曰：一身尽疼发热，风湿在表也。日晡，申时也。阳明王于申酉戌，土恶湿，今
为风湿所干，当其王时，邪正相抟，则反剧也。汗也湿类，或汗出当风而成风湿者，
或劳伤汗出而入冷水者，皆成风湿之病也。
魏荔彤曰：痉家非风不成，虽有寒，亦附于风；湿痹无寒不作，虽有风，亦附于寒，
此一定之理也。
麻黄（去节）三两 桂枝（去皮）二两 甘草（炙）二两 杏仁（去皮、尖）七十个
白术四两
以上五味药，用水九升，先煮麻黄，水量减少二升，撇去浮沫，加入其余药物，煎取药液二升半，滤去药渣，温服八合，服药后覆盖衣被使身体微微出汗。
【按语】
桂枝的气味辛甘，主要存在于树皮中，如果去掉树皮就是枯木了。怎么还能有解肌发汗的功效呢？应当删去“去皮”这两个字，后面的条文仿照此例处理。
@@@
太阳病（太阳经受邪所致的病证），关节疼痛且烦躁，脉象沉而细的，这叫做湿痹（因湿邪闭阻经络引起的痹证）。湿痹的症状表现是，小便不通利，大便反而稀溏，只应当通利小便。
【注解】
这是承接上一条互相详述其含义，意思是患湿病的患者身体疼痛不可发汗，应当采用通利小便的方法。太阳病，全身关节烦扰疼痛，如果脉象浮而细，说明湿气在体表，应当用发汗法；如果小便不通利，大便反而稀溏，脉象沉而细，说明湿气在体内，应当用通利小便法。如今湿气弥漫于内外，所以关节烦扰疼痛，气机不畅，小便不通利，大便反而稀溏，这叫做湿痹。虽然有身体疼痛，但脉象不浮不细，所以不可以发汗。假如脉象沉细，所以只应当通利小便，如果小便利了，濡泻停止，但痹证未愈，身体仍然疼痛，这时才可以发汗。
【集注】
赵良说：痹痛也，因为关节烦扰疼痛，脉象沉而细，所以叫做湿痹。医经说：湿气盛则导致大便稀溏，小便不通利，大便反而稀溏的，这是湿气内盛的征象，只应当先通利小便，以泻除腹中的湿气，所以说治疗湿病如果不通利小便，就不是正确的治法。假如小便利了之后，而关节的痹证仍未去除，又必须从表证来治疗。
李□说：太阳经行于人体体表，外邪都能伤害它，所以也会受湿气侵袭。关节疼痛，是因为湿气滞留关节；湿气郁结蒸腾而生热，所以感到烦扰。医经说：水湿潜伏蓄积，脉沉细是内湿的脉象。痹，是指闭塞不通的意思，即《内经》中“湿气胜者为痹”的意思，如今小便不通利，是湿气盛于体内。即《内经》所说的“湿胜则濡泄”。通利小便则湿气去除，而腹泻和烦扰就会停止。
@@@
患湿病的患者，只有头部出汗，背部僵硬，想要盖被子靠近火源取暖，如果过早使用攻下法，就会出现呃逆，或者胸满，小便不通利，舌苔像胎一样（白滑），这是因为丹田有热，胸中有寒，口渴想喝水，但不能喝下去，从而出现口燥烦扰。
【注解】
湿病患者头部出汗，是由于上湿下热，蒸腾所致，不是阳明腑实的热邪蒸腾而上越的汗。背部僵硬，是湿邪沉重导致的僵硬，不是风湿导致的拘急僵硬。想要盖被子靠近火源，是一时湿气盛产生寒象，不是伤寒的恶寒。如果错误地把阳明内湿的热邪、上越的头汗当作实证而使用攻下法，那么湿气就会随寒化，乘虚侵入上部，就会导致肺气上逆而胸满；侵入中部，就会导致胃不和而发生呃逆；侵入下部，就会导致膀胱气化不行，出现小便不通利。舌上白滑如胎，是因为误用攻下法导致热邪陷入，丹田有热。寒气聚于上部，胸中有寒，所以口渴想喝水，但不能喝下去。由于下有热而生出口燥烦扰，由于上有寒而不能化生津液，虽然口燥舌干，但不能多饮水。
@@@
湿病患者误用攻下法，额头出汗，轻微气喘，小便通利的，预后不良（死）；腹泻不止的，也预后不良（死）。
【注解】
这是承接上一条互相详述误用攻下法，以阐明湿病患者头汗的死证。误用攻下法，出现额头出汗、轻微气喘，如果小便不通利，这是湿病患者额头出汗的气喘，还不能说是死证。如今小便反而通利，就知道这不是湿气上溢，而是阳气上脱导致的额头出汗和气喘，所以说预后不良。如果腹泻不止，也知道这不是湿气去除的腹泻，而是中气下脱导致的直下之利，所以说也预后不良。
【集注】
赵良说：这是妄用攻下法，因而导致逆乱，逆乱则阳气从上越出，阴气从下脱失，额头出汗、轻微气喘的，是阳气的越出；小便通利与腹泻不止的，是阴气的脱失，阴阳离决，是必死的征兆。由此推论，误用攻下法虽然额头出汗、轻微气喘，但如果大小便都不通利，这是阴气没有脱失，而阳气的根本还在；误用攻下法虽然大小便通利，假如额头没有出汗与气喘，这是阳气没有越出，而阴气的根本还在，这就不是阴阳离决，可以根据其证候进行治疗。
李玮西说：前文说湿病患者应当通利小便，因为湿气内瘀，小便原本就不通利，宜用药通利它。这里误下后里气虚弱，小便自利，津液脱失而死，不能一概而论。
@@@
患者全身都疼痛，发热，下午申时左右加重的，叫做风湿。这种病是由于出汗时当风，或久处寒冷环境受冷所致，可以用麻黄杏仁薏苡甘草汤。
【注解】
“病者”，指全身都疼痛的病人。湿病患者全身都疼痛，风湿病患者也全身都疼痛，然而湿病的疼痛，沉重得不能翻身转动；风湿病的疼痛，轻掣得不能屈伸，这是疼痛的区别。湿病患者发热，早晚不分轻重；风湿病的发热，下午申时左右必定加重，因为湿气没有来去变化，而风邪有发作休止，所以叫做风湿。追溯其来源，或者是出汗时当风，或者是久处寒冷环境受冷，两者结合而导致，那么麻黄杏仁薏苡甘草汤，发散风湿，是可以使用的，这很明白了。
【集注】
程林说：全身都疼痛发热，是风湿在体表。日晡，指申时。阳明经旺于申、酉、戌时，土恶湿，如今被风湿所干扰，当其旺时，邪正相争，所以反而加重。汗属于湿类，或者是出汗时当风而成风湿，或者是劳伤出汗后进入冷水，都会形成风湿病。
Ephedrae Herba (Mahuang, 麻黄) [devoid of nodes] three liang; Cinnamomi Ramulus (Guizhi, 桂枝) [devoid of bark] two liang; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [roasted] two liang; Armeniacae Semen Amarum (Xingren, 杏仁) [devoid of skin and tip] seventy seeds; Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) four liang.
The above five herbs are boiled in nine sheng of water. First, boil Ephedrae Herba until the volume reduces by two sheng, then skim off the foam on the surface. Add the remaining herbs and continue boiling to obtain two and a half sheng of decoction. Strain the dregs, and take eight he of the liquid warm. After ingestion, cover with blankets to induce a slight perspiration.
[Commentary]
Cinnamomi Ramulus has acrid and sweet properties, which reside primarily in its bark. If the bark is removed, it becomes dead wood; how could it still possess the efficacy of releasing the muscle layer and inducing sweating? The characters "devoid of bark" should be deleted, and subsequent prescriptions should follow this principle.
@@@
Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), characterized by joint pain accompanied by irritability, and a deep and fine pulse, is named Shi Bi (Bi syndrome due to dampness obstruction). The manifestations of Shi Bi include difficulty in urination and loose stools. The treatment principle is to promote diuresis.
[Annotation]
This passage elaborates on the previous one, stating that for patients with dampness suffering from body pain, sweating is contraindicated; instead, promoting diuresis is indicated. In Taiyang disease, if there is irritative pain in all joints and the pulse is floating and fine, the dampness is exterior, and sweating is appropriate. However, if there is difficulty in urination, loose stools, and a deep and fine pulse, the dampness is interior, and promoting diuresis is appropriate. Currently, when dampness pervades both interior and exterior, causing irritative joint pain, qi stagnation, difficulty in urination, and loose stools, it is termed Shi Bi. Although there is body pain, the pulse is neither floating nor fine, so sweating is contraindicated. If the pulse is deep and fine, only promoting diuresis is indicated. If diuresis resolves and loose stools cease, but the Bi syndrome persists and body pain remains, then sweating may be employed.
[Collected Notes]
Zhao Liang stated: Bi pain, due to irritative joint pain and a deep and fine pulse, is named Shi Bi. The Classics state: "Excess dampness leads to loose stools." Difficulty in urination and loose stools indicate internal excess of dampness. One must first promote diuresis to drain dampness from the abdomen. Thus, it is said: "Treating dampness without promoting diuresis is not the correct method." If, after urination improves, the joint Bi syndrome remains unresolved, treatment from the exterior is necessary.
Li [Name Redacted] stated: The Taiyang channel runs along the exterior of the body, so external pathogens can invade it, including dampness. Joint pain indicates dampness retained in the joints. Dampness stagnation and steaming generate heat, causing irritability. The Classics state: "Submerged and accumulated water presents with a deep and fine pulse," which is the pulse of internal dampness. "Bi" means blockage and obstruction, consistent with the meaning in the *Nei Jing* that "excess dampness causes Bi." Current difficulty in urination indicates dampness excess internally, corresponding to the *Nei Jing*'s statement: "Excess dampness leads to loose stools." Promoting diuresis removes dampness, stopping diarrhea and irritability.
@@@
Patients with chronic dampness may present with sweating only on the head, stiffness of the back, and a desire to cover themselves with blankets and seek warmth from fire. If purgatives are administered prematurely, hiccups, chest fullness, difficulty in urination, and a tongue coating resembling a fur (white and slippery) may occur. This pattern is due to heat in the Dantian (lower abdomen) and cold in the chest. The patient feels thirsty and desires water but cannot drink, resulting in dry mouth and irritability.
[Annotation]
Sweating only on the head in dampness patients results from upper dampness and lower heat steaming upward, not from the heat of Yangming interior excess steaming upward. Back stiffness is due to the heaviness of dampness, not the spasm caused by wind-damp. The desire to cover oneself and seek warmth reflects temporary cold generated by excessive dampness, not the aversion to cold seen in Cold Damage. If one mistakenly treats the head sweat (misinterpreted as Yangming interior heat) with purgatives, dampness transforms into cold and invades the deficiency. Invading the upper jiao causes lung qi rebellion and chest fullness; invading the middle jiao causes stomach disharmony and hiccups; invading the lower jiao impairs bladder qi transformation, leading to difficulty in urination. A white, slippery tongue coating resembling fur indicates that erroneous purgation caused heat to sink, creating heat in the Dantian. Cold accumulates in the upper jiao (chest), causing thirst for water that cannot be swallowed. Heat below generates dry mouth and irritability, while cold above prevents the generation of body fluids. Thus, despite dry mouth and tongue, the patient cannot drink much.
@@@
If dampness patients are erroneously purged and present with sweating on the forehead, mild wheezing, and free urination, the prognosis is fatal. Similarly, persistent diarrhea is also fatal.
[Annotation]
This continues the discussion on the previous paragraph regarding the consequences of erroneous purgation, clarifying the fatal signs of head sweating in dampness patients. Erroneous purgation leading to forehead sweating and mild wheezing, if accompanied by difficulty in urination, does not necessarily indicate death. However, if urination is free, it indicates that this is not dampness overflowing upward, but rather yang collapsing upward, hence the term "fatal." If diarrhea persists, it indicates not the expulsion of dampness, but the collapse of middle qi with downward flow, hence also "fatal."
[Collected Notes]
Zhao Liang stated: Erroneous purgation leads to reversal. Reversal causes yang to escape from above and yin to collapse from below. Forehead sweating and mild wheezing represent the escape of yang; free urination and persistent diarrhea represent the collapse of yin. The separation of yin and yang is a sign of certain death. By inference, if purgation causes forehead sweating and wheezing but bowel and bladder movements are obstructed, yin has not collapsed, and the root of yang remains; if purgation causes free bowel and bladder movements but there is no forehead sweating or wheezing, yang has not escaped, and the root of yin remains. In these cases, yin and yang are not separated, and treatment can be tailored to the specific syndrome.
Li Weixi stated: Previously, it was stated that dampness patients should have their urination promoted because internal dampness stagnation naturally impedes urination. Here, post-purgation interior deficiency leads to spontaneous free urination and fluid exhaustion causing death. These situations cannot be generalized.
@@@
When a patient suffers from whole-body pain and fever that worsens in the late afternoon (Shi hour, approx. 3-5 PM), it is named Feng Shi (Wind-Damp). This condition arises from sweating exposed to wind or prolonged exposure to cold. Mahuang Xingyi Yicao Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) may be administered.
[Annotation]
"Patient" refers to those with whole-body pain. Both dampness patients and wind-damp patients suffer from whole-body pain. However, dampness pain is heavy and limits turning over, whereas wind-damp pain is light and spasmodic, limiting flexion and extension. This distinguishes the pain types. Dampness fever does not vary significantly between morning and evening, whereas wind-damp fever inevitably worsens in the late afternoon. This is because dampness is constant, while wind fluctuates. Tracing the etiology, it results from sweating exposed to wind or prolonged cold exposure. Therefore, Mahuang Xingyi Yicao Gancao Tang, which disperses wind-damp, is indicated.
[Collected Notes]
Cheng Lin stated: Whole-body pain and fever indicate wind-damp at the exterior. "Ribu" refers to the Shen hour (3-5 PM). The Yangming channel is prosperous during Shen, You, and Xu hours. Earth dislikes dampness. When wind-damp interferes during the peak time of Yangming, the struggle between pathogen and healthy qi causes worsening symptoms. Sweat belongs to the category of dampness. Whether caused by sweating exposed to wind or entering cold water after exertion, both result in wind-damp disease.
Wei Litong stated: Spasm syndromes require wind to manifest; even if cold is present, it attaches to wind. Bi syndrome due to dampness requires cold to manifest; even if wind is present, it attaches to cold. This is a fixed principle.