痛，可与麻黄汤加术同义。
程应旄曰∶湿家不惟不可误下，即汗亦不可误汗。风湿相抟一证，一身尽疼痛，虽是微挟表邪，然其脉
不浮，终是汗难大汗，治风兼治湿，但使微微似欲汗出者，是其法也。
伤寒八九日，风湿相抟，身体疼烦，不
能自转侧，不呕不渴，脉浮虚而涩者，桂枝附子汤主之。若其人大便硬，小便自利者，去桂枝加白术汤主之。
【注】此承上条，详申脉证，以明其治也。伤寒八九日，不呕不渴，是无伤寒里病之证也；脉浮虚涩，是
无伤寒表病之脉也。脉浮虚，主在表，虚风也；涩者主在经，寒湿也。身体疼烦属风也，不能转侧属湿也，乃
风湿相抟之证，非伤寒也，与桂枝附子汤温散其风湿，使从表而解也。若脉浮实者，则又当以麻黄加术汤，大
发其风湿也。如其人有是证，虽大便硬，小便自利，而不议下者，以其非邪热入里之硬，乃风燥湿去之硬，故
仍以桂枝附子汤去桂枝，以大便硬，小便自利，不欲其发汗，再夺津液也；加白术，以身重着，湿在肉分，用
以佐附子逐湿气于肌也。
【集注】成无己曰∶烦者，风也。身疼不能自转侧者，湿也。经曰∶风则浮虚。《脉经》曰∶脉来涩者，
为病寒湿也。
桂枝附子去桂枝加白术汤方
附子（炮，去皮，破，三枚） 白术（四两） 生姜（切，三两） 大枣（擘，十二枚） 甘草（炙，二两）
上五味，以水六升，煮取二升，去滓，分温三服。初一服，其人身如痹，半日许，复服之，三服都尽，其
人如冒状，勿怪。此以附子、术，并走皮内，逐水气未得除，故使之耳。法当加桂四两。此本一方二法，以大
便硬、小便自利去桂也。以大便不硬、小便不利，当加桂。附子三枚，恐多也，虚弱家及产妇，宜减服之。
风湿相抟，骨节疼烦，掣痛不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不欲去衣，或身微肿者，
甘草附子汤主之。
【注】风湿相抟，骨节疼烦，重着不能转侧，湿胜风也。掣痛不可屈伸，风胜湿也。今掣痛不可屈伸，近
之则痛剧，汗出、短气，恶风不欲去衣，皆风邪壅盛，伤肌表也。小便不利，湿内蓄也。身微肿者，湿外薄也。
以甘草附子汤微汗之，祛风为主，除湿次之也。以上二条，皆详风湿之义，以明风湿之治也。
【集注】方有执曰∶抟，捏聚也。言风与湿捏合抟聚，共为一家之病也。烦，风也。痛，湿也。风淫则
掣，湿淫则痛，风湿之邪注经络，流关节，渗骨髓，身体所以烦痛、掣痛而不利也。近之则痛剧者，外邪客于
内，迕之则逆也。短气者，汗多亡阳而气伤也。恶风不欲去衣者，以重伤，故恶甚也。甘草益气和中，附子温
经散湿，术能胜湿燥脾，桂枝祛风固卫，此四物者，所以为风湿相抟之的药也。
吴人驹曰∶必脉之沉而细者，若浮大而盛，则风多而湿少，附子须在审之。
甘草附子汤方
甘草（炙，二两） 附子（炮，去皮，破，二枚） 桂枝（四两） 白术（二两）
上四味，以水六升，煮取三升，去滓，温服一升，日三服。初服得微汗则解，能食。汗止复烦者，服五
合。恐一升多者，宜服六七合为妙。
【方解】风湿之治，用甘草附子汤，即桂枝附子汤去姜、枣加白术也。去姜、枣者，畏助汗也。加白术
者，燥中湿也。日三服，初服一升，不得汗解，则仍服一升。若微得汗则解，解则能食，是解已彻也，可止再
服。若汗出而复烦者，是解未彻也，仍当服之，但不可更服一升，恐已经汗，多服而过汗也，服五合可也。如
不解，再服六七合为妙。似此服法，总是示人不可尽剂之意，学人于理有未解处，即于本文中求之自得矣。
太阳中热者， 是也。其人汗出恶寒，身热而渴也。
【注】中暑热病，亦由太阳表入，故曰∶太阳中热者， 是也。其人汗出恶寒，身热而渴，颇似太阳温
热之病。但温热无恶寒，以
热从内发，故虽汗出而不恶寒；中 恶寒者，以暑由外入，故汗出而恶寒也。究之于脉，温热之浮，必浮而实；
中之浮，必浮而虚，以暑热伤气也。究之于渴，温热之渴，初病不过欲饮水；中 之渴，一病即大渴引饮也。温
热则传经，变病不一，中 则不传，不愈即死也。虽同为太阳经中之病，而虚实施治不同，宜以人参白虎汤主治之。
【集注】方有执曰∶蒸热谓之暑，伤暑谓之 。汗出恶寒者，太阳表不固也。身热者，暑邪伤阳也。渴
者，亡津液而内燥也。
程知曰∶此辨暑热脉证也。太阳中热者，谓是太阳表证而属中热也。均是太阳表病，汗出恶寒，身热而
不渴者，为中风；汗出身热而渴，不恶寒者，为温病。今汗出恶寒，身热而渴，则是中 。 者，暑热之气也。
不言 而言热，以其胃热为独重也。里有热，故身热而渴，暑伤气，故汗出恶寒。
吴人驹曰∶不可因恶寒而用辛温，又不可因汗出而固表，惟宜甘寒以解其暑热可也。
太阳中 者，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已，洒洒然毛耸，手足逆冷，小有劳身即热，
口开，前板齿燥。若发汗则恶寒甚，加温针则发热甚，数下之则淋甚。
【注】此申上条，详出证脉，戒人不可妄行汗、下温针也。太阳中 ，无汗身重疼痛者，似伤寒也，但
脉弦细芤迟，非伤寒脉也。且有小便已，而洒洒然恶寒毛耸之证，乃太阳膀胱表气为暑所伤而然也。手足逆冷
者，乃暑伤气，气伤不能达四肢，则寒也。小有劳身即发热，口开前板齿燥者，乃劳则动热，暑热益烈，伤阴
液也，此皆中 危证。若以发热无汗，恶寒身痛，误为伤寒之表，妄行发汗，则表气愈虚，恶寒更甚也。若以
手足逆冷，误为阳虚，妄加温针，则暑邪愈盛，发热更炽也。若以壮热齿干，误为胃火而数下，则水源竭涩，尿
淋窘甚也。凡此之证，皆中 妄行汗、下、温针致变，惟宜以白虎加人参汤主之。或人参汤调辰砂六一散亦可也。
【集注】成无己曰∶经云∶因于暑汗，烦则喘喝。口开，谓喘喝也，喘喝不止，故前板齿燥。
程知曰∶人身之阳，以汗而外泄；人身之阴，以热而内竭。故 证禁用汗、下、温针，谓汗则伤阳，下
则伤阴，温针则引火内入也。
张锡驹曰∶洒洒者，恶寒之象也。毛耸者，毫毛竖起也。
太阳中 者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。
【注】太阳中 之证，身热疼重者，暑伤形也；脉微弱者，暑伤气也。以此证脉揆之，亦其人夏月盛暑
喜贪风凉，过饮冷水，水气输行于皮中，表为邪束，不得汗泄所致也。此时即以香薷饮、大顺散汗之，可立愈
也。若因循不治，则水气既不得外泄于表而作肿，势必内攻于里而喘胀矣，是又当以葶苈大枣汤或瓜蒂一物散
下之也。上条戒人不可汗下，此条示人宜当汗下。仲景之法，多是如此，盖恐人固执失宜也。
【集注】方有执曰∶身热疼重，而曰夏月伤冷水，水行皮中所致者，土主肌肉而恶湿，水渗土而蒸发也。
脉微弱者，热则血干而气耗也。然夏月饮水，人之常事，而曰伤何哉？良由暑迫饮之过多，或得之冷水澡洗，
暑反内入也。
张璐曰∶按论 三条，首言动而得之之病，谓中 ，属外因；次言静而得之之病，虽曰中 ，实暑病也，
属内因；末言因热伤冷之病，乃中 之变证，属不内外因，不得以三者混称也。
程应旄曰∶可见中 之病，大都阳气在表，而胃中虚冷，所以身热疼重，而脉微弱。夏月饮冷水，里阴
郁住表阳，水气不得宣泄，而行于皮中，多有此证。此则开郁宣阳，又为 证中增一义也。
程应旄说：患湿病的人，不仅不可误用下法，即使是发汗也不可以误治。风湿相搏这一证候，全身都疼痛，虽然轻微挟带表邪，但是脉象不浮，终究难以大汗出，治疗风邪兼治湿邪，只要使病人微微似有出汗的样子，这就是正确的方法。
伤寒病程到了第八九日，风湿相搏，身体疼痛烦躁，不能自行翻身转动，没有呕吐也没有口渴，脉象浮虚而涩的，用桂枝附子汤主治。如果这个人大便干硬，小便自利的，用去桂枝加白术汤主治。
【注】这是承接上一条，详细阐述脉证，以明确其治疗方法。伤寒八九日，不呕不渴，说明没有伤寒里病的证候；脉象浮虚涩，说明没有伤寒表病的脉象。脉浮虚，主病在表，是虚风；涩脉主病在经络，是寒湿。身体疼痛烦躁属于风邪，不能转侧属于湿邪，这是风湿相搏的证候，不是伤寒，用桂枝附子汤温散风湿，使邪气从体表解除。如果脉象浮实，则又应当用麻黄加术汤，大发风湿。如果这个人有这些证候，虽然大便干硬，小便自利，但不议用下法，因为这不是邪热入里的干硬，而是风燥、湿气去除后的干硬，所以仍然用桂枝附子汤去掉桂枝，因为大便干硬、小便自利，不希望它再发汗，从而再次耗伤津液；加入白术，是因为身体沉重着滞，湿邪在肌肉分界之间，用来辅助附子在肌表驱逐湿气。
【集注】成无己说：烦，是风邪的表现。身体疼痛不能自行转侧，是湿邪的表现。经书说：风邪致脉浮虚。《脉经》说：脉来涩，是寒湿病。
桂枝附子去桂枝加白术汤方
附子（炮制，去皮，破开，三枚） 白术（四两） 生姜（切，三两） 大枣（掰开，十二枚） 甘草（炙，二两）
以上五味药，用水六升，煮取二升，去渣，分三次温服。第一次服用后，病人身体感觉麻木不仁，约半天时间，再服用第二次，三次全部服完后，病人感觉像头昏目眩的样子，不要奇怪。这是因为附子、白术并走皮内，驱逐水气尚未除去，所以导致这种现象。法度上应当加桂枝四两。这原本是一方两种用法，因大便硬、小便自利而去掉桂枝。因大便不硬、小便不利，应当加桂枝。附子三枚，恐怕剂量过多，虚弱人家及产妇，应当减少服用量。
风湿相搏，骨节疼痛烦躁，牵掣痛不得屈伸，靠近则疼痛剧烈，汗出短气，小便不利，恶风不想脱衣，或者身体微肿的，用甘草附子汤主治。
【注】风湿相搏，骨节疼痛烦躁，沉重不能转侧，是湿胜风邪。牵掣痛不可屈伸，是风胜湿邪。现在牵掣痛不可屈伸，靠近则疼痛剧烈，汗出、短气，恶风不想脱衣，都是风邪壅盛，损伤肌表。小便不利，是湿邪内蓄。身体微肿，是湿邪外迫。用甘草附子汤微汗之，以祛风为主，除湿次之。以上两条，都详细阐述了风湿的含义，以明确风湿的治疗方法。
【集注】方有执说：抟，捏聚的意思。指风与湿捏合聚集，共同成为一家的病。烦，是风邪。痛，是湿邪。风淫盛则掣动，湿淫盛则疼痛，风湿之邪注入经络，流注关节，渗透骨髓，身体所以烦痛、掣痛而不利。靠近则疼痛加剧，是因为外邪客于体内，违逆它则气机逆乱。短气，是因为汗多亡阳而气伤。恶风不想脱衣，是因为重伤，所以恶风严重。甘草益气和中，附子温经散湿，白术能胜湿燥脾，桂枝祛风固卫，这四味药，是用来治疗风湿相搏的药物。
吴人驹说：必须脉象沉而细的，如果脉象浮大而盛，则风多湿少，附子的使用必须审慎。
甘草附子汤方
甘草（炙，二两） 附子（炮制，去皮，破开，二枚） 桂枝（四两） 白术（二两）
以上四味药，用水六升，煮取三升，去渣，温服一升，每日三次。初次服用得到微汗则病解，能进食。汗止后又出现烦闷的，服用五合。恐怕一升剂量过多的，宜服用六七合为妙。
【方解】风湿的治疗，使用甘草附子汤，即桂枝附子汤去掉生姜、大枣加上白术。去掉生姜、大枣，是担心助长发汗。加入白术，是为了燥中焦之湿。每日三次服用，初次服用一升，如果没有汗解，则仍服用一升。如果微微得汗则病解，解则能进食，说明病已彻底解除，可以停止再服。如果汗出而又烦闷，说明病未彻底解除，仍当服用，但不可再服一升，恐怕已经发汗，多服会导致过汗，服用五合即可。如不解，再服用六七合为妙。这样的服法，总是向人们展示不可服尽剂量的意思，学者如果在理上有不理解的地方，就在本文中寻找答案自然就能明白。
【注】中暑热病，也是由太阳表传入，所以说：太阳中热者，就是暍病。其人汗出恶寒，身热而口渴，颇像太阳温热病。但是温热病没有恶寒，因为热从内发，所以虽然汗出而不恶寒；中暍有恶寒，因为暑由外入，所以汗出而恶寒。究之于脉，温热病的浮脉，必浮而实；中暍的浮脉，必浮而虚，因为暑热伤气。究之于渴，温热病的渴，初病不过想喝水；中暍的渴，一发病就大渴引饮。温热病会传经，变病不一，中暍病不传经，不愈即死。虽然同为太阳经中的病，但虚实施治不同，宜用人参白虎汤主治。
【集注】方有执说：蒸热叫做暑，伤暑叫做暍。汗出恶寒，是太阳表气不固。身热，是暑邪伤阳。渴，是亡失津液而内燥。
程知说：这是辨别暑热脉证。太阳中热者，谓是太阳表证而属中热。均是太阳表病，汗出恶寒，身热而不渴的，为中风；汗出身热而渴，不恶寒的，为温病。现在汗出恶寒，身热而渴，则是中暍。暍者，是暑热之气。不言暍而言热，是因为胃热特别重。里有热，所以身热而渴，暑伤气，所以汗出恶寒。
吴人驹说：不可因为恶寒而用辛温药，也不可因为汗出而固表，只宜用甘寒药来解其暑热即可。
太阳中暍者，发热恶寒，身重而疼痛，脉象弦细芤迟，小便后，洒洒然毛耸（寒战），手足逆冷，稍微劳动身体即发热，口开，前板齿干燥。如果发汗则恶寒更甚，加温针则发热更甚，多次用下法则淋证更甚。
【注】这是申述上一条，详细列出证脉，告诫人们不可妄行汗、下、温针。太阳中暍，无汗身重疼痛，似伤寒，但脉象弦细芤迟，不是伤寒脉。且有小便后，洒洒然恶寒毛耸的证候，这是太阳膀胱表气被暑所伤所致。手足逆冷，是暑伤气，气伤不能达四肢，所以寒。稍微劳动身体即发热，口开前板齿干燥，是劳则动热，暑热益烈，伤阴液，这些都是中暍危证。如果以发热无汗，恶寒身痛，误认为伤寒之表，妄行发汗，则表气愈虚，恶寒更甚。如果以手足逆冷，误认为阳虚，妄加温针，则暑邪愈盛，发热更炽。如果以壮热齿干，误认为胃火而多次攻下，则水源枯竭涩滞，尿淋窘迫严重。凡此证候，都是中暍妄行汗、下、温针导致的变证，只宜用白虎加人参汤主治。或者用人参汤调辰砂六一散也可以。
【集注】成无己说：经书说：因于暑汗，烦则喘喝。口开，谓喘喝也，喘喝不止，所以前板齿干燥。
程知说：人身之阳，随汗而外泄；人身之阴，随热而内竭。所以暍证禁用汗、下、温针，谓汗则伤阳，下则伤阴，温针则引火内入。
太阳中暍者，身热疼重，而脉微弱，这也是夏月伤冷水，水气行于皮中所致。
【注】太阳中暍的证候，身热疼重，是暑伤形；脉微弱，是暑伤气。以此证脉推测，也是其人夏月盛暑喜欢贪风凉，过饮冷水，水气输布行于皮中，表为邪束，不得汗泄所致。此时立即用香薷饮、大顺散发汗，可立即痊愈。如果因循不治，则水气既不得外泄于表而作肿，势必内攻于里而喘胀，这时又当用葶苈大枣汤或瓜蒂一物散下之。上一条告诫人不可汗下，这一条示人宜当汗下。仲景之法，多是如此，大概是怕人固执失宜。
【集注】方有执说：身热疼重，而说是夏月伤冷水，水行皮中所致，土主肌肉而恶湿，水渗土而蒸发。脉微弱，是热则血干而气耗。然而夏月饮水，是人之常事，为什么说伤呢？良由暑迫使人饮水过多，或用冷水洗澡，暑反内入。
张璐说：按论暍三条，首言动而得之的病，谓中暍，属外因；次言静而得之的病，虽曰中暍，实暑病，属内因；末言因热伤冷的病，乃中暍的变证，属不内外因，不得将三者混称。
程应旄说：可见中暍的病，大都阳气在表，而胃中虚冷，所以身热疼重，而脉微弱。夏月饮冷水，里阴郁住表阳，水气不得宣泄，而行于皮中，多有此证。这是开郁宣阳，又为暍证中增加一种含义。
Pain, which is consistent in principle with Mahuang Tang (Ephedra Decoction) plus Baizhu (Atractylodis Macrocephalae Rhizoma).
Cheng Yingmao stated: For patients with dampness disorders, not only should purgation be avoided as a mistake, but also diaphoresis must not be misapplied. In the syndrome of wind-dampness intermingling, where there is generalized body pain, although it slightly involves exterior pathogens, the pulse is not floating, and profuse sweating is ultimately difficult to achieve. The treatment for wind should simultaneously address dampness; the method is to induce slight perspiration, resembling a desire to sweat.
After eight or nine days of Shanghan (Cold Damage), if wind-dampness intermingles, causing severe bodily pain and restlessness, inability to turn over independently, absence of vomiting and thirst, and a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is the primary prescription. If the patient presents with hard stools and spontaneous urination, remove Guizhi (Cinnamomi Ramulus) and add Baizhu (Atractylodis Macrocephalae Rhizoma); Baizhu Tang (Atractylodis Macrocephalae Rhizoma Decoction) is the primary prescription.
[Annotation] This follows the previous clause, detailing the pulse and symptoms to clarify the treatment. After eight or nine days of Shanghan, the absence of vomiting and thirst indicates no interior pathology of Shanghan; a floating, deficient, and choppy pulse indicates no exterior pathology of Shanghan. A floating and deficient pulse signifies pathogen in the exterior due to deficient wind; a choppy pulse signifies cold-dampness in the meridians. Severe bodily pain belongs to wind; inability to turn over belongs to dampness. This is a syndrome of wind-dampness intermingling, not Shanghan. Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is used to warm and disperse wind-dampness, allowing resolution from the exterior. If the pulse is floating and excess, Mahuang Jia Zhu Tang (Ephedra Plus Atractylodis Macrocephalae Rhizoma Decoction) should be used to vigorously disperse wind-dampness. If the patient has these symptoms, despite hard stools and spontaneous urination, purgation is not considered because the hardness is not due to heat pathogens entering the interior, but rather dryness from wind and removal of dampness. Therefore, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is still used, removing Guizhi (Cinnamomi Ramulus) because hard stools and spontaneous urination suggest avoiding further diaphoresis that would deplete fluids; Baizhu (Atractylodis Macrocephalae Rhizoma) is added because heavy sensation and dampness in the muscle layer require assisting Fuzi (Aconiti Lateralis Radix Preparata) to expel dampness from the skin and muscles.
[Collected Annotations] Cheng Wuji stated: Restlessness indicates wind. Bodily pain and inability to turn over indicate dampness. The Classics state: Wind results in a floating and deficient pulse. The Mai Jing (Pulse Classic) states: A choppy pulse indicates cold-dampness disease.
Formula for Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) with Guizhi Removed and Baizhu Added
Fuzi (Prepared, peeled, broken, three pieces), Baizhu (Four liang), Shengjiang (Sliced, three liang), Dazao (Broken open, twelve pieces), Gancao (Honey-fried, two liang).
The above five ingredients are boiled in six sheng of water until two sheng remain. Strain and divide into three warm doses. After the first dose, the patient may feel numbness; after about half a day, administer the second dose. After all three doses are consumed, the patient may experience a sensation of dizziness or confusion; do not be alarmed. This occurs because Fuzi (Aconiti Lateralis Radix Preparata) and Baizhu (Atractylodis Macrocephalae Rhizoma) move within the skin, expelling water qi that has not yet been eliminated. According to the method, Guizhi (Cinnamomi Ramulus) four liang should be added. This was originally one formula with two methods: remove Guizhi (Cinnamomi Ramulus) for hard stools and spontaneous urination; add Guizhi (Cinnamomi Ramulus) for non-hard stools and inhibited urination. Three pieces of Fuzi (Aconiti Lateralis Radix Preparata) may be excessive; for weak individuals and postpartum women, the dosage should be reduced.
If wind-dampness intermingles, causing painful and restless bone joints, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, inhibited urination, aversion to wind with reluctance to remove clothing, or slight edema, Gancao Fuzi Tang (Licorice and Aconite Root Decoction) is the primary prescription.
[Annotation] Wind-dampness intermingling causes painful and restless bone joints, heaviness, and inability to turn over; this is dampness prevailing over wind. Pulling pain preventing flexion and extension is wind prevailing over dampness. Now, pulling pain prevents flexion and extension, pain worsens upon touch, sweating and shortness of breath occur, and there is aversion to wind with reluctance to remove clothing; all these indicate excess wind pathogens damaging the muscle and exterior. Inhibited urination indicates internal accumulation of dampness. Slight edema indicates external pressure of dampness. Gancao Fuzi Tang (Licorice and Aconite Root Decoction) is used to induce slight sweating, primarily dispelling wind and secondarily removing dampness. The above two clauses detail the meaning of wind-dampness to clarify its treatment.
[Collected Annotations] Fang Youzhi stated: "Tuan" means kneading together. It refers to wind and dampness combining to form a single pathological entity. "Fan" (restlessness) is wind; "Tong" (pain) is dampness. Excess wind causes pulling sensations; excess dampness causes pain. Wind-dampness pathogens enter the meridians, flow into the joints, and seep into the marrow, causing the body to suffer from restlessness, pain, pulling pain, and dysfunction. Pain worsening upon touch occurs because external pathogens lodge internally, and opposing them causes rebellion. Shortness of breath results from excessive sweating leading to loss of Yang qi and damage to Qi. Aversion to wind with reluctance to remove clothing indicates severe injury, hence severe aversion. Gancao (Glycyrrhizae Radix et Rhizoma) tonifies Qi and harmonizes the middle; Fuzi (Aconiti Lateralis Radix Preparata) warms the meridians and disperses dampness; Baizhu (Atractylodis Macrocephalae Rhizoma) overcomes dampness and dries the Spleen; Guizhi (Cinnamomi Ramulus) dispels wind and secures the Wei. These four herbs are the specific medicines for wind-dampness intermingling.
Wu Renju stated: The pulse must be deep and fine. If it is large and floating and vigorous, wind is abundant and dampness is scarce; the use of Fuzi (Aconiti Lateralis Radix Preparata) requires careful consideration.
Formula for Gancao Fuzi Tang (Licorice and Aconite Root Decoction)
Gancao (Honey-fried, two liang), Fuzi (Prepared, peeled, broken, two pieces), Guizhi (Four liang), Baizhu (Two liang).
The above four ingredients are boiled in six sheng of water until three sheng remain. Strain and take one sheng warm, three times daily. Initial administration inducing slight sweating resolves the condition and restores appetite. If sweating stops and restlessness recurs, take five he. If one sheng is feared to be too much, taking six or seven he is optimal.
[Formula Analysis] The treatment for wind-dampness uses Gancao Fuzi Tang (Licorice and Aconite Root Decoction), which is Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) minus Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) plus Baizhu (Atractylodis Macrocephalae Rhizoma). Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) are removed to avoid aiding diaphoresis. Baizhu (Atractylodis Macrocephalae Rhizoma) is added to dry dampness in the middle. Taking three doses daily, starting with one sheng: if sweating does not resolve the condition, continue with one sheng. If slight sweating resolves the condition and appetite returns, the resolution is complete, and further dosing can stop. If sweating recurs with restlessness, resolution is incomplete, and dosing should continue, but not another full sheng, to avoid excessive sweating after prior diaphoresis; five he is appropriate. If unresolved, taking six or seven he is optimal. Such dosing instructions always demonstrate the principle of not consuming the entire dose. Scholars who do not understand the rationale can find answers within the text itself.
Taiyang Zhongre (Heat Stroke in Taiyang Meridian), also known as Ye (Summerheat), is characterized by sweating, aversion to cold, fever, and thirst.
[Annotation] Summerheat diseases also enter via the Taiyang exterior, hence it is said: Taiyang Zhongre (Heat Stroke in Taiyang Meridian) is Ye (Summerheat). The patient exhibits sweating, aversion to cold, fever, and thirst, resembling Taiyang Warmth Disease. However, Warmth Disease lacks aversion to cold because heat originates internally; thus, despite sweating, there is no aversion to cold. Ye (Summerheat) involves aversion to cold because summerheat enters from the exterior; thus, sweating accompanies aversion to cold. Regarding the pulse, the floating pulse of Warmth Disease is floating and excess; the floating pulse of Ye (Summerheat) is floating and deficient because summerheat damages Qi. Regarding thirst, in Warmth Disease, early-stage thirst only desires drinking water; in Ye (Summerheat), thirst is intense immediately upon onset. Warmth Disease transmits through the meridians with varied transformations; Ye (Summerheat) does not transmit, and if unhealed, leads to death. Although both are diseases of the Taiyang meridian, their deficiency and excess require different treatments; Renshen Baihu Tang (Ginseng and White Tiger Decoction) is indicated.
[Collected Annotations] Fang Youzhi stated: Steaming heat is called Shu (Summerheat); injuring Shu is called Ye (Summerheat). Sweating and aversion to cold indicate insecure Taiyang exterior. Fever indicates Shu pathogen damaging Yang. Thirst indicates loss of Jin-Ye (Body Fluids) and internal dryness.
Cheng Zhi stated: This distinguishes the pulse and symptoms of summerheat. Taiyang Zhongre (Heat Stroke in Taiyang Meridian) refers to a Taiyang exterior syndrome belonging to middle heat. All are Taiyang exterior diseases: sweating, aversion to cold, fever without thirst is Fengzhong (Wind Strike); sweating, fever, and thirst without aversion to cold is Wenbing (Warm Disease). Now, sweating, aversion to cold, fever, and thirst indicate Zhongye (Summerheat). Ye (Summerheat) is the Qi of summerheat. Referring to "Re" (Heat) instead of "Ye" emphasizes the severity of Stomach heat. Internal heat causes fever and thirst; summerheat damages Qi, causing sweating and aversion to cold.
Wu Renju stated: Do not use acrid-warm herbs due to aversion to cold, nor secure the exterior due to sweating; only sweet-cold herbs should be used to resolve summerheat.
In Taiyang Zhongye (Summerheat in Taiyang Meridian), there is fever, aversion to cold, heaviness, and pain. The pulse is string-taut, fine, knotted, and slow. After urination, there is chills and piloerection. The extremities are cold. Slight exertion causes immediate fever. The mouth opens, and the anterior teeth are dry. If diaphoresis is induced, aversion to cold becomes severe. If moxibustion needles are applied, fever becomes severe. If purgation is repeated, strangury becomes severe.
[Annotation] This elaborates on the previous clause, detailing symptoms and pulse, warning against reckless diaphoresis, purgation, or moxibustion. Taiyang Zhongye (Summerheat in Taiyang Meridian) with no sweating, heaviness, and pain resembles Shanghan (Cold Damage), but the string-taut, fine, knotted, and slow pulse is not characteristic of Shanghan. Additionally, chills and piloerection after urination indicate the Taiyang Bladder exterior Qi is damaged by summerheat. Cold extremities indicate summerheat damaging Qi, which fails to reach the limbs, causing cold. Immediate fever upon slight exertion, opening the mouth, and dry anterior teeth indicate that exertion stirs heat, intensifying summerheat and damaging Yin fluids. These are critical signs of Zhongye (Summerheat). Mistaking fever, no sweating, aversion to cold, and body pain for an exterior Shanghan syndrome and inducing diaphoresis will further weaken exterior Qi, worsening aversion to cold. Mistaking cold extremities for Yang deficiency and applying moxibustion needles will intensify summerheat pathogens, worsening fever. Mistaking high fever and dry teeth for Stomach fire and repeatedly purging will deplete the water source, causing severe strangury. All these conditions result from mishandling Zhongye (Summerheat) with diaphoresis, purgation, or moxibustion. Only Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is suitable. Alternatively, Renshen Tang (Ginseng Decoction) mixed with Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) may be used.
[Collected Annotations] Cheng Wuji stated: The Classics say: Due to summerheat sweating, restlessness leads to panting and drinking. Opening the mouth refers to panting and drinking; continuous panting and drinking cause dry anterior teeth.
Cheng Zhi stated: Human Yang escapes via sweat; human Yin is depleted internally by heat. Therefore, Ye (Summerheat) contraindicates diaphoresis, purgation, and moxibustion: diaphoresis damages Yang, purgation damages Yin, and moxibustion draws fire inward.
Zhang Xiju stated: "Sasha" describes the sensation of aversion to cold. "Mao Song" refers to piloerection.
In Taiyang Zhongye (Summerheat in Taiyang Meridian), there is fever, heaviness, pain, and a weak or faint pulse. This is also caused by injuring cold water in summer, with water qi circulating in the skin.
[Annotation] In Taiyang Zhongye (Summerheat in Taiyang Meridian), fever, heaviness, and pain indicate summerheat damaging the形体 (Form/Body); a weak or faint pulse indicates summerheat damaging Qi. Based on these symptoms and pulse, this condition arises when a person, during summer heat, enjoys cool breezes and drinks excessive cold water. Water qi circulates in the skin, the exterior is constrained by pathogens, and sweating is inhibited. At this time, Xiangru Yin (Elsholtzia Decoction) or Da Shun San (Great Harmony Powder) should be administered to induce sweating for immediate recovery. If neglected, water qi cannot escape externally, leading to edema, and inevitably attacks internally, causing wheezing and distension. Then, Tingli Dazao Tang (Lepidii Seed and Jujube Decoction) or Goudi Yi Wu San (Melon Trichosanthes Single-Ingredient Powder) should be used to purge. The previous clause warns against diaphoresis and purgation; this clause indicates when they are appropriate. Zhang Zhongjing's methods often follow this pattern, fearing rigid adherence leads to error.
[Collected Annotations] Fang Youzhi stated: Fever, heaviness, and pain, attributed to summer cold water injury with water qi in the skin, occur because Earth governs muscles and dislikes dampness; water infiltrates Earth and evaporates. A weak or faint pulse indicates heat drying blood and depleting Qi. Drinking water in summer is normal; why is it termed injury? Because summer heat forces excessive drinking, or bathing in cold water causes summerheat to enter internally.
Zhang Lu stated: Regarding the three clauses on Ye (Summerheat): The first describes illness acquired through movement, Zhongye (Summerheat), belonging to external causes; the second describes illness acquired through stillness, also called Zhongye (Summerheat) but actually a Summerheat disease, belonging to internal causes; the third describes illness from heat injuring cold, a variant of Zhongye (Summerheat), belonging to neither internal nor external causes. They should not be conflated.
Cheng Yingmao stated: This shows that Zhongye (Summerheat) diseases generally have Yang Qi at the exterior while the Stomach is deficient and cold, causing fever, heaviness, pain, and a weak or faint pulse. Drinking cold water in summer causes interior Yin to stagnate exterior Yang, preventing water qi from venting and causing it to circulate in the skin, resulting in many such cases. This represents opening stagnation and promoting Yang, adding another dimension to the understanding of Ye (Summerheat).