病者，身热足寒，颈项强急，恶寒，时头热，面赤，目赤，独头动摇，卒口噤，背
反张者，痉病也。若发其汗者，寒湿相搏，其表益虚，即恶寒甚。发其汗已，其脉如蛇。
【按】诸家以刚、柔二痉，列为首条，今以此为第一条者，盖刚，柔之辨，俱从此条
分出。痉病之最备者，宜冠诸首。再痉病也之下，“若发其汗……”六句，与上文义不属，
与后之十一条中“为欲解，脉如故，反伏弦者痉”句，文义相属，宜分于彼。
【注】病患身热恶寒，太阳证也；颈项强急，面赤目赤，阳明证也。头热，阳郁于上
也；足寒，阴凝于下也。太阳之脉循背上头，阳明之筋上挟于口，风寒客于二经，则有头
摇口噤，反张拘强之证矣。此皆痉病之形证，故首揭之，以为要领。
【集注】李 曰∶手三阳之筋，结入于颔颊。足阳明之筋，上挟于口。风寒乘虚，入
其筋则挛，故牙关急而口噤。
夫痉脉，按之紧如弦，直上下行。
【注】痉之为病，其状劲急强直，故其脉亦劲急强直。按之紧，劲急之象也，如弦直
行之象也。
《脉经》云∶痉家，其脉伏坚，直上下。
【注】痉家其脉紧弦，直上下者，以痉病属太阳表也。《脉经》所云其脉伏坚，直上下者，
以痉病属阳明里也。盖痉家原属二经，故有太阳葛根汤汗之，阳明大承气汤下之之治也。伏
坚，沉实也；直上下，弦直也，即沉实弦直之脉也。
太阳病发热无汗，反恶寒者，名曰刚痉。太阳病发热汗出，而不恶寒，名曰柔痉。
【按】反恶寒之“反”字，衍文也。玩痉病之条自知当恶寒也。
【注】痉病既属太阳，当以太阳虚实例之，故曰∶太阳病发热、无汗、恶寒为实邪，名
曰刚痉者，强而有力也。发热汗出、不恶寒为虚邪，名曰柔痉者，强而无力也。
太阳病，无汗而小便反少，气上冲胸，口噤不得语，欲作刚痉，葛根汤主之。
【注】此申明刚痉在表，以明其治也。太阳病，为头项强痛、发热等证也。无汗，谓
伤寒也。太阳伤寒，小便不当少，今反少者，是寒气盛而收引也。不当气上冲胸，今气上
冲胸，是寒气盛而上逆也。不当口噤不得语，今口噤不得语，是寒气盛，牙关紧急而甚也。
以太阳伤寒，而有此冲击劲急之象，是欲作刚痉之病也。麻黄汤能治太阳，而不能治阳
明，故以葛很汤兼太阳、阳明两经之治，为刚痉无汗之正法也。
痉为病，胸满口噤，卧不着席，脚挛急，必 齿，可与大承气汤。
【注】此申痉病入里，以明其治也。痉病而更胸满，里气壅也；卧不着席，反张甚也；
脚挛急，劲急甚也；必 齿，牙紧甚也。此皆阳明热盛灼筋，筋急而甚之象，故以大承
气汤直攻其热，非攻阳明之实也。其曰可与，非尽言其可与，有慎重之意。
大承气汤方
大黄（酒洗，四两） 浓朴（炙，去皮，半斤） 枳实（炙，五枚） 芒硝（三合）
上四味，以水一斗，先煮二物，取五升，去滓，内大黄，煮取二升，去滓，内芒硝，更
上火，微一二沸，分温再服，得下止服。
太阳病，其证备，身体强，几几然，脉反沉迟，此为痉，栝萎桂枝汤主之。
【注】太阳病，其证备，谓头痛、项强、发热、恶风寒具见也。而更身体强，有几几
然俯仰不能自如之象，痉病也。但脉反见沉迟太阴之脉，非太阳浮紧无汗刚痉者比，故
不与葛根汤，而与栝篓桂枝汤，和太阳之表，清太阴之里也。
栝蒌桂枝汤方
栝萎根（二两） 桂枝（三两） 芍药（三两） 甘草（二两） 生姜（三两） 大枣（十
二枚）
上六味，以水九升，煮取三升，分温三服，取微汗；汗不出，食顷，啜热粥发之。
太阳病，发热，脉沉而细者，名曰痉，为难治。
【注】发热，太阳病也。脉沉细，少阴脉也。而名曰痉者，必有或刚或柔之证见也。以
太阳痉证，而见少阴之脉，表里兼病也。夫太阳之邪郁于外，故病发热；少阴之邪凝于
内，故脉沉细。然痉病而见弦紧之脉，是为本脉，即或沉迟，尚为可治。今沉而细，邪
入少阴，阳气已衰，岂易治乎？故曰难也。
夫风病，下之则痉，复发汗。必拘急。
【注】以上论痉，皆外感风、寒。湿而为病也。亦有因风邪为病，不应下而下之伤液，
不应汗而汗之伤津，以致津液枯燥，筋失所养而病痉者，故曰∶风病下之则痉，复发汗
必拘急。此不可以外感痉病治之，当以专养津液为务也。
太阳病，发汗大多，因致痉。
【注】此承上文，详申发汗过多成痉之义也。太阳病当发汗，若发汗太过，腠理大开，
表气不固，邪风乘虚而入，因成痉者，乃内虚所召入也，宜以桂枝加附子汤主之，固表
温经也。由此推之，凡病出汗过多，新产、金
疮破伤出血过多，而变生此证者，皆其类也。
暴腹胀大者，为欲解；脉如故，反伏弦者，痉。
【按】本门首条痉病也之下“若发其汗……”六句，当移于此条之首，文义始属。此
条“暴腹胀大者”句，衍文也，当删之。
【注】不但风病，发汗过多则痉，即寒湿相抟之病，发汗过多亦痉也。发汗过多，其
表益虚，表虚则必即恶寒甚也。发寒湿汗后，其脉不直紧，如蛇之曲缓，则为邪退，不成
痉病，为欲解也。若脉仍直紧不缓，或不直紧反伏坚弦急者，为邪不退，成痉病矣。
疮家，虽身疼痛，不可发汗，汗出则痉。
【注】疮家初起，毒热未成，法当汗散。已经溃后，血气被伤，虽有身痛表证，亦不
可发汗，恐汗出血液愈竭，筋失所养，因而成痉，或邪风乘之，亦令痉也。
痉病有灸疮，难治。
【注】痉病宜灸，如有灸疮，若不发脓，则为营卫已绝，故曰难治。
湿家之为病，一身尽疼，发热，身色如熏黄也。
【注】湿家，谓病湿之人。湿之为病，或因外受湿气，则一身尽痛；或因内生湿病，则
发热身黄。若内外同病，则一身尽痛，发热，身色如熏黄也。湿家之身痛发黄，不似伤寒
之身痛发黄者，以无六经之形证也。
【集注】徐彬曰∶此言全乎湿而久郁为热者。若湿挟风者，风走空窍，故痛只在关节；
今单湿为病，则浸淫遍体，一身尽痛，不止关节矣。然湿久而郁，郁则热，故发热。热
久而气蒸于皮毛，故疼之所至，即湿之所至，湿之所至，即热之所至。而色如熏黄者，熏
火气也。湿为火气所熏，故发色黄带黑而不亮也。
湿家，病身疼发热，面黄而喘，头痛鼻塞而烦，其脉大，自能饮食，腥中和无病，病
在头中寒湿，故鼻塞，内药鼻中则愈。
【注】此申上条，详其义，出其脉，别其治也。湿家病，身疼发热，面黄而喘，此内
生外受之湿病也。外宜羌活胜湿汤；内宜茵陈五苓散；喘甚，大陷胸丸。若更头痛鼻塞
而烦，其脉大，证类伤寒，但其人里和能食，知非伤寒，不可发汗，乃头中寒湿之邪，故
头痛鼻塞，惟宜纳药鼻中，取黄水从涕出，而寒湿以泄，病可愈也。所纳之药，如栝蒂散
之类。
【集注】魏荔彤曰；头中为诸阳之首，非寒湿能犯之地。今头中有寒湿，则热气挟之
上炎，非寒湿外邪自能然也，有湿热则内为之主持也。热引湿邪，上乾清分，鼻必为塞。
故用纳鼻药，宣通清气而病愈矣。
湿家，身烦疼，可与麻黄加术汤，发其汗为宜，慎不可以火攻之。
【注】湿家外证，身痛甚者，羌活胜湿汤；内证发黄甚者，茵陈五苓散。若惟身烦痛而
不发黄者，则为外感寒湿，与麻黄加术汤发其汗，寒湿两解也。慎不可以火攻之者，谓
不可以火劫大发其汗，必致变也。
【集注】赵良曰∶湿与寒合，令人身疼。大法，表实成热，则可发汗。无热是阳气尚
微，汗之恐虚其表。是证虽不云热而烦，以生烦由热也，所以服药不敢大发其汗。且湿
亦非暴汗可散，用麻黄汤治寒，加术去湿，使其微汗耳。不可火攻，火攻则增其热，必有
他变，所以戒人慎之。
喻昌曰∶麻黄加术，则虽发汗不至多汗，而术得麻黄，并可以行表里之湿。不可以火
攻者，反增发热也。
麻黄加术汤方
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）
上五味，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，着而不行，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，是湿气内胜也，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》湿气胜者为着痹之意。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，若下之早，则哕，或胸满，小便不利，
舌上如苔者，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，乃湿邪重着之强，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
白滑如苔者，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，谓一身尽痛之病患也。湿家一身尽痛，风湿亦一身尽痛，然湿家痛，则
重着不能转侧；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，盖以湿元来去，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，当其旺时，邪正相搏，则反剧也。汗亦湿类，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。
麻黄杏仁薏苡甘草汤方
麻黄（去节，汤泡，半两） 甘草（炙，一两） 薏苡仁（半两） 杏仁（去皮尖，炒，十枚）
上锉麻豆大，每服四钱，水盏半，煮八分，去滓，温服，有微汗，避风。
风湿，脉浮，身重，汗出恶风者，防己黄 汤主之。
【注】脉浮风也，身重湿也，寒湿则脉沉，风湿则脉浮。若浮而汗不出恶风者，为实邪，
可与麻黄杏仁薏苡甘草汤汗之。浮而汗出恶风者，为虚邪，故以防己、白术以去湿，黄 、
甘草以固表，生姜、大枣以和营卫也。
患者身体发热，双脚发凉，颈项僵硬拘急，怕冷，有时头部发热，面色发红，眼睛发红，只有头部摇动，突然牙关紧闭，背部向后反折呈弓形，这是痉病。如果误用发汗法治疗，寒湿相互搏结，体表更加虚弱，就会极度怕冷。发汗之后，脉象像蛇一样蜿蜒曲折。
【按语】各家将刚痉、柔痉列为首条，现在将此条作为第一条的原因，大概是因为刚痉与柔痉的辨别，都从此条分出。痉病的证候最完备的，应当放在篇首。另外，“若发其汗……”这六句在“痉病也”之下，与上文文义不连贯，而与后文第十一条中“为欲解，脉如故，反伏弦者痉”一句文义相属，应当移到那里。
【注释】病患身体发热、怕冷，是太阳经证候；颈项僵硬拘急，面红目赤，是阳明经证候。头部发热，是阳气郁结于上部；脚部发凉，是阴气凝滞于下部。太阳经脉循行背部和头部，阳明经筋上行挟持口角，风寒邪气侵袭这两条经络，就会出现头摇、牙关紧闭、角弓反张、拘挛强直等证候。这些都是痉病的形态和证候，所以首先揭示出来，作为要领。
【集注】李 说：手三阳经的筋，结入颔颊部。足阳明经的筋，上行挟持口角。风寒乘虚侵入筋脉，导致筋脉挛缩，所以牙关紧急而牙关紧闭。
至于痉病的脉象，重按时紧如弦，直上下而行。
【注释】痉病这种病，其症状劲急强直，所以它的脉象也是劲急强直的。重按时感觉紧，是劲急的征象；像弦一样直行，是直行的征象。
《脉经》说：患痉病的人，脉象伏坚，直上下而行。
【注释】患痉病的人脉象紧弦，直上下而行，是因为痉病属于太阳表证。《脉经》所说的脉象伏坚，直上下而行，是因为痉病属于阳明里证。大概痉病原本涉及这两条经络，所以有太阳经用葛根汤发汗，阳明经用大承气汤攻下的治法。伏坚，就是沉实；直上下，就是弦直，即沉实弦直的脉象。
太阳病，发热，无汗，反而怕冷的，名叫刚痉。太阳病，发热，出汗，而不怕冷的，名叫柔痉。
【按语】“反恶寒”中的“反”字，是衍文（多余的字）。玩味痉病的条文自然知道应该怕冷。
【注释】痉病既然属于太阳经，应当以太阳经的虚实来分类，所以说：太阳病发热、无汗、恶寒属于实证，名叫刚痉，意思是强直而有力。发热、出汗、不怕冷属于虚证，名叫柔痉，意思是强直而无力。
太阳病，无汗而且小便反而少，气向上冲撞胸部，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治。
【注释】这里申明刚痉在表，以明确其治法。太阳病，是指头痛、项强、发热等证候。无汗，指伤寒。太阳伤寒，小便不应当少，现在反而少，是寒气盛而收敛牵引所致。不应当气上冲胸，现在气上冲胸，是寒气盛而上逆所致。不应当牙关紧闭不能说话，现在牙关紧闭不能说话，是寒气盛，牙关紧急而严重。因为太阳伤寒，而有这些冲击劲急的征象，是即将发作刚痉的病状。麻黄汤能治太阳经病，而不能治阳明经病，所以用葛根汤兼治太阳、阳明两经，是刚痉无汗的正治之法。
痉病，胸满，牙关紧闭，睡觉时背部不能着席（角弓反张严重），脚部拘挛急迫，必定咬齿，可以用大承气汤。
【注释】这里申明痉病入里，以明确其治法。痉病并且出现胸满，是里气壅滞；睡觉时背部不能着席，是角弓反张严重；脚部拘挛急迫，是劲急严重；必定咬齿，是牙关紧闭严重。这些都是阳明热盛灼伤筋脉，筋脉拘急严重的征象，所以用大承气汤直接攻逐热邪，不是攻逐阳明经的实邪。说“可与”，并非完全肯定可以服用，含有慎重的意思。
大承气汤方
大黄（酒洗，四两） 浓朴（炙，去皮，半斤） 枳实（炙，五枚） 芒硝（三合）
以上四味药，用水一斗，先煮前两种药，取五升药液，去掉药渣，加入大黄，煮取二升药液，去掉药渣，加入芒硝，再上火，微沸一两次，分两次温服，得到通便效果后停止服药。
太阳病，证候具备，身体强直，几几然（形容俯仰不能自如的样子），脉象反而沉迟，这是痉病，用栝萎桂枝汤主治。
【注释】太阳病，证候具备，是指头痛、项强、发热、恶风寒都见到。并且身体强直，有俯仰不能自如的几几然之象，是痉病。但是脉象反而出现沉迟这种太阴经的脉象，不同于太阳经浮紧无汗的刚痉，所以不给葛根汤，而给栝篓桂枝汤，调和太阳经的表，清泄太阴经的里。
栝蒌桂枝汤方
栝萎根（二两） 桂枝（三两） 芍药（三两） 甘草（二两） 生姜（三两） 大枣（十二枚）
以上六味药，用水九升，煮取三升药液，分三次温服，取微汗；如果不出汗，过一会儿，喝热粥以助发汗。
【注释】发热，是太阳病。脉象沉细，是少阴经脉象。而名叫痉的，一定有或刚或柔的证候出现。因为是太阳经痉证，却见到少阴经的脉象，是表里兼病。太阳经的邪气郁结在外，所以病发热；少阴经的邪气凝滞在內，所以脉沉细。然而痉病见到弦紧的脉象，是本脉，即使见沉迟脉，还可以治疗。现在见沉而细的脉象，邪气进入少阴，阳气已经衰败，难道容易治疗吗？所以说难治。
风病，如果用下法，则成痉，如果再发汗，必定拘急。
【注释】以上论述的痉病，都是外感风、寒、湿邪引起的。也有因风邪致病，不应当用下法而误下损伤津液，不应当发汗而误汗损伤津液，导致津液枯燥，筋脉失去滋养而患痉病的，所以说：风病误下则成痉，再发汗必定拘急。这种情况不可以用外感痉病的方法治疗，应当专门以滋养津液为务。
【注释】这里承接上文，详细申述发汗过多导致痉病的道理。太阳病应当发汗，如果发汗太过，腠理大开，表气不固，邪风乘虚而入，因而成痉的，是由于内虚招致外邪入侵，宜用桂枝加附子汤主治，以固表温经。由此推论，凡是病出汗过多，新产、金疮破伤出血过多，而变生此证的，都属于这一类。
突然腹部胀大的，是病情将要解除；脉象如旧，反而伏弦的，是痉病。
【按语】本门首条“痉病也”之下的“若发其汗……”六句，应当移到此条之首，文义才连贯。此条“暴腹胀大者”一句，是衍文，应当删除。
【注释】不仅是风病，发汗过多会成痉，即使是寒湿相搏的病，发汗过多也会成痉。发汗过多，体表更加虚弱，表虚就会立即极度怕冷。发寒湿汗后，脉象如果不直紧，像蛇一样曲缓，则是邪气退去，不成痉病，为欲解。如果脉象仍然直紧不缓，或不直紧反而伏坚弦急，是邪气不退，成为痉病了。
【注释】疮疡初起，毒热未成，依法应当发汗消散。已经溃烂后，血气被损伤，虽然有身体疼痛的表证，也不可以发汗，恐怕发汗使血液更加枯竭，筋脉失去滋养，因而成痉，或者邪风乘虚而入，也会导致痉病。
痉病患者有灸疮，难治。
【注释】痉病适宜艾灸，如果有灸疮，如果不化脓，说明营卫之气已绝，所以说难治。
患湿病的人，全身疼痛，发热，身体颜色像熏黄一样。
【注释】湿家，指患湿病的人。湿邪致病，或因外受湿气，则全身疼痛；或因内生湿病，则发热身黄。如果内外同病，则全身疼痛，发热，身体颜色像熏黄一样。湿家的身体疼痛发黄，不像伤寒的身体疼痛发黄，因为没有六经的形证。
【集注】徐彬说：这是说纯粹是湿邪久郁化为热的情况。如果湿邪挟带风邪，风性走窜空窍，所以疼痛只在关节；现在是单纯湿邪致病，则浸淫遍体，全身疼痛，不止在关节了。然而湿邪久郁，郁则生热，所以发热。热邪久了，气蒸腾于皮毛，所以疼痛所到之处，就是湿邪所到之处，湿邪所到之处，就是热邪所到之处。而颜色像熏黄的，是熏火之气。湿邪被火气所熏，所以发出黄色带黑且不亮的颜色。
湿病患者，病见身体疼痛、发热，面色黄且气喘，头痛鼻塞且烦躁，脉象大，自己能饮食，脾胃中和无病，病在头部感受寒湿，所以鼻塞，将药物纳入鼻中则痊愈。
【注释】这里申明上一条，详细说明其义，指出其脉，区别其治法。湿病患者，身体疼痛发热，面色黄且气喘，这是内生和外受的湿病。外治宜用羌活胜湿汤；内治宜用茵陈五苓散；气喘严重的，用大陷胸丸。如果再加上头痛鼻塞且烦躁，脉象大，证候类似伤寒，但此人里气和能进食，知道不是伤寒，不可发汗，是头部感受寒湿之邪，所以头痛鼻塞，只宜将药物纳入鼻中，取黄水从鼻涕排出，寒湿得以泄出，病可痊愈。所纳的药物，如瓜蒂散之类。
【集注】魏荔彤说：头部是诸阳之首，不是寒湿能侵犯的地方。现在头部有寒湿，则是热气挟带它上炎，不是寒湿外邪自己就能这样的，有湿热在内部主持。热引动湿邪，上犯清窍，鼻子必然堵塞。所以用纳鼻药，宣通清气而病愈。
湿病患者，身体烦痛，可以用麻黄加术汤，发其汗为宜，千万不要用火攻法。
【注释】湿病的外证，身体疼痛严重的，用羌活胜湿汤；内证发黄严重的，用茵陈五苓散。如果只是身体烦痛而不发黄的，则是外感寒湿，用麻黄加术汤发其汗，寒湿两解。千万不要用火攻法，是指不可以用火劫法大发其汗，必定导致变证。
【集注】赵良说：湿与寒结合，使人身体疼痛。大法，表实成热，则可以发汗。无热说明阳气尚微弱，发汗恐怕使表气更虚。这个证候虽然没有说热但有烦，因为生烦是由热引起的，所以服药不敢大发其汗。而且湿邪也不是暴汗可以驱散的，用麻黄汤治寒，加白术祛湿，使其微汗而已。不可火攻，火攻则增加其热，必定有其他变故，所以告诫人们谨慎。
喻昌说：麻黄加术，虽然发汗但不会多汗，而白术得麻黄，并可以行散表里的湿邪。不可以火攻，是因为火攻反而增加发热。
麻黄加术汤方
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，减去二升，去掉上面的沫，加入其他药，煮取二升半药液，去掉药渣，温服八合，覆盖取微似汗。
【按语】桂枝气味辛甘，全在于皮，如果去皮就是枯木了，怎么有解肌发汗的功效？应当删除“去皮”二字，后面仿照此例。
太阳病，关节疼痛且烦躁，脉象沉而细的，这叫湿痹。湿痹的候象，小便不利，大便反而快利。只应当利小便。
【注释】这里承接上一条互相详述其义，谓湿病患者身体疼痛不可发汗，应当有利小便的方法。太阳病，全身关节烦疼，如果脉象浮细，湿邪在表，应当发汗；小便不利，大便反而快利，脉象沉细，湿邪在内，应当利小便。现在湿气淫溢于内外，所以关节烦疼，留着不行，小便不利，大便反快，这叫湿痹。虽然有身体疼痛，但其脉不浮细，所以不可发汗。假设脉沉细，所以只应当利小便。如果小便利，濡泻止住，痹症不愈，身体仍疼痛，可以发汗。
【集注】赵良说：痹，就是痛。因为关节烦疼，脉沉而细，所以名叫湿痹。经书说：湿胜则濡泻。小便不利，大便反快的，是湿气内胜，只应当先利小便，以泻腹中湿气，所以说：治湿不利小便，不是正确的治法。假设小便利后，而关节的痹症不去，又必须从表治疗。
李 说：太阳经行于身体表面，外邪都能伤害它，所以也受湿气。关节疼痛，是湿气停留在关节。湿气郁蒸而生热，所以烦躁。经书说：沉潜水蓄，沉细为内湿脉。痹，是闭塞不通的意思，即《内经》湿气胜者为着痹的意思。现在小便不利，是湿盛于内，即《内经》“湿胜则濡泄”。利小便则湿去，而泻和烦就停止了。
湿病患者，其人只是头部出汗，背部强直，想要盖被子、靠近火源，如果过早使用下法，则呃逆，或者胸满，小便不利，舌上有苔，这是因为丹田有热，胸中有寒，口渴想喝水，但不能饮，所以口燥烦躁。
【注释】湿病患者头部出汗，是上湿下热，蒸腾所致，不是阳明内实的热，蒸腾而上越的汗。背部强直，是湿邪重着的强直，不是风湿拘急的强直。想要盖被子靠近火源，是一时湿盛生寒，不是伤寒的怕冷。如果误以为阳明内湿的热，上越的头部汗而随即用下法，则湿从寒化，乘虚进入上部，则肺气逆而胸满；进入中部，则胃不和而为呃逆；进入下部，则膀胱气化不行，为小便不利，舌上白滑如苔，是因为误下热陷，丹田有热。寒聚于上，胸中有寒，所以渴欲得水，但不能饮。由下有热而生口燥烦，由上有寒而不化生津液，虽然口燥舌干，但不能多饮。
湿病患者误用下法，额头出汗，微喘，小便利的，死；下利不止的，也死。
【注释】这里承接上一条互相详述误用下法，以阐明湿病患者头部出汗的死证。误用下法，额头出汗微喘，如果小便不利，是湿病患者额头出汗的喘，还不能说是死证。现在小便反利，则知道不是湿气上溢，而是上脱的额头出汗之喘，所以说死。如果下利不止，也知不是湿去之利，是中脱直下的利，所以说也死。
【集注】赵良说：这是妄用下法，因而导致逆证，逆则阳从上越，阴从下脱。其额头出汗、微喘的，是阳气的越脱；小便利与下利不止的，是阴气的脱失。阴阳离决，必死的征兆。由此推论，下法虽然额头出汗微喘，如果大小便不利，是阴气不脱，而阳之根犹在；下法虽然大小便利，假设额头无汗与喘，是阳气不越，而阴之根犹在，则非离决，可以根据其证候治疗。
李玮西说：前文说湿家应当利小便，因为湿气内瘀，小便原自不利，宜用药利之。这里下后里虚，小便自利，液脱而死，不可一概而论。
患者全身疼痛，发热，下午加剧的，名叫风湿。这个病是因出汗当风，或久伤取冷所致的，可以用麻黄杏仁薏苡甘草汤。
【注释】患者，指全身疼痛的病人。湿病患者全身疼痛，风湿病患者也全身疼痛，然而湿病的疼痛，沉重不能转侧；风湿病的疼痛，轻掣不可屈伸。这是疼痛的区别。湿病发热，早晚不分轻重；风湿的热，下午必定加剧，大概因为湿本来去留不定，而风有休止发作，所以名叫风湿。推究其来源，或是因为出汗当风，或是因为久伤取冷，相结合而导致，则麻黄杏仁薏苡甘草汤，发散风湿，可以使用是明确的。
【集注】程林说：全身疼痛发热，是风湿在表。日晡，是申时。阳明旺于申酉戌，土恶湿，现在被风湿干扰，当其旺时，邪正相搏，则反而加剧。汗也是湿类，或是出汗当风而成风湿，或是劳伤出汗而入冷水，都成为风湿病。
魏荔彤说：痉家非风不成，虽有寒，也依附于风；湿痹无寒不作，虽有风，也依附于寒。这是一定的道理。
麻黄杏仁薏苡甘草汤方
麻黄（去节，汤泡，半两） 甘草（炙，一两） 薏苡仁（半两） 杏仁（去皮尖，炒，十枚）
以上切碎如麻豆大，每次服四钱，水一盏半，煮至八分，去渣，温服，有微汗，避风。
【注释】脉浮是风，身体重是湿，寒湿则脉沉，风湿则脉浮。如果浮而不出汗怕风的，为实证，可用麻黄杏仁薏苡甘草汤发汗。浮而出汗怕风的，为虚证，所以用防己、白术以祛湿，黄芪、甘草以固表，生姜、大枣以调和营卫。
The patient presents with fever in the body, coldness in the feet, stiffness and tension in the neck and nape, aversion to cold, occasional heat in the head, redness of the face and eyes, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (arching of the back). This is known as Jing disease (Spasm disorder). If sweating methods are induced erroneously, cold and dampness contend with each other, the exterior becomes more deficient, leading to severe aversion to cold. After inducing sweating, the pulse resembles a snake winding.
[Commentary] Various schools list Gang-Jing (Stiff Spasm) and Rou-Jing (Soft Spasm) as the first items. The reason for listing this item as the first here is that the distinction between Gang and Rou stems from this item. Since this item presents the most complete syndrome of Jing disease, it should be placed at the beginning. Furthermore, the six sentences "If inducing sweating..." under "Jing disease" do not connect logically with the preceding text but relate to the later sentence in Item 11: "For resolution, if the pulse remains unchanged but becomes hidden and wiry, it is Jing." These should be moved there.
[Annotation] Fever and aversion to cold in the patient indicate Taiyang syndrome; stiffness in the neck and nape, along with redness of the face and eyes, indicate Yangming syndrome. Heat in the head signifies Yang Qi constrained above; coldness in the feet signifies Yin Qi stagnant below. The Taiyang meridian runs along the back and head; the Yangming sinews run up to flank the mouth. When Wind-Cold pathogens invade these two meridians, symptoms such as head shaking, lockjaw, opisthotonos, and rigidity occur. These are all manifestations of Jing disease, hence revealed first as the key principle.
[Collected Commentaries] Li said: The sinews of the three Hand-Yang meridians knot into the jaw and cheeks. The sinew of the Foot-Yangming meridian runs up to flank the mouth. When Wind-Cold enters the sinews due to deficiency, they contract, causing tightness of the jaw and lockjaw.
Regarding the pulse of Jing disease, when pressed, it feels tight like a string, running straight up and down.
[Annotation] The condition of Jing disease involves stiff, urgent, and rigid symptoms; thus, its pulse is also stiff, urgent, and rigid. Feeling tight upon pressure is the image of urgency; feeling like a straight string is the image of straight movement.
The *Mai Jing* (Pulse Classic) states: In patients prone to spasms, the pulse is hidden and firm, running straight up and down.
[Annotation] A tight and wiry pulse running straight up and down indicates that Jing disease belongs to the Taiyang exterior. The "hidden and firm" pulse mentioned in the *Mai Jing* indicates that Jing disease belongs to the Yangming interior. Generally, Jing disease involves both meridians; therefore, treatment may involve sweating via Gegen Tang (Kudzu Decoction) for the Taiyang aspect or purging via Dachengqi Tang (Major Order the Qi Decoction) for the Yangming aspect. "Hidden and firm" refers to deep and solid; "straight up and down" refers to wiry and straight, i.e., a deep, solid, wiry, and straight pulse.
In Taiyang disease, if there is fever, no sweating, and paradoxical aversion to cold, it is named Gang-Jing (Stiff Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is named Rou-Jing (Soft Spasm).
[Commentary] The character "paradoxically" (fan) in "paradoxical aversion to cold" is likely an interpolation. Examining the Jing disease clauses reveals that aversion to cold should naturally be present.
[Annotation] Since Jing disease belongs to Taiyang, it should be classified by Taiyang deficiency and excess. Thus, Taiyang disease with fever, no sweating, and aversion to cold represents Excess pathogen, named Gang-Jing, meaning strong and forceful rigidity. Fever, sweating, and lack of aversion to cold represent Deficient pathogen, named Rou-Jing, meaning weak rigidity.
In Taiyang disease, if there is no sweating, urination is surprisingly scanty, Qi rushes upward to the chest, there is lockjaw preventing speech, and Gang-Jing is about to develop, Gegen Tang (Kudzu Decoction) is the primary treatment.
[Annotation] This clarifies that Gang-Jing is on the exterior to define its treatment. Taiyang disease involves headache, neck stiffness, fever, etc. No sweating indicates Cold Damage. In Taiyang Cold Damage, urination should not be scanty; if it is, it is due to excessive Cold Qi causing contraction. Qi should not rush to the chest; if it does, it is due to excessive Cold Qi reversing upward. Lockjaw should not occur; if it does, it is due to excessive Cold Qi causing severe jaw tension. Given these signs of violent upward rush and urgency in Taiyang Cold Damage, the disease is developing into Gang-Jing. Mahuang Tang (Ephedra Decoction) treats Taiyang but not Yangming; therefore, Gegen Tang is used to treat both meridians, serving as the standard method for Gang-Jing without sweating.
In Jing disease, if there is chest fullness, lockjaw, inability to lie flat (severe opisthotonos), leg cramps, and teeth grinding, Dachengqi Tang (Major Order the Qi Decoction) may be administered.
[Annotation] This clarifies that Jing disease has entered the interior to define its treatment. Chest fullness indicates stagnation of Interior Qi; inability to lie flat indicates severe opisthotonos; leg cramps indicate severe urgency; teeth grinding indicates severe jaw tension. These are images of Yangming Heat flourishing and scorching the sinews, causing severe tension. Therefore, Dachengqi Tang is used to directly attack the Heat, not necessarily the Excess of the Yangming organ. The phrase "may be administered" implies caution rather than absolute certainty.
Dachengqi Tang Formula
Dahuang (Rhubarb Root, wine-washed, 4 liang) Houpo (Magnolia Bark, roasted, skin removed, 8 liang) Zhishi (Immature Bitter Orange, roasted, 5 pieces) Mangxiao (Mirabilite, 3 he)
These four ingredients are boiled in 10 sheng of water. First boil the first two ingredients to obtain 5 sheng, remove dregs, add Dahuang, boil to obtain 2 sheng, remove dregs, add Mangxiao, boil briefly over fire, divide into two warm doses. Stop taking after defecation occurs.
In Taiyang disease, when symptoms are complete, the body is stiff and rigid ("jijiran," describing difficulty in bending and extending), and the pulse is surprisingly deep and slow, this is Jing disease. Gualou Guizhi Tang (Trichosanthes Twig Decoction) is the primary treatment.
[Annotation] "Symptoms complete" means headache, neck stiffness, fever, and aversion to wind-cold are all present. The additional body stiffness with "jijiran" appearance indicates Jing disease. However, the pulse is surprisingly deep and slow (a Taiyin pulse), unlike the floating, tight, non-sweating pulse of Taiyang Gang-Jing. Therefore, Gegen Tang is not given; instead, Gualou Guizhi Tang is used to harmonize the Taiyang exterior and clear the Taiyin interior.
Guolou Guizhi Tang Formula
Gualougen (Trichosanthes Root, 2 liang) Guizhi (Cinnamon Twig, 3 liang) Shaoyao (Peony Root, 3 liang) Gancao (Licorice Root, roasted, 2 liang) Shengjiang (Fresh Ginger, 3 liang) Dazao (Jujube, 12 pieces)
These six ingredients are boiled in 9 sheng of water to obtain 3 sheng. Divide into three warm doses to induce slight sweating. If sweating does not occur, drink hot porridge shortly after to assist.
In Taiyang disease, if there is fever and the pulse is deep and fine, it is named Jing, and is difficult to treat.
[Annotation] Fever indicates Taiyang disease. A deep and fine pulse indicates Shaoyin meridian involvement. It is named Jing only if specific Gang or Rou symptoms appear. Having Taiyang Jing symptoms with a Shaoyin pulse indicates simultaneous Exterior and Interior disease. Exterior constraint of Taiyang causes fever; Interior stagnation of Shaoyin causes the deep and fine pulse. While a wiry-tight pulse is typical for Jing (and even deep-slow might be treatable), a deep and fine pulse suggests pathogen entering Shaoyin and declining Yang Qi, making it difficult to treat. Hence, "difficult."
In Wind disease, using purgatives leads to spasm; re-inducing sweating will cause severe cramping.
[Annotation] The previous discussions on Jing involved external Wind, Cold, and Dampness. However, some cases arise from Wind pathology where inappropriate purgation damages fluids, or inappropriate sweating damages Jin-Ye, leading to dryness and loss of nourishment to the sinews, resulting in Jing. Thus, "Wind disease purged leads to spasm; re-sweating causes cramping." This cannot be treated as external Jing disease; the focus must be on nourishing fluids.
In Taiyang disease, excessive sweating can lead to Jing disease.
[Annotation] This elaborates on how excessive sweating causes Jing. Taiyang disease requires sweating, but if done excessively, pores open widely, exterior Qi fails to secure, and Wind pathogens enter due to internal deficiency, causing Jing. This is caused by internal deficiency inviting external pathogens. Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) should be used to secure the exterior and warm the meridians. By analogy, any condition involving excessive sweating, postpartum hemorrhage, or traumatic bleeding leading to this syndrome falls into this category.
Sudden abdominal distension indicates impending resolution; if the pulse remains unchanged but becomes hidden and wiry, it is Jing disease.
[Commentary] The six sentences "If inducing sweating..." under the first item of this chapter should be moved to the beginning of this item for logical coherence. The phrase "Sudden abdominal distension" in this item is likely an interpolation and should be deleted.
[Annotation] Not only does excessive sweating in Wind disease cause Jing, but it also causes Jing in Cold-Damp contention diseases. Excessive sweating makes the exterior more deficient, leading to severe aversion to cold. After sweating out Cold-Damp, if the pulse is not tight-straight but wavy like a snake, it indicates pathogen retreat and resolution. If the pulse remains tight-straight or becomes hidden-firm and wiry-urgent, the pathogen has not retreated, and Jing disease develops.
Patients with chronic sores, despite body pain, should not undergo sweating therapy; sweating will cause spasm.
[Annotation] Initially, when sore toxins have not matured, sweating is indicated to disperse them. After ulceration, Blood and Qi are damaged. Even with body pain and exterior signs, sweating is contraindicated to prevent further depletion of Blood and loss of nourishment to sinews, which could cause spasm or allow Wind pathogens to invade.
Jing disease combined with moxibustion sores is difficult to treat.
[Annotation] Moxibustion is suitable for Jing disease. However, if moxa sores are present and fail to suppurate, it indicates exhaustion of Ying and Wei Qi, hence "difficult to treat."
Patients with Dampness disease experience whole-body pain, fever, and a sallow, dark yellow complexion (like smoked yellow).
[Annotation] "Shi-jia" refers to those suffering from Dampness. Dampness disease may result from external exposure to dampness (causing whole-body pain) or internal generation (causing fever and jaundice). If both internal and external factors combine, symptoms include whole-body pain, fever, and a sallow, dark yellow complexion. Unlike Cold Damage jaundice, Dampness jaundice lacks Six Meridian syndromes.
[Collected Commentaries] Xu Bin stated: This describes pure Dampness long-stagnated transforming into Heat. If Dampness carries Wind, pain is limited to joints due to Wind's nature. Pure Dampness permeates the body, causing widespread pain. Long-standing Dampness stagnates and generates Heat, causing fever. Prolonged Heat steams the skin, so pain locations correspond to Dampness and Heat. The "smoked yellow" color results from Dampness being scorched by Fire-Qi, appearing yellow-black and dull.
In Dampness disease, if there is body pain, fever, yellowish face, wheezing, headache, nasal congestion, and irritability, with a large pulse, yet the patient can eat and the interior is harmonious, the pathology is Cold-Damp in the head causing nasal congestion. Medication inserted into the nose will cure it.
[Annotation] This elaborates on the previous clause, detailing the etiology, pulse, and treatment. Body pain, fever, yellow face, and wheezing indicate internal and external Dampness. External treatment uses Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness); internal treatment uses Ychen Wuling San (Artemisia Capillaris Five-Ingredient Powder); severe wheezing requires Daxiexion Wan (Major Collapse the Chest Pill). If accompanied by headache, nasal congestion, irritability, and a large pulse, resembling Cold Damage but with a harmonious interior and appetite, it is not Cold Damage. It is Cold-Damp in the head. Sweating is contraindicated. Instead, medication (such as Gua Di San) should be inserted into the nose to drain turbid fluids, expelling Cold-Damp.
[Collected Commentaries] Wei Litong stated: The head is the summit of all Yang meridians, not easily invaded by Cold-Damp. Its presence there implies Heat carrying it upward, driven by internal Damp-Heat. Heat draws Dampness upward to obstruct clear orifices, causing nasal congestion. Nasal medication ventilates Clear Qi, curing the disease.
In Dampness disease, if there is vexatious body pain, Mahuang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction) may be used to induce sweating. Caution: Do not use Fire Therapy.
[Annotation] For severe external Dampness pain, use Qianghuo Shengshi Tang; for severe internal jaundice, use Ychen Wuling San. For isolated vexatious pain without jaundice (external Cold-Damp), Mahuang Jia Zhu Tang induces sweating to resolve both Cold and Damp. Fire therapy is forbidden because coercive sweating via fire will cause complications.
[Collected Commentaries] Zhao Liang stated: Cold and Damp combined cause body pain. Generally, if Exterior Excess transforms into Heat, sweating is allowed. Lack of Heat suggests weak Yang Qi; sweating might further weaken the exterior. Although this case mentions "vexation" (indicating latent Heat), one must avoid heavy sweating. Dampness cannot be dispersed by violent sweating; gentle sweating via Mahuang Tang (for Cold) plus Atractylodes (for Damp) is appropriate. Fire therapy increases Heat and risks complications.
Yu Chang stated: Mahuang plus Atractylodes induces sweating without excessive fluid loss, and Atractylodes helps move Dampness in both Exterior and Interior. Fire therapy exacerbates Heat.
Mahuang Jia Zhu Tang Formula
Mahuang (Ephedra Stem, nodes removed, 3 liang) Guizhi (Cinnamon Twig, bark removed, 2 liang) Gancao (Licorice Root, roasted, 2 liang) Xingren (Apricot Seed, skin and tips removed, 70 seeds) Baizhu (Atractylodes Macrocephala Rhizome, 4 liang)
These five ingredients are boiled in 9 sheng of water. First boil Mahuang to reduce by 2 sheng, skim off foam, add remaining herbs, boil to obtain 2.5 sheng, remove dregs, take 0.8 sheng warm. Cover to induce slight sweating.
[Commentary] The instruction "bark removed" for Guizhi is erroneous; the active properties reside in the bark. Removing it renders it useless for releasing the muscle layer. This phrase should be deleted.
In Taiyang disease, if joint pain is accompanied by vexation and the pulse is deep and fine, it is named Shi-Bi (Damp Bi). Signs of Shi-Bi include impaired urination and loose stools. Treatment should focus on promoting urination.
[Annotation] This reiterates that Dampness pain should not be treated with sweating but with promoting urination. If Taiyang joint pain has a floating-fine pulse, Dampness is in the Exterior, requiring sweating. If urination is impaired and stools are loose with a deep-fine pulse, Dampness is in the Interior, requiring promotion of urination. Here, Dampness pervades both, causing joint pain, impaired urination, and loose stools, termed Shi-Bi. Since the pulse is not floating-fine, sweating is contraindicated. With a deep-fine pulse, only promoting urination is indicated. If urination improves but pain persists, sweating may then be considered.
[Collected Commentaries] Zhao Liang stated: Bi means pain. Joint pain with deep-fine pulse defines Shi-Bi. Classics state: Excess Dampness causes loose stools. Impaired urination and loose stools indicate internal Dampness excess. Promoting urination drains abdominal Dampness. If Bi persists after urination normalizes, treat from the Exterior.
Li stated: Taiyang governs the exterior and is susceptible to Dampness. Joint pain indicates Dampness lodging in joints. Stagnant Dampness generates Heat, causing vexation. Deep-fine pulses indicate internal Dampness. Bi means obstruction, akin to "Zhuo-Bi" (Fixed Bi) in the *Neijing*. Impaired urination confirms internal Dampness excess. Promoting urination eliminates Dampness, stopping diarrhea and vexation.
In Dampness disease, if the patient sweats only on the head, has back stiffness, desires covering and warmth near fire, but is purged prematurely, symptoms include hiccups, chest fullness, impaired urination, and a tongue coating resembling moss. This is due to Heat in the Dan Tian (Lower Jiao) and Cold in the Chest (Upper/Middle Jiao). The patient feels thirsty for water but cannot drink, resulting in dry mouth and vexation.
[Annotation] Head sweating alone results from Upper Damp and Lower Heat steaming upward, not Yangming Interior Excess Heat. Back stiffness is due to the heaviness of Dampness, not Wind-Damp contraction. Desire for warmth indicates temporary Cold generated by Dampness excess, not Cold Damage aversion to cold. Premature purgation causes Dampness to transform into Cold, invading upwards (causing Lung Qi reversal/chest fullness), middle (causing Stomach disharmony/hiccups), or downwards (causing Bladder Qi failure/impaired urination). A white slippery tongue coating indicates Heat sinking due to error, creating Heat in the Lower Jiao and Cold in the Upper Jiao. Thirst without desire to drink arises from Lower Heat causing dryness/vexation and Upper Cold failing to transform fluids.
If Dampness disease is purged, leading to sweating on the forehead, slight wheezing, and free urination, death ensues. If purging leads to unceasing diarrhea, death also ensues.
[Annotation] This details fatal outcomes of erroneous purgation. Forehead sweating and wheezing with impaired urination might not be fatal (indicating Dampness rising). However, free urination indicates Upper Collapse of Yang Qi (forehead sweat/wheeze) and Lower Collapse of Yin Qi (free urination/diarrhea). This separation of Yin and Yang is a sign of death.
[Collected Commentaries] Zhao Liang stated: Erroneous purgation causes rebellion: Yang escapes upward (forehead sweat/wheeze), Yin escapes downward (free urination/diarrhea). Separation of Yin and Yang signals death. If bowel/bladder function remains blocked, Yang root is preserved; if sweating/wheezing are absent despite free excretion, Yin root is preserved. In such cases, treatment based on symptoms is possible.
Li Weixi stated: Previously, promoting urination was advised for internal Dampness stasis. Here, post-purgation internal deficiency leads to spontaneous urination and fluid exhaustion causing death. These cases differ and should not be generalized.
When a patient experiences whole-body pain and fever that worsens in the late afternoon (You period), it is named Feng-Shi (Wind-Damp). This arises from sweating while exposed to wind or prolonged exposure to cold. Mahuang Xingyi Gancao Tang (Ephedra, Apricot Seed, Coix Seed, Licorice Decoction) is indicated.
[Annotation] Both Dampness and Wind-Damp cause whole-body pain. Dampness pain is heavy and immobile; Wind-Damp pain is light and restricts flexion/extension. Dampness fever is constant; Wind-Damp fever worsens in the late afternoon (Shen hour, 3-5 PM) because Wind has periodicity. Etiology includes sweating with wind exposure or cold immersion. Mahuang Xingyi Gancao Tang disperses Wind-Damp.
[Collected Commentaries] Cheng Lin stated: Whole-body pain and fever indicate Wind-Damp in the Exterior. Late afternoon corresponds to Shen hour, when Yangming Earth is prosperous. Earth dislikes Dampness; when Wind-Damp interferes during peak Yangming time, pathogen and healthy Qi clash, worsening symptoms. Sweat is related to Dampness; sweating with wind or cold immersion causes Wind-Damp.
Wei Litong stated: Jing disease requires Wind; even with Cold, it attaches to Wind. Shi-Bi requires Cold; even with Wind, it attaches to Cold. This is a fixed principle.
Mahuang Xingyi Gancao Tang Formula
Mahuang (Ephedra Stem, nodes removed, soaked in boiling water, 0.5 liang) Gancao (Licorice Root, roasted, 1 liang) Yiyiren (Coix Seed, 0.5 liang) Xingren (Apricot Seed, skin/tips removed, roasted, 10 seeds)
Crush to size of hemp seeds. Take 4 qian per dose, boiled in 1.5 cups of water to 0.8 portion. Strain and take warm. Induce slight sweating and avoid wind.
In Wind-Damp, if the pulse is floating, body is heavy, and there is sweating with aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is the primary treatment.
[Annotation] Floating pulse indicates Wind; heaviness indicates Dampness. Cold-Damp pulses are deep; Wind-Damp pulses are floating. If floating with no sweating and aversion to wind, it is Exterior Excess, treated with Mahuang Xingyi Gancao Tang. If floating with sweating and aversion to wind, it is Exterior Deficiency. Fangji Huangqi Tang uses Fangji and Baizhu to dispel Dampness, Huangqi and Gancao to secure the Exterior, and Shengjiang and Dazao to harmonize Ying and Wei.