【集注】赵良曰∶此证风湿皆从表受之，其病在外，故脉浮汗出。凡身重，有肌肉痿
而重者，有骨痿而重者。此之身重，乃风湿在皮毛之表，故不作疼。虚其卫气，而湿着
为身重，故以黄 实卫，甘草佐之；防己去湿，白术佐之。然则风湿二邪，独无散风之
药何耶？盖汗多，知其风已不留，以表虚而风出入乎其间，因之恶风尔。惟实其卫，正
气壮则风自退，此不治而治者也。
尤怡曰∶风湿在表，法当从汗而解，乃汗不得发而自出，表尚未解而已虚，汗解之
法，不可守矣。故不用麻黄，出之皮毛之表，而用防己，驱之肌肤之里。服后如虫行皮中
及腰下如冰，皆湿下行之征也。然非 、术、甘草，焉能使卫阳复振，而驱湿下行哉。
防己黄 汤方
防己（一两） 甘草（半两） 白术（七钱半） 黄 （去芦，一两一分）
上锉麻豆大，每抄五钱匕，生姜四片，大枣一枚，水盏半，煎八分，去滓温服，良久
再服。
喘者，加麻黄半两。胃中不和者，加芍药三分。气上冲者，加桂枝三分。下有陈寒
者，加细辛三分。
服后当如虫行皮中，从腰下如冰，后坐被上，又以一被绕腰以下，温令微汗瘥。
风湿相抟，一身尽疼痛，法当汗出而解。值天阴雨不止，医云此可发汗，汗之病不愈
者，何也？盖发其汗，汗大出者，但风气去，湿气在，是故不愈也。若治风湿者，发其汗，
但微微似欲汗出者，风湿俱去也。
【注】风湿相抟，一身尽痛，法当从汗而解，而汗亦不可失其宜也。值雨淫湿盛之时，
若发其汗使大出，亦不能愈，以风气去，湿气在，故不愈。然治风湿者，必俟其天气晴
明发其汗，使微微似欲汗出者，则风湿皆去，病斯愈矣。
【集注】徐彬曰∶此言风湿当汗解，而不可过也。谓风湿相抟疼痛，原当汗解，值天
阴雨，则湿更甚，可汗无疑。而不愈何故？盖风性急可骤驱，湿性滞当渐解，汗大出则骤，
风去而湿不去，故不愈。若发之微，则出之缓，缓则风湿俱去矣。然则湿在人身，粘滞
难去，骤汗且不可，而况骤下乎？故前章曰下之死，此但云不愈，见用法不当，而非误
下比也。
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；若大便坚，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。谓此风湿之病，虽得之伤寒八九日，而不呕
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，表虚风也。涩
者，湿也。身体烦疼，风也。不能转侧，湿也。乃风湿相抟之身体疼痛，非伤寒骨节疼
痛也。与桂枝附子汤温散其风湿，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。去桂枝者，以大便坚，小便自利，不欲其发汗，再
夺津液也。加白术者，以身重着湿在肌分，用以佐附子逐水气于皮中也。
【集注】程林曰∶风淫所胜，则身烦疼；湿淫所胜，则身体难转侧。风湿相抟于营卫
之间，不干于里，故不呕不渴也。脉浮为风。涩为湿，以其脉近于虚，故用桂枝附子汤温
经以散风湿。小便利者，大便必硬，桂枝近于解肌，恐大汗故去之；白术能去肌湿，不
妨乎内，故加之。凡方后有如虫、如醉、如冒等状者，皆药势将行使然。
周扬俊曰∶伤寒至八九日，亦云久矣。既不传经，复不入腑者，因风湿持之也。所现
外证烦疼者风也，不能转侧者湿也，不呕不渴者无里证也，其脉浮虚而涩，正与相应。然
后知风湿之邪，在肌肉而不在筋节，故以桂枝表之。不发热为阳气素虚，故以附子逐湿。
两相绾合，自不能留矣。
桂枝附子汤方
桂枝（去皮，四两） 附子（炮，去皮，破八片，三枚） 甘草（炙，二两） 生姜（切，三
两） 大枣（擘，十二枚）
上五味，以水六升，煮取二升，去滓，分温三服。
白术附子汤方
白术（二两） 附子（炮，去皮，一枚半） 甘草（炙，一两） 生姜（切，一两半） 大
枣（擘，六枚）
上五味，以水三升，煮取一升，去滓，分温三服，一服觉身痹，半日许再服，三服都
尽，其人如冒状勿怪，即是术附并走皮中，逐水气未得除故耳！
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，身体烦疼重着，不能转侧者，湿胜风也。今掣痛不可屈伸，风胜湿
也。掣痛不可屈伸，近之则痛剧，汗出、短气、恶风不欲去衣，皆风邪壅盛也。小便不
利，湿内蓄也。身微肿者，湿外抟也。以甘草附子汤微汗之，祛风为主，除湿次之也。此
上二条，皆详风湿之义，以明风湿之治也。
甘草附子汤方
甘草（炙，二两） 附子（炮，去皮，二枚） 白术（二两） 桂枝（去皮，四两）
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
出复烦者，服五合。恐一升多者，宜服六七合为妙。
【方解】甘草附子汤，即桂枝附子汤去姜、枣加白术也。去姜、枣者，畏过散也。加白
术者，燥中湿也。日三服，初服一升，不得汗，则仍服一升，若得微汗则解，解则能食，
解已彻也，可止再服，若汗出而复烦者，是解未彻，仍当服也，但不可服一升，恐已经
汗出而过汗也，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，学人宜详求之。
太阳中热者， 是也。汗出恶寒，身热而渴，白虎加人参汤主之。
【注】中暑热病，亦由太阳而入，故曰太阳中热者， 是也。汗出恶寒，身热而渴，颇
似太阳温热之病，但温热无恶寒，以热从里生，故虽汗出而不恶寒也。中 暑邪，由表
而入，故汗出恶寒也。究之于脉，温热之浮，浮而实，中 之浮，浮而虚，以暑热伤气也。
究之于渴，温热之渴，初病不过欲饮，中 之渴，初病即大引饮也。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，自有不同。用白
虎加人参汤主之者，盖以益气为主，清暑热次之也。
【集注】李 曰∶热伤气，气泄则汗出，气虚则恶寒，热蒸肌腠则身热，热伤津液则
作渴，此恶寒身热，与伤寒相类。然所异者，伤寒初起无汗不渴，中 初起即汗出而渴也。
白虎加人参汤方
知母（六两） 石膏（碎，一斤） 甘草（二两） 粳米（六合） 人参（三两）
上五味，以水一斗，煮米熟，汤成去滓，温服一升，日三服。
太阳中 ，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。若发其汗，则恶寒甚；加温针，则发热甚；数
下之，则淋甚。
【注】此承上文互详证脉，不可妄行汗、下也，中 本有汗，若发热无汗，身重疼痛
者，虽证似伤寒，然见弦细芤迟虚脉，则非伤寒也。且有小便己，洒洒然恶寒毛耸之状，
皆太阳膀胱表气，为暑所伤而畏也；手足逆冷者，暑伤气，气不能达四肢则寒也；小有
劳，身即发热，口开，前板齿燥者，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
数下之，则水源竭涩，尿淋窘甚也。凡此之证，皆中 ，妄行汗，下、温针致变，以白
虎加人参汤主之，或人参汤调辰砂六一散亦可也。
【集注】程林曰∶《内经》云∶先夏至为病温，后夏至为病暑。又曰∶热病者，皆伤
寒之类也。以其太阳受病与伤寒相似，亦令发热恶寒，身重而疼痛也。经曰∶寒伤形，暑
伤气。气伤则气消而脉虚弱，所以弦细芤迟也。小便已毛耸者，阳气内陷，不能卫外，手
足亦逆冷也。劳动则扰乎阳，故热甚，则口开，口开则前板齿燥也。发汗虚其阳，则恶
寒甚。温针动火邪，则发热甚。下之亡津液，则淋甚也。
太阳中 ，身热疼重，而脉微弱，此以夏月伤冷水，水行皮中所致也，一物瓜蒂汤
主之。
【注】太阳中 之证，身热而倦者，暑也；身热疼重者，湿也；脉微弱者，暑伤气也。以
此证脉揆之，乃因夏月中暑之人，暴贪风凉，过饮冷水，水气虽输行于皮中，不得汗泻所
致也。此时即以香薷饮、大顺散汗之，可立愈矣。若稍缓，水气既不得外泻，势必内攻
于中而作喘肿胀矣。喘则以葶苈大枣汤，肿胀则以瓜蒂一物汤下之可也。
【集注】周扬俊曰∶无形之热伤其肺金，则用白虎加人参汤；有形之水伤其肺金，则
用瓜蒂汤，各有所主也。
李 曰∶中 邪在表，故身热。伤冷水，故身疼。中暑伤气，气虚故脉微弱也。瓜蒂治身
面四肢浮肿，散皮肤中水气，苦以泄之也。
一物瓜蒂汤方
瓜蒂（二十个）
上锉，以水一升，煮取五合，去滓，顿服。
【集注】赵良说：这种证候的风湿邪气都是从体表受邪，病位在表，所以脉象浮而汗出。凡是身体沉重，有因肌肉痿弱而重的，有因骨骼痿弱而重的。这里的身体沉重，是因为风湿邪气在皮毛之表，所以不疼痛。卫气虚弱，湿气留着导致身体沉重，所以用黄芪来充实卫气，甘草辅助它；防己去除湿气，白术辅助它。那么风湿两种邪气，难道没有散风的药吗？因为汗多，知道风邪已经不留存，是因为表虚而风邪在体表出入，因此恶风。只要充实卫气，正气强壮则风邪自然退去，这是不治而治的方法。
尤怡说：风湿在表，法度上应当通过发汗来解除，但汗不是强行发出的而是自行流出，表证尚未解除而正气已虚，发汗解表的方法就不能固守了。所以不用麻黄将邪气从皮毛之表排出，而用防己将邪气从肌肤之里驱除。服药后感觉像虫子在皮中爬行以及腰部以下像冰一样冷，都是湿气向下运行的征兆。然而如果没有黄芪、白术、甘草，怎么能使卫阳重新振奋，从而驱赶湿气下行呢？
防己黄芪汤方
防己（一两） 甘草（半两） 白术（七钱半） 黄芪（去掉芦头，一两一分）
以上药材切碎如麻豆大小，每次取五钱匕，生姜四片，大枣一枚，水一盏半，煎至八分，去渣温服，过一段时间再服。
气喘的，加麻黄半两。胃中不和的，加芍药三分。气上冲的，加桂枝三分。下部有陈寒的，加细辛三分。
服药后应当感觉像虫子在皮中爬行，从腰部以下像冰一样冷，之后坐在被子上，再用一条被子围绕腰部以下，温热令其微微出汗即愈。
风湿相互搏结，全身都疼痛，法度上应当发汗而解。正值天下雨不停，医生说这可以发汗，发汗后病不愈，为什么呢？因为发汗，汗出太多的话，只是风气去了，湿气还在，所以不愈。如果治疗风湿，发汗时，只要微微似欲出汗的样子，风湿就能一起去除。
【注】风湿相互搏结，全身都疼痛，法度上应当通过发汗来解除，但发汗也不可失去适宜的程度。正值雨水淫溢湿气盛的时候，如果发汗使其大汗出，也不能痊愈，因为风气去了，湿气还在，所以不愈。然而治疗风湿的人，必须等到天气晴朗时发汗，使微微似欲出汗的样子，则风湿都能去除，病就痊愈了。
【集注】徐彬说：这里说风湿应当通过发汗解除，但不可过度。说风湿相互搏结疼痛，原本应当发汗解除，正值天阴雨，则湿气更甚，可发汗无疑。为什么不愈呢？因为风性急骤可以迅速驱除，湿性滞涩应当逐渐解除，大汗出则过于急骤，风去而湿不去，所以不愈。如果发汗轻微，则排出缓慢，缓慢则风湿都能去除。那么湿在人身，粘滞难去，急汗尚且不可以，何况急下呢？所以前章说下法会导致死亡，这里只说不愈，说明用法不当，而不是误用下法相比拟。
伤寒经过八九日，风湿相互搏结，身体疼痛烦躁，不能自己翻身转侧，不呕吐不口渴，脉象浮虚而涩的，用桂枝附子汤主治；如果大便坚硬，小便自利的，用去桂枝加白术汤主治。
【注】这里承接上一条详细阐述脉证，以明确其治疗方法。说这种风湿的病，虽然是得自伤寒八九日，但不呕吐不口渴，是没有伤寒里证的脉象。脉浮虚涩，是没有伤寒表病的脉象。脉浮虚，是表虚风邪。涩者，是湿邪。身体烦疼，是风邪。不能转侧，是湿邪。这是风湿相互搏结的身体疼痛，不是伤寒的骨节疼痛。给予桂枝附子汤温散其风湿，从表而解。如果脉浮实，则又应当用麻黄加术汤，大发其风湿。如果其人具有这些证候，虽然大便硬，小便自利，而不议用下法的，因为这不是邪热入里的硬，而是风燥湿去后的硬，所以仍以桂枝附子汤。去掉桂枝的原因，是因为大便坚，小便自利，不希望其再发汗，再次耗夺津液。加入白术的原因，是因为身体重着湿在肌分，用来辅助附子在皮中驱逐水气。
【集注】程林说：风淫胜则身烦疼；湿淫胜则身体难转侧。风湿相互搏结于营卫之间，不干扰于里，所以不呕吐不口渴。脉浮为风。涩为湿，因为其脉近于虚，所以用桂枝附子汤温经以散风湿。小便利者，大便必硬，桂枝近于解肌，恐怕大汗所以去掉它；白术能去肌湿，不妨碍在内，所以加上它。凡是方剂后面有如虫行、如醉、如冒等状况的，都是药势将要行使才这样。
周扬俊说：伤寒到八九日，也算久了。既不传经，又不入腑的，是因为风湿持留所致。所表现的外证烦疼的是风邪，不能转侧的是湿邪，不呕吐不口渴的是无里证，其脉浮虚而涩，正与相应。然后知道风湿之邪，在肌肉而不在筋节，所以用桂枝解表。不发热为阳气素虚，所以用附子逐湿。两者相结合，自然不能留住了。
桂枝附子汤方
桂枝（去皮，四两） 附子（炮制，去皮，破成八片，三枚） 甘草（炙，二两） 生姜（切，三两） 大枣（掰开，十二枚）
以上五味药，用水六升，煮取二升，去渣，分三次温服。
白术附子汤方
白术（二两） 附子（炮制，去皮，一枚半） 甘草（炙，一两） 生姜（切，一两半） 大枣（掰开，六枚）
以上五味药，用水三升，煮取一升，去渣，分三次温服。一服后感觉身体麻木，约半日后再服，三服都服完后，其人如有头晕目眩状不要奇怪，这就是术和附子并走皮中，驱逐水气还未得除的缘故！
风湿相互搏结，骨节疼痛烦躁，牵引痛不得屈伸，靠近则痛剧，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】风湿相互搏结，身体烦疼重着，不能转侧的，是湿胜风也。现在牵引痛不可屈伸，是风胜湿也。牵引痛不可屈伸，靠近则痛剧，汗出、短气、恶风不想脱衣，都是风邪壅盛。小便不利，是湿内蓄。身体微肿的，是湿外搏。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。
甘草附子汤方
甘草（炙，二两） 附子（炮制，去皮，二枚） 白术（二两） 桂枝（去皮，四两）
以上四味药，用水六升，煮取三升，去渣，温服一升，每日三次。初服得到微汗，则病解能食。汗出又烦躁的，服五合。恐怕一升多的，宜服六七合为妙。
【方解】甘草附子汤，就是桂枝附子汤去掉姜、枣加白术。去掉姜、枣，是担心发散太过。加白术，是燥中湿。每日三次服，初服一升，不得汗，则仍服一升，若得微汗则病解，解则能食，解已彻底，可停止再服，若汗出而复烦躁的，是解未彻底，仍当服，但不可服一升，恐已经汗出而过汗，服五合即可。如不解，再服六七合为妙。这样的服法，总是示人不可尽剂的意思，学人应当详细探求。
太阳中热者，即暍病（中暑）。汗出恶寒，身热而渴，用白虎加人参汤主治。
【注】中暑热病，也是由太阳经而入，所以说太阳中热者，即暍病。汗出恶寒，身热而渴，颇似太阳温热病，但温热病无恶寒，因为热从里生，所以虽汗出而不恶寒。中暑邪，由表而入，所以汗出恶寒。究之于脉，温热病的浮脉，浮而实，中暑的浮脉，浮而虚，因为暑热伤气。究之于渴，温热病的渴，初病不过想饮水，中暑的渴，初病即大引饮。温热病则传经，变病不一；中暑则不传经，不愈即死。虽然同为太阳经中的病，而虚实施治，自有不同。用白虎加人参汤主治的，大概是以益气为主，清暑热次之。
【集注】李的说：热伤气，气泄则汗出，气虚则恶寒，热蒸肌腠则身热，热伤津液则作渴，这种恶寒身热，与伤寒相似。然而不同的是，伤寒初起无汗不渴，中暑初起即汗出而渴。
白虎加人参汤方
知母（六两） 石膏（碎，一斤） 甘草（二两） 粳米（六合） 人参（三两）
以上五味药，用水一斗，煮米熟，汤成去渣，温服一升，每日三次。
太阳中暍，发热恶寒，身体重而疼痛，其脉弦细芤迟，小便后，洒洒然毛耸，手足逆冷，小有劳，身即热，口开，前板齿燥。如果发其汗，则恶寒更甚；加温针，则发热更甚；多次下之，则淋证更甚。
【注】这里承接上文互相详细论证证脉，不可妄行汗、下法。中暑本有汗，如果发热无汗，身重疼痛的，虽然证似伤寒，然而见弦细芤迟虚脉，则不是伤寒。且有小便后，洒洒然恶寒毛耸的状态，都是太阳膀胱表气，为暑所伤而畏缩；手足逆冷的，是暑伤气，气不能达四肢则寒；小有劳，身即发热，口开，前板齿燥的，劳则动热，暑热益烈，伤阴液。这些都是中暑危证。如果以发热无汗，恶寒身痛，误为伤寒之表，妄行发汗，则表气愈虚，恶寒更甚。如果以手足逆冷，误为阳虚，妄加温针，则暑邪愈盛，发热更炽。如果以壮热齿干，误为胃火，而多次下之，则水源竭涩，尿淋窘迫更甚。凡此之证，都是中暑，妄行汗、下、温针导致变证，用白虎加人参汤主治，或用人参汤调辰砂六一散也可以。
【集注】程林说：《内经》说：先夏至为病温，后夏至为病暑。又说：热病者，皆伤寒之类。以其太阳受病与伤寒相似，也令发热恶寒，身重而疼痛。经说：寒伤形，暑伤气。气伤则气消而脉虚弱，所以弦细芤迟。小便后毛耸的，是阳气内陷，不能卫外，手足亦逆冷。劳动则扰乎阳，故热甚，则口开，口开则前板齿燥。发汗虚其阳，则恶寒甚。温针动火邪，则发热甚。下之亡津液，则淋甚。
太阳中暍，身热疼重，而脉微弱，这是因为夏月伤冷水，水行皮中所致，用一物瓜蒂汤主治。
【注】太阳中暍的证候，身热而倦的，是暑；身热疼重的，是湿；脉微弱的，是暑伤气。以此证脉推测，乃是因夏月中暑之人，暴贪风凉，过饮冷水，水气虽输行于皮中，不得汗泻所致。此时即以香薷饮、大顺散汗之，可立愈。如果稍缓，水气既不得外泻，势必内攻于中而作喘肿胀。喘则以葶苈大枣汤，肿胀则以瓜蒂一物汤下之可也。
【集注】周扬俊说：无形之热伤其肺金，则用白虎加人参汤；有形之水伤其肺金，则用瓜蒂汤，各有所主。
[Collected Commentaries] Zhao Liang said: In this syndrome, both wind and dampness pathogens enter from the exterior, so the disease is located in the exterior; therefore, the pulse is floating (Fú, indicating an exterior condition) and there is sweating. Generally, a heavy sensation in the body can be due to flaccidity of muscles or flaccidity of bones. The heaviness here is caused by wind-dampness residing on the surface of the skin and hair, thus it does not cause pain. Due to deficiency of Wei Qi (Defensive Qi), dampness lingers causing heaviness; therefore, Huangqi (Astragali Radix) is used to consolidate the Wei Qi, assisted by Gancao (Glycyrrhizae Radix et Rhizoma); Fangji (Stephaniae Tetrandrae Radix) removes dampness, assisted by Baizhu (Atractylodis Macrocephalae Rhizoma). Then, regarding the two pathogens of wind and dampness, why are there no herbs to disperse wind? Because there is excessive sweating, it indicates that the wind pathogen has already dispersed; however, due to exterior deficiency, wind moves in and out between the pores, causing aversion to wind. By consolidating the Wei Qi, when Zheng Qi (Upright Qi) becomes strong, the wind naturally retreats; this is a method of treating without direct treatment.
You Yi said: When wind-dampness is in the exterior, the standard method is to resolve it through sweating. However, if sweat occurs spontaneously rather than being induced, and the exterior is still unresolved yet already deficient, the method of resolving via sweating cannot be rigidly adhered to. Therefore, Mahuang (Ephedrae Herba) is not used to expel pathogens from the superficial layer of skin and hair, but Fangji (Stephaniae Tetrandrae Radix) is used to drive them from the deeper layers of muscle and skin. After taking the medicine, sensations such as insects crawling under the skin or coldness below the waist like ice are signs of dampness moving downward. Without Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma), how could Wei Yang (Defensive Yang) be revitalized to drive dampness downward?
Fangji Huangqi Tang (Stephania and Astragalus Decoction) Formula
Fangji (Stephaniae Tetrandrae Radix) [1 liang], Gancao (Glycyrrhizae Radix et Rhizoma) [0.5 liang], Baizhu (Atractylodis Macrocephalae Rhizoma) [0.75 liang], Huangqi (Astragali Radix, removed rhizome) [1.1 liang].
Crush the ingredients to the size of hemp seeds. Take 5 qianbi per dose, with 4 slices of Shengjiang (Zingiberis Rhizoma Recens) and 1 Dazao (Jujubae Fructus). Add 1.5 cups of water, decoct until 0.8 cup remains, remove dregs, and take warm. Repeat after some time.
For wheezing, add Mahuang (Ephedrae Herba) [0.5 liang]. For disharmony in the stomach, add Shaoyao (Paeoniae Radix Alba) [0.3 fen]. For rising Qi, add Guizhi (Cinnamomi Ramulus) [0.3 fen]. For chronic cold below, add Xixin (Asari Radix et Rhizoma) [0.3 fen].
After taking the medicine, one should feel as if insects are crawling under the skin, and coldness below the waist like ice. Afterwards, sit on a quilt, wrap another quilt around the waist and lower body, keep warm to induce slight sweating for recovery.
When wind and dampness contend together, causing pain throughout the whole body, the standard method is resolution through sweating. If it happens during continuous rainy weather, and the physician suggests inducing sweating, but the illness does not improve after sweating, why is this? Because excessive sweating only disperses the wind pathogen while leaving the dampness behind, hence the lack of improvement. To treat wind-dampness, inducing sweating should result only in a slight, continuous perspiration, allowing both wind and dampness to be expelled.
[Annotation] When wind and dampness contend together, causing pain throughout the whole body, the standard method is resolution through sweating, but sweating must be appropriate. During periods of heavy rain and abundant dampness, forcing excessive sweating will not cure the illness because the wind disperses while the dampness remains. However, when treating wind-dampness, one must wait for clear weather to induce sweating, aiming for a slight, continuous perspiration, so that both wind and dampness are expelled, and the illness heals.
[Collected Commentaries] Xu Bin said: This passage states that wind-dampness should be resolved through sweating, but not excessively. It says that pain from contending wind-dampness originally requires sweating. During rainy weather, dampness is worse, so sweating is undoubtedly indicated. Why does it fail to heal? Wind is swift and can be driven out rapidly, whereas dampness is stagnant and must be resolved gradually. Excessive sweating is too rapid; wind leaves but dampness stays, so it fails to heal. If sweating is mild, the expulsion is slow; slowly, both wind and dampness are expelled. Since dampness in the body is sticky and hard to remove, even rapid sweating is inadvisable, let alone purgation. Thus, the previous chapter stated that purgation leads to death, whereas here it only says "does not heal," indicating improper usage rather than a mistake comparable to erroneous purgation.
After eight or nine days of Shanghan (Cold Damage), if wind and dampness contend together, causing painful restlessness in the body, inability to turn over independently, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is the primary treatment. If the stool is hard and urination is normal, remove Guizhi (Cinnamomi Ramulus) and add Baizhu (Atractylodis Macrocephalae Rhizoma) for treatment.
[Annotation] This follows the previous clause to detail the pulse and symptoms to clarify the treatment. Although this wind-dampness disease arises after eight or nine days of Shanghan (Cold Damage), the absence of vomiting and thirst indicates no interior Shanghan syndrome. A floating, deficient, and choppy pulse indicates no exterior Shanghan pulse. Floating and deficient indicate exterior deficiency and wind; choppy indicates dampness. Painful restlessness indicates wind; inability to turn indicates dampness. This is pain from contending wind-dampness, distinct from joint pain in Shanghan (Cold Damage). Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is given to warmly disperse wind-dampness and resolve it from the exterior. If the pulse is floating and excess, Mahuang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) should be used to vigorously expel wind-dampness. If a person has these symptoms, even with hard stool and normal urination, purgation is not considered because the hardness is not due to heat entering the interior, but rather dryness from wind and dispersion of dampness. Thus, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is still used. Guizhi (Cinnamomi Ramulus) is removed because hard stool and normal urination suggest avoiding further sweating to prevent fluid depletion. Baizhu (Atractylodis Macrocephalae Rhizoma) is added because body heaviness and dampness in the muscle layer require assisting Fuzi (Aconiti Lateralis Radix Praeparata) to drive water qi from the skin.
[Collected Commentaries] Cheng Lin said: Excess wind causes painful restlessness; excess dampness causes difficulty turning the body. Wind-dampness contending between Ying (Nutritive) and Wei (Defensive) levels does not affect the interior, hence no vomiting or thirst. Floating pulse indicates wind; choppy indicates dampness. Since the pulse is near deficient, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is used to warm the meridians and disperse wind-dampness. Normal urination implies hard stool; Guizhi (Cinnamomi Ramulus) tends to release the muscle layer, fearing excessive sweating, so it is removed. Baizhu (Atractylodis Macrocephalae Rhizoma) removes dampness in the muscles without affecting the interior, so it is added. Phenomena described in formulas such as feeling like insects, intoxication, or dizziness occur as the medicinal force acts.
Zhou Yangjun said: Eight or nine days of Shanghan (Cold Damage) is long. If it does not transmit to other meridians nor enter the fu organs, it is because wind-dampness persists. The external symptom of painful restlessness is wind; inability to turn is dampness; no vomiting or thirst means no interior syndrome. The floating, deficient, and choppy pulse corresponds accordingly. Thus, we know the wind-dampness pathogen is in the muscles, not the sinews/joints, so Guizhi (Cinnamomi Ramulus) is used to release the exterior. Lack of fever indicates inherent Yang deficiency, so Fuzi (Aconiti Lateralis Radix Praeparata) is used to drive out dampness. Combined, they cannot remain.
Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) Formula
Guizhi (Cinnamomi Ramulus, bark removed) [4 liang], Fuzi (Aconiti Lateralis Radix Praeparata, processed, peeled, broken into 8 pieces) [3 pieces], Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) [2 liang], Shengjiang (Zingiberis Rhizoma Recens, sliced) [3 liang], Dazao (Jujubae Fructus, torn open) [12 pieces].
These five ingredients are boiled in 6 sheng of water until 2 sheng remains. Remove dregs and divide into three warm doses.
Baizhu Fuzi Tang (Atractylodes and Aconite Decoction) Formula
Baizhu (Atractylodis Macrocephalae Rhizoma) [2 liang], Fuzi (Aconiti Lateralis Radix Praeparata, processed, peeled) [1.5 pieces], Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) [1 liang], Shengjiang (Zingiberis Rhizoma Recens, sliced) [1.5 liang], Dazao (Jujubae Fructus, torn open) [6 pieces].
These five ingredients are boiled in 3 sheng of water until 1 sheng remains. Remove dregs and divide into three warm doses. After the first dose, if numbness is felt in the body, take the second dose after half a day. After all three doses, if the patient feels dizzy, do not be alarmed; this is because Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) move together in the skin to drive out water qi which has not yet been fully eliminated.
When wind and dampness contend together, causing painful restlessness in the joints, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, dysuria, aversion to wind with reluctance to remove clothes, or slight edema, Gancao Fuzi Tang (Licorice and Aconite Decoction) is the primary treatment.
[Annotation] When wind and dampness contend together, causing painful heaviness and inability to turn, dampness exceeds wind. Now, pulling pain preventing flexion and extension indicates wind exceeds dampness. Pulling pain, severe pain on touch, sweating, shortness of breath, and aversion to wind indicate excess wind pathogen obstruction. Dysuria indicates internal accumulation of dampness. Slight edema indicates external contention of dampness. Gancao Fuzi Tang (Licorice and Aconite Decoction) induces slight sweating, primarily dispelling wind and secondarily removing dampness. These two clauses detail the meaning of wind-dampness to clarify its treatment.
Gancao Fuzi Tang (Licorice and Aconite Decoction) Formula
Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) [2 liang], Fuzi (Aconiti Lateralis Radix Praeparata, processed, peeled) [2 pieces], Baizhu (Atractylodis Macrocephalae Rhizoma) [2 liang], Guizhi (Cinnamomi Ramulus, bark removed) [4 liang].
These four ingredients are boiled in 6 sheng of water until 3 sheng remains. Remove dregs, take 1 sheng warm, three times daily. After the first dose, if slight sweating occurs, the condition resolves and appetite returns. If sweating recurs with irritability, take 0.5 sheng. If 1 sheng is feared to be too much, taking 0.6-0.7 sheng is optimal.
[Formula Analysis] Gancao Fuzi Tang (Licorice and Aconite Decoction) is Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) minus Jiang (Zingiberis Rhizoma Recens) and Zao (Jujubae Fructus), plus Baizhu (Atractylodis Macrocephalae Rhizoma). Jiang and Zao are removed to fear excessive dispersion. Baizhu is added to dry middle dampness. Taking three times daily, start with 1 sheng; if no sweat, take another 1 sheng. If slight sweat occurs, the condition resolves and appetite returns, indicating complete resolution; stop further doses. If sweating recurs with irritability, resolution is incomplete, continue dosing, but avoid 1 sheng to prevent excessive sweating; 0.5 sheng is sufficient. If unresolved, 0.6-0.7 sheng is optimal. This dosing method illustrates that one should not consume the entire dose at once; students should study this carefully.
Taiyang Zhongre (Heat Stroke in Taiyang Meridian), also known as Ye (Heat Stroke), presents with sweating, aversion to cold, fever, and thirst. Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is the primary treatment.
[Annotation] Heat stroke disease enters via the Taiyang meridian, hence called Taiyang Zhongre (Heat Stroke in Taiyang Meridian), i.e., Ye (Heat Stroke). Sweating, aversion to cold, fever, and thirst resemble Taiyang Warmth Disease, but Warmth Disease lacks aversion to cold because heat originates from within, so although there is sweating, there is no aversion to cold. Ye (Heat Stroke) pathogen enters from the exterior, hence sweating and aversion to cold. Regarding the pulse, Warmth Disease has a floating, excess pulse; Ye (Heat Stroke) has a floating, deficient pulse because summer heat damages Qi. Regarding thirst, Warmth Disease involves only desire to drink initially; Ye (Heat Stroke) involves intense drinking immediately. Warmth Disease transmits through meridians with varied changes; Ye (Heat Stroke) does not transmit and is fatal if not cured. Although both are diseases of the Taiyang meridian, their deficiency and excess require different treatments. Baihu Juen Tang (White Tiger plus Ginseng Decoction) is used primarily to tonify Qi and secondarily to clear summer heat.
[Collected Commentaries] Li Gao said: Heat damages Qi; Qi leakage causes sweating; Qi deficiency causes aversion to cold; heat steaming muscle and pores causes fever; heat damaging fluids causes thirst. This aversion to cold and fever resembles Shanghan (Cold Damage). The difference is that Shanghan (Cold Damage) begins without sweating or thirst, whereas Ye (Heat Stroke) begins with sweating and thirst.
Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) Formula
Zhimu (Anemarrhenae Rhizoma) [6 liang], Shigao (Gypsum Fibrosum, crushed) [1 jin], Gancao (Glycyrrhizae Radix et Rhizoma) [2 liang], Jingmi (Oryza Sativa Germen) [6 he], Renshen (Ginseng Radix et Rhizoma) [3 liang].
These five ingredients are boiled in 1 dou of water until the rice is cooked. Remove dregs, take 1 sheng warm, three times daily.
Taiyang Zhongshu (Summerheat Stroke in Taiyang Meridian) presents with fever, aversion to cold, heaviness, and pain. The pulse is string-taut, fine, hollow, and slow. After urination, there is chills and piloerection. The hands and feet are cold. Upon slight exertion, the body heats up, the mouth opens, and the front teeth become dry. If sweating is induced, aversion to cold worsens; if moxibustion/needling with heat is applied, fever worsens; if purgation is repeated, strangury worsens.
[Annotation] This elaborates on the pulse and symptoms from the previous text, warning against reckless sweating or purgation. Summerheat stroke typically involves sweating. If there is fever without sweating, heaviness, and pain, resembling Shanghan (Cold Damage), the presence of string-taut, fine, hollow, and slow deficient pulses indicates it is not Shanghan (Cold Damage). Additionally, chills and piloerection after urination indicate the Taiyang Bladder exterior Qi is damaged by summerheat and fearful. Cold hands and feet indicate summerheat damages Qi, preventing it from reaching the limbs. Slight exertion causing fever, open mouth, and dry front teeth indicates exertion stirs heat, intensifying summerheat damage to Yin fluids. These are critical signs of summerheat stroke. Mistaking fever without sweating and aversion to cold/pain for exterior Shanghan (Cold Damage) and inducing sweating will further weaken exterior Qi, worsening aversion to cold. Mistaking cold hands and feet for Yang deficiency and applying heat needling will intensify summerheat pathogen, worsening fever. Mistaking high fever and dry teeth for Stomach fire and repeatedly purging will deplete water source fluids, worsening strangury. All these conditions result from errors in treating summerheat stroke with sweating, purgation, or heat needling. Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is the primary treatment, or Ren Shen Tang (Ginseng Decoction) mixed with Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) may also be used.
[Collected Commentaries] Cheng Lin said: The Neijing states: Diseases before Summer Solstice are Warmth; after Summer Solstice are Summerheat. Also: Heat diseases belong to the category of Shanghan (Cold Damage). Because Taiyang involvement resembles Shanghan (Cold Damage), it causes fever, aversion to cold, heaviness, and pain. The classics state: Cold damages the form; Summerheat damages Qi. Qi damage leads to Qi consumption and weak pulses, hence string-taut, fine, hollow, and slow. Piloerection after urination indicates Yang Qi sinking inward, unable to protect the exterior, leading to cold extremities. Exertion disturbs Yang, causing intense heat, open mouth, and dry front teeth. Sweating damages Yang, worsening aversion to cold. Heat needling stirs Fire Evil, worsening fever. Purgation destroys fluids, worsening strangury.
Taiyang Zhongshu (Summerheat Stroke in Taiyang Meridian) presenting with fever, body ache and heaviness, and a weak pulse is caused by injuring cold water in summer, with water qi circulating in the skin. Yiwu Gudi Tang (Single Ingredient Melon Seed Decoction) is the primary treatment.
[Annotation] In Taiyang Zhongshu (Summerheat Stroke in Taiyang Meridian), fever with fatigue indicates Summerheat; fever with body ache and heaviness indicates Dampness; weak pulse indicates Summerheat damaging Qi. Based on these symptoms and pulse, this condition arises when a person suffering from summerheat in summer greedily seeks coolness and drinks excessive cold water. Water qi circulates in the skin but cannot be excreted through sweating. At this time, Xiangru Yin (Elsholtzia Decoction) or Da Shun San (Great Harmony Powder) can induce sweating for immediate cure. If delayed, water qi cannot exit externally and will attack internally, causing wheezing and edema. Wheezing is treated with Tingli Dazao Tang (Descurainia Seed and Jujube Decoction); edema is treated with Yiwu Gudi Tang (Single Ingredient Melon Seed Decoction) to purge.
[Collected Commentaries] Zhou Yangjun said: Formless heat damaging Lung Metal uses Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction); formed water damaging Lung Metal uses Gudi Tang (Melon Seed Decoction); each has its specific indication.
Li Gao said: Summerheat pathogen in the exterior causes fever. Injury from cold water causes body ache. Summerheat damages Qi, causing Qi deficiency and weak pulse. Gudi (Momordicae Fructus) treats edema of face, body, and limbs, dissipating water qi in the skin through bitter drainage.
Yiwu Gudi Tang (Single Ingredient Melon Seed Decoction) Formula
Gudi (Momordicae Fructus) [20 pieces].
Crush the ingredient, boil in 1 sheng of water until 0.5 sheng remains. Remove dregs and take in one dose.