小儿素灵慧。忽目迟而神机阻滞者。 。
病患身不热。时反弓。或抽掣而厥。卒口噤。不得出声者。当归四逆汤主之。惊者加龙骨、牡蛎。乳食急不到口
者。膻中干热而烦悸故也。当归四逆合黄连阿胶汤主之。（以上方。俱见伤寒论。）
病。小便色白。厥不止者。死。
十三条 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。
太阳病。详已见。二经交通之处为关。两骨相续之处为节。关节者。人之坎泽也。故湿气多入于此。湿气入关
节。则气血滞而不利。故疼痛。烦者。郁湿化热之应也。沉为在里。细为阳虚。人身惟阳气充足。则湿不能伤。今
在里之阳虚。则关节烦疼。明系湿邪滞其气血。而太阳之头痛发热等症。又明系湿邪化热。上冲经表之候。
故知为湿痹也。痹者卑也。湿着关节。有不能举动之义。故曰湿痹。里阳既虚。则不能分布水气。故小便不利。
关节之湿气。内淫肠胃。故大便反快也。利其小便。则湿去而关节疼痛等症自止矣。
十四条 湿家之为病。一身尽疼。发热。身色如熏黄也。
凡言家者。俱指夙病。如酒家、风家、亡血家之类。上条是初病湿。此系湿久而成家者。故曰湿家也。湿流关节。
故初病则关节烦疼。湿久化热。而热充经表。故一身尽疼而发热也。黄为土色。身色如熏黄者。湿热伤脾。在
上之汗孔不疏。在下之小便不利。故蒸其湿土之色于外也。
十五条 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。胸上有寒。渴欲得水而不能饮。则口燥烦也。
湿家。已见头汗出者。湿热上冲。而蒸其气血于上之义。背强者。湿持经表而不得汗也。欲覆被且欲向火者。
太阳被伤之本症也。湿家俱阳气不足。故不能以汗送湿。若更以寒药下之。则元阳更虚。而真呼于中道自
伏。故哕。胸为阳气之署。阳气以寒下而虚馁。则下阴上乘阳位。故胸满也。小便不利者。气机夺于后阴之下
故也。舌苔、当指白苔而滑者。丹田以湿化之热在下。胸中以攻药之寒在上。下热、故渴欲得水而口烦燥。上
寒、故不能饮也。此条言湿家误下之小逆如此。条中下早早字。疑是衍文。以湿家前后禁下故也。
十六条 湿家下之。额上汗出。微喘。小便利者死。若下利不止者亦死。
湿家化热上冲。症见头汗微喘者常也。但在下之之后。则逆矣。盖下之则里空。而在上之阳液阳气。理当下
陷。今阳液反上而额上汗出。阳气反上而微喘。故逆也。小便利。亦湿家去湿之一路。特见于误下而额汗微
喘之后。则逆甚矣。盖下后则液夺于后阴。小便之不当利者。一也。额汗微喘。气机已经上浮。而不应下送。此
小便之不当利者。二也。兼见、则上脱下绝之势已成。而中无所蕴。故主死也。下利不止。当承微喘以上等句。
盖谓下后而前症具。纵小便不利。若大便下利不止者。亦死。言与小便利者。同为下绝也。此条言湿家误下
之大逆、又如此。
十七条 风湿相搏。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。
风湿。即后文第八条。所谓汗出当风者是也。盖津液已离经络。化而为汗。即如天地氤氲之气。已化成雨之
象。雨着地而为水。与汗伏皮而为湿。同一义也。汗出当风。汗之将出未出者。即便伏住。加之汗出而毛窍已
开。风邪袭其玄府。则风与不出之汗相搏矣。不必中风而复中湿之谓也。久伤取冷。亦能落汗。汗客为湿。湿
生热。热生风。此虽湿风。亦可名为风湿。故八条并及之。后凡言风湿者俱仿此。无着处、而烦热者曰疼。是为
风因。有着处而沉滞者曰痛。是为湿因。若单湿化热以生风。则疼痛亦有时而互见者。一身、指手足太阳之
部而言。湿从当风而汗不出。故其法仍宜出汗以解湿。并解其风也。阴雨不止。是天地湿胜之时。乘此而以
汗去湿。是腾一内湿之空。而仍为外湿入之之地也。况汗大而不得其法乎。其不能尽解宜也。盖风性轻浮。
理或可以骤泄。湿性凝滞。势必燥于熏蒸。此汗大而愈风不愈湿之道也。故治风湿者。乘晴明之日。已应天
地之燥化。又微微似汗。则得熏蒸之法。而湿自去。湿去而风亦与之俱去者。湿本而风标故也。意者主桂枝
加术汤乎。抑即八条之麻杏薏甘。或九条之防 加桂汤耶。
十八条 湿家。病身疼。发热。面黄而喘。头痛。鼻塞而烦。其脉大。自能饮食。腹中和。无病。
病在头中寒湿。故鼻塞。纳药鼻中。则愈。
此条当是裹湿枕湿。而湿中于头之症。故无事于发汗。及利小便。但纳药鼻中。使湿从嚏涕而出也。身、指太
阳之夹脊而言。身疼痛者。湿中于头。湿性将下流。而太阳之经气阻滞也。发热者。湿虽在头。然已阻滞其经
气。皮毛为经气之合。郁湿化热。故发热也。面黄者。阳气不充之应。若面色红而不黄。则阳气力能蒸湿外解。
而身疼发热。便不得谓之湿因矣。喘者。湿滞太阳之皮毛。皮毛内合肺窍。而不能通畅也。头痛者。太阳之经。
上聚于头。今为湿所把持而闷冒也。鼻塞者。湿滞气机。即上文喘症之义。烦亦单指鼻而言。盖谓鼻因塞而
烦热也。脉大者。湿持其上。太阳之经气。欲浮不得。而闷为旁鼓之象。自能饮食六句。谓湿在头而腹中无病。
若发汗及利小便。则徒伤中下二焦之气。是反招头上之湿。使之下流也。岂如纳药鼻中。因涕以去其湿。得
高者越之之旨乎。不列方者。或失之耶。王氏谓宜瓜蒂散为细末。如大豆许。缩入、则出黄水。夫瓜蒂入鼻以
出黄水。未验。且云忌吹。当令缩入。似与本文纳字之旨有碍。附录鼻渊一方。凡头痛鼻塞。而稠黄浊涕不
止者。用鹅不食草一味。干为细末。纳鼻中少许。令嚏出秽物。数次则愈。虽非汉时古方。而鼻渊一症。颇似久
湿在头。而化为风热之候。用此甚神。故并记之。以资同志者之会悟云。
十九条 湿家。身烦疼。可与麻黄加术汤。发其汗为宜。慎不可以火攻之。
麻黄加术汤方
麻黄（二两去节） 桂枝（二两去皮） 杏仁（七十个去皮尖） 白术（四两） 甘草（一两炙）
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。去渣。温服八合。覆取微似汗。
天地当五六月时。地气上浮。阶潮础润。不得天气泄而为雨。则燥蒸郁冒者。湿之象也。天地之燥蒸郁冒解
于雨。与人身之烦疼解于汗。其理同也。外火攻之。则经络关节之湿。因火逼而内入于脏腑矣。此洒物之湿
聚于下。蒸物之气浮于上之义也。主麻黄加术汤者。湿气能塞毛窍。故湿家每皆无汗。用麻黄者。所以疏卫
表之云翳也。桂枝善行营气。得东方风木之正。所谓风以燥之也。五脏惟肺最恶湿。且其脏与皮毛相合。故
皮毛受湿。肺管先为之不利。加杏仁者。所以通肺窍也。白术性温。与甘草同用。则善理脾胃土气。土得甘温。
则蒸湿于上而为汗。此治外湿之正药也。
二十条 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。
麻黄杏仁薏苡甘草汤方
麻黄（半两去节汤泡） 杏仁（十个去皮尖炒） 薏苡仁（半两） 甘草（一两炙）
上锉麻豆大。每服四钱匕。水一盏。煮八分。去滓。温服。有微汗。避风。
病者。即湿病也。一身尽疼、发热。详已见。日晡为阳明经气之旺时。有自振以推湿出表之势。而湿邪不受其
驱逐。遂相持于太阳阳明之界。故剧也。风湿三句。见本篇五条注。主麻杏薏甘汤者。甘草属土。为内主脾胃。
外主肌肉之药。以之为君。盖欲其由脾胃以达肌肉之意。薏苡甘温。善燥中土。且趁甘草浮缓之性。则能从
下从里。而熏蒸其湿于在上在表也。杏仁通利肺窍。以引其机。为薏甘熏蒸之接应。麻黄发越毛孔。以开滞
郁之障。譬之驱贼。薏甘为内室之传呼。杏仁为中途之援引。麻黄直开大门以放其去路耳。与前条麻黄加
术汤同意。特其制之大小略殊。并少桂枝一层症候而已。上条曰湿家。则为病既久。非小剂可愈者。故大其
制。此条曰病者。则其湿尚浅。故不必用大剂。以过伤其气。且麻黄加泡。杏仁加炒。止用其轻清之气。而已足
矣。又本条较前条。多日晡而剧一症。日晡而剧。为肌肉当王时。而有自振之气。则营分尚未受湿。故不必用
桂枝也。
二十一条 风湿。脉浮身重。汗出恶风者。防己黄 汤主之。
防己黄 汤方
防己（一两） 黄 （一两一分去芦） 白术（七钱半） 甘草（一两）
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。
此条。病则双名风湿。症则颇似单风。汤意却又全治单湿。仲景心细如发。学人透得此关。则入木三分矣。盖
汗出当风。是汗郁于风而成湿。如上条所云。故曰风湿。则风湿之病。湿为本而风为标矣。夫郁湿化热。湿热
与虚阳相并于外。故脉见浮。虚阳外并。则阴无健主。而坤呈地象。故身重。脉浮身重。系虚阳为湿热熏蒸。故
汗出。汗出。则毛窍疏洞。故恶风也。湿家必由汗解。汗出而湿自去者。常也。今脉浮、身重、恶寒如故。则知汗出。
为虚阳自越。而湿邪自在也。湿邪自在。故主防术甘草以燥之。虚阳自越。故君黄 以敛之耳。双言风湿者。
兼及其标也。脉症颇似单风者。中标之病也。单治湿邪者。专责其本也。按四分为一两。一分当是二钱半。
方中黄 一两一分。为一两二钱五分也。方后加减之三分。即正方白术之七钱半。以铢数计之。一分得六
铢。古人以二十四铢为一两也。后仿此。五钱匕。谓以一钱之匕首。五抄其药也。喘为湿邪伤肺。而肺窍不
利之应。故加麻黄以发之。胃不和者。湿气滞脾。能使胃中 胀。或雷鸣溏泄之类。芍药酸敛。下行入脏。能引
防术温燥之性。下入脾中。使之温中以燥土。故加之。气上冲者。胸中阳气虚馁。而下气乘上之应。桂枝甘温。
能填胸分之阳。故加之。细辛辛温而香细。善达下焦气分。寒能召湿。陈寒者必积湿。加此者。亦犹加芍药之
义也。如虫行。言上身。如冰。言下体。坐被绕被。总以温暖为熏蒸去湿之法耳。微汗瘥。当兼小便言。盖腰上之
湿解于汗。腰下之湿解于小便利。故也。
二十二条 伤寒八九日。风湿相搏。身体烦疼。不能自转侧。不呕。不渴。脉浮虚而涩者。桂枝附子汤主之。
若（伤寒论多其人二字）大便坚。小便自利者。去桂（伤寒论多枝字）加白术汤主之。
桂枝附子汤方
桂枝（四两去皮） 甘草（二两炙） 生姜（三两切） 大枣（十二枚劈） 附子（三枚炮去皮切八片）
上五味。以水三升。煮取一升。去滓。分温三服。（伤寒作水六升。煮二升。以后方诸药减半之水数计之。则
此方之三升一升。恐为错误。当从伤寒为是。）
白术附子汤方
白术（二两） 附子（一枚半炮去皮） 甘草（一两炙） 生姜（一两半切） 大枣（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。
此条头一症。系风寒兼湿。第二症。系单寒兼湿。然俱在太阳经表。而不干腑脏者也。身体指躯壳而言。烦疼
为热因。以风为阳热。寒湿二邪。俱能化热故也。阳主健用。湿主沉滞。阳虚而湿邪中之。沉滞而失其健用。故
不能转侧也。不呕者。内无寒也。不渴者。里无热也。盖谓伤寒至八九日。已过六七日自愈之期。即宜见表邪
入里之候。乃外不见解。里不见传。加之脉浮为在表。浮而且虚。则虚从浮断。是为表无阳气。更兼涩脉。涩为
湿诊。明系表阳虚微。不能送邪出表。以致湿与风寒相搏。故日久不解。而亦不传也。是则表阳虚微。为病之
本。风寒与湿。为病之标。故君附子至三枚者。一以温阳。一以散寒。一以驱湿也。加于桂枝汤中者。桂枝行营
卫之气。风从汗解。而寒湿亦与之俱去矣。独去芍药者。以为在经表。不欲其酸敛也。下文三句。紧顶伤寒八
九日六句。犹言前症具而脉既如此之人。若大便坚硬。又为寒燥津液。如水冻冰之象。平脉所谓阴结者。是
也。小便自利。为肺与小肠。气微而不能提守之应。桂枝行津泄气。故去之。白术苦温。能滋脾胃肌肉之阳液。
以消客湿。故加之。冒者。躯壳浮虚散大之貌。详伤寒注。减诸药于前方之半者。前方注意在汗。犹之以风雨
小儿原本聪明伶俐，突然眼神呆滞、神志活动受阻的。
病人身体不发热，时而身体反张后仰，或者出现抽搐并四肢厥冷，突然牙关紧闭，不能发出声音的，用当归四逆汤主治。伴有惊悸症状的，加龙骨、牡蛎。乳食急迫却吃不下东西的，是因为膻中部位干燥有热而心烦心悸，用当归四逆汤合黄连阿胶汤主治。（以上方剂，均见于《伤寒论》。）
患病期间，小便颜色发白，四肢厥冷不止的，预后不良，属死证。
第十三条 太阳病，关节疼痛且伴有心烦，脉象沉而细的，这叫做湿痹。湿痹的表现，是小便不通利，大便反而稀溏快利，治疗应当通利小便。
太阳病，详情已在前面论述过。两经交通的地方称为“关”，两块骨头连接的地方称为“节”。关节，是人体的“坎泽”（喻指阴寒湿气聚集之处）。所以湿气容易侵入这里。湿气进入关节，气血就会停滞而不通畅，因此产生疼痛。心烦，是郁结的湿气化热的反应。脉沉表示病在里，脉细表示阳气虚弱。人体只有阳气充足，湿气才不能伤害身体。现在体内阳气虚弱，所以关节烦痛，这明显是湿邪阻滞了气血；而太阳病的头痛、发热等症状，又明显是湿邪化热，向上冲犯经络体表的征候。因此知道这是湿痹。痹，就是卑下之意，湿气附着在关节，有不能活动的含义，所以叫湿痹。里阳既然虚弱，就不能布散水气，所以小便不利。关节的湿气，向内浸淫肠胃，所以大便反而稀溏快利。通利小便，湿气去除，关节疼痛等症状自然停止。
第十四条 素有湿病的患者，全身都疼痛，发热，身体颜色像被烟熏过的黄色。
凡是说“家”的，都指宿疾，如酒家、风家、亡血家等。上一条是初患湿病，这一条是湿邪久留而成宿疾，所以叫湿家。湿气流注关节，所以初病时关节烦痛。湿气久了化热，热气充斥经络体表，所以全身都疼痛且发热。黄是土的颜色。身体颜色像熏黄，是湿热损伤脾脏，上部的汗孔不开泄，下部的小便不通利，所以将湿土的颜色蒸腾到体表。
第十五条 素有湿病的患者，只有头部出汗，背部僵硬，想要盖被子，想要靠近火源。如果过早使用泻下法，就会出现呃逆，或者胸满，小便不利，舌面上像有一层苔的情况。这是因为丹田（下焦）有热，胸中有寒，口渴想喝水却喝不下去，所以口燥心烦。
素有湿病的患者，已经见到头汗出，这是湿热向上冲逆，蒸腾气血于上的意思。背强，是湿气束缚经络体表而不能发汗。想要盖被子并且想要靠近火源，是太阳经受伤的本来症状。湿病患者都阳气不足，所以不能通过发汗来排出湿气。如果再使用寒凉药泻下，元气之阳更加虚弱，真气在中道潜伏，所以出现呃逆。胸是阳气驻守的地方，阳气因为寒凉泻下而虚损，那么下部的阴气上乘占据阳位，所以胸满。小便不利，是因为气机被夺于后阴之下。舌苔，应当指白滑苔。丹田因湿所化的热在下，胸部因攻下药产生的寒在上，下热所以口渴想喝水而口烦躁，上寒所以不能饮水。这条讲湿病患者误用下法的小逆证。条文中的“早”字，怀疑是衍文，因为湿病患者前后都禁忌使用下法。
第十六条 湿病患者误用下法，额头出汗，轻微气喘，小便通利的，属死证。如果腹泻不止的，也属死证。
湿病患者化热向上冲逆，症见头汗、微喘是常见情况。但在误用下法之后，就变成逆证了。因为下法导致里虚，而在上的阳液和阳气，按理应该下陷。现在阳液反而上行导致额头出汗，阳气反而上行导致微喘，所以是逆证。小便通利，也是湿病患者排湿的途径之一，但出现在误用下法且额头出汗、微喘之后，则逆乱非常严重。因为下法之后，津液被夺于后阴，小便本不应该通利，这是一点。额头出汗、微喘，气机已经上浮，不应当再向下送，这是小便本不该通利的第二点。同时出现，说明上脱下绝的形势已经形成，中间无所蕴蓄，所以主死证。腹泻不止，应当承接微喘以上的句子。意思是下法之后前面的症状具备，即使小便不通利，如果大便腹泻不止，也是死证。说与小便通利一样，都是下元竭绝。这条讲湿病患者误用下法的大逆证，又是如此。
第十七条 风湿相互搏结，全身都疼痛，按照治法应当发汗而解。正值天下阴雨不停，医生说，这可以发汗。发汗后病没有痊愈，为什么呢？因为发汗，汗出太多，只去了风气，湿气还在，所以不愈。如果要治疗风湿，发汗时，只要微微似要出汗的样子，风湿就能一起去除。
风湿，即后文第八条所说的“汗出当风”。津液已经离开经络，化为汗，就像天地氤氲之气，已经化成雨的样子。雨落在地上成为水，与汗伏在皮肤成为湿，意义相同。出汗时受风，汗将要出未出的时候，就被风邪伏住。加上出汗时毛孔已开，风邪袭击玄府（汗孔），风与不出来的汗相互搏结。不一定是既中风又中湿的意思。长久贪凉，也能导致落汗（汗出不畅）。汗客变为湿，湿生热，热生风。这虽然是湿风，也可以名为风湿。所以第八条一并提及。后面凡是提到风湿的都仿照此例。没有固定处所而烦热的叫疼，这是风的成因；有固定处所而沉滞的叫痛，这是湿的成因。如果单纯湿化热而生风，那么疼和痛有时也会交替出现。“一身”，指手足太阳经的部位。湿气随着出汗当风而汗不出，所以治法仍宜出汗以解湿，并解其风。阴雨不止，是天地湿气旺盛的时候，趁着这个时候用汗法去湿，是腾出一个内部湿气空虚的地方，而仍然成为外部湿气进入的地方。何况大汗出又不符合治法呢？它不能完全解除是应该的。风性轻浮，理论上或许可以骤然发泄；湿性凝滞，势必需要燥热熏蒸才能去除。这就是大汗能愈风但不能愈湿的道理。所以治疗风湿，应趁晴天明朗的日子，顺应天地的燥化，微微似汗，得到熏蒸的方法，湿气自然去除。湿气去除，风也随之而去，因为湿是本，风是标。推测可能是桂枝加术汤吗？或者是第八条的麻杏薏甘汤，还是第九条的防己加桂汤呢？
第十八条 湿病患者，身体疼痛，发热，面色黄且气喘，头痛，鼻塞且心烦，脉象大，自己能饮食，腹部平和，无病。
病在头部寒湿，所以鼻塞。将药物纳入鼻中，就能痊愈。
这一条应该是裹湿、枕湿，湿气侵袭头部的症状。所以不需要发汗及利小便，只需将药物纳入鼻中，使湿气从喷嚏和鼻涕中排出。身，指太阳经夹脊的部位。身体疼痛，是湿气侵袭头部，湿性向下流，导致太阳经气阻滞。发热，是湿气虽然在头部，但已经阻滞了经气，皮毛是经气的合部，郁结的湿气化热，所以发热。面黄，是阳气不充的反应。如果面色红而不黄，则阳气有力能蒸湿外解，身体疼痛发热就不能说是湿引起的。气喘，是湿气阻滞太阳经的皮毛，皮毛内合肺窍，不能通畅。头痛，是太阳经气上聚于头，现在被湿气把持而闷胀昏冒。鼻塞，是湿气阻滞气机，即上文气喘症的含义。心烦也单指鼻子而言，意思是鼻子因堵塞而烦热。脉大，是湿气占据上部，太阳经气欲浮而不能，闷胀旁鼓的现象。“自能饮食”六句，是说湿在头部而腹中没有病。如果发汗及利小便，则会徒然损伤中下二焦的气，反而招致头上的湿气向下流。哪里比得上纳药鼻中，借着涕液排出湿气，符合“高者越之”的宗旨呢？不列出方剂，或许是失传了吧。王氏认为应用瓜蒂散研成细末，如大豆大小，塞入鼻孔，就会流出黄水。用瓜蒂入鼻引出黄水，未经验证，而且说忌讳吹入，应当令其塞入，似乎与本文“纳”字的宗旨有抵触。附录一个治疗鼻渊的方子：凡是头痛鼻塞，稠黄浊涕不止的，用鹅不食草一味，晒干研为细末，纳入鼻中少许，令其打出喷嚏排出秽物，数次即可痊愈。虽然不是汉代的古方，但鼻渊一症，颇似久湿在头部化为风热的证候，使用此方很灵验，所以一并记录，以供志同道合者领悟。
第十九条 湿病患者，身体烦痛，可以用麻黄加术汤，发汗为宜。千万不要用火攻法。
麻黄加术汤方
麻黄（二两，去节） 桂枝（二两，去皮） 杏仁（七十枚，去皮尖） 白术（四两） 甘草（一两，炙）
以上五味药，用水九升，先煮麻黄，减少二升，去掉上面的沫，加入其他药物，煮取二升半，去渣，温服八合，覆盖衣被使微微似有汗出。
天地在五六月时，地气上浮，台阶潮湿，础石湿润，如果没有天气宣泄成为雨，那么燥热蒸郁闷冒，就是湿的征象。天地间的燥热蒸郁闷冒通过雨来解除，与人身体的烦痛通过汗来解除，道理是一样的。外部用火攻，经络关节的湿气，会因为火的逼迫而内入脏腑。这是洒物之湿聚于下，蒸物之气浮于上的道理。主治麻黄加术汤，是因为湿气能堵塞毛窍，所以湿病患者通常都没有汗。用麻黄，是为了疏解卫表的云翳。桂枝善于运行营气，得东方风木的正气，所谓“风以燥之”。五脏中肺最厌恶湿气，且肺脏与皮毛相合，所以皮毛受湿，肺管首先变得不利。加杏仁，是为了通利肺窍。白术性温，与甘草同用，善于调理脾胃土气。土得甘温，就能在上蒸湿为汗。这是治疗外湿的正药。
第二十条 病人，全身都疼痛，发热，傍晚时分加剧的，名叫风湿。这个病是由于出汗当风，或长久贪凉所致。
可以用麻黄杏仁薏苡甘草汤。
麻黄杏仁薏苡甘草汤方
麻黄（半两，去节，汤泡） 杏仁（十个，去皮尖，炒） 薏苡仁（半两） 甘草（一两，炙）
以上锉碎如麻豆大，每次服四钱匕，水一盏，煮至八分，去渣，温服。要有微汗，避风。
病人，就是湿病。全身疼痛、发热，详情已在前面论述。日晡（下午3-5点）是阳明经气旺盛的时候，有自身振奋以推湿出表的趋势，但湿邪不接受驱逐，于是相持在太阳阳明之间，所以加剧。风湿三句，见本篇第五条注释。主治麻杏薏甘汤，甘草属土，是内主脾胃、外主肌肉的药，用它做君药，大概是希望它由脾胃到达肌肉的意思。薏苡仁甘温，善于燥中土，且趁着甘草浮缓的性质，就能从下从里，熏蒸湿气于在上在表。杏仁通利肺窍，以引导气机，作为薏甘熏蒸的接应。麻黄发越毛孔，以打开滞郁的障碍。譬如驱贼，薏甘是内室的传呼，杏仁是中途的援引，麻黄直开大门放其去路。与前条麻黄加术汤意旨相同，只是制剂大小略有不同，并少了一层桂枝的症候。前条说“湿家”，则是病已久，非小剂可愈，所以加大制剂。此条说“病者”，则湿气尚浅，所以不必用大剂，以免过度伤气。且麻黄用汤泡，杏仁用炒，只用其轻清之气，就已经足够了。另外本条较前条，多了一个“日晡而剧”的症状。日晡而剧，是肌肉当旺时，有自振之气，则营分尚未受湿，所以不必用桂枝。
防己黄芪汤方
防己（一两） 黄芪（一两一分，去芦） 白术（七钱半） 甘草（一两）
以上锉碎如麻豆大，每次抄五钱匕，生姜四片，大枣一枚，水盏半，煎至八分，去渣，温服。隔一段时间再服。喘的，加麻黄半两。胃不和的，加芍药三分。气上冲的，加桂枝三分。下有陈寒的，加细辛三分。服后应当感觉像虫子在皮中行，腰部以下像冰一样冷。后来坐在被子上，再用一条被子绕腰以下，温暖令微微出汗，病愈。
这一条，病名双称风湿，症状颇似单风，汤意却又全治单湿。仲景心思细腻如发，学者透得此关，则入木三分。大概出汗当风，是汗郁于风而成湿，如上条所说。所以叫风湿，则风湿之病，湿是本而风是标。郁湿化热，湿热与虚阳相并于外，所以脉见浮。虚阳外并，则阴无健主，而坤呈地象，所以身重。脉浮身重，是虚阳为湿热熏蒸，所以汗出。汗出，则毛窍疏洞，所以恶风。湿病患者必由汗解，汗出而湿自去，是常理。现在脉浮、身重、恶寒如故，则知汗出是虚阳自越，而湿邪自在。湿邪自在，所以主防己、白术、甘草以燥之。虚阳自越，所以用黄芪为君以敛之。双言风湿，是兼及其标。脉症颇似单风，是中标的病。单治湿邪，是专责其本。按四分为一两，一分当是二钱半。方中黄芪一两一分，是一两二钱五分。方后加减的三分，即正方白术的七钱半，以铢数计，一分得六铢，古人以二十四铢为一两。后面仿照此例。五钱匕，谓用一钱的匕首形勺子，五勺取药。喘是湿邪伤肺，而肺窍不利的反应，所以加麻黄以发之。胃不和，是湿气滞脾，能使胃中胀满，或雷鸣溏泄之类。芍药酸敛，下行入脏，能引防己、白术温燥之性，下入脾中，使之温中以燥土，所以加之。气上冲，是胸中阳气虚馁，而下气乘上之应。桂枝甘温，能填胸分之阳，所以加之。细辛辛温而香细，善达下焦气分。寒能召湿，陈寒者必积湿，加此，也如同加芍药的意义。如虫行，指上身；如冰，指下体。坐被绕被，总以温暖为熏蒸去湿的方法。微汗病愈，应当兼谈小便。因为腰上的湿通过汗解，腰下的湿通过小便利解。
第二十二条 伤寒八九日，风湿相搏，身体烦疼，不能自转侧，不呕，不渴，脉浮虚而涩者，桂枝附子汤主治。
如果（《伤寒论》多“其人”二字）大便坚硬，小便自利的，去桂枝加白术汤主治。
桂枝附子汤方
桂枝（四两，去皮） 甘草（二两，炙） 生姜（三两，切） 大枣（十二枚，劈） 附子（三枚，炮，去皮，切八片）
以上五味药，用水三升，煮取一升，去渣，分三次温服。（《伤寒论》作水六升，煮二升，以后方诸药减半的水数计算，则此方的三升一升，恐怕是错误的，应当以《伤寒论》为准。）
白术附子汤方
白术（二两） 附子（一枚半，炮，去皮） 甘草（一两，炙） 生姜（一两半，切） 大枣（六枚）
以上五味药，用水三升，煮取一升，去渣，分三次温服。一服觉得身体麻木，半日许再服。三服都吃完，其人如有冒状，不要奇怪。这就是术、附并走皮中，逐水气，还未除去的缘故。
这一条第一个症，系风寒兼湿，第二个症，系单寒兼湿。然而都在太阳经表，而不干脏腑。身体指躯壳而言。烦疼为热因，因为风为阳热，寒湿二邪，都能化热。阳主健用，湿主沉滞。阳虚而湿邪中之，沉滞而失其健用，所以不能转侧。不呕，内无寒。不渴，里无热。意思是伤寒至八九日，已过六七日自愈之期，即宜见表邪入里之候，乃外不见解，里不见传，加之脉浮为在表，浮而且虚，则虚从浮断，是为表无阳气，更兼涩脉，涩为湿诊，明系表阳虚微，不能送邪出表，以致湿与风寒相搏，故日久不解，而亦不传。是则表阳虚微，为病之本，风寒与湿，为病之标。所以用附子至三枚，一以温阳，一以散寒，一以驱湿。加于桂枝汤中，桂枝行营卫之气，风从汗解，而寒湿亦与之俱去。独去芍药，因为在经表，不欲其酸敛。下文三句，紧顶伤寒八九日六句。犹言前症具而脉既如此之人，若大便坚硬，又为寒燥津液，如水冻冰之象，平脉所谓阴结者，是也。小便自利，为肺与小肠，气微而不能提守之应。桂枝行津泄气，故去之。白术苦温，能滋脾胃肌肉之阳液，以消客湿，故加之。冒者，躯壳浮虚散大之貌，详伤寒注。减诸药于前方之半者，前方注意在汗，犹之以风雨
The child was originally intelligent and quick-witted, but suddenly presents with dull eyes and blocked mental activity.
The patient's body is not hot, yet occasionally exhibits opisthotonos (backward arching of the body), or convulsions accompanied by cold extremities, sudden lockjaw, and inability to make sounds. This should be treated with *Danggui Sini Tang* (Cinnamon Twig Decoction with Angelica). If palpitations due to fright are present, add *Longgu* (Fossilized Bones) and *Muli* (Oyster Shell). If there is an urgent need for milk or food but an inability to eat, it is due to dryness and heat in the *Dan Zhong* (Conception Vessel area at the chest) causing vexation and palpitations; this should be treated with a combination of *Danggui Sini Tang* (Cinnamon Twig Decoction with Angelica) and *Huanglian Ejiao Tang* (Coptis and Donkey-Hide Gelatin Decoction). (The above formulas are all found in the *Shanghan Lun*.)
If the disease manifests with white urine and unrelenting cold extremities, the prognosis is fatal.
Article 13: In *Taiyang* disease (disease of the Taiyang channel), if there is pain in the joints accompanied by vexation, and the pulse is deep and fine, this is named *Shi Bi* (Dampness Bi Syndrome). The manifestations of *Shi Bi* include difficulty in urination and loose stools. Treatment should focus on promoting urination to drain dampness.
*Taiyang* disease has been detailed previously. The junction where two channels communicate is called "Guan" (Pass); the place where two bones connect is called "Jie" (Joint). Joints are the "Kan Ze" (Marshes of Kan/Water) of the human body, so dampness easily enters here. When dampness enters the joints, Qi and Blood stagnate and fail to circulate freely, causing pain. Vexation is the response to dampness stagnating and transforming into heat. A deep pulse indicates the pathogen is in the interior; a fine pulse indicates deficiency of Yang Qi. Only when the body's Yang Qi is sufficient can dampness not injure it. Now, with interior Yang deficiency, joint pain and vexation clearly result from dampness obstructing Qi and Blood. Furthermore, symptoms such as headache and fever in *Taiyang* disease clearly indicate that dampness has transformed into heat and rushed upward to attack the exterior of the channels. Thus, we know this is *Shi Bi*. "Bi" implies inferiority or obstruction; dampness adhering to the joints prevents movement, hence the name *Shi Bi*. Since interior Yang is deficient, it cannot distribute water fluids, leading to difficulty in urination. Dampness from the joints invades the intestines and stomach internally, causing loose stools. Promoting urination removes dampness, and symptoms such as joint pain will cease naturally.
Article 14: Patients with chronic dampness (*Shi Jia*) suffer from generalized body pain, fever, and a yellowish complexion resembling smoke-staining.
The term "Jia" (Family/Patient) refers to chronic conditions, such as those addicted to alcohol, those with chronic wind disorders, or those with chronic blood loss. The previous article described initial dampness; this one describes dampness that has persisted to become a chronic condition, hence "Shi Jia". Dampness flows into the joints, causing initial joint pain and vexation. After a long time, dampness transforms into heat, which fills the channels and exterior, causing generalized body pain and fever. Yellow is the color of Earth. A complexion like smoke-stained yellow indicates damp-heat injuring the Spleen. With open pores above failing to sweat and difficulty urinating below, the color of damp-Earth is steamed outward.
Article 15: In patients with chronic dampness, if only the head sweats, the back is stiff, and they desire to cover themselves with blankets or sit near fire, premature purgation will lead to hiccups, chest fullness, difficulty in urination, and a coating on the tongue resembling moss. This is because there is heat in the *Dan Tian* (Lower Abdomen/Lower Jiao) and cold in the Chest (Upper Jiao). The patient feels thirsty and wants to drink but cannot, resulting in dry mouth and vexation.
In chronic dampness, head sweating indicates damp-heat rushing upward and steaming Qi and Blood to the upper part. Back stiffness occurs because dampness binds the exterior channels, preventing sweating. Desiring blankets and fire reflects the original symptom of *Taiyang* channel injury. Patients with chronic dampness always have insufficient Yang Qi and thus cannot expel dampness through sweating. If cold purgatives are used, Yuan Yang (Original Yang) becomes even more deficient, and true Qi hides in the middle pathway, causing hiccups. The chest is the residence of Yang Qi; when Yang Qi becomes deficient due to cold purgation, Yin from below overcomes the Yang position, causing chest fullness. Difficulty in urination occurs because Qi mechanism is seized by the lower orifices. The tongue coating refers to a white, slippery coating. Heat generated by dampness resides in the Lower Jiao (*Dan Tian*), while cold from attacking medicines resides in the Chest. Lower heat causes thirst and dry mouth/vexation; upper cold prevents drinking. This article discusses the minor deviation caused by misusing purgation in chronic dampness. The character "early" (zao) in the text is suspected to be a later addition, as purgation is contraindicated throughout the discussion of dampness.
Article 16: If a patient with chronic dampness is purged prematurely, presenting with sweating on the forehead, slight panting, and free urination, the prognosis is fatal. If diarrhea persists without stopping, it is also fatal.
When dampness transforms into heat and rushes upward, head sweating and slight panting are common. However, after purgation, this becomes a deviation. Purgation empties the interior; Yang fluids and Qi from above should descend. Now, Yang fluids ascend causing forehead sweating, and Yang Qi ascends causing slight panting, which is deviant. Free urination is another way dampness leaves the body, but appearing after purgation, forehead sweating, and panting indicates severe deviation. First, after purgation, fluids are lost via the lower orifices, so urination should not be free. Second, with forehead sweating and panting, Qi mechanism is already floating upward and should not be further driven down; thus, free urination is inappropriate. The simultaneous occurrence indicates a pattern of collapse above and exhaustion below, with nothing retained in the center, hence fatal. Persistent diarrhea should be understood in conjunction with the preceding sentences regarding panting. It means that if the previous symptoms persist after purgation, even if urination is not free, persistent diarrhea leads to death. This is considered similar to free urination, representing exhaustion of the lower Yuan. This article discusses the major deviation caused by misusing purgation in chronic dampness.
Article 17: When Wind-Dampness combats each other, causing generalized body pain, the method dictates resolving it through sweating. If it rains continuously and the physician says sweating is indicated, but the disease does not resolve after sweating, why? Because profuse sweating expels only the Wind, leaving the Dampness behind, hence no resolution. To treat Wind-Dampness, sweating should be slight, as if about to occur, so that both Wind and Dampness are expelled.
Wind-Dampness refers to what is mentioned in Article 8 as "sweating and then exposed to wind." Body fluids leave the channels, transform into sweat, akin to the misty vapor of heaven and earth turning into rain. Rain falling on the ground becomes water, just as sweat remaining on the skin becomes dampness—the principle is the same. When sweating and exposed to wind, if the wind strikes the *Xuan Fu* (pores) before sweat fully emerges, Wind combats with the retained sweat. This does not necessarily mean contracting both Wind and Dampness separately. Long-term exposure to cold can also cause retained sweat. Retained sweat generates dampness, dampness generates heat, and heat generates wind. Although this is technically Wind-Dampness, it is named Wind-Dampness. Hence, Article 8 mentions it together. All subsequent mentions of Wind-Dampness follow this logic. Pain without fixed location and accompanied by vexation/heat is attributed to Wind; pain with fixed location and heaviness/stagnation is attributed to Dampness. If pure dampness transforms into heat generating wind, pain and ache may alternate. "Whole body" refers to the regions of the Hand and Foot Taiyang channels. Since dampness follows wind and sweat fails to emerge, the treatment remains inducing sweat to resolve both dampness and wind. Continuous rain represents excessive external dampness. Using sweating methods during this time creates an empty space internally for dampness, inviting external dampness to enter. Especially with improper, profuse sweating, failure to resolve is expected. Wind is light and floating, possibly expellable rapidly; Dampness is sticky and stagnant, requiring drying and steaming to remove. Profuse sweating resolves Wind but not Dampness. Therefore, treating Wind-Dampness should be done on clear days to align with heavenly dryness, using slight sweating to achieve steaming, thereby removing dampness. As dampness is the root and Wind is the branch, expelling dampness expels Wind. Perhaps *Guizhi Jia Zhu Tang* (Cinnamon Twig Decoction plus Atractylodes Macrocephala) is intended? Or perhaps *Mahuang Xingyi Gancao Tang* (Ephedra, Apricot Kernel, Licorice, and Coix Seed Decoction) from Article 8, or *Fangji Jia Gui Tang* (Stephania and Cinnamon Twig Decoction) from Article 9?
Article 18: A patient with chronic dampness suffers from body pain, fever, yellowish face, panting, headache, nasal congestion, and vexation. The pulse is large. The patient can eat normally, the abdomen is harmonious, and there is no internal disease.
The pathology is Cold-Dampness in the head, causing nasal congestion. Inserting medicine into the nose will cure it.
This article likely describes dampness invading the head due to wet bedding or pillows. Thus, sweating or promoting urination is unnecessary. Instead, inserting medicine into the nose allows dampness to exit via sneezing and runny nose. "Body" refers to the paraspinal region of the Taiyang channel. Body pain occurs because dampness in the head causes downward flow, blocking Taiyang channel Qi. Fever arises because although dampness is in the head, it blocks channel Qi; since the skin/hair is connected to channel Qi, stagnant dampness transforms into heat. A yellowish face indicates insufficient Yang Qi. If the face were red rather than yellow, Yang Qi would be strong enough to steam out dampness, and body pain/fever would not be due to dampness. Panting results from dampness blocking the Taiyang skin/hair, which connects internally to the Lung orifices, causing obstruction. Headache occurs because Taiyang channel Qi gathers in the head but is constrained by dampness, causing stuffiness and dizziness. Nasal congestion is due to dampness blocking Qi mechanism, consistent with the panting symptom. Vexation specifically refers to nasal stuffiness causing heat. A large pulse indicates dampness occupying the upper part, preventing Taiyang Qi from floating freely, causing pressure and lateral bulging. "Can eat normally..." six phrases indicate that while dampness is in the head, the middle and lower Jiao are healthy. Sweating or promoting urination would vainly injure Middle and Lower Jiao Qi, potentially drawing head dampness downward. Inserting medicine into the nose to expel dampness via secretions aligns with the principle of "treating high conditions by vomiting/sneezing." No formula is listed, perhaps lost. Wang Shi suggested using *Gua Di San* (Melon Trichosanthes Powder) finely ground, inserted like a soybean size, to discharge yellow fluid. However, using *Gua Di* nasally is unverified, and the instruction to avoid blowing seems contradictory to "insertion." An appendix formula for *Bi Yuan* (Nasal Polyps/Chronic Rhinitis) is provided: For headache, nasal congestion, and thick yellow turbid discharge, use *E Bu Shi Cao* (Centipede Weed) dried and powdered, inserted slightly into the nose to induce sneezing and expel foul matter. Repeated several times cures it. Though not a Han dynasty ancient formula, *Bi Yuan* resembles chronic head dampness transforming into Wind-Heat. This formula is effective, so it is recorded for colleagues' reference.
Article 19: Patients with chronic dampness suffering from vexing body pain may take *Mahuang Jia Zhu Tang* (Ephedra and Atractylodes Macrocephala Decoction) to induce sweating. Fire therapy must be strictly avoided.
*Mahuang Jia Zhu Tang* Formula:
*Mahuang* (Ephedrae Herba, 2 liang, remove nodes)
*Guizhi* (Cinnamomi Ramulus, 2 liang, remove bark)
*Xingren* (Armeniacae Semen Amarum, 70 pieces, remove skin and尖)
*Bai Zhu* (Atractylodis Macrocephalae Rhizoma, 4 liang)
*Gan Cao* (Glycyrrhizae Radix et Rhizoma, 1 liang, honey-fried)
These five ingredients are boiled in 9 sheng of water. First boil *Mahuang*, reduce by 2 sheng, skim off foam. Add remaining herbs, boil to obtain 2.5 sheng. Strain. Warm dose: 8 ge. Cover to induce slight sweating.
In the fifth and sixth lunar months, Earth Qi rises, steps become damp, and pillars moisten. Without Heaven's weather releasing this as rain, dry heat steams and stifles, indicating dampness. Just as rain resolves heavenly dryness/steaming, sweat resolves bodily vexing pain. External fire therapy forces dampness from channels/joints into the Zang-Fu organs due to heat pressure. This illustrates the principle: dampness from sprinkling settles below, while qi from steaming floats above. *Mahuang Jia Zhu Tang* is used because dampness blocks hair follicles, so chronic dampness patients usually lack sweat. *Mahuang* disperses the cloud-like obstruction of the Wei (Defensive) surface. *Guizhi* promotes Ying (Nutritive) Qi, embodying the positive energy of East Wind-Wood, achieving "wind dries dampness." Among the Five Zang, the Lung hates dampness most and connects with the skin/hair. Thus, skin/dampness affects the Lung tubes first. *Xingren* opens Lung orifices. *Bai Zhu* is warm; combined with *Gan Cao*, it regulates Spleen-Stomach Earth Qi. Sweet-warm Earth steams dampness upward into sweat. This is the correct herb for external dampness.
Article 20: A patient suffers from generalized body pain, fever, worsening in the late afternoon (You hour, 5-7 PM), named Wind-Dampness. This disease results from sweating while exposed to wind or long-term exposure to cold.
*Mahuang Xingyi Gancao Tang* (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) may be used.
*Mahuang Xingyi Gancao Tang* Formula:
*Mahuang* (Ephedrae Herba, 0.5 liang, remove nodes, soak in boiling water)
*Xingren* (Armeniacae Semen Amarum, 10 pieces, remove skin and尖, stir-fry)
*Yi Yi Ren* (Coicis Semen, 0.5 liang)
*Gan Cao* (Glycyrrhizae Radix et Rhizoma, 1 liang, honey-fried)
Crush to the size of hemp seeds. Take 4 qian bi per dose. Boil in 1 cup of water until reduced to 0.8 cup. Strain. Warm dose. Aim for slight sweating. Avoid wind.
"Patient" refers to damp disease. Generalized pain and fever are detailed previously. You hour (late afternoon) is when Mingyang channel Qi is prosperous, having the momentum to push dampness to the exterior. However, dampness resists expulsion, stalling at the boundary of Taiyang and Mingyang, causing worsening. The three phrases on Wind-Dampness refer to Article 5 notes. *Mahuang Xingyi Gancao Tang* uses *Gan Cao* (Earth element) as Sovereign, governing Spleen/Stomach internally and Muscles externally, intending to transmit from Spleen/Stomach to muscles. *Yi Yi Ren* is sweet-warm, drying Middle Earth, leveraging *Gan Cao*'s floating/slow nature to steam dampness from interior/lower to exterior/upper. *Xingren* opens Lung orifices to guide Qi, assisting the steaming of *Yi Yi* and *Gan Cao*. *Mahuang* opens pores to break stagnation. Like driving away thieves: *Yi/Gan* call from inside, *Xingren* guides from midway, *Mahuang* opens the main gate. Similar intent to *Mahuang Jia Zhu Tang*, but smaller dosage and lacking *Guizhi*. Previous article said "Shi Jia" (chronic), requiring larger dose. This says "Patient" (acute/shallow), avoiding large doses to prevent Qi injury. Soaking *Mahuang* and frying *Xingren* uses their light/clear properties sufficiently. Also, this article adds "worsening at You hour," indicating Muscle prosperity and self-stirring Qi, meaning Ying level is not yet affected, so *Guizhi* is unnecessary.
Article 21: Wind-Dampness with floating pulse, heavy body, sweating, and aversion to wind is treated with *Fangji Huangqi Tang* (Stephania and Astragalus Decoction).
*Fangji Huangqi Tang* Formula:
*Fangji* (Stephaniae Tetrandrae Radix, 1 liang)
*Huang Qi* (Astragali Radix, 1 liang 1 fen, remove roots)
*Bai Zhu* (Atractylodis Macrocephalae Rhizoma, 7 qian 5 candareens)
*Gan Cao* (Glycyrrhizae Radix et Rhizoma, 1 liang)
Crush to hemp seed size. Take 5 qian bi per dose with 4 slices of *Sheng Jiang* (Zingiberis Rhizoma Recens) and 1 *Da Zao* (Ziziphi Jujubae Fructus). Boil in 1.5 cups water to 0.8 cup. Strain. Warm dose. Repeat after some time. If panting, add *Mahuang* 0.5 liang. If Stomach disharmony, add *Shaoyao* (Paeoniae Radix Alba) 3 fen. If Qi rushes upward, add *Guizhi* 3 fen. If old cold below, add *Xixin* (Asari Radix et Rhizoma) 3 fen. After taking, sensation of insects crawling in skin and ice-cold feeling below waist is expected. Sit on blanket, wrap another around waist/lower body, keep warm until slight sweating occurs. Disease resolves.
This article names the disease "Wind-Dampness," symptoms resemble "Wind," but the formula treats "Dampness." Zhang Zhongjing's precision is meticulous; understanding this key insight penetrates deeply. Sweating while exposed to wind causes sweat to stagnate and transform into dampness (as in previous article). Thus, Wind-Dampness: Dampness is Root, Wind is Branch. Stagnant dampness transforms into heat; damp-heat combines with deficient Yang on exterior, causing floating pulse. Deficient Yang floating outward means Yin lacks mastery, presenting as Earth heaviness (heavy body). Floating pulse/heavy body result from deficient Yang steamed by damp-heat, causing sweating. Sweating opens pores, causing aversion to wind. Chronic dampness resolves via sweat; sweat expels dampness naturally. Now, with persistent floating pulse, heaviness, and aversion to cold, sweating indicates deficient Yang escaping, while dampness remains. Since dampness remains, *Fangji*, *Bai Zhu*, *Gan Cao* dry it. Since deficient Yang escapes, *Huang Qi* consolidates it. Mentioning both Wind/Damp covers the Branch. Symptoms resembling Wind reflect the Branch pathology. Treating only Damp addresses the Root. Note: 4 fen = 1 liang; 1 fen = 2.5 qian. *Huang Qi* 1 liang 1 fen = 1 liang 2.5 qian. Additions of 3 fen equal 7.5 qian of *Bai Zhu* (1 fen = 6 zhu, 24 zhu = 1 liang). 5 qian bi means 5 scoops with a dagger-shaped spoon measuring 1 qian. Panting indicates Lung injury by dampness/blockage; add *Mahuang* to disperse. Stomach disharmony (bloating/borborygmus/loose stool) indicates Spleen stagnation; *Shaoyao* is sour/astringent, descending to Zang, guiding warming-drying herbs to Spleen to warm middle/dry Earth. Qi rushing upward indicates deficient Chest Yang allowing lower Qi to rise; *Guizhi* sweet-warm fills Chest Yang. *Xixin* pungent-warm/aromatic reaches Lower Jiao Qi; cold attracts dampness, old cold implies accumulated dampness; adding *Xixin* parallels adding *Shaoyao*. "Insects crawling" refers to upper body; "Ice-cold" refers to lower body. Sitting/wrapping in blankets warms to steam out dampness. Slight sweating resolves disease, implying urination also clears dampness below waist.
Article 22: After 8-9 days of Shanghan, Wind-Dampness combats, causing vexing body pain, inability to turn oneself, no vomiting, no thirst, floating-deficient-choppy pulse. *Guizhi Fuzi Tang* (Cinnamon Twig and Aconite Decoction) is indicated.
If (Shanghan Lun adds "Ren") stool is hard and urination is free, remove *Guizhi* and add *Baizhu* (treated as *Baizhu Fuzi Tang*).
*Guizhi Fuzi Tang* Formula:
*Guizhi* (Cinnamomi Ramulus, 4 liang, remove bark)
*Gan Cao* (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried)
*Sheng Jiang* (Zingiberis Rhizoma Recens, 3 liang, sliced)
*Da Zao* (Ziziphi Jujubae Fructus, 12 pieces, split)
*Fuzi* (Aconiti Lateralis Radix Praeparata, 3 pieces, roasted, remove skin, cut into 8 slices)
Boil these five in 3 sheng water to 1 sheng. Strain. Divide into 3 warm doses. (Shanghan Lun uses 6 sheng to 2 sheng; calculating based on halving water for subsequent formulas, 3 to 1 might be an error; follow Shanghan Lun.)
*Baizhu Fuzi Tang* Formula:
*Bai Zhu* (Atractylodis Macrocephalae Rhizoma, 2 liang)
*Fuzi* (Aconiti Lateralis Radix Praeparata, 1.5 pieces, roasted, remove skin)
*Gan Cao* (Glycyrrhizae Radix et Rhizoma, 1 liang, honey-fried)
*Sheng Jiang* (Zingiberis Rhizoma Recens, 1.5 liang, sliced)
*Da Zao* (Ziziphi Jujubae Fructus, 6 pieces)
Boil these five in 3 sheng water to 1 sheng. Strain. Divide into 3 warm doses. After first dose, body numbness is felt; repeat after half a day. Finish all three doses. Patient may feel dizzy/confused; do not worry. This is *Baizhu* and *Fuzi* moving in the skin, expelling water-Qi, not yet removed.
First symptom: Wind-Cold combined with Dampness. Second symptom: Cold combined with Dampness. Both affect Taiyang Exterior, not Zang-Fu. "Body" refers to the躯壳 (shell/exterior). Vexing pain is due to Heat (Wind is Yang-Heat; Cold-Damp can transform into Heat). Yang governs vigorous function; Dampness governs stagnation. Yang deficiency allows Damp invasion; stagnation loses vigorous function, causing inability to turn. No vomiting = no interior Cold. No thirst = no interior Heat. Meaning: By day 8-9 of Shanghan, past the 6-7 day self-healing period, signs of interior transmission should appear. But exterior unresolved, interior unchanged. Floating pulse indicates Exterior; Floating-Deficient indicates Exterior Yang deficiency. Choppy pulse indicates Damp diagnosis. Clearly, weak Exterior Yang cannot expel pathogen, causing Wind-Cold and Damp to combat, lingering without transmitting. Weak Exterior Yang is Root; Wind-Cold-Damp is Branch. Use 3 pieces of *Fuzi*: one to warm Yang, one to dispel Cold, one to drive Damp. Added to *Guizhi Tang*: *Guizhi* moves Ying-Wei Qi, Wind resolves via sweat, Cold-Damp goes with it. Remove *Shaoyao* because in Exterior, avoiding astringency. Next three sentences follow the 8-9 day context. If stool is hard, it indicates Cold-Dry consuming fluids, like frozen ice (Yin Knot). Free urination indicates Lung/Small Intestine Qi too weak to control. *Guizhi* moves fluids/releases Qi, so remove it. *Bai Zhu* bitter-warm nourishes Spleen/Stomach/Muscle Yang fluids to eliminate guest dampness, so add it. "Mao" (dizziness/confusion) is the appearance of floating/deficient/scattered shell. See Shanghan notes. Halving herbs from previous formula: Previous focused on sweat (like wind/rain)...