解潮湿。利于疏爽。故大其制。此方注意在湿。犹之以旭日解寒湿。义取熏蒸。故半其制耳。
二十三条 风湿相搏。骨节烦疼。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。
甘草附子汤方 甘草（二两炙） 附子（二枚泡去皮） 白术（二两） 桂枝（四两去皮）
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（一本有解能食汗出五字）复烦
者。服五合。恐一升多者。宜服六七合为妙。
此条当重看风字。症则以汗出恶风为主。盖以风为本。而湿为标者也。故方意君桂枝者。一则取其行营卫
之汗以解风。随便令其领术附以解湿也。湿流关节而能化热。风又为阳热之邪。两热相持于骨节。故烦疼
也。风火之性。以动而张。故掣痛。风湿鼓满于骨节之上下。故不得屈伸。并不可近也。风邪疏卫表。故汗出。湿
邪滞肺窍。故短气。小便不利者。风湿以热相得。而气机浮壅也。恶风者。汗出表疏。畏风所袭也。表疏恶风。故
不欲去衣。微肿者。风湿阻其经气之应。此因风为重。故于甘草术附。温脾燥湿之外。不得不尊桂枝以解其
风湿耳。
二十四条 太阳中 者。发热恶寒。身重而疼痛。其脉弦细芤迟。小便已。洒洒然毛耸。手足逆冷。小有劳。
身即热。口开。前板齿燥。若发其汗。则恶寒甚。加温针。则发热甚。数下之。则淋甚。
即下条所云中热是也。人身之阳气。托根于命门。分光于脏腑。各从其本经。而熏蒸于在上在外。乃于皮
腠之间。与太阳之气。汇成一片。而包裹于躯壳之表。是为卫气。卫气周密。不特以阳拒阴。寒邪不能入。即热
邪亦不能入者。里气充。而外气不敢犯故也。此条是脏腑之阳虚。而卫气衰薄。故 邪得以热伤其表气也。
热伤其表气。故发热。卫气衰薄而受伤。故恶寒也。阳主轻清。阳虚而且见伤。故身重。疼痛者。热邪逼其经气。
而不得上浮外鼓之应。夫太阳之脉宜浮。夏月之脉宜洪。今见弦细芤迟。弦细为减。减者瘦削之义。是阳气
之不能充其脉体也。迟为在脏。是脏阳气微。故不能健应于脉至也。芤者。无阴之诊。阳生于阴。明系阴精短
少。而 热之邪充之。故以芤见。阳气因之而弱。故以弦细与迟同见也。太阳外主皮毛。内通小便。小便已。则
膀胱气空。而皮毛之气。争赴空处。故洒洒然毛耸也。手足、为阳气之充。阳虚且病。故不能贯于四末。而逆冷
也。劳则神浮。神者火也。火浮。故身热。口开者。虚阳为 邪所逼。有下陷而不能收摄其唇口之象。板齿为督
脉之所入处。督脉两界于太阳。而与之为合。太阳伤 。故督脉热于所入而燥也。发汗。则阳益虚。故恶寒甚。
温针。则外火与 邪相衬。故热甚。数下之。则气机夺于后阴。而膀胱之治化不能传送。且 邪因虚下沉。故
淋甚者也。本经不列方。以鄙意拟之。炙甘草汤滋阴以实其芤。合四逆汤扶阳以益其弦细与迟之脉。阴阳
充畅。 邪或解于自汗乎。
二十五条 太阳中热者。 是也。汗出恶寒。身热而渴也。白虎加人参汤主之。
白虎加人参汤方 石膏（一斤碎） 知母（二两） 甘草（二两） 人参（三两） 粳米（六合）
上五味。以水一斗。煮米熟。汤成。去滓。温服一升。日三服。
大热在内。故蒸其液出而为汗。又逼其阴出而恶寒也。身热者。 热外蒸皮腠之应。渴者。 热内铄阴津之
应。此系太阳阴精短少。而大热伤其津液之症。故主白虎。以救大热。白虎加参。以救大热所伤之津液耳。汤
意见伤寒本汤下。
二十六条 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。
一物瓜蒂汤方 瓜蒂（二十个锉）
以水一升。煮五合。去滓。顿服。
此亦阳虚、而 热伤气之症也。身热。为太阳中 之本症。疼重。即下文水行皮中之候。盖疼为热因。重为湿
因。湿热相搏。故疼重也。微弱为阳虚之诊。若阳气充足。 邪不能相犯。即或犯之。便于渴饮凉水中。送为汗
解矣。岂有身热疼重之症乎。今以脉微弱审之。则知身热疼重。始以阳虚而受 热于前。复以阳虚而不能
运凉水于后之应。故直断之曰。夏月伤冷水。水行皮中所致也。主瓜蒂汤者。瓜蒂苦寒。苦则能令胃系急而
不下。寒则能拒 热之邪内侵。且此药善涌。涌则开提阳气。能使微弱之脉自振。将水气运为自汗。而身热
疼重。俱可尽解。是去 行水之权。只用一涌以提其阳气、而已足矣。其言一物者。不欲以余药牵制其性耳。
解除潮湿之气，有利于气机的疏泄通畅。因此加大药量。此方的重点在于祛湿，如同用初升的太阳来化解寒湿，取意于熏蒸发散，所以将剂量减半罢了。
第二十三条：风湿二邪相互搏结，导致骨节剧烈疼痛，牵掣作痛，不能随意屈伸，触碰时疼痛加剧，伴有出汗、气短、小便不通利、怕风、不想脱去衣物，或者身体轻微浮肿的，用甘草附子汤主治。
甘草附子汤方：甘草（二两，炙）、附子（二枚，炮制后去皮）、白术（二两）、桂枝（四两，去皮）。
以上四味药，用水六升，煮取三升，滤去药渣。每次温服一升，每日服用三次。初次服药后若微微出汗，则病可解；如果服药后反而感到烦闷，应改为服用五合（约半升）；如果担心一升药量过多，以服用六七合为妙。
这一条应当着重看“风”字。症状以出汗、怕风为主。这是因为风邪为本，湿邪为标。所以方中以桂枝为君药，一是取其能调和营卫、通过发汗来解除风邪，顺便带领白术、附子来化解湿邪。湿气流注关节并能化热，风邪又属于阳热之邪，两股热邪在骨节处相持不下，所以出现烦疼。风和火的本性，都是主动而张扬的，所以出现牵掣样的疼痛。风湿二邪鼓胀于骨节的上下，所以导致关节不能屈伸，并且不可触碰。风邪疏泄卫表，所以导致出汗；湿邪阻滞肺窍，所以导致气短。小便不利，是因为风湿与热邪相结合，导致气机浮越壅滞。怕风，是因为出汗导致肌表疏松，畏惧风邪侵袭。肌表疏松且怕风，所以不想脱去衣物。身体微肿，是因为风湿阻碍了经气的正常运行。这是因为风邪较重，所以在用甘草、白术、附子温脾燥湿的基础上，不得不重用桂枝来解除风湿。
第二十四条：太阳中暍（中暑），表现为发热、恶寒、身体沉重且疼痛，脉象弦细、芤或迟。小便结束后，感觉寒冷战栗、毫毛竖起，手足逆冷。稍微劳动一下，身体就发热，张口呼吸，门齿干燥。如果误用发汗法，则恶寒加重；如果用温针疗法，则发热加重；如果多次使用泻下法，则淋证加重。
这就是下一条所说的“中热”。人体的阳气，根基在于命门，分布到各脏腑，各自顺着本经，熏蒸于上部和外周，在皮肤腠理之间，与太阳经之气汇合，形成一片，包裹在躯壳表面，这就是卫气。卫气周密，不仅用阳气抵御阴寒，连热邪也不能侵入，这是因为里气充足，外邪不敢侵犯。这一条是脏腑阳气虚弱，导致卫气衰薄，所以暑热邪气得以从外部损伤体表之气。热邪损伤体表之气，所以发热；卫气衰薄且受损伤，所以恶寒。阳气主轻清，阳气虚弱且受损伤，所以身体沉重。疼痛，是因为热邪逼迫经气，使其不能上浮外达。太阳经脉的脉象宜浮，夏季的脉象宜洪大。现在却见到弦、细、芤、迟的脉象。弦细表示脉气减弱，“减”有瘦削的意思，这是阳气不能充盈脉体的表现。迟脉主脏，说明脏气阳气微弱，所以不能在脉搏跳动时表现出健旺的状态。芤脉是无阴的征象，阳生于阴，这明显是阴精短少，被暑热邪气充斥，所以出现芤脉。阳气因此变得衰弱，所以弦、细、迟同时出现。太阳经外主皮毛，内通小便。小便排完后，膀胱之气空虚，皮毛之气争着奔赴空虚之处，所以感觉寒冷战栗、毫毛竖起。手足是阳气充盛的地方，阳气虚弱且生病，所以不能通达四肢末端，导致手足逆冷。劳作会使神气浮越，神属火，火气浮越，所以身体发热。张口呼吸，是因为虚阳被暑邪逼迫，有下陷而不能收摄唇口的现象。门齿是督脉进入的地方，督脉左右界于太阳经，并与之相合。太阳经受暑邪伤害，所以督脉在入口处受热而干燥。发汗，会使阳气更加虚弱，所以恶寒加重。温针，会使外火与暑邪相互衬托，所以发热加重。多次泻下，会夺夺后阴的气机，导致膀胱的气化功能不能正常传导，且暑邪因虚而下沉，所以淋证加重。本经没有列出方剂，依我个人的意见拟方：用炙甘草汤滋阴以充实芤脉所代表的阴液不足，合用四逆汤扶助阳气以改善弦细和迟脉所代表的阳气虚弱。阴阳充盛通畅，暑邪或许能通过自汗而解除。
第二十五条：太阳中热，就是中暍。表现为出汗、怕风、身体发热且口渴。用白虎加人参汤主治。
白虎加人参汤方：石膏（一斤，捣碎）、知母（二两）、甘草（二两）、人参（三两）、粳米（六合）。
以上五味药，用水一斗，煮至米熟，药汤成，滤去药渣。每次温服一升，每日服用三次。
体内有大热，所以蒸发津液外出成为汗，又逼迫阴气外泄而感到怕风。身体发热，是暑热向外蒸腾皮腠的表现；口渴，是暑热向内灼伤阴津的表现。这是太阳经阴精短少，且大热损伤津液的病症。所以主治用白虎汤来救大热，加人参是为了救大热所伤的津液。汤剂的用意参见《伤寒论》原方下的解说。
第二十六条：太阳中暍，身体发热，疼痛沉重，且脉象微弱。这是因为夏天受了冷水，水气行走在皮肤中所导致的。用一物瓜蒂汤主治。
用水一升，煮取五合，滤去药渣，一次性服下。
这也是阳气虚弱，且暑热损伤气机的病症。身体发热，是太阳中暍的根本症状。疼痛沉重，就是下文所说的水气行走在皮肤中的候象。疼痛是因为热邪所致，沉重是因为湿邪所致。湿热相互搏结，所以出现疼痛沉重。脉微弱是阳气虚弱的诊断。如果阳气充足，暑邪就不能侵犯，即使侵犯了，也会因为想喝凉水并随汗排出而解，怎么会有身体发热、疼痛沉重的症状呢？现在根据脉微弱来判断，就知道身体发热、疼痛沉重，起初是因为阳气虚弱而受到暑热侵袭，后来又因为阳气虚弱而不能运化凉水，导致水气停留在皮肤中。所以直接断定说：这是夏天受了冷水，水气行走在皮肤中所致。主治瓜蒂汤，是因为瓜蒂味苦性寒，苦味能使胃系收紧而不向下，寒性能拒绝暑热邪气内侵。而且此药善于催吐，涌吐能开提阳气，能使微弱的脉象自行振奋，将水气运化为自汗，那么身体发热、疼痛沉重都可以完全解除。这是去除水气运行的权力，只用涌吐的方法来提举阳气，就足够了。说只用一味药，是不想用其他药物牵制它的药性罢了。
To resolve dampness and facilitate the smooth flow of Qi. Therefore, the dosage is increased. The focus of this formula lies in dispelling dampness, similar to using the morning sun to resolve cold-dampness, taking the meaning of steaming and evaporating; thus, the dosage is halved.
Article 23: When Wind-Dampness combats each other, causing severe pain in the bone joints, pulling pain that prevents flexion and extension, with pain worsening upon touch, accompanied by sweating, shortness of breath, difficulty in urination, aversion to wind, reluctance to remove clothing, or slight swelling of the body, Gancao Fuzi Tang (Licorice and Aconite Decoction) is the primary treatment.
Gancao Fuzi Tang Formula: Gancao (Zhi Gancao, Processed Licorice Root, 2 liang), Fuzi (Pao Fuzi, Prepared Aconite Lateral Root, 2 pieces, peeled after processing), Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang), Guizhi (Cinnamon Twig, 4 liang, peeled).
Take the above four herbs, add six sheng of water, boil to obtain three sheng, strain the dregs. Take one sheng warm, three times a day. After the first dose, if slight sweating occurs, the condition resolves. If restlessness follows, reduce the dose to five he. If one sheng is considered too much, taking six or seven he is optimal.
In this article, emphasis should be placed on the character "Wind." The symptoms are primarily sweating and aversion to wind. This is because Wind is the root, while Dampness is the branch. Therefore, the formula uses Guizhi as the sovereign herb: firstly, to harmonize Ying and Wei and release Wind through sweating, and secondly, to lead Baizhu and Fuzi to resolve Dampness. When Dampness flows into the joints and transforms into Heat, combined with Wind which is a Yang-Heat pathogen, two heats contend at the bone joints, causing painful restlessness. The nature of Wind and Fire is dynamic and expansive, causing pulling pain. Wind-Dampness distends above and below the joints, preventing flexion and extension and making them tender to touch. Wind disperses the Wei surface, causing sweating; Dampness obstructs the Lung orifices, causing shortness of breath. Difficulty in urination arises because Wind-Dampness combines with Heat, leading to floating and stagnant Qi mechanism. Aversion to wind results from sweating causing surface laxity and susceptibility to Wind invasion. Surface laxity and aversion to wind lead to reluctance to remove clothing. Slight swelling occurs because Wind-Dampness obstructs the circulation of Jing-Qi. Since Wind is predominant, besides warming the Spleen and drying Dampness with Gancao, Baizhu, and Fuzi, it is necessary to honor Guizhi to resolve Wind-Dampness.
Article 24: Taiyang Zhongshu (Summerheat Stroke in Taiyang) presents with fever, aversion to cold, heaviness and pain in the body, and a pulse that is Xian (Wiry), Xi (Fine), Kou (Hollow), or Chi (Slow). After urination, there is a sensation of chills and piloerection, cold extremities. Upon slight exertion, the body becomes hot, the mouth opens, and the incisors become dry. If sweat-inducing methods are used, aversion to cold worsens; if warm needle therapy is applied, fever intensifies; if purgatives are used repeatedly, strangury worsens.
This refers to "Zhongre" (Summerheat Heat) mentioned in the next article. The body's Yang Qi takes root in the Mingmen (Gate of Life) and distributes to the Zang-Fu organs, following their respective meridians to steam upwards and outwards. In the skin and interstices, it merges with Taiyang Qi to form a unified layer wrapping the exterior of the body, known as Wei Qi. Wei Qi is dense and tight; not only does it repel Yin-Cold pathogens, but even Heat pathogens cannot enter because the interior Qi is sufficient, preventing external invasion. This article describes deficiency of Zang-Fu Yang Qi and thinning of Wei Qi, allowing Summerheat pathogens to damage the exterior Qi. Heat damaging exterior Qi causes fever; Wei Qi being thin and damaged causes aversion to cold. Yang governs lightness and clarity; Yang deficiency and damage cause heaviness. Pain occurs because Heat forces Jing-Qi to fail in its upward and outward movement. The Taiyang pulse should be Floating; summer pulses should be Hong (Surging). Seeing Xian, Xi, Kou, and Chi indicates reduction. "Reduction" implies emaciation, showing Yang Qi fails to fill the pulse vessel. Chi indicates involvement of the Zang, showing weak Zang Yang Qi failing to respond vigorously to the pulse. Kou indicates lack of Yin; Yang is born from Yin, indicating shortness of Yin Essence filled by Summerheat, hence the Kou pulse. Yang Qi becomes weak, appearing with Xian, Xi, and Chi. Taiyang governs skin/hair externally and connects to urination internally. After urination, Bladder Qi empties, and Skin Qi rushes to the empty space, causing chills and piloerection. Extremities are where Yang Qi fills; Yang deficiency and illness prevent reaching the four ends, causing cold extremities. Exertion floats the Shen (Spirit); Shen belongs to Fire, so floating Fire causes body heat. Opening the mouth indicates deficient Yang forced downward by Summerheat, unable to control the lips and mouth. Incisors are where the Du Mai (Conception Vessel) enters; Du Mai borders Taiyang and combines with it. Taiyang injured by Summerheat causes Du Mai to become hot and dry at its entry point. Sweating further depletes Yang, worsening aversion to cold. Warm needles combine external fire with Summerheat, worsening fever. Repeated purging drains Qi from the lower orifice, impairing Bladder transformation and transportation, and Summerheat sinks due to deficiency, worsening strangury. This classic does not list a formula; I propose: Zhigancao Tang (Licorice Decoction) to nourish Yin and fill the Kou pulse, combined with Sini Tang (Frigid Extremities Decoction) to support Yang and improve the Xian-Xi-Chi pulse. With sufficient Yin and Yang, Summerheat may resolve through spontaneous sweating.
Article 25: Taiyang Zhongre (Summerheat Heat in Taiyang) is Zhongshu. It presents with sweating, aversion to wind, body heat, and thirst. Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
Baihu Jia Renshen Tang Formula: Shigao (Gypsum Fibrosum, 1 jin, crushed), Zhimu (Anemarrhenae Rhizoma, 2 liang), Gancao (Licorice Root, 2 liang), Renshen (Ginseng Radix et Rhizoma, 3 liang), Gengmi (Oryza Sativa, 6 he).
Take the above five herbs, add ten dou of water, boil until rice is cooked and decoction is ready, strain. Take one sheng warm, three times a day.
Intense internal heat steams fluids out as sweat and forces Yin out, causing aversion to cold. Body heat is the manifestation of Summerheat steaming the skin and interstices externally. Thirst is the manifestation of Summerheat melting Yin-Jin internally. This is a syndrome of short Taiyin Yin Essence and great Heat damaging Jin-Ye. Thus, Baihu Tang is used to rescue from great Heat, and adding Renshen rescues the Jin-Ye damaged by great Heat. See the commentary under the original formula in Shanghan Lun for the rationale.
Article 26: Taiyang Zhongshu presents with body heat, pain and heaviness, and a weak pulse. This is caused by injuring cold water in summer, with water qi circulating in the skin. Yiwu Gaudi Tang (Single Herb Melon Seed Decoction) is the primary treatment.
Yiwu Gaudi Tang Formula: Gaudi (Momordicae Fructus, 20 pieces, chopped).
Add one sheng of water, boil to obtain five he, strain. Take all at once.
This is also a syndrome of Yang deficiency and Summerheat damaging Qi. Body heat is the fundamental symptom of Taiyang Zhongshu. Pain and heaviness are signs of water circulating in the skin. Pain is due to Heat, heaviness is due to Dampness. Heat and Dampness combat each other, causing pain and heaviness. Weak pulse indicates Yang deficiency. If Yang Qi were sufficient, Summerheat could not invade; even if it did, drinking cold water would resolve it through sweating. How could there be body heat and pain/heaviness? Judging by the weak pulse, we know that body heat and pain/heaviness initially resulted from Yang deficiency allowing Summerheat invasion, followed by Yang deficiency failing to transport cold water, leading to water accumulation in the skin. Hence, it is concluded: injuring cold water in summer causes water qi to circulate in the skin. Gaudi Tang is used because Gaudi is bitter and cold. Bitterness tightens the stomach connection preventing downward flow; coldness repels Summerheat invasion. Moreover, this herb induces vomiting; vomiting lifts Yang Qi, revitalizing the weak pulse, transforming water qi into spontaneous sweat, resolving body heat and pain/heaviness. This removes the power of water retention, using only vomiting to lift Yang Qi, which is sufficient. Using only one herb avoids other drugs restraining its action.