太阳病。关节疼痛而烦。脉沉而细者。此名湿痹之候。其人小便不利。大便反快。但当利其小便。
夫湿者。六气之一也。然一气之中。犹有别焉。雾露之气。为升于地之轻清而上腾者。故为湿中之清。伤人皆中于
上。
雨雪泥水之湿。为着于地之重浊而在下者。为湿中之浊。伤人皆中于下。经云。清邪中上。浊邪中下。
所以金匮要略云。湿伤于下。雾伤于上。雾伤皮腠。湿流关节也。亦称太阳病者。以风寒暑湿之邪。皆由
卫气不密。其气得从皮毛而入。以营卫皆属太阳故也。关节。筋骨肢节之间也。凡湿邪中人。必流注
于肢节而烦疼肿痛。故素问阴阳应象论。所谓地之湿气。感则害人皮肉筋骨者是也。以雨露水湿之气。
因卫阳不能外固。由太阳而流入于关节筋骨之间。致肢节疼痛而烦扰不宁。其脉沉而细者。此名湿
痹。然何以辨之。譬之寒伤营证。虽亦身疼腰痛。骨节疼痛。而其脉则浮紧。 病之脉沉细。而症则
发热颈项强急。口噤反张。湿病脉亦沉细而骨节烦疼。症异则脉同。症同则脉异。所以为不同也。沉细者。
寒湿流于皮肉筋脉之间。血凝气滞。营卫不快于流行。故脉细而疼痛也。湿痹之候。寒湿内淫。则
三焦不能施化。气化不得流行。其人小便不利。是以水谷不能泌别。湿气流溢于大肠。故大便不得燥
结而反快也。若此者。不必以燥湿为治。其湿气淫溢。非燥湿之所能胜。故但当利其小便。因燥湿之所
去者少。渗利之所去者多。故小便利。则水谷分而湿淫去矣。此条盖论雨雪泥水地气之湿。乃湿中之浊者。
故曰但当利其小便。若雾露之清邪。即当以微似汗解之矣。然利小便句。当审察其脉证机宜。未可泛
然以淡渗为治也。脉既沉细。关节已疼。而小便不利。则阴寒可知。自当以寒湿为治。责之下焦无火。
膀胱之气化不行。则五苓散。及甘草附子汤之类。当意在言表。
湿家之为病。一身尽疼。发热。身色如似熏黄。
此亦论两水地气之湿也。一身尽疼。即前湿流关节之义。前云脉沉而细。明是寒湿之邪。此虽无脉象。
而云发热。则邪犹在经。身色如熏黄。是湿已入里。脾受湿伤。而中央土色已现于外。湿邪充塞浸灌于表
里肌肉肢节之间。所以
一身尽疼而身色如熏黄也。熏黄者。如烟熏之状。黄中带黑而不明润也。盖黄家有阴阳之别。阳黄明润。
阴黄则黑暗而无光泽。素问五脏生成篇云。黄如蟹腹者生。黄如枳实者死。如阳明篇伤寒发黄。身如橘
子色者。而用茵陈蒿汤下之。及身黄发热而以栀子柏皮汤。以至麻黄连轺赤小豆汤者。皆以瘀热在里。
小便不利。湿热停蓄所致。悉属阳黄。此证一身尽疼。已属寒湿之邪。流于关节而身色如似熏黄。即
阴黄之属也。外虽发热。尚为太阳在表之邪。其发现之色。则由内达外。既如烟熏。或当于寒湿中求之。
未可知也。但必详审其脉证而施治耳。仲景所以不立治法者。盖欲人于阴阳寒热中求之耳。未有一定
可拟之法也。设一立治法。即胶于一偏。恐后人执着其说而不能圆通变化耳。
湿家病。身上疼痛。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。故鼻塞内药鼻中则愈。
成注每不能阐发仲景深义。遂为后世所讥。惟此条注释。颇得原文精义。但尚嫌其语焉不详。多所
缺失。今即因其意而申之云。此盖言雾露所感之湿。所谓清邪中上者是也。既称湿家而不云关节疼痛。
又不言一身尽疼痛。更不言骨节烦疼掣痛。但曰身上疼痛。身上者。身之上也。邪在上焦。是湿未流
于关节。而外客于身上之肌表也。不云发热身似熏黄。但曰发热面黄而喘。是湿未入里而色但现于头面也。
喘者。肺主皮毛。开窍于鼻。湿袭皮毛。内壅肺气。所以鼻塞而喘。非胸腹胀满而喘也。若寒湿在里。
则属阴邪。无头痛发热之见症。脉当沉细。此则发热头痛。鼻塞而烦。是邪气但在上焦。毫不犯里。
故其脉大而自能饮食。腹中和而身躯脏腑无病也。其病但因头中寒湿故鼻塞也。
病浅不必探求。毋庸制剂。但当以辛香开发之药。纳之鼻中。以宣泄头中之寒湿则愈。朱奉议及王氏准绳。
俱用瓜蒂散。
湿家。其人但头汗出。背强。欲得被覆向火。若下之早。则哕胸满小便不利。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。
此言雾露寒湿之邪中人也。太阳之经脉。挟背脊而行于两旁。寒湿中之。故背强。寒邪在表。所以欲得
被覆而向火也。寒湿之邪。留着于太阳之经。阳气不得流行。以头为诸阳之会。诸阴络不能至头。皆剂颈而还。
阳气不行。独聚于头。故其人但头汗出。所谓清邪中上也。当表邪未解之时。若早下之。则寒湿之邪。乘下后之虚。
内陷入胃。胃气伤败而哕。哕者。俗所谓冷呃是也。哕而胸满。小便不利者。寒湿在中。胃气不行。三焦不运。
上焦之气不降。则浊气郁塞而胸满。下焦之清阳不升。则气化不行而小便不利也。舌上如苔者。若热邪入胃。
则舌上或黄或黑。或芒刺。或干硬。或燥裂。皆苔也。此云如苔乃湿滑而色白似苔非苔也。然何以致此。因寒湿
之邪。陷入于里而在胸膈。命门之真阳。不得上升而在下焦。上下不通。故曰丹田有热。胸中有寒。下焦之真火。
既不得上达。即所谓清阳不升。是下焦无蒸腾之用。气液不得上腾而为涕唾。故渴。又以寒湿在胸。道路阻绝。
故虽欲得水而不能饮。则口燥而烦渴也。仲景虽不立治法。然以理推之。邪在太阳之表。则当汗解。头汗既出。
不当用麻黄。胸中之寒邪当去。下焦之气化当行。于法当温。则下文之桂枝附子汤。甘草附子汤。即其治也。前人
拟陷胸汤。恐非其治。即五苓散理中汤。虽近于理。犹未尽善。何也。以但能温中而不能解外。故必以用桂枝
者为妥也。
湿家下之。额上汗出。微喘。小便利者死。若下利不止者亦死。
治湿但有汗法。及利小便法而无下法。上文因寒邪在表。下早即有哕而胸满。小便不利之变。然
为寒湿所中。阳气已伤而误下之。必致亡阳变逆而死矣。夫湿邪在表。本宜于汗。若误下之。致虚阳欲
亡而上奔。额上汗出而喘。乃孤阳绝于上也。湿邪在里。唯恐其小便不利。下后而小便反利。及下利不
止者。肾主二阴之窍而不摄。是真阳脱于下也。上绝下脱。故皆为死证也。
病者一身尽疼。发热。日晡所剧者。此名风湿。此病伤于汗出当风。或久伤取冷所致也。
一身尽疼者。湿流关节也。发热者。风邪在表也。日晡所。阳明气旺之时也。风为阳邪。湿为淫气。
风湿之邪。留着于肌肉关节之间。阴阳应象论所谓湿伤肉者是也。以阳明专主肌肉。故至阳明气旺之时而剧也。
风湿两伤。故曰此名风湿。然此病因何得之。皆伤于汗出当风故也。盖汗欲出则阳气已动。腠理已开。
阴液已出矣。汗出当风。则风乘腠理之开而入矣。风邪既入。汗不得出。以离经之汗液。既不得外出皮毛。
又不能内返经络。留于腠理肌肉之中而为湿矣。虽非泥水雨雪之湿。亦非雾露岚瘴之比。乃人身汗液之湿也。
湿虽不同。而其为病则大同小异。与他湿同然也。所以湿流于关节肌肉而身疼。风入皮肤腠理而发热也。
其或暑汗当出之时。久伤于取冷太过。使欲出之汗。不得外泄。留着于肌肉腠理之所致。与汗出当风。
无以异也。此处虽无治法。然仲景于金匮要略此文之下。即有麻黄杏仁薏苡甘草汤。温服取汗之法。
即其治也。
问曰。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。汗之不愈者。何也。答曰。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。
此又设为问答。以明风湿兼治之法也。风湿相搏。谓风湿两相搏聚。而使一身尽疼也。天阴雨不止。
言又值湿气盛行之时也。汗大出而湿气尚在者。以风乃无形之邪。外袭皮毛。故随汗可去。湿乃重浊之气。
淫着于肌肉。流滞于关节之间。不能随迅发之大汗而骤出。故大汗则风气去而湿气在也。若治风湿之法。
固当发其汗矣。然服药之后。但令其热气从内达外。如蒸蒸发热之状。使微微似欲汗出。气蒸肤润。久令
如此。则风湿留着之邪。渐出而俱去矣。治法如此。方得尽去。不然。则风去而湿仍在矣。
伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求之。
此条本在太阳篇中伤寒条下。因湿病又为六气之一。非伤寒所得而该。故留此一条于伤寒例中。以为标
目。使后之临证者。遇伤寒而有寒湿之兼证者。当另于寒湿门中求其治法可也。今附于此。以便学人之
寻求追讨焉。以下二条。王叔和亦编入伤寒条内。及观金匮要略。则此二条。仍在 湿 三症篇中。故亦移
入于此。萃成寒湿一门。倘伤寒有此兼症。当于此中寻求治法。即仲景所谓于寒湿中求之是也。
此言见证虽
属伤寒。头痛发热。恶风无汗。法当汗解。而以麻黄汤发其汗。至发汗以后。邪气不解而身目又为之发黄。
何也。究其所以然者。不但有在表之邪。盖因寒邪与湿气。抟结在里而不解故也。然寒湿之邪。非阳明瘀热
发黄。及身黄如橘子色者。可与茵陈蒿汤下之可比。阴寒本无下法。所以此证为不可下也。故当于湿病一门之寒湿中
求之。即下文桂枝附子汤。及去桂枝加白术汤。与甘草附子汤者是也。尚论谓即麻黄连翘赤小豆汤。茵陈蒿汤。栀
子柏皮汤三法。误矣。此条不言伤寒之脉证。但云发汗已。身目为黄。若此。何以知为寒湿在里乎。不知阳明
篇中。湿热郁蒸之发黄。一则曰发热汗出者。此为热越不能发黄。但头汗出。身无汗。剂颈而还。小便不利。
渴饮水浆者。此为瘀热在里。身必发黄。而以茵陈蒿汤下之。又曰阳明病。面合赤色。不可攻之。必发身黄。小
便不利也。又云阳明病。无汗小便不利。心中懊 。身必发黄。又云阳明病。被火。额上微汗出。小便不利者。必发黄。
又云伤寒瘀热在里。身必发黄。麻黄连翘赤小豆汤主之。伤汗七八日。身黄如橘子色。小便不利。腹微满者。茵
陈蒿汤主之。伤寒身黄发热者。栀子柏皮汤主之。此条不言发热。亦不言小便不利。不言被火。并不言头汗。则非瘀
热可知。但以伤寒无汗而发之。得汗后。亦可谓热邪发越。亦不能发黄矣。乃至身目为黄。盖因其证本属伤寒而
汗不能解。是以知寒不在表而在里矣。然非湿不能发黄。故又知寒湿在里也。寒湿之治。不应混列于伤寒篇中。
故当于寒湿症中求之耳。仲景之文。虽似不言其证治。而细揣其义。不啻耳提面命矣。学人果能寻绎其文。则领会其
不言之教亦多矣。故自序云。若能寻余所集。思过半矣。
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。
此条既云伤寒。又曰风湿相搏。当是风寒并感。应入太阳下编。不应置之太阳中篇。因本是湿邪兼症。故移入湿证
条中。汇集一门。以便查核。大凡中风伤寒之邪。至八九日。设不传入他经。亦必入里而不在表矣。夫寒为阴邪。在
表则当体痛。风为阳邪。热郁
则必发烦。至八九日之久。烦则或有。体痛者绝少矣。此证虽属伤寒。因又有湿邪搏聚。湿亦阴邪。流于关节。
所以身体烦疼。而身重不能转侧也。不呕不渴。邪不在胃。未入于里也。脉浮虚而涩者。浮则为风。浮则按之
无力。即所谓浮则为虚也。寒邪在营。血脉不得流利则涩。湿流关节。气血不快于流行亦涩。正风寒湿三气
所着之脉。名为湿痹者是也。法当兼治。故以桂枝附子汤主之。
若其人大便硬。小便自利者。去桂枝加白术汤主之。
湿在里则小便不利。大便反快。大便硬则湿不在里。小便利则湿气已去。不须汗泄。故去桂枝。想风湿之后。
寒湿之余气未尽。身体尚疼。转侧未便。故仍用去桂枝之白术附子汤也。
桂枝附子汤方
桂枝（四两） 附子（二枚） 生姜（三两） 甘草（二两） 大枣（十二枚）
上五味。以水六升。煮取二升。去滓。分温三服。
风邪非桂枝不能汗解。寒邪非附子不足以温经。非生姜亦不能宣散。甘草大枣。缓姜附之性。助桂枝而行津液也。
此方乃太阳上编误下之后。脉促胸满微恶寒之桂枝去芍药汤而加附子。非汗后遂漏不止之桂枝加附子汤也。
桂枝附子汤乃去芍药者。故另立一名而无加字。桂枝加附子汤乃不去芍药者。即于桂枝全汤中加入。故多一加
字。若不去芍药之酸收。即为伤寒无汗之禁剂矣。然既曰伤寒而不用麻黄汤。独取桂枝者。非但用之以解散卫分
风邪。因其见证皆属阴寒。阳气已弱。脉已浮虚。不宜大汗。若大汗之。非惟犯上文汗大出者。但风气去湿气在之戒。
具有亡阳之祸。故用桂枝附子汤。但令微微似欲汗出。则风湿皆去。不必用术燥湿也。观仲景立法处方无不各有
太阳病。关节疼痛且伴有烦扰感，脉象沉而细的，这称为湿痹的证候。患者小便不通畅，大便反而稀溏，治疗时只应当通利小便。
湿气，是六气（风、寒、暑、湿、燥、火）之一。然而在一气之中，还有区别。雾露之气，是从地面升腾起来的轻清之气，所以属于湿中的“清”邪。伤害人体时，多从上部的皮毛腠理侵入。
雨雪泥水之湿，是附着在地面的重浊之气，在下部，所以属于湿中的“浊”邪。伤害人体时，多从下部的筋骨关节侵入。医经说：清邪伤上部，浊邪伤下部。
所以《金匮要略》说：湿邪伤下部，雾邪伤上部。雾邪伤害皮肉腠理，湿邪流注于关节。之所以也称为太阳病，是因为风寒暑湿等邪气，都是因为卫气不固密，邪气得以从皮毛而入。因为营气和卫气都归属于太阳经的缘故。关节，是指筋骨肢节之间。凡是湿邪中人，必定流注于肢节，导致烦疼肿痛。所以《素问·阴阳应象大论》中说：地之湿气，感受了就会伤害人的皮肉筋骨。由于雨露水湿之气，因卫阳不能在外固护，由太阳经流入到关节筋骨之间，导致肢节疼痛且烦扰不宁。其脉象沉而细的，这就叫湿痹。
那么如何辨别呢？譬如寒伤营分的证候，虽然也有身疼、腰痛、骨节疼痛，但其脉象是浮紧的。本病的脉象沉细，症状却有发热、颈项强直紧急、口噤、角弓反张。湿病的脉象也是沉细，症状也是骨节烦疼。症状不同则脉象相同，症状相同则脉象不同，这就是它们的区别所在。脉象沉细，是因为寒湿流注在皮肉筋脉之间，血液凝滞，气机阻滞，营卫运行不畅，所以脉细且疼痛。
湿痹的证候中，如果寒湿内侵，三焦就不能正常气化施化，气机不得流行。患者小便不利，因此水谷不能分别清浊，湿气流溢到大肠，所以大便不会燥结，反而稀溏快利。像这种情况，不需要用燥湿的方法治疗。因为湿气淫溢泛滥，不是单纯燥湿所能胜过的。所以只应当通利小便。因为通过燥湿去除的湿气很少，而通过渗利去除的湿气很多。所以小便利，则水谷分清，湿邪淫溢也就去除了。这一条大概论述的是雨雪泥水地气之湿，乃是湿中的浊邪。所以说只应当通利小便。如果是雾露的清邪，就应当用微微出汗的方法来解表。然而，“利小便”这句话，应当审察其脉证机理，不可泛然地只用淡渗利湿的方法治疗。脉象既已沉细，关节已经疼痛，且小便不利，那么阴寒可知。自然应当以寒湿为治，责之于下焦无火，膀胱的气化功能不行。那么五苓散，以及甘草附子汤之类的方剂，其中的意旨就在言外了。
患有湿病的病人，全身都疼痛，发热，身体颜色像被烟熏过一样发黄。
这也是论述两水地气之湿。全身都疼痛，就是前面所说的湿流注关节的意思。前面说脉沉而细，明确是寒湿之邪。这里虽然没有提到脉象，但说发热，说明邪气还在经络。身体颜色像烟熏黄，是湿邪已经入里，脾脏受到湿邪伤害，中央土的颜色已经显露于外部。湿邪充塞浸灌在表里肌肉肢节之间，所以全身都疼痛且身体颜色像烟熏黄。熏黄，是指像烟熏的样子，黄中带黑且不明亮润泽。大概黄疸家有阴阳的区别，阳黄明亮润泽，阴黄则黑暗而无光泽。《素问·五脏生成篇》说：黄色像蟹腹那样生的，黄色像枳实那样死的。如阳明篇伤寒发黄，身体像橘子色，用茵陈蒿汤攻下；以及身体发黄发热，用栀子柏皮汤；甚至用麻黄连轺赤小豆汤的，都是因为瘀热在里，小便不利，湿热停蓄所致。这些都属阳黄。此证全身都疼痛，已属寒湿之邪，流注于关节且身体颜色像烟熏黄，即属于阴黄一类。外部虽然发热，尚为太阳在表的邪气。其显现的颜色，是由内达外的，既然像烟熏，或许应当在寒湿中寻求治疗方法，也未可知。但必须详细审察其脉证然后施治。张仲景之所以不设立治法，大概是希望人们在阴阳寒热中去寻求罢了。没有一定可以模仿的法度。如果设立一个固定的治法，就会拘泥于一偏，恐怕后人执着于此说而不能圆通变化。
患湿病的人，身上疼痛，发热，面色黄且气喘，头痛鼻塞且烦闷。脉象大，能正常饮食，腹部平和，没有病。这是因为病在头部受寒湿侵袭，所以鼻塞，将药物纳入鼻中就能痊愈。
成无己的注释往往不能阐发张仲景的深义，从而被后世讥讽。只有这一条的注释，颇得原文的精义。但还嫌其语焉不详，多有缺失。现在我就顺着他的意思加以申述。这大概是说感受了雾露所致的湿，也就是所谓清邪伤上部的情况。既然称为湿家，却不提关节疼痛，也不说全身都疼痛，更不说骨节烦疼掣痛，只说身上疼痛。“身上”指的是身体的上部。邪气在上焦，这是湿邪未流注于关节，而是外客于身体上部的肌表。不说发热身体像熏黄，只说发热面黄且气喘。这说明湿邪未入里，颜色仅现于头面。气喘，是因为肺主皮毛，开窍于鼻，湿邪侵袭皮毛，内壅肺气，所以鼻塞且气喘。这不是胸腹胀满引起的气喘。如果寒湿在里，则属于阴邪，不会有头痛发热的症状，脉象应当沉细。此处却是发热头痛，鼻塞且烦闷，这是邪气仅在上焦，丝毫不犯里。所以脉象大而能正常饮食，腹部平和而身躯脏腑无病。这个病只是因为头部受寒湿侵袭所以鼻塞。
病位浅不必探求，不需要配制汤药。只应当用辛香开发性质的药物，纳入鼻中，以宣泄头中的寒湿就能痊愈。朱奉议和王氏《准绳》，都用瓜蒂散。
患湿病的人，只是头部出汗，背部僵硬，想要盖被子靠近火源取暖。如果过早使用攻下法，就会出现呃逆、胸满、小便不利，舌面上好像有苔的情况。这是因为丹田有热，胸中有寒。想喝水却不能喝，所以口干燥烦闷。
这是说雾露寒湿之邪伤害人体。太阳经脉，挟持背脊行于两旁。寒湿侵犯它，所以背部僵硬。寒邪在表，所以想要盖被子靠近火源。寒湿之邪，留滞在太阳经脉，阳气不能流行。因为头是诸阳之会，诸阴络不能到达头部，都在颈部以下返回。阳气不行，独聚于头部，所以这个人只是头部出汗。这就是所谓清邪伤上部。当表邪未解的时候，如果过早攻下，那么寒湿之邪，就会乘下后正气虚弱，内陷入胃。胃气受伤败坏而发生呃逆。呃逆，就是俗话说的冷呃。呃逆且胸满，小便不利，是因为寒湿在中焦，胃气不行，三焦不运。上焦之气不降，则浊气郁塞而胸满。下焦的清阳不升，则气化不行而小便不利。舌面上好像有苔，如果是热邪入胃，则舌面上或黄或黑，或有芒刺，或干硬，或燥裂，这些都是苔。这里说“好像有苔”，乃是湿滑而色白，似苔非苔。那么为什么会这样呢？因为寒湿之邪，陷入于里而在胸膈，命门的真阳，不能上升而在下焦。上下不通，所以说丹田有热，胸中有寒。下焦的真火，既然不能上达，就是所谓清阳不升。这是下焦没有蒸腾的作用，气液不能上腾而为涕唾，所以口渴。又因为寒湿在胸，道路阻绝，所以虽然想喝水却不能喝，导致口干燥而烦渴。张仲景虽然不设立治法，但以理推测，邪在太阳之表，则应当发汗解表。头部既已出汗，不应当用麻黄。胸中的寒邪应当去除，下焦的气化应当运行。依法应当温补。那么下文的桂枝附子汤、甘草附子汤，就是它的治疗方剂。前人拟定的陷胸汤，恐怕不是正确的治法。即使是五苓散、理中汤，虽然接近道理，却未尽善尽美。为什么呢？因为它们只能温中而不能解表。所以必须用桂枝附子汤才妥当。
患湿病的人，误用攻下法后，额头出汗，微喘，小便自利的，死。如果下利不止的，也死。
治疗湿病只有发汗法和利小便法，而没有攻下法。上文因为寒邪在表，过早攻下就有呃逆、胸满、小便不利等变证。然而被寒湿所中，阳气已经受伤而误用攻下法，必定导致亡阳变逆而死。湿邪在表，本来适宜发汗。如果误用攻下法，导致虚阳欲亡而上奔，额头出汗而喘，这是孤阳绝于上。湿邪在里，唯恐其小便不利。攻下后小便反而利，以及下利不止的，肾主管二阴之窍而不摄纳，这是真阳脱于下。上绝下脱，所以都是死证。
病人全身都疼痛，发热，在日晡时分（下午3-5点）加重的，这称为风湿。这个病是由于出汗时当风，或者久伤于贪凉取冷所导致的。
全身都疼痛，是湿流注关节。发热，是风邪在表。日晡时分，是阳明气旺盛的时候。风为阳邪，湿为淫气。风湿之邪，留滞在肌肉关节之间，正如《阴阳应象大论》所说湿伤肉。因为阳明专主肌肉，所以到了阳明气旺的时候病情加重。风湿两伤，所以称为风湿。那么这个病因何得来？都是因为出汗时当风造成的。大概汗欲出时阳气已动，腠理已开，阴液已出。汗出当风，则风邪乘腠理之开而入。风邪既入，汗不得出。离经的汗液，既不能外出皮毛，又不能内返经络，留于腠理肌肉之中而成为湿。虽然不是泥水雨雪之湿，也不是雾露岚瘴之比，乃是人身汗液之湿。湿虽然不同，但其致病则大同小异，与其他湿邪相同。所以湿流于关节肌肉而身疼，风入皮肤腠理而发热。或者是暑天汗欲出之时，久伤于贪凉取冷太过，使欲出的汗，不能外泄，留滞在肌肉腠理所致。与汗出当风，没有什么不同。这里虽然没有治法，但张仲景在《金匮要略》此文之下，就有麻黄杏仁薏苡甘草汤，温服取汗的方法。就是它的治疗方剂。
问曰：风湿相搏，全身都疼痛，依法应当发汗而解。正值天阴雨不止，医生说：这可以发汗。发汗后不愈，为什么呢？答曰：发其汗，汗大出的，只是风气去了，湿气还在，所以不愈。如果治疗风湿，发其汗，只要微微似欲汗出的，风湿俱去。
这又是设为问答，以阐明风湿兼治的方法。风湿相搏，是说风湿两相搏聚，而使全身都疼痛。天阴雨不止，是说又值湿气盛行之时。汗大出而湿气尚在的，因为风乃无形之邪，外袭皮毛，所以随汗可去。湿乃重浊之气，淫着于肌肉，流滞于关节之间，不能随迅发之大汗而骤出。所以大汗则风气去而湿气在。如果治疗风湿的方法，固然应当发其汗了。然而服药之后，只令其热气从内达外，如蒸蒸发热之状，使微微似欲汗出，气蒸肤润，久令如此，则风湿留着之邪，渐出而俱去矣。治法如此，方能尽去。不然，则风去而湿仍在。
伤寒发汗后，身体和眼睛发黄。之所以这样，是因为寒湿在里不解的缘故。认为不可以攻下。应当在寒湿中寻求治法。
这一条原本在太阳篇中伤寒条下，因为湿病又是六气之一，不是伤寒所能包括的，所以留这一条于伤寒例中，作为标目，使后来的临证者，遇到伤寒而有寒湿兼证的，应当另在寒湿门中寻求其治法即可。现在附于此，以便学人寻求追讨。以下两条，王叔和也编入伤寒条内。及观《金匮要略》，则这两条，仍在湿病篇中。所以也移入于此，萃成寒湿一门。倘若伤寒有此兼症，应当于此中寻求治法，就是仲景所谓“于寒湿中求之”。
这里说见证虽属伤寒，头痛发热，恶风无汗，依法应当发汗解表。如果用麻黄汤发其汗，至发汗以后，邪气不解而身体和眼睛又为之发黄。为什么呢？究其所以然，不但有在表之邪，盖因寒邪与湿气，抟结在里而不解。然而寒湿之邪，不像阳明瘀热发黄，及身黄如橘子色者，可与茵陈蒿汤攻下可比。阴寒本无攻下法，所以此证为不可下。故应当在湿病一门的寒湿中寻求。即下文桂枝附子汤，及去桂枝加白术汤，与甘草附子汤是。尚论谓即麻黄连翘赤小豆汤、茵陈蒿汤、栀子柏皮汤三法，是错误的。这一条不言伤寒的脉证，只说发汗后，身体和眼睛发黄。像这样，怎么知道是寒湿在里呢？不知道阳明篇中，湿热郁蒸之发黄，一则曰发热汗出者，此为热越不能发黄。但头汗出，身无汗，剂颈而还，小便不利，渴饮水浆者，此为瘀热在里，身必发黄，而以茵陈蒿汤攻下。又曰阳明病，面合赤色，不可攻之，必发身黄，小便不利也。又云阳明病，无汗小便不利，心中懊憹，身必发黄。又云阳明病，被火，额上微汗出，小便不利者，必发黄。又云伤寒瘀热在里，身必发黄，麻黄连翘赤小豆汤主之。伤汗七八日，身黄如橘子色，小便不利，腹微满者，茵陈蒿汤主之。伤寒身黄发热者，栀子柏皮汤主之。这一条不言发热，也不言小便不利，不言被火，并不言头汗，则非瘀热可知。但以伤寒无汗而发之，得汗后，亦可谓热邪发越，亦不能发黄矣。乃至身目为黄，盖因其证本属伤寒而汗不能解，是以知寒不在表而在里矣。然非湿不能发黄，故又知寒湿在里也。寒湿之治，不应混列于伤寒篇中，故当于寒湿症中寻求。仲景之文，虽似不言其证治，而细揣其义，不啻耳提面命矣。学人果能寻绎其文，则领会其不言之教亦多矣。故自序云：若能寻余所集，思过半矣。
伤寒八九日，风湿相搏，身体烦疼，不能自己转侧，不呕不渴，脉浮虚而涩的，桂枝附子汤主治。
这一条既云伤寒，又曰风湿相搏，应当是风寒并感，应入太阳下编，不应置之太阳中篇。因本是湿邪兼症，故移入湿证条中，汇集一门，以便查核。大凡中风伤寒之邪，至八九日，设不传入他经，亦必入里而不在表矣。夫寒为阴邪，在表则当体痛。风为阳邪，热郁则必发烦。至八九日之久，烦则或有，体痛者绝少矣。此证虽属伤寒，因又有湿邪搏聚，湿亦阴邪，流于关节，所以身体烦疼，而身重不能转侧。不呕不渴，邪不在胃，未入于里。脉浮虚而涩者，浮则为风，浮则按之无力，即所谓浮则为虚也。寒邪在营，血脉不得流利则涩。湿流关节，气血不快于流行亦涩。正风寒湿三气所着的脉，名为湿痹者是也。法当兼治，故以桂枝附子汤主治。
湿在里则小便不利，大便反快。大便硬则湿不在里，小便利则湿气已去，不须汗泄，故去桂枝。想风湿之后，寒湿之余气未尽，身体尚疼，转侧未便，故仍用去桂枝之白术附子汤。
桂枝附子汤方
桂枝（四两） 附子（二枚） 生姜（三两） 甘草（二两） 大枣（十二枚）
以上五味，以水六升，煮取二升，去滓，分温三服。
风邪非桂枝不能汗解，寒邪非附子不足以温经，非生姜亦不能宣散。甘草大枣，缓姜附之性，助桂枝而行津液也。此方乃太阳上编误下之后，脉促胸满微恶寒之桂枝去芍药汤而加附子，非汗后遂漏不止之桂枝加附子汤也。桂枝附子汤乃去芍药的，故另立一名而无加字。桂枝加附子汤乃不去芍药的，即于桂枝全汤中加入，故多一加字。若不去芍药之酸收，即为伤寒无汗之禁剂矣。然既曰伤寒而不用麻黄汤，独取桂枝者，非但用之以解散卫分风邪，因其见证皆属阴寒，阳气已弱，脉已浮虚，不宜大汗。若大汗之，非惟犯上文汗大出者，但风气去湿气在之戒，具有亡阳之祸。故用桂枝附子汤，但令微微似欲汗出，则风湿皆去，不必用术燥湿也。观仲景立法处方无不各有
Taiyang disease (disease of the Taiyang channel). Joint pain accompanied by restlessness, with a deep and thin pulse, is named Wet-Bi syndrome (Bi syndrome caused by dampness). The patient has difficulty urinating, while the stool is loose. Treatment should focus solely on promoting diuresis.
Dampness is one of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire). However, within this single Qi, there are distinctions. The misty dew vapor rises from the ground as light and clear energy ascending upwards; thus, it belongs to the "clear" aspect of dampness. When injuring the human body, it typically affects the upper parts.
The dampness of rain, snow, mud, and water adheres to the ground as heavy and turbid energy residing below; thus, it belongs to the "turbid" aspect of dampness. When injuring the human body, it typically affects the lower parts. The Classics state: Clear pathogens affect the upper part, turbid pathogens affect the lower part.
Therefore, *Jin Gui Yao Lue* states: Dampness injures the lower part, mist injures the upper part. Mist injures the skin and interstices, while dampness flows into the joints. It is also referred to as Taiyang disease because pathogens such as Wind, Cold, Summerheat, and Dampness enter through the pores due to the insecurity of Defensive Qi (Wei Qi). This is because Ying (Nutritive) and Wei (Defensive) energies both belong to the Taiyang channel. Joints refer to the spaces between bones, sinews, and limbs. Whenever dampness invades the human body, it must flow into the limbs and joints, causing painful swelling and restlessness. Thus, in *Su Wen: Yin Yang Ying Xiang Lun*, it is said: "Earth's dampness, when contracted, harms the skin, flesh, bones, and sinews." Due to the vapor of rain, dew, and water, and because Defensive Yang fails to secure the exterior, it flows from the Taiyang channel into the joints and sinews, causing joint pain and restlessness. A deep and thin pulse indicates Wet-Bi.
How then can it be distinguished? For example, in Cold injuring the Ying level, although there may be body ache, waist pain, and joint pain, the pulse is floating and tight. In this disease, the pulse is deep and thin, yet symptoms include fever, neck stiffness, lockjaw, and opisthotonos. In Wet-Bi, the pulse is also deep and thin, and symptoms include joint pain and restlessness. Different symptoms with the same pulse, or same symptoms with different pulses, distinguish them. A deep and thin pulse occurs because Cold-Damp flows into the skin, flesh, sinews, and vessels, causing blood coagulation and Qi stagnation, leading to poor circulation of Ying and Wei, resulting in a thin pulse and pain.
In Wet-Bi, if Cold-Damp invades internally, the San Jiao cannot perform its transformative functions, and Qi mechanism fails to circulate. The patient experiences difficulty urinating; consequently, food and fluids fail to separate clearly, and dampness overflows into the Large Intestine. Thus, the stool does not become dry but becomes loose. In such cases, treatment should not focus on drying dampness. Since dampness is overflowing and profuse, simple drying methods cannot overcome it. Therefore, one should only promote diuresis. Because the amount of dampness removed by drying is small, whereas that removed by渗利 (percolating and draining) is large. When urination improves, food and fluids separate, and the overflowing dampness is eliminated. This clause discusses the dampness of earth from rain, snow, mud, and water, which is the "turbid" aspect of dampness. Hence, it states to promote diuresis. If it were the "clear" pathogen of mist and dew, treatment would involve inducing slight sweating. However, the phrase "promote diuresis" requires careful examination of the pulse and symptoms; one should not generically use bland percolating agents. With a deep and thin pulse, joint pain, and difficulty urinating, Yin-Cold is evident. Treatment should address Cold-Damp, attributing it to the lack of fire in the Lower Jiao and the failure of Bladder Qi transformation. Formulas such as Wuling San (Five-Ling Powder) and Gancao Fuzi Tang (Licorice and Aconite Decoction) are implied.
Patients suffering from Dampness diseases experience whole-body pain, fever, and a complexion resembling smoked yellow.
This also discusses the dampness of earth waters. Whole-body pain refers to the previously mentioned flowing of dampness into joints. Previously, the pulse was described as deep and thin, indicating Cold-Damp. Although no pulse is mentioned here, the presence of fever indicates the pathogen remains in the channels. A complexion resembling smoked yellow indicates dampness has entered the interior, damaging the Spleen, causing the color of Central Earth to manifest externally. Dampness fills and saturates the interior, exterior, muscles, and joints, causing whole-body pain and a smoked-yellow complexion. "Smoked yellow" resembles smoke staining, appearing yellowish-black without brightness or luster. Jaundice cases have Yin and Yang distinctions: Yang Jaundice is bright and lustrous, while Yin Jaundice is dark and dull. *Su Wen: Wu Zang Sheng Cheng Pian* states: "Yellow like crab belly indicates survival; yellow like zhi shi (immature orange) indicates death." In the Yangming chapter, jaundice from Cold-Damp presents with a body color like an orange, treated with Yinchen Hao Tang (Artemisia Capillaris Decoction) via purgation; or with fever and jaundice, treated with Zhizi Bapi Tang (Gardenia and Phellodendron Bark Decoction); or even Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction). These are all caused by stagnant heat in the interior, difficulty urinating, and accumulation of Damp-Heat, belonging to Yang Jaundice. This case involves whole-body pain, indicating Cold-Damp flowing into joints and a smoked-yellow complexion, belonging to Yin Jaundice. Although there is external fever, it remains a Taiyang exterior pathogen. The manifested color arises from the interior reaching the exterior. Since it resembles smoke, perhaps treatment should seek solutions within Cold-Damp. Detailed examination of pulse and symptoms is necessary. Zhang Zhongjing did not establish specific treatments here, likely hoping practitioners would seek solutions within Yin-Yang and Cold-Heat dynamics, avoiding rigid formulas. Establishing a fixed method might lead to dogmatism, preventing flexible application.
Patients with Dampness diseases experience body pain, fever, yellow face, and wheezing; headache, nasal congestion, and restlessness. The pulse is large, they can eat normally, the abdomen is harmonious, and there is no internal disease. This is because cold-damp resides in the head, causing nasal congestion. Inserting medicine into the nose will cure it.
Cheng Wuji's annotations often fail to elucidate Zhang Zhongjing's profound meaning, inviting criticism. Only this annotation captures the essence, though it remains vague. Expanding on this: This describes dampness contracted from mist and dew, i.e., clear pathogens affecting the upper part. Calling it "Dampness patient" without mentioning joint pain or whole-body pain, but only "body pain," implies the pathogen is in the upper Jiao, affecting the surface muscles of the upper body rather than flowing into joints. Not mentioning fever and smoked-yellow body, but only fever, yellow face, and wheezing, indicates dampness has not entered the interior, and color manifests only on the head and face. Wheezing occurs because the Lung governs skin and hair and opens into the nose; dampness invading the skin obstructs Lung Qi, causing nasal congestion and wheezing, not abdominal distension. If Cold-Damp were in the interior, it would be a Yin pathogen, lacking headache and fever, with a deep-thin pulse. Here, fever, headache, nasal congestion, and restlessness indicate the pathogen is solely in the Upper Jiao, not affecting the interior. Thus, the pulse is large, appetite is normal, and the abdomen is harmonious. The disease is merely cold-damp in the head causing nasal congestion.
For superficial diseases, extensive investigation is unnecessary, and decoctions are not required. Use pungent and aromatic opening medicines inserted into the nose to ventilate and disperse cold-damp in the head. Zhu Fengyi and Wang Shi's *Zhunsheng* both used Gengti San (Melon Tip Powder).
Dampness patients exhibit sweating only on the head, back stiffness, and a desire to cover themselves with blankets and face fire. If purged prematurely, hiccups, chest fullness, and difficulty urinating occur, with a tongue coating resembling moss. This is because there is heat in the Dantian (Lower Jiao) and cold in the Chest (Upper/Middle Jiao). Thirst for water but inability to drink leads to dry mouth and restlessness.
This describes invasion by misty cold-damp. The Taiyang meridian runs along both sides of the spine. Cold-damp invasion causes back stiffness. Cold pathogen in the exterior creates a desire for warmth. Cold-damp lingering in the Taiyang channel prevents Yang Qi circulation. Since the head is the meeting point of all Yang meridians, and Yin collaterals do not reach the head, stopping at the neck, Yang Qi accumulates in the head, causing head sweating ("clear pathogens affect the upper"). If purged while exterior pathogen persists, cold-damp enters the Stomach due to deficiency, damaging Stomach Qi and causing hiccups (cold hiccups). Hiccups with chest fullness and difficulty urinating indicate cold-damp in the Middle Jiao, Stomach Qi stagnation, and San Jiao dysfunction. Upper Jiao Qi fails to descend, causing turbid Qi obstruction and chest fullness. Lower Jiao Clear Yang fails to ascend, causing Qi transformation failure and difficulty urinating. "Tongue resembling moss" differs from heat-induced coatings (yellow, black, prickly, dry). Here, it is wet, slippery, white, and moss-like. This results from cold-damp sinking into the interior (chest/diaphragm), preventing Mingmen True Yang from rising to the Lower Jiao. Upper-lower blockage causes "heat in Dantian, cold in chest." Lower Jiao fire cannot ascend (Clear Yang not rising), failing to vaporize fluids into saliva, causing thirst. Cold-damp in the chest blocks pathways, preventing drinking despite thirst, causing dry mouth and restlessness. Although Zhang Zhongjing sets no formula, reasoning suggests: Exterior Taiyang pathogen requires sweating. Since head sweating already occurred, Mahuang is contraindicated. Chest cold must be removed, and Lower Jiao Qi transformation restored. Warmth is indicated. Thus, Guizhi Fuzi Tang or Gancao Fuzi Tang are appropriate. Qianxiong Tang is unsuitable. Wuling San or Lizhong Tang are close but incomplete as they warm the middle but do not resolve the exterior. Guizhi-based formulas are best.
If a Dampness patient is purged, sweating on the forehead, slight wheezing, and free urination indicate death. If diarrhea persists, it also indicates death.
Treatment for Dampness involves sweating and diuresis, never purgation. Earlier, premature purgation for exterior Cold caused hiccups, chest fullness, and urinary difficulty. Here, Cold-Damp has damaged Yang Qi; erroneous purgation leads to Yang collapse and death. Exterior Dampness suits sweating. Erroneous purgation causes deficient Yang to flee upward, causing forehead sweating and wheezing (isolated Yang severed above). Interior Dampness fears urinary difficulty. Post-purgation free urination or persistent diarrhea indicates Kidney failure to control the two yin orifices, signifying True Yang collapse below. Severed above and collapsed below are fatal.
Patients experience whole-body pain, fever, worsening at dusk (You hour). This is named Wind-Damp. Caused by sweating while exposed to wind, or prolonged exposure to cold.
Whole-body pain indicates dampness in joints. Fever indicates Wind pathogen in the exterior. You hour (3-5 PM) is when Yangming Qi is vigorous. Wind is Yang pathogen; Dampness is excessive Qi. Wind-Damp lingers in muscles and joints, as stated in *Yin Yang Ying Xiang Lun*: "Dampness harms flesh." Yangming governs flesh, hence worsening during Yangming time. Both Wind and Damp injure, hence "Wind-Damp." Cause: Sweating while exposed to wind. When sweat emerges, Yang Qi moves, pores open, and Yin fluids exit. Wind enters opened pores. Sweat cannot exit; displaced fluid stays in interstices and muscles, becoming damp. Though not mud/rain dampness, nor mist dampness, it is bodily sweat-damp. Pathogenesis is similar to other dampness. Dampness in joints/muscles causes pain; Wind in skin/pores causes fever. Alternatively, summer sweating followed by excessive cooling traps sweat in muscles/pores, similar to wind exposure. No formula is given here, but *Jin Gui Yao Lue* provides Mahuang Xingyi Yiyi Gancao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction), taken warm to induce sweating.
Q: Wind-Damp binding causes whole-body pain. Method dictates sweating resolves it. Why does sweating fail during rainy weather?
A: Profuse sweating expels Wind but leaves Dampness, hence failure. To treat Wind-Damp, induce slight, continuous sweating so both Wind and Damp are expelled.
This dialogue clarifies combined treatment. Wind-Damp binding causes pain. Rainy weather indicates abundant Dampness. Profuse sweating removes Wind (formless, exits with sweat) but leaves Dampness (heavy/turbid, stuck in muscles/joints). Slight, continuous sweating allows internal heat to reach the exterior, moistening skin, gradually expelling both pathogens. Otherwise, Wind leaves, Damp remains.
After Taiyang disease sweating, body and eyes turn yellow. Reason: Cold-Damp unresolved in the interior. Purging is contraindicated. Seek treatment within Cold-Damp protocols.
This clause originally follows Taiyang Cold-Damp sections. Dampness is one of Six Qi, distinct from Cold Damage. Included here as a marker for clinicians encountering Cold-Damp complications in Cold Damage. Moved to align with *Jin Gui Yao Lue*. If Cold Damage presents with Cold-Damp, seek treatment in the Cold-Damp section ("seek within Cold-Damp").
Symptoms resemble Cold Damage: headache, fever, aversion to wind, no sweat. Method: sweating with Mahuang Tang. Post-sweating, pathogen persists, and jaundice appears. Why? Cold and Damp bind in the interior. Unlike Yangming Stagnant Heat Jaundice (orange-colored, treated with Yinchen Hao Tang), Cold-Damp lacks purgation indication. Yin-Cold has no purgation method. Seek treatment in Cold-Damp protocols: Guizhi Fuzi Tang, Baizhu Fuzi Tang (Guizhi removed), or Gancao Fuzi Tang. Claiming it uses Mahuang Lianqiao Chixiaodou Tang, Yinchen Hao Tang, or Zhizi Bapi Tang is incorrect. This clause mentions post-sweating jaundice but lacks pulse/symptom details for interior heat. How to know it is Cold-Damp? *Yangming* chapter distinguishes Heat Jaundice: fever/sweat prevents jaundice; head sweat only, no body sweat, urinary difficulty, thirst indicate stagnant heat (Yinchen Hao Tang). Face redness, no attack allowed, causes jaundice. No sweat, urinary difficulty, inner restlessness cause jaundice. Fire therapy, forehead sweat, urinary difficulty causes jaundice. Stagnant heat in interior causes jaundice (Mahuang Lianqiao Chixiaodou Tang). 7-8 days post-sweat, orange jaundice, urinary difficulty, mild abdominal fullness (Yinchen Hao Tang). Fever and jaundice (Zhizi Bapi Tang). This clause lacks fever, urinary difficulty, fire therapy, or head sweat, ruling out stagnant heat. Sweating failed to resolve exterior Cold, implying interior location. Without Dampness, jaundice cannot occur. Thus, Cold-Damp in interior. Cold-Damp treatment should not be mixed in Cold Damage chapters; seek in Cold-Damp section. Zhang Zhongjing's text implies treatment through subtle meaning. Students who explore deeply grasp much. As he wrote: "If you follow my collected works, you will understand half of what is needed."
After 8-9 days of Cold Damage, Wind-Damp binding causes body pain and restlessness, inability to turn over, no vomiting, no thirst, floating-deficient and choppy pulse. Treated with Guizhi Fuzi Tang.
Though labeled Cold Damage, "Wind-Damp binding" implies concurrent Wind and Cold. Should be in Lower Taiyang but moved here due to Dampness complication. After 8-9 days, pathogens usually enter interior unless transmitted elsewhere. Cold is Yin, causing body pain in exterior. Wind is Yang, causing restlessness with heat. After 8-9 days, restlessness may exist, but body pain is rare. Here, Cold-Damp binds, Damp (Yin) flows into joints, causing pain and heaviness/inability to move. No vomiting/thirst indicates pathogen not in Stomach/interior. Floating-deficient-choppy pulse: Floating indicates Wind; deficient indicates weakness; choppy indicates Cold in Ying blocking flow, and Damp in joints blocking Qi/Blood. This is the pulse of Wind-Cold-Damp binding, named Wet-Bi. Combined treatment is needed; Guizhi Fuzi Tang is indicated.
If stool is hard and urination is free, remove Guizhi and add Baizhu (Baizhu Fuzi Tang).
Interior Dampness causes urinary difficulty and loose stool. Hard stool means no interior Dampness; free urination means Dampness is gone. Sweating is unnecessary, so remove Guizhi. Residual Cold-Damp remains after Wind-Damp, causing pain and stiffness. Thus, use Guizhi-removed Baizhu Fuzi Tang.
Formula: Guizhi Fuzi Tang
Guizhi (Cinnamon Twig) 4 liang, Fuzi (Prepared Aconite Root) 2 pieces, Shengjiang (Fresh Ginger) 3 liang, Gancao (Licorice Root) 2 liang, Dazao (Jujube) 12 pieces.
Boil five ingredients in 6 sheng of water to obtain 2 sheng. Remove dregs. Divide into three warm doses.
Wind pathogen requires Guizhi to induce sweating. Cold pathogen requires Fuzi to warm channels. Shengjiang disperses. Gancao and Dazao moderate Jiang/Fu properties and assist Guizhi in circulating fluids. This formula derives from Guizhi Shaoyao Tang minus Shaoyao plus Fuzi (for post-error purgation with rapid pulse/chest fullness), NOT Guizhi Jia Fuzi Tang (for post-sweating leakage). Guizhi Fuzi Tang removes Shaoyao (astringent), hence no "Jia" (Add) in name. Guizhi Jia Fuzi Tang keeps Shaoyao. Keeping Shaoyao in non-sweating Cold Damage is contraindicated. Using Guizhi instead of Mahuang is not just for Wind, but because symptoms are Yin-Cold, Yang is weak, pulse is floating-deficient. Profuse sweating is dangerous (leaves Dampness, risks Yang collapse). Guizhi Fuzi Tang induces slight sweating, expelling Wind-Damp without needing Baizhu for drying. Observe Zhang Zhongjing's prescriptions...