【纲】仲景曰。太阳病。下之而不愈。因复发汗。此表里俱虚。其人因致冒。冒家汗出自愈。
所以然者。汗出邪和故也。得里未和。然后复下之。伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。发汗
则动经。身为振振摇者。茯
苓桂枝白术甘草汤主之。伤寒吐下后。发汗。虚烦。脉甚微。八九日心下痞硬。胁下痛。气上冲咽
喉。眩冒。经脉动惕者。久而成痿。太阳病。发汗太多。因致痉。脉沉而细。身热足寒。头项强急。时头热。面赤。目
脉赤。独头
面摇。卒口噤。背反张者。痉病也。
【目】成无己曰。 为眼花。眩为眼黑。眩也。运也。冒也。三者形俱相近。有谓眩运者。有谓
眩冒者。运为转运之运。世谓头旋者是。冒为蒙冒之冒。世谓昏迷者是。少阳病目眩。以少阳居表
里之间。表邪所传。渐行于里。表中阳虚。故时时目眩也。二阳并病。或眩运眩冒者。以少阳与
太阳并病。故眩者责其虚也。伤寒有起则头眩与眩冒者。皆汗吐下后所致。是知其阳虚也。故针经曰。
上虚则眩。下虚则厥。眩虽为虚。而风家亦有眩者。风主运动耳。阳明中风。亦有头眩。诸如此者。
皆非逆也。及其诸逆发汗。剧者。言乱目眩。必死之症也。
吴绶曰。太阳中风。头眩头摇者。脉浮弦而急也。羌活神术汤加天麻、防风之类。若血虚头眩。
四物汤加人参、天麻。痰火上攻。加黄芩、竹沥。内伤劳倦。阴虚头眩。补中益气汤加川芎、
天麻、防风、蔓荆子。下焦元气虚脱作眩。人参养荣汤。或大建中汤加天麻。
易老曰。头旋目黑。非天麻不能除。故必加之。
鳌按。妄汗下。亡津液。致表里俱虚。而其阳邪仍在。故表里不解而成冒。冒者如物蒙蔽。欲
汗之兆也。故汗出冒自解。妄吐下后而表阳虚。因致起则头眩。又复妄汗而经络虚。因致一身振摇
也。
吐汗下三者齐备。致脉微而虚烦。则眩冒动惕。皆虚烦之所发也。此亦半夏泻心汤之症。汗多亡
液。不转属阳明而成痉。因有头面动摇口噤反张等症。其时胃家津液未干。故变见者。仍是太阳表
症。如头项强急等也。当滋阴以和其里。勿用温药。炙甘草汤主之。
【纲】仲景曰。太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎、肺
俞、肝俞。诸乘寒者。则为厥。郁冒不仁。
【目】成无己曰。郁为郁结而气不舒。冒为虚冒而神不清。郁冒之来。皆虚热而乘寒也。金匮
云。新产妇人有三病。一者病痉。二者病郁冒。三者大便难。亡血复汗寒多。故令郁冒。又曰。产
妇郁冒。其脉微弱。呕不能食。大便坚。所以然者。血虚而厥。厥而必冒。冒家欲解。必大汗出。
即此观之。郁冒为虚寒可知矣。
喻昌曰。少阳之脉。络胁肋间。并入太阳之邪。则与结胸症似是而实非也。肝与胆合。刺肝俞。
所以泻胆也。膀胱不与肺合。然肺主气。刺肺俞以通其气。斯膀胱之气化行。而邪自不能留矣。
魏荔彤曰。考之穴图。大椎为督脉之穴。居于身后。肺俞肝俞。俱属太阳膀胱之穴。亦次第由
大椎而下。同居于背。是
皆太阳行身后之道路也。于此三刺。皆泄太阳经之表邪。而与肺肝膀胱之脏腑无涉焉。诸家牵扯傅
会。总由不知刺三穴泄经邪之义耳。原文当刺大椎第一间。考穴图。大椎穴在背后脊骨第一节之间
也。为督脉自项而下之第一穴。
鳌按。魏氏刺三穴。皆泄太阳经之表邪一句。诚为破的。盖病虽太少二阳相并。而治必归于一
经也。仲景论当刺大椎第一间肺俞肝俞之下。接云。慎不可发汗。发汗则谵语。脉弦。五六日谵语
不止。当刺期门。考期门。亦是太阳经穴。仲景云然者。以太阳阳明并病者。则宜汗。若太少二阳
并病。有少阳在。不宜汗也。即三阳合病中。亦无汗法。故仲景深戒为慎不可发汗。盖汗之。则太
阳之经邪不除。徒伤阳明之腑。以致谵语。故虽见少阳之弦脉。而少阳不宜汗。仍刺太阳经期门之
穴以代汗。不伤阳明少阳。而太阳治。此以刺法为并病之治法也。
头项强痛。或眩冒时如结胸。心下痞硬。其症全是太阳。而少阳之眩冒。亦为太阳所有。故治之
全从太阳也。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），经过攻下治疗后病情未愈，又再次发汗。这导致表里两方面的正气都虚弱，病人因此出现头目昏蒙的症状（冒）。患有这种昏蒙症状的人，如果自然出汗，病情就会痊愈。
之所以这样，是因为出汗后邪气调和的缘故。如果体内尚未调和，然后再进行攻下治疗。伤寒病如果经过催吐或攻下之后，胃脘部感到逆满不适，气向上冲至胸部，起身时头晕目眩，脉象沉而紧。此时如果再发汗，就会扰动经络，导致身体震颤摇晃。这种情况应当用茯苓桂枝白术甘草汤（Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction）来主治。
伤寒病经过催吐、攻下之后，又发汗，导致心中烦乱但无实邪（虚烦），脉象非常微弱。到了第八九日，胃脘部痞塞坚硬，胁肋部疼痛，气向上冲至咽喉，出现头晕目眩和头目昏蒙，经脉跳动不安，时间久了会发展成痿证（肢体萎软无力）。
太阳病，发汗过多，因此导致痉病（肌肉痉挛、角弓反张）。脉象沉而细，身体发热但脚冷，头项强直拘急，有时头部发热，面色发红，眼脉络赤红，只有头部和面部摇动，突然牙关紧闭，背部向后反折僵硬，这是痉病。
【目】成无己说：冒是指眼花视物模糊，眩是指眼前发黑。眩、运（眩晕）、冒这三种表现形态都很相近。有的称为眩运，有的称为眩冒。“运”是转运的意思，世俗所说的“天旋地转”就是这类情况；“冒”是蒙蔽的意思，世俗所说的昏迷就是这类情况。少阳病（少阳经受邪所致的病证）会出现目眩，因为少阳位于表里之间，表邪传入，逐渐向里发展，表中阳气虚弱，所以时常出现目眩。二阳并病（太阳与阳明同时发病），或者出现眩运、眩冒的情况，是因为少阳与太阳并病，所以出现眩症的责任在于虚。伤寒病中有起身时头晕目眩和眩冒的情况，都是由发汗、催吐、攻下之后引起的，由此可知这是阳气虚弱。所以《针经》说：上部虚弱则眩晕，下部虚弱则厥逆。眩症虽然属于虚证，但风病患者也有眩晕的，因为风主运动。阳明中风，也会出现头晕目眩，诸如此类的情况，都不是危重逆症。等到各种误治发汗后，病情严重的，会出现言语错乱、目眩，这是必死的病症。
吴绶说：太阳中风，出现头晕、头部摇动的，脉象浮弦而急。可以用羌活神术汤加入天麻、防风等药物。如果是血虚导致的头晕，用四物汤加入人参、天麻。如果是痰火上攻，加入黄芩、竹沥。如果是内伤劳倦、阴虚导致的头晕，用补中益气汤加入川芎、天麻、防风、蔓荆子。如果是下焦元气虚脱导致的眩晕，用人参养荣汤，或者大建中汤加入天麻。
易老说：头晕目黑，不用天麻不能消除，所以必须加入天麻。
沈金鳌按语：妄自发汗或攻下，耗伤津液，导致表里俱虚，而阳邪依然存在，所以表里之邪不解而形成冒症。冒症就像被物体蒙蔽一样，是想要出汗的先兆。所以出汗后冒症自然解除。妄自催吐、攻下后导致表阳虚弱，因而出现起身时头晕目眩。又再次妄自发汗导致经络虚弱，因而出现全身震颤摇晃。
吐、汗、下三种治疗方法都用上了，导致脉象微弱且虚烦，那么眩冒、经脉跳动不安，都是虚烦引发的。这也是半夏泻心汤（Pinellia, Scutellaria, Ginger, Jujube, Ginseng, Coptis and Licorice Decoction）的适应症。发汗过多导致津液亡失，没有转化为阳明病而是形成了痉病，因此出现头面动摇、口噤、反张等症状。此时胃中的津液尚未干枯，所以变见的症状，仍然是太阳表的症候，如头项强直拘急等。应当滋阴以调和里气，不要用温燥药物，用炙甘草汤（Prepared Licorice Decoction）主治。
【纲】张仲景说：太阳与少阳并病，出现头项强痛，有时头晕目眩或头目昏蒙，有时感觉像结胸症（胸膈痞硬疼痛），胃脘部痞塞坚硬的，应当针刺大椎穴、肺俞穴、肝俞穴。凡是受寒邪侵袭的，就会发生厥逆，郁冒且肢体麻木不仁。
【目】成无己说：郁是指气机郁结而不舒展，冒是指因虚而神志不清。郁冒的产生，都是因为虚热乘袭寒邪所致。《金匮要略》说：刚生产完的妇女有三种病，一种是痉病，一种是郁冒，一种是大便难。因为失血后又出汗，感受寒邪较多，所以导致郁冒。又说：产妇郁冒，脉象微弱，呕吐不能进食，大便干结。之所以这样，是因为血虚导致厥逆，厥逆必然导致郁冒。患郁冒病的人想要痊愈，一定会大汗出。从这一点可以看出，郁冒属于虚寒证。
喻昌说：少阳的经脉，联络胁肋之间，并入太阳的邪气，那么症状与结胸症相似但实际上不同。肝与胆相合，针刺肝俞穴，是为了泻除胆腑的邪气。膀胱不与肺直接相合，然而肺主气，针刺肺俞穴以通畅肺气，这样膀胱的气化功能就能运行，邪气自然不能停留。
魏荔彤说：考证穴位图，大椎穴是督脉的穴位，位于身后。肺俞穴、肝俞穴都属于足太阳膀胱经的穴位，也是依次从大椎穴向下排列，都位于背部。这些都是太阳经行于身后的道路。在这三个穴位上施刺，都是泄除太阳经的表邪，而与肺、肝、膀胱这些脏腑没有直接关系。各家牵强附会，总归是不懂得刺这三个穴位是为了泄除经络邪气的道理。原文应当刺大椎第一间隙。考证穴位图，大椎穴位于背后脊骨第一节之间的凹陷处。是督脉从颈部向下的第一个穴位。
沈金鳌按语：魏氏说刺这三个穴位，都是泄除太阳经的表邪，这句话确实切中要害。大概病情虽然是太阳和少阳两经同时发病，但治疗必须归结到一经上来。张仲景论述应当刺大椎第一间隙、肺俞、肝俞之下，接着说：千万不要发汗。如果发汗，就会出现谵语（胡言乱语），脉象弦。五六天后谵语不止，应当刺期门穴。考察期门穴，也是太阳经的穴位。张仲景这样说，是因为如果是太阳阳明并病，适宜发汗；如果是太阳少阳并病，因为有少阳病存在，不宜发汗。即使在三阳合病中，也没有发汗的方法。所以张仲景深深告诫不要发汗。因为发汗的话，太阳经的邪气不能去除，只会损伤阳明腑，从而导致谵语。所以即使见到少阳的弦脉，但因为少阳不宜发汗，仍然针刺太阳经的期门穴来代替发汗，不损伤阳明和少阳，而太阳经的病得以治愈。这是用针刺法作为并病的治疗方法。
头项强痛，有时头晕目眩或头目昏蒙，有时感觉像结胸症，胃脘部痞塞坚硬，这些症状完全是太阳病的表现，而少阳病的头晕目眩，也包含在太阳病的范畴内。所以治疗完全从太阳经入手。
[General Principle] Zhang Zhongjing said: In Taiyang disease (disease of the Taiyang channel), if purgation is performed but the condition does not resolve, and sweating is subsequently induced, this results in deficiency of both the exterior and interior. Consequently, the patient experiences Mao (a sensation of mental cloudiness or dizziness). For those suffering from Mao, spontaneous sweating indicates recovery.
The reason for this is that sweating harmonizes the pathogenic factors. If the interior remains disharmonious, purgation may be applied again. After vomiting or purgation in Shanghan (cold damage) disease, there may be a sensation of fullness and rebellion in the epigastrium, Qi rushing up to the chest, dizziness upon rising, and a deep, tight pulse. If sweating is induced at this stage, it will disturb the meridians, causing tremors and shaking of the body. This should be treated with Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction).
After vomiting and purgation in Shanghan disease, followed by sweating, there may be empty irritability (Xu Fan) and a very faint pulse. By the eighth or ninth day, there may be hardness and fullness in the epigastrium, pain in the hypochondrium, Qi rushing up to the throat, dizziness, Mao (cloudiness), and twitching of the meridians; if prolonged, this develops into Wei syndrome (flaccidity syndrome).
In Taiyang disease, excessive sweating can lead to Jing syndrome (spasm syndrome). The pulse is deep and fine, the body is hot while the feet are cold, the head and neck are stiff and rigid, sometimes with heat in the head, red face, and red eye vessels. Only the head and face tremble, sudden lockjaw occurs, and the back arches backward (opisthotonos); this is Jing syndrome.
[Commentary] Cheng Wuji stated: "Mao" refers to blurred vision, while "Xuan" refers to darkness before the eyes. Xuan, Yun (vertigo), and Mao have similar manifestations. Some refer to "Xuan Yun," others to "Xuan Mao." "Yun" implies rotation, commonly known as vertigo or spinning sensation. "Mao" implies covering or obscuring, commonly known as coma or confusion. Shaoyang disease (disease of the Shaoyang channel) presents with visual disturbances because Shaoyang resides between the exterior and interior; as exterior pathogens transmit inward, leading to deficiency of Yang in the exterior, frequent visual disturbances occur. In Bingbing (concurrent diseases) of two Yang channels, or when presenting with Xuan Yun or Xuan Mao, it is due to concurrent Shaoyang and Taiyang diseases; thus, Xuan is attributed to deficiency. In Shanghan disease, dizziness upon rising and Xuan Mao are caused by improper sweating, vomiting, or purgation, indicating Yang deficiency. Therefore, the *Zhen Jing* states: Deficiency above causes dizziness; deficiency below causes Jue (reversal cold). Although dizziness is often due to deficiency, wind-pattern patients also experience dizziness because Wind governs movement. Yangming Fengzhong (Wind-stroke in Yangming) also presents with dizziness. Such cases are not adverse conditions. However, after various mis-treatments involving sweating, severe cases may present with disordered speech and dizziness, which are fatal signs.
Wu Shou stated: In Taiyang Fengzhong, dizziness and head trembling present with a floating, wiry, and rapid pulse. Qianghuo Shenzhu Tang added with Tianma (Gastrodia Rhizome) and Fangfeng (Saposhnikovia Root) may be used. If dizziness is due to Blood deficiency, Siwu Tang added with Renshen (Ginseng) and Tianma is indicated. If Phlegm-Fire attacks upward, Huangqin (Scutellaria Root) and Zhuli (Bamboo Sap) are added. If internal injury from overwork leads to Yin-deficiency dizziness, Buzhong Yiqi Tang added with Chuanxiong (Ligusticum Chuanxiong), Tianma, Fangfeng, and Manjingzi (Vittex Seed) is indicated. If Yuanqi (Original Qi) deficiency in the Lower Jiao causes dizziness, Renshen Yangrong Tang or Dajianzhong Tang added with Tianma is used.
Yi Lao stated: For dizziness and blackening of vision, only Tianma can eliminate it; therefore, it must be included.
Shen Jin'ao commented: Improper sweating or purgation depletes Body Fluids, leading to deficiency of both exterior and interior, while Yang pathogens remain. Thus, exterior and interior pathogens do not resolve, resulting in Mao. Mao feels like being covered or obscured, signaling impending sweating. Therefore, once sweating occurs, Mao resolves. Improper vomiting and purgation lead to exterior Yang deficiency, causing dizziness upon rising. Subsequent improper sweating damages the meridians, causing whole-body tremors.
When vomiting, sweating, and purgation are all improperly applied, resulting in a faint pulse and empty irritability, Xuan Mao and meridian twitching arise from this empty irritability. This is also an indication for Banxia Xiexin Tang (Pinellia, Scutellaria, Ginger, Jujube, Ginseng, Coptis and Licorice Decoction). Excessive sweating depletes fluids without transforming into Yangming disease, instead forming Jing syndrome, manifesting as head/facial tremors, lockjaw, and opisthotonos. At this time, Stomach fluids are not yet exhausted, so the manifested symptoms remain Taiyang exterior patterns, such as head and neck stiffness. One should nourish Yin to harmonize the interior and avoid warm drugs. Zhigancao Tang (Prepared Licorice Decoction) is indicated.
[General Principle] Zhang Zhongjing said: In concurrent diseases of Taiyang and Shaoyang, presenting with stiffness and pain in the head and neck, occasional dizziness or Mao, sensations resembling Jiexiong (Chest Binding syndrome), and hardness/fullness in the epigastrium, one should needle Da Zhui (GV14), Fei Shu (BL13), and Gan Shu (BL18). When Cold pathogens invade, Jue (reversal) occurs, accompanied by Yu Mao (depressed cloudiness) and numbness.
[Commentary] Cheng Wuji stated: "Yu" means stagnation and lack of free flow of Qi; "Mao" means cloudiness due to deficiency and unclear spirit. Yu Mao arises from deficient Heat combined with Cold invasion. The *Jin Gui Yao Lue* states: Postpartum women suffer from three diseases: Jing syndrome, Yu Mao, and difficulty with bowel movements. Due to blood loss, subsequent sweating, and excess Cold, Yu Mao occurs. It further states: In postpartum Yu Mao, the pulse is faint, there is vomiting and inability to eat, and hard stools. This is because Blood deficiency leads to Jue, and Jue inevitably leads to Mao. For Yu Mao to resolve, profuse sweating must occur. From this, we know Yu Mao is a pattern of deficiency and Cold.
Yu Chang stated: The Shaoyang meridian connects the hypochondrium and merges with Taiyang pathogens; thus, the presentation resembles Jiexiong but is distinct. Liver and Gallbladder are internally-externally related; needling Gan Shu (BL18) drains the Gallbladder. Bladder does not directly connect with Lung, but Lung governs Qi; needling Fei Shu (BL13) unblocks Lung Qi, thereby facilitating Bladder Qi transformation, preventing pathogen retention.
Wei Litong stated: According to acupoint charts, Da Zhui (GV14) is a Du Meridian point located on the posterior aspect. Fei Shu (BL13) and Gan Shu (BL18) belong to the Foot-Taiyang Bladder Meridian. They are arranged sequentially downward from Da Zhui on the back, representing the pathway of the Taiyang meridian along the back. Needling these three points drains exterior pathogens from the Taiyang meridian and has no direct relation to the Zang-Fu organs of Lung, Liver, and Bladder. Previous commentators forced interpretations due to ignorance of the principle that needling these points drains meridian pathogens. The original text specifies needling the first interstice of Da Zhui. Charts show Da Zhui is located in the depression between the first thoracic vertebrae, being the first point of the Du Meridian descending from the neck.
Shen Jin'ao commented: Wei's statement that needling these three points drains Taiyang exterior pathogens is indeed accurate. Although the disease involves concurrent Taiyang and Shaoyang, treatment must focus on one meridian. Following the instruction to needle Da Zhui, Fei Shu, and Gan Shu, Zhongjing adds: Do not induce sweating. If sweating is induced, delirium ensues, and the pulse becomes wiry. If delirium persists for five to six days, Qimen (LR14) should be needled. Qimen is also a Taiyang meridian point. Zhongjing states this because in concurrent Taiyang-Yangming disease, sweating is appropriate; however, in concurrent Taiyang-Shaoyang disease, sweating is contraindicated due to the presence of Shaoyang pathology. Even in concurrent Three-Yang disease, sweating is not indicated. Thus, Zhongjing strictly warns against sweating. Sweating fails to remove Taiyang meridian pathogens and injures Yangming Fu, causing delirium. Therefore, despite the wiry pulse indicating Shaoyang, since Shaoyang prohibits sweating, needling Qimen (a Taiyang point) substitutes for sweating, sparing Yangming and Shaoyang while treating Taiyang. This illustrates using needling as a treatment for concurrent diseases.
Stiffness/pain in head/neck, occasional dizziness/Mao, sensations resembling Jiexiong, and epigastric hardness/fullness are entirely Taiyang symptoms. Shaoyang dizziness/Mao is also encompassed within Taiyang presentations. Therefore, treatment focuses entirely on the Taiyang meridian.