【纲】仲景曰。太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。伤寒六七日。发热。微恶寒。肢节烦疼。微呕。
心下支结。外
症未去者。柴胡加桂枝汤主之。太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风。无汗而喘者。麻
黄汤主之。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。
【目】张兼善曰。脉沉而细。本少阴脉。今太阳病而见此脉。太阳与少阴为表里。故相似。乃
太阳之变脉也。湿流关节。故疼痛。太阳气不宣。故烦。湿气痹闭而不行。故脉应其象而沉细。太
阳之脉。从风则缓。从寒则紧。从湿则细。伤上则浮。伤下则沉。当因症而合脉。
魏荔彤曰。伤寒六七日。宜传里矣。乃有半未离太阳之表。而半已微入少阳之里者。惟不离太
阳。故结胸之结。变而结于心下。复不正结而偏出。微入少阳两侧之界。因谓之支结。虽云带少阳。
实皆太阳表里之症也。故用少阳柴胡之治。仍加太阳之桂枝。本条何以见太阳多少阳少也。如正
文发热微恶寒支节烦疼微呕。太阳之症有四。独心下支结一症。侵入少阳。其实又系大小结胸
之流派。惟以部位在少阳。故治少阳。正所以治太阳也。用柴胡加入桂枝者。犹如太阳之贼。侵少
阳之界。用太阳之兵捕。协同少阳之兵捕。方可治太阳少阳两界之贼寇也。
【纲】仲景曰。寸口脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤营。营卫俱病。骨肉
烦疼。当发其汗也。
【目】柯琴曰。风寒本相因。必风先开腠理。寒得入经络。紧者急也。即数也。紧以形象言。
数以至数言。紧则为寒。指伤寒也。数则为热。指发热也。辞异而义同。故脉浮数浮紧者。皆是麻黄
症。骨肉烦疼。即是风寒两伤。营卫俱病。要之冬月风寒。本同一体。故中风伤寒。皆恶风恶寒。
营病卫必病。中风之重者。便是伤寒。伤寒之浅者。便是中风。不必在风寒上细分。须当在有汗无
汗上着眼耳。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），关节疼痛且心烦，脉象沉而细的，这称为湿痹（因湿气阻滞经络导致的痹证）。伤寒病经过六七天，出现发热、轻微怕冷、肢体关节烦痛、轻微呕吐、心下部有支撑感结聚的症状，表证尚未解除的，用柴胡加桂枝汤主治。太阳病，头痛、发热、身体疼痛、腰痛、骨节疼痛、怕风、无汗且气喘的，用麻黄汤主治。风湿之邪相互搏结，骨节烦痛，牵引作痛，不能屈伸，触碰则疼痛加剧，出汗、气短、小便不利、怕风、不想脱衣，或者身体轻微浮肿的，用甘草附子汤主治。
【目】张兼善说：脉象沉而细，本是少阴脉（少阴经病变常见的脉象）。现在太阳病却出现这种脉象，因为太阳与少阴互为表里，所以脉象相似，这是太阳病的变脉。湿气流注于关节，所以导致疼痛。太阳经气不宣通，所以感到心烦。湿气痹阻闭塞而不运行，所以脉象相应地表现为沉细。太阳经的脉象，受风邪影响则缓，受寒邪影响则紧，受湿邪影响则细，伤于上部则浮，伤于下部则沉。应当根据症状结合脉象来判断。
魏荔彤说：伤寒病经过六七天，按理应该传入里了。但此时有一半尚未离开太阳之表，一半已经微微进入少阳之里。正因为没有完全离开太阳，所以原本结胸证的“结”，变化为结于心下，又不正当地结聚而偏出，微微侵入少阳两侧的界限，因此称之为“支结”。虽然说是带有少阳病，但实际上都是太阳表里的症状。所以使用治疗少阳病的柴胡，仍然加上治疗太阳病的桂枝。本条如何看出是太阳病多还是少阳病少呢？如正文中提到的发热、微恶寒、支节烦痛、微呕，这是太阳病的四个症状；唯独“心下支结”一个症状，侵入了少阳领域，其实它又是大结胸和小结胸的流派，只因为部位在少阳，所以治疗少阳，正是为了治疗太阳。使用柴胡加入桂枝，就像太阳的士兵去捕捉侵犯少阳边界的贼寇，协同少阳的士兵一起行动，才能治理太阳和少阳两个边界的贼寇。
【纲】张仲景说：寸口脉浮而紧，浮脉表示风邪，紧脉表示寒邪。风邪伤害卫气，寒邪伤害营血。营气和卫气都患病，骨肉烦痛，应当采用发汗的方法治疗。
【目】柯琴说：风邪和寒邪本来相互伴随，必定是风先打开腠理（皮肤纹理及汗孔），寒邪才得以进入经络。“紧”指急迫，也就是快速的意思。“紧”是从形象上说的，“数”是从至数（脉搏跳动频率）上说的。紧脉表示寒邪，指伤寒；数脉表示热邪，指发热。言辞不同但意义相同，所以脉象浮数或浮紧的，都是麻黄汤证。骨肉烦痛，就是风寒两伤，营卫俱病。总之，冬季的风寒，本是一体，所以中风和伤寒，都怕风怕寒。营分有病，卫分必然也病。中风严重的，就是伤寒；伤寒轻微的，就是中风。不必在风邪和寒邪上过分细分，应当在有汗和无汗上着眼观察罢了。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), if there is joint pain accompanied by vexation, and the pulse is deep and fine, this is termed Shi Bi (Bi syndrome caused by dampness obstruction). After six or seven days of Shanghan disease (cold damage disease), if fever, slight aversion to cold, vexing pain in the limbs and joints, slight vomiting, and a sensation of support and accumulation in the epigastrium occur, while the exterior syndrome has not yet resolved, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) should be administered. In Taiyang disease, if there is headache, fever, body pain, lower back pain, bone and joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, Mahuang Tang (Ephedra Decoction) should be administered. When Wind-Dampness pathogens contend with each other, causing vexing pain in the bones and joints, pulling pain, inability to flex and extend, severe pain upon touch, sweating, shortness of breath, dysuria, aversion to wind, reluctance to remove clothing, or slight bodily edema, Gancao Fuzi Tang (Licorice and Aconite Decoction) should be administered.
[Commentary] Zhang Jianshan said: A deep and fine pulse is originally characteristic of Shaoyin pulse (pulse pattern common in Shaoyin channel pathology). Its appearance in Taiyang disease occurs because Taiyang and Shaoyin are interior-exteriorly related, hence their similarity; this is a variant pulse of Taiyang disease. Dampness flowing into the joints causes pain. The non-circulation of Taiyang Qi causes vexation. The obstruction and stagnation of dampness cause the pulse to manifest as deep and fine correspondingly. The Taiyang pulse becomes slow when affected by Wind, tight when affected by Cold, and fine when affected by Dampness; it floats when injured above and sinks when injured below. One must diagnose by combining symptoms with pulse characteristics.
Wei Litong said: By the sixth or seventh day of Shanghan disease, transmission to the interior is expected. However, at this stage, half remains on the Taiyang exterior, and half has slightly entered the Shaoyang interior. Because it has not completely left the Taiyang, the "accumulation" of the Jie Xiong syndrome (Chest Binding Syndrome) transforms into accumulation in the epigastrium. It does not accumulate centrally but deviates outward, slightly invading the boundaries of both sides of Shaoyang, thus termed "Zhi Jie" (Supporting Accumulation). Although described as involving Shaoyang, these are essentially Taiyang exterior-interior syndromes. Therefore, Bupleurum (Chai Hu), used for treating Shaoyang, is combined with Cinnamon Twig (Gui Zhi), used for treating Taiyang. How can one determine the proportion of Taiyang versus Shaoyang involvement? As seen in the main text—fever, slight aversion to cold, vexing limb/joint pain, slight vomiting—these are four Taiyang symptoms. Only the single symptom of "epigastric supporting accumulation" invades the Shaoyang domain. In fact, it is a variation of Da Jie Xiong (Major Chest Binding) and Xiao Jie Xiong (Minor Chest Binding). Since the location is in Shaoyang, treating Shaoyang is precisely treating Taiyang. Using Chai Hu added with Gui Zhi is like Taiyang soldiers pursuing bandits who have invaded Shaoyang borders, cooperating with Shaoyang soldiers to pacify the bandits in both Taiyang and Shaoyang territories.
[General Principle] Zhang Zhongjing stated: If the Cun Kou pulse (radial artery pulse) is floating and tight, floating indicates Wind, and tight indicates Cold. Wind injures Wei Qi (Defensive Qi), and Cold injures Ying Blood (Nutritive Blood). When both Ying and Wei are diseased, causing vexing pain in the bones and flesh, diaphoresis (sweating therapy) should be employed.
[Commentary] Ke Qin said: Wind and Cold pathogens naturally accompany each other; typically, Wind first opens the Cou Li (skin pores and interstices), allowing Cold to enter the meridians. "Tight" implies urgency or speed. "Tight" describes the shape/form, while "Rapid" (Shu) describes the frequency/rate. A tight pulse indicates Cold, referring to Shanghan; a rapid pulse indicates Heat, referring to fever. The terminology differs, but the meaning is the same. Thus, floating-rapid or floating-tight pulses both indicate Mahuang Tang syndrome. Vexing pain in bones and flesh signifies injury by both Wind and Cold, with both Ying and Wei being diseased. Essentially, Wind and Cold in winter constitute a unified entity; therefore, both Feng Zhong (Wind Strike/Exogenous Wind) and Shang Han (Cold Damage) present with aversion to wind and cold. If Ying is diseased, Wei must also be diseased. Severe Feng Zhong is equivalent to Shang Han, and mild Shang Han is equivalent to Feng Zhong. There is no need to overly distinguish between Wind and Cold; rather, one must focus on the presence or absence of sweating.