【纲】仲景曰。太阳病。发汗。汗出不解。其人仍发热。心下悸。头眩。身 动。振振欲擗地
者。真武汤主之。若脉微弱。汗出恶风者。不可服。服之则厥逆。筋惕肉 。此为逆也。太阳病。医发汗。仍发
热恶寒。复下之。心下痞。表里俱虚。阴阳气并竭。无阳则阴独。复加烧针。因胸烦。面色青黄。
肤者。难治。今色微黄。手足温者。易愈。
【目】朱肱曰。大凡发汗过多。即身 动振摇。虚羸之人。微发汗。便有此症。宜服真武汤。
羸甚者。去芍药。或少用之。有热症。恶热药者。去附子。
杨士瀛曰。伤寒筋惕身 。发汗太过所致也。古人以真武汤主之。然真武汤能止其汗。而不能
定其 。 者。动也。盖汗多则伤血。血虚无以荣筋。筋愈急而四体百骸俱为之 。宜以四物去地黄加人参、半夏、茯
苓、甘草作剂。以五灵脂为佐。入生姜、乌梅煎服。自有神效。此专主生血。生血乃以收汗也。
陶华曰。筋惕肉 者。非常常有之。内经曰。阳气者。精则养神。柔则养筋。发汗过多。津液
枯少。阳气偏虚。筋肉失所养。故惕惕然跳。 然动。非温经助阳不能愈。仲景特设真武汤救之。
或因发汗吐下后。表里俱虚而有此状者。此又逆之甚矣。
柯琴曰。此条用真武汤。全在降火利水。重在发热心下悸。头眩身 。因心下悸所致。脉微弱
而自汗出。是无阳也。是桂枝症。不可与大青龙。以中有麻黄、石膏也。服之则血气不周于身。必
筋惕肉 。因汗下后加烧针。以致虚烦。多汗伤血。故经脉动惕。烧针伤肉。故面青肤 。此亦半
夏泻心汤症也。
【纲】仲景曰。动气在左。不可发汗。发汗则头眩。汗不止。筋惕肉 。
【目】魏荔彤曰。脐左属肝。故肝虚风动为头眩。肝藏血之脏。风动扰阴。故汗出不止也。筋
惕肉 者。肝主筋。血主肉。俱因气虚而振振惕 也。
陶华曰。此候最逆。先宜防风白术牡蛎汤。次服小建中汤。十救一二。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），经过发汗治疗后，出汗后病情仍未解除。患者仍然发热，感到心下悸动（胃脘部跳动不安），头晕目眩，身体肌肉跳动，震颤不稳，想要趴在地上。这种情况应当用真武汤（温阳利水方剂）主治。如果脉象微弱，出汗且怕风，则不可服用真武汤。如果误服，会导致四肢厥冷（手脚冰凉），肌肉跳动，这是治疗失误造成的逆证。
太阳病，医生进行发汗治疗，患者仍然发热、怕冷，医生又错误地使用了攻下法，导致心下痞满（胃脘部堵塞感），表里之气都虚弱，阴阳之气都衰竭。没有阳气则阴气独盛，此时如果再使用烧针（一种温热刺激疗法），会导致胸中烦闷，面色青黄，皮肤干燥枯槁的，属于难治之症。如果面色微黄，手足温暖，则容易痊愈。
【目】朱肱说：大凡发汗过多，就会出现身体肌肉跳动、震颤摇晃的症状。体质虚弱消瘦的人，即使轻微发汗，也会出现这种症状，适宜服用真武汤。身体极度虚弱的，去掉芍药，或者少量使用。如果有热症，厌恶温热药物的，去掉附子。
杨士瀛说：伤寒引起的肌肉跳动和身体震颤，是由于发汗太过导致的。古人用真武汤主治。然而真武汤能止住汗液，但不能平息肌肉的跳动。惕（tì），是跳动的意思；瞤（shún），是颤动的意思。大概因为出汗多损伤了血液，血虚无法滋养筋脉，筋脉更加拘急，导致四肢百骸都为之颤动。应该用四物汤去掉地黄，加入人参、半夏、茯苓、甘草作为主剂，以五灵脂为佐使，加入生姜、乌梅煎服，自有神效。这专门侧重于生血，通过生血来收敛汗液。
陶华说：肌肉跳动和身体震颤，并不是经常有的症状。《内经》说：阳气，精纯时滋养精神，柔和时滋养筋脉。发汗过多，津液枯竭减少，阳气偏虚，筋肉失去滋养，所以惊恐般地跳动，颤动不已。不是温经助阳就不能痊愈。张仲景特别设立真武汤来救治。也有因为发汗、催吐、攻下之后，表里俱虚而出现这种状况的，这又是严重的逆证。
柯琴说：这一条使用真武汤，关键在于降火利水，重点在于发热、心下悸动、头晕、身体震颤。这是因为心下悸动所致。脉象微弱而自汗出，说明是无阳（阳气虚衰）。这是桂枝汤证，不可用大青龙汤，因为大青龙汤中含有麻黄、石膏。如果误服，气血不能周流全身，必然导致肌肉跳动。因为发汗、攻下后又加用烧针，导致虚烦，多汗伤血，所以经脉跳动警惕。烧针损伤肌肉，所以面色青、皮肤枯槁。这也是半夏泻心汤的适应证。
【纲】张仲景说：脐左有动气（腹部搏动感），不可发汗。如果发汗，会导致头晕，汗出不止，肌肉跳动，身体震颤。
【目】魏荔彤说：脐左侧属肝，所以肝虚风动导致头晕。肝是藏血的脏器，风动扰动阴血，所以汗出不止。肌肉跳动和身体震颤，是因为肝主筋，血主肉，都因为气虚而导致震颤惊惕。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel), after sweating therapy, if the condition remains unresolved despite perspiration, and the patient still has fever, palpitations in the epigastrium (sensation of beating in the stomach area), dizziness, body tremors, and a sensation of trembling instability as if wanting to fall to the ground, Zhenwu Tang (True Warrior Decoction) should be administered. However, if the pulse is faint and there is spontaneous sweating with aversion to wind, Zhenwu Tang must not be used. If mistakenly administered, it will lead to cold limbs (coldness of the extremities) and muscle twitching; this constitutes a therapeutic error (adverse reaction).
In Taiyang disease, if the physician induces sweating, yet fever and aversion to cold persist, and subsequently applies purgation (downward-draining method), resulting in epigastric fullness (stagnation in the chest/epigastrium), both exterior and interior qi are depleted, and yin and yang qi are exhausted. The absence of yang leads to the predominance of yin. If moxibustion via burning needles is then applied, causing chest irritability, a greenish-yellow complexion, and dry, shriveled skin, the prognosis is difficult. Conversely, if the complexion is slightly yellow and the hands and feet are warm, recovery is likely.
[Commentary] Zhu Gong said: Generally, excessive sweating leads to body tremors and shaking. In frail and emaciated individuals, even mild sweating can induce these symptoms, for which Zhenwu Tang is appropriate. For those severely emaciated, remove Paeoniae Radix Alba (Shaoyao) or use it in small quantities. If heat syndromes are present and the patient dislikes warm-hot herbs, remove Aconiti Lateralis Radix Praeparata (Fuzi).
Yang Shiy ing stated: Muscle twitching and body tremors in Shanghan (Cold Damage) are caused by excessive sweating. Ancients treated this with Zhenwu Tang. However, while Zhenwu Tang can stop sweating, it cannot stabilize the twitching. 'Ti' refers to jumping/twitching; 'Shun' refers to trembling. Since excessive sweating damages blood, blood deficiency fails to nourish the sinews, leading to increased tension in the sinews and trembling of all four limbs and bones. One should use Siwu Tang (Four Substance Decoction) minus Rehmanniae Radix (Dihuang), adding Ginseng Radix (Renshen), Pinelliae Rhizoma (Banxia), Poria (Fuling), and Glycyrrhizae Radix et Rhizoma (Gancao) as the main formula, with Psoraleae Fructus (Wulingzhi) as an assistant, decocted with Zingiberis Rhizoma Recens (Shengjiang) and Vitis Vinifera Fructus (Wumei). This yields miraculous effects. This approach specifically focuses on generating blood, thereby consolidating sweat.
Tao Hua stated: Muscle twitching and body tremors are not common occurrences. The *Neijing* states: "Yang qi, when refined, nourishes the spirit; when soft, it nourishes the sinews." Excessive sweating depletes body fluids, causing relative deficiency of yang qi, leaving muscles and sinews without nourishment, resulting in fearful twitching and trembling. Without warming the channels and assisting yang, recovery is impossible. Zhang Zhongjing specifically established Zhenwu Tang to rescue such cases. This may also occur after sweating, vomiting, or purging, where both exterior and interior are deficient, representing a severe adverse outcome.
Ke Qin stated: The use of Zhenwu Tang in this clause focuses on descending fire and promoting diuresis, emphasizing fever, epigastric palpitations, dizziness, and body tremors caused by the epigastric palpitations. A faint pulse with spontaneous sweating indicates deficiency of yang. This is a Guizhi Tang (Cinnamon Twig Decoction) pattern; Da Qing Long Tang (Major Green Dragon Decoction) is contraindicated because it contains Ephedrae Herba (Mahuang) and Gypsum Fibrosum (Shigao). Misuse would prevent qi and blood from circulating throughout the body, inevitably causing muscle twitching. The addition of burning needles after sweating and purging leads to deficiency-irritability; excessive sweating damages blood, causing vessel twitching. Burning needles damage flesh, causing a blue face and shriveled skin. This is also a Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction) pattern.
[General Principle] Zhang Zhongjing stated: If there is pulsation (moving qi) on the left side of the umbilicus, sweating therapy is contraindicated. If sweating is induced, it will cause dizziness, incessant sweating, muscle twitching, and body tremors.
[Commentary] Wei Litong stated: The area to the left of the umbilicus belongs to the Liver. Thus, Liver deficiency with internal wind causes dizziness. As the Liver stores blood, wind disturbing the yin leads to incessant sweating. Muscle twitching and body tremors occur because the Liver governs the sinews and blood governs the flesh; both tremble due to qi deficiency.
Tao Hua stated: This syndrome is extremely adverse. Initially, Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes Macrocephala, and Oyster Shell Decoction) should be administered, followed by Xiaojianzhong Tang (Minor Construct the Middle Decoction). Only one or two out of ten patients may be saved.