【纲】仲景曰。太阳病。八九日。脉微而恶寒者。此阴阳俱虚。不可更发汗。更吐。更下也。
面色反有热色者。未欲解也。以其不得小汗出。身必痒。宜桂枝麻黄合半汤。
【目】朱肱曰。不可更汗吐下。小柴胡汤主之。若反重发汗。则气虚。必两耳聋无闻。素无热
人。可芍药甘草附子汤。有热人可黄 建中汤。
柯琴曰。八九日。是当解未解之时。阴阳俱虚。当调其阴阳。若其人热多寒少。面色正赤者。
是阳气怫郁在表。不得越出。当汗不汗。其身必痒。八九日来。正已虚。邪未解。不可汗。又不可
不汗。故立此法。
【纲】仲景曰。太阳病。或已发热。或未发热。必恶寒。体痛。呕逆。脉阴阳俱紧者。名曰伤
寒。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。太阳病。脉浮紧。
无汗。发热。身疼痛。八九日不解。表症仍在。此当发其汗。麻黄汤主之。脉浮紧者。法当身疼
痛。宜以汗解之。假令尺中迟者。不可发汗。以营气不足。血少故也。
【目】朱肱曰。尺脉迟者。先以小建中汤以养之。
王肯堂曰。体痛。乃六经俱有之症。有表有里。有寒有热。有风有湿。如太阳伤寒。荣血不利
身疼者。宜发汗。若汗后脉沉迟体痛者。又宜温之。中 身疼者。白虎汤解之。里寒外热身疼者。先
与救里。而后攻表。寒在三阴。则脉沉身疼。寒在三阳。则一身支节烦疼。四逆柴胡。可不辨欤。
太阳身痛。但拘急。耳中湿。身痛不可转侧。阴毒身痛。体势沉重。宛
如被杖。以此别之。发热恶寒身体痛者。属太阳。麻黄汤、大青龙汤是也。若兼心下支结。柴胡加
桂枝汤。若兼下利清谷腹胀。先以四逆温里。后以桂枝发表。若尺迟血少。营气不足也。活人先以
小建中汤养血。俟尺脉回。却用柴胡等汤剂解之。按热多寒少。尺脉沉迟者。荣血不足。黄 建中
汤。夫血不足而用黄 者。黄 味甘。加以甘草。大能生血。此仲景妙法。盖稼穑作甘。甘能补胃。
胃为气血之海。血所从以生。又经云。无阳则阴无以生。以甘益胃而生血。旨哉。今人但知参、
为气药。故表而出之。
柯琴曰。太阳受病。当一二日发。盖寒邪凝不遽发。非若风邪易于发热也。然不论已未发热。
而恶寒体痛呕逆之症。阴阳俱紧之脉。先见即可断为太阳之伤寒。而非中风矣。寒邪外束。故体痛。
寒邪内侵。故呕逆。太阳主一身之表。风寒外束。阳气不伸。故一身尽疼。此麻黄八症头痛发热
恶风。同桂枝症。无汗身疼。同大青龙症。本症重在发热身疼无汗而喘。
鳌按。法者。脉法也。以浮紧之脉法言。当身痛。宜发汗。然必三部浮紧。乃可发汗。今浮紧
之脉。虽见寸口。而尺中迟。则不得主发汗之法矣。且尺主血。血少而尺迟。虽发汗亦不能作汗。
不但身疼不除。必至有亡血亡津之变。
【纲】仲景曰。发汗后。身疼痛。脉沉迟者。桂枝加芍药生姜人参新加汤主之。
【目】成无己曰。汗后身痛。邪气未尽也。脉沉迟。营血不足也。经云。其脉沉者。营血微也。
又云迟者。营气不足。血少故也。与桂枝以解未尽之邪。加参、芍、姜以益不足之血。
朱肱曰。小建中汤。兼治汗后身疼。脉沉而迟者。若霍乱吐泻止。而身疼痛不休者。少与桂枝
汤即愈。金匮要略云。疮家虽身体痛。不可发汗。汗出则痉。
张元素曰。经言表邪盛。脉浮而紧。法当身疼痛。宜以汗解之。况身疼皆系表邪未尽。此又加
人参、芍药、生姜以益血。
何也。予曰。表邪盛则身疼。血虚则身亦疼。其脉浮紧者。邪盛也。其脉沉迟者。血虚也。盛者损
之则安。虚者益之则愈。仲景凡言发汗后。以外无表症。里无热症。止余身疼一事而已。若脉稍浮
盛。则为表邪未尽解。今言脉沉迟。此血虚致然也。故加三味以益血。
【纲】仲景曰。伤寒医下之。续得下利清谷不止。身疼痛者。急当救里。后清便自调。身体痛
者。急当救表。救里宜四逆汤。救表宜桂枝汤。下利。腹胀满。身体疼痛者。先温其里。乃攻其表。
温里宜四逆汤。攻表宜桂枝汤。吐利止。而身痛不休者。当消息和解其外。宜桂枝汤小和之。
【目】柯琴曰。寒邪在表而妄下之。移寒于脾。下利完谷。胃阳已亡。身疼未除。是表里皆困。
身疼犹有表邪也。然当舍表而救里。里症既瘥。表症仍在。救表亦不容缓。身疼本麻黄症。而下
利清谷。腠理之疏可知。必桂枝汤和营卫而痛自解。故不曰攻而仍曰救。救表仍合和中也。温中之
后。仍可用桂枝汤。其神乎。下利而腹尚胀满。即伏清谷之机。先温其里。不待其急而始救也。里
和而表不解。可专治其表。故不曰救而曰攻。吐利是脏腑不和。非桂枝汤所治。止后而身痛不休。是营卫不和。非麻黄
汤所宜和解其外。惟
有桂枝之法消息其宜。更有小与之法也。
【纲】仲景曰。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。或久伤寒
冷所致也。
问曰。值天阴雨不止。风湿相搏。一身尽疼。法当汗出而解。医云。此可发汗。汗之病不解者。
何也。答曰。发其汗。汗大出者。风湿俱去也。湿家之为病。一身尽疼。发热。面色如熏黄。
伤寒八九日。风湿相搏。身体烦疼。不能自转侧。不呕不渴。脉虚浮而涩者。桂枝附子汤主之。
若其人大便硬。小便自利者。去桂加白术汤主之。
【目】成无己曰。伤寒与中风家。至七八日再经之时。则邪气都在里。身必不苦疼痛。今日数
多。复身体痛。烦。不能自转侧者。风湿相搏也。烦者。风也。疼者。湿也。经曰。风则浮虚。脉
经曰。脉来涩者。为病寒湿也。不呕渴。里无邪也。脉得浮
虚而涩。身疼烦。知风湿俱在经也。与桂枝附子汤。以散表中风湿。
李杲曰。风湿相搏。一身尽疼者。补中益气汤加羌活、防风、升麻、 本、苍术治之。如病去。
勿再服。以诸风药。损人元气而益其病也。麻黄复煎汤。治阴室中汗出。懒语。四肢困倦乏力。
走注疼痛。乃下焦伏火。不得升浮。而躁热汗出。一身疼痛。盖风湿相搏也。以麻黄发汗。渐渐发之。
在经者。亦宜发汗。况值季春之月。脉缓而迟。尤宜发之。令风湿去而阳气升。困倦乃退。血气
俱得生旺也。
王好古曰。神术汤。治风湿恶寒脉紧无汗。白术汤。治风湿恶寒脉缓有汗。上二术汤治风湿。
又当随症加减。其法。详在二汤之后。
闵芝庆曰。汗出当风寒。则汗不得越。久留骨节。故一身尽痛。元府反闭。故发热。日晡为阳
明之时。太阴湿土。郁而不伸。故剧。此虽伤于湿。而实因于风寒也。金匮用麻黄杏仁薏苡甘草汤。
凡湿不得泄。热不得越。则身黄。若伤寒发黄时。身疼已解。此湿流关节。故不解也。须用五
苓散以除其湿。
鳌按。风湿身疼。与伤寒身疼。各不同。盖伤寒身疼无止时。风湿身疼。多在日晡时发。若更
遇阴雨。与天气相合。则疼更甚。亦不必拘于日晡时矣。
【纲】仲景曰。太阳中暑者。身热疼重而恶寒。脉微弱。此以夏月伤冷水。水行皮中所致也。
太阳中暑者。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。若发汗。则恶寒甚。加温针。则发热甚。下之。则淋。
【目】柯琴曰。中暑者。与伤寒迥别。而亦有因于伤寒者。太阳之气。在天为寒。在地为水。
冬之伤寒。伤于天之寒风。夏之伤寒。伤于地之寒水。脉微亡阳。脉弱发热。此身热脉微。本是暑
伤于气。而疼重恶寒。实由于寒水沐浴。留在皮肤
而然。亦是伤寒所致耳。宜五苓散、藿香饮之类。弦细芤迟。不得连读。言中暑夹寒之脉。或微弱。
或弦细。或芤迟。皆是虚脉。以此等而见发热恶寒身重疼痛等症。虽当炎夏。而虚寒可知。东垣
用补中益气汤。深合仲景心也。
【纲】仲景曰。太阳中风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。若
脉微弱。汗出恶风者。不可服。服之则厥逆。筋惕肉 。此为逆也。以真武汤救之。
【目】方中行曰。末以真武汤救之六字。黄氏正之。以原文为传写之误。甚是。当从之。盖既
曰不可服。服之为逆。则安得又复有大青汤主之之文。故黄氏正以真武汤是也。
魏荔彤曰。既曰中风。又曰脉浮紧。浮为在表。紧为寒邪。则是合中风与寒邪在表为一症也。更
见发热恶寒。身疼。不汗出烦躁诸症。大率伤寒之症多。然言太阳中风。而中风诸症亦在矣。主以
大青龙。仍伤寒麻黄发汗之义也。
【纲】仲景曰。太阳病。脉浮紧。无汗。发热。身疼痛。八九日不解。表症仍在。此当发其汗。
服药已。微除。其人发烦。目瞑。剧者必衄。衄乃解。所以然者。阳气重故也。麻黄汤主之。
【目】魏荔彤曰。他条脉浮紧发热无汗而自衄愈。纯是寒邪伤营。犹轻微也。此竟身疼痛。则
寒伤者重矣。八九日不解。表症仍在。因以麻黄汤发汗。微除而不全除。其人发烦目瞑者。非麻
黄治寒邪不效。必少带中风之阳邪。故用麻黄辛热。至于发烦目瞑。剧者更必衄血也。设预审之。
知其寒重风轻。斟酌青龙用之。不至是矣。然寒虽发汗未尽除。风因衄已悉去。乃解者。风邪解也。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），经过八九天，脉象微弱且怕冷的人，这是阴阳两虚，不可以再使用发汗、催吐或泻下的方法。如果面色反而出现红热之色，说明病邪尚未解除，是因为不能微微出汗，身体必定发痒，适宜用桂枝麻黄各半汤（调和营卫、小发其汗的方剂）。
【目】朱肱说：不可再用发汗、催吐或泻下法，应以小柴胡汤（和解少阳的方剂）为主治。如果反而重度发汗，会导致气虚，必然导致双耳失聪听不见声音。原本没有内热的人，可以用芍药甘草附子汤（温经复阳的方剂）；有内热的人可以用黄芪建中汤（温中补虚的方剂）。
柯琴说：到了第八九天，是应当解除却未解除的时候。阴阳两虚，应当调理阴阳。如果此人热多寒少，面色正红，这是阳气怫郁在体表，无法发散出去，应当出汗却没有出，身体必定发痒。过了八九天，正气已虚，邪气未解，既不可以发汗，又不可以不发汗，所以设立此法。
【纲】张仲景说：太阳病，有的已经发热，有的还未发热，一定伴有怕冷，身体疼痛，呕吐逆气，寸关尺三部脉象都紧的，称为伤寒（感受寒邪引起的疾病）。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，主治用麻黄汤（发汗解表、宣肺平喘的方剂）。太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九天仍未解除，表证仍在，这应当发汗，主治用麻黄汤。脉象浮紧的，按照医理应当身体疼痛，适宜用发汗法解除。假如尺部脉象迟缓的，不可以发汗，因为营气不足，血少的缘故。
【目】朱肱说：尺脉迟缓的，先用小建中汤（温中补虚的方剂）来调养。
王肯堂说：身体疼痛，是六经（手足三阴三阳经脉及其所属脏腑）都有的症状，有表证有里证，有寒证有热证，有风邪有湿邪。如太阳伤寒，营血运行不利导致身体疼痛的，适宜发汗。如果发汗后脉象沉迟且身体疼痛的，又适宜温补。阳明经身疼的，用白虎汤（清热生津的方剂）解除。里寒外热的身体疼痛，先救治里证，然后攻表证。寒邪在三阴经，则脉沉身体疼痛；寒邪在三阳经，则全身肢节烦痛。四逆汤（回阳救逆的方剂）和柴胡汤（和解少阳的方剂），能不辨别吗？太阳经身体疼痛，只是拘急，耳朵里有湿气感，身体疼痛不能转侧；阴毒（一种重症寒邪）身体疼痛，身体沉重，宛如被棍棒打过一样，以此区别。发热恶寒身体痛的，属于太阳病，麻黄汤、大青龙汤（发汗解表、兼清里热的方剂）是适用的。如果兼有心下部支撑结聚，用柴胡加桂枝汤（和解少阳、调和营卫的方剂）。如果兼有腹泻完谷不化、腹胀，先用四逆汤温里，后用桂枝汤（调和营卫的方剂）解表。如果尺脉迟、血少、营气不足，活人书主张先用小建中汤养血，等到尺脉恢复，再用柴胡等汤剂解除表邪。按热多寒少、尺脉沉迟的，是荣血不足，用黄芪建中汤。血不足而用黄芪，是因为黄芪味甘，加上甘草，大能生血，这是张仲景的妙法。大概稼穑作甘，甘味能补胃，胃是气血的海源，血由此而生。又经文说：没有阳则阴无法生成，用甘味益胃而生血，旨意深远啊。现在的人只知道人参、当归是气药，所以将其理论阐发出来。
柯琴说：太阳受病，应当在一两天内发作。大概寒邪凝滞不会立即发作，不像风邪容易发热那样。然而不论是否已经发热，只要恶寒、体痛、呕逆的症状，以及阴阳俱紧的脉象先出现，就可以断定为太阳伤寒，而不是中风（感受风邪引起的疾病）。寒邪束缚体表，所以身体疼痛；寒邪侵入体内，所以呕吐逆气。太阳主管一身之表，风寒束缚体外，阳气不能伸展，所以全身都疼。这个病症重在发热、身疼、无汗且气喘。
沈金鳌按语：法，指脉法。从浮紧的脉法来说，应当身体疼痛，适宜发汗。但是必须三部脉都浮紧，才可以发汗。现在虽然寸口见浮紧之脉，但尺中迟缓，就不能主用发汗之法了。而且尺部主血，血少而尺迟，即使发汗也不能出汗。不但身体疼痛不能消除，必然会有亡血、亡津液的变证。
【纲】张仲景说：发汗后，身体疼痛，脉象沉迟的，主治用桂枝加芍药生姜人参新加汤（调和营卫、益气养血的方剂）。
【目】成无己说：发汗后身体疼痛，是邪气未尽。脉象沉迟，是营血不足。经文说：脉沉的，是营血微少。又说：脉迟的，是营气不足，血少的缘故。给予桂枝以解除未尽的邪气，加入人参、芍药、生姜以补益不足的血液。
朱肱说：小建中汤，兼治发汗后身体疼痛，脉象沉而迟缓的。如果是霍乱吐泻停止后，身体疼痛不休的，少量给予桂枝汤即可痊愈。《金匮要略》说：疮家（长期患疮疡的人）虽然身体疼痛，不可发汗，发汗则会导致痉病（肌肉痉挛）。
张元素说：经文说表邪盛，脉象浮而紧，医理上当身体疼痛，适宜用发汗法解除。何况身体疼痛都是表邪未尽，这里又加入人参、芍药、生姜来益血。为什么呢？我说：表邪盛则身体疼痛，血虚也会身体疼痛。脉象浮紧的，是邪气盛；脉象沉迟的，是血虚。盛的则损减它就能安宁，虚的则补益它就能痊愈。张仲景凡是说发汗后，外无表证，内无热证，只剩下身体疼痛这一件事罢了。如果脉稍浮盛，就是表邪未尽解。现在说脉沉迟，这是血虚导致的。所以加入三味药来益血。
【纲】张仲景说：伤寒，医生误用泻下法，接着得到腹泻完谷不化不止，身体疼痛的，紧急应当救治里证。后来大便正常，身体疼痛的，紧急应当救治表证。救治里证适宜用四逆汤（回阳救逆的方剂），救治表证适宜用桂枝汤。腹泻，腹胀满，身体疼痛的，先温其里，然后攻其表。温里适宜用四逆汤，攻表适宜用桂枝汤。呕吐腹泻停止，但身体疼痛不休的，应当斟酌和解其外，适宜用桂枝汤轻微调和。
【目】柯琴说：寒邪在表而误用下法，寒气移于脾，导致下利完谷不化，胃阳已亡，身体疼痛未除，这是表里皆困。身体疼痛说明还有表邪。然而应当舍去表证而救里证。里证既然好转，表证仍在，救表也不容迟缓。身体疼痛本是麻黄汤证，但下利完谷，腠理疏松可知，必须用桂枝汤调和营卫而疼痛自解，所以不说“攻”而仍说“救”。救表仍然合乎和中之道。温中之后，仍可用桂枝汤，真是神妙啊。下利而腹部尚胀满，即潜伏着完谷不化的机转，先温其里，不等其危急才开始救治。里气和而表不解，可以专治其表，所以不说“救”而说“攻”。呕吐腹泻是脏腑不和，不是桂枝汤所治。停止后身体疼痛不休，是营卫不和，不是麻黄汤所宜，应和解其外，只有桂枝法斟酌其适宜，更有少量给予的方法。
【纲】张仲景说：病人全身都疼痛，发热，傍晚时分加剧的，这名叫风湿（风湿痹阻经络的病证）。这种病是由于出汗时当风，或久伤寒冷所致。
问曰：正值天阴雨不停，风湿相搏，全身都疼痛，按照医理应当出汗而解。医生说，这可以发汗，发汗后病不解除，为什么呢？答曰：发其汗，如果大汗出，风湿俱去。湿家（素患湿病的人）的病，全身都疼痛，发热，面色像熏黄一样。伤寒八九天，风湿相搏，身体烦痛，不能自行转侧，不呕吐不口渴，脉象虚浮而涩的，主治用桂枝附子汤（祛风除湿、温经助阳的方剂）。如果这个人大便硬，小便自利的，去掉桂枝加入白术汤（健脾祛湿的方剂）主治。
【目】成无己说：伤寒与中风患者，到了七八日再经之时，邪气都在里，身体必定不苦于疼痛。今天日数多，又身体痛、烦，不能自行转侧的，是风湿相搏。烦，是风邪；疼，是湿邪。经文说：风则脉浮虚。脉经说：脉来涩的，为病寒湿。不呕不渴，说明里没有邪气。脉得浮虚而涩，身疼烦，知道风湿都在经络。给予桂枝附子汤，以散表中风湿。
李杲说：风湿相搏，全身都疼痛的，用补中益气汤（补中益气、升阳举陷的方剂）加羌活、防风、升麻、本（藁本）、苍术治疗。如病去，不要再服，因为各种风药会损伤人的元气而加重病情。麻黄复煎汤，治疗阴室中出汗，懒言，四肢困倦乏力，游走性疼痛，这是下焦伏火，不得升浮，而躁热出汗，全身疼痛，大概是风湿相搏。用麻黄发汗，渐渐发出。在经络的，也适宜发汗，何况正值季春之月，脉缓而迟，尤其适宜发之，令风湿去而阳气升，困倦乃退，血气俱得生旺。
王好古说：神术汤，治疗风湿恶寒脉紧无汗；白术汤，治疗风湿恶寒脉缓有汗。上二术汤治疗风湿，又应当随症加减，其法详细在两汤之后。
闵芝庆说：出汗当风寒，则汗不得发散，久留骨节，所以全身都痛。元府（汗孔）反闭，所以发热。日晡（下午3-5点）为阳明之时，太阴湿土，郁而不伸，所以加剧。这虽然是伤于湿，而实因于风寒。《金匮》用麻黄杏仁薏苡甘草汤。凡湿不得泄，热不得越，则身黄。如果伤寒发黄时，身体疼痛已解，这是湿流关节，所以不解。须用五苓散（利水渗湿的方剂）以除其湿。
沈金鳌按语：风湿身疼，与伤寒身疼，各不相同。大概伤寒身疼没有止时，风湿身疼，多在日晡时发作。如果更遇阴雨，与天气相合，则疼痛更甚，也不一定拘泥于日晡时了。
【纲】张仲景说：太阳中暑者，身热疼重而恶寒，脉微弱，这是因为夏天伤了冷水，水行皮中所致。
太阳中暑者，发热恶寒，身重而疼痛，脉象弦细芤迟（形容脉搏形态的术语），小便后，洒洒然毛耸（感觉寒冷毛发竖起），手足逆冷，稍微劳动，身体即热，口开，前板齿燥。如果发汗，则恶寒更甚；加温针，则发热更甚；下之，则淋（小便淋漓涩痛）。
【目】柯琴说：中暑，与伤寒截然不同，但也有因于伤寒的。太阳之气，在天为寒，在地为水。冬天的伤寒，伤于天之寒风；夏天的伤寒，伤于地之寒水。脉微亡阳，脉弱发热，这身热脉微，本是暑伤于气，而疼重恶寒，实在由于寒水沐浴，留在皮肤而然，也是伤寒所致。适宜用五苓散、藿香饮之类。弦细芤迟，不得连读，是说中暑夹寒的脉，或微弱，或弦细，或芤迟，皆是虚脉。以此等脉象见到发热恶寒身重疼痛等症状，虽在炎夏，而虚寒可知。东垣用补中益气汤，深合张仲景的心意。
【纲】张仲景说：太阳中风，脉浮紧，发热恶寒，身体疼痛，无汗而烦躁的，主治用大青龙汤。如果脉微弱，汗出恶风的，不可服用。服用则会导致厥逆（四肢冰冷），筋惕肉瞤（肌肉跳动），这是逆证。用真武汤（温阳利水的方剂）救治。
【目】方中行说：末尾“以真武汤救之”六个字，黄氏校正，认为原文是传写之误，甚是。应当依从。既然说不可服，服之为逆，怎么又会有大青龙汤主治的文字呢？所以黄氏校正为真武汤是正确的。
魏荔彤说：既然叫中风，又说脉浮紧，浮为在表，紧为寒邪，则是将中风与寒邪在表合为一症。更见发热恶寒、身疼、无汗烦躁诸症，大体是伤寒的症候多。然而言太阳中风，而中风诸症也在。主以大青龙，仍是伤寒麻黄发汗的意义。
【纲】张仲景说：太阳病，脉浮紧，无汗，发热，身体疼痛，八九天未解，表证仍在，这应当发汗。服药后，症状轻微缓解。其人发烦，目瞑（眼睛闭合不适），严重的必定衄血（鼻出血），衄血乃解。之所以这样，是因为阳气重的缘故。主治用麻黄汤。
【目】魏荔彤说：其他条文说脉浮紧发热无汗而自衄愈，纯是寒邪伤营，还比较轻微。这里竟然身体疼痛，则寒伤者重了。八九天未解，表证仍在，因此用麻黄汤发汗，轻微缓解而不全除。其人发烦目瞑的，不是麻黄治寒邪不效，必少带中风之阳邪，所以用麻黄辛热，至于发烦目瞑，严重的更必衄血。如果预先审察，知道寒重风轻，斟酌用大青龙汤，不至于此。然而寒虽发汗未尽除，风因衄已悉去，乃解者，是风邪解也。
[Outline] Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), after eight or nine days, if the pulse is faint and there is aversion to cold, this indicates deficiency of both Yin and Yang. One must not employ sweating, vomiting, or purging methods again. If the facial complexion instead shows a red, hot color, it means the disease has not yet resolved because slight sweating has not occurred, and the body will inevitably feel itchy. Guizhi Mahuang Ban Tang (Cinnamon Twig and Ephedra Half-Decoction) is appropriate.
[Commentary] Zhu Gong said: Sweating, vomiting, and purging methods should not be used; Xiao Chaihu Tang (Minor Bupleurum Decoction) should be the primary treatment. If heavy sweating is induced in error, Qi deficiency will result, leading to bilateral deafness. For those without internal heat, Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) can be used; for those with internal heat, Huangqi Jianzhong Tang (Astragalus Middle-Nourishing Decoction) is suitable.
Ke Qin said: By the eighth or ninth day, the time for resolution has arrived but the disease persists. With deficiency of both Yin and Yang, one should regulate Yin and Yang. If the patient has more heat than cold and a red face, this indicates Yang Qi constrained on the exterior, unable to vent. Sweating was required but did not occur, causing body itching. After eight or nine days, Zheng Qi (Upright Qi) is deficient while pathogens remain. One cannot sweat, nor can one refrain from sweating; thus, this method is established.
[Outline] Zhang Zhongjing said: In Taiyang disease, some may already have fever, others may not, but all will have aversion to cold, body pain, vomiting, and reverse flow of Qi, with tight pulses at the cun, guan, and chi positions. This is named Shanghan (Cold Damage). In Taiyang disease, with headache, fever, body pain, lower back pain, joint pain, aversion to wind, anhidrosis, and wheezing, Ma Huang Tang (Ephedra Decoction) is indicated. In Taiyang disease, with a floating-tight pulse, anhidrosis, fever, and body pain, persisting for eight or nine days without resolution, with exterior symptoms still present, sweating should be induced, and Ma Huang Tang is indicated. A floating-tight pulse typically presents with body pain and should be resolved by sweating. However, if the chi position pulse is slow, sweating is contraindicated due to insufficiency of Ying Qi (Nutritive Qi) and blood deficiency.
[Commentary] Zhu Gong said: If the chi pulse is slow, Xiaojianzhong Tang (Minor Construct the Middle Decoction) should be used first to nourish.
Wang Kentang said: Body pain is a symptom present in all six meridians, involving exterior and interior, cold and heat, wind and dampness. In Taiyang Shanghan, if Ying Blood circulation is impaired causing body pain, sweating is appropriate. If after sweating the pulse becomes deep and slow with persistent body pain, warming is appropriate. For Yangming meridian body pain, Baihu Tang (White Tiger Decoction) resolves it. For interior cold with exterior heat causing body pain, treat the interior first, then the exterior. Cold in the Three Yin meridians presents with deep pulse and body pain; cold in the Three Yang meridians presents with painful joints throughout the body. How can Sini Tang (Four Reversal Decoction) and Chaihu Tang (Bupleurum Decoction) be confused? Taiyang body pain with stiffness, wetness in the ears, and inability to turn the body differs from Yindu (Yin Toxin) body pain, which feels heavy as if beaten by a stick. Fever, aversion to cold, and body pain belong to Taiyang, treated with Ma Huang Tang or Da Qinglong Tang (Major Blue Dragon Decoction). If accompanied by epigastric fullness, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is used. If accompanied by diarrhea with undigested food and abdominal distension, warm the interior with Sini Tang first, then release the exterior with Guizhi Tang (Cinnamon Twig Decoction). If the chi pulse is slow indicating blood deficiency and insufficient Ying Qi, Huoren Shu suggests using Xiaojianzhong Tang to nourish blood first; once the chi pulse recovers, use Chaihu decoctions to resolve the exterior. Regarding heat-dominant/cold-minor cases with deep-slow chi pulse indicating Ying Blood deficiency, Huangqi Jianzhong Tang is used. Astragalus is sweet; combined with Licorice, it greatly generates blood. This is Zhongjing’s ingenious method. Sweetness tonifies the Stomach, the sea of Qi and Blood, from which blood is generated. As the classics state, "Without Yang, Yin cannot be generated"; using sweetness to benefit the Stomach and generate blood is profound. Modern practitioners only know Ginseng and Danggui as Qi herbs, so I elucidate this theory.
Ke Qin said: Taiyang disease usually manifests within one or two days. Cold pathogens do not manifest immediately due to coagulation, unlike Wind pathogens which easily cause fever. Regardless of whether fever has appeared, the presence of aversion to cold, body pain, vomiting, and tight pulses allows diagnosis of Taiyang Shanghan rather than Fengzhong (Wind Strike). Cold binding the exterior causes body pain; cold invading the interior causes vomiting. Taiyang governs the exterior; when Wind-Cold binds externally, Yang Qi cannot extend, causing whole-body pain. This case emphasizes fever, body pain, anhidrosis, and wheezing.
Shen Jin'ao's Note: "Method" refers to pulse methodology. A floating-tight pulse indicates body pain and warrants sweating. However, all three positions must be floating-tight to sweat. If only the cun position is floating-tight but the chi is slow, sweating is contraindicated. The chi governs Blood; blood deficiency with a slow chi pulse means sweating will not produce sweat. Not only will body pain persist, but loss of Blood and Body Fluids may occur.
[Outline] Zhang Zhongjing said: After sweating, if body pain persists with a deep-slow pulse, Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang (Cinnamon Twig Decoction with Added Peony, Ginger, and Ginseng) is indicated.
[Commentary] Cheng Wuji said: Post-sweating body pain indicates residual pathogen. Deep-slow pulse indicates Ying Blood deficiency. The classics state: "Deep pulse indicates deficient Ying Blood" and "Slow pulse indicates insufficient Ying Qi and blood deficiency." Use Guizhi to resolve residual pathogens, and add Renshen (Ginseng), Shaoyao (Peony), and Shengjiang (Fresh Ginger) to replenish deficient Blood.
Zhu Gong said: Xiaojianzhong Tang also treats post-sweating body pain with deep-slow pulse. If vomiting and diarrhea stop but body pain persists, a small dose of Guizhi Tang will cure it. Jingui Yaolue states: Patients with sores who have body pain must not be sweated; sweating leads to spasms.
Zhang Yuansu said: The classics state that excess exterior pathogens with floating-tight pulses cause body pain, requiring sweating. Since body pain stems from unresolved exterior pathogens, adding Renshen, Shaoyao, and Shengjiang benefits Blood. Why? Exterior excess causes body pain; Blood deficiency also causes body pain. Floating-tight pulse indicates excess; deep-slow pulse indicates deficiency. Excess requires reduction; deficiency requires tonification. When Zhongjing mentions post-sweating body pain with no exterior or interior heat symptoms, it is solely due to body pain. A slightly floating-full pulse indicates unresolved exterior pathogens. A deep-slow pulse indicates Blood deficiency, hence the addition of these three herbs to tonify Blood.
[Outline] Zhang Zhongjing said: In Shanghan, if a physician erroneously uses purgatives, leading to continuous diarrhea with undigested food and body pain, urgent rescue of the Interior is required. Once bowel movements normalize and body pain remains, urgent rescue of the Exterior is required. Rescue the Interior with Sini Tang; rescue the Exterior with Guizhi Tang. For diarrhea, abdominal distension, and body pain, warm the Interior first, then attack the Exterior. Warm the Interior with Sini Tang; attack the Exterior with Guizhi Tang. If vomiting and diarrhea cease but body pain persists, harmonize the Exterior moderately with Guizhi Tang.
[Commentary] Ke Qin said: Erroneous purging of exterior Cold transfers it to the Spleen, causing diarrhea with undigested food and loss of Stomach Yang, while body pain persists, leaving both Interior and Exterior compromised. Body pain indicates residual exterior pathogen. One must abandon the Exterior to save the Interior. Once the Interior improves, if Exterior symptoms remain, saving the Exterior cannot be delayed. Body pain is typically a Ma Huang Tang pattern, but with diarrhea, pores are loose; Guizhi Tang harmonizes Ying and Wei to resolve pain. Hence "rescue" rather than "attack," aligning with harmonizing the Middle. After warming the Interior, Guizhi Tang can still be used—how divine! Abdominal distension with diarrhea suggests impending undigested food; warm the Interior preemptively. If the Interior harmonizes but the Exterior does not, focus on the Exterior ("attack"). Vomiting/diarrhea indicate Zang-Fu disharmony, not treated by Guizhi Tang. Post-cease body pain indicates Ying-Wei disharmony, not suitable for Ma Huang Tang; harmonize the Exterior with Guizhi Tang's method, adjusting dosage carefully.
[Outline] Zhang Zhongjing said: If a patient has whole-body pain, fever, and worsening in the late afternoon, this is named Fengshi (Wind-Dampness). This condition results from sweating followed by exposure to wind, or prolonged exposure to cold.
Question: During rainy weather, Wind-Dampness combines causing whole-body pain. Medically, sweating should resolve it. The doctor says sweating is possible, but why does the disease not resolve after sweating? Answer: If heavy sweating occurs, Wind and Dampness leave together. Patients with chronic Dampness have whole-body pain, fever, and sallow-yellow complexion. After eight or nine days of Shanghan, Wind-Dampness combines causing severe body pain, inability to turn, no vomiting/thirst, and a deficient-floating-choppy pulse. Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is indicated. If the stool is hard and urination normal, remove Guizhi and add Baizhu Tang (Atractylodes Macrocephala Decoction).
[Commentary] Cheng Wuji said: By the seventh or eighth day, pathogens move inward, so body pain should cease. Persistent pain, restlessness, and inability to turn indicate Wind-Dampness combination. Restlessness is Wind; pain is Dampness. Classics state: "Wind presents with floating-deficient pulse"; Pulse Jing states: "Choppy pulse indicates Cold-Dampness." No vomiting/thirst means no Interior pathogen. Floating-deficient-choppy pulse with painful restlessness confirms Wind-Dampness in the channels. Guizhi Fuzi Tang disperses Wind-Dampness from the exterior.
Li Gao said: For Wind-Dampness causing whole-body pain, Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction) plus Qianghuo, Fangfeng, Shengma, Bencao, and Cangzhu treats it. Stop administration once cured, as Wind-dispersing herbs damage Yuan Qi. Mahuang Fupian Tang treats sweating in cool rooms, lethargy, limb fatigue, wandering pain, and restless heat due to latent Fire in the Lower Jiao failing to ascend. This is Wind-Dampness combination. Use Mahuang to induce gradual sweating. Even channel pathogens require sweating, especially in early spring with slow-warm pulses, to raise Yang Qi and resolve fatigue.
Wang Haogu said: Shenzhu Tang treats Wind-Dampness with aversion to cold, tight pulse, and anhidrosis; Baizhu Tang treats Wind-Dampness with aversion to cold, slow pulse, and diaphoresis. Adjust these formulas based on symptoms.
Min Zhiqing said: Sweating exposed to Wind-Cold prevents sweat dispersion, trapping pathogens in joints causing pain. Closed pores cause fever. Late afternoon corresponds to Yangming; Taiyin Dampness stagnates, worsening pain. Though caused by Dampness, it originates from Wind-Cold. Jingui uses Mahuang Xingyi Gancao Tang. If Dampness fails to drain and Heat fails to vent, jaundice occurs. In Shanghan jaundice, body pain resolves; persistent pain indicates Dampness in joints, requiring Wuling San (Five-Ingredient Powder with Poria) to drain Dampness.
Shen Jin'ao's Note: Wind-Dampness body pain differs from Shanghan body pain. Shanghan pain is constant; Wind-Dampness pain worsens in the late afternoon or during rain. It is not strictly confined to the late afternoon.
[Outline] Zhang Zhongjing said: Taiyang Summerheat presents with fever, heavy painful body, aversion to cold, and faint pulse, caused by drinking cold water in summer, causing water to remain in the skin.
Taiyang Summerheat presents with fever, aversion to cold, heavy painful body, and string-thin-hollow-slow pulse. After urination, chills and piloerection occur. Hands and feet are cold. Minor exertion causes fever. Mouth opens, and front teeth dry out. Sweating exacerbates aversion to cold; moxibustion exacerbates fever; purging causes strangury.
[Commentary] Ke Qin said: Summerheat differs significantly from Shanghan, though sometimes caused by Cold. Taiyang Qi is Cold in Heaven and Water in Earth. Winter Shanghan is caused by Heavenly Cold Wind; Summer Shanghan is caused by Earthly Cold Water. Faint pulse indicates Yang loss; weak pulse with fever indicates Summerheat damaging Qi. Heavy pain and aversion to cold result from cold water bathing remaining in the skin, essentially Shanghan. Wuling San or Huoxiang Yin are appropriate. String-thin-hollow-slow should not be read together; they describe varying deficient pulses in Summerheat complicated by Cold. These pulses with fever/aversion-to-cold/heavy-pain indicate deficiency-cold even in summer. Dongyuan’s use of Buzhong Yiqi Tang aligns with Zhongjing’s principles.
[Outline] Zhang Zhongjing said: Taiyang Fengzhong with floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and irritability is treated with Da Qinglong Tang. If the pulse is faint, with sweating and aversion to wind, it is contraindicated. Administration causes reversal cold limbs, muscle twitching, and tremors—a adverse reaction. Rescue with Zhenwu Tang (True Warrior Decoction).
[Commentary] Fang Zhongxing said: The phrase "Rescue with Zhenwu Tang" corrects a transcription error identified by Huang. Since it states "contraindicated" and "adverse reaction," the original text likely meant Zhenwu Tang for rescue, not Da Qinglong Tang.
Wei Litong said: Naming it "Fengzhong" yet describing a floating-tight pulse combines Wind Strike and Exterior Cold. Symptoms like fever, aversion to cold, body pain, anhidrosis, and irritability resemble Shanghan. Using Da Qinglong follows the principle of Ma Huang sweating for Cold.
[Outline] Zhang Zhongjing said: Taiyang disease with floating-tight pulse, anhidrosis, fever, body pain, persisting eight or nine days without resolution, with exterior symptoms remaining, requires sweating. After medication, symptoms mildly improve. The patient experiences irritability and eye closure. Severe cases may experience nosebleeds, which resolve the disease. This occurs due to excessive Yang Qi. Ma Huang Tang is indicated.
[Commentary] Wei Litong said: Other texts mention spontaneous nosebleed resolving floating-tight Shanghan due to mild Ying Blood injury. Here, severe body pain indicates heavier Cold damage. Persisting eight or nine days with exterior symptoms warrants Ma Huang Tang. Mild improvement without full resolution, accompanied by irritability and eye closure, suggests minor Yang pathogen mixed with Cold. Mahuang’s acrid-hot nature may cause these symptoms; severe cases bleed. If Cold were dominant over Wind, Da Qinglong Tang would have been considered. Although Cold is not fully resolved by sweating, Wind is expelled via nosebleed, achieving resolution.