李杲曰。内伤等病。是心肺之气。已绝于外。必怠惰嗜卧。四肢沉困不收。此乃热伤元气。脾
主四肢。既为热所乘。无气以动。经云。热伤气。又云。热则骨消筋缓。此之谓也。若外伤风寒。
是肾肝之气已绝于内。肾主骨为寒。肝主筋为风。自古肾肝之病同一治。以其递相维持也。故经言
胆主筋。膀胱主骨是也。或中风。或伤寒。得病之日。便着床枕。非扶不起。筋骨为之疼痛。不能
动摇。乃形质之伤。经云。寒伤形。又云。寒则筋挛骨痛。此之谓也。
【纲】仲景曰。太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。发作有时。头痛。心
下痞。硬满。引胁下痛。干呕短气。汗出不恶寒者。此表解里未和也。十枣汤主之。
【目】朱肱曰。身凉汗出。两胁疼痛。或干呕。此十枣汤症也。大抵胁下痛者。此为有饮。须
分表里。干呕微利发热而渴。为表有水。小青龙加芫花主之。身体凉。表症罢。干呕而胁下痛。
为里有水。十枣汤主之。十枣非小青龙之比。须量人虚实。不可妄投。
柯琴曰。水气为患。此则外走皮毛而汗出。上走咽喉而呕逆。中走胁肋而牵痛。下走肠胃而下
利。浩浩莫御。非得利
水之峻剂以直折之。中气不支矣。此十枣与五苓、青龙、泻心等法悬殊也。
【纲】仲景曰。太阳病。十日已去。脉浮细而嗜卧者。外已解也。设胸满胁痛者。与小柴胡汤。
脉但浮者。与麻黄汤。
【目】楼全善曰。脉微细欲寐。少阴症也。浮细嗜卧。无少阴症。虽十日后。尚属太阳。此表
解而不了了之谓。设见胸满嗜卧。亦太阳之余邪未散。兼胁痛。是太阳少阳合病矣。以少阳脉弦细
也。少阳为枢。枢机不利。一阳之气不升。故胸满胁痛而嗜卧。与小柴胡和之。若脉浮而不细。是
浮而有力也。无胸胁痛。则不属少阳也。但浮而不大。则不涉阳明。仍在太阳也。太阳为开。用麻
黄汤以开之。然与太阳初病。用以发汗不同。当小其制而少与之也。
鳌按。此言太阳少阳脉症相关处也。胁痛。本少阳症。
【纲】仲景曰。伤寒吐下后。复发汗。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。
【目】鳌按。此条胁下痛。兼见经脉动惕。属于虚气也。冲咽喉眩冒。即虚烦之处。
李杲说：内伤等疾病，是心肺之气在外已衰竭。必然出现倦怠嗜睡、四肢沉重困倦无法收持的症状。这是因为热邪损伤了元气。脾主四肢，既然被热邪所乘袭，就没有气力来运动。医经说：“热伤气”，又说：“热则骨消筋缓”，说的就是这种情况。如果是外感风寒，是肾肝之气在内已衰竭。肾主骨对应寒邪，肝主筋对应风邪。自古以来，肾和肝的病证治疗原则相同，因为它们相互维持。所以医经说胆主筋、膀胱主骨。或者中风，或者伤寒，得病当天就卧床不起，不扶起就不能动，筋骨因此疼痛，不能摇动，这是形体质地的损伤。医经说：“寒伤形”，又说：“寒则筋挛骨痛”，说的就是这种情况。
【纲】张仲景说：太阳中风证，伴有下利、呕吐逆气。表证解除后，才可以攻里。其人汗出，发作有定时，头痛，胃脘部痞塞，硬满，牵引胁下疼痛，干呕，短气，汗出且不恶寒的，这是表证已解而里气未和，用十枣汤主治。
【目】朱肱说：身体凉爽汗出，两胁疼痛，或干呕，这是十枣汤证。大抵胁下疼痛的，这是因为体内有水饮，必须分辨表里。如果干呕、微利、发热且口渴，是表有水饮，用小青龙加芫花汤主治。如果身体凉，表证已罢，干呕而胁下疼痛，是里有水饮，用十枣汤主治。十枣汤不是小青龙汤可比拟的，必须衡量病人的虚实情况，不可妄然投药。
柯琴说：水气为患，这里水气外走皮毛而汗出，上走咽喉而呕吐逆气，中走胁肋而牵拉疼痛，下走肠胃而下利，浩浩荡荡不可抵御，非得用利水的峻剂来直接折服它，否则中气就要支撑不住了。这与五苓散、小青龙汤、泻心汤等治法截然不同。
【纲】张仲景说：太阳病，过了十天以上，脉象浮细且嗜睡的，说明外邪已解。如果出现胸满胁痛，给予小柴胡汤。脉象仅见浮象的，给予麻黄汤。
【目】楼全善说：脉微细欲寐，是少阴病证。脉浮细嗜睡，没有少阴病证，虽然过了十天，仍属于太阳病，这就是表证已解但病情尚未完全清爽的意思。如果出现胸满嗜睡，也是太阳余邪未散，兼有胁痛，这是太阳少阳合病。因为少阳脉弦细。少阳为枢机，枢机不利，一阳之气不能升发，所以胸满胁痛且嗜睡，用小柴胡汤调和它。如果脉浮而不细，是浮而有力，没有胸胁痛，就不属于少阳病。脉浮但不大，就不涉及阳明病，仍在太阳病。太阳为开，用麻黄汤来开启它。然而这与太阳初病时用麻黄汤发汗不同，应当减小剂量并少量给予。
沈金鳌按语：这里说的是太阳和少阳脉症相关联的地方。胁痛，本是少阳病的症状。
【纲】张仲景说：伤寒经过吐法和下法治疗后，又再次发汗，导致虚烦，脉象非常微弱。到了第八九天，胃脘部痞硬，胁下疼痛，气向上冲至咽喉，眩晕昏冒，经脉跳动惕惧的，时间久了会形成痿证。
Li Gao stated: In diseases of internal injury, the Qi of the Heart and Lung has already failed externally. There must be lethargy and a desire to sleep, with the four limbs sinking and feeling heavy, unable to be held or moved. This is due to heat damaging the Yuan Qi (Original Qi). The Spleen governs the four limbs; once attacked by heat, there is no Qi to move. The Classics state: "Heat damages Qi," and also: "Heat causes bones to waste and tendons to relax." This refers to such cases. If it is an external contraction of Wind-Cold, the Qi of the Kidney and Liver has already failed internally. The Kidney governs the bones and corresponds to Cold; the Liver governs the tendons and corresponds to Wind. Since ancient times, diseases of the Kidney and Liver have been treated similarly because they maintain each other. Thus, the Classics state that the Gallbladder governs the tendons and the Bladder governs the bones. Whether contracting Wind-Stroke or Cold Damage, on the day of illness, one lies in bed, unable to rise without support, with pain in the sinews and bones, unable to move. This is an injury to the physical form. The Classics state: "Cold damages the form," and also: "Cold causes sinew spasm and bone pain." This refers to such cases.
[Gang] Zhang Zhongjing said: In Taiyang Wind-Strike syndrome, accompanied by diarrhea and vomiting/retching, only after the exterior syndrome is resolved can one attack the interior. If the patient sweats, with episodes occurring at specific times, headache, epigastric fullness and obstruction, hardness and distension pulling into the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. Shizao Tang (Ten Jujube Decoction) should be administered.
[Mu] Zhu Gong said: Cool body with sweating, pain in both hypochondria, or dry retching, are symptoms of Shizao Tang syndrome. Generally, pain in the hypochondrium indicates the presence of fluid retention (Yin), requiring differentiation between exterior and interior. If there is dry retching, slight diarrhea, fever, and thirst, it is water-fluid in the exterior, treated with Xiao Qinglong Tang plus Yuanhua (Kansui Root). If the body is cool, the exterior syndrome has ceased, with dry retching and hypochondriac pain, it is water-fluid in the interior, treated with Shizao Tang. Shizao Tang is not comparable to Xiao Qinglong Tang; one must assess the patient's deficiency and excess before administering, and it should not be given recklessly.
Ke Qin said: When pathogenic water-fluid acts as a disease, here it moves outward to the skin and hair causing sweating, upward to the throat causing vomiting and retching, medially to the hypochondrium causing pulling pain, and downward to the intestines and stomach causing diarrhea. It is vast and uncontrollable; unless a harsh purgative for draining water-fluid is used to directly subdue it, the Middle Qi will collapse. This differs significantly from methods such as Wuling San (Five-Ingredient Powder with Poria), Xiao Qinglong Tang, and Xiexin Tang.
[Gang] Zhang Zhongjing said: In Taiyang disease, if ten days have passed, and the pulse is floating and fine with a desire to sleep, the exterior has been resolved. If chest fullness and hypochondriac pain appear, administer Xiaochaihu Tang (Minor Bupleurum Decoction). If the pulse is merely floating, administer Mahuang Tang (Ephedra Decoction).
[Mu] Lou Quanshan said: A faint, fine pulse with drowsiness is Shaoyin syndrome. A floating, fine pulse with a desire to sleep, without Shaoyin symptoms, even after ten days, still belongs to Taiyang. This refers to the state where the exterior is resolved but the condition is not yet completely clear. If chest fullness and drowsiness appear, it is also residual pathogen of Taiyang not yet dispersed. With added hypochondriac pain, it is a combined disease of Taiyang and Shaoyang. This is because the Shaoyang pulse is wiry and fine. Shaoyang serves as the pivot; when the pivot mechanism is unfavorable, the Qi of One Yang cannot ascend, resulting in chest fullness, hypochondriac pain, and drowsiness. Treat with Xiaochaihu Tang to harmonize. If the pulse is floating but not fine, it is floating and forceful; without chest and hypochondriac pain, it does not belong to Shaoyang. If floating but not large, it does not involve Yangming, remaining in Taiyang. Taiyang serves as the opening; use Mahuang Tang to open it. However, this differs from using Mahuang Tang to induce sweating in the initial stage of Taiyang disease. The dosage should be reduced and administered in small amounts.
Shen Jin'ao commented: This discusses the correlation between Taiyang and Shaoyang pulses and symptoms. Hypochondriac pain is originally a Shaoyang symptom.
[Gang] Zhang Zhongjing said: After Cold Damage was treated with emesis and purgation, followed by repeated sweating, leading to vexatious restlessness, with a very faint pulse. By the eighth or ninth day, epigastric hardness and obstruction, hypochondriac pain, Qi rushing up to the throat, vertigo and dizziness, and twitching/trembling of the meridians, if prolonged, will develop into Wei Syndrome (Flaccidity Syndrome).
[Mu] Shen Jin'ao commented: In this clause, hypochondriac pain accompanied by twitching/trembling of the meridians belongs to deficient Qi. The Qi rushing to the throat and vertigo/dizziness are manifestations of the aforementioned vexatious restlessness.