于桂枝汤内，加葛根三两，余根据桂枝汤法。
@@@
太阳病，发汗太多，因致痉。
【注】
以上论痉，皆外感风、寒、湿而为病也。若太阳病发汗太多，津液大亡，表气不固，
邪风乘虚而入，因成痉者，乃内虚之所致也，不可以柔痉刚痉例之，宜以桂枝加附子
汤，以固表祛风为主治。由此推之，凡病出汗过多，新产亡血过多，而变生此证者，
皆类此也。
【集注】
程应旄曰：即此一端推之，则知此病得之亡津亡血，而因虚致寒，因虚致燥者不少。
盖阳气者，柔则养筋，发汗太多，则亡其阳，而损其经脉之血液故也。
@@@
湿家之为病，一身尽疼，发热，身色如似熏黄。
【注】
湿家，谓病湿之人。湿之为病，或因外受湿气，则一身尽痛，或因内生湿病，则发热
身黄。若内外同病，则一身尽痛发热，身色如熏黄也。熏黄者，湿盛之发黄，属脾之
瘀湿，故其色暗如烟熏也。不似伤寒热盛之发黄，属阳明之郁热，故其色明如橘子色
也。
【集注】
张璐曰：湿证发黄，须分阴阳表里。阳湿，在里茵陈蒿汤；在表麻黄连轺赤小豆汤。
阴湿，在里白术附子汤，在表麻黄白术汤，此阴湿在表而发黄也。『金匮』有云：湿
家身烦痛，可与麻黄加术汤，盖寒与湿合，不宜大汗，故加白术。以麻黄得术，则汗
不致于骤发，白术得麻黄，则湿滞得以宣通也。
@@@
湿家病，身上疼痛，发热，面黄而喘，头痛、鼻塞而烦，其脉大，自能饮食，腹中和
无病，病在头中寒湿，故鼻塞，内药鼻中则愈。
【注】
此申上条，详其证出其脉，以别其治也。湿家病，身上疼痛发热，面黄而喘，此内生
外受之湿病也，外宜羌活胜湿汤，内宜茵陈五苓散，喘甚大陷胸丸。若更头痛鼻塞而
烦，其脉大，证类伤寒，但其人里和能食，知非伤寒，不可发汗，乃湿邪之病在头，
故头痛鼻塞，惟宜纳药鼻中，取黄水从涕出，自可愈也。所纳之药，即瓜蒂散类也。
【集注】
郑重光曰：身上疼痛发热，面黄而喘，头痛鼻塞，则寒湿之邪客于上焦。经曰：因于
湿首如裹是也。用瓜蒂散吹鼻，此在上者，因而越之之法也。
@@@
太阳病，关节疼痛而烦，脉沉而细者，此名湿痹。湿痹之候，其人小便不利，大便反
快，但当利其小便。
【注】
湿家脉浮细，湿在外也，当汗之。今太阳病，关节疼痛而烦，小便不利，大便反快，
脉不浮细而沉细，是湿邪内盛而为湿痹不通之候也。故但当利其小便，使湿从小便而
去，乃湿淫于内之正治也。
【集注】
成无己曰：湿盛则濡泄。小便不利，大便反快者，湿气内流也。但当利其小便，以宣
泄腹中湿气。古云：治湿不利小便，非其治也。
方有执曰：此以湿之入里者言也。关节疼痛者，寒湿之气，走注内渗，所以脉沉而细
也。痹以疼痛言，小便不利，大便反快者，湿即水，水不外渗，则横流不遵故道。利
其小便者，导其遵故道而行也。
张志聪曰：关节者，腰背肘膝之大关，大筋之所统属，不同于骨节也。湿流关节，大
筋不和，故疼痛痹闭也。湿伤太阳，筋脉涩滞，故名湿痹，利其小便，则水道行而决
渎无愆，湿邪去而筋脉调和矣。
@@@
湿家，其人但头汗出，背强，欲得被覆、向火，若下之早则哕，胸满，小便不利，舌
上如胎者，以丹田有热，胸中有寒，渴欲得水，而不能饮，口燥烦也。
【注】
湿家但头汗出，乃湿气上淫之汗，非阳明之热不得越也。湿家背强，乃湿气涩滞之重
强，非痉病之拘强也。欲得覆被向火，非外恶寒，乃湿盛生内寒也。若误以湿淫之头
汗，为阳明瘀热之头汗而下之，寒湿之气，乘虚入胸则胸满，入胃则哕矣。寒湿不化
，故小便不利；胸中有寒，故舌上滑白如胎；丹田有热，故口燥渴，欲得水而不能饮
，由胸中有寒湿故也。
【集注】
成无己曰：伤寒则无汗，湿家虽有汗而不能周身，故但头汗出也。
程应旄曰：虽渴欲得水似热，而不能饮可辨，则只是口燥烦，而实非胸中燥烦可知，
证同病别也。
@@@
湿家下之，额上汗出，微喘，小便利者死，若下利不止者，亦死。
【注】
此承上条湿家误下之逆也。湿家误下，胸满而哕，小便不利，舌上如胎，口燥渴不能
饮，已属逆矣，尚在可治。此误下后，额汗不已，微喘不止，是阳脱于上也；小便反
利，下利不止，是阴脱于下也，阴阳相离，故死也。
【集注】
方有执曰：治湿当利其小便，而以小便利主死，何也？误治而阴阳散亡也。
程知曰：湿之中人，阴先受之，故本经湿证，多从助阳温散为治，若妄下，则阳虚阴
盛而不可救矣。额上汗出微喘，虚阳欲上脱也；二便不禁，盛阴欲下脱也，阴阳离决
，死矣！
@@@
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，或久伤取冷所致
也。
【注】
病者，谓一身尽痛之病人也。湿家一身尽痛，风湿亦一身尽痛。然湿家之痛，则重着
不能转侧；风湿之痛，则轻掣不可屈伸，此痛之有别者也。至于发热，湿家之热，早
暮不分微甚；风湿之热，则日晡必剧。此得之于汗出当风，或久伤湿，复受风冷所致
也。
【集注】
张志聪曰：汗出当风，则为风湿；久伤取冷，则为寒湿。
张锡驹曰：发热日晡所剧者，日晡而阳气衰，阴气盛，湿为阴邪，故主旺时而甚也。
@@@
问曰：风湿相搏，一身尽疼痛，法当汗出而解。值天阴雨不止，医云：此可发汗。汗
之病不愈者，何也？答曰：发其汗，汗大出者，但风气去，湿气在，是故不愈也。若
治风湿者，发其汗，但微微似欲汗出者，风湿俱去也。
【注】
此详风湿相搏，一身尽痛，不惟不可下，即发汗亦不可失其宜也。风阳邪，湿阴邪，
风湿相搏，阴阳受邪，故一身尽痛也。法当汗出而解，值天阴雨不止，则湿气盛，虽
发其汗，汗大出而病不愈者，但以风气去，湿气在，是故不愈也。以其值湿盛之时，
发其汗，大汗出，此汗之不如法，所以不解也。若治风湿者，必俟天气睛明发其汗，
但令其汗微微似欲出状，则风与湿俱去，而病自解矣。
【集注】
方有执曰：阴雨不止，则湿不除，所以益当发汗也。然风湿本由汗出当风而得，则汗
之大出者，必反湿转加甚，微微似欲汗出，而不见出，则湿消而风散矣。此发汗之微
机，后之人动辄以大汗为言者，去道远矣。
张璐曰：风湿相搏，法当汗出而解，合用桂枝加术，使微微蒸发，表里气和，风湿皆
去。正如湿家身烦痛，可与麻黄汤加术同义。
程应旄曰：湿家不惟不可误下，即汗亦不可误汗。风湿相搏一证，一身尽疼痛，虽是
微挟表邪，然其脉不浮，终是汗难大汗，治风兼治湿，但使微微似欲汗出者，是其法
也。
@@@
伤寒八、九日，风湿相搏，身体疼烦，不能自转侧，不呕不渴，脉浮虚而涩者，桂枝
附子汤主之。若其人大便□，小便自利者，去桂枝加白术汤主之。
【注】
此承上条，详申脉证，以明其治也。伤寒八、九日，不呕不渴，是无伤寒里病之证也
；脉浮虚涩，是无伤寒表病之脉也。脉浮虚，主在表，虚风也；涩者，主在经，寒湿
也。身体疼烦属风也，不能转侧属湿也，乃风湿相搏之证，非伤寒也，与桂枝附子汤
温散其风湿，使从表而解也。若脉浮实者，则又当以麻黄加术汤，大发其风湿也。如
其人有是证，虽大便□，小便自利，而不议下者，以其非邪热入里之□，乃风燥湿去
之□，故仍以桂枝附子汤去桂枝，以大便□，小便自利，不欲其发汗，再夺津液也；
加白术，以身重着，湿在肉分，用以佐附子逐湿气于肌也。
【集注】
成无己曰：烦者，风也。身疼不能自转侧者，湿也。经曰：风则浮虚。『脉经』曰：
脉来涩者，为病寒湿也。
在桂枝汤的基础上，加入三两葛根，其余按照桂枝汤的煎服法进行。
@@@
太阳病（太阳经受邪所致的病证），如果发汗过多，就会导致痉病（以项背强直、口噤不开甚至角弓反张为特征的病证）。
【注】
以上论述的痉病，都是由外感风、寒、湿邪引起的。如果是太阳病发汗过多，导致津液大量耗损，表气不固，邪风乘虚而入而形成的痉病，是由于内部虚弱所致，不能将其归类为柔痉或刚痉，适宜使用桂枝加附子汤，以固护体表、祛除风邪为主要治法。由此类推，凡是疾病出汗过多，或者新产后失血过多，从而变生这种证候的，都属于这种情况。
【集注】
程应旄说：从这一端推论，就知道这种病是由于亡失津液和血液，因虚而导致寒，因虚而导致燥的情况不少。大概阳气具有柔和滋养筋脉的作用，发汗太多，就会亡失阳气，从而损伤经脉中的血液。
@@@
患有湿病的人，全身都疼痛，发热，身体颜色像被烟熏过的黄色。
【注】
“湿家”是指患湿病的人。湿病这种病，如果是由于外受湿气，就会全身疼痛；如果是由于内生湿病，就会发热、身黄。如果内外同病，就会全身疼痛、发热，身体颜色像熏黄一样。“熏黄”，是指湿气盛极导致的发黄，属于脾脏瘀滞的湿邪，所以颜色暗哑像烟熏一样。不像伤寒热盛导致的发黄，那是阳明经郁热的表现，所以颜色明亮像橘子皮的颜色。
【集注】
张璐说：湿证发黄，必须区分阴阳表里。阳湿，在里的用茵陈蒿汤；在表的用麻黄连轺赤小豆汤。阴湿，在里的用白术附子汤，在表的用麻黄白术汤，这是阴湿在表而发黄的情况。《金匮要略》中说：湿家身体烦痛，可以用麻黄加术汤，因为寒与湿结合，不宜大汗，所以加入白术。麻黄得到白术，就不会导致汗出太急骤；白术得到麻黄，就能宣通湿气的阻滞。
@@@
湿病患者，身上疼痛，发热，面色黄且气喘，头痛、鼻塞且心烦，脉象大，能正常饮食，腹部平和没有病，这是病邪在头部感受了寒湿，所以鼻塞，将药物纳入鼻中就能痊愈。
【注】
这是对上一条的补充，详细阐述其症状和脉象，以区别治疗方法。湿病患者，身上疼痛发热，面色黄且气喘，这是内生病湿和外受湿邪共同作用的结果，外治宜用羌活胜湿汤，内治宜用茵陈五苓散，气喘严重的用大陷胸丸。如果再加上头痛鼻塞且心烦，脉象大，症状类似伤寒，但是病人里气和缓能进食，知道不是伤寒，不可发汗，这是湿邪病在头部，所以头痛鼻塞，只适宜将药物纳入鼻中，引导黄水随鼻涕排出，自然可以痊愈。所纳的药物，就是瓜蒂散之类的方剂。
【集注】
郑重光说：身上疼痛发热，面色黄且气喘，头痛鼻塞，说明寒湿之邪客居在上焦。医经说：因于湿，头感觉像被包裹住一样。用瓜蒂散吹入鼻中，这是针对在上部的病邪，采用因势利导使其涌吐的方法。
@@@
太阳病，关节疼痛且烦躁，脉象沉而细的，这叫做湿痹。湿痹的表现，病人小便不利，大便反而通畅，只应当通利小便。
【注】
湿病的脉象通常浮细，说明湿邪在表，应当发汗。现在是太阳病，关节疼痛且烦躁，小便不利，大便反而通畅，脉象不浮细而是沉细，这是湿邪内盛导致湿痹不通的表现。所以只应当通利小便，使湿气从小便排出，这是治疗湿邪淫溢于内的正确治法。
【集注】
成无己说：湿气盛则会导致濡泄。小便不利，大便反而通畅，是湿气内流的表现。只应当通利小便，以宣泄腹中的湿气。古语说：治疗湿病如果不通利小便，就不是正确的治法。
方有执说：这是讲湿邪入里的情况。关节疼痛，是因为寒湿之气走窜内渗，所以脉象沉而细。“痹”指疼痛，小便不利，大便反而通畅，是因为湿即水，水不外渗，就会横流而不遵循常道。通利小便，是引导它遵循常道而行。
张志聪说：关节，是指腰背肘膝的大关节，是大筋所统属的地方，不同于骨节。湿气流注关节，大筋不和，所以疼痛痹阻。湿邪伤及太阳经，筋脉涩滞，所以名叫湿痹，通利小便，则水道运行，决渎功能没有差错，湿邪去除而筋脉调和了。
@@@
湿病患者，只有头部出汗，背部僵硬，想要盖被子、靠近火源，如果过早使用下法，就会出现呃逆，胸满，小便不利，舌苔像胎垢一样，这是因为丹田有热，胸中有寒，口渴想喝水，但不能喝，口燥心烦。
【注】
湿病患者只有头部出汗，这是湿气上淫导致的汗，不是阳明经的热邪不得宣泄。湿病患者背部僵硬，这是湿气涩滞导致的沉重僵硬，不是痉病的拘挛强直。想要盖被子靠近火源，不是因为外面怕冷，而是湿气盛导致内部产生寒邪。如果错误地把湿淫导致的头汗，当作阳明瘀热的头汗而使用下法，寒湿之气就会乘虚进入胸部导致胸满，进入胃部导致呃逆。寒湿不化，所以小便不利；胸中有寒，所以舌上滑白像胎垢；丹田有热，所以口燥渴，想喝水但不能喝，这是由于胸中有寒湿的缘故。
【集注】
成无己说：伤寒是无汗的，湿病患者虽然有汗但不能遍及全身，所以只有头部出汗。
程应旄说：虽然口渴想喝水看似有热，但不能喝就可以辨别，这只是口燥烦，实际上并不是胸中燥烦，可知证候相同但病机不同。
@@@
湿病患者误用下法后，额头出汗，轻微气喘，小便通利的会死亡，如果腹泻不止的，也会死亡。
【注】
这是承接上一条，讲述湿病患者误用下法的逆证。湿病患者误用下法，出现胸满而呃逆，小便不利，舌上像胎垢，口燥渴不能饮，已经属于逆证，尚在可治范围。这次误下后，额头汗出不止，微喘不止，这是阳气脱失于上；小便反而通利，腹泻不止，这是阴气脱失于下，阴阳分离，所以死亡。
【集注】
方有执说：治疗湿病应当通利小便，而以小便通利为主死证，为什么呢？是因为误治导致阴阳散亡。
程知说：湿邪中人，阴先受之，所以本经的湿证，多从助阳温散来治疗，如果妄用下法，则阳虚阴盛而不可救。额头出汗微喘，是虚阳欲向上脱失；二便不禁，是盛阴欲向下脱失，阴阳离决，就会死亡！
@@@
病人全身都疼痛，发热。在日晡时（下午3-5点）加重的，这叫做风湿。这种病是由于出汗时当风，或者久伤取冷所导致的。
【注】
“病人”，是指全身疼痛的病人。湿病患者全身疼痛，风湿病患者也全身疼痛。然而湿病的疼痛，是沉重着滞不能转侧；风湿病的疼痛，是轻掣不可屈伸，这是疼痛的区别。至于发热，湿病的发热，早晚不分轻重；风湿病的发热，则在日晡时必然加重。这是得之于出汗时当风，或者久伤湿气，又受风冷所导致的。
【集注】
张志聪说：出汗当风，则为风湿；久伤取冷，则为寒湿。
张锡驹说：发热在日晡时加重的，是因为日晡时阳气衰，阴气盛，湿为阴邪，所以在其旺盛的时候病情加重。
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问曰：风湿相搏，全身都疼痛，按理应发汗而解。正值天阴雨不停，医生说：这可以发汗。发汗后病不愈，为什么呢？答曰：发其汗，汗出太多的，只是风气去了，湿气还在，所以不愈。如果治疗风湿，发其汗，只要微微似欲汗出的样子，风湿就都去除了。
【注】
这里详细论述风湿相搏，全身疼痛，不仅不可用下法，即使发汗也不可以失去适宜的程度。风是阳邪，湿是阴邪，风湿相搏，阴阳受邪，所以全身都疼痛。按理应发汗而解，正值天阴雨不停，则湿气盛，虽然发其汗，汗出太多而病不愈的，只是因为风气去了，湿气还在，所以不愈。因为正值湿气盛的时候，发其汗，大汗出，这是发汗不如法，所以不解。如果治疗风湿，必须等到天气晴朗时发其汗，只要让病人汗微微似欲出的状态，则风与湿都去除，而病自然解了。
【集注】
方有执说：阴雨不停，则湿不除，所以更应当发汗。然而风湿本来是由汗出当风得到的，那么汗出太多的，必定反而使湿转加严重，微微似欲汗出，而不见汗出，则湿消而风散了。这是发汗的微妙关键，后人动辄以大汗来说事的，距离正道远矣。
张璐说：风湿相搏，按理应发汗而解，合用桂枝加术汤，使微微蒸发，表里气和，风湿皆去。正如湿家身烦痛，可用麻黄汤加术同义。
程应旄说：湿病患者不仅不可误下，即使发汗也不可误汗。风湿相搏一证，全身都疼痛，虽然是微挟表邪，然而其脉不浮，终究难以大汗，治风兼治湿，只要使微微似欲汗出，就是其法度。
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伤寒八、九天，风湿相搏，身体疼烦，不能自己转侧，不呕不渴，脉浮虚而涩的，用桂枝附子汤主治。如果这个人大便硬，小便自利的，去掉桂枝加白术汤主治。
【注】
这是承接上一条，详细阐述脉证，以明确其治法。伤寒八、九天，不呕不渴，是没有伤寒里病的证候；脉浮虚涩，是没有伤寒表病的脉象。脉浮虚，主病在表，是虚风；涩者，主病在经，是寒湿。身体疼烦属风，不能转侧属湿，乃风湿相搏的证候，不是伤寒，给予桂枝附子汤温散其风湿，使从表而解。如果脉浮实，则又应当用麻黄加术汤，大发其风湿。如果人有这些证候，虽然大便硬，小便自利，而不议用下法的，因为这不是邪热入里的便秘，而是风燥湿去后的便秘，所以仍以桂枝附子汤去掉桂枝，因为大便硬，小便自利，不希望其发汗，再夺津液；加入白术，因为身体重着，湿在肉分，用以佐助附子驱逐肌表的湿气。
【集注】
成无己说：烦，是风邪的表现。身疼不能自己转侧，是湿邪的表现。医经说：风则脉浮虚。《脉经》说：脉来涩的，是患寒湿的病。
Add three liang of Radix Puerariae (Gegen, 葛根) to the Guizhi Tang (Cinnamon Twig Decoction). For the remainder, follow the preparation and administration method of the Guizhi Tang.
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In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), excessive sweating may lead to Jing disease (a syndrome characterized by stiffness of the neck and back, trismus, and opisthotonos).
[Annotation]
The above discussions on Jing disease all refer to illnesses caused by external contraction of Wind, Cold, and Dampness. If Taiyang disease is treated with excessive sweating, leading to a massive loss of Body Fluids and insecurity of the Exterior Qi, allowing Pathogenic Wind to enter due to deficiency, resulting in Jing disease, this is caused by internal deficiency. It should not be classified as Rou Jing (Soft Spasm) or Gang Jing (Hard Spasm). The appropriate treatment is Guizhi Jia Fuzi Tang (Guizhi Decoction with Added Prepared Aconite Root), which primarily aims to consolidate the Exterior and dispel Wind. By analogy, any condition arising from excessive sweating during illness, or excessive blood loss after childbirth, that develops into this syndrome, belongs to this category.
[Collected Notes]
Cheng Yingmao stated: Inferring from this single aspect, one can understand that there are many cases where the disease results from the loss of Body Fluids and Blood, leading to Cold due to deficiency, and Dryness due to deficiency. Generally, Yang Qi softens and nourishes the sinews. Excessive sweating causes the loss of Yang Qi, thereby damaging the blood within the meridians.
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Patients suffering from Dampness diseases present with pain throughout the entire body, fever, and a skin color resembling smoked yellow.
[Annotation]
"Shi Jia" (Dampness Patient) refers to a person suffering from a Dampness disease. Such diseases may arise from external contraction of Dampness, causing pain throughout the body, or from internally generated Dampness, causing fever and jaundice. If both internal and external Dampness are present, the patient experiences pain throughout the body, fever, and a "smoked yellow" complexion. "Smoked yellow" refers to jaundice caused by excessive Dampness, belonging to stagnant Dampness in the Spleen; thus, the color is dark and dull like smoke. This differs from the jaundice caused by intense Heat in Shanghan (Cold Damage), which belongs to stagnant Heat in the Yangming channel, resulting in a bright orange-yellow color.
[Collected Notes]
Zhang Lu stated: Jaundice in Dampness syndromes must be differentiated by Yin/Yang and Interior/Exterior. For Yang Dampness, use Yinchen Hao Tang (Artemisia Capillaris Decoction) for Interior involvement, and Mahuang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction) for Exterior involvement. For Yin Dampness, use Baizhu Fuzi Tang (Atractylodes Macrocephala and Prepared Aconite Root Decoction) for Interior involvement, and Mahuang Baizhu Tang (Ephedra and Atractylodes Macrocephala Decoction) for Exterior involvement; this addresses jaundice due to Yin Dampness at the Exterior. The *Jingui Yaolue* states: "For a Dampness patient with painful restlessness, Mahuang Jia Zhu Tang (Ephedra and Atractylodes Macrocephala Decoction) may be used." Since Cold combines with Dampness, heavy sweating is inappropriate, hence Atractylodes Macrocephala is added. When Ephedra is combined with Atractylodes Macrocephala, sweating does not occur abruptly; when Atractylodes Macrocephala is combined with Ephedra, stagnant Dampness is disseminated and unblocked.
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In Dampness disease, the patient suffers from body pain, fever, yellowish complexion, and wheezing, along with headache, nasal congestion, and irritability. The pulse is large. The patient can eat normally, and the abdomen is harmonious without pathology. The disease lies in Cold-Dampness affecting the head, causing nasal congestion. Administering medication into the nose will result in recovery.
[Annotation]
This elaborates on the previous clause, detailing the symptoms and pulse to distinguish the treatment. In Dampness disease, body pain, fever, yellowish complexion, and wheezing indicate Dampness originating internally and contracting externally. Externally, Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) is suitable; internally, Ychen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Powder) is suitable. For severe wheezing, Daxiexiong Wan (Major Thorax-Sinking Pill) is used. If accompanied by headache, nasal congestion, and irritability, with a large pulse, the presentation resembles Shanghan. However, since the interior is harmonious and the patient can eat, it is not Shanghan, and diaphoresis (sweating) is contraindicated. The pathogen is Cold-Dampness located in the head, causing headache and nasal congestion. The only appropriate treatment is to administer medication intranasally, guiding the yellow fluid out via nasal discharge, leading to natural recovery. The administered medication would be similar to Gouti San (Melon Trichosanthes Powder).
[Collected Notes]
Zheng Zhongguang stated: Body pain, fever, yellowish complexion, wheezing, headache, and nasal congestion indicate that Cold-Dampness pathogens reside in the Upper Jiao (Upper Burner). The Classics state: "Due to Dampness, the head feels wrapped." Using Gouti San insufflated into the nose follows the principle of "treating those in the upper by inducing vomiting/emesis."
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In Taiyang disease, if there is joint pain accompanied by vexation, and the pulse is deep and fine, this is named Shi Bi (Dampness Bi Syndrome). The manifestation of Shi Bi includes difficulty in urination and loose stools. The treatment should focus on promoting urination.
[Annotation]
The pulse in Dampness disease is typically floating and fine, indicating Dampness at the Exterior, which should be treated with diaphoresis. Now, in Taiyang disease, with joint pain, vexation, difficulty in urination, loose stools, and a deep-fine pulse (rather than floating-fine), this indicates excessive internal Dampness leading to obstruction characteristic of Shi Bi. Therefore, the treatment should solely focus on promoting urination to allow Dampness to exit via the urine. This is the correct treatment for Dampness overflowing internally.
[Collected Notes]
Cheng Wuji stated: Excessive Dampness leads to loose stools. Difficulty in urination and loose stools indicate the flow of Dampness inward. One should promote urination to ventilate and drain abdominal Dampness. As the ancients said: "Treating Dampness without promoting urination is not the proper treatment."
Fang Youzhi stated: This discusses Dampness entering the Interior. Joint pain occurs because Cold-Dampness qi wanders and infiltrates inward, resulting in a deep and fine pulse. "Bi" refers to pain. Difficulty in urination and loose stools occur because Dampness is Water; if Water does not seep outward properly, it flows horizontally, deviating from its normal path. Promoting urination guides it back to its normal path.
Zhang Zicong stated: Joints refer to the major joints of the waist, back, elbows, and knees, governed by the large sinews, distinct from bone joints. When Dampness flows into the joints, the large sinews become disharmonious, causing pain and obstruction. Dampness injures the Taiyang channel, causing stagnation in the sinews and vessels, hence named Shi Bi. Promoting urination allows the water passages to function, ensuring the regulation of water metabolism proceeds without error; once Dampness is expelled, the sinews and vessels return to harmony.
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A Dampness patient sweats only on the head, has a stiff back, and desires to be covered with blankets or sit near fire. If purgatives are used prematurely, hiccups, chest fullness, difficulty in urination, and a tongue coating resembling a membrane will appear. This is due to Heat in the Lower Dantian (Lower Abdomen) and Cold in the Chest, thirst desire for water but inability to drink, dry mouth, and irritability.
[Annotation]
Sweating only on the head in Dampness patients is sweat caused by Dampness steaming upward, not Heat in the Yangming channel failing to vent. Back stiffness in Dampness patients is heaviness and stiffness due to Dampness obstructing flow, not the spasmodic rigidity of Jing disease. Desiring blankets and fire is not aversion to cold from the exterior, but internal Cold generated by excessive Dampness. If one mistakenly treats the head sweat (caused by Dampness overflow) as Yangming stagnant Heat and uses purgatives, Cold-Dampness qi enters the chest due to deficiency, causing chest fullness, and enters the Stomach, causing hiccups. Since Cold-Dampness fails to transform, urination is difficult; Cold in the chest causes a slippery white tongue coating resembling a membrane; Heat in the Lower Dantian causes dry mouth and thirst for water, but the inability to drink is due to Cold-Dampness in the chest.
[Collected Notes]
Cheng Wuji stated: In Shanghan, there is no sweating. Although Dampness patients have sweat, it does not cover the whole body, hence only the head sweats.
Cheng Yingmao stated: Although the patient desires water, appearing hot, the inability to drink distinguishes it. This is merely dry mouth and irritability, confirming that the interior is not truly dry and irritated, showing identical symptoms but different pathogenesis.
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If a Dampness patient is incorrectly treated with purgatives, and subsequently presents with sweating on the forehead, slight wheezing, and free urination, death ensues. If diarrhea persists uncontrollably, death also ensues.
[Annotation]
This continues from the previous clause, describing the adverse reactions of incorrectly using purgatives on Dampness patients. Incorrect purgation in Dampness patients leads to chest fullness, hiccups, difficulty in urination, a tongue coating like a membrane, and thirst with inability to drink; this is already an adverse reaction but remains treatable. After incorrect purgation, if forehead sweating and slight wheezing persist, this indicates the collapse of Yang Qi upward. If urination becomes free and diarrhea persists, this indicates the collapse of Yin Qi downward. The separation of Yin and Yang leads to death.
[Collected Notes]
Fang Youzhi stated: Treating Dampness requires promoting urination, yet here free urination is a sign of death. Why? Because mistreatment causes the dispersion and loss of Yin and Yang.
Cheng Zhi stated: Dampness affects humans, and Yin is affected first. Thus, Dampness syndromes in this classic are often treated by assisting Yang and warming/dispersing. If purgatives are wrongly used, Yang deficiency and Yin excess become incurable. Forehead sweating and slight wheezing indicate vacuous Yang attempting to collapse upward; incontinence of urine and stool indicates abundant Yin attempting to collapse downward. The separation of Yin and Yang leads to death.
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The patient suffers from pain throughout the entire body and fever. The condition worsens in the late afternoon (Ri Bu, approx. 3-5 PM). This is named Feng Shi (Wind-Dampness). This disease is caused by sweating while exposed to wind, or long-term exposure to cold.
[Annotation]
"The patient" refers to one suffering from body-wide pain. Both Dampness patients and Wind-Dampness patients suffer from body-wide pain. However, the pain in Dampness is heavy and fixed, preventing turning over; the pain in Wind-Dampness is light and pulling, preventing flexion and extension. This distinguishes the nature of the pain. Regarding fever: in Dampness, fever intensity does not vary significantly between morning and evening; in Wind-Dampness, fever inevitably worsens in the late afternoon. This results from sweating while exposed to wind, or long-term injury by Dampness followed by exposure to Wind-Cold.
[Collected Notes]
Zhang Zicong stated: Sweating while exposed to wind leads to Wind-Dampness; long-term exposure to cold leads to Cold-Dampness.
Zhang Xiju stated: Fever worsening in the late afternoon occurs because Yang Qi declines and Yin Qi rises at this time. Since Dampness is a Yin pathogen, the disease intensifies during its dominant time (Yin time).
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Question: When Wind and Dampness contend, causing pain throughout the body, the method dictates resolving it through sweating. If it rains continuously and the physician says sweating is indicated, why does the disease not resolve after sweating? Answer: If sweating induces profuse perspiration, only the Wind pathogen is expelled, while Dampness remains; therefore, the disease does not resolve. To treat Wind-Dampness, induce sweating such that the patient appears slightly moist with sweat; then both Wind and Dampness are expelled.
[Annotation]
This details that in Wind-Dampness contention with body-wide pain, not only is purgation contraindicated, but diaphoresis must also be applied appropriately. Wind is a Yang pathogen, Dampness is a Yin pathogen. Their contention affects both Yin and Yang, causing body-wide pain. Resolution via sweating is indicated. However, during continuous rain, Dampness is abundant. Even if sweating is induced, if perspiration is profuse and the disease does not resolve, it is because Wind is gone but Dampness remains. During times of high Dampness, inducing profuse sweating is improper technique, hence failure to resolve. To treat Wind-Dampness, one should wait for clear weather to induce sweating, ensuring only a slight, continuous moisture of sweat. Then both Wind and Dampness are expelled, and the disease resolves.
[Collected Notes]
Fang Youzhi stated: Continuous rain means Dampness is not removed, so sweating is even more necessary. However, since Wind-Dampness originates from sweating while exposed to wind, profuse sweating will likely exacerbate the Dampness. Only slight, continuous moisture without visible dripping will dissipate Dampness and scatter Wind. This is the subtle key to diaphoresis; later practitioners who advocate for profuse sweating are far from the correct path.
Zhang Lu stated: In Wind-Dampness contention, resolution via sweating is indicated. Combining Guizhi Jia Zhu Tang (Guizhi Decoction with Added Atractylodes Macrocephala) allows for slight evaporation, harmonizing the Interior and Exterior, expelling both Wind and Dampness. This is analogous to using Mahuang Tang (Ephedra Decoction) with added Atractylodes Macrocephala for Dampness patients with painful restlessness.
Cheng Yingmao stated: Dampness patients must not be incorrectly purged, nor incorrectly sweated. In Wind-Dampness contention with body-wide pain, although it involves mild Exterior pathogens, the pulse is not floating, making profuse sweating difficult. Treating Wind while addressing Dampness, ensuring only slight, continuous moisture of sweat, is the correct method.
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After eight or nine days of Shanghan, Wind and Dampness contend. The body is painful and vexed, unable to turn over independently. There is no vomiting or thirst. The pulse is floating, deficient, and choppy. Guizhi Fuzi Tang (Guizhi Decoction with Added Prepared Aconite Root) is the primary formula. If the patient has hard stools and spontaneous free urination, remove Cinnamon Twig and add Atractylodes Macrocephala (Guizhi Fuzi Tang minus Cinnamon Twig plus Atractylodes Macrocephala) as the primary formula.
[Annotation]
This continues from the previous clause, detailing the pulse and symptoms to clarify treatment. After eight or nine days of Shanghan, absence of vomiting and thirst indicates no Interior Shanghan pathology. A floating-deficient-choppy pulse indicates no Exterior Shanghan pathology. A floating-deficient pulse indicates Exterior pathology due to deficient Wind; a choppy pulse indicates Meridian pathology due to Cold-Dampness. Body pain and vexation belong to Wind; inability to turn over belongs to Dampness. This is a Wind-Dampness contention syndrome, not Shanghan. Guizhi Fuzi Tang is used to warm and disperse Wind-Dampness, allowing resolution from the Exterior. If the pulse were floating and solid, Mahuang Jia Zhu Tang (Ephedra and Atractylodes Macrocephala Decoction) would be used to vigorously disperse Wind-Dampness. If the patient has these symptoms but hard stools and free urination, purgation is not considered because the hard stool is not due to Heat entering the Interior, but rather dryness from Wind and expulsion of Dampness. Therefore, Guizhi Fuzi Tang is used with Cinnamon Twig removed. Since stools are hard and urination is free, we avoid sweating to prevent further depletion of Body Fluids. Atractylodes Macrocephala is added because body heaviness indicates Dampness in the muscle layer; it assists Prepared Aconite Root in driving Dampness from the muscles.
[Collected Notes]
Cheng Wuji stated: Vexation indicates Wind. Body pain and inability to turn over indicate Dampness. The Classics state: "Wind manifests as floating and deficient pulses." The *Maijing* states: "A choppy pulse indicates Cold-Dampness disease."