喻昌曰∶痉证之显者，后世且并其名而失之，况痉脉之微乎？然而可得言也。痉证异于常证，痉脉必异于常脉，是
故体强其脉亦强，求其柔软和缓，必不可得，况强脉恒杂于阴脉之内，所以沉弦沉紧，邪深脉锢，难于亟夺。仲景谓脉
阴阳俱紧，亡阳也。此属少阴，见非太阳之紧比也。又谓少阴病脉紧，至七八日脉暴微，手足反温，脉紧反去者，为欲
解。可见痉证之欲解，必紧实之脉，转为微弱，而现剧病之本象，乃可渐返平脉，不遽解也。古今言痉证之及脉者，莫
如《金匮》，然皆片言居要，非深明伤寒比类互推之法，茫不知其立言之意，故因论痉病而并及痉脉焉。其曰∶太阳病发
热，脉沉而细，名曰痉，为难治。以发热为太阳证，沉细为少阴脉，阳病而得阴脉，故难治也。难治初非不治，仲景治
发热脉沉，原有麻黄附子细辛之法，正当比例用之。设仍用太阳之桂枝葛根二方，则立铲孤阳之根，真不治矣。以少阴
所藏者精，所宅者神。精者阴也，神者阳也。凡见微脉即阳之微，见细脉即阴之细，微则易于亡阳，细则易于亡阴，此
其所以难治也。故病传厥阴，而少阴之精神未亏，即无死证。其厥逆下利烦躁，脉微而死者，究竟以厥阴而累少阴之
绝耳。此脉中之真消息，凡病皆然，不但为痉脉之金针也。其曰∶太阳病其证备，身体强，KT KT 然，脉反沉迟，此
为痉。虽亦阳证阴脉，而迟与微细，大有不同。迟乃太阳荣血之阴受病，故脉之朝于寸口者，其来迟迟，是荣血不能充
养筋脉而成痉。但取益阴生津，以和筋脉，而不与少阴同法矣。两证之夹阴脉，其辨如此。其引《脉经》云∶痉家其脉
伏，坚直上下，而复以按之紧如弦，直上下行，互发其义。明伏非伏藏之伏，按之可得，即所谓沉也。坚非漫无着落，
即紧如弦，不为指挠，邪气坚实也，直上下行者，督脉与足太阳合行于脊里，太阳邪盛，督脉亦显其盛，缘督脉行身之
背，任脉行身之前，如天地子午之位，居南北之中，故其脉见则直上直下。《脉经》谓直上下行者，督脉也。见之则大人
癫，小儿 者是也。惟其夹于沉脉之内，重按始得，所以病癫 及痉，有非阳病可比。若举指即见直上直下，则病为阳
狂。其证登高逾垣，勇力且倍平昔，何至挛缩若是耶？痉证阴脉之似阳，其辨又如此。然在伤寒误发少阴汗者，必动其
血，为下厥上竭，亡阴而难治。而痉病之误发其汗者，必动其湿，湿虽阴类，乃外受之阴邪，非身中阴血之比。但所动
之阳，奔入湿中，为湿所没，而成灭顶之凶，即是亡阳之变证。仲景曰∶其脉如蛇。不言其证，然未发汗之先，已见恶
寒头摇，口噤背张，脚挛KT KT ，阳之欲亡。则发汗以后，肉 筋惕，舌卷囊缩，背曲肩垂，项似拔，腰似折，颈
筋粗劲，四末逆冷，皆痉病之所毕具，不待言矣。第因发汗而动下焦之湿，又因发汗逼令真阳脱入湿中，是则多汗亡阳
之外，更添亡阳一证，所以形容其脉如蛇。言脱出之阳，本急疾亲上，轻矫若龙，为湿之迟滞所纽，则如蛇行之象，尽
力奔迸，究竟不能奋飞也。此脉之至变，义之至精，而从来未解者也。更有暴腹胀大者为欲解，脉如故，反复弦者，《经》
之文不叙病之原委。突云欲解，如禅家半偈，令人何处下参耶？试一参之，妙不容言矣。盖伤寒传至厥阴，有欲解者，
有过经不解者。此之出欲解之证，复出不解之脉，殆谓痉传厥阴，其经已尽。解与不解，辨其脉证而可知也。欲解之证，
厥阴之邪，必传脾土，克其所胜，腹当为之暴胀。本《内经》厥阴在泉，民病腹胀之义以论证。亦见厥阴不再传太阳，
而但转太阴，邪欲解耳。解则其脉必见微浮，何以知之？于伤寒厥阴中风，脉微浮为欲愈，不浮为未愈而知之也。若脉
仍阴象，反见沉弦，必自病其筋脉，而拘急成痉，亦如过经之例，未可定其解期矣。至于论治，六经皆有成法。《金匮》
但取太阳二方，阳明一方为例，而厥阴之筋脉自病，又必少阴之阳虚，不能柔养筋脉所致，所以脉反沉弦，此当用温以
救其阳也。伤寒厥阴亡阳，必显内拘急之证。内拘急者，即《灵枢》在内者阴病不能仰之奥旨。故知少阴主内，厥阴之
用温，仍从少阴温之也。又厥阴下利，腹胀满者，仲景亦先温其里。病机虽云诸腹胀大，皆属于热；而暴腹胀大，乃是
少阴阳虚，更兼阴盛，故其腹之胀大，不徐而暴也。阴故暴，阳即不暴，故知厥阴亦从少阴之温法也。不温则不但无解
期，且有死期矣。昌特推原仲景，以诱掖来学，未知其能弋获否也？谨论。
《经》曰∶伤于湿者，下先受之。言地湿之中人，先中其履地之足，然后渐及于上者也。曰湿流关节，言地湿之中
人，流入四肢百节，犹未入于脏腑者也。曰阴受湿气，言地湿之中人，已入于太阴脾土，未入于阳明胃土者也。曰
湿上甚为热，此则下受之湿，袭入三阳，胸背头面之间，从上焦之阳，而变为热湿者也。湿至上焦而变热，其证夏月为
最多。盖夏月地之湿气，上合于天之热气，日之暑气，结为炎蒸。人身应之，头面赤肿，疮疖丛生，疫邪窃据，其由来
自非一日矣。
诸家论湿，但云湿流关节止耳。至湿上甚为热之旨，从未言及，今悉论之。湿上甚为热，《内经》申一义云∶汗出
如
故而止，妙不容言。盖湿上甚为热，即所谓地气上为云也。汗出如故，即所谓天气下为雨也。天气下为雨，而地气之上
升者，已解散不存矣。治病之机，岂不深可会哉！
湿上甚为热，其人小便必不利。盖膀胱之气化，先为湿热所壅而不行，是以既上之湿，难于下趋。《经》又云治湿
不
利小便，非其治也。可见治上甚之湿热，利其小便，即为第二义矣。然有阳实阳虚二候∶阳实者，小便色赤而痛，利其
小便，则上焦遏郁之阳气通，其湿热自从膀胱下注而出矣。阳虚者，小便色白，不时淋滴而多汗，一切利小水之药，即
不得施。若误施之，即犯虚虚之戒，不可不辨也。
《金匮》治上焦之湿，本《内经》湿上甚为热之义，而分轻重二证。轻者但发热面赤而喘，头痛鼻塞而烦。邪在上
焦，里无别病者，但内药鼻中，搐去湿热所酿黄水而已。以鼻窍为脑之门户，故即从鼻中行其宣利之法，乃最神最捷之
法也。重者身热足寒，时头热面赤目赤，皆湿上甚为热之明征。湿热上甚，故头热面赤目赤。湿热上甚，故阳气上壅，
不下通于阴而足寒。自成无已谓是湿伤于下，风伤于上，仲景发明《内经》奥旨，成土苴矣，岂其不读《内经》耶？
岂风始生热，湿不生热耶？在冬月伤寒，已为热病。岂夏月伤湿，反不为热病耶？详仲景以上甚为热之重证。发入痉病
最重之条，而不言其治。昌欲于此，微露一纤，然而竿头之步，观者得无望之却走乎？《内经》原有上者下之之法，邪
从下而上，必驱之使从下出，一定之理也。其证轻者，里无别病，但搐其黄水，从清阳之鼻窍而下出。则其重而里多危
证者，必驱其黄水，从前后二阴之窍而出，所可意会也。《金匮》于本文之下，增若发其汗者二十四字，垂戒初不以下为
戒，又可意会也。但下法之难。不推其所以不可汗之故，即不得其所以用下之权。仲景以其头摇口噤，背张KT KT ，
阳之欲亡，若更发其汗，重虚卫外之阳，恶寒必转甚。若发汗已，其脉如蛇，真阳脱离，顷刻死矣。由是推之，湿上甚
为热之重者，非用下法，难以更生。而下法必以温药下之，庶几湿去而阳不随之俱去耳，此非无征之言也。仲景即于本
篇申一义云∶下之额上汗出微喘，小便利者死。岂非因下而并夺其阳之大戒乎？噫嘻！此殆与性与天道同义矣。
论《金匮》治湿用麻黄白术汤方 本文云∶湿家身烦疼，可与麻黄汤，发其汗为宜，慎不可以火攻之。此治热
湿两停，表里兼治之方也。身烦者热也，身疼者湿也。用麻黄取微汗以散表热，用白术健脾以行里湿，而麻黄得术，则
虽发汗，不至多汗。术得麻黄，并可行表里之湿，下趋水道，又两相维持也。伤寒失汗而发黄，用麻黄连翘赤小豆汤，
分解湿热，亦是此意。但伤寒无用术之法，《金匮》复出此法，又可见杂证脾湿内淫，必以术为主治矣。
合论《金匮》治湿用桂枝附子汤白术附子汤甘草附子汤三方
凡夏月之湿，皆为热湿，非如冬月之湿为寒湿也。
而《金匮》取用附子之方，不一而足者，何耶？宜乎据方推证者，莫不指热湿为寒湿矣。不思阳气素虚之人，至夏月必
且益虚，虚故阳气不充于身，而阴湿得以据之。此而以治湿之常药施之，其虚阳必随湿而俱去，有死而已。故阳虚湿盛，
舍助阳别无驱湿之法，亦不得不用之法耳。
桂枝附子汤 白术附子汤 本文云∶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。若大便坚，小便自利者，去桂加白术汤主之。
用桂枝附子，温经助阳，固护表里以驱其湿。以其不呕不渴，津液未损，故用之也。若其人大便坚，则津液不充矣。
小便自利，则津液不走矣。故去桂枝之走津液，而加白术以滋大便之干也。此连下条甘草附子汤，俱《伤寒论》太阴篇
中之文也。伤寒痉湿 篇中不载，而《金匮》痉湿 篇中载之，可见治风湿与治热湿，其阳虚者之用本方，不当彼此异
同矣。而《伤寒论》但云∶若大便坚，小便自利者，去桂加白术汤主之。《金匮》重立其方，且于方下云一服，觉身痹，
半日许，再服，三服都尽，其人如 状，勿怪，即是术附并走皮中，逐水气，未得除故耳。成无己注伤寒于此条云∶以
桂枝散表之风，附子逐经中之湿，总不言及阳虚。而昌谆复言之∶得此一段，始为有据。其一服觉身痹者，药力虽动其
湿，而阳气尚未充，不便运旋也。三服都尽，阳气若可行矣。遍身如攒针之刺，其涣而难萃之状尚若此，《金匮》可谓善
于形容矣。不但此也，人身借有阳气，手持足行，轻矫无前，何至不能自转侧乎？此岂可诿咎于湿乎？即谓湿胜，阳气
果安往乎？况其证不呕不渴，其脉浮虚而涩，阳虚确然无疑，无己辄以治风湿之外邪为训，宁不贻误后人耶！
甘草附子汤 本文云∶风湿相搏，骨节疼烦，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。
此亦阳虚之证，与前条大约相同，风伤其卫，而阳不固于外。湿流关节，而阳不充于经。用此固卫温经散湿也。
论《金匮》防己黄 汤本文云∶风湿脉浮，身重，汗出恶风者，防己黄 汤主之。
此治卫外之阳太虚，而在里之真阳无患者，附子即不可用，但用黄 实卫，白术健脾，取甘温从阳之义，以缓图而
平治之。方下云∶服后当如虫行皮中，从腰以下如冰，暖坐被上，又以一被围腰以下，温令微汗差。可见汗出乃是阳虚
自汗，而腰以下属阴之分，则无汗也。服此虽动其湿，而卫外之阳，尚不足以胜之。故皮中如虫行，较前遍身如 之状，
为少杀矣。姑以暖被围腰以下，致令微汗，以渐取差。亦从下受者，从下出之之法也。
脾恶湿，夏月湿热相蒸，多有发黄之候。然与伤寒阳明瘀热发黄，微有不同。彼属热多，其色明亮。此属湿多，其
色黯晦。
《内经》云∶湿胜为着痹。《金匮》独以属之肾，名曰肾着。云肾着之病，其人身体重，腰中冷。如坐水中，形如水
状，反不渴，小便自利，饮食如故。病属下焦，身劳汗出，衣里冷湿，久久得之，腰以下冷痛，腹重如带五千钱，甘姜
苓术汤主之。此证乃湿阴中肾之外廓，与肾之中藏无预也。地湿之邪，着寒藏外廓，则阴气凝聚，故腰中冷，如坐水中，
实非肾藏之精气冷也。若精气冷，则膀胱引之，从夹脊逆于中上二焦，荣卫上下之病，不可胜言。今邪止着下焦，饮
食如故，不渴，小便自利，且于肠胃之府无预，况肾藏乎？此不过身劳汗出，衣里冷湿，久久得之，但用甘草、干姜、
茯苓、白术，甘温从阳，淡渗行湿足矣。又何取暖胃壮阳为哉！甘姜苓术汤。
《内经》病机十九条，叙热病独多。谓诸病喘呕吐酸，暴注下迫，转筋，小便混浊，腹胀大，鼓之有声如鼓，痈疽
疡疹，瘤气结核，吐下霍乱，瞀郁肿胀，鼻塞鼽衄，血溢血泄，淋闷，身热恶寒，战栗惊惑，悲笑谵妄，衄 血污，皆
属于热。刘河间逐病分注了明，所以后世宗之，故《原病式》不可不读也。
杂病恶寒者，乃热甚于内也。《经》云恶寒战栗者，皆属于热。又云禁栗如丧神守，皆属于火，《原病式》曰∶病热
甚而反觉其寒，此为病热，实非寒者是也。古人遇战栗之证，有以大承气汤下燥粪而愈者。恶寒战栗，明是热证，但有
虚实之分耳。
杂病发热者，乃阴虚于下也。《经》云∶阴虚则发热。夫阳在外，为阴之卫；阴在内，为阳之守。精神外驰，嗜欲无
节，阴气耗散，阳无所附，遂至浮散于肌表之间而恶热也。实非有热，当作阴虚治，而用补养之法可也。
喻昌说：痉证表现明显的，后世甚至连它的名称都失传了，何况是痉脉的细微变化呢？然而还是可以谈论的。痉证不同于一般的病证，痉脉也必然不同于一般的脉象，所以身体强直，其脉象也强劲，想要找到柔软和缓的脉象，绝对不可能得到。况且强劲的脉象常常夹杂在阴脉之中，表现为沉弦或沉紧，说明邪气深入、脉气固结，难以迅速祛除。张仲景说：“脉阴阳俱紧，这是亡阳的表现。”这属于少阴病，见到的不是太阳病的紧脉。他又说：“少阴病脉紧，到了七八天，脉突然变微，手足反而温暖，脉紧反而消失的，是病情将要解除。”由此可见，痉证若要解除，必须是原本紧实的脉象转为微弱，显露出重病本来的面貌，然后才能逐渐恢复为平和的脉象，不会立刻痊愈。古往今来论述痉证及其脉象的，没有比《金匮要略》更详尽的了，但都是片言只语居于关键地位。如果不是深明伤寒病类相比、互相推演的法则，茫然不知作者立论的本意，所以我在讨论痉病时一并论述痉脉。
《金匮要略》说：“太阳病发热，脉沉而细，名叫痉，属于难治。”因为发热是太阳病的证候，沉细是少阴病的脉象，阳病却得了阴脉，所以难治。难治并非不可治，张仲景治疗发热脉沉，本来就有麻黄附子细辛汤的方法，正当参照类比使用。如果仍然使用治疗太阳病的桂枝汤或葛根汤，就会立即铲断孤阳的根本，那就真的无法救治了。少阴所藏的是精，所居的是神。精属于阴，神属于阳。凡是见到微脉就是阳气微弱，见到细脉就是阴血枯竭，微则容易亡阳，细则容易亡阴，这就是它难治的原因。所以病传到厥阴，如果少阴的精气神没有亏损，就没有死证。那些出现四肢厥逆、下利、烦躁，脉微而死的，归根结底是因为厥阴病累及少阴导致绝症罢了。这是脉象中真正的微妙之处，所有疾病都是这样，不仅仅是针对痉脉的关键所在。
《金匮要略》又说：“太阳病证候具备，身体强直，项背拘急不舒（KT KT 然），脉象反而沉迟，这叫痉。”这也属于阳证见阴脉，但迟脉与微细脉大有不同。迟脉是太阳经荣血的阴分受了病，所以脉气到达寸口时，来势迟缓，这是因为荣血不能充养筋脉而导致痉证。此时只需采取益阴生津的方法，来调和筋脉，而不必采用治疗少阴病的方法。这两种证候夹带阴脉的区别就是这样。
书中引用《脉经》说：“患痉病的人，其脉伏，坚直上下，并且重按时紧如弦，直上下行，这两者互相阐发其义理。”这说明“伏”不是潜伏隐藏的意思，重按可以摸到，就是所谓的“沉”。“坚”不是漫无着落，而是紧如弦，不为手指所动摇，说明邪气坚实。“直上下行”，是因为督脉与足太阳膀胱经合行于脊柱内部，太阳邪气盛，督脉也显现其盛。因为督脉行于人体背部，任脉行于人体前面，如同天地子午之位，居于南北之中，所以脉象出现时就直上直下。《脉经》说直上下行的是督脉。见到这种脉象，大人会患癫狂，小儿会患惊痫。正因为这种脉夹杂在沉脉之内，必须重按才能得之，所以患癫疾惊痫及痉病，有不是阳病可以比拟的。如果轻举手指就能见到脉直上直下，那就是病为阳狂。其症状是登高跨越墙垣，勇力甚至超过平时，怎么会像痉病那样挛缩呢？痉证阴脉似阳的区别又在于此。
然而在伤寒误用发汗法治疗少阴病时，必定会动血，导致下厥上竭，亡阴而难治。而痉病误用发汗法时，必定会动湿，湿虽然属于阴类，但是外受的阴邪，不同于体内的阴血。只是所动的阳气，奔入湿气之中，被湿气淹没，从而形成灭顶之灾般的凶险，这就是亡阳的变证。张仲景说：“其脉如蛇。”虽然没有描述症状，但在未发汗之前，已经见到恶寒、头摇、口噤、背张、脚挛急（KT KT），这是阳气将要亡脱的表现。那么发汗以后，肌肉跳动、筋惕肉瞤、舌卷囊缩、背曲肩垂、项似拔、腰似折、颈筋粗劲、四肢末端逆冷，这些都是痉病所具备的症状，不用多说。只是因为发汗而动摇了下焦的湿气，又因为发汗逼迫真阳脱入湿气之中，所以在多汗亡阳之外，更增添了亡阳这一证候，所以形容其脉如蛇。意思是说，脱出的阳气，本来急切地亲近上部，轻捷矫健如龙，但因为湿气的迟滞牵制，就像蛇爬行的样子，虽然尽力奔突迸发，终究不能奋起飞翔。这是脉象的极致变化，义理的极致精微，而从来没有人解释过。
更有暴发性腹胀大的说是病情将要解除，脉象依然如故，反复出现弦脉，《内经》的原文没有叙述疾病的原委。突然说“欲解”，像禅宗的半偈诗，让人从哪里去参悟呢？试着参悟一下，妙处就不可言说了。大概伤寒传到厥阴，有将要解除的，也有过了经界仍未解除的。这里提出的欲解的证候，又提出不解的脉象，大概是说痉病传到厥阴，该经的病邪已经穷尽。解与不解，辨别其脉证就可以知道了。欲解的证候，厥阴的病邪，必定传给脾土，克制它所胜的脏腑，腹部应当因此暴胀。依据《内经》“厥阴在泉，民病腹胀”的道理来论证证候。也可见厥阴不再传给太阳，而只是转归太阴，邪气将要解除。解除的话，脉象必定见微浮，怎么知道的呢？从伤寒厥阴中风，脉微浮为欲愈，不浮为未愈这一点就可以知道。如果脉象仍然是阴象，反而出现沉弦，必定是自己损伤筋脉，而拘急成痉，也像过了经界未解的例子，不可以确定其解除的日期了。
至于治疗原则，六经都有成法。《金匮要略》只取太阳病的两个方剂、阳明病的一个方剂作为例子，而厥阴的筋脉自病，又必定是由于少阴阳虚，不能柔养筋脉所致，所以脉象反而沉弦，这时应当用温法来救助其阳气。伤寒厥阴亡阳，必定显现内拘急的证候。内拘急，就是《灵枢》中“在内者阴病不能仰”的深奥旨意。所以知道少阴主内，厥阴使用温法，仍然是从少阴温补而来。另外厥阴下利、腹胀满的，张仲景也是先温其里。病机虽然说是“诸腹胀大，皆属于热”；但暴发性腹胀大，乃是少阴阳虚，更兼阴盛，所以腹部的胀大，不缓慢而是暴发的。阴气暴发，阳气就不暴发，所以知道厥阴也从少阴的温法。不温补的话，不但没有解除的日期，而且有死亡的期限了。我特意推究张仲景的原意，以引导后学，不知道能否有所收获呢？谨此论述。
《内经》说：“伤于湿的人，下部先受邪。”说的是地湿之气中人，先中伤接触地面的足部，然后逐渐波及上部。说“湿流关节”，说的是地湿之气中人，流入四肢百节，还没有进入脏腑。说“阴受湿气”，说的是地湿之气中人，已经进入太阴脾土，还没有进入阳明胃土。说“湿上甚为热”，这是指下部受之湿，袭入三阳，在胸背头面之间，从上焦的阳气，而变为湿热。湿邪至上焦而变为热，其证候在夏季最多。大概夏季地的湿气，上合于天的热气、日的暑气，结为炎蒸。人身感应于此，头面赤肿，疮疖丛生，疫邪窃据，其由来已非一日了。
各家论述湿邪，只说“湿流关节”罢了。对于“湿上甚为热”的旨意，从未有人提及，现在全部论述它。“湿上甚为热”，《内经》补充了一个道理：“汗出如故而止”，妙处不可言说。大概“湿上甚为热”，就是所谓的地气上为云。“汗出如故”，就是所谓的天气下为雨。天气下为雨，而地气上升的部分，已经解散不存在了。治病的机理，难道不深刻可领会吗！
“湿上甚为热”，其人小便必定不利。因为膀胱的气化功能，先被湿热壅塞而不能运行，所以既已上泛的湿，难于向下趋行。《内经》又说：“治湿不利小便，非其治也。”可见治疗上焦甚盛的湿热，通利小便，就是第二个要点了。然而有阳实和阳虚两种情况：阳实的，小便色赤且痛，通利小便，则上焦遏郁的阳气通畅，其湿热自然从膀胱向下注入而出。阳虚的，小便色白，不时淋滴且多汗，一切利小水的药物，就不能施用。如果误用，就犯了虚虚的禁忌，不可不辨别。
《金匮要略》治疗上焦的湿，依据《内经》“湿上甚为热”的意义，而分为轻重两证。轻的只是发热、面赤、气喘、头痛、鼻塞且烦闷。邪气在上焦，里没有别的病，只要将药纳入鼻中，搐去湿热所酿成的黄水就可以了。因为鼻窍是脑的门户，所以就从鼻中行其宣通利窍的方法，这是最神奇最快捷的方法。重的身体热、足寒，时常头热、面赤、目赤，这都是湿上甚为热的明显征象。湿热上甚，所以头热、面赤、目赤。湿热上甚，所以阳气上壅，不能向下通达于阴，因而足寒。自从成无己说是湿伤于下、风伤于上，张仲景阐发了《内经》的深奥旨意，成无己的解释就成了糟粕，难道他不读《内经》吗？难道是风始生热，湿不生热吗？在冬季伤寒，已经是热病了。难道夏季伤湿，反而不是热病吗？详细考察张仲景关于“上甚为热”的重证，列入痉病最重的条目，而没有说治疗方法。我试图在此略微透露一点线索，然而这只是竿头进一步的步骤，观看的人会不会望而却步呢？《内经》原有“上者下之”的方法，邪气从下而上，必定驱使其从下排出，这是确定的道理。证候轻的，里没有别的病，只要搐去黄水，从清阳的鼻窍向下排出。那么证候重且里有多重危证的，必定要驱除黄水，从前阴和后阴的窍道排出，这可以意会。《金匮要略》在本文之下，增加了“若发其汗者”二十四字，告诫初学者不以“下法”为戒，也可以意会。但是下法的难点，如果不推究为什么不可用汗法的原因，就不能得到为什么用下法的权变。张仲景因为他头摇、口噤、背张、脚挛急，阳气将要亡脱，如果再发汗，重伤卫外的阳气，恶寒必定更加严重。如果发汗之后，脉象如蛇，真阳脱离，顷刻间就会死亡。由此推之，湿上甚为热的重证，不用下法，难以再生。而下法必须用温药下之，这样才能湿去而阳气不随之俱去，这不是没有根据的话。张仲景就在本篇补充了一个道理：“下之额上汗出微喘，小便利者死。”这难道不是因为下法并夺其阳气的重大禁忌吗？唉！这大概性与天道同义了。
论述《金匮要略》治疗湿用麻黄白术汤方。本文说：“湿家身烦疼，可与麻黄汤，发其汗为宜，慎不可以火攻之。”这是治疗热湿两停、表里兼治的方剂。身烦是热，身疼是湿。用麻黄取微汗以散表热，用白术健脾以行里湿，而麻黄得到白术，则虽然发汗，不至于多汗。白术得到麻黄，并可行表里之湿，向下趋行水道，又是两者相互维持。伤寒失于发汗而发黄，用麻黄连翘赤小豆汤，分解湿热，也是这个意思。但伤寒没有用白术的方法，《金匮要略》又提出这种方法，又可见杂病脾湿内淫，必须以白术为主治。
综合论述《金匮要略》治疗湿用桂枝附子汤、白术附子汤、甘草附子汤三方。凡是夏季的湿，都是热湿，不像冬季的湿是寒湿。而《金匮要略》取用附子的方剂，不止一个，为什么呢？适宜依据方剂推究证候的人，无不指热湿为寒湿。不考虑阳气素虚的人，到了夏季必定更加虚弱，虚故阳气不充满身体，而阴湿得以占据。此时如果用治疗湿的常药施治，其虚阳必定随湿而去，只有死路一条。所以阳虚湿盛，除了助阳别无驱湿的方法，也是不得不用的方法。
桂枝附子汤、白术附子汤。本文说：“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。若大便坚，小便自利者，去桂加白术汤主之。”用桂枝、附子，温经助阳，固护表里以驱其湿。因为不呕不渴，津液未受损，所以用这些药。如果其人大便坚硬，则津液不充足。小便自利，则津液没有流失。所以去掉走津液的桂枝，而加白术以滋润大便之干。这与下一条甘草附子汤，都属于《伤寒论》太阴篇中的文字。《伤寒论》痉湿暍篇中没有记载，而《金匮要略》痉湿暍篇中记载了，可见治疗风湿与治疗热湿，对于阳虚者使用本方，不应彼此有不同。而《伤寒论》只说：“若大便坚，小便自利者，去桂加白术汤主之。”《金匮要略》重新确立其方，并且在方下说：“一服，觉身痹，半日许，再服，三服都尽，其人如冒状，勿怪，即是术附并走皮中，逐水气，未得除故耳。”成无己注释《伤寒论》于此条时说：“以桂枝散表之风，附子逐经中之湿”，总不言及阳虚。而我反复强调：得到这一段，才有依据。其一服感觉身体麻木，药力虽然动了湿邪，而阳气尚未充实，不便运旋。三服都尽，阳气如果可以行了。遍身如攒针之刺，其涣散而难聚集的状态尚且如此，《金匮要略》可以说是善于形容了。不仅如此，人身借有阳气，手持足行，轻捷无前，怎么会不能自转侧呢？这怎么能推卸给湿邪呢？即使说是湿胜，阳气果在哪里呢？况且其证不呕不渴，其脉浮虚而涩，阳虚确凿无疑，成无己却以治风湿之外邪为训，岂不是贻误后人吗！
甘草附子汤。本文说：“风湿相搏，骨节疼烦，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。”这也是阳虚的证候，与前条大致相同，风伤其卫，而阳不固于外。湿流关节，而阳不充于经。用此方固卫、温经、散湿。
论述《金匮要略》防己黄芪汤。本文说：“风湿脉浮，身重，汗出恶风者，防己黄芪汤主之。”这是治疗卫外之阳太虚，而在里之真阳无患者，附子即不可用，只用黄芪实卫，白术健脾，取甘温从阳的意义，以缓图而平治之。方下说：“服后当如虫行皮中，从腰以下如冰，暖坐被上，又以一被围腰以下，温令微汗差。”可见汗出乃是阳虚自汗，而腰以下属阴之分，则无汗。服用此方虽然动了湿邪，而卫外之阳，尚不足以战胜它。所以皮中如虫行，较之前遍身如冒状的情况，稍微减轻。姑且用暖被围腰以下，致使微汗，以渐取愈。也是从下受者，从下出的方法。
脾恶湿，夏月湿热相蒸，多有发黄的证候。然而与伤寒阳明瘀热发黄，略有不同。彼属热多，其色明亮。此属湿多，其色黯晦。
《内经》说：“湿胜为着痹。”《金匮要略》独以属之肾，名叫肾着。说肾着的病，其人身体重，腰中冷。如坐水中，形如水状，反不渴，小便自利，饮食如故。病属下焦，身劳汗出，衣里冷湿，久久得之，腰以下冷痛，腹重如带五千钱，甘姜苓术汤主之。此证乃是湿阴中肾之外廓，与肾之中藏无关。地湿之邪，附着于寒藏之外廓，则阴气凝聚，所以腰中冷，如坐水中，实在不是肾藏的精气冷。如果精气冷，则膀胱引之，从夹脊逆于中上二焦，营卫上下之病，不可胜言。如今邪气只附着于下焦，饮食如故，不渴，小便自利，且于肠胃之府无关，何况肾藏呢？这不过是身劳汗出，衣里冷湿，久久得之，只用甘草、干姜、茯苓、白术，甘温从阳，淡渗行湿就够了。又何必取暖胃壮阳呢！甘姜苓术汤。
《内经》病机十九条，叙述热病独多。谓诸病喘呕吐酸，暴注下迫，转筋，小便混浊，腹胀大，鼓之有声如鼓，痈疽疡疹，瘤气结核，吐下霍乱，瞀郁肿胀，鼻塞鼽衄，血溢血泄，淋闷，身热恶寒，战栗惊惑，悲笑谵妄，衄血污，皆属于热。刘河间逐病分注了明，所以后世宗之，故《原病式》不可不读。
杂病恶寒者，乃热甚于内也。《内经》说：“恶寒战栗者，皆属于热。”又说：“禁栗如丧神守，皆属于火。”《原病式》说：“病热甚而反觉其寒，此为病热，实非寒者是也。”古人遇战栗之证，有大承气汤下燥粪而愈者。恶寒战栗，明是热证，但有虚实之分而已。
杂病发热者，乃阴虚于下也。《内经》说：“阴虚则发热。”夫阳在外，为阴之卫；阴在内，为阳之守。精神外驰，嗜欲无节，阴气耗散，阳无所附，遂至浮散于肌表之间而恶热也。实非有热，当作阴虚治，而用补养之法可也。
Yu Chang said: For spasm (Jing syndrome, a condition characterized by muscle stiffness and convulsions) with obvious manifestations, later generations have even lost its name, let alone the subtle changes of the pulse in spasm. However, it can still be discussed. Spasm differs from ordinary diseases, and the pulse in spasm must differ from ordinary pulses; therefore, when the body is stiff, the pulse is also strong. It is impossible to find a soft and moderate pulse. Moreover, a strong pulse often mixes with Yin pulses, manifesting as deep-choppy (Chen Xian) or deep-tight (Chen Jin), indicating that the pathogenic factor is deep and the pulse qi is constrained, making it difficult to rapidly eliminate. Zhang Zhongjing stated, "When both Yin and Yang aspects of the pulse are tight, this indicates the loss of Yang." This belongs to Shaoyin disease, and the tightness seen here is not comparable to the tightness of Taiyang disease. He also said, "In Shaoyin disease, if the pulse is tight, and after seven or eight days, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness disappears, this indicates that the condition is about to resolve." From this, we can see that for spasm to resolve, the originally tight and solid pulse must transform into a faint one, revealing the true nature of the severe illness, before it can gradually return to a normal pulse; it will not resolve immediately. Among ancient and modern discussions on spasm and its pulse, none are more detailed than those in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet). However, these are merely fragmentary statements at key points. Without a profound understanding of the methods of comparing and inferring among Taishang (Cold Damage) diseases, one would be ignorant of the author's intent. Therefore, while discussing spasm disease, I also discuss the pulse of spasm.
*Jin Gui Yao Lue* states: "Taiyang disease with fever, deep and fine pulse is named spasm, which is difficult to treat." Because fever is a symptom of Taiyang disease, and deep-fine is the pulse of Shaoyin disease; a Yang disease presenting with a Yin pulse is therefore difficult to treat. Difficult to treat does not mean untreatable. Zhang Zhongjing had methods for treating fever with a deep pulse, such as Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction), which should be applied by analogy. If one were to still use Guizhi Tang (Cinnamon Twig Decoction) or Gegen Tang (Kudzu Decoction) for Taiyang disease, it would instantly destroy the root of isolated Yang, rendering it truly untreatable. The organ of Shaoyin stores Jing (Essence), and its residence is Shen (Spirit). Jing belongs to Yin, and Shen belongs to Yang. Whenever a faint pulse appears, it indicates weak Yang; whenever a fine pulse appears, it indicates depleted Yin. Weakness makes one prone to loss of Yang, and fineness makes one prone to loss of Yin; this is why it is difficult to treat. Thus, if the disease transmits to Jueyin, but the Jing and Shen of Shaoyin are not depleted, there will be no death. Those who present with cold limbs, diarrhea, irritability, and a faint pulse leading to death ultimately do so because Jueyin disease has exhausted Shaoyin. This is the true subtlety of the pulse, applicable to all diseases, not just a golden key for spasm pulses.
It further states: "Taiyang disease with complete symptoms, stiff body, rigidity of the neck and back (Xiang Bei Qiang Jin), and a pulse that is surprisingly slow (Chi), is called spasm." This also belongs to a Yang disease with a Yin pulse, but a slow pulse is vastly different from a faint or fine one. A slow pulse indicates that the Ying (Nutrient) blood of the Taiyang channel has been affected by Yin pathogens. Thus, when the pulse arrives at the Cunkou (radial artery position), its arrival is slow, meaning Ying blood cannot nourish the sinews, resulting in spasm. One should only employ methods to tonify Yin and generate fluids to harmonize the sinews, without using the same methods as for Shaoyin disease. This is how to distinguish between these two conditions involving Yin pulses.
The text cites *Mai Jing* (Pulse Classic): "Patients with spasm have a Fu (Hidden) pulse, firm and straight up and down, and upon pressing, it feels tight like a string, running straight up and down, mutually explaining their meanings." This clarifies that "Fu" does not mean hidden away; it can be felt upon pressing, which is what is meant by "Chen" (Deep). "Firm" does not mean unfocused; it means tight like a string, unyielding to the finger, indicating solid pathogenic factors. "Running straight up and down" occurs because the Du Mai (Governing Vessel) and the Foot-Taiyang Bladder Channel run together within the spine. When Taiyang pathogenic factors are abundant, the Du Mai also manifests abundance. Since the Du Mai runs along the back of the body and the Ren Mai (Conception Vessel) along the front, like the Zi-Wu positions of heaven and earth, situated in the center of North and South, the pulse appears to go straight up and straight down. *Mai Jing* states that "running straight up and down" refers to the Du Mai. Seeing this pulse in adults leads to Dian (epilepsy/madness), and in children to Kong (startle/fright). Because it is mixed within the Deep pulse and requires heavy pressure to detect, diseases like epilepsy and spasm cannot be compared to ordinary Yang diseases. If the pulse goes straight up and down and is visible with light touch, it indicates Yang Kuang (mania). The symptoms include climbing over walls and fences, with strength double that of usual; how could it be as contracted as in spasm? This is how to distinguish the apparent Yang nature of Yin pulses in spasm.
However, in Cold Damage, if one mistakenly induces sweating in Shaoyin disease, it will surely disturb the blood, causing lower cold and upper exhaustion, leading to loss of Yin and difficulty in treatment. In contrast, if one mistakenly induces sweating in spasm disease, it will surely disturb Dampness. Although Dampness is a Yin category, it is an externally acquired Yin pathogen, distinct from internal Yin blood. The Yang Qi that is disturbed rushes into the Dampness and is submerged by it, creating a catastrophic disaster, which is a transformation of loss of Yang. Zhang Zhongjing said, "Its pulse is like a snake." Although he did not describe the symptoms, before inducing sweat, one already sees aversion to cold, head shaking, locked jaw, stiff back, and leg cramps, indicating that Yang is about to perish. After inducing sweat, symptoms such as muscle twitching, tongue retraction, scrotal retraction, curved back, drooping shoulders, neck feeling like being pulled, waist feeling like being broken, coarse neck tendons, and cold extremities are all fully present in spasm disease,无需 saying. Because inducing sweat disturbs Lower Jiao Dampness and forces True Yang to escape into the Dampness, besides the loss of Yang from excessive sweating, another manifestation of Yang loss is added. Hence, the pulse is described as "like a snake." This means that the escaped Yang, originally eager to rise and agile like a dragon, is hindered by the sluggishness of Dampness, resembling the movement of a snake. Despite struggling to break free, it cannot fly. This is the ultimate variation of the pulse and the utmost precision of the principle, never before explained.
Furthermore, sudden abdominal distension is said to indicate resolution, while the pulse remains unchanged and repeatedly shows a String-like (Xian) quality. The *Classic* text does not narrate the origin and details of the disease. Suddenly mentioning "resolution" is like a half-gatha in Zen Buddhism, leaving one wondering where to meditate. Try to meditate on it, and the wonder is beyond words. Generally, when Cold Damage transmits to Jueyin, there are cases of impending resolution and cases of non-resolution after passing through the meridian stages. Here, the presentation of resolving symptoms alongside unresolved pulses suggests that when spasm transmits to Jueyin, the meridian pathology is exhausted. Whether it resolves or not can be known by distinguishing the pulse and symptoms. In resolving cases, Jueyin pathogens must transmit to Spleen Earth, overcoming what it controls, causing sudden abdominal distension. This aligns with the *Nei Jing* principle that "when Jueyin governs the lower, people suffer from abdominal distension." It also shows that Jueyin does not transmit further to Taiyang but turns to Taiyin, indicating the pathogen is about to resolve. Upon resolution, the pulse must show slight floating. How do we know this? From the statement in Cold Damage Jueyin Wind Strike: "A slightly floating pulse indicates impending recovery; a non-floating pulse indicates no recovery." If the pulse remains Yin-like, showing Deep-Choppy qualities, it will damage its own sinews, leading to contraction and spasm, similar to non-resolution after passing the meridian stage, and the date of resolution cannot be determined.
Regarding treatment, each of the Six Meridians has established methods. *Jin Gui Yao Lue* only takes two formulas from Taiyang and one from Yangming as examples. However, Jueyin sinus disease itself is caused by Shaoyin Yang deficiency failing to soften and nourish the sinews, hence the pulse is surprisingly Deep-Choppy. In such cases, one should use Warmth to rescue Yang. Cold Damage Jueyin loss of Yang must manifest internal tension. Internal tension is the profound meaning of *Ling Shu*: "Diseases inside belong to Yin and cannot extend upwards." Thus, knowing that Shaoyin governs the interior, the use of Warmth in Jueyin still follows warming Shaoyin. Additionally, for Jueyin diarrhea and abdominal fullness, Zhang Zhongjing first warms the interior. Although the Pathogenesis states "All abdominal distensions and swellings belong to Heat," sudden abdominal distension is due to Shaoyin Yang deficiency combined with Yin excess, causing the abdomen to swell suddenly rather than gradually. Since Yin is sudden, Yang is not sudden; thus, Jueyin also follows the warming method of Shaoyin. Without warming, there is not only no hope of resolution but also a risk of death. I specifically trace back to Zhang Zhongjing to guide future students, hoping for some success. Respectfully discussed.
*Nei Jing* says: "Those injured by Dampness receive it first in the lower part." This means earthly Dampness attacks humans, first striking the feet that touch the ground, then gradually affecting the upper parts. "Dampness flows into the joints" means earthly Dampness enters the four limbs and hundred joints, having not yet entered the Zang-Fu organs. "Yin receives Damp Qi" means earthly Dampness has entered Taiyin Spleen Earth but not Yangming Stomach Earth. "Excessive Dampness above transforms into Heat" refers to Dampness received below invading the Three Yang, transforming into Damp-Heat in the chest, back, head, and face via the Upper Jiao Yang. Damp-Heat transforming at the Upper Jiao is most common in summer. Summer earthly Dampness combines with heavenly Heat and solar暑 (Summer Heat) to form steaming heat. The human body responds with red and swollen head and face, numerous boils and sores, and epidemic pathogens taking hold, a process not occurring overnight.
Various schools discuss Dampness only saying "Dampness flows into the joints." They never mention the principle of "Excessive Dampness above transforms into Heat." Now I discuss it fully. "Excessive Dampness above transforms into Heat," *Nei Jing* adds one point: "Sweating as usual brings relief," a subtlety beyond words. "Excessive Dampness above transforms into Heat" is what is meant by "Earthly Qi rises to form clouds." "Sweating as usual" is what is meant by "Heavenly Qi descends to form rain." When Heavenly Qi descends as rain, the rising Earthly Qi is dispersed and ceases to exist. Is not the mechanism of treating disease deeply understandable?
"Excessive Dampness above transforms into Heat," the patient's urination will definitely be obstructed. Because the Qi transformation of the Bladder is first blocked by Damp-Heat and fails to function, the Dampness that has risen finds it difficult to descend. *Nei Jing* again says: "Treating Dampness without promoting urination is not the correct treatment." Thus, treating excessive Damp-Heat above by promoting urination is the second principle. However, there are two patterns: Yang Excess and Yang Deficiency. In Yang Excess, urine is red and painful; promoting urination allows the obstructed Yang Qi of the Upper Jiao to flow freely, and the Damp-Heat naturally drains downward through the Bladder. In Yang Deficiency, urine is white, with frequent dribbling and excessive sweating; all drugs that promote urination cannot be used. Misusing them violates the prohibition against weakening the deficient, which must be distinguished.
*Jin Gui Yao Lue* treats Upper Jiao Dampness based on the *Nei Jing* principle of "Excessive Dampness above transforms into Heat," dividing it into mild and severe cases. Mild cases present only with fever, red face, wheezing, headache, nasal congestion, and irritability. With pathogen in the Upper Jiao and no other internal disease, one simply inserts medicine into the nose to extract the yellow fluid brewed by Damp-Heat. Since the nasal orifice is the gateway to the brain, applying dispersing and draining methods through the nose is the most miraculous and rapid method. Severe cases present with body heat, cold feet, frequent head heat, red face, and red eyes, all clear signs of excessive Damp-Heat above. Damp-Heat excessive above causes head heat, red face, and red eyes. Damp-Heat excessive above causes Yang Qi to congest upward, failing to descend to the Yin, resulting in cold feet. Since Cheng Wuji claimed this was Damp injuring below and Wind injuring above, Zhang Zhongjing elucidated the profound meaning of *Nei Jing*, rendering Cheng Wuji's interpretation worthless. Did he not read *Nei Jing*? Does Wind generate Heat but Dampness not? Winter Cold Damage is already a Heat disease. Why would Summer Damp injury not be a Heat disease? Examining Zhang Zhongjing's severe case of "excessive above transforms into Heat," listed under the most severe spasm条款, without stating treatment... I attempt to reveal a thread here, but it is merely a step up the bamboo pole; will observers turn away in disappointment? *Nei Jing* originally had the method "Treat those above by lowering them." Pathogens moving from below to above must be driven out from below; this is a fixed principle. In mild cases with no other internal disease, extracting yellow fluid from the clear Yang nasal orifice suffices. In severe cases with many critical internal symptoms, one must drive out the yellow fluid from the anterior and posterior orifices; this can be inferred. *Jin Gui Yao Lue* adds twenty-four characters below the text: "If sweating is induced..." warning beginners not to use sweating as a cure, which can also be inferred. However, the difficulty of purgation lies in not deducing why sweating is contraindicated, one cannot grasp the rationale for using purgation. Zhang Zhongjing notes head shaking, locked jaw, stiff back, and leg cramps, indicating Yang is about to perish. If sweating is induced again, it severely damages the defensive Yang, and aversion to cold will worsen. If sweating is induced and the pulse becomes like a snake, True Yang escapes, and death occurs instantly. From this, we infer that severe cases of excessive Damp-Heat above cannot survive without purgation. Purgation must use Warm herbs to ensure Dampness leaves without Yang departing with it; this is not baseless talk. Zhang Zhongjing supplements in this chapter: "After purgation, if sweat appears on the forehead, slight wheezing, and free urination occur, death results." Is this not a major taboo against purging and simultaneously depriving Yang? Alas! This is likely equivalent to the principles of Human Nature and the Way of Heaven.
Discussing *Jin Gui Yao Lue*'s use of Mahuang Baizhu Tang for Dampness. The text says: "For damp patients with bodily restlessness and pain, Mahuang Tang may be given to induce sweating; fire therapy must be strictly avoided." This is a formula for treating simultaneous Heat and Dampness, addressing both exterior and interior. Restlessness indicates Heat; pain indicates Dampness. Using Mahuang to induce slight sweating dissipates exterior Heat; using Baizhu to strengthen the Spleen moves interior Dampness. When Mahuang meets Baizhu, although it induces sweating, it does not cause excessive sweating. When Baizhu meets Mahuang, it can move both exterior and interior Dampness downward through the water passages, maintaining a balance. For Cold Damage failing to sweat leading to jaundice, Mahuang Lianqiao Chixiaodou Tang is used to separate Heat and Dampness, following the same logic. However, Cold Damage treatment does not typically use Baizhu; *Jin Gui Yao Lue* introduces this method, showing that for miscellaneous diseases with internal Spleen Dampness invasion, Baizhu must be the primary treatment.
Comprehensively discussing *Jin Gui Yao Lue*'s use of Guizhi Fuzi Tang, Baizhu Fuzi Tang, and Gancao Fuzi Tang for Dampness. All Summer Dampness is Damp-Heat, unlike Winter Dampness which is Cold-Damp. Why does *Jin Gui Yao Lue* use formulas containing Fuzi (Aconite) in various forms? Those analyzing formulas to deduce symptoms invariably mistake Damp-Heat for Cold-Damp. They fail to consider that individuals with inherent Yang deficiency become even more deficient in Summer. Due to deficiency, Yang Qi does not fill the body, allowing Yin Dampness to occupy it. Using standard Dampness treatments in such cases will cause deficient Yang to depart with the Dampness, leading only to death. Therefore, in cases of Yang deficiency with Dampness excess, aside from assisting Yang, there is no other way to expel Dampness; it is a necessary method.
Guizhi Fuzi Tang and Baizhu Fuzi Tang. The text says: "After eight or nine days of Cold Damage, Wind and Dampness intertwine, causing bodily pain and restlessness, inability to turn oneself, no vomiting or thirst, and a floating, deficient, and choppy pulse; Guizhi Fuzi Tang governs. If stool is hard and urination is free, remove Guizhi and add Baizhu; Baizhu Tang governs." Using Guizhi and Fuzi warms the channels and assists Yang, securing the exterior and interior to expel Dampness. Since there is no vomiting or thirst, body fluids are not damaged, so these are used. If stool is hard, body fluids are insufficient. If urination is free, body fluids are not retained. Thus, Guizhi, which depletes fluids, is removed, and Baizhu is added to moisten dry stool. This, along with the next line Gancao Fuzi Tang, comes from the Taiyin Chapter of *Shang Han Lun*. It is not recorded in the *Shang Han Lun* Spasm-Dampness-Sunstroke chapter, but is recorded in the *Jin Gui Yao Lue* Spasm-Dampness-Sunstroke chapter, showing that for Yang deficiency in treating Wind-Damp versus Damp-Heat, the use of this original formula should not differ. *Shang Han Lun* only says: "If stool is hard and urination is free, remove Guizhi and add Baizhu; Baizhu Tang governs." *Jin Gui Yao Lue* re-establishes the formula and adds under it: "After one dose, feel body numbness; after half a day, take another dose; after three doses are finished, the person may feel like they are in a trance; do not be alarmed. This is because Baizhu and Fuzi are moving together in the skin, driving out water qi, which has not yet been eliminated." Cheng Wuji annotates this line in *Shang Han Lun*: "Guizhi disperses exterior Wind, Fuzi drives out channel Dampness," never mentioning Yang deficiency. I repeatedly emphasize: obtaining this passage provides evidence. Feeling body numbness after one dose means the drug power has moved the Dampness, but Yang Qi is not yet sufficient to circulate. After three doses, Yang Qi can move. The whole body feeling like needle pricks, with a state of dispersion and difficulty in gathering, is described well by *Jin Gui Yao Lue*. Furthermore, humans rely on Yang Qi to hold hands and walk feet, moving lightly and fearlessly; how could they be unable to turn themselves? How can this be blamed on Dampness? Even if Dampness is dominant, where has the Yang Qi gone? Moreover, with no vomiting or thirst, and a floating, deficient, choppy pulse, Yang deficiency is undeniable. Cheng Wuji teaching the treatment of external Wind-Damp pathogens would surely mislead future generations!
Gancao Fuzi Tang. The text says: "Wind and Dampness intertwine, causing bone and joint pain and restlessness, pulling pain, inability to bend or stretch, extreme pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with reluctance to remove clothes, or slight body swelling; Gancao Fuzi Tang governs." This is also a Yang deficiency pattern, roughly similar to the previous line. Wind injures Wei (Defensive) Qi, and Yang does not secure the exterior. Dampness flows into joints, and Yang does not fill the channels. This formula secures Wei, warms channels, and dispels Dampness.
Discussing *Jin Gui Yao Lue*'s Fangji Huangqi Tang. The text says: "Wind-Damp with floating pulse, heavy body, sweating, and aversion to wind; Fangji Huangqi Tang governs." This treats cases where exterior Defensive Yang is too deficient, but interior True Yang is intact; Fuzi cannot be used. Instead, Huangqi (Astragalus) strengthens Wei, Baizhu strengthens Spleen, utilizing the meaning of sweet-warm supporting Yang to achieve gradual healing. The formula instructions say: "After taking, one should feel insects crawling in the skin; from the waist down, it feels like ice. Sit warmly on a blanket, wrap another blanket around the waist and below, warming until slight sweating occurs for recovery." This shows that sweating is spontaneous sweating due to Yang deficiency, while the area below the waist, belonging to Yin, has no sweat. Taking this formula moves the Dampness, but exterior Defensive Yang is still insufficient to overcome it. Hence, insects crawling in the skin is less severe than the previous whole-body trance-like state. Gently warming the lower body with blankets induces slight sweating for gradual recovery. This is also a method of treating lower-received pathogens by expelling them from below.
Spleen dislikes Dampness. In Summer, Heat and Dampness steam each other, often leading to jaundice. However, this differs slightly from Yangming Stasis-Heat Jaundice in Cold Damage. The latter belongs to more Heat, with bright color. This belongs to more Dampness, with dark and dull color.
*Nei Jing* says: "Excessive Dampness leads to Bi (Obstruction) Syndrome." *Jin Gui Yao Lue* uniquely attributes it to the Kidney, naming it Kidney Bi. It says: "In Kidney Bi disease, the person has a heavy body and cold waist, as if sitting in water, appearing watery, yet not thirsty, with free urination and normal diet. The disease is in the Lower Jiao, caused by labor and sweating, with cold and wet inner clothes over time, leading to cold pain below the waist and heaviness in the abdomen as if carrying five thousand coins; Gan Jiang Ling Zhu Tang governs." This condition involves Damp-Yin attaching to the outer layer of the Kidney, unrelated to the inner storage of the Kidney. Earthly Dampness pathogen attaches to the cold outer layer of the storage, causing Yin Qi to condense, hence cold waist as if sitting in water; it is truly not cold essence of the Kidney storage. If the essence were cold, the Bladder would draw it, reversing from the paraspinal region to the Middle and Upper Jiao, resulting in countless disorders of Ying and Wei circulation. Now the pathogen only attaches to the Lower Jiao, diet is normal, not thirsty, urination is free, and it is unrelated to the Fu organs of the intestines and stomach, let alone the Kidney storage. This is merely caused by labor, sweating, and cold/wet clothes over time. Using Gan Cao (Licorice), Gan Jiang (Dried Ginger), Fu Ling (Poria), and Bai Zhu (Atractylodes), sweet-warm to support Yang and bland-draining to move Dampness is sufficient. Why seek to warm the Stomach and strengthen Yang? Gan Jiang Ling Zhu Tang.
The Nineteen Pathogenesis Mechanisms in *Nei Jing* describe Heat diseases predominantly. It states: "All diseases involving wheezing, vomiting, acid regurgitation, sudden diarrhea with tenesmus, muscle cramps, turbid urination, abdominal distension and swelling, drum-like sound upon percussion, carbuncles, ulcers, rashes, tumors, lymph node swelling, vomiting and diarrhea cholera, dizziness and depression, swelling, nasal congestion, rhinorrhea, epistaxis, hematemesis, hematochezia, dysuria and distress, body heat with aversion to cold, shivering,惊惑 (fright and confusion), crying and laughing delirium, nasal bleeding, bloody污 (filth)" all belong to Heat. Liu Hejian annotated each disease clearly, so later generations followed him; thus, *Yuan Bing Shi* (Original Treatise on Disease Causes) must be read.
In miscellaneous diseases, aversion to cold is due to Heat being severe internally. *Nei Jing* says: "Aversion to cold and shivering all belong to Heat." It also says: "Trembling as if losing spiritual control all belong to Fire." *Yuan Bing Shi* states: "When Heat disease is severe, one feels cold; this is Heat disease, truly not Cold." Ancients treated shivering with Dachengqi Tang to purge dry feces and achieve cure. Aversion to cold and shivering are clearly Heat patterns, differing only in deficiency and excess.
In miscellaneous diseases, fever is due to Yin deficiency in the lower part. *Nei Jing* says: "Yin deficiency generates Heat." Yang is outside, guarding Yin; Yin is inside, keeping Yang. If spirit wanders outward and desires are unregulated, Yin Qi is consumed, Yang has no attachment, and floats to the muscle surface, causing aversion to Heat. It is truly not Heat; it should be treated as Yin deficiency using tonifying and nourishing methods.