太阳病，关节疼痛而烦，脉沉而细者，此名湿痹。其候，小便不利，大便反快，但当利其小便。
沈尧封曰∶《伤寒论·原序》云∶撰用《素》《难》，当即以《素》《难》释之。《难经》伤寒有五，即《素问》寒、暑、
燥、湿、风之五气为病也，故仲景于太阳论中五证并列，挨次剖析。此论湿痹，即《难经》之湿温证也。《素问》在天为
湿，在地为土，湿乃土之气也。故湿为五气之一，湿温乃伤寒有五之一。编伤寒者，以湿、 为非伤寒，置之别论，然
则中风亦非伤寒，何以独存卷首耶？《难经》云∶湿温之脉，阳濡而弱，阴小而急。与此稍异。
又曰∶伤寒既以头痛胃实等项分六经。即以“汗”字判“风寒”，“渴”字认“燥热”，“小便不利”认“湿气”。纵横
辨别，邪无遁形矣。读者当于此等着实处留心。
湿家之为病，一身尽疼，发热，身色如熏黄。
倪冲之《伤寒汇言》∶此湿家为病之总纲也（金锦）盖体气素以湿为事者，是为湿家（条辨）。其痛与痹痛不同，湿
在关节而疼，故曰痹。今一身尽疼，而表有热，故聊摄称曰在经。熏黄与橘子黄，同是湿热，彼以热胜者黄而明，此以
湿胜者黄而晦，宜茵陈五苓散主之。海藏以熏黄为阴黄。盖既湿胜，则次传寒中，小便自利者有之。
雄按∶此由但清其
热，不治其湿，故次传寒中。术附汤主之。折衷。
沈尧封曰∶丹溪云∶如造曲然，湿热郁久则发黄也。
雄按∶湿热发黄，名曰黄胆，皆是暴病。故仲景以十八日为期，其余所因甚多，有谷疸、酒疸、女劳疸、黄汗，及
冷汗便溏气虚之阴黄。身面浮肿睛白，能餐劳倦之弱黄。神志不足，卒受恐吓，胆气外泄之惊黄。肝木横肆，脾胃伤残，
土败而色外越之痿黄。皆与暴病不同，不可概目为湿热病矣。
湿家，其人但头汗出，背强，欲得被复向火，若下之早则哕，胸满、小便不利，舌上如苔者，以丹田有热，胸中有
寒，渴欲得水而不能饮，则口燥烦也。
尤在泾曰∶寒湿居表，阳气不得外通，而但上越，为头汗出，为背强，欲得被覆向火，是宜用温药以通阳，不可与
攻法以逐湿，乃反下之，则阳更被抑而哕乃作矣。或上焦之阳不布而胸中满，或下焦之阳不化而小便不利，随其所伤之
处而为病也。舌上如苔者，本非胃热，而舌上津液燥聚，如苔之状，实非苔也。盖下后阳气反陷于下，而寒湿仍聚于上，
于是丹田有热，而渴欲得水，胸中有寒，而复不能饮，则口舌燥烦，而津液乃聚耳！
雄按∶胸中有寒之“寒”字，当作“痰”字解，胸中有痰，故舌上如苔。其津液为痰所阻，故口燥烦。而痰饮乃水
之凝结，故虽渴而不能饮也。杨云∶此注极明确，凡《伤寒论》言胸中有寒者，俱作痰解。
湿家，下之，额上汗出，微喘，小便利者，死；若下利不止者，亦死。
尤在泾曰∶湿病在表者，宜汗；在里者，宜利小便。苟非湿热蕴积成实，未可遽用下法。杨云∶湿证不可妄下。额
汗出，微喘，阳已离而上行；小便利，下利不止，阴复决而下走。阴阳离决，故死。一作小便不利者，死，谓阳上浮而
阴不下济也。亦通。
雄按∶张石顽云∶自此而推之，虽额汗出，微喘，若大小便不利者，是阴气未脱，而阳之根犹在也，下虽大小便利，
若额上无汗不喘，是阳气不越，而阴之根犹在也。则非离决，可以随其虚实而救之。至于下利不止，虽无头汗喘逆，阳
气上脱之候，亦死。亦有下利不止，小便反闭，而额上汗出者，谓之关。经云∶关格不通，头无汗者，可活；有汗者，
死。
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。汪按:古人即
表汗，亦须有节度如此，奈何近人必令其汗，又欲令其多耶？此与《伤寒论》桂枝汤下语，亦可互参。
倪冲之《伤寒汇言》∶湿家不惟不可误下，亦不可误汗。惟风湿相搏一证（郊倩），风从前来，湿伤卑下，两至搏击，
一身尽为疼痛（子繇）。此是微挟表邪，法当汗出而病方解（郊倩）。然时值淫雨（隐庵），不免湿气盛行（纯一）。医云∶
此可发汗。若发大汗而病不愈，不惟风湿之邪不解，而且伤真气矣（郊倩）。况风之乘罅也速，湿之侵人也渐（子繇）。
然风在外而湿在内，且大汗出而渍衣被，汗转为湿，风气虽去，而湿气仍隐伏而存留，是故不愈也（纯一）。使之微微似
欲汗出，则正气宣发，充身泽毛，若雾露之灌溉，与病相应。斯正气行而邪气却，营卫和而风湿并解矣（忠可）。
章虚谷曰∶治风湿者，必通其阳气，调其营卫，和其经络，使阴阳表里之气周流，则其内湿随三焦气化，由小便而
去，表湿随营卫流行，化微汗而解，阴湿之邪既解，风邪未有不志者。若大发其汗，阳气奔腾。风为阳邪，随气而泄，
湿邪阴滞，故反遗留而病不愈也。此治风湿与治风寒不同者，虽寒湿同为阴邪，而寒清湿浊，清者易散，浊者粘滞，故
汗法大有区别也。
湿家病，身疼痛，发热，面黄而喘，头晕鼻塞而烦，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。
章虚谷曰∶此所谓雾露清邪中于上也。三阳经脉，上头而行于身表，头中寒湿，则表气不宣，故身疼发热。肺开窍
于鼻，而行气于皮毛，邪从鼻入，湿遏其阳而上蒸，则面黄。气闭则喘，气壅则头痛鼻塞而烦，皆肺气窒塞，不得下降，
故脉反大，其与湿中于下，而在阴之脉沉细者，迥不同也。肺通喉，胃通咽，邪在肺，不在胃，故自能饮食，腹中和无
病。止头中寒湿，故鼻塞。当用辛香苦泄之药纳鼻中，如近世之痧药。
雄按∶鼻烟亦可用，古人惟用瓜蒂散。使肺气通
达，其湿邪化水，从鼻中出则愈。汪按∶瓜蒂末嗅，则水从鼻出，若汤饮则吐。
伤寒，瘀热在里，身必发黄，麻黄连翘赤小豆汤主之。
章虚谷曰∶表邪未解，湿热内瘀，身必发黄，故以麻黄解表，连翘、赤豆等味，利肺气以清湿热，其邪在经络，故
从表解之。
雄按∶余治夏月湿热发黄，而表有风寒者，本方以香薷易麻黄辄效。杨云∶夏月用香薷，与冬月用麻黄，其理正同。
伤寒，身黄、发热者，栀子柏皮汤主之。
尤在泾曰∶此热瘀而未实之证。热瘀故身黄，热未实故发热而腹不满。栀子，彻热于上。柏皮，清热于下。而中未
及实，故须甘草以和之耳。
沈尧封曰∶栀柏汤，清热利小便，治湿热之主方也。程扶生以麻黄小豆汤为湿热主方，不思麻黄小豆汤发汗之方，
惟外兼风寒者宜之，栀柏汤利小便之方也。杨云∶分析极清。若以麻连小豆汤为主方，不惟栀柏汤无着落，即论内但当
利小便句，亦无着落。
伤寒，七八日，身黄如橘子色，小便不利，腹微满者，茵陈蒿汤主之。
尤在泾曰∶此则热结在里之证也。身黄如橘子色者，色黄而明，为热黄也；若阴黄则色黄而晦矣。热结在里，为小
便不利、腹满，故宜茵陈蒿汤下热通瘀为主也。
阳明病，发热汗出，此为热越，不能发黄也。但头汗出，身无汗，剂颈而还，小便不利，渴饮水浆者，此为瘀热在
里，身必发黄，茵陈蒿汤主之。
尤在泾曰∶热越，热随汗而外越也。热越则邪不蓄而散，安能发黄哉？若但头汗出而身无汗，剂颈而还，则热不得
外达，小便不利，则热不得下泄，而又渴饮水浆。则其热之蓄于内者方炽，而湿之引于外者无已。湿与热合，瘀郁不解，
则必蒸发为黄矣。茵陈蒿汤，苦寒通泄，使病从小便出也。
阳明病，面合赤色，不可攻之。攻之必发热，色黄，小便不利也。
沈尧封曰∶此是寒邪外束之湿温证也，麻连小豆汤是其主方。除却恶寒，即是栀柏证。更加腹微满，即是茵陈蒿证。
章虚谷曰∶上明发黄之证，此又明致黄之由也。面赤者，热郁在经，当以汗解。若攻之伤其腑气，则在经之热，反
从内走，与水谷之气，郁蒸发黄，三焦闭塞，而小便不利也。
阳明病，无汗，小便不利，心中懊 者，身必发黄。
章虚谷曰∶虽未误下，而无汗、小便不利，其邪热闭结，心中懊 ，与胃中水液郁蒸，而身必发黄也。
阳明病，被火，额上微汗出小便不利者，必发黄。
喻嘉言曰∶湿停热郁而误火之，则热邪愈炽，津液上奔，额虽微汗，而周身之汗与小便，愈不可得矣。发黄之变，
安能免乎？
太阳病，出现关节疼痛且伴有烦扰感，脉象沉而细的，这称为湿痹。其症状表现为小便不通畅，大便反而稀溏，治疗时应当采用通利小便的方法。
沈尧封说：《伤寒论·原序》中说：“撰用《素问》《难经》”，就应当以《素问》和《难经》来解释它。《难经》中提到伤寒有五种类型，即对应《素问》中寒、暑、燥、湿、风这五种气候异常所致的疾病，所以张仲景在太阳病篇中将这五种证候并列，依次剖析。这篇论述湿痹的内容，就是《难经》中所说的湿温证。《素问》说湿气在天为湿，在地为土，湿气是土的气化表现。所以湿气是五气之一，湿温是伤寒五种类型之一。编纂伤寒著作的人，认为湿温和风邪不属于伤寒，将其放在别论中，然而中风也不属于典型的伤寒，为什么唯独保留在卷首呢？《难经》说：湿温的脉象，阳部（寸）濡软而弱，阴部（尺）细小而急。这与本条所述的脉象稍有不同。
又说：既然伤寒已经通过头痛、胃实等症状分为六经辨证。那么就可以用“汗”字来判断风寒，用“渴”字来识别燥热，用“小便不利”来辨识湿气。纵横交错地辨别，病邪就无法隐藏了。读者应当在此处切实留心。
患有湿病的人，全身都感到疼痛，发热，身体颜色像被烟熏过的黄色（晦暗发黄）。
倪冲之在《伤寒汇言》中说：这是湿病患者疾病的总纲。（金锦注）大概体质素来多湿的人，称为湿家。（条辨注）这种疼痛与痹证的疼痛不同，湿气停留在关节导致疼痛，所以叫作痹。现在是全身都痛，且体表有热，所以聊摄派称之为病在经络。熏黄与橘子黄，都是湿热所致，前者因热邪胜则色黄而鲜明，后者因湿邪胜则色黄而晦暗，适宜用茵陈五苓散主治。海藏将熏黄视为阴黄。因为既然湿邪胜，随后会传变为寒中，出现小便自利的情况。
王士雄按语：这是因为只清除了热邪，没有治疗湿邪，所以随后传变为寒中。应用术附汤主治。（折衷观点）
沈尧封说：朱丹溪说：就像制作酒曲一样，湿热郁积久了就会发黄。
王士雄按语：湿热发黄，称为黄疸，都是急性发作的疾病。所以张仲景以十八天为期限。其余病因很多，有谷疸、酒疸、女劳疸、黄汗，以及冷汗、便溏、气虚导致的阴黄；还有身面浮肿、眼白正常、能进食但劳累后疲倦的弱黄；神志不足，突然受到惊吓，胆气外泄导致的惊黄；肝木横逆，脾胃受损，土气败坏而面色外越导致的痿黄。这些都与急性发作的疾病不同，不能一概看作是湿热病。
患湿病的人，只有头部出汗，背部僵硬，想要盖着被子靠近火源取暖。如果过早使用泻下法，会导致呃逆，胸满，小便不利，舌面上像有一层苔状物，这是因为丹田（下焦）有热，胸中有寒，想喝水却喝不下去，从而导致口干燥、心烦。
尤在泾说：寒湿停留在体表，阳气不能向外通达，只能向上浮越，导致头部出汗，背部僵硬，想要盖被向火，这时适宜用温药来通阳，不可用攻下法来逐湿。如果反而使用下法，阳气更受抑制，于是产生呃逆。或者上焦阳气不布散导致胸中满闷，或者下焦阳气不气化导致小便不利，随着受伤部位的不同而产生相应的病症。舌面上像苔一样的东西，本来不是胃热，而是舌上津液干燥聚集，呈现苔的形状，实际上并不是苔。因为下法之后，阳气反而陷入下焦，而寒湿仍然聚结在上焦，于是丹田有热，想喝水，胸中有寒，却又不能喝，导致口舌干燥烦渴，津液才聚集在这里！
王士雄按语：胸中有寒的“寒”字，应当解释为“痰”，胸中有痰，所以舌面上像有苔。津液被痰阻滞，所以口干燥烦渴。而痰饮是水的凝结物，所以虽然口渴却不能饮水。杨云说：这个注释非常明确，凡是《伤寒论》中说胸中有寒的，都当作痰来解释。
患湿病的人，如果使用泻下法，额头出汗，轻微气喘，小便通畅的，预后不良（死）；如果腹泻不止的，也预后不良（死）。
尤在泾说：湿病在表，适宜发汗；在里，适宜利小便。如果不是湿热蕴积成实，不可以轻易使用下法。杨云说：湿证不可妄用下法。额头出汗，轻微气喘，说明阳气已脱离本体而上行；小便通畅，腹泻不止，说明阴气也决裂而下走。阴阳离决，所以死亡。另一种说法是小便不利者死，意思是阳气上浮而阴气不能下行济助。这也讲得通。
王士雄按语：张石顽说：由此推论，即使是额头出汗、轻微气喘，如果大小便都不利，说明阴气未脱，阳气的根本还在；即使大小便利，如果额上没有汗且不喘，说明阳气没有浮越，阴气的根本还在。这就不是阴阳离决，可以根据虚实情况进行救治。至于腹泻不止，虽然没有头汗和喘逆等阳气上脱的症状，也是死证。也有腹泻不止，小便反而闭塞，而额头出汗的，称为关格。经文说：关格不通，头部没有汗的，可以存活；有汗的，死亡。
问曰：风湿相互搏结，全身都疼痛，按照法则应当通过出汗来解除，正值天下阴雨不停，医生说：这可以发汗，发了汗病却没有好，为什么呢？答曰：发汗时，如果汗出太多，只是风气去了，湿气还在，所以病不好。如果治疗风湿病，发汗时，只要微微似要出汗的样子，风湿就能一起去除。汪按：古人即使是用表汗法，也必须要有节度，为什么近代人一定要让病人出汗，又想让汗出得多呢？这与《伤寒论》桂枝汤下的语句，也可以互相参考。
倪冲之《伤寒汇言》：湿家不仅不可误用下法，也不可误用汗法。只有风湿相搏这一证候（郊倩注），风从前方来，湿伤及下部，两者搏击，全身都疼痛（子繇注）。这是微挟表邪，按照法则应当出汗而病才解（郊倩注）。然而当时正值淫雨（隐庵注），不免湿气盛行（纯一注）。医生说：这可以发汗。如果发大汗而病不好，不仅风湿之邪不解，而且损伤真气了（郊倩注）。况且风邪乘隙而入很快，湿邪侵入人体是渐进的（子繇注）。然而风在外而湿在内，加上大汗出浸渍衣被，汗转化为湿，风气虽然去了，而湿气仍然隐伏存留，所以病不好（纯一注）。如果使病人微微似要出汗，那么正气宣发，充盈身体润泽毫毛，像雾露灌溉一样，与病邪相应。这样正气运行而邪气退却，营卫调和而风湿并解（忠可注）。
章虚谷说：治疗风湿病，必须通利阳气，调和营卫，疏通经络，使阴阳表里的之气周流不息，那么体内的湿气随三焦气化，从小便而去，体表的湿气随营卫流行，化为微汗而解，阴湿之邪既已解除，风邪没有不随之消散的。如果大发其汗，阳气奔腾。风为阳邪，随气而泄，湿邪阴滞，所以反而遗留下来导致病不好。这是治疗风湿与治疗风寒不同的地方，虽然寒湿同为阴邪，但寒清湿浊，清气易散，浊气粘滞，所以汗法有很大区别。
湿病患者，身体疼痛，发热，面色黄且气喘，头晕鼻塞且烦闷，脉象大，能正常饮食，腹部平和无病，这是病在头部感受寒湿，所以鼻塞。将药物纳入鼻中即可痊愈。
章虚谷说：这就是所说的雾露清邪中于上部。三阳经脉，上行头部而行于体表，头中寒湿，则表气不宣散，所以身体疼痛发热。肺开窍于鼻，而行气于皮毛，邪气从鼻入，湿遏阻阳气而上蒸，则面色黄。气闭则喘，气壅则头痛鼻塞且烦闷，都是肺气窒塞，不得下降，所以脉象反而大，这与湿气中于下部，而在阴的脉象沉细者，截然不同。肺通喉，胃通咽，邪在肺，不在胃，所以能正常饮食，腹部平和无病。仅是头中寒湿，所以鼻塞。应当用辛香苦泄的药物纳入鼻中，如近世的痧药。
王士雄按语：鼻烟也可以使用，古人只用瓜蒂散。使肺气通达，其湿邪化为水，从鼻中排出则痊愈。汪按：瓜蒂末嗅闻，则水从鼻出，若汤剂饮用则会呕吐。
章虚谷说：表邪未解，湿热内瘀，身体必定发黄，所以用麻黄解表，连翘、赤豆等味，利肺气以清湿热，邪气在经络，所以从表解除。
王士雄按语：我治疗夏季湿热发黄，而体表有风寒者，本方用香薷代替麻黄往往有效。杨云说：夏季用香薷，与冬季用麻黄，道理正是相同的。
尤在泾说：这是热瘀而未成实的证候。热瘀故身体发黄，热未成实故发热而腹部不胀满。栀子，彻除上部的热。柏皮，清泄下部的热。而中部尚未及实，所以需要甘草来调和罢了。
沈尧封说：栀柏汤，清热利小便，是治疗湿热的主方。程扶生以麻黄连翘赤小豆汤为湿热主方，没考虑到麻黄连翘赤小豆汤是发汗的方剂，只有外兼风寒者适宜，栀柏汤是利小便的方剂。杨云说：分析极其清晰。如果以麻连小豆汤为主方，不仅栀柏汤没有着落，就连原文中“但当利小便”一句，也没有着落了。
伤寒，经过七八天，身体黄得像橘子色，小便不利，腹部轻微胀满的，用茵陈蒿汤主治。
尤在泾说：这是热结在里的证候。身体黄得像橘子色，色黄而明，是热黄；如果是阴黄则色黄而晦暗了。热结在里，导致小便不利、腹满，所以适宜茵陈蒿汤以下热通瘀为主。
阳明病，发热汗出，这叫热邪随汗外越，不会发黄。只有头部出汗，身上无汗，仅到颈部停止，小便不利，口渴想喝水浆的，这叫瘀热在里，身体必定发黄，用茵陈蒿汤主治。
尤在泾说：热越，指热随汗而向外发散。热越则邪气不蓄积而消散，怎么能发黄呢？如果只有头部出汗而身上无汗，仅到颈部停止，则热不能向外达，小便不利，则热不能向下排泄，而又口渴想喝水浆。那么其蓄积在体内的热正炽盛，而引动外湿的力量没有止境。湿与热结合，瘀郁不解，则必然蒸发为黄。茵陈蒿汤，苦寒通泄，使病邪从小便排出。
阳明病，面部全部发红，不可攻下。攻下必定导致发热，色黄，小便不利。
沈尧封说：这是寒邪外束的湿温证，麻黄连翘赤小豆汤是其主方。除去恶寒，就是栀柏证。再加上腹部轻微胀满，就是茵陈蒿证。
章虚谷说：上文阐明发黄的证候，这里又阐明导致发黄的原因。面赤，是热郁在经络，应当用汗法解。如果攻下损伤腑气，则在经的热，反而从内走窜，与水谷之气，郁蒸发黄，三焦闭塞，而小便不利。
章虚谷说：虽然未误用下法，但无汗、小便不利，邪热闭结，心中懊恼，与胃中水液郁蒸，而身体必定发黄。
喻嘉言说：湿停热郁而误用火疗，则热邪更炽盛，津液上奔，额头虽微汗，而周身之汗与小便，更加不可得了。发黄的变证，怎么能避免呢？
Taiyang disease (Disease of the Taiyang/Bladder channel), characterized by joint pain accompanied by restlessness, and a pulse that is deep and fine, is named Shi Bi (Dampness Bi-syndrome). Its manifestations include difficulty in urination and loose stools; treatment should focus on promoting diuresis.
Shen Yaofeng states: The "Original Preface" of *Shanghan Lun* (Treatise on Cold Damage) says, "I have compiled it using *Suwen* (Basic Questions) and *Nanjing* (Classic of Difficult Issues)," implying that it should be interpreted through these texts. *Nanjing* mentions five types of cold damage, corresponding to the diseases caused by the five qi—cold, summerheat, dryness, dampness, and wind—in *Suwen*. Therefore, Zhang Zhongjing listed five syndromes together in the Taiyang chapter, analyzing them sequentially. This discussion on Shi Bi corresponds to the Shi Wen (Damp-Heat) syndrome in *Nanjing*. *Suwen* states that dampness is associated with heaven as dampness and earth as soil; dampness is the qi of earth. Thus, dampness is one of the five qi, and Shi Wen is one of the five types of cold damage. Compilers of Shanghan works considered Shi Wen and Feng (Wind) not to be Shanghan, placing them in separate discussions. However, if Feng Wind is also not typical Shanghan, why is it retained at the beginning of the volume? *Nanjing* states: "The pulse of Shi Wen is soggy and weak at the Yang position (Cun/Inch) and small and rapid at the Yin position (Chi/Cubit)." This differs slightly from the pulse described here.
Furthermore, since Shanghan has been differentiated into six channels based on symptoms such as headache and stomach excess, one can identify Wind-Cold by "sweating," Dryness-Heat by "thirst," and Dampness by "difficulty in urination." Through this vertical and horizontal differentiation, pathogenic factors cannot hide. Readers should pay close attention to this practical aspect.
Patients with chronic dampness suffer from generalized body pain, fever, and a sallow complexion resembling smoked yellow (dull yellow).
Ni Chongzhi in *Shanghan Huiyan* (Compilation of Sayings on Cold Damage): This is the general outline for diseases of patients with chronic dampness. Generally, individuals whose constitution is prone to dampness are called "Shijia" (Dampness-prone persons). Their pain differs from Bi-pain; when dampness lodges in joints causing pain, it is called Bi. Here, the whole body hurts, and there is exterior heat, so the Liaoshe school calls it a disease in the meridians. Smoked yellow and orange-yellow both result from damp-heat; the former is bright yellow due to dominant heat, while the latter is dull yellow due to dominant dampness. Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction) is indicated. Haizang regarded smoked yellow as Yin Huang (Yellow Syndrome due to Cold-Damp). Since dampness dominates, it may subsequently transmit to Cold-Middle, presenting with spontaneous urination.
Wang Shixiong adds: This occurs because only heat was cleared without treating dampness, leading to subsequent transmission to Cold-Middle. Shu Fu Tang (Aconite and Atractylodes Macrocephala Decoction) is indicated.
Shen Yaofeng states: Zhu Danxi said: "It is like making yeast; when damp-heat stagnates for a long time, jaundice develops."
Wang Shixiong adds: Jaundice caused by damp-heat is called Huangdan (Jaundice), which is an acute illness. Therefore, Zhang Zhongjing sets an eighteen-day limit. There are many other causes, including Gudan (Grain Jaundice), Jiudan (Alcohol Jaundice), Nulaodan (Sexual Exhaustion Jaundice), Huanghan (Yellow Sweat), and Yin Huang (Yellow Syndrome due to Cold-Damp) caused by cold sweat, loose stools, and Qi deficiency. There is also Ruohuang (Weak Yellow) characterized by facial and bodily edema, white sclerae, ability to eat, but fatigue upon exertion. Jinghuang (Fright Jaundice) results from insufficient spirit and sudden fright causing Gallbladder Qi to leak outward. Weihuang (Withered Yellow) arises from Liver Wood overacting, damaging Spleen and Stomach, leading to Earth failure and color protruding outward. All these differ from acute illnesses and cannot be broadly categorized as damp-heat diseases.
Patients with chronic dampness may experience sweating only on the head, stiffness in the back, and a desire to cover themselves and face fire for warmth. If purgatives are used prematurely, hiccups, chest fullness, difficulty in urination, and a tongue coating resembling moss may occur. This is due to heat in the Dantian (Lower Jiao) and cold in the chest (Upper/Middle Jiao), thirst for water but inability to drink, resulting in dry mouth and irritability.
You Zaijing states: When cold-damp resides in the exterior, Yang Qi cannot circulate outward but floats upward, causing head sweating, back stiffness, and a desire to cover up and face fire. Warm herbs should be used to unblock Yang Qi; attacking methods should not be used to expel dampness. If purgatives are mistakenly used, Yang Qi is further suppressed, leading to hiccups. Alternatively, if Upper Jiao Yang Qi does not distribute, chest fullness occurs; if Lower Jiao Yang Qi fails to transform, difficulty in urination occurs. Symptoms arise according to the site of injury. The moss-like substance on the tongue is not due to Stomach Heat but rather the drying and accumulation of fluids on the tongue surface, mimicking a coating. After purgation, Yang Qi sinks to the lower part while cold-damp remains gathered above. Thus, there is heat in the Dantian causing thirst, and cold in the chest preventing drinking, leading to dry mouth and irritability as fluids gather.
Wang Shixiong adds: The character "Han" (Cold) in "Cold in the Chest" should be interpreted as "Tan" (Phlegm). Phlegm in the chest causes the moss-like appearance on the tongue. Fluids are blocked by phlegm, causing dry mouth and irritability. Phlegm-fluid is condensed water; thus, although thirsty, one cannot drink. Yang Yun states: This annotation is very clear. Whenever *Shanghan Lun* mentions "cold in the chest," it should be interpreted as phlegm.
If patients with chronic dampness are treated with purgatives, and they develop sweating on the forehead, slight panting, and free urination, the prognosis is fatal. If diarrhea persists incessantly, it is also fatal.
You Zaijing states: For dampness in the exterior, sweating is appropriate; for dampness in the interior, promoting diuresis is appropriate. Unless damp-heat accumulates into solid excrement, purgatives should not be used hastily. Yang Yun states: Purgatives must not be used recklessly in dampness syndromes. Sweating on the forehead and slight panting indicate Yang Qi detaching and moving upward; free urination and persistent diarrhea indicate Yin Qi rupturing and moving downward. The separation of Yin and Yang leads to death. Another interpretation suggests that difficulty in urination indicates death, meaning Yang floats up while Yin fails to descend. This is also plausible.
Wang Shixiong adds: Zhang Shiweng states: Extending from this, even if there is forehead sweating and slight panting, if both stool and urine are difficult, Yin Qi has not detached, and the root of Yang remains. Even if stool and urine are free, if there is no forehead sweating or panting, Yang Qi has not floated, and the root of Yin remains. This is not a separation of Yin and Yang, and rescue can be attempted based on deficiency or excess. However, if diarrhea persists incessantly, even without signs of Yang Qi detaching upward like head sweating or panting, it is still fatal. There are cases of persistent diarrhea with reversed closure of urine and forehead sweating, known as Guan Ge (Obstruction and Repletion). The classic states: In Guan Ge obstruction, if the head has no sweat, survival is possible; if there is sweat, death ensues.
Question: When Wind and Dampness contend, causing generalized body pain, the method dictates resolving it through sweating. If it rains continuously, and the doctor says sweating is appropriate, but the patient does not recover after sweating, why? Answer: If sweating produces profuse perspiration, only the Wind pathogen is expelled, while Dampness remains, hence the lack of recovery. To treat Wind-Dampness, sweating should be mild, appearing as if the patient is about to sweat slightly; then both Wind and Dampness will be expelled. Wang An notes: Even ancient practitioners exercised moderation in inducing sweating. Why do modern physicians insist on profuse sweating? This aligns with the instructions under Guizhi Tang (Cinnamon Twig Decoction) in *Shanghan Lun*.
Ni Chongzhi in *Shanghan Huiyan*: Patients with chronic dampness should not be mistreated with purgatives nor with sweating methods. Only in the syndrome of Wind-Dampness contention... Wind comes from the front, Dampness injures the lower parts; their collision causes generalized pain. This involves slight exterior pathogens, requiring sweating for resolution. However, during continuous rain, Dampness prevails. If profuse sweating is induced, not only will the Wind-Dampness pathogens remain unresolved, but True Qi will also be damaged. Wind enters quickly through gaps, while Dampness invades gradually. With Wind outside and Dampness inside, profuse sweating soaks clothes and bedding, turning sweat into dampness. Although Wind is gone, Dampness remains latent, hence no recovery. Mild sweating allows Zheng Qi (Upright Qi) to disseminate, nourishing the body and hair like mist and dew. As Zheng Qi moves, Xie Qi (Pathogenic Qi) retreats, Ying and Wei harmonize, and Wind-Dampness resolve simultaneously.
Zhang Xugu states: Treating Wind-Dampness requires unblocking Yang Qi, harmonizing Ying and Wei, and smoothing meridians so that Qi flows freely between interior/exterior and Yin/Yang. Internal dampness leaves via urine through Sanjiao (Triple Burner) transformation; external dampness resolves via mild sweating through Ying-Wei circulation. Once Yin-Dampness is resolved, Wind pathogens dissipate. Profuse sweating causes Yang Qi to surge wildly. Wind, being a Yang pathogen, escapes with the Qi, while Dampness, being Yin and stagnant, remains, failing to resolve. This distinguishes treating Wind-Dampness from Wind-Cold. Although both Cold and Damp are Yin pathogens, Cold is clear and easy to scatter, while Damp is turbid and sticky, necessitating different sweating methods.
In dampness disease, if there is body pain, fever, yellowish face, panting, dizziness, nasal congestion, and irritability, with a large pulse, normal appetite, and a peaceful abdomen, the pathology lies in Cold-Dampness in the head, causing nasal congestion. Administering medication nasally will cure it.
Zhang Xugu states: This refers to clear pathogens like fog and dew injuring the upper jiao. The three Yang meridians ascend to the head and run along the exterior. Cold-Dampness in the head obstructs exterior Qi, causing pain and fever. The Lung opens into the nose and governs the skin/hair. Pathogens enter via the nose; Dampness obstructs Yang, causing steaming and a yellow face. Qi obstruction causes panting; Qi stagnation causes headache, nasal congestion, and irritability—all due to Lung Qi blockage failing to descend, resulting in a paradoxically large pulse. This contrasts sharply with dampness injuring the lower jiao, where the Yin pulse is deep and fine. The Lung connects to the throat, the Stomach to the pharynx. Since the pathogen is in the Lung, not the Stomach, appetite is normal and the abdomen is peaceful. Only Cold-Dampness in the head causes nasal congestion. Acrid-aromatic and bitter-draining drugs should be administered nasally, similar to modern Sha medicines.
Wang Shixiong adds: Snuff can also be used; ancients used Genti San (Gardenia and Melon Trunk Powder). Unblocking Lung Qi allows dampness to transform into fluid and exit via the nose. Wang An notes: Sniffing Genti powder induces fluid discharge from the nose; ingesting it as a decoction induces vomiting.
In Shanghan, if Stagnant Heat resides in the interior, jaundice will certainly develop. Mahlian Qiaochi Xiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction) is indicated.
Zhang Xugu states: Exterior pathogens remain unresolved, and damp-heat stagnates internally, causing jaundice. Ephedra releases the exterior; Forsythia and Red Beans benefit Lung Qi to clear damp-heat. Since the pathogen is in the meridians, it is resolved from the exterior.
Wang Shixiong adds: In my clinical practice, for summer damp-heat jaundice with exterior Wind-Cold, replacing Ephedra with Xiangru (Elsholtzia) in this formula is effective. Yang Yun states: Using Xiangru in summer is analogous to using Ephedra in winter.
In Shanghan, if there is jaundice and fever, Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) is indicated.
You Zaijing states: This is a syndrome of Heat stagnation without excess formation. Heat stagnation causes jaundice; lack of excess explains fever without abdominal fullness. Gardenia clears heat from above; Phellodendron Bark clears heat from below. Since the middle is not yet excessive, Licorice is needed to harmonize.
Shen Yaofeng states: Zhizi Bopi Tang clears heat and promotes diuresis; it is the principal formula for damp-heat. Cheng Fusheng considers Mahlian Qiaochi Xiaodou Tang the principal formula for damp-heat, failing to realize that Mahlian Qiaochi Xiaodou Tang is a sweating formula suitable only for exterior Wind-Cold complications, whereas Zhizi Bopi Tang is a diuretic formula. Yang Yun states: This analysis is very clear. If Mahlian Qiaochi Xiaodou Tang were the principal formula, Zhizi Bopi Tang would have no place, nor would the text's instruction to "promote diuresis."
In Shanghan, after seven to eight days, if the body is yellow like an orange peel, urination is difficult, and there is slight abdominal fullness, Yinchenshao Tang (Artemisia Scoparia and Mugwort Seed Decoction) is indicated.
You Zaijing states: This is a syndrome of Heat結 (knotting) in the interior. Yellow like an orange peel indicates bright yellow, characteristic of Heat Jaundice; Yin Jaundice is dull yellow. Heat knotting in the interior causes difficulty in urination and abdominal fullness, making Yinchenshao Tang appropriate to purge heat and unblock stasis.
In Yangming disease, fever and sweating indicate Heat venting outward, preventing jaundice. However, if only the head sweats, the body has no sweat (stopping at the neck), urination is difficult, and there is thirst for liquids, this indicates Stagnant Heat in the interior, leading to jaundice. Yinchenshao Tang is indicated.
You Zaijing states: "Heat venting" means Heat escapes outward with sweat. If Heat vents, pathogens disperse and cannot cause jaundice. If only the head sweats and the body does not, Heat cannot reach the exterior. Difficulty in urination prevents Heat from draining downward. Thirst for liquids exacerbates internal Heat accumulation and draws in external Dampness. Damp and Heat combine, stagnate, and fail to resolve, inevitably steaming into jaundice. Yinchenshao Tang is bitter-cold and purgative, expelling pathogens via urine.
In Yangming disease, if the entire face is red, purgatives must not be used. Using them will cause fever, jaundice, and difficulty in urination.
Shen Yaofeng states: This is a Shi Wen syndrome constrained by exterior Cold pathogens; Mahlian Qiaochi Xiaodou Tang is the principal formula. Removing chills makes it a Zhibo syndrome. Adding slight abdominal fullness makes it a Yinchenshao syndrome.
Zhang Xugu states: The previous section clarified jaundice syndromes; this clarifies the cause of jaundice. Facial redness indicates Heat stagnating in the meridians, requiring sweating. Purgatives damage Fu organ Qi, causing meridian Heat to move inward, combining with food/digestive Qi to steam into jaundice, blocking Sanjiao and causing difficulty in urination.
In Yangming disease, if there is no sweat, difficulty in urination, and mental restlessness (Ao Nao), jaundice will certainly develop.
Zhang Xugu states: Even without erroneous purgation, lack of sweat and difficulty in urination cause pathogenic Heat to close and knot. Mental restlessness combined with郁蒸 (stagnant steaming) of Stomach fluids leads to jaundice.
In Yangming disease, if Fire therapy is applied, resulting in slight forehead sweating and difficulty in urination, jaundice will certainly develop.
Yu Jiayan states: If Dampness stops and Heat stagnates, and Fire therapy is erroneously applied, Heat becomes more intense. Fluids rush upward; although the forehead sweats slightly, general sweating and urination become impossible. How can changes leading to jaundice be avoided?