（四十九）问两胫逆冷。胸腹满。多汗。头目痛苦。妄言。
此名湿温也。其人尝伤于湿。因而中暑。湿热相搏。则发湿温。病苦两胫逆冷腹满。又胸多汗
头目痛苦妄言。其脉阳濡而弱。阴小而急。治在太阴（脾属土主湿）不可发汗。汗出必不能言。
耳聋。不知痛所在。身青面色变。名曰重HT 。如此死者。医杀之耳。白虎加苍术汤。（杂百十七）
主之（此方出伤寒微旨。亦仿金匮白虎加桂汤。）（杂四十）
（五十）问发热恶寒。颈项强急。腰身反张如中风状。或螈 口噤。
此名 也。伤风颈项强急。身体反张。属太阳经。先因伤风。又感寒湿而致然也。古人谓之
病。（ 音帜。又作痉。巨郢反。 者。强直也。古人以强直为 。金匮要略云。太阳病。
其身体KT KT 。便为 也）外证发热恶寒。与伤寒相似。但其脉沉迟弦细。而项背反张强硬。如
发痫之状。此为异耳。（新产血虚多汗出喜中风亦有此证）当察其有汗无汗。以分刚 柔 。
（无汗恶寒名刚 。有汗不恶寒名柔 ，）无汗葛根汤主之（正廿六）有汗桂枝加葛根汤（正十八
）主之。（本草葛根主伤风有湿开窍解肌）凡刚柔二 。小续命汤。（杂五七）并可与之。
（有汗者小续命汤去麻黄加葛根也）若审知刚 。胸满口噤。其人卧不着席。脚挛急。咬齿。当
行大承气汤。（正四一）（外台云。热而 者死。热病痉者。反折螈 。齿噤 也）○又问刚
柔二 。与阴阳二痉是如何 亦作痉。阳痉属刚 。阴痉属柔 。附术散、（杂五八）桂心白术
汤、（杂五九）附子防风散、（杂六十）八物白术散、（杂六一）桂枝煮散。可选而用之。（活人续
集解惑论云．合面而卧为阴痉。仰目者为阳痉。又云或因湿家发汗多。则发 也）
（又五十）问初春病患肌肉发斑瘾疹如锦纹。或咳心闷。但呕清汁。
此名温毒也。温毒发斑者。冬时触冒疹毒。至春始发。病初在表。或已发汗吐下而表证未罢。毒瓦斯不
散。故发斑黑膏主之。又有冬月温暖。人感乖戾之气。冬未即病。至春或被积寒所折。毒瓦斯不得泄。
至天气暄热。温毒始发。则肌肉斑烂瘾疹如锦纹而咳心闷。但呕清汁葛根橘皮汤主之。（杂九四）
黄连橘皮汤（杂百廿五）尤佳。
（四十九）问：两小腿逆冷，胸腹部胀满，多汗，头部和眼部疼痛，胡言乱语。
这是名为湿温的病证。患者曾经受湿邪所伤，因而又感受暑热，湿热相互搏结，于是发生湿温病。病症表现为两小腿逆冷、腹部胀满，以及胸部多汗、头目痛苦、胡言乱语。其脉象寸部濡软而弱，尺部细小而急。治疗应在太阴经（脾属土，主湿），不可使用发汗法。如果误用发汗，患者必然不能言语，出现耳聋，不知道疼痛所在之处，身体发青，面色改变，这叫做“重暍”（zhòng yē，指病情危重的中暑或湿温重症）。像这样死亡的，是医生杀死了他。应使用白虎加苍术汤来主治。（此方出自《伤寒微旨》，也是仿照《金匮要略》中的白虎加桂枝汤。）
（五十）问：发热恶寒，颈项强直紧急，腰身反张如中风状，或者抽搐、牙关紧闭。
这是名为“痉”（jìng，音同“帜”，又写作“痉”，读音为巨郢反，“痉”意为强直）的病证。伤风导致颈项强直紧急，身体反张，属于太阳经。起初是因为伤风，又感受寒湿而导致这种情况。古人称之为“痓”（chì，通“痉”）病。（《金匮要略》说：太阳病，身体拘挛不适，就称为痉病。）外证表现为发热恶寒，与伤寒相似，但其脉象沉迟弦细，且项背反张强硬，如同发作癫痫的样子，这是不同之处。（新产后血虚多汗出，容易受风，也有这种证候。）应当观察患者有汗还是无汗，以区分刚痉和柔痉。（无汗恶寒称为刚痉，有汗不恶寒称为柔痉。）无汗者，用葛根汤主治；有汗者，用桂枝加葛根汤主治。（本草记载：葛根主治伤风有湿，能开窍解肌。）凡是刚痉和柔痉，都可以使用小续命汤。（有汗的小续命汤需去掉麻黄，加上葛根。）如果确切知道是刚痉，出现胸满、牙关紧闭，患者卧床时背部不着席，脚部痉挛拘急，咬紧牙齿，应当使用大承气汤。（《外台秘要》说：发热而患痉病的会死亡，热病致痉，会出现角弓反张、抽搐、牙关紧闭等症状。）○又问：刚痉和柔痉，与阳痉和阴痉是如何区分的？（“痉”也写作“痉”。）阳痉属于刚痉，阴痉属于柔痉。可以使用附术散、桂心白术汤、附子防风散、八物白术散、桂枝煮散，选择其中一种使用。（《活人续集解惑论》说：脸朝下趴着睡的是阴痉，仰面睁眼的是阳痉。又说：有的因为湿家发汗过多，就会引发痉病。）
（又五十）问：初春时节，病人肌肉出现斑疹瘾疹，像锦缎花纹一样，或者咳嗽、心中闷痛，只是呕吐清稀液体。
这是名为温毒的病证。温毒发斑，是因为冬季触冒了疹毒，到了春天才发作。病初在表，或者已经经过发汗、催吐、泻下等治疗，但表证未解除，毒气不散，所以发出黑斑，用黑膏主治。又有冬季天气温暖，人感受了乖戾之气，冬天没有立即发病，到了春天又被积寒所遏制，毒气不得宣泄，等到天气变暖炎热时，温毒才开始发作，这时肌肉出现斑烂、瘾疹像锦缎花纹，伴有咳嗽、心中闷痛，只是呕吐清稀液体，用葛根橘皮汤主治。（黄连橘皮汤更好。）
(49) Question: Coldness of both lower legs, fullness in the chest and abdomen, profuse sweating, pain in the head and eyes, and delirious speech.
This is named Damp-Heat Warmth (Shi Wen). The person has previously been injured by dampness, and subsequently contracted summerheat. When dampness and heat struggle with each other, Damp-Heat Warmth develops. The disease causes coldness of both lower legs and abdominal fullness, as well as profuse sweating in the chest, pain in the head and eyes, and delirious speech. The pulse is superficially soggy and weak (Yang position), and deep small and rapid (Yin position). Treatment should focus on the Taiyin channel (the Spleen belongs to Earth and governs dampness); diaphoresis (inducing sweating) must not be used. If diaphoresis is induced, the patient will inevitably lose the ability to speak, experience deafness, be unaware of where the pain is located, have a bluish body, and change in complexion. This is called "Chong Ye" (severe heatstroke or damp-heat critical condition). Those who die in this manner are killed by the physician. Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Macrocephala Decoction) should be used to govern it. (This formula comes from *Shanghan Weizhi*, also modeled after the White Tiger plus Cinnamon Twig Decoction in *Jingui Yaolue*.)
(50) Question: Fever and aversion to cold, stiffness and tension in the neck and nape, opisthotonos of the waist and body resembling wind-stroke, or convulsions and trismus (lockjaw).
This is named Jing (Spasm/Stiffness). Wind-injury causing stiffness and tension in the neck and nape, with body opisthotonos, belongs to the Taiyang channel. Initially due to wind-injury, and further caused by contracting cold-dampness, this condition arises. Ancient people called it "Chi" disease (synonymous with Jing, meaning stiffness). (*Jingui Yaolue* states: In Taiyang disease, if the body feels cramped, it is termed Jing.) The external manifestations include fever and aversion to cold, similar to Cold Damage (Shanghan), but the pulse is deep, slow, wiry, and fine, and the neck and back are rigid and arched backward, resembling an epileptic seizure; this is the difference. (Postpartum blood deficiency with profuse sweating makes one prone to wind invasion, which can also present this syndrome.) One must observe whether there is sweat or no sweat to distinguish between Gang Jing (Rigid Spasm) and Rou Jing (Soft Spasm). (No sweat with aversion to cold is named Gang Jing; sweating without aversion to cold is named Rou Jing.) For no sweat, Gegen Tang (Kudzu Root Decoction) governs it; for sweating, Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction) governs it. (Materia Medica records that Kudzu Root treats wind-injury with dampness, opens orifices, and releases the muscle layer.) For both Gang Jing and Rou Jing, Xiao Xuming Tang (Minor Continuation Life Decoction) can be used. (For those with sweat, remove Ephedrae Herba from Xiao Xuming Tang and add Radix Puerariae [Gegen].) If it is confirmed as Gang Jing, presenting with chest fullness, trismus, inability to lie flat with the back touching the bed, leg cramps, and teeth grinding, Dachengqi Tang (Major Order the Qi Decoction) should be administered. (*Waitai Miyao* states: Heat accompanied by spasm leads to death; heat disease causing spasm involves opisthotonos, convulsions, and lockjaw.) ○ Another question: How do Gang Jing and Rou Jing differ from Yang Jing and Yin Jing? (Jing is also written as Jing.) Yang Jing belongs to Gang Jing, and Yin Jing belongs to Rou Jing. Fuzhu San (Aconite and Atractylodes Powder), Guixin Baizhu Tang (Cinnamon Heart and Atractylodes Macrocephala Decoction), Fuzi Fangfeng San (Aconite and Saposhnikovia Divaricata Powder), Bawu Baizhu San (Eight Ingredients and Atractylodes Macrocephala Powder), and Guizhi Zhusan (Cinnamon Twig Boiled Powder) can be selected for use. (*Huoren Xuji Jiehuo Lun* states: Sleeping face down is Yin Jing; looking up with open eyes is Yang Jing. It also says: Some develop spasm due to excessive diaphoresis in patients with dampness.)
(Another 50) Question: In early spring, patients develop macules and urticaria on the skin resembling brocade patterns, or experience cough and chest oppression, vomiting only clear fluid.
This is named Wendu (Warm Toxin). Wendu with macules occurs when one is exposed to toxin during winter, which manifests in spring. At the beginning, the pathogen is in the exterior. Even if diaphoresis, emesis, or purgation have been performed, if the exterior syndrome remains unresolved and the toxin does not dissipate, black macules appear, treated by Heigao (Black Plaster). Additionally, if the winter is warm, people may contract aberrant qi. The disease does not manifest immediately in winter; in spring, it is constrained by accumulated cold, preventing the toxin from being excreted. When the weather becomes warm and hot, Wendu begins to manifest, causing macular erosion and urticaria resembling brocade patterns on the skin, accompanied by cough, chest oppression, and vomiting of clear fluid. Gegen Jupi Tang (Kudzu Root and Tangerine Peel Decoction) governs it. Huanglian Jupi Tang (Coptis Chinensis and Tangerine Peel Decoction) is even better.