经云∶诸痉项强，皆属于湿。又云∶诸暴强直，皆属于风。论曰∶太阳病，发汗太多，因成痉。夫六气皆
足以致痉，不专在湿也；六经皆有痉证，亦不专在太阳一经也。盖身以后，属太阳，凡头项强急，项背KT KT ，
脊强反张，腰似折，髀不可以曲， 如结，皆太阳痉也。身以前属阳明，头面动摇，口噤齿 ，缺盆纽痛，脚
挛急，皆阳明痉也。身之侧属少阳，口眼 邪，手足牵引，两胁拘急，半身不遂，皆少阳痉也。至若腹内拘急，
因吐利后而四肢挛急者，未尝非太阴痉也。恶寒蜷卧，尻以代踵，脊以代头，俯而不能仰者，未尝非少阴痉也。
睾丸上升，宗筋下注，少腹里急，阴中拘挛，膝胫拘急者，未尝非厥阴痉也。大抵痉以状名，而痉因筋急，故
凡六经筋病，皆得以痉称之。其因于风寒者，必发热恶寒而无汗，其脉浮紧，其状身强直而口噤，即经所云∶
诸病强直，皆属于风者也。其势劲急，故名曰刚痉。其因于风湿者，发热汗出，不恶寒，其脉浮缓，其状项强
KTKT ，而身不强直，即经所云∶诸痉项强，皆属于湿者也。其势濡弱，故名曰柔痉。若夫因误汗亡阳，津
竭无以养筋而致痉者，即本论所云∶太阳病，发汗太多而成痉，又非因湿因风，而却因燥者也。盖痉之始，本
非正病，多杂于他病之中，如妇人之脱血，跌扑之破伤，俱能致痉。今见患此者，悉指为风，殊非确论。学人
当于证中审察风、寒、湿、燥、内外、虚实之因，分别施治，庶不致误，慎勿概指为风也。
伤寒所致太阳病，痉、湿、 ，此三种，宜应别论，以为与伤寒相似，故此见之。
【按】“伤寒所致”四字，甚无所谓，衍文也。
【注】伤寒，太阳经中之一病，非谓太阳经惟病伤寒也。盖以六气外感之邪，人中伤之者，未有不由太阳
之表而入者也。痉，风邪也。湿，湿邪也。 ，暑邪也。夫风寒暑湿之病，固皆统属太阳，然痉、湿、 三种，
虽与伤寒形证相似，但其为病传变不同，故曰宜应别论也。
【集注】方有执曰∶痉、湿、 三者，皆风寒之变证。既成变证，则当别为立论。然自风寒变来，本属太
阳，犹有风寒涉似之疑，须当并为辨论。
病身热足寒，颈项强急，恶寒，时头热面赤，目脉赤，独头面摇，卒口噤，背反张者，痉病也。
【注】病患身热恶寒，太阳证也。颈项强急、面赤目赤，阳明证也。头热，阳郁于上也；足寒，阴凝于下也
。太阳之脉，循背上头；阳明之筋，上挟于口。风寒客于二经，则有头摇、口噤、反张、拘强之证，故名痉病也。
【集注】方有执曰∶此以痉之具证。言身热头热，面赤目脉赤，阳邪发于阳也。足寒，阴邪逆于阴也。独
头面摇，风行阳而动于上也。卒，忽然也。噤，寒而口闭也，言忽然唇口吻合，噤急而饮食不通也。背反张者，
太阳之脉挟背，寒则筋急而拘挛，热则筋缓而纵驰也。然刚、柔二痉，则各见证之一偏，惟风寒俱有而致证者，
则具见也。
郑重光曰∶此总论痉之经俞皆病，气血并伤，而为强急反张之证也。风湿俱有，故为痉之具证也。
太阳病，发热，脉沉而细者，名曰痉。
【注】太阳病发热，脉当浮大，脉若沉细，兼少阴也。今发热脉沉细，而名曰痉者，何也？以其已病痉证，
而得沉细脉，不可名太阳、少阴伤寒之脉，当名太阳风湿痉病之脉也。因风邪郁于阳，故病发热也。湿邪凝于
阴，故脉沉细也。此承上条痉病得沉细脉之义，非谓太阳病发热，脉沉细，即名之曰痉病也。
【集注】方有执曰∶发热，太阳未除也。沉，寒也。细，湿也。
程知曰∶脉沉细，法宜救里，而痉又为燥热之病，故《金匮》谓难治。谓未可轻同于太阳发热脉反沉之例也。
张璐曰∶发热脉当浮数，而反沉细，知邪风为湿气所着，所以身虽发热，而脉不能浮数，是阳证见阴脉，故
《金匮》指为难治也。
程应旄曰∶痉病有同有独，固以其独者名之矣。然脉在太阳，更有独而无同，以头面摇，口噤背反张之证，
合沉细之脉，虽有太阳发热等证，不致为伤寒所溷，乃可定其名曰痉也。
太阳病，发热无汗，反恶寒者，名曰刚痉。太阳病，发热汗出，而不恶寒，名曰柔痉。
【按】反恶寒之“反”字，衍文也。刚痉证应恶寒，非反也。
【注】痉病既属太阳，当以太阳虚实例之。故曰∶太阳病发热无汗，恶寒，为实邪，名曰刚痉；发热汗出，
不恶寒，为虚邪，名曰柔痉。此详申上二条痉病虚实，非谓太阳病，发热无汗、恶寒，汗出不恶寒，即名之曰
刚、柔痉病之证也。
【集注】程知曰∶太阳病，发热，无汗，恶寒，为伤寒；发热，汗出，恶风，为伤风；发热，汗出，不
恶寒，为温热。以证有颈项强急，甚则反张，故不谓之风寒、温热病，而谓之痉也。
张璐曰∶《金匮》云∶太阳病无汗，而小便反少，气上冲胸，口噤不能言，欲作刚痉，葛根汤主之。即
是申明此条之义，而补其治法也。无汗而小便少者，以太阳、阳明二经之热，聚于胸中，延伤肺金清肃之气，
内外不能宣通故也。又云∶太阳病，其证备，身体强KT KT 然脉反沉迟，此为痉，栝蒌桂枝汤主之，即是申
明此条之义，而补其治法也。其证备，则发热汗出等证，《金匮》已详，不必赘矣。
太阳病，项背强KT KT ，无汗恶风，葛根汤主之。
【注】此略其证脉，单举痉之颈项强急者，以明其治也。太阳脉，下项循肩挟脊；阳明脉循喉咙，入缺
盆，贯膈、下乳内廉。太阳主后，前合阳明；阳明主前，后合太阳。今邪壅于二经之中，故有KT KT 拘强之
貌也。太阳之强，不过颈项强；此痉之强，则不能俯仰，项连胸背而俱强，故曰项背强KT KT 也。无汗恶风，
实邪也，宜葛根汤发之，即桂枝汤加麻黄、葛根，两解太阳、阳明之邪也。
【集注】方有执曰∶KT KT ，鸟之短羽者，动则引颈KT KT 然。形容病患之颈项俱病者，俯仰不能
自如之貌。
太阳病，项背强KT KT ，反汗出恶风者，桂枝加葛根汤主之。
【注】太阳病，项背强KT KT ，无汗恶风者，实邪也。今反汗出恶风者，虚邪也，宜桂枝加葛根汤，
解太阳之风，发阳明之汗也。
【集注】汪琥曰∶太阳病项背强矣，复KT KT 然，颈不得舒，颈之经属阳明，项背与颈KT KT 然，
其状当无汗，今反汗出、恶风，仲
景法∶太阳病汗出恶风者，桂枝汤主之。今因其KT KT 然，故加葛根于桂枝汤中，以兼祛阳明经之风也。
桂枝加葛根汤方
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，麻黄连招赤小豆汤。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，纳药鼻中则愈。
【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，舌上如苔者；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，故舌上滑白如苔。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。
程应旋曰∶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，舌上如苔，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，谓一身尽痛之病患也。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∶风湿相抟，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】此详风湿相抟，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，风湿相抟，
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，
必俟天气晴明发其汗，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∶风湿相抟，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
《内经》说：各种痉病出现项背强直，都归属于湿邪。又说：各种突然发生的强直症状，都归属于风邪。医论中说：太阳病，发汗过多，因而导致痉病。其实六气都能导致痉病，并不专指湿邪；六经都有痉证，也不仅仅局限于太阳一经。大概身体后部属太阳经，凡是头项强急、项背部拘紧不舒、脊柱强直角弓反张、腰部像折断一样、大腿不能弯曲、腘窝像被捆绑结扎一样的，都是太阳经的痉病。身体前部属阳明经，凡是头面部动摇、牙关紧闭咬齿、缺盆部位疼痛、脚部挛急，都是阳明经的痉病。身体侧面属少阳经，凡是口眼歪斜、手足牵引抽搐、两胁拘急、半身不遂，都是少阳经的痉病。至于腹部拘急，在呕吐腹泻之后出现四肢挛急的，未尝不是太阴经的痉病。恶寒蜷缩而卧，臀部着地代替脚跟，脊背弯曲代替头部，只能俯身不能仰起的，未尝不是少阴经的痉病。睾丸上缩，宗筋向下灌注，小腹部里急，阴部拘挛，膝盖和小腿拘急的，未尝不是厥阴经的痉病。大抵“痉”是根据症状命名的，而痉病的成因是筋脉拘急，所以凡是六经的筋病，都可以称为痉。其中因风寒引起的，必定发热恶寒且无汗，脉象浮紧，症状表现为身体强直且牙关紧闭，这就是经文所说的：各种强直病症，都归属于风邪。其病势强劲急迫，所以名叫刚痉。其中因风湿引起的，发热汗出，不恶寒，脉象浮缓，症状表现为项背部拘紧不舒而身体不强直，这就是经文所说的：各种痉病项背强直，都归属于湿邪。其病势濡弱，所以名叫柔痉。如果是因误用汗法导致亡阳，津液枯竭无法滋养筋脉而导致痉病的，就是本论所说的：太阳病，发汗太多而成痉，这又不是因湿或因风，而是因燥所致。大概痉病起始时，本来不是正病，多夹杂在其他疾病之中，如妇女产后失血、跌打损伤破伤等，都能导致痉病。现在看到患这种病的，全都归咎于风邪，这绝不是确切的结论。学习的人应当在证候中仔细审察风、寒、湿、燥、内、外、虚、实的病因，分别施治，这样才不会出错，千万不要一概归咎于风邪。
伤寒所致的太阳病，有痉、湿、暍（暑病）这三种，应当分别论述，因为它们与伤寒相似，所以在此处见到。
【按语】“伤寒所致”这四个字，没有什么意义，是衍文（多余的文字）。
【注解】伤寒，只是太阳经中的一种病，并不是说太阳经只病伤寒。大概因为六气外感之邪，人受伤害的，没有不从太阳之表而入的。痉，是风邪；湿，是湿邪；暍，是暑邪。风寒暑湿的病，固然都统属于太阳，然而痉、湿、暍这三种，虽然与伤寒的形证相似，但其传变不同，所以说应当分别论述。
【集注】方有执说：痉、湿、暍三者，都是风寒的变证。既然成为变证，就应当另外立论。然而既然是从风寒变化而来，原本属于太阳，还有风寒涉似（类似）的疑惑，应当合并进行辨析。
病人身体发热，足部寒冷，颈项强直紧急，恶寒，有时头部发热面红，眼睛血脉赤红，只有头面部摇动，突然牙关紧闭，背部反张的，这是痉病。
【注解】病人身体发热恶寒，是太阳证。颈项强直、面红目赤，是阳明证。头部发热，是阳气郁结在上部；足部寒冷，是阴气凝滞在下部。太阳经脉，循行背部上行至头；阳明经筋，上行挟持口唇。风寒客居于这两条经脉，就会出现头摇、口噤、反张、拘强的证候，所以名叫痉病。
【集注】方有执说：这是列举痉病的完整证候。说身体热、头部热，面红目赤血脉赤红，是阳邪发于阳分。足冷，是阴邪逆于阴分。只有头面部摇动，是风气行于阳而动于上部。卒，是忽然的意思。噤，是因为寒冷而口闭，是说忽然嘴唇牙齿闭合，拘急而不能进食。背部反张，是因为太阳经脉挟持背部，寒则筋脉拘急挛缩，热则筋脉弛缓纵伸。然而刚痉和柔痉，各自只见证候的一个方面，只有风寒兼具而致病的，才会全部显现出来。
郑重光说：这是总论痉病经络腧穴都受病，气血并伤，而出现强直反张的证候。风湿兼具，所以是痉病的完整证候。
【注解】太阳病发热，脉应当浮大，如果脉象沉细，兼有少阴证。现在发热脉沉细，却名叫痉，为什么呢？因为已经得了痉病，而出现沉细脉，不能命名为太阳、少阴伤寒的脉，应当命名为太阳风湿痉病的脉。因为风邪郁结于阳分，所以病发热。湿邪凝滞于阴分，所以脉沉细。这是承接上一条痉病得沉细脉的意义，并不是说太阳病发热，脉沉细，就名叫痉病。
【集注】方有执说：发热，说明太阳病未除。沉，主寒。细，主湿。
程知说：脉沉细，依法应当救里，而痉又是燥热的病，所以《金匮要略》说难治。意思是不可轻易等同于太阳发热脉反沉的例子。
张璐说：发热脉应当浮数，反而沉细，可知邪风为湿气所附着，所以身体虽然发热，而脉不能浮数，这是阳证见阴脉，所以《金匮要略》指出为难治。
程应旄说：痉病有共同点也有独有特点，固然以其独有特点命名。然而脉在太阳，更有独而无同的情况，以头面摇、口噤、背反张的证候，结合沉细的脉，虽然有太阳发热等证，不至于被伤寒混淆，才可以定其名叫做痉。
太阳病，发热无汗，反而恶寒的，名叫刚痉。太阳病，发热汗出，而不恶寒的，名叫柔痉。
【按语】“反恶寒”的“反”字，是衍文。刚痉证应当恶寒，并非相反。
【注解】痉病既属于太阳，应当用太阳的虚实来验证。所以说：太阳病发热无汗，恶寒，是实邪，名叫刚痉；发热汗出，不恶寒，是虚邪，名叫柔痉。这是详细申述上面两条痉病的虚实，并不是说太阳病，发热无汗、恶寒，或者发热汗出不恶寒，就名叫刚、柔痉病的证候。
【集注】程知说：太阳病，发热，无汗，恶寒，是伤寒；发热，汗出，恶风，是伤风；发热，汗出，不恶寒，是温热病。因为证候有颈项强直，甚至反张，所以不称之为风寒、温热病，而称之为痉。
张璐说：《金匮要略》说：太阳病无汗，而小便反而少，气上冲胸，口噤不能说话，想要发作刚痉，用葛根汤主治。这就是申明这一条的意义，而补充其治法。无汗而小便少，是因为太阳、阳明二经的热，聚于胸中，延及损伤肺金清肃之气，内外不能宣通缘故。又说：太阳病，证候具备，身体强直拘紧不舒而脉反而沉迟，这是痉，用栝蒌桂枝汤主治，这也是申明这一条的意义，而补充其治法。其证候具备，那么发热汗出等证，《金匮要略》已经详细说明，不必赘述了。
【注解】这里省略了证候和脉象，单独举出痉病的颈项强急，来说明其治法。太阳经脉，下行颈部循行肩膀挟持脊柱；阳明经脉循行喉咙，进入缺盆，贯穿膈肌，下行乳房内侧。太阳主后方，前方合于阳明；阳明主前方，后方合于太阳。现在邪气壅滞于这两条经脉之中，所以有拘紧强直的样子。太阳的强直，不过是颈项强直；这个痉病的强直，则是不能俯仰，项连胸背都强直，所以叫项背部拘紧不舒。无汗恶风，是实邪，宜用葛根汤发散，即桂枝汤加麻黄、葛根，两解太阳、阳明之邪。
【集注】方有执说：KT KT（此处原文为“几几”，形容短羽鸟伸颈貌），是鸟短羽者，动则引颈KT KT然。形容病人的颈项都患病，俯仰不能自如的样子。
太阳病，项背部拘紧不舒，反而汗出恶风的，用桂枝加葛根汤主治。
【注解】太阳病，项背部拘紧不舒，无汗恶风的是实邪。现在反而汗出恶风，是虚邪，宜用桂枝加葛根汤，解散太阳之风，发越阳明之汗。
【集注】汪琥说：太阳病项背强直，又KT KT然，颈部不得舒展，颈部的经脉属阳明，项背与颈KT KT然，其状应当无汗，现在反而汗出、恶风，仲景的法度：太阳病汗出恶风的，用桂枝汤主治。现在因其KT KT然，所以在桂枝汤中加入葛根，以兼祛阳明经的风邪。
桂枝加葛根汤方
在桂枝汤内，加入葛根三两，其余依照桂枝汤的方法煎服。
【注解】以上论述痉病，都是外感风、寒、湿而致病。如果太阳病发汗太多，津液大量亡失，表气不固，邪风乘虚而入，因而成痉的，乃是内虚所致，不可以柔痉、刚痉的例子来对待，宜用桂枝加附子汤，以固表祛风为主要治法。由此推之，凡是病出汗过多，新产妇失血过多，而变生此证的，都与此类似。
【集注】程应旄说：就这一点推究，就知道此病得之于亡津亡血，而因虚致寒，因虚致燥的不少。盖阳气者，柔和则能养筋，发汗太多，则亡其阳，而损伤经脉的血液的缘故。
患有湿病的人，全身疼痛，发热，身体颜色像烟熏一样黄。
【注解】湿家，指患湿病的人。湿之为病，或因外受湿气，则全身疼痛，或因内生湿病，则发热身黄。如果内外同病，则全身疼痛发热，身体颜色像烟熏黄。熏黄，是湿盛的发黄，属于脾的瘀湿，所以颜色暗如烟熏。不像伤寒热盛的发黄，属于阳明的郁热，所以颜色明如橘子色。
【集注】张璐说：湿证发黄，须分阴阳表里，阳湿在里，用茵陈蒿汤；在表，用麻黄连翘赤小豆汤。阴湿在里，用白术附子汤；在表，用麻黄白术汤，这是阴湿在表而发黄。《金匮要略》说：湿家身体烦痛，可与麻黄加术汤。盖寒与湿合，不宜大汗，所以加白术。因为麻黄得白术，则汗不至于骤发；白术得麻黄，则湿滞得以宣通。
湿病患者，身上疼痛，发热，面黄而喘，头痛鼻塞而烦闷，脉象大，自己能饮食，腹部平和无病，病在头部寒湿，所以鼻塞，将药纳入鼻中则痊愈。
【注解】这是申述上一条，详细列出证候和脉象，以区别其治法。湿病患者，身上疼痛发热，面黄而喘，这是内生外受的湿病。外治宜用羌活胜湿汤，内治宜用茵陈五苓散，喘甚用大陷胸丸。如果再加上头痛鼻塞而烦闷，脉象大，证候类似伤寒，但此人里气和能食，知道不是伤寒，不可发汗，这是湿邪的病在头部，所以头痛鼻塞，只宜将药纳入鼻中，取黄水从鼻涕流出，自然可以痊愈。所纳的药，就是瓜蒂散之类。
【集注】郑重光说：身上疼痛发热，面黄而喘，头痛鼻塞，则是寒湿之邪客居在上焦。经文说：因于湿，头感觉像被包裹一样。用瓜蒂散吹鼻，这是在上者，因而涌越之法。
太阳病，关节疼痛而烦扰，脉象沉而细的，这名叫湿痹。湿痹的候象，其人小便不利，大便反而快利。只应当利其小便。
【注解】湿家脉浮细，湿在外，应当发汗。现在太阳病，关节疼痛而烦扰，小便不利，大便反而快利，脉不浮细而沉细，是湿邪内盛而为湿痹不通的候象。所以只应当利其小便，使湿从小便而去，这是湿淫于内的正治法。
【集注】成无己说：湿盛则濡泄。小便不利，大便反而快利的，是湿气内流。只应当利其小便，以宣泄腹中湿气。古话说：治湿不利小便，不是正确的治法。
方有执说：这是说湿邪入里的情况。关节疼痛，是寒湿之气，走注内渗，所以脉沉而细。痹是指疼痛。小便不利，大便反而快利的，湿即水，水不外渗，则横流不遵循故道。利其小便，是引导其遵循故道而行。
张志聪说：关节，是腰背肘膝的大关节，是大筋所统属，不同于骨节。湿流关节，大筋不和。所以疼痛痹闭。湿伤太阳，筋脉涩滞，所以名叫湿痹，利其小便，则水道行而决渎无过失，湿邪去而筋脉调和了。
湿病患者，其人只是头部出汗，背部强直，想要盖被子、靠近火源。如果过早使用下法，则会出现呃逆，胸满，小便不利，舌上有苔；这是因为丹田有热，胸中有寒，口渴想喝水，却不能喝，口燥烦闷。
【注解】湿家只是头部出汗，是湿气上淫的汗，不是阳明之热不得越出的汗。湿家背部强直，是湿气涩滞的重强，不是痉病的拘强。想要覆盖被子靠近火源，不是外感恶寒，是湿盛产生内寒。如果误将湿淫的头汗，当作阳明瘀热的头汗而下之，寒湿之气，乘虚进入胸部则胸满，进入胃腑则呃逆。寒湿不化，所以小便不利。胸中有寒，所以舌上滑白如苔。丹田有热，所以口燥渴。想喝水却不能喝，是由胸中有寒湿缘故。
【集注】成无己说：伤寒则无汗，湿家虽有汗而不能周身，所以只是头部出汗。
程应旋说：虽然口渴想喝水似热，但不能喝可辨别，则只是口燥烦，而实际上并非胸中燥烦可知，证同病别。
湿病患者误用下法，额头出汗，微喘，小便自利的死；如果下利不止的，也死。
【注解】这是承接上一条湿家误下的逆证。湿家误下，胸满而呃逆，小便不利，舌上如苔，口燥渴不能饮，已经属于逆证，尚在可治。此误下后，额汗不止，微喘不止，是阳脱于上部；小便反利，下利不止，是阴脱于下部。阴阳相离，所以死。
【集注】方有执说：治湿当利其小便，而以小便利主死，为什么呢？误治而阴阳散亡。
程知说：湿中人，阴先受之，所以本经湿证，多从助阳温散为治，如果妄用下法，则阳虚阴盛而不可救了。额头出汗微喘，虚阳欲上脱；二便不禁，盛阴欲下脱。阴阳离决，死矣！
病人全身疼痛，发热，下午加剧的，这名叫风湿。此病是由于出汗当风，或久伤取冷所导致的。
【注解】病人，指全身疼痛的患者。湿家全身疼痛，风湿也全身疼痛。然而湿家的痛，则重着不能转侧；风湿的痛，则轻掣不可屈伸，这是痛的差别。至于发热，湿家的热，早晚不分轻重；风湿的热，则下午必然加剧。这是得之于出汗当风，或久伤湿，复受风冷所导致的。
张锡驹说：发热下午加剧的，下午阳气衰，阴气盛，湿为阴邪，所以主旺时而甚。
问曰：风湿相搏，全身疼痛，依法应当汗出而解。正值天阴雨不止，医生说此可发汗。发汗后病不愈，为什么呢？
答曰：发其汗，汗大出的，只是风气去，湿气在，所以不愈。如果治风湿，发其汗，只要微微似欲汗出的，风湿俱去。
【注解】这是详细论述风湿相搏，全身疼痛，不仅不可下，即使发汗也不可失去适宜。风是阳邪，湿是阴邪，风湿相搏，阴阳受邪，所以全身疼痛。依法应当汗出而解，正值天阴雨不止，则湿气盛，虽发其汗，汗大出而病不愈的，只是因为风气去，湿气在，所以不愈。因为其值湿盛之时，发其汗，大汗出，这是汗法不如法，所以不解。如果治风湿，必须等到天气晴明发其汗，只要令其汗微微似欲出状，则风与湿俱去，而病自解了。
【集注】方有执说：阴雨不止，则湿不除，所以更应当发汗。然而风湿本由出汗当风而得，则汗之大出者，必反使湿转加甚，微微似欲汗出，而不见出，则湿消而风散了。这是发汗的微妙机枢，后人动辄以大汗为言的，相差太远。
The *Neijing* (Inner Canon) states: "All spasms with neck stiffness are attributed to dampness." It also states: "All sudden stiffness and rigidity are attributed to wind." The treatise says: "In Taiyang disease, excessive sweating leads to spasms." In fact, all six qi can cause spasms, not just dampness; spasms can occur in all six meridians, not exclusively in the Taiyang meridian. Generally, the posterior aspect of the body belongs to the Taiyang meridian. Any case of stiff and rigid neck and head, tightness and stiffness in the neck and back (*jǐn jǐn*), rigid spine with opisthotonos, waist feeling as if broken, thighs unable to bend, and the popliteal fossa feeling bound or knotted, are all Taiyang spasms. The anterior aspect of the body belongs to the Yangming meridian. Any case of shaking of the head and face, trismus (locked jaw) and teeth grinding, pain in the supraclavicular fossa (Jianjing/Quepen area), and cramping of the feet, are all Yangming spasms. The lateral aspect of the body belongs to the Shaoyang meridian. Any case of facial paralysis (deviation of mouth and eyes), traction and convulsions of the hands and feet, stiffness and tension in both hypochondria, and hemiplegia, are all Shaoyang spasms. As for abdominal stiffness and tension, followed by cramping of the four limbs after vomiting and diarrhea, this may well be a Taoyin spasm. Aversion to cold, curling up and lying down, using the buttocks instead of the heels, bending the spine forward so that the head is lower than the back, being able to bend but not straighten, may well be a Shaoyin spasm. Retraction of the testicles, downward flow of the Zongjin (converging sinews), urgency in the lower abdomen, cramping in the genitalia, and stiffness and tension in the knees and shins, may well be a Jueyin spasm. Broadly speaking, "spasm" is named according to its manifestations, and the cause of spasm is sinew tension. Therefore, any disease of the sinews of the six meridians can be called spasm. Those caused by wind-cold must present with fever, aversion to cold, and anhidrosis, with a floating-tight pulse, and symptoms of body rigidity and trismus. This corresponds to the classic statement: "All stiffness and rigidity diseases are attributed to wind." Because the condition is vigorous and urgent, it is named Gang Jing (Yang Spasm). Those caused by wind-damp present with fever, sweating, no aversion to cold, and a floating-slow pulse, with symptoms of neck stiffness and tightness (*jǐn jǐn*) but without full-body rigidity. This corresponds to the classic statement: "All spasms with neck stiffness are attributed to dampness." Because the condition is soft and weak, it is named Rou Jing (Yin Spasm). If spasm is caused by erroneous sweating leading to loss of Yang, exhaustion of fluids, and inability of fluids to nourish the sinews, this is what the treatise refers to as: "Taiyang disease, excessive sweating leads to spasm." This is neither due to dampness nor wind, but due to dryness. Generally, spasm is not a primary disease at its onset but often complicates other diseases, such as postpartum blood loss in women or traumatic injuries, all of which can cause spasm. Currently, those suffering from this are all attributed to wind, which is certainly not an accurate conclusion. Students should carefully examine the causes of wind, cold, damp, dryness, interior, exterior, deficiency, and excess within the syndromes and treat them accordingly to avoid errors. Do not simply attribute everything to wind.
Taiyang disease caused by Cold Damage involves three types: Spasm (Jing), Dampness (Shi), and Heatstroke/Yu (Ye). These should be discussed separately because they resemble Cold Damage, hence their appearance here.
[Note] The four characters "caused by Cold Damage" are meaningless and are likely interpolations.
[Annotation] Cold Damage is merely one type of disease in the Taiyang meridian, not implying that the Taiyang meridian only suffers from Cold Damage. Generally, pathogenic factors of the six qi invading humans do so through the exterior of the Taiyang. Spasm is Wind Pathogen; Dampness is Damp Pathogen; Yu is Summerheat Pathogen. Although diseases of wind, cold, summerheat, and dampness all fall under Taiyang, the transmission and progression of Spasm, Dampness, and Yu differ from Cold Damage, hence they should be discussed separately.
[Collected Notes] Fang Youzhi said: Spasm, Dampness, and Yu are all variations of wind-cold. Once they become variation syndromes, separate discussions should be established. However, since they originate from wind-cold and belong to Taiyang, there remains doubt regarding their similarity to wind-cold, so they should be differentiated together.
If a patient has fever, cold feet, stiff and rigid neck, aversion to cold, occasional fever and redness of the head and face, red eye vessels, isolated shaking of the head and face, sudden trismus, and opisthotonos (backward arching of the back), this is Spasm Disease.
[Annotation] Fever and aversion to cold are Taiyang syndromes. Stiff neck, red face, and red eyes are Yangming syndromes. Head fever indicates Yang Qi stagnating upward; foot cold indicates Yin Qi coagulating downward. The Taiyang meridian runs along the back to the head; the Yangming sinews run up to flank the mouth. When wind-cold lodges in these two meridians, symptoms such as head shaking, trismus, opisthotonos, and stiffness occur, hence named Spasm Disease.
[Collected Notes] Fang Youzhi said: This lists the complete symptoms of spasm. Body heat, head heat, red face, and red eye vessels indicate Yang pathogen manifesting in Yang aspects. Foot cold indicates Yin pathogen reversing into Yin aspects. Isolated head and face shaking indicates wind moving in Yang and acting upward. "Sudden" means abruptly. "Trismus" means closure of the mouth due to cold, indicating abrupt locking of lips and teeth, preventing eating. Opisthotonos occurs because the Taiyang meridian flanks the back; cold causes sinew tension and contraction, while heat causes sinew relaxation and extension. Gang Jing and Rou Jing each show only one aspect of the syndrome; only when both wind and cold are present do all symptoms appear fully.
Zheng Zhongguang said: This generally discusses how spasm affects meridians and acupoints, injuring both Qi and Blood, resulting in stiffness and opisthotonos. The presence of both wind and damp makes this the complete syndrome of spasm.
In Taiyang disease, if there is fever and the pulse is deep and fine, it is named Spasm.
[Annotation] In Taiyang disease with fever, the pulse should be floating and large. If the pulse is deep and fine, it involves Shaoyin. Why is fever with a deep-fine pulse named Spasm? Because the patient already has a spasm syndrome presenting with a deep-fine pulse, it cannot be named the pulse of Taiyang or Shaoyin Cold Damage. It should be named the pulse of Taiyang Wind-Damp Spasm. Wind pathogen stagnating in Yang causes fever. Damp pathogen coagulating in Yin causes a deep-fine pulse. This continues the meaning of the previous clause regarding spasm obtaining a deep-fine pulse; it does not mean that any Taiyang fever with a deep-fine pulse is automatically named Spasm.
[Collected Notes] Fang Youzhi said: Fever indicates Taiyang disease is unresolved. Deep indicates Cold. Fine indicates Damp.
Cheng Zhi said: A deep-fine pulse typically warrants treating the Interior, but spasm is a disease of dryness and heat, hence *Jinkui Yaolue* states it is difficult to treat. One should not lightly equate it with the example of Taiyang fever with a reversed deep pulse.
Zhang Lu said: Fever usually presents with a floating-rapid pulse. A reversed deep-fine pulse indicates evil wind is adhered to by dampness. Thus, although the body is hot, the pulse cannot be floating-rapid. This is a Yang syndrome showing a Yin pulse, hence *Jinkui Yaolue* points out it is difficult to treat.
Cheng Yingmao said: Spasm has common and unique features. It is named by its unique features. However, when the pulse is in Taiyang, there are unique features without common ones. Combining symptoms like head shaking, trismus, and opisthotonos with a deep-fine pulse, even if there are Taiyang fever symptoms, it will not be confused with Cold Damage, allowing the name Spasm to be confirmed.
In Taiyang disease, if there is fever, anhidrosis, and reversed aversion to cold, it is named Gang Jing (Yang Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is named Rou Jing (Yin Spasm).
[Note] The character "reversed" (fan) in "reversed aversion to cold" is an interpolation. Gang Jing should present with aversion to cold; it is not reversed.
[Annotation] Since spasm belongs to Taiyang, it should be verified by Taiyang deficiency and excess. Therefore: Taiyang disease with fever, anhidrosis, and aversion to cold is Excess Evil, named Gang Jing; fever with sweating and no aversion to cold is Deficiency Evil, named Rou Jing. This elaborates on the deficiency and excess of spasm mentioned in the previous two clauses. It does not mean that any Taiyang fever with anhidrosis/aversion to cold or fever/sweating/no aversion to cold is automatically named Gang or Rou Spasm.
[Collected Notes] Cheng Zhi said: Taiyang disease with fever, anhidrosis, and aversion to cold is Cold Damage; fever, sweating, and aversion to wind is Wind Strike; fever, sweating, and no aversion to cold is Warm-Heat disease. Because the syndrome includes stiff neck and even opisthotonos, it is not called Cold Damage, Wind Strike, or Warm-Heat disease, but Spasm.
Zhang Lu said: *Jinkui Yaolue* states: "Taiyang disease with anhidrosis, yet urine is scanty, Qi rushes up to the chest, trismus prevents speech, intending to develop Gang Jing, Ge Gen Tang governs." This clarifies the meaning of this clause and supplements its treatment. Anhidrosis with scanty urine occurs because heat from Taiyang and Yangming gathers in the chest, damaging the clear descending Qi of the Lung, preventing internal and external circulation. It also states: "Taiyang disease, syndromes are complete, body is stiff and rigid (*jin jin*), yet pulse is reversed deep and slow, this is Spasm, Gua Lou Gui Zhi Tang governs." This also clarifies the meaning and supplements treatment. The "complete syndromes" refer to fever and sweating detailed in *Jinkui Yaolue*, so no need to repeat.
In Taiyang disease, if the neck and back are stiff and rigid (*jin jin*), with anhidrosis and aversion to wind, Ge Gen Tang governs.
[Annotation] Here, symptoms and pulse are briefly omitted, focusing solely on the stiff neck of spasm to illustrate treatment. The Taiyang meridian descends to the neck, runs along the shoulders, and flanks the spine; the Yangming meridian runs along the throat, enters the supraclavicular fossa, pierces the diaphragm, and descends to the inner breast. Taiyang governs the posterior, connecting anteriorly with Yangming; Yangming governs the anterior, connecting posteriorly with Taiyang. Now, evil obstructs these two meridians, causing stiffness and rigidity. Taiyang stiffness is limited to the neck; Spasm stiffness prevents flexion and extension, involving the neck, chest, and back, hence "neck and back stiff and rigid (*jin jin*)." Anhidrosis and aversion to wind indicate Excess Evil; Ge Gen Tang should be used to release it. This is Gui Zhi Tang plus Ma Huang and Ge Gen, resolving evil in both Taiyang and Yangming.
[Collected Notes] Fang Youzhi said: *Jin jin* describes a bird with short wings stretching its neck. It depicts patients whose necks are diseased, unable to flex or extend freely.
In Taiyang disease, if the neck and back are stiff and rigid (*jin jin*), with reversed sweating and aversion to wind, Gui Zhi Jia Ge Gen Tang governs.
[Annotation] Taiyang disease with neck/back stiffness, anhidrosis, and aversion to wind is Excess Evil. Now, with reversed sweating and aversion to wind, it is Deficiency Evil. Gui Zhi Jia Ge Gen Tang should be used to resolve Wind in Taiyang and induce sweat in Yangming.
[Collected Notes] Wang Hu said: Taiyang disease with stiff neck and *jin jin* sensation means the neck cannot relax. The neck's meridian belongs to Yangming. With neck/back *jin jin*, the state should be anhidrotic. Now, with reversed sweating and aversion to wind, per Zhang Zhongjing's method: Taiyang disease with sweating and aversion to wind is governed by Gui Zhi Tang. Due to the *jin jin* sensation, Ge Gen is added to Gui Zhi Tang to simultaneously dispel Wind in the Yangming meridian.
Gui Zhi Jia Ge Gen Tang Formula
Add 3 liang of Ge Gen (Puerariae Radix) to Gui Zhi Tang. Follow the rest of the Gui Zhi Tang preparation method.
In Taiyang disease, excessive sweating leads to spasm.
[Annotation] The above discussions on spasm involve external Wind, Cold, and Damp. If Taiyang disease involves excessive sweating, leading to massive fluid loss, insecure exterior Qi, and pathogenic wind entering via deficiency, causing spasm, this is due to internal deficiency. It cannot be treated as Gang or Rou Spasm. Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction plus Prepared Aconite Root) should be used, primarily to secure the exterior and dispel wind. By analogy, any disease with excessive sweating, or new postpartum blood loss, leading to this syndrome, is similar.
[Collected Notes] Cheng Yingmao said: From this, we know that many cases arise from loss of fluids and blood, leading to cold and dryness via deficiency. Yang Qi softens and nourishes the sinews. Excessive sweating loses Yang and damages the blood in the meridians.
Patients with Dampness disease experience whole-body pain, fever, and a body color resembling smoked yellow.
[Annotation] "Dampness patient" refers to one suffering from Dampness. Dampness disease, whether externally contracted or internally generated, causes whole-body pain or fever and jaundice. If both interior and exterior are involved, there is whole-body pain, fever, and smoked-yellow discoloration. Smoked yellow indicates severe Dampness causing jaundice, belonging to Spleen stasis-dampness, hence dark like smoke. This differs from Cold Damage heat-excess jaundice, which belongs to Yangming stagnant heat, appearing bright orange.
[Collected Notes] Zhang Lu said: Jaundice in Dampness must be differentiated by Yin/Yang and Interior/Exterior. Yang-Damp in Interior: Yin Chen Hao Tang; in Exterior: Ma Huang Lian Qiao Chi Xiao Dou Tang. Yin-Damp in Interior: Bai Zhu Fu Zi Tang; in Exterior: Ma Huang Bai Zhu Tang (this is Yin-Damp in Exterior causing jaundice). *Jinkui Yaolue* states: "Dampness patient with bodily irritability and pain, Ma Huang Jia Zhu Tang may be given." Cold combined with Damp should not induce heavy sweating, hence Bai Zhu is added. Ma Huang with Bai Zhu prevents sudden sweating; Bai Zhu with Ma Huang promotes dispersion of Damp stagnation.
A Dampness patient experiences body pain, fever, yellow face, wheezing, headache, nasal congestion, and irritability. The pulse is large, digestion is normal, and the abdomen is peaceful. The disease is Cold-Damp in the head, causing nasal congestion. Inserting medicine into the nose cures it.
[Annotation] This elaborates on the previous clause, detailing symptoms and pulse to distinguish treatment. Body pain, fever, yellow face, and wheezing indicate internal and external Dampness. External treatment: Qiang Huo Sheng Shi Tang; Internal treatment: Yin Chen Wu Ling San; severe wheezing: Da Xian Xiong Wan. If accompanied by headache, nasal congestion, and irritability with a large pulse, resembling Cold Damage, but with a peaceful interior and normal appetite, it is not Cold Damage. Sweating is contraindicated. The Damp-Evil is in the head, causing headache and congestion. Only inserting medicine into the nose is suitable, extracting yellow fluid via nasal discharge for cure. The inserted medicine is similar to Gua Di San (Melon Dispersant).
[Collected Notes] Zheng Zhongguang said: Body pain, fever, yellow face, wheezing, headache, and nasal congestion indicate Cold-Damp lodging in the Upper Jiao. The Classic states: "Due to Dampness, the head feels wrapped." Using Gua Di San insufflated into the nose follows the principle of evacuating pathogens from above.
In Taiyang disease, joint pain with irritability and a deep-fine pulse is named Shi Bi (Dampness Bi). In Shi Bi, the patient has difficulty urinating and loose stools. The treatment is to promote urination.
[Annotation] Dampness patients typically have floating-fine pulses, indicating exterior Dampness to be released by sweating. Now, Taiyang disease with joint pain, irritability, difficulty urinating, loose stools, and a deep-fine pulse indicates interior Dampness excess causing Shi Bi obstruction. Therefore, promoting urination is the correct treatment to drain Dampness via the bladder.
[Collected Notes] Cheng Wuji said: Excess Dampness causes loose stools. Difficulty urinating and loose stools indicate Dampness flowing inward. Promoting urination excretes abdominal Dampness. Ancient saying: "Treating Dampness without promoting urination is incorrect treatment."
Fang Youzhi said: This discusses Dampness entering the Interior. Joint pain results from Cold-Damp penetrating inward. Deep-fine pulse reflects this. "Bi" denotes pain. Difficulty urinating and loose stools indicate water failing to follow its proper course. Promoting urination guides it back to the proper path.
Zhang Zicong said: Joints are major connections of the waist, back, elbows, and knees, governed by large sinews, distinct from bone joints. Dampness flowing into joints disrupts large sinews, causing pain and obstruction. Dampness injuring Taiyang causes sinew stagnation, named Shi Bi. Promoting urination unblocks water passages, removes Dampness, and harmonizes sinews.
A Dampness patient sweats only on the head, has a stiff back, and desires covering with blankets or sitting near fire. If purged prematurely, hiccups, chest fullness, difficulty urinating, and a tongue coating resembling moss appear. This is due to Heat in the Dan Tian and Cold in the Chest, thirst wanting water but unable to drink, and oral dryness/irritability.
[Annotation] Head-only sweating in Dampness is due to Dampness steaming upward, not Yangming Heat trapped inside. Back stiffness in Dampness is heavy rigidity from Dampness stagnation, not the cramping of Spasm. Desiring warmth indicates internal Cold generated by severe Dampness, not external aversion to cold. Erroneously purging based on mistaken diagnosis of Yangming Heat leads to Cold-Damp invading the Chest (fullness) and Stomach (hiccups). Untransformed Cold-Damp causes difficulty urinating. Cold in the Chest causes a slippery-white tongue coating. Heat in the Dan Tian causes oral dryness/thirst. Thirst without desire to drink is due to Cold-Damp in the Chest.
[Collected Notes] Cheng Wuji said: Cold Damage presents with anhidrosis. Dampness patients may sweat but not over the whole body, hence only head sweating.
Cheng Yingxuan said: Thirst wanting water resembles Heat, but inability to drink distinguishes it. It is merely oral dryness/irritability, not true Chest dryness/irritability. The syndrome appears similar, but the disease is different.
If a Dampness patient is purged, sweating on the forehead, slight wheezing, and free urination indicate death. If diarrhea persists uncontrollably, it also indicates death.
[Annotation] This continues the adverse effects of erroneous purging in Dampness. Premature purging leads to chest fullness, hiccups, difficulty urinating, tongue coating, and thirst without desire to drink—already adverse but potentially treatable. Post-purging persistent forehead sweating and wheezing indicate Yang collapsing upward. Free urination and persistent diarrhea indicate Yin collapsing downward. Separation of Yin and Yang leads to death.
[Collected Notes] Fang Youzhi said: Treating Dampness requires promoting urination, yet free urination indicates death. Why? Mis-treatment causes scattering of Yin and Yang.
Cheng Zhi said: Dampness invades Yin first. Dampness treatments in this chapter often use warming and dispersing methods to assist Yang. Erroneous purging leads to Yang deficiency and Yin excess, which is incurable. Forehead sweating and slight wheezing indicate deficient Yang attempting to collapse upward. Incontinence indicates abundant Yin attempting to collapse downward. Separation of Yin and Yang leads to death.
A patient with whole-body pain and fever, worsening in the late afternoon, is named Feng Shi (Wind-Damp). This disease results from sweating while exposed to wind, or prolonged exposure to cold/damp.
[Annotation] "Patient" refers to one with whole-body pain. Both Dampness and Wind-Damp cause whole-body pain. However, Dampness pain is heavy and immovable, while Wind-Damp pain is light and restricts flexion/extension. Regarding fever: Dampness fever varies little day and night, whereas Wind-Damp fever worsens significantly in the late afternoon. This results from sweating into wind or prolonged damp-cold exposure.
[Collected Notes] Zhang Zicong said: Sweating into wind causes Wind-Damp; prolonged cold exposure causes Cold-Damp.
Zhang Xiqiu said: Fever worsening in the late afternoon occurs because Yang Qi declines and Yin Qi rises at this time. Dampness is a Yin pathogen, so it exacerbates during its prosperous time (Yin hours).
Q: Wind-Damp binding causes whole-body pain. By law, sweating should resolve it. If it rains continuously, and the doctor suggests sweating, why does the patient not recover after sweating?
A: Heavy sweating expels Wind but leaves Dampness behind, hence no recovery. To treat Wind-Damp, induce only slight, continuous sweating, so both Wind and Damp are expelled.
[Annotation] This details that Wind-Damp binding causing pain cannot be purged, nor should sweating be misapplied. Wind is Yang Evil, Damp is Yin Evil. Binding injures both Yin and Yang, causing whole-body pain. Sweating is indicated. However, during rainy weather, Dampness is abundant. Heavy sweating expels Wind but fails to remove Dampness, hence no recovery. Sweating heavily during high Dampness is improper technique. For Wind-Damp, wait for clear weather and induce only slight, continuous sweating ("like wanting to sweat"), so both Wind and Damp are expelled, and the disease resolves.
[Collected Notes] Fang Youzhi said: Continuous rain means Dampness remains, necessitating sweating. However, since Wind-Damp originates from sweating into wind, heavy sweating worsens Dampness. Slight, continuous sweating dissipates Dampness and scatters Wind. This is the subtle mechanism of sweating; later practitioners advocating heavy sweating are far off track.
Zhang Lu said: Wind-Damp binding requires sweating to resolve. Use Gui Zhi Jia Zhu Tang to induce slight evaporation, harmonizing Interior and Exterior, expelling both Wind and Damp. Just as Dampness patients with bodily irritability...