夫风之为病，当半身不遂；或但臂不遂者，此为痹。脉微而数，中风使然。
【注】风病，《内经》论之详矣。但往往与痹合论，后人惑之，故仲景复言之曰∶风
之为病，当半身不遂，即经所谓偏枯也；或但两臂不遂者，非中风也，即痹病也。盖痹
为阴病，脉多沉涩，风为阳病，脉多浮缓，今脉微而数，中风使然。其脉微者，正气虚也，
数者，邪气胜也。故病中凤之人，因虚而召风者，未有不见微弱之脉者也；因热而生风
者，未有不见数急之脉者也。
【集注】沈明宗曰∶此分中风与痹也。风之为病，非伤于卫，即侵于荣，故当半身不
遂，谓半身之气伤而不用也。若但臂不遂，此为痹；痹者，闭也，谓一节之气，闭而不仁
也。于是诊之于脉，必微而数。微者，阳之微也；数者，风之数也。此中风使然，谓风
乘虚入，而后使半身不遂也。
寸口脉浮而紧，紧则为寒，浮则为虚，寒虚相搏，邪在皮肤。浮者血虚，络脉空虚，贼
邪不泻，或左或右；邪气反缓，正气即急，正气引邪， 僻不遂。邪在于络，肌肤不仁；邪
在于经，即重不胜；邪入于腑，即不识人；邪入于脏，舌则难言，口吐涎。
【按】“寸口脉浮而紧，紧则为寒，浮则为虚，寒虚相搏，邪在皮肤”，此五句与本条
文义不属，当在后条之首。后条“寸口脉迟而缓，迟则为寒，缓则为虚；荣缓则为亡血，
卫缓则为中风；邪气中经”，此六句亦与本条文义不属，当在此条之首，文气相属，必是
错简。其中有“浮者血虚”一句，必是衍文。浮则为虚，寒虚相搏，二“虚”字当是
“风”字，是传写之讹。
【注】中风虚邪之脉，皆当浮缓，以浮主风，缓主虚也，荣分见缓，经络之血亡也；卫
分见缓，经络之气空也。盖邪风中人，未有不由经络血气空虚而中也。贼邪不泻，留而
不去，在左则病左，在右则病右，浅则病经络，深则病脏腑。邪在于络，则为病肌肤，麻
木不仁也；邪在于经，则为病身肢偏重， 斜不遂也；邪入于腑，则为病九窍闭不识人
也；邪入于脏，则为病舌喑难言，唇缓吐涎也。
寸口脉迟而缓，迟则为寒，缓则为虚；荣缓则为亡血，卫缓则为中风；邪气中经，则
身痒而瘾疹；心气不足，邪气入中，则胸满而气短。
【按】寸口脉迟而缓，迟则为寒，二“迟”字当是“浮”字，“寒”字当是“风”字，
始得文义了然，且迟、缓二脉不能并见，必是传写之讹。
【注】上条发明虚邪贼风之为病，此条发明荣卫风寒之为病也。寸口脉浮而紧，紧则
为寒，浮则为风，风寒之邪，相搏于表，郁于皮肤经络，则令人身痒而发瘾疹也。若其
人心气不足，谓心胸之气不足，而邪气入心胸，故令人胸满而短气也。
寸口脉沉而弱，沉即主骨，弱即主筋，沉即为肾，弱即为肝，汗出入水中，如水伤心，
历节黄汗出，故曰历节。
【注】寸口脉沉而弱，肝肾之气不足也。盖肝主筋，肾主骨，肝肾不足，筋骨痿缓，一
为风寒湿邪所乘，即病筋骨关节交会之处。夫人汗出时，腠理开，风尚易入，况入水中浴，
焉得不致寒耶！水伤心，心主汗，汗郁成湿，故风胜为历节，湿胜为黄汗出也。
【集注】赵良曰∶肾主水，骨与之合，故脉沉者，病在骨也。肝藏血，筋与之合，血
虚则脉弱，故病在筋也。心主汗，汗出入水，其汗为水所阻，水汗相搏，聚以成湿，久变
为热，湿热相蒸，是以历节发出黄汗也。
味酸则伤筋，筋伤则缓，名曰泄；咸则伤骨，骨伤则痿，名曰枯。枯泄相搏，名曰
断泄。荣气不通，卫不独行，荣卫俱微，三焦无所御，四属断绝，身体羸瘦。独足肿大，
黄汗出，胫冷。假令发热，便为历节也。病历节，不可屈伸，疼痛，乌头汤主之。
【按】名曰断泄之“泄”字，当是“绝”字，始与下文相属，必是传写之讹。
【注】此详申上条，互发其义，以明其治也。历节之病，属肝、肾虚。肝、肾不足于
内，筋骨不荣于外，客邪始得乘之而为是病也。究其所以致虚之由，不止一端也。如饮
食之味过伤，日久亦为是病也。味过于酸则
伤肝，肝伤则筋伤，筋伤则缓不收持，名曰泄也。味过于咸则伤肾，伤肾则骨伤，骨伤
则枯不能立，名曰枯也。枯泄相搏，名曰断绝。断绝者，即荣气不通，卫不独行，荣卫
俱虚，三焦失所，四维断绝，身体羸瘦也。若独足肿、胫冷，寒胜凝于下也；黄汗自出，湿
胜发于中也。假令发热，则属风，便为历节也。病历节者，历节疼痛不能屈伸也，故主
之以乌头汤，通荣行卫，并驱风寒湿之邪也。以蜜制乌头，亦缓毒法耳！
【集注】沈明宗曰∶《金匮》补示饮食内伤，脾、胃、心、肺、肝、肾致病，名曰历
节。然出脉证，皆因饮酒，湿壅内热而招外邪合病。谓饮酒汗出当风所致，即邪之所凑，
其气必虚是矣。或外风而合内湿，外寒而合内湿，内寒而招外湿，内热而招外湿，此等
关头，不可不晓。又当分别风、寒、湿气，偏多偏少，而处发表、温中、行阳、补虚。散
邪之法，故治此当与《灵》、《素》、《金匮》合看则备，若泛用成方，则非良工所为之事也。
乌头汤方
麻黄 芍药 黄 （各三两） 甘草（炙，三两） 川乌（ 咀，以蜜二升，煎取一升，即出
乌头，五枚）
上五味， 咀四味，以水三升，煮取一升，去滓，内蜜煎中，更煎之，服七合；不
知，尽服之。
诸肢节疼痛，身体 赢，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之。
【按】温温当是“ ”。
【注】历节之证，诸肢节疼痛也。身体 羸，即上条身体羸瘦，甚言其瘦之甚也。脚
肿如脱，即上条独足肿大，甚言其肿之甚也。头眩短气，阳气虚也。 欲吐，寒邪盛也。
而不用乌头汤者，因无黄汗之湿胜也。用桂枝芍药知母汤者，以壮阳气，散寒湿为急也，
故方中桂枝芍药倍于麻黄、防风，大加白术、附子，其意专在温行阳气，次在散寒湿也。多
用生姜，因其欲吐；更佐知母、甘草者，以其剂过辛热，监制之也。
【集注】李 曰∶此历节病，由气血两虚而致者也。风湿相搏，四肢节节皆痛，即历
节病也。身体 赢，邪胜正衰也。脚肿如脱，气绝于下也。头眩短气，气虚于上也。
欲吐，气逆于中也。此三焦气血两虚，故是汤主祛风湿而温气血。
桂枝芍药知母汤方
桂枝（四两） 芍药（三两） 甘草（二两） 麻黄（二两） 生姜（五两） 白术（五
两） 知母（四两） 防风（二两） 附子（炮，二枚）
上九味，以水七升，煮取二升，温服七合，日三服。
跗阳脉浮而滑，滑则谷气实，浮则汗自出。
【注】跗阳胃脉也。谷气，胃气也。浮则为风外薄，滑则为胃实热，风热蒸于肌腠之
间，故汗自出。此发明黄汗，亦有因风热之义也。
少阴脉浮而弱，弱则血不足，浮则为风，风血相搏，即疼痛如掣。
【注】少阴心脉也，心主血。心脉浮而弱，弱则为血虚，浮则为风邪，风血相搏，而交
争于经络之间，故疼痛牵引如掣也。此发明历节亦有因血虚之义也。
【集注】李 曰∶风在血中，则剽悍劲切，无所不至，为风血相搏。盖血主荣养筋骨者
也，若风以燥之，则血愈耗而筋骨失其所养，故疼痛如掣。昔人曰∶治风先养血，血生风
自灭。此其治也。
盛人脉涩小，短气，自汗出，历节疼，不可屈伸，此皆饮酒汗出当风所致。
【注】盛人脉盛，不应涩小；盛人气长，不应气短。今盛人脉涩小，短气，是形气脉
息不合也。审其证，自汗出，历节疼不可屈伸，询其由，得之于饮酒汗出当风也。此又
发明历节不止一端之义也。
【集注】徐彬曰∶盛人，肥人也。肥人湿多，脉得涩小，此痹象也。于是气为湿所搏
而短，因风作使而自汗，气血为邪所痹而疼痛不可屈伸，然肥人固多湿，何以脉骤涩小，
岂非酒湿困之乎？何以疼痛有加而汗出不已，岂非湿而挟风乎？脉证不同，因风则一，故
曰∶此皆饮酒汗出当风所致。
风邪致病，通常表现为半身不遂；如果仅仅是手臂不能活动，这属于痹证。脉象微而数，这是中风所致。
【注】关于风病，《黄帝内经》论述得非常详尽。但往往将风病与痹证合并讨论，导致后人产生困惑，所以张仲景再次阐明说：风邪致病，应当出现半身不遂，这就是《内经》所说的“偏枯”；如果只是双臂不能活动，这不是中风，而是痹病。大概痹证属于阴病，脉象多沉涩；风证属于阳病，脉象多浮缓。现在脉象微而数，是中风造成的。脉象微，说明正气虚弱；脉象数，说明邪气亢盛。因此，因虚招致风邪的人，没有不见微弱脉象的；因热而生风的人，没有不见数急脉象的。
【集注】沈明宗说：这一段区分了中风与痹证。风邪致病，如果不是伤及卫分，就是侵入营分，所以应当出现半身不遂，意思是半身的气机受损而不能使用。如果只是手臂不能活动，这是痹证；痹，就是闭塞的意思，指某一部位的气机闭塞而不感觉知觉。于是诊察其脉象，必定是微而数。微，是阳气微弱；数，是风邪频数。这是中风所致，意思是风邪乘虚而入，从而导致半身不遂。
寸口脉浮而紧，紧脉主寒，浮脉主虚，寒与虚相互搏结，邪气在皮肤。浮脉表示血虚，络脉空虚，贼邪无法排泄，或者在左边，或者在右边；邪气所在的一侧肌肉松弛，正气所在的一侧拘急，正气牵引邪气，导致口眼歪斜、肢体不能随意运动。邪气在络脉，肌肤麻木不仁；邪气在经脉，身体沉重难以抬举；邪气进入腑，就不能识别他人；邪气进入脏，舌头僵硬难以言语，口吐涎沫。
【按】“寸口脉浮而紧，紧则为寒，浮则为虚，寒虚相搏，邪在皮肤”，这五句与本条文义不连贯，应当放在后一条文的开头。后一条文“寸口脉迟而缓，迟则为寒，缓则为虚；荣缓则为亡血，卫缓则为中风；邪气中经”，这六句也与本条文义不连贯，应当放在本条文的开头，这样文气才相连属，必然是竹简错乱所致。其中有一句“浮者血虚”，必定是衍文（多余的文字）。“浮则为虚，寒虚相搏”中的两个“虚”字，应当是“风”字，这是传抄之误。
【注】中风虚邪的脉象，都应当是浮缓，因为浮主风，缓主虚。营分见到缓脉，说明经络之血亏损；卫分见到缓脉，说明经络之气空虚。大凡风邪中人，没有不是通过经络气血空虚而入侵的。贼邪不能排泄，停留不去，在左边则病在左，在右边则病在右，浅则病在经络，深则病在脏腑。邪气在络，则病在肌肤，麻木不仁；邪气在经，则病在身肢偏重，口眼歪斜不能随意运动；邪气入腑，则病在九窍闭塞、不识人；邪气入脏，则病在舌暗难言，唇缓流涎。
寸口脉迟而缓，迟脉主寒，缓脉主虚；营分缓则血亏，卫分缓则中风；邪气中于经脉，则身体瘙痒并出现瘾疹；心气不足，邪气入中，则胸满且气短。
【按】寸口脉迟而缓，迟则为寒，这两个“迟”字应当是“浮”字，“寒”字应当是“风”字，这样才能文义通晓，而且迟、缓两种脉象不能同时出现，必定是传抄之误。
【注】上一条文阐明了虚邪贼风致病的情况，这一条文阐明了营卫风寒致病的情况。寸口脉浮而紧，紧则为寒，浮则为风，风寒之邪，相搏于体表，郁积在皮肤经络，就会使人身体瘙痒并发生瘾疹。如果其人心气不足，即心胸之气不足，而邪气侵入心胸，所以使人胸满且气短。
寸口脉沉而弱，沉脉主骨，弱脉主筋，沉脉对应肾，弱脉对应肝。出汗时进入水中，水邪伤害心脏，历节病出现黄汗，所以称为历节。
【注】寸口脉沉而弱，是肝肾之气不足。大概肝主筋，肾主骨，肝肾不足，筋骨痿软弛缓，一旦受到风寒湿邪侵袭，就会在筋骨关节交会之处发病。人在出汗时，腠理开泄，风邪容易侵入，何况在水中沐浴，怎能不导致受寒呢！水伤心，心主汗，汗液郁结成湿，所以风胜则发为历节，湿胜则发为黄汗。
【集注】赵良说：肾主水，与骨相合，所以脉沉，病在骨。肝藏血，与筋相合，血虚则脉弱，所以病在筋。心主汗，出汗时入水，汗液被水所阻，水汗相搏，聚而成湿，久则变为热，湿热蒸腾，所以历节发出黄汗。
味酸则伤筋，筋受伤则弛缓，称为“泄”；味咸则伤骨，骨受伤则痿弱，称为“枯”。枯和泄相互搏结，称为“断泄”。营气不通，卫气不能独行，营卫俱微，三焦无所统御，四肢失去营养而断绝，身体消瘦。唯独脚部肿大，小腿发冷。假如发热，就是历节病。患历节病，关节不可屈伸，疼痛，用乌头汤主治。
【按】“名曰断泄”的“泄”字，应当是“绝”字，才能与下文相连接，必定是传抄之误。
【注】这一段详细申述上一条文，互相发挥其义，以阐明治疗方法。历节病，属于肝、肾虚。肝、肾在内不足，筋骨在外得不到滋养，外邪才得以乘虚而入导致此病。追究其导致虚损的原因，不止一端。如饮食滋味过度损伤，日久也会得此病。味道过于酸则伤肝，肝伤则筋伤，筋伤则弛缓不能持握，称为“泄”。味道过于咸则伤肾，伤肾则骨伤，骨伤则枯槁不能站立，称为“枯”。枯和泄相互搏结，称为“断绝”。断绝，就是营气不通，卫气不能独行，营卫俱虚，三焦失所，四肢断绝，身体消瘦。如果只有脚肿、小腿冷，是寒胜凝滞于下；黄汗自出，是湿胜发于中。假如发热，则属风，就是历节病。患历节病，关节疼痛不能屈伸，所以用乌头汤主治，以通行营卫，并驱除风寒湿之邪。用蜂蜜炮制乌头，也是减缓其毒性的方法罢了！
【集注】沈明宗说：《金匮要略》补充说明了饮食内伤，脾、胃、心、肺、肝、肾致病，称为历节。然而出现的脉证，都是因为饮酒，湿壅内热而招致外邪合病。说是饮酒出汗后当风所致，也就是“邪之所凑，其气必虚”的道理。或者是外风结合内湿，外寒结合内湿，内寒招致外湿，内热招致外湿，这些关键关头，不可不明白。又应当分别风、寒、湿气，偏多偏少，而采取发表、温中、行阳、补虚、散邪的方法，所以治疗此病应当与《灵枢》、《素问》、《金匮要略》合看才完备，如果泛用成方，就不是高明医生所做的事。
乌头汤方
麻黄、芍药、黄芪（各三两）、甘草（炙，三两）、川乌（切碎，用蜜二升，煎取一升，取出乌头，五枚）
以上五味药，将前四味切碎，用水三升，煮取一升，去渣，加入蜜汁中再煎，服七合；若无效，全部服下。
各种肢节疼痛，身体消瘦，脚肿得像脱落一样，头晕气短，心中烦闷想吐，用桂枝芍药知母汤主治。
【按】“温温”应当是“愠愠”（心中烦闷）。
【注】历节的症状，是各种肢节疼痛。身体消瘦，就是上一条说的身体羸瘦，极言其瘦的程度。脚肿得像脱落一样，就是上一条说的独足肿大，极言其肿的程度。头晕气短，是阳气虚。心中烦闷想吐，是寒邪盛。之所以不用乌头汤，是因为没有黄汗这种湿胜的情况。用桂枝芍药知母汤，是为了壮阳气，急散寒湿，所以方中桂枝、芍药的用量倍于麻黄、防风，大量加入白术、附子，其意图专在温行阳气，其次在散寒湿。多用生姜，是因为患者想吐；再加知母、甘草，是因为药剂过于辛热，用来制约它。
【集注】李说：这个历节病，是由气血两虚导致的。风湿相搏，四肢关节都痛，就是历节病。身体消瘦，是邪胜正衰。脚肿像脱落，是气绝于下。头晕气短，是气虚于上。心中烦闷想吐，是气逆于中。这是三焦气血两虚，所以此汤主要祛风湿而温气血。
桂枝芍药知母汤方
桂枝（四两）、芍药（三两）、甘草（二两）、麻黄（二两）、生姜（五两）、白术（五两）、知母（四两）、防风（二两）、附子（炮，二枚）
以上九味药，用水七升，煮取二升，温服七合，每日三次。
跗阳脉浮而滑，滑脉表示谷气实，浮脉表示汗自出。
【注】跗阳是胃脉。谷气，就是胃气。浮则是风邪外迫，滑则是胃实热，风热蒸腾于肌腠之间，所以汗自出。这里阐明了黄汗也有因风热的含义。
少阴脉浮而弱，弱脉表示血不足，浮脉表示有风，风与血相搏，就会出现牵掣样疼痛。
【注】少阴是心脉，心主血。心脉浮而弱，弱则是血虚，浮则是风邪，风与血相搏，而在经络之间交争，所以疼痛牵引如掣。这里阐明了历节也有因血虚的含义。
【集注】李说：风在血中，则剽悍劲切，无处不到，称为风血相搏。大概血主要荣养筋骨，如果风燥之，则血更耗损而筋骨失去其所养，所以疼痛如掣。古人说：治风先养血，血生风自灭。这就是治疗方法。
肥胖之人脉涩小，气短，自汗出，历节疼痛，不可屈伸，这都是饮酒出汗后当风所致。
【注】肥胖之人脉应当盛大，不应当涩小；肥胖之人气息应当长，不应当气短。现在肥胖之人脉涩小，气短，这是形、气、脉、息不相符合。审察其症状，自汗出，历节疼痛不可屈伸，询问其原因，是由于饮酒出汗后当风所致。这里又阐明了历节病不止一端的原因。
【集注】徐彬说：盛人，就是肥人。肥人多湿，脉见涩小，这是痹证的征象。于是气被湿所阻滞而短促，因风作祟而自汗，气血被邪气痹阻而疼痛不可屈伸。然而肥人固然多湿，为什么脉突然涩小？难道不是酒湿困阻吗？为什么疼痛加重而汗出不止？难道不是湿而挟风吗？脉证不同，但因风则一，所以说：这都是饮酒出汗后当风所致。
Wind pathogen causing disease typically manifests as hemiplegia (half-body paralysis); if only the arms are unable to move, this is classified as Bi syndrome (obstruction syndrome). The pulse is faint and rapid, which is caused by wind-stroke.
[Annotation] Regarding wind diseases, the *Neijing* (Inner Canon) has discussed them in detail. However, they were often discussed together with Bi syndrome, leading to confusion among later generations. Therefore, Zhang Zhongjing reiterates: Wind pathogen causing disease should result in hemiplegia, which is what the Classics call "Pian Ku" (hemiplegia); if only both arms are unable to move, it is not wind-stroke, but Bi syndrome. Generally, Bi syndrome is a Yin disease, with pulses that are often deep and choppy; wind disease is a Yang disease, with pulses that are often floating and moderate. Now, the pulse is faint and rapid, which is due to wind-stroke. A faint pulse indicates deficiency of healthy Qi; a rapid pulse indicates excess of pathogenic factors. Thus, those who contract wind due to deficiency invariably show a faint pulse; those who generate wind due to heat invariably show a rapid and urgent pulse.
[Collected Annotations] Shen Mingzong said: This section distinguishes between wind-stroke and Bi syndrome. Wind pathogen causing disease, whether injuring the Wei (Defensive) level or invading the Ying (Nutritive) level, should result in hemiplegia, meaning the Qi of half the body is damaged and non-functional. If only the arms are unable to move, this is Bi syndrome; "Bi" means obstruction, referring to the obstruction of Qi in a specific segment leading to loss of sensation. Upon palpating the pulse, it must be faint and rapid. Faint indicates weak Yang; rapid indicates frequent wind. This is caused by wind-stroke, meaning wind enters due to deficiency, subsequently causing hemiplegia.
The Cun Kou (radial artery at the wrist) pulse is floating and tight. Tightness indicates cold; floating indicates deficiency. Cold and deficiency interact, placing the pathogen in the skin. Floating indicates blood deficiency and emptiness of collateral vessels. The thief pathogen cannot be expelled, affecting either the left or right side. The side affected by the pathogen becomes flaccid, while the side of healthy Qi becomes tense. Healthy Qi pulls toward the pathogen, resulting in deviation of the mouth and eye and inability to move freely. If the pathogen is in the collaterals, the skin and muscles become numb and insensitive; if in the meridians, the body feels heavy and difficult to lift; if entering the Fu organs, the person loses consciousness and fails to recognize others; if entering the Zang organs, the tongue becomes stiff and speech is difficult, accompanied by drooling.
[Commentary] The five sentences "Cun Kou pulse floating and tight, tightness indicates cold, floating indicates deficiency, cold and deficiency interact, pathogen in the skin" do not belong to the context of this paragraph and should be placed at the beginning of the next paragraph. The six sentences from the next paragraph, "Cun Kou pulse slow and moderate, slowness indicates cold, moderation indicates deficiency; moderate Ying indicates blood loss, moderate Wei indicates wind-stroke; pathogen strikes the meridians," also do not fit the current context and should be moved to the beginning of this paragraph to ensure logical coherence. This is likely due to bamboo slip dislocation. The phrase "Floating indicates blood deficiency" is likely an interpolation. The two instances of "deficiency" in "Floating indicates deficiency, cold and deficiency interact" should be "wind," indicating a transcription error.
[Annotation] The pulses for wind-stroke and deficient pathogens should all be floating and moderate, as floating governs wind and moderation governs deficiency. Seeing a moderate pulse in the Ying level indicates depletion of blood in the meridians; seeing it in the Wei level indicates emptiness of Qi in the meridians. Generally, when wind pathogen invades humans, it does so through the emptiness of Qi and blood in the meridians. When the thief pathogen cannot be expelled and remains stagnant, it causes disease on the left if located on the left, and on the right if located on the right. Superficially, it affects meridians and collaterals; deeply, it affects Zang and Fu organs. Pathogen in collaterals causes numbness and insensitivity in skin and muscles; pathogen in meridians causes heaviness of the body and limbs, and deviation of the mouth and eye with immobility; pathogen entering Fu organs causes nine orifices to close and loss of recognition; pathogen entering Zang organs causes aphasia and drooping lips with salivation.
The Cun Kou pulse is slow and moderate. Slowness indicates cold; moderation indicates deficiency. Moderate Ying indicates blood loss; moderate Wei indicates wind-stroke. If the pathogen strikes the meridians, the body itches and urticaria appears. If Heart Qi is insufficient, and the pathogen enters the center, chest fullness and shortness of breath occur.
[Commentary] In "Cun Kou pulse slow and moderate, slowness indicates cold," the two characters "slow" should be "floating," and "cold" should be "wind," to make the meaning clear. Furthermore, slow and moderate pulses cannot coexist, confirming a transcription error.
[Annotation] The previous paragraph elucidated diseases caused by deficient and thief winds; this paragraph elucidates diseases caused by Ying-Wei, wind, and cold. Cun Kou pulse floating and tight: tightness indicates cold, floating indicates wind. Wind and cold pathogens interact at the exterior, stagnating in the skin and meridians, causing body itching and urticaria. If the person's Heart Qi is insufficient, meaning the Qi of the heart and chest is lacking, and the pathogen enters the heart and chest, it causes chest fullness and shortness of breath.
The Cun Kou pulse is deep and weak. Deepness governs bones; weakness governs sinews. Deep corresponds to Kidney; weak corresponds to Liver. Sweating and then entering water damages the Heart. Li Jie (Joint Pain) presents with yellow sweat, hence called Li Jie.
[Annotation] Cun Kou pulse deep and weak indicates insufficiency of Liver and Kidney Qi. The Liver governs sinews, and the Kidney governs bones. Insufficiency of Liver and Kidney leads to flaccidity and laxity of sinews and bones. Once attacked by wind, cold, and damp pathogens, disease occurs at the junctions of sinews, bones, and joints. When sweating, the pores open, making it easy for wind to enter; bathing in water exacerbates cold injury. Water damages the Heart; the Heart governs sweat. Sweat stagnation forms dampness. Thus, wind dominance causes Li Jie, and damp dominance causes yellow sweat.
[Collected Annotations] Zhao Liang said: The Kidney governs water and combines with bones, so a deep pulse indicates bone disease. The Liver stores blood and combines with sinews; blood deficiency leads to a weak pulse, indicating sinew disease. The Heart governs sweat. Entering water while sweating blocks the sweat with water. Water and sweat interact, gathering into dampness, which eventually transforms into heat. The steaming of damp-heat causes yellow sweat in Li Jie.
Sour taste injures sinews; injured sinews become flaccid, termed "Xie" (leakage/relaxation). Salty taste injures bones; injured bones become atrophic, termed "Ku" (withered/dry). The interaction of Ku and Xie is termed "Duan Xie" (severance and leakage). Ying Qi becomes obstructed, Wei Qi cannot circulate independently, both Ying and Wei become deficient, the San Jiao (Triple Burner) loses control, the four extremities are severed from nourishment, and the body becomes emaciated. Only the feet swell, and the calves feel cold. If fever occurs, it is Li Jie. For Li Jie characterized by inability to flex and extend joints and pain, Wu Tou Tang (Aconite Decoction) is the primary treatment.
[Commentary] The character "Xie" in "termed Duan Xie" should be "Jue" (severance) to connect with the following text, indicating a transcription error.
[Annotation] This section elaborates on the previous paragraph, mutually expounding its meaning to clarify treatment. Li Jie disease belongs to Liver and Kidney deficiency. Internal insufficiency of Liver and Kidney fails to nourish sinews and bones externally, allowing external pathogens to invade and cause disease. The causes of this deficiency are manifold. Prolonged excessive consumption of flavors can also lead to this disease. Excessive sour flavor injures the Liver; Liver injury injures sinews; sinew injury leads to flaccidity and inability to grasp, termed "Xie." Excessive salty flavor injures the Kidney; Kidney injury injures bones; bone injury leads to atrophy and inability to stand, termed "Ku." The interaction of Ku and Xie is termed "Duan Jue" (complete severance). Severance means Ying Qi is obstructed, Wei Qi cannot circulate independently, Ying and Wei are both deficient, the San Jiao loses its foundation, the four limbs are severed, and the body is emaciated. Isolated foot swelling and cold calves indicate cold dominance stagnating below; spontaneous yellow sweat indicates damp dominance manifesting in the middle. If fever occurs, it belongs to wind, constituting Li Jie. For Li Jie with joint pain and immobility, Wu Tou Tang is used to promote Ying and Wei circulation and expel wind, cold, and damp pathogens. Honey-processing of Wu Tou (Radix Aconiti Lateralis Preparata) is a method to mitigate toxicity.
[Collected Annotations] Shen Mingzong said: *Jinkui Yaolue* supplements that internal injuries from diet affect the Spleen, Stomach, Heart, Lung, Liver, and Kidney, causing Li Jie. However, the presented pulses and symptoms arise from alcohol consumption, where internal dampness and heat attract external pathogens. This is caused by sweating after drinking and exposing oneself to wind, illustrating the principle that "where pathogen gathers, Qi is deficient." External wind combining with internal dampness, external cold with internal dampness, internal cold attracting external dampness, and internal heat attracting external dampness are critical distinctions one must understand. One must differentiate the predominance of wind, cold, and dampness and apply methods such as releasing the exterior, warming the interior, promoting Yang, tonifying deficiency, and dispersing pathogens. Therefore, treating this condition requires integrating insights from *Ling Shu*, *Su Wen*, and *Jinkui Yaolue*. Blindly using fixed prescriptions is not the work of a skilled physician.
Wu Tou Tang Formula
Mahuang (Ephedrae Herba), Shaoyao (Paeoniae Radix Alba), Huangqi (Astragali Radix) (each 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 liang), Chuanwu (Aconiti Radix Praeparata, crushed, boiled in 2 sheng of honey until 1 sheng remains, remove Chuanwu, 5 pieces).
Take the above five herbs. Crush the first four. Boil in 3 sheng of water until 1 sheng remains. Strain. Add the honey decoction. Simmer further. Take 7 ge. If ineffective, take the entire dose.
For pain in various limb joints, emaciation of the body, swollen feet as if detached, dizziness, shortness of breath, and a feeling of nausea, Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) is the primary treatment.
[Commentary] "Wen wen" should be "Yun yun" (feeling of stifled heat/nausea).
[Annotation] The symptom of Li Jie is pain in various limb joints. "Body emaciation" refers to the severe emaciation mentioned in the previous paragraph. "Feet swollen as if detached" refers to the isolated foot swelling mentioned previously, emphasizing the severity of the edema. Dizziness and shortness of breath indicate Yang Qi deficiency. Nausea indicates excess cold pathogen. Wu Tou Tang is not used because there is no yellow sweat indicating damp dominance. Guizhi Shaoyao Zhimu Tang is used to strengthen Yang Qi and urgently dispel cold and dampness. Hence, the dosage of Guizhi (Cinnamon Twig) and Shaoyao (Peony Root) is double that of Mahuang (Ephedra) and Fangfeng (Saposhnikoviae Radix). Large doses of Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) are added. The intent is primarily to warm and circulate Yang Qi, secondarily to dispel cold and dampness. More Shengjiang (Zingiberis Rhizoma Recens) is used because of the desire to vomit. Zhimu (Anemarrhenae Rhizoma) and Gancao (Licorice Root) are added to counteract the excessive pungent and hot nature of the formula.
[Collected Annotations] Li Gao said: This Li Jie disease results from dual deficiency of Qi and Blood. Wind-dampness intermingling causes pain in all joints of the four limbs, which is Li Jie. Body emaciation indicates pathogen excess and healthy Qi decline. Feet swollen as if detached indicates Qi exhaustion below. Dizziness and shortness of breath indicate Qi deficiency above. Nausea indicates Qi rebellion in the middle. This is dual deficiency of Qi and Blood in the San Jiao. Thus, this decoction primarily dispels wind-dampness and warms Qi and Blood.
Guizhi Shaoyao Zhimu Tang Formula
Guizhi (Cinnamomi Ramulus, 4 liang), Shaoyao (Paeoniae Radix, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Mahuang (Ephedrae Herba, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 5 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 5 liang), Zhimu (Anemarrhenae Rhizoma, 4 liang), Fangfeng (Saposhnikoviae Radix, 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, fried, 2 pieces).
Take the above nine herbs. Boil in 7 sheng of water until 2 sheng remains. Take 7 ge warm, three times daily.
The Fu Yang pulse is floating and slippery. Slippery indicates substantial Gu Qi (Grain Qi/Stomach Qi); floating indicates spontaneous sweating.
[Annotation] Fu Yang is the Stomach pulse. Gu Qi refers to Stomach Qi. Floating indicates external pressure by wind; slippery indicates excess heat in the Stomach. Wind and heat steam between the muscle and cutaneous layers, causing spontaneous sweating. This elucidates that Huang Han (Yellow Sweat) can also be caused by wind-heat.
The Shao Yin pulse is floating and weak. Weakness indicates blood insufficiency; floating indicates wind. Wind and blood interact, causing pain like pulling or jerking.
[Annotation] Shao Yin is the Heart pulse; the Heart governs blood. Floating and weak Heart pulse indicates blood deficiency and wind pathogen. Wind and blood interact and contend within the meridians, causing radiating, jerking pain. This elucidates that Li Jie can also be caused by blood deficiency.
[Collected Annotations] Li Gao said: When wind is in the blood, it becomes fierce and penetrating, reaching everywhere, termed wind-blood interaction. Blood primarily nourishes sinews and bones. If wind dries it, blood is further depleted, and sinews and bones lose their nourishment, causing jerking pain. Ancients said: To treat wind, first nourish blood; when blood is generated, wind extinguishes itself. This is the treatment principle.
In robust individuals, the pulse is choppy and small, accompanied by shortness of breath and spontaneous sweating. Li Jie pain prevents flexion and extension. This is all caused by sweating after drinking and exposing oneself to wind.
[Annotation] Robust individuals should have a strong pulse, not choppy and small; they should have long breath, not shortness of breath. Here, the robust individual has a choppy and small pulse and shortness of breath, indicating a mismatch between form, Qi, pulse, and respiration. Examining the symptoms: spontaneous sweating, Li Jie pain with immobility. Asking the cause: it resulted from sweating after drinking and exposure to wind. This further elucidates that Li Jie has multiple etiologies.
[Collected Annotations] Xu Bin said: "Sheng ren" refers to obese people. Obese people have much dampness. A choppy and small pulse is a sign of Bi syndrome. Qi is obstructed by dampness, causing shortness of breath. Wind acts as an agent, causing spontaneous sweating. Qi and Blood are bi-zhou (obstructed) by pathogens, causing pain and immobility. Although obese people are prone to dampness, why is the pulse suddenly choppy and small? Is it not due to alcohol-dampness confinement? Why does pain worsen and sweating persist? Is it not dampness combined with wind? Although pulses and symptoms differ, the role of wind is consistent. Hence, it is stated: "This is all caused by sweating after drinking and exposure to wind."