（论一首脉证三条方十二首）
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。
〔衍义〕此证半身不遂者。偏风所中也。但臂不遂者。风邪上受也。风之所客。凝涩
荣卫。经脉不行。分肉筋骨俱不利。故曰此为痹。卫者。水谷之悍气。阳也。温分肉。
肥腠理。循行脉外。佐其动也。滑利充溢。荣者。水谷之精气。阴也。循脉中。应刻而
动。沉动翕徐。今因风着为痹。荣遂改微。卫遂变量。故脉微数也。此即内经风论
谓风各入其门户所中者之一证耳。其余散于各篇。不言风而病偏枯者。则不
可胜数。或得之汗出偏沮。或得之阳盛阴不足。或胃脉内外大小不一。或心脉
小坚急。或肾水虚者。灵枢亦叙于热病篇中。皆能致偏枯喑痱之病。观夫经旨
不言其邪。惟从阴阳脏气有余不足之故。岂无深旨。是六淫七情饮食起居房
劳。凡能伤其阴阳脏气之虚。致荣卫经脉痹而不能周流于身者。皆其邪也。不
可一言而尽指之故耳。刘河间因不以此证列于风类。而乃入火类。曰中风瘫
痪者。非谓肝木之风实甚。亦非外中于风。良由将息失宜。而心火暴甚。肾水虚
衰。不能制之。而热气拂郁。心神昏冒。筋骨不用。卒倒无知也。或即不死。发过而
偏枯者。由经络左右双行而热。郁结气血。不能宣通。若一例得通则否者。痹而
瘫痪也。此论发前人所未发。观是书者。尤宜兼通焉。
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。舌即难言。口吐涎沫。
〔衍义〕内经有谓十二经络脉者。皮之部也。百病之生。必先于皮毛。邪中之。腠理
开。开则邪入。客于经络。留而不去。传入于经。留而不去。传入于腑。禀于肠胃。仲
景今言是病。即此之谓也。络脉。盖经脉行气。皆在皮部。络脉浮近于皮肤。故善
恶之色见于外。经脉伏行于隧道。故善恶之脉。朝于寸口而后见。络脉不自动。
随经脉而动。此由络脉之血空虚。所以脉见得也。寒邪之气紧束。故浮紧之脉。
并见于寸口。络脉从经脉。左右双行。当邪入之时不治。至于其邪随络脉流行。
邪所在之侧。则血虚。虚则经气缓。邪所不在之侧。则血和。和则经气行如度而
急。缓急牵引。故口缓 僻不遂。邪在于络。其卫气循于皮肤之中。分肉之间者。
与之相遇。则不荣于肌肤。故肌肤不仁。邪在于经。则荣气之行涩。内不养于骨。
则骨重。外不滋于肉。则身重而不胜。仲景所谓入腑入脏者。腑六脏五。果何属
也。意即内经之所谓禀于胃者也。夫胃者土也。水谷之海。十二经皆受气于胃。
胃者六腑之总司。多气多血者也。心者神明之宅。五脏之主。由是诸腑经络受
邪。变气则归于胃。胃得之则热甚。津液壅溢为痰涎。闭塞隧道。荣卫不行。胃之
支。别脉上络于心者。并塞其神气出入之窍。故不识人也。诸脏受邪。极而变者。
亦必归于心。于是心得邪。则神散而枢机息。舌者心之窍。机息则舌纵。廉泉开。
舌纵。则难以言。廉泉开。则口流涎。此是俗所宗之说也。
侯氏黑散 治大风。四肢烦重。心中恶寒不足者。（外台治风癫）
菊花（四十分） 白术（十分） 细辛（三分） 茯苓（三分）
牡蛎（三分） 桔梗（八分） 防风（十分） 人参（三分）
矾石（三分） 黄芩（五分） 当归（三分） 干姜（三分） 芎 （三分） 桂枝（三分）
上十四味。杵为散。酒服方寸匕。日一服。初服二十日。温酒调服。禁一切鱼肉大
蒜。常宜冷食。六十日止。即药积在腹中不下也。热食即下矣。冷食能助药力。
〔衍义〕心主血。阳脏也。荣卫不布。内无所养。则心中恶寒。不足生焉。是以菊花为
君。治风兼治湿。治风以防风佐。治湿以白术佐。桔梗亦能治风痹。通膈气。舟楫
诸药。细辛、桂枝助防风。矾石茯苓助白术。黄芩、干姜、牡蛎。开利内外寒热痹气。
参、归更与干姜、牡蛎。治心中恶寒不足者。初治欲开其痹着。则用温酒以行药
势。禁诸热物。宜冷食者。为矾石能固涩诸药。助其久效。而矾石性得冷即止。得热即下故也。
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。则胸满而短气。
〔衍义〕天道干健而坤静顺。人道亦应之。气健而血顺也。血气和平。然后脉不缓
不急。不迟不数。日行百刻。以周于身而朝寸口。是以候寸口以求其虚实。迟则
知阳气之不能健运。缓则知荣气之应刻不逮。荣气不逮则亡血。卫气不运。因
而中风。经虚邪入。荣卫不布于皮肤。血凝津滞。发为身痒瘾疹。然疹有赤白。不独属风也。原属津凝
血滞。治与湿同。且荣卫不健。与邪混郁于胸中。则害其宗气之布息。故胸满而短气也。
风引汤 除热瘫痫。
大黄 干姜 龙骨（各四两） 桂枝（三两） 甘草 牡蛎（各二两）
寒水石 滑石 赤石脂 白石脂 紫石英 石膏（各六两）
上十二味。杵粗筛。以韦囊盛之。取三指。提井花水三升。煮三沸。温服一升。
治大人风引。少小惊痫螈 。日发数十次难疗等证。热邪以除。巢氏云。香港脚宜风引。
〔衍义〕风者外司厥阴。内属肝木。上隶手经。下隶足经。中见少阳相火。所以风自
内发者。由火热而生也。风生必害中土。土主四肢。土病则四末不用。聚液成痰。
瘫痪者。以风邪挟痰于四肢故也。痫者。以风热急其筋脉。内应于心主故也。由
是二者。尽可用此汤治之。首用大黄之寒走而不止者泻之。俾火退风息。凝痰
扫去矣。复用干姜之热止而不走者。何哉。前哲有云。大黄之推陈致新。如将军
之戡定祸乱。然使将无监军。兵无向导。能独成其功乎。夫一阴一阳之为道。故
寒与热相济。行与止相须。然后寒者不惨。热者不酷。行者不疾。止者不停。所以
大黄逐热行滞。以通荣卫而利关节。则必以干姜安之。桂枝导之。佐大黄之达
四肢脏腑而不肆其峻快。不然。将从诸药石而下走矣。桂枝又散风木。干姜又
能治血。祛风湿痹。去风毒痹。二者因得以相制为使。犹虑干姜之热中。更以石
膏、滑石制之。禀清肃之金性。以制木救土。泻阳明肺热。解肌肉风痹也。阴水不
足。火因妄动而生风。满招损。自役其心。精神不守。非镇重之剂。则不能安其神。
益其水。故以寒水石补阴水。紫石英、白石脂、赤石脂、牡蛎、龙骨敛精神。定魂魄。固根本也。
防己地黄汤 治病如狂状。妄行。独语不休。无寒热。其脉浮。
防己（一分） 桂枝（三分） 防风（三分） 甘草（一分）
上四味。以酒一杯。渍之一宿。绞取汁。生地黄二斤。 咀蒸之。如斗米饭久。以铜
器盛其汁。更绞地黄汁。和分再服。
〔衍义〕狂走谵语有热。脉长者则阳明。若此无寒热。其脉浮者。非其证也。然脉浮
者。血虚从邪。并于阳而然也。内经曰。邪入于阳则狂。此狂者。谓五脏阴血虚乏。
魂魄不清。昏动而然也。桂枝、防风、防己、甘草。酒浸其汁。用是轻清。归之于阳。以
散其邪。用生地黄之凉血补阴。熟蒸以归五脏。益精养神也。盖药生则散表。熟
则补衰。此煎煮法也。又降阴法也。阴之不降者。须少升以提其阳。然后降之。方
可下。不然则气之相并。不得分解矣。
头风摩散方
大附子（一枚炮） 盐（等分）
上二味。为散沐了。以方寸匕摩上。令药力行。
〔衍义〕头者诸阳之所会。太阳为之长。若风寒湿客之。诸阳不得流通。与邪壅塞
于巅而作痛。故用附子性之走者。于疾处散其邪。以盐味之润下。从太阳膀胱
水性者佐之。用以引诸药下降。则壅通而病愈矣。
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。
〔衍义〕肾主水。骨与之合。水性下。故脉沉者。病在骨也。肝藏血。筋与之合。血性濡。
血虚则脉弱。故脉弱者病在筋也。心主汗。汗出入水。其汗为水所主。心气不得
越。因而伤之。水汗相搏。聚以成湿。湿成则内应于脾。脾、土也。土克肾水。是以湿
伤其骨。关节者。骨之所凑。筋之所束。故湿独善流关节。以克其所胜。侮其不胜。
然水汗所郁之湿。久变为热。湿热相蒸。湿属土。土色黄。是以历节发出黄汗也。
趺阳脉浮而滑。滑则谷气实。浮则汗自出。
〔衍义〕趺阳胃脉属土。土湿所化也。脉经谓浮滑为有宿食。此虽非宿食之谷。然
滑乃阳盛也。内经曰。食入于胃。长气于阳。是乃饮食肥美所长之阳。成其湿热
之气。宜乎亦得称以谷也。脉浮汗自出者。内经曰。汗者谷之精气。今谷之盛阳。
出之于表。浮为卫虚。不能固腠理。因自汗出也。
少阴脉浮而弱。弱则血不足。浮则为风。风血相搏。即疼痛如掣。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。
〔衍义〕少阴脉者。太冲肾脉也。肾脉本沉。因饮食当风使之浮。浮则肾伤。肾属阴。
主血。伤必不足而脉弱也。肥人本多气多血。其脉充盛。今反涩。由其血不足也。
小者气衰也。由饮酒所致。盖因酒湿热有毒。饮之过则伤卫伤荣。迫津为汗。汗
出当风。乘虚入客。与卫相干。则短气自汗出。入伤筋骨。则历节疼痛。不可屈伸。
诸肢节疼痛。身体 羸。脚肿如脱。头眩短气。温温欲吐。桂枝芍药知母汤主之。
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（四两） 附子（二两炮）
上九味。以水七升。煮取二升。温服七合。日三服。
〔衍义〕此风寒湿痹其荣卫。三焦之病。头眩短气。上焦痹也。诸肢节疼痛。身体
羸。筋骨痹。韵书以 为火。以羸为筋结也。然湿多则肿。寒多则痛。风多则动。故
用桂枝治风。麻黄治寒。白术治湿。防风佐桂。附子佐麻黄、白术。其芍药、生姜、甘
草。亦和发其荣卫。如桂枝汤例也。知母治脚肿。引诸药祛邪益气力。附子行药
势为开痹大剂。然分两多而水少。恐分其服而非一剂也。三因方云。每服四钱。
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。
〔衍义〕内经云。味过于酸。肝气以津。味过于咸。大骨气劳。短肌以津。盖谓津液不
仁而内溢。短肌。谓走血而肌缩。大骨气劳。谓咸入骨走血。髓无养也。由是知此
之谓泄。即溢也。津液不溢。蓄而成湿。筋得湿。则弛长而缓。故名为泄。髓无血也。
咸多伤骨。因致痿而为枯。血走。绝而不流。谓之断。湿胜谓之泄。血不流则荣不通。
荣与卫相将。荣不通。则卫不独行也。三焦形体。皆藉血以养。血亡则三焦无
所根据。四属者。皮肉脂髓也。无血以滋。则身体羸瘦。独有所蓄之湿。下流伤肾。肾
主下焦。故脚肿大。湿胜则多汗。脾色黄。湿本于脾。故黄汗出。肾虚而阳不下降。
则胫冷。假令阴虚湿郁变热。则湿不泄而流于筋骨关节也。夫仲景诚善于立
言者矣。即历节一证。各分其因。以水。以酒。以天气。此又以饮食之味。然独出治
天气一方。人或怪其不具。噫。方可具哉。病有不常。体有强弱。时有寒暑。已出之
方。犹自为准绳而已。又焉可执而不变也。若能求经气。辨邪正。明药性。亦何患其有证而无方欤。
病历节不可屈伸。疼痛。乌头汤主之。
乌头汤方 治香港脚疼痛不可屈伸。
麻黄 芍药 黄 （各三两） 甘草（炙）
川乌（五枚 咀以蜜二升煎取一升即出乌头）
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。
〔衍义〕此汤概治历节不可屈伸疼痛。于方下又复言治香港脚疼痛。必仲景书历
节条下有方。而无药石。见香港脚中方名同而有药。集书者遂两出之。且二病皆
因风寒伤于筋。麻黄开玄府。通腠理。散寒邪。解气痹。芍药以理血痹。甘草通经
脉而和药。黄 益卫气。气壮则邪退。乌头善走。入肝筋逐风寒。蜜煎以缓其性。
使之留连筋骨。以利其屈伸。且蜜之润。又可益血养筋。并制乌头燥热之毒也。
矾石汤 治香港脚冲心。
矾石（二两）
上一味。以浆水一斗五升。煎三五沸。浸脚良。
〔衍义〕脚心病者。古人谓感水湿之邪。即内经痿痹厥逆证也。东垣有饮乳酪之
说。予思足六经起于足五趾间。若天之六淫。饮食寒热劳逸之气。凡留滞于下
（本篇包含一篇论述、三条脉证、十二首方剂）
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。
〔衍义〕这种半身不遂的病症，是偏侧受风邪侵袭所致。仅手臂不能活动的，是风邪从上受入所致。风邪客居体内，使营卫气血凝滞涩阻，经脉运行不畅，肌肉、筋骨都不利索，所以说是痹证。卫气，是水谷中剽悍的气，属阳，温煦分肉，肥厚腠理，循行于脉外，辅助气的运动，滑利充溢。营气，是水谷中的精气，属阴，循行于脉中，随着刻漏计时而动，深沉、跳动和缓。如今因风邪留着成为痹证，营气遂变得微弱，卫气遂发生变异，所以脉象微而数。这就是《内经·风论》所说的风邪从各个门户侵入所中的一种证候罢了。其余散见于各篇中，虽未明言风邪但病见偏枯的，多得数不清。有的因出汗时半身汗出较少而得病，有的因阳气盛而阴气不足而得病，有的因胃脉内外大小不一而得病，有的因心脉小且坚急而得病，有的因肾水虚衰而得病，《灵枢》也在热病篇中叙述了这些情况。这些都能导致偏枯、喑痱（失语、四肢瘫痪）的病证。观察经旨，不言及具体的邪气，只从阴阳脏气有余不足的缘故来解释，难道没有深意吗？凡是六淫、七情、饮食、起居、房劳，凡能损伤人体阴阳脏气之虚，导致营卫经脉痹阻而不能周身流通的，都是邪气。之所以不能用一句话就完全指出的原因吧。刘河间因为不把此证列于风类，而将其归入火类，说中风瘫痪，并非肝木之风实盛，也不是外感风邪，实在是因为调摄失宜，导致心火暴盛，肾水虚衰，不能制约心火，热气拂郁，心神昏冒，筋骨不用，突然倒下无知觉。或者即使不死，发作后出现偏枯的，是由于经络左右双行而热，郁结气血，不能宣通，如果一概认为通则没事，那就是痹而瘫痪了。此论阐发了前人未曾发现的问题，阅读此书的人，尤其应当兼通这一点。
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，贼邪不能排泄，或左或右，邪气所在的一侧相对松弛，正气一侧则紧张，正气牵引邪气，导致口眼歪斜、肢体不能随意运动。邪气在于络脉，肌肤麻木不仁；邪气在于经脉，身体沉重难以抬举；邪气进入腑，就不认识人；邪气进入脏，舌头僵硬难以说话，口吐涎沫。
〔衍义〕《内经》有说十二经络脉是皮肤的分区。百病的产生，必定先从皮毛开始。邪气中伤人体，腠理开泄，开泄则邪气进入，客居于经络，停留不去，传入于经，停留不去，传入于腑，禀受于肠胃。仲景现在说的这个病，就是这个意思。络脉，大概是经脉运行的气，都在皮部。络脉浮近于皮肤，所以善恶的颜色表现于外。经脉伏行于隧道，所以善恶的脉象，早晨汇聚于寸口然后显现。络脉自己不主动跳动，随经脉而动。这是因为络脉之血空虚，所以脉象得以显现。寒邪之气紧束，所以浮紧的脉象并见于寸口。络脉跟随经脉，左右双行。当邪气侵入时如果不治疗，等到邪气随络脉流行，邪气所在的侧面，则血虚，虚则经气缓；邪气不在的侧面，则血调和，调和则经气运行如常而急。缓急牵引，所以口角歪斜、肢体不能随意运动。邪气在于络脉，卫气循行于皮肤之中、分肉之间，与之相遇，就不能荣养肌肤，所以肌肤麻木不仁。邪气在于经脉，则营气运行涩滞，内不能滋养骨骼，则骨重；外不能滋润肌肉，则身重而无力。仲景所说的入腑入脏，腑有六，脏有五，究竟属于哪一类呢？我想就是《内经》所说的禀受于胃的那一类。胃属土，是水谷之海，十二经都受气于胃。胃是六腑的总司，是多气多血的脏腑。心是神明的宅舍，五脏的主宰。因此诸腑经络受邪，变气则归于胃。胃得到邪气则热甚，津液壅溢成为痰涎，闭塞隧道，营卫不行。胃的支脉，别出的脉络上络于心者，一并闭塞其神气出入的窍道，所以不认识人。诸脏受邪，极而变化的，也必归于心。于是心得到邪气，则神散而枢机停息。舌是心的窍，枢机停息则舌纵，廉泉穴开，舌纵则难以言语，廉泉开则口流涎水。这是世俗所推崇的说法。
侯氏黑散：治疗大风，四肢烦重，心中恶寒不足。（《外台秘要》用于治疗风癫）
菊花（四十分） 白术（十分） 细辛（三分） 茯苓（三分）
牡蛎（三分） 桔梗（八分） 防风（十分） 人参（三分）
矾石（三分） 黄芩（五分） 当归（三分） 干姜（三分） 川芎（三分） 桂枝（三分）
以上十四味药，捣碎成散剂。用酒送服一方寸匕，每日一次。初服二十天，用温酒调服。禁止食用一切鱼肉大蒜，平时宜冷食，六十天为止，这样药物就会积聚在腹中不下行。热食就会下行。冷食能助药力。
〔衍义〕心主血，是阳脏。营卫不布散，内无所养，则心中恶寒，不足由此产生。所以用菊花为君药，治风兼治湿。治风以防风为佐，治湿以白术为佐。桔梗也能治风痹，通膈气，作为舟楫之药载诸药上行。细辛、桂枝辅助防风，矾石、茯苓辅助白术，黄芩、干姜、牡蛎，开通利导内外的寒热痹气。参、归更与干姜、牡蛎配合，治疗心中恶寒不足者。初治想要开通痹着，所以用温酒以行药势。禁止各种热物，宜冷食的原因，是因为矾石能固涩诸药，助其长效，而矾石的性质遇冷即止，遇热即下行的缘故。
寸口脉迟而缓，迟脉主寒，缓脉主虚。营缓则为亡血，卫缓则为中风。邪气中伤经脉，则身体痒而生瘾疹。心气不足，邪气入中，则胸满而短气。
〔衍义〕天道刚健而地道静顺，人道也应合于此，气健而血顺。血气和平，然后脉不缓不急，不迟不数，日行百刻，周流于身而朝于寸口。所以通过候寸口来求其虚实。迟则知阳气不能健运，缓则知营气应刻不及。营气不及则亡血，卫气不运，因而中风。经虚邪入，营卫不布于皮肤，血凝津滞，发为身痒瘾疹。然而疹有赤白，不只属于风。原本属于津凝血滞，治疗与湿相同。况且营卫不健，与邪混郁于胸中，则损害宗气的布息，所以胸满而短气。
风引汤：除热瘫痫。
大黄 干姜 龙骨（各四两） 桂枝（三两） 甘草 牡蛎（各二两）
寒水石 滑石 赤石脂 白石脂 紫石英 石膏（各六两）
以上十二味药，捣粗筛。用韦囊盛装。取三指量的药，提井花水三升，煮三沸，温服一升。
治疗大人风引，小儿惊痫抽搐，每天发作数十次难疗等证。热邪以此除去，巢元方说脚气宜用风引汤。
〔衍义〕风在外主管厥阴，在内属肝木，上隶手经，下隶足经，中见少阳相火。所以风自内发的，是由火热而生。风生必害中土，土主四肢，土病则四末不用，聚液成痰。瘫痪，是因为风邪挟痰于四肢。痫，是因为风热急其筋脉，内应于心主。因此这两种病，都可以用此汤治疗。首先用大黄的寒性走而不止来泻之，使火退风息，凝痰扫去。再用干姜的热性止而不走，为什么呢？前哲有话说，大黄推陈致新，像将军平定祸乱，然而如果没有监军，士兵没有向导，能独自成功吗？一阴一阳是道的体现，所以寒与热相济，行与止相须，然后寒者不惨烈，热者不酷烈，行者不疾速，止者不停滞。所以大黄逐热行滞，以通营卫而利关节，则必须以干姜安之，桂枝导之，辅助大黄通达四肢脏腑而不使其峻快。不然，药石将从下面走泄。桂枝又散风木，干姜又能治血，祛风湿痹，去风毒痹，二者因得以相制为使。还担心干姜的热性中伤，更以石膏、滑石制约它，禀承清肃的金性，以制木救土，泻阳明肺热，解肌肉风痹。阴水不足，火因妄动而生风，满招损，自役其心，精神不守，非镇重之剂，则不能安其神，益其水。所以用寒水石补阴水，紫石英、白石脂、赤石脂、牡蛎、龙骨收敛精神，定魂魄，固根本。
防己地黄汤：治疗病状如狂，妄行，独语不休，无寒热，其脉浮。
防己（一分） 桂枝（三分） 防风（三分） 甘草（一分）
以上四味药，用酒一杯，浸泡一夜，绞取汁。生地黄二斤，切碎蒸熟，像蒸斗米饭的时间那样久，用铜器盛其汁，再绞地黄汁，混合分两次服用。
〔衍义〕狂走谵语有热，脉长者则是阳明证。如果此症无寒热，其脉浮，就不是那个证。然而脉浮，是血虚从邪，并于阳所致。《内经》说：邪入于阳则狂。此狂，是说五脏阴血虚乏，魂魄不清，昏动而然。桂枝、防风、防己、甘草，酒浸取汁，用此轻清之品，归之于阳，以散其邪。用生地黄的凉血补阴，熟蒸以归五脏，益精养神。大概药生则散表，熟则补衰，这是煎煮法。又是降阴法。阴之不降者，须稍加升提以提其阳，然后降之，方可下行。不然则气相并，不得分解。
头风摩散方
大附子（一枚炮制） 盐（等分）
以上二味药，研为散，沐浴后，用一方寸匕涂抹患处，令药力运行。
〔衍义〕头是诸阳会聚之处，太阳经为之长。若风寒湿客犯之，诸阳不得流通，与邪壅塞于巅顶而作痛。所以用附子性走的特性，在患处散其邪，以盐味润下的特性，从太阳膀胱水性者佐之，用以引诸药下降，则壅通而病愈。
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，所以叫历节。
〔衍义〕肾主水，骨与之合，水性下，所以脉沉者，病在骨。肝藏血，筋与之合，血性濡，血虚则脉弱，所以脉弱者病在筋。心主汗，汗出入水，其汗为水所主，心气不得越，因而伤之。水汗相搏，聚以成湿，湿成则内应于脾，脾属土，土克肾水，是以湿伤其骨。关节者，骨之所凑，筋之所束，所以湿独善流关节，以克其所胜，侮其不胜。然而水汗所郁之湿，久变为热，湿热相蒸，湿属土，土色黄，是以历节发出黄汗。
〔衍义〕趺阳胃脉属土，由土湿所化。《脉经》谓浮滑为有宿食，这里虽然不是宿食的谷，然而滑乃阳盛。《内经》说：食入于胃，长气于阳，这是饮食肥美所长之阳，成其湿热之气，宜乎也称以谷。脉浮汗自出者，《内经》说：汗者谷之精气，今谷之盛阳，出于表，浮为卫虚，不能固腠理，因自汗出。
少阴脉浮而弱，弱则血不足，浮则为风，风血相搏，即疼痛如掣。盛人脉涩小，短气，自汗出，历节疼，不可屈伸，这都是饮酒汗出当风所致。
〔衍义〕少阴脉，即太冲肾脉。肾脉本沉，因饮食当风使之浮，浮则肾伤，肾属阴，主血，伤必不足而脉弱。肥人本多气多血，其脉充盛，今反涩，由其血不足也。小者气衰也，由饮酒所致。盖因酒湿热有毒，饮之过则伤卫伤荣，迫津为汗，汗出当风，乘虚入客，与卫相干，则短气自汗出，入伤筋骨，则历节疼痛，不可屈伸。
诸肢节疼痛，身体羸瘦，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之。
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（四两） 附子（二两炮制）
以上九味药，用水七升，煮取二升，温服七合，每日三次。
〔衍义〕此风寒湿痹其营卫，是三焦的病。头眩短气，是上焦痹。诸肢节疼痛，身体羸瘦，是筋骨痹。“ ”韵书解释为火，“羸”解释为筋结。然而湿多则肿，寒多则痛，风多则动。所以用桂枝治风，麻黄治寒，白术治湿，防风佐桂枝，附子佐麻黄、白术。芍药、生姜、甘草，也是调和发越其营卫，如桂枝汤例。知母治脚肿，引诸药祛邪益气力，附子行药势为开痹大剂。然而分量多而水少，恐怕分其服而非一剂。《三因方》说，每服四钱。味酸则伤筋，筋伤则缓，名叫泄。咸则伤骨，骨伤则痿，名叫枯。枯泄相搏，名叫断泄。营气不通，卫不独行，营卫俱微，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。
〔衍义〕《内经》说：味过于酸，肝气以津；味过于咸，大骨气劳，短肌以津。是说津液不仁而内溢，短肌，是说走血而肌缩。大骨气劳，是说咸入骨走血，髓无养也。由此知道此之谓“泄”，即溢也。津液不溢，蓄而成湿，筋得湿，则弛长而缓，故名为泄。髓无血也，咸多伤骨，因致痿而为枯。血走，绝而不流，谓之断。湿胜谓之泄，血不流则荣不通，荣与卫相将，荣不通，则卫不独行也。三焦形体，皆藉血以养，血亡则三焦无所根据。四属者，皮肉脂髓也，无血以滋，则身体羸瘦。独有所蓄之湿，下流伤肾，肾主下焦，故脚肿大。湿胜则多汗，脾色黄，湿本于脾，故黄汗出。肾虚而阳不下降，则胫冷。假令阴虚湿郁变热，则湿不泄而流于筋骨关节。夫仲景诚善于立言者矣，即历节一证，各分其因，以水，以酒，以天气，此又以饮食之味。然而独出治天气一方，人或怪其不具，噫，方可具哉？病有不常，体有强弱，时有寒暑，已出之方，犹自为准绳而已，又焉可执而不变也。若能求经气，辨邪正，明药性，亦何患其有证而无方欤。
乌头汤方 治疗脚气疼痛不可屈伸。
麻黄 芍药 黄芪（各三两） 甘草（炙）
川乌（五枚 切碎，以蜜二升煎取一升即出乌头）
以上五味药切碎，四味药用水三升，煮取一升，去滓，内蜜煎中更煎之，服七合，不知，尽服之。
〔衍义〕此汤概治历节不可屈伸疼痛，于方下又复言治脚气疼痛，必定仲景书中历节条下有方，而无药石，见脚气中方名同而有药，集书者遂两出之。且二病皆因风寒伤于筋，麻黄开玄府，通腠理，散寒邪，解气痹，芍药以理血痹，甘草通经脉而和药，黄芪益卫气，气壮则邪退，乌头善走，入肝筋逐风寒，蜜煎以缓其性，使之留连筋骨，以利其屈伸。且蜜之润，又可益血养筋，并制乌头燥热之毒。
矾石汤 治疗脚气冲心。
矾石（二两）
以上一味药，用浆水一斗五升，煎三五沸，浸脚良。
〔衍义〕脚心病者，古人谓感水湿之邪，即《内经》痿痹厥逆证。东垣有饮乳酪之说，我思足六经起于足五趾间，若天之六淫，饮食寒热劳逸之气，凡留滞于下
(One treatise, three pulse-symptom patterns, twelve formulas)
When wind pathogen causes disease, it typically manifests as hemiplegia (paralysis of one side of the body). If only the arm is unable to move, this is considered a Bi syndrome (obstruction syndrome). The pulse is faint and rapid; this is caused by Wind Stroke (Zhong Feng).
[Commentary] This condition of hemiplegia is due to wind pathogen attacking the lateral side. When only the arm cannot move, it is because wind pathogen has been received from above. Wherever wind pathogen lodges, it causes Ying (Nutrient) and Wei (Defensive) Qi to become stagnant and obstructed, meridian circulation fails, and muscles, flesh, bones, and joints all lose their flexibility. Therefore, it is said to be a Bi syndrome. Wei Qi is the fierce Qi of food and fluids, belonging to Yang; it warms the muscles, thickens the interstices, circulates outside the vessels, and assists movement, being slippery and abundant. Ying Qi is the essence Qi of food and fluids, belonging to Yin; it circulates within the vessels, moving with each time interval, deep and slow. Now, because wind pathogen remains causing Bi syndrome, Ying Qi becomes faint, and Wei Qi undergoes change, hence the pulse is faint and rapid. This is exactly one of the conditions mentioned in the *Nei Jing: Treatise on Wind*, where wind enters through various portals. The rest are scattered in various chapters; those mentioning paralysis without explicitly stating wind are countless. Some arise from sweating with unilateral lack of sweat, some from excess Yang and deficiency of Yin, some from inconsistency in the Stomach pulse internally and externally, some from a small, firm, and urgent Heart pulse, and some from deficiency of Kidney Water. These are also narrated in the *Ling Shu* chapter on Heat Diseases. All can lead to diseases such as hemiplegia, aphasia, and flaccid paralysis. Observing the canonical principles, it does not speak of specific pathogens but only attributes them to the excess or deficiency of Yin-Yang and Zang-Fu Qi. Is there no profound meaning? Any factor—such as the six exogenous pathogens, seven emotions, diet, daily routine, or sexual fatigue—that damages the deficiency of Yin-Yang and Zang-Fu Qi, leading to obstruction of Ying-Wei and meridians preventing their circulation throughout the body, is all considered pathogenic. The reason they cannot be pointed out in a single statement is likely due to this complexity. Liu Hejian did not classify this condition under Wind but rather under Fire, stating that stroke and paralysis are not due to excessive Liver Wood wind nor external wind invasion, but rather due to improper care, causing sudden暴盛 (violent excess) of Heart Fire and decline of Kidney Water, which fails to control it. Heat qi stagnates, the spirit becomes confused and overwhelmed, tendons and bones cease to function, leading to sudden collapse and loss of consciousness. Or if death does not occur, paralysis ensues after the attack. This is because heat affects both sides of the meridians, stagnating Qi and Blood, preventing free flow. If treated simply as "blockage" and resolved, it would not result in paralysis. This discussion reveals insights previously unexplored; readers of this book should particularly understand this comprehensively.
The pulse at the Cun Kou (Radial Artery) 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 empty collateral vessels; evil pathogens cannot be expelled. They may affect either the left or right side. On the side affected by the pathogen, the tissues become relaxed/slow; on the unaffected side, the healthy Qi is tense. The healthy Qi pulls towards the pathogen, resulting in deviation (facial paralysis) and inability to move freely. If the pathogen is in the collaterals, the skin and muscles become insensible. If in the meridians, the body feels heavy and weak. If entering the Fu organs, the person loses recognition of others. If entering the Zang organs, the tongue becomes stiff and speech difficult, with drooling of saliva.
[Commentary] The *Nei Jing* states that the twelve meridian systems correspond to the skin regions. The generation of all diseases begins first in the hair and skin. When pathogens strike, the interstices open; when open, pathogens enter and lodge in the meridians. If they remain, they transmit into the deeper meridians; if they remain there, they transmit into the Fu organs, specifically affecting the stomach and intestines. What Zhang Zhongjing describes here refers to this process. Collateral vessels carry Qi from the main meridians and lie close to the skin surface, so pathological colors appear externally. Main meridians run deep within tunnels, so pathological pulses manifest at the Cun Kou in the morning. Collaterals do not pulse independently but follow the main meridians. This occurs because blood in the collaterals is deficient, making the pulse visible. Cold pathogen constricts, so floating and tight pulses appear together at the Cun Kou. Collaterals follow the meridians, running bilaterally. If not treated when the pathogen enters, as it flows with the collaterals, the side where the pathogen resides suffers Blood Deficiency, causing the meridian Qi to relax. On the opposite side, Blood is harmonious, so meridian Qi moves normally and becomes tense. The tension and relaxation pull against each other, causing deviation of the mouth and inability to move limbs. When the pathogen is in the collaterals, Wei Qi circulates between the skin and muscles. Meeting the pathogen, it fails to nourish the skin and muscles, causing insensitivity. When in the meridians, Ying Qi flow becomes sluggish; internally failing to nourish bones makes them feel heavy; externally failing to moisten flesh makes the body feel heavy and weak. Regarding Zhang Zhongjing's mention of entering Fu and Zang organs: there are six Fu and five Zang. Which do they belong to? I believe they refer to what the *Nei Jing* calls "influencing the Stomach." The Stomach belongs to Earth, is the sea of food and fluids, and all twelve meridians receive Qi from it. It is the master of the six Fu organs and is rich in Qi and Blood. The Heart is the residence of Spirit and master of the five Zang organs. Thus, when pathogens affect the Fu organs and meridians, the altered Qi returns to the Stomach. The Stomach, receiving the pathogen, becomes excessively hot, causing fluids to accumulate and transform into phlegm and saliva, blocking the tunnels, stopping Ying-Wei circulation. The branch vessels of the Stomach, which connect to the Heart, block the orifices for Spirit entry and exit, causing loss of recognition. When pathogens affect the Zang organs and reach extremity changes, they must return to the Heart. Once the Heart receives the pathogen, Spirit scatters and pivot mechanisms cease. The tongue is the orifice of the Heart; when the pivot ceases, the tongue hangs loose, the Lianquan point opens, speech becomes difficult, and saliva flows. This is the view commonly accepted by laypeople.
Hou Shi Hei San (Mr. Hou's Black Powder): Treats severe wind, heaviness and discomfort in the four limbs, and a feeling of cold insufficiency in the heart. (*Wai Tai Mi Yao* uses it for wind epilepsy.)
Chrysanthemi Flos (40 fen), Atractylodis Rhizoma (10 fen), Asari Radix (3 fen), Poria (3 fen), Ostrea Concha (3 fen), Platycodonis Radix (8 fen), Saposhnikoviae Radix (10 fen), Ginseng Radix (3 fen), Alumen (3 fen), Scutellariae Radix (5 fen), Angelicae Sinensis Radix (3 fen), Zingiberis Rhizoma Recens (3 fen), Ligustici Chuanxiong Rhizoma (3 fen), Cinnamomi Ramulus (3 fen).
Grind these fourteen ingredients into powder. Take one cun-bi (square-inch measure) with wine, once daily. For the first twenty days, take with warm wine. Avoid all fish, meat, and garlic. Prefer cold food for sixty days so the medicine accumulates in the abdomen without descending. Hot food will cause it to descend immediately. Cold food aids the medicinal power.
[Commentary] The Heart governs Blood and is a Yang organ. If Ying-Wei do not distribute, internal nourishment is lacking, leading to a feeling of cold insufficiency in the heart. Therefore, Chrysanthemum is used as the sovereign drug to treat wind and dampness. Saposhnikovia assists in treating wind; Atractylodes assists in treating dampness. Platycodon also treats wind-Bi and opens chest Qi, acting as a boat to carry medicines upward. Asari and Cinnamon Twig assist Saposhnikovia; Alumen and Poria assist Atractylodes. Scutellaria, Dried Ginger, and Oyster Shell open and drain cold-heat Bi Qi internally and externally. Ginseng and Angelica, combined with Dried Ginger and Oyster Shell, treat the cold insufficiency in the heart. Initially, to open the lodged Bi, warm wine is used to promote the action of the medicine. Prohibiting hot foods and preferring cold food is because Alumen can astringe the other medicines to prolong their effect, and Alumen itself stops when cold and descends when hot.
The pulse at Cun Kou is slow and moderate. Slow indicates Cold; moderate indicates Deficiency. Moderate Ying indicates loss of Blood; moderate Wei indicates Wind Stroke. If pathogen strikes the meridians, the body itches and hives appear. If Heart Qi is insufficient and pathogen enters the center, chest fullness and shortness of breath occur.
[Commentary] Heaven's way is vigorous and Earth's way is quiet and compliant; human nature responds accordingly, with Qi vigorous and Blood compliant. When Blood and Qi are peaceful, the pulse is neither moderate nor rapid, neither slow nor hurried. It travels 100 intervals daily, circulating the body and arriving at the Cun Kou. Thus, we examine the Cun Kou to determine deficiency and excess. Slowness indicates Yang Qi's failure to move vigorously; moderation indicates Ying Qi's failure to arrive on schedule. Failure of Ying leads to Blood loss; failure of Wei leads to Wind Stroke. With meridian deficiency and pathogen entry, Ying-Wei do not distribute to the skin. Blood coagulates and fluids stagnate, causing itching and hives. Hives can be red or white, not solely attributed to wind. Originally, they stem from fluid coagulation and blood stagnation; treatment is similar to dampness. Moreover, if Ying-Wei are weak and mix with pathogens in the chest, they hinder the distribution of Zong Qi, causing chest fullness and shortness of breath.
Feng Yin Tang (Wind Pulling Decoction): Clears heat, treats paralysis and epilepsy.
Rhei Radix et Rhizoma, Zingiberis Rhizoma, Longgu (each 4 liang), Cinnamomi Ramulus (3 liang), Glycyrrhizae Radix et Rhizoma, Ostrea Concha (each 2 liang), Hypostasis Aquae Frigidus, Talcum, Halloysit Rubra, Halloysit Alba, Purpurit Quartzum, Gypsum Fibrosum (each 6 liang).
Grind these twelve ingredients coarsely and sieve. Store in a leather bag. Take an amount held by three fingers, boil in 3 sheng of well water for three boils. Take 1 sheng warm.
Treats adult wind-pulling, pediatric convulsions and spasms occurring dozens of times daily, and other difficult-to-treat conditions. Heat pathogens are cleared. Chao Yuanfang states Foot Bi (Gouty Arthritis/Jiangyang) should use Feng Yin Tang.
[Commentary] Wind externally governs Jueyin and internally belongs to Liver Wood, connecting to hand and foot meridians, revealing Shaoyang Minister Fire. Thus, wind arising internally is generated by fire-heat. Wind generation harms Spleen Earth; Earth governs the four limbs. If Earth is diseased, the extremities fail to function, accumulating fluids into phlegm. Paralysis is caused by wind pathogen carrying phlegm to the limbs. Epilepsy is caused by wind-heat tightening tendons and meridians, internally corresponding to the Heart Master. Therefore, both can be treated with this decoction. First, Rhei is used for its cold nature and moving property to purge, allowing fire to retreat and wind to subside, sweeping away condensed phlegm. Then, Zingiberis is used for its hot nature and stationary property. Why? Ancients said Rhei eliminates old and generates new like a general quelling rebellion, but without a supervisor or guide, can it succeed alone? Yin and Yang constitute the Dao; thus, cold and heat must complement each other, movement and stillness must require each other. Then cold is not harsh, heat is not cruel, movement is not frantic, stillness is not stagnant. So, while Rhei drives out heat and moves stagnation to unblock Ying-Wei and benefit joints, it must be stabilized by Zingiberis and guided by Cinnamomi Ramulus, assisting Rhei in reaching limbs and organs without being too harsh. Otherwise, the minerals would just pass downward. Cinnamomi Ramulus disperses wind-wood; Zingiberis treats blood, dispels wind-damp-bi, and removes wind-toxic bi. These two mutually restrain each other as assistants. Still fearing Zingiberis' heat, Gypsum and Talc are added to control it, inheriting the metal nature of clarity and severity to control wood and save earth, draining Yangming Lung heat, and resolving muscle wind-bi. Insufficient Yin water allows fire to move recklessly and generate wind. Fullness invites damage; self-serving the heart scatters spirit. Without heavy sedatives, spirit cannot be calmed and water nourished. Thus, Hypostasis Aquae Frigidus supplements Yin water; Purpurit Quartzum, Halloysit Alba, Halloysit Rubra, Ostrea Concha, and Longgu gather spirit, settle soul, and solidify the root.
Fang Ji Di Huang Tang (Stephania and Rehmannia Decoction): Treats symptoms resembling mania, wandering behavior, talking to oneself incessantly, without chills or fever, with a floating pulse.
Stephaniae Tetrandrae Radix (1 fen), Cinnamomi Ramulus (3 fen), Saposhnikoviae Radix (3 fen), Glycyrrhizae Radix et Rhizoma (1 fen).
Soak these four ingredients in one cup of wine overnight, squeeze out the juice. Take 2 jin of fresh Rehmanniae Radix, chop and steam until done like steaming rice. Collect the juice in a copper vessel, squeeze out more Rehmannia juice, mix, and divide into two doses.
[Commentary] Manic walking and delirium with heat and long pulse indicate Yangming syndrome. If there is no chills/fever and the pulse is floating, it is not that syndrome. However, a floating pulse indicates Blood Deficiency following the pathogen, merging with Yang. The *Nei Jing* says: "Pathogen entering Yang causes mania." This mania is due to deficiency of Yin Blood in the five Zang organs, unclear Hun and Po spirits, causing confusion and agitation. Stephania, Cinnamomi Ramulus, Saposhnikovia, and Glycyrrhiza are soaked in wine to extract light and clear juices, returning to Yang to disperse pathogens. Fresh Rehmannia's cooling properties nourish Yin and Blood; steamed to enter the five Zang organs, benefiting essence and nourishing spirit. Generally, raw herbs scatter the exterior, cooked herbs tonify deficiency; this is the decoction method. It is also a method of descending Yin. To descend Yin, one must slightly ascend to lift Yang, then descend; otherwise, Qi merges and cannot separate.
Tou Feng Mo San (Head Wind Rubbing Powder) Formula
Aconiti Lateralis Radix Preparata (one large piece, prepared), Salt (equal parts).
Grind these two ingredients into powder. After bathing, rub one cun-bi onto the affected area to allow the medicinal power to penetrate.
[Commentary] The head is the meeting place of all Yang meridians, with the Taiyang meridian as the leader. If wind-cold-dampness lodges there, Yang Qi cannot circulate freely, obstructing the vertex and causing pain. Therefore, Prepared Aconite Root, with its moving nature, is used to disperse pathogens at the site. Salt, with its moistening and descending nature, assists via the Taiyang Bladder Water nature, guiding the medicines downward. This clears obstruction and cures the disease.
The pulse at Cun Kou is deep and weak. Deep governs bones; weak governs sinews. Deep indicates Kidney; weak indicates Liver. Sweating and entering water injures the Heart. Lijie (Joint Pain) presents with yellow sweat, hence called Lijie.
[Commentary] Kidney governs Water and combines with bones; water nature is downward, so a deep pulse indicates bone disease. Liver stores Blood and combines with sinews; blood nature is moistening. Blood deficiency leads to a weak pulse, so a weak pulse indicates sinew disease. Heart governs sweat. Sweating and entering water means the sweat is controlled by water; Heart Qi cannot escape, causing injury. Water and sweat interact, forming dampness. Dampness internally corresponds to Spleen. Spleen is Earth; Earth controls Kidney Water. Thus, dampness injures the bones. Joints are where bones gather and sinews bind, so dampness tends to flow into joints, controlling what it overcomes and insulting what it cannot. However, dampness stagnated by water and sweat eventually transforms into heat. Heat and dampness steam each other; dampness belongs to Earth, and Earth color is yellow, hence Lijie produces yellow sweat.
The pulse at Fu Yang is floating and slippery. Slippery indicates substantial Grain Qi; floating indicates spontaneous sweating.
[Commentary] Fu Yang Stomach pulse belongs to Earth, transformed by Earth dampness. The *Mai Jing* states floating and slippery indicates retained food. Although this is not retained food, slippery indicates Yang excess. The *Nei Jing* says: "Food enters the Stomach, grows Yang Qi." This is the Yang grown by rich food, forming damp-heat Qi, appropriately called "grain." Floating pulse with spontaneous sweating: The *Nei Jing* says sweat is the essence Qi of grain. Now, the abundant Yang of grain emerges to the exterior. Floating indicates Wei Deficiency, failing to secure interstices, leading to spontaneous sweating.
The pulse at Shao Yin is floating and weak. Weak indicates Blood insufficiency; floating indicates wind. Wind and Blood struggle, causing pain like pulling. In robust people, a choppy and small pulse, shortness of breath, spontaneous sweating, Lijie pain, and inability to flex/extend are all caused by sweating after drinking alcohol and exposing to wind.
[Commentary] Shao Yin pulse refers to the Taichong Kidney pulse. Kidney pulse is originally deep; exposure to wind after drinking makes it float. Floating injures the Kidney. Kidney belongs to Yin and governs Blood; injury leads to insufficiency and a weak pulse. Robust people naturally have abundant Qi and Blood, with full pulses. Now the pulse is choppy due to Blood insufficiency. Small indicates Qi decline, caused by drinking. Alcohol contains damp-heat and toxicity; excessive drinking injures Wei and Ying, forcing fluids into sweat. Sweating and exposing to wind allows pathogens to enter voids, interfering with Wei, causing shortness of breath and sweating. Entering and injuring sinews and bones causes Lijie pain and immobility.
For pain in all limb joints, emaciated body, swollen feet as if detached, dizziness, shortness of breath, and nausea, Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) is the primary treatment.
Guizhi Shaoyao Zhimu Tang Formula
Cinnamomi Ramulus (4 liang), Paeoniae Radix Alba (3 liang), Glycyrrhizae Radix et Rhizoma (2 liang), Ephedrae Herba (2 liang), Zingiberis Rhizoma Recens (5 liang), Atractylodis Macrocephalae Rhizoma (5 liang), Anemarrhenae Rhizoma (4 liang), Saposhnikoviae Radix (4 liang), Aconiti Lateralis Radix Preparata (2 liang, prepared).
Boil these nine ingredients in 7 sheng of water, reduce to 2 sheng. Take 7 ge warm, three times daily.
[Commentary] This formula treats Wind-Cold-Damp Bi affecting Ying-Wei, a disease of the Sanjiao. Dizziness and shortness of breath indicate Upper Jiao Bi. Pain in all limb joints and emaciation indicate sinew-bone Bi. " " is explained as fire in rhyme books; "Lei" means sinew knotting. Dampness causes swelling, Cold causes pain, Wind causes movement. Thus, Cinnamomi Ramulus treats wind, Ephedra treats cold, Atractylodes treats damp, Saposhnikovia assists Cinnamon Twig, and Prepared Aconite assists Ephedra and Atractylodes. Peony, Fresh Ginger, and Licorice harmonize and release Ying-Wei, similar to Guizhi Tang. Anemarrhena treats foot swelling and guides other drugs to expel pathogens and boost energy. Prepared Aconite promotes medicinal power as a major dose for opening Bi. However, with many ingredients and little water, it may be divided into multiple doses rather than one. *San Yin Fang* states: Take 4 qian per dose. Sour taste injures sinews; injured sinews relax, called "Xie" (leak). Salty taste injures bones; injured bones wither, called "Ku" (wither). Withering and leaking combine, called "Duan Xie" (cut leak). Ying Qi does not flow, Wei Qi does not move alone; Ying-Wei both become minute. Sanjiao has nothing to command; the four attachments are severed. Body becomes emaciated, feet swell alone, yellow sweat appears, calves feel cold. If fever occurs, it becomes Lijie.
[Commentary] The *Nei Jing* says: Excessive sour makes Liver Qi overflow; excessive salty makes Great Bone Qi labor and muscles shrink. This means fluids become insensible and overflow internally. "Shrink muscles" means blood moves and muscles contract. "Great Bone Qi labor" means salt enters bones and moves blood, leaving marrow without nourishment. Thus, "Xie" here means overflow. Fluids do not overflow but accumulate into dampness. Sinews receiving dampness become lax and relaxed, hence called "Xie." Marrow lacks blood. Excessive salt injures bones, causing withering. Blood moves, cuts off, and stops flowing, called "Duan" (cut). Damp excess is called "Xie." Blood not flowing means Ying does not flow. Ying and Wei accompany each other; if Ying does not flow, Wei cannot move alone. Sanjiao forms rely on blood for nourishment; if blood is lost, Sanjiao has no basis. The four attachments are skin, flesh, fat, and marrow. Without blood to moisten, the body becomes emaciated. Only accumulated dampness flows down to injure the Kidney. Kidney governs Lower Jiao, hence feet swell. Damp excess causes much sweat. Spleen color is yellow; damp originates from Spleen, hence yellow sweat. Kidney deficiency and failing descent of Yang cause cold calves. If Yin deficiency and damp stagnation transform into heat, damp does not leak but flows into sinews, bones, and joints. Zhang Zhongjing was indeed skilled in expression. For Lijie, he differentiated causes by water, wine, and weather. Here, he adds dietary flavors. Yet, he only provided one formula for weather-related causes; people might find it incomplete. Alas, can formulas be complete? Diseases vary, constitutions differ, seasons change. Existing formulas serve as guidelines; how can they be rigidly applied? If one seeks meridian Qi, distinguishes pathogen from righteousness, and understands drug properties, why worry about having symptoms but no formula?
For Lijie with inability to flex/extend and pain, Wutou Tang (Aconite Decoction) is the primary treatment.
Wutou Tang Formula: Treats Jiangyang (Foot Bi/Gout) pain with inability to flex/extend.
Ephedrae Herba, Paeoniae Radix Alba, Astragali Membranacei Radix (each 3 liang), Glycyrrhizae Radix et Rhizoma (roasted), Chuanwu (Aconiti Radix Carnea, 5 pieces, chopped, boiled in 2 sheng honey to 1 sheng, then remove Chuanwu).
Chop these five ingredients. Boil the first four in 3 sheng water, reduce to 1 sheng, strain, add to the honey decoction, and boil again. Take 7 ge. If ineffective, take the remainder.
[Commentary] This decoction generally treats Lijie pain with immobility. Mentioning Jiangyang pain below suggests Zhang Zhongjing's original text had the formula name under Lijie but lacked specific drugs, while Jiangyang had the same name but different drugs. Compilers included both. Both diseases are caused by wind-cold injuring sinews. Ephedra opens Xuanguan (pores), unblocks interstices, disperses cold, and resolves Qi Bi. Peony regulates Blood Bi. Licorhea unblocks meridians and harmonizes drugs. Astragalus boosts Wei Qi; strong Qi repels pathogens. Aconite moves well, enters Liver sinews, and expels wind-cold. Honey boiling slows its nature, keeping it in sinews/bones to aid flexion/extension. Honey's moisture also benefits blood and sinews, counteracting Aconite's dry heat toxicity.
Fanshi Tang (Alumen Decoction): Treats Jiangyang rushing to the heart.
Alumen (2 liang).
Boil this single ingredient in 15 sheng of sour water for three to five boils. Soak feet; this is excellent.
[Commentary] Heart disease of the feet, according to ancients, is caused by water-damp pathogens, corresponding to Wei, Bi, and Jue Ni syndromes in the *Nei Jing*. Dong Yuan mentioned drinking milk/cheese. I consider that the six meridians of the foot originate between the five toes. Just as heaven's six exogenous pathogens, diet, cold/heat, and labor/rest qi, whatever stagnates in the lower...