（论一首脉证十二条方十一首）
太阳病。发热无汗。反恶寒者。名曰刚痉。
〔补注〕此论痉病也。非伤寒也。非寒而何得以太阳目之。以其头痛腰脊痛。与太
阳伤营不异。故以太阳定之。然既曰太阳。又何以名痉。其角弓反张。正内经之
所谓痉也。痉亦为寒因。故寒郁而热。气闭皮毛。汗无由出。全是伤营本证。所异
者。止是不恶热而反恶寒尔。其所以反恶寒者。何也。因其人先伤于湿。后复感
寒。两阴相合则寒。虽发热。终为湿气挟持。经络筋节之间。闭而不宣。一身之阳。
郁抑而不外越。故身即热。而情则恶寒也。又湿在筋节。则寒为所持。遂流连而
不得去。正气阻滞。邪气独留。又安望其屈伸如故。转运无碍乎。角弓反张。有由
来也。名曰刚者。寒气坚劲。性使然也。后诸名家。惟王海藏得之。以扩仲景之意。
谓三阳太阴皆病痉。项背反张属太阳。若低头视小。手足牵引。肘膝相构。阳明
痉也。若一目或左右斜视。并一手一足搐搦者。少阳痉也。若发热腹痛脉沉细
者。太阴也。此论固善矣。惜其不及少阴厥阴。以全三阴之痉。岂二脏之经。不为内外之强，有类于太阴者乎。且灵枢
曰足少阴之筋。循脊内。挟脊上至项。与足太阳筋合。其病在此。为主痫螈及痉。在外阳病者。不能俯。在内阴病者。
不能仰。此非少阴之病痉者乎。况厥阴肝脏主筋。又岂有风寒过甚。犹不自伤其筋。以
致其筋 短者耶。是可触而悟矣。
太阳病。发热汗出而不恶寒。名曰柔痉。
〔衍义〕是症亦出伤寒论中。注谓太阳病。发热汗出为表虚。则当恶寒。其不恶寒
者。为阳明病。今发热汗出而不恶寒者。非阳明症。则是太阳中风。重感于湿。为
柔痉也。表虚感湿。故曰柔痉。即上条所引内经为表里兼湿内攻。大筋 短。小
筋弛长之痉也。所谓柔痉者。非不强也。但刚痉强而有力。柔痉强而无力为异尔。
太阳病。发热脉沉而细者。名曰痉。为难治。
〔衍义〕此条尝出伤寒论痉病篇。彼不言难治。于是成无己止注其重感于湿。意
殆以沉而细。系寒湿之本脉。故不言其难治。设不因寒湿之邪。而沉细见于太
阳发热之表病。则是阳病见阴脉。诚为难矣。若朱奉议以痉病脉尽沉迟弦细
者非也。如脉经云。脉沉细。名曰阳中之阴。少气。阴气不通为痉。病发热者。殆与此无少异尔。
〔补注〕太阳、阳经也。发热、阳证也。何以知为痉。以有或刚或柔之证见也。脉沉与
细阴脉也。沉为少阴本脉。而复不能鼓之使显。乃有如丝者来去其间。则是无
阳中又属阴虚矣。何也。惟无阳令沉。无阴因细也。阳症阴脉。岂易治乎。嘉言为
难治。初非不治。比类而观。则仲景少阴例中。原有麻黄附子细辛汤之法。余以
为不可也。盖始得之。反发热脉沉者。以脉沉是本。而发热为标。是少阴兼太阳
之表。犹易为力也。若夫太阳显少阴之脉。有不难为功者乎。况较少阴更多一
细乎。虽然。后条太阳病。脉亦沉细。何以不云难治。以有湿也。湿不但细宜。即沉
并宜矣。然则又何以知其病之非湿乎。湿必流于关节。今关节无疼痛。故知之
太阳病。发汗太多。因致痉。
〔衍义〕成无己注伤寒论。谓发汗太多则亡阳。阳气者。精则养神。柔则养筋。阳微
不能养。则筋脉紧急而成痉。虽然。发汗之阳。阳亡寒起。致紧急而为痉。固也。然
发汗复为痉者。难以紧急概言。发汗必用辛热之剂。汗虽出。热不为汗解。反得
辛热之剂以助之。热愈甚而拘挛其筋脉亦有之。又如伤寒论中有云。伤寒头
痛。翕翕发热。形象中风。常微汗出。自呕者。不可发汗。发汗则成痉。身强难以屈
伸。注云。伤寒当无汗恶寒。今头痛发热。微汗自呕。则伤寒之邪传而为热。欲行
于里。若发汗则虚其表。热归经络。热甚风生。故身强直为痉。
夫风病。下之则痉。复发汗。必拘急。
〔补注〕筋者肝之合。脉者心之合。风内应于肝。外应于筋。热内应于心。外应于脉。
是故风病而成热者。其邪气即以应筋脉。若更下之。则虚其阴。复汗之。则虚其
阳。阴虚则荣血微。筋无养而成痉。阳虚则卫气衰。脉无养而拘急。
疮家虽身疼痛。不可发汗。汗出则痉。
〔衍义〕此条亦见伤寒注。谓表虚聚热则生疮。疮家身疼如伤寒。不可发汗。发汗
则表愈虚。热愈甚。虚热生风。故变痉也。虽然疮已。以其热从腠理开。汗出而散之可也。
病者身热足寒。颈项强急。恶寒。时头热面赤。目赤。独头动摇。卒口噤。背反张者。痉
病也。若发其汗者。寒湿相搏。其表益虚。即恶寒甚。发其汗已。其脉如蛇。（一云其脉沧沧）
〔衍义〕伤寒注曰太阳中风。重感寒湿。乃变为痉也。身热足寒者。寒湿伤下。时头
热面赤目赤。风伤于上也。头摇者。风主动也。独头摇者。头为诸阳之会。风伤阳
也。若纯伤风者。则一身尽动摇。手足搐搦。此皆内挟寒湿。故头摇也。口噤者。寒
主急也。卒口噤者。不常噤也。有时而缓。若风寒相搏。则口噤而不时开。此皆加
之风湿。故卒口噤也。风寒客于足太阳。故筋脉拘急。头项强背反张也。此症出
伤寒论中。其衍文者。无发其汗以后二十五字。
愚按金匮有此。则所重者。正在此二十五字矣。岂可无以注之乎。故谓痉病之
发其汗者。误也。误则阳气徒虚。而邪不复出。且反以动其湿而湿不去。两相搏
聚。蒂固根深。遂使卫气更虚。较之未汗前之恶寒。为尤甚矣。试言其脉。则因误
汗。逼令真阳脱入湿中。所以形容其如蛇也。言脱出之阳。本疾急亲上。轻矫若
龙。为湿气所纽。则迟滞如蛇之象。尽力奔迸。究竟不能奋飞矣。此脉之至变。义之至精者也。
暴腹胀大者。为欲解。脉如故。反伏弦者痉。
〔衍义〕肝在五行为木。在六气为风。所胜之者燥金。不胜之者为湿土。若金旺则
木受制而郁矣。木郁必发。发则从火。过其所不胜之中土。故脾土得木火而腹
为暴胀大。如内经所谓厥阴在泉者腹胀。与诸腹胀大皆属于热者同类也。是
故以腹之暴胀。因知木之郁于脾者也。已出之脾而木气行矣。火与俱而燥金
之气退矣。金退木行。故曰欲解。解则其脉行。应脉大。今不浮大而如故。反伏弦
者。则是风犹郁在肝而自病。其所合之筋脉已成痉矣。此条暴胀之先。不见叙
症。遽曰欲解。必有所解之病在也。
夫痉脉。按之紧如弦。直上下行。（一作筑筑而弦）
〔衍义〕痉病由风寒互为之。重感于邪。寒脉则紧。风脉则弦。是本脉也。脉经谓直
上下行者。督脉也。见之则大人癫。小儿痫。二者尽为背反张。由督脉与太阳合。
行于脊里相引而急。故显出督脉之象也。今痉强无异于癫痫之背反张者。是亦相干于督脉。而见其上下行之象矣。
痉病有灸疮。难治。
〔衍义〕痉病有风热。燥急其筋骨。不当复灸以火。且助火深入。风热得之。愈固而
不散。所以难治。
脉经云。痉家其脉伏坚。直上下。
〔衍义〕内经谓脉沉而坚。病在中。今所伏非沉者欤。坚非如肾之弹石者欤。此两
条出脉不出症。殆为前条明其表。此见其病在内外。如内经之柔痉骨强之类也。
太阳病。其症备。身体强KT KT （音如）然。脉反沉迟。此为痉。栝蒌桂枝汤主之。
栝蒌桂枝汤方
栝蒌根（二两） 桂枝（三两） 芍药（三两） 甘草（三两） 生姜（三两） 大枣（十三枚）
上六味。以水九升。煮取三升。分温三服。取微汗。汗不出。食顷。啜热粥发之。
〔衍义〕谓太阳病。其症备。是何症之备也。大抵太阳经脉。自足上行。循背至头项。
此是其所过之部。而为之状者。皆是其症也。考之伤寒论。有谓太阳病。项背强
KTKT 然。反汗出恶风者。桂枝加葛根汤主之。亦是其一也。正与此同。而少异者。
彼以汗出恶风。其脉必浮。此言脉沉迟。必汗不出。不出则亦不恶风。故不加葛
根而加栝蒌根。俱是益津和血养筋之剂。彼之KT KT 然。项背强。虽未至于痉。然
经脉已拘急。不利于运动。故用葛根之甘行阳。从表分卫中以生津液。和其经
脉。沉迟。汗必不出。不出则亦不恶风。则是病在表之荣血分。荣血阴也。其体沉。
其行迟。所以脉应其象。外息于寸口。内不养于筋经。故痉强之病作焉。所以栝
蒌根味苦入阴。用以生荣血。益阴分津液。养其筋经者为君。桂枝之辛以散。芍
药之酸以收。一阴一阳。在里在表者为臣。甘草、姜、枣合辛甘之味。行脾之津液。
而和荣卫者为使。立方之旨。其在斯欤。
太阳病。无汗而小便反少。气上冲胸。口噤不能语。欲作刚痉。葛根汤主之。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂（二两去皮） 芍药（二两）
甘草（二两炙） 生姜（三两） 大枣（十二枚）
上七味。 咀。以水一斗。先煮麻黄、葛根减二升。去沫。内诸药。煮取三升。去滓。温
服一升。覆取微似汗。不须啜粥。余如桂枝汤法将息及禁忌。
〔衍义〕按伤寒论中有太阳病。项背强KT KT 。无汗恶风。葛根汤主之。注曰。轻可去
实。以中寒表实。故加麻黄葛根以祛风。桂枝汤以和表也。今以小便反少。气上
冲胸。口噤不能语。欲作刚痉者。亦用之何也。盖太阳欲入传阳明。然阳明不受
邪。故气逆上冲胸。而阳明筋脉内结胃口。外行胸中。过人迎。环唇口。以其经多
气多血。胸中肺部也。上焦主分布津液。行水道今太阳与阳明热并胸中。故水
道不行则小便少。津液不布则无汗。人迎在结喉两旁。近会厌发声机关之处。
由阳明所过筋脉。遇所并之热。遂挛急牵引。以口噤不能语。欲作刚痉。胸中近
表。论其在上。则属太阳。论其居前。则属阳明。宜乎是方治其两经之病也。何以
言之。盖葛根本阳明经药。能生津出汗。行小便。解肌。易老云。太阳初病。未入阳
明。不可便服葛根。是引贼破家也。又云。用此以断太阳之路。即是开发阳明经
气。以却太阳传入之邪也。故仲景治太阳、阳明合病。桂枝汤加麻黄、葛根也|
痉为病。（一本痉字上有刚字）胸满口噤。卧不着席。脚挛急。必 齿。可与大承气汤。
大承气汤方
大黄（四两酒洗） 浓朴（半斤炙去皮） 枳实（五枚炙） 芒硝（三合）
上四味。以水一斗。先煮二物。取五升。去滓。内大黄。煮取二升。去滓。内芒硝。更上
火。微一二沸。分温再服。得下。止服。
〔衍义〕此传阳明风热之深者也。无己谓伤寒症。以阳明入腑。腹满者下之。而胸
满者未深入。犹带表邪。所郁阳气不宣故尔。非汗即吐。然而未论及此痉病之
胸满也。胸满岂可一概而言带表乎。有表则属表。有里则属里。若此背不着席。
齿与项肩强口噤之属表者不同。由热入甚深之所致。故此言胸满。亦热之
极也。况风热燥烁津液。阴血消亡。至于下焦属阴之筋脉皆挛急矣。然其热入
深者。非苦寒咸下之。不足以除其热。救其阴。夫伤寒病螈 者。以热生风而搐。
尚为难治。况此甚于搐者。非下之不能疗也。然亦有不治者。若灵枢热而痉者死。腰折螈 齿 也。
太阳病。关节疼痛而烦。脉沉而细者。（一作缓）此名湿痹。（玉函云中湿）湿痹之候。小便不利。
大便反快。但当利其小便。
〔衍义〕此症出伤寒论注云。雾伤皮腠。湿流关节。疼痛而烦者。湿气内流也。湿同
水也。脉沉而细者。水性趋下也。痹痛也。因其关节烦疼而名曰湿痹。非香港脚之
痹也。内经曰。湿胜则濡泄小便不利。大便反快者。湿气内郁胜也。但当利其小
便。以宣泄腹中湿气。故云治湿不利小便。非其治也。虽然。大抵此为小便通阳
气。行水道。今为湿气内胜。阳气被郁。故小便不利。利之则阳气行。虽在关节之
湿。亦得宣泄矣。设小便利已。而关节之痹不去。必又自表治之。
湿家之为病。一身尽疼。（一云疼烦）发热。身色如熏黄也。
〔衍义〕此症见伤寒注曰。色黄如橘子色者。阳明瘀热也。此身色似熏黄。即非阳
明瘀热者。栀子柏皮主之。为表里有热。则身不疼痛。此一身尽痛。非伤寒客热
也。知湿邪在经而使之。脾恶湿。湿伤。则脾病而色见。是以身发黄者。为色黄如烟熏。非正黄色也。
湿家。其人但头汗出。背强。欲得被覆向火。若下之早则哕。或胸满。小便不利。（一云利）
舌上如苔者。以丹田有热。胸中有寒。渴欲得饮而不能饮。则口燥烦也。
〔衍义〕按伤寒论成无己注曰。湿家有风湿。有寒湿。此寒湿相搏者也。湿胜则多
汗。伤寒则无汗。寒湿相搏。虽有汗而不能周身。故但头汗出也。背、阳也。腹、阴也。
太阳之脉。挟脊抵腰。太阳客寒湿。表气不利而背强也。里有邪者。外不恶寒。表
有邪者。则恶寒。欲得被覆向火者。寒湿在表而恶寒也。若下之早。则伤动胃气。
（本篇包含一条总论、十二条脉证、十一个方剂）
太阳病。发热无汗。反而恶寒的，称为刚痉。
〔补注〕这是论述痉病。不是伤寒。既然不是寒邪致病，为何将其归为太阳经呢？因为患者出现头痛、腰脊痛，与太阳经受营气损伤的情况没有区别，所以用“太阳”来定性。然而既然说是太阳病，又为什么叫作“痉”呢？那种身体向后反折如弓状的症状，正是《内经》中所说的“痉”。痉病也是由寒邪引起的，所以寒邪郁结而化热，气机闭塞皮毛，汗液无法排出，完全是伤营的本证。所不同的地方，只是不恶热反而恶寒罢了。为什么会反而恶寒呢？这是因为患者先被湿邪所伤，后又感受寒邪，两股阴邪相合则生寒。虽然发热，但终究被湿气挟持，经络筋节之间，闭阻而不宣通，全身的阳气，郁抑而不能向外发散。所以身体虽然发热，但感觉上却恶寒。另外，湿邪在筋节之间，寒邪被其牵制，于是流连不去。正气阻滞，邪气独留，又怎能希望肢体屈伸自如，运转无碍呢？角弓反张，是有其原因的。命名为“刚”，是因为寒气坚劲，本性使然。后来的各位名医中，只有王海藏领悟了这一点，以扩展仲景的原意。他认为三阳经和太阴经都会发生痉病。项背反张属于太阳经；如果低头视物，手足牵引，肘膝相互靠拢，是阳明经痉病；如果一只眼睛或向左右斜视，并伴有一只手一只脚抽搐的，是少阳经痉病；如果发热腹痛脉沉细的，是太阴经痉病。这个论述固然很好，可惜没有涉及少阴和厥阴，未能完整阐述三阴经的痉病。难道这两脏的经脉，不会发生内外强直，类似太阴经的情况吗？况且《灵枢》说：足少阴之筋，沿脊柱内侧，夹着脊柱上行至项部，与足太阳之筋会合。病变发生在这里，主要表现为痫证抽搐及痉病。在外侧阳经发病者，不能俯身；在内侧阴经发病者，不能仰头。这难道不是少阴经的病痉吗？何况厥阴肝脏主司筋脉，又怎么会有风寒过重，却不伤害其筋脉，导致筋脉缩短的呢？这是可以触类旁通领悟到的。
太阳病。发热汗出且不恶寒的，称为柔痉。
〔衍义〕这个症状也出现在《伤寒论》中。注释说太阳病，发热汗出属于表虚，应当恶寒。那些不恶寒的，属于阳明病。现在发热汗出且不恶寒的，不是阳明症，那就是太阳中风，再次感受湿邪，形成柔痉。表虚感湿，所以叫柔痉。也就是上一条引用的《内经》所说的表里兼受湿邪内攻，大筋缩短，小筋弛长导致的痉病。所谓柔痉，并不是不强硬，只是刚痉强硬有力，柔痉强硬无力而已。
太阳病。发热且脉象沉而细的，称为痉病，属于难治。
〔衍义〕这一条曾经出现在《伤寒论·痉病篇》中。那里没说难治，于是成无己只注释其重感于湿。大概认为沉而细是寒湿的根本脉象，所以不说它难治。假设不是因为寒湿之邪，而在太阳发热的表病中出现沉细脉，那就是阳病见阴脉，确实很难治疗。如果朱奉议认为痉病的脉象全是沉迟弦细的，那就错了。如《脉经》所说：“脉沉细，名为阳中之阴，少气，阴气不通导致痉病。”患病发热的人，大概与此没有什么不同。
〔补注〕太阳是阳经。发热是阳证。怎么知道是痉病呢？因为有或刚或柔的症状出现。脉沉和细都是阴脉。沉是少阴的本脉，而又不能鼓动使其显现，只是像丝线一样在来去之间微弱存在，这就是无阳之中又属阴虚了。为什么呢？因为只有无阳才会脉沉，无阴才会脉细。阳症见阴脉，难道容易治疗吗？嘉言认为是难治，起初并非不可治。类比观察，那么在仲景少阴病例中，原本就有麻黄附子细辛汤的方法。我认为这不行。因为刚开始得病，反而发热脉沉的，是因为脉沉是本，而发热是标，这是少阴兼太阳之表，还比较容易处理。如果是太阳经显现出少阴的脉象，难道有不难以见效的吗？况且比少阴脉多了一个“细”字呢。虽然如此，后一条太阳病，脉也是沉细，为什么不说难治呢？因为有湿邪。湿邪不仅适宜见细脉，见沉脉也适宜。那么又怎么知道这个病不是湿邪呢？湿邪必定流注于关节，现在关节没有疼痛，所以知道这不是湿邪。
太阳病。发汗太多，因此导致痉病。
〔衍义〕成无己注释《伤寒论》时说，发汗太多则会亡阳。阳气，精微则养神，柔和则养筋。阳气微弱不能滋养，则筋脉紧急而成痉。虽然如此，发汗导致亡阳，阳亡寒起，导致紧急而成痉，固然是对的。然而发汗后复变为痉的，难以只用“紧急”来概括。发汗必须用辛热药物，汗虽出，热不为汗解，反而得到辛热药物的帮助，热更甚而拘挛其筋脉也是有的。又如《伤寒论》中说：“伤寒头痛，翕翕发热，形象中风，常微汗出，自呕的，不可发汗。发汗则成痉。身强难以屈伸。”注释说：伤寒应当无汗恶寒，现在头痛发热，微汗自呕，则是伤寒之邪传变而为热，欲行于里。若发汗则虚其表，热归经络，热甚风生，所以身强直成为痉。
凡是风病。误用下法则成痉，再发汗，必定拘急。
〔补注〕筋是肝的外合，脉是心的外合。风内应于肝，外应于筋。热内应于心，外应于脉。所以风病而成热的，其邪气即应合于筋脉。如果再误下，则虚其阴，再发汗，则虚其阳。阴虚则荣血微少，筋失滋养而成痉。阳虚则卫气衰败，脉失滋养而拘急。
患有疮疡的人，即使身体疼痛，也不可发汗。汗出则成痉。
〔衍义〕这一条也见于《伤寒论》注释。说表虚聚热则生疮。疮家身体疼如同伤寒，不可发汗。发汗则表更虚，热更甚，虚热生风，所以变生痉病。虽然如此，疮已愈合，因其热从腠理开放，汗出而散之是可以的。
病人身体发热，脚冷，颈项强急，恶寒，有时头部发热面赤，目赤，只有头部动摇，突然口噤，背反张的，是痉病。如果误发其汗，寒湿相搏，其表更虚，即恶寒更甚。发汗之后，其脉象如蛇一般蜿蜒。（一说脉象沧沧）
〔衍义〕《伤寒论》注释说：太阳中风，重感寒湿，乃变为痉。身体发热脚冷的，是寒湿伤下；有时头部发热面赤目赤的，是风伤于上。头摇的，是风主动。只有头部摇动的，是因为头为诸阳之会，风伤阳也。如果纯伤风，则全身都动摇，手足搐搦。这些都是内挟寒湿，所以只有头摇。口噤的，是寒主急。卒口噤，是不经常噤口，有时缓解。如果风寒相搏，则口噤而不时常张开。这都是加之风湿的缘故，所以卒口噤。风寒客居于足太阳经，所以筋脉拘急，头项强直背反张。这个症状出自《伤寒论》，其中衍文部分是“无发其汗以后二十五字”。
我按察《金匮要略》有此内容，那么重视的，正是在这二十五字啊。怎么能不加注释呢？所以说痉病误发其汗，是错误的。错误则阳气徒然虚弱，而邪气不再外出，并且反而触动湿邪而湿邪不去，两者相搏聚，根深蒂固，遂使卫气更虚，比起未发汗前的恶寒，更为严重。试论其脉象，则因误汗，逼迫真阳脱入湿中，所以形容其脉象如蛇。说脱出的阳气，本来疾速亲上，轻矫若龙，被湿气扭结，则迟滞如蛇之象，尽力奔迸，究竟不能奋飞。这是脉象的变化，义理的精深之处。
突然腹部胀大的，是病情将要解除。脉象如故，反而伏弦的，是痉病。
〔衍义〕肝在五行中属木，在六气中属风。其所胜的是燥金，不胜的是湿土。如果金旺，则木受制而郁结。木郁必发，发则从火，越过其所不胜的中土，所以脾土得木火之气而腹部突然胀大。如《内经》所说“厥阴在泉者腹胀”，与“诸腹胀大皆属于热”同类。所以通过腹部的暴胀，得知木气郁结于脾。已经出于脾而木气运行了。火与之俱行而燥金之气退却。金退木行，所以说“欲解”。解则其脉运行，应脉大。现在不浮大而如故，反而伏弦的，则是风犹郁在肝而自病。其所合的筋脉已成痉。这一条在暴胀之前，不见叙述症状，突然说“欲解”，必定有某种病在解除。
痉病的脉象，按之紧如弦，直上下行。（一作筑筑而弦）
〔衍义〕痉病由风寒互结所致，重感于邪。寒脉则紧，风脉则弦，这是本脉。《脉经》说“直上下行者”，是指督脉。见到这种脉象，则大人癫狂，小儿痫证，两者都表现为背反张。由于督脉与太阳经会合，行于脊里，相互牵引而急，所以显出督脉的象。现在的痉强无异于癫痫的背反张，这也是相干于督脉，而显出其上下行的象。
痉病患者有灸疮，难治。
〔衍义〕痉病有风热，燥急其筋骨，不应当再用火灸，且助火深入。风热得到火助，更加坚固而不散，所以难治。
《脉经》说：痉家的脉象伏坚，直上下行。
〔衍义〕《内经》说脉沉而坚，病在中。现在所谓的伏，不就是沉吗？坚不就是像肾脉弹石那样吗？这两条只出脉不出症，大概是给前一条做明辨，这里显示病在内外，如《内经》所说的柔痉骨强之类。
太阳病，其症状具备，身体强直KT KT （音如）然，脉象反而沉迟，这是痉病。用栝蒌桂枝汤主治。
栝蒌桂枝汤方
栝蒌根（二两） 桂枝（三两） 芍药（三两） 甘草（三两） 生姜（三两） 大枣（十三枚）
以上六味药，用水九升，煮取三升，分三次温服。取微汗。汗不出，过一顿饭的时间，喝热粥以助发汗。
〔衍义〕说太阳病，其症状具备，是什么症状具备呢？大体上太阳经脉，自足上行，循背至头项。这是其所经过的部位，而为之状的，都是其症状。考证《伤寒论》，有说太阳病，项背强KT KT 然，反汗出恶风的，用桂枝加葛根汤主治。也是其中之一。正与此相同，而稍有不同的是，彼处因汗出恶风，其脉必浮；此处说脉沉迟，必无汗。无汗则也不恶风，所以不加葛根而加栝蒌根。都是益津和血养筋的药剂。彼处的KT KT 然，项背强，虽然未到痉的程度，但经脉已拘急，不利于运动，所以用葛根的甘味行阳，从表分卫中以生津液，和其经脉。沉迟，汗必不出，不出则也不恶风，则是病在表的荣血分。荣血属阴，其体沉，其行迟，所以脉应其象。外息于寸口，内不养于筋经，所以痉强的病发作。所以栝蒌根味苦入阴，用以生荣血，益阴分津液，养其筋经作为君药。桂枝的辛以散，芍药的酸以收，一阴一阳，在里在表作为臣药。甘草、姜、枣合辛甘之味，行脾之津液，而和荣卫作为使药。立方的宗旨，就在这里吧。
太阳病，无汗而小便反而少，气上冲胸，口噤不能语，欲作刚痉。用葛根汤主治。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂（二两去皮） 芍药（二两）
甘草（二两炙） 生姜（三两） 大枣（十二枚）
以上七味药，切碎。用水一斗，先煮麻黄、葛根，减少二升，去掉浮沫，加入其他药，煮取三升，去滓，温服一升。覆盖衣被取微似汗，不需要喝粥。其余按照桂枝汤法调养及禁忌。
〔衍义〕按《伤寒论》中有太阳病，项背强KT KT ，无汗恶风，葛根汤主治。注释说：轻可去实，以中寒表实，所以加麻黄葛根以祛风，桂枝汤以和表。现在因小便反少，气上冲胸，口噤不能语，欲作刚痉的，也用这个方子为什么呢？盖太阳欲传入阳明，然而阳明不受邪，所以气逆上冲胸。而阳明筋脉内结胃口，外行胸中，过人迎，环唇口。以其经多气多血，胸中肺部也。上焦主分布津液，行水道。现在太阳与阳明热并胸中，所以水道不行则小便少，津液不布则无汗。人迎在结喉两旁，近会厌发声机关之处。由阳明所过筋脉，遇所并之热，遂挛急牵引，以致口噤不能语，欲作刚痉。胸中近表，论其在上，则属太阳；论其居前，则属阳明。适宜这个方子治疗这两经的病。为什么说呢？盖葛根本是阳明经药，能生津出汗，行小便，解肌。易老说：太阳初病，未入阳明，不可便服葛根，是引贼破家也。又说：用此以断太阳之路，即是开发阳明经气，以却太阳传入之邪也。所以仲景治太阳、阳明合病，用桂枝汤加麻黄、葛根。
痉病。（一本痉字上有刚字）胸满口噤，卧不着席，脚挛急，必定齘齿。可与大承气汤。
大承气汤方
大黄（四两酒洗） 浓朴（半斤炙去皮） 枳实（五枚炙） 芒硝（三合）
以上四味药，用水一斗，先煮二物，取五升，去滓，加入大黄，煮取二升，去滓，加入芒硝，再上火，微一二沸，分两次温服。得下，停止服用。
〔衍义〕这是传入阳明风热很深的病症。无己说伤寒症，以阳明入腑，腹满者下之。而胸满者未深入，犹带表邪，所郁阳气不宣故尔。非汗即吐。然而未论及此痉病的胸满。胸满岂可一概而言带表乎？有表则属表，有里则属里。若此背不着席，齘齿与项肩强口噤等属表的不同，是由热入甚深所致。所以此言胸满，也是热之极。况风热燥烁津液，阴血消亡，至于下焦属阴的筋脉皆挛急了。然而其热入深者，非苦寒咸下之，不足以除其热，救其阴。夫伤寒病抽搐者，以热生风而搐，尚为难治，何况此甚于搐者，非下之不能疗也。然而也有不治的，若《灵枢》说热而痉者死，腰折抽搐齘齿也。
太阳病，关节疼痛而烦，脉沉而细的。（一作缓）此名湿痹。（玉函云中湿）湿痹的候证，小便不利，大便反快。只应当利其小便。
〔衍义〕这个症状出自《伤寒论》注释说：雾伤皮腠，湿流关节，疼痛而烦的，是湿气内流。湿同水也。脉沉而细的，水性趋下。痹痛也。因其关节烦疼而名曰湿痹，不是香港脚的痹。《内经》说：湿胜则濡泄。小便不利，大便反快的，是湿气内郁胜也。只当利其小便，以宣泄腹中湿气。所以说治湿不利小便，非其治也。虽然，大体此为小便通阳气，行水道。现在为湿气内胜，阳气被郁，所以小便不利。利之则阳气行，虽在关节之湿，亦得宣泄矣。设小便利已，而关节之痹不去，必又从表治之。
湿家之为病，一身尽疼。（一云疼烦）发热，身色如熏黄也。
〔衍义〕这个症状见于《伤寒论》注释说：色黄如橘子色者，是阳明瘀热。此身色似熏黄，即非阳明瘀热者，用栀子柏皮汤主治。为表里有热，则身不疼痛。此一身尽痛，不是伤寒客热。知湿邪在经而使之。脾恶湿，湿伤，则脾病而色见。是以身发黄者，为色黄如烟熏，非正黄色也。
湿家，其人但头汗出，背强，欲得被覆向火。如果早用下法则哕，或胸满，小便不利。（一云利）舌上如苔的，以丹田有热，胸中有寒，渴欲得饮而不能饮，则口燥烦也。
〔衍义〕按《伤寒论》成无己注释说：湿家有风湿，有寒湿，此寒湿相搏者也。湿胜则多汗，伤寒则无汗。寒湿相搏，虽有汗而不能周身，故但头汗出也。背，阳也。腹，阴也。太阳之脉，挟脊抵腰。太阳客寒湿，表气不利而背强也。里有邪者，外不恶寒。表有邪者，则恶寒。欲得被覆向火的，是寒湿在表而恶寒也。如果早用下法，则伤动胃气。
(One general discussion, twelve pulse and symptom patterns, eleven formulas)
Taiyang disease. Fever without sweating, accompanied by aversion to cold, is called Gang Jing (Stiff Spasm).
[Supplementary Note] This discusses Jing disease (stiff spasm syndrome characterized by muscle rigidity and spasms). It is not Shanghan (Cold Damage). Since it is not caused by cold pathogen, why is it attributed to the Taiyang channel? Because the patient presents with headache and pain in the waist and spine, which is no different from the damage to Ying (Nutritive Qi) in the Taiyang channel; thus, it is defined as Taiyang. However, since it is called Taiyang disease, why is it named "Jing"? The symptom of opisthotonos (arching of the back like a bow) is precisely what the *Neijing* refers to as "Jing". Jing is also caused by cold pathogen; therefore, cold stagnates and transforms into heat, Qi closes the skin and hair pores, and sweat cannot exit. This is entirely the original pattern of Ying damage. The only difference is that there is aversion to heat but rather aversion to cold. Why is there aversion to cold? Because the person was first injured by Dampness, and subsequently contracted Cold. When two Yin pathogens combine, cold is generated. Although there is fever, it is ultimately held by Dampness. Between the meridians, sinews, and joints, blockage prevents free circulation. The Yang Qi of the whole body is depressed and cannot diffuse outward. Thus, although the body is hot, the subjective feeling is aversion to cold. Furthermore, when Dampness is in the sinews and joints, Cold is constrained by it, lingering and unable to depart. Zheng Qi (Upright Qi) is obstructed, while Xie Qi (Pathogenic Qi) remains alone. How can one expect normal flexion and extension, and unimpeded movement? Opisthotonos has its origins. It is named "Gang" (Hard/Firm) because Cold pathogen is firm and strong, which is its nature. Among later famous physicians, only Wang Haizang grasped this point, expanding Zhang Zhongjing's intent. He stated that Jing can occur in the Three Yang channels and the Taiyin channel. Opisthotonos belongs to the Taiyang channel. If the head bends forward to look down, limbs are pulled, and elbows and knees touch, it is Yangming Jing. If one eye deviates left or right, accompanied by twitching of one hand and one foot, it is Shaoyang Jing. If there is fever, abdominal pain, and a deep, fine pulse, it is Taiyin Jing. This discussion is sound, but it fails to address Shaoyin and Jueyin, failing to fully cover Jing of the Three Yin channels. Do the meridians of these two organs not undergo internal and external stiffness, similar to Taiyin? Moreover, the *Lingshu* states: The tendon of Foot-Shaoyin runs along the interior of the spine, flanking it up to the nape, where it joins the tendon of Foot-Taiyang. Disease here primarily manifests as epilepsy, convulsions, and Jing. In exterior Yang diseases, the patient cannot bend forward; in interior Yin diseases, the patient cannot extend backward. Is this not Shaoyin Jing? Furthermore, the Liver of Jueyin governs the sinews. How could excessive Wind-Cold fail to injure the sinews, causing them to shorten? This can be understood by analogy.
Taiyang disease. Fever with sweating and without aversion to cold is called Rou Jing (Soft Spasm).
[Extended Meaning] This symptom also appears in the *Shanghan Lun*. The annotation states that Taiyang disease with fever and sweating indicates exterior deficiency, which should involve aversion to cold. Those without aversion to cold belong to Yangming disease. Now, fever with sweating and without aversion to cold is neither Yangming nor simply Taiyang wind-strike; it is Taiyang wind-strike compounded by Dampness, resulting in Rou Jing. Exterior deficiency combined with Dampness is thus called Rou Jing. This corresponds to the *Neijing* description of Dampness attacking internally from both interior and exterior, causing large sinews to shorten and small sinews to relax, leading to Jing. "Rou" (Soft) does not mean lack of stiffness; the difference lies in the fact that Gang Jing is stiff and forceful, whereas Rou Jing is stiff but lacks force.
Taiyang disease. Fever with a deep and fine pulse is called Jing disease, and is difficult to treat.
[Extended Meaning] This clause appeared in the *Jingbing Pian* (Chapter on Jing Disease) of the *Shanghan Lun*, where it was not described as difficult to treat. Cheng Wuji annotated it as being due to compounding Dampness. He likely considered deep and fine pulses as the root pulse of Cold-Dampness, hence not deeming it difficult to treat. However, if deep and fine pulses appear in the context of Taiyang fever (an exterior condition) not due to Cold-Dampness, it represents Yang disease presenting with Yin pulses, which is indeed very difficult to treat. Zhu Fengyi's assertion that all Jing pulses are deep, slow, wiry, and fine is incorrect. As the *Mai Jing* states: "Deep and fine pulses are named Yin within Yang, indicating shortness of Qi; obstruction of Yin Qi leads to Jing." Patients with fever and Jing are roughly similar to this.
[Supplementary Note] Taiyang is a Yang channel. Fever is a Yang syndrome. How do we know it is Jing? Because symptoms of either Gang or Rou are present. Deep and fine pulses are Yin pulses. Deep is the root pulse of Shaoyin, yet it fails to surge and manifest, appearing only faintly like a silk thread. This indicates a lack of Yang within a state of Yin deficiency. Why? Because lack of Yang causes deepness, and lack of Yin causes fineness. Can Yang syndrome with Yin pulses be easily treated? Jiayan considers it difficult to treat, implying not untreatable. By analogy, in Zhang Zhongjing's Shaoyin examples, there is the method of Mahuang Fuzi Xixin Tang. I believe this is inappropriate. In early-stage Shaoyin disease presenting with fever and deep pulse, the deep pulse is the root and fever is the branch, representing Shaoyin combined with Taiyang exterior, which is relatively manageable. But if Taiyang displays Shaoyin pulses, how could it be easy to treat? Moreover, compared to Shaoyin, there is an additional "fine" quality. Although, in the subsequent clause regarding Taiyang disease, the pulse is also deep and fine, yet it is not called difficult to treat because of Dampness. Dampness suits both fine and deep pulses. So how do we know this disease is not Dampness? Dampness must flow into the joints; since there is no joint pain, we know it is not Dampness.
Taiyang disease. Excessive sweating leads to Jing disease.
[Extended Meaning] Cheng Wuji annotates the *Shanghan Lun*: Excessive sweating causes loss of Yang. Yang Qi, when refined, nourishes the Shen (Spirit); when soft, it nourishes the sinews. If Yang is weak and cannot nourish, the sinews become tight and Jing results. While it is true that loss of Yang through sweating leads to Cold arising and tension causing Jing, describing post-sweating Jing merely as "tightness" is insufficient. Sweating requires acrid-warm agents. Even if sweat exits, heat may not resolve; instead, the acrid-warm agent aids the heat, making it more severe and causing spasms of the sinews. Also, the *Shanghan Lun* states: "In Shanghan with headache, mild fever resembling wind-strike, frequent slight sweating, and spontaneous vomiting, sweating should not be induced. Inducing sweating will result in Jing, with body stiffness and difficulty in flexion and extension." The annotation explains: Shanghan should have no sweat and aversion to cold. Headache, fever, slight sweating, and vomiting indicate the Shanghan pathogen transforming into heat and moving inward. Sweating would further weaken the exterior, allowing heat to enter the meridians. Severe heat generates Wind, causing body stiffness and Jing.
In Wind disease, purgation leads to Jing; subsequent sweating causes stiffness.
[Supplementary Note] Sinews correspond to the Liver; vessels correspond to the Heart. Wind resonates internally with the Liver and externally with the sinews. Heat resonates internally with the Heart and externally with the vessels. Therefore, in Wind disease becoming hot, the pathogen affects the sinews and vessels. If purged, Yin is depleted; if sweated, Yang is depleted. Yin deficiency leads to scant Ying Blood, causing sinews to lose nourishment and develop Jing. Yang deficiency leads to decline of Wei (Defensive) Qi, causing vessels to lose nourishment and become stiff.
Patients with chronic sores (Chuang Jia), even if they have body pain, should not be sweated. Sweating will lead to Jing.
[Extended Meaning] This clause also appears in the *Shanghan Lun* annotations. It states that exterior deficiency with accumulated heat generates sores. Patients with sores have body pain resembling Shanghan and should not be sweated. Sweating increases exterior deficiency and heat. Deficient heat generates Wind, transforming into Jing. However, if the sore has healed, and heat dissipates through open pores via sweating, this is acceptable.
A patient with body fever, cold feet, neck and nape stiffness, aversion to cold, occasional head fever, red face, red eyes, isolated head tremor, sudden lockjaw, and opisthotonos has Jing disease. If mistakenly sweated, Cold and Dampness contend, the exterior becomes more deficient, and aversion to cold worsens. After sweating, the pulse resembles a snake winding. (Alternatively described as "cang cang")
[Extended Meaning] The *Shanghan Lun* annotation says: Taiyang wind-strike compounded by Cold-Dampness transforms into Jing. Body fever and cold feet indicate Cold-Dampness injuring the lower body. Occasional head fever, red face, and red eyes indicate Wind injuring the upper body. Head tremor indicates Wind's active nature. Only the head trembles because the head is the meeting point of all Yang channels, and Wind injures Yang. Pure Wind injury would cause whole-body trembling and limb convulsions. Here, internal Cold-Dampness causes only head tremor. Lockjaw indicates Cold's property of tension. Sudden lockjaw means it is not constant but intermittent. If Wind-Cold contend, lockjaw persists without opening. This is due to added Wind-Dampness. Wind-Cold lodging in Foot-Taiyang causes sinew and vessel tension, leading to neck stiffness and opisthotonos. This symptom comes from the *Shanghan Lun*; the twenty-five characters following "no sweating" are interpolations.
I note that the *Jinkui Yaolue* contains this content, emphasizing these twenty-five characters. They require annotation. Mistakenly sweating Jing disease is wrong. This error leaves Yang Qi vainly deficient while pathogenic factors remain. It agitates Dampness, preventing its removal. The two contend and take root deeply, making Wei Qi more deficient than before sweating. Regarding the pulse: mistaken sweating forces True Yang to escape into the Dampness. Hence, the pulse is likened to a snake. Escaping Yang is naturally swift and agile like a dragon, but constrained by Dampness, it becomes sluggish like a snake, striving to move but unable to soar. This describes the variation in pulse and the subtlety of pathology.
Sudden abdominal distension indicates impending resolution. If the pulse remains unchanged but becomes hidden and wiry, it is Jing.
[Extended Meaning] The Liver corresponds to Wood in Five Elements and Wind in Six Qi. Its overcoming element is Dry Metal; the element it cannot overcome is Wet Earth. If Metal is prosperous, Wood is restricted and stagnant. Stagnant Wood must erupt, transforming into Fire, surpassing the central Earth it cannot overcome. Thus, Spleen Earth receives Wood and Fire, causing sudden abdominal distension. This aligns with the *Neijing*: "When Jueyin is in authority, abdominal distension occurs," and "All abdominal distensions belong to Heat." Thus, sudden abdominal distension indicates Wood stagnation in Spleen. Once released from Spleen, Wood Qi moves. Fire moves with it, and Dry Metal retreats. Metal retreats and Wood moves, hence "impending resolution." Resolution implies pulse movement, corresponding to a large pulse. Now, the pulse is not floating and large but unchanged, becoming hidden and wiry. This indicates Wind is still stagnant in the Liver, affecting itself. Its associated sinews and vessels have formed Jing. Before sudden distension, no symptoms were listed, yet "resolution" is mentioned, implying some prior pathology is resolving.
The pulse in Jing disease, when pressed, is tight and wiry, running straight up and down. (Alternatively described as "thumping and wiry")
[Extended Meaning] Jing disease arises from mutual interaction of Wind and Cold, compounded by pathogenic factors. Cold pulse is tight; Wind pulse is wiry; these are the root pulses. The *Mai Jing* states that "running straight up and down" refers to the Du Mai (Governing Vessel). Seeing this pulse indicates epilepsy in adults or infantile convulsions in children, both manifesting as opisthotonos. This is because the Du Mai combines with the Taiyang channel, running within the spine, pulling tightly, thus displaying the image of the Du Mai. Current Jing stiffness is indistinguishable from epileptic opisthotonos, involving the Du Mai and showing its up-and-down image.
Jing patients with moxibustion sores are difficult to treat.
[Extended Meaning] Jing involves Wind-Heat, drying and tightening sinews and bones. Moxibustion should not be used, as it aids Fire and drives it deeper. Wind-Heat combined with Fire becomes entrenched and undispersed, making treatment difficult.
The *Mai Jing* states: The pulse of Jing patients is hidden, firm, and runs straight up and down.
[Extended Meaning] The *Neijing* states: Deep and firm pulses indicate disease in the interior. The current "hidden" is equivalent to deep; "firm" is like the kidney pulse striking stones. These two clauses mention pulse without symptoms, clarifying the exterior for the previous clause and revealing interior-exterior involvement here, similar to the *Neijing*'s description of Rou Jing with rigid bones.
Taiyang disease, with all symptoms present, body stiffness and rigidity (*kukuku*), and a pulse that is surprisingly deep and slow, is Jing. Treat with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction).
Formula: Gualou Guizhi Tang
Gualou Gen (Trichosanthes Radix) - 2 liang
Guizhi (Cinnamomi Ramulus) - 3 liang
Shaoyao (Paeoniae Radix Alba) - 3 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 3 liang
Shengjiang (Zingiberis Rhizoma Recens) - 3 liang
Dazao (Zizyphi Fructus) - 13 pieces
These six ingredients are decocted in 9 sheng of water to yield 3 sheng. Divide into three warm doses. Aim for slight sweating. If no sweat occurs, after a meal interval, drink hot congee to induce sweating.
[Extended Meaning] "All symptoms present" refers to the full manifestation of Taiyang disease. The Taiyang meridian ascends from the foot, follows the back to the head and nape. Symptoms in these areas constitute the disease. In the *Shanghan Lun*, Taiyang disease with neck/back stiffness (*kukuku*), sweating, and aversion to wind is treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root). This is similar. The difference is that the former has sweating, aversion to wind, and a floating pulse; this case has a deep, slow pulse and no sweating (thus no aversion to wind). Therefore, Gegen is omitted and Gualou Gen is added. Both formulas nourish fluids, harmonize blood, and benefit sinews. In the former, neck/back stiffness precedes Jing, causing meridian tension and limited mobility. Gegen's sweet nature promotes Yang, generating fluids from the Wei level to harmonize meridians. Here, deep/slow pulse indicates no sweating and no aversion to wind, placing the disease in the Ying-Blood level of the exterior. Ying-Blood is Yin, heavy and slow, matching the pulse. Internally, sinews lack nourishment, causing Jing. Gualou Gen, bitter and entering Yin, generates Ying-Blood, benefits Yin fluids, and nourishes sinews as the Sovereign herb. Guizhi's acridity disperses; Shaoyao's sourness astringes. One Yin, one Yang, interior and exterior, serve as Ministers. Gancao, Ginger, and Jujube combine acrid-sweet flavors to move Spleen fluids and harmonize Ying-Wei as Envoys. This is the principle of the formula.
Taiyang disease, with no sweating, reduced urination, Qi rushing to the chest, lockjaw preventing speech, and impending Gang Jing. Treat with Gegen Tang (Kudzu Root Decoction).
Formula: Gegen Tang
Gegen (Puerariae Radix) - 4 liang
Mahuang (Ephedrae Herba) - 3 liang, nodes removed
Guizhi (Cinnamomi Ramulus) - 2 liang, bark removed
Shaoyao (Paeoniae Radix Alba) - 2 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried
Shengjiang (Zingiberis Rhizoma Recens) - 3 liang
Dazao (Zizyphi Fructus) - 12 pieces
These seven ingredients are chopped. Decoct in 1 dou of water. First boil Mahuang and Gegen, reducing by 2 sheng, skimming foam. Add other herbs, boil to yield 3 sheng. Strain. Warm dose 1 sheng. Cover to obtain slight sweat. No need for congee. Rest follow Guizhi Tang instructions and taboos.
[Extended Meaning] The *Shanghan Lun* mentions Taiyang disease with neck/back stiffness (*kukuku*), no sweating, and aversion to wind, treated with Gegen Tang. Annotation: Light agents remove excess; due to Cold and exterior excess, Mahuang and Gegen dispel Wind, and Guizhi Tang harmonizes the exterior. Why use this for reduced urination, Qi rushing to chest, lockjaw, and impending Gang Jing? Taiyang is about to transmit to Yangming. Yangming rejects the pathogen, causing Qi to rush upward to the chest. Yangming sinews knot at the stomach entrance, run through the chest, pass Renying, and circle the lips/mouth. As a channel with abundant Qi and Blood, and located near the Lung in the Upper Jiao (which distributes fluids and governs water passages), simultaneous Heat in Taiyang and Yangming in the chest blocks water passages (reduced urination) and fluid distribution (no sweating). Renying is near the larynx and voice mechanism. Sinews passing through encounter combined Heat, contracting and pulling, causing lockjaw and impending Gang Jing. The chest is near the exterior; superiorly it relates to Taiyang, anteriorly to Yangming. This formula treats both channels. Gegen is a Yangming herb, generating fluids, inducing sweat, promoting urination, and releasing muscles. Yi Lao said: In early Taiyang disease not yet in Yangming, Gegen should not be used, as it invites thieves to destroy the home. Using it cuts off Taiyang, developing Yangming Qi to repel invading Taiyang pathogen. Thus, Zhang Zhongjing treats Taiyang-Yangming combined disease with Guizhi Tang plus Mahuang and Gegen.
Jing disease. (Some editions add "Gang" before Jing.) Chest fullness, lockjaw, inability to lie flat (back not touching the mat), leg cramps, and teeth grinding. Administer Dachengqi Tang (Major Order the Qi Decoction).
Formula: Dachengqi Tang
Dahuang (Rhei Radix et Rhizoma) - 4 liang, wine-washed
Houpo (Magnoliae Officinalis Cortex) - 0.5 jin, honey-fried, bark removed
Zhishi (Aurantii Fructus Immaturus) - 5 pieces, honey-fried
Mangxiao (Natrii Sulfas) - 3 he
These four ingredients are decocted in 1 dou of water. First boil Houpo and Zhishi to yield 5 sheng. Strain. Add Dahuang, boil to yield 2 sheng. Strain. Add Mangxiao. Boil briefly over fire. Divide into two warm doses. Stop taking once bowel movement occurs.
[Extended Meaning] This represents deep transmission of Wind-Heat to Yangming. Wuji states that in Shanghan, Yangming fu organ fullness is treated with purgation. Chest fullness indicates shallow invasion, retaining exterior pathogen, with stagnant Yang Qi unable to disperse. Treatment should be sweating or vomiting. However, this does not address chest fullness in Jing. Can chest fullness always be attributed to the exterior? Exterior cases belong to exterior; interior cases belong to interior. Unlike back stiffness, teeth grinding, and neck/shoulder tension which are exterior, this is caused by deep Heat penetration. Thus, chest fullness here signifies extreme Heat. Wind-Heat dries fluids and consumes Yin-Blood, causing lower Jiao Yin sinews to cramp. Deep Heat requires bitter-cold and salty-purgative methods to clear Heat and save Yin. In Shanghan, convulsions caused by Heat generating Wind are difficult to treat; Jing worse than convulsions requires purgation. However, some are untreatable. The *Lingshu* states: Heat with Jing leads to death, with back bending, convulsions, and teeth grinding.
Taiyang disease, with joint pain and irritability, and a deep, fine pulse. (Alternatively described as slow). This is named Shi Bi (Dampness Bi). (Yufan edition says "Middle Dampness"). Signs of Shi Bi include difficult urination and loose stools. Treatment should focus on promoting urination.
[Extended Meaning] This symptom appears in *Shanghan Lun* annotations: Fog injures skin and pores; Dampness flows into joints, causing pain and irritability due to internal Dampness flow. Dampness is like Water. Deep and fine pulses reflect Water's tendency to sink. Bi pain is named Shi Bi due to joint pain and irritability, distinct from gouty Bi. The *Neijing* states: Excess Dampness causes loose stools. Difficult urination and loose stools indicate internal Dampness excess. Promote urination to drain abdominal Dampness. Thus, treating Dampness without promoting urination is incorrect. Generally, urination regulates Yang Qi and water passages. Internal Dampness excess depresses Yang Qi, causing difficult urination. Promoting urination allows Yang Qi to move, draining Dampness from joints. If urination improves but joint Bi persists, treat from the exterior.
Patients prone to Dampness suffer from generalized body pain. (Alternatively described as painful irritability), fever, and a sallow complexion resembling smoked yellow.
[Extended Meaning] This symptom appears in *Shanghan Lun* annotations: Yellow like orange peel indicates Yangming stasis-heat. Sallow color resembling smoked yellow is not Yangming stasis-heat; it is treated with Zhizi Baipi Tang (Gardeniae and Phellodendri Decoction). Interior-exterior heat usually causes no body pain. Generalized pain indicates non-Shanghan exogenous heat. Dampness in the meridians causes this. Spleen dislikes Dampness; Dampness injury damages Spleen, manifesting in complexion. Yellow skin resembles smoke, not bright yellow.
Patients prone to Dampness sweat only on the head, have back stiffness, and desire covering with blankets facing fire. Early purgation causes hiccups, chest fullness, or difficult urination. (Alternatively described as normal urination). Tongue coating resembling moss indicates Heat in the Lower Dantian and Cold in the Chest. Thirst with desire to drink but inability to swallow causes dry mouth and irritability.
[Extended Meaning] Cheng Wuji annotates: Dampness patients have Wind-Damp or Cold-Damp. This is Cold-Damp contention. Excess Dampness causes sweating; Shanghan causes no sweating. Cold-Damp contention allows sweating but not over the whole body, hence only head sweating. Back is Yang; abdomen is Yin. Taiyang meridian flanks the spine to the waist. External Cold-Damp impedes exterior Qi, causing back stiffness. Interior pathogens do not cause exterior aversion to cold. Exterior pathogens cause aversion to cold. Desire for blankets facing fire indicates Cold-Damp in the exterior causing aversion to cold. Early purgation injures Stomach Qi.