风湿痛。则轻。掣不可屈伸。此痛之有别者也。湿家发热早暮不分微甚。风湿之热。日晡所必剧。盖以湿
无来去。而风有休作。故名风湿。原其由来。或为汗出当风。或为久伤取冷。相合而致。
则麻黄杏仁薏苡甘草汤。发散风湿。可与也。明矣。
〔尤〕痉病非风不成。湿痹无寒不作。故以麻黄散寒。薏
苡除湿。杏仁利气。助通泄之用。甘草补中。予胜湿之权也。
麻黄杏仁薏苡甘草汤方
麻黄（去节半两汤泡○案外台作四两无汤泡二字是） 甘草（一两炙○案外台作二
两是） 薏苡仁（半两○案外台作半升是） 杏仁（十个去皮尖炒○案外台作二两无炒字徐沈亦删炒是）
上锉麻豆大。每服四钱匕。水盏半。煮八分。去滓。温服。有微汗避风。
案此方剂小。而煎法与诸方异。盖后人所改定。外台香港脚门所载却是原方。（分两注于各药下。）云。
湿家始得病时。可与薏苡麻黄汤。（引古今录验。）方后云。上四味 咀。以水五升。煮取
二升。分再服。汗出即愈。湿家烦疼。可以甘草麻黄汤发汗。不瘥更合。饮家。加白术四两。名白术麻黄汤。
是也。薏苡。本经云。治风湿痹。别录云。除筋骨中邪气。本方证。比之
于麻黄加术汤证。湿邪滞着较深。故用此等品。
风湿脉浮。身重。汗出恶风者。防己黄 汤主之。
〔鉴〕脉浮。风也。身重。湿也。寒湿则脉沉。风湿则脉浮。若浮而汗不出恶风者。为实邪。可与麻
黄杏仁薏苡甘草汤汗之。浮而汗出恶风者。为虚邪。故以防己白术。以去湿。黄 甘草。以固表。生姜大枣。
以和营卫也。赵良曰。身重。乃风湿在皮毛之表。故不作疼。虚其卫气。而湿着为身重。
故以黄 实卫。甘草佐之。防己去湿。白术佐之。然则风湿二邪。无散风之药何耶。盖汗多。知其风已不留。
以表虚而风出入乎其间。因之恶风尔。惟实其卫。正气壮则风自退。此不治而治者也。
〔尤〕风湿在表。法
当从汗而解。乃汗不得发。而自出。表尚未解。而已虚。汗解之法。不可守矣。故
不用麻黄。出之皮毛之表。而用防己。驱之肌肤之里。然非 术甘草。焉能使卫阳复振。而驱湿下行哉。
防己黄 汤方
防己（一两○案千金外台作四两是） 甘草（半两炒○案水气病篇炒作炙外台作一
两是） 白术（七钱半○案千金作三两是） 黄 （一两一分去芦○案千金外台作五两是）
上锉麻豆大。每抄五钱匕。生姜四片。大枣一枚。水盏半。煎八分。去滓温服。良久再服。○喘者。
加麻黄半两。○胃中不和者。加芍药三分。○气上冲者。加桂枝三分。○下有陈寒者。加细辛三分。○服后当
如虫行皮中。从腰下如冰。后坐被上。又以一被绕腰下。温令微汗瘥。（冰赵本。作水。绕腰下。
赵徐沈金鉴。作绕腰以下。）
案此方分两煎法。亦系于后人改定。千金却是原方。作生姜三两。大枣十二枚。云。上六味 咀。以
水六升。煮取三升。分三服。服了坐被中。欲解如虫行皮。卧取汗。千金。
无方名。脉经。作防己汤。活人书。名汉防己汤。
溯源集云。脉浮汗出恶风。似乎风邪在表。应用桂枝。而仲景又侦知其卫气已虚。皮肤不密。毛孔
不闭。所以汗出恶风。乃湿家之表虚者。故用防己利水。以黄 固表。白术甘草。燥湿补中而已。皆因其表气
已虚。卫阳不固。并微似汗之桂枝。亦不轻用矣。非用意渊深。而能制方若是耶。
伤寒八九日。风湿相搏。身体疼烦。不能自转侧。不呕不渴。脉浮虚而涩者。桂枝附子汤主之。若大
便坚。小便自利者。去桂加白术汤主之。（渴下。千金翼。有下已二字。外台。有下之二字。
太阳下编。若下有其人二字。坚作硬。宋版注。一云。脐下心下硬。脉经。作去桂加术附子汤。是。）
〔鉴〕谓此风湿之病。虽得之伤寒八九日。而不呕不渴。是无伤寒里病之证也。脉浮虚涩。是无伤寒
表病之脉也。脉浮虚。表虚风也。涩者湿也。身体烦疼。风也。不能转侧。湿也。乃风湿相搏之身体疼痛。
非伤寒骨节疼痛也。与桂枝附子汤。温散其风湿。从表而解也。若脉浮实者。则又当以
麻黄加术汤。大发其风湿也。如其人有是证。虽大便硬小便自利。而不议下者。以其非邪热入里之硬。乃风
燥湿去之硬。故仍以桂枝附子汤。去桂枝者。以大便坚小便自利。不欲其发汗。再夺津液也。加白术者。以
身重着湿在肌分。用以佐附子。逐水气于皮中也。
〔尤〕脉浮虚而涩。知风湿外持。而
卫阳不正。故以桂枝汤。去芍药之酸收。加附子之辛温。以振阳气。而敌阴邪。若大便坚。小便自利。知其
在表之阳虽弱。而在里之气犹冷。则皮中之湿。自可驱之于里。使从水道而出。不必更发其表。以危久弱之
阳矣。故于前方。去桂枝之辛散。加白术之苦燥。合附子之大力健行者。于以并走
皮中。而逐水气。亦因势利导之法也。
案去桂加白术之义。未得其详。沈云。若中虚邪陷。逼迫津液。偏渗前阴。不润肠间。则大便坚。小便
自利。所以去走表之桂枝。加白术。安中而生营血津液。滋润肠间之燥耳。白术润燥。恐误。
溯源集云。湿在里。则小便不利。大便反快。大便硬则湿不在里。小便利。则湿气已去。不须汗泄。故
去桂枝。想风湿之后。寒湿之余气未尽。身体尚疼。转侧未便。故仍用去桂枝之白术附子汤也。
桂枝附子汤方
桂枝（四两去皮） 生姜（三两切） 附子（三枚炮去皮破八片） 甘草（二两炙） 大枣（十二枚擘）
上五味。以水六升。煮取二升。去滓。分温三服。
溯源集云。风邪。非桂枝不能汗解。寒邪。非附子不足以温经。非生姜。亦不能宣发。甘草大枣。缓
姜附之性。助桂枝而行津液也。此方乃太阳上编误下之后。脉促胸满微恶
寒之桂枝去芍药汤。而加附子。非汗后遂漏不止之桂枝加附
子汤也。桂枝附子汤。乃去芍药者。故另立一名。而无加字。桂枝加附子汤。乃不去芍药者。即于桂枝全
汤中加入。故多一加字。观仲景立法处方。无不各有深意。
三因术附汤。治冒雨湿着于肌肤。与胃气相并。或腠开汗出。因浴得之。（即于本方。加白术茯苓。）
白术附子汤方
白术（二两） 附子（一枚半炮去皮） 甘草（一两炙） 生姜（一两半切） 大枣（六枚）
上五味。以水三升。煮取一升。去滓分温三服。一服觉身痹。半日许再服。三服都尽。其人如冒状。
勿怪。即是术附并走皮中。逐水气未得除故耳。（太阳下编。白术四两。附子三枚。甘草二两。生姜三两。
大枣十二枚。擘。外台同。魏云如冒。法律。改为如 。不敢从。）
溯源集云。即术附汤也。因承上文桂枝附子汤加减。故云去桂枝加白术汤也。古方术上。无白字。故
称术附汤。（成本伤寒论。误附桂枝加附子汤后。）方中用附子二枚。古之附子。乃山野所生。或小于今之
种莳者。亦未可为定法。恐是后人传写之误。以愚意度之。当以应用之分两为度。桂枝四两。即宋
之一两八分。元则较重于宋。今更重矣。生姜三两。即宋之八钱。附子若用一枚。约重一两二三钱。炮过可
得干者三钱半。若分三次服。亦不为过。前人有古方不可治今病之说。皆不知古今斤两不同故也。
三因。生附白术汤。治中风湿。昏闷恍惚。胀满身重。
手足缓纵。 自汗。失音不语。便利不禁。（于本方。干姜。代生姜。去大枣。）
曾氏活幼口议云。术附汤。治小儿脏腑虚寒。泄泻洞利。手足厥冷。（即本方。干姜代生姜。去大枣。）
风湿相搏。骨节疼烦。掣痛不得屈伸。近之则痛剧。汗
出短气。小便不利。恶风不欲去衣。或身微肿者。甘草附子汤主之。（疼烦。成本伤寒论。作烦疼。）
〔沈〕此阳虚邪盛之证也。风湿伤于营卫。流于关节经络之间。邪正相搏。骨节疼烦掣痛。阴血凝滞。
阳虚不能轻跷。故不得屈伸。近之则痛剧也。卫阳虚而汗出。里气不足。则短气而小便不利。表阳虚而恶风不
欲去衣。阳伤气滞。故身微肿。然表里阴阳。正虚邪实。故用甘术附子。助阳健脾除湿。固护而防汗脱。桂
枝宣行营卫。兼去其风。乃补中有发。不驱邪而风湿自除。盖风湿证。须识无热自汗。便是阳气大
虚。当先固阳为主。
喻氏尚论篇云。此条复互上条之意。而辨其症之较重者。痛不可近。汗出短气。恶风不欲去衣。小便
不利。或身微肿。正相搏之最剧处。方氏条辨云。或未定之词。身微肿湿外薄也。不外薄则不肿。故曰或也。
甘草附子汤方
甘草（二两炙） 附子（二枚炮去皮） 白术（二两） 桂枝（四两去皮）
上四味。以水六升。煮取三升。去滓温服一升。日三服。初服得微汗则解。能食汗出复烦者。服五合。
恐一升多者。服六七合为妙。（妙。宋版伤寒论。作始。徐沈作佳。）
徐氏方论云。此与桂枝附子汤证。同是风湿相搏。然后彼以病浅寒多。故肢体为风湿所困。而患止躯壳
之中。此则风湿两胜。挟身中之阳气。而奔逸为灾。故骨节间。风入增劲。不能屈伸。大伤其卫。而汗出短
气恶风。水亦乘风作势。而身微肿。其病势方欲扰乱于肌表。与静而困者不侔矣。此
方附子除湿温经。桂枝祛风和营。术去湿实卫。甘草补诸药。而成敛散之功也。
溯源集云。虽名之曰甘草附子汤。实用桂枝去芍药汤。以汗解风邪。增入附子白术。以驱寒燥湿也。
千金。香港脚门。四物附子汤。即是。后方云。体肿者。加防己四两。悸气小便不利。加茯苓三两。既
有附子。今加生姜三两。三因方。名之六物附子汤。外台。载古今录验附子汤。即本方。
三因桂枝附子汤。主疗同本条。（即本方。）
太阳中 。发热恶寒。身重而疼痛。其脉弦细芤迟。小便已洒洒然毛耸。手足逆冷。小有劳身即热。口
前开板齿燥。若发其汗。则其恶寒甚。加温针则发热甚。数下之则淋甚。（伤寒论。作口开前板齿燥。诸家注
本亦同。宜改。伤寒论。恶寒甚上。无其字。玉函脉经。作发热益甚。脉经。淋上。有复字。）
〔程〕内经曰。先夏至为病温。后夏至为病暑。又曰。热病者。皆伤寒之类也。以其太阳受病。与伤寒相
似。亦令发热恶寒。身重而疼痛也。内经曰。寒伤形。热伤气。气伤则气消。而脉虚弱。所以弦细芤迟也。
小便已毛耸者。阳气内陷。不能卫外。手足亦逆冷也。劳动则扰乎阳。故小劳身即热也。内经曰。因于暑汗。
烦则喘喝。故热盛则口开。口开则前板齿燥也。发汗虚其阳。则恶寒甚。温针动火邪。则发
热甚。下之亡津液。则淋甚也。（案此注本于成氏。）
溯源集云。太阳中 。而发热恶寒。不云汗出。而又不渴。是以知其非阳邪独盛之 也。脉弦则阴邪
劲急。细则元气已虚。芤则脉空。迟则为寒。小便已洒洒然毛耸者。小便虽通。其茎中艰涩可知。卫阳已虚。
恶寒之状可见。乃下焦无火。气化不快于流行也。四肢为诸阳之本。手足逆冷者。是阳虚而气不达于四肢也。
凡此皆阴寒无火之脉症也。小有劳身即热者。起居动静间。小有劳动。即扰动其阳气。而虚
邪伏暑。即因之而发热也。口开前板齿燥者。脉虽弦细芤迟。
症虽手足逆冷。以小劳而鼓动其阳邪。身热而枯燥其津液。虽不渴。而板齿燥矣。若发其汗。则卫阳愈虚。阳
虚则生外寒。故恶寒甚。若加温针。则火力内攻。必反助其暑热之阳邪。故发热甚。邪不在里。而数下之。适
足以败坏真阳。使下焦愈冷。气化不行。小便艰涩而淋甚也。
喻氏医门法律云。夏月人身之阳。以汗而外泄。人身之阴以热而内耗。阴阳两俱不足。仲景于中 。禁
汗下温针。汗则伤其阳。下则伤其阴。温针则引火热内攻。故禁之也。而其用药。但取甘寒生津保肺。固阳
益阴为治。此等关系最钜。○伤寒选录云。徐氏曰。此条无治法。东垣以清暑益气汤主之。所谓发千古之秘也。
案医垒元戎。黄 汤。治中 。脉弦细芤迟。人参、白术、黄 、甘草、茯苓、芍药、生姜、
各等分。正为此条证设。东垣方有黄柏。专治长夏湿热之证。与本条之证自别。
太阳中热者。 是也。汗出恶寒。身热而渴。白虎加人参汤主之。（伤寒论。渴下。有也字。无白虎加
人参汤主之八字。以此条揭中 之首。沈本金鉴。亦举之首条。玉函脉经。无加人参三字。）
〔沈〕此言正暑病也。邪之伤人。无有不从皮毛而入。故曰太阳中热。
〔鉴〕汗出恶寒。身热而渴。颇
似太阳温热之病。但温热无恶寒。以热从里生。故虽汗出而不恶寒也。中 暑邪由表而入。故汗出恶寒也。
究之于渴。温热之渴。初病不过欲饮。中 之渴。初病即大引饮也。用白虎加人参汤主之者。盖以益气为主。
清暑热次之也。李 曰。热伤气。气泄则汗出。气虚则恶寒。热蒸肌腠则身热。热伤津液则作渴。
此恶寒身热。与伤寒相类。然所异者。伤寒初起。无汗不渴。中 初起。即汗出而渴也。
风湿病引起的疼痛，在活动时减轻，但牵掣感强烈，导致关节无法屈伸。这是疼痛性质有别于其他病症的表现。患湿病的人发热，早晚程度没有明显区别；而风湿病的发热，在下午申时（日晡所）必然加重。这是因为湿气没有明显的来去变化，而风邪则有发作和休止的规律，所以称为“风湿”。追溯其病因，有的是因为出汗时受风，有的是因为长期贪凉受寒，风与湿相合而致病。此时应当使用麻黄杏仁薏苡甘草汤，发散风湿，这是很明确的。
〔尤在泾〕痉病没有风邪不能形成，湿痹没有寒邪不能发作。所以用麻黄散寒，薏苡仁除湿，杏仁理气，以助通泄的作用；甘草补益中气，赋予胜湿的权力。
麻黄杏仁薏苡甘草汤方
麻黄（去节半两，用汤浸泡○按：《外台秘要》作四两，无“汤泡”二字，是正确的） 甘草（一两，炙○按：《外台秘要》作二两，是正确的） 薏苡仁（半两○按：《外台秘要》作半升，是正确的） 杏仁（十个，去皮尖，炒○按：《外台秘要》作二两，无“炒”字，徐灵胎、沈明宗也删去“炒”字，是正确的）
以上药物锉成如麻豆大小。每次服用四钱匕，用水一盏半，煮至八分，去渣，温服。服药后若有微汗，应注意避风。
案：此方剂量较小，且煎法与其他方剂不同，大概是后人改定的。《外台秘要·香港脚门》所载的却是原方。（分量注在各药下面。）说：“湿家初得病时，可与薏苡麻黄汤。”（引用自《古今录验》）。方后说：“以上四味，咀碎，用水五升，煮取二升，分两次服。汗出即愈。湿家烦疼，可以用甘草麻黄汤发汗，如果不愈再配制。如果是饮水多的人，加白术四两，名叫白术麻黄汤。”这就是了。薏苡仁，《本经》说治风湿痹，《别录》说除筋骨中的邪气。本方的证候，与麻黄加术汤证相比，湿邪滞留较深，所以用这类药物。
风湿病脉浮，身体沉重，汗出恶风的，用防己黄芪汤主治。
〔赵良〕脉浮，是风邪；身重，是湿邪。寒湿则脉沉，风湿则脉浮。如果脉浮而不出汗、恶风，属于实邪，可用麻黄杏仁薏苡甘草汤发汗。如果脉浮而出汗、恶风，属于虚邪，所以用防己、白术去湿，黄芪、甘草固表，生姜、大枣调和营卫。赵良说：身重，是因为风湿在皮毛之表，所以不痛。卫气虚弱，湿气附着导致身重。所以用黄芪充实卫气，甘草辅助它；防己去湿，白术辅助它。那么风湿二邪，为什么不用散风的药呢？因为汗多，知道风邪已经不再停留。由于表虚，风邪出入其间，因此恶风。只要充实卫气，正气壮盛则风邪自退，这是不治风而风自去的治法。
〔尤在泾〕风湿在表，法当从汗而解，但是汗不得发，反而自出，表证尚未解除，而正气已虚，汗解的方法不可拘守了。所以不用麻黄从皮毛之表发出，而用防己从肌肤之里驱除。然而如果没有白术、甘草，怎么能使卫阳复振，从而驱湿下行呢？
防己黄芪汤方
防己（一两○按：《千金方》、《外台秘要》作四两，是正确的） 甘草（半两，炒○按：《水气病篇》写作炙，《外台秘要》作一两，是正确的） 白术（七钱半○按：《千金方》作三两，是正确的） 黄芪（一两一分，去芦○按：《千金方》、《外台秘要》作五两，是正确的）
以上药物锉成如麻豆大小。每次取五钱匕，生姜四片，大枣一枚，用水一盏半，煎至八分，去渣温服。隔一段时间再服。○如果有喘症，加麻黄半两。○如果胃中不和，加芍药三分。○如果有气上冲的感觉，加桂枝三分。○如果下部有陈寒，加细辛三分。○服药后应当感觉像虫子在皮肤中爬行，腰部以下像冰一样冷。之后坐在被子上，再用一条被子绕在腰下，温热令其微汗出则病愈。（“冰”字，赵本、徐灵胎、沈明宗、《医宗金鉴》作“水”。绕腰下，赵本、徐灵胎、沈明宗、《医宗金鉴》作“绕腰以下”。）
案：此方的分量和煎法，也是后人改定的。《千金方》却是原方，作生姜三两，大枣十二枚。说：“以上六味，咀碎，用水六升，煮取三升，分三次服。服完坐在被中，想要解病时感觉像虫子在皮肤中爬，躺着取汗。”《千金方》没有方名。《脉经》作防己汤。《活人书》名汉防己汤。
《溯源集》说：脉浮、汗出、恶风，似乎风邪在表，应用桂枝。但张仲景又探测到其卫气已虚，皮肤不密，毛孔不闭，所以汗出恶风，这是湿家的表虚证。所以用防己利水，用黄芪固表，白术、甘草燥湿补中罢了。都是因为表气已虚，卫阳不固，连微似汗出的桂枝也不敢轻易使用。如果不是用意深远，怎么能制方如此精妙呢？
伤寒八九日，风湿相搏，身体疼痛烦躁，不能自行转侧，不呕不渴，脉浮虚而涩的，用桂枝附子汤主治。如果大便坚硬，小便自利的，用去桂加白术汤主治。（“渴”字下，《千金翼方》有“下已”二字，《外台秘要》有“之下”二字，《太阳下编》若下有“其人”二字。“坚”作“硬”。宋版注：一说脐下、心下硬。《脉经》作去桂加术附子汤，是正确的。）
〔赵良〕说这个风湿病，虽然是伤寒八九日后得的，但不呕不渴，是没有伤寒里病的证候。脉浮虚涩，是没有伤寒表病的脉象。脉浮虚，是表虚风邪；涩者，是湿邪。身体烦疼，是风邪；不能转侧，是湿邪。这是风湿相搏的身体疼痛，不是伤寒的骨节疼痛。给予桂枝附子汤，温散其风湿，从表而解。如果脉浮实，则又应当用麻黄加术汤，大发其风湿。如果病人有这些证候，虽然大便硬、小便自利，也不议攻下，因为这不是邪热入里的硬结，而是风燥、湿去后的硬结，所以仍以桂枝附子汤为主。去掉桂枝的原因，是因为大便坚、小便自利，不想让它再发汗，再次劫夺津液。加入白术的原因，是因为身体重着，湿在肌分，用来佐助附子，驱逐皮中的水气。
〔尤在泾〕脉浮虚而涩，知道风湿外持，而卫阳不正。所以用桂枝汤，去掉芍药的酸收，加入附子的辛温，以振奋阳气，抵御阴邪。如果大便坚、小便自利，知道在表的阳气虽弱，但在里的气犹冷，则皮中的湿，自然可以驱之于里，使从水道而出，不必再发其表，以危及久弱的阳气。所以在前方中，去掉桂枝的辛散，加入白术的苦燥，配合附子的大力健行者，一起走于皮中，驱逐水气，这也是因势利导的方法。
案：关于去桂加白术的含义，没有得到详细解释。沈明宗说：如果中虚邪陷，逼迫津液，偏渗前阴，不润肠间，则大便坚、小便自利。所以去掉走表的桂枝，加入白术，安中而生营血津液，滋润肠间的干燥罢了。白术润燥，恐怕是错误的。
《溯源集》说：湿在里，则小便不利，大便反快。大便硬则湿不在里，小便利则湿气已去，不需要汗泄。所以去桂枝。想风湿之后，寒湿之余气未尽，身体尚疼，转侧未便，所以仍用去桂枝的白术附子汤。
桂枝附子汤方
桂枝（四两，去皮） 生姜（三两，切） 附子（三枚，炮，去皮，破为八片） 甘草（二两，炙） 大枣（十二枚，擘开）
以上五味，用水六升，煮取二升，去渣，分三次温服。
《溯源集》说：风邪，非桂枝不能汗解；寒邪，非附子不足以温经；非生姜，也不能宣发。甘草、大枣，缓和姜、附的性子，助桂枝而行津液。此方乃是《太阳上编》误下之后，脉促胸满微恶寒的桂枝去芍药汤，再加附子，而不是汗后遂漏不止的桂枝加附子汤。桂枝附子汤，是去芍药的，所以另立一名，而无“加”字。桂枝加附子汤，是不去芍药的，即在桂枝全汤中加入，故多一个“加”字。看张仲景立法处方，无不各有深意。
三因术附汤，治疗冒雨湿着于肌肤，与胃气相并，或者腠理开泄汗出，因沐浴得之。（即在本方基础上，加白术、茯苓。）
白术附子汤方
白术（二两） 附子（一枚半，炮，去皮） 甘草（一两，炙） 生姜（一两半，切） 大枣（六枚）
以上五味，用水三升，煮取一升，去渣，分三次温服。第一服觉得身体麻木，约半小时后再服。三服都喝完，病人如有头昏蒙的样子，不要奇怪。这就是术、附并走皮中，逐水气未得除的缘故。（《太阳下编》，白术四两，附子三枚，甘草二两，生姜三两，大枣十二枚，擘开。《外台秘要》相同。魏荔彤说“如冒”，《法律》改为“如瘖”，不敢从。）
《溯源集》说：就是术附汤。因为承接上文桂枝附子汤的加减，所以说去桂枝加白术汤。古方“术”上，无“白”字，故称术附汤。（《成本伤寒论》误放在附桂枝加附子汤后。）方中用附子二枚，古代的附子，乃山野所生，可能小于现在的种植者，也不可定为定法。凭我推测，应当以应用的分量为度。桂枝四两，即宋代的一两八分。元代比宋代重，现在更重了。生姜三两，即宋代的八钱。附子若用一枚，约重一两二三钱，炮过后可得干者三钱半。若分三次服，也不算过量。前人有人说古方不可治今病，都是不知道古今斤两不同的缘故。
三因方生附白术汤，治疗中风湿，昏闷恍惚，胀满身重，手足缓纵，自汗，失音不语，大小便不禁。（在本方中，用干姜代替生姜，去大枣。）
曾氏《活幼口议》说：术附汤，治疗小儿脏腑虚寒，泄泻洞利，手足厥冷。（即本方，用干姜代替生姜，去大枣。）
风湿相搏，骨节疼烦，掣痛不得屈伸，靠近则痛剧，汗出短气，小便不利，恶风不欲去衣，或者身体微肿的，用甘草附子汤主治。（“疼烦”，《成本伤寒论》作“烦疼”。）
〔沈明宗〕这是阳虚邪盛的证候。风湿伤于营卫，流于关节经络之间，邪正相搏，骨节疼烦掣痛，阴血凝滞，阳虚不能轻跷，所以不得屈伸，靠近则痛剧。卫阳虚而汗出，里气不足，则短气而小便不利。表阳虚而恶风不欲去衣，阳伤气滞，故身体微肿。然而表里阴阳，正虚邪实，所以用甘、术、附子，助阳健脾除湿，固护而防止汗脱。桂枝宣行营卫，兼去其风，这是补中有发，不驱邪而风湿自除。大概风湿证，须识别无热自汗，便是阳气大虚，应当先固阳为主。
喻嘉言《尚论篇》说：此条反复互参上条之意，而辨别其症状较重者。痛不可近，汗出短气，恶风不欲去衣，小便不利，或身体微肿，正是相搏最剧烈的地方。方有执《条辨》说：或者是不确定的词，身体微肿是湿邪外薄。不外薄则不肿，所以说“或”。
甘草附子汤方
甘草（二两，炙） 附子（二枚，炮，去皮） 白术（二两） 桂枝（四两，去皮）
以上四味，用水六升，煮取三升，去渣温服一升，每日三次。初服得微汗则病解。能食但汗出又烦的，服五合。恐怕一升太多的，服六七合为妙。（“妙”字，宋版《伤寒论》作“始”。徐灵胎、沈明宗作“佳”。）
徐灵胎《方论》说：此方与桂枝附子汤证，同是风湿相搏。但彼方因病浅寒多，所以肢体为风湿所困，而病止于躯壳之中。此方则是风湿两胜，挟身中之阳气，而奔逸为灾。所以骨节间，风入增劲，不能屈伸，大伤其卫，而汗出短气恶风。水也乘风作势，而身体微肿。其病势正欲扰乱于肌表，与静而困者不同了。此方附子除湿温经，桂枝祛风和营，白术去湿实卫，甘草补诸药，而成敛散之功。
《溯源集》说：虽然名为甘草附子汤，实际是用桂枝去芍药汤，以汗解风邪，增入附子、白术，以驱寒燥湿。《千金方·香港脚门》的四物附子汤，即是此方。后方说：体肿者，加防己四两。悸气小便不利，加茯苓三两。既有附子，今加生姜三两，《三因方》名之六物附子汤。《外台秘要》载《古今录验附子汤》，即本方。
三因桂枝附子汤，主疗同本条。（即本方。）
太阳中暍，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已洒洒然毛耸，手足逆冷，小有劳身即热，口前开板齿燥。如果发其汗，则其恶寒甚；加温针则发热甚；数下之则淋甚。（《伤寒论》作“口开前板齿燥”，诸家注本亦同，宜改。《伤寒论》“恶寒甚”上，无“其”字。《玉函》、《脉经》作“发热益甚”。《脉经》“淋”上，有“复”字。）
〔程知〕《内经》说：先夏至为病温，后夏至为病暑。又说：热病者，皆伤寒之类也。因其太阳受病，与伤寒相似，也令发热恶寒，身重而疼痛。《内经》说：寒伤形，热伤气。气伤则气消，而脉虚弱，所以弦细芤迟。小便已毛耸者，阳气内陷，不能卫外，手足亦逆冷。劳动则扰乎阳，故小劳身即热。《内经》说：因于暑汗，烦则喘喝。故热盛则口开，口开则前板齿燥。发汗虚其阳，则恶寒甚；温针动火邪，则发热甚；下之亡津液，则淋甚。（案：此注本于成无己。）
《溯源集》说：太阳中暍，而发热恶寒，不云汗出，而又不渴，是以知其非阳邪独盛之暍。脉弦则阴邪劲急，细则元气已虚，芤则脉空，迟则为寒。小便已洒洒然毛耸者，小便虽通，其茎中艰涩可知，卫阳已虚，恶寒之状可见，乃下焦无火，气化不快于流行也。四肢为诸阳之本，手足逆冷者，是阳虚而气不达于四肢也。凡此皆阴寒无火之脉症也。小有劳身即热者，起居动静间，小有劳动，即扰动其阳气，而虚邪伏暑，即因之而发热也。口开前板齿燥者，脉虽弦细芤迟，症虽手足逆冷，以小劳而鼓动其阳邪，身热而枯燥其津液，虽不渴，而板齿燥矣。若发其汗，则卫阳愈虚，阳虚则生外寒，故恶寒甚。若加温针，则火力内攻，必反助其暑热之阳邪，故发热甚。邪不在里，而数下之，适足以败坏真阳，使下焦愈冷，气化不行，小便艰涩而淋甚也。
喻嘉言《医门法律》说：夏月人身之阳，以汗而外泄，人身之阴以热而内耗，阴阳两俱不足。仲景于中暍，禁汗下温针。汗则伤其阳，下则伤其阴，温针则引火热内攻，故禁之也。而其用药，但取甘寒生津保肺，固阳益阴为治。此等关系最钜。○《伤寒选录》说：徐氏曰：此条无治法，东垣以清暑益气汤主之。所谓发千古之秘也。
案：《医垒元戎》黄耆汤，治疗中暍，脉弦细芤迟。人参、白术、黄耆、甘草、茯苓、芍药、生姜，各等分。正是为此条证设。东垣方有黄柏，专治长夏湿热之证，与本条之证自别。
太阳中热者，暍是也。汗出恶寒，身热而渴，白虎加人参汤主治。（《伤寒论》“渴”下，有“也”字，无“白虎加人参汤主之”八字，以此条揭中暍之首。沈金鳌、《医宗金鉴》，亦举之首条。《玉函》、《脉经》，无“加人参”三字。）
〔沈明宗〕此言正暑病也。邪之伤人，无有不从皮毛而入，故曰太阳中热。
〔赵良〕汗出恶寒，身热而渴，颇似太阳温热之病。但温热无恶寒，以热从里生，故虽汗出而不恶寒也。中暍暑邪由表而入，故汗出恶寒也。究之于渴，温热之渴，初病不过欲饮，中暍之渴，初病即大引饮也。用白虎加人参汤主治者，盖以益气为主，清暑热次之也。李杲曰：热伤气，气泄则汗出，气虚则恶寒，热蒸肌腠则身热，热伤津液则作渴。此恶寒身热，与伤寒相类，然所异者，伤寒初起，无汗不渴，中暍初起，即汗出而渴也。
Rheumatic pain that alleviates with movement but causes pulling sensations preventing flexion and extension indicates a distinct nature of the pain. Patients with dampness conditions experience fever without significant difference between morning and evening, whereas rheumatic fever intensifies in the late afternoon (Shen hour). This is because dampness lacks distinct onset and resolution patterns, while wind has periods of activity and rest; hence it is named "rheumatism." Tracing its origin, it may result from sweating followed by exposure to wind, or from long-term cold injury, where wind and dampness combine to cause disease. In such cases, Mahuang Xingren Yiyi Gancao Decoction should be used to disperse wind-dampness, which is clear.
[You] Spasm diseases cannot form without wind, and damp bi syndrome cannot occur without cold. Therefore, Mahuang is used to dispel cold, Yiyiren to remove dampness, Xingren to regulate qi to assist unblocking and draining, and Gancao to tonify the middle, granting the power to overcome dampness.
Mahuang Xingren Yiyi Gancao Decoction Formula
Mahuang (Cinnamon Twig, Ephedrae Herba) (half liang, removed joints, soaked in boiling water ○ Note: *Waitai* uses four liang, without "soaked in boiling water," which is correct.) Gancao (Licorice Root, Glycyrrhizae Radix) (one liang, honey-fried ○ Note: *Waitai* uses two liang, which is correct.) Yiyiren (Coicis Semen, Job's Tears Seed) (half liang ○ Note: *Waitai* uses half sheng, which is correct.) Xingren (Apricot Seed, Armeniacae Semen Amarum) (ten kernels, skin and tip removed, stir-fried ○ Note: *Waitai* uses two liang, without "stir-fried"; Xu Lingtai and Shen Mingzong also delete "stir-fried," which is correct.)
Chop the above ingredients to the size of hemp seeds. Take four qianbi per dose, add one and a half cups of water, boil to eight-tenths, strain, and take warm. Avoid wind if slight sweating occurs.
Note: The dosage of this formula is small, and the decoction method differs from other formulas, likely revised by later generations. What is recorded in *Waitai Mi Yao* under the "Hong Kong Foot" section is actually the original formula (dosages noted under each herb). It states: "For patients with dampness at the onset of illness, Yi Yi Ma Huang Tang may be given" (citing *Gujin Luyian*). The post-formula note says: "Chop the above four herbs, add five sheng of water, boil to obtain two sheng, divide into two doses. Cure upon sweating. For patients with dampness experiencing painful heaviness, Gancao Ma Huang Tang can be used to induce sweating; if ineffective, prepare again. For those with excessive fluid retention, add four liang of Baizhu, named Baizhu Ma Huang Tang." This is it. *Benjing* states Yiyiren treats wind-damp bi; *Bielu* states it removes pathogenic factors from bones and muscles. Compared to the Zheng for Mahuang Jia Zhu Tang, the dampness stagnation here is deeper, hence these herbs are used.
When rheumatism presents with a floating pulse, heavy body, sweating, and aversion to wind, Fangji Huangqi Tang should govern it.
[Zhao Liang] A floating pulse indicates wind; heavy body indicates dampness. Cold-damp yields a deep pulse, while wind-damp yields a floating pulse. If floating without sweating and with aversion to wind, it is an excess pathogen, treatable with Mahuang Xingren Yiyi Gancao Decoction to induce sweating. If floating with sweating and aversion to wind, it is a deficiency pathogen; thus, Fangji and Baizhu are used to remove dampness, Huangqi and Gancao to secure the exterior, and Shengjiang and Dazao to harmonize Ying and Wei. Zhao Liang states: Heavy body results from wind-damp in the superficial skin and hair layers, hence no pain. Deficiency of Wei Qi leads to dampness adhering, causing heaviness. Thus, Huangqi strengthens Wei, assisted by Gancao; Fangji removes dampness, assisted by Baizhu. Why no wind-dispelling herbs? Because profuse sweating indicates wind has already dispersed. Due to exterior deficiency, wind enters and exits, causing aversion to wind. By strengthening Wei, righteous Qi becomes robust, and wind retreats spontaneously; this is treating without directly attacking wind.
[You] Wind-damp in the exterior should theoretically be resolved through sweating, but sweat does not emerge properly, instead occurring spontaneously. The exterior is unresolved yet deficient; thus, standard sweating methods cannot be strictly followed. Therefore, Mahuang is not used to expel from the skin-hair level, but Fangji is used to drive out from the muscle-skin interior. However, without Baizhu and Gancao, how can Wei Yang recover to drive dampness downward?
Fangji Huangqi Tang Formula
Fangji (Stephaniae Tetrandrae Radix) (one liang ○ Note: *Qianjin* and *Waitai* use four liang, which is correct.) Gancao (Licorice Root, Glycyrrhizae Radix) (half liang, stir-fried ○ Note: *Shuiqi Bing Pian* writes "roasted/honey-fried"; *Waitai* uses one liang, which is correct.) Baizhu (Atractylodis Macrocephalae Rhizoma) (seven qian half ○ Note: *Qianjin* uses three liang, which is correct.) Huangqi (Astragali Membranacei Radix) (one liang one fen, removed root ends ○ Note: *Qianjin* and *Waitai* use five liang, which is correct.)
Chop the above ingredients to the size of hemp seeds. Take five qianbi per dose, add four slices of Shengjiang and one Dazao, add one and a half cups of water, boil to eight-tenths, strain, and take warm. Repeat after some time. ○ For asthma, add half liang of Mahuang. ○ For stomach disharmony, add three fen of Shaoyao. ○ For sensation of Qi rushing upward, add three fen of Guizhi. ○ For chronic cold below, add three fen of Xixin. ○ After taking the medicine, one should feel as if insects are crawling in the skin, with ice-cold sensation below the waist. Sit on a quilt afterwards, wrap another quilt around the waist, keep warm until slight sweating occurs, then the disease resolves. ("Ice" in Zhao’s edition, Xu Lingtai, Shen Mingzong, and *Yizong Jinjian* read "water". Wrapping around waist: Zhao, Xu, Shen, *Jinjian* read "around lower waist".)
Note: The dosages and decoction method of this formula were also revised by later generations. *Qianjin Fang* contains the original formula: Shengjiang three liang, Dazao twelve pieces. It states: "Chop the above six herbs, add six sheng of water, boil to obtain three sheng, divide into three doses. After finishing, sit within a quilt; desire for relief feels like insects crawling in skin; lie down to induce sweating." *Qianjin* has no formula name. *Mai Jing* calls it Fangji Tang. *Huo Ren Shu* names it Han Fangji Tang.
*Su Yuan Ji* states: Floating pulse, sweating, and aversion to wind seem to indicate exterior wind pathogen, suggesting Guizhi. However, Zhang Zhongjing discerns that Wei Qi is already deficient, skin pores are not tight, and follicles are open, causing sweating and aversion to wind. This is exterior deficiency in dampness patients. Thus, Fangji promotes water metabolism, Huangqi secures the exterior, and Baizhu and Gancao dry dampness and tonify the middle. Because exterior Qi is deficient and Wei Yang insecure, even Guizhi (which induces slight sweating) is not lightly used. Only with profound intent could such a formula be created.
After eight or nine days of Shanghan, wind and dampness interlock, causing bodily pain and irritability, inability to turn oneself over, no vomiting, no thirst, and a floating, deficient, and choppy pulse. Guizhi Fuzi Tang should govern it. If stool is hard and urination is spontaneous, remove Guizhi and add Baizhu Tang should govern it. (Under "thirst," *Qianjin Yi* has "xia yi" two characters; *Waitai* has "xia zhi" two characters; *Taiyang Xia Bian* has "you qi ren" two characters under "ruo". "Jian" reads "ying". Song edition note: One version says hardness at umbilicus and epigastrium. *Mai Jing* reads "Remove Guizhi, Add Baizhu and Fuzi Tang," which is correct.)
[Zhao Liang] This rheumatic disease, though acquired after eight or nine days of Shanghan, shows no vomiting or thirst, indicating no interior Shanghan pathology. Floating, deficient, and choppy pulses indicate no exterior Shanghan pathology. Floating and deficient pulse indicates exterior deficiency and wind; choppy indicates dampness. Bodily pain and irritability indicate wind; inability to turn over indicates dampness. This is bodily pain from wind-damp interlocking, distinct from Shanghan joint pain. Give Guizhi Fuzi Tang to warm and disperse wind-damp, resolving from the exterior. If the pulse is floating and solid, Mahuang Jia Zhu Tang should be used to vigorously disperse wind-damp. If the patient has these symptoms, even with hard stool and spontaneous urination, purgation is not considered, because the hardness is not due to heat entering the interior, but rather dryness from wind and loss of dampness. Thus, Guizhi Fuzi Tang remains primary. Guizhi is removed because hard stool and spontaneous urination suggest avoiding further sweating to prevent fluid depletion. Baizhu is added because heaviness indicates dampness in the muscle layer; it assists Fuzi to drive water qi from the skin.
[You] Floating, deficient, and choppy pulses indicate external holding of wind-damp and improper Wei Yang. Thus, Guizhi Tang is used, removing Sour-constringing Shaoyao and adding Pungent-warm Fuzi to振奋 Yang Qi and resist Yin pathogens. If stool is hard and urination is spontaneous, it indicates that while exterior Yang is weak, interior Qi is still cold. Dampness in the skin can naturally be driven inward to exit via the urinary pathway, without needing to attack the exterior and endanger weakened Yang. Therefore, in the previous formula, pungent-scattering Guizhi is removed, bitter-drying Baizhu is added, combined with powerful Fuzi, all moving through the skin to drive out water qi. This is a method of guiding according to momentum.
Note: The meaning of removing Guizhi and adding Baizhu is not fully detailed. Shen Mingzong says: If middle deficiency allows pathogen sinking, forcing fluids to drain anteriorly without moistening intestines, stool becomes hard and urination frequent. Hence, surface-moving Guizhi is removed, and Baizhu is added to calm the middle, generate Ying blood and fluids, and moisten intestinal dryness. Claiming Baizhu moistens dryness is likely mistaken.
*Su Yuan Ji* states: Dampness in the interior causes difficult urination and loose stools. Hard stool means dampness is not in the interior; free urination means dampness has gone, requiring no sweating. Thus, Guizhi is removed. After rheumatism, residual cold-damp may remain, causing lingering pain and difficulty turning. Hence, the formula without Guizhi (Baizhu Fuzi Tang) is still used.
Guizhi Fuzi Tang Formula
Guizhi (Cinnamon Twig, Cinnamomi Ramulus) (four liang, skin removed) Shengjiang (Fresh Ginger, Zingiberis Rhizoma Recens) (three liang, sliced) Fuzi (Prepared Aconite Root, Aconiti Lateralis Radix Praeparata) (three pieces, prepared, skin removed, broken into eight pieces) Gancao (Licorice Root, Glycyrrhizae Radix) (two liang, honey-fried) Dazao (Jujube Fruit, Zizyphi Fructus) (twelve pieces, split)
The above five herbs, add six sheng of water, boil to obtain two sheng, strain, divide into three warm doses.
*Su Yuan Ji* states: Wind pathogen requires Guizhi for sweating resolution; Cold pathogen requires Fuzi to warm meridians; Shengjiang is needed for dissemination. Gancao and Dazao moderate the nature of Jiang and Fu, assisting Guizhi in distributing fluids. This formula is derived from Guizhi Qu Shaoyao Tang (used after erroneous purgation in Taiyang Upper Chapter presenting with rapid pulse, chest fullness, slight aversion to cold), plus Fuzi. It is not Guizhi Jia Fuzi Tang (used after sweating leading to continuous leakage). Guizhi Fuzi Tang removes Shaoyao, hence a new name without "Jia". Guizhi Jia Fuzi Tang retains Shaoyao, adding to the complete Guizhi Tang, hence the extra "Jia". Observing Zhang Zhongjing’s prescriptions reveals profound intent in every detail.
Sanyin Shufu Tang treats rain exposure causing dampness adhering to skin and muscles, combining with Stomach Qi, or resulting from open pores/sweating during bathing. (This is the base formula plus Baizhu and Fuling.)
Baizhu Fuzi Tang Formula
Baizhu (Atractylodis Macrocephalae Rhizoma) (two liang) Fuzi (Prepared Aconite Root, Aconiti Lateralis Radix Praeparata) (one and a half pieces, prepared, skin removed) Gancao (Licorice Root, Glycyrrhizae Radix) (one liang, honey-fried) Shengjiang (Fresh Ginger, Zingiberis Rhizoma Recens) (one and a half liang, sliced) Dazao (Jujube Fruit, Zizyphi Fructus) (six pieces)
The above five herbs, add three sheng of water, boil to obtain one sheng, strain, divide into three warm doses. After the first dose, if numbness is felt, take the second dose after half a day. Finish all three doses. If the patient feels dizzy, do not be alarmed. This is because Baizhu and Fuzi move through the skin, driving out water qi which has not yet been eliminated. (*Taiyang Xia Bian*: Baizhu four liang, Fuzi three pieces, Gancao two liang, Shengjiang three liang, Dazao twelve pieces, split. *Waitai* is same. Wei Litong reads "Ru Mao", *Falü* changes to "Ru Yin", I dare not follow.)
*Su Yuan Ji* states: This is Shufu Tang. Following the modifications of Guizhi Fuzi Tang mentioned above, it is called "Remove Guizhi, Add Baizhu Tang." Ancient texts omit "Bai" before "Zhu," hence called Shufu Tang. (*Chengben Shanghan Lun* mistakenly places it after Fuguijia Fuzi Tang). Using two pieces of Fuzi: ancient wild-grown Fuzi might be smaller than cultivated ones today; this cannot be fixed law. Estimating by modern standards: Four liang Guizhi equals roughly 1.8 liang in Song dynasty. Yuan dynasty weights were heavier than Song, modern even heavier. Three liang Shengjiang equals eight qian in Song. One piece Fuzi weighs approx. 1.2-1.3 liang; dried after preparation approx. 3.5 qian. Dividing into three doses is not excessive. Predecessors said ancient formulas cannot treat modern diseases, ignoring differences in weight standards.
Sanyin Shengfu Baizhu Tang treats internal wind-damp causing dizziness, confusion, distension, heaviness, flaccid limbs, spontaneous sweating, aphonia, and incontinence. (In this formula, Ganjiang replaces Shengjiang, remove Dazao.)
Zengshi Huoyou Kouyi states: Shufu Tang treats pediatric internal organ deficiency-cold, diarrhea with liquid stool, and cold extremities. (This is the base formula, Ganjiang replaces Shengjiang, remove Dazao.)
When wind and dampness interlock, causing joint pain and irritability, pulling pain preventing flexion/extension, severe pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with desire to keep clothes on, or slight body swelling, Gancao Fuzi Tang should govern it. ("Teng Fan" in *Chengben Shanghan Lun* reads "Fan Teng".)
[Shen Mingzong] This is a syndrome of Yang deficiency and pathogen excess. Wind-damp injures Ying and Wei, flowing into joints and meridians. Pathogen and righteous Qi clash, causing joint pain, irritability, and pulling pain. Yin blood stagnates, Yang deficiency prevents light movement, hence inability to flex/extend, severe pain on touch. Wei Yang deficiency causes sweating; interior Qi insufficiency causes shortness of breath and difficult urination. Exterior Yang deficiency causes aversion to wind and desire to keep clothes. Yang injury and Qi stagnation cause slight swelling. Since interior/exterior and Yin/Yang show righteous deficiency and pathogen excess, Gancao, Baizhu, and Fuzi are used to assist Yang, strengthen Spleen, remove dampness, secure protection, and prevent collapse from sweating. Guizhi circulates Ying and Wei, dispelling wind. This is tonifying while releasing, removing wind-damp without direct expulsion. Generally, in wind-damp syndromes, recognizing non-febrile spontaneous sweating indicates severe Yang deficiency; securing Yang must be primary.
Yu Jiayan *Shanglun Pian* states: This clause reiterates the previous one, distinguishing more severe symptoms. Pain intolerable to touch, sweating, shortness of breath, aversion to wind, difficult urination, or slight swelling represent the most intense interlocking. Fang Youzhi *Tiaobian* states: "Or" implies uncertainty; slight swelling is dampness pressing externally. Without external pressing, there is no swelling, hence "or".
Gancao Fuzi Tang Formula
Gancao (Licorice Root, Glycyrrhizae Radix) (two liang, honey-fried) Fuzi (Prepared Aconite Root, Aconiti Lateralis Radix Praeparata) (two pieces, prepared, skin removed) Baizhu (Atractylodis Macrocephalae Rhizoma) (two liang) Guizhi (Cinnamon Twig, Cinnamomi Ramulus) (four liang, skin removed)
The above four herbs, add six sheng of water, boil to obtain three sheng, strain, take one sheng warm, three times daily. Initial dose inducing slight sweating resolves the condition. If eating causes sweating and recurrence of irritability, take five he. If one sheng is too much, taking six or seven he is optimal. ("Miao" in Song edition *Shanghan Lun* reads "Shi". Xu Lingtai and Shen Mingzong read "Jia".)
Xu Lingtai *Fanglun* states: This shares the same wind-damp interlocking pattern as Guizhi Fuzi Tang. The former involves shallow disease with more cold, confining limbs within the body shell. Here, wind and damp both prevail, carrying internal Yang to rampage. Wind enters joints increasing strength, preventing flexion/extension, severely injuring Wei, causing sweating, shortness of breath, and aversion to wind. Water follows wind’s momentum, causing slight swelling. The pathological trend disturbs the muscle-surface, differing from static confinement. Here, Fuzi removes dampness and warms meridians, Guizhi dispels wind and harmonizes Ying, Baizhu removes dampness and strengthens Wei, Gancao tonifies all herbs, achieving both astringent and dispersing effects.
*Su Yuan Ji* states: Though named Gancao Fuzi Tang, it practically uses Guizhi Qu Shaoyao Tang to sweat out wind pathogen, adding Fuzi and Baizhu to drive cold and dry dampness. *Qianjin Fang Honggangjiao Men* Siwu Fuzi Tang is identical. Later formula notes: For swelling, add four liang Fangji. For palpitations and difficult urination, add three liang Fuling. With Fuzi present, add three liang Shengjiang; *Sanyin Fang* names this Liuwu Fuzi Tang. *Waitai* records *Gujin Luyian Fuzi Tang*, which is this formula.
Sanyin Guizhi Fuzi Tang treats the same indications as this clause. (It is this formula.)
Taiyang Zhong Yue presents with fever, aversion to cold, heavy body and pain, string-thin, hollow, and slow pulse. After urination, chills and goosebumps occur, extremities are cold. Slight exertion causes immediate body heat. Mouth opens, front plate teeth become dry. If sweating is induced, aversion to cold worsens. If moxibustion/needling with heat is applied, fever worsens. If purgatives are frequently used, strangury worsens. (*Shanghan Lun* reads "mouth opens, front plate teeth dry"; various annotations agree, should be corrected. *Shanghan Lun* lacks "Qi" before "E Han Shen". *Yuhan* and *Mai Jing* read "Re Yi Shen". *Mai Jing* adds "Fu" before "Lin".)
[Cheng Zhi] *Neijing* states: Before Summer Solstice, disease is Wen; after, it is Shu. Also: Heat diseases belong to Shanghan category. Because Taiyang is affected, resembling Shanghan, it causes fever, aversion to cold, heavy body, and pain. *Neijing* states: Cold injures form, Heat injures Qi. Qi injury depletes Qi, making pulse weak. Hence string-thin, hollow, slow. Chills/goosebumps after urination indicate Yang sinking internally, unable to guard exterior, causing cold extremities. Exertion disturbs Yang, so slight labor causes heat. *Neijing* states: Affected by Shu sweating, irritability causes panting. Thus, intense heat causes mouth opening, leading to dry front plate teeth. Sweating depletes Yang, worsening aversion to cold. Heat needling moves fire pathogen, worsening fever. Purging destroys fluids, worsening strangury. (Note: Based on Cheng Wuji.)
*Su Yuan Ji* states: Taiyang Zhong Yue with fever and aversion to cold, without mentioning sweating or thirst, indicates it is not pure Yang pathogen excess Zhong Yue. String pulse indicates Yin pathogen tension; thin indicates Yuan Qi deficiency; hollow indicates empty pulse; slow indicates cold. Chills/goosebumps after urination, though urine passes, urethral difficulty is known; Wei Yang is deficient, aversion to cold visible, indicating lower Jiao firelessness and sluggish Qi transformation. Limbs are root of all Yang; cold extremities indicate Yang deficiency failing to reach limbs. All these are Yin-cold, fireless pulses/symptoms. Slight exertion causing heat: minor movement disturbs Yang, triggering latent summer-heat pathogen to cause fever. Mouth opening/dry teeth: despite string-thin/hollow/slow pulse and cold extremities, slight labor stirs Yang pathogen, heating body and drying fluids. Though not thirsty, teeth dry. If sweating is induced, Wei Yang becomes more deficient, generating exterior cold, worsening aversion to cold. Heat needling drives fire inward, aiding summer-heat Yang pathogen, worsening fever. Pathogen is not in interior, yet frequent purging damages True Yang, cooling lower Jiao, stopping Qi transformation, causing difficult urination and strangury.
Yu Jiayan *Yimen Falü* states: In summer, human Yang escapes via sweat, Yin consumes internally via heat; both Yin and Yang are insufficient. Zhang Zhongjing prohibits sweating, purging, and heat needling for Zhong Yue. Sweating injures Yang, purging injures Yin, heat needling draws fire inward; hence prohibited. Medication should focus on sweet-cold herbs to generate fluids, protect Lung, secure Yang, and benefit Yin. This relationship is crucial. ○ *Shanghan Xuanlu* states: Xu Shi says this clause lacks treatment method; Dong Yuan uses Qingshu Yiqi Tang. This reveals a millennium secret.
Note: *Yilei Yuanrong* Huangqi Tang treats Zhong Yue with string-thin, hollow, slow pulse. Renshen, Baizhu, Huangqi, Gancao, Fuling, Shaoyao, Shengjiang, equal parts. Specifically set for this syndrome. Dong Yuan’s formula includes Huangbai, specifically for late summer damp-heat, distinct from this clause.
Taiyang Zhong Re, also known as Yue, presents with sweating, aversion to cold, body heat, and thirst. Baihu Jia Renshen Tang should govern it. (*Shanghan Lun* adds "Ye" after "Ke", omits "Baihu Jia Renshen Tang Zhu Zhi" eight characters; Shen Jinao and *Yizong Jinjian* list this as the first clause of Zhong Yue. *Yuhan* and *Mai Jing* omit "Jia Renshen" three characters.)
[Shen Mingzong] This describes true Summerheat disease. Pathogens enter humans invariably through skin and hair, hence "Taiyang Zhong Re."
[Zhao Liang] Sweating, aversion to cold, body heat, and thirst resemble Taiyang Warm-Heat disease. But Warm-Heat lacks aversion to cold because heat generates from interior; thus, despite sweating, there is no aversion to cold. Zhong Yue summer-heat pathogen enters from exterior, hence sweating and aversion to cold. Regarding thirst: Warm-heat thirst initially only desires drinking; Zhong Yue thirst immediately demands large amounts of water. Using Baihu Jia Renshen Tang prioritizes Qi tonification over clearing summer-heat. Li Gao states: Heat injures Qi, Qi leakage causes sweating, Qi deficiency causes aversion to cold, heat steaming muscle-courts causes body heat, heat injuring fluids causes thirst. This aversion to cold and body heat resembles Shanghan, but differs: Shanghan initial stage has no sweating/thirst; Zhong Yue initial stage has immediate sweating/thirst.