太阳病。发热无汗。反恶寒者。名曰刚痉。太阳病。发热汗出而不恶寒。名曰柔痉。
成氏曰。千金云。太阳中风。重感寒湿则变痉。太阳病。发热无汗为表实。则不当恶寒。今反恶
寒者。则太阳中风。重感于寒。为痉病也。以其表实有寒。故曰刚痉。太阳病。发热汗出为表虚。则
当恶寒。今不恶寒
者。风邪变热。外伤筋脉为痉病也。以其表虚无寒。故曰柔痉。然痉者强也。其病在筋。故必兼有颈
项强急。头热足寒。目赤头摇。口噤背反等证。仲景不言者。以痉字该之也。活人书亦云。痉证发热
恶寒。与伤寒相似。但其脉沉迟弦细。而项背反张为异耳。
太阳病。发热。脉沉而细者。名曰痉。为难治。
太阳脉本浮。今反沉者。风得湿而伏。故为痉。痉脉本紧弦。今反细者。阴气适不足。故难治。
太阳病。发汗太多。因致痉。夫风病下之则痉。复发汗。必拘急。疮家虽身疼痛。不可发汗。汗
出则痉。此原痉病之由。有此三者之异。其为脱液伤津则一也。盖病有太阳风寒不解。重感寒湿而成
痉者。亦有亡血竭气。损伤阴阳。而病变成痉者。经云。气主 之。血主濡之。又云。阳气者。精则
养神。柔则养筋。阴阳既衰。筋脉失其濡养。而强直不柔矣。此痉病标本虚实之异。不可不辨也。
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。寒湿相得。其表益虚。即恶寒甚。发其汗已。其脉如蛇。
痉病不离乎表。故身热恶寒。痉为风强病。而筋脉受之。故口噤、头项强、背反张、脉强直。经
云。诸暴强直。皆属于风也。头热足寒。面目赤。头动摇者。风为阳邪。其气上行而又主动也。寒湿
相得者。汗液之湿。与外寒之气。相得不解。而表气以汗而益虚。寒气得湿而转增。则恶寒甚也。其脉
如蛇者。脉伏而曲。如蛇行也。痉脉本直。汗之则风去而湿存。故脉不直而曲也。
暴腹胀大者为欲解。脉如故。反伏弦者痉。
此即上文风去湿存之变证。魏氏云。风去不与湿相丽。则湿邪无所依着。必顺其下坠之性。而入
腹作胀矣。风寒外解。而湿下行。所以为欲解也。如是诊之。其脉必浮而不沉。缓而不弦矣。乃其脉
如故。而反加伏弦。知其邪内连太阴。里病转增。而表病不除。乃痉病诸证中之一变也。
夫痉脉按之紧如弦。直上下行。
紧如弦。即坚直之象。李氏曰。上下行者。自寸至尺。皆见紧直之脉也。脉经亦云。痉病脉坚伏。
直上下行。痉病有灸疮。难治。
有灸疮者。脓血久溃。穴俞不闭。娄全善云。即破伤风之意。盖阴伤而不胜风热。阳伤而不任攻
伐也。故曰难治。
太阳病。其证备。身体强。KT KT 然。脉反沉迟。此为痉。栝蒌桂枝汤主之。
太阳证备者。赵氏谓太阳之脉。自足上行。循背至头项。此其所过之部。而为之状者。皆是其证
是也。KT KT 。背强连颈之貌。沉本痉之脉。迟非内寒。乃津液少而营卫之行不利也。伤寒项背强KT KT 。汗
出恶风者。脉必浮数。为邪风盛于表。此证身体强KT KT 然。脉反沉迟者。为风淫于外。而津伤于内。
故用桂枝则同。而一加葛根以助其散。一加栝蒌根兼滋其内。则不同也。
栝蒌桂枝汤方
栝蒌根（二两） 桂枝（三两） 芍药（三两） 甘草（二两） 生姜（三两） 大枣（十二枚）
上六味。以水九升。煮取三升。分温三服。微汗。汗不出。食顷。啜热粥发。
太阳病。无汗而小便反少。气上冲胸。口噤不得语。欲作刚痉。葛根汤主之。
无汗而小便反少者。风寒湿甚。与气相持。不得外达。亦并不下行也。不外达。不下行。势必逆
而上冲。为胸满。为口噤不得语。驯至面赤头摇。项背强直。所不待言。故曰欲作刚痉。葛根汤。即桂
枝汤加麻黄、葛根。乃刚痉无汗者之正法也。
按痉病多在太阳、阳明之交。身体强。口噤不得语。皆其验也。故加麻黄以发太阳之邪。加葛根
兼疏阳明之经。而阳明外主肌肉。内主津液。用葛根者。所以通隧谷而逐风湿。加栝蒌者。所以生津
液而濡经脉也。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂枝 甘草（炙） 芍药（各二两） 生姜（三两） 大枣
（十二枚）
上七味。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。
痉为病。胸满口噤。卧不着席。脚挛急。必 齿。可与大承气汤。
此痉病之属阳明瘀热者。阳明之筋起于足。结于跗。其直者上结于髀。阳明之脉。入齿中。挟口
环唇。其支者。循喉咙。入缺盆下膈。故为是诸证。然无燥实见证。自宜涤热而勿荡实。乃不用调胃
而用大承气者。岂病深热极。非此不能治欤。然曰可与。则犹有斟酌之意。用者慎之。
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。先煮枳、朴取五升。去滓。内大黄。煮二升。去滓。内芒硝。更上微火一两
沸。分温再服。得下。余勿服。
太阳病。关节疼痛而烦。脉沉而细者。此名中湿。亦名湿痹。湿痹之候。小便不利。大便反快。但
当利其小便。湿为六淫之一。故其感人。亦如风寒之先在太阳。但风寒伤于肌腠。而湿则流入关节。
风脉浮。寒脉紧。而湿脉则沉而细。湿性濡滞。而气重着。故亦名痹。痹者闭也。然中风者。必先有
内风而后召外风。中湿者。亦必先有内湿而后感外湿。故其人平日土德不及而湿动于中。由是气化不
速。而湿侵于外。外内合邪。为关节疼烦。为小便不利。大便反快。治之者必先逐内湿。而后可以除
外湿。故曰当利其小便。东垣亦云。治湿不利小便。非其治也。然此为脉沉而小便不利者设耳。若风
寒在表。与湿相搏。脉浮恶风。身重疼痛者。则必以麻黄、白术、薏苡、杏仁、桂枝、附子等。发其
汗为宜矣。详见后条。湿家之为病。一身尽疼。发热。身色如熏黄也。
湿外盛者。其阳必内郁。湿外盛为身疼。阳内郁则发热。热与湿合。交蒸互郁。则身色如熏黄。
熏黄者。如烟之熏。色黄而晦。湿气沉滞故也。若热黄则黄而明。所谓身黄如橘子色也。
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。舌上如苔者。以
丹田有热。胸上有寒。渴欲得饮而不能饮。则口燥烦也。
寒湿居表。阳气不得外通而但上越。为头汗出。为背强。欲得被覆向火。是宜驱寒湿以通其阳。乃
反下之。则阳更被抑。而哕乃作矣。或上焦之阳不布。而胸中满。或下焦之阳不化。而小便不利。随
其所伤之处而为病也。舌上如苔者。本非胃热。而舌上津液燥聚。如苔之状。实非苔也。盖下后阳气
反陷于下。而寒湿仍聚于上。于是丹田有热而渴欲得饮。胸上有寒而复不能饮。则口舌燥烦。而津液
乃聚耳。
湿家下之。额上汗出。微喘。小便利者死。若下利不止者亦死。
湿病在表者宜汗。在里者宜利小便。苟非湿热蕴积成实。未可遽用下法。额汗出微喘。阳已离而
上行。小便利。下利不止。阴复决而下走。阴阳离决。故死。一作小便不利者死。谓阳上游而阴不下济也。
亦通。风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不止。医云。此可发其汗。汗之病不愈者。何
也。盖发其汗。汗大出者。但风气去。湿气在。是故不愈也。若治风湿者。但微微似欲汗出者。风湿
俱去也。
风湿虽并为六淫之一。然风无形而湿有形。风气迅而湿气滞。值此雨淫湿胜之时。自有风易却而
湿难除之势。而又发之速而驱之过。宜其风去而湿不与俱去也。故欲湿之去者。但使阳气内蒸而不骤
泄。肌肉关节之间充满流行。而湿邪自无地可容矣。此发其汗。但微微似欲汗出之旨欤。
湿家病。身疼发热。面黄而喘。头痛鼻塞而烦。其脉大。自能饮食。腹中和无病。病在头中寒湿。
故鼻塞。内药鼻中则愈。
寒湿在上。则清阳被郁。身疼头痛。鼻塞者。湿上甚也。发热面黄烦喘者。阳上郁也。而脉大。
则非沉细之比。腹和无病。则非小便不利。大便反快之比。是其病不在腹中而在头。疗之者宜但治其
头。而毋犯其腹。内药鼻中。如瓜蒂散之属。使黄水出则寒湿去而愈。不必服药以伤其和也。
湿家身烦疼。可与麻黄加术汤。发其汗为宜。慎不可以火攻之。
身烦疼者。湿兼寒而在表也。用麻黄汤以散寒。用白术以除湿。喻氏曰。麻黄得术。则虽发汗。不
至多汗。而术得麻黄。并可以行表里之湿。不可以火攻者。恐湿与热合而反增发热也。
麻黄加术汤方
麻黄（三两去节） 桂枝（二两） 甘草（一两炙） 白术（四两） 杏仁（七十个去皮尖）
上五味。以水九升。先煮麻黄。减二升。去上沫。内诸药。煮取二升半。去滓。温服八合。覆取
微汗。
病者一身尽疼。发热。日晡所剧者。此名风湿。此病伤于汗出当风。或久伤取冷所致也。可与麻
黄杏仁薏苡甘草汤。
此亦散寒除湿之法。日晡所剧。不必泥定肺与阳明。但以湿无来去。而风有休作。故曰此名风湿。
然虽言风而寒亦在其中。观下文云。汗出当风。又曰久伤取冷。意可知矣。盖痉病非风不成。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（半两） 杏仁（十个去皮尖） 薏苡（半两） 甘草（一两炙）
上锉麻豆大。每服四钱匕。水一盏半。煎八分。去滓温服。有微汗。避风。
风湿。脉浮身重。汗出恶风者。防己黄 汤主之。
风湿在表。法当从汗而解。乃汗不待发而自出。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。服后如虫行皮中。及从腰下如冰。皆湿下行之征也。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） 甘草（半两炙） 白术（七钱半） 黄 （一两一分）
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。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。
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。去桂枝加白术汤主之。
身体疼烦不能自转侧者。邪在表也。不呕不渴。里无热也。脉浮虚而涩。知其风湿外持。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。而在里之气犹治。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。
桂枝附子汤方
桂枝（四两） 附子（三枚炮去皮破八片） 生姜（三两切） 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。
白术附子汤方
白术（一两） 附子（一枚炮去皮） 甘草（二两炙） 生姜（一两半） 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。
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。
此亦湿胜阳微之证。其治亦不出助阳散湿之法。云得微汗则解者。非正发汗也。阳复而阴自解耳。
夫风湿在表。本当从汗而解。麻黄加术汤、麻黄杏仁薏苡甘草汤。其正法也。而汗出表虚者。不宜重
发其汗。则有防己黄 实表行湿之法。而白术附子。则又补阳以为行者也。表虚无热者。不可遽发其
阳。则有桂枝附子温经散湿之法。而甘草附子。则兼补中以为散者也。即此数方。而仲景审病之微。用
法之变。盖可见矣。
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）
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。宜服六七合为妙。
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。口开。前板齿燥。若发其汗。则恶寒甚。加温针。则发热甚。数下之。则淋甚。
中 即中暑。暑亦六淫之一。故先伤太阳而为寒热也。然暑、阳邪也。乃其证反身重疼痛。其脉
太阳病，发热且无汗，反而恶寒的，称为刚痉。太阳病，发热且有汗出，却不恶寒的，称为柔痉。
成无己说：《千金方》记载，太阳中风证，若再次感受寒湿邪气，就会转变为痉病。太阳病中，发热无汗属于表实证，本不应恶寒；如今反而恶寒，说明是太阳中风证，再次感受了寒邪，从而形成痉病。因为表实而有寒邪，所以称为刚痉。太阳病中，发热有汗属于表虚证，本应恶寒；如今不恶寒，是因为风邪化热，外伤筋脉而形成痉病。因为表虚无寒邪，所以称为柔痉。然而，“痉”字意为强直，病变部位在筋脉，所以必定兼有颈项强急、头部发热足部发冷、眼睛发红、头部摇动、牙关紧闭、角弓反张等症状。张仲景没有单独列出这些症状，是因为“痉”这个字已经概括了它们。《活人书》也说，痉病的发热恶寒，与伤寒相似，但其脉象沉迟弦细，以及出现项背反张，则是不同的地方。
太阳脉本应当浮，如今反而沉，是因为风邪遇到湿气而潜伏，所以导致痉病。痉病的脉象本应当紧弦，如今反而细，是因为阴气恰好不足，所以难以治疗。
太阳病，发汗过多，因而导致痉病。患风病误用攻下法会导致痉病，如果再次发汗，必然导致肢体拘挛紧急。患有疮疡的人，即使身体疼痛，也不可以发汗，如果发汗导致津液外泄，就会引发痉病。这些都是导致痉病的原因，虽然有这三种情况的不同，但本质都是耗伤津液、损伤阴津。大概疾病有因太阳风寒不解，再次感受寒湿而成痉的；也有因亡血竭气，损伤阴阳，而病情演变为痉的。经书说：“气主要起到温煦作用，血主要起到濡养作用。”又说：“阳气，精纯时能养神，柔和时能养筋。”既然阴阳都衰弱了，筋脉失去了濡养，就会出现强直而不柔和的症状。这是痉病在标本虚实方面的差异，不可不加以辨别。
病人身体发热，足部发冷，颈项强急，恶寒，有时头部发热、面色红赤、眼睛红赤，只有头部摇动，突然牙关紧闭，背部反张的，是痉病。如果对此发汗，寒湿相合，体表更加虚弱，就会恶寒严重。发汗之后，脉象像蛇一样蜿蜒曲折。
痉病不离乎表证，所以身体发热、恶寒。痉属于风强之病，筋脉受邪，所以出现牙关紧闭、头项强直、背部反张、脉象强直。经书说：“所有突然发生的强直症状，都属于风邪。”头部发热、足部发冷，面目红赤，头部摇动，是因为风为阳邪，其气上行且主动。寒湿相合，是指汗出的湿气与外来的寒邪之气相结合而不能解散，导致表气因出汗而更加虚弱，寒气得到湿气而增强，所以恶寒严重。脉象像蛇一样，是指脉象伏匿而弯曲，像蛇爬行一样。痉病的脉象本应当直，发汗后风邪去而湿气留存，所以脉象不再直而变曲。
突然腹部胀大的，是病情将要解除的表现；如果脉象如旧，反而出现伏弦脉，则是痉病。
这就是上文所述风邪去而湿气留的变证。魏氏说：风邪离去后不与湿气相附丽，那么湿邪就无所依附，必然顺着其下坠的特性，进入腹部造成胀满。风寒在外部解除，而湿气向下方运行，所以说是病情将要解除。这样诊断的话，脉象应当浮而不沉，缓而不弦。然而脉象如旧，反而加上伏弦，知道邪气内连太阴，里证加重，而表证未除，这是痉病诸证中的一种变化。
痉病的脉象，按之紧硬如弦，直上下行。
紧硬如弦，就是坚直的征象。李氏说：上下行，是指从寸口到尺部，都见到紧直的脉象。《脉经》也说：痉病的脉象坚硬伏匿，直上下行。痉病患者如果有灸疮，属于难治之证。
有灸疮的人，脓血长期溃烂，穴位俞窍不能闭合。娄全善说：这也就是破伤风的含义。大概是阴液受伤而不能耐受风热，阳气受伤而不能承受攻伐，所以说难治。
太阳病，症状具备，身体强直，KT KT（形容背强不舒的样子），脉象反而沉迟，这是痉病，用栝蒌桂枝汤主治。
太阳证具备，赵氏认为太阳经脉从足向上，循行背部至头项，这些经过的部位出现的症状，都是太阳证的体现。KT KT，是背强连颈的样子。沉脉本是痉病的脉象，迟脉并非内寒，而是津液少导致营卫运行不利。伤寒症见项背强直KT KT，汗出恶风，脉象必浮数，这是邪风盛于表；此证身体强直KT KT，脉象反而沉迟，是因为风淫于外，而津液损伤于内。所以使用桂枝是一样的，但一个加葛根以助发散，一个加栝蒌根兼以滋润内部，这就不同了。
栝蒌桂枝汤方
栝蒌根（二两） 桂枝（三两） 芍药（三两） 甘草（二两） 生姜（三两） 大枣（十二枚）
以上六味药，用水九升，煮取三升，分三次温服。微微出汗。如果不出汗，过一会儿，喝热粥以助发汗。
太阳病，无汗且小便反而少，气上冲胸部，牙关紧闭不能说话，想要发作刚痉，用葛根汤主治。
无汗且小便反而少，是因为风寒湿邪气盛，与正气相持，既不能向外通达，也不能向下运行。不外达，不下行，势必逆而上冲，导致胸满、牙关紧闭不能说话，逐渐发展到面赤头摇、项背强直，是不言而喻的。所以说想要发作刚痉。葛根汤，就是桂枝汤加上麻黄、葛根，是刚痉无汗的正治之法。
按语：痉病多在太阳、阳明经交界处发病。身体强直、牙关紧闭不能说话，都是其验证。所以加麻黄以发散太阳之邪，加葛根兼疏阳明之经。而阳明外主肌肉，内主津液，使用葛根，是为了通利谷道而驱逐风湿；加入栝蒌，是为了生津液而濡养经脉。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂枝 甘草（炙） 芍药（各二两） 生姜（三两） 大枣（十二枚）
以上七味药，用水一斗，先煮麻黄、葛根，减去二升，撇去浮沫，加入其他药物，煮取三升，去渣，温服一升，覆盖衣被使微微似有汗出，不需要喝热粥。其余调养及禁忌同桂枝汤法。
痉病，胸满、牙关紧闭、睡觉时脚伸不直触不到席子、脚部拘挛紧急，一定伴有咬齿（磨牙），可以给予大承气汤。
这是属于阳明瘀热的痉病。阳明之筋起于足，结于跗骨，直行者上结于大腿。阳明经脉，入齿中，挟口环绕嘴唇，其支脉，循喉咙，入缺盆下膈，所以出现这些症状。然而如果没有燥实见证，自然适宜涤荡热邪而不荡涤实邪。这里不用调胃承气汤而用大承气汤，难道是病深热极，非此不能治愈吗？然而说“可与”，则还有斟酌之意，使用者需谨慎。
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，先煮枳实、厚朴，取五升，去渣，加入大黄，煮取二升，去渣，加入芒硝，再上火微沸一两滚，分两次温服。得下（排便）后，余药勿服。
太阳病，关节疼痛且烦躁，脉象沉而细的，这名叫中湿，也叫湿痹。湿痹的候证，小便不利，大便反而快（溏泄），只应当利小便。湿是六淫之一，所以它伤人，也像风寒一样先在太阳经。但风寒伤于肌腠，而湿则流入关节。风脉浮，寒脉紧，而湿脉则沉而细。湿性濡滞，且气机重着，所以也叫痹。痹的意思是闭塞。然而中风者，必先有内风而后招致外风；中湿者，也必先有内湿而后感受外湿。所以此人平日土德不及（脾虚）而湿动于中，由此气化不速，而湿侵于外。内外合邪，导致关节疼烦、小便不利、大便反而快。治疗者必须先祛除内湿，然后才可以除去外湿。所以说应当利小便。东垣也说：治湿不利小便，不是正确的治法。然而这是针对脉沉且小便不利的情况设立的。如果风寒在表，与湿相搏，脉浮恶风，身重疼痛，则必须用麻黄、白术、薏苡仁、杏仁、桂枝、附子等药，发汗为宜。详见后文。
湿家（患湿病的人）患病，全身疼痛，发热，身体颜色像烟熏一样黄。
湿气外盛，阳气必然内郁。湿气外盛导致身疼，阳气内郁导致发热。热与湿结合，交蒸互郁，所以身体颜色像烟熏黄。熏黄，像烟熏的颜色，色黄而晦暗，是因为湿气沉滞的缘故。如果是热黄，则黄色鲜明，所谓身黄如橘子色。
湿家其人只有头部出汗，背部强直，想要盖被子靠近火源。如果过早使用下法，就会导致呃逆，或者胸满，小便不利，舌上好像有苔。这是因为丹田有热，胸上有寒，口渴想喝水却不能喝，所以口燥烦躁。
寒湿停留在体表，阳气不能外通而只能上越，导致头部出汗、背部强直、想要盖被子靠近火源。这时应当驱散寒湿以通阳，却反而使用下法，那么阳气更被抑制，于是产生呃逆。或者上焦阳气不布散，导致胸中满闷；或者下焦阳气不化，导致小便不利。随着所受伤的部位不同而产生病症。舌上好像有苔，本来不是胃热，而是舌上津液干燥聚集，像苔的形状，实际上并不是苔。大概是下法之后，阳气反而陷入下部，而寒湿仍然聚于上部，于是丹田有热而口渴想喝水，胸上有寒而又不能喝水，导致口舌燥烦，而津液乃聚集于此。
湿家误用下法，额头出汗，轻微气喘，小便通畅的，死证。如果腹泻不止的，也是死证。
湿病在表的宜发汗，在里的宜利小便。如果不是湿热蕴积成实，不可以轻易使用下法。额头出汗、轻微气喘，说明阳气已离决而上行；小便通畅、腹泻不止，说明阴气复决而下走。阴阳离决，所以死亡。另一种说法是小便不利的死证，意思是阳气上游而阴气不下济，也通顺。
风湿相搏，全身疼痛，依法应当发汗而解。正值天阴雨不停，医生说：这可以发汗。发汗后病不愈，为什么呢？大概是因为发汗，汗出太多，只是风气去了，湿气还在，所以不愈。如果治疗风湿，只要微微似有汗出，风湿就能一起去除。
风湿虽然同为六淫之一，但风无形而湿有形，风气迅疾而湿气滞涩。值此雨淫湿胜之时，自有风易去而湿难除的趋势。而又发汗太速而驱赶过度，难怪风去而湿不与俱去。所以想要湿气去除，只要使阳气在内蒸腾而不骤然泄露，肌肉关节之间充满流行，而湿邪自然无处可容。这就是发汗只需微微似有汗出的宗旨吧。
湿家患病，身体疼痛，发热，面黄而喘，头痛鼻塞且烦躁，脉象大，自己能饮食，腹部调和无病，病在头中寒湿，所以鼻塞，将药纳入鼻中则痊愈。
寒湿在上，清阳被郁，导致身疼头痛。鼻塞，是湿气在上部很重的表现。发热、面黄、烦躁、气喘，是阳气上部郁结的表现。而脉大，就不是沉细脉的比类。腹部调和无病，就不是小便不利、大便反而快的比类。这说明病不在腹中而在头部。治疗者应当只治头部，而不侵犯腹部。将药纳入鼻中，如瓜蒂散之类，使黄水流出则寒湿去除而痊愈，不必服药以伤害脏腑的和气。
湿家身体烦疼，可以用麻黄加术汤，发汗为宜。千万不要用火攻法。
身体烦疼，是湿兼寒邪在表。用麻黄汤以散寒，用白术以除湿。喻氏说：麻黄得到白术，虽然发汗，但不会多汗；而白术得到麻黄，并可以行散表里之湿。不可以用火攻，是恐怕湿与热结合而反而增加发热。
麻黄加术汤方
麻黄（三两去节） 桂枝（二两） 甘草（一两炙） 白术（四两） 杏仁（七十个去皮尖）
以上五味药，用水九升，先煮麻黄，减去二升，撇去浮沫，加入其他药物，煮取二升半，去渣，温服八合，覆盖衣被使微微出汗。
病人全身疼痛，发热，下午申时加剧的，这名叫风湿。此病是由于出汗当风，或久伤取冷所致。可以用麻黄杏仁薏苡甘草汤。
这也是散寒除湿的方法。下午申时加剧，不必拘泥于肺与阳明经，只是因为湿邪无来去之分，而风邪有休止发作之别，所以叫此名为风湿。然而虽言风，寒也在其中。看下文说：出汗当风，又说久伤取冷，意思可知了。大概痉病非风不成，湿痹无寒不作。所以用麻黄散寒，薏苡仁除湿，杏仁利气，辅助通泄的作用；甘草补中，给予胜湿的权力。
麻黄杏仁薏苡甘草汤方
麻黄（半两） 杏仁（十个去皮尖） 薏苡（半两） 甘草（一两炙）
以上锉成麻豆大小，每次服用四钱匕，水一盏半，煎至八分，去渣温服。有微汗，避风。
风湿在表，依法应当从汗而解。然而汗不待发而自出，表尚未解而已虚，汗解之法，不可固守。所以不用麻黄出于皮毛之表，而用防己驱之于肌肤之里。服药后如虫行皮中，以及从腰下如冰，都是湿邪下行的征象。然而没有白术、甘草，怎么能使卫阳复振，而驱湿下行呢？
防己黄芪汤方
防己（一两） 甘草（半两炙） 白术（七钱半） 黄芪（一两一分）
以上锉成麻豆大小，每次抄五钱匕，生姜四片，大枣一枚，水盏半，煎至八分，去渣温服。喘的，加麻黄半两。胃中不和的，加芍药三分。气上冲的，加桂枝三分。下有陈寒的，加细辛三分。服药后应当如虫行皮中，从腰下如冰，之后坐在被子上，又用一条被子绕腰下，温令微微出汗病愈。
伤寒八九日，风湿相搏，身体疼烦，不能自行转侧，不呕不渴，脉浮虚而涩的，桂枝附子汤主治。如果大便坚硬，小便自利的，去桂枝加白术汤主治。
身体疼烦不能自行转侧，是邪在表。不呕不渴，里无热。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，以振奋阳气而抵御阴邪。如果大便坚硬，小便自利，知道其在表的阳虽弱，而在里的气犹治，那么皮中之湿，自然可以驱之于里，使其从水道而出，不必再发其表，以危及久弱之阳。所以在前方中去掉桂枝的辛散，加入白术的苦燥，配合附子的强力健行者，一同走于皮中而逐水气，也是因势利导的方法。
桂枝附子汤方
桂枝（四两） 附子（三枚炮去皮破八片） 生姜（三两切） 甘草（二两炙） 大枣（十二枚擘）
以上五味药，用水六升，煮取二升，去渣，分三次温服。
白术附子汤方
白术（一两） 附子（一枚炮去皮） 甘草（二两炙） 生姜（一两半） 大枣（六枚）
以上五味药，用水三升，煮取一升，去渣，分三次温服。一服觉得身体麻木，约半日后再服，三服都吃完。其人如有冒状（头晕目眩的感觉），不要奇怪。这就是术、附并走皮中，逐水气未得除的缘故。
风湿相搏，骨节疼烦掣痛，不得屈伸，接近则痛剧，汗出短气，小便不利，恶风不欲去衣，或身体微肿的，甘草附子汤主治。
这也是湿胜阳微的证候。其治疗也不超出助阳散湿的方法。说得到微汗则解，不是正发汗，而是阳复而阴自解。夫风湿在表，本当从汗而解。麻黄加术汤、麻黄杏仁薏苡甘草汤，是其正法。而汗出表虚者，不宜重发其汗，则有防己黄芪汤实表行湿的方法。而白术附子汤，则是又补阳以为行的方法。表虚无热者，不可遽发其阳，则有桂枝附子汤温经散湿的方法。而甘草附子汤，则是兼补中以为散的方法。仅从这几个方剂，就可以看出张仲景审病之微妙，用法之变化。
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）
以上四味药，用水六升，煮取三升，去渣，温服一升，每日三次。初服得微汗则解，能食。如果汗出又烦躁，服用五合。恐怕一升太多的话，宜服用六七合为妙。
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（战栗），手足逆冷。小有劳，身即热，口开，前板齿燥。如果发其汗，则恶寒甚。加温针，则发热甚。数下之，则淋甚。
Taiyang disease (disease of the Taiyang channel), characterized by fever and absence of sweating, with an aversion to cold, is named Gang Jing (Stiff Spasm). Taiyang disease, characterized by fever and presence of sweating, without an aversion to cold, is named Rou Jing (Soft Spasm).
Cheng Wuji stated: The *Qianjin Fang* records that in Taiyang Wind-Strike syndrome, if one is additionally affected by Cold-Dampness, it transforms into Jing disease. In Taiyang disease, fever with absence of sweating indicates Exterior Excess, which should not involve an aversion to cold; the current presence of an aversion to cold indicates that Taiyang Wind-Strike has been additionally affected by Cold, resulting in Jing disease. Because the exterior is excess and Cold is present, it is called Gang Jing. In Taiyang disease, fever with sweating indicates Exterior Deficiency, which should involve an aversion to cold; the current absence of an aversion to cold indicates that Wind pathogen has transformed into Heat, injuring the sinews and vessels externally to form Jing disease. Because the exterior is deficient and Cold is absent, it is called Rou Jing. However, "Jing" means stiffness; the pathology lies in the sinews, so there must be accompanying symptoms such as stiffness and tension of the neck and nape, heat in the head and cold in the feet, red eyes, head shaking, trismus (lockjaw), and opisthotonos. Zhang Zhongjing did not list these separately because the term "Jing" encompasses them. The *Huo Ren Shu* also states that the fever and aversion to cold of Jing syndrome are similar to Shang Han (Cold Damage), but the pulse is deep, slow, wiry, and thin, and the opisthotonos is different.
In Taiyang disease, if there is fever and the pulse is deep and thin, it is named Jing, which is difficult to treat.
The Taiyang pulse should originally be floating; the current deepness indicates that Wind has sunk due to Dampness, thus causing Jing. The Jing pulse should originally be tight and wiry; the current thinness indicates that Yin Qi is insufficient, hence it is difficult to treat.
In Taiyang disease, excessive sweating leads to Jing. If a Wind disease is treated with purgation, it leads to Jing; if sweating is induced again, rigidity and cramping will certainly occur. Patients with chronic sores, even if they have body pain, should not undergo sweating therapy; if sweating occurs, Jing will result. These describe the causes of Jing disease. Although there are differences among these three scenarios, they all share the commonality of depleting fluids and damaging Yin. Generally, diseases may transform into Jing due to unresolved Taiyang Wind-Cold combined with additional Cold-Dampness; or they may transform into Jing due to blood loss and Qi exhaustion, damaging Yin and Yang. The Classics state: "Qi primarily provides warming, Blood primarily provides nourishment." It also states: "Yang Qi, when refined, nourishes the Spirit; when soft, it nourishes the sinews." Since both Yin and Yang are declining, the sinews and vessels lose their nourishment, becoming stiff and inflexible. This highlights the differences in root and branch, deficiency and excess in Jing disease, which must be distinguished.
When a patient presents with body heat, cold feet, stiffness and tension of the neck and nape, aversion to cold, occasional head heat, red face and eyes, isolated head shaking, sudden trismus, and opisthotonos, it is Jing disease. If sweating is induced, Cold and Dampness combine, further weakening the exterior, leading to severe aversion to cold. After sweating, the pulse becomes winding like a snake.
Jing disease remains at the Exterior level, hence body heat and aversion to cold. Jing is a Wind-Stiffness disease affecting the sinews and vessels, hence trismus, head and neck stiffness, opisthotonos, and strong, straight pulses. The Classics state: "All sudden stiffness belongs to Wind." Head heat, foot cold, red face and eyes, and head shaking occur because Wind is a Yang pathogen whose Qi ascends and moves actively. When Cold and Dampness combine, it refers to the moisture from sweat combining with external Cold Qi, failing to resolve, thereby further weakening the Exterior Qi due to sweating, while Cold strengthens with Dampness, causing severe aversion to cold. A pulse "like a snake" refers to a pulse that is hidden and curved, resembling a snake's movement. The Jing pulse is originally straight; after sweating, Wind leaves but Dampness remains, so the pulse becomes curved rather than straight.
Sudden abdominal distension indicates the condition is about to resolve. If the pulse remains unchanged but becomes hidden and wiry, it is still Jing.
This is a variation of the previously mentioned scenario where Wind leaves but Dampness remains. Mr. Wei stated: When Wind leaves and no longer adheres to Dampness, the Dampness pathogen has no basis and must follow its downward nature, entering the abdomen to cause distension. With Wind-Cold resolving externally and Dampness moving downward, it is considered a sign of resolution. In such cases, the pulse should be floating rather than deep, and slow rather than wiry. However, if the pulse remains unchanged and adds hidden wiriness, it indicates the pathogen has connected internally to the Taiyin, worsening the Interior condition while the Exterior condition persists. This is one variation among Jing syndromes.
The Jing pulse, when pressed, feels tight and wiry, running straight up and down.
"Tight and wiry" signifies a stiff and straight quality. Mr. Li stated: "Running up and down" means that from the Cun (inch) position to the Chi (cubit) position, a tight and straight pulse is seen. The *Mai Jing* also states: "The Jing disease pulse is hard and hidden, running straight up and down." If a Jing patient has moxibustion sores, it is difficult to treat.
Patients with moxibustion sores have long-standing suppuration and ulceration, leaving acupoints open. Lou Quanshan stated: This is equivalent to broken wind (tetanus). Essentially, Yin injury cannot withstand Wind-Heat, and Yang injury cannot withstand attack and depletion. Hence, it is said to be difficult to treat.
In Taiyang disease, with full manifestation of symptoms, body stiffness, and back stiffness extending to the neck (KT KT describes the appearance of back stiffness connecting to the neck), but the pulse is unexpectedly deep and slow, this is Jing. It is treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction).
Mr. Zhao explained that the Taiyang pulse travels upward from the foot, along the back to the head and neck; symptoms appearing in these areas constitute the Taiyang syndrome. KT KT describes the stiffness of the back connecting to the neck. A deep pulse is typical for Jing; a slow pulse here does not indicate Interior Cold, but rather insufficient fluids leading to impaired circulation of Ying and Wei. In Shang Han, if there is neck and back stiffness, sweating, and aversion to wind, the pulse is typically floating and rapid, indicating abundant Wind-Cold at the Exterior. Here, with body stiffness and an unexpectedly deep and slow pulse, it indicates Wind invading the Exterior while fluids are damaged internally. Thus, using Guizhi (Cinnamon Twig) is the same, but adding Gegen (Kudzu Root) aids dispersion, whereas adding Gualougen (Trichosanthes Root) nourishes the interior, making them different.
Gualou Guizhi Tang Formula
Gualougen (Trichosanthes Radix) (2 liang) Guizhi (Cinnamomi Ramulus) (3 liang) Shaoyao (Paeoniae Radix Alba) (3 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang) Shengjiang (Zingiberis Rhizoma Recens) (3 liang) Dazao (Ziziphi Jujubae Fructus) (12 pieces)
These six ingredients are boiled in 9 sheng of water to yield 3 sheng. Divide into three warm doses. Induce slight sweating. If sweating does not occur, after a meal interval, drink hot porridge to promote sweating.
In Taiyang disease, with absence of sweating and unexpectedly decreased urination, Qi rushing upward to the chest, trismus, and inability to speak, indicating impending Gang Jing, Gegen Tang (Kudzu Decoction) is indicated.
Absence of sweating and decreased urination indicate that Wind-Cold-Dampness is abundant, conflicting with Zheng Qi, preventing outward release or downward drainage. Unable to go out or down, it must rush upward, causing chest fullness and trismus with inability to speak. Gradually, facial flushing, head shaking, and neck/back stiffness will ensue. Hence, it is termed "impending Gang Jing." Gegen Tang is essentially Guizhi Tang plus Mahuang (Ephedrae Herba) and Gegen. It is the standard treatment for Gang Jing without sweating.
Note: Jing disease often occurs at the junction of Taiyang and Yangming channels. Body stiffness and trismus with inability to speak are confirmations. Therefore, Mahuang is added to disperse Taiyang pathogens, and Gegen is added to soothe Yangming channels. Yangming governs muscles externally and fluids internally. Gegen is used to unblock collaterals and expel Wind-Dampness; Gualou is used to generate fluids and moisten sinews.
Gegen Tang Formula
Gegen (Puerariae Lobatae Radix) (4 liang) Mahuang (Ephedrae Herba) (3 liang, tips removed) Guizhi (Cinnamomi Ramulus) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Shaoyao (Paeoniae Radix Alba) (2 liang) Shengjiang (Zingiberis Rhizoma Recens) (3 liang) Dazao (Ziziphi Jujubae Fructus) (12 pieces)
These seven ingredients are boiled in 10 sheng of water. First boil Mahuang and Gegen, reduce by 2 sheng, remove foam. Add remaining herbs, boil to yield 3 sheng. Remove dregs. Warm dose of 1 sheng. Cover to induce slight sweating. No need to drink porridge. Rest and dietary restrictions follow Guizhi Tang methods.
For Jing disease presenting with chest fullness, trismus, inability to lie flat with legs touching the mat, leg cramps, and teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be given.
This represents Jing disease belonging to Yangming Stagnant Heat. The Yangming sinews originate at the foot, knot at the dorsum, and ascend to the thigh. The Yangming meridian enters the teeth, surrounds the mouth and lips, and its branch follows the throat to the clavicle and diaphragm, explaining these symptoms. However, without signs of dryness and excess, one should clear heat without purging excess. Why use Da Chengqi Tang instead of Tiaoweichengqi Tang? Perhaps the disease is deep and heat extreme, requiring this potent formula. The phrase "may be given" implies caution; practitioners should exercise care.
Da Chengqi Tang Formula
Dahuang (Rhei Radix et Rhizoma) (4 liang, wine-washed) Houpo (Magnoliae Officinalis Cortex) (0.5 jin, skin removed, honey-fried) Zhishi (Aurantii Fructus Immaturus) (5 pieces, honey-fried) Mangxiao (Natrii Sulfas) (3 he)
These four ingredients are boiled in 10 sheng of water. First boil Zhishi and Houpo to yield 5 sheng, remove dregs. Add Dahuang, boil to yield 2 sheng, remove dregs. Add Mangxiao, boil briefly over low fire. Divide into two warm doses. If bowel movement occurs, stop taking the remainder.
In Taiyang disease, joint pain accompanied by vexation, with a deep and thin pulse, is named Zhong Shi (Struck by Dampness) or Shi Bi (Dampness Bi Syndrome). Symptoms of Shi Bi include difficulty in urination and loose stools. Treatment should focus on promoting urination. Dampness is one of the Six Evils; like Wind and Cold, it initially affects Taiyang. However, Wind-Cold injures muscle interstices, while Dampness flows into joints. Wind pulse is floating, Cold pulse is tight, but Dampness pulse is deep and thin. Dampness is sticky and stagnant, causing heaviness, hence named Bi (Obstruction). Bi means closure. Just as Wind Strike requires internal Wind to attract external Wind, Zhong Shi requires internal Dampness to attract external Dampness. Thus, individuals with Spleen deficiency (Earth virtue lacking) have internal Dampness moving, leading to sluggish Qi transformation and external Dampness invasion. Internal and external pathogens combine, causing joint pain and vexation, urinary difficulty, and loose stools. Treatment must first eliminate internal Dampness before removing external Dampness. Hence, "promote urination." Dong Yuan also stated: Treating Dampness without promoting urination is incorrect. However, this applies to cases with deep pulse and urinary difficulty. If Wind-Cold is at the exterior combing with Dampness, with floating pulse, aversion to wind, heaviness, and pain, then sweating with Mahuang, Baizhu (Atractylodis Macrocephalae Rhizoma), Yiyiren (Coicis Semen), Xingren (Armeniacae Semen Amarum), Guizhi, and Fuzi (Aconiti Lateralis Radix Praeparata) is appropriate. See later sections.
Patients with chronic Dampness suffer from generalized body pain, fever, and a sallow complexion resembling smoked yellow.
Excessive external Dampness causes internal stagnation of Yang. External Dampness causes body pain; internal Yang stagnation causes fever. Heat and Dampness mix and ferment, causing the skin to appear smoked-yellow. Smoked-yellow is dull and dark yellow due to the heavy and stagnant nature of Dampness. In contrast, Heat-Yellow is bright yellow, described as "yellow like an orange peel."
Patients with chronic Dampness may only sweat on the head, have back stiffness, and desire to cover themselves near fire. If purged prematurely, hiccups, chest fullness, urinary difficulty, and a tongue coating resembling moss may occur. This is due to Heat in the Lower Dan Tian and Cold in the Upper Chest. Thirst with desire to drink but inability to do so causes dry mouth and vexation.
Cold-Dampness residing at the exterior prevents Yang from circulating outward, causing it to rise, leading to head sweating and back stiffness. Desire for warmth indicates the need to dispel Cold-Dampness to unblock Yang. Instead, using purgation suppresses Yang further, causing hiccups. Or, Upper Jiao Yang fails to distribute, causing chest fullness; or Lower Jiao Yang fails to transform, causing urinary difficulty. Pathology arises where damage occurs. A tongue coating resembling moss is not Stomach Heat, but dried fluid aggregating on the tongue like moss. After purgation, Yang sinks to the Lower, while Cold-Dampness remains in the Upper. Thus, Heat in the Lower Dan Tian causes thirst, while Cold in the Upper Chest prevents drinking, leading to oral dryness and vexation, causing fluid aggregation.
If a Dampness patient is purged, leading to sweating on the forehead, slight panting, and free urination, it is a death sign. If diarrhea persists uncontrollably, it is also fatal.
Dampness at the exterior should be treated with sweating; Dampness at the interior with promoting urination. Unless Damp-Heat accumulates into excess, purgation should not be used hastily. Sweating on the forehead and panting indicate Yang separating and ascending; free urination and persistent diarrhea indicate Yin separating and descending. Separation of Yin and Yang leads to death. Another interpretation suggests urinary difficulty is fatal, meaning Yang ascends but Yin does not descend, which is also valid.
When Wind and Dampness combat, causing generalized pain, sweating should resolve it. If rain continues and the physician prescribes sweating, but the disease does not improve, why? Profuse sweating removes Wind but leaves Dampness behind, hence no improvement. To treat Wind-Dampness, one should induce only slight, continuous sweating, allowing both Wind and Dampness to leave together.
Although Wind and Dampness are both among the Six Evils, Wind is formless and Dampness is tangible; Wind is swift and Dampness is stagnant. During damp seasons, Wind is easier to expel than Dampness to remove. Rapid and excessive sweating expels Wind but fails to expel Dampness. To remove Dampness, Yang Qi must steam internally without sudden leakage, filling the muscles and joints, leaving no room for Dampness. This explains the principle of inducing only slight sweating.
Patients with chronic Dampness suffering from body pain, fever, yellow face, wheezing, headache, nasal congestion, and vexation, with a large pulse, normal appetite, and harmonious abdomen, have Cold-Dampness in the head causing nasal congestion. Administering medicine nasally will cure it.
Cold-Dampness above obstructs Clear Yang, causing body/head pain. Nasal congestion indicates severe Dampness above. Fever, yellow face, vexation, and wheezing indicate Yang stagnation above. A large pulse differs from deep/thin pulses. A harmonious abdomen differs from urinary difficulty/loose stools. The pathology is in the head, not the abdomen. Treatment should focus on the head without disturbing the abdomen. Nasal administration, such as Gouti San (Melon Dispersant Powder), expels yellow fluid, removing Cold-Dampness. Medication should not be ingested to avoid harming the interior harmony.
For patients with chronic Dampness suffering from painful body aches, Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction) to induce sweating is appropriate. Fire therapy must be avoided.
Painful body aches indicate Dampness combined with Cold at the exterior. Mahuang Tang disperses Cold; Baizhu eliminates Dampness. Yu Jia stated: Mahuang with Baizhu induces sweating without excessive loss; Baizhu with Mahuang treats both exterior and interior Dampness. Fire therapy is contraindicated to prevent Dampness combining with Heat, increasing fever.
Mahuang Jia Zhu Tang Formula
Mahuang (Ephedrae Herba) (3 liang, tips removed) Guizhi (Cinnamomi Ramulus) (2 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (1 liang, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma) (4 liang) Xingren (Armeniacae Semen Amarum) (70 seeds, skin and tips removed)
These five ingredients are boiled in 9 sheng of water. First boil Mahuang, reduce by 2 sheng, remove foam. Add other herbs, boil to yield 2.5 sheng. Remove dregs. Warm dose of 8 ge. Cover to induce slight sweating.
When a patient suffers from generalized body pain, fever, worsening in the late afternoon (Shi hour), it is named Feng Shi (Wind-Dampness). This results from sweating exposed to wind or prolonged exposure to cold. Mahuang Xingren Yiyi Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) is indicated.
This is another method to disperse Cold and eliminate Dampness. Worsening in the late afternoon need not be strictly attributed to Lung or Yangming; it is named Wind-Dampness because Dampness is constant while Wind comes and goes. Although termed Wind, Cold is included, as indicated by "sweating exposed to wind" and "prolonged cold exposure." Jing disease requires Wind; Shi Bi requires Cold. Thus, Mahuang disperses Cold, Yiyiren eliminates Dampness, Xingren regulates Qi to assist drainage, and Gancao tonifies the Middle to empower overcoming Dampness.
Mahuang Xingren Yiyi Gancao Tang Formula
Mahuang (Ephedrae Herba) (0.5 liang) Xingren (Armeniacae Semen Amarum) (10 seeds, skin and tips removed) Yiyi (Coicis Semen) (0.5 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (1 liang, honey-fried)
Crush to size of hemp seeds. Take 4 qian bi per dose with 1.5 sheng of water, decoct to 0.8 sheng. Remove dregs and take warm. Induce slight sweating; avoid wind.
For Wind-Dampness with floating pulse, heaviness, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is indicated.
Wind-Dampness at the exterior should be resolved via sweating. However, spontaneous sweating indicates the exterior is already deficient despite unresolved pathology. Standard sweating methods are unsuitable. Thus, Mahuang is not used to expel from the skin surface, but Fangji is used to drive Dampness from the muscle layer. Post-administration sensations of insects crawling under the skin or ice-cold feeling below the waist indicate Dampness descending. Without Baizhu and Gancao, Wei Yang cannot recover to drive Dampness downward.
Fangji Huangqi Tang Formula
Fangji (Stephaniae Tetrandrae Radix) (1 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (0.5 liang, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma) (0.75 liang) Huangqi (Astragali Radix) (1.1 liang)
Crush to size of hemp seeds. Take 5 qian bi per dose with 4 slices of Shengjiang and 1 Dazao in 1.5 sheng of water, decoct to 0.8 sheng. Remove dregs and take warm. For wheezing, add 0.5 liang Mahuang. For stomach disharmony, add 0.3 liang Shaoyao. For Qi rushing upward, add 0.3 liang Guizhi. For old Cold below, add 0.3 liang Xixin (Asari Radix et Rhizoma). After taking, expect sensation of insects crawling under skin and ice-cold feeling below waist. Sit on blankets and wrap another around the waist to maintain warmth until slight sweating occurs and condition improves.
After eight or nine days of Shang Han, Wind-Dampness combats, causing severe body pain, inability to turn over, no vomiting or thirst, and a floating, empty, and choppy pulse. Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is indicated. If stool is hard and urination is free, remove Guizhi and add Baizhu; Baizhu Fuzi Tang is indicated.
Severe body pain and inability to turn indicate Exterior pathogen. No vomiting or thirst indicates no Interior Heat. Floating, empty, choppy pulse indicates Wind-Dampness holding the exterior and improper Wei Yang. Thus, Guizhi Tang removes sour-astringent Shaoyao and adds pungent-warm Fuzi to boost Yang against Yin. If stool is hard and urination is free, Interior Qi is functional despite weak Exterior Yang. Dampness in the skin can be driven inward to exit via urine, avoiding further sweating that might endanger weak Yang. Thus, remove pungent-dispersing Guizhi and add bitter-drying Baizhu, combined with powerful Fuziu, to move through the skin and expel water-Qi. This is guiding according to momentum.
Guizhi Fuzi Tang Formula
Guizhi (Cinnamomi Ramulus) (4 liang) Fuzi (Aconiti Lateralis Radix Praeparata) (3 pieces, peeled, split into 8) Shengjiang (Zingiberis Rhizoma Recens) (3 liang, sliced) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Dazao (Ziziphi Jujubae Fructus) (12 pieces, split)
These five ingredients are boiled in 6 sheng of water to yield 2 sheng. Remove dregs. Divide into three warm doses.
Baizhu Fuzi Tang Formula
Baizhu (Atractylodis Macrocephalae Rhizoma) (1 liang) Fuzi (Aconiti Lateralis Radix Praeparata) (1 piece, peeled) Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Shengjiang (Zingiberis Rhizoma Recens) (1.5 liang) Dazao (Ziziphi Jujubae Fructus) (6 pieces)
These five ingredients are boiled in 3 sheng of water to yield 1 sheng. Remove dregs. Divide into three warm doses. After the first dose, if numbness is felt, repeat after half a day. Finish all three doses. A sensation of dizziness is expected; do not be alarmed. This is due to Baizhu and Fuzi moving through the skin to expel water-Qi.
When Wind-Dampness combats, causing joint pain, tenderness, pulling pain, inability to flex or extend, exacerbation upon touch, sweating, shortness of breath, urinary difficulty, aversion to wind with desire to keep clothes on, or slight edema, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated.
This is a syndrome of Dampness overwhelming weak Yang. Treatment involves boosting Yang and dispersing Dampness. "Resolving with slight sweating" is not true sweating, but Yang recovery leading to Yin resolution. While Wind-Dampness at the exterior usually resolves via sweating (standard methods being Mahuang Jia Zhu Tang and Mahuang Xingren Yiyi Gancao Tang), patients with sweating and deficient exterior should not be heavily sweated. Fangji Huangqi Tang solidifies the exterior and moves Dampness. Baizhu Fuzi Tang boosts Yang to facilitate movement. For deficient exterior without Heat, Guizhi Fuzi Tang warms meridians and disperses Dampness. Gancao Fuzi Tang supplements the Middle while dispersing. These formulas demonstrate Zhang Zhongjing’s subtle diagnosis and flexible application.
Gancao Fuzi Tang Formula
Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) (2 liang, honey-fried) Fuzi (Aconiti Lateralis Radix Praeparata) (2 pieces, peeled) Baizhu (Atractylodis Macrocephalae Rhizoma) (2 liang) Guizhi (Cinnamomi Ramulus) (4 liang)
These four ingredients are boiled in 6 sheng of water to yield 3 sheng. Remove dregs. Warm dose of 1 sheng, three times daily. Initial dose inducing slight sweating resolves symptoms and restores appetite. If sweating recurs with vexation, take 0.5 sheng. If 1 sheng is too much, 0.6–0.7 sheng is optimal.
Taiyang Zhong Shu (Summerheat Strike) presents with fever, aversion to cold, heaviness, and pain. The pulse is wiry, thin, hollow, and slow. After urination, chills and piloerection occur. Hands and feet are cold. Minor exertion causes body heat. Mouth opens, and anterior teeth are dry. If sweating is induced, aversion to cold worsens. If moxibustion is applied, fever worsens. If purged repeatedly, strangury worsens.
Zhong Shu is Summerheat. Summerheat is one of the Six Evils, initially injuring Taiyang causing chills and fever. However, Summerheat is a Yang pathogen, yet symptoms include heaviness and pain, and the pulse is...