门而追寇哉。
（病有递历关节而为痛者。名曰历节。大抵由于肝肾先虚。而心阳复郁而起。诊其
两手寸关尺之）寸口脉沉而弱。沉即主骨。弱即主筋。沉即为肾。弱即为肝。（脉象如
此。肝肾之虚可知也。然人身之汗。由于心液所化。今）汗出入（浴）水中。（虽
有形之水。不能直入。而无形之寒气。从汗孔而内侵。）如水伤心。（盖心火也。水水
也。外水内火。郁为湿热。则病成）历节（而）黄汗（亦时）出。（然此非中风不遂者
比。）故（但）曰历节。
此言历节之病。明其病因。大抵寒郁其热。究其病源。大抵虚致邪聚也。然汗出入
水四字。言寒热互搏。不过于最易见者示其端。惟善读易者。可以悟其理也。尤在泾云
、此证若非肝肾先虚。则虽得水气。未必便入筋骨。非水湿内侵。则肝肾虽虚。未必便成历
节。仲景明其委而先溯其源。以为历节多从虚得之也。 又云、后水气篇中云。黄汗之
病。以汗出入水中浴。水从汗孔入得之。合观二条。知历节黄汗。为同源异流之病。其
瘀郁上焦者。则为黄汗。其并伤筋骨者。则为历节也。
（亦有湿热在内。因风而成历节者。难以一言括其病由。惟以饮酒汗出当风所致八
个字。浅浅言之。人可共晓。然致之则有三。一曰在胃。胃脉取之趺阳。若）趺阳脉浮
而滑。（滑本主实。今诊其脉）滑则（知其）谷气（之）实。（然则谷何以不行而实。
岂非酒湿先伤之乎。浮为阳象。今诊其脉）浮则（知其胃热而）汗自出。（然则胃何以
致热。岂非风搏其湿而化热乎。一曰在肾。肾脉取之太溪。亦谓之少阴脉。若）少
阴脉浮而弱。弱则血不足。浮则为风。风血相搏。即疼痛如掣。（然则风
何以得至于少阴。岂非因酒湿挟风乘之乎。一曰肥盛之人。若肥）盛（之）
人（其）脉（不滑而为）涩小。（便知因湿阻滞而）短气。（因风作使而）自汗出。
（风湿相搏。则）历节疼不可屈伸。（然则肥人多湿。其脉宜滑。今何以反见涩小。
岂非酒湿困之乎。且汗出之后，其痛宜从汗而解。今何
以汗出而疼不可忍。岂非湿而挟风乎。三证不同。而因湿热而受
风则一。可以一言断之曰。）此皆饮酒汗出当风所致。
此节、节中分三段。皆言饮酒汗出当风。而成历节也。饮酒主湿热而言。凡湿热内
盛之人。皆以饮酒例之。与上节汗出入水。俱宜活看。上节拈出水字为例。以阴邪郁其
内热者。视诸此也。此节拈出风字为例。以阳邪搏其湿热者。视诸此也。
（上言脉沉而弱。沉即主骨。弱即主筋等。尚未出方。兹更申言其虚极之证。而补
其方。）诸肢节疼痛。（历节之证既成也。）身体 羸。（其虚证一望便见。而且）脚
肿如脱。（气绝于下。）头眩短气。（气虚于上。）温温欲吐。（气逆于中。此三焦气血
两虚。以）桂枝芍药知母汤主之。
此言肝肾俱虚。虚极而营卫三焦亦因之而俱病也。徐忠可云、桂枝行阳。知芍养阴。
方中药品颇多。独挈此三味以名方者。以此证阴阳俱痹也。 又云、欲制其寒。则上
之郁热已甚。欲治其热。则下之肝肾已痹。故桂芍知附。寒热辛苦并用而各当也。
桂枝芍药知母汤方
桂枝（四两） 芍药（三两） 甘草 麻黄 附子（各二两） 白术 知母 防风
（各四两） 生姜（五两）
上九味。以水七升。煮取二升。温服七合。日三服。
（上言因虚而病历节。既出其方治矣。而所以致虚之由。未言也。盖致虚之由。不
止一端。因虚而病。不止历节一证。兹请更详其病由。兼别其疑似。如饮食间）味（
过）酸则（病肝而）伤筋。筋伤则（不收持而）缓。名曰泄。（过）咸则（病肾而）伤
骨。骨伤则（不能立而）痿。名曰枯。枯泄相搏。名曰断泄。（断泄者。）营气（涸流
而）不通。（营不通则）卫不独行。营卫俱微。（盖营卫者。水谷之气。三焦受气于水
谷。而四肢秉气于三焦。故营卫征。则）三焦（气乏。而）无所御。四属（失养而）断绝。
（由是精微不化于上。而）身体羸瘦。（阴浊全注
于下。他处瘦小。而）独足肿大。（而且）黄汗出。胫（常）冷。（此肝肾虽虚。不由于
湿当风所致。不成历节。绝无发热之证也。）假令发热。便为历节也。
此承上节肝肾俱虚证。而究其致虚之由。而推展言之。又以因虚成病。不发热者为劳
伤。而发热者为历节。虚同而证则不同也。徐忠可云、历节与黄汗最难辨。观仲景两言。
假令发热便为历节。似历节有热。而黄汗无热。然仲景叙黄汗。又每曰身热。则知黄
汗亦可有热。总无不热之历节耳。若黄汗由汗出入水中浴。历节亦有由汗出入水而水伤
心。故黄汗汗黄。历节或亦汗黄。则知历节之汗亦有不黄。总无汗不黄之黄汗耳。若历
节言肢节疼。言疼痛如掣。黄汗不言疼痛。则知肢节痛。历节所独也。若黄汗言渴。言
四肢头面肿。言上焦有寒。其口多涎。言胸中窒不能食。反聚痛。暮躁不得眠。而历节
但有足肿黄汗。则知以上证。皆黄汗所独也。若是者何也。黄汗历节。皆是湿郁成热。
逡巡不已。但历节之湿。邪流关节。黄汗之湿。邪聚膈间。故黄汗无肢节痛。而历节少
上焦证也。
病历节不可屈伸。疼痛。（上既言其证。今可补其方。以）乌头汤主之。
尤在泾云、此治寒湿历节之正法也。徐忠可云、病历节。括足肿发热言。承上文也。
按足肿而膝胫不冷。似可加黄柏知母。
乌头汤方 亦治香港脚疼痛不可屈伸。
麻黄 芍药 黄 甘草（各三两炙） 乌头（五枚 咀以蜜三升煎服一升即无乌
头大附子亦可）
上四味。以水三升。煮取一升。去滓。纳蜜煎中。更煎之。服七合。不知。尽服之。
矾石汤 治香港脚冲心。
矾石（二两）
上一味。以浆水一斗五升。煎三五沸。浸脚良。此香港脚外治之方也。前云疼痛不可屈
伸。以乌头汤主之。至于冲心重证。似难以外法幸功。然冲心是肾水挟香港脚以凌心。而
矾能却水。兼能护心。所以为妙。想必以乌头汤内服后。又以此汤外浸也。
附方 （考岐伯谓中风有四。一曰偏枯。半身不遂。二曰风痱。于身无所痛。四肢不
收。三曰风懿。奄忽不知人。四曰风痹。诸痹类风状。风懿。即该中风卒倒内。金匮不重
举。）
古今录验续命汤 治中风痱。身体不能自收持。口不能言。冒昧不知痛处。或
拘急不得转侧。
麻黄 桂枝 甘草 干姜 石膏 当归 人参（各三两） 杏仁（四十粒） 川
芎（一两五钱）
上九味。以水一斗。煮取四升。温服一升。当小汗。薄覆脊凭几坐。汗出则愈。不
汗更服。无所禁。勿当风。并治但伏不得卧。咳逆上气。面目浮肿。
徐忠可云、痱者。痹之别名也。因营卫素虚。风入而痹之。故外之营卫痹。而身体
不能自收持。或拘急不得转侧。内之营卫痹。而口不能言。冒昧不知痛处。因从外感来。
故以麻黄汤行其营卫。干姜石膏调其寒热。而加芎归参草以养其虚。必得小汗者。使
邪仍从表出也。若但伏不得卧。咳逆上气。面目浮肿。此风入而痹其胸膈之气。使肺气
不得通行。独逆而上攻面目。故亦主之。
千金三黄汤 治中风。手足拘急。百节疼痛。烦热心乱。恶寒。经日不欲饮食。
麻黄（五分） 独活（四分） 细辛 黄 （各二分） 黄芩（三分）
上五味。以水六升。煮取二升。分温三服。一服小汗出。二服大汗出。心热加大黄
二分。腹满加枳实一枚。气逆加人参三分。悸加牡蛎三分。渴加栝蒌根三分。先有寒、
加附子一枚。
徐忠可云、此风入营卫肢节之间。扰乱既久。因而邪袭肾府。手足拘急。阳不运也。
百节疼痛。阴不通也。烦热心乱。热收于心也。恶寒经日。不欲饮食。肾家受邪。不能
交心关胃也。故以麻黄通阳开痹。而合黄 以走肌肉。合黄芩以清邪热。独活细辛专攻
肾邪为主。而心热腹满气逆悸渴。及先有寒。各立加法。为邪入内者治法之准绳也。
近效术附汤 治风虚头重眩。苦极。不知食味。暖肌补中。益精气。
白术（一两） 附子（一枚半炮去皮） 甘草（一两炙）
上三味锉。每五钱匕。姜五片。枣一枚。水盏半。煎七分。去滓温服。
按喻嘉言云、经谓内夺而厥。则为风痱。仲景见成方中。有治外感风邪。兼治内伤
不足者。有合经意。取其三方。以示法程。一则曰古今录验续命汤。治营卫素虚而风入
者。再则曰千金三黄汤。治虚热内炽而风入者。三则曰近效术附汤。治风已入脏。脾肾
两虚。兼诸痹类风状者。学人当会仲景意。而于浅深寒热之间。以三隅反矣。
崔氏八味丸 治香港脚上入。少腹不仁。
干地黄（八两） 山茱萸 山药（各四两） 泽泻 茯苓 牡丹皮（各三两）
附子（一枚） 桂枝（一两）
上八味末之。炼蜜丸梧子大。酒下十五丸。日再服。（按宜服三钱）
按、汉之一两。今之三钱零。此方附子用一枚。计今之法马。重应一两。此方地黄
应用二两六钱六分。山药山茱萸应用一两三钱三分。泽泻茯苓丹皮应用一两。桂枝应用
三钱三分。附子一枚应用一两。今人分两多误。今特核正。如若多用。照此递加。
千金越婢加术汤 治内极热则身体津脱。腠理开。汗大泄。厉风气。下焦脚弱。
麻黄（六两） 石膏（半斤） 生姜（二两） 甘草（二两） 白术（四两）
大枣（十五枚）
上六味。以水六升。先煮麻黄。去上沫。内诸药。煮取三升。分三服。恶风加附子
一枚。（炮）
难道还要去门外追赶盗贼吗？
（疾病有逐渐传变至关节并引起疼痛的，称为历节病。这大抵是由于肝肾先已虚弱，而心阳随后郁结所致。诊察两手寸、关、尺脉时，）寸口脉沉而弱。沉脉主骨病，弱脉主筋病；沉脉对应肾，弱脉对应肝。（脉象如此，可知肝肾虚损。然而人体的汗液，是由心液所化生。如今）出汗后进入（洗澡）水中。（虽然有形的水不能直接侵入体内，但无形的寒气却从汗孔内侵。）这就如同水伤害了心。（因为心属火，水属阴，外水与内火相搏，郁滞化为湿热，于是病症形成）成为历节病，（并且）黄汗（也时常）流出。（但这与中风导致半身不遂的情况不同。）所以（只）称之为历节病。
这里论述历节病的病因，明确指出其病机。大体上是寒邪郁遏内热，追溯病源，大抵是正气虚损导致邪气聚集。然而“汗出入水”这四个字，说明寒热相互搏击，只是指出了最容易见到的情况作为开端，只有善于研读《易经》的人，才能领悟其中的道理。尤在泾说：此证如果不是肝肾先虚，那么即使遇到水湿之气，未必就会侵入筋骨；如果不是水湿内侵，那么即使肝肾虚弱，也未必就会形成历节病。张仲景明确阐述了结果并追溯源头，认为历节病多因虚损而得。又说：在《水气病篇》中说，黄汗病，是因为出汗后进入水中洗澡，水从汗孔进入而导致的。结合这两条经文来看，可知历节病和黄汗病是同源于湿气而表现不同的疾病。其瘀滞郁结在上焦的，就形成黄汗；其同时损伤筋骨的，就形成历节病。
（也有因体内湿热，感受风邪而成为历节病的，难以用一句话概括其病因，只用“饮酒汗出当风”这八个字浅显地说明，人们可以共同知晓。然而致病原因有三种：一是在胃，胃脉取之于趺阳脉。如果）趺阳脉浮而滑。（滑脉本主实证，如今诊察其脉）滑则（知道是）谷气（之）实。（既然这样，为什么谷物精气不能正常运化而显得充实呢？难道不是酒湿先损伤了它吗？浮脉为阳象，如今诊察其脉）浮则（知道是胃中有热而）自然出汗。（既然这样，胃为什么会致热呢？难道不是风邪搏击湿气而化热吗？二是在肾，肾脉取之于太溪穴，也称为少阴脉。如果）少阴脉浮而弱。弱脉则血不足，浮脉则为风邪。风与血相互搏结，就会出现疼痛如牵引般的症状。（既然这样，风邪怎么会到达少阴经呢？难道不是因酒湿挟带风邪乘虚而入吗？三是肥胖之人，如果肥）盛（之）人（其脉）不滑反而）涩小。（便知是因湿气阻滞而）短气。（因风邪作祟而）自然出汗。（风湿相互搏结，则）历节疼痛不可屈伸。（既然这样，肥胖人多湿气，其脉应当滑利，如今为何反而出现涩小脉呢？难道不是酒湿困阻了吗？而且出汗之后，疼痛应当随汗而解，如今为何出汗而疼痛难以忍受呢？难道不是湿气挟带风邪吗？这三种证候不同，但因湿热而受风邪是一致的，可以用一句话来断定：）这些都是因饮酒后出汗，当风受凉所致。
这一节分为三段，都论述因饮酒后出汗，当风受凉而成为历节病。饮酒主要指代湿热。凡是体内湿热旺盛的人，都可以用饮酒为例来类比。这与上节的“汗出入水”，都应当灵活看待。上节提出“水”字为例，以阴邪郁遏内热的情况，以此类推。本节提出“风”字为例，以阳邪搏击湿热的情况，以此类推。
（上文论述脉象沉而弱，沉主骨，弱主筋等，尚未给出方剂。现在进一步论述虚损至极的证候，并补充相应的方剂。）各个肢节疼痛。（历节病证已经形成。）身体消瘦羸弱。（其虚损证候一望便知，而且）脚肿得像要脱落一样。（下部元气断绝。）头晕目眩，呼吸短促。（上部气虚。）心中温温欲吐。（中焦气逆。这是三焦气血两虚，用）桂枝芍药知母汤主治。
这里论述肝肾俱虚，虚损至极而导致营卫和三焦也因此全部患病。徐忠可说：桂枝行阳气，芍药养阴血。方中药品种类很多，唯独提取这三味药来命名方剂，是因为此证阴阳俱痹。又说：想要制约寒邪，则上部的郁热已经很严重；想要治疗热邪，则下部的肝肾已经痹阻。所以桂枝、芍药、知母、附子，寒热辛苦并用，各得其宜。
桂枝芍药知母汤方
桂枝（四两） 芍药（三两） 甘草 麻黄 附子（各二两） 白术 知母 防风（各四两） 生姜（五两）
以上九味药，用水七升，煮取二升，温服七合，每日三次服用。
（上文论述因虚损而患历节病，既给出了方治，但未说明导致虚损的原因。导致虚损的原因不止一端，因虚损而患病，也不止历节这一种证候。现在请更详细地阐述病因，兼且辨别疑似证候。例如饮食方面，）味道过）酸则（伤肝而）伤筋。筋受伤则（松弛不收持而）缓纵，称为泄泻。（味道过）咸则（伤肾而）伤骨。骨受伤则（不能站立而）痿废，称为枯证。枯证和泄泻相互搏结，称为断泄。（所谓断泄，是指）营气（枯竭流散而）不通。（营气不通则）卫气不能独行。营卫都微弱。（因为营卫是水谷精微之气，三焦接受水谷之气，而四肢依赖三焦之气，所以营卫衰征，则）三焦（之气匮乏，而）无法抵御外邪，四肢所属组织（失养而）断绝。（由此精微物质不能在上方化生，而）身体消瘦羸瘦。（阴浊之气完全注于下方，他处瘦小，而）唯独足部肿大。（而且）黄汗流出，小腿（经常）发冷。（这是肝肾虽虚，但不是由于湿邪当风所致，不会形成历节病，绝无发热证候。）假如发热，就是历节病了。
这里承接上节肝肾俱虚的证候，而探究导致虚损的原因，并推展论述。又以因虚而成病、不发热的为劳伤，而发热的为历节病。虚损相同但证候不同。徐忠可说：历节病和黄汗病最难辨别。看张仲景两次提到“假令发热便为历节”，似乎历节病有热，而黄汗病无热。然而张仲景叙述黄汗病时，又常说身热，则知黄汗病也可以有热。总之没有不发热的历节病。至于黄汗病由出汗后进入水中洗澡所致，历节病也有因出汗后进入水中而水伤心所致，所以黄汗的病汗色黄，历节病的汗也可能色黄，则知历节病的汗也有不黄的。总之没有汗不黄的黄汗病。至于历节病论述肢节疼痛，论述疼痛如牵引，黄汗病不论述疼痛，则知肢节痛是历节病独有的。至于黄汗病论述口渴，论述四肢头面肿，论述上焦有寒，口中多涎，论述胸中窒塞不能进食，反而聚痛，傍晚烦躁不得睡眠，而历节病只有足肿和黄汗，则知以上证候，都是黄汗病独有的。像这样的情况为什么呢？黄汗病和历节病，都是湿气郁结化热，缠绵不已。但历节病的湿邪，流窜于关节；黄汗病的湿邪，郁结于膈间。所以黄汗病没有肢节痛，而历节病很少有上焦证候。
患历节病，不可屈伸，疼痛。（上文既已论述其证候，现在可以补充方剂，用）乌头汤主治。
尤在泾说：这是治疗寒湿历节病的正法。徐忠可说：患历节病，包括足肿发热而言，是承接上文。按语：足肿而膝胫不冷，似乎可以加黄柏、知母。
乌头汤方 也治疗香港脚疼痛不可屈伸。
麻黄 芍药 黄芪 甘草（各三两，炙） 乌头（五枚，切碎，用蜜三升煎煮，取一升即服，若无乌头，大附子亦可代替）
以上四味药，用水三升，煮取一升，去渣滓，纳入蜂蜜中煎煮，再煎一下。服七合。若无效，全部服完。
以上一味药，用浆水一斗五升，煎煮三五沸，浸泡双脚，效果良好。这是治疗香港脚的外治方。前文说疼痛不可屈伸，用乌头汤主治。至于冲心这种重症，似乎难以单靠外治法侥幸成功。然而冲心是肾水挟带香港脚邪气来凌犯心脏，而矾石能退水，兼能护心，所以很妙。想必是在内服乌头汤后，再用此汤外浸。
附方 （考证岐伯说中风有四类：一是偏枯，半身不遂；二是风痱，身体无痛，四肢不收；三是风懿，突然不知人事；四是风痹，各种痹症类似风状。风懿，即包含在中风卒倒之内，《金匮要略》不再重点列举。）
古今录验续命汤 治疗中风痱，身体不能自我收持，口不能言语，神志昏蒙不知痛处，或者拘急不能转侧。
麻黄 桂枝 甘草 干姜 石膏 当归 人参（各三两） 杏仁（四十粒） 川芎（一两五钱）
以上九味药，用水一斗，煮取四升，温服一升，应当微微出汗。背部覆盖薄被，靠着几案坐立，出汗则痊愈。不出汗则再服，没有禁忌。不要当风。同时也治疗只能伏卧不能仰卧，咳嗽气逆，面目浮肿。
徐忠可说：痱，是痹症的别名。因为营卫素来虚弱，风邪侵入而痹阻，所以外在的营卫痹阻，而身体不能自我收持，或者拘急不能转侧；内在的营卫痹阻，而口不能言语，神志昏蒙不知痛处。因为是从外感而来，所以用麻黄汤运行其营卫，干姜、石膏调和其寒热，而加入川芎、当归、人参、甘草来补养其虚损。必须得到微微出汗，是为了使邪气仍然从表而出。如果只是伏卧不能仰卧，咳嗽气逆，面目浮肿，这是风邪侵入而痹阻其胸膈之气，使肺气不能通行，独自逆而上攻面部和头部，所以也主治此证。
千金三黄汤 治疗中风，手足拘急，百节疼痛，心烦发热，心神扰乱，恶寒，多日不想饮食。
麻黄（五分） 独活（四分） 细辛 黄芪（各二分） 黄芩（三分）
以上五味药，用水六升，煮取二升，分三次温服。第一服微微出汗，第二服大汗出。心中热加大黄二分，腹部胀满加枳实一枚，气逆加人参三分，心悸加牡蛎三分，口渴加栝蒌根三分。先前有寒证，加附子一枚。
徐忠可说：这是风邪侵入营卫肢节之间，扰乱已久，因而邪气侵袭肾府。手足拘急，是阳气不能运达；百节疼痛，是阴气不通畅；心烦发热，是热邪收敛于心；恶寒多日，不想饮食，是肾家受邪，不能交泰于心、关通于胃。所以用麻黄通阳开痹，配合黄芪以走肌肉，配合黄芩以清邪热，独活、细辛专门攻逐肾邪为主。而对于心热、腹满、气逆、心悸、口渴及先前有寒证，分别设立加法，作为邪气入内的治法准则。
近效术附汤 治疗风虚引起的头重眩晕，痛苦至极，不知食物味道，温暖肌肉，补益中气，增益精气。
白术（一两） 附子（一枚半，炮制，去皮） 甘草（一两，炙）
以上三味药切碎。每次取五钱匕，加生姜五片，大枣一枚，水一盏半，煎至七分，去渣滓温服。
按语：喻嘉言说：《内经》谓内夺而厥，则为风痱。张仲景见到成方中，有治疗外感风邪，兼治内伤不足的，符合经旨，选取这三个方子，以示法度。一则曰古今录验续命汤，治疗营卫素虚而风邪侵入者；再则曰千金三黄汤，治疗虚热内炽而风邪侵入者；三则曰近效术附汤，治疗风邪已入脏，脾肾两虚，兼有各种痹症类似风状者。学习的人应当领会张仲景的心意，而在深浅、寒热之间，举一反三。
崔氏八味丸 治疗香港脚上行，少腹麻木不仁。
干地黄（八两） 山茱萸 山药（各四两） 泽泻 茯苓 牡丹皮（各三两） 附子（一枚） 桂枝（一两）
以上八味药研末，炼蜜为丸，如梧子大。酒送服十五丸，每日两次服用。（按语：适宜服用三钱）
按语：汉代的一两，相当于现在的三钱多一点。此方附子用一枚，按照现在的方法计算，重量应为一两。此方地黄应用二两六钱六分，山药、山茱萸应用一两三钱三分，泽泻、茯苓、丹皮应用一两，桂枝应用三钱三分，附子一枚应用一两。今人对于分两多有错误，现在特别核实纠正。如果多用，照此比例递增。
千金越婢加术汤 治疗内热极盛则身体津液脱失，腠理开泄，大汗淋漓，厉风气，下焦脚弱。
麻黄（六两） 石膏（半斤） 生姜（二两） 甘草（二两） 白术（四两） 大枣（十五枚）
Is it necessary to chase the thief outside the door?
(When a disease progressively spreads to the joints causing pain, it is called Li Jie (Lijie) disease. This is generally due to a prior deficiency of the Liver and Kidney, followed by the stagnation of Heart Yang. Upon examining the Cun, Guan, and Chi pulses on both wrists,) the Cun Kou (Cunkou, pulse position at the wrist) pulse is deep (Chen) and weak (Ruo). A deep pulse governs bone diseases, while a weak pulse governs tendon diseases; a deep pulse corresponds to the Kidney, and a weak pulse corresponds to the Liver. (With such pulse manifestations, the deficiency of the Liver and Kidney can be known. However, human sweat is transformed from Heart fluids. Now,) after sweating, one enters (bathes in) water. (Although visible water cannot directly enter the body, invisible cold pathogenic factors invade internally through the sweat pores.) This is like water injuring the Heart. (Since the Heart belongs to Fire and Water belongs to Yin, external water and internal fire struggle, stagnating and transforming into damp-heat, thus forming the disease) as Li Jie (Lijie), and (also) Huang Han (Yellow Sweat) (occasionally) flows out. (But this is different from Zhong Feng (Wind Strike) leading to hemiplegia.) Therefore, it is (only) called Li Jie (Lijie).
This section discusses the etiology of Li Jie (Lijie), clarifying its pathogenesis. Generally, cold pathogens constrain internal heat; tracing the source, it is largely due to righteous Qi deficiency leading to pathogen accumulation. However, the phrase "sweating and entering water" indicates the mutual struggle of cold and heat, pointing only to the most easily observable manifestation as a starting point. Only those skilled in studying the *I Ching* (Book of Changes) can comprehend the underlying principles. You Zaijing stated: If this syndrome did not involve prior Liver and Kidney deficiency, even if exposed to water-dampness, it would not necessarily invade the sinews and bones. If there were no internal invasion of water-dampness, even with Liver and Kidney deficiency, it would not necessarily form Li Jie (Lijie). Zhang Zhongjing clearly elucidates the outcome and traces back to the source, indicating that Li Jie (Lijie) often arises from deficiency. He also stated: In the chapter on Water Qi Diseases, it is said that Yellow Sweat disease occurs because one bathes in water after sweating, allowing water to enter through the sweat pores. Observing these two passages together, we know that Li Jie (Lijie) and Yellow Sweat are diseases originating from the same source but manifesting differently. When dampness stagnates and accumulates in the Upper Jiao, it forms Yellow Sweat; when it simultaneously injures the sinews and bones, it forms Li Jie (Lijie).
(There are also cases where internal damp-heat, combined with Wind pathogen, leads to Li Jie (Lijie). It is difficult to summarize the etiology in one sentence, so it is simply explained using the eight characters "drinking alcohol, sweating, and exposing to wind," which people can easily understand. However, there are three causes: First, in the Stomach. The Stomach pulse is taken at the Zu Yang (Foot-Yangming) position. If the) Zu Yang (Zuyang, pulse position on the dorsum of the foot) pulse is floating (Fu) and slippery (Hua). (A slippery pulse typically indicates excess. Now, examining the pulse,) a slippery pulse (indicates that) Gu Qi (Grain Qi/Nutritive essence from food) is (excessively) substantial. (Then why does Grain Qi fail to circulate properly and appear substantial? Is it not because Alcohol-Dampness has first injured it? A floating pulse is a Yang image. Now, examining the pulse,) a floating pulse (indicates that there is) Stomach Heat, leading to spontaneous sweating. (Then why does the Stomach develop heat? Is it not because Wind combats Dampness and transforms into heat? Second, in the Kidney. The Kidney pulse is taken at the Tai Xi (Taixi) acupoint, also known as the Shao Yin (Shaoyin) pulse. If the) Shao Yin (Shaoyin, pulse position at the medial malleolus) pulse is floating (Fu) and weak (Ruo). A weak pulse indicates Blood insufficiency; a floating pulse indicates Wind. Wind and Blood combat each other, resulting in pain as if being pulled or tugged. (Then how does Wind reach the Shaoyin channel? Is it not because Alcohol-Dampness carries Wind to take advantage of the deficiency? Third, in obese individuals. If an obese) person (their pulse is) not slippery but rather) coarse and small (Se Xiao). (One can deduce that this is due to Dampness obstruction causing) shortness of breath. (And due to Wind acting as a catalyst, there is) spontaneous sweating. (When Wind and Dampness combat each other,) Li Jie (Lijie) pain becomes severe, preventing flexion and extension. (Then, since obese people usually have Dampness and their pulse should be slippery, why does it appear coarse and small now? Is it not because of Alcohol-Dampness constraint? Moreover, after sweating, the pain should resolve with the sweat. Why is the pain unbearable despite sweating? Is it not because Dampness carries Wind? Although these three syndromes differ, they all involve Wind attacking due to Damp-Heat. This can be summarized in one statement:) All of these are caused by drinking alcohol, sweating, and exposing oneself to the wind.
This section is divided into three parts, all discussing how Li Jie (Lijie) results from drinking alcohol, sweating, and exposing oneself to the wind. Drinking alcohol primarily refers to Damp-Heat. Anyone with abundant internal Damp-Heat can be analogized to this scenario. Like the previous section's "sweating and entering water," this should be interpreted flexibly. The previous section used "Water" as an example to illustrate Yin pathogens constraining internal heat. This section uses "Wind" as an example to illustrate Yang pathogens combating Damp-Heat.
(The above discussed the deep and weak pulses, stating deep governs bone and weak governs sinews, but no formula was given. Here, further discussing the syndrome of extreme deficiency, a formula is supplemented.) Pain in various limbs and joints. (The Li Jie (Lijie) syndrome is established.) The body is emaciated and weak. (The deficiency signs are obvious at a glance, and) the feet are swollen as if detached. (Qi is severed below.) Dizziness and shortness of breath. (Qi is deficient above.) A feeling of warmth and nausea in the chest. (Qi rebels in the middle. This indicates a dual deficiency of Qi and Blood in the Three Jiao. It is treated with) Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemone Decoction).
This discusses the dual deficiency of the Liver and Kidney, where extreme deficiency leads to disorders of Ying Wei (Nutritive and Defensive Qi) and the Three Jiao. Xu Zhongke stated: Gui Zhi (Cinnamon Twig) promotes Yang, while Shao Yao (Peony) nourishes Yin. Although the formula contains many herbs, these three are highlighted in the name because this syndrome involves blockage of both Yin and Yang. He also stated: To control Cold, the upper郁 (stagnant) Heat is already severe; to treat Heat, the lower Liver and Kidney are already blocked. Therefore, Gui Zhi, Shao Yao, Zhi Mu, and Fu Zi (Aconite Root) are used together, combining cold/hot and bitter/acrid properties appropriately.
Gui Zhi Shao Yao Zhi Mu Tang Formula
Gui Zhi (Cinnamomi Ramulus, 4 liang) Shao Yao (Paeoniae Radix Alba, 3 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma) Ma Huang (Ephedrae Herba) Fu Zi (Aconiti Lateralis Radix Praeparata, 2 liang each) Bai Zhu (Atractylodis Macrocephalae Rhizoma) Zhi Mu (Anemarrhenae Rhizoma) Fang Feng (Saposhnikoviae Radix, 4 liang each) Sheng Jiang (Zingiberis Rhizoma Recens, 5 liang)
Take nine ingredients. Add seven sheng of water, boil to obtain two sheng. Take seven ge warm, three times daily.
(Above, it was stated that Li Jie (Lijie) is caused by deficiency, and a treatment was provided, but the cause of the deficiency was not explained. The causes of deficiency are manifold, and illness due to deficiency is not limited to Li Jie (Lijie). Now, let us detail the etiology and distinguish similar conditions. For instance, regarding diet,) excessive sour taste (will) injure the Liver and) damage the sinews. Damaged sinews become (loose and unable to hold, leading to) laxity, termed Xie (Leakage/Flaccidity). Excessive salty taste will (injure the Kidney and) damage the bones. Damaged bones lead to (inability to stand and) flaccid paralysis, termed Ku (Withering). The combination of Withering and Leakage is termed Duan Xie (Severance and Depletion). (Duan Xie means that) Ying Qi (Nutritive Qi) (dries up and flows without circulation, becoming) obstructed. (If Ying Qi is obstructed,) Wei Qi (Defensive Qi) cannot move independently. Both Ying and Wei become diminished. (Since Ying and Wei are derived from the Qi of Food and Drink, and the Three Jiao receives Qi from Food and Drink, while the four limbs derive Qi from the Three Jiao, when Ying and Wei show signs of decline, the) Three Jiao (Qi becomes scarce, and) loses its ability to defend, causing the Four Belongings (limbs and tissues) to lose nourishment and become severed. (Consequently, essences and micro-nutrients fail to transform upwards, leading to) emaciation of the body. (Yin turbidity fully sinks downwards; while other parts are thin, the) feet alone become swollen. (Moreover,) Yellow Sweat flows out, and the calves (are often) cold. (This indicates Liver and Kidney deficiency, but not caused by Dampness and Wind, so it does not form Li Jie (Lijie) and absolutely lacks fever symptoms.) If there is fever, it is Li Jie (Lijie).
This continues from the previous section on Liver and Kidney dual deficiency, exploring the cause of deficiency and expanding upon it. It distinguishes that illness arising from deficiency without fever is Lao Shang (Labor Injury), while with fever is Li Jie (Lijie). The deficiency is the same, but the syndromes differ. Xu Zhongke stated: Li Jie (Lijie) and Yellow Sweat are hardest to differentiate. Seeing Zhang Zhongjing say twice "if there is fever, it is Li Jie (Lijie)," it seems Li Jie (Lijie) has heat while Yellow Sweat does not. However, Zhang Zhongjing describes Yellow Sweat often mentioning body heat, implying Yellow Sweat can also have heat. In total, there is no Li Jie (Lijie) without heat. Regarding Yellow Sweat caused by bathing in water after sweating, Li Jie (Lijie) can also result from water injuring the Heart after sweating. Thus, Yellow Sweat has yellow sweat, and Li Jie (Lijie) sweat may also be yellow, meaning Li Jie (Lijie) sweat can be non-yellow. In total, there is no Yellow Sweat without yellow sweat. Since Li Jie (Lijie) mentions limb/joint pain and pulling pain, while Yellow Sweat does not mention pain, limb/joint pain is unique to Li Jie (Lijie). Since Yellow Sweat mentions thirst, swelling of limbs/head/face, cold in the Upper Jiao with excessive saliva, chest oppression preventing eating, gathering pain, evening irritability and insomnia, while Li Jie (Lijie) only has foot swelling and yellow sweat, the aforementioned symptoms are unique to Yellow Sweat. Why is this? Both Yellow Sweat and Li Jie (Lijie) involve dampness stagnating and transforming into heat, lingering endlessly. However, in Li Jie (Lijie), the dampness pathogen flows to the joints; in Yellow Sweat, the dampness pathogen gathers in the diaphragm area. Thus, Yellow Sweat lacks limb/joint pain, while Li Jie (Lijie) rarely has Upper Jiao symptoms.
For Li Jie (Lijie) with inability to flex/extend and pain, (since the syndrome was described above, now supplement the formula, treating with) Wu Tou Tang (Aconite Decoction).
You Zaijing stated: This is the standard method for treating Cold-Damp Li Jie (Lijie). Xu Zhongke stated: "Li Jie (Lijie)" here includes foot swelling and fever, continuing from the previous text. Note: If the feet are swollen but the knees and calves are not cold, Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma) could be added.
Wu Tou Tang Formula Also treats Hong Kong Foot (Gouty Arthritis) pain with inability to flex/extend.
Ma Huang (Ephedrae Herba) Shao Yao (Paeoniae Radix Alba) Huang Qi (Astragali Radix) Gan Cao (Glycyrrhizae Radix et Rhizoma, Prepared, 3 liang each) Wu Tou (Aconiti Radix, 5 pieces, crushed. Decoct with 3 sheng of honey to obtain 1 sheng. If Wu Tou is unavailable, large Fu Zi (Aconiti Lateralis Radix Praeparata) may be substituted)
Take four ingredients. Add three sheng of water, boil to obtain one sheng. Remove dregs, add honey, and decoct again. Take seven ge. If ineffective, consume the remainder.
Fan Shi Tang (Alum Decoction) Treats Hong Kong Foot (Gouty Arthritis) rushing to the Heart.
Fan Shi (Alumen, 2 liang)
Take one ingredient. Add fifteen dou of Jiang Shui (Sour Rice Water), boil for three to five boils, and soak the feet. This is an external treatment for Hong Kong Foot (Gouty Arthritis). The text previously stated that pain with inability to flex/extend is treated with Wu Tou Tang. For the severe condition of "rushing to the Heart," external methods alone are unlikely to succeed. However, "rushing to the Heart" involves Kidney Water carrying Hong Kong Foot (Gouty Arthritis) pathogen to oppress the Heart. Alum can repel water and protect the Heart, making it effective. It is likely used externally after internal administration of Wu Tou Tang.
Attached Formulas (Researching Qibo, Wind Strike has four types: 1. Pian Ku (Hemiplegia), hemiplegia; 2. Feng Fei (Wind Flaccidity), no body pain, limbs unresponsive; 3. Feng Yi (Wind Stupor), sudden loss of consciousness; 4. Feng Bi (Wind Bi), various Bi syndromes resembling Wind. Feng Yi is included within sudden collapse of Wind Strike. *Jin Gui Yao Lue* does not emphasize this separately.)
Gu Jin Lu Yan Xu Ming Tang (Ancient and Modern Verified Reviving Decoction) Treats Wind Flaccidity (Feng Fei), body unable to self-control, inability to speak, mental confusion unaware of pain location, or stiffness preventing turning over.
Ma Huang (Ephedrae Herba) Gui Zhi (Cinnamomi Ramulus) Gan Cao (Glycyrrhizae Radix et Rhizoma) Gan Jiang (Zingiberis Rhizoma) Shi Gao (Gypsi Fibrosus) Dang Gui (Angelicae Sinensis Radix) Ren Shen (Ginseng Radix) (3 liang each) Xing Ren (Armeniacae Semen Amarum, 40 grains) Chuan Xiong (Ligustici Chuanxiong Rhizoma, 1.5 liang)
Take nine ingredients. Add ten dou of water, boil to obtain four sheng. Take one sheng warm. Should induce slight sweating. Cover the back thinly, sit leaning on a table. Sweating leads to recovery. If no sweating, administer again. No restrictions. Avoid wind. Also treats inability to lie flat, coughing and rebellious Qi, facial and ocular edema.
Xu Zhongke stated: Fei (Flaccidity) is another name for Bi (Obstruction). Due to prior deficiency of Ying and Wei, Wind enters and causes Bi. Thus, external Ying and Wei are blocked, leading to inability to self-control or stiffness preventing turning over; internal Ying and Wei are blocked, leading to inability to speak and mental confusion. Since it originates from external contraction, Ma Huang Tang is used to move Ying and Wei, Gan Jiang and Shi Gao to harmonize cold and heat, and Chuan Xiong, Dang Gui, Ren Shen, and Gan Cao to nourish deficiency. Inducing slight sweating ensures the pathogen exits via the exterior. If only lying prone is possible, with coughing/rebellious Qi and facial edema, this indicates Wind invading and blocking Qi in the chest/diaphragm, preventing Lung Qi from circulating, causing it to rebel upward to the face/head. Thus, this formula is also indicated.
Qian Jin San Huang Tang (Thousand Golden Three Yellows Decoction) Treats Wind Strike, stiff/tense hands and feet, pain in all joints, vexation, heart heat, mental disturbance, aversion to cold, days without desire for food.
Ma Huang (Ephedrae Herba, 5 fen) Du Huo (Angelicae Pubescentis Radix, 4 fen) Xi Xin (Asari Radix et Rhizoma) Huang Qi (Astragali Radix) (2 fen each) Huang Qin (Scutellariae Radix, 3 fen)
Take five ingredients. Add six sheng of water, boil to obtain two sheng. Divide into three warm doses. First dose induces slight sweating; second dose induces heavy sweating. For heart heat, add Da Huang (Rhei Radix et Rhizoma) 2 fen. For abdominal fullness, add Zhi Shi (Aurantii Fructus Immaturus) one piece. For rebellious Qi, add Ren Shen (Ginseng Radix) 3 fen. For palpitations, add Mu Li (Ostreae Concha) 3 fen. For thirst, add Gua Lou Gen (Trichosanthis Radix) 3 fen. For pre-existing cold, add Fu Zi (Aconiti Lateralis Radix Praeparata) one piece.
Xu Zhongke stated: This is Wind invading Ying, Wei, and joints, disturbing for a long time, subsequently attacking the Kidney mansion. Hand/foot stiffness indicates Yang failure to transport; joint pain indicates Yin obstruction. Vexation/heart heat indicates Heat collecting in the Heart. Aversion to cold for days and lack of appetite indicate Kidney pathogen failing to interact with Heart and Stomach. Thus, Ma Huang is used to open Yang and relieve Bi, combined with Huang Qi to penetrate muscles, and Huang Qin to clear pathogenic heat. Du Huo and Xi Xin specifically target Kidney pathogens. Additions for heart heat, abdominal fullness, rebellious Qi, palpitations, thirst, and pre-existing cold serve as standards for treating internal pathogens.
Jin Xiao Zhu Fu Tang (Recent Effect Atractylodes and Aconite Decoction) Treats Wind-Deficiency causing heavy/dizzy head, extreme suffering, inability to taste food, warming muscles, tonifying Middle, benefiting Jing and Qi.
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang) Fu Zi (Aconiti Lateralis Radix Praeparata, 1.5 pieces, processed, peeled) Gan Cao (Glycyrrhizae Radix et Rhizoma, Prepared, 1 liang)
Crush the three ingredients. Each time take 5 qian bi (approx. 15g), add 5 slices of Ginger and 1 Jujube. Add 1.5 cups of water, decoct to 70%, remove dregs, and take warm.
Note: Yu Jiayan stated: The Classic says internal depletion and reversal leads to Wind Flaccidity (Feng Fei). Zhang Zhongjing saw existing formulas treating external Wind contraction combined with internal deficiency, aligning with the Classic. He selected three formulas to demonstrate principles. First, Gu Jin Lu Yan Xu Ming Tang for prior Ying/Wei deficiency with Wind invasion. Second, Qian Jin San Huang Tang for internal vacuous heat with Wind invasion. Third, Jin Xiao Zhu Fu Tang for Wind entering the Zang, Spleen/Kidney dual deficiency, with Bi-like Wind symptoms. Students should grasp Zhang Zhongjing's intent and apply it to depth and cold/heat differentiation.
Cui Shi Ba Wei Wan (Cui's Eight-Ingredient Pill) Treats Hong Kong Foot (Gouty Arthritis) ascending, numbness in the lower abdomen.
Shu Di Huang (Rehmanniae Radix Preparata, 8 liang) Shan Zhu Yu (Corni Fructus) Shan Yao (Dioscoreae Rhizoma) (4 liang each) Ze Xie (Alismatis Rhizoma) Fu Ling (Poria) Mu Dan Pi (Moutan Cortex) (3 liang each) Fu Zi (Aconiti Lateralis Radix Praeparata, 1 piece) Gui Zhi (Cinnamomi Ramulus, 1 liang)
Powder the eight ingredients. Mix with refined honey to make pills the size of wutong seeds. Take 15 pills with wine, twice daily. (Note: Suitable dose is 3 qian)
Note: One Han dynasty liang equals slightly more than 3 modern qian. This formula uses one Fu Zi, calculated by modern standards as 1 liang. This formula should use 2.66 liang of Di Huang, 1.33 liang each of Shan Yao and Shan Zhu Yu, 1 liang each of Ze Xiang, Fu Ling, and Mu Dan Pi, 0.33 liang of Gui Zhi, and 1 liang for one Fu Zi. People often err in measurements; this corrects them. Scale proportionally if increasing dosage.
Qian Jin Yue Bi Jia Shu Tang (Thousand Golden Yuebi Plus Atractylodes Decoction) Treats extreme internal heat causing fluid depletion, open pores, profuse sweating, Li Feng Qi (severe wind pathogen), and lower jiao leg weakness.
Ma Huang (Ephedrae Herba, 6 liang) Shi Gao (Gypsi Fibrosus, 0.5 jin) Sheng Jiang (Zingiberis Rhizoma Recens, 2 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 4 liang) Da Zao (Jujubae Fructus, 15 pieces)
Take six ingredients. Add six sheng of water. First boil Ma Huang, remove surface foam. Add remaining herbs. Boil to obtain three sheng. Divide into three doses. For aversion to wind, add one Fu Zi (processed).