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。
（风湿之证。前既详言。犹未言其致此风湿之因也。）病者（风湿相搏。）一身尽
疼。（其）发热。（每在于申酉戌之）日晡所剧者。（以阳明旺于申酉戌。当其旺时。邪
正相搏。则增也。）此名风湿。（然所以致）此（风湿之）病（乃）伤于汗出当风。（
汗随风复入皮腠。而为风湿也。）或久伤取冷（亦）所（以）致（此风湿）也。（致风
湿者以此。而所以致寒湿。亦可类推矣。）可与麻黄杏仁薏苡甘草汤。
此又为风湿无汗者而出其方也。寒湿亦可用之。上节麻黄加术汤为大剂。此方为
小剂。亦随其证之微甚而择用之。亦随其证之上下。而取亲上亲下之理也。
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（之病）。脉浮。（为风。）身重。（为湿。若见此脉此证。汗不出而恶风者。
为实邪。大剂有麻黄加术汤。小剂有麻黄杏仁薏苡甘草汤可用。若）汗出恶风者。（为虚
邪。以）防己黄 汤主之。
此为风湿证汗自出者出其方也。合上二方。即伤寒论麻黄汤大青龙汤桂枝汤之意乎。
钱天来云、病因汗出当风。夫汗出则腠理开。当风则风乘腠理矣。风邪既入。汗不得
出。以离经之汗液。既不得外出皮毛。又不能内返经络。留于肌腠而为湿。此即人身汗
液之湿也。其或暑汗当出之时。伤于纳凉太过。使欲出之汗不得外泄。留着肌腠而致病。
与汗出当风无异也。按金匮以痉湿 三证合篇。痉证兼湿。 证亦兼湿。湿证最重。
必须如此活看方得。
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。又以一被绕腰以下。温令微汗瘥。
伤寒（至于）八九日。（九日值少阳主气之期。宜从少阳之枢而外出矣。乃不解。
而复感）风湿（合而）相搏。（寒邪拘束。故）身体疼（风邪煽火。故心）烦。（湿邪沉着。故）不能自
转侧。（邪未入里。故）不呕不渴。脉浮虚而涩者。（浮虚则为风。涩则为湿也。此风
多于湿之证。以）桂枝附子汤主之。若（脾受湿伤。不能为胃行其津液。则）大便坚。
（大便愈坚。则）小便（愈觉其）自利者。（脾受伤。而津液不能还入胃中故也。即于
前方）去桂（枝）加白术汤主之。（湿若去。则风无所恋而自解矣。）
此又于伤寒不愈。合风湿为病而出二方也。上方治风多于湿。下方治湿多于风。
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（四两） 附子（三枚炮去皮） 甘草（二两炙） 生姜（三两） 大枣（十
二枚）
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。（凡方中有如虫
行状。如醉状。如冒状者。皆药势将行使然也。）
（伤寒合风湿而病。上既详言之矣。若其病较剧者。用药亦须较缓。今）风湿相搏。
（业已深入。其）骨节疼烦掣痛。不得屈伸。近之则痛剧。（此风寒湿三气之邪。阻遏
正气。不令宣通之象也。）汗出短气。小便不利。恶风不欲去衣。或身微肿者。（荣气
卫气三焦之气俱病。总由于坎中元阳之气失职也。务使阳回气暖。而经脉柔和。阴气得
煦。而水泉流动矣。以）甘草附子汤主之。
此承上节。言风湿相搏。在外者利在速去。深入者妙在缓攻。师恐前方附子三枚过
多。其性猛急。筋节
未必骤开。风湿未必遽去。徒使大汗出而邪不尽耳。故减去一枚。并去姜枣。而以甘草
为君者。欲其缓也。
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）
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。
（ 者暑也。暑亦六淫之一。故先伤太阳。）太阳中 。（病标本之气。故）发热恶
寒。（病所过之经。故）身重而疼痛。（热伤气。故）其脉弦细芤迟。（膀胱者。毫毛
其应。故）小便已洒洒然毛耸。（阳气虚。不能荣于四肢。故）手足逆冷。小有劳。身即
热。（气虚不能自支也。）口前开。板齿燥。（以劳而动阳热。阴液不能上滋也。此表
里经脉俱虚。不可汗下温针。倘）若（误认为伤寒。而）发其汗。则其（表虚而）恶寒甚。（若因其寒甚。而）
加温针。则（经脉虚而）发热甚。（若因其发热甚。而）数下之。（里虚而津液伤。）
则淋甚。
此言中暑之证。从经脉表里俱病处。绘出虚证模样。意者。寒则伤形。责其实。热
则伤气。责其虚也。汗下火皆为所戒。而治法从可知矣。
太阳中热者。 是也。（暑干肌表。而气虚微。所以）汗出。（太阳以寒为本。所以
）恶寒。（暑热之邪。内合太阳之标热。所以）身热而渴。（以）白虎加人参汤主之。
此言中暑而不兼湿之证治也。
白虎加人参汤方
知母（六两） 石膏（一斤碎绵裹） 甘草（二两炙） 粳米（六合） 人参（三
两）
上五味。以水一斗。煮米熟汤成。去滓。温服一升。日三服。
太阳中 。身热疼重。而脉微弱。此以夏月（因暑热而复）伤冷水。水行皮中所致
也。一物瓜蒂汤主之。（推之夏月阳虚阴伏。凡畏热贪凉。皆可以伤冷水例之。病在阴
经。即为阴证。岂可一以清凉治暑哉。）
此言暑合湿邪为患。而出其方治也。后人用五苓散。大顺散。小半夏加伏苓汤。十
味香薷饮。白虎加苍术汤。皆推展其法而兼治湿也。
瓜蒂汤方
瓜蒂（二七个）
上锉。以水一升。煮取五合。去滓。顿服。
暑者。夏令炎热之气也。有伏病。有正病。有变病。何谓伏病。经云、凡病伤寒而
成热者。先夏至为病温。后夏至为病暑。是病伏于冬时。愈郁而愈热。与温病同例也。
何谓正病。经云、热气大来。火之胜也。又云、火热受邪。心病生焉。言夏时酷暑炎热。
人感之而为暑病。病在心也。白虎加人参汤。是其正治欤。何谓变病。元人谓静而得
之为中暑。处于高厦凉室。畏热贪凉而成病。其恶寒与伤寒同。而发热较重以别之。心
烦以别之。脉虚以别之。此病在人事。不在天时。故谓之变也。然而更有深义焉。暑必
挟湿。是暑阳而
湿阴也。夏月伏阴在内。是暑热而阴寒也。读者当得其言外之旨。
以上五味药。用水九升，先煮麻黄，水量减少二升，撇去水面上的浮沫，加入其余药物，煎取药液二升半，滤去药渣。每次温服八合，服药后覆盖衣被以取得微汗。
（风湿的证候，前面已经详细论述过，但还没有说明导致这种风湿的原因。）患者全身疼痛。（这是由于风湿相互搏结。）发热，（在申时、酉时、戌时即下午3点到7点之间）加重的，（是因为阳明经气旺盛于申、酉、戌这三个时辰，当经气旺盛时，邪气与正气相搏结，所以症状加重。）这称为风湿病。（然而导致）这种（风湿）病（的原因是）出汗时受风侵袭，（汗水随风再次进入皮肤腠理，从而形成风湿病。）或者是长期贪凉受冷（也）是（导致）这种风湿病（的原因）。（导致风湿的原因在于此，而导致寒湿的原因，也可以由此类推了。）可以服用麻黄杏仁薏苡甘草汤。
这又是为无汗的风湿证而设立的方剂。寒湿证也可以使用它。上一节的麻黄加术汤是大剂量方，此方是小剂量方，也是根据病证的轻重来选择使用。也是根据病位的上下，而采取亲近上部或下部病位的道理来治疗。
麻黄杏仁薏苡甘草汤方
麻黄（半两） 杏仁（十个，去皮尖） 薏苡仁（半两） 甘草（一两，炙）
将上述药物锉碎如麻豆大小。每次服用四钱匕，用水一盏半煎至八分满，滤去药渣，温服。服药后应有微汗，注意避风。
风湿病，脉象浮，（这是风邪的表现。）身体沉重，（这是湿邪的表现。如果见到这种脉象和证候，不出汗且怕风的，属于实证，大剂量可用麻黄加术汤，小剂量可用麻黄杏仁薏苡甘草汤。如果）出汗且怕风的，（属于虚证，用）防己黄芪汤主治。
这是为风湿证自汗出的情况而设立的方剂。结合上面两个方子，是否体现了《伤寒论》中麻黄汤、大青龙汤、桂枝汤的意旨呢？钱天来说：病因是出汗时受风。出汗则腠理开泄，受风则风邪乘虚而入腠理。风邪既已入内，汗液不得排出，这些离经的汗液，既不能外出皮毛，又不能内返经络，滞留于肌腠之间而形成湿邪。这就是人身汗液所化的湿邪。或者是在暑天出汗时，因贪凉太过，使欲出的汗液不得外泄，留滞于肌腠而致病。这与出汗受风没有区别。按《金匮要略》将痉、湿、暍三证合为一篇。痉证兼夹湿邪，暍证也兼夹湿邪，湿证最为重要。必须这样灵活理解才能得其真谛。
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）
将上述药物锉碎如麻豆大小。每次取五钱匕，加生姜四片，大枣一枚，用水一盏半煎至八分满，滤去药渣，温服。若有喘症，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。服药后应当感觉像有虫子在皮中游走，腰部以下感觉像冰一样冷，之后坐在被子上，再用一条被子缠绕腰以下部位，使其温暖并微微出汗即可痊愈。
伤寒（到了）八九日，（第九天值少阳主气的时期，本应从少阳之枢机向外透解。但病情未解，又感受了）风湿（合并）相搏，（寒邪束缚体表，故）身体疼痛，（风邪煽动火热，故心中）烦乱，（湿邪沉着重浊，故）不能自行翻身转动侧身，（邪气未入里，故）不呕吐也不口渴，脉象浮虚而涩的，（浮虚则为风邪，涩则为湿邪。这是风多于湿的证候，用）桂枝附子汤主治。如果（脾脏受湿邪损伤，不能为胃传输津液，则）大便干硬，（大便越干硬，则）小便（越发觉得）通利的，（这是因为脾受伤，津液不能回流到胃中。此时应在前方基础上）去掉桂（枝）加上白术汤主治。（若湿邪去除，则风邪无所依附而自然解散。）
这又是针对伤寒未愈，合并风湿为病而设立的两个方剂。上方治疗风多于湿，下方治疗湿多于风。
桂枝附子汤方
桂枝（四两） 附子（三枚，炮制，去皮，破成八片） 生姜（三两，切） 甘草（二两，炙） 大枣（十二枚，掰开）
以上五味药。用水六升，煎取二升，滤去药渣，分三次温服。
白术附子汤方
白术（四两） 附子（三枚，炮制，去皮） 甘草（二两，炙） 生姜（三两） 大枣（十二枚）
以上五味药。用水三升，煎取一升，滤去药渣，分三次温服。第一次服药后感觉身体麻木，约半天后再服第二次，三次都服完。病人如有头昏沉的感觉，不要惊慌。这是因为白术和附子共同作用于皮中，驱逐水气，尚未完全排除的缘故。（凡是方剂中有感觉像虫子爬、像醉酒、像头昏沉的情况，都是药力即将发挥作用时的正常反应。）
（伤寒合并风湿而发病，上面已经详细论述过了。如果病情较重，用药也必须较为缓和。现在）风湿相搏，（已经深入体内，其）骨节疼痛烦扰、牵引作痛，不能屈伸，靠近则疼痛加剧，（这是风寒湿三气邪气，阻遏正气，不允许宣通的现象。）出汗、短气、小便不利、怕风不想脱衣、或者身体轻微浮肿的，（营气、卫气、三焦之气都生病了，总归是由于肾中元阳之气失职所致。务必使阳气回复、气温煦，经脉柔和，阴气得温煦，而水液流动。用）甘草附子汤主治。
这是承接上一节，论述风湿相搏，在表者利于速去，深入者妙在缓攻。老师担心前面的方剂中附子三枚过多，其药性猛烈急促，筋节未必能骤然舒展，风湿未必能立刻去除，只会导致大汗出而邪气不尽。所以减去一枚，并去掉生姜和大枣，而以甘草为君药，是想让药效缓慢释放。
甘草附子汤方
甘草（二两，炙） 附子（二枚，炮制，去皮） 白术（二两） 桂枝（四两）
以上四味药。用水六升，煎取三升，滤去药渣，温服一升，每日三次。初次服药得到微汗则病解。如果能进食，但出汗后又感到烦闷的，服用五合。如果担心一升药量过多，宜服用六七合为好。
（“暍”指中暑。暑也是六淫之一，所以先伤太阳经。）太阳中暍，（因为病涉及标本之气，故）发热恶寒，（因为病经过的经脉，故）身体沉重而疼痛，（热邪伤气，故）脉象弦细芤迟，（膀胱对应毫毛，故）小便完后感觉洒洒然毛发耸立，（阳气虚弱，不能荣养四肢，故）手足逆冷，稍微劳动，身体就发热，（因为气虚不能支撑）。口张开，牙齿干燥，（因为劳动而动阳热，阴液不能上滋。这是表里经脉都虚，不可发汗、攻下、温针。如果）误认为伤寒，而（错误地）发其汗，则其（表虚而）恶寒更严重，（如果因其恶寒严重，而）加用温针，则（经脉虚而）发热更严重，（如果因其发热严重，而）多次攻下，（里虚而津液受损。）则淋证更严重。
这是在论述中暑的证候，从经脉表里俱病的角度，描绘出虚证的样子。大意是：寒邪伤形，责之于实；热邪伤气，责之于虚。发汗、攻下、火疗都是禁忌，治疗方法也就由此可知了。
太阳中热者，就是暍病。（暑邪侵犯肌表，而气虚轻微，所以）出汗，（太阳经以寒为本，所以）恶寒，（暑热之邪，内合太阳之标热，所以）身热而口渴，（用）白虎加人参汤主治。
这是在论述中暑而不兼夹湿邪的证治。
白虎加人参汤方
知母（六两） 石膏（一斤，捣碎，用绵布包裹） 甘草（二两，炙） 粳米（六合） 人参（三两）
以上五味药。用水一斗，煮至米熟汤成，滤去药渣，温服一升，每日三次。
太阳中暍，身热疼重，而脉微弱，这是因为夏天（因暑热而复）伤冷水，水气行于皮肤中所导致的。用一物瓜蒂汤主治。（推而言之，夏天阳气虚而阴气潜伏，凡是畏热贪凉，都可以用伤冷水来类比。病在阴经，即为阴证，怎么能一概用清凉药治疗暑病呢？）
这是在论述暑邪夹杂湿邪为患，而设立的方治。后人使用五苓散、大顺散、小半夏加茯苓汤、十味香薷饮、白虎加苍术汤，都是推广其法而兼治湿邪。
将上述药物锉碎。用水一升，煎取五合，滤去药渣，一次性顿服。
暑，是夏季炎热的气候。有伏病、正病、变病。什么是伏病？经文说：凡是患伤寒而变成热的，夏至前为温病，夏至后为暑病。这是病邪潜伏于冬季，郁积越久越热，与温病同类。什么是正病？经文说：热气大来，是火的胜气。又说：火热受邪，心病产生。意思是夏季酷暑炎热，人感受它而成为暑病，病在心。白虎加人参汤，是其正治之法吗？什么是变病？元代医家说：静而得之为中暑，处于高楼大厦凉爽房间，畏热贪凉而成病。其恶寒与伤寒相同，而发热较重以此区别。心烦以此区别。脉虚以此区别。这种病在于人事，不在于天时，所以称之为变病。然而还有更深层的含义。暑必挟湿，这是暑为阳而湿为阴。夏月伏阴在内，这是暑热而阴寒。读者应当领会其言外之意。
The above five herbs. Use nine sheng of water, first decoct Ephedrae Herba (Mahuang, 麻黄) until the volume decreases by two sheng, remove the foam on the surface, add the remaining herbs, and decoct to obtain two and a half sheng of liquid. Strain the dregs. Take eight ge warm after each dose. Cover with blankets to induce slight sweating.
(The syndrome of Wind-Dampness was discussed in detail previously, but the cause leading to this Wind-Dampness has not yet been explained.) The patient suffers from pain throughout the body. (This is due to the binding of Wind and Dampness.) Fever, (which worsens during the Shen, You, and Xu hours [3 PM to 7 PM],) (occurs because the Yangming channel is prosperous during these hours; when the channel qi is prosperous, pathogenic factors and healthy qi contend, thus exacerbating symptoms.) This is named Wind-Dampness disease. (However, the reason for contracting this Wind-Dampness lies in) exposure to wind while sweating. (Sweat re-enters the skin and interstices along with the wind, forming Wind-Dampness.) Or it may be caused by long-term excessive cooling. (These are also causes of Wind-Dampness.) (The causes of Wind-Dampness are as stated; the causes of Cold-Dampness can be inferred similarly.) Mahuang Xingren Yiyi Gancao Decoction (Cinnamon Twig, Apricot Seed, Coix Seed, and Licorice Decoction) may be administered.
This formula is prescribed for Wind-Dampness without sweating. It can also be used for Cold-Dampness. The previous Mahuang Jia Zhu Tang (Ephedra, Cinnamon Twig, and Atractylodes Macrocephala Decoction) is a large-dose formula, whereas this one is a small-dose formula. Selection depends on the severity of the syndrome. It also follows the principle of treating upper or lower locations based on the site of the pathology.
**Mahuang Xingren Yiyi Gancao Decoction Formula**
* Ephedrae Herba (Mahuang, 麻黄) (half liang)
* Armeniacae Semen Amarum (Xingren, 杏仁) (ten seeds, skin and tip removed)
* Coicis Semen (Yiyiren, 薏苡仁) (half liang)
* Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (one liang, honey-fried)
Crush the herbs to the size of hemp seeds. Each dose consists of four qianbi (approx. 4 grams), decocted in one and a half sheng of water until reduced to eight parts. Strain and take warm. Slight sweating should occur; avoid wind.
In Wind-Dampness disease, if the pulse is floating, (this indicates Wind.) If the body feels heavy, (this indicates Dampness. If this pulse and syndrome are present, and there is no sweating with aversion to wind, it is an Excess syndrome; a large-dose formula like Mahuang Jia Zhu Tang or a small-dose formula like Mahuang Xingren Yiyi Gancao Decoction may be used. However,) if there is sweating with aversion to wind, (it is a Deficiency syndrome, treated with) Fangji Huangqi Tang (Stephania and Astragalus Decoction).
This formula is prescribed for Wind-Dampness with spontaneous sweating. Combining the previous two formulas, do they reflect the principles of Mahuang Tang, Da Qinglong Tang, and Guizhi Tang from the *Shanghan Lun*? Qian Tianlai stated: The cause is sweating followed by wind exposure. When sweating, the pores open; exposure to wind allows Wind pathogens to enter the pores. Once Wind pathogens enter, sweat cannot exit. These abnormal sweat fluids, unable to exit through the skin or return to the meridians, remain in the muscle interstices to form Dampness. This is the Dampness generated from bodily sweat fluids. Alternatively, during summer sweating, excessive cooling prevents sweat from dissipating externally, causing it to stagnate in the muscle interstices and induce disease. This is no different from sweating while exposed to wind. According to the *Jin Gui Yao Lue*, Spasm, Dampness, and Heatstroke syndromes are combined in one chapter. Spasm syndrome involves Dampness, and Heatstroke syndrome also involves Dampness, with Dampness being the most critical. One must understand this flexibly.
**Fangji Huangqi Tang Formula**
* Stephaniae Tetrandrae Radix (Fangji, 防己) (one liang)
* Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (half liang, honey-fried)
* Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) (seven qian half)
* Astragali Membranacei Radix (Huangqi, 黄芪) (one liang one fen)
Crush the herbs to the size of hemp seeds. Each dose takes five qianbi, plus four slices of fresh ginger and one jujube. Decoct in one and a half sheng of water until reduced to eight parts. Strain and take warm. For asthma, add Ephedrae Herba (Mahuang, 麻黄) half liang. For stomach disharmony, add Paeoniae Radix Alba (Shaoyao, 芍药) three fen. For Qi rushing upward, add Cinnamomi Ramulus (Guizhi, 桂枝) three fen. For chronic cold below, add Asari Radix (Xixin, 细辛) three fen. After taking the medicine, one should feel as if insects are crawling under the skin, and the area below the waist will feel cold as ice. Sit on a blanket afterward, wrap another blanket around the waist and below, keep warm, and induce slight sweating for recovery.
After eight or nine days of *Shanghan* (Cold Damage), (the ninth day corresponds to the Shaoyang governing period, where the pathogen should ideally exit via the Shaoyang pivot. However, if unresolved and compounded by) Wind-Dampness contending together, (Cold pathogens constrain the exterior, causing) body pain, (Wind pathogens stir fire, causing mental) vexation, (Damp pathogens are heavy and stagnant, causing inability to turn over independently, (pathogens have not entered the interior, so there is) no vomiting or thirst. If the pulse is floating, deficient, and choppy, (floating and deficient indicate Wind, choppy indicates Dampness. This is a syndrome where Wind exceeds Dampness, treated with) Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction). If (the Spleen is injured by Dampness and cannot transport fluids for the Stomach, then) stool becomes hard, (and the harder the stool, the more) urination seems free-flowing, (because the Spleen is injured and fluids cannot return to the Stomach. In this case, use) the formula removing Cinnamon Twig (Guizhi, 桂枝) and adding Atractylodis Macrocephalae Rhizoma (Baizhu, 白术). (Once Dampness is removed, Wind has no attachment and resolves spontaneously.)
These are two formulas for cases where *Shanghan* does not resolve and combines with Wind-Dampness. The former treats Wind exceeding Dampness; the latter treats Dampness exceeding Wind.
**Guizhi Fuzi Tang Formula**
* Cinnamomi Ramulus (Guizhi, 桂枝) (four liang)
* Aconiti Lateralis Radix Praeparata (Fuzi, 附子) (three pieces, processed, skin removed, broken into eight slices)
* Zingiberis Recens Rhizoma (Shengjiang, 生姜) (three liang, sliced)
* Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (two liang, honey-fried)
* Ziziphi Jujubae Fructus (Dazao, 大枣) (twelve pieces, split)
Take the above five herbs. Use six sheng of water, decoct to obtain two sheng. Strain and divide into three warm doses.
**Baizhu Fuzi Tang Formula**
* Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) (four liang)
* Aconiti Lateralis Radix Praeparata (Fuzi, 附子) (three pieces, processed, skin removed)
* Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (two liang, honey-fried)
* Zingiberis Recens Rhizoma (Shengjiang, 生姜) (three liang)
* Ziziphi Jujubae Fructus (Dazao, 大枣) (twelve pieces)
Take the above five herbs. Use three sheng of water, decoct to obtain one sheng. Strain and divide into three warm doses. After the first dose, if numbness is felt in the body, take the second dose after about half a day. Finish all three doses. The patient may experience a sensation of dizziness; do not be alarmed. This is because Baizhu and Fuzi act together in the skin to drive out water qi, which has not yet been fully expelled. (Whenever a formula causes sensations like insects crawling, drunkenness, or dizziness, it indicates that the medicinal power is about to take effect.)
(*Shanghan* combined with Wind-Dampness was discussed above. If the condition is more severe, medication must be administered more gently. Now,) Wind and Dampness contend, (having penetrated deeply, causing) severe pain and distension in the bone joints, inability to flex or extend, and intensified pain upon touch. (This is the obstruction of healthy qi by Wind, Cold, and Damp pathogens, preventing their free flow.) Sweating, shortness of breath, difficulty in urination, aversion to wind with reluctance to remove clothes, or slight swelling of the body, (indicate that Ying Qi, Wei Qi, and Sanjiao Qi are all diseased, ultimately due to the failure of Yuan Yang Qi in the Kidney. It is essential to restore Yang warmth, soften the meridians, warm Yin Qi, and promote fluid movement. Treat with) Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction).
This continues the discussion on Wind-Dampness contending. For pathogens in the exterior, rapid expulsion is beneficial; for those that have penetrated deeply, slow attack is subtle. The Master feared that using three pieces of Fuzi in the previous formula might be too potent and abrupt, potentially failing to relax the sinews and joints quickly or expel Wind-Dampness immediately, resulting only in profuse sweating without complete elimination of pathogens. Therefore, reduce the dosage by one piece, remove Ginger and Jujube, and make Licorice the sovereign herb to ensure a slow, gentle action.
**Gancao Fuzi Tang Formula**
* Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (two liang, honey-fried)
* Aconiti Lateralis Radix Praeparata (Fuzi, 附子) (two pieces, processed, skin removed)
* Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) (two liang)
* Cinnamomi Ramulus (Guizhi, 桂枝) (four liang)
Take the above four herbs. Use six sheng of water, decoct to obtain three sheng. Strain and take one sheng warm, three times daily. If slight sweating occurs after the first dose, the condition resolves. If the patient can eat but becomes vexated again after sweating, take five ge. If one sheng is considered too much, taking six or seven ge is optimal.
("Ye" refers to Heatstroke. Summer heat is one of the Six Evils, so it first injures the Taiyang channel.) Taiyang Heatstroke, (as the disease involves both root and branch qi, causes) fever and aversion to cold, (as the disease passes through meridians, causes) heaviness and pain in the body, (Heat injures Qi, causing) a string-taut, thin, hollow, or slow pulse, (the Bladder corresponds to body hair, so after urination there is) a chilly sensation with bristling hair, (Yang Qi deficiency fails to nourish the four limbs, causing) cold extremities. Slight exertion causes body heat, (due to Qi deficiency failing to support the body). Mouth open, teeth dry, (due to exertion stirring Yang Heat, failing to nourish Yin fluids from above. This indicates deficiency in both exterior and interior meridians; sweating, purging, and moxibustion are contraindicated. If mistakenly diagnosed as *Shanghan* and sweating is induced, then (due to exterior deficiency) aversion to cold becomes severe. (If due to severe aversion to cold, moxibustion is added,) then (due to meridian deficiency) fever becomes severe. (If due to severe fever, repeated purging is applied,) (interior deficiency damages fluids,) then strangury becomes severe.
This describes the syndrome of Heatstroke, illustrating the appearance of Deficiency syndromes from the perspective of simultaneous exterior and interior meridian involvement. The implication is: Cold injures the form, attributed to Excess; Heat injures Qi, attributed to Deficiency. Sweating, purging, and fire therapy are all prohibited, revealing the treatment method.
Taiyang Heatstroke is Ye syndrome. (Summer Heat invades the muscle surface, and Qi deficiency is mild, causing) sweating, (Taiyang is rooted in Cold, causing) aversion to cold, (Summer Heat pathogens internally combine with Taiyang's branch Heat, causing) body heat and thirst. Treat with Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction).
This discusses the treatment of Heatstroke without accompanying Dampness.
**Baihu Jia Renshen Tang Formula**
* Anemarrhenae Rhizoma (Zhimu, 知母) (six liang)
* Gypsum Fibrosum (Shigao, 石膏) (one jin, crushed, wrapped in cotton)
* Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (two liang, honey-fried)
* Oryza Sativa (Jingmi, 粳米) (six he)
* Ginseng Radix et Rhizoma (Renshen, 人参) (three liang)
Take the above five herbs. Use ten dou of water, decoct until the rice is cooked and the soup is ready. Strain and take one sheng warm, three times daily.
Taiyang Heatstroke presents with body heat, heaviness, and pain, with a weak and faint pulse. This is caused by summer Heatstroke combined with injury from cold water, where water qi circulates in the skin. Treat with Yi Wu Gudi Tang (Single Herb Momordica Seed Decoction). (By extension, in summer when Yang is deficient and Yin lurks within, any fear of heat and greed for coolness can be analogized to injury from cold water. Disease in Yin meridians constitutes a Yin syndrome; how can Summer Heat be treated solely with cooling agents?)
This discusses the treatment of Summer Heat combined with Dampness. Later practitioners used Wuling San, Dashun San, Xiao Banxia Jia Fuling Tang, Shiwei Xiangru Yin, and Baihu Jia Cangzhu Tang, extending the method to treat Dampness concurrently.
**Gudi Tang Formula**
* Momordicae Fructus (Gudi, 瓜蒂) (twenty-seven pieces)
Crush the herbs. Use one sheng of water, decoct to obtain five ge. Strain and take in one dose.
Summer Heat is the hot climate of the summer season. There are latent diseases, normal diseases, and altered diseases. What is a latent disease? The classic states: Any disease originating from Cold Damage that turns into heat is called Warmth before the Summer Solstice and Heatstroke after. This means the pathogen lies dormant in winter, becoming hotter as it stagnates, similar to Warmth diseases. What is a normal disease? The classic states: Great arrival of Hot Qi represents the victory of Fire. It also states: Injury by Fire-Heat generates Heart disease. This means that during the intense heat of summer, humans contract Heatstroke, and the disease resides in the Heart. Is Baihu Jia Renshen Tang its standard treatment? What is an altered disease? Yuan dynasty physicians stated: Obtaining Heatstroke while resting quietly is due to staying in high buildings or cool rooms, fearing heat and seeking coolness, inducing disease. Its aversion to cold is similar to Cold Damage, but distinguished by more severe fever, mental vexation, and a deficient pulse. This disease arises from human behavior rather than natural timing, hence termed "altered." However, there is deeper meaning. Summer Heat must carry Dampness; Summer Heat is Yang, Dampness is Yin. In summer, Yin lurks within while Summer Heat is external; this is Summer Heat (Yang/Hot) and Internal Yin (Cold). Readers should grasp the implicit meaning.