Spasms, Dampness, and Heatstroke

辨痓濕暍脉證第四

Biàn chì shī yē mài zhèng dì sì

Three illnesses that look like cold damage and are not: spasms, dampness, and heatstroke.The chapter is short and entirely clinical. It distinguishes the stiff, backward arching spasm from the soft one, gives the pulse of each, and warns that a body already sweating must not be sweated again. It describes dampness as it attacks from outside, as it settles in the joints, and as it rises to the head; and it describes heatstroke as the case in which a man is hot, sweats, hates cold and is thirsty, as against the case in which dampness and heat hold the body and the pulse is fine and hollow.All five prescriptions of the chapter — Trichosanthes and Cinnamon Twig Decoction, Ephedra plus Atractylodes, the Ephedra-Apricot-Coix-Glycyrrhiza Decoction, White Tiger plus Ginseng, and the single drug Melon Stalk Powder — stand in the small graphs of the commentary, four of them expressly referred to the Synopsis of the Golden Casket. They are not printed as classic text here.

View

18 paragraphs

傷寒所致太陽痓、濕、暍三種，宜應别論，以爲與傷寒相似，故此見之。伤寒所致太阳痓、湿、暍三种，宜应别论，以为与伤寒相似，故此见之。

shāng hán suǒ zhì tài yáng chì shī yē sān zhǒng yí yīng bié lùn yǐ wèi yǔ shāng hán xiāng shì gù cǐ jiàn zhī

因傷寒而起的太陽痓病、濕病、暍病三種，本應另立專篇論述；因為這三種病與傷寒的證候相似，所以附在這裡一并說明。

The three conditions arising from cold damage, namely convulsion, dampness and heatstroke of the taiyang stage, deserve separate discussion; because their signs resemble those of cold damage, they are presented here.

太陽病，發熱無汗，反惡寒者，名曰：「剛痓」。太阳病，发热无汗，反恶寒者，名曰：“刚痓”。

tài yáng bìng fā rè wú hàn fǎn wù hán zhě míng yuē gāng chì

太陽病，發熱而不出汗，却反而怕冷的，叫做剛痓。

In taiyang disease with fever, absence of sweating and paradoxical aversion to cold, the disorder is called rigid convulsion.

太陽病，發熱，汗出，不惡寒者，名曰：「柔痓」。太阳病，发热，汗出，不恶寒者，名曰：“柔痓”。

tài yáng bìng fā rè hàn chū bù wù hán zhě míng yuē róu chì

太陽病，發熱，出汗，而不怕冷的，叫做柔痓。

In taiyang disease with fever, sweating and no aversion to cold, the disorder is called soft convulsion.

太陽病，發熱，脉沉而細者，名曰：「痓」。太阳病，发热，脉沉而细者，名曰：“痓”。

tài yáng bìng fā rè mài chén ér xì zhě míng yuē chì

太陽病，發熱，脉象沉而細的，叫做痓。

In taiyang disease with fever and a deep, thin pulse, the disorder is called convulsion.

太陽病，發汗太多，因致痓。太阳病，发汗太多，因致痓。

tài yáng bìng fā hàn tài duō yīn zhì chì

太陽病，發汗太過，因而導致痓病。

Excessive sweating in taiyang disease may bring on convulsion.

病身熱足寒，頸項強急，惡寒，時頭熱，面赤，目脉赤，獨頭面揺，卒口噤，背反張者，痓病也。病身热足寒，颈项强急，恶寒，时头热，面赤，目脉赤，独头面摇，卒口噤，背反张者，痓病也。

bìng shēn rè zú hán jǐng xiàng qiáng jí wù hán shí tóu rè miàn chì mù mài chì dú tóu miàn yáo cù kǒu jìn bèi fǎn zhāng zhě chì bìng yě

病人身體發熱而兩脚寒冷，頸項強直拘急，怕冷，時時頭部發熱，面色發紅，眼中血脉發紅，只有頭面摇動，突然牙關緊閉，脊背向後反張的，這是痓病。

When the patient has fever with cold feet, stiffness and tension of the neck, aversion to cold, intermittent heat in the head, flushing of the face, redness of the eye vessels, shaking confined to the head and face, sudden locking of the jaw, and backward arching of the spine, this is convulsion.

太陽病，關節疼痛而煩，脉沉而細者，此名濕痺之候。其人小便不利，大便反快，但當利其小便。太阳病，关节疼痛而烦，脉沉而细者，此名湿痹之候。其人小便不利，大便反快，但当利其小便。

tài yáng bìng guān jié téng tòng ér fán mài chén ér xì zhě cǐ míng shī bì zhī hòu qí rén xiǎo biàn bù lì dà biàn fǎn kuài dàn dāng lì qí xiǎo biàn

太陽病，關節疼痛而心煩，脉象沉而細的，這是濕痺的證候。患者小便不通利，大便反而通快，只須通利他的小便。

In taiyang disease with painful joints, restlessness and a deep, thin pulse, the condition is dampness impediment. The patient passes little urine while the stool is instead loose; one should simply promote urination.

濕家之爲病，一身盡疼，發熱，身色如似熏黃。湿家之为病，一身尽疼，发热，身色如似熏黄。

shī jiā zhī wèi bìng yī shēn jìn téng fā rè shēn sè rú sì xūn huáng

患濕病的人，全身都疼，發熱，身上的顏色像烟熏過的黃色。

A person with dampness disease aches all over, has fever, and the body colour is a smoky yellow.

濕家，其人但頭汗出，背強，欲得被覆向火。若下之早，則噦，胃滿，小便不利，舌上如胎者，以丹田有熱，胸中有寒，渴欲得水而不能飲，則口燥煩也。湿家，其人但头汗出，背强，欲得被覆向火。若下之早，则哕，胃满，小便不利，舌上如胎者，以丹田有热，胸中有寒，渴欲得水而不能饮，则口燥烦也。

shī jiā qí rén dàn tóu hàn chū bèi qiáng yù dé bèi fù xiàng huǒ ruò xià zhī zǎo zé yuě wèi mǎn xiǎo biàn bù lì shé shàng rú tāi zhě yǐ dān tián yǒu rè xiōng zhōng yǒu hán kě yù dé shuǐ ér bù néng yǐn zé kǒu zào fán yě

患濕病的人，只有頭部出汗，背部強直，想要蓋被、向着火取暖。如果過早用下法，就會打呃、胃部脹滿、小便不通利；舌上像結了苔的，是因為丹田有熱、胸中有寒，口渴想喝水却不能喝下，於是口中乾燥而心煩。

A person with dampness disease sweats only from the head, has stiffness of the back, and wants to be covered and to sit by a fire. If purged too early, hiccup, fullness of the stomach and difficult urination follow; a coating on the tongue indicates heat below in the elixir field and cold above in the chest, so that he is thirsty and wants water yet cannot drink, leaving the mouth dry and the mind restless.

濕家下之，額上汗出，微喘，小便利者死。若下利不止者，亦死。湿家下之，额上汗出，微喘，小便利者死。若下利不止者，亦死。

shī jiā xià zhī é shàng hàn chū wēi chuǎn xiǎo biàn lì zhě sǐ ruò xià lì bù zhǐ zhě yì sǐ

患濕病而用下法，額上出汗，微微氣喘，小便通利的，是死證；如果腹瀉不止，也是死證。

When dampness disease is purged and the forehead sweats, with slight panting and free urination, the outcome is death; if diarrhoea sets in and does not stop, it is likewise fatal.

問曰：「風濕相搏，一身盡疼痛，法當汗出而解，值天陰雨不止。醫云：『此可發汗。』汗之病不愈者，何也？」问曰：“风湿相搏，一身尽疼痛，法当汗出而解，值天阴雨不止。医云：‘此可发汗。’汗之病不愈者，何也？”

wèn yuē fēng shī xiāng bó yī shēn jìn téng tòng fǎ dāng hàn chū ér jiě zhí tiān yīn yǔ bù zhǐ yī yún cǐ kě fā hàn hàn zhī bìng bù yù zhě hé yě

問道：風與濕相合，全身都疼痛，按理應當出汗而病解，却恰逢天氣陰雨不止。醫生說這病可以發汗，可是發了汗病却不痊愈，這是甚麼緣故？

Question: when wind and dampness combine and the whole body aches, the proper treatment is to induce sweating and resolve it, yet the weather happens to be continuously overcast and rainy. The physician says sweating may be induced, but after sweating the illness is not cured. Why is this?

答曰：「發其汗，汗大出者，但風氣去，濕氣在，是故不愈也。若治風濕者，發其汗，但微微似欲汗出者，風濕俱去也。」答曰：“发其汗，汗大出者，但风气去，湿气在，是故不愈也。若治风湿者，发其汗，但微微似欲汗出者，风湿俱去也。”

dá yuē fā qí hàn hàn dà chū zhě dàn fēng qì qù shī qì zài shì gù bù yù yě ruò zhì fēng shī zhě fā qí hàn dàn wēi wēi sì yù hàn chū zhě fēng shī jù qù yě

答道：發他的汗，汗出得很多，只是風邪去了，濕邪還在，所以不痊愈。治風濕病，發他的汗，只須微微像要出汗的樣子，風與濕就一起去了。

Answer: when sweating is induced and the sweat pours out, only the wind departs while the dampness remains, and so the illness is not cured. In treating wind-dampness one should induce sweating only until the skin is faintly moist, and then wind and dampness leave together.

濕家病，身上疼痛，發熱，面黃而喘，頭痛鼻塞而煩，其脉大，自能飲食，腹中和無病。病在頭中寒濕，故鼻塞，内藥鼻中則愈。湿家病，身上疼痛，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。

shī jiā bìng shēn shàng téng tòng fā rè miàn huáng ér chuǎn tóu tòng bí sè ér fán qí mài dà zì néng yǐn shí fù zhōng hé wú bìng bìng zài tóu zhōng hán shī gù bí sè nà yào bí zhōng zé yù

濕病，身上疼痛，發熱，面色發黃而氣喘，頭痛、鼻塞而心煩，脉象大，自己能飲食，腹中平和無病。病在頭部的寒濕，所以鼻塞，把藥納入鼻中就會痊愈。

In dampness disease with pain of the body, fever, a yellow face with panting, headache, nasal obstruction and restlessness, the pulse is large and the patient eats and drinks as usual while the abdomen is calm and free of disease. The illness lies in cold-dampness within the head, hence the nasal blockage; inserting medicine into the nose will cure it.

病者一身盡疼，發熱，日晡所劇者，此名：「風濕」。此病傷於汗出當風，或久傷取冷所致也。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。

bìng zhě yī shēn jìn téng fā rè rì bū suǒ jù zhě cǐ míng fēng shī cǐ bìng shāng yú hàn chū dāng fēng huò jiǔ shāng qǔ lěng suǒ zhì yě

病人全身都疼，發熱，到傍晚時分加重，這叫風濕。這病是出汗時受了風，或者長期受冷所造成的。

When the patient aches all over and the fever worsens towards evening, this is called wind-dampness. It is caused by exposure to wind while sweating, or by prolonged exposure to cold.

太陽中熱者，暍是也。太阳中热者，暍是也。

tài yáng zhòng rè zhě yē shì yě

太陽病感受暑熱的，就是暍病。

When taiyang disease is struck by summer heat, this is heatstroke.

太陽中暍者，身熱疼重，而脉微弱，此亦夏月傷冷水，水行皮中所致也。太阳中暍者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。

tài yáng zhòng yē zhě shēn rè téng zhòng ér mài wēi ruò cǐ yì xià yuè shāng lěng shuǐ shuǐ xíng pí zhōng suǒ zhì yě

太陽病中暍的，身體發熱、疼痛沉重，而脉象微弱，這也是夏天被冷水所傷、水氣行於皮膚之中所造成的。

In taiyang heatstroke with fever, heavy and painful body and a faint, weak pulse, the cause is likewise injury by cold water in summer, so that water spreads through the skin.

太陽中暍者，發熱惡寒，身重而疼痛，其脉弦、細、芤、遲，小便已，灑灑然毛聳，手足逆冷，小有勞，身即熱，口開，前板齒燥。太阳中暍者，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。

tài yáng zhòng yē zhě fā rè wù hán shēn zhòng ér téng tòng qí mài xián xì kōu chí xiǎo biàn yǐ sǎ sǎ rán máo sǒng shǒu zú nì lěng xiǎo yǒu láo shēn jí rè kǒu kāi qián bǎn chǐ zào

太陽病中暍的，發熱怕冷，身體沉重而疼痛，脉象弦、細、芤、遲；小便完了，身上陣陣發冷、汗毛豎起，手足發涼，稍微勞累，身體就發熱，口張開，門牙乾燥。

In taiyang heatstroke with fever and aversion to cold, a heavy aching body and a pulse that is wiry, thin, hollow and slow, the patient shivers with bristling hair after passing urine, has cold hands and feet, and grows hot on the least exertion, with the mouth held open and the front teeth dry.

若發汗，則惡寒甚，加温針則發熱甚，數下之則淋甚。若发汗，则恶寒甚，加温针则发热甚，数下之则淋甚。

ruò fā hàn zé wù hán shèn jiā wēn zhēn zé fā rè shèn shuò xià zhī zé lín shèn

如果發汗，怕冷就會加重；用温針，發熱就會加重；多次用下法，小便淋澀就會加重。

Inducing sweating aggravates the aversion to cold; warming needling aggravates the fever; repeated purgation aggravates the strangury.

Textual notes

Readings follow the base edition; significant variants are recorded here.

辨痓濕暍脉證第四通行本作「辨痙濕暍脈證」
「痓」从疒从坐，成注首條云「痓當作痙，傳冩之誤也。痓者，惡也，非強也」，是底本字作痓而義當為痙。全篇痓字二十餘見，與注中「痙」字並存，一書之中兩形不並軌。今從底本錄作痓，音隨字形讀 chì，不徑改為痙，亦不破讀；讀者知其为痙之借形可矣。
太陽痓、濕、暍三種通行本作「太陽病痙濕暍三種」
影印本第一葉「太陽」下逕接「痓」，無「病」字。通行本補「病」，讀作「太陽病，痙濕暍三種」。底本無者不補：此句主語本為三種病，非太陽病，下「與傷寒相似」正承三種言之。
名曰：「痓」。通行本此下更有「為難治」三字
影印本第三葉此條止於「名曰痓」，其下另起「太陽主表」小字注，注中亦無「為難治」之語。通行本於「痓」下增三字，蓋別有所據；底本既無，不補，入校勘存之。
此名濕痺之候通行本作「此名濕痹，濕痹之候」
底本以「之候」二字連上句，讀作「此名濕痺之候」，一氣而下；通行本於「濕痹」下斷句，復以「濕痹之候」起下。兩讀皆通，底本句法較緊，照錄不改，句讀之異附見於此。
身色如似熏黃通行本作「身色如熏黃也」
影印本第六葉「如」下有「似」字，與上「一身盡疼」同列，字與前後同大，非衍文。「如似」連文，漢魏以來常語，謂彷彿相似；通行本刪「似」，文較簡而失其口氣。
則噦，胃滿通行本作「或胸滿」，底本注文自作「胸滿」
影印本第七葉經文作「胃滿」，其字上从田、下从月，與「胸」之从肉从匈者有别；而同條注文云「故致噦而胸滿」，仍作「胸」。一經一注，同句異字，疑經文「胃」為「胸」之形近而訛，然「噦而胃滿」於理亦通，無據不改，照錄並存。
自能飲食電子本作「自能飯食」
影印本第十葉此字从食从欠，是「飲」非「飯」；同條注文亦云「又以自能飲食，胸腹别無滿痞」，兩處互證。電子本識作「飯」，形近而訛，據影印本回改。
此名：「風濕」通行本作「名風濕」，無「此」字
底本「此名風濕」四字連書，與上「日晡所劇者」共成一列，無刪省之跡。「此名」云者，承上症狀而指目之，與前數條「名曰剛痓」「名曰柔痓」同一句法，底本自成一例。
此亦夏月傷冷水通行本作「此以夏月傷冷水」
影印本第十二葉此字作「亦」，上从亠、下从八，非「以」之从人从㠯者。「亦」承上條「太陽中熱者暍是也」而言，謂此條亦屬夏月傷水所致；作「以」則逕指其因，語氣有别。
其脉弦、細、芤、遲通行本作「其脉弦細芤遲」，連書無點
四脉並見，底本逐字分書，電子本於其間施頓號；通行本連書四字，讀者每以「弦細芤遲」為一脉之名。成注云「脉弦細、芤、遲者，中暑脉虚也」，亦以四字分舉，正與分書相應。今存頓號，非增字，乃别其為四脉耳。
可與麻黃加朮四兩電子本作「麻黃加術」
影印本第八葉此字作「朮」，从木而右上著點，無艸頭；「術」則从行从朮，為邑中道，與藥名無涉。方名「麻黃加朮湯」，朮讀 zhú，即白朮；電子本以形近識作「術」，據影印本回改。
太陽中熱者，暍是也。通行本此下逕接「汗出惡寒，身熱而渴，白虎加人參湯主之」
影印本第十二葉「暍是也」三字下即轉小字，其上八字與前條經文同大，故知底本此條經文止此八字；「其人汗出惡寒，身熱而渴也」以下皆成注，方治亦在注中。底本方治每入注，與通行本分經、方為二者不同。
舌上如胎通行本同，「胎」即「苔」
「胎」借為「苔」，舌上生白垢如苔也。成注云「使舌上生白胎滑也」，正以「胎」為舌垢之名。今不改作「苔」，存底本借字；讀者知其为舌苔，則文義自明。
傳冩之誤也通行本作「傳寫之誤」
底本「冩」从宀从舄，為「寫」之俗省，全書與「寫」並見，卷一已見「冩」形。此非異文，乃一刻之體；照錄，不回改，與全站各依底本用字之例同。
内經曰通行本或作「內經曰」
「内」从入，與「內」从冂者異形。底本全篇作「内」，與卷一至卷三同一刻工之體；照錄，不改為「內」。惟「内藥鼻中」之「内」借為「納」，讀 nà，與此「内經」之讀 nèi 者同形異音，已於拼音列分别標出。
脉後世排印本多云「脈」
底本通篇作「脉」，从肉从永，不作「脈」。此非版本異文，乃一刻之體；全篇二十一字無一作「脈」者，與卷一至卷三並同。照錄，不代以「脈」，亦不視為訛字。
𤍠／𠉀／𠂀／𤓰電子本訛形，影印本作「熱」「候」「甘」「瓜」
電子本卷四殘存非 BMP 字形四種，共四十五字：𤍠四十二、𠉀一、𠂀一、𤓰一。逐一比對影印本，皆為 OCR 訛形，非底本異體，已悉數回改；回改後全卷再無非 BMP 字符。

Cite this page

APA

Shanghan Lun 傷寒論 (Zhang Zhongjing, early 3rd century CE; the received text was reconstituted in the Song.). Biàn chì shī yē mài zhèng dì sì 辨痓濕暍脉證第四 [Spasms, Dampness, and Heatstroke], Chapter 4. In Classica Sinica Medica. Base text: 《注解傷寒論》十卷二十二篇，漢·張機撰，金·成無己注。據上海涵芬樓《四部叢刊》子部影印明嘉靖汪濟眀刊本錄入。底本經文用大字、成注用雙行小字，二者版面上截然可分；本站錄經文，成注擇要節引，標「成注（節）」，不入正文。卷末附釋音，逐字注反切或直音，為定音之第一手。底本與影印本均屬公有領域。 Retrieved 28 October 2026, from https://classicstcm.com/classics/shanghan-lun/spasms-dampness-and-heatstroke/

MLA

"Biàn chì shī yē mài zhèng dì sì 辨痓濕暍脉證第四 [Spasms, Dampness, and Heatstroke]." Shanghan Lun 傷寒論, chapter 4, Classica Sinica Medica, 2026, https://classicstcm.com/classics/shanghan-lun/spasms-dampness-and-heatstroke/. Accessed 28 Oct. 2026. Base text: 《注解傷寒論》十卷二十二篇，漢·張機撰，金·成無己注。據上海涵芬樓《四部叢刊》子部影印明嘉靖汪濟眀刊本錄入。底本經文用大字、成注用雙行小字，二者版面上截然可分；本站錄經文，成注擇要節引，標「成注（節）」，不入正文。卷末附釋音，逐字注反切或直音，為定音之第一手。底本與影印本均屬公有領域。

Chinese scholarly

《傷寒論·辨痓濕暍脉證第四》（Shānghán lùn）。《注解傷寒論》十卷二十二篇，漢·張機撰，金·成無己注。據上海涵芬樓《四部叢刊》子部影印明嘉靖汪濟眀刊本錄入。底本經文用大字、成注用雙行小字，二者版面上截然可分；本站錄經文，成注擇要節引，標「成注（節）」，不入正文。卷末附釋音，逐字注反切或直音，為定音之第一手。底本與影印本均屬公有領域。Classica Sinica Medica，2026 年 10 月 28 日存取，https://classicstcm.com/classics/shanghan-lun/spasms-dampness-and-heatstroke/。

For classical material the edition is what makes a citation checkable: cite the base text, not the web page alone.

Passage credits

This passage has not been attributed yet.

Not yet reviewed — unreviewed passages are published as transcribed, not as reviewed.