仲景曰。太阳中风。以火劫发其汗。邪风被火热。血气流溢。失
其常度。两阳相熏灼。其身发黄。阳盛则欲衄。阴虚小便难。阴阳俱
虚竭。身体则枯燥。但头汗出。剂颈而还。腹满微喘。口干咽烂。或不
大便。久则谵语。甚者至哕。手足躁扰。循衣摸床。小便利者。可治。
雍曰。宜桂枝去芍药加蜀漆牡蛎龙骨救逆汤、五苓散。
又曰。太阳病。医发汗。遂发热恶寒。复下之。则心下痞。此表里
俱虚。阴阳气并竭。无阳则阴独。复加烧针。因胸烦。面色青黄。肤
者难治。今色微黄。手足温者。易愈。雍曰。发热恶寒。宜小柴胡汤。
心下痞者。生姜泻心汤。火逆。宜救逆汤。
又曰。阳脉浮。阴脉弱。则血虚。虚则筋急。其脉沉者。营气微
也。其脉浮而汗出如流珠者。卫气衰也。营气微者。加烧针则血流不
行。更发热而烦躁也。雍曰。和营卫。宜柴胡桂枝汤。因烧针烦躁者。
宜桂枝甘草龙骨牡蛎汤也。
又曰。伤寒脉浮。医以火劫迫之。亡阳。必惊狂。卧起不安者。属
桂枝去芍药加蜀漆牡蛎龙骨救逆汤。
又问曰。得病十五六日。身体黄。下利。狂欲走。师脉之。言当下
清血如豚肝乃已。后如师言。何以知此。师曰。寸口脉。阳浮而阴濡。
阳浮为风。阴濡为弱。为少血。(一作虚)浮虚受风。少血发热。恶寒
洒淅。项强头眩。医加以火熏。郁令汗出。恶寒遂罢。客热因火而发。
怫郁蒸肌肤。身目为黄。小便微难。短气。从鼻中出血。而复下之。胃
无津液。泄利遂不止。热瘀在于膀胱。蓄结成积聚。状如豚肝。当下
不下。心乱迷愦。奔走赴水。不能自制。蓄血若去。目明心了。此皆医
所为。他无祸患。微轻者得愈。重极者不治。雍曰。宜犀角地黄汤。有
热如狂者。加黄芩。
又曰。形作伤寒。其脉不弦紧而弱。弱者必渴。被火者谵语。弱
者发热脉浮。解之当汗出愈。雍曰。宜救逆汤。
又曰。太阳病。以火熏之。不得汗。其人必躁。到经不解。必圊
血。雍曰。宜犀角地黄汤。
又曰。阳明病。被火。额上微汗出。而小便不利。必发黄。常氏
云。可茵陈汤、五苓散。
又曰。阳明病。其脉浮紧。咽干口苦。腹满而喘。发热汗出。不恶
寒。反恶热。身体重。发汗则躁。心愦愦。而反谵语。加温针。必怵惕
烦躁不得眠。雍曰。宜桂枝甘草龙骨牡蛎汤。若误下者。栀子豉汤。
庞氏曰。脉浮紧。不可下。恐变风温。宜详之。
又曰。少阴病。咳而下利谵语。是谓被火气劫也。故小便必难。
为强责少阴汗也。常氏云。宜用救逆汤解其火气。五苓散通其小便。
又曰。太阳病。二日反躁。反熨其背。大汗出。火气入胃。胃中水
竭。躁烦。必发谵语。十余日。振 自下利者。此为欲解也。故其汗从
腰以下不得汗。其人欲小便不得。反呕。欲失溲。足下恶风。大便硬。
小盒饭数而反不数及多。大便已。其头卓然而痛。其人足心必热。谷
气下流故也。雍曰。大便坚及烦躁谵语者。宜调胃承气汤以和其胃。
不得小便者。宜五苓散。
张仲景说:太阳中风证,若用火法强行发汗,邪风与火热相合,导致气血运行紊乱,失去正常的规律。风邪与火邪两阳相互熏灼,患者身体会出现发黄;阳气偏盛则想要鼻出血,阴液亏虚则小便困难。如果阴阳俱虚且枯竭,身体就会干枯粗糙。仅头部出汗,至颈部而止。腹部胀满,轻微气喘,口干咽部溃烂,或者大便不通。时间久了会出现胡言乱语,严重的甚至发生呃逆(哕),手足躁动不安,抓扯衣被,摸弄床沿。如果小便通畅,尚可治疗。
郭雍说:适宜使用桂枝去芍药加蜀漆牡蛎龙骨救逆汤、五苓散。
又说:太阳病,医生发汗后,出现发热恶寒,又用攻下法,导致心下部痞塞。这是表里俱虚,阴阳之气都衰竭了。没有阳气则阴气独盛,如果再加上烧针,会导致胸中烦闷。面色青黄,皮肤枯槁的难治;现在面色微黄,手足温暖的,容易痊愈。郭雍说:发热恶寒,适宜用小柴胡汤。心下部痞塞的,用生姜泻心汤。因火法导致的逆证,适宜用救逆汤。
又说:阳脉浮,阴脉弱,说明血虚。血虚则筋脉拘急。脉象沉的,是营气微弱。脉象浮且汗出如流珠般的,是卫气衰败。营气微弱的,再加烧针,就会导致血流不行,更加发热并烦躁。郭雍说:调和营卫,适宜用柴胡桂枝汤。因烧针导致烦躁的,适宜用桂枝甘草龙骨牡蛎汤。
又说:伤寒脉浮,医生用火法逼迫发汗,导致亡阳,必定出现惊狂,卧起不安的症状,属于桂枝去芍药加蜀漆牡蛎龙骨救逆汤的主治范围。
又问:得病十五六天,身体发黄,下利,狂躁想跑。医生诊脉后说,应当排出像猪肝一样的瘀血才会停止。后来果然如医生所说。为什么能知道这一点?医生说:寸口脉,阳部浮而阴部濡。阳浮为风邪,阴濡为脉弱,代表血少(一说血虚)。浮虚之体受风邪侵袭,血少而发热,恶寒战栗,项强头眩。医生又用火熏法,郁闭导致汗出,恶寒于是停止。客热因火而发作,怫郁蒸腾肌肤,导致身目发黄,小便微难,短气,从鼻中出血,然后又用攻下法,导致胃中津液枯竭,泄利不止。热邪瘀结在膀胱,蓄积结成积聚,形状像猪肝。应当下瘀血而未下,导致心神混乱迷乱,奔走赴水,不能自制。如果瘀血去除,眼睛明亮,心神安定。这都是医生造成的失误,原本没有祸患。病情轻的能痊愈,极重的无法治疗。郭雍说:适宜用犀角地黄汤。如果有热像狂躁的,加黄芩。
又说:外形像伤寒,但脉不弦紧而弱。脉弱者必定口渴。被火法治疗的会出现胡言乱语。脉弱且发热脉浮的,解表应当汗出而愈。郭雍说:适宜用救逆汤。
又说:太阳病,用火熏法,不得汗出,其人必定烦躁。到了病程周期仍未解除,必定出现便血。郭雍说:适宜用犀角地黄汤。
又说:阳明病,被火法治疗,额头微微出汗,而小便不利,必定发黄。常氏说:可用茵陈汤、五苓散。
又说:阳明病,脉浮紧,咽干口苦,腹部胀满而喘,发热汗出,不恶寒,反恶热,身体沉重。发汗则躁动,心中烦闷,反而胡言乱语。加温针,必定惊恐烦躁不得睡眠。郭雍说:适宜用桂枝甘草龙骨牡蛎汤。如果误用下法,用栀子豉汤。庞氏说:脉浮紧,不可用下法,恐怕变为风温,应当详察。
又说:少阴病,咳嗽而下利并伴有胡言乱语,这叫做被火气劫迫。所以小便必定困难,这是因为强行要求少阴病发汗所致。常氏说:适宜用救逆汤解其火气,五苓散通利小便。
又说:太阳病,第二天反而烦躁,反而熨烫背部,大汗出,火气入胃,胃中津液枯竭,烦躁,必定发胡言乱语。十余天后,振颤自下利的,这是欲解的表现。所以其汗从腰部以下不得出。其人想小便却尿不出,反而呕吐,想失禁,足下怕冷。大便硬,小便次数多但量不多及量少。大便排出后,头部突然疼痛,其人足心必定发热,这是谷气下行流通的缘故。郭雍说:大便坚硬及烦躁胡言乱语的,适宜用调胃承气汤以调和胃气。不能小水的,适宜用五苓散。
Zhang Zhongjing said: In Taiyang Wind-stroke (Taiyang wind-strike syndrome), if fire therapy is used to forcibly induce sweating, the pathogenic wind combines with fire heat, causing the flow of blood and qi to become chaotic and lose its normal rhythm. The two yang pathogens (wind and fire) mutually scorch and roast, leading to jaundice in the body; when yang is excessive, epistaxis may occur, while yin deficiency leads to difficult urination. If both yin and yang are deficient and exhausted, the body becomes dry and rough. Sweating occurs only on the head, stopping at the neck. There is abdominal fullness, slight wheezing, dry mouth, and ulceration of the throat, or constipation. Over time, delirium may appear; in severe cases, hiccups (yueh) may occur, along with restlessness of the hands and feet, clutching at clothing, and groping at the bedrail. If urination is smooth, the condition is treatable.
Guo Yong stated: It is appropriate to use Guizhi Qu Shaoyao Jia Shujie Muli Longgu Jiuni Tang (Cinnamon Twig Decoction without Paeonia, plus Fleeceflower Root, Oyster Shell, and Dragon Bone to Rescue from Adverse Effects) and Wuling San (Five-Ingredient Powder with Poria).
He also said: In Taiyang disease, after a physician induces sweating, fever and aversion to cold persist. If purgation is then applied, epigastric stuffiness (pi) results. This indicates that both the exterior and interior are deficient, and the qi of yin and yang are exhausted. Without yang, yin stands alone. If moxibustion with burning needles is added, chest irritability ensues. A bluish-yellow complexion with withered skin indicates a difficult-to-treat condition; however, a slightly yellow complexion and warm hands and feet indicate an easy recovery. Guo Yong stated: For fever and aversion to cold, Xiaochaihu Tang (Minor Bupleurum Decoction) is appropriate. For epigastric stuffiness, Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is appropriate. For adverse effects caused by fire therapy, Jiuni Tang (Rescue from Adverse Effects Decoction) is appropriate.
He further said: A floating pulse at the yang position and a weak pulse at the yin position indicate blood deficiency. Blood deficiency leads to tendon stiffness. A sinking pulse indicates faint Ying-nutrient qi. A floating pulse with sweat droplets flowing like beads indicates the decline of Wei-defensive qi. In cases of faint Ying-nutrient qi, adding burning needles causes blood flow to stagnate, resulting in increased fever and irritability. Guo Yong stated: To harmonize Ying and Wei, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate. For irritability caused by burning needles, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is appropriate.
He also said: In Shanghan (Cold Damage) with a floating pulse, if a physician uses fire therapy to force sweating, it leads to the loss of Yang (Wangyang), inevitably causing fright, mania, and restlessness in lying down and rising. This belongs to the indication for Guizhi Qu Shaoyao Jia Shujie Muli Longgu Jiuni Tang.
Another question was raised: After being ill for fifteen or sixteen days, the patient has a yellow body, diarrhea, and manic behavior wanting to run away. The physician palpated the pulse and predicted that passing stool resembling pig liver would mark the end of the condition. Later, this happened as predicted. How did the physician know this? The physician said: At the Cun-kou (radial artery) position, the yang aspect is floating and the yin aspect is soft/viscid. Floating yang indicates wind; soft yin indicates weakness and scant blood (or deficiency). A floating and deficient constitution exposed to wind, combined with scant blood and fever, presents with aversion to cold, shivering, stiff neck, and dizziness. The physician applied fire moxibustion, causing郁闭 (stagnation) and sweating, which stopped the aversion to cold. However, external heat erupted due to the fire, steaming the skin and causing jaundice of the body and eyes, difficult urination, shortness of breath, and nasal bleeding. Subsequent purgation depleted stomach fluids, leading to uncontrolled diarrhea. Heat stagnation in the Bladder formed accumulations resembling pig liver. Because the blood stasis was not purged, mental confusion ensued, causing the patient to run wildly towards water, unable to control themselves. Once the blood stasis is removed, vision clears and the mind settles. These errors were caused by the physician; originally, there was no disaster. Mild cases recover; extreme cases are untreatable. Guo Yong stated: Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is appropriate. If there is heat resembling mania, add Huangqin (Scutellaria Root).
He also said: The appearance resembles Shanghan, but the pulse is not wiry and tight; instead, it is weak. Weakness implies thirst. Fire therapy causes delirium. If the pulse is weak, febrile, and floating, resolution requires sweating to achieve cure. Guo Yong stated: Jiuni Tang (Rescue from Adverse Effects Decoction) is appropriate.
He also said: In Taiyang disease, if fire moxibustion is applied and no sweat is produced, the patient will inevitably become irritable. If the disease course passes without resolution, hematochezia (blood in stool) will occur. Guo Yong stated: Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is appropriate.
He also said: In Yangming disease, if fire therapy is applied, slight sweating on the forehead combined with urinary difficulty inevitably leads to jaundice. Chang Shi stated: Yinchen Tang (Artemisia Capillaris Decoction) and Wuling San (Five-Ingredient Powder with Poria) can be used.
He also said: In Yangming disease, with a floating-tight pulse, dry throat, bitter taste, abdominal fullness and wheezing, fever, sweating, absence of aversion to cold, but presence of aversion to heat, and heavy body: Inducing sweating causes agitation, mental confusion, and delirium. Adding warm needles causes fear, irritability, and insomnia. Guo Yong stated: Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is appropriate. If mistakenly treated with purgation, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. Pang Shi stated: With a floating-tight pulse, purgation should not be used, lest it transform into Fengwen (Wind-Warmth); careful examination is required.
He also said: In Shaoyin disease, cough with diarrhea and delirium indicates coercion by fire qi. Consequently, urination becomes difficult because sweating was forced upon the Shaoyin stage. Chang Shi stated: Jiuni Tang (Rescue from Adverse Effects Decoction) should be used to resolve the fire qi, and Wuling San (Five-Ingredient Powder with Poria) to promote urination.
He also said: In Taiyang disease, on the second day, irritability appears contrary to expectation. Back moxibustion causes profuse sweating. Fire qi enters the Stomach, depleting stomach fluids, leading to irritability and inevitable delirium. After more than ten days, if tremors and spontaneous diarrhea occur, this indicates impending resolution. Therefore, sweating does not occur below the waist. The patient desires to urinate but cannot, experiences vomiting, desires to lose urine control, and feels aversion to wind in the feet. The stool is hard. Urination frequency is high but volume is low. After defecation, sudden head pain occurs, and the soles of the feet feel hot; this is because Grain Qi flows downward. Guo Yong stated: For hard stool, irritability, and delirium, Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction) is appropriate to harmonize the Stomach. For inability to urinate, Wuling San (Five-Ingredient Powder with Poria) is appropriate.