太阳病三日。已发汗。若吐若下若温针仍不解者。此为坏病。桂枝不中与也。观其脉证。知犯何逆。随证
治之。
太阳中风之三日。邪犹在表。当用桂枝汤取微似汗以解之。乃为正治。若曰已发汗。是以麻黄汤误
汗之矣。与夫若吐若下若温针而误用之于邪气在表之时。皆足以致里虚邪陷之变。故仍不解也。何以言之。以
本未坏之太阳病。而以误汗吐下温针坏之。乃为医所坏也。故曰坏病。非前注所谓过经不解。日久不痊。
亦非治法多端。无一定可拟。而谓之坏病也。既因汗吐下温针之误。必有变证蜂起。非复桂枝之旧证矣。故曰
桂枝不中与也。但观其所变之脉证。即知其所犯因何而变逆。随其见证而治之可也。论中凡属误汗吐下之变。
皆坏病也。故治之之法。即下文误汗误吐误下误烧针诸条是也。
辨误 从来立言诸家。俱谓仲景既有坏病一则。惜其不立治法。但曰随证治之。以法治之而已。使后人临证束手。
诚为缺典。或曰仲景。有法必有方。大约因久远遗亡。遂成不全之书。良可叹也。不知仲景本意。原以太阳病三日之
一条。以冠中风误治之前。又以本太阳病不解一条。列于少阳误治之始。其下文误汗误吐误下误温针诸条。即其
治也。向因王叔和编次之失。致杂乱于正治误治之中。纷纭难辨。故使后人有此疑叹耳。初非不立治法也。岂意后
贤殚心竭虑。终不可得。故又别立坏病一门。而其治法。究无所措。是以知读仲景书之不易也。然六经之中。仲景独
以阳经之太少为言者。盖以在表之误治居多。在里之误治少也。且二经之表里虚实。疑似多端。难于察识。
其误治独多。变逆尤甚。其害有不可胜言者。故特立此一法。以重其事也。学人其可忽诸。
太阳病经过三天，已经发过汗，如果又用了吐法、下法或温针治疗，病情仍然没有解除的，这叫做坏病。此时桂枝汤不再适用了。应当观察病人的脉象和证候，了解医生犯了什么错误导致病情变化，然后根据当前的证候进行治疗。
太阳中风证到了第三天，邪气仍在体表，应当使用桂枝汤，使病人微微出汗来解除表邪，这才是正确的治疗方法。如果说已经发过汗，那就是误用了麻黄汤发汗所致。再加上如果在邪气还在体表的时候误用吐法、下法或温针，都足以导致里气虚弱、邪气内陷的变证，所以病情仍然没有解除。为什么这样说呢？因为原本没有发生病变的太阳病，因为误用汗、吐、下、温针而变成了坏病，这是被医生治坏的，所以叫作坏病。这并不是指前人的注释中所说的“经过一个经的阶段仍未解除”或“日久不愈”，也不是指治疗方法繁多、没有一定规律可遵循而称之为坏病。既然因为汗、吐、下、温针的误治，必然会出现各种变证蜂拥而起，就不再是桂枝汤证原有的证候了，所以说桂枝汤不再适用。只要观察病人所出现的脉象和证候，就能知道是因为什么原因导致了逆乱的变化，顺着这些见证进行治疗就可以了。《伤寒论》中凡是属于误用汗、吐、下法导致的变证，都属于坏病。所以治疗的方法，就是下文关于误汗、误吐、误下、误烧针等条文所述的内容。
【辨析】自古以来阐述医理各家，都认为张仲景既然提出了坏病这一条，可惜没有设立具体的治法，只是说“随证治之”，按照法治疗罢了，这使得后人在临证时束手无策，确实是一个缺失。有人说张仲景是有法必有方的，大概是因为年代久远遗失亡佚，才成了不完整的书，实在令人叹息。却不知道张仲景的本意，原本是用“太阳病三日”这一条，作为中风误治章节的开头；又以“本太阳病不解”这一条，列在少阳误治的开始。其下文关于误汗、误吐、误下、误温针的各种条文，就是具体的治疗方法。过去因为王叔和编次时的失误，导致这些内容混杂在正治和误治之中，纷繁复杂难以分辨，所以才让后人产生这种疑惑和感叹。这起初并不是不设立治法。岂料后世贤者殚精竭虑，终究无法找到确定的治法，所以另外设立了坏病一门，但其治法最终还是没有着落。因此可知阅读张仲景的书是不容易的。然而六经之中，张仲景唯独以阳经中的太阳、少阳为例进行论述，大概是因为在表的误治情况居多，在里的误治情况较少。而且这两经的表里虚实，疑似的情况很多端绪，难以辨识。其误治的情况尤其多，变逆的危害尤其严重，其危害有说不完的地方。所以特别确立这一法则，以重视此事。学习的人怎么可以忽视呢？
Taiyang disease for three days. Sweating has already been administered. If emesis, purgation, or warm needle therapy were also used and the condition remains unresolved, this is termed a "ruined disease" (Huai Bing). Guizhi Tang (Cinnamon Twig Decoction) is no longer indicated. One must observe the pulse and signs/symptoms, determine what error was committed, and treat according to the current presentation.
On the third day of Taiyang Wind Strike syndrome, the pathogenic factor remains in the exterior. The correct treatment should be Guizhi Tang (Cinnamon Twig Decoction) to induce slight sweating to resolve the exterior. However, if it is stated that sweating has already been performed, it implies an erroneous use of Mahuang Tang (Ephedra Decoction) to induce sweating. Furthermore, if emesis, purgation, or warm needle therapy are erroneously applied while the pathogenic factor is still in the exterior, all these can lead to variations involving deficiency in the interior and sinking of the pathogen into the interior, thus the condition remains unresolved. Why is this so? Because the original Taiyang disease, which had not yet deteriorated, was ruined by erroneous sweating, emesis, purgation, and warm needle therapy; it was ruined by medical error. Hence it is called a "ruined disease." This does not refer to the previous commentary's definition of "failure to resolve after passing through a meridian stage" or "prolonged illness without recovery," nor does it refer to having numerous treatment methods with no fixed pattern. Since erroneous sweating, emesis, purgation, and warm needle therapy have occurred, various altered manifestations will inevitably arise, and it is no longer the original presentation suitable for Guizhi Tang. Therefore, it is said that Guizhi Tang is no longer indicated. By observing the altered pulse and signs/symptoms, one can know the cause of the adverse changes. Treatment should follow the current presentation. In the Treatise, any alterations resulting from erroneous sweating, emesis, or purgation are considered ruined diseases. Thus, the methods of treatment are those described in the subsequent articles regarding erroneous sweating, emesis, purgation, and burning needles.
[Analysis] Throughout history, commentators on medical texts have generally held that since Zhang Zhongjing mentioned the category of "ruined disease," he unfortunately did not establish specific treatment methods, merely stating "treat according to the presentation," leaving later physicians helpless when encountering such cases, which is indeed a deficiency. Some argue that Zhang Zhongjing always paired methods with formulas, but due to long-standing loss and omission, his work became incomplete, which is lamentable. However, one should understand that Zhang Zhongjing's original intent was to place the article on "Taiyang disease for three days" at the beginning of the section on mismanagement of Wind Strike, and to list the article on "original Taiyang disease unresolved" at the start of the section on Shaoyang mismanagement. The subsequent articles on erroneous sweating, emesis, purgation, and warm needle therapy constitute the actual treatments. Previously, due to editorial errors by Wang Shuhe, these contents were mixed among correct and incorrect treatments, becoming chaotic and difficult to distinguish, thereby causing doubt and sighing among later generations. It was not originally intended to lack treatment methods. Unexpectedly, later scholars exhausted their minds and efforts but could not find them, leading to the separate establishment of a "Ruined Disease" chapter, yet its treatment methods remained unsettled. Thus, it is known that reading Zhang Zhongjing's book is not easy. Among the Six Meridians, Zhang Zhongjing specifically discusses the Yang meridians, particularly Taiyang and Shaoyang, likely because erroneous treatments affecting the exterior are more common than those affecting the interior. Moreover, the similarities and differences between exterior/interior and deficiency/excess in these two meridians are manifold and difficult to discern. Consequently, erroneous treatments occur frequently, and the adverse changes are severe, with harms beyond description. Therefore, this specific principle was established to emphasize the importance of the matter. Students of medicine should not neglect this.