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。观其脉症，知犯何逆，
随症治之。
《内经》曰∶“未满三日者，可汗而已”。汗不解者，须当更汗。吐、下、温针之法，非太阳所宜，而三日
中亦非吐下之时也。治之不当，故病仍不解。坏病者，即变症也。若误汗，则有遂漏不止，心下悸、脐下悸
等症；妄吐，则有饥不能食，朝食暮吐，不欲近衣等症；妄下，则有结胸痞硬，协热下利，胀满清谷等症，火
逆，则有发黄圊血，亡阳奔豚等症。是桂枝症已罢，故不可更行桂枝汤也。桂枝以五味成方，减一增一，便非
桂枝汤。非谓桂枝竟不可用，下文皆随症治逆法。
服桂枝汤，大汗出、脉洪大者，与桂枝汤如前法。若形如疟，日再发者，汗出必解，宜桂枝二麻黄一汤。
服桂枝汤，取微似有汗者佳，若大汗出，病必不除矣。然服桂枝后大汗，仍可用之更汗，非若麻黄之不可
复用也。即大汗出后，脉洪大，大烦渴，是阳邪内陷，不是汗多亡阳。此大汗未止，内不烦渴，是病犹在表，桂
枝症未罢，当仍与之，乘其势而更汗之，汗自 ，邪不留矣。是法也，可以发汗，汗生于谷也，即可以止汗，
精胜而邪却也。若不用此法，使风寒乘汗客于玄府，必复恶寒发热如疟状。然疟发作有时，日不再发，此则风
气留其处，故日再发耳。必倍加桂枝以解肌，少与麻黄以开表，所谓奇之不去则偶之也。此又服桂枝后少加麻
黄之一法。
太阳病，发汗，遂漏不止，其人恶风，小便难，四肢微急，难以屈伸者，桂枝加附子汤主之。
太阳固当汗，若不取微似有汗而发之太过，阳气无所止息，而汗出不止矣。汗多亡阳，玄府不闭，风乘虚
入，故复恶风。汗多于表，津弱于里，故小便难。四肢者，诸阳之末，阳气者，精则养神，柔则养筋，
开阖不得，寒气从之，故筋急而屈伸不利也。此离中阳虚，不能摄水，当用桂枝以补心阳，阳密则漏汗自止矣。
坎中阳虚，不能行水，必加附子以回肾阳，阳归则小便自利矣。内外调和，则恶风自罢，而手足便利矣。
漏不止，与大汗出同，若无他变症，仍与桂枝汤。若形如疟，是玄府反闭，故加麻黄，此玄府不闭，故加
附子。若大汗出后而大烦渴，是阳陷于内，急当滋阴，故用白虎加人参汤。此漏不止而小便难，四肢不利，是
阳亡于外，急当扶阳。此发汗虽不言何物，其为麻黄汤可知。盖桂枝汤有芍药而无麻黄，故虽大汗出，而玄府
能闭，但使阳陷于里，断不使阳亡于外也。
此与伤寒自汗出条颇同而义殊。彼脚挛急在未汗前，是阴虚；此四肢急在汗后，是阳虚。自汗因心烦，其
出微；遂漏因亡阳，故不止。小便数尚未难，恶寒微不若恶风之甚，挛急在脚尚轻于四肢不利，故彼用芍药甘
草汤，此用桂枝加附子，其命剂悬殊矣。
发汗后，身疼痛、脉沉迟者，桂枝去芍药生姜新加人参汤主之。
发汗后身疼是表虚，不得更兼辛散，故去生姜；沉为在里，迟为在藏，自当远阴寒，故去芍药。当存甘温
之品以和营，更兼人参以通血脉，里和而表自解矣。名曰新加者，见表未解无补中法，今因脉沉迟而始用之，
与用四逆汤治身疼脉沉之法同义。彼在未汗前而脉反沉，是内外皆寒，故用干姜、生附大辛大热者，协甘草以
逐里寒，而表寒自解。此在发汗后而脉沉迟，是内外皆虚，故用人参之补中益气，以率领桂枝、甘、枣而通血
脉，则表里自和也。此又与人参桂枝汤不同。彼因妄下而胃中虚寒，故用姜术，尚协表热，故倍桂、甘。此因
发汗不如法，亡津液而经络空虚，故加人参，胃气未伤，不须白术，胃中不寒，故不用干姜，此温浓和平之剂。
发汗，病不解，反恶寒者，虚故也，芍药甘草附子汤主之。
发汗后反恶寒，里虚也，表虽不解，急当救里，若反与桂枝攻表，此误也。故于桂枝汤去桂、姜、枣，加
附子以温经散寒，助芍药、甘草以和中耳。
脚挛急与芍药甘草汤，本治阴虚，此阴阳俱虚，故加附子，皆仲景治里不治表之义。
发汗过多，其人叉手自冒心，心下悸，欲得按者，桂枝甘草汤主之。
汗多则心液虚，心气馁故悸；叉手自冒，则外有所卫，得按则内有所凭，则望之而知其虚矣。桂枝为君，
独任甘草为佐，去姜之辛散、枣之泥滞，并不用芍药，不藉其酸收，且不欲其苦泄，甘温相得，气血和而悸自
平。与心中烦、心下有水气而悸者迥别。
发汗后，其人脐下悸，欲作奔豚，茯苓桂枝甘草大枣汤主之。
心下悸欲按者，心气虚；脐下悸者，肾水乘火而上克。豚为水畜，奔则昂首疾驰，酷肖水势上干之象。然
水势尚在下焦，欲作奔豚，尚未发也，当先其时而治之。茯苓以伐肾邪，桂枝以保心气，甘草、大枣培土以制
水。甘澜水状似奔豚，而性则柔弱，故名劳水，用以先煮茯苓，取其下伐肾邪，一惟趋下也。本方取味皆下，
以畏其泛耳。
服桂枝汤，或下之，仍头项强痛，翕翕发热，无汗，心下满微痛，小便不利者，桂枝去桂加茯苓白术汤主
之。小便利则愈。
汗出不彻而遽下之，心下之水气凝结，故反无汗而外不解，心下满而微痛也。然病根在心下，而病机在膀胱。
若小便利，病为在表，仍当发汗；如小便不利，病为在里，是太阳之本病，而非桂枝症未罢也。故去桂枝，而
君以苓、术，则姜、芍即散邪行水之法，佐甘、枣效培土制水之功。此水结中焦，只可利而不可散，所以与小青
龙、五苓散不同法。但得膀胱水去，而太阳表里症悉除，所谓治病必求其本也。
太阳病二三日，不得卧，但欲起，心下必结，脉微弱者，此本有寒分也。反下之，若利止，必作结胸；未
止者，四日复下之，此作协热利也。
不得卧，但欲起，在二三日，似乎与阳明并病。必心下有结，故作
此状。然结而不硬，脉微弱而不浮大，此其人素有久寒宿饮结于心下，非亡津液而胃家实也，与小青龙以逐水
气。而反下之，表实里虚，当利不止。若利自止者，是太阳之热入，与心下之水气交持不散，必作结胸矣。若利
未止者，里既已虚，表尚未解，宜葛根汤、五苓散辈。医以心下结为病不尽，而复下之，表热里寒不解，此协
热利所由来也。
太阳病，外症未除，而数下之，遂协热而利。利下不止，心下痞硬，表里不解者，桂枝人参汤主之。
上条论协热之因，此明下利之治也。外热未除，是表不解，利下不止，是里不解，此之谓有表里症。然病
根在心下，非辛热何能化痞而软硬？非甘温无以止利而解表。故用桂枝、甘草为君，佐以干姜、参、术，先煎
四物，后内桂枝，使和中之力骁，而解肌之气锐，于以奏双解表里之功，又一新加法也。
太阳病，桂枝症，医反下之，利遂不止，脉促者表未解也。喘而汗出者，葛根黄连黄芩汤主之。
桂枝症上复冠太阳，见诸经皆有桂枝症，是桂枝不独为太阳设矣，葛根岂独为阳明药乎？桂枝症，脉本弱，
误下后而反促者，阳气重故也。邪束于表，阳扰于内，故喘而汗出。利遂不止者，所谓暴注下迫，皆属于热，与
脉弱而协热下利不同。此微热在表，而大热入里，固非桂枝、芍药所能和，浓朴、杏仁所宜加矣。故君葛根之
轻清以解肌，佐连、芩之苦寒以清里，甘草之甘平以和中，喘自除而利自止，脉自舒而表自解，与补中逐邪之
法迥别。上条脉症是阳虚，此条脉症是阳盛；上条表热里寒，此条表里俱热；上条表里俱虚，此条表里俱实。
同一协热利，同是表里不解，而寒热虚实攻补不同。补中亦能解表，亦能除痞，寒中亦能解表，亦能止利，神
化极矣。
太阳病，下之后，脉促胸满者，桂枝去芍药汤主之。若微恶寒者，去芍药方中加附子汤主之。
促为阳脉，胸满为阳症，然阳盛则促，阳虚亦促，阳盛则胸满，阳虚亦胸满。此下后脉促而不汗出，胸满
而不喘，非阳盛也，是寒邪内结，将作结胸之症。桂枝汤阳中有阴，去芍药之酸寒，则阴气流行，而
邪自不结，即扶阳之剂矣。若微恶寒，则阴气凝聚，恐姜、桂之力不能散，必加附子之辛热。仲景于桂枝汤一加
一减，遂成三法。
太阳病，下之，微喘者，表未解故也，桂枝加浓朴杏仁汤主之。喘家作桂枝汤，加浓朴、杏仁佳。
喘为麻黄症，治喘者功在杏仁。此妄下后，表虽不解，腠理已疏，故不宜麻黄而宜桂枝。桂枝汤中有芍药，
若但加杏仁，喘虽微，恐不胜任，复加浓朴以佐之，喘随汗解矣。
本太阳病，医反下之，因而腹满时痛者，属太阴也，桂枝加芍药汤主之。大实痛者，桂枝加大黄汤主之。
腹满时痛，因于下后，是阳邪转属，非太阴本病，表症未罢，故仍用桂枝汤解外。满痛既见，故倍加芍药以
和里。此病本于阳，故用阴以和阳。若因下后而腹大实痛，是太阳转属阳明而胃实，尚未离乎太阳。此之谓有表
里症，仍用桂枝汤加大黄，以除实痛。此双解表里法也。凡妄下必伤胃气，胃气虚则阳邪袭阴，故转属太阴；胃
气实则两阳相搏，故转属阳明。太阴则满痛不实，阴道虚也；阳明则大实而痛，阳道实也。满而时痛，下利之
兆；大实而痛，是燥屎之征。桂枝加芍药，即建中之方；桂枝加大黄，即调胃之剂。
伤寒若吐若下后，心下逆满，气上冲胸，起则头眩，脉沉紧，发汗则动经，身为振振摇者，茯苓桂枝白术甘
草汤主之。
伤寒初起，正宜发表，吐下非法也。然吐下后不转属太阴，而心下逆满，气上冲胸，阳气内扰也；起则头眩，
表阳虚也。若脉浮者，可与桂枝汤如前法。今脉沉紧，是为在里，反发汗以攻表，经络更虚，故一身振摇也。夫
诸紧为寒，而指下须当深辨。浮沉俱紧者，伤寒初起之本脉也；浮紧而沉不紧者，中风脉也。若下后结胸热实而
脉沉紧，便不得谓之里寒。此吐下后而气上冲者，更非里寒之脉矣。盖紧者弦之别名，弦如弓弦，言紧之体，紧如
转索，谓弦之用，故弦紧二字可以并称，亦可互见。浮而紧者名弦，是风邪外伤。此沉紧之弦，是木邪内发。观
厥阴为病气上撞心，正可为此症发明也。吐下后胃中空虚，木邪为患，故君茯苓以清胸中之肺气，而治节出；用桂
枝散心下之
逆满，而君主安。白术培既伤之胃土，而元气复；佐甘草以调和气血，而营卫以行，头自不眩，身自不摇矣。
若遇粗工，鲜不认为真武病。
烧针令其汗，针处被寒，核起而赤者，必发奔豚，气从小腹上冲心者、灸其核上各一壮，与桂枝加桂汤。
寒气不能外散，发为赤核，是奔豚之兆也。从小腹冲心，是奔豚之气象也。此阳气不舒，阴气反胜，必灸
其核，以散寒邪，服桂枝以补心气。更加桂者，不特益火之阳，且以制木邪而逐水气耳。前条发汗后，脐下悸，
是水邪欲乘虚而犯心，故君茯苓以正治之，则奔豚自不发。此表寒未解而小腹气冲，是木邪挟水气以凌心，
故于桂枝汤倍加桂以平肝气，而奔豚自除。前在里而未发，此在表而已发，故治有不同。
伤寒脉浮，医以火迫劫之，亡阳，必惊狂起卧不安者，桂枝去芍药加蜀漆龙骨牡蛎救逆汤主之。
伤寒者，寒伤君主之阳也。以火迫劫汗，并亡离中之阴，此为火逆矣。妄汗亡阴，而曰亡阳者，心为阳中
之太阳，故心之液，为阳之汗也。惊狂者，神明扰乱也。阴不藏精，惊发于内；阳不能固，狂发于外。起卧不
安者，起则狂，卧则惊也。凡发热自汗者，是心液不收，桂枝方用芍药，是酸以收之也。此因迫汗，津液既亡，
无液可敛，故去芍药。加龙骨者，取其咸以补心，重以镇怯，涩以固脱，故曰救逆也。且去芍药之酸，则肝家
得辛甘之补；加牡蛎之咸，肾家有既济之力。此虚则补母之法，又五行承制之妙理也。蜀漆不见本草，未详何
物，诸云常山苗则谬。
火逆，下之，因烧针，烦躁者，桂枝甘草龙骨牡蛎汤主之。
三番误治，阴阳俱虚竭矣。烦躁者，惊狂之渐，起卧不安之象也，急用此方，以安神救逆。
上论桂枝坏病十八条。凡坏病不属桂枝者，见各症中。
太阳病经过三天，已经发过汗，如果又用了催吐、泻下或温针等治疗方法，病情仍然没有解除的，这叫做“坏病”，此时不能再使用桂枝汤了。应当观察患者的脉象和症状，了解是哪一种误治导致了病变，然后根据具体的症状进行针对性治疗。
《内经》说：“病程未满三天的，可以通过发汗的方法治愈。”如果发汗后病未解，应当再次发汗。但是，催吐、泻下、温针这些方法，并不适合太阳病，而且在发病三天内也不是使用吐法和下法的时机。因为治疗不当，所以病邪依然没有解除。“坏病”就是变证的意思。如果误用发汗法，可能会出现汗漏不止、心下悸动、脐下悸动等症状；如果妄用吐法，可能会出现饥饿却不想吃东西、早上吃晚上吐、不喜欢穿衣等症状；如果妄用下法，可能会出现结胸、痞硬、协热下利、腹胀满且大便中有未消化的食物等症状；如果误用火疗（如火逆），可能会出现发黄、便血、亡阳、奔豚等症状。既然桂枝汤证已经消失，所以不能再使用桂枝汤。桂枝汤由五味药组成，减去一味增加一味，就不再是桂枝汤了。这并不是说桂枝完全不能用，下文讲述的都是针对误治后的各种变证的治疗方法。
服用桂枝汤后，如果大汗出，脉象洪大的，仍按前面的方法给予桂枝汤。如果出现像疟疾一样的寒热往来，一天发作两次的，出汗后病必能解除，适宜使用桂枝二麻黄一汤。
服用桂枝汤，以微微似有汗出的效果最好，如果大汗出，病一定不能去除。然而，服用桂枝汤后即使大汗出，仍然可以继续使用它来发汗，不像麻黄汤那样不可复用。即是大汗出之后，出现脉洪大、心中大烦大渴，这是阳邪内陷，并不是因为汗多导致亡阳。这里的大汗尚未停止，体内不感到烦渴，说明病邪仍在体表，桂枝汤证未罢，应当仍然给予桂枝汤，趁势再次发汗，汗出自然通畅，邪气就不会停留了。这种方法，既可以发汗，汗液来源于水谷精微，也可以止汗，正气胜而邪气退。如果不使用这种方法，让风寒趁着毛孔张开侵入玄府（汗孔），一定会再次出现像疟疾一样的恶寒发热。然而疟疾发作是有定时的，一天不会发作两次，这是因为风气停留在肌表，所以一天发作两次。必须加倍桂枝以解肌表之邪，少量加入麻黄以开泄腠理，这就是所谓的“奇方不去病则用偶方”。这也是服用桂枝汤后少加麻黄的另一种方法。
太阳病，发汗后，导致汗漏不止，病人怕风，小便困难，四肢轻微拘急，难以屈伸的，主治方剂为桂枝加附子汤。
太阳病确实应当发汗，但如果不是取微微似有汗的效果，而是发汗太过，阳气无所依附而外越，就会导致汗出不止。汗多导致亡阳，玄府（汗孔）不能闭合，风邪乘虚而入，所以再次出现怕风。汗出过多导致表虚，津液亏损导致里虚，所以小便困难。四肢是诸阳经的末端，阳气能够滋养精神，柔和筋脉，如果开阖功能失常，寒气随之侵入，所以筋脉拘急，屈伸不利。这是离卦中的阳气虚弱，不能摄纳水液，应当使用桂枝来补益心阳，阳气致密则漏汗自止。坎卦中的阳气虚弱，不能运化水液，必须加入附子来恢复肾阳，阳气回归则小便自然通利。内外调和，则怕风自除，手足活动自如。
汗漏不止与大汗出类似，如果没有其他变证，仍给予桂枝汤。如果出现像疟疾一样的寒热往来，说明玄府反而闭塞，所以加入麻黄；这里是玄府不闭，所以加入附子。如果在大汗出后出现大烦渴，说明阳邪陷入内部，急需滋阴，所以使用白虎加人参汤。这里是汗漏不止且小便困难、四肢不利，说明阳气亡失于外部，急需扶阳。这里虽然没说是用什么发的汗，但应该是麻黄汤。因为桂枝汤中有芍药而无麻黄，所以即使大汗出，玄府也能闭合，只会使阳邪陷入内部，绝不会使阳气亡失于外部。
这一条与伤寒论中“自汗出”那条条文颇相似但含义不同。那条文中脚部挛急发生在未发汗前，属于阴虚；这里四肢拘急发生在发汗后，属于阳虚。自汗是因为心烦，汗出量少；汗漏不止是因为亡阳，所以汗出不止。小便频数但尚未困难，恶寒轻微不如怕风严重，脚部挛急比四肢不利轻，所以那条文用芍药甘草汤，这里用桂枝加附子汤，用药剂量和用意相差悬殊。
发汗后，身体疼痛、脉象沉迟的，主治方剂为桂枝去芍药生姜新加人参汤。
发汗后身体疼痛是表虚，不能再兼用辛散药物，所以去掉生姜；脉沉表示病在里，脉迟表示病在脏，应当远离阴寒，所以去掉芍药。应当保留甘温的药物来调和营卫，再加入人参来疏通血脉，里气调和而表证自然解除。命名为“新加”，是因为表证未解通常没有补中的治法，现在因为脉象沉迟才使用此法，与使用四逆汤治疗身痛脉沉的道理相同。那是在未发汗前而脉象反沉，是内外皆寒，所以使用干姜、生附子等大辛大热的药物，配合甘草来驱逐里寒，表寒自然解除。这是在发汗后而脉象沉迟，是内外皆虚，所以使用人参补中益气，率领桂枝、甘草、大枣来疏通血脉，则表里自然调和。这与人参桂枝汤不同。那个人参桂枝汤是因为误下导致胃中虚寒，所以使用干姜、白术，还配合表热，所以加倍桂枝、甘草。这个是因发汗不得法，损伤津液导致经络空虚，所以加入人参，胃气未伤，不需要白术，胃中不寒，所以不用干姜，这是一个温和平和的方剂。
发汗后，病未解除，反而怕冷的，是虚证的表现，主治方剂为芍药甘草附子汤。
发汗后反而怕冷，是里虚，表证虽然未解，急需救里，如果反而用桂枝汤攻表，这是错误的。所以在桂枝汤中去掉桂枝、生姜、大枣，加入附子以温经散寒，辅助芍药、甘草来调和脾胃。
脚挛急用芍药甘草汤，本是治疗阴虚，这里是阴阳俱虚，所以加入附子，这都是张仲景治疗里证而不治表证的道理。
发汗过多，病人双手交叉护住心口，心下悸动，喜欢按压的，主治方剂为桂枝甘草汤。
汗多则心液虚，心气衰弱所以悸动；双手交叉护住心口，是为了在外有所护卫，得到按压则在内有依靠，从望诊上就知道这是虚证。桂枝作为君药，独任甘草作为佐药，去掉生姜的辛散、大枣的黏滞，也不使用芍药，不借助它的酸收，也不希望它的苦泄，甘温相得，气血调和则悸动自然平息。这与心中烦、心下有停饮而悸动的情况截然不同。
发汗后，病人脐下悸动，想要发作奔豚的，主治方剂为茯苓桂枝甘草大枣汤。
心下悸动喜欢按压，是心气虚；脐下悸动，是肾水乘心火而上克。豚是水畜，奔跑时昂首疾驰，很像水势上冲的景象。然而水势还在下焦，想要发作奔豚，还没有发作，应当在其发作之前进行治疗。茯苓用来伐除肾邪，桂枝用来保护心气，甘草、大枣培补脾土以制约水邪。甘澜水形状像奔豚，但性质柔弱，所以名叫劳水，用来先煮茯苓，取其向下伐除肾邪的作用，一心趋向下方。本方选取的药味都偏于下行，是因为害怕药性上浮。
服用桂枝汤，或者被误用下法后，仍然头项强痛，翕翕发热，无汗，心下胀满微痛，小便不利的，主治方剂为桂枝去桂加茯苓白术汤。小便通利就会痊愈。
汗出不彻底就急于用下法，导致心下的水气凝结，所以反而无汗且表证不解，心下胀满而微痛。然而病根在心下，病机在膀胱。如果小便通利，病在表，仍当发汗；如果小便不利，病在里，这是太阳病的本病，而不是桂枝汤证未罢。所以去掉桂枝，而以茯苓、白术为君药，则生姜、芍药就是散邪行水的方法，辅助甘草、大枣发挥培土制水的功效。这是水结在中焦，只能利水而不能发散，所以与小青龙汤、五苓散的治法不同。只要膀胱的水邪去除，太阳表的病症全部消除，这就是所谓治病必求其本。
太阳病二三日，不能躺卧，只想起来，心下必然有结聚，脉象微弱的，这是原本就有寒饮停聚。如果误用下法，如果腹泻停止，一定会形成结胸；如果腹泻不停止，到了第四天再次用下法，这会形成协热利。
不能躺卧，只想起来，在二三日时，似乎与阳明并病有关。必定心下有结聚，所以出现这种状态。然而结聚但不坚硬，脉象微弱而不浮大，这说明此人素有久寒宿饮结于心下，并不是津液枯竭导致的胃家实，应当用小青龙汤来逐水气。如果误用下法，表实里虚，应当腹泻不止。如果腹泻自行停止，是太阳的热邪进入，与心下的水气交结不散，一定会形成结胸。如果腹泻未停止，里气已虚，表证未解，适宜用葛根汤、五苓散之类。医生认为心下结聚是病邪未尽，再次用下法，表热里寒不解，这就是协热利产生的原因。
太阳病，外证未除，却多次用下法，于是导致协热利。腹泻不止，心下痞硬，表里同病的，主治方剂为桂枝人参汤。
上一条论述协热利的成因，这条明确下利的治法。外热未除，是表证未解，腹泻不止，是里证未解，这就叫有表里同病。然而病根在心下，非辛热药物怎能化解痞硬？非甘温药物怎能止利并解表。所以使用桂枝、甘草为君药，辅助干姜、人参、白术，先煎煮这四味药，后加入桂枝，使和中之力强劲，而解肌之气锐利，从而奏效双解表里的功效，这也是一种新的加法。
太阳病，桂枝证，医生反而用下法，腹泻随即不止，脉象急促的，说明表证未解。气喘而且出汗的，主治方剂为葛根黄连黄芩汤。
桂枝证前面冠以“太阳”，说明各经都有桂枝证，桂枝不仅仅为太阳病设立，葛根难道仅仅是阳明病的药吗？桂枝证，脉象本来弱，误下后反而急促，是因为阳气重。邪气束缚于表，阳气扰乱于内，所以气喘而且出汗。腹泻随即不止，这就是所谓“暴注下迫，皆属于热”，与脉弱而协热下利不同。这是微热在表，而大热入里，固非桂枝、芍药所能调和，也非厚朴、杏仁所宜加入。所以以葛根的轻清来解肌，辅助黄连、黄芩的苦寒来清里，甘草的甘平来调和脾胃，气喘自然消除，腹泻自然停止，脉象自然舒缓，表证自然解除，与补中逐邪的方法截然不同。上一条脉症是阳虚，这条脉症是阳盛；上一条表热里寒，这条表里俱热；上一条表里俱虚，这条表里俱实。同样是协热利，同样是表里不解，但寒热虚实攻补不同。补中能解表，也能除痞；寒中能解表，也能止利，变化神妙极了。
太阳病，用下法后，脉象急促、胸部胀满的，主治方剂为桂枝去芍药汤。如果伴有轻微怕冷的，在去芍药方中加入附子，主治方剂为桂枝去芍药加附子汤。
促脉是阳脉，胸满是阳证，然而阳盛则脉促，阳虚亦脉促；阳盛则胸满，阳虚亦胸满。这里是下法后脉促且不汗出，胸满但不气喘，不是阳盛，而是寒邪内结，将要形成结胸的症状。桂枝汤是阳中有阴，去掉芍药的酸寒，则阴气流行，邪气自然不结聚，这就成为扶阳的方剂了。如果轻微怕冷，则阴气凝聚，恐怕姜、桂的力量不能散寒，必须加入附子的辛热。张仲景在桂枝汤上加一味减一味，就形成了三种治法。
太阳病，用下法后，轻微气喘的，是表证未解的缘故，主治方剂为桂枝加厚朴杏子汤。素有喘疾的人发作桂枝证，加入厚朴、杏仁较好。
气喘是麻黄汤证，治疗气喘的功效在于杏仁。这里是误用下法后，表证虽未解，但腠理已疏松，所以不宜用麻黄而宜用桂枝。桂枝汤中有芍药，如果只加杏仁，气喘虽然轻微，恐怕力量不够，再加厚朴来辅助它，气喘随汗而解。
原本是太阳病，医生反而用下法，因而出现腹部胀满、时时疼痛的，属于太阴病，主治方剂为桂枝加芍药汤。如果腹部大实疼痛的，主治方剂为桂枝加大黄汤。
腹部胀满、时时疼痛，是因为误下后，阳邪转属太阴，并非太阴的本病，表证未罢，所以仍用桂枝汤解表。既然出现了胀满疼痛，所以加倍芍药来调和里气。这个病本源于阳，所以用阴药来调和阳。如果因为误下后腹部大实疼痛，是太阳转属阳明而胃实，尚未脱离太阳。这就叫有表里同病，仍用桂枝汤加大黄，以除去实痛。这是双解表里的方法。凡是误下必伤胃气，胃气虚则阳邪侵袭阴分，所以转属太阴；胃气实则两阳相搏，所以转属阳明。太阴则是胀满疼痛但不坚实，阴道虚；阳明则是大实而痛，阳道实。胀满而时时疼痛，是下利的征兆；大实而痛，是燥屎的特征。桂枝加芍药汤，就是建中汤的方义；桂枝加大黄汤，就是调胃承气汤的方义。
伤寒脉浮，医生用火法强迫发汗，导致亡阳，必定出现惊狂、起卧不安的症状，主治方剂为桂枝去芍药加蜀漆龙骨牡蛎救逆汤。
伤寒，是寒邪伤了君主之阳。用火法强迫发汗，同时耗伤了离卦中的阴液，这叫火逆。妄用汗法亡阴，却说亡阳，是因为心为阳中之太阳，所以心的津液，就是阳之汗。惊狂，是神明扰乱。阴不能藏精，惊发于内；阳不能固守，狂发于外。起卧不安，起来则狂，躺下则惊。凡是发热自汗的，是心液不收，桂枝汤方中使用芍药，是用酸味来收敛它。这里因为火迫发汗，津液既已亡失，无液可敛，所以去掉芍药。加入龙骨，取其咸味以补心，重镇以怯，涩味以固脱，所以叫救逆。而且去掉芍药的酸味，则肝家得到辛甘的补益；加入牡蛎的咸味，肾家有既济的力量。这是虚则补母的方法，又是五行承制的妙理。蜀漆不见于本草，不详是什么东西，众人说是常山的嫩芽则是谬误。
火逆，又用下法，接着又用烧针，出现烦躁的，主治方剂为桂枝甘草龙骨牡蛎汤。
Taiyang disease (Disease of the Taiyang Channel) for three days, after sweating has been induced, if emesis, purgation, or warm needle therapy has also been applied, yet the condition remains unresolved, this is termed a "ruined disease" (Huai Bing). Guizhi Tang (Cinnamon Twig Decoction) should no longer be administered. One must observe the pulse and symptoms to determine which therapeutic error occurred, and then treat according to the specific manifestations.
The *Neijing* (Classic of Internal Medicine) states: "If the disease duration is less than three days, it can be cured by inducing sweat." If sweating fails to resolve the condition, sweating should be repeated. However, emesis, purgation, and warm needle therapies are not suitable for Taiyang disease, nor is the third day an appropriate time for emesis or purgation. Due to improper treatment, the pathogen remains unresolved. A "ruined disease" refers to a transformed syndrome. If sweating was misapplied, symptoms such as continuous leakage of sweat, palpitations in the epigastrium, or palpitations below the umbilicus may occur; if emesis was recklessly used, symptoms like hunger without desire to eat, morning consumption with evening vomiting, and aversion to removing clothing may appear; if purgation was recklessly used, symptoms such as chest binding (Jie Xiong), epigastric fullness and hardness, heat-collateral diarrhea, abdominal distension with undigested food in stool may arise; if fire therapy (fire reversal) was misused, symptoms like jaundice, hematochezia, Yang collapse, or Ben Tun (running piglet syndrome) may manifest. Since the Guizhi Tang syndrome has ceased, Guizhi Tang cannot be used again. Guizhi Tang consists of five herbs; altering even one ingredient changes the formula entirely. This does not mean Cinnamon Twig (Guizhi) is absolutely contraindicated; the following text describes treatments for various post-error syndromes.
After taking Guizhi Tang, if profuse sweating occurs and the pulse is flooding (Hong Da), administer Guizhi Tang as previously directed. If the patient presents with chills and fever resembling malaria, occurring twice daily, resolution will follow sweating; Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction) is indicated.
When administering Guizhi Tang, slight perspiration is ideal. Profuse sweating will fail to eliminate the disease. However, even after profuse sweating from Guizhi Tang, it may still be used to induce sweat, unlike Mahuang Tang (Ephedra Decoction) which cannot be reused. If after profuse sweating, the pulse becomes flooding and there is severe restlessness and thirst, this indicates Yang pathogen sinking inward, not Yang collapse due to excessive sweating. Here, if sweating continues but there is no internal restlessness or thirst, the pathogen remains at the exterior, and the Guizhi Tang syndrome persists. It should still be administered to capitalize on the momentum and induce further sweating, allowing sweat to flow freely so the pathogen does not linger. This method can both induce and stop sweating; when Jing (Essence) prevails, the pathogen retreats. If this method is not used, wind-cold may invade the pores (Xuan Fu) while they are open, leading to recurrent chills and fever resembling malaria. However, malaria has fixed timing and does not occur twice daily; here, wind pathogen lingers in the muscle layer, causing twice-daily episodes. One must double the amount of Guizhi to release the muscle layer and add a small amount of Mahuang (Ephedrae Herba) to open the exterior. This illustrates the principle: "If the odd-numbered formula fails, use the even-numbered formula." This is another method of adding a small amount of Mahuang after Guizhi Tang.
In Taiyang disease, after inducing sweating, if sweating leaks continuously, the patient feels aversion to wind, experiences difficulty urinating, slight stiffness in the four limbs making flexion and extension difficult, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite Root) is the primary treatment.
Taiyang disease requires sweating, but if not done gently to produce slight perspiration, and instead sweating is excessive, Yang Qi loses its anchor and escapes, causing continuous sweating. Excessive sweating leads to Yang collapse, failure of the pores to close, and wind invading through the deficiency, resulting in renewed aversion to wind. Surface fluid is depleted, and interior fluids are weak, causing difficulty urinating. The four limbs are the extremities of all Yang channels. Yang nourishes the spirit and softens the sinews. If the opening and closing mechanisms fail, cold pathogen enters, causing tendon stiffness and limited movement. This represents deficiency of Yang within Li (Heart/Fire), failing to control water; Guizhi (Cinnamomi Ramulus) should be used to tonify Heart Yang. When Yang is dense, leaking sweat stops. Deficiency of Yang within Kan (Kidney/Water) fails to transform water; Fuzi (Aconiti Lateralis Radix Praeparata) must be added to restore Kidney Yang. When Yang returns, urination normalizes. With interior-exterior harmony, aversion to wind ceases, and limbs move freely.
Continuous leakage is similar to profuse sweating. Without other transformed symptoms, Guizhi Tang is still given. If symptoms resemble malaria, indicating closed pores, Mahuang is added; here, since pores are open, Fuzi is added. If after profuse sweating there is severe restlessness and thirst, Yang has sunk inward, requiring immediate Yin nourishment, hence Baihu Jia Renshen Tang (White Tiger Decoction with Added Ginseng Root). Here, leakage with difficulty urinating and limb stiffness indicates Yang collapsing outward, requiring immediate Yang support. Although the initial sweating agent isn't specified, it was likely Mahuang Tang. Guizhi Tang contains Shaoyao (Paeoniae Radix Alba) but no Mahuang, so even with profuse sweating, pores can close; Yang may sink inward but will not collapse outward.
This differs significantly from the clause on spontaneous sweating in Shanghan. In that case, foot cramping occurred before sweating, indicating Yin deficiency. Here, limb stiffness occurs after sweating, indicating Yang deficiency. Spontaneous sweating is due to mental agitation and is slight; leaking sweat is due to Yang collapse and is continuous. Frequent urination without difficulty, mild aversion to cold rather than wind, and mild foot cramping compared to limb stiffness led to the use of Shaoyao Gancao Tang (Peony and Licorice Decoction) in the former, whereas Guizhi Jia Fuzi Tang is used here, showing a vast difference in prescription strategy.
After sweating, if body pain persists and the pulse is deep and slow, Xinjia Renshen Tang (Newly Added Ginseng Decoction, derived from Guizhi Tang by removing Shaoyao and Shengjiang) is the primary treatment.
Body pain after sweating indicates exterior deficiency; pungent dispersants should not be combined, hence Shengjiang (Zingiberis Rhizoma Recens) is removed. Deep pulse indicates interior location; slow pulse indicates Zang organ involvement; Yin-cold should be avoided, hence Shaoyao is removed. Sweet-warm herbs should remain to harmonize Ying (Nutrient) Qi, and Renshen (Ginseng Radix et Rhizoma) is added to unblock blood vessels. Interior harmony resolves the exterior. Named "Newly Added" because exterior-unresolved cases typically lack central-tonifying methods; now, due to deep-slow pulse, it is used, analogous to using Sini Tang (Frigid Extremities Decoction) for body pain with deep pulse. In the latter case, before sweating, a deep pulse indicates interior-exterior cold, treated with Ganjiang (Zingiberis Rhizoma) and Sheng Fuzi (Prepared Aconite Root) to drive out interior cold, resolving exterior cold. Here, after sweating, deep-slow pulse indicates interior-exterior deficiency. Renshen tonifies middle Qi and leads Guizhi, Gancao, and Dazao to unblock vessels, harmonizing interior-exterior. This differs from Renshen Guizhi Tang. The latter treats stomach deficiency-cold from erroneous purgation, using Ganjiang and Baizhu, doubling Guizhi and Gancao to assist exterior heat. This case results from improper sweating damaging fluids and emptying meridians; Renshen is added. Stomach Qi is intact, so Baizhu is unnecessary; stomach is not cold, so Ganjiang is omitted. This is a mild and balanced formula.
After sweating, if the disease remains unresolved and aversion to cold appears, it is due to deficiency. Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is the primary treatment.
Aversion to cold after sweating indicates interior deficiency. Although the exterior is unresolved, saving the interior is urgent. Using Guizhi Tang to attack the exterior would be an error. Thus, Guizhi, Shengjiang, and Dazao are removed from Guizhi Tang, and Fuzi is added to warm channels and scatter cold, assisting Shaoyao and Gancao to harmonize the middle.
Jiao Luan Ji (Foot Cramping) treated with Shaoyao Gancao Tang addresses Yin deficiency. Here, both Yin and Yang are deficient, so Fuzi is added, reflecting Zhang Zhongjing's principle of treating the interior over the exterior.
After excessive sweating, if the patient crosses their hands over the heart, experiences palpitations in the epigastrium, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is the primary treatment.
Excessive sweating depletes Heart fluid and weakens Heart Qi, causing palpitations. Crossing hands provides external protection; pressure provides internal support, indicating deficiency upon observation. Guizhi is the Sovereign herb, with Gancao as Minister. Shengjiang's pungency and Dazao's cloying nature are removed. Shaoyao is excluded to avoid sour astringency and bitter drainage. Sweet and warm together harmonize Qi and Blood, calming palpitations. This differs distinctly from palpitations caused by mental restlessness or fluid retention in the heart region.
After sweating, if the patient experiences palpitations below the umbilicus and impending Ben Tun (Running Piglet Syndrome), Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is the primary treatment.
Palpitations in the epigastrium desiring pressure indicate Heart Qi deficiency. Palpitations below the umbilicus indicate Kidney Water attacking Heart Fire. "Tun" refers to a water animal; running with head high resembles water surging upward. Since the water energy is still in the Lower Jiao and Ben Tun has not yet erupted, treatment should precede onset. Fuling (Poria) attacks Kidney pathogen; Guizhi protects Heart Qi; Gancao and Dazao strengthen Earth to control Water. Ganlan Shui (Agitated Water), resembling running piglets but soft in nature, is used to decoct Fuling first, guiding it downward to attack Kidney pathogen. All ingredients in this formula act downward to prevent floating.
After taking Guizhi Tang, or if erroneously purged, if headache and neck stiffness persist, low-grade fever, absence of sweat, epigastric fullness with slight pain, and difficulty urinating occur, Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment. Healing occurs when urination becomes free.
Incomplete sweating followed by premature purgation causes water-Qi condensation in the epigastrium, leading to absent sweat and unresolved exterior, plus epigastric fullness and slight pain. The root is in the epigastrium, but the mechanism involves the Bladder. If urination is free, the disease is exterior, requiring sweating. If urination is difficult, the disease is interior, representing the primary Taiyang pathology, not an unresolved Guizhi Tang syndrome. Thus, Guizhi is removed, and Fuling and Baizhu become Sovereign. Shengjiang and Shaoyao disperse pathogen and move water; Gancao and Dazao strengthen Earth to control water. This is water accumulation in the Middle Jiao, treatable only by draining, not dispersing, differing from Xia Qing Long Tang (Minor Blue Dragon Decoction) and Wu Ling San (Five-Ling Powder). Once bladder water is removed, Taiyang exterior-interior symptoms clear, illustrating "treating disease requires seeking the root."
In Taiyang disease for two to three days, if the patient cannot lie down but wants to rise, and the epigastrium is bound with a faint pulse, this indicates pre-existing cold-fluid retention. Erroneous purgation may lead to Jie Xiong (Chest Binding) if diarrhea stops, or Xie Re Li (Heat-Collateral Diarrhea) if purgation is repeated on the fourth day with persistent diarrhea.
Inability to lie down suggests similarity to Yangming concurrent disease. Epigastric binding causes this state. However, the binding is not hard, and the pulse is faint, not floating-large, indicating chronic cold-fluid retention in the epigastrium, not fluid depletion with Yangming excess. Xiao Qing Long Tang (Blue Dragon Decoction) should have been used to drain water. Erroneous purgation creates exterior excess and interior deficiency, leading to persistent diarrhea. If diarrhea stops, Taiyang heat enters and binds with epigastric water, forming Jie Xiong. If diarrhea persists, interior is deficient, exterior unresolved; Gegen Tang (Kudzu Decoction) or Wu Ling San are appropriate. If the physician, seeing epigastric binding as incomplete disease, purges again, exterior heat and interior cold persist, causing Xie Re Li.
In Taiyang disease, if exterior symptoms remain and multiple purgations are used, Xie Re Li (Heat-Collateral Diarrhea) ensues. With persistent diarrhea, epigastric fullness and hardness, and unresolved exterior-interior, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is the primary treatment.
The previous clause discussed the cause of Xie Re Li; this clarifies the treatment. Unresolved exterior heat means exterior is unresolved; persistent diarrhea means interior is unresolved. The root is in the epigastrium; only pungent-hot herbs can resolve binding, and only sweet-warm herbs can stop diarrhea and release the exterior. Guizhi and Gancao are Sovereign; Ganjiang, Renshen, and Baizhu are Ministers. The first four are decocted first, then Guizhi added, strengthening middle-harmonizing power and exterior-releasing vigor, achieving dual exterior-interior resolution.
In Taiyang disease with Guizhi syndrome, if erroneously purged, diarrhea persists, and the pulse is rapid (Cu), the exterior is unresolved. With wheezing and sweating, Ge Gen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) is the primary treatment.
Prefacing Guizhi syndrome with "Taiyang" shows Guizhi applies to all channels, just as Gegen applies beyond Yangming. Guizhi syndrome normally has a weak pulse; after erroneous purgation, a rapid pulse indicates heavy Yang Qi. Pathogen constrains the exterior, Yang disturbs the interior, causing wheezing and sweating. Persistent diarrhea reflects "acute diarrhea with tenesmus belongs to heat," differing from weak-pulse heat-collateral diarrhea. Here, slight heat is exterior, major heat is interior; Guizhi and Shaoyao cannot harmonize, nor are Houpo and Xingren suitable. Gegen light-clearing releases the muscle layer; Huanglian and Huangqin bitter-cold clear interior; Gancao sweet-neutral harmonizes middle. Wheezing and diarrhea cease, pulse relaxes, exterior resolves. This differs from tonifying middle to expel pathogen. Previous clause: Yang deficiency; this clause: Yang excess. Previous: Exterior heat, interior cold; this: Exterior-interior heat. Previous: Exterior-interior deficiency; this: Exterior-interior excess. Both are Xie Re Li with unresolved exterior-interior, but cold-heat and deficiency-excess treatments differ greatly. Tonifying middle can release exterior and resolve binding; clearing heat can release exterior and stop diarrhea. Divine transformation is profound.
In Taiyang disease, after purgation, if the pulse is rapid and chest is full, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Peony) is the primary treatment. If slightly aversed to cold, Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without Peony plus Aconite) is used.
Rapid pulse is Yang pulse; chest fullness is Yang symptom. Full Yang causes rapid pulse and chest fullness; deficient Yang also causes rapid pulse and chest fullness. Here, post-purgation rapid pulse without sweating and chest fullness without wheezing indicates not Yang excess, but cold pathogen binding internally, impending Jie Xiong. Guizhi Tang is Yang containing Yin. Removing Shaoyao's sour-cold allows Yin Qi to circulate, preventing pathogen binding, becoming a Yang-supporting formula. If slight aversion to cold indicates Yin Qi coagulation, Ginger and Cinnamon may be insufficient; Fuzi's pungent-hot nature is needed. Zhang Zhongjing adds/removes one herb from Guizhi Tang to create three methods.
In Taiyang disease, after purgation, if slight wheezing occurs, the exterior is unresolved. Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction with Added Magnolia Flower and Apricot Seed) is the primary treatment. For chronic wheezers with Guizhi syndrome, adding Houpo and Xingren is beneficial.
Wheezing is a Mahuang syndrome; Xingren treats wheezing. After erroneous purgation, although exterior is unresolved, pores are loose, so Mahuang is unsuitable; Guizhi is preferred. Guizhi Tang contains Shaoyao. Adding only Xingren may be insufficient for even slight wheezing; adding Houpo assists, and wheezing resolves with sweat.
Originally Taiyang disease, if erroneously purged, leading to abdominal fullness and intermittent pain, it belongs to Taiyin. Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony) is the primary treatment. For severe fullness and pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb) is used.
Abdominal fullness and intermittent pain result from purgation, where Yang pathogen transfers to Taiyin, not Taiyin's primary disease. Exterior symptoms persist, so Guizhi Tang releases the exterior. With fullness and pain, Shaoyao is doubled to harmonize the interior. The disease originates in Yang, so Yin herb harmonizes Yang. If severe fullness and pain follow purgation, Taiyang transfers to Yangming with stomach excess, yet remains connected to Taiyang. This is exterior-interior simultaneous disease. Guizhi Tang plus Dahuang removes excess pain, a dual exterior-interior method. Erroneous purgation damages Stomach Qi. Deficient Stomach Qi allows Yang pathogen to invade Yin, transferring to Taiyin; Excess Stomach Qi causes two Yangs to clash, transferring to Yangming. Taiyin presents with fullness/pain but no firmness (Yin deficiency); Yangming presents with severe excess/pain (Yang excess). Fullness with intermittent pain signals diarrhea; severe excess/pain signals dry feces. Guizhi Jia Shaoyao is akin to Jianzhong Tang; Guizhi Jia Dahuang is akin to Tiaowei Chengqi Tang.
In Shanghan with floating pulse, if the physician uses fire coercion to induce sweating, causing Yang collapse, resulting in fright, mania, and restlessness, Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Ji Ni Tang (Cinnamon Twig Decoction without Peony plus Metanephrite, Dragon Bone, and Oyster Shell Rescue Counter-Action Decoction) is the primary treatment.
Shanghan is cold injuring the Monarch's Yang. Fire coercion induces sweating and depletes Yin within Li (Heart), termed Fire Reversal. Erroneous sweating depletes Yin, yet is called Yang collapse because Heart is Yang among Yangs; Heart fluid is Yang sweat. Fright/mania is spirit disturbance. Yin fails to store essence, causing internal fright; Yang fails to secure, causing external mania. Restlessness: rising causes mania, lying causes fright. Fever with spontaneous sweating indicates unrestrained Heart fluid; Guizhi Tang uses Shaoyao to astringe. Here, fire coercion depletes fluids, leaving none to astringe, so Shaoyao is removed. Longgu (Dragon Bone) adds salinity to tonify Heart, heaviness to calm fear, and astringency to secure collapse, hence "Rescue Counter-Action." Removing Shaoyao allows Liver to receive pungent-sweet tonification; adding Muli (Oyster Shell) salinity aids Kidney-Jiaoji balance. This is "tonify mother when deficient" and Five Elements control theory. Shuqi's identity is unclear; claiming it is Changshan sprout is erroneous.
For Fire Reversal, followed by purgation and burning needle, causing irritability, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is the primary treatment.
Three erroneous treatments exhaust Yin and Yang. Irritability is the precursor to fright/mania and restlessness. This formula must be used urgently to calm spirit and rescue counter-action.
Above discusses eighteen clauses of Guizhi ruined diseases. Ruined diseases not belonging to Guizhi are detailed in respective symptom clauses.