太阳病中风，以火劫发汗，邪风被火热，血气流溢，失其常度。两阳相熏灼，身体则枯燥。但头汗出，剂颈
而还，其身发黄。阳盛则欲衄，阴虚则小便难。阴阳俱虚竭，腹满而喘，口渴咽烂，或不大便。久则谵语，甚者
至哕，手足躁扰，捻衣摸床。小便利者，其人可治。
太阳中风，不以麻黄、青龙发汗，而以火攻其汗，则不须言风邪之患，当知火邪之利害矣。血得热则流，气
得热则溢。血气不由常度，而变由生也。风为阳邪，火为阳毒，所谓两阳也。两阳相灼，故即见两阳合明之病，
身体枯燥。身无汗也，故身发黄。头汗至颈，故但身黄，而头至颈不黄也。首为元阳之会，不枯燥，是阳未虚竭；
有汗出，是阴未虚竭。此两阳尚熏于形身，而未内灼于脏腑也。此血气流溢之轻者。若其人阳素盛者，因熏灼而
伤血，其鼻必衄。其人阴素虚者，因熏灼而伤津，小便必难。若其人阴阳之气俱虚竭者，胸满而喘，口干咽烂
而死者有矣。或胃实而谵语，或手足躁扰，而至于捻衣摸床者有矣。皆气血流溢，失其常度故也。小便利，是反
应小便难句。凡伤寒之病，以阳为主，故最畏亡阳。而火逆之病，则以阴为主，故最怕阴竭。小便利者为可治，
是阴不虚，津液未亡，太阳膀胱之气化犹在也。阳盛阴虚，是火逆一症之纲领。阳盛则伤血，阴虚则亡津，又是
伤寒一书之大纲领。
太阳病二日，烦躁，反熨其背而大汗出。大热入胃，胃中水竭，躁烦，必发谵语。十余日振栗自下利者，此为
欲解也。故其汗从腰以下不得汗，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，头卓然而痛。其人足心必热，谷气下流故也。
此指火逆之轻者言之。太阳病经二日，不汗出而烦躁，此大青龙
症也。不知发汗而兼以清火，而反以火熨其背。背者，太阳之部也。太阳被火迫，因转属阳明。胃者，阳明之府，
水谷之海也。火邪入胃，胃中水竭，屎必燥硬。烦躁不止，谵语所由发也。非调胃承气下之，胃气绝矣。十余
日句，接大汗出来。盖其人虽大汗出，而火热未入胃中。胃家无恙，谵语不发，烦躁已除。至二候之后，火气已
衰。阳气微，故振栗而解；阴气复，故自利而解。此阴阳自和而自愈者也。“故其汗”至末，是倒叙法。释未利
未解前症，溯其因而究其由也。言所以能自下利者，何以故？因其自汗出时，从腰以下不得汗。夫腰以下为地，
地为阴，是火邪未陷入于阴位也，二肠膀胱之液俱未伤也。欲小便不得，而反呕欲失溲，此非无小便也，其津液
在上焦，欲还入胃中故也。凡大便硬者，小盒饭数而不多。今小便反不数而反多，此应前欲小便不得句，正以明
津液自还入胃中而下利之意也。利是通利，非泻利之谓，观大便已可知矣。头为诸阳之会，卓然而痛者，阴气复则
阳气虚也。足心必热，响应足下恶风句。前大汗出则风已去，故身不恶风。汗出不至足，故足下恶风也。今火气下
流，故足心热。火气下流，则谷气因之下流，故大便自利也。大便已头疼，可与小便已阴疼者参之。欲小便不得，
反失溲，小盒饭数，反不数、反多，与上条小便难、小便利，俱是审其阴气之虚不虚、津液之竭不竭耳。
太阳病，以火熏之，不得汗，其人必躁，过经不解，必圊血。名为火邪。
首条以火劫发汗而衄血，是阳邪盛于阳位，故在未过经时。此条以火熏不得汗而圊血，是阳邪下陷入阴分，
故在过经不解时。次条大汗出后十余日，振栗下利而解。此条不得汗，过经圊血而犹不解。可知劫汗而得汗者，
其患速；不得汗者，其患迟。名为火邪，则但治其火，而不虑其前此之风寒矣。
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。
上文皆阳盛之症，以中风为阳邪也。此后是阳虚之症，以伤寒为阴邪也。阳盛者，轻则发狂谵语，重则衄
血圊血，此不戢自焚者也。阳虚者，神不守舍，起居如惊，其人如狂，是弃国而逃者也。
方注详桂枝篇。
上论火逆症。
太阳伤寒者，加温针必惊也。
温针者，即烧针也，烧之令其温耳。寒在形躯而用温针刺之，寒气内迫于心，故振惊也。
若重发汗，复加烧针者，四逆汤主之。
重发汗而病不解，则不当汗矣。复加烧针，以迫其汗，寒气内侵，当救其里。烧针后宜有脱文。
火逆下之，因烧针烦躁者，桂枝甘草龙骨牡蛎汤主之。
方注详桂枝篇。
其脉沉者，营气微也。营气微者加烧针，则血流不行，更发热而烦躁也。
按∶流、行二字，必有一误。此阴阳俱虚竭之候也。
烧针令其汗，针处被寒，核起而赤者，必发奔豚。气从少腹上冲者，灸其核上各一壮，与桂枝加桂汤。
方注详桂枝篇。
上论火针症。
脉浮宜以汗解。用火灸之，邪无从出，因火而盛，病从腰以下必重而痹，名火逆也。脉浮热甚，反灸之，
此为实，实以虚治，因火而动，必咽燥吐血。
微数之脉，慎不可灸。因火为邪，则为烦逆，追虚逐实，血散脉中。火气虽微，内攻有力，焦骨伤筋，血
难复也。
此皆论灸之而生变也。腰以下重而痹者，因腰以下不得汗也。咽燥吐血者，亦阳盛而然也，比衄加甚矣。
当知灸法为虚症设，不为风寒设，故叮咛如此。
上论火灸症。
太阳病中风证，用火法强行发汗，风邪与火热相合，导致气血运行溢出常态。两阳（风邪与火邪）相互熏灼，身体就会变得干枯燥热。仅头部出汗，至颈部而止，身体会出现发黄。阳气偏盛则想流鼻血，阴液亏虚则小便困难。阴阳之气都虚弱枯竭时，会出现腹部胀满且气喘、口渴咽部溃烂，或者大便不通。时间久了会说胡话，严重的甚至出现呃逆，手足躁动不安，手抓衣被和床沿。如果小便通畅，说明病情还有治愈的希望。
太阳中风证，不用麻黄汤或大青龙汤来发汗，却用火法攻取汗液，那么就不必多言风邪的危害，应当了解火邪带来的利害了。血液遇到热就会流动加速，气遇到热就会外溢。气血不再遵循正常的规律，病变由此产生。风是阳邪，火是阳毒，这就是所谓的“两阳”。两阳相互灼烧，所以立即出现类似“两阳合明”的病证，表现为身体干枯燥热。身上没有汗，所以身体发黄。头汗只到颈部，所以只有身体发黄，而头部到颈部不发黄。头部是元阳汇聚之处，如果不干枯，说明阳气尚未虚竭；如果有汗出，说明阴液尚未虚竭。这是两阳之邪还在体表熏蒸，而没有向内灼伤脏腑的表现。这是气血运行溢出较轻的情况。如果其人原本阳气旺盛，因熏灼而损伤血络，鼻子一定会流鼻血。如果其人原本阴液亏虚，因熏灼而损伤津液，小便一定困难。如果其人的阴阳之气都虚弱枯竭，会出现胸部胀满且气喘，口干咽部溃烂，甚至有死亡的危险。或者胃中实热导致说胡话，或者手足躁动不安，以至于抓衣摸床的。这些都是因为气血运行溢出，失去了正常规律所致。小便利，是回应前文提到的小便难。凡是伤寒病，以阳气为主，所以最害怕亡阳。而火逆证，以阴液为主，所以最怕阴竭。小便利说明可以治疗，这是因为阴液不虚，津液未亡，太阳膀胱的气化功能还存在。阳盛阴虚，是火逆这一病症的纲领。阳盛则伤血，阴虚则亡津，又是整本《伤寒论》的大纲领。
太阳病第二天，出现烦躁，反而用熨背法导致大汗出。大热邪气进入胃中，胃中津液枯竭，躁动烦乱，必定会说胡话。十多天后，如果出现战栗并自然下利的，这是病情将要解除的表现。所以他的汗从腰部以下不得出，想要小便却排不出，反而呕吐，想要失禁小便。脚底怕冷。大便干硬，小便次数应该频繁但反而不频繁且量多。大便排出后，头部突然疼痛。这个人的脚心必定发热，这是因为谷气向下流通的缘故。
这里指的是火逆证中较轻的情况。太阳病经过两天，无汗而烦躁，这是大青龙汤证的症候。不知道用发汗法兼清里热，反而用火熨背部。背部是太阳经所主的部位。太阳经被火邪逼迫，因此转属阳明经。胃是阳明经的腑，是水谷之海。火邪入胃，胃中津液枯竭，大便必然干燥坚硬。烦躁不止，是说胡话产生的原因。如果不是用调胃承气汤攻下，胃气就要绝灭了。“十余日”一句，承接上文的大汗出而来。大概是因为此人虽然大汗出，但火热邪气未进入胃中。胃气安然无恙，不会说胡话，烦躁也已消除。到了第二个七天之后，火气已经衰退。阳气微弱，所以通过战栗而解；阴气恢复，所以通过自利而解。这是阴阳自我调和而自愈的情况。“故其汗”到最后，是倒叙的手法。解释在自下利之前未解的症状，追溯其原因和根源。为什么说能自下利呢？为什么？因为在他自汗出时，腰部以下没有出汗。腰以下为地，地为阴，说明火邪没有陷入阴位，大肠、小肠和膀胱的津液都没有受伤。想要小便却排不出，反而呕吐想要失禁小便，这并不是没有小便，而是津液在上焦，想要回流进入胃中。凡是大便干硬的，小便次数应该频繁但不多。现在小便反而不频繁且量多，这正应验了前文“想要小便却排不出”的句子，正是为了说明津液自行回流进入胃中而导致下利的意思。这里的“利”是通利的意思，不是泻利的意思，看大便排出就可以知道了。头部是诸阳经汇聚之处，突然疼痛，是因为阴气恢复而阳气相对虚弱。脚心必定发热，是响应前文“脚底怕冷”的句子。前文大汗出则风邪已去，所以身体不怕冷。汗出不到脚底，所以脚底怕冷。现在火气向下流，所以脚心发热。火气向下流，谷气也随之向下流，所以大便自然通利。大便排出后头疼，可以与小便排出后阴部疼痛的情况参照理解。想要小便却排不出，反而失禁，小便次数应该频繁，反而不频繁、反而多，与上一条的小便难、小便利，都是用来审察阴气是否虚弱、津液是否枯竭罢了。
太阳病，用火熏法，不能出汗，这个人必定烦躁，过了传经的时间仍未解除，必定会出现便血。这称为火邪。
第一条是用火劫发汗导致流鼻血，是阳邪盛于阳位，所以在未过经的时候。这一条是用火熏不能出汗导致便血，是阳邪下陷陷入阴分，所以在过经不解的时候。第二条是大汗出后十多天，战栗下利而解。这一条是不能出汗，过经便血而仍然不解。可知劫汗而得汗的，其危害来得快；不能出汗的，其危害来得慢。称为火邪，就只需治疗火邪，而不必顾虑之前的风寒了。
伤寒脉浮，医生用火法强迫发汗，导致亡阳，必定出现惊恐狂乱、起卧不安的症状，用桂枝去芍药加蜀漆龙骨牡蛎救逆汤主治。
上文论述的都是阳盛的症候，因为中风属于阳邪。此后论述的是阳虚的症候，因为伤寒属于阴邪。阳盛的，轻则发狂说胡话，重则流鼻血或便血，这是不收敛而自焚。阳虚的，神志不守舍，起居惊惶，人好像发狂，这是弃国而逃。
方剂注释详见桂枝篇。
以上论述火逆证。
温针，就是烧针，烧到让它温热而已。寒气在形体躯壳，却用温针刺入，寒气内迫于心，所以引起战栗惊恐。
再次发汗而病不解，就不应当再发汗了。又加上烧针，以逼迫出汗，寒气内侵，应当救治里寒。烧针后原文可能有脱漏。
火逆证误用下法，又因烧针导致烦躁的，用桂枝甘草龙骨牡蛎汤主治。
方剂注释详见桂枝篇。
脉象沉的，说明营气微弱。营气微弱的再加烧针，就会导致血流不畅，更加发热且烦躁。
按：流、行二字，必有一个是错误的。这是阴阳俱虚枯竭的征候。
烧针令其出汗，针孔处受寒，红肿如核且发红的，必定引发奔豚病。气从少腹上冲心胸的，在红肿处各灸一壮，并用桂枝加桂汤。
方剂注释详见桂枝篇。
以上论述火针证。
脉浮适宜用发汗法解除。用火灸法，邪气无从外出，反而因火而亢盛，病从腰部以下必定沉重且麻木，称为火逆。脉浮热势很盛，反而用灸法，这是实证，却用虚证的方法治疗，因火而动血，必定咽喉干燥吐血。
脉象微数的，千万不可用灸法。因为火成为邪气，会导致烦闷逆乱，追补虚损追逐实邪，导致血液散乱于脉中。火气虽然微小，内攻的力量很大，会焦骨伤筋，血液难以恢复。
这些都在论述灸法导致的变证。腰部以下沉重且麻木，是因为腰部以下没有出汗。咽喉干燥吐血，也是阳盛所致，比流鼻血更严重。应当知道灸法是专为虚证设立的，不为风寒设立，所以如此叮咛告诫。
以上论述火灸证。
Taiyang disease with wind-stroke, treated by fire to forcibly induce sweating, causes the pathogenic wind and heat to combine. This leads to blood and qi overflowing beyond their normal limits. The two yangs (wind and fire) mutually scorch and smolder, causing the body to become dry and withered. Sweat appears only on the head, stopping at the neck, while the body turns yellow. Excess yang may lead to epistaxis; yin deficiency results in difficult urination. When both yin and yang are depleted, symptoms include abdominal fullness and wheezing, thirst with throat ulceration, or constipation. Prolonged cases may develop delirium; severe cases may present with hiccups, restlessness of the hands and feet, and unconscious picking at clothes and bedrails. If urination is free, the condition is treatable.
In Taiyang wind-stroke, if Ma Huang Tang or Da Qing Long Tang are not used to induce sweating, but fire therapy is employed instead, one need not discuss the harm of wind pathogen but should understand the benefits and harms of fire pathogen. Blood flows faster when heated; qi overflows when heated. When blood and qi deviate from their normal course, pathology arises. Wind is a yang pathogen; fire is a yang toxin. These are the "two yangs." Their mutual scorching produces symptoms akin to "Two Yangs Combining Brightness," manifesting as a dry and withered body. Without sweat on the body, jaundice occurs. Head sweat stops at the neck, so the body is yellow but the head and neck remain unyellowed. The head is the meeting point of primal yang; lack of dryness indicates yang is not yet exhausted; presence of sweat indicates yin fluids are not yet exhausted. This represents mild fire pathogen steaming the exterior without burning the zang-fu organs internally. This is a mild case of blood and qi overflow. If the person originally has strong yang, scorching damages blood vessels, leading to epistaxis. If the person originally has weak yin, scorching damages fluids, leading to difficult urination. If both yin and yang qi are depleted, chest fullness and wheezing occur, along with dry mouth and throat ulceration, potentially leading to death. Alternatively, stomach excess may cause delirium, or hand/foot restlessness may progress to picking at clothes and bedrails. All these result from blood and qi overflowing and losing their normal rhythm. Free urination responds to the earlier mention of difficult urination. In all shanghan diseases, yang is primary, hence fear of yang collapse. In fire-ni (reversal) diseases, yin is primary, hence fear of yin exhaustion. Free urination indicates treatability because yin is not deficient, fluids are preserved, and the Qi transformation of the Taiyang Bladder remains intact. Yang excess and yin deficiency constitute the guideline for fire-ni syndrome. Yang excess damages blood; yin deficiency loses fluids. This is the overarching principle of the entire Shanghan Lun.
On the second day of Taiyang disease, irritability occurs. Instead of sweating, the back is moxibusted/warmed, causing profuse sweating. Intense heat enters the Stomach, depleting Stomach fluids. Irritability inevitably leads to delirium. After more than ten days, if chills and spontaneous diarrhea occur, this indicates impending resolution. Thus, sweat does not appear from the waist down. There is an urge to urinate but inability to do so, accompanied by vomiting and urinary incontinence. The soles of the feet feel aversion to cold. Stool is hard. Urination frequency should be high but is actually low or excessive in volume. After defecation, sudden headache occurs. The soles of the feet must feel hot because Gu Qi (Grain Qi) flows downward.
This refers to mild fire-ni cases. On the second day of Taiyang disease, absence of sweat with irritability indicates Da Qing Long Tang syndrome. Failure to use sweating methods combined with clearing heat, and instead warming the back with fire, affects the Back, which is the domain of the Taiyang channel. Taiyang forced by fire transforms into Yangming. The Stomach is the Fu organ of Yangming, the sea of water and grain. Fire pathogen entering the Stomach depletes fluids, making stool dry and hard. Persistent irritability leads to delirium. Without Tiao Wei Cheng Qi Tang to purge, Stomach Qi would perish. The "ten-plus days" clause follows the profuse sweating. Although sweat was profuse, heat did not enter the Stomach. Stomach Qi remained safe, no delirium occurred, and irritability resolved. After two weeks, fire qi declined. Weak yang resolves via chills; restored yin resolves via spontaneous diarrhea. This is self-healing through yin-yang harmony. The section from "thus his sweat" to the end uses flashback narration to explain pre-diarrhea symptoms and trace causes. Why spontaneous diarrhea? Because during sweating, no sweat appeared below the waist. Below the waist is Earth/Yin, indicating fire pathogen did not sink to Yin positions, sparing fluids of the Large Intestine, Small Intestine, and Bladder. Urinary retention with vomiting/incontinence is not true anuria but fluid retention in the Upper Jiao seeking return to the Stomach. Usually, hard stool implies frequent but small-volume urination. Here, infrequent but large-volume urination confirms fluid returning to the Stomach and causing diarrhea. "Li" here means smooth passage, not purgative diarrhea. Sudden headache after defecation relates to pain after urination. The head is the meeting of all yangs; pain indicates yin restoration and relative yang deficiency. Hot soles respond to cold soles. Earlier profuse sweat expelled wind, so no aversion to cold. Lack of sweat to feet caused cold soles. Now fire qi sinks, heating soles. Sinking fire qi allows Gu Qi to flow down, causing spontaneous diarrhea.
Taiyang disease treated with fire fumigation fails to induce sweat. The patient becomes irritable. If the disease persists past the transmission period, rectal bleeding (qing xue) will occur. This is named Huo Xie (Fire Pathogen).
The first case involved epistaxis due to forced sweating, where yang pathogen was abundant in yang positions before transmission. This case involves rectal bleeding due to failed fumigation, where yang pathogen sank into yin positions after transmission. The previous case resolved via chills/diarrhea after ten days. This case persists with rectal bleeding. Forced sweating leading to sweat brings rapid complications; failure to sweat brings delayed complications. Named "Fire Pathogen," treatment focuses solely on fire, ignoring prior wind-cold.
Shanghan with floating pulse, treated by doctor using fire to force sweating, results in Yang Collapse. Symptoms include fright, mania, restlessness, and inability to lie still. Gui Zhi Qu Shao Yao Jia Shu Xi Long Gu Mu Li Jiu Ni Tang is indicated.
The above discussed yang-excess syndromes (wind-stroke is yang pathogen). This discusses yang-deficiency syndromes (shanghan is yin pathogen). Yang excess: mild cases involve mania/delirium; severe cases involve epistaxis/rectal bleeding (self-burning). Yang deficiency: spirit does not reside, causing fright-like behavior and mania (fleeing the country).
Formula notes refer to Gui Zhi Chapter.
Above discusses fire-ni syndromes.
Taiyang shanghan treated with warm needle invariably causes fright.
Warm needle refers to burning needles until warm. Cold in the exterior treated with warm needles forces cold inward to the Heart, causing tremors and fright.
If excessive sweating is followed by burning needles, Si Ni Tang is indicated.
Excessive sweating failing to resolve the disease contraindicates further sweating. Adding burning needles to force sweat invites internal cold; interior rescue is needed. Text likely missing content post-needle burning.
Fire-ni treated with purgatives, followed by burning needles causing irritability, is treated with Gui Zhi Gan Cao Long Gu Mu Li Tang.
Formula notes refer to Gui Zhi Chapter.
Pulse sinking indicates weak Ying Qi. Adding burning needles to weak Ying Qi blocks blood flow, causing fever and irritability.
Note: Either "liu" (flow) or "xing" (move) is erroneous. This signifies dual depletion of yin and yang.
Burning needles to induce sweat, with the puncture site exposed to cold, forming red nodules, inevitably triggers Ben Tun (Running Piglet). Qi rushing from the lower abdomen upward requires moxibustion on each nodule (one cone) and Gui Zhi Jia Gui Tang.
Formula notes refer to Gui Zhi Chapter.
Above discusses fire-needle syndromes.
Floating pulse indicates sweating is appropriate. Using moxa prevents pathogen exit, causing pathogen to flourish due to fire. Symptoms include heaviness and numbness below the waist, named Fire-Ni. Floating pulse with intense heat treated with moxa constitutes treating excess as deficiency. Fire agitates blood, causing dry throat and hemoptysis.
Micro-rapid pulse strictly contraindicates moxa. Fire becomes pathogen, causing烦逆 (irritation/rebellion), chasing deficiency and pursuing excess, scattering blood in vessels. Though fire's power is slight, its internal attack is potent, scorching bones and injuring sinews, making blood recovery difficult.
These discuss complications from moxibustion. Heaviness/numbness below waist stems from lack of sweat there. Dry throat/hemoptysis stems from yang excess, worse than epistaxis. Moxa is for deficiency, not wind-cold; thus the warning.
Above discusses fire-moxa syndromes.