【纲】仲景曰。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。
【目】李 曰。伤寒病未退。重感寒。变为温疟。重感风。变为风温。重感湿热。变为温毒。
重感疫气。变为温疫。又太阳病经汗吐下温针不解。过经不解。皆名坏病。或医人不辨阴阳。差谬
汗下。使病不解。坏症乱经。久而不瘥。视其犯何逆以治之。表症多者。知母麻黄汤。半表者。小
柴胡汤。余热不解者。参胡芍药汤。危急者。夺命散。诸药不效者。则用鳖甲散救之。
柯琴曰。三日非吐下温针之时。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。则有发黄亡阳。圊血奔豚等症。是桂枝症已罢。故不中与。
【纲】仲景曰。本太阳病不解。转入少阳者。胁下硬满。干呕。不能食。往来寒热。尚未吐下。
脉弦细者。与小柴胡汤。若已吐下。发汗。温针。谵语。柴胡症罢。此为坏病。知犯何逆。以法
治之。
【目】赵嗣真曰。仲景论中所言坏病者。以太阳病误汗吐下后。虚烦结胸痞气。吐后内烦胀满
等症是也。此正谓桂枝不中与。小柴胡症罢者。曷尝指异气之病。如活人书所谓异气为坏病之说乎。
仲景又云。更感异气。变为他病者。即索矩所谓二气三气杂合为病是也。以其未可定名。而非有名
四种温病之比。故以变病名之。且四种温病。仲景以为冬伤于寒。至春变为温病。温病未已。重遇
于邪。变为温疟。风温。温毒。温疫。病未尝坏。故以变名之。一曰坏病。一曰变症。名目自是不同。可见异
气。非为坏病也。审矣。假如温疟果为坏病。则仲景不言小柴胡症罢也。请人思焉而自悟乎。
王履曰。太阳外症不解。风寒从枢而入少阳矣。若见少阳诸症。尚可用柴胡治之。若误治后。
不见半表半里症而谵语。是将转入阳明而不属少阳矣。故柴胡不中与之。然亦不得以谵语即为胃实
也。当察何逆。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），经过三天，已经发汗，如果又用了催吐、泻下或温针等疗法，病情仍然没有解除的，这叫做坏病（因误治导致病情恶化或变异的病证）。此时桂枝汤（调和营卫、解肌发表的经典方剂）不再适用。应当观察患者的脉象和症状，判断医生犯了什么错误（如误汗、误吐等），然后根据具体的症状进行针对性治疗。
【目】李氏说：伤寒病未退，再次感受寒邪，变为温疟（以寒热往来、定时发作为特征的疟疾类型）；再次感受风邪，变为风温（春季常见的温热病）；再次感受湿热之邪，变为温毒（具有热毒性质的温热病）；再次感受疫气（具有传染性的致病因素），变为温疫（急性传染病）。另外，太阳病经过发汗、催吐、泻下、温针治疗后仍未解除，或者病程超过一经传变周期仍未解除的，都称为坏病。或者是医生不能辨别阴阳属性，错误地使用了发汗或泻下法，导致疾病无法解除，坏证扰乱了经络运行，日久不愈。这时要查看其犯了什么错误来进行治疗。表证较多的，用知母麻黄汤；半表半里证的，用小柴胡汤（和解少阳的代表方剂）；余热未清的，用参胡芍药汤；病情危急的，用夺命散；各种药物无效的，则用鳖甲散来救治。
柯琴说：“三日”并不是必须使用催吐、泻下或温针的时候，治疗不当，所以病仍不解除。所谓坏病，就是变症。如果误用发汗，会出现汗出不止、心下悸动、脐下悸动等症状；妄用催吐，会出现饥饿却不想吃东西、早上吃晚上吐、不喜欢靠近衣物（喜凉恶热）等症状；妄用泻下，会出现结胸（痰水互结于胸膈）、痞硬（心下痞塞胀满坚硬）、协热下利（伴随发热的腹泻）、腹胀满且大便中有未消化食物等症状；火逆（误用火疗导致的变证），会出现发黄、亡阳（阳气极度衰竭）、便血、奔豚（气从少腹上冲心胸）等症状。因此，桂枝汤证已经消失，所以不再适用桂枝汤。
【纲】张仲景说：原本太阳病未解除，转入少阳经（足少阳胆经及手少阳三焦经所属的病证）的，出现胁下硬满（胁肋部胀满坚硬）、干呕、不能进食、往来寒热（恶寒与发热交替出现），尚未使用催吐、泻下、发汗或温针等疗法，脉象弦细的，给予小柴胡汤。如果已经使用了催吐、泻下、发汗、温针等疗法，出现谵语（神志不清，胡言乱语），柴胡证已消失，这叫做坏病。应当判断犯了什么错误，按照相应的法则进行治疗。
【目】赵嗣真说：张仲景在论述中所说的坏病，是指太阳病误用发汗、催吐、泻下后，出现的虚烦、结胸、痞气、吐后内烦胀满等症状。这正是指桂枝汤不再适用、小柴胡证已消失的情况，何曾是指异气（不同的外感邪气）引起的病，像《活人书》所说“异气为坏病”的说法呢？张仲景又说：“更感异气，变为他病者”，即朱肱（字翼中，号无求子，世称朱索矩）所说的二气、三气杂合为病的情况。因为这种病暂时无法确定名称，不像那四种温病有明确的名字，所以称之为变病。而且那四种温病，张仲景认为是冬天受寒，到春天变为温病；温病未愈，再次遇到邪气，变为温疟、风温、温毒、温疫。这些病并未发生“坏”的变化，所以称为“变”。一个是坏病，一个是变症，名称自然不同。由此可见，异气并不是坏病，这是很明确的。假如温疟果真是坏病，那么张仲景就不会说“柴胡证罢”了。请大家思考一下自然会明白。
王履说：太阳的外证未解除，风寒之邪从枢机进入少阳。如果见到少阳的各种症状，还可以用柴胡剂治疗。如果误治后，没有出现半表半里的症状反而出现谵语，这说明病将转入阳明经（足阳明胃经及手阳明大肠经所属的病证）而不属于少阳了。因此，柴胡汤不再适用。然而，也不能仅仅因为谵语就断定是胃实（胃肠燥屎内结的实证）。应当仔细考察究竟犯了什么错误。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), after three days, if sweating therapy has been administered, or if emesis, purgation, or warm needle therapy has been used, yet the condition remains unresolved, this is termed Huai Bing (deteriorated disease resulting from mismanagement). Guizhi Tang (Cinnamon Twig Decoction) is no longer indicated. One must observe the pulse and symptoms, determine the nature of the error committed, and treat according to the specific manifestations.
[Detailed Commentary] Li stated: If Shanghan disease (cold damage) does not resolve and is re-exposed to cold pathogens, it transforms into Wen Nue (warm malaria); if re-exposed to wind pathogens, it transforms into Feng Wen (wind-warmth); if re-exposed to damp-heat pathogens, it transforms into Wen Du (warm toxicity); if re-exposed to epidemic qi (epidemic pathogenic factors), it transforms into Wen Yi (warm epidemic). Furthermore, if Taiyang disease remains unresolved after sweating, emesis, purgation, or warm needle therapies, and persists beyond its normal course, all are named Huai Bing. Alternatively, if physicians fail to distinguish between Yin and Yang and erroneously apply sweating or purgation, causing the disease to persist, leading to chaotic meridians due to deteriorated symptoms that do not heal over time, one must examine the specific errors committed and treat accordingly. For cases with predominant exterior symptoms, Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction) is used; for half-exterior half-interior symptoms, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used; for lingering residual heat, Shen Hu Shaoyao Tang (Ginseng, Bupleurum, and Peony Decoction) is used; in critical conditions, Duoming San (Life-Snatching Powder) is used; and if various medicines prove ineffective, Biejia San (Turtle Shell Powder) is employed for rescue.
Ke Qin stated: "Three days" is not a fixed time for administering emesis, purgation, or warm needles; improper treatment causes the disease to persist. Huai Bing refers to Bian Zheng (changed symptoms). If sweating is misapplied, symptoms such as continuous leakage of sweat, palpitations at the epigastrium, and palpitations below the umbilicus may occur. If emesis is misapplied, symptoms such as hunger without desire to eat, morning food vomited in the evening, and aversion to removing clothing may occur. If purgation is misapplied, symptoms such as Jie Xiong (chest binding), Pi Ying (fullness and hardness in the epigastrium), Xie Re Xia Li (diarrhea accompanied by fever), abdominal fullness, and undigested food in stool may occur. If fire therapy is misapplied (Huo Ni), symptoms such as jaundice, Wang Yang (collapse of Yang), hematochezia, and Ben Tun (rushing pig syndrome) may occur. Thus, the Guizhi Tang syndrome has ceased, so Guizhi Tang is no longer applicable.
[General Principle] Zhang Zhongjing stated: When original Taiyang disease does not resolve and transfers to Shaoyang (a syndrome caused by pathogenic factors affecting the Shaoyang meridian), presenting with hardness and fullness in the hypochondrium, dry retching, inability to eat, alternating chills and fever, and a string-taut and fine pulse, Xiao Chaihu Tang should be administered. If emesis, purgation, sweating, or warm needle therapies have already been used, resulting in Chan Yu (delirious speech), and the Chaihu syndrome has ceased, this constitutes Huai Bing. One must determine the nature of the error and treat according to the appropriate principles.
[Detailed Commentary] Zhao Sizhen stated: The Huai Bing mentioned in Zhang Zhongjing's discussions refers to symptoms such as deficiency-related vexation, chest binding, Qi stagnation, and internal vexation with abdominal fullness following emesis, which occur after erroneous sweating, emesis, or purgation of Taiyang disease. This precisely indicates that Guizhi Tang is no longer applicable and the Xiao Chaihu syndrome has ceased. How could it refer to diseases caused by "heterogeneous qi" as described in the *Huoren Shu*? Zhang Zhongjing also stated: "Re-exposure to heterogeneous qi transforms into other diseases," which corresponds to Sun Zhao's (courtesy name Suoju) concept of two or three types of qi mixing to cause disease. Since these cannot be definitively named, unlike the four specific warm diseases, they are termed Bian Bing (changed diseases). Moreover, regarding the four warm diseases, Zhang Zhongjing posits that winter cold damage transforms into Wen Bing (warm disease) in spring; if the warm disease persists and encounters further pathogens, it transforms into Wen Nue, Feng Wen, Wen Du, and Wen Yi. These diseases have not become Huai Bing, hence they are called Bian Bing. One is Huai Bing, the other is Bian Zheng; their names are inherently different. Thus, it is clear that heterogeneous qi does not constitute Huai Bing. If Wen Nue were truly Huai Bing, Zhang Zhongjing would not have stated that the Chaihu syndrome has ceased. Please reflect on this to understand naturally.
Wang Lü stated: When the exterior symptoms of Taiyang do not resolve, wind-cold pathogens enter the Shaoyang via the pivot mechanism. If the various Shaoyang symptoms appear, Chaihu formulas can still be used. However, if after erroneous treatment, half-exterior half-interior symptoms are absent but Chan Yu appears, the disease is transitioning to Yangming (a syndrome caused by pathogenic factors affecting the Yangming meridian) and no longer belongs to Shaoyang. Therefore, Chaihu Tang is no longer indicated. Nevertheless, one should not assume that Chan Yu alone indicates Wei Shi (excess in the stomach/intestines). One must carefully investigate what error was committed.