（此系仲景原文。散见太阳少阳少阴等篇。今集于此）
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。
（中去声。成注云。太阳病三日中。曾经发汗吐下温针。虚其正气。病仍不解者。谓之坏病。言治不对证。为医所坏也。
桂枝不中与者。以其初。本系太阳。中风乃桂枝汤证。至此则其病已坏。桂枝汤不中与也。更当审其脉证。知犯何逆。
随其逆而救之。愚按此条论。仲景无救逆之法。补亡论亦不言及。惟准绳云。逆者谓汗下皆不顺于理也。随证治之者。
即仲景原论中云汗后病不解。及发汗若下之病仍不解。某汤主之类是也。后条辩又云有如汗后亡阳动经渴躁谵语。下后
虚烦结胸痞气。吐后内烦腹胀满。温针后吐衄惊狂之类。变证多端。治非一法。仲景恐人以桂枝汤证误治。仍执定一桂
枝汤。故令医人舍汤辩脉。另寻一看证之活法耳。学人须以意会之。）
太阳病二日。反躁。反熨其背而大汗出。火热入胃。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。及不多。大便已。
头卓然而痛。其人足心必热。谷气下流故也。（此为欲解也。也字当在故字之下。太阳病止二日。邪犹在表。不当躁而反
躁者。此必是大青龙汤证。故无汗成注云。躁者。热气行于里也。医人不知。反用火熨其背。强发其汗使之大出。火热
之邪。因而入胃。胃中之水告竭。阴不胜阳。其发躁烦谵语之证必矣。至十余日。正气渐复。阴与阳争。故作振战悚栗
之候。自下利者。火邪由大肠而得泄。此为欲自解也。其有不自解者。必在前所熨之汗从腰以下未出。成注云。此为津
液虚。不得下通。故欲小便并不得也。津液既虚。火邪上逆。其势不惟躁烦而反增呕。欲失溲者。此是形容不得小便之
状。足下恶风者。腰以下无汗风邪犹郁于下部。故恶风也。大便硬者。胃中水竭之故。此非津液偏渗。故小盒饭数。而
反不数。及不多也。凡此者。实由大便硬。不自下利。皆未解证也。法宜用药以通其大便。大便已则火邪自泄。阴气得
复而上升。头必卓然而反空痛。阳气得伸而下降。足不恶风而其心必热。此是谷气下流故也。谷气者。食气也。食气下
流。则胃中输转。火邪皆去而病即愈。按此条论。仲景无治法。补亡论常器之云。可与白虎加人参汤。五苓散。调胃承
气汤郭白云云。推常氏之意。谓火气入胃。胃中枯燥。故用白虎加人参汤解之。然须无表证。渴饮水者。可服。小便不
利者。固当用五苓散。然亦必渴饮水者。宜服。其大便硬者。用调胃承气汤。亦必小便不利。谵语仍在者。然后可服。
又云。此条论。于诸证未生时。必须先去火邪。宜救逆汤。愚以人参白虎汤犹可用。五苓散断不可用。此系胃中水竭。
津液燥。故欲小便不得。非小便不行也。大便硬。虽小便不数亦系火热燥证。其用调胃承气汤。不若以麻仁丸代之至于
救逆汤。与上条证不合。不必用也。）
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。其身发黄。阳盛则欲衄。阴虚则小便难。
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。
捻衣摸床。小便利者。其人可治。（太阳中风。此必是桂枝汤证。医人误以火劫强发其汗。邪风加以火热。以致血气流溢。
失其常行之度。风阳也。火亦阳也。两阳相熏灼。邪热搏于外。则肌肉受伤。脾主肌肉而属土。故身发黄邪热搏于阳明
之经。为阳盛。阳盛则火升。故欲衄。邪热搏于太阳之府。为阴虚。阴虚则水涸。故小便难。水火者。人身之阴阳。实
则气与血也。偏胜者。势必至于交病。故云阴阳俱虚竭也。阴阳俱虚。则前之流溢者。至此而衰耗。身体焉得不枯燥也。
成注云。三阳经络至颈。三阴至胸中而还。剂。分也。但头汗出。剂颈而还者。邪热炎上。搏阳而不搏于阴也。腹满微
喘者。邪热内郁也。口干咽烂者。邪热上熏也。或不大便者。邪热耗其津液也。久则胃中燥热。必发谵语。甚者。至哕。
则邪热气逆。为病更深矣。四肢者。诸阳之本。邪热亢盛则手足扰乱。甚至捻衣而摸床矣。后条辩云。以上诸证。无非
邪风火热。逆乱其气血。一至于此。乃真阴立亡之象。此际欲治风。则火势蒸腾。欲治火。则风势壅遏。惟有利小便一
法。使小便利。庶几火邪得泄。津液得通。其人病犹可治也。诸家注皆言小便自利。夫上文既云。小便难岂有病剧而反
自利之理。必须用药以探之。其人小便利。犹为可治之证。如其不利。虽治之恐无效矣。此实仲景言外之意。按此条论。
仲景无治法。愚意云。但当利其小便。宜猪苓汤。初亡论云。与五苓散。恐太燥津液。不宜用也。又云救逆。可桂枝去
芍药加蜀漆牡蛎龙骨汤。亦非对证之药。又云。发黄者宜茵陈蒿汤。愚以此非胃实。有瘀湿。乃干黄也。上药非所宜用。
又云。不大便。宜大承气汤。愚以此非。胃实谵语乃燥热神志昏乱。故手足为之躁扰也。上药更非所宜。但当从小便中
导去其热。而诸证悉平。）
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。加蜀漆牡蛎龙骨救逆汤主之。（伤寒脉浮者。
是伤寒见风脉也。风脉既见。其为表虚可知。医人误以火迫劫之。汗乃大出而亡其阳。成注云。汗者。心之液。亡阳。
则心气虚。心恶热。火邪内迫则心神浮越。故惊狂起卧不安。汤名救逆者。以惊狂不安。皆逆证也。）
（这是张仲景的原文。散见于太阳、少阳、少阴等篇章。现在汇集在此处。）
太阳病，经过三天，已经发汗，或者使用吐法，或者使用下法，或者使用温针，病情仍然没有解除的，这称为坏病。此时不宜再给予桂枝汤治疗。应当观察患者的脉象和证候，了解医生犯了哪种误治（逆乱），根据具体的证候进行治疗。
（“中”字读去声。成无己注解说：太阳病在三天期间，曾经接受过发汗、吐法、下法或温针治疗，导致正气虚弱，但疾病仍未解除的，称为坏病。意思是治疗不对症，被医生治坏了。
所谓“桂枝不中与也”，是因为起初本是太阳中风证，属于桂枝汤的适应证。到了这个时候，病情已经变坏，桂枝汤不再适用。更应当仔细审查其脉象和证候，了解犯了哪种误治。
顺着这种误治的情况进行补救。我认为这一条论述中，张仲景没有提出补救误治的具体方法，《补亡论》也没有提及。只有《医宗金鉴·准绳》说：“逆”是指汗法和下法都不顺理成章。“随证治之”的意思，就是张仲景原论中提到的“发汗后病不解”以及“发汗或下之后病仍不解，用某某汤主治”之类的方法。后续条文辨析又说：如有发汗后亡阳、动经、口渴烦躁、谵语；下后虚烦、结胸、痞气；吐后内烦、腹胀满；温针后吐血、鼻衄、惊狂等情况。变证多种多样，治疗方法并非单一。张仲景恐怕人们因为桂枝汤证而误治，仍然固执地只用桂枝汤，所以让医生舍弃固定的汤剂，辨别脉象，另外寻找一种灵活看诊治病的方法。学习者必须用心领会其中的意旨。）
太阳病第二天，反而出现躁动不安，反而用火熨背部导致大汗出。火热之邪入胃，导致胃中津液枯竭，出现躁动烦躁，必然发生谵语。过了十多天，如果出现战栗并自行腹泻的，这是病情将要解除的表现。如果有的患者从腰部以下没有汗出，想小便却解不出来，反而呕吐，想要失禁小便，脚底怕冷，大便干硬，小便次数多但量不多。大便排出后，头部突然感到疼痛，这个人的脚心必定发热，这是因为谷气向下流通的缘故。（这是病情将要解除的表现。“也”字应当放在“故”字下面。太阳病仅两天，邪气还在体表，不应当躁动而反而躁动的，这一定是大青龙汤的适应证。所以无汗。成无己注解说：躁动，是热气行于体内的表现。医生不知道这一点，反而用火熨背部，强行发汗使其大量出汗。火热之邪因此进入胃中，胃中的津液告罄。阴不能胜阳，那么出现躁动、烦躁、谵语的病症就必然发生了。到了十多天，正气逐渐恢复，阴与阳相争，所以出现战栗发抖的症状。自行腹泻的，是火邪通过大肠得以排泄，这是病情将要自行解除。那些没有自行解除的，一定是之前熨背出的汗从腰部以下没有出来。成无己注解说：这是因为津液虚弱，不能向下通导，所以想小便也解不出来。津液既然虚弱，火邪上逆，其势头不仅表现为躁烦，反而增加呕吐。想要失禁小便，这是形容无法小便的状态。脚底怕冷的，是因为腰部以下无汗，风邪郁结在下部，所以怕冷。大便干硬的，是胃中津液枯竭的缘故。这并不是津液偏渗到别处，所以小便次数多但反而不多。凡此种种，实际上都是由大便干硬、没有自行腹泻引起的，都是未解除的证候。治法适宜用药通便。大便通畅后，火邪自然泄出，阴气得以恢复并上升，头部必然会突然感到空痛。阳气得以伸展并下降，脚不再怕冷且心中必热。这是谷气向下流通的缘故。谷气，就是饮食之气。饮食之气向下流通，则胃中输转功能正常，火邪全部去除，病即痊愈。按此条论述，张仲景没有提出治法。《补亡论》中常器之说：可以给予白虎加人参汤、五苓散、调胃承气汤。郭白云说：推究常氏的本意，认为火气入胃，胃中枯燥，所以用白虎加人参汤来解之。但是必须没有表证，且口渴饮水者，才可以服用。小便不利者，固然应当用五苓散，但也必须口渴饮水者，才宜服用。大便干硬者，用调胃承气汤，但也必须小便不利、谵语仍在，然后才可以服用。又说：此条论述，在诸证尚未产生时，必须先去除火邪，适宜用救逆汤。我认为人参白虎汤还可以用，五苓散绝对不可用。这是胃中津液枯竭，津液燥热，所以想小便却解不出来，并不是小便不通畅。大便干硬，虽然小便次数不多，也属于火热燥证。使用调胃承气汤，不如用麻仁丸代替。至于救逆汤，与上一条的证候不合，不必使用。）
太阳病中风，用火劫迫发汗。邪风被火热所伤，气血流溢，失去了正常的运行规律。两阳（风和火）相互熏灼，身体发黄。阳气盛则想要鼻出血，阴气虚则小便困难。阴阳都虚弱枯竭，身体就会干枯粗糙。只有头部出汗，齐颈而止。腹部胀满，轻微气喘，口干，咽喉溃烂，或者不大便。时间久了则谵语。严重的，甚至出现呃逆，手足躁扰，捻衣摸床。如果小便通利的，这个人还可以治愈。（太阳中风，这一定是桂枝汤的适应证。医生错误地用火劫迫强发其汗。邪风加上火热，导致气血流溢，失去了正常运行的节度。风属阳，火也属阳。两阳相互熏灼，邪热搏结于外，则肌肉受伤。脾主肌肉而属土，所以身体发黄。邪热搏结于阳明经，为阳盛。阳盛则火升，所以想要鼻出血。邪热搏结于太阳腑，为阴虚。阴虚则水涸，所以小便困难。水和火，是人身的阴阳。实则指气和血。偏胜的一方，势必导致双方都生病，所以说阴阳都虚弱枯竭。阴阳都虚弱，那么之前流溢的气血，到这里就会衰耗，身体怎么能不干枯呢？成无己注解说：三阳经络到达颈部，三阴经络到达胸中而回返。“剂”是分界的意思。只有头部出汗，齐颈而止，是邪热炎上，搏结于阳而不搏结于阴。腹部胀满、轻微气喘，是邪热内郁。口干、咽喉溃烂，是邪热上熏。或者不大便，是邪热耗伤了津液。时间久了，胃中燥热，必然发生谵语。严重的，甚至出现呃逆，则是邪热气逆，病情更深了。四肢是诸阳之本。邪热亢盛，则手足扰乱，甚至捻衣摸床。后续条文辨析说：以上各种证候，无非是邪风火热，逆乱其气血，达到这种地步，是真阴即将消亡的迹象。这个时候如果想治风，火势蒸腾；如果想治火，风势壅遏。只有利小便这一种方法，使小便通利，或许火邪得以泄出，津液得以通畅，这个人的病还可以治愈。各家注解都说小便自利。上文既然说了小便难，哪里有病重了反而小便自利的道理？必须用药试探。如果这个人小便通利，还是可治的证候。如果小便不通利，虽然治疗恐怕也无效。这实际上是张仲景言外之意。按此条论述，张仲景没有提出治法。我认为，只应当利其小便，适宜用猪苓汤。《初亡论》说：给予五苓散，恐怕太燥伤津液，不宜使用。又说：救逆，可以用桂枝去芍药加蜀漆牡蛎龙骨汤，也不是对症的药。又说：发黄的适宜用茵陈蒿汤。我认为这不是胃实有瘀湿，而是干黄，上面的药不适宜使用。又说：不大便的适宜用大承气汤。我认为不是这样。胃实谵语乃是燥热导致神志昏乱，所以手足为之躁扰。上面的药更不适宜使用。只应当从小便中引导去除其热，而各种证候都会平息。）
伤寒脉浮，医生用火迫劫之法。导致亡阳，必然出现惊狂，坐卧不安的，用桂枝去芍药加蜀漆牡蛎龙骨救逆汤主治。（伤寒脉浮，是伤寒见到风脉。风脉既已出现，其为表虚可知。医生错误地用火迫劫之法，汗液大量流出而亡其阳。成无己注解说：汗是心的体液。亡阳，则心气虚。心恶热，火邪内迫则心神浮越，所以惊狂、坐卧不安。汤名叫救逆，是因为惊狂不安，都是逆证。）
(This is the original text of Zhang Zhongjing. It is scattered in chapters such as Taiyang, Shaoyang, and Shaoyin. It is now collected here.)
Taiyang disease (disease of the Taiyang channel), after three days, having undergone sweating therapy, or emesis, or purgation, or warm needle therapy, with the condition still unresolved, is termed a "ruined disease" (Huai Bing). Guizhi Tang (Cinnamon Twig Decoction) should not be administered at this time. One must observe the pulse and signs/symptoms, determine what therapeutic error (Ni) was committed, and treat according to the specific presentation.
(Cheng Wuji's commentary states: In Taiyang disease within three days, if sweating, emesis, purgation, or warm needles have been used, depleting the healthy Qi, yet the disease remains unresolved, it is called a "ruined disease." This means the treatment did not match the syndrome, and the physician caused harm.
The phrase "Guizhi Tang should not be administered" implies that initially, it was a Taiyang Wind-strike syndrome, which is an indication for Guizhi Tang. By this point, the disease has become complicated/ruined, so Guizhi Tang is no longer applicable. One must carefully examine the pulse and signs/symptoms to identify the nature of the therapeutic error.
Remedies should follow the nature of the error. I believe that in this clause, Zhang Zhongjing does not specify a method for remedying errors, nor does *Bu Wang Lun* (Supplementary Lost Treatises). Only *Zhun Sheng* (Standard Guidelines) states: "Ni" refers to sweating and purging methods that are contrary to reason. "Treating according to the syndrome" refers to statements in Zhang Zhongjing's original work such as "after sweating, the disease is not resolved," or "after sweating or purging, the disease remains unresolved, treat with [Specific Formula]." Subsequent commentaries also mention scenarios like post-sweating Yang depletion, channel agitation, thirst, irritability, delirium; post-purgation empty irritability, chest binding, epigastric fullness; post-emesis internal heat, abdominal distension; post-warm-needle vomiting, epistaxis, fright, and mania. There are numerous variations in transformed syndromes, and treatments are not uniform. Zhang Zhongjing likely feared that physicians, misled by the initial Taiyang Wind-strike indication, would rigidly stick to Guizhi Tang. Thus, he instructed physicians to abandon fixed formulas, differentiate based on pulses, and seek flexible diagnostic and therapeutic approaches. Students must comprehend this intent.)
In Taiyang disease on the second day, there is irritability instead of calmness. The back is forcibly heated with hot irons, causing profuse sweating. The fire-heat pathogen enters the Stomach, exhausting the fluids in the Stomach. Irritability and restlessness occur, inevitably leading to delirium. After more than ten days, if chills and spontaneous diarrhea occur, this indicates the disease is about to resolve. However, if sweat is absent from the waist down, urination is difficult, vomiting occurs, there is a sensation of urinary incontinence, coldness in the feet, hard stools, frequent but scanty urination, and after defecation, sudden headache occurs, while the soles of the feet feel hot, this is due to the downward flow of Grain Qi (Gu Qi). (Note: The character "ye" should grammatically follow "gu". Taiyang disease lasting only two days implies the pathogen is still in the exterior, where irritability is inappropriate. This suggests it was originally a Da Qing Long Tang (Major Blue Green Dragon Decoction) indication, characterized by absence of sweat. Cheng Wuji notes: Irritability indicates heat moving inward. The physician, unaware of this, used hot irons on the back to force profuse sweating. Fire-heat entered the Stomach, depleting its fluids. Yin fails to control Yang, leading to irritability, restlessness, and delirium. After ten days, healthy Qi recovers, and Yin and Yang contend, causing shivering. Spontaneous diarrhea allows fire-pathogens to exit via the Large Intestine, indicating self-resolution. If unresolved, sweat from the previous ironing may not have occurred below the waist. Cheng Wuji notes: Fluid deficiency prevents downward circulation, causing difficulty in urination. With fluid deficiency, fire-pathogens rise, causing vomiting. The sensation of incontinence describes the inability to urinate. Coldness in the feet results from wind-pathogen stagnating in the lower body due to lack of sweat below the waist. Hard stools result from Stomach fluid exhaustion. This is not due to fluid diversion, hence frequent but scanty urine. These are all unresolved conditions caused by hard stools and lack of spontaneous diarrhea. Treatment should involve herbs to unblock the bowels. Once stool passes, fire-pathogens exit, Yin Qi restores and rises, causing sudden empty pain in the head. Yang Qi extends and descends, relieving foot coldness and generating heat in the heart/mind. This is the downward flow of Grain Qi (dietary energy). As dietary energy flows down, Stomach transformation functions normally, eliminating fire-pathogens and curing the disease. Regarding treatment, Zhang Zhongjing provides none. Chang Qizhi in *Bu Wang Lun* suggests Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng), Wu Ling San (Five-Ingredient Powder with Poria), or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction). Guo Baiyun interprets Chang's intent: Fire entering the Stomach causes dryness, treated by White Tiger plus Ginseng, provided there is no exterior syndrome and thirst with desire to drink water exists. For difficulty in urination, Wu Ling San is indicated, but only if thirst exists. For hard stools, Tiao Wei Cheng Qi Tang is used, but only if urination is difficult and delirium persists. Another view suggests using Jiu Ni Tang (Rescue the Adverse Decoction) early to remove fire-pathogens. I argue White Tiger plus Ginseng is usable, but Wu Ling San is contraindicated as it further dries fluids. The issue is fluid exhaustion, not obstruction. Hard stools with infrequent urination indicate fire-dryness. Instead of Tiao Wei Cheng Qi Tang, Ma Ren Wan (Hemp Seed Pill) is preferable. Jiu Ni Tang is unsuitable here as it matches the previous clause's syndrome.)
In Taiyang Wind-strike, if fire therapy is used to force sweating, the wind-pathogen combines with fire. Blood and Qi overflow, losing their normal rhythm. The combination of two Yangs (Wind and Fire) scorching each other causes jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to difficult urination. When both Yin and Yang are depleted, the body becomes dry and rough. Sweat appears only on the head, stopping at the neck. Abdominal fullness, slight wheezing, dry mouth, throat ulceration, or constipation may occur. Prolonged cases lead to delirium. Severe cases manifest as hiccups, restless limbs, picking at clothes, and touching the bed. If urination is free, the patient can be cured. (Taiyang Wind-strike is typically indicated for Guizhi Tang. The physician erroneously used fire to force sweating. Wind combined with fire causes blood and Qi to overflow abnormally. Wind is Yang, Fire is Yang. Their mutual scorching damages muscles. Spleen governs muscles and belongs to Earth, hence jaundice. Heat combusting in the Yangming channel causes excess Yang and epistaxis. Heat combusting in the Taiyang fu-organ causes Yin deficiency and difficult urination. Water and Fire represent Yin and Yang in the body, corresponding to Qi and Blood. Imbalance leads to mutual damage, hence "Yin and Yang both depleted." Depleted Yin and Yang cause the previously overflowing Qi and Blood to waste away, resulting in a dry body. Cheng Wuji notes: Three Yang channels reach the neck; Three Yin channels reach the chest. "Ji" means boundary. Head-only sweat stopping at the neck indicates heat rising and affecting Yang but not Yin. Abdominal fullness and wheezing indicate internal heat stagnation. Dry mouth and throat ulcers indicate heat steaming upward. Constipation indicates fluid consumption by heat. Prolonged heat causes stomach dryness and delirium. Severe heat causes rebellious Qi and hiccups. Limbs are the root of Yang; excessive heat causes limb restlessness and picking behaviors. Commentaries state these symptoms result from wind-fire disrupting Qi and Blood, signaling imminent loss of True Yin. At this stage, treating wind exacerbates fire; treating fire obstructs wind. The only solution is to promote urination to release fire-pathogens and restore fluids. If urination is free, the case is treatable. Previous commentators assumed "free urination" contradicted earlier "difficult urination." One must test with medicine. If urination becomes free, it is treatable; if not, treatment may fail. This is Zhang Zhongjing's implicit meaning. No specific formula is given. I suggest promoting urination with Zhu Ling Tang (Polyporus Decoction). *Chu Wang Lun* suggests Wu Ling San, but it is too drying. Another suggestion is Gui Zhi Qu Shao Yao Jia Shu Ku Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Acorus, Oyster Shell, and Dragon Bone to Rescue Adversity), but this is not appropriate. For jaundice, Yin Chen Hao Tang is suggested, but this is "dry jaundice" without stomach excess or damp-heat, so it is unsuitable. For constipation, Da Cheng Qi Tang is suggested, but this is delirium due to dry-heat disturbing the spirit, not stomach excess, so it is unsuitable. Heat should be guided out through urination to resolve all symptoms.)
In Shanghan (Cold Damage) with a floating pulse, if the physician uses fire therapy to force sweating, Yang is depleted. This inevitably leads to fright, mania, restlessness, and inability to sit or lie still. Gui Zhi Qu Shao Yao Jia Shu Ku Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Acorus, Oyster Shell, and Dragon Bone to Rescue Adversity) is the primary treatment. (A floating pulse in Shanghan indicates the presence of Wind-pulse, suggesting exterior deficiency. The physician erroneously used fire to force sweating, causing massive sweat loss and Yang depletion. Cheng Wuji notes: Sweat is the fluid of the Heart. Yang depletion leads to Heart Qi deficiency. The Heart dislikes heat; internal fire-pathogens cause the Heart Spirit to float and scatter, resulting in fright, mania, and restlessness. The decoction is named "Rescue Adversity" because fright and mania are adverse conditions.)