孙真人云。病形不可攻。不可灸。因火为邪。血散脉中。伤脉尚可。伤脏。则剧。井 益肿。黄汁出。经合外烂。
肉腐为痈脓。此为火疽。医所伤也。夫脉数者不可灸。因火为邪。即为烦。因虚逐实。血走脉中。火气虽微。内攻有力。
焦骨伤筋。血难复也。应在泻心。宜泻心汤（即仲景半夏泻心汤方也。见前第七卷少阳篇中）
琥按上论。即仲景火逆证。而借用仲景泻心之法也。推千金之意。以心属火。火逆。应在泻心。愚以原方中有芩
连。固为火逆所宜。若干姜一味。恐太辛热。不宜用也。
（活人书云坏伤寒。）
鳖甲（炙） 蜀升麻 前胡 乌梅 枳实（炒） 犀角（磅因） 黄芩（各二两） 生地黄 甘草（一两）
上九味。切以水七升。煮取二升半。分五服日三服。夜二服。（外台云此出支太医方）
琥按仲景云太阳病三日。已发汗若吐若下若温针。仍不解者。此为坏病。少阳经病亦然。此云八九日。诸药不能
消。则知汗吐下诸法。皆误用之而至逆矣。上药专走阳明兼入厥阴。为清热滋燥之剂。
庞安时总病论云。火邪证。谓医。以火于卧床下。或周身用火迫劫汗。或焚或误灸。皆属火邪也。又云。论曰灸久
烧针后。证似火劫者。并宜火劫治之。（证似火劫者。谓惊狂烦躁之候见也。）
又云。烦躁惊及狂。用六石风引汤尤良。柴胡加龙骨牡蛎汤。亦通用。病患因火劫。至十五六日。身黄下利。狂欲
走。师脉之。言当下清血。如豚肝。乃愈。后如师言。何以知之。师曰。寸口脉。阳浮而阴濡弱。阳浮为风。濡弱为虚
浮。虚受风少血发热。恶寒洒淅项强头眩。医以火熏郁。令汗出恶寒遂甚。客热因火。而发怫郁。蒸于肌肤。身目为黄。
小便微难短气。鼻中出血。而复下之。胃无津液。利遂不止。热瘀在膀胱。蓄结成积。状如豚肝。当下未下。必乱迷愦。
狂走赴水。不能自制蓄血若去。目明心了。此皆医所为轻者得愈。极者不治。
琥按上论。皆因火而致逆之证。仲景治火逆惊狂。有桂枝去芍药。加蜀漆牡蛎龙骨汤。治火逆烦躁证。有桂枝甘
草龙骨牡蛎汤。今庞氏用六石风引汤。又柴胡加龙骨牡蛎汤。可见证非一候。方不可执。此又变通乎。仲景之法者也。
柴胡加龙骨牡蛎汤。见前第七卷少阳篇中。六石风引汤。总论不载。今采金匮方。附之于后。
孙真人说：病势不可用攻法，也不可用灸法。若因用火治疗而致邪气内生，会导致血液散乱于脉中。损伤经脉尚且尚可忍受，若损伤脏腑，则病情加剧。表现为井穴部位肿胀，流出黄色汁液，经络与体表溃烂，肌肉腐烂化为痈脓。这称为火疽，是医生误治所致。凡是脉象数疾者不可施灸，因为用火治疗会引邪入内，导致心烦。因正气虚弱而强行驱逐实邪，血液妄行于脉中。火势虽然微弱，但内攻之力强大，会导致骨骼焦枯、筋脉受损，血液难以恢复。此时应当采用泻心之法，适宜使用泻心汤（即张仲景的半夏泻心汤方，见前第七卷少阳篇中）。
琥按：上述论述，即是张仲景所说的火逆证，此处借用了张仲景泻心的治法。推测《千金方》的本意，是以心属火，火逆之证，应当在泻心上下功夫。我认为原方中有黄芩、黄连，确实适合火逆之证；但干姜一味，恐怕过于辛热，不宜使用。
（《活人书》称之为坏伤寒。）
鳖甲（炙） 蜀升麻 前胡 乌梅 枳实（炒） 犀角（一两） 黄芩（各二两） 生地黄 甘草（一两）
以上九味药，切碎，用水七升，煮取二升半，分五次服用，白天服三次，晚上服两次。（《外台秘要》云此方出自支太医方）
琥按：张仲景说，太阳病经过三天，已经发汗，或者用吐法、下法、温针等治疗，仍然不解的，这叫坏病。少阳经的病也是如此。这里说经过八九日，各种药物都不能消除病邪，可知发汗、吐、下等各种治法都是误用而导致逆证的。上述药物主要走阳明经，兼入厥阴经，是清热滋润燥热的方剂。
庞安时《总病论》说：火邪证，是指医生在卧床下用火，或者周身用火逼迫出汗，或者焚烧或误用灸法，都属于火邪。又说，论述中提到灸法时间过长或烧针后，证候类似火劫的，都宜用火劫法来治疗。（所谓证候类似火劫，是指出现惊狂、烦躁等症状。）
又说，对于烦躁、惊悸及狂乱，使用六石风引汤尤为良效。柴胡加龙骨牡蛎汤，也通用。患者因火劫治疗，到了十五六天，身体发黄、腹泻、狂乱欲奔走。医生诊脉后，说应当通下清血，排出如猪肝样的瘀血，病才能痊愈。后来果然如医生所言。怎么知道的呢？医生说：寸口脉，阳部浮而阴部濡弱。阳浮表示有风，濡弱表示虚浮。虚受风邪，少血发热，恶寒战栗，项强头眩。医生用火熏蒸郁闭，令其出汗，导致恶寒更加严重。客热因火而发，怫郁于内，蒸腾于肌肤，导致身目发黄，小便微难短气，鼻中出血，而又误用下法，导致胃中津液枯竭，腹泻不止。热邪瘀结在膀胱，蓄积结成瘀块，形状如猪肝。应当通下而未通下，必然神志迷乱昏愦，狂跑赴水，不能自制。若瘀血去除，则眼明心清。这都是医生误治造成的，轻者得愈，重者不治。
琥按：上述论述，都是因为用火而导致逆证的证候。张仲景治疗火逆惊狂，有桂枝去芍药加蜀漆牡蛎龙骨汤；治疗火逆烦躁证，有桂枝甘草龙骨牡蛎汤。现在庞氏使用六石风引汤，以及柴胡加龙骨牡蛎汤，可见证候并非单一，方剂不可拘执，这是变通运用张仲景之法。
Sun Simiao stated: When the pathogenic condition is not suitable for purgation, moxibustion must also be avoided. If fire therapy induces pathogenic factors, blood scatters within the vessels. Injury to the vessels may be tolerable, but injury to the Zang organs leads to severe deterioration. Manifestations include swelling at the Jing-well points, discharge of yellow fluid, ulceration of meridians and external tissues, and muscle rotting into abscesses and pus. This is termed "Fire Abscess" (Huo Ju), caused by medical error. In cases with a rapid pulse (Shu Mai), moxibustion is contraindicated because fire introduces pathogens, causing irritability. Forcing expulsion of excess in a state of deficiency causes blood to rush through the vessels. Although the fire energy is slight, its internal attacking power is strong, leading to scorched bones and damaged sinews, making blood restoration difficult. The treatment should focus on draining the Heart; the Xixin Decoction (Banxia Xiexin Tang) is appropriate.
Hu notes: The above discussion refers to Zhang Zhongjing's Fire Reversal Syndrome (Huo Ni Zheng), borrowing Zhang's method of draining the Heart. It is inferred that the intent of *Qianjin Fang* is based on the Heart belonging to Fire; thus, Fire Reversal should be treated by draining the Heart. I believe that while Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma) in the original formula are suitable for Fire Reversal, Ganjiang (Zingiberis Rhizoma) is likely too acrid and hot, and thus unsuitable.
(*Wuren Shu* refers to this as Damaged Cold Syndrome.)
Bie Jia (Prepared Turtle Shell) [Shuijia]
Shu Shengma (Angelicae Pubescentis Radix)
Qianhu (Peucedani Radix)
Wumei (Mume Fructus)
Zhishi (Aurantii Fructus Immaturus) - Stir-fried
Xijiao (Rhinocerotis Cornu) - 1 liang
Huangqin (Scutellariae Radix) - 2 liang each
Sheng Dihuang (Rehmanniae Radix Recens)
Gancao (Glycyrrhizae Radix et Rhizoma) - 1 liang
Cut the nine ingredients. Boil in 7 sheng of water to obtain 2.5 sheng. Divide into five doses: three during the day, two at night. (*Waitai Miyao* states this formula originates from Physician Zhi.)
Hu notes: Zhang Zhongjing stated that if Taiyang disease persists after three days despite sweating, vomiting, purging, or warm needle therapy, it is termed Bad Disease (Huai Bing). The same applies to Shaoyang channel diseases. Here, after eight or nine days, various medicines fail to resolve the condition, indicating that sweating, vomiting, and purging methods were misapplied, leading to reversal. The above herbs primarily enter the Yangming channel and secondarily the Jueyin channel, serving as a formula to clear heat and moisten dryness.
Pang Anshi in *Zongbing Lun* stated: Fire Pathogen Syndrome refers to situations where physicians use fire under the bed, apply fire around the body to force sweating, or use burning or incorrect moxibustion; all belong to Fire Pathogen. He further stated that after prolonged moxibustion or cauterization with needles, if symptoms resemble those of Fire Coercion, they should be treated with Fire Coercion methods. (Symptoms resembling Fire Coercion refer to manifestations of fright, mania, irritability, and restlessness.)
He added: For irritability, fright, and mania, Liushi Fengyin Tang is particularly effective. Chaihu Jia Longgu Muli Tang is also generally applicable. If a patient undergoes Fire Coercion and, after fifteen to sixteen days, presents with jaundice, diarrhea, and manic running away, the physician palpates the pulse and prescribes purging to expel dark blood resembling pig liver, after which the patient recovers. How did he know? The physician said: The Cun Kou pulse shows floating at the Yang position and weak/soft at the Yin position. Floating indicates Wind; weak/soft indicates Deficiency and floating. Deficiency allows Wind invasion; scanty blood leads to fever, aversion to cold, shivering, stiff neck, and dizziness. The physician used fire fumigation to cause sweating, worsening the aversion to cold. External heat, triggered by fire, becomes constrained and steams the skin, causing jaundice of the body and eyes, difficult and short urination, epistaxis, and subsequent erroneous purging. This depletes stomach fluids, causing persistent diarrhea. Heat stagnates in the Bladder, forming masses resembling pig liver. If not purged, confusion and mania will ensue. Once the stagnant blood is removed, clarity returns. These outcomes result from medical errors; mild cases recover, severe cases do not.
Hu notes: The above discussions describe conditions resulting in reversal due to fire. Zhang Zhongjing treated Fire Reversal with Fright and Mania using Guizhi Qushaoyao Jia Shuqi Muli Longgu Tang, and treated Fire Reversal with Irritability using Guizhi Gancao Longgu Muli Tang. Pang Anshi’s use of Liushi Fengyin Tang and Chaihu Jia Longgu Muli Tang demonstrates that syndromes vary, and formulas cannot be rigidly applied; this is a flexible application of Zhang Zhongjing’s methods.
Chaihu Jia Longgu Muli Tang is found in the previous Volume 7, Shaoyang chapter. Liushi Fengyin Tang is not recorded in the General Treatise; it is now extracted from *Jingui Yaolue* and appended below.