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。
脉浮者。病在表。不以汗解。而以火攻。肌腠未开。则邪无从出。反因火气而热乃盛也。
夫阳邪被迫而不去者。则必入而之阴。病从腰以下重而痹者。邪因火迫而在阴也。故曰火逆。
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。
脉微数者。虚而有热。是不可以火攻。而反灸之。热得火气。相合为邪。则为烦逆。烦逆者。内烦而火逆也。
血被火迫。谓之追虚。热因火动。谓之逐实。由是血脉散乱而难复。筋骨焦枯而不泽。火之为害何如耶。
脉浮。热甚。反灸之。此为实。实以虚治。因火而动。必咽燥唾血。
此火邪迫血。而血上行者也。脉浮热甚。此为表实。古法泻多用针。补多用灸。医不知而反
灸之。是实以虚治也。两实相合。迫血妄行。必咽燥而唾血。
太阳病。以火熏之。不得汗。其人必躁。到经不解。必圊血。名为火邪。
此火邪迫血。而血下行者也。太阳表病。用火熏之。而不得汗。则邪无从出。热气内攻。必发
躁也。六日传经尽。至七日则病当解。若不解。火邪迫血。下走肠间。则必圊血。圊血、便血也
。
太阳伤寒者。加温针。必惊也。
寒邪在表。不以汗解。而以温针。心虚热入。必作惊也。成氏曰。温针损营血而动心气。
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。
风为阳邪。火为阳气。风火交煽。是为两阳。阳盛而热胜为发黄。阳盛则血亡而阴竭。为欲
衄。为小便难也。阴阳俱虚竭。非阳既盛而复虚也。盛者。阳邪自盛。虚者。阳气自虚也。身体
枯燥以下。并阴阳虚竭。火气熏灼之征。于法不治。乃小便本难而反利。知其阴气未绝。犹可调
之使复也。故曰其人可治。
太阳病。二日。反躁。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。反多。大便已。头卓然而痛。其人足心必热。谷气下流故也。
太阳病二日。不应发躁而反躁者。热气行于里也。是不可以火攻之。而反熨其背。汗出热入。
胃干水竭。为躁烦。为谵语。势有所必至者。至十余日。火气渐衰。阴气复生。忽振栗自下利者。
阳得阴而和也。故曰欲解。因原其未得利时。其人从腰以下无汗。欲小便不得者。阳不下通于阴
也。反呕者。阳邪上逆也。欲失溲。足下恶风者。阳上逆。足下无气也。大便硬。津液不下行也。
诸皆阳气上盛。升而不降之故。及乎津液入胃。大便得行。于是阳气暴降而头反痛。谷气得下而
足心热。则其腰下有汗。小便得行可知。其不呕不失溲。又可知矣。
火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
火逆复下。已误复误。又加烧针。火气内迫。心阳内伤。则生烦躁。桂枝、甘草。以复心阳
之气。牡蛎、龙骨。以安烦乱之神。此与下条参看更明。
桂枝甘草龙骨牡蛎汤方
桂枝 炙甘草（各一两） 牡蛎 龙骨（各二两）
上为末。以水五升。煮取二升半。去滓。温服八合。日三服。
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阳主
之。
阳者。心之阳。即神明也。亡阳者。火气通于心。神被火迫而不守。此与发汗亡阳者不同。
发汗者。摇其精则厥逆筋惕肉 。故当用四逆。被火者。动其神则惊狂起卧不安。故当用龙、蛎。
其去芍药者。盖欲以甘草急复心阳。而不须酸味更益营气也。与发汗后。其人叉手自冒心。心、
下悸。欲得按者。用桂枝甘草汤同意。蜀漆、即常山苗。味辛。能去胸中邪结气。此证火气内迫心包
。故须之以逐邪而安正耳。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤方
桂枝（三两） 生姜（三两切） 蜀漆（三两洗去腥） 甘草（二两炙） 牡蛎（五两熬）
龙骨（四两） 大枣（十二枚擘）
上为末。以水一斗二升。先煮蜀漆减二升。纳诸药。煮取三升。去滓。温服一升。
烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从少腹上冲心者。灸其核上各一壮。与桂
枝加桂汤。烧针发其汗。针处被寒者。故寒虽从汗而出。新寒复从针孔而入也。核起而赤者。针处
红肿如核。寒气所郁也。于是心气因汗而内虚。肾气乘寒而上逆。则发为奔豚。气从少腹上冲心也
。灸其核上。以杜再
入之邪。与桂枝加桂。以泄上逆之气。
桂枝加桂汤方
于桂枝汤方内更加桂二两。共五两。余根据前法。
脉象浮，应当用发汗的方法解除表邪。如果错误地用火灸治疗，病邪就无法从体表排出，反而因为火气的助长而更加炽盛。病人的腰部以下必定感到沉重且麻木不仁，这被称为“火逆”。
脉象浮，说明病邪在体表。如果不通过发汗来解表，反而用火攻法，导致肌肤腠理没有打开，病邪就没有出路，反而借助火气使热势更盛。
阳邪被火气逼迫而不能外散，就会内陷进入阴分。病症表现为腰部以下沉重麻木，是因为邪气因火迫而陷入阴分。所以称之为“火逆”。
脉象微细而数，千万不可用火灸。因为火本身也是一种邪气，施灸后会导致心烦、气逆。这种治法既追逐了本已虚弱的正气（追虚），又加剧了本已实盛的热邪（逐实），导致血液散乱于脉中。虽然火气看似微弱，但向内攻伐的力量却很大，会造成骨骼焦枯、筋脉损伤，血液难以恢复。
脉象微细而数，表示体内阴虚而有虚热，不可以用火攻法。如果反而用火灸，热邪与火气相结合成为新的邪气，就会导致心烦气逆。“烦逆”是指内部烦扰且伴有火气上逆。
血液被火气逼迫妄行，称为“追虚”；热邪因火气煽动而亢盛，称为“逐实”。由此导致血脉散乱难以恢复，筋骨焦枯失去润泽。火的危害竟然如此之大啊！
脉象浮，热势很盛，反而用火灸，这是实证。将实证当作虚证来治疗，因为火气的扰动，必然导致咽喉干燥、唾血。
这是火邪逼迫血液，使血液向上逆行。脉浮热甚，属于表实证。古法中泻法多用针刺，补法多用艾灸。医生不懂此理反而施灸，这就是把实证当虚证治。实邪与火邪两相结合，逼迫血液妄行，必然出现咽喉干燥和唾血。
太阳病，用火熏法治疗，未能出汗，病人必定烦躁。如果过了传经的周期病情仍未缓解，必定会出现便血，这被称为“火邪”。
这是火邪逼迫血液，使血液向下流失。太阳表证，用火熏法治疗却不出汗，邪气就没有出路，热气内攻，必然引发烦躁。六天传经完毕，到第七天病应当解除。如果未解除，火邪逼迫血液下行至肠道，就必然便血。“圊血”即指便血。
寒邪在体表，不通过发汗解表，反而用温针，导致心气虚弱、热邪内入，必定产生惊悸。成无己说：温针会损耗营血并扰动心气。
太阳病中风证，用火劫法强行发汗。风邪被火热所困，气血运行溢出常度。风与火两种阳邪相互熏灼，身体会出现发黄。阳热过盛则想流鼻血，阴液枯竭则小便困难。阴阳都虚竭了，身体就会干枯粗糙。只有头部出汗，齐颈部而止。腹部胀满，轻微气喘，口干，咽喉溃烂。或者大便不通，时间久了会出现胡言乱语，严重的甚至出现呃逆，手足躁动不安，两手抓空摸床。如果小便通畅，这个人还有治愈的希望。
风是阳邪，火也是阳气，风火交相煽动，称为“两阳”。阳盛而热胜导致发黄。阳盛则耗伤血液导致阴竭，所以想要流鼻血，小便也会困难。这里说的“阴阳俱虚竭”，不是指阳邪盛了之后又变虚，而是指阳邪自身亢盛，而人体的阳气自身虚弱。身体干枯粗糙以下等症状，都是阴阳虚竭、火气熏灼的表现，按常规法治不好。但如果小便本来困难反而通畅了，就知道阴气还没有绝灭，还可以调理使其恢复，所以说此人可治。
太阳病第二天，本不该烦躁却出现了烦躁，这是热气已经行于里部。此时不可以用火攻，反而熨烫背部，导致大汗出。大热之气内入胃中，胃中津液枯竭，出现烦躁，必定发生谵语。过了十多天，如果出现战栗并自然下利，这是病情将要解除的迹象。所以之前腰以下不得汗，想小便却排不出，反而呕吐，想失禁小便，脚底怕冷，大便干硬，脉象本应数却反而不快，反而显得慢。大便通下后，头部突然疼痛，这是因为谷气（水谷精微之气）下行所致，所以其人脚心必定发热。
太阳病第二天，不应该发躁却反常发躁，说明热气行于里部。这时不可以用火攻，反而熨烫背部，汗出后热邪内入，导致胃干水竭，产生烦躁和谵语，这是必然的趋势。到了十多天，火气逐渐衰退，阴气重新生发，忽然出现战栗并自然下利，这是阳气得到阴气调和的结果，所以说病情欲解。推究之前未得利时，病人腰以下无汗，想小便不得，是因为阳气不能下行通达于阴分。反而呕吐，是阳邪上逆。想失禁小便、脚底怕冷，是因为阳气上逆，下部无气。大便干硬，是因为津液不下行。这些都是阳气上盛、只升不降的缘故。等到津液进入胃中，大便得以通行，于是阳气骤然下降而头部反而疼痛，谷气得以下行而脚心发热，那么腰下有汗、小便得行的情况也就知道了，不呕吐、不失禁的情况也可以推知了。
因火逆误治后又用下法，再加上烧针导致烦躁的，用桂枝甘草龙骨牡蛎汤主治。
火逆之后又误用下法，已是错误叠加错误，再加烧针，火气内迫，心阳内伤，从而产生烦躁。桂枝、甘草用来恢复心阳之气；牡蛎、龙骨用来安定烦乱的神志。这与下一条互相参照看会更明白。
桂枝甘草龙骨牡蛎汤方
桂枝、炙甘草（各一两） 牡蛎、龙骨（各二两）
以上药物研为末，用水五升，煮取二升半，去渣，温服八合，每日三次。
伤寒脉浮，医生用火迫劫法治疗，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牡蛎龙骨救逆汤主治。
这里的“阳”指的是心阳，也就是神明。所谓“亡阳”，是指火气通于心，神明被火气逼迫而不能守舍。这与发汗导致的亡阳不同。发汗过多，动摇精气会导致厥逆、筋惕肉瞤，所以应当用四逆汤。被火邪所伤，扰动神明会导致惊狂、起卧不安，所以应当用龙骨、牡蛎。去掉芍药的原因，是想用甘草紧急恢复心阳，而不需要酸味的芍药再补充营气。这与发汗后，病人双手交叉护住心口，心下悸动，喜欢按压的情况，使用桂枝甘草汤的道理相同。蜀漆，就是常山的嫩芽，味辛，能去除胸中的邪结之气。此证是火气内迫心包，所以需要用它来驱逐邪气以安正。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤方
桂枝（三两） 生姜（三两，切） 蜀漆（三两，洗去腥味） 甘草（二两，炙） 牡蛎（五两，熬）
龙骨（四两） 大枣（十二枚，掰开）
以上药物研为末，用水一斗二升，先煮蜀漆，减少二升水量，再加入其他药物，煮取三升，去渣，温服一升。
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，感觉有气从少腹上冲心脏。应在红肿处各灸一壮，并服用桂枝加桂汤。
烧针发汗，针孔处受寒，所以虽然寒气随汗而出，但新的寒气又从针孔侵入。红肿如核，是寒气郁结在针处。此时心气因发汗而内虚，肾气乘寒气而上逆，就发为奔豚，感觉有气从少腹上冲心脏。在红肿处施灸，是为了杜绝邪气再次进入；服用桂枝加桂汤，是为了泄降上逆之气。
The pulse is floating. Sweating should be used to resolve the exterior. If moxibustion is applied, the pathogenic factor has no outlet. Consequently, due to the fire, the condition worsens. The disease will definitely cause heaviness and numbness from the waist down, named "Fire Reversal" (Huo Ni).
A floating pulse indicates the disease is at the exterior. Without resolving it via sweating, but instead attacking with fire, the muscle interstices remain unopened, so the pathogen has no way out. Instead, it becomes excessive due to the fire qi.
When Yang pathogen is forced by fire and cannot depart, it must enter and go to Yin. When the disease presents as heaviness and numbness below the waist, it is because the pathogen, driven by fire, has entered Yin. Therefore, it is called Fire Reversal.
A pulse that is slightly rapid (Wei Shu) must not be treated with moxibustion. Because fire itself becomes a pathogen, it causes irritability and counterflow. It chases deficiency and pursues excess; blood scatters within the vessels. Although the fire qi is slight, its internal attack is powerful. It scorches bones and injures sinews, making blood difficult to restore.
A pulse that is slightly rapid indicates deficiency with heat. This cannot be treated with fire attacks. If moxibustion is reversedly applied, heat combines with fire qi to become a pathogen, causing irritability and counterflow. Irritability and counterflow refer to internal irritability and fire counterflow.
Blood being forced by fire is called "chasing deficiency." Heat moving due to fire is called "pursuing excess." Thus, blood vessels become disordered and hard to restore. Tendons and bones become scorched and dry without luster. How harmful is fire!
The pulse is floating, and heat is severe. Reversely applying moxibustion treats this as Excess. Treating Excess as Deficiency, due to fire movement, will definitely cause dry throat and spitting of blood.
This is fire pathogen forcing blood upward. Floating pulse with severe heat is Exterior Excess. Ancient methods use needles for draining and moxibustion for tonifying. If the doctor does not know this and reversely applies moxibustion, it is treating Excess as Deficiency. Two excesses combine, forcing blood to run recklessly, definitely causing dry throat and spitting of blood.
Taiyang Disease, treated with fumigation. No sweat occurs. The person must become irritable. If the disease does not resolve after the transmission cycle, it will definitely cause defecation of blood, named "Fire Pathogen."
This is fire pathogen forcing blood downward. Taiyang exterior disease, treated with fumigation without sweat, means the pathogen has no outlet. Heat qi attacks internally, definitely causing irritability. After six days, transmission ends; on the seventh day, the disease should resolve. If not, fire pathogen forces blood downward into the intestines, definitely causing defecation of blood. "Qing Xue" refers to defecation of blood.
Taiyang Cold Damage, adding warm needle therapy, will definitely cause fright.
Cold pathogen is at the exterior. Not resolving via sweating, but using warm needles, heart deficiency allows heat to enter, definitely causing palpitations/fright. Cheng Shi said: Warm needles damage Ying Blood and move Heart Qi.
Taiyang Disease Wind Strike, using fire coercion to induce sweating. The wind pathogen is covered by fire heat. Blood and Qi flow溢 (overflow), losing their normal measure. Two Yangs smoke and scorch each other. The body turns yellow. Yang excess desires nosebleed. Yin deficiency causes difficult urination. Both Yin and Yang are deficient and exhausted. The body becomes dry and rough. Only head sweat comes out, stopping at the neck. Abdominal fullness, slight wheezing. Dry mouth, rotten throat. Or constipation. Long term leads to delirium. Severe cases reach hiccups. Hands and feet toss restlessly, picking at clothes and touching the bed. If urine flows freely, the person can be treated.
Wind is Yang pathogen. Fire is Yang qi. Wind and fire fan each other, called "Two Yangs." Yang excess and heat victory cause yellowing. Yang excess causes blood loss and Yin exhaustion, leading to desire for nosebleed and difficult urination. "Both Yin and Yang deficient and exhausted" does not mean Yang was excess then became deficient. "Excess" refers to Yang pathogen self-excess. "Deficient" refers to Yang qi self-deficiency. Below "body dry and rough," all are signs of Yin/Yang deficiency/exhaustion and fire scorching. By method, untreatable. But if urine was originally difficult and now flows freely, knowing Yin qi is not yet extinct, it can still be regulated to recover. Hence, "the person can be treated."
Taiyang Disease, second day. Reversely irritable. Reversely ironing the back causes heavy sweating. Great heat enters the Stomach. Stomach water dries up. Irritability and vexation definitely lead to delirium. Ten-plus days later, shaking chills and spontaneous diarrhea indicate impending resolution. Thus, previously, no sweat from waist down. Desire to urinate but unable. Reversely vomiting. Desire to lose urine. Fear of cold under feet. Hard stool. Pulse box (likely typo in source for 'Mai') should be frequent but is not. Reversely many. After stool, head suddenly hurts. The person's sole must be hot. Grain Qi flows downward.
Taiyang Disease second day. Should not emit irritability but reversely does. Heat qi travels to interior. Cannot use fire attack. Reversely ironing back. Sweat out, heat enters. Stomach dry, water exhausted. Causes irritability and delirium. Trend is inevitable. To ten-plus days. Fire qi gradually declines. Yin qi regenerates. Suddenly shaking chills and spontaneous diarrhea. Yang harmonizes with Yin. Hence "impending resolution." Tracing back to when benefit was not obtained. Person has no sweat from waist down. Desire to urinate but unable. Yang does not descend to communicate with Yin. Reversely vomiting. Yang pathogen counterflows upward. Desire to lose urine, fear of cold under feet. Yang counterflows upward, under feet lack Qi. Hard stool. Fluids do not descend. All are due to Yang Qi excess above, ascending not descending. When fluids enter Stomach, stool moves. Then Yang Qi violently descends, head reversely hurts. Grain Qi gets to descend, sole heats. Then waist below has sweat, urination flows, known. Not vomiting, not losing urine, also known.
Fire reversal followed by purging. Due to burning needle causing irritability and vexation. Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig, Licorice, Dragon Bone, Oyster Shell Decoction) governs it.
Fire reversal again purged. Already mistaken, then mistaken again. Plus burning needle. Fire qi presses internally. Heart Yang injured internally. Generates irritability and vexation. Gui Zhi, Gan Cao, to restore Heart Yang Qi. Mu Li, Long Gu, to calm chaotic Shen (Spirit). Compare with next clause for clarity.
Gui Zhi Gan Cao Long Gu Mu Li Tang Formula
Gui Zhi (Cinnamon Twig), Zhi Gan Cao (Prepared Licorice Root) (each 1 liang). Mu Li (Oyster Shell), Long Gu (Dragon Bone) (each 2 liang).
Grind into powder. Use 5 sheng of water. Boil to obtain 2.5 sheng. Remove dregs. Warm dose 8 ge. Three times daily.
Shang Han (Cold Damage) pulse floating. Doctor uses fire coercion. Wang Yang (Loss of Yang). Definitely fright, mania, rising and lying down uneasy. Gui Zhi Qu Shao Yao Jia Shu Qi Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Rhizoma Dichroae, Oyster Shell, and Dragon Bone for Rescue from Reversal) governs it.
Yang refers to Heart Yang, i.e., Shen (Spirit/Mind). Wang Yang here means fire qi communicates with Heart. Shen is forced by fire and does not stay. This differs from sweating-induced Wang Yang. Sweating shakes Jing (Essence), causing Jue Ni (Cold extremities), Jin Ti Rou Yu (twitching tendons and muscles). Hence Si Ni Tang (Four Counterflow Decoction) is used. Being harmed by fire moves Shen, causing fright, mania, rising/lying uneasy. Hence Long Gu, Mu Li are used. Removing Shao Yao aims to use Gan Cao urgently to restore Heart Yang, without needing sour flavor to further benefit Ying Qi. Same intent as post-sweating case where person crosses hands over heart, Xin Xia Ji (epigastric palpitation), desires pressure, using Gui Zhi Gan Cao Tang. Shu Qi is Chang Shan Miao (young shoot of Dichroa febrifuga). Taste pungent. Can remove chest pathogen knot qi. This case fire qi presses internally to Xin Bao (Pericardium). Hence need it to expel pathogen and calm Zheng (Righteous Qi).
Gui Zhi Qu Shao Yao Jia Shu Qi Mu Li Long Gu Jiu Ni Tang Formula
Gui Zhi (3 liang), Sheng Jiang (Fresh Ginger, 3 liang, sliced), Shu Qi (Rhizoma Dichroae, 3 liang, washed to remove fishy smell), Zhi Gan Cao (Prepared Licorice Root, 2 liang), Mu Li (Oyster Shell, 5 liang, calcined), Long Gu (Dragon Bone, 4 liang), Da Zao (Jujube, 12 pieces, split).
Grind into powder. Use 1 dou 2 sheng of water. First boil Shu Qi, reduce by 2 sheng. Add other herbs. Boil to obtain 3 sheng. Remove dregs. Warm dose 1 sheng.
Burning needle induces sweat. Needle site exposed to cold. Nodule rises and turns red. Definitely Fa Ben Tun (Rushing Pig). Qi rushes from lower abdomen to heart. Moxa one Zhu (cone) on each nodule. Give Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon). Burning needle induces sweat. Needle site exposed to cold. Though cold exits with sweat, new cold enters via needle hole. Nodule rises red. Needle site red swollen like nodule. Cold qi stagnates. Heart Qi becomes internally deficient due to sweat. Kidney Qi takes advantage of cold to counterflow upward. Fa Ben Tun occurs. Qi rushes from lower abdomen to heart. Moxa nodule to prevent re-entry of pathogen. Give Gui Zhi Jia Gui to drain counterflowing Qi.
Gui Zhi Jia Gui Tang Formula
In Gui Zhi Tang formula, add Gui (Cinnamon) 2 liang more. Total 5 liang. Rest according to previous method.