妇人中□近隐处，取烧作灰。
右一味，水服方寸匕，日三服，小便即利，阴头微肿，此为愈矣。妇人病，取男子□
烧服。
【方解】
男女□裆，浊败之物也。烧灰用者，取其通散，亦同气相求之义耳。服后或汗出，或
小便利则愈。阴头微肿者，是所易之毒从阴窍而出，故肿也。
音切
垢音苟 沸音佛 郁音熨 挛力全切 胫胡定切 □音昆、同裤
坏病者，谓不当汗，而汗，不当吐而吐，不当下而下，即当汗、吐、下而过甚，或当
汗、吐、下而失时，皆为施治失宜，所以成坏病也。凡三阴三阳，若汗、若吐、若下
，若温针、火熏、火熨、火灸、火劫等法，致诸坏病者，有汗后亡阳，眩冒振惕，魄
汗不收；有下后虚中，结胸痞□，下利不止；有吐后烦乱腹满，有温针失血惊狂，甚
至阳毒斑狂，阴躁欲死，神昏□语，循衣摸床之类是也。其论散见诸篇，今合为一集
，以便后学。其中或有挂漏，是在能三反者。
@@@
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。
【注】
太阳病三日，邪在三阳时也。若已经发汗，若吐、若下、若温针，其法备施，病仍不
解者，此为坏病，由施治失宜也。此时即有表证，桂枝亦不中与，当观其脉证，知所
误犯者何逆，而随证治之，不可以成法拘也。
【集注】
方有执曰：既不可定以正名，则亦难以出其正治，故但示人以随机应变之微旨，一以
贯之，斯言尽之矣。
程知曰：病在太阳，治之不当，即成坏病，故初治不可不慎。桂枝不可与，以桂枝证
罢也，若桂枝证仍在，则不谓之坏病矣。
程应旄曰：如汗后亡阳动经，渴躁□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，纷纭错出者，俱是为前治所坏，后人切不得执成法以救逆。所以
前证虽属桂枝，若坏则桂枝亦不中与也，观其脉证，知犯何逆，随证治之。盖欲反逆
为顺也，非从望、闻、问、切上，探出前后根因，无从随证用法，非头痛医头之为随
证治之也。
吴人驹曰：不得拘三日为表病，而与桂枝，当根据现在之变坏者，而为救治。
@@@
本太阳病不解，转入少阳者，□下□满，干呕不能食，往来寒热，尚未吐下，脉沉紧
者，与小柴胡汤。若已吐、下、发汗、温针，□语，柴胡汤证罢，此为坏病，知犯何
逆，以法治之。
【按】
脉沉紧，当是「脉沉弦」，若是沉紧，是寒实在胸，当吐之证也。惟「脉沉弦」，始
与上文之义相属，故可与小柴胡汤。
【注】
本太阳病不解，而见□下□满，干呕不能食，往来寒热等证。脉沉弦，是邪转入少阳
也，若未经吐下者，当与小柴胡汤，解其半表半里之邪可也。其已经吐下，发汗，温
针者，则表里俱虚，更加□语，柴胡证罢，此为坏病，即小柴胡汤亦不中与也，当审
其所犯何逆，随证以法治之可也。
【集注】
成无己曰：转入少阳，柴胡证也。若已吐、下，发汗、温针，不惟犯少阳三禁，更加
温针以迫劫之，损耗津液，胃中干燥，必发□语。柴胡证罢者，谓无□下□满，干呕
不能食，往来寒热等证也，此为坏病。
沈明宗曰：太阳不解而传少阳，当与小柴胡和解，乃为定法。反以吐下、发汗、温针
，以犯少阳之戒，而邪热陷入阳明，故发□语，已为坏证。要知□语乃阳明受病，即
当知犯阳明之逆而治之，若无□语，而见他经坏证，须证书凭脉，另以活法治之也。
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□语，甚者至哕，手足躁扰，捻衣摸床，小便
利者，其人可治。
【注】
太阳病中风，不以桂枝汤汗之，而以火劫发汗，故致生诸逆也。风属阳邪，被火益热
，故血气流溢，失其常度也。以风火俱阳，故曰两阳熏灼；热蒸血瘀达于肌表，故其
身发黄也。血为热迫，故上逆欲衄；阴虚液竭，故小便难；阴阳虚竭，故身体枯燥；
阳热熏灼，阴液上越，故头汗出剂颈而还也。热传太阴，故腹满口燥；热传少阴，故
口干咽烂；热壅于胸，故肺燥微喘；热结于胃，故不大便。愈久则热益深，故哕逆□
语，神明昏乱，手足躁扰，捻衣摸床之证见矣。凡此诸坏证，推求其源，皆由邪火逆
乱，真阴立亡，多不可治。然或小便利者，则阴气尚在，故犹为可治也，可不慎之于
始哉！
【集注】
成无己曰：『内经』云：诸胀腹大，皆属于热。腹满微喘者，热气内郁也。经云：火
气内发，上为口干咽烂者，火热上熏也。热气上而不下，则大便不□，若热气下入胃
中，消耗津液，则大便□，故云：或不大便，久则胃中燥热，必发□语。经云：病深
者，其声哕，火气太甚，正气逆乱，故哕。经云：四肢者，诸阳之本也，阳盛则动，
故手足躁扰，捻衣摸床也。小便利者，是阴未竭，犹可治也。
喻昌曰：此证阳邪挟火，扰乱阴分，而亡其阴，与前二条亡阳证，天渊悬绝。观阳盛
欲衄，身体枯燥诸句，则知此证宜急驱其阳，以存一线之阴，不得泥「阴阳俱虚竭」
一语，而补其阳、劫其阴也。且头汗为阳邪上壅，不下通于阴，所以剂颈以下不能得
汗。设见衄血，则邪从衄解，头间且无汗矣。设有汗，则邪从汗解，又不衄矣。后条
火邪深入，必圊血，亦身体枯燥而不得汗，设有汗，便不圊血矣。读古人书，全要会
意，岂有得汗仍衄血、圊血之理哉！又曰：仲景以小便利一端，办真阴之亡与未亡最
细。盖水出高源，小便利则津液不枯，肺气不绝可知也；肾以膀胱为府，小便利则膀
胱之气化行，肾水未绝可知也。
程应旄曰：以上诸证，莫非邪火逆乱，真阴立亡之象，推求其原，一皆血气流溢，失
其常度，至于如此，邪风被火热之害，可胜言哉！此际，欲治风而火势沸腾，欲治火
而风邪壅遏，何从治之？惟利小便一法。如猪苓汤类，可以导热滋干，使小便得利，
则太阳之邪亦从膀胱为去路，尚可治也。倘利之而不利，火无从出，危矣。
@@@
太阳病，医发汗，遂发热恶寒，因复下之，心下痞，表里俱虚，阴阳气并竭，无阳则
阴独，复加烧针。因胸烦，面色青黄，肤□者，难治；今色微黄，手足温者，易愈。
【注】
太阳表病，医过发汗，已虚其表，因复下之，又虚其里，虽有未尽之表邪，陷里成痞
，但表里俱虚，阴阳并竭，已成坏证矣。况无阳则阴不生，阴独则阳不化，而复加烧
针，火气内攻，阴阳皆病，故胸满而烦，面色青黄，肌肤□动也。见证如此错杂，故
为难治。若面色微黄不青，手足不厥而温，则为阴阳之气未竭，故曰易治也。
【集注】
方有执曰：表以误汗言，里以误下言，故曰俱虚。阴指里，阳指表，无阳谓阳竭也，
阴独谓痞也。青黄，脾受克贼之色。微黄，土见回生之色。手足温，阳气回于四末也
。言既经反复之误，又见克贼之色，肌肤□动而不宁，则脾家之真阴败，为难治也。
今则土见回生之色，四末得温，胃家之阳复，故为易愈也。
@@@
伤寒脉浮，自汗出，小便数，心烦，微恶寒，脚挛急，反与桂枝汤，欲攻其表，此误
也，得之便厥。咽中干，烦燥吐逆者，作甘草干姜汤与之，以复其阳。若厥愈足温者
，更作芍药甘草汤与之，其脚即伸；若胃气不和，□语者，少与调胃承气汤；若重发
汗，复加烧针者，四逆汤主之。
【注】
伤寒脉浮，自汗出，中风证也；小便数，心烦，里无热之虚烦也。微恶寒者，表阳虚
不能御也；脚挛急者，表寒收引拘急也，是当与桂枝增桂加附子汤，以温经止汗。今
反与桂枝汤攻发其表，此大误也。服后便厥者，阳因汗亡也。咽干者，阴因汗竭也；
烦燥者，阳失藏也；吐逆者，阴拒格也，故作甘草干姜汤与之，以缓其阴，而复其阳
。若厥愈足温，则是阳已复，宜更作芍药甘草汤与之，以调其阴，而和其阳，则脚即
伸也。若胃不和而□语，知为邪已转属阳明，当少少与调胃承气汤，令其微溏，胃和
自可愈也。若重发汗者，谓不止误服桂枝汤，而更误服麻黄汤也。或复加烧针劫取其
汗，以致亡阳证具。则又非甘草干姜汤所能治，故又当与四逆汤，以急救其阳也。
【集注】
程应旄曰：脉浮自汗，虽似桂枝证，而头项不痛，知阳神自歉于上部；恶寒脚挛急，
知阴邪更袭于下焦。阳虚阴盛，而里气上逆，故有心烦证，里阴攻及表阳，差讹只在
「烦」字上。观结句若重发汗，复加烧针者，四逆汤主之。可见阴证不必真直中也，
治之一误，寒即中于治法中矣。
@@@
问曰：证象阳旦，按法治之而增剧，厥逆，咽中干，两胫拘急而□语。师言夜半手足
当温，两脚当伸。后如师言，何以如此？答曰：寸口脉浮而大，浮为风，大为虚，风
则生微热，虚则两胫挛，病形象桂枝，因加附子参其间，增桂令汗出，附子温经，亡
阳故也。厥逆，咽中干，烦躁，阳明内结，□语烦乱，更饮甘草干姜汤，夜半阳气还
，两足当热，胫尚微拘急，重与芍药甘草汤，尔乃胫伸，以承气汤微溏，则止其□语
，故知病可愈。
【注】
此设问答，申明上条之义也。桂枝证当用桂枝，值时令温热，或其人有热，用阳旦汤
，即桂枝汤加黄芩也。值时令寒冷，或其人有寒，用阴旦汤，即桂枝汤加干姜也。证
象阳旦，谓心烦似乎有热也。按法治之，谓按法用阳旦汤也。盖心烦小便数，咽中干
，似乎阳旦，而不审脚挛急，微恶寒之证，是阴寒也，即以阳旦汤攻其表误也。所以
增剧，厥逆咽中干，两胫拘急，□语等坏证作也。师言夜半手足当温，两脚当伸，如
其言者何也？答曰：诊脉浮大，则为风虚，非寒虚也，故此知用桂枝不足以治其寒，
而加附子温经。即有阳明内结，□语烦乱等证，浑不为意。且更与甘草干姜汤，至夜
半阳回足热，胫尚微拘急，即与芍药甘草汤以和其阴，尔乃胫伸，继以承气治其阳明
内结，故微溏而□语止，其病可愈矣。是皆由于救之得法耳！
【方解】
妇女外阴部（原文缺字，指阴户），将其烧成灰末。
以上一味药，用水送服一方寸匕，每日三次，小便通畅后，阴头轻微肿胀，这就是病愈了。如果是女性患病，取男性的裤裆烧成灰服用。
【方解】
男女的裤裆，是污浊败坏之物。烧成灰使用的目的，是取其通散的作用，也符合“同气相求”的道理。服药后如果出汗，或者小便通畅，病就会好。阴头轻微肿胀，是因为原本积聚的毒邪从阴窍排出，所以会出现肿胀。
音切
垢读作苟 沸读作佛 郁读作熨 挛读作力全切 胫读作胡定切 □读作昆、同裤
所谓“坏病”，是指本不该发汗却发了汗，本不该催吐却用了吐法，本不该攻下却用了下法；或者是该用汗、吐、下法但过度了，或者该用这些方法却错过了时机。这些都是治疗不当，从而形成了坏病。无论是三阴经还是三阳经的病，如果经过发汗、催吐、攻下、温针、火熏、火熨、火灸、火劫等治法，导致各种坏病的，有的表现为发汗后阳气亡失，出现眩晕昏冒、震颤惊恐、冷汗淋漓不收；有的表现为攻下后中气虚弱，出现结胸、痞满、腹泻不止；有的表现为催吐后心烦意乱、腹部胀满；有的表现为温针后导致失血、惊悸狂乱，甚至出现阳毒斑疹、狂躁，阴证烦躁欲死，神志昏迷、胡言乱语，以及循衣摸床等症状。这些论述散见于各篇之中，现在汇总为一集，以便初学者学习。其中或许有所遗漏，这就要靠善于反复推究的人来补足了。
@@@
太阳病三天，已经发过汗，如果又用了催吐、攻下、温针等方法，病仍然没有解除，这就叫坏病，此时不能再给桂枝汤了。应当观察病人的脉象和症状，知道犯了什么错误，根据当前的证候进行治疗。
【注】
太阳病三天，邪气还在三阳经的时候。如果已经发过汗，或者用了催吐、攻下、温针等方法，各种治法都用过了，病仍然不解除，这就叫坏病，是由于治疗不当造成的。此时即使还有表证，也不能给桂枝汤，应当观察病人的脉象和症状，知道误治犯了什么逆乱，然后随证治疗，不能被固定的成法所拘束。
【集注】
方有执说：既然不能确定正名，也就难以给出正治之法，所以只是向人们展示随机应变的精微旨意，以此贯穿始终，这句话就概括尽了。
程知说：病在太阳，治疗不当，就会变成坏病，所以初治不可不谨慎。不能用桂枝汤，是因为桂枝汤证已经消失了，如果桂枝汤证还在，就不叫坏病了。
程应旄说：比如发汗后阳气亡失、经脉动扰，口渴烦躁、胡言乱语；攻下后心中虚烦、结胸痞气；催吐后内热心烦、腹胀满，温针后吐血鼻衄、惊悸狂乱等等，纷纭错杂地出现，这都是被前人的治疗所破坏，后人千万不要拿着成法去救逆。所以前面的证候虽然属于桂枝汤证，但如果变成了坏病，桂枝汤也不能用了，要观察脉证，知道犯了什么逆乱，随证治疗。这是想把逆乱转为顺调，不是从望闻问切上探查出前后的根由，就无法随证用药，这不是头痛医头的随证治疗。
吴人驹说：不能拘泥于说是三日表病，就给桂枝汤，应当根据现在变坏的情况，来进行救治。
@@@
原本的太阳病没有解除，转入少阳经的，出现胁下痞硬胀满，干呕不能进食，寒热往来，还没有用过催吐或攻下法，脉象沉紧的，给予小柴胡汤。如果已经用过催吐、攻下、发汗、温针，出现胡言乱语，小柴胡汤证已经消失，这就叫坏病，要知道犯了什么逆乱，按照法治之。
【按】
脉沉紧，应该是“脉沉弦”。如果是沉紧，那是寒邪实于胸中，应当用吐法的证候。只有“脉沉弦”，才与上文的意义相衔接，所以可以给予小柴胡汤。
【注】
原本的太阳病没有解除，而出现胁下痞硬胀满，干呕不能进食，寒热往来等症状。脉象沉弦，说明邪气转入少阳，如果没有经过催吐或攻下，应当给予小柴胡汤，以解除半表半里的邪气。如果已经经过催吐、攻下、发汗、温针，那么表里都虚了，再加上胡言乱语，小柴胡汤证消失，这就叫坏病，即使是小柴胡汤也不能用了，应当审察他所犯的什么逆乱，随证用法治之即可。
【集注】
成无己说：转入少阳，是柴胡汤证。如果已经催吐、攻下，发汗、温针，不仅犯了少阳三禁，再加上温针逼迫劫夺，损耗津液，胃中干燥，必然发生胡言乱语。柴胡证消失，是指没有胁下痞硬胀满、干呕不能食、寒热往来等症状，这叫坏病。
沈明宗说：太阳病不解而传变到少阳，应当用小柴胡汤和解，这才是定法。反而用催吐、攻下、发汗、温针，来触犯少阳的禁忌，邪热陷入阳明，所以发生胡言乱语，已经成为坏证。要知道胡言乱语是阳明受病，就应当知道犯了阳明的逆乱而治疗它，如果没有胡言乱语，而是出现其他经络的坏证，必须凭据症状和脉象，另外用灵活的方法治疗。
太阳病中风，用火劫法发汗，邪风被火热之气侵袭，气血流溢，失去了正常的度，两阳相互熏灼，身体发黄，阳盛则想要鼻出血，阴虚则小便困难，阴阳都虚竭，身体就会干枯燥涩，只有头部出汗，到颈部为止，腹部胀满微微气喘，口干咽喉腐烂，或者不大便，时间久了就会胡言乱语，严重的甚至呃逆，手足躁动不安，捻衣摸床，如果小便通畅，这个人还可以治愈。
【注】
太阳病中风，不用桂枝汤发汗，而用火劫法发汗，所以导致各种逆乱。风属于阳邪，被火助热，所以气血流溢，失去常度。因为风和火都是阳，所以叫两阳熏灼；热气蒸腾血液瘀滞达于肌表，所以身体发黄。血被热逼迫，所以上逆想要鼻出血；阴虚液竭，所以小便困难；阴阳虚竭，所以身体干枯；阳热熏灼，阴液上越，所以头部出汗到颈部停止。热传到太阴，所以腹部胀满口燥；热传到少阴，所以口干咽喉腐烂；热壅在胸中，所以肺燥微微气喘；热结在胃中，所以不大便。时间越久热越深，所以出现呃逆、胡言乱语，神志昏乱，手足躁动不安，捻衣摸床的症状。凡是这些坏证，推求其根源，都是由邪火逆乱，真阴立刻亡失，大多不可治愈。然而如果小便通畅，说明阴气还在，所以还可以治愈，能不慎重于开始吗！
【集注】
成无己说：《内经》说：各种胀大腹大的病，都属于热。腹满微微气喘，是热气内郁。经文说：火气内发，上行为口干咽喉腐烂，是火热上熏。热气向上而不向下，则大便不通，如果热气下入胃中，消耗津液，则大便干结，所以说：或者不大便，时间久了胃中燥热，必然发生胡言乱语。经文说：病深的，声音就是呃逆，火气太甚，正气逆乱，所以呃逆。经文说：四肢，是诸阳的根本，阳盛则动，所以手足躁动不安，捻衣摸床。小便通畅，说明阴未竭，还可以治。
喻昌说：这个证候是阳邪挟带火热，扰乱阴分，而亡失阴液，与前两条亡阳证，天壤之别。看阳盛想要鼻出血，身体干枯等句，就知道这个证候应当急驱其阳，以保存一线之阴，不能拘泥于“阴阳俱虚竭”一句话，而去补阳、劫阴。而且头汗是阳邪上壅，不能向下通达于阴，所以颈部以下不能得汗。假如见到鼻出血，那么邪气就从鼻出血而解，头部就没有汗了。假如有汗，那么邪气就从汗而解，就不会鼻出血了。后条火邪深入，必然便血，也是身体干枯而不得汗，假如有汗，就不会便血了。读古人的书，全要领会意思，哪有得了汗仍然鼻出血、便血的道理呢！又说：仲景用小便利这一端，来判断真阴是否亡失，最为细致。大概水出高源，小便通畅则津液不枯，肺气不绝可知；肾以膀胱为府，小便通畅则膀胱的气化运行，肾水未绝可知。
程应旄说：以上诸证，无非是邪火逆乱，真阴立刻亡失的现象，推求其原，都是一切气血流溢，失去常度，到了如此地步，邪风被火热伤害的危害，能说尽吗？这个时候，想治风而火势沸腾，想治火而风邪壅遏，从哪里治起？只有利小便一法。如猪苓汤之类，可以导热滋润干燥，使小便得利，那么太阳的邪气也从膀胱为出路，还可以治。如果利了而不通，火无从排出，就危险了。
@@@
太阳病，医生发汗，于是发热恶寒，接着又用攻下法，心下痞塞，表里都虚，阴阳之气都衰竭，没有阳气则阴独存，再加上烧针。因为胸部烦闷，面色青黄，肌肤跳动的，难治；现在面色微黄，手足温暖的，容易痊愈。
【注】
太阳表病，医生过度发汗，已经使表虚，接着又用攻下法，又使里虚，虽然有未尽的表邪，陷里形成痞证，但是表里都虚，阴阳并竭，已经成为坏证了。况且没有阳气则阴不生，阴独存则阳不化，再加上烧针，火气内攻，阴阳都生病，所以胸满而烦，面色青黄，肌肤跳动。见证如此错杂，所以难治。如果面色微黄不青，手足不冷而温暖，则是阴阳之气未竭，所以说易治。
【集注】
方有执说：表是指误汗而言，里是指误下而言，所以说都虚。阴指里，阳指表，无阳谓阳气竭，阴独谓痞证。青黄，是脾受克贼的颜色。微黄，是土见回生的颜色。手足温，是阳气回复到四肢末端。说既经过反复的错误，又见到克贼之色，肌肤跳动而不宁，则是脾家的真阴败坏，为难治。现在是土见回生之色，四肢末端得到温暖，胃家的阳复，所以为易愈。
@@@
伤寒脉浮，自汗出，小便数，心烦，微恶寒，脚挛急，反而给桂枝汤，想要攻其表，这是错误，得了这种误治后就出现四肢厥冷。咽中干，烦躁吐逆的，制作甘草干姜汤给它喝，以恢复其阳气。如果厥冷好了足部温暖的，再制作芍药甘草汤给它喝，它的脚就能伸直；如果胃气不和，出现胡言乱语的，少量给予调胃承气汤；如果再次发汗，再加上烧针的，四逆汤主治。
【注】
伤寒脉浮，自汗出，是中风证；小便数，心烦，是里没有热的虚烦。微恶寒，是表阳虚不能抵御；脚挛急，是表寒收引拘急，这应当给桂枝增桂加附子汤，以温经止汗。现在反而给桂枝汤攻发其表，这是大错误。服后便出现厥冷的，是阳气因发汗而亡失。咽干的，是阴液因发汗而枯竭；烦躁的，是阳气失藏；吐逆的，是阴气拒格，所以给甘草干姜汤，以缓和其阴，而恢复其阳。如果厥冷好足部温暖，则是阳已恢复，宜再给芍药甘草汤，以调和其阴，而和其阳，则脚就能伸直了。如果胃不和而胡言乱语，知道是邪气已转属阳明，当少量给予调胃承气汤，令其轻微腹泻，胃和自然可愈。如果重发汗，是说不仅误服桂枝汤，而更误服麻黄汤。或者再加烧针劫取其汗，以致亡阳证具备。则又不是甘草干姜汤所能治，所以又当给四逆汤，以急救其阳。
【集注】
程应旄说：脉浮自汗，虽然像桂枝证，但头项不痛，知道阳气神气自歉于上部；恶寒脚挛急，知道阴邪更袭于下焦。阳虚阴盛，而里气上逆，所以有心烦证，里阴攻及表阳，差错只在“烦”字上。看结句若重发汗，复加烧针者，四逆汤主之。可见阴证不必真是直中，治疗上一误，寒即中于治法中了。
@@@
问曰：证象阳旦，按法治之而病情加重，四肢厥逆，咽中干，两小腿拘急而胡言乱语。老师说半夜手足应当温暖，两脚应当伸直。后来像老师说的，为什么这样？答曰：寸口脉浮而大，浮为风，大为虚，风则生微热，虚则两小腿拘挛，病形象桂枝，因此加附子参在其中，增加桂枝令其出汗，附子温经，这是因为亡阳。四肢厥逆，咽中干，烦躁，阳明内结，胡言乱语烦乱，再饮甘草干姜汤，夜半阳气还，两足当热，小腿尚微拘急，再给芍药甘草汤，然后小腿伸直，用承气汤轻微腹泻，则停止其胡言乱语，所以知道病可愈。
【注】
这是设问答，申明上一条的意义。桂枝证应当用桂枝，正值时令温热，或者其人本身有热，用阳旦汤，即桂枝汤加黄芩。正值时令寒冷，或者其人本身有寒，用阴旦汤，即桂枝汤加干姜。证象阳旦，是说心烦似乎有热。按法治之，是说按法用阳旦汤。大概心烦小便数，咽中干，似乎阳旦，但不审察脚挛急、微恶寒的证候，这是阴寒，即以阳旦汤攻其表是错误的。所以病情加重，出现厥逆咽中干，两小腿拘急，胡言乱语等坏证发作。老师说半夜手足应当温暖，两脚应当伸直，如其所言的原因是什么呢？答曰：诊脉浮大，则为风虚，非寒虚，所以知道用桂枝不足以治其寒，而加附子温经。即有阳明内结，胡言乱语烦乱等证，全然不在意。并且再给甘草干姜汤，至夜半阳回足热，小腿尚微拘急，即给芍药甘草汤以和其阴，然后小腿伸直，继以承气治其阳明内结，所以轻微腹泻而胡言乱语停止，其病可愈了。这都是由于救治得法啊！
[Formula Analysis]
The female external genitalia (original text missing character, referring to the vulva), burn it into ash.
Take this single ingredient, administer with water in a measure of one "cun bi" (a square-inch spoonful), three times daily. Once urination becomes smooth and the glans penis/vulva swells slightly, this indicates recovery. If a woman is ill, take the male's underwear, burn it, and administer.
[Formula Analysis]
Underwear of men and women is a turbid and deteriorated substance. Burning it into ash for use aims at its penetrating and dispersing properties, also adhering to the principle of "similar qi seeking each other." After administration, if sweating occurs or urination becomes smooth, the disease will resolve. Slight swelling of the glans is because the accumulated toxin is discharged from the yin orifice, hence the swelling.
Phonetics
Gou sounds like Gou; Fei sounds like Fo; Yu sounds like Yun; Luan sounds like Li Quan Qie; Jing sounds like Hu Ding Qie; □ sounds like Kun, same as Ku (trousers).
"Huai Bing" (Ruined Disease) refers to situations where sweating was induced when it should not have been, vomiting was induced when it should not have been, purging was induced when it should not have been; or when sweating, vomiting, or purging methods were used excessively when they should have been, or when these methods were applied at the wrong time. All these constitute improper treatment, resulting in a "Ruined Disease." Whether involving the Three Yin or Three Yang meridians, if various treatments such as sweating, vomiting, purging, warm needle therapy, fire moxibustion, fire ironing, fire acupuncture, or fire coercion are employed, leading to various ruined diseases, some manifest as post-sweating Yang collapse with dizziness, vertigo, trembling, fright, and unremitting cold sweat; some manifest as post-purging middle Qi deficiency with chest binding, epigastric fullness, and incessant diarrhea; some manifest as post-vomiting mental restlessness and abdominal fullness; some manifest as post-warm needle bleeding, palpitations, and mania, even progressing to Yang toxicity with macules, mania, Yin irritability desiring death, coma, delirious speech, and behaviors like grasping at clothes or touching the bed. These discussions are scattered across various chapters; now they are compiled into one collection for the benefit of students. There may be omissions, which rely on those capable of triple reflection to supplement.
@@@
In Taiyang disease lasting three days, if sweating has already been performed, and if vomiting, purging, or warm needle therapies are still ineffective in resolving the condition, this is termed a "Ruined Disease." Guizhi Tang (Cinnamon Twig Decoction) should no longer be administered. One must observe the pulse and symptoms, identify the nature of the iatrogenic error, and treat according to the current syndrome pattern.
[Annotation]
Taiyang disease at day three implies the pathogen is still within the Three Yang levels. If sweating, vomiting, purging, or warm needle therapies have all been exhausted without resolution, this constitutes a "Ruined Disease" due to improper treatment. Even if exterior signs persist, Guizhi Tang (Cinnamon Twig Decoction) is contraindicated. One must observe the pulse and symptoms, determine the specific iatrogenic deviation, and treat accordingly, rather than being bound by fixed protocols.
[Collected Annotations]
Fang Youzhi states: Since the standard diagnosis cannot be fixed, standard treatment is difficult to prescribe. Thus, only the subtle principle of adapting to changing circumstances is demonstrated, encompassing the entire argument.
Cheng Zhi states: When disease is in Taiyang, improper treatment leads to a Ruined Disease; therefore, initial treatment must be cautious. Guizhi Tang (Cinnamon Twig Decoction) is withheld because the Guizhi Tang syndrome has ceased; if the syndrome persisted, it would not be called a Ruined Disease.
Cheng Yingmao states: For instance, post-sweating Yang collapse causing meridian agitation, thirst, irritability, and delirium; post-purging empty irritability, chest binding, and Qi stagnation; post-vomiting internal heat and abdominal fullness; post-warm needle hematemesis, epistaxis, palpitations, and mania—these diverse manifestations are all caused by prior improper treatment. Practitioners must not apply fixed formulas to correct these deviations. Although previous symptoms might belong to Guizhi Tang (Cinnamon Twig Decoction), once ruined, it is contraindicated. One must observe pulse and symptoms, identify the deviation, and treat accordingly. This aims to reverse deviation to normalcy, requiring investigation of root causes through observation, listening, inquiry, and palpation, not merely symptomatic treatment ("treating headache for head pain").
Wu Renju states: One must not rigidly adhere to "three days equals exterior disease" and administer Guizhi Tang (Cinnamon Twig Decoction); instead, rescue measures must be based on the current altered state.
@@@
If original Taiyang disease remains unresolved and transitions to Shaoyang, presenting with hypochondriac fullness and hardness, dry retching, inability to eat, alternating chills and fever, and if emetic or purgative methods have not yet been used, and the pulse is deep and tight, administer Xiao Chaihu Tang (Minor Bupleurum Decoction). If emetic, purgative, diaphoretic, or warm needle therapies have already been used, resulting in delirious speech, and the Xiao Chaihu Tang syndrome has ceased, this is a "Ruined Disease." Identify the iatrogenic error and treat according to the law.
[Commentary]
"Pulse deep and tight" should likely be "pulse deep and wiry." A deep and tight pulse indicates cold excess in the chest, warranting emesis. Only a "deep and wiry" pulse aligns with the preceding context, justifying the use of Xiao Chaihu Tang (Minor Bupleurum Decoction).
[Annotation]
Unresolved Taiyang disease presenting with hypochondriac fullness/hardness, dry retching, anorexia, and alternating chills/fever indicates pathogen transition to Shaoyang with a deep/wiry pulse. If emesis/purging have not occurred, Xiao Chaihu Tang (Minor Bupleurum Decoction) resolves half-exterior/half-interior pathogens. However, if emesis, purging, sweating, or warm needles have been used, both exterior and interior are depleted. With added delirious speech, the Xiao Chaihu Tang syndrome ceases, constituting a "Ruined Disease"; Xiao Chaihu Tang (Minor Bupleurum Decoction) is then contraindicated. One must assess the specific iatrogenic error and treat accordingly.
[Collected Annotations]
Cheng Wuji states: Transition to Shaoyang presents Xiao Chaihu Tang (Minor Bupleurum Decoction) indications. Subsequent emesis, purging, sweating, or warm needles violate the Three Prohibitions of Shaoyang. Coercion via fire depletes fluids, drying the stomach and causing delirium. "Xiao Chaihu syndrome ceased" means absence of hypochondriac fullness, dry retching, and alternating chills/fever, defining a Ruined Disease.
Shen Mingzong states: Taiyang transmission to Shaoyang requires harmonization via Xiao Chaihu Tang (Minor Bupleurum Decoction). Using emesis, purging, sweating, or warm needles violates Shaoyang precautions, allowing pathogenic heat to sink into Yangming, causing delirium. Delirium indicates Yangming involvement; treat the Yangming deviation. If other meridian ruins appear, diagnose via pulse/symptoms and apply flexible methods.
In Taiyang Wind Strike, using fire coercion to induce sweating causes wind-pathogen to combine with fire heat. Blood and Qi flow erratically, losing their normal regulation. The interaction of two Yangs scorches the body, causing jaundice. Excess Yang predisposes to epistaxis; Yin deficiency leads to difficult urination. Total depletion of Yin and Yang results in dry, withered body. Sweating is limited to the head up to the neck. Abdominal fullness and slight wheezing occur. Dry mouth and rotten throat develop. Constipation may ensue. Prolonged heat leads to delirium. Severe cases involve hiccups, restless limbs, and picking at clothes/bed sheets. If urination is free, the patient is treatable.
[Annotation]
Taiyang Wind Strike treated with fire coercion instead of Guizhi Tang (Cinnamon Twig Decoction) causes adverse reactions. Wind is a Yang pathogen; fire adds heat, causing erratic blood/Qi flow. As both wind and fire are Yang, they scorch the body, causing jaundice via heat-induced blood stasis. Heat forces blood upward (epistaxis); Yin fluid depletion causes dysuria. Total Yin/Yang depletion causes dryness. Yang heat steams Yin upward, causing head-only sweating. Heat transmitting to Taiyin causes abdominal fullness/dry mouth; to Shaoyin, dry mouth/rotten throat; congesting chest, lung dryness/wheezing; knotting in stomach, constipation. Prolonged deepening heat causes hiccups, delirium, coma, limb restlessness, and picking behaviors. These ruins stem from chaotic evil fire destroying True Yin, usually untreatable. Free urination indicates residual Yin, making treatment possible. Caution at the outset is vital!
[Collected Annotations]
Cheng Wuji cites *Neijing*: "All distension and abdominal enlargement belong to heat." Abdominal fullness/wheezing indicates internal heat stagnation. Fire heat rising causes dry mouth/rotten throat. If heat rises but does not descend, stool is obstructed; if it sinks to stomach, consuming fluids, stool becomes hard, leading to delirium. Deep disease manifests as hiccups due to excessive fire disrupting righteous Qi. Limbs are the root of Yang; Yang excess causes movement/restlessness. Free urination indicates unexhausted Yin, implying treatability.
Yu Chang states: This syndrome involves Yang pathogen combining with fire, disturbing Yin and causing Yin loss, vastly different from previous Yang-collapse syndromes. Signs like impending epistaxis and dryness indicate urgent need to drive out Yang to preserve remaining Yin. Do not be misled by "Yin and Yang both depleted" to tonify Yang or further injure Yin. Head sweating results from Yang pathogen blocking upper flow, preventing lower sweating. Epistaxis would release pathogen; sweating would release pathogen. One must grasp the underlying meaning, as simultaneous sweating and bleeding is illogical. Zhongjing uses free urination to finely judge Yin preservation. Free urination implies intact Lung Qi (source of fluids) and Kidney/Bladder Qi transformation, indicating preserved Kidney Water.
Cheng Yingmao states: These syndromes reflect chaotic evil fire destroying True Yin, stemming from erratic blood/Qi flow. At this stage, treating wind exacerbates fire; treating fire is blocked by wind. The only method is promoting urination. Formulas like Zhu Ling Tang (Polyporus Decoction) guide heat and moisten dryness. If urination flows, Taiyang pathogen exits via Bladder, offering hope. If urination fails, fire has no exit, leading to danger.
@@@
In Taiyang disease, physician-induced sweating led to fever and aversion to cold. Subsequent purging caused epigastric痞 (fullness/stuffiness). Both exterior and interior are deficient; Yin and Yang Qi are exhausted. Absence of Yang leaves Yin alone. Adding warm needle therapy causes chest irritability. Cyan-yellow complexion and skin twitching indicate difficult prognosis. Pale yellow complexion and warm hands/feet indicate easy recovery.
[Annotation]
Over-sweating in Taiyang exterior disease first depleted the exterior; subsequent purging depleted the interior. Residual exterior pathogen sank inward, forming Pi (stuffiness). With both exterior/interior deficient and Yin/Yang exhausted, a Ruined Disease exists. Without Yang, Yin cannot generate; isolated Yin cannot transform Yang. Warm needle therapy drives fire inward, sickening both Yin and Yang, causing chest fullness/irritability, cyan-yellow face, and skin twitching. Such complex signs are difficult to treat. Pale yellow face (not cyan) and warm extremities indicate unexhausted Yin/Yang, signifying easy recovery.
[Collected Annotations]
Fang Youzhi states: Exterior deficiency stems from mistaken sweating; interior deficiency from mistaken purging. Yin refers to interior, Yang to exterior. "No Yang" means Yang exhaustion; "Yin alone" refers to Pi (stuffiness). Cyan-yellow is the color of Spleen being overcome. Pale yellow is the color of Earth recovering. Warm extremities indicate Yang returning to the four limbs. Repeated errors plus overcoming colors and twitching indicate Spleen True Yin failure (difficult). Pale yellow and warm extremities indicate Stomach Yang recovery (easy).
@@@
Shaoyin Cold Damage with floating pulse, spontaneous sweating, frequent urination, heart vexation, slight aversion to cold, and leg cramps. Administering Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is an error, resulting in limb coldness (Jue). Dry throat, irritability, and vomiting require Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang. If limbs warm, administer Shaoyao Gancao Tang (Peony and Licorice Decoction) to extend the legs. If stomach disharmony causes delirium, give Shaoyang Tiaowei Chengqi Tang (Minor Regulating Stomach and Orderly Bowel Decoction) in small doses. If severe sweating and warm needle therapy were used, Sini Tang (Four Counterflow Decoction) is indicated.
[Annotation]
Floating pulse, spontaneous sweating, and aversion to cold indicate Wind Strike; frequent urination and heart vexation indicate interior deficiency-empty vexation without heat. Slight aversion to cold reflects deficient exterior Yang unable to defend; leg cramps reflect exterior cold contracting sinews. Guizhi Tang with added Cinnamon and Aconite should warm meridians and stop sweating. Using plain Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is a major error. Post-administration Jue (cold limbs) indicates Yang loss via sweat. Dry throat indicates Yin fluid depletion. Irritability indicates Yang loss of storage. Vomiting indicates Yin rejection. Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) moderates Yin and restores Yang. Once limbs warm (Yang restored), Shaoyao Gancao Tang (Peony and Licorice Decoction) harmonizes Yin and Yang, extending the legs. Stomach disharmony with delirium indicates pathogen shifting to Yangming; small doses of Tiaowei Chengqi Tang (Regulating Stomach and Orderly Bowel Decoction) induce mild loose stools to harmonize Stomach. "Severe sweating" implies mistaken Ephedra Decoction (Mahuang Tang) after Guizhi Tang. Warm needle coercion causing complete Yang collapse requires Sini Tang (Four Counterflow Decoction) for emergency Yang rescue.
[Collected Annotations]
Cheng Yingmao states: Floating pulse/spontaneous sweating resembles Guizhi Tang (Cinnamon Twig Decoction) syndrome, but lack of head/neck pain suggests deficient Upper Jiao Yang. Aversion to cold/cramps suggest Lower Jiao Yin pathogen invasion. Yang deficiency/Yin excess causes rebellious Qi (heart vexation). Inner Yin attacking Outer Yang creates error centered on "vexation." The conclusion regarding severe sweating/warm needles requiring Sini Tang (Four Counterflow Decoction) shows Yin syndromes need not be direct transmission; treatment error can introduce Cold.
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Question: Syndrome resembles Yangdan, but following standard treatment worsened it, causing Jue (cold limbs), dry throat, leg cramps, and delirium. Master predicted warmth/extending legs at midnight. Why? Answer: Floating/large Cun Kou pulse indicates Wind (floating) and Deficiency (large). Wind causes slight heat; deficiency causes leg cramps. Syndrome resembles Guizhi, so Fuzi (Aconite) was added, Cinnamon increased to induce sweating, and Fuzi warmed meridians due to Yang collapse. Jue, dry throat, irritability, Yangming internal knotting, and delirium required Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction). Midnight Yang return warmed feet. Persistent mild cramps required Shaoyao Gancao Tang (Peony and Licorice Decoction) to extend legs. Chengqi Tang (Bowel-Ordering Decoction) mildly loosened bowels to stop delirium. Thus, recovery was assured.
[Annotation]
This Q&A clarifies the previous article. Guizhi Tang (Cinnamon Twig Decoction) is standard. In warm seasons or heat constitutions, Yangdan Tang (Guizhi + Scutellaria) is used. In cold seasons or cold constitutions, Yindan Tang (Guizhi + Dried Ginger) is used. "Resembling Yangdan" implies heart vexation suggesting heat. Following protocol with Yangdan Tang for symptoms resembling it (vexation, frequent urination, dry throat) but ignoring leg cramps/slight aversion to cold (indicating Cold) was erroneous. This worsened the condition, causing Jue, dry throat, cramps, and delirium. Why did the prediction hold? Floating/large pulse indicates Wind-Deficiency, not Cold-Deficiency. Guizhi alone insufficient for Cold; Fuzi (Aconite) warms meridians. Ignoring Yangming knotting/delirium initially, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) was given. Midnight Yang return warmed feet. Mild cramps resolved with Shaoyao Gancao Tang (Peony and Licorice Decoction). Finally, Chengqi Tang (Bowel-Ordering Decoction) addressed Yangming knotting, inducing mild stool to stop delirium. Recovery resulted from correct rescue methodology.