5.伤寒酒病桂勿与, 呕吐不巳血脓鲜, 尺迟服麻致漏汗, 恶风肢急小
便难, 微弱汗风青龙发, 厥惕悸眩热仍然, 身??振振欲擗地, 桂加附
子真武痊.
【注】伤寒, 谓伤寒无汗之实邪也. 酒病, 谓病酒状似中风也. 桂勿
与,谓皆勿与桂枝汤也. 误与伤寒, 则表气愈固, 里气更逆, 呕吐不
巳也. 误与酒病, 则湿热内酿, 伤营吐血脓也. 此皆误用桂枝汤之变
证,当随其变证治之可也. 尺迟, 谓伤寒尺中脉迟也. 服麻, 谓服麻
黄汤发汗, 遂致汗出不止, 名曰漏汗也. 肢急, 四肢拘急也. 小便难,
谓小便少而难也. 伤寒脉证, 当用麻黄汤发汗, 若尺中脉迟, 是营气
不足, 不可发汗, 若误发之, 则致漏汗恶风, 四肢拘急, 小便难等变
证也. 当以桂枝加附子汤救逆可也. 微弱, 谓大青龙证脉微弱也. 汗
风,谓大青龙证自汗恶风也. 大青龙证脉不浮紧, 若浮缓而微弱反汗
出,是大青龙脉证未具也. 误以大青龙发之, 致其人厥冷筋惕, 心悸
头眩, 热仍不退, 身肉?? 动也. 振振欲擗地, 谓耸动不已, 不能兴起
欲堕于地也. 此皆误与大青龙汤发汗之变证, 当以真武汤救逆可也.
详太阳篇.
5. 伤寒无汗实证及饮酒致病，均不可使用桂枝汤；若误用导致呕吐不止、吐血或便脓血；尺脉迟者服用麻黄汤会导致汗出不止（漏汗），出现怕风、四肢拘急、小便困难等症状；脉微弱且自汗恶风者误服大青龙汤，会导致四肢厥冷、惊恐悸动、头晕目眩而热势不退，身体肌肉跳动，震颤不已欲倒地；此时应使用桂枝加附子汤治疗因误治导致的变证，或使用真武汤治愈。
【注】“伤寒”，指的是伤寒病中无汗的实邪证候。“酒病”，指的是饮酒后出现的症状类似中风的情况。“桂勿与”，意思是这两种情况都不可给予桂枝汤。如果误用于伤寒实证，则表气更加闭塞，里气更加上逆，导致呕吐不止。如果误用于酒病，则湿热在体内酝酿，损伤营血，导致吐血或便脓血。这些都是误用桂枝汤产生的变证，应当根据具体的变证进行治疗即可。
“尺迟”，指的是伤寒病中尺部脉象迟缓。“服麻”，指的是服用麻黄汤发汗，从而导致汗出不止，这种情况称为“漏汗”。“肢急”，即四肢拘挛紧急。“小便难”，指的是尿量少且排尿困难。伤寒病的脉证，本应当使用麻黄汤发汗，但如果尺中脉迟，说明营气不足，不可发汗；如果误用发汗法，就会导致漏汗、怕风、四肢拘急、小便难等变证。此时应当使用桂枝加附子汤来救治逆证即可。
“微弱”，指的是大青龙汤证的脉象微弱。“汗风”，指的是大青龙汤证患者出现自汗和怕风的症状。大青龙汤证的脉象不应是浮紧，如果是浮缓且微弱，反而有出汗，说明大青龙汤证的脉证并不具备。误用大青龙汤发汗，会导致患者四肢厥冷、筋脉跳动惊恐、心悸头晕，热势仍然不退，身体肌肉跳动。所谓“振振欲擗地”，是指身体耸动不停，无法起身，想要倒在地上。这些都是误用大青龙汤发汗产生的变证，应当使用真武汤来救治逆证即可。详细情况参见《太阳篇》。
5. For exogenous cold (Shanghan) presenting with anhidrosis and excess pathogenic factors, as well as for alcohol-induced diseases manifesting like wind-stroke, Guizhi Tang (Cinnamon Twig Decoction) must not be administered. If mistakenly given to exogenous cold, it leads to persistent vomiting; if mistakenly given to alcohol-induced disease, it causes damp-heat to brew internally, damaging the Ying level (Nutritive Level) and resulting in hematemesis or purulent stool. For patients with a slow pulse at the Chi position (cun-kou pulse location), administering Mahuang Tang (Ephedra Decoction) induces continuous sweating known as "leaking sweat" (Louhan), accompanied by aversion to wind, stiffness of the four limbs, and difficulty in urination. For patients with a faint pulse and spontaneous sweating with aversion to wind, administering Da Qinglong Tang (Major Green Dragon Decoction) leads to cold extremities, palpitations with fright, dizziness, persistent fever, muscle twitching, and severe tremors where the patient feels unable to rise and desires to fall to the ground. In such cases of adverse reactions due to misprescription, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) should be used to rescue from the adverse reaction, or Zhenwu Tang (True Warrior Decoction) should be employed to cure the condition.
[Annotation] "Exogenous cold" refers to the excess syndrome of exogenous cold characterized by anhidrosis. "Alcohol-induced disease" refers to conditions resembling wind-stroke caused by excessive alcohol consumption. "Guizhi Tang must not be given" means that Guizhi Tang is contraindicated in both scenarios. Mistakenly using Guizhi Tang for exogenous cold further consolidates the exterior Qi while causing interior Qi to rebel, leading to persistent vomiting. Mistakenly using it for alcohol-induced disease causes damp-heat to ferment internally, damaging the Ying level and resulting in hematemesis or pus in the stool. These are adverse reactions from the misuse of Guizhi Tang; treatment should follow the specific adverse manifestations.
"Chi slow" refers to a slow pulse at the Chi position in exogenous cold. "Taking Mahuang" refers to the administration of Mahuang Tang for diaphoresis, which results in unceasing sweating, termed "leaking sweat." "Limb stiffness" denotes tetany or contracture of the four limbs. "Difficulty in urination" implies oliguria and dysuria. Although exogenous cold typically requires Mahuang Tang for diaphoresis, a slow pulse at the Chi position indicates deficiency of Ying Qi, making diaphoresis contraindicated. Mistaken diaphoresis leads to adverse reactions such as leaking sweat, aversion to wind, limb stiffness, and urinary difficulty. In such cases, Guizhi Jia Fuzi Tang should be used to rescue from the adverse reaction.
"Faint" refers to a faint pulse in the context of Da Qinglong Tang syndrome. "Sweating with wind aversion" refers to spontaneous sweating and aversion to wind in Da Qinglong Tang syndrome. The pulse for Da Qinglong Tang should not be floating and tight; if it is floating, moderate, and faint with accompanying sweating, the indications for Da Qinglong Tang are not fully present. Mistakenly inducing diaphoresis with Da Qinglong Tang causes cold extremities, muscle twitching with fright, palpitations, dizziness, persistent fever, and body muscle tremors. "Trembling and desiring to fall to the ground" describes incessant shaking and inability to stand, feeling as though collapsing. These are adverse reactions from the misuse of Da Qinglong Tang for diaphoresis; Zhenwu Tang should be used to rescue from the adverse reaction. See the Taiyang Chapter for details.