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，结胸痞硬，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，神昏谵语，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，
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，当根据现下之变坏者而为救治。
本太阳病不解，转入少阳者，胁下硬满，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，谵语，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，当吐之诊也。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，而见胁下硬满，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，更加谵语，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，必发谵语。柴胡证罢者，谓无胁下硬满，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，故发谵语，已为坏证。要知谵语乃阳明受病，即当知犯阳明之逆而治之；若无谵语，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，久则谵语，
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，故哕逆谵语，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，则大便不硬，若热气下入胃中，消耗津液，则大便硬，故云∶或
不大便，久则胃中燥热，必发谵语。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，辨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；肾以膀胱为腑，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，烦躁吐逆者，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，谵语者，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；烦躁者，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。
若胃不和而谵语，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，两胫拘急而谵语。师言夜半手足当温，两脚当伸。
后如师言。何以知此？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，谵语烦乱，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，则止其谵语，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，谵语等坏证作也。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，谵语烦乱等证，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，故微溏而谵语止，其病可愈矣。是皆由于救之得法耳！
阳旦汤方（补）
桂枝（三钱） 芍药（酒焙，二钱） 甘草（炙，二钱） 黄芩（酒炒，三钱） 生姜（三片） 大枣
（擘，二枚）
上水煎，去滓温服，无时，日二三服。本方加干姜，名阴旦汤。
甘草干姜汤方
甘草（炙，四两） 干姜（炮，二两）
上二味，以水三升，煮取一升五合，去滓，分温再服。
芍药甘草汤方
芍药（四两） 甘草（炙，四两）
上二味，以水三升，煮取一升五合，去滓，分温再服。
伤寒吐、下后，发汗，虚烦，脉甚微，八九日心下痞硬，胁下痛，气上冲咽喉，眩冒，经脉动惕者，久而成痿。
【按】“八九日心下痞硬，胁下痛，气上冲咽喉”三句，与上下文义不属，必是错简。注家因此三句，皆
蔓衍支离，牵强注释。不知此证，总因汗出过多，大伤津液而成，当用补气补血益筋壮骨之药，经年始可愈也。
【注】伤寒吐下后，复发其汗，治失其宜矣，故令阳气阴液两虚也。阴液虚，故虚烦；阳气虚，故脉微；
阳气微而不升，故目眩冒；阴液虚而不濡，故经脉动惕也。阳气阴液亏损，久则百体失所滋养，故力乏筋软而
成痿矣。
伤寒六七日，大下后，寸脉沉而迟，手足厥逆，下部脉不至，咽喉不利，唾脓血，泄利不止者，为难治，
麻黄升麻汤主之。
【注】伤寒六七日，邪传厥阴，厥热胜复之时，医不详审阴阳，而大下之，致变中寒下竭之坏证。中寒故
寸脉沉迟，手足厥逆；下竭故尺脉不至，泄利不止也。盖未下之前，阳经尚伏表热，大下之后，则其热乘虚下
陷，内犯厥阴，厥阴经循喉咙，贯膈注肺，故咽喉不利，唾脓血也。此为阴阳错杂，表里混淆之证，若温其下，
恐助上热，欲清其上，愈益中寒，仲景故以此汤主之，正示人以阴阳错杂为难治，当于表里上下求治法也。盖
下寒上热，固为难温，里寒无汗，还宜解表，故里麻黄升麻汤，以解表和里，清上温下，随证治之也。
【集注】程知曰∶言厥逆有因于误下致变者也。凡伤寒热炽者，其阴必虚，六七日虽当传里之时，设表证
仍在而大下之，则阴伤而阳亦陷。寸脉沉迟，手足厥冷，下利不止，伤其阳而气内陷也；下部脉不至，咽喉不
利吐脓血，伤其阴而热内逼也。一下之误，既伤其阳，复伤其阴，故难治。与麻黄升麻汤，以升阳调下，清热
滋阴。盖传经热邪，从外入于内者，仍当从内出于外也，故曰∶汗出愈。
喻昌曰∶寸脉沉而迟，明是阳去入阴之故，非阳气衰微可拟。故虽手足厥冷，下部脉不至，泄利不止，
其不得为纯阴无阳可知。况咽喉不利，唾脓血，又阳邪搏阴上逆之征验，所以仲景特于阴中提出其阳，得汗出
而错杂之邪尽解矣。
麻黄升麻汤方
麻黄（去节，二两半） 升麻（一两一分） 当归（一两一分） 知母（十八铢） 黄芩（十八铢）
葳蕤（十八铢） 石膏（碎，绵裹，六铢） 白术（六铢） 干姜（六铢） 芍药（六铢） 天冬（去心，六
铢） 桂枝（六铢） 茯苓（六铢） 甘草（炙，六铢）
上十四味，以水一斗，先煮麻黄一二沸，去上沫，纳诸药，煮取三升，去滓，分温三服，相去如炊三升米
顷，令尽。汗出愈。
【方解】下寒上热若无表证，当以黄连汤为法，今有表证，故复立此方，以示随证消息之治也。升麻、萎
坏病，是指不应当发汗却发了汗，不应当催吐却用了吐法，不应当攻下却用了下法，或者是虽然应当使用汗、吐、下法但用药过猛过度，或者虽然应当使用汗、吐、下法但错过了最佳时机。这些都是因为治疗不当，所以形成了坏病。凡是三阴三阳病，如果经过发汗、催吐、攻下，或者温针、火熏、火熨、火灸、火劫等治疗方法，导致出现各种坏病的，有的发汗后阳气亡失，出现头晕目眩、身体震颤惊恐、大汗淋漓不止；有的攻下后中气虚弱，出现结胸、心下痞硬、腹泻不止；有的催吐后心烦意乱、腹部胀满；有的温针后导致出血、惊狂，甚至出现阳毒斑疹、狂躁，阴证躁动欲死，神志昏迷、胡言乱语，以及抓摸衣被、抚摸床沿等症状。这些论述散见于各篇之中，现在将它们合编在一起，以便初学者学习。其中或许有所遗漏，这取决于读者能否反复推究。
太阳病三天，已经发过汗，如果又用了催吐、攻下或温针等方法，病仍然没有解除的，这就叫做坏病，此时不能再给桂枝汤（Cinnamon Twig Decoction）。应当观察病人的脉象和症状，了解犯了什么错误，根据具体的证候进行治疗。
【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，病仍然没有解除的，这就是坏病，是由于治疗不当造成的。这时候即使还有表证，也不能给桂枝汤，应当观察脉象和症状，知道误治犯了什么逆乱，从而根据证候进行治疗，不能被固定的成法所拘束。
【集注】方有执说：既然不能确定其正名，也就难以用常规的正治法，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，如果桂枝汤证仍然存在，就不叫坏病了。
程应旄说：如发汗后阳气亡失、经脉动摇、口渴烦躁、胡言乱语，攻下后虚烦、结胸、痞气，催吐后心中烦闷、腹胀满，温针后吐血鼻衄、惊狂等，纷繁杂乱地出现，都是因为前面的治疗破坏了病情，后人千万不要拿着成法去救治这种逆乱。所以前面的证候虽然属于桂枝汤证，但如果变成了坏病，桂枝汤也不能再用。观察脉象和症状，了解犯了什么逆乱，根据证候治疗。这是想把逆乱转为顺调，不是从望、闻、问、切上探求前后的原因，就无法根据证候用药，这不是头痛医头的随证治之。
吴人驹说：不能拘泥于三天是表病就给桂枝汤，应当根据现在变坏的情况来进行救治。
原本太阳病没有解除，转入少阳的，表现为胁下硬满、干呕、不能进食、往来寒热，还没有用过催吐、攻下，脉象沉紧的，给予小柴胡汤（Minor Bupleurum Decoction）。
如果已经用了催吐、攻下、发汗、温针，出现胡言乱语，小柴胡汤证已经消失的，这就是坏病，了解犯了什么逆乱，根据法治疗。
【按】脉沉紧，应当是“脉沉弦”，如果是沉紧，是寒邪实于胸中，应当用吐法的诊候。只有“脉沉弦”，才与上文的意义相符合，所以可以给予小柴胡汤。
【注】原本是太阳病没有解除，而出现胁下硬满、干呕不能进食、往来寒热等证候。脉沉弦，说明邪气转入少阳，如果没有经过催吐、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，再加上胡言乱语，小柴胡汤证消失，这就是坏病，连小柴胡汤也不能再用了，应当审察所犯的是什么逆乱，根据证候用法治疗即可。
【集注】成无己说：转入少阳，是小柴胡汤证。如果已经催吐、攻下、发汗、温针，不仅犯了少阳的三禁，再加上温针逼迫劫夺，损耗津液，胃中干燥，必定发胡言乱语。小柴胡汤证消失，是指没有胁下硬满、干呕不能进食、往来寒热等证候，这就是坏病。
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之；如果没有胡言乱语，而见其他经络的坏证，必须结合证候和脉象，另外用灵活的方法治之。
太阳病中风，用火劫法发汗，邪风被火热之气侵袭，气血流溢，失去了正常的规律，两阳相互熏灼，身体发黄，阳盛则想要鼻衄，阴虚则小便困难，阴阳都虚竭，身体干枯粗糙，只有头部出汗，齐颈而止，腹部胀满、轻微气喘，口干咽烂，或者不大便，时间久了则胡言乱语，严重的甚至呃逆，手足躁动不安，捻弄衣被、抚摸床沿。如果小便通利的，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，所以导致产生各种逆乱。风属于阳邪，被火助热，所以气血流溢，失去正常规律。因为风火都是阳，所以叫两阳熏灼；热气蒸腾血瘀达于肌表，所以身体发黄。血被热逼迫，所以上逆想要鼻衄；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，所以头部出汗齐颈而止。热传太阴，所以腹满口燥；热传少阴，所以口干咽烂；热壅于胸，所以肺燥微喘；热结于胃，所以不大便。时间越久则热越深，所以出现呃逆、胡言乱语，神明昏乱，手足躁动不安，捻衣摸床的症状。凡此种种坏证，推求其根源，都是由邪火逆乱，真阴立刻亡失，大多不可治愈。然而如果小便通利，说明阴气还在，所以还可以治愈，能不从一开始就谨慎吗！
【集注】成无己说：《内经》说：各种胀大腹大，都属于热。腹满微喘，是热气内郁。经文说：火气内发，上为口干咽烂，是火热上熏。热气上而不下降，则大便不硬，如果热气下入胃中，消耗津液，则大便硬，所以说：或者不大便，久了胃中燥热，必发胡言乱语。经文说：病深了，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。小便通利，说明阴未竭，还可以治愈。
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。看阳盛想要鼻衄，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，不通达于阴，所以颈部以下不能出汗。假设见到鼻衄，则邪气从衄解，头部就没有汗了。假设有汗，则邪气从汗解，又不衄了。后条火邪深入，必定便血，也是身体干枯而不出汗，假设有汗，就不便血了。读古人的书，全要领会意思，哪有得汗仍鼻衄、便血的道理呢！又说：仲景用小便利这一端，辨别真阴是否亡失最为细致。水出高源，小便利则津液不枯，肺气不绝可知；肾以膀胱为腑，小便利则膀胱的气化行，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。推求其原由，都是一概气血流溢，失去正常规律，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，可以导热滋干，使小便得利，则太阳的邪气也从膀胱为去路，还可以治。如果利之而不通利，火无从排出，就危险了。
太阳病，医生发汗，于是发热恶寒；接着又攻下，心下痞塞；表里都虚，阴阳之气并竭，无阳则阴独，又加上烧针。因为胸中烦闷，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，接着又攻下，又使里虚，虽然有未尽的表邪，陷里形成痞证，但表里都虚，阴阳并竭，已经成为坏证了。况且无阳则阴不生，阴独则阳不化，又加上烧针，火气内攻，阴阳皆病，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：表指误汗而言，里指误下而言，所以说都虚。阴指里，阳指表，无阳谓阳竭也，阴独谓痞也。青黄，是脾受克贼的颜色。微黄，是土见回生的颜色。手足温，是阳气回复于四肢末端。说既经过反复的错误，又见克贼之色，肌肤跳动不宁，则是脾家的真阴败坏，为难治。现在则是土见回生之色，四肢末端得温，胃家的阳复，所以为易愈。
伤寒脉浮，自汗出，小便频数，心烦，轻微恶寒，脚挛急。反而给予桂枝汤，想要攻表，这是错误。服药后就出现四肢厥逆，咽喉干燥，烦躁吐逆的，制作甘草干姜汤（Licorice and Dried Ginger Decoction）给它，以恢复其阳气；如果厥逆好转、足部温暖的，再制作芍药甘草汤（Rehmannia and Licorice Decoction）给它，它的脚就能伸直；如果胃气不和，胡言乱语的，少量给予调胃承气汤（Harmonizing the Stomach and Directing Downward Decoction）；如果再次发汗，又加上烧针的，用四逆汤（Four Reversal Decoction）主治。
【注】伤寒脉浮，自汗出，是中风证；小便频数，心烦，是里没有热的虚烦；轻微恶寒，是表阳虚不能抵御；脚挛急，是表寒收引拘急。这应当给予桂枝加附子汤（Guizhi Tang with Aconite），以温经止汗，现在反而给桂枝汤攻发表邪，这是大错误。服后便厥逆，是阳气因汗亡失；咽干，是阴液因汗枯竭；烦躁，是阳气失藏；吐逆，是阴气拒格。所以制作甘草干姜汤给它，以缓和其阴，而恢复其阳。如果厥逆好转足温，则是阳已恢复，适宜再制作芍药甘草汤给它，以调和其阴，而和其阳，则脚就能伸直。如果胃不和而胡言乱语，知道是邪气已转属阳明，应当少量多次给予调胃承气汤，令其轻微腹泻，胃和自然可愈。如果重发汗，是指不止误服桂枝汤，而更误服麻黄汤（Ephedra Decoction）。或者又加烧针劫取其汗，以致亡阳证具备，则又不是甘草干姜汤所能治，所以又当给予四逆汤，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，知道阳神自歉于上部；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（Yangdan Decoction），按法治疗而加重，厥逆，咽中干，两小腿拘急而胡言乱语。老师说半夜手足当温暖，两脚当伸直。后来像老师说的。怎么知道这一点？回答说：寸口脉浮而大，浮为风，大为虚，风则生微热，虚则两小腿挛急，病形象桂枝，因此加附子参在其中，增桂令汗出，附子温经，是亡阳的缘故。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，重与芍药甘草汤，然后小腿伸直，以承气汤轻微腹泻，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，或者其人是有热，用阳旦汤，即桂枝汤加黄芩（Scutellaria Root）。正值时令寒冷，或者其人是有寒，用阴旦汤（Yindan Decoction），即桂枝汤加干姜（Dried Ginger）。证象阳旦，是说心烦似乎有热。按法治疗，是说按法用阳旦汤。大概心烦，小便数，咽中干，似乎阳旦，而不审察脚挛急、微恶寒的证候，这是阴寒，即以阳旦汤攻其表是错误的。所以加重，厥逆，咽中干，两小腿拘急，胡言乱语等坏证发作。老师说半夜手足当温，两脚当伸，如其言者为什么呢？回答说：诊脉浮大，则为风虚，非寒虚也，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，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，继以承气汤治其阳明内结，所以轻微腹泻而胡言乱语止，其病可愈矣。这都是由于救疗得法啊！
阳旦汤方（补遗）
桂枝（三钱） 芍药（酒焙，二钱） 甘草（炙，二钱） 黄芩（酒炒，三钱） 生姜（三片） 大枣（掰开，二枚）
以上用水煎，去渣温服，不限时候，每日二三服。本方加干姜，名叫阴旦汤。
甘草干姜汤方
甘草（炙，四两） 干姜（炮，二两）
以上两味，用水三升，煮取一升五合，去渣，分两次温服。
芍药甘草汤方
芍药（四两） 甘草（炙，四两）
以上两味，用水三升，煮取一升五合，去渣，分两次温服。
伤寒吐、下后，发汗，虚烦，脉象非常微弱，八九天后心下痞硬，胁下痛，气上冲咽喉，头晕目眩，经脉跳动惕惧的，时间久了成为痿证。
【按】“八九日心下痞硬，胁下痛，气上冲咽喉”这三句，与上下文意义不连贯，必定是错简。注家因此三句，都蔓衍支离，牵强注释。不知道这个证候，总因汗出过多，大伤津液而成，应当用补气补血益筋壮骨的药物，经过一年才可以痊愈。
【注】伤寒吐下后，又发其汗，治疗失宜了，所以令阳气阴液两虚。阴液虚，所以虚烦；阳气虚，所以脉微；阳气微而不升，所以目眩冒；阴液虚而不濡，所以经脉动惕。阳气阴液亏损，久则百体失所滋养，所以力乏筋软而成为痿证。
伤寒六七天，大下后，寸脉沉而迟，手足厥逆，下部脉不至，咽喉不利，唾脓血，泄利不止的，为难治，麻黄升麻汤（Ephedra and Corydalis Decoction）主治。
【注】伤寒六七天，邪传厥阴，厥热胜复之时，医生不详审阴阳，而大下之，导致变成中寒下竭的坏证。中寒故寸脉沉迟，手足厥逆；下竭故尺脉不至，泄利不止。大概未下之前，阳经尚伏表热，大下之后，则其热乘虚下陷，内犯厥阴，厥阴经循喉咙，贯膈注肺，所以咽喉不利，唾脓血。此为阴阳错杂，表里混淆之证，若温其下，恐助上热，欲清其上，愈益中寒，仲景故以此汤主治，正是向人们展示阴阳错杂为难治，应当在表里上下寻求治法。大概下寒上热，固然难温，里寒无汗，还宜解表，所以立麻黄升麻汤，以解表和里，清上温下，随证治之。
【集注】程知说：说厥逆有因于误下致变的。凡伤寒热炽者，其阴必虚，六七天虽当传里之时，设表证仍在而大下之，则阴伤而阳亦陷。寸脉沉迟，手足厥冷，下利不止，伤其阳而气内陷也；下部脉不至，咽喉不利吐脓血，伤其阴而热内逼也。一下之误，既伤其阳，复伤其阴，故难治。给予麻黄升麻汤，以升阳调下，清热滋阴。大概传经热邪，从外入于内的，仍应当从内出于外，所以说：汗出愈。
喻昌说：寸脉沉而迟，明明是阳去入阴的缘故，不是阳气衰微可比拟。所以虽手足厥冷，下部脉不至，泄利不止，其不得为纯阴无阳可知。况咽喉不利，唾脓血，又是阳邪搏阴上逆的征验，所以仲景特于阴中提出其阳，得汗出而错杂之邪尽解矣。
麻黄升麻汤方
麻黄（去节，二两半） 升麻（一两一分） 当归（一两一分） 知母（十八铢） 黄芩（十八铢）
葳蕤（十八铢） 石膏（碎，绵裹，六铢） 白术（六铢） 干姜（六铢） 芍药（六铢） 天冬（去心，六铢） 桂枝（六铢） 茯苓（六铢） 甘草（炙，六铢）
以上十四味，用水一斗，先煮麻黄一二沸，去上沫，纳诸药，煮取三升，去渣，分三次温服，间隔如煮三升米的时间，令服完。汗出愈。
【方解】下寒上热若无表证，应当以黄连汤（Coptis Decoction）为法，今有表证，所以复立此方，以示随证消息之治也。升麻、萎
Huai Bing (Bad Disease) refers to conditions resulting from inappropriate treatment: sweating when it should not be done, vomiting when it should not be used, purging when it should not be applied, or excessive use of sweating, vomiting, or purging methods when they are indicated; or missing the proper timing for these treatments. All these constitute improper therapeutic interventions, leading to Huai Bing (Bad Disease). In cases involving the Six Yang and Six Yin channels, if various treatments such as sweating, vomiting, purging, warm needle therapy, moxibustion by fire, hot compresses, or fire coercion have been employed, resulting in Huai Bing (Bad Disease), manifestations may include: post-sweating loss of Yang Qi (Vital Energy), dizziness, vertigo, tremors, and fright; post-purging deficiency of the Middle Jiao (Middle Burner), chest binding, epigastric fullness and hardness, and persistent diarrhea; post-vomiting mental restlessness and abdominal distension; post-warm needle bleeding, mania, and fright, or even Yang Du (Toxic Heat) with skin eruptions, extreme restlessness due to Yin pathology resembling death, coma, delirium, picking at clothes, and touching the bed. These discussions are scattered across various chapters; here they are compiled into one collection for the benefit of students. There may be omissions, which depend on the reader's ability to reflect repeatedly.
In Taiyang Disease (Disease of the Exterior/Superficial Level) lasting three days, if sweating has already been administered, and further treatments like vomiting, purging, or warm needle therapy fail to resolve the condition, this is termed Huai Bing (Bad Disease). Guizhi Tang (Cinnamon Twig Decoction) should no longer be given. One must observe the pulse and symptoms, identify the nature of the iatrogenic error, and treat according to the specific syndrome pattern.
[Annotation] Taiyang Disease (Disease of the Exterior/Superficial Level) for three days indicates the pathogen is still in the Three Yang channels. If sweating, vomiting, purging, or warm needle therapies have all been attempted without resolution, this constitutes Huai Bing (Bad Disease) due to improper treatment. Even if exterior signs persist, Guizhi Tang (Cinnamon Twig Decoction) is contraindicated. The practitioner must examine the pulse and symptoms to determine the specific deviation caused by mismanagement and treat accordingly, rather than being bound by fixed formulas.
[Collected Commentaries] Fang Youzhi stated: Since the disease cannot be classified under a standard name, it is difficult to apply standard treatments. Thus, the principle is to demonstrate adaptability, applying this concept consistently.
Cheng Zhi noted: When Taiyang Disease (Disease of the Exterior/Superficial Level) is treated improperly, it becomes Huai Bing (Bad Disease); therefore, initial treatment must be cautious. Guizhi Tang (Cinnamon Twig Decoction) is withheld because the Guizhi Tang (Cinnamon Twig Decoction) syndrome has resolved; if it had persisted, it would not be called Huai Bing (Bad Disease).
Cheng Yingmao explained: For instance, post-sweating Yang Qi (Vital Energy) loss with channel agitation, thirst, irritability, and delirium; post-purging empty irritability, chest binding, and epigastric fullness; post-vomiting internal heat and abdominal distension; or post-warm needle hematemesis, epistaxis, mania, and fright—these chaotic manifestations result from prior destructive treatments. Practitioners must not apply rigid protocols to correct these deviations. Although the preceding symptoms might resemble a Guizhi Tang (Cinnamon Twig Decoction) pattern, once transformed into Huai Bing (Bad Disease), Guizhi Tang (Cinnamon Twig Decoction) is contraindicated. Observing the pulse and symptoms to identify the deviation allows for corrective treatment, aiming to restore harmony through diagnostic inquiry (inspection, auscultation/olfaction, inquiry, palpation), not merely symptomatic relief ("treating the head when the head hurts").
Wu Renju remarked: One should not rigidly adhere to the "three-day" rule for exterior diseases to prescribe Guizhi Tang (Cinnamon Twig Decoction); instead, treatment must address the current pathological transformation.
If original Taiyang Disease (Disease of the Exterior/Superficial Level) fails to resolve and transitions to Shaoyang Disease (Disease of the Half-Exterior/Half-Interior), presenting with hypochondriac fullness and hardness, dry retching, inability to eat, alternating chills and fever, and a deep, tight pulse (likely Deep and Wiry), Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
However, if vomiting, purging, sweating, or warm needle therapies have already been used, resulting in delirium and the resolution of the Xiaochaihu Tang (Minor Bupleurum Decoction) syndrome, this is Huai Bing (Bad Disease). Treatment should be guided by identifying the specific iatrogenic error.
[Note] A Deep and Tight pulse suggests cold excess in the chest, warranting emesis; however, a Deep and Wiry pulse aligns with the transition to Shaoyang, justifying Xiaochaihu Tang (Minor Bupleurum Decoction).
[Annotation] Transition from unresolved Taiyang Disease (Disease of the Exterior/Superficial Level) to Shaoyang Disease (Disease of the Half-Exterior/Half-Interior) presents with hypochondriac fullness, dry retching, anorexia, and alternating chills/fever. A Deep and Wiry pulse confirms Shaoyang involvement. If no emetic, purgative, sweating, or warm needle therapies were used, Xiaochaihu Tang (Minor Bupleurum Decoction) resolves the half-exterior/half-interior pathogen. If these therapies were previously applied, both exterior and interior are depleted. The emergence of delirium indicates the Xiaochaihu Tang (Minor Bupleurum Decoction) syndrome has ceased, constituting Huai Bing (Bad Disease). Even Xiaochaihu Tang (Minor Bupleurum Decoction) is contraindicated; treatment must address the specific deviation.
[Collected Commentaries] Cheng Wuji stated: Transition to Shaoyang Disease (Disease of the Half-Exterior/Half-Interior) constitutes a Xiaochaihu Tang (Minor Bupleurum Decoction) pattern. Subsequent use of emetics, purgatives, sweating, or warm needles violates Shaoyang contraindications, depletes fluids, causes stomach dryness, and leads to delirium. Resolution of the Xiaochaihu Tang (Minor Bupleurum Decoction) syndrome means the absence of hypochondriac fullness, dry retching, etc., defining Huai Bing (Bad Disease).
Shen Mingzong noted: Unresolved Taiyang Disease (Disease of the Exterior/Superficial Level) transmitting to Shaoyang Disease (Disease of the Half-Exterior/Half-Interior) requires Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonization. Improper use of emetics/purgatives/sweating/warm needles drives heat into Yangming Disease (Disease of the Interior/Food), causing delirium. Delirium indicates Yangming involvement; thus, treat the Yangming deviation. If other channel deviations occur without delirium, treat based on combined symptom-pulse analysis.
In Taiyang Disease (Disease of the Exterior/Superficial Level) with Wind Strike, if fire coercion is used to induce sweating, the wind pathogen combines with fire heat. Blood and Qi flow excessively, losing their normal rhythm. The interaction of two Yang pathogens scorches the body, causing jaundice. Excess Yang may cause epistaxis; Yin deficiency leads to dysuria. Complete depletion of Yin and Yang results in dry, rough skin. Sweating is limited to the head up to the neck. Abdominal distension, slight wheezing, dry mouth, and throat erosion occur. Constipation may develop; prolonged heat causes delirium, severe cases lead to hiccups, restless limbs, picking at clothes, and touching beds. If urination remains free, the prognosis is favorable.
[Annotation] Using fire coercion instead of Guizhi Tang (Cinnamon Twig Decoction) for Wind Strike causes iatrogenic complications. Wind is a Yang pathogen; fire exacerbates heat, disrupting blood and Qi dynamics. The combination of wind and fire (two Yangs) scorches the body, causing jaundice. Heat forces blood upward (epistaxis); fluid depletion causes dysuria. Yang heat steams Yin fluids upward, causing head-only sweating. Heat transmitting to Taiyin causes abdominal distension; to Shaoyin causes throat erosion; stagnation in the chest causes lung dryness and wheezing; accumulation in the stomach causes constipation. Prolonged heat deepens, leading to hiccups, delirium, coma, and limb restlessness. These Huai Bing (Bad Disease) states stem from fire chaos destroying True Yin, often incurable. However, preserved urination indicates residual Yin, allowing for treatment. Caution is essential from the start.
[Collected Commentaries] Cheng Wuji cited the *Neijing*: "All bloating and abdominal distension belong to Heat." Abdominal distension and slight wheezing indicate internal heat stagnation. Fire heat rising causes throat erosion. If heat descends to the stomach, it consumes fluids, hardening stool and causing delirium. Severe disease manifests as hiccups due to rebellious Qi. Limbs are the root of Yang; excess Yang causes movement (restlessness). Free urination indicates non-depleted Yin, suggesting treatability.
Yu Chang argued: This pattern involves Yang pathogens combining with fire to disrupt Yin, causing Yin depletion, distinct from previous Yang-loss patterns. Symptoms like impending epistaxis and dryness indicate the need to urgently clear Yang to preserve remaining Yin. One must not misinterpret "depletion of Yin and Yang" as a indication to tonify Yang. Head sweating results from Yang obstruction preventing downward flow. Epistaxis or sweating would allow pathogen exit. Reading classics requires understanding intent; sweating followed by epistaxis/bloody stool is logically inconsistent. Yu Chang praised Zhang Zhongjing’s use of urination status to assess Yin preservation, linking kidney/bladder function to fluid metabolism.
Cheng Yingmao summarized: These symptoms reflect fire chaos destroying True Yin. The root is disrupted blood/Qi dynamics. At this stage, treating wind exacerbates fire; treating fire is hindered by wind stagnation. The only viable approach is promoting urination (e.g., Zhu Ling Tang [Polyporus Decoction]) to guide heat out via the bladder. Failure to promote urination leads to danger.
If Taiyang Disease (Disease of the Exterior/Superficial Level) is over-treated with sweating, resulting in persistent fever and aversion to cold, followed by purging causing epigastric痞 (fullness/stuffiness), both exterior and interior are depleted, and Yin/Yang Qi are exhausted. "No Yang implies Yin stands alone." Adding fire needle therapy causes chest irritability. Cyan-yellow complexion and muscle twitching indicate a difficult prognosis. Mild yellow complexion and warm hands/feet indicate ease of recovery.
[Annotation] Over-sweating depletes the exterior; subsequent purging depletes the interior. Residual pathogen sinks inward, forming epigastric痞 (fullness/stuffiness). With both exterior/interior and Yin/Yang depleted, Huai Bing (Bad Disease) is established. "No Yang" prevents Yin generation; "Yin alone" prevents Yang transformation. Fire needle therapy aggravates this, causing chest fullness/irritability, cyan-yellow face, and muscle twitching. Complex symptoms make treatment difficult. Mild yellow color and warm extremities indicate surviving Yin/Yang, ensuring easier recovery.
[Collected Commentaries] Fang Youzhi explained: "Exterior" refers to erroneous sweating; "Interior" to erroneous purging. "Yin" denotes interior; "Yang" denotes exterior. "No Yang" means Yang exhaustion; "Yin alone" refers to epigastric痞 (fullness/stuffiness). Cyan-yellow represents Spleen suppression; mild yellow represents Spleen recovery. Warm extremities indicate Yang returning to the limbs. Complex errors with suppression signs and muscle twitching indicate Spleen Yin collapse (difficult). Recovery signs (yellow color, warmth) indicate Stomach Yang restoration (easy).
In Cold Damage with Floating Pulse, spontaneous sweating, frequent urination, heart vexation, slight aversion to cold, and foot cramping: Prescribing Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is an error. This leads to limb coldness, dry throat, irritability, and vomiting. Administer Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang. Once limbs warm, administer Shaoyao Gancao Tang (Rehmannia and Licorice Decoction) to extend the legs. If stomach disharmony causes delirium, give small amounts of Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction). If severe sweating and fire needles cause Yang collapse, Sini Tang (Four Reversal Decoction) is indicated.
[Annotation] Floating pulse with spontaneous sweating indicates Wind Strike; frequent urination and heart vexation indicate interior deficiency heat; slight aversion to cold indicates exterior Yang deficiency; foot cramping indicates exterior cold contraction. The correct formula is Guizhi Tang with Added Aconite (Guizhi Jia Fuzi Tang) to warm channels and stop sweating. Using plain Guizhi Tang (Cinnamon Twig Decoction) is erroneous. Post-medication limb coldness indicates Yang loss; dry throat indicates Yin depletion; irritability indicates Yang instability; vomiting indicates Yin rejection. Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) restores Yang. Once Yang returns (warm limbs), Shaoyao Gancao Tang (Rehmannia and Licorice Decoction) nourishes Yin to relieve cramping. Delirium indicates transmission to Yangming Disease (Disease of the Interior/Food); Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction) clears stomach heat gently. Severe errors involving Ephedra Decoction (Mahuang Tang) or fire needles require Sini Tang (Four Reversal Decoction) to rescue collapsed Yang.
[Collected Commentaries] Cheng Yingmao noted: Although floating pulse and sweating resemble Guizhi Tang (Cinnamon Twig Decoction) syndrome, absence of head/neck pain suggests deficient Upper Jiao (Upper Burner) Yang. Aversion to cold and cramping suggest Lower Jiao (Lower Burner) Yin pathogen invasion. Yang deficiency with Yin excess causes rebellious Qi (heart vexation). The error lies in misinterpreting "vexation." The conclusion regarding Sini Tang (Four Reversal Decoction) for severe errors shows that Yin patterns can arise from treatment errors, not just direct pathogen entry.
Q: A pattern resembles Yangdan Tang (Yangdan Decoction); treatment worsens it, causing limb coldness, dry throat, calf cramping, and delirium. The Master predicted recovery at midnight. How?
A: Floating and Large pulse at Cun position indicates Wind and Deficiency. Wind causes slight heat; deficiency causes calf cramping. The pattern mimics Guizhi Tang (Cinnamon Twig Decoction), but requires Aconite and increased Cinnamon to induce sweating and warm channels due to Yang loss. Limb coldness, dry throat, irritability, and delirium indicate Yangming Disease (Disease of the Interior/Food) internal binding. Re-administering Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) restores Yang at midnight. Shaoyao Gancao Tang (Rehmannia and Licorice Decoction) relieves cramping. Chengqi Tang (Bowel-Purging Decoction) clears Yangming Disease (Disease of the Interior/Food) binding, stopping delirium. Thus, recovery is assured.
[Annotation] This Q&A clarifies the previous case. Yangdan Tang (Yangdan Decoction) is Guizhi Tang (Cinnamon Twig Decoction) plus Huangqin (Scutellaria Root) for heat, or Ganjiang (Dried Ginger) for cold. "Resembling Yangdan" implies apparent heat (vexation). Misdiagnosing Yin-cold signs (cramping, aversion to cold) as heat and using Yangdan Tang (Yangdan Decoction) worsens the condition. Floating/Large pulse indicates Wind-Deficiency, not Cold-Deficiency. Aconite warms channels; Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) restores Yang. Shaoyao Gancao Tang (Rehmannia and Licorice Decoction) harmonizes Yin. Chengqi Tang (Bowel-Purging Decoction) addresses Yangming Disease (Disease of the Interior/Food). Success depends on accurate rescue strategies.
Yangdan Tang Formula (Supplement):
Guizhi (3 qian), Shaoyao (2 qian, wine-baked), Gancao (2 qian, honey-fried), Huangqin (3 qian, wine-fried), Shengjiang (3 slices), Dazao (2 pieces, split).
Decoct in water, strain, take warm at any time, 2-3 times daily. Adding Ganjiang (Dried Ginger) creates Yindan Tang (Yindan Decoction).
Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) Formula:
Gancao (4 liang, honey-fried), Ganjiang (2 liang, roasted).
Decoct 3 sheng water to 1.5 sheng, strain, divide into 2 warm doses.
Shaoyao Gancao Tang (Rehmannia and Licorice Decoction) Formula:
Shaoyao (4 liang), Gancao (4 liang, honey-fried).
Decoct 3 sheng water to 1.5 sheng, strain, divide into 2 warm doses.
After Cold Damage vomiting/purging and sweating, empty vexation, very faint pulse, followed after 8-9 days by epigastric fullness/hardness, hypochondriac pain, Qi rushing to the throat, dizziness, and channel twitching, long-term progression leads to Wei Syndrome (Flaccidity Syndrome).
[Note] The phrases "8-9 days epigastric fullness... Qi rushing..." seem disconnected and likely textual errors. The core pathology is excessive sweating damaging fluids. Treatment requires Qi/Blood tonification and tendon/bone strengthening over a year.
[Annotation] Post-emesis/purging/sweating causes dual deficiency of Yang Qi and Yin Fluids. Yin deficiency causes empty vexation; Yang deficiency causes faint pulse. Low Yang fails to rise, causing dizziness; deficient Yin fails to moisten, causing channel twitching. Long-term deficiency leads to malnourishment of tissues, resulting in weakness and flaccidity (Wei Syndrome).
After 6-7 days of Cold Damage, severe purging leads to Deep/Slow Cun pulse, limb coldness, absent lower pulses, throat obstruction, spitting pus/blood, and persistent diarrhea. This is difficult to treat; Mahuang Shengma Tang (Ephedra and Corydalis Decoction) is indicated.
[Annotation] Day 6-7 marks the Jueyin Disease (Disease of the Terminal Yin) phase of alternating cold/heat. Erroneous severe purging causes Middle Cold and Lower Exhaustion. Middle Cold causes Deep/Slow pulse and limb coldness; Lower Exhaustion causes absent lower pulses and diarrhea. Pre-purging, latent heat existed; post-purging, heat sinks into Jueyin Disease (Disease of the Terminal Yin), affecting the throat/lungs (pus/blood). This complex pattern mixes Yin/Yang and Exterior/Interior. Warming the lower risks aiding upper heat; clearing the upper risks worsening middle cold. Mahuang Shengma Tang (Ephedra and Corydalis Decoction) harmonizes exterior/interior, clears upper heat, and warms lower cold.
[Collected Commentaries] Cheng Zhi stated: Limb coldness can result from erroneous purging. High heat depletes Yin; purging exterior patterns damages both Yin and Yang. Deep/Slow pulse/diarrhea indicates Yang damage/depression; absent lower pulses/throat issues indicate Yin damage/heat pressure. Dual damage makes it difficult. Mahuang Shengma Tang (Ephedra and Corydalis Decoction) raises Yang, regulates lower, clears heat, and nourishes Yin. Pathogens entering internally should exit externally; sweating cures this.
Yu Chang argued: Deep/Slow Cun pulse indicates Yang sinking into Yin, not mere Yang decline. Despite cold limbs and diarrhea, it is not pure Yin without Yang. Throat issues indicate Yang pathogen attacking Yin upward. Zhang Zhongjing extracts Yang from Yin; sweating resolves the mixed pathogens.
Mahuang Shengma Tang (Ephedra and Corydalis Decoction) Formula:
Mahuang (2.5 liang, nodes removed), Shengma (1.1 liang), Danggui (1.1 liang), Zhimu (18 zhu), Huangqin (18 zhu), Weirui (18 zhu), Shigao (6 zhu, wrapped), Baizhu (6 zhu), Ganjiang (6 zhu), Shaoyao (6 zhu), Tiandong (6 zhu, heart removed), Guizhi (6 zhu), Fuling (6 zhu), Gancao (6 zhu, honey-fried).
Decoct 10 dou water. Boil Mahuang briefly, remove foam, add other herbs. Cook to 3 sheng, strain, divide into 3 warm doses. Take within the time it takes to cook 3 sheng of rice. Cure upon sweating.
[Formula Analysis]: If Lower Cold/Upper Heat lacks exterior signs, Huanglian Tang (Coptis Decoction) is appropriate. Here, exterior signs exist, necessitating this formula to demonstrate adaptive treatment. Shengma, Weirui...