蕤、黄芩、石膏、知母、天冬，乃升举走上清热之品，用以避下寒，且以滋上也；麻黄、桂枝、干姜、当归、
白芍、白术、茯苓、甘草，乃辛甘走外温散之品，用以远上热，且以和内也。分温三服令尽，汗出愈，其意在
缓而正不伤，彻邪而尽除也。脉虽寸脉沉迟、尺脉不至，证虽手足厥逆、下利不止，究之原非纯阴寒邪，故兼
咽喉痛、唾脓血之证，是寒热混淆、阴阳错杂之病，皆因大下夺中所变。故仲景用此汤，以去邪为主，邪去而
正自安也。
伤寒八九日，下之，胸满烦惊，小便不利，谵语，一身尽重，不可转侧者，柴胡加龙骨牡蛎汤主之。
【注】伤寒八九日，邪不解，表不尽，不可下也。若下之，其邪乘虚内陷。在上者，轻则胸满，重则结
胸。胸满者，热入于胸，气壅塞也。在中者，轻则烦惊，重则昏狂。烦惊谵语者，热乘于心，神不宁也。在下
者，轻则小便不利，重则少腹满痛。小便不利者，热客下焦，水道阻也。邪壅三焦，则荣卫不行，
水无去路，则外渗肌体，故一身尽重，不可转侧也。以柴胡加龙骨牡蛎汤主之，其大意在和解镇固，攻补兼施也。
【按】此条乃阳经湿热之身重，若以为津亡血涩，阳气不能宣布，阴经湿寒之身重则误矣。寒湿身重，用
真武汤、桂枝附子汤，以不渴里无热也；热湿身重，用白虎汤、柴胡加龙骨牡蛎汤，以谵烦胃有热也。其风湿、
风温身重，亦不外乎兼寒兼热，故此汤中用苓、半、大黄为佐也。
【集注】方有执曰∶胸满者，下后里虚，外热入里，挟饮上搏于膈，所以烦也。惊伤心，心藏神而居膈，
正虚邪胜所以不宁。一身尽重，不可转侧者，伤寒本一身疼痛，亡津液而血涩不利，故变为沉滞而重甚也。
程知曰∶下而心烦腹满，治以栀、朴，为邪入腹也。下而胸满烦惊，治以龙、牡，为邪入心也。因火劫
而致烦惊，治以桂枝龙牡，挽心阳之外越也。因下而致烦惊，治以柴胡龙骨牡蛎，解心阳之内塞也。大、小陷
胸，以高下缓急别之；诸泻心汤，以寒热虚实辨之。半、苓治痰，芩、连降逆，栀、豉涌虚烦，参、附回阳虚，
下后大法，备于斯矣。
喻昌曰∶八九日过经乃下之，可谓慎矣！孰知外邪未尽，乘虚而陷，邪方在表里，其患已及于神明，于
此而补天浴日，岂复易易。
张璐曰∶此系少阳之里证，诸家注作心经病，误也。盖少阳有三禁，不可妄犯。虽八九日过经，下之尚
且邪气内犯，胃土受伤，胆木失荣，痰聚膈上，有如是之变，故主以小柴胡和解内外，逐饮通津，加龙骨、牡
蛎，以镇肝胆之惊也。
柴胡加龙骨牡蛎汤方
柴胡（四两） 半夏（洗，二合） 龙骨（一两半） 人参（一两半） 大黄（二两） 牡蛎（一两半）
茯苓（一两半） 铅丹（一两半） 桂枝（一两半） 生姜（一两半） 大枣（擘，二枚）
上十一味，以水八升，煮取四升，纳大黄切如棋子，更煮一二沸，去滓，温服一升。
【方解】是证也，为阴阳错杂之邪；是方也，亦攻补错杂之药。柴、桂解未尽之表邪，大黄攻已陷之里热，
人参、姜、枣补虚而和胃，茯苓、半夏利水而降逆，龙骨、牡蛎、铅丹之涩重，镇惊收心而安神明，斯为以错
杂之药，而治错杂之病也。
汗家重发汗，必恍惚心乱，小便已，阴痛，与禹余粮丸。
【按】禹余粮丸为涩痢之药，与此证不合。“与禹余粮丸”五字，衍文也。
【注】汗家，谓平素好出汗之人也。重发汗，谓大发汗也。心主血，汗乃心之液，重发其汗，血液大伤，
心失所恃，故神情恍惚，心志不宁也。液竭于下，宗筋失养，故小便已阴茎疼也。
【集注】方有执曰∶心主血而藏神，汗多则血虚而舍空。恍惚心乱者，以舍空神纷散也。阴，宗筋也。痛
者，液竭而失其所荣养也。
程应旄曰∶心主血，汗者心之液，平素多汗之家，心虚血少可知。重发其汗，遂至心失所养，神恍惚而多
忡憧之象，此之谓乱。小肠与心为表里，心液虚而小肠之水亦竭，故小便已而阴疼也。
衄家不可发汗，汗出必额上陷脉紧急，目直视，不能 ，不得眠。
【注】衄家者，该吐血而言也。谓凡衄血、吐血之人，阴气暴亡，若再发其汗，汗出液竭，诸脉失养，则
额角上陷中之脉，为热所灼，故紧且急也。目直视，目瞪不转睛也。不能 ，目睫不合也。亦皆由热灼其脉，
引缩使然。不得眠者，阳气不能行于阴也。凡此所见之病，皆阳盛阴微之危证。谁谓衄家可轻发其汗耶！
【集注】喻昌曰∶目得血而能视，汗为血液，衄血之人清阳之气素伤，更发其汗，则额上必陷，乃上焦
枯竭之应也。诸脉皆属于目筋，脉紧急，则目上瞪而不能合，目不合，则不得眠也。伤寒发烦目瞑者，必衄，
宜麻黄汤发其汗。此言素常失血之人，戒发其汗，以重虚其虚故也。
亡血家不可发汗，发汗则寒栗而振。
【注】凡失血之后，血气未复，为亡血虚家，皆不可发汗也。盖失血之初，固属阳热，然亡血之后，热
随血去，热固消矣，而气随血亡，阳亦危矣。若再发汗，则阳气衰微，力不能支，故身寒噤栗，振振耸动，所
必然也。盖发阴虚之汗，汗出则亡阴，即发暴吐衄血之汗也，故见不能 、不得眠、亡阴等病也。发阳虚之汗，
汗出则亡阳，即发亡血虚家之汗也，故见寒栗而振、亡阳等病也。
【集注】方有执曰∶亡血阴已虚矣，发汗复亡其阳，故寒栗而振也。
程应旄曰∶亡血阴虚，阳已失根据，若发其汗，阳从外脱，故寒粟而振，是为阴阳两竭。凡遇当汗证，便
当顾虑阴经之荣血，有如此者。
魏荔彤曰∶与其汗出亡阳方救阳，何如汗未出先救阴以维阳，不令汗出亡阳之为愈也。
咽喉干燥者，不可发汗。
【注】咽喉干燥，津液不足也。更发其汗，则津液益枯，故戒。人虽有可汗之证，亦不可发汗也。
【集注】方有执曰∶咽喉干燥，津液素亏，本于肾水不足，盖少阴之脉循喉咙也，发汗则津液愈亡。
程应旄曰∶凡遇可汗之证，必当顾虑上焦之津液，又有如此者。
张璐曰∶此条与咽中闭塞，似同实异。此戒发汗以夺阳明之津，彼戒发汗以夺少阴之血也。
淋家不可发汗，发汗则便血。
【注】淋家者，湿热蓄于膀胱，水道涩痛之病也。若发其汗，湿随汗去，热必独留，水腑告匮，迫其本
经之血，从小便而出矣。
【集注】程知曰∶膀胱里热则淋，更发其汗则膀胱愈燥，而小便血矣。
疮家虽身疼痛，不可发汗，发汗则痉。
【注】疮家初起毒热未成，法当汗散，已经溃后，血气被伤，虽有身痛应汗表证，亦不可发汗。恐汗出
荣卫愈虚，外风乘袭，即不受外风，筋失液养，亦必致项强反张，而成痉病也。
【集注】喻昌曰∶身疼痛为寒伤荣之证，本当发汗，疮疡之人，肌表素虚，荣血暗耗，更发其汗，则外
风袭虚，内血不荣，必致颈项强，身反张而成痉。痉亦膀胱之病也。
太阳伤寒者，加温针必惊也。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，先
灸核上各一壮，与桂枝加桂汤，更加桂。
【注】太阳伤寒，加温针必惊者，谓病伤寒之人，卒然加以温针，其心畏而必惊也，非温针之后，必生
惊病也。烧针即温针也，烧针取汗，亦是汗法，但针处宜当避寒，若不谨慎，外被寒袭，火郁脉中，血不流行，
必结肿核赤起矣。且温针之火，发为赤核，又被寒侵，故不但不解，反召阴邪。盖加针之时，心既被惊，所以
肾阴乘心之虚。上凌心阳而发奔豚也。奔豚者，肾阴邪也，其状气从少腹上冲于心也。先灸核上各一壮者，外
去寒邪，继与桂枝加桂汤。更加桂者，内伐肾邪也。
桂枝加桂汤方
于桂枝汤方内，更加桂二两，成五两，余
根据桂枝汤法。
【集解】徐彬曰∶此乃太阳风邪，因烧针令汗，复感于寒，邪从太阳之腑膀胱袭入相合之肾脏，而作奔豚，
故仍从太阳之例，用桂枝全方。倍加桂者，以内泻阴气，兼驱外邪也。
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。
【注】火熏，古劫汗法也，即今火炕温覆取汗之法。太阳病，以火熏之不得汗，其人必内热躁甚，阴液愈
伤，阳不得阴，无从化汗，故反致不解也。其火袭入阴中，伤其阴络，迫血下行，故必圊血也。命名火邪，示
人以当治火邪，不必治圊血也。
【集注】方有执曰∶躁，手足疾动也；到，犹言反也，谓徒躁扰而反不得解也。汗为血之液，血得热则行，
火性大热，既不得汗，则血必横溢，所以必圊血也。
程应旄曰∶太阳病以火熏之，取汗竟不得汗，其液之素少可知，盖阳不得阴，则无从化汗也。阴虚被火，
热无从出，故其人躁扰不宁也。
脉浮热甚，反灸之，此为实，实以虚治。因火而动，故咽燥而吐血。
【注】脉浮热甚，实热在表也，无灸之之理，而反灸之，此为实实，谓其误以实为虚也。故热因火动，其
势炎炎，致咽燥而吐血必矣。盖上条火伤阴分，迫血下行，故令圊血；此条火伤阳分，迫血上行，故吐血也。
【集注】程应旄曰∶表实有热，误认虚寒，而用灸法，热无从泄，因火而动，自然内攻。邪束于外，火攻
于内，肺金被伤，故咽燥而吐血。
汪琥曰∶表有风热而反灸，是以实作虚治也。
微数之脉，甚不可灸，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。
【注】微数之脉，乃阴虚血少之诊，断不可灸，若误灸之，艾火内攻，为烦为逆。烦者，阴为阳扰也。逆
者，追虚逐实也。阴本虚，而加以火则愈虚，是为追虚；阳本实，而加以火则愈实，是为逐实。然血已耗散，
脉中艾火之气虽微，而内攻有力矣。故致焦骨伤筋，血难复也。
【集注】喻昌曰∶脉微而数，阴虚多热之征也。此而灸之，则虚者愈虚，热者愈热，不致伤残不止矣。
程应旄曰∶若血少阴虚之人，脉见微数，尤不可灸，以血主濡之，主润筋骨也。若失其所濡，则火之所至，
其骨必焦，其筋必损，内伤其阴，未有不流散于经脉者也。
荣气微者，加烧针，则血留不行，更发热而躁烦也。
【注】荣气微者，荣血虚微也。荣血既已虚微，若误加烧针，则荣血涸留而无所行也。岂止焦骨伤筋而已
哉！所以更发热而躁烦也。
【集注】程知曰∶言荣微忌烧针也。阴虚则内热，若加烧针以助阳，则两热相合，而荣血不行，必更外发
热而内烦躁也。
唐不岩曰∶其始也虽微流，烧针以逼之也；其既也留而不行，烧针以竭之也。
张璐曰∶火为阳邪，必伤阴血，治此者，当以救阴为主。
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。
【注】脉浮表邪，宜以汗解，误用火灸，伤其血液，不能作汗，反令表邪无所从出，以致邪因火盛，外不
焦骨伤筋，内不吐衄、圊血，而病腰以下重痹者，必其人素有湿邪在下，故从湿化也。重者，着也，重着不移
也。然不以痹名者，以非风寒湿之痹，乃因火逆不相交通，故名火逆也。
【集注】方有执曰∶痹，湿病也。因火逆治火邪夹阳邪而上逆，阳不下通，阴不用事，化不行而水不得泄，
故湿着下体而重痹也。
程应旄曰∶脉浮在表，汗解为宜矣。因火灸之，不能得汗，则邪无出路，因火而盛，即不焦骨伤筋，而火
阻其邪，阴气渐竭，下焦乃荣血所治，荣气竭而不运，必重着而为痹，名曰火逆。示人欲治其痹，宜先治其火也。
形作伤寒，其脉不弦紧而弱，弱者必渴，被火者必谵语。弱者，发热。脉浮，解之当汗出愈。
【按】三“弱”字，当俱是“数”字，若是“弱”字，热从何有？不但文义不属，且论中并无此说。
【注】形作伤寒者，言其病形作伤寒之状也。但其脉不弦紧而数，数者热也。脉浮数，热在表，太阳证也；
沉数，热在里，阳明证也。数脉为热，热入阳明，故必口渴；若被火劫，其热更甚，故必谵语。脉数之病，虽
皆发热，然其施治不无别焉。若脉浮数发热，解之当以汗，汗出可愈，宜大青龙汤；脉沉数发热，解之当以下，
下之可愈，宜调胃承气汤，若脉数无表里证，惟发热而渴谵语者，不可汗下，宜白虎汤、黄连解毒汤，清之可也。
伤寒脉浮，医以火逼劫之，亡阳，必惊狂，起卧不安者，桂枝去芍药加蜀漆龙骨牡蛎救逆汤主之。
【注】伤寒脉浮，医不用麻桂之药，而以火劫取杆，汗过亡阳，故见惊狂，起卧不安之证。盖由火劫之误，
热气从心，且大脱津液，神明失倚也。然不用附子四逆辈者，以其为火劫亡阳也。宜以桂枝汤去芍药加蜀漆龙
骨牡蛎救逆汤主之。去芍药者，恐其阴性迟滞，兼制桂枝不能迅走其外，反失救急之旨。况既加龙、蛎之固脱，
亦不须芍药之酸收也。蜀漆气寒味苦，寒能胜热，苦能降逆，火邪错逆，在所必需也。
【集注】喻昌曰∶篇中误服大青龙汤，厥逆，筋惕肉 ，而亡阳者，乃汗多所致，故用真武汤救之。此以
（前文接续）蕤仁、黄芩、石膏、知母、天冬，属于升发向上、清热的药物，用来避开下部的寒邪，并且滋养上部的津液；麻黄、桂枝、干姜、当归、白芍、白术、茯苓、甘草，属于辛甘发散、走表温散的药物，用来远离上部的热邪，并且调和内部。分三次温服，服完即止，若出汗则病愈，其用意在于药性缓和而不损伤正气，彻底祛除病邪并完全清除。脉象虽然寸部沉迟、尺部脉搏摸不到，症状虽然有手足冰冷、腹泻不止，但究其根本并非纯粹的阴寒邪气，所以兼有咽喉疼痛、咳吐脓血的症状，这是寒热混淆、阴阳错杂的疾病，都是因为误用峻下法攻伐中焦而变生出来的。所以张仲景使用此汤，以祛除病邪为主，病邪去除后正气自然安宁。
伤寒病程到了第八九日，经过泻下治疗后，出现胸中胀满、烦躁惊悸、小便不利、说胡话、全身沉重、不能翻身转侧的症状，应当用柴胡加龙骨牡蛎汤主治。
【注解】伤寒病程到了第八九日，邪气未解，表证未尽，不可使用泻下法。如果误用泻下法，邪气就会乘虚内陷。在上部的，轻则胸中胀满，重则形成结胸。胸中胀满，是因为热邪进入胸中，气机壅塞所致。在中部的，轻则烦躁惊悸，重则昏迷狂乱。烦躁、惊悸、说胡话，是因为热邪侵犯心脏，神志不宁所致。在下部的，轻则小便不利，重则少腹满痛。小便不利，是因为热邪客居下焦，水道阻塞所致。邪气壅滞三焦，导致营卫运行不畅，水液没有出路，外渗于肌肤，所以全身沉重，不能翻身转侧。用柴胡加龙骨牡蛎汤主治，其大意在于和解表里、镇固心神，攻邪与补正兼施。
【按语】这一条所述的是阳经湿热导致的身体沉重，如果认为是津液枯竭、血液涩滞、阳气不能宣通所致的阴经湿寒身体沉重，那就错了。寒湿引起的身体沉重，用真武汤、桂枝附子汤治疗，因为患者口不渴且体内无热；热湿引起的身体沉重，用白虎汤、柴胡加龙骨牡蛎汤治疗，因为患者有谵语、烦躁且胃中有热。风湿、风温引起的身体沉重，也不外乎兼夹寒邪或热邪，所以此方中使用茯苓、半夏、大黄作为佐药。
【集注】方有执说：胸中胀满，是泻下后里气虚弱，外部热邪入里，挟带痰饮上搏于膈膜，所以烦闷。惊悸伤及心脏，心藏神且居于膈下，正气虚弱邪气亢盛，所以神志不宁。全身沉重，不能翻身转侧，是因为伤寒本来全身疼痛，亡失津液导致血液涩滞不通，所以变为沉滞且沉重更甚。
程知说：泻下后心烦腹满，用栀子、厚朴治疗，是因为邪气进入腹部。泻下后胸中胀满、烦躁惊悸，用龙骨、牡蛎治疗，是因为邪气进入心脏。因火疗劫汗导致烦躁惊悸，用桂枝加龙骨牡蛎汤治疗，是为了挽回外越的心阳。因泻下导致烦躁惊悸，用柴胡加龙骨牡蛎汤治疗，是为了解除心阳的内塞。大陷胸汤和小陷胸汤，是根据病位高下和病情缓急来区分的；各种泻心汤，是根据寒热虚实来辨别的。半夏、茯苓治痰，黄芩、黄连降逆，栀子、豆豉涌吐虚烦，人参、附子回阳救逆，泻下后的治疗大法，都包含在这里了。
喻昌说：过了八九日传经之后才使用泻下法，可以说是谨慎了！谁知道外邪未尽，乘虚内陷，邪气尚在表里之间，祸患已经波及神明，在此时想要补救，难道容易吗？
张璐说：这属于少阳病的里证，各家注解都说是心病，是错误的。少阳病有三禁，不可妄犯。虽然过了八九日传经，误用泻下尚且导致邪气内犯，胃土受伤，胆木失养，痰聚积在膈上，出现这样的变化，所以主张用小柴胡汤和解内外，逐饮通津，加上龙骨、牡蛎，来镇摄肝胆的惊悸。
柴胡加龙骨牡蛎汤方
柴胡（四两） 半夏（洗，二合） 龙骨（一两半） 人参（一两半） 大黄（二两） 牡蛎（一两半）
茯苓（一两半） 铅丹（一两半） 桂枝（一两半） 生姜（一两半） 大枣（掰开，二枚）
以上十一味药，用水八升，煮取四升，放入切好的大黄，再煮一二沸，去渣，温服一升。
【方解】这个病症，是阴阳错杂的邪气；这个方剂，也是攻补错杂的药物。柴胡、桂枝解除未尽的表邪，大黄攻逐已陷入里的热邪，人参、生姜、大枣补虚和胃，茯苓、半夏利水降逆，龙骨、牡蛎、铅丹的涩重之性，镇惊收心以安神志，这就是用错杂的药物来治疗错杂的疾病。
平素多汗的人，如果再大发汗，必定会出现心神恍惚、心中混乱，小便结束后阴茎疼痛，给予禹余粮丸。
【按语】禹余粮丸是涩肠止痢的药物，与此证不合。“给予禹余粮丸”五个字，是衍文（多余的文字）。
【注解】汗家，指平素喜欢出汗的人。重发汗，指大发汗。心主血，汗是心的体液，大发其汗，血液大伤，心失去依靠，所以神情恍惚，心志不宁。津液枯竭于下，宗筋失去滋养，所以小便结束后阴茎疼痛。
【集注】方有执说：心主血而藏神，汗多则血虚而心舍空虚。心神恍惚、心中混乱，是因为心舍空虚、神志纷散。阴，指宗筋。疼痛，是因为津液枯竭而失去荣养。
程应旄说：心主血，汗是心的体液，平素多汗的人，可知心虚血少。再大发其汗，致使心失所养，神志恍惚而有多种惊恐之象，这就叫乱。小肠与心互为表里，心液虚亏则小肠之水也枯竭，所以小便结束后阴部疼痛。
有鼻出血病史的人，不可发汗，若发汗导致汗出，必定出现额角动脉凹陷、脉搏紧急、两眼直视不能转动、眼睑无法闭合、不能入睡。
【注解】衄家，包括吐血在内。凡是经常鼻出血、吐血的人，阴气突然亡失，如果再发其汗，汗出津液枯竭，各条经脉失去滋养，那么额角凹陷处的脉络，被热邪灼烧，所以紧绷且紧急。两眼直视，是指眼睛瞪大不转动。眼睑无法闭合，是指眼皮合不上。这些都是由于热邪灼烧脉络，牵引收缩所致。不能入睡，是因为阳气不能行于阴分。凡此所见到的病症，都是阳盛阴微的危险证候。谁说衄家可以轻易发汗呢！
【集注】喻昌说：眼睛得到血液才能视物，汗是血液的液体，鼻出血的人清阳之气素来受损，再发其汗，则额部必然凹陷，这是上焦枯竭的反应。诸条脉络都连属于目筋，脉搏紧急，则眼睛上瞪而不能闭合，眼睛不闭合，就不能入睡。伤寒出现心烦、眼睛昏花者，必定会鼻出血，适宜用麻黄汤发其汗。这里说的是平素失血的人，告诫不可发汗，以免使虚者更虚。
【注解】凡是失血之后，气血尚未恢复，称为亡血虚家，都不可发汗。大概失血之初，固然属于阳热，但亡血之后，热随血去，热邪固然消减，但气随血亡，阳气也危险了。如果再发汗，则阳气衰微，力量不能支撑，所以身体寒冷、战栗发抖，这是必然的。大概发阴虚之汗，汗出则亡阴，即发暴吐、鼻出血者的汗，所以出现眼睑无法闭合、不能入睡、亡阴等病症。发阳虚之汗，汗出则亡阳，即发亡血虚家的汗，所以出现恶寒战栗、身体颤抖、亡阳等病症。
【集注】方有执说：亡血则阴已虚，发汗又亡其阳，所以恶寒战栗、身体颤抖。
程应旄说：亡血阴虚，阳气已经失去依托，若发其汗，阳气从体表脱失，所以恶寒战栗、身体颤抖，这是阴阳两竭。凡是遇到应当发汗的证候，就应当顾虑阴经的营血，情况像这样。
魏荔彤说：与其等到汗出亡阳再去救阳，何如汗未出先救阴以维系阳气，不让汗出亡阳更好呢？
咽喉干燥的人，不可发汗。
【注解】咽喉干燥，是津液不足。再发其汗，则津液更加枯槁，所以告诫不可发汗。人即使有可发汗的证候，也不可发汗。
【集注】方有执说：咽喉干燥，是津液素来亏损，根源在于肾水不足，因为少阴经脉循行喉咙，发汗则津液更加亡失。
程应旄说：凡是遇到可发汗的证候，必须顾虑上焦的津液，情况又像这样。
张璐说：这一条与咽中闭塞，看似相同实则不同。这条是告诫发汗会剥夺阳明经的津液，那条是告诫发汗会剥夺少阴经的血。
【注解】淋家，是指湿热蓄积在膀胱，水道涩痛疾病的人。如果发其汗，湿气随汗而去，热邪必定独自留下，水腑告急匮乏，逼迫本经之血，从小便排出。
【集注】程知说：膀胱里有热则淋，再发其汗则膀胱更加燥热，从而小便出血。
【注解】疮家初起毒热未成，依法应当发汗解散，已经溃破后，血气被损伤，即使有身体疼痛应当发汗解表的证候，也不可发汗。恐怕汗出导致营卫更加虚弱，外风乘虚侵袭，即使不受外风，筋脉失去津液滋养，也必定导致项强反张，而成痉病。
【集注】喻昌说：身体疼痛是寒伤营血的证候，本当发汗，疮疡之人，肌表素来虚弱，营血暗中耗损，再发其汗，则外风袭击虚弱之处，内血不能荣养，必定导致颈项强直、身体反张而成痉病。痉病也是膀胱的病。
烧针令其出汗，针孔处受寒，出现红肿硬结且发红，必定会发作奔豚病，气从少腹上冲心脏的，先在每个红肿硬结上灸一壮，然后给予桂枝加桂汤，增加桂枝用量。
【注解】太阳伤寒证，加用温针必定惊悸，是说患伤寒病的人，突然加上温针，心里畏惧而必定惊悸，并不是温针之后必定生出惊病。烧针就是温针，烧针取汗，也是汗法，但针孔处应当避寒，如果不谨慎，外部寒气侵袭，火郁结在脉中，血液不流通，必定结成红肿硬结且发红。而且温针之火，发为赤色硬结，又被寒气侵扰，所以不仅不解，反而招引阴邪。大概加针的时候，心既被惊，所以肾阴乘心之虚，上凌心阳而发奔豚。奔豚，是肾的阴邪，其状是气从少腹上冲于心。先在每个红肿硬结上灸一壮，是为了外部祛除寒邪，继而又给予桂枝加桂汤。增加桂枝用量的原因，是为了内部伐除肾邪。
桂枝加桂汤方
在桂枝汤方内，再增加桂枝二两，共成五两，其余根据桂枝汤的方法煎服。
【集解】徐彬说：这是太阳风邪，因烧针令汗，又感受寒气，邪气从太阳之腑膀胱袭入相合的肾脏，而发作奔豚，所以仍从太阳病的例子，用桂枝全方。加倍桂枝，是为了内部泻除阴气，兼驱外部邪气。
太阳病，用火熏法，不得汗，其人必定烦躁，到了该解的日期仍未解，必定会出现大便下血，这叫火邪。
【注解】火熏，是古代劫汗的方法，即现在火炕温覆取汗的方法。太阳病，用火熏法却不得汗，其人必定内热烦躁严重，阴液更加受伤，阳气得不到阴液，无从化汗，所以反而致病情不解。那火邪侵入阴分，损伤阴络，逼迫血液下行，所以必定大便下血。命名为火邪，是告诉人们应当治疗火邪，不必专门治疗大便下血。
【集注】方有执说：躁，是指手足疾动；到，犹言反，谓徒然烦躁扰乱反而不得解。汗是血的液体，血得热则行，火性大热，既然不得汗，则血必定横溢，所以必定大便下血。
程应旄说：太阳病用火熏法，想取汗竟不得汗，可知其津液素来少，大概阳气得不到阴液，则无从化汗。阴虚被火邪所伤，热无从外出，所以其人烦躁不宁。
脉浮且热势很盛，反而用灸法，这是实证，却用虚证的方法治疗。因为火邪而动血，所以咽喉干燥且吐血。
【注解】脉浮热势很盛，是实热在表，没有灸法的道理，反而用灸法，这是实实之误，谓其误将实证当作虚证。所以热因火邪而动，其势炎炎，导致咽喉干燥且吐血是必然的。上一条火伤阴分，逼迫血液下行，所以令大便下血；这一条火伤阳分，逼迫血液上行，所以吐血。
【集注】程应旄说：表实有热，误认为虚寒，而用灸法，热无从泄，因火邪而动，自然内攻。邪气束于外，火攻于内，肺金被伤，所以咽喉干燥且吐血。
汪琥说：表有风热反而灸，是以实证作虚证治疗。
脉象微弱而数，极不可以用灸法，因为火成为邪气，则产生烦闷逆乱，追虚逐实；血液散于脉中，火气虽然微小，内攻的力量很大，致使骨骼焦枯、筋脉损伤，血液难以恢复。
【注解】脉象微弱而数，是阴虚血少的诊察，断不可灸，如果误灸，艾火内攻，产生烦闷逆乱。烦，是阴被阳扰。逆，是追虚逐实。阴本虚，再加上火则更虚，这叫追虚；阳本实，再加上火则更实，这叫逐实。然而血已耗散，脉中艾火之气虽然微小，而内攻的力量很大了。所以导致骨骼焦枯、筋脉损伤，血液难以恢复。
【集注】喻昌说：脉微而数，是阴虚多热的征象。对此而用灸法，则虚者更虚，热者更热，不致伤残不止。
程应旄说：如果是血少阴虚的人，脉见微数，尤其不可灸，因为血主濡润，主润筋骨。如果失去其所濡润，则火所到达的地方，其骨必焦，其筋必损，内伤其阴，没有不流散于经脉的。
【注解】营气微弱，是营血虚微。营血既然已经虚微，如果误加烧针，则营血枯竭留滞而无所运行。岂止是骨骼焦枯、筋脉损伤而已啊！所以更加发热且躁烦。
【集注】程知说：说的是营气微弱忌讳烧针。阴虚则内热，如果加烧针以助阳，则两热相合，而营血不行，必定更加外发热而内烦躁。
唐不岩说：起初虽然是微弱流动，是用烧针逼迫它；后来则是留滞而不行，是用烧针竭尽它。
张璐说：火是阳邪，必定伤阴血，治疗此证，应当以救阴为主。
脉浮，适宜用发汗法解表，如果用火灸，邪气无从外出，因火而邪盛，病从腰部以下必定沉重且麻痹，名叫火逆。
【注解】脉浮表示表邪，适宜用发汗法解表，误用火灸，损伤血液，不能作汗，反而令表邪无处可出，以致邪气因火而盛，外部不焦骨伤筋，内部不吐血、大便下血，而出现腰部以下沉重麻痹的病症，必定是此人素来有湿邪在下，所以从湿化。重，是着的意思，重着不移。然而不以痹命名，是因为这不是风寒湿之痹，而是因火逆不相交通，所以名叫火逆。
【集注】方有执说：痹，是湿病。因火逆治火邪夹阳邪而上逆，阳不下通，阴不用事，气化不行而水不得泄，所以湿着于下体而重痹。
程应旄说：脉浮在表，汗解为宜。因火灸之，不能得汗，则邪无出路，因火而盛，即不焦骨伤筋，而火阻其邪，阴气渐竭，下焦乃营血所治，营气竭而不运，必定重着而为痹，名叫火逆。示人想要治其痹，应当先治其火。
病形像伤寒，但其脉不弦紧而弱，弱脉必定口渴，被火劫者必定说胡话。弱脉，发热。脉浮，解之应当汗出痊愈。
【按语】三个“弱”字，应当都是“数”字，如果是“弱”字，热从何来？不但文义不属，且论中并无此说。
【注解】形作伤寒，是说其病形像伤寒的样子。但其脉不弦紧而数，数是热。脉浮数，热在表，是太阳证；沉数，热在里，是阳明证。数脉为热，热入阳明，所以必定口渴；如果被火劫，其热更甚，所以必定说胡话。数脉之病，虽然都发热，然而施治不能没有区别。如果脉浮数发热，解之应当发汗，汗出可愈，适宜用大青龙汤；脉沉数发热，解之应当泻下，下之可愈，适宜用调胃承气汤，如果脉数无表里证，惟独发热而口渴说胡话，不可汗下，适宜用白虎汤、黄连解毒汤，清之即可。
伤寒脉浮，医生用火逼劫法，导致亡阳，必定出现惊狂、坐卧不安的症状，用桂枝去芍药加蜀漆龙骨牡蛎救逆汤主治。
【注解】伤寒脉浮，医生不用麻黄、桂枝的药，而以火劫取汗，汗出过多导致亡阳，所以见到惊狂、坐卧不安的证候。大概是由于火劫之误，热气从心，且大量脱失津液，神明失去依托。然而不用附子、四逆汤之类，是因为这是火劫亡阳。适宜用桂枝汤去掉芍药，加上蜀漆、龙骨、牡蛎救逆汤主治。去掉芍药的原因，是恐怕其阴性迟滞，兼制桂枝不能迅速走表，反而失去救急的宗旨。况且既然加了龙骨、牡蛎的固脱，也不需要芍药的酸收。蜀漆气寒味苦，寒能胜热，苦能降逆，火邪错逆，在所必需。
(Rest of text continues from previous context) Renshen (Ginseng Radix), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Tiantong (Asparagi Radix) are herbs that ascend and rise to clear heat; they are used to avoid lower cold and to nourish the upper. Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Ganjiang (Zingiberis Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma) are acrid-sweet herbs that move outward and disperse warmth; they are used to distance from upper heat and to harmonize the interior. Divided into three warm doses to be taken completely, if sweating occurs the disease is cured. The intention lies in being gentle so as not to damage righteous qi, thoroughly eliminating pathogenic factors and removing them completely. Although the pulse is deep and slow at the cun position and absent at the chi position, and symptoms include cold limbs and unceasing diarrhea, upon investigation it is fundamentally not a pure yin-cold pathogen. Therefore, there are concurrent symptoms of sore throat and expectoration of pus and blood. This is a disease of confused cold and heat, and mixed yin and yang, all resulting from drastic purgation damaging the middle jiao. Thus, Zhang Zhongjing uses this decoction with the primary goal of eliminating pathogens; once pathogens are removed, righteous qi naturally settles.
After eight or nine days of Taiyang Shanghan (Exogenous Cold Damage), purgation was performed. The patient presents with chest fullness, irritability, fright, difficulty urinating, delirium, heaviness of the entire body, and inability to turn over. Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) should be administered.
[Annotation] After eight or nine days of Taiyang Shanghan, if the pathogen is unresolved and the exterior syndrome is incomplete, purgation must not be used. If purgation is mistakenly applied, the pathogen sinks inward due to deficiency. In the upper jiao, lightly it causes chest fullness; heavily, it forms Jie Xiong (Chest Binding). Chest fullness results from heat entering the chest and qi stagnation. In the middle jiao, lightly it causes irritability and fright; heavily, it causes coma and mania. Irritability, fright, and delirium result from heat invading the heart and spirit unrest. In the lower jiao, lightly it causes difficulty urinating; heavily, it causes hypogastric fullness and pain. Difficulty urinating results from heat lodging in the lower jiao and obstruction of water passages. Pathogenic factors obstructing the Sanjiao (Triple Burner) prevent Ying and Wei (Nutritive and Defensive Qi) from circulating. With no outlet for water, it seeps into the muscles and skin, causing heaviness of the entire body and inability to turn over. Chaihu Jua Longgu Muli Tang is used, with the main principle being harmonization and stabilization, combining attack and tonification.
[Commentary] This clause describes heaviness due to damp-heat in Yang meridians. Mistaking it for heaviness due to yin-cold-dampness caused by fluid exhaustion, blood stasis, and failure of yang qi to circulate would be an error. For heaviness due to cold-dampness, Zhenwu Tang (True Warrior Decoction) or Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) are used because there is no thirst and no internal heat. For heaviness due to hot-dampness, Baihu Tang (White Tiger Decoction) or Chaihu Jia Longgu Muli Tang are used because there is delirium, irritability, and stomach heat. Heaviness due to wind-dampness or wind-warmth also involves concomitant cold or heat; thus, this formula uses Fuling (Poria) and Banxia (Pinelliae Rhizoma) along with Dahuang (Rhei Radix et Rhizoma) as assistants.
[Ji Zhu Commentary] Fang Youzhi stated: Chest fullness occurs after purgation when interior deficiency allows external heat to enter the interior, carrying phlegm-fluids to clash upward at the diaphragm, causing irritability. Fright injures the heart; the heart stores the spirit and resides below the diaphragm. When righteous qi is deficient and pathogenic factors prevail, the spirit is unsettled. Heaviness of the body and inability to turn over occur because Shanghan originally causes whole-body pain. Exhaustion of fluids leads to blood stasis and poor circulation, transforming into sluggishness and severe heaviness.
Cheng Zhi stated: Irritability and abdominal fullness after purgation are treated with Zhizi (Gardeniae Fructus) and Houpo (Magnoliae Officinalis Cortex) because the pathogen has entered the abdomen. Chest fullness, irritability, and fright after purgation are treated with Longgu (Fossilized Mammoth Bones) and Muli (Ostreae Concha) because the pathogen has entered the heart. Irritability and fright caused by fire therapy are treated with Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) to retrieve externally floating heart-yang. Irritability and fright caused by purgation are treated with Chaihu Jia Longgu Muli Tang to resolve internal blockage of heart-yang. Da Xianxiong Tang (Major Chest-Binding Decoction) and Xiao Xianxiong Tang (Minor Chest-Binding Decoction) are distinguished by high/low location and urgency/severity. Various Xiexin Tang (Drain the Epigastrium Decoctions) are distinguished by cold/heat and deficiency/excess. Banxia and Fuling treat phlegm; Huangqin and Lianmu (Coptidis Rhizoma) descend rebellious qi; Zhizi and Chishao (Sojae Preparata) induce vomiting for empty irritability; Renshen and Fuzi (Aconiti Lateralis Radix Praeparata) restore deficient yang. The major principles of post-purgation treatment are contained herein.
Yu Chang stated: It is considered cautious to use purgation only after passing through the stages for eight or nine days! Who knew that residual external pathogens would sink inward due to deficiency? While the pathogen is still between the exterior and interior, the disorder has already affected the Spirit. To repair heaven and bathe the sun at this point, is it not difficult?
Zhang Lu stated: This belongs to the interior syndrome of Shaoyang (Lesser Yang). Many commentators incorrectly classify it as a Heart meridian disease. Shaoyang has three prohibitions and must not be violated recklessly. Even though eight or nine days have passed and stages have been traversed, mistaken purgation still allows pathogens to invade internally, damaging Stomach Earth and depriving Gallbladder Wood of nourishment. Phlegm accumulates above the diaphragm, causing such changes. Therefore, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to harmonize the interior and exterior, expel fluids, and promote fluid circulation. Longgu and Muli are added to calm Liver-Gallbladder fright.
Chaihu Jia Longgu Muli Tang Formula
Chaihu (4 liang), Banxia (washed, 2 he), Longgu (1.5 liang), Renshen (1.5 liang), Dahuang (2 liang), Muli (1.5 liang), Fuling (1.5 liang), Qiandan (Lead Carbonate, 1.5 liang), Guizhi (1.5 liang), Shengjiang (Fresh Ginger, 1.5 liang), Dazao (Jujube, split, 2 pieces).
These eleven ingredients are boiled in 8 sheng of water to yield 4 sheng. Add cut Dahuang, boil for one or two more boils, strain, and take 1 sheng warm.
[Formula Analysis] This syndrome involves mixed yin and yang pathogens; this formula contains mixed attacking and tonifying herbs. Chaihu and Guizhi resolve residual exterior pathogens; Dahuang attacks internal heat that has sunk inward; Renshen, Shengjiang, and Dazao tonify deficiency and harmonize the Stomach; Fuling and Banxia promote urination and descend rebellious qi; the astringent and heavy properties of Longgu, Muli, and Qiandan calm fright, secure the Heart, and pacify the Spirit. This is using mixed herbs to treat a mixed disease.
Individuals who sweat profusely (Han Jia) should not undergo strong diaphoresis again. Doing so will cause mental confusion and vagueness, and pain in the genitalia after urination. Yu Yuliang Wan (Yuku Lithospermum Pill) should be given.
[Commentary] Yu Yuliang Wan is an astringent herb for dysentery and does not fit this syndrome. The five characters "give Yu Yuliang Wan" are likely interpolations (erroneous additions).
[Annotation] Han Jia refers to individuals prone to sweating. Strong diaphoresis means inducing heavy sweating. The Heart governs Blood, and sweat is the fluid of the Heart. Heavy sweating severely damages Blood, leaving the Heart without support, resulting in mental vagueness and restlessness. Fluid depletion in the lower part causes the Zongjin (major tendons/genitals) to lose nourishment, leading to penile pain after urination.
[Ji Zhu Commentary] Fang Youzhi stated: The Heart governs Blood and stores the Spirit. Profuse sweating leads to Blood deficiency and an empty Heart residence. Mental vagueness and confusion occur because the empty residence causes the Spirit to scatter. Yin refers to the Zongjin. Pain occurs because fluid depletion leads to loss of nourishment.
Cheng Yingmao stated: The Heart governs Blood, and sweat is the Heart's fluid. Individuals who sweat frequently clearly have Heart deficiency and Blood scarcity. Heavy sweating causes the Heart to lose nourishment, leading to vague Spirit and palpitations, which is called confusion. The Small Intestine and Heart are exterior-interior partners. Heart fluid deficiency leads to Small Intestine water depletion, causing genital pain after urination.
Individuals with a history of epistaxis (Nu Jia) must not undergo diaphoresis. If diaphoresis is induced, sweating will cause the arteries in the depression of the forehead to become tight and urgent, eyes staring straight ahead without movement, inability to close the eyelids, and insomnia.
[Annotation] Nu Jia includes those with hematemesis. For anyone with frequent nosebleeds or vomiting blood, Yin Qi is suddenly exhausted. If diaphoresis is induced again, fluid exhaustion causes all vessels to lose nourishment. The vessels in the depression of the forehead corners are scorched by heat, becoming tight and urgent. Staring straight ahead means the eyes are wide open and immobile. Inability to close eyelids means the lids cannot shut. All these result from heat scorching vessels, causing contraction. Insomnia occurs because Yang Qi cannot enter Yin. These diseases represent critical conditions of excess Yang and deficient Yin. Who says Nu Jia can be lightly diaphoresed!
[Ji Zhu Commentary] Yu Chang stated: Eyes see because of Blood; sweat is the liquid of Blood. Individuals with nosebleeds have damaged Clear Yang Qi. Further diaphoresis causes the forehead to depress, reflecting upper Jiao exhaustion. All vessels connect to eye tendons. Tight pulses cause eyes to stare upward and not close. Unclosed eyes lead to insomnia. In Shanghan, irritability and dizziness indicate impending epistaxis, suitable for Mahuang Tang to induce sweating. Here, it warns against diaphoresis for chronic blood-loss individuals to avoid further deficiency.
Individuals with blood loss (Wang Xue Jia) must not undergo diaphoresis. If diaphoresis is induced, they will experience chills and tremors.
[Annotation] After blood loss, when Qi and Blood have not recovered, termed Wang Xue Xu Jia (Blood-Loss Deficient Individuals), diaphoresis must not be used. Initially, blood loss may involve Yang-Heat, but after blood loss, Heat leaves with the Blood, and Qi perishes with Blood, endangering Yang. Further diaphoresis causes Yang Qi to become weak and unable to sustain itself, inevitably resulting in cold chills and trembling. Inducing sweat in Yin-deficiency leads to Yin collapse (e.g., sudden hematemesis/epistaxis), causing inability to close eyes, insomnia, and Yin collapse signs. Inducing sweat in Yang-deficiency leads to Yang collapse (e.g., Wang Xue Xu Jia), causing chills, tremors, and Yang collapse signs.
[Ji Zhu Commentary] Fang Youzhi stated: Blood loss implies Yin deficiency; diaphoresis further destroys Yang, causing chills and tremors.
Cheng Yingmao stated: Blood loss and Yin deficiency mean Yang has lost its foundation. Diaphoresis causes Yang to escape externally, leading to chills and tremors, representing dual exhaustion of Yin and Yang. Whenever diaphoresis is indicated, one must consider the Ying Blood of the Yin meridians, as seen here.
Wei Litong stated: Rather than saving Yang after sweat-induced Yang collapse, is it not better to save Yin beforehand to sustain Yang, preventing Yang collapse via sweating?
Individuals with dry throat (Yan Hou Gan Zao Zhe) must not undergo diaphoresis.
[Annotation] Dry throat indicates insufficient fluids. Further diaphoresis will further deplete fluids, hence the warning. Even if indications for diaphoresis exist, it must not be performed.
[Ji Zhu Commentary] Fang Youzhi stated: Dry throat indicates chronic fluid deficiency rooted in Kidney Water insufficiency, as the Shaoyin Meridian circles the throat. Diaphoresis causes further fluid loss.
Cheng Yingmao stated: Whenever diaphoresis is indicated, one must consider Upper Jiao fluids, as seen here.
Zhang Lu stated: This clause differs from "closure in the throat." This warns that diaphoresis deprives Yangming fluids; the other warns that diaphoresis deprives Shaoyin blood.
Individuals with Lin syndrome (Lin Jia) must not undergo diaphoresis. If diaphoresis is induced, hematuria will occur.
[Annotation] Lin Jia refers to diseases where damp-heat accumulates in the Bladder, causing painful, difficult urination. Diaphoresis removes dampness via sweat, leaving Heat behind. The Water Organ becomes depleted, forcing blood from its own channels to exit via urine.
[Ji Zhu Commentary] Cheng Zhi stated: Internal heat in the Bladder causes Lin syndrome. Further diaphoresis dries the Bladder further, causing hematuria.
Individuals with chronic sores/ulcers (Chuang Jia) must not undergo diaphoresis even if they have body pain. If diaphoresis is induced, Jing (Spasm) disease will result.
[Annotation] At the onset of Chuang Jia, before toxicity matures, diaphoresis is indicated to dissipate. After ulceration, Qi and Blood are damaged. Even with body pain indicating exterior syndrome requiring diaphoresis, it must not be used. Fear that sweating further weakens Ying and Wei, allowing external Wind to invade. Even without external Wind, tendons losing fluid nourishment will inevitably lead to neck stiffness and opisthotonos, forming Jing disease.
[Ji Zhu Commentary] Yu Chang stated: Body pain is a sign of Cold injuring Ying Blood, warranting diaphoresis. However, Chuang Jia individuals have weak exterior and hidden Ying Blood consumption. Further diaphoresis allows external Wind to attack weakness and internal Blood to fail to nourish, leading to neck stiffness and opisthotonos. Jing disease is also a Bladder disease.
In Taiyang Shanghan, adding warm needle therapy will definitely cause fright.
If burning needles are used to induce sweating, and the needle sites are exposed to cold, resulting in red nodules, Ben Tun (Running Piglet) disease will definitely develop, characterized by Qi rushing from the lower abdomen to the Heart. First, moxa one cone on each nodule, then administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon), increasing the amount of Cinnamon.
[Annotation] In Taiyang Shanghan, adding warm needles causes fright because the patient fears the sudden application, not necessarily developing a fright disease afterward. Burning needles is warm needle therapy. Inducing sweat via burning needles is a diaphoretic method, but needle sites must avoid cold. If careless, external Cold invades, Fire stagnates in vessels, blood fails to circulate, and red nodules form. The fire from warm needles creates red nodules; invaded by Cold, it not only fails to resolve but attracts Yin pathogens. When needles were added, the Heart was frightened, allowing Kidney Yin to exploit Heart deficiency, harassing Heart Yang and causing Ben Tun. Ben Tun is Kidney Yin pathogen, characterized by Qi rushing from lower abdomen to Heart. Moxa one cone on each nodule externally dispels Cold; subsequently, Guizhi Jia Gui Tang is given. Increasing Cinnamon internally attacks Kidney pathogens.
Guizhi Jia Gui Tang Formula
In the Guizhi Tang formula, add two liang of Gui (Cinnamon), totaling five liang. Rest follows Guizhi Tang method.
[Ji Jie Commentary] Xu Bin stated: This is Taiyang Wind Pathogen. Due to burning needles inducing sweat and subsequent Cold exposure, pathogens enter from Taiyang Fu (Bladder) into the paired Kidney, causing Ben Tun. Thus, following Taiyang example, the full Guizhi Tang is used. Doubling Cinnamon internally drains Yin Qi and drives out external pathogens.
In Taiyang Bing, fire fumigation was used. No sweat was produced. The person became irritable. When the appropriate time for resolution passed without relief, defecation of blood occurred. This is named Huo Xie (Fire Pathogen).
[Annotation] Fire fumigation is an ancient coercive sweating method, similar to modern heated kang covering for sweating. In Taiyang Bing, fire fumigation failed to produce sweat. The person suffered severe internal heat and irritability, further injuring Yin fluids. Without Yin, Yang cannot transform sweat, so the condition remains unresolved. Fire enters Yin, damaging Yin collaterals, forcing blood downward, causing bloody stool. Named Huo Xie to indicate treating the Fire Pathogen rather than just the bloody stool.
[Ji Zhu Commentary] Fang Youzhi stated: Zao (restlessness) is rapid movement of hands and feet. Dao (arrive) means reverse; meaning futile agitation without resolution. Sweat is fluid of Blood; Blood moves with Heat. Fire is intensely hot. Since no sweat occurred, Blood must overflow, causing bloody stool.
Cheng Yingmao stated: Taiyang Bing treated with fire fumigation failed to produce sweat, indicating chronic fluid deficiency. Without Yin, Yang cannot transform sweat. Yin deficiency injured by Fire, Heat has no exit, causing restlessness.
If the pulse is floating and heat is severe, moxibustion is contraindicated. Applying it to an Excess pattern while treating it as Deficiency causes Heat to move due to Fire, resulting in dry throat and hematemesis.
[Annotation] Floating pulse with severe heat indicates Excess Heat in the Exterior. Moxibustion is inappropriate. Applying it mistakes Excess for Deficiency (Shi Shi error). Heat stirred by Fire flares up, inevitably causing dry throat and hematemesis. The previous clause: Fire injured Yin, forcing blood downward (bloody stool). This clause: Fire injured Yang, forcing blood upward (hematemesis).
[Ji Zhu Commentary] Cheng Yingmao stated: Exterior Excess with Heat misdiagnosed as Deficiency-Cold, treated with moxibustion. Heat has no outlet, moves due to Fire, attacks internally. Pathogens bound externally, Fire attacks internally, damaging Lung Metal, causing dry throat and hematemesis.
Wang Hu stated: Exterior Wind-Heat treated with moxibustion treats Excess as Deficiency.
If the pulse is fine and rapid, moxibustion is extremely contraindicated. Fire becomes a pathogen, causing irritability and rebellion, chasing deficiency and pursuing excess. Blood scatters in vessels. Though Fire Qi is slight, its internal attack is powerful, scorching bones and damaging tendons, making blood recovery difficult.
[Annotation] Fine and rapid pulse indicates Yin deficiency and Blood scarcity; moxibustion is absolutely contraindicated. Mistaken moxibustion causes internal attack by Mugwort Fire, leading to irritability and rebellion. Irritability is Yin disturbed by Yang. Rebellion is chasing deficiency and pursuing excess. Yin is originally deficient; adding Fire makes it more deficient (chasing deficiency). Yang is originally excess; adding Fire makes it more excess (pursuing excess). Blood is already consumed; though Mugwort Fire Qi in vessels is slight, its internal attack is powerful. This causes scorched bones, damaged tendons, and difficult blood recovery.
[Ji Zhu Commentary] Yu Chang stated: Fine and rapid pulse indicates Yin deficiency with Heat. Moxibustion here makes deficiency worse and Heat worse, leading to injury unless stopped.
Cheng Yingmao stated: In Blood-deficient Yin-deficient individuals with fine-rapid pulse, moxibustion is especially contraindicated. Blood moistens and lubricates bones and tendons. Loss of moisture means Fire scorches bones and damages tendons, internally injuring Yin, scattering into meridians.
If Ying Qi is weak, adding burning needles causes blood to stagnate and not flow, leading to further fever and irritability.
[Annotation] Weak Ying Qi means deficient Ying Blood. If Ying Blood is already deficient, mistaken burning needles cause Ying Blood to dry up and stagnate, failing to circulate. This goes beyond scorched bones and damaged tendons! Hence, further fever and irritability occur.
[Ji Zhu Commentary] Cheng Zhi stated: This warns against burning needles in weak Ying. Yin deficiency causes internal heat. Adding burning needles to assist Yang combines two heats, stopping Ying Blood circulation, causing external fever and internal irritability.
Tang Buyan stated: Initially, it flows slightly, forced by burning needles; later, it stagnates and stops, exhausted by burning needles.
Zhang Lu stated: Fire is Yang pathogen, injuring Yin Blood. Treatment should prioritize saving Yin.
If the pulse is floating, diaphoresis is appropriate. Using moxibustion prevents pathogen exit. Due to Fire, pathogen intensifies. Disease manifests as heaviness and numbness from waist down, named Huo Ni (Fire Reversal).
[Annotation] Floating pulse indicates exterior pathogen, suitable for diaphoresis. Mistaken moxibustion injures Blood, preventing sweat formation. Pathogens have no exit, intensifying due to Fire. Instead of scorched bones/damaged tendons or hematemesis/bloody stool, heaviness and numbness from waist down occur. This implies chronic Dampness in the lower part, transforming according to Dampness. "Heavy" means adherent and immovable. Not named Bi (Obstruction) because it is not Wind-Cold-Damp Bi, but Huo Ni (Fire Reversal) causing lack of communication.
[Ji Zhu Commentary] Fang Youzhi stated: Bi is Damp disease. Fire reversal treats Fire Pathogen combined with Yang Pathogen reversing upward. Yang fails to descend, Yin fails to function, Qi transformation fails, Water fails to drain. Dampness adheres to lower body causing heavy Bi.
Cheng Yingmao stated: Floating pulse in exterior favors diaphoresis. Moxibustion prevents sweat, leaving pathogen with no exit, intensifying due to Fire. Even without scorched bones/tendons, Fire blocks pathogen, gradually exhausting Yin Qi. Lower Jiao is governed by Ying Blood. Ying exhaustion fails to transport, causing heaviness and Bi, named Huo Ni. This shows that to treat Bi, one must first treat the Fire.
The presentation resembles Shanghan, but the pulse is not wiry-tight but weak. Weak pulse indicates thirst. Fire coercion causes delirium. Weak pulse indicates fever. Floating pulse resolves with sweating and cure.
[Commentary] The three instances of "weak" should be "rapid". If "weak", where does the heat come from? The text logic fails, and this theory is absent elsewhere in the Treatise.
[Annotation] "Resembling Shanghan" means symptoms mimic Shanghan. But the pulse is not wiry-tight but rapid; rapid indicates Heat. Floating-rapid pulse, Heat in Exterior, Taiyang syndrome. Deep-rapid pulse, Heat in Interior, Yangming syndrome. Rapid pulse indicates Heat; Heat entering Yangming causes thirst. Fire coercion increases Heat, causing delirium. Although rapid pulse diseases all involve fever, treatment differs. Floating-rapid fever resolves with diaphoresis (Da Qinglong Tang). Deep-rapid fever resolves with purgation (Tiaowei Chengqi Tang). Rapid pulse without exterior/interior signs, only fever/thirst/delirium, requires neither diaphoresis nor purgation; Baihu Tang or Huanglian Jiedu Tang clears Heat.
In Shanghan with floating pulse, the doctor used fire coercion, causing Yang collapse. Symptoms include fright, mania, restlessness. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Freesia Rhizome, Dragon Bone, and Oyster Shell to Rescue the Counterflow) should be administered.
[Annotation] Shanghan with floating pulse should be treated with Mahuang or Guizhi. Using fire coercion induces excessive sweating, collapsing Yang, causing fright, mania, and restlessness. Fire error sends Heat to the Heart and depletes fluids, leaving Spirit unsupported. Fuzi and Sini Tang are not used because this is Yang collapse from Fire. Guizhi Tang minus Shaoyao, plus Shuqi, Longgu, and Muli is used. Shaoyao is removed fearing its Yin nature is sluggish and restricts Guizhi from rapidly reaching the exterior, defeating the emergency rescue purpose. With Longgu and Muli securing collapse, Shaoyao's sour astringency is unnecessary. Shuqi is cold and bitter; cold conquers Heat, bitter descends rebellious Qi. Essential for chaotic Fire Pathogen.
[Ji Zhu Commentary] Yu Chang stated: In the chapter, mistaken Da Qinglong Tang caused cold extremities, muscle twitching, and Yang collapse from excessive sweat, treated with Zhenwu Tang. This case...