逆者。汗吐下三法。与病相逆也。救逆者。救其误治之变症也。仲景一百十三方。
每多因救误而设。兹特汇集救误诸条。分汗下两门。以便查阅。
伤寒脉证。当服麻黄汤发汗。若尺中脉迟。是营气不足。不可发汗。若误汗之。遂漏
不止。恶风。小便难。四肢微厥。难以屈伸。此津脱阳虚也。当以桂枝加附子汤。回阳止汗。
邵评∶尺迟营弱。不可发汗。误汗而津脱亡阳。外风复袭。此势所必然也。
伤寒发汗过多。其人叉手自冒心。心下悸。欲得按者。桂枝甘草汤主之。盖汗为心
液。过多则心气虚。桂枝甘草。能扶阳以补心气也。若至振振擗地。则当用真武矣。
邵评∶妄汗伤心。液亏气馁而心悸。与心下有水气而悸者。迥别。
伤寒汗出恶风。脉浮缓微弱。桂枝症也。误以大青龙汗之。致其人厥冷筋惕。心下
悸。头眩。热仍不退。身肉 动。振振欲擗地者。真武汤主之。内镇少阴水逆。外救太
阳亡阳。
邵评∶发汗过多。亡肾阳而水气上侵。凌心作悸。与上条心虚而悸者不同。
伤寒脉浮。医以火迫劫其汗。致亡阳惊狂。起卧不安。宜桂枝去芍药加蜀漆、龙骨、
牡蛎救逆汤主之。敛镇心阳。其狂自定矣。
邵评∶阳者心之阳。即神明也。亡阳者。火气通于心神。被火迫而不守。则外亡也。
故用桂枝加龙牡。取其补心镇逆而固脱。故曰救逆。去芍药者。欲其急复心阳耳。
脉浮宜以汗解。误以火灸之。邪无从出。因火而盛。病从腰以下。必重而痹。名火逆
也。火逆又误下之。以虚其阴。复因烧针以益其阳。致烦躁者。桂枝甘草龙骨牡蛎汤主之。
邵评∶火逆、烧针、又复下之。三番误治。阴阳俱已虚竭。烦躁者。惊狂之渐也。心阳
内伤。故用桂、甘以复心伤之气。龙、牡以安烦乱之神。的是正法。
发汗多致亡阳谵语。此非胃实。不可下。柴胡桂枝汤。和其营卫。以通津液。后自愈。
邵评∶少阳不可发汗。汗则津液越出。必胃燥而谵语。故用柴胡桂枝汤和其营
卫。上焦得通。津液得下。胃和则愈。
服桂枝汤大汗出后。大烦渴不解。脉洪大者。胃中津液干。而火独盛也。白虎加人参汤主之。
邵评∶服桂枝汗大出。而大烦渴。脉见洪大。其邪已去太阳之表。而入阳明之里
矣。阳明为津液之府。热邪内入。津伤火盛。故用白虎加人参汤。清热存阴为治。的是正法。
下之后。复发汗。昼日烦躁。夜而生静。不呕不渴。无表症。身微热。此邪已退而阳气
衰弱也。干姜附子汤主之。
邵评∶此条下后复汗。昼烦夜静。无表里症。而脉沉微。是纯阴无阳之象。阳将去
矣。幸此微热未除。烦躁不宁之际。独任干姜附子。以急回其阳为治也。
伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。复发汗动经。身为振振
摇者。茯苓桂枝白术甘草汤主之。此亦阳虚饮蓄。而致头身振摇。即真武之轻者。
邵评∶尤在泾曰。此伤寒邪发饮发之症。逆发气冲。寒饮上搏于膈也。故令头眩。
脉沉为在里。且既经吐下。复发其汗。则阳益虚。而津液耗。故身振振摇也。与此
汤导饮和中。益阳固卫。柯韵伯注。此症是木邪侮胃。吐下之后。阳气内扰。故心
下逆满。里虚气逆。则气上冲胸。起则头眩。表阳虚也。脉沉紧为弦。肝木犯胃则
弦。邪在里而反发汗以攻表。经络更虚。寒邪由经而入里。阳气外虚。不能主持诸脉。
故一身振摇也。与此汤和经散寒。益阳补阴。此说与尤说不同。录存以备合参。然当从尤注为是。
伤寒脉浮。自汗出。小便数。心烦。微恶寒。（以上俱似桂枝症）脚挛急。（此一
症与桂枝独异乃阴虚之象）反与桂枝汤。欲攻其表。此误也。得之便厥。咽中干。烦躁吐逆者。（有
阳越之象）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。（此汤
纯阴以复其阴阴阳两和其脚即伸矣）若胃气不和。谵语者。（中焦有留邪）少与调胃承气汤。
（微涤阳明所结之余邪则谵语自止）
邵评∶此症即阴虚于下。而又阳逆于上。则必先复阳气。而后复其阴气。故用甘
草干姜辛甘。以复其阳。阳复。则厥止而足温矣。更作芍药甘草。甘酸以复其阴。
阴生。则两脚即伸矣。或胃不和而谵语。少与调胃承气。和胃则愈。
发汗后。腹胀满者。虚邪入里也。浓朴生姜半夏人参汤主之。
邵评∶此汗后气虚。气窒不行而腹胀满。其人内虽作胀。外无胀形。故汤中用人
参、甘草。甘温补中而益元气。然徒补则愈窒滞。故用浓朴、姜、夏。行气而除腹满。此补泄兼行之法也。
Ni (Reversal/Adverse reaction) refers to the three methods of sweating, vomiting, and purging being contrary to the disease condition. Jiu Ni (Rescuing from reversal) refers to treating the complications arising from mismanagement. Among Zhang Zhongjing's 113 formulas, many are established specifically to rescue from errors in treatment. Here, we have collected these clauses on rescuing from errors, divided into two categories: sweating and purging, for easy reference.
In Taiyang cold damage (Taiyang Shanghan), when the pulse and symptoms indicate the need for Mahuang Tang (Ephedra Decoction) to induce sweating, if the chi (cun-guan-chi) pulse at the wrist is slow, it indicates a deficiency of Ying Qi (Nutritive Qi). Sweating should not be induced. If sweating is mistakenly induced, leakage of sweat will persist, accompanied by aversion to wind, difficulty in urination, slight coldness of the four limbs, and difficulty in flexing and extending them. This is a state of exhaustion of body fluids and deficiency of Yang Qi. Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite) should be used to restore Yang Qi and stop sweating.
Shao's Commentary: A slow chi pulse indicates weak Ying blood; sweating should not be induced. Mistakenly inducing sweating leads to exhaustion of fluids and loss of Yang Qi, making the patient susceptible to external wind invasion again. This outcome is inevitable.
If sweating is excessively induced in Taiyang cold damage, the patient may cross their hands over the heart region, experience palpitations (Xin Ji), and desire pressure. Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is indicated. Since sweat is the fluid of the Heart, excessive sweating depletes Heart Qi. Cinnamon Twig and Licorice can support Yang Qi to tonify Heart Qi. If the condition progresses to tremors and restlessness where the patient wants to roll on the ground, Zhenwu Tang (True Warrior Decoction) should be used.
Shao's Commentary: Reckless sweating damages the Heart. Palpitations caused by fluid depletion and Qi deficiency are distinctly different from those caused by water-Qi stagnation under the heart.
In Taiyang cold damage, if there is sweating, aversion to wind, and a floating, moderate, and weak pulse, it is a Guizhi Tang syndrome. If mistakenly treated with Da Qinglong Tang (Major Green Dragon Decoction) to force sweating, the patient may develop cold extremities, twitching of tendons, palpitations, dizziness, persistent fever, muscle twitching, and severe tremors with a desire to fall. Zhenwu Tang (True Warrior Decoction) is indicated. It internally stabilizes the counterflow of Water in Shaoyin (Kidney) and externally rescues the loss of Yang Qi in Taiyang (Bladder).
Shao's Commentary: Excessive sweating leads to the loss of Kidney Yang, causing Water-Qi to invade upwards and harass the Heart, resulting in palpitations. This differs from the palpitations caused by Heart deficiency mentioned in the previous clause.
If the pulse is floating in Taiyang cold damage, and the physician uses fire therapy to forcibly induce sweating, leading to the loss of Yang Qi, panic, mania, and restlessness (sitting and lying down uneasily), Guizhi Qu Shaoyao Jia Shujie Longgu Muli Jiuni Tang (Cinnamon Twig Decoction without Peony, plus Fleeceflower Root, Dragon Bone, and Oyster Shell, for Rescuing from Reversal) is indicated. This formula astringes and calms the Heart Yang, and the mania will subside.
Shao's Commentary: The "Yang" here refers to Heart Yang, which is synonymous with Shen Ming (Spirit/Mind). Loss of Yang occurs because fire energy communicates with the Heart Spirit; when forced by fire therapy, the Spirit cannot remain contained and escapes outward. Therefore, Cinnamon Twig is used with Dragon Bone and Oyster Shell to tonify the Heart, calm rebellious Qi, and secure collapse. Hence it is called "Rescuing from Reversal." Peony is removed to urgently restore Heart Yang.
A floating pulse indicates that sweating should be used to resolve the exterior. If mistakenly treated with moxibustion, the pathogenic factor has no outlet and becomes intensified by the fire. From the waist down, the body will feel heavy and numb. This is called Huo Ni (Fire Reversal). If Huo Ni is further mistreated with purging, depleting Yin, and then treated with burning needles to augment Yang, resulting in irritability, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is indicated.
Shao's Commentary: Fire reversal, burning needles, and subsequent purging constitute three errors in treatment, exhausting both Yin and Yang. Irritability is a precursor to panic and mania. Internal injury to Heart Yang necessitates using Cinnamon Twig and Licorice to restore the damaged Qi, and Dragon Bone and Oyster Shell to calm the agitated Spirit. This is the correct method.
Excessive sweating leading to loss of Yang Qi and delirium (Zhen Yu) is not due to excess in the Stomach and should not be treated with purging. Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used to harmonize Ying and Wei Qi and unblock body fluids, after which the patient will recover spontaneously.
Shao's Commentary: Shaoyang disorders should not be treated with sweating. Sweating causes fluids to escape, leading to dryness in the Stomach and delirium. Therefore, Chaihu Guizhi Tang is used to harmonize Ying and Wei Qi. Once the Upper Jiao is unblocked and fluids descend, the Stomach Qi harmonizes, and the patient recovers.
After taking Guizhi Tang, if profuse sweating occurs followed by severe vexation and thirst that does not resolve, and the pulse is flooding and large, it indicates that stomach fluids are dried up and fire is flourishing alone. Baihu Jia Renshen Tang (White Tiger Decoction with Added Ginseng) is indicated.
Shao's Commentary: Profuse sweating after taking Guizhi Tang, accompanied by severe vexation and thirst, and a flooding pulse, indicates that the pathogen has left the Taiyang exterior and entered the Yangming interior. Yangming is the residence of fluids. When heat pathogens enter internally, damaging fluids and intensifying fire, Baihu Jia Renshen Tang is used to clear heat and preserve Yin. This is the correct method.
After purging, if sweating is induced again, and the patient experiences irritability during the day but quietness at night, without vomiting or thirst, and without exterior symptoms, but with slight fever, it indicates that the pathogen has retreated but Yang Qi is weak. Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is indicated.
Shao's Commentary: In this clause, purging followed by sweating results in daytime irritability and nighttime quietness, without exterior or interior symptoms, but with a deep and minute pulse. This is a sign of pure Yin without Yang, indicating that Yang Qi is about to depart. Fortunately, slight fever remains. During this period of irritability and unrest, Ganjiang and Fuzi are used exclusively to urgently restore Yang Qi.
If, after vomiting or purging in Taiyang cold damage, the patient experiences fullness and rebellious Qi rising from the epigastrium, Qi rushing to the chest, dizziness upon standing, and a deep, tight pulse, and if sweating is subsequently induced disturbing the meridians, leading to bodily tremors and swaying, Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is indicated. This is also a case of Yang deficiency with fluid retention causing tremors of the head and body, representing a milder form of Zhenwu Tang syndrome.
Shao's Commentary: You Zaijing states: This is a condition where cold damage triggers fluid retention. Rebellious Qi rushes upward, and cold-fluid attacks the diaphragm, causing dizziness. A deep pulse indicates an interior condition. Furthermore, after vomiting and purging, inducing sweating further depletes Yang and consumes fluids, causing bodily tremors. This formula guides out fluid retention, harmonizes the middle, benefits Yang, and secures the exterior. Ke Yunbo annotates: This condition involves Wood pathogen harassing the Stomach. After vomiting and purging, internal disturbance of Yang causes epigastric fullness. Interior deficiency with rebellious Qi causes rushing to the chest and dizziness upon standing. This is exterior Yang deficiency. A deep, tight pulse manifests as wiry; Liver Wood invading the Stomach causes wiriness. With the pathogen in the interior, mistakenly attacking the exterior with sweating further weakens the meridians. Cold pathogens enter from the meridians into the interior. Exterior Yang deficiency fails to govern the vessels, causing whole-body tremors. This formula harmonizes the meridians, disperses cold, benefits Yang, and tonifies Yin. This view differs from You's. It is recorded for comparison, but You's annotation is considered correct.
In Taiyang cold damage, if there is a floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold (all resembling Guizhi Tang syndrome), and cramped/tight legs (this symptom is unique to Guizhi Tang deficiency and indicates Yin deficiency), mistakenly administering Guizhi Tang to attack the exterior is an error. This may result in cold extremities, dry throat, irritability, and vomiting/rebellious Qi (signs of Yang escaping). Gantang Ganjiang Tang (Licorice and Dried Ginger Decoction) should be given to restore Yang Qi. If the cold extremities resolve and feet warm, Shaoyao Gancao Tang (Peony and Licorice Decoction) should be given next, and the legs will extend. (This formula is purely Yin to restore Yin; when Yin and Yang are harmonized, the legs extend.) If there is disharmony of Stomach Qi and delirium (indicating residual pathogen in the Middle Jiao), a small amount of Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction) should be given. (Mildly clearing residual accumulation in Yangming stops delirium.)
Shao's Commentary: This condition involves Yin deficiency below and rebellious Yang above. Therefore, Yang Qi must be restored first, then Yin Qi. Gantang Ganjiang Tang uses acrid-sweet properties to restore Yang. Once Yang is restored, cold extremities cease, and feet warm. Shaoyao Gancao Tang uses sweet-sour properties to restore Yin. Once Yin generates, the legs extend. If delirium occurs due to Stomach disharmony, a small amount of Tiaowei Chengqi Tang harmonizes the Stomach, leading to recovery.
After sweating, if abdominal fullness occurs, it indicates deficient pathogen entering the interior. Nongpu Shengjiang Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, and Ginseng Decoction) is indicated.
Shao's Commentary: This is Qi deficiency after sweating, causing Qi stagnation and abdominal fullness. Although the patient feels internal fullness, there is no visible distension externally. Therefore, Ginseng and Licorice are used in the decoction for their sweet-warm properties to tonify the Middle and benefit Yuan Qi. However, tonification alone would cause more stagnation; thus, Magnolia Bark, Ginger, and Pinellia are used to move Qi and eliminate abdominal fullness. This is a method combining tonification and draining.