必为烦热。乃能有汗而解也。何以知之。以脉浮。气机仍欲外达。故知汗出而解也。〔程〕名曰火逆。则欲治
其痹者。宜先治其火矣。〔汪〕补亡论。郭白云云。宜与救逆汤。
案方氏诸家。截欲自解以下。移载上编。以为太阳病自解之总例。大失本条之义。
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。灸其核上各一壮。与桂枝加桂
汤。更加桂二两也。（玉函。脉经。奔。作贲。脉经。无各字。注云。一本。作各一壮。玉函。脉经。千金翼。
无更以下六字。二两。全书。作三两。非。）
〔钱〕烧针者。烧热其针而取汗也。玉机真藏论云。风寒客于人。使人毫毛毕直。皮肤闭而为热。当是之
时。可汗而发也。或痹不仁肿痛。可汤熨及火灸刺而去之。观此则风寒本当以汗解。而漫以烧针取汗。虽或不
至于因火为邪。而针处孔穴不闭。已被寒邪所浸。故肿起如核。皮肤赤色。直达阴经。阴邪迅发。所以必发奔
豚气也。〔魏〕崇明何氏云。奔豚一证。乃寒邪自针孔入。风邪不能外出。直犯太阳本腑。引动肾中素有阴寒。
因发而上冲。〔锡〕张均卫问曰。烧针亦是火攻。因火而逆。何以复用火灸。答曰。灸者。灸其被寒之处也。
外寒束其内火。火郁于内。故核起而赤也。
伤寒类方曰。不止一针。故云各一壮。
桂枝加桂汤方
桂枝（五两去皮） 芍药（三两） 甘草（二两炙） 大枣（十二枚擘） 生姜（三两切○玉函。二两）
上五味。以水七升。煮取三升。去滓。温服一升。本云桂枝汤。今加桂满五两。所以加桂者。以能泄奔
豚气也。（案成本。不载方。为是。本条已云更加桂二两故也。玉函。无满以下十五字。）
〔柯〕寒气外束。火邪不散。发为赤核。是将作奔豚之兆也。从少腹上冲心。是奔豚已发之象也。此因
当汗不发汗。阳气不舒。阴气上逆。必灸其核以散寒。仍用桂枝以解外。更加桂者。益火之阳。而阴自平也。
桂枝更加桂。治阴邪上攻。只在一味中加分两。不于本方外求他味。不即不离之妙如此。茯苓桂枝甘草大枣汤。
证已在里。而奔豚未发。此症尚在表而发。故治有不同。
案方中桂。方氏以下。多用肉桂。是泥于后世诸本草之说。不可从。
火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
〔鉴〕火逆者。谓凡火劫取汗。致逆者也。此火逆。因火针也。〔吴〕病者既火逆矣。治者从而下之。
于是真阴重伤。因烧针余毒。使人烦躁不安者。外邪未尽。而真阳欲亡。故但用桂枝以解外。龙骨牡蛎以安内。
甘草以温补元气。而散表寒也。〔钱〕因发汗而又下之。病仍不解而烦躁。以茯苓四逆汤主之者。以汗下两亡
其阳。故用温经复阳之治。此虽汗下。而未经误汗。且挟火邪。而表犹未解。故止宜解肌镇坠之法也。
案烧针。即火逆。非火逆而又烧针。成氏以为先火而下之。又加烧针。凡三误。程氏汪氏志聪锡驹魏氏
等注并同。皆谬矣。
桂枝甘草龙骨牡蛎汤方
桂枝（一两去皮） 甘草（二两炙） 牡蛎（二两熬） 龙骨（二两○玉函。以上三味。各三两）
上四味。以水五升。煮取二升半。去滓。温服八合。日三服。（成本。四味。作为末。非也。玉函。无半字。）
〔成〕桂枝甘草之辛甘。以发散经中之火邪。龙骨牡蛎之涩。以收敛浮越之正风。〔魏〕烦躁。即救逆
汤惊狂卧起不安之渐也。故用四物。以扶阳安神为义。不用姜枣之温补。不用蜀漆之辛快。正是病轻则药轻也。
柯琴方论曰。近世治伤寒者无火熨之法。而病伤寒者。多烦躁惊狂之变。大抵用白虎承气辈。作有余治
之。然此证属实热者固多。而属虚寒者间有。则温补安神之法。不可废也。更有阳盛阴虚。而见此症者。当用
炙甘草加减。用枣仁远志茯苓当归等味。又不可不择。
太阳伤寒者。加温针必惊也。（玉函。无者字。脉经。千金翼。无太阳二字。千金翼。作火针。）
〔钱〕温针。即前烧针也。太阳伤寒。当以麻黄汤发汗。乃为正治。若以温针取汗。虽欲以热攻寒。而邪
受火迫。不得外泄而反内走。必致火邪内犯阳神。故震惊摇动也。〔汪〕补亡论。常器之云。可根据前救逆汤。
太阳病当恶寒发热。今自汗出。反不恶寒发热。关上脉细数者。以医吐之过也。一二日吐之者。腹中饥
口不能食。三四日吐之者。不喜糜粥。欲食冷食。朝食暮吐。以医吐之所致也。此为小逆。（玉函。两恶寒下。
并有而字。过。作故。成本。无反字。一二日上。脉经。有若得病三字。）
〔钱〕病在太阳。自当恶寒发热。今自汗出而不恶寒。已属阳明。然阳明当身热汗出。不恶寒而反恶热。
今不发热。
及关上脉见细数。则又非阳明之脉证矣。其所以脉证不相符合者。以医误吐而致变也。夫太阳表证。当以汗解。
自非邪在胸中。岂宜用吐。若妄用吐法。必伤胃气。然因吐得汗。有发散之义寓焉。故不恶寒发热也。关上。
脾胃之部位也。细则为虚。数则为热。误吐之后。胃气既伤。津液耗亡。虚邪误入阳明。胃脘之阳虚躁。故细
数也。一二日邪在太阳之经。因吐而散。故表证皆去。虽误伤其胃中之阳气。而胃未大损。所以腹中犹饥。然
阳气已伤。胃中虚冷。故口不能食。三四日则邪已深入。若误吐之。损胃尤甚。胃气虚冷。状如阳明中寒。不
能食。故不喜糜粥也。及胃阳虚躁。故反欲食冷食。及至冷食入胃。胃中虚冷不化。故上逆而吐也。此虽因误
吐致变。然表邪既解。无内陷之患。不过当温中和胃而已。此为变逆之小者也。〔程〕吐之不当。则周身之气皆
逆。而五脏颠覆。下空上逆。气不能归。故有如此景气。〔汪〕补亡论。常器之云。可与小半夏汤。亦与半夏
干姜汤。郭白云云。活人书大小半夏加茯苓汤。半夏生姜汤。皆可选用。
锡驹云。自汗出者。吐伤中气。而脾津外泄也。程云。表邪不外越而上越。故为小逆。
志聪云。本论曰。脉浮大。应发汗医反下之。此为大逆。今但以医吐之。故为小逆。
案金鉴云。欲食冷食之下。当有五六日吐之者六字。若无此一句。则不喜糜粥。欲食冷食。与朝食暮吐
之文。不相联属。且以上文一二日。三四日之文。细玩之。则可知必有五六日吐之一句。由浅及深之谓也。柯
氏本。此为小逆四字。移吐之过也下。二说皆不可从。
太阳病吐之。但太阳病当恶寒。今反不恶寒。不欲近衣。此为吐之内烦也。
〔鉴〕太阳病吐之表解者。当不恶寒。里解者亦不恶热。今反不恶寒。不欲近衣者。是恶热也。此由吐之
后。表解里不解。内生烦热也。盖无汗烦热。热在表。大青龙证也。有汗烦热。热在里。白虎汤证也。吐下后
心中懊 。无汗烦热。大便虽硬。热犹在内。栀子豉汤证也。有汗烦热。大便已硬。热悉入腑。调胃承气汤证
也。今因吐后。内生烦热。是为气液已伤之虚烦。非未经汗下之实烦也。以上之法。皆不可施。惟宜用竹叶石
膏汤。于益气生津中。清热宁烦可也。〔方〕此亦误吐之变证。不恶寒不欲近衣。言表虽不显热。而热在里也。
内烦者。吐则津液亡胃中干。而热 内作也。〔汪〕补亡论。常器之云。可与竹叶石膏汤。
病患脉数。数为热。当消谷引食。而反吐者。此以发汗。令阳气微。膈气虚。脉乃数也。数为客热。不能
消谷。以胃中虚冷。故吐也。（此以发汗。玉函。作以医发其汗。脉乃数也。作脉则为数。汪本。删冷字。非也。）
〔钱〕此条之义。盖以发热汗自出之中风。而又误发其汗。致令卫外之阳。与胃中之阳气皆微。膈间之宗气
大虚。故虚阳浮动。而脉乃数也。若胃脘之阳气盛。则能消谷引食矣。然此数非胃中之热气盛而数也。乃误汗
之后。阳气衰微。膈气空虚。其外越之虚阳所致也。以其非胃脘之真阳。故为客热。其所以不能消谷者。以胃
中虚冷。非唯不能消谷。抑且不能容纳。故吐也。〔汪〕补亡论。常器之云。可与小半夏汤。又云宜小温中汤。
太阳病过经十余日。心下温温欲吐。而胸中痛。大便反溏。腹微满。郁郁微烦。先此时。自极吐下者。
与调胃承气汤。若不尔者。不可与。但欲呕。胸中痛。微溏者。此非柴胡汤证。以呕故知极吐下也。（玉函。
温温。作 。而下。有又字。但。作
反。无柴胡二字。脉经。无调胃二字。成本。无柴胡汤之汤。千金翼。无若不以下三十字。柯本亦删。）
〔钱〕此辨症似少阳。而实非柴胡症也。言邪在太阳。过一候而至十余日。已过经矣。而有心下温温欲吐。
胸中痛。大便反溏。腹微满。郁郁微烦之证。若先此未有诸症之时。已自极其吐下之者。则知胃气为误吐误下
所伤。致温温欲吐而大便反溏。邪气乘虚入里。故胸中痛。而腹微满。热邪在里。所以郁郁微烦。乃邪气内陷。
胃实之症也。胃实则当用攻下之法。以胃气既为吐下所虚。不宜峻下。唯当和其胃气而已。故与调胃承气汤。
阳明篇。所谓胃和则愈也。若不尔者。谓先此时未曾极吐下也。若未因吐下。而见此诸症者。此非由邪陷所致。
盖胸为太阳之分。邪在胸膈。故温温欲吐。而胸中痛也。大便反溏。热邪未结于里也。腹满郁烦。邪将入里。
而烦满也。若此者。邪气犹在太阳。为将次入里之征。若以承气汤下之。必致邪热陷入。而为结胸矣。故曰不
可与也。但前所谓欲呕。胸中痛微溏者。虽有似乎少阳之心烦喜呕。胸胁苦满。腹中痛之证。然此非柴胡症也。
更何以知其为先此时极吐下乎。以欲呕乃胃气受伤之见证。故知极吐下也。〔锡〕呕者。即温温欲吐也。欲吐而
不得吐。故呕。〔程〕心中温温欲吐。而胸中痛。是言欲吐时之象。欲吐则气逆。故痛。着一而字。则知痛从欲
呕时见。不尔亦不痛。凡此之故。缘胃有邪蓄。而胃之上口。被浊熏也。大便溏。腹微满。郁郁微烦。是言大
便时之象。气逆则不下行。故以大便溏为反。大便溏则气得下泄。腹不应满。烦不应郁郁。今仍腹微满。郁郁
微烦。凡此之故。缘胃有阻留。而胃于下后。仍不快畅也。云先其时者。见未吐下之先。向无此证。缘吐下徒
虚其上下二焦。而中焦之气阻升降。遂从津液干燥处。涩结
成实。胃实则溏。故日进之水谷。只从胃旁溜下。不得胃气坚结之大便反溏。而屎气之留中者。自搅扰不宁。
而见出诸证。其遏在胃。故与调胃承气。一荡除之。
案王氏云。案经文。温温。当作 。此本于玉函。程氏云。温温者。热气泛沃之状。欲吐而不能吐。则
其为干呕可知矣。此以温热之义为解。并不可从矣。盖温温。与愠愠同。素问玉机真藏。背痛愠愠。马氏注。
愠愠。不舒畅也。脉经。作温温。可以证矣。（少阴篇第三十九条。心中温温。千金。作愠愠。）
案非柴胡证。汪氏用葛根加半夏汤。郭白云云。宜大半夏加橘皮汤。金鉴则云。须从太阳少阳合病。下利
若呕者。与黄芩加半夏生姜汤可也。魏氏云。若不尔者。指心下郁郁微烦言。若不郁郁微烦。则其人但正虚。
而无邪以相溷。岂调胃承气可用乎。又系建中甘草附子等汤之证矣。又岂诸柴胡可言耶。示禁甚深也。以上三
说。未知孰是。王氏云。以呕下。当有阙文。徐大椿云。此段疑有误字。千金翼。删若不以下三十字。柯氏遂
从之。要之此条极难解。姑举数说备考。（志聪锡驹注。以若不尔者。为里虚。意与魏氏同。）
太阳病。六七日表证仍在。脉微而沉。反不结胸其人发狂者。以热在下焦。少腹当硬满。小便自利者。下
血乃愈。所以然者。以太阳随经。瘀热在里故也。抵当汤主之。（玉函。六七。作七八。当硬满。作坚而满。）
〔钱〕太阳病至六七日。乃邪当入里之候。不应表证仍在。若表证仍在者。法当脉浮。今反脉微而沉。又非
邪气在表之脉矣。邪气既不在表。则太阳之邪。当陷入而为结胸矣。今又反不结胸而其人发狂者。何也。盖以
邪不在阳分气分。故脉微。邪不在上焦胸膈而在下。故脉沉。热在下焦者。即桃核承气条。所谓热结膀胱也。
热邪煎迫。血沸妄溢。留于少
腹。故少腹当硬满。热在阴分血分。无伤于阳分气分。则三焦之气化。仍得营运。故小便自利也。若此者。当
下其血乃愈。其所以然者。太阳以膀胱为腑。其太阳在经之表邪。随经内入于腑。其郁热之邪。瘀蓄于里故也。
热瘀膀胱。逼血妄行。溢入回肠。所以少腹当硬满也。桃核承气条。不言脉。此言脉微而沉。彼言如狂。此言
发狂。彼云少腹急结。此云少腹硬满。彼条之血。尚有自下而愈者。其不下者。方以桃仁承气下之。此条之血。
必下之乃愈。证之轻重。迥然不同。故不用桃仁承气汤。而以攻坚破瘀之抵当汤主之。〔方〕瘀。血气壅秘也。
案瘀。伤寒直格。于预切。积也。又音于。
吴氏瘟疫论曰。案伤寒太阳病不解。从经传腑。热结膀胱。其人如狂。血自下者愈。血结不行者。宜抵
It will inevitably result in vexation and heat. Only then can there be sweating leading to resolution. How do we know this? Because the pulse is floating, indicating that the Qi mechanism still desires to reach the exterior; thus, we know it will resolve through sweating. [Cheng] Since it is named "Fire Reversal" (Huo Ni), those wishing to treat Bi syndrome should first treat the fire pathogen. [Wang] In *Bu Wang Lun*, Guo Baiyun stated that Jiu Ni Tang (Rescue Reversal Decoction) is appropriate.
Note: Fang Shi and other scholars moved the section from "Jie Yu Zi Jie" downwards to the upper compilation, treating it as a general example of spontaneous resolution in Taiyang disease, which greatly deviates from the original meaning of this clause.
When burning needles are used to induce sweating, and the needle sites are exposed to cold, resulting in nodules rising and turning red, Ben Tun (Running Piglet) will inevitably occur, with Qi rushing from the lower abdomen up to the heart. One should moxa each nodule once (Yi Zhuang) and administer Guizhi Jia Gui Tang (Cinnamon Twig Plus Cinnamon Decoction), adding two liang more of Cinnamon Twig. (*Yu Han Jing* and *Mai Jing* write "Ben" as "Ben"; *Mai Jing* lacks the character "Ge". The note says: another version writes "Ge Yi Zhuang". *Yu Han Jing*, *Mai Jing*, and *Qian Jin Yi Fang* lack the six characters below "Geng Jia". "Two liang" is written as "Three liang" in the complete book, which is incorrect.)
[Qian] Burning needles refers to heating the needles to induce sweating. *Su Wen: Yu Ji Zhen Zang Lun* states: When wind-cold invades the person, causing all body hairs to stand erect and skin pores to close, leading to heat, at this time, sweating can be induced to release it. Or if Bi syndrome, numbness, swelling, and pain occur, they can be removed by hot compresses and fire moxibustion/acupuncture. Observing this, wind-cold should originally be resolved by sweating, but arbitrarily using burning needles to induce sweating, although it may not lead to fire becoming a pathogen, the needle puncture sites remain open and are infiltrated by cold pathogens, causing swelling like nodules and reddish skin. The cold reaches the Yin meridians, and Yin pathogens rapidly manifest, hence Ben Tun Qi inevitably occurs. [Wei] He Shi from Chongming stated that Ben Tun is caused by cold pathogens entering from the needle puncture, while wind pathogens cannot exit, directly attacking the Taiyang organ, stirring up inherent Yin cold in the Kidney, causing it to rise and rush upward. [Xi] Zhang Junwei asked: Burning needles is also a fire attack; why does fire reversal occur due to fire, yet fire moxibustion is used again? The answer is: Moxa is applied to the site affected by cold. External cold binds internal fire, causing fire to stagnate internally, hence the nodules rise and turn red.
*Shang Han Lei Fang* states: It involves more than one needle, hence "each one Zhuang."
**Guizhi Jia Gui Tang Formula**
Guizhi (Cinnamon Twig, five liang, peeled) Shaoyao (Peony Root, three liang) Gancao (Licorice Root, two liang, honey-fried) Dazao (Jujube, twelve pieces, split) Shengjiang (Fresh Ginger, three liang, sliced ○ *Yu Han Jing* makes it two liang)
The above five ingredients are boiled in seven sheng of water to obtain three sheng. Strain and take one sheng warm. Originally called Guizhi Tang, now Cinnamon Twig is added to total five liang. The reason for adding Cinnamon Twig is its ability to drain Ben Tun Qi. (Note: Song Ben edition does not record this formula, which is correct, as this clause already states "add two liang more of Cinnamon Twig". *Yu Han Jing* lacks the fifteen characters below "Man".)
[Ke] External cold binds, fire pathogen does not dissipate, developing red nodules; this is a sign of impending Ben Tun. Qi rushing from the lower abdomen to the heart is the manifestation of developed Ben Tun. This occurs because sweating was indicated but not performed, Yang Qi did not舒展 (spread), and Yin Qi reversed upward. One must moxa the nodules to disperse cold and still use Guizhi to release the exterior. Adding more Cinnamon Twig benefits Fire Yang, so Yin naturally levels out. Adding Cinnamon Twig to Guizhi treats Yin pathogen attacking upward; increasing the dosage within the same herb, without seeking other herbs outside the base formula, demonstrates such subtlety of being neither too close nor too far. Linggui Zhigan Dazao Tang applies when the syndrome is interior and Ben Tun has not yet started; this case is still exterior and active, hence different treatments.
Note: Regarding the "Gui" in the formula, Fang Shi and later practitioners mostly used Rougui (Cinnamon Bark), adhering to later Materia Medica theories, which should not be followed.
If Fire Reversal is treated with purgation, and restlessness (Fan Zao) is caused by burning needles, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is the primary treatment.
[Jian] Fire Reversal refers to any condition where fire coercion induces sweating, leading to reversal. This Fire Reversal is due to fire needles. [Wu] The patient already suffered Fire Reversal; the physician subsequently used purgation, severely injuring True Yin. Combined with residual toxicity from burning needles, causing restlessness, it indicates external pathogens are not fully resolved, and True Yang is about to perish. Thus, only Guizhi is used to release the exterior, Longgu (Dragon Bone) and Muli (Oyster Shell) to calm the interior, and Gancao to tonify Yuan Qi and disperse exterior cold. [Qian] If sweating is followed by purgation, and the disease remains unresolved with restlessness, Fuling Sini Tang (Poria, Aconite, Licorice, and Jujube Decoction) is used because both sweating and purgation have injured Yang, requiring warming meridians and restoring Yang. Here, although sweating and purgation occurred, it was not mistaken sweating, and it involves fire pathogen with unresolved exterior, so only muscle-releasing and settling methods are suitable.
Note: Burning needles is Fire Reversal, not Fire Reversal followed by burning needles. Cheng Wuji believed it was fire attack then purgation, then burning needles, totaling three errors. Commentaries by Cheng Jiaoqian, Wang Lingyou, Zhicong, Xiju, Wei Litong, etc., agree, all of which are erroneous.
**Guizhi Gancao Longgu Muli Tang Formula**
Guizhi (Cinnamon Twig, one liang, peeled) Gancao (Licorice Root, two liang, honey-fried) Muli (Oyster Shell, two liang, roasted) Longgu (Dragon Bone, two liang ○ *Yu Han Jing*: Above three ingredients, each three liang)
The above four ingredients are boiled in five sheng of water to obtain two and a half sheng. Strain and take eight ge warm, three times daily. (Song Ben: Four ingredients made into powder, which is incorrect. *Yu Han Jing* lacks the character "Ban".)
[Cheng] The pungent-sweet nature of Guizhi and Gancao disperses fire pathogen in the meridians; the astringent nature of Longgu and Muli gathers floating Zheng Qi. [Wei] Restlessness is the gradual onset of the惊狂 (frightened madness) and restlessness seen in Jiu Ni Tang. Thus, these four herbs are used to support Yang and calm the spirit. Ginger and Jujube's warm tonification and Shuji's pungent dispersion are omitted, precisely because mild illness requires mild medicine.
Ke Qin's *Fang Lun* states: Modern practitioners lack fire-warming methods, yet patients often develop restlessness and fright. Generally, Baihu Tang (White Tiger Decoction) and Chengqi Tangs are used as excess-heat conditions. However, while many cases are excess-heat, some are deficiency-cold; thus, warming and calming methods cannot be abandoned. For cases of Yang excess and Yin deficiency presenting similarly, modified Zhigancao Tang with Suanzaoren, Yuanzhi, Fuling, Danggui, etc., must be carefully selected.
In Taiyang Cold Damage, applying warm needles inevitably causes fright. (*Yu Han Jing* lacks "Zhe". *Mai Jing* and *Qian Jin Yi Fang* lack "Taiyang". *Qian Jin Yi Fang* writes "Huo Zhen".)
[Qian] Warm needles refer to the previously mentioned burning needles. Taiyang Cold Damage should be treated with Mahuang Tang (Ephedra Decoction) to induce sweating, which is the correct treatment. If warm needles are used to induce sweating, although intending to use heat to attack cold, the pathogen is forced by fire, unable to exit externally, and instead moves inward, inevitably causing fire pathogen to invade Yang Shen (Spirit), leading to shock and trembling. [Wang] *Bu Wang Lun* states Chang Qizhi said: One can refer to the previous Jiu Ni Tang.
In Taiyang disease, chills and fever are expected. Now, spontaneous sweating occurs, yet there are no chills or fever, and the Guan pulse is fine and rapid; this is due to the physician's error in using emesis. If emesis is used on days 1-2, the patient feels hungry in the abdomen but cannot eat; if used on days 3-4, the patient dislikes congee, desires cold food, vomits what was eaten in the morning by evening; this is caused by the physician's erroneous emesis. This is considered a minor reversal. (*Yu Han Jing* adds "Er" after both "chills"; "Guo" is written as "Gu". Song Ben lacks "Fan". *Mai Jing* adds "Ruo De Bing" before "Yi Er Ri".)
[Qian] The disease is in Taiyang, so chills and fever are natural. Now, spontaneous sweating without chills indicates transition to Yangming. However, Yangming should present with body heat, sweating, aversion to heat rather than cold. Now, there is no fever, and the Guan pulse is fine and rapid, which contradicts Yangming pulse/syndrome. The discrepancy arises from the physician's erroneous emesis. Taiyang exterior syndromes should be resolved by sweating; unless the pathogen is in the chest, emesis is inappropriate. Erroneous emesis damages Stomach Qi. However, obtaining sweat through emesis implies a dispersing effect, explaining the absence of chills/fever. The Guan position corresponds to Spleen and Stomach. Fine indicates deficiency; rapid indicates heat. After erroneous emesis, Stomach Qi is damaged, fluids are consumed, and deficient pathogens enter Yangming. Deficient Yang in the Stomach cavity becomes restless, causing fine-rapid pulses. On days 1-2, pathogens are in Taiyang channels; emesis disperses them, resolving exterior signs. Although Stomach Yang is mildly injured, the Stomach is not severely damaged, so hunger persists. However, with injured Yang and cold Stomach, eating is difficult. By days 3-4, pathogens have penetrated deeply; erroneous emesis severely damages the Stomach. Stomach Qi deficiency and cold resemble Yangming Middle Cold, preventing intake of congee. With deficient Yang and internal restlessness, cold food is desired. Once cold food enters the cold Stomach, it fails to digest, causing regurgitation. Although changes resulted from erroneous emesis, exterior pathogens are resolved, eliminating risk of interior sinking; only warming and harmonizing the Stomach is needed. This is a minor reversal. [Cheng] Inappropriate emesis causes Qi reversal throughout the body, overturning the Five Zang, creating emptiness below and reversal above, with Qi failing to return, resulting in such phenomena. [Wang] *Bu Wang Lun* states Chang Qizhi said: Xiaobanxia Tang (Minor Pinellia Decoction) or Banxia Jiangxin Tang (Pinellia and Fresh Ginger Decoction) can be given. Guo Baiyun suggested Da/Xiao Banxia Jia Fuling Tang or Banxia Shengjiang Tang from *Huo Ren Shu*.
Xiju stated: Spontaneous sweating results from emesis damaging Middle Qi and leaking Spleen fluids. Cheng stated: Exterior pathogens fail to vent outward and reverse upward, hence termed minor reversal.
Zhicong stated: *Ben Lun* says: Pulse floating and large warrants sweating; if the physician erroneously purges, it is major reversal. Here, only erroneous emesis occurs, hence minor reversal.
Note: *Yi Zong Jin Jian* states: Six characters "Wu Liu Ri Tu Zhi Zhe" (those who emesis on days 5-6) should follow "Yu Shi Leng Shi" (desires cold food). Without this, the text linking "dislikes congee/desires cold food" with "morning eat/evening vomit" is disjointed. Comparing with days 1-2 and 3-4, it is evident these characters belong here, indicating progression from shallow to deep. Ke Qin moved "Ci Wei Xiao Ni" (This is minor reversal) under "Tu Zhi Guo Ye", both interpretations are unacceptable.
In Taiyang disease, if emesis is used, and although Taiyang disease typically involves chills, now there are no chills and an aversion to wearing clothes, this is internal vexation caused by emesis.
[Jian] If Taiyang disease resolves after emesis, chills should cease. If interior resolves, heat aversion should cease. Now, absence of chills and aversion to clothing indicate heat aversion. This results from emesis resolving the exterior but not the interior, generating internal vexation-heat. No-sweat vexation-heat indicates exterior heat (Da Qinglong Tang syndrome). Sweat-vexation-heat indicates interior heat (Baihu Tang syndrome). Post-emesis/purgation mental depression with no-sweat vexation-heat and hard stool indicates heat remaining inside (Zhizi Chi Tang syndrome). Post-emesis/purgation mental depression with sweat, hard stool, and heat fully entering the Fu organs indicates Tiaowei Chengqi Tang syndrome. Now, post-emesis internal vexation-heat represents deficiency vexation due to Qi/fluid injury, not excess vexation prior to sweating/purgation. None of the above methods apply; only Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used to clear heat and calm vexation while benefiting Qi and generating fluids. [Fang] This is also a variation of erroneous emesis. Absence of chills and aversion to clothing means exterior heat is not obvious, but interior heat exists. Internal vexation arises because emesis depletes fluids, drying the Stomach and generating internal heat. [Wang] *Bu Wang Lun* states Chang Qizhi said: Zhuye Shigao Tang can be given.
If the patient's pulse is rapid, rapid indicates heat, which should promote digestion and appetite, yet vomiting occurs instead. This is because sweating made Yang Qi weak and Ge Qi (Diaphragm Qi) deficient, causing the rapid pulse. Rapid here denotes guest heat, incapable of digesting food, due to cold deficiency in the Stomach, hence vomiting. ("Ci Yi Fa Han" in *Yu Han Jing* is "Yi Yi Fa Qi Han". "Mai Nai Shu Ye" is "Mai Ze Wei Shu". Wang edition deleted "Leng", which is incorrect.)
[Qian] This clause discusses Wind Strike with fever and spontaneous sweating, further mistreated by sweating. This injures Wei Yang (Defensive Yang) and Stomach Yang, causing significant deficiency of Zong Qi (Gathering Qi) in the Diaphragm. Floating deficient Yang causes the rapid pulse. If Stomach Yang were strong, digestion would proceed normally. This rapid pulse is not due to excess heat in the Stomach, but rather deficient Yang floating outward due to post-sweating Yang depletion and Diaphragm emptiness. Since it is not true Stomach Yang, it is called "guest heat." Inability to digest stems from cold deficiency in the Stomach, preventing both digestion and retention, hence vomiting. [Wang] *Bu Wang Lun* states Chang Qizhi said: Xiaobanxia Tang can be given; also suggests Xiaowenzhong Tang.
In Taiyang disease, after passing the meridian for over ten days, if there is a sensation of nausea in the epigastrium, chest pain, loose stools, slight abdominal fullness, and mild depression/vexation, and if prior to this, the patient had undergone extreme emesis or purgation, Tiaowei Chengqi Tang (Harmonizing the Stomach and Ordering the Qi Decoction) should be given. If not, it should not be given. If merely desiring to vomit, with chest pain and loose stools, this is not a Chaihu Tang syndrome; the vomiting indicates prior extreme emesis/purgation. (*Yu Han Jing*: "Wen Wen" is written as "Yun Yun"; adds "You" after "Xia"; "Dan" is "Fan"; lacks "Chai Hu". *Mai Jing* lacks "Tiao Wei". Song Ben lacks "Tang" in "Chai Hu Tang". *Qian Jin Yi Fang* lacks thirty characters from "Ru Bu Er Zhe". Ke Qin edition deletes them too.)
[Qian] This distinguishes symptoms resembling Shaoyang but actually not Chaihu syndrome. Pathogen in Taiyang passes one period to over ten days, exceeding the meridian. Symptoms include epigastric nausea, chest pain, loose stools, slight abdominal fullness, and mild depression/vexation. If prior to these symptoms, the patient subjected themselves to extreme emesis/purgation, it indicates Stomach Qi was damaged by erroneous emesis/purgation, causing nausea and loose stools. Pathogens entered the interior via deficiency, causing chest pain and abdominal fullness. Interior heat causes depression/vexation, indicating interior sinking and Stomach excess. Stomach excess warrants purgation, but since Stomach Qi is deficient from prior emesis/purgation, harsh purgation is unsuitable; only harmonizing Stomach Qi is appropriate. Hence, Tiaowei Chengqi Tang is given, aligning with *Yangming Pian*: "When Stomach harmonizes, healing occurs." "Ru Bu Er Zhe" means prior extreme emesis/purgation did not occur. If these symptoms appear without prior emesis/purgation, they are not due to pathogen sinking. The chest belongs to Taiyang; pathogen in chest/diaphragm causes nausea and chest pain. Loose stools indicate heat has not consolidated in the interior. Abdominal fullness and vexation suggest pathogen approaching interior. In such cases, pathogen remains in Taiyang, signaling impending interior entry. Using Chengqi Tang would cause heat to sink, forming Jie Xiong (Chest Binding). Hence, it is contraindicated. The previously mentioned desire to vomit, chest pain, and loose stools resemble Shaoyang's vexation, frequent vomiting, hypochondriac fullness, and abdominal pain, but are not Chaihu syndrome. How do we know prior extreme emesis/purgation occurred? Vomiting indicates Stomach Qi injury. [Xi] Vomiting is the inability to expel the urge to vomit ("Wen Wen"). [Cheng] Epigastric nausea and chest pain describe the state during the urge to vomit. Urge to vomit causes Qi reversal, hence pain. The character "Er" indicates pain coincides with the urge. Otherwise, no pain. This occurs because pathogens accumulate in the Stomach, turbidity steams the upper opening. Loose stools, abdominal fullness, and vexation describe the state during defecation. Qi reversal prevents downward flow, making loose stools abnormal. Loose stools allow Qi to descend, so abdomen shouldn't be full, nor should vexation be depressed. Current fullness and vexation indicate Stomach obstruction and lack of smoothness post-defecation. "Xian Qi Shi" implies these symptoms were absent before emesis/purgation. Emesis/purgation only depleted Upper/Lower Jiao, obstructing Middle Jiao Qi升降 (ascending/descending), leading to dryness and solidification. Stomach excess leads to loose stools because daily food passes around the Stomach rather than forming solid stool due to lack of Stomach Qi consolidation. Retained fecal gas disturbs the interior, causing these symptoms. Since obstruction is in the Stomach, Tiaowei Chengqi Tang clears it entirely.
Note: Wang Shi states: According to the text, "Wen Wen" should be "Yun Yun", based on *Yu Han Jing*. Cheng Shi states: "Wen Wen" describes heat surging. Urge to vomit without expulsion indicates dry heaving. Interpreting "Wen Wen" as warmth is incorrect. "Wen Wen" is synonymous with "Yun Yun". *Su Wen: Yu Ji Zhen Zang Lun* mentions back pain "Yun Yun"; Ma Shi notes: "Yun Yun" means discomfort. *Mai Jing* writes "Wen Wen", confirming this. (*Shaoyin Pian* Clause 39: "Xin Zhong Wen Wen", *Qian Jin* writes "Yun Yun".)
Note: Regarding non-Chaihu syndrome, Wang Shi uses Gegen Jia Banxia Tang. Guo Baiyun suggests Banxia Jia Jupi Tang. *Yi Zong Jin Jian* suggests Huangqi Jia Banxia Shengjiang Tang for Taiyang-Shaoyang combined disease with diarrhea/vomiting. Wei Litong states: "Ru Bu Er Zhe" refers to epigastric depression/vexation. Without this, the patient is merely deficient without pathogen confusion; Tiaowei Chengqi Tang is inappropriate. It might require Jianzhong or Gancao Fuzi Tangs, let alone Chaihu formulas. This serves as a strong prohibition. Among these three views, correctness is uncertain. Wang Shi suggests missing text after "Yi Ou". Xu Dachun suspects textual errors. *Qian Jin Yi Fang* deletes thirty characters from "Ru Bu Er Zhe"; Ke Qin follows this. This clause is extremely difficult to interpret; several views are presented for reference. (Zhicong and Xiju interpret "Ru Bu Er Zhe" as interior deficiency, similar to Wei Shi.)
In Taiyang disease, after six or seven days, if exterior signs persist, pulse is faint and deep, there is no Jie Xiong (Chest Binding), but the patient experiences mania (Fa Kuang), it is because heat is in the Lower Jiao. The lower abdomen should be hard and full. If urination is normal, blood letting/stooling blood will cure it. This is because Taiyang pathogens followed the meridians, causing stasis-heat in the interior. Didang Tang (Mustard Seed Decoction) is the primary treatment. (*Yu Han Jing*: "Liu Qi" is "Qi Ba"; "Dang Ying Man" is "Jian Er Man".)
[Qian] Taiyang disease at six or seven days is when pathogens should enter the interior; exterior signs should not persist. If they persist, the pulse should be floating. Now, the pulse is faint and deep, inconsistent with exterior pathogens. Since pathogens are not exterior, Taiyang pathogens should sink to form Jie Xiong. Yet, there is no Jie Xiong, but mania occurs. Why? Because pathogens are not in Yang/Qi layers (hence faint pulse), but in the Lower Jiao/Blood layers (hence deep pulse). Heat in Lower Jiao refers to "Heat Consolidating in Bladder" from Taohe Chengqi Tang clause. Heat forces blood to boil and overflow, accumulating in the lower abdomen, causing hardness/fullness. Heat in Yin/Blood layers does not injure Yang/Qi layers, so San Jiao Qi transformation operates normally, allowing normal urination. In such cases, draining blood cures it. The reason is that Taiyang's organ is the Bladder; exterior pathogens in the meridian follow it into the organ, where stagnant heat accumulates. Heat-stasis in the Bladder forces blood to overflow into the Large Intestine, causing lower abdominal hardness/fullness. Taohe Chengqi Tang clause does not mention pulse; this one mentions faint/deep. That clause mentions "Ru Kuang" (like mad); this one mentions "Fa Kuang" (mania). That clause mentions "Shao Fu Ji Jie" (lower abdomen urgent/knotting); this one mentions "Shao Fu Ying Man" (lower abdomen hard/full). In that clause, blood may pass spontaneously to cure; if not, Taohe Chengqi Tang is used. In this clause, blood must be drained to cure. The severity differs significantly; thus, Taohe Chengqi Tang is not used, but Didang Tang, which breaks stasis and attacks hardness, is used. [Fang] Yu means congestion and blockage of blood and Qi.
Note: *Yu*, *Shang Han Zhi Ge* pronunciation is "Yu Qie", meaning accumulation. Also pronounced "Yu".
Wu Shi's *Wen Yi Lun* states: Note: Untreated Taiyang disease transmits from meridian to organ, heat consolidates in Bladder, patient is like mad; if blood passes spontaneously, it heals. If blood clots and does not move, Didang Tang is appropriate.