（已见前第三卷太阳上编）更加桂（二两）金匮方共成（五两）
琥按桂枝汤。虽系解肌之剂。今者寒邪之气。内入肾藏而上冲于心。此水来犯火之证。条辩议所加者。当是桂而
非枝。此深合仲景之旨。
或问伤寒本系热病。复加烧针。则上冲之气。宜从火治。议者不当加桂。余答云。子言甚合鄙意。然此证。须知是
太阳病未发热之时。误用烧针开泄腠理。以引寒气入藏。故与中寒同治。若内有郁热。则必见烦躁等证矣。设见烦躁等
证。理宜从子言。以活法治之。
又按成注云。烧针发汗则内损阴血。而惊动心气。愚意以若损阴血而惊动心气。是为阳盛阴虚。非寒证比矣。此与
仲景加桂之意不合。误极误极。
火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。（火逆下之者。此必是太阳病。误以火熨其背或以火劫其汗。
病患更加谵语腹满。起卧不安等证。医认以为里实而下之。里气重虚。又加以烧针之大热。火邪内迫则生烦躁。条辩云。
此条病逆而又逆。但未变重。故与桂枝甘草龙骨牡蛎汤。以散解火邪。）
桂枝（一两） 甘草（二两） 牡蛎（二两熬） 龙骨（二两）
上为末。以水五升。煮取二升半。去滓。温服八合。日三服。
成注云。辛甘发散。桂枝甘草之辛甘。以发散经中之火邪。涩可去脱龙骨牡蛎之涩。以收敛浮越之正气。
琥按上方。即前桂枝去芍药。加蜀漆龙蛎救逆汤。制小其剂而用之也。火邪迫内。则生烦躁。故用龙骨牡蛎之咸寒
甘平。以胜火热而收敛浮越之气。盖烦躁不比惊狂之甚。而其气亦浮越也。愚以烦躁虽带表邪。不宜散以桂枝之辛热。
又火逆既经下之。此阴血受伤。较之救逆汤。宜增芍药。仲景之方不可执也。
太阳伤寒者。加温针。必惊也。（太阳伤寒。宜用麻黄汤以发汗。医人误加温针。以攻其寒。殊不知寒盛于外。热郁
于内。针用火温。营血得之。反增其热。热气凑心。必见惊证。惊者。神不宁而时作耸动故也。按此条论。仲景无治法。
补亡论常器之云可根据前救逆汤。愚以救逆汤。宜加减用之。）
太阳病当恶寒发热。今自汗出。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。（太阳病当恶寒发热。今者自汗出。不恶寒但
发热。是转阳明证矣。及切其脉。又非阳明之脉。乃细数。见于关上。关主中焦。为脾胃之分。细则为虚。数则为热。
以医误吐之为过也。尚论篇云。吐中亦有发散之义。故得自汗出。不恶寒。一二日太阳之邪气尚浅。吐之者。胃不尽伤。
吐后胃虚。故腹中饥。胃口受伤。故欲食而不能也。三四日。阳明之邪气渐深吐之者。胃气全伤。吐后。胃虚大热。故
不喜糜粥之热。欲食冷食。及冷食朝食。暮则吐出缘阳明之气。由吐而逆。不能下行。此医误吐之所致胃伤而脾亦受伤
也。成注云。胃气尚在。故云。小逆。言此实由误吐。一时气逆使然。非关格大逆之候比也。按此条论。仲景无治法。
补亡论常器之云。可与小半夏汤。小治中汤。亦可。与半夏干姜汤。出金匮方。郭白云。云。活人书大小半夏加茯苓汤。
半夏生姜汤。皆可选用。愚以上方如治中汤。半夏干姜汤。断不可用。盖此证。系胃中虚热。而非虚寒。成氏原注云。
表寒传于胃中。胃中虚寒者。大误。若胃中果系虚寒。则不当见数脉矣。）
以上太阳逆证共一十四条（自原论中第三卷集入于此）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。（按此条。原论上文云。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。此承上文尚未吐下而言。若已吐下发汗温针不惟犯少阳三禁。更加温针。以迫劫之。成注云。
损耗津液。胃中干燥。木邪干胃。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。
知犯何逆。以法治之。谓不当尚认为少阳证。小柴胡汤之外。另宜以活法治之也。愚按此条论仲景无救逆之法。补亡论
庞安时云。犯何逆者。犯四种温病坏候也。郭白云云。温针谵语。亦宜桂枝甘草龙骨牡蛎汤。愚以上二家之言。皆以臆
见轻拟前圣之旨。盖仲景云。知犯何逆者。与太阳病坏证云云略同。谓汗吐下温针四者之治。各有逆证。而医人犯之。
非谓四者齐犯也。偶出谵语一条。亦不当强划温针所致。强执一方以治之。况在当日。仲景必有少阳坏病之条。及救逆
之方。今皆亡之耳。学人。设遇少阳坏病。只须证书。以活法治之。）
以上少阳逆证一条。（自原论中第五卷集入于此）
少阴病。咳而下利。谵语者。被火气劫故也。小便必难。以强责少阴汗也。（此条乃热邪传入少阴。误用火劫而致逆
之证。夫曰少阴病。则知其脉微细而但欲寐矣。医人不知。误认以为虚寒。妄加火气劫之。少阴之支脉别出肺。今以火
气强劫其汗。尚论篇云。热邪挟火气。上攻必为咳。下攻必为利。内攻必谵语。此以里。有伏热。外被火气逼迫。两热
相并。势必致神乱而谵语。小便。必难者。火气迫其津液。外泄而为汗。内泄而为利。水道枯涩。以故小便难且肾开窍
于二阴。少阴水藏被火所迫。以致前阴之水。从后阴而并出。救逆之法。可无方乎。按此条论。仲景无治法。补亡论常
器之云。宜桂枝去芍药。加蜀漆龙骨牡蛎救逆汤。以救火逆。猪苓汤。五苓散。以通小便。愚以常氏治火逆。不论何经。
皆用救逆汤。焉能与病相合。至其用猪苓汤以通小便。庶几犹可若五苓散。太辛燥。恐非火逆所宜。）
以上少阴逆证一条（自原论中第六卷集入于此）
(See the previous Volume 3, Taiyang Upper Section) Add Guizhi (Cinnamon Twig, 2 liang) to the original formula. Combined with the formula from *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), the total amount becomes (5 liang).
Huang Yuanyu notes: Guizhi Tang (Cinnamon Twig Decoction) is a medication for resolving the muscle layer. Currently, cold pathogenic qi has entered internally into the Kidney Zang and rushed upward to the Heart. This is a syndrome where Water attacks Fire. The discussion in Tiaobian suggests that what should be added is Guizhi (the twig), not just the branch. This deeply aligns with Zhang Zhongjing's intent.
Someone asked: Shanghan (Cold Damage) is originally a heat disease. Adding burning needle therapy would cause the rushing-upward qi to be treated via fire. Those discussing it should not add Guizhi. I replied: Your words accord well with my views. However, regarding this syndrome, one must know that it occurred when the Taiyang disease had not yet manifested fever. The physician mistakenly used burning needles to open the pores (Couli), thereby drawing cold qi into the Zang organs. Therefore, it is treated similarly to Zhonghan (Internal Cold). If there were internal stagnant heat, symptoms such as Fan Zao (restlessness) would definitely appear. If such symptoms as Fan Zao were present, logic dictates following your advice and using flexible methods for treatment.
I further note: Cheng Wuji's commentary states: Burning needles induce sweating, which internally damages Yin blood and startles the Heart Qi. In my opinion, if Yin blood is damaged and Heart Qi is startled, this constitutes Yang Excess and Yin Deficiency, which cannot be compared to a Cold syndrome. This contradicts Zhang Zhongjing's intention for adding Guizhi. It is extremely wrong, extremely wrong.
When Huoni (Fire Reversal) is followed by Purging (Xia), and restlessness arises due to burning needles, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is the primary treatment. (Regarding "Huoni Xia zhi": This must be a Taiyang disease where the physician mistakenly used fire to warm the back or forced sweating with fire. The patient additionally developed Chan Yu (delirious speech), Fu Man (abdominal fullness), and inability to lie still. The physician misidentified this as interior excess and administered purgatives, causing the interior Qi to become doubly deficient. Furthermore, the intense heat of the burning needles caused Fire Pathogens to press inward, generating Fan Zao (restlessness). Tiaobian states: This condition involves reversal upon reversal, but has not yet become severe; thus, Guizhi Gancao Longgu Muli Tang is given to dissipate and resolve the Fire Pathogen.)
Guizhi (Cinnamon Twig, 1 liang) Gancao (Licorice Root, 2 liang) Muli (Oyster Shell, 2 liang, calcined) Longgu (Dragon Bone, 2 liang)
Grind the above ingredients into powder. Use five sheng of water, boil to obtain two and a half sheng. Remove the dregs. Take eight ge warm, three times daily.
Cheng Wuji comments: Pungent and Sweet disperse outward. The pungent and sweet nature of Guizhi and Gancao disperses Fire Pathogens within the meridians. Astringency removes collapse. The astringent nature of Longgu and Muli converges floating and hyperactive Zheng Qi (Upright Qi).
Huang Yuanyu notes: The above formula is essentially Guizhi Qu Shaoyao Jia Shujie Longmu Jiuniu Tang (Cinnamon Twig Decoction without Peony, plus Fleeceflower Root, Dragon Bone, and Oyster Shell to Rescue Reversal), used in a reduced dosage. When Fire Pathogens press inward, Fan Zao (restlessness) arises. Therefore, the salty-cold and sweet-neutral properties of Longgu and Muli are used to overcome Heat Fire and converge floating Qi. Generally, Fan Zao (restlessness) is not as severe as Jing Kuang (panic and mania), yet the Qi is also floating. I believe that although Fan Zao carries exterior pathogens, it is unsuitable to use the pungent-hot nature of Guizhi to disperse it. Moreover, since Huoni was followed by purging, Yin blood is injured. Compared to Jiuniu Tang, Shaoyao (Peony Root) should be increased. One should not rigidly adhere to Zhang Zhongjing's formulas.
In Taiyang Shanghan (Cold Damage), adding warm needles will inevitably cause Jing (fright/startle). (Taiyang Shanghan should be treated with Mahuang Tang (Ephedra Decoction) to induce sweating. The physician mistakenly added warm needles to attack the cold. Unaware that Cold is abundant externally while Heat is stagnant internally, the warmth of the needles affects Ying Blood,反而 increasing the heat. Heat Qi gathers at the Heart, inevitably manifesting as Jing (fright). Jing refers to the Spirit being unsettled and the body occasionally trembling. Regarding this clause, Zhang Zhongjing provides no treatment method. Bu Wang Lun (Supplement to Lost Chapters) by Chang Qizhi suggests referring to the preceding Jiuniu Tang. I believe Jiuniu Tang should be modified for use.)
In Taiyang Bing (Disease), one should experience E Han (aversion to cold) and Fa Re (fever). Now, if there is spontaneous sweating, absence of aversion to cold and fever, and a fine-rapid pulse at the Guan position, this is due to the physician's error in inducing vomiting. If vomiting is induced on days 1-2, the abdomen feels hungry but the mouth cannot eat. If vomiting is induced on days 3-4, there is dislike for congee, desire for cold food, eating in the morning and vomiting in the evening. This is caused by the physician's erroneous induction of vomiting. This is considered a Minor Reversal (Xiao Ni). (In Taiyang Bing, E Han and Fa Re are expected. Now, with spontaneous sweating, absence of E Han but presence of Fa Re, the condition has transformed into Yangming. However, the pulse is not typical of Yangming; it is fine and rapid at the Guan position. Guan governs the Middle Jiao, corresponding to the Spleen and Stomach. Fine indicates Deficiency; Rapid indicates Heat. This is the fault of the physician's erroneous emesis. Shanglun Pian states: Emesis also has a dispersing effect, hence spontaneous sweating and absence of E Han occur. On days 1-2, Taiyang pathogenic qi is shallow; emesis does not fully injure the Stomach. After emesis, Stomach Qi is deficient, hence hunger. The appetite is injured, hence desire to eat but inability. On days 3-4, Yangming pathogenic qi is deeper; emesis fully injures Stomach Qi. Post-emesis, Stomach Deficiency generates significant Heat, hence dislike for hot congee and desire for cold food. Cold food eaten in the morning is vomited in the evening because Yangming Qi reverses due to emesis and cannot descend. This is caused by the physician's erroneous emesis injuring the Stomach and Spleen. Cheng Wuji notes: Stomach Qi remains, hence termed Minor Reversal. This implies it is merely temporary Qi reversal due to erroneous emesis, not comparable to the major reversal of Guan Ge. Regarding this clause, Zhang Zhongjing provides no treatment. Bu Wang Lun by Chang Qizhi suggests Xiao Banxia Tang (Minor Pinellia Decoction) or Xiao Zhizhong Tang (Minor Regulate the Middle Decoction) may be used. Banxia Ganjiang Tang (Pinellia and Dried Ginger Decoction) from Jingui Fang is also an option. Guo Baiyun states: Da Xiao Banxia Jia Fuling Tang (Large/Small Pinellia with Polyporus Decoctions) and Banxia Shengjiang Tang (Pinellia and Fresh Ginger Decoction) from Huoren Shu are all selectable options. I believe formulas like Zhizhong Tang and Banxia Ganjiang Tang are absolutely contraindicated. This syndrome involves Stomach Deficient Heat, not Deficient Cold. Cheng Shi's original note claiming "Exterior Cold transmits to the Stomach causing Stomach Deficient Cold" is a major error. If the Stomach truly had Deficient Cold, a Rapid pulse would not appear.)
The above Taiyang Reversal Syndromes total fourteen clauses (collected from Volume 3 of the original treatise here). If Vomiting, Purging, Sweating, and Warm Needles have been applied, resulting in Chan Yu (delirium), and the Chaihu Tang syndrome has ceased, this is called Huai Bing (Ruined Disease). Knowing what reversal has occurred, treat according to the method. (Regarding this clause, the preceding text of the original treatise states: If the original Taiyang disease does not resolve and transfers to Shaoyang, presenting with hardness and fullness under the hypochondrium, dry retching, inability to eat, alternating chills and fever, and before vomiting/purging, with a deep-tight pulse, give Xiao Chaihu Tang. This follows the statement "before vomiting/purging." If vomiting, purging, sweating, and warm needles have already been applied, not only do they violate the Three Prohibitions of Shaoyang, but the addition of warm needles forces and coerces. Cheng Wuji notes: This depletes Body Fluids, causing Dryness in the Stomach. Wood Pathogen attacks the Stomach, inevitably causing delirium. "Shaoyang syndrome ceases" means the absence of hypochondriac hardness, dry retching, and alternating chills/fever. This is Huai Bing. Knowing what reversal occurred, treat accordingly. This means one should not still consider it a Shaoyang syndrome; besides Xiao Chaihu Tang, other flexible methods should be employed. I note that Zhang Zhongjing provides no rescue method for this clause. Bu Wang Lun by Pang Anshi states: "What reversal?" refers to four types of ruined conditions from warm diseases. Guo Baiyun states: Delirium from warm needles should also be treated with Guizhi Gancao Longgu Muli Tang. I consider both scholars' opinions to be presumptuous interpretations of the ancient sage's intent. Zhang Zhongjing says "Knowing what reversal occurred," which is similar to the Taiyang Ruined Syndrome clauses. It means the treatments of sweating, vomiting, purging, and warm needles each have their own reversal syndromes, which physicians may commit; it does not mean all four are committed simultaneously. The occasional appearance of delirium should not be forcibly attributed solely to warm needles. Rigidly adhering to one formula for treatment is inappropriate. Furthermore, in Zhang Zhongjing's time, there must have been clauses on Shaoyang Ruined Diseases and rescue formulas, which are now lost. Students, if encountering Shaoyang Ruined Disease, simply match the symptoms and treat with flexible methods.)
The above Shaoyang Reversal Syndrome totals one clause (collected from Volume 5 of the original treatise here).
In Shaoyin Bing, coughing with diarrhea and delirium occurs because the patient was subjected to Fire coercion. Urination will certainly be difficult, due to forcing sweat from Shaoyin. (This clause describes a condition where Heat Pathogen enters Shaoyin, and erroneous Fire coercion leads to reversal. Since it is Shaoyin Bing, the pulse is known to be minute and fine, with only a desire to sleep. The physician, unaware, mistakenly identifies it as Deficient Cold and recklessly applies Fire coercion. The collateral branches of Shaoyin diverge to the Lung. Forcing sweat with Fire... Shanglun Pian states: Heat Pathogen carrying Fire Qi attacking upward causes cough; attacking downward causes diarrhea; attacking inward causes delirium. Because there is latent Heat inside, and external Fire Qi presses upon it, the two heats combine, inevitably leading to Spirit confusion and delirium. Urination being difficult: Fire Qi forces Body Fluids to leak outwards as sweat and inwards as diarrhea, drying the water passages, hence difficult urination. Additionally, the Kidney opens into the two yin openings. The Shaoyin Water Zang, pressured by Fire, causes fluids from the anterior yin to exit through the posterior yin. Is there no formula for rescuing reversal? Regarding this clause, Zhang Zhongjing provides no treatment. Bu Wang Lun by Chang Qizhi suggests: Guizhi Qu Shaoyao Jia Shujie Longmu Jiuniu Tang to rescue Fire reversal; Zhuling Tang (Polyporus Decoction) and Wuling San (Five-Ingredient Powder with Poria) to promote urination. I believe Chang's approach to treating Fire reversal uses Jiuniu Tang regardless of the meridian, which cannot match the specific pathology. Using Zhuling Tang to promote urination is somewhat acceptable. However, Wuling San is too pungent and drying, likely unsuitable for Fire reversal.)
The above Shaoyin Reversal Syndrome totals one clause (collected from Volume 6 of the original treatise here).