（此系仲景原文。散见太阳少阳少阴等篇。今集于此）
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。
（中去声。成注云。太阳病三日中。曾经发汗吐下温针。虚其正气。病仍不解者。谓之坏病。言治不对证。为医所坏也。
桂枝不中与者。以其初。本系太阳。中风乃桂枝汤证。至此则其病已坏。桂枝汤不中与也。更当审其脉证。知犯何逆。
随其逆而救之。愚按此条论。仲景无救逆之法。补亡论亦不言及。惟准绳云。逆者谓汗下皆不顺于理也。随证治之者。
即仲景原论中云汗后病不解。及发汗若下之病仍不解。某汤主之类是也。后条辩又云有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。变证多端。治非一法。仲景恐人以桂枝汤证误治。仍执定一桂
枝汤。故令医人舍汤辩脉。另寻一看证之活法耳。学人须以意会之。）
太阳病二日。反躁。反熨其背而大汗出。火热入胃。胃中水竭。躁烦。必发谵语。十余日。振栗。自下利者。此为
欲解也。故其汗从腰以下不得汗欲小便不得。反呕。欲失溲。足下恶风。大便硬。小盒饭数而反不数。及不多。大便已。
头卓然而痛。其人足心必热。谷气下流故也。（此为欲解也。也字当在故字之下。太阳病止二日。邪犹在表。不当躁而反
躁者。此必是大青龙汤证。故无汗成注云。躁者。热气行于里也。医人不知。反用火熨其背。强发其汗使之大出。火热
之邪。因而入胃。胃中之水告竭。阴不胜阳。其发躁烦谵语之证必矣。至十余日。正气渐复。阴与阳争。故作振战悚栗
之候。自下利者。火邪由大肠而得泄。此为欲自解也。其有不自解者。必在前所熨之汗从腰以下未出。成注云。此为津
液虚。不得下通。故欲小便并不得也。津液既虚。火邪上逆。其势不惟躁烦而反增呕。欲失溲者。此是形容不得小便之
状。足下恶风者。腰以下无汗风邪犹郁于下部。故恶风也。大便硬者。胃中水竭之故。此非津液偏渗。故小盒饭数。而
反不数。及不多也。凡此者。实由大便硬。不自下利。皆未解证也。法宜用药以通其大便。大便已则火邪自泄。阴气得
复而上升。头必卓然而反空痛。阳气得伸而下降。足不恶风而其心必热。此是谷气下流故也。谷气者。食气也。食气下
流。则胃中输转。火邪皆去而病即愈。按此条论。仲景无治法。补亡论常器之云。可与白虎加人参汤。五苓散。调胃承
气汤郭白云云。推常氏之意。谓火气入胃。胃中枯燥。故用白虎加人参汤解之。然须无表证。渴饮水者。可服。小便不
利者。固当用五苓散。然亦必渴饮水者。宜服。其大便硬者。用调胃承气汤。亦必小便不利。谵语仍在者。然后可服。
又云。此条论。于诸证未生时。必须先去火邪。宜救逆汤。愚以人参白虎汤犹可用。五苓散断不可用。此系胃中水竭。
津液燥。故欲小便不得。非小便不行也。大便硬。虽小便不数亦系火热燥证。其用调胃承气汤。不若以麻仁丸代之至于
救逆汤。与上条证不合。不必用也。）
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。（太阳中风。此必是桂枝汤证。医人误以火劫强发其汗。邪风加以火热。以致血气流溢。
失其常行之度。风阳也。火亦阳也。两阳相熏灼。邪热搏于外。则肌肉受伤。脾主肌肉而属土。故身发黄邪热搏于阳明
之经。为阳盛。阳盛则火升。故欲衄。邪热搏于太阳之府。为阴虚。阴虚则水涸。故小便难。水火者。人身之阴阳。实
则气与血也。偏胜者。势必至于交病。故云阴阳俱虚竭也。阴阳俱虚。则前之流溢者。至此而衰耗。身体焉得不枯燥也。
成注云。三阳经络至颈。三阴至胸中而还。剂。分也。但头汗出。剂颈而还者。邪热炎上。搏阳而不搏于阴也。腹满微
喘者。邪热内郁也。口干咽烂者。邪热上熏也。或不大便者。邪热耗其津液也。久则胃中燥热。必发谵语。甚者。至哕。
则邪热气逆。为病更深矣。四肢者。诸阳之本。邪热亢盛则手足扰乱。甚至捻衣而摸床矣。后条辩云。以上诸证。无非
邪风火热。逆乱其气血。一至于此。乃真阴立亡之象。此际欲治风。则火势蒸腾。欲治火。则风势壅遏。惟有利小便一
法。使小便利。庶几火邪得泄。津液得通。其人病犹可治也。诸家注皆言小便自利。夫上文既云。小便难岂有病剧而反
自利之理。必须用药以探之。其人小便利。犹为可治之证。如其不利。虽治之恐无效矣。此实仲景言外之意。按此条论。
仲景无治法。愚意云。但当利其小便。宜猪苓汤。初亡论云。与五苓散。恐太燥津液。不宜用也。又云救逆。可桂枝去
芍药加蜀漆牡蛎龙骨汤。亦非对证之药。又云。发黄者宜茵陈蒿汤。愚以此非胃实。有瘀湿。乃干黄也。上药非所宜用。
又云。不大便。宜大承气汤。愚以此非。胃实谵语乃燥热神志昏乱。故手足为之躁扰也。上药更非所宜。但当从小便中
导去其热。而诸证悉平。）
伤寒脉浮。医以火迫劫之。亡阳。必惊狂。起卧不安者。桂枝。去芍药。加蜀漆牡蛎龙骨救逆汤主之。（伤寒脉浮者。
是伤寒见风脉也。风脉既见。其为表虚可知。医人误以火迫劫之。汗乃大出而亡其阳。成注云。汗者。心之液。亡阳。
则心气虚。心恶热。火邪内迫则心神浮越。故惊狂起卧不安。汤名救逆者。以惊狂不安。皆逆证也。）
(This is the original text of Zhang Zhongjing. It is scattered in chapters such as Taiyang, Shaoyang, and Shaoyin. It is now collected here.)
Taiyang disease (disease of the Taiyang channel), after three days, having undergone sweating therapy, or emesis, or purgation, or warm needle therapy, with the condition still unresolved, is termed a "ruined disease" (Huai Bing). Guizhi Tang (Cinnamon Twig Decoction) should not be administered at this time. One must observe the pulse and signs/symptoms, determine what therapeutic error (Ni) was committed, and treat according to the specific presentation.
(Cheng Wuji's commentary states: In Taiyang disease within three days, if sweating, emesis, purgation, or warm needles have been used, depleting the healthy Qi, yet the disease remains unresolved, it is called a "ruined disease." This means the treatment did not match the syndrome, and the physician caused harm.
The phrase "Guizhi Tang should not be administered" implies that initially, it was a Taiyang Wind-strike syndrome, which is an indication for Guizhi Tang. By this point, the disease has become complicated/ruined, so Guizhi Tang is no longer applicable. One must carefully examine the pulse and signs/symptoms to identify the nature of the therapeutic error.
Remedies should follow the nature of the error. I believe that in this clause, Zhang Zhongjing does not specify a method for remedying errors, nor does *Bu Wang Lun* (Supplementary Lost Treatises). Only *Zhun Sheng* (Standard Guidelines) states: "Ni" refers to sweating and purging methods that are contrary to reason. "Treating according to the syndrome" refers to statements in Zhang Zhongjing's original work such as "after sweating, the disease is not resolved," or "after sweating or purging, the disease remains unresolved, treat with [Specific Formula]." Subsequent commentaries also mention scenarios like post-sweating Yang depletion, channel agitation, thirst, irritability, delirium; post-purgation empty irritability, chest binding, epigastric fullness; post-emesis internal heat, abdominal distension; post-warm-needle vomiting, epistaxis, fright, and mania. There are numerous variations in transformed syndromes, and treatments are not uniform. Zhang Zhongjing likely feared that physicians, misled by the initial Taiyang Wind-strike indication, would rigidly stick to Guizhi Tang. Thus, he instructed physicians to abandon fixed formulas, differentiate based on pulses, and seek flexible diagnostic and therapeutic approaches. Students must comprehend this intent.)
In Taiyang disease on the second day, there is irritability instead of calmness. The back is forcibly heated with hot irons, causing profuse sweating. The fire-heat pathogen enters the Stomach, exhausting the fluids in the Stomach. Irritability and restlessness occur, inevitably leading to delirium. After more than ten days, if chills and spontaneous diarrhea occur, this indicates the disease is about to resolve. However, if sweat is absent from the waist down, urination is difficult, vomiting occurs, there is a sensation of urinary incontinence, coldness in the feet, hard stools, frequent but scanty urination, and after defecation, sudden headache occurs, while the soles of the feet feel hot, this is due to the downward flow of Grain Qi (Gu Qi). (Note: The character "ye" should grammatically follow "gu". Taiyang disease lasting only two days implies the pathogen is still in the exterior, where irritability is inappropriate. This suggests it was originally a Da Qing Long Tang (Major Blue Green Dragon Decoction) indication, characterized by absence of sweat. Cheng Wuji notes: Irritability indicates heat moving inward. The physician, unaware of this, used hot irons on the back to force profuse sweating. Fire-heat entered the Stomach, depleting its fluids. Yin fails to control Yang, leading to irritability, restlessness, and delirium. After ten days, healthy Qi recovers, and Yin and Yang contend, causing shivering. Spontaneous diarrhea allows fire-pathogens to exit via the Large Intestine, indicating self-resolution. If unresolved, sweat from the previous ironing may not have occurred below the waist. Cheng Wuji notes: Fluid deficiency prevents downward circulation, causing difficulty in urination. With fluid deficiency, fire-pathogens rise, causing vomiting. The sensation of incontinence describes the inability to urinate. Coldness in the feet results from wind-pathogen stagnating in the lower body due to lack of sweat below the waist. Hard stools result from Stomach fluid exhaustion. This is not due to fluid diversion, hence frequent but scanty urine. These are all unresolved conditions caused by hard stools and lack of spontaneous diarrhea. Treatment should involve herbs to unblock the bowels. Once stool passes, fire-pathogens exit, Yin Qi restores and rises, causing sudden empty pain in the head. Yang Qi extends and descends, relieving foot coldness and generating heat in the heart/mind. This is the downward flow of Grain Qi (dietary energy). As dietary energy flows down, Stomach transformation functions normally, eliminating fire-pathogens and curing the disease. Regarding treatment, Zhang Zhongjing provides none. Chang Qizhi in *Bu Wang Lun* suggests Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng), Wu Ling San (Five-Ingredient Powder with Poria), or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction). Guo Baiyun interprets Chang's intent: Fire entering the Stomach causes dryness, treated by White Tiger plus Ginseng, provided there is no exterior syndrome and thirst with desire to drink water exists. For difficulty in urination, Wu Ling San is indicated, but only if thirst exists. For hard stools, Tiao Wei Cheng Qi Tang is used, but only if urination is difficult and delirium persists. Another view suggests using Jiu Ni Tang (Rescue the Adverse Decoction) early to remove fire-pathogens. I argue White Tiger plus Ginseng is usable, but Wu Ling San is contraindicated as it further dries fluids. The issue is fluid exhaustion, not obstruction. Hard stools with infrequent urination indicate fire-dryness. Instead of Tiao Wei Cheng Qi Tang, Ma Ren Wan (Hemp Seed Pill) is preferable. Jiu Ni Tang is unsuitable here as it matches the previous clause's syndrome.)
In Taiyang Wind-strike, if fire therapy is used to force sweating, the wind-pathogen combines with fire. Blood and Qi overflow, losing their normal rhythm. The combination of two Yangs (Wind and Fire) scorching each other causes jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to difficult urination. When both Yin and Yang are depleted, the body becomes dry and rough. Sweat appears only on the head, stopping at the neck. Abdominal fullness, slight wheezing, dry mouth, throat ulceration, or constipation may occur. Prolonged cases lead to delirium. Severe cases manifest as hiccups, restless limbs, picking at clothes, and touching the bed. If urination is free, the patient can be cured. (Taiyang Wind-strike is typically indicated for Guizhi Tang. The physician erroneously used fire to force sweating. Wind combined with fire causes blood and Qi to overflow abnormally. Wind is Yang, Fire is Yang. Their mutual scorching damages muscles. Spleen governs muscles and belongs to Earth, hence jaundice. Heat combusting in the Yangming channel causes excess Yang and epistaxis. Heat combusting in the Taiyang fu-organ causes Yin deficiency and difficult urination. Water and Fire represent Yin and Yang in the body, corresponding to Qi and Blood. Imbalance leads to mutual damage, hence "Yin and Yang both depleted." Depleted Yin and Yang cause the previously overflowing Qi and Blood to waste away, resulting in a dry body. Cheng Wuji notes: Three Yang channels reach the neck; Three Yin channels reach the chest. "Ji" means boundary. Head-only sweat stopping at the neck indicates heat rising and affecting Yang but not Yin. Abdominal fullness and wheezing indicate internal heat stagnation. Dry mouth and throat ulcers indicate heat steaming upward. Constipation indicates fluid consumption by heat. Prolonged heat causes stomach dryness and delirium. Severe heat causes rebellious Qi and hiccups. Limbs are the root of Yang; excessive heat causes limb restlessness and picking behaviors. Commentaries state these symptoms result from wind-fire disrupting Qi and Blood, signaling imminent loss of True Yin. At this stage, treating wind exacerbates fire; treating fire obstructs wind. The only solution is to promote urination to release fire-pathogens and restore fluids. If urination is free, the case is treatable. Previous commentators assumed "free urination" contradicted earlier "difficult urination." One must test with medicine. If urination becomes free, it is treatable; if not, treatment may fail. This is Zhang Zhongjing's implicit meaning. No specific formula is given. I suggest promoting urination with Zhu Ling Tang (Polyporus Decoction). *Chu Wang Lun* suggests Wu Ling San, but it is too drying. Another suggestion is Gui Zhi Qu Shao Yao Jia Shu Ku Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Acorus, Oyster Shell, and Dragon Bone to Rescue Adversity), but this is not appropriate. For jaundice, Yin Chen Hao Tang is suggested, but this is "dry jaundice" without stomach excess or damp-heat, so it is unsuitable. For constipation, Da Cheng Qi Tang is suggested, but this is delirium due to dry-heat disturbing the spirit, not stomach excess, so it is unsuitable. Heat should be guided out through urination to resolve all symptoms.)
In Shanghan (Cold Damage) with a floating pulse, if the physician uses fire therapy to force sweating, Yang is depleted. This inevitably leads to fright, mania, restlessness, and inability to sit or lie still. Gui Zhi Qu Shao Yao Jia Shu Ku Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Acorus, Oyster Shell, and Dragon Bone to Rescue Adversity) is the primary treatment. (A floating pulse in Shanghan indicates the presence of Wind-pulse, suggesting exterior deficiency. The physician erroneously used fire to force sweating, causing massive sweat loss and Yang depletion. Cheng Wuji notes: Sweat is the fluid of the Heart. Yang depletion leads to Heart Qi deficiency. The Heart dislikes heat; internal fire-pathogens cause the Heart Spirit to float and scatter, resulting in fright, mania, and restlessness. The decoction is named "Rescue Adversity" because fright and mania are adverse conditions.)