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。
脉浮者。病在表。不以汗解。而以火攻。肌腠未开。则邪无从出。反因火气而热乃盛也。
夫阳邪被迫而不去者。则必入而之阴。病从腰以下重而痹者。邪因火迫而在阴也。故曰火逆。
微数之脉。慎不可灸。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。
脉微数者。虚而有热。是不可以火攻。而反灸之。热得火气。相合为邪。则为烦逆。烦逆者。内烦而火逆也。
血被火迫。谓之追虚。热因火动。谓之逐实。由是血脉散乱而难复。筋骨焦枯而不泽。火之为害何如耶。
脉浮。热甚。反灸之。此为实。实以虚治。因火而动。必咽燥唾血。
此火邪迫血。而血上行者也。脉浮热甚。此为表实。古法泻多用针。补多用灸。医不知而反
灸之。是实以虚治也。两实相合。迫血妄行。必咽燥而唾血。
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。
此火邪迫血。而血下行者也。太阳表病。用火熏之。而不得汗。则邪无从出。热气内攻。必发
躁也。六日传经尽。至七日则病当解。若不解。火邪迫血。下走肠间。则必圊血。圊血、便血也
。
太阳伤寒者。加温针。必惊也。
寒邪在表。不以汗解。而以温针。心虚热入。必作惊也。成氏曰。温针损营血而动心气。
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。
风为阳邪。火为阳气。风火交煽。是为两阳。阳盛而热胜为发黄。阳盛则血亡而阴竭。为欲
衄。为小便难也。阴阳俱虚竭。非阳既盛而复虚也。盛者。阳邪自盛。虚者。阳气自虚也。身体
枯燥以下。并阴阳虚竭。火气熏灼之征。于法不治。乃小便本难而反利。知其阴气未绝。犹可调
之使复也。故曰其人可治。
太阳病。二日。反躁。反熨其背。而大汗出。大热入胃。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。反多。大便已。头卓然而痛。其人足心必热。谷气下流故也。
太阳病二日。不应发躁而反躁者。热气行于里也。是不可以火攻之。而反熨其背。汗出热入。
胃干水竭。为躁烦。为谵语。势有所必至者。至十余日。火气渐衰。阴气复生。忽振栗自下利者。
阳得阴而和也。故曰欲解。因原其未得利时。其人从腰以下无汗。欲小便不得者。阳不下通于阴
也。反呕者。阳邪上逆也。欲失溲。足下恶风者。阳上逆。足下无气也。大便硬。津液不下行也。
诸皆阳气上盛。升而不降之故。及乎津液入胃。大便得行。于是阳气暴降而头反痛。谷气得下而
足心热。则其腰下有汗。小便得行可知。其不呕不失溲。又可知矣。
火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
火逆复下。已误复误。又加烧针。火气内迫。心阳内伤。则生烦躁。桂枝、甘草。以复心阳
之气。牡蛎、龙骨。以安烦乱之神。此与下条参看更明。
桂枝甘草龙骨牡蛎汤方
桂枝 炙甘草（各一两） 牡蛎 龙骨（各二两）
上为末。以水五升。煮取二升半。去滓。温服八合。日三服。
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阳主
之。
阳者。心之阳。即神明也。亡阳者。火气通于心。神被火迫而不守。此与发汗亡阳者不同。
发汗者。摇其精则厥逆筋惕肉 。故当用四逆。被火者。动其神则惊狂起卧不安。故当用龙、蛎。
其去芍药者。盖欲以甘草急复心阳。而不须酸味更益营气也。与发汗后。其人叉手自冒心。心、
下悸。欲得按者。用桂枝甘草汤同意。蜀漆、即常山苗。味辛。能去胸中邪结气。此证火气内迫心包
。故须之以逐邪而安正耳。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤方
桂枝（三两） 生姜（三两切） 蜀漆（三两洗去腥） 甘草（二两炙） 牡蛎（五两熬）
龙骨（四两） 大枣（十二枚擘）
上为末。以水一斗二升。先煮蜀漆减二升。纳诸药。煮取三升。去滓。温服一升。
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。烧针发其汗。针处被寒者。故寒虽从汗而出。新寒复从针孔而入也。核起而赤者。针处
红肿如核。寒气所郁也。于是心气因汗而内虚。肾气乘寒而上逆。则发为奔豚。气从少腹上冲心也
。灸其核上。以杜再
入之邪。与桂枝加桂。以泄上逆之气。
桂枝加桂汤方
于桂枝汤方内更加桂二两。共五两。余根据前法。
The pulse is floating. Sweating should be used to resolve the exterior. If moxibustion is applied, the pathogenic factor has no outlet. Consequently, due to the fire, the condition worsens. The disease will definitely cause heaviness and numbness from the waist down, named "Fire Reversal" (Huo Ni).
A floating pulse indicates the disease is at the exterior. Without resolving it via sweating, but instead attacking with fire, the muscle interstices remain unopened, so the pathogen has no way out. Instead, it becomes excessive due to the fire qi.
When Yang pathogen is forced by fire and cannot depart, it must enter and go to Yin. When the disease presents as heaviness and numbness below the waist, it is because the pathogen, driven by fire, has entered Yin. Therefore, it is called Fire Reversal.
A pulse that is slightly rapid (Wei Shu) must not be treated with moxibustion. Because fire itself becomes a pathogen, it causes irritability and counterflow. It chases deficiency and pursues excess; blood scatters within the vessels. Although the fire qi is slight, its internal attack is powerful. It scorches bones and injures sinews, making blood difficult to restore.
A pulse that is slightly rapid indicates deficiency with heat. This cannot be treated with fire attacks. If moxibustion is reversedly applied, heat combines with fire qi to become a pathogen, causing irritability and counterflow. Irritability and counterflow refer to internal irritability and fire counterflow.
Blood being forced by fire is called "chasing deficiency." Heat moving due to fire is called "pursuing excess." Thus, blood vessels become disordered and hard to restore. Tendons and bones become scorched and dry without luster. How harmful is fire!
The pulse is floating, and heat is severe. Reversely applying moxibustion treats this as Excess. Treating Excess as Deficiency, due to fire movement, will definitely cause dry throat and spitting of blood.
This is fire pathogen forcing blood upward. Floating pulse with severe heat is Exterior Excess. Ancient methods use needles for draining and moxibustion for tonifying. If the doctor does not know this and reversely applies moxibustion, it is treating Excess as Deficiency. Two excesses combine, forcing blood to run recklessly, definitely causing dry throat and spitting of blood.
Taiyang Disease, treated with fumigation. No sweat occurs. The person must become irritable. If the disease does not resolve after the transmission cycle, it will definitely cause defecation of blood, named "Fire Pathogen."
This is fire pathogen forcing blood downward. Taiyang exterior disease, treated with fumigation without sweat, means the pathogen has no outlet. Heat qi attacks internally, definitely causing irritability. After six days, transmission ends; on the seventh day, the disease should resolve. If not, fire pathogen forces blood downward into the intestines, definitely causing defecation of blood. "Qing Xue" refers to defecation of blood.
Taiyang Cold Damage, adding warm needle therapy, will definitely cause fright.
Cold pathogen is at the exterior. Not resolving via sweating, but using warm needles, heart deficiency allows heat to enter, definitely causing palpitations/fright. Cheng Shi said: Warm needles damage Ying Blood and move Heart Qi.
Taiyang Disease Wind Strike, using fire coercion to induce sweating. The wind pathogen is covered by fire heat. Blood and Qi flow溢 (overflow), losing their normal measure. Two Yangs smoke and scorch each other. The body turns yellow. Yang excess desires nosebleed. Yin deficiency causes difficult urination. Both Yin and Yang are deficient and exhausted. The body becomes dry and rough. Only head sweat comes out, stopping at the neck. Abdominal fullness, slight wheezing. Dry mouth, rotten throat. Or constipation. Long term leads to delirium. Severe cases reach hiccups. Hands and feet toss restlessly, picking at clothes and touching the bed. If urine flows freely, the person can be treated.
Wind is Yang pathogen. Fire is Yang qi. Wind and fire fan each other, called "Two Yangs." Yang excess and heat victory cause yellowing. Yang excess causes blood loss and Yin exhaustion, leading to desire for nosebleed and difficult urination. "Both Yin and Yang deficient and exhausted" does not mean Yang was excess then became deficient. "Excess" refers to Yang pathogen self-excess. "Deficient" refers to Yang qi self-deficiency. Below "body dry and rough," all are signs of Yin/Yang deficiency/exhaustion and fire scorching. By method, untreatable. But if urine was originally difficult and now flows freely, knowing Yin qi is not yet extinct, it can still be regulated to recover. Hence, "the person can be treated."
Taiyang Disease, second day. Reversely irritable. Reversely ironing the back causes heavy sweating. Great heat enters the Stomach. Stomach water dries up. Irritability and vexation definitely lead to delirium. Ten-plus days later, shaking chills and spontaneous diarrhea indicate impending resolution. Thus, previously, no sweat from waist down. Desire to urinate but unable. Reversely vomiting. Desire to lose urine. Fear of cold under feet. Hard stool. Pulse box (likely typo in source for 'Mai') should be frequent but is not. Reversely many. After stool, head suddenly hurts. The person's sole must be hot. Grain Qi flows downward.
Taiyang Disease second day. Should not emit irritability but reversely does. Heat qi travels to interior. Cannot use fire attack. Reversely ironing back. Sweat out, heat enters. Stomach dry, water exhausted. Causes irritability and delirium. Trend is inevitable. To ten-plus days. Fire qi gradually declines. Yin qi regenerates. Suddenly shaking chills and spontaneous diarrhea. Yang harmonizes with Yin. Hence "impending resolution." Tracing back to when benefit was not obtained. Person has no sweat from waist down. Desire to urinate but unable. Yang does not descend to communicate with Yin. Reversely vomiting. Yang pathogen counterflows upward. Desire to lose urine, fear of cold under feet. Yang counterflows upward, under feet lack Qi. Hard stool. Fluids do not descend. All are due to Yang Qi excess above, ascending not descending. When fluids enter Stomach, stool moves. Then Yang Qi violently descends, head reversely hurts. Grain Qi gets to descend, sole heats. Then waist below has sweat, urination flows, known. Not vomiting, not losing urine, also known.
Fire reversal followed by purging. Due to burning needle causing irritability and vexation. Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig, Licorice, Dragon Bone, Oyster Shell Decoction) governs it.
Fire reversal again purged. Already mistaken, then mistaken again. Plus burning needle. Fire qi presses internally. Heart Yang injured internally. Generates irritability and vexation. Gui Zhi, Gan Cao, to restore Heart Yang Qi. Mu Li, Long Gu, to calm chaotic Shen (Spirit). Compare with next clause for clarity.
Gui Zhi Gan Cao Long Gu Mu Li Tang Formula
Gui Zhi (Cinnamon Twig), Zhi Gan Cao (Prepared Licorice Root) (each 1 liang). Mu Li (Oyster Shell), Long Gu (Dragon Bone) (each 2 liang).
Grind into powder. Use 5 sheng of water. Boil to obtain 2.5 sheng. Remove dregs. Warm dose 8 ge. Three times daily.
Shang Han (Cold Damage) pulse floating. Doctor uses fire coercion. Wang Yang (Loss of Yang). Definitely fright, mania, rising and lying down uneasy. Gui Zhi Qu Shao Yao Jia Shu Qi Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Rhizoma Dichroae, Oyster Shell, and Dragon Bone for Rescue from Reversal) governs it.
Yang refers to Heart Yang, i.e., Shen (Spirit/Mind). Wang Yang here means fire qi communicates with Heart. Shen is forced by fire and does not stay. This differs from sweating-induced Wang Yang. Sweating shakes Jing (Essence), causing Jue Ni (Cold extremities), Jin Ti Rou Yu (twitching tendons and muscles). Hence Si Ni Tang (Four Counterflow Decoction) is used. Being harmed by fire moves Shen, causing fright, mania, rising/lying uneasy. Hence Long Gu, Mu Li are used. Removing Shao Yao aims to use Gan Cao urgently to restore Heart Yang, without needing sour flavor to further benefit Ying Qi. Same intent as post-sweating case where person crosses hands over heart, Xin Xia Ji (epigastric palpitation), desires pressure, using Gui Zhi Gan Cao Tang. Shu Qi is Chang Shan Miao (young shoot of Dichroa febrifuga). Taste pungent. Can remove chest pathogen knot qi. This case fire qi presses internally to Xin Bao (Pericardium). Hence need it to expel pathogen and calm Zheng (Righteous Qi).
Gui Zhi Qu Shao Yao Jia Shu Qi Mu Li Long Gu Jiu Ni Tang Formula
Gui Zhi (3 liang), Sheng Jiang (Fresh Ginger, 3 liang, sliced), Shu Qi (Rhizoma Dichroae, 3 liang, washed to remove fishy smell), Zhi Gan Cao (Prepared Licorice Root, 2 liang), Mu Li (Oyster Shell, 5 liang, calcined), Long Gu (Dragon Bone, 4 liang), Da Zao (Jujube, 12 pieces, split).
Grind into powder. Use 1 dou 2 sheng of water. First boil Shu Qi, reduce by 2 sheng. Add other herbs. Boil to obtain 3 sheng. Remove dregs. Warm dose 1 sheng.
Burning needle induces sweat. Needle site exposed to cold. Nodule rises and turns red. Definitely Fa Ben Tun (Rushing Pig). Qi rushes from lower abdomen to heart. Moxa one Zhu (cone) on each nodule. Give Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon). Burning needle induces sweat. Needle site exposed to cold. Though cold exits with sweat, new cold enters via needle hole. Nodule rises red. Needle site red swollen like nodule. Cold qi stagnates. Heart Qi becomes internally deficient due to sweat. Kidney Qi takes advantage of cold to counterflow upward. Fa Ben Tun occurs. Qi rushes from lower abdomen to heart. Moxa nodule to prevent re-entry of pathogen. Give Gui Zhi Jia Gui to drain counterflowing Qi.
Gui Zhi Jia Gui Tang Formula
In Gui Zhi Tang formula, add Gui (Cinnamon) 2 liang more. Total 5 liang. Rest according to previous method.