于桂枝汤方内更加桂二两。共五两。余根据前法。
火逆下之因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
先火为逆。复以下除之。里气因虚。又加烧针。里虚而为火热所烦。故生烦躁。与
桂枝甘草龙骨牡蛎汤以散火邪。
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。
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。
太阳伤寒者。加温针。必惊也。
寒则伤荣。荣气微者。加烧针。则血留不行。惊者。温针损荣血而动心气。金匮要
略曰。血气少者。属于心。
王宇泰云。心属火。火先入心。心主血而藏神。血如水也。神如鱼也。两阳相熏灼。
水热汤沸。则鱼惊跃不能安矣。
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。
恶寒发热。为太阳表病。自汗出。不恶寒发热者。阳明证本太阳表病。医反吐之。
伤动胃气。表邪乘虚。传于阳明也。以关脉细数。知医吐之所致。病一二日。为表邪尚
寒而未成热。吐之则表寒传于胃中。胃中虚寒。故腹中饥而口不能食。病三四日。则表
邪已传成热。吐之则表热乘虚入胃。胃中虚热。故不喜糜粥。欲食冷食。朝食暮吐也。朝
食暮吐者。食晨入于胃。胃虚不能克化。即知至暮胃气行里。与邪气相搏。则胃气反逆。
而以胃气尚在。故止云小逆。
张兼善云。此病虽逆。当自愈。吐中便有发散之义也。但当节饮食。静养调摄。则
余邪自去。若更妄治之。则变证起矣。
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。
太阳表病。医反吐之。伤于胃气。邪热乘虚入胃。胃为邪热内烦。故不恶寒。不欲
近衣也。
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。
阳受气于胸中。发汗外虚阳气。是令阳气微。膈气虚也。数为热。本热则合消谷。
客热则不能消谷。因发汗外损阳气。致胃中虚冷。故吐也。
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
证。以呕故知极吐下也。
心下温温欲吐。郁郁微烦。胸中痛。当责邪热客于胸中。大便反溏。腹微满。则邪
热已下于胃也。日数虽多。若不经吐下。止是传邪。亦未可下。当与柴胡汤。以除上中二
焦之邪。若曾吐下。伤损胃气。胃虚则邪乘虚。入胃为实。非柴胡汤所能去。调胃承气
汤下胃热。以呕。知胃气先曾伤动也。
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。
太阳、经也。膀胱、腑也。此太阳随经入腑者也。六七日邪气传里之时。脉微而沉。
邪气在里之脉也。表证仍在者。则邪气犹浅。当结于胸中。若不结于胸中。其人发狂者。
热结在膀胱也。经曰。热结膀胱。其人如狂。此发狂。则热又深也。少腹硬满。小便不
利者。为无血也。小便自利者。血证谛也。与抵当汤以下蓄血。
Increase the dosage of Cinnamon Twig (Guizhi) by two liang in the Guizhi Tang (Cinnamon Twig Decoction). The total amount is five liang. Follow the previous method for preparation and administration for the rest.
For cases where fire therapy was misused followed by purgation, resulting in irritability due to burning needles, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is the primary treatment.
Fire therapy constitutes a counter-indicated treatment (Ni). Subsequent use of purgatives depletes interior Qi. The addition of burning needles further exacerbates the deficiency of interior Qi, allowing heat-fire pathogenic factors to disturb the interior, thereby generating irritability. Guizhi Gancao Longgu Muli Tang is administered to dissipate the fire pathogen.
Cinnamon Twig (Guizhi), one liang; Licorice Root (Gancao), two liang; Oyster Shell (Muli), two liang, calcined; Dragon Bone (Longgu), two liang.
Grind the above four ingredients into coarse powder. Add five sheng of water, boil to obtain two and a half sheng, remove the dregs. Warm administer eight ge per dose, three times daily.
Pungent and Sweet disperse: The pungent and sweet properties of Cinnamon Twig and Licorice Root are used to disperse fire pathogenic factors within the meridians. Astringency removes collapse: The astringent nature of Dragon Bone and Oyster Shell is used to consolidate floating and dispersing Zheng Qi (Upright Qi).
In Taiyang Cold Damage (Taiyang Shanghan), the application of warm needle therapy inevitably induces fright.
Cold injures Ying Blood (Nutritive Blood). If Ying Qi is weak, the addition of burning needles causes blood stasis and stagnation. Fright arises because warm needle therapy damages Ying Blood and disturbs Heart Qi. *Jin Gui Yao Lue* states: "Deficiency of Blood and Qi belongs to the Heart."
Wang Yutai stated: The Heart belongs to Fire. Fire pathogenic factors first enter the Heart. The Heart governs Blood and houses the Shen (Spirit). Blood is like water; Shen is like a fish. When two Yangs (external heat and fire therapy heat) scorch each other, it is like boiling water; the fish becomes frightened and leaps, unable to remain calm.
In Taiyang disease, chills and fever are expected. Currently, the patient has spontaneous sweating, without chills or fever, and the Guan pulse is fine and rapid. This is an error caused by the physician's misuse of emesis. If emesis is used on the first or second day, the patient feels hungry in the abdomen but cannot eat. If used on the third or fourth day, the patient dislikes congee and desires cold food, vomiting what was eaten in the morning by evening. This is caused by the physician's misuse of emesis. This is termed a "minor counter-indication" (Xiao Ni).
Chills and fever indicate a Taiyang exterior syndrome. Spontaneous sweating and absence of chills/fever suggest a Yangming pattern. Originally a Taiyang exterior syndrome, the physician incorrectly used emesis, damaging Stomach Qi. The exterior pathogen took advantage of the deficiency to transmit to Yangming. The fine and rapid Guan pulse indicates this was caused by the physician's misuse of emesis. On days one or two, the exterior pathogen is still cold and has not transformed into heat. Emesis transmits this cold to the Stomach, causing Stomach deficiency-cold. Thus, there is hunger in the abdomen but an inability to eat. By days three or four, the exterior pathogen has transmitted and transformed into heat. Emesis allows this heat to enter the Stomach due to deficiency, causing Stomach deficiency-heat. Thus, the patient dislikes congee, desires cold food, and vomits by evening. Vomiting by evening occurs because food ingested in the morning enters the Stomach, but the deficient Stomach Qi cannot transform it. By evening, Stomach Qi moves inward and combats the pathogen, causing Stomach Qi to rebel upward. However, since Stomach Qi remains, it is only called a "minor counter-indication."
Zhang Jianshan said: Although this condition is a counter-indication, it should resolve spontaneously. Emesis contains the principle of dispersion. By regulating diet and maintaining quiet recuperation, residual pathogens will naturally dissipate. Further improper treatment will lead to transformation syndromes.
In Taiyang disease, after misuse of emesis, the patient exhibits only Taiyang characteristics. Originally, Taiyang disease involves chills. Now, there is no aversion to cold, and the patient does not desire clothing. This is internal irritability caused by emesis.
The Taiyang exterior syndrome was incorrectly treated with emesis by the physician, damaging Stomach Qi. Pathogenic heat entered the Stomach due to deficiency, causing internal irritability in the Stomach. Therefore, there is no aversion to cold, and the patient does not desire clothing.
The patient presents with a rapid pulse. Rapidness indicates heat, which should promote digestion and appetite, yet vomiting occurs instead. This is because sweating depleted Yang Qi, leading to deficiency of Qi in the Diaphragm, resulting in a rapid pulse. This rapidness represents "guest heat" (false heat), which cannot digest food, due to cold deficiency in the Stomach, hence vomiting.
Yang Qi receives its qi from the chest. Sweating causes external deficiency of Yang Qi, leading to mild Yang Qi and deficiency of Diaphragm Qi. While a rapid pulse typically indicates heat that aids digestion, guest heat cannot digest food. External damage to Yang Qi via sweating results in Stomach deficiency-cold, causing vomiting.
After more than ten days of Taiyang disease, the patient feels nauseous with pain in the chest and epigastrium, loose stools, slight abdominal fullness, depression, and mild irritability. If the patient had previously undergone excessive emesis or purgation at that time, Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) should be administered. If not, do not administer it. If there is merely desire to vomit, chest pain, and loose stools, this is not a Chaihu Tang (Bupleurum Decoction) pattern. The vomiting indicates prior excessive emesis and purgation.
Nausea, depression, mild irritability, and chest pain suggest pathogenic heat lodged in the chest. Loose stools and slight abdominal fullness indicate that pathogenic heat has descended to the Stomach. Although many days have passed, if no emesis or purgation was performed, it is merely transmitted pathogen, and purgation is not indicated; Chaihu Tang should be used to clear pathogens in the Upper and Middle Jiao. If emesis or purgation was performed, Stomach Qi is damaged. Deficient Stomach Qi allows pathogens to enter and form excess patterns, which Chaihu Tang cannot resolve. Tiaowei Chengqi Tang purges Stomach heat. The presence of vomiting indicates prior injury to Stomach Qi.
In Taiyang disease, after six or seven days, the exterior syndrome persists. The pulse is faint and deep, but there is no formation of Jie Xiong (Chest Binding) syndrome. The patient exhibits mania. This is because heat is in the Lower Jiao. The lower abdomen should be hard and full. If urination is normal, bleeding will cure the condition. This is because the Taiyang pathogen follows the meridians into the interior, resulting in blood stasis and heat in the interior. Didang Tang (Efficacious to Overcome Decoction) is the primary treatment.
Taiyang corresponds to the meridian, and Bladder corresponds to the fu organ. This is a case of Taiyang transmitting from the meridian to the fu organ. Six to seven days is the time when pathogens transmit to the interior. A faint and deep pulse indicates pathogens in the interior. With the exterior syndrome persisting, the pathogen is still shallow and should bind in the chest. If it does not bind in the chest but the patient becomes manic, the heat is bound in the Bladder. The classics state: "Heat bound in the Bladder, the person is like manic." Here, the mania indicates deeper heat. Hardness and fullness in the lower abdomen, with normal urination, confirm a blood stasis pattern. If urination were obstructed, it would not be blood stasis. Normal urination confirms the blood stasis diagnosis. Didang Tang is administered to purge accumulated blood.