火迫劫而亡阳者，乃方寸元阳之神，被火迫劫而飞腾散乱，故惊狂起卧不安。有如此者，少缓须臾，神丹莫挽
矣，故以此汤救之。盖阳神散乱，当求之于阳，桂枝汤阳药也，然必去芍药之阴敛，始得疾趋以达于阳位。更
加蜀漆者，缘蜀漆之性最急，又加龙骨、牡蛎，有形之骨属，为之舟楫，以载神而返其宅也。
桂枝去芍药加蜀漆龙骨牡蛎救逆汤方
桂枝（三两） 甘草（炙，二两） 生姜（切，三两） 牡蛎（熬，五两） 龙骨（四两） 大枣（擘，十二枚）
蜀漆（洗，去脚，三两）
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。
火逆下之，因烧针烦躁者，桂枝甘草龙骨牡蛎汤主之。
【注】火逆者，谓凡火劫取汗致逆者也。此火逆因火针之。烧针劫汗，而复下之，火逆之邪，虽因下减，
而烦躁一证独不除者，盖因汗下，大伤津液而然也。故用桂枝、甘草以救表，龙骨、牡蛎以固中，不治烦躁而
烦躁自愈也。
【集注】喻昌曰∶此证误而又误，虽无惊狂等变，然烦躁则外邪未尽之候，亦真阳欲亡之机也。
程应旄曰∶火逆下之，里气虚矣，不治其虚，更加烧针，自致亡阳。但见烦躁证，而不尽如前条之惊狂起
卧不安者，由热势之缓急有殊，故前方之加减稍异，总不容烦躁之以假乱真也。
桂枝甘草龙骨牡蛎汤方
桂枝（一两） 甘草（炙，二两） 龙骨（二两） 牡蛎（熬，二两）
上四味，为末，以水五升，煮取二升半，去滓，温服八合，日三服。
【集解】汪琥曰∶此方即桂枝去芍药加蜀漆龙骨牡蛎救逆汤，制小其剂而用之也。火邪迫内，则生烦躁，
虽烦躁似带表邪，不宜散以桂枝之辛热，而火逆既经下之，则阴血受伤，较之救逆汤，似当增芍药也。
In cases where Yang collapse (Yang Wang, loss of vital Yang) occurs due to the coercive use of fire therapy to induce sweating, it is the primordial Yang spirit residing in the heart that is driven by the fire coercion, causing it to fly and scatter chaotically. Consequently, symptoms such as palpitations, mania, restlessness, and inability to sit or lie still arise. If there is a delay even for a moment, even miraculous divine pills cannot save the patient; therefore, this decoction is used to rescue the condition. Since the Yang spirit is scattered, treatment should seek to restore it through Yang. Guizhi Tang (Cinnamon Twig Decoction) consists of Yang-promoting herbs, but one must remove Shaoyao (Paeoniae Radix Alba), which has Yin-astringent properties, so that the action can swiftly reach the Yang positions. The addition of Shuqi (Herba Pteridis Preparata) is because its nature is most urgent and rapid. Furthermore, Longgu (Fossilized Bones) and Muli (Concha Ostreae) are tangible bone-derived substances that act as vessels to carry the spirit back to its residence.
Formula: Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuniu Tang (Cinnamon Twig Decoction without White Peony plus Pteris Herb, Fossilized Bones, and Oyster Shell to Rescue from Reversal)
Guizhi (Cinnamomi Ramulus) - 3 liang
Gancao (Glycyrrhizae Radix et Rhizoma, prepared with honey) - 2 liang
Shengjiang (Zingiberis Rhizoma Recens, sliced) - 3 liang
Muli (Concha Ostreae, calcined) - 5 liang
Longgu (Os Draconis seu Mastodi) - 4 liang
Dazao (Jujubae Fructus, broken open) - 12 pieces
Shuqi (Herba Pteridis Preparata, washed, remove root base) - 3 liang
Grind all ingredients into powder. Use 1 dou 2 sheng of water. First boil Shuqi until the volume reduces by 2 sheng. Then add the remaining herbs. Boil until 3 sheng remains. Strain and take warm.
When fire reversal (Huo Ni, adverse reaction to fire therapy) is complicated by purgation, and irritability arises due to moxibustion on needles (shao zhen), Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction with Fossilized Bones and Oyster Shell) is the primary treatment.
[Annotation] "Fire reversal" refers to any adverse condition caused by using fire methods to forcibly induce sweating. This specific case involves fire reversal due to fire needles. After inducing sweat via burning needles, purgatives were incorrectly administered. Although the pathogenic fire may be somewhat reduced by purgation, the symptom of irritability persists alone. This is because both sweating and purgation severely damage body fluids and Yin. Therefore, Guizhi and Gancao are used to rescue the exterior Yang, while Longgu and Muli are used to secure the middle jiao. By not directly treating irritability, the irritability resolves spontaneously.
[Collected Annotations] Yu Chang stated: This syndrome results from misdiagnosis compounded by further error. Although it lacks severe variations like mania, irritability indicates that external pathogens remain unresolved and signals the impending collapse of true Yang.
Cheng Yingmao stated: Fire reversal followed by purgation leaves the interior Qi deficient. If this deficiency is not treated and burning needles are applied again, Yang collapse will inevitably occur. The presence of irritability without the preceding mania and restlessness indicates that the heat pathogen's intensity differs. Thus, the modifications to the previous formula vary slightly. The key is to distinguish true irritability from false manifestations.
Formula: Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction with Fossilized Bones and Oyster Shell)
Guizhi (Cinnamomi Ramulus) - 1 liang
Gancao (Glycyrrhizae Radix et Rhizoma, prepared with honey) - 2 liang
Longgu (Os Draconis seu Mastodi) - 2 liang
Muli (Concha Ostreae, calcined) - 2 liang
Grind the four ingredients into powder. Use 5 sheng of water. Boil until 2.5 sheng remains. Strain and take 8 he of the warm liquid, three times daily.
[Collected Exegesis] Wang Hu stated: This formula is essentially Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuniu Tang, but with a reduced dosage. When fire pathogens force their way inward, irritability arises. Although irritability may seem accompanied by exterior pathogens, dispersing them with Guizhi's acrid-warm nature is inappropriate. Moreover, since the fire reversal was already treated with purgation, Yin blood is injured. Compared to the Jiuniu Tang, adding Shaoyao (Paeoniae Radix Alba) might seem more suitable here.