桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 牡蛎（五两熬） 龙骨（四两） 大枣（十二枚擘） 蜀
漆（三两洗去腥）
上为末。以水一斗二升。先煮蜀漆减二升。内诸药煮取三升。去滓。温服一升。
成注云。与桂枝汤以解未尽之表邪。去芍药。以芍药益阴非亡阳所宜也。火邪错逆。加蜀漆之辛以散之。阳气亡
脱。加龙骨牡蛎之涩以固之。本草云。涩可去脱。龙骨牡蛎之属是也。
琥按成注。犹未尽仲景制方之义。夫亡阳者。汗必多。汗为血液。何不用芍药以和营。以方中已有牡蛎之咸寒。龙
骨之收涩。而芍药可不用也。且也。牡蛎龙骨。兼能胜火热之气而镇惊狂。其加蜀漆者。必病患素有痰热结于胸膈。至
此复挟火邪错逆。故用蜀漆之辛以散之也。否则亡阳证。而用此暴悍之剂。大非所宜。又桂枝汤中生姜一味。亦太辛散。
虽有寒邪。宜稍减用之。
形作伤寒。其脉不弦紧而弱。弱者。必渴被火者必谵语。弱者。发热脉浮解之当汗出愈（愚疑以发热二字。当在渴
字之前。形作伤寒。言病患之形。似太阳伤寒。头项强痛。恶寒而无汗矣。及诊其脉。不弦紧而反弱。弱者。风脉也。
风为阳。其人必发热而渴。误被火劫汗虽不出风火相合。热搏于胃。胃中躁烦。必至谵语。然此谵语者。非胃实。不可
下也。还诊其脉。而弱中带浮。邪乃在表。解之之法。当用药使汗出而愈。按此条论。仲景无治法。补亡论辄用救逆汤。
误矣。愚意云。宜大青龙汤。更加凉药主之。）
太阳病以火熏之。不得汗其人必躁。到经不解。必清血。名为火邪。（清同圊厕也。成注云。此为火邪迫血而下行者
也。太阳病。本无汗。此麻黄汤证也。医人误以火熏迫之。究不得汗。则热无从出。火邪入胃。以故发躁而不宁也。寒
伤营而汗又为血液。到经不解者。太阳到六七日。为传经已尽。邪仍不解。则胃中所郁火热之邪。将迫血下行而如圊矣。
此名为火邪者。是申明圊血之故。实由火邪所迫而然也。按此条论。仲景无治法。补亡论常器之云。可根据前救逆汤。黄
芩芍药汤。愚以黄芩芍药汤。庶几犹可救逆汤。还宜加减用之。）
脉浮热甚。反灸之。此为实。实以虚治。因而火动。必咽燥唾血。（成注云。此火邪迫血。而上行者也。脉浮热甚。
乃风邪盛于表。此为表实。灸法多补。病惟虚寒者。宜之。今者表有风热而反灸。是以实作虚治也。邪因火动。内搏于
胃。故咽燥而唾血。此条论。仲景无治法。补亡论常器之云。可根据前救逆汤。误矣。愚意云宜犀角地黄汤。）
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
微而数。此必是风寒之后。阴虚而热未除也。虚寒可灸。虚热慎不可灸。若反灸之。则热因火入。相搏为邪。上攻则为
烦为逆。且阴本虚也。更追以火。使虚者愈虚。热本实也。更逐以火。使实者愈实。阴主营血而行于脉中。当追逐之余。
脉中已无血聚。故曰散也。艾火之气虽微。其内攻之力能焦骨伤筋。所以然者。盖由血散而难复故也。此条论。仲景无
治法。补亡论常器之云。可根据前救逆汤。其有汗者。宜桂枝柴胡汤愚以二汤俱与病未合。另宜斟酌用药。）
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。邪居于表。故宜以汗
解之。医人误以火灸之。邪因火迫。无外出之路而愈盛。邪盛。则病从腰以下。必重而痹。何也。盖汗者。湿热之气也。
今者。邪因火迫。汗不出而热甚剧。则湿气下流而成痹矣。此名火逆者。言此亦由火气所逆而使然也。此条论。仲景无
治法。补亡论郭白云云。宜少与救逆汤。愚意云。虽宜救逆。亦宜兼痹治之。）
欲自解者。必当先烦。乃有汗而解。何以知之。脉浮。故知汗出解也。（此承上文脉浮而言。成注云。烦热也。邪气
还表。则为烦热。汗出而解。以脉浮。故为邪还表也。愚按此条。是言未灸之先。有不用药。汗自出而解者。则知上条
病。为汗已将出。用火遏其出路。故致湿热之气下流。而成重痹之候。又按补亡论。以此条与上条合为一条甚通。）
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。更加桂二两。
（病至用烧针发汗。此必是太阳伤寒证也。仲景法。宜用麻黄汤以汗之。今医误用烧针。以令其汗。太阳初得病。为寒
气在表。故其寒邪。即从针孔处。反入于里。在外。则肉肿起如核而色赤。在内必发奔豚。其气从少腹直上冲心也。盖
太阳为寒水之经。肾即为寒水之藏。脏腑相合。经病用针。故引寒邪之气。内入于藏也。成注云先灸核上以散其寒。与
桂枝加桂汤。以泄奔豚之气。）
桂枝（三两，去皮） 甘草（二两，炙） 生姜（三两，切） 牡蛎（五两，熬） 龙骨（四两） 大枣（十二枚，掰开） 蜀漆（三两，洗去腥味）
以上药物研为细末。用水一斗二升。先煮蜀漆，减少二升水。加入其余药物，煎取三升药液。滤去药渣。温服一升。
成无己注解说：给予桂枝汤以解除未尽的表邪。去掉芍药，是因为芍药益阴，不适合亡阳证。火邪错乱逆乱，加蜀漆的辛味以发散它。阳气亡脱，加龙骨、牡蛎的涩味以固摄它。本草说：涩可以治疗滑脱，龙骨、牡蛎这类药物就是这样的。
琥按：成无己的注解，还没有完全阐明张仲景制定方剂的深意。所谓亡阳，出汗必然很多。汗是血液所化，为何不用芍药来调和营血？因为方中已有牡蛎的咸寒之性，龙骨的收涩之效，所以芍药可以不用。况且，牡蛎和龙骨，兼能胜伏火热之气而镇惊狂。之所以加蜀漆，一定是患者平素有痰热结聚在胸膈，到了此时又夹杂火邪错乱逆乱，所以用蜀漆的辛味来发散它。否则，若是亡阳证，却使用这种暴烈悍猛的药剂，非常不合适。另外，桂枝汤中的生姜一味，也过于辛散。虽然有寒邪，应该稍微减少用量。
症状表现像伤寒，但脉象不弦紧而弱。脉弱的人，必定口渴；被火法误治的人，必定出现谵语。脉弱，发热，脉浮，应当通过发汗来治愈（我怀疑“发热”二字，应当在“渴”字之前。形作伤寒，是说患者的外形，类似太阳伤寒，头项强痛，恶寒而无汗了。等到诊察其脉象，不弦紧反而弱。弱脉，是风脉。风属阳，其人必定发热且口渴。误用火法劫汗，虽然汗不出，但风火相合，热邪搏结于胃，胃中躁动烦乱，必定导致谵语。然而这种谵语，不是胃实，不可用下法。再诊其脉，弱中带浮，邪气仍在表。解表的办法，应当用药使汗出而痊愈。按此条论述，张仲景没有给出治法，《补亡论》随意使用救逆汤，是错误的。我的意思是，宜用大青龙汤，再加凉药主治。）
太阳病用火熏法治疗，不得汗，其人必定烦躁。到经期限不解，必定出现便血。这称为火邪。（清同圊，指厕所。成无己注解说：这是火邪迫血下行。太阳病，本来无汗，这是麻黄汤证。医生误用火熏迫之，终究不得汗，则热无从排出，火邪入胃，因此发躁而不安宁。寒伤营分，汗又是血液。到经不解，是指太阳病到六七日，为传经已尽，邪气仍不解，则胃中所郁积的火热之邪，将迫血下行而如厕出血。这称为火邪，是说明便血的原因，实际上是由火邪逼迫所致。按此条论述，张仲景没有给出治法，《补亡论》常器之说：可根据前文救逆汤、黄芩芍药汤。我认为黄芩芍药汤，或许还可以挽救逆乱，救逆汤，还应该加减使用。）
脉浮，热势很盛，反而用灸法。这是实证，以虚证来治，因而火气发动，必定咽喉干燥，唾血。（成无己注解说：这是火邪迫血上行。脉浮热甚，乃是风邪盛于表，这是表实证。灸法多补，只有虚寒病适宜。现在表有风热反而灸，是以实作虚治。邪气因火而动，内搏于胃，所以咽喉干燥而唾血。此条论述，张仲景没有给出治法，《补亡论》常器之说：可根据前文救逆汤。这是错误的。我的意思是宜用犀角地黄汤。）
脉微数，千万不可灸。因火成为邪气，则产生烦逆，追虚逐实，血液散乱于脉中。火气虽然微弱，内攻的力量很大，焦骨伤筋，血液难以恢复。（脉微而数，这必定是风寒之后，阴虚而热未除。虚寒可灸，虚热千万不可灸。如果反而灸之，则热因火入，相互搏结成为邪气，上攻则产生烦闷逆乱。而且阴本虚，更追加以火，使虚者愈虚；热本实，更追逐以火，使实者愈实。阴主营血而行于脉中，在被追逐之余，脉中已无血聚，所以说散。艾火之气虽然微弱，其内攻之力能焦骨伤筋。之所以这样，是因为血散而难复的缘故。此条论述，张仲景没有给出治法，《补亡论》常器之说：可根据前文救逆汤。有汗的，宜用桂枝柴胡汤。我认为这两首汤剂都与病情不合，另外宜斟酌用药。）
脉浮，应当用发汗法解表。用火灸之，邪气无从排出，因火而邪气更盛，病从腰部以下必定沉重而麻痹，称为火逆。（脉浮，邪气居于表，所以应当用发汗法解表。医生误用火灸，邪气因火逼迫，没有外出的路而更加旺盛。邪气盛，则病从腰部以下，必定沉重而麻痹。为什么呢？汗是湿热之气。现在，邪气因火逼迫，汗不出而热很剧烈，则湿气下流而成痹。这称为火逆，是说这也由火气逆乱而使然。此条论述，张仲景没有给出治法，《补亡论》郭白云说：宜少量给予救逆汤。我的意思是，虽然宜用救逆汤，也宜兼治痹症。）
想要自行痊愈的，必定先感到烦闷，然后才有汗而解。怎么知道呢？脉浮，所以知道汗出而解。（这是承接上文脉浮而言。成无己注解说：烦热。邪气还表，则为烦热。汗出而解，因为脉浮，所以是邪气还表。我按：此条，是说未灸之前，有不用药，汗自出而解的情况，则知上条的病，是汗将要出来，用火遏制了其出路，导致湿热之气下流，而成沉重麻痹的证候。又按《补亡论》，将此条与上条合并为一条，非常通顺。）
烧针令其出汗，针处受寒，起核而色红的，必定发作奔豚，气从少腹上冲心者，在核上各灸一壮，给予桂枝加桂汤，再加桂二两。（病至用烧针发汗，这必定是太阳伤寒证。仲景的法度，宜用麻黄汤发汗。现在医生误用烧针，令其出汗。太阳初得病，寒气在表，所以寒邪，即从针孔处，反而入里。在外，则肉肿起如核而色赤。在内必定发作奔豚，其气从少腹直上冲心。盖太阳为寒水之经，肾即为寒水之藏，脏腑相合，经病用针，故引寒邪之气，内入于脏。成无己注解说：先在核上灸以散其寒，给予桂枝加桂汤，以泄奔豚之气。）
Cinnamon Twig (Guizhi, *Ramulus Cinnamomi*) three liang, bark removed; Licorice Root (Gancao, *Radix Glycyrrhizae*) two liang, honey-fried; Fresh Ginger (Shengjiang, *Rhizoma Zingiberis Recens*) three liang, sliced; Oyster Shell (Muli, *Concha Ostreae*) five liang, calcined; Dragon Bone (Longgu, *Os Mastodi* or *Os Dentis Fossilis*) four liang; Jujube (Dazao, *Fructus Jujubae*) twelve pieces, split open; Shuqi (*Herba Taxilli* or *Herba Artemisiae Annuae*, depending on interpretation, here likely referring to a phlegm-resolving herb like *Taxillus chinensis* or similar in ancient context, but strictly translated as Shuqi) three liang, washed to remove fishy odor.
Crush the above ingredients into powder. Use one dou and two sheng of water. First decoct Shuqi until the volume reduces by two sheng. Then add the remaining herbs and decoct to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm.
Cheng Wuji commented: Administer Guizhi Tang (Cinnamon Twig Decoction) to resolve the residual exterior pathogenic factors. Remove Shaoyao (White Peony Root), because Shaoyao nourishes Yin and is not suitable for Yang collapse. For Fire Pathogen disorder and reversal, add the acrid nature of Shuqi to disperse it. For Yang Qi collapse and depletion, add the astringent nature of Longgu and Muli to consolidate it. The Materia Medica states: Astringents can treat sliding and leakage; Longgu and Muli are examples of such.
Hu noted: Cheng Wuji’s annotation has not fully elucidated Zhang Zhongjing’s intent in formulating this prescription. In cases of Yang collapse, sweating must be profuse. Since sweat is derived from blood, why not use Shaoyao to harmonize the Ying (Nutritive) level? This is because the formula already contains the salty-cold nature of Muli and the astringent effect of Longgu, so Shaoyao is unnecessary. Moreover, Muli and Longgu can also overcome fiery heat and calm fright and mania. The reason for adding Shuqi is that the patient likely had Phlegm-Heat congealed in the chest and diaphragm since before, and at this time, it is complicated by Fire Pathogen disorder and reversal. Therefore, the acrid nature of Shuqi is used to disperse it. Otherwise, if it were truly a Yang collapse syndrome, using such a violent and harsh agent would be highly inappropriate. Furthermore, the ginger in Guizhi Tang is too acrid and dispersing. Even if there is Cold Pathogen, its dosage should be slightly reduced.
The presentation resembles Taiyang Cold Damage (Taiyang Shanghan), but the pulse is not wiry-tight but weak. Those with a weak pulse will certainly feel thirsty; those treated erroneously with fire therapy will certainly experience delirious speech. Weak pulse, fever, floating pulse: resolution should be achieved through sweating (I suspect the characters "fever" should precede "thirst". "Resembling Cold Damage" refers to the patient's appearance, similar to Taiyang Cold Damage, with stiffness and pain of the head and nape, aversion to cold, and absence of sweat. However, upon palpation, the pulse is not wiry-tight but weak. A weak pulse indicates Wind. Wind is Yang, so the person will certainly have fever and thirst. Erroneous fire therapy attempts to induce sweating; although sweat does not come out, Wind and Fire combine, Heat binds in the Stomach, causing restlessness and agitation in the Stomach, inevitably leading to delirious speech. However, this delirium is not due to Stomach Excess, so purgation is contraindicated. Re-palpating the pulse, weakness mixed with floating indicates the pathogen is still at the Exterior. The method of resolution is to use medication to induce sweating for recovery. Regarding this clause, Zhang Zhongjing provides no treatment method. *Bu Wang Lun* arbitrarily uses Jiuni Tang, which is incorrect. My opinion is that Da Qinglong Tang (Major Green Dragon Decoction) should be used, supplemented with cooling herbs.)
In Taiyang Disease, if fire fumigation is applied and sweat is not obtained, the person will certainly become irritable. If the disease persists beyond the meridian cycle, hematochezia (bleeding from the rectum) will occur. This is called Fire Pathogen. ("Qing" is synonymous with "Qingshi," meaning toilet. Cheng Wuji commented: This is Fire Pathogen forcing blood downward. Taiyang Disease originally has no sweat; this is a Mahuang Tang (Ephedra Decoction) pattern. The physician erroneously forces fire fumigation. Ultimately, no sweat is produced, so Heat has no outlet. Fire Pathogen enters the Stomach, causing irritability and unrest. Cold injuring the Ying level, and sweat being blood: "Persisting beyond the meridian cycle" means Taiyang disease reaches six or seven days, marking the end of transmission, yet the pathogen remains unresolved. Thus, the郁 Heat in the Stomach will force blood downward, resulting in rectal bleeding. This is termed "Fire Pathogen" to explain the cause of rectal bleeding, actually caused by the coercion of Fire Pathogen. Regarding this clause, Zhang Zhongjing provides no treatment method. *Bu Wang Lun* Chang Qizhi says: One may refer to the previous Jiuni Tang or Huangqin Shaoyao Tang (Scutellaria and White Peony Decoction). I believe Huangqin Shaoyao Tang might suffice to rescue the reversal, while Jiuni Tang should be modified.)
Pulse is floating, heat is severe; contrary to indications, moxibustion is applied. This is an Excess condition, treated as Deficiency. Consequently, Fire moves, causing dry throat and spitting of blood. (Cheng Wuji commented: This is Fire Pathogen forcing blood upward. Floating pulse with severe heat indicates Wind Pathogen abundant at the Exterior, constituting an Exterior Excess. Moxibustion is mostly tonifying, suitable only for Deficiency-Cold. Now, with Exterior Wind-Heat, moxibustion is wrongly applied, treating Excess as Deficiency. The pathogen moves due to Fire, internalizes and attacks the Stomach, hence dry throat and spitting blood. Regarding this clause, Zhang Zhongjing provides no treatment method. *Bu Wang Lun* Chang Qizhi says: One may refer to the previous Jiuni Tang. This is incorrect. My opinion is that Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used.)
Pulse is faint and rapid; moxibustion must absolutely be avoided. If Fire becomes a pathogen, it causes vexation and rebellion. It pursues Deficiency and drives Excess, scattering blood within the vessels. Although Fire Qi is subtle, its internal attacking power is strong, scorching bones and damaging sinews, making blood difficult to restore. (Faint and rapid pulse indicates that after Wind-Cold, Yin Deficiency with lingering Heat exists. Deficiency-Cold can be moxa-ed; Deficiency-Heat must absolutely not be. If moxa-ed erroneously, Heat enters via Fire, combining to become pathogen, attacking upward causing vexation and rebellion. Yin is originally deficient; pursuing it with Fire makes deficiency more deficient. Heat is originally excess; driving it with Fire makes excess more excess. Yin manages Ying Blood moving in vessels. After pursuit, no blood gathers in vessels, hence described as scattered. Mugwort fire Qi, though subtle, has internal attacking power capable of scorching bones and damaging sinews. This is because blood is scattered and hard to restore. Regarding this clause, Zhang Zhongjing provides no treatment method. *Bu Wang Lun* Chang Qizhi says: One may refer to the previous Jiuni Tang. For those with sweat, Guizhi Chaihu Tang (Cinnamon Twig and Bupleurum Decoction) is suggested. I believe both formulas do not match the pathology; medication should be carefully considered.)
Pulse is floating; it should be resolved by sweating. If moxibustion is applied, the pathogen has no exit, and due to Fire, the pathogen becomes vigorous. The disease from the waist down will certainly be heavy and numb, named Fire Reversal. (Floating pulse indicates pathogen residing at the Exterior, thus suitable for resolution by sweating. Physician erroneously applies moxibustion; pathogen is coerced by Fire, having no outward route, becoming more vigorous. Pathogen vigor causes heaviness and numbness from the waist down. Why? Sweat is damp-heat Qi. Now, pathogen coerced by Fire, sweat does not come out, Heat is severe, so Dampness flows downward forming Bi (obstruction) syndrome. This is named Fire Reversal, indicating it is caused by the reversal of Fire Qi. Regarding this clause, Zhang Zhongjing provides no treatment method. *Bu Wang Lun* Guo Baiyun says: Administer a small amount of Jiuni Tang. My opinion is that although Jiuni Tang is suitable, Bi syndrome treatment should also be combined.)
If the body intends to resolve spontaneously, it will first manifest vexation, then sweat will appear and the disease resolves. How do we know? The pulse is floating, thus knowing that sweating leads to resolution. (This follows the previous discussion on floating pulse. Cheng Wuji commented: Vexatious heat. Pathogen returning to the Exterior causes vexatious heat. Sweating resolves it; because the pulse is floating, it indicates pathogen returning to the Exterior. I note: This clause describes a case before moxibustion where the disease resolves spontaneously without medication via sweating. Thus, regarding the previous clause, the sweat was about to emerge, but Fire obstructed its exit, causing damp-heat to flow downward, resulting in heavy numbness. Also, *Bu Wang Lun* combines this clause with the previous one, which is very logical.)
Needle-cauterization induces sweating. The needle site is exposed to Cold, nodules rise and turn red. Ben Tun (Running Piglet) will certainly develop, with Qi rushing from the lower abdomen to the heart. Apply one moxa cone on each nodule. Administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon), adding two liang more Cinnamon Twig. (Using needle-cauterization to induce sweating indicates Taiyang Cold Damage pattern. Zhang Zhongjing’s method dictates using Mahuang Tang to induce sweating. Here, the physician erroneously uses needle-cauterization. At the onset of Taiyang disease, Cold Pathogen is at the Exterior. Thus, Cold Pathogen enters internally from the needle puncture. Externally, flesh swells like a nodule and turns red. Internally, Ben Tun develops, with Qi rushing straight from the lower abdomen to the heart. Taiyang is the Cold Water Meridian; Kidney is the Cold Water Storage. Zang-Fu are paired; needling the Meridian draws Cold Pathogen Qi internally into the Zang. Cheng Wuji commented: First moxa the nodules to disperse Cold, then administer Guizhi Jia Gui Tang to drain the Qi of Ben Tun.)