27. 太阳三日已发汗, 若吐若下若温针, 不解致逆成坏证, 观其脉证
犯何经, 难辨阴阳六经证, 重困垂危莫可凭, 惟用独参煎冷服, 鼻上
津津有汗生.
【注】太阳病三日, 巳发汗不解, 若吐, 若下, 若温针, 苟或相当即
成解证. 如其不当, 不但病不解, 或因而致逆变成坏证, 当观其脉证,
知犯何经之逆. 如汗后亡阳, 渴躁谵语, 下后寒中, 结胸痞硬, 吐后
内烦腹满, 温针后黄, 衄, 惊, 狂之类, 随证治之可也. 甚或脉微欲
绝, 神昏不能言, 循衣摸床, 叉手冒心等, 重因垂危, 难辨阴阳, 六
经莫可凭之证, 此时此际, 惟用人参煎汤, 徐徐冷服, 以待其机. 倘
得鼻上津津有汗, 则为可生之兆也.
28. 表证宜汗太阳经, 无汗发热恶寒风, 头项强痛身体痛, 若出自汗
表虚明.
【注】表证, 谓寒邪在表, 无汗发热, 恶寒恶风, 头项强痛, 身体痛
也.太阳经主表, 故曰表证. 有是证无汗者, 皆属表实. 虽有是证,
若自汗出者, 皆属表虚, 未可轻汗, 即有风邪, 只宜桂枝汤解肌可也.
表实无汗, 重者麻黄汤主之. 轻者麻桂各半汤主之. 时有汗时无汗者,
桂枝二麻黄一汤主之. 表实躁热甚者, 三黄石膏汤主之; 微者, 大青
龙汤主之. 不躁有热者, 桂枝二越婢一汤主之. 以上表证, 不必悉具,
亦不论日之多寡, 但见有头痛恶寒一, 二证, 即为表未罢, 虽有里证,
当先解表. 表解已, 乃可攻之, 临证者不可不详辨也. 详太阳篇.
27. 太阳病经过三天，已经发过汗，如果再用吐法、下法或温针治疗，病情仍未解除，导致变证成为坏证。此时观察患者的脉象和症状，判断病邪侵犯了哪一经络，难以辨别阴阳及六经的具体证候，患者病情沉重且处于垂危状态，无法依靠常规方法判断。只能使用独参汤（单用人参煎煮的汤剂），冷却后服用，若见鼻部微微出汗，则为生机之兆。
【注】太阳病三天，已经发汗但病未解，如果用吐法、下法或温针，如果用法恰当，就会痊愈。如果不恰当，不仅病不能解除，反而可能因此导致逆证，变成坏证。应当观察患者的脉象和症状，了解病邪侵犯了哪一经络而产生逆乱。例如：发汗后出现亡阳（阳气耗散）、口渴烦躁、胡言乱语；攻下后出现中焦虚寒、结胸（胸胁部硬满疼痛）、痞硬（心下痞塞坚硬）；催吐后出现心中烦闷、腹部胀满；温针后出现发黄、鼻衄（流鼻血）、惊悸、狂躁等情况，应根据具体证候进行治疗。甚至出现脉搏微弱几乎摸不到、神志昏迷不能说话、手抓衣角床沿、双手交叉护住心胸等重症垂危、难以辨别阴阳、六经证候无法依据的情况。在此时此刻，只有用人参煎汤，慢慢冷服，以等待转机。倘若见到鼻子上微微出汗，就是可以生存的征兆。
28. 表证适宜用发汗法治疗。太阳经受邪，表现为无汗、发热、恶风恶寒，头项强痛，身体疼痛。如果是自汗出，则明确为表虚证。
【注】表证，是指寒邪在体表，表现为无汗、发热、恶风恶寒、头项强痛、身体疼痛。太阳经主管体表，所以称为表证。有这些症状且无汗的，都属于表实证。虽然有这些症状，但如果出现自汗出的，都属于表虚证，不可轻易发汗。即使有风邪，只宜用桂枝汤（Cinnamon Twig Decoction）解肌发表即可。表实证无汗，病情重的，主用麻黄汤（Ephedra Decoction）。病情轻的，主用麻黄桂枝各半汤（Mahuang and Guizhi Half-Half Decoction）。有时有汗、有时无汗的，主用桂枝二麻黄一汤（Guizhi Er Mahuang Yi Decoction）。表实证伴有严重烦躁发热的，主用三黄石膏汤（Sanhuang Shigao Decoction）；症状轻微的，主用大青龙汤（Major Blue Green Dragon Decoction）。不烦躁但有热的，主用桂枝二越婢一汤（Guizhi Er Yuebi Yi Decoction）。以上表证，不必具备所有症状，也不论患病天数多少，只要见到头痛、恶寒中的一个或两个症状，就表明表证未解。即使有里证，也应当先解表。表证解除后，才可以攻治里证。临证医生不可不详细辨证。详见《伤寒论·太阳病篇》。
27. After three days of Taiyang disease (Taiyang Syndrome), if sweating therapy has already been applied, but emesis, purgation, or warm needle therapy is subsequently used without resolving the condition, it may lead to adverse changes and become a "ruined syndrome" (Bad Zheng). At this stage, one must observe the pulse and symptoms to determine which meridian has been affected. It becomes difficult to distinguish between Yin and Yang or the specific manifestations of the Six Meridians. The patient's condition is critical and life-threatening, making conventional diagnostic reliance precarious. In such cases, only Du Shen Tang (Single Ginseng Decoction) should be administered cold. If sweat appears gently on the nose, it indicates a sign of recovery.
[Annotation] When Taiyang disease persists for three days and sweating therapy fails to resolve it, the use of emesis, purgation, or warm needles—if appropriately indicated—would lead to resolution. However, if these methods are inappropriate, not only will the disease remain unresolved, but it may also cause adverse reactions, transforming into a "ruined syndrome." One must observe the pulse and symptoms to identify which meridian's pathology has caused the deviation. For instance: after sweating, symptoms of Yang collapse (Yang Wang), thirst, restlessness, and delirium may occur; after purgation, middle-jiao cold, chest binding (Jie Xiong), or epigastric fullness and hardness (Pi Ying) may arise; after emesis, internal irritability and abdominal distension may appear; after warm needle therapy, jaundice, epistaxis, palpitations, or mania may ensue. Treatment should follow the specific symptoms. In severe cases where the pulse is faint and nearly imperceptible, consciousness is lost with inability to speak, patients grasp at clothing or bedrails, or cross their hands over the heart, indicating a critical state where Yin/Yang differentiation and Six Meridian patterns are indistinguishable. At this juncture, only Ren Shen (Ginseng Root) decoction, taken slowly while cool, should be used to await a turning point. If gentle sweat appears on the nose, it signifies a prognosis of survival.
28. Exterior syndromes are suitable for sweating therapy. Taiyang meridian involvement presents with anhidrosis (lack of sweat), fever, aversion to wind and cold, stiffness and pain in the head and nape, and body aches. If spontaneous sweating occurs, it clearly indicates an Exterior Deficiency syndrome.
[Annotation] An exterior syndrome refers to pathogenic cold residing in the exterior, characterized by anhidrosis, fever, aversion to wind and cold, stiffness and pain in the head and nape, and body aches. Since the Taiyang meridian governs the exterior, it is termed an exterior syndrome. Cases presenting these symptoms without sweat belong to Exterior Excess. However, even with these symptoms, if spontaneous sweating is present, it belongs to Exterior Deficiency, and gentle sweating therapies should not be used lightly. Even if wind pathogens are present, only Guizhi Tang (Cinnamon Twig Decoction) should be used to release the muscle layer. For Exterior Excess with anhidrosis, severe cases are primarily treated with Mahuang Tang (Ephedra Decoction); mild cases with Mahuang Guizhi Banxia Banxia Tang (Mahuang and Guizhi Half-Half Decoction). Cases with intermittent sweating are primarily treated with Guizhi Er Mahuang Yi Tang (Guizhi Two, Mahuang One Decoction). For Exterior Excess with severe irritability and heat, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) is primary; for milder cases, Da Qinglong Tang (Major Blue-Green Dragon Decoction) is primary. For those without irritability but with heat, Guizhi Er Yuebi Yi Tang (Guizhi Two, Yuebi One Decoction) is primary. Regarding the above exterior syndromes, it is not necessary for all symptoms to be present, nor does the number of days matter. As long as one or two symptoms such as headache and aversion to cold are observed, it indicates that the exterior syndrome has not resolved. Even if interior syndromes exist, the exterior must be resolved first. Only after the exterior is resolved can interior treatments be applied. Clinicians must not fail to differentiate carefully. See the Taiyang Chapter for details.