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。
在桂枝汤的方剂基础上，增加桂枝二两。总共五两。其余按照前面的煎服方法执行。
因火疗误治后又用攻下法，导致因烧针而烦躁的，主治方为桂枝甘草龙骨牡蛎汤。
先施以火疗属于逆治，随后又用攻下法清除病邪，导致体内正气虚弱，再加上烧针的刺激，里气虚衰而被火热之邪所扰，因此产生烦躁症状。给予桂枝甘草龙骨牡蛎汤以疏散火邪。
桂枝（一两） 甘草（二两） 牡蛎（二两，熬制） 龙骨（二两）
以上四味药研为粗末。用水五升，煮取二升半，滤去药渣。每次温服八合，每日服用三次。
辛甘发散：桂枝和甘草的辛甘之性，用以发散经络中的火邪。涩可固脱：龙骨和牡蛎的涩味，用以收敛浮越的正气。
太阳伤寒证，若加用温针，必然引起惊恐。
寒邪伤及营血，若营气微弱者，再加烧针，则血液凝滞不行。惊恐是因为温针损伤了营血并扰动心气。《金匮要略》说：气血少者，归属于心。
王宇泰说：心属火，火邪首先侵犯心脏。心主血脉而藏神。血好比水，神好比鱼。两阳（指外感热邪与火疗之热）相互熏灼，如同水被煮沸，鱼就会惊跃不安。
太阳病，应当恶寒发热。现在患者自汗出，且不恶寒发热，关脉细数，这是医生误用吐法造成的过失。发病一二日时误用吐法，患者腹中饥饿但口不能进食；发病三四日时误用吐法，患者不喜欢喝稀粥，想吃冷食，早晨吃晚上吐，这都是因为医生误用吐法所致。这称为“小逆”。
恶寒发热是太阳表证。自汗出、不恶寒发热，本是阳明证。原本太阳表证，医生反而使用吐法，损伤了胃气，表邪乘虚传入阳明。通过关脉细数，可知这是医生命误用吐法所致。发病一二日，表邪尚属寒邪而未化热，误吐则表寒传入胃中，导致胃中虚寒，所以腹中感觉饥饿但口中无法进食。发病三四日，表邪已传变化热，误吐则表热乘虚入胃，导致胃中虚热，所以不喜欢喝稀粥，想吃冷食，出现早晨吃晚上吐的症状。早晨吃晚上吐，是因为食物早晨进入胃中，胃气虚弱不能腐熟消化，等到傍晚胃气行于里部，与邪气相搏结，导致胃气上逆。但因为胃气尚存，所以只称为“小逆”。
张兼善说：此病虽然属于逆证，应当自愈。吐法中本身就含有发散的含义。只要节制饮食，安静调养摄护，余邪自然去除。如果再次妄加治疗，就会产生变证。
太阳病，误用吐法后，仅表现为太阳病特征。原本太阳病应当恶寒，现在反而不恶寒，不想穿衣，这是因为误吐导致内部烦热。
太阳表证，医生反而误用吐法，损伤了胃气，邪热乘虚入胃，胃被邪热内扰而烦闷，所以不恶寒，不想穿衣。
患者脉数，数为热象，应当能消化食物且食欲旺盛，却反而呕吐，这是因为发汗导致阳气微弱，膈间气虚，脉象才表现为数。这种数是客热（假热），不能消化食物，是因为胃中虚冷，所以发生呕吐。
阳气受气于胸中，发汗使体表阳气虚弱，这就是导致阳气微弱、膈气虚的原因。数脉本为热象，若是真热则能消谷；若是客热则不能消谷。因为发汗外损阳气，导致胃中虚冷，所以发生呕吐。
太阳病，经过十余日，患者心中泛泛欲吐且胸中疼痛，大便反而稀溏，腹部轻微胀满，情绪郁郁寡欢且轻微烦躁。如果在之前此时已经过度使用吐法或下法，给予调胃承气汤。如果不是这种情况，不可给予。如果只是想要呕吐、胸中痛、大便微溏，这不是柴胡汤证，因为呕吐可知此前曾过度使用吐下法。
心中泛泛欲吐，郁郁微烦，胸中疼痛，应当责问是否为邪热客居胸中。大便反而稀溏，腹部轻微胀满，说明邪热已下行至胃。虽然日数较多，若未经过吐下法，仅仅是传经之邪，也不可攻下，应当给予柴胡汤以清除上、中二焦之邪。若曾经过吐下，损伤了胃气，胃虚则邪气乘虚入胃形成实证，非柴胡汤所能去除。调胃承气汤用于攻下胃热。因为有呕吐症状，可知胃气先前曾受损伤。
太阳病，六七日，表证仍在，脉象微而沉，反而没有形成结胸证。患者出现发狂症状，这是因为热邪在下焦，少腹部应当硬满，小便自利的，必须下血才能痊愈。之所以这样，是因为太阳随经入腑，瘀热在里的缘故。主治方为抵当汤。
太阳对应经脉，膀胱对应腑脏。这是太阳随经传入腑证的例子。六七日邪气传入里部的时期，脉微而沉，是邪气在里的脉象。表证仍在，说明邪气尚浅，应当结于胸中。若不结于胸中，患者出现发狂，说明热结在膀胱。经书说：“热结膀胱，其人如狂。”此处发狂，说明热势更深。少腹硬满，若小便不利，是无血证；若小便自利，则是血证的确凿证据。给予抵当汤以攻下蓄积之血。
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.