三十证,方一十五首
发汗后,水药不得入口,为逆。
未持脉时,病患手叉自冒心,师因教试令咳,而不即咳者,此必两耳无所闻也,所以然
者,重发其汗,虚故也。
发汗后身热,又重发其汗,胃中虚冷,必反吐也。
大下后发汗,其人小便不利,此亡津液,勿治,其小便利,必自愈。
病患脉数,数为热,当消谷引食,而反吐者,以医发其汗,阳气微,膈气虚,脉则为数
,数为客热,不能消谷,胃中虚冷,故吐也。
病者有寒,复发其汗,胃中冷,必吐蛔。(一云吐逆。)
发汗后,重发其汗,亡阳谵语,其脉反和者,不死,服桂枝汤,汗出,大烦渴不解,若
脉洪大,与白虎汤。(方见杂疗中。)
发汗后,身体疼痛,其脉沉迟,桂枝加芍药生姜人参汤主之。方∶
桂枝(三两) 芍药(四两) 生姜(四两,切) 甘草(二两,炙) 大枣(十二枚,
擘) 人
参(三两)
上六味,以水一斗二升,煮取三升,去滓,温服一升。本云∶桂枝汤令加芍药、生姜、
人参。
太阳病,发其汗而不解,其人发热,心下悸,头眩,身 而动,振振欲擗地者,玄武汤
主之。(方见少阴门。)
发汗后,其人脐下悸,欲作奔豚,茯苓桂枝甘草大枣汤主之。方∶
茯苓(半斤) 桂枝(四两) 甘草(一两,炙) 大枣(十五枚,擘)
上四味,以水一斗,先煮茯苓减二升,纳诸药,煮取三升,去滓,温服一升,日三服。
发汗过多以后,其人叉手自冒心,心下悸,而欲得按之,桂枝甘草汤主之。方∶
桂枝(四两) 甘草(二两,炙)
上二味,以水三升,煮取一升,去滓,顿服即愈。
发汗,脉浮而数,复烦者,五苓散主之。(方见结胸门中。)
发汗后,腹胀满,浓朴生姜半夏甘草人参汤主之。方∶
浓朴(半斤,炙) 生姜(半斤,切) 半夏(半升,洗) 甘草(二两,炙) 人参
(一两)
上五味,以水一斗,煮取三升,去滓,温服一升,日三服。
发其汗不解,而反恶寒者,虚故也,芍药甘草附子汤主之。方∶
芍药 甘草(各三两,炙) 附子(一枚、炮,去皮,破六片)
上三味,以水三升,煮取一升二合,去滓,分温三服。
不恶寒但热者,实也,当和其胃气,宜小承气汤。(方见承气汤门,一云调胃承气汤。)
伤寒,脉浮,自汗出,小便数,颇复微恶寒,而脚挛急。反与桂枝欲攻其表,得之便厥
,咽干,烦躁吐逆,当作甘草干姜汤,以复其阳;厥愈足温,更作芍药甘草汤与之,其脚即
伸;而胃气不和,可与承气汤。重发汗,复加烧针者,四逆汤主之。
甘草干姜汤方∶
甘草(四两,炙) 干姜(二两)
上二味,以水三升,煮取一升,去滓,分温再服。
芍药甘草汤方∶
芍药 甘草(炙,各四两)
上二味,以水三升,煮取一升半,去滓,分温再服。
凡病,若发汗、若吐、若下、若亡血,无津液,而阴阳自和者,必自愈。
伤寒,吐下发汗后,心下逆满,气上撞胸,起即头眩,其脉沉紧,发汗即动,经身为振
摇,茯苓桂枝白术甘草汤主之。方∶
茯苓(四两) 桂枝(三两) 白术 甘草(炙,各二两)
上四味,以水六升,煮取六升,去滓,分温三服。
发汗吐下以后不解,烦躁,茯苓四逆汤主之。方∶
茯苓(四两) 人参(一两) 甘草(二两,炙) 干姜(一两半) 附子(一枚,生,
去皮,
破八片)
上五味,以水五升,煮取二升,去滓,温服七合,日三服。
发汗吐下后,虚烦不得眠,剧者反复颠倒,心中懊 ,栀子汤主之;若少气,栀子甘草
汤主之;若呕者,栀子生姜汤主之。(栀子汤方见阳明门。)
栀子甘草汤方∶
于栀子汤中加甘草二两即是。
栀子生姜汤方∶
于栀子汤中加生姜五两即是。
伤寒下后,烦而腹满,卧起不安,栀子浓朴汤主之。方∶
栀子(十四枚,擘) 浓朴(四两,炙) 枳实(四枚,炙)
上三味,以水三升半,煮取一升半,去滓,分二服,温进一服快吐,止后服。
下以后,发其汗,必振寒,又其脉微细,所以然者,内外俱虚故也。发汗若下之,烦热
,胸中窒者,属栀子汤证。
下以后,复发其汗者,则昼日烦躁不眠,夜而安静,不呕不渴,而无表证,其脉沉微,
身无大热,属附子干姜汤。方∶
附子(一枚,生,去皮,破八片) 干姜(一两)
上二味,以水三升,煮取一升,去滓,顿服即安。
太阳病,先下而不愈,因复发其汗,表里俱虚,其人因冒,冒家当汗出自愈,所以然者
,汗出表和故也,表和故下之。
伤寒,医以丸药大下后,身热不去,微烦,栀子干姜汤主之。方∶
栀子(十四枚,擘) 干姜(二两)
上二味,以水三升半,煮取一升半,去滓,分二服,温进一服,得快吐,止后服。
脉浮数,法当汗出而愈,而下之,则身体重,心悸者,不可发其汗,当自汗出而解,所
以然者,尺中脉微,此里虚,须表里实,津液自和,自汗出愈。
发汗以后,不可行桂枝汤,汗出而喘,无大热,与麻黄杏子石膏甘草汤∶
麻黄(四两,去节) 杏仁(五十枚,去皮尖) 石膏(半斤,碎) 甘草(二两,炙)
上四味,以水七升,先煮麻黄一二沸,去上沫,纳诸药,煮取三升,去滓,温服一升,
本云黄耳杯。
伤寒吐下后,七八日不解,热结在里,表里俱热,时时恶风,大渴,舌上干燥而烦,欲
饮水数升,白虎汤主之。(方见杂疗中。)
伤寒,吐下后未解,不大便五六日,至十余日,其人日晡所发潮热,不恶寒,犹如见鬼
神之状。剧者,发则不识人,循衣妄掇,怵惕不安,微喘直视,脉弦者生,涩者死。微者,
但发热谵语,与承气汤,若下者,勿复服。
大下后,口燥者,里虚故也。
**Proof 30, comprising fifteen prescriptions.**
After sweating therapy, if water and medicine cannot be taken into the mouth, it is considered a counter-indication (adverse reaction).
Before taking the pulse, if the patient crosses their hands over the heart area, and upon the physician's instruction to cough, the patient fails to cough immediately, this indicates bilateral hearing loss. This occurs because excessive sweating has depleted the body's vital energy (Zheng Qi), leading to deficiency.
After sweating, if the body remains feverish and sweating is induced again, causing coldness and deficiency in the Stomach, vomiting will inevitably occur.
After severe purgation followed by sweating, if the patient experiences difficulty urinating, this is due to the depletion of Body Fluids (Jin Ye); do not treat it forcibly. If urination becomes normal, the condition will likely resolve spontaneously.
If the patient presents with a rapid pulse (Shu Mai), which typically indicates heat and an increased appetite for digestion, but instead vomits, it is because the physician incorrectly induced sweating, damaging the Yang Qi and causing deficiency in the Diaphragm Qi. The rapid pulse here represents "guest heat" (deficiency heat) rather than excess heat; thus, digestion is impaired due to coldness and deficiency in the Stomach, leading to vomiting.
If the patient has internal cold and sweating is induced again, causing coldness in the Stomach, vomiting of roundworms may occur. (Another version states vomiting and reflux.)
After sweating, if further sweating leads to Yang exhaustion and delirious speech (Chan Yu), but the pulse remains harmonious, the prognosis is good (not fatal). Administer Guizhi Tang (Cinnamon Twig Decoction). If, after sweating, there is severe irritability and unquenchable thirst with a flooding pulse (Hong Da Mai), administer Baihu Tang (White Tiger Decoction). (Prescription found in Miscellaneous Treatments section.)
After sweating, if body pain persists with a deep and slow pulse (Chen Chi Mai), treat with Guizhi Jia Shaoyao Shengjiang Renshen Tang (Cinnamon Twig Decoction with Added Peony, Fresh Ginger, and Ginseng). Prescription:
Guizhi (Cinnamomi Ramulus) - 3 liang
Shaoyao (Paeoniae Radix) - 4 liang
Shengjiang (Zingiberis Rhizoma Recens) - 4 liang, sliced
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried
Dazao (Zizyphi Fructus) - 12 pieces, split
Renshen (Panacis Ginseng Radix) - 3 liang
These six ingredients are boiled in 12 sheng of water until reduced to 3 sheng. Strain and take 1 sheng warm. Originally, this was Guizhi Tang with added Shaoyao, Shengjiang, and Renshen.
In Taiyang disease, if sweating fails to resolve the condition, and the patient presents with fever, palpitations in the epigastrium, dizziness, tremors, and a sensation of being unable to stand steady (Zhen Zhen Yu Pi Di), treat with Xuanwu Tang (Black Tortoise Decoction). (Prescription found in Shaoyin section.)
After sweating, if the patient feels palpitations below the umbilicus and anticipates Ben Tun (Rushing Pig Syndrome), treat with Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction). Prescription:
Fuling (Poria) - 8 liang
Guizhi (Cinnamomi Ramulus) - 4 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 1 liang, honey-fried
Dazao (Zizyphi Fructus) - 15 pieces, split
These four ingredients are boiled in 10 sheng of water. First boil Fuling until reduced by 2 sheng, then add the remaining herbs. Boil until reduced to 3 sheng. Strain and take 1 sheng warm, three times daily.
After excessive sweating, if the patient crosses their hands over the heart, experiences palpitations, and desires pressure on the chest, treat with Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). Prescription:
Guizhi (Cinnamomi Ramulus) - 4 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried
These two ingredients are boiled in 3 sheng of water until reduced to 1 sheng. Strain and take all at once (dun fu) for immediate recovery.
After sweating, if the pulse is floating and rapid, and irritability recurs, treat with Wuling San (Five-Ingredient Powder with Poria). (Prescription found in Jie Xiong section.)
After sweating, if abdominal fullness occurs, treat with Nongpu Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction). Prescription:
Nongpu (Magnoliae Officinalis Cortex) - 8 liang, honey-fried
Shengjiang (Zingiberis Rhizoma Recens) - 8 liang, sliced
Banxia (Pinelliae Tuber) - 0.5 sheng, washed
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried
Renshen (Panacis Ginseng Radix) - 1 liang
These five ingredients are boiled in 10 sheng of water until reduced to 3 sheng. Strain and take 1 sheng warm, three times daily.
If sweating fails to resolve the condition and chills appear, it indicates deficiency. Treat with Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction). Prescription:
Shaoyao (Paeoniae Radix)
Gancao (Glycyrrhizae Radix et Rhizoma) - 3 liang each, honey-fried
Fuzi (Aconiti Lateralis Radix Praeparata) - 1 piece, processed, skin removed, broken into six pieces
These three ingredients are boiled in 3 sheng of water until reduced to 1.2 sheng. Strain and divide into three warm doses.
If there is no chills but only heat, it indicates excess. Harmonize the Stomach Qi using Xiao Chengqi Tang (Minor Order the Intestines Decoction). (Prescription found in Chengqi Tang section; another version suggests Tiaowei Chengqi Tang.)
In Shanghan (Cold Damage), if the pulse is floating, there is spontaneous sweating, frequent urination, slight aversion to cold, and leg cramps, one might mistakenly use Guizhi Tang to attack the exterior. This would lead to cold limbs (Jue), dry throat, irritability, and vomiting/reflux. In this case, use Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang. Once the limbs warm, administer Shaoyao Gancao Tang (Peony and Licorice Decoction) to extend the legs. If the Stomach Qi is disharmonious, administer Chengqi Tang. If excessive sweating is combined with moxibustion/cauterization (Shao Zhen), use Sini Tang (Recover the Counterflow Decoction).
**Gancao Ganjiang Tang Prescription:**
Gancao (Glycyrrhizae Radix et Rhizoma) - 4 liang, honey-fried
Ganjiang (Zingiberis Rhizoma) - 2 liang
Boil these two in 3 sheng of water until reduced to 1 sheng. Strain and divide into two warm doses.
**Shaoyao Gancao Tang Prescription:**
Shaoyao (Paeoniae Radix)
Gancao (Glycyrrhizae Radix et Rhizoma) - 4 liang each, honey-fried
Boil these two in 3 sheng of water until reduced to 1.5 sheng. Strain and divide into two warm doses.
Generally, for any disease treated with sweating, vomiting, purgation, or involving blood loss and fluid depletion, if Yin and Yang achieve self-harmony, the disease will resolve spontaneously.
In Shanghan, after vomiting, purgation, and sweating, if there is fullness and rebellious Qi in the epigastrium, Qi rushing to the chest, dizziness upon standing, and a deep, tight pulse, inducing sweating would cause tremors. Use Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). Prescription:
Fuling (Poria) - 4 liang
Guizhi (Cinnamomi Ramulus) - 3 liang
Baizhu (Atractodis Rhizoma)
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang each, honey-fried
Boil these four in 6 sheng of water until reduced to 6 sheng. Strain and divide into three warm doses.
If sweating, vomiting, and purgation fail to resolve the condition and irritability ensues, use Fuling Sini Tang (Poria and Sini Decoction). Prescription:
Fuling (Poria) - 4 liang
Renshen (Panacis Ginseng Radix) - 1 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried
Ganjiang (Zingiberis Rhizoma) - 1.5 liang
Fuzi (Aconiti Lateralis Radix Praeparata) - 1 piece, raw, skin removed, broken into eight pieces
Boil these five in 5 sheng of water until reduced to 2 sheng. Strain and take 0.7 sheng warm, three times daily.
After sweating, vomiting, and purgation, if deficiency-heat causes insomnia, with severe cases tossing and turning and feeling stifled in the heart, use Zhizi Tang (Gardenia Decoction). If there is shortness of breath, use Zhizi Gancao Tang (Gardenia and Licorice Decoction). If vomiting occurs, use Zhizi Shengjiang Tang (Gardenia and Fresh Ginger Decoction). (Zhizi Tang prescription found in Yangming section.)
**Zhizi Gancao Tang Prescription:**
Add 2 liang of Gancao to Zhizi Tang.
**Zhizi Shengjiang Tang Prescription:**
Add 5 liang of Shengjiang to Zhizi Tang.
After purgation in Shanghan, if there is irritability, abdominal fullness, and restlessness day and night, use Zhizi Nongpu Tang (Gardenia and Magnolia Bark Decoction). Prescription:
Zhizi (Gardeniae Fructus) - 14 pieces, split
Nongpu (Magnoliae Officinalis Cortex) - 4 liang, honey-fried
Zhishi (Aurantii Fructus Immaturus) - 4 pieces, honey-fried
Boil these three in 3.5 sheng of water until reduced to 1.5 sheng. Strain and divide into two doses. Take one dose warm; if it induces rapid vomiting, stop subsequent doses.
After purgation followed by sweating, chills and trembling may occur with a faint, thin pulse, indicating interior and exterior deficiency. If sweating or purgation leads to irritability, heat, and chest oppression, it belongs to the Zhizi Tang pattern.
If purgation is followed by sweating, resulting in daytime irritability and insomnia but quietness at night, without vomiting, thirst, or exterior signs, and with a deep, faint pulse and no significant fever, it belongs to the Fuzi Ganjiang Tang pattern. Prescription:
Fuzi (Aconiti Lateralis Radix Praeparata) - 1 piece, raw, skin removed, broken into eight pieces
Ganjiang (Zingiberis Rhizoma) - 1 liang
Boil these two in 3 sheng of water until reduced to 1 sheng. Strain and take all at once for immediate calm.
In Taiyang disease, if purgation is used first without success, followed by sweating, both exterior and interior become deficient, leading to dizziness/malaise (Mao). Patients with Mao should recover through spontaneous sweating, as this indicates the exterior harmony is restored. Therefore, no further purgation is needed.
In Shanghan, if a physician uses pill-based strong purgatives, leaving residual heat and mild irritability, use Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction). Prescription:
Zhizi (Gardeniae Fructus) - 14 pieces, split
Ganjiang (Zingiberis Rhizoma) - 2 liang
Boil these two in 3.5 sheng of water until reduced to 1.5 sheng. Strain and divide into two doses. Take one dose warm; if it induces rapid vomiting, stop subsequent doses.
If the pulse is floating and rapid, sweating is indicated for resolution. However, if purgation is used instead, leading to heavy body and palpitations, do not induce sweating. Wait for spontaneous sweating to resolve the condition. This is because a faint pulse at the Chi position indicates interior deficiency. One must wait for the interior and exterior to strengthen and fluids to harmonize before spontaneous sweating can heal the disease.
After sweating, Guizhi Tang should not be used. If there is sweating, wheezing, and no high fever, administer Mahuang Xingzi Shigao Gancao Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction):
Mahuang (Ephedrae Herba) - 4 liang, nodes removed
Xingren (Armeniacae Semen Amarum) - 50 pieces, skin and tips removed
Shigao (Gypsum Fibrosum) - 8 liang, crushed
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried
Boil these four in 7 sheng of water. First boil Mahuang for one or two boils, skim off the foam, then add other herbs. Boil until reduced to 3 sheng. Strain and take 1 sheng warm. Originally measured as a "Yellow Ear Cup."
After vomiting and purgation in Shanghan, if the condition persists for seven to eight days with heat accumulating internally, presenting with interior-exterior heat, occasional aversion to wind, extreme thirst, dry tongue, irritability, and desire to drink several sheng of water, use Baihu Tang (White Tiger Decoction). (Prescription found in Miscellaneous Treatments section.)
In Shanghan, if vomiting and purgation fail to resolve the condition, and constipation lasts five to six days up to ten-plus days, the patient may experience tidal fever in the late afternoon, aversion to cold ceases, and hallucinations (seeing spirits). Severe cases involve unconsciousness, picking at clothes, fearfulness, shortness of breath, and fixed gaze. A wiry pulse indicates survival; a choppy pulse indicates death. Mild cases present only with fever and delirium; administer Chengqi Tang. If purgation has already occurred, do not administer again.
After severe purgation, dry mouth indicates interior deficiency.