二十证 方一十三首
中风发热，六七日不解而烦，有表里证，渴欲饮水，水入而吐，此为水逆，五苓散主之
（方见结胸闷中。）
伤寒二三日，心中悸而烦者，小建中汤主之。方∶
桂枝（三两） 甘草（二两，炙） 芍药（六两） 生姜（三两，切） 大枣（十一枚，
擘） 胶
饴（一升）
上六味，以水七升，煮取三升，去滓，纳饴，温服一升。呕家不可服，以甘故也。
伤寒脉浮，而医以火迫劫之，亡阳，惊狂，卧起不安，桂枝去芍药加蜀漆牡蛎龙骨救逆
汤主之。方∶
桂枝 生姜（切） 蜀漆（各三两，洗去腥） 甘草（二两，炙） 牡蛎（五两，熬） 龙
骨（
四两） 大枣（十二枚，擘）
上七味，以水八升，先煮蜀漆减二升，纳诸药，煮取三升，去滓，温服一升。（一法以
水一斗二升煮取五升。）
烧针令其汗，针处被寒，核起而赤者，必发奔豚，气从少腹上冲者，灸其核上一壮，与
桂枝加桂汤。
方∶
桂枝（五两） 芍药 生姜（各三两） 大枣（十二枚，擘） 甘草（二两，炙）
上五味，以水七升，煮取三升，去滓，温服一升。本云∶桂枝汤，今加桂满五两，所以
加桂者，以能泻奔豚气也。
火逆下之，因烧针烦躁者，桂枝甘草龙骨牡蛎汤主之。方∶
桂枝（一两） 甘草 龙骨 牡蛎（各二两，熬）
上四味，以水五升，煮取二升，去滓，温服八合，日三服。
伤寒，加温针，必惊。
太阳病六七日，出表证续在，脉微而沉，反不结胸，其人发狂者，以热在下焦。少腹坚
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，宜下之，以抵当汤。
太阳病，身黄，脉沉结，少腹坚，小便不利者，为无血；小便自利，其人如狂者，血证
谛也，抵当汤主之。
伤寒有热，少腹满，应小便不利，今反利者，为有血也，当须下之，不可余药，宜抵当
丸。
抵当汤方∶
大黄（二两，破六片） 桃仁（二十枚，去皮尖，熬） 虻虫（去足翅，熬） 水蛭（各
三十
枚，熬）
上四味，以水五升，煮取三升，去滓，温服一升。不下更服。
抵当丸方∶
大黄（三两） 桃仁（二十五枚，去皮尖，熬） 虻虫（去足翅，熬） 水蛭（各二十
枚，熬）
上四味，捣分为四丸，以水一升煮取一丸，取七合服， 时当下，不下更服。
妇人中风，发热恶寒，经水适来，得七八日，热除而脉迟，身凉，胸胁下满，如结胸状
，谵语，此为热入血室，当刺期门，随其虚实而取之。
妇人中风七八日，续得寒热，发作有时，经水适断者，此为热入血室，其血必结，故使
如疟状，发作有时，小柴胡汤主之（方见柴胡汤门。）
妇人伤寒，发热，经水适来，昼日了了，暮则谵语如见鬼状，此为热入血室，无犯胃气
及上二焦，必当自愈。
伤寒无大热，口燥渴而烦，其背微恶寒，白虎汤主之。
伤寒脉浮，发热无汗，其表不解，不可与白虎汤；渴欲饮水无表证，白虎汤主之。
伤寒脉浮滑，此以表有热，里有寒，白虎汤主之。方∶
知母（六两） 石膏（一斤，碎） 甘草（二两，炙） 粳米（六合）
上四味，以水一斗，煮米熟汤成，去滓，温服一升，日三服。
又方∶
知母（六两石膏一斤，碎） 甘草（二两，炙） 人参（三两） 粳米（六合）
上五味，以水一斗，煮米熟汤成，去滓，温服一升，日三服。立夏后至立秋前得用之，
立秋后不可服，春三月病常苦里冷，白虎汤亦不可与之，与之即呕利而腹痛，诸亡血及虚家，
亦不可与白虎汤，得之则腹痛而利，但当温之。
太阳与少阳合病，自下利者，与黄芩汤；若呕者，与黄芩加半夏生姜汤。
黄芩汤方∶
黄芩（三两） 芍药 甘草（各二两，炙） 大枣（一十二枚，擘）
上四味，以水一斗，煮取三升，去滓，温服一升，日再、夜一服。
黄芩加半夏生姜汤方∶
半夏（半升，洗） 生姜（一两半，切）
上二味，加入前方中即是。
伤寒，胸中有热，胃中有邪气，腹中痛，欲呕吐，黄连汤主之。方∶
黄连 甘草（炙） 干姜 桂枝 人参（各三两） 半夏（半升，洗） 大枣（十二枚，
擘）
上七味，以水一斗，煮取六升，去滓，温分五服，昼三夜二服。
伤寒八九日，风湿相搏，身体疼烦，不能自转侧，不呕不渴，下已脉浮而紧，桂枝附子
汤主之。若其人大便坚，小便自利，术附子汤主之。方∶
桂枝（四两） 附子（三枚，炮） 生姜（三两，切） 大枣（十二枚，擘） 甘草（二
两，炙
上五味，以水六升，煮取二升，去滓，分温三服。
术附子汤方∶于前方中去桂，加白术四两即是。一服觉身痹，半日许复服之尽，其人如
冒状，勿怪。即是附子术并走皮中，逐水气未得除，故使之耳，法当加桂四两，以大便坚，
小便自利，故不加桂也。
风湿相搏，骨节疼烦，掣痛不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不欲去
衣，或身微肿，甘草附子汤主之。方∶
甘草（二两，炙） 附子（二枚，炮） 白术（三两） 桂枝（四两）
上四味，以水六升，煮取三升，去滓，温服一升，日三服，初服得微汗即止，能食汗止
复烦者，将服五合，恐一升多者，后服六七合愈。
伤寒脉结代，心动悸，炙甘草汤主之。方∶
甘草四两，炙 桂枝 生姜（各三两，切） 麦门冬（去心，半升） 麻子仁（半升） 人
参
上九味，以清酒七升，水八升，煮取三升，去滓，纳胶消烊尽，温服一升，日三服。
Twenty syndromes, thirteen prescriptions included.
Wind-stroke with fever, persisting for six or seven days without resolution accompanied by vexation, presenting both exterior and interior signs. The patient desires to drink water, but vomits immediately after ingestion; this is termed "Water Reversal" (Shui Ni), treated primarily with Wuling San (Five-Ingredient Powder with Poria). (Prescription see Chapter on Chest Fullness and Stagnation.)
In cold damage disease, if within two or three days the heart palpitates and feels vexed, it is treated primarily with Xiaojianzhong Tang (Minor Construct the Middle Decoction). Prescription:
Guizhi (Cinnamon Twig) (3 liang) Gancao (Licorice Root, honey-fried) (2 liang) Shaoyao (Peony Root) (6 liang) Shengjiang (Fresh Ginger, sliced) (3 liang) Dazao (Jujube, broken open) (11 pieces) Yitang (Maltose) (1 sheng)
The above six ingredients are boiled in 7 sheng of water to obtain 3 sheng of decoction. Strain the dregs, add maltose, and take 1 sheng warm. It is contraindicated for patients with vomiting tendencies due to the cloying nature of sweet substances.
In cold damage disease with a floating pulse, if a physician uses fire therapy to force sweating and deplete fluids, leading to Yang collapse, resulting in fright, mania, restlessness in lying down and rising up, it is treated primarily with Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang (Cinnamon Twig Decoction without Peony plus Coix Seed, Oyster Shell, and Dragon Bone to Rescue from Deviation). Prescription:
Guizhi (Cinnamon Twig) Shengjiang (Fresh Ginger, sliced) Shuqi (Coir of Radish Stem, washed to remove fishy smell) (each 3 liang) Gancao (Licorice Root, honey-fried) (2 liang) Muli (Oyster Shell, calcined) (5 liang) Longgu (Dragon Bone) (4 liang) Dazao (Jujube, broken open) (12 pieces)
The above seven ingredients are boiled in 8 sheng of water. First boil Shuqi until reduced by 2 sheng, then add the remaining herbs. Boil to obtain 3 sheng of decoction. Strain the dregs and take 1 sheng warm. (Alternative method: boil in 12 sheng of water to obtain 5 sheng.)
If needle-cauterization is used to induce sweating, and the puncture site becomes cold, presenting as nodular redness, Ben Tun (Rushing Pig) will inevitably occur, with Qi rushing upward from the lower abdomen. Apply one moxa cone on the nodule and administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon).
Prescription:
Guizhi (Cinnamon Twig) (5 liang) Shaoyao (Peony Root) Shengjiang (Fresh Ginger) (each 3 liang) Dazao (Jujube, broken open) (12 pieces) Gancao (Licorice Root, honey-fried) (2 liang)
The above five ingredients are boiled in 7 sheng of water to obtain 3 sheng of decoction. Strain the dregs and take 1 sheng warm. Originally this was Guizhi Tang, now Cinnamon is increased to 5 liang. Cinnamon is added because it can drain the Qi of Ben Tun.
If fire deviation is followed by purging, and cauterization causes vexation, it is treated primarily with Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction with Dragon Bone and Oyster Shell). Prescription:
Guizhi (Cinnamon Twig) (1 liang) Gancao (Licorice Root) Longgu (Dragon Bone) Muli (Oyster Shell) (each 2 liang, calcined)
The above four ingredients are boiled in 5 sheng of water to obtain 2 sheng of decoction. Strain the dregs and take 0.8 sheng warm, three times daily.
In cold damage disease, the addition of warm needles will inevitably cause fright.
In Taiyang disease lasting six or seven days, if exterior signs persist, the pulse is faint and deep, yet there is no Jie Xiong (Chest Binding) syndrome, and the patient exhibits mania, it is because heat is in the Lower Jiao. If the lower abdomen is hard and full, and urination is spontaneous, healing occurs through the evacuation of blood. This is because Taiyang pathogenic factors follow the meridians into the interior, causing stasis and heat. Evacuation is indicated using Danggui Tang (Dangui Decoction).
In Taiyang disease, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, and urination is obstructed, there is no blood stasis. If urination is spontaneous and the patient resembles mania, blood stasis is confirmed; treat primarily with Danggui Tang (Dangui Decoction).
In cold damage disease with fever and lower abdominal fullness, urination should be obstructed. If urination is instead free, blood stasis is present. Evacuation is required; do not use other medicines, but rather Dihuang Wan (Dihuang Pill).
Danggui Tang Prescription:
Dahuang (Rhubarb Root, broken into six pieces) (2 liang) Taoren (Peach Kernel, skin and tip removed, fried) (20 pieces) Mengchong (Blue Bottle Fly Larva, feet and wings removed, fried) Shuizhi (Leech) (each 30 pieces, fried)
The above four ingredients are boiled in 5 sheng of water to obtain 3 sheng of decoction. Strain the dregs and take 1 sheng warm. If stool is not passed, administer again.
Dihuang Wan Prescription:
Dahuang (Rhubarb Root) (3 liang) Taoren (Peach Kernel, skin and tip removed, fried) (25 pieces) Mengchong (Blue Bottle Fly Larva, feet and wings removed, fried) Shuizhi (Leech) (each 20 pieces, fried)
The above four ingredients are crushed and divided into four pills. Boil one pill in 1 sheng of water to obtain 0.7 sheng. Take this amount. Stool should pass at this time; if not, administer again.
In women with wind-stroke, fever and aversion to cold, with menstruation just beginning, after seven or eight days, when fever subsides, pulse becomes slow, body cools, chest and hypochondrium become full resembling Jie Xiong, and delirium occurs, this is Heat Entering the Blood Chamber. Acupoint Qimen should be needled, applying tonification or reduction according to deficiency or excess.
In women with wind-stroke for seven or eight days, continuing to have alternating chills and fever occurring at specific times, with menstruation just stopping, this is Heat Entering the Blood Chamber. The blood must be congealed, causing symptoms resembling malaria with periodic occurrence. Treat primarily with Xiaochaihu Tang (Minor Bupleurum Decoction) (Prescription see Chapter on Bupleurum Decoctions).
In women with cold damage disease, fever, with menstruation just beginning, who are clear during the day but experience delirium seeing ghosts at night, this is Heat Entering the Blood Chamber. Do not injure Stomach Qi or the Upper and Middle Jiao; self-healing will occur.
In cold damage disease without high fever, with dry mouth, thirst, and vexation, and slight aversion to cold on the back, treat primarily with Baihu Tang (White Tiger Decoction).
In cold damage disease with a floating pulse, fever, and absence of sweat, if the exterior is not resolved, Baihu Tang (White Tiger Decoction) is contraindicated. If there is thirst and desire to drink water without exterior signs, treat primarily with Baihu Tang (White Tiger Decoction).
In cold damage disease with a floating and slippery pulse, indicating exterior heat and interior cold, treat primarily with Baihu Tang (White Tiger Decoction). Prescription:
Zhimu (Anemarrhena Rhizome) (6 liang) Shigao (Gypsum Fibrosum, crushed) (1 jin) Gancao (Licorice Root, honey-fried) (2 liang) Jingmi (Glutinous Rice) (6 he)
The above four ingredients are boiled in 1 dou of water until the rice is cooked and the decoction is ready. Strain the dregs and take 1 sheng warm, three times daily.
Another prescription:
Zhimu (Anemarrhena Rhizome) (6 liang) Shigao (Gypsum Fibrosum, crushed) (1 jin) Gancao (Licorice Root, honey-fried) (2 liang) Renshen (Ginseng Root) (3 liang) Jingmi (Glutinous Rice) (6 he)
The above five ingredients are boiled in 1 dou of water until the rice is cooked and the decoction is ready. Strain the dregs and take 1 sheng warm, three times daily. Use from Start of Summer to Before Start of Autumn. Do not use after Start of Autumn. In spring months, illness often involves interior cold; Baihu Tang is also contraindicated. Administration leads to vomiting, diarrhea, and abdominal pain. It is also contraindicated for those with blood loss or constitutions of deficiency, as it causes abdominal pain and diarrhea. Warmth should be applied instead.
When Taiyang and Shaoyang combined diseases present with spontaneous diarrhea, administer Huangqin Tang (Scutellaria Decoction). If vomiting occurs, administer Huangqin Jia Banxia Shengjiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger).
Huangqin Tang Prescription:
Huangqin (Scutellaria Root) (3 liang) Shaoyao (Peony Root) Gancao (Licorice Root, honey-fried) (each 2 liang) Dazao (Jujube, broken open) (12 pieces)
The above four ingredients are boiled in 1 dou of water to obtain 3 sheng of decoction. Strain the dregs and take 1 sheng warm, twice daily and once at night.
Huangqin Jia Banxia Shengjiang Tang Prescription:
Banxia (Pinellia Tuber, washed) (0.5 sheng) Shengjiang (Fresh Ginger, sliced) (1.5 liang)
Add these two ingredients to the previous prescription.
In cold damage disease, with heat in the chest and pathogenic qi in the stomach, abdominal pain, and desire to vomit, treat primarily with Huanglian Tang (Coptis Decoction). Prescription:
Huanglian (Coptis Rhizome) Gancao (Licorice Root, honey-fried) Jiangzhi (Dried Ginger) Guizhi (Cinnamon Twig) Renshen (Ginseng Root) (each 3 liang) Banxia (Pinellia Tuber, washed) (0.5 sheng) Dazao (Jujube, broken open) (12 pieces)
The above seven ingredients are boiled in 1 dou of water to obtain 6 sheng of decoction. Strain the dregs and divide into five warm doses: three during the day and two at night.
After eight or nine days of cold damage disease, if wind-dampness intertwines, causing severe body pain preventing turning over, without vomiting or thirst, and with hard stool and a floating, tight pulse, treat primarily with Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). If the patient has hard stool and free urination, treat primarily with Shu Fuzi Tang (Atractylodes Macrocephala and Aconite Decoction). Prescription:
Guizhi (Cinnamon Twig) (4 liang) Fuzi (Prepared Aconite Lateral Root) (3 pieces, processed) Shengjiang (Fresh Ginger, sliced) (3 liang) Dazao (Jujube, broken open) (12 pieces) Gancao (Licorice Root, honey-fried) (2 liang)
The above five ingredients are boiled in 6 sheng of water to obtain 2 sheng of decoction. Strain the dregs and divide into three warm doses.
Shu Fuzi Tang Prescription: Remove Guizhi from the previous prescription and add Baizhu (Atractylodes Macrocephala Rhizome) 4 liang. After one dose, if numbness is felt, take the remainder after half a day. The patient may feel dizzy; do not be alarmed. This is due to Fuzi and Baizhu moving together in the skin to expel water qi which has not yet been eliminated. According to protocol, Guizhi 4 liang should be added, but because stool is hard and urination is free, Guizhi is omitted.
If wind-dampness intertwines, causing joint pain and vexation, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, obstructed urination, aversion to wind preferring to keep clothes on, or slight body swelling, treat primarily with Gancao Fuzi Tang (Licorice and Aconite Decoction). Prescription:
Gancao (Licorice Root, honey-fried) (2 liang) Fuzi (Prepared Aconite Lateral Root) (2 pieces, processed) Baizhu (Atractylodes Macrocephala Rhizome) (3 liang) Guizhi (Cinnamon Twig) (4 liang)
The above four ingredients are boiled in 6 sheng of water to obtain 3 sheng of decoction. Strain the dregs and take 1 sheng warm, three times daily. Stop after the first dose if slight sweating occurs. If appetite returns but sweating stops and vexation recurs, take 0.5 sheng. If 1 sheng is considered too much, subsequent doses of 0.6–0.7 sheng are sufficient for cure.
In cold damage disease with knotted and intermittent pulse and palpitations, treat primarily with Zhigancao Tang (Honey-Fried Licorice Decoction). Prescription:
Gancao (Licorice Root, honey-fried) (4 liang) Guizhi (Cinnamon Twig) Shengjiang (Fresh Ginger, sliced) (each 3 liang) Maidong (Ophiopogon Tuber, heart removed) (0.5 sheng) Maziren (Hemp Seed) (0.5 sheng) Renshen (Ginseng Root)
(The text lists "Up to nine flavors" but only lists ingredients up to Renshen explicitly in the count line, implying E'jiao and Ejiao are part of the standard formula context or implied by "na jiao". Based on standard Zhigancao Tang composition found in Shanghan Lun, Ejiao is included. The source text says "Na Jiao" (add gelatin) later.)
The above nine ingredients are boiled in 7 sheng of Qingjiu (Clear Wine) and 8 sheng of water to obtain 3 sheng of decoction. Strain the dregs, add Ejiao (Donkey-hide Gelatin) and melt completely. Take 1 sheng warm, three times daily.