九证 方四首
发汗后,恶寒者,虚故也;不恶寒,但热者,实也,当和其胃气,宜小承气汤。
太阳病未解,其脉阴阳俱停,必先振,汗出而解,但阳微者,先汗出而解,阴微者,先
下之而解,宜承气汤。(一云大柴胡汤。)
伤寒十三日,过经而谵语,内有热也,当以汤下之。小便利者,大盒饭坚,而反利,其
脉调和者,知医以丸药下之,非其治也,自利者,其脉当微厥。今反和者,此为内实,宜承
气汤。
太阳病,过经十余日,心下温温欲吐,而胸中痛,大便反溏,其腹微满,郁郁微烦,先
时自极吐下者,宜承气汤。
二阳并病,太阳证罢,但发潮热,手足 汗出,大便难,谵语者,下之愈,宜承气汤
太阳病三日,发其汗不解,蒸蒸发热者,调胃承气汤主之。
伤寒吐后,腹满者,承气汤主之。
太阳病,吐下发汗后,微烦,小便数,大便因坚,可与小承气汤和之则愈。
承气汤方∶
大黄(四两) 浓朴(八两,炙) 枳实(五枚,炙) 芒硝(三合)
上四味,以水一斗,先煮二味,取五升,纳大黄,更煮取二升,去滓,纳芒硝,更煎一
沸,分再服,得下者止。
又方∶
大黄(四两) 浓朴(二两,炙) 枳实(大者三枚,炙)
上三味,以水四升,煮取一升二合,去滓,温分再服,初服谵语即止,服汤当更衣,不
尔尽服之。
又方∶
大黄(四两) 甘草(二两,炙) 芒硝(半两)
上三味,以水三升,煮取一升,去滓,纳芒硝,更一沸,顿服。
太阳病,不解,热结膀胱,其人如狂,血自下,下者即愈。其外不解,尚未可攻,当先
解其外。外解,少腹急结者,乃可攻之,宜桃核承气汤。方
桃仁(五十枚,去皮尖) 大黄(四两) 桂枝(二两) 甘草(二两,炙) 芒硝(一
两)
上五味,以水七升,煮取二升半,去滓,纳芒硝,更煎一沸,分温三服。
九种证候,四首方剂
发汗治疗后,如果感到恶寒,这是虚证的表现;如果不恶寒,只发热,这是实证的表现,应当调和胃气,适宜使用小承气汤。
太阳病尚未解除,脉象的寸部和尺部都暂时隐伏不见(阴阳俱停),病人必定先出现战栗,随后出汗而病解。如果是阳脉微,先通过发汗使病解;如果是阴脉微,先通过泻下使病解,适宜使用承气汤。(另一种说法是大柴胡汤。)
伤寒病程超过十三天,经过传变后出现谵语,说明体内有热,应当用汤药攻下。如果小便通畅,大便本该干结,反而稀溏,且脉象调和,可知是医生误用了丸药攻下,这不是正确的治法。如果是自发性腹泻,脉象应当微弱或四肢厥冷。现在脉象反而调和,这说明体内有实邪积滞,适宜使用承气汤。
太阳病,病程超过十余日,心中泛恶欲吐,胸部疼痛,大便反而稀溏,腹部轻微胀满,情绪抑郁且轻微烦躁,这是因为先前被剧烈地催吐或泻下所致,适宜使用承气汤。
二阳并病(太阳与阳明合病),太阳证的表证已罢,只出现潮热,手足出汗,大便困难,谵语,应当使用泻下法治疗,适宜使用承气汤。
太阳病三天,发汗后病未解,身体蒸蒸发热,应当以调胃承气汤为主治方。
太阳病,经过催吐、泻下、发汗治疗后,出现轻微烦躁,小便频数,大便因此干结,可以给予小承气汤调和,即可痊愈。
承气汤方:
大黄(四两) 厚朴(八两,炙烤) 枳实(五枚,炙烤) 芒硝(三合)
以上四味药,用水一斗,先煮厚朴和枳实两味药,取汁五升,加入大黄,再煮取汁二升,滤去药渣,加入芒硝,再煮沸一次,分两次服用,若已通便则停止服用。
又一方:
大黄(四两) 厚朴(二两,炙烤) 枳实(大的三枚,炙烤)
以上三味药,用水四升,煮取汁一升二合,滤去药渣,温服,分两次服用。初次服用后谵语即止,服药后应当排便,若不排便则服完剩余药液。
又一方:
大黄(四两) 甘草(二两,炙烤) 芒硝(半两)
以上三味药,用水三升,煮取汁一升,滤去药渣,加入芒硝,再煮沸一次,一次性顿服。
太阳病,病邪未解,热邪结聚于膀胱,病人神志如狂,若瘀血自行排出,排出后即愈。如果表证仍未解除,尚不可攻里,应当先解表。表证解除后,若少腹拘急结痛,才可以攻逐瘀血,适宜使用桃核承气汤。方剂如下:
桃仁(五十枚,去皮尖) 大黄(四两) 桂枝(二两) 甘草(二两,炙烤) 芒硝(一两)
以上五味药,用水七升,煮取汁二升半,滤去药渣,加入芒硝,再煮沸一次,分三次温服。
Nine Syndromes, Four Prescriptions
After inducing sweating, if the patient experiences aversion to cold, it is due to deficiency; if there is no aversion to cold but only fever, it is due to excess. One should harmonize the Stomach Qi (Stomach Energy), and Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated.
In Taiyang disease (Disease of the Taiyang/Bladder Channel) that has not yet resolved, if the pulse at both the Cun (distal) and Chi (proximal) positions becomes imperceptible (Yin and Yang pulses both stop), the patient will first experience chills and tremors, followed by sweating, after which the disease resolves. If the Yang pulse (Cun position) is faint, resolution comes first through sweating; if the Yin pulse (Chi position) is faint, resolution comes first through purgation. Chengqi Tang (Order the Qi Decoction) is indicated. (Another version suggests Da Chaihu Tang (Major Bupleurum Decoction).)
In Shanghan (Cold Damage) lasting thirteen days, after the pathogen has passed its original stage and delirium occurs, it indicates internal heat. One should use a decoction to purge. If urination is free and clear, the stool should normally be hard; if it is instead loose, and the pulse is harmonious, it is known that the physician mistakenly used pill-based purgatives, which was not the correct treatment. In spontaneous diarrhea, the pulse should be faint or accompanied by cold extremities. Since the pulse is now harmonious, this indicates internal excess (accumulation of pathogens), and Chengqi Tang is indicated.
In Taiyang disease, after more than ten days, if the patient feels nauseous with an urge to vomit, suffers from chest pain, has loose stools, slight abdominal fullness, depression, and mild irritability, it is because they were previously subjected to extreme vomiting or purging. Chengqi Tang is indicated.
In Bing (Combined Disease) of two Yang channels (Taiyang and Yangming), when the Taiyang syndrome has ceased, but tidal fever (fever that rises at specific times), sweating on the hands and feet, difficulty in defecation, and delirium occur, purgation will cure it. Chengqi Tang is indicated.
In Taiyang disease, after three days of treatment with sweating, if the disease does not resolve and the patient experiences steaming fever (heat radiating from within), Tiaowei Chengqi Tang (Harmonizing the Stomach Order the Qi Decoction) is the primary prescription.
After vomiting in Shanghan (Cold Damage), if abdominal fullness occurs, Chengqi Tang is the primary prescription.
In Taiyang disease, after vomiting, purging, and sweating, if there is mild irritability, frequent urination, and consequently hard stools, Xiao Chengqi Tang (Minor Order the Qi Decoction) may be given to harmonize the condition, leading to recovery.
Chengqi Tang Prescription:
Dahuang (Rhubarb Root, 4 liang) Houpo (Magnolia Bark, 8 liang, stir-fried) Zhishi (Immature Bitter Orange, 5 pieces, stir-fried) Mangxiao (Mirabilite, 3 he)
Take the above four herbs, add one dou (approx. 10 liters) of water, first boil Houpo and Zhishi, reduce to five sheng (approx. 5 liters), add Dahuang, boil further to obtain two sheng, strain, add Mangxiao, boil once more, divide into two doses. Stop taking if defecation occurs.
Another Prescription:
Dahuang (Rhubarb Root, 4 liang) Houpo (Magnolia Bark, 2 liang, stir-fried) Zhishi (Immature Bitter Orange, 3 large pieces, stir-fried)
Take the above three herbs, add four sheng of water, boil to obtain one sheng and two he, strain, take warm, divided into two doses. Delirium stops after the first dose. Defecation should follow; if not, consume the remainder.
Another Prescription:
Dahuang (Rhubarb Root, 4 liang) Gancao (Licorice Root, 2 liang, stir-fried) Mangxiao (Mirabilite, 0.5 liang)
Take the above three herbs, add three sheng of water, boil to obtain one sheng, strain, add Mangxiao, boil once more, take all at once.
In Taiyang disease, if the pathogen remains unresolved and heat binds in the Bladder, the patient may appear manic. If blood discharges spontaneously, the disease resolves upon discharge. If the exterior syndrome has not yet resolved, attack from the interior is not yet appropriate; one must first resolve the exterior. Once the exterior is resolved, if there is urgency and binding pain in the lower abdomen, then attack the interior. Taohe Chengqi Tang (Peach Kernel Order the Qi Decoction) is indicated. Prescription:
Tao Ren (Peach Seed, 50 pieces, skin and tip removed) Dahuang (Rhubarb Root, 4 liang) Guizhi (Cinnamon Twig, 2 liang) Gancao (Licorice Root, 2 liang, stir-fried) Mangxiao (Mirabilite, 1 liang)
Take the above five herbs, add seven sheng of water, boil to obtain two sheng and half, strain, add Mangxiao, boil once more, divide into three warm doses.