一十六证,方四首
太阳病,或已发热,或未发热,必恶寒,体痛,呕逆,脉阴阳俱紧,为伤寒。
伤寒一日,太阳脉弱,至四日,太阴脉大。
伤寒一日,太阳受之,脉若静者为不传;颇欲呕,若躁烦,脉数急者,乃为传。
伤寒其二阳证不见,此为不传。
太阳病,头痛发热,身体疼,腰痛,骨节疼,恶风,无汗而喘,麻黄汤主之。
太阳与阳明合病,喘而胸满,不可下也,宜麻黄汤。
病十日已去,其脉浮细,嗜卧,此为外解。设胸满胁痛,与小柴胡汤,浮者麻黄汤主之。
太阳病,脉浮紧,无汗而发热,其身疼痛,八九日不解,其表证仍在,此当发其汗。服
药微除,其人发烦,目瞑,增剧者必衄,衄乃解,所以然者,阳气重故也。宜麻黄汤。
脉浮热数者,可发其汗,宜麻黄汤。
伤寒,脉浮紧,不发其汗,因致衄,宜麻黄汤。
脉浮而紧,浮则为风,紧则为寒,风则伤卫,寒则伤荣,荣卫俱病骨节烦疼,可发其汗,
宜麻黄汤。
太阳病下之微喘者,外未解故也,宜麻黄汤(一云桂枝汤。)
麻黄汤方∶
麻黄(去节,三两) 桂枝(二两) 甘草(一两,炙) 杏仁(七十枚,去皮尖两仁
者)
上四味,以水九升,煮麻黄减二升,去上沫,纳诸药,煮取二升半,去滓,温服八合,
覆取微似汗,不须啜粥,余如桂枝法。
太阳病,项背强几几,无汗,恶风,葛根汤主之。方∶
葛根(四两) 麻黄(三两,去节) 桂枝 芍药 甘草(炙,各二两) 生姜(三两,
切)
大枣(十一枚,擘)
上七味,以水一斗,煮麻黄葛根减二升,去上沫,纳诸药,煮取三升,去滓,分温三服
。不须与粥取微汗。
太阳与阳明合病而自利,葛根汤主之(用上方,一云用后葛根黄芩黄连汤。)
不下利但呕,葛根加半夏汤主之。葛根汤中加半夏半升,洗即是。
太阳病,桂枝证,医反下之,遂利不止,其脉促,表未解,喘而汗出,宜葛根黄芩黄连
汤方∶
葛根(半斤) 甘草(二两,炙) 黄芩 黄连(各三两)
上四味,以水八升,先煮葛根减二升,纳诸药煮取二升,去滓,分温再服。
十六种证候,对应四个方剂。
太阳病,有的已经发热,有的尚未发热,必定伴有恶寒,身体疼痛,呕吐气逆,寸关尺三部脉象都紧,这是伤寒。
伤寒第一天,太阳经的脉象微弱;到了第四天,太阴经的脉象变大。
伤寒第一天,邪气侵犯太阳经,如果脉象平静(没有变化),说明病邪没有传变;如果病人很想呕吐,或者出现烦躁不安,脉象变得数而急促,这才是病邪发生了传变。
太阳病,头痛、发热,身体疼痛,腰痛,骨节疼痛,怕风,无汗且气喘,用麻黄汤主治。
太阳经与阳明经同时发病(合病),出现气喘且胸部胀满,不可使用泻下法,适宜用麻黄汤。
患病十天以上,脉象浮而细,想睡觉,这说明表邪已解。如果此时出现胸满胁痛,用小柴胡汤;如果脉仍浮,用麻黄汤主治。
太阳病,脉象浮紧,无汗且发热,身体疼痛,经过八九天仍未痊愈,表证依然存在,这应当发汗治疗。服药后症状轻微缓解,但病人感到心烦,眼睛闭合不想睁开,病情反而加重者,一定会流鼻血,鼻血流出后病才会解除,之所以这样,是因为阳气郁闭过重的缘故。适宜用麻黄汤。
脉象浮而紧,浮代表风邪,紧代表寒邪,风邪伤害卫气,寒邪伤害营血,营卫两伤导致骨节烦扰疼痛,可以发汗,适宜用麻黄汤。
太阳病误用泻下法后出现轻微气喘,这是因为表邪未解的缘故,适宜用麻黄汤(另一种说法是用桂枝汤)。
麻黄汤方:
麻黄(去掉节,三两) 桂枝(二两) 甘草(一两,蜜炙) 杏仁(七十枚,去皮尖,双仁者)
以上四味药,用水九升,先煮麻黄,减少二升水,去掉水面上的浮沫,加入其余药物,煮取二升半药液,去渣,温服八合,服药后覆盖衣被使身体微微出汗,不需要喝热粥助汗,其余护理方法参照桂枝汤法。
太阳病,项背部僵硬拘急不舒,无汗,怕风,用葛根汤主治。方剂如下:
葛根(四两) 麻黄(三两,去掉节) 桂枝 芍药 甘草(蜜炙,各二两) 生姜(三两,切片)
大枣(十一枚,掰开)
以上七味药,用水一斗,先煮麻黄和葛根,减少二升水,去掉水面上的浮沫,加入其余药物,煮取三升药液,去渣,分三次温服。不需要喝热粥来取微汗。
太阳经与阳明经同时发病并出现自发性腹泻,用葛根汤主治(使用上方,另一种说法是用下方的葛根黄芩黄连汤)。
不下利只呕吐的,用葛根加半夏汤主治。即在葛根汤中加入半夏半升,洗净即可。
太阳病,本应属于桂枝汤证,医生反而误用泻下法,导致腹泻不止,脉象急促,表证未解,气喘且出汗,适宜用葛根黄芩黄连汤方:
葛根(半斤) 甘草(二两,蜜炙) 黄芩 黄连(各三两)
以上四味药,用水八升,先煮葛根,减少二升水,加入其余药物,煮取二升药液,去渣,分两次温服。
Sixteen syndromes, corresponding to four prescriptions.
Taiyang disease (Disease of the Taiyang Channel), whether fever has already appeared or not, must be accompanied by aversion to cold, body pain, vomiting and regurgitation, and a tight pulse at all three positions (Cun, Guan, Chi). This is Cold Damage (Shanghan).
On the first day of Cold Damage, the Taiyang pulse is weak; by the fourth day, the Taiyin pulse becomes large.
On the first day of Cold Damage, when the pathogen invades the Taiyang channel, if the pulse remains tranquil (unchanged), it indicates that the disease has not transmitted; if the patient desires to vomit frequently, or exhibits restlessness and irritability, and the pulse becomes rapid and urgent, then transmission has occurred.
If the manifestations of other Yang channels do not appear after Cold Damage, this indicates that the disease has not transmitted.
In Taiyang disease, with headache, fever, body pain, lower back pain, joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, Mahuang Tang (Ephedra Decoction) is the primary treatment.
When Taiyang and Yangming channels are involved simultaneously (Combined Disease), presenting with wheezing and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate.
Ten days or more after illness onset, if the pulse is floating and fine, and the patient feels drowsy, this indicates that the exterior pathogen has resolved. If chest fullness and hypochondriac pain occur subsequently, Xiaochaihu Tang (Minor Bupleurum Decoction) should be used; if the pulse remains floating, Mahuang Tang (Ephedra Decoction) is the primary treatment.
In Taiyang disease, with a floating and tight pulse, anhidrosis, fever, and body pain persisting for eight or nine days without resolution, if the exterior syndrome still exists, diaphoresis (sweating therapy) should be induced. After taking the medicine, if symptoms slightly alleviate but the patient becomes irritable, keeps eyes closed, and the condition worsens, epistaxis (nosebleed) will likely occur, and the disease will resolve upon bleeding. This occurs because of excessive retention of Yang Qi. Mahuang Tang (Ephedra Decoction) is appropriate.
For those with a floating pulse, obvious heat signs, and rapid pulse rate, diaphoresis can be induced; Mahuang Tang (Ephedra Decoction) is appropriate.
In Cold Damage, with a floating and tight pulse, if diaphoresis is not performed in time leading to epistaxis, Mahuang Tang (Ephedra Decoction) is appropriate.
A floating and tight pulse indicates floating represents Wind pathogen and tight represents Cold pathogen. Wind injures the Defensive Qi (Wei Qi), and Cold injures the Nutritive Qi (Ying Qi). When both Ying and Wei are diseased, causing severe bone and joint pain, diaphoresis can be induced; Mahuang Tang (Ephedra Decoction) is appropriate.
If Taiyang disease is incorrectly treated with purgation resulting in slight wheezing, it is because the exterior pathogen has not resolved; Mahuang Tang (Ephedra Decoction) is appropriate (another view suggests Guizhi Tang).
Mahuang Tang Prescription:
Ephedrae Herba (Mahuang, Ephedra Stem) - remove nodes, 3 liang
Cinnamomi Ramulus (Guizhi, Cinnamon Twig) - 2 liang
Glycyrrhizae Radix et Rhizoma (Gancao, Licorice Root) - 1 liang, honey-fried
Pruni Semen Armeniacae Amarum (Xingren, Apricot Seed) - 70 seeds, remove skin and sharp ends, use double-kernel seeds
The above four ingredients are boiled in 9 sheng of water. First boil Ephedra until reduced by 2 sheng, skim off the foam on the surface, then add the remaining herbs. Boil until 2.5 sheng remains, strain, and take 8 he of the decoction warm. Cover with blankets to induce a slight sweat. There is no need to drink hot porridge to assist sweating. Other care instructions follow the method for Guizhi Tang.
For Taiyang disease presenting with stiffness and rigidity of the neck and back (Jinjin), anhidrosis, and aversion to wind, Gegen Tang (Kudzu Decoction) is the primary treatment. Prescription:
Puerariae Lobatae Radix (Gegen, Kudzu Root) - 4 liang
Ephedrae Herba (Mahuang, Ephedra Stem) - 3 liang, remove nodes
Cinnamomi Ramulus (Guizhi, Cinnamon Twig)
Paeoniae Radix Alba (Shaoyao, White Peony Root)
Glycyrrhizae Radix et Rhizoma (Gancao, Licorice Root) - honey-fried, 2 liang each
Zingiberis Recens Rhizoma (Shengjiang, Fresh Ginger) - 3 liang, sliced
Jujubae Fructus (Dazao, Jujube) - 11 pieces, split open
The above seven ingredients are boiled in 1 dou of water. First boil Ephedra and Kudzu until reduced by 2 sheng, skim off the foam, then add the remaining herbs. Boil until 3 sheng remains, strain, and divide into three warm doses. There is no need to drink porridge to induce a slight sweat.
When Taiyang and Yangming channels are involved simultaneously with spontaneous diarrhea, Gegen Tang (Kudzu Decoction) is the primary treatment (use the above prescription; another view suggests Gegen Huangqin Huanglian Tang).
If there is no diarrhea but only vomiting, Gegen Banxia Tang (Kudzu and Pinellia Decoction) is the primary treatment. Add half a sheng of Pinelliae Rhizoma (Banxia, Pinellia Tuber) washed clean to the Gegen Tang formula.
In Taiyang disease, where the pattern corresponds to Guizhi Tang, if the physician incorrectly uses purgation, resulting in incessant diarrhea, a hurried pulse, unresolved exterior syndrome, wheezing, and sweating, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) is appropriate:
Puerariae Lobatae Radix (Gegen, Kudzu Root) - 8 liang (half jin)
Glycyrrhizae Radix et Rhizoma (Gancao, Licorice Root) - honey-fried, 2 liang
Scutellariae Radix (Huangqin, Scutellaria Root)
Coptidis Rhizoma (Huanglian, Coptis Rhizome) - 3 liang each
The above four ingredients are boiled in 8 sheng of water. First boil Kudzu until reduced by 2 sheng, then add the remaining herbs. Boil until 2 sheng remains, strain, and divide into two warm doses.