【纲】仲景曰。大病瘥后。从腰以下有水气者。牡蛎泽泻汤主之。
大病瘥后。喜唾。久不了了者。胃上有寒。当以丸药温之。宜理中丸。伤寒解后。虚羸少气。
气逆欲吐者。竹叶石膏汤主之。病患脉已解。而日暮微烦。以病新瘥。人强与谷。脾胃气弱。不能
消谷。故令微烦。损谷则愈。
【目】成无己曰。瘥后脾胃虚。不能制约肾水。归于隧道。故水溢下焦。腰以下为肿也。
王肯堂曰。千金方瘥后口干喜唾或咽痛。用大枣十枚。乌梅三个。共捣。蜜丸。枣核大。含口
中。徐徐咽下。或咽痛不愈者。以山豆根凉水浸含。
庞安常曰。解后津液不足而虚羸。余热未尽。热则伤气。故少气而气逆。与竹叶石膏。所以散
热调胃也。
阳明旺于申酉戌。宿食在胃。故日暮微烦。当小下之。以消宿谷。只用栀豉汤。痞硬。加枳实。
鳌按。以上水气喜唾欲吐微烦四症。皆仲景书所载。但瘥后病正多。如王氏肯堂补遗十四症。
皆瘥后所常患者。今特采之。条附于后。并录陶节庵瘥后症二条。
一、惊悸 伤寒后虚羸。心气乏。力弱。惊悸。多忘。茯神散。伤寒后伏热在心。心虚惊悸。
龙齿丸。瘥后心胆虚怯。触事易惊。梦寐不安。气郁生涎。涎与气搏。变生诸症。或短气困乏。或
自汗盗汗。四肢浮肿。饮食无味。心虚烦闷。坐卧不安。加味
温胆汤。
一、烦热 瘥后夹劳者。心烦热。背膊疼痛。手足无力。不能饮食。柴胡汤。
一、虚汗 瘥后虚羸。盗汗不止。四肢无力。向晚憎寒。鳖甲散。瘥后虚羸。日夜汗出不止。心
躁口干。咽喉不利者。黄雄鸡汤。
一、喘嗽 瘥后肺痿劳嗽。唾脓血腥臭。连连不止。渐将羸瘦。紫菀散。
一、梦泄 瘥后虚损。心多怔悸。夜梦泄精。牡蛎散。伤寒夜梦。精泄不禁。身体枯燥。瘦瘠
骨立者。羚羊角散。
一、失音 伤寒失音不语。二沥汤。
一、呕哕 瘥后虚羸少力。呕哕气逆。人参汤。
一、下利 瘥后脓血痢。下部疼痛。诃黎勒饮。伤寒热病。热毒下利脓血。黄连丸。大小便
自利。腹中痛者。燥肠丸。
一、腰痛 伤寒汗吐下后。体虚。元脏积冷。气刺腰痛。难于转动。杜仲酒。外贴蚕蛾膏。
一、不眠 瘥后虚烦不眠。栀子乌梅汤。
一、遗毒 瘥后汗出不彻。邪热结耳后一寸二三分。或耳下俱肿硬者。名曰发颐。此为遗热成
毒之所致也。宜速消散之。若缓则成脓为害。初起。宜连翘败毒散。外敷。消毒救苦散。已破。内托
消毒散。未破亦可服。
一、昏冒 伤寒汗出愈后。渐觉昏昏不省。如鬼祟之状。或错语呻吟者。此因汗出未尽。邪热
伏于心包所致。活人用知母麻黄汤以汗之。但虑病后血气空虚。岂可发汗。若脉弱人。宜十味温胆
汤。加黄连主之。若有寒热潮热。日晡发热者。小柴胡汤随症增损治之。
一、发豌豆疮 千金方治豌豆疮。只以酒炒黄连一味。水煎服。外以赤小豆末。加青黛。用鸡
子清和涂。神效。
一、瘥后虚弱治例伤寒新瘥后虚弱。盗汗不止。当归六黄汤。阳虚无热。恶寒。盗汗无力。下虚者。
加味黄 建中汤。瘥后阴虚。精血不足。四肢少力。心神不宁。夜梦遗泄。或虚热盗汗。饮食少
进。不为肌肉。身体羸弱。面色青黄无血色。滋阴补肾丸。或加味补阴丸。亦可。瘥后心神不安。
夜卧不宁。或多梦不眠。朱砂安神丸。瘥后胃弱食少。加味枳术丸。瘥后脾胃虚弱。不思饮食。养
脾汤。纵食不能消化者。健脾散。或六君子汤亦可。
[General Principles] Zhang Zhongjing stated: After a major illness has subsided, if there is fluid retention (Shui Qi) below the waist, Muli Zexie Tang (Oyster Shell and Alisma Decoction) should be administered.
After a major illness has subsided, if the patient frequently spits saliva and this condition persists for a long time without resolution, it indicates cold in the stomach (Wei Shang You Han). It should be treated with pills to warm the interior; Lizhong Wan (Regulate the Middle Pill) is appropriate.
After the exterior syndrome of Cold Damage (Shanghan) has resolved, if the patient presents with emaciation and shortness of breath (Xu Lei Shao Qi), and rebellious Qi causing nausea or vomiting, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be administered.
If the patient's pulse has returned to normal, but they experience slight irritability towards evening, it is because the disease has just subsided, and people have forced them to eat. The Qi of the Spleen and Stomach is weak and unable to digest food, thus causing slight irritability. Reducing food intake will lead to recovery.
[Commentaries] Cheng Wuji stated: After the illness subsides, the Spleen and Stomach are deficient and cannot control Kidney Water. The water flows into the collaterals and channels, overflowing into the Lower Jiao, resulting in edema below the waist.
Wang Kentang stated: In *Qianjin Fang*, for post-illness dry mouth, frequent spitting, or sore throat, ten large dates and three sour plums are crushed together, formed into honey pills the size of date pits, held in the mouth, and slowly swallowed. If the sore throat does not heal, Sophora root (Shandougen) soaked in cool water can be held in the mouth.
Pang Anchang stated: After the resolution of Cold Damage, fluid and essence are insufficient, leading to emaciation. Residual heat remains; heat injures Qi, causing shortness of breath and rebellious Qi. Zhuye Shigao Tang is given to dissipate heat and regulate the Stomach.
The Yangming channel is vigorous during the Shen, You, and Xu hours (3 PM to 9 PM). If retained food is in the Stomach, slight irritability occurs towards evening. A mild purgation should be used to eliminate the retained grain. Only Chizhi Tang (Gardenia and Fermented Soybean Decoction) should be used. If there is fullness and hardness, add Zhishi (Immature Bitter Orange).
Shen Jin'ao noted: The four symptoms mentioned above—fluid retention, frequent spitting, desire to vomit, and slight irritability—are all recorded in Zhang Zhongjing's writings. However, there are many conditions after illness subsides. For instance, the fourteen supplementary cases by Wang Kentang are common post-illness conditions. I have specifically selected these and listed them item by item below, along with two cases of post-illness symptoms from Tao Jian'an.
1. Palpitations and Fright: After Cold Damage, due to emaciation, deficiency of Heart Qi, and weakness, palpitations and fright occur, along with forgetfulness. Fushen San (Poria Powder) is used. If latent heat resides in the Heart after Cold Damage, causing Heart deficiency and palpitations, Longchi Wan (Dragon Bone Pill) is used. After illness subsides, if the Heart and Gallbladder are deficient and timid, easily frightened by events, with restless sleep, Qi stagnation generates phlegm-fluids, which contend with Qi, transforming into various symptoms such as shortness of breath, fatigue, spontaneous sweating, night sweats, edema of the four limbs, loss of taste, mental restlessness, and inability to sit or lie comfortably, Jiawei Wendan Tang (Modified Warm the Gallbladder Decoction) is used.
2. Irritable Heat: If post-illness is complicated by consumptive fatigue, causing mental irritability and heat, pain in the back and shoulders, weakness in the hands and feet, and inability to eat, Chaihu Tang (Bupleurum Decoction) is used.
3. Deficient Sweating: Post-illness emaciation with incessant night sweats, weakness in the four limbs, and aversion to cold towards evening, using Biejia San (Turtle Shell Powder). Post-illness emaciation with day and night incessant sweating, mental agitation, dry mouth, and unsmooth throat, using Huangxiongji Tang (Yellow雄 Chicken Decoction).
4. Wheezing and Cough: Post-illness Lung萎 (Lung Flaccidity) and consumptive cough, expectorating pus and blood with a foul odor continuously, gradually becoming emaciated, using Ziwan San (Aster Powder).
5. Nocturnal Emission: Post-illness deficiency with frequent palpitations and nocturnal emissions in dreams, using Lishu San (Oyster Shell Powder). After Cold Damage, nocturnal emissions in dreams without control, with a dry body and extreme emaciation, using Lingyangjiao San (Antelope Horn Powder).
6. Loss of Voice: Loss of voice and inability to speak after Cold Damage, using Erli Tang (Two Pours Decoction).
7. Vomiting and Hiccups: Post-illness emaciation and weakness with vomiting, hiccups, and rebellious Qi, using Renshen Tang (Ginseng Decoction).
8. Diarrhea: Post-illness dysentery with pus and blood and lower body pain, using Helile Yin (Terminalia Drink). In Cold Damage febrile diseases, heat-toxin causing diarrhea with pus and blood, using Huanglian Wan (Coptis Pill). If urination and defecation are free, but abdominal pain exists, using Zaochang Wan (Dry Intestine Pill).
9. Lower Back Pain: After Cold Damage treated with sweating, vomiting, or purging, the body is deficient, and the Yuan Organ accumulates cold, causing stabbing lower back pain difficult to turn, using Duzhong Jiu (Eucommia Wine). Externally apply Can'e Gao (Silkworm Moth Plaster).
10. Insomnia: Post-illness mental restlessness and insomnia, using Zhizi Wumei Tang (Gardenia and Sour Plum Decoction).
11. Residual Toxins: If post-illness sweating is incomplete, pathogenic heat knots one cun two fen to three fen behind the ear, or both sides of the ear become swollen and hard, it is called "Fa Yi" (Opening the Cheek). This is caused by residual heat forming toxins. It should be dissipated quickly; otherwise, it will suppurate and cause harm. At the onset, use Liaoqiao Baidu San (Forsythia Detoxification Powder) internally and Xiaodu Jiuku San (Detoxification and Salvation Powder) externally. If already ruptured, use Neituo Xiaodu San (Internal Support and Detoxification Powder); it can also be taken before rupture.
12. Confusion and Dizziness: After Cold Damage resolves with sweating, if the patient gradually feels dizzy and unconscious, resembling possession, or speaks confusedly and groans, it is because sweating was incomplete and pathogenic heat lies hidden in the Pericardium. *Ren Shu* uses Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction) to induce sweating. However, considering the emptiness of Blood and Qi after illness, how can sweating be induced? For those with a weak pulse, Shiwei Wendan Tang (Ten-Ingredient Warm the Gallbladder Decoction) added with Huanglian is appropriate. If there is alternating chills and fever, or tidal fever at dusk (You hour), Xiao Chaihu Tang (Minor Bupleurum Decoction) should be modified according to symptoms.
13. Smallpox-like Rash: *Qianjin Fang* treats smallpox-like rashes using only wine-fried Huanglian (Coptis), decocted in water. Externally, mix Chi Xiaodou powder (Adzuki Bean) with Qingdai (Indigo Naturalis) and chicken egg white for application, which is miraculous.
14. Treatment Examples for Post-Illness Weakness: After recent recovery from Cold Damage, if weak with incessant night sweats, use Danggui Liuhuang Tang (Angelica Six-Yellow Decoction). If Yang deficiency without heat, aversion to cold, weak night sweats, and lower Jiao deficiency, use Jiawei Huangqi Jianzhong Tang (Modified Astragalus Establish the Middle Decoction). If post-illness Yin deficiency with insufficiency of Essence and Blood, weakness in four limbs, restless mind, nocturnal emissions in dreams, or deficient heat night sweats, poor appetite, failure to gain flesh, emaciation, and sallow complexion without luster, use Ziyin Bushen Wan (Nourish Yin Tonify Kidney Pill) or Jiawei Buyin Wan (Modified Nourish Yin Pill). If post-illness mental unrest, restless sleep, or excessive dreaming and insomnia, use Zhusha Anshen Wan (Cinnabar Calming Spirit Pill). If post-illness weak Stomach and poor appetite, use Jiawei Zhizhu Wan (Modified Immature Bitter Orange and Atractylodes Pill). If post-illness Spleen and Stomach deficiency with no desire to eat, use Yangpi Tang (Nourish Spleen Decoction). If food cannot be digested even when eaten, use Jianpi San (Strengthen Spleen Powder) or Liujunzi Tang (Six-Gentleman Decoction).