伤寒阴阳易之为病。其人身体重。少气。少腹里急。或引阴中拘挛。热上冲胸。头重不欲举。眼中生花。
（【原注】花。一作眵。）膝胫拘急者。烧 散主之。（花下。玉函。有眼胞赤三字。千金翼。作痂胞赤花。
巢源。作眯。）
〔成〕大病新瘥。血气未复。余热未尽。强合阴阳得病者。名曰易。男子新病瘥未平复。而妇人与之交
得病。名曰阳易。妇人新病瘥未平复。男子与之交得病。名曰阴易。（案以上。出巢源。）以阴阳相感动。其
余毒相染着。如换易也。其人病身体重。少气者。损动真气也。少腹里急。引阴中拘挛。膝胫拘急。阴气极也。
热上冲胸。头重不欲举。眼中生花者。感动之毒。所易之气。熏蒸于上也。与烧 散。以道阴气。〔钱〕男女
一交之后。自然元气空虚。余邪错杂于精气之中。走入精隧。溢入经络。乘其交后虚隙之中。入而浸淫于脏腑
筋骨脉络俞穴之间。则正气因邪而益虚。邪气因虚而益盛。故有此阴盛阳衰之诸证也。邪入阴经。身体必重。
真阳亏损。三焦不运。宗气不行。所以少气。邪从阴窍。而溜入少阴厥阴。故少腹里急。若里急之甚。或引阴
中拘挛。皆阴邪之所致也。阴邪在下。而虚阳上走。故热上冲胸。头重不欲举。眼中生花。下焦虚冷。所以膝
胫拘急也。此真所谓阴阳之患。故以烧 散主之。
肘后方。两男两女。并不自相易。则易之为名。阴阳交换之谓也。
方云。伤寒。包中风而言也。易犹交易变易之易。言大病新瘥。血气未复。强合阴阳。则二气交感。互
相换易。而为病也。
烧 散方
妇人中 近隐处。取烧作灰。
上一味。水服方寸匕。日三服。小便即利。阴头微肿。此为愈矣。妇人病。取男子 烧服。（成本。玉函。
作上取妇人中 近隐处。剪烧灰。以水和服方寸匕。日三服。小便即利。阴头微肿则愈。妇人病。取男子剪当烧灰。）
〔钱〕男女之交媾。易所谓二气感应。以相与也。以未净之邪。随交合之情。精神魂魄。无不动摇。翕然
而感。感而遂通。混入于少阴之里。故以近隐处之 裆。引出其阴中之邪。所谓物从其类。同气相求之义也。
〔鉴〕男女 裆。浊败之物也。烧灰用者。取其通散。亦同气相求之义耳。服后或汗出。或小便利则愈。阴头
微肿者。是所易之毒。从阴窍而出。故肿也。
伤寒蕴要曰。阴阳易。仲景治以烧 散。活人书。以 鼠屎汤。栝蒌根竹茹汤。竹皮汤。当归白术散之类
主之。易老分寒热而治。若伤在少阴肾经。有寒无热者。以附子汤。调下烧 散。若伤在厥阴肝经者。以当归
四逆汤。加吴茱萸附子。送下烧 散主之。如有热者。以鼠屎竹茹汤之类。送下烧 散主之。要在审察脉症。
分其冷热而治矣。
阴证略例曰。若阴阳易。果得阴脉。当随证用之。若脉在厥阴。当归四逆汤。送下烧 散。若脉在少阴。
通脉四逆汤。送下烧 散。若脉在太阴。四顺理中丸。送下烧 散。
证治准绳曰。尝治伤寒病未平复。犯房室。命在须臾。用独参汤。调烧 散。凡服参一二斤余。得愈者三四人。
信哉。用药不可执一也。
大病瘥后。劳复者。枳实栀子汤主之。
〔钱〕凡大病新瘥。真元大虚。气血未复。精神倦怠。余热未尽。但宜安养。避风节食。清虚无欲。则元
气日长。少壮之人。岂惟复旧而已哉。若不知节养。必犯所禁忌。而有劳复女劳复食复饮酒复剧诸证矣。夫劳
复者。如多言多虑。多怒多哀。则劳其神。梳洗澡浴。早坐早行。则劳其力。皆可令人重复发热。如死灰之复
燃。为重复之复。故谓之复。但劳复之热。乃虚热之从内发者。虽亦从汗解。然不比外感之邪。可从辛温发散
取汗也。故以枳实栀子豉汤主之。惟女劳复。虽为劳复之一。而其见证危险。治法迥别。多死不救。所以吴绶
谓前人有大病新瘥。如大水浸墙。水退墙苏。不可轻犯之喻也。〔喻〕劳复。乃起居作劳。复生余热之病。方
注作女劳复。大谬。
病源候论曰。伤寒病新瘥。津液未复。血气尚虚。若劳动早。更复成病。故云复也。若言语思虑。则劳神。
梳头澡洗则劳力。劳则生热。热气乘虚。还入经络。故复病也。又大病之后。脾胃尚虚。谷气未复。若食猪肉
肠血肥鱼。及久腻物。必大下利。医所不能治也。必至于死。若食饼KT 黍饴 炙脍枣栗诸果脯物。及牢强难
消之物。胃气虚弱。不能消化。必更结热。适以药下之。则胃虚冷。大利难禁。不可下之。必死。下之亦危。
皆难救也。
枳实栀子汤方。（○成本。玉函。子下。有豉字。）
枳实（三枚炙） 栀子（十四个擘） 豉（一升绵裹）
上三味。以清浆水七升。空煮取四升。纳枳实栀子。煮
取二升。下豉。更煮五六沸。去滓。温分再服。覆令微似汗。若有宿食者。纳大黄如博棋子。五六枚。服之愈。
（清浆水。千金。作酢浆。千金翼同。空煮取四升。玉函。作空煎减三升。纳大黄。成本。作加大黄。子下。
成本。有大字。无服之愈三字。五六枚。千金。外台。作一枚。）
〔成〕劳复。则热气浮越。与枳实栀子豉汤以解之。食复则胃有宿积。加大黄以下之。〔汪〕劳复证。以
劳则气上。热气浮越于胸中也。故用枳实为君。以宽中下气。栀子为臣。以除虚烦。香豉为佐。以解劳热。煮
以清浆水者。以瘥后复病。宜助胃气也。〔周〕如果虚劳而复。当用补矣。乃立此汤。虽曰劳复。实食复也。
何也。新瘥未必大劳。或偶不慎起居。致食不能消化者有之。若有宿食。竟自过饱矣。故枳实宽中破结。栀子
散热除烦。香豉解虚热微汗。合三物之苦寒。主劳伤之复热也。如多食停滞。因生热者。必按之痛。宜加大
黄去之。快愈之速。使不大耗胃液也。设不知者。以病后不可用。所损多矣。
伤寒类方曰。浆水。即淘米泔水。久贮味酸。为佳。本草蒙筌曰。浆水造法。炊粟米。热投冷水中。浸五
六日。生白花。色类浆者。医方祖剂曰。浆水。乃HT 米和曲酿成。如酢而淡。字汇曰。浆。米汁也。吴云。清
浆水。一名酸浆水。炊粟米。熟投冷水中。浸五六日。味酢。生白花。色类浆。故名。若浸至败者。害人。其
性凉善走。能调中宣气。通关开胃。解烦渴。化滞物。○案李时珍引嘉谟云。浆水。酢也。误。
千金方。羊脂煎方后云。棋子。大小如方寸匕。又服食门。博棋子。长二寸。方一寸。
伤寒蕴要。枳实栀子汤。治食复劳复。身热心下痞闷。如有宿食不下。大便秘实。脉中有力者。可加大黄。内外伤
辨惑论。食膏粱之物过多。烦热闷乱者。亦宜服之。
伤寒瘥以后。更发热。小柴胡汤主之。脉浮者。以汗解之。脉沉实（【原注】一作紧）者。以下解之。
（成本。玉函。热下有者字。）
〔钱〕伤寒既瘥以后。更发热者。若病后余气作虚热。固当以柴胡黄芩。清解余热。以人参补其病后之虚。
而以姜枣和之。若复感外邪。而发热。亦属病后新虚。理宜和解。但察其脉证之有类于半表半里之少阳者。以
小柴胡汤主之。若脉浮则邪盛于表。必有可汗之表证。仍当以汗解之。但病后新虚。不宜用麻黄过汗。使伤卫
亡阳。若脉沉实者。沉为在里。实则胃实。仍当用下法解之。但卫气已虚。不宜用承气峻下。宜消息其虚实。
或小承气。或调胃。或如博棋子之法。随其轻重。以为进止。可也。〔方〕脉浮。有所重感也。沉脉。饮食失节也。
案喻云。汗下之法。即互上条。汗用枳实栀豉微汗。下用枳实栀豉加大黄微下也。此恐非是。
千金方。黄龙汤。治伤寒瘥后。更头痛壮热烦闷方。仲景名小柴胡汤。
大病瘥后。从腰以下。有水气者。牡蛎泽泻散主之。
〔钱〕大病后。若气虚。则头面皆浮。脾虚则胸腹胀满。此因大病之后。下焦之气化失常。湿热壅滞。膀
胱不泻。水性下流。故但从腰以下。水气壅积。膝胫足跗。皆肿重也。以未犯中上二焦。中气未虚。为有余之
邪。脉必沉数有力。故但用排决之法。而以牡蛎泽泻散主之。
牡蛎泽泻散方
牡蛎（熬） 泽泻 蜀漆（暖水洗去腥） 葶苈子（熬） 商陆根（熬） 海藻（洗去咸） 栝蒌根（各等分）
上七味。异捣。下筛为散。更于臼中治之。白饮和服方
寸匕。日三服。小便利。止后服。（成本。葶苈下。无子字。于臼。作入臼。钱本。金鉴。葶苈上有苦字。）
〔钱〕牡蛎咸而走肾。同渗利。则下走水道。泽泻利水入肾。泻膀胱之火。为渗湿热之要药。栝蒌根。
解烦渴。而行津液。导肿气。蜀漆。能破其 。为驱痰逐水。必用之药。苦葶苈。泄气导肿。去十肿水气。商
陆。苦寒。专于行水。治肿满。小便不利。海藻。咸能润下。使邪气自小便出也。〔鉴〕此方。施之于形气实
者。其肿可随愈也。若病后土虚。不能制水。肾虚不能行水。则又当别论。慎不可服也。
大病瘥后。喜唾。久不了了。胸上有寒。当以丸药温之。宜理中丸。（玉函。成本。胸上。作胃上。玉函。
无以丸药三字。）
〔方〕唾。口液也。寒以饮言。〔锡〕大病瘥后喜唾者。脾气虚寒也。脾之津为唾。而开窍于口。脾虚
不能摄津。故反喜从外窍而出也。久不了了者。气不清爽也。所以然者。以胃上有寒。故津唾上溢。而不了了
也。〔钱〕胃上者。胃之上口。贲门也。不用理中汤。而用理中丸者。非取其缓也。因病后余症。不必用大剂
力救。但欲其常服耳。〔周〕理中者。理中焦。利在下焦。已为非治。今寒在胃上。何宜理中乎。不知痰积膈
上者。总胃虚不能健运也。设复以逐饮破滞之药与之。痰即出矣。独不虞今日之痰虽去。而明日之痰复积乎。
惟温补其胃。自使阳气得以展布。而积者去。去者不复积已。
伤寒解后。虚羸少气。气逆欲吐。竹叶石膏汤主之。（成本。吐下。有者字。）
〔汪〕伤寒。本是热病。热邪所耗。则精液销铄。元气亏损。故其人必虚羸少气。气逆欲吐者。气虚不能
消饮。胸中停蓄。故上逆而欲作吐也。与竹叶石膏汤。以调胃气散热逆〔钱〕仲景虽未言脉。若察其脉虚数。
而渴者。当以竹叶石膏
汤主之。虚寒者。别当消息也。
竹叶石膏汤方
竹叶（二把） 石膏（一斤） 半夏（半升洗） 麦门冬（一升去心） 人参（二两○玉函。成本。作三两）
甘草（二两炙） 粳米（半升）
上七味。以水一斗。煮取六升。去滓。纳粳米。煮米熟。汤成去米。温服一升。日三服。
〔鉴〕是方也。即白虎汤。去知母。加人参麦门冬半夏竹叶。以大寒之剂。易为清补之方。此仲景白虎变
方也。〔钱〕竹叶性寒。而止烦热。石膏入阳明。而清胃热。半夏蠲饮而止呕吐。人参补病后之虚。同麦冬。
而大添胃中之津液。又恐寒凉损胃。故用甘草和之。而又以粳米。助其胃气也。
本草序例云。凡云一把者。二两为正。
千金方。本方。用生姜四两。外台秘要。文仲疗天行表里虚烦。不可攻者。竹叶汤。本方。用石膏一升。
人参二两粳米一升。方后云。此仲景方。
千金竹叶汤。治产后虚渴。少气力。
于本方。去石膏粳米。加茯苓大枣小麦。
千金月令。主风毒香港脚。多睡心中悸。石发攻心。口干方。
于本方。去半夏粳米甘草。加茯苓生姜。
外台。崔氏。疗骨蒸。唇干口燥。欲得饮水。止渴。竹叶饮。
于本方。去石膏。加生姜大枣。
王氏易简方。既济汤。治发热下利者。
于本方。去石膏。加熟附子。
和剂局方。竹叶石膏汤。治伤寒时气。表里俱虚。遍身发热。心胸烦闷。或得汗已解。内无津液。虚羸少
气。胸中
烦满。气逆欲吐。及诸虚烦热。并宜服之。诸虚烦热。与伤寒相似。但不恶寒。身不疼痛。头亦不痛。脉不紧
数。即不可汗下。宜服此药。（即本方）
总病论。竹叶汤。治虚烦病。兼治中 渴吐逆。而脉滑数者。（即本方）
直指方。本方。治伏暑内外热炽。烦躁大渴。
伤寒选录。竹叶汤。阳明汗多而渴。衄而渴欲水。水入即瘥后渴。即本方。汤成去滓。入生姜自然汁三匙。
再煎一沸服。神效。
证治要诀。热嗽诸药不效。竹叶石膏汤。去竹叶。入粳米。少加知母。多加五味杏仁。此必审是伏热。在
上焦心肺间者可用。
张氏医通。上半日嗽多。属胃中有火。竹叶石膏汤。降泄之。
又唇青有二。若唇与爪甲俱青。而烦渴引饮者。为热伏厥阴。竹叶石膏汤。若唇青。厥冷而畏寒。振振
欲擗地者。为寒犯少阴。真武汤。
又夏月感冒吐泻霍乱。甚则手足厥逆。少气。唇面爪甲皆青。六脉俱伏。而吐出酸秽。泻下臭恶。便溺
黄赤者。此火伏于厥阴也。为热极似阴之候。急作地浆。煎竹叶石膏汤。误作寒治必死。
夷坚志。袁州天庆观主首王自正病伤寒。旬余。四肢乍冷乍热。头重气塞。唇寒面青。累日不能食。势
已甚殆。医徐生诊之曰。脉极虚。是为阴证。必服桂枝汤乃可。留药而归。未及煮。若有语之。曰何故不服竹
The disease of Yin-Yang Yi (Exchange) following Shanghan (Cold Damage). The patient has a heavy body, shortness of breath, urgency and tension in the lower abdomen, sometimes with spasms drawing into the genitalia, heat rushing up to the chest, heaviness of the head making it unwilling to be lifted, and visual disturbances or seeing spots.
([Original Note] "Spots" is written as "eye discharge" in another version.) For those with spasms and tension in the knees and calves, Shao Kun San (Burned Underwear Powder) is the primary treatment. (Below the character for "spots", *Yuhan Jing* has three characters meaning "red eye lids"; *Qianjin Yi Fang* writes "scabbed eyelids red and spots"; *Chao Yuan* writes "blurred vision".)
[Cheng Wuji] After a major illness has just healed, blood and qi have not yet recovered, and residual heat remains. If one forces sexual intercourse and becomes ill, it is called "Yi" (Exchange). If a man, having just recovered from a major illness but not yet fully restored, engages in intercourse with a woman and becomes ill, it is called "Yang Yi" (Yang Exchange). If a woman, having just recovered from a major illness but not yet fully restored, engages in intercourse with a man and becomes ill, it is called "Yin Yi" (Yin Exchange). (Note: The above content comes from *Zhu Bing Yuan Hou Lun* [Source Book of Pathogenesis of All Diseases].) Because Yin and Yang mutually affect each other, their residual toxins infect and adhere to one another, like an exchange. The patient's heavy body and shortness of breath are due to damage and movement of true Qi. Urgency and tension in the lower abdomen, spasms drawing into the genitalia, and tension in the knees and calves indicate extreme Yin Qi. Heat rushing up to the chest, heaviness of the head unwilling to be lifted, and visual disturbances are caused by the moved residual toxin and the exchanged Qi steaming upwards. Administer Shao Kun San to guide Yin Qi downwards. [Qian Yi] After male-female intercourse, Yuan Qi naturally becomes empty, and residual pathogens mix within Jing and Qi, entering the essence tunnels and overflowing into the meridians. Taking advantage of the void after intercourse, they enter and infiltrate between the Zang-Fu organs, sinews and bones, collaterals, and Shu points. Thus, Zheng Qi becomes more deficient due to Xie Qi, and Xie Qi becomes more prosperous due to deficiency. Hence these various syndromes of Yin excess and Yang deficiency. When pathogens enter Yin meridians, the body must feel heavy. True Yang is damaged, San Jiao transport fails, and Zong Qi does not move, hence shortness of breath. Pathogens slip from the Yin apertures into the Shaoyin and Jueyin meridians, hence lower abdominal urgency. If the urgency is severe, even drawing into genital spasms, all are caused by Yin pathogens. Yin pathogens are below, while deficient Yang floats upward, hence heat rushing to the chest. Heaviness of the head unwilling to be lifted and visual disturbances occur because the Lower Jiao is deficient and cold, causing knee and calf tension. This is truly what is meant by disorders of Yin and Yang, hence Shao Kun San is the primary treatment.
*Zhouhou Beiji Fang* states: Two men and two women do not exchange with each other; thus the name "Yi" refers to the exchange of Yin and Yang.
Formulary texts say: Shanghan includes Fengzhong (Wind Strike). "Yi" is like trade or change. It means that after a major illness has just healed, blood and qi have not recovered, and forcing sexual intercourse causes the two Qi to interact and mutually exchange, resulting in disease.
Shao Kun San Formula
Take the middle garment (underwear) of a woman, cut the part near the yin organs, and burn it to ash.
One ingredient. Take one Cun Bi (a square inch measure) with water, three times daily. When urination becomes smooth and the glans penis swells slightly, this indicates cure. If the patient is a woman, take the underwear of a man, burn it, and administer. (*Cheng Ben*, *Yu Han Jing*: Take the part of the woman's underwear near the yin organs, cut and burn to ash, mix with water, take one Cun Bi, three times daily. When urination becomes smooth and the glans swells slightly, it cures. If the patient is a woman, take the part of the man's underwear covering the navel, cut and burn to ash.)
[Qian Yi] Intercourse between men and women involves the mutual interaction of two Qi. Because unclean pathogens follow the emotion of intercourse, the spirit, soul, and hun po are all shaken, rapidly sensing and connecting, mixing into the interior of the Shaoyin meridian. Therefore, the underwear near the yin organs is used to draw out the pathogens from the Yin, embodying the principle that "things follow their kind, and similar Qi seeks each other."
[Lin Yi et al.] The underwear of men and women is a turbid and decadent substance. Burning it to ash utilizes its dispersing property, also based on the principle of similar Qi seeking each other. After taking it, if sweating occurs or urination becomes smooth, it cures. Slight swelling of the glans penis is because the exchanged toxin exits through the yin aperture, hence the swelling.
*Shanghan Yunyao* states: For Yin-Yang Yi, Zhang Zhongjing treats with Shao Kun San. *Huoren Shu* uses Shushi Tang (Rat Dropping Decoction), Gualougen Zhuru Tang (Trichosanthes Root and Bamboo Rind Decoction), Zhupi Tang (Bamboo Peel Decoction), Danggui Baizhu San (Angelica and Atractylodes Macrocephala Powder), etc. Yi Lao (Pang Anshi) treats by distinguishing cold and heat. If the injury is in the Shaoyin Kidney meridian, with cold but no heat, use Fuzi Tang (Aconite Decoction) to swallow Shao Kun San. If the injury is in the Jueyin Liver meridian, use Danggui Sini Tang (Angelica Decoction for Cold Extremities) plus Wuzhuyu and Fuzi to swallow Shao Kun San. If there is heat, use Shushi Zhuru Tang, etc., to swallow Shao Kun San. The key is to examine pulse and symptoms, distinguish cold and heat, and treat accordingly.
*Yinzheng Lueli* states: If Yin-Yang Yi indeed presents with a Yin pulse, treat according to the syndrome. If the pulse is at Jueyin, use Danggui Sini Tang to swallow Shao Kun San. If the pulse is at Shaoyin, use Tongmai Sini Tang (Pulse-Returning Sini Decoction) to swallow Shao Kun San. If the pulse is at Taiyin, use Sishun Lizhong Wan (Four-Gentle Replenishing Center Pill) to swallow Shao Kun San.
*Zhengzhi Zhunsheng* states: I once treated someone who contracted Shanghan, had not yet recovered, and committed sexual offenses, whose life was hanging by a thread. I used Dushen Tang (Single Ginseng Decoction) to swallow Shao Kun San. Of those who took over one to two Jin of Ginseng, three or four were cured. Indeed, medication should not be applied rigidly.
After a major illness heals, if recurrence occurs due to labor (Laofu), Zhishi Zhizi Tang (Immature Bitter Orange and Gardenia Decoction) is the primary treatment.
[Qian Yi] Generally, after a major illness has just healed, Yuan Yuan is greatly deficient, blood and qi have not recovered, spirit is fatigued, and residual heat remains. One should only rest peacefully, avoid wind, regulate diet, maintain emptiness and desirelessness, so that Yuan Qi grows daily. Young and strong people will not only return to their former state. If one does not know how to regulate and nourish, one will inevitably violate taboos and develop syndromes such as Laofu (recurrence due to labor), Nulaofu (recurrence due to female labor/sex), Shipfu (recurrence due to food), and worsening due to alcohol. Laofu, for example, involves excessive talking and worrying, which labors the Shen (Spirit); combing hair, bathing, sitting early, walking early, which labors the Li (Strength). All can cause recurrent fever, like dead ashes reigniting. This repetition is called "Fu" (Recurrence). However, the heat of Laofu is deficient heat arising internally. Although it can be resolved via sweating, it differs from external pathogens that can be released via acrid-warm diaphoresis. Hence Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) is the primary treatment. Only Nulaofu, although a type of Laofu, has dangerous manifestations and radically different treatment methods, often leading to death without rescue. Thus Wu Shou said that predecessors compared major illness newly healed to a wall soaked in water; when the water recedes, the wall revives, but one must not lightly offend it. [Yu Jiyuan] Laofu is a disease where起居 (daily activities/labor) generates residual heat again. The commentary labeling it as Nulaofu is a great error.
*Bingyuan Hou Lun* states: After Shanghan has just healed, fluids are not recovered, blood and qi are still deficient. If labor begins too early, the disease recurs, hence called "Fu". Excessive speech and thought labor the Shen; combing hair and bathing labor the Li. Labor generates heat; heat takes advantage of deficiency to re-enter the meridians, hence recurring disease. Furthermore, after a major illness, the Spleen and Stomach are still deficient, and Gu Qi (Grain Qi) has not recovered. Eating pork, intestines, blood, fatty fish, and long-stored greasy foods will definitely cause severe diarrhea, which doctors cannot treat, leading to death. Eating cakes, millet malt, roasted meat, dates, chestnuts, and other dried fruits, as well as hard-to-digest foods, will cause the weak Stomach Qi to fail to digest them, leading to renewed internal heat. If medicine is then used to purge, the Stomach becomes cold, severe diarrhea ensues and cannot be controlled, purging is contraindicated, leading to death. Purging is also dangerous and difficult to save.
Zhishi Zhizi Tang Formula. (○ *Cheng Ben*, *Yu Han Jing*: Add "Chi" after "Zi".)
Zhishi (Immature Bitter Orange) (3 pieces, roasted) Zhizi (Gardenia) (14 pieces, broken) Chi (Fermented Soybeans) (1 Sheng, wrapped in silk)
These three ingredients. Use 7 Sheng of Qingjiang Shui (Clear Sour Rice Water), boil empty to reduce to 4 Sheng. Add Zhishi and Zhizi, boil to obtain 2 Sheng. Add Chi, boil for 5-6 boils. Remove dregs. Take warm, divided into two doses. Cover to induce slight sweating. If there is retained food, add Dahuang (Rhubarb) sized like Go stones, 5-6 pieces. Take until cured. (Qingjiang Shui: *Qianjin Fang* calls it Cu Jiang (Vinegar Juice); *Qianjin Yi Fang* agrees. Boil empty to 4 Sheng: *Yu Han Jing* says boil empty to reduce by 3 Sheng. Add Dahuang: *Cheng Ben* says add Dahuang. After "Zi": *Cheng Ben* has the character "Da" (Large), lacks "Fu Zhi Yu" (Take until cured). 5-6 pieces: *Qianjin Fang*, *Waitai Mi Yao* say 1 piece.)
[Cheng Wuji] Laofu causes heat to float and surge; Zhishi Zhizi Chi Tang resolves it. Shipfu (Food Recurrence) means retained accumulation in the stomach; adding Dahuang purges it. [Wang Ren'an] In Laofu syndrome, labor causes Qi to rise, and heat floats in the chest. Hence Zhishi is used as the Sovereign herb to broaden the middle and descend Qi; Zhizi as the Minister herb to remove deficiency vexation; Xiangchi as the Assistant herb to resolve labor heat. Boiling with Qingjiang Shui is because post-illness recurrence benefits from aiding Stomach Qi. [Zhou Yangjun] If it is deficiency-labor recurrence, tonification should be used. Yet this formula is established. Although called Laofu, it is actually Shipfu. Why? Newly healed people may not have labored heavily, but perhaps negligently managed daily life, leading to undigested food. If there is retained food, it is due to overeating. Thus Zhishi broadens the middle and breaks knots, Zhizi dissipates heat and removes vexation, Xiangchi resolves deficiency heat and induces slight sweat. Combining the bitter-cold nature of these three herbs treats recurrence heat from labor injury. If overeating causes stagnation and heat, pressing will cause pain; adding Dahuang to remove it leads to rapid cure without excessive consumption of Stomach fluids. Those who do not understand this think post-illness usage is harmful, causing much damage.
*Shanghan Leifang* states: Jiangshui (Rice Water) is rice washing water, stored for a long time until sour, which is best. *Bencao Mengqian* states: Method for making Jiangshui: Cook millet, throw hot into cold water, soak for 5-6 days, white flowers grow, color resembles paste. *Yifang Zuji* states: Jiangshui is made from Jingmi (Japonica rice) mixed with Qu (yeast), like vinegar but lighter. *Zihui* states: Jiang is rice juice. Wu Qian says: Qingjiangshui, also known as Suangjiangshui, cook millet, throw cooked into cold water, soak 5-6 days, taste sour, white flowers grow, color resembles paste, hence the name. If soaked until spoiled, it harms people. Its nature is cool and mobile, able to regulate the middle, disseminate Qi, open orifices and stimulate appetite, relieve thirst and vexation, and transform stagnation. ○ Note: Li Shizhen quotes Jiamo saying Jiangshui is vinegar, which is incorrect.
*Qianjin Fang* Sheep Fat Fry formula postscript says: Go stones, size like a Cun Bi. Also in Food Service section, Go stones are 2 Cun long, 1 Cun square.
*Shanghan Yunyao*: Zhishi Zhizi Tang treats Shipfu and Laofu, with body heat, epigastric fullness/stuffiness, feeling like retained food cannot go down, constipation, and forceful pulse; Dahuang can be added. *Neiwai Shang Bianhuo Lun*: Eating too much rich/greasy food causing vexation, heat, and confusion should also take this.
After Shanghan heals, if fever recurs, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment. If the pulse is Floating, resolve with sweating. If the pulse is Deep and Real (or Tight), resolve with purging.
(*Cheng Ben*, *Yu Han Jing*: Add "Zhe" (particle) after "Re" (heat).)
[Qian Yi] After Shanghan has healed, if fever recurs: if it is deficiency heat from residual Qi post-illness, one should certainly use Chaihu and Huangqin to clear residual heat, Renshen to tonify post-illness deficiency, and Jiang/Zao (Ginger/Jujube) to harmonize. If it is a new contraction of external pathogens causing fever, it also belongs to new deficiency post-illness, and harmonizing is appropriate. As long as the pulse and symptoms resemble the Half-Exterior/Half-Interior Shaoyang pattern, Xiaochaihu Tang is the primary treatment. If the pulse is Floating, pathogen is abundant at the Exterior, there must be exterior signs suitable for sweating; still resolve with sweating. But post-illness new deficiency makes Ma Huang inappropriate for excessive sweating to avoid damaging Wei Qi and losing Yang. If the pulse is Deep and Real, Deep indicates Interior, Real indicates Stomach excess; purging method should still be used to resolve. But Wei Qi is already deficient, so harsh purging with Chengqi Decoctions is inappropriate. One should assess deficiency and excess, using Xiao Chengqi Tang, Tiaowei Chengqi Tang, or the Go stone method, advancing or retreating according to severity. [Fang Youzhi] Floating pulse indicates secondary contraction. Deep pulse indicates dietary irregularity. Note: Yu Chang says: Sweating and purging methods here correspond to the previous clause. Sweating uses Zhishi Zhizi Chi with mild sweating; purging uses Zhishi Zhizi Chi plus Dahuang with mild purging. This is likely incorrect.
*Qianjin Fang* Huanglong Tang treats post-Shanghan healing, recurring headache, high fever, and vexation. Zhang Zhongjing names this Xiaochaihu Tang.
After a major illness heals, if there is fluid accumulation from the waist downward, Musi Zeixie San (Oyster Shell and Alisma Powder) is the primary treatment.
[Qian Yi] After a major illness, if Qi is deficient, the face and head swell. If Spleen is deficient, the chest and abdomen become full. This is because after a major illness, the Qi transformation of the Lower Jiao fails, damp-heat obstructs, the Bladder does not drain, and water flows downward. Hence only from the waist down does fluid accumulate, with swelling and heaviness in the knees, calves, and dorsum of feet. Because the Middle and Upper Jiao are not invaded, and Middle Qi is not deficient, this is an excess pathogen. The pulse must be Deep, Rapid, and Forceful. Hence only draining methods are used, and Musi Zeixie San is the primary treatment.
Musi Zeixie San Formula
Muli (Oyster Shell) (roasted) Zeixia (Alisma) Shuqi (Patrinia) (wash with warm water to remove fishy smell) Tinglizi (Descurainia Seed) (roasted) Shanglugen (Phytolacca Root) (roasted) Haizao (Seaweed) (wash to remove saltiness) Gualougen (Trichosanthes Root) (equal parts)
Seven ingredients. Crush separately, sift into powder, then grind together in a mortar. Mix with Baiyin (rice water) and take one Cun Bi, three times daily. Stop subsequent doses when urination becomes smooth. (*Cheng Ben*: No "Zi" after "Tingli". "Yu Jiu" written as "Ru Jiu". *Qian Ben*, *Jin Jian*: Add "Ku" (Bitter) before "Tingli".)
[Qian Yi] Muli is salty and enters the Kidney; combined with draining herbs, it descends via the water pathways. Zeixia drains water into the Kidney and clears Bladder fire, being a key herb for draining damp-heat. Gualougen relieves thirst and vexation, moves fluids, and guides swelling Qi. Shuqi breaks accumulations, being essential for driving phlegm and water. Ku Tinglizi drains Qi, guides swelling, and removes ten types of edema water. Shanglu is bitter and cold, specifically moving water, treating edema and fullness, and difficult urination. Haizao is salty and moistening downward, expelling pathogens via urination. [Lin Yi et al.] This formula applies to those with substantial constitution and strength; swelling can heal immediately. If post-illness Earth deficiency fails to control Water, or Kidney deficiency fails to move Water, the discussion changes; caution, do not take.
After a major illness heals, if there is a tendency to salivate, lasting long without resolution, with Cold in the Chest Upper area, pills should be used to warm it; Lizhong Wan (Replenish the Center Pill) is suitable. (*Yu Han Jing*, *Cheng Ben*: "Xiong Shang" (Chest Upper) written as "Wei Shang" (Stomach Upper). *Yu Han Jing*: Lacks "Yi Wan Yao" (with pill medicine).)
[Fang Youzhi] Tu (Saliva) is mouth fluid. Han (Cold) refers to drinking fluids. [Shen Mingzong] Post-major illness salivation is due to Spleen Qi deficiency and Cold. Spleen fluid is saliva, opening at the mouth. Spleen deficiency fails to control fluids, so they exit externally. Lasting long without resolution means Qi is not clear. This is because Cold in the Stomach causes saliva to overflow upwards. [Qian Yi] Wei Shang refers to the upper opening of the Stomach, the贲门 (Cardia). Using Lizhong Wan instead of Lizhong Tang is not for its slow action, but because post-illness residual symptoms do not require large doses for urgent rescue, but rather for frequent administration. [Zhou Yangjun] Lizhong regulates the Middle Jiao; benefit is in the Lower Jiao, which is already non-treatment. Now Cold is in the Stomach Upper, why use Lizhong? Not knowing that phlegm accumulating in the Diaphragm Upper is always due to Stomach deficiency failing to transport. If one gives drugs to chase fluids and break stagnation, phlegm will exit. Do you not worry that today's phlegm leaves, but tomorrow's accumulates again? Only by warming and tonifying the Stomach can Yang Qi spread, causing accumulated phlegm to leave and not re-accumulate.
After Shanghan resolves, if the body is emaciated and weak, with shortness of breath and rebellious Qi wanting to vomit, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is the primary treatment. (*Cheng Ben*: Adds "Zhe" after "Tu" (vomit).)
[Wang Ren'an] Shanghan is originally a heat disease. Heat pathogens consume fluids and damage Yuan Qi, so the person must be emaciated, weak, and short of breath. Rebellious Qi wanting to vomit is due to Qi deficiency failing to transform fluids, which accumulate in the chest, rebelling upwards to cause vomiting. Give Zhuye Shigao Tang to regulate Stomach Qi and dissipate heat/rebellious Qi. [Qian Yi] Although Zhongjing did not mention the pulse, if the pulse is Deficient-Rapid and there is thirst, Zhuye Shigao Tang is the primary treatment. For Deficiency-Cold, consider differently.
Zhuye Shigao Tang Formula
Zhuye (Bamboo Leaves) (2 Bundles) Shigao (Gypsum) (1 Jin) Banxia (Pinellia) (Half Sheng, washed) Maidong (Ophiopogon) (1 Sheng, heart removed) Renshen (Ginseng) (2 Liang ○ *Yu Han Jing*, *Cheng Ben*: 3 Liang) Gancao (Licorice) (2 Liang, roasted) Jingmi (Japonica Rice) (Half Sheng)
Seven ingredients. Use 1 Dou of water, boil to obtain 6 Sheng. Remove dregs. Add Jingmi, boil until rice is cooked. Remove rice. Take 1 Sheng warm, three times daily.
[Lin Yi et al.] This formula is Baizhu Tang (White Tiger Decoction) minus Zhimu, plus Renshen, Maidong, Banxia, Zhuye. It changes a major cold agent into a clearing and tonifying formula. This is Zhongjing's variation of Baizhu Tang. [Qian Yi] Zhuye is cold and stops vexation/heat. Shigao enters Yangming and clears Stomach heat. Banxia eliminates fluids and stops vomiting. Renshen tonifies post-illness deficiency, combined with Maidong to greatly replenish Stomach fluids. Fearing cold damages the Stomach, Gancao is used to harmonize, and Jingmi aids Stomach Qi.
*Bencao Xuli* states: Whenever "one bundle" is mentioned, 2 Liang is standard.
*Qianjin Fang* original formula uses 4 Liang Shengjiang (Fresh Ginger). *Waitai Mi Yao*, Wen Zhong treating Tianxing (Epidemic) exterior-interior deficiency vexation, unable to attack, Zhuye Tang, original formula uses 1 Sheng Shigao, 2 Liang Renshen, 1 Sheng Jingmi. Post-formula says: This is Zhongjing's formula.
*Qianjin* Zhuye Tang treats postpartum deficiency thirst and lack of Qi/strength.
From original formula, remove Shigao and Jingmi, add Fuling (Poria), Dazao (Jujube), Xiaomai (Wheat).
*Qianjin Yueling* treats Wind-Toxic Hongjiao (Gout/Leg Ulcer), excessive sleep, palpitations, Shi Fa attacking the Heart, dry mouth.
From original formula, remove Banxia, Jingmi, Gancao, add Fuling, Shengjiang.
*Waitai*, Cui Shi, treating Bone Steaming, dry lips/mouth, desire to drink, stopping thirst, Zhuye Yin.
From original formula, remove Shigao, add Shengjiang, Dazao.
Wang Shi *Yijian Fang*, Ji Ji Tang, treating fever and diarrhea.
From original formula, remove Shigao, add Shu Fuzi (Prepared Aconite).
*Heji Jufang*, Zhuye Shigao Tang, treating Shanghan/Shiqi (Seasonal Qi), exterior-interior both deficient, whole body fever, chest/heart vexation, or after sweating resolved, internal lack of fluids, emaciation/weakness/shortness of breath, chest vexation/fullness, rebellious Qi wanting to vomit, and all deficiency vexation/heat, all suitable. All deficiency vexation/heat resembles Shanghan, but without aversion to cold, body pain, or headache, and pulse not tight-rapid, then sweating/purging are contraindicated; take this medicine. (This is the original formula.)
*Zongbing Lun*, Zhuye Tang, treating Xu Fan (Deficiency Vexation) disease, also treating Zhong E (Heat Stroke) thirst/vomiting/rebellion with slippery-rapid pulse. (This is the original formula.)
*Zhizhi Fang*, original formula, treating Fu Shu (Hidden Summerheat) with intense internal/external heat, vexation, and great thirst.
*Shanghan Xuanlu*, Zhuye Tang, Yangming excessive sweating/thirst, epistaxis/thirst/water intake relief, post-healing thirst. This is the original formula. After boiling and removing dregs, add 3 spoons of natural Shengjiang juice, boil once more, take, miraculous effect.
*Zhengzhi Yaojue*, hot cough ineffective with other medicines: Zhuye Shigao Tang, remove Zhuye, add Jingmi, small amount of Zhimu, increased Wuweizi (Schisandra) and Xingren (Apricot Seed). This can only be used if confirmed as hidden heat in the Upper Jiao Heart/Lungs.
*Zhangshi Yitong*: Cough mostly in the first half of the day belongs to Fire in the Stomach; Zhuye Shigao Tang descends and purges.
Also, blue lips come in two types: If lips and nails are both blue, with vexation/thirst/desire to drink, it is Heat hiding in Jueyin; Zhuye Shigao Tang. If lips are blue, cold extremities, aversion to cold, trembling wanting to stretch out, it is Cold invading Shaoyin; Zhenwu Tang.
Also, summer month cold/diarrhea/Huoluan, even to cold extremities, shortness of breath, blue lips/face/nails, six pulses all hidden, vomiting sour/foul, diarrhea smelly/foul, yellow/red urine: This is Fire hiding in Jueyin, a sign of Extreme Heat resembling Yin. Quickly make Dijiang (Earth Slurry), decoct Zhuye Shigao Tang. Mistaking for Cold treatment leads to death.
*Yijian Zhi*: Wang Zizheng, chief priest of Tianqing Temple in Yanzhou, suffered Shanghan for over ten days, limbs alternating cold/hot, heavy head/qi obstruction, cold lips/blue face, unable to eat for days, condition critical. Doctor Xu Sheng diagnosed: Pulse extremely deficient, this is Yin syndrome, must take Guizhi Tang (Cinnamon Twig Decoction). Left medicine and returned, before boiling, someone told him: Why not take Zhu...