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After the recent recovery from Shanghan (Cold Damage), if illness recurs due to excessive physical exertion in daily activities, it is termed "Laofu" (Relapse due to Labor). If illness recurs due to forced consumption of grain foods, it is termed "Shifu" (Relapse due to Diet). If a patient falls ill again after sexual intercourse, it is termed "Fanglaofu" (Relapse due to Sexual Exhaustion). If both parties contract illness through sexual intercourse, transferring the pathogen between a healthy male and female, it is termed "Yinyangyi" (Exchange of Yin and Yang), resembling an exchange transaction. This occurs because, upon recent recovery, residual pathogens remain latent in the Zang-Fu organs (Internal Organs) and have not been fully resolved; thus, any transgression leads to recurrence. Clinicians must carefully examine the pulse and symptoms for detailed differentiation during practice, ensuring accurate treatment.

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For relapse due to labor following the recovery from a major illness, Zhishi Zhizi Chi Tang (Bitter Orange, Gardenia and Fermented Soybean Decoction) is the primary prescription. If there is retained food stagnation, add Dahuang (Rhei Radix et Rhizoma), in quantities equivalent to five or six Boqi seeds (approx. 10-15g).

[Annotation]

"Recovery from a major illness" refers to the recent recovery from Shanghan. "Laofu" refers to relapse caused by physical exertion in daily life, not relapse due to sexual exhaustion; it should be treated with Zhishi Zhizi Chi Tang. Covering the patient with warm blankets to induce slight sweating will lead to self-healing; vigorous vomiting is not sought because the heat is located in the meridians rather than the chest-diaphragm area. If relapse is caused by overeating, it is called "Shifu" due to retained food; it should be treated with Zhishi Zhizi Chi Tang plus Dahuang to purge the stagnation.

[Collected Annotations]

Cheng Wuji stated: In Laofu, heat qi floats upward; Zhishi Zhizi Chi Tang is used to resolve it. In Shifu, there is retained accumulation in the stomach; Dahuang is added to purge it.

Wang Kentang stated: The pathogen of Shanghan enters from the exterior, while the pathogen of Laofu originates from within.

Zhishi (Stir-fried with bran) 3 pieces, Zhizi (Broken) 14 pieces, Chidou (Wrapped in silk) 1 sheng.

Take these three ingredients, use 7 sheng of Qingjiangshui (Clear Acidic Rice Water), boil empty first until reduced to 4 sheng, then add Zhishi and Zhizi, boil until 2 sheng remains. Add Chidou, boil for 5-6 boils, strain, and take warm, divided into two doses. Cover with blankets to induce slight sweating.

[Formula Analysis]

In this formula, using 7 sheng of Qingjiangshui and boiling empty down to 4 sheng aims to make the water's nature heavy and descending, preventing it from causing upward vomiting. Adding Chidou and boiling only 5-6 boils before straining utilizes its light, fermented aroma to reach the exterior, facilitating sweating. In Taiyang disease, it is used to induce vomiting; in Laofu, it is used to induce sweating. The subtlety of Zhang Zhongjing's prescriptions lies in the fact that although the herbs are the same, the decoction methods differ, leading to different therapeutic effects; this principle can be extrapolated to other cases.

[Collected Exegesis]

Fang Youzhi stated: After the major pathogen recedes, blood and qi are newly deficient. Physical exertion generates residual heat. Using bitter-cold herbs to induce slight sweating is appropriate because the heat from labor-induced relapse differs fundamentally from the excess heat of initial illness. Using Qingjiangshui boiled down serves to make the water heavy and descending, avoiding upward vomiting, which differs from the purgative-vomiting method described in the Taiyang chapter for post-purgation fever. Thus, the goal is slight sweating via covering.

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If fever recurs after the resolution of Shanghan, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary prescription. If the pulse is floating, resolve it with diaphoresis (sweating method); if the pulse is deep and solid, resolve it with purgation.

[Annotation]

This follows the previous clause to detail symptoms and pulses to differentiate treatments. For recurrent fever after Shanghan recovery, despite distinctions between Laofu and Shifu, one must distinguish whether harmonization, diaphoresis, or purgation is indicated. If the pulse is floating indicating exterior syndrome, use Zhishi Zhizi Chi Tang to induce sweating; if the pulse is deep indicating interior syndrome, use Zhishi Zhizi Chi Tang plus Dahuang to purge; if there are no exterior or interior signs, use Xiaochaihu Tang to harmonize. Treating according to the syndrome is the correct approach.

[Collected Annotations]

Fang Youzhi stated: This demonstrates the general principles for relapse caused by improper regimen after illness. A floating pulse indicates re-infection with external pathogens. A deep pulse indicates dietary irregularity.

Wei Litong stated: After a major illness, vigorous sweating is contraindicated; Yu Jiayan's note that Zhishi Zhizi Chi Tang induces slight sweating is correct. Vigorous purgation is also contraindicated; Yu Jiayan's note that Zhishi Zhizi Chi Tang plus Dahuang induces slight purgation is correct. However, this does not cover all cases. One must keep in mind the post-major-illness context when applying sweating or purging methods, so as to treat relapse without harming the recovering body.

For edema/water retention below the waist after recovery from a major illness, Muli Zexie San (Oyster Shell and Alisma Powder) is the primary prescription.

[Annotation]

Swelling below the waist after Shanghan recovery indicates water qi stagnation. Muli Zexie San should be used to vigorously expel water qi, lest delay allow water to accumulate and invade the upper yang regions.

[Collected Annotations]

Cheng Wuji stated: After recovery from a major illness, Spleen-Stomach qi deficiency fails to control Kidney water, causing water to overflow into the Lower Jiao, resulting in swelling below the waist.

The *Jingui Yaolue* states: For swelling below the waist, promote urination. Muli Zexie San promotes urination to dissipate water.