伤寒病服药,中病即已,不必尽剂。《千金方》云∶伤寒新瘥后食猪肉羊血鱼脍肥
腻等味,必大下利。若食饼饵煎爆瓜果等物,胃气尚虚,不能克化,必更作热,皆难治
也。又云∶新病瘥后,但得少食糜粥,常令稍饥,不可过饱,不可恣欲妄食,虽思勿与也。
又忌大肉诸般骨汁。《本草》注∶羊肉热,病瘥后食之,发热杀人。又新差后当静卧,切勿
早起梳沐,劳动多言,用心使意,此皆令劳复。又新瘥后未满百日,气力未平复而犯房
室者,皆再热作而死不治。此新愈后之大禁也。
一、伤寒发狂奔走,人难制伏,先于病患房内着火一盆,用醋一碗倾于火上,其醋
气入鼻内即安,方可察其阳狂虚实,用药无差。若病初起,头痛发热恶寒方除已后,登高
而歌,弃衣而走,逾墙上屋,骂 叫
喊大渴欲死,脉来有力,乃因邪传入里,阳盛发狂,当用寒药下之。凡见舌卷囊缩
者不治。若病初起,无头痛,身微热,面赤戴阳,烦躁,脉来沉微无力,欲坐卧凉水中,
乃因寒极而发躁,即是阴证似阳,当用热药温之,此为阴躁。凡见厥冷下利谵语者不
治。若医者不察其脉,以虚阳上膈而躁,误为实热,反与凉药,使渴盛躁急,则气消而成
大害矣。须察脉来有力无力,此为良法。
一、伤寒腹中痛甚,将凉水一碗与患者饮之。其痛稍可者属热痛,当用凉药清之。清
之不已,而或绕脐硬痛,大便结实烦渴,属燥粪痛,急用寒药下之。若食积痛者,同治。若
小腹硬痛,小水自利,大便黑,身目黄者,属蓄血痛,亦用寒剂加行血药,下尽黑物则愈。
此三者皆痛随利减之法也。
若饮水痛甚者属寒,当用温药和之。和之不已,而成四肢厥冷,腹痛呕吐泻利,急用温
药投之。须察脉来有力无力,此为良法。
一、伤寒直中阴经真寒证,甚重而无脉,或吐泻脱元气而无脉,将好酒姜汁各半盏与
病患服之,其脉来者可治。当察其阴用药,不拘脉之浮沉大小,但指下出见者生。如用此
法,脉不至者必死。又当问病患身有痛处,要知痛甚者脉必伏,不为凶。如无痛证,用此
法而脉不至者凶。又问病患平素原有出部位之脉,当覆手取之,有脉者无事。若原不出
部,今覆取而有之,亦为阴阳之错乱也,宜和阴阳。正取覆取俱无脉者必死。
一、伤寒舌上生胎,不拘滑白黄黑,俱用井水浸青布片于舌上、洗净后用生姜片子时
时浸水刮之,其胎自退。凡见舌上黑胎芒刺者必死,此热毒入深,肾水克心火也。(此谓
肾水克心火恐误也。既云热毒入深,或肾水不能制火邪也。)若发黄者,用生姜时时周
身擦之,其黄自退。若心胸胁下有邪气。结实满闷硬痛,又法用生姜一 ,捣渣去汁,
炒微燥带润,用绢包于患处,疑疑熨之,稍可,又将渣和匀前汁、炒干再熨良久、豁然宽
快。
一、伤寒鼻衄成流,久不止者、将山栀炒黑色为细末、吹入鼻内,外将水湿草纸搭
于鼻冲,其血自止。若滴点不成流者,其邪在经未解,照后秘方用药,不在此法。
一、伤寒热邪传里,服药后用盐炒麸皮一升,将绢包于病患腹上,款款熨之,
使药气得热则行,大便易通矣。
一、伤寒吐血不止,用韭汁磨京墨呷之,其血见黑必止。如无韭汁,用鸡子清
亦可。正谓赤属火而黑属水也,故有相制之理焉。
一、伤寒直中阴经真寒证,或阴毒证,身如被杖,腹中绞痛,呕逆沉重,不知人
事,四体冷如冰石,指甲唇青,药不得入口,六脉沉细,或无脉欲绝者,将葱束缚一握,
切去根叶,留白三寸许捣如饼,先将麝香半分填于脐中,后加葱饼于上、以火熨之,烂
则易之,换二三饼,稍醒,灌入生姜汁煎服回阳救急汤。如不醒,再灸关元穴、气海穴二
三十壮,使热气通其内,邪气出于外,以回阳气于至阴之中。用此法,手足温和汗出即
醒者,为有生也;如用此法,手足不温汗不出,不省人事者,必死也。
一、伤寒热病,热邪传里,亢极无解,用黄连煎水一盏,放井中顿冷,浸青布搭
于胸上,稍热则易之,待热势稍退则除,不可久渍,夏用此法,冬不宜用。
一、伤寒服药、吐出不纳者,随用竹管重捺内关,后将生姜自然汁半盏热饮,其吐即
止。大凡服寒药热饮,服热药寒饮,中和之剂温和服之。如要取汗,虽辛甘之剂亦宜热
服;如要止汗,虽辛甘温剂亦宜温服。
一、中风痰厥,昏迷卒倒,不省人事欲绝者,先用皂荚末捻纸烧烟,冲入鼻中,有
嚏可治。随用吐痰法,将皂荚末五分、半夏白矾各三分为细末,姜汁调服,探吐后服导痰
汤加减治之。无嚏者不可治。
一、治干霍乱不得吐者,用滚汤一碗,入皂荚末三分、盐一撮、调服探吐,莫与米
汤。设与即死,是谷气反助邪气也。
一、中寒卒倒,昏迷不省者,先用热酒姜汁各半盏灌下,稍省后服加味理中饮为
效。如不饮酒者,只用姜
汁灌之,根据法调治。此证腊月甚有之,余月几希矣。
一、伤寒若兼十余日以上尚有表证宜汗者,羌活冲和汤微汗之。十余日若有里证
宜下者,可与大柴胡汤下之。盖伤寒过经,正气多虚,恐麻黄承气,其汤太峻。误用麻
黄,令人亡阳;误用承气,令人不禁,故有此戒。若表证尚未除,而里证又急,不得不
下者,只得以大柴胡汤通表里而缓治之。又老弱及气血两虚之人有下证者,亦用大柴胡
下之,不伤元气。如其年盛气壮者,不在禁例,当随酌宜而治之。
When taking medicine for Shanghan (Cold Damage disease), stop medication as soon as the condition improves; there is no need to finish the entire dose. *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) states: After a recent recovery from Shanghan, consuming pork, mutton blood, raw fish, and other rich or greasy foods will inevitably cause severe diarrhea. Consuming wheat cakes, fried foods, or fruits may also lead to recurrent fever because the Stomach Qi is still deficient and unable to digest them; these conditions are difficult to treat. It further states: After a recent recovery, one should only consume small amounts of rice gruel, maintaining a slight sense of hunger, avoiding overeating, indulgence, or arbitrary eating; even if cravings arise, such foods should not be provided. One must also avoid heavy meats and various bone broths. *Bencao* (Materia Medica) notes: Mutton is hot in nature; consuming it after recovery can cause fever leading to death. Furthermore, after a recent recovery, one should rest quietly in bed; one must not get up early to comb hair or bathe, nor engage in excessive physical labor, talking, or mental exertion, as these will cause Laofu (recurrence due to overexertion). Additionally, engaging in sexual activity within 100 days of recovery, before strength has fully returned, will invariably cause recurrent fever and death, which is untreatable. These are the major taboos after recent recovery.
1. In cases of Shanghan where the patient runs wildly and becomes uncontrollable, first place a basin of fire in the patient's room and pour a bowl of vinegar onto the fire. The inhalation of vinegar vapor will calm the patient, allowing for an accurate assessment of the excess heat and mania (Yang Kuang) to ensure correct medication. If, after the initial symptoms of headache, fever, and aversion to cold have subsided, the patient climbs high, sings, discards clothes, runs around, climbs walls or roofs, shouts curses, feels extreme thirst desiring death, and presents with a forceful pulse, this indicates that pathogenic factors have entered the interior, causing Yang excess and mania. Cold-purgative herbs should be used. Cases presenting with curled tongue and retracted testicles are untreatable. Conversely, if at the onset there is no headache, only slight body heat, a red face resembling "floating Yang" (Dai Yang), irritability, and a deep, faint, and weak pulse, with a desire to sit or lie on cool water, this is caused by extreme cold triggering agitation, known as Yin syndrome resembling Yang (Yin Zuo Si Yang). Hot-warming herbs should be used; this is called Yin Restlessness (Yin Zao). Cases presenting with cold extremities, diarrhea, and delirious speech are untreatable. If physicians fail to examine the pulse and mistake restlessness caused by floating deficiency Yang for excess heat, administering cooling medicines will exacerbate thirst and agitation, depleting Qi and causing great harm. One must distinguish between forceful and weak pulses; this is a sound method.
1. For severe abdominal pain in Shanghan, give the patient a bowl of cool water. If the pain alleviates slightly, it is classified as Heat Pain, treated with cooling herbs. If cooling fails and the patient develops hard, painful tenderness around the umbilicus, dry stool, irritability, and thirst, it is Dry Feces Pain, requiring urgent purgation with cold herbs. Food stagnation pain is treated similarly. If there is hardness and pain in the lower abdomen, free urination, black stool, and yellowing of the body and eyes, it is Blood Stasis Pain, treated with cold agents combined with blood-invigorating herbs until black material is discharged, indicating cure. These three scenarios follow the principle that pain diminishes with unblocking.
If drinking water exacerbates the pain, it is Cold Pain, treated with warming harmonizing herbs. If this fails and progresses to cold extremities, abdominal pain, vomiting, and diarrhea, urgent administration of warming herbs is required. Distinguishing between forceful and weak pulses is essential.
1. For true cold syndromes directly attacking the Yin meridians in Shanghan, characterized by severe illness and absence of pulse, or loss of Yuan Qi due to vomiting and diarrhea resulting in absent pulse, administer half a cup of good wine mixed with half a cup of ginger juice. Recovery of the pulse indicates treatability. Medication should be based on Yin syndrome characteristics, regardless of whether the pulse is floating, sunken, large, or small; any palpable pulse indicates life. If the pulse remains absent after this intervention, death is certain. Inquire about specific painful areas; intense pain often causes the pulse to become hidden (Fu), which is not necessarily ominous. However, if there is no pain and the pulse remains absent after intervention, it is ominous. Also, check if the patient normally has a pulse in a specific position; when taking the pulse with the hand reversed, presence of pulse indicates safety. If the pulse was previously absent in that position but appears upon reversal, it indicates disorder of Yin and Yang, requiring harmonization. Absence of pulse in both normal and reversed positions indicates death.
1. For coating on the tongue in Shanghan, regardless of whether it is slippery, white, yellow, or black, soak a piece of blue cloth in well water, apply it to the tongue, clean it, and then repeatedly scrape the tongue with slices of fresh ginger dipped in water until the coating recedes. Black coating with prickles on the tongue indicates death, signifying deep penetration of heat toxin where Kidney Water fails to control Heart Fire. (Note: The statement that Kidney Water controls Heart Fire here may be erroneous; given the deep heat toxin, it is more likely that Kidney Water fails to restrain the Fire pathogen.) For jaundice, rub the whole body frequently with fresh ginger until the yellowing subsides. For stubborn fullness, oppression, and hard pain in the chest, heart, and hypochondrium due to pathogenic accumulation, crush one piece of fresh ginger, remove the juice, stir-fry the residue until slightly dry yet moist, wrap it in silk, and apply warm compresses to the affected area. Once relieved, mix the residue with the reserved juice, dry it again, and apply warm compresses for a prolonged period until a sensation of relief is achieved.
1. For persistent epistaxis (nosebleed) in Shanghan, grind roasted black Gardenia (Shanzhi) into fine powder, insufflate it into the nose, and apply wet grass paper to the nostrils externally to stop bleeding. If the bleeding is merely dripping and not flowing, the pathogen remains in the meridians; refer to secret formulas elsewhere, not this method.
1. When heat pathogen transmits to the interior in Shanghan, after taking medicine, take one sheng of bran stir-fried with salt, wrap it in silk, and place it on the patient's abdomen. Apply gentle warm compresses to facilitate the movement of medicinal Qi via heat, aiding bowel movement.
1. For continuous hematemesis (vomiting blood) in Shanghan, swallow small sips of chive juice mixed with ground Jingmo (Beijing Inkstick). The blood will turn black and stop. If chive juice is unavailable, egg white can be used. This relies on the principle that red corresponds to Fire and black to Water, thus achieving mutual restriction.
1. For true cold syndromes directly attacking Yin meridians or Yin Toxic syndromes in Shanghan, presenting with body pain like being beaten, severe abdominal cramping, heavy retching, unconsciousness, limbs cold as ice, cyanosis of nails and lips, inability to ingest medicine, deep and thin six pulses, or absent/nearly absent pulses: Bind a handful of green onions, cut off roots and leaves leaving about three inches of white part, and mash into a cake. Place half a fen of Musk in the umbilicus, cover with the onion cake, and apply warm compresses. Replace the cake when it rots, changing two or three times. Once the patient regains slight consciousness, administer Ginger Juice Decoction along with Hu yang Jiu Ji Tang (Restore Yang Rescue Crisis Decoction). If unconscious, moxa Guanyuan (CV-4) and Qihai (CV-6) acupoints for 20-30 moxa cones to conduct internal heat, expel external pathogen, and restore Yang Qi within the extreme Yin. Warming extremities and sweating indicate survival; lack of warmth, sweating, and continued unconsciousness indicate death.
1. For Shanghan febrile diseases where heat transmits to the interior and reaches extreme hyperactivity without resolution: Decoct Coptis (Huanglian) in water, chill it in well water, soak a blue cloth, and apply to the chest. Replace when slightly warm. Remove once heat subsides slightly; do not leave for long. Use this in summer, not in winter.
1. For Shanghan patients who vomit immediately after taking medicine and cannot retain it: Firmly press Neiguan (PC-6) acupoint using a bamboo tube, then administer half a cup of hot natural ginger juice to stop vomiting. Generally, cold medicines should be taken warm, hot medicines cold, and neutral medicines lukewarm. To induce sweating, even pungent-sweet formulas should be taken hot; to stop sweating, even pungent-sweet-warm formulas should be taken warm.
1. For Stroke (Zhong Feng) with phlegm-jue, sudden collapse, coma, and near-death state: First, burn paper twisted with Soap Pod (Zaojiao) powder and inhale the smoke into the nose. Presence of sneezing indicates treatability. Then use expectorant method: Mix 5 fen of Soap Pod powder, 3 fen each of Pinellia (Banxia) and Alum (Baifan) into fine powder, mix with ginger juice, and induce vomiting. Follow with modified Dao Tan Tang (Guide Out Phlegm Decoction). Absence of sneezing indicates untreatability.
1. For Gan Huoluan (Dry Cholera) unable to vomit: Drink one bowl of boiling water mixed with 3 fen of Soap Pod powder and a pinch of salt to induce vomiting. Do not provide rice soup; doing so is fatal as grain Qi aids the pathogen.
1. For sudden collapse due to Cold invasion, coma, and unconsciousness: Administer half a cup of hot wine mixed with half a cup of ginger juice. Once slightly conscious, administer Jia Wei Li Zhong Yin (Modified Regulate Middle Drink) for efficacy. Non-drinkers should receive only ginger juice, following the same protocol. This condition is common in the twelfth lunar month but rare in other months.
1. For Shanghan persisting beyond ten days with exterior signs suitable for diaphoresis: Use Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) for mild sweating. If interior signs suitable for purgation appear after ten days: Use Da Chaihu Tang (Greater Bupleurum Decoction) for purgation. Since Shanghan lasting many days depletes Zheng Qi, strong formulas like Mahuang Tang or Chengqi Tang are too harsh. Misuse of Mahuang leads to loss of Yang; misuse of Chengqi leads to uncontrollable purging. Hence the warning. If exterior signs remain while interior urgency requires purgation, Da Chaihu Tang is used to harmonize exterior and interior gently. For elderly, weak, or Qi-Blood deficient patients with interior excess signs, Da Chaihu Tang is also used to avoid damaging Yuan Qi. Young and robust patients are not bound by this prohibition and should be treated according to individual suitability.