伤寒新愈，起居作劳，因而复病，谓之劳复。强食谷食，因而复病，谓之食复。男女交接，复而自病，谓
之房劳复。男女交接，相易为病，谓之阴阳易，谓男传不病之女，女传不病之男，有如交易也。盖因其人新差，
余邪伏于脏腑，未经悉解，故犯之辄复也。学人于临证时，审其脉证而详辨之，则施治自无误矣。
大病瘥后，劳复者，枳实栀子豉汤主之。若有宿食者，加大黄，如博棋子五六枚。
【注】大病瘥后，谓伤寒病新瘥后也。劳复者，谓起居作劳复病，非房劳复也，宜枳实栀子豉汤主之。温
覆，令微似汗自愈，不取其涌者，以热不在胸而在经也。若因过食复病者，谓之食复，以有宿食也，宜枳实桅
子豉汤加大黄下之。
【集注】成无己曰∶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。
王肯堂曰∶伤寒之邪自外入，劳复之邪自内发。
枳实栀子豉汤方
枳实（炙，三枚） 栀子（擘，十四枚） 豉（绵裹，一升）
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。
【方解】是方也，用清浆水七升，空煮至四升者，是欲水之熟而趋下，不欲上涌作吐也。下豉煮五六沸即
去滓者，取其清腐之气走表，易于取汗也。太阳用之以作吐，劳复用之以作汗。仲景用方之妙，药品虽同，煎
法各异，故施用不同也，于此可类推矣。
【集解】方有执曰∶大邪初退，血气新虚，起居作劳，复生余热，乃用苦寒以发其微汗者，以劳伤之复
热，与初病之实热不同伦也。方中用清浆水七升，空煮至四升，全是欲水之熟而趋下，不至上涌作吐，与太阳
中篇下后身热取吐之法不同，所以覆令微似汗也。
伤寒瘥已，后更发热，小柴胡汤主之。脉浮者，以汗解之，脉沉实者，以下解之。
【注】此承上条详言证脉，以别其治也。伤寒瘥已，后更复发热者，虽有劳复、食复之别，然须分或宜
和、或宜汗、或宜下之不同。如脉浮有表，当以汗解者，用枳实栀子豉汤汗之；脉沉有里者，当以下解者，用
枳实栀子豉加大黄汤下之；若无表里证，当和解之者，用小柴胡汤和之。对证施治，斯为合法。
【集注】方有执曰∶此示病后不谨调理，致复之大法。脉浮，有所重感者也。脉沉，饮食失节也。
魏荔彤曰∶大病后不宜大汗，喻注谓用枳实栀豉汤以微汗是也。大病后不宜大下，喻注谓枳实栀豉汤加
大黄以微下是也。然亦有不能尽该者，凡于汗下之中，留心其为大病之后，庶治复病，而不碍于大病后也。
大病瘥后，从腰以下有水气者，牡蛎泽泻散主之。
【注】伤寒病瘥后，从腰以下肿者，是有水气也，宜牡蛎泽泻散，峻逐水气，恐缓则
水盛，必上犯阳部也。
【集注】成无己曰∶大病瘥后，脾胃气虚，不能制约肾水，水溢下焦，故腰以下为肿也。《金匮要略》云∶
腰以下肿，当利小便，与牡蛎泽泻散，利小便而散水可也。
牡蛎泽泻散方
牡蛎（熬） 泽泻 栝蒌根 蜀漆（暖水洗去腥） 商陆根（熬） 海藻（洗去咸） 苦葶苈（熬，各等分）
上七味，异捣下筛为散，更入臼中治之。白饮和服方寸匕，日三服。小便利，止后服。
【方解】水停于内，外泛作肿，腰以上者，当汗之，小青龙、越婢是也；腰以下者，当利小便，此方是
也。以牡蛎破水之坚，泽泻利水之蓄，海藻散水之泛，栝蒌根消水之肿，又以蜀漆、苦葶苈、商陆根辛苦有毒
之品，直捣其巢，峻逐水气，使从大、小二便而出。然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。
【注】大病瘥后，喜唾，久不了了者，胃中虚寒，不能运化津液，聚而成唾，故唾日久无已时也，宜理
中丸以温补其胃，自可已也。
【集注】程知曰∶病后阳气不足，胃中虚寒，不内津液，故喜唾不了了。前牡蛎泽泻用散者，欲其恋肺
而下水也；此理中用丸者，欲其温胃而收唾也。
喻昌曰∶身中津液，因胃寒凝结而成浊唾，久而不清，其人必消瘦索泽，故不用汤药荡涤，而用丸药缓图也。
张璐曰∶伤寒瘥后体虚，每有遗热，故禁温补，即间有素禀虚寒者，只宜理中丸调理，未尝轻用桂、附也。
伤寒解后，虚羸少气，气逆欲吐，竹叶石膏汤主之。
【注】伤寒解后虚羸，寒伤形也；少气，热伤气也；气逆欲吐，余邪挟饮犯胃也。故宜竹叶石膏汤，益虚
清热，以降逆气也。
【集注】方有执曰∶病后虚羸少气，脾胃未强，饮食难化，则痰饮易生，饮停气逆，故欲吐也。
程知曰∶伤寒解后，津液不足，则虚羸；余热不尽，则伤气。与竹叶石膏汤，以调胃而去虚热。盖前条
是治病后虚寒，此条是治病后虚热也。
竹叶石膏汤方
竹叶（二把） 石膏（一斤） 半夏（洗，半升） 人参（二两） 甘草（炙，二两） 粳米（半升）
麦冬（去心，一升）
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。
【方解】是方也，即白虎汤去知母，加人参、麦冬、半夏、竹叶也。以大寒之剂，易为清补之方，此仲
景白虎变方也。经曰∶形不足者，温之以气；精不足者，补之以味。故用人参、粳米，补形气也。佐竹叶、石
膏，清胃热也。加麦冬生津；半夏降逆，更逐痰饮；甘草补中，且以调和诸药也。
病患脉已解，而日暮微烦，以病新瘥，人强与谷，脾胃气尚弱，不能消谷，故令微烦，损谷则愈。
【注】病患脉已解，谓病脉悉解也。惟日西微烦者，以病新瘥，强食谷早，胃气尚弱，不能消谷，故令
微烦，不须药也，损谷自愈。
【集注】方有执曰∶强与谷，谓强其进食也。损者，言当节减之也。
喻昌曰∶注家牵引日暮为阳明之旺时，故以损谷为当小下。不知此论瘥后之证，非论六经转阳明之证也。
日暮，即《内经》日西而阳气已衰之意，所以不能消谷也。不可引前条宿食，轻用大黄，重伤脾胃也。
王鹤田曰∶此言瘥后强食，而为虚中之实证也。病后起居坐卧，俱宜听其自然，不可勉强，强则非其所欲，
反逆其性而不安矣，不特一食也。
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，
膝胫拘急者，烧 散主之。
【注】伤寒新愈之后，男女不谨，偶犯余事，发热复病者，谓之房劳复。男以六味地黄汤主之，女以四物
汤主之，随证加减治之可也。若犯余事，男病传女，女病传男，相易为病，谓之阴阳易。其证身重少气，少腹
急痛，牵引阴中，膝胫拘急，或热气冲胸，头重不欲举，眼中生花等证，皆余毒乘虚传易也，当以烧 散主之。
【集注】王肯堂曰∶房劳复病，谓新瘥之后，或尚未愈，而男妇相交接复病者，若同阴阳易证，则从阴阳
易治。亦有寒热多汗，头重目眩，腹中拘急，百节解离，经脉缓弱，筋骨痿软，不能动移，精髓空虚，心神恍
惚，迁延岁月方死者，宜当归四逆汤。厥者加附子，寒者加吴茱萸、生姜，以治之。按∶瘥后男女交合而病者，
若无阴阳易证，而有表证，则不可从阴阳易治，当从房事后犯风寒治，汗、吐、下法，皆不可轻用。即有应汗、
应吐之证，汗则以补中益气汤加麻、桂微汗之，厥者加炮附子；吐则以补中益气汤加淡豆豉探吐之。适可即止，
总当识此为新病之后也。
方有执曰∶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。身体重少气，真元亏竭而困倦也。少腹里急，或引阴中拘挛者，所易之气内攻也。热上冲
胸，头不欲举，眼中生花者，虚阳生热而上蒸也。膝胫拘急者，脉乱而筋伤也， 裆近阴处，阴阳二气之气聚
也。男女易用，物各归本也。
喻昌曰∶病伤寒之人，热毒藏于气血中者，渐从表里解散，惟热毒藏于骨髓之中者，无曲发泄。故差后与
不病之体交接，男病传不病之女，女病传不病之男，所以名为阴阳易，即交易之义也。
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。
【方解】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。
After the recent recovery from Shanghan (Cold Damage), if illness recurs due to excessive physical or mental exertion in daily activities, it is termed "Lao Fu" (Relapse due to Fatigue). If illness recurs due to forced consumption of grain foods, it is termed "Shi Fu" (Relapse due to Diet). If sexual intercourse occurs after recovery and illness ensues spontaneously, it is termed "Fang Lao Fu" (Relapse due to Sexual Exhaustion). If sexual intercourse leads to mutual transmission of disease between partners, it is termed "Yin Yang Yi" (Exchange of Yin and Yang), meaning a man transmits his illness to an uninfected woman, or a woman to an uninfected man, akin to an exchange. This occurs because residual pathogenic factors remain latent in the Zang-Fu organs after recent recovery and have not been fully cleared; thus, any transgression leads to recurrence. Clinicians must carefully examine the pulse and symptoms during practice to distinguish these conditions accurately, ensuring correct treatment.
For relapse due to fatigue following a major illness, Zhishi Zhizi Chitang (Bitter Orange, Gardenia, and Fermented Soybean Decoction) is the primary formula. If there is retained food stagnation, add Dahuang (Rhubarb Root), approximately five to six pieces the size of a Go stone.
[Annotation] "Major illness recovery" refers to the recent healing from Shanghan. "Lao Fu" refers to relapse due to daily labor, not specifically sexual exhaustion, and is treated with Zhishi Zhizi Chitang. Covering the patient to induce slight sweating will lead to self-healing; inducing vomiting is not sought because the heat is in the meridians, not in the chest-diaphragm region. If relapse is caused by overeating, it is called "Shi Fu" due to retained food, and Zhishi Zhizi Chitang with added Dahuang should be used to purge.
[Collected Annotations] Cheng Wuji stated: In Lao Fu, floating heat requires Zhishi Zhizi Chitang to resolve it. In Shi Fu, retained food in the stomach requires Dahuang to purge it.
Wang Kentang stated: The pathogen of Shanghan enters from the exterior, while the pathogen of Lao Fu arises from within.
Zhishi Zhizi Chitang Formula
Zhishi (Zhi/Roasted Bitter Orange, 3 pieces)
Zhizi (Broken Gardenia Fruit, 14 pieces)
Chishi (Mianwrapped/Silk-wrapped Fermented Soybean, 1 Sheng)
Process: Boil the three ingredients in 7 Sheng of Qingjiangshui (Clear Acidic Rice Water), reducing by empty boiling to 4 Sheng. Add Zhishi and Zhizi, boil to obtain 2 Sheng. Add Chishi, boil for 5-6 boils, remove dregs. Take warm, divided into two doses. Cover to induce slight sweating.
[Formula Analysis] Using 7 Sheng of Qingjiangshui and empty-boiling to 4 Sheng aims to make the water cooked and directed downward, avoiding upward涌吐 (vomiting). Adding Chishi at the end and boiling briefly utilizes its clear, fermented aroma to reach the exterior and facilitate sweating. In the Taiyang chapter, this combination is used for vomiting; here for Lao Fu, it is used for sweating. The subtlety of Zhang Zhongjing's prescriptions lies in varying decoction methods despite identical ingredients, leading to different effects.
[Jie Jie] Fang Youzhi stated: After the major pathogen recedes, blood and Qi are newly deficient. Exertion generates residual heat. Using bitter-cold herbs to induce slight sweating is appropriate because the heat from fatigue differs from the excess heat of initial illness. Empty-boiling the water directs it downward, preventing vomiting, unlike the method for vomiting after purgation in the Taiyang chapter, thus inducing slight sweating instead.
If fever recurs after Shanghan has resolved, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. If the pulse is Floating, resolve via sweating; if Sinking and Excess, resolve via purgation.
[Annotation] This elaborates on the previous section regarding pulse and symptom differentiation for treatment. Recurrent fever after recovery may stem from Lao Fu or Shi Fu, but treatment must distinguish between harmonizing, sweating, or purging. If the pulse is Floating with exterior signs, use Zhishi Zhizi Chitang to sweat; if Sinking with interior signs, use Zhishi Zhizi Chitang plus Dahuang to purge; if no exterior/interior signs exist, use Xiaochaihu Tang to harmonize. Treating according to the syndrome is correct.
[Collected Annotations] Fang Youzhi stated: This warns against improper post-illness care causing relapse. Floating pulse indicates re-infection; Sinking pulse indicates dietary irregularity.
Wei Litong stated: Post-major illness, heavy sweating is contraindicated; Yu Chang’s note that Zhishi Zhizi Chitach induces slight sweating is correct. Heavy purgation is also contraindicated; adding Dahuang to Zhishi Zhizi Chitang for slight purgation is correct. However, one must always consider the post-major illness state when applying sweating or purging methods to avoid damaging the recovering body.
For edema/water accumulation below the waist after major illness recovery, Mussei Zeixie San (Oyster Shell and Alisma Powder) is indicated.
[Annotation] Edema below the waist after Shanghan recovery indicates water retention. Mussei Zeixie San should be used to vigorously drain water, as delay may allow water to rise and attack Yang regions.
[Collected Annotations] Cheng Wuji stated: Post-recovery Spleen-Stomach Qi deficiency fails to control Kidney Water, causing overflow in the Lower Jiao and edema below the waist. *Jingui Yaolue* states: For edema below the waist, promote urination. Mussei Zeixie San promotes urination to dissipate water.
Mussei Zeixie San Formula
Mussei (Roasted Oyster Shell)
Zeixie (Alisma Rhizome)
Gualougen (Trichosanthes Root)
Shuqi (Washed with warm water to remove fishy odor)
Shanglugen (Roasted Commercial Phytolacca Root)
Haizao (Washed to remove saltiness)
Tinglizi (Roasted Semen Lepidii/Semen Descurainiae, equal parts)
Process: Pulverize each ingredient separately, sieve, and mix. Take 1 Cunbi (square-inch measure) mixed with rice water, three times daily. Stop medication once urination becomes free.
[Formula Analysis] Internal water retention causing external edema: Above the waist requires sweating (Xiao Qinglong Tang, Yuebi Tang); below the waist requires promoting urination (this formula). Mussei breaks water hardness; Zeixie drains water accumulation; Haizao disperses water flooding; Gualougen reduces swelling. Shuqi, Tinglizi, and Shanglugen are pungent, bitter, and toxic, attacking the root to vigorously drain water via bowel and bladder movements. This formula is for excess constitution; it is contraindicated in post-illness Spleen deficiency or Kidney failure to transform fluids.
Post-major illness, frequent spitting that persists long-term, with cold above the chest, should be treated with warming pills, specifically Lizhong Wan (Regulate the Middle Pill).
[Annotation] Frequent spitting persisting after recovery indicates Stomach deficiency-cold failing to transform fluids, which accumulate into saliva. Lizhong Wan warms and tonifies the Stomach to cure this.
[Collected Annotations] Cheng Zhi stated: Post-illness Yang deficiency and Stomach cold fail to retain fluids, causing persistent spitting. Mussei Zeixie San uses powder to descend water via the Lung; Lizhong Wan uses pill form to warm the Stomach and stop spitting.
Yu Chang stated: Fluids congeal into turbid saliva due to Stomach cold. Long-standing clarity loss leads to emaciation. Thus, slow-acting pills are preferred over flushing decoctions.
Zhang Lu stated: Post-Shanghan weakness often leaves residual heat, so warming tonics are generally forbidden. Even for constitutional deficiency-cold, only Lizhong Wan is suitable for regulation, rarely using Guizhi (Cinnamon Twig) or Fuzi (Aconite Root).
After Shanghan resolves, if the patient is emaciated, short of breath, and experiences rebellious Qi with nausea, Zhuyeshigao Tang (Bamboo Leaf and Gypsum Decoction) is indicated.
[Annotation] Emaciation indicates Cold damaged the Form; shortness of breath indicates Heat damaged Qi; rebellious Qi and nausea indicate residual pathogens carrying fluid retention invading the Stomach. Zhuyeshigao Tang tonifies deficiency, clears heat, and descends rebellious Qi.
[Collected Annotations] Fang Youzhi stated: Post-illness weakness and shortness of breath imply weak Spleen-Stomach, leading to difficult digestion and phlegm-fluid generation. Fluid retention causes Qi rebellion and nausea.
Cheng Zhi stated: Insufficient fluids cause emaciation; lingering residual heat damages Qi. Zhuyeshigao Tang regulates the Stomach and clears deficient heat. The previous clause treated post-illness deficiency-cold; this treats post-illness deficiency-heat.
Zhuyeshigao Tang Formula
Zhuye (Two handfuls)
Shigao (One Jin)
Banxia (Washed, Half Sheng)
Renshen (Two Liang)
Gancao (Zhi/Roasted Licorice Root, Two Liang)
Jingmi (Half Sheng)
Maidong (Heart-removed, One Sheng)
Process: Boil seven ingredients in 10 Dou of water to obtain 6 Sheng. Remove dregs, add Jingmi, cook until rice is done. Remove rice. Take 1 Sheng warm, three times daily.
[Formula Analysis] This is Baihu Tang (White Tiger Decoction) minus Zhimu, plus Renshen, Maidong, Banxia, and Zhuye. It transforms a major cold formula into a clearing and tonifying one. As the Canon states: Tonify deficient Form with Qi; tonify deficient Essence with Flavor. Renshen and Jingmi tonify Qi and Form. Zhuye and Shigao clear Stomach heat. Maidong generates fluids; Banxia descends Qi and eliminates phlegm-fluid. Gancao tonifies the Middle and harmonizes the herbs.
If the patient's pulse has normalized but they experience mild vexation in the evening, it is because the illness recently resolved, and forced eating overwhelms the still-weak Spleen-Stomach Qi, which cannot digest the food, causing mild vexation. Reducing food intake will lead to recovery.
[Annotation] "Pulse resolved" means pathological pulses have disappeared. Evening vexation occurs because recent recovery means weak Stomach Qi cannot digest forced early meals. No medicine is needed; reducing food intake allows self-healing.
[Collected Annotations] Fang Youzhi stated: "Forced eating" means compelling intake. "Reduce" means to ration.
Yu Chang stated: Annotators link evening time to the flourishing of Yangming, suggesting minor purgation. This is incorrect; this discusses post-recovery syndromes, not Six Meridian transmission to Yangming. Evening corresponds to declining Yang energy per *Neijing*, explaining poor digestion. Do not confuse this with retained food stagnation and lightly use Dahuang to injure Spleen-Stomach.
Wang Hetian stated: This describes a deficiency-excess syndrome caused by forced eating post-illness. Post-illness activity should follow nature; forcing actions goes against their nature and causes discomfort, not just regarding food.
In Shanghan, the disease of Yin Yang Yi presents with heavy body, shortness of breath, lower abdominal urgency, possibly drawing pain into the genitalia with spasms, hot Qi rushing to the chest, heavy head unwilling to lift, visual disturbances (seeing spots), and stiffness/spasms in knees and calves. Shaokui San (Burned Underwear Powder) is indicated.
[Annotation] After recent Shanghan recovery, careless sexual activity causing recurrent fever is "Fang Lao Fu," treated with Liuwei Dihuang Tang for men and Siwu Tang for women, modified by syndrome. If sexual contact causes mutual transmission ("Yin Yang Yi"), symptoms include heaviness, shortness of breath, lower abdominal pain radiating to genitals, knee/calf stiffness, hot Qi rushing to chest, heavy head, and visual spots. These are residual toxins transmitting via deficiency. Shaokui San is indicated.
[Collected Annotations] Wang Kentang stated: "Fang Lao Fu" is relapse after recovery or incomplete healing via intercourse. If similar to Yin Yang Yi, treat as such. Cases with chills, fever, sweating, dizziness, abdominal cramping, joint separation, weak meridians, flaccid sinews/bones, emptiness of essence/marrow, and confusion may die slowly; treat with Danggui Sini Tang. Add Fuzi for cold limbs, Wuzhuyu and Shengjiang for cold. Note: If post-intercourse illness has exterior signs but no Yin Yang Yi signs, treat as wind-cold invasion post-coitus. Sweating, vomiting, or purging should be avoided. If sweating is needed, use Buzhong Yiqi Tang plus Mahuang/Guizhi for slight sweating; add Pao Fuzi for cold limbs. If vomiting is needed, use Buzhong Yiqi Tang plus Danshichidou for induced vomiting. Stop appropriately, remembering this is a new illness post-recovery.
Fang Youzhi stated: "Shanghan" includes Fengzhong. "Yi" means exchange. After major illness, blood/Qi are unrepaid; forced intercourse causes Qi interaction and mutual exchange of disease. Heaviness/shortness of breath is Yuan Qi depletion. Lower abdominal urgency/genital spasms is exchanged Qi attacking internally. Hot Qi to chest/head heaviness/vision issues are deficient Yang generating heat rising. Knee/calf stiffness is chaotic pulse damaging sinews. The crotch area near genitals gathers Yin/Yang Qi. Exchange returns matter to its source.
Yu Chang stated: Heat toxins in blood/Qi disperse via surface/interior. Toxins hidden in bone marrow cannot easily exit. Thus, intercourse with healthy persons transmits disease (Man to Woman, Woman to Man), named Yin Yang Yi, meaning exchange.
Shaokui San Formula
Take the inner garment of a woman near the genitals, burn to ash.
Process: Take one Cunbi with water, three times daily. When urination becomes free and the glans swells slightly, recovery is achieved. For female patients, take the man's garment and burn it for administration.
[Formula Analysis] Male/female underwear is turbid/deteriorated matter. Burning it utilizes its penetrating/dispersing nature, following the principle of "similar Qi seeking each other." Recovery follows sweating or free urination. Slight swelling of the glans indicates the exchanged toxin exiting via the yin orifice.