（一名伤寒夹房劳）
【因】房劳伤精而后。骤感风寒。或夏月行房后。恣意乘凉。触犯风露。
【证】身热面赤。或不热而面青。小腹绞痛。足冷蜷卧。或吐或利。心下胀满。甚则舌卷囊缩。阴极发躁。
或昏沉不省。手足指甲皆青。冷过肘膝。舌苔淡白滑嫩。或苔黑滑。舌本胖嫩。
【脉】六部沉细。甚或伏绝。或反浮大无伦。沉按豁豁然空。陶节庵所谓不拘脉之浮沉大小。但指下无力
而软。或空大而散。甚则重按全无。皆为色欲内伤。猝受寒邪。阴气独盛。阳气以衰是也。
【治】外则先灸关元、气海。以回元汤。内则先用参附再造汤。助阳发表。或用麻附细辛汤加人参、干姜、温
经散寒。如脉伏绝。阴极发躁。继即神气昏沉。不省人事者。速用回阳急救汤。提神益气。回阳生脉。
如脉沉迟。身疼足冷。下利清谷。俗呼漏底者。速用附姜归桂参甘汤去当归。加白术、肉果、砂仁、升麻。破阴
回阳。提气止泻。如脉沉微。手足指甲皆青。四肢冷过肘膝。舌卷囊缩者。速用附子理中汤加吴萸、坎气、肉桂、
姜汁。温补命阳。热壮脾肾。一俟阳气将回。病势已有转机者。但用附姜归桂参甘汤。双补气血。调和阴阳。
次用理阴煎加砂仁、红枣。滋补肾阴。温运脾阳。终用左归饮。峻补肾阴以善后。总之、夹阴症。不分热与不热。
面赤面青。凭脉下药。最为切当。
【秀按】不但房劳不谨后。感冒风寒者。谓之夹阴伤寒。即曾犯房室。及冒雨涉水伤肾。一起即身热面赤。
足胫逆冷者。亦当参夹阴例治。伤寒夹阴。由太阳少阴二经同时受病。较直中寒证尤危。盖夹阴者。虽患表邪
发热。其中必夹虚寒。所以尺脉必不能实。足胫必不能温也。乃世俗混称夹阴。医者亦漫不加察。岂知伤寒阴
证有三。一传经之阴证。阴中之热证也。二直中之阴证。阴中之寒证也。三房室之阴证。阴中之虚证也。既犯
房室而得寒证。则阴寒极甚。温剂宜重。俞君于发表温里药中。每兼热药破阴以回阳。阳回而阴寒自散。寒散
而元阴自固。庶不致阴下竭。阳上厥。酿变虚脱危候。况末路理阴左归等剂。填补真阴。以复房室所伤之元
精。治法井然。可为夹阴伤寒之标准。虽然。予每见春夏感寒夹阴。足冷阳缩者。骤用四逆汤辛热回阳。多致
烦躁血溢而死者。以阴中既虚。不胜附子之雄悍也。故《伤寒秘旨》治夹阴伤寒。凡诊尺脉迟弱。而足冷
阳缩者。但于黄 建中汤内。用附子汁炒黄 以温卫气。肉桂酒炒白芍以调营血。不应。改用麻附细辛汁炒甘
草以汗之。若尺中弦数而多虚火。面赤戴阳者。但于小建中汤内。用党参汁炒甘草以助胃气。丹皮、酒炒白芍以
降阴火。不应。加连附汁炒黄 。略加葱豉以摄之。方药较俞君所用虽轻。而稳健则过之。亦其人阳气虽虚。
本无大寒伤犯。阴邪尚轻。犹可收敛。若夹阴伤寒。病于严冬。则真阳惫极。阴邪亢甚者多死。故许学士述古
谚云。伤寒偏死下虚人。至若曾犯房室。而遭风溺水。最忌热酒火烘。但宜温暖覆盖。原其溺水之时。必多惊
恐。心肾受伤。虽有发热头痛。骨节烦疼等症。治必解表药中。兼通心肾。在冬月用麻附细辛汤。以麻黄发汗
通心。附子温经通肾。细辛通彻表里之邪。更加苓、半以开豁惊痰。若在夏月。当以五苓散加葱、豉、辰砂。
因惊则气乱。故于发汗利水中加辰砂以镇之。或脉浮而见表症多者。五苓散加羌、防、益元。微汗以疏利之。
至于暴怒悲号。投河跃井。虽有表证当解。只须香苏葱豉汤加木香、乌药、川芎、郁金。理气发汗为要。兼有
跌伤作痛者。方中去木香、乌药。再加当归、桂枝、桃仁。活血去瘀以止痛。
【廉勘】房劳后得外感病。病适至行房。不过比他人略重。寒证则发寒更甚。热证则灼热尤极。在医者识时
审证。辨体立方。宜发表则发表。宜温中则温中。宜清里则清里。察其受病之浅深。决其用药之轻重。量其素
体之阴虚阳虚。于发表温中清里等法之中。兼顾其虚而补托之。如辨其人真阳素虚者。阴寒为本。邪多挟水而
动。除表寒症外。必兼为呕为咳。或腹痛下利。甚或面青足冷等症。发表药中。急宜加附子桂枝等品。如参附
再造汤。助阳破阴以发汗。庶免逼汗亡阳之患。如辨其人真阴素虚者。阳亢为本。邪多挟火而动。除新感症
外。必兼口燥咽干。或心烦不寐。甚或面赤肢厥等症。发表药中。亦宜加生地、麦冬。如七味葱白汤。养血滋
阴以发汗。始能津津汗出而解。表邪解后。阳虚者中气必亏。温中药中。早宜加肉桂、附子等品。如附子理中
汤加肉桂。以助阳而御阴。庶免中阳暴脱之患。阴虚者元精益亏。清里药中。亦宜加生地、麦冬。如导赤清心
汤。以救阴而生津。庶免元精暴绝之虞。即或有寒入精室。其症阴肿足冷。小腹绞痛。面赤阳缩。筋惕肉 。
犹可用真武汤。加两头尖、韭白等。或用当归四逆汤加烧 散。（即妇人 裆近阴处、剪取一块、烧灰、
调入药汤中服、妇人病取男子 裆、如前一般。）回阳摄阴。兼通阴浊。以救济之。外罨通阴达阳法。（用
来复丹二钱、研末、放入脐中、上罨活杀白鹁鸽对剖半只、内去肠杂、外不去毛。再加软绵扎紧、约三小时即
去之。）或用生姜汁一碗。浸肾囊。汁渐收干。肾茎即出。或用回阳散二三分。放入脐中。外贴阳和解凝膏。
即痛除而茎出。如热入精室。即俗称夹阴温病。较夹阴伤寒尤险。由欲火与伏火交蒸。深恐转瞬阴竭。急宜
救阴泄浊。峻泻其交蒸之火。以存真阴。如陶氏逍遥汤及滋任益阴煎加减。（本方去砂仁、熟地、炙草、
加烧 散、槐米、白薇、生甘细梢、熟地露代水煎药。）神气昏厥者。外用通窍透邪法。（用安宫牛黄丸
两颗、研细、用银花露调和成饼、安入心下、上罨对剖白鹁鸽半只、用帛扎紧、一俟鸽有臭气、即揭去之。）
犹可十救三四。
【炳章按】宋爱人曰。徐灵胎《医学源流论》曰。今之医者曰。有人入房之后。或遗精之后。其复感冒风
寒而发热者。谓之阴证。不问其见证若何。总用参、术、附、桂、姜、萸等温热峻补之药。此可称绝倒者也。
阴虚之人。而感风寒。亦由太阳经入。仍属阳邪。其热必盛。兼以躁闷烦闷。尤宜清热解邪。岂可反用热药。
若果直入三阴。则断无发热之理。必有恶寒蜷卧。厥冷喜热等症。方可用温散也。然亦终无用滋补之法者。即
如伤寒瘥后。房事不慎。又发寒热。谓之女劳复。此乃久虚之人。复患大证。根据今人之见。尤宜峻补者也。而
古人治之。仅用竹茹一升煎汤后。故凡治病之法。总视目前之现症状况。如果六脉沉迟。表里皆寒。的系三
阴寒证者。即使其人本体强壮。又或绝欲十年。亦从阴治。若使所见脉证。的系阳邪。发热烦渴便闭。并无三阴寒证
者。即使其人本体虚弱。又复房劳过度。亦从阳治。如《伤寒论》中。阳明大热之症。宜用葛根、黄芩、
白虎、承气之类。设使转瞬之间。转入三阴。即改用温补。若阴症转变阳症。治法亦可于温补后。改
用凉散。此一定之法也。
喻嘉言治黄长人犯房劳。病伤寒十余日厥逆。医将投以姜桂温散之药。作阴症治矣。喻氏改进调胃承
气汤。而厥还热透。继以大柴胡汤。而热退身安。归而告门人曰。凡伤寒病。初起发热。煎熬津液。鼻干口渴
便闭。渐至发厥者。不问而知为热也。若阳证忽变阴厥者。万中无一也。盖阴厥得之阴证。一起便直中阴
证。唇青面白。遍体冷汗。便利不渴。身倦多睡。醒则人事了了。与伤寒传经之热邪。转入转深。人事昏厥
者。万万不同。如是证先犯房事。后成伤寒。世医无不为阴证之名所惑。往往投以四逆等汤。促其暴亡。而
卒至阴竭莫救。尚不知悟也。夫房劳而至伤寒者。其势不过比常较重。如发热则热之极。恶寒则寒之甚。头
痛则痛之剧。所以然者。以阴虚阳往乘之。非阴盛无阳之比也。伤寒初起。便觉发热发渴。定然阴分先亏。
是以治阴症以救阳为主。治伤寒以救阴为主。伤寒纵有阳虚。治当看其人之血肉充甚。阴分可受阳药者。
方可还阳。若面黧舌黑。身如枯柴。一团邪火内燔腑脏。则阴已先尽。何阳可还耶。故见厥除热。存津液之
气于什一。已失之晚。况敢助阳劫阴乎。
江苓友《伤寒辨证广注》曰。人身一阴阳耳。而阴阳之根蒂。皆本于肾。好色之徒。两肾受伤。阴虚
者多。阳虚者少。阳虚者、命门火衰也。阴虚者、肾中水竭也。凡人入房过度。则精多所遗。所遗之精。
皆为水而属阴。况其作强之时。心火必炽。火炽则水流。水愈流则火愈炽。五内燥热。外复伤寒而病邪热。
两热相交。肾水必枯。其人发烦躁。而舌黑生芒。则就死矣。语曰、伤寒偏打下虚人者。正此谓也。或
曰诚如子言。则是人病伤寒。无所为阴症矣。余曰有之。阴症中寒也。其症乃是阳虚。阳虚之人。命门火
衰。其平日必言语低微。饮食
不化。四肢痿厥。腰以下冷。前阴不举。小便清白。此为正气不足。复为寒邪所袭。表里四末皆冷。是为真寒
之症。然亦不全因入房所致。即小儿亦有阴症者。斯恍然于房后不可尽作阴症观矣。据炳章经验所得。风寒感
冒于表。食物生冷由胃传脾。为真夹阴伤寒。若行房后。伤寒身热。其病不从行房而得。无夹阴可言。其治法
亦照表症用药。惟伤寒热退新瘥。即犯房事。名曰房劳复。身热、下体沉重疼痛。大病初瘥。元气精血本虚。
犯房失精。重虚其虚。新邪乘虚而入故身热。败精留于精室。故下体沉重作痛。治宜扶元清热。化瘀导浊。仍
大小便而出。凡房劳复。详明治法。已另补于第十一章伤寒复证条下。本节不复重赘。
【荣斋按】本节（夹阴伤寒）俞氏根据王海藏阴证治例，主张初用“温经散寒”，继用“温补命阳热壮脾
肾，”善后用“双补气血调和阴阳”；他认定证因是由于房事后中寒，所以处治始终以破阴回阳立法。然而早
在明末清初之际，喻嘉言、徐灵胎辈，都不同意以“温热峻补”之药来治疗所谓“夹阴伤寒”（见曹炳章先生
按语中），陆九芝《世补斋医书》里更肯定的说∶“惟有发热不是阴证，惟有阴证必不发热。”在此，我们可以得
出结论∶俞氏的治法，它适应证为房后中寒，它现证必不发热。他所述“身热面赤”的证状，是不应当有的；
如其有之，便不适宜于“温补”了。王德森《市隐庐医学杂着》说∶“今人于年轻有室之人，一经发热，治之不
应，必指为夹阴症，改用附、桂、参、地，大热大补之品以杀之。不知房劳或遗精之后，感受风寒，亦必由太
阳经入，仍属阳邪，其热必甚；兼以躁闷烦渴，尤宜清热散邪，岂可反用热药？若果直中三阴，则断无壮热之
理，必有恶寒蜷卧，厥冷喜热等症，方可用温散；然亦终无用滋补之法。”说理明白，可以作所谓“夹阴伤
寒”的治疗指针。
(Also known as Cold Damage with Coitus Depletion)
[Etiology] Following excessive sexual activity that injures Kidney Essence, sudden exposure to Wind-Cold pathogens. Or after sexual intercourse in summer months, indulging in cooling off and being exposed to Wind-Dew pathogens.
[Symptoms] Body heat and flushed face, or no heat but a cyanotic face, severe cramping pain in the lower abdomen, cold feet with curling up for sleep, vomiting or diarrhea, fullness in the epigastrium, even to the point of tongue retraction and scrotal contraction. This is restlessness caused by extreme Yin-cold, or lethargy and unconsciousness, cyanosis of fingernails and toenails, coldness extending beyond elbows and knees, pale white and slippery tender tongue coating, or black slippery coating, and a fat, tender tongue body.
[Pulse] All six pulse positions are deep and fine, or even hidden (Fú Mài, 伏脉) or imperceptible. Or conversely floating and excessively large, but hollow upon heavy pressure. As Tao Jie'an stated, regardless of whether the pulse is floating, sunken, large, or small, if it feels weak and soft under the fingers, or empty, large, and scattered, or completely absent upon heavy pressure, this is due to internal injury from sexual excess, sudden invasion of Cold pathogen, resulting in solitary dominance of Yin Qi and decline of Yang Qi.
[Treatment] Externally, moxa should be applied first to Guanyuan (CV4, Gate of Origin) and Qihai (CV6, Sea of Qi) acupoints to restore Yuan Qi. Internally, Shenfu Zaizao Tang (Ginseng and Aconite Restoration Decoction) should be used first to assist Yang and release the exterior. Alternatively, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) added with Renshen (Ren Shen, Ginseng Radix et Rhizoma) and Ganjiang (Gan Jiang, Zingiberis Rhizoma) to warm the meridians and dissipate Cold. If the pulse is hidden or absent, extreme Yin-cold causes restlessness, followed by lethargy and unconsciousness, use Huiyang Jijiu Tang (Return Yang Emergency Rescue Decoction) immediately to revive spirit, benefit Qi, return Yang, and generate pulse. If the pulse is deep and slow, body ache, cold feet, and diarrhea with undigested food (colloquially called "leaky bottom"), use Fuzi Jiang Gui Can Gan Tang (Aconite, Ginger, Cinnamon Twig, Ginseng, and Licorice Decoction) removing Danggui (Dang Gui, Angelicae Sinensis Radix), adding Baizhu (Bai Zhu, Atractylodis Macrocephalae Rhizoma), Rouguou (Rou Dou Kou, Myristicae Semen), Sharen (Sha Ren, Amomi Fructus), and Shengma (Sheng Ma, Cimicifugae Rhizoma) to break Yin, return Yang, lift Qi, and stop diarrhea. If the pulse is deep and faint, cyanosis of nails, coldness beyond elbows and knees, tongue retraction, and scrotal contraction, use Fuzi Lizhong Tang (Aconite and Poria Decoction) added with Wuyu (Wu Zhu Yu, Evodiae Fructus), Kanqi (Kan Qi, Umbilicus Humanus), Rougui (Rou Gui, Cinnamomi Cortex), and Jiangzhi (Jiang Zhi, Zingiberis Juice) to warm and tonify Mingmen Fire, strengthen Spleen and Kidney with heat. Once Yang Qi is about to return and the disease shows signs of turning, use only Fuzi Jiang Gui Can Tang to double-tonify Qi and Blood, harmonize Yin and Yang. Next, use Liyin Jian (Nourishing Yin Decoction) added with Sharen and Hongzao (Hong Zao, Jujubae Fructus) to nourish Kidney Yin and warm Spleen Yang. Finally, use Zuogui Yin (Left Restoring Drink) to severely tonify Kidney Yin for convalescence. In summary, for Cold Damage with Coitus Depletion, regardless of fever or not, red or cyanotic face, prescribing medicine based on the pulse is most appropriate.
[Xiu's Note] It is not only those who catch Wind-Cold after careless sexual activity that are called Cold Damage with Coitus Depletion; even those who have engaged in intercourse, or waded in rain/water injuring the Kidney, presenting with body heat, flushed face, and reversed cold in calves/shins from onset, should also be treated according to the example of Cold Damage with Coitus Depletion. Cold Damage with Coitus Depletion involves simultaneous disease of the Taiyang and Shaoyin meridians, which is more critical than direct transmission of Cold patterns. Generally, although there is exterior pathogen fever, there must be internal deficiency-cold; thus, the Chi pulse cannot be solid, and calves/shins cannot be warm. However, laypeople confuse the term, and doctors fail to examine carefully. One must know there are three types of Yin patterns in Cold Damage: 1. Transmitted Yin pattern, which is Heat within Yin; 2. Directly transmitted Yin pattern, which is Cold within Yin; 3. Coital Yin pattern, which is Deficiency within Yin. Having engaged in intercourse and contracted Cold means extreme Yin-cold, so warming agents should be heavy. Master Yu often combines hot herbs with exterior-releasing and interior-warming drugs to break Yin and return Yang; when Yang returns, Yin-cold disperses naturally, and when Cold disperses, Yuan Yin stabilizes, preventing Yin exhaustion below and Yang rebellion above, avoiding critical collapse. Furthermore, using Liyin Jian and Zuogui Yin at the end to fill True Yin and recover Yuan Essence injured by coitus provides an orderly treatment method, serving as a standard for Cold Damage with Coitus Depletion. Nevertheless, I have seen patients in spring/summer with Cold Damage and Coitus Depletion, cold feet and retracted penis, suddenly given Si Ni Tang (Four Reversal Decoction), a pungent-hot Yang-returning formula, leading to restlessness and hemorrhage death. This is because the interior Yin is already deficient and cannot withstand the fierce nature of Fuzi (Fu Zi, Aconiti Lateralis Radix Praeparata). Thus, *Shanghan Mizhi* (Secrets of Cold Damage) treats Cold Damage with Coitus Depletion: whenever Chi pulse is slow and weak with cold feet/retracted penis, use Huangqi Jianzhong Tang (Astragalus Middle-Nourishing Decoction), stir-frying Huangqi (Huang Qi, Astragali Radix) with Fuzi juice to warm Wei Qi, and stir-frying Baishao (Bai Shao, Paeoniae Radix Alba) with Rougui juice to regulate Ying Blood. If ineffective, switch to Mahuang Fuzi Xixin juice stir-fried Gancao (Gan Cao, Glycyrrhizae Radix et Rhizoma) to induce sweating. If Chi pulse is wiry-rapid with deficient fire and flushed face (Dai Yang, floating yang), use Xiaojianzhong Tang (Minor Middle-Nourishing Decoction), stir-frying Gancao with Dangshen (Dang Shen, Codonopsis Radix) to assist Stomach Qi, and Danpi (Mu Dan Pi, Moutan Cortex) with stir-fried Baishao to descend Yin fire. If ineffective, add Lianfu (Lian Suo? Likely refers to a specific preparation involving Coptis/Aconite) stir-fried Huangqi, plus Congchi (Scallion and Soybean Fermented Product) to gather. Although milder than Master Yu's prescriptions, it is steadier. This is because the patient's Yang is deficient but not severely damaged by Cold, and Yin pathogen is light enough to be gathered. If Cold Damage with Coitus Depletion occurs in harsh winter, true Yang is exhausted and Yin pathogen is hyperactive, mostly resulting in death. As Xu Xueshi quoted: "Cold damage tends to kill those with lower deficiency." Regarding those who had intercourse and then suffered wind/water drowning, hot wine and fire heating are strictly contraindicated; only warmth covering is suitable. Drowning implies fright, injuring Heart and Kidney. Even with fever, headache, bone/joint pain, treatment must combine Heart-Kidney unblocking with exterior-releasing herbs. In winter, use Mahuang Fuzi Xixin Tang: Mahuang induces sweat and unblocks Heart, Fuzi warms meridians and unblocks Kidney, Xixin penetrates interior/exterior pathogens, plus Fuling (Fu Ling, Polyporus) and Banxia (Ban Xia, Pinelliae Rhizoma) to resolve fright-phlegm. In summer, use Wuling San (Five-Ingredient Poria Powder) plus Cong, Chi, Zhensha (Cinnabar). Since fright disrupts Qi, Zhensha is added to calm during sweating and diuresis. If pulse is floating with many exterior symptoms, use Wuling San plus Qianghuo (Qiang Huo, Notopterygii Rhizoma et Radix), Fangfeng (Fang Feng, Saposhnikoviae Radix), Yiyuan San (Benefit-Yuan Powder) for mild sweating to disperse. For violent anger/sobbing, jumping into water/wells, even with exterior symptoms requiring release, use Xiangsu Congchi Tang (Fragrant Perilla Scallion and Soybean Decoction) plus Muxiang (Mu Xiang, Aucklandiae Radix), Wuyao (Wu Yao, Linderae Radix), Chuanxiong (Chuan Xiong, Ligustici Chuanxiong Rhizoma), Yujin (Yu Jin, Curcumae Radix) to regulate Qi and induce sweating. For accompanying trauma pain, remove Muxiang/Wuyao, add Danggui, Guizhi (Gui Zhi, Cinnamomi Ramulus), Taoren (Tao Ren, Persicae Semen) to invigorate blood and remove stasis for pain relief.
[Lian's Verification] Exterior contraction after coitus is only slightly heavier than others. Cold patterns present with worse chills; Heat patterns present with more intense burning heat. The physician must judge timing, syndrome, constitution, and prescribe accordingly. Release exterior if indicated, warm middle if indicated, clear interior if indicated. Assess depth of pathogen, decide weight of medication, measure innate Yin/Yang deficiency, and support deficiency while releasing/warming/clearing. If True Yang is innately deficient, Yin-cold is root, pathogen carries Water. Besides exterior cold, expect vomiting/cough, abdominal pain/diarrhea, or cyanotic face/cold feet. Urgently add Fuzi, Guizhi to exterior-releasing meds, e.g., Shenfu Zaizao Tang, to assist Yang/break Yin for sweating, avoiding forced sweating causing Yang collapse. If True Yin is innately deficient, Yang hyperactivity is root, pathogen carries Fire. Besides new contraction, expect dry mouth/throat, irritability/insomnia, or flushed face/cold limbs. Add Shengdi (Sheng Di Huang, Rehmanniae Radix), Maidong (Mai Dong, Ophiopogonis Radix) to exterior-releasing meds, e.g., Qiwei Congbai Tang (Seven-Ingredient Scallion White Decoction), to nourish blood/yin for sweating, ensuring gentle sweat resolution. After exterior resolves, Yang-deficient patients have weak Middle Qi; early add Rougui, Fuzi to warming meds, e.g., Fuzi Lizhong Tang + Rougui, to assist Yang against Yin, avoiding Middle Yang collapse. Yin-deficient patients have depleted Yuan Essence; early add Shengdi, Maidong to clearing meds, e.g., Daochi Qingxin Tang (Guide Out Redness Clear Heart Decoction), to save Yin/generate fluids, avoiding Yuan Essence abrupt cessation. If Cold enters Essence Chamber (Jingshi), symptoms include swollen yin, cold feet, lower abdominal cramping, flushed face/retracted penis, muscle twitching. Still usable: Zhenwu Tang (True Warrior Decoction) + Liangtoujian (Li Anger?), Jiubai (Leek White); or Danggui Sini Tang (Angelus Sinensis Reversal-Cold Decoction) + Shao Kun San (Burnt Underwear Powder). (Cut piece of woman's underwear near yin, burn to ash, mix into decoction; for women's illness, take man's underwear similarly.) Return Yang, retain Yin, unblock turbid Yin to rescue. External application: Tongyin Dayang Method. (Use Laifu Dan [Revive-Yellow Pill] 2 qian, powder, into umbilicus; cover with half split live white pigeon, gutted but feathered, wrapped tightly, remove after ~3 hours.) Or soak scrotum in ginger juice until dry, penis emerges. Or use Huiyang San (Return Yang Powder) 2-3 fen into umbilicus, paste Yanghe Jiexing Gao (Yang-Harmonizing Resolution-Stasis Plaster) externally; pain ceases, penis emerges. If Heat enters Essence Chamber, colloquially "Coitus Depletion Warm Disease," more dangerous than Coitus Depletion Cold Damage. Desire fire and latent fire steaming together, fearing rapid Yin exhaustion. Urgently save Yin, drain turbidity, severely purge steaming fire to preserve True Yin. Use Tao's Xiaoyao Tang (Free and Easy Wanderer Decoction) and Ziren Yiyin Jian (Nourish Ren Benefit Yin Decoction) modified. (Remove Sharen, Shudi, Zhigancao; add Shao Kun San, Huaimi, Baiwei, Sheng Ganxi Shao; decoct with Shudi Lu [Rehmannia Dew].) For spirit coma/fainting, external Tongqiao Touxie Method. (An Gong Niuhuang Wan [Calculus Bovis Heart-Unblocking Pill] 2 pills, powder, mix with Yinhua Lu [Honeysuckle Dew] into cake, place on chest/xia, cover with half split white pigeon, wrap tight; remove when pigeon smells foul.) Still can save 3-4 out of 10.
[Bingzhang's Note] Song Airen said: Xu Lingtai in *Yixue Yuanliu Lun* (Discussions on Origins of Medicine) states: Modern doctors say that after intercourse or spermatorrhea, if one catches Wind-Cold and develops fever, it is called a Yin pattern. Regardless of symptoms, they always use heavy warming/tonifying drugs like Renshen, Baizhu, Fuzi, Rougui, Ganjiang, Wuyu. This is laughable. Yin-deficient persons catching Wind-Cold enter via Taiyang, remaining Yang pathogen, heat must be intense, accompanied by irritability/distress, especially requiring clearing heat/resolving pathogen. How can hot drugs be used? If truly entering Three Yin, there would be no fever; instead, aversion to cold, curling up, cold limbs, preference for warmth would exist, allowing warming/dispersing. Yet, tonification is never used. Like post-Cold Damage relapse due to intercourse (Nülaofu, Female Labor Recurrence), where long-term deficient persons suffer major syndrome. By modern view, heavy tonification is needed. But ancients used only Zhuru (Zhu Ru, Bambusae Caulis in Taenia) 1 sheng decocted. Thus, treatment depends on current symptoms. If six pulses are deep-slow, interior/exterior all cold, confirmed Three Yin Cold Pattern, treat as Yin even if constitution strong or celibate for 10 years. If symptoms confirm Yang pathogen (fever, irritability, thirst, constipation, no Three Yin Cold signs), treat as Yang even if constitution weak or excessive coitus. E.g., Yangming High Heat uses Gegen, Huangqin, Baihu Tang, Chengqi Tang. If suddenly turns to Three Yin, switch to warming/tonifying. If Yin turns to Yang, switch to cooling/dispersing after warming. This is a fixed rule.
Yu Jiayan treated Huang Changren who had intercourse, caught Cold Damage for 10+ days with reversal cold. Doctor prepared Jiang/Gui warming/dispersing meds for Yin pattern. Yu changed to Tiaowei Chengqi Tang (Regulate-Stomach Purge-Decoction), reversal returned, heat penetrated, then Da Chaihu Tang (Major Bupleurum Decoction), heat subsided, body safe. He told disciples: Cold Damage starting with fever, consuming fluids, dry nose/thirst/constipation, progressing to reversal, is definitely Heat. Yang turning to Yin reversal is 1 in 10,000. Yin reversal comes from Yin pattern, directly hitting Yin: blue lips/pale face, cold sweat, loose stool/no thirst, fatigue/sleepiness, clear mind when awake. Totally different from transmitted Heat deepening into coma. Such cases, having intercourse then Cold Damage, doctors confused by "Yin Pattern" name, often give Si Ni Tang, hastening death from Yin exhaustion without rescue. Intercourse-caused Cold Damage is only slightly heavier than usual: extreme heat, severe chills, severe headache. Reason: Yin deficiency allows Yang to invade, not Yin excess excluding Yang. Cold Damage starting with fever/thirst implies prior Yin deficiency. Thus, treating Yin pattern focuses on saving Yang; treating Cold Damage focuses on saving Yin. Even with Yang deficiency in Cold Damage, check if flesh/blood are robust enough to accept Yang drugs before returning Yang. If sallow face/black tongue, body like dried firewood, evil fire roasting organs, Yin is exhausted, how can Yang be returned? Saving fluids is late enough; daring to assist Yang and rob Yin is wrong.
Jiang Lingyou in *Shanghan Bianzheng Guangzhu* says: Human body is Yin/Yang, rooted in Kidney. Lustful people injure both Kidneys, mostly Yin deficiency, less Yang deficiency. Yang deficiency is Mingmen Fire decline; Yin deficiency is Kidney Water exhaustion. Excessive intercourse loses essence, which is Water/Yin. During exertion, Heart Fire blazes, Fire blazing makes Water flow, Water flowing makes Fire blaze, internal dryness/heat, plus exterior Cold/Damage pathogen Heat, two heats intersect, Kidney Water dries, person becomes irritable, black tongue with prickles, leads to death. Saying "Cold damage kills lower deficient" fits here. Someone asks: If so, no Yin pattern in Cold Damage? I say: Yes, Yin pattern with Cold invasion. Symptoms are Yang deficiency. Yang deficient people have low voice, indigestion, limb flaccidity/cold, cold below waist, impotence, clear urine. This is righteous Qi deficiency attacked by Cold, cold in interior/extremities, true Cold pattern. Not solely due to intercourse; children also have Yin patterns. Thus, post-coitus is not always Yin pattern. Based on Bingzhang's experience: Wind-Cold exterior, cold food Stomach-to-Spleen is true Coitus Depletion Cold Damage. If intercourse then Cold Damage fever, disease does not come from intercourse, no Coitus Depletion applies, treat as exterior pattern. Only if Cold Damage just resolved, then intercourse, named Nülaofu. Fever, heavy/painful lower body. Major illness just resolved, Yuan Qi/Essence/Blood inherently deficient, intercourse/loss of essence doubly depletes, new pathogen enters void causing fever, failed essence stays in Essence Chamber causing lower body heaviness/pain. Treatment: Support Yuan, clear Heat, transform stasis, guide turbidity, exit via urine/stool. Nülaofu detailed in Chapter 11 Cold Damage Recurrence section, not repeated here.
[Rongzhai's Note] This section (Coitus Depletion Cold Damage) follows Wang Haicang's Yin Pattern examples, advocating initial "Warm Meridians Dissipate Cold," then "Warm Tonify Mingmen Strengthen Spleen/Kidney," finally "Double Tonify Qi/Blood Harmonize Yin/Yang." He attributes cause to Cold invasion post-coitus, so treatment always breaks Yin/returns Yang. However, late Ming/early Qing, Yu Jiayan, Xu Lingtai disagreed with "heavy warming tonification" for "Coitus Depletion Cold Damage" (see Cao Bingzhang's note). Lu Jiuzhi in *Shibu Zhai Yishu* firmly stated: "Only fever is not Yin pattern; only Yin pattern has no fever." Conclusion: Yu's method suits post-coital Cold invasion without current fever. His described "body heat/flushed face" should not exist; if present, "warm tonification" is unsuitable. Wang Desen in *Shiyinlu Yixue Zazhu* says: "Modern people, young married men, once febrile, if treatment fails, label 'Coitus Depletion,' switch to Fu/Gui/Shen/Di, great heat/tonification to kill them. Don't know post-coitus/spermatorrhea Wind-Cold enters Taiyang, remains Yang pathogen, heat intense; with irritability/thirst, especially need clearing heat/dispersing pathogen. How use hot drugs? If truly hitting Three Yin, no high heat; must have aversion to cold/curling/cold limbs/preference for warmth for warming/dispersing; yet never use tonification." Reasoning is clear, serves as pointer for treating "Coitus Depletion Cold Damage."