【纲】仲景曰。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。
【目】成无己曰。劳为劳动之劳。复为再发也。是伤寒瘥后。因劳动再发者也。伤寒新瘥后。血
气未平。余热未尽。劳动其热。热还经络。遂复发也。此有二种。一因劳动外伤。一因饮食内伤。
其劳动外伤者。非止强力摇体。持重远行。即如梳洗则动气。忧思悲虑则劳神。皆令复也。况其过
用者乎。其饮食内伤者。为多食则遗。食肉则复也。内经曰。热病已愈而时有遗者。何也。以热盛
而强食。病已衰而热有所藏。因其谷气留薄。两阳相合。故有所遗。经曰。病已瘥。尚微烦。损谷
则愈。夫伤寒邪气之传。自表至里。有次第焉。发汗吐下。自轻至重。有等差焉。又其劳复则不然。
见其邪气之复来也。必迎夺之。不待其传也。枳实栀豉则吐之。岂必虚烦懊 之症。加大黄则下之。
岂必谵语腹满之候。经曰。伤寒瘥后更发热。小柴胡汤。浮脉。以汗解之。脉沉实。以下解之。亦
是便要折其邪也。盖伤寒之邪自外入。劳复之邪自内出。发汗吐下。随宜施用。劳复。食复。诸劳。
皆可治。及御内则死矣。若男女相易。为阴阳易。其不易而自病者。为女劳复。以其内损真气。
外动热邪。正虚邪盛。故不可治也。
魏荔彤曰。此下申解伤寒病愈后。血气虚羸。余热未尽。饮食起居。俱宜节慎也。至房劳一事。
更关性命。故不必列于
此。其示禁更切矣。言大病瘥后者。凡病皆然。不但伤寒也。瘥后血气必虚。凡费心费力。过喜过
怒。多言多动。皆可因劳而复病也。因劳而动其既虚之血气。虚劳而生其未尽之余热。热邪退而病
瘥。热邪生而病复。可见伤寒传经之邪。连绵难尽如此。伤寒后血气之亏。因循难复如此。推之自
凡病后皆然。
【纲】仲景曰。伤寒瘥已后。更发热者。小柴胡汤主之。脉浮者。以汗解。脉沉者。以下解之。
【目】许叔微曰。有人患伤寒。得汗数日。身热自汗。脉弦数。心不得宁。真劳复也。予诊之
曰。劳心之所致。神之所舍。未复其初。而又劳伤其神。荣卫失度。当补其子。益其脾。解其劳。
庶几得愈。授以补脾汤。佐以柴胡汤解之。或曰。虚则补其母。今补其子。何也。予曰。子不知虚
劳之异乎。难经曰。虚则补其母。实则泻其子。此虚当补母。人所共知也。千金曰。心劳甚者。补
脾气。脾旺则感之于心矣。方治其虚。则补其生我者。与锦囊所谓本骸得气。遗体受荫同义。方治
其劳。则补其助我者。与荀子言未有子富而父贫同义。此治虚与劳所以异也。
王好古曰。大抵劳者动也。动非一种。有气血内外之异焉。若劳乎气而无力与精神者。法宜微
举之。若劳乎血与筋骨者。以四物之类补之。若在脾。内为中州。调中可已。此为有形病也。但见
外症。则谓之复。非为劳也。如再感风寒是已。
吴绶曰。劳复病古人所谓如大水浸墙。水退则墙苏。不可犯之。但可安卧守静以养气。设或早
起劳动。则血气沸腾而发热也。
喻昌曰。瘥已后更发热。乃余热在内。以热召热也。但热当辨其何在。不可泛为施治以虚其虚。如在半表半里。仍
用小柴胡和解。在表仍用汗法。在里仍用下法。然汗下之法。即上条用枳实栀豉微汗。下用枳实栀豉加大黄微下也。
【纲】仲景曰。大病瘥后。从腰以下有水气者。牡蛎泽泻散主之。
【目】喻昌曰。腰下有水气者。水渍为肿也。金匮曰。腰以下肿。当利小便。此定法矣。乃大病
后脾土告困。不能摄水。以致水气泛溢。用本汤峻攻。何反罔顾其虚耶。正因水势未犯身半以上。
急逐其水。所全甚大。设用轻剂。则阴水必袭入阳界。驱之无及矣。庸工遇大病后。悉用温补。自
以为善。孰知其大谬哉。
【纲】仲景曰。大病瘥后。喜唾。久不了了者。胃上有寒。当以丸药温之。宜理中丸。
【目】喻昌曰。身中津液。因胃寒凝结而成浊唾。久而不清。其人必瘦削索泽。故不用汤药荡
涤。而用丸药缓图。理中丸。乃区分阴阳。温补脾胃之善药。
【纲】仲景曰。伤寒解后。虚羸少气。气逆欲吐者。竹叶石膏汤主之。
【目】喻昌曰。身中津液。为热邪所耗。余热不清。必致虚羸少气。难于康复。若更气逆欲吐。
是余邪复挟津液滋扰。故用本汤以益虚清热散逆也。
【纲】仲景曰。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。
【目】朱肱曰。大抵新病瘥。多因伤食。便作痞。干噫食臭。腹中雷鸣。下利等症。可与生姜
泻心汤。
陈士铎曰。伤寒火退邪散。胃气初转。是忌急与之食。一得食而胃气转闭。不可复开。此时即
以药下之。则胃气大伤。而火邪复聚。反成不可解之症。不若禁不与食。则中州之地。自然转输。
渐渐关开搬运。不至阻隔。方用茯苓、陈皮、山栀各一钱。白芍三钱。陈曲、枳壳、浓朴、甘草各
五分。麦芽二钱。此方似平平无奇。却调理自然无事。然必待其饥饿之时。方可与服。饱时服之。
徒滋满闷。伤寒愈后。邪已退。正自虚。理宜补正。但脾胃弱。多食补剂。恐不能受。法当用补胃
药少。补脾药多。尤不宜补脾药多。而补肾药少。盖肾能生土。土自能生金。金旺则木有所畏。不
至来克脾土。然则补肾正所以补脾也。方用熟地一两。麦冬、白芍、白术、苡仁各三钱。五味子五分。
肉桂三分。白芥子一钱。此方专补脾肾二经。不必通补各脏。而各脏无不补也。
庞安常曰。凡新瘥。只宜先进白稀粥。次进浓者。又次进糜粥。亦须少少与之。不得过吃肉食。
凡男子大病后。早犯女色而为病者。名女劳复。其候头重不举。目中生花。腰背疼痛。或小腹里急
绞痛。或憎寒发热。或时阴火上冲。头面烘热。心胸烦闷。活人以 鼠屎汤主之。有热者。竹皮汤。
千金以赤农散主之。虚弱者。人参三白汤调下赤衣散。若少腹急痛。脉沉逆冷者。当归四逆汤。加
附子、吴萸。送下赤衣散。仍以吴萸一升。酒拌炒。熨少腹。凡卵缩入腹。离经脉见。死不可救
李 曰。复者。其病如初也。新瘥津液未复。血气尚虚。或梳洗言动太早。或思维太过。则成
劳复。盖劳则生热。热气乘虚。还入经络。未免再复。宜小柴胡汤、麦门冬汤和之。食复者。新瘥
后胃气尚弱。若恣食欲。不能克化。根据前发热。若用补药。则胃热益增。治须清热消食。轻者腹中
微满。损谷自愈。重者必须吐下。宜栀豉枳大黄汤。胸痞者。生姜泻心汤。饮酒复病者。黄连解毒
汤。凡复症。先病七日出汗而解。今复举。亦必七日而解。先病十四日出汗而解。今复举。亦必十
四日而解。虽三四次复举。亦必三四次发汗而解。但劳复经久不愈。恐成痨瘵。
【纲】张仲景说：大病初愈后因劳累而复发者，用枳实栀子豉汤主治。如果兼有宿食停滞，加大黄如博棋子大小的五六枚。
【目】成无己说：“劳”指劳动，“复”指再次发作。这是伤寒病初愈后，因劳动导致病情再次发作。伤寒病刚痊愈时，气血尚未平复，余热未尽。劳动扰动内热，热邪回归经络，于是再次发病。这有两种情况：一是因劳动导致的外伤，二是因饮食不当导致的内伤。那些因劳动导致外伤的，不仅仅是强力摇动身体、负重远行，即使是梳洗也会耗气，忧思悲虑也会劳神，都会导致复发，何况是过度使用体力的人呢？那些因饮食导致内伤的，是因为多吃导致遗留病邪，吃肉类导致复发。《内经》说：热病已经痊愈但仍有遗留症状，为什么呢？因为热势正盛却强行进食，病势虽衰但热邪有所藏留。由于谷气滞留并与余热搏结，两阳相合，所以出现遗留症状。经书说：病已痊愈，尚且轻微心烦，减少饮食即可痊愈。伤寒邪气的传变，从表到里，是有次第的；发汗、催吐、泻下，从轻到重，是有等差的。但是劳复却不是这样，见到邪气复发，必须迎头痛击，不等它传变。枳实栀子豉汤具有涌吐作用，难道一定要有虚烦懊憹的症状才用吗？加大黄具有泻下作用，难道一定要有谵语腹满的证候才用吗？经书说：伤寒初愈后又发热，用小柴胡汤治疗。脉浮的，用发汗法解除；脉沉实的，用泻下法解除。这也是为了迅速遏制邪气。大概伤寒之邪从外侵入，劳复之邪从内生发。发汗、催吐、泻下，根据适宜的情况施用。劳复、食复以及其他各种劳损，都可以治疗。但如果房事后发病就会死亡。如果男女交接感染，称为阴阳易；如果不交接而自己发病，称为女劳复。因为内损真气，外动热邪，正气虚弱邪气亢盛，所以不可治愈。
魏荔彤说：此处进一步解释伤寒病愈后，气血虚弱羸瘦，余热未尽，饮食起居都应当节制谨慎。至于房事这一项，更关乎性命，所以不必列在此处，其示禁更加迫切。说大病初愈后的情况，凡是疾病都是如此，不只是伤寒。初愈后气血必然虚弱，凡是耗费心力、过度喜悦或愤怒、多言多动，都可以因劳累而再次生病。因劳累而动摇了已经虚弱的气血，虚劳而生出未尽的余热，热邪退去则病愈，热邪产生则病复。可见伤寒传经之邪，连绵难尽像这样；伤寒后气血亏损，因循拖延难以恢复也像这样。推及所有疾病之后都是如此。
【纲】张仲景说：伤寒初愈后，又发热者，用小柴胡汤主治。脉浮的，用发汗法解除；脉沉的，用泻下法解除。
【目】许叔微说：有人患伤寒，出汗数日后，身热自汗，脉弦数，心神不宁，这是真正的劳复。我诊断说是用心过度所致。心是神志所居之处，未恢复如初，又劳伤心神，营卫失调，应当补益心之子（脾），益气健脾，解除劳倦，或许才能痊愈。给予补脾汤，辅以柴胡汤和解。有人说：虚证应当补其母，现在补其子，为什么呢？我说：您不知道虚与劳的区别吗？《难经》说：虚则补其母，实则泻其子。这是虚证当补母，人们都知道。《千金方》说：心劳严重的，补脾气。脾旺则能感应于心。治疗其虚证，则补益生我者（母），这与锦囊所说“本骸得气，遗体受荫”意义相同。治疗其劳证，则补益助我者（子），这与荀子所说“没有儿子富有而父亲贫穷”的意义相同。这就是治疗虚证和劳证不同的原因。
王好古说：大体上，“劳”就是动。动不是一种，有气血内外的区别。如果是气劳而无力气和精神，治法宜微微升举；如果是血劳和筋骨劳，用四物汤之类补益。如果在脾，内部属于中州，调理中焦即可痊愈。这是有形之病。只见到外在症状，就称为复发，不是劳损。比如再次感受风寒就是这样。
吴绶说：劳复病古人所说的像大水浸墙，水退后墙才复苏，不可触犯。只能安静卧床守静以养气。如果过早起床劳动，就会气血沸腾而发热。
喻昌说：初愈后又发热，是余热在内，以热召热。但热邪应当辨别其在何处，不可泛泛施治以损伤正气。如果在半表半里，仍用小柴胡汤和解；在表仍用汗法；在里仍用下法。然而汗下之法，即上一条所述用枳实栀子豉汤微汗，用枳实栀子豉加大黄汤微下。
【纲】张仲景说：大病初愈，腰部以下有水气者，用牡蛎泽泻散主治。
【目】喻昌说：腰下有 water qi（水气），是水液浸润导致肿胀。《金匮要略》说：腰以下肿，当利小便。这是定法。但是大病后脾土困顿，不能摄水，导致水气泛溢。用本方峻猛攻逐，为何反而不顾及其虚损呢？正是因为水势尚未侵犯身体上半部，急逐其水，保全的东西很多。如果用轻剂，那么阴水必定袭入阳界，届时驱赶就来不及了。庸医遇到大病后，全部使用温补，自以为善，谁知道这是大错特错啊。
【纲】张仲景说：大病初愈，喜欢吐唾沫，长久不好者，是胃上有寒，应当用丸药温补，宜用理中丸。
【目】喻昌说：体内的津液，因胃寒凝结而成浊唾，久而不清。此人必然消瘦枯槁。所以不用汤药荡涤，而用丸药缓慢图治。理中丸，是区分阴阳、温补脾胃的良药。
【纲】张仲景说：伤寒解后，身体虚弱羸瘦，少气，气逆想吐者，用竹叶石膏汤主治。
【目】喻昌说：体内的津液，被热邪耗伤，余热不清，必然导致虚弱羸瘦、少气，难以康复。如果再气逆想吐，是余邪再次挟持津液滋扰。所以用本汤来益虚、清热、降逆。
【纲】张仲景说：病人脉象已平和，但傍晚轻微心烦，因为病刚痊愈，人强迫进食，脾胃之气尚弱，不能消化食物，所以令其轻微心烦。减少饮食即可痊愈。
【目】朱肱说：大体上新病初愈，多因伤食，便出现痞满、干噫食臭、腹中雷鸣、下利等症状。可与生姜泻心汤。
陈士铎说：伤寒火退邪散，胃气初转，此时忌讳急于喂食。一进食则胃气闭塞，无法再开。此时即使用药攻下，则会大伤胃气，而火邪重新聚集，反成不可解之症。不如禁止不给食物，则中焦自然转输，渐渐开通搬运，不至阻隔。这时可用茯苓、陈皮、山栀各一钱，白芍三钱，陈曲、枳壳、浓朴、甘草各五分，麦芽二钱。此方看似平平无奇，却能自然调理无事。但必须等到饥饿之时，方可服用。饱食时服用，徒增胀闷。伤寒愈后，邪气已退，正气自虚，理应补正。但脾胃弱，多吃补剂，恐怕不能承受。治法应当用补胃药少，补脾药多。尤其不宜补脾药多而补肾药少。因为肾能生土，土自能生金，金旺则木有所畏，不至来克脾土。然而补肾正是为了补脾。方用熟地一两，麦冬、白芍、白术、苡仁各三钱，五味子五分，肉桂三分，白芥子一钱。此方专补脾肾二经，不必通补各脏，而各脏无不补也。
庞安常说：凡新近初愈，只宜先进白稀粥，次进稠粥，又次进糜粥，也必须少量给予，不得过吃肉食。凡男子大病后，早犯女色而致病者，名为女劳复。其症状为头重不能抬起，眼中见花，腰背疼痛，或小腹拘急绞痛，或憎寒发热，或有时阴火上冲，头面烘热，心胸烦闷。活人用鼠矢汤主治。有热者，用竹皮汤。《千金方》用赤农散主治。虚弱者，用人参三白汤调下赤衣散。若小腹急痛，脉沉逆冷者，用当归四逆汤，加附子、吴茱萸，送下赤衣散。仍以吴茱萸一升，酒拌炒，熨烫小腹。凡睾丸缩入腹中，离经脉显现，死不可救。
李曰：复，是指病情如初。新近初愈，津液未复，气血尚虚。或者梳洗言语活动太早，或者思虑太过，则成为劳复。因为劳则生热，热气乘虚，还入经络，难免再次复发。宜用小柴胡汤、麦门冬汤调和。食复者，新近初愈后胃气尚弱，如果放纵食欲，不能消化，依据前文发热。如果用补药，则胃热增加。治疗须清热消食。轻者腹中微满，减少饮食自愈。重者必须吐下，宜用栀豉枳大黄汤。胸痞者，用生姜泻心汤。饮酒复病者，用黄连解毒汤。凡复发之症，先病七日出汗而解，今复发，也必七日而解。先病十四日出汗而解，今复发，也必十四日而解。虽然三四次复发，也必三四次发汗而解。但劳复经久不愈，恐怕成为痨瘵。
[Outline] Zhang Zhongjing said: For recurrence due to exertion after a major illness has subsided, Zhi Shi Zhi Zi Chi Tang (Immature Bitter Orange and Fermented Soybean Decoction) is the primary treatment. If there is retained food stagnation, add Da Huang (Rhubarb Rhizome) in pieces the size of five or six "boqi" chessmen.
[Commentary] Cheng Wuji stated: "Lao" (exertion) refers to physical labor, and "Fu" (recurrence) means re-emergence. This refers to the re-emergence of symptoms after recovery from Shaoyang disease due to physical activity. After the recent recovery from Shaoyang disease, the Qi and Blood have not yet stabilized, and residual heat remains. Physical exertion stirs up this internal heat, which returns to the meridians, causing the disease to recur. There are two types: one caused by external injury due to exertion, and the other by internal injury due to diet. Those suffering from external injury due to exertion are not limited to forcefully shaking the body or carrying heavy loads over long distances; even combing hair and washing can disturb Qi, and worry, sorrow, and anxiety can exhaust the Shen (Spirit), all leading to recurrence, let alone excessive physical use. Those suffering from internal injury due to diet occur because overeating leads to lingering pathogens, and eating meat causes recurrence. The *Neijing* states: "Why do residual symptoms persist after the resolution of heat diseases?" It is because strong eating occurs while heat is intense, and although the disease has declined, heat is still stored. Because grain Qi lingers and combines with residual heat, two Yangs merge, resulting in residual symptoms. The classics state: "If the disease has resolved but slight irritability remains, reducing food intake will lead to healing." The transmission of Shaoyang pathogens proceeds from exterior to interior in a sequence; sweating, vomiting, and purging proceed from mild to severe in degrees. However, recurrence due to exertion is different. When pathogenic factors recur, they must be intercepted immediately, without waiting for transmission. Zhi Shi Zhi Zi Tang induces vomiting; does it require symptoms of deficiency-heat and agitation? Adding Da Huang induces purging; does it require delirium and abdominal fullness? The classics state: "For fever recurring after Shaoyang disease, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used. If the pulse is floating, resolve via sweating; if the pulse is deep and solid, resolve via purging." This is also to swiftly curb the pathogen. Generally, Shaoyang pathogens enter from the exterior, while those in exertion recurrence emerge from within. Sweating, vomiting, and purging are applied according to appropriateness. Exertion recurrence, dietary recurrence, and various other forms of exhaustion are all treatable. However, death ensues if sexual intercourse occurs post-recovery. If infection occurs through male-female exchange, it is called Yin-Yang Exchange; if one falls ill without such exchange, it is called Female Exertion Recurrence. Because internal True Qi is damaged and external heat pathogens are stirred, with deficient Zheng Qi and abundant Xie Qi, it is considered incurable.
Wei Litong stated: This section further explains that after recovery from Shaoyang disease, Qi and Blood are deficient and emaciated, and residual heat remains. Diet and daily life must be regulated and cautious. Regarding sexual activity, it concerns life and death more critically, so it is not listed here, emphasizing the prohibition even more strongly. Saying "after recovery from major illness" applies to all diseases, not just Shaoyang disease. After recovery, Qi and Blood are inevitably deficient. Any consumption of heart and effort, excessive joy or anger, excessive talking or movement can cause relapse due to exertion. Exertion disturbs already deficient Qi and Blood, and deficiency-exhaustion generates remaining residual heat. When heat pathogens retreat, the disease resolves; when heat pathogens arise, the disease recurs. Thus, we see that pathogens transmitted through Shaoyang meridians are continuous and hard to eradicate, and the deficit of Qi and Blood after Shaoyang disease is difficult to restore through neglect. Extending this logic, it applies to all post-illness conditions.
[Outline] Zhang Zhongjing said: For fever recurring after Shaoyang disease has resolved, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. If the pulse is floating, resolve via sweating; if the pulse is deep, resolve via purging.
[Commentary] Xu Shuwei said: A patient suffered from Shaoyang disease. After sweating for several days, he had body heat, spontaneous sweating, a wiry and rapid pulse, and an unsettled mind. This was true exertion recurrence. I diagnosed it as caused by mental overexertion. The Heart is the residence of the Shen (Spirit). Since it had not returned to its original state, further exhausting the Shen disrupted Ying and Wei (Nutritive and Defensive Qi). One should tonify the Son (Spleen) of the Heart, benefit Spleen Qi, and relieve exertion, hoping for recovery. I prescribed Bu Pi Tang (Spleen-Tonifying Decoction), assisted by Chai Hu Tang (Bupleurum Decoction) to harmonize. Someone asked: "In deficiency, one tonifies the Mother. Why tonify the Son now?" I replied: "Do you not know the difference between deficiency and exertion? The *Nan Jing* states: 'In deficiency, tonify the Mother; in excess, drain the Son.' Everyone knows deficiency requires tonifying the Mother. The *Qian Jin Fang* states: 'For severe Heart exertion, tonify Spleen Qi. When Spleen is prosperous, it influences the Heart.' To treat deficiency, one tonifies what generates me (Mother), consistent with the meaning of 'the root receives Qi, the branches receive shade.' To treat exertion, one tonifies what assists me (Son), consistent with Xunzi's saying that 'there is no case of a son being rich while the father is poor.' This is why treating deficiency and exertion differs."
Wang Haogu stated: Generally, "Lao" (exertion) implies movement. Movement is not uniform; there are differences in Qi and Blood, interior and exterior. If it is Qi exertion manifested as weakness and lack of spirit, the method should be to slightly lift and raise. If it is Blood or sinew-bone exertion, tonify with formulas like Si Wu Tang (Four Substance Decoction). If it affects the Spleen, which is the Central Pivot internally, regulating the Middle Jiao can cure it. This is a tangible pathology. If only external symptoms are seen, it is called recurrence, not exertion. For example, contracting wind-cold again is such a case.
Wu Shou stated: Exertion recurrence is like a wall soaked by floodwaters; the wall recovers only after the water recedes. One must not provoke it. One should lie quietly and rest to nourish Qi. If rising early to work, Qi and Blood will boil, causing fever.
Yu Chang stated: Fever recurring after resolution is due to residual heat inside, calling forth heat. One must distinguish where the heat lies and not treat generically, thereby damaging the deficient Zheng Qi. If in the half-exterior half-interior, still use Xiao Chai Hu Tang to harmonize; if in the exterior, use sweating; if in the interior, use purging. However, these sweating and purging methods refer to using Zhi Shi Zhi Zi Tang for mild sweating and Zhi Shi Zhi Zi Jia Da Huang Tang for mild purging mentioned in the previous clause.
[Outline] Zhang Zhongjing said: For edema/water accumulation below the waist after recovery from a major illness, Mu Li Ze Xie San (Oyster Shell and Alisma Powder) is the primary treatment.
[Commentary] Yu Chang stated: Water accumulation below the waist causes swelling due to fluid infiltration. The *Jin Gui Yao Lue* states: "For swelling below the waist, promote urination." This is a fixed rule. However, after a major illness, Spleen Earth is exhausted and cannot control water, leading to water overflow. Using this formula for harsh attack seems to ignore the deficiency. Precisely because the water momentum has not invaded the upper half of the body, urgently draining the water preserves much health. If mild agents were used, Yin water would surely invade the Yang realm, making it impossible to drive out later. Quack doctors, encountering post-major illness cases, all use warming and tonifying, thinking it is good, unaware of their great error.
[Outline] Zhang Zhongjing said: For excessive spitting and chronic non-resolution after recovery from a major illness, it indicates Cold in the Stomach. One should warm it with pill medicine, preferably Li Zhong Wan (Regulate the Middle Pill).
[Commentary] Yu Chang stated: Body fluids, congealed by Stomach Cold, become turbid saliva. If unresolved for a long time, the person will become emaciated and withered. Therefore, decoctions for drastic cleansing are not used, but pills for slow action are employed. Li Zhong Wan is an excellent medicine for distinguishing Yin and Yang and warming/tonifying the Spleen and Stomach.
[Outline] Zhang Zhongjing said: After Shaoyang disease resolves, for emaciation, shortness of breath, and rebellious Qi with desire to vomit, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is the primary treatment.
[Commentary] Yu Chang stated: Body fluids are consumed by heat pathogens. Unclear residual heat inevitably leads to emaciation and shortness of breath, making recovery difficult. If accompanied by rebellious Qi and desire to vomit, it means residual pathogens are disturbing fluids again. Thus, this decoction is used to tonify deficiency, clear heat, and descend rebellious Qi.
[Outline] Zhang Zhongjing said: When the patient's pulse has normalized but slight irritability occurs at dusk, it is because the disease has recently resolved, and people force-feed them. The Spleen and Stomach Qi are still weak and cannot digest food, causing slight irritability. Reducing food intake will lead to healing.
[Commentary] Zhu Gong stated: Generally, new recovery often involves food injury, leading to fullness, dry belching with food odor, borborygmus, and diarrhea. One may prescribe Sheng Jiang Xie Xin Tang (Ginger Decoction for Draining the Epigastrium).
Chen Shiduo stated: After Shaoyang fire retreats and pathogens scatter, Stomach Qi begins to turn. At this time, one must avoid feeding hastily. Once fed, Stomach Qi closes and cannot reopen. Even if purgatives are used then, Stomach Qi is severely damaged, and fire pathogens gather again, becoming incurable. It is better to abstain from food, allowing the Middle Jiao to naturally transport and transform, gradually opening and moving without obstruction. Then, use Fu Ling (Poria), Chen Pi (Tangerine Peel), Shan Zhi (Gardenia) each 1 qian, Bai Shao (White Peony Root) 3 qian, Chen Qu (Aged Leaven), Zhi Qiao (Immature Bitter Orange), Hou Po (Magnolia Bark), Gan Cao (Licorice Root) each 0.5 qian, and Mai Ya (Barley Sprout) 2 qian. This formula seems ordinary but regulates naturally without incident. However, it must be taken when hungry. Taking it when full merely increases bloating. After Shaoyang resolution, pathogens have retreated, and Zheng Qi is inherently deficient. Tonification is appropriate. But since Spleen and Stomach are weak, heavy tonics may not be tolerated. The method should use less Stomach-tonifying medicine and more Spleen-tonifying medicine. Especially, one should not use too much Spleen-tonifying medicine and too little Kidney-tonifying medicine. Because the Kidney generates Earth (Spleen), Earth generates Metal (Lung). When Metal is prosperous, Wood (Liver) is restrained and does not attack Spleen Earth. Thus, tonifying the Kidney is precisely to tonify the Spleen. Use Shu Di (Prepared Rehmannia Root) 1 liang, Mai Dong (Ophiopogon Tuber), Bai Shao (White Peony Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Yi Yi Ren (Coix Seed) each 3 qian, Wu Wei Zi (Schisandra Berry) 0.5 qian, Rou Gui (Cinnamon Bark) 0.3 qian, Bai Jie Zi (Mustard Seed) 1 qian. This formula specifically tonifies the Spleen and Kidney meridians. There is no need to tonify all organs generally, yet all organs are benefited.
Pang Anchang stated: For recent recovery, one should first consume thin white rice porridge, then thicker porridge, then mushy porridge. Give in small amounts repeatedly. Do not overconsume meat. For men who engage in sexual activity early after a major illness and fall ill, it is named Female Exertion Recurrence. Symptoms include heavy head unable to lift, visual disturbances, lower back pain, or sudden urgent/cramping pain in the lower abdomen, aversion to cold with fever, occasional surging of Yin Fire causing facial flushing, chest and heart irritability. Huo Ren Ren uses Shu Shi Tang (Mouse Feces Decoction) as primary treatment. For heat, use Zhu Pi Tang (Bamboo Bark Decoction). *Qian Jin Fang* uses Chi Nong San (Red Mud Powder). For the weak, use Ren Shen San Bai Tang (Ginseng Three Whites Decoction) to wash down Chi Yi San (Red Coat Powder). For urgent lower abdominal pain with deep, reversed, and cold pulses, use Dang Gui Si Ni Tang (Angelica Four Reversals Decoction), add Fu Zi (Aconite Lateral Root) and Wu Zhu Yu (Evodia Fruit), and take with Chi Yi San. Also, stir-fry 1 sheng of Wu Zhu Yu with wine and apply hot compress to the lower abdomen. If the testicles retract into the abdomen and the Li Mai (Departing Pulse) appears, death is inevitable and incurable.
Li stated: "Recurrence" means the disease returns to its initial state. After recent recovery, fluids have not restored, and Qi and Blood are still deficient. If combing, washing, speaking, or moving happens too early, or if thinking is excessive, it becomes Exertion Recurrence. Because exertion generates heat, heat takes advantage of deficiency and returns to the meridians, inevitably causing recurrence again. Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Mai Men Dong Tang (Ophiopogon Decoction) should be used to harmonize. For Dietary Recurrence, after recent recovery, Stomach Qi is still weak. If appetite is indulged, digestion fails, leading to fever as described previously. If tonics are used, Stomach heat increases. Treatment requires clearing heat and resolving food stagnation. For mild cases with slight abdominal fullness, reducing food heals itself. For severe cases, vomiting and purging are necessary. Use Zhi Chi Zhi Da Huang Tang (Immature Bitter Orange, Fermented Soybean, and Rhubarb Decoction). For chest fullness, use Sheng Jiang Xie Xin Tang (Ginger Decoction for Draining the Epigastrium). For recurrence due to alcohol, use Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity). For any recurrence syndrome, if the initial illness resolved via sweating on the seventh day, the recurrence will also resolve via sweating on the seventh day. If the initial illness resolved on the fourteenth day, the recurrence will also resolve on the fourteenth day. Even if recurrence happens three or four times, it will resolve after three or four rounds of sweating. However, if Exertion Recurrence persists for a long time without healing, it may develop into Lao Fei (Consumption/Tuberculosis).