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，余邪伏于藏府，未经悉解，故犯之辄
复也。学者于临证时，审其脉证而详辨之，则施治自无误矣。
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大病差后，劳复者，枳实栀子豉汤主之。若有宿食者，加大黄，如博碁子五六枚。
【注】
大病差后，谓伤寒病新差后也。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，宜枳实栀子豉汤加大黄下之。
【集注】
成无己曰：劳复则热气浮越，与枳实栀子鼓汤以解之。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（炙）三枚 栀子（擘）十四枚 豉（绵裹）一升
右三味，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。
@@@
伤寒差已，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。伤寒差已，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。
大病差后，从腰以下有水气者，牡蛎泽泻散主之。
【注】
伤寒病差后，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：大病差后，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。
伤寒病刚刚痊愈，因起居活动过度劳累而导致疾病复发，这称为“劳复”。强行进食谷物食物，导致疾病复发，这称为“食复”。男女发生性行为后，患者自身再次生病，这称为“房劳复”。男女发生性行为后，双方相互传染致病，这称为“阴阳易”，即男性传给未曾患病的女性，女性传给未曾患病的男性，就像进行交换一样。这是因为这些人刚病愈，体内残留的病邪潜伏在脏腑中，尚未完全清除，所以一旦触犯就会复发。医者在临证时，仔细审查其脉象和症状并详细辨别，那么施治自然就不会有误了。
@@@
大病初愈后，因劳累而复发者，用枳实栀子豉汤（Zhishe Zhizi Chi Tang, Bitter Orange, Gardenia and Fermented Soybean Decoction）主治。如果兼有积滞宿食者，加大黄（Rhei Radix et Rhizoma），用量如同博棋子大小五六枚。
【注】
大病初愈，是指伤寒病刚刚痊愈。所谓劳复，是指因起居劳作而导致的复发，并非指房事劳累引起的复发，适宜用枳实栀子豉汤主治。服药后温覆衣被，使身体微微似有汗出即可自愈，不追求强烈的涌吐效果，因为热邪不在胸膈而在经络。如果是因饮食过量导致复发，称为食复，因为有宿食停滞，适宜用枳实栀子豉汤加大黄以攻下积滞。
【集注】
成无己说：劳复则热气浮越，用枳实栀子豉汤来解除它。食复则胃中有积滞宿食，加大黄来攻下它。
以上三味药，用清浆水七升，先空煮至四升，加入枳实、栀子，煮取二升，再加入豆豉，再煮五到六沸，去渣，温服，分两次服用，服药后覆盖衣被使身体微微似有汗出。
【方解】
这个方子，用清浆水七升，先空煮至四升，是想让水性变得熟软而下趋，不希望它向上涌吐。加入豆豉煮五到六沸就去除药渣，是取其清淡腐熟之气走表，易于发汗。在太阳病阶段用它来催吐，在劳复时用它在来发汗。张仲景用方的精妙之处，虽然药品相同，但煎煮方法不同，所以施用效果也不同，由此可以类推其他情况。
【集解】
方有执说：大邪气刚刚消退，气血新近虚弱，起居劳作，又产生余热，于是用苦寒药物来发微汗，是因为这种因劳伤引起的复发之热，与初病时的实热性质不同。方中使用清浆水七升，空煮至四升，完全是为了让水性熟软而下趋，不至于向上涌吐作呕，这与太阳病篇中下法后身热取吐的方法不同，所以目的是覆盖衣被使身体微微似有汗出。
@@@
伤寒病痊愈后，后来又发热，用小柴胡汤（Xiaochaihu Tang, Minor Bupleurum Decoction）主治。脉象浮的，用发汗法解除；脉象沉实的，用攻下法解除。
【注】
这是承接上一条详细论述证候和脉象，以区别治疗方法。伤寒病痊愈后，后来又复发发热，虽然有劳复、食复的区别，但是必须分辨出或宜和解，或宜发汗、或宜攻下的不同。如脉浮且有表证，应当用发汗法解除，用枳实栀子豉汤发汗；脉沉且有里证，应当用攻下法解除，用枳实栀子豉汤加大黄汤攻下；如果没有表里证，应当用和解法治疗的，用小柴胡汤和解。对证施治，这才是合法的治疗原则。
【集注】
方有执说：这是提示病后如果不谨慎调理，导致复发的总大法。脉浮，是有重感外邪。脉沉，是饮食失节所致。
魏荔彤说：大病后不宜大汗，喻嘉言注解说用枳实栀子豉汤来微汗是正确的。大病后不宜大下，喻嘉言注解说用枳实栀子豉汤加大黄来微下是正确的。然而也有不能完全涵盖的情况，凡是在使用汗法和下法时，留心考虑这是大病之后，这样治疗复发疾病，才不会妨碍到大病后的恢复。
大病初愈后，腰部以下有水气肿胀者，用牡蛎泽泻散（Muli Zexie San, Oyster Shell and Alisma Powder）主治。
【注】
伤寒病痊愈后，腰部以下肿胀的，这是有水气停滞，适宜用牡蛎泽泻散，峻猛驱逐水气，恐怕拖延久了水势旺盛，必定向上侵犯阳部。
【集注】
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.
@@@
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.
@@@
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.