许学士云。记有人伤寒得汗。病退数日。忽身热自汗。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。营卫失度。当补脾以解其
劳。庶几得愈。授以补脾汤合入小柴胡。或者难曰。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。补脾气以益之。脾王则感之于心矣。此劳则当补子。人所未闻也。盖母。生我
者也。子。继我而助我者也。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。
滑伯仁治潘子庸。得感冒证已汗而愈。数日。复大发热恶寒。头痛眩晕。呕吐却食。烦
满。咳而多汗。滑诊其脉。两手皆浮而紧。在仲景法。劳复证浮以汗解。沉以下解。为作麻
黄葛根汤。三进。更汗。旋调理数日愈。其时众医以病后虚惫。且图温补。伯仁曰。法当如
是。因违众用之。
王海藏治李良佐子病太阳证。尺寸脉俱浮数。按之无力。谓其内阴虚。与神术加干姜汤
愈后再病。海藏视之。见神不舒。垂头不欲语。疑其有房过。问之犯房过乎。必头重目暗
曰然。因与大建中三四服。外阳内收。脉反沉小。始见阴候。又与已寒加芍药茴香等丸五
六服。三日内。约服六七百丸。脉复生。又用大建中接之。大汗作而解。
侯国华病伤寒四五日。身微斑。渴饮。海藏诊之。沉弦欲绝。厥阴脉也。服温药数日。
不已。又以姜附等药。阳回脉生。因渴。私饮水一杯。脉复退。但头不举。目不开。问之则
犯阴易。若只与烧 散。恐寒而不济。遂煎吴茱萸汤一大碗。调烧 散。连进二服。作大汗
两昼夜而愈。
张路玉治冯茂之。夏月阴阳易。而腰痛少腹急。烦躁谵妄。舌色青紫。而中有黄胎肿裂
虽渴欲冷冻饮料。而舌却不甚干。心下按之硬痛。嗳而失气。此挟宿食也。所可虑者。六脉虚
大。而两尺则弦。按之皆无根耳。遂以逍遥汤加大黄一剂。下黑秽甚多。下后诸证悉除。但
少腹微冷作痛。又与烧 散一服。煎五苓散送下而安。
〔附〕范汪方云。故督邮顾子献。得病已瘥未健。诣华 视脉。 曰。虽瘥。尚虚。未
平复。阳气不足。勿为劳事也。诸劳尚可。女劳即死。当吐舌数寸。献妇闻其瘥。从百余里
来省之。住数宿。因与交接。一二日死。巢氏病源论曰。妇人伤寒虽瘥。未满百日。气血骨
髓未牢实。而合阴阳。当时虽未觉恶。经日则令百节解离。经络缓弱。气血虚。骨髓空。恍
恍吸吸。起居仰人。饮食如故。是其证也。丈夫亦然。
千金方云。妇人温病虽瘥。未平复。血脉未和。尚有热毒。而与之交接得病者。为阴阳
易。医者张苗。说有婢得病瘥后数日。有六人奸之。皆死。
震按学士撄宁二案。均为劳复而有虚实之不同。海藏二案皆女劳复。而次案云犯阴易则
误。合观张路玉案亦有寒热之不同。夫阴阳易女劳复。因虽同而病则异易者。以不病之人易
其人之病。不过余邪乘虚而入。故烧 散导其邪使从来路而去也。复者病方瘥。人尚虚。女
劳则虚而益虚。病乃重发。故多死也。若现虚寒之象。犹可以大剂参附挽回之。若现实象热
与虚热象。补阳则势不相合。养阴又迫不及待。奚自求生。至如巢氏所云。乃女劳伤。非女
劳复也。势颇缓矣。张苗之婢。不死于奸之者。而奸之者皆死。是天道恶淫。又出于医理之
许学士说：我记得曾有一人患伤寒，出汗后病势减退。过了几天，突然身体发热、自汗，脉象弦而数，心中烦乱不安，这确实是“劳复”（病后因劳累而复发）。
我诊治他，说：这是用心过度所致。神志依附于心，心神尚未恢复如初，又因劳累损伤了神气，导致营卫失调。应当通过补益脾气来解除这种疲劳，或许才能痊愈。于是给予补脾汤，并合用小柴胡汤。有人质疑说：“虚证应当补其母脏，现在却补其子脏，为什么呢？”我说：“您不知道‘虚劳’与普通‘虚证’的区别吗？《难经》说：‘虚则补其母，实则泻其子。’对于一般的虚证，确实应该补母，这是人所共知的道理。但《千金方》说：‘心劳严重时，应补益脾气以辅助它。脾气旺盛，就能感应并滋养心脏。’对于这种‘劳’证，反而应当补子脏，这是人们很少听说的道理。母亲，是生养我的人；儿子，是继承我并帮助我的人。治疗虚损时，补益生养我的母脏，这与《锦囊》所说的‘本骸得气，遗体受荫’意义相同；治疗疲劳时，补益帮助我的子脏，这与荀子所说的‘没有儿子富有而父亲贫穷的道理’相同。这就是治疗虚证与劳证的不同之处。”
滑伯仁治疗潘子庸，此人患有感冒症状，发汗后痊愈。几天后，再次出现大热、恶寒、头痛、眩晕、呕吐、食欲不振、烦闷胀满、咳嗽且多汗的症状。滑伯仁诊察其脉象，两手脉皆浮而紧。按照张仲景的法则，劳复证若脉浮应用发汗法解表，脉沉应用攻下法通里。于是给他服用麻黄葛根汤，连续服用三次，再次发汗，随后调理数日便痊愈了。当时其他医生认为病人病后身体虚弱疲惫，打算使用温补疗法。滑伯仁说：“治疗方法应当如此。”因此违背众人的意见使用了该方。
王海藏治疗李良佐的儿子，患太阳病，寸关尺三部脉俱浮数，但按之无力，判断为体内阴液亏虚，给予神术加干姜汤治愈。后来病情复发，王海藏诊视，见他神情不舒展，低头不想说话，怀疑他有房事过度。问他是否犯了房事禁忌，他说必定感到头重眼花，承认了这一点。于是给予大建中丸三四服，使外阳内收，脉象反而变得沉小，这才显现出阴证的候象。又给予已寒加芍药茴香等药制成的丸药五六服，三天内大约服用了六七百丸，脉象重新出现。接着再用大建中丸接续治疗，大汗出后病愈。
侯国华患伤寒四五日，身上出现轻微斑疹，口渴想喝水。王海藏诊察其脉，沉弦欲绝，这是厥阴脉。服用温药数日，病情未好转。又用姜、附等药物，阳气回复，脉象重现。但因口渴，私自喝了一杯水，脉象又退去，仅表现为头抬不起来，眼睛睁不开。询问得知是犯了“阴易”（指病后男女交接传染疾病）。如果只给烧裈散，恐怕药性寒凉而不能胜任，于是煎煮一大碗吴茱萸汤，调入烧裈散，连续服用两次，经过两昼夜的大汗后痊愈。
张路玉治疗冯茂之，夏季患阴阳易，腰痛且少腹拘急，烦躁谵语妄言，舌色青紫，中间有黄色厚苔且肿胀开裂。虽然口渴想要喝冷饮，但舌头却不甚干燥，心下部按压硬痛，嗳气并失气，这是夹杂宿食。令人担忧的是，六脉虚大，但两尺脉弦，按之无根。于是给予逍遥汤加大黄一剂，排出大量黑色秽浊之物。服药后各种症状全部消除，只是少腹微冷作痛。又给予烧裈散一服，用五苓散煎汤送下，从而安定病情。
〔附〕范汪方记载：原督邮顾子献，得病后虽已痊愈但未完全康复，去拜访华佗诊脉。华佗说：“虽然病愈，但身体尚虚，未完全平复。阳气不足，不要从事劳累之事。一般的劳累还可以忍受，如果是女劳（房事），就会致死，会出现吐舌数寸的症状。”顾子献的妻子听说他病愈，从百余里赶来探望，住了几夜，于是与他发生性行为，一二日后顾子献死亡。巢元方《诸病源候论》说：妇女患伤寒即使痊愈，未满百日，气血骨髓尚未牢固充实，此时行房事，当时虽然不觉难受，过几日就会导致全身关节松散，经络缓弱，气血虚弱，骨髓空虚，精神恍惚，气息微弱，起居需要依靠他人，饮食如常，这就是其证候。男子也是如此。
《千金方》说：妇女患温病即使痊愈，未完全康复，血脉未调和，体内尚有热毒，此时与之发生性行为而致病者，称为“阴阳易”。医生张苗说，他曾有一个婢女得病痊愈后几天，有六人与她发生性行为，结果那六人都死了。
俞震按：许学士撄宁的两个医案，都是劳复，但有虚实的不同。王海藏的两个医案都是女劳复，而第二个医案中提到的“犯阴易”则是错误的。综合观察张路玉的医案，也有寒热的不同。阴阳易和女劳复，起因虽然相同，但病症却不同。“易”是指健康的人与患病的人交接，不过是残余的病邪乘虚而入，所以用烧裈散引导病邪从原来的途径排出。“复”是指病刚痊愈，人体尚虚弱，女劳会使虚者更虚，导致疾病重新发作，所以大多致死。如果现出虚寒之象，还可以用大剂量的参、附挽回生机；如果现出实热象或虚热象，补阳则势不相合，滋阴又迫在眉睫，从哪里求得生存呢？至于像巢氏所说的情形，乃是女劳伤，而非女劳复，病势比较缓慢。张苗的婢女，不是死于与她发生性行为的人，而是那些与她发生性行为的人都死了，这是天道厌恶淫乱，又超出了医理的范畴……
Xu Xueshi said: I recall a case where a patient suffered from Shanghan (Cold Damage), and after sweating, the illness receded. A few days later, he suddenly developed fever, spontaneous sweating, a wiry and rapid pulse, and mental restlessness. This was indeed "Lao Fu" (Relapse due to overexertion).
Upon examination, I stated: This is caused by excessive mental exertion. The Shen (Spirit) resides in the Heart. Since the Shen has not yet returned to its original state, further exertion has damaged it, leading to disharmony between Ying (Nutritive Qi) and Wei (Defensive Qi). Treatment should focus on tonifying Spleen Qi to resolve this fatigue, which may lead to recovery. I prescribed Bupi Tang (Spleen-Tonifying Decoction) combined with Xiaochaihu Tang (Minor Bupleurum Decoction). Someone questioned: "In deficiency patterns, one should tonify the Mother organ. Why are you tonifying the Child organ here?" I replied: "Do you not understand the distinction between Xu Lao (Deficiency Fatigue) and ordinary deficiency? The Nan Jing (Classic of Difficult Issues) states: 'Tonify the Mother in deficiency, drain the Child in excess.' For general deficiency, tonifying the Mother is common knowledge. However, the Qian Jin Fang (Essential Prescriptions Worth a Thousand Pieces of Gold) states: 'When Heart fatigue is severe, tonify Spleen Qi to assist it. When Spleen Qi is prosperous, it influences and nourishes the Heart.' In cases of 'Lao' (Fatigue/Overuse), one should tonify the Child organ, which is rarely known. The Mother generates me; the Child succeeds me and assists me. When treating deficiency, we tonify the one who generated us, similar to the principle in Jin Nang that 'when the root receives Qi, the branches receive shade.' When treating fatigue, we tonify the one who assists us, analogous to Xunzi's saying that 'a son cannot be wealthy while the father is poor.' This is why the treatment for deficiency differs from that for fatigue."
Hua Bren treated Pan Ziyong, who had recovered from a Ganmao (Common Cold) via sweating. A few days later, he relapsed with high fever, aversion to cold, headache, dizziness, vomiting, loss of appetite, irritability, fullness, coughing, and profuse sweating. Hua examined his pulses, finding both hands floating and tight. According to Zhang Zhongjing's methods, for Lao Fu with a floating pulse, release via sweating; with a sinking pulse, resolve via purgation. He administered Mahuang Gegen Tang (Ephedra and Pueraria Decoction) three times, inducing further sweating, followed by several days of regulation until recovery. Other physicians at the time believed the patient was weak and exhausted post-illness and intended to use warming and tonifying methods. Hua said: "The method must be as such," and thus acted against the consensus.
Wang Haizang treated the son of Li Liangzuo, who presented with Taiyang Zheng (Taiyang Syndrome). The pulses at Cun, Guan, and Chi were all floating and rapid but empty upon pressure, indicating internal Yin deficiency. He cured him with Shenzhu Jia Ganjiang Tang (Atractylodes Macrocephala Decoction with Dried Ginger). The illness recurred later. Wang observed the patient looking depressed, head down, and unwilling to speak, suspecting sexual misconduct. Upon asking if he had engaged in intercourse, the patient admitted to feeling heavy-headed and dim vision. Wang then administered Dajianzhong Wan (Great Construct Center Pills) three or four doses, causing external Yang to retreat inward, making the pulse sink and small, revealing Yin signs. He then gave pills containing Yi Han, Shaoyao, and Huixiang (Alpinia Oxyphylla) five or six doses. Within three days, approximately 600-700 pills were taken, and the pulse reappeared. He continued with Dajianzhong to consolidate, resulting in profuse sweating and recovery.
Hou Guohua suffered from Shanghan for four to five days, presenting with slight macules, thirst, and desire to drink. Wang Haizang palpated the pulse as deep, wiry, and nearly absent, characteristic of Jueyin Mai (Jueyin Pulse). After taking warming medicines for several days without improvement, he used Jiang (Ginger) and Fu (Aconite) to restore Yang and regenerate the pulse. Due to thirst, he privately drank a cup of water, causing the pulse to retreat again. He could only lift his head slightly and open his eyes. Inquiry revealed he had committed "Yin Yi" (Yin Exchange). Suspecting that Shaokui San (Burnt Underwear Powder) alone might be too cold and ineffective, Wang decocted a large bowl of Wuzhuyu Tang (Evodia Decoction), mixed in Shaokui San, and administered two doses consecutively. After two days and nights of profuse sweating, he recovered.
Zhang Luyu treated Feng Maozhi, who contracted Yin Yang Yi (Yin-Yang Exchange) in summer, presenting with lower back pain, acute tension in the lower abdomen, irritability, delirium, cyanotic-purple tongue coating, yellow thick coating in the center with swelling and cracks. Although thirsty for cold drinks, the tongue was not very dry. Pressing the epigastrium revealed hardness and pain, accompanied by belching and passing gas, indicating retained food stagnation. The concern was the empty and large pulses in all six positions, while the Chi pulses were wiry and rootless upon pressure. He prescribed Xiaoyao Tang (Free and Easy Wanderer Decoction) with added Rhubarb (Dahuang) for one dose, evacuating much black filth. After evacuation, all symptoms resolved, except for mild coldness and pain in the lower abdomen. He then gave one dose of Shaokui San, taken with Wuling San (Five-Ingredient Powder with Poria) decoction, leading to stability.
[Appendix] Fan Wang's Formula records: Former Inspector Gu Zixian fell ill, recovered but was not fully robust. He visited Hua Tuo for pulse diagnosis. Hua said: "Although recovered, you are still deficient and not fully restored. Yang Qi is insufficient. Do not engage in labor. General exertion is tolerable, but female labor (sexual intercourse) will cause death, manifesting as protruding tongue several inches long." Gu's wife heard of his recovery and traveled over a hundred li to visit him. After staying for several nights, they engaged in intercourse. One or two days later, Gu died. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* (Source Book of Diseases and Syndromes) states: If a woman suffers from Shanghan and recovers within 100 days, her Qi, Blood, bones, and marrow are not yet solid. Engaging in intercourse at this time may not cause immediate discomfort, but after a few days, it leads to loose joints, weak meridians, deficient Qi and Blood, and empty marrow. Symptoms include恍惚 (mental confusion), weak breathing, dependence on others for daily activities, while eating remains normal. Men suffer similarly.
*Qian Jin Fang* states: If a woman suffers from Wenbing (Warm Disease) and recovers before full restoration, with unharmonized blood vessels and residual heat toxins, engaging in intercourse causes "Yin Yang Yi." Physician Zhang Miao reported a case where a maid, a few days after recovering from illness, was assaulted by six men; all six men died.
Yu Zhen notes: The two cases from Xu Xueshi Yingning are both Lao Fu, differing in deficiency and excess. The two cases from Wang Haizang are both Nu Lao Fu (Female Labor Relapse), but the second case's mention of "Fan Yin Yi" is erroneous. Observing Zhang Luyu's case together reveals differences in cold and heat. Yin Yang Yi and Nu Lao Fu share similar causes but different pathologies. "Yi" implies a healthy person acquiring disease from an infected person through exchange; residual pathogens enter via deficiency. Thus, Shaokui San guides pathogens out through their original route. "Fu" implies relapse when the body is still weak post-recovery. Nu Lao makes the weak even weaker, causing severe relapse and often death. If deficiency-cold signs appear, large doses of Renshen (Ginseng) and Fuzi (Prepared Aconite) can save life. If excess-heat or deficiency-heat signs appear, tonifying Yang is inappropriate, and nourishing Yin is urgent; survival is difficult. As described by Chao, this is Nu Lao Shang (Female Labor Injury), not Nu Lao Fu, with a slower progression. The maid of Zhang Miao did not die from the assaulters, but the assaulters died. This reflects Heaven's disgust for licentiousness, exceeding medical logic...