论曰伤寒潮热者,谓潮作有时,由邪气入里,故病有日晡所发潮热,已而微利者,有微
发潮热而大便溏者,有潮热而咳逆者,有结胸而潮热者,大凡潮热,皆以邪气内实也,制方
者宜酌其轻重。
治伤寒阳明病发潮热,大便溏,小便自可,胸胁满不去者,小柴胡汤方
柴胡(去苗八两) 黄芩(去黑心) 甘草(炙) 人参(各三两) 半夏(二两半汤
洗七遍)
上五味,细锉,如麻豆大拌匀,每服四钱匕,水一盏半,生姜半分切,大枣二枚劈破。
煎至八分,去滓温服日三。
治伤寒十三日不解,胸胁满而呕,日晡所发潮热,已而微利,此本柴胡证,下之而不得
利,今反利者,知医以丸药下之,非其治也,潮热者实也,先宜小柴胡汤以解外,后以柴胡
加芒硝汤主之方
柴胡(去苗二两) 黄芩(去黑心) 人参 甘草(炙各一两) 半夏(八钱汤洗七遍)
芒硝
(研二两)
上六味,除芒硝外,细锉如麻豆大,每服四钱匕,水一盏半,生姜半分切,大枣二枚劈
破,煎至八分去滓,入芒硝末一钱匕,再煎令沸温服。
治阳明病谵语潮热,脉滑而疾者。小承气汤方
大黄(酒洗锉炒四两) 浓朴(去粗皮姜汁炙二两) 枳实(麸炒一两)
上三味,细锉如麻豆大,拌匀,每服四钱匕,水一盏半,煎至八分,去滓温服,初服当
利,不尔再服。
治伤寒阳明病,潮热大便微硬者。大承气汤方
大黄(酒洗锉炒四两) 浓朴(去粗皮姜汁炙半斤) 枳实(麸炒) 芒硝(研各二两)
上四味, 咀如麻豆大,每服四钱匕,水一盏半,煎至七分,去滓温服,以利为度,热
不潮者,不可与之。
治伤寒十日以上,潮热不解,日晡即发,发即壮热如火,胸满呕逆,六味柴胡汤方
柴胡(去苗一两) 桂(去粗皮) 栝蒌根(各半两) 黄芩(去黑心三分) 牡蛎(烧
赤) 甘
草(炙各一分)
上六味,粗捣筛,每服五钱匕,水一盏半,生姜半分拍碎,煎至七分,去滓温服。
治伤寒后潮热不退。或时头痛目眩,此是腹中有结燥。柴胡浓朴汤方
柴胡(去苗) 浓朴(去粗皮姜汁炙) 朴硝(研各一两) 大黄(锉炒一两半) 枳
壳(去麸
炒三分)
上五味,粗捣筛,每服五钱匕,水一盏半,煎至七分,去滓温服,以利为度。
治伤寒十日以上,潮热不退。柴胡石膏汤方
柴胡(去苗) 石膏(碎) 赤茯苓(去黑皮) 白术 葳蕤 羚羊角(镑各一两) 栀
子仁
(一分) 桑根(白皮锉三分)
上八味,粗捣筛,每服五钱匕,水一盏半,煎至七分,去滓温服。
治伤寒瘥后,已经十余日,潮热不退,身体沉重,昏昏如醉。前胡汤方
前胡(去芦头) 百合 葛根(锉各一两) 麦门冬(去心焙半两) 石膏碎 麻黄(去
根
节各三分)
上六味,粗捣筛,每服五钱匕,水一盏半,煎至八分,去滓温服。
治伤寒过经潮热不解,或时作寒如疟状,柴胡鳖甲汤方
柴胡(去苗) 鳖甲(去裙 醋炙) 赤茯苓(去黑皮各一两) 黄芩(去黑心) 知
母(焙) 桑根白皮(锉各三分) 甘草(炙半两)
上七味,粗捣筛,每服五钱匕,水一盏半,生姜半分拍碎,煎至七分,去滓温服不拘时。
治伤寒后潮热不退,发歇无时。秦艽汤方
秦艽(去苗土) 鳖甲(醋炙去裙 各一两) 甘草(炙半两)
上三味,粗捣筛,每服五钱匕,水一盏半,生姜半分拍碎,豉一百粒,葱白五寸。煎至
七分,去滓温服。
治伤寒汗下后,潮热不退,口干烦躁。柴胡人参汤方
柴胡(去苗) 人参 知母(焙) 石膏(碎) 葛根(锉) 赤茯苓(去黑皮各一两)
甘草
(炙半两)
上七味,粗捣筛,每服五钱匕,水一盏半,生姜半分拍碎,煎至七分,去滓温服不拘时。
治伤寒余毒,潮热不解。秦艽柴胡汤方
秦艽(去土) 柴胡(去苗) 知母(焙) 青蒿(各一两) 大黄(锉炒) 鳖甲(醋
炙去裙 ) 鬼臼 常山(各半两)
上八味,粗捣筛,每服三钱匕,水一盏,煎至半盏,去滓温服,不拘时。
治伤寒潮热不退。常山汤方
常山(锉三分) 乌梅肉(炒) 鳖甲(去裙 醋炙) 黄 (锉各一两) 大黄(锉
炒) 甘草炙(各半两)柴胡(去苗二两)
上七味,粗捣筛,每服三钱匕,水一盏半,入小麦一匙,生姜三片,煎至七分。去滓热
服,不拘时,日三。
论述说:伤寒潮热,是指发热如潮水般定时发作。这是由于邪气深入体内所致,因此病症表现为:有的于傍晚时分(日晡时)出现潮热,随后伴有轻微腹泻;有的仅有轻微潮热且大便稀溏;有的潮热伴随咳嗽气逆;有的结胸证兼见潮热。大凡潮热,都是因为邪气在体内壅实所致,制定方剂时应斟酌病情的轻重。
治疗伤寒阳明病出现潮热,大便稀溏,小便正常,胸胁部胀满感持续不消的,用小柴胡汤方。
药材:柴胡(去苗八两)、黄芩(去黑心)、甘草(炙)、人参(各三两)、半夏(二两半,用汤洗七遍)。
以上五味药,切碎如麻豆大小拌匀,每次服用四钱匕,加水一盏半,生姜半分切块,大枣二枚掰破。煎煮至八分满,滤去药渣,温服,每日三次。
治疗伤寒十三天未愈,胸胁胀满且呕吐,傍晚时分出现潮热,随后轻微腹泻。这原本是小柴胡汤证,误用下法后并未导致腹泻,如今反而腹泻,可知是医生使用了丸药攻下,这不是正确的治法。潮热说明体内有实邪,应先宜用小柴胡汤以解表邪,随后再用柴胡加芒硝汤主治。方药如下:
药材:柴胡(去苗二两)、黄芩(去黑心)、人参、甘草(炙各一两)、半夏(八钱,用汤洗七遍)、芒硝(研细二两)。
以上六味药,除芒硝外,其余切碎如麻豆大小,每次服用四钱匕,加水一盏半,生姜半分切块,大枣二枚掰破,煎煮至八分满,滤去药渣,加入芒硝末一钱匕,再煮沸,温服。
治疗阳明病出现谵语、潮热,脉象滑而急促的,用小承气汤方。
药材:大黄(酒洗、切碎、炒制四两)、浓朴(去粗皮,姜汁炙二两)、枳实(麸炒一两)。
以上三味药,切碎如麻豆大小,拌匀,每次服用四钱匕,加水一盏半,煎煮至八分满,滤去药渣温服。初次服用应当通便,若不通便则再次服用。
治疗伤寒阳明病,潮热且大便微硬的,用大承气汤方。
药材:大黄(酒洗、切碎、炒制四两)、浓朴(去粗皮,姜汁炙半斤)、枳实(麸炒)、芒硝(研细各二两)。
以上四味药,切碎如麻豆大小,每次服用四钱匕,加水一盏半,煎煮至七分满,滤去药渣温服,以通便为度。若热势不呈潮热状,不可给予此方。
治疗伤寒十日以上,潮热未解,傍晚即发,发作时壮热如火,胸满呕吐气逆的,用六味柴胡汤方。
药材:柴胡(去苗一两)、桂枝(去粗皮)、栝蒌根(各半两)、黄芩(去黑心三分)、牡蛎(烧至赤红)、甘草(炙各一分)。
以上六味药,粗捣筛过,每次服用五钱匕,加水一盏半,生姜半分拍碎,煎煮至七分满,滤去药渣温服。
治疗伤寒后潮热不退,有时头痛目眩,这是腹中有燥结。用柴胡浓朴汤方。
药材:柴胡(去苗)、浓朴(去粗皮,姜汁炙)、朴硝(研细各一两)、大黄(切碎炒制一两半)、枳壳(去麸炒三分)。
以上五味药,粗捣筛过,每次服用五钱匕,加水一盏半,煎煮至七分满,滤去药渣温服,以通便为度。
治疗伤寒十日以上,潮热不退。用柴胡石膏汤方。
药材:柴胡(去苗)、石膏(捣碎)、赤茯苓(去黑皮)、白术、葳蕤、羚羊角(镑片各一两)、栀子仁(一分)、桑根白皮(切碎三分)。
以上八味药,粗捣筛过,每次服用五钱匕,加水一盏半,煎煮至七分满,滤去药渣温服。
治疗伤寒痊愈后,已过十余日,潮热不退,身体沉重,昏昏沉沉如同醉酒状态。用前胡汤方。
药材:前胡(去芦头)、百合、葛根(切碎各一两)、麦门冬(去心焙干半两)、石膏(捣碎)、麻黄(去根节各三分)。
以上六味药,粗捣筛过,每次服用五钱匕,加水一盏半,煎煮至八分满,滤去药渣温服。
治疗伤寒经过传变后潮热未解,有时出现像疟疾一样的寒战症状,用柴胡鳖甲汤方。
药材:柴胡(去苗)、鳖甲(去裙边,醋炙)、赤茯苓(去黑皮各一两)、黄芩(去黑心)、知母(焙干)、桑根白皮(切碎各三分)、甘草(炙半两)。
以上七味药,粗捣筛过,每次服用五钱匕,加水一盏半,生姜半分拍碎,煎煮至七分满,滤去药渣温服,不拘时间。
治疗伤寒后潮热不退,发作间歇无固定时间。用秦艽汤方。
药材:秦艽(去苗土)、鳖甲(醋炙去裙边各一两)、甘草(炙半两)。
以上三味药,粗捣筛过,每次服用五钱匕,加水一盏半,生姜半分拍碎,淡豆豉一百粒,葱白五寸。煎煮至七分满,滤去药渣温服。
治疗伤寒发汗或攻下后,潮热不退,口干烦躁。用柴胡人参汤方。
药材:柴胡(去苗)、人参、知母(焙干)、石膏(捣碎)、葛根(切碎)、赤茯苓(去黑皮各一两)、甘草(炙半两)。
以上七味药,粗捣筛过,每次服用五钱匕,加水一盏半,生姜半分拍碎,煎煮至七分满,滤去药渣温服,不拘时间。
治疗伤寒余毒未尽,潮热不解。用秦艽柴胡汤方。
药材:秦艽(去土)、柴胡(去苗)、知母(焙干)、青蒿(各一两)、大黄(切碎炒制)、鳖甲(醋炙去裙边)、鬼臼、常山(各半两)。
以上八味药,粗捣筛过,每次服用三钱匕,加水一盏,煎煮至半盏,滤去药渣温服,不拘时间。
治疗伤寒潮热不退。用常山汤方。
药材:常山(切碎三分)、乌梅肉(炒制)、鳖甲(去裙边,醋炙)、黄芪(切碎各一两)、大黄(切碎炒制)、甘草(炙各半两)、柴胡(去苗二两)。
以上七味药,粗捣筛过,每次服用三钱匕,加水一盏半,加入小麦一匙,生姜三片,煎煮至七分满。滤去药渣热服,不拘时间,每日三次。
Commentary states: Shaohao re (Tidal Fever in Cold Damage) refers to fever that occurs at regular intervals, like the tide. This is caused by pathogenic factors entering the interior. Therefore, symptoms may present as tidal fever occurring during the You hour (17:00-19:00), followed by slight diarrhea; or slight tidal fever with loose stools; or tidal fever accompanied by cough and counterflow qi; or Jie Xiong (Chest Binding) combined with tidal fever. Generally, all cases of tidal fever are due to the internal excess of pathogenic factors. When formulating prescriptions, one should assess the severity of the condition.
For Taiyang disease progressing to Yangming disease presenting with tidal fever, loose stools, normal urination, and persistent fullness and distension in the chest and hypochondrium, use Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Ingredients: Chai Hu (Bupleuri Radix, 8 liang, remove seedlings); Huang Qin (Scutellariae Radix, remove black heart); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma); Ren Shen (Ginseng Radix, each 3 liang); Ban Xia (Pinelliae Rhizoma, 2.5 liang, wash seven times in decoction).
The above five herbs are finely chopped to the size of hemp seeds and mixed evenly. Each dose consists of 4 qian bi (approx. 12-15g), boiled with 1.5 sheng (approx. 300ml) of water, plus 0.5 fen (approx. 1.5g) of sliced Sheng Jiang (Zingiberis Rhizoma Recens) and 2 fractured Da Zao (Jujubae Fructus). Boil until reduced to 0.8 volume, strain, and take warm. Administer three times daily.
For cold damage persisting for thirteen days without resolution, presenting with chest and hypochondriac fullness, vomiting, tidal fever at the You hour, followed by slight diarrhea: this was originally a Chai Hu syndrome. If purgation was incorrectly applied and did not result in diarrhea, but now diarrhea has occurred, it indicates the physician used pill-based purgatives, which is inappropriate. Tidal fever indicates an internal excess condition. First, use Xiao Chai Hu Tang to resolve the exterior, then treat with Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Natrii Sulfas).
Ingredients: Chai Hu (Bupleuri Radix, 2 liang, remove seedlings); Huang Qin (Scutellariae Radix, remove black heart); Ren Shen (Ginseng Radix); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, each 1 liang); Ban Xia (Pinelliae Rhizoma, 8 qian, wash seven times in decoction); Mang Xiao (Natrii Sulfas, ground, 2 liang).
The above six herbs, excluding Mang Xiao, are finely chopped to the size of hemp seeds. Each dose consists of 4 qian bi, boiled with 1.5 sheng of water, plus 0.5 fen of sliced Sheng Jiang and 2 fractured Da Zao. Boil until reduced to 0.8 volume, strain, add 1 qian bi of Mang Xiao powder, boil again until bubbling, and take warm.
For Yangming disease presenting with delirium and tidal fever, with a slippery and rapid pulse, use Xiao Cheng Qi Tang (Minor Order the Qi Decoction).
Ingredients: Da Huang (Rhei Radix et Rhizoma, wine-washed, chopped, stir-fried, 4 liang); Hou Po (Magnoliae Officinalis Cortex, remove rough bark, ginger-juice processed, 2 liang); Zhi Shi (Immaturus Citri Grandis Fructus, bran-fried, 1 liang).
The above three herbs are finely chopped to the size of hemp seeds and mixed evenly. Each dose consists of 4 qian bi, boiled with 1.5 sheng of water until reduced to 0.8 volume, strained, and taken warm. The first dose should induce bowel movement; if not, administer again.
For cold damage Yangming disease presenting with tidal fever and slightly hard stools, use Da Cheng Qi Tang (Major Order the Qi Decoction).
Ingredients: Da Huang (Rhei Radix et Rhizoma, wine-washed, chopped, stir-fried, 4 liang); Hou Po (Magnoliae Officinalis Cortex, remove rough bark, ginger-juice processed, half jin); Zhi Shi (Immaturus Citri Grandis Fructus, bran-fried); Mang Xiao (Natrii Sulfas, ground, each 2 liang).
The above four herbs are chopped to the size of hemp seeds. Each dose consists of 4 qian bi, boiled with 1.5 sheng of water until reduced to 0.7 volume, strained, and taken warm. Use bowel movement as the endpoint. Do not administer if the fever does not present as tidal fever.
For cold damage lasting more than ten days with unresolved tidal fever, occurring at the You hour, manifesting as intense heat like fire, chest fullness, vomiting, and counterflow qi, use Liu Wei Chai Hu Tang (Six-Ingredient Bupleurum Decoction).
Ingredients: Chai Hu (Bupleuri Radix, 1 liang, remove seedlings); Gui Zhi (Cinnamomi Ramulus, remove rough bark); Gua Lou Gen (Trichosanthis Radix, each half liang); Huang Qin (Scutellariae Radix, remove black heart, 3 qian); Mu Li (Ostreae Concha, calcined until red); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, each 1 qian).
The above six herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water, plus 0.5 fen of crushed Sheng Jiang, until reduced to 0.7 volume, strained, and taken warm.
For post-cold damage tidal fever that does not recede, occasionally accompanied by headache and dizziness, indicating dryness accumulation in the abdomen, use Chai Hu Hou Po Tang (Bupleurum and Magnolia Bark Decoction).
Ingredients: Chai Hu (Bupleuri Radix, remove seedlings); Hou Po (Magnoliae Officinalis Cortex, remove rough bark, ginger-juice processed); Pu Xiao (Natrii Sulfas, ground, each 1 liang); Da Huang (Rhei Radix et Rhizoma, chopped and stir-fried, 1.5 liang); Zhi Ke (Aurantii Fructus, remove bran-fried husk, 3 qian).
The above five herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water until reduced to 0.7 volume, strained, and taken warm. Use bowel movement as the endpoint.
For cold damage lasting more than ten days with unresolved tidal fever, use Chai Hu Shi Gao Tang (Bupleurum and Gypsum Decoction).
Ingredients: Chai Hu (Bupleuri Radix, remove seedlings); Shi Gao (Gypsi Fibrosum, crushed); Chi Fu Ling (Poria Cocos with Red Peel, remove black skin); Bai Zhu (Atractylodis Macrocephalae Rhizoma); Wei Yu (Polygonati Odorati Rhizoma); Ling Yang Jiao (Saigae Tataricae Cornu, shaved, each 1 liang); Zhi Zi Ren (Gardeniae Semen, 1 qian); Sang Bai Pi (Mori Cortex, chopped, 3 qian).
The above eight herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water until reduced to 0.7 volume, strained, and taken warm.
For post-recovery from cold damage, after more than ten days, with unresolved tidal fever, heavy body, and a dizzy state resembling drunkenness, use Qian Hu Tang (Peucedani Radix Decoction).
Ingredients: Qian Hu (Peucedani Radix, remove rhizome head); Bai He (Lilii Bulbus); Ge Gen (Puerariae Lobatae Radix, chopped, each 1 liang); Mai Men Dong (Ophiopogonis Radix, remove core, roasted, half liang); Shi Gao (Gypsi Fibrosum, crushed); Ma Huang (Ephedrae Herba, remove root nodes, each 3 qian).
The above six herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water until reduced to 0.8 volume, strained, and taken warm.
For cold damage that has passed through meridians with unresolved tidal fever, occasionally presenting with chills similar to malaria, use Chai Hu Bie Jia Tang (Bupleurum and Turtle Shell Decoction).
Ingredients: Chai Hu (Bupleuri Radix, remove seedlings); Bie Jia (Testudinis Carapax et Plastrum, remove skirt, vinegar-processed); Chi Fu Ling (Poria Cocos with Red Peel, remove black skin, each 1 liang); Huang Qin (Scutellariae Radix, remove black heart); Zhi Mu (Anemarrhenae Rhizoma, roasted); Sang Bai Pi (Mori Cortex, chopped, each 3 qian); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, half liang).
The above seven herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water, plus 0.5 fen of crushed Sheng Jiang, until reduced to 0.7 volume, strained, and taken warm at any time.
For post-cold damage tidal fever that does not recede, with irregular onset and cessation, use Qin Jiao Tang (Genki Gentian Decoction).
Ingredients: Qin Jiao (Gentianae Macrophyllae Radix, remove seedlings and soil); Bie Jia (Testudinis Carapax et Plastrum, vinegar-processed, remove skirt, each 1 liang); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, half liang).
The above three herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water, plus 0.5 fen of crushed Sheng Jiang, 100 grains of Chi Xiao Dou (Sojae Semen Preparatum), and 5 cun of Cong Bai (Allii Fistulosi Bulbus). Boil until reduced to 0.7 volume, strain, and take warm.
For post-cold damage sweating or purgation leading to unresolved tidal fever, dry mouth, and irritability, use Chai Hu Ren Shen Tang (Bupleurum and Ginseng Decoction).
Ingredients: Chai Hu (Bupleuri Radix, remove seedlings); Ren Shen (Ginseng Radix); Zhi Mu (Anemarrhenae Rhizoma, roasted); Shi Gao (Gypsi Fibrosum, crushed); Ge Gen (Puerariae Lobatae Radix, chopped); Chi Fu Ling (Poria Cocos with Red Peel, remove black skin, each 1 liang); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, half liang).
The above seven herbs are coarsely pounded and sifted. Each dose consists of 5 qian bi, boiled with 1.5 sheng of water, plus 0.5 fen of crushed Sheng Jiang, until reduced to 0.7 volume, strained, and taken warm at any time.
For residual toxins from cold damage with unresolved tidal fever, use Qin Jiao Chai Hu Tang (Genki Gentian and Bupleurum Decoction).
Ingredients: Qin Jiao (Gentianae Macrophyllae Radix, remove soil); Chai Hu (Bupleuri Radix, remove seedlings); Zhi Mu (Anemarrhenae Rhizoma, roasted); Qing Hao (Artemisiae Annuae Herba, each 1 liang); Da Huang (Rhei Radix et Rhizoma, chopped and stir-fried); Bie Jia (Testudinis Carapax et Plastrum, vinegar-processed, remove skirt); Gui Jiu (Podophylli Fructus); Chang Shan (Dichroae Radix, each half liang).
The above eight herbs are coarsely pounded and sifted. Each dose consists of 3 qian bi, boiled with 1 sheng of water until reduced to half a sheng, strained, and taken warm at any time.
For unresolved tidal fever from cold damage, use Chang Shan Tang (Dichroa Decoction).
Ingredients: Chang Shan (Dichroae Radix, chopped, 3 qian); Wu Mei Rou (Mume Fructus flesh, roasted); Bie Jia (Testudinis Carapax et Plastrum, remove skirt, vinegar-processed); Huang Qi (Astragali Membranacei Radix, chopped, each 1 liang); Da Huang (Rhei Radix et Rhizoma, chopped and stir-fried); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, each half liang); Chai Hu (Bupleuri Radix, remove seedlings, 2 liang).
The above seven herbs are coarsely pounded and sifted. Each dose consists of 3 qian bi, boiled with 1.5 sheng of water, plus one spoonful of Xiao Mai (Tritici Fructus), and 3 slices of Sheng Jiang, until reduced to 0.7 volume. Strain, take hot, at any time, three times daily.