【因】瘥后伏热未尽。复感新邪。其病复作。
【证】头痛发热。恶风或恶寒。舌燥口渴。或兼咳嗽。
【脉】兼风者脉浮缓。兼湿者濡数。兼寒脉紧或浮数。
【治】感寒身热恶寒者。葱豉葛根汤。(鲜葱白二枚、淡豆豉三钱、生葛根钱半。)加薄荷、
连翘壳。寒重骨疼者。加羌活、苏叶。偏于热重者。加花粉、知母。咳嗽者。加光杏仁、前胡、
桔梗。兼风热重者。银翘散。桑菊饮。桑杏汤。随症酌用。邪郁于内。见烦躁者。荷杏石甘汤。
(苏薄荷一钱、光杏仁三钱、石膏四钱、知母三钱、生甘六分、细辛三分。鲜竹叶三十片。)
或葱豉白虎汤。(鲜葱白三枚、豆豉三钱、生石膏四钱、知母三钱、细辛三分、生甘五分、粳米三
钱、荷叶包。)营分有伏热者。七味葱白汤(淡豆豉三钱、生葛根钱半、鲜生地三钱、麦冬钱半、
葱白三枚、生姜二片、百劳水煎。)
【因】伤寒瘥后。因事触怒。相火暴发。因而余热复作。
【证】身热胸闷。心烦懊 。气逆喘呼。甚则胁痛呕血。或少腹急痛。不语如 。形厥如尸者。
【脉】多弦浮躁盛。或弦劲。或弦涩。或沉弦搏坚。
【治】先宜苏子降香汤。(炙苏子、制香附各钱半、降香一钱、川贝、广郁金、焦山栀、旋复花包煎、
各三钱、淡竹茹、白薇各二钱、葱须三分冲。)加桑叶、丹皮、银胡、地骨皮。平其气以清泄之。
若瘀血结聚。少腹急痛者。代抵当汤。(酒炒锦纹二钱、桃仁钱半。炒穿甲一钱、醋炒莪术、归尾、
玄明粉各一钱、细生地三钱、官桂三分)加杜牛膝主之。香壳散。(制香附、归尾各三钱、炒枳壳二钱、
炒青皮、新会皮、乌药、赤芍、醋炒莪术各一钱、西藏红花、炙甘草各五分、上药共研为散、每用五钱、
水煎去渣。调童便半杯。空心温服。)加白薇、玄胡索、炒穿甲、尤捷。不语如 。形如尸者。宜犀角
地黄汤(黑犀角一钱、鲜生地六钱、丹皮二钱、赤芍二钱。)加桃仁、归尾、白薇。厥症返魂丹等。
甘咸以平之。芳香以宣之。虽然。怒复有大怒郁怒之分。大怒者。其志愤激。则气血易于奔迫。而无
所节制。《经》所谓怒则伤志也。脉多浮弦躁盛。症多失血。甚或痛厥。仍宜苏子降香汤。加蜜炙延胡、
醋炒锦纹、盐水炒川连等。以降泄之。血虚火旺者。拔萃犀角地黄汤。(白犀角一钱、鲜生地一两五钱、
生锦纹三钱、川连一钱、青子芩二钱)加白芍、白薇、童便、金汁等。以通降之。郁怒者。其志怫戾。
则气血易于瘀壅。而不克宽舒。《经》所谓怒则气逆也。脉多弦涩。甚则沉弦搏坚。症多瘕疝。久则成痨
成蛊。治法。瘕疝、宜开郁正元散。(方见前)茴香橘核丸。(小茴香五钱、橘核炒三两、延胡一两五钱、
青皮八钱、桃仁三两、川楝子一两五钱、两头尖五钱、归须一两五钱、杜牛膝一两五钱、炒穿甲一两、
柏子仁三两、上为末、葱白汁捣丸、朱砂为衣、每服钱半、淡盐汤下。)等选用。成痨宜紫菀散。(紫菀、
北沙参各二两、麦冬、桔梗、茯苓、阿胶、川贝母各一两、五味子、炙甘草各五钱、上药为末、
每四五钱、水煎去滓服。)
劫痨散。(细生地、生白芍各三钱、白归身二钱、潞党参、阿胶、仙半夏、炙绵 各钱半、炙甘草一钱、
五味子五分、以上各药为散、每服三四钱、温汤调下、空心服。)顾氏清金散。(生桑皮、百合、
冬花、川贝各三钱、生苡仁五钱、地骨皮四钱、麦冬二钱、生甘八分、生藕汁一杯冲、童便一杯冲、
枇杷叶去毛一两、鲜茅根一两、煎汤代水。)等选用。成蛊当归活血汤。(全当归三钱、桃仁二钱、
桂枝钱半、炒枳壳、赤芍、鳖血柴胡各八分、赤苓一钱、黑炮姜四分、藏红花二分、炙甘草五分、
鲜生地一两。陈酒一瓢冲入。)服之不应。再加炙穿甲五分。又不应。加附子三分。有实热者。禁用。
须加大黄一钱亦可。或下瘀血汤。(原桃仁三钱、生锦纹钱半、醋炒地鳖虫十只。)或桃仁承气汤。
合逍遥散。(原桃仁、全当归、赤苓各三钱、生锦纹钱半、风化硝一钱、川柴胡、官桂、炙甘草各五分、
薄荷四分、细辛三分、生白术八分、炒蝼蛄十只、研包。)奏功更捷。
【病因】病后余热未清,又感受新的外邪,导致疾病复发。
【症状】头痛、发热,怕风或怕冷,舌面干燥且口渴,有时伴有咳嗽。
【脉象】兼夹风邪的,脉象浮而缓;兼夹湿邪的,脉象濡软而数;兼夹寒邪的,脉象紧或浮数。
【治法】因感寒而出现身热恶寒的,用葱豉葛根汤(鲜葱白两根、淡豆豉三钱、生葛根一钱半),加入薄荷、连翘壳。若寒重且骨节疼痛的,加入羌活、苏叶。若偏于热重的,加入天花粉、知母。有咳嗽的,加入光杏仁、前胡、桔梗。兼夹风热较重的,选用银翘散、桑菊饮、桑杏汤,根据具体症状斟酌使用。邪气郁结在体内,出现烦躁不安的,用荷杏石甘汤(苏薄荷一钱、光杏仁三钱、石膏四钱、知母三钱、生甘草六分、细辛三分、鲜竹叶三十片)。或者用葱豉白虎汤(鲜葱白三枚、豆豉三钱、生石膏四钱、知母三钱、细辛三分、生甘草五分、粳米三钱,用荷叶包裹煎煮)。营分有伏热的,用七味葱白汤(淡豆豉三钱、生葛根一钱半、鲜生地三钱、麦冬一钱半、葱白三枚、生姜两片,用百劳水煎煮)。
【病因】伤寒病愈后,因事情触动而发怒,相火暴发,导致余热再次发作。
【症状】身体发热、胸闷,心烦意乱且心中懊恼,气逆喘息呼叫,严重时胁痛呕血,或少腹急痛,不语如痴呆状,四肢厥冷如尸体一般。
【脉象】多呈弦、浮、躁、盛之象,或弦劲有力,或弦涩,或沉弦搏指坚硬。
【治法】首先宜用苏子降香汤(炙苏子、制香附各一钱半、降香一钱、川贝、广郁金、焦山栀、旋复花包煎各三钱、淡竹茹、白薇各二钱、葱须三分冲服),加入桑叶、丹皮、银柴胡、地骨皮,以平抑气机并清泄火热。若有瘀血结聚,少腹急痛的,用代抵当汤(酒炒锦纹大黄二钱、桃仁一钱半、炒穿山甲一钱、醋炒莪术、归尾、玄明粉各一钱、细生地三钱、官桂三分)加杜牛膝主治。或用香壳散(制香附、归尾各三钱、炒枳壳二钱、炒青皮、新会皮、乌药、赤芍、醋炒莪术各一钱、西藏红花、炙甘草各五分,上药共研为散,每次用五钱,水煎去渣,调童便半杯,空腹温服),加白薇、玄胡索、炒穿山甲,效果更佳。若不语如痴呆、形如尸体的,宜用犀角地黄汤(黑犀角一钱、鲜生地六钱、丹皮二钱、赤芍二钱)加桃仁、归尾、白薇。也可用厥症返魂丹等,用甘咸之品以平之,芳香之品以宣通。虽然如此,怒复有大怒和郁怒之分。大怒者,其志愤激,则气血易于奔迫而无节制,《内经》所谓“怒则伤志”。脉多浮弦躁盛,症状多为失血,甚或痛厥,仍宜用苏子降香汤,加蜜炙延胡索、醋炒锦纹大黄、盐水炒黄连等,以降泄之。血虚火旺者,用拔萃犀角地黄汤(白犀角一钱、鲜生地一两五钱、生锦纹大黄三钱、黄连一钱、青子芩二钱)加白芍、白薇、童便、金汁等,以通降之。郁怒者,其志怫戾不舒,则气血易于瘀滞壅塞而不能宽舒,《内经》所谓“怒则气逆”。脉多弦涩,甚则沉弦搏指坚硬,症状多为瘕疝,久则成痨成蛊。治疗方法:对于瘕疝,宜选用开郁正元散(方见前文)、茴香橘核丸(小茴香五钱、橘核炒三两、延胡一两五钱、青皮八钱、桃仁三两、川楝子一两五钱、两头尖五钱、归须一两五钱、杜牛膝一两五钱、炒穿山甲一两、柏子仁三两,上药为末,葱白汁捣丸,朱砂为衣,每服一钱半,淡盐汤送下)等。成痨者宜用紫菀散(紫菀、北沙参各二两、麦冬、桔梗、茯苓、阿胶、川贝母各一两、五味子、炙甘草各五钱,上药为末,每次四五钱,水煎去滓服用)、劫痨散(细生地、生白芍各三钱、白归身二钱、潞党参、阿胶、仙半夏、炙绵黄芪各一钱半、炙甘草一钱、五味子五分,以上各药为散,每次服三四钱,温开水调下,空腹服)、顾氏清金散(生桑皮、百合、冬花、川贝各三钱、生苡仁五钱、地骨皮四钱、麦冬二钱、生甘草八分、生藕汁一杯冲入、童便一杯冲、枇杷叶去毛一两、鲜茅根一两,煎汤代水)等选用。成蛊者用当归活血汤(全当归三钱、桃仁二钱、桂枝一钱半、炒枳壳、赤芍、鳖血柴胡各八分、赤苓一钱、黑炮姜四分、藏红花二分、炙甘草五分、鲜生地一两、陈酒一瓢冲入)。服药无效,再加炙穿山甲五分;再无效,加附子三分。有实热者禁用此法。需加大黄一钱亦可。或用下瘀血汤(原方桃仁三钱、生锦纹大黄一钱半、醋炒地鳖虫十只)或桃仁承气汤合逍遥散(原方桃仁、全当归、赤苓各三钱、生锦纹大黄一钱半、风化硝一钱、川柴胡、官桂、炙甘草各五分、薄荷四分、细辛三分、生白术八分、炒蝼蛄十只研碎包煎),奏效更快。
[Pathogenesis] Residual heat remains after recovery, and a new pathogen is contracted, causing the disease to recur.
[Symptoms] Headache, fever, aversion to wind or cold, dry tongue with thirst, sometimes accompanied by cough.
[Pulse] If complicated by wind, the pulse is floating and moderate; if complicated by dampness, the pulse is soggy and rapid; if complicated by cold, the pulse is tight or floating and rapid.
[Treatment] For those with body heat and aversion to cold due to contracting cold, use Congchi Gegen Tang (Congchi Radish Root Decoction) (fresh scallion white two stalks, light fermented soybean three qian, raw kudzu root one and a half qian), added with mint and Forsythia fruit shell. If cold is severe with bone pain, add Notopterygium root and Perilla leaf. If heat predominates, add Trichosanthes root and Anemarrhena rhizome. For cough, add Apricot seed and Peucedanum root. If wind-heat is heavy, choose Yinqiao San, Sangju Yin, or Sangxing Tang, selecting according to symptoms. If pathogens are constrained internally presenting with irritability, use Hexing Shigan Tang (Lotus Leaf-Almond-Gypsum Decoction) (Mint one qian, Apricot seed three qian, Gypsum four qian, Anemarrhena rhizome three qian, Raw licorice six fen, Asarum three fen, fresh bamboo leaves thirty pieces). Alternatively, use Congchi Baihu Tang (Congchi White Tiger Decoction) (fresh scallion white three stalks, fermented soybean three qian, raw Gypsum four qian, Anemarrhena rhizome three qian, Asarum three fen, Raw licorice five fen, Rice three qian, wrapped in lotus leaf for decoction). If latent heat exists in the Ying level, use Qiwei Congbai Tang (Seven-Ingredient Scallion White Decoction) (fermented soybean three qian, raw kudzu root one and a half qian, fresh Rehmannia root three qian, Ophiopogon tuber one and a half qian, scallion white three stalks, ginger two slices, decocted with Bailao water).
[Pathogenesis] After recovery from Cold Damage, anger is triggered by circumstances, causing Ministerial Fire to erupt, leading to the recurrence of residual heat.
[Symptoms] Body heat, chest fullness, mental restlessness and inner vexation, rebellious qi with panting and calling, severe cases present with hypochondriac pain and hematemesis, or acute lower abdominal pain, mutism resembling stupor, and cold limbs resembling a corpse.
[Pulse] Often wiry, floating, restless, and vigorous; or wiry and forceful; or wiry and choppy; or deep, wiry, and hard upon pressure.
[Treatment] Initially, Su Zi Jiang Xiang Tang (Perilla Seed and Aquilaria Wood Decoction) (roasted Perilla seed and processed Cyperus rhizome each one and a half qian, Aquilaria wood one qian, Fritillaria bulb, Curcuma aromatica rhizome, scorched Gardenia fruit, and Inula flower wrapped for decoction each three qian, light bamboo shavings and Anemarrhena asphodeloides rhizome each two qian, scallion root three fen mixed in) should be used, added with Mulberry leaf, Moutan bark, Silver Bupleurum, and Ground-berry bark, to calm the qi and clear/vent the heat. If blood stasis accumulates with acute lower abdominal pain, Dai Didang Tang (Substitute Dangdang Decoction) (wine-fried Rheum palmatum root two qian, Peach kernel one and a half qian, fried Pangolin scale one qian, vinegar-fried Curcuma zedoaria rhizome, Angelica sinensis tail, Mirabilite each one qian, fine Rehmannia root three qian, Cinnamon twig three fen) combined with Achyranthes bidentata root is indicated. Or use Xiangke San (Fragrant Shell Powder) (processed Cyperus rhizome and Angelica sinensis tail each three qian, fried Aurantium peel two qian, fried Citrus reticulata peel, Xinhui peel, Lindera root, Red Peony root, vinegar-fried Curcuma zedoaria rhizome each one qian, Tibetan Safflower, roasted licorice each five fen, powdered together, take five qian each time, decoct in water, remove dregs, mix with half cup of child's urine, take warm on an empty stomach), added with Anemarrhena asphodeloides rhizome, Corydalis rhizome, and fried Pangolin scale for better effect. For mutism resembling stupor and form like a corpse, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) (black Rhinoceros horn one qian, fresh Rehmannia root six qian, Moutan bark two qian, Red Peony root two qian) added with Peach kernel, Angelica sinensis tail, and Anemarrhena asphodeloides rhizome is suitable. Also Juezheng Fanhun Dan etc., using sweet and salty substances to calm it, and aromatic substances to diffuse it. Although so, Nu Fu (Anger Recurrence) distinguishes between Da Nu (Great Anger) and Yu Nu (Depressed Anger). In Great Anger, the spirit is indignant, causing qi and blood to rush uncontrollably. The Classic states "anger injures the will." The pulse is often floating, wiry, restless, and vigorous; symptoms often involve bleeding, even syncope with pain. Still, Su Zi Jiang Xiang Tang is appropriate, added with honey-roasted Corydalis rhizome, vinegar-fried Rheum palmatum root, and salt-water fried Coptis chinensis rhizome to descend and vent. For blood deficiency with hyperactive fire, Bacui Xijiao Dihuang Tang (Extractive Rhinoceros Horn and Rehmannia Decoction) (white Rhinoceros horn one qian, fresh Rehmannia root one tael five qian, raw Rheum palmatum root three qian, Coptis chinensis rhizome one qian, Qingzihuang Qin two qian) added with White Peony root, Anemarrhena asphodeloides rhizome, child's urine, and Jin Zhi to unblock and descend. In Depressed Anger, the spirit is frustrated, causing qi and blood to easily stagnate and obstruct without relaxation. The Classic states "anger causes qi to rebel." The pulse is often wiry and choppy, even deep, wiry, and hard; symptoms often involve masses and hernias, which over time become Lao (Consumption) or Gu (Parasitic Disease). Treatment: For masses and hernias, select Kaiyu Zhengyuan San (see previous section) or Huixiang Juzhu Wan (Fennel and Tangerine Seed Pill) (fennel five qian, stir-fried tangerine seed three taels, Corydalis one tael five qian, Citrus reticulata peel eight qian, Peach kernel three taels, Toosendan fruit one tael five qian, Liangtoujian five qian, Angelica sinensis tendril one tael five qian, Achyranthes bidentata root one tael five qian, fried Pangolin scale one tael, Biota seed three taels, powdered, pill with scallion white juice, coat with Cinnabar, take one and a half qian each time, swallow with light salt soup). For Consumption, use Ziwan San (Aster Powder) (Aster and North Ginseng each two taels, Ophiopogon, Platycodon, Poria, Donkey-hide gelatin, Fritillaria bulb each one tael, Schisandra berry, roasted licorice each five qian, powdered, take four or five qian each time, decoct in water, remove dregs and drink), Jielaosan (Consumption-Collapsing Powder) (fine Rehmannia root, raw White Peony root each three qian, White Angelica sinensis body two qian, Lu Codonopsis pilosula, Donkey-hide gelatin, Fairy Pinellia, roasted Astragalus membranaceus each one and a half qian, roasted licorice one qian, Schisandra berry five fen, all powdered, take three or four qian each time, mix with warm water, take on empty stomach), Gu Shi Qingjin San (Gu's Clear Metal Powder) (raw Mulberry bark, Lily bulb, Adenophora flower, Fritillaria bulb each three qian, raw Coix seed five qian, Ground-berry bark four qian, Ophiopogon two qian, raw licorice eight fen, raw lotus root juice one cup mixed in, child's urine one cup mixed in, loquat leaf de-haired one tael, fresh Imperata rhizome one tael, decoct in water to replace water) etc. For Parasitic Disease, use Danggui Huoxue Tang (Angelica Blood-Invigorating Decoction) (whole Angelica sinensis three qian, Peach kernel two qian, Cinnamon twig one and a half qian, fried Aurantium peel, Red Peony root, turtle-blood processed Bupleurum root each eight fen, red Poria one qian, black prepared ginger four fen, Tibetan Safflower two fen, roasted licorice five fen, fresh Rehmannia root one tael, aged wine one ladle mixed in). If ineffective, add fried Pangolin scale five fen; if still ineffective, add Aconite carmichaelii lateral root three fen. Contraindicated for excess heat. Adding Rheum palmatum root one qian is also acceptable. Or use Xiayuxue Tang (Descend Stasis Blood Decoction) (original Peach kernel three qian, raw Rheum palmatum root one and a half qian, vinegar-fried Sibynagynum chinense ten insects) or Tao Ren Chengqi Tang combined with Xiaoyao San (original Peach kernel, whole Angelica sinensis, red Poria each three qian, raw Rheum palmatum root one and a half qian, weathered saltpeter one qian, Chuan Bupleurum root, Cinnamon twig, roasted licorice each five fen, mint four fen, Asarum three fen, raw Atractylodes macrocephala rhizome eight fen, fried Blatta orientalis ten insects ground and wrapped), achieving results more swiftly.