吾尝治一孕妇伤寒，表汗过后，忽唤婢作伸冤之声，知其扰动阳气，急迫无奈，令进参汤，不可捷得。
遂以白术三两，熬浓汁一碗与服，实时安妥，况人参之力，百倍白术耶！
二十三 一人昔年感症，治之不善，一身津液尽为
邪热所灼，究竟十年，余热未尽去，右耳之窍尝闭，今夏复病感，缠绵五十多日，面足浮肿，卧
寐不宁，耳间气往外出。盖新热与旧热相合，野狼狈为患，是以难于去体。医者不察其绸缪胶结之
情，治之茫不中肯，延至秋深，金寒水冷，病方自退。然浅者可退，深者莫由遽退也。面足浮肿
者，肺金之气，为热所逼，失其清肃下行之权也；卧寐不宁者，胃中之津液干枯，不能内荣其魂魄
也；耳间大气撞出者，久闭之窍，气来不觉，今病体 羸，中无阻隔，气逆上冲，始知之也，外病
虽愈，而饮食药饵之内调者，尚居其半，特挈二事大意，为凡病感者，明善后之法焉。盖人当感后，
身中之元气已虚，身中之邪热未净，于此而补虚，则热不可除，于此而清热，则虚不能任，即一半
补虚，一半清热，终属模糊，不得要领，然舍补虚清热外，更无别法，当细辨之。补虚有二法∶一补
脾，一补胃。如疟痢后，脾气衰弱，饮食不能运化，宜补其脾。如伤寒后，胃中津液久耗，新者未
生，宜补其胃。二者有霄壤之殊也。清热亦有二法∶初病时之热为实热，宜用苦寒药清之；大病后
之热，为虚热，宜用甘寒药清之。二者亦有霄壤之殊也。人身天真之气，全在胃口，津液不足，即是
虚，生津液即是补虚，故以生津之药，合甘寒泻热之药，而治感后之虚热，如生地、麦冬、骨皮、人
参、梨汁、竹沥之属，皆为合法。仲景每用天水散以清虚热，正取滑石、甘草，一甘一寒之甘寒也。
设误用参、 、苓、术补脾之药为补，宁不并邪热而补之乎？至于饮
食之补，但取其气，不取其味。如五谷之气以养之，五菜之气以充之，每食之间，便觉津津汗透，将
身中蕴蓄之邪热，以渐运出于毛孔，何其快哉！人皆不知此理，急于用肥甘之味以补之，目下虽精采
健旺可喜，不思油腻阻滞经络，邪热不能外出，久久充脊完固，愈无出期矣。前哲有鉴于此，宁食淡
茹蔬，使体暂虚，而邪易出，乃为贵耳。前药中以浮肿属脾，用苓、术为治，以不寐属心，用茯神、枣仁
为治，总以补虚清热之旨未明，故详及之。
我曾经治疗一位患有伤寒的孕妇，在发汗解表之后，突然呼唤婢女发出喊冤的声音，我知道这是阳气受到扰动，病人感到急切无奈，于是让人进服人参汤，但当时无法立即获取。
随即我用白术三两，熬制成浓汁一碗让病人服用，病人立刻安定下来，何况人参的药力是白术的百倍呢！
第二十三条：有一人早年感受外邪，治疗不当，导致全身津液被邪热灼烧殆尽，此后十年间，余热未能完全清除，右耳耳窍时常闭塞。今年夏天再次感受外邪，病情缠绵五十多天，面部和足部浮肿，睡眠不安宁，感觉耳中有气息向外冲出。这是因为新的热邪与旧的热邪相结合，狼狈为患，所以难以从体内去除。医生没有察觉这种纠缠胶结的情况，治疗茫然不得要领，拖延到深秋时节，金气寒冷、水气寒凉，病才自然消退。然而浅层的病邪可以消退，深层的病邪则不能迅速消退。面部和足部浮肿，是因为肺金之气被热邪逼迫，失去了清肃下行的功能；睡眠不安宁，是因为胃中的津液干枯，不能内在地滋养魂魄；耳中大气冲出，是因为耳窍长期闭塞，平时气息往来不觉察，如今病体虚弱，内部没有阻隔，气逆上冲，才开始察觉到这一点。外在的病虽然好了，但通过饮食药物进行内部调理的工作还占一半，特别提出这两件事的大意，是为了让所有感受外邪的人明白病后调理的方法。大概人在感受外邪之后，体内的元气已经虚弱，体内的邪热尚未清除干净，在此时如果只补虚，则热邪无法消除；如果只清热，则虚弱的身体无法承受。即使是一半补虚、一半清热，最终也属于模糊不清，不得要领。然而除了补虚清热之外，也没有其他方法，应当仔细辨别。补虚有两种方法：一是补脾，二是补胃。如在疟疾、痢疾之后，脾气衰弱，饮食不能运化，适宜补脾。如在伤寒之后，胃中津液久已耗损，新的津液尚未生成，适宜补胃。这两者有着天壤之别。清热也有两种方法：初病时的热邪属于实热，适宜用苦寒药来清除；大病之后的热邪属于虚热，适宜用甘寒药来清除。这两者也有着天壤之别。人体的天真之气，全在于胃口（胃气），津液不足就是虚，生津液就是补虚，所以用生津的药物，配合甘寒泻热的药物，来治疗感邪后的虚热，如生地黄、麦冬、地骨皮、人参、梨汁、竹沥等，都是合法的治疗。张仲景常常使用天水散（即六一散）来清虚热，正是取滑石、甘草，一甘一寒，构成甘寒之法。如果错误地使用人参、茯苓、白术等补脾的药物作为补益，难道不是连同邪热一起补进去了吗？至于饮食方面的补益，只需取其气，不取其味。如五谷之气来滋养它，五菜之气来充实它，每次进食之间，就会觉得汗水津津透出，将身中蕴蓄的邪热，逐渐运出毛孔，这是多么痛快啊！人们都不懂这个道理，急于用肥腻甘甜的食物来补益，眼下虽然精神健旺可喜，但不想油腻会阻滞经络，使邪热不能外出，久而久之充塞脊背，完善坚固，再也没有排出的时期了。前代哲人鉴于此，宁愿吃清淡蔬菜，使身体暂时虚弱，而邪气容易排出，这才是宝贵的。前面的药物中，将浮肿归属于脾，用茯苓、白术治疗；将不寐归属于心，用茯神、酸枣仁治疗，总因为补虚清热的宗旨没有阐明，所以详细谈及这些。
I once treated a pregnant woman suffering from Shanghan (Cold Damage). After sweating to release the exterior, she suddenly called for her maid, making sounds of crying injustice. I realized this indicated disturbance of Yang Qi (the body's defensive and warming energy), with the patient feeling urgent distress. I ordered Ginseng Decoction to be administered, but it could not be obtained immediately.
Consequently, I used three taels of Atractylodis Rhizoma (Baizhu, 白术), boiled it into a thick decoction of one bowl, and gave it to her to drink. She was instantly pacified. How much more potent is Ren Shen (Ginseng) compared to Baizhu!
Case 23: A man had contracted an external pathogen in his youth. Due to improper treatment, all his body fluids were scorched by the evil heat. For ten years thereafter, residual heat remained uneliminated, causing his right ear orifice to frequently become blocked. This summer, he contracted another external pathogen. The illness lingered for over fifty days, accompanied by edema of the face and feet, restless sleep, and a sensation of qi rushing out from the ears. This occurred because the new heat combined with the old heat, creating a compounded pathology that was difficult to expel. The physician failed to observe this tangled and knotted condition, treating blindly without hitting the key point. It was not until late autumn, when Metal Qi (associated with Autumn/Lungs) became cold and Water Qi (Kidneys) turned chilly, that the disease naturally receded. However, superficial pathogens can recede easily, while deep-seated ones cannot disappear abruptly.
The edema of the face and feet results from Lung Metal Qi being forced by heat, losing its function of clearing, purifying, and descending. Restless sleep occurs because stomach fluids are dried up, failing to internally nourish the Hun and Po (spiritual aspects). The sensation of large amounts of qi rushing out from the ears happens because the long-blocked orifice usually does not perceive normal qi movement; now, due to the debilitated state of the body and lack of internal obstruction, rebellious qi rushes upward, making the sensation noticeable. Although the external illness has healed, internal regulation through diet and medicine still accounts for half the recovery. I highlight these two main points to clarify post-illness care methods for those who have suffered from external pathogens. Generally, after contracting a pathogen, the body's Yuan Qi (Original Qi) is deficient, and residual evil heat is not yet cleared. If one tonifies deficiency at this stage, the heat cannot be eliminated; if one clears heat, the deficient body cannot tolerate it. Even combining half tonification and half clearing remains vague and misses the essence. Yet, apart from tonifying deficiency and clearing heat, there is no other method; careful differentiation is required.
Tonifying deficiency has two methods: one is tonifying the Spleen, the other is tonifying the Stomach. For example, after malaria or dysentery, if Spleen Qi is weak and digestion fails, tonifying the Spleen is appropriate. After Shanghan, if stomach fluids have been depleted for a long time and new fluids have not yet generated, tonifying the Stomach is appropriate. These two differ vastly.
Clearing heat also has two methods: Heat present at the onset of illness is Excess Heat, suitable for clearing with Bitter-Cold herbs. Heat remaining after a severe illness is Deficiency Heat, suitable for clearing with Sweet-Cold herbs. These two also differ vastly.
The innate Qi of the human body resides entirely in the Stomach Qi (appetite/digestive function). Insufficient body fluids constitute deficiency; generating body fluids constitutes tonifying deficiency. Therefore, using fluid-generating herbs combined with Sweet-Cold heat-clearing herbs to treat post-infection deficiency heat is correct. Examples include Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Gu Pi (Cortex Lycii), Ren Shen (Ginseng), Li Zhi (Pear Juice), and Zhu Li (Bamboo Sap). Zhang Zhongjing often used Tian Shui San (Heavenly Water Powder, i.e., Liu Yi San) to clear deficiency heat, precisely utilizing Hua Shi (Talcum) and Gan Cao (Licorice Root)—one sweet and one cold—to form a Sweet-Cold formula. If one mistakenly uses Ren Shen, Fu Ling (Poria), and Bai Zhu as tonics for the Spleen, would one not be tonifying the evil heat along with it?
Regarding dietary tonification, one should seek their Qi (energetic quality) rather than their Flavor (taste/substance). Nourish with the Qi of the five grains, fill with the Qi of the five vegetables. During each meal, one will feel a gentle sweat permeating the skin, gradually transporting accumulated evil heat out through the pores. How refreshing! People do not understand this principle; they urgently use rich, sweet, and fatty foods to tonify. While this may temporarily boost vitality and spirit, greasy foods obstruct the meridians, preventing evil heat from exiting. Over time, this accumulates firmly within the body, leaving no way out. Forefathers, aware of this, preferred light diets and vegetables, accepting temporary bodily weakness to facilitate the expulsion of pathogens, which is truly valuable.
In the previous prescription, edema was attributed to the Spleen, treated with Fu Ling and Bai Zhu; insomnia was attributed to the Heart, treated with Fu Shen (Poria with Hostwood) and Suan Zao Ren (Ziziphus Seed). This was done because the principles of tonifying deficiency and clearing heat were not clearly understood, hence this detailed explanation.