大枣(四十枚煮去皮核) 乌梅(肥者十个去核为末)
上以枣肉和为丸。含化自然汁。
琥按仲景云。大病瘥后。喜唾。宜理中丸。以胃上有寒也。上主疗云。口干。则非胃寒。乃胃家虚。而津液败矣。
故用大枣之甘温以补之。乌梅之酸平以敛之。
朱奉议云。伤寒病新瘥。阴阳气未和。因合房室。则令人阴肿。入腹绞痛。妇人。则里急。腰胯连腹内痛。名为阴
阳易也。(云云)宜烧 散。(即仲景原方) 鼠粪汤(已见前。但范汪方用薤。此用韭根尤妙。)竹皮汤。干姜汤。(并
见前)青竹茹汤。(内有栝蒌根。即前栝蒌竹茹汤也。)当归白术汤。(见下)可选用之。
治妇人病未平复。因有所动。小腹急痛。腰胯疼。四肢不任。举动无力热发方。
白术(一分) 当归(一两) 桂枝(去皮) 甘草(炙) 芍药 附子(生去皮破半片) 人参 黄 (各一分)
生姜(半两)
上锉如麻豆大。以水三升。煮取一升半。去滓。通口服一盏。食顷。再服一盏。温覆微汗。便瘥。
琥按上主疗云。妇人病未平复。当是劳复之证。其名阴易者误也。上方乃温甘辛热。大补气血之剂。又阳虚畏寒
者。宜用。阴虚发热者。审用之。
刘河间云。汗下后。劳复。柴胡饮子。(见前第七卷少阳篇中)饮酒复剧。黄连解毒汤。(见前第十卷厥阴篇中)或
双解散。加黄连。(见前第五卷太阳篇中)在里者。三乙承气汤(见前第六卷阳明篇中)在表者。益元散。(即天水散亦
见前太阳篇中)或双解散。半表半里。大小柴胡汤。(即仲景原方)凉膈散。(亦见前阳明篇中)解毒汤。随证用之。食
复。三乙承气汤。
琥按上刘氏用药。各有所宜。有如少阳劳复。宜小柴胡汤。食复。宜大柴胡汤。虚而食复者。宜柴胡饮子。饮酒
复。三焦皆热者。宜黄连解毒汤。阳明食复。大热大实者。宜凉膈散。三乙承气汤。劳复。阳明气分大热者。宜益元散
至若双解散。药味杂乱。徒伤元气。非瘥后复病。所宜用也。
王海藏治一人。患伤寒得汗数日。忽身热自汗。脉弦数。心不得宁。真劳复也。王诊之曰。劳心之所致。神之所舍。
未复其初。而又劳伤其神。营卫失度。当补其子。益其脾。解其劳。庶几得愈。授以补脾汤。佐以小柴胡汤而解。云云。
(全文已见前第一卷手经篇中。上论出名医类案准绳云。学士许叔微记不知何考)
大枣(四十枚,煮后去皮去核) 乌梅(选用肥大者十个,去核研为粉末)
以上两味药,用枣肉调和制成丸剂。含在口中慢慢化开,使其自然流出津液。
琥按:张仲景说,大病初愈后,喜欢吐唾沫,适宜服用理中丸,这是因为胃中有寒邪。上述主治条文说的是口干,这就不是胃寒了,而是胃气虚弱,导致津液枯竭败坏。
所以使用大枣的甘温之性来补益它,使用乌梅的酸平之性来收敛它。
朱奉议说,伤寒病刚刚痊愈,阴阳之气尚未调和,如果此时行房事,就会使人阴部肿胀,疼痛传入腹部绞痛。妇女则会出现里急后重,腰胯连接腹部内部疼痛,这叫做“阴阳易”。……适宜服用烧裈散。(即张仲景的原方)鼠粪汤(前面已经见过,只是范汪方中使用薤白,这里使用韭根尤其好。)竹皮汤,干姜汤。(都见在前面章节)青竹茹汤。(里面含有栝蒌根,就是前面的栝蒌竹茹汤。)当归白术汤。(见下文)可以从中选择使用。
治疗妇人疾病尚未完全康复,因为有所活动,导致小腹拘急疼痛,腰胯疼痛,四肢无法承受身体重量,举动无力且发热的方法。
白术(一分) 当归(一两) 桂枝(去掉外皮) 甘草(炙烤) 芍药 附子(生用,去掉外皮,剖成半片) 人参 黄芪(各一分)
生姜(半两)
以上药材切碎如麻豆大小。用水三升,煮取一升半药液,去除药渣。一次性口服一盏杯量。过一顿饭的时间,再服用一盏杯量。服药后覆盖衣被使其微微出汗,病就好了。
琥按:上述主治条文说,妇人疾病未完全康复,这应当是劳复的病证,将其命名为“阴易”是错误的。上面的方子是温、甘、辛、热性质的药物,是大补气血的方剂。另外,对于阳虚怕冷的人,适宜使用;对于阴虚发热的人,要仔细审察后使用。
刘河间说,发汗或攻下之后,因劳累而复发,可用柴胡饮子。(见前第七卷少阳篇中)因饮酒而病情加重,可用黄连解毒汤。(见前第十卷厥阴篇中)或者用双解散,加入黄连。(见前第五卷太阳篇中)病邪在里的,用三乙承气汤(见前第六卷阳明篇中);病邪在表的,用益元散。(即天水散,也见前太阳篇中)或者用双解散;在半表半里的,用小柴胡汤和大柴胡汤。(即张仲景原方)凉膈散。(也见前阳明篇中)解毒汤。根据证候选择使用。因饮食不当而复发的,用三乙承气汤。
琥按:上面刘河间的用药,各有其适宜之处。比如少阳经的劳复,适宜用小柴胡汤;饮食不当引起的复发,适宜用大柴胡汤;体虚且因饮食不当复发的,适宜用柴胡饮子;因饮酒复发的,若三焦都有热,适宜用黄连解毒汤;阳明经的饮食不当复发,若大热大实,适宜用凉膈散和三乙承气汤。至于劳复,若是阳明气分大热的,适宜用益元散。至于双解散,药味杂乱,徒然损伤元气,不是病愈后复发所适宜使用的。
王海藏治疗一个人,患伤寒发汗数日后,忽然身体发热、自汗,脉象弦数,心中不安宁,这是真正的劳复。王海藏诊断说:这是用心过度所致。神志寄居在心,心神未能恢复如初,又因劳累损伤了神气,导致营卫失调,应当补益心之子脏(脾),益气健脾,解除疲劳,或许才能痊愈。给予补脾汤,配合小柴胡汤而治愈。……(全文已见前第一卷手经篇中。上述论述出自名医类案,准绳一书记载,学士许叔微记录,不知依据何考)
(Dates, forty pieces, boiled, skin and pits removed) (Mume Fructus, ten plump ones, pits removed, ground into powder)
Take the above two ingredients, mix with date pulp to form pills. Hold in the mouth and let dissolve naturally to produce saliva.
Hu notes: Zhang Zhongjing stated that after a major illness has convalesced, if there is a tendency to spit frequently, Lizhong Wan (Regulate the Middle Pill) should be used, because there is cold in the Stomach. The aforementioned main treatment describes dry mouth, which indicates it is not Stomach cold, but rather deficiency of the Stomach leading to the exhaustion and deterioration of body fluids.
Therefore, the sweet and warm nature of Dates is used to tonify it, and the sour and neutral nature of Mume Fructus is used to astringe it.
Zhu Fengyi stated that when a Shanghan (Cold Damage) disease has just convalesced, the Yin and Yang Qi are not yet harmonized. If sexual intercourse occurs at this time, it causes swelling of the yin organs and colicky pain radiating into the abdomen. In women, it causes urgency in the interior and pain connecting the waist and hips to the interior of the abdomen, named "Yin-Yang Exchange" (Yin Yang Yi). ... It is appropriate to use Shao Kun San (Burning Underwear Powder). (This is Zhang Zhongjing's original formula) Shufen Tang (Rat Feces Decoction) (seen previously; however, Fan Wang's formula uses Scallion White, while using Chive Root here is particularly good.) Zhupi Tang (Bamboo Peel Decoction), Ganjiang Tang (Dried Ginger Decoction). (Both seen previously) Qingzhuru Tang (Green Bamboo Slurry Decoction). (Contains Gualou Gen, which is the previous Gualou Zhuru Tang) Danggui Baizhu Tang (Angelica and Atractylodes Macrocephala Decoction). (See below) These can be selected for use.
Formula for treating women whose diseases have not fully recovered, and due to physical exertion, suffer from urgent pain in the lower abdomen, pain in the waist and hips, inability of the four limbs to bear weight, weakness in movement, and fever.
Baizhu (Atractylodis Macrocephalae Rhizoma, one fen) Danggui (Angelicae Sinensis Radix, one liang) Guizhi (Cinnamomi Ramulus, bark removed) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) Shaoyao (Paeoniae Radix) Fuzi (Aconiti Lateralis Radix Praeparata, raw, skin removed, split into half slices) Renshen (Ginseng Radix) Huangqi (Astragali Membranacei Radix, each one fen)
Shengjiang (Zingiberis Rhizoma Recens, half liang)
Cut the above herbs into pieces the size of hemp seeds. Use three sheng of water, boil to obtain one and a half sheng of liquid. Remove the dregs. Drink one zhan cup orally at once. After the duration of a meal, take another zhan cup. Cover warmly to induce slight sweating, and the condition will resolve.
Hu notes: The aforementioned main treatment states that if a woman's disease has not fully recovered, this should be classified as Laofu (Relapse due to overexertion); naming it "Yin Yi" is incorrect. The above formula consists of warm, sweet, acrid, and hot herbs, acting as a major tonic for Qi and Blood. Furthermore, it is suitable for those with Yang deficiency and aversion to cold; for those with Yin deficiency and fever, it must be used with careful examination.
Liu Hejian stated that after sweating or purging, if relapse occurs due to overexertion, Chaihu Yinzi (Bupleurum Drink) should be used. (Seen in Volume 7, Shaoyang Chapter previously) If the condition worsens due to alcohol consumption, Huanglian Jiedu Tang (Coptis Decoction for Detoxification) should be used. (Seen in Volume 10, Jueyin Chapter previously) Or Shuangjie San (Double-Release Powder) with added Huanglian. (Seen in Volume 5, Taiyang Chapter previously) For pathogens in the interior, Sanyi Chengqi Tang (Three-Ethanol Purgative Decoction) should be used. (Seen in Volume 6, Yangming Chapter previously) For pathogens in the exterior, Yiyuan San (Benefit Origin Powder) should be used. (Also known as Tianshui San, seen in the Taiyang Chapter previously) Or Shuangjie San. For half-exterior and half-interior conditions, Xiaochaihu Tang (Minor Bupleurum Decoction) and Dachaihu Tang (Major Bupleurum Decoction) should be used. (These are Zhang Zhongjing's original formulas) Liangge San (Cool the Diaphragm Powder). (Also seen in the Yangming Chapter previously) Jiedu Tang (Detoxification Decoction). Use according to the syndrome. For relapse due to improper diet, Sanyi Chengqi Tang should be used.
Hu notes: Liu's medication choices above each have their appropriateness. For example, Shaoyang Laofu is suitable for Xiaochaihu Tang; dietary relapse is suitable for Dachaihu Tang; deficiency with dietary relapse is suitable for Chaihu Yinzi; alcohol-induced relapse with heat in all three Jiaos is suitable for Huanglian Jiedu Tang; Yangming dietary relapse with severe heat and excess is suitable for Liangge San and Sanyi Chengqi Tang. As for Laofu, if there is excessive heat in the Qi level of Yangming, Yiyuan San is suitable. Regarding Shuangjie San, the herbal ingredients are mixed and chaotic, merely damaging the Yuan Qi, and it is not suitable for use in post-convalescence relapse.
Wang Haicang treated a patient who, after several days of sweating from Shanghan, suddenly developed fever, spontaneous sweating, a wiry and rapid pulse, and mental restlessness. This was true Laofu. Wang diagnosed: "This is caused by mental overexertion. The Shen (Spirit) resides in the Heart. Since the Shen has not returned to its original state, and has been further damaged by labor, causing disharmony of Ying and Wei, one should tonify the child organ (Spleen), benefit the Spleen, and relieve fatigue, so that recovery may be achieved." He prescribed Bupi Tang (Spleen-Tonifying Decoction), assisted by Xiaochaihu Tang, resulting in resolution. ... (The full text is seen in Volume 1, Hand Meridian Chapter previously. The above discussion comes from Mingyi Leian [Collected Cases of Famous Physicians], recorded by Xu Shuwei, source of record unknown.)