治伤寒得汗。瘥后脾胃伤冷物。胸膈不快及寻常血气不和者。
人参 白术 甘草 橘皮（去白） 青皮（去瓤） 干姜（各等分）
上为末。每服三钱。水一盏。煎数沸。热服。入盐点。亦得。
琥按上方。乃温补中气之剂。其用青皮者。泻木。所以扶土。木为土之贼也。
海藏又云。大抵劳者。动也。动非一种。有内外血气之异焉。若劳乎气。无力与精神者。法宜微举之。若劳乎血与
筋骨者。以四物之类补之。若劳在脾。内为中州。调中可已。此为有形病也。但见外证。则谓之复病。非为劳也。如再
感风寒是已。
琥按上论云云。以病后内伤为劳。外感为复。此发仲景未发之旨。又其治有形病。以四物汤之类。其治无形病。
有微举法。又调中之法。未及论方。愚意云。大约是东垣补中益气之类耳。方不尽录。全在医者。以意取之。
云岐子云。大病瘥后。真气未全。强行房事。劳损督任二经。故少腹里急。或引阴中急痛。拘急。热气上冲胸。头
重不能举。目中生花。胫拘急。两足 脉督任四经病。可易取男子妇人 。烧之服。名烧 散。
琥按上论。当是男女劳复证。亦取 烧散者。乃相假而合治之法也。
琥又按阴阳易病。仲景不言何经。兹云督任受伤。阴阳 脉。四经合病。可谓畅发病情。又易老用烧 散。分寒热
而治。病在三阴。煎附子四逆等汤调下。如有热者。以鼠屎竹茹汤之类送下。可见古方。亦不可执也。
张兼善云。假如妇人病。新瘥。未平复而男子与之交。因感外邪而卒病。实非余邪相染。医见病速。谓之阴易于法。
何以别乎。夫易病者。有上条所见之证存焉。其与外所感。岂相侔哉。设若风寒外伤当有表证。安有少腹里急引阴中拘
挛者。乎。或又云假如男子病新瘥。未平复。强合阴阳而自病。仍小腹里急。引阴中。拘挛。证同易病。求其理。何故
不染易他人。而自复。未审其证治。可同何法也。病虽自复理与易同。亦用烧 散。以诱安其正气。夫易病之为合阴阳。
感动余邪。而其人正气本虚。故能染着。不然。安得受其邪哉。今病自复。缘正气尚虚。而余邪因动。悉非外感。故与
易同。亦用烧 散。以安正气。正气安。余邪自平矣。
琥按上张氏论。反复圆活。可谓发仲景之未发。要之既病易。复挟外感者。未必无之。此亦不可执也。
琥又按仲景止言阴阳易。而千金复增女劳复证。昔贤相传。阴阳易犹可生。若女劳复。必死者何也。愚以复病。由
病后正气大虚。余邪不能传易于人。因而自病。则多死。以其人不堪再病。故也。易病由病患正气稍复。不病之人。正
气反虚余邪遂至传易因而忽病。然犹可生。以其人病尚初发也。倘两人正气皆不虚。虽合阴阳。复者不复。易者。亦不
易矣。两人正气皆虚强合阴阳复者。自复。易者。自易。有同时而病者矣。巢氏病源云。易者。阴阳相感动。其毒度着
如人之换易也。若二男二女并不相易。愚又以二女。或不能易。若二男。亦有强相合者。焉知其不易也。古人着书。言
不尽意全在后学。以意会之。
琥又按烧 散一方。海藏云。若果得阴脉。各随三阴经。用四逆等汤调送下。此热因寒用也。吴仁斋以竹皮汤合主
之。此寒因热用也。娄全善煎人参汤调服。此虚者补之也。信哉。用药炎不可执也。
医林云离经脉见。多主死。太过曰至。一呼三至曰至。不及曰损。一呼一至曰损二脉。惟阴阳易病有之。
琥按脉一呼三至由可不死。余脉皆死。
（琥）总按伤寒阴阳易并瘥后病。仲景止引其端至诸家方论。各有变通。是皆彼此祖述。互相发明者也。至于瘥后
病。愚曾细阅病源千金外台等书证。非一候治亦多方。兹不能尽采附焉。
治疗伤寒发汗后，病愈期间因食用生冷食物损伤脾胃，导致胸膈部不适，以及平时气血不和的患者。
人参、白术、甘草、橘皮（去掉白色部分）、青皮（去掉瓤）、干姜（各取等量）
将上述药物研成细末。每次服用三钱，用水一盏，煮沸数滚。热服，加入少许盐调味也可以。
王琥按：上面的方子，是温补中焦元气的药剂。其中使用青皮的原因，是为了疏泄肝木之气，从而扶持脾土。因为木气过盛会成为脾土的贼邪。
张元素（海藏）又说：大抵“劳”这个概念，指的是动。动的情况不是一种，有内伤血气和外感等不同区别。如果是气劳，表现为无力、精神萎靡，治法应当轻微升举阳气。如果是血和筋骨劳损，用四物汤之类的方剂来补益。如果劳损在脾脏，病位在中焦，通过调理中焦即可痊愈。这属于有形之病。但如果只见到外部症状，则称为“复病”，而不是劳损。比如再次感受风寒就是这种情况。
王琥按：上面的论述说，病后内伤称为“劳”，外感称为“复”。这是阐发了张仲景未曾明确阐述的宗旨。另外，对于有形之病的治疗，用四物汤之类；对于无形之病的治疗，有轻微升举的方法；还有调理中焦的方法，但没有具体列出方剂。我个人的意见，大约是李东垣的补中益气汤之类的方子罢了。这里没有全部收录，全凭医生根据病情意会选取。
云岐子说：大病初愈后，真气尚未完全恢复，如果强行进行房事，会劳损督脉和任脉两条经脉，导致小腹部拘急紧迫，或者牵引阴部剧烈疼痛，身体拘挛紧急，热气上冲胸部，头部沉重无法抬起，眼中出现闪光，小腿拘挛紧急，两足无力。这是督脉、任脉、阴维脉、阳维脉四条经脉的病证。可以改用男女烧裈散。烧制后服用，名叫烧裈散。
王琥按：上面的论述，应当是男女劳复证。也采用烧裈散，这是相互借喻而结合治疗的法则。
王琥又按：阴阳易病，张仲景没有说明是哪条经脉受伤。这里说督脉和任脉受伤，加上阴维、阳维脉，四条经脉合病，可以说是透彻地阐发了病情的机理。另外，易老（张元素）使用烧裈散，区分寒热而进行治疗。如果病在三阴经，煎煮附子四逆汤等药液调服散剂；如果有热象，用鼠矢竹茹汤之类的药液送下。由此可见，古方的运用也是不可固执僵化的。
张兼善说：假如妇女生病，刚刚痊愈，身体尚未平复，男子与她发生性行为，因此感受外邪而突然发病。这实际上并不是余邪互相传染。医生看到病势急促，称之为“阴易”。用什么方法来辨别呢？所谓易病，具备上面条文所看到的证候存在。这与外感邪气引起的疾病，难道是一样的吗？假设若是风寒外伤，应当有表证，怎么会有小腹部拘急紧迫并牵引阴部拘挛的情况呢？有人又说：假如男子生病刚痊愈，身体尚未平复，强行行房而自己生病，仍然出现小腹部拘急，牵引阴部拘挛，证候与易病相同。探求其道理，为什么没有传染给他人，而是自己复发？如果不审察其证治，可以用什么方法呢？病虽然是自己复发，但道理与易病相同，也使用烧裈散，以诱导安护正气。所谓易病，是因为合阴阳时，感动余邪，而患者正气本来虚弱，所以能够染着。否则，怎么会受到邪气侵害呢？现在的病是自己复发，原因是正气尚且虚弱，而余邪随之而动，都不是外感邪气，所以与易病相同，也使用烧裈散，来安护正气。正气安定，余邪自然平息。
王琥按：上面张氏的论述，反复周全灵活，可以说是阐发了张仲景未曾阐述的内容。总之，既患易病或复病，又夹杂外感的，未必没有这种情况。这也是不可固执僵化的。
王琥又按：张仲景只提到阴阳易，而《千金方》又增加了女劳复证。过去贤人相传，阴阳易还可以存活，如果女劳复，必定死亡，为什么呢？我认为复病，是由于病后正气大虚，余邪不能传易给别人，因而自己发病，大多死亡。因为这个人承受不住再次生病。易病是由于患者正气稍微恢复，而未患病的人正气反而虚弱，余邪于是传到对方身上，因而突然发病。然而还可以存活，因为那个人病才刚开始发作。如果两个人的正气都不虚弱，即使发生性行为，复病的不会复发，易病的也不会易传。如果两个人的正气都虚弱，强行发生性行为，复病的自己复发，易病的自己易传，有同时发病的情况。巢元方《诸病源候论》说：易病，是阴阳相互感动，其毒气转移附着，就像人更换衣物一样。如果是两个男人或两个女人，并不互相易传。我又认为两个女人，或许不能易传；如果是两个男人，也有强行结合的，怎么知道他们不会易传呢？古人著书，言语不能完全表达心意，全在于后学者用心领会。
王琥又按：烧裈散这一方子，张元素（海藏）说：如果确实得到阴脉，分别根据三阴经，用四逆汤等药液调送下服。这是热因寒用的治法。吴仁斋用竹皮汤配合主治。这是寒因热用的治法。娄全善煎人参汤调服。这是虚者补之的治法。确实如此。用药的道理不可固执僵化。
《医林》说：离经脉出现，大多主死。太过叫做“至”，一呼脉跳三次叫做“至”。不及叫做“损”，一呼脉跳一次叫做“损”。这两种脉象，只有阴阳易病会出现。
王琥按：脉象一呼三至，由可不死，其余脉象都是死证。
（王琥）总评：伤寒中的阴阳易以及病后诸病，张仲景只是引出了开端，至于各家方论，各有变通，这都是彼此继承阐述，互相发明阐发的结果。至于病后诸病，我曾仔细查阅《病源》、《千金方》、《外台秘要》等书籍，证候不止一种，治疗方法也很多，这里不能全部采集附录于此。
Treats patients who, after sweating in the course of Cold Damage (Shanghan), have damaged their Spleen and Stomach by consuming cold substances during convalescence, resulting in discomfort in the chest and diaphragm, as well as those with chronic disharmony of Qi and Blood.
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Rhizoma), Gan Cao (Licorice Radix et Rhizoma), Ju Pi (Citri Reticulatae Pericarpium, remove white pith), Qing Pi (Citri Reticulatae Pericarpium Viride, remove seeds/pith), Gan Jiang (Zingiberis Rhizoma) — equal parts each.
Grind the above herbs into a fine powder. Take three qian per dose. Add one zhan of water, boil for several boils. Take hot. Adding a pinch of salt is also acceptable.
Wang Hu notes: The above prescription is a formula that warms and tonifies Middle Jiao Yuan Qi (Primary Qi of the Middle Burner). The use of Qing Pi is to drain Liver Wood Qi, thereby supporting Spleen Earth. Because excessive Wood becomes a thief to Earth.
Zhang Yuansu (Hai Zang) further states: Generally speaking, "Lao" (Consumptive Disease/Fatigue) refers to movement. This movement is not uniform; it differs between internal Qi-Blood disturbances and other types. If it is Qi Lao, characterized by weakness and listlessness, the treatment method should be to gently lift and raise Yang Qi. If it is Blood or Sinew-Bone Lao, tonify using formulas similar to Si Wu Tang (Four Substances Decoction). If the Lao affects the Spleen, located in the Central Region (Zhong Zhou), regulating the Middle can cure it. This belongs to diseases with tangible pathology. However, if only external symptoms are seen, it is called "Fu Bing" (Relapse Disease), not Lao. For example, contracting Wind-Cold again falls into this category.
Wang Hu notes: The aforementioned discussion defines post-illness internal injury as "Lao" and external contraction as "Fu". This elucidates principles not explicitly stated by Zhang Zhongjing. Furthermore, regarding the treatment of tangible diseases, formulas like Si Wu Tang are used; for intangible diseases, there is a method of gentle lifting; and methods for regulating the Middle are mentioned without specific formulas listed. My opinion is that these are likely similar to Li Dongyuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). They are not fully recorded here; the physician must select them based on clinical judgment.
Yun Qi Zi states: After a major illness has resolved, if True Qi is not yet fully restored, forcing sexual intercourse will damage the Du Mai (Governing Vessel) and Ren Mai (Conception Vowel), leading to urgency and tightness in the lower abdomen, or pain radiating to the genitalia, muscle spasms, rising heat rushing to the chest, heaviness of the head making it difficult to lift, visual disturbances (seeing spots), calf spasms, and weakness in both feet. These are pathologies of the Du, Ren, Yin Wei, and Yang Wei vessels. One may alternatively use Shao Kun San (Burned Underwear Powder) for either men or women. Burn it and take it orally; it is named Shao Kun San.
Wang Hu notes: The above discussion refers to male and female Lao Fu (Post-illness Relapse due to Fatigue/Intercourse). The use of Shao Kun San here implies a therapeutic principle of mutual analogy and combined treatment.
Wang Hu further notes: Regarding Yin Yang Yi (Mutual Transmission of Pathogen via Intercourse), Zhang Zhongjing did not specify which meridians were injured. Here, it is stated that the Du and Ren meridians are injured, combining with Yin Wei and Yang Wei, affecting four meridians simultaneously. This thoroughly expounds the pathological mechanism. Additionally, Yi Lao (Zhang Yuansu) uses Shao Kun San, treating differently based on cold or heat patterns. If the disease is in the Three Yin meridians, administer the powder mixed with decoctions of Fu Zi Si Ni Tang (Aconite Four Reversal Decoction); if there is heat, send it down with formulas like Shu Shi Zhu Ru Tang (Mouse Dropping and Bamboo Sheath Decoction). This demonstrates that ancient prescriptions should not be applied rigidly.
Zhang Jianshan says: Suppose a woman has just recovered from an illness and her body has not yet stabilized, and she engages in intercourse with a man, thereby contracting external pathogens and falling ill suddenly. This is actually not a transmission of residual pathogens. Physicians seeing the rapid onset call it "Yin Yi" (Female Mutual Transmission). How can one distinguish it? The so-called Yi Bing (Transmission Disease) presents with the symptoms described in the preceding clause. Is it comparable to diseases caused by external pathogens? If it were merely Wind-Cold external invasion, there would be exterior syndrome signs. How could there be lower abdominal urgency radiating to genital spasms? Others say: Suppose a man has just recovered and forces intercourse, causing himself to fall ill, presenting with lower abdominal urgency and genital spasms, identical to Yi Bing. Seeking the rationale, why does he not transmit it to others but relapse himself? Without examining the syndrome and treatment, what method applies? Although the pathology is self-relapse, the principle is the same as Yi Bing; thus, Shao Kun San is also used to guide and stabilize Righteous Qi. The term "Yi Bing" implies that through intercourse, residual pathogens are stirred, and because the patient's Righteous Qi was originally deficient, transmission occurs. Otherwise, how could they receive the pathogen? Now, self-relapse occurs because Righteous Qi is still weak, and residual pathogens move accordingly; these are not external contractions. Hence, it is treated similarly to Yi Bing, using Shao Kun San to stabilize Righteous Qi. Once Righteous Qi is stable, residual pathogens naturally subside.
Wang Hu notes: Zhang's discussion above is comprehensive and flexible, elucidating points not previously made by Zhang Zhongjing. In summary, cases where Yi Bing or Fu Bing is complicated by external pathogens do exist. Rigidity in application is inadvisable.
Wang Hu further notes: Zhang Zhongjing only mentioned Yin Yang Yi, while Qian Jin Fang added the syndrome of Nv Lao Fu (Female Fatigue Relapse). Ancient sages transmitted that Yin Yang Yi could survive, but Nv Lao Fu was invariably fatal. Why? I believe that Fu Bing results from severe deficiency of Righteous Qi post-illness; residual pathogens cannot transmit to others and instead cause self-relapse, often leading to death because the body cannot withstand another illness. Yi Bing occurs when the patient's Righteous Qi has slightly recovered, but the healthy partner's Righteous Qi is relatively weak, allowing residual pathogens to transmit and cause sudden illness in the healthy person. Survival is possible because the new illness is in its early stage. If both parties have strong Righteous Qi, even with intercourse, neither will relapse nor transmit. If both have weak Righteous Qi and force intercourse, the sick party relapses, and the healthy party transmits; simultaneous illness may occur. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* (Source Book of All Categories of Diseases) states: Yi Bing involves mutual stimulation of Yin and Yang, where toxic qi transfers and attaches, akin to changing clothes. Two men or two women do not transmit to each other. I argue that two women might not transmit; however, two men forcing intercourse—how do we know they do not transmit? Ancient authors' words do not always capture full intent; later scholars must interpret the meaning.
Wang Hu further notes: Regarding Shao Kun San, Zhang Yuansu states: If Yin pulses are indeed present, treat according to the Three Yin meridians using Si Ni Tang etc. for administration. This is "treating heat with cold" (using cold-natured delivery for heat pathology, or vice versa depending on interpretation context, here implying adapting vehicle to pulse). Wu Renzhai combines it with Zhu Pi Tang. This is "treating cold with heat". Lou Quanshan administers it with Ren Shen Tang. This is "tonifying the deficient". Indeed, the application of medicines must not be rigid.
*Yi Lin* states: The appearance of Li Jing Mai (Departing Pulse) mostly indicates death. Excessive speed is called "Zhi" (Arrival), defined as three beats per exhalation. Insufficient speed is called "Sun" (Damage), defined as one beat per exhalation. These two pulse conditions are unique to Yin Yang Yi disease.
Wang Hu notes: A pulse of three beats per exhalation may not necessarily lead to death; all other such abnormal pulses indicate death.
(Wang Hu) General Commentary: In Cold Damage, regarding Yin Yang Yi and post-illness syndromes, Zhang Zhongjing only introduced the beginning. Various schools' prescriptions and theories offer modifications. These are mutual inheritances and illuminations of each other. Regarding post-illness syndromes, I have carefully reviewed *Bing Yuan*, *Qian Jin*, *Wai Tai*, etc. The syndromes are numerous, and treatments are manifold. I cannot record them all here.