汗后而病不解,寒热如旧,或表邪未尽,或邪传里,或邪气乘虚内客,宜各因其证
而治之。
【汗】曾服麻黄桂枝,若脉洪大,形为疟状,再发汗必解,麻黄汤。
【表里兼解】发热汗出不解,心下痞硬,呕吐下利,大柴胡汤。
【清】服桂枝大汗出,大渴,烦不解,脉洪大,白虎加人参汤。
【下】发汗后不恶寒,但恶热,及蒸蒸发热者,实也,调胃承气汤。发汗后不可更行
桂枝,汗出而喘,无大热者,麻黄杏仁石膏甘草汤。
【分利】太阳病发汗后,大汗出,胃中干燥,不得眠,欲饮水者,少少与之,令胃气
和则愈。若脉浮小便不利,微热消渴,五苓散。发汗已,脉洪数烦渴,五苓散。
【和中】汗后腹胀满,浓朴生姜半夏甘草人参汤。汗过多,心下悸,欲得发颤,
桂枝甘草汤。
【温经】发汗后病不解反恶寒者,表虚也,芍药甘草附子汤,脉细身倦者方
可服。太阳病发汗,汗出不解,仍发热,心中悸,身 动,振欲擗地,真武汤。发汗后
身疼痛,脉沉者,桂枝加芍药人参汤。太阳发汗遂漏不止,其人恶风,小便难,四肢拘
急,难以屈伸,桂枝加附子汤。大汗出,热不去,内拘急,四肢疼,下利恶寒,四逆
汤。发汗后脐下悸,欲作奔豚,茯苓桂枝甘草大枣汤。
身热不去,利不止,胸腹满,渴烦。《活人》∶去伤寒之邪,不过汗吐下之三法也。
三法得当,病势易衰则愈矣。倘三法失宜,加以病势危恶,则传变不已,诚可虑也。况发
汗吐下后,邪气乘虚而未解,或壅窒而未尽,则当量其虚实以治之。先贤谓知邪气之虚
实,发汗吐下之不瘥,温补针灸之适当,则十全之功可自得矣。
【吐】伤寒五六日,大下后,身热不去,心中结痛,未欲解也,栀子豉汤。下后心烦
腹满,卧起不安,栀子浓朴汤。
【清热】太阳桂枝证,医反下之,利遂不止,脉促者,表未解,喘而汗出者,葛根黄
连黄芩汤。
【下】阳明下之,心下懊 而烦,栀子豉汤。有燥屎者,大承气汤。
【温】太阳下后脉促胸满,桂枝去芍药汤。微寒,去芍药加附子。丸药下之,身热
不去,微烦,栀子干姜汤。
【解错离之邪】六七日大下后,寸沉而迟,手足厥逆,下利,脉不至,咽喉不
利,唾脓血,泻利不止为难治,麻黄升麻汤。
汗法之后,疾病仍未解除,寒热症状依旧,这可能是表邪尚未清除干净,或者是病邪传入体内,亦或是邪气趁正气虚弱而内侵。应当根据具体的证候分别进行治疗。
【汗法】曾经服用过麻黄汤或桂枝汤,如果脉象洪大,身体呈现类似疟疾的症状,再次使用发汗法必然能治愈,方用麻黄汤(Mahuang Tang, Ephedra Decoction)。
【表里双解】发热且出汗后病情未解,胃脘部痞塞坚硬,伴有呕吐和下利,方用大柴胡汤(Dachaihu Tang, Major Bupleurum Decoction)。
【清热法】服用桂枝汤后大汗出,极度口渴,烦躁不安无法缓解,脉象洪大,方用白虎加人参汤(Baihu Jia Renshen Tang, White Tiger Decoction with Ginseng)。
【下法】发汗后不再怕冷,只怕热,以及出现蒸蒸而出的发热,这是实证,方用调胃承气汤(Tiaowei Chengqi Tang, Regulate the Stomach and Order the Qi Decoction)。发汗后不可再用桂枝汤,若见汗出且气喘,体表没有明显高热,方用麻黄杏仁石膏甘草汤(Mahuang Xingren Shigao Gancao Tang, Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)。
【分利法】太阳病经过发汗后,大汗出导致胃中干燥,无法入睡,想要喝水时,应少量多次给予饮水,使胃气调和即可痊愈。如果脉浮、小便不利、轻微发热且有消渴症状,方用五苓散(Wuling San, Five-Ingredient Powder with Poria)。发汗后,脉象洪数、烦躁口渴,方用五苓散。
【和中法】发汗后出现腹部胀满,方用浓朴生姜半夏甘草人参汤(Noupo Shengjiang Banxia Gancao Renshen Tang, Pinellia, Ginger, Licorice and Ginseng Decoction with Magnolia Bark)。发汗过多,导致心下悸动,想要通过颤抖来缓解不适,方用桂枝甘草汤(Guizhi Gancao Tang, Cinnamon Twig and Licorice Decoction)。
【温经法】发汗后病情未解反而更加怕冷,这是表虚的表现,方用芍药甘草附子汤(Shaoyao Gancao Fuzi Tang, Peony, Licorice and Aconite Decoction),只有当脉象细弱、身体疲倦时才适合服用。太阳病发汗后,汗出而病不解,仍然发热,心中悸动,身体颤动,振颤欲倒在地上,方用真武汤(Zhenwu Tang, True Warrior Decoction)。发汗后身体疼痛,脉象沉者,方用桂枝加芍药人参汤(Guizhi Jia Shaoyao Renshen Tang, Cinnamon Twig Decoction with Added Peony and Ginseng)。太阳病发汗导致汗漏不止,患者怕风,小便困难,四肢拘挛紧急,难以屈伸,方用桂枝加附子汤(Guizhi Jia Fuzi Tang, Cinnamon Twig Decoction with Added Aconite)。大汗出,热势不退,内部拘急,四肢疼痛,下利且怕冷,方用四逆汤(Sini Tang, Four Reversal Decoction)。发汗后脐下悸动,有奔豚发作的趋势,方用茯苓桂枝甘草大枣汤(Fuling Guizhi Gancao Dazao Tang, Poria, Cinnamon Twig, Licorice and Jujube Decoction)。
身体发热不退,腹泻不止,胸腹部胀满,口渴烦躁。《活人书》指出:治疗伤寒的邪气,不过汗、吐、下这三种方法罢了。如果这三种方法使用得当,病势容易衰退从而痊愈。倘若三种方法使用不当,加上病情危重恶劣,那么病邪传变就不会停止,确实令人担忧。况且在发汗、催吐、泻下之后,邪气趁虚而入而未解除,或者壅滞阻塞而未清除,就应当衡量患者的虚实状况来进行治疗。先贤曾说,了解邪气的虚实,知道汗、吐、下法无效后,恰当使用温补和针灸,就能达到十全十美的疗效。
【吐法】伤寒五六天,经过猛烈泻下后,身体发热不退,心中结聚疼痛,病情尚未解除,方用栀子豉汤(Zhizi Chi Tang, Gardenia and Fermented Soybean Decoction)。泻下后心烦、腹部胀满,卧起不安,方用栀子厚朴汤(Zhizi Houpo Tang, Gardenia and Magnolia Bark Decoction)。
【清热法】太阳病桂枝证,医生反而使用泻下法,导致腹泻不止,脉象急促,说明表邪未解;若有气喘且出汗,方用葛根黄连黄芩汤(Gegen Huanglian Huangqin Tang, Kudzu, Coptis and Scutellaria Decoction)。
【下法】阳明病经过泻下后,心中懊恼烦乱,方用栀子豉汤。如果有燥屎内结,方用大承气汤(Da Chengqi Tang, Major Order the Qi Decoction)。
【温法】太阳病泻下后脉象急促、胸部胀满,方用桂枝去芍药汤(Guizhi Qu Shaoyao Tang, Cinnamon Twig Decoction without Peony)。如果伴有轻微恶寒,去掉芍药并加入附子。如果是被丸药误下,导致身体发热不退、轻微烦躁,方用栀子干姜汤(Zhizi Ganjiang Tang, Gardenia and Dried Ginger Decoction)。
【解错离之邪】发病六七天,经过猛烈泻下后,寸脉沉而迟,手足厥冷,下利,脉搏摸不到,咽喉不利,唾脓血,如果腹泻不止则属于难治之症,方用麻黄升麻汤(Mahuang Shengma Tang, Ephedra and Cyptotricha Decoction)。
After sweating therapy, if the disease remains unresolved, with chills and fever persisting as before, it may be due to incomplete elimination of exterior pathogens, transmission of pathogens into the interior, or pathogens invading internally by taking advantage of deficiency. Treatment should be administered according to the specific syndrome.
[Sweating Therapy] If Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) have been taken previously, and the pulse is surging (Hongda), with symptoms resembling malaria, re-administering sweating therapy will likely resolve the condition; use Mahuang Tang (Ephedra Decoction).
[Simultaneous Resolution of Exterior and Interior] If fever and sweating do not resolve the condition, accompanied by epigastric fullness and hardness, vomiting, and diarrhea, use Dachaihu Tang (Major Bupleurum Decoction).
[Clearing Heat] If excessive sweating occurs after taking Guizhi Tang (Cinnamon Twig Decoction), leading to extreme thirst, unrelenting irritability, and a surging pulse, use Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng).
[Purgation] After sweating, if there is no aversion to cold but only aversion to heat, or if there is steaming fever, this indicates excess; use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). After sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be used again; if sweating and wheezing occur without significant surface heat, use Mahuang Xingren Shigao Gancao Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction).
[Separating and Draining] After sweating therapy for Taiyang disease (Disease of the Bladder Channel), excessive sweating dries the stomach, causing insomnia. If the patient desires water, give it in small amounts frequently until the stomach qi harmonizes and recovery ensues. If the pulse is floating, urination is difficult, with slight fever and thirst characteristic of Xiao Ke (Wasting-Thirst), use Wuling San (Five-Ingredient Powder with Poria). After sweating, if the pulse is surging and rapid with irritability and thirst, use Wuling San (Five-Ingredient Powder with Poria).
[Harmonizing the Middle] If abdominal fullness occurs after sweating, use Noupiao Shengjiang Banxia Gancao Renshen Tang (Pinellia, Ginger, Licorice and Ginseng Decoction with Magnolia Bark). If excessive sweating causes palpitations at the heart region, with a desire to tremble/shiver, use Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction).
[Warming the Channels] If the disease remains unresolved after sweating but aversion to cold worsens, indicating exterior deficiency, use Shaoyao Gancao Fuzi Tang (Peony, Licorice and Aconite Decoction); this is suitable only when the pulse is fine and the body feels fatigued. If Taiyang disease sweating leads to unresolved condition with persistent fever, palpitations, body tremors, and a sensation of shaking as if falling to the ground, use Zhenwu Tang (True Warrior Decoction). If body pain persists after sweating with a deep pulse, use Guizhi Jia Shaoyao Renshen Tang (Cinnamon Twig Decoction with Added Peony and Ginseng). If Taiyang disease sweating causes continuous leakage of sweat, aversion to wind, difficulty in urination, and spasm/stiffness of the four limbs making flexion and extension difficult, use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite). If excessive sweating leaves heat unabated, with internal spasms, limb pain, diarrhea, and aversion to cold, use Sini Tang (Four Reversal Decoction). If after sweating there is palpitation below the umbilicus with a tendency toward Ben Tun (Running Piglet), use Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice and Jujube Decoction).
If body heat persists, diarrhea continues, chest and abdomen are full, and there is thirst and irritability: The *Huo Ren* book states that eliminating pathogenic factors in Shang Han (Cold Damage) relies on only three methods: sweating, vomiting, and purgation. If these three methods are applied appropriately, the disease trend will easily decline and heal. However, if these methods are misapplied, especially when the disease is critical and severe, the transmission and transformation will not cease, which is indeed worrying. Moreover, after sweating, vomiting, or purgation, if pathogens invade due to deficiency and remain unresolved, or if obstruction persists, one must assess the deficiency and excess to treat accordingly. Ancients stated that understanding the deficiency and excess of pathogens, knowing when sweating, vomiting, and purgation fail, and appropriately applying warming tonification and acupuncture can achieve perfect therapeutic results.
[Vomiting Therapy] In Shang Han (Cold Damage) lasting five to six days, after severe purgation, if body heat persists and there is painful knotting in the heart region indicating the condition is not yet resolved, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If after purgation there is irritability, abdominal fullness, and restlessness lying down or sitting up, use Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction).
[Clearing Heat] In Taiyang disease presenting with Guizhi Tang (Cinnamon Twig Decoction) syndrome, if the physician incorrectly uses purgation, leading to unceasing diarrhea and a hurried pulse indicating the exterior is not resolved; if accompanied by wheezing and sweating, use Gegen Huanglian Huangqin Tang (Kudzu, Coptis and Scutellaria Decoction).
[Purgation] In Yangming disease, after purgation, if there is mental distress and irritability (Ao Nan), use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If there are dry feces, use Da Chengqi Tang (Major Order the Qi Decoction).
[Warming] After Taiyang disease purgation, if the pulse is hurried and there is chest fullness, use Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Peony). If there is slight aversion to cold, remove Peony and add Aconite. If treated erroneously with pill-based purgatives, resulting in persistent body heat and slight irritability, use Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction).
[Resolving Erroneous/Displaced Pathogens] After seven days, following severe purgation, if the cun pulse is deep and slow, hands and feet are cold, there is diarrhea, the pulse is imperceptible, throat discomfort occurs, and pus and blood are expectorated; if diarrhea is unceasing, it is difficult to treat; use Mahuang Shengma Tang (Ephedra and Cyptotricha Decoction).