论曰伤寒病后,余热不解者,盖阴阳未和,邪气未尽,流传经络,蕴而生热,潮作如疟,
鼻衄烦躁。面赤目黄,腹满小便不利,大便干涩,或即谵言。渴欲得水,脉沉数者,当以里
证求之。若脉但浮者,当消息治其外。
治伤寒后余热脉浮者,麻黄汤方
麻黄(去根节煎掠去沫焙) 芍药 甘草(炙令微赤锉各一两) 桂(去粗皮) 细辛
(去苗叶各半两)
上五味,粗捣筛,每服五钱匕,以水一盏半,煎取八分,去滓温服。日三。
治伤寒发汗热已解,半日许复发烦脉浮数者,可更发汗。桂枝汤方
桂(去粗皮) 芍药(各三分) 甘草(二两炙)
上三味, 咀如麻豆大,每服五钱匕,水一盏半,入生姜一枣大切,枣二枚劈,煎取一
盏,去滓温服,取汗为度。
治伤寒余热,汗出如疟状,日晡发热,脉实者可下,宜大柴胡汤方
柴胡(去苗八两) 黄芩(去黑心三两) 半夏(生姜汁制焙干二两) 枳实(去瓤麸
炒四枚) 大黄(二两)
上五味, 咀,每服五钱匕,水一盏半,生姜半分切,煎至八分,去滓温服,以下利热
退为度。
治伤寒瘥后,更发热,小柴胡主之。脉浮者,以汗解,脉沉实或紧者,以下解,小柴胡
汤方。
柴胡(去苗四两) 黄芩(去黑心) 人参 甘草(炙各一两半) 半夏(二两生姜汁
制焙干)
上五味, 咀如麻豆大,每服五钱匕,水二盏,入生姜半分切,枣二枚劈,煎取八分去
滓,不拘时温服。
治伤寒及天行后,头痛余热不解。葛根汤方
葛根(锉) 柴胡(去苗各一两) 麻黄(去根节煎掠去沫焙三分) 芍药 黄芩(去
黑心) 甘草(炙锉) 桂(去粗皮各半两)
上七味,粗捣筛,每服五钱匕,水一盏半,枣二枚劈。煎至六分去滓,不计时候温服。
治伤寒后,余热不除,及寒热头重体痛,表证尚未罢。葛根汤方
葛根 芍药 白茯苓(去黑皮) 黄芩(去黑心) 乌头(炮裂去皮脐) 芎 (各一
两) 栀子仁(半两)
上七味, 咀如麻豆大,每服五钱匕,水一盏半。入豉三七粒。煎至七分,去滓温服。
治伤寒汗后,余热不退,心神烦躁。茯苓汤方
赤茯芩(去黑皮一两半) 人参(一分) 甘草(炙锉半两)
上三味,粗捣筛,每服三钱匕,用水一盏,煎至七分,去滓不拘时温服。
治伤寒汗后,余热不除,及四肢拘急痛,胸膈不利,呕逆不思饮食。茯苓汤方
赤茯苓(去黑皮) 柴胡(去苗) 枳壳(去瓤麸炒) 桑根白皮(锉) 麦门冬(去
心焙各半两) 葛根(锉三分) 甘草(炙锉半两) 桂(去粗皮) 人参(各一分)
上九味,粗捣筛,每服三钱匕,用水一盏,生姜三片,大枣二枚劈,煎至七分,去滓温
服。
治伤寒发汗及吐下后,余热不退,头痛满闷口干。葛根人参汤方
葛根(锉一两) 人参(一两) 麦门冬(去心焙半两) 黄芩(去黑心半两) 黄
(锉一两) 地骨皮 石膏(碎各半两)
上七味,粗捣筛,每服五钱匕,用水一盏半,煎至八分,去滓温服。
治伤寒数日余热不解,时发寒热。葳蕤汤方
葳蕤 柴胡(去苗) 羚羊角(镑各一两) 石膏(碎半两)
上四味。粗捣筛,每服五钱匕,水一盏半,煎至八分去滓,不计时候温服。
治伤寒后余热不退。人参汤方
人参(一两) 知母(一分) 甘草(炙锉) 石膏(碎) 黄芩(去黑心各半两)
上五味,粗捣筛,每服三钱匕,水一盏,入竹叶粳米各少许,同煎至七分,去滓不计时
候温服。
治伤寒后余毒不解,颊赤口干,四肢烦热。柴胡汤方
柴胡(去苗) 茵陈蒿 甘草(炙锉) 人参(各一两) 大黄(锉炒半两)
上五味,粗捣筛,每服三钱匕,水一盏,小麦五十粒,同煎至七分,去滓温服,不计时
候。
论述说:伤寒病痊愈后,余热未能清除的,是因为阴阳之气尚未调和,邪气没有完全祛除,流窜于经络之中,蕴结而化热。症状表现为定时发作发热如疟疾状,鼻出血,烦躁不安。面色红赤,眼睛发黄,腹部胀满,小便不通畅,大便干涩难解,或者出现胡言乱语。口渴想喝水,脉象沉而数的,应当从里证的角度来寻求治疗方法。如果脉象只是浮的,应当斟酌处理表证(外感)。
治疗伤寒后余热未清、脉象浮的,用麻黄汤方:
麻黄(去掉根和节,煎煮时撇去浮沫,焙干)一两,芍药一两,甘草(炙烤至微红,锉碎)一两,桂枝(去掉粗皮)一两,细辛(去掉苗叶)半两。
以上五味药,粗捣筛过,每次服用五钱匕,用水一盏半,煎取八分,去渣温服。每日三次。
治疗伤寒发汗后热已解除,约半天左右又复发烦热、脉象浮数的,可以再次发汗。用桂枝汤方:
桂枝(去掉粗皮)三分,芍药三分,甘草(炙)二两。
以上三味药,锉碎如麻豆大小,每次服用五钱匕,用水一盏半,加入生姜一块(切得很大片),大枣两枚(劈开),煎取一盏,去渣温服,以出汗为度。
治疗伤寒余热,出汗像疟疾发作的样子,傍晚时分发热,脉象实大的可以用下法,宜用大柴胡汤方:
柴胡(去掉苗)八两,黄芩(去掉黑心部分)三两,半夏(用生姜汁制后焙干)二两,枳实(去掉瓤,麸炒)四枚,大黄二两。
以上五味药,锉碎,每次服用五钱匕,用水一盏半,加入生姜半分(切片),煎至八分,去渣温服,以下利且热退为度。
治疗伤寒病愈后,再次发热,以小柴胡汤为主治。脉浮的,用发汗法解表;脉沉实或紧的,用泻下法解里。小柴胡汤方:
柴胡(去掉苗)四两,黄芩(去掉黑心部分),人参一两半,甘草(炙)一两半,半夏(用生姜汁制后焙干)二两。
以上五味药,锉碎如麻豆大小,每次服用五钱匕,用水二盏,加入生姜半分(切片),大枣两枚(劈开),煎取八分,去渣,不拘时候温服。
治疗伤寒及瘟疫流行后,头痛、余热未清。用葛根汤方:
葛根(锉碎)一两,柴胡(去掉苗)一两,麻黄(去掉根节,煎煮时撇去浮沫,焙干)三分,芍药半两,黄芩(去掉黑心部分)半两,甘草(炙,锉碎)半两,桂枝(去掉粗皮)半两。
以上七味药,粗捣筛过,每次服用五钱匕,用水一盏半,大枣两枚(劈开),煎至六分,去渣,不计时候温服。
治疗伤寒后,余热不除,以及寒热往来、头重身体疼痛,表证尚未解除。用葛根汤方:
葛根一两,芍药一两,白茯苓(去掉黑皮)一两,黄芩(去掉黑心部分)一两,乌头(炮裂,去皮脐)一两,川芎一两,栀子仁半两。
以上七味药,锉碎如麻豆大小,每次服用五钱匕,用水一盏半,加入淡豆豉三七粒,煎至七分,去渣温服。
治疗伤寒发汗后,余热不退,心神烦躁。用茯苓汤方:
赤茯苓(去掉黑皮)一两半,人参一分,甘草(炙,锉碎)半两。
以上三味药,粗捣筛过,每次服用三钱匕,用水一盏,煎至七分,去渣,不拘时候温服。
治疗伤寒发汗后,余热不除,以及四肢拘挛急痛,胸膈部不适,呕吐逆气,不想吃东西。用茯苓汤方:
赤茯苓(去掉黑皮)半两,柴胡(去掉苗)半两,枳壳(去掉瓤,麸炒)半两,桑根白皮(锉碎)半两,麦门冬(去掉心,焙干)半两,葛根(锉碎)三分,甘草(炙,锉碎)半两,桂枝(去掉粗皮)一分,人参一分。
以上九味药,粗捣筛过,每次服用三钱匕,用水一盏,生姜三片,大枣两枚(劈开),煎至七分,去渣温服。
治疗伤寒发汗及吐下后,余热不退,头痛、胸闷、口干。用葛根人参汤方:
葛根(锉碎)一两,人参一两,麦门冬(去掉心,焙干)半两,黄芩(去掉黑心部分)半两,黄芪(锉碎)一两,地骨皮半两,石膏(打碎)半两。
以上七味药,粗捣筛过,每次服用五钱匕,用水一盏半,煎至八分,去渣温服。
治疗伤寒数日后余热未清,时常发作寒热。用葳蕤汤方:
葳蕤一两,柴胡(去掉苗)一两,羚羊角(镑成薄片)一两,石膏(打碎)半两。
以上四味药,粗捣筛过,每次服用五钱匕,用水一盏半,煎至八分,去渣,不计时候温服。
治疗伤寒后余热不退。用人参汤方:
人参一两,知母一分,甘草(炙,锉碎)半两,石膏(打碎)半两,黄芩(去掉黑心部分)半两。
以上五味药,粗捣筛过,每次服用三钱匕,用水一盏,加入竹叶、粳米各少许,同煎至七分,去渣,不计时候温服。
治疗伤寒后余毒未清,脸颊红赤,口干,四肢烦热。用柴胡汤方:
柴胡(去掉苗)一两,茵陈蒿一两,甘草(炙,锉碎)一两,人参一两,大黄(锉碎,炒)半两。
以上五味药,粗捣筛过,每次服用三钱匕,用水一盏,加入小麦五十粒,同煎至七分,去渣温服,不计时候。
Commentary states: After the recovery from cold damage disease (Shanghan), if residual heat fails to dissipate, it is because Yin and Yang have not yet harmonized, and pathogenic factors have not been completely eliminated. These factors circulate through the meridians, accumulate, and generate heat. Symptoms include paroxysmal fever resembling malaria, epistaxis (nosebleed), irritability, flushed face, yellow eyes, abdominal fullness, difficulty in urination, dry and difficult defecation, or even delirious speech. Thirst with desire for water and a deep, rapid pulse indicate that treatment should be sought based on interior syndromes. If the pulse is merely floating, the exterior syndrome should be addressed after careful consideration.
For treating residual heat after cold damage with a floating pulse, use Ma Huang Tang (Ephedra Decoction):
Ma Huang (Ephedrae Herba, 麻黄) [remove roots and nodes, boil and skim off foam, then dry] 1 liang, Bai Shao (Paeoniae Radix Alba, 芍药) 1 liang, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted until slightly red, crushed] 1 liang, Gui Zhi (Cinnamomi Ramulus, 桂枝) [remove coarse bark] 1 liang, Xi Xin (Asari Radix et Rhizoma, 细辛) [remove seedlings and leaves] 0.5 liang.
The above five herbs are coarsely ground and sieved. Take 5 qian bi per dose, add 1.5 zhan of water, decoct to obtain 0.8 zhan, remove dregs, and take warm. Three times daily.
For treating recurrence of irritability and floating, rapid pulse half a day after sweating resolves heat in cold damage, sweating may be induced again. Use Gui Zhi Tang (Cinnamon Twig Decoction):
Gui Zhi (Cinnamomi Ramulus, 桂枝) [remove coarse bark] 3 fen, Bai Shao (Paeoniae Radix Alba, 芍药) 3 fen, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted] 2 liang.
The above three herbs are crushed to the size of hemp seeds. Take 5 qian bi per dose, add 1.5 zhan of water, add one large slice of fresh ginger (Sheng Jiang, 生姜) and two split dates (Da Zao, 大枣). Decoct to obtain one zhan, remove dregs, and take warm. The goal is to induce sweating.
For treating residual heat in cold damage where sweating resembles malaria attacks, fever occurs at dusk, and the pulse is excess/solid, purgation may be used. Da Chai Hu Tang (Major Bupleurum Decoction) is suitable:
Chai Hu (Bupleuri Radix, 柴胡) [remove seedlings] 8 liang, Huang Qin (Scutellariae Radix, 黄芩) [remove black heart] 3 liang, Ban Xia (Pinelliae Rhizoma Preparatum, 半夏) [processed with fresh ginger juice, dried] 2 liang, Zhi Shi (Aurantii Fructus Immaturus, 枳实) [remove pith, stir-fried with bran] 4 pieces, Da Huang (Rhei Radix et Rhizoma, 大黄) 2 liang.
The above five herbs are crushed. Take 5 qian bi per dose, add 1.5 zhan of water and half a portion of sliced fresh ginger. Decoct to 0.8 zhan, remove dregs, and take warm. The goal is diarrhea and resolution of heat.
For treating recurrent fever after recovery from cold damage, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary formula. For floating pulses, resolve via sweating; for deep, solid, or tight pulses, resolve via purgation. Xiao Chai Hu Tang:
Chai Hu (Bupleuri Radix, 柴胡) [remove seedlings] 4 liang, Huang Qin (Scutellariae Radix, 黄芩) [remove black heart], Ren Shen (Ginseng Radix, 人参) 1.5 liang, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted] 1.5 liang, Ban Xia (Pinelliae Rhizoma Preparatum, 半夏) [processed with fresh ginger juice, dried] 2 liang.
The above five herbs are crushed to the size of hemp seeds. Take 5 qian bi per dose, add 2 zhan of water, half a portion of sliced fresh ginger, and two split dates. Decoct to 0.8 zhan, remove dregs, and take warm at any time.
For treating headache and unresolved residual heat after cold damage and epidemic febrile diseases, use Ge Gen Tang (Kudzu Root Decoction):
Ge Gen (Puerariae Lobatae Radix, 葛根) [crushed] 1 liang, Chai Hu (Bupleuri Radix, 柴胡) [remove seedlings] 1 liang, Ma Huang (Ephedrae Herba, 麻黄) [remove roots and nodes, skim foam, dry] 3 fen, Bai Shao (Paeoniae Radix Alba, 芍药) 0.5 liang, Huang Qin (Scutellariae Radix, 黄芩) [remove black heart] 0.5 liang, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted, crushed] 0.5 liang, Gui Zhi (Cinnamomi Ramulus, 桂枝) [remove coarse bark] 0.5 liang.
The above seven herbs are coarsely ground and sieved. Take 5 qian bi per dose, add 1.5 zhan of water and two split dates. Decoct to 0.6 zhan, remove dregs, and take warm at any time.
For treating persistent residual heat after cold damage, alternating chills and fever, heavy head, body pain, and unresolving exterior syndromes, use Ge Gen Tang (Kudzu Root Decoction):
Ge Gen (Puerariae Lobatae Radix, 葛根) 1 liang, Bai Shao (Paeoniae Radix Alba, 芍药) 1 liang, Bai Fu Ling (Poria, 白茯苓) [remove black skin] 1 liang, Huang Qin (Scutellariae Radix, 黄芩) [remove black heart] 1 liang, Wu Tou (Aconiti Lateralis Radix Praeparata, 乌头) [pao-processed, remove skin and navel] 1 liang, Xiong Qiong (Ligustici Chuanxiong Rhizoma, 川芎) 1 liang, Zhi Zi Ren (Gardeniae Semen, 栀子仁) 0.5 liang.
The above seven herbs are crushed to the size of hemp seeds. Take 5 qian bi per dose, add 1.5 zhan of water and 37 grains of Dan Chi (Fermented Soybean, 淡豆豉). Decoct to 0.7 zhan, remove dregs, and take warm.
For treating persistent residual heat and mental restlessness after sweating in cold damage, use Fu Ling Tang (Poria Decoction):
Chi Fu Ling (Poria with Red Skin, 赤茯苓) [remove black skin] 1.5 liang, Ren Shen (Ginseng Radix, 人参) 1 fen, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted, crushed] 0.5 liang.
The above three herbs are coarsely ground and sieved. Take 3 qian bi per dose, add 1 zhan of water. Decoct to 0.7 zhan, remove dregs, and take warm at any time.
For treating persistent residual heat, limb spasms and pain, chest and diaphragm discomfort, vomiting, and loss of appetite after sweating in cold damage, use Fu Ling Tang (Poria Decoction):
Chi Fu Ling (Poria with Red Skin, 赤茯苓) [remove black skin] 0.5 liang, Chai Hu (Bupleuri Radix, 柴胡) [remove seedlings] 0.5 liang, Zhi Ke (Aurantii Fructus, 枳壳) [remove pith, stir-fried with bran] 0.5 liang, Sang Bai Pi (Mori Cortex, 桑根白皮) [crushed] 0.5 liang, Mai Men Dong (Ophiopogonis Radix, 麦门冬) [remove heart, dried] 0.5 liang, Ge Gen (Puerariae Lobatae Radix, 葛根) [crushed] 3 fen, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted, crushed] 0.5 liang, Gui Zhi (Cinnamomi Ramulus, 桂枝) [remove coarse bark] 1 fen, Ren Shen (Ginseng Radix, 人参) 1 fen.
The above nine herbs are coarsely ground and sieved. Take 3 qian bi per dose, add 1 zhan of water, three slices of fresh ginger, and two split dates. Decoct to 0.7 zhan, remove dregs, and take warm.
For treating persistent residual heat, headache, chest stuffiness, and dry mouth after sweating, vomiting, and purgation in cold damage, use Ge Gen Ren Shen Tang (Kudzu Root and Ginseng Decoction):
Ge Gen (Puerariae Lobatae Radix, 葛根) [crushed] 1 liang, Ren Shen (Ginseng Radix, 人参) 1 liang, Mai Men Dong (Ophiopogonis Radix, 麦门冬) [remove heart, dried] 0.5 liang, Huang Qin (Scutellariae Radix, 黄芩) [remove black heart] 0.5 liang, Huang Qi (Astragali Radix, 黄芪) [crushed] 1 liang, Di Gu Pi (Lycii Cortex, 地骨皮) 0.5 liang, Shi Gao (Gypsum Fibrosum, 石膏) [crushed] 0.5 liang.
The above seven herbs are coarsely ground and sieved. Take 5 qian bi per dose, add 1.5 zhan of water. Decoct to 0.8 zhan, remove dregs, and take warm.
For treating intermittent chills and fever due to unresolved residual heat several days after cold damage, use Wei Rui Tang (Polygonatum Decoction):
Wei Rui (Polygonati Odorati Rhizoma, 葳蕤) 1 liang, Chai Hu (Bupleuri Radix, 柴胡) [remove seedlings] 1 liang, Ling Yang Jiao (Saiga Tataricae Cornu, 羚羊角) [sliced] 1 liang, Shi Gao (Gypsum Fibrosum, 石膏) [crushed] 0.5 liang.
The above four herbs are coarsely ground and sieved. Take 5 qian bi per dose, add 1.5 zhan of water. Decoct to 0.8 zhan, remove dregs, and take warm at any time.
For treating persistent residual heat after cold damage, use Ren Shen Tang (Ginseng Decoction):
Ren Shen (Ginseng Radix, 人参) 1 liang, Zhi Mu (Anemarrhenae Rhizoma, 知母) 1 fen, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted, crushed] 0.5 liang, Shi Gao (Gypsum Fibrosum, 石膏) [crushed] 0.5 liang, Huang Qin (Scutellariae Radix, 黄芩) [remove black heart] 0.5 liang.
The above five herbs are coarsely ground and sieved. Take 3 qian bi per dose, add 1 zhan of water, along with a small amount of Zhu Ye (Bambusae Folium, 竹叶) and Jing Mi (Oryza Sativa, 粳米). Decoct together to 0.7 zhan, remove dregs, and take warm at any time.
For treating unresolved residual toxicity after cold damage, flushed cheeks, dry mouth, and restless heat in limbs, use Chai Hu Tang (Bupleurum Decoction):
Chai Hu (Bupleuri Radix, 柴胡) [remove seedlings] 1 liang, Yin Chen Hao (Artemisiae Scopariae Herba, 茵陈蒿) 1 liang, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 甘草) [roasted, crushed] 1 liang, Ren Shen (Ginseng Radix, 人参) 1 liang, Da Huang (Rhei Radix et Rhizoma, 大黄) [crushed, stir-fried] 0.5 liang.
The above five herbs are coarsely ground and sieved. Take 3 qian bi per dose, add 1 zhan of water and 50 grains of Xiao Mai (Tritici Capillaris Semen, 小麦). Decoct together to 0.7 zhan, remove dregs, and take warm at any time.