论曰伤寒大阳病三日,已发汗,吐下若温针,仍不解者,多变为坏病,转入少阳,已吐
下发汗,少阳证罢,此为坏病,知犯何逆,以法治之,此皆由伤寒病在诸经络,发汗吐下而
病证不除,又感客气,气有寒暑燥湿风不同,病亦随变,故谓之坏病,又有伤寒过经,再受
热邪,留蓄脏腑,病后多变者,及伤寒解后,虚羸少气,余证未除者,皆谓之坏病也。
治伤寒坏病瘥后,或十数日,或半月二十日,终不惺惺,精神昏,语言错,又无寒热,
医或作鬼祟,或作风疾,多端治疗弗效,或朝夕潮热颊赤,或似疟,皆由发汗不尽,余毒在
心包络间所致。知母麻黄汤方
知母(焙一两半) 麻黄(去根节煎掠去沫) 甘草(炙锉) 芍药 黄芩(去黑心各
半两)
桂(去粗皮半两盛暑中可减半)
上六味,锉如麻豆大,每服五钱匕,水一盏半,煎至八分,去滓温服,半日内可相次三
服,温覆取汗,未汗再服,若心烦不眠,欲饮水者,当稍稍与之,令胃中和即愈。
治伤寒坏病,经数日未瘥,诸药不能除。升麻汤方
升麻 鳖甲醋炙去裙 枳壳(去瓤麸炒) 犀角(镑) 葛根 黄芩(去黑心各三分)
甘
草(炙锉) 前胡(去芦头) 乌头(炮裂去皮脐各半两)
上九味,锉如麻豆,每服五钱匕,水一盏半,煎至八分,去滓下地黄汁二合,搅匀食后
温服。
治伤寒坏病,医所不能治,热在胸中,不能言语,麦奴丸方
麦奴 釜底墨 灶突墨 梁上尘 大黄锉炒 黄芩(去黑心) 朴硝(研各半两) 麻
黄
(去根节一两)
上八味,捣研为末,炼蜜和捣三五百杵。丸如弹丸大,每服一丸,新汲水研下,如渴当
极饮水,不欲水,亦强饮之,须臾必寒,寒已,汗出瘥。
治伤寒坏病,冷热相搏,心下结,胸满气急,大便不利,体变黄青黑如桃枝色,四肢逆
冷,热结在内者,不可服汤饮。宜麝香丸方
麝香(研) 猪苓(去黑皮) 朴硝(研) 荛花(炒) 芫花(醋炒各一分) 大黄
(锉炒) 商
陆甘遂(炮各半两)
上八味,粗捣研为末,炼蜜和捣三五百杵,丸如绿豆大,每服十丸,食前温汤下,良久
必利,未利再服。
治伤寒坏病,头与骨肉俱痛,狂言妄语,医所不疗者。黑奴丸方
麻黄(去根节一两半) 黄芩(去黑心) 甘草(炙锉) 灶突墨 芒硝(各一两) 豉
(一合
炒)
上六味,捣罗为末,炼蜜和捣三五百杵,丸如弹子大,每服一丸,新汲水研下,不拘时
候。
治伤寒坏病。大效丸方
乌头 附子(各一两二味去皮脐为末用醋一升煎尽为度又入好酒一升再煎成膏后入诸
药)
乌蛇(酒浸去皮骨炙) 细辛(去苗叶) 浓朴(去粗皮姜汁炙) 人参 赤茯苓(去黑皮)
桂
(去粗皮) 干蝎(炒) 木香 乳香(研) 草豆蔻(去皮) 砂(研) 胡桐泪 槟
榔锉 腻粉
不灰木(各一分)
上一十七味,将一十五味,捣研为末,入二味膏子内,和捣丸如梧桐子大,每服十丸,
如阳盛研牛黄腻粉水下,如阴盛发厥,心胸结痞,煎柳枝汤下。
治伤寒坏病,经久不瘥,潮热不退,身体沉重,昏愦烦闷。麦门冬汤方
麦门冬(去心焙) 赤茯苓(去黑皮各一两) 鳖甲(去裙 醋炙二两) 甘草(炙锉
半两)
上四味,粗捣筛,每服三钱匕,水一盏,乌梅一个,小麦五十粒,同煎至七分,去滓温
服,不拘时候。
治伤寒坏病,潮热颊赤,口干烦躁,神思昏塞,经久不瘥。前胡汤方
前胡(去芦头二两) 柴胡(去苗) 常山 人参 葛根(锉各一两) 甘草(炙锉三
分)
上六味,粗捣筛,每服三钱匕,水一大盏,乌梅一个椎碎,生姜三片,煎至七分,去滓
温服,不拘时候。
论述说:伤寒太阳病经过三天,已经使用了发汗、催吐、泻下或温针等治疗方法,但病情仍未解除的,大多会转变为坏病。如果病邪转入少阳经,或者在已经使用过吐法、下法和发汗法后,少阳病的证候消失,这被称为坏病。此时需要明确患者犯了何种误治之逆,再根据具体情况依法治疗。这些情况都是因为伤寒病邪在诸经络中,经过发汗、催吐、泻下治疗后,病证没有消除,又感受了外界的客气(外邪),由于客气有寒、暑、燥、湿、风等不同性质,病症也随之变化,所以称为坏病。另外,又有伤寒病传变超过一经,再次感受热邪,热邪留滞蓄积在脏腑内,病后多变的,以及伤寒病虽然解除,但身体虚弱消瘦、气短,其余症状未除的,都称为坏病。
治疗伤寒坏病痊愈后,或者过了十几天,或者半个月、二十天,始终精神不振,神志昏沉,言语错乱,又没有寒热往来症状的,医生有时误认为是鬼祟作怪,有时误认为是风疾,采用多种方法治疗都无效;或者出现早晚定时发热、两颊发红,或者症状类似疟疾的情况,这都是因为发汗不彻底,余毒留存在心包络之间所导致的。知母麻黄汤方:知母(焙干一两半)、麻黄(去掉根和节,煎煮时撇去浮沫)、甘草(炙过并切碎)、芍药、黄芩(去掉黑心部分,各半两)、桂枝(去掉粗皮,半两,盛夏季节可减半)。以上六味药,锉碎如麻豆大小,每次服用五钱匕,加水一盏半,煎至八分,去掉药渣,温服。半天内可以连续服用三次,服药后覆盖衣被以取汗,如果没有出汗则再次服用。如果出现心烦失眠、想喝水的情况,应当少量给予饮水,使胃气调和即可痊愈。
治疗伤寒坏病,经过几天仍未痊愈,各种药物都无法去除病邪的。升麻汤方:升麻、鳖甲(用醋炙后去掉裙边)、枳壳(去掉瓤,麸炒)、犀角(镑成薄片)、葛根、黄芩(去掉黑心部分,各三分)、甘草(炙过并切碎)、前胡(去掉芦头)、乌头(炮裂后去掉皮和脐,各半两)。以上九味药,锉碎如麻豆大小,每次服用五钱匕,加水一盏半,煎至八分,去掉药渣,加入地黄汁二合,搅拌均匀,饭后温服。
治疗伤寒坏病,医生无法治疗的,热邪在胸中,导致不能言语的。麦奴丸方:麦奴、釜底墨(锅底灰)、灶突墨(烟囱里灰)、梁上尘、大黄(锉碎炒制)、黄芩(去掉黑心部分)、朴硝(研磨,各半两)、麻黄(去掉根和节,一两)。以上八味药,捣碎研为细末,用炼蜜调和,捣杵三五百下。制成如弹丸大小的药丸,每次服用一丸,用新汲水研化送服。如果口渴,应当尽量多喝水;如果不渴,也要强行饮水。不久之后必定感到寒冷,冷感过后,出汗即愈。
治疗伤寒坏病,冷热之气相互搏结,心下部痞结,胸部胀满,气息急促,大便不通利,身体颜色变为黄、青、黑,像桃树枝的颜色,四肢逆冷,热邪结聚在体内的,不可服用汤剂。宜用麝香丸方:麝香(研磨)、猪苓(去掉黑皮)、朴硝(研磨)、荛花(炒制)、芫花(醋炒,各一分)、大黄(锉碎炒制)、商陆、甘遂(炮制,各半两)。以上八味药,粗捣研为细末,用炼蜜调和,捣杵三五百下,制成如绿豆大小的药丸,每次服用十丸,饭前用温水送服。很久之后必定会腹泻,如果未腹泻则再次服用。
治疗伤寒坏病,头部与骨肉俱痛,胡言乱语,医生无法治疗的。黑奴丸方:麻黄(去掉根和节,一两半)、黄芩(去掉黑心部分)、甘草(炙过并切碎)、灶突墨、芒硝(各一两)、豆豉(一合,炒制)。以上六味药,捣碎过筛为细末,用炼蜜调和,捣杵三五百下,制成如弹子大小的药丸,每次服用一丸,用新汲水研化送服,不拘泥于具体时间。
治疗伤寒坏病的大效丸方:乌头、附子(各一两,这两味药去皮和脐后研为末,用醋一升煎至干尽为标准,然后加入好酒一升再煎成膏状,最后加入其他药物)。乌蛇(酒浸后去掉皮和骨,炙干)、细辛(去掉苗叶)、浓朴(去掉粗皮,姜汁炙干)、人参、赤茯苓(去掉黑皮)、桂枝(去掉粗皮)、干蝎(炒制)、木香、乳香(研磨)、草豆蔻(去皮)、砂仁(研磨)、胡桐泪、槟榔(锉碎)、腻粉、不灰木(各一分)。以上十七味药,将其中十五味药捣研为细末,加入两种膏状物内,调和捣匀,制成如梧桐子大小的药丸。每次服用十丸,如果是阳盛体质,用牛黄和腻粉的水研化送服;如果是阴盛导致四肢厥冷、心胸痞结,用柳枝汤送服。
治疗伤寒坏病,经久不愈,潮热不退,身体沉重,神志昏愦烦闷的。麦门冬汤方:麦门冬(去掉心,焙干)、赤茯苓(去掉黑皮,各一两)、鳖甲(去掉裙边,醋炙,二两)、甘草(炙过并切碎,半两)。以上四味药,粗捣过筛,每次服用三钱匕,加水一盏,乌梅一个,小麦五十粒,共同煎至七分,去掉药渣,温服,不拘泥于具体时间。
治疗伤寒坏病,潮热两颊发红,口干烦躁,神思昏塞,经久不愈的。前胡汤方:前胡(去掉芦头,二两)、柴胡(去掉苗)、常山、人参、葛根(锉碎,各一两)、甘草(炙过并切碎,三分)。以上六味药,粗捣过筛,每次服用三钱匕,加水一大盏,乌梅一个拍碎,生姜三片,煎至七分,去掉药渣,温服,不拘泥于具体时间。
Discourse states: When Taiyang disease (disease of the Taiyang channel) of Shanghan (Cold Damage) has passed for three days, and sweating, vomiting, purging, or warm needle therapies have already been applied, yet the condition remains unresolved, it often transforms into a Huai Bing (ruined disease). If the pathogen shifts to Shaoyang (Lesser Yang), or if after vomiting, purging, and sweating, the Shaoyang syndrome symptoms cease, this is termed Huai Bing. One must ascertain what error in treatment was committed and then apply therapy accordingly. These situations arise because the Shanghan pathogen resided in the various channels and collaterals; after sweating, vomiting, and purging, the pathological signs were not eliminated, and the patient was subsequently affected by external pathogenic factors (Ke Qi). Since these external factors vary in nature—cold, heat, dryness, dampness, or wind—the diseases also change accordingly, hence the term "Huai Bing." Furthermore, when Shanghan has progressed beyond its original meridian stage and is re-exposed to heat pathogens, which remain stagnant and accumulate within the Zang-Fu organs, leading to variable post-illness conditions; or when Shanghan has resolved but the patient remains emaciated with shortness of breath and residual symptoms persist—all these are referred to as Huai Bing.
To treat the aftermath of Shanghan Huai Bing, whether ten-plus days, half a month, or twenty days have passed, and the patient remains listless, mentally confused, speaking incoherently, without alternating chills and fever, physicians may mistakenly attribute it to demonic influence or wind disease, employing various ineffective treatments. Alternatively, the patient may exhibit tidal fever with flushed cheeks or symptoms resembling malaria. All these result from incomplete sweating, leaving residual toxins in the Pericardium Collateral (Xin Bao Luo).
Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction):
Zhimu (Anemarrhenae Rhizoma, roasted, 1.5 liang), Mahuang (Ephedrae Herba, roots and joints removed, boiled and scum skimmed off), Gancao (Licorice Root, honey-fried and chopped), Shaoyao (Paeoniae Radix), Huangqin (Scutellariae Radix, black heart removed, each 0.5 liang), Guizhi (Cinnamomi Ramulus, bark removed, 0.5 liang; reduce by half in midsummer).
The above six herbs are chopped like hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.8 sheng. Strain and take warm. Three doses can be taken sequentially within half a day. Cover warmly to induce sweating. If no sweat occurs, administer again. If there is mental restlessness, insomnia, or thirst, provide small amounts of water gradually until the Stomach Qi harmonizes and recovery ensues.
Shengma Tang (Cimicifugae Decoction) for treating Shanghan Huai Bing that has persisted for several days without improvement, unresponsive to various medications:
Shengma (Cimicifugae Rhizoma), Biejia (Testudinis Carapax et Plastrum, vinegar-roasted, skirt removed), Zhike (Aurantii Fructus, pith removed, bran-fried), Xijiao (Rhinocerotis Cornu, shaved), Gegen (Puerariae Radix), Huangqin (Scutellariae Radix, black heart removed, each 3 fen), Gancao (Licorice Root, honey-fried and chopped), Qianhu (Peucedani Radix, radix head removed), Wutou (Aconiti Lateralis Radix Praeparata, cracked, skin and navel removed, each 0.5 liang).
The above nine herbs are chopped like hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.8 sheng. Strain, add Dihuang juice (Rehmanniae Radix Juice, 2 he), mix well, and take warm after meals.
Mainu Wan (Wheat Parasite Pill) for treating Shanghan Huai Bing refractory to medical treatment, with heat in the chest causing inability to speak:
Mainu (Triticum Aestivum Parasitum), Fudi Mo (Soot from cooking pot bottom), Zaotu Mo (Soot from chimney flue), Liangshang Chen (Dust from roof beams), Dahuang (Rhei Radix et Rhizoma, chopped and fried), Huangqin (Scutellariae Radix, black heart removed), Puxiao (Natrii Sulfas, ground, each 0.5 liang), Mahuang (Ephedrae Herba, roots and joints removed, 1 liang).
The above eight herbs are pounded and ground into powder. Mix with refined honey and pound 300–500 times. Form pills the size of bullet shots. Take one pill per dose, dissolved in fresh cold water. If thirsty, drink as much water as possible; if not thirsty, force drinking. Soon, chills will occur, followed by sweating and recovery.
Moxiang Wan (Musk Pill) for Shanghan Huai Bing where cold and heat contend, resulting in epigastric knotting, chest fullness, shortness of breath, constipation, body discoloration (yellow, green, black like peach branches), cold limbs, and internal heat accumulation. Decoctions are contraindicated.
Moxiang (Moschus, ground), Zhuling (Polypori Umbellati Sclerotium, black skin removed), Puxiao (Natrii Sulfas, ground), Raohua (Genistae Despiciensis Radix, fried), Yuanhua (Genistae Monspessulani Flos, vinegar-fried, each 1 fen), Dahuang (Rhei Radix et Rhizoma, chopped and fried), Shangling (Phytolaccae Radix), Gansui (Kansui Radix, prepared, each 0.5 liang).
The above eight herbs are coarsely pounded and ground into powder. Mix with refined honey and pound 300–500 times. Form pills the size of mung beans. Take 10 pills per dose before meals with warm water. Diarrhea will likely occur after some time; if not, repeat the dose.
Heiniu Wan (Black Slave Pill) for Shanghan Huai Bing with pain in the head and bones/flesh, delirious speech, refractory to treatment:
Mahuang (Ephedrae Herba, roots and joints removed, 1.5 liang), Huangqin (Scutellariae Radix, black heart removed), Gancao (Licorice Root, honey-fried and chopped), Zaotu Mo (Soot from chimney flue), Mangxiao (Natrii Sulfas, each 1 liang), Chi (Fermented Soybean, 1 he, fried).
The above six herbs are pounded and sifted into powder. Mix with refined honey and pound 300–500 times. Form pills the size of bullets. Take one pill per dose, dissolved in fresh cold water, at any time.
Da Xiao Wan (Great Efficacy Pill) for Shanghan Huai Bing:
Wutou (Aconiti Radix), Fuzi (Aconiti Lateralis Radix Praeparata, each 1 liang; remove skin and navel, grind to powder, boil in 1 sheng of vinegar until dry, then add 1 sheng of good wine and boil into a paste, then add other herbs). Wushe (Bungarus Parvus, soaked in wine, skin and bones removed, roasted), Xixin (Asari Radix et Rhizoma, seedlings and leaves removed), Houpo (Magnoliae Officinalis Cortex, rough bark removed, ginger juice-roasted), Renshen (Ginseng Radix), Chifuling (Polypori Umbellati Sclerotium cum Rubro, black skin removed), Guizhi (Cinnamomi Ramulus, bark removed), Ganxie (Scorpio, fried), Muxiang (Aucklandiae Radix), Ruxiang (Olibanum, ground), Caodoukou (Cardamomi Fructus, skin removed), Sharen (Amomi Fructus Rotundus, ground), Hutonglei (Tamarisci Caulis Exsudatio), Binglang (Arecae Semen, chopped), Nifen (Calomel), Bu Hui Mu (Asbestus, each 1 fen).
Of the seventeen ingredients, fifteen are pounded and ground into powder. Mix with the two pastes and pound into pills the size of Sophora seeds. Take 10 pills per dose. For excess Yang patterns, dissolve with Ni Fen and Niu Huang (Calomel and Bovis Calculus) in water. For excess Yin patterns causing cold extremities and epigastric stagnation, take with Liu Zhi Tang (Willow Branch Decoction).
Maimendong Tang (Ophiopogonis Decoction) for Shanghan Huai Bing persisting long-term with unremitting tidal fever, heavy body, confusion, and irritability:
Maimendong (Ophiopogonis Radix, core removed, roasted), Chifuling (Polypori Umbellati Sclerotium cum Rubro, black skin removed, each 1 liang), Biejia (Testudinis Carapax et Plastrum, skirt removed, vinegar-roasted, 2 liang), Gancao (Licorice Root, honey-fried and chopped, 0.5 liang).
The above four herbs are coarsely pounded and sifted. Take 3 qianbi per dose with 1 sheng of water, one Wu Mei (Mume Fructus), and 50 Xiaomai (Tritici Semen). Boil until reduced to 0.7 sheng. Strain and take warm, at any time.
Qianhu Tang (Peucedani Decoction) for Shanghan Huai Bing with tidal fever, flushed cheeks, dry mouth, irritability, mental cloudiness, and long-term non-resolution:
Qianhu (Peucedani Radix, radix head removed, 2 liang), Chaihu (Bupleuri Radix, seedlings removed), Changshan ( Dichroae Radix), Renshen (Ginseng Radix), Gegen (Puerariae Radix, chopped, each 1 liang), Gancao (Licorice Root, honey-fried and chopped, 3 fen).
The above six herbs are coarsely pounded and sifted. Take 3 qianbi per dose with one large sheng of water, one crushed Wu Mei (Mume Fructus), and three slices of Shengjiang (Zingiberis Rhizoma Recens). Boil until reduced to 0.7 sheng. Strain and take warm, at any time.