枳实(三枚炙苦寒) 栀子(十四枚擘苦寒) 豉(一升绵裹苦寒)
上三味。以清浆水七升。空煮。取四升。内枳实栀子。煮取二升。下豉。更煮五六
沸。去滓。温分再服。覆令微似汗。
枳实栀子豉汤。则应吐剂。此云覆令微似汗出者。以其热聚于上。苦则吐之。热散
于表者。苦则发之。内经曰。火淫所胜。以苦发之。此之谓也。
王宇泰云。伤寒之邪自外入。劳复之邪自内发。汗、吐、下。随宜施治。
伤寒瘥以后。更发热者。小柴胡汤主之。脉浮者。以汗解之。脉沉实者。以下解之。
瘥后余热未尽。更发热者。与小柴胡汤以和解之。脉浮者。热在表也。故以汗解。
脉沉者。热在里也。故以下解之。
大病瘥后。从腰以下。有水气者。牡蛎泽泻散主之。
大病瘥后。脾胃气虚。不能制约肾水。水溢下焦。腰以下为肿也。金匮要略曰。腰
以下肿当利小便。与牡蛎泽泻散。利小便而散水也。
牡蛎(咸平熬) 泽泻(咸寒) 栝蒌根(苦寒) 蜀漆(辛平洗去腥) 葶苈(苦寒
熬) 商陆根(熬辛酸咸平) 海藻(咸寒洗去咸以上各等分)
上七味。异捣下筛为散。更入臼中。治之。白饮和服方寸匕。小便利。止后服。日
三服。
咸味涌泄。牡蛎泽泻海藻之咸。以泄水气。内经曰。湿淫于内。平以苦。佐以酸辛。
以苦泄之。蜀漆葶苈栝蒌商陆之酸辛与苦。以导肿湿。
大病瘥后。喜唾。久不了了者。胃上有寒。当以丸药温之。宜理中丸。
汗后阳气不足。胃中虚寒。不内津液。故喜唾。不了了。与理中丸。以温其胃。
伤寒解后。虚羸。少气。气逆欲吐者。竹叶石膏汤主之。
伤寒解后。津液不足而虚羸。余热未尽。热则伤气。故少气。气逆欲吐。与竹叶石
膏汤。调胃散热。
枳实(三枚,炙,性味苦寒) 栀子(十四枚,掰开,性味苦寒) 豆豉(一升,用绵布包裹,性味苦寒)
以上三味药。用清浆水七升。先空煮至四升。加入枳实和栀子。煮取二升。再加入豆豉。再煮五六沸。去渣。温服,分两次服用。服药后覆盖衣被使身体微微似有汗出。
枳实栀子豉汤,本应是催吐剂。这里说服药后覆盖衣被使身体微微似有汗出,是因为热邪聚集在上部。苦味药能引起呕吐,热邪散在体表的,苦味药能发散它。《内经》说:火气过胜,用苦味药发散。说的就是这个道理。
王宇泰说:伤寒的病邪从外侵入,劳复的病邪从内发出。汗法、吐法、下法,根据情况适宜施用。
伤寒病愈后,又发热的,用小柴胡汤主治。脉浮的,用发汗法解表。脉沉实的,用泻下法解里。
大病初愈,余热未尽,又发热的,给小柴胡汤以和解少阳。脉浮的,说明热在体表。所以用发汗法解除。
脉沉的,说明热在体内。所以用泻下法解除。
大病初愈,腰部以下有水气停留的,用牡蛎泽泻散主治。
大病初愈,脾胃气虚,不能制约肾水,水湿泛滥于下焦,导致腰部以下浮肿。《金匮要略》说:腰部以下的浮肿应当利小便。给予牡蛎泽泻散,通过利小便来消散水气。
牡蛎(咸平,熬制) 泽泻(咸寒) 瓜蒌根(苦寒) 蜀漆(辛平,洗去腥味) 葶苈子(苦寒,熬制) 商陆根(熬,辛、酸、咸,平) 海藻(咸寒,洗去咸味。以上各等分)
以上七味药。分别捣碎过筛成散剂。再放入臼中研磨均匀。用米汤送服一方寸匕。如果小便通利,停服后面的药。每日服三次。
咸味具有涌泄作用。牡蛎、泽泻、海藻的咸味,用来泄除水气。《内经》说:湿气盛于内,用苦味药平抑,佐以酸辛味。用苦味药泄除湿邪。蜀漆、葶苈子、瓜蒌、商陆的酸辛与苦味,用来引导消除肿胀湿气。
大病初愈,喜欢流口水,久久不能停止的,是胃上有寒。应当用丸药温补。宜用理中丸。
发汗后阳气不足,胃中虚寒,不能化生津液,所以喜欢流口水,久久不能停止。给予理中丸,以温补胃气。
伤寒病解后,身体虚弱消瘦,气短,气逆想吐的,用竹叶石膏汤主治。
伤寒病解后,津液不足导致身体虚弱消瘦,余热未尽。热邪伤气,所以气短。气逆想吐。给予竹叶石膏汤,调理胃气,散热。
Zhi Shi (Fructus Aurantii Immaturus, three pieces, prepared by stir-frying with bran, bitter and cold) Zhi Zi (Fructus Gardeniae, fourteen pieces, broken open, bitter and cold) Chi Xiao Dou (Semen Sojae Preparatum, one sheng, wrapped in silk cloth, bitter and cold)
The above three herbs. Use seven sheng of clear fermented grain water. Boil empty first until reduced to four sheng. Add Zhi Shi and Zhi Zi. Boil until two sheng remain. Add Chi Xiao Dou. Boil for five or six more boils. Strain. Take warm, divided into two doses. After taking the medicine, cover with blankets to induce a slight perspiration.
Zhi Shi Zhi Zi Chi Tang (Bitter Orange, Gardenia, and Fermented Soybean Decoction) should theoretically be an emetic agent. Here it states that covering with blankets induces slight perspiration because the heat is concentrated in the upper jiao. Bitter substances induce vomiting; when heat scatters to the exterior, bitter substances disperse it. The *Nei Jing* (Inner Canon) says: "When fire excess prevails, use bitter substances to disperse it." This refers to this principle.
Wang Yutai said: The pathogen of Shanghan (Cold Damage) enters from the exterior, while the pathogen of Laofu (relapse due to overexertion after recovery) arises from within. Diaphoresis (sweating), emesis, and purgation therapies should be applied according to suitability.
After recovery from Shanghan, if fever recurs, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. If the pulse is floating, resolve it via diaphoresis. If the pulse is deep and solid, resolve it via purgation.
If residual heat remains after recovery and fever recurs, administer Xiao Chai Hu Tang to harmonize Shaoyang (Lesser Yang). A floating pulse indicates heat in the exterior; thus, resolve via diaphoresis.
A deep pulse indicates heat in the interior; thus, resolve via purgation.
After recovery from a major illness, if there is fluid accumulation below the waist, Mu Li Ze Xie San (Oyster Shell and Alisma Powder) is the primary treatment.
After recovery from a major illness, Spleen and Stomach Qi deficiency fails to control Kidney Water, causing water to overflow into the Lower Jiao, resulting in edema below the waist. The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: "Edema below the waist should be treated by promoting urination." Administer Mu Li Ze Xie San to promote urination and dissipate fluid retention.
Mu Li (Concha Ostreae, salty and neutral, calcined) Ze Xie (Rhizoma Alismatis, salty and cold) Gua Lou Gen (Radix Trichosanthis, bitter and cold) Shu Qi (Herba Perillae, pungent and neutral, washed to remove fishy odor) Ting Li Zi (Semen Lepidii seu Descurainiae, bitter and cold, calcined) Shang Lu Gen (Radix Phytolaccae, calcined, pungent, sour, salty, and neutral) Hai Zao (Thallus Laminariae seu Eckloniae, salty and cold, washed to remove saltiness. All ingredients in equal proportions)
The above seven herbs. Crush each separately and sieve into powder. Then place in a mortar and grind thoroughly. Mix with rice water and take one Fang Cun Bi (one cubic inch measure) per dose. Stop subsequent doses if urination becomes smooth. Take three times daily.
Salty flavors have the effect of inducing vomiting and purging. The salinity of Mu Li, Ze Xie, and Hai Zai excretes fluid retention. The *Nei Jing* states: "When dampness abounds internally, treat with bitter flavor to level it, assisted by pungent and sour flavors. Use bitter flavor to drain it." The pungent, sour, and bitter properties of Shu Qi, Ting Li Zi, Gua Lou, and Shang Lu guide the resolution of edema and dampness.
After recovery from a major illness, if there is excessive salivation that persists indefinitely, it is due to Cold in the Stomach. Pill medication should be used to warm it. Li Zhong Wan (Regulate the Middle Pill) is suitable.
After sweating, Yang Qi is insufficient, leading to Deficient Cold in the Stomach, which fails to transform fluids, causing excessive salivation and indefinite persistence. Administer Li Zhong Wan to warm the Stomach.
After resolution of Shanghan, if there is emaciation, shortness of breath, and rebellious Qi with nausea, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is the primary treatment.
After resolution of Shanghan, insufficient Jin Ye (Body Fluids) leads to emaciation, and residual heat remains. Heat injures Qi, causing shortness of breath. Rebellious Qi causes nausea. Administer Zhu Ye Shi Gao Tang to regulate Stomach Qi and dissipate heat.