论伤寒 论虫痛 论霍乱
天师曰∶饥治者，不可饱食，俟其饥而用药治之也。如伤寒邪火初退之时，虫痛枵腹，胃空之候是
也。伤寒火退邪散，则胃气初转，最忌急与之食。一得食，则胃气转闭，不可复开。此时即以药下之，则
胃气大伤，而火邪复聚，反成不可解之症。不若禁之不与之食，则中州之地自然转输，渐渐关开搬运，不至
有阻隔之虞。方用陈皮一钱，甘草五分，白芍三钱，神曲五分，枳壳五分，浓朴五分，栀子一钱，茯苓一
钱，麦芽二钱，水煎服。（〔批〕退邪消食饮。）此方药味平平，似无甚奇妙。然而此症本不可以大剂出
奇，得此平调，转能化有事为无事。然必待其饥饿之时，始可与服。若正饱之时服之，徒滋满闷而已矣。
虫痛之症，得食则痛减，无食则痛增。以酸梅汤一盏试之，饮下而痛即止者，乃虫痛，饮下而痛增重或
少减者，非虫痛也。方用楝树根一两，黄连三钱，乌梅肉三钱，吴茱萸三钱，炒栀子三钱，白薇一两，白术
二两，茯苓三钱，甘草
三钱，鳖甲三钱，各为末，蜜为丸，每服三钱，丸如小米大。（〔批〕杀虫丹。）此丸必须乘其饥饿思
食之时与之。此丸服下，必痛甚，不可与之水。盖虫得水即生也。此方之妙，妙在健脾之中而用杀虫之品。
既是杀虫之药，何故必待其饥饿而始杀之？盖腹中无食则虫无所养，虫口必上向而索食，待其饥饿枵腹
之时，则虫头尽向上而不向下矣。一与之食，彼必以为食也，尽来争食之，奈入口拂其性，则又乱动而
跳跃，故转痛甚也。禁与之水，则周身上下、耳目口鼻，无非沾染药气，内外夹攻，有死而已，设不知禁
忌，仍与之水，则虫且借势而翻腾沐浴，药少水多，自然解体，止可杀虫一半，而不能剪草除根矣。故必
坚忍须臾一刻之痛，使终身之痛除，愿人忍之哉。此饥治之宜知也。大黄亦可加三钱，不加亦可，腹之上
疼不宜加，腹之下痛宜加也。
张公曰∶饥治之法，尽此二条，无可增也，惟消虫之法。予尚有一方，可传于世，省事而效捷，凡人
腹中不论生何虫，只消食榧子，每日十个，不消三日，尽化为水矣。或用生甘草一两，榧子二两，米饭为
丸，白滚水饥时送下五钱。五日虫皆便出。皆不费钱，而又去病之捷，急宜加载者也。
华君曰∶同。然余尚有一法。霍乱之症，一时而来，少顷即定，切不可与之食。当令其忍饥一日，
而后以陈皮一钱。甘草五分，白术二钱，茯苓三钱、山楂五粒，香薷一钱，藿香五分，木瓜一钱，白芍三
钱治之，则痛不再发。盖霍乱乃暑之热气也，暑热得食，复聚而不可解，所以必使之饿，则暑邪尽散也。
名为定乱汤。
（虫系湿热所生，故祛热是标，燥湿是本，燥湿是标健脾是本。李子永识。）
天师说：所谓“饥治法”，就是不能给患者吃饱，要等到他们感到饥饿时再用药治疗。比如伤寒病邪火刚刚消退的时候，或者虫痛在空腹（胃空）的情况下，就是这种情况。伤寒火热退去、邪气消散后，胃气刚开始恢复，最忌讳立刻给予食物。一旦进食，胃气的运转就会闭塞，无法再打开。此时如果直接用药物攻下，会严重损伤胃气，导致火邪再次聚集，反而变成难以解决的病症。不如禁止进食不给食物，那么中焦脾胃自然能够恢复运化功能，逐渐疏通转运，就不会有阻滞的担忧了。方剂用陈皮一钱，甘草五分，白芍三钱，神曲五分，枳壳五分，厚朴五分，栀子一钱，茯苓一钱，麦芽二钱，水煎服。（批注：退邪消食饮。）这个方子的药味很平常，似乎没有什么奇妙之处。然而这种病症本来就不适合用大剂量出奇制胜的药物，得到这种平和调理的药方，反而能将复杂的病情转化为无事的状态。但是必须等到患者感到饥饿的时候，才可以服用。如果在正饱腹的时候服用，只会增加胀闷感罢了。
虫痛的病症特点，是吃东西后疼痛减轻，没有食物时疼痛加重。可以用一盏酸梅汤来测试，喝下去后疼痛立即停止的，就是虫痛；喝下去后疼痛加重或稍微减轻的，就不是虫痛。方剂用楝树根一两，黄连三钱，乌梅肉三钱，吴茱萸三钱，炒栀子三钱，白薇一两，白术二两，茯苓三钱，甘草三钱，鳖甲三钱，各研为末，用蜂蜜制成丸药，每次服用三钱，丸药大小如小米粒。（批注：杀虫丹。）这个丸药必须在患者饥饿想吃饭的时候给予服用。这个丸药服下后，疼痛一定会加剧，不能给水喝。因为虫子遇到水就会活跃生长。这个方子的妙处，在于健脾的同时使用杀虫的药物。既然是杀虫的药，为什么一定要等到饥饿时才杀呢？因为肚子里没有食物，虫子就没有营养来源，虫口必然向上寻找食物，等到它们饥饿空腹的时候，虫头都朝上而不朝下了。一旦给它们食物，它们一定以为是食物，都会过来争抢吃，但因为入口违背了它们的本性，所以又会乱动跳跃，因此疼痛加剧。禁止给水喝，那么全身上下、耳目口鼻，无处不沾染药气，内外夹攻，虫子只有死路一条。如果不知道禁忌，仍然给水喝，那么虫子就会借势翻腾沐浴，药少水多，药效自然分解，只能杀死一半的虫子，而不能斩草除根。所以必须忍受片刻一时的痛苦，以除去终身的病痛，希望人们能忍耐啊。这就是饥治法的适宜之处。大黄也可以加三钱，不加也可以，腹部上方疼痛不宜加，腹部下方疼痛宜加。
张公说：饥治的方法，就这这两条，没有可以增加的了，只有杀虫的方法。我还有一个方子，可以流传于世，省事且见效快，凡是肚子里不论生出什么虫子，只吃消食的榧子，每天十个，不超过三天，全部化为水了。或者用生甘草一两，榧子二两，米饭做丸，用白开水在饥饿时送服五钱。五天虫子都会从大便排出。都不花钱，又是去除疾病快捷的方法，应该紧急记载下来。
华君说：同意。然而我还有一种方法。霍乱的病症，突然发作，一会儿就平息，千万不要给它吃东西。应当让它忍受饥饿一天，然后用陈皮一钱，甘草五分，白术二钱，茯苓三钱，山楂五粒，香薷一钱，藿香五分，木瓜一钱，白芍三钱来治疗，那么疼痛就不再复发。因为霍乱是暑天的热气所致，暑热遇到食物，会再次聚集而无法解开，所以必须让它饥饿，使暑邪完全散尽。名为定乱汤。
On Cold Damage, On Worm Pain, and on Cholera
The Heavenly Master said: The method of "treating while hungry" means not feeding the patient to fullness, but waiting until they feel hungry before administering medication. This applies, for instance, when the pathogenic fire of cold damage (Shanghan, a disease caused by external cold pathogens) has just subsided, or in cases of worm pain when the stomach is empty. After the heat of cold damage dissipates and the pathogen scatters, the Stomach Qi begins to recover; it is most taboo to give food immediately. Once food is ingested, the movement of Stomach Qi becomes blocked and cannot be reopened. If purgative drugs are used at this time, it will severely injure Stomach Qi, causing the pathogenic fire to gather again, resulting in an incurable condition. It is better to prohibit eating so that the Middle Jiao (the spleen and stomach region responsible for transformation and transportation) can naturally resume its functions, gradually opening the pathways and facilitating transport, thus avoiding obstruction. The prescription consists of Chenpi (Tangerine Peel), 1 qian; Gancao (Licorice Root), 5 fen; Baishao (White Peony Root), 3 qian; Shenqu (Medicated Leaven), 5 fen; Zhiqiao (Aurantium Fructus), 5 fen; Houpo (Magnolia Bark), 5 fen; Zhizi (Gardenia Fruit), 1 qian; Fuling (Poria), 1 qian; and Maiya (Sprouted Barley), 2 qian. Decoct in water and take orally. (Commentary: Drink to eliminate pathogen and digest food.) The ingredients of this prescription are ordinary and seem unremarkable. However, this condition should not be treated with large doses of extraordinary drugs; such mild regulation can transform a complex situation into a harmless one. Yet, it must only be administered when the patient feels hungry. If taken during satiety, it will merely increase bloating and oppression.
Worm pain is characterized by pain relief after eating and exacerbation when fasting. One may test with a cup of Suanmei Tang (Sour Plum Soup): if the pain stops immediately upon ingestion, it is worm pain; if the pain worsens or slightly alleviates, it is not worm pain. The prescription uses Liangun (Root of Chinaberry Tree), 1 liang; Huanglian (Coptis Rhizome), 3 qian; Wumei Rou (Flesh of Mume Fruit), 3 qian; Wuzhuyu (Evodia Fruit), 3 qian; Chao Zhizi (Stir-fried Gardenia Fruit), 3 qian; Baiwei (Cynanchum Atratum Root), 1 liang; Baizhu (Atractylodes Macrocephala Rhizome), 2 liang; Fuling (Poria), 3 qian; Gancao (Licorice Root), 3 qian; and Biejia (Tartar Testudinis Carapax et Plastrum), 3 qian. Each is ground into powder, mixed with honey to form pills, each pill sized like a millet seed. Take 3 qian per dose. (Commentary: Pill to kill worms.) These pills must be given when the patient is hungry and craving food. After taking these pills, the pain will intensify significantly; do not provide water. This is because worms become active and thrive in water. The brilliance of this formula lies in killing worms while strengthening the Spleen. Since it contains vermifuges, why wait until hunger to kill them? When there is no food in the abdomen, worms lack nourishment, and their mouths turn upward seeking food. During hunger and emptiness, the heads of the worms face upward rather than downward. Upon being fed, they mistake it for food and swarm to eat. However, entering the mouth contradicts their nature, causing them to move chaotically and jump, thus intensifying the pain. Prohibiting water ensures that the medicinal qi permeates the entire body—ears, eyes, mouth, and nose—attacking from both inside and out, leading to the death of the worms. If one ignores this prohibition and provides water, the worms will use the water to thrash about, diluting the medicine. With little medicine and much water, the efficacy dissipates, killing only half the worms without eradicating the root cause. Therefore, one must endure the momentary pain to eliminate lifelong suffering. I urge people to bear this. This is the appropriate application of treating while hungry. Dahuang (Rhubarb Root and Rhizome) may also be added, 3 qian; it is optional. Do not add it if the pain is in the upper abdomen; add it if the pain is in the lower abdomen.
Master Zhang said: The methods of treating while hunger are limited to these two points, with nothing to add. Regarding the method of eliminating worms, I have another prescription to pass down to the world, which is convenient and effective. Regardless of what kind of worms are in the abdomen, simply consume Feizi (Torreya Seed), ten per day. Within three days, they will all dissolve into water. Alternatively, use Sheng Gancao (Raw Licorice Root), 1 liang, and Feizi (Torreya Seed), 2 liang, made into pills with rice flour. Take 5 qian with plain boiled water when hungry. The worms will be expelled via stool within five days. These remedies cost nothing and offer rapid relief, warranting urgent documentation.
Master Hua said: Agreed. However, I have another method. Cholera (Huoluan, a syndrome characterized by sudden vomiting and diarrhea) strikes suddenly and subsides shortly after. One must absolutely avoid giving food. Let the patient fast for one day, then treat with Chenpi (Tangerine Peel), 1 qian; Gancao (Licorice Root), 5 fen; Baizhu (Atractylodes Macrocephala Rhizome), 2 qian; Fuling (Poria), 3 qian; Shanzha (Hawthorn Fruit), 5 pieces; Xiangru (Elsholtzia Herb), 1 qian; Huoxiang (Patchouli Herb), 5 fen; Mugua (Chaenomelis Fructus), 1 qian; and Baishao (White Peony Root), 3 qian. This will prevent the recurrence of pain. Cholera is caused by the hot qi of summer heat. Summer heat combined with food gathers again and becomes intractable. Therefore, fasting is necessary to disperse the summer-heat pathogen completely. This is named Dingluan Tang (Stabilizing Chaos Decoction).
(Note: Parasites are generated by damp-heat. Thus, clearing heat is treating the branch, while drying dampness is the root; drying dampness treats the branch, while strengthening the Spleen is the root. Recorded by Li Zi Yong.)