寒药清之。大病后之热为虚热。宜用甘寒药清之。二者有霄壤之殊。凡人身天真之气。全在胃口。津液不
足。即是虚。生津液即是补虚。故以生津之药。合甘寒泻热之药。以治感后之虚热。如麦冬、生地、丹皮、
北沙参、西洋参、鲜石斛、梨汁、蔗浆、竹沥、鲜茅根之类。皆为合法。仲景河间主用竹叶石膏汤。
天水散。以清虚热。亦取甘寒之义也。设误投参、 、苓、术、补脾之药为补。宁不并邪热而补之乎。
此为瘥后调理脾胃之要诀也。
伤寒温热之症。多属胃肠伏邪。早已失其消化力。最宜忍饥耐饿。平卧安静。热退舌净无苔。始可渐进粥
饮汤。渐进渐浓。不致转复。爰将瘥后进食法。食物之忌宜。食物调补法。胪举于下。
(甲)瘥后进食法
庞安常曰。凡病瘥后。先进清粥汤。次进浓粥汤。次进糜粥。亦须少与之。切勿任意过食也。至于酒肉。尤当禁忌。若
有不谨。便复发热。名曰食复。王士雄云。瘥后必小便清。舌苔净。始可吃粥饭、鲫鱼、台鲞之类。
油腻酒醴甜食新鲜补滞诸物。必解过坚矢新粪。始可渐渐而进。切勿欲速。以致转病。陈氏云。
伤寒初瘥。进食最难。如胃中余热未清。进食过早。则邪热必复发。若胃热已清。舌苔亦净。不与
饮食。使几微之元气一脱。从何处续命耶。此际全以验舌苔为主。如胃中有积热者。舌必有苔。苔
必干燥。重则焦槁。甚则芒刺。在此时期。止可与白滚汤频频调之。禁绝谷气。全要使胃脘空虚。
则邪热易退。今之为父母者。不知伤寒食复之利害。但狃于平昔之爱好。止记伤寒之不吃粥饭。而
床头果品。枕边酸甜。一概不禁。不知此等滋味。一入胃肠。则稠粘胶结。反助胃火里邪。其害甚
于谷气。如果看得舌苔渐净。即宜渐进谷气。以扶正胜邪。其法、先用荷叶擦洗杓器。次用青竹
叶带水一滚。倾去竹叶。止用净水一碗。次入嫩鲜芦根指大数寸。置汤中一滚。再去芦根。次入陈
冬米研磨之粉。法以水搅和粉。澄去沉底粗者。止取上浮细者。入前汤中十数沸后。粉糊已熟。
芦根、竹叶。气清香入胃。能回清气退浊气。有湿化湿。有火清火。有痰消痰。如有燥粪。自能润
下之。此伤寒瘥后进食第一法也。其糊初进最薄。续进逐渐加浓。至后进糜粥软饭。若进米糊数日。
大便不下。药方中加当归、紫菀、麦冬。大便液足。燥粪自行矣。若误用大黄。多损气血阴液。戒之戒
之。
(乙)食物之忌宜
伤寒温热愈后。虽能食糜粥软饭。正气未复。凡饮食居处。俱不可不慎也。如酒肴、甘脆、
肥鲜、生冷等物。皆不可犯。
少食而频。则易运化。不可过饱。及他有所食。虽思之勿与也。不但油腻腥发麴 炙 。薰灼脏腑者。
固宜禁绝。即瓜果生冷。凡能冰伏脾胃者。亦宜禁不入口。最妙以萝卜汤。陈干菜汤。疏导其胃肠。
渴则饮清快露。和开水少许。或但饮细芽茶。输运其精液。病势轻减后。佐其点心。可略进流动性
之滋养品。如藕粉、燕窝粥。及开水冲鸡蛋等。每次之食量宜少。每日之次数宜多。不过以之略充
饥肠而已。病将就痊时。凡各种未熟之果实油类。及一切之固形物而不易消化者。均不宜入口。恐
损胃肠。反增病也。
(丙)食物调补法
程钟龄云。药补不如食补。凡病邪未尽。元气虽虚。而不任重补。则从容和缓以补之。相其机宜。
循序渐进。脉症相安。渐为减药。谷肉果菜。食养尽之。以底于平康。故饮食之补。但取其气。不取其味。
如五谷之气以养之。五菜之气以充之。每食之间。便觉津津汗透。将身中蕴蓄之邪热。以渐运出于毛孔。
何其快哉。人皆不知此理。急于用肥甘之味以补之。临时虽精采健旺可喜。不思油腻阻滞经络。邪热
不能外出。久久充养完固。愈无出期矣。庞安常有鉴于此。如所云凡病新瘥。只宜先进白稀粥。次进浓
粥汤。又次进糜粥。亦须少少与之。不得早吃肉食。旨哉言乎。顾松园云。百合麦冬汤。清肺止咳。
真柿霜消痰解热。人乳为补血神品。童便为降火仙丹。悉尼生食能清火。蒸熟则滋阴。苡仁汤、肺热脾虚。
服之有益。淡莲子汤、芡实粥、遗精泄泻。最属相宜。扁豆红枣汤。专补脾胃。龙眼肉汤。兼养心脾。
鳇鲟鳔、线鱼胶、(同猪蹄、燕窝、海参、或鸡、鸭、荤中煮烂、饮汁更佳。)填精益髓。凤头白鸭。
乌骨白鸡。补阴
除热。猪肺蘸白芨末。保肺止血。以上诸物。病患如已食饭多日。行动自如。方可随宜恒食。此食补
方法之大要也。
用寒凉性质的药物来清热。大病之后的发热属于虚热,适宜使用甘寒性质的药物来清解。这两者有着天壤之别。凡是人体先天的真气,都依赖于胃气的存在。津液不足,就是虚证;生津液也就是补虚。因此,采用能生津的药物配合甘寒泻热的药物,来治疗感邪后的虚热。例如麦冬、生地、丹皮、北沙参、西洋参、鲜石斛、梨汁、蔗浆、竹沥、鲜茅根等类药物,都是合法的治法。张仲景和刘河间主张使用竹叶石膏汤(Zhu Ye Shi Gao Tang, Bamboo Leaf and Gypsum Decoction)和天水散(Tian Shui San, Heavenly Water Powder),以清除虚热,这也是取法于甘寒的道理。如果错误地投用人参、[此处原文缺字,推测为黄芪或类似补气药]、茯苓、白术等补脾的药物作为补益,岂不是连同邪热一起补进去了吗?这是病后调理脾胃的关键诀窍。
伤寒和温病的病症,多属于胃肠中潜伏的邪气,早已失去了消化能力。最适宜忍受饥饿和空腹,平卧保持安静。直到热退、舌苔干净无苔时,才可以逐渐少量进食粥、饮、汤类食物。由稀到稠,逐渐增加浓度,才不会导致病情反复。现将病后进食的方法、食物的禁忌与适宜、以及食物的调补方法,列举如下:
(甲)病后进食法
庞安常说:“凡是病愈之后,先进清淡的米汤,其次进浓稠的米汤,再次进糜烂的粥食。也必须少量给予,千万不要任意过量饮食。”至于酒肉,尤其应当禁忌。如果不谨慎,就会再次发热,这叫做“食复”(Food Relapse)。王士雄说:“病后必须等到小便清长、舌苔干净,才可以吃粥饭、鲫鱼、台鲞(腌制鱼干)之类。油腻、酒醴、甜食、新鲜且滋腻碍胃的食物,必须等到大便坚硬的新粪排尽之后,才可以渐渐进食。千万不要急于求成,以致导致疾病复发。”陈氏说:“伤寒初愈,进食最为困难。如果胃中余热未清,进食过早,那么邪热必然复发。如果胃热已清,舌苔也干净了,不给饮食,使得微弱的元气一旦脱失,又从何处续命呢?这个时候完全以观察舌苔为主。如果胃中有积热,舌头上一定有苔,苔必干燥,重则焦枯,甚至出现芒刺。在这个时期,只可给白开水频频调服,禁止摄入谷气,一定要使胃脘空虚,这样邪热才容易消退。现在的父母们,不知道伤寒‘食复’的危害,只是拘泥于平时的喜好,只记得伤寒不吃粥饭,而床头的果品、枕边的酸甜食物,一概不加禁止。不知道这些滋味,一旦进入胃肠,就会变得稠粘胶结,反而助长胃火和里邪,其危害甚于谷气。如果看到舌苔渐渐干净,就应当逐渐引入谷气,以扶助正气战胜邪气。具体方法是:先用荷叶擦洗勺器,再用青竹叶带水煮沸一次,倒掉竹叶,只用净水一碗;接着放入指头粗细、数寸长的嫩鲜芦根,在汤中煮滚一次,取出芦根;然后放入陈年冬米研磨成的粉。做法是以水搅拌米粉,澄清去掉沉底的粗渣,只取上浮的细粉,倒入前面的汤中煮十几沸,待粉糊煮熟。芦根、竹叶气味清香入胃,能回纳清气、退除浊气,有湿则化湿,有火则清火,有痰则消痰。如果有燥屎,自然能润下排出。这是伤寒病后进食的第一种方法。这种米糊刚开始进服时要最薄,随后逐渐加浓,到最后进糜粥软饭。如果吃了几天米糊,大便仍不下,可在药方中加入当归、紫菀、麦冬。大便津液充足,燥屎自然排出。如果误用大黄,会严重损伤气血阴液,务必戒慎!”
(乙)食物的禁忌与适宜
伤寒温热病痊愈后,虽然能吃糜粥软饭,但正气尚未恢复。凡饮食起居,都不可不谨慎。如酒肴、甘甜脆硬、肥美鲜嫩、生冷等食物,都不可触犯。
少食而多次进食,则容易运化吸收。不可过饱,即使有其他想吃的食物,虽然心里想吃也不要给。不但那些油腻腥膻、发物、曲炙、熏灼脏腑的食物,固然应该禁绝;即使是瓜果生冷,凡是能使脾胃受寒凝滞的,也应该禁止入口。最好的是用萝卜汤、陈干菜汤,来疏导胃肠。口渴时饮用清凉的露水,兑少许开水;或者只喝细芽茶,以输布精液。病势减轻后,佐以点心,可以略微进食流动性的滋养品,如藕粉、燕窝粥,以及开水冲鸡蛋等。每次的食量宜少,每日的次数宜多,不过是为了稍微充饥而已。病即将痊愈时,各种未成熟的果实、油类,以及一切固体且不易消化的食物,均不宜入口,恐怕损伤胃肠,反而增加病痛。
(丙)食物的调补法
程钟龄说:“药补不如食补。”凡是病邪未尽,元气虽虚,但不能承受峻补,则应从容和缓地进行补益,观察时机,循序渐进。脉象和症状相安定时,逐渐减少药物用量。“五谷、五肉、五果、五菜”,通过饮食调养使其完全康复,从而达到平安健康。所以饮食的补益,只取其气,不取其味。用五谷之气来滋养它,用五菜之气来充实它。每餐之间,便觉得微微汗出,将体内蕴蓄的邪热,逐渐运出毛孔,这是多么畅快啊!人们都不知道这个道理,急于用肥甘厚味来补益,临时虽然精神健旺可喜,但不思油腻阻滞经络,邪热不能外出,久而久之充养完固,邪热更没有出路了。庞安常鉴于此,曾说:“凡是病新愈,只宜先进白稀粥,次进浓粥汤,又次进糜粥,也必须少量给予,不得早吃肉食。”这话真是深刻啊!顾松园说:百合麦冬汤,清肺止咳;真柿霜,消痰解热;人乳,是补血的神品;童便,是降火的仙丹;悉尼生吃能清火,蒸熟则滋阴;苡仁汤,适用于肺热脾虚,服用有益;淡莲子汤、芡实粥,适用于遗精泄泻,最属相宜;扁豆红枣汤,专补脾胃;龙眼肉汤,兼养心脾;鳇鲟鳔、线鱼胶(同猪蹄、燕窝、海参,或鸡、鸭荤中煮烂,饮汁更佳),填精益髓;凤头白鸭、乌骨白鸡,补阴除热;猪肺蘸白芨末,保肺止血。以上诸物,病患如果已经吃饭多日,行动自如,才可以随意长期食用。这是食补方法的大要。
Clear heat with cold-natured medicines. The fever after a major illness is deficient heat (Xu Re), which should be cleared using sweet-cold (Gan Han) medicines. There is a world of difference between the two. The innate vital energy (Zhen Qi) of the human body relies entirely on the Stomach Qi. Insufficiency of body fluids constitutes deficiency; generating body fluids is equivalent to tonifying deficiency. Therefore, combining herbs that generate fluids with sweet-cold heat-clearing herbs is used to treat deficient heat following an infection. Examples include Ophiopogonis Radix (Maidong, 麦冬), Rehmanniae Radix (Shengdi, 生地), Moutan Cortex (Danpi, 丹皮), Glehniae Radix (Beishashen, 北沙参), Panax quinquefolius Radix (Xiyangshen, 西洋参), Dendrobii Caulis (Shihu, 石斛), Pyri Fructus Juice (Lizhi, 梨汁), Saccharum Sinense Juice (Zheshuang, 蔗浆), Phyllostachys Nigra Bamboo Sap (Zhuli, 竹沥), and Imperatae Rhizoma (Maogen, 茅根). These are all appropriate methods. Zhang Zhongjing and Liu Wansu advocated the use of *Zhu Ye Shi Gao Tang* (Bamboo Leaf and Gypsum Decoction) and *Tian Shui San* (Heavenly Water Powder) to clear deficient heat, also deriving from the principle of sweet-cold. If one mistakenly administers tonifying spleen herbs such as Ginseng Radix [text missing], Poria (Fuling, 茯苓), and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) as tonification, would it not be tonifying both the pathogenic heat? This is the key secret for regulating the Spleen and Stomach after recovery.
Typhoid and warm disease syndromes often involve latent pathogens in the Intestines and Stomach, which have long lost their digestive capacity. It is most suitable to endure hunger and fasting, lie flat, and remain quiet. Only when the fever subsides and the tongue coating becomes clean and absent can one gradually advance to rice gruel, drinks, and soups. Gradually increase the thickness and concentration to avoid relapse. The following details the method of eating after recovery, dietary taboos and preferences, and food-based conditioning methods.
(A) Method of Eating After Recovery
Pang Anchang stated: "After any illness recovers, first consume light rice soup, then thick rice soup, then soft porridge. It must be given in small amounts. Do not overeat arbitrarily. Alcohol and meat are especially taboo. If one is not careful, fever will recur, known as 'food relapse' (Shi Fu). Wang Shixiong said: "After recovery, one must wait until urination is clear and the tongue coating is clean before consuming rice, carp, or dried fish. Greasy foods, alcohol, sweets, and fresh cloying items that obstruct the stomach must only be introduced after hard feces have been passed. Do not rush, lest you cause the disease to return." Chen氏 said: "It is hardest to eat after the initial recovery of typhoid. If residual heat in the Stomach is not cleared and food is eaten too early, the pathogenic heat will inevitably recur. If the Stomach heat is cleared and the tongue coating is clean, but no food is provided, causing the slightest amount of Yuan Qi to escape, where will life continue from? At this time, diagnosis relies entirely on observing the tongue coating. If there is accumulated heat in the Stomach, the tongue will definitely have a coating, which will be dry. In severe cases, it will be scorched and withered, or even have prickles. During this period, only clear boiled water should be given frequently to moisten. Grain intake must be strictly prohibited to keep the Epigastrium empty, so that pathogenic heat can retreat easily. Parents today do not understand the dangers of 'food relapse' in typhoid. They indulge in past preferences, remembering only that typhoid patients shouldn't eat rice, while allowing fruits at the bedside and sweet/sour snacks by the pillow without restriction. They do not know that these flavors, once entering the intestines and stomach, become sticky and adhesive,反而助长 (bolstering) Stomach fire and interior pathogens, doing more harm than grain itself. Once the tongue coating gradually clears, grain should be gradually introduced to support righteous Qi to overcome pathogenic factors. The method is as follows: First, wash spoons and vessels with Lotus Leaves. Second, boil Green Bamboo Leaves (Qingzhuye) in water once, discard the leaves, and use only one bowl of clean water. Third, add several inches of tender fresh Reed Rhizome (Lugen) to the boiling water, remove the rhizome. Fourth, add powder made from aged winter rice. Mix the powder with water, let it settle, discard the coarse sediment at the bottom, and take only the fine floating portion. Add this to the previous water and boil for ten-plus boils until the paste is cooked. The aromatic scent of Reed Rhizome and Bamboo Leaves enters the Stomach, restoring clear Qi and dispelling turbid Qi. It resolves dampness if present, clears fire if present, and eliminates phlegm if present. If there is dry stool, it will naturally lubricate and expel it. This is the primary method for eating after typhoid recovery. The paste should be very thin initially, gradually thickened, and eventually advanced to soft porridge and rice. If after several days of rice paste the bowel movement does not occur, add Angelicae Sinensis Radix (Danggui, 当归), Aster Tataricus Radix (Ziwan, 紫菀), and Ophiopogonis Radix (Maidong, 麦冬) to the prescription. When intestinal fluids are sufficient, dry stool will pass naturally. If Da Huang (Rhubarb) is mistakenly used, it will severely damage Qi, Blood, and Yin fluids. Beware!"
(B) Dietary Taboos and Preferences
After recovery from typhoid or warm diseases, although one can eat soft porridge and rice, Righteous Qi has not yet recovered. Diet and lifestyle must be handled with caution. Alcoholic beverages, sweet and crisp foods, fatty and fresh delicacies, and raw/cold items must all be avoided.
Eat small amounts frequently to facilitate digestion. Do not overeat. Even if other foods are desired, do not provide them. Not only greasy, fishy, stimulating, fermented, roasted, or organ-heating foods should be strictly prohibited, but also fruits and raw/cold items that chill and stagnate the Spleen and Stomach should be kept out of the mouth. It is best to use Radish Soup or Aged Vegetable Soup to dredge the intestines and stomach. When thirsty, drink cool dew diluted with a little boiled water, or simply drink fine bud tea to transport essence and fluids. As the condition lightens, light snacks may be taken, such as lotus root starch, swallow's nest porridge, or eggs beaten into hot water. Each meal should be small in quantity, but frequent in daily occurrence, merely to slightly satisfy hunger. When the illness is nearing cure, unripe fruits, oils, and all solid, indigestible foods should not be ingested, as they may damage the intestines and stomach and worsen the illness.
(C) Food Conditioning and Tonification Methods
Cheng Zhongling said: "Medicinal tonification is inferior to dietary tonification." When pathogens are not fully eliminated and Yuan Qi is deficient but cannot withstand strong tonification, one should tonify gently and slowly, observing the timing and proceeding step-by-step. When pulse and symptoms are stable, gradually reduce medication. "Grains, meats, fruits, and vegetables" should be used to complete the nourishment and restore health. Thus, dietary tonification relies on the Qi of the food, not its flavor. Use the Qi of five grains to nourish, and the Qi of five vegetables to fill. After each meal, one feels a slight sweat, allowing the accumulated pathogenic heat in the body to gradually exit through the pores. How refreshing! People do not understand this principle; they rush to use rich and sweet flavors for tonification. Although spirit and vigor may temporarily improve, the grease blocks the meridians, preventing pathogenic heat from exiting. Over time, as the body becomes fortified, the heat has no way out. Pang Anchang, aware of this, stated: "For new recoveries, only white thin rice gruel should be consumed first, then thick rice soup, then soft porridge, given in small amounts. Meat should not be eaten early." Profound words indeed! Gu Songyuan said: *Baihe Maidong Tang* (Lily and Ophiopogon Decoction) clears the Lungs and stops cough; Persimmon Frost (Shishuang) resolves phlegm and clears heat; Human Milk (Renru) is a divine product for tonifying Blood; Child Urine (Tongbian) is an immortal pill for descending fire; Sydney nuts (likely referring to a specific nut or seed, context implies cooling) clear fire when raw and nourish Yin when steamed; Coix Seed Soup is beneficial for Lung Heat and Spleen Deficiency; Light Lotus Seed Soup and Euryale Seed Porridge are most suitable for seminal emission and diarrhea; Lablab Bean and Red Date Soup specializes in tonifying Spleen and Stomach; Longan Flesh Soup nourishes both Heart and Spleen; Sturgeon Bladder and Thread Fish Glue (boiled with pig trotters, swallow's nest, sea cucumber, chicken, or duck, drinking the broth is better) fill essence and marrow; White-headed Ducks and Black-boned Chickens nourish Yin and clear heat; Pig Lungs dipped in Bletilla Striata powder protect the Lungs and stop bleeding. For all the above items, patients should only consume them regularly after eating rice for several days and moving freely. This is the gist of food tonification methods.