Recurrence during a recovery period, diagnosis and treatment

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医宗金鉴卷十

<<Yi Zong Jin Jian>> Chapter 10

辨差後劳复食复阴阳易病脉证并治篇

Recurrence during a recovery period, diagnosis and treatment

伤寒新愈,起居作劳,因而复病,谓之劳复。强食谷食,因而复病,谓之食复。男女交接,复而自病,谓之房劳复。男女交接,相易为病,谓之阴阳易,谓男传不病之女,女传不病之男,有如交易也。盖因其人新差,馀邪伏於藏府,未经悉解,故犯之辄复也。学者於临证时,审其脉证而详辨之,则施治自无误矣。

After a person gets recovered from a Shanghan disease (or from any other diseases), if his condition become returned due to heavy work, physically or emotionally, it is called Laofu. If it is due to overeating, it is called Shifu. If it is due to improper sex activity during the recovering period, it is called Fanglaofu. If the sex activity causes the opposite sex partner be sick, it is called Yin-Yang Yi. For example, if the male is sick, then the sex activity transfers and makes the female sick and if the female is the first one to be sick, the sex activity makes the male partner sick too. Just as a exchange phenomenon. This is because the person just starts to get recovery and there is still residue of Xieqi in the body. Heavy labor, overeating, and sex activity can all cause the depletion of body Yangqi and the depletion of the defense system, so to make the remained Xieqi attacks the body again. Readers should be careful in their clinic work to make the diagnosis of such conditions and to get proper treatments to solve the remaining diseases.

 

01 大病差後,劳复者,枳实栀子豉汤主之。若有宿食者,加大黄,如博 子五六枚。(温覆,令微似汗自愈,不取其涌者,以热不在胸而在经也.)

It the person gets sick due to Laofu,[1] us Zhishi Zhizi Chi Tang. If he has old food remaining in his Stomach[2], add Dahuang (about 5 to 6 badges, about 1 cm in diameter each) in the formula. After drinking of the herbal tea, lie down and cover the body to get mild sweat.

枳实栀子鼓汤方

Zhishi Zhizi Chi Tang

枳实(炙)三枚, 栀子(擘)十四枚,淡豆豉(绵裹)一升

Zhishi (prcessed) three badges, Zhizi 14 badges, Dandouchi 124 gram.

右三味,以清浆水七升,空煮取四升,纳枳实、栀子,煮取二升,下豉更煮五、六沸,去滓,温分再服,覆令微似汗。

Add the qingjiang water 1750 ml into a herbal pot. Bring to boil then keep in mild boiling until there is 1000 ml left. Add the Zhishi and Zhizi in, continue to boiling until there is 500 ml liquid in the pot. Add the Dandouchi in, continue to boil for 5 to 10 minutes. Collect the herbal tea. Separate it into several parts. Drink one part each time, repeat every 2 to 3 hours until the body has mild sweat. [3]

02 伤寒差已,後更发热,小柴胡汤主之。脉浮者,以汗解之 (注:枳实栀子鼓汤),脉沉实者,以下解之(注:枳实栀子鼓汤加大黄)。

After recovery from Shanghan disease, the person has fever again, use Xiao Chaihu Tang. If the pulse is floating, use sweat therapy (Zhishi Zhizi Chi Tang). If it is deep and strong, use bowel-cleansing therapy (Zhishi Zhizi Chi Tang jia Dahuang.  

03 大病差後,从腰以下有水气者,牡蛎泽泻散主之。

After recovery from Shanghan disease, the person has Shiqi[4] under the lower stomach level, use Muli Zexie San. [5]

牡蛎泽泻散方

Muli Zixie San

牡蛎(熬),泽泻,栝蒌根, 蜀漆(暖水洗去腥),   商陆根(熬), 海藻(洗去咸), 苦葶苈(熬)各等分

Muli (cooked), Zexie, Gualugen, Shuqi (wash with warm water to remove odor), Shanglugen (cooked), Haizao (washed), Ku Qinlizi (processed), the same amount for each.

右七分,异捣下筛为散,更入臼中治之,白饮和服方寸匕,日三服,小便利,止後服。

Grind separately the herbal ingredients into powder. Mix them well. Drink the powder 1 gram with water. Three times a day until the urine is smoothly.

04 大病差後,喜唾,久不了了,胸上有寒,当以丸药温之,宜理中丸。

After recovery from Shanghan disease, the person has frequent spit. This is because he has Cold in the chest. Use Lizhong Wan.  

05 伤寒解後,虚羸少气,气逆欲吐,竹叶石膏汤主之。

After recovery from Shanghan disease, the person feels short of breath, weakness, nausea, willing to vomit, use Zhuye Shigao Tang. 

竹叶石膏汤方

Zhuye Shigao Tang

竹叶 二把,  石膏 一斤, 半夏(洗)半升, 人参二两, 甘草(炙)二两, 粳米半升, 麦冬(去心)一升

Zhuye 24 gram, Shigao 150 gram, Banxia (washed) 65 gram, Renshen 30 gram, Gancao (processed) 30 gram, Genmi 124 gram, Maidong (remove kernel) 250 gram.

右七味,以水一斗,煮取六升,去滓,内粳米,煮米熟汤成。去米,温服一升,日三服。

Add the ingredients (except Genmi) and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 1500 ml liquid left. Remove the resides, add the Genmi into the collected herbal tea and continue to cook until the rise is eatable. Remove the rice, drink the herbal tea 250 ml each time, three times a day.

06 病人脉已解,而日暮微烦,以病新差,人强与谷,脾胃气尚弱,不能消谷,故令微烦,损谷则愈。

After recovery from Shanghan disease, the pulse is normal, but the person feels slight annoyed around the sunset time[6]. This is because the person’s stomach is weak after a severe disease, hard to digest food, but he ate large amount of food that damaged the stomach ability (the Weiqi) again, so that he feels annoyed. In this case, simply reduce the amount of eating.[7]

07 伤寒阴阳易之为病,其人身体重,少气,少腹里急,或引阴中拘挛,热上冲胸,头重不欲举,眼中生花,膝胫拘急者,烧裩散主之。(男以六味地黄汤主之,女以四物汤主之,随证加减治之可也)

After recovery from Shanghan disease, the person has sex activity, which causes Yinyangyi condition[8]. The person feels heaviness in the body, short of breath, spasm in the lower stomach. H e may also feel pulling and spasm in the vagina or pennies, hot pushing feeling up to the chest, heavy in the head to lift, dizziness in eyes, spasm in the knee or calf. In this case, use Shaokun San.

 

【集注】王肯堂曰:房劳复病,谓新差之後,或尚未愈,而男妇相交接复病者,若同阴阳易证,则从阴阳易治。亦有寒热多汗,头重目眩,腹中拘急,百节解离,经脉缓弱,筋骨痿软,不能动移,精髓空虚,心神恍惚,迁延岁月方死者,宜当归四逆汤。厥者加附子,寒者加吴茱萸、生姜,以治之。

Dr. Wang Kentang: Fanglao condition means the person has sex activity during the recovery period. If the condition is as the Yinyangyi, treat it with as Yinyangyi. However, some people may feel chilly and hot and heavy sweat, heavy head and dizziness in eyes, spasm in stomach, lost joints, weakness in the arms and legs so hard to move, he may also feel empty-hollow feeling in heart/mind/emotion, hardly to focus on daily life/work. For such condition, use Dangui Sini Tang. If with reverse cold hands or feet, include herb Fuzi; if with Cold, add Wuzhuyu and Shenjiang in it.

按:差後男女交合而病者,若无阴阳易证,而有表证,则不可从阴阳易治,当从房事後犯风寒治,汗、吐、下法,皆不可轻用。即有应汗、应吐之证,汗则以补中益气汤加麻、桂微汗之,厥者加炮附子。吐则以补中益气汤加淡豆豉探吐之。适可即止,总当识此为新病之後也。

If the disease is caused due to sex during a recovery period, and if there is no Yinyangyi condition but there is Taiyang condition, it should not be treated as Yinyangyi. It should be regarded as Taiyang stage during the recovery period. It should be very careful to use sweat therapy, vomiting therapy, or bowel-cleansing therapy. If a sweat therapy is indicated however, use Buzhong Yiqi Tang jia Mahuang, Guizhi to create slight sweat; if there is reverse Jue condition, add herb Fuzi in it. If the vomiting therapy is indicated, use Buzhong Yiqi Tang jia Dandouchi to create little vomiting. Don’t create a heavy vomiting.

烧裩散

妇人中裩近隐出处,取烧作灰。

右一味,水服方寸匕,日三服,小便即利,阴头微肿,此为愈矣。妇人病,取男子裩烧服。



[1] For a Shanghan disease, the Xieqi comes and invades from outside of the body. In the Laofu, the Xieqi develops and expands from inside of the body. Lao means over-labor work; fu means return. So Laofu means the sick is due to the over-labor work that makes the disease comes back again, though the clinic manifestations may not be the same as original disease.

[2] When the letter “s” is as a big letter, it means a special meaning in Chinese: Stomach so means whole digestion system, from stomach, to small and large intestine, to colon.

[3] For the herbal formula here is not the same as the Zhizi Chi Tang introduced in Taiyang stage for the cooking procedures. The formula used in Taiyang stage is for vomiting therapy, while used here for Laofu condition, for a sweat therapy.

[4] Shiqi, such as swelling, heavy feeling.

[5] This is a urine therapy to deplete swelling. After a severe disease, the person has weakness in the stomach and spleen system, e.g. the weak Soil. The weak Soil cannot control the Water, e.g. the Kidney system so cause the swelling.  Usually, if the Shiqi causes swelling over the lower back, us Xiao Qinglong Tang, or Yuebi Tang to deplete the Shiqi through sweat. If the Shiqi accumulated in the lower part of the body, use formulars as here to deplete extra water through urine. It should not be used if the swelling is due to Kidney deficiency.

[6] Sunset time is a time the stomach has less ability to digest food.

[7] If the pulse is deep, it may suggest the presence of the old-food in the stomach and Zhishi Zhizi Chi Tang jia Dahuang is needed.

[8] It is also called Fanglaofu condition. The condition is due to the improper sex activity during the recovery stage of a disease. Yinyangqi means the disease in the male transfers to healthy female to make her become sick; or the disease in the female transfers to a healthy male to make him sick.