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[General Principle] Zhang Zhongjing stated: In Yangming disease, if there is dryness in the mouth and a desire only to rinse water in the mouth without swallowing it, this indicates that epistaxis (nosebleed) will certainly occur.

[Commentary] Zhu Gong said: This condition must be accompanied by symptoms of headache and fever. If the patient has no exterior syndrome, no aversion to cold or heat, distension and fullness in the chest and abdomen, dry lips, and a desire only to rinse water in the mouth without swallowing it, this indicates the presence of blood stasis within, and mania will certainly develop. For mild cases, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used; for severe cases, Didang Tang (Definite Attack Decoction) should be used.

Wang Kentang said: This symptom belongs to the Yangming channel. Generally, those with internal heat desire to drink water. Now, since the patient desires water but does not wish to swallow it, it indicates that heat is in the channels while there is no heat in the interior organs. The Qi and Blood of the Yangming channel are abundant. When heat is severe in the channels, it forces blood to move recklessly, thus indicating that epistaxis will certainly occur.

Zhang Jiebin said: In all cases of Yangming disease, where there is dryness in the mouth and a desire only to rinse water in the mouth without swallowing it, it is because heat is in the channels while there is no heat in the interior. Epistaxis will inevitably occur, and cooling medicines should not be administered. The indication for drinking water is originally suitable for cases where internal heat is severe and Yang toxicity is profound. It seems suitable only for excess pathogens and not for deficiency pathogens. However, one must not ignore that deficiency syndromes vary. For instance, in cases of Yang deficiency without fire, the unsuitability of water is self-evident. In cases of Yin deficiency with hyperactive fire, where Yuan Qi is weak and Essence and Blood are depleted, symptoms such as cracked tongue, scorched lips, extreme thirst preferring cold drinks, burning sensation in the Sanjiao (Triple Burner), and constipation of both stool and urine are common. Without relying on water, how can urgency be relieved? Therefore, ice water should first be used to resolve the branch symptoms, followed by sweet-warm medicines to cultivate the root. Taking both water and medicine together is acceptable. In cases of true cold inside with false heat outside, or Yin exuberance repelling Yang, observing the Yuan Qi reveals that only sweet-warm medicines can restore vitality. Observing the throat and tongue reveals that even slight acrid-hot medicines cannot enter the mouth. In such cases, only sweet-warm tonic formulas, or Dushen Tang (Single Ginseng Decoction) soaked in extremely cold beverages, should be used. This uses the taste of false cold to resolve the false heat of the Upper Jiao, while the true warm nature restores the true Yang of the Lower Jiao. This is not rejecting water, but actually utilizing the concept of water. I have saved many people using this method; it is wonderful. However, in cases of false heat, although the symptoms indicate heat, the pulse is faint; although the mouth is thirsty, the bowels are not obstructed. In such cases, if the patient desires water, it must absolutely not be given. If this mistake is made, the destruction of Yuan Yang will cause significant harm.

Yu Chang said: Dryness in the mouth differs from thirst. "Rinsing water without swallowing" indicates absence of thirst. Since the Yangming channel has abundant Qi and Blood, the fact that water is rinsed but not swallowed indicates that the pathogen has entered the Blood level. The Yangming meridian originates at the nose; therefore, knowing that blood moves recklessly due to heat, it must exit through the nose.

Wei Litong said: If it is Yangming disease with exterior heat and spontaneous sweating, the Stomach becomes dry, and the mouth, as the opening of the Stomach, must also be dry. However, desiring only to rinse without swallowing indicates that blood in the Stomach rises with the heat, hence stating that epistaxis will certainly occur. Although this is a variation of excessive heat in Yangming, once blood overflows causing epistaxis, it is not a loss of body fluids, but rather the exhaustion of Stomach Yin. Even after epistaxis, it is not certain that the disease will resolve, but since the heat has been vented, a Stomach excess syndrome may not necessarily form.

[General Principle] Zhang Zhongjing stated: With no exterior syndrome, no aversion to cold or heat, distension and fullness in the chest and abdomen, dry lips, dry mouth, rinsing water without swallowing, and frequent urination, this is blood stasis, and mania will certainly develop. For mild cases, Tao Ren Chengqi Tang (Peach Kernel and Rhubarb Decoction) should be used; for severe cases, Didang Wan (Definite Attack Pill) should be used.

[Commentary] Yang Shiyin said: Dry lips and dry mouth often appear in blood-related diseases, where there is definitely a desire to take water for rinsing. But why rinse without swallowing? Generally, those who are thirsty find it easy to drink. When Yang-heat enters the interior and Stomach fluids are dried up, patients refuse to take water. Only when there is blood stasis in the Upper Jiao and accumulated blood stasis in the Lower Jiao, affecting the Lungs causing dryness, yet lacking the symptom of thirst, does one rinse without desiring to swallow. Regarding the protocol of rinsing water, it exists only in blood-related diseases.