【纲】仲景曰。阳明病。脉浮而紧者。必潮热。发作有时。但浮者。必盗汗出。
【目】朱肱曰。脉浮盗汗。黄 汤。或柴胡姜桂汤。桂枝茯苓白术汤。
王履曰。盗汗者。睡而汗出也。睡则胃气行里。表中阳气不致。故津液得泄。觉则气行于表。
而汗止矣。
楼英曰。杂病盗汗。责其阴虚。伤寒盗汗。由邪气在半表里使然也。若邪气在表。则又谓之自
汗矣。经曰。微盗汗出。反恶寒者。表未解也。又阳明当作里实。而脉浮者。云必盗汗。是犹有表
邪也。非若自汗有表里虚实之别。
【纲】仲景曰。三阳合病。脉浮大。上关上。但欲眠睡。合目则汗。
【目】刘完素曰。关脉以候少阳之气。太阳之脉浮。阳明之脉大。浮大之脉上关上。故知三阳
合病也。胆热则睡。少阴病且欲眠睡。目合则汗出。以阴不得有汗。但欲眠睡。目合则汗出。知三
阳合病。胆有热也。小柴胡汤、泻心汤。
张元素曰。或谓。此症俱属少阳。篇中亦可用小柴胡否。答曰。可用。夫三阳合病。其邪发见于脉
也。浮者太阳。大者阳明。关上者少阳也。但欲眠睡。目合则汗。此胆有热。脉症相符。故出于少
阳篇下。盖脉浮无症不可汗。脉大无症不可下。浮大之脉俱上关。知三阳合病而热在胆也。胆居在
半表里。用小柴胡亦当。
[General Principle] Zhang Zhongjing stated: In Yangming disease, if the pulse is floating and tight, tidal fever (Chao Re) will certainly occur, with regular onset; if the pulse is merely floating, night sweats (Dao Han) will certainly occur during sleep.
[Commentary] Zhu Gong stated: For floating pulse accompanied by night sweats, Huangqin Tang (Scutellaria Decoction) may be used, or Chaihu Jianggui Tang (Bupleurum, Ginger, and Cinnamon Twig Decoction), Guizhi Fuling Baizhu Tang (Cinnamon Twig, Poria, and Atractylodes Macrocephala Decoction).
Wang Lv stated: Night sweats refer to sweating during sleep. Upon falling asleep, Stomach Qi moves inward, and the defensive Yang Qi on the exterior fails to secure the surface, allowing body fluids (Jin Ye) to leak out. Upon waking, Qi circulates on the exterior, and sweating ceases.
Lou Ying stated: Night sweats in miscellaneous diseases are attributed to Yin deficiency; night sweats in Shanghan (Cold Damage) result from pathogenic factors located at the half-exterior and half-interior level. If the pathogen is on the exterior, it is termed spontaneous sweating (Zi Han). The Classic states: "Mild night sweats with aversion to cold indicate that the exterior syndrome has not yet resolved." Furthermore, Yangming disease typically pertains to interior excess patterns; however, if the pulse is floating and night sweats are predicted, this indicates the presence of residual exterior pathogens. This differs from spontaneous sweating, which has distinctions between exterior/interior and deficiency/excess.
[General Principle] Zhang Zhongjing stated: In combined disease of the Three Yangs, the pulse is floating and large, rising toward the Guan position. The patient desires sleep, and sweating occurs when closing the eyes.
[Commentary] Liu Wansu stated: The Guan pulse observes Shaoyang Qi. The Taiyang pulse is floating, and the Yangming pulse is large. A floating and large pulse rising to the Guan position indicates combined disease of the Three Yangs. Gallbladder heat causes drowsiness. In Shao Yin disease, there is also a desire to sleep, and sweating occurs upon closing the eyes. Since Yin syndromes should not present with sweating, the presentation of "desiring sleep and sweating upon closing eyes" indicates combined disease of the Three Yangs with heat in the Gallbladder. Xiao Chaihu Tang (Minor Bupleurum Decoction) and Xiexin Tang (Drain the Epigastrium Decoction) may be used.
Zhang Yuansu stated: Some ask: Since these symptoms belong to Shaoyang, can Xiao Chaihu Tang be used in this chapter? The answer is yes. In combined disease of the Three Yangs, the pathogen manifests in the pulse: the floating aspect corresponds to Taiyang, the large aspect to Yangming, and the Guan position to Shaoyang. "Desiring sleep and sweating upon closing eyes" indicates heat in the Gallbladder, where the pulse and symptoms correspond, hence it appears under the Shaoyang chapter. Generally, a floating pulse without corresponding symptoms precludes diaphoresis (Fahan), and a large pulse without corresponding symptoms precludes purgation (Xiafa). With both floating and large pulses rising to the Guan position, it is known to be combined disease of the Three Yangs with heat in the Gallbladder. As the Gallbladder resides at the half-exterior and half-interior level, using Xiao Chaihu Tang is appropriate.