自汗在太阳,谓之风邪,桂枝汤证也。在阳明,谓之热越,白虎汤证也。若大热蒸蒸,汗出过多,宜用调
胃承气汤急下其热,以救其津也。若更兼发热,下利不休,内外两脱属凶。如头汗出,剂颈而还,则为热不得
外越,是以上蒸于首也。或因黄郁未发,或因湿家误下,或因水结胸蒸,或因火劫热迫,或因阳明蓄血,或因
热入血室,当分门施治。
胃主四肢,为津液之主。如热聚于胃,蒸其津液,旁达于四肢,故手足 然汗出,且小便自利,胃中
津液必干,大便必硬,本当攻也。若中寒胃阳土虚,脾不约束,津液横溢四肢,故汗出而冷;阳虚失运,中寒
不化,故小便不利;今虽便硬,而手足汗,非为热越者比,慎不可攻,攻之必变生固瘕,泄泻澄清不止也。
潮热阳明腑证也,阳明旺于申酉,故潮热发于午后,是可下之证也。发热汗蒸蒸无休止时,亦属阳明内实
,可下之证。时热谓发热时轻时重,而有自汗,必不兼里实可下之证,知风邪留连在表,可用桂枝汤主治。
言语心之主也,心气实热而神有余,则发为谵语,谵语为实,故声长而壮,乱言无次,数数更端也。心
气虚热,而神不足,则发为郑声,郑声为虚,故音短而细,只将一言重复呢喃也。凡谵语郑声,与阳经同见
者,均属热证,可以攻之。与阴经同见者,总为寒证,可以温之。然虽与阳经同见,而无可攻之证,不可攻
之,当清解也。虽与阴经同见,而无可温之证,不可温之,当清补也。
Sweating occurring in the Taiyang disease stage is attributed to Wind pathogenic factors and indicates an indication for Guizhi Tang (Cinnamon Twig Decoction). When it occurs in the Yangming disease stage, it is termed "Heat dispersing outward" and indicates an indication for Baihu Tang (White Tiger Decoction). If there is high fever with steaming sensation and excessive sweating, Daowei Chengqi Tang (Stomach-Regulating Purging Decoction) should be used urgently to purge the heat and rescue the body fluids. If accompanied by fever and unceasing diarrhea, leading to a collapse of both exterior and interior Qi, this is a ominous condition. If only the head sweats, stopping at the neck, it is because the Heat cannot disperse outward but instead steams upward to the head. This may be due to unresolved damp-heat stagnation, mistaken purgative treatment in patients with dampness, water accumulation in the chest causing steaming heat, heat forced by fire therapy, blood stasis in the Yangming, or heat entering the Blood chamber; treatment must be applied according to the specific syndrome category.
The Stomach governs the four limbs and is the master of body fluids. If Heat accumulates in the Stomach, steaming the fluids which then spread to the four limbs, continuous sweating occurs on the hands and feet, along with free urination. This implies that the Stomach's fluids are necessarily dry and the stool hard, indicating that purgative treatment is originally indicated. However, if Cold invades the middle, causing deficiency of Stomach Yang and Spleen Earth, the Spleen loses its ability to constrain, allowing fluids to overflow to the limbs, resulting in cold sweating. Due to Yang deficiency failing to transport and Middle Jiao Cold failing to transform, urination becomes difficult. Although the stool is hard and there is sweating on the hands and feet, this differs from Heat dispersing outward; purgatives must strictly be avoided. Using them will inevitably lead to complications such as fixed masses (Gu Xia) and unceasing clear diarrhea.
Tidal fever is a syndrome of Yangming Fu-organ excess. The Yangming channel is vigorous during Shen and You hours (3 PM–7 PM), so tidal fever often manifests in the afternoon, indicating an indication for purgative treatment. Fever accompanied by profuse, ceaseless sweating also belongs to Yangming internal excess and is an indication for purgative treatment. Intermittent fever refers to fever that fluctuates in intensity, accompanied by spontaneous sweating; this definitely does not involve interior excess suitable for purgation. It indicates that Wind pathogenic factors are lingering in the exterior, and Guizhi Tang (Cinnamon Twig Decoction) should be used as the primary treatment.
Speech is governed by the Heart. When Heart Qi is full and hot, with excess Spirit, Delirious Speech (Zhanyu) occurs. Delirious speech is a Excess pattern, characterized by long, loud voices, incoherent rambling without order, and frequent topic changes. When Heart Qi is deficient and hot, with insufficient Spirit, Prostrate Speech (Zhengsheng) occurs. Prostrate speech is a Deficiency pattern, characterized by short, faint voices, merely repeating a single phrase in a murmuring manner. Whenever Delirious Speech or Prostrate Speech appears concurrently with Yang-channel diseases, they all belong to Heat patterns and can be treated with purgation. When they appear concurrently with Yin-channel diseases, they generally belong to Cold patterns and can be treated with warming methods. However, even if concurrent with Yang-channel diseases, if there are no indications for purgation, one must not use purgatives but should instead employ clearing and resolving methods. Even if concurrent with Yin-channel diseases, if there are no indications for warming, one must not use warming methods but should instead employ clearing combined with tonification.