东垣治一人。二月天气。阴雨寒湿。又因饮食失节。劳役所伤。病解之后。汗出不止。
沾濡数日。恶寒。重添浓衣。心胸间时烦热。头目昏愦。上壅。食少减。此胃中阴火炽盛。
与天雨之湿气相合。湿热太甚。则汗出不休。兼见风化也。以助东方甲乙之风药以去其湿。
甘寒以泻其热。生芩、酒芩、人参、炙草、羌、独、 、防、细辛、川芎、蔓荆子各三分。
黄、生甘草、升、柴各五分。薄荷一分。煎服即愈。
震按汗出不止。尚用诸般风药。非东垣不能。故录之以见病情之变化无穷。不专以敛涩
为止汗定法也。
慎斋治一人。自汗。足冷不能行动。尺脉沉大。此脾气下陷也。故肺失养而汗出。足乃
脾肾经行之地。脾阳不舒。肾气亦郁。所以冷也。以启脾养肺为本。温肾为标。用参、 、
山药。补脾阴固表扶肺。稍加桂温之而愈。
震按自汗而足冷不能行动。显系下焦虚寒矣。尺脉当沉细。何反沉大。粗工舍脉证书。
必将温补肝肾而用熟地、枸杞、苁蓉、鹿茸、桂、附等药。缪工凭脉论证。或认下焦湿热而
用二妙散、防己、黄 等方。俱与脾气下陷隔一层也。慎斋善用温补。此案只稍加肉桂。亦
以尺脉之沉大也。
张景岳曰。余尝治一衰翁。年逾七旬。陡患伤寒。初起即用温补调理。至十日之外。正
气将复。忽尔作战。自且至晨。不能得汗。寒栗危甚。告急于余。余用六味回阳饮。入人参
一两。姜、附各三钱。使之煎服。下咽少顷。即大汗如浴。时将及午。而浸汗不收。身冷如
脱。鼻息几无。复以告余。余令以前药复煎与之。告者曰。先服此药。已大汗不堪。今又服
此。尚堪再汗乎。余笑谓曰。此中有神。非尔所知也。急令再进。遂汗收神复。不旬日而起
矣。呜呼。发汗用此。而收汗复用此。无怪乎人之疑之也。而不知汗之出。与汗之收。皆元
气为之枢机耳。人能如阖辟之权。其放与收。有所以主之者。则无惑矣。
震按景岳之言。的系医宗三味。诚能悟此。则线索在手。操纵咸宜矣。但所选三案。皆
取高超者以示模范。非全法也。如阳虚自汗。用参附、 附、黄 建中。阴虚盗汗。用当归
六黄汤、地黄汤。加白芍、牡蛎、浮小麦、糯稻根须。表虚。用玉屏风散。心虚。用归脾汤
肝火。用左金、白芍、龙、牡。胃火。用凉膈散、白虎汤。风胜。用桂枝汤。湿胜。用羌
活胜湿汤。痰用导痰、温胆。暑用清暑益气。以及麻黄根、败蒲扇、封脐药、外扑法。法宜
遍求。他如头汗、阴汗、心窝汗、饮食汗。方各另采。总宜多阅诸书。固难备述是编。
Li Dongyuan treated a patient. It was February, with continuous rain, cold and dampness. Additionally, due to irregular diet and overwork, the body was injured. After the pathogenic factor was resolved, sweating continued incessantly.
For several days, the clothes were soaked with sweat. The patient felt aversion to cold, requiring heavier clothing. There was occasional irritability and heat in the chest and heart region, dizziness and confusion of the head and eyes, a sensation of fullness and obstruction in the upper body, and reduced appetite. This indicated blazing Yin fire in the stomach,
combined with the dampness from the rainy weather. Excessive damp-heat caused continuous sweating, accompanied by symptoms of wind transformation. Wind herbs associated with the East (Jia-Yi wood) were used to dispel dampness.
Sweet-cold herbs were used to purge heat. Raw Scutellariae Radix (Shengqin), Wine-processed Scutellariae Radix (Jiuqin), Ginseng Radix et Rhizoma (Renshen), Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao), Notopterygii Rhizoma et Radix (Qianghuo), Saussureae Radix (Duhuo), Saposhnikoviae Radix (Fangfeng), Asari Radix et Rhizoma (Xixin), Ligusticum Chuanxiong Rhizoma (Chuanxiong), and Vitex Fructus (Manjingzi) each 3 fen.
Astragali Membranacei Radix (Huangqi), Raw Glycyrrhizae Radix et Rhizoma (Shenggancao), Cimicifugae Rhizoma (Shengma), and Bupleuri Radix (Chaihu) each 5 fen. Menthae Haplocalycis Herba (Bohe) 1 fen. Decocted and taken orally, the patient recovered immediately.
Yu Zhen commented: Using various wind herbs for incessant sweating is something only Li Dongyuan could do. Thus, this case is recorded to show that pathological conditions are infinitely variable, and stopping sweating is not solely determined by astringent methods.
Shenzhai treated a patient with spontaneous sweating, cold feet unable to move, and a deep and large pulse at the chi position. This was due to sinking of Spleen Qi. Consequently, the Lungs lost nourishment, leading to sweating. The feet are the pathways of the Spleen and Kidney meridians. When Spleen Yang is not free-flowing, Kidney Qi also becomes stagnant, causing coldness. The treatment focused on invigorating the Spleen and nourishing the Lungs as the root, and warming the Kidneys as the branch. Ren Shen, Atractylodis Macrocephalae Rhizoma (Baizhu), and Dioscoreae Rhizoma (Shanyao) were used to tonify Spleen Yin, secure the exterior, and support Lung Qi. A small amount of Cinnamomi Ramulus (Guizhi) was added for warmth, resulting in recovery.
Yu Zhen commented: Spontaneous sweating with cold feet unable to move clearly indicates deficiency-cold in the Lower Jiao. The chi pulse should be deep and fine; why was it deep and large? Incompetent physicians ignore the pulse and rely only on symptoms, likely using warm-tonifying herbs for Liver and Kidney such as Rehmanniae Radix Preparata (Shudihuang), Lycii Fructus (Gouqi), Cynomorii Herba (Rongcong), Cervi Cornu Degelatinatum (Lurong), Guizhi, and Aconiti Lateralis Radix Preparata (Fuzi). Skilled physicians analyze based on the pulse, possibly diagnosing damp-heat in the Lower Jiao and using Er Miao San, Pseudostellariae Radix (Fangji - *Note: Context implies Fangji/Poria mix or similar damp-draining formula context, but text says Fangji*), and Huangqi formulas. These approaches miss the mark of Spleen Qi sinking by one step. Shenzhai excels in warm-tonifying methods. In this case, only a small amount of Rougui was added, considering the deep and large chi pulse.
Zhang Jingyue said: I once treated an elderly man over seventy years old who suddenly contracted Shanghan (Cold Damage). Warm-tonifying regulation was used from the beginning. After ten days, when Zheng Qi (Upright Qi) was about to recover, he suddenly experienced chills and shivering. This lasted from midnight until morning, without sweating. The cold tremors were critical. He urgently sought my help. I prescribed Liuwei Huiyang Yin (Six-Ingredient Decoction to Return Yang), adding one liang of Renshen, and three qian each of Ginger (Shengjiang) and Fuzi. He took the decoction. Shortly after swallowing, he sweated profusely like a bath. By noon, the sweating continued uncontrollably. His body became cold as if shedding its skin, and his breathing was nearly absent. He reported this emergency again. I ordered the previous medicine to be decocted again for him. The messenger said, "After taking this medicine before, he already sweated excessively and could barely endure it. Now taking it again, can he bear another bout of sweating?" I smiled and said, "There is a divine principle here unknown to you." Urgently ordering further administration, the sweating ceased, and consciousness returned. Within ten days, he rose from bed. Alas! Using this method to induce sweating, and then using it again to stop sweating, no wonder people doubt it. But they do not know that both the release and retention of sweat are governed by Yuan Qi (Original Qi) as the pivot. If humans could master the opening and closing like a door hinge, where release and retention have their master, there would be no confusion.
Yu Zhen commented: Zhang Jingyue's words truly capture the essence of medical doctrine. If one comprehends this, diagnostic threads are in hand, and manipulation is appropriate. However, the selected cases are all high-level examples for modeling, not the complete set of rules. For example, for Yang-deficiency spontaneous sweating, use Renshen-Fuzi Tang, Zhenwu Tang, or Huangqi Jianzhong Tang. For Yin-deficiency night sweating, use Danggui Liuhuang Tang or Dihuang Tang, plus Baishao, Muli, Fu Xiaomai, and Nu Dao Gen Xu. For Exterior deficiency, use Yupingfeng San. For Heart deficiency, use Guipi Tang. For Liver Fire, use Zuojin Wan, Baishao, Longgu, and Muli. For Stomach Fire, use Liangge San or Baihu Tang. For Wind excess, use Guizhi Tang. For Dampness excess, use Qianghuo Shengshi Tang. For Phlegm, use Daotan Tang or Wendan Tang. For Summerheat, use Qingshu Yiqi Tang. Also, Mahuang Gen, Baipushan, umbilical sealing medicines, and external powder methods. Therapeutic methods should be widely sought. Others include Head sweating, Genital sweating, Epigastric sweating, and Food-induced sweating, for which specific formulas are collected separately. One must read many books; it is difficult to list them all in this compilation.