少阴病,脉细沉数,病为在里,不可发其汗。
脉浮而紧,法当身体疼痛,当以汗解。假令尺中脉迟者,不可发其汗。何以知然?此为荣气不足,血微少故也。
少阴病,脉微(一作濡而微弱)。不可发其汗,无阳故也。
脉濡而弱,弱反在关,濡反在巅。微反在上,涩反在下。微则阳气不足,涩则无血。阳气反微,中风汗出而反躁烦,
涩则无血,厥而且寒,阳微发汗,躁不得眠。
动气在右,不可发汗。发汗则衄而渴,心苦烦,饮即吐水。
动气在左,不可发汗。发汗则头眩,汗不止,筋惕肉 。
动气在上,不可发汗。发汗则气上冲,正在心端。
动气在下,不可发汗。发汗则无汗,心中大烦,骨节苦疼,目运恶寒,食即反吐,谷不得前(一云谷不消化)。
咽中闭塞,不可发汗。发汗则吐血,气微绝,手足逆冷,欲得蜷卧,不能自温。
诸脉数,动微弱,并不可发汗。发汗则大便难,腹中干(一云小便难,胞中干)胃燥而烦。其形相象根本异源。脉
濡而弱,弱反在关,濡反在巅,弦反在上,微反在下。弦为阳运,微为阴寒,上实下虚,意欲得温。微弦为虚,不可发
汗,发汗则寒栗,不能自还。
咳者则剧,数吐涎沫,咽中必干,小便不利,心中饥烦, 时而发,其形似疟,有寒无热,虚而寒栗。咳而发汗,
蜷而苦满(满,一作心痛),腹中复坚。厥,不可发汗,发汗则声乱,咽嘶,舌萎,谷不得前。
诸逆发汗,微者难愈,剧者言乱,睛眩者死,命将难全。
太阳病,得之八、九日,如疟状,发热而恶寒,热多寒少,其人不呕,清便续自可,一日再三发,其脉微而恶寒,
此为阴阳俱虚,不可复发汗也。
太阳病,发热恶寒,热多寒少,脉微弱,则无阳也,不可复发其汗。咽干燥者,不可发汗。
亡血家,不可攻其表,汗出则寒栗而振。
衄家,不可攻其表,汗出必额陷,脉上促急而紧,直视而不能 ,不得眠。
汗家,重发其汗,必恍惚心乱,小便已阴疼,可与禹余粮丸。
淋家,不可发汗,发其汗,必便血。
疮家,虽身疼痛,不可攻其表,汗出则 (一作痉,下同)
冬时发其汗,必吐利,口中烂,生疮。
下利清谷,不可攻其表,汗出必胀满。咳而小便利,若失小便,不可攻其表,汗出则厥逆冷。汗出多极,发其汗,
亦坚。
伤寒一、二日至四、五日,厥者必发热,前厥者后必热,厥深者热亦深,厥微者热亦微。厥应下之,而反发其汗,
必口伤烂赤。病患脉数,数为有热,当消谷引食。反吐者,医发其汗,阳微,膈气虚,脉则为数,数为客阳,不能消谷,
胃中虚冷,故令吐也。
伤寒四、五日,其脉沉,烦而喘满,脉沉者,病为在里,反发其汗,津液越出,大便为难,表虚里实,久则谵语。
伤寒头痛,翕翕发热,形象中风,常微汗出。又自呕者,下之益烦心,懊 如饥,发汗则致 ,身强难以屈伸,熏
之则发黄,不得小便,久则发咳唾。
太阳病,发其汗,因致 。
伤寒脉弦细,头痛而反发热,此属少阳,少阳不可发其汗。
太阳与少阳并病,头项强痛,或眩冒,时如结胸,心下痞坚者,不可发其汗。
少阴病,咳而下利,谵语者,此被火气劫故也。小便必难,以强责少阴汗也。
少阴病,但厥无汗,而强发之,必动其血,未知从何道出,或从口鼻,或从目出,(一本作耳目)者是为下厥上竭,
为难治。
伤寒有五,皆热病之类也。同病异名,同脉异经。病虽俱伤于风,其人自有痼疾,则不得同法,其人素伤于风,因
复伤于热,风热相薄,则发风温,四肢不收,头痛身热,常汗出不解,治在少阴、厥阴,不可发汗。汗出谵言独语,内
烦,躁扰不得卧,善惊,目乱无精,治之复发其汗,如此者医杀之也。伤寒湿温,其人常伤于湿,因而中 ,湿热相薄,
则发湿温。病苦两胫逆冷,腹满叉胸,头目痛苦,妄言,治在足太阴,不可发汗。汗出必不能言,耳聋,不知痛所在,
身青,面色变,名曰重 ,如此者死医杀之也。(上二首出《医律》)
Shaoyin disease, with a fine, deep, and rapid pulse, indicates the pathology is in the interior; sweating therapy is contraindicated.
A floating and tight pulse typically presents with body pain and should be resolved by sweating. However, if the chi (cun kou) position pulse is slow, sweating is contraindicated. Why is this so? This is due to insufficiency of Ying Qi (Nutritive Qi) and slight deficiency of blood.
In Shaoyin disease, if the pulse is faint (alternatively described as soft and weak), sweating is contraindicated due to Yang Qi deficiency.
A pulse that is soft and weak: the weak quality is found at the guan (middle) position, while the soft quality is found at the cun (superficial/distal) position. The faint quality is found superiorly, and the choppy quality inferiorly. Faintness indicates insufficient Yang Qi; choppy indicates lack of blood. If Yang Qi is faint, wind-stroke with sweating may paradoxically cause restlessness and vexation. Choppy indicates lack of blood, leading to cold limbs and chills. Applying sweating to faint Yang Qi causes restlessness and insomnia.
If there is pulsation (Dong Qi) on the right, sweating is contraindicated. Sweating will cause epistaxis and thirst, severe mental distress, and vomiting immediately after drinking.
If pulsation is on the left, sweating is contraindicated. Sweating will cause dizziness, incessant sweating, and twitching of muscles and sinews.
If pulsation is above, sweating is contraindicated. Sweating will cause Qi to rush upward, striking directly at the heart region.
If pulsation is below, sweating is contraindicated. Sweating will result in anhidrosis, extreme mental distress, severe joint pain, vertigo, aversion to cold, regurgitation of food after eating, and inability of food to pass downward (alternatively stated as indigestion).
If the throat feels obstructed, sweating is contraindicated. Sweating will cause hematemesis, extremely weak or nearly absent respiration, cold limbs, a desire to curl up, and inability to self-warm.
For various pulses that are rapid but weak and faint, sweating is contraindicated. Sweating will cause difficult defecation and dry abdomen (alternatively stated as difficult urination and dry bladder), leading to gastric dryness and vexation. Although these conditions appear similar, their origins differ fundamentally. A pulse that is soft and weak: the weak quality is at the guan position, the soft at the cun position, the wiry quality superiorly, and the faint quality inferiorly. Wiry indicates abnormal Yang movement; faint indicates Yin cold. Upper excess and lower deficiency suggest a need for warming. Faint and wiry indicate deficiency; sweating is contraindicated. Sweating will cause shivering and inability to recover.
Severe coughing with frequent expectoration of saliva, dry throat, difficult urination, and mental hunger/vexation, occurring intermittently like malaria but with chills only and no fever, indicates deficiency-cold chills. Coughing combined with sweating leads to curling up and chest fullness (alternatively stated as heart pain) and abdominal hardness. In cases of Jue (cold limbs), sweating is contraindicated; it will cause voice disorder, hoarseness, tongue flaccidity, and inability of food to pass.
For various adverse conditions, if sweating is applied, mild cases may be difficult to cure, severe cases may present with confused speech, and those with dizzy eyes will die; life cannot be preserved.
In Taiyang disease, after eight or nine days, presenting like malaria with fever and aversion to cold, where heat predominates over cold, without vomiting, and with normal bowel/bladder function, occurring two or three times a day: if the pulse is faint and there is aversion to cold, this indicates dual deficiency of Yin and Yang, and re-sweating is contraindicated.
In Taiyang disease, with fever, aversion to cold, heat predominating over cold, and a faint pulse indicating absence of Yang, re-sweating is contraindicated. Dry throat also contraindicates sweating.
Patients who have lost blood should not undergo surface-attacking sweating; sweating will cause chills and tremors.
Patients prone to epistaxis should not undergo surface-attacking sweating; sweating will cause depression of the forehead, rapid and tense pulse, fixed staring gaze, and insomnia.
Patients prone to sweating, if subjected to heavy sweating, will suffer from mental confusion and anxiety, and pain in the genitalia after urination; Yu Yu Liang Wan (Hematite Pill) may be administered.
Patients with strangury (Lin syndrome) should not sweat; sweating will cause hematuria.
Patients with sores/ulcers, even if experiencing body pain, should not undergo surface-attacking sweating; sweating will lead to Jing (spasm/stiffness).
Sweating during winter will cause vomiting and diarrhea, oral ulcers, and sores.
Diarrhea with undigested food (Qing Gu) contraindicates surface-attacking sweating; sweating will cause abdominal distension. Cough with free urination, or urinary incontinence, contraindicates surface-attacking sweating; sweating will cause cold reversal (Jue Ni). Excessive sweating followed by further sweating will also cause hard stool.
In Shanghan (Cold Damage) from one to two days to four to five days, Jue (cold limbs) must be followed by fever; previous Jue will later become hot. Deeper Jue corresponds to deeper heat; slight Jue corresponds to slight heat. Jue should be treated with purgation; if sweating is mistakenly used, it will cause oral injury and redness. If a patient has a rapid pulse, indicating heat, they should digest food well. If they vomit instead, it is because the physician mistakenly induced sweating, causing faint Yang and deficient Qi in the diaphragm. The rapid pulse here represents "guest Yang" (false heat) which cannot digest food; the stomach is cold and deficient, causing vomiting.
In Shanghan, four to five days in, with a deep pulse, vexation, wheezing, and fullness: a deep pulse indicates interior pathology. Mistaken sweating will cause fluids to leak out, leading to difficult defecation, exterior deficiency and interior excess, and eventually delirium.
Shanghan headache, fever resembling being wrapped in cloth, mimicking wind-stroke, with slight spontaneous sweating and spontaneous vomiting: purgation will worsen mental vexation and discomfort; sweating will cause Jing (spasm), stiff body difficult to flex/extend; moxibustion/fumigation will cause jaundice, urinary retention, and eventually coughing with sputum.
Taiyang disease, after sweating, may lead to Jing (spasm).
Shanghan with wiry-thin pulse, headache, and fever belongs to Shaoyang; Shaoyang disease is contraindicated for sweating.
Combined Taiyang and Shaoyang disease, with stiffness/pain in head and neck, occasional dizziness, intermittent feeling of chest binding, and hardness/fullness below the heart: sweating is contraindicated.
Shaoyin disease with cough and diarrhea, presenting with delirium, results from fire therapy forcing fluids. Urination will be difficult due to forced sweating in Shaoyin.
Shaoyin disease with only Jue (cold limbs) and no sweat: forced sweating will disturb blood, which may exit from any orifice (mouth, nose, eyes); this is called "lower Jue and upper exhaustion," a difficult-to-treat condition.
Shanghan encompasses five types, all belonging to heat diseases. Same disease, different names; same pulse, different meridians. Although all are injured by wind, pre-existing chronic conditions dictate different treatments. If a person previously injured by wind is subsequently injured by heat, wind and heat clash, causing Feng Wen (Wind-Warmth): limbs collapse, headache, body heat, persistent sweating without resolution. Treatment focuses on Shaoyin and Jueyin meridians; sweating is contraindicated. If sweating causes isolated talking, internal vexation, restlessness preventing sleep, fright, and scattered gaze, and the physician sweats again, the physician kills the patient. Wet-Warmth (Shi Wen) in Shanghan: chronic dampness injury leads to middle-jiao stagnation; damp and heat clash, causing Shi Wen. Symptoms include cold reverse legs, abdominal fullness with hands crossing chest, head/eye pain, and delirium. Treatment focuses on Foot-Taiyin; sweating is contraindicated. Sweating causes inability to speak, deafness, unawareness of pain, cyanosis, and color change, named Zhong Ming (deep coma); such patients die, killed by the physician. (The above two sections are from *Yi Lü*).