(诸阳经络皆循于头邪搏诸阳乃为头汗故三阴无头汗也经曰关格不通不得尿头有
汗者死湿家下之额上汗出小便不利者死下利不止者亦死)
太阳水结胸。无大热头微汗。(大陷胸汤)阳明头汗。剂颈而还。小便不利。而渴。瘀热
在里。身
血症。(四物汤加桃仁红花白术甘草以益脾土)
(胃主四肢为津液之主手足汗出为热聚于胃是津液旁达也经曰手足 然汗出大
便已硬宜下之阳明中寒不能食小便不利手足汗欲作痼瘕不可下)
阳明谵渴满闭。手足汗出。(大承气汤)中寒不能食。水谷不化。手足汗出。(理中汤)
(藏气不调肌肤间筑筑跳动病患先有痞积而后感寒医者不知妄施汗下致动其气随
藏所主而见于脐之左右上下独不言当脐者脾为中州以行四脏之津液左右上下且不宜汗
下何况中州其敢轻动乎)
动气在右。误汗则衄。烦渴饮即吐水。(先服五苓散次服竹叶汤)误下则津渴。咽燥。鼻
干。眩悸。(人参白虎汤加川芎)动气在左误汗则头眩汗不止。筋惕肉 。(先服防风白术牡蛎汤
汗止服小建中汤)误下则腹内拘急。食不下。虽身热而蜷卧。(先服甘草干姜汤后服小建中汤
)动气在上。误汗则气上冲心。(李根汤)误下则掌握。热烦。身上浮冷。热汗自泄。欲得水
自灌。(竹叶汤)动气在下。误汗则无汗。心大烦。骨节痛。目晕。恶寒。食即吐。(先服大
橘皮汤吐止小建中汤)误下则腹满。头眩。食则下清谷。(甘草泻心汤)
(全身的阳经经络都循行于头部,邪气与诸阳经搏结,就会引起头汗,所以三阴经病不会出现头汗。《内经》说:关格不通,小便不能排出,如果头部出汗,是死证;湿病患者被误用下法,额头出汗、小便不利的是死证;如果腹泻不止的,也是死证。)
太阳病水饮结聚于胸膈。没有大热,只有头部微微出汗。(可用大陷胸汤治疗)阳明病出现头汗。汗出仅到颈部而止,小便不利,口渴,这是瘀热蕴结在体内,身体可能出现发斑或出血的症状。(可用四物汤加入桃仁、红花、白术、甘草以补益脾土)
(胃主管四肢,是津液的主宰。手足出汗,是因为热邪聚集在胃中,导致津液向四周渗透外达。《内经》说:手足濈然汗出,说明大便已经变硬,应当使用下法;如果是阳明中寒,不能进食,小便不利,手足出汗,这可能是将要形成顽固积聚的病证,不可使用下法。)
阳明病出现谵语、口渴、腹满、二便闭塞。手足出汗。(可用大承气汤治疗)中寒证,不能进食,水谷不消化,手足出汗。(可用理中汤治疗)
(脏腑之气不调和,肌肤之间会有悸动感。病人原本就有痞块积聚,又感受了寒邪。医生不知道病情,妄自使用发汗或泻下的方法,导致脏气扰动。这种动气会随着所伤脏腑的主司部位,出现在脐部的左、右、上、下方。唯独不提及当脐部,是因为脾位于中州,负责运行四脏的津液。既然左右上下都不宜轻易发汗或泻下,何况是中州的脾脏,怎么敢轻易扰动它呢?)
动气出现在右侧。误用发汗法会导致鼻衄(流鼻血),心烦口渴,喝水后立即呕吐清水。(应先服用五苓散,再服用竹叶汤)。误用泻下法会导致津液受损而口渴,咽喉干燥,鼻子干,头晕心悸。(可用人参白虎汤加入川芎)。动气出现在左侧。误用发汗法会导致头晕,出汗不止,筋脉跳动,肌肉瞤动。(应先服用防风白术牡蛎汤,汗止后服用小建中汤)。误用泻下法会导致腹部拘急疼痛,无法进食,虽然身体发热却蜷缩着躺卧。(应先服用甘草干姜汤,后服用小建中汤)。动气出现在上方。误用发汗法会导致气向上冲撞心脏。(可用李根汤)。误用泻下法会导致手心发热,烦躁,身上感觉浮冷,冷汗自出,想要喝水并自行浇灌身体。(可用竹叶汤)。动气出现在下方。误用发汗法会导致无汗,心中大烦,骨节疼痛,眼睛昏花,恶寒,吃东西就呕吐。(应先服用大橘皮汤,吐止后服用小建中汤)。误用泻下法会导致腹部胀满,头晕,吃东西后排泄未消化的食物。(可用甘草泻心汤)。
(The meridians of all Yang channels circulate around the head. When pathogenic factors contend with the Yang meridians, it results in sweating on the head; therefore, diseases of the Three Yin channels do not present with sweating on the head. The Classics state: If Guan-Ge (obstruction of Qi and fluid metabolism) is unblocked and urination is impossible, yet there is sweating on the head, this is a fatal sign. In patients with dampness, if purgation is incorrectly applied and sweating occurs on the forehead accompanied by difficulty in urination, this is fatal. Similarly, if diarrhea persists incessantly, this is also fatal.)
In Taiyang disease where water accumulates in the chest, there is no significant fever, but only slight sweating on the head. (Da Xianxiong Tang / Great Trap the Chest Decoction may be used). In Yangming disease, sweating occurs on the head, extending only to the neck. With difficulty in urination and thirst, this indicates stagnant heat accumulating within the interior, potentially leading to blood stasis or bleeding manifestations. (Siwu Tang / Four Substances Decoction added with Taoren / Peach Kernel, Honghua / Safflower, Baizhu / Atractylodis Rhizoma, and Gancao / Licorice Root to tonify the Spleen Earth)
(The Stomach governs the four limbs and is the master of body fluids. Sweating on the hands and feet indicates that heat has gathered in the Stomach, causing body fluids to diffuse outward to the periphery. The Classics state: If there is continuous sweating on the hands and feet, it suggests that the stool has hardened, and purgation should be employed. However, in Yangming cold-dampness where the patient cannot eat, has difficulty in urination, and sweats on the hands and feet, this may indicate the impending formation of a stubborn accumulation (Gu Jia), and purgation is contraindicated.)
In Yangming disease presenting with delirium, thirst, abdominal fullness, and constipation/incontinence, there is sweating on the hands and feet. (Da Chengqi Tang / Great Order the Qi Decoction may be used). In Cold-Dampness patterns where the patient cannot eat, food and water are not digested, and there is sweating on the hands and feet, Lizhong Tang / Regulate the Middle Decoction may be used.
(When the Qi of the Zang organs is disharmonious, palpitations may be felt in the skin and muscles. If a patient already has a fixed mass (Pi Ji) and subsequently contracts cold, and the physician, unaware of the condition, erroneously applies sweating or purging methods, it disturbs the organ Qi. This 'moving Qi' manifests according to the area governed by the affected Zang organ, appearing above, below, left, or right of the umbilicus. It does not mention the center of the umbilicus because the Spleen resides in the Central Region (Zhong Zhou) and distributes fluids to the four Zang organs. Since sweating and purging are inadvisable for the left, right, upper, and lower areas, how much more so for the central Spleen? How dare one lightly disturb it?)
Moving Qi located on the Right: Erroneous sweating leads to epistaxis (nosebleed), irritability, thirst, and vomiting water immediately after drinking. (First administer Wuling San / Five-Ingredient Powder with Poria, then Zhuye Tang / Bamboo Leaf Decoction). Erroneous purging leads to fluid deficiency with thirst, dry throat, dry nose, dizziness, and palpitations. (Renshen Baihu Tang / Ginseng White Tiger Decoction added with Chuanxiong / Ligustici Rhizoma). Moving Qi located on the Left: Erroneous sweating leads to dizziness, incessant sweating, twitching of tendons, and muscle fasciculations. (First administer Fangfeng Baizhu Muli Tang / Saposhnikovia, Atractylodes, and Oyster Shell Decoction; once sweating stops, administer Xiaojianzhong Tang / Minor Construct the Middle Decoction). Erroneous purging leads to abdominal cramping, inability to eat, and despite body heat, a desire to curl up and lie down. (First administer Gancao Ganjiang Tang / Licorice and Dried Ginger Decoction, then administer Xiaojianzhong Tang / Minor Construct the Middle Decoction). Moving Qi located Above: Erroneous sweating leads to Qi rushing upward to strike the Heart. (Ligen Tang / Li Tree Root Decoction may be used). Erroneous purging leads to hot palms, irritability, a sensation of floating coldness on the body, spontaneous leakage of cold sweat, and a desire to drink water and pour it over oneself. (Zhuye Tang / Bamboo Leaf Decoction may be used). Moving Qi located Below: Erroneous sweating leads to anhidrosis (no sweat), severe mental restlessness, pain in the bone joints, blurred vision, aversion to cold, and vomiting immediately after eating. (First administer Dajupi Tang / Large Tangerine Peel Decoction; once vomiting stops, administer Xiaojianzhong Tang / Minor Construct the Middle Decoction). Erroneous purging leads to abdominal fullness, dizziness, and passing undigested food in the stool after eating. (Ganxiao Xiexin Tang / Licorice and Pinellia Decoction to Drain the Epigastrium may be used).