(凡渴问所饮欲冷欲热欲多欲少饮多而欲冷者阳渴也饮少而喜温者阴渴也隔明不甚
渴太阴乃大渴有救肾花粉知母是也有利小便茯苓猪苓是也太阳无汗而渴禁白虎汤阳明汗多而渴禁
五苓散大抵在表渴少在里渴多三阳或渴不如三阴之甚也渴欲饮水稍稍与之若不与无以解其枯
燥若过多恐成动悸水结胸咳呕KT 哕肿满下利等症可不慎哉
太阳汗后。烦渴。少少与水若脉浮。小便不利。微热者。(五苓散)六七日不解而烦。有
表里
阳明脉长微洪。无汗而渴。(葛根解肌汤)阳明恶热。自汗。面赤。谵渴。脉洪数。(人参白
虎汤加花粉黄连)阳明腑症。谵黄狂渴。脉沉数。(大承气汤)阳毒。目赤。唇焦。鼻如烟煤
,
便白。(四逆汤)少阴渴。自利。纯青色水者。(大承气汤)厥阴消渴。大热。甚则谵闭。舌
卷囊缩。(大承气汤)食少而渴。胃脉弱者。宜白术茯苓。勿用凉药益伤中气。
(干燥俱为热症有因汗下后而得者有不因汗下而得者或和解或微汗或急下或
微下当考兼见之症而施治经谓咽干不可汗以其多里症故也)
阳明便硬。舌干口燥者。(调胃承气汤)少阳口苦舌干。(小柴胡汤加天花粉干葛)阳明身
热。背恶寒。口燥舌干。(白虎加人参汤)少阴口燥咽干。下利清水。色纯青。恐热消肾汁。(大
承气汤急下之)燥干脉沉。足冷者。多死。
凡是询问口渴,要看患者想喝冷水还是热水,想多喝还是少喝。饮水多且喜冷饮的,属于阳渴;饮水少且喜温饮的,属于阴渴。阳明经病证口渴不甚严重,太阴经病证则大渴,可用肾花粉(天花粉)、知母来治疗,可用茯苓、猪苓来利小便。太阳病无汗而口渴者,禁用白虎汤;阳明病汗多而口渴者,禁用五苓散。大抵在表的口渴较轻,在里的口渴较重,三阳经的病出现口渴,不如三阴经的病那么严重。口渴想喝水时,应少量给予。如果不给,无法解除其枯燥;如果给得过多,恐怕会导致动悸、水结胸、咳嗽呕吐、呃逆、肿胀满闷、下利等症状,能不谨慎吗?
太阳病发汗后,出现心烦口渴,少量给水。如果脉浮,小便不利,微热者,用五苓散。六七天病不解而心烦,有表里证。
阳明经脉长而微洪,无汗而口渴,用葛根解肌汤。阳明病恶热,自汗,面赤,谵语口渴,脉洪数,用人参白虎汤加花粉、黄连。阳明腑实证,谵语发黄狂躁口渴,脉沉数,用大承气汤。阳毒证,目赤,唇焦,鼻如烟煤色,大便色白,用四逆汤。少阴病口渴,自利,泻下纯青色水样便,用大承气汤。厥阴病消渴,大热,甚则谵语闭窍,舌卷囊缩,用大承气汤。食少而口渴,胃脉弱者,宜用白术、茯苓,不要用凉药以免损伤中气。
干燥都属于热证,有因发汗或攻下后得到的,也有不因发汗或攻下而得的。或和解,或微汗,或急下,或微下,应当考察兼见的症状而施治。经文说咽干不可发汗,因为多属里证。
阳明病大便硬,舌干口燥者,用调胃承气汤。少阳病口苦舌干,用小柴胡汤加天花粉、干葛。阳明病身热,背恶寒,口燥舌干,用白虎加人参汤。少阴病口燥咽干,下利清水,色纯青,恐热消肾汁,用大承气汤急下之。燥干脉沉,足冷者,多死。
Regarding thirst, one must inquire whether the patient desires cold or hot drinks, and whether they wish to drink large or small amounts. Drinking much and preferring cold indicates Yang-type thirst; drinking little and preferring warm indicates Yin-type thirst. In Yangming disease (Disease of the Yangming channel), thirst is not severe; in Taiyin disease (Disease of the Taiyin channel), there is severe thirst, which can be treated with Tianhuafen (Radix Angelicae Dahuricae) and Zhimu (Cortex Mahoniae); diuresis can be achieved using Fuling (Poria) and Zhuling (Polyporus). For Taiyang disease (Disease of the Taiyang channel) with no sweat and thirst, Baihu Tang (White Tiger Decoction) is contraindicated; for Yangming disease with profuse sweating and thirst, Wuling San (Five-Ingredient Powder with Poria) is contraindicated. Generally, thirst associated with exterior conditions is mild, while that associated with interior conditions is severe. Thirst occurring in the Three-Yang channels is less severe than that in the Three-Yin channels. When a patient with thirst desires water, it should be given in small amounts. If not given, the dryness cannot be resolved; if given in excess, it may lead to palpitations, fluid accumulation in the chest (Shui Jie Xiong), coughing, vomiting, hiccups, distension, edema, or diarrhea. One must be cautious.
After sweating in Taiyang disease, if vexation and thirst occur, give water in small amounts. If the pulse is floating, urination is difficult, and there is slight fever, use Wuling San (Five-Ingredient Powder with Poria). If after six or seven days the condition remains unresolved accompanied by vexation, indicating both exterior and interior involvement:
In Yangming channel patterns, the pulse is long and slightly surging, with no sweat and thirst; use Gegen Jiemo Tang (Kudzu Muscle-Releasing Decoction). In Yangming disease, with aversion to heat, spontaneous sweating, red face, delirium and thirst, and a surging-rapid pulse, use Renshen Baihu Tang (Ginseng White Tiger Decoction) plus Tianhuafen and Huanglian. In Yangming fu-organ excess syndrome, with delirium, yellowing, mania, thirst, and a deep-rapid pulse, use Dachengqi Tang (Major Order the Qi Decoction). In Yangdu (Yang Toxin) syndrome, with red eyes, scorched lips, nose resembling soot, and white stool, use Sini Tang (Frigid Extremities Decoction). In Shaoyin disease, with thirst, spontaneous diarrhea, and purgation of pure green watery stool, use Dachengqi Tang. In Jueyin disease, with Xiao Ke (Wasting-Thirst), high fever, and in severe cases, delirium and closure, curled tongue, and retracted testicles, use Dachengqi Tang. With poor appetite and thirst, and a weak Stomach pulse, use Baizhu (Rhizoma Atractylodis Macrocephalae) and Fuling; avoid cold-natured herbs to prevent damaging Middle Qi.
Dryness generally belongs to Heat syndromes. It may arise after sweating or purgation, or independently. Treatment may involve harmonization, mild sweating, urgent purgation, or mild purgation, depending on accompanying symptoms. The classic states that dry throat prohibits sweating because it often indicates interior syndromes.
In Yangming disease, with hard stool, dry tongue, and dry mouth, use Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction). In Shaoyang disease, with bitter taste and dry tongue, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Tianhuafen and Gegen. In Yangming disease, with body heat, aversion to cold on the back, dry mouth, and dry tongue, use Baihu Jia Renshen Tang (White Tiger Decoction Plus Ginseng). In Shaoyin disease, with dry mouth and throat, diarrhea of clear watery stool colored pure green, fearing the depletion of Kidney fluids by heat, use Dachengqi Tang for urgent purgation. With dryness, deep pulse, and cold feet, death is likely.