【纲】仲景曰。脉浮发热。口干鼻燥。能食者则衄。阳明病。口燥。但欲漱水。不欲咽者。此必衄。阳明病。但头
眩。不恶寒。故能食而咳。其人
必咽痛。若不咳者。咽不痛。
【目】朱肱曰。脾脏有热。则津液枯少。故令口燥而舌干。
李杲曰。若饮食劳役所伤。其外症必显在口。必口失谷味。必腹中不和。必不欲言。纵勉强对
答。声必怯弱。口沃沫。多吐。鼻中清涕。或有或无。即阴症也。外伤风寒。则其外症必显在鼻。
气不利。声重浊不清。其言壅塞。盛而有力。口中必和。伤寒则面赤。鼻壅塞而干。伤风则鼻流清
涕而已。伤食则恶食。
庞安常曰。鼻头色青者。腹中痛。苦冷者死。微黑者水气。黄色者小便难。白色者气虚。
赤色者肺热。鲜明者有留饮也。鼻孔干燥。燥者。阳明热。必将衄血也。鼻孔干燥。黑如烟煤。
阳毒热深也。鼻孔冷滑而黑。阴毒冷极也。鼻息鼾睡者。风湿也。鼻塞浊涕者。风热也。鼻孔 张
为肺风。肺绝而不可以治也。（此庞氏察鼻法）
【纲】仲景曰。阳明中风。口苦咽干。腹满微喘。发热恶寒。脉浮而紧。若下之。则腹满小便
难也。
【目】鳌按。此为阳明初病。属在里之表也。口为胃窍。咽为胃门。故不兼少阳。而有口苦咽
干之症。
【纲】仲景曰。伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
【目】鳌按。此不言躁。但口渴心烦。阳邪将入里也。此虽有表里症。其实表轻里甚。故用白
虎汤也。
【纲】仲景曰。伤寒若吐若下后。七八日不解。热结在里。表里俱热。时时恶风。大渴。舌上
干燥而烦。欲饮水数升者。白虎加人参汤主之。阳明病。若渴欲饮水。口干舌燥者。白虎加人参汤
主之。
【目】成无己曰。此条是热耗津液。而滑者已干也。若热聚于胃。则舌为之黄。是热已深也。
金匮曰。舌黄未下者。下之黄自去。若舌上色黄者。又为热之极也。黄帝针经曰。热病口干。舌黑
者死。以心为君主。黑为肾水克心火。邪热已极。故知必死也。
张介宾曰。舌上黑苔生芒刺者。热极深也。宜凉膈散、承气汤、大柴胡之属。酌宜下之。若苔
色虽黑。滑而不涩者。便非实邪。亦非火症。非惟不可下。且不可清也。
柯琴曰。烦躁舌干大渴。为阳明热结不散也。故当救里以滋津液。二条白虎所治。皆阳明燥症。
揭为阳明主方。信为有见。此为阳明自浅入深之症。前此口苦咽燥恶热。热虽在里。尚未犯心。
至愦愦怵惕懊 。虽入心。尚未及胃。今燥渴引饮。则邪已入胃。然尚未燥硬。用本汤泻胃火而扶
元气。全不涉吐汗下三法矣。
【纲】仲景曰。少阴病得之二三日。不大便。口燥咽干者。急下之。宜大承气汤。
【目】柯琴曰。热淫于内。胃火上炎。故口燥咽干也。急下之。火归于坎。津液自升也。
【纲】仲景曰。阳明病。脉浮而紧。咽燥口苦。腹满而喘。发热汗出。不恶寒反恶热。身重。
栀子豉汤主之。
【目】陶华曰。邪热聚于胃腑。消耗津液。故口干燥热而渴也。盖阳明气血俱多。经中热甚。
有迫血妄行而作鼻衄。漱水不欲咽者。犀角地黄汤。无衄血表症。加之胸腹满而如狂。则为蓄血在
内。桃仁承气汤。少阳口燥咽干。小柴胡汤调之。
【纲】仲景曰。少阴病。自利清水。色纯青。心下必痛。口干舌燥者。急下之。宜大承气汤。
【目】柯琴曰。自利清水。疑其为寒矣。而利清水时。必心下痛。必口燥舌干。是土燥火炎。
脾气不濡。胃气反浓。水去而谷不去。故纯青也。
【纲】张仲景说：脉象浮，发热，口干，鼻燥，能够进食的，就会发生鼻出血。这是阳明病，口干燥，只想用水漱口，却不想咽下，这一定会发生鼻出血。这是阳明病，只有头昏眩，不恶寒，所以能进食且咳嗽，这个人一定咽喉痛。如果不咳嗽，咽喉就不痛。
【目】朱肱说：脾脏有热，津液枯少，所以导致口干燥而舌干。
李杲说：如果是饮食和劳役所伤，其外在症状必然显现在口部，必定口中失去谷物的味道，必定腹中不和，必定不想说话。即使勉强对答，声音必定怯弱，口中流口水，多吐，鼻中流出清涕，或有或无，这就是阴症。外伤风寒，其外在症状必然显现在鼻部，气机不利，声音重浊不清，言语壅塞，声音盛大有力，口中必定调和。伤寒则面赤，鼻壅塞而干；伤风则鼻流清涕而已；伤食则厌恶食物。
庞安常说：鼻头颜色发青的，腹中痛；苦冷（指病情危重，手足厥冷）的死；微黑的有水气；黄色的小便难；白色的气虚；赤色的肺热；鲜明有光泽的有留饮。鼻孔干燥，是燥邪，阳明热盛，必将发生鼻衄血。鼻孔干燥，黑如烟煤，是阳毒热深。鼻孔冷滑而黑，是阴毒冷极。鼻息鼾睡，是风湿。鼻塞浊涕，是风热。鼻孔张开为肺风，肺绝证，不可治。（这是庞氏观察鼻子的方法）
【纲】张仲景说：阳明中风，口苦咽干，腹部胀满，轻微气喘，发热恶寒，脉象浮而紧。如果误用下法，就会导致腹部胀满，小便困难。
【目】沈金鳌按：这是阳明病初起，属于在里的表证。口是胃之窍，咽是胃之门，所以不兼少阳病，而有口苦咽干的病症。
【纲】张仲景说：伤寒没有大热，口干燥渴，心烦，背部微微恶寒的，用白虎加人参汤主治。
【目】沈金鳌按：这里不说躁扰，只是口渴心烦，阳邪将要入里。这虽然有表里症状，其实表证轻而里证重，所以用白虎汤。
【纲】张仲景说：伤寒如果经过吐法或下法后，七八天病仍未解，热结在里，表里都发热，时时恶风，极度口渴，舌上干燥而烦，想要喝几升水的，用白虎加人参汤主治。阳明病，如果口渴想喝水，口干舌燥的，用白虎加人参汤主治。
【目】成无己说：这一条是热耗伤津液，而滑润的已经变干了。如果热聚于胃，舌头就会发黄，这是热已深入。《金匮要略》说：舌苔黄而未用下法的，用下法后黄苔自去。如果舌面上色黄，又是热到了极点。《黄帝针经》说：热病口干，舌苔黑的死，因为心为君主，黑为肾水克心火，邪热已到极点，所以知道必死。
张介宾说：舌上生黑苔且有芒刺的，是热极深。宜用凉膈散、承气汤、大柴胡汤之类，酌情用下法。如果苔色虽黑，但滑润而不涩的，就不是实邪，也不是火症，不仅不能用下法，而且也不能用清热法。
柯琴说：烦躁、舌干、大渴，是阳明热结不散。所以应当救里以滋津液。这两条白虎汤所治疗的，都是阳明燥症，列为阳明主方，确实是有见地。这是阳明病由浅入深的病症。此前口苦咽燥恶热，热虽然在里，尚未犯心；至愦愦怵惕懊恼，虽然入心，尚未及胃；如今燥渴引饮，则邪已入胃。然而尚未燥硬，用本汤泻胃火而扶元气，完全不涉及吐、汗、下三法了。
【纲】张仲景说：少阴病得之二三日，不大便，口干燥咽干的，急当用下法，宜用大承气汤。
【目】柯琴说：热淫于内，胃火上炎，所以口干燥咽干。急用下法，使火归于坎位，津液自然上升。
【纲】张仲景说：阳明病，脉浮而紧，咽燥口苦，腹部胀满而喘，发热汗出，不恶寒反恶热，身体沉重，用栀子豉汤主治。
【目】陶华说：邪热聚于胃腑，消耗津液，所以口干燥热而渴。大概阳明气血俱多，经中热甚，有迫血妄行而作鼻衄，漱水不欲咽的，用犀角地黄汤；无衄血表症，加之胸腹满而如狂的，则为蓄血在内，用桃仁承气汤；少阳口燥咽干，用小柴胡汤调理。
【纲】张仲景说：少阴病，自利清水，颜色纯青，心下必定痛，口干舌燥的，急当用下法，宜用大承气汤。
【目】柯琴说：自利清水，怀疑其为寒证。但在拉清水时，必定心下痛，必定口燥舌干，这是土燥火炎，脾气不濡润，胃气反而浓烈，水去而谷不去，所以纯青。
[Outline] Zhang Zhongjing said: When the pulse is floating and there is fever, dry mouth, and dry nose, if the patient can eat, epistaxis (nosebleed) will occur. This is Yangming disease. If there is dryness of the mouth, with a desire only to rinse the water in the mouth but no desire to swallow, this must lead to epistaxis. In Yangming disease, if there is only dizziness of the head, without aversion to cold, so that the patient can eat and cough, the person must have sore throat. If there is no cough, there will be no sore throat.
[Commentary] Zhu Gong said: When there is heat in the Spleen organ, body fluids are dried up and reduced, thus causing dryness of the mouth and dry tongue.
Li Gao said: If injured by diet and labor, the external symptoms must manifest in the mouth. There must be loss of taste for grains in the mouth, disharmony in the abdomen, and unwillingness to speak. Even if forced to answer, the voice must be weak. There may be drooling, excessive spitting, and clear nasal discharge, present or absent; this is Yin syndrome. If externally injured by wind-cold, the external symptoms must manifest in the nose. Qi movement is obstructed, the voice is heavy and turbid, speech is blocked, the voice is loud and powerful, and the mouth feels harmonized. In Cold Damage (Shanghan), the face is red, and the nose is congested and dry; in Wind Injury (Shangfeng), only clear nasal discharge occurs; in Food Injury (Shangshi), there is aversion to food.
Pang Anchang said: If the tip of the nose is blue-green, there is abdominal pain. If it is bitter and cold (indicating severe condition with cold limbs), death ensues. If slightly black, there is water retention. If yellow, difficulty in urination. If white, deficiency of Qi. If red, Lung heat. If bright and lustrous, there is retained fluid. Dry nostrils indicate dryness; Yangming heat will inevitably cause epistaxis. Dry nostrils turning black like coal smoke indicate deep heat from Yang toxicity. Cold, slippery, and black nostrils indicate extreme cold from Yin toxicity. Snoring during breathing indicates Wind-Dampness. Nasal congestion with turbid discharge indicates Wind-Heat. Flaring nostrils indicate Lung Wind; this is Lung exhaustion and is incurable. (This is Pang's method of observing the nose.)
[Outline] Zhang Zhongjing said: In Yangming Wind Strike, there is bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, and a floating and tight pulse. If purgation is used incorrectly, abdominal fullness and difficulty in urination will result.
[Commentary] Shen Jin'ao notes: This is the initial stage of Yangming disease, belonging to the exterior aspect of the interior. The mouth is the orifice of the Stomach, and the throat is the gate of the Stomach; therefore, Shaoyang disease is not concurrent, yet symptoms of bitter taste in the mouth and dry throat appear.
[Outline] Zhang Zhongjing said: In Cold Damage, if there is no high fever, but dry mouth and thirst, irritability, and slight aversion to cold on the back, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be administered.
[Commentary] Shen Jin'ao notes: Here, restlessness is not mentioned, only thirst and irritability, indicating that Yang pathogenic factors are about to enter the interior. Although there are both exterior and interior symptoms, the exterior is light and the interior is severe; therefore, Baihu Tang (White Tiger Decoction) is used.
[Outline] Zhang Zhongjing said: After Cold Damage has been treated with emesis or purgation, if after seven or eight days the illness remains unresolved, with heat binding in the interior, fever and heat in both the exterior and interior, occasional aversion to wind, extreme thirst, dryness and irritability on the tongue, and a desire to drink several liters of water, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be administered. In Yangming disease, if there is a desire to drink water due to thirst, with dry mouth and tongue, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be administered.
[Commentary] Cheng Wuji said: This clause describes heat consuming body fluids, where what was once moist has become dry. If heat gathers in the Stomach, the tongue will turn yellow, indicating deep heat. *Jinkui Yaolue* states: If the tongue coating is yellow and purgation has not yet been used, purgation will remove the yellow coating. If the tongue surface itself turns yellow, it indicates extreme heat. *Huangdi Zhenjing* states: In heat diseases, dry mouth with a black tongue indicates death, because the Heart is the sovereign organ, black corresponds to Kidney Water overcoming Heart Fire, and the pathogenic heat is at its extreme, hence death is certain.
Zhang Jiebin said: A black tongue coating with prickles indicates extreme and deep heat. One should use Liangge San (Cool the Chest Powder), Chengqi Tang (Downward Draining Decoctions), or Daxion Hu Tang (Major Bupleurum Decoction) and酌情 apply purgation as appropriate. If the coating is black but slippery and not rough, it is not an excess pathogen nor a fire syndrome; not only is purgation contraindicated, but clearing heat is also contraindicated.
Ke Qin said: Irritability, dry tongue, and extreme thirst indicate unresolving heat binding in Yangming. Therefore, one must rescue the interior to nourish body fluids. These two clauses treated by Baihu Tang address Yangming dryness syndromes and are listed as the main formula for Yangming, which is indeed insightful. This represents Yangming disease progressing from shallow to deep. Previously, bitter taste, dry throat, and aversion to heat indicated heat in the interior but not affecting the Heart; later, confusion and fear indicated entry into the Heart but not yet the Stomach; now, dryness and thirst driving drinking indicate the pathogen has entered the Stomach. However, it has not yet hardened. Using this decoction drains Stomach fire and supports Yuan Qi, completely avoiding the three methods of emesis, sweating, and purgation.
[Outline] Zhang Zhongjing said: In Shaoyin disease, if after two or three days there is no bowel movement, with dry mouth and dry throat, urgent purgation is required; Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
[Commentary] Ke Qin said: Heat rampant within causes Stomach fire to flare upward, resulting in dry mouth and dry throat. Urgent purgation returns the fire to Kan (Water), and body fluids naturally rise.
[Outline] Zhang Zhongjing said: In Yangming disease, with a floating and tight pulse, dry throat and bitter mouth, abdominal fullness and panting, fever and sweating, aversion to neither cold but rather aversion to heat, and heaviness of the body, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered.
[Commentary] Tao Hua said: Pathogenic heat gathering in the Stomach fu consumes body fluids, causing dry, hot, and thirsty mouth. Since Yangming has abundant Qi and Blood, intense heat in the meridians may force blood to move recklessly causing epistaxis; if rinsing water but not swallowing, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used. Without epistaxis or exterior symptoms, but with chest and abdominal fullness and mania-like behavior, it indicates blood stasis internally, and Taoren Chengqi Tang (Peach Kernel Downward Draining Decoction) is used. For Shaoyang dry mouth and dry throat, Xiaochaihu Tang (Minor Bupleurum Decoction) regulates it.
[Outline] Zhang Zhongjing said: In Shaoyin disease, if there is spontaneous diarrhea of clear water, purely green in color, with必定 pain in the epigastrium, dry mouth, and dry tongue, urgent purgation is required; Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
[Commentary] Ke Qin said: Spontaneous diarrhea of clear water might be suspected as a Cold syndrome. However, when passing clear water, there must be pain in the epigastrium and dry mouth and tongue. This indicates dry Earth and flaming Fire, where Spleen Qi is not moistening, and Stomach Qi becomes concentrated. Water leaves but grain remains, hence the stool is purely green.