咽喉干燥者。不可发汗。
病寒之人。非汗不解。而亦有不可发汗者。不可不审。咽喉者。诸阴之所集。而干燥则阴不足
矣。汗者。出于阳而生于阴也。故咽喉干燥者。虽有邪气。不可以温药发汗。若强发之。干燥益甚。为咳。
为咽痛。为吐脓血。无所不至矣。云不可发汗者。谓本当汗而不可发之。非本不当汗之证也。此所
谓之变也。下文仿此。淋家不可发汗。发汗必便血。
巢氏云、淋者肾虚而膀胱热也。更发其汗，损伤脏阴。增益腑热。则必便血。如强发少阴汗而动
其血之例也。
疮家虽身疼痛。不可发汗。汗出则痉。
身疼痛、表有邪也。疮家脓血流溢。损伤阴气。虽有表邪。不可发汗。汗之血虚生风。必发痉
也。
衄家不可发汗。汗出必额上陷。脉紧急。目直视。不能 。不得眠。
额上陷。脉紧急者。额上两旁之动脉。陷伏不起。或紧急不柔也。灵枢云、两跗之上。脉陷竖
者。足阳明。陷谓陷伏。竖即紧急。与此正相发明。目直视。不能 。不得眠。皆亡阴之证也。
亡血家不可发汗。发汗则寒栗而振。
阴亡者。阳不守。亡血复汗。寒栗而振者。阴气先虚。而阳气后竭也。按疮家衄家。并属亡血。
而此条复出亡血家者。该吐下跌仆金刃产后等证为言也。
汗家重发汗。必恍惚心乱。小便已阴疼。与禹余粮丸。
五液在心为汗。心液亡者。心阳无附。则恍惚心乱。心虚生热。下流所合。则小便已阴疼。禹余粮
丸方缺。常器之云、只禹余粮一味。火 服亦可。按禹余粮。体重可以去怯。甘寒可以除热。又
性涩。主下焦前后诸病也。
病患有寒。复发汗。胃中冷。必吐蛔。
有寒、里有寒也。里有寒者。虽有表邪。必先温里而后攻表。如后四逆汤之法。乃不与温里
而反发汗。损伤阳气。胃中虚冷。必吐蛔也
形作伤寒。其脉不弦紧而弱。弱者必渴。被火者必谵语。弱者发热脉浮。解之当汗出愈。
形作伤寒。其脉当弦紧而反弱。为病实而正虚也。脉弱为阴不足。而邪气乘之。生热损阴。则
必发渴。乃更以火劫汗。两热相合。胃中燥烦。汗必不出。而谵语立至矣。若发热脉浮。则邪欲出
表。阴气虽虚。可解之。使从汗而愈。如下条桂枝二越婢一等法。若脉不浮。则邪热内扰。将救
阴之不暇。而可更取其汗耶。脉浮数者。法当汗出而愈。若下之。身重心悸者。不可发汗。当自汗
出乃解。所以然者。尺中脉微。此里虚。须表里实。津液自和。便自汗出愈。
脉浮数者。其病在表。法当汗出而愈。所谓脉浮数者可发汗。宜麻黄汤是也。若下之。邪入里而
身重。气内虚而心悸者。表虽不解。不可以药发汗。当俟其汗自出而邪乃解。所以然者。尺中脉微
。为里虚不足。若更发汗。则并虚其表。里无护卫。而散亡随之矣。故必候其表里气复。津液通和
。而后汗出而愈。岂可
以药强迫之哉。
脉浮紧者。法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。何以知然。以营气不足。
血少故也。
脉浮紧者。寒邪在表。于法当身疼痛。而其治宜发汗。假令尺中脉迟。知其营虚而血不足。则
虽身疼痛。而不可发汗。所以然者。汗出于阳而生于阴。营血不足而强发之。汗必不出。汗即出
而筋惕肉 。散亡随之矣，可不慎哉。
咽喉干燥的人，不可以使用发汗法治疗。
患寒病的人，通常需要通过发汗才能解除病邪，但也有不可发汗的情况，必须仔细审察。
咽喉是诸阴经汇聚之处，如果咽喉干燥，说明阴液已经不足。
汗液由阳气蒸化而出，但其根源在于阴液。
因此，对于咽喉干燥的人，即使有外邪侵袭，也不可以使用温性药物强行发汗。
如果强行发汗，会导致干燥更加严重，进而引发咳嗽、咽痛，甚至吐出脓血等严重后果，各种变证都可能发生。
这里所说的“不可发汗”，是指本应当用汗法但不可强行发汗，并非指原本就不属于应当发汗的证候。
这被称为“变证”。下文的情况与此类似。
患有淋证（小便频数短涩、滴沥刺痛）的人，不可发汗。
如果发汗，必然导致尿血。
巢元方说：淋证是由于肾虚而膀胱有热所致。
如果再发汗，会损伤脏器的阴液，增加腑的热邪，那么必然会导致尿血。
这就像强行发少阴经之汗而扰动血液的例子一样。
患有疮疡（皮肤溃烂流脓）的人，虽然身体疼痛，也不可以发汗。
如果发汗，会导致痉病（肌肉痉挛、抽搐）。
身体疼痛，说明体表有邪气。
疮疡患者脓血流溢，已经损伤了阴气。
虽然体表有邪气，也不可以发汗。
如果发汗，会导致血虚生风，必然引发痉病。
经常鼻出血（衄血）的人，不可发汗。
如果发汗，必然出现额旁动脉凹陷、脉象紧急、两眼直视不能转动、无法入睡等症状。
额旁动脉凹陷、脉象紧急，是指额头两侧的动脉陷伏不起，或者脉象紧急而不柔和。
《灵枢》说：足背上的脉搏陷伏竖起的，是足阳明胃经的脉象；“陷”指陷伏，“竖”即紧急。这与本文正相印证。
两眼直视不能转动、无法入睡，都是阴液亡失的证候。
失血的人，不可发汗。
如果发汗，会出现寒战颤抖的症状。
阴液亡失，阳气就无法依附。
在失血的基础上再发汗，出现寒战颤抖，是因为阴气先已虚弱，随后阳气也竭尽了。
按：疮疡患者和经常鼻出血的患者，都属于失血范畴。
但此处再次提出“失血者”，是为了涵盖吐血、下血、跌打损伤、金刃创伤、产后出血等各种情况而言。
平素多汗的人，如果再发汗，必然出现心神恍惚、心中烦乱，小便结束后阴茎疼痛的症状，应给予禹余粮丸治疗。
五液在心中化为汗。
心液亡失，心阳就没有依附，所以会出现心神恍惚、心中烦乱。
心虚产生内热，热邪下行影响到前阴，所以小便结束后阴茎疼痛。
禹余粮丸的方剂缺失。
常器之说：只用禹余粮一味药，煅烧后服用也可以。
按：禹余粮质地沉重可以去怯安神，味甘性寒可以清热，又具有涩性，主治下焦前后二阴的各种疾病。
病人体内有寒，如果再发汗，会导致胃中寒冷，必然呕吐蛔虫。
“有寒”是指里有寒邪。
里有寒邪的人，即使有表邪，也必须先温补里寒，然后再解表。
如后文四逆汤的方法。
如果不先温里反而发汗，就会损伤阳气，导致胃中虚冷，必然呕吐蛔虫。
病症表现像伤寒，但脉象不弦紧而弱。
脉弱的人必定口渴，如果被火疗强迫发汗，必然出现谵语（胡言乱语）。
如果脉弱且发热、脉浮，通过解表法治疗应当出汗而痊愈。
病症表现像伤寒，脉象应当弦紧却反而弱，这是病邪实而正气虚的表现。
脉弱表示阴液不足，邪气乘虚而入，产生热邪损伤阴液，所以必然出现口渴。
此时如果再用火疗劫夺汗液，两热相合，导致胃中燥热烦扰，汗必不出，而谵语立刻就会出现。
如果发热且脉浮，说明邪气欲从表出，虽然阴气虚弱，但可以通过解表法治疗，使邪气随汗而解。
如下条文中桂枝二越婢一汤等治法。
如果脉不浮，则邪热内扰，抢救阴液尚且来不及，难道还可以再去取汗吗？
脉浮数的，按照法则应当出汗而痊愈。
如果使用下法，出现身体沉重、心悸的症状，就不可发汗，应当等待其自汗出而病解。
之所以这样，是因为尺部脉微，这是里虚的表现。
需要表里之气充实，津液自然调和，便会自汗出而痊愈。
脉浮数，说明病在表，按照法则应当出汗而痊愈。
所谓“脉浮数者可发汗，宜用麻黄汤”就是这种情况。
如果使用下法，邪气入里导致身体沉重，气虚导致心悸，虽然表证未解，也不可以用药物强行发汗。
应当等待其自汗出，邪气才能解除。
之所以这样，是因为尺部脉微，为里虚不足。
如果更发汗，则会同时使表气也虚，里气无护卫，正气散亡随之而来。
所以必须等待表里之气恢复，津液通调和谐，然后才会汗出而痊愈。
怎么可以用药物强迫发汗呢？
脉浮紧的，按照法则应当身体疼痛，适宜用汗法解除。
假如尺部脉迟的，不可发汗。
为什么知道是这样？因为营气不足，血少的缘故。
脉浮紧，说明寒邪在表，按照法则应当身体疼痛，其治疗方法适宜发汗。
假如尺部脉迟，就知道营血虚弱而不足。
那么即使身体疼痛，也不可以发汗。
之所以这样，是因为汗液出于阳气而生于阴液。
营血不足而强行发汗，汗必不出。
即使汗出，也会导致筋惕肉瞤（肌肉跳动），正气散亡随之而来，能不谨慎吗？
Those with dryness of the throat and pharynx should not be treated with diaphoresis (sweating therapy).
Patients suffering from cold pathogens generally require diaphoresis to resolve the pathogen, yet there are cases where diaphoresis is contraindicated; this must be carefully examined.
The throat and pharynx are the gathering point of all Yin meridians. Dryness here indicates a deficiency of Yin fluids.
Sweat is generated by the vaporization of Yang Qi but originates from Yin fluids.
Therefore, for those with dryness of the throat and pharynx, even if external pathogens are present, one must not use warm-natured herbs to force diaphoresis.
If forced, the dryness will worsen, leading to cough, sore throat, and even vomiting of pus and blood, with various adverse transformations potentially occurring.
The phrase "should not be treated with diaphoresis" refers to conditions that theoretically warrant sweating but should not be forcibly induced, not to conditions that inherently do not require sweating.
This is referred to as an "adverse transformation." The following cases follow this pattern.
Patients with strangury (a syndrome characterized by frequent, urgent, and painful urination) should not be treated with diaphoresis.
If diaphoresis is induced, hematuria (blood in urine) will inevitably occur.
Chao Yuan-fang stated: Strangury arises from Kidney deficiency and Bladder heat.
Inducing sweat further damages Zang organ Yin and exacerbates Fu organ heat, inevitably leading to hematuria.
This is analogous to the case of forcibly inducing sweat in Shaoyin disease and disturbing the blood.
Patients with chronic sores and ulcers, although experiencing body pain, should not be treated with diaphoresis.
If diaphoresis is induced, spasm (tetany or convulsions) will occur.
Body pain indicates the presence of pathogenic factors on the exterior.
Patients with sores have lost pus and blood, thereby damaging their Yin Qi.
Even with exterior pathogens, diaphoresis is contraindicated.
Inducing sweat leads to Blood deficiency generating Wind, inevitably causing spasm.
Patients prone to epistaxis (nosebleeds) should not be treated with diaphoresis.
If diaphoresis is induced, depression of the temporal arteries, tense pulse, fixed gaze, inability to move the eyes, and insomnia will occur.
Depression of the temporal arteries and tense pulse refer to the sunken or rigid, non-pliable nature of the arteries on both sides of the forehead.
The *Ling Shu* states: Sunken and erect pulses on the dorsum of the foot indicate the Foot-Yangming Stomach meridian; "sunken" means depressed, and "erect" means tense. This perfectly elucidates the current text.
Fixed gaze, inability to move the eyes, and insomnia are all signs of Yin fluid exhaustion.
Patients who have suffered significant blood loss should not be treated with diaphoresis.
If diaphoresis is induced, chills and trembling will occur.
When Yin fluids are exhausted, Yang Qi cannot remain anchored.
Following blood loss with diaphoresis results in chills and trembling because Yin Qi was previously deficient, followed by the exhaustion of Yang Qi.
Note: Patients with chronic sores and those prone to epistaxis both fall under the category of blood loss.
However, this specific clause reiterates "patients with blood loss" to encompass other conditions such as hematemesis, hematochezia, traumatic injuries, surgical wounds, and postpartum hemorrhage.
Patients who habitually sweat, if subjected to further diaphoresis, will suffer from mental confusion and restlessness, along with penile pain after urination. They should be administered Yu Yu Liang Wan (Hematitum Pill).
The five fluids transform into sweat within the Heart.
When Heart fluids are depleted, Heart Yang has no anchor, resulting in mental confusion and restlessness.
Heart deficiency generates internal heat, which flows downward to affect the genitalia, causing penile pain after urination.
The formula for Yu Yu Liang Wan is missing.
Chang Qizhi stated: Using only Hematitum (Yu Yu Liang), calcined and taken orally, is also effective.
Note: Hematitum is heavy in nature and can dispel fright; it is sweet and cold, clearing heat; and it is astringent, treating various disorders of the lower Jiao anterior and posterior orifices.
Patients with interior cold, if subjected to diaphoresis, will develop coldness in the Stomach and inevitably vomit roundworms.
"Having cold" refers to interior cold.
In cases of interior cold, even if exterior pathogens exist, the interior must first be warmed before addressing the exterior, as demonstrated by the Si Ni Tang (Frigid Extremities Decoction) method later in the text.
Failing to warm the interior and instead inducing sweat damages Yang Qi, leading to Stomach deficiency-cold and the vomiting of roundworms.
A condition presenting like Taiyang Cold Damage (Shanghan) but with a pulse that is neither wiry-tight nor floating-superficial, but rather weak.
A weak pulse indicates thirst. If fire therapy is applied to induce sweat, delirium will ensue.
If the pulse is weak, accompanied by fever and floating qualities, resolution through diaphoresis should result in sweating and recovery.
A presentation resembling Shanghan with a pulse that should be wiry-tight but is actually weak indicates excess pathogen and deficient healthy Qi.
A weak pulse signifies insufficient Yin; pathogens exploit this deficiency, generating heat and damaging Yin, thus causing thirst.
Applying fire therapy to劫 (rob) sweat combines two heats, causing dryness and irritability in the Stomach. Sweat will not emerge, and delirium will immediately follow.
If fever and a floating pulse are present, the pathogen desires to exit via the exterior. Although Yin is deficient, it can be resolved by promoting sweating, similar to the Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice, Green Ginger Once Decoction) method mentioned below.
If the pulse is not floating, the pathogenic heat disturbs the interior; rescuing Yin is already urgent enough, let alone inducing sweat.
A floating and rapid pulse typically indicates that sweating should lead to recovery.
If purgation is used instead, resulting in heaviness of the body and palpitations, diaphoresis is contraindicated. Recovery occurs when spontaneous sweating happens.
This is because a faint pulse at the Chi position indicates interior deficiency. The interior and exterior must become solid, and once fluids harmonize naturally, spontaneous sweating will occur, leading to recovery.
A floating and rapid pulse indicates the disease is on the exterior, where diaphoresis is the standard treatment for recovery ("Floating and rapid pulses may be treated with diaphoresis, appropriate for Mahuang Tang").
If purgation is used, pathogens enter the interior causing heaviness, and Qi deficiency causes palpitations. Even if the exterior syndrome persists, pharmacological diaphoresis is contraindicated. One must wait for spontaneous sweating to resolve the pathogen.
This is because a faint Chi pulse indicates interior deficiency. Further diaphoresis would deplete the exterior Qi as well, leaving the interior unprotected and leading to collapse.
Thus, one must wait for the restoration of exterior and interior Qi and the harmony of fluids before sweating occurs. How could one force it with medication?
A floating and tight pulse typically presents with body pain and is suitable for resolution via diaphoresis.
However, if the pulse at the Chi position is slow, diaphoresis is contraindicated. Why? Because Ying Qi is insufficient and Blood is scant.
A floating and tight pulse indicates Cold pathogens on the exterior, typically causing body pain, treated with diaphoresis.
If the Chi pulse is slow, it indicates deficiency of Ying and insufficiency of Blood.
Even with body pain, diaphoresis is contraindicated.
This is because sweat emerges from Yang but originates from Yin. Forcing sweat when Ying-Blood is insufficient will prevent sweating.
If sweat does occur, it leads to muscle twitching and tremors, followed by the dissipation of healthy Qi. Can one not be cautious?