1.自汗表阳虚恶冷, 阳实蒸热汗津津, 盗汗阴虚分心肾, 心虚不固
火伤阴.
【注】无因汗出, 谓之自汗. 自汗谓表阳虚, 汗出则恶寒冷, 宜用后
方. 若蒸蒸发热, 汗出不恶寒, 则为里阳实, 宜以调胃承气汤下之.
睡则出, 觉则汗止, 谓之盗汗. 盗汗为阴虚, 当分心虚不固, 心火伤
阴也.
黄耆六一汤 玉屏风散 黄耆建中汤
2.自汗表虚黄耆草, 玉屏风散术耆防, 气虚加参阳虚附, 血虚黄耆
建中汤.
【注】黄耆六一汤, 即黄耆六钱, 甘草一钱也. 玉屏风散, 即黄耆,
白术, 防风也. 二方皆治表虚自汗, 若气虚加人参, 阳虚加附子可也
.若不恶寒不气少, 则为血虚, 不可用参, 附, 宜黄耆建中汤, 即小
建中汤加黄耆也. 方在伤寒门.
当归六黄汤 酸枣仁汤
3.盗汗心火下伤阴, 归耆二地柏连芩, 心虚酸枣芍归地, 知柏苓耆
五味参.
【注】当归六黄汤, 治心火伤阴盗汗, 即当归, 黄芩, 黄连, 黄柏,
生熟地黄也. 酸枣仁汤, 治心虚不固盗汗, 即酸枣仁, 当归 , 白芍,
生地, 知母, 黄柏, 茯苓, 黄耆, 五味子, 人参也.
1.九窍出血名大衄, 鼻出鼻衄脑如泉, 耳目出血耳目衄, 肤出肌衄
齿牙宣, 内衄嗽涎脾唾肾, 咯心咳肺呕属肝, 精窍溺血膀胱淋, 便血
大肠吐胃间.
【注】九窍一齐出血, 名曰大衄. 鼻出血, 曰鼻衄. 鼻出血如泉, 曰
脑衄. 耳出血, 曰耳衄. 目出血, 曰目衄. 皮肤出血, 曰肌衄. 齿牙
出血, 曰齿衄, 又名牙宣. 此皆衄血随所患处而命名也. 若从口出则
为内衄. 内衄出血, 涎嗽出于脾, 唾出于肾, 咯出于心, 咳出于肺,
呕出于肝, 吐出于胃. 溺血从精窍而出, 淋血从膀胱而出. 呕吐之分
,呕则有上逆漉漉之声, 吐则无声也.
1. 自汗(不因劳累、炎热或服药而自然出汗)表现为表阳虚衰且怕冷;若阳气实盛则蒸腾发热,汗出连绵不断。盗汗(睡中出汗,醒后汗止)属阴虚,需区分是心气虚弱不能固摄,还是心火亢盛损伤阴液。
【注】没有特定诱因而自然出汗的,称为自汗。自汗是因为体表阳气虚弱,出汗后感到恶风怕冷,适宜使用后面的方剂。如果是蒸蒸发热,出汗且不恶寒,则是体内阳气实盛,适宜用调胃承气汤攻下泄热。睡着时出汗,醒来后汗就停止的,称为盗汗。盗汗属于阴虚,应当区分是心气虚弱不能固摄,还是心火损伤阴液。
黄耆六一汤 玉屏风散 黄耆建中汤
2. 治疗表虚自汗,可用黄耆配甘草(即黄耆六一汤),或用玉屏风散(由白术、黄耆、防风组成)。若兼有气虚加用人参,兼有阳虚加入附子;若为血虚,则用黄耆建中汤。
【注】黄耆六一汤,就是黄耆六钱、甘草一钱的配方。玉屏风散,就是由黄耆、白术、防风组成的。这两个方子都治疗表虚引起的自汗,如果兼有气虚可以加人参,兼有阳虚可以加附子。如果不恶寒且没有气短症状,则是血虚,不可用人参、附子,适宜用黄耆建中汤,也就是在小建中汤的基础上加入黄耆。该方剂记载在伤寒门中。
当归六黄汤 酸枣仁汤
3. 盗汗因心火下行损伤阴液所致,可用当归、黄耆、生地、熟地、黄柏、黄连、黄芩(即当归六黄汤)。若是心气虚弱不固导致的盗汗,可用酸枣仁、白芍、当归、生地、知母、黄柏、茯苓、黄耆、五味子、人参(即加减后的酸枣仁汤类方)。
【注】当归六黄汤,治疗心火伤阴引起的盗汗,由当归、黄芩、黄连、黄柏、生地黄和熟地黄组成。酸枣仁汤,治疗心气虚弱不固引起的盗汗,由酸枣仁、当归、白芍、生地黄、知母、黄柏、茯苓、黄耆、五味子、人参组成。
1. 九窍同时出血称为大衄。鼻出血称为鼻衄,若如泉涌般严重则称为脑衄。耳出血称为耳衄。目出血称为目衄。皮肤出血称为肌衄。牙齿出血称为齿衄,又名牙宣。体内出血从口而出称为内衄。其中,咳唾涎沫出自脾脏病变,唾出自肾脏病变,咯血出自心脏病变,咳嗽出自肺脏病变,呕吐出自肝脏病变,吐食出自胃腑病变。精窍出血及小便带血出自膀胱淋证,大便出血出自大肠,呕吐出自胃腑。
【注】九个孔窍一齐出血,名叫大衄。鼻子出血,叫鼻衄。鼻子出血像泉水一样涌出,叫脑衄。耳朵出血,叫耳衄。眼睛出血,叫目衄。皮肤出血,叫肌衄。牙齿出血,叫齿衄,也叫牙宣。这些都是根据出血部位来命名的。如果血液从口中吐出,就称为内衄。内衄出血中,涎沫和咳嗽源于脾,唾液源于肾,咯血源于心,咳嗽源于肺,呕吐源于肝,吐食源于胃。尿血从精窍流出,淋证出血从膀胱流出。关于呕吐的区别:呕是有上逆且发出漉漉声音的,吐是没有声音的。
1. Spontaneous sweating (sweating naturally without exertion, heat, or medication) manifests as deficiency of exterior Yang with aversion to cold. If Yang is excess and full, it steams and generates heat with continuous sweating. Night sweating (sweating during sleep, stopping upon waking) belongs to Yin deficiency; one must distinguish whether it is due to Heart Qi deficiency failing to secure the exterior, or Heart Fire damaging Yin fluids.
[Note] Sweating without specific cause is called spontaneous sweating. It is caused by deficiency of exterior Yang, where sweating leads to aversion to wind and cold; the following formulas are appropriate. If there is a steaming fever, sweating without aversion to cold, this indicates interior Yang excess, and the Tiaowei Chengqi Decoction should be used to purge downward. Sweating that occurs during sleep and stops upon waking is called night sweating. Night sweating is attributed to Yin deficiency; one must differentiate between Heart Qi deficiency failing to secure and Heart Fire damaging Yin.
Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) Yupingfeng San (Jade Windscreen Powder) Huangqi Jianzhong Tang (Astragalus Establish the Middle Decoction)
2. For treating exterior deficiency spontaneous sweating, use Astragalus paired with Licorice (i.e., Huangqi Liuyi Tang), or Yupingfeng San (composed of Atractylodis Macrocephalae Rhizoma, Astragali Radix, and Saposhnikoviae Radix). If accompanied by Qi deficiency, add Codonopsis Radix; if accompanied by Yang deficiency, add Aconiti Lateralis Radix Praeparata. If it is Blood deficiency, use Huangqi Jianzhong Tang.
[Note] Huangqi Liuyi Tang consists of six qian of Astragali Radix and one qian of Glycyrrhizae Radix et Rhizoma. Yupingfeng San consists of Astragali Radix, Atractylodis Macrocephalae Rhizoma, and Saposhnikoviae Radix. Both formulas treat spontaneous sweating due to exterior deficiency. If Qi deficiency is present, Ginseng Radix may be added; if Yang deficiency is present, Prepared Aconite Root may be added. If there is no aversion to cold and no shortness of breath, it is Blood deficiency; Ginseng and Prepared Aconite Root should not be used. Instead, Huangqi Jianzhong Tang is appropriate, which is Xiao Jianzhong Tang with added Astragali Radix. This formula is recorded in the Treatise on Cold Damage section.
Danggui Liu Huang Tang (Angelica Sinensis Six-Yellow Decoction) Suanzaoren Tang (Ziziphus Seed Decoction)
3. Night sweating caused by Heart Fire descending and damaging Yin fluids can be treated with Dang Gui Liu Huang Tang (comprising Angelicae Sinensis Radix, Astragali Radix, Rehmanniae Radix Preparata, Rehmanniae Radix, Phellodendri Cortex, Coptidis Rhizoma, and Scutellariae Radix). If night sweating is due to Heart Qi deficiency failing to secure, a modified Suanzaoren Tang may be used (comprising Ziziphi Spinosae Semen, Angelicae Sinensis Radix, Paeoniae Radix Alba, Rehmanniae Radix, Anemarrhenae Rhizoma, Phellodendri Cortex, Poria, Astragali Radix, Schisandrae Fructus, and Panax Ginseng Radix).
[Note] Danggui Liu Huang Tang treats night sweating caused by Heart Fire damaging Yin, composed of Angelicae Sinensis Radix, Scutellariae Radix, Coptidis Rhizoma, Phellodendri Cortex, Raw Rehmanniae Radix, and Prepared Rehmanniae Radix. Suanzaoren Tang treats night sweating due to Heart Qi deficiency failing to secure, composed of Ziziphi Spinosae Semen, Angelicae Sinensis Radix, Paeoniae Radix Alba, Rehmanniae Radix, Anemarrhenae Rhizoma, Phellodendri Cortex, Poria, Astragali Radix, Schisandrae Fructus, and Panax Ginseng Radix.
1. Bleeding from all nine orifices simultaneously is called Da Nu (Major Hemorrhage). Nasal bleeding is called Bi Nu (Nasal Epistaxis); if it flows like a spring, it is called Nao Nu (Cranial Epistaxis). Ear bleeding is called Er Nu (Auricular Hemorrhage). Eye bleeding is called Mu Nu (Ocular Hemorrhage). Skin bleeding is called Ji Nu (Cutaneous Hemorrhage). Dental bleeding is called Chi Nu (Gingival Hemorrhage), also known as Ya Xuan (Gum Recession/Hemorrhage). Internal bleeding exiting from the mouth is called Nei Nu (Internal Hemorrhage). Among internal hemorrhages: saliva and cough originate from Spleen pathology; sputum originates from Kidney pathology; hemoptysis originates from Heart pathology; cough originates from Lung pathology; vomiting originates from Liver pathology; regurgitation/vomiting food originates from Stomach pathology. Hematuria from the essence orifice and blood in urine originate from Bladder Lin syndrome; hematochezia originates from Large Intestine; vomiting originates from the Stomach.
[Note] When all nine orifices bleed simultaneously, it is named Da Nu. Bleeding from the nose is called Bi Nu. If nasal bleeding gushes like a spring, it is called Nao Nu. Bleeding from the ears is called Er Nu. Bleeding from the eyes is called Mu Nu. Bleeding from the skin is called Ji Nu. Bleeding from the teeth/gums is called Chi Nu, also known as Ya Xuan. These are all named according to the site of hemorrhage. If blood exits from the mouth, it is termed Nei Nu. In cases of Nei Nu: saliva and cough stem from the Spleen, sputum from the Kidneys, hemoptysis from the Heart, cough from the Lungs, vomiting from the Liver, and vomiting of food from the Stomach. Urinary blood exiting from the essence orifice, and bleeding associated with Lin syndrome, exit from the Bladder. Regarding the distinction between Ou (vomiting with sound) and Tu (vomiting without sound): Ou involves upward reversal with a gurgling sound, whereas Tu occurs without sound.