2．热证：热盛因热邪煎熬，津液不能上承，故口渴。治宜泻火救阴，如三黄之类。兼便秘者，急下存阴，如承气之类。
3。燥证：因燥伤津液而致肺胃之水津不足，其人必频引水自救也。治宜润肺生津或清胃滋阴，方如沙参麦冬汤、玉女煎等。
4．伤寒阳明病或温病热在气分：热甚口渴，兼见大热、大汗、脉洪大。对这类里热口渴症，当清其热则渴自止，如白虎汤类、雪梨浆等。
5．蓄水证：伤寒蓄水证而见口渴者，乃阳虚有寒，水停不化，津气不能上升也，其症小便必不利，腹满有水。治宜温阳散寒化水，方用五苓散、真武汤之类。
6．暑证：暑热深入少阴消渴者，饮水不止。乃暑热亢盛，伤及肾津也。宜连梅汤主之。
7．伤寒厥阴病：宜乌梅丸主之。
8．阴虚火旺：口渴引饮而不解渴，夜间为甚，且伴五心烦热，骨蒸潮热等。治宜养阴生津，方选六味地黄汤合增液汤。
9．血虚证：血虚口渴者，为血虚热盛，水津不足也。治宜补血清热生津，方用圣愈汤加天门冬、天花粉，或当归补血汤加天花粉、苎麻根、玉竹、麦冬。
此外，口渴欲饮还是桂枝汤的禁忌证。
(三)口渴不欲饮或不多饮
多见于湿温。湿温为感受湿热病邪所致，有热则渴，有湿则不多饮，或喜热饮，且伴身热不扬或午后身热。胸脘痞闷，身重头蒙，便溏不爽等。治宜清热化湿并举，宜黄芩滑石汤或茯苓皮汤。
(四)口干但欲漱水不欲咽
常为邪在血分之指征。如瘀血口渴，系气为血阻，水津不能随气上布也，其人虽口渴，但欲漱水而不欲咽，其症必有瘀血之主症。治宜祛瘀，或祛瘀兼生津，兼清热，兼除寒等，方用血府逐瘀汤或小柴胡汤加丹皮、杏仁。瘀血兼热之口渴用桃仁承气汤；月经不调兼有瘀血，且上热下寒之口渴，用温经汤；跌打损伤瘀血之口渴便闭，用玉烛散。
(五)饮水下咽即吐
可见于：
1．水逆证：水饮停聚，水津不能四布，必兼小便不利。治宜五苓散以温阳化饮。
2．伏暑在肺：本该用温散，却误用温补，致肺气不能清肃下行。治宜泻白散合清燥救肺汤。 (六)渴喜热饮 可见于： 湿温：有热则渴，有湿则喜热饮(湿为阴邪，非温不化)。
此外，渴喜热饮还是黄芩汤的禁忌证，一切喜热性饮食的寒证泻痢，绝对禁忌使用黄芩汤。 (七)渴喜冷饮
这是有内热的表现。根据喜冷程度的轻重，饮水数量的多少，可以测知内热的轻重，因而可以决定用药的品种和剂量。在伤寒来说有三种类型：
1．太阳病发热兼口渴者，为温病。
2．太阳病咳嗽或气喘兼口渴者，为小青龙汤加石膏或去半夏加蒌根的证候。
3．阳明病大热大汗大渴者，为白虎汤证。
二、口味
(一)口腻
口腻，是指口舌粘腻，滞涩不爽，味觉不佳，为湿证主症之一。但有寒热之别，寒湿者口腻较轻，口淡乏味，口中不渴，大便溏薄，舌淡苔白，脉濡而缓；湿热者口腻较重，口气秽浊，味觉或苦或甘，口渴不欲饮，大便粘滞不爽，小便黄赤，舌红苔黄，脉数。前者治宜芳香化湿，方用藿香正气散、平胃散；后者治宜清热化湿，方用三仁汤、藿朴夏苓汤。若湿聚成痰，蕴久化热，而致痰热阻滞，也可见到口舌粘腻，兼见口渴不欲饮，多有黄痰而不易咯出，胸膈满闷，舌红苔黄，脉滑数。治宜清热化痰，方选黄连温胆汤，或用清气化痰丸。
(二)口苦
苦为胆味，口苦多为肝胆郁热之征，多兼胸胁苦满。头痛眩晕、性急易怒等症。方用蒿芩清胆汤以清胆利湿，和胃化痰。
(三)口淡
口淡而微腻者，湿证也，方选三仁汤、藿朴夏苓汤。也可由脾胃虚弱所致，必兼体倦乏力，便溏，舌淡脉弱等。治宜益气健脾和胃，方选香砂六君子汤。
(四)口甜
口甜多为脾热症状，有实热、虚热之分。实热者多为脾胃热盛，症兼口渴引饮，多食易饥，大便于结，舌红苔燥，脉数有力，可子泻黄散以清胃泻火；虚热者为脾胃气阴两虚，以纳少、神疲乏力、舌红少苔、脉细数为主症，治宜补气滋阴，方选七味白术散加山药、石斛等。口甜也可见于湿温病湿证偏重者，其或口甜，或口淡，或口腻，不渴，或渴不欲饮，或渴喜热饮。治宜宣化湿浊，方宜三仁汤、藿朴夏苓汤。
练习诊脉应以缓脉为标准
缓脉，是不浮不沉、不大不小、不虚不实、不迟不数的一种正常脉象，也就是在无病时的一种脉象。初学练习诊脉的时候，必须先掌握缓脉，就是以缓脉作为标准进行对比。比此脉接近皮肤的就叫作浮，比此脉接近筋骨的就叫作沉，比此脉大的就叫作洪，比此脉小的就叫作微，比此脉有力的就叫作实，比此脉无力的就叫作虚，比此脉快的就叫作数，比此脉慢的就叫作迟，比此脉流动滑利的就叫作滑脉，比此脉流动涩滞的就叫作涩脉。
伤寒、温病细鉴别
伤寒有广义、狭义之分，广义的伤寒，为多种外感热病的总称，而狭义的伤寒，为外受寒邪，感而即发的病变。这里所说的伤寒是指狭义的伤寒而言。温病是多种外感急性热病的总称。二者同属外感而发，都有表证特征，但治法各异。临证需详审才易斟别。
1．从发病原因来辨：伤寒是感受寒邪，温病则是感受温热病邪。
2．从主要症状来辨：伤寒、温病初起时都有发热、恶寒、头痛的症候，但伤寒恶寒较重，发热较轻，甚者还有但寒不热者，其头痛的程度较重，往往兼有项强；温病发热较重，恶寒较轻，甚者也有但热不恶寒者，头痛的程度较轻，从来不兼项强。
3．从舌、口、饮食、脉象、小便等方面来辨：伤寒初起一般舌质正常不变，舌苔或淡白而薄，或无苔而润，口不干不苦不渴，不喜冷性饮食，脉象浮紧或浮缓，小便多清利；温病初起有的舌质较红，有的舌苔黄白而燥，口或苦或干，或渴或喜冷性饮食，脉象多浮数或浮大，小便多黄赤。
关于阳虚 一、什么是阳 《内经》云： “阳受气于天，以温皮肤分肉之间。”顾松园说：“凡通体之温者阳气也。”章次公说：“回阳之说为恢复体温。”根据以上之说，阳即体温。但李老认为阳指人体整个热力而言，非单纯指体温计测量之温度。 二、什么是阳虚 李老认为阳虚即人体热力不足。三、阳虚的原因(1)禀赋不足。(2)饮食生冷过度(为脾胃阳虚之主要原因)。(3)出汗过多(造成卫阳虚的主要原因)。(4)服寒凉药品失当。(5)房室过度(肾阳虚的主要原因)。(6)阴虚：阴阳互根，阴虚日久，也必然引起阳虚。(7)气虚(阳虚须补气的通理)。(8)气候寒冷：衣服单薄(如冻死即亡阳之死)。四、阳虚的种类(1)肾阳虚。(2)脾阳虚。(3)心阳虚。(4)肺阳虚。(5)胃阳虚。(6)卫阳虚。(7)肝阳虚。(8)表阳虚。(9)里阳虚。(10)真阳虚脱。(11)阴盛格阳(于上，于外)。(12)膀胱阳虚。(13)亡阳。 五、阳虚的症状 (一)阳虚的全身症状 头部：①头痛(如阳虚头痛)，头顶如冰。②面色赤(如戴阳证)．
鬓部：汗出鬂润至巅。
面部：色青，面白如刮，面赤(如涂丹)，面部觉热。
目部：睛突，眼黑，倦视，目视无光，目中有光。
耳部：先鸣后聋。
鼻部：鼻衄。
口部：不渴， 口吐沫，恶心欲吐，口虽渴而不欲饮，吐痰多清稀，吐血，呕吐。
舌部：舌胀，舌苔虽有必滑。
牙部：齿牙浮动。
咽喉：咽喉肿痞疼痛。
颈部：颈项如冰，颈项粗大。
胸胁：胸胁刺痛，胀满。
腹部：腹痛，膨胀，脐腹作痛，小腹如卵上下走痛，疝痛，肠绞痛，肠管麻痹，腹痛肠鸣，腹肌挛急。 背脊：背恶寒。 腰部：腰脊酸困腰痛。 前后阴：阴部发冷，精滑白出，无于，阳痿，遗精，子宫冷，阴囊水肿。
大小便：小便清白，小便不禁，小便清长，癃闭(膀胱麻痹)，大便溏泻，下利，便秘，饮一溲一。
四肢：手足逆冷，脚气，腰膝酸困。
全身：体冷畏寒，周身青紫，自汗淋漓，多汗，易感冒，多寒，痘疮顶陷。
神识：沉默，神气不足，神疲气怯。
感觉：多寒，面部觉热。
睡眠：蜷卧，昼日烦躁不眠，夜而安静。
喜恶：喜热畏凉，恶寒，喜引衣，喜阳光，向火，喜热食。
脉象：脉沉小迟，微细，浮大无根，右尺部沉小迟。
呼吸：喘，气冷，咳嗽。
皮肤：肌肉粟起，浮肿，身热，按之筋骨之间反觉寒。
肌肉：肉（目闰）。
筋骨：筋惕。
血：吐血、衄血必有黑点。
肠胃：饮食稍冷即溏泻。
饮食：食欲减少，口不渴，或渴不欲饮，虽思凉性饮食，但索而不食(个别亦有索而食者，但舌必不燥)。
衣服：虽暑月，不离复衣(甚者着棉衣者)。
房事：性欲减退，房事后呻吟不已。
按：以上之证有阳虚之证(阳虚则寒)，亦有阳虚火不归原，真寒假热，内寒外热，而出现吐衄面赤等假象者，所以不能单凭某一点即认为是阳虚，当以主症为依据(阳虚之证亦要考虑是否热之假象)。
(二)阳虚的主症
体温不足，恶寒(包括怕风寒和不喜冷性饮食两方面)，手足冷，溺清，便溏，舌润，脉沉迟、微细、无力，阳痿早泄，腰膝酸软。
1．头痛：多清晨痛，并兼有其他阳虚证候，头喜热物包裹之，遇阴遇寒即痛。
2．目中有光：真阳外露之象。无论睁眠或闭眠，自己看到目中有光彩的样子。
3．先鸣后聋：肾虚不能闭藏，阴气充塞于阳窍也，尺脉必弱，宜桂附地黄丸加磁石、菖蒲、苁蓉之类。
4．恶心呕吐：为肾阳虚，阴火上冲，宜正元丹。
5．口吐涎沫：如系阴虚者，口必渴。
6．齿牙浮动：这是由于肾阳虚，虚火上逆所致(若服凉药必加重)。
7．大便泄泻：多为黎明泻，或下利清谷，或溏便如鸭溏。
8．大便秘：有寒结者。有肾阳虚兼肠结者。
9．手足逆冷：时厥时温的不是阳虚，当细辨之。
10．咳嗽：阳虚喘咳者极少。 (凡是慢性虚寒咳嗽都是阳虚。)
11．喘：阳虚喘者较少。阳虚气喘多属危候，因为它是真阳上脱的主症。
12．饮一溲一：这是三消中的下消。
六、诊断
1．必须了解阳虚的主症和一般症状。
2．阳虚必须和阴虚各证互相对照衡量之。
3．阳虚必须和气虚互相对照衡量之。因中医很多地方阳虚和气虚有关系，其实不同，故须加以鉴别。 七、机制 阳虚则气虚，阳虚则血也虚，不能运化精微以生气血。(阳与气的关系，气属阳，气有余即化火。)
阳虚则阴也虚：阳生则阴长。
阳虚则生外寒：如经常怕冷，易感寒邪(抵抗力不足)。
阳虚则浊阴上千：浊阴之象弥漫，胸中易生喘嗽痰壅胸满。
阳虚水泛为痰：肾阳虚易形成痰饮。
阳虚则喜阳助：如早轻暮重之象。
阳虚则阴必走：为大吐大衄之病。
阳虚则元气不能自摄：阳上脱多喘。
脾阳虚则湿不化。
八、阳虚各证
1．表阳虚(即卫阳虚)：主症：自汗恶寒(自汗为阳虚，汗之后恶冷)。常用方剂：黄芪六一散或玉屏风散加附子(气虚加人参)，芍药甘草附子汤(汗后阴阳两虚)。
2. 热证：由于热邪炽盛，煎熬津液，导致津液无法向上输布，因此出现口渴。治疗应当泻火救阴，例如使用三黄类药物。如果兼有大便秘结，需急下以保存阴液，例如使用承气汤类方剂。
3. 燥证：因燥邪损伤津液，导致肺胃的水津不足，患者必然频繁饮水以自救。治疗应当润肺生津或清胃滋阴，方剂如沙参麦冬汤、玉女煎等。
4. 伤寒阳明病或温病热在气分：表现为热甚口渴，同时伴有高热、大汗、脉象洪大。对于这类里热引起的口渴症，应当清除其热邪，则口渴自止，例如使用白虎汤类方剂、雪梨浆等。
5. 蓄水证：伤寒蓄水证出现口渴者，是由于阳气虚弱且有寒，水液停聚不能气化，津气不能上升所致，其症状必见小便不利，腹部胀满有水。治疗应当温阳散寒化水，方剂用五苓散、真武汤之类。
6. 暑证：暑热深入少阴经导致消渴者，饮水不止。这是由于暑热亢盛，损伤了肾之津液。宜用连梅汤主治。
8. 阴虚火旺：口渴引饮但不能解渴，夜间加重，且伴有心烦发热（五心烦热）、骨蒸潮热等症状。治疗应当养阴生津，方剂选用六味地黄汤合增液汤。
9. 血虚证：血虚导致的口渴，是因为血虚而热盛，水津不足。治疗应当补血清热生津，方剂用圣愈汤加天门冬、天花粉，或者当归补血汤加天花粉、苎麻根、玉竹、麦冬。
(三) 口渴但不想喝水或喝水量不多
多见于湿温病。湿温是由感受湿热病邪所致，有热则口渴，有湿则不想多喝，或者喜欢喝热水，且伴有身热不扬或午后发热、胸脘痞闷、身体沉重头昏蒙、大便溏薄不爽等症状。治疗应当清热与化湿并举，宜用黄芩滑石汤或茯苓皮汤。
(四) 口干但只想含水漱口而不想咽下
这通常是邪气在血分的指征。如瘀血导致的口渴，是由于气被血阻滞，水津不能随气上行布散，所以人虽然口渴，但只想含水漱口而不想咽下，其症状必有瘀血的主症。治疗应当祛瘀，或祛瘀兼生津、兼清热、兼除寒等，方剂用血府逐瘀汤或小柴胡汤加丹皮、杏仁。瘀血兼热的口渴用桃仁承气汤；月经不调兼有瘀血，且上热下寒的口渴，用温经汤；跌打损伤瘀血导致的口渴和大便闭结，用玉烛散。
(五) 饮水下咽即吐
可见于以下情况：
1. 水逆证：水饮停聚，水津不能四布，必兼小便不利。治疗宜用五苓散以温阳化饮。
2. 伏暑在肺：本该用温散法，却误用温补，导致肺气不能清肃下行。治疗宜用泻白散合清燥救肺汤。
(六) 口渴喜欢喝热水
可见于：
湿温：有热则口渴，有湿则喜欢喝热水（湿为阴邪，非温不能化解）。
此外，口渴喜欢喝热水也是黄芩汤的禁忌证，一切喜热性饮食的寒证泻痢，绝对禁忌使用黄芩汤。
(七) 口渴喜欢喝冷饮
这是有内热的表现。根据喜欢冷的程度轻重，饮水数量的多少，可以测知内热的轻重，因而可以决定用药的品种和剂量。在伤寒中有三种类型：
1. 太阳病发热兼口渴者，属于温病。
2. 太阳病咳嗽或气喘兼口渴者，属于小青龙汤加石膏或去半夏加瓜蒌根的证候。
3. 阳明病大热、大汗、大渴者，属于白虎汤证。
二、口味
(一) 口腻
口腻，是指口舌粘腻，滞涩不爽，味觉不佳，是湿证的主要症状之一。但有寒热之别，寒湿者口腻较轻，口淡乏味，口中不渴，大便溏薄，舌淡苔白，脉濡而缓；湿热者口腻较重，口气秽浊，味觉或苦或甘，口渴但不想喝水，大便粘滞不爽，小便黄赤，舌红苔黄，脉数。前者治疗宜芳香化湿，方剂用藿香正气散、平胃散；后者治疗宜清热化湿，方剂用三仁汤、藿朴夏苓汤。若湿聚成痰，蕴久化热，导致痰热阻滞，也可见到口舌粘腻，兼见口渴不想喝水，多有黄痰而不易咯出，胸膈满闷，舌红苔黄，脉滑数。治疗宜清热化痰，方选黄连温胆汤，或用清气化痰丸。
(二) 口苦
苦为胆的味道，口苦多为肝胆郁热的征象，多兼有胸胁苦满、头痛眩晕、性情急躁易怒等症状。方剂用蒿芩清胆汤以清胆利湿，和胃化痰。
(三) 口淡
口淡而微腻者，是湿证，方剂选三仁汤、藿朴夏苓汤。也可由脾胃虚弱所致，必兼体倦乏力、便溏、舌淡脉弱等症状。治疗宜益气健脾和胃，方选香砂六君子汤。
(四) 口甜
口甜多为脾热的症状，有实热、虚热之分。实热者多为脾胃热盛，症状兼有口渴引饮、多食易饥、大便秘结、舌红苔燥、脉数有力，可用泻黄散以清胃泻火；虚热者为脾胃气阴两虚，以纳少、神疲乏力、舌红少苔、脉细数为主症，治疗宜补气滋阴，方选七味白术散加山药、石斛等。口甜也可见于湿温病湿证偏重者，其或口甜，或口淡，或口腻，不渴，或渴不欲饮，或渴喜热饮。治疗宜宣化湿浊，方宜三仁汤、藿朴夏苓汤。
练习诊脉应以缓脉为标准
缓脉，是不浮不沉、不大不小、不虚不实、不迟不数的一种正常脉象，也就是在无病时的一种脉象。初学练习诊脉的时候，必须先掌握缓脉，就是以缓脉作为标准进行对比。比此脉接近皮肤的就叫作浮脉，比此脉接近筋骨的就叫作沉脉，比此脉大的就叫作洪脉，比此脉小的就叫作微脉，比此脉有力的就叫作实脉，比此脉无力的就叫作虚脉，比此脉快的就叫作数脉，比此脉慢的就叫作迟脉，比此脉流动滑利的就叫作滑脉，比此脉流动涩滞的就叫作涩脉。
伤寒、温病细鉴别
伤寒有广义、狭义之分，广义的伤寒，是多种外感热病的总称，而狭义的伤寒，是外受寒邪，感而即发的病变。这里所说的伤寒是指狭义的伤寒而言。温病是多种外感急性热病的总称。二者同属外感而发，都有表证特征，但治法各异。临证需详审才容易辨别。
1. 从发病原因来辨：伤寒是感受寒邪，温病则是感受温热病邪。
2. 从主要症状来辨：伤寒、温病初起时都有发热、恶寒、头痛的症候，但伤寒恶寒较重，发热较轻，甚者还有只寒不热的，其头痛的程度较重，往往兼有项强；温病发热较重，恶寒较轻，甚者也有只热不恶寒的，头痛的程度较轻，从来不兼项强。
3. 从舌、口、饮食、脉象、小便等方面来辨：伤寒初起一般舌质正常不变，舌苔或淡白而薄，或无苔而润，口不干不苦不渴，不喜冷性饮食，脉象浮紧或浮缓，小便多清利；温病初起有的舌质较红，有的舌苔黄白而燥，口或苦或干，或渴或喜冷性饮食，脉象多浮数或浮大，小便多黄赤。
关于阳虚
一、什么是阳
《内经》云：“阳受气于天，以温皮肤分肉之间。”顾松园说：“凡通体之温者阳气也。”章次公说：“回阳之说为恢复体温。”根据以上之说，阳即体温。但李老认为阳指人体整个热力而言，非单纯指体温计测量之温度。
二、什么是阳虚
李老认为阳虚即人体热力不足。
三、阳虚的原因
(1) 禀赋不足。(2) 饮食生冷过度（为脾胃阳虚之主要原因）。(3) 出汗过多（造成卫阳虚的主要原因）。(4) 服寒凉药品失当。(5) 房室过度（肾阳虚的主要原因）。(6) 阴虚：阴阳互根，阴虚日久，也必然引起阳虚。(7) 气虚（阳虚须补气的通理）。(8) 气候寒冷：衣服单薄（如冻死即亡阳之死）。
四、阳虚的种类
(1) 肾阳虚。(2) 脾阳虚。(3) 心阳虚。(4) 肺阳虚。(5) 胃阳虚。(6) 卫阳虚。(7) 肝阳虚。(8) 表阳虚。(9) 里阳虚。(10) 真阳虚脱。(11) 阴盛格阳（于上，于外）。(12) 膀胱阳虚。(13) 亡阳。
五、阳虚的症状
(一) 阳虚的全身症状
头部：① 头痛（如阳虚头痛），头顶如冰。② 面色赤（如戴阳证）。
鬓部：汗出鬓润至巅。
面部：色青，面白如刮，面赤（如涂丹），面部觉热。
目部：睛突，眼黑，倦视，目视无光，目中有光。
耳部：先鸣后聋。
鼻部：鼻衄。
口部：不渴，口吐沫，恶心欲吐，口虽渴而不欲饮，吐痰多清稀，吐血，呕吐。
舌部：舌胀，舌苔虽有必滑。
牙部：齿牙浮动。
咽喉：咽喉肿痞疼痛。
颈部：颈项如冰，颈项粗大。
胸胁：胸胁刺痛，胀满。
腹部：腹痛，膨胀，脐腹作痛，小腹如卵上下走痛，疝痛，肠绞痛，肠管麻痹，腹痛肠鸣，腹肌挛急。
背脊：背恶寒。
腰部：腰脊酸困腰痛。
前后阴：阴部发冷，精滑白出，无尿，阳痿，遗精，子宫冷，阴囊水肿。
大小便：小便清白，小便不禁，小便清长，癃闭（膀胱麻痹），大便溏泻，下利，便秘，饮一溲一。
四肢：手足逆冷，脚气，腰膝酸困。
全身：体冷畏寒，周身青紫，自汗淋漓，多汗，易感冒，多寒，痘疮顶陷。
神识：沉默，神气不足，神疲气怯。
感觉：多寒，面部觉热。
睡眠：蜷卧，昼日烦躁不眠，夜而安静。
喜恶：喜热畏凉，恶寒，喜引衣，喜阳光，向火，喜热食。
脉象：脉沉小迟，微细，浮大无根，右尺部沉小迟。
呼吸：喘，气冷，咳嗽。
皮肤：肌肉粟起，浮肿，身热，按之筋骨之间反觉寒。
肌肉：肉瞤（肌肉跳动）。
筋骨：筋惕。
血：吐血、衄血必有黑点。
肠胃：饮食稍冷即溏泻。
饮食：食欲减少，口不渴，或渴不欲饮，虽思凉性饮食，但索而不食（个别亦有索而食者，但舌必不燥）。
衣服：虽暑月，不离复衣（甚者着棉衣者）。
房事：性欲减退，房事后呻吟不已。
按：以上之证有阳虚之证（阳虚则寒），亦有阳虚火不归原，真寒假热，内寒外热，而出现吐衄面赤等假象者，所以不能单凭某一点即认为是阳虚，当以主症为依据（阳虚之证亦要考虑是否热之假象）。
(二) 阳虚的主症
体温不足，恶寒（包括怕风寒和不喜冷性饮食两方面），手足冷，溺清，便溏，舌润，脉沉迟、微细、无力，阳痿早泄，腰膝酸软。
1. 头痛：多清晨痛，并兼有其他阳虚证候，头喜热物包裹之，遇阴遇寒即痛。
2. 目中有光：真阳外露之象。无论睁眼或闭眼，自己看到目中有光彩的样子。
3. 先鸣后聋：肾虚不能闭藏，阴气充塞于阳窍也，尺脉必弱，宜桂附地黄丸加磁石、菖蒲、肉苁蓉之类。
4. 恶心呕吐：为肾阳虚，阴火上冲，宜正元丹。
5. 口吐涎沫：如系阴虚者，口必渴。
6. 齿牙浮动：这是由于肾阳虚，虚火上逆所致（若服凉药必加重）。
7. 大便泄泻：多为黎明泻，或下利清谷，或溏便如鸭溏。
8. 大便秘：有寒结者。有肾阳虚兼肠结者。
9. 手足逆冷：时厥时温的不是阳虚，当细辨之。
10. 咳嗽：阳虚喘咳者极少。（凡是慢性虚寒咳嗽都是阳虚。）
11. 喘：阳虚喘者较少。阳虚气喘多属危候，因为它是真阳上脱的主症。
12. 饮一溲一：这是三消中的下消。
六、诊断
1. 必须了解阳虚的主症和一般症状。
2. 阳虚必须和阴虚各证互相对照衡量之。
3. 阳虚必须和气虚互相对照衡量之。因中医很多地方阳虚和气虚有关系，其实不同，故须加以鉴别。
七、机制
阳虚则气虚，阳虚则血也虚，不能运化精微以生气血。（阳与气的关系，气属阳，气有余即化火。）
阳虚则阴也虚：阳生则阴长。
阳虚则生外寒：如经常怕冷，易感寒邪（抵抗力不足）。
阳虚则浊阴上千：浊阴之象弥漫，胸中易生喘嗽痰壅胸满。
阳虚水泛为痰：肾阳虚易形成痰饮。
阳虚则喜阳助：如早轻暮重之象。
阳虚则阴必走：为大吐大衄之病。
阳虚则元气不能自摄：阳上脱多喘。
脾阳虚则湿不化。
八、阳虚各证
1. 表阳虚（即卫阳虚）：主症：自汗恶寒（自汗为阳虚，汗之后恶冷）。常用方剂：黄芪六一散或玉屏风散加附子（气虚加人参），芍药甘草附子汤（汗后阴阳两虚）。
2. Heat Syndrome: Due to the excessive heat pathogen boiling and consuming body fluids, the fluids cannot ascend to moisten the mouth, resulting in thirst. The treatment should focus on purging fire and preserving yin, such as using Sanhuang (Three Yellows) preparations. If accompanied by constipation, urgent purgation is required to preserve yin, such as using Chengqi Tang (Gut-Clearing Decoction).
3. Dryness Syndrome: Caused by dryness damaging body fluids, leading to insufficient water and fluids in the Lung and Stomach. The patient will necessarily drink water frequently to save themselves. Treatment should moisten the Lung and generate fluids or clear the Stomach and nourish yin, with formulas such as Shashen Maidong Tang (Glehnia and Ophiopogon Decoction) and Yupu Jian (Jade Woman Decoction).
4. Yangming Disease of Cold Damage or Qi-Level Heat in Warm Diseases: Characterized by severe thirst due to heat, accompanied by high fever, profuse sweating, and a surging pulse. For this type of interior heat causing thirst, clearing the heat will stop the thirst naturally, such as using Baihu Tang (White Tiger Decoction) or Xueli Jiang (Pear Juice Syrup).
5. Water-Storage Syndrome: In Cold Damage Water-Storage Syndrome, thirst occurs because yang deficiency leads to cold, causing water stagnation without transformation, and fluid-qi cannot ascend. Symptoms must include difficult urination and abdominal fullness with water retention. Treatment should warm yang, dispel cold, and transform water, using formulas like Wuling San (Five-Ingredient Powder with Poria) or Zhenwu Tang (True Warrior Decoction).
6. Summerheat Syndrome: When summerheat penetrates deep into the Shaoyin channel causing Xiao Ke (Wasting-Thirst), drinking water does not stop. This is due to excessive summerheat damaging kidney fluids. Lianmei Tang (Lotus Seed and Mume Decoction) should be used.
7. Jueyin Disease of Cold Damage: Wu Mei Wan (Mume Pill) should be used.
8. Yin Deficiency with Hyperactive Fire: Thirst with desire to drink but no relief, worsening at night, accompanied by five-palm heat (heat sensation in palms, soles, and chest) and bone-steaming tidal fever. Treatment should nourish yin and generate fluids, selecting Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) combined with Zengye Tang (Fluid-Increasing Decoction).
9. Blood Deficiency Syndrome: Thirst caused by blood deficiency results from blood deficiency leading to heat excess and insufficient water fluids. Treatment should tonify blood, clear heat, and generate fluids, using Shengyu Tang (Sage Renewal Decoction) plus Tianmendong (Asparagus Root) and Tianhuafen (Trichosanthes Root), or Danggui Buxue Tang (Angelica Tonifying Blood Decoction) plus Tianhuafen, Zhuma Gen (Nedum Bamboo Rhizome), Yuzhu (Polygonatum Odoratum Rhizome), and Maidong (Ophiopogon Tuber).
Additionally, thirst with desire to drink is a contraindication for Guizhi Tang (Cinnamon Twig Decoction).
(III) Thirst with little desire to drink or drinking small amounts
Commonly seen in Damp-Warmth. Damp-Warmth is caused by contracting damp-heat pathogens. Heat causes thirst, while dampness reduces the desire to drink much, or preference for hot drinks. It is accompanied by fever that is not obvious on initial touch or afternoon fever, chest and epigastric oppression, heavy body and head feeling wrapped, and loose, unsmooth stools. Treatment should combine clearing heat and resolving dampness, using Huangqin Huashi Tang (Scutellaria and Talc Decoction) or Fuping Tang (Poria Peel Decoction).
(IV) Dry mouth but only wanting to rinse water in the mouth without swallowing
This is often a sign of pathogen in the Blood level. For example, thirst due to blood stasis is caused by qi being blocked by blood, preventing fluids from ascending and distributing with qi. Although thirsty, the person only wants to rinse water in the mouth without swallowing. Symptoms must include main signs of blood stasis. Treatment should remove stasis, or remove stasis combined with generating fluids, clearing heat, or dispelling cold, using Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction) or Xiaochaihu Tang (Minor Bupleurum Decoction) plus Mudanpi (Tree Peony Bark) and Xingren (Apricot Seed). For thirst with blood stasis and heat, Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) is used; for irregular menstruation with blood stasis and upper heat/lower cold thirst, Wenjing Tang (Warm the Menses Decoction) is used; for thirst and constipation due to traumatic injury and blood stasis, Yuzhu San (Jade Candle Powder) is used.
(V) Vomiting immediately after swallowing water
Can be seen in:
1. Water-Reversal Syndrome: Water-fluids are stagnant, and fluids cannot distribute to all parts, accompanied by difficult urination. Treatment should use Wuling San to warm yang and transform fluids.
2. Hidden Summerheat in the Lung: Should have been treated with warming dispersal, but mistakenly treated with warming tonification, causing lung qi to fail to descend clearly. Treatment should use Xiebai San (Drain White Powder) combined with Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction).
(VI) Thirst preferring hot drinks
Can be seen in:
Damp-Warmth: Heat causes thirst, dampness causes preference for hot drinks (dampness is a yin pathogen, requiring warmth to transform).
Additionally, thirst preferring hot drinks is a contraindication for Huangqin Tang (Scutellaria Decoction); all cold-type dysentery cases preferring hot foods/drinks absolutely forbid the use of Huangqin Tang.
(VII) Thirst preferring cold drinks
This indicates internal heat. Based on the degree of preference for cold and the volume of water drunk, the severity of internal heat can be assessed, determining the type and dosage of medication. In Cold Damage, there are three types:
1. Taiyang disease with fever and thirst belongs to Warm Diseases.
2. Taiyang disease with cough or wheezing and thirst belongs to the syndrome of Xiao Qinglong Tang (Minor Green Dragon Decoction) plus Shigao (Gypsum) or Banxia (Pinellia Tuber) removed plus Lougen (Trichosanthes Root).
3. Yangming disease with high fever, profuse sweating, and severe thirst belongs to the Baihu Tang (White Tiger Decoction) syndrome.
II. Taste Sensations
(I) Sticky Mouth
Sticky mouth refers to a sticky and obstructive sensation in the mouth and tongue, with poor taste, which is one of the main symptoms of Dampness Syndromes. However, there are cold and heat distinctions. In Cold-Dampness, the stickiness is mild, with bland taste, no thirst, loose stools, pale tongue with white coating, and soggy-slow pulse. In Damp-Heat, the stickiness is heavier, with foul breath, bitter or sweet taste, thirst without desire to drink, sticky/unsmooth stools, yellow-red urine, red tongue with yellow coating, and rapid pulse. The former should be treated with aromatic resolution of dampness, using Huoxiang Zhengqi San (Agastache Harmonizing the Qi Powder) or Pingwei San (Calm the Stomach Powder); the latter should be treated with clearing heat and resolving dampness, using Saren Tang (Three Seeds Decoction) or Huopo Xialing Tang (Aucklandia, Pinellia, and Poria Decoction). If dampness condenses into phlegm and transforms into heat over time, causing phlegm-heat obstruction, sticky mouth may also appear, accompanied by thirst without desire to drink, yellow phlegm difficult to expectorate, chest/epigastric fullness, red tongue with yellow coating, and slippery-rapid pulse. Treatment should clear heat and resolve phlegm, selecting Huanglian Wendan Tang (Coptis Calming the Gallbladder Decoction) or Qingqi Huatan Wan (Clear Qi and Resolve Phlegm Pill).
(II) Bitter Mouth
Bitterness is the taste of the Gallbladder. Bitter mouth is mostly a sign of Liver-Gallbladder depression-heat, often accompanied by chest and hypochondriac fullness/discomfort, headache, dizziness, irritability, and anger. Haoqin Qingdan Tang (Artemisiae Scopariae and Scutellariae Clearing Gallbladder Decoction) is used to clear the gallbladder, promote dampness drainage, harmonize the stomach, and resolve phlegm.
(III) Bland Mouth
Bland mouth with slight stickiness indicates Dampness, using Saren Tang (Three Seeds Decoction) or Huopo Xialing Tang (Aucklandia, Pinellia, and Poria Decoction). It can also be caused by Spleen-Stomach weakness, accompanied by fatigue, loose stools, pale tongue, and weak pulse. Treatment should tonify qi, strengthen the spleen, and harmonize the stomach, using Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Ingredient Decoction).
(IV) Sweet Mouth
Sweet mouth is mostly a symptom of Spleen heat, divided into Excess Heat and Deficiency Heat. Excess heat is mostly due to strong Spleen-Stomach heat, accompanied by thirst with desire to drink, polyphagia with easy hunger, constipation, red tongue with dry coating, and forceful rapid pulse. Xiheang San (Drain Yellow Powder) can be used to clear the stomach and purge fire. Deficiency heat is due to Spleen-Stomach qi and yin dual deficiency, mainly characterized by poor appetite, mental fatigue, red tongue with scant coating, and fine-rapid pulse. Treatment should tonify qi and nourish yin, selecting Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) plus Shanyao (Dioscorea Rhizome) and Shihu (Dendrobium Stem). Sweet mouth can also be seen in Damp-Warmth diseases where dampness is predominant, presenting as sweet, bland, or sticky mouth, no thirst, or thirst without desire to drink, or thirst preferring hot drinks. Treatment should ventilate and transform turbid dampness, using Saren Tang (Three Seeds Decoction) or Huopo Xialing Tang (Aucklandia, Pinellia, and Poria Decoction).
Practicing Pulse Diagnosis Should Use the Slow Pulse as Standard
The Slow Pulse (Huan Mai) is a normal pulse that is neither floating nor sunken, neither large nor small, neither deficient nor excess, neither slow nor rapid. It is the pulse state when free from disease. Beginners practicing pulse diagnosis must first master the Slow Pulse, using it as a standard for comparison. A pulse closer to the skin than this is called Floating; closer to the tendons/bones is Sunken; larger is Surging; smaller is Minute; more forceful is Excess; less forceful is Deficient; faster is Rapid; slower is Delayed; smooth and flowing is Slippery; rough and obstructed is Choppy.
Detailed Differentiation between Cold Damage and Warm Diseases
Cold Damage has broad and narrow senses. Broad Cold Damage is a general term for various external febrile diseases, while narrow Cold Damage refers to pathological changes caused by external cold pathogen manifesting immediately upon contraction. The Cold Damage mentioned here refers to the narrow sense. Warm Diseases are a general term for various acute external febrile diseases. Both originate from external contraction and share exterior syndrome characteristics, but their treatments differ. Careful examination is needed for differentiation during clinical practice.
1. Differentiate by cause: Cold Damage is caused by contracting cold pathogens; Warm Diseases are caused by contracting warm-heat pathogens.
2. Differentiate by main symptoms: Both Cold Damage and Warm Diseases initially present with fever, aversion to cold, and headache. However, in Cold Damage, aversion to cold is heavier, fever is lighter, and in severe cases, there may be only cold without fever; headache is severe, often accompanied by neck stiffness. In Warm Diseases, fever is heavier, aversion to cold is lighter, and in severe cases, there may be only heat without aversion to cold; headache is lighter and never accompanied by neck stiffness.
3. Differentiate by tongue, mouth, diet, pulse, and urination: In early Cold Damage, tongue quality is generally normal, coating is pale-white and thin or absent and moist, mouth is not dry/bitter/thirsty, no preference for cold food/drink, pulse is floating-tight or floating-slow, and urine is usually clear and abundant. In early Warm Diseases, tongue quality may be redder, coating may be yellow-white and dry, mouth may be bitter/dry/thirsty, preference for cold food/drink, pulse is mostly floating-rapid or floating-large, and urine is mostly yellow-red.
Regarding Yang Deficiency
I. What is Yang?
The *Neijing* states: "Yang receives qi from heaven to warm the skin and muscle intervals." Gu Songyuan said: "The warmth throughout the body is yang qi." Zhang Cigong said: "The concept of returning yang refers to restoring body temperature." Based on these statements, Yang is body temperature. However, Master Li believes Yang refers to the entire thermal energy of the human body, not merely the temperature measured by a thermometer.
II. What is Yang Deficiency?
Master Li believes Yang Deficiency is insufficient thermal energy in the human body.
III. Causes of Yang Deficiency
(1) Congenital insufficiency. (2) Overconsumption of raw/cold food (main cause of Spleen-Stomach Yang deficiency). (3) Excessive sweating (main cause of Wei-Yang deficiency). (4) Improper use of cold-cooling medicines. (5) Excessive sexual activity (main cause of Kidney Yang deficiency). (6) Yin Deficiency: Yin and Yang are mutually rooted; long-term Yin deficiency inevitably causes Yang deficiency. (7) Qi Deficiency (the general principle that Yang deficiency requires qi tonification). (8) Cold climate: Thin clothing (e.g., freezing to death is death by loss of Yang).
IV. Types of Yang Deficiency
(1) Kidney Yang Deficiency. (2) Spleen Yang Deficiency. (3) Heart Yang Deficiency. (4) Lung Yang Deficiency. (5) Stomach Yang Deficiency. (6) Wei-Yang Deficiency. (7) Liver Yang Deficiency. (8) Exterior Yang Deficiency. (9) Interior Yang Deficiency. (10) True Yang Collapse. (11) Yin Excess Repelling Yang (to the upper or exterior). (12) Bladder Yang Deficiency. (13) Loss of Yang.
V. Symptoms of Yang Deficiency
(A) Systemic Symptoms of Yang Deficiency
Head: ① Headache (e.g., Yang-deficiency headache), top of head feels like ice. ② Red complexion (e.g., Dai Yang Syndrome - floating yang).
Temples: Sweat makes temples moist up to the vertex.
Face: Blue color, pale face like scraped, red face (like painted cinnabar), sensation of heat in the face.
Eyes: Protruding eyes, dark eyes, tired vision, eyes lack luster, light inside the eyes.
Ears: Tinnitus followed by deafness.
Nose: Epistaxis.
Mouth: No thirst, spitting saliva, nausea/vomiting, though thirsty no desire to drink, vomiting clear thin phlegm, hematemesis, vomiting.
Tongue: Swollen tongue, if coating exists it must be slippery.
Teeth: Loose teeth.
Throat: Swollen, painful throat.
Neck: Neck feels like ice, swollen neck.
Chest/Hypochondrium: Piercing pain in chest/hypochondrium, fullness.
Abdomen: Abdominal pain, distension, umbilical/abdominal pain, lower abdomen pain moving up and down like an egg, hernia pain, intestinal colic, intestinal paralysis, abdominal pain with borborygmus, abdominal muscle spasms.
Back: Aversion to cold in the back.
Waist: Soreness, heaviness, and pain in waist/spine.
Genitals/Anus: Cold genitals, seminal emission/leukorrhea, anuria, impotence, nocturnal emission, cold uterus, scrotal edema.
Urination/Defecation: Clear urine, urinary incontinence, copious clear urine, strangury (bladder paralysis), loose diarrhea, dysentery, constipation, drinking one part urinating one part.
Limbs: Cold hands and feet, beriberi, sore/heavy waist and knees.
Whole Body: Cold body with aversion to cold, cyanosis of whole body, spontaneous profuse sweating, hyperhidrosis, prone to colds, excessive cold sensitivity, depressed acne lesions.
Spirit/Mind: Silence, lack of spirit, mental fatigue and timidity.
Sensation: Feeling cold, sensation of heat in the face.
Sleep: Curling up, daytime restlessness/insomnia, nighttime quietness.
Preferences: Likes heat, fears coolness, aversion to cold, likes covering up, likes sunlight/fire, likes hot food.
Pulse: Deep-small-delayed, minute/fine, floating-large without root, right Chi position deep-small-delayed.
Respiration: Wheezing, cold qi, cough.
Skin: Gooseflesh, edema, body heat, but feeling cold when pressing between muscles and bones.
Muscles: Muscle twitching.
Tendons/Bones: Tendon tremors.
Blood: Hematemesis and epistaxis must have black spots.
Intestines/Stomach: Loose stool immediately after eating slightly cold food.
Diet: Reduced appetite, no thirst, or thirst without desire to drink, thinking of cold food but refusing to eat (rarely eats when asked, but tongue is definitely not dry).
Clothing: Even in summer, does not leave layered clothes (severe cases wear cotton).
Sexual Activity: Decreased libido, moaning after intercourse.
Note: The above syndromes include Yang Deficiency (Yang deficiency leads to cold), but also cases of Yang Deficiency with Fire not returning to its source, True Cold False Heat, Interior Cold Exterior Heat, presenting with false signs like hematemesis/epistaxis and red face. Therefore, one cannot judge Yang Deficiency based on a single point; main symptoms must be the basis (consider if Yang Deficiency symptoms are false heat signs).
(B) Main Symptoms of Yang Deficiency
Insufficient body temperature, aversion to cold (including fear of wind-cold and dislike of cold food/drink), cold hands and feet, clear urine, loose stools, moist tongue, deep-delayed/minite/fine/weak pulse, impotence/premature ejaculation, sore/heavy waist and knees.
1. Headache: Mostly morning pain, accompanied by other Yang-deficiency signs, head prefers warm wrapping, pain triggered by yin/cold exposure.
2. Light in Eyes: Sign of True Yang revealing externally. Regardless of open or closed eyes, one sees a luminous quality inside the eyes.
3. Tinnitus then Deafness: Kidney deficiency fails to secure, yin qi fills the yang orifices. Chi pulse must be weak. Gui Fu Di Huang Wan (Rehmannia Pill with Cinnamon and Aconite) plus Cishi (Magnetite), Changpu (Acorus Rhizome), and Rongrong (Cistanche) should be used.
4. Nausea/Vomiting: Due to Kidney Yang Deficiency and Yin Fire rushing upward. Zhengyuan Dan (Origin-Returning Pill) should be used.
5. Spitting Saliva: If Yin Deficiency, the mouth must be thirsty.
6. Loose Teeth: Caused by Kidney Yang Deficiency and Deficiency Fire rushing upward (taking cooling medicines will worsen it).
7. Diarrhea: Mostly dawn diarrhea, or passing undigested food, or duck-like loose stool.
8. Constipation: Due to Cold Binding. Or Kidney Yang Deficiency combined with Intestinal Binding.
9. Cold Hands and Feet: Alternating cold and warmth is not Yang Deficiency; differentiate carefully.
10. Cough: Yang-deficiency wheezing/cough is rare. (All chronic deficiency-cold coughs are Yang Deficiency.)
11. Wheezing: Yang-deficiency wheezing is less common. Yang-deficiency asthma is mostly critical, as it is a main sign of True Yang escaping upward.
12. Drinking One Part Urinating One Part: This is Lower Xiao (Wasting-Thirst) among the Three Xiao.
VI. Diagnosis
1. Must understand the main and general symptoms of Yang Deficiency.
2. Yang Deficiency must be compared and weighed against Yin Deficiency syndromes.
3. Yang Deficiency must be compared and weighed against Qi Deficiency. Since TCM often links Yang and Qi Deficiency, they are actually different and require differentiation.
VII. Mechanisms
Yang Deficiency leads to Qi Deficiency; Yang Deficiency leads to Blood Deficiency, failing to transform essence to generate Qi and Blood. (Relationship between Yang and Qi: Qi belongs to Yang; excess Qi transforms into Fire.)
Yang Deficiency leads to Yin Deficiency: When Yang grows, Yin grows.
Yang Deficiency generates Exterior Cold: e.g., frequent fear of cold, susceptibility to cold pathogens (insufficient resistance).
Yang Deficiency allows Turbid Yin to rise: Diffusion of Turbid Yin images easily causes wheezing, cough, phlegm congestion, and chest fullness.
Yang Deficiency causes Water Flooding into Phlegm: Kidney Yang Deficiency easily forms phlegm-fluids.
Yang Deficiency desires Yang assistance: e.g., symptoms lighter in morning, heavier in evening.
Yang Deficiency causes Yin to escape: Leads to severe vomiting and epistaxis.
Yang Deficiency causes Yuan Qi to fail self-retention: Yang escaping upward mostly causes wheezing.
Spleen Yang Deficiency fails to transform dampness.
VIII. Various Syndromes of Yang Deficiency
1. Exterior Yang Deficiency (i.e., Wei-Yang Deficiency): Main symptoms: Spontaneous sweating and aversion to cold (spontaneous sweating is Yang Deficiency; aversion to cold follows sweating). Common formulas: Huangqi Liuyi San (Astragalus Six-to-One Powder) or Yupingfeng San (Jade Windscreen Powder) plus Fuzi (Aconite) (add Renshen/Ginseng for Qi Deficiency), Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) (for Yin-Yang dual deficiency after sweating).