大法,春夏宜发汗。
凡发汗,欲令手足皆周至, 一时间益佳,但不欲如水流离。若病不解,当重发汗。汗多则亡阳,阳虚不得重发
汗也。
凡服汤药发汗,中病便止,不必尽剂也。
凡云可发汗而无汤者,丸散亦可用,要以汗出为解,然不如汤随证良。
太阳病,外证未解,其脉浮弱,当以汗解,宜桂枝汤。
太阳病,脉浮而数者,可发其汗,属桂枝汤证。
阳明病,脉迟,汗出多,微恶寒,表为未解,可发其汗,属桂枝汤证。
夫病脉浮大,问病者,言但坚耳。设利者为虚,大逆。坚为实,汗出而解,何以故?脉浮,当以汗解。伤寒,其脉
不弦紧而弱,弱者必渴,被火必谵语。弱者发热脉浮,解之,当汗出愈。病者烦热,汗出即解。复如疟状,日晡所发热,
此属阳明。脉浮虚者,当发其汗,属桂枝汤证。病常自汗出,此为荣气和,荣气和而外不解,此卫不和也。荣行脉中,
为阴,主内;卫行脉外,为阳,主外。复发其汗,卫和则愈,属桂枝汤证。病患脏无他病,时发热自汗出,而不愈,此
卫气不和也。先其时发汗即愈,属桂枝汤证。脉浮而紧,浮则为风,紧则为寒,风则伤卫,寒则伤荣,荣卫俱病,骨节
烦疼,可发其汗,宜麻黄汤。
太阳病不解,热结膀胱,其人如狂,血必自下,下者即愈。其外未解者,尚未可攻,当先解其外,属桂枝汤证。
太阳病,下之,微喘者,表未解故也。属桂枝加浓朴杏子汤证。
伤寒,脉浮紧,不发其汗,因衄,属麻黄汤证。
阳明病,脉浮,无汗,其人必喘。发其汗则愈,属麻黄汤证。
太阴病,脉浮者,可发其汗,属桂枝汤证。
太阳病,脉浮紧,无汗而发热,其身疼痛,八、九日不解,表候续在,此当发其汗,服汤微除。发烦目瞑,剧者必
衄,衄乃解。所以然者,阳气重故也。属麻黄汤证。脉浮者,病在表,可发其汗,属桂枝汤证。
伤寒不大便六、七日,头痛有热,与承气汤,其大便反青(一作小便清者)。此为不在里故在表也,当发其汗。头痛
者,必衄,属桂枝汤证。
下利后,身体疼痛,清便自调,急当救表,宜桂枝汤。
太阳病,头痛发热,汗出恶风,若恶寒,属桂枝汤证。
太阳中风,阳浮而阴濡弱。浮者热自发,濡弱者汗自出,啬啬恶寒,淅淅恶风,翕翕发热,鼻鸣干呕,属桂枝汤证。
太阳病,发热汗出,此为荣弱卫强,故使汗出,欲救邪风,属桂枝汤证。
太阳病,下之,气上撞,可与桂枝汤;不撞,不可与之。
太阳病,初服桂枝汤,而反烦不解者,法当先刺风池、风府,却与桂枝汤则愈。烧针令其汗,针处被寒,核起而赤
者,必发贲豚。气从少腹上撞心者,灸其核上一壮,与桂枝加桂汤。
太阳病,项背强KT KT ,反汗出恶风,属桂枝加葛根汤。
太阳病,项背强KT KT ,无汗恶风,属葛根汤。
太阳与阳明合病,而自利不呕者,属葛根汤证。
太阳与阳明合病,不下利,但呕,属葛根加半夏汤。
太阳病,桂枝证,医反下之,遂利不止,其脉促者,表未解,喘而汗出,属葛根黄芩黄连汤。
太阳病,头痛发热,身体疼,腰痛,骨节疼痛,恶风,无汗而喘,属麻黄汤证。
太阳与阳明合病,喘而胸满,不可下也。属麻黄汤证。
太阳中风,脉浮紧,发热恶寒,身体疼痛,不汗出而烦躁,头痛,属大青龙汤。脉微弱,汗出恶风,不可服之。服
之则厥,筋惕肉 ,此为逆也。
伤寒脉浮缓,其身不疼,但重,乍有轻时,无少阴证者,大青龙汤发之。
伤寒表不解,心下有水气,干呕,发热而咳,或渴,或利,或噎,或小便不利,小腹满,或微喘,属小青龙汤。
伤寒,心下有水气,咳而微喘,发热不渴,服汤已而渴者,此寒去,为欲解,属小青龙汤证。阳明中风,脉弦浮大
而短气,腹都满,胁下及心痛,久按之,气不通(一作按之不痛),鼻干,不得汗,嗜卧,一身及目悉黄,小便难,有潮
热,时时哕,耳前后肿,刺之小瘥,外不解,病过十日,脉续浮,与小柴胡汤。但浮,无余证,与麻黄汤。不溺,腹满
加哕,不治。太阳病,十日以去,脉浮细,嗜卧,此为外解。设胸满胁痛,与小柴胡汤。脉浮者,属麻黄汤证。中风,
往来寒热,伤寒五、六日以后,胸胁苦满,嘿嘿不欲饮食,烦心喜呕,或胸中烦而不呕,或渴,或腹中痛,或胁下痞坚,
或心中悸,小便不利,或不渴,外有微热,或咳者,属小柴胡汤。
伤寒四、五日,身体热,恶风,颈项强,胁下满,手足温而渴,属小柴胡汤证。
伤寒六、七日,发热、微恶寒,支节烦疼,微呕,心下支结,外证未去者,属柴胡桂枝汤。少阴病,得之二、三日,
麻黄附子甘草汤微发汗,以二、三日无证,故微发汗也。
脉浮,小便不利,微热,消渴,与五苓散,利小便发汗。
治疗的大法,春夏季节适宜使用发汗法。
凡是发汗,要使手足周身都达到汗出,持续一段时间效果更好,但不要像水流一样淋漓不止。如果病邪没有解除,应当再次发汗。但是汗出过多会损伤阳气,阳气虚损后就不可以再发汗了。
凡是服用汤药来发汗的,只要病愈就停止服药,不必把整剂药全部喝完。
凡是说可以发汗但没有现成汤药的,丸剂和散剂也可以使用,关键在于通过出汗来解除病邪,然而不如汤药能随证候变化而灵活施治效果好。
太阳病,表证未解,脉象浮弱,应当用汗法解表,适宜用桂枝汤。
太阳病,脉象浮而数的,可以发汗,属于桂枝汤的适应证。
阳明病,脉象迟,汗出较多,轻微恶寒,说明表证未解,可以发汗,属于桂枝汤的适应证。
患病者脉象浮大,询问病人,他说只是感觉腹部坚硬。如果大便泄利则属虚证,这是严重的误治。腹部坚硬属实证,通过发汗可以解除,为什么呢?因为脉浮,应当用汗法解表。伤寒病,脉象不弦紧而软弱,脉弱的人必定口渴,如果被火疗逼迫发汗,一定会出现胡言乱语的症状。脉弱且发热、脉浮的,通过解表法,应当出汗后痊愈。病人烦热,出汗后即缓解。又像疟疾发作一样,傍晚时分发热,这属于阳明病。脉象浮虚的,应当发汗,属于桂枝汤的适应证。病人经常自发出汗,这是因为营气调和,营气调和而体表之邪不解,这是卫气不和。营气行于脉中,属阴,主内守;卫气行于脉外,属阳,主外御。再次发汗,卫气调和则病愈,属于桂枝汤的适应证。病患内脏没有其他疾病,时常发热并自汗出,但病不好,这是卫气不和。在发热出汗之前发汗即可痊愈,属于桂枝汤的适应证。脉象浮而紧,浮代表风邪,紧代表寒邪,风邪伤及卫气,寒邪伤及营气,营卫都受病,骨节烦痛,可以发汗,适宜用麻黄汤。
太阳病未解,热邪结聚在膀胱,病人神志如狂,瘀血会自行下行,下血后病即愈。如果表证仍未解除,还不可以攻下瘀血,应当先解表,属于桂枝汤的适应证。
太阳病,被误用泻下法后,出现轻微气喘的,是因为表证未解的缘故。属于桂枝加厚朴杏子汤的适应证。
伤寒病,脉象浮紧,没有及时发汗,导致鼻出血,属于麻黄汤的适应证。
阳明病,脉象浮,无汗,病人一定气喘。发汗后则痊愈,属于麻黄汤的适应证。
太阴病,脉象浮的,可以发汗,属于桂枝汤的适应证。
太阳病,脉象浮紧,无汗且发热,身体疼痛,经过八九天病未解,表证依然存在,这应当发汗,服药后症状轻微减轻。如果出现心烦、眼睛昏花,严重的必然鼻出血,出血后病才解。之所以这样,是因为阳气郁闭重的缘故。属于麻黄汤的适应证。脉象浮的,病在表,可以发汗,属于桂枝汤的适应证。
伤寒病六七天不大便,头痛且有发热,给予承气汤(攻下药),结果大便反而变清(一说小便清),这说明病不在里而在表,应当发汗。头痛的,必然鼻出血,属于桂枝汤的适应证。
腹泻之后,身体疼痛,大小便正常,应当紧急救治表证,适宜用桂枝汤。
太阳病,头痛发热,汗出恶风,如果恶寒,属于桂枝汤的适应证。
太阳中风证,脉象阳部(寸)浮而阴部(尺)濡弱。浮表示热气自发,濡弱表示汗自出,怕冷畏缩,怕风吹,微微发热,鼻塞鸣响,干呕,属于桂枝汤的适应证。
太阳病,发热汗出,这是因为营弱卫强,所以导致汗出,想要救治风邪,属于桂枝汤的适应证。
太阳病,被误用泻下法后,气向上冲撞,可以给予桂枝汤;如果不冲撞,不可给予。
太阳病,初次服用桂枝汤后,反而更加烦闷不解的,按照法则应当先针刺风池穴、风府穴,然后再给予桂枝汤就会痊愈。用烧针强迫发汗,针孔处受寒,起核发红,必然会引发奔豚病。气从少腹上冲心胸的,在红肿的核上灸一壮,然后给予桂枝加桂汤。
太阳病,项背部僵硬不适,反而汗出恶风的,属于桂枝加葛根汤。
太阳病,项背部僵硬不适,无汗恶风的,属于葛根汤。
太阳与阳明合病,出现自下利但不呕吐的,属于葛根汤的适应证。
太阳与阳明合病,不下利,只呕吐的,属于葛根加半夏汤的适应证。
太阳病,本应是桂枝汤证,医生反而误用泻下法,导致腹泻不止,脉象急促的,说明表证未解,气喘且汗出,属于葛根芩连汤的适应证。
太阳病,头痛发热,身体疼,腰痛,骨节疼痛,恶风,无汗而气喘,属于麻黄汤的适应证。
太阳与阳明合病,气喘且胸满,不可用下法。属于麻黄汤的适应证。
太阳中风证,脉象浮紧,发热恶寒,身体疼痛,无汗且烦躁,头痛,属于大青龙汤的适应证。脉象微弱,汗出恶风的,不可服用。服用了就会导致四肢厥冷,筋肉跳动,这是逆治的错误。
伤寒病,脉象浮缓,身体不疼,只是沉重,偶尔有轻的时候,如果没有少阴病的证候,用大青龙汤发汗。
伤寒病表证未解,心下有停饮,干呕,发热而咳嗽,或者口渴,或者腹泻,或者噎塞,或者小便不利,小腹胀满,或者轻微气喘,属于小青龙汤的适应证。
伤寒病,心下有停饮,咳嗽且轻微气喘,发热不渴,服药后感到口渴的,这是寒邪已去,病情将要解除,属于小青龙汤的适应证。阳明中风,脉象弦浮大而短气,腹部胀满,胁下及心痛,久按之气不通(一说按之不痛),鼻干,不能出汗,嗜睡,全身及眼睛发黄,小便困难,有潮热,时时呃逆,耳前后肿胀,针刺后稍好转,但表证未解,病程超过十天,脉象继续浮,给予小柴胡汤。如果仅见脉浮,没有其他证候,给予麻黄汤。如果不排尿,腹胀加上呃逆,属于不治之症。太阳病,过了十几天,脉象浮细,嗜卧,这是外邪已解。如果胸部满闷胁肋痛,给予小柴胡汤。脉象浮的,属于麻黄汤的适应证。中风证,往来寒热,伤寒五、六天以后,胸胁苦满,默默不想饮食,心烦喜呕,或者胸中烦闷而不呕,或者口渴,或者腹痛,或者胁下痞硬,或者心中悸动,小便不利,或者不渴,体表有微热,或者咳嗽的,属于小柴胡汤的适应证。
伤寒四、五天,身体发热,恶风,颈项强直,胁下满闷,手足温暖而口渴,属于小柴胡汤的适应证。
伤寒六、七天,发热、轻微恶寒,肢节烦痛,轻微呕吐,心下部支撑胀满,表证未去的,属于柴胡桂枝汤的适应证。少阴病,得病二、三天,用麻黄附子甘草汤轻微发汗,因为二、三天没有明显的里证,所以只是轻微发汗。
脉象浮,小便不利,微热,消渴,给予五苓散,通利小便兼以发汗。
The general principle is that in spring and summer, diaphoresis (sweating therapy) is appropriate.
When inducing sweating, it is desired that sweat covers the hands and feet uniformly; maintaining this state for a period is better, but one should avoid profuse sweating like flowing water. If the disease does not resolve, diaphoresis may be repeated. However, excessive sweating leads to the loss of Yang Qi (Vital Energy), and when Yang Qi is deficient, further diaphoresis is contraindicated.
When using decoctions to induce sweating, stop administration once the disease is cured; there is no need to finish the entire dose.
If it is stated that diaphoresis is indicated but no decoction is available, pills or powders may also be used, provided that sweating occurs to resolve the pathogen. However, this is not as effective as decoctions, which can be tailored to specific syndromes.
In Taiyang Disease (Disease of the Bladder and Small Intestine channels/Exterior syndrome), if exterior signs persist and the pulse is floating and weak, resolution via diaphoresis is required; Guizhi Tang (Cinnamon Twig Decoction) is suitable.
In Taiyang Disease, if the pulse is floating and rapid, diaphoresis may be applied; this belongs to the indication for Guizhi Tang.
In Yangming Disease (Disease of the Stomach and Large Intestine channels/Interior Heat syndrome), if the pulse is slow, sweating is abundant, and there is slight aversion to cold, the exterior remains unresolved, and diaphoresis may be applied; this belongs to the indication for Guizhi Tang.
If the patient's pulse is floating and large, and upon inquiry, the patient reports only abdominal hardness: if diarrhea is present, it indicates deficiency, which is a severe error. Hardness indicates excess; resolution via diaphoresis is possible. Why? Because a floating pulse indicates the need for diaphoresis. In Shanghan (Cold Damage), if the pulse is neither wiry-tight nor weak, but weak, thirst will necessarily occur. If fire therapy is applied, delirium will ensue. If the weak pulse presents with fever and floating characteristics, resolution via diaphoresis leads to recovery through sweating. If the patient experiences irritability and heat, relief follows sweating. If symptoms resemble malaria with afternoon fever, this belongs to Yangming Disease. If the pulse is floating and deficient, diaphoresis is indicated; this belongs to the indication for Guizhi Tang.
If the patient frequently sweats spontaneously, it indicates that Ying Qi (Nutritive Qi) is harmonious. If Ying Qi is harmonious but the exterior pathogen persists, it is due to disharmony of Wei Qi (Defensive Qi). Ying Qi circulates within the vessels, belonging to Yin, governing the interior; Wei Qi circulates outside the vessels, belonging to Yang, governing the exterior. Re-inducing sweating harmonizes Wei Qi, leading to recovery; this belongs to the indication for Guizhi Tang.
If a patient has no internal organ pathology but experiences intermittent fever and spontaneous sweating without recovery, it is due to disharmony of Wei Qi. Diaphoresis administered prior to the onset of fever leads to recovery; this belongs to the indication for Guizhi Tang.
If the pulse is floating and tight, floating indicates Wind, and tight indicates Cold. Wind injures Wei Qi, and Cold injures Ying Qi. When both Ying and Wei are diseased, causing severe bone and joint pain, diaphoresis may be applied; Mahuang Tang (Ephedra Decoction) is suitable.
If Taiyang Disease is unresolved, heat accumulates in the Bladder, causing mental agitation resembling madness. If blood discharges spontaneously, the disease resolves. If the exterior remains unresolved, attack on the interior is premature; the exterior must first be resolved; this belongs to the indication for Guizhi Tang.
If Taiyang Disease is treated with purgation and results in slight wheezing, it is because the exterior remains unresolved. This belongs to the indication for Guizhi Jia Houpo Xiren Tang (Guizhi Decoction with Magnolia Bark and Apricot Kernel).
In Shanghan, if the pulse is floating and tight, and diaphoresis is not performed, leading to epistaxis (nosebleed), this belongs to the indication for Mahuang Tang.
In Yangming Disease, if the pulse is floating, there is no sweating, and the patient likely suffers from wheezing. Resolution via diaphoresis leads to recovery; this belongs to the indication for Mahuang Tang.
In Taiyin Disease (Disease of the Spleen and Stomach channels/Cold-Damp syndrome), if the pulse is floating, diaphoresis may be applied; this belongs to the indication for Guizhi Tang.
In Taiyang Disease, if the pulse is floating and tight, there is no sweating, fever is present, and body pain persists for eight or nine days without resolution, indicating the exterior pattern continues, diaphoresis is indicated. After taking the decoction, symptoms may slightly improve. Irritability and blurred vision may occur; in severe cases, epistaxis occurs, after which the disease resolves. This is due to heavy accumulation of Yang Qi. This belongs to the indication for Mahuang Tang. If the pulse is floating, the disease is at the exterior, and diaphoresis may be applied; this belongs to the indication for Guizhi Tang.
In Shanghan, if there is constipation for six or seven days accompanied by headache and fever, Chengqi Tang (Gastrointestinal Purging Decoction) might be considered. However, if the stool is clear (or urine is clear), it indicates the disease is not in the interior but at the exterior, so diaphoresis is indicated. Headache may lead to epistaxis; this belongs to the indication for Guizhi Tang.
After dysentery, if body pain persists but bowel and bladder functions are normal, urgent treatment of the exterior is required; Guizhi Tang is suitable.
In Taiyang Disease, if there is headache, fever, sweating, and aversion to wind (or cold), this belongs to the indication for Guizhi Tang.
In Taiyang Wind Strike syndrome, the pulse is floating at the Yang position (cun) and deficient-weak at the Yin position (chi). Floating indicates spontaneous heat; deficient-weak indicates spontaneous sweating. Symptoms include shivering aversion to cold, chilly aversion to wind, mild fever, nasal congestion with humming, and dry retching. This belongs to the indication for Guizhi Tang.
In Taiyang Disease, if there is fever and sweating, it is due to weak Ying Qi and strong Wei Qi, causing sweating. To rescue from pathogenic wind, this belongs to the indication for Guizhi Tang.
In Taiyang Disease, if purgation is mistakenly applied and qi rushes upward, Guizhi Tang may be given; if there is no upward rush, it should not be given.
In Taiyang Disease, if Gui Zhi Tang causes increased irritability without resolution, Fengchi (GB20) and Fengfu (GV16) acupoints should be needled first, followed by Guizhi Tang for recovery.
If burning needle therapy induces sweating, and cold enters the needle site causing red nodules, Ben Tun (Rushing Pig) syndrome may develop. If qi rushes from the lower abdomen to the heart, moxa should be applied to the nodule (one cone), followed by Guizhi Jia Gui Tang (Guizhi Decoction with Added Cinnamon).
In Taiyang Disease, if there is stiffness in the neck and back with sweating and aversion to wind, this belongs to Guizhi Jia Gegen Tang (Guizhi Decoction with Added Kudzu Root).
In Taiyang Disease, if there is stiffness in the neck and back without sweating and with aversion to wind, this belongs to Gegen Tang (Kudzu Root Decoction).
In combined Taiyang and Yangming disease, if there is spontaneous diarrhea without vomiting, this belongs to the indication for Gegen Tang.
In combined Taiyang and Yangming disease, if there is no diarrhea but only vomiting, this belongs to the indication for Gegen Jia Banxia Tang (Gegen Decoction with Added Pinellia).
In Taiyang Disease, if the Guizhi pattern is mistakenly treated with purgation, leading to persistent diarrhea, a rapid pulse indicates the exterior remains unresolved. With wheezing and sweating, this belongs to the indication for Gegen Qinlian Tang (Gegen, Scutellaria, and Coptis Decoction).
In Taiyang Disease, if there is headache, fever, body pain, lower back pain, joint pain, aversion to wind, no sweating, and wheezing, this belongs to the indication for Mahuang Tang.
In combined Taiyang and Yangming disease, if there is wheezing and chest fullness, purgation is contraindicated. This belongs to the indication for Mahuang Tang.
In Taiyang Wind Strike syndrome, if the pulse is floating and tight, with fever, aversion to cold, body pain, no sweating, irritability, and headache, this belongs to Da Qing Long Tang (Great Blue Dragon Decoction). If the pulse is weak and faint, with sweating and aversion to wind, it is contraindicated. Administration would lead to limb coldness and muscle twitching, which is an adverse reaction.
In Shanghan, if the pulse is floating and slow, the body is not painful but heavy, occasionally feeling lighter, and there are no Shaoyin patterns, Da Qing Long Tang is used to induce sweating.
In Shanghan, if the exterior is unresolved and there is fluid retention in the stomach region, causing dry retching, fever, and cough, or thirst, diarrhea, choking, urinary difficulty, lower abdominal fullness, or slight wheezing, this belongs to Xiao Qing Long Tang (Minor Blue Dragon Decoction).
In Shanghan, if there is fluid retention in the stomach region, causing cough and slight wheezing, fever, and no thirst, but thirst develops after taking the decoction, it indicates the cold has dispersed and the disease is resolving. This belongs to the indication for Xiao Qing Long Tang.
In Yangming Wind Strike, if the pulse is wiry, floating, and large, with shortness of breath, abdominal fullness, hypochondriac and cardiac pain, unrelieved pressure, dry nose, inability to sweat, lethargy, jaundice of the body and eyes, difficult urination, tidal fever, frequent hiccups, and swelling around the ears, acupuncture may provide slight relief. If the exterior remains unresolved after ten days and the pulse continues to float, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is given. If only the pulse is floating without other symptoms, Mahuang Tang is given. If there is no urination, abdominal fullness, and hiccups, it is incurable.
In Taiyang Disease, after ten days, if the pulse is floating and fine, and the patient is lethargic, the exterior has resolved. If there is chest fullness and hypochondriac pain, Xiao Chai Hu Tang is given. If the pulse is floating, this belongs to the indication for Mahuang Tang.
In Wind Strike syndrome, with alternating chills and fever, occurring five to six days after Shanghan, with bitter fullness in the chest and hypochondrium, silent desire not to eat, irritability, and frequent vomiting, or chest irritability without vomiting, thirst, abdominal pain, hypochondriac hardness, palpitations, urinary difficulty, absence of thirst, slight exterior heat, or cough, this belongs to the indication for Xiao Chai Hu Tang.
In Shanghan, four to five days in, with body heat, aversion to wind, neck stiffness, hypochondriac fullness, warm hands and feet, and thirst, this belongs to the indication for Xiao Chai Hu Tang.
In Shanghan, six to seven days in, with fever, slight aversion to cold, joint pain, slight vomiting, subcostal support/fullness, and unresolved exterior signs, this belongs to the indication for Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
In Shaoyin Disease (Disease of the Kidney and Heart channels/Deficiency-Cold syndrome), two to three days in, Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) is used for mild diaphoresis, as there are no significant interior symptoms in two to three days.
If the pulse is floating, there is urinary difficulty, slight fever, and polydipsia, Wu Ling San (Five-Ingredient Powder with Poria) is given to promote urination and induce mild sweating.