仲景曰。太阳病。发汗后。若大汗出。胃中干。烦躁不眠。其人欲
得饮水者。当稍饮之。令胃中和则愈。
又曰。厥阴病。渴欲饮水者。少少与之愈。
又曰。太阳病。寸缓。关浮。尺弱。其人发热汗出。复恶风寒。不
呕。但心下痞者。此为医下之也。若其不下。病患不恶寒而渴者。为
转属阳明。小便数者。大便则坚。不更衣。十日无所苦也。渴欲饮水。
少少与之。但以法救之。渴者。宜五苓散。
又曰。寸口脉洪而大。数而滑。洪大则营气长。滑数则胃气实。
营气长。则阳盛怫郁。不得出身。胃实则坚难。大便则干燥。三焦闭塞。
津液不通。医发其汗。阳气不周。复重下之。胃燥蓄热。大便遂燥。
小便不利。营卫相搏。心烦发热。两眼如火。鼻干面赤。舌燥。齿
黄焦。故大渴。过经成坏病。针药所不能制。与水灌枯槁。阳气微散。
身寒。温衣覆令汗出。表里通然。其病即除。形脉都不同。此愈非治
法。但医所当慎。妄犯伤营卫。
又曰。呕吐而病在膈上。后思水者解。急与猪苓散。饮水亦得
也。千金亦曰。必思煮饼。急思水者。与五苓散饮之。(余同)
又曰。霍乱而头痛发热。身体疼痛。热多饮水者。属五苓散。
庞氏曰。病患水药入口则吐。或渴而呕者。或汗后脉尚浮而烦
渴者。或下利渴而小便不利者。或呕而小便不利者。五苓散皆主之。
或因渴。停水心下。短息者难治。
又曰。若头痛无热。但狂言。烦躁不安。精神不与人相当。勿以
火导之。但以猪苓散方寸匕服之。当连饮新水三升。即令指刺喉中
吐去之。病随手愈。若不能吐者而强与水。水停则结心下也。当以药
吐之。不尔。更致危病。若当吐。不时以猪苓散吐之。其死殆速矣。亦
可针之佳。水饮膈实难治。此三死一生也。(千金之文)
张仲景说:太阳病(太阳经受邪所致的病证),经过发汗治疗后,如果出汗过多,导致胃中津液干燥,出现烦躁、无法入睡的症状。此时病人想要喝水,应当稍微给予饮水,使胃气调和即可痊愈。
又说:厥阴病(足厥阴肝经病变引起的病证),口渴想喝水的,少量多次给予饮水即可痊愈。
又说:太阳病,寸脉缓,关脉浮,尺脉弱。病人发热、出汗,又怕风怕冷,没有呕吐症状,只是感到心下(胃脘部)痞塞不适。这是医生误用攻下法导致的。如果没有误用攻下法,病人不恶寒反而口渴,说明病邪转属阳明(阳明经受邪或腑实内结的病证)。小便频数的,大便就会干硬。即使十天不大便,也没有痛苦的感觉。如果口渴想喝水,少量多次给予饮水,只需根据病情法则进行救治。对于口渴者,适宜使用五苓散(利水渗湿、温阳化气的方剂)。
又说:寸口脉洪大且数而滑。洪大表示营气偏盛,滑数表示胃气充实。营气偏盛,则阳气亢盛郁滞,不能正常宣发透达;胃气充实则体内燥结坚硬,大便干燥。三焦(上焦、中焦、下焦的总称,主司气化与水液代谢)闭塞,津液运行不通。医生若再发其汗,导致阳气周流不畅,随后又重施攻下法,致使胃中燥热蓄积,大便更加燥结。出现小便不利,营卫之气相互搏结,心烦发热,双眼如火燎,鼻干面赤,舌燥,牙齿枯黄焦黑,因此极度口渴。病情传变过经,形成坏病(因误治而病情恶化复杂的病证),针药难以控制。此时如同给干枯之物浇水,若阳气微弱消散,身体发冷,需用厚衣覆盖使其微微汗出,表里通畅,疾病即可消除。但形体与脉象已完全不同,这种痊愈并非正常的治疗方法,只是医生应当谨慎之处。妄加触犯会损伤营卫。
又说:呕吐且病位在膈上,后来思虑喝水的,是病情将解之兆,急予猪苓散(利水渗湿的方剂)。喝水也可以。(《千金方》也说:必定想吃煮饼,急切想喝水的,给予五苓散饮用。)(其余内容相同)
又说:霍乱(以突发剧烈吐泻为主要特征的疾病)伴有头痛、发热、身体疼痛,热象较多且想喝水的,属于五苓散主治范围。
庞安时(宋代医家)说:病人服用汤药入口即吐,或者口渴且呕吐的,或者发汗后脉象仍浮且烦渴的,或者腹泻口渴且小便不利的,或者呕吐且小便不利的,五苓散皆为主治方剂。如果因为口渴导致水饮停聚于心下,伴有呼吸短促的,则难治。
又说:如果头痛但没有发热,只是胡言乱语,烦躁不安,精神恍惚与人不相应对,不要用火疗等方法导引治疗。只需用猪苓散一方寸匕的量服用,并连续饮用新汲水三升,随即用手指刺激喉咙催吐排出。病随手而愈。如果不能吐出而强行给水,水饮停聚则会结于心下。应当用药催吐,否则会导致更危险的病症。如果应当催吐而不及时用猪苓散催吐,死亡可能会更快。也可以用针刺治疗较好。水饮停聚膈间实证难治,这是“三死一生”的情况。(出自《千金方》的文字)
Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel), after sweating therapy, if excessive sweating occurs causing dryness in the Stomach, accompanied by restlessness and insomnia, when the patient desires to drink water, one should allow them to drink slightly. When the Stomach Qi harmonizes, the condition will resolve.
It is also stated: In Jueyin disease (disease of the Jueyin channel), if the patient is thirsty and desires to drink water, giving small amounts frequently will lead to recovery.
It is also stated: In Taiyang disease, with a slow pulse at the Cun position, floating pulse at the Guan position, and weak pulse at the Chi position. The patient presents with fever, sweating, aversion to wind and cold, no vomiting, but only epigastric fullness and oppression. This results from the physician's erroneous use of purgation. If purgation had not been used, and the patient is not averse to cold but is thirsty, it indicates the disease has transferred to Yangming disease (disease of the Yangming channel or fu-organ excess). Frequent urination leads to hard stools. Even without bowel movement for ten days, there may be no discomfort. If thirsty and desiring water, give small amounts frequently; rescue according to appropriate principles. For thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated.
It is also stated: The pulse at the Cun Kou (radial artery) is surging, large, rapid, and slippery. Surging and large indicate abundant Ying Qi (nutritive Qi); rapid and slippery indicate excess Wei Qi (defensive Qi) in the Stomach. Abundant Ying Qi leads to excess Yang stagnation, preventing proper diffusion. Excess in the Stomach leads to hardness and dry stools. The Sanjiao (Triple Burner) becomes blocked, and body fluids fail to circulate. If the physician induces sweating, Yang Qi fails to circulate fully; subsequent heavy purgation causes dry heat accumulation in the Stomach, making stools even drier. There is difficulty in urination, Ying and Wei Qi contend, causing mental restlessness, fever, eyes burning like fire, dry nose, red face, dry tongue, yellow and scorched teeth, leading to extreme thirst. After passing through meridians, it becomes a Huai Bing (complicated disease due to mismanagement), resistant to acupuncture and herbs. Giving water to a withered state dissipates weak Yang Qi, causing cold limbs; covering with warm clothes to induce slight sweating allows interior and exterior to communicate, resolving the disease. However, the form and pulse are entirely different; this recovery is not a standard treatment method, but a caution for physicians. Reckless interference damages Ying and Wei Qi.
It is also stated: Vomiting with pathology above the diaphragm, followed by craving water, indicates resolution. Immediately administer Zhuling San (Polyporus Powder). Drinking water is also acceptable. Qianjin Fang (Essential Prescriptions Worth a Thousand Gold) also states: The patient must crave boiled noodles; if urgently thirsty, administer Wuling San to drink. (The remainder is identical.)
It is also stated: In Huoluan (acute vomiting and diarrhea syndrome) with headache, fever, and body pain, where heat signs predominate and the patient desires water, it falls under the indication for Wuling San.
Pang Anshi (Song Dynasty physician) stated: For patients who vomit immediately upon swallowing medicine, or have thirst with vomiting, or have floating pulse with mental restlessness and thirst after sweating, or have diarrhea with thirst and difficulty urinating, or have vomiting with difficulty urinating, Wuling San is the primary treatment. If thirst leads to water retention below the heart with shortness of breath, it is difficult to treat.
It is also stated: If there is headache without fever, only delirium, mental restlessness, and disorientation, do not use moxibustion or heat therapies. Administer one cun bi (unit of measure) of Zhuling San, and have the patient continuously drink three sheng (units of volume) of fresh water, then stimulate the throat to induce vomiting. The disease resolves instantly. If vomiting cannot be induced and water is forced, water retention will knot below the heart. One must induce vomiting with medicine; otherwise, critical danger ensues. If vomiting is indicated but Zhuling San is not used promptly to induce it, death may occur faster. Acupuncture is also a good option. Water retention in the diaphragm as an excess syndrome is difficult to treat; this represents a "three deaths, one life" scenario. (Text from Qianjin Fang.)