口干者,邪热聚胃,消耗津液,故少阴证,口燥咽干,急下之。口干漱水不欲咽者,若见表证,
鼻衄,为邪热在经。缘阳明血气俱多,经中热甚,迫血妄行,犀角地黄汤。口干,身大热,背恶寒
者,人参白虎汤。若无表证,加之胸腹满,如狂者,又为蓄血证,桃仁承气汤。少阳口干,小柴胡
和之也。
渴者,里有热也,津液为热所耗。伤寒传至厥阴为消渴者,谓饮水多而小便少,乃热能消水也。
脉浮而渴,属太阳,小青龙去半夏,加天花粉。有汗而渴,属阳明,人参白虎汤;便实者,宜当下
之。脉沉而渴,属少阴,大承气汤。至于厥阴,又热之极矣,俱当下之无疑矣。太阳无汗喜渴,忌
白虎,宜小柴胡汤。阳明汗多而渴,
戒五苓,宜竹叶石膏汤。先呕后渴,此为欲解,当与水解。先渴后呕,为水停心下,赤茯苓汤。小
便不利而渴,五苓散。发黄头汗出,小水不利而渴者,茵陈五苓散。中暑脉虚,身热而渴者,白虎
汤为要也。
胸满者,膈间气塞满闷也,非心下满。胁满者,胁肋下胀满也,非腹中满。盖表邪传里,必先
胸以至心腹入胃,是以胸满多带表证,宜微汗。惟胁满多带半表半里,小柴胡加枳、桔和之。胸中
痰实者,涌之。如胸中结实,燥渴,大便秘者,下之,大陷胸汤可也。
口干,是由于邪热聚集在胃中,消耗了津液所致。因此,对于少阴病证出现口燥咽干的情况,应当紧急使用下法治疗。如果口干但只想含水漱口而不想吞咽,若同时伴有表证和鼻出血,说明邪热在经络之中。这是因为阳明经气血旺盛,经络中热势炽盛,逼迫血液妄行,可用犀角地黄汤治疗。如果出现口干、身体高热且背部怕冷的症状,用人参白虎汤治疗。如果没有表证,反而加上胸腹部胀满、神志狂乱的症状,这又是蓄血证,可用桃仁承气汤治疗。少阳病引起的口干,用小柴胡汤和解治疗。
口渴,是因为体内有热,津液被热邪耗伤。伤寒病传变到厥阴经出现消渴症状的,是指喝水多而小便少,这是热邪能够消耗水液的表现。脉象浮且口渴,属于太阳病,用小青龙汤去掉半夏,加入天花粉。有汗且口渴,属于阳明病,用人参白虎汤;大便干结的,适宜用下法攻下。脉象沉且口渴,属于少阴病,用大承气汤。至于厥阴病,又是热邪极盛的情况,都应当用下法治疗,毫无疑问。太阳病无汗且喜欢口渴,忌用白虎汤,宜用小柴胡汤。阳明病汗多且口渴,忌用五苓散,宜用竹叶石膏汤。先呕吐后口渴,这是病情将要解除的迹象,应当给予水分补充。先口渴后呕吐,是水饮停滞在心下(胃脘),用赤茯苓汤治疗。小便不利且口渴,用五苓散。发黄、头出汗、小便不利且口渴的,用茵陈五苓散。中暑脉象虚弱,身体发热且口渴的,白虎汤是主要用药。
胸满,是指膈间气机阻塞导致的满闷感,不是心下(胃脘部)的胀满。胁满,是指胁肋下方的胀满感,不是腹中的胀满。因为表邪传入体内,必定先从胸部传到心腹再进入胃,所以胸满多带有表证,适宜用微汗法治疗。只有胁满多带有半表半里的特征,用小柴胡汤加枳实、桔梗来和解治疗。胸中有痰实证的,用涌吐法。如果胸中结实、干燥口渴、大便秘结的,用下法,可用大陷胸汤。
Dry mouth is caused by pathogenic heat gathering in the Stomach and consuming body fluids. Therefore, in Shaoyin syndrome presenting with dry mouth and throat, urgent purgation (Xia Fa) should be applied. If there is a desire to rinse the mouth with water but no desire to swallow, accompanied by exterior syndrome and epistaxis, it indicates that pathogenic heat is in the meridians. This is because the Yangming meridian has abundant Qi and blood; intense heat in the meridian forces blood to move recklessly, for which Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated. If dry mouth is accompanied by high fever of the whole body and aversion to cold in the back, Renshen Baihu Tang (Ginseng White Tiger Decoction) is used. If there is no exterior syndrome, but instead chest and abdominal fullness and manic behavior occur, this is Blood Accumulation Syndrome (Xue Yu Zheng), for which Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) is indicated. For dry mouth due to Shaoyang disease, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to harmonize.
Thirst indicates interior heat consuming body fluids. In Taiyang disease transmitting to Jueyin, resulting in Xiao Ke (Wasting-Thirst), it refers to drinking large amounts of water while producing little urine, meaning heat consumes water. If the pulse is floating and there is thirst, it belongs to Taiyang; use Qinglong Tang (Green Dragon Decoction) removing Banxia (Pinelliae Rhizoma) and adding Tianhuafen (Trichosanthis Radix). If there is sweating and thirst, it belongs to Yangming; use Renshen Baihu Tang (Ginseng White Tiger Decoction); if stool is solid, purgation (Xia Fa) is appropriate. If the pulse is deep and there is thirst, it belongs to Shaoyin; use Dachengqi Tang (Major Order the Qi Decoction). Regarding Jueyin disease, heat is at its extreme, and purgation is undoubtedly indicated. For Taiyang disease with no sweating and preference for thirst, Baihu Tang (White Tiger Decoction) is contraindicated; Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable. For Yangming disease with excessive sweating and thirst, Wuling San (Five-Ingredient Powder with Poria) is contraindicated; Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is suitable. Vomiting followed by thirst indicates the condition is about to resolve; provide water to rehydrate. Thirst followed by vomiting indicates fluid retention in the heart region (epigastrium); Chifuling Tang (Red Poria Decoction) is used. For difficulty in urination accompanied by thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated. For jaundice, sweating on the head, difficulty in urination, and thirst, Yinchen Wuling San (Artemisia Capillaris Five-Ingredient Powder with Poria) is used. For summerheat stroke with a deficient pulse, fever, and thirst, Baihu Tang (White Tiger Decoction) is essential.
Chest fullness refers to a sensation of obstruction and stuffiness in the diaphragm area, distinct from fullness in the epigastrium (Xia Xin). Hypochondriac fullness refers to distension under the ribs, distinct from abdominal fullness. Since exterior pathogens transmitting inward must first pass through the chest to the heart/abdomen and then enter the Stomach, chest fullness often accompanies exterior syndrome and is treated with mild sweating (Wei Han). Hypochondriac fullness, however, often accompanies half-exterior/half-interior conditions and is treated with Xiaochaihu Tang (Minor Bupleurum Decoction) augmented with Zhishi (Aurantii Fructus) and Jiegie (Magnoliae Flos) to harmonize. For phlegm-solidity in the chest, emesis (Yong Zhi) is indicated. If there is solidity in the chest, dry thirst, and constipation, purgation (Xia Fa) is indicated, and Daxiexiong Tang (Major Chest-Breaking Decoction) may be used.