口干燥者，邪热结聚上焦，阳明胃经所主，肺热者亦有之。肺热，凉膈散。胃热，竹叶石膏
汤。身热已减，表邪已解，有下症者，三承气汤选用。少阳病，口苦舌干，小柴胡去半夏加
天花粉。阳明病背恶寒，口干燥，白虎汤。热传少阴，口燥咽干而渴，手足冷，脉反沉涩不
治之症也。按口燥与口渴不同。口渴者，口中尚有津液，但时时欲饮水。口燥咽干者，口中
燥裂，津液全无。仲景于背恶寒条，以口中和、不干燥者，为阴寒，若背恶寒，口干燥者，
为阳热。然又当以消水不消水，小便清白红赤，以定寒热。
夫唇口焦裂，人身大病也。在杂症中，有脾肺心及肠胃五条；在外感门，惟手足阳明所主。
上唇挟口，属手阳明大肠；下唇挟口，属足阳明胃。伤寒热在太阳，则唇口不焦；热传在阳
明，则唇口焦裂。故曰阳明燥热，唇口焦裂。然又有分别唇焦而消水者，为燥热；唇焦不消
水者，为湿热。又曰热在气分，则焦而口渴；热在血分，则焦而不渴。又曰唇口焦，渴而消
水，胸前宽适者，为热而无滞，宜清热。渴不消水，胸前饱闷者，为热而有食滞，宜消滞。
此言足阳明胃上部热也。唇口焦，不渴不饮水，腹中烦满者，为热在大肠，有燥粪。此言手
阳明大肠下部热也。故唇焦之症，有用保和散，消导上部胃家食滞而愈者；有用承气汤，去
下部大肠燥粪而愈者。不独凉膈清热一法可尽之，例如热邪谵语，唇焦口燥，渴而消水，用
凉膈散、导赤各半汤，清上焦燥热者。食滞谵语，唇焦口燥，渴不消水，用枳实豆豉汤、保和
散冲竹沥、芦卜汁，润燥消中焦滞者。燥结大肠，谵语唇焦，用承气汤，行下焦燥屎者。另
有热病与发 ，误食荤腥油腻，与热邪 毒，结纽不解，唇口焦裂，口臭牙疳，渴不消水，
烦热昏沉，若以保和散等，消谷食治之，病必不减。若以干葛、石膏、知母、三黄清热治
之，其热愈甚。若误认大肠燥屎唇焦，用承气汤下行逆治，其死更速。医家至此，束手待
毙。余以晚年之悟，思得 邪热毒伏于肠胃，蒸酿发出者也。初起必用升麻干葛汤，宣发阳
明伏毒。若膏粱积热，非升麻清胃汤不能宣扬肠胃积热，故清热化 ，必用余化此汤，加山
楂、槟榔；若食肉多，再加三棱、阿魏。治夹食症，常有得生者。夫热在气分，唇焦发渴，
用干葛石膏知母汤，人人知之者。热在血分，用升麻生地川连清胃汤主治，人多忽之。不知
干葛清胃汤，治阳明气分渴水之唇焦口渴；升麻清胃汤，治阳明血分不消水之唇焦口渴。余
以升麻清胃汤化 ，此化法也。又以此汤清阳明血分发渴不消水，是法外之法也。今又以此
汤，治膏粱积热，荤腥发热之唇焦，此化外化出者也。再详仲景治太阳渴欲饮水，微热消渴
者，脉数烦渴者，汗出而渴，渴而口烦躁者，不用清解上焦肺胃积热，皆用五苓散主治。良
以太阳汗多口渴，表热不减，表里皆病，热结膀胱下焦，非同表热里热，单以发表退热，单
以清里止渴者，故以五苓散双解太阳也。夫口渴消水，用清里，人人知之；口渴消水，有表
邪，用不得清里，人不知也。
口部干燥的，是邪热结聚在上焦，由阳明胃经所主管，肺热也会有这种情况。如果是肺热，用凉膈散治疗；如果是胃热，用竹叶石膏汤治疗。如果身体发热已经减轻，表邪已经解除，但出现可以使用下法的症状时，在三承气汤中选用合适的方剂。少阳病，表现为口苦舌干，用小柴胡汤去掉半夏，加入天花粉。阳明病，表现为背部怕冷、口部干燥，用白虎汤治疗。热邪传入少阴，出现口燥咽干且口渴，手足发冷，脉象反而沉涩，这是难以治愈的病症。按语：口燥与口渴不同。口渴的人，口中还有津液，只是时常想喝水。口燥咽干的人，口中干燥裂开，津液完全枯竭。张仲景在背恶寒的条文中指出，如果口中中和、不干燥，属于阴寒证；如果背恶寒且口干燥，属于阳热证。然而，还应当通过观察患者是否饮水以及小便颜色是清还是赤，来判定寒热性质。
至于嘴唇和口角焦裂，这是人体患大病时的表现。在内伤杂病中，涉及脾、肺、心及肠胃五个方面；在外感病门类中，只由手足阳明经所主管。上唇夹着口，属于手阳明大肠经；下唇夹着口，属于足阳明胃经。伤寒热邪在太阳经时，嘴唇和口角不会焦裂；热邪传入阳明经时，嘴唇和口角就会焦裂。所以说，阳明燥热会导致嘴唇和口角焦裂。然而又有区分：嘴唇焦裂且能喝水的，属于燥热；嘴唇焦裂但不能喝水的，属于湿热。又说：热邪在气分，就会焦裂且口渴；热邪在血分，就会焦裂但不口渴。又说：嘴唇和口角焦裂，口渴且能喝水，胸部宽舒舒适的，属于有热而无积滞，适宜清热。口渴但不能喝水，胸部饱闷的，属于有热且有食积停滞，适宜消导积滞。这是说足阳明胃上部有热的情况。嘴唇和口角焦裂，不渴也不喝水，腹部烦闷胀满的，属于热邪在大肠，有燥屎内结。这是说手阳明大肠下部有热的情况。所以治疗嘴唇焦裂的病症，有用保和散消导上部胃家食积而痊愈的；有用承气汤攻下下部大肠燥屎而痊愈的。不仅仅只有凉膈散清热这一种方法可以解决所有问题。例如热邪导致谵语，嘴唇焦裂口燥，口渴且能喝水，用凉膈散、导赤各半汤，清除上焦燥热；食积导致谵语，嘴唇焦裂口燥，口渴但不能喝水，用枳实豆豉汤、保和散冲服竹沥、萝卜汁，润燥并消除中焦积滞；燥屎结于大肠，谵语且嘴唇焦裂，用承气汤，通导下焦燥屎。另外有热病与痘疹（此处原文可能有缺字或异体字，结合语境指痘疹或类似出疹性疾病），误食荤腥油腻食物，与热邪毒气纠结不解，导致嘴唇口角焦裂，口臭牙疳，口渴不能喝水，烦躁发热昏沉，如果用保和散等药消谷食治疗，病情必定不会减轻。如果用干葛、石膏、知母、三黄清热治疗，热势会更加严重。如果误认为是大肠燥屎导致的嘴唇焦裂，用承气汤下行攻下逆治，死亡速度更快。医生到了这种地步，束手待毙。我凭借晚年的感悟，思考得出这是邪热毒气潜伏在肠胃，蒸酿发出的结果。初起时必须用升麻干葛汤，宣发阳明伏毒。如果是膏粱厚味积热，不用升麻清胃汤就不能宣扬肠胃积热，所以清热化湿（此处原文“化 ”可能指化浊或化积，结合下文推测为化积/化浊之意，暂译为化积/化解郁热），必须用余氏此汤，加山楂、槟榔；如果吃肉多，再加三棱、阿魏。治疗夹食症，常有获救的。热邪在气分，嘴唇焦裂发渴，用干葛石膏知母汤，这是人人都知道的。热邪在血分，用升麻生地川连清胃汤主治，人们往往忽视它。不知道干葛清胃汤，治疗阳明气分口渴引饮的嘴唇焦裂口渴；升麻清胃汤，治疗阳明血分不消水的嘴唇焦裂口渴。我用升麻清胃汤进行变化应用，这是法外之法。又用此汤治疗阳明血分发渴且不消水的情况，这也是法外之法。现在又用此汤治疗因膏粱厚味积热、荤腥发热导致的嘴唇焦裂，这是从变化中再变化出来的方法。再详细考察张仲景治疗太阳病口渴想喝水，微热消渴的，脉数烦渴的，出汗后口渴的，口渴且口烦躁的，都不用清解上焦肺胃积热的方法，都用五苓散主治。大概因为太阳病汗多导致口渴，表热未减，表里同病，热结膀胱下焦，不同于单纯的表热或里热，不能单纯以发表退热、单纯以清里止渴的方法处理，所以用五苓散双解太阳表里之邪。人们都知道口渴能喝水，用清里法；但不知道口渴能喝水且有表邪时，不能用清里法，这一点人们并不知晓。
When the mouth is dry, it indicates that pathogenic heat has aggregated in the Upper Jiao (Upper Burner), which is governed by the Stomach Meridian of Foot-Yangming. This condition can also occur due to Lung Heat. For Lung Heat, Liang Ge San (Cooling the Diaphragm Powder) is used; for Stomach Heat, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is used. If the body fever has subsided, the exterior pathogens have been resolved, but symptoms indicating the need for purgation appear, one of the Three Cheng Qi Decoctions (Three Major Purgative Formulas) should be selected according to the specific presentation. In Shaoyang Disease, characterized by a bitter taste in the mouth and dry tongue, Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Banxia (Pinelliae Rhizoma) removed and Tian Hua Fen (Trichosanthis Radix) added is prescribed. In Yangming Disease, presenting with aversion to cold on the back and dry mouth, Bai Hu Tang (White Tiger Decoction) is indicated. When heat transmits to the Shaoyin channel, causing dry mouth, dry throat, thirst, cold hands and feet, and a pulse that is unexpectedly deep and choppy, this is considered an untreatable condition. Note: "Mouth dryness" differs from "thirst." Thirst implies there is still some saliva in the mouth, but the patient frequently desires to drink water. Mouth dryness with dry throat implies the mouth is cracked and dry, with a complete lack of fluids. Zhang Zhongjing, in the section on aversion to cold on the back, states that if the mouth feels neutral and not dry, it is a Yin-Cold pattern; if there is aversion to cold on the back and the mouth is dry, it is a Yang-Heat pattern. However, one must also determine cold versus heat by observing whether the patient drinks water and whether the urine is clear or red.
Regarding cracked and scorched lips and mouth, this is a sign of severe illness in the human body. In miscellaneous diseases, it involves five aspects: Spleen, Lung, Heart, and Intestines and Stomach. In external contraction diseases, it is solely governed by the Hand and Foot Yangming meridians. The upper lip, flanking the mouth, belongs to the Large Intestine Meridian of Hand-Yangming; the lower lip, flanking the mouth, belongs to the Stomach Meridian of Foot-Yangming. When Shanghan (Cold Damage) heat is in the Taiyang stage, the lips and mouth do not crack; when heat transmits to the Yangming stage, the lips and mouth become cracked and scorched. Thus, it is said that Yangming Dryness-Heat causes cracked and scorched lips and mouth. However, distinctions exist: scorched lips that allow drinking indicate Dryness-Heat; scorched lips that do not allow drinking indicate Damp-Heat. Furthermore, heat in the Qi Level results in cracking and thirst; heat in the Blood Level results in cracking without thirst. Additionally, scorched lips and mouth with thirst and ability to drink, accompanied by a comfortable chest, indicate heat without stagnation, suitable for clearing heat. Thirst without ability to drink, accompanied by chest fullness and oppression, indicate heat with food stagnation, suitable for resolving stagnation. This refers to heat in the upper part of the Foot-Yangming Stomach. Scorched lips and mouth without thirst or desire to drink, accompanied by abdominal irritability and fullness, indicate heat in the Large Intestine with dry feces. This refers to heat in the lower part of the Hand-Yangming Large Intestine. Therefore, treatments for scorched lips may include Bao He San (Preserve Harmony Powder) to resolve food stagnation in the upper stomach, or Cheng Qi Tang formulas to purge dry feces from the lower large intestine. It is not limited to the method of clearing heat with Liang Ge San. For example, in cases of delirium caused by heat, with scorched lips, dry mouth, thirst, and ability to drink, Liang Ge San and Dao Chi Ge Ban Tang (Half Dao Chi Decoction) are used to clear upper Jiao dryness-heat. In cases of delirium caused by food stagnation, with scorched lips, dry mouth, thirst, but inability to drink, Zhi Shi Dou Chi Tang (Immature Soybean and Immature Bitter Orange Decoction) and Bao He San mixed with Zhu Li (Bambusa Textilis Sap) and Lu Bo Zhi (Raphani Juice) are used to moisten dryness and resolve middle Jiao stagnation. In cases of dry accumulation in the Large Intestine, with delirium and scorched lips, Cheng Qi Tang is used to move lower Jiao dry stool. There are also cases where heat disease combined with eruptive diseases (such as smallpox/measles) involves the mistaken consumption of rich, greasy, or animal products, causing pathogenic heat and toxins to knot together unresolvedly. This leads to scorched lips and mouth, foul breath, gingival ulcers, thirst without ability to drink, irritability, fever, drowsiness, and lethargy. If treated with Bao He San to digest food, the disease will not subside. If treated with Gan Ge (Puerariae Radix), Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), and San Huang (Three Bitters) to clear heat, the heat will worsen. If mistakenly diagnosed as dry stool in the Large Intestine causing scorched lips and treated with Cheng Qi Tang to purge downward, death will occur more rapidly. Physicians at this point are helpless. Based on my insights in my later years, I deduce that this is due to pathogenic heat and toxins lurking in the intestines and stomach, steaming and fermenting to emerge. Initially, Sheng Ma Gan Ge Tang (Cimicifugae and Puerariae Decoction) must be used to vent the latent toxin in Yangming. If the heat stems from rich diet accumulation, Sheng Ma Qing Wei Tang (Cimicifugae Stomach-Clearing Decoction) is required to ventilate intestinal and gastric heat; thus, to clear heat and resolve stagnation, this formula must be modified with Shan Zha (Crataegi Fructus) and Bing Lang (Arecae Semen); if meat consumption was high, add San Leng (Sparganii Rhizoma) and A Wei (Asini Corii Colla). Treating syndromes with food retention often yields survival. Heat in the Qi level, causing scorched lips and thirst, is treated with Gan Ge Shi Gao Zhi Mu Tang, a method known to all. Heat in the Blood level is treated primarily with Sheng Ma Sheng Di Chuan Lian Qing Wei Tang (Cimicifugae, Rehmanniae, and Coptidis Stomach-Clearing Decoction), a method often overlooked. One must know that Gan Ge Qing Wei Tang treats scorched lips and thirst due to Yangming Qi-level fluid consumption; Sheng Ma Qing Wei Tang treats scorched lips and thirst without fluid consumption due to Yangming Blood-level heat. I apply modifications to Sheng Ma Qing Wei Tang, representing methods beyond standard application. Using this decoction to treat Yangming Blood-level heat with thirst and no fluid consumption is another layer of methodological extension. Currently, using this decoction to treat scorched lips from rich-diet accumulation heat or meat/grease-induced heat represents further evolution of these methods. Re-examining Zhang Zhongjing’s treatment of Taiyang thirst with desire to drink, mild heat, and excessive thirst; rapid pulse with irritability and thirst; thirst after sweating; and thirst with oral irritability—he does not use methods to clear upper Jiao Lung and Stomach accumulated heat, but instead uses Wu Ling San (Five-Ingredient Powder with Poria). This is likely because Taiyang profuse sweating leads to thirst, exterior heat remains unsubsided, and both exterior and interior are affected, with heat binding in the Bladder/Lower Jiao. This differs from simple exterior or interior heat, which cannot be treated solely by releasing the exterior or clearing the interior alone. Thus, Wu Ling San is used to simultaneously resolve Taiyang. Everyone knows that thirst with ability to drink requires clearing the interior; however, few realize that when thirst with ability to drink is accompanied by exterior pathogens, clearing the interior is contraindicated.