忌发表者,表邪已解,身汗已多,无表症,不必再用升提发散。故曰手足多汗,恶热不恶寒
者,忌发表。口渴唇焦,热而消水者,忌发表。口燥咽干,脉沉而数,忌发表。潮热谵语,
舌赤生刺,忌发表。心腹胀满,二便赤涩,忌发表。又有汗出太过,后反恶寒身痛,脉大而
空,此是阳虚亡阳之症,宜温补真阳,更忌发表。若汗出太多,津液消耗,时或恶寒,时或
身痛,脉细而数,似表症实非表症,此是阴虚生内热,宜养阴生津液,亦忌发表。又恶寒身
痛,头痛项强,脉沉而细,此痉病血虚也,忌发表。
表邪已解,表汗已多,热邪传里,里有结热,宜清里。故心烦多汗不得卧者,宜用黄连阿胶
汤。恶热多汗,唇焦消水者,宜人参白虎汤。神志不清,脉沉数大者,宜陶氏导赤各半汤。
口渴舌刺,潮热便闭者,宜凉膈散。赤 已透,多汗烦热者,宜化 汤。肠胃热结,大便不
通,宜调胃承气汤。欲便而不得便,时转臭气,小腹胀满,下症悉具,宜三乙承气汤。
清里之药,但能解里热,不能解表热。故凡身热无汗,头痛身痛,忌清里。手足逆冷,身热
脉伏,忌清里。脉浮身热,忌清里。 痧未透,忌清里。口干不渴,渴不消水,忌清里。二
便清利,里无热结,忌清里。舌苔而滑,身热足冷,忌清里。身热面赤,表汗未彻,忌清
里。谵语狂言,渴不消水,呕吐恶心,脉滑不数,痰食滞于中焦者,忌清里。 紫不化,口
反不渴,脉反不数者,阳明湿毒,非血热也,忌清里。血蓄上焦,漱水不咽者,忌清里。胁
痛干呕,口反不渴,水饮内停者,忌清里。阴极发燥,不能消水,脉迟下利,面赤戴阳者,
阴症也,忌清里。
忌用发汗解表法的情况:表邪已经解除,身体出汗已经很多,没有表证,不需要再用升提发散的方法。所以说,如果手足多汗,怕热不怕冷,是忌用发汗解表法的。口渴嘴唇焦裂,发热消耗津液,是忌用发汗解表法的。口燥咽干,脉象沉而数,是忌用发汗解表法的。潮热谵语(定时发热说胡话),舌质红赤生芒刺,是忌用发汗解表法的。心腹胀满,大小便赤涩不通,是忌用发汗解表法的。又有因为发汗太过,后来反而出现怕冷身痛,脉象大而空豁,这是阳虚亡阳的证候,应当温补真阳,更忌用发汗解表法。如果出汗太多,津液消耗,有时怕冷,有时身痛,脉象细而数,看似表证其实不是表证,这是阴虚产生内热,应当滋养阴液生津液,也忌用发汗解表法。还有怕冷身痛,头痛项强,脉象沉而细,这是痉病(以项背强直、角弓反张为特征的疾病)血虚所致,忌用发汗解表法。
表邪已解,表汗已出过多,热邪传入里部,里有结聚之热,应当清泄里热。所以心烦多汗不能安卧的,宜用黄连阿胶汤。怕热多汗,嘴唇焦裂消耗津液的,宜用人参白虎汤。神志不清,脉象沉数大的,宜用陶氏导赤各半汤。口渴舌生芒刺,潮热大便闭结的,宜用凉膈散。斑疹已经透出,多汗烦热的,宜用化斑汤。肠胃热结,大便不通的,宜用调胃承气汤。想排便却排不出,时常转动放出臭气,小腹胀满,下焦蓄血证候齐全,宜用三乙承气汤。
清泄里热的药物,只能解除里热,不能解除表热。所以凡是身体发热无汗,头痛身痛,忌用清泄里热法。手足逆冷,身体发热脉象伏匿,忌用清泄里热法。脉浮身体发热,忌用清泄里热法。痧疹未透发,忌用清泄里热法。口干但不渴,渴但不消耗水液,忌用清泄里热法。大小便清利,里没有热结,忌用清泄里热法。舌苔滑腻,身体发热脚冷,忌用清泄里热法。身体发热面色红赤,表汗未透彻,忌用清泄里热法。谵语狂言,渴但不消耗水液,呕吐恶心,脉滑而不数,痰食停滞在中焦的,忌用清泄里热法。斑色紫暗不化,口反而不渴,脉反而不数的,是阳明湿毒,不是血热,忌用清泄里热法。瘀血蓄积在上焦,漱口不想咽下的,忌用清泄里热法。胁痛干呕,口反而不渴,水饮内停的,忌用清泄里热法。阴寒极盛导致烦躁,不能消耗水液,脉迟下利,面赤戴阳(虚阳上浮)的,是阴证,忌用清泄里热法。
Contraindications for Releasing the Exterior: When exterior pathogens have been resolved and profuse sweating has already occurred, with no exterior syndrome present, there is no need to use ascending and dispersing methods again. Therefore, it is stated that excessive sweating of the hands and feet, aversion to heat without aversion to cold, contraindicates releasing the exterior. Thirst with dry and cracked lips, fever consuming body fluids, contraindicates releasing the exterior. Dry mouth and throat, with a deep (Chen) and rapid (Shu) pulse, contraindicates releasing the exterior. Tidal fever and delirious speech, with a red tongue bearing prickles, contraindicates releasing the exterior. Abdominal distension and fullness, with dark and scanty urination and difficult defecation, contraindicates releasing the exterior. Furthermore, if excessive sweating leads to subsequent aversion to cold and body pain, with a large but empty pulse, this indicates Yang deficiency and collapse of Yang; warming and tonifying True Yang is indicated, and releasing the exterior is strictly contraindicated. If excessive sweating depletes Jin-Ye (Body Fluids), causing intermittent aversion to cold and body pain, with a fine and rapid pulse, it resembles an exterior syndrome but is not one; this is Yin deficiency generating internal heat, requiring nourishing Yin and generating fluids, and releasing the exterior is also contraindicated. Additionally, aversion to cold, body pain, headache, and stiff neck, with a deep and fine pulse, indicate Blood deficiency in Jing-Bing (Spasm Disease); releasing the exterior is contraindicated.
When exterior pathogens are resolved and excessive sweating has occurred, if Heat pathogens transmit to the interior resulting in accumulated interior Heat, clearing the interior is indicated. Therefore, for irritability, excessive sweating, and inability to lie down, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated. For aversion to heat, excessive sweating, and dry, cracked lips consuming fluids, Renshen Baihu Tang (Ginseng White Tiger Decoction) is indicated. For clouded consciousness, with a deep, rapid, and large pulse, Tao Shi Daochi Geban Tang (Mr. Tao's Half-Daochi Decoction) is indicated. For thirst, tongue prickles, tidal fever, and constipation, Liangge San (Cooling the Diaphragm Powder) is indicated. For erupted macules/rash with excessive sweating and irritability, Huaban Tang (Transform Macules Decoction) is indicated. For intestinal and stomach Heat accumulation with unpassable stool, Tiaowei Chengqi Tang (Regulating the Stomach and Guiding Out Qi Decoction) is indicated. For the urge to defecate without success, frequent passage of foul odor, lower abdominal fullness, and complete presentation of Lower Jiao Blood Accumulation syndrome, Sanyi Chengqi Tang (Three Yi Chengqi Decoction) is indicated.
Medicines that clear the interior can only resolve interior Heat, not exterior Heat. Therefore, for any case involving fever without sweating, headache, and body pain, clearing the interior is contraindicated. For cold extremities, fever, and a hidden (Fu) pulse, clearing the interior is contraindicated. For a floating pulse and fever, clearing the interior is contraindicated. For un-erupted Sha-rash, clearing the interior is contraindicated. For dry mouth without thirst, or thirst without fluid consumption, clearing the interior is contraindicated. For clear and free urination and defecation, indicating no interior Heat accumulation, clearing the interior is contraindicated. For a slippery tongue coating and fever with cold feet, clearing the interior is contraindicated. For fever and red face with incomplete exterior sweating, clearing the interior is contraindicated. For delirious speech, mania, thirst without fluid consumption, vomiting, nausea, a slippery but not rapid pulse, and Phlegm-Food stagnation in the Middle Jiao, clearing the interior is contraindicated. For purple macules that do not transform, with lack of thirst and a non-rapid pulse, this is Yangming Damp-Toxin, not Blood Heat, so clearing the interior is contraindicated. For Blood stasis accumulating in the Upper Jiao, with rinsing the mouth but not swallowing water, clearing the interior is contraindicated. For hypochondriac pain, dry retching, lack of thirst, and internal retention of Water-Fluid, clearing the interior is contraindicated. For extreme Yin Cold causing restlessness, inability to consume fluids, slow pulse with diarrhea, and red face with Floating Yang (Dai-Yang), this is a Yin Syndrome, so clearing the interior is contraindicated.