盗汗者,睡中乃出,醒则止矣。杂症门,责之血虚有火,故用当归六黄汤等补血凉血。外感
盗汗,是邪热在半表半里之间,故用小柴胡汤。然不独少阳一经,有盗汗,三阳三阴,皆有
盗汗也。三阳盗汗,皆邪热未尽;三阴盗汗,皆热伏血分。故盗汗之症,有热无寒者也。治
太阳盗汗,羌活冲和汤。阳明盗汗,干葛石膏汤。少阳盗汗,小柴胡汤。三阴盗汗,当归六
黄汤。在厥阴,倍生地、白芍药;在少阴者,倍生地、黄柏、黄连;在太阴者,倍当归、黄
芩。仲景论中,但有三阳盗汗,无三阴盗汗,以盗汗皆表症耳。今见热邪传入三阴,亦有盗汗者。
太阳病,脉浮而动数。浮则为风,数则为热;动则为痛,数则为虚。头痛发热,微盗汗出,
而反恶寒者,表未解也。医反下之,动数变迟,膈内拒痛,胃中空虚,客气动膈,短气烦
躁,心中懊 ,阳气内陷,心下因硬,则为结胸。大陷胸汤主之。若不结胸,但头汗出,剂
颈而还,小便不利,身必发黄。详注结胸宜参看。
阳明病,脉浮而紧,必潮热发作有时。但浮者,必盗汗出。
前条申明太阳脉浮动数,盗汗症,表邪未解,误下而变结胸发黄。此条申明阳明脉浮而
紧,潮热发作有时症,表邪未散,亦不可下。即脉之但浮不紧,亦必见盗汗之表症。详注潮热。
三阳合病,脉浮大,上关上,但欲眠睡,合目则汗。
脉浮,太阳也。脉大,阳明也。上关上,少阳也。欲眠睡,合目则盗汗,此热在胆也,用
小柴胡汤、泻心汤。今余推展清胆汤,重加柴胡、黄芩,互注合病,互参看。
羌活冲和汤 见发热。
仲景治盗汗,惟以小柴胡汤主治。盗汗尚见太阳表症者,家秘用此汤治之。
干葛石膏汤 见寒热。
盗汗而见太阳表症,用羌活冲和汤;盗汗而见阳明表症,化立此方。太阳不用败毒散,用
冲和汤;阳明不用干葛汤,用此方,以盗汗表里症,宜和解耳。
小柴胡汤 见寒热头眩。
当归六黄汤
当归 地黄 黄 黄连 黄芩 黄柏
此治血中伏火,内伤盗汗。家秘去黄 。加柴胡、白芍药,治外感盗汗。再加牡丹皮,其方更专。
大陷胸汤 见结胸。
盗汗本非此方治者,因下后,心下直至小腹硬痛,故以此方治结胸为急。
清胆汤
柴胡 黄芩 竹茹 浓朴 广皮 甘草
合目则汗,胆经火旺,故用此方。若左寸脉大,是胆涎沃心,家秘加陈胆星、川黄连;兼
小便不利,合导赤各半汤;左关数大,合龙胆泻肝汤,加归、芍、山栀、牡丹皮。
盗汗,是指在睡眠中出汗,醒来后汗止。在杂病门类中,多责之于血虚有火,因此使用当归六黄汤等方剂来补血凉血。外感引起的盗汗,是邪热位于半表半里之间,因此使用小柴胡汤。然而,不仅少阳一经会出现盗汗,三阳和三阴经也都有盗汗的情况。三阳经的盗汗,都是邪热未尽;三阴经的盗汗,都是热邪潜伏在血分。所以,盗汗这一症状,是有热无寒的。治疗太阳经的盗汗,用羌活冲和汤。阳明经的盗汗,用干葛石膏汤。少阳经的盗汗,用小柴胡汤。三阴经的盗汗,用当归六黄汤。若病在厥阴,加倍使用生地黄、白芍药;若病在少阴,加倍使用生地黄、黄柏、黄连;若病在太阴,加倍使用当归、黄芩。张仲景的论述中,只有三阳经的盗汗,没有三阴经的盗汗,因为认为盗汗都属于表证。如今见到热邪传入三阴经,也有出现盗汗的情况。
太阳病,脉象浮而动数。浮脉主风邪,数脉主热邪;动脉主痛,数脉也主虚。头痛发热,微微盗汗,反而恶寒,这是表证未解。医生反而使用攻下法,导致动数之脉变为迟脉,膈内拒按疼痛,胃中空虚,客气扰动膈膜,出现短气烦躁,心中懊恼,阳气内陷,心下因而硬满,这就形成了结胸。以大陷胸汤主治。如果不形成结胸,只是头部出汗,至颈部而止,小便不利,身体必然发黄。详细的注解请参考关于结胸的章节。
阳明病,脉象浮而紧,必定会有潮热,发作有定时。如果脉象只浮而不紧,必定会出现盗汗。
前一条阐明了太阳病脉象浮动数,以及盗汗症状,表明表邪未解,误用下法会导致变证为结胸或发黄。这一条阐明了阳明病脉象浮而紧,以及潮热发作有时的症状,表明表邪未散,也不可攻下。即使脉象只是浮而不紧,也必定会出现盗汗这一表证。详细的注解请参考关于潮热的章节。
三阳合病,脉象浮大,关部以上明显,只想睡觉,闭上眼睛就出汗。
脉浮,属于太阳经。脉大,属于阳明经。脉气上至关部以上,属于少阳经。想睡觉,闭上眼睛就盗汗,这是热邪在胆经,使用小柴胡汤、泻心汤。现在我推演清胆汤,重用柴胡、黄芩,互相参照合病的理论,互参查看。
张仲景治疗盗汗,只以小柴胡汤为主治。如果盗汗还伴有太阳经表证,家传秘方使用此汤治疗。
干葛石膏汤 见寒热章节。
盗汗而伴有太阳经表证,用羌活冲和汤;盗汗而伴有阳明经表证,化裁创立此方。太阳经不用败毒散,用冲和汤;阳明经不用干葛汤,用此方,因为盗汗涉及表里证,适宜和解。
小柴胡汤 见寒热头眩章节。
当归六黄汤
组成:当归、地黄、黄芪、黄连、黄芩、黄柏。
这是治疗血中伏火、内伤引起的盗汗。家传秘方去掉黄芪,加入柴胡、白芍药,用于治疗外感引起的盗汗。再加入牡丹皮,该方更为专效。
盗汗本来不是此方治疗的适应症,但因为误下后,从心下直至小腹硬痛,所以以此方急治结胸。
清胆汤
组成:柴胡、黄芩、竹茹、浓朴、广皮、甘草。
闭上眼睛就出汗,是胆经火旺,所以使用此方。如果左寸脉大,是胆涎沃心,家传秘方加陈胆星、川黄连;兼有小便不利,合用导赤各半汤;左关脉数大,合用龙胆泻肝汤,加入当归、白芍、山栀、牡丹皮。
Dao Han (Night Sweats) refers to sweating during sleep, which stops upon waking. In the category of miscellaneous diseases, it is attributed to Blood Deficiency with Fire, thus Danggui Liuhuang Tang (Angelica Sinensis and Six Yellow Decoction) and other formulas are used to nourish Blood and cool Blood. Dao Han caused by external contraction is due to pathogenic heat located between the exterior and interior, thus Xiaochaihu Tang (Minor Bupleurum Decoction) is used. However, Dao Han is not exclusive to the Shaoyang channel; it can occur in all three Yang and all three Yin channels. Dao Han in the three Yang channels indicates that pathogenic heat is not yet exhausted; Dao Han in the three Yin channels indicates that heat is latent in the Blood level. Therefore, the symptom of Dao Han involves Heat without Cold. For Dao Han of the Taiyang channel, Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) is used. For Dao Han of the Yangming channel, Gange Shigao Tang (Pueraria and Gypsum Decoction) is used. For Dao Han of the Shaoyang channel, Xiaochaihu Tang (Minor Bupleurum Decoction) is used. For Dao Han of the three Yin channels, Danggui Liuhuang Tang (Angelica Sinensis and Six Yellow Decoction) is used. If the disease is in Jueyin, increase the dosage of Shengdihuang (Rehmanniae Radix) and Baishaoyao (Paeoniae Radix Alba); if in Shaoyin, increase Shengdihuang (Rehmanniae Radix), Huangbai (Phellodendri Cortex), and Huanglian (Coptidis Rhizoma); if in Taiyin, increase Danggui (Angelicae Sinensis Radix) and Huangqin (Scutellariae Radix). In Zhang Zhongjing's treatises, only Dao Han of the three Yang channels is discussed, not the three Yin channels, because Dao Han was considered a manifest symptom. Nowadays, it is observed that when pathogenic heat transmits into the three Yin channels, Dao Han also occurs.
In Taiyang Bing (Taiyang Disease), the pulse is Floating, Moving, and Rapid. Floating indicates Wind, Rapid indicates Heat; Moving indicates Pain, and Rapid also indicates Deficiency. Headache, fever, slight Dao Han (Night Sweats), and aversion to cold indicate that the exterior syndrome is unresolved. If the physician erroneously applies purgation, the Moving-Rapid pulse changes to Slow, pain resists pressure in the epigastrium, the Stomach becomes empty, rebellious Qi disturbs the Diaphragm, leading to shortness of breath, irritability, and mental restlessness (Ao Nao). The Yang Qi sinks inward, causing hardness in the epigastrium, resulting in Jie Xiong (Chest Binding). Da Xiexiong Tang (Major Chest-Binding Decoction) is indicated. If Jie Xiong does not form, but there is sweating only on the head up to the neck, urination is difficult, and jaundice will inevitably develop. For detailed notes, refer to the section on Jie Xiong.
In Yangming Bing (Yangming Disease), the pulse is Floating and Tight, indicating tidal fever occurring at specific times. If the pulse is only Floating, Dao Han (Night Sweats) will definitely occur.
The previous clause explained the Taiyang pulse being Floating, Moving, and Rapid, and the symptom of Dao Han, indicating that pathogenic factors at the exterior are unresolved; erroneous purgation leads to complications like Jie Xiong or Jaundice. This clause explains the Yangming pulse being Floating and Tight, and the symptom of tidal fever, indicating that pathogenic factors at the exterior have not dispersed and purgation should not be used. Even if the pulse is only Floating and not Tight, the exterior symptom of Dao Han will definitely appear. For detailed notes, refer to the section on Tidal Fever.
In San Yang He Bing (Combined Disease of the Three Yang Channels), the pulse is Floating and Large, prominent above the Guan position. The patient desires sleep, and sweats when closing the eyes.
A Floating pulse belongs to Taiyang. A Large pulse belongs to Yangming. Pulse prominence above the Guan position belongs to Shaoyang. Desire for sleep and Dao Han upon closing the eyes indicate Heat in the Gallbladder channel. Xiaochaihu Tang (Minor Bupleurum Decoction) and Xiexin Tang (Drain the Epigastrium Decoction) are used. I now propose Qingdan Tang (Clear the Gallbladder Decoction), heavily dosed with Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix), referring mutually to the theory of combined diseases.
Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) - See "Fever".
Zhang Zhongjing treated Dao Han (Night Sweats) primarily with Xiaochaihu Tang (Minor Bupleurum Decoction). When Dao Han presents with Taiyang exterior symptoms, this family secret formula uses this decoction for treatment.
Gange Shigao Tang (Pueraria and Gypsum Decoction) - See "Chills and Fever".
For Dao Han with Taiyang exterior symptoms, use Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction); for Dao Han with Yangming exterior symptoms, this formula was created by modification. Taiyang does not use Baidu San (Detoxification Powder) but uses Chonghe Tang; Yangming does not use Gange Tang (Pueraria Decoction) but uses this formula, because Dao Han involves both exterior and interior symptoms, requiring harmonization.
Xiaochaihu Tang (Minor Bupleurum Decoction) - See "Chills, Fever, Dizziness".
Danggui Liuhuang Tang (Angelica Sinensis and Six Yellow Decoction)
Ingredients: Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Huangqi (Astragali Radix), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huangbai (Phellodendri Cortex).
This treats internal injury Dao Han caused by latent fire in the Blood. The family secret formula removes Huangqi (Astragali Radix), adds Chaihu (Bupleuri Radix) and Baishaoyao (Paeoniae Radix Alba) to treat external contraction-induced Dao Han. Adding Mudanpi (Moutan Cortex) makes the formula more specialized.
Da Xiexiong Tang (Major Chest-Binding Decoction) - See "Jie Xiong".
Dao Han is originally not an indication for this formula. However, after erroneous purgation, hardness and pain extend from the epigastrium to the lower abdomen, so this formula is used urgently to treat Jie Xiong.
Qingdan Tang (Clear the Gallbladder Decoction)
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taeniam), Houpo (Magnoliae Officinalis Cortex), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Sweating upon closing the eyes indicates hyperactive fire in the Gallbladder channel, hence this formula is used. If the Left Cun pulse is Large, it indicates Gallbladder phlegm flooding the Heart; add Chen Danxing (Arisaematis Cum Bile) and Chuan Huanglian (Coptidis Rhizoma). If accompanied by difficulty in urination, combine with Daochi Banjie Tang (Guide Out Red Half-Half Decoction). If the Left Guan pulse is Rapid and Large, combine with Longdan Xiegan Tang (Gentian Liver-Draining Decoction), adding Danggui (Angelicae Sinensis Radix), Baoshao (Paeoniae Radix Alba), Zhizi (Gardeniae Fructus), and Mudanpi (Moutan Cortex).