自汗热越多急下，更兼热利不休凶，头汗热蒸不得越，黄湿水火血皆成。
【注】自汗在太阳，谓之风邪，桂枝汤证也。在阳明，谓之热越，白虎汤证也。若大
热蒸蒸汗出过多，则宜调胃承气汤，急下其热，救其津也。若更兼发热下利不休，内外
两脱，故凶也。头汗出，剂颈而还，则为热不得外越，上蒸于首也。或因黄郁未发，或
因湿家误下，或因水结胸蒸，或因火劫热迫，或因阳明蓄血，或因热入血室，皆令成之，则
当分门施治可也。
手足 然汗出，便硬尿利本当攻，寒中汗冷尿不利，攻之固瘕泻澄清。
【注】胃主四肢为津液之主，今热聚于胃，蒸其津液，傍达于四肢，故手足 然汗出，
且小便自利，胃中津液必干，大便必硬，本当攻也。若中寒胃阳土虚，脾不约束，津液
横溢，四肢犹如阴盛淫雨滂沱，故汗出而冷也。阳虚失运，中寒不化，故小便不利也。今
虽便硬而手足汗出，非为热越者比，慎不可攻，攻之必变生，固瘕泄泻澄清不止也。
午后一发为潮热，无休发热汗蒸蒸，时热自汗无里证，先时与药桂枝称。
【注】潮热，阳明腑证也。阳明旺于申酉，故潮热发于午后，如潮信之不失，因名之曰
潮热，可下之证也。无休发热汗蒸蒸，谓发热无休止之时，热气透手溱漆有汗，名曰蒸
蒸发热，亦属阳明内实，可下之证也。时热自汗者，谓发热时轻时重而有自汗也，似潮
热而次数，似蒸蒸而休止。潮热蒸蒸之热，则必兼有可下之证。时热时止之热，则必不兼
可下之证，故曰∶无里证也。因其无里证，热而有汗，知风邪留连在表不已，故用桂枝主
治。然必先其发热汗出之时与桂枝汤也，盖桂枝不为时热自汗者设，而为时热自汗有表
无里证者设也。此处重在无里证，非谓凡有时热自汗，皆可服桂枝汤也。
自汗若伴随高热，病情危急需急下攻里；若同时伴有发热且腹泻不止，则预后凶险。头部出汗，热气蒸腾却无法向外发散，这是由于湿热、水饮或瘀血等邪气郁结所致。
【注】自汗出现在太阳病阶段，属于风邪侵袭，是桂枝汤的适应证。出现在阳明病阶段，称为“热越”（热邪向外发散），是白虎汤的适应证。如果大热蒸腾、汗出过多，应当使用调胃承气汤，急下以清除热邪，保存津液。如果同时伴有发热和腹泻不止，导致体内正气与津液双重耗脱，所以预后凶险。头部出汗，仅到颈部而止，说明热邪不能向外发散，反而向上蒸腾于头部。这可能是由于黄疸郁滞尚未发作，或者是湿病患者被误用泻下法，又或是水饮结聚于胸膈导致热气蒸腾，亦或是火疗劫迫导致热邪内陷，还可能是阳明腑实蓄血，或者热邪陷入血室，这些情况都会导致头汗，治疗时应当分类施治。
手足持续出汗，大便干硬且小便通畅，本应当使用攻下法。若是中寒导致手足冷汗、小便不利，此时若误用攻下法，会导致形成顽固性积块或泄泻清稀不止。
【注】胃主管四肢，是津液生成的源头。如今热邪聚集在胃中，蒸腾津液，旁达于四肢，所以手足持续出汗，且小便自利，这意味着胃中津液必然干枯，大便必然干硬，本应当使用攻下法。如果是中寒导致胃阳虚弱，脾土失守，约束无力，津液横溢，四肢就像阴盛时暴雨滂沱一样，所以汗出且冷。阳气虚衰失去运化功能，中寒导致气化不利，所以小便不利。现在虽然大便干硬且手足出汗，但这不属于热邪外越的情况，千万不可攻下，一旦攻下必然变生他证，出现顽固性积块或泄泻清稀不止。
午后定时发作一次为潮热，无休止地发热且汗出蒸蒸，如果是时轻时重的发热伴自汗且没有里实证，应在发热前给予桂枝汤治疗。
【注】潮热属于阳明腑实证。阳明经气旺盛于申时和酉时（下午3点至7点），所以潮热发于午后，像潮水涨落一样准时，因此命名为潮热，这是可以使用下法的证候。无休止地发热且汗出蒸蒸，指发热没有停止的时候，热气透达皮肤，汗出淋漓，名为“蒸蒸发热”，这也属于阳明内实，是可以使用下法的证候。时热自汗，指发热时轻时重并伴有自汗，看起来像潮热但频率不同，看起来像蒸蒸发热但有间歇。潮热和蒸蒸发热的热势，必然兼有可以使用下法的里实证。时热时止的热势，必然不兼有可以使用下法的里实证，所以说“没有里证”。因为没有里证，且有热有汗，可知风邪留恋在表不解，所以用桂枝汤主治。然而必须在发热出汗之时给予桂枝汤，因为桂枝汤不是为单纯的时热自汗者设立的，而是为时热自汗且表现为有表证无里证的患者设立的。此处重点在于“无里证”，并非说凡是有时热自汗都可以服用桂枝汤。
If spontaneous sweating is accompanied by high fever, the condition is critical and requires urgent purgation. If it is further complicated by continuous fever and diarrhea, the prognosis is ominous. Head sweating with steaming heat that cannot dissipate outward indicates the formation of pathogenic factors such as damp-heat, water retention, or blood stasis.
[Note] Spontaneous sweating in the Taiyang stage refers to wind pathogen invasion, which is an indication for Guizhi Tang (Cinnamon Twig Decoction). In the Yangming stage, it is called "Re Yue" (Heat Dissipation), which is an indication for Baihu Tang (White Tiger Decoction). If there is intense steaming heat and excessive sweating, Daowei Chengqi Tang (Stomach-Regulating Purging Decoction) should be used to urgently purge the heat and preserve body fluids. If accompanied by continuous fever and diarrhea, leading to a dual depletion of internal righteous qi and fluids, the prognosis is ominous. Head sweating that stops at the neck indicates that heat cannot dissipate outward but instead steams upward to the head. This may result from latent jaundice not yet manifesting, mistaken purgation in patients with dampness, water accumulation in the chest causing steaming heat, heat forced inward by fire therapy, Yangming blood accumulation, or heat entering the Blood Chamber. All these conditions cause head sweating, and treatment should be administered according to specific categories.
Continuous sweating of the hands and feet, with hard stool and free urination, indicates that purgation is indicated. However, if cold extremities with cold sweat and difficult urination occur due to interior cold, purgation must be avoided; otherwise, it will lead to stubborn accumulations or clear, watery diarrhea.
[Note] The Stomach governs the four limbs and is the source of body fluids. When heat gathers in the Stomach, it steams the fluids and distributes them to the limbs, causing continuous sweating of the hands and feet and free urination. This implies that Stomach fluids are dried up and stool becomes hard, indicating that purgation is indicated. If interior cold causes deficiency of Stomach Yang and Spleen Earth, failing to constrain fluids, fluids overflow horizontally. The limbs resemble heavy rain during Yin excess, resulting in cold sweat. Yang deficiency fails to transport, and interior cold fails to transform, leading to difficult urination. Although stool is hard and hands/feet sweat, this is not due to heat dissipating outward. Purgation must be strictly avoided; doing so will cause complications such as stubborn accumulations or unceasing clear diarrhea.
Tidal fever occurring once in the afternoon, continuous steaming fever with sweating, or intermittent fever with spontaneous sweating without interior signs, should be treated with Guizhi Tang (Cinnamon Twig Decoction) prior to the onset of fever.
[Note] Tidal fever belongs to Yangming Fu-organ syndrome. The Yangming channel is vigorous during Shen and You hours (3 PM–7 PM), so tidal fever occurs in the afternoon, resembling the regularity of tides, hence the name. It is a syndrome suitable for purgation. Continuous steaming fever with profuse sweating, where heat penetrates the skin and sweat flows freely, is called "Zheng Zheng Fa Re" (Steaming Fever). This also belongs to Yangming interior excess and is suitable for purgation. Intermittent fever with spontaneous sweating refers to fever that fluctuates in intensity with spontaneous sweating. It resembles tidal fever in frequency but differs in pattern, and resembles steaming fever in nature but has intervals. Tidal fever and steaming fever are invariably accompanied by interior signs suitable for purgation. Intermittent fever is invariably not accompanied by interior signs suitable for purgation, hence it is stated as "no interior signs." Because there are no interior signs, and there is fever with sweating, it is known that wind pathogen lingers in the exterior. Therefore, Guizhi Tang is indicated. However, the decoction must be administered during the time of fever and sweating. Guizhi Tang is not designed for simple intermittent fever with sweating, but specifically for cases with exterior signs but no interior signs. The emphasis here is on "no interior signs"; it does not mean that all cases of intermittent fever with spontaneous sweating can take Guizhi Tang.