【纲】仲景曰。阳明病。口燥。但欲漱水不欲咽者。此必衄。
【目】朱肱曰。此必有头疼身热之症。若病患无表症。不恶寒热。胸腹满。唇燥。但欲漱水不
欲咽者。此为有瘀血。必发狂也。轻者犀角地黄汤。重者抵当汤。
王肯堂曰。此症属阳明。凡内有热者欲饮水。今欲水而不欲咽。是热在经而里无热也。阳明
经气血俱多。经中热甚。逼血妄行。故知必作衄也。
张介宾曰。凡阳明病。口燥。但欲漱水而不欲咽者。以热在经而里无热也。必将为衄。不可与
凉药。盖饮水一症。本以内热甚而阳毒甚者。最为相宜。若似乎止宜于实邪。不宜乎虚邪也。不知
虚症亦有不同。如阳虚无火。其不宜水不待言也。其有阴虚火盛者。元气既弱。精血又枯。多见舌
裂唇焦。大渴喜冷。三焦如焚。二便秘结等症。使非藉水。何以济急。故先宜以冰水解其标。而继
以甘温培其本。水药兼进。无不可也。其有内真寒。外假热。阴盛格阳等症。察其元气。则非用甘
温。必不足以挽回。察其喉舌。则些微辛热。又不可以近口。有如是者。则但将甘温大补之剂。或
用独参汤水浸极冷冻饮料之。此以假冷之味。解上焦之假热。而真温之性。复下焦之真阳。是非用水
而实亦用水之意。余用此活人多矣。妙甚。惟是假热之症。症虽热而脉则微。口虽渴而便不闭者。
此而欲水。必不可与。若误犯之。其败泄元阳。为害不小。
喻昌曰。口中干燥与渴异。漱水不欲咽。知不渴也。阳明气血俱多。以漱水不欲咽。知邪入血分。
阳明之脉起于鼻。故知血得热而妄行。必由鼻而出也。
魏荔彤曰。如阳明病。表热汗自出。则胃燥。而开窍之口亦必燥。然但欲漱而不欲咽。此则胃
中之血。随热上行。所以言必衄也。此虽为阳明热盛之变。然血既溢而衄。则非亡津液。而胃阴绝
可知。即衄后未可定其必解。而热势已泄。胃实自未必成矣。
【纲】仲景曰。无表症。不寒热。胸腹满。唇燥。口干。漱水不咽。小便多。此为瘀血。必发
狂。轻者桃仁承气汤。重者抵当丸。
【目】杨士瀛曰。唇燥口干。血症类有之。必欲取水不灌漱也。然漱水而不咽何哉。盖渴者。
易为饮。阳热入里。胃中液干。患不与水耳。惟夫上焦瘀血。下焦蓄血。乘肺若燥。渴症独无。是
以漱而不欲咽也。漱水条例。惟血症有焉。
【纲】张仲景说：阳明病，出现口干燥，只想含水漱口而不想吞咽的症状，这必定会发生鼻出血。
【目】朱肱说：这种情况一定伴有头痛、身体发热的症状。如果病人没有表证，不恶寒发热，胸腹部胀满，嘴唇干燥，只想含水漱口而不想吞咽，这是体内有瘀血，一定会发生狂躁症。病情轻的，用犀角地黄汤；病情重的，用抵当汤。
王肯堂说：这种症状属于阳明经。凡是体内有热的人想要喝水，现在想要水却不想吞咽，说明热邪在经络中而脏腑内部没有热。阳明经的气血都很旺盛，经络中热势严重，逼迫血液妄行，所以知道必定会发生鼻出血。
张介宾说：凡是阳明病，口干燥，只想含水漱口而不想吞咽，是因为热邪在经络中而脏腑内部没有热。必将发生鼻出血，不可给予凉药。因为饮水这一症状，本来是因为内热严重且阳毒深重时最为适宜。似乎只适合实邪，不适合虚邪。却不知道虚证也有不同。比如阳气虚弱而无火的情况，不宜用水是不言而喻的。那些阴虚火旺的人，元气已经虚弱，精血又枯竭，多见舌裂唇焦，极度口渴喜欢冷饮，三焦像焚烧一样，大小便便秘等症状。如果不是借助水，怎么能缓解急迫？所以先用冰水解其标症，接着用甘温药物培补根本。水和药一起服用，没有什么不可以的。那些内有真寒、外有假热、阴盛格阳等病症，观察其元气，则非用甘温药物，不足以挽回生机。观察其喉舌，则少许辛热药物又不可以入口。有这样的情况，就将甘温大补的药物，或者用独参汤浸泡在极冷的饮料中饮用。这是用假冷的味道来解除上焦的假热，而用真正温性的药物来恢复下焦的真阳。这不是不用水，实际上也是用水的意思。我使用这种方法救活了很多病人，非常奇妙。只是那种假热的病症，症状虽然发热但脉象微弱，口虽然渴但大便不通畅的，这种情况下想要喝水，绝对不可以给予。如果误犯此禁忌，败泄元阳，危害不小。
喻昌说：口中干燥与口渴不同。“漱水不欲咽”，说明并不口渴。阳明经气血都很旺盛，通过“漱水不欲咽”可知邪气已入血分。阳明经脉起于鼻部，所以知道血液受热而妄行，必定会从鼻子流出。
魏荔彤说：如果是阳明病，表热出汗自出，那么胃就会干燥，作为开窍之口的嘴巴也必然干燥。然而只想漱口而不想吞咽，这是因为胃中的血液随着热邪上行，所以说必定会发生鼻出血。这虽然是阳明热盛的变证，但是血液既然溢出而鼻衄，就不是亡失津液，而是胃阴断绝可知。即使鼻衄之后不能确定病一定痊愈，但热势已经发泄，胃实证未必会形成。
【纲】张仲景说：没有表证，不恶寒发热，胸腹部胀满，嘴唇干燥，口干，含水漱口但不吞咽，小便频多，这是瘀血，一定会发生狂躁症。病情轻的，用桃仁承气汤；病情重的，用抵当丸。
【目】杨士瀛说：嘴唇干燥、口干，血症类疾病中常有这种情况，一定是想要取水灌漱。然而为什么只漱口而不吞咽呢？大概口渴的人，容易饮水。阳热进入体内，胃中津液干枯，患者不愿与水接触罢了。只有上焦有瘀血，下焦蓄积瘀血，乘袭肺部导致燥象，唯独没有口渴症状，因此只漱口而不想吞咽。关于漱水的条例，只有血症中才有这种情况。
[General Principle] Zhang Zhongjing stated: In Yangming disease, if there is dryness in the mouth and a desire only to rinse water in the mouth without swallowing it, this indicates that epistaxis (nosebleed) will certainly occur.
[Commentary] Zhu Gong said: This condition must be accompanied by symptoms of headache and fever. If the patient has no exterior syndrome, no aversion to cold or heat, distension and fullness in the chest and abdomen, dry lips, and a desire only to rinse water in the mouth without swallowing it, this indicates the presence of blood stasis within, and mania will certainly develop. For mild cases, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used; for severe cases, Didang Tang (Definite Attack Decoction) should be used.
Wang Kentang said: This symptom belongs to the Yangming channel. Generally, those with internal heat desire to drink water. Now, since the patient desires water but does not wish to swallow it, it indicates that heat is in the channels while there is no heat in the interior organs. The Qi and Blood of the Yangming channel are abundant. When heat is severe in the channels, it forces blood to move recklessly, thus indicating that epistaxis will certainly occur.
Zhang Jiebin said: In all cases of Yangming disease, where there is dryness in the mouth and a desire only to rinse water in the mouth without swallowing it, it is because heat is in the channels while there is no heat in the interior. Epistaxis will inevitably occur, and cooling medicines should not be administered. The indication for drinking water is originally suitable for cases where internal heat is severe and Yang toxicity is profound. It seems suitable only for excess pathogens and not for deficiency pathogens. However, one must not ignore that deficiency syndromes vary. For instance, in cases of Yang deficiency without fire, the unsuitability of water is self-evident. In cases of Yin deficiency with hyperactive fire, where Yuan Qi is weak and Essence and Blood are depleted, symptoms such as cracked tongue, scorched lips, extreme thirst preferring cold drinks, burning sensation in the Sanjiao (Triple Burner), and constipation of both stool and urine are common. Without relying on water, how can urgency be relieved? Therefore, ice water should first be used to resolve the branch symptoms, followed by sweet-warm medicines to cultivate the root. Taking both water and medicine together is acceptable. In cases of true cold inside with false heat outside, or Yin exuberance repelling Yang, observing the Yuan Qi reveals that only sweet-warm medicines can restore vitality. Observing the throat and tongue reveals that even slight acrid-hot medicines cannot enter the mouth. In such cases, only sweet-warm tonic formulas, or Dushen Tang (Single Ginseng Decoction) soaked in extremely cold beverages, should be used. This uses the taste of false cold to resolve the false heat of the Upper Jiao, while the true warm nature restores the true Yang of the Lower Jiao. This is not rejecting water, but actually utilizing the concept of water. I have saved many people using this method; it is wonderful. However, in cases of false heat, although the symptoms indicate heat, the pulse is faint; although the mouth is thirsty, the bowels are not obstructed. In such cases, if the patient desires water, it must absolutely not be given. If this mistake is made, the destruction of Yuan Yang will cause significant harm.
Yu Chang said: Dryness in the mouth differs from thirst. "Rinsing water without swallowing" indicates absence of thirst. Since the Yangming channel has abundant Qi and Blood, the fact that water is rinsed but not swallowed indicates that the pathogen has entered the Blood level. The Yangming meridian originates at the nose; therefore, knowing that blood moves recklessly due to heat, it must exit through the nose.
Wei Litong said: If it is Yangming disease with exterior heat and spontaneous sweating, the Stomach becomes dry, and the mouth, as the opening of the Stomach, must also be dry. However, desiring only to rinse without swallowing indicates that blood in the Stomach rises with the heat, hence stating that epistaxis will certainly occur. Although this is a variation of excessive heat in Yangming, once blood overflows causing epistaxis, it is not a loss of body fluids, but rather the exhaustion of Stomach Yin. Even after epistaxis, it is not certain that the disease will resolve, but since the heat has been vented, a Stomach excess syndrome may not necessarily form.
[General Principle] Zhang Zhongjing stated: With no exterior syndrome, no aversion to cold or heat, distension and fullness in the chest and abdomen, dry lips, dry mouth, rinsing water without swallowing, and frequent urination, this is blood stasis, and mania will certainly develop. For mild cases, Tao Ren Chengqi Tang (Peach Kernel and Rhubarb Decoction) should be used; for severe cases, Didang Wan (Definite Attack Pill) should be used.
[Commentary] Yang Shiyin said: Dry lips and dry mouth often appear in blood-related diseases, where there is definitely a desire to take water for rinsing. But why rinse without swallowing? Generally, those who are thirsty find it easy to drink. When Yang-heat enters the interior and Stomach fluids are dried up, patients refuse to take water. Only when there is blood stasis in the Upper Jiao and accumulated blood stasis in the Lower Jiao, affecting the Lungs causing dryness, yet lacking the symptom of thirst, does one rinse without desiring to swallow. Regarding the protocol of rinsing water, it exists only in blood-related diseases.