〔孙〕凡水结胸胁间,头必有汗,治以半夏茯苓汤。
〔《活》〕病患表实里虚,玄府不开,则阳气上出,汗见于头。凡头汗出者,五脏干枯,胞中空虚,津液
少也,慎不可下,下之谓之重虚。
〔成〕头者诸阳之会,邪搏诸阳,津液上凑,则汗见于头也。
〔海〕头汗出,剂颈而还,血证也。额上偏多者,属心部,为血证也。独益中州脾土,以血药治之,其法
无以加矣。
舌上白胎,若阳明胃实,胁下满,不大便而呕者,小柴胡汤。(论见胃实。)若下后,心中懊 者,
栀子豉汤。(方论见烦。)若下后哕而胸满,小便不利者,丹田有热,胸中有寒也。(论见牙疼。)
〔《脉》〕阴阳俱紧者,口中气出,唇口干燥,倦卧足冷,鼻中涕出,舌上胎滑,勿妄治也,到七日以来,
其人微发热,手足温者,此为欲解。或到八日以上,反大热者,此为难治。设使恶寒者,必欲呕也,腹内痛者,
必欲利也。(海藏云∶恶寒必欲呕者,小柴胡汤;腹中痛者,理中汤。)脏结如结胸状,饮食如故,时时
下利,寸脉浮,关脉小细沉
紧,舌上白胎滑者,难治也。若无阳症,不往来寒热,其人反静者,不可攻也。(论见脏结。)
〔成〕舌者心之官,法应南方火,本红而泽。伤寒三四日以后,舌上有膜,白滑如胎,甚者或燥涩黄黑,
是数者热气浅深之故也。邪气在表者,舌上即无胎。及邪气传里,津液结搏,则舌上生胎矣。寒邪初传,未全
成热,或在半表,或在半里,或邪气客于胸中者,皆舌上白胎而滑也。经曰∶舌上如胎者,以丹田有热,胸上
有寒,邪初传入里也。阳明病,胁下硬满,不大便而呕,舌上白胎者,可与小柴胡汤,是邪在半表半里也。太
阳病若下之,则胃中空虚,客气动膈,心中懊 ,舌上胎者,栀子豉汤主之,是邪客于胸中也。若病在脏,宜
若可下,如舌上滑胎者,则不可攻,是邪未全成热,犹带表寒故也。
及其邪传为热,则其舌上之胎不滑而涩也。经曰∶伤寒七八日不解,热结在里,表里俱热,时时恶风,大
渴,舌上干燥而烦,欲饮水数升者,白虎加人参汤主之,是热耗津液,而滑者已干也。
若热聚于胃,则为之舌黄,是热已深矣。《金匮要略》曰∶舌黄未下者,下之黄自去。
若舌上黑色者,又为热之极也。《针经》曰∶热病口干舌黑者死。以心为君主之官,开窍于舌,黑为肾色,
见于心部,心部者火也,肾者水也,水之邪热已极,鬼贼相刑,故知必死也。
〔垣〕下后病嗽,加五味子、麦门冬,如舌上有滑胎者,是胸中有寒,勿用之。胸有微寒,加辛热之剂立
效。舌燥涩如杨梅刺者,用生姜切浓片,蘸蜜于舌上揩之,其刺立消,神效。
〔无〕薄荷蜜 治舌上白胎干涩,语话不真。
先以生姜浓片蘸蜜水揩洗,有用薄荷自然汁与白蜜等分调匀,敷之良。
[孙思邈] 凡是水饮结聚于胸胁之间,头部必定出汗,治疗用半夏茯苓汤。
[《活人书》] 患者表实里虚,玄府(汗孔)不开,阳气上越外泄,汗出见于头部。凡是头汗出的,是五脏津液干枯,胞宫中空空虚,津液匮乏的缘故,千万不可使用下法,使用下法叫做重虚其虚。
[成无己] 头部是诸阳经会合之处,邪气搏结于诸阳经,津液向上汇聚,所以汗出见于头部。
[海藏] 头汗出,仅到颈部而还,这是血证的表现。额头偏多出汗的,属于心部病变,也是血证。只需补益中焦脾土,用治血的药物来治疗,这种方法没有能超过它的了。
舌苔发白,如果是阳明胃腑实证,伴有胁下胀满、大便不通且呕吐的,用小柴胡汤。(相关论述见“胃实”条。)如果经过攻下后,心中烦闷懊恼的,用栀子豉汤。(方剂论述见“烦”条。)如果攻下后出现呃逆且胸部胀满、小便不利的,这是丹田有热、胸中有寒。(相关论述见“牙疼”条。)
[《脉经》] 阴阳脉都紧的,口中呼气,嘴唇口角干燥,疲倦嗜卧且脚冷,鼻流清涕,舌苔白滑,不要胡乱治疗。等到第七天左右,病人微微发热,手足温暖的,这是病将要解除。或者到了八天以上,反而大热的,这是难治。假使恶寒的,必定想呕吐;腹内疼痛的,必定想腹泻。(海藏云:恶寒想呕吐的,用小柴胡汤;腹中疼痛的,用理中汤。)脏结的症状像结胸一样,饮食如常,时常腹泻,寸脉浮,关脉小细沉紧,舌苔白滑的,难治。如果没有阳证,没有往来寒热,病人反而安静的,不可攻下。(相关论述见“脏结”条。)
[成无己] 舌是心的官窍,法象对应南方的火,本色红润而有光泽。伤寒三四日以后,舌上有膜,白滑像胎垢,严重的或干燥涩滞呈黄色黑色,这些情况是热气深浅不同的缘故。邪气在表的,舌上就没有胎垢。等到邪气传入里,津液凝结阻滞,舌上就生胎垢了。寒邪刚传入,尚未完全化热,或在半表,或在半里,或邪气客居在胸中的,都是舌上白苔而滑。经文说:“舌上像有胎垢”,是因为丹田有热,胸上有寒,邪气刚开始传入里。阳明病,胁下硬满,大便不通且呕吐,舌上白苔的,可以给予小柴胡汤,这是邪气在半表半里。太阳病如果误用下法,导致胃中空虚,客气扰动膈间,心中烦闷懊恼,舌上有胎的,用栀子豉汤主治,这是邪气客居在胸中。如果病在脏,似乎可以用下法,但如果舌上滑胎的,则不可攻下,这是邪气未完全化热,仍带有表寒的缘故。
等到邪气传变为热,那么舌上的胎垢就不滑而变得涩滞了。经文说:“伤寒七八日不解,热结在里,表里俱热,时常恶风,大渴,舌上干燥而烦躁,想要喝几升水的,用白虎加人参汤主治”,这是热耗伤津液,而原本滑润的已经变干。
如果热聚集在胃,就会使舌苔变黄,这是热已深入。《金匮要略》说:“舌苔黄而未用下法的,用下法后黄苔自去。”
如果舌上出现黑色,又是热极的表现。《针经》说:“热病口干舌黑的预后不良。”因为心是君主之官,开窍于舌,黑是肾的颜色,出现在心部,心属火,肾属水,水的邪热已至极点,水火相克(鬼贼相刑),所以知道必死。
[李东垣] 攻下后生病咳嗽,加入五味子、麦门冬,如果舌上有滑胎的,这是胸中有寒,不要用这些药。胸中有微寒,加入辛热性质的药剂立刻见效。舌燥涩像杨梅刺一样的,用生姜切成厚片,蘸蜂蜜在舌上擦拭,那些刺感立刻消失,神效。
[王好古] 薄荷蜜治疗舌上白苔干涩,说话声音不真。先用生姜厚片蘸蜜水揩洗,有用薄荷自然汁与白蜜各一半调匀,敷在舌上很好。
[Sun Simiao] Whenever water retention binds in the chest and hypochondrium, sweat must appear on the head. Treat with Banxia Fuling Tang (Pinellia and Poria Decoction).
[The Huoren Book] When a patient has exterior excess and interior deficiency, and the xuanku (sweat pores) are not open, yang qi escapes upward, causing sweat to appear on the head. In cases of head sweating, the five zang organs are dry and withered, the bladder is empty and hollow, and body fluids are scant. One must be cautious not to use purgation; using purgation in this context constitutes a double deficiency.
[Cheng Wuji] The head is the confluence of all yang meridians. When pathogenic factors contend with the yang meridians, body fluids gather upward, resulting in sweat appearing on the head.
[Hai Zang] Head sweating that stops at the neck indicates a blood disorder. Excessive sweating on the forehead belongs to the heart region and also indicates a blood disorder. One should solely tonify the central earth (spleen) and treat with blood-invigorating herbs; no method surpasses this approach.
A white coating on the tongue: If it is Yangming stomach excess syndrome, accompanied by fullness in the hypochondrium, constipation, and vomiting, administer Xiaochaihu Tang (Minor Bupleurum Decoction). (See discussion under "Stomach Excess".) If after purgation there is mental restlessness and oppression (ao nao), administer Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). (See formula discussion under "Restlessness".) If after purgation there is hiccups, chest fullness, and dysuria, this indicates heat in the dantian and cold in the chest. (See discussion under "Toothache".)
[The Mai Jing] When both yin and yang pulses are tight, there is warm breath from the mouth, dry lips and mouth, fatigue with desire to lie down, cold feet, nasal discharge, and a slippery white tongue coating. Do not treat rashly. After seven days, if the person has slight fever and warm hands and feet, this indicates impending resolution. However, if after eight or more days there is instead high fever, this is difficult to treat. If there is aversion to cold, vomiting will likely occur; if there is abdominal pain, diarrhea will likely occur. (Hai Zang states: For aversion to cold with desire to vomit, use Xiaochaihu Tang; for abdominal pain, use Lizhong Tang.) Zang Jie (Organ Accumulation) presents similarly to Xiong Jie (Chest Accumulation), with normal appetite but frequent loose stools. The cun pulse is floating, the guan pulse is small, fine, deep, and tight, and the tongue coating is white and slippery; this is difficult to treat. If there are no yang symptoms, no alternating chills and fever, and the person appears quiet, do not attack with purgatives. (See discussion under "Zang Jie".)
[Cheng Wuji] The tongue is the organ of the Heart, corresponding to the fire element of the South, naturally red and lustrous. After three or four days of Shanghan (Cold Damage), a membrane may appear on the tongue, white and slippery like a coating; severe cases may become dry, rough, yellow, or black. These variations depend on the depth of the pathogenic heat. When pathogens are in the exterior, there is no coating on the tongue. When pathogens transmit to the interior and body fluids coagulate and bind, a coating forms on the tongue. When cold pathogens first transmit and have not fully transformed into heat, whether in the half-exterior, half-interior, or lodged in the chest, the tongue will have a white and slippery coating. The Classic states: "A tongue looking as if it has a coating" indicates heat in the dantian and cold in the upper chest, marking the initial transmission of pathogens to the interior. In Yangming disease, with hardness and fullness in the hypochondrium, constipation, vomiting, and a white tongue coating, Xiaochaihu Tang may be given, indicating pathogens in the half-exterior and half-interior. If Taiyang disease is incorrectly treated with purgation, the stomach becomes empty, rebellious qi disturbs the diaphragm, causing mental restlessness (ao nao) and a coated tongue; Zhizi Chi Tang is indicated, showing pathogens lodged in the chest. If the disease is in the zang organs, purgation might seem appropriate, but if the tongue coating is slippery, do not purge, as the pathogens have not fully transformed into heat and still retain exterior cold.
When pathogens transform into heat, the tongue coating becomes dry and rough rather than slippery. The Classic states: "Shanghan unresolved after seven or eight days, with heat bound in the interior, simultaneous exterior and interior heat, occasional aversion to wind, intense thirst, a dry and irritable tongue, and a desire to drink several liters of water; treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction)." This indicates heat consuming body fluids, where the previously slippery state has dried up.
If heat gathers in the Stomach, the tongue turns yellow, indicating deep-seated heat. The Jin Gui Yao Lue says: "For a yellow tongue coating before purgation, purgation will cause the yellow coating to disappear."
If the tongue turns black, it indicates extreme heat. The Zhen Jing states: "Death occurs in heat diseases with dry mouth and a black tongue." Because the Heart is the sovereign organ opening into the tongue, and black is the color of the Kidney appearing in the Heart region (Fire), while the Kidney represents Water, the extreme heat of Water overcoming Fire (ghostly penalty) indicates certain death.
[Li Dongyuan] After purgation, if cough develops, add Wuweizi (Schisandra Fruit) and Maimendong (Ophiopogon Root). However, if there is a slippery coating on the tongue, indicating cold in the chest, do not use them. For slight cold in the chest, adding acrid-warm agents yields immediate results. If the tongue is dry and rough like prickles of a bayberry, slice fresh ginger thickly, dip in honey, and rub the tongue; the prickles will disappear immediately, which is miraculous.
[Wang Haogu] Bohe Mi (Mint Honey) treats a dry and rough white tongue coating with distorted speech. First wipe and wash with thick slices of ginger dipped in honey water. Alternatively, mix equal parts of natural mint juice and white honey, apply to the tongue; this is effective.