9.手足濈濈然汗出, 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,
故手足濈濈然汗出, 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.
10.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. 阳明王于申酉, 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, 谓发无休止
之时, 热气透手溱溱有汗, 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. 上处重在
无里证, 非谓凡有时热自汗, 皆可服桂枝汤也.
9. 手足濈濈然汗出，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。如今热邪聚集于胃，蒸腾津液，旁达于四肢，因此手足濈濈然（连续不断）出汗，且小便自利（通畅），胃中的津液必然干枯，大便必然坚硬，本应当使用攻下法治疗。如果是中寒证，胃阳虚衰，脾气虚弱不能约束，津液横溢，四肢如同阴盛时淫雨滂沱一般，所以汗出而寒冷。阳气虚衰失去运化功能，中寒导致水湿不化，所以小便不利。如今虽然大便坚硬且手足出汗，但这并非热邪外越的情况，千万不可攻下，如果攻下，必然变生他病，出现固瘕（指腹内结块或慢性腹泻）和澄澈清冷的泄泻不止。
10. 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，是阳明腑证的表现。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，像潮水一样按时而至，不失时机，因此命名为潮热，属于可以使用下法的证候。“无休发热汗蒸蒸”，是指发热没有休止的时候，热气透达体表，溱溱然有汗，称为“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”，是指发热时轻时重，并且伴有自汗，这种热象类似潮热但发作次数较少，类似蒸蒸发热但有休止。潮热和蒸蒸发热的热象，必定兼有可以使用下法的证候；时热时止的热象，必定不兼有可以使用下法的证候，所以说：“没有里证”。因为患者没有里证，发热且有汗，可知风邪留恋在表不解，所以用桂枝汤主治。然而必须在其发热汗出的时候给予桂枝汤，这是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而无里证的患者设立的。上述处理的重点在于强调“无里证”，并非说凡是有时热自汗症状的，都可以服用桂枝汤。
9. Continuous sweating of the hands and feet, with hard stool and free urination indicates that purgation is indicated; if cold invades the interior causing cold sweat and difficult urination, purgation will lead to chronic diarrhea with clear, unformed stools.
[Annotation] The Stomach governs the four limbs and is the master of body fluids. When heat accumulates in the Stomach, it steams the body fluids, which then diffuse to the four limbs, resulting in continuous sweating of the hands and feet. Since urination is free, the fluids in the Stomach must be dry, leading to hard stool. In such cases, purgation is indicated. However, if Cold invades the interior, causing deficiency of Stomach Yang and Spleen Qi failing to constrain fluids, fluids may overflow excessively. The limbs may resemble a heavy downpour during Yin excess, resulting in cold sweat due to Yang deficiency and failure of transformation caused by Cold. If stool is hard but accompanied by hand and foot sweating, this is not due to Heat venting outward. Purgation must be strictly avoided; otherwise, complications such as *Gu Jia* (chronic abdominal masses or diarrhea) and persistent clear, watery diarrhea will arise.
10. Tidal fever occurring once in the afternoon, unremitting fever with profuse sweating, intermittent fever with spontaneous sweating without interior signs: administer Guizhi Tang (Cinnamon Twig Decoction) at the appropriate time.
[Annotation] Tidal fever (*Chao Re*) is a manifestation of Yangming Fu-organ syndrome. The Yangming channel is vigorous during Shen and You hours (3 PM to 7 PM); thus, tidal fever occurs in the afternoon, arriving like the tide without fail, hence the name. It is an indication for purgation. "Unremitting fever with profuse sweating" refers to fever without cessation, where heat penetrates the surface with abundant sweat, termed "steaming fever" (*Zheng Zheng Fa Re*). This also belongs to Yangming internal excess and is an indication for purgation. "Intermittent fever with spontaneous sweating" refers to fever that fluctuates in intensity accompanied by spontaneous sweating. This resembles tidal fever in frequency but differs from steaming fever by having intervals. Fever patterns of tidal fever and steaming fever are invariably accompanied by indications for purgation. Conversely, intermittent fever is invariably not accompanied by indications for purgation; hence, it is stated: "without interior signs." Since there are no interior signs, and fever is accompanied by sweating, it indicates that Wind pathogen remains lingering on the exterior. Therefore, Guizhi Tang (Cinnamon Twig Decoction) should be used. However, it must be administered precisely when the fever and sweating occur. Guizhi Tang (Cinnamon Twig Decoction) is not prescribed for simple intermittent fever with spontaneous sweating, but specifically for cases presenting with exterior signs and absence of interior signs. The emphasis here is on the absence of interior signs; it does not imply that all cases of intermittent fever with spontaneous sweating can be treated with Guizhi Tang (Cinnamon Twig Decoction).