盗汗者,谓睡去则出,醒来则止。然杂症盗汗,责其阳虚。伤寒盗汗,由邪气在半表半里使然也。何则。
以邪气在表,干于卫中,则自然汗出。此则邪气侵行于里,外连于表,睡则卫气行里,表中阳气不致,
津液得泄,故睡则汗出,觉则气散于表,而汗止矣。且自汗有虚有实,而盗汗悉皆知表而已。
头者诸阳之会,邪博诸阳津液上凑则汗见于头也。若邪热内蓄,蒸发腠理,遍身汗出,谓之热越。今
瘀热在里,不能发越,热蒸于阳,故令头汗出也。何者。以三阴之经,至颈而还,不循于头,独诸阳脉上
循于头耳。夫头汗出者,五内干枯,津液衰少,慎不可再汗也。一云、将欲发黄,先出头汗,则头汗之症,
发黄症也,治宜清理湿热。又有水结而头汗出者,宜温散水气。若半表半里而头汗出者,当和营卫。
其或瘀热在里,或热入血室,并虚烦之症,皆令头汗,或吐或下,以去其邪。设或小便不利,湿家下后,
又为阳脱而不可治也。
手足,即四肢也。四肢乃诸阳之本,而胃主四肢,手足汗出者,是阳明之症也然有自汗出,有头汗出,
有手足汗出者,悉属阳明也。何者。若一身汗出,谓之热越,是热外达者也。若头汗出,是热不得越,而
热气上达者也。今手足汗出,为热聚于胃,逼其津液而旁达于四肢者也。或谓热聚于胃,故手足汗
出矣,而寒聚于胃,独无汗出者,何故。经曰、蕴热则燥屎谵语,手足汗出者,承气汤主之。挟寒则水谷
不分,手足冷,汗自出者,理中汤主之。是以有承气理中之不同。
盗汗,是指入睡后出汗,醒来后汗止。然而,杂病中的盗汗,责之于阳气虚弱。伤寒病中的盗汗,是由邪气处于半表半里之间所致。为什么呢?因为邪气在体表,干扰卫气,就会自然出汗。这里是邪气侵入体内,向外连及体表,睡眠时卫气运行于体内,体表的阳气不能固守,津液得以外泄,所以睡觉时出汗;觉醒时气散于体表,汗就停止了。而且自汗有虚证和实证之分,而盗汗都属于表证(此处原文逻辑似有误或特指某种语境,按字面翻译:悉皆知表而已)。
头部是诸阳经汇聚的地方,邪气搏结于诸阳经,津液向上涌聚,就会在头部出现汗出。如果邪热内蕴,蒸腾腠理,导致全身出汗,称为“热越”。现在瘀热郁结在体内,不能发散,热气蒸腾于阳经,所以导致头部出汗。为什么呢?因为三阴经的经脉,走到颈部就返回,不循行于头部,只有诸阳经向上循行至头部。凡是头部出汗的,如果是五脏干枯、津液衰少的情况,千万不能再使用发汗法。另一种说法认为,将要出现黄疸时,先出现头部出汗,那么头汗症就是发黄症的前兆,治疗应当清理湿热。又有因水饮停聚而导致头部出汗的,适宜温散水气。如果是邪在半表半里而导致头部出汗的,应当调和营卫。或者是瘀热在体内,或者热入血室,以及虚烦的症状,都会导致头部出汗,可以通过催吐或泻下的方法,以祛除邪气。假如小便不利,湿病患者经过误下之后,又导致阳气脱失,那就不可治了。
手足,就是四肢。四肢是诸阳经的根本,而胃主管四肢。手足出汗,属于阳明病的症状。但是有全身自汗出的,有头部出汗的,有手足出汗的,都归属于阳明病。为什么呢?如果全身出汗,称为“热越”,这是热邪向外发散的表现。如果只有头部出汗,说明热邪不能向外发散,而是热气向上冲达。现在手足出汗,是因为热邪聚集在胃中,逼迫津液向旁侧到达四肢。有人问,热邪聚集在胃,所以手足出汗;那么寒邪聚集在胃,难道就没有出汗的吗?为什么?医经说:蕴积热邪则导致燥屎内结、谵语,手足出汗的,用承气汤主治。夹杂寒邪则导致水谷不分、手足冰冷、汗自出的,用理中汤主治。因此有承气汤与理中汤的不同应用。
Dao Han (Night Sweats) refers to sweating during sleep and cessation upon waking. However, Dao Han in miscellaneous diseases is attributed to Yang Deficiency (deficiency of the body's warming and defensive energy). Dao Han in Shanghan (Cold Damage) is caused by pathogenic factors residing at the Half-Exterior and Half-Interior (the Shaoyang stage). Why is this? When pathogenic factors are on the exterior and interfere with the Wei Qi (Defensive Qi), sweating occurs naturally. In this case, pathogenic factors have invaded the interior and connect externally to the exterior. During sleep, Wei Qi travels inward; thus, the Yang Qi on the exterior fails to consolidate, allowing Body Fluids (Jin Ye) to escape, resulting in sweating during sleep. Upon waking, Qi disperses to the exterior, and sweating ceases. Furthermore, while Zi Han (Spontaneous Sweating) can be either deficiency or excess, Dao Han is considered related to the Exterior (Note: The original text states "all known as exterior," which may imply a specific diagnostic context or potential textual error, but translated literally here).
The Head is the convergence point of all Yang meridians. When pathogens contend with Yang Qi and fluids rush upward, sweating appears on the head. If pathogenic heat accumulates internally and steams the Cou Li (skin pores and interstices), causing sweating over the entire body, it is called "Re Yue" (Heat Venting/Dispersal). Now, if Stagnant Heat (Yu Re) is trapped in the interior and cannot vent, but steams upward along the Yang channels, it causes sweating on the head. Why? Because the Three Yin meridians reach the neck and return, not circulating to the head; only the Yang meridians ascend to the head. For those with head sweating due to dryness of the Five Viscera and depletion of fluids, sweating-inducing methods must strictly be avoided. Another view holds that before Jaundice (Huang Dan) manifests, head sweating often appears first; thus, head sweating can be a precursor to Jaundice, and treatment should focus on clearing damp-heat. In cases where water retention causes head sweating, warming and dispersing the water qi is appropriate. If head sweating occurs due to pathology at the Half-Exterior and Half-Interior, harmonizing Ying (Nutritive) and Wei (Defensive) Qi is indicated. Whether due to stagnant heat in the interior, heat entering the Blood Chamber (Xue Shi), or deficiency irritability causing head sweating, emesis or purgation may be used to eliminate the pathogen. However, if urination is difficult, and after a mistaken purgation in a patient with dampness, leading to Yang collapse, the condition becomes incurable.
The hands and feet constitute the four limbs. The limbs are the root of all Yang meridians, and the Stomach governs the limbs. Sweating of the hands and feet is a symptom of Yangming disease. Cases include spontaneous sweating of the whole body, head sweating, and hand-foot sweating, all of which belong to the Yangming pattern. Why? Generalized sweating is termed "Re Yue" (Heat Venting), indicating heat escaping outward. Head-only sweating indicates that heat cannot vent outward but rises upward. Hand-and-foot sweating occurs because heat aggregates in the Stomach, forcing fluids to distribute laterally to the limbs. One might ask: If heat aggregation in the Stomach causes hand-and-foot sweating, does cold aggregation in the Stomach cause no sweating? The Classics state: Accumulated heat leads to dry feces and delirious speech; for hand-and-foot sweating in such cases, Chengqi Tang (Gastrodrinia Decoction) is the primary formula. If accompanied by cold, leading to indistinguishable food and water, cold limbs, and spontaneous sweating, Lizhong Tang (Centrum Decoction) is the primary formula. Thus, there is a distinction between the use of Chengqi Tang and Lizhong Tang.