自汗表阳虚恶冷,阳实蒸热汗津津,盗汗阴虚分心肾,心虚不固火伤阴。
【注】无因汗出,谓之自汗。自汗谓表阳虚,汗出则恶寒冷,宜用后方。若蒸蒸发热,
汗出不恶寒,则为里阳实,宜以调胃承气汤下之。睡则汗出,觉则汗止,谓之盗汗。盗
汗为阴虚,当分心虚不固,心火伤阴也。
黄 六一汤 玉屏风散 黄 建中汤
自汗表虚黄 草,玉屏风散术 防,气虚加参阳虚附,血虚黄 建中汤。
【注】黄 六一汤,即黄 六钱,甘草一钱也。玉屏风散,即黄 、白术、防风也,二
方皆治表虚自汗,若气虚加人参,阳虚加附子可也。若不恶寒不气少,则为血虚,不可
用参、附,宜黄 建中汤,即小建中汤加黄 也。方在伤寒门。
当归六黄汤 酸枣仁汤
盗汗心火下伤阴,归 二地柏连芩,心虚酸枣芍归地,知柏苓 五味参。
【注】当归六黄汤,治心火伤阴盗汗,即当归、黄 、黄芩、黄连、黄柏、生熟地黄
也。酸枣仁汤,治心虚不固盗汗,即酸枣仁、当归、白芍、生地、知母、黄柏、茯苓、黄
、五味子、人参也。
九窍出血名大衄,鼻出鼻衄脑如泉,耳目出血耳目衄,肤出肌衄齿牙宣,内衄嗽涎
脾唾肾,咯心咳肺呕属肝,精窍尿血膀胱淋,便血大肠吐胃间。
【注】九窍一齐出血,名曰大衄。鼻出血,曰鼻衄。鼻出血如泉,曰脑衄。耳出血,曰
耳衄。目出血,曰目衄。皮肤出血,曰肌衄。齿牙出血,曰齿衄,又名牙宣。此皆衄血随
所患处而命名也。若从口出则为内衄,内衄出血,涎嗽出于脾,唾出于肾,咯出于心,咳
出于肺,呕出于肝,吐出于胃,尿血从精窍而出,淋血从膀胱而出。呕吐之分,呕则有
上逆漉漉之声,吐则无声也。
自汗是由于体表阳气虚弱,表现为怕冷;若体内阳气实盛,则表现为蒸腾发热、汗出津津。盗汗是由于阴液亏虚,需区分是心气虚弱不能固摄,还是心火损伤阴液所致。
【注】没有特定诱因而自然出汗的,称为自汗。自汗属于表阳虚,出汗后感到恶寒怕冷,适宜使用后面的方剂。如果身体蒸蒸发热,出汗且不恶寒,则属于里阳实,适宜用调胃承气汤攻下。睡着时出汗,醒来后汗止,称为盗汗。盗汗属于阴虚,应当区分是心气虚弱不能固摄,还是心火损伤阴液。
黄芪六一汤、玉屏风散、黄芪建中汤。
自汗因表虚引起,可用黄芪配甘草(即黄芪六一汤),或玉屏风散(黄芪、白术、防风)。若兼有气虚加用人参,兼有阳虚加入附子;若为血虚,则用黄芪建中汤。
【注】黄芪六一汤,即黄芪六钱,甘草一钱。玉屏风散,即黄芪、白术、防风。这两个方子都治疗表虚引起的自汗,如果是气虚可以加人参,阳虚可以加附子。如果不恶寒且没有气短症状,则是血虚,不可用人参、附子,适宜用黄芪建中汤,即小建中汤加黄芪。该方记载在伤寒门。
当归六黄汤、酸枣仁汤。
盗汗因心火旺盛下伤阴液,可用当归、地黄、黄柏、黄连、黄芩(即当归六黄汤)。若是心气虚弱不固,可用酸枣仁汤(酸枣仁、白芍、当归、地黄、知母、黄柏、茯苓、黄芪、五味子、人参)。
【注】当归六黄汤,治疗心火伤阴引起的盗汗,由当归、黄芪、黄芩、黄连、黄柏、生地黄和熟地黄组成。酸枣仁汤,治疗心气虚弱不固引起的盗汗,由酸枣仁、当归、白芍、生地、知母、黄柏、茯苓、黄芪、五味子、人参组成。
九窍同时出血称为大衄。鼻部出血称为鼻衄,若如泉水般涌出称为脑衄。耳部出血称为耳衄。眼部出血称为目衄。皮肤出血称为肌衄。牙齿牙龈出血称为齿衄,又名牙宣。这些都是根据出血部位来命名的。如果从口腔内部出血则称为内衄。内衄出血中,咳出的涎沫源于脾,唾出的唾液源于肾,咯出的痰血源于心,咳嗽源于肺,呕吐物源于肝,吐血源于胃。尿血是从精窍流出,淋证出血是从膀胱流出。关于呕吐的区别:呕是有上逆并伴有漉漉声音的表现,吐则是无声的。
Spontaneous sweating (Zihan) is caused by deficiency of exterior Yang, manifesting as aversion to cold; if interior Yang is excess, it manifests as steaming fever with profuse sweating. Night sweating (Daohan) is caused by Yin deficiency, which requires differentiation between Heart Qi deficiency failing to secure the exterior and Heart Fire injuring Yin.
[Note] Sweating without a specific cause is called spontaneous sweating. Spontaneous sweating belongs to exterior Yang deficiency; after sweating, there is aversion to cold and fear of cold, suitable for the following formulas. If there is a steaming sensation of heat, sweating without aversion to cold, it indicates interior Yang excess, suitable for purging with Tiaowei Chengqi Tang (Regulate the Stomach Order Qi Decoction). Sweating during sleep that stops upon waking is called night sweating. Night sweating belongs to Yin deficiency; one must differentiate whether it is due to Heart Qi deficiency failing to secure or Heart Fire injuring Yin.
Huangqi Liuyi Tang (Astragalus Six-One Decoction), Yupingfeng San (Jade Windscreen Powder), Huangqi Jianzhong Tang (Astragalus Establish the Middle Decoction).
For spontaneous sweating due to exterior deficiency, use Huangqi paired with Gancao (i.e., Huangqi Liuyi Tang), or Yupingfeng San (Huangqi, Baizhu, Fangfeng). If accompanied by Qi deficiency, add Renshen; if accompanied by Yang deficiency, add Fuzi. If it is Blood deficiency, use Huangqi Jianzhong Tang.
[Note] Huangqi Liuyi Tang consists of six qian of Huangqi and one qian of Gancao. Yupingfeng San consists of Huangqi, Baizhu, and Fangfeng. Both formulas treat spontaneous sweating due to exterior deficiency. For Qi deficiency, add Renshen; for Yang deficiency, add Fuzi. If there is no aversion to cold and no shortness of breath, it is Blood deficiency; Renshen and Fuzai should not be used. Instead, Huangqi Jianzhong Tang is suitable, which is Xiaojianzhong Tang added with Huangqi. This formula is recorded in the Shanghan Section.
Danggui Liu Huang Tang (Angelica Hexa-Cinnabar Decoction), Suanzaoren Tang (Sour Jujube Seed Decoction).
Night sweating due to Heart Fire injuring Yin downward can be treated with Danggui, Dihuang, Huangbai, Huanglian, Huangqin (i.e., Danggui Liu Huang Tang). If due to Heart Qi deficiency failing to secure, use Suanzaoren Tang (Suanzaoren, Shaoyao, Danggui, Dihuang, Zhimu, Huangbai, Fuling, Huangqi, Wuweizi, Renshen).
[Note] Danggui Liu Huang Tang treats night sweating caused by Heart Fire injuring Yin, composed of Danggui, Huangqi, Huangqin, Huanglian, Huangbai, Sheng Dihuang, and Shu Dihuang. Suanzaoren Tang treats night sweating due to Heart Qi deficiency failing to secure, composed of Suanzaoren, Danggui, Baishao, Shengdi, Zhimu, Huangbai, Fuling, Huangqi, Wuweizi, and Renshen.
Bleeding from all nine orifices simultaneously is called Da Nu (Great Hemorrhage). Bleeding from the nose is called Bi Nu (Nasal Hemorrhage); if it flows like a spring, it is called Nao Nu (Brain Hemorrhage). Bleeding from the ears is called Er Nu (Ear Hemorrhage). Bleeding from the eyes is called Mu Nu (Eye Hemorrhage). Bleeding from the skin is called Ji Nu (Muscle Hemorrhage). Bleeding from the teeth and gums is called Chi Nu (Tooth Hemorrhage), also known as Ya Xuan. These are all named according to the site of hemorrhage. If bleeding occurs from within the mouth, it is called Nei Nu (Internal Hemorrhage). In internal hemorrhage: saliva coughed up originates from the Spleen; spittle originates from the Kidney; blood phlegm spat out originates from the Heart; cough originates from the Lung; vomiting originates from the Liver; hematemesis originates from the Stomach. Hematuria flows from the essence orifice (urethra/genital opening); bloody strangury flows from the Bladder. Regarding vomiting: "Ou" involves upward regurgitation accompanied by gurgling sounds, whereas "Tu" is silent.