窦汉卿曰∶夫疮疡作渴,若 痛发热,便利调和者,上焦热也,用竹叶石膏汤。肿
痛发热,大便秘涩者,五内热也,用四顺清凉饮。 肿痛甚者,热毒蕴结也,用仙
方活命饮。漫肿微痛者,气血虚壅也,用补中益气汤。若因胃火消烁,而津液短少
者,用竹叶黄 汤。若因胃气虚而不能生津液者,用补中益气汤。若因胃气伤而内
亡津液者,用七味白术散。若因肾水干涸作渴,或口舌干燥者,用加减八味丸最妙。
或先口干作渴,小便频数,而后患疽,或疽愈后,口渴饮水,或舌黄干硬,小便数
而疽生者,尤其恶也。苟能逆知其因,预服加减八味丸、补中益气汤,以滋化源,可
免是患。疽安服此丸则渴止,安而未渴者,服此丸,永不发渴,或未疽而先渴者,服
此丸,不惟渴止,而疽亦不作。
朱丹溪曰∶夫疮疡作渴,不言食味起火,怒气生火,房劳激火,吾恐渴亦未易言止也。
《精要》曰∶口渴与口干不同,不宜妄用丹药镇坠,祸如反掌;惟取桑枝同五味
子煎汤饮之,以救阴水甚妙。
冯鲁瞻曰∶夫痈疽愈后,忽发渴而不救者,十有八九,或先渴而患疽者,尤为
难治。故宜多服八味丸,非特杜绝渴疾,抑亦大滋气血,生长肌肉。
申斗垣曰∶夫渴者,乃消烁津液,因热极生渴,心火煎燔所致。如疮疡未溃而
作渴者,是疮毒炽盛,其心肺脉必洪数实大者,宜降火清金,芩连内疏之剂;如尺
脉洪大而无力者,宜滋阴降火,大补气血等药,或独参汤;如溃后气血大虚,而生
渴证者,十有八九,宜用黄 六一汤、加减八味丸;但痈疽已发,已溃未溃,加减
八味丸治之,均有大效。如无痈疽,而肺脉洪数甚,作渴者,必发痈疽,此其候也。
伍氏云∶疮作渴甚,急与神仙追毒丸,取下恶物,如利后仍渴,却用生津药,津
液生,气血充,渴自止。(《精要》用嫩桑枝,细切一升炒,水煎,日服五七剂,更止大渴,多服尤妙。如
治肾水枯涸,口燥舌干,用五味子汤,即 草六一汤、生脉汤合用,其效如神。)
张景岳曰∶凡内热之甚,则大渴喜冷,冰水不绝而腹坚便结,脉实气壮者,此阳证也。
又曰∶凡口虽渴,而喜热不喜冷者,此非火证,中寒可知,既非火证,何以作渴,乃水亏故也。
又曰∶凡病患问其渴否?则曰∶口渴。问其欲汤水否?则曰∶不欲。盖其内无邪
火,所以不欲汤水,真阴内亏,所以口无津液,此口干也,非口渴也,不可以干作渴治。
又曰∶凡阳邪虽盛而真阴又虚者,不可因其火盛喜冷,便云实热,盖其内水不
足,欲得外水以济,水涸精亏,真阴枯也。必兼脉证细察之,此而略差,死生立判。余
尝治垂危最重伤寒,有如此者,每以峻补之剂,浸冷而服,或以冰水、人参、熟附
等剂,相间迭进,活人多矣。常人见之,咸以为奇,不知理当如是,何奇之有!然必
其干渴燥结之甚者,乃可以参附凉水并进,若无实结,不可与水,如痈疽亦不可与凉水并进也。
又曰∶里热熏灼脏腑,必口渴便闭,或下利肠垢,而小水短赤。
窦汉卿说:疮疡引起口渴,如果伴有疼痛发热,大小便调和正常的,属于上焦有热,使用竹叶石膏汤。如果肿胀疼痛且发热,大便秘结不通的,属于五脏内部有热,使用四顺清凉饮。如果肿痛剧烈的,属于热毒蕴结,使用仙方活命饮。如果漫肿微痛的,属于气血虚弱导致的气血壅滞,使用补中益气汤。如果是由于胃火消烁津液,导致津液短少的,使用竹叶黄耆汤(原文“黄 ”应为黄芪之误)。如果是由于胃气虚弱不能生津液的,使用补中益气汤。如果是由于胃气受伤而内部津液亡失的,使用七味白术散。如果是由于肾水干涸引起的口渴,或者口舌干燥的,使用加减八味丸最为巧妙。或者先出现口干口渴,小便频数,而后患疽病,或者疽病痊愈后,口渴饮水,或者舌苔黄干硬,小便频数而疽病发生的,这尤其属于恶候。如果能够预先知道病因,提前服用加减八味丸、补中益气汤,以滋养化源,可以避免这种祸患。疽病发作时服用此丸则口渴停止,安稳而未口渴的人,服用此丸,永远不再发生口渴,或者尚未患疽病而先出现口渴的人,服用此丸,不仅口渴停止,而且疽病也不会发生。
朱丹溪说:疮疡引起口渴,如果不排除饮食口味不当引发的内火,怒气引发的肝火,房劳过度的相火,我恐怕这口渴也不容易止住。
《精要》说:口渴与口干不同,不宜胡乱使用丹药进行镇坠治疗,灾祸如反掌之间即可发生;只取桑枝同五味子煎汤饮用,来救阴水,非常奇妙。
冯鲁瞻说:痈疽病痊愈后,忽然发生口渴而不救治的,十有八九会死亡;或者先出现口渴而后患疽病的,尤其难以治疗。所以应该多服用八味丸,这不仅能够杜绝口渴疾病,也能大大滋补气血,促进肌肉生长。
申斗垣说:所谓渴症,是消烁津液,因热极而生渴,由心火煎熬燔灼所致。如疮疡未溃破而引发口渴的,这是疮毒炽盛,其心肺脉象必定洪数实大的,应当降火清金,使用芩连内疏之剂;如果尺脉洪大而无力,应当滋阴降火,使用大补气血等药物,或独参汤;如果溃破后气血大虚,而生出渴证的,十有八九,应当使用黄耆六一汤、加减八味丸;但是痈疽已经发生,无论已溃或未溃,用加减八味丸治疗,都有很大疗效。如果没有痈疽,而肺脉洪数严重,出现口渴的,必定会发痈疽,这是征兆。
伍氏说:疮疡引起极度口渴,急忙给予神仙追毒丸,攻下恶物,如果泻利后仍然口渴,却改用生津药,津液生成,气血充盈,口渴自然停止。(《精要》记载使用嫩桑枝,细切一升炒制,水煎,每日服用五至七剂,更能止住大渴,多服尤其好。如治疗肾水枯涸,口燥舌干,使用五味子汤,即甘草六一汤、生脉汤合用,效果神奇。)
张景岳说:凡是体内热邪严重的,就会大渴喜冷饮,冰水不断摄入而腹部坚硬大便结块,脉象实而气壮者,这是阳证。
又说:凡是口虽渴,但喜欢热饮不喜欢冷饮的,这不是火证,可知是中寒,既然不是火证,为什么会出现口渴,这是由于阴水亏损的缘故。
又说:凡是病人问其是否口渴?回答说:口渴。问其想要喝汤水吗?回答说:不想要。这是因为内部没有邪火,所以不想喝汤水,真阴内部亏损,所以口中没有津液,这是口干,不是口渴,不可以把口干当作口渴来治疗。
又说:凡是阳邪虽然旺盛而真阴又虚弱的人,不可因为其火盛喜冷,就说是实热,盖因其内部阴水不足,想要得到外部的水来济助,水枯竭精亏耗,真阴干枯。必须兼看脉象和症状仔细考察,这里如果稍微差错,生死立刻判定。我曾经治疗垂危的重度伤寒患者,有这种情况的,常用峻补的药物,浸泡在冷水中服用,或者用冰水、人参、熟附子等药剂,交替进服,救活了很多病人。常人见到,都认为很奇怪,不知道道理应当如此,有什么奇怪的!然而必须是干渴燥结特别严重的,才可以用人参、附子与凉水并进,如果没有实结,不可给水,如痈疽也不可让凉水与人参附子并进。
Dou Hanqing stated: When sores and ulcers cause thirst, if accompanied by pain and fever, with normal bowel movements and urination, it indicates heat in the Upper Jiao (Upper Burner), treated with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). If there is swelling, pain, and fever, with constipation, it indicates heat within the five Zang organs, treated with Sishun Qingliang Yin (Four-Obedience Cooling Beverage). If the swelling and pain are severe, it indicates accumulation and knotting of heat-toxin, treated with Xianfang Huoming Yin (Immortal Life-Activating Beverage). If there is diffuse swelling with slight pain, it indicates qi and blood deficiency leading to stagnation, treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If caused by stomach fire consuming fluids, resulting in shortness of body fluids, treat with Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction). If caused by deficiency of stomach qi failing to generate fluids, treat with Buzhong Yiqi Tang. If caused by injury to stomach qi leading to internal loss of fluids, treat with Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). If caused by depletion of kidney water leading to thirst, or dry mouth and tongue, treat with Jiaban Bawei Wan (Modified Eight-Ingredient Pill) for best results. Alternatively, if one first experiences dry mouth and thirst, frequent urination, followed by carbuncles, or after carbuncles heal, experiences thirst and drinking, or yellow dry hard tongue coating with frequent urination preceding carbuncles, this is particularly ominous. If the cause can be anticipated, pre-administering Jiaban Bawei Wan and Buzhong Yiqi Tang to nourish the source of transformation can prevent this affliction. Administering this pill during active carbuncles stops thirst; administering it when stable and without thirst prevents future thirst; administering it before carbuncles appear not only stops thirst but also prevents carbuncles.
Zhu Danxi stated: Regarding thirst caused by sores and ulcers, if one does not rule out internal fire from improper diet, liver fire from anger, or ministerial fire from sexual exhaustion, I fear the thirst will not be easily stopped.
The *Jingyao* states: Thirst (Kou Ke) differs from dry mouth (Kou Gan); one should not recklessly use mineral pills for sedation, as disaster can occur instantly. It is best to decoct mulberry twig with Schisandra chinensis (Wuweizi) and drink the soup to rescue yin fluids, which is excellent.
Feng Luzhan stated: After the healing of abscesses and carbuncles, sudden onset of thirst without treatment leads to death in eight or nine out of ten cases. Those who experience thirst prior to developing carbuncles are particularly difficult to treat. Therefore, one should frequently administer Bawei Wan (Eight-Ingredient Pill), which not only prevents thirst but also greatly tonifies qi and blood and promotes muscle growth.
Shen Douyuan stated: Thirst involves the consumption of fluids, arising from extreme heat causing thirst due to the scorching of heart fire. If thirst occurs before a sore ulcerates, it indicates rampant toxin; the pulse at the heart and lung positions will likely be surging, rapid, full, and large. One should descend fire and clear metal using agents like Qinlian Neishu (Scutellaria and Coptis Internal Purging Agent). If the chi position pulse is surging but forceless, one should nourish yin and descend fire using agents that greatly tonify qi and blood, or Dushen Tang (Single Ginseng Decoction). If thirst arises after ulceration due to severe qi and blood deficiency (eight or nine out of ten cases), use Huangqi Liuyi Tang (Astragalus Six-One Decoction) and Jiaban Bawei Wan. However, for developed abscesses and carbuncles, whether ulcerated or not, Jiaban Bawei Wan is highly effective. If there is no abscess or carbuncle, but the lung pulse is extremely surging and rapid with thirst, an abscess or carbuncle will certainly develop; this is the sign.
Wu Shi stated: For severe thirst caused by sores, urgently administer Shenxian Zhuidu Wan (Immortal Poison-Chasing Pill) to purge evil matter. If thirst persists after purgation, switch to fluid-generating medicines. Once fluids are generated and qi and blood are abundant, thirst ceases naturally. (*Jingyao* records using tender mulberry twig, finely cut one sheng, stir-fried, decocted in water, taken five to seven doses daily to stop severe thirst; more administration is even better. For treating depleted kidney water with dry mouth and tongue, use Wuweizi Tang (Schisandra Decoction), which combines Licorice Six-One Decoction and Shengmai Tang (Generate Pulse Decoction), yielding miraculous effects.)
Zhang Jingyue stated: When internal heat is severe, there is great thirst preferring cold drinks, continuous intake of ice water, hard abdomen, and constipation, with a full pulse and strong qi; this is a yang syndrome.
He further stated: If one has thirst but prefers hot drinks over cold, this is not a fire syndrome; rather, it indicates middle jiao cold. Since it is not a fire syndrome, why does thirst occur? It is due to the deficiency of yin water.
He also stated: When asking patients if they are thirsty, they may say "thirsty." But when asked if they desire soup or water, they may say "no desire." This is because there is no pathogenic fire internally, hence no desire for liquids. True yin is deficient internally, resulting in lack of saliva in the mouth. This is dry mouth, not thirst. One must not treat dry mouth as thirst.
He further stated: When pathogenic yang is excessive yet true yin is also deficient, one cannot label it as excess heat simply because the patient desires cold drinks due to fire. The internal yin water is insufficient, seeking external water to compensate. With dried-up water and depleted essence, true yin is withered. One must carefully examine the pulse and symptoms together. A slight error here determines life or death immediately. I have treated critical cases of severe typhoid fever with such presentations, often using potent tonics cooled in water, or alternating ice water, Ginseng, and Prepared Aconite, saving many lives. Laypeople find this strange, not realizing it follows principle. However, this approach of combining Ginseng, Aconite, and cool water is only suitable for severe dry thirst and dryness-constipation. Without actual excrement retention, water should not be given alone. Similarly, for abscesses and carbuncles, cool water should not be combined with Ginseng and Aconite.
He finally stated: Internal heat steaming and burning the zang-fu organs必然 causes thirst and constipation, or diarrhea with intestinal mucus, and scanty dark urine.