作，头痛，两耳后 肿，上连承灵，下至天牖，急邀余视。余适他出，别延外科，谓当成耳枕痈，势甚危，投
以搜风败毒之剂，脑后肩胛筋络，益抽掣急绊，燥渴躁闷，小便淋沥如火，迨余至，困惫不支矣。脉之，洪数
异常，知其中热，邪在阳明少阳，以阴虚过汗，火就升上，又为风药所鼓而然。不可与柴胡，乃君以黄芩、石
膏，臣以鲜干两地黄，佐以滑石、生甘草，使以连翘、木通，大剂饮之，次日肿痛减。肿处尚赤色，前方入绿
豆一合，肿痛全消。再与导赤散合六一散而愈。
徐灵胎曰∶治病之法，不外汗、下二端。下之害人，其危立见，故医者病者皆不敢轻投。至于汗多亡阳而
死者，十有二三，虽死而人不觉也。何则？凡人患风寒之症，必相戒以为宁暖无凉，病者亦重加覆护，医者亦
云服药必须汗出而解。故病患之求得汗，人人以为当然也。秋冬之时，过暖尚无大害。至于盛夏初秋，天时暑
燥，卫气开而易泄，更加闭户重衿，复投发散之剂，必至大汗不止而亡阳矣。又外感之疾，汗未出之时，必烦
闷恶热。及汗大出之后，卫气尽泄，必阳衰而畏寒，始之暖覆，犹属勉强。至此时虽欲不覆而不能，愈覆愈汗。
愈汗愈寒，直至汗出如油，手足厥冷，而病不可为矣。其死也神气甚清，亦无痛苦，病者医者及旁观之人，皆
不解其何故而忽死，惟有相顾噩然而已。总之，有病之人不可过凉，亦不宜太暖，无事不可令汗出。惟服药之
时，宜令小汗。仲景服桂枝汤法云∶服汤已，温覆令微汗，不可如水淋漓，此其法也。至于亡阳未剧，犹可挽
回。《伤寒论》中真武、理中、四逆等法可考。若以脱尽无补救矣。又盛暑之时，病者或居楼上，或卧近灶之所，
无病之人，一立其处，汗出如雨，患病者必至时时出汗，即不亡阳，亦必阴竭而死。虽无移徙之所，必择一席
稍凉之地而处之，否则补丹不救也。
裴兆期曰∶一士人大病久虚，后已大受餐，且日服大补气血之药，兼旬越月，宜其起矣。不谓饮食顿减，
遍体畏寒，自汗盗汗，昼夜不止。已延二三名家，进以桂、附、参、 、汗愈多而寒益甚，参、 加至两许亦
不验。余以羌活、防风为君，苍术、半夏为臣，黄连、陈皮、砂仁、浓朴、茯苓、桂枝、浮麦为使，一剂而汗
收，并不畏寒矣。随制人参大补脾丸与之，调理不逾月而康。盖大病久虚之后，胃虽强而脾尚弱，易于加餐，
难于运化，且汤药之补无虚日，湿热郁于中宫，故饮食顿减，而多汗多寒也。人身捍卫之气出于胃，胃既为痰
涎所闭，则捍卫之气不能布皮毛，充腠理。先哲谓中脘有痰，令人多寒，脾湿不流，令人多汗，此之谓也。其
多汗而反用羌、防者，以其腠理开疏，风气乘虚来客，必先去其风，而汗始易收也。其畏寒而反用黄连者，以
寒非虚寒，乃湿热生痰所致之寒，湿清而汗自止也。凡人当大病之后，切不可恣投以药。无论药谬，即对病者，
亦不可不慎。盖人之元气以胃气为本，胃气又以谷气为本。大病之人，与谷气久疏，则所喜者食物，所恶者药
物，理之常也。此际正当以食投其所好，以养胃气。胃气旺则元气亦旺，不补之中有至补者在，安用此拂意之
物，妨碍胃气耶？今之医者不明此理，每遇病久乍痊，必谓气血两虚，尚须大补，其药不外当归、地黄、枸杞、
故纸、山药、苁蓉、参、 、苓、术等类，不煎则丸，恣投无忌。有服之而饮食反减者，有服之而作泻作呕与
肿满者，甚至有膈胀不能食，而反生他症者。名为补人，而实害人矣，可不戒哉！
裴兆期治一孝廉，为诸生时，以迁居萦扰，复不免有少年事，于秋尽冬初，日晡发热，亦恬不为意。裴诊
之，则六脉已虚疾无伦，为之骇然。以人参五钱，桂、附、归、术各二钱，嘱曰∶急急煎服，庶可无虞。犹泄
泄未之遽信，不移时辄汗流如洗，手足冷而目眩神疲，就枕不能布语，始急以前药连服五、六剂，人参加至一
两余，势乃稍定，脉尚几几欲绝。越日往视，脉状如前，汗复以时至，裴即宿于其家，用人参一两，附子半枚，
另用黄 二两，煎汤煮药。凡四进汗犹不止，时漏已三下，无处市药，不得已以前渣合煎，以济权时之急。至
子后阳生，胃气方回，啖糜粥二瓯，肉食数箸，汗始渐止，脉亦自此有叙。天明急市参以继之，调理而愈。
藜按∶此自汗之极重者，不惟阳虚，阴亦大伤。纯用参、 、桂、附，已不免偏胜之弊。参入当归，尤
不合法。得药渣甘淡之力，胃气始回。复得粥食，助其胃气，而汗始敛，非得力于参、 、桂、附也。
徐灵胎曰∶经云，夺血者无汗，夺汗者无血。血属阴，是汗多乃亡阴也。故治汗之法，必用凉心敛肺之药，
何也？心主血，汗为心之液，故当清心火。汗必从皮毛出，肺主皮毛，故又当敛肺气，此正治也。惟汗出太甚，
则阴气上竭，而肾中龙雷之火，随水而上。若以寒凉折之，其火愈炽。惟用大剂参、附佐以咸降之品，如童便、
牡蛎之类。冷冻饮料一碗直达下焦，引其真阳下降，则龙雷之火，反乎其位，而汗随止。此与亡阴之汗，真大相悬
绝，故亡阴亡阳，其治法截然，而转机在顷刻。当阳气之未动也，以阴药止汗。及阳气之既动也，以阳药止汗。
而龙骨、牡蛎、黄 、五味收涩之药，则两方皆可随宜用之。医者能于亡阴亡阳之交，分其界限，则用药无误
矣。其亡阴亡阳之辨法何也？亡阴之汗，身畏热，手足温，肌热汗亦热，而味咸口渴喜凉饮，气粗脉洪实，此
其验也。亡阳之汗，身反恶寒，手足冷，肌凉汗冷，而味淡微粘，口不渴而喜热饮，气微，脉浮数而空，此其
验也。至于寻常之正汗、热汗、邪汗、自汗，又不在二者之列。此理知者绝少，即此汗之一端，而聚讼纷纷，
毫无定见，误治甚多也。
又曰∶汗出总由于心火不宁，属热者多，属寒者少。今人皆用补阳治法，乃一偏之见，皆由不知汗出之液，
在何经也，误人多矣。亡阳之汗，乃阳气飞越，下焦空虚，此乃危急之症，非参、附不能回阳，与自汗、盗汗，
大不相同。医者全然不知，并为一病，贻误无穷，深为可笑。
尤在泾曰∶一人食咸，头汗如注，食淡则否，诊之，心脉独大而持指。因问曰∶燥欲饮乎？曰∶然，每晨
起舌必有刺。因悟所以头汗出者，心火太盛，而水不胜之也。味咸属水而能降火，火与水持，火盛水微不能胜
之而反外越也。其出于头者，水本润下而火性上炎，水为火激，反从其化也。食淡则否者，咸味涌泄为阴，淡
味渗泄为阳，阳与阳从，不相激射，故得遂其渗泄之性，而下行也。
（患者）发作时，头痛，两耳后方肿胀，向上连及承灵穴，向下至天牖穴，急忙邀请我诊治。我恰好外出，另请外科医生诊治，认为是耳枕痈，病情非常危险，投用搜风败毒的药剂后，脑后肩胛部的筋络更加抽搐拘急，出现燥渴、烦躁闷乱的症状，小便淋沥如火烧一般。等到我到达时，病人已经困倦疲惫到无法支撑的地步。诊脉，脉象洪大数急异常，知道其中热盛，邪气在阳明经和少阳经，这是因为阴虚之人过汗，火气升腾于上，又被风药鼓动所致。不可使用柴胡，以黄芩、石膏为君药，鲜地黄、干地黄为臣药，滑石、生甘草为佐药，连翘、木通为使药，大剂量服用，第二天肿痛减轻。肿胀处仍然呈红色，前方中加入绿豆一合，肿痛完全消除。再用导赤散合六一散治疗而痊愈。
徐灵胎说：治病的方法，不外乎发汗、攻下两端。攻下法伤害人，其危险立刻显现，所以医者和病者都不敢轻易使用。至于因发汗过多导致亡阳而死的人，十中有二三，虽然死了别人也不知道。为什么呢？凡是患风寒病症的人，一定互相告诫宁可保暖不要受凉，病者也重重覆盖保护，医者也说服药必须出汗才能解除。所以病患求得出汗，人人都认为是理所当然的。秋冬季节，过于保暖还没有大害。到了盛夏初秋，天气暑热干燥，卫气开泄容易耗散，再加上关窗闭户、穿着厚重，又投用发散药剂，必然导致大汗不止而亡阳。另外外感疾病，汗未出时，必定烦闷恶热。等到汗大出之后，卫气全部泄出，必然阳气衰微而畏寒，起初的保暖覆盖，还算是勉强忍受。到了这个时候即使想不覆盖也不能够，越覆盖越出汗。越出汗越寒冷，直到汗出如油，手足冰冷，病就无法救治了。他死的时候神志很清醒，也没有痛苦，病人、医者和旁观的人，都不明白为什么突然死亡，只有面面相觑惊恐而已。总之，有病的人不可过于凉，也不宜太暖，没有事不可以让他出汗。只有在服药的时候，应该让微微出汗。张仲景服用桂枝汤的方法说：服药后，温覆令微微出汗，不可像水淋漓那样，这是法则。至于亡阳还不严重，还可以挽回。《伤寒论》中的真武汤、理中汤、四逆汤等方法可以参考。如果脱尽就没有补救了。又在盛暑之时，病人有的住在楼上，有的睡靠近灶台的地方，没病的人一站在那里，汗出如雨，患病的人必然时时出汗，即使不亡阳，也必然阴液枯竭而死。虽然没有转移住所的地方，也必须选择一个稍微凉爽的地方居住，否则补药丹剂也无法挽救。
裴兆期说：一位士人大病久虚，后来已经大量进食，并且每天服用大补气血的药物，经过十天半月，应该能起来了。没想到饮食突然减少，全身畏寒，自汗盗汗，昼夜不停。已经延请二三位名医，进用桂枝、附子、人参、黄芪，汗越多而寒冷越厉害，人参、黄芪加到一两也不见效。我用羌活、防风为君药，苍术、半夏为臣药，黄连、陈皮、砂仁、厚朴、茯苓、桂枝、浮小麦为使药，一剂药汗就止住了，也不再畏寒了。随后配制人参大补脾丸给他，调理不超过一个月就好了。大概大病久虚之后，胃虽然强但脾还弱，容易增加饮食，难于运化，而且汤药的滋补没有一天间断，湿热郁结在中焦，所以饮食突然减少，而多汗多寒。人身抵御之气出于胃，胃既然被痰涎闭塞，那么抵御之气就不能布散皮毛，充实腠理。先哲说中脘有痰，让人多寒，脾湿不流，让人多汗，说的就是这个道理。那多汗反而用羌活、防风的原因，是因为腠理开疏，风气乘虚而来客居，必须先去除风邪，然后汗才容易收敛。那畏寒反而用黄连的原因，是因为这个寒不是虚寒，是湿热生痰导致的寒，湿清除而汗自然停止。凡人在大病之后，切不可肆意投药。无论药是否对症，即使是针对病的药，也不可不小心。因为人的元气以胃气为本，胃气又以谷气为本。大病的人，与谷气长久疏远，那么所喜欢的是食物，所厌恶的是药物，这是常理。此时正当以食物投其所好，来养胃气。胃气旺盛则元气也旺盛，在不补之中有至补的作用存在，哪里用得着这些违背心意的东西，妨碍胃气呢？现在的医者不明白这个道理，每次遇到病久刚痊愈，一定说是气血两虚，还需要大补，他们的药不外乎当归、地黄、枸杞、故纸、山药、苁蓉、参、芪、苓、术等类，不煎煮就是丸药，肆意投用毫无顾忌。有服用后饮食反而减少的，有服用后作泻作呕和肿满的，甚至有膈胀不能食，反而生出其他病症的。名义上是补人，实际上是害人，能不警惕吗！
裴兆期治疗一位孝廉，在做诸生时，因为搬家困扰，又不免有少年时的纵欲之事，在秋末冬初，傍晚发热，也淡然不在意。裴兆期诊脉，六脉已经虚弱急促无比，为此感到惊骇。用人参五钱，桂枝、附子、当归、白术各二钱，嘱咐说：赶快煎服，或许可以无忧虑。那人还是拖沓没有立即相信，不一会儿就汗流如洗，手足冷而目眩神疲，躺下不能说话，才急忙以前药连续服用五六剂，人参加到一两多，势头才稍微稳定，脉象还几乎要断绝。第二天前往诊治，脉状如前，汗又按时而至，裴兆期就住在他家，用人参一两，附子半枚，另外用黄芪二两，煎汤煮药。总共四次服药汗仍不止，当时漏壶已滴过三刻，无处买药，不得已用之前的药渣合煎，以济权时之急。到子时后阳气生发，胃气才恢复，吃粥两碗，肉食几筷子，汗才渐渐停止，脉象也从此起复有序。天亮急忙买人参继续服用，调理而痊愈。
藜按：这是自汗极严重的情况，不仅是阳虚，阴液也大大受伤。纯用人参、黄芪、桂枝、附子，已不免偏胜的弊端。人参加入当归，尤其不符合法度。得到药渣甘淡的力量，胃气才恢复。再得到粥食，帮助胃气，而汗才收敛，不是得力于人参、黄芪、桂枝、附子。
徐灵胎说：经典说，夺血者无汗，夺汗者无血。血属阴，所以汗多是亡阴。因此治汗的方法，必须用凉心敛肺的药，为什么呢？心主血，汗为心之液，所以应当清心火。汗必从皮毛出，肺主皮毛，所以又当敛肺气，这是正治法。只有汗出太甚，则阴气上竭，而肾中龙雷之火，随水而上。如果用寒凉药折损它，火更炽盛。只有用大剂人参、附子佐以咸降之品，如童便、牡蛎之类。冷冻饮料一碗直达下焦，引其真阳下降，则龙雷之火，返回原位，而汗随之停止。这与亡阴之汗，真的相差极大，所以亡阴亡阳，治疗方法截然相反，而转机在顷刻之间。当阳气未动时，用阴药止汗。等到阳气既动时，用阳药止汗。而龙骨、牡蛎、黄芪、五味子收涩的药，两个方子都可以随意使用。医者能在亡阴亡阳的交界处，分清界限，那么用药就不会错误。那亡阴亡阳的辨别方法是什么呢？亡阴之汗，身体畏热，手足温，肌肤热汗也热，味道咸口渴喜凉饮，气粗脉洪实，这是验证。亡阳之汗，身体反恶寒，手足冷，肌肤凉汗冷，味道淡微粘，口不渴而喜热饮，气微，脉浮数而空，这是验证。至于寻常的正汗、热汗、邪汗、自汗，又不在这两者之列。这个道理知道的人极少，就这出汗一端，而聚讼纷纷，毫无定见，误治很多。
又说：汗出总由于心火不宁，属热的多，属寒的少。现在人都用补阳治法，乃是一偏之见，都是不知道汗出的液体，在哪条经络，误导人多。亡阳之汗，是阳气飞越，下焦空虚，这是危急的症候，非人参、附子不能回阳，与自汗、盗汗，大不相同。医者全然不知，并为一病，贻误无穷，深为可笑。
尤在泾说：一个人吃咸的东西，头汗如注，吃淡的就否，诊脉，心脉独大而持指。于是问：干燥想喝水吗？回答说：是的，每晨起舌必有刺。于是领悟之所以头汗出，是心火太盛，而水不胜它。味咸属水而能降火，火与水相持，火盛水微不能胜它而反外越。出于头的，水本润下而火性上炎，水为火激，反从其化。吃淡的就否的原因，咸味涌泄为阴，淡味渗泄为阳，阳与阳从，不相激射，所以得遂其渗泄之性，而下行。
(When the disease) manifested, there was headache, swelling behind both ears, extending upward to Chengling (BL9), and downward to Tianyou (TE16). I was urgently invited to examine the patient. As I happened to be out, another surgeon was consulted, who diagnosed it as an ear pillow carbuncle (Erzhen Yong), a very critical condition. A formula for expelling wind and resolving toxicity was administered. Consequently, the tendons and collaterals in the back of the head and shoulder blades became more spasmodic and contracted. The patient suffered from dryness, thirst, restlessness, and oppression, with urination scanty and burning like fire. When I arrived, the patient was exhausted and unable to support himself. Palpation revealed a pulse that was flooding (Hong) and rapid (Shu) abnormally. It was determined that there was heat in the interior, with pathogenic factors in the Yangming and Shaoyang channels. This was due to excessive sweating in a Yin-deficient constitution, causing Fire to ascend, further aggravated by wind-dispersing herbs. Chaihu should not be used. Huangqin (Scutellariae Radix) and Shigao (Gypsum Fibrosum) were used as Sovereign herbs; Xian Dihuang (Rehmanniae Radix Recens) and Gan Dihuang (Rehmanniae Radix Preparata) as Ministers; Huashi (Talcum) and Sheng Gancao (Glycyrrhizae Radix et Rhizoma Recens) as Assistant herbs; Lianqiao (Forsythiae Fructus) and Mutong (Akebiae Caulis) as Envoys. A large dose was administered. The next day, swelling and pain decreased. The swollen area remained red. One he (approx. 50g) of Ludou (Phaseoli Semen Mungo) was added to the previous formula, after which swelling and pain completely subsided. Finally, Daochi San combined with Liuyi San was administered, leading to recovery.
Xu Lingtai stated: The methods of treating diseases do not exceed two ends: sweating (Han) and purging (Xia). Purging harms the body, and its danger is immediately apparent; thus, neither doctors nor patients dare to use it lightly. However, those who die from excessive sweating leading to collapse of Yang (Wang Yang) account for two or three out of ten. Although they die, people are unaware of it. Why? Whenever people suffer from Wind-Cold disorders, they mutually warn each other to keep warm rather than cool. Patients cover themselves heavily, and doctors say that medication must induce sweating for resolution. Therefore, patients seek sweating, considering it natural. In autumn and winter, being too warm causes little harm. But in midsummer and early autumn, when the weather is hot and dry, Wei Qi (Defensive Qi) opens and dissipates easily. If one closes doors and windows, wears heavy clothes, and takes dispersing agents, it will inevitably lead to continuous profuse sweating and collapse of Yang. Furthermore, in external contraction diseases, before sweating occurs, there must be irritability, oppression, and aversion to heat. After profuse sweating, Wei Qi is entirely exhausted, leading to Yang deficiency and aversion to cold. The initial covering was merely endured. At this stage, even if one wishes to uncover, it is impossible; the more covered, the more one sweats. The more one sweats, the colder one becomes, until sweat flows like oil and extremities become cold, at which point the disease is incurable. Death occurs with clear spirit and no pain. Patients, doctors, and bystanders do not understand why death occurred suddenly, only staring at each other in horror. In short, sick people should not be too cool, nor too warm; under normal circumstances, sweating should not be induced. Only during medication, slight sweating is appropriate. Zhang Zhongjing's method for taking Guizhi Tang states: "After taking the decoction, cover warmly to induce slight sweating; do not let it flow like water." This is the rule. If collapse of Yang is not severe, it can still be rescued. Methods such as Zhenwu Tang, Lizhong Tang, and Sini Tang in *Shanghan Lun* can be consulted. If exhaustion is complete, there is no remedy. Also, during intense summer heat, if patients stay upstairs or near stoves, healthy people standing there sweat profusely. Sick people will sweat constantly; even if they do not suffer collapse of Yang, they will die from exhaustion of Yin. If relocation is impossible, one must choose a cooler place; otherwise, tonics cannot save them.
Pei Zhaoqi said: A scholar suffered from severe illness and chronic deficiency. Later, he ate heavily and took large doses of Qi- and Blood-tonifying herbs daily for weeks or months. He should have recovered. Instead, his appetite suddenly decreased, he felt cold all over, and had spontaneous and night sweats continuously day and night. Several famous doctors treated him with Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Preparata), Renshen (Ginseng Radix et Rhizoma), and Huangqi (Astragali Radix). The more he sweated, the colder he felt. Even increasing Renshen and Huangqi to one liang (approx. 37.5g) was ineffective. I used Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) as Sovereign herbs; Cangzhu (Atractylodis Rhizoma) and Banxia (Pinelliae Tuber) as Ministers; Huanglian (Coptidis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus Rotundus), Houpo (Magnoliae Officinalis Cortex), Fuling (Poria), Guizhi (Cinnamomi Ramulus), and Fumai (Tritici Levis Fructus) as Assistants/Envoys. After one dose, sweating stopped, and aversion to cold disappeared. Subsequently, Ren Shen Da Bu Pi Wan was prescribed. Within a month of regulation, he recovered. Generally, after severe illness and chronic deficiency, although Stomach Qi may be strong, Spleen Qi remains weak. Digestion is difficult despite increased intake. Continuous tonic decoctions cause Damp-Heat to stagnate in the Middle Jiao, leading to sudden loss of appetite, excessive sweating, and chills. The body's defensive Qi originates from the Stomach. If the Stomach is blocked by Phlegm-Saliva, defensive Qi cannot distribute to the skin and hair or fill the interstices. Ancients said: Phlegm in Zhongwan (CV12) causes chills; stagnant Spleen Dampness causes sweating. This is what they meant. Regarding the use of Qianghuo and Fangfeng for excessive sweating: since the interstices are open, Wind pathogens invade vacuity. Wind must be expelled first for sweating to stop. Regarding the use of Huanglian for chills: this chills is not Deficiency-Cold, but Cold caused by Damp-Heat generating Phlegm. Clearing Dampness stops sweating. After severe illness, one must never recklessly administer drugs. Regardless of whether the prescription is correct, caution is needed. Yuan Qi (Original Qi) relies on Wei Qi (Stomach Qi); Wei Qi relies on Grain Qi. After severe illness, the body is distant from Grain Qi; it prefers food and dislikes medicine. This is normal. At this time, one should feed preferred foods to nourish Stomach Qi. When Stomach Qi is robust, Yuan Qi is also robust. There is supreme tonification within non-tonification. Why use disagreeable substances that hinder Stomach Qi? Modern doctors, misunderstanding this, often diagnose Qi and Blood deficiency after prolonged illness and prescribe massive tonics consisting of Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Gouqi (Lycii Fructus), Gushi (Psoraleae Fructus), Shanyao (Dioscoreae Rhizoma), Congrong (Cynomorii Herba), Renshen, Huangqi, Fuling, Baizhu (Atractylodis Macrocephalae Rhizoma), etc., either as decoctions or pills, without restraint. Some experience reduced appetite, diarrhea, vomiting, or distension after taking them. Some develop chest fullness, inability to eat, and other symptoms. Named as tonifying, they actually harm. One must beware!
Pei Zhaoqi treated a Xiaolian (degree holder) who, while a student, suffered from disturbance due to moving and youthful indulgence. In late autumn and early winter, he had afternoon fever but ignored it. Pei palpated the pulse and found all six positions extremely deficient and rapid, which alarmed him. He prescribed Renshen 5 qian, Guizhi, Fuzi, Danggui, and Baizhu 2 qian each, advising immediate administration to avoid danger. The patient hesitated. Soon, he sweated profusely, extremities became cold, eyes spun, spirit fatigued, and he could not speak lying down. He then urgently took the previous medicine for five or six doses, increasing Renshen to over 1 liang. The condition stabilized slightly, but the pulse was nearly imperceptible. The next day, the pulse remained similar, and sweating continued hourly. Pei stayed overnight, using Renshen 1 liang, Fuzi half piece, and Huangqi 2 liang decocted separately to cook the medicine. After four administrations, sweating persisted. It was past midnight, and no pharmacy was available. Desperately, he boiled the dregs again to meet the emergency. After Zi hour (11 PM - 1 AM), Yang generated, Stomach Qi returned. After eating two bowls of porridge and some meat, sweating gradually stopped, and the pulse recovered order. At dawn, fresh Renshen was purchased to continue treatment, leading to recovery.
Li noted: This is an extreme case of spontaneous sweating. Not only is Yang deficient, but Yin is also severely damaged. Purely using Renshen, Huangqi, Guizhi, and Fuzai has the drawback of bias. Adding Danggui to Renshen is particularly inappropriate. It was the sweet and bland nature of the herb dregs that restored Stomach Qi. Combined with porridge aiding Stomach Qi, sweating ceased. This was not due to Renshen, Huangqi, Guizhi, or Fuzi.
Xu Lingtai stated: The Classics say, "Those who lose blood should not sweat; those who lose sweat should not bleed." Blood belongs to Yin; thus, excessive sweating is exhaustion of Yin. Therefore, the treatment for sweating must use herbs that cool the Heart and astringe the Lung. Why? The Heart governs Blood, and Sweat is the fluid of the Heart; thus, clearing Heart Fire is necessary. Sweat exits through the skin and hair, which are governed by the Lung; thus, astringing Lung Qi is required. This is the direct treatment. However, if sweating is too severe, Yin ascends and exhausts, and Dragon-Leopard Fire from the Kidneys rises with Water. If cooled with cold/bitter herbs, the Fire flares up. One must use large doses of Renshen and Fuzi assisted by salty-descending agents like Tongbian (Urine of Children) and Muli (Ostreae Concha). A bowl of frozen beverage reaches the Lower Jiao directly, guiding True Yang downward. Then Dragon-Leopard Fire returns to its position, and sweating stops. This is vastly different from sweating due to exhaustion of Yin. Thus, treatments for exhaustion of Yin and Yang are distinct, and the turning point is instantaneous. When Yang is inactive, use Yin herbs to stop sweating. When Yang is active, use Yang herbs. Longgu (Fossilia Ossis Mastodi), Muli, Huangqi, and Wuweizi (Schisandrae Fructus) are astringents usable in both cases. If doctors can distinguish the boundary between exhaustion of Yin and Yang, medication will be error-free. How to differentiate? Sweating from exhaustion of Yin: body fears heat, hands and feet are warm, skin is hot, sweat is hot, taste is salty, thirst with preference for cold drinks, coarse breathing, flooding and solid pulse. Sweating from exhaustion of Yang: body fears cold, hands and feet are cold, skin is cool, sweat is cold, taste is bland and slightly sticky, no thirst with preference for hot drinks, faint breathing, floating, rapid, and empty pulse. Ordinary Zheng Han (Correct Sweat), Re Han (Hot Sweat), Xie Han (Pathogenic Sweat), and Zi Han (Spontaneous Sweat) do not fall into these categories. Few know this principle. Regarding sweating alone, debates are endless, lacking definite views, leading to many misdiagnoses.
He also said: Sweating generally results from restless Heart Fire; it is mostly Heat, rarely Cold. People now use Yang-tonifying methods, which is a biased view, stemming from ignorance of which channel the sweat fluid belongs to, misleading many. Sweating from exhaustion of Yang is Flying Away of Yang and emptiness of the Lower Jiao, a critical condition requiring Renshen and Fuzi to restore Yang. It is very different from spontaneous and night sweating. Doctors ignore this, treating them as one disease, causing infinite delay, which is laughable.
You Zaijing said: A person sweated profusely on the head after eating salty food, but not after eating bland food. Palpation showed the Heart pulse alone was large and firm. Questioned: Do you feel dry and desire water? Answered: Yes, my tongue prickles every morning upon waking. I realized the reason for head sweating is excessive Heart Fire, which Water cannot overcome. Salty taste belongs to Water and can descend Fire. When Fire and Water contend, if Fire is strong and Water weak, Water cannot overcome Fire and instead overflows outward. Since it exits the head: Water naturally moistens downward, while Fire nature ascends. Provoked by Fire, Water follows Fire's transformation. Eating bland food does not cause this because salty taste is surging and draining (Yin), while bland taste is seeping and draining (Yang). Yang follows Yang, not clashing, allowing it to follow its seeping nature and descend.