（口干 舌干 咽不利 口烂 ）
成 咽干口燥舌涩俱为热证但有微甚耳惟太阳中寒桂枝附子汤证由误汗咽干作甘草干姜汤以复其阳者随其逆治
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病者也非治其本寒也然咽干之由有由汗下后而得者有不因汗下而得者其间治法或和解或微汗或急下或微下当考兼有之
证而施轻重之治然其为热则一也盖经谓咽喉干燥亦不可汗以其多有里证故也实无寒病善治者尤宜互考渴条乃获全功
太阳 咽喉干燥者不可发汗（津液不足也）伤寒脉浮自汗小便数心烦微恶寒脚挛急本桂枝附子汤证反与桂枝汤攻表
得之便厥咽干烦躁吐逆者甘草干姜汤 伤寒吐下后七八日不解表里俱热时时恶风大渴舌上干燥而烦者白虎加人参汤
本下之心下痞与泻心汤痞不解其人渴而口燥烦小便不利者五苓散 太阳病重发汗复下之不大便五六日舌上燥渴日晡小
有潮热从心下至小腹硬满而痛者大陷胸汤
阳明 病腹满脉浮紧口苦咽干而喘若其人发热恶寒误下之则腹满小便难若其人发热不恶寒反恶热误下之则胃空虚
为懊 误下之则谵语误加烧针则不得眠（许学士云宜小柴胡汤）阳明病口燥漱水不欲咽者必衄或用黄芩芍药汤犀角地黄
汤阳明病汗若下后渴欲饮水口干舌燥者白虎加人参汤 脉浮发热口干鼻燥能食者必衄或用黄芩汤阳明中风口苦咽干腹
满微喘发热恶寒脉浮而紧或用麻黄小柴胡汤
少阳 口苦咽干目眩宜小柴胡汤
少阴 病自利清水色纯青心下痛口干燥者急下之宜大承气汤 少阴病得之二三日口燥咽干者急下之大承气汤（成
伤寒传经五六日邪传少阴则口燥舌干而渴为邪渐深也今少阴病得之二三日邪气未深入之时便作口燥咽干者是邪热已甚
肾水干也急与大承气汤下之以全肾也正经自病其深入宜急下之若躁则死肾水干燥故也 张 或云承气汤阳明当下之证
宜用今少阴病亦用何也盖胃为水谷之海主养四旁四旁有病皆能传之入胃其胃土燥则肾水干以二三日则口燥咽干是热之
深传之速也故曰急下之以全肾水夫土实则水清谓水谷不相混故自利清水而口干燥此胃土实热而致然也下利色青青肝也
乃肝邪传肾缘肾之经脉从肺出络心注胸中由是而心下痛故急下以去实热逐肾邪其六七日腹胀不大便以入腑之邪壅甚胃
土胜则肾涸故急下以逐胃热滋肾水盖阳明与少阴皆有急下之条然而证虽不同其入腑之理则一是以皆用大承气也 按舌
干轻咽干重者盖咽舌虽皆通于少阴之络而舌又为心之苗也伤寒喜阳而恶阴故舌干为轻也）
厥阴 伤寒六七日大下后寸脉沉而迟手足厥冷下部脉不至咽喉不利唾脓血泄利不止者难治麻黄升麻汤伤寒一二日
至四五日而厥者必发热应下之反发其汗必口伤烂赤
吴 少阴脉疾可下脉沉附子汤加知母黄柏麦门冬五味子天花粉若虚热病后烦热不解者以竹叶石膏汤须去半夏加
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花粉润之凡发汗吐下后口燥咽干此津液衰少肾水不升虚火上炎也宜生津益气汤或竹叶石膏汤若脉沉微足冷舌燥者多难
治其少阴有急下以救肾水之例若虚人水竭火燥不可下者以补中益气汤倍加人参五味麦门冬天花粉黄柏知母以滋水也
狐惑病亦咽干默默不欲眠目不能闭声嗄咽干为狐惑但虫蚀下部者为狐其咽干下唇有疮黄连犀角汤
赵 活人谓脾脏有热则津液枯少故令口燥而咽干津液枯少固也然非独脾脏有热脾主太阴太阴腹满而咽干此可言
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热特一证耳余皆非也如白虎加人参汤证口舌干燥者表里俱热也口苦咽干者少阳经热或阳明中风也口燥咽干急下之自利
清水色纯青心下痛口干燥者少阴经热也咽干烦躁吐逆者误汗津液少而欲作阳明内热者也如上数证岂亦脾脏有热哉
成无己注：咽干、口燥、舌涩均属于热证，只是有轻微和严重的区别。唯独太阳中寒的桂枝加附子汤证，是因为误用发汗法导致咽干，此时应使用甘草干姜汤来恢复阳气，这是针对逆乱病势的治疗，并非治疗原本的中寒之邪，而是处理因误治导致的坏病。然而，咽干的原因，有的是在发汗或攻下之后出现的，有的并非由汗下引起。其中的治疗方法，有的采用和解法，有的采用微汗法，有的采用急下法，有的采用微下法，应当考察兼有的症状，从而施以轻重不同的治疗。虽然原因不同，但其本质为热是一致的。正如经文所说：“咽喉干燥者，也不可用发汗法”，因为这种情况多伴有里证。真正没有寒病的患者，善于治病的人尤其应当参考“渴”条的内容，才能取得全面的效果。
太阳病：咽喉干燥者，不可发汗（因为津液不足）。伤寒脉浮、自汗出、小便频数、心烦、轻微恶寒、脚部拘挛急迫，本是桂枝加附子汤证，反而给予桂枝汤攻表，服药后出现四肢厥冷、咽干、烦躁、呕吐逆乱的症状，应用甘草干姜汤。伤寒经吐法或下法治疗后，七八天病情仍未解除，表里俱热，时时恶风，极度口渴，舌上干燥而烦闷，应用白虎加人参汤。原本是下法导致的心下痞满，服用泻心汤后痞满未解，其人感到口渴且口燥烦闷，小便不利的，应用五苓散。太阳病重发汗后又攻下，导致不大便五六天，舌上干燥口渴，傍晚时分有轻微潮热，从心下直到小腹部硬满疼痛的，应用大陷胸汤。
阳明病：腹部胀满，脉浮紧，口苦咽干而气喘。如果其人发热恶寒，误用下法，则会导致腹部胀满、小便困难；如果其人发热不恶寒反而恶热，误用下法，则胃中空虚，产生懊憹感；误用下法导致谵语，若再加用烧针，则会导致失眠（许学士说适宜用小柴胡汤）。阳明病口燥漱水但不想咽下的，必定会出现鼻衄，或者使用黄芩芍药汤、犀角地黄汤。阳明病发汗或攻下后，口渴想喝水，口干舌燥的，应用白虎加人参汤。脉浮、发热、口干、鼻燥、能进食的，必定会出现鼻衄，或者使用黄芩汤。阳明中风，口苦咽干，腹部胀满，轻微气喘，发热恶寒，脉浮而紧的，或者使用麻黄汤合小柴胡汤。
少阴病：自行腹泻清水，颜色纯青，心下疼痛，口干燥的，应当急下，适宜用大承气汤。少阴病得病二三天，口燥咽干的，应当急下，用大承气汤。（成无己注：伤寒传经五六日，邪气传入少阴，则出现口燥舌干而渴，这是因为邪气逐渐深入。如今少阴病得病仅二三天，邪气尚未深入之时便出现口燥咽干，这是邪热非常严重，肾水枯竭的表现，应当急与大承气汤攻下，以保全肾水。正经自病，邪气深入宜急下。如果出现躁动不安则预后不良，因为肾水已经干燥。张元素认为：有人说大承气汤是阳明病当下之证才宜用，如今少阴病也用，为什么呢？盖因胃为水谷之海，主滋养四旁，四旁有病皆能传入胃中。其胃土燥热则肾水干枯。发病二三日即口燥咽干，说明热邪深重且传变迅速，所以说急下以保全肾水。所谓“土实则水清”，指水谷不相混杂，所以自利清水而口干燥，这是胃土实热所致。下利色青，青色属肝，乃肝邪传肾。缘于肾之经脉从肺出，络心，注胸中，因此心下疼痛，故急下以去除实热，驱逐肾邪。六七日腹胀不大便，是因为入腑之邪壅盛，胃土胜则肾水枯竭，故急下以驱逐胃热，滋补肾水。盖阳明与少阴皆有急下之条文，然而证候虽不同，其入腑之理则一致，因此都用大承气汤。按语：舌干较轻，咽干较重者，盖因咽、舌虽都通于少阴之络，但舌又为心之苗窍。伤寒喜阳而恶阴，故舌干为轻。）
厥阴病：伤寒六七天，经大下之后，寸脉沉而迟，手足厥冷，下部脉摸不到，咽喉不利，唾脓血，泄利不止的，难治，用麻黄升麻汤。伤寒一二日至四五日而出现四肢厥冷的，必定会发热，本应下之，反而发其汗，必定导致口腔损伤溃烂发红。
吴谦注：少阴脉疾速者可下，脉沉者用附子汤加知母、黄柏、麦门冬、五味子、天花粉。如果是虚热病后烦热不解的，用竹叶石膏汤，须去掉半夏，加天花粉以润之。凡是发汗、吐、下之后，出现口燥咽干，这是津液衰少，肾水不升，虚火上炎所致，适宜用生津益气汤或竹叶石膏汤。如果脉沉微、足冷、舌燥的，大多难治。少阴有急下以救肾水的例子。如果是虚人，水竭火燥不可下的，用补中益气汤倍加人参、五味子、麦门冬、天花粉、黄柏、知母以滋水。狐惑病也表现为咽干、默默不欲眠、目不能闭、声音嘶哑。咽干为狐惑，但虫蚀下部者为狐，其咽干下唇有疮，用黄连犀角汤。
赵献可注：《活人书》认为脾脏有热则津液枯少，所以令人口燥而咽干，津液枯少固然正确。然而并非只有脾脏有热才会如此。脾主太阴，太阴病腹满而咽干，这可以说是脾热特有一证而已，其余都不是。如白虎加人参汤证口舌干燥的，是表里俱热；口苦咽干的是少阳经热或阳明中风；口燥咽干需急下的，是自利清水、颜色纯青、心下痛、口干燥的少阴经热；咽干、烦躁、呕吐逆乱的，是误汗导致津液少而欲作阳明内热的。如上所述几种证候，难道也是脾脏有热吗？
(Mouth dryness, tongue dryness, throat discomfort, oral ulceration)
Cheng Wuji's Commentary: Throat dryness, mouth dryness, and tongue astringency all belong to heat syndromes, differing only in severity. The exception is the Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite Root) syndrome of Taiyang Cold Damage due to cold, where throat dryness results from erroneous sweating. In this case, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be used to restore Yang Qi. This is a treatment for counter-flow pathology, not treating the original cold pathogen, but rather addressing the "transformed disease" (Huai Bing, 坏病) caused by mismanagement. However, the causes of throat dryness vary: some occur after sweating or purging, while others do not. Treatment methods may include harmonization, mild sweating, urgent purging, or mild purging. One must examine accompanying symptoms to apply treatments of appropriate intensity. Although the causes differ, the underlying nature is heat. As stated in the classic text: "Those with dry throat and mouth cannot be treated with sweating," because such cases often involve interior syndromes. For those truly lacking cold pathogens, skilled practitioners should cross-reference the section on thirst to achieve comprehensive success.
Taiyang Disease: Those with dry throat cannot be treated with sweating (due to insufficient body fluids). In Cold Damage with floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to wind, and cramping of the legs, the pattern originally indicated Guizhi Jia Fuzi Tang. If erroneously treated with Guizhi Tang to attack the exterior, it may result in cold limbs, throat dryness, restlessness, vomiting, and counterflow. Gancao Ganjiang Tang should be administered. After emesis or purging in Cold Damage, if the condition remains unresolved after seven to eight days, with exterior and interior both presenting heat, occasional aversion to wind, extreme thirst, dry tongue, and vexation, Baihu Jia Renshen Tang (White Tiger Decoction with Added Ginseng) should be used. If epigastric fullness resulted from prior purging and Xixin Tang (Heart-Draining Decoctions) failed to resolve it, and the patient presents with thirst, dry mouth, vexation, and dysuria, Wuling San (Five-Ingredient Powder with Poria) is indicated. In Taiyang disease, if heavy sweating followed by purging leads to constipation for five to six days, dry tongue with thirst, slight tidal fever at dusk, and hardness/fullness/pain extending from the epigastrium to the lower abdomen, Daxiexiong Tang (Major Great Accumulation Decoction) is indicated.
Yangming Disease: Abdominal fullness, floating-tight pulse, bitter taste, dry throat, and wheezing. If the patient has fever and aversion to wind, erroneous purging leads to abdominal fullness and difficult urination. If the patient has fever without aversion to wind but aversion to heat, erroneous purging leaves the stomach empty, causing inner vexation (Ao Nao, 懊憹). Erroneous purging leading to delirium, combined with moxibustion/cauterization, causes insomnia (Xu Xueshi suggests Xiaochaihu Tang, Minor Bupleurum Decoction). In Yangming disease, mouth dryness with rinsing water but no desire to swallow indicates impending epistaxis; Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) may be used. After sweating or purging in Yangming disease, if there is thirst for water, dry mouth, and dry tongue, Baihu Jia Renshen Tang is indicated. Floating pulse, fever, dry mouth, dry nose, and ability to eat indicate impending epistaxis; Huangqin Tang (Scutellaria Decoction) may be used. Yangming Wind-Strike with bitter taste, dry throat, abdominal fullness, slight wheezing, fever, aversion to wind, floating-tight pulse may be treated with Mahuang Tang (Ephedra Decoction) combined with Xiaochaihu Tang.
Shaoyang Disease: Bitter taste, dry throat, and vertigo are suitable for Xiaochaihu Tang.
Shaoyin Disease: Spontaneous diarrhea of clear green water, pain in the epigastrium, and dry mouth/throat require urgent purging with Dachengqi Tang (Major Order the Qi Decoction). In Shaoyin disease, if dry mouth and throat appear within two to three days of onset, urgent purging with Dachengqi Tang is required. (Cheng Wuji notes: When Cold Damage transmits channels over five to six days and enters Shaoyin, dry mouth/tongue/thirst indicates deepening pathogen. Here, dry mouth/throat appearing within two to three days, before deep penetration, indicates severe heat depleting Kidney Water. Urgent purging with Dachengqi Tang preserves Kidney Water. In primary illness with deep penetration, urgent purging is needed. Restlessness indicates death due to dried Kidney Water. Zhang Yuansu argues: Dachengqi Tang is typically for Yangming excess. Why use it in Shaoyin? The Stomach is the Sea of Grain and Water, nourishing the four peripheries. Pathogens in the peripheries transmit to the Stomach. Dry Stomach Earth depletes Kidney Water. Rapid transmission causing dry mouth/throat in two to three days indicates deep heat requiring urgent purging to preserve Kidney Water. "When Earth is solid, Water is clear." Clear diarrhea and dry mouth result from Stomach Earth excess-heat. Green stool indicates Liver pathogen transmitting to Kidney. The Kidney meridian originates from Lung, connects Heart, and enters Chest, causing epigastric pain. Urgent purging removes excess heat and Kidney pathogen. Abdominal distension and constipation after six to seven days indicate severe interior accumulation; Excess Stomach Earth dries Kidney Water, requiring urgent purging to drain Stomach heat and nourish Kidney Water. Both Yangming and Shaoyin have urgent purging indications. Though symptoms differ, the mechanism of entering the Fu organs is identical, hence both use Dachengqi Tang. Note: Tongue dryness is milder than throat dryness. Though both connect to Shaoyin collaterals, the tongue is the sprout of the Heart. Cold Damage favors Yang and dislikes Yin, so tongue dryness is considered milder.)
Jueyin Disease: In Cold Damage after seven days, following severe purging, if the Cun (inch) pulse is deep and slow, hands and feet are cold, lower pulses are absent, throat is obstructed, expectoration of pus and blood occurs, and diarrhea is unceasing, the prognosis is poor; Mahuang Shengma Tang (Ephedra and Ma Huang Shen Decoction) is used. In Cold Damage progressing from one to two days to four to five days, if cold limbs appear, fever should follow. If purging was indicated but sweating was erroneously induced, oral ulceration and redness will result.
Wu Qian's Commentary: In Shaoyin disease, a rapid pulse indicates purging is possible; a deep pulse indicates using Fuzi Tang (Aconite Root Decoction) added with Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Maimendong (Ophiopogon Tuber), Wuweizi (Schisandra Fruit), and Tianhuafen (Trichosanthes Root). For post-illness deficiency-heat with persistent vexation, Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction) is used, removing Banxia (Pinellia Tuber) and adding Tianhuafen for moistening. After sweating, emesis, or purging, dry mouth and throat indicate depleted body fluids, failing ascent of Kidney Water, and defluxion of deficient fire. Shengjin Yiqi Tang (Generate Fluids and Boost Qi Decoction) or Zhuyeshigu Tang is indicated. If the pulse is deep and faint, feet are cold, and tongue is dry, the prognosis is generally poor. Shaoyin disease has examples of urgent purging to save Kidney Water. For deficient patients with exhausted water and dry fire who cannot tolerate purging, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen (Ginseng), plus Wuweizi, Maimendong, Tianhuafen, Huangbai, and Zhimu is used to nourish water. Huhu Disease also presents with dry throat, silence, desire to sleep but inability to close eyes, hoarseness. Dry throat characterizes Huhu; parasitic erosion of the lower part defines "Hu"; dry throat with ulcers on the lower lip is treated with Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction).
Zhao Xianke's Commentary: *Huo Ren Shu* (Book of Saving Lives) states that heat in the Spleen depletes body fluids, causing dry mouth and throat. While fluid depletion is correct, it is not solely due to Spleen heat. The Spleen governs Taiyin; Taiyin disease presents with abdominal fullness and dry throat, which can be attributed to Spleen heat as a specific symptom, but other cases are different. For example, Baihu Jia Renshen Tang syndrome with dry mouth/tongue indicates exterior-interior heat. Bitter taste and dry throat indicate Shaoyang channel heat or Yangming Wind-Strike. Urgent purging for dry mouth/throat with clear green diarrhea, epigastric pain, and dry mouth indicates Shaoyin channel heat. Dry throat, vexation, vomiting, and counterflow after erroneous sweating indicate depleted fluids leading to potential Yangming interior heat. Do these multiple syndromes all stem from Spleen heat?