13. 表證 Exterior Pattern on 3rd volume of the book of living persons (活人書3-13-2)
冬發汗法
Method of
inducing sweating in winter
冬不可汗者, 以陽氣伏臧, 不可妄擾. 不問傷寒中風, 以輕藥解利之. 傷寒無汗者, 只與桂枝麻黃各般湯, 傷風有汗, 只與柴胡桂枝湯, 或得少汗而解, 或無汗自解. 病勢甚者, 不拘此.
It
is not appropriate to sweat in winter because it is a time when yang qi
retreats inward and should not be disturbed recklessly. For diseases such as
cold damage and wind strike, only light medicines should be used to resolve the
condition. If there is no sweating in a patient with cold damge, only 桂枝麻黃各半湯 (Cinnamon Twig and Ephedra Half and-Half Decoction, Gui Zhi Ma
Huang Ge Ban Tang) should be administered, and if the patient has sweating due
to damage to wind, only 柴胡桂枝湯 (Bupleurum and Cinnamon
Twig Decoction, Chai Hu Gui Zhi Tang) should be used. In some cases, the
condition can be resolved with little sweating or without sweating. In severe cases, do not be restricted by these points.
夏月發汗法
Method of inducing sweating in summer
夏月天氣大熱, 玄府開, 脈洪大, 宜正發汗. 但不可用麻黃ㆍ桂枝熱性藥, 須是桂枝麻黃湯加黃芩ㆍ石膏ㆍ知母ㆍ升麻也. 加減法, 在第十二卷, 藥方中, 夏月有桂枝麻黃證, 不加黃金輩服之, 轉助熱氣, 便發黃斑出也. 白虎湯雖可用, 然, 治中暑, 與汗後, 一解表藥耳, 一白虎, 未能驅逐表邪. 況夏月陰氣在內, 或患熱病而氣虛人, 妄投白虎, 往往有成結胸者. 以白虎性寒, 非治傷寒藥也.
During the hot summer months, the climate
is very hot, the sweat pores are open, and the pulse is surging and large. At
this time, it is appropriate to induce sweating. However, one should not use
the hot-natured herbs of Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig);
insteadIt is necessary to add Huang Qin, Shi Gao, Zhi Mu, and Sheng Ma to Gui
Zhi Tang and Ma Huang Tang. The method of dosage adjustment is described in the
12th volume of the prescription book.
If Gui Zhi Tang and Ma Huang Tang are used
during the summer without adding Huang Qin, Shi Gao, Zhi Mu, and Sheng Ma, it
can actually exacerbate the heat and cause yellow spots to appear. Bai Hu Tang
can be used, it treats heatstroke. But medicine for exterior pattern and Bia hu
Tang (White Tiger Decoction) cannot dispel evil in the exterior after
overheating or sweating.
Furthermore, in the summer, Yin Qi is
inside the body. If Bai Hu Tang is used indiscriminately in a person who is
suffering from heat illness and has weak Qi, it can often lead to chest
congestion. This is because Bai Hu Tang has a cold nature and is not a medicine
for treating Shang Han (cold damgage) disorder.
凡發汗法
General sweating
method
凡發汗, 欲令手足俱周濈濈然, 一時許爲佳, 不欲如水淋漓. 服湯中病, 則止, 不必盡劑. 然發汗, 須如常覆腰以上, 厚衣覆腰以下, 蓋腰以上流漓, 而腰以下至足心微潤,
病終不解. 凡發汗病證, 仍在者, 三日內, 可二三汗之, 令腰脚周遍爲度.
To induce sweating, it is necessary to
sweat enough to make the hands and feet moist, but not to the point where sweat
is dripping. If sweating while taking medicine, stop when the symptoms improve,
and there's no need to sweat excessively. When sweating, it is necessary to
cover the area above the waist with regular clothes, and the area below the
waist with thick clothing. This is because even if the sweat flows like water
from the area above the waist, if there is not much sweat from below the waist
to the soles of the feet, the illness will not be cured. If a disease that
requires sweating has been contracted, it is recommended to sweat 2-3 times
within 3 days to the point where sweat comes out from the waist to the
calves."
陰病發汗法
The method of inducing sweating for
yin diseases
又問, 三陰, 有可汗者乎? 陰病不當發汗, 發汗則動經. 然, 太陰脈浮, 少陰發熱, 亦須微微取汗. 但不正發汗耳. 大抵, 風寒中人, 與榮衛俱薄, 而發熱, 又未曾行諸汗藥, 雖無陽證, 須少汗解逐之.
Another question is, can sweating be used
for the three yin diseases? Sweating is not suitable for yin disease because it
can stimulate the meridians. However, if there is a floating pulse in the
Taiyin stage or fever in the Shaoyin stage, sweating should be used, but only
in small amounts and not excessively. In general, when wind and cold invade the
body, they will clash with construction and defense and cause heat effusion.
If sweating medication has not been taken, even if there is no yang symptom, a
small amount of sweating must be induced to resolve the condition.
王叔和云, 表中風寒入裏, 則不消. 故知初病脈沈細數, 雖裏不消, 本表中風寒, 須宜溫覆少汗而解.
Wang Shuhe said that if wind and cold enter the body through the surface, it cannot be dispelled. Therefore, in the early stages of the disease, even if the pulse is deep, thin, and rapid, and there are internal symptoms, it is a disease caused by wind and cold entering the body from the surface, so it is necessary to cover the patient warmly and induce slight sweating.
As for Zhongjing's recommendations, if the pulse is floating in Taiyin pattern, sweating is necessary, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate. If Shaoyin disease causes heat effusion and the pulse is deep, Ma Huang Xi Xin Fu Zi Tang (Ephedra, Asarum, and Aconite Decoction) is suitable. If Shaoyin disease persists for 2-3 days with continuing Shaoyin symptoms and no signs of Yang pattern, Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) is appropriate.
Inducing slight sweating is all for
applying surface-level herbs for Yin pattern. The general principle is that if
the pulse is deep, thin, and rapid, indicating an interior pattern, sweating
should be avoided. If the pulse indicates an interior pattern but there is heat
effusion in the exterior, it is appropriate to use mildly pungent herbs to
induce slight sweating and disperse the warmth.
不可發汗症
symptoms of not being able to sweat
slightly weak pulse, slow cubit pulse 1
1
大抵, 傷寒太陽證, 發熱, 惡寒, 宜發其汗. 然熱多寒少, 其脈微弱, 或尺脈遲者, 不可表也. 太陽病, 發熱惡寒, 熱多寒少, 脈微弱者, 此無陽也. 不可發汗, 宜桂枝二越婢一湯. 尺脈遲者, 血少也. 先以小建中加黃耆湯, 以養其血, 晬時用小柴胡ㆍ桂枝二越婢一湯, 小分劑, 以和解之.
In general, for the syndrome of Taiyang in
Shanghan (cold damage) disease with heat effusion and aversion to cold, it is
appropriate to promote sweating.
However, if the heat effusion is severe but there is little aversion t o cold
and the pulse is slightly weak or the cubit pulse is slow, it cannot be treated
as an exterior syndrome. If a patient with Taiyang
disease has fever and aversion to cold, more fever than cold, and a weak pulse,
this indicates a deficiency of Yang and sweating should be avoided. Instead, Gui
Zhi Er Yue Bi Yi Tang (Cinnamon Twig and One Part Spleen-Effusing Decoction)
should be used. If
the cubit pulse is slow, it indicates a deficiency of blood. First, nourish the
blood with Xiao Jian Zhong Jia Huang Qi Tang, and then use Xiao Chai Hu Tang
(Minor Bupleurum Decoction) or Gui Zhi Er Yue Bi Yi Tang (Cinnamon Twig and One
Part Spleen-Effusing Decoction) in small doses to harmonize and resolve the
condition.
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