身大热。反欲近衣者。热在皮肤。寒在骨髓也。身大寒。反不欲近衣者。寒在皮肤。热
在骨髓也。
按丹溪云。大热当喜冷。反欲得衣者。表气虚不足以自温。其人阴弱。阳无所附。飞越
而出。发为大热。宜作阴虚治之。大寒反不欲衣者。邪郁肤腠。表气大实。宜作邪郁治之。赵嗣
真云。虚弱表寒之人。感邪发热。热邪浮浅。不胜沉寒。故外怯而欲衣也。治宜辛温。壮盛素热
之人。感邪之初。寒未变热。阴邪闭于伏热。阴凝于外。热郁于内。故内烦而不欲衣也。治
宜辛凉。二说虽殊。各有至理。学人当因症察之。
伤寒脉浮。此表有热。里有寒。（白虎汤）少阴下利清谷。里寒外热。手足厥逆。脉微。
反不恶寒。面赤。或腹痛。或呕。或咽痛。或利止脉不出。（通脉四逆汤）既吐且利。小便复利。
大汗出。下利清谷。内寒外热。脉微。（四逆汤）下利清谷。里寒外热。汗出而厥。（通脉四
逆汤）脉浮而迟。表热里寒。下利清谷。（四逆汤）
太阳病。发热恶寒。热多寒少。脉微弱者。无阳也。不可汗。桂枝二越婢一汤）太阳病
。七
。脉微。恶寒。此阴阳俱虚。不可汗吐下也。面色反热者。未欲解也。以其不得小汗出。身
必痒。（桂枝麻黄各半汤）
（须知此症脉必浮虚而涩若沉实滑大数者非也）
伤寒八九日。风湿相搏。身体烦疼。不能转侧。不呕不渴。脉浮虚而涩。（桂枝附子汤
若大便硬小
便自利桂枝去桂加白术）风湿相搏。骨节烦疼。掣痛。不得屈伸。近之则痛剧。汗出
短气。小便不利。恶风不欲去衣。或身微肿。（甘草附子汤）
The body is extremely hot, yet there is a desire to keep close to clothing; this indicates heat in the superficial skin layer and cold in the deep bone marrow.
The body is extremely cold, yet there is no desire to keep close to clothing; this indicates cold in the superficial skin layer and heat in the deep bone marrow.
According to Zhu Danxi: Extreme heat should be accompanied by a preference for coolness. If there is a desire to wear clothes despite extreme heat, it is due to deficiency of Wei Qi (Defensive Qi) on the exterior, insufficient to warm the body self-sufficiently. The person has Yin deficiency, causing Yang to have no attachment, flying outward, resulting in high fever. This should be treated as a Yin deficiency syndrome. If there is extreme cold but no desire to wear clothes, it is because pathogenic factors are stagnant in the skin and interstices, with excess Wei Qi on the exterior. This should be treated as a pathogenic stagnation syndrome. Zhao Sizhen stated: In individuals with weakness and exterior cold, upon contracting pathogens, fever arises. The heat pathogen is superficial and cannot overcome the deep cold, hence the exterior feels fearful of cold and desires clothing. Treatment should employ Acrid-Warm methods. In robust individuals with inherent heat, at the initial stage of contracting pathogens, the cold has not yet transformed into heat. Yin pathogen closes off latent heat; Yin congeals on the outside while heat stagnates inside, causing internal restlessness and a lack of desire to wear clothes. Treatment should employ Acrid-Cool methods. Although these two theories differ, each contains profound truth. Students should analyze based on symptoms.
In Shanghan (Cold Damage), if the pulse is floating, this indicates heat on the exterior and cold on the interior. (Baihu Tang / White Tiger Decoction) In Shaoyin disease, with diarrhea passing undigested food, interior cold with exterior heat, cold extremities, faint pulse, yet no aversion to cold, red complexion, or possibly abdominal pain, vomiting, sore throat, or cessation of diarrhea without return of pulse. (Tongmai Sini Tang / Pulse-Returning Four Reversal Decoction) With both vomiting and diarrhea, urination becomes frequent/clear, profuse sweating, diarrhea passing undigested food, interior cold with exterior heat, faint pulse. (Sini Tang / Four Reversal Decoction) Diarrhea passing undigested food, interior cold with exterior heat, sweating with cold extremities. (Tongmai Sini Tang / Pulse-Returning Four Reversal Decoction) Pulse floating and slow, exterior heat with interior cold, diarrhea passing undigested food. (Sini Tang / Four Reversal Decoction)
In Taiyang disease, with fever and aversion to cold, where heat predominates over cold, and the pulse is faint/weak, this is "No Yang," and sweating therapy is contraindicated. (Guizhi Er Yuebi Yi Tang / Cinnamon Twig Twice-Yuebi One Third Decoction) In Taiyang disease, after seven days or more, with faint pulse and aversion to cold, this indicates simultaneous deficiency of Yin and Yang; sweating, emesis, and purgation are all contraindicated. If the face appears unusually hot, the condition is not resolving, because slight sweating has not occurred, leading to itching of the body. (Guizhi Mahuang Gehan Tang / Equal-Half Cinnamon Twig and Ephedra Decoction)
(Note: For this syndrome, the pulse must be floating, deficient, and choppy; sinking, solid, slippery, large, or rapid pulses are incorrect.)
After eight or nine days of Shanghan (Cold Damage), Wind-Dampness combats together, causing severe body pain, inability to turn over, no vomiting, no thirst, and a floating, deficient, and choppy pulse. (Guizhi Fuzi Tang / Cinnamon Twig and Aconite Root Decoction) If the stool is hard and urination is normal/spontaneous, use Guizhi Qu Gui Jia Baizhu Tang / Remove Cinnamon Twig from Cinnamon Twig Decoction plus Atractylodes Macrocephala Rhizome). Wind-Dampness combats together, causing severe joint pain, pulling pain, inability to flex or extend, pain worsening upon touch, sweating, shortness of breath, difficulty in urination, aversion to wind with reluctance to remove clothing, or slight bodily swelling. (Gancao Fuzi Tang / Licorice and Aconite Root Decoction)