〔丹〕火郁当看热在何经，轻者可降，重者则随其性而升之。人虚火盛颠者，用生姜汤，若投以冰水正治之，
立死。实火可泻，小便降火极速。有补阴即火自降，炒柏、地黄之类。凡气有余便是火，急甚者必缓之。生甘
草兼泻兼缓，参、术亦可。凡火盛者，不可骤用寒凉药，必兼温散之。左金丸治肝火，用黄连六两，吴茱萸一
两。阴虚火动，难治。吃酒人发热，难治。不饮酒人，因酒发热者，难治。
一男子二十三岁，因酒发热，用青黛、栝蒌仁，入姜汁，每日数匙，入口中，三两月而愈。
〔垣〕小儿 后，余热不退，痂不收敛，大便不行，是谓血燥，则当以阴药治之，因而补之，用清凉饮子，
通大便而泻其热。洁古云∶凉风至而草木实。夫清凉饮子，乃秋风彻热之剂也。（此甘寒泻火也。）伤寒表邪入于里，
日晡潮热，大渴引饮，谵语狂躁，不大便，是胃实，乃可攻之。夫胃气为热所伤，以承气汤泻其上实，元气乃
得周流，承气之名于此具矣。（此苦寒泻湿热也。）今世人以苦泄火，故备陈之。除热泻火，非甘寒不可，以苦寒泻火
非徒无益而反害之。故有大热脉洪大，服苦寒剂而热不退者，加石膏。如症退而脉数不退，洪大而病有加者，
宜减苦寒，加石膏。如大便软或泄者，加桔梗，食后服之。此药误用，则其害非细，用者旋旋加之。如食少者，
不可用石膏，石膏善能去脉数，如病退而脉数不退者，不治。
〔海〕大热而脉反细小，不可下者，泻心汤主之。脉有力，可用之。骨肉筋血皮毛，阴足而热反胜之，是谓实热。
〔垣〕能食而热，口舌干燥，大便难者，实热也，以辛苦大寒之剂下之，泻热补阴。经云∶阳盛阴虚，下之
则愈。脉洪盛而有力者是已。
〔丹〕人壮气实，火盛颠狂者，可用正治，芒硝、冰水之类饮之。
〔海〕骨痿肉燥，筋缓血枯，皮聚毛落，阴不足而有热疾，是谓虚热。
〔垣〕不能食而热，自汗气短者，虚热也，以甘寒之剂泻热补气。经云∶治热以寒？温而行之。脉虚
弱无力者是已。
当归补血汤 治妇人肌热，大渴引饮，目赤面红，昼夜不息，其脉洪大而虚，重按全无。《内经》曰∶
脉虚血虚，脉实血实。又云∶血虚发热是也。症象白虎，惟脉不长实难辨也，误服白虎汤必死，此病得于饥困劳役。
黄 （一两） 当归（二钱，酒洗）
上锉作一服，水二盏，煎至一盏，去渣，稍热，空心服之。
补中益气汤 治饮食劳倦所伤，始为热中。盖人受水谷之气以生，所谓清气、营气、运气、卫气、春升之气，
皆胃气之别名也。夫胃气为水谷之海，饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，
下输膀胱，水精四布，五经并行，合于四时五脏阴阳，揆度以为常也。若饮食失节，寒温不适，则脾胃乃伤。
喜怒忧恐，损耗元气，脾胃气衰，元气不足，而心火独盛。心火者，阴火也，起于下焦，其系系于心，心不
主令，相火代之，相火包络之火，元气之贼也，火与元气不两立，一胜则一负。脾胃气虚，则下流于肾，
阴火得以乘其土位。故脾症始得，则气高而喘，身热而烦，其脉洪大而头痛，或渴不止，其皮肤不任风寒，而
生寒热。盖阴火上冲，则气高喘而烦热，为头痛，为渴，而脉洪。脾胃之气下流，使谷气不得升浮，是春生
之令不行，则无阳以护其营卫，故不任风寒，乃生寒热，此皆脾胃之气不足所致也。然与外感风寒之症，颇
同而实异。内伤脾胃，乃伤其气，外感风寒。乃伤其形。伤其外则有余，有余者泻之。伤其内则不足，不足
者补之。汗之下之吐之克之之类，皆泻也。温之和之调之养之之类，皆补也。内伤不足之病，苟误认作外感
有余之症，而反泻之，则虚其虚也，实实虚虚如此，死者医杀之耳。然则奈何？唯当以辛甘温剂，补其中而
升其阳，甘寒以泻其火则愈矣。经曰∶劳者温之，损者温之。又曰∶温能除大热。大忌苦寒之药，损其脾胃。
脾胃之症始得，则热中，今立法治始得之症。
黄 （病甚热甚者，一钱） 人参（三分，有嗽去之） 甘草（五分，炙） 当归身（二分，酒制） 橘
皮（二分） 升麻（二分） 柴胡（二分） 白术（三分）
上 咀作一服，水二盏，煎至一盏，量气弱气盛，临病斟酌水盏大小，去渣，食远稍热服。如伤重者，不
过二服而愈。若病久者，以权立加减法治之。如腹中痛者，加白芍五分，炙甘草三分。恶寒冷痛者，加中桂
去皮二分。如恶热喜寒而腹痛者，于已加芍药、甘草中，更加生黄芩三分，或二分。或夏月腹痛而不恶热者，
亦然。治时热也，若天凉恶热而痛，于加白芍、甘草、黄芩中更加桂少许。天寒腹痛，去芍药，味酸寒故也。
加益智仁三分，或加半夏五分，生姜三片。如头痛加蔓荆子三二分。痛甚者加川芎二分。顶痛脑痛，加 本
三分，或五分。若苦头痛者，加细辛二分。诸头痛者，并用此四味足矣。若头上有热，则此不能治，别以清
空膏治之。如脐下痛者，加真熟地五分，其痛立止。如不止者，乃大寒也，更加肉桂去皮三分或二分，《内
经》所说小腹痛皆寒症，从复法相报中来也。经曰∶大胜必大复。从热病中变而作也，非伤寒厥阴之症也。仲景
用抵当汤并丸主之，乃血结下焦膀胱也。如胸中气壅滞，加青皮二分，气促少气者去之。如身有疼痛者属湿，
若身重者亦湿，加去桂五苓散一钱。如风湿相搏，一身尽痛，加羌活、防风各五分，升麻、 本根、苍术各
一钱，勿用五苓散。所以然者，为风药已能胜湿，故别作一服与之。如病去，勿再服。以治风之药，大损元
气，而益其病故也。如大便秘涩，加当归梢一钱。如闭涩不行，煎成正药，先用一口调玄明粉半钱或一钱，
得行则止。此病不宜下，下之恐变成凶症也。如久病痰嗽者，去人参，初病者勿去。冬月、春寒或秋凉时，
各宜加不去节麻黄半钱。如春令大温，则加佛耳草三分，款冬花二分。如夏月病嗽，加五味子三分，去心麦
冬二分或三分。如舌上白滑苔，是胸中有寒，勿用之。如夏月不嗽，亦加人参三二分。并五味子、麦冬各等
分，救肺受火邪也。如病患能食而心下痞，加黄连二分或三分。如不能食而心下痞，勿用。如胁下痛或急缩
者，俱加柴胡、甘草。
上一方加减，是饮食劳倦喜怒不节，始病热中则可用之。若末传寒中，则不可用也。盖甘酸适足益其病
耳。如黄 、人参、甘草、芍药、五味之类是也。
〔垣〕气运衰旺图
湿胃化热小肠长风胆生皆陷下不足，先补，则用黄 、甘草、当归、升麻、柴胡、人参。乃辛甘发
散，以助春夏生长之用者也。
土脾形 火心神 木肝血 皆大盛上乘生长之气，后泻，则用甘草梢之甘寒，泻肺火逆于胸中伤气者也。
黄芩之苦寒，以泄胸中之热，喘气上奔者也。红花以破恶血。用黄芩大补肾水。益肺气，泻血中火燥者也。
寒膀胱藏气 燥大肠收气 皆大旺，后泻，则用黄 之甘温，止自汗，实表虚，使不受寒邪，当归之辛温，
能润燥，更加桃仁以通幽门闭塞，利其阴路，除大便之难燥者也。
水肾精 金肺气 皆虚衰不足，先补，则用黄柏之苦寒，除湿热为痿，乘于肾，救足膝无力，亦除阴汗阴痿
而益精。甘草梢、黄芩补肺气，泄阴火之下行。肾苦气上逆，急食苦以泄之也。
此初受热中常治之法也，非权也，权者临病制宜之谓也。
〔海〕昼热则行阳二十五度，大抵柴胡饮子。夜热则行阴二十五度，大抵四顺饮子。（又云一身尽热，
或日晡潮热，或夜则行阴发热者，皆血热也。四顺饮子或桃仁承气汤选而用之。当视其由表入里，腹痛血刺
痛，腹中有无转矢气之异。）平旦发热，热在行阳之分，肺气主之，故用白虎汤以泻气中之火。（又云∶白虎治
脉洪，故抑之使秋气得以下降也。）日晡潮热，热在行阴之分，肾气主之，故用地骨皮以泻血中之火。（
（又云∶地骨皮散治脉弦，故举之使春气得以上升也。按地骨皮散治虚热方也。）
气分热∶柴胡饮子、白虎汤。
血分热∶清凉饮子（即四顺散）、桃仁承气汤。
〔垣〕牵牛味辛烈，能泻气中之湿热，不能除血中之湿热。防己味苦寒，能泻血中之湿热，又通血中之滞塞。
柴胡饮子（方见劳热。） 白虎汤（方见伤寒。） 地骨皮散（方见骨蒸门。）
清凉饮子 大黄（蒸） 甘草（炙） 当归（洗） 芍药（洗。各等分）
上 咀，每服五钱，薄荷十叶，水一盏半，同煎至七分，去渣温服。
桃仁承气汤（方见伤寒。）
〔丹〕人病脉虚气郁发热。
芍药（酒炒，一两二钱五分） 香附（一两） 苍术（半两） 沙参（三钱） 甘草（一钱五分）
上炊饼丸服。
脉滑，肠有宿食，常暮发热，明日复止者，于宿食门求之。湿痿夜热，以三补丸加白芍药为丸。
三补丸方
黄芩 黄柏 黄连 为末，粥糊为丸。
〔洁〕有表而热者谓之表热，无表而热者谓之里热。故苦者以治五脏，五脏属阴而居于内。辛者以治六腑，
六腑属阳而在于外。故曰∶内者下之，外者发之。又宜养血益阴，身热自除。（以脉言之，浮数为外热，
沉数为内热。浮大有力为外热，沉大有力为内热。）
〔仲〕热在上焦者，因咳为肺痿。热在中焦者，为坚，热在下焦者，为尿血，亦令淋闭不通。
肘前热者，腰以上热。手前独热者，腰以下热。肘前独热者，膺前热。肘后独热者，肩背热。臂中独热者，
腰腹热。肘后以下三四寸热者，肠中有虫。掌中热者，腹中亦热。（全文见诊法。）
〔海〕三焦热用药大例上焦热，栀子、黄芩。中焦热，小便不利，黄连、芍药。下焦热，黄柏、大黄。
上焦热∶清神散、连翘防风汤、凉膈散、龙脑饮子、犀角地黄汤。
中焦热∶小承气汤、调胃承气汤、洗心散、四顺清凉饮、桃仁承气汤。
下焦热，大承气汤、五苓散、立效散、八正散、石苇散、四物汤。
身热脉洪无汗多渴者，热在上焦，宜桔梗汤。
桔梗 连翘 山栀 薄荷 黄芩 甘草（各等分）
上为粗末，竹叶白水煎，温服。汗之，热服。春倍加防风、羌活。夏倍加黄芩、知母。季夏淫雨倍加羌活。
秋加桂五钱。冬加桂一两。亦可以意消息，随症增损而用之。
〔《局》〕清神散消风壅，化痰涎，治头目眩面热。
檀香（挫） 人参（去芦） 羌活（去苗） 防风（去芦。各一两） 薄荷（去土） 甘草 荆芥
穗（各二两） 石膏（研，四两） 细辛（去苗，焙五钱）
上为末，每服二钱，沸汤点服，或入茶末点服。（此方虚热可用。）
龙脑饮子 治蕴积邪热，咽喉肿痛，眼赤口疮，心烦鼻衄。（丹溪云；上中二焦药也。）
砂仁 栝蒌根（各三两） 藿香叶（二两四钱） 石膏（四两） 甘草（蜜炙，六两） 栀子（微炒，十二两。）
上为末，每服二钱至三钱，用新汲水入蜜调下。
〔无择〕加减凉膈散退六经热。（丹溪云∶凉膈散，心肺脾胃药也。）
〔易老〕凉膈散减大黄、芒硝，加桔梗、甘草，一法加防风，同为舟楫之剂，浮而上之。治胸膈中与六经
之热。以手足少阳之气俱下膈，络胸中，三焦之气同相火游于身之表，膈与六经乃至高之分，此药浮载亦至
高之剂，故施于无形之中，随高而走，去胸膈中及六经之热也。
凉膈散 栀子仁（一两五钱） 芒硝（半两） 连翘 薄荷 黄芩 甘草（各一两半） 大黄（五钱）
上为粗末，每一两，水二盏，竹叶七片，同煎至一盏，去渣，入蜜少许，食后服，加姜煎亦得。去六经热，
减大黄、芒硝，加桔梗、甘草、人参、防风。治肺经邪气，咳嗽有痰，加半夏。凉膈与四物汤各半服，能益
血泄热，名双和散。钱氏去连翘，加藿香、石膏，为泻黄散。
〔《本事方》〕治大人小儿五脏积热，烦躁多渴，唇裂喉闭，目赤鼻颔结硬，口舌生疮，阳明症伤寒，发狂见
鬼谵语，大小便闭，一切风壅，并皆治之。
山栀仁 甘草 赤芍药（各一两） 大黄 朴硝 连翘 薄荷 （净叶） 干葛（各二两）
上为散，每服二钱，水一盏，入竹叶七片，蜜三匙，同煎至七分，去渣食后服，唯阳明症伤寒忌下。此药
《局方》亦载，缘味数与用药大段不同。予一侄妇忽患热病欲死，付之一服立效，后来累服累验，幸毋忽。
又方
白术 荆芥 赤芍药（各三两） 大黄 车前子（生用） 木通 甘草 当归（各二两）
上为细末，大便秘结，米泔调空心服三钱。上膈壅热，或生赤丹，或生痈疖，用水二盏，煎六分。若小便
结如淋状，用芦根打碎洗净，煎汤下。五心烦热，用生姜一片，同煎服效。
小承气汤（方见伤寒。） 调胃承气汤（方见伤寒。） 四顺饮子（方见前气血。） 桃仁承气汤（
方见伤寒。） 大承气汤（方见伤寒。）
立效散 治下焦结热，小便黄赤，淋闭疼痛，或出血。
山栀（炒，半两） 瞿麦穗（一两） 甘草（炙，三分）
[Background Information]
Book: Medical Outline (Yixue Gangmu)
Author: Lou Ying
Dynasty: Ming
Chapter: Treating Fever (Part 1/2)
Category: Medical Discourse
[Translation]
[Discussion by Zhu Danxi] In cases of Fire Stagnation, one must observe which meridian the heat resides in. For mild cases, a descending method may be used; for severe cases, one should follow its nature and use an ascending method. If the body's healthy Qi is deficient while Fire is exuberant, leading to madness, Ginger Decoction should be used. If Ice Water is mistakenly applied as a direct treatment (using cold to counteract heat), death will occur immediately. Excess Fire can be purged; draining urine reduces Fire very rapidly. There is a method of nourishing Yin so that Fire descends naturally, such as using Stir-fried Phellodendri Cortex (Huangbai) and Rehmanniae Radix (Dihuang). Whenever there is an excess of Qi, it becomes Fire. When extremely urgent, it must be moderated. Raw Licorice Root (Gancao) possesses both purging and moderating properties; Ginseng Root (Renshen) and Atractylodis Macrocephalae Rhizome (Baizhu) can also be used. Whenever Fire is exuberant, cold and cooling medicines should not be used abruptly; warm and dispersing methods must be combined. Zuo Jin Pill treats Liver Fire, using six taels of Coptidis Rhizoma (Huanglian) and one tael of Evodiae Fructus (Wuzhuyu). Yin deficiency with Fire movement is difficult to treat. Fever in alcohol drinkers is difficult to treat. Fever in non-drinkers caused by alcohol consumption is also difficult to treat.
A twenty-three-year-old man suffered from fever due to alcohol consumption. He was treated with Indigo Naturalis (Qingdai) and Trichosanthis Semen (Gualu Ren), mixed with Ginger Juice, taken orally several times a day. He recovered after two or three months.
[Discussion by Li Dongyuan] After a child's illness, if residual heat does not recede, scabs do not heal, and defecation does not occur, this is called Blood Dryness. It should be treated with Yin-nourishing medicines and subsequently supplemented. Qingliang Yinzi is used to unblock the bowels and purge heat. Jiegu stated: "When cool winds arrive, grasses and trees bear fruit." Qingliang Yinzi is a formula that clears heat like autumn wind. (This is a sweet-cold method to purge Fire.) When exterior pathogenic factors of Cold Damage enter the interior, causing tidal fever at dusk, extreme thirst with desire to drink, delirious speech and mania, and constipation, this is Stomach Excess, and purgation is permissible. Since Stomach Qi is injured by heat, Chengqi Tang is used to purge upper excess, allowing Yuan Qi (Original Qi) to circulate throughout the body; thus the name Chengqi Tang is established. (This is a bitter-cold method to purge damp-heat.) Nowadays, people believe that bitter flavors purge Fire, so these methods are detailed. To remove heat and purge Fire, only sweet-cold methods are effective; using bitter-cold methods to purge Fire is not only useless but harmful. Therefore, in cases of high fever and a洪 (Surging) pulse, if bitter-cold agents fail to reduce fever, add Gypsum Fibrosum (Shigao). If symptoms subside but the rapid pulse remains, and the pulse is surging while the condition worsens, reduce bitter-cold herbs and add Gypsum Fibrosum. If stools are soft or loose, add Platycodonis Radix (Jiegeng) and take it after meals. Misuse of this medicine causes significant harm; users should add it gradually. If appetite is poor, Gypsum Fibrosum should not be used, as it effectively eliminates rapid pulses; if the disease subsides but the rapid pulse persists, it is incurable.
[Hai Zang Discussion] High fever with a thin and small pulse indicates that purgation is contraindicated; Xixin Tang is the primary treatment. If the pulse is forceful, it can be used. When Yin fluids are sufficient but Heat overcomes them in bones, flesh, sinews, blood, skin, and hair, this is called Excess Heat.
[Li Dongyuan Discussion] Fever accompanied by ability to eat, dry mouth and tongue, and difficult defecation is Excess Heat. It should be treated with bitter-acrid and great-cold purgatives to drain heat and tonify Yin. The Classics state: "Yang excess and Yin deficiency are cured by purgation." This applies when the pulse is surging, full, and forceful.
[Zhu Danxi Discussion] For robust individuals with excess Qi, exuberant Fire, and madness, direct treatment is applicable. Drinking Mirabilite (Mangxiao) or Ice Water is suitable.
[Hai Zang Discussion] Bone atrophy, dry flesh, relaxed sinews, depleted blood, contracted skin, and fallen hair, where Yin insufficiency leads to heat diseases, is called Deficiency Heat.
[Li Dongyuan Discussion] Fever accompanied by inability to eat, spontaneous sweating, and shortness of breath is Deficiency Heat. It should be treated with sweet-cold agents to drain heat and tonify Qi. The Classics state: "Treat heat with cold? Administer it warmly." This applies when the pulse is weak and powerless.
Danggui Buxue Tang: Treats women's muscle fever, extreme thirst with desire to drink, red eyes and face, continuous day and night, with a surging yet empty pulse that vanishes upon heavy pressure. The *Neijing* states: "Empty pulse indicates Blood deficiency; solid pulse indicates Blood excess." It also says: "Fever due to Blood deficiency" refers to this syndrome. The symptoms resemble Baihu Tang syndrome, but the pulse lacks solidity, making differentiation difficult. Mistaken use of Baihu Tang will cause death. This disease arises from hunger, distress, and labor.
Astragali Radix (Huangqi) (1 liang)
Angelicae Sinensis Radix (Danggui) (2 qian, washed with wine)
Crush into coarse powder for one dose. Add two cups of water, decoct to one cup, strain, and take slightly warm on an empty stomach.
Buzhong Yiqi Tang: Treats injury from diet and fatigue, initially manifesting as Heat in the Middle. Humans derive life from the Qi of water and grain. Clear Qi, Ying (Nutritive) Qi, Yun (Transporting) Qi, Wei (Defensive) Qi, and Spring-rising Qi are all aliases of Stomach Qi. Stomach Qi is the sea of water and grain. Food enters the Stomach, its essence floats up, transports to the Spleen, the Spleen scatters essence, sends it up to the Lung, regulates water passages, and transports down to the Bladder. Water essence distributes everywhere, meridians run together, harmonizing with the four seasons and five zang organs' Yin-Yang, establishing normalcy. If diet is irregular or temperature regulation fails, the Spleen and Stomach are injured. Joy, anger, worry, and fear deplete Yuan Qi. Spleen and Stomach Qi decline, Yuan Qi is insufficient, and Heart Fire alone becomes exuberant. Heart Fire is Yin Fire, originating from the Lower Jiao, connected to the Heart. When the Heart does not govern, Ministerial Fire takes over. Ministerial Fire is Pericardium Fire, the thief of Yuan Qi. Fire and Yuan Qi cannot coexist; when one wins, the other loses. Spleen and Stomach Qi deficiency causes Qi to flow downward to the Kidney, allowing Yin Fire to invade the Earth position. Thus, early Spleen syndrome presents with high Qi and wheezing, body heat and vexation, surging pulse and headache, or unquenchable thirst. The skin cannot withstand wind and cold, generating chills and fever. Yin Fire rushing upward causes high Qi, wheezing, vexation, heat, headache, thirst, and surging pulse. Downward flow of Spleen and Stomach Qi prevents Grain Qi from rising, halting the Spring-generation command. Without Yang to protect Ying and Wei, the body cannot withstand wind and cold, generating chills and fever. All these result from Spleen and Stomach Qi insufficiency. However, this differs from exterior Wind-Cold invasion. Internal injury to Spleen and Stomach injures Qi; external Wind-Cold injures Form. Exterior excess is drained; interior deficiency is tonified. Sweating, purging, vomiting, and attacking are draining methods. Warming, harmonizing, regulating, and nourishing are tonifying methods. If internal deficiency is mistaken for external excess and drained, it further depletes deficiency, creating a fatal error. Death results from medical error. What then? One must use acrid-sweet-warm agents to tonify the center and raise Yang, and sweet-cold agents to drain Fire for recovery. The Classics say: "For exhaustion, use warmth; for loss, use warmth." Also: "Warmth can eliminate great heat." Bitter-cold medicines are strictly forbidden as they damage Spleen and Stomach. Early Heat in the Middle syndrome requires this treatment.
Astragali Radix (Huangqi) (1 qian if severe/high fever)
Ginseng Radix (Renshen) (3 fen, remove if coughing)
Licorice Root (Gancao) (5 fen, honey-fried)
Angelicae Sinensis Radix (Danggui) (2 qian, wine-processed)
Citrus Reticulatae Pericarpium (Chenpi) (2 qian)
Cimicifugae Rhizoma (Shengma) (2 qian)
Bupleuri Radix (Chaihu) (2 qian)
Atractylodis Macrocephalae Rhizome (Baizhu) (3 qian)
Crush into coarse powder for one dose. Add two cups of water, decoct to one cup. Adjust water amount based on Qi weakness or strength. Strain and take slightly warm well after meals. For severe injuries, recovery occurs within two doses. For chronic conditions, modify according to weight. For abdominal pain, add White Peony Root (Baishao) 5 fen, Honey-fried Licorice (Zhi Gancao) 3 fen. For aversion to cold and cold pain, add Cinnamon Twig (Rougui) without bark 2 qian. For aversion to heat, preference for cold, and abdominal pain, add Raw Scutellariae Radix (Huangqin) 3 or 2 qian to the Baishao and Gancao mixture. Similarly for summer abdominal pain without cold aversion. For seasonal heat, if cold weather causes heat aversion and pain, add a little Cinnamon Twig to Baishao, Gancao, and Huangqin. For winter abdominal pain, remove Baishao due to its sour-cold nature. Add Alpinia Oxyphylla Fruit (Yizhiren) 3 qian, or Pinelliae Tuber (Banxia) 5 qian, and 3 slices of Fresh Ginger (Shengjiang). For headache, add Vitex Fruit (Manjingzi) 3-2 qian. For severe pain, add Ligusticum Chuanxiong Rhizoma (Chuanxiong) 2 qian. For vertex or brain pain, add Ligustici Wallichii Rhizoma (Gaoben) 3 or 5 qian. For persistent headache, add Asari Radix et Rhizoma (Xixin) 2 qian. These four herbs suffice for various headaches. For heat on the head, this formula is ineffective; use Kongqing Gao instead. For umbilical pain, add Prepared Rehmanniae Radix (Shudi) 5 qian; pain stops immediately. If not, it is severe cold; add Cinnamon Twig (Rougui) without bark 3 or 2 qian. *Neijing* states lower abdominal pain is always cold, resulting from the law of retribution. The Classics say: "Great victory brings great retribution." This arises from transformation in heat diseases, not Jueyin Cold Damage. Zhang Zhongjing uses Didang Tang and pills for blood stasis in the Lower Jiao Bladder. For chest Qi stagnation, add Citrus Aurantium Fructus (Qingpi) 2 qian; remove if shortness of breath occurs. For body pain due to dampness or heaviness, add Wuling San without Cinnamon 1 qian. For wind-damp bi with whole-body pain, add Notopterygii Rhizoma et Radix (Qianghuo) and Saposhnikoviae Radix (Fangfeng) 5 qian each, Cimicifugae Rhizoma (Shengma), Ligustici Wallichii Rhizoma root (Gaoben gen), and Atractylodis Rhizoma (Cangzhu) 1 qian each; do not use Wuling San. Wind herbs resolve dampness, so prepare separately. Stop taking when the disease resolves, as wind herbs severely damage Yuan Qi and worsen the condition. For constipation, add Angelicae Sinensis Radix tip (Danggui shao) 1 qian. For severe blockage, take one mouthful of the decoction mixed with Mirabilite (Xuanningfen) 0.5 or 1 qian; stop once bowel movement occurs. Purging is contraindicated here to avoid凶 (fatal) complications. For chronic phlegm-cough, remove Ginseng (Renshen); do not remove in acute cases. In winter, spring cold, or autumn chill, add Ephedrae Herba (Mahuang) without joints 0.5 qian. In warm springs, add Petasitae Flos (Foercao) 3 qian and Farfarae Flos (Kuandonghua) 2 qian. In summer cough, add Schisandrae Fructus (Wuweizi) 3 qian and Ophiopogonis Tuber (Maidong) heartless 2-3 qian. If white slippery coating on tongue indicates cold in chest, do not use. In summer without cough, add Ginseng 3-2 qian, along with equal parts Schisandra and Ophiopogon to rescue Lung from Fire evil. If patient can eat but has epigastric fullness, add Scutellariae Radix (Huangqin) 2-3 qian. If unable to eat with epigastric fullness, do not use. For hypochondriac pain or contraction, add Bupleuri Radix (Chaihu) and Licorice (Gancao).
The above modifications apply to Heat in the Middle caused by irregular diet, fatigue, and emotions. If it transmits to Cold in the Middle, it is contraindicated. Sweet and sour herbs may aggravate the disease, such as Astragalus (Huangqi), Ginseng (Renshen), Licorice (Gancao), White Peony (Baishao), and Schisandra (Wuweizi).
[Li Dongyuan Discussion] Chart of Qi Transport Decline and Prosperity
Dampness transforms Stomach heat; Small Intestine generates wind; Gallbladder produces sinking deficiency. First tonify with Astragali Radix (Huangqi), Licorice (Gancao), Angelicae Sinensis Radix (Danggui), Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu), and Ginseng Radix (Renshen). These are acrid-sweet dispersing agents to assist Spring-Summer growth.
Earth Spleen Form, Fire Heart Spirit, Wood Liver Blood are all excessively flourishing, overcoming the growing Qi. Then purge with sweet-cold Licorice Tip (Gancaoshao) to purge Lung Fire reversing in the chest injuring Qi. Bitter-cold Scutellariae Radix (Huangqin) drains chest heat and wheezing. Safflower (Honghua) breaks bad blood. Using Scutellaria greatly tonifies Kidney Water, benefits Lung Qi, and drains fire-dryness in blood.
Cold Bladder Storage Qi, Dry Large Intestine Receiving Qi are all overly prosperous. Then purge with sweet-warm Astragali Radix (Huangqi) to stop spontaneous sweating, solidify exterior deficiency, prevent cold invasion. Acrid-warm Angelicae Sinensis Radix (Danggui) moistens dryness; add Peach Kernel (Taoren) to open pyloric closure, benefit Yin pathways, and relieve dry constipation.
Water Kidney Essence, Metal Lung Qi are both deficient and insufficient. First tonify with bitter-cold Phellodendri Cortex (Huangbai) to drain damp-heat causing flaccidity invading Kidney, save weak knees, remove Yin sweat and impotence, and benefit essence. Licorice Tip (Gancaoshao) and Scutellariae Radix (Huangqin) tonify Lung Qi and drain downward-flowing Yin Fire. Kidney suffers from rebellious Qi; urgently eat bitter to drain it.
This is the standard treatment for initial Heat in the Middle, not flexibility (Quan). Flexibility means adapting to the specific case.
[Hai Zang Discussion] Daytime fever corresponds to Yang circulation (25 degrees), generally treated with Chaihu Yinzi. Nighttime fever corresponds to Yin circulation (25 degrees), generally treated with Sishun Yinzi. (Also said: Whole-body heat, dusk tidal fever, or nighttime Yin-fever are all Blood Heat. Choose between Sishun Yinzi or Taoren Chengqi Tang. Observe progression from exterior to interior, abdominal pain, stabbing pain, and presence of passing gas.) Morning fever, heat in Yang circulation, governed by Lung Qi, so use Baihu Tang to drain Qi Fire. (Also said: Baihu treats surging pulse, suppressing it to allow Autumn Qi to descend.) Dusk tidal fever, heat in Yin circulation, governed by Kidney Qi, so use Lycii Cortex (Digupi) to drain Blood Fire. (Also said: Digupi San treats wiry pulse, lifting it to allow Spring Qi to ascend. Note: Digupi San treats Deficiency Heat.)
Qi Branch Heat: Chaihu Yinzi, Baihu Tang.
Blood Branch Heat: Qingliang Yinzi (i.e., Sishun San), Taoren Chengqi Tang.
[Li Dongyuan Discussion] Prunellae Spica (Qianniu) is acrid and pungent, draining damp-heat from Qi but not from Blood. Stephania Tetrandra (Fangji) is bitter and cold, draining damp-heat from Blood and unblocking Blood stasis.
Chaihu Yinzi (See Labor Fever).
Baihu Tang (See Cold Damage).
Digupi San (See Bone Steaming).
Qingliang Yinzi: Rhubarb (Zheng), Licorice (Zhi), Angelica (Xi), White Peony (Xi). Equal parts.
Crush. Take 5 qian per dose with 10 Mint leaves (Bohe), 1.5 cups water, decoct to 0.7 cups, strain, and take warm.
Taoren Chengqi Tang (See Cold Damage).
[Zhu Danxi Discussion] Fever with empty pulse and Qi stagnation.
White Peony (Shaoyao) (wine-fried, 1 liang 2 qian 5 fen)
Cyperi Rhizoma (Xiangfu) (1 liang)
Atractylodis Rhizoma (Cangzhu) (0.5 liang)
Glehniae Radix (Shashen) (3 qian)
Licorice (Gancao) (1 qian 5 fen)
Form pills with steamed bread dough.
Slippery pulse, retained food in intestines, evening fever stopping next day: consult Retained Food section. Damp flaccidity with night fever: use Sanbu Wan with added White Peony.
Sanbu Wan Formula: Scutellariae Radix (Huangqin), Phellodendri Cortex (Huangbai), Coptidis Rhizoma (Huanglian). Powder, pill with porridge paste.
[Zhang Yuansu (Jiegu) Discussion] Fever with exterior signs is Exterior Heat; fever without exterior signs is Interior Heat. Bitter flavors treat Five Zang (Yin, interior). Acrid flavors treat Six Fu (Yang, exterior). Thus: "Interior is purged, exterior is dispersed." Also, nourish Blood and benefit Yin to resolve fever. (Pulse-wise: Floating-rapid is exterior heat; deep-rapid is interior heat. Floating-large-forceful is exterior; deep-large-forceful is interior.)
[Zhang Zhong Discussion] Heat in Upper Jiao causes lung atrophy via cough. Heat in Middle Jiao causes hardness. Heat in Lower Jiao causes hematuria and strangury/obstruction.
Heat before elbow: upper body heat. Heat only on front of hand: lower body heat. Heat only before elbow: chest heat. Heat only behind elbow: shoulder/back heat. Heat only in arm: waist/abdomen heat. Heat 3-4 cun below elbow: intestinal worms. Heat in palm: abdominal heat. (Full text in Diagnosis section.)
[Hai Zang Discussion] General principles for Three Jiao Heat: Upper Jiao heat, Gardenia (Zhizi) and Scutellaria (Huangqin). Middle Jiao heat with difficult urination, Coptis (Huanglian) and White Peony (Baishao). Lower Jiao heat, Phellodendron (Huangbai) and Rhubarb (Dahuang).
Upper Jiao Heat: Qingshen San, Lianqiao Fangfeng Tang, Liangge San, Longnao Yinzi, Xijiao Dihuang Tang.
Middle Jiao Heat: Xiaochengqi Tang, Tiaowei Chengqi Tang, Xixin San, Sishun Qingliang Yin, Taoren Chengqi Tang.
Lower Jiao Heat: Dachengqi Tang, Wuling San, Lixiao San, Bazheng San, Shiwei San, Siwu Tang.
Body heat, surging pulse, no sweat, excessive thirst: Heat in Upper Jiao, suitable for Jiegeng Tang.
Platycodonis Radix (Jiegeng), Forsythiae Fructus (Lianqiao), Gardeniae Fructus (Shanzhi), Mint (Bohe), Scutellariae Radix (Huangqin), Licorice (Gancao). Equal parts.
Coarse powder. Decoct with Bamboo Leaf (Zhuye) and plain water, take warm. For sweating, take hot. Spring: double Fangfeng and Qianghuo. Summer: double Huangqin and Zhimu. Late Summer rain: double Qianghuo. Autumn: add Cinnamon 5 qian. Winter: add Cinnamon 1 liang. Adjust according to judgment and symptoms.
*[Ju Fang]* Qingshen San dissipates wind obstruction, transforms phlegm, treats dizziness and facial heat.
Sandalwood (Tanxiang), Ginseng (Renshen), Notopterygii Rhizoma (Qianghuo), Saposhnikoviae Radix (Fangfeng). Each 1 liang. Mint (Bohe), Licorice (Gancao), Schizonepeta Spike (Jingjie Sui). Each 2 liang. Gypsum (Shigao) 4 liang. Asari Radix (Xixin) 5 qian.
Powder. Take 2 qian with boiling water or tea. (Suitable for deficiency heat.)
Longnao Yinzi: Treats accumulated pathogenic heat, sore throat, red eyes, mouth ulcers, irritability, nosebleeds. (Danxi: Upper/Middle Jiao medicine.)
Amomi Fructus (Sharen), Trichosanthis Radix (Gualou Gen). Each 3 liang. Pogostemonis Herba (Huoxiang Ye) 2 liang 4 qian. Gypsum (Shigao) 4 liang. Licorice (Gancao) honey-fried 6 liang. Gardenia (Zhizi) lightly fried 12 liang.
Powder. Take 2-3 qian with fresh water and honey.
[Wuze] Modified Liangge San clears Six Meridians heat. (Danxi: Liangge San is Heart/Lung/Spleen/Stomach medicine.)
[Yilao] Liangge San removes Rhubarb and Mirabilite, adds Jiegeng and Gancao; another method adds Fangfeng. All act as boat-like agents floating upward. Treats chest/diaphragm and Six Meridians heat. Shaoyang Qi passes below diaphragm to chest; Sanjiao Qi travels with Ministerial Fire on body surface. Diaphragm and Six Meridians are highest points; this medicine floats to highest points, clearing heat in formless regions, moving upward to clear chest/diaphragm and Six Meridians heat.
Liangge San: Gardenia (Zhizi Ren) 1 liang 5 qian. Mirabilite (Mangxiao) 0.5 liang. Forsythia (Lianqiao), Mint (Bohe), Scutellaria (Huangqin), Licorice (Gancao). Each 1.5 liang. Rhubarb (Dahuang) 5 qian.
Coarse powder. 1 liang per dose, 2 cups water, 7 Bamboo Leaves. Decoct to 1 cup, strain, add honey, take after meals. Can add ginger. To clear Six Meridians heat, remove Dahuang/Mangxiao, add Jiegeng, Gancao, Renshen, Fangfeng. For Lung pathogen with cough-phlegm, add Banxia. Liangge + Siwu Tang half-half is Shuanghe San (benefits blood, drains heat). Qian Yi removed Lianqiao, added Huoxiang/Shigao to make Xiehuang San.
*[Ben Shi Fang]* Treats adult/child five-zang accumulated heat, irritability, thirst, cracked lips, throat closure, red eyes, hard chin/jaw, mouth ulcers, Yangming Cold Damage with mania/hallucinations, constipation, all wind obstruction.
Gardenia (Shanzhi Ren), Licorice (Gancao), Red Peony (Chishaoyao). Each 1 liang. Rhubarb (Dahuang), Mirabilite (Puxiao), Forsythia (Lianqiao), Mint (Bohe), Kudzu Root (Gegen). Each 2 liang.
Powder. Take 2 qian, 1 cup water, 7 Bamboo Leaves, 3 spoons honey. Decoct to 0.7 cups, strain, take after meals. Contraindicated in Yangming Cold Damage with purgation indication. Recorded in Ju Fang but differs significantly. My niece died of sudden heat disease; one dose saved her. Repeated use verified. Do not neglect.
Another Formula: Atractylodis Rhizoma (Baizhu), Schizonepeta (Jingjie), Red Peony (Chishaoyao). Each 3 liang. Rhubarb (Dahuang), Plantago Seed (Cheqianzi) raw, Akebia Caulis (Mutong), Licorice (Gancao), Angelica (Danggui). Each 2 liang.
Fine powder. Constipation: mix with rice wash, take 3 qian empty stomach. Upper chest heat/red rash/boils: 2 cups water, decoct to 0.6 cups. Urinary strangury: decoct Reed Rhizome (Lugen) and take. Five-palm heat: decoct with 1 slice Ginger.
Xiaochengqi Tang (See Cold Damage).
Tiaowei Chengqi Tang (See Cold Damage).
Sishun Yinzi (See Qi/Blood above).
Taoren Chengqi Tang (See Cold Damage).
Dachengqi Tang (See Cold Damage).
Lixiao San: Treats Lower Jiao knot-heat, yellow-red urine, strangury/pain, or bleeding.
Gardenia (Zhizi) fried 0.5 liang. Dianthus Caulis (Qumai Sui) 1 liang. Licorice (Gancao) fried 3 fen.