世间发热类伤寒者数种。治各不同。伤寒伤风及寒疫也。则用仲景法。温病及瘟疫也。则用河间法。此皆
论外感者也。今人一见发热。皆认作伤寒。率用汗药以发其表。汗后不解。又用表药以凉其肌。柴胡凉膈白虎
双解等汤。杂然并进。若是虚证。岂不殆哉。自东垣出。而发内伤补中益气之论。此用气药以补气之
不足者也。至于劳心好色。内伤真阴。真阴既伤。则阳无所附。
故亦发热其人必面赤烦躁。口渴引饮。骨痛脉数而大。或尺数而无力者是也。惟丹溪发明补阴之说。以四物汤
加黄柏知母。此用血药以补血之不足者也。世袭相因。屡用不效何耶。盖因阴字认不真。误以血为阴耳。当作
肾中之真阴。即先天也。内经曰。诸寒之而热者。取之阴。诸热之而寒者。取之阳。所谓求其属也。王太仆先生
注云。大寒而盛。热之不热。是无火也。大热而盛。寒之不寒。是无水也。又云。倏忽往来。时发时止。是无
火也。昼见夜伏。夜见昼止。时节而动。是无水也。当求其属而主之。无火者。宜益火之源。以消阴翳。无水
者。宜壮水之主。以镇阳光。必须六味八味二丸。出入增减。以补真阴。屡用屡效。若泥黄柏知母苦寒之说。必
致损伤脾阴而毙者。不可胜举。大抵病热作渴。饮冷便秘。此属实热。人皆知之。或恶寒发热。引衣蜷卧。四肢
逆冷。大便清利。此属真寒。人亦易知。至于烦扰狂越。不欲近衣。欲坐卧泥水中。此属假热之证。其甚者。
烦极发燥。渴饮不绝。舌如芒刺。两唇燥裂。面如涂朱。身如焚燎。足心如烙。吐痰如涌。喘急大便秘结。小
便淋沥。三部脉洪大而无伦。当是时也。却似承气证。承气入口即毙。却似白虎证。白虎下咽即亡。若用二
丸。缓不济事。急以加减八味丸料一斤。内肉桂一两。以水顿煎五六碗。水冷与饮。诸证自退。翌日
必畏寒脉脱。是无火也。当补其阳。急以附子八味丸料。煎服自愈。此证与脉俱变其常。而不以常法治之者
也。若有产后。及大失血后。阴血暴伤。必大发热。亦名阴虚发热。此阴字正谓气血之阴。若以凉药正治
立毙。正所谓象白虎汤证。误服白虎汤必死。当此之时。偏不用四物汤。有形之血。不能速化。几
希之气。所宜急固。须用独参汤。或当归补血汤。使无形生出有形来。此阳生阴长之妙用。不可不知也。或问
曰。子之论则详矣。气虚血虚。均是内伤。何以辨之。予曰。悉乎子之问也。盖阴
虚者。面必赤。无根之火。载于上也。若是阳证。火入于内。面必不赤。其口渴者。肾水干枯。引水自救也。
但口虽渴。而舌必滑。脉虽数而尺必无力。甚者尺虽洪数。而按之必不鼓。此为辩耳。虽然若问其人曾服过凉
药。脉亦有力而鼓指矣。戴复庵云。服凉药而脉反加数者。火郁也。宜升宜补。切忌寒凉。犯之必
死。临证之工。更宜详辨。毫厘之差。柱人性命。慎哉慎哉。
There are several types of fever in the world that resemble Taiyang disease (Taiyang disease, a syndrome caused by pathogenic factors invading the Taiyang channel). Their treatments differ. For Taiyang disease, wind-strike, and cold epidemic, one should use the methods of Zhang Zhongjing. For warm diseases and pestilential diseases, one should use the methods of Liu Wansu. These all discuss exogenous pathogens. Nowadays, people see fever and immediately assume it is Taiyang disease, rashly using diaphoretic medicines to release the exterior. If the fever persists after sweating, they then use exterior-releasing medicines to cool the muscles. Decoctions such as Chaihu Tang (Bupleurum Decoction), Liangge San (Cooling the Chest Powder), Baihu Tang (White Tiger Decoction), and Shuangjie San (Double-Resolving Powder) are mixed and administered simultaneously. If this is a deficiency syndrome, would not such treatment be perilous? Since Li Dongyuan emerged, he proposed theories on internal injury and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). This uses qi-tonifying medicines to supplement insufficient qi. As for those who overwork their minds and indulge in sexual activity, causing internal injury to True Yin, once True Yin is damaged, Yang has no foundation to attach to. Thus, fever also occurs. Such individuals must present with red face, irritability, thirst with desire to drink, bone pain, and a rapid and large pulse, or a rapid but forceless pulse at the Chi position. Only Zhu Danxi elucidated the theory of tonifying Yin, using Siwu Tang (Four Substances Decoction) added with Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). This uses blood-nourishing medicines to supplement insufficient blood. The world follows this precedent, yet repeated use yields no effect. Why? It is because the understanding of "Yin" is inaccurate, mistakenly identifying blood as Yin. It should be understood as the True Yin within the Kidney, which is the Pre-heaven Essence. The *Neijing* states: "For various heat conditions treated with cold remedies that do not resolve, seek the Yin; for various cold conditions treated with hot remedies that do not resolve, seek the Yang." This is called seeking the root affiliation. Master Wang Taipu annotated: "When severe cold prevails and warming does not generate warmth, there is no Fire. When severe heat prevails and cooling does not reduce heat, there is no Water." He further stated: "Sudden alternations of cold and heat, occurring intermittently, indicate no Fire. Manifesting during the day and subsiding at night, or vice versa, occurring seasonally, indicates no Water." One must seek the root affiliation and treat accordingly. For no Fire, one should benefit the source of Fire to dissipate yin shadows; for no Water, one should strengthen the master of Water to suppress excessive yang. One must use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill), adjusting them according to circumstances to tonify True Yin, achieving consistent efficacy. If one adheres rigidly to the bitter-cold nature of Huangbai and Zhimu, it will inevitably damage Spleen Yin and lead to death, a phenomenon too numerous to recount. Generally speaking, fever with thirst, preference for cold drinks, and constipation belongs to Excess Heat, which everyone knows. Aversion to cold with fever, curling up holding clothes, cold limbs, and clear loose stools belong to True Cold, which is also easily recognized. However, restlessness, mania, aversion to clothing, and desire to sit in mud or water belong to False Heat syndromes. In severe cases, extreme irritability and dryness, incessant thirst, tongue like thorns, cracked lips, face painted with cinnabar, body burning like fire, soles of feet scorched, profuse phlegm, urgent panting, severe constipation, scanty dysuria, and boundless surging pulses at all three positions occur. At this time, it resembles Chengqi Tang (Gastrointestinal Purging Decoction) syndrome, but if Chengqi Tang enters the mouth, death ensues instantly. It resembles Baihu Tang syndrome, but if Baihu Tang is swallowed, death follows immediately. If Liuwei or Bawei pills are used, they act too slowly to save the emergency. Urgently, use one jin of Jiabian Bawei Wan formula material, adding one liang of Rougui (Cinnamon Bark), decoct rapidly in water to yield five or six bowls. Cool the liquid and administer it; symptoms will naturally recede. The next day, chills and absent pulse will appear, indicating no Fire. One must tonify Yang urgently with Fuzi Bawei Wan (Aconite Eight-Ingredient Pill) decoction, and recovery will follow spontaneously. This syndrome and pulse deviate from norms and cannot be treated with standard methods. After childbirth or massive blood loss, sudden injury to Yin-blood causes high fever, also named Yin-deficiency fever. Here, "Yin" refers precisely to the Yin of Qi and Blood. Using cold medicines for direct treatment leads to immediate death. This mimics Baihu Tang syndrome; misusing Baihu Tang causes death. At this moment, Siwu Tang must not be used, because substantial blood cannot be generated quickly. The slight Qi should be urgently consolidated. One must use Dushen Tang (Single Ginseng Decoction) or Danggui Buxue Tang (Angelica Tonify Blood Decoction) to allow formless Qi to generate substantial Blood. This is the subtle application of Yang generating Yin, which must not be ignored. Someone asked: Your discussion is detailed. Qi deficiency and Blood deficiency are both internal injuries; how to distinguish them? I said: Your question is thorough. In Yin deficiency, the face must be red due to Rootless Fire floating upward. In Yang syndromes, Fire enters inward, and the face is not red. Those with thirst have dried-up Kidney Water seeking self-rescue through drinking. Although thirsty, the tongue must be slippery; although the pulse is rapid, the Chi pulse must be forceless. In severe cases, even if the Chi pulse is surging and rapid, pressing it reveals no pulsation. This is the distinction. However, if the patient has taken cold medicines, the pulse may become forceful and striking. Dai Fu'an said: If the pulse becomes more rapid after taking cold medicines, it is Fire stagnation. One should lift and tonify, strictly avoiding cold medicines; violating this leads to death. Practitioners must discriminate carefully. A difference of a hair's breadth can cost a life. Be cautious, be cautious.