表热者。多因伤风寒之故。喜人怀抱。畏缩恶风寒。不欲露头面。面有惨色。不渴。清
便自调者。此热在表也。宜发散。惺惺散。败毒散。升阳散。火汤。十神汤。选而用之。
里热者。喜露顶面而卧。扬手掷足。揭去衣被。渴饮冷水。儿小不能言。吮乳不休者是
小便赤。大便秘。此热在里也。宜解利之。凉惊丸。三黄丸。四顺清凉饮。凉膈散。钱氏抱
龙丸。牛黄凉膈丸。黄芩汤。选而用之。
有表里俱热者。宜通圣散。柴芩汤。人参白虎汤。选用。
虚热者。多在大病之后。或温热。兼潮热。或渴或不渴。大小便如常。宜调之。竹
叶汤调元汤地骨皮散主之。
实热者。面赤腮燥。鼻干焦。喜就冷。或合面卧。或仰卧。露出手足。掀去衣被。大渴
饮水。大小便秘。宜泻之。神芎丸。大金花丸。大便不通者。用胆导法。
或问治热以寒。治寒以热。良工不能废其绳墨也。今治虚热。乃用温药者。亦有说乎。
。说见内经。实热者。邪火也。可以水制。可以实折。故以寒治热者。逆治法也。虚热者。
真火也。水不能制。寒不能折。唯甘温之剂。可以胜之。故以温治虚热者。从治法也。逆之
从之。不离乎正。
按钱氏书中。有潮热发搐似惊者。附会之说也。盖热则生风。诸热不退。皆能发搐。不特潮
热也。其以十二时分五脏者固是。愚窃有疑焉。人身之气。昼则行阳二十五度。故昼则发热
。夜则明了者。此热在气分。宜小柴胡汤白虎汤主之。夜则行阴二十五度。故夜则发热。昼
则明了者。此热在血分。宜四物合桂枝汤主之。如昼夜发热者。此气血俱虚也。宜如前法。
分表里虚实治之。如日晡潮热。乃胃中有宿食也。宜下之。小承气汤。三黄枳术丸主之。
如伤风发热。伤饮食发热。变蒸疮疹发热。胎热疳热。各随其类治之。
生犀散 治风热。
地骨皮 赤芍药 北柴胡 干姜（各一两） 甘草（半两） 生犀角（二钱） 上为细末。每
服一二钱。水一盏。煎七分温服。
脱甲散 治夹惊伤寒。烦躁口渴。
柴胡 当归 龙胆草 甘草炙 知母（各三钱） 白茯苓（二钱五分） 人参 川芎（各
钱） 麻黄（连根节二钱） 热甚。加升麻葛根。上为细末。每服一钱。入连须葱白煎服。
黄连安神丸 治心热。
朱砂（飞四钱） 黄连（五钱） 甘草（五分） 上为末。饼丸。黍米大。每服一二十丸。灯
草汤下。
木通散 治心肺热。
生地黄 木通 荆芥 地骨皮 桑白皮（炒） 炙甘草 桔梗（各等分） 上锉细。入生姜
水煎服。
地骨皮散 治夜热及潮热虚热。病后余热。
知母 柴胡 甘草（炙） 人参 地骨皮（初采者） 半夏 赤茯苓（各等分） 上为末。量
人大小加减。入生姜水煎。
升阳散火汤 治诸热在表者。宜发散之。乃火郁则发之也。
升麻 葛根 独活 羌活 人参 白芍药（各五分） 防风（二钱五分） 柴胡（八分） 甘
草（炙二分） 甘草（生二分） 上用水煎。
牛黄凉膈丸 治上焦壅热。口干咽痛。燥烦涎潮。
马牙硝 寒水石 石膏（各二两） 甘草（微炙一两） 胆星（三钱） 紫石英（五钱飞） 牛
黄脑子 麝香 上为末。炼蜜丸。每一两分二十四丸。每一丸薄荷汤化下。
神芎丸 治一切诸热。实者服之。虚者禁用。
大黄 黄芩（各二两） 牵牛头末 滑石（各四两） 黄连 薄荷叶 川芎（各半两） 上为
末。水丸。随大小加减。温水下。
黄芩汤 治心肺蕴热。口疮痛。淋浊不利。
泽泄 栀子仁 黄芩 麦门冬 木通 生地黄 甘草 黄连（各等分） 上锉入生姜一片
竹叶汤治虚热。
竹叶 石膏 半夏 麦门冬 人参 甘草（炙） 粳米 上锉。除粳米外。先煎众药成。
去渣入米再煎。米熟去米服。
柴苓汤 小柴胡合五苓散 通圣散 大金花丸 败毒散 凉膈散 河间凉膈散。用硝磺
。东垣凉膈散。去硝磺。加桔梗。 四顺清凉饮十神汤 茵陈五苓散（五苓散加茵陈）
一儿生下。便有目赤口疮之症。自是头常热。山根青筋横截。幼疾甚多。予曰。此胎热
其治在肝。小儿者纯阳之体。头者诸阳之会。肝为乙木旺于春。乃少阳发生之气。经云。春
气者病在头。故头常热也。肝之色青。故青筋浮露也。肝常有余。不治。恐发惊风。乃用泻
青丸去大黄加黄芩为末。炼蜜为丸服之。自此头凉。青筋泯没。亦少病矣。
一儿发热。至日晡尤甚。其医作疟治。不效。又作潮热治。亦不效。予曰。此胃虚有宿
。谓疟疾则寒热有发有止。谓潮热则发有时。如水之潮过即退。次日根据时复发。此儿身常温
热。至申酉时则甚。故知是宿食发热也。彼曰。有所据乎。曰。出仲景伤寒正理论阳明病证
云。潮热者。实也。宜下之。以三化丸下之愈。
一儿惊风后热不退。群医有议用小柴胡者。有欲用竹叶汤者。有欲用凉惊丸者。予曰。
惊之后。脾胃已虚。宜温补之。三药寒凉。不可服也。乃作理中汤用炒干姜。一剂热除。
已未冬十月。本府三守张公子。于初三日发热。初五日热益甚。目上直视。口多妄言。众医
作风治。无效。时代巡在府。所属州县官各举其医。皆莫治。吾县大尹云阁朱公以全荐。张
公亟召之。全往。此二十七日也。诊其外证。禀曰。公子病势将退。但肺热未除耳。公曰。
何如。全曰。三关黄润。两目精明。此病当愈。惟正面载阳。喘气上息。此肺虚热也。公喜
曰。予正忧其气喘。汝谓无妨。当用何药。全曰。小阿胶散。众医嗾而阻之。公不听。竟服
一剂。其夕喘止热退。始求微食。二十八日早。公谓众医曰。汝等作风治误矣。昨听汝等之
言。则无此效。早请汝来。此儿不受苦也。众惭而退。二十九日。赐金驰驿而归。
**Exterior Heat Syndrome.** It is mostly caused by injury from wind-cold. The child likes to be held in someone's arms, shrinks away fearing wind and cold, does not wish to expose the head and face, has a gloomy complexion, feels no thirst, and has normal bowel and bladder functions. This indicates heat located in the exterior. It is suitable to use dispersing methods. Select and use Xingxing San (Xingxing Powder), Baidu San (Baidu Powder), Shengyang Sanhuo Tang (Shengyang Decoction to Disperse Fire), or Shishen Tang (Ten Gods Decoction).
**Interior Heat Syndrome.** The child likes to lie with the top of the head and face exposed, throws hands and feet about, removes clothes and blankets, desires to drink cold water; for infants who cannot speak, continuous sucking on breast milk is observed, along with dark red urine and dry constipation. This indicates heat located in the interior. It is suitable to use clearing and purging methods. Select and use Liangjing Wan (Liangjing Pill), Sanhuang Wan (Three Yellows Pill), Sishun Qingliang Yin (Sishun Cooling Drink), Liange San (Liange Powder), Qian Shi Baolong Wan (Qian's Bao Long Pill), Niuhuang Liange Wan (Calculus Bovis Liange Pill), Huangqin Tang (Scutellaria Decoction).
For cases with **Heat in Both Exterior and Interior**, select Tongsheng San (Tongsheng Powder), Chaiqin Tang (Bupleurum and Scutellaria Decoction), or Renshen Baihu Tang (Ginseng White Tiger Decoction).
**Deficiency Heat Syndrome.** Often occurs after severe illness or during the later stages of warm diseases, accompanied by tidal fever (fever at fixed times), with thirst or no thirst, and normal bowel and bladder functions. It is suitable to regulate and tonify. Treat mainly with Zhuye Tang (Bamboo Leaf Decoction), Tianyuan Tang (Tianyuan Decoction), or Digupi San (Digupi Powder).
**Excess Heat Syndrome.** The face is red and cheeks are dry, the nose is dry and cracked, the child prefers coolness, may sleep face down or supine with limbs exposed, removes clothes and blankets, experiences extreme thirst and desire to drink, and has dry constipation. It is suitable to use purgative methods. Treat with Shenxiong Wan (Shenxiong Pill) or Dajinhua Wan (Great Golden Flower Pill). If there is fecal impaction, use Dan Dao Fa (Gallbladder Enema Method).
A question arises: Treating heat with cold, and treating cold with heat, these are principles that skilled physicians cannot abandon. Now, regarding the treatment of deficiency heat using warm medicines, is there an explanation? This explanation is found in the *Neijing* (Inner Canon). Excess heat is pathogenic fire; it can be controlled by water and subdued by excess-reducing methods. Therefore, treating heat with cold is the "counter-treatment" method (orthodox treatment). Deficiency heat is true fire (deficiency fire); it cannot be controlled by water or subdued by cold. Only sweet-warm formulas can overcome it. Therefore, treating deficiency heat with warm medicine is the "following-treatment" method (paradoxical treatment). Whether counter-treating or following, one does not depart from the correct path.
Note: In Qian Yi's books, the view that tidal fever causing convulsions resembles epilepsy is considered an forced interpretation. Generally, heat generates wind; any persistent heat can cause convulsions, not just tidal fever. While his theory of mapping the twelve double-hours to the five zang organs has merit, I have private doubts. The qi of the human body travels through the yang aspect twenty-five times during the day, so daytime fever with nighttime clarity indicates heat in the qi level; treat with Xiaochaihu Tang (Minor Bupleurum Decoction) or Baihu Tang (White Tiger Decoction). It travels through the yin aspect twenty-five times at night, so nighttime fever with daytime clarity indicates heat in the blood level; treat with Siwu Tang (Four Substances Decoction) combined with Guizhi Tang (Cinnamon Twig Decoction). Fever occurring both day and night indicates deficiency of both qi and blood; treat as previously described, distinguishing between exterior/interior and excess/deficiency. Tidal fever in the late afternoon (Shen and You hours) indicates food retention in the stomach; treat with purgatives. Use Xiao Chengqi Tang (Minor Chengqi Decoction) or Sanhuang Zhi Zhu Wan (Three Yellows and Immature Bitter Orange Pill). For fever due to wind-cold, food stagnation, physiological eruption (bianzheng), exanthems, fetal heat, or malnutrition heat, treat according to their respective categories.
**Shengxi San (Rhino Horn Powder)** treats wind-heat.
Ingredients: Digupi (Cortex Lycii Radicis), Chishaoyao (Radix Paeoniae Rubra), Beichaihu (Radix Bupleuri), Ganjiang (Rhizoma Zingiberis Recens) (each 1 liang), Gancao (Radix Glycyrrhizae) (0.5 liang), Shengxijiao (Cornu Rhinocerotis) (2 qian). Grind into fine powder. Take 1-2 qian per dose, decoct with 1 cup of water until 0.7 cup remains, and take warm.
**Tuojia San (Shell-Shedding Powder)** treats cold damage complicated with fright, characterized by irritability and thirst.
Ingredients: Chaihu (Radix Bupleuri), Danggui (Radix Angelicae Sinensis), Longdancao (Radix et Rhizoma Gentianae), Zhigancao (Radix Glycyrrhizae Preparata), Zhimu (Rhizoma Anemarrhenae) (each 3 qian), Baifuling (Poria) (2.5 qian), Renshen (Radix Ginseng), Chuanxiong (Rhizoma Chuanxiong) (each 1 qian), Mahuang (Herba Ephedrae) (with root nodes, 2 qian). If heat is severe, add Shengma (Rhizoma Cimicifugae) and Gegen (Radix Puerariae). Grind into powder. Take 1 qian per dose, decoct with scallion whites including roots.
**Huanglian Anshen Wan (Coptis Calming Pill)** treats heart heat.
Ingredients: Fei Zhusha (Prepared Cinnabar) (4 qian), Huanglian (Rhizoma Coptidis) (5 qian), Gancao (Radix Glycyrrhizae) (0.5 fen). Grind into powder, make pills with dough paste, size of millet seeds. Take 10-20 pills per dose, wash down with Dengcao Tang (Juncus Decoction).
**Mutong San (Akebia Decoction)** treats heart and lung heat.
Ingredients: Shengdihuang (Radix Rehmanniae Preparata), Mutong (Caulis Akebiae), Jingjie (Fructus Schizonepetae), Digupi (Cortex Lycii Radicis), Sangbaipi (Cortex Mori Radicis, stir-fried), Zhigancao (Radix Glycyrrhizae Preparata), Jiegeng (Radix Platycodi) (equal parts). Cut finely, decoct with ginger water.
**Digupi San (Digupi Powder)** treats night fever, tidal fever, deficiency heat, and residual heat after illness.
Ingredients: Zhimu (Rhizoma Anemarrhenae), Chaihu (Radix Bupleuri), Zhigancao (Radix Glycyrrhizae Preparata), Renshen (Radix Ginseng), Digupi (Cortex Lycii Radicis, freshly harvested), Banxia (Rhizoma Pinelliae), Chifuling (Poria with Red Mycelium) (equal parts). Grind into powder, adjust dosage based on age, decoct with ginger water.
**Shengyang Sanhuo Tang (Shengyang Decoction to Disperse Fire)** treats heat in the exterior, suitable for dispersing. This follows the principle of "dispersing stagnant fire."
Ingredients: Shengma (Rhizoma Cimicifugae), Gegen (Radix Puerariae), Duohuo (Radix Angelicae Pubescentis), Qianghuo (Rhizoma Notopterygii), Renshen (Radix Ginseng), Baishaoyao (Radix Paeoniae Alba) (each 5 fen), Fangfeng (Radix Saposhnikoviae) (2.5 qian), Chaihu (Radix Bupleuri) (8 fen), Zhigancao (Radix Glycyrrhizae Preparata) (2 fen), Shenggancao (Radix Glycyrrhizae) (2 fen). Decoct with water.
**Niuhuang Liange Wan (Calculus Bovis Liange Pill)** treats upper jiao congestion and heat, dry mouth, sore throat, restlessness, and excessive saliva.
Ingredients: Mayaxiao (Natrii Sulfas), Hanshuishi (Halloysitum Rubrum), Shigao (Gypsum Fibrosum) (each 2 liang), lightly roasted Gancao (Radix Glycyrrhizae) (1 liang), Danning (Felix Carbonatus) (3 qian), Fei Zhiyingshi (Fluorite) (5 qian), Niuhuang (Calculus Bovis), Naonao (Camphora), Shexiang (Moschus). Grind into powder, make pills with refined honey. Divide each liang into 24 pills. Dissolve one pill in mint water before taking.
**Shenxiong Wan (Shenxiong Pill)** treats all kinds of heat; for excess patterns, contraindicated for deficiency patterns.
Ingredients: Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae) (each 2 liang), Qianniu Toumo (Semen Pharbitidis, head powder), Huashi (Talcum) (each 4 liang), Huanglian (Rhizoma Coptidis), Boheye (Folium Menthae), Chuanxiong (Rhizoma Chuanxiong) (each 0.5 liang). Grind into powder, make water pills. Adjust dosage by age, take with warm water.
**Huangqin Tang (Scutellaria Decoction)** treats heat accumulation in heart and lungs, mouth ulcers, painful dysuria, and turbid urine.
Ingredients: Zexie (Rhizoma Alismatis), Zhizi Ren (Semen Gardenoliae), Huangqin (Radix Scutellariae), Maimendong (Radix Ophiopogonis), Mutong (Caulis Akebiae), Shengdihuang (Radix Rehmanniae Preparata), Gancao (Radix Glycyrrhizae), Huanglian (Rhizoma Coptidis) (equal parts). Cut finely, decoct with one slice of ginger.
**Zhuye Tang (Bamboo Leaf Decoction)** treats deficiency heat.
Ingredients: Zhuye (Folium Bambusae), Shigao (Gypsum Fibrosum), Banxia (Rhizoma Pinelliae), Maimendong (Radix Ophiopogonis), Renshen (Radix Ginseng), Zhigancao (Radix Glycyrrhizae Preparata), Jingsmi (Oryza Sativa). Cut finely. Except for rice, decoct the other herbs first. Strain, add rice, and decoct again until rice is cooked. Remove rice residue and take.
Chailing Tang is a combination of Xiaochaihu Tang and Wuling San. Tongsheng San. Dajinhua Wan. Baidu San. Liange San. Hejian Liange San uses Xiaoshi (Mangxiao) and Huangqi (Dahuang). Dongyuan Liange San removes Xiaoshi and Dahuang, adds Jiegeng. Sishun Qingliang Yin. Shishen Tang. Yichen Wuling San (Wuling San plus Yichen).
An infant was born with red eyes and mouth ulcers. Since then, the head has been constantly hot, with blue veins crossing horizontally at the shangen (root of the nose). Many childhood illnesses occurred. I said: This is fetal heat. The treatment focuses on the Liver. Children are pure yang bodies; the head is the meeting place of all yang meridians. The Liver belongs to Wood (Yi), flourishing in Spring, representing the rising qi of Shaoyang. The classics state: "In Spring, diseases affect the head." Hence, constant head heat. The color of the Liver is green, hence the protruding blue veins. Liver qi is often in excess; if untreated, it may develop into convulsive disorders. Thus, I used Xieqing Wan (Draining Green Pill) removing Dahuang and adding Huangqin, ground into powder, made into pills with honey. From then on, the head cooled, the blue veins disappeared, and the child fell ill less often.
One child had fever, worsening significantly in the late afternoon. Physicians treated it as malaria without effect. Then treated as tidal fever, also without effect. I said: This is stomach deficiency with food retention. Malaria has alternating chills and fever with intervals; tidal fever has fixed timing, like the tide receding and returning at the same time the next day. This child is usually normal temperature but worsens at Shen and You hours (3-7 PM). Thus, it is food retention fever. Asked for evidence, I replied: Zhang Zhongjing's *Shanghan Lun* states regarding Yangming disease: "Tidal fever indicates excess." It should be treated with purgatives. It was cured using Sanhua Wan (Sanhua Pill).
After a child suffered from convulsive disorder, the fever did not subside. Some doctors suggested Xiaochaihu Tang, others Zhuye Tang, others Liangjing Wan. I said: After convulsions, the Spleen and Stomach are already deficient; warm tonification is suitable. These three medicines are cold and cooling, and should not be taken. Instead, Lizhong Tang (Regulate the Middle Decoction) was used with fried Ganjiang (Dried Ginger). One dose cleared the fever.
In the tenth month of winter in the Jiwei year, the son of Governor Zhang of our prefecture developed fever on the third day, intensifying by the fifth day, with upward staring of the eyes and delirious speech. Doctors treated it as wind-related issues without success. At that time, the Provincial Inspector was in the prefecture, and officials from subordinate counties recommended various doctors, none of whom could cure him. Zhu Gong, the County Magistrate of Yun Ge, recommended me. Governor Zhang urgently summoned me. I visited on the twenty-seventh day. Examining the external signs, I reported: The prince's condition is about to improve, only lung heat remains. He asked: How so? I said: The three-barrier pulse is yellow and moist, the eyes are bright and clear. The illness should resolve. However, the frontal face shows redness, and there is panting breath. This is deficiency heat in the lungs. The governor rejoiced: I was worried about his panting. You say it is not serious. What medicine should be used? I said: Xiao Ejiao San (Minor Donkey-Hide Gelatin Powder). Other doctors instigated opposition, but the governor did not listen and administered one dose. That evening, the panting stopped and fever subsided, and he began to seek food. On the morning of the twenty-eighth day, the governor told the other doctors: You were wrong to treat it as wind disease. Listening to you yesterday yielded no such effect. Inviting me earlier spared the child suffering. The doctors withdrew in shame. On the twenty-ninth day, he bestowed gold, and I returned via postal relay.