东垣云。仲景论内外不足。发热自汗之证。大禁发汗。若饮食劳倦。杂病发热。自汗表虚之
证。认作有余。误用表药发之。汗大出而表益虚也。身尽热。先太阳也。从外而之内者为外伤。
手足不和。两胁俱热如火。先少阳也。从内而之外者为内伤。伤食令人头痛。脉数发热。但左手
脉平和。身不疼痛是也。人迎气口俱紧盛。或举按皆实大。发热而恶寒。腹不和而口液。此内外
俱伤也。夏月火乘土位。湿热相合。病多烦躁闷乱。四肢发热。或身体沉重。走注疼痛。皆湿热
相搏。郁而不伸。故致热也。发热身疼。而身如熏黄者。湿热也。一身尽痛发热。日晡所剧者。
风湿也。汗出而身热者。风热也。身热脉弦数。战栗而不恶寒者。瘅疟也。中脘有痰。令人憎寒
发热。恶风自汗。寸口脉浮。胸膈痞满。有类伤寒。但头不疼。项不强为异。虚烦与伤寒相似。
身热脉不浮紧。不恶寒。但热而烦。头不痛。香港脚为病。大便坚。脚膝两胫肿痛。或枯细者。当
其发时。亦发热憎寒呕恶。有似伤寒也。春夏之交。发热而渴。或微恶寒。右手脉来数盛者。温
病也。身热头疼。自汗多眠。阳脉浮滑。阴脉濡弱者。风温也。夏月大热而渴。脉盛躁者。热
病也。夏月脉虚。身热而喘乏者。伤暑也。四肢发热。口舌咽干。烦躁闷乱者。心与小肠之火。
乘脾土之位。脾主四
肢。为诸阳之本。脾热故四肢发热。每日晡时憎寒壮热。脉数盛而有痛处者。痈毒之将发也。
李士材治夏彝仲太夫人。年届八十。因彝仲远仕闽中。忧思成疾。忽发热头疼。医以伤寒发散
禁食。一剂而汗如浴。喘促神昏。其脉大无力。即令进食。而投参、 、白术、橘红、甘草、煨
姜。一剂而喘汗差减。倍用参、术至一两。证愈七八。惟食未强。此火衰不能生土。加熟附、干
姜。服二月而痊。
Li Dongyuan stated that Zhang Zhongjing discussed the conditions of internal deficiency and external insufficiency. For symptoms such as fever and spontaneous sweating, diaphoresis (sweating-inducing therapy) is strictly prohibited. If a miscellaneous disease causes fever and spontaneous sweating due to improper diet or overexertion, presenting as a superficial deficiency syndrome, mistaking it for an excess condition and erroneously using exterior-releasing drugs to induce sweating will result in profuse sweating, thereby further weakening the exterior Qi.
Generalized heat, starting first from the head, indicates a Taiyang (Greater Yang) meridian pathology. Heat entering from the outside to the inside constitutes an external injury (exogenous pathogen). Disharmony of the hands and feet, with intense heat in both hypochondriac regions like fire, indicates a Shaoyang (Lesser Yang) meridian pathology. Heat arising from the inside and radiating outward constitutes an internal injury.
Food stagnation causes headache, rapid pulse, and fever, but the left-hand pulse remains peaceful, and there is no body pain; this characterizes food stagnation. When both the Renying (ST9) and Qikou (LU9) pulses are tight and vigorous, or feel solid and large upon both lifting and pressing, accompanied by fever, aversion to cold, abdominal discomfort, and drooling, it indicates simultaneous external and internal injury.
In summer, Fire Qi invades the Earth position (Spleen/Stomach), where dampness and heat combine. Symptoms often include irritability, restlessness, heat in the four limbs, heavy body, or migrating pain. These arise from damp-heat clashing and stagnating without being able to extend, thus causing fever.
Fever with body ache, and a body color resembling smoke-stained yellow, indicates damp-heat. Generalized body pain with fever, worsening during the Shen-You hours (3 PM - 7 PM), indicates wind-dampness. Body heat persisting after sweating indicates wind-heat. Fever with a wiry and rapid pulse, tremors/chills without aversion to cold, indicates Dan-Nue (Malaria with high fever).
Phlegm retention in the Zhongwan (CV12) region causes aversion to cold, fever, aversion to wind, spontaneous sweating, floating pulse at the Cunkou (radial artery), and chest/epigastric fullness. These resemble Shanghan (Cold Damage), distinguished by the absence of headache and neck stiffness. Xu-Fan (Deficiency Irritability) resembles Shanghan: body heat without a floating-tight pulse, no aversion to cold, only heat and irritability, and no headache.
Hongxiangjiao (Jiaogong/Feet Coldness/Gout-like condition) presents with hard stool, swelling and pain in the feet, knees, and shins, or emaciation of these areas. During attacks, it also manifests with fever, aversion to cold, vomiting, and nausea, resembling Shanghan.
At the transition between spring and summer, fever with thirst, or slight aversion to cold, with a rapid and vigorous right-hand pulse, indicates Wenbing (Warm Disease). Body heat, headache, spontaneous sweating, and excessive sleepiness, with a floating-slippery Yang pulse and a soggy-weak Yin pulse, indicate Fengwen (Wind-Warmth). In summer, extreme heat with thirst and a盛大-vigorous/restless pulse indicates Rebing (Heat Disease). A weak pulse with fever and panting/laborious breathing in summer indicates Shanggong (Summerheat Injury).
Heat in the four limbs, dry mouth/tongue/throat, and irritability/restlessness indicate Fire of the Heart and Small Intestine invading the Spleen Earth position. Since the Spleen governs the four limbs and is the root of all Yang meridians, Spleen heat causes heat in the four limbs. Daily aversion to cold and severe fever during the Shen-You hours, with a rapid-vigorous pulse and fixed pain, indicates the impending eruption of Yongdu (Carbuncle/Pus-toxin).
Case Study: Li Shicai treated the elderly lady of Xia Yizhong. Approaching eighty years old, she fell ill due to worry and thinking caused by her son Xia Yizhong serving far away in Fujian. She suddenly developed fever and headache. Physicians treated it as Shanghan with dispersing methods and forbade food intake. After one dose, she sweated profusely like a bath, followed by panting and coma. Her pulse was large but powerless. Li immediately ordered her to eat and prescribed Renshen (Ginseng Radix et Rhizoma), [missing herb in text, context implies spleen-tonifying], Baizhu (Atractylodis Macrocephalae Rhizoma), Juhong (Citri Reticulatae Pericarpium Rubrum), Gancao (Glycyrrhizae Radix et Rhizoma), and Wei Jiang (Zingiberis Rhizoma Preparatum). After one dose, panting and sweating decreased. Doubling the dosage of Renshen and Baizhu to one liang, her condition improved by seventy to eighty percent, though appetite remained poor. This indicated Mingmen Fire deficiency failing to generate Earth (Spleen). He added Shu Fuzi (Aconiti Lateralis Radix Praeparata) and Ganjiang (Zingiberis Rhizoma). After two months of medication, she recovered completely.