经云。热至则身热。吐下霍乱。痈疽疮疡。瞀郁注下。 螈肿胀。呕。鼽衄头痛。骨节变。
肉痛。血溢血泄。淋闭之病生矣。病机云。诸风掉眩。皆属于肝。诸寒收引。皆属于肾。诸气 郁。
皆属于肺。诸湿肿满。皆属于脾。诸痛痒疮。皆属于心。（五条分属五脏证。）诸厥固泄。皆属
于下。（谓下焦肝肾之病。）诸痿喘呕。皆属于上。（谓上焦心肺之病。）诸热瞀螈。皆属于火。
（手少阳三焦经。）诸禁鼓栗。如丧神守。皆属于火。（手少阴心经。）诸痉项强。皆属于湿。
（足太阳膀胱经。）诸逆冲上。皆属于火。（手厥阴心胞络经。）诸胀腹大。皆属于热。（足太
阴脾经。）诸躁狂越。皆属于心。（足阳明胃经。）诸暴强直。皆属于风。（足厥阴肝经。）诸
病有声。鼓之如鼓。皆属于热。（手太阴肺经。）诸病 肿。疼酸惊骇。皆属于火。（手阳明大
肠经。）诸转反戾。水液混浊。皆属于热。（手太阳小肠经。）诸病水液。澄澈清冷。皆属于寒。
（足少阴肾经。）诸呕吐酸。暴注下迫。皆属于热。（足少阳胆经。）
按病机十九条。邵元伟分属经脏。前五条各属五脏之病。次二条兼该上下之病。后十二条分
隶十二经证。而河间原病式从未论及。皆偏言盛气实邪。立言若此。虚者何堪。故楼氏指其治法
之偏。诚非过也。观十九条中。除五
脏上下外。其间属火者五。属热者四。其外惟风寒湿三气而已。况五脏中之心脏。岂非亦属火乎。
今以全节类诸热门。使学人比例而观。庶寒热热盛之机。可了然无惑矣。
盛启东云。治热须辨真假。夫真热则发热恶寒。脉数有力。按之更实。烦躁口渴。大便燥。
小便赤涩。或利臭积。发言壮厉。不欲近衣者是也。亲乎表者宜发散。亲乎里者宜通泄。假热亦
发热恶寒。而足必不热。脉大而虚。按之微弱。身虽炽热而不躁不渴。或见虚狂躁渴而不能引饮。
发过顷之即止。终不及声高詈骂者也。经曰。寒热有真假。治法有逆从。此之谓也。
杂病发热。阴虚于下也。经云。阴虚则发热。夫阳在外。为阴之卫。阴在内。为阳之守。精
神外驰。嗜欲无节。阴气耗散。阳无所附。遂致浮散于肌表间而发热也。实非有热。当作阴虚治。
而用补养之法可也。
丹溪论昼夜发热。昼重夜轻。口中无味为阳虚。午后发热。夜半则止。口中知味为阴虚。阳
全阴半。阳得以兼阴。阴不得以兼阳也。至于或昼或夜。或作或止。不时而发者。此脾胃气血俱
虚。火气不宁之证。不可拘于昼夜之候也。阳虚责在胃。阴虚责在肾。盖饥饱伤胃。劳役则兼伤
脾。阳气虚矣。房劳伤肾。竭力则伤肝。阴血亏矣。
肾虚火不归源。游行于外而发热者。烦渴引饮。面目俱赤。遍舌生刺。两唇黑裂。喉间如烟
火上冲。两足心似烙。痰涎壅盛。喘急气促。脉洪大而数疾无伦。按之微弱者是也。法当导火归
源。误用寒凉必殆。即或知其本虚而用补益。不辨阴虚阳虚。漫投参、术。则阳愈盛。而阴愈虚。
壮热转增。八味、桂、附之属愈不敢施。不得已用知、枯、芩、连折之。必至燥渴咽痛腹痛泄泻而死。
凡暴热不止。脉滑数。或洪盛。皆为实热。宜随表里孰轻孰重而清理之。或脉虽沉而按之实坚者。
为里实。必用苦寒下夺之。若热久不止。脉来虚数无力。服调补药不应。饮食无味。或至夜烦渴。
或反加干咳者。此必阴血受伤。当以血药调补其阴。则阳热自化。阴阳虚盛之机。不可不审而急
为转关也。
〔诊〕脉数为热。浮数表热。沉数里热。无力虚热。有力实热。滑数心下结热。缓而滑为热中。
牢为脾胃盛热。若发热而脉反沉细。或数疾无力者。病脉相反也死。病热有火者生。心脉洪是也。
浮而涩。涩而身有热者死。热而脉静者难治。脉盛汗出不解者死。脉虚热不止者死。脉弱四肢厥。
不欲见人。食不入。利下不止者死。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When heat is excessive, the body becomes hot, accompanied by vomiting, diarrhea, and cholera; carbuncles, sores, and ulcers; mental confusion and depression with persistent diarrhea; convulsions and swelling; vomiting; nasal congestion, rhinorrhea, or epistaxis; headache; deformation of bone joints; muscle pain; hematemesis, hematochezia, or other forms of bleeding. These diseases arise from these conditions.
The pathogenesis principles in the *Suwen* (Basic Questions) state: All wind diseases characterized by tremors and dizziness belong to the Liver. All cold syndromes characterized by contraction and pulling belong to the Kidney. All qi stagnation belongs to the Lung. All dampness syndromes characterized by swelling and fullness belong to the Spleen. All pain, itching, and sores belong to the Heart. (These five items correspond respectively to the syndromes of the Five Zang organs.) All jue (rebellious qi) and constipation or incontinence belong to the Lower Jiao (referring to diseases of the Liver and Kidney in the Lower Jiao). All flaccidity, asthma, and vomiting belong to the Upper Jiao (referring to diseases of the Heart and Lung in the Upper Jiao). All heat syndromes characterized by mental confusion and convulsions belong to Fire (Hand-Shaoyang Sanjiao Meridian). All cases of locked jaw, shivering, and trembling, as if losing spiritual control, belong to Fire (Hand-Shaoyin Heart Meridian). All spasm and neck stiffness belong to Dampness (Foot-Taiyang Bladder Meridian). All rebellious qi rushing upward belong to Fire (Hand-Jueyin Pericardium Meridian). All abdominal distension and enlargement belong to Heat (Foot-Taiyin Spleen Meridian). All restlessness, mania, and deviation from normal behavior belong to the Heart (Foot-Yangming Stomach Meridian). All sudden rigidity and straightening belong to Wind (Foot-Jueyin Liver Meridian). All diseases accompanied by sounds, where percussion of the abdomen produces a drum-like sound, belong to Heat (Hand-Taiyin Lung Meridian). All diseases characterized by edema, soreness, pain, and fright belong to Fire (Hand-Yangming Large Intestine Meridian). All cases of tendon conversion, opisthotonos, and twisting, with turbid excreta, belong to Heat (Hand-Taiyang Small Intestine Meridian). All water-fluid excretions that are clear and cold belong to Cold (Foot-Shaoyin Kidney Meridian). All vomiting of sour fluid, sudden violent diarrhea with tenesmus, belong to Heat (Foot-Shaoyang Gallbladder Meridian).
Regarding the Nineteen Pathogenic Mechanisms, Shao Yuanwei classified them into meridians and zang-fu organs. The first five items each belong to the diseases of the Five Zang organs; the next two items cover both upper and lower diseases; the remaining twelve items are classified according to the syndromes of the Twelve Meridians. However, Liu Hejian in his *Yuanbing Shi* (Treatise on Original Causes of Diseases) never discussed these classifications, focusing solely on excess qi and real pathogens. With such assertions, how can patients with deficiency syndromes endure? Therefore, Lou's criticism of the bias in treatment methods is indeed justified. Observing the nineteen mechanisms, excluding the Five Zang and upper/lower categories, there are five belonging to Fire and four to Heat. The remainder involve only Wind, Cold, and Dampness. Moreover, does not the Heart among the Five Zang also belong to Fire? Now, classifying the entire section under "Heat" allows students to observe by analogy, so that the mechanisms of Cold, Heat, and Excessive Heat can be clearly understood without confusion.
Sheng Qidong stated: In treating heat, one must distinguish between true and false. True heat presents with fever and aversion to cold, a rapid and forceful pulse that feels even more solid upon pressure, irritability, thirst, dry stool, dark and scanty urine, or passage of foul-smelling accumulation, loud and aggressive speech, and a dislike for clothing. If the pathogen is close to the exterior, dispersing methods should be used; if close to the interior, purging methods should be used. False heat also presents with fever and aversion to cold, but the feet are necessarily cold. The pulse is large but empty, feeling weak upon pressure. Although the body feels intensely hot, there is no irritability or thirst, or there may be apparent manic irritability and thirst but an inability to drink. Attacks stop after a short while, and there is never high-pitched cursing. As the classic says: "Cold and heat have true and false aspects; treatment methods have contrary and conforming approaches." This refers to this principle.
Fever in miscellaneous diseases is due to yin deficiency in the lower jiao. The classic states: "Yin deficiency leads to fever." Yang is on the outside, guarding Yin; Yin is inside, guarding Yang. If spirit wanders outward and desires are uncontrolled, yin qi is consumed, leaving yang without attachment. Consequently, it floats and scatters between the muscles and skin, causing fever. This is not truly heat; it should be treated as yin deficiency using nourishing methods.
Zhu Danxi discussed fevers varying by day and night: Fever heavier during the day and lighter at night, with a tasteless mouth, indicates yang deficiency. Fever starting in the afternoon and stopping at midnight, with a normal sense of taste, indicates yin deficiency. Yang is whole, yin is half; yang can combine with yin, but yin cannot combine with yang. Fevers that occur at random times, sometimes day, sometimes night, or intermittent, indicate deficiency of both qi and blood in the Spleen and Stomach, with unsettled fire. This cannot be confined to day/night patterns. Yang deficiency is blamed on the Stomach; yin deficiency is blamed on the Kidney. Generally, irregular eating damages the Stomach; overwork damages the Spleen, leading to yang deficiency. Sexual exhaustion damages the Kidney; overexertion damages the Liver, leading to yin-blood deficiency.
When Kidney deficiency causes fire to fail to return to its source, wandering outward and causing fever, symptoms include irritability and thirst with desire to drink, redness of face and eyes, prickling sensation on the entire tongue, black cracked lips, sensation of smoke/fire rising in the throat, burning sensation in the soles of the feet, copious phlegm-saliva,急促 breathing, and a pulse that is surging, rapid, and extremely fast but feels weak upon deep pressure. The treatment method should guide the fire back to its source. Misusing cold-cooling herbs will surely lead to danger. Even if one knows it is root deficiency and uses tonics, failing to distinguish between yin and yang deficiency and blindly administering Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) will make yang more abundant and yin more deficient, increasing intense heat. Formulas like Bawei Wan (Eight-Ingredient Pill), Cinnamon Twig (Guizhi), and Aconite Root (Fuzi) become不敢施 (dare not be used). Forced to use Anemarrhenae Rhizoma (Zhimu), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian) to suppress heat, the patient will inevitably die from dryness, thirst, sore throat, abdominal pain, and diarrhea.
Sudden continuous fever with a slippery-rapid or surging pulse indicates real heat. Treatment should clear and regulate based on whether the exterior or interior is more affected. If the pulse is sunken but firm upon pressure, it indicates interior excess, requiring bitter-cold purgative methods. If fever persists for a long time with a deficient-rapid and weak pulse, and tonic medicines are ineffective, with loss of appetite, nighttime irritability/thirst, or worsening dry cough, this indicates injury to yin-blood. One should tonify yin with blood-nourishing herbs, and the yang-heat will transform naturally. The mechanism of yin-yang deficiency and excess must be carefully examined and urgently adjusted.
[Diagnosis] A rapid pulse indicates heat. Floating-rapid indicates exterior heat; sunken-rapid indicates interior heat; weak indicates deficiency heat; forceful indicates excess heat. Slippery-rapid indicates heat knotting below the heart; slow and slippery indicates heat in the middle jiao; deep-firm pulse indicates excessive heat in the Spleen and Stomach. If fever occurs but the pulse is instead sunken-thin, or rapid-weak, this is a contradiction between disease and pulse, indicating death. Disease with heat and fire signs indicates survival (e.g., surging Heart pulse). Floating and choppy pulse with choppy quality and fever indicates death. Heat with a quiet pulse is difficult to treat. Surging pulse with sweating that does not resolve the condition indicates death. Deficient pulse with persistent heat indicates death. Weak pulse with cold limbs, aversion to people, inability to eat, and persistent diarrhea indicates death.