痼冷积热，本是病因，不必有一病，然亦不必无一病。是以《巢源》有冷热病诸候，而《千金》创立此一门，
遂为后学所取则。唯丹溪于《局方》颇有辨诘，其说陂而难通，今所不从。若火病则创见运气篇，而金元诸家务
表章之，然是古经所不言，要不过亢阳煽摇之谓，故略拈其说而已。
脉候 沉细滑疾者热，迟紧为寒（又云洪数滑疾为热，涩迟沉细为寒）。脉盛滑紧者，病在外热；脉
小实而紧者，病在内冷。脉浮滑，其人外热，风走刺，有饮，难治。脉沉而紧，上焦有热，下寒得冷即便下∶
脉沉而细，下焦有寒，小便数，时苦绞痛，下利重。脉浮紧且滑直者，外热内冷，不得大小便。脉洪大紧急，病
速进在外，苦头发热痈肿；脉细小紧急，病速进在中，寒为疝瘕积聚，腹中刺痛。（《脉经》）（《巢源》有说，见后。）
脉大，寒热在中。迟而缓者，有寒。微而紧者，有寒。沉而迟，腹脏有冷病。微弱者，有寒，少气。实紧，
胃中有寒，苦不能食，时时利者，难治（一作时时呕，稽留难治）。滑数，心下结，热盛。滑疾，胃中有热。
（同上）
诊其脉候数在上，则阳中之阳也；数在下，则阴中之阳也。迟在上，则阳中之阴也；迟在下，则阴中之阴也。
数在中，则中热；迟在中，则中寒。（《中藏》）
源候总说 夫以脏腑禀赋不同，亦有将理失宜，遂致偏冷偏热，故方论中有痼冷积热之说。痼冷者，中
寒也，多因真气既微，胃气不实，复啖生冷冰雪之属，致肠胃虚寒，阴既停凝，阳不能正，大便洞泄，小便频并，
鼻多清涕，呕吐涎沫，水谷不化，洒洒淅淅，皆阳虚阴盛之所为也。积热者，脏腑燥也，多因精血既衰，三焦烦
壅，复饵丹石酒炙之属，致肠胃蕴毒，阳既炽盛，阴不能制，大便秘涩，小便赤淋，口苦咽干，涎稠眵泪，饮食
无度，辉辉 ，皆阴虚阳盛之所为也。治各有方。（《三因》）
一阴一阳之谓道，偏阴偏阳之谓疾。夫一人身，不外乎阴阳气血，相与流通焉耳。如阴阳得其平，则疾不生，
阴阳偏胜，则为痼冷积热之患也。所谓痼冷者，阴毒沉痼而不解也。积热者，阳毒蕴积而不散也。故阴偏胜则偏
而为痼冷，阳偏胜则偏而为积热。古贤云∶偏胜则有偏害，偏害则致偏绝，不可不察也。（《济生》）
积热者，热毒蕴积于其内也。夫人固有体气素实，一时感触热毒之气，故郁积脏腑之间，或在心肺之内，令
人口苦咽干，涎唾稠粘，眼涩多泪，口舌生疮，大小便秘结。又有阴
盛血衰，三焦已燥，服饵酒炙之物，并丹石之药，愈助其热，结滞于内，亦能令人变生诸证。治之须详其脉证，
若在心膈者清之，结于脏腑者荡涤之，更量人气体虚实轻重用药。（《大成》）
夫痼冷者，痼为年久长固者也，冷为寒极至甚者也。沉寒痼冷之证，乃真阳耗散，脾胃虚弱，失于调理，以
致胃寒，食啖冷物粘腻难化生硬之类，经年累月，久积而成痼冷，脾肾渐被其伤，因而渍积脏腑，以成痼疾矣。
但有寒冷等辈触犯，速然而作，以致手足厥逆，畏冷憎寒，饮食不化，或呕吐涎沫，或大便洞泄，米谷不消，或
小便频数，或肚腹绞痛，或逢寒咳嗽，或癫疝大作，是其证也。（《奇效》）
病由邪气 夫患热者，皆由血气有虚实，邪在脾胃，阳气有余，阴气不足，则风邪不得宣散，因而生热，
热搏于腑脏，故为病热也。诊其脉，关上浮而数，胃中有热。滑而疾者，亦为有热。弱者无胃气，是为虚热。
跗阳脉数者，胃中有热，热则消谷引食。跗阳脉粗而浮者，其病难治。若病者苦发热身体疼痛，此为表有病，其脉
自当浮；今脉反沉而迟，故知难瘥，其人不即得愈，必当死，以其病与脉相反故也。（《病源论》）
夫虚邪在于内，与卫气相搏，阴胜者则为寒。真气去，去则虚，虚则内生寒。视其五官色白，为有寒。诊其
脉，迟则为寒，紧则为寒，涩迟为寒，微者为寒，迟而缓为寒，微而紧为寒，寸口虚为寒。（同上）
客热三焦之别（火亢之由）客热者，由人腑脏不调，生于虚热。客于上焦，则胸膈生痰实，口苦舌干。
客于中焦，则烦心闷满，不能下食。客于下焦，则大便难，小便赤涩。（《病源论》）
大凡人之生长乎两间，莫不恃气血以维持其性命，所以气不能离血，血不能离气。使气能平缓清肃，一如
常度，自然营卫调顺，血脉流通，津精充溢，所谓气血相从，阴阳相和，何火之有。倘使七情抑郁，五志感触，
六淫外侵，以致营卫不调，气血变乱，阴阳舛错，即我之真元，变而为烁石消金之烈焰，津精血液从此而枯，
枯则虚火愈甚，轻为舌破口糜，齿疼目痛，二便秘结，淋浊不清，吞酸呕吐，头风斑疹等恙；重当呕血便血，
痰壅气逆，痨热喘嗽，癃痹失音诸病；甚至热极生风，风痰内结，必成痰厥暴中，瘫痪卒死，种种急证者矣。
谁谓火之患小，而可不预为之地哉。（《百问》）
上热下冷（治验）冷热不调候。夫人荣卫不调，致令阴阳痞塞，阳并于上则上热，阴并于下则下冷。上
焦有热，或喉口生疮，胸膈烦满；下焦有冷，则腹胀肠鸣，绞痛泄痢。（《病源论》）
中书右丞姚公茂，六旬有七，宿有时毒。至元戊辰春，因酒再发，头面赤肿而痛，耳前后肿尤甚，胸中烦
闷，咽嗌不利，身半以下皆寒，足胫尤甚。由是以床相接连炕，身半以上卧于床，身半以下卧于炕，饮食减少，
精神困倦而体弱，命予治之。诊得脉浮缓，按之弦细，上热下寒明矣。《内经》云热胜则肿，又曰春气者病在头，
难经云蓄则肿热，砭射之也，盖取其易散故也。遂于肿上约五十余刺，其血紫黑，如露珠之状，顷时肿痛消散。
又于气海中，大艾炷灸百壮，乃助下焦阳虚，退其阴寒。次于三里二穴，各灸三七壮，治足 冷，亦引导热气
下行故也。遂处一方，名曰既济解毒汤，以热者寒之。投剂之后，肿消痛减，大便利，再服减大黄，慎言语，
节饮食，不旬日良愈。（《宝鉴》）
（按∶既济解毒汤用大黄、芩、连、甘、桔、柴、升、翘、归。又有虚中有热治验，旨趣相近，均不录出。）
又有一证，喉闭面肿，至于腹中，泄泻作痛。脉浮而数，按之沉细，上热下寒，此证明矣。腹痛宜温，喉闭
为忌；喉闭宜寒，腹痛反是。医之到此，莫知为计，当以热药，待冷服之。又或寒药，热含吐之，寒热因用，
古法如斯。（《医读》）（宜参《伤寒》厥阴病及妇人）
阴中伏阳 又有一证，烦满呕恶，指末皆寒，头痛时作。六脉不见，深按紧弱，阴中伏阳，难用常药。
或以热攻，为阴隔绝，不能至阳，反生客热。或以寒治，亦为疏略，所伏真火，愈见消铄。宜用破阴，导达真火，
火升水降，得汗乃可。（《医读》）
死生诀 病热人，四肢厥脉弱，不欲见人，食不入，利下不止者死，食入四肢温，脉大语狂，无睡者
生。病寒人，狂言不寐，身冷脉数，喘息目直者死；脉有力而不喘者生。（《中藏》）
治当求其属 人之所借以生者，气也。气者何？阴阳是也。夫阴与阳可以和而平，可以乖而否，善摄
与否，吉凶于是乎歧之。夫惟摄之不能以皆善也，故偏寒偏热之病，始莫逃于乖否之余矣。虽然，寒也热也，苟
未至于甚，粗工为之而不难；设热积而寒沉，良工犹弗能以为计，况其下乎。奈之何俗尚 蒙，恪持方药，愈
投愈盛，迷不之反。岂知端本澄源，中含至理，执其枢要，众妙俱呈。且以积热言之，始而凉和，次而寒取，寒
取不愈，则因热而从之，从之不愈，则技穷矣，由是苦寒频岁而弗停。又以沉寒言之，始而温和，次而热取，热
取不愈，则因寒而从之，从之不愈，则技穷矣，由是辛热比年而弗止。嗟夫！苦寒益深而积热弥炽，
辛热太过而苦寒愈滋，苟非大圣慈仁，明垂枢要，生也孰从而全之。经曰∶寒之而热者取之阴，热之而寒者
取之阳，所谓求其属也。属也者，其枢要之所存乎。斯旨也，王太仆知之。故曰益火之原，以消阴翳；壮水之主，
以制阳光。又曰取心者，不必齐以热；取肾者，不必齐以寒。但益心之阳，寒亦通行；强肾之阴，热之犹可。
吁！混乎千言万语之间，殆犹和璧之在璞也，其宝久湮，岂过焉者石之而弗凿乎，余僭得而推衍之。夫偏寒偏
热之病，其免者固千百之一二，而积热沉寒，亦恐未至于数见也。然而数见者，得非粗工不知求属之道，不能防
微杜渐，遂致滋蔓难图以成之欤。夫寒之而热者，徒知以寒治热，而不知热之不衰者，由乎真水之不足也。热
之而寒者，徒知以热治寒，而不知寒之不衰者，由乎真火之不足也。不知真水火不足， 以寒热药治之，非惟
脏腑习熟，药反见化于其病，而有者弗去，无者弗至矣。故取之阴，所以益肾水之不足，而使其制夫心火之有
余。取之阳，所以益心火之不足，而使其胜夫肾水之有余也。其，指水火也。属，犹主也，谓心肾也。求其属者，
言水火不足而求之于心肾也。火之原者，阳气之根，即心是也。水之主者，阴气之根，即肾是也。非谓火为心
而原为肝，水为肾而主为肺也。寒亦益心，热亦强肾，此太仆达至理于规矩准绳之外，而非迂士曲生之可以 及
矣。彼迂士曲生，不明真水火于寒热之病，有必制必胜之道，但谓药未胜病，久远期之，是以恪守方药，愈投
愈盛，卒至殒灭而莫之悟，呜呼悲夫！余见积热沉寒之治，每蹈于覆辙也，因表而出之以劝。（《溯洄集》）
（宜与《药治通义》第七卷相参。）
痼冷治法 疗治之法，虽贵乎温补，不贵乎太刚，惟于滋血养气中，佐以姜、桂、雄、附为愈。抑
古人所谓精不足
者，补之以味，继此尤当加意焉。若夫执剂刚燥，亟欲阳气顿回，吾恐肾水易涸，心火独炎，识者未保其性。
（《直指》）
治之须暖下元，兼理脾胃。若又有脾虚而畏寒者，令人咳嗽，又当于咳嗽门求之。（《大成》）
积热治法 至于诸热为治，有泛热，有实热。泛热者，荆芥、薄荷、栀子、黄芩等投之，正其所宜。
实热者，非大黄、芒消则不能效。（《得效》）
实火可泻，黄连解毒之类。虚火可补，参、术、生甘草之类。郁火可发，当看何经。小便降火极速。山栀能
降火，从小便泄去，其性能屈曲下行，人所不知。气有余，便是火。气从左边起者，肝火也。气从脐下起者，
阴火也。热从脚下起入腹者，虚之极也，盖火起九泉，此病十不救一，治法以四物汤加降火药服之，以附子末窨
涌泉穴。（《丹溪纂要》）
凡热皆出于心，热甚则能伤血，或以洗心散、四顺清凉饮子之类，此皆前人立议处方。后之学人不可将阴阳
虚盛之热，又有血分气分之热，阴盛格阳之热，一例作积热证治之，反误多矣。（《奇效》）
有下虚之人，口燥烦渴，精神短少，懒于动作，此是虚火上炎。当滋肾水，使虚火得安其位，不可一概作实
热施治。（《原病集》）
三焦气血寒热治方目 上焦热，凉膈散、龙脑鸡苏丸（用柴胡、木通、阿胶、蒲黄、麦冬、参、 、薄
荷、生干地、甘）、洗心散（用术、芍、麻黄、当归、荆芥、大黄、甘草）。
中焦热，调胃承气汤、泻脾散（用藿香、山栀、石膏、
甘草、防风）、贯众散（用黄连、贯众、甘草、骆驼蓬）。
下焦热，大承气汤、三才封髓丹（用天门、熟地、人参、黄柏、砂仁、甘草）、滋肾丸（用肉桂、知母、
黄柏）。
气分热，柴胡饮子（用柴胡、参、芩、归。芍、甘草、大黄）、白虎汤。
血分热，桃仁承气汤、清凉四顺饮子。
通治三焦甚热之气，三黄丸、黄连解毒汤。
上焦寒，铁刷汤（用半夏、草蔻、丁香、干姜、诃子、生姜）、桂附丸（用川乌、黑附、干姜、赤石脂、
川椒、桂）、胡椒理中丸（用胡椒、甘草、款冬、荜茇、良姜、细辛、陈皮、干姜、白术）。
中焦寒，附子理中丸、二气丹、大建中汤（虚劳中方是）。
下焦寒，八味丸、还少丹（系补元大方）、天真丹（用沉香、巴戟、茴香，萆 、胡芦巴、破故纸、杜仲、
琥珀、牵牛、官桂）。
气分寒，桂枝加附子汤、桂枝加芍药生姜人参新加汤。
血分寒，巴戟丸（用术、参、五味、巴戟、茴香、熟地、苁蓉、覆盆、菟丝、牡蛎、益智、骨碎补、龙
骨）、离珠丹（用杜仲、萆 、诃子、龙骨、破故纸、胡桃、巴戟、砂仁、朱砂）。
通治三焦甚寒气，大已寒丸、四逆汤。（《宝鉴》）
冷疾服药法 有人每日早起，须大泻一行，或时腹痛，或不痛，空心服热药，亦无效。后有智者察之，
令于晚食前，更进热药遂安，如此常服，竟无恙。盖暖药虽平旦空腹，至晚药力已过，一夜阴气，何以敌之。
于晚间再进热药，则一夜暖药在腹，遂再以胜阴气，凡治冷疾皆如此。（《医说》
引《医余》）
散寒诸方 （散寒清热方剂，既录出各门及《伤寒》中，故此所举，仅为数方。后《恶寒发热》亦然。）
"Stagnant Cold and Accumulated Heat" are essentially concepts of etiology; they do not refer to a single specific disease, nor can it be said that they do not exist in any disease. Therefore, *Zhu Bing Yuan Hou Lun* (Source Book of Pathogenesis and Symptoms of All Diseases) lists various syndromes of cold and heat diseases, while *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) established a dedicated section on this topic, thereby becoming a model for later scholars. However, Zhu Danxi raised many objections to *Tai Ping Hui Min He Ji Ju Fang* (Formulas of the Bureau of People's Welfare), and his arguments were biased and difficult to reconcile; thus, I do not adopt his views today. As for "Fire Disease," it was first proposed by Li Dongyuan in his *Yun Qi Pian* (Chapter on Six Qi Transformations), and physicians of the Jin-Yuan period enthusiastically promoted it. However, this is not mentioned in ancient classics; it roughly refers to the agitation caused by excessive Yang fire. Therefore, I merely briefly mention this theory.
Pulse Diagnosis: A pulse that is deep, fine, slippery, and rapid indicates Heat; a pulse that is slow and tight indicates Cold (It is also stated that a surging, rapid, slippery, and rapid pulse indicates Heat, while a choppy, slow, deep, and fine pulse indicates Cold). A pulse that is full, slippery, and tight indicates external Heat; a pulse that is small, solid, and tight indicates internal Cold. A floating and slippery pulse, accompanied by external heat, wandering stabbing pain due to wind, and retained fluids in the body, is difficult to treat. A deep and tight pulse indicates Heat in the Upper Jiao and Cold in the Lower Jiao; upon exposure to cold, diarrhea occurs immediately. A deep and fine pulse indicates Cold in the Lower Jiao, frequent urination, occasional severe cramping pain, and heavy diarrhea. A floating, tight, and straight slippery pulse indicates external Heat and internal Cold, with difficulty in passing both urine and stool. A surging, large, and urgent pulse indicates rapidly progressing external disease, suffering from feverish head, carbuncles, and sores; a fine, small, and urgent pulse indicates rapidly progressing internal disease, where Cold causes hernia, mass formations, accumulations, and stabbing abdominal pain. (From *Mai Jing*) (*Zhu Bing Yuan Hou Lun* has relevant discussions, see below.)
A large pulse indicates alternating Cold and Heat within. A slow and moderate pulse indicates Cold. A faint and tight pulse indicates Cold. A deep and slow pulse indicates Cold disease in the abdominal organs. A weak pulse indicates Cold and shortness of breath. A solid and tight pulse indicates Cold in the Stomach, suffering from inability to eat; if there is frequent diarrhea, it is difficult to treat (another version says frequent vomiting, with lingering difficulty). A slippery and rapid pulse indicates knotting below the heart and excess Heat. A slippery and rapid pulse indicates Heat in the Stomach. (Same source)
Diagnosing the pulse: A rapid pulse appearing in the upper position indicates Yang within Yang; a rapid pulse in the lower position indicates Yang within Yin. A slow pulse in the upper position indicates Yin within Yang; a slow pulse in the lower position indicates Yin within Yin. A rapid pulse in the middle position indicates Middle Jiao Heat; a slow pulse in the middle position indicates Middle Jiao Cold. (From *Zhong Zang Jing*)
General Discussion on Source Syndromes: Due to different innate constitutions of the Zang-Fu organs, improper care leads to tendencies toward either Cold or Heat. Thus, theories of "Stagnant Cold" and "Accumulated Heat" appear in medical texts. "Stagnant Cold" refers to Middle Jiao Cold, often caused by weakened True Qi and insufficient Stomach Qi, compounded by consuming raw, cold, or icy foods. This results in deficiency-Cold of the intestines and stomach, where Yin stagnates and Yang cannot function normally, leading to watery diarrhea, frequent urination, clear nasal discharge, vomiting of saliva, undigested food, and shivering—all manifestations of Yang deficiency and Yin excess. "Accumulated Heat" refers to dryness-Heat of the Zang-Fu organs, often caused by depleted essence and blood, and congestion in the San Jiao, compounded by taking cinnabar/mercury pills (Dan Shi) or rich, fried foods. This leads to toxic heat accumulation in the intestines and stomach, where Yang blazes and Yin cannot control it, resulting in constipation, dark scanty urination, bitter taste, dry throat, thick saliva, sticky eye discharge, excessive eating, and mental restlessness—all manifestations of Yin deficiency and Yang excess. Treatments vary according to formulas. (From *San Yin Fang*)
The unity of Yin and Yang is called the Dao; deviation into Yin or Yang is called disease. The human body consists of Yin, Yang, Qi, and Blood flowing together. If Yin and Yang are balanced, disease does not arise; if one prevails excessively, it leads to the afflictions of Stagnant Cold or Accumulated Heat. "Stagnant Cold" is Yin pathogen deeply entrenched and unresolved; "Accumulated Heat" is Yang pathogen accumulated and unscattered. Thus, Yin excess becomes Stagnant Cold, and Yang excess becomes Accumulated Heat. Ancient sages said: Excess leads to harm; harm leads to extremity; this must be carefully observed. (From *Ji Sheng Fang*)
Accumulated Heat is heat-toxin accumulating internally. Some individuals have strong constitutions but are suddenly affected by heat-toxin qi, which stagnates between the Zang-Fu organs, or within the Heart and Lungs, causing bitter taste, dry throat, thick saliva, dry eyes with tearing, mouth ulcers, and constipation of stool and urine. Others may have Yin excess and blood deficiency, with dry San Jiao, who take wine-fried substances and mineral drugs, further aiding Heat, causing internal stagnation and various symptoms. Treatment requires detailed examination of pulse and symptoms: if located in the chest/diaphragm, clear it; if knotted in the Zang-Fu, purge it; dosage must be adjusted based on the patient's Qi and Blood deficiency or excess. (From *Yi Xue Ru Men*)
"Stagnant Cold": "Gu" means long-standing and fixed; "Leng" means extreme Cold. The syndrome of sinking cold and stagnant cold arises from dissipated True Yang and weak Spleen-Stomach, losing proper regulation, leading to Stomach Cold. Consuming cold, sticky, hard-to-digest, or raw foods over years accumulates into Stagnant Cold, gradually injuring the Spleen and Kidneys, permeating the Zang-Fu, and forming chronic illness. Upon exposure to cold pathogens, it attacks suddenly, causing cold limbs, aversion to cold, indigestion, vomiting of saliva, watery diarrhea, frequent urination, abdominal colic, cough triggered by cold, or severe hernia. These are its symptoms. (From *Qi Xiao Liang Fang*)
Disease Caused by Pathogenic Factors: Heat diseases arise from deficiencies or excesses of Qi and Blood. When pathogenic factors reside in the Spleen and Stomach, with excess Yang and deficient Yin, Wind pathogen cannot be dispersed, generating Heat. Heat combats the Zang-Fu, resulting in Heat disease. Pulse diagnosis: Floating and rapid at Guan position indicates Stomach Heat. Slippery and rapid also indicates Heat. Weak pulse indicates lack of Stomach Qi, signifying Deficiency Heat. Rapid Fu Yang pulse indicates Stomach Heat, leading to increased appetite. Rough and floating Fu Yang pulse indicates difficult treatment. If a patient suffers from fever and body ache, indicating exterior disease, the pulse should naturally be floating; if it is instead deep and slow, recovery is unlikely, and death is certain because the disease contradicts the pulse. (From *Bing Yuan Lun*)
Deficient pathogenic factors remaining inside combat with Wei Qi; Yin excess results in Cold. Loss of True Qi leads to deficiency, which generates internal Cold. White color of the five orifices indicates Cold. Pulse diagnosis: Slow indicates Cold, tight indicates Cold, choppy-slow indicates Cold, faint indicates Cold, slow-moderate indicates Cold, faint-tight indicates Cold, empty Cunkou indicates Cold. (Same source)
Guest Heat in the Three Jiaos (Causes of Hyperactive Fire): Guest Heat arises from disharmony of Zang-Fu organs, originating as Deficiency Heat. If lodged in the Upper Jiao, phlegm-solidity forms in the chest/diaphragm, with bitter taste and dry tongue. If lodged in the Middle Jiao, mental restlessness and fullness occur, preventing eating. If lodged in the Lower Jiao, difficult defecation and dark, scanty urination occur. (From *Bing Yuan Lun*)
Generally, human life depends on Qi and Blood. Qi cannot exist without Blood, and Blood without Qi. If Qi is calm and pure, Ying and Wei harmonize, vessels flow smoothly, and fluids abound—this is Qi and Blood following each other, Yin and Yang harmonizing, leaving no room for Fire. However, if Seven Emotions cause depression, Five Wishes trigger disturbances, or Six Evils invade externally, Ying and Wei become disordered, Qi and Blood chaotic, and Yin and Yang reversed. The True Yuan transforms into a flame hot enough to melt stone and metal; fluids and blood dry up. Dryness exacerbates Deficiency Fire, causing mild symptoms like tongue ulcers, gum pain, eye pain, constipation, turbid urination, acid regurgitation, vomiting, headache, and rashes; severe cases involve hematemesis, melena, phlegm obstruction, asthma, loss of voice, or even wind-stroke, paralysis, and sudden death due to extreme heat generating wind. Who would say Fire's harm is small and need not be prevented? (From *Bai Wen*)
Upper Heat and Lower Cold (Treatment Case): Disharmony of Cold and Heat. Disordered Ying and Wei cause blockage of Yin and Yang. Yang merging upward causes Upper Heat; Yin merging downward causes Lower Cold. Upper Heat manifests as mouth/throat ulcers and chest fullness; Lower Cold manifests as abdominal distension, borborygmus, colic, and dysentery. (From *Bing Yuan Lun*)
Yao Gongmao, Right Director of Secretariat, aged 67, had a history of seasonal toxins. In spring of Wuchen year, relapse occurred after drinking. Head and face swelled red and painful, especially around ears. Chest felt stifled, throat uncomfortable. Lower half of body was cold, legs particularly so. He slept with bed connected to kang: upper body on bed, lower body on kang. Appetite decreased, spirit fatigued, body weak. I treated him. Pulse was floating-moderate, string-tight-fine upon pressure. Upper Heat and Lower Cold were evident. *Nei Jing* states heat excess causes swelling; Spring qi diseases affect the head. *Nan Jing* states accumulation causes swelling and heat, treatable by bloodletting (Bian) to disperse easily. I pricked ~50 points on the swelling, releasing purple-black blood like dewdrops; swelling and pain subsided quickly. I moxaated Qihai with large cones, 100 moxibustions, to boost Lower Jiao Yang deficiency and dispel Yin Cold. Then moxaated Zusanli bilaterally, 21 moxibustions each, to treat leg coldness and guide Heat downward. I prescribed Jiji Jiedu Tang (Decoction for Extinction and Detoxification), using "treat Heat with Cold." After administration, swelling reduced, pain lessened, bowel movement normalized. Second dose reduced Rhubarb. Advised speech restraint and diet control. Recovered well within ten days. (From *Wei Sheng Bao Jian*)
(Note: Jiji Jiedu Tang uses Rhubarb, Scutellaria, Coptis, Licorice, Platycodon, Bupleurum, Bupleurum (Sheng Ma), Forsythia, Angelica. Another case of deficiency with Heat has similar principles, omitted here.)
Another case: Throat closure and facial swelling extending to abdomen, with diarrhea and pain. Pulse floating-rapid, pressing string-tight-fine. Upper Heat and Lower Cold are clear. Abdominal pain requires warming; throat closure contraindicates warming. Throat closure requires cooling; abdominal pain contradicts this. Physicians are baffled. Use Hot herbs but administer cold; or use Cold herbs but administer warm. This is "treating Cold with Heat, Heat with Cold," an ancient method. (From *Yi Du*) (Refer to *Shang Han Lun* Jueyin disease and Gynecology.)
Yang Hidden within Yin: Another case: Restlessness, fullness, nausea, cold fingertips, intermittent headache. Six pulses invisible; deep press reveals tight-weak. This is Yang hidden within Yin, difficult to treat with standard herbs. Using Hot herbs is blocked by Yin, failing to reach Yang, generating guest Heat. Using Cold herbs is negligent, melting the hidden True Fire. One must break Yin to guide True Fire; when Fire rises and Water descends, sweating indicates cure. (From *Yi Du*)
Life and Death Decisions: Heat patients with cold limbs, weak pulse, aversion to people, inability to eat, and continuous diarrhea die. Those who eat, have warm limbs, large pulse, delirium, and insomnia survive. Cold patients with delirium, insomnia, cold body, rapid pulse, panting, and fixed gaze die. Those with strong pulse but no panting survive. (From *Zhong Zang Jing*)
Treatment Must Seek the Root: Humans rely on Qi for life. What is Qi? It is Yin and Yang. Yin and Yang can harmonize or conflict. Proper preservation determines fortune or misfortune. Since preservation is imperfect, Cold and Heat diseases arise. Mild cases are easy for mediocre doctors; severe accumulated Heat and sinking Cold challenge even experts. Yet commoners cling to formulas blindly, worsening conditions. They fail to understand seeking the root. Consider Accumulated Heat: start with cooling/harmonizing, then purging Heat. If ineffective, follow the Heat. If still ineffective, skill fails, leading to endless Bitter-Cold herbs. For Sinking Cold: start with warming/mild, then heating. If ineffective, follow the Cold. If still ineffective, skill fails, leading to endless Acrid-Hot herbs. Alas! Bitter-Cold deepens Heat; Acrid-Hot intensifies Cold. Only Great Sages reveal the pivot. Classics say: "If Cold treatment yields Heat, seek Yin; if Heat treatment yields Cold, seek Yang." This is "seeking the root/shu." Wang Tai Pu understood this: "Boost the source of Fire to dissipate Yin shadows; strengthen the master of Water to control Yang brilliance." Also: "Treating Heart need not always use Heat; treating Kidney need not always use Cold." Boosting Heart Yang allows Cold to circulate; strengthening Kidney Yin allows Heat to work. This profound truth is lost in thousands of words. Those pedantic scholars ignore the necessity of controlling True Water/Fire, believing only time will make herbs effective, leading to death. I record this to warn others. (From *Su Hui Ji*)
(Refer to *Yao Zhi Tong Yi*, Vol 7.)
Treatment of Stagnant Cold: Therapy values warming and tonifying, but avoids excessive harshness. Nourish Blood and Qi, assisting with Ginger, Cinnamon, Realgar, and Aconite. As ancients said, for deficiency of Essence, use flavor-rich tonics. Do not rigidly use drying-hot herbs hoping for instant Yang return, lest Kidney Water dry and Heart Fire blaze. (From *Zhi Zhi Fang*)
Treatment must warm the Lower Origin and regulate Spleen-Stomach. If Spleen deficiency causes cold-aversion and cough, refer to Cough section. (From *Yi Xue Ru Men*)
Treatment of Accumulated Heat: Heat treatments distinguish between General Heat and Excess Heat. General Heat responds to Schizonepeta, Mentha, Gardenia, Scutellaria. Excess Heat requires Rhubarb and Mirabilite. (From *De Xiao Fang*)
Excess Fire is purged (e.g., Huanglian Jiedu Tang). Deficiency Fire is tonified (e.g., Ginseng, Atractylodes, Raw Licorice). Stagnant Fire is dispersed (check meridian). Urination rapidly reduces Fire. Gardenia reduces Fire via urination. Excess Qi is Fire. Qi rising from left is Liver Fire; from umbilicus is Yin Fire. Heat rising from feet to abdomen is extreme deficiency ("Fire from Nine Springs"), rarely curable; treat with Siwu Tang plus Fire-reducing herbs, apply Aconite powder to Yongquan point. (From *Dan Xi Zuan Yao*)
All Heat originates from Heart; severe Heat injures Blood. Formulas like Xixin San or Sishun Qingliang Yinzi are used. Do not confuse Yin/Yang deficiency-excess Heat, Qi/Blood Heat, or Yin排斥 Yang Heat with simple Accumulated Heat, or errors will abound. (From *Qi Xiao Liang Fang*)
Lower deficiency with dry mouth, thirst, low spirit, and lethargy indicates Deficiency Fire flaming upward. Tonify Kidney Water to settle Fire; do not treat as Excess Heat. (From *Yuan Bing Ji*)
Formulas for Three Jiaos, Qi/Blood, Cold/Heat:
Upper Jiao Heat: Liangge San, Longnao Jisu Wan... Xixin San...
Middle Jiao Heat: Tiaowei Chengqi Tang, Xiepi San... Guanzhong San...
Lower Jiao Heat: Dachengqi Tang, Santai Fengsui Dan... Zishen Wan...
Qi Level Heat: Chaihu Yinzi, Baihu Tang.
Blood Level Heat: Tao Ren Chengqi Tang, Qingliang Sishun Yinzi.
General Severe Heat of Three Jiaos: Sanhuang Wan, Huanglian Jiedu Tang.
Upper Jiao Cold: Tieshua Tang, Gui Fu Wan... Hujiao Lizhong Wan...
Middle Jiao Cold: Fuzi Lizhong Wan, Erqi Dan, Dajianzhong Tang...
Lower Jiao Cold: Bawei Wan, Huanshao Dan... Tianzhen Dan...
Qi Level Cold: Guizhi Jia Fuzi Tang, Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang.
Blood Level Cold: Bajie Wan, Lizhu Dan...
General Severe Cold of Three Jiaos: Da Yihan Wan, Sini Tang. (From *Wei Sheng Bao Jian*)
Medication Method for Cold Diseases: Someone had morning diarrhea, sometimes abdominal pain. Taking Hot herbs on empty stomach failed. A wise doctor advised taking Hot herbs before evening meal, bringing relief. Continuous use cured him. Warm herbs taken in morning lose potency by night; Yin Qi dominates night. Taking Warm herbs at night keeps warmth in abdomen to counter Yin Qi. This applies to all Cold diseases. (From *Yi Shuo* citing *Yi Yu*)
Various Formulas for Dispelling Cold: (Cold-dispelling and Heat-clearing formulas are listed in respective sections and *Shang Han Lun*; only a few are cited here. Same for "Aversion to Cold and Fever".)