东垣曰昼则发热夜则安静是阳气自旺于阳分也昼则安静夜则发热烦躁是阳气下陷入阴中
也名曰热入血室昼则发热烦躁夜则发热烦躁是重阳无阴也当亟泻其阳峻补其阴
以手扪摸有三法以轻手扪之则热重按之则不热是热在皮毛血脉也重按之至筋骨之分则热
蒸手
极甚轻手则不热是邪在筋骨之间也轻手扪之不热重力以按之不热不轻不重按之而热是在筋骨
之上皮毛血脉之下乃热在肌肉也
肺热者轻手乃得微按全无日西热甚乃皮毛之热其证必见喘咳寒热轻者泻白散重者凉膈散
地骨散
心热者微按至皮肤之下肌肉之上轻手乃得微按至皮毛之下则热少加力按之则全不热是热
在血脉也其证烦心心痛掌中热而哕以黄连泻心汤导赤散朱砂安神丸
脾热者轻手扪之不热重按至筋骨又不热不轻不重在轻手重手其间热在肌肉遇夜尤甚其证
必怠惰嗜卧四肢不收无气以动泻黄散
肝热者重按之肌肉之下至骨之上乃肝之热寅卯间尤甚其脉弦四肢满闷便难转筋多怒多惊
四肢困热筋痿不能起于床泻青丸柴胡饮子
肾热者轻手重手俱不热如重手按至骨分其热蒸手如火其人骨苏苏如虫蚀其骨困热不任亦
不能起于床滋肾丸主之
按此手太阴少阴足太阴厥阴少阴本病为皮毛肌肉骨分热也然面热者足阳明 口中热如胶
足少
阴口热舌干足少阴 耳肌热若寒手太阳 掌中热手厥阴少阴太阴 足下热而痛足少阴 足
外热足少阳 身热肤痛手少阴 身前热足阳明 洒淅寒热手太阴 肩上热肩似拔手太阳 中
热而喘足少阴 肩背热及足小指外 胫踝后皆热足太阳 一身尽热狂而妄闻妄见妄言足阳明
热而筋纵缓不收阴痿足阳明厥阴手少阴与前热在气血之分皆诸经现证腑脏阴阳是动所生之
本病也
Li Dongyuan stated: Fever during the day and quietness at night indicates that Yang Qi (vital energy) is flourishing in the Yang divisions. Quietness during the day and fever with irritability at night indicates that Yang Qi has sunk into the Yin divisions. This condition is also named "Heat Entering the Blood Chamber" (Re Ru Xue Shi). If there is fever and irritability both during the day and at night, it signifies an excess of Yang without Yin (Chong Yang Wu Yin), requiring urgent draining of Yang heat and vigorous tonification of Yin fluids.
There are three methods for palpating to determine heat:
1. If light palpation reveals significant heat but firm pressure eliminates it, the heat is located in the skin-hair layer and blood vessels.
2. If firm pressure down to the sinews and bones reveals steaming heat felt intensely by the hand, while light palpation shows no heat, the pathogenic factor is located between the sinews and bones.
3. If light palpation shows no heat, firm pressure shows no heat, but moderate pressure reveals heat, the heat is located above the sinews and bones but below the skin-hair layer and blood vessels, i.e., in the muscle layer.
Lung Heat: Light palpation detects heat; slight firm pressure makes it disappear. Heat intensifies in the late afternoon (Ding West). This is heat in the skin-hair layer. Symptoms must include panting, coughing, aversion to cold, and fever. For mild cases, use Xie Bai San (Drain White Powder); for severe cases, use Liang Ge San (Cool the Chest Powder) or Di Gu San (Ground Bone Powder).
Heart Heat: Slight firm pressure to beneath the skin and above the muscles detects heat. Light palpation detects it; pressing beneath the skin-hair layer reduces the sensation; adding force makes it disappear completely. This indicates heat in the blood vessels. Symptoms include vexation, heart pain, heat in the palms, and hiccups. Treatments include Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Heart), Dao Chi San (Guide Out Red Powder), or Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill).
Spleen Heat: Light palpation shows no heat; firm pressure to the sinews and bones shows no heat. Heat is detected only between light and firm pressure, located in the muscle layer, worsening at night. Symptoms include lethargy, desire to lie down, flaccidity of the four limbs, and lack of qi to move. Treat with Xie Huang San (Drain Yellow Powder).
Liver Heat: Firm pressure beneath the muscles to above the bones detects heat. This is Liver heat, worsening during Yin-Mao hours (3:00–7:00 AM). The pulse is wiry. Symptoms include fullness and stuffiness in the four limbs, difficult urination/defecation, tendon spasms, irritability, fright, fatigue and heat in the four limbs, tendon flaccidity unable to rise from bed. Treat with Xie Qing Wan (Drain Green Pill) or Chai Hu Yin Zi (Bupleurum Infusion).
Kidney Heat: Neither light nor firm pressure detects heat. Only when firm pressure reaches the bone level does one feel steaming heat like fire. The patient feels bone soreness as if gnawed by insects, with fatigue, heat, inability to endure discomfort, and inability to rise from bed. Treat primarily with Zi Shen Wan (Nourish Kidney Pill).
Note: The above describes the primary diseases of the Hand-Taiyin Lung Meridian, Hand-Shaoyin Heart Meridian, Foot-Taiyin Spleen Meridian, Foot-Jueyin Liver Meridian, and Foot-Shaoyin Kidney Meridian, corresponding to heat in the skin-hair, muscle, and bone layers respectively. However:
- Facial heat belongs to the Foot-Yangming Stomach Meridian.
- Mouth feeling sticky/hot and dry tongue belong to the Foot-Shaoyin Kidney Meridian.
- Ear and cheek heat with aversion to cold belong to the Hand-Taiyang Small Intestine Meridian.
- Palm heat involves the Hand-Jueyin Pericardium, Hand-Shaoyin Heart, and Hand-Taiyin Lung meridians.
- Sole heat and pain belong to the Foot-Shaoyin Kidney Meridian.
- Lateral foot heat belongs to the Foot-Shaoyang Gallbladder Meridian.
- Body heat and skin pain belong to the Hand-Shaoyin Heart Meridian.
- Anterior body heat belongs to the Foot-Yangming Stomach Meridian.
- Shivering chills and fever belong to the Hand-Taiyin Lung Meridian.
- Shoulder heat and shoulder pain resembling dislocation belong to the Hand-Taiyang Small Intestine Meridian.
- Chest heat with panting belongs to the Foot-Shaoyin Kidney Meridian.
- Shoulder/back heat and heat in the lateral little toe and posterior tibia/ankle belong to the Foot-Taiyang Bladder Meridian.
- Generalized heat, mania, hallucinations, and delirious speech belong to the Foot-Yangming Stomach Meridian.
- Heat leading to tendon laxity, flaccidity, and impotence involves the Foot-Yangming Stomach, Foot-Jueyin Liver, and Hand-Shaoyin Heart meridians.
The aforementioned distinctions of heat in Qi and Blood represent the manifest symptoms of these meridians and the primary diseases generated by the movement and generation of Zang-Fu organ Yin and Yang.