此一卷论发热。大抵伤寒。寒多易治。热多难愈。伤寒发热者。以其寒极则生热。治法多用
冷药。故令热不去。仲景热多寒少。用桂枝二越婢一汤。不渴外有微热者。用小柴胡加桂汤。皆温
表之义也。近时多行小柴胡汤。不问阴阳表里。凡伤寒家皆令服之。此药差寒。不可轻用。虽不
若大柴胡汤、小承气汤之紧。然药病不相主。其为害一也。往往因服小柴胡汤而成阴证者甚多。仲
景虽云。伤寒中风有柴胡证。但见一证便是。不必悉具。此为是少阳证。当服小柴胡。不必少阳证
悉具耳。况本方又有加减随证增损。古人方治。审谛如此。后人妄投。良可怪也。
（五十五） 问发热
发热而恶寒者。属太阳也。太阳病必发热而恶寒。盖太阳主气以温皮肤分肉。寒气留于外。
皮肤致密。则寒栗而发热。宜发其汗。麻黄汤（正方二十）大青龙汤（正方三十五）主之。若发热
微恶寒者。柴胡桂枝汤。（正方三十一）桂枝二越婢一汤。（正方四）主之。若吐利而发热恶寒者。霍乱也
太阳病发热而渴。不恶寒。为温病。若发汗已。身体灼热者。为风温也。○身热汗出。 然者。
属阳明也。（阳明病脉浮者宜桂枝）（正方一）（微汗之。脉实者调胃承气汤下之）（正方四
三）大便不秘者。白虎汤和解。（方六十四）（若阳明病发汗多者。宜大承气汤急下之）（正四
十一）（盖汗多发热者。胃汁干故也。仲景云。太阳证汗后不恶寒但热者。实也。当和其胃气。宜
调胃承气汤）（正四三）（太阳病三日发汗不解。蒸蒸发热者。属于胃也。宜下之）○脉细头
疼呕而发热者。属少阳也。（少阳发热。小柴胡汤主之）（正二十九）（不可发汗。发汗即谵语。
）○病患不渴。外有微热者。小柴胡加桂也。（杂三十九）（小柴胡加桂主表热最良。此法不特
伤寒也。仲景表有热者。小柴胡加桂也。里有热者。白虎加人参也）（正六五）（大抵身热不饮
水者。为表热也。口燥烦渴者。为里热也。二药均治发热。然分表里。不可不知也）○发汗已。
身灼热者。名风温。（素问云。汗出而身热者。风热也。其人素伤于风
因复伤于热。风热相搏。即身热常自汗出。此名风温。在第六卷第四十五问也）○病患
无表里证。发热七八日。脉虽浮数。宜大柴胡汤下之。（正方三十）（大便秘者。加大黄）假
令已下。脉数不解。今热则消谷善饥。至六七日不大便者。有瘀血也。抵当汤主之。（正九十一）
○若伤寒瘥后更发热者。小柴胡汤（正二十九）主之。（脉浮者。以汗解。脉实者可下之）○又
问阴证有发热者乎。太阴厥阴皆不发热。只少阴发热有二证。仲景谓之反发热也。少阴病初得之
。发热脉沉者。麻黄细辛附子汤（正廿三）主之。（少阴病脉沉发汗则动经。此大略之言耳。脉
应里而发热在表。亦当以小辛之药泄汗而温散也。仲景云。伤寒之病从风寒得之。表中风。寒入里
。则不消。须用温药少汗而解）少阴病下利清谷。里寒外热。手足厥逆。脉不出者。通脉四逆汤主
之。（正八十一）大抵阴证发热。终是不同。脉须沉或下利手足厥也。
（五十六）问热多寒少
太阳热多寒少有三证。有热多寒少而不呕。清便自可者。有热多寒少而脉微弱者。有热多寒少
而尺脉迟者。其用药皆不同也。○太阳病八九日如疟状。热多寒少。不呕。清便自可。宜桂枝麻黄
各半汤。（正方二）○热多寒少而脉都大微弱者。无阳也。不可发汗。宜桂枝二越婢一汤（正方四
）主之。（若脉浮虽热多寒少。亦自可发汗也）热多寒少而尺中迟者。血少也。先以小建中加黄 。
（正三十七）以养其血。尺尚迟。再作一剂。然后 时用小柴胡汤、（正二十九）桂枝二越婢一汤
（正方四）辈小剂随证治之。
（五十七）问潮热
潮热者。大率当下。仲景云。潮热者实也。大承气汤证云。其热不潮。未可与也。则知潮热
当下无疑矣。虽然。
更看脉与外证。脉若弦若浮。及外证恶寒。犹有表证。且与小柴胡汤以解之。（正二十九）
若腹大满不通者。可与小承气。（正四十二）微和其胃气。勿令大泄也。（仲景云。日晡发
热者属阳明也。脉实者大承气）（正四二）（大柴胡也）（正三十）脉虚者。桂枝也。（正
方一）纵使潮热当行大承气。亦须先少与小承气。若不转失气。不可攻之。后发热复硬者。大柴
胡下之。（正三十）○若胸胁满而呕。日晡发潮热者。小柴胡加芒硝（正三十四）主之。○又有日晡发
潮热已而微利者。又有微发潮热而大便溏者。或潮热而咳逆者。皆当用小柴胡也（正二十九）（伤寒十三日不解。胸胁满
而呕。日晡发潮热，已而微利。潮热者。实也。先服小柴胡以解外。后以柴胡加芒硝汤下之。阳明潮热。大便溏。胸满
不去者。小柴胡
汤主之）。○冬阳明潮热。当行黄芩汤。（冬阳明病脉浮而紧。必发潮热。发作有时。但脉浮
者。必盗汗。黄芩汤主之）（正八十五）以上潮热。并属阳明也。○太阳有潮热乎。仲景大陷胸
汤一证。（正三十八）结胸有潮热者。为大结胸。属太阳也。
（五十八）问往来寒热者。阴阳相胜也。阳不足则先寒后热。阴不足则先热后寒。
往来寒热有三证。小柴胡汤、大柴胡汤、柴胡桂枝干姜汤。○有表证而往来寒热者。用小柴胡
也。（正二十九）○有里证而往来寒热者。大柴胡也。（正三十）○已表或已下而往来寒热者。
皆可用柴胡桂枝干姜汤也（正三十二）○仲景云。血弱气尽。腠理开。邪气因入与正气分争。往来
寒热。休作有时。小柴胡主之。又云。伤寒五六日中风。往来寒热。胸胁苦满。默默不欲食。心烦
喜呕。或胸烦而不呕。或渴。或腹中痛。或胁下痞硬。或心下悸。小便不利。或不渴。身有微热
。或咳者。小柴胡主之。伤寒十余日。热结在里。往来寒热者。大柴胡主之。伤寒五六日已发汗
。复下之。胸胁满。小便不利。渴而不呕。头汗出。往来寒热心烦。柴胡桂
枝干姜汤也。
（五十九）问伤寒疟状
形证似疟。有太阳证。有阳明证。有妇人热入血室证。 太阳证。服桂枝汤。（正方一）大
汗出。脉洪大者。与桂枝汤如前法。若形似疟。一日再发者。汗出必解。宜桂枝二麻黄一汤。（
正三）伤寒八九日如疟状。热多寒少。其人不呕。清便欲自可。日一二发者。麻黄桂枝各半汤。
（太阳证形似疟寒热等者。与桂枝二麻黄一汤。热多寒少者。麻黄桂枝各半汤）（正方二）○有
阳明证。病患烦热。汗出如疟状。日晡发热而脉浮虚者。与桂枝汤脉实者。宜承气汤。（正四二）
○妇人热入血室。其血必结。故使如疟状。小柴胡汤主之。（正二十九）
（六十）问汗之而寒热者
太阴证发汗后。根据前寒热者。须看脉如何。若脉浮数。或洪大。则表证犹在。当再表也。如桂
枝汤、（正方一）或桂枝二麻黄一（正方三）之类。医人为见已汗、或已下而发寒热。不敢再表。
误矣。盖脉浮为在表。表之必愈也。○或得汗而解。复如疟状。日晡而发者。此属阳明也。若脉
实者。可下之。宜大柴胡、（正三十）大承气（正方四一）也。○若发汗后只恶寒者。虚也。发汗
后只发热者。实也。只恶寒属芍药甘草附子汤。（正七二）只发热属调胃承气汤。（正方四三）○
若厥阴证。大汗出。热不去。内拘急。四肢疼。又下利厥逆而恶寒者。四逆汤主之。（正七五）
（六十一）问汗之而仍发热者
素问云。温病汗出辄复热而脉躁疾。不为汗衰。狂言不能食。谓之阴阳交。交者死也。又云。
热病已得汗而脉躁盛者死。今不与汗相应。是不胜其病也。其死明矣。大抵病患得汗而脉静者生。
今汗之而仍发热者。若脉浮数。则表证犹在。汗之必愈也。仲景云。发汗解半日许复热烦。脉
浮数者。可更发汗。宜桂枝汤。（正一）发汗后不敢再表者。为脉沉实耳。脉若浮者。须再汗也。
发汗后不恶寒。只发热脉沉实。或狂语。此为胃实、阳盛。即不可再汗也。须当下之设令下后。又
不解。表里邪亦衰矣。仲景云。太阳病三日发汗不解。蒸蒸发热者。宜调胃承气汤。（正四十
三）和其胃气也。太医云。若伤寒得汗后。热不退。发昏及狂言者。便可用承气汤。（正四十
二）下之立愈。未瘥再服。若汗后热不解。但心下痞。呕逆。又自利。大柴胡去大黄主之。（
正方三十）○又有太阳证合行桂枝。却用麻黄之类。发汗多。亡阳仍发热者。真武汤（正方一百五）主之。
○更有风温一证。初得病发热而渴。不恶寒。虽发汗已。身灼热者。为风温。属葳蕤汤。
（杂四十五）（岐伯所谓汗出而身热者。风热也）○若伤寒得汗后。病解。虚羸微热不去。可行
竹叶石膏汤。（正方九五）随其虚实而治之。
（六十二）问下之而热不退者（劳复食复附）
仲景云。病患脉微而涩。为医所病。大发其汗。使阳气微。又大下之。使阴气弱。其人亡血
。病当恶寒。后乃发热无休止时。盖阳微则恶寒。阴弱则发热。阳微恶寒四逆汤主之。（正七十
五）阴弱发热。为内热葶苈苦酒汤主之。（杂方十六）大抵伤寒八日以上。大发热者。此为难治。
（仲景云。脉阴阳俱虚。热不止者死）又有医人多用丸子药下之。身热不去微烦者。栀子干姜汤
主之。（正方四九）伤寒五六日大下之后。身热不去。心中结痛者。未欲解也。栀子豉汤主之。
（正方四十五）○又问伤寒瘥后发热者何也。此名劳食复也。病新瘥。血气尚
虚。津液未复。因劳动生热。热气既还。复入经络。名曰劳复。仲景云。伤寒瘥以后。更发热。小
柴胡汤主之。（正二十九）脉浮者以汗解。（宜柴胡桂枝汤）（正三十一）脉实者以下解。（宜
大柴胡汤）（正方三十）又大病瘥后劳复者。枳实栀子汤主之。（正方九十六）麦门冬汤（杂
一百二十六）雄鼠屎汤、（杂七十七）七味葱白汤、（杂一百十八）皆可选用。○又食复者。大
病新瘥。脾胃尚弱。谷气未复。强食过多。停积不化。因尔发热名曰食复。大抵新病瘥。多因伤食
。便作痞。干噫。食臭。腹中雷鸣。下利等证。可与生姜泻心汤。（正方六十三）仲景于枳实栀子
汤证云。若有宿食。内大黄如薄棋子五六枚。服之愈。黄帝曰。热病已愈。时有所遗者。何也。
岐伯曰。诸遗者。热甚而强食。故有所遗也。若此者。皆病已衰。而热有所藏。因其谷食相搏。
两热相合。故有所遗也。帝曰善。治遗奈河。岐伯曰。视其虚实。调其逆从。可使必已。食肉则
复。多食则遗。此其禁也。
This volume discusses fever. Generally, in cold damage (Shanghan) diseases, those with more cold pathogen are easier to treat, while those with more heat pathogen are difficult to cure. Fever occurring in cold damage is because extreme cold generates heat; treatment methods often use cold-natured medicines, which causes the heat to persist. Zhang Zhongjing uses Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Breathing-Opening One Decoction) for cases where heat is predominant and cold is scanty; for cases without thirst but with slight external heat, he uses Xiaochaihu Jia Guizhi Tang (Minor Bupleurum Plus Cinnamon Twig Decoction), both embodying the principle of warming and releasing the exterior. In recent times, doctors often administer Xiaochaihu Tang (Minor Bupleurum Decoction), regardless of yin-yang or interior-exterior differentiation, prescribing it to all patients with cold damage. This medicine is relatively cold in nature and should not be used lightly. Although it is not as harsh as Daxiehu Tang (Major Bupleurum Decoction) or Xiao Chengqi Tang (Minor Order-the-Gut Decoction), if the medicine does not match the disease, the harm is the same. Many patients have turned into yin-patterns due to taking Xiaochaihu Tang. Although Zhang Zhongjing stated, "In cold damage and wind-stroke, if there are Chaihu patterns, seeing one symptom is sufficient, it need not be complete," this refers specifically to Shaoyang patterns where Xiaochaihu Tang should be taken even if not all Shaoyang symptoms are present. Moreover, the original formula has modifications and adjustments based on the pattern. Ancient physicians were so prudent in treatment. It is strange that later generations prescribe recklessly.
(55) Inquiry on Fever
Fever accompanied by aversion to cold belongs to Taiyang disease. Taiyang disease must present with fever and aversion to cold. The Qi of the Taiyang meridian warms the skin and muscles. When cold qi remains on the exterior, the skin becomes dense, leading to chills and fever. Sweating should be induced; Mahuang Tang (Ephedra Decoction) or Da Qinglong Tang (Major Green Dragon Decoction) are indicated. If fever is slight with slight aversion to cold, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) or Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Breathing-Opening One Decoction) are indicated. If vomiting and diarrhea occur with fever and aversion to cold, it is Huoluan (Cholera-like disorder).
Taiyang disease with fever and thirst, but no aversion to cold, is Wenbing (Warm Disease). If after sweating, the body feels burning hot, it is Fengwen (Wind-Warmth).
Body heat with sweating that persists is Yangming disease. (For Yangming disease with a floating pulse, Guizhi Tang is suitable to induce slight sweating; for a solid pulse, Tiaowei Chengqi Tang is used to purge.) If stool is not unobstructed, Baihu Tang (White Tiger Decoction) is used to harmonize. (If Yangming disease results from excessive sweating, Dachengqi Tang should be used urgently to purge.) (Generally, fever due to excessive sweating occurs because stomach fluids are dried up. Zhang Zhongjing said: After Taiyang syndrome sweating, if there is no aversion to cold but only heat, it is excess. One should harmonize the stomach qi, using Tiaowei Chengqi Tang.) (If Taiyang syndrome for three days remains unresolved after sweating, with steaming internal heat, the pathology is in the stomach, and purging is indicated.)
A fine pulse, headache, vomiting, and fever belong to Shaoyang. (Shaoyang fever is treated with Xiaochaihu Tang.) (Sweating is contraindicated; inducing sweating will lead to delirium.)
If the patient has no thirst but slight external heat, Xiaochaihu Jia Guizhi Tang is used. (Xiaochaihu Jia Guizhi Tang is best for treating exterior heat; this method applies not only to cold damage. Zhang Zhongjing considered exterior heat treated with Xiaochaihu Jia Guizhi Tang, and interior heat treated with Baihu Jia Renshen Tang.) (Generally, body heat without desire to drink indicates exterior heat; dry mouth and irritability indicate interior heat. Both medicines treat fever, but distinguishing between interior and exterior is essential.)
After sweating, if the body feels burning hot, it is named Fengwen. ("Suwen" states: Body heat after sweating is Wind-Heat. If the person was previously injured by wind and then again by heat, wind and heat contend, causing constant body heat and spontaneous sweating; this is Fengwen, discussed in Volume 6, Question 45.)
If the patient has neither exterior nor interior signs, but has had fever for seven to eight days, and although the pulse is floating and rapid, Dachengqi Tang should be used to purge. (If constipation exists, add Rhubarb.) Suppose purging has been done, but the rapid pulse persists, and now there is heat, digestion of food, and frequent hunger, followed by no bowel movement for six or seven days, this indicates blood stasis, treated with Didang Tang.
If fever recurs after recovery from cold damage, Xiaochaihu Tang is indicated. (If the pulse is floating, resolve via sweating; if solid, purge.)
Another question: Are there fevers in yin-patterns? Taiyin and Jueyin do not typically feature fever. Only Shaoyin fever has two patterns, which Zhang Zhongjing calls "counter-fever." For early Shaoyin disease with fever and a deep pulse, Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) is indicated. (Shaoyin disease with a deep pulse should not be sweated, as it disturbs the channels; this is a general statement. Since the pulse corresponds to the interior but fever is on the exterior, mild acrid-warm medicines should be used to induce slight sweating and disperse warmth. Zhang Zhongjing said: Cold damage arises from wind-cold. If wind affects the exterior and cold enters the interior, it cannot dissipate; warm medicines must be used to induce slight sweating for resolution.) For Shaoyin disease with clear watery diarrhea, interior cold with exterior heat, cold limbs, and absent pulse, Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) is indicated. Generally, fever in yin-patterns is different; the pulse must be deep, or accompanied by diarrhea and cold limbs.
(56) Inquiry on Predominant Heat and Scanty Cold
There are three Taiyang patterns of predominant heat and scanty cold. One has predominant heat and scanty cold without vomiting, with normal bowel and bladder function. Another has predominant heat and scanty cold with a faint pulse. The third has predominant heat and scanty cold with a slow Chi pulse. Their treatments differ.
Taiyang disease lasting eight or nine days resembling malaria, with predominant heat and scanty cold, no vomiting, and normal excretion, is treated with Guizhi Mahuang Ge Ban Tang (Half-Half Decoction of Cinnamon Twig and Ephedra).
If heat is predominant and cold scanty with an overall faint pulse, there is a deficiency of Yang; sweating is contraindicated. Guizhi Er Yuebi Yi Tang is indicated. (If the pulse is floating, even with predominant heat and scanty cold, natural sweating may occur.) If heat is predominant and cold scanty with a slow Chi pulse, there is blood deficiency. First, use Xiaojianzhong Tang plus Huangqi (Astragalus) to nourish blood. If the Chi pulse remains slow, administer another dose, then occasionally use small doses of Xiaochaihu Tang or Guizhi Er Yuebi Yi Tang according to the pattern.
(57) Inquiry on Tidal Fever
Tidal fever generally requires purging. Zhang Zhongjing said: Tidal fever indicates excess. The Dachengqi Tang pattern states: If the heat is not tidal, do not administer [the decoction]. Thus, tidal fever definitely requires purging. However, one must also examine the pulse and external signs. If the pulse is wiry or floating, and there is aversion to cold externally, an exterior pattern still exists; temporarily use Xiaochaihu Tang to resolve the exterior. (If the abdomen is distended and obstructed, Xiao Chengqi Tang can be given to slightly harmonize the stomach qi, avoiding severe purging.) (Zhang Zhongjing said: Fever at dusk belongs to Yangming. Solid pulse indicates Dachengqi Tang; Major Bupleurum Decoction; empty pulse indicates Guizhi Tang. Even if tidal fever warrants Dachengqi Tang, one must first give a small amount of Xiao Chengqi Tang. If there is no passage of gas, do not attack. If fever returns and stool becomes hard, use Dachengqi Tang to purge.)
If there is fullness in the chest and hypochondrium with vomiting, and tidal fever at dusk, Xiaochaihu Jia Mangxiao Tang (Minor Bupleurum Plus Mirabilite Decoction) is indicated.
There are cases of tidal fever at dusk followed by slight diarrhea, or slight tidal fever with loose stools, or tidal fever with cough and counterflow qi; all should be treated with Xiaochaihu Tang. (Cold damage unresolved for thirteen days, with chest/hypochondriac fullness, vomiting, and tidal fever at dusk, followed by slight diarrhea. Tidal fever indicates excess. First take Xiaochaihu Tang to resolve the exterior, then use Chaihu Jia Mangxiao Tang to purge. Yangming tidal fever with loose stools and persistent chest fullness is treated with Xiaochaihu Tang.)
Winter Yangming tidal fever should be treated with Huangqin Tang. (Winter Yangming disease with floating and tight pulses must present with tidal fever at specific times; if the pulse is floating, there must be night sweats, treated with Huangqin Tang.) All the above tidal fevers belong to Yangming.
Does Taiyang have tidal fever? Zhang Zhongjing's Daxiexiong Tang (Major Chest-Sinking Decoction) presents one pattern. (Jieyu [Constraint in the Chest] with tidal fever is Major Jieyu, belonging to Taiyang.)
(58) Inquiry on Alternating Chills and Fever is due to the contention of Yin and Yang. Insufficiency of Yang leads to chills first then fever; insufficiency of Yin leads to fever first then chills.
Alternating chills and fever has three patterns: Xiaochaihu Tang, Dachengqi Tang, and Chaihu Guizhi Ganjiang Tang.
With an exterior pattern and alternating chills and fever, use Xiaochaihu Tang.
With an interior pattern and alternating chills and fever, use Dachengqi Tang.
After exterior release or purging, if alternating chills and fever persist, Chaihu Guizhi Ganjiang Tang can be used.
Zhang Zhongjing said: Weak blood and exhausted Qi, open pores, pathogenic qi enters and contends with healthy Qi, causing alternating chills and fever at intervals; Xiaochaihu Tang is indicated. He also said: Cold damage or wind-stroke after five or six days, with alternating chills and fever, bitter fullness in the chest and hypochondrium, silent desire not to eat, irritability, and frequent vomiting, or chest irritability without vomiting, thirst, abdominal pain, hypochondriac hardness, palpitations, difficulty urinating, no thirst with slight body heat, or cough; Xiaochaihu Tang is indicated. Cold damage for ten-plus days, heat constrained in the interior with alternating chills and fever, is treated with Dachengqi Tang. Cold damage after five or six days, already sweated and then purged, with chest/hypochondriac fullness, difficulty urinating, thirst without vomiting, head sweating, alternating chills and fever with irritability, is treated with Chaihu Guizhi Ganjiang Tang.
(59) Inquiry on Cold Damage Resembling Malaria
Symptoms resembling malaria include Taiyang patterns, Yangming patterns, and patterns of Heat Entering the Blood Chamber in women.
For Taiyang patterns, administer Guizhi Tang. If there is heavy sweating and a surging-large pulse, give Guizhi Tang as before. If symptoms resemble malaria and occur twice a day, sweating will resolve it; Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice and Ephedra One Decoction) is indicated.
Cold damage after eight or nine days resembling malaria, with predominant heat and scanty cold, no vomiting, normal excretion, occurring once or twice a day, is treated with Guizhi Mahuang Ge Ban Tang.
For Yangming patterns, if the patient has irritability and heat, sweating resembling malaria, fever at dusk with a floating-empty pulse, give Guizhi Tang; if the pulse is solid, use Chengqi Tang.
For women with Heat Entering the Blood Chamber, the blood must congeal, causing symptoms like malaria; Xiaochaihu Tang is indicated.
(60) Inquiry on Chills and Fever Persisting After Sweating
After sweating in Taiyin patterns, regarding previous chills and fever, one must check the pulse. If the pulse is floating-rapid or surging-large, the exterior pattern remains, and exterior release should be repeated, such as with Guizhi Tang or Guizhi Er Mahuang Yi Tang. Doctors dare not re-release the exterior because they see chills and fever after prior sweating or purging; this is an error. Generally, a floating pulse indicates the exterior; releasing the exterior will surely cure.
If resolved by sweating but recurring like malaria at dusk, this belongs to Yangming. If the pulse is solid, purging is indicated, using Dachengqi Tang or Dachengqi Tang.
If only aversion to cold persists after sweating, it is deficiency; if only fever persists, it is excess. Aversion to cold alone is treated with Shaoyao Gancao Fuzi Tang. Fever alone is treated with Tiaowei Chengqi Tang.
For Jueyin patterns, if heavy sweating leaves heat unabated, internal cramping, limb pain, along with diarrhea, cold limbs, and aversion to cold, Sini Tang is indicated.
(61) Inquiry on Fever Persisting After Sweating
"Suwen" states: In Warm Disease, fever returns immediately after sweating, the pulse is rapid and restless, not diminished by sweating, with delirium and inability to eat; this is called Yin-Yang Intersection, which is fatal. It also states: Death occurs if the pulse remains rapid and full after sweating in Heat Disease. Now, if the pulse does not correspond to sweating, the disease cannot be overcome; death is evident. Generally, survival is indicated if the pulse calms after sweating. If fever persists after sweating and the pulse is floating-rapid, the exterior pattern remains, and sweating will cure. Zhang Zhongjing said: If half a day after sweating, fever and irritability return with a floating-rapid pulse, sweating can be repeated with Guizhi Tang. Those who dare not re-sweat after initial sweating do so because the pulse is deep and solid. If the pulse is floating, re-sweating is necessary. If after sweating there is no aversion to cold, only fever with a deep-solid pulse, or delirium, this is Stomach Excess and Yang Prosperity; re-sweating is contraindicated. Purging is required. Suppose purging fails to resolve it; exterior and interior pathogens have declined. Zhang Zhongjing said: Taiyang disease unresolved after three days of sweating, with steaming heat, is treated with Tiaowei Chengqi Tang to harmonize stomach qi. Imperial Physicians say: If after sweating in cold damage, heat does not recede, accompanied by confusion and delirium, Chengqi Tang can be used; cure follows immediately. If unhealed, repeat. If heat persists after sweating, with epigastric stuffiness, vomiting, and diarrhea, Dachengqi Tang minus Rhubarb is indicated.
There is also a case where Taiyang patterns requiring Guizhi were mistakenly treated with Mahuang, causing excessive sweating, Yang collapse, yet fever persists; Zhenwu Tang is indicated.
There is also the Fengwen pattern: initial fever with thirst and no aversion to cold; even after sweating, if the body feels burning hot, it is Fengwen, treated with Weiyu Tang. (Qibo stated: Body heat after sweating is Wind-Heat.)
If after sweating in cold damage, the disease resolves but weakness and slight fever persist, Zhuye Shigao Tang (Leaf of Bamboo and Gypsum Decoction) can be used, treating according to deficiency or excess.
(62) Inquiry on Fever Persisting After Purging (Including Relapse due to Labor and Diet)
Zhang Zhongjing said: A patient with a faint and choppy pulse, mistreated by a physician who heavily sweated them (weakening Yang) and heavily purged them (weakening Yin), resulting in blood loss, will initially feel aversion to cold, then develop ceaseless fever. Yang deficiency causes aversion to cold; Yin deficiency causes fever. Yang deficiency with aversion to cold is treated with Sini Tang. Yin deficiency with fever, indicating internal heat, is treated with Tingli Kujiu Tang. Generally, high fever after eight days of cold damage is difficult to treat. (Zhang Zhongjing said: Death if Yin and Yang pulses are both deficient and heat persists.) Some physicians use pill medicines to purge; if fever persists with slight irritability, Zhizi Ganjiang Tang is indicated. After heavy purging in cold damage at five or six days, if fever persists and there is painful knotting in the heart, the disease is not resolving; Zhizi Chi Tang is indicated.
Another question: Why is there fever after recovery from cold damage? This is called relapse due to labor or diet. When the disease just heals, Qi and Blood are still weak, and body fluids are not restored. Labor generates heat; when this heat returns to the meridians, it is called relapse due to labor. Zhang Zhongjing said: Fever after cold damage recovery is treated with Xiaochaihu Tang. (Floating pulse: resolve via sweating, use Chaihu Guizhi Tang; Solid pulse: resolve via purging, use Dachengqi Tang.) For relapse due to labor after major illness, Zhishi Zhizi Tang is indicated. Maidong Tang, Xiongshushi Tang, and Qiwei Congbai Tang are also selectable.
Relapse due to diet occurs when the spleen and stomach are weak after major illness, grain Qi is not restored, and overeating causes stagnation and indigestion, leading to fever. Generally, after new illness recovery, injury from food causes epigastric stuffiness, dry belching, food odor, borborygmus, and diarrhea; Shengjiang Xiexin Tang can be given. Zhang Zhongjing stated in the Zhishi Zhizi Tang pattern: If there is retained food, add Rhubarb equivalent to five or six thin chess pieces; cure follows. The Yellow Emperor asked: Why do residual symptoms occur after Heat Disease resolves? Qibo answered: Residual symptoms occur because heat is severe and forced eating happens. In these cases, the disease has declined but heat is hidden; grain food contends with residual heat, combining two heats, causing residuals. The Emperor asked how to treat residuals. Qibo said: Observe deficiency or excess, regulate reversal or smoothness, and cure is certain. Eating meat causes recurrence; overeating causes residuals; these are prohibitions.