【脉】 浮大而虚为虚，脉细而实为实。脉沉细或数者，皆死。病热有火者，心
脉洪是也；无火者死，细沉是也。脉弱四肢厥，不欲见人，食不入，利下不止，死。
【因】 因心火为之。心者，君火也。火旺则金烁水亏，惟火独存。
【证治】 暴热，病在心肺；积热，病在肾肝。
虚热，如不能食而热，自汗气短，属脾虚，治宜甘寒温而行之。实热，如能食口干，舌
燥便
难者，属胃实，治宜辛苦大寒下之。火热而郁，乃心火下陷脾土，抑而不伸，五心热，宜汗
之、发之。心神烦乱，血中伏火，病蒸蒸然不安，宜镇阴火，朱砂安神丸主之。蒸劳热，乃
五脏齐损，病久憔悴，盗汗下血，宜养血益阴。阴虚而热者，用四物加柏。
治法 小热之气，凉以和之；大热之气，寒以取之；甚热之气，汗而发之。不尽
，则逆治之。
又治法 养血益阴，其热自治。《经》曰∶壮水之主，以制阳光。轻者可降，重
者从其性而伸之。
李论∶外有元气虚而热，有五脏而热，有内中外而热。轻手扪之则热。重之则不热，在
皮
毛血脉也。轻按之不热，重至筋骨，热蒸手足甚，筋骨热也。不轻不重而热，在肌肉也。
凡三法，以三黄丸通治之。
肺热者，轻按之瞥瞥见于皮毛，日西甚。其证喘咳，洒淅寒热。轻者泻白散，重者凉膈
、白虎、地骨皮散。
心热者，微按之热见于血脉，日中甚。其证烦心、心痛，掌中热而 ，以黄连泻心汤、
导赤散、朱砂安神丸。
肝热，肉下骨上热，寅卯间甚。脉弦，四肢满闷，便难，转筋多怒惊，四肢困热，筋痿
不起床，泻青丸、柴胡饮。
脾热，轻重之中见于肌肉，夜甚，怠惰嗜卧，无气以动。泻黄散、调胃承气治实热，补
中益气汤治虚热。
肾热，按至骨，蒸手如火，困热不任起床，宜滋肾丸、六味地黄丸。
平旦潮热，热在行阳之分，肺气主之，白虎加芩。日晡潮热，热在行阴之分，肾气主之
，地骨皮、牡丹皮、知母、柏。
木香金铃子散 治暴热心肺，上喘不已。
大黄（五钱） 金铃子（三钱） 木香（三钱） 轻粉 朴硝
上为末，柳白皮汤下三钱，以利为度。止喘亦止。
大黄散 治上焦烦，不得卧睡。
大黄 栀子 郁金（各五钱） 甘草（二钱半）
煎服，微利则止。
黄牛散 治相火之气游走脏腑，大便闭。
大黄（一两） 牵牛头末（半两）
酒下三钱，以利为度。此不时热，温热也。
金花丸 柏 连 芩 栀 大黄（便实则加）
煎、丸任用。或腹满吐呕，欲作利，加半夏、苓、朴、生姜；如白脓下利后重，加大黄
。
凉膈散 退六经热。
连翘 山栀 大黄 薄荷 甘草（一两半） 黄芩（半两） 朴硝（二钱半）
如咽噫不利，肿痛，并涎嗽，加桔梗一两、荆芥半两。咳而呕，加半夏三钱，姜煎。鼻
衄、
呕血，加白芍、地黄。如淋闭，加滑石四两、茯苓一两；或闷而不通，腹下状如覆碗，痛闷
难忍。乃肠胃干涸，膻中气不下。先用木香三钱、沉香三钱，酒下，或八正散。甚则宜上涌
。
当归承气汤 治阳狂奔走，骂詈不避亲疏。此阳有余阴不足也。
当归 大黄 芒硝（各一两） 甘草（半两）
每二两，姜、枣煎。
牛黄膏 治热入血室，发狂不认人。
牛黄（二钱半） 朱砂（一两） 郁金 甘草（各半两） 脑子（一钱） 丹皮（三钱）
上炼蜜丸，皂子大，水下。
三黄丸 治实热能食者。能食，为实热也。
白虎汤 治表热恶寒而渴者。
柴胡饮子 治两胁下肌热，脉浮弦者。
四顺饮子 治一身尽热，日晡肌热，皆血热也。
桃仁承气 治血热，夜发热者。
潮热者，黄芩、生甘草，辰戍时，加羌活；午间，黄连；未时，石膏；申时，柴胡；酉
时，升麻；夜间，当归根。如有寒者，黄 、参、术。
两手大热为骨厥，如在火中，可灸涌泉五壮，立愈。
地黄丸 治久新憔悴，寝汗发热，肠 下血，骨蒸，痿弱无力，五脏齐损，不能运动，
烦渴，皮肤索泽。食后更宜当归饮子。
熟地（八两） 山茱萸 山药（各四两） 丹皮 茯苓 泽泻（各三两）
上炼蜜和丸，梧子大。每服五十丸，空心酒下。
当归饮子 柴胡 人参 黄芩 甘草（各一两） 大黄 当归 白芍（各三两） 滑
石（三两） 姜煎服。
如痰实咳嗽，加半夏；五谷不化完出，淋闷惊悸，上下血，宜金花丸。
朱砂安神丸 治心神烦乱怔忡，兀兀欲吐，胸中气乱而热，似懊 状，皆是膈上
血中伏火。
朱砂（一钱，研） 黄连（一钱半，酒制） 炙甘草（五分） 生地（五钱） 当归（半钱）
饼丸，津下。如心痞，食入反出，加煨大黄，除地黄。
补血汤 治肌热燥热，目赤面黄红，烦渴引饮，日夜不息，脉浮大而虚，重按之
全无，为血虚发热。证似白虎，唯脉不长并实耳。
黄 （一两） 当归（二钱，酒制）
热服。
火剂汤 黄芩 黄连 山栀 黄柏
火郁汤 治四肢热，五心烦热。因热伏土中，或血虚得之；或胃虚，多飧冷物，
抑遏阳气于土中。
羌活 升麻 葛根 人参 白芍（各半两） 柴胡 甘草（炙，各三钱） 防风（二钱半）
葱白（三寸） 煎服。
朱砂凉膈丸 治上焦虚热。肺脘咽膈，有气如烟抢上。
黄连 山栀（各一两） 人参（半两） 朱砂（三钱，另研） 脑子（另研，五钱） 茯苓（五
钱）
上蜜丸，朱砂为衣，水下。
黄连清膈丸 治心肺间及经中热。
麦冬（一两） 黄连（五钱） 鼠尾（三钱）
上蜜丸，绿豆大，温水下。
补中益气汤 治脾胃虚弱而热。
辰砂滑石丸 治表里热。
辰砂 龙脑 薄荷 六一散
秘方 治阴虚发热。
四物汤、黄柏、龟板、人参、白术（二味，气虚加之）
治酒发热 青黛 栝蒌仁 生姜。
[Pulse] A pulse that is floating, large, and empty indicates deficiency; a pulse that is fine but firm upon pressure indicates excess. A pulse that is deep and fine or rapid are all signs of death. In febrile diseases with internal fire, the heart pulse manifests as surging (Hong); if there is no fire, it is a sign of death, and the pulse manifests as deep and fine. A weak pulse accompanied by cold extremities, aversion to people, inability to ingest food, and unceasing diarrhea indicates death.
[Etiology] This condition arises from Heart Fire. The Heart is the Sovereign Fire. When Fire flares up, it scorches Metal (Lung) and depletes Water (Kidney), leaving only Fire alone.
[Symptoms and Treatment] Sudden high fever indicates pathology in the Heart and Lung; accumulated heat indicates pathology in the Kidney and Liver.
Deficiency heat, characterized by inability to eat yet feeling feverish, spontaneous sweating, and shortness of breath, belongs to Spleen Deficiency. Treatment should employ sweet and cold herbs taken warm to promote circulation. Excess heat, characterized by ability to eat but with dry mouth, dry tongue, and difficult defecation, belongs to Stomach Excess. Treatment should employ bitter, pungent, and great-cold herbs to purge downward. Heat-Fire stagnation occurs when Heart Fire sinks into Spleen Earth, being suppressed and unable to extend, resulting in heat in the five centers (palms, soles, and chest). Treatment should employ diaphoresis to disperse. Mental restlessness and agitation, with latent fire in the blood causing a sensation of steaming heat and unease, require suppressing Yin Fire; Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill) is the primary formula. Bone-steaming consumptive fever results from damage to all five Zang organs, leading to long-term emaciation, night sweats, and hematochezia/hematuria. Treatment should nourish Blood and benefit Yin. For Yin deficiency with heat, Si Wu Tang (Four Substances Decoction) plus Huang Bo (Phellodendri Cortex) is used.
Therapeutic Methods: For mild heat Qi, use cool properties to harmonize; for severe heat Qi, use cold properties to eliminate; for extreme heat Qi, use diaphoresis to disperse. If not resolved, employ contrary treatment (Zheng Zhi).
Another method: Nourish Blood and benefit Yin, and the heat will resolve spontaneously. As stated in the Classics: "Strengthen the master of Water to control the sunlight." Mild cases can be descended; severe cases should follow their nature and be extended/dispersed.
Li's Discussion: External conditions include heat due to Yuan Qi (Original Qi) deficiency, heat from the five Zang organs, and internal heat combined with external heat. Light palpation reveals heat on the skin surface, but heavy pressure does not; this is located in the skin, hair, and blood vessels. Light pressure does not reveal heat, but heavy pressure down to the sinews and bones reveals steaming heat in the hands and feet; this is located in the sinews and bones. Moderate pressure reveals heat; this is located in the muscles. These three methods can be generally treated with San Huang Wan (Three Yellows Pill).
Lung Heat: Light palpation reveals a flickering pulse at the skin surface, worsening in the evening. Symptoms include wheezing and coughing, alternating chills and fever. Mild cases use Xie Bai San (Drain White Powder); severe cases use Liang Ge San (Cool the Diaphragm Powder), Bai Hu Tang (White Tiger Decoction), or Di Gu Pi San (Lycii Cortex Powder).
Heart Heat: Gentle pressure reveals heat in the blood vessels, worsening at noon. Symptoms include mental vexation, heart pain, and heat in the palms. Treat with Huang Lian Xie Xin Tang (Coptis Decocture to Drain the Heart), Dao Chi San (Direct Red Powder), or Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill).
Liver Heat: Heat below the muscle and above the bone, worsening during Yin and Mao hours (3-7 AM). Pulse is wiry (Xian), limbs feel full and stifled, difficult defecation, muscle twitching, irritability, and fright. Limbs feel heavy and hot, tendons become flaccid making bed-rest necessary. Treat with Xie Qing Wan (Drain Green Pill) or Chai Hu Yin (Bupleurum Drink).
Spleen Heat: Revealed between light and heavy pressure in the muscles, worsening at night. Symptoms include lethargy, desire to lie down, and lack of Qi to move. Excess heat is treated with Xie Huang San (Drain Yellow Powder) or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction); deficiency heat is treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
Kidney Heat: Pressure reaches the bone, hands and feet steam like fire, heavy heat makes rising from bed impossible. Use Zi Shui Wan (Nourish Water Pill) or Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
Morning tidal fever: Heat is in the Yang-moving aspect, governed by Lung Qi. Use Bai Hu Tang (White Tiger Decoction) plus Huang Qin (Scutellariae Radix). Afternoon tidal fever: Heat is in the Yin-moving aspect, governed by Kidney Qi. Use Di Gu Pi (Lycii Cortex), Mu Dan Pi (Moutan Cortex), Zhi Mu (Anemarrhenae Rhizoma), and Huang Bo (Phellodendri Cortex).
Mu Xiang Jin Ling Zi San (Costus and Goldbellflower Powder): Treats sudden heat in Heart and Lung, with incessant upper asthma/wheezing.
Da Huang (Rhubarb Root, 5 qian), Jin Ling Zi (Melia Toosendan Fruit, 3 qian), Mu Xiang (Aucklandiae Radix, 3 qian), Qing Fen (Calomel), Po Xiao (Mirabilite).
Grind into powder. Take 3 qian with Willow White Bark Decoction. Stop when bowels move. Asthma also stops.
Da Huang San (Rhubarb Powder): Treats upper Jiao (Upper Burner) vexation and insomnia.
Da Huang (Rhubarb Root), Zhi Zi (Gardenia Fruit), Yu Jin (Curcuma Longa Rhizome) (each 5 qian), Gan Cao (Licorice Root, 2.5 qian).
Decoct and take. Stop when slight diarrhea occurs.
Huang Niu San (Yellow Ox Powder): Treats Ministerial Fire Qi wandering through Zang-Fu organs and constipation.
Da Huang (Rhubarb Root, 1 liang), Qian Niu Tou Mo (Morning Glory Seed Head Powder, 0.5 liang).
Take 3 qian with wine. Stop when bowels move. This is intermittent fever, classified as warm-heat.
Jin Hua Wan (Golden Flower Pill): Huang Bo (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Zhi Zi (Gardenia Fruit), Da Huang (Rhubarb Root - add if stool is dry).
Use as decoction or pill. If abdominal fullness and vomiting occur, or diarrhea is impending, add Ban Xia (Pinelliae Rhizoma), Fu Ling (Poria), Hou Po (Magnoliae Officinalis Cortex), and Sheng Jiang (Zingiberis Rhizoma Recens). If dysentery with white pus and tenesmus occurs, add Da Huang.
Liang Ge San (Cool the Diaphragm Powder): Clears heat from the Six Channels.
Lian Qiao (Forsythiae Fructus), Shan Zhi (Gardenia Fruit), Da Huang (Rhubarb Root), Bo He (Menthae Haplocalycis Herba), Gan Cao (Licorice Root, 1.5 liang), Huang Qin (Scutellariae Radix, 0.5 liang), Po Xiao (Mirabilite, 2.5 qian).
If throat qi stagnation, swelling, pain, and phlegm-cough occur, add Jie Geng (Platycodonis Radix, 1 liang) and Jing Jie (Schizonepetae Spica, 0.5 liang). If cough with vomiting, add Ban Xia (Pinelliae Rhizoma, 3 qian) and Sheng Jiang (Zingiberis Rhizoma Recens). If epistaxis or hematemesis, add Bai Shao (Paeoniae Radix Alba) and Di Huang (Rehmanniae Radix). If stranguria/obstruction, add Hua Shi (Talcum, 4 liang) and Fu Ling (Poria, 1 liang). Or if stifling obstruction with abdomen like an inverted bowl and unbearable pain, this indicates dry intestines/stomach and stagnant Qi in Dan Zhong. First use Mu Xiang (Aucklandiae Radix, 3 qian) and Chen Xiang (Aquilariae Lignum Resinatum, 3 qian) with wine, or Ba Zheng San (Eight-Herb Powder for Unblocking Stranguria). Severe cases may require emesis.
Dang Gui Cheng Qi Tang (Angelica Sinensis Direct-Downward Decoction): Treats Yang running wild, cursing without regard for kinship. This is excess Yang and insufficient Yin.
Dang Gui (Angelicae Sinensis Radix), Da Huang (Rhubarb Root), Mang Xiao (Mirabilite) (each 1 liang), Gan Cao (Licorice Root, 0.5 liang).
Take 2 liang per dose, decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).
Niu Huang Gao (Calculus Bovis Ointment/Pill): Treats heat entering the Blood Chamber, madness, and failure to recognize people.
Niu Huang (Calculus Bovis, 2.5 qian), Zhu Sha (Cinnabaris, 1 liang), Yu Jin (Curcuma Longa Rhizoma), Gan Cao (Licorice Root) (each 0.5 liang), Nao Zi (Camphora, 1 qian), Dan Pi (Moutan Cortex, 3 qian).
Refine honey into pills, size of soap pods. Take with water.
San Huang Wan (Three Yellows Pill): Treats excess heat where the patient can eat. Ability to eat indicates excess heat.
Bai Hu Tang (White Tiger Decoction): Treats exterior heat, aversion to cold, and thirst.
Chai Hu Yin Zi (Bupleurum Drink): Treats heat in the muscles under the hypochondrium, with a floating and wiry pulse.
Si Shun Yin Zi (Four-Obedience Drink): Treats whole-body heat, afternoon muscle heat, all indicating Blood heat.
Tao Ren Cheng Qi (Peach Kernel Direct-Downward Decoction): Treats Blood heat, fever at night.
For tidal fever: At Chen/Xu hours, use Huang Qin (Scutellariae Radix) and Sheng Gan Cao (Raw Licorice Root), add Qiang Huo (Notopterygii Rhizoma et Radix); at Wu hour, use Huang Lian (Coptidis Rhizoma); at Wei hour, use Shi Gao (Gypsum Fibrosum); at Shen hour, use Chai Hu (Bupleuri Radix); at You hour, use Sheng Ma (Cimicifugae Rhizoma); at night, use Dang Gui (Angelicae Sinensis Radix). If cold signs exist, add Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma).
Great heat in both hands is Bone Jue (Bone Reversal/Collapse), feeling like being in fire. Moxibustion on Yongquan (KI1) for 5 moxa cones cures it immediately.
Di Huang Wan (Rehmannia Pill): Treats new and old emaciation, night sweats with fever, intestinal wind bleeding, bone-steaming, flaccidity and weakness, damage to all five Zang organs, inability to move, vexation and thirst, and dry/shriveled skin. After eating, use Dang Gui Yin Zi (Angelica Sinensis Drink).
Shu Di Huang (Prepared Rehmanniae Radix, 8 liang), Shan Zhu Yu (Corni Fructus), Shan Yao (Dioscoreae Rhizoma) (each 4 liang), Dan Pi (Moutan Cortex), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma) (each 3 liang).
Refine honey and make pills, size of Sophora seeds. Take 50 pills per dose with wine on an empty stomach.
Dang Gui Yin Zi (Angelica Sinensis Drink): Chai Hu (Bupleuri Radix), Ren Shen (Ginseng Radix), Huang Qin (Scutellariae Radix), Gan Cao (Licorice Root) (each 1 liang), Da Huang (Rhubarb Root), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba) (each 3 liang), Hua Shi (Talcum, 3 liang).
Decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and take.
If phlegm-excess cough, add Ban Xia (Pinelliae Rhizoma). If undigested grains appear in stool, stifling sensation, palpitations, and upper/lower bleeding, use Jin Hua Wan (Golden Flower Pill).
Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill): Treats mental restlessness, palpitations, dizziness with urge to vomit, chaotic Qi and heat in the chest resembling regret/vexation. All these indicate latent fire in the blood above the diaphragm.
Zhu Sha (Cinnabaris, 1 qian, ground), Huang Lian (Coptidis Rhizoma, 1.5 qian, wine-processed), Zhi Gan Cao (Honey-fried Licorice Root, 0.5 fen), Sheng Di Huang (Rehmanniae Radix, 5 qian), Dang Gui (Angelicae Sinensis Radix, 0.5 qian).
Make pills with wheat paste, swallow with saliva. If Heart Pi (fullness/blockage) occurs with regurgitation after eating, add Wei Da Huang (Baked Rhubarb Root) and remove Di Huang.
Bu Xue Tang (Blood-Tonifying Decoction): Treats muscle heat and dry heat, red eyes, yellow-red face, vexation and thirst with excessive drinking, ceaseless day and night, floating-large-empty pulse, completely absent upon heavy pressure. This is heat due to Blood deficiency. The presentation resembles Bai Hu Tang syndrome, except the pulse is neither long nor firm.
Huang Qi (Astragali Radix, 1 liang), Dang Gui (Angelicae Sinensis Radix, 2 qian, wine-processed).
Take hot.
Huo Ji Tang (Fire Agent Decoction): Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Shan Zhi (Gardenia Fruit), Huang Bo (Phellodendri Cortex).
Huo Yu Tang (Stagnant Fire Decoction): Treats limb heat and heat in the five centers. Caused by heat hidden in Earth, or Blood deficiency; or Stomach deficiency with excessive consumption of cold/raw foods, suppressing Yang Qi within Earth.
Qiang Huo (Notopterygii Rhizoma et Radix), Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Ren Shen (Ginseng Radix), Bai Shao (Paeoniae Radix Alba) (each 0.5 liang), Chai Hu (Bupleuri Radix), Zhi Gan Cao (Honey-fried Licorice Root) (each 3 qian), Fang Feng (Saposhnikoviae Radix, 2.5 qian), Cong Bai (Allii Fistulosi Bulbus, 3 cun).
Decoct and take.
Zhu Sha Liang Ge Wan (Cinnabar Cool-Diaphragm Pill): Treats Upper Jiao deficiency heat. Qi rushes up to the lung/throat/diaphragm like smoke.
Huang Lian (Coptidis Rhizoma), Shan Zhi (Gardenia Fruit) (each 1 liang), Ren Shen (Ginseng Radix, 0.5 liang), Zhu Sha (Cinnabaris, 3 qian, separately ground), Nao Zi (Camphora, 5 qian, separately ground), Fu Ling (Poria, 5 qian).
Honey pills coated with Cinnabar. Take with water.
Huang Lian Qing Ge Wan (Coptis Clear-Diaphragm Pill): Treats heat between Heart/Lung and in the meridians.
Mai Dong (Ophiopogonis Radix, 1 liang), Huang Lian (Coptidis Rhizoma, 5 qian), Shu Wei (Prunella Vulgaris Spike, 3 qian).
Honey pills, size of mung beans. Take with warm water.
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction): Treats heat due to Spleen/Stomach deficiency.
Chen Sha Hua Shi Wan (Cinnabar Talcum Pill): Treats exterior-interior heat.
Chen Sha (Cinnabaris), Long Nao (Camphora), Bo He (Menthae Haplocalycis Herba), Liu Yi San (Six-to-One Powder).
Secret Formula: Treats Yin deficiency with fever.
Si Wu Tang (Four Substances Decoction), Huang Bo (Phellodendri Cortex), Gui Ban (Testudinis Carapax et Plastrum), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (add these two for Qi deficiency).
Treatment for Alcohol-Induced Fever: Qing Dai (Indigo Naturalis), Gua Lou Ren (Trichosanthis Semen), Sheng Jiang (Zingiberis Rhizoma Recens).