脉 脉多沉细而数。或弦涩而短。或弦细而微。左偏大无力。为血虚。右偏大无力。为气虚
。六脉形大力薄。为气血俱虚。滑数者有汗。沉涩者无汗。两尺细数者。阴虚火动。宜详辨
之。
症 潮热者。若潮水之来。不失其时。一日一发。必有定时。于日晡时为多。若一日三五发
。即是发热。非潮热也。气虚潮热。热在平旦。肺气主之。血虚潮热。热在晡时。肾气主之
。阴虚火动。潮热寝汗者。皆由血气虚损。亦当从金水二脏求之。大抵潮热为虚。发热为实
。治各有异。
治 平旦潮热属阳。心肺主之。人参白虎汤，加黄芩、日晡潮热。属阴。脾肾主之。四物汤
，加白术、陈皮、牡丹皮、地骨皮、知母、黄柏、阴虚火动潮热脉细数。八物汤，加知母、
黄柏、麦门冬、柴胡、地骨皮、大抵潮热。宜以四物汤，加柴胡、黄芩、生甘草、辰戌时发
。加羌活、午时。加黄连、未时。加石膏、申时。加升麻、夜。加当归、知母、昼。加地
骨
皮、人参、血虚。多加当归、地黄。气虚多加参、术、黄 、大略如此。临症尤加详审。
方 八物汤治气血俱虚。寝汗潮热。
川芎（七分） 当归（一钱五分） 白芍药（一钱五分） 人参（一钱） 白术（一钱五分） 白茯苓
（一钱） 甘草（三分） 地黄（一钱凉血用生补血用熟）
上作一服。姜枣煎。食远服。兼有他症。根据后加减。
一切潮热。并加黄 、黄柏、知母、柴胡、牡丹皮、地骨皮（各等分）。
男子血虚。有汗。潮热。本方，去川芎，加黄 （一钱）、陈皮（八分）、远志、五味子（各
五分）、官桂（三分）、名人参养荣汤。治有汗潮热咳嗽。
男子气虚。有汗潮热。本方减川芎、白芍药、熟地黄、白茯苓，加黄 、陈皮、升麻、
柴胡、名补中益气汤。有嗽。加麦门冬、紫菀、五味子、黄柏、知母、更妙。
男子血虚。无汗潮热。本方，加陈皮、半夏（各一钱）、枳壳、桔梗、前胡、
紫苏、干葛、柴胡（各八分）、名茯苓补心汤。
男子气虚。无汗潮热。本方去川芎、芍药、地黄，加黄 、地骨皮、防风、柴胡（各等分）、
薄荷（减半）、名人参清气散。
男子气血两虚。有汗潮热。咳嗽。加知母、麦门冬、牡丹皮、地骨皮、柴胡、贝母、紫菀、
（各等分），去川芎。
男子气血两虚。无汗潮热。咳嗽。加秦艽、地骨皮、柴胡（各等分）、紫苏、薄荷（各减半）、
款冬花（八分）。
妇人血虚。有汗潮热。加黄 、麻黄根（各一钱）。
妇人气虚。有汗潮热。本方，去川芎、地黄。加柴胡、荆芥、薄荷、地骨皮（各等分）。
妇人血虚。无汗潮热。本方，去参 ，加秦艽、知母、地骨皮、沙参、鳖甲、前胡（各等
妇人气虚。无汗潮热。本方，去川芎、地黄，加半夏、柴胡（各一钱）、干葛（七分）、名人参柴胡散。
妇人气血两虚。无汗潮热。咳嗽咯血。本方，去参、芎、地黄，加柴胡、薄荷、地骨皮、紫
菀、麦门冬（各等分）。
妇人气血两虚。有汗潮热。咳嗽。本方，去川芎、白芍药，加半夏、柴胡、黄芩、桔梗、阿
胶、款冬花（各八分）、知母、麦门冬（各一钱）、五味子、薄荷（各五分）、名知母茯苓汤。
男子阴虚火动。骨蒸劳热。咳嗽。吐红。吐痰。本方去川芎、人参，加天门冬、麦门冬、知母、贝
母、黄柏、远志、陈皮、阿胶、北五味子（各等分）、名滋阴降火汤。此病大忌过服参 。如
久服寒凉。伤脾。气血俱损者。参 亦可用。
妇人室女。经闭成劳。自汗潮热。咳嗽吐红。皆由七情损伤心脾所致。宜本方，去参芎、地
黄，加柴胡（一钱五分）、黄芩、麦门冬、紫菀、地骨皮、牡丹皮、贝母、知母、香附、陈皮
（各等分）。
凡火病易效亦易误。医家当按脉辨症而慎治之。
[Pulse]
The pulse is mostly deep, fine, and rapid. It may also be wiry, choppy, and short, or wiry, fine, and faint. If the left-side pulse is larger but forceless, it indicates Blood Deficiency (Xue Xu); if the right-side pulse is larger but forceless, it indicates Qi Deficiency (Qi Xu). If all six positions of the pulse appear large in form but weak upon pressure (Xing Da Li Bo), it indicates both Qi and Blood Deficiency. A slippery and rapid pulse accompanied by sweating indicates sweating; a deep and choppy pulse without sweating indicates no sweating. Fine and rapid pulses at both Chi (Kidney) positions indicate Yin Deficiency with Fire Hyperactivity (Yin Xu Huo Dong), which requires careful differentiation.
[Symptoms]
"Zao Re" (Tidal Fever) resembles the tide, occurring regularly without missing its time, once a day, at a fixed hour, mostly during Shen Hour (15:00-17:00). If it occurs three to five times a day, it is classified as "Fa Re" (Fever), not Zao Re. Tidal fever caused by Qi Deficiency occurs at Ping Dan (early morning) and is governed by Lung Qi; tidal fever caused by Blood Deficiency occurs at Bu Hour (15:00-17:00) and is governed by Kidney Qi. Tidal fever with night sweats caused by Yin Deficiency with Fire Hyperactivity results from damage to Qi and Blood, and etiology should also be sought in the Lung (Metal) and Kidney (Water) organs. Generally, Zao Re belongs to Deficiency patterns, while Fa Re belongs to Excess patterns, and their treatments differ.
[Treatment Principles]
Tidal fever occurring at Ping Dan (early morning) belongs to Yang and is governed by the Heart and Lung. Use Renshen Baihu Tang (Ginseng White Tiger Decoction) with added Huang Qin (Scutellariae Radix). Tidal fever occurring at Bu Hour (15:00-17:00) belongs to Yin and is governed by the Spleen and Kidney. Use Siwu Tang (Four Substance Decoction) with added Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Mudanpi (Moutan Cortex), Digupi (Lycii Cortex), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex). For tidal fever with fine and rapid pulses caused by Yin Deficiency with Fire Hyperactivity, use Bawu Tang (Eight Substance Decoction) with added Zhimu, Huangbai, Maidong (Ophiopogonis Radix), Chaihu (Bupleuri Radix), and Digupi. Broadly speaking, for treating tidal fever, Siwu Tang (Four Substance Decoction) with Chaihu, Huang Qin, and Sheng Gancao (Raw Licorice Root) is suitable. For onset at Chen Hour (07:00-09:00), add Qianghuo (Notopterygii Rhizoma et Radix); for Wu Hour (11:00-13:00), add Huang Lian (Coptidis Rhizoma); for Wei Hour (13:00-15:00), add Shigao (Gypsum Fibrosum); for Shen Hour (15:00-17:00), add Shengma (Cimicifugae Rhizoma); for nighttime onset, add Danggui (Angelicae Sinensis Radix) and Zhimu; for daytime onset, add Digupi and Renshen (Ginseng Radix et Rhizoma). In cases of Blood Deficiency, increase Danggui and Dihuang (Rehmanniae Radix); in cases of Qi Deficiency, increase Renshen, Baizhu, and Huangqi (Astragali Radix). This is the general principle; clinical examination must be detailed.
[Formulas]
Bawu Tang (Eight Substance Decoction) treats night sweats and tidal fever due to combined Qi and Blood Deficiency.
Chuanxiong (7 fen), Danggui (1.5 qian), Baishao (1.5 qian), Renshen (1 qian), Baizhu (1.5 qian), Baifuling (1 qian), Gancao (3 fen), Dihuang (1 qian; use raw Dihuang for cooling blood, cooked Dihuang for tonifying blood).
Take as one dose, decoct with Shengjiang (Fresh Ginger) and Dazao (Jujube), and take after meals. For concurrent symptoms, modify according to the following additions.
For all types of tidal fever, add Huangqi, Huangbai, Zhimu, Chaihu, Mudanpi, and Digupi (equal parts).
For men with Blood Deficiency, sweating, and tidal fever: Remove Chuanxiong from this formula, add Huangqi (1 qian), Chenpi (8 fen), Yuanzhi (Polygalae Radix), Wuzi (Schisandrae Fructus) (each 5 fen), Guanzi (Cinnamomi Ramulus), named Renshen Yangrong Tang (Ginseng Nourishing Glory Decoction). Treats cough with sweating and tidal fever.
For men with Qi Deficiency, sweating, and tidal fever: Reduce/Remove Chuanxiong, Baishao, Shudihuang (Prepared Rehmanniae Radix), and Baifuling from this formula, add Huangqi, Chenpi, Shengma, and Chaihu, named Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If cough is present, add Maidong, Ziwan (Asteris Radix), Wuzi, Huangbai, and Zhimu for better effect.
For men with Blood Deficiency, non-sweating, and tidal fever: Add Chenpi, Banxia (Pinelliae Rhizoma) (each 1 qian), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), Zisu (Perillae Folium), Gange (Puerariae Radix), and Chaihu (each 8 fen), named FulingBXixin Tang (Poria Nourishing Heart Decoction).
For men with Qi Deficiency, non-sweating, and tidal fever: Remove Chuanxiong, Shaoyao, and Dihuang from this formula, add Huangqi, Digupi, Fangfeng (Saposhnikoviae Radix), and Chaihu (equal parts), Bohe (Menthae Haplocalycis Herba) (half dose), named Renshen Qingqi San (Ginseng Clearing Qi Powder).
For men with combined Qi and Blood Deficiency, sweating, tidal fever, and cough: Add Zhimu, Maidong, Mudanpi, Digupi, Chaihu, Beimu (Fritillariae Bulbus), and Ziwan (equal parts), remove Chuanxiong.
For men with combined Qi and Blood Deficiency, non-sweating, tidal fever, and cough: Add Qinjiao (Gentianae Macrophyllae Radix), Digupi, and Chaihu (equal parts), Zisu, Bohe (half dose), Kuaodonghua (Farfarae Flos) (8 fen).
For women with Blood Deficiency, sweating, and tidal fever: Add Huangqi and Mahuanggen (Ephedrae Radix et Rhizoma) (each 1 qian).
For women with Qi Deficiency, sweating, and tidal fever: Remove Chuanxiong and Dihuang from this formula. Add Chaihu, Jingjie (Schizonepetae Spica), Bohe, and Digupi (equal parts).
For women with Blood Deficiency, non-sweating, and tidal fever: Remove Renshen and Huangqi from this formula. Add Qinjiao, Zhimu, Digupi, Shashen (Glehniae Radix), Biejia (Trionycis Carapax), and Qianhu (equal parts).
For women with Qi Deficiency, non-sweating, and tidal fever: Remove Chuanxiong and Dihuang from this formula, add Banxia and Chaihu (each 1 qian), Gange (7 fen), named Renshen Chaihu San (Ginseng Bupleurum Powder).
For women with combined Qi and Blood Deficiency, non-sweating, tidal fever, cough, and hemoptysis: Remove Renshen, Chuanxiong, and Dihuang from this formula. Add Chaihu, Bohe, Digupi, Ziwan, and Maidong (equal parts).
For women with combined Qi and Blood Deficiency, sweating, tidal fever, and cough: Remove Chuanxiong and Baishao from this formula. Add Banxia, Chaihu, Huang Qin, Jiegeng, Ejiao (Colla Corii Asini), and Kuaodonghua (each 8 fen), Zhimu and Maidong (each 1 qian), Wuzi and Bohe (each 5 fen), named Zhimu Fuling Tang (Anemarrhena Poria Decoction).
For men with Yin Deficiency with Fire Hyperactivity, bone-steaming consumptive fever, cough, hemoptysis, and expectoration: Remove Chuanxiong and Renshen from this formula. Add Tiandong (Asparagi Radix), Maidong, Zhimu, Beimu, Huangbai, Yuanzhi, Chenpi, Ejiao, and Bei Wuzi (Schisandrae Fructus) (equal parts), named Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction). This condition strictly forbids excessive use of Renshen and Huangqi. However, if prolonged use of cold-cooling herbs damages the Spleen, leading to combined Qi and Blood Deficiency, Renshen and Huangqi may be used.
For unmarried women with amenorrhea progressing to consumption, spontaneous sweating, tidal fever, cough, and hemoptysis: These are caused by emotional injuries (Seven Emotions) damaging the Heart and Spleen. Use this formula, remove Renshen, Chuanxiong, and Dihuang. Add Chaihu (1.5 qian), Huang Qin, Maidong, Ziwan, Digupi, Mudanpi, Beimu, Zhimu, Xiangfu (Cyperi Rhizoma), and Chenpi (equal parts).
Fire-related diseases are easy to treat effectively but also easy to mismanage. Physicians must carefully examine the pulse and differentiate symptoms before treating.