吐血家脉静身凉。不药可愈。以阴虽亏而阳犹不亢。阴与阳尚得其和。故易愈也。或身有微热。皮毛似汗。
此为阳来求阴。水来就血。亦可自愈。所谓发热者。与身有微热不同。
失血家阳气郁于血分之中。则身热郁冒。但头汗出。身热者。火闭于内。而不得达于外故也。但头汗出者。
火性炎上。外有所束。则火不能四达。故愈炎上。而头汗也。治法宜解其郁。使遍身微汗。则气达于外。而阳
不乘阴。热止血亦治矣。此如盛暑遏热。得汗而解。小柴胡汤主之。
又有瘀血发热者。瘀血在肌肉。则翕翕发热。证象白虎。口渴心烦。肢体刺痛。宜当归补血汤。合甲己化土
汤。加桃仁红花柴胡防风知母石膏。血府逐瘀汤亦治之。瘀血在肌腠。则寒热往来。以肌腠为半表半里。
内阴外阳。互相胜复也。宜小柴胡汤。加当归白芍丹皮桃仁荆芥红花治之。桃奴散。加黄芩柴胡亦治之。
瘀血在腑。则血室主之。证见日晡潮热。昼日明了。暮则谵语。以冲为血海。其脉丽于阳明。故有阳明燥热
之证。桃仁承气汤治之。小柴胡汤。加桃仁丹皮白芍亦治之。瘀血在脏。则肝主之。以肝司血故也。证见骨
蒸痨热。手足心烧。眼目青黑。毛发摧折。世以为难治之证。而不知热血在肝脏使然。宜柴胡清骨散。加桃
仁琥珀干漆丹皮治之。
以上所论。皆属血家发热之实证也。又有发热之虚证。分血虚水虚两类。另条如左。
血虚者。发热汗出。以血不配气。则气盛而外泄也。或夜则发热。以夜主血分故也。或寅卯时即发热。以寅
卯属少阳。肝血既虚。则少阳之相火。当寅卯旺时而发热。地骨皮散。加柴胡青蒿胡黄连云茯苓甘草治
之。又或胞中之火。因血不足。上合阳明燥气。日晡潮热者。犀角地黄汤治之。
水虚者。水为气之所化。水津不足。则气热。皮毛枯燥。口咽生疮。遗精淋秘。午后发热。大补阴丸。以补水济
火。或清燥救肺汤。从肺胃以生水津。水足以濡血。则阳气不亢。燥热自除。五蒸汤亦统治之。
复有阴虚于内。阳浮于外。而发热者。须大补其阴。而复纳其阳。故产后发热。用四物汤。加黑姜。失血发热。
亦可用之。火重者。再加芩连。若肾阴不足。真阳外浮。发热喘促者。是为阴不恋阳。阳不入阴。宜从阴引阳。
用二加龙骨汤。加五味子麦门冬阿胶。或三才汤。加盐炒肉桂少许。桑叶云苓白芍冬虫夏草山茱萸牛
膝五味子知母沉香龟板。此外又有食积发热者。手足心腹热。胸满哕呃。大便不调。日晡及夜发烦。宜枳
壳浓朴大黄。消去之。则不壅热矣。勿谓虚人无实证也。
For patients with hematemesis (vomiting blood), if the pulse is calm and the body is cool, recovery can occur without medication. This is because although Yin fluids are deficient, Yang Qi is not yet hyperactive, allowing Yin and Yang to maintain harmony, thus facilitating easier recovery. If there is slight heat in the body and the skin pores appear moist with sweat, this indicates that Yang Qi is coming to assist Yin, and fluids are nourishing the blood; self-recovery is also possible. The "fever" discussed here differs from slight body heat.
In patients who have lost blood, if Yang Qi becomes stagnant within the Blood aspect, it results in body heat accompanied by dizziness and vertigo, with sweating only on the head. Body heat occurs because Fire is closed internally and cannot reach the exterior. Sweating only on the head happens because the nature of Fire is to flare upwards; when constrained externally (e.g., by closed pores), Fire cannot disperse in all directions, causing it to flare upwards more intensely, resulting in head sweating. The treatment method should focus on resolving stagnation to induce mild sweating over the entire body. This allows Qi to reach the exterior, preventing Yang from invading Yin. Once heat subsides and bleeding stops, the condition is cured. This is akin to resolving heat trapped during midsummer through sweating. The primary formula is Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Another cause of fever is blood stasis. If blood stasis resides in the muscles, it presents as intermittent fever resembling Bai Hu Tang syndrome, accompanied by thirst, irritability, and stabbing pain in the limbs. Dang Gui Bu Xue Tang (Astragalus and Angelica Decoction) combined with Jia Ji Hua Tu Tang (Wood-Earth Transforming Earth Decoction), added with Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Chai Hu (Bupleuri Radix), Fang Feng (Saposhnikoviae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Shi Gao (Gypsum Fibrosum) is indicated. Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) is also applicable. If blood stasis is in the muscle-couplings (interstitial spaces between skin and muscle), alternating chills and fever occur because this area belongs to the half-exterior and half-interior, where internal Yin and external Yang compete and alternate. Xiao Chai Hu Tang added with Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Mu Dan Pi (Moutan Cortex), Tao Ren, Jing Jie (Schizonepetae Spica), and Hong Hua is suitable. Tao Nu San (Decoction of Peach Bud) added with Huang Qin (Scutellariae Radix) and Chai Hu is also effective.
If blood stasis is in the Fu organs, it involves the Blood Chamber (Xue Shi). Symptoms include tidal fever at Ding Wu (3-5 PM), clear consciousness during the day, and delirium at night. Since the Chong Mai (Penetrating Vessel) is the Sea of Blood and its pulse attaches to the Yangming channel, Yangming dryness-heat symptoms appear. Tao Ren Cheng Qi Tang (Persicae and Rheum Decoction for Directing Downward) treats this. Xiao Chai Hu Tang added with Tao Ren, Mu Dan Pi, and Bai Shao is also effective. If blood stasis is in the Zang organs, it involves the Liver, as the Liver governs Blood. Symptoms include bone-steaming tubercular fever, burning sensation in the palms and soles, dark/blackish eyes, and brittle hair. Although considered difficult to treat, this is caused by hot blood residing in the Liver. Chai Hu Qing Gu San (Bupleurum Decoction for Clearing Bone Heat) added with Tao Ren, Hu Po (Fossilia Subcorium), Gan Qi (Drynariae Rhizoma), and Mu Dan Pi is indicated.
The above discussions pertain to excess-type fevers in patients with blood disorders. There are also deficiency-type fevers, categorized into Blood Deficiency and Water (Fluid) Deficiency, detailed in separate sections.
In Blood Deficiency, fever and sweating occur because Blood fails to anchor Qi, leading to excessive Qi escaping outward. Fever may occur at night since night governs the Blood aspect. Fever may also start at Yin-Mao hours (3-7 AM) because these hours belong to Shaoyang; with deficient Liver Blood, the Ministerial Fire of Shaoyang flares during its peak time. Di Gu Pi San (Lycii Cortex Powder) added with Chai Hu, Qing Hao (Artemisiae Annuae Herba), Hu Huang Lian (Coptidis Rhizoma - specifically H. chinensis or C. deltoidea depending on context, usually Coptis), Lian Qiao (Forsythiae Fructus), Fu Ling (Poria), and Gan Cao (Glycyrrhizae Radix et Rhizoma) is used. Alternatively, if fire in the Bao Zhong (Uterus/Cavity) rises due to insufficient Blood, combining with Yangming dryness-heat to cause tidal fever at Ding Wu, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated.
In Water Deficiency, water is transformed by Qi. Insufficient fluid leads to Qi heat, dry and rough skin, mouth and throat ulcers, spermatorrhea, stranguria, and urinary retention. Afternoon fever occurs. Da Bu Yin Wan (Great Tonifying Yin Pill) is used to tonify water and balance fire. Or Qing Zao Jiu Fei Tang (Clear Dryness and Rescue Lung Decoction) generates fluids from the Lung and Stomach. Sufficient water nourishes blood, preventing Yang hyperactivity and eliminating dryness-heat. Wu Zheng Tang (Five Steaming Decoction) can also manage these conditions.
Furthermore, in cases of internal Yin deficiency with floating Yang causing fever, one must greatly tonify Yin to anchor Yang. For postpartum fever, Si Wu Tang (Four Substance Decoction) added with Hei Jiang (Charred Ginger) is used; it is also applicable for fever after blood loss. If fire is severe, add Huang Qin and Huang Lian. If Kidney Yin is insufficient and True Yang floats outward, causing fever and panting, this indicates Yin failing to retain Yang and Yang failing to enter Yin. Treatment should draw Yang from Yin using Er Jia Long Gu Tang (Two-Added Dragon Bone Decoction) added with Wu Wei Zi (Schisandrae Fructus), Mai Men Dong (Ophiopogonis Tuber), and E Jiao (Colla Corii Asini); or San Cai Tang (Three Talents Decoction) added with a small amount of salt-fried Rou Gui (Cinnamomi Cortex). Other herbs like Sang Ye (Mori Folium), Yun Ling (Poria), Bai Shao, Dong Chong Xia Cao (Cordyceps), Shan Zhu Yu (Corni Fructus), Niu Xi (Achyranthis Bidentatae Radix), Wu Wei Zi, Zhi Mu, Chen Xiang (Aquilariae Lignum), and Gui Ban (Testudinis Carapax et Plastrum) may be selected. Additionally, food stagnation can cause fever, presenting as heat in the palms, soles, and abdomen, chest fullness, hiccups, irregular bowel movements, and irritability in the afternoon and night. Zhi Ke (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), and Da Huang (Rhei Radix et Rhizoma) should be used to eliminate stagnation and prevent heat accumulation. Do not assume that deficient patients lack excess patterns.