大意
经曰。阴虚则发热。此一端也。其他除外感客邪之外。有劳力劳色。气郁火郁。伤食伤酒。挟瘀挟痰。疮毒虚
烦。皆能发热。宜熟辨之。（汇补）
内因
阴虚而阳气偏胜则发热。阳虚而下陷阴中亦发热。（东垣）
外候
五脏发热。各有其状。以手扪之。轻举则热。重按不热。是热在皮毛血脉间也。重按则热。轻举不热。是热在
筋骨间也。轻手重手俱不热。不轻不重乃热者。是热在肌肉间也。肺热者。热在皮肤。日西尤甚。洒淅喘咳。
心热者。热在血脉。日中则甚。心烦掌热。脾热者。热在肌肉。遇夜尤甚。倦怠嗜卧。肝热者。热在筋肉。寅卯则
甚。筋缓善怒。肾热者。热蒸在骨。夜半尤甚。骨蒸如苏。（东垣）
郁火发热
郁火发热。左关弦数有力。或缓弱有力。肌肉如火。筋骨如烧。扪之烙手。或昼夜不减。或夜分即热。天明暂
缓。其热必手足四肢更甚。缘脾主四末。热伏地中故也。此症亦有因血虚而得者。亦有胃虚过食生冷。阴
覆乎阳。郁遏阳气于脾土之中者。宜用火郁发之之法。火郁汤主之。（准绳）
阳郁发热
阳郁发热。由劳役饥饱失宜。其潮热宛类瘵疾。日出气暄则热。天阴夜凉即缓。六脉弦数。宜补中益气汤
加地骨皮。或逍遥散。（汇补）
骨蒸发热
四肢蒸灼如火者。必阴气虚阳气盛。四肢者。诸阳之本也。两阳相搏而阴气虚少。少水不能灭盛火。而阳
独治。独治者。不能生长也。独胜则止耳。如炙如火者。当肉烁也。（素问）外候口干体瘦。食少懒倦。遇夜尤甚。
平旦不觉。宜秦艽鳖甲散主之。（汇补）
内伤发热
内伤饥饿劳倦发热。六脉微弱。或右手大三倍于左手。按之无力。懒言自汗。浑身酸软。甚至肌肤壮热。目
赤面红。谵语烦渴。日夜不息。身不恶寒。为血虚发热。虽像白虎汤症。而脉不长实。宜当归补血汤。（准绳）轻
者头眩倦惰。饮食无味。恶寒发热。时作时止。下午乃发。手心热而手背不热。所谓阳虚下陷发热也。轻者
三发即止。南人呼为劳发者即此。又饮食失节。劳役过度。一切火症。悉属内真寒而外假热。故肚腹频喜
手按。口畏冷物。乃形气病气俱不足也。补中益气汤大剂服之。甚者加附子。若因热而汗下之。立危。（汇补）
阳虚发热
有肾虚水冷。火不归经。游行于外而发热者。自汗。不任风寒。烦渴引饮。不能下咽。面目俱赤。舌生芒刺。两
唇黑裂。喉间如火。两足如烙。痰涎壅盛。喘息不宁。脉浮洪大。按之微弱。宜用八味丸导龙入海。所谓踞其
窟宅而招之。即益火之原以消阴翳也。（汇补）
阴虚发热
有劳心好色。内伤真阴。阴血既伤。阳气独盛。发热不止。向晚更甚。或饮食如常。头胀时作。脉洪数无力。视
其舌。大而色赤者阴虚也。当滋真阴。宜地黄汤。若久而盗汗遗精。咳嗽毛枯。宜三才丸补水以匹火。是亦
壮水之主以镇阳光之义耳。（汇补）
血虚发热
一切吐衄便血。产后崩漏。血虚不能配阳。阳亢发热者。治宜养血。然亦有阳虚而阴走者。不可徒事滋阴。
所以有脱血益气。阳生阴长之法。使无形生出有形来。此千古传心之法。尝见庸流专执四物以争长。此
未明大易之义也。（汇补）
痰症发热
痰症发热。向夜大作。天明渐止。必兼胸膈不快。恶心不食。肢倦体瘦。盖痰滞中宫。阻碍升降。故恶心痞闷。
血无所滋。故夜分转甚。津液不化而体瘦。气血阻滞而倦怠。均宜健脾化痰。宽中清火。则痰利而热除矣。
如果实痰为患。滚痰化痰二丸。皆可选用。（汇补）
伤食发热
伤食发热。必气口紧盛。或沉伏。头疼呕恶。噫气吞酸。胸口饱闷。或胀或痛。手不可按。蒸蒸然热。明知其热
在内也。消导则已。（指掌）若兼左脉弦急。又是伤食夹寒。先宜解表。然后消导。如不愈。后变口舌干燥心下
硬痛等症。当急攻之。大柴胡汤、枳术丸。（汇补）
瘀血发热
瘀血发热。必脉涩。漱水不咽。或痰涎呕恶。或两足厥冷。或胸胁小腹急结。或吐红鼻衄。均宜桃仁承气汤
下之。（仁斋）
疮毒发热
疮毒发热。饮食如故。日晡寒热。拘急倦怠。脉数而急。须问有无痛处。以验其疮毒之候。治先发散。然后和
血。（六要）
作止分辨
夫外感寒热。齐作无间。内伤寒热。间作不齐。此特论其常耳。（东垣）然外感初起似疟状。发亦作止不时。此
邪气尚浅。而未能混淆正气。故乍离乍合。脉必至数有力。仍当解散。更有内伤劳倦。似阳明白虎。发热昼
夜不减。此气血两虚。故亦齐作无间。脉必重按无力。仍当温补。（汇补）
昼夜热辨
昼则发热。夜则安静。是阳气偏胜于阳分也。昼则安静。夜则发热。是阳气下陷于阴中也。昼则发热烦躁。
夜亦发热烦躁。是重阳无阴也。（东垣）更有昼热阳虚。口中无味。病责之胃。宜甘温补气。暮热阴虚。口中有
味。病责之肾。宜甘寒滋阴。（汇补）
三焦热辨
热在上焦。咽干口糜。热在中焦。心烦口渴。热在下焦。便闭溺赤。（入门）
虚实热辨
胸闷而恶心引饮便实者。实热也。胸爽而少食自汗短气者。虚热也。（入门）
表里热辨
有表症而身热者。外感表热也。无表症而身热者。内伤里热也。（汇补）
气血热辨
气分虚热者。用甘温以除热。盖大热在上。大寒必伏于内。用甘温以助地气。使真气旺而邪火自熄。血分
虚热者。用甘寒以胜热。盖阴火浮于外。必真阴竭于内。用甘寒以补肾。使真水充而虚焰潜灭也。（汇补）
假热有二
如大热而甚。寒之不寒。是无水也。热去复来。昼见夜伏。夜见昼止。时节而动。是无火也。热动复止。倏忽往
来。时作时止。是无水也。当助其肾。又寒之不寒。责肾之虚。寒之不久。责肾之少。方有治热以寒。寒之而谷
食不入。此为气不疏通。壅而为是也。（玄珠）有病热脉数。按之不鼓击于指下者。此阴盛格阳。内真寒而外
假热。阴症似阳也。病热忽寒。手足俱冷。按之脉来鼓击于指下有力者。此阳盛拒阴。外假寒而内实热。阳
症似阴也。（伤寒书）
汇补曰。发热真假。幽显难明。苟不力辨。则刹那生死。能不畏哉。如上所说。深悉玄奥。真化工笔也。然究
其参稽之力。非洞晓易义。不能道其只字。要知阴阳虽备于内经。而变化莫详乎羲画。若是则太少刚
柔。阴阳动静。乌可不究乎哉。既明太少刚柔。阴阳动静。方知阳中有阴。阴中有阳。一切真假逆顺。五脏
幽显。无难推测矣。故医易曰。病治脉药。须识动中有静。声色气味。当知柔里藏刚。知刚柔阴阳之运用。
而医中之玄妙。思过及半矣。
脉法
浮大无力为虚热。沉实有力为实热。病热有火者生。心脉洪大是也。无火者死。心脉细沉是也。脉盛。汗出
不解者死。脉虚。身热不止者死。身有热。脉涩脉静者。皆难治。
治法
小热之气。凉以和之。大热之气。寒以取之。实热之气。下以折之。虚热之气。温以从之。郁热之气。因其势而
发之。假热之气。求其属而衰之。（汇补）
用药
内伤劳役气虚。补中益气汤。肝经郁火发热。逍遥散。血虚发热。四物汤。阴虚发热。六味丸。阳虚发热。八味
丸。郁火发热者。火郁汤。瘀血发热者。当归复元汤。伤食发热者。平胃合二陈小柴胡汤。
发热选方
补中益气汤 六味丸 八味丸 四物汤（四方俱见中风） 逍遥散 火郁汤（二方俱见火症） 秦艽鳖甲散（方见
痨瘵） 桃仁承气汤（见血症） 二陈汤 滚痰丸 化痰丸（三方俱见痰症） 平胃散（方见暑症） 枳术丸（方见伤
食）
当归补血汤
黄 （三钱） 当归（一钱） 枣（二枚）
当归复元汤
柴胡（八分） 当归 穿山甲 花粉（各一钱） 甘草 红花（各七分） 桃仁（钱半） 酒浸大黄（三钱） 加
青皮（七分）
小柴胡汤
人参 柴胡（各一钱） 黄芩（五分） 半夏（七分） 甘草（七分）
加姜、枣。
大柴胡汤
即小柴胡汤加大黄、枳壳、浓朴。
白虎汤
石膏（三钱） 知母 花粉（各一钱半） 甘草（一钱）
加竹叶。粳米。
[General Principle]
The *Neijing* states: "Yin deficiency leads to fever." This is but one category. Besides external pathogenic factors, there are other causes such as overexertion, sexual exhaustion, Qi stagnation, Fire constraint, dietary injury, alcohol damage, concurrent blood stasis, concurrent phlegm-dampness, toxin from sores/ulcers, and deficiency vexation, all of which can cause fever. Careful differentiation is required. (From *Zhengzhi Huibu*)
[Etiology]
When Yin is deficient and Yang is hyperactive, fever occurs; when Yang is deficient and sinks into the Yin level, fever also occurs. (From Li Dongyuan)
[External Manifestations]
Fever originating from the five Zang organs has distinct characteristics. Palpating the body: if heat is felt with light pressure but not heavy pressure, the heat is in the skin, hair, and vessels; if heat is felt with heavy pressure but not light pressure, the heat is in the sinews and bones; if neither light nor heavy pressure elicits heat, but moderate pressure does, the heat is in the muscles.
Lung heat: Heat is in the skin, worse in the evening, accompanied by chills, panting, and coughing.
Heart heat: Heat is in the vessels, worse at noon, accompanied by mental restlessness and hot palms.
Spleen heat: Heat is in the muscles, worse at night, accompanied by fatigue and drowsiness.
Liver heat: Heat is in the sinews and flesh, worse during the Yin-Mao hours (3-7 AM), accompanied by flaccid sinews and irritability.
Kidney heat: Heat steams within the bones, worse at midnight, presenting as bone-steaming sensation. (From Li Dongyuan)
[Fever due to Constrained Fire]
Fever due to constrained fire presents with a wiry and rapid, forceful pulse at the left Guan position, or a slow/weak yet forceful pulse. The muscles feel like fire, the bones feel like burning, and palpation reveals scalding heat. The heat may be constant day and night, or appear only at night and temporarily subside at dawn. The heat in the hands and feet is particularly severe because the Spleen governs the four extremities, and the heat is concealed deep within. This condition may also arise from Blood deficiency, or from Stomach deficiency combined with excessive consumption of cold/raw foods, causing Yin cold to cover Yang and constrain Yang Qi within the Spleen Earth. The treatment principle is to disperse constrained fire using the method of "dispersing constrained fire," primarily using Huoyu Tang. (From *Yixue Zhunsheng*)
[Fever due to Constrained Yang]
Fever due to constrained Yang results from labor, fatigue, and irregular eating habits. The tidal fever resembles tuberculosis (consumption). Fever occurs when the sun rises and the air warms, and subsides when the sky is cloudy and nights are cool. The six pulses are wiry and rapid. Treatment involves Buzhong Yiqi Tang added with Digupi, or Xiaoyao San. (From *Zhengzhi Huibu*)
[Bone-Steaming Fever]
When the four limbs steam and burn like fire, it indicates Yin deficiency and Yang excess. The four limbs are the root of all Yang meridians. When two Yangs contend and Yin is insufficient, little water cannot extinguish raging fire, leaving Yang to dominate alone. Dominance without balance prevents growth; it is merely solitary excess. Like being roasted, this leads to muscle wasting. (From *Suwen*) External signs include dry mouth, emaciation, poor appetite, lassitude, worsening at night, and no fever at dawn. Qinjiao Biejia San is indicated. (From *Zhengzhi Huibu*)
[Internal Injury Fever]
Fever due to internal injury from hunger, fatigue, and overwork presents with weak pulses, or a Right Cun pulse three times larger than the Left, forceless upon pressure. Symptoms include reluctance to speak, spontaneous sweating, generalized soreness, and even high fever, red eyes, flushed face, delirium, thirst, occurring day and night without cessation, without aversion to cold. This is Blood deficiency fever. Although it resembles Baihu Tang syndrome, the pulse is not long and solid; Danggui Buxue Tang is indicated. (From *Yixue Zhunsheng*)
Milder cases present with dizziness, lethargy, loss of taste, alternating aversion to cold and fever, starting in the afternoon, with hot palms but cool backs of hands. This is Yang deficiency sinking fever. Milder cases stop after three episodes; Southerners call this "Labor Fever."
Furthermore, irregular diet and excessive labor leading to various Fire syndromes belong to "True Cold Inside, False Heat Outside." Thus, the abdomen prefers pressure, and the mouth fears cold substances. This indicates insufficiency of both Form-Qi and Pathogenic-Qi. Large doses of Buzhong Yiqi Tang should be taken; for severe cases, Fuzi is added. Using diaphoresis or purgatives for fever will lead to immediate danger. (From *Zhengzhi Huibu*)
[Yang Deficiency Fever]
In cases of Kidney deficiency with cold water, Fire fails to return to its source and wanders outward, causing fever. Symptoms include spontaneous sweating, intolerance to wind-cold, vexation and thirst with inability to swallow fluids, flushed face and eyes, prickly tongue, cracked black lips, throat feeling like fire, feet feeling like scalding, copious phlegm-saliva, restless panting, floating-large pulse that is weak upon pressure. Eight Flavor Rehmannia Pill (Bawei Wan) is used to guide the Dragon back to the sea, i.e., occupying its lair to attract it, which means benefiting the source of Fire to eliminate Yin shadows. (From *Zhengzhi Huibu*)
[Yin Deficiency Fever]
Due to mental overwork and excessive sexual activity injuring True Yin, once Yin Blood is damaged, Yang becomes solitary and excessive, causing persistent fever, worse in the evening. Diet may remain normal, with occasional head distension. The pulse is large-rapid but forceless. A large, red tongue indicates Yin deficiency. Nourish True Yin using Dihuang Tang. If prolonged with night sweats, spermatorrhea, cough, and withered hair, Santian Wan is used to tonify Water to match Fire, following the principle of strengthening the Master of Water to suppress Solar flare. (From *Zhengzhi Huibu*)
[Blood Deficiency Fever]
For all types of hematemesis, epistaxis, hematochezia, postpartum flooding, where Blood deficiency fails to control Yang, leading to Yang hyperactivity and fever, treatment should nourish Blood. However, there are cases where Yang deficiency causes Yin to leak; thus, one must not solely rely on nourishing Yin. Hence the method of "Tonifying Qi for Hemorrhage" and "Yang generates Yin," allowing无形 (formless) Qi to generate 有形 (formed) Blood. This is an ancient secret method. I have seen mediocre physicians stubbornly adhering to Siwu Tang, failing to understand the Great Meaning of the *I Ching*. (From *Zhengzhi Huibu*)
[Phlegm Syndrome Fever]
Phlegm syndrome fever worsens at night and subsides at dawn, accompanied by chest oppression, nausea, anorexia, limb fatigue, and emaciation. Phlegm stagnates in the Middle Palace (Spleen/Stomach), obstructing ascending and descending movements, causing nausea and fullness. Blood lacks nourishment, hence worsening at night. Fluids fail to transform, causing emaciation; Qi and Blood obstruction causes fatigue. Treatment should invigorate the Spleen, resolve phlegm, broaden the middle, and clear fire, so that phlegm clears and fever subsides. For excess phlegm, Kundan Wan or Huatan Wan may be selected. (From *Zhengzhi Huibu*)
[Dietary Injury Fever]
Fever due to dietary injury presents with a tight or submerged pulse at the Qikou position, headache, nausea/vomiting, belching, acid regurgitation, chest fullness, distension or pain, tenderness to touch, and steaming heat, indicating heat inside. Resolution and digestion will cure it. (From *Yizong Jinjian*) If accompanied by a wiry-tight Left pulse, it is dietary injury with cold. First release the exterior, then digest food. If unresolved, progressing to dry mouth/tongue and hard/painful epigastrium, urgent purgation is needed using Daxiehu Tang or Zhizhu Wan. (From *Zhengzhi Huibu*)
[Blood Stasis Fever]
Fever due to blood stasis presents with a choppy pulse, rinsing mouth without swallowing, or phlegm-saliva with nausea/vomiting, cold feet, hypochondriac/lower abdominal urgency/clumping, or hematemesis/epistaxis. Tao Ren Chengqi Tang is indicated for purgation. (From *Renzhai Zhizhi Fanglun*)
[Sore-Toxin Fever]
Fever due to sore-toxins presents with normal diet, alternating chills and fever in the late afternoon (You hour), stiffness, fatigue, rapid and urgent pulse. One must ask about painful areas to verify the presence of sores/toxins. Treatment first disperses pathogens, then harmonizes Blood. (From *Jingyue Quanshu*)
[Differentiation of Onset and Cessation]
External contraction chills/fever occur simultaneously without interruption; internal injury chills/fever occur intermittently. This describes the norm. (From Li Dongyuan) However, early external contraction resembles malaria with irregular onset, as pathogens are shallow and have not confused Zheng Qi, so they come and go. Pulses are forceful; release the exterior is still indicated. Internal injury/fatigue may resemble Yangming Baihu syndrome with constant day/night fever due to Qi/Blood deficiency, also occurring continuously, but pulses are forceless upon deep pressure; warming and tonification is indicated. (From *Zhengzhi Huibu*)
[Differentiation by Day/Night]
Daytime fever, nighttime quietness: Yang excess in Yang level. Daytime quietness, nighttime fever: Yang sinking into Yin. Daytime fever/restlessness, nighttime fever/restlessness: Extreme Yang without Yin. (From Li Dongyuan) Additionally, daytime heat with Yang deficiency and tasteless mouth points to Stomach disease; treat with sweet-warm Qi tonification. Evening heat with Yin deficiency and flavorful mouth points to Kidney disease; treat with sweet-cool Yin nourishment. (From *Zhengzhi Huibu*)
[Three Burner Differentiation]
Heat in Upper Burner: dry throat, oral ulceration. Heat in Middle Burner: vexation, thirst. Heat in Lower Burner: constipation, dark urine. (From *Yixue Rumen*)
[Deficiency/Excess Heat Differentiation]
Chest oppression, nausea, thirst, constipation: Excess Heat. Chest comfort, poor appetite, spontaneous sweating, shortness of breath: Deficiency Heat. (From *Yixue Rumen*)
[Exterior/Interior Heat Differentiation]
Body heat with exterior symptoms: Exterior Heat from external contraction. Body heat without exterior symptoms: Interior Heat from internal injury. (From *Zhengzhi Huibu*)
[Qi/Blood Heat Differentiation]
Qi-level deficiency heat: Use sweet-warm to remove heat. Great heat above implies great cold hidden inside; sweet-warm aids Earth Qi, strengthening True Qi to extinguish pathogenic fire. Blood-level deficiency heat: Use sweet-cool to overcome heat. Yin fire floating outside implies True Yin exhausted inside; sweet-cool tonifies Kidney, filling True Water to extinguish defamatory flames. (From *Zhengzhi Huibu*)
[Two Types of False Heat]
1. Extreme heat unresponsive to cold herbs: Water deficiency (Yin deficiency).
2. Heat returns after subsiding, appearing by day and hiding by night, or vice versa, moving with seasons: Fire deficiency (Yang deficiency).
3. Heat fluctuates, coming and going suddenly, intermittent: Water deficiency (Yin deficiency). Tonify the Kidney.
If cold fails to reduce heat, blame Kidney deficiency; if cold effect is short-lived, blame Kidney insufficiency. Regarding treating heat with cold: if cold herbs prevent food intake, it is due to Qi obstruction and congestion. (From *Xuanzhu Mi Yu*)
Disease with heat and rapid pulse, but forceless upon pressure: Yin excess repelling Yang, True Cold Inside, False Heat Outside, Yin syndrome resembling Yang.
Disease with sudden chill, cold limbs, but forceful pulse upon pressure: Yang excess repelling Yin, False Cold Outside, True Heat Inside, Yang syndrome resembling Yin. (From *Shanghan Shu*)
*Zhengzhi Huibu* remarks: The truth and falsehood of fever are profound and difficult to clarify. Without vigorous differentiation, life and death hang in the balance. The above explanations reveal profound mysteries, truly masterful writing. However, such analysis requires deep understanding of the *I Ching*. While Yin-Yang is complete in the *Neijing*, changes are most detailed in Fuxi's trigrams. Therefore, Shaoyang/Taiyang, Gang/Rou, Yin/Yang, Motion/Quietness must be studied. Understanding these reveals Yin within Yang and Yang within Yin, making prediction of truth/falsehood, reversal/adherence, and Zang organ mysteries easy. Thus, medical Yi-Jing states: In treating disease, diagnosing pulses, and prescribing, recognize Quietness within Motion; in voice/color/smell/taste, recognize Rigidity within Softness. Knowing the application of Gang/Rou and Yin/Yang covers half the mystery of medicine.
[Pulse Methods]
Floating-large and forceless: Deficiency Heat. Sunken-solid and forceful: Excess Heat. Disease with heat and Fire presence survives (Heart pulse large-rapid); without Fire dies (Heart pulse fine-sunken). Pulse strong, sweating does not resolve: Death. Pulse weak, fever persists: Death. Body heat with choppy or quiet pulse: Difficult to treat.
[Treatment Methods]
Minor heat: Cool to harmonize. Major heat: Cold to subdue. Excess heat: Purge to break. Deficiency heat: Warm to follow. Constrained heat: Disperse according to trend. False heat: Seek its root to diminish. (From *Zhengzhi Huibu*)
[Medication]
Internal injury, labor, Qi deficiency: Buzhong Yiqi Tang. Liver channel constrained fire: Xiaoyao San. Blood deficiency fever: Siwu Tang. Yin deficiency fever: Liuwei Wan. Yang deficiency fever: Bawei Wan. Constrained fire fever: Huoyu Tang. Blood stasis fever: Danggui Fuyuan Tang. Dietary injury fever: Pingwei San combined with Erchen Tang and Xiao'erhu Tang.
[Selected Formulas for Fever]
Buzhong Yiqi Tang, Liuwei Wan, Bawei Wan, Siwu Tang (see Stroke), Xiaoyao San, Huoyu Tang (see Fire Syndromes), Qinjiao Biejia San (see Consumption), Tao Ren Chengqi Tang (see Bleeding Disorders), Erchen Tang, Kundan Wan, Huatan Wan (see Phlegm Syndromes), Pingwei San (see Summerheat), Zhizhu Wan (see Dietary Injury).
Danggui Buxue Tang
Huangqi (3 qian), Danggui (1 qian), Jujube (2 pieces).
Danggui Fuyuan Tang
Chaihu (8 fen), Danggui, Schisandra chinensis? (Note: Text says Chuanshanjia - Pangolin scales), Shihu/Fenhua (each 1 qian), Gancao, Honghua (each 7 fen), Taoren (1.5 qian), Wine-soaked Dahuang (3 qian), add Qingpi (7 fen).
Xiao'erhu Tang
Renshen, Chaihu (each 1 qian), Huangqin (5 fen), Banxia (7 fen), Gancao (7 fen). Add Ginger, Jujube.
Da'erhu Tang
Same as Xiao'erhu Tang plus Dahuang, Zhike, Houpo.
Baihu Tang
Shigao (3 qian), Zhimu, Fenhua (each 1.5 qian), Gancao (1 qian). Add Zhuye, Jingmi.