治大人小儿时气瘟疫,头痛发热,肢体烦疼,及疮疹未发,凝似之间,并宜服之。
升麻 白芍 甘草(各一钱) 葛根(二钱)
水煎服。
治小儿感冒发热。
前胡(一钱四分) 柴胡 半夏(汤泡,七次) 黄芩 人参 桔梗 甘草(各七分)
姜枣水煎,温服。
治感寒头昏体热,小儿乳母同服。
紫麻叶 香附子(炒) 橘皮 甘草 桔梗 白芷 川芎 姜枣水煎服。一方加麻
黄
治小儿血气壅盛,脏腑生热,颊赤多涕,五心烦热,咽喉闭痛,乳哺不时,寒温
无度,潮热往来,睡卧不安,手足振掉,欲生风候。
人参 川芎 防风 当归尾 赤芍药 大黄(裹煨) 甘草 入灯心七茎,麦门
冬去心七粒,同煎,不拘时服。
治婴孩温壮伏热来去。
柴胡 麦门冬(去心) 人参 赤茯苓 甘草 黄芩 加小麦二十粒,竹叶三
片,水煎服。
黄柏(制,三钱) 知母(二钱) 桂(五分) 为末,热水丸,百沸汤下。
小儿百日内,忽作寒热,与寒药反作呕吐,与热药其病益加,乃于石室得秘术,歌
云∶桃花阴末一钱余,甘草冲汤力更殊,蓝花只须二二字,灌之入口立消除。
发热证候不一,故诸方不可备载,各具本门。
夫人居处清净,则阳气周密,邪不能害。若在事烦劳,则阳气解散,邪入伤人,
七情伤气,饮食伤形,风寒暑湿伤神,饮食男女伤阴,故《经》曰∶邪之生也,或生于
阴,或生于阳。生于阳者,得之风邪寒暑;生于阴者,得之饮食居处,阴阳喜怒。故发
热症候不一,治各不同,有外感内伤之迥别,寒热补泻之有殊。如伤寒伤风,此外感
也。自表入里,宜发表以解散之,此麻黄桂枝之义。以其感于冬令寒冷之日,实时发
病,故谓之伤寒,而药用辛热,以胜寒。若时非寒冷,则药当以随时处变矣。如春温之
月,则当变以辛凉之药,如夏暑之月,即当变以甘苦寒之药。又云∶冬伤寒不即病,至
春变温,至夏变热,其治法必四时而有异也。又有一种冬温之病,谓之非其时而有其
病。盖冬寒时也,而反病温焉,此天时不正,阳气反泄,用药不可温热。又有一种时
行寒疫,却在温暖之时,时本温暖,而寒反为病,此亦天时不正,阴气反逆,用药不可
寒凉,又有一种天行温疫热病,多发于春夏之间,沿门阖境相同者,此天地之疠气,当
随时令,参运气而施治,宜用河间辛凉甘苦寒之药,以清热解毒,以上诸症,皆外感天
地之邪者也。若夫饮食劳倦,内伤元气,《经》曰∶有所劳倦,形气衰少,谷气不胜,
(言胃虚谷少,不能胜任其劳倦也。)上焦不行,(言清气不升也。)下脘不通,(言浊
明不降也。)胃气热,(浊阴不降,故胃气热。)热气熏胸中,(少只皆成壮火而上
炎,)故内热。此系真阳下陷,内生虚热,故东垣发补中益气之论,用人参、黄 ,甘温
之药,大补其气,而提其下陷,此用气药以补气之不足者也。又,若劳心好色,内伤真
阴,阴血既伤,则阳气偏胜,而变为火矣。是为阴虚火旺劳瘵之症,故丹溪发阳有余,
阴不足之论,用四物加知柏,补其阴,而火自降,此用血药以补血之不足者也。益气补
阴,皆内伤症也。一则因阳气之下陷,而补其气以升提之,一则因阳火之上升,而滋阴
以降下之,一升一降,迥然不同矣。又有夏月伤暑之病,虽属外感,却类内伤,与伤寒
大异。盖寒伤形,寒邪客表、有余之症,故宜汗之。暑伤气,元气为热所伤而耗散,不
足之症,故宜补之,东垣所谓清暑益气者是也。又有因时暑热,过食冷物,以伤其内,
或过取凉风,以伤其外,此则非暑伤人,乃因暑而自致之病,治宜辛热解表,或辛温理
中之药,却与伤寒治法相类者也。凡此数症,皆外形相似,而虚实大有不同,治法多
端,不可妄谬,故必审其果,为伤寒伤风及寒疫也,则用仲景法。若果为温病热病及温
疫也,则用河间法。果为气虚也,则用东垣法。果为阴虚也,则用丹溪法。如是则药无
误用,而天人性命者矣。令人但见发热之症,一概认作伤寒外感,率用汗药以发其
表,汗后不解,又有表药以凉其肌,设是虚症,岂不误哉!更有一闻,因虚而发致发热
者,遂用补药,又不知气血之分,或气病而补血,或血病而补气,害人亦多矣。故外感
之与内伤,寒病之与热炳,气虚之与血虚水炭相反,治之若差,则轻病必重,重病必
死矣,可不慎欤!
《经》曰∶春气在经脉,夏气在孙络,长夏气在肌肉,秋气在皮肤,冬气在骨髓
中。是故邪气者,常随四时之气血而入客也。至其变化,不可为度。然必从其经气,
辟除其邪。
发热之症,实非一端,前论已详,不复再举,令于发热症下,再具阳虚阴虚,二者
以申之。夫阳虚阴虚二症,凡昼夜发热,昼重夜轻,口中无味,阳虚之证也。午后发
热,夜半则止,口中有味,阴虚之症也。阳全阴半,阳得以兼阴,阴不得已兼阳,自然
之理也。阳虚之症责在胃,阴虚之症责在肾,盖饥饱伤胃,则阳气虚矣;房劳伤肾,
则阴血虚矣。以药而论之,甘温则能补阳气,苦寒则能补阴血,如四君以补气,四物
以补血是也。若气血两虚,但以甘温之剂以补其气为先,兼补其血,盖气旺则能生血
也。若只血虚而气不虚,忌用甘温之剂,以补其气,盖旺则阴血愈消矣。故阳虚之与阴
虚,苦寒之与甘温,不可不详审而明辩之。虚热大禁发汗,退热不可过用凉剂,故有和
取从折属之五法,皆可合宜采用。《经》曰∶阴气不足,则内热乃真不足也。阳气有余则
外热,乃假有余也。凡人元气素弱,或因起居失宜,或因饮食劳倦,或因用心太过,以
致遗精白浊,自汗盗汗,或内热晡热潮热发热,口干作渴,喉痛舌裂,或胸乳膨胀,胁
肚作痛,头颈时疼,眩晕目花,或心神不宁,寐而不寐,小便赤涩,茎中作痛,便溺
余沥,脐腹阴冷,或形容不充,肢体畏寒,鼻气急促,一切热症,皆是无根虚火,但服
十全大补,有益气汤之类,固其根本,诸症自息。若攻其风热则误矣。
阴虚发热,丹溪用四物加知柏,何如六
味壮水之主,以镇阳光?八味益火之源,以消阴翳,为同气相求之妙。
有因大劳,复感风水暑热,或发似疟症,或夜发热咳嗽,医者但知有劳,而不知
外邪内陷,误与补药,其邪留滞血脉之间,随气升降,其热如阴虚火动之状而游走经
络,此又不可作阴虚火动治也。当以柴葛羌防轻扬之剂,佐以参归抚芎香附之类,以导
散之。然阴虚火动之脉,则涩数而无力;外邪内郁之脉,则弦数而有力,是其异也。
有因饮食失宜,日晡发热,口干体倦,小便赤涩,两腿酸痛,一切阴亏症见,而系
脾虚者,盖脾为至阴而生血,然禀气于胃,宜用甘温之剂,生发胃中元气而除大热,不
可误用苦寒,复伤脾血。若果属肾经阴虚,亦因肾经阳虚,不能生阴耳。《经》曰∶无
阳则阴无以生,无阴则阳无以化。不可误投知柏,反伤胃中生气,宜滋肾中水火以固本
补脾土,以滋化源,万举万当。
有称发热为劳发者,盖谓劳力辛苦不能收摄,以致元阳浮越在外也,即东垣所谓内
伤。若一发散,不更元阳脱尽。若一苦寒,不更虚阳顿亡。
《经》曰∶阳虚则外寒,阴盛则内热,阳盛则外热,阴盛则内寒。盖阳受气于上
焦,以温皮肤分肉之间,令寒气在外、则上焦不通,上焦不通,则寒气独留于外,故寒
栗也。若有所劳倦,形气衰少,谷气不盛,上焦不行,下脘不通,骨气热,热气熏胸
中,故内热也。若上焦不通利,则皮肤致密,腰理闭塞,玄府不通,卫气不得泄逆,
故外热也。若阳气上逆,寒气积于胸中而不泻,不泻则温气去寒独留,则血凝泣,凝则
脉不通,其脉盛大以涩,故中寒也。若夜则恶寒,昼则安静,是阴血自旺于阴分也。夜
则恶寒,昼亦恶寒,是重阴无阳也。夜则安静,昼则恶寒是阴气自旺于阳中也。昼则发
热,夜则安静,是阳气自旺于阳分也。昼则安静,夜则发热烦躁,是阳气下陷入阴中
也。昼则发热烦躁,夜亦发热烦躁,是重阳无阴也。子午潮热,一切发热憎寒者,邪在
半表半里也。烦属阳,为有根之火,多出于心也。躁属阴,为无根之火,多起于肾也。
病热而脉数按之不鼓动者,乃寒盛格阳,实非热也。形症似寒,按之而鼓指有力者,此
为热盛拒阴,实非寒也。寸口脉微,为阳不足,阴气上入阳中,则洒浙恶寒也。尺脉
弱,为阴不足,阳气下陷入阴中,则发热也。内伤发热是阳气自伤,不能布达,降下
阴分,而为内热,乃阳虚也。故其脉大而无力,属脾肺,宜补中汤以升补阳气。若阴虚
发热,是阴血自伤,不能制火,致阳气升腾,而为表热,乃阳旺也。阴虚也,故其脉
数而无力,属心肾,宜六味丸,以培补阴血。然虽有阴阳气血之分,总不出脾胃阳气
不足,无以输化所致,一切寒凉俱宜禁用。
凡不时发热者,阳浮在外,里无火也。倦怠少食者,中气不健运也。口干喜饮者,
引水自救,里无水也。脉大无力为阳虚,脉数有力为阴虚,法当湿补,以敛浮阳,脉虽
鼓指有力,此真气虚而邪气实也。
伤寒发热,是寒邪入卫,阳气交争,而为外热,夫阳气主外,为寒所伤而失职,故
为热。其脉紧而有力,是外之寒邪,伤卫也,治主乎外。伤暑发热,是火邪伤心,元
气耗散,而邪热客入于中,故发为热。汗大泄,无气以动,其脉虚迟而无力,是外之热
邪伤荣也,治主乎内。凡病有感者,在皮毛为轻,有伤者,在肌肉稍重,有中者,属脏
腑最重。
凡当外感内伤之后,身中之元气已虚,身中之邪热未尽,于此补虚则热不可除,于
此清热则虚不能任,半补半清,终非良法,故补虚有二法,一补脾,一养胃。如疟痢后
脾气衰弱,饮食不能运化,宜补其脾。如伤寒后,胃中津液久耗者,新者未生,宜养其
胃。二者有霄壤之殊也。清热,亦有二法。初病之热为实热。宜用苦寒之药清之;大病
后之热为虚热,宜用甘寒之药滋之。二者,亦有霄壤之殊也。况人天真之气,全在胃
中,津液不足,生津即是补虚,胃中阳气衰微,温暖即是补虚。脾阴不足,补气须兼润
剂。脾气虚寒,补中更要回阳。然天真之源,尤在两肾,寒者温之,热者滋之,阳和
得中,无过不及,则所谓少火生气,使气能煦,而血自濡矣。
虚实症候,皆可发热,辨认不真,治则舛锗。大抵人迎脉大于气口为外感;气口脉
大于人迎为内伤。浮数为外热,沉数为内热;浮大有力为外热,沉大有力为内热;浮
大无力为虚,沉细有力为实。脉紧恶寒谓之伤寒,脉缓恶风谓之伤风;脉盛壮热谓之伤
热,脉虚身热谓之伤暑,热而精神不倦,能言有力者为实,精神倦怠懒言无力者为虚。
初按则热,久按不热者,是里阳浮表也,为虚;初按则热,久按愈热者,是里热彻表
也,为实。壮热时常不减,头足身体一样火烙者,为实;如乍热乍减,头热足冷者,此
无根之火,浮越在表在上也,为虚。口干饮冷而多者为实;口干饮汤而少者为虚。身壮
热而脉沉细,及极大极数,按之乍大乍大者为虚;身微热而脉洪数不改者为实。身热无
汗,二便闭涩者为实;身热有汗,二便通调者为虚;有表而热属表,元表而热属里。发
热恶寒者,阳也;无热恶寒者,阴也。时当秋冬收敛闭藏发热者多实;当春夏升生浮长
发热者多虚。总热之来,由于里出,或外邪感凑,扰动清阳,或内滞蒸郁,酿成壮火,
舍此二实之候,其余非气虚不能收摄元阳,即阴虚不能镇约雷火。潮热之症,有阴阳之
分,平旦潮热自寅至申,行阳二十五度,诸阳用事,热在行阳之分,肺气主之,日晡潮
热自申至寅,行阴二十五度,诸阴用事,热在行阴之分,肾气主之,一以清肺,一以滋
肾。若气虚潮热,参、 、熟、附,所谓温能除大热也。血虚潮热,归、芍、骨皮,所
谓养阴退阳也。
凡身虽热而脉和思食者,此表病而里不病也。薄粥浓饮,听其自然,只可节之,不
可绝之。常见因热而绝其食,以致中气日虚,里不病者,而亦病焉。若身热而脉微懒
食者,引表病有余,而里气不足也。只宜调脾养胃,以敛虚阳。火与元气,势不两立,
元气复而火热自己,所谓甘温能除大热也。若身热而脉弦数无力者,此阴虚不能敛阳
也,宜养阴以退之。若初病身热而脉浮洪有力者,外感也,从外治。若初病身热而脉沉
数有力者,此内伤也,从内治。久则不分内外,未有元气不伤,便宜或从阳虚,或从阴
虚,顾本为治。盖初病当分内外,久则总致一虚,此(张)之管见也。
病热有火者生,心脉洪是也。无火者死。沉细是也。沉细或数者,死。浮而涩,
涩而身有热者,死。热而脉静者,难治。脉盛汗出不解者,死。脉虚热不止者,死。三
治疗成人和儿童时行疫病,出现头痛发热、肢体烦痛,以及疮疹尚未发出、处于疑似阶段的情况,都适宜服用此方。
升麻 白芍 甘草(各一钱) 葛根(二钱)
用水煎煮后服用。
治疗小儿感冒发热。
前胡(一钱四分) 柴胡 半夏(用汤浸泡七次) 黄芩 人参 桔梗 甘草(各七分)
用生姜和大枣的水煎煮,温服。
治疗因感受寒邪导致的头昏体热,小儿及其乳母同时服用。
紫苏叶 香附子(炒制) 橘皮 甘草 桔梗 白芷 川芎 用生姜和大枣的水煎煮服用。另一方案加入麻黄。
治疗小儿气血壅盛,脏腑产生内热,脸颊发红、鼻涕多,五心烦热,咽喉闭塞疼痛,哺乳不定时,寒热无度,潮热往来,睡眠卧不安稳,手足震颤抖动,有欲发惊风的征兆。
人参 川芎 防风 当归尾 赤芍药 大黄(包裹后煨制) 甘草 加入灯心草七茎,麦门冬去心七粒,共同煎煮,不拘时间服用。
治疗婴幼儿温热壮热伏热来去不定。
柴胡 麦门冬(去心) 人参 赤茯苓 甘草 加小麦二十粒,竹叶三片,用水煎煮服用。
黄柏(炮制,三钱) 知母(二钱) 桂枝(五分) 研为细末,用热水泛丸,用滚开水送服。
婴儿在百日内,忽然出现寒热症状,若用寒凉药反而引起呕吐,若用温热药病情加重,这是在石室得到的秘术,歌诀说:桃花阴末一钱余,甘草冲汤力更殊,蓝花只须二二字,灌之入口立消除。
发热证候不一,所以各种方剂不能全部记载,各自具备在本门类中。
人居处清净,则阳气周密,邪气不能侵害。如果在事务中烦劳,则阳气解散,邪气侵入伤人,七情伤气,饮食伤形,风寒暑湿伤神,饮食男女伤阴,所以《内经》说:邪气的产生,有的生于阴,有的生于阳。生于阳的,得之于风邪寒暑;生于阴的,得之于饮食居处,阴阳喜怒。所以发热症候不一,治疗各不相同,有外感内伤的明显区别,寒热补泻有所不同。如伤寒伤风,这是外感。病邪从表入里,宜用发表法以解散它,这是麻黄汤、桂枝汤的意义。因为是在冬季寒冷之时感受邪气,随即发病,所以称为伤寒,用药用辛热之品,以战胜寒邪。如果时节不是寒冷,则用药应当随季节变化而调整。如春季温热的月份,就应当变为辛凉的药物,如夏季暑热的月份,就应当变为甘苦寒的药物。又说:冬季伤寒如果不立即发病,到春季变为温病,到夏季变为热病,其治疗方法必然随四季而异。又有一种冬温的病,称为非其时而有其病。冬天是寒冷的时候,却反而得了温病,这是天时不正,阳气反而泄越,用药不可用温热。又有一种时行寒疫,却在温暖的时候发生,时节本是温暖的,而寒反成为病,这也是天时不正,阴气反而逆乱,用药不可用寒凉。又有一种天行温疫热病,多发于春夏之间,沿门阖境相同的,这是天地间的疠气,应当随时令,参合运气而施治,宜用河间(刘完素)辛凉甘苦寒的药物,以清热解毒。以上诸症,都是外感天地之邪所致。如果是饮食劳倦,内伤元气,《内经》说:有所劳倦,形体之气衰少,谷气不胜。(意思是胃虚谷少,不能胜任其劳倦也。)上焦不行,(意思是清气不升也。)下脘不通,(意思是浊阴不降也。)胃气热,(浊阴不降,所以胃气热。)热气熏胸中,(少火皆成壮火而上炎,)所以内生热。这属于真阳下陷,内生虚热,所以李东垣提出补中益气的理论,用人参、黄芪,甘温的药物,大补其气,并提升下陷之气,这是用气药以补气之不足。另外,如果劳心好色,内伤真阴,阴血既已受伤,则阳气偏胜,而变为火。这是阴虚火旺劳瘵的症状,所以朱丹溪提出阳有余、阴不足的论点,用四物汤加知母、黄柏,补其阴,而火自降,这是用血药以补血之不足。益气补阴,都属于内伤症。一种是因为阳气下陷,而补其气以升提之;一种是因为阳火上升,而滋阴以降下之,一升一降,截然不同。又有夏季伤暑的病,虽然属于外感,却类似内伤,与伤寒大不相同。寒伤形,寒邪客于体表,是有余之症,所以宜用汗法。暑伤气,元气被热所伤而耗散,是不足之症,所以宜用补法,这就是李东垣所说的清暑益气。又有因时令暑热,过食冷物,从而损伤内部,或过度贪凉风,从而损伤外部,这并非暑邪伤人,而是因为暑而自行导致的病,治疗宜用辛热解表,或辛温理中的药物,这与伤寒的治疗方法相似。凡这些病症,外形相似,但虚实大有不同,治疗方法多样,不可妄谬,所以必须审察清楚,如果是伤寒伤风及寒疫,则用张仲景的方法。如果是温病热病及瘟疫,则用刘河间的方法。如果是气虚,则用李东垣的方法。如果是阴虚,则用朱丹溪的方法。这样就不会误用药物,而保全人的性命了。让人只见发热之症,一概认作伤寒外感,率用汗药以发散表邪,汗后不解,又有表药以凉其肌,如果是虚症,岂不误人!更有一闻,因虚而发致发热者,遂用补药,又不知气血之分,或气病而补血,或血病而补气,害人也很多。所以外感与内伤,寒病与热病,气虚与血虚,水火相反,治疗如果有差错,则轻病必重,重病必死,能不谨慎吗!
《内经》说:春气在经脉,夏气在孙络,长夏气在肌肉,秋气在皮肤,冬气在骨髓中。所以邪气,常随着四时的气血而入客。至于其变化,不可为限度。然而必须顺从其经气,辟除其邪。
发热之症,实非一端,前论已详,不再重复列举,现在于发热症下,再具阳虚阴虚二者以申述之。夫阳虚阴虚二症,凡是昼夜发热,昼重夜轻,口中无味,是阳虚之证。午后发热,夜半则止,口中有味,是阴虚之症。阳全阴半,阳得以兼阴,阴不得已兼阳,是自然之理。阳虚之症责在胃,阴虚之症责在肾,因为饥饱伤胃,则阳气虚矣;房劳伤肾,则阴血虚矣。以药而论,甘温则能补阳气,苦寒则能补阴血,如四君子汤以补气,四物汤以补血是也。如果气血两虚,但以甘温之剂以补其气为先,兼补其血,因为气旺则能生血也。如果只血虚而气不虚,忌用甘温之剂,以补其气,因为气旺则阴血愈消矣。所以阳虚与阴虚,苦寒与甘温,不可不详审而明辨之。虚热大禁发汗,退热不可过用凉剂,所以有和、取、从、折、属之五法,皆可合宜采用。《内经》说:阴气不足,则内热乃真不足也。阳气有余则外热,乃假有余也。凡人元气素弱,或因起居失宜,或因饮食劳倦,或因用心太过,以致遗精白浊,自汗盗汗,或内热晡热潮热发热,口干作渴,喉痛舌裂,或胸乳膨胀,胁肚作痛,头颈时疼,眩晕目花,或心神不宁,寐而不寐,小便赤涩,茎中作痛,便溺余沥,脐腹阴冷,或形容不充,肢体畏寒,鼻气急促,一切热症,皆是无根虚火,但服十全大补汤,有益气汤之类,固其根本,诸症自息。如果攻其风热则误矣。
阴虚发热,丹溪用四物汤加知母、黄柏,何如六味地黄丸壮水之主,以镇阳光?八味地黄丸益火之源,以消阴翳,为同气相求之妙。
有因大劳,复感风水暑热,或发似疟症,或夜发热咳嗽,医者但知有劳,而不知外邪内陷,误与补药,其邪留滞血脉之间,随气升降,其热如阴虚火动之状而游走经络,这又不可作阴虚火动治也。当以柴胡、葛根、羌活、防风轻扬之剂,佐以人参、当归、抚芎、香附之类,以导散之。然而阴虚火动之脉,则涩数而无力;外邪内郁之脉,则弦数而有力,是其异也。
有因饮食失宜,日晡发热,口干体倦,小便赤涩,两腿酸痛,一切阴亏症见,而系脾虚者,盖脾为至阴而生血,然禀气于胃,宜用甘温之剂,生发胃中元气而除大热,不可误用苦寒,复伤脾血。如果果属肾经阴虚,亦因肾经阳虚,不能生阴耳。《内经》说:无阳则阴无以生,无阴则阳无以化。不可误投知母、黄柏,反伤胃中生气,宜滋肾中水火以固本补脾土,以滋化源,万举万当。
有称发热为劳发者,盖谓劳力辛苦不能收摄,以致元阳浮越在外也,即李东垣所谓内伤。如果一发散,不更元阳脱尽。如果一苦寒,不更虚阳顿亡。
《内经》说:阳虚则外寒,阴盛则内热,阳盛则外热,阴盛则内寒。盖阳受气于上焦,以温皮肤分肉之间,令寒气在外、则上焦不通,上焦不通,则寒气独留于外,故寒栗也。若有所劳倦,形气衰少,谷气不盛,上焦不行,下脘不通,骨气热,热气熏胸中,故内热也。若上焦不通利,则皮肤致密,腠理闭塞,玄府不通,卫气不得泄逆,故外热也。若阳气上逆,寒气积于胸中而不泻,不泻则温气去寒独留,则血凝泣,凝则脉不通,其脉盛大以涩,故中寒也。若夜则恶寒,昼则安静,是阴血自旺于阴分也。夜则恶寒,昼亦恶寒,是重阴无阳也。夜则安静,昼则恶寒是阴气自旺于阳中也。昼则发热,夜则安静,是阳气自旺于阳分也。昼则安静,夜则发热烦躁,是阳气下陷入阴中也。昼则发热烦躁,夜亦发热烦躁,是重阳无阴也。子午潮热,一切发热憎寒者,邪在半表半里也。烦属阳,为有根之火,多出于心也。躁属阴,为无根之火,多起于肾也。病热而脉数按之不鼓动者,乃寒盛格阳,实非热也。形症似寒,按之而鼓指有力者,此为热盛拒阴,实非寒也。寸口脉微,为阳不足,阴气上入阳中,则洒浙恶寒也。尺脉弱,为阴不足,阳气下陷入阴中,则发热也。内伤发热是阳气自伤,不能布达,降下阴分,而为内热,乃阳虚也。故其脉大而无力,属脾肺,宜补中汤以升补阳气。若阴虚发热,是阴血自伤,不能制火,致阳气升腾,而为表热,乃阳旺也。阴虚也,故其脉数而无力,属心肾,宜六味丸,以培补阴血。然虽有阴阳气血之分,总不出脾胃阳气不足,无以输化所致,一切寒凉俱宜禁用。
凡不时发热者,阳浮在外,里无火也。倦怠少食者,中气不健运也。口干喜饮者,引水自救,里无水也。脉大无力为阳虚,脉数有力为阴虚,法当湿补,以敛浮阳,脉虽鼓指有力,此真气虚而邪气实也。
伤寒发热,是寒邪入卫,阳气交争,而为外热,夫阳气主外,为寒所伤而失职,故为热。其脉紧而有力,是外之寒邪,伤卫也,治主乎外。伤暑发热,是火邪伤心,元气耗散,而邪热客入于中,故发为热。汗大泄,无气以动,其脉虚迟而无力,是外之热邪伤荣也,治主乎内。凡病有感者,在皮毛为轻,有伤者,在肌肉稍重,有中者,属脏腑最重。
凡当外感内伤之后,身中之元气已虚,身中之邪热未尽,于此补虚则热不可除,于此清热则虚不能任,半补半清,终非良法,故补虚有二法,一补脾,一养胃。如疟痢后脾气衰弱,饮食不能运化,宜补其脾。如伤寒后,胃中津液久耗者,新者未生,宜养其胃。二者有霄壤之殊也。清热,亦有二法。初病之热为实热。宜用苦寒之药清之;大病后之热为虚热,宜用甘寒之药滋之。二者,亦有霄壤之殊也。况人天真之气,全在胃中,津液不足,生津即是补虚,胃中阳气衰微,温暖即是补虚。脾阴不足,补气须兼润剂。脾气虚寒,补中更要回阳。然天真之源,尤在两肾,寒者温之,热者滋之,阳和得中,无过不及,则所谓少火生气,使气能煦,而血自濡矣。
虚实症候,皆可发热,辨认不真,治则舛锗。大抵人迎脉大于气口为外感;气口脉大于人迎为内伤。浮数为外热,沉数为内热;浮大有力为外热,沉大有力为内热;浮大无力为虚,沉细有力为实。脉紧恶寒谓之伤寒,脉缓恶风谓之伤风;脉盛壮热谓之伤热,脉虚身热谓之伤暑,热而精神不倦,能言有力者为实,精神倦怠懒言无力者为虚。初按则热,久按不热者,是里阳浮表也,为虚;初按则热,久按愈热者,是里热彻表也,为实。壮热时常不减,头足身体一样火烙者,为实;如乍热乍减,头热足冷者,此无根之火,浮越在表在上也,为虚。口干饮冷而多者为实;口干饮汤而少者为虚。身壮热而脉沉细,及极大极数,按之乍大乍大者为虚;身微热而脉洪数不改者为实。身热无汗,二便闭涩者为实;身热有汗,二便通调者为虚;有表而热属表,元表而热属里。发热恶寒者,阳也;无热恶寒者,阴也。时当秋冬收敛闭藏发热者多实;当春夏升生浮长发热者多虚。总热之来,由于里出,或外邪感凑,扰动清阳,或内滞蒸郁,酿成壮火,舍此二实之候,其余非气虚不能收摄元阳,即阴虚不能镇约雷火。潮热之症,有阴阳之分,平旦潮热自寅至申,行阳二十五度,诸阳用事,热在行阳之分,肺气主之,日晡潮热自申至寅,行阴二十五度,诸阴用事,热在行阴之分,肾气主之,一以清肺,一以滋肾。若气虚潮热,参、芪、熟、附,所谓温能除大热也。血虚潮热,归、芍、骨皮,所谓养阴退阳也。
凡身虽热而脉和思食者,此表病而里不病也。薄粥浓饮,听其自然,只可节之,不可绝之。常见因热而绝其食,以致中气日虚,里不病者,而亦病焉。若身热而脉微懒食者,引表病有余,而里气不足也。只宜调脾养胃,以敛虚阳。火与元气,势不两立,元气复而火热自己,所谓甘温能除大热也。若身热而脉弦数无力者,此阴虚不能敛阳也,宜养阴以退之。若初病身热而脉浮洪有力者,外感也,从外治。若初病身热而脉沉数有力者,此内伤也,从内治。久则不分内外,未有元气不伤,便宜或从阳虚,或从阴虚,顾本为治。盖初病当分内外,久则总致一虚,此(张)之管见也。
病热有火者生,心脉洪是也。无火者死。沉细是也。沉细或数者,死。浮而涩,涩而身有热者,死。热而脉静者,难治。脉盛汗出不解者,死。脉虚热不止者,死。三
Treats adults and children with seasonal epidemics, presenting with headache, fever, and limb discomfort, as well as cases where sores or rashes have not yet erupted but are in a suspected stage; this formula is suitable for all such conditions.
Shengma (Rhizoma Cimicifugae), Baishao (Radix Paeoniae Rubra), Gancao (Radix Glycyrrhizae) (each 1 qian), Gegen (Puerariae Radix) (2 qian).
Decoct in water and take orally.
Treats pediatric febrile diseases due to cold damage.
Qianhu (Peucedani Radix) (1.4 qian), Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma) (soaked in decoction seven times), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix et Rhizoma), Jiegeng (Platycodonis Radix), Gancao (Radix Glycyrrhizae) (each 0.7 qian).
Decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), take warm.
Treats dizziness and body heat caused by cold pathogen invasion; taken simultaneously by the infant and the nursing mother.
Zima Ye (Perilla Folium), Xiangfu (Cyperi Rhizoma) (stir-fried), Ju Pi (Citri Reticulatae Pericarpium), Gancao (Radix Glycyrrhizae), Jiegeng (Platycodonis Radix), Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Chuanxiong Rhizoma). Decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) and take orally. Another prescription adds Mahuang (Ephedrae Herba).
Treats infants with excessive Qi and Blood stagnation, internal heat in the Zang-Fu organs, red cheeks, excessive nasal discharge, heat sensation in the five centers (palms, soles, and chest), throat obstruction and pain, irregular feeding, alternating chills and fever without regulation, tidal fever, restless sleep, trembling of hands and feet, and signs suggesting impending wind syndrome (convulsions).
Renshen (Ginseng Radix et Rhizoma), Chuanxiong (Chuanxiong Rhizoma), Fangfeng (Saposhnikoviae Radix), Danggui Wei (Radix Angelicae Sinensis Cauda), Chi Shaoyao (Radix Paeoniae Rubra), Dahuang (Rhei Radix et Rhizoma) (wrapped and roasted), Gancao (Radix Glycyrrhizae). Add Dengxin Cao (Junci Medulla) (7 stems) and Maimendong (Ophiopogonis Radix) (7 grains, heart removed). Decoct together and take at any time.
Treats infants with fluctuating warm-fever and latent heat.
Chaihu (Bupleuri Radix), Maimendong (Ophiopogonis Radix) (heart removed), Renshen (Ginseng Radix et Rhizoma), Chi Fuling (Poria cum Ligno), Gancao (Radix Glycyrrhizae). Add Xiaomai (Tritici Fructus) (20 grains) and Zhuye (Phyllostachidis Folium) (3 leaves). Decoct in water and take orally.
Huangbai (Phellodendri Cortex) (processed, 3 qian), Zhimu (Anemarrhenae Rhizoma) (2 qian), Guizhi (Cinnamomi Ramulus) (0.5 fen). Grind into powder, make pills with hot water, and swallow with boiling water.
For infants within one hundred days who suddenly develop chills and fever: if cold-natured herbs cause vomiting, and heat-natured herbs exacerbate the condition, this secret method from the Stone Chamber is used. The song says: "One qian plus of Peach Blossom Yin powder, mixed with Licorice decoction enhances its power; just two characters of Blue Flower, poured into the mouth eliminates it immediately."
Febrile syndromes vary, so various formulas cannot be fully listed; they are detailed in their respective sections.
When a person resides in a quiet and clean environment, Yang Qi is dense and pathogens cannot harm. However, if one labors excessively in affairs, Yang Qi dissipates, allowing pathogens to invade and harm the body. Seven emotions injure Qi, diet injures the form, Wind-Cold-Heat-Dampness injure Shen, diet and sexual activity injure Yin. Thus, the *Classic* states: "Pathogens arise either from Yin or from Yang." Those arising from Yang result from Wind, Cold, and Heat; those arising from Yin result from diet, residence, and emotional extremes. Therefore, febrile syndromes vary, and treatments differ; there is a distinct difference between external contraction and internal injury, and between cold, heat, tonification, and purgation. For example, Shanghan (Cold Damage) and Shangfeng (Wind Damage) are external contractions. Pathogens move from the exterior to the interior; it is appropriate to use exterior-releasing methods to disperse them. This is the principle behind Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). Because these occur on cold winter days and manifest immediately, they are called Shanghan, and medicinal materials should be pungent and hot to overcome the cold. If the season is not cold, medication should adapt to changes. In warm spring months, pungent-cool medications should be used; in hot summer months, sweet-bitter-cold medications should be used. It is also said: Winter Shanghan that does not manifest immediately becomes Wenbing (Warm Disease) in spring and Rebing (Heat Disease) in summer; treatment methods must vary with the four seasons. There is also a type of disease called Dongwen (Winter Warmth), described as having the disease out of season. Winter is cold, yet warmth disease occurs; this is due to improper heavenly timing where Yang Qi leaks abnormally, so medications should not be hot. There is also a type of seasonal cold epidemic occurring during warm times; although the season is warm, cold acts as the pathogen; this is also due to improper heavenly timing where Yin Qi rebels abnormally, so medications should not be cold. There is also Tianxing Wenyi (Heavenly Epidemic Warmth) heat disease, mostly occurring between spring and summer, affecting entire households similarly; this is Liqi (Miasma Qi) of Heaven and Earth. Treatment should follow the seasonal command and incorporate Yungui (Luck Theory), using Liu Wan-su’s (Hejian’s) pungent-cool, sweet-bitter-cold medications to clear heat and resolve toxicity. All the above syndromes are caused by external pathogens of Heaven and Earth. If it is dietary and fatigue-induced internal injury damaging Yuan Qi, the *Classic* states: "With labor and fatigue, physical Qi declines, and Grain Qi cannot withstand [the strain]." (Meaning: Stomach deficiency and insufficient Grain Qi cannot cope with labor.) "Upper Jiao fails to function" (Meaning: Clear Qi does not ascend). "Lower Wan is obstructed" (Meaning: Turbid Yin does not descend). "Stomach Qi becomes hot" (Because turbid Yin does not descend, Stomach Qi becomes hot). "Hot Qi steams the chest" (Minor fire becomes major fire and flares upward), thus causing internal heat. This belongs to True Yang sinking and generating internal deficient heat. Therefore, Li Dongyuan proposed the theory of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), using Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), sweet-warm medications, to greatly tonify Qi and lift the sinking Qi. This uses Qi-tonifying drugs to supplement Qi deficiency. Furthermore, if mental labor and excessive sexual activity internally injure True Yin, and Yin Blood is damaged, then Yang Qi becomes excessive and transforms into Fire. This is the syndrome of Yin Deficiency with Hyperactive Fire and consumptive disease. Therefore, Zhu Danxi proposed the theory of "Yang Excess, Yin Insufficiency," using Siwu Tang (Four Substances Decoction) added with Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) to tonify Yin, thereby subduing Fire. This uses Blood-tonifying drugs to supplement Blood deficiency. Tonifying Qi and Yin both belong to internal injury syndromes. One type involves sinking Yang Qi, treated by tonifying Qi to lift it; the other involves rising Yang Fire, treated by nourishing Yin to descend it. One lifts, one descends; they are completely different. There is also Summerheat Injury in summer. Although it belongs to external contraction, it resembles internal injury and is very different from Shanghan. Cold injures the Form; Cold Pathogen lodges in the exterior, representing an Excess syndrome, so sweating is indicated. Summerheat injures Qi; Yuan Qi is damaged and dissipated by heat, representing a Deficiency syndrome, so tonification is indicated. This is what Li Dongyuan referred to as Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction). There is also illness caused by consuming cold foods during summer heat, injuring the interior, or seeking excessive cool breezes, injuring the exterior. This is not Summerheat harming the person, but self-inflicted illness due to Summerheat. Treatment should use pungent-hot exterior-releasing or pungent-warm middle-regulating medications, similar to Shanghan treatment. All these syndromes appear similar externally but differ greatly in Deficiency and Excess. Treatments are diverse and must not be erroneous. Therefore, one must carefully examine: if it is Shanghan, Shangfeng, or Cold Epidemic, use Zhang Zhongjing’s methods. If it is Warm Disease, Heat Disease, or Epidemic, use Liu Hejian’s methods. If it is Qi Deficiency, use Li Dongyuan’s methods. If it is Yin Deficiency, use Zhu Danxi’s methods. In this way, medications will not be misused, and human life will be preserved. People often see only fever and assume it is Shanghan external contraction, rashly using sweating drugs to release the exterior. If fever persists after sweating, they use exterior drugs to cool the muscles. If it is a Deficiency syndrome, how could this not be harmful! Moreover, upon hearing of fever caused by deficiency, some use tonifying drugs without distinguishing between Qi and Blood, treating Qi disease with Blood drugs or Blood disease with Qi drugs, causing much harm. Therefore, external contraction vs. internal injury, cold disease vs. heat disease, Qi deficiency vs. Blood deficiency, Water vs. Fire are opposites. If treatment is mistaken, mild disease becomes severe, and severe disease leads to death. Can one not be cautious?
The *Classic* states: "Spring Qi is in the meridians, Summer Qi is in the collateral vessels, Late Summer Qi is in the muscles, Autumn Qi is in the skin, Winter Qi is in the bone marrow." Thus, pathogens often enter and lodge according to the Qi and Blood of the four seasons. Their changes are immeasurable. However, one must follow the Meridian Qi to dispel the pathogens.
Febrile syndromes are not limited to one type; the previous discussion was detailed, so it is not repeated here. Now, under the section of Febrile Syndromes, we elaborate on Yang Deficiency and Yin Deficiency. Regarding Yang Deficiency and Yin Deficiency syndromes: Fever day and night, heavier by day and lighter by night, with no taste in the mouth, indicates Yang Deficiency. Fever starting in the afternoon and stopping at midnight, with a taste in the mouth, indicates Yin Deficiency. Yang is whole, Yin is half; Yang can encompass Yin, but Yin cannot help but encompass Yang. This is natural law. Yang Deficiency is attributed to the Stomach; Yin Deficiency is attributed to the Kidney. Hunger and fullness injure the Stomach, leading to Yang Qi deficiency; sexual fatigue injures the Kidney, leading to Yin Blood deficiency. In terms of medication: Sweet-warm can tonify Yang Qi; bitter-cold can tonify Yin Blood. For example, Sijunzi Tang (Four Gentlemen Decoction) tonifies Qi, and Siwu Tang (Four Substances Decoction) tonifies Blood. If both Qi and Blood are deficient, prioritize sweet-warm formulas to tonify Qi, while also tonifying Blood, because abundant Qi generates Blood. If only Blood is deficient and Qi is not, avoid sweet-warm formulas to tonify Qi, because abundant Qi will further consume Yin Blood. Therefore, Yang Deficiency vs. Yin Deficiency, bitter-cold vs. sweet-warm, must be carefully examined and clearly distinguished. Deficient heat strictly prohibits sweating; reducing heat should not overuse cooling agents. Therefore, the five methods of Harmonizing, Extracting, Following, Breaking, and Belonging can be appropriately adopted. The *Classic* states: "Insufficiency of Yin Qi leads to internal heat, which is true insufficiency. Excess of Yang Qi leads to external heat, which is false excess." When a person's Yuan Qi is inherently weak, or due to improper living habits, dietary fatigue, or excessive mental effort, leading to seminal emission, white turbidity, spontaneous sweating, night sweating, or internal heat, evening tidal fever, fever, dry mouth with thirst, sore throat, cracked tongue, chest/breast distension, hypochondriac/abdominal pain, head/neck pain, dizziness, blurred vision, restlessness, insomnia, red/scanty urination, penile pain, dribbling urine, cold umbilical/abdominal region, emaciation, aversion to cold in limbs, rapid nasal breathing—all these heat syndromes are Rootless Deficient Fire. Taking Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) or Yi Qi Tang (Augment Qi Decoction) to consolidate the root will cause symptoms to subside. Attacking Wind-Heat would be a mistake.
For Yin Deficiency fever, Danxi used Siwu Tang (Four Substances Decoction) added with Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex). How does this compare to Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) strengthening the master of Water to suppress Solar Fire? Or Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia) benefiting the source of Fire to eliminate Yin Shadows? These represent the wonder of seeking similarity in energy.
There are cases where severe labor is compounded by Wind-Water-Summerheat, manifesting like malaria or nighttime fever with cough. Physicians only recognize labor and do not realize external pathogens have sunk inward. Mistakenly administering tonics causes pathogens to stagnate in the blood vessels, moving up and down with Qi. The heat resembles Yin Deficiency with Hyperactive Fire wandering through meridians. This cannot be treated as Yin Deficiency with Hyperactive Fire. Instead, use light and ascending agents like Chaihu (Bupleuri Radix), Gegen (Puerariae Radix), Qianghuo (Notopterygii Rhizoma et Radix), and Fangfeng (Saposhnikoviae Radix), assisted by Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Fuxiong (Chuanxiong Rhizoma), and Xiangfu (Cyperi Rhizoma) to guide and disperse. However, the pulse for Yin Deficiency with Hyperactive Fire is choppy, rapid, and forceless; the pulse for External Pathogen Internal Depression is wiry, rapid, and forceful. This is the distinction.
There are cases where improper diet causes afternoon fever, dry mouth, fatigue, red/scanty urination, and sore legs. All Yin Deficiency symptoms appear, but the root is Spleen Deficiency. The Spleen is Extreme Yin and generates Blood, but derives Qi from the Stomach. Use sweet-warm formulas to generate Stomach Yuan Qi and remove great heat. Do not mistakenly use bitter-cold, which further injures Spleen Blood. If it truly belongs to Kidmer Channel Yin Deficiency, it is also because Kidney Yang Deficiency cannot generate Yin. The *Classic* states: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." Do not mistakenly administer Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex), which injure the vital Qi of the Stomach. Instead, nourish Water and Fire in the Kidneys to consolidate the root and tonify Spleen Earth, thereby nourishing the source of transformation. This is infallible.
Some call fever "Labor Fever," meaning hard physical labor prevents retention, causing Yuan Yang to float outward. This is what Li Dongyuan calls Internal Injury. If one uses dispersing methods, Yuan Yang will completely escape. If one uses bitter-cold, Deficient Yang will instantly perish.
The *Classic* states: "Yang Deficiency leads to external cold; Yin Excess leads to internal heat; Yang Excess leads to external heat; Yin Deficiency leads to internal cold." Yang receives Qi from the Upper Jiao to warm the skin and muscles. If Cold Qi is outside, the Upper Jiao becomes obstructed. If the Upper Jiao is obstructed, Cold Qi remains alone outside, causing shivering. If there is labor and fatigue, physical Qi declines, Grain Qi is insufficient, Upper Jiao fails to function, Lower Wan is obstructed, Bone Qi becomes hot, and Hot Qi steams the chest, causing internal heat. If the Upper Jiao is not unobstructed, skin becomes dense, pores close, Xuangu (mysteric gates) are blocked, and Wei Qi cannot vent, causing external heat. If Yang Qi rebels upward, Cold Qi accumulates in the chest and does not drain. If it does not drain, warming Qi departs, leaving Cold alone. Blood coagulates, vessels become obstructed, the pulse is large and choppy, causing mid-body cold. If one feels aversion to cold at night but is calm by day, Yin Blood is flourishing in the Yin portion. If one feels aversion to cold both night and day, it is Heavy Yin without Yang. If one is calm at night but feels aversion to cold by day, Yin Qi is flourishing in the Yang portion. If one has fever by day but is calm at night, Yang Qi is flourishing in the Yang portion. If one is calm by day but has fever and irritability at night, Yang Qi has sunk into Yin. If one has fever and irritability both day and night, it is Heavy Yang without Yin. Tidal fever at Zi/Wu hours, and all fevers with aversion to cold, indicate pathogens in the Half-Exterior Half-Interior. Fan (restlessness) belongs to Yang, is rooted fire, mostly originating from the Heart. Zao (agitation) belongs to Yin, is rootless fire, mostly originating from the Kidney. In heat disease, if the pulse is rapid but does not throb upon pressing, it is Cold Excess repelling Yang, actually not heat. If symptoms resemble cold but pulsation is strong upon pressing, it is Heat Excess rejecting Yin, actually not cold. Cun Kou (Inch position) pulse is faint, indicating Yang insufficiency; Yin Qi enters Yang, causing shivering aversion to cold. Chi position (Cubit position) pulse is weak, indicating Yin insufficiency; Yang Qi sinks into Yin, causing fever. Internal injury fever is self-injury of Yang Qi, unable to distribute, descending into Yin portion, becoming internal heat, which is Yang Deficiency. Thus, the pulse is large and forceless, belonging to Spleen and Lung; use Buzhong Tang (Tonify Middle Decoction) to raise and tonify Yang Qi. If Yin Deficiency fever, it is self-injury of Yin Blood, unable to control Fire, causing Yang Qi to rise and become external heat, which is Yang Excess. Since it is Yin Deficiency, the pulse is rapid and forceless, belonging to Heart and Kidney; use Liuwei Wan (Six-Ingredient Pill) to cultivate and tonify Yin Blood. Although there are distinctions among Yin-Yang and Qi-Blood, it ultimately stems from Spleen-Stomach Yang Qi insufficiency and inability to transport and transform. All cold-cooling agents should be prohibited.
For irregular fever, Yang floats outside, and there is no fire inside. Fatigue and poor appetite indicate Middle Qi failing to transport. Dry mouth preferring drink indicates drawing water to save oneself, meaning no water inside. Pulse large and forceless indicates Yang Deficiency; pulse rapid and forceful indicates Yin Deficiency. The method should be moistening tonification to gather floating Yang. Even if the pulse throbs strongly, this is True Qi Deficiency and Pathogenic Qi Excess.
Shanghan fever is Cold Pathogen entering the Defensive layer, Yang Qi struggling, causing external heat. Yang Qi governs the exterior; injured by Cold, it loses function, thus causing heat. The pulse is tight and forceful, indicating external Cold Pathogen injuring Defense; treatment focuses on the exterior. Summerheat injury fever is Fire Pathogen injuring the Heart, Yuan Qi dissipating, and pathogenic heat lodging inside, thus causing fever. Profuse sweating, lack of Qi to move, pulse empty, slow, and forceless, indicates external Heat Pathogen injuring Nutritive layer; treatment focuses on the interior. Generally, pathogens affecting the hair and skin are mild; those injuring muscles are slightly severe; those penetrating organs are most severe.
After external contraction or internal injury, Yuan Qi in the body is already deficient, and pathogenic heat is not yet cleared. Tonifying deficiency here will not remove heat; clearing heat here will not withstand deficiency. Half-tonifying, half-clearing is ultimately not a good method. Therefore, tonifying deficiency has two methods: one tonifies Spleen, one nourishes Stomach. After malaria/dysentery, if Spleen Qi is weak and food cannot be transformed, tonify the Spleen. After Shanghan, if Stomach fluids have been exhausted for a long time and new ones not yet generated, nourish the Stomach. The difference between these two is vast. Clearing heat also has two methods. Initial disease heat is Excess Heat; use bitter-cold drugs to clear it. Post-major illness heat is Deficient Heat; use sweet-cold drugs to nourish it. The difference is vast. Moreover, Human Primal Qi resides entirely in the Stomach. Insufficient fluids, generating fluids is tonifying deficiency. Declining Stomach Yang Qi, warming is tonifying deficiency. Spleen Yin insufficiency: tonifying Qi must include moistening agents. Spleen Qi Deficiency Cold: tonifying middle must restore Yang. However, the source of Primal Qi lies especially in the two Kidneys. Cold: warm it; Heat: nourish it. When Yang Harmony is moderate, neither excessive nor insufficient, this is called "Minor Fire generates Qi," allowing Qi to warm and Blood to moisten naturally.
Deficiency and Excess syndromes can all cause fever. If not recognized accurately, treatment will be erroneous. Generally, Renying (Human Welcome) pulse larger than Qikou (Qi Opening) indicates external contraction; Qikou pulse larger than Renying indicates internal injury. Floating-rapid is external heat; sinking-rapid is internal heat; floating-large-forceful is external heat; sinking-large-forceful is internal heat; floating-large-forceless is Deficiency; sinking-thin-forceful is Excess. Tight pulse with aversion to cold is called Shanghan; slow pulse with aversion to wind is called Shangfeng. Full pulse with high fever is called Shangre (Heat Injury); empty pulse with body heat is called Shangshu (Summerheat Injury). Fever with energetic spirit, able to speak forcefully is Excess; fever with fatigued spirit, reluctant to speak, forceless is Deficiency. Heat upon initial palpation but not after prolonged pressure indicates Interior Yang floating to Exterior, which is Deficiency. Heat upon initial palpation increasing with prolonged pressure indicates Interior Heat penetrating Exterior, which is Excess. Constant high fever, head, feet, and body feeling like burning iron is Excess. Intermittent fever, head hot and feet cold, indicates Rootless Fire floating to Exterior/Upper, which is Deficiency. Dry mouth desiring cold drinks in large amounts is Excess; dry mouth desiring warm drinks in small amounts is Deficiency. High fever with sinking-thin pulse, or extremely large/rapid pulse changing upon pressure, is Deficiency. Mild fever with consistent flooding-rapid pulse is Excess. Body heat without sweat, closed urination/defecation is Excess; body heat with sweat, free urination/defecation is Deficiency. Exterior pattern with heat belongs to Exterior; No-Exterior pattern with heat belongs to Interior. Fever with aversion to cold is Yang; No fever with aversion to cold is Yin. Fever during autumn/winter (concealment periods) is mostly Excess; fever during spring/summer (growth periods) is mostly Deficiency. Overall, heat comes from the interior. Either external pathogens disturb Clear Yang, or internal stagnation steams to create Major Fire. Apart from these two Excess patterns, the rest are either Qi Deficiency failing to retain Yuan Yang, or Yin Deficiency failing to suppress Thunder Fire. Tidal fever has Yin-Yang distinctions. Morning tidal fever from Yin to Shen hours (Yang phase): Yang Qi operates, heat is in the Yang portion, governed by Lung Qi. Evening tidal fever from Shen to Yin hours (Yin phase): Yin Qi operates, heat is in the Yin portion, governed by Kidney Qi. One clears Lung, one nourishes Kidney. For Qi Deficiency tidal fever, use Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Shudi (Rehmanniae Radix Preparata), Fuzi (Aconiti Lateralis Radix Preparata); this is "Warmth can remove great heat." For Blood Deficiency tidal fever, use Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Muguanpi (Lycii Cortex), this is "Nourishing Yin retreats Yang."
Generally, if the body is hot but the pulse is harmonious and appetite exists, this is Exterior disease without Interior disease. Thin porridge and thick drinks, let nature take its course; only regulate, do not abolish. Often seen: abolishing food due to heat causes Middle Qi to daily weaken, turning non-diseased Interior into diseased. If body is hot, pulse is faint, and appetite is lazy, it indicates Exterior disease Excess and Interior Qi Deficiency. Only regulate Spleen and nourish Stomach to gather Deficient Yang. Fire and Yuan Qi are mutually exclusive. When Yuan Qi recovers, fire subsides naturally; this is "Sweet-warm can remove great heat." If body is hot, pulse is wiry-rapid-forceless, this is Yin Deficiency failing to gather Yang; nourish Yin to retreat it. If initial disease body heat with floating-huge-forceful pulse, it is external contraction; treat from exterior. If initial disease body heat with sinking-rapid-forceful pulse, it is internal injury; treat from interior. Over time, exterior-interior distinction blurs; Yuan Qi is inevitably damaged. One should treat based on Yang Deficiency or Yin Deficiency, focusing on the root. Initially, distinguish exterior-interior; long-term results in general deficiency. This is (Zhang)'s humble opinion.
Disease with heat and Fire lives; Heart pulse flooding is the sign. No Fire dies; sinking-thin is the sign. Sinking-thin or rapid dies. Floating-choppy, choppy with body heat dies. Heat with quiet pulse is difficult to treat. Full pulse with sweating not resolving dies. Empty pulse with continuous heat dies. Three