凡病多属火。丹溪谓气有余便是火，此一火也，治宜清凉。气不足亦郁而
成火，东垣所谓阳虚发热也，又一火也，治宜甘温以补其气，少加甘寒以泻其火。
外感暑热燥气，增助内气成热，此一火也，治宜辛润清凉。外感风寒湿气，闭郁表
气成热，亦一火也，治宜辛温发散。内伤饮食辛热之物，致火得热益炽，此一火也，
宜以苦寒之剂消导之。内伤饮食生冷之物，致火被遏愈怒，又一火也，治宜辛热之
剂消导之。肾水虚，致令下焦之火上炎，此一火也，治宜六味，（见虚损。）壮水以制阳
光。肾阴盛，逼其浮游之火上升，又一火也，治宜八味（见虚损），益火以消阴翳。又
凡动皆属火，醉饱火起于胃，大怒火起于肝，悲哀火起于肺，房劳火起于肾，五脏
火炽，心火自焚。种种已散见于各篇中，而发热篇更详，细阅自见。夫人非寒则热，
非实则虚耳。今寒热虚实皆能生火，然则凡病多属火，河间、丹溪之言，岂不信哉？
而张景岳辈不达其旨，极力谰诋，亦已过矣。或曰∶虚火既不可用寒凉，是有火之
名，无火之实，故景岳诸公直谓之非火，子何訾之乎？曰∶虚火不可用寒凉，
谓苦寒之味耳，若甘寒之品，何可废乎？盖虚火有二∶其一可用温热，如内寒外热，
下寒上热等证是也，目为非火犹可也。其一宜用甘寒，水虚火炎者是也，目为非实
火则可，竟目为非火，可乎？至于滞下、消渴、吞酸、虫疳等证，明明属热者，亦
概目为非火，且反谓之为寒，真菽麦不辨者矣。彼意以为必目之为非火，而后人不
敢用寒凉，不知立论失实，徒起后人之疑也。今夫驽马之驾而败，尽人而知之矣。
直言此为驽马不可驾，未有不信者也。必谓之非马也，鹿也，谁则信之乎？不信则
有驾之而败者矣。是非火之说，固将使人不信而用寒凉也。熟若仍其虚火之名，
而明夫不可用寒凉之故、之为，实而可信哉。
或谓上世人所禀浓实，可任攻伐；晚近人所禀薄弱，止宜温补，谬也。丹溪去
景岳不过二百余年，如果禀赋强弱相悬如是，将数千百年而后，人皆变为阴鬼乎。
惟古人谓劳扰之人多火，与安静者不同；黑瘦之人多火，与肥白者不同，其说深为
得理。
桂、附引火归元，此为下寒上热者言之，若水涸火炎之证，上下皆热，不知用
此引火引归何处。今日医者动用桂、附，动云引火归元，杀人如麻，可叹也。（说详八
味丸方注。）
凡病有形者是痰，无形者是火。如红肿结块，或痛或不痛，皆形也，痰也。（按
结块肿而不痛、不红者，纯痰也；红肿而痛者，兼火也。）但痛不肿者，无形也，火也。（又谓湿火肿而不
痛，燥火痛而不肿，亦此意也。）又谓胀痛是湿火，筋缩痛是燥火。（又谓平时筋不缩，偶直足一曲即缩
是火。盖火性欲舒伸，一屈则激而暴发，陡然抽击。观蛇之动而击曲，是其象也。）又谓火证、睡觉忽
腰背重滞，转觉不便，（睡则火敛于内，蒸其血液滞于腰背也。腰背着席，故滞。）隆冬薄衣不冷，非
壮盛，食时有涕无痰，（痰为食压暂下，故无痰。火气得谷气助之上升，故化涕以出。）不食时有
痰无涕。弱证，左侧睡则心左坠一响，右侧睡则心右坠一响，（弱证人，心血少，易于
动，故转侧则倾坠。与火气相搏击，故响。）心中滴滴当当响，（火气搏击心血作响。）头眩耳鸣。心火，
黄连、生地、木通。小肠火，木通。肝火，柴胡，片芩佐之。胆火，龙胆草。脾火，
白芍。胃火，石膏。肺火，黄芩，桑皮佐之。大肠火，子芩。肾、膀胱火，知母、
黄柏。凡用知、柏、芩、连等寒药，少加枳壳行之，否则凝滞。又寒凉药不可久服，
致伤脾胃，不救。三焦火，山栀。上中二焦火，连翘。虚火，姜皮、竹叶、麦冬、
童便、生甘草、生姜缓之散之，或参、 等补之。实火热甚，黄芩、黄连、山栀、
黄柏。宜下者，芒硝、大黄。血虚发热，当归、生熟地。无根之火，游行作热，（肾
水干涸，相火上炎也。阳以阴为根，肾阴虚，故曰无根。）六味丸（见虚损）加元参，作汤服。气如火从脚
下起入腹，（肾阳虚极欲脱。）十不救一，六味加肉桂五钱作汤。外用附子末，津调涂涌泉
穴，引火下行。燥火，归、地、麦冬。湿火，苍术、茯苓、猪苓、木通。郁火，重
按烙手，轻按不觉，取汗则愈。过食生冷，遏少阳之火于脾部者，升、柴、葛根、
羌活、细辛、香附、葱白。肝火郁，青黛。
凡是疾病大多与火有关。朱丹溪说“气有余便是火”，这是其中一种火，治疗应当使用清凉之法。气不足也会郁结而化火，即李东垣所说的“阳虚发热”，这是另一种火，治疗应当用甘温药物来补气，并少量加入甘寒药物来泻火。外感暑热燥邪，助长体内之气化为热，这是第三种火，治疗应当用辛润清凉之法。外感风寒湿邪，闭塞体表之气而化热，这也是第四种火，治疗应当用辛温发散之法。内伤饮食辛辣温热之物，导致火势因热而更盛，这是第五种火，适宜用苦寒药物进行消导。内伤饮食生冷之物，导致火被遏制而更加愤怒（亢盛），这是第六种火，治疗应当用辛热药物进行消导。肾水虚弱，导致下焦之火上炎，这是第七种火，治疗应当用六味地黄丸（见虚损篇），通过壮水之主以制约阳光（亢盛之阳）。肾阴过盛（此处指阴寒内盛或真寒假热语境下的误读，原文意指阴盛格阳或类似病机，但按字面翻译为肾阴盛，结合后文“益火消阴翳”实指肾阳虚衰，阴寒内盛逼浮游之火上升，通常中医理论中“肾阴盛”较少见，多为肾阳虚，但此处依原文直译并保留术语），逼迫其浮游之火上升，这是第八种火，治疗应当用八味丸（见虚损篇），通过益火之源以消除阴翳（阴寒）。此外，凡活动多属火，醉酒饱食之火起于胃，大怒之火起于肝，悲哀之火起于肺，房劳过度之火起于肾，五脏之火炽盛，心火便会自焚。种种情况已散见于各篇之中，而在发热篇中更为详细，细阅即可明白。人非寒证就是热证，非实证就是虚证罢了。如今寒、热、虚、实都能生火，既然如此，那么凡是疾病大多属于火证，刘河间、朱丹溪的说法，难道不可信吗？然而张景岳等人不理解其中的旨意，极力谩骂诋毁，这也太过分了。有人说：“虚火既然不能用寒凉药，那就是有火之名而无火之实，所以张景岳诸位先生直接称其为非火，你为何指责他们呢？”我说：“虚火不可用寒凉药，指的是苦寒的药物；至于甘寒的药物，怎么可以废除呢？大概虚火有两种：其一可以用温热药，如内寒外热、下寒上热等证候，称之为非火还可以接受。其二适宜用甘寒药，如水亏火炎的情况，称之为非实火是可以的，竟然称之为非火，这可以吗？至于痢疾、消渴、吞酸、虫疳等证候，明明属于热证，也一概称之为非火，甚至反而称之为寒证，真是连豆子和麦子都分辨不清的人了。他们的意图认为，只有称之为非火，后人就不敢用寒凉药了，殊不知这种立论不符合事实，只会徒然引起后人的疑惑。如今劣马驾车失败，是人人都知道的。直言这是劣马不能驾车，没有人会不相信的。如果硬说这不是马，是鹿，谁会相信呢？如果不相信，就会有驾车失败的情况发生。这种‘非火’的说法，本来就会使人不信从而滥用寒凉药。还不如沿用‘虚火’的名称，并阐明不可用寒凉药的原因，这样真实且可信。”
有人说上古之人禀赋浓厚结实，可以承受攻伐；近代之人禀赋薄弱，只适宜温补，这是错误的。朱丹溪距离张景岳不过二百多年，如果禀赋强弱相差如此之大，难道要经过数千年几百年之后，人都变成阴鬼了吗？只有古人说劳累烦扰的人多火，与安静的人不同；黑瘦的人多火，与肥白的人不同，这种说法深得道理。
桂枝、附子引火归元，这是针对下寒上热证而言的，如果是水干涸火炎盛的证候，上下皆热，不知道用此法将火引回何处。如今的医生动不动就用桂枝、附子，动不动就说引火归元，杀人无数，令人叹息。（详细说明见八味丸方注。）
凡是疾病中有形的是痰，无形的是火。如红肿结块，或者痛或者不痛，都是有形的，属于痰。（按语：结块肿而不痛、不红的，纯属痰；红肿而痛的，兼有火。）只痛不肿的，是无形的，属于火。（又说湿火肿而不痛，燥火痛而不肿，也是这个意思。）又说胀痛是湿火，筋脉拘挛疼痛是燥火。（又说平时筋脉不收缩，偶尔伸直脚弯曲一下就收缩，这是火。因为火性喜欢舒展伸展，一屈曲则激发而暴发，突然抽击。看蛇行动时攻击弯曲处，就是这个象。）又说火证患者，睡觉醒来忽然感觉腰背沉重滞涩，转动觉得不便。（睡觉时火收敛于内，蒸腾血液滞留在腰背部。腰背着席，所以滞涩。）隆冬季节穿薄衣却不觉得冷，并非身体强壮，吃饭时有鼻涕没有痰。（痰被食物压迫暂时下行，所以无痰。火气得谷气帮助而上升，所以化为涕排出。）不吃饭时有痰没有鼻涕。虚弱证患者，左侧睡则感觉心脏向左坠响一声，右侧睡则感觉心脏向右坠响一声。（虚弱证患者心血少，容易动，所以转侧时倾斜坠落。与火气相搏击，所以发出响声。）心中滴滴当当作响，（火气搏击心血发出响声。）头晕目眩耳鸣。心火，用黄连、生地、木通。小肠火，用木通。肝火，用柴胡，片芩辅助。胆火，用龙胆草。脾火，用白芍。胃火，用石膏。肺火，用黄芩，桑白皮辅助。大肠火，用子芩。肾、膀胱火，用知母、黄柏。凡是使用知母、黄柏、黄芩、黄连等寒药，少量加入枳壳行气，否则会导致凝滞。另外寒凉药不可久服，以免损伤脾胃，无法挽救。三焦火，用山栀。上中二焦火，用连翘。虚火，用姜皮、竹叶、麦冬、童便、生甘草、生姜来缓和消散，或者用人参、[缺字，推测为五味子或麦冬等]等来补益。实火热势很盛，用黄芩、黄连、山栀、黄柏。适宜用下法的，用芒硝、大黄。血虚发热，用当归、生熟地。无根之火，游行作热，（肾水干涸，相火上炎。阳以阴为根，肾阴虚，所以叫无根之火），用六味地黄丸（见虚损篇）加玄参，煎汤服用。气如火从脚下起入腹，（肾阳虚极欲脱），十救不一，用六味地黄丸加肉桂五钱煎汤。外用附子末，用唾液调匀涂在涌泉穴，引火下行。燥火，用当归、生地、麦冬。湿火，用苍术、茯苓、猪苓、木通。郁火，重按烫手，轻按不觉，取汗则痊愈。过食生冷，遏制少阳之火在脾部的，用升麻、柴胡、葛根、羌活、细辛、香附、葱白。肝火郁结，用青黛。
Generally, most diseases are related to Fire. Zhu Danxi stated that "excess Qi transforms into Fire," which is one type of Fire; treatment should employ cooling methods. Insufficient Qi can also stagnate and transform into Fire, known as Li Dongyuan's "Yang deficiency causing fever," which is another type of Fire; treatment should use sweet-warm herbs to tonify Qi, with a small addition of sweet-cold herbs to drain the Fire. External contraction of summer-heat, dryness, and heat pathogens assists internal Qi to generate heat, which is a third type of Fire; treatment should employ pungent-moistening and cooling methods. External contraction of wind-cold and dampness pathogens closes the exterior Qi, generating heat, which is a fourth type of Fire; treatment should employ pungent-warm dispersing methods. Internal injury from consuming spicy and warm foods causes Fire to become more intense due to heat, which is a fifth type of Fire; it is suitable to use bitter-cold agents for digestion and elimination. Internal injury from consuming raw and cold foods causes Fire to be suppressed and become more agitated (hyperactive), which is a sixth type of Fire; treatment should employ pungent-hot agents for digestion and elimination. Deficiency of Kidney Water leads to the flaming upward of Fire in the Lower Jiao, which is a seventh type of Fire; treatment should use Liuwei Dihuang Wan (see Deficiency Damage chapter), strengthening Water to control excessive Yang. [Note: Text says "Kidney Yin Excess" but context implies Kidney Yang deficiency/Yin Cold excess forcing floating Fire up], excessive Kidney Yin forces floating Fire to rise, which is an eighth type of Fire; treatment should use Bawei Wan (see Deficiency Damage chapter), benefiting Fire source to eliminate Yin shadows. Furthermore, all movement belongs to Fire; drunkenness and overeating generate Fire from the Stomach; great anger generates Fire from the Liver; sorrow generates Fire from the Lung; sexual exhaustion generates Fire from the Kidney; when Fire of the Five Zang organs blazes, Heart Fire burns itself. Various situations have been scattered across different chapters, and are detailed further in the Fever Chapter; careful reading will reveal them. Humans either have Cold or Heat patterns, either Excess or Deficiency patterns. Now, Cold, Heat, Excess, and Deficiency can all generate Fire. Given this, if most diseases belong to Fire, are not the words of Liu Hejian and Zhu Danxi credible? However, Zhang Jingyue and others failed to understand their intent and vigorously slandered them, which was excessive. Some say: "Since deficient Fire cannot be treated with cold-cooling herbs, it has the name of Fire but not the reality of Fire; thus Mr. Zhang Jingyue directly calls it non-Fire. Why do you criticize him?" I say: "Deficient Fire cannot be treated with cold-cooling herbs refers specifically to bitter-cold flavors; how can sweet-cold products be abolished? There are two types of deficient Fire: one can be treated with warm-hot herbs, such as internal Cold with external Heat, or Lower Cold with Upper Heat syndromes; calling these non-Fire is acceptable. The other requires sweet-cold herbs, such as Water deficiency with Fire flaming; calling these non-excess Fire is fine, but calling them non-Fire entirely, is this acceptable? As for dysentery, Xiao Ke (wasting-thirst), acid regurgitation, and worm-related malnutrition syndromes, which clearly belong to Heat, are generally called non-Fire, and even conversely called Cold; this is truly confusing beans with wheat. Their intention seems to be that by calling it non-Fire, later generations will dare not use cold-cooling herbs, not realizing that such arguments are factually incorrect and only serve to arouse doubt among later practitioners. Today, everyone knows that a inferior horse pulling a carriage will fail. If one directly states this is an inferior horse unfit for driving, no one would disbelieve. But if one insists it is not a horse, but a deer, who would believe it? Disbelief leads to failure in driving. This theory of 'non-Fire' inevitably causes people to disbelieve and misuse cold-cooling herbs. It is better to retain the name 'deficient Fire' and clearly explain why cold-cooling herbs are contraindicated, making it authentic and credible."
Some argue that ancients had robust constitutions and could withstand attacking methods, while modern people have weak constitutions and only suit warming-tonifying methods; this is erroneous. Zhu Danxi lived only about two hundred years before Zhang Jingyue; if constitution strength varied so drastically, would humans turn into yin ghosts after thousands of years? Only the ancient saying that laborious and harassed people have more Fire, differing from quiet people; and dark, thin people have more Fire, differing from fat, white people, is deeply reasonable.
Guizhi (Cinnamon Twig) and Fuzi (Aconite Lateral Root) guide Fire back to its origin, speaking here of Lower Cold and Upper Heat cases. For cases where Water is dried up and Fire flares, with Heat throughout upper and lower, it is unknown where this method guides the Fire. Today, physicians frequently use Guizhi and Fuzi, often claiming to "guide Fire back to origin," killing countless people, which is lamentable. (See notes on Bawei Wan formula for details.)
Diseases with form are Phlegm; those without form are Fire. Redness, swelling, and nodules, whether painful or painless, are formed entities, belonging to Phlegm. (Commentary: Nodules swollen but painless and non-red are pure Phlegm; red, swollen, and painful involve Fire.) Pain without swelling is formless, belonging to Fire. (Also, Damp-Fire causes swelling without pain, Dry-Fire causes pain without swelling, which conveys the same meaning.) Also, distending pain is Damp-Fire; tendon contraction pain is Dry-Fire. (Also, normally tendons do not contract; occasional straightening followed by curling indicates Fire. Fire nature prefers extension; upon curling, it激ates and erupts suddenly, twitching violently. Observing snakes striking when bent illustrates this image.) Also, in Fire syndromes, waking from sleep brings sudden heaviness and stagnation in the waist and back, making movement inconvenient. (During sleep, Fire敛s inward, steaming blood and causing stagnation in the waist/back. Contact with the mat causes stagnation.) In deep winter, wearing thin clothes does not feel cold, not because of robust health; during meals, there is nasal discharge but no phlegm. (Phlegm is pressed down by food, hence absent. Fire Qi, aided by grain Qi, rises and transforms into nasal discharge.) When not eating, there is phlegm but no nasal discharge. In weak conditions, sleeping on the left side causes a thumping sound as the Heart sinks left; sleeping on the right causes a thump as it sinks right. (Weak patients have little Heart Blood, easily disturbed; turning causes tilting/sinking. Striking against Fire Qi produces sound.) A dripping/clanging sound in the Heart region occurs due to Fire Qi striking Heart Blood. Vertigo and tinnitus. Heart Fire: Huanglian (Coptis Rhizome), Shengdi (Rehmannia Root), Mutong (Akebia Stem). Small Intestine Fire: Mutong. Liver Fire: Chaihu (Bupleurum Root), assisted by Pianqin (Scutellaria Baicalensis Slice). Gallbladder Fire: Longdancao (Gentiana Root). Spleen Fire: Baishao (White Peony Root). Stomach Fire: Shigao (Gypsum Fibrosum). Lung Fire: Huangqin (Scutellaria Root), assisted by Sangbai (Morus Root Bark). Large Intestine Fire: Zi Qin (Scutellaria Root). Kidney and Bladder Fire: Zhimu (Anemarrhena Rhizome), Huangbo (Phellodendron Bark). When using cold herbs like Zhimu, Huangbo, Huangqin, Huanglian, add a small amount of Zhike (Aurantii Fructus) to promote circulation, otherwise they cause stagnation. Moreover, cold-cooling herbs should not be taken long-term, as they damage the Spleen and Stomach, leading to incurable conditions. Sanjiao (Triple Burner) Fire: Shanzhi (Gardeniae Fructus). Upper and Middle Jiao Fire: Lianqiao (Forsythia Fruit). Deficient Fire: Jiangpi (Zingiberis Pericarpium), Zhuye (Bambusa Leaf), Maidong (Ophiopogon Tuber), Tongbian (Child Urine), Sheng Gancao (Raw Licorice Root), Shengjiang (Fresh Ginger) to soothe and dissipate; or Renshen (Ginseng Root) etc. to tonify. Excess Heat-Fire being severe: Huangqin, Huanglian, Shanzhi, Huangbo. Cases suitable for purgation: Mangxiao (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma). Blood deficiency causing fever: Danggui (Angelica Sinensis Root), Sheng/Shu Di (Rehmannia Root). Rootless Fire, wandering causing heat (Kidney Water dried up, Minister Fire flaming upward. Yang takes Yin as root; Kidney Yin deficiency makes it 'rootless'): Liuwei Wan plus Xuanshen (Scrophularia Root), decocted and taken. Qi rising like fire from feet into abdomen (Extreme Kidney Yang deficiency approaching collapse): ten out of ten cases are fatal; treat with Liuwei Wan plus Rougui (Cinnamomi Cortex) 5 qian decocted. Externally, apply Fuzi powder mixed with saliva to Yongquan (KI1) acupoint to guide Fire downward. Dry-Fire: Danggui, Di, Maidong. Damp-Fire: Cangzhu (Atractylodes Rhizome), Fuling (Poria), Zhuling (Polyporus), Mutong. Stagnant Fire: Hot to heavy pressure, not felt to light pressure; induce sweating to cure. Overconsumption of raw/cold foods suppressing Shaoyang Fire in the Spleen region: Shengma (Cimicifugae Rhizoma), Chaihu, Gegen (Puerariae Lobatae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Xixin (Asari Radix et Rhizoma), Xiangfu (Cyperi Rhizoma), Congbai (Allii Fistulosi Bulbus). Liver Fire stagnation: Qingdai (Indigo Naturalis).