伤寒热症烦躁口干。耳聋目昏。唇焦舌赤。甚则发斑发黄。谵语狂妄。皆火
为之芩连栀柏大黄之属。非正治之药乎。然而未可以骤也。如太阳表未
解而脉浮数。火郁则宜发之也。少阳寒热呕而口苦。木郁则宜达之也。阳
明胃实而热者。上郁则宜夺之也。惟邪热已深。蓄而不解。脉洪且数。长而
有力。上焦。凉膈散。中焦。白虎汤。三焦。黄连解毒汤。虚烦。栀子豆豉汤。斑毒。
三黄石膏汤。发黄。茵陈栀子汤。导赤散。皆治火之剂也。殊不知有虚火实
火之分。上焦虚渴。生脉散。中焦血虚发热。症类白虎。当归补血汤。下焦真
水已竭。屡清不解。六味地黄汤。仲景恐肾水干。急下以存津液。何不亟亟
滋阴。尚恐不及。反用承气以下之乎。余每治伤寒发热不止。脉来虚数。大
便或行或结。口燥咽干。耳聋目瞀。胸中觉饥无所胀满。即股六味地黄大
剂饮之。无不应手获效。真百发百中之神剂也。若以芩连栀柏。大苦大寒。
反伤真气。赵氏所谓以有形之水。沃无形之火。适足以伤生耳。安见其有济也。
按清火。有直折。从治。升散。甘缓。壮水诸法。须看其形色脉候虚实。及进
寒凉而弥甚者。不可不知变计也。东垣升阳散火。内经导火归元。固有
采其微者矣。
凉膈散
大黄 朴硝 甘草 黄芩 山栀 薄荷（各二两） 连翘（四两）
各为末。每服五七钱。水煎服。
白虎汤
石膏 知母（各三钱） 甘草（五分炙） 粳米（半合）
水煎服
黄连解毒汤
黄连 黄芩 黄柏 栀子（各等分）
水煎。
栀子豆豉汤
肥栀子（四枚） 香豉（五钱）
水二钟。煎栀子一钟。入豉煎至七分。去渣服。
三黄石膏汤
黄连 黄芩 大黄 石膏
水煎。
茵陈栀子汤
茵陈（三钱） 山栀 大黄（各二钱）
水煎。
导赤散
生地黄 木通 甘草（炙各一钱）
为末。每服一钱。竹叶汤调服。
升阳散火汤
升麻 独活 羌活 防风 柴胡 葛根 人参 甘草 白芍药
水煎。
生脉散
人参（二钱） 麦门冬（一钱半） 五味子（三分杵）
水煎。
当归补血汤
黄 （六钱蜜炙） 当归（四钱）
水煎。
伤寒热症表现为烦躁、口干、耳聋、目昏、唇焦舌赤，甚至出现发斑发黄、谵语狂妄等症状，这些都是火邪作祟所致。黄芩、黄连、栀子、黄柏、大黄等药物，难道不是治疗火邪的正治之药吗？然而，不可以骤然使用。如果太阳表证未解而脉象浮数，说明火郁于内，适宜用发散的方法；少阳病表现为寒热往来、呕吐且口苦，说明木气郁结，适宜用疏达的方法；阳明胃腑实证而有热，说明热气上郁，适宜用攻下的方法。只有当邪热已经深入，蓄积而不能解除，脉象洪大且数，长而有力时，才分别针对不同部位进行治疗：上焦热盛用凉膈散，中焦热盛用白虎汤，三焦热盛用黄连解毒汤。虚烦用栀子豆豉汤，斑毒用三黄石膏汤，发黄用茵陈栀子汤或导赤散，这些都是治疗火邪的方剂。
殊不知火邪有虚火和实火之分。上焦虚渴，用生脉散；中焦血虚发热，症状类似白虎汤证，用当归补血汤；下焦真水已枯竭，多次清热无效，用六味地黄汤。张仲景担心肾水干枯，主张急下以保存津液，为什么不急于滋阴呢？尚恐来不及，反而使用承气汤来攻下吗？我每次治疗伤寒发热不止，脉象虚数，大便有时通畅有时干结，口燥咽干，耳聋目昏，胸中感觉饥饿但没有胀满感，就大量服用六味地黄汤，没有不立即见效的。这真是百发百中的神效方剂啊。如果用黄芩、黄连、栀子、黄柏等大苦大寒的药物，反而会损伤真气。正如赵献可所说，用有形之水去浇灌无形的火，只会足以伤害生命罢了，哪里见得到有什么帮助呢？
按清火的方法，有直折（直接抑制）、从治（顺从其性而治）、升散、甘缓、壮水等方法。必须观察病人的形色脉候虚实，以及进服寒凉药物后病情反而加重的情况，不可不知道变通之计。李东垣的升阳散火法，《内经》的导火归元法，确实有值得采纳的精微之处。
凉膈散：大黄、朴硝、甘草、黄芩、山栀、薄荷（各二两），连翘（四两）。将上述药物研为细末，每次服用五至七钱，用水煎服。
白虎汤：石膏、知母（各三钱），甘草（五分，炙），粳米（半合）。用水煎服。
栀子豆豉汤：肥栀子（四枚），香豉（五钱）。用水二钟，先煎栀子取一钟，加入香豉再煎至七分，去渣服用。
导赤散：生地黄、木通、甘草（炙，各一钱）。研为细末，每次服用一钱，用竹叶汤调服。
升阳散火汤：升麻、独活、羌活、防风、柴胡、葛根、人参、甘草、白芍药。用水煎服。
In the heat syndromes of cold damage, symptoms such as irritability, dry mouth, deafness, blurred vision, scorched lips, and red tongue appear. In severe cases, macules (skin eruptions) and jaundice may occur, along with delirious speech and madness. All these are caused by fire pathogen. Are not herbs such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), and Dahuang (Rhei Radix et Rhizoma) the correct treatments for fire? However, they should not be administered abruptly. If the Taiyang exterior syndrome is unresolved and the pulse is floating and rapid, indicating fire stagnation, it is appropriate to use dispersing methods. If Shaoyang syndrome presents with alternating chills and fever, vomiting, and bitter taste in the mouth, indicating wood qi stagnation, it is appropriate to use unblocking methods. If Yangming stomach excess with heat indicates upward stagnation of heat, purgative methods are appropriate. Only when the evil heat has penetrated deeply, accumulated, and cannot be resolved, and the pulse is surging, rapid, long, and forceful, should treatment be targeted at specific levels: Liangge San (Cooling the Diaphragm Powder) for upper jiao heat, Baihu Tang (White Tiger Decoction) for middle jiao heat, and Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) for triple jiao heat. Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) for deficiency vexation, Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction) for macule toxicity, Yinchen Zhizi Tang (Artemisiae Scopariae and Gardeniae Decoction) or Daochi San (Guide Out the Red Powder) for jaundice; all these are formulas treating fire.
Yet one must not ignore the distinction between deficiency fire and excess fire. For upper jiao deficiency thirst, Shengmai San (Generate the Pulse Powder) is used. For middle jiao blood deficiency causing fever, where symptoms resemble those treatable by Baihu Tang, Danggui Buxue Tang (Angelica Sinensis Decoction for Replenishing Blood) is used. When lower jiao true water is exhausted and repeated clearing fails, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) is used. Zhang Zhongjing feared the drying of kidney water and advocated urgent purgation to preserve body fluids; why not urgently nourish yin? He might even fear it is too late, yet instead uses Chengqi Tang (Chengqi Decoction) to purge? Whenever I treat continuous fever from cold damage with a deficient and rapid pulse, bowel movements that are sometimes loose and sometimes constipated, dry mouth and throat, deafness and blurred vision, and a sensation of hunger in the chest without fullness, I administer large doses of Liuwei Dihuang Tang, which invariably yields immediate results. This is truly a divine formula with hundred percent efficacy. Using the great bitter and cold herbs like Huangqin, Huanglian, Zhizi, and Huangbai would instead damage the true qi. As Zhao Xianke stated, using tangible water to douse intangible fire only suffices to harm life, offering no real benefit.
Regarding clearing fire, there are methods of direct suppression (zhezhe), following the nature of the disease (congzhi), ascending and dispersing, sweet and緩 (gan huan), and strengthening water (zhuangshui). One must observe the patient's complexion, form, pulse, and signs of deficiency or excess, as well as situations where condition worsens after taking cold-cooling herbs; one must know how to adapt. Li Dongyuan's method of ascending yang and dispersing fire, and the Inner Classic's method of guiding fire back to its source, indeed contain subtle wisdom worth adopting.
Liangge San: Dahuang, Poxiao, Gancao, Huangqin, Zhizi, Bohe (each 2 liang); Lianqiao (4 liang). Grind into powder. Take 5–7 qian per dose, decoct in water and take orally.
Baihu Tang: Shigao, Zhimu (each 3 qian); Gancao (0.5 qian, honey-fried); Jingmi (0.5 he). Decoct in water and take orally.
Huanglian Jiedu Tang: Huanglian, Huangqin, Huangbai, Zhizi (equal parts). Decoct in water.
Zhi Zi Chi Tang: Fei Zhizi (4 fruits); Xiangchi (5 qian). Use 2 zhong of water, decoct Zhizi until 1 zhong remains, add Xiangchi, decoct until 0.7 zhong remains, strain and take.
Sanhuang Shigao Tang: Huanglian, Huangqin, Dahuang, Shigao. Decoct in water.
Yinchen Zhizi Tang: Yinchen (3 qian); Zhizi, Dahuang (each 2 qian). Decoct in water.
Daochi San: Shengdihuang, Mutong, Gancao (honey-fried, each 1 qian). Grind into powder. Take 1 qian per dose, mix with Zhu Ye (Bamboo Leaf) decoction.
Shengyang Sanhuo Tang: Shengma, Duohuo, Qianghuo, Fangfeng, Chaihu, Gegen, Renshen, Gancao, Baishao Yao. Decoct in water.
Shengmai San: Renshen (2 qian); Maimendong (1.5 qian); Wuweizi (0.3 fen, crushed). Decoct in water.
Danggui Buxue Tang: Huangqi (6 qian, honey-fried); Danggui (4 qian). Decoct in water.