夫疮疡初起未溃脓。时有发热恶寒者。有不恶寒者。是荣卫不行。经络阻塞。疮毒 发之所为也。
如已溃之后。脓血大泄。未有不虚者也。经云。阳微即恶寒。阴弱还生热是也。丹溪云。恶寒非寒。
是卫气虚衰不能温分肌肉。实于腠理而恶寒者。又有上焦之邪。隔绝荣卫。不能升降。出于肌表而恶
寒者。东垣云。夜则恶寒。昼则安静。是阴血自旺于阴分也。有日夜恶寒而不发热者。是重阴无阳也。
当泄其阴而峻补其阳也。又夜则安静。昼则恶寒。是阴盛而上溢于阳分也。如昼则发热。夜则安静。
是阳气自旺于阳分也。昼则安静。夜则发热。是阳气下陷入阴分也。名曰热入血室。如昼夜俱发热烦
躁。是重阳而无阴也。当亟泄其阳而峻补其阴。王注云。病热而脉数。按之不鼓动。乃寒盛格阳而致
之。非热也。形症俱寒而脉气鼓击于手下者。此为热盛拒阴而生病。非寒也。如
脉浮数而弱。恶寒者。阳气虚也。宜补气。如脉涩而热者。血虚也。宜补血。又午前发热宜补气。午
后发热宜补血。如脉浮数发热而痛者。邪在表宜散之。脉沉数发热而痛者。邪在里。宜下之。又法候
之以手扪摸分轻重五法。以轻手扪之于皮毛间热者。肺热也。微重于肌肉间热者。脾热也。再微少重
于血脉间热者。心热也。又重手按之于血脉之下。筋骨之间。肝热也。又至重按之于骨分。其热蒸手
如火。其人骨苏苏如虫食。其骨困热。不任其身。亦不能起于床者。肾热也。又一法十二经候之于十
二时中发热。形症可推。亦随症施治。无不验耳。
疮疡在初起阶段，脓液尚未溃破时，有时会出现发热、恶寒的症状，也有不出现恶寒的情况。这是由于营卫之气运行不畅，经络阻塞，导致疮毒发散所引起的。
如果疮疡已经溃破之后，脓血大量流失，没有不出现虚证情况的。医经中说：“阳气微弱就会恶寒，阴气虚弱就会产生热”，说的就是这种情况。朱丹溪说：恶寒并非因为外感寒邪，而是卫气虚衰，不能温煦肌肉腠理，导致寒气实于腠理而感到恶寒；又有上焦的邪气，隔绝了营卫之气的运行，使其不能正常升降，出于肌表而感到恶寒。李东垣说：夜间恶寒，白天安静，这是阴血在阴分时段自然旺盛的表现。有日夜都恶寒而不发热的，这是重阴无阳（阴寒极盛而阳气衰竭）。应当泻其阴寒而峻补其阳气。又有夜间安静，白天恶寒的，这是阴气过盛而上溢于阳分。如果白天发热，夜间安静，这是阳气在阳分时段自然旺盛。白天安静，夜间发热，这是阳气下陷进入阴分。这种情况称为“热入血室”。如果昼夜都发热且烦躁，这是重阳无阴（阳热极盛而阴液枯竭）。应当紧急泄其阳热而峻补其阴液。王冰注解说：患病发热而脉象数急，但按之无力鼓动，这是寒盛格拒阳气所致，并非真热。形体症状都表现为寒象，但脉气在手下鼓击有力的，这是热盛拒阴所致生病，并非真寒。
如果脉象浮数而弱，伴有恶寒，是阳气虚衰。适宜补气。如果脉象涩而发热，是血虚。适宜补血。又法：午前发热适宜补气，午后发热适宜补血。如果脉象浮数、发热且疼痛，说明邪气在表，适宜用发散法；脉象沉数、发热且疼痛，说明邪气在里，适宜用攻下法。
另外有一种方法，用手触摸诊察来分辨轻重，分为五法：轻手触摸皮毛之间感到热的，是肺热；稍微重一点触摸肌肉之间感到热的，是脾热；再稍微重一点触摸血脉之间感到热的，是心热；重手按压在血脉之下、筋骨之间感到热的，是肝热；用力最重按压在骨分，感觉热气蒸腾如火，患者感觉骨头酸软如虫蛀啃食，骨骼困热难忍，身体沉重无法起床的，是肾热。
When a carbuncle or sore first appears and has not yet suppurated, there are times when fever and aversion to cold occur, and times when aversion to cold does not occur. This is caused by the failure of Ying (Nutritive) and Wei (Defensive) Qi to circulate, blockage of the meridians, and the eruption of toxic pathogens from the lesion.
After the lesion has ulcerated and pus and blood have been largely discharged, deficiency patterns invariably arise. The Classics state: "When Yang is deficient, aversion to cold occurs; when Yin is weak, heat arises." This refers to such cases. Zhu Danxi stated that aversion to cold is not due to external cold, but rather because Wei Qi is deficient and weak, failing to warm the muscles and interstices, causing cold to accumulate in the cou li (skin and muscle interstices). Additionally, pathogenic factors in the Upper Jiao may obstruct the circulation of Ying and Wei Qi, preventing their normal ascending and descending movements, manifesting as aversion to cold on the body surface. Li Dongyuan stated that aversion to cold at night with calmness during the day indicates that Yin Blood is naturally flourishing in the Yin aspect. Aversion to cold occurring both day and night without fever indicates an excess of Yin with absence of Yang. In such cases, one should drain the Yin and vigorously tonify the Yang. Conversely, calmness at night with aversion to cold during the day indicates that Yin is excessive and overflowing into the Yang aspect. Fever during the day with calmness at night indicates that Yang Qi is naturally flourishing in the Yang aspect. Calmness during the day with fever at night indicates that Yang Qi has sunk into the Yin aspect, a condition named "Heat entering the Blood Chamber" (Re Ru Xue Shi). Fever and irritability occurring both day and night indicate an excess of Yang with absence of Yin. In such cases, one must urgently drain the Yang and vigorously tonify the Yin. Wang Bing's commentary notes: If a patient has fever with a rapid pulse that feels empty and lacks force upon deep pressure, this is caused by severe Cold repelling Yang, and it is not true Heat. If the physical symptoms all suggest Cold, but the pulse beats forcefully under the fingers, this is caused by severe Heat repelling Yin, and it is not true Cold.
If the pulse is floating, rapid, and weak, accompanied by aversion to cold, it indicates deficiency of Yang Qi, and Qi-tonifying methods are appropriate. If the pulse is choppy and there is fever, it indicates Blood deficiency, and Blood-tonifying methods are appropriate. Furthermore, fever occurring before noon suggests the need to tonify Qi, while fever after noon suggests the need to tonify Blood. If the pulse is floating and rapid, accompanied by fever and pain, the pathogen is in the Exterior, and dispersing methods are appropriate. If the pulse is sunken and rapid, accompanied by fever and pain, the pathogen is in the Interior, and purgative methods are appropriate.
Another method involves palpation to assess severity, divided into five levels: Light palpation revealing heat in the skin and hair level indicates Lung Heat. Slightly heavier palpation revealing heat in the muscle level indicates Spleen Heat. Palpating slightly deeper into the vessel level reveals Heart Heat. Heavy pressure applied below the vessels, between sinews and bones, revealing heat indicates Liver Heat. Deepest pressure applied to the bone level, where heat radiates like fire, and the patient feels bone soreness as if gnawed by insects, with bones feeling oppressively hot, making the body too heavy to rise from bed, indicates Kidney Heat.
Another diagnostic method involves observing fever patterns according to the Twelve Meridians across the Twelve Two-Hour Periods (Shichen). The clinical manifestations can be deduced, and treatment can be administered accordingly based on symptoms, yielding reliable results.