疮疡发热烦躁，或出血过多，或溃脓大泄，或汗多亡阳，或下多亡阴，以致阴血耗散，
阳无所根据，浮散于肌表之间，而非火也。若发热无寐，血虚也，用圣愈汤。兼汗不止，气虚也，
急用独参汤。发热烦躁，肉 筋惕，气血虚也，用八珍汤。大渴面赤，脉洪大而虚，阴虚发
热也，用当归补血汤。肢体微热，烦燥面赤，脉沉而微，阴盛发躁也，用四君加姜、附。东
垣云∶昼发热而夜安静，是阳气自旺于阳分也；昼安静而夜发热，是阳气下陷于阴中也；
如昼夜俱发热者，重阳无阴也，当峻补其阴。故王太仆云∶如大寒而甚，热之不热，是无火
也，当治其心；如大热而甚，寒之不寒，是无水也；热动复止，倏忽往来，时动时止，是无
水也，当助其肾。故心盛则生热，肾盛则生寒，肾虚则寒动于中，心虚则热收于内。又热不
胜寒，是无火也。寒不胜热，是无水也。夫寒之不寒，责其无水；热之无热，责其无火；热
之不久，责心之虚；寒之不久，责肾之弱。治者当深味之。
治验
操江都宪伍松月背疮愈后，大热，误为热火，用苦寒药一钟，寒热益甚，欲冷水浴身，
脉浮大，按之全无。余曰∶此阳气虚浮于肌表，无根之火也，急用六君子加附子一剂，即愈。
春元沈震川之内，暑月面生痤疖，乘凉入风，面目浮肿。越二日，左臂肿痛，瘾疹如丹
，背胁髀股等处，发肿块三四，肉色不红，痛甚昼夜呼号，寒热往来，饮食不思，服活命饮，及
行气败毒之剂。其势愈炽，肝脉浮涩，脾脉弦弱，此属二经荣气不行，风邪乘虚流注经络为
患。先以八珍加黄 、柴胡、青皮数剂，肿处渐渐红 ；又以十全大补加金银花、白芷、龙
胆草、贝母，十余剂，胁腿二处，溃脓碗许，余块渐平；仍服十全大补汤，调理月余而安。
向使专于祛风攻毒，鲜不败事矣。
一儒者患流注，发热作渴，头痛自汗，脉洪大，按之无力，此气血虚寒也，用十全大补
加麦门、五味治之，其症益甚；仍用前药加附子一钱，四剂诸症悉退；却去附子，加肉桂二十余
剂，气血渐复；又因劳心，发热恶寒，饮食减少，
此脾胃复伤，元气下陷，用补中益气加附子一钱，二剂热止食进，仍用
大补元气而安。后因考试不利，怀抱不舒，更兼劳役，饮食日少，形气日衰，吐痰作渴，头
痛恶寒，或热来复去，或不时而动，仍用补中益气数剂，诸症渐愈，元气渐复，乃去附子，
再加肉桂五分，百余剂而愈。
一男子背疮不敛，小便赤涩， 肿发热，口干体倦，脉洪数而无力，用参、 、归、术
、熟地、芎、芍、陈皮、麦门、五味、炙草、肉桂，以补元气，引火归经，脉症益甚，此药力未
能及也；再剂顿退，却去肉桂，又数剂而愈。此症因前失补元气故耳。
疮疡出现发热烦躁，或者是因为出血过多，或者是因为溃破流脓导致津液大量流失，或者是因为出汗过多导致阳气亡失，或者是因为泻下过多导致阴液亡失，从而导致阴血耗散。此时阳气失去了依附的基础，浮散在肌肤体表之间，这并非实火所致。如果发热且无法入睡，这是血虚的表现，使用圣愈汤治疗。如果兼有汗出不止，这是气虚的表现，急需使用独参汤治疗。如果发热烦躁，肌肉跳动、筋脉抽搐，这是气血两虚的表现，使用八珍汤治疗。如果极度口渴、面色红赤，脉象洪大但按之空虚，这是阴虚发热，使用当归补血汤治疗。如果肢体轻微发热，烦躁面赤，脉象沉而微弱，这是阴盛格阳导致的躁动，使用四君子汤加入干姜、附子治疗。
李东垣说：白天发热而夜间安静，是阳气在阳分旺盛；白天安静而夜间发热，是阳气下陷于阴分中；如果昼夜都发热，这是重阳无阴（阴精枯竭），应当峻补其阴。所以王太仆说：如果极寒且严重，用热药治疗却不见温热效果，这是命门火衰（无火），应当温补心肾之阳；如果极热且严重，用寒药治疗却不见凉效，这是肾水枯竭（无水）；如果热势时作时止，忽冷忽热，时而发作时而停止，这也是肾水枯竭，应当滋助肾阴。所以心火亢盛则生热，肾水充足则生寒；肾气虚弱则寒气内生，心气虚弱则热气内收。另外，如果用寒药不能退热，是因为体内缺水（肾阴不足）；如果用热药不能退寒，是因为体内缺火（肾阳不足）。热证用药不久即见效，责任在于心气虚；寒证用药不久即见效，责任在于肾气弱。医者应当深刻体会这些道理。
治验案例：
操江都宪伍松月背部疮疡愈合后，出现高热，被误认为是实热火毒，使用了苦寒药物一剂，导致寒热症状更加严重，甚至想用冷水洗澡。诊其脉象浮大，但重按完全无力。我说：这是阳气虚弱，浮越于肌表，属于无根之火，急忙使用六君子汤加入附子，一剂后即痊愈。
春元沈震川的妻子，在暑天面部生了痤疮疖肿，因乘凉受风，导致面目浮肿。过了两天，左臂肿痛，皮肤出现如丹毒般的瘾疹，背部、胁部、大腿等处，发肿块三四处，肉色不红，疼痛剧烈，昼夜呼号，伴有寒热往来，不思饮食。之前服用了仙方活命饮以及行气败毒的药物，病情反而更加炽盛。诊得肝脉浮涩，脾脉弦弱，这属于肝胆和脾胃二经的营气运行不畅，风邪乘虚侵入经络为患。先用八珍汤加入黄芪、柴胡、青皮等数剂，肿胀处渐渐变红；接着又用十全大补汤加入金银花、白芷、龙胆草、贝母，十余剂后，胁部和腿部的两处肿块溃破流出约一碗脓液，其余肿块逐渐平复；之后继续服用十全大补汤调理一个多月而安定。假如当初专门专注于祛风攻毒，很少有不失败的。
一位儒者患有流注病，发热口渴，头痛自汗，脉象洪大但按之无力，这是气血虚寒的表现，使用十全大补汤加入麦冬、五味子治疗，症状反而加重；仍然使用前药并加入一钱附子，四剂后所有症状全部消退；随后去掉附子，加入肉桂二十余剂，气血逐渐恢复；后来因为用心过度，出现发热恶寒，饮食减少，这是脾胃再次受伤，元气下陷，使用补中益气汤加入一钱附子，两剂后热止食进，随后继续大补元气而痊愈。后来因为考试不利，心情抑郁，再加上劳累，饮食日渐减少，形体和气力日渐衰弱，吐痰口渴，头痛恶寒，有时发热有时退去，有时不时发作，仍然使用补中益气汤数剂，诸症逐渐痊愈，元气逐渐恢复，于是去掉附子，再加五分肉桂，百余剂后痊愈。
一名男子背部疮疡久不收敛，小便赤涩，身体浮肿发热，口干体倦，脉象洪数但无力，使用人参、黄芪、当归、白术、熟地黄、川芎、白芍、陈皮、麦冬、五味子、炙甘草、肉桂，以补元气，引火归经，服药后脉症反而加重，这是因为药力尚未达到病所；再服两剂后症状顿时减退，随后去掉肉桂，又服数剂而痊愈。这个病症是因为之前未能及时补益元气造成的。
Ulcerative sores presenting with fever and irritability, or resulting from excessive bleeding, or profuse discharge of pus after ulceration, or excessive sweating leading to the loss of Yang Qi, or excessive purgation leading to the loss of Yin fluids, result in the consumption and dispersion of Yin blood. At this point, Yang Qi has no foundation to rely upon and floats and scatters between the muscle and skin layers; this is not due to Fire (excess heat). If there is fever accompanied by insomnia, it indicates Blood deficiency (Xue Xu), treated with Shengyu Tang (Sage-Enhancing Decoction). If accompanied by incessant sweating, it indicates Qi deficiency (Qi Xu), urgently treated with Dushen Tang (Single Ginseng Decoction). If there is fever and irritability with muscle twitching and tendon tremors (Rou Ji Jin Ti), it indicates a deficiency of both Qi and Blood, treated with Bazhen Tang (Eight-Treasure Decoction). If there is extreme thirst and redness of the face, with a洪大 (Hóng Dà - large and surging) pulse that is empty upon pressure, it indicates Yin deficiency fever (Yin Xu Fa Re), treated with Danggui Buxue Tang (Angelica Sinensis Decoction for Nourishing Blood). If there is slight fever of the limbs, irritability with facial redness, and a 沉而微 (Chén ér Wēi - deep and faint) pulse, it indicates agitation caused by Yin excess repelling Yang (Yin Sheng Fa Zao), treated with Sijunzi Tang (Four Gentlemen Decoction) added with Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite Root).
Li Dongyuan stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang aspect; quietness during the day and fever at night indicates Yang Qi sinking into the Yin aspect; if there is fever both day and night, it indicates Extreme Yang without Yin (Chong Yang Wu Yin), requiring vigorous tonification of Yin. Therefore, Wang Taipu said: If there is severe cold that does not respond to warming treatment, it indicates the absence of Fire (Wu Huo), and one should treat the Heart (and Kidney); if there is severe heat that does not respond to cooling treatment, it indicates the absence of Water (Wu Shui - Kidney Yin); if heat comes and goes intermittently, suddenly appearing and disappearing, it also indicates the absence of Water, and one should assist the Kidney. Thus, an excess of Heart generates heat, while an abundance of Kidney generates cold; Kidney deficiency causes cold to move within, and Heart deficiency causes heat to be retained internally. Furthermore, if cold cannot be dispelled, it is due to the lack of Water (Kidney Yin); if heat cannot be cleared, it is due to the lack of Fire (Kidney Yang). If heat resolves quickly with treatment, the responsibility lies in Heart deficiency; if cold resolves quickly with treatment, the responsibility lies in Kidney weakness. Practitioners should deeply contemplate these principles.
Case Record 1:
Wu Songyue, Censor of Caojiang, experienced high fever after his back sore healed. He was mistakenly diagnosed with excess internal fire and administered a dose of bitter-cold herbs, which exacerbated the chills and fever, leading him to desire a cold water bath. His pulse was floating and large but completely empty upon deep pressure. I stated: This is Yang Qi deficiency with floating Yang on the surface, representing rootless Fire. I urgently prescribed Liujunzi Tang (Six-Gentlemen Decoction) with one piece of Fuzi (Prepared Aconite Root). He recovered after one dose.
Case Record 2:
The wife of Shen Zhenchuan, a Chunyuan (scholar), developed acne and boils on her face during the summer month. After seeking coolness and being exposed to wind, her face and eyes became swollen. Two days later, her left arm became painful and swollen, with urticaria resembling erysipelas. Swollen lumps appeared on her back, flanks, thighs, and other areas. The skin color was not red, but pain was severe, causing her to cry out day and night. She had alternating chills and fever, no appetite, and had taken Xianfang Huoming Yin (Immortal Life Preserving Elixir) and formulas for moving Qi and resolving toxicity. Her condition worsened. Her Liver pulse was floating and choppy, and her Spleen pulse was wiry and weak. This indicated stagnation of Ying (Nutritive) Qi in the Liver and Spleen meridians, with Wind pathogen invading the collaterals due to deficiency. Initially, she took Bazhen Tang (Eight-Treasure Decoction) added with Huangqi (Astragalus Root), Chaihu (Bupleurum Root), and Qingpi (Aged Tangerine Peel) for several doses, after which the swelling gradually turned red. Then, she took Shiquan Dabu Tang (Ten-Tonics Great Tonifying Decoction) added with Jinyinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), Longdancao (Gentiana Root), and Beimu (Fritillaria Bulb) for over ten doses. The two swellings on her flanks and legs ulcerated, discharging about a bowl of pus, and the remaining lumps gradually flattened. She continued taking Shiquan Dabu Tang for over a month until she stabilized. Had they focused solely on expelling Wind and attacking toxicity, failure would have been inevitable.
Case Record 3:
A scholar suffered from Liuzhu (flowing deposits/abscesses), with fever, thirst, headache, spontaneous sweating, and a large pulse that was powerless upon pressure. This indicated Qi and Blood deficiency with Cold. I treated him with Shiquan Dabu Tang (Ten-Tonics Great Tonifying Decoction) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), but his symptoms worsened. I continued using the previous formula but added one qian of Fuzi (Prepared Aconite Root). After four doses, all symptoms subsided. I then removed the Fuzi and added Rougui (Cinnamon Bark) for over twenty doses, gradually restoring Qi and Blood. Later, due to mental exertion, he developed fever and aversion to cold with reduced appetite. This indicated further injury to the Spleen and Stomach and sinking of Yuan (Original) Qi. I used Buzhong Yiqi Tang (Middle-Boosting Qi-Rescuing Decoction) with one qian of Fuzi. After two doses, the fever ceased and appetite improved. I then continued to greatly tonify Yuan Qi until he recovered. Later, due to unsuccessful examinations and frustration, combined with physical labor, his diet decreased daily, and his form and Qi declined. He presented with expectoration, thirst, headache, aversion to cold, intermittent fever, and irregular episodes. I again used Buzhong Yiqi Tang for several doses. His symptoms gradually improved, and his Yuan Qi recovered. I then removed the Fuzi and added five fen of Rougui (Cinnamon Bark). After over a hundred doses, he was cured.
Case Record 4:
A man had a back sore that failed to heal, with dark and scanty urine, body swelling, fever, dry mouth, fatigue, and a rapid, large pulse that was powerless. I used Renshen (Ginseng Root), Huangqi (Astragalus Root), Danggui (Angelica Sinensis Root), Baizhu (Atractylodes Rhizome), Shudihuang (Rehmannia Root Prepared), Chuanxiong (Ligusticum Rhizome), Shaoyao (Peony Root), Chenpi (Tangerine Peel), Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), Zhigancao (Honey-fried Licorice Root), and Rougui (Cinnamon Bark) to tonify Yuan Qi and guide Fire back to its source. However, the pulse and symptoms worsened initially, indicating that the medicinal power had not yet reached the disease site. After two more doses, symptoms suddenly receded. I then removed Rougui and administered several more doses until he recovered. This case occurred because Yuan Qi had not been supplemented earlier.