④应忌医药麻醉药、峻补药、按摩、针治（此指中医而言）及一切偏方，一切中西补药。（患者不得医生许可，万不可自购市上所售之补药滥服。）10.阳虚发热此种发热，率皆由于大汗、大下及大吐泻之后，日久天长，全身之阳气，消耗殆尽。在小儿则于吐泻症、痘后、疹后，或因秉赋素弱、饮食积聚、过用攻伐，或过服凉药，皆可演成此症。在中医干小儿科即名慢惊风，其症状最易见者，即为全身瘦弱、头颈极细、发细而脱、皮肤甲错、甚则神昏气喘、二目无神、热不退、或乍寒乍热、面色青黄、口唇虽燥裂出血、但不喜欢冷水、而出气极凉、泻利、冷汗、完谷不化、或四肢冰冷、角弓反张、寐不合眼、日久泄泻频频、或干嗽，以上诸症均属危候。凡日久热不退，及由吐泻而成者，此即属孤阳外越（阴虚阳越），必用姜、桂、附子、参、芪、术、芍、熟地等培补根本，庶可挽回一线元阳。庄一夔氏所著之《福幼编》，以温补见长。余治阳虚发热症，不论大人小儿，试验四十余年，无不神效，可取法也。此症若纯以西药治之，绝对无效，医者必识其言。又有小儿时常发热解表暂愈，又发热；攻里暂愈，又发热；养阴滋阴发热仍然，此亦阳气浮游，无所归着之象，以四君子汤加山药、扁豆治之多效，不必用附子、肉桂。凡口起白疳及身肿者，则更危矣。
以上病者皮肤发热，约分十种，病原不同，治法亦不同，差之毫厘，谬之千里，医者无不知之，惟发热之症，与1．汗，2．衄，3．大小便，4．，舌苔，尤有重要关系，兹再分别说明于下，不厌求详也。
①发汗即用发散药蒸发津液，开发表阳，使在表之寒邪（注意寒字），得汗而解，凡初得之伤寒病，有头痛、身痛、恶寒者，皆宜发散。又有一种温病，自汗恶寒发热者，亦宜做解其表（例如荆芥。防风之类），不可用止汗药，表解之后，汗自止也。
此症有主用桂枝者，大误，以桂枝性太燥，用之必衄血。以荆芥、防风、葛根、薄荷、藿香等解表最为相宜。（但须兼清内热之药，例如连翘、银花等）若系严冬伤寒病，用麻黄、羌活等药发汗，自是正理。若温病盛行之际，内有郁热，外为寒束（天气骤冷、骤暖变动剧烈之时，此症最多，例如春末秋深之温病是也。亦宜表里双解，而解表尤不可忽，（荆、防解表热，银花、连翘解上焦内热，温病初起之定法也。）此用药发汗之理由也。
②自汗、盗汗（俗名虚汗）此二种汗症，虽有自汗系阳虚，盗汗系阴虚之说。然在久病（注意久病二字，若在初得伤寒、温病之自汗，不在此例。）之人，如此现象，总以斟酌补阳（参、芪之类）补阴（生地、熟地、白芍之类），以期挽回衰弱之颓势为宜。又有所谓大汗亡阳、孤阳外越者，则系元气将散（阳脱症），西医称之为死汗（此与下列之过服发汗药，致大汗淋漓者不同-），则非大剂人参、附子、肉桂、白芍、熟地大补阴阳（补阳敛汗必兼用补阴之品，否则阳无附丽也），加以介类潜阳之法（例如牡蛎、鳖甲、龟板之类），不足挽回生命于万一也。（又有一种过用发汗药，以致大汗淋漓不止者，顷刻之间，可以心脏停止，致人于死，凡中药之麻黄、羌活，西医之退热药例如安基比林等，用之过量，往往发生此种危险，但西药退热剂，与中医发汗药不同，其汗出乃该药之副作用，医者不可认安基比林等为发汗药，自不待言，倘遇此种危险汗出之场合，西药中之强心注射，在所必施，不可不知也。）又中医介类潜阳之类，以治虚汗，尤为奇效，历试不爽，附识于此，学者应注意也。
⑧战汗此是所受之邪，欲借汗解。故此种汗解之前，病者必有一番极剧烈之不安，如疯如狂，喊叫哭笑，手舞足蹈，一如邪魔，恐怖状态，不一而足，或则周身战栗，颤动不宁、脉停气促（汗后脉自出），因而继续汗出。或则大汗淋漓，立时表里透澈，脉静身凉。此种战汗，盖即内外邪正相争，既得汗出，即是邪有出路，为温病及伤寒症固闭实邪解散之佳兆，实为病势一大转机。亦有战汗之后，邪尚未净，再作战汗而解者。更有战而不汗，（邪盛正衰）必待鼻衄，（凡疹一现即隐，身热气喘，实为危症，不易再出，若得鼻衄者；尚可救，亦同此理。）或屡用清下之药而解者。最危险者，为一战之后，正气不敌，邪气不退，不能再作战汗，遂即精神散乱，寻衣摸床，昏迷愈甚而死（此种危象，多由于病者素衰弱，或大病日久，元气消耗太甚而然）此战汗之大略也。以上战汗，多因得病过程中，失于汗下，邪正交持日久，自然分解之现象，其战汗乘机而作，不拘一格。有因服下药后得泻而作战汗者，有因大渴恣饮凉水（余亲见之或有饱啖西瓜及饮冰激凌而作战汗者。）而作战汗者，有服清凉活血生津之品而得战汗者。盖邪方欲解，稍得助力，以启其机，自然战汗。此种汗解，不可强求，然实为表里透澈之好现象，自无疑也。（病家遇此战汗，不知吉凶，往往惶恐无措，医者可详告之。）当战汗之时，万不可服补药，亦不可用汗下、和解、清凉等药。只宜稳静看护，稍与温水饮之，以助其津液可矣。至若正气太虚，大汗不已，诊断确实有虚脱之虑时，始可与独参汤，（或注射强心西药，以防汗脱而死，然万不可误断也。
2．衄鼻内出血，除女人逆经（俗名倒经）及习惯性鼻衄，均不在本题范围，姑从略。兹所申明者，为热性病之鼻衄。盖凡衄血现象，率皆由于血热上行，关系肺热尤显。此种衄血，凡温病过服发散药太大，或误服（病已不在表）发汗药及热药，逼热上行，往往如此。（尤以桂枝最甚，余曾见有温病因误服佳枝，死后口鼻出血者，慎之。）若于最险之斑疹，一现即隐，身大热，神昏气促，险象环生之顷，服清热解毒药后，一得鼻衄，自是佳兆。盖疹方外透，骤遭寒凉（例如外受风寒），或内受寒冷（例如饮冷水），顷刻毒气收聚入内；，立呈险象。此时若欲疹再透出，百不获一，惟有急服连翘、双花、犀角等以图挽回。此时若有衄血，是邪有出路，尚有生望，（再照清热宣透之药治之，可以望生）否则不易求生矣。又有温病日久，邪已入内，失于清下，若有鼻衄，亦系佳兆，（与战汗皆是邪有出路）不可不知。
3．大小便此种诊断，必分虚实二种言之。
①先说明实证之大小便，凡实证发热，（参看论热诸条）例如伤寒、温病等，本病认定之后，其大便之多少，或有或无及其颜色，均宜注意。大凡热在表时（尚未入里），大小便均无影响，一如平人，清利如常。迨至胃肠渐起变化，（中医谓之传经，或名传变）诊断上最重要者，即为二便。凡大便极干燥，或数日不解大便，或腹痛，或泻极恶臭之稀粪，或一日数次泻下，（中医谓之热结旁流）或大便黑色如油，（此血便最危险）或大便如脓血，（痢疾如有此象，后重异常）或大便白色，（缺乏胆汁，凡胆石、疝痛多有之，中医谓之胁痛。）绿色，（小儿多有此症，亦胆热也。）皆为实证。（多有潮热，非表证也。）均宜用下剂，（中药则有大黄、芒硝等，西药则有甘汞、硫苦等药均可酌用。但此种泻药作用不同，不可盲用。）若迟延不下，反误病机，或致神经受其侵害，（精神昏迷、谵语发狂）或至炎症延及腹膜，（当下不下，肠管破裂，西医谓之穿孔，出血、溃烂，诱起腹膜炎，全腹皆肿，不可救药矣。）立致危险。故一见肠胃燥结，总宜速下，不可拘泥于保存津液，下不厌迟之说也。但温病逆传，邪入心包，泻药不可妄用，此条应参看温病说明，不再重叙。至于实证之小便，或黄或赤，或少或频数不禁，（此句必切记热性病三字）或溺极混浊沉淀（白粉样物），甚则点滴不通，精神错乱（尿中毒），皆为实热。（必与大便及全身症状对勘，清利小便之药，固所应用，但重要关键，仍宜注重清除大肠实热（泻下法），肠热既去？小便自利，不可不知。但热尚未在肠，例如热闭膻中，则不可泻其大便，所谓诛伐无过也。（盲肠炎、肾脏炎、尿石等症，均有时必须用外科手术者，不在此例。）②再说明虚证之大小便，凡虚证之大便多稀薄，或一日数次，（亦有由实证之痢疾日久，转成虚证者，一日数次，所下仍有脓佯物，腹亦微疼，然不可认为实证，必大补元阳，乃可望愈）。或完谷不化，下利清水（若系肠结核之症，往往由肺病而来，不易治疗。）小便均清白顺利或不禁。又有一种虚证小便，亦有极短、极赤而臊者，此阳虚不化，不可疑为实热。例如水肿症虚弱已极，非用大补元阳之药，不能得其小便通利。此症参看杂症编肿胀病，赵氏医案自明。此症并无其它热象，而小便短赤如此，非由经验得来，不易知也。此种病状，多半皆系久病，（中医谓之脾虚或名肾泻）且多无表热，（亦有发虚热者）脉多无力，精神多清醒，身体多瘦弱，医者不难诊断，不致认症错误。惟有一种久泻阳虚，（小儿尤多此症，俗名慢惊风信）孤阳外越（西医书殊无此症状，俟考）之症状，内里愈是虚寒，表皮愈发干热，甚至日久发热，皮肤甲错，渐渐角弓反张，二目天吊，口噤气散而死。其脉细微，小便自利，虽易诊断，然此病症绝非只用普通健脾、（中药白术；山药等）止泻（例如粟壳）等药，所能奏功。必须以大剂参、芪、白芍、熟地，甚则加附子、肉桂、干姜，佐以大补脾肾之药，始能有效。医者稍存观望模棱之念，必致误事，（庸工见其表热，多不敢用补阳之品，何能有济？）故余详细说明之。至若小便，亦是虚证多清白，．或遗溺，或癃闭，（气虚水肿小便极少）均宜寻其病源，施用补剂，未可概用利尿药也。（子宫瘤之重者，（血崩）压迫尿道，亦多小便不利，不在此例。）关于止泻之药，中医书率列入收涩门，除罂粟壳（即鸦片花果之外皮）有收涩之效外，余如赤石脂、禹余粮、诃子肉之类，其效均不及西药之次硝酸苍铅、单那尔并、单宁酸、阿片末等‘阿片末小儿不可用，易中毒也。
）之确实而有特效。（对久泻之病尤效）然若遇本节所述之阳虚久泻，（中医俗名五更泻，肾泻，鸡鸣泻，稀屎痨，小儿慢睥风，慢惊风均属此症。）用西药止泻剂，不过一时有效，且无退热之功。根本治疗，必以中药之人参、炙黄芪、附子、肉崔、干姜、补骨脂、桑螵蛸、白术、白芍、熟地、山药、粟壳（粟壳原始亦为外国产，以后《本草纲目》始收入中药类。）等，方能退热止泻，挽回生命。最妙者，即以此等热药，而能退其顽固虚劳之表热而止泻，结果热退泻止，日臻于强壮而复其健康。
余试验四十年，百不爽一，不得不惊为神工，试以西药之补剂及强壮剂治此重症，必不能得如此之效果。余敢下此断语，但余之学问浅陋，愿读者于此场合，追究其科学之原理也。更愿西医注意及之，以补其不足之点，自此以后，对此种慢性之虚泻，得一完全根治之法，岂不善哉。（中西药互用，其效更速，）4．舌苔热病舌苔，最关重要，故简单说明之。大凡初起之伤寒，邪在表者，舌多无苔，热泻及温病初起，则多白滑薄苔或无苔。总之舌无苔，或仅白滑之薄苔，即是邪热之初起不可即用泻药。舌苔渐黄腻而厚，则邪热渐入里，若干黄、酱黄或黑苔、燥裂，则里热极盛，再证以其他现象（例如便燥），则泻药应用之时也。此说不过言舌苔之最普见者，若虚证发热，（参看论热诸节，舌上虽有苔，亦必须照虚热治，医者不可仅据舌苔，而忘却病之虚实也。（此段应列入诊断学与脉症合参方为准确。
）痛（二）痛此病者感觉身体某部分，有疼痛之谓也。此疼痛之病理，即应简单说明之，中医论疼痛，有极概括之定义及治法，曰痛则不通，通则不痛是也，此二语虽极简单，．然其理想则甚圆到，此病征与西医所称之炎症相关联，故不得不连类说明之。
④应当禁忌使用西药麻醉药、峻补药、按摩、针灸治疗（此处指中医而言）以及一切偏方，还包括所有中西医药的补药。（患者未经医生许可，绝对不可自行购买市面上销售的补药滥服。）10.阳虚发热这种发热，大多是由于大汗、大泻及剧烈呕吐腹泻之后，日久天长，全身阳气消耗殆尽所致。在小儿中，则多见于吐泻症、痘疹之后，或因先天禀赋素来虚弱、饮食积滞、过度使用攻伐药物，或过量服用寒凉药物，皆可演变成此症。在中医儿科中即称为慢惊风，其最容易见到的症状是：全身瘦弱、头颈极细、头发干枯稀疏且脱落、皮肤粗糙如鳞甲交错，甚至神志昏迷、气喘、两眼无神、发热不退、或忽冷忽热、面色青黄、口唇虽然干燥开裂出血，但不喜欢喝冷水，呼出的气息极凉、腹泻、出冷汗、大便中有未消化的食物、或四肢冰冷、角弓反张、睡眠不安、日久泄泻频繁、或干咳，以上诸症均属于危重证候。凡是日久发热不退，以及由吐泻演变而成的，这即属于孤阳外越（阴虚导致阳气浮越），必须用干姜、肉桂、附子、人参、黄芪、白术、白芍、熟地黄等药物培补根本，才可能挽回一线元阳。庄一夔氏所著的《福幼编》，以温补疗法见长。我治疗阳虚发热症，不论大人小孩，试验四十余年，无不神效，值得取法。此症如果纯用西药治疗，绝对无效，医者务必牢记此言。又有小儿时常发热，解表后暂时痊愈，又发热；攻里后暂时痊愈，又发热；养阴滋阴后发热依然，这也是阳气浮游、无所归依的现象，用四君子汤加山药、扁豆治疗多有效，不必用附子、肉桂。凡是口起白疳及身体浮肿的，则更加危险了。
以上所述病者皮肤发热，大约分为十种，病原不同，治法也不同，差之毫厘，谬以千里，医者没有不知道的，惟独发热的病症，与1．汗，2．鼻衄，3．大小便，4．舌苔，尤其有重要关系，兹再分别说明如下，不厌求详。
①发汗即用发散药蒸发津液，开发表阳，使在表的寒邪（注意“寒”字），得汗而解。凡初得的伤寒病，有头痛、身痛、恶寒者，皆宜发散。又有一种温病，自汗、恶寒、发热者，也宜做解其表（例如荆芥、防风之类），不可用止汗药，表解之后，汗自然停止。
此症若主用桂枝，是大误，因为桂枝性太燥，用之必致鼻衄血。用荆芥、防风、葛根、薄荷、藿香等解表最为相宜。（但须兼清内热之药，例如连翘、金银花等）。若是严冬伤寒病，用麻黄、羌活等药发汗，自然是正理。若温病盛行之际，内有郁热，外为寒束（天气骤冷、骤暖变动剧烈之时，此症最多，例如春末秋深之温病是也），亦宜表里双解，而解表尤不可忽略，（荆芥、防风解表热，金银花、连翘解上焦内热，这是温病初起的定法。）这就是用药发汗的理由。
②自汗、盗汗（俗名虚汗）这两种汗症，虽然有自汗系阳虚，盗汗系阴虚的说法。然而在久病之人（注意“久病”二字，若在初得伤寒、温病的自汗，不在此例。）身上，出现这种现象，总以斟酌补阳（人参、黄芪之类）、补阴（生地、熟地、白芍之类），以期挽回衰弱之颓势为宜。又有所谓大汗亡阳、孤阳外越者，则是元气将散（阳脱症），西医称之为死汗（这与下列因过服发汗药，致大汗淋漓者不同），则非大剂人参、附子、肉桂、白芍、熟地大补阴阳（补阳敛汗必兼用补阴之品，否则阳无依附），加以介类潜阳之法（例如牡蛎、鳖甲、龟板之类），不足以挽回生命于万一也。（又有一种因过用发汗药，以致大汗淋漓不止者，顷刻之间，可以心脏停止，致人于死，凡中药之麻黄、羌活，西医之退热药例如安基比林等，用之过量，往往发生此种危险，但西药退热剂，与中医发汗药不同，其汗出乃该药之副作用，医者不可认安基比林等为发汗药，自不待言，倘遇此种危险汗出之场合，西药中之强心注射，在所必施，不可不知也。）另外，中医介类潜阳之类，以治虚汗，尤为奇效，历试不爽，附识于此，学者应注意也。
③战汗这是所受之邪，欲借汗解。故此种汗解之前，病者必有一番极剧烈之不安，如疯如狂，喊叫哭笑，手舞足蹈，一如邪魔，恐怖状态，不一而足，或则周身战栗，颤动不宁、脉停气促（汗后脉自出），因而继续汗出。或则大汗淋漓，立时表里透澈，脉静身凉。此种战汗，盖即内外邪正相争，既得汗出，即是邪有出路，为温病及伤寒症固闭实邪解散之佳兆，实为病势一大转机。亦有战汗之后，邪尚未净，再作战汗而解者。更有战而不汗，（邪盛正衰）必待鼻衄，（凡疹一现即隐，身热气喘，实为危症，不易再出，若得鼻衄者；尚可救，亦同此理。）或屡用清下之药而解者。最危险者，为一战之后，正气不敌，邪气不退，不能再作战汗，遂即精神散乱，寻衣摸床，昏迷愈甚而死（此种危象，多由于病者素衰弱，或大病日久，元气消耗太甚而然）此战汗之大略也。以上战汗，多因得病过程中，失于汗下，邪正交持日久，自然分解之现象，其战汗乘机而作，不拘一格。有因服下药后得泻而作战汗者，有因大渴恣饮凉水（余亲见之或有饱啖西瓜及饮冰激凌而作战汗者。）而作战汗者，有服清凉活血生津之品而得战汗者。盖邪方欲解，稍得助力，以启其机，自然战汗。此种汗解，不可强求，然实为表里透澈之好现象，自无疑也。（病家遇此战汗，不知吉凶，往往惶恐无措，医者可详告之。）当战汗之时，万不可服补药，亦不可用汗下、和解、清凉等药。只宜稳静看护，稍与温水饮之，以助其津液可矣。至若正气太虚，大汗不已，诊断确实有虚脱之虑时，始可与独参汤，（或注射强心西药，以防汗脱而死，然万不可误断也。）
2．衄鼻内出血，除女人逆经（俗名倒经）及习惯性鼻衄，均不在本题范围，姑从略。兹所申明者，为热性病之鼻衄。盖凡衄血现象，率皆由于血热上行，关系肺热尤显。此种衄血，凡温病过服发散药太大，或误服（病已不在表）发汗药及热药，逼热上行，往往如此。（尤以桂枝最甚，余曾见有温病因误服桂枝，死后口鼻出血者，慎之。）若于最险之斑疹，一现即隐，身大热，神昏气促，险象环生之顷，服清热解毒药后，一得鼻衄，自是佳兆。盖疹方外透，骤遭寒凉（例如外受风寒），或内受寒冷（例如饮冷水），顷刻毒气收聚入内；，立呈险象。此时若欲疹再透出，百不获一，惟有急服连翘、双花、犀角等以图挽回。此时若有衄血，是邪有出路，尚有生望，（再照清热宣透之药治之，可以望生）否则不易求生矣。又有温病日久，邪已入内，失于清下，若有鼻衄，亦系佳兆，（与战汗皆是邪有出路）不可不知。
3．大小便此种诊断，必分虚实二种言之。
①先说明实证之大小便，凡实证发热，（参看论热诸条）例如伤寒、温病等，本病认定之后，其大便之多少，或有或无及其颜色，均宜注意。大凡热在表时（尚未入里），大小便均无影响，一如平人，清利如常。迨至胃肠渐起变化，（中医谓之传经，或名传变）诊断上最重要者，即为二便。凡大便极干燥，或数日不解大便，或腹痛，或泻极恶臭之稀粪，或一日数次泻下，（中医谓之热结旁流）或大便黑色如油，（此血便最危险）或大便如脓血，（痢疾如有此象，后重异常）或大便白色，（缺乏胆汁，凡胆石、疝痛多有之，中医谓之胁痛。）绿色，（小儿多有此症，亦胆热也。）皆为实证。（多有潮热，非表证也。）均宜用下剂，（中药则有大黄、芒硝等，西药则有甘汞、硫苦等药均可酌用。但此种泻药作用不同，不可盲用。）若迟延不下，反误病机，或致神经受其侵害，（精神昏迷、谵语发狂）或至炎症延及腹膜，（当下不下，肠管破裂，西医谓之穿孔，出血、溃烂，诱起腹膜炎，全腹皆肿，不可救药矣。）立致危险。故一见肠胃燥结，总宜速下，不可拘泥于保存津液，下不厌迟之说也。但温病逆传，邪入心包，泻药不可妄用，此条应参看温病说明，不再重叙。至于实证之小便，或黄或赤，或少或频数不禁，（此句必切记热性病三字）或溺极混浊沉淀（白粉样物），甚则点滴不通，精神错乱（尿中毒），皆为实热。（必与大便及全身症状对勘，清利小便之药，固所应用，但重要关键，仍宜注重清除大肠实热（泻下法），肠热既去？小便自利，不可不知。但热尚未在肠，例如热闭膻中，则不可泻其大便，所谓诛伐无过也。（盲肠炎、肾脏炎、尿石等症，均有时必须用外科手术者，不在此例。）②再说明虚证之大小便，凡虚证之大便多稀薄，或一日数次，（亦有由实证之痢疾日久，转成虚证者，一日数次，所下仍有脓佯物，腹亦微疼，然不可认为实证，必大补元阳，乃可望愈）。或完谷不化，下利清水（若系肠结核之症，往往由肺病而来，不易治疗。）小便均清白顺利或不禁。又有一种虚证小便，亦有极短、极赤而臊者，此阳虚不化，不可疑为实热。例如水肿症虚弱已极，非用大补元阳之药，不能得其小便通利。此症参看杂症编肿胀病，赵氏医案自明。此症并无其它热象，而小便短赤如此，非由经验得来，不易知也。此种病状，多半皆系久病，（中医谓之脾虚或名肾泻）且多无表热，（亦有发虚热者）脉多无力，精神多清醒，身体多瘦弱，医者不难诊断，不致认症错误。惟有一种久泻阳虚，（小儿尤多此症，俗名慢惊风信）孤阳外越（西医书殊无此症状，俟考）之症状，内里愈是虚寒，表皮愈发干热，甚至日久发热，皮肤甲错，渐渐角弓反张，二目天吊，口噤气散而死。其脉细微，小便自利，虽易诊断，然此病症绝非只用普通健脾、（中药白术；山药等）止泻（例如粟壳）等药，所能奏功。必须以大剂参、芪、白芍、熟地，甚则加附子、肉桂、干姜，佐以大补脾肾之药，始能有效。医者稍存观望模棱之念，必致误事，（庸工见其表热，多不敢用补阳之品，何能有济？）故余详细说明之。至若小便，亦是虚证多清白，．或遗溺，或癃闭，（气虚水肿小便极少）均宜寻其病源，施用补剂，未可概用利尿药也。（子宫瘤之重者，（血崩）压迫尿道，亦多小便不利，不在此例。）关于止泻之药，中医书率列入收涩门，除罂粟壳（即鸦片花果之外皮）有收涩之效外，余如赤石脂、禹余粮、诃子肉之类，其效均不及西药之次硝酸苍铅、单那尔并、单宁酸、阿片末等‘阿片末小儿不可用，易中毒也。）之确实而有特效。（对久泻之病尤效）然若遇本节所述之阳虚久泻，（中医俗名五更泻，肾泻，鸡鸣泻，稀屎痨，小儿慢睥风，慢惊风均属此症。）用西药止泻剂，不过一时有效，且无退热之功。根本治疗，必以中药之人参、炙黄芪、附子、肉崔、干姜、补骨脂、桑螵蛸、白术、白芍、熟地、山药、粟壳（粟壳原始亦为外国产，以后《本草纲目》始收入中药类。）等，方能退热止泻，挽回生命。最妙者，即以此等热药，而能退其顽固虚劳之表热而止泻，结果热退泻止，日臻于强壮而复其健康。
余试验四十年，百不爽一，不得不惊为神工，试以西药之补剂及强壮剂治此重症，必不能得如此之效果。余敢下此断语，但余之学问浅陋，愿读者于此场合，追究其科学之原理也。更愿西医注意及之，以补其不足之点，自此以后，对此种慢性之虚泻，得一完全根治之法，岂不善哉。（中西药互用，其效更速，）4．舌苔热病舌苔，最关重要，故简单说明之。大凡初起之伤寒，邪在表者，舌多无苔，热泻及温病初起，则多白滑薄苔或无苔。总之舌无苔，或仅白滑之薄苔，即是邪热之初起不可即用泻药。舌苔渐黄腻而厚，则邪热渐入里，若干黄、酱黄或黑苔、燥裂，则里热极盛，再证以其他现象（例如便燥），则泻药应用之时也。此说不过言舌苔之最普见者，若虚证发热，（参看论热诸节，舌上虽有苔，亦必须照虚热治，医者不可仅据舌苔，而忘却病之虚实也。（此段应列入诊断学与脉症合参方为准确。）
5．痛（二）痛此病者感觉身体某部分，有疼痛之谓也。此疼痛的病理，即应简单说明之，中医论疼痛，有极概括之定义及治法，曰痛则不通，通则不痛是也，此二语虽极简单，．然其理想则甚圆到，此病征与西医所称之炎症相关联，故不得不连类说明之。
④ Medicinal anesthetics, drastic tonics, massage, acupuncture therapy (referring to Traditional Chinese Medicine here), and all folk remedies, as well as all Chinese and Western tonics, should be contraindicated. (Patients must absolutely not purchase and indiscriminately consume tonics sold in the market without the doctor's permission.) 10. Fever due to Yang Deficiency: This type of fever mostly occurs after profuse sweating, severe purgation, and violent vomiting and diarrhea. Over a long period, the body's Yang Qi is completely exhausted. In children, it often develops after vomiting and diarrhea syndromes, or following smallpox and measles, or due to congenital weakness, food stagnation, excessive use of attacking/draining drugs, or overconsumption of cold-natured medicines. In TCM pediatrics, this is called Slow Convulsion (Man Jing Feng). The most visible symptoms include: emaciation of the whole body, extremely thin neck, dry and sparse hair with alopecia, skin rough like scales, and even coma, panting, spiritless eyes, persistent fever, alternating chills and fever, bluish-yellow complexion, dry and cracked lips bleeding but aversion to cold water, very cool exhaled breath, diarrhea, cold sweat, undigested food in stool, cold limbs, opisthotonos, insomnia, frequent chronic diarrhea, or dry cough. All these symptoms belong to critical conditions. Whenever fever persists for a long time without subsiding, or arises from vomiting and diarrhea, it belongs to "Lone Yang Floating Outward" (Yin deficiency leading to Yang floating). It is essential to use dried ginger, cinnamon twig, aconite root, ginseng root, astragalus root, atractylodes macrocephala rhizome, white peony root, and prepared rehmannia root to nourish the root, so that a thread of Primordial Yang can be salvaged. Zhuang Yikui's book *Fu You Bian* excels in warm-tonifying therapies. I have treated fever due to Yang deficiency in both adults and children for over forty years with miraculous effects; this method is worthy of emulation. If this condition is treated purely with Western medicine, it is absolutely ineffective; physicians must bear this in mind. There are also cases where children frequently develop fever, temporarily resolving after releasing the exterior, only to recur; temporarily resolving after purging the interior, only to recur; or persisting despite nourishing Yin. These are signs of floating Yang with no fixed abode. Treating with Si Jun Zi Tang (Four Gentlemen Decoction) plus yam and lablab bean is often effective, without needing aconite or cinnamon. If white ulcers appear in the mouth and edema occurs, the condition is even more critical.
The above-mentioned skin fever is roughly divided into ten types. Different pathogens require different treatments; a slight error leads to great deviation, which every physician knows. However, regarding fever syndromes, they are particularly related to 1. Sweating, 2. Epistaxis, 3. Urination and defecation, and 4. Tongue coating. I will explain them separately below, in detail.
1. Sweating is roughly divided into four types: inducing sweating, spontaneous sweating, night sweating, and shivering sweating.
① Inducing sweating uses dispersing drugs to evaporate body fluids and open the Exterior Yang, allowing Exterior Cold pathogenic factors (note the character "Cold") to resolve through sweating. For initial Shang Han (Cold Damage) disease presenting with headache, body ache, and aversion to cold, dispersing methods are appropriate. For a certain type of Wen Bing (Warm Disease) presenting with spontaneous sweating, aversion to cold, and fever, releasing the exterior is also appropriate (e.g., using schizonepeta spike and saposhnikovia root). Antiperspirants should not be used; once the exterior is resolved, sweating stops naturally. Using gui zhi tang (Cinnamon Twig Decoction) as the main treatment for this condition is a major error because cinnamon twig is too drying and may cause epistaxis. Schizonepeta spike, saposhnikovia root, kudzu root, mint herb, and patchouli herb are most suitable for releasing the exterior. (However, herbs clearing internal heat, such as forsythia fruit and honeysuckle flower, should be combined.) For Shang Han in deep winter, inducing sweating with ephedra stem and notopterygium root is correct. During outbreaks of Warm Disease, if there is internal stagnant heat constrained by external cold (common during sudden weather changes, e.g., late spring or deep autumn), simultaneous release of exterior and clearance of interior is indicated, with particular attention to releasing the exterior. (Schizonepeta and saposhnikovia clear exterior heat; honeysuckle and forsythia clear upper jiao internal heat; this is the standard method for early-stage Warm Disease.) This explains the rationale for drug-induced sweating.
② Spontaneous sweating and night sweating (colloquially known as "deficient sweating"). Although there is a theory that spontaneous sweating relates to Yang deficiency and night sweating to Yin deficiency, in patients with chronic illness (note "chronic illness"; spontaneous sweating in initial Shang Han or Warm Disease does not fall under this category), these phenomena generally require careful balancing of tonifying Yang (e.g., ginseng, astragalus) and tonifying Yin (e.g., rehmannia root, prepared rehmannia root, white peony root) to reverse the declining trend. Cases of "profuse sweating causing Yang collapse" or "lone Yang floating outward" indicate impending dispersion of Yuan Qi (Yang collapse syndrome), referred to by Western medicine as "death sweat" (distinct from profuse sweating caused by overdose of diaphoretic drugs described below). Such cases require large doses of ginseng, aconite, cinnamon, white peony, and prepared rehmannia to greatly tonify Yin and Yang. (Tonifying Yang to stop sweating must be combined with tonifying Yin, otherwise Yang has no anchor.) Additionally, methods using shell/turtle substances to subdue floating Yang (e.g., oyster shell, softshell turtle carapace, tortoise plastron) are necessary to save life. (Another case involves profuse sweating due to overdose of diaphoretic drugs, which can cause cardiac arrest and death within moments. Overdose of Chinese herbs like ephedra or notopterygium, or Western antipyretics like antipyrine, often causes this danger. Note that Western antipyretics differ from TCM diaphoretics; their sweating is a side effect. Physicians must not mistake antipyrine for a diaphoretic. In such dangerous sweating scenarios, intravenous cardiac stimulants in Western medicine are essential. Do not forget this.) Furthermore, TCM shell/turtle substances for treating deficient sweating are remarkably effective and reliable; scholars should pay attention to this.
③ Shivering sweating occurs when the pathogen seeks resolution through sweating. Before this resolution, the patient experiences extreme agitation, resembling madness, screaming, crying, laughing, dancing wildly, and terrifying states. Or there is whole-body trembling, restlessness, stopped pulse, and rapid breathing (pulse returns after sweating), followed by continued sweating. Or there is profuse sweating, immediately clearing the interior and exterior, resulting in a calm pulse and cool body. This shivering sweating represents the struggle between pathogenic factors and righteous Qi internally and externally. Once sweating occurs, the pathogen has an exit, which is a good omen for the dissolution of solid pathogenic factors in Warm Disease and Shang Han, marking a major turning point in the disease process. Sometimes, after shivering sweating, if pathogens remain, another episode occurs for resolution. More critically, if shivering occurs without sweating (excess pathogen, deficient righteous Qi), one must wait for epistaxis. (If rashes appear and vanish instantly, accompanied by high fever, shortness of breath, and critical signs, it is difficult for them to reappear; epistaxis offers a chance of rescue, for similar reasons.) Or resolution may come after repeated use of clearing and purging drugs. The most dangerous scenario is after one episode of shivering, if righteous Qi cannot overcome the pathogen, and no further shivering sweating occurs, the patient becomes mentally disoriented, groping at clothes and beds, falling into deeper coma, and dying. (This critical sign often results from inherent weakness or prolonged severe illness exhausting Yuan Qi.) This is a general overview of shivering sweating. Most shivering sweating arises from failure to induce sweating or purge during the disease course, leading to prolonged stalemate between pathogen and righteous Qi, eventually resolving naturally. The timing varies. Some occur after purgatives cause diarrhea; some after drinking large amounts of cold water (I have personally seen cases after eating watermelon or ice cream); some after taking cooling, blood-invigorating, and fluid-generating herbs. When the pathogen is about to resolve, slight assistance triggers this mechanism. This type of sweating resolution cannot be forced but is undoubtedly a good sign of interior-exterior clarity. (Families often panic upon encountering this; physicians should explain it in detail.) During shivering sweating, tonics, diaphoretics, harmonizers, and cooling drugs must absolutely not be administered. Only steady nursing and offering warm water to assist body fluids are appropriate. If righteous Qi is severely deficient with unceasing profuse sweating, and diagnosis confirms risk of collapse, Du Shen Tang (Single Ginseng Decoction) may be given (or inject Western cardiac stimulants to prevent death from sweat collapse, but do not misdiagnose).
2. Epistaxis: Nasal bleeding, excluding retrograde menstruation (colloquially "reverse flow") and habitual epistaxis in women, is outside the scope of this topic and is briefly omitted. Here, we clarify epistaxis in febrile diseases. Generally, bleeding phenomena result from upward movement of Blood Heat, closely related to Lung Heat. This type of epistaxis often occurs when Warm Disease patients take excessive dispersing drugs, or mistakenly take diaphoretics and hot drugs (when the pathogen is no longer in the exterior), forcing heat upward. (Gui Zhi Tang is particularly culpable; I have seen Warm Disease patients die with bleeding from mouth and nose after mistakenly taking cinnamon twig. Be cautious.) In critical cases of maculopapular rashes appearing and vanishing instantly, with high fever, coma, and shortness of breath, if epistaxis occurs after administering heat-clearing and detoxifying drugs, it is a good omen. When rashes are trying to emerge externally but are suddenly constrained by cold (external wind-cold or internal cold from drinking cold water), toxins gather inward, presenting critical signs. At this point, attempting to force rashes out again has less than one in a hundred chances. One must urgently administer forsythia, honeysuckle, and rhinoceros horn (substituted in modern practice) to salvage the situation. If epistaxis occurs now, it indicates the pathogen has an exit, offering hope for survival. (Continuing with heat-clearing and venting drugs can lead to recovery; otherwise, survival is unlikely.) Also, in prolonged Warm Disease where pathogens have entered the interior and clearing/purging was neglected, epistaxis is also a good omen (indicating the pathogen has an exit, similar to shivering sweating). This must be known.
3. Urination and Defecation: Diagnosis must distinguish between Excess and Deficiency patterns.
① First, explain Excess pattern urination and defecation. For Excess fever syndromes (see sections on heat), such as Shang Han and Warm Disease, once diagnosed, note the quantity, presence/absence, and color of stool. Generally, when heat is in the exterior (not yet entered the interior), urination and defecation are unaffected, normal like healthy people. As gastrointestinal changes occur (TCM calls this transmission of meridians or progression), the two excretions become crucial for diagnosis. Extremely dry stool, constipation for several days, abdominal pain, or diarrhea of extremely foul-smelling loose stool, or multiple diarrheal episodes per day (TCM: Heat binding with peripheral flow), black oily stool (most dangerous bloody stool), pus-and-blood-like stool (dysentery with abnormal tenesmus), white stool (lack of bile, common in gallstones and hernias, TCM: Hypochondriac pain), or green stool (common in children, also Gallbladder Heat) are all Excess patterns. (Often accompanied by tidal fever, not an exterior syndrome.) Purging agents are indicated. (Chinese herbs: rhubarb root and mirabilite; Western herbs: calomel and saline cathartics can be used酌情. But these laxatives have different mechanisms; do not use blindly.) Delaying purgation misses the therapeutic window, potentially harming nerves (coma, delirium, mania) or extending inflammation to the peritoneum (intestinal perforation, bleeding, ulceration, inducing peritonitis, abdominal swelling, incurable), leading to immediate danger. Thus, upon seeing intestinal dryness and binding, prompt purgation is essential; do not adhere rigidly to theories of preserving fluids or delaying purgation. However, in Warm Disease with reverse transmission where pathogens enter the Pericardium, purgatives must not be used recklessly; refer to Warm Disease explanations. Regarding Excess urination: yellow or red urine, scanty or frequent/incontinent (remember "febrile disease"), extremely turbid sediment (white powder-like), or even anuria with mental confusion (uremia) are all Excess Heat. (Must correlate with stool and systemic symptoms. While diuretics are applied, the key focus remains clearing Large Intestine Excess Heat via purgation. Once intestinal heat is removed, urination improves naturally. Do not forget this. However, if heat is not in the intestine, e.g., heat closing the Dan Zhong, do not purge stool, as this punishes the innocent. [Appendicitis, nephritis, urinary stones sometimes require surgery, which is not covered here.])
② Next, explain Deficiency pattern urination and defecation. Deficiency stool is mostly loose or frequent (several times a day). (Some chronic dysentery Excess cases turn into Deficiency, with pus-like stool and mild abdominal pain daily; do not treat as Excess, must strongly tonify Primordial Yang for hope of cure.) Or undigested food in stool, watery diarrhea (if intestinal tuberculosis, often originating from lung disease, difficult to treat). Urine is usually clear, white, smooth, or incontinent. Another Deficiency urine type is extremely scanty, dark red, and pungent; this is Yang deficiency failing to transform, not to be mistaken for Excess Heat. For example, in severe edema with extreme weakness, only strong Primordial Yang tonification can restore urination. Refer to Zhao's medical records in the Edema section of Miscellaneous Diseases for clarity. Without other heat signs, yet with scanty dark urine, this is known only through experience. These conditions are mostly chronic illnesses (TCM: Spleen Deficiency or Kidney Diarrhea), mostly lacking exterior heat (though some have deficient heat), pulse is mostly powerless, spirit is mostly clear, body is emaciated. Diagnosis is not difficult, avoiding misidentification. However, a specific case of chronic diarrhea with Yang deficiency (common in children, colloquially Slow Convulsion) presents with "Lone Yang Floating Outward" (no equivalent symptom in Western books, pending verification). The interior becomes increasingly cold-deficient, while the surface becomes increasingly dry-hot. Even with prolonged fever, rough skin, gradual opisthotonos, upward-rolling eyes, locked jaw, scattered Qi, and death. Pulse is fine and minute, urination is free. Though easy to diagnose, this condition cannot be cured by ordinary spleen-tonifying (atractylodes, yam) or anti-diarrheal (poppy shell) drugs alone. Large doses of ginseng, astragalus, white peony, and prepared rehmannia are required, possibly adding aconite, cinnamon, and dried ginger, assisted by strong Spleen-Kidney tonics, to be effective. Any hesitation or ambiguity by the physician leads to errors. (Incompetent doctors, seeing exterior heat, dare not use Yang-tonifying drugs, how can they help?) Hence, I explain this in detail. Regarding urination, Deficiency patterns mostly present with clear urine, enuresis, or retention (Qi deficiency edema with very little urine). One must find the source and apply tonics, not generally use diuretics. (Severe uterine tumors compressing the urethra causing difficulty urinating is excluded.) Regarding anti-diarrheal drugs, TCM texts list them in the Astringent category. Besides poppy shell (outer skin of opium fruit) having astringent effects, others like red kaolin, yuyuliang, and chebula fruit are less effective than Western drugs like bismuth subnitrate, tannalbin, tannic acid, and opium powder. (Opium powder is toxic to children and should not be used.) Of these, the latter group is indeed effective and specific (especially for chronic diarrhea). However, for the Yang-deficient chronic diarrhea described above (colloquially Morning Diarrhea, Kidney Diarrhea, Cockcrow Diarrhea, Loose Stool Consumption, Pediatric Spleen Deficiency Wind, Slow Convulsion), Western anti-diarrheals offer only temporary relief and no heat-reducing effect. Fundamental treatment requires Chinese herbs: ginseng, honey-fried astragalus, aconite, cinnamon, dried ginger, psoralea fruit, mulberry silk pupa, atractylodes, white peony, prepared rehmannia, yam, and poppy shell. (Poppy shell originated abroad and was included in Ben Cao Gang Mu later.) Only these can reduce fever, stop diarrhea, and save life. The marvel is that these hot drugs can reduce stubborn deficient-consumption exterior heat and stop diarrhea. Resultantly, fever subsides, diarrhea stops, strength increases, and health restores.
I have tested this for forty years with near-perfect success, amazed by its divine efficacy. Trying Western tonics and strengtheners for this severe condition cannot achieve such results. I dare make this assertion, though my learning is shallow. I wish readers to explore the scientific principles here. I also hope Western medicine takes note to supplement its deficiencies, thereby obtaining a complete curative method for this chronic deficient diarrhea. Would that not be excellent? (Combined use of Chinese and Western medicines yields faster effects.)
4. Tongue Coating: Tongue coating in febrile diseases is most important, so I briefly explain it. Generally, in initial Shang Han with pathogen in the exterior, the tongue often has no coating. In heat diarrhea and early Warm Disease, there is often a thin, white, slippery coating or no coating. In short, no coating or only a thin white slippery coating indicates the initial stage of pathogenic heat; purgatives should not be used immediately. If the coating gradually becomes yellow, greasy, and thick, pathogenic heat is entering the interior. If dry yellow, soy-sauce yellow, black, or cracked, interior heat is extremely盛. Corroborated by other signs (e.g., dry stool), it is time to use purgatives. This describes the most common tongue coatings. If fever is due to Deficiency (see heat sections), even if there is coating, it must be treated as deficient heat. Physicians must not rely solely on tongue coating and forget the Excess/Deficiency nature of the disease. (This paragraph should be listed under Diagnostics and correlated with pulse and symptoms for accuracy.)
5. Pain: Pain refers to the sensation of discomfort in a part of the body. The pathology of this pain should be simply explained. TCM has a generalized definition and treatment principle for pain: "Pain implies obstruction; freedom from obstruction means no pain." Though simple, this concept is profound. This sign correlates with Western inflammation, so I explain it in conjunction.