东垣曰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烦躁是阳气下陷入阴中
也名曰热入血室昼则发热烦躁夜则发热烦躁是重阳无阴也当亟泻其阳峻补其阴
以手扪摸有三法以轻手扪之则热重按之则不热是热在皮毛血脉也重按之至筋骨之分则热
蒸手
极甚轻手则不热是邪在筋骨之间也轻手扪之不热重力以按之不热不轻不重按之而热是在筋骨
之上皮毛血脉之下乃热在肌肉也
肺热者轻手乃得微按全无日西热甚乃皮毛之热其证必见喘咳寒热轻者泻白散重者凉膈散
地骨散
心热者微按至皮肤之下肌肉之上轻手乃得微按至皮毛之下则热少加力按之则全不热是热
在血脉也其证烦心心痛掌中热而哕以黄连泻心汤导赤散朱砂安神丸
脾热者轻手扪之不热重按至筋骨又不热不轻不重在轻手重手其间热在肌肉遇夜尤甚其证
必怠惰嗜卧四肢不收无气以动泻黄散
肝热者重按之肌肉之下至骨之上乃肝之热寅卯间尤甚其脉弦四肢满闷便难转筋多怒多惊
四肢困热筋痿不能起于床泻青丸柴胡饮子
肾热者轻手重手俱不热如重手按至骨分其热蒸手如火其人骨苏苏如虫蚀其骨困热不任亦
不能起于床滋肾丸主之
按此手太阴少阴足太阴厥阴少阴本病为皮毛肌肉骨分热也然面热者足阳明 口中热如胶
足少
阴口热舌干足少阴 耳肌热若寒手太阳 掌中热手厥阴少阴太阴 足下热而痛足少阴 足
外热足少阳 身热肤痛手少阴 身前热足阳明 洒淅寒热手太阴 肩上热肩似拔手太阳 中
热而喘足少阴 肩背热及足小指外 胫踝后皆热足太阳 一身尽热狂而妄闻妄见妄言足阳明
热而筋纵缓不收阴痿足阳明厥阴手少阴与前热在气血之分皆诸经现证腑脏阴阳是动所生之
本病也
李东垣说：白天发热、夜间安静，这是阳气在阳分旺盛的表现；白天安静、夜间发热且烦躁，这是阳气下陷进入阴分之中。这种情况也被称为“热入血室”。如果白天发热烦躁，夜间也发热烦躁，这属于重阳无阴的证候，应当紧急泻其阳热，峻补其阴液。
用手触摸诊察热势有三种方法：轻轻抚摸皮肤感觉热重，用力按压反而不热，说明热邪在皮毛和血脉之间；用力按压直到筋骨部位，感觉热气蒸腾，手感到极热，而轻抚皮肤却不热，说明邪气在筋骨之间；轻轻抚摸不热，用力按压也不热，只有中等力度按压时才感觉热，说明热邪位于筋骨之上、皮毛血脉之下，即在肌肉层中。
肺有热邪时，轻按即可感觉到，稍加用力按压则完全感觉不到热度，傍晚时分热势加重，这是皮毛的热邪。其症状必然出现气喘咳嗽、寒热往来。病情轻的用泻白散，重的用凉膈散或地骨皮散。
心有热邪时，稍加用力按压至皮肤之下、肌肉之上才能感觉到，轻按即可感知，若按压至皮毛之下则热感减少，稍微加力按压则完全感觉不到热，说明热邪在血脉中。其症状表现为心烦、心痛、手掌心发热以及呃逆。治疗可用黄连泻心汤、导赤散或朱砂安神丸。
脾有热邪时，轻按不热，重按至筋骨也不热，只有在轻按与重按之间的力度下才感觉热，且热在肌肉层，到了夜晚尤其严重。其症状必然表现为倦怠嗜睡、四肢无力不收摄、没有力气活动。治疗可用泻黄散。
肝有热邪时，用力按压至肌肉之下、骨骼之上才能感觉到，这是肝的热邪，在寅时到卯时（凌晨3点至7点）尤为严重。其脉象弦，症状表现为四肢胀满闷痛、大便困难、筋脉拘挛抽搐、容易发怒、容易受惊、四肢困倦发热、筋痿软无力不能起床。治疗可用泻青丸或柴胡饮子。
肾有热邪时，轻按和重按都不热，只有用力按压至骨骼深处，才感觉热气蒸腾如火，其人感觉骨头酸软，像被虫子啃噬一样，困倦发热难以忍受，也不能起床。治疗以滋肾丸为主方。
按语：以上所述手太阴肺经、手少阴心经、足太阴脾经、足厥阴肝经、足少阴肾经的本病，分别对应皮毛、肌肉、骨骼层面的热邪。然而，面部发热是足阳明胃经的病证；口中热如胶黏是足少阴肾经的病证；口舌干燥发热也是足少阴肾经的病证；耳部及颊肌发热伴恶寒是手太阳小肠经的病证；手掌心发热涉及手厥阴心包经、手少阴心经和手太阴肺经；足底发热疼痛是足少阴肾经的病证；足外侧发热是足少阳胆经的病证；身体发热、肌肤疼痛是手少阴心经的病证；身前发热是足阳明胃经的病证；洒淅恶寒发热是手太阴肺经的病证；肩上发热、肩部似拔举样疼痛是手太阳小肠经的病证；胸中发热且喘息是足少阴肾经的病证；肩背部发热及足小趾外侧、小腿后侧皆发热是足太阳膀胱经的病证；全身尽热、狂妄妄闻妄见妄言是足阳明胃经的病证；热盛导致筋脉弛缓不收、阳痿是足阳明胃经和足厥阴肝经、手少阴心经共同涉及的病证。上述热在气血之分的情况，都是各经脉显现的证候，以及脏腑阴阳经气变动所产生的本病。
Li Dongyuan stated: Fever during the day and quietness at night indicates that Yang Qi (vital energy) is flourishing in the Yang divisions. Quietness during the day and fever with irritability at night indicates that Yang Qi has sunk into the Yin divisions. This condition is also named "Heat Entering the Blood Chamber" (Re Ru Xue Shi). If there is fever and irritability both during the day and at night, it signifies an excess of Yang without Yin (Chong Yang Wu Yin), requiring urgent draining of Yang heat and vigorous tonification of Yin fluids.
There are three methods for palpating to determine heat:
1. If light palpation reveals significant heat but firm pressure eliminates it, the heat is located in the skin-hair layer and blood vessels.
2. If firm pressure down to the sinews and bones reveals steaming heat felt intensely by the hand, while light palpation shows no heat, the pathogenic factor is located between the sinews and bones.
3. If light palpation shows no heat, firm pressure shows no heat, but moderate pressure reveals heat, the heat is located above the sinews and bones but below the skin-hair layer and blood vessels, i.e., in the muscle layer.
Lung Heat: Light palpation detects heat; slight firm pressure makes it disappear. Heat intensifies in the late afternoon (Ding West). This is heat in the skin-hair layer. Symptoms must include panting, coughing, aversion to cold, and fever. For mild cases, use Xie Bai San (Drain White Powder); for severe cases, use Liang Ge San (Cool the Chest Powder) or Di Gu San (Ground Bone Powder).
Heart Heat: Slight firm pressure to beneath the skin and above the muscles detects heat. Light palpation detects it; pressing beneath the skin-hair layer reduces the sensation; adding force makes it disappear completely. This indicates heat in the blood vessels. Symptoms include vexation, heart pain, heat in the palms, and hiccups. Treatments include Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Heart), Dao Chi San (Guide Out Red Powder), or Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill).
Spleen Heat: Light palpation shows no heat; firm pressure to the sinews and bones shows no heat. Heat is detected only between light and firm pressure, located in the muscle layer, worsening at night. Symptoms include lethargy, desire to lie down, flaccidity of the four limbs, and lack of qi to move. Treat with Xie Huang San (Drain Yellow Powder).
Liver Heat: Firm pressure beneath the muscles to above the bones detects heat. This is Liver heat, worsening during Yin-Mao hours (3:00–7:00 AM). The pulse is wiry. Symptoms include fullness and stuffiness in the four limbs, difficult urination/defecation, tendon spasms, irritability, fright, fatigue and heat in the four limbs, tendon flaccidity unable to rise from bed. Treat with Xie Qing Wan (Drain Green Pill) or Chai Hu Yin Zi (Bupleurum Infusion).
Kidney Heat: Neither light nor firm pressure detects heat. Only when firm pressure reaches the bone level does one feel steaming heat like fire. The patient feels bone soreness as if gnawed by insects, with fatigue, heat, inability to endure discomfort, and inability to rise from bed. Treat primarily with Zi Shen Wan (Nourish Kidney Pill).
Note: The above describes the primary diseases of the Hand-Taiyin Lung Meridian, Hand-Shaoyin Heart Meridian, Foot-Taiyin Spleen Meridian, Foot-Jueyin Liver Meridian, and Foot-Shaoyin Kidney Meridian, corresponding to heat in the skin-hair, muscle, and bone layers respectively. However:
- Facial heat belongs to the Foot-Yangming Stomach Meridian.
- Mouth feeling sticky/hot and dry tongue belong to the Foot-Shaoyin Kidney Meridian.
- Ear and cheek heat with aversion to cold belong to the Hand-Taiyang Small Intestine Meridian.
- Palm heat involves the Hand-Jueyin Pericardium, Hand-Shaoyin Heart, and Hand-Taiyin Lung meridians.
- Sole heat and pain belong to the Foot-Shaoyin Kidney Meridian.
- Lateral foot heat belongs to the Foot-Shaoyang Gallbladder Meridian.
- Body heat and skin pain belong to the Hand-Shaoyin Heart Meridian.
- Anterior body heat belongs to the Foot-Yangming Stomach Meridian.
- Shivering chills and fever belong to the Hand-Taiyin Lung Meridian.
- Shoulder heat and shoulder pain resembling dislocation belong to the Hand-Taiyang Small Intestine Meridian.
- Chest heat with panting belongs to the Foot-Shaoyin Kidney Meridian.
- Shoulder/back heat and heat in the lateral little toe and posterior tibia/ankle belong to the Foot-Taiyang Bladder Meridian.
- Generalized heat, mania, hallucinations, and delirious speech belong to the Foot-Yangming Stomach Meridian.
- Heat leading to tendon laxity, flaccidity, and impotence involves the Foot-Yangming Stomach, Foot-Jueyin Liver, and Hand-Shaoyin Heart meridians.
The aforementioned distinctions of heat in Qi and Blood represent the manifest symptoms of these meridians and the primary diseases generated by the movement and generation of Zang-Fu organ Yin and Yang.