夫疮疡初起，未溃脓时，有发热恶寒者，乃营卫不行，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。经曰∶阳微即恶寒，阴弱还生热
是也。丹溪曰∶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
焦之邪鬲绝，营卫不能升降，出于表而恶
寒者。东垣曰∶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。形证俱寒，而脉鼓击于手下者，此为热甚拒阴而生病，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，以轻手按之于皮
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者，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，发热形证可推，亦随证施治，无不验耳。
薛立斋曰∶夫疮疡发热烦躁，或出血过多，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，烦躁面
赤，脉沉而微，阴盛发躁也，用四君子汤加姜附。东垣曰∶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，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，是心盛则生热，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；热之不热，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。
汪省之曰∶凡疮疡脓血大泄，当大补气血为先，虽有他证，当末治之。故痈疽
溃后发热恶寒者，皆属气血虚甚，若左手脉不足，补血药当多于补气药，右手脉不
足者，补气药当多于补血药，切不可发表以犯虚虚之祸，故东垣曰∶七情皆能动火，
各经之热不同，宜分治之。
戴院使曰∶未溃之际，憎寒壮热，狂言妄语，如见鬼神，脓去已多，而大热不
休者，似为难治。盖毒之得脓，犹伤寒表证之得汗，汗已而反大热，则为坏伤寒矣。
又云∶患痈毒人，脓血已溃，所去过多，津液枯竭，多病于渴，纵有发热躁扰等证，不
可妄治。宜用益荣生津之剂，若大热不止者，难治。
李东垣曰∶痈疽发热恶热，大渴不止，烦躁肌热，不欲近衣，脉洪大，按之无力，
或目痛鼻干者，非白虎汤证也。此血虚发躁，宜当归补血汤主之。
张景岳曰∶用手摸热，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；不
轻不重按之而热，是热在筋骨之上，皮毛血脉之下，乃热在肌肉也。
张仲景曰∶脉虚则血虚，血虚生寒，阳气不足也。
又曰∶寸口脉微，为阳不足，阴气上入阳中，则洒淅恶寒；尺脉弱，为阴不足，
阳气下陷入阴中，则发热也。
又曰∶阳虚则外寒，阴虚则内热。阳盛则外热，阴盛则内寒。
又曰∶阳气有余为身热无汗。（此言表邪之
实也。）又曰∶阴气有余为多汗身寒。（此言阳气之虚也。）又曰∶发热恶寒者，发于阳也；无
热恶寒者，发于阴也。又曰∶极寒反汗出，身必冷如冰。（此与经旨义相上下。）
经曰∶阴胜则阳病，阳胜则阴病，阳胜则热，阴胜则寒。
张仲景曰∶寒邪在表者，必身热无汗，以邪闭皮毛也。
又曰∶寒邪客于经络，必身体疼痛，或拘急而酸者，以邪气乱营气，血脉不利也。
又曰∶寒邪在表而头痛者，有四经焉，足太阳经脉最长，挟于头顶，其痛居多，足
阳明脉上至头维，足少阳脉上行两角，三阴经无头痛，三阴至颈而还，何得头痛？厥
阴脉与督脉上会于巅顶，都摄诸阳，故有头痛也。惟太阴少阴，皆无头痛之证，然
厥阴头痛，亦不常见，必呕吐涎沫，内无热证，乃直中也，当温之。
又曰∶寒邪在表，多恶寒者，盖伤于此者必恶此，所谓伤食恶食，伤寒恶寒也。
又曰∶太阳经脉起自内 ，上顶巅，下项挟脊行腰 ，故邪在太阳者，必恶寒发
热，而兼头项痛，腰脊强，或膝 酸痛也。
又曰∶阳明经脉起目下，循面鼻，行胸腹，故邪在阳明者，必发热微恶寒，而
兼目痛、鼻干、不眠也。
又曰∶少阳为半表半里之经，其脉绕耳前后，由肩井下协肋，故邪在少阳者，必
发热而兼耳聋胁痛，口苦而呕，或往来寒热也。
又曰∶身虽微热，而 汗出不止，及无身体酸痛拘急，而脉不紧数者，此热非在表也。
又曰∶证似外感，不恶寒，反恶热，而绝无表证者，此热盛于内也。
又曰∶表实者，或为发热，或为身痛，或为恶热掀衣，或为恶寒鼓栗；寒束于表
者无汗，火盛于表者有疡；走注而红痛者，知营卫之有热，拘急而酸痛者，知经络之有寒。
又曰∶阳实者，多热恶热，阴实者，为痛结而寒，气实者，气必喘粗，而声色壮
厉，血实者，血必凝聚，而且痛且坚。
又曰∶表虚者，或为汗多，或为肉战，或为怯寒，或肢体多见麻木，目暗羞明，耳聋眩晕。
又曰∶阳虚者，火虚也，为神气不足，为眼黑头眩，或多寒而畏寒。阴虚者，水
亏也，为亡血失血，为戴阳，为骨蒸劳热。
又曰∶病患身大热，反欲得近衣者，热在皮肤，寒在骨髓也。身大寒，反不欲近
衣者，寒在皮肤，热在骨髓也。若内热之甚者，亦每多畏寒，此当以脉证参合察之。
又曰∶阳邪在表，则表热，阴邪在表，则表寒；阳邪在里，则里热，阴邪在里，则
里寒；邪在半表半里之间，而无定处，则往来寒热。
又曰∶邪气在表发热者，表热里不热也，宜温散之，邪气在里发热者，里热散
而达于外也，宜清之。
又曰∶阳不足，则阴气上入阳中，而为恶寒，阴胜则寒也，宜温之。阴不足，则
阳气陷入阴中，而为发热，阳胜则热也，宜清之。
又曰∶寒热往来者，阴阳相争，阴胜则寒，阳胜则热也。盖热为阳，寒为阴；表
为阳，里为阴；邪之客于表者，为寒邪与阳相争，则为寒栗；邪之传于里者，为热
邪与阴相争，则为热躁；其邪在半表半里之间者，外与阳争则为寒，内与阴争则为
热，或表或里，或出或入，是以寒热往来也，此半表半里之证也。故凡寒胜者，必
多寒，热胜者，必多热，但审其寒热之势，则可知邪气之浅深也。
经曰∶阳微则恶寒，阴弱则发热。
仲景曰∶人身外为阳，为表，寒属阴邪，今表虚为寒所乘，名曰阴盛阳虚，盖
阳不能温其肤，卫于外，致令空虚，虽居密室，亦引衣自盖，谓之恶寒，阴盛阳虚，
汗之自愈，故恶寒属表。假热在肌肤，必
裸体烦躁，是曰恶热，又焉得为恶寒！若见恶寒，知寒在肌肤，急投甘辛之剂可也。
又曰∶寒郁腠理则闭塞而发热，翕翕然烙手，此热止在皮肤，而内无热，名曰
表病里和。《内经》诸证亦论，凡风寒客人，使人毫毛毕直，皮肤闭而为热，当汗。又
云∶体若燔炭，汗出而解。又《热病论》云∶人伤于寒则为热病，若大汗其热解矣。（以上
各条，疮疡而兼外感者，当以此辨之。）
疮疡在初起、尚未化脓溃破时，出现发热和恶寒的症状，这是因为营卫之气运行不畅，经络阻塞，由疮毒激发所致。如果已经溃破之后，脓血大量流失，身体没有不虚弱的。医经说：“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，不能温煦肌肉皮肤，导致腠理（皮肤纹理及汗孔）空虚而感觉寒冷；又有上焦的邪气阻隔，导致营卫之气不能正常升降，浮越于体表而出现恶寒。”李东垣说：“夜间恶寒，白天安静，这是阴血在阴分时段旺盛的表现；有日夜都恶寒但不发热的，这是重阴无阳的表现；应当泻其阴邪而峻补阳气。又有夜间安静，白天恶寒，这是阴气盛而上溢于阳分；如果白天发热，夜间安静，这是阳气在阳分时段旺盛；白天安静，夜间发热，这是阳气下陷进入阴分，名叫热入血室；如果昼夜都发热烦躁，这是重阳而无阴的表现；应当紧急泄其阳热，而峻补阴液。王冰注解说：患病发热且脉象数急，但重按之下脉搏不鼓动有力，这是寒盛格拒阳气所致，并非真热。形体症状表现为寒象，但脉搏在手下鼓击有力的，这是热甚排斥阴气而生病，并非寒证。如果脉象浮数而弱，伴有恶寒，是阳气虚，宜补气；如果脉象涩而发热，是血虚，宜补血；又如果在午前发热，宜补气；午后发热，宜补血；如果脉象浮数，发热且疼痛，说明邪气在表，宜发散解表；脉象沉数，发热且疼痛，说明邪气在里，宜攻下。
另一种方法：用手触摸候诊，分为轻重五种方法来辨别热度深浅：轻手按压在皮毛之间感到热的，是肺热；稍微重一点按在肌肉之间感到热的，是脾热；再稍微重一点按在血脉之间感到热的，是心热；又用重手按压，在血脉之下、筋骨之间感到热的，是肝热；再用极重的手按在骨分，热气蒸腾烫手如火，病人感觉骨头酸软如虫蚀骨，困倦发热不堪忍受，甚至不能起床的，是肾热。还有一种方法，根据十二经脉对应十二时辰来候诊发热症状，也可以推断病情，随证施治，无不灵验。
薛立斋说：疮疡发热烦躁，或者出血过多，溃脓大量流失，或者出汗多导致亡阳，或者泻下多导致亡阴，致使阴血耗散，阳气无所依附，浮散在肌表之间，这并不是实火。如果发热且无法入睡，是血虚，用圣愈汤。兼有汗出不止，是气虚，急用独参汤。发热烦躁，肌肉跳动筋惕，是气血两虚，用八珍汤。大渴面赤，脉象洪大但按之空虚，是阴虚发热，用当归补血汤。肢体微热，烦躁面赤，脉象沉而微弱，是阴盛发躁，用四君子汤加干姜、附子。李东垣说：白天发热而夜间安静，是阳气在阳分时段旺盛。白天安静而夜间发热，是阳气下陷于阴中。如果昼夜都发热，是重阳无阴，应当峻补阴液。所以王太仆说：如果大寒非常严重，用寒药治疗却退不了热，是因为无水（肾阴亏虚）；热势动而复止，忽来忽去，时而动时而止，也是因为没有水（肾阴亏虚），应当资助肾阴。这是心火盛则生热，肾气盛则生寒。肾虚则寒动于中，心虚则热收于内。又如果热不胜寒，是无火（心阳虚）；寒不胜热，是无水（肾阴虚）。治寒而不退寒，责任在于无水；治热而不退热，责任在于无火。热症持续时间不长，责任在心之虚；寒症持续时间不长，责任在肾之弱，医者应当深刻体会。
汪省之说：凡是疮疡脓血大量流失，应当以大补气血为先，即使有其他病症，也应当放在次要位置治疗。所以痈疽溃后出现发热恶寒，都属于气血极度虚弱。如果左手脉不足，补血药应当多于补气药；右手脉不足者，补气药应当多于补血药。切不可发表（使用发汗解表药）而犯“虚虚”之祸（使虚者更虚），所以李东垣说：七情（喜怒忧思悲恐惊）都能动火，各经的热证不同，应当分别治疗。
戴院使说：在疮疡未溃破之际，憎寒壮热，胡言乱语，如见鬼神，脓液排出已多，但大热不退的，似乎难以治疗。大概毒邪得脓，就像伤寒表证得汗一样，汗出后反而大热，那就成了坏病（变证）。又说：患痈毒的人，脓血已经溃破，流失过多，津液枯竭，大多会口渴，纵然有发热躁扰等症状，不可妄加治疗。宜用益荣生津的药剂，如果大热不止的，难治。
李东垣说：痈疽发热恶热，大渴不止，烦躁肌热，不想靠近衣物，脉象洪大，按之无力，或者目痛鼻干的，不是白虎汤证。这是血虚发躁，宜用当归补血汤主治。
张景岳说：用手摸热，有三种方法：用轻手抚摸则热，重按则不热，说明热在皮毛血脉；重按至筋骨之分，则热气蒸手极甚，轻手则不热，说明邪在筋骨之间；不轻不重按之而热，说明热在筋骨之上，皮毛血脉之下，即热在肌肉。
又说：寸口脉微，为阳气不足，阴气上入阳中，就会洒淅恶寒；尺脉弱，为阴气不足，阳气下陷入阴中，就会发热。
又说：阳气有余会导致身热无汗。（这是指表邪实证。）又说：阴气有余会导致多汗身寒。（这是指阳气虚证。）又说：发热恶寒的，发于阳经；无热恶寒的，发于阴经。又说：极寒反而汗出，身体必定冷如冰。（这与经旨义理相通。）
又说：寒邪客于经络，必定身体疼痛，或者拘急酸痛，因为邪气扰乱营气，血脉不利。
又说：寒邪在表而头痛的，涉及四条经脉，足太阳经脉最长，挟持头顶，头痛居多；足阳明脉上行至头维穴，足少阳脉上行至两角，三阴经没有头痛，三阴经至颈部就返回了，怎么会头痛？厥阴脉与督脉上会于巅顶，统摄诸阳，所以会有头痛。只有太阴、少阴，都没有头痛的证候，然而厥阴头痛也不常见，必须伴有呕吐涎沫，体内无热证，这是直中（寒邪直接侵入脏腑），应当温治。
又说：寒邪在表，多恶寒的，因为受伤于此必厌恶此，所谓伤食恶食，伤寒恶寒。
又说：太阳经脉起自内眼角，上顶巅，下项部挟脊行于腰背，所以邪在太阳的，必定恶寒发热，兼有头项痛，腰脊强，或者膝部酸痛。
又说：阳明经脉起自眼下，循行面鼻，行于胸腹，所以邪在阳明的，必定发热微恶寒，兼有目痛、鼻干、不眠。
又说：少阳为半表半里的经脉，其脉绕耳前后，由肩井下走胁肋，所以邪在少阳的，必定发热兼有耳聋胁痛，口苦而呕，或者往来寒热。
又说：身体虽然微热，但是汗出不止，以及没有身体酸痛拘急，而脉象不紧数的，此热不在表。
又说：证候似外感，不恶寒，反恶热，而绝无表证的，这是热盛于内。
又说：表实的，或者为发热，或者为身痛，或者为恶热掀衣，或者为恶寒战栗；寒束于表的无汗，火盛于表的有疮疡；走注而红痛的，知道营卫有热；拘急而酸痛的，知道经络有寒。
又说：阳实的，多热恶热；阴实的，为痛结而寒；气实的，气必喘粗，声音神色壮厉；血实的，血必凝聚，而且痛且坚。
又说：表虚的，或者为汗多，或者为肉颤，或者为怯寒，或者肢体多见麻木，目暗羞明，耳聋眩晕。
又说：阳虚的，是火虚，表现为神气不足，眼黑头眩，或多寒而畏寒。阴虚的，是水亏，表现为亡血失血，戴阳，骨蒸劳热。
又说：病患身体大热，反而想要靠近衣物的，是热在皮肤，寒在骨髓。身体大寒，反而不想要靠近衣物的，是寒在皮肤，热在骨髓。如果内热严重的，也常常多畏寒，这应当以脉证参合来察辨。
又说：阳邪在表，则表热；阴邪在表，则表寒；阳邪在里，则里热；阴邪在里，则里寒；邪在半表半里之间，而无定处，则往来寒热。
又说：邪气在表发热的，是表热里不热，宜温散；邪气在里发热的，是里热散发达于外，宜清解。
又说：阳不足，则阴气上入阳中，而为恶寒，这是阴胜则寒，宜温之。阴不足，则阳气陷入阴中，而为发热，这是阳胜则热，宜清之。
又说：寒热往来的，是阴阳相争，阴胜则寒，阳胜则热。盖热为阳，寒为阴；表为阳，里为阴；邪气客于表的，为寒邪与阳相争，则为寒栗；邪气传于里的，为热邪与阴相争，则为热躁；其邪在半表半里之间的，外与阳争则为寒，内与阴争则为热，或表或里，或出或入，所以寒热往来，这是半表半里的证候。所以凡是寒胜的，必多寒；热胜的，必多热，只要审察寒热之势，就可以知道邪气的浅深。
仲景说：人身外部为阳，为表，寒属阴邪，现在表虚被寒所乘，名叫阴盛阳虚，因为阳不能温煦肌肤，卫护于外，致使空虚，虽然居住在密室，也会拉过被子自己盖上，这叫恶寒，阴盛阳虚，发汗即可自愈，所以恶寒属于表证。假热在肌肤，必定裸体烦躁，这叫恶热，又怎么能说是恶寒！如果见到恶寒，知道寒在肌肤，急投甘辛之剂即可。
又说：寒郁腠理则闭塞而发热，翕翕然烫手，此热只在皮肤，而内无热，名叫表病里和。《内经》诸证也论述过，凡风寒客人，使人毫毛毕直，皮肤闭而为热，应当发汗。又说：身体像炭火一样烧灼，汗出而解。又《热病论》说：人伤于寒则为热病，若大汗其热解矣。（以上各条，对于疮疡兼有外感的，应当以此辨别。）
When a carbuncle or sore first appears and has not yet suppurated, the presence of fever and aversion to cold is due to the stagnation of Ying (Nutrient) and Wei (Defensive) Qi, obstruction of the meridians, and stimulation by the toxin of the lesion. After ulceration, when pus and blood are profusely discharged, deficiency inevitably follows. The Classics state: "When Yang is deficient, there is aversion to cold; when Yin is weak, heat arises." This refers to this situation. Zhu Danxi stated: "Aversion to cold is not caused by external cold, but by the deficiency and decline of Wei Qi, which fails to warm the muscles and skin, leaving the Cou Li (interstices and pores) empty, resulting in aversion to cold; additionally, pathogenic factors in the Upper Jiao may block the ascent and descent of Ying and Wei Qi, causing them to float on the exterior and induce aversion to cold." Li Dongyuan stated: "Aversion to cold at night with calmness during the day indicates that Yin Blood is flourishing in the Yin aspect; aversion to cold throughout the day and night without fever indicates excessive Yin and absence of Yang; one should drain the Yin and vigorously tonify Yang. Calmness at night with aversion to cold during the day indicates excess Yin overflowing into the Yang aspect; fever during the day with calmness at night indicates Yang flourishing in the Yang aspect; calmness during the day with fever at night indicates Yang sinking into the Yin aspect, termed 'Heat entering the Blood Chamber'; fever and irritability throughout the day and night indicate excessive Yang and absence of Yin; one should urgently clear Yang and vigorously tonify Yin." Wang Bing's commentary notes: "Fever with a rapid pulse that does not throb under heavy pressure indicates Cold excess repelling Yang, not true Heat. Symptoms and signs appearing cold but with a pulse that beats forcefully under the fingers indicate severe Heat rejecting Yin, not Cold. If the pulse is floating, rapid, and weak with aversion to cold, it is Yang deficiency, suitable for Qi tonification. If the pulse is choppy with fever, it is Blood deficiency, suitable for Blood tonification. Fever before noon suggests Qi deficiency; fever after noon suggests Blood deficiency. Floating, rapid pulse with fever and pain indicates pathogen in the Exterior, suitable for dispersing. Deep, rapid pulse with fever and pain indicates pathogen in the Interior, suitable for purging.
Another method involves palpation to assess heat depth using five degrees of pressure: heat felt with light pressure on the skin and hair indicates Lung Heat; slightly heavier pressure on the muscles indicates Spleen Heat; further pressure on the vessels indicates Heart Heat; heavy pressure below the vessels between muscles and bones indicates Liver Heat; extreme pressure on the bone level with steaming heat like fire, accompanied by bone soreness as if eaten by insects, severe fatigue, inability to bear the body's weight, and inability to rise from bed, indicates Kidney Heat. Another method correlates the twelve meridians with the twelve two-hour periods to deduce fever patterns and treat accordingly, which is invariably effective.
Xue Lizhai stated: Carbuncle and sore fever with irritability, or excessive bleeding, profuse pus discharge, excessive sweating leading to collapse of Yang, or excessive purgation leading to collapse of Yin, causes consumption of Yin Blood, leaving Yang unrooted and floating on the muscle surface, which is not Fire. Fever with insomnia indicates Blood deficiency, treated with Shengyu Decoction. Accompanied by incessant sweating indicates Qi deficiency, urgently treated with Dushen Decoction. Fever, irritability, muscle twitching, and tendon tremors indicate Qi and Blood deficiency, treated with Bazhen Decoction. Thirst, red face, and a flooding pulse that is empty upon pressure indicate Yin deficiency fever, treated with Danggui Buxue Tang. Slight limb fever, irritability, red face, and a deep, faint pulse indicate Yin excess with false agitation, treated with Sijunzi Decoction plus Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite). Li Dongyuan stated: Fever during the day with calmness at night indicates Yang flourishing in the Yang aspect. Calmness during the day with fever at night indicates Yang sinking into Yin. Fever throughout day and night indicates excessive Yang and absence of Yin, requiring vigorous Yin tonification. Thus, Wang Taipu said: Severe cold that does not respond to cold medicines indicates lack of Water (Kidney Yin); intermittent heat that comes and goes indicates lack of Water, requiring assistance to the Kidney. Excess Heart Fire generates heat; excess Kidney Qi generates cold. Kidney deficiency causes internal cold; Heart deficiency causes internal retention of heat. If heat cannot overcome cold, it indicates lack of Fire (Heart Yang); if cold cannot overcome heat, it indicates lack of Water (Kidney Yin). Failure to resolve cold lies in lack of Water; failure to resolve heat lies in lack of Fire. Brief duration of heat symptoms blames Heart deficiency; brief duration of cold symptoms blames Kidney weakness. Practitioners must deeply comprehend this.
Wang Shengzhi stated: When carbuncles and sores have profusely discharged pus and blood, the priority must be massive tonification of Qi and Blood. Even if other syndromes exist, they should be treated secondarily. Therefore, fever and aversion to cold after ulceration of abscesses belong to severe Qi and Blood deficiency. If the left hand pulse is insufficient, Blood-tonifying herbs should outweigh Qi-tonifying ones; if the right hand pulse is insufficient, Qi-tonifying herbs should outweigh Blood-tonifying ones. One must absolutely avoid exterior-releasing methods to prevent the disaster of 'deficiency inducing deficiency.' Thus, Li Dongyuan stated: The Seven Emotions can all stir Fire; heat in different meridians varies and requires distinct treatments.
Dai Yuan Shi stated: Before ulceration, severe aversion to cold with high fever, delirium, and hallucinations; or after significant pus discharge, persistent high fever, seems difficult to treat. The expulsion of pus is akin to sweating in Taiyang syndrome; if high fever persists after sweating, it becomes a complicated disease. Furthermore, patients with abscesses who have lost excessive pus and blood suffer from dried-up fluids and frequent thirst. Even with fever and restlessness, one must not treat recklessly. Use formulas that nourish Ying and generate fluids. If high fever persists, it is difficult to treat.
Li Dongyuan stated: Carbuncle and sore fever with aversion to heat, incessant thirst, irritability, muscle heat, desire to remove clothing, flooding pulse that is empty upon pressure, or eye pain and dry nose, are not indications for Baihu Tang. This is irritability due to Blood deficiency, primarily treated with Danggui Buxue Tang.
Zhang Jingyue stated: Palpating heat involves three methods: heat felt with light touch but not with heavy pressure indicates heat in the skin and vessels; intense heat felt only with heavy pressure down to the bones, but not with light touch, indicates pathogen in the muscles and bones; heat felt with neither light nor heavy pressure specifically indicates heat in the muscles, between the skin/vessels and the bones.
Zhang Zhongjing stated: A deficient pulse indicates Blood deficiency; Blood deficiency generates cold, indicating insufficient Yang.
He also stated: A faint Cunkou (radial artery at the wrist) pulse indicates Yang insufficiency, allowing Yin Qi to enter the Yang region, causing shivering aversion to cold. A weak Chichi pulse indicates Yin insufficiency, allowing Yang Qi to sink into the Yin region, causing fever.
He also stated: Yang deficiency leads to exterior cold; Yin deficiency leads to interior heat. Yang excess leads to exterior heat; Yin excess leads to interior cold.
He also stated: Excess Yang results in body heat without sweat (indicating exterior excess pathogen). Excess Yin results in profuse sweating and body cold (indicating Yang deficiency).
He also stated: Fever with aversion to cold originates in Yang; absence of fever with aversion to cold originates in Yin. Extreme cold with sweating results in a body cold as ice.
The Classics state: Yin excess injures Yang; Yang excess injures Yin. Yang excess produces heat; Yin excess produces cold.
Zhang Zhongjing stated: Cold pathogen in the Exterior必然 causes body heat and no sweat due to closure of the skin and hair.
He also stated: Cold pathogen lodging in the meridians必然 causes body pain, stiffness, or soreness because the pathogen disrupts Ying Qi and impedes blood vessels.
He also stated: Regarding headache from exterior cold, four meridians are involved. The Foot-Taiyang meridian is the longest, flanking the vertex, accounting for most headaches. The Foot-Yangming ascends to Touwei, and the Foot-Shaoyang ascends to the temples. The Three Yin meridians do not cause headaches as they return at the neck. However, the Jueyin meridian meets the Du Meridian at the vertex, governing all Yang, thus causing headaches. Only Taiyin and Shaoyin lack headache syndromes. Jueyin headache is rare, occurring only with vomiting of saliva/phlegm and no internal heat, indicating direct invasion, requiring warming treatment.
He also stated: Exterior cold often causes aversion to cold because injury to cold induces aversion to cold, just as food injury induces aversion to food.
He also stated: The Taiyang meridian starts from the inner canthus, ascends to the vertex, descends the neck, flanks the spine, and runs along the waist. Pathogen in Taiyang必然 causes aversion to cold and fever, accompanied by head/neck pain, stiff back/spine, or knee soreness.
He also stated: The Yangming meridian starts below the eyes, follows the face and nose, and runs through the chest and abdomen. Pathogen in Yangming必然 causes fever with slight aversion to cold, accompanied by eye pain, dry nose, and insomnia.
He also stated: Shaoyang is the Half-Exterior Half-Interior meridian, circling the ears and running from the shoulder down the costal region. Pathogen in Shaoyang必然 causes fever with deafness, hypochondriac pain, bitter taste, vomiting, or alternating chills and fever.
He also stated: Slight body heat with incessant sweating, without body ache or stiffness, and a non-tight/rapid pulse, indicates the heat is not in the Exterior.
He also stated: Syndromes resembling exterior invasion but lacking aversion to cold, preferring heat, and having no exterior signs, indicate heat excess in the Interior.
He also stated: Exterior excess manifests as fever, body pain, aversion to heat with clothing removal, or aversion to cold with shivering. Cold binding the Exterior causes no sweat; Fire excess in the Exterior causes sores. Migratory red pain indicates Heat in Ying and Wei; stiffness and soreness indicate Cold in the meridians.
He also stated: Yang excess causes heat and aversion to heat; Yin excess causes pain, knotting, and cold. Qi excess causes rough breathing and loud voice/strong demeanor. Blood excess causes coagulation, pain, and hardness.
He also stated: Exterior excess manifests as profuse sweating, muscle trembling, fear of cold, limb numbness, dim vision, photophobia, deafness, and vertigo.
He also stated: Yang deficiency is Fire deficiency, manifesting as lack of spirit, blackouts, dizziness, and aversion to cold. Yin deficiency is Water deficit, manifesting as blood loss, Dai Yang (floating Yang), and bone-steaming tidal fever.
He also stated: If a patient has high body heat but desires to cover up with clothes, the heat is superficial while the cold is profound. If the body is very cold but the patient refuses to cover up, the cold is superficial while the heat is profound. Severe internal heat may also present with aversion to cold; this must be differentiated by correlating pulse and symptoms.
He also stated: Yang pathogen in the Exterior causes exterior heat; Yin pathogen in the Exterior causes exterior cold. Yang pathogen in the Interior causes interior heat; Yin pathogen in the Interior causes interior cold. Pathogen between Half-Exterior and Half-Interior without fixed location causes alternating chills and fever.
He also stated: Fever from exterior pathogen indicates exterior heat without interior heat, suitable for warm dispersal. Fever from interior pathogen indicates interior heat radiating outward, suitable for clearing.
He also stated: Yang insufficiency allows Yin to enter Yang, causing aversion to cold (Yin excess producing cold), suitable for warming. Yin insufficiency allows Yang to sink into Yin, causing fever (Yang excess producing heat), suitable for clearing.
He also stated: Alternating chills and fever result from Yin-Yang struggle. Yin excess causes cold; Yang excess causes heat. Heat is Yang, Cold is Yin; Exterior is Yang, Interior is Yin. Exterior pathogens clashing with Yang cause chills; interior pathogens clashing with Yin cause heat/restlessness. Pathogens between Half-Exterior and Half-Interior clash with Yang externally (causing cold) and Yin internally (causing heat), moving in and out, resulting in alternating chills and fever. This is a Half-Exterior Half-Interior syndrome. Thus, cold excess implies more cold; heat excess implies more heat. Assessing the trend of cold and heat reveals the depth of the pathogen.
The Classics state: Yang deficiency causes aversion to cold; Yin weakness causes fever.
Zhongjing stated: The exterior is Yang and Exterior. Cold is a Yin pathogen. When the Exterior is deficient and invaded by Cold, it is named Yin Excess and Yang Deficiency. Yang fails to warm the skin and defend the exterior, causing emptiness. Even in a sealed room, the patient covers themselves, called aversion to cold. Yin excess and Yang deficiency resolve with sweating; thus, aversion to cold belongs to the Exterior. False heat in the skin causes naked irritability, called aversion to heat, not aversion to cold. Seeing aversion to cold indicates cold in the skin; urgently administer sweet and acrid agents.
He also stated: Cold stagnating in the Cou Li causes closure and fever, feeling hot to the touch, but this heat is only in the skin with no interior heat, named Exterior Disease with Interior Harmony. The Neijing discusses this: Wind-Cold invasion makes hair stand erect and skin close, causing heat, requiring sweating. It also states: "Body burning like charcoal resolves with sweating." The Treatise on Warm Diseases states: Injury by Cold leads to heat disease; profuse sweating resolves the heat. (These points apply to carbuncles and sores complicated by exterior invasion.)