气游走四肢，身面俱肿者，似是而实非也。夫治水肿腹胀，以辛苦寒药为君，而大利其大小
便也。《经》曰∶“中满者治之于内；”然则岂为脾土之虚也？此说正与《素问》相反。《经》曰∶“诸湿
肿满，皆属脾土。”又云∶“太阴所主 肿。”又云∶“湿胜则濡泄，甚则水闭 肿，皆所谓太
阴脾土湿气之实甚也。”又《经》曰∶“诸腹胀大，皆属于热。又云∶诸 肿疼酸惊骇，皆属
于火。”又曰∶“热胜则 肿。”皆所谓心火实热，而安得言脾虚不能制肾水之实甚乎？故诸水
肿者，湿热之相兼也。如六月湿热太甚，而庶物隆盛，水肿之象，明可见矣。故古人制以辛
苦寒药治之，盖以辛散结，而苦燥湿，以寒除热，而随其利，湿去结散，热退气和而已。
所以妄谓脾虚不能制其肾水者，但谓数下致之，又多水液故也。
岂知巴豆热毒，耗损肾水阳气，则心火及脾土自甚，湿热相搏，则怫热痞隔，小便不利
而水肿也。更宜下之者，以其辛苦寒药，能除湿热怫郁痞隔故也。亦由伤寒下之太早。而热
入以成结胸者，更宜陷胸汤、丸寒药下之。又如伤寒误用巴豆热毒下之，而热势转甚，更宜
调胃承气汤寒药下之者也。若夫世传银粉之药，以治水肿而愈者，以其善开怫郁痞隔故也，
慎不可过度而加害尔！况银粉亦能伤牙齿者，谓毒瓦斯感于肠胃，而精神气血水谷不能胜其毒
，故毒瓦斯循经上行，而至齿龈嫩薄之分，则为害也。上下齿缝者，手足阳明胃之经也。凡用此
药，先当固济尔！或云阴水遍身，而又恶寒，止是寒者，非也。《经》言∶“少阴所至为惊惑，恶寒
战栗，悲笑谵妄，谓少阴君火热气之至也。”详见下文恶寒战栗论中。
（瞀）
瞀∶昏也，热气甚则浊乱昏昧也。
（郁）
郁∶怫郁也。结滞壅塞而气不通畅，所谓热甚则腠理闭密而郁结也。如火炼物，热极相
合，而不能相离，故热郁则闭塞而不通畅也。然寒水主于闭藏，而今反属热者，谓火热亢极
，则反兼水化制之故也。
（肿胀）
肿胀∶热胜于内，则气郁而为肿也。阳热气甚，则腹胀也。火主长而茂，形貌彰显，升
明、舒荣，皆肿胀之象也。
（鼻窒）
鼻窒∶窒，塞也；火主 肿胀，故热客阳明，而鼻中 胀则窒塞也。或
谓寒主闭藏，妄以鼻窒为寒者，误也。盖阳气甚于上，而侧卧则上窍通利而下窍闭塞者，谓
阳明之脉左右相交，而左脉注于右窍，右脉注于左窍，故风热郁结，病偏于左。则右窍反塞
之类也。俗不知阳明之脉左右相交，注于鼻孔，但见侧卧则上窍通利，下窍窒塞，反疑为寒
尔。所以否泰之道者，象其肺金之盈缩也。
（鼽）
鼽者，鼻出清涕也。夫五行之理，微则当其本化，甚则兼有鬼贼。故《经》曰∶“亢则害，承
乃制”也。《易》曰∶燥万物者，莫 乎火。以火炼金，热极而反化为水，及身热极，则
反汗出也；水体柔顺，而寒极则反冰如地也。土主湿阴云雨而安静，土湿过极，则反为骤注
，烈风，雨淫溃也。木主温和而生荣，风大则反凉而毁折也。金主清凉，秋凉极而万物反燥
也。皆所谓过极则反兼鬼贼之化，制其甚也。由是肝热甚则出泣，心热甚则出汗，脾热甚则
出涎，肺热甚则出涕，肾热甚则出唾也。《经》曰∶鼻热者，出浊涕。凡痰、涎、涕、唾稠浊者
，火热极甚，销烁致之然也。或言鼽为肺寒者，误也。彼但见鼽、嚏、鼻窒，冒寒则甚，遂
以为然。岂知寒伤皮毛，则腠理闭密，热极怫郁，而病愈甚也。
（衄）
衄者，阳热怫郁，干于足阳明而上，热甚，则血妄行为鼻衄也。
（血溢）
血溢者，上出也。心养于血，故热甚则血有余而妄行。或谓呕吐紫凝血为寒者，误也。
此非冷凝，由热甚销烁以为稠浊，而热甚则水化制之，故赤兼黑而为紫也。
（血泄）
血泄∶热客下焦。而大小便血也。
（淋）
淋∶小便涩痛也。热客膀胱，郁结不能渗泄故也。或曰，小便涩而不通者为然，遗尿不禁
者为冷。岂知热甚客于肾部，干于足厥阴之经，廷孔郁结极甚，而气血不能宣通，则痿痹，
而神无所用，故液渗入膀胱，而旋溺遗失，不能收禁也。《经》曰∶目得血而能视，耳得血而能
听，手得血而能摄，掌得血而能握，足得血而能步，脏得血而能液，腑得血而能气。夫血随
气运，气血宣行，则其中神自清利，而应机能为用矣。
又曰∶“血气者人之神，不可不谨养也。”
；故诸所运用，时习之则气血通利，而能为用；闭壅之则气血行微，而其道不得通利，故劣
弱也。若病热极甚则郁结，而气血不能宣通，神无所用，而不遂其机，随其郁结之微甚，有
不用之大小焉。是故目郁则不能视色，耳郁则不能听声，鼻郁则不能闻香臭，舌郁则不能知
味，至如筋痿骨痹，诸所出不能为用，皆热甚郁结之所致也；故仲景论少阴病热极曰∶“溲便
遗失，狂言，目反直视者，肾先绝也。”《灵枢经》曰∶“肾主二阴。”然水衰虚而怫热客其部分
，二阴郁结则痿痹，而神无所用，故溲便遗失，而不能禁止，然则热证明矣。
是故世传方论，虽曰冷淋，复用榆皮、黄芩、蘧麦、茯苓、通草、鸡苏、郁李仁、栀子之类寒药治之而已
。其说虽妄，其方乃是，由不明气运变化之机。宜乎认是而为非也。或谓患淋而服茴香、益
智、滑石、醇酒温药而愈者，然则非冷欤？殊不知此皆利小便之要药也。盖醇酒、益智之性虽
热，而茴香之性温，滑石之性寒，所以能开发郁结，使气液宣通，热散而愈也。
（ ）
∶俗作秘，大便涩滞也；热耗其液，则粪坚结，而大肠燥涩紧敛故也。或大便溏
而者，燥热在于肠胃之外，而湿热在内故也。义同泄痢后重之义，见“下迫”论中。
（身热恶寒）
身热恶寒，此热在表也。邪热在表而浅，邪畏其正，故病热而反恶寒也。或言恶寒为寒
在表，或言身热恶寒为热在皮肤，寒在骨髓者，皆误也。仲景法曰∶“无阳病寒，不可发汗。”
又言:“身热恶寒，麻黄汤汗之。汗泄热去，身凉即愈。”然则岂有寒者欤？又如热生壅肿疮疡而
恶寒者，亦由邪热在于表也。虽尔，不可汗之。故仲景曰∶患疮者汗之则作 ，大法烦
躁多渴，欲寒恶热，为病热也。
亦有亢则害，承乃制之，则病热甚而反觉其冷者也。虽觉其
冷，而病为热。实非寒也。其病热郁甚，而反恶寒，得寒转甚，而得暖少愈者，谓暖则腠理
疏通，而阳气得散，怫热少退，故少愈也。其寒则腠理闭密，阳气怫郁，而热转甚，故病加
尔。上下中外，周身皆然。俗因之妄谓寒病，误以热药投之，为害多矣。假令或因热药以使
怫热稍散而少愈者，药力尽则病反甚也。其减则微，其加则甚。俗无所悟，但云服之而获效
，力尽而病加，因而加志服之，由是诸热病皆生矣。
阳热发则郁甚于上，故多目昏眩，耳聋
鸣，上壅癫疾。上热甚而下热微，俗辈复云肾水衰弱，不能制心火，妄云虚热也。抑不知养
水泻火，则宜以寒，反以热药欲养肾水，而令胜退心火，因而成祸不为少矣。可不慎欤？
（战栗）
战栗∶动摇，火之象也。阳动阴静，而水火相反，故厥逆禁固，屈伸不便，为病寒也。
栗者，寒冷也。或言寒战为脾寒者，未明变化之道也。此由心火热甚，亢极而战，反兼水化
制之，故寒栗也。然寒栗者，由火甚似水，实非兼有寒气也。故以大承气汤下之，多有燥粪
，下后热退，则战栗愈矣。或平人冒极寒而战栗者，由寒主闭藏，而阳气不能散越，则怫热
内作故也。如冬寒而地中反暖也。
或云∶冬，阳在内而阴在外，地上寒而地中暖，夏则反此
者，乃真理也。假令冬至为地阴极，而生阳上升，至夏则阳在上而阴在地中者，当地上热而
地中寒可也。奈何夏至为天阳极，而生阴下降，至冬则入地反暖，地上反寒欤！或曰∶冬后
阳升而出，则阴降而入，夏后阳降而入，则阴升而出者，乃妄意也，如冬至子正一阳升，而
得其复 \r图\p01-e29a1.bmp\r （《易》地雷复卦），至于巳则阴绝，而六阳备，
是故得其纯干 \r图\p01-e29a2.bmp\r （八纯干）；夏至午正则一阴生，而
得 \r图\p01-e29a3.bmp\r （天风 ），至
于亥则阳绝，而六阴备，是故得
其纯坤 \r图\p01-e29a4.bmp\r （八纯坤），至于
冬至则阳复也。然子后面南，午后面北，视卦之爻，则子后阳
升，午后阴降明矣。安得反言冬后阴降，而夏后阳降耶？
所谓四时天气者，皆随运气之兴衰
也。然岁中五运之气者，风、暑、燥、湿、寒各主七十三日五刻，合为期岁也。岁中六部之
主位者，自大寒至春分属木，故温和而多风也；春分至小满属君火，故暄暖也。小满至大暑
属相火，故炎热也；大暑至秋分属土，故多湿阴云雨也；秋分至小雪属金，故凉而物燥也；
小雪至大寒属水，故寒冷也。然则岂由阴阳升降于地之内外乎？
其地中寒燠者，《经》言∶火热主于出行，寒水主于闭藏。故天气热，则地气通泄而出行，故地中寒也，犹人汗出之
后体凉；天气寒则地凝冻而闭塞，气难通泄，故怫郁而地中暖也。《经》言∶“人之伤于寒也，则为病热。”
又如水本寒，寒极则水冰如地，而冰下之水反不寒也，冰浓则水温，即闭藏之道也。或大雪
加冰，闭藏之甚，则水大温，而鱼乃死矣，故子正一阳生，而至于正月寅，则三阳生，而得
其泰 \r图\p01-e29a5.bmp\r （地天泰）。泰者，通利而非否塞也。午正一阴生，而至于七月申，则三阴生，而
得否 \r图\p01-e29a6.bmp\r （天地否）。否者，否塞而非通泰也，然而否极则泰，泰极则否。故六月泰极，则
地中至寒；十二月否极，则地中至暖。然则地中寒燠，明可见焉。故知人之冒于寒，而内为
热者，亦有之矣。
或问曰∶人冬阳在内而热，夏阴在内而寒者，何也？答曰∶俗已误之久矣！
夫一身之气，皆随四时五运六气兴衰，而无相反矣。适其脉候，明可知也。如夏月心火生而
热，则其脉滑数洪大而长，烦热多渴，岂为寒也？余候皆然。
或平人极恐而战栗者，由恐为
肾志，其志过度，则劳伤本脏，故恐则伤肾，肾水衰则心火自甚，而为战栗也。又如酒苦性
热，养于心火，故饮之过多，则心火热甚，而为战栗。俗谓之酒禁也。
《经》曰∶“阳并于阴，阴
则实而阳明虚，阳虚故寒栗而鼓颔也。”注曰∶“阳并于阴，言阳气入于阴分也。阳明胃脉也，
故不足则恶寒战栗而鼓颔振动也。”然阳明经络在表，而主于肌肉，而气并于里，故言阳明虚
也。
又《经》曰∶“夫疟之始发也，阳气并于阴，当是时阳虚阴实，而外无阳气，故先寒栗也。阴
气逆极，则阳复出之，阳与阴复并于外，则阴虚而阳实，故先热而渴。”然阴气逆极，则复出
之阳者，是言阳为表，而里为阴也。其气复出，而并之于表，非谓阴寒之气出之于表，而反
为阳热也。
又《经》曰∶“夫疟气者，并于阳则阳胜，并于阴则阴胜。阴胜则寒，阳胜则热。”
然气并于阳而在于表，故言阳胜；气并于阴而在于里，故言阴胜，此乃表里阴阳之虚实，非
寒热阴阳之胜负，但阳气之出入耳。
如伤寒病日深，表证已罢，而热入于里，若欲作大汗，
则阳气必须出之于外，郁极乃发，而阳热大作于里，亢则害，承乃制，故为战栗；而后阳气
出之于表，则蒸热作而腠理开，大汗泄而病气已矣！或战栗无汗而愈者，必因发汗吐下亡津
液过多，则不能作汗，但热退气和而愈。或不战栗而汗解者，虽因日深表热不罢，内外俱热
，阳不并阴，而外气不衰，里无亢极，故无害承乃制，则无战栗也。或不战栗而亦无汗愈者，
阳不并阴而气液虚损故也，故诸战栗者，表之阳气与邪热并甚于里，热极而水化制之，故寒
栗也。虽尔，为热极于里，乃火极而似水化也！
（惊）
惊∶心卒动而不宁也，火主于动，故心火热甚也。虽尔，止为热极于里，乃火极似水则
喜惊也。反兼肾水之恐者，亢则害承乃制故也。所谓恐则喜惊者，恐则伤肾而水衰，心火自
甚，故喜惊也。
（惑）
惑∶疑惑，犹豫，浊乱，而志不一也。象火参差而惑乱。故火实则水衰，失志而惑乱也
。志者，肾水之神也。
（悲）
悲∶金肺之志也。金本燥，能令燥者火也。心火主于热，喜痛，故悲痛苦恼者，心神烦
热躁乱，而非清净也。所以悲哭而五液俱出者，火热亢极，而反兼水化制之故也。夫五脏者
，肝、心、脾、肺、肾也。五脏之志者，怒、喜、悲、思、恐也。悲，一作忧。若志过度则
劳，劳则伤本脏。凡五志所伤皆热也。
如六欲者，眼、耳、鼻、舌、身、意也。七情者，喜
气邪游走于四肢，导致全身及面部浮肿的病症，看似是脾虚所致，实则并非如此。治疗水肿和腹胀，应当以辛苦寒性质的药物为主药，并大力通利大小便。《内经》说：“中焦胀满的病证，应从内部调理。”既然如此，这难道是脾土虚弱造成的吗？这种说法恰恰与《素问》的观点相反。《内经》说：“各种湿邪引起的肿胀和胀满，都归属于脾土。”又说：“太阴湿土主令时，容易出现肿胀。”又说：“湿气胜则导致濡泄（大便稀溏），严重时会导致小便闭塞和肿胀，这都是指太阴脾土湿气过盛实证的表现。”另外，《内经》说：“各种腹部胀大，都归属于热证。”又说：“各种肿胀、疼痛、酸楚、惊骇，都归属于火证。”还说：“热气胜则导致肿胀。”这些都是指心火实热证，怎么能说是脾虚不能制约肾水导致的实证呢？所以各种水肿病，都是湿热相互夹杂的结果。就像六月时节湿热极盛，万物茂盛生长，水肿的现象，明显可见。因此古人制定用辛苦寒药物治疗此类疾病，大概是因为辛味能发散结滞，苦味能燥湿，寒性能清除热邪，随着二便的通利，湿气去除、结滞消散、热退气和，病就好了。
之所以有人妄称脾虚不能制约肾水，只是认为多次使用泻下法导致了这种情况，又因为体内有多余的水液罢了。哪里知道巴豆的热毒，会耗损肾水的阳气，导致心火和脾土自然亢盛，湿热相互搏结，导致气机郁滞痞塞，小便不利，从而出现水肿。此时更适宜使用泻下法，是因为辛苦寒的药物，能够消除湿热的郁滞痞塞。这也如同伤寒病误用过早的泻下法，导致热邪内陷形成结胸证，这时更适宜用陷胸汤、丸等寒性药物来泻下。又如伤寒病误用巴豆这类热毒药物泻下，导致热势更加严重，这时更适宜用调胃承气汤等寒性药物来泻下。至于世间流传的银粉药物，用来治疗水肿而痊愈的，是因为它善于开通郁滞痞塞的缘故，但千万不可过度使用而伤害身体！况且银粉也能损伤牙齿，这是因为毒气感于肠胃，而精神、气血、水谷之气不能抵御其毒性，所以毒气沿着经络上行，到达牙龈嫩薄之处，就造成了危害。上下牙齿的缝隙处，是手足阳明胃经所经过的地方。凡是使用这种药物，首先应当固护脾胃！有人说阴水遍布全身，并且恶寒，仅仅是寒证，这是不对的。《内经》说：“少阴君火热气到来时，会出现惊惑、恶寒战栗、悲笑无常、谵语妄言等症状。”详见下文关于恶寒战栗的论述中。
（郁）
郁：即怫郁。指气机结滞壅塞而不通畅，所谓热气极盛时腠理闭密而导致的气机郁结。就像用火冶炼物体，热极时两者相合而不能分离，所以热郁结就会导致闭塞而不通畅。然而寒水主闭藏，现在反而归属于热证，是因为火热亢盛到极点，反而兼有水化的性质来制约它。
（肿胀）
肿胀：热气胜在体内，导致气机郁结而形成肿胀。阳热气盛，则导致腹胀。火主生长茂盛，形态容貌彰显，升明、舒荣，都是肿胀的象征。
（鼻窒）
鼻窒：窒，即堵塞。火主肿胀，所以热邪客居阳明经，导致鼻中肿胀而堵塞。有人说寒主闭藏，妄将鼻窒归为寒证，这是错误的。这是因为阳气盛于上部，侧卧时上侧鼻孔通气而下侧鼻孔闭塞，是因为阳明经脉左右交叉，左脉注入右窍，右脉注入左窍，所以风热郁结，病偏于左侧，则右侧鼻孔反而堵塞之类的原因。世俗之人不知道阳明经脉左右交叉注入鼻孔，只看到侧卧时上侧鼻孔通气，下侧鼻孔堵塞，反而怀疑是寒证。所以鼻塞不通的道理，是象应于肺金的盈缩变化。
（鼽）
鼽：指出清鼻涕。五行的道理，轻微时表现为本气的化生，严重时则兼有克制它的“鬼贼”之气。所以《内经》说：“亢盛则有害，有承制才能平衡。”《易经》说：“使万物干燥的，没有比火更厉害的了。”用火炼金，热极反而化为水；人体热极，反而出汗；水性柔顺，寒极反而结冰如地。土主湿阴云雨而安静，土湿过极，反而变为暴雨、烈风、雨水淫溢溃决。木主温和而生发繁荣，风大则反凉而毁折。金主清凉，秋凉极则万物反而干燥。这都是说过度极盛时反而兼有克制它的五行之化，以制约其过盛。因此肝热甚则流泪，心热甚则出汗，脾热甚则流涎，肺热甚则流涕，肾热甚则吐唾沫。《内经》说：“鼻中有热者，流出浊涕。”凡痰、涎、涕、唾稠浊的，都是火热极盛，消烁津液所致。有人说鼽是肺寒，这是错误的。他们只是见到流清涕、打喷嚏、鼻塞，受寒后加重，就认为是这样。哪里知道寒伤皮毛，导致腠理闭密，热极郁结，病情反而加重。
（衄）
衄：阳热怫郁，干犯足阳明经而上行，热盛则血液妄行，导致鼻出血。
（血溢）
血溢：指血液向上溢出。心主血，所以热盛则血有余而妄行。有人说呕吐紫黑色凝血是寒证，这是错误的。这不是冷凝，而是由热盛消烁使血液变得稠浊，且热盛时水化制约它，所以红色兼黑色而呈现紫色。
（淋）
淋：小便涩痛。热邪客居膀胱，郁结不能渗泄所致。有人说，小便涩滞不通的是这样，遗尿不禁的是冷证。哪里知道热邪极盛客居肾部，干犯足厥阴肝经，前阴郁结极甚，气血不能宣通，导致痿痹，神志无法发挥作用，所以津液渗入膀胱，随即小便遗失，不能控制。《内经》说：“眼睛得到血的滋养就能视物，耳朵得到血的滋养就能听声，手得到血的滋养就能抓取，手掌得到血的滋养就能握持，脚得到血的滋养就能行走，脏腑得到血的滋养就能分泌津液，六腑得到血的滋养就能运行气机。血随气运行，气血宣通，其中的神志自然清明流利，并能应机发挥作用。”又说：“血气是人的神志所在，不可不谨慎调养。”所以各种运用功能，经常练习则气血通利，并能发挥作用；闭阻壅塞则气血运行微弱，其道不得通利，所以功能减弱。如果病热极盛则郁结，气血不能宣通，神志无法发挥作用，不能顺应机能，根据郁结的轻重，有不用的程度差异。因此目郁则不能视色，耳郁则不能听声，鼻郁则不能闻香臭，舌郁则不能知味道，乃至筋痿骨痹，各种功能不能发挥，都是热盛郁结所致。所以张仲景论述少阴病热极时说：“小便失禁，胡言乱语，两眼直视反张的，是肾气先绝。”《灵枢经》说：“肾主二阴。”然而水衰虚而怫热客居该部位，二阴郁结则痿痹，神志无法发挥作用，所以大小便失禁，不能禁止，那么热证就很明显了。因此世间流传的方论，虽然称为冷淋，却复用榆皮、黄芩、蘧麦、茯苓、通草、鸡苏、郁李仁、栀子等寒性药物治疗。这种说法虽然荒谬，但方剂却是正确的，只是因为不明白气运变化的机理。难怪会认此为非。有人说患淋病服用茴香、益智仁、滑石、醇酒等温药而痊愈，那么这就不是冷证了吗？殊不知这些都是利小便的要药。大概醇酒、益智仁的性质虽热，但茴香的性质温，滑石的性质寒，所以能开发郁结，使气液宣通，热散而痊愈。
（ ）
：俗写作秘，指大便涩滞。热邪耗伤津液，则粪便坚硬结聚，大肠燥涩紧敛所致。或者大便溏泄而排便不畅的，是因为燥热在肠胃之外，而湿热在内部所致。含义同泄痢后重的意义，见“下迫”论述中。
（身热恶寒）
身热恶寒，这是热在表证。邪热在表且浅，邪气畏惧正气，所以生病发热反而恶寒。有人说恶寒是寒在表，或者说身热恶寒是热在皮肤、寒在骨髓，都是错误的。张仲景的法度说：“无阳病寒，不可发汗。”又说：“身热恶寒，用麻黄汤发汗。汗出热去，身体凉爽即愈。”那么怎么会有寒证呢？又如热生壅肿疮疡而恶寒的，也是由于邪热在于体表。虽然如此，不可发汗。所以张仲景说：患疮疡者发汗则会变成痈脓，大法烦躁多渴，喜寒恶热，这是热病。也有亢则害、承乃制的情况，则病热极盛反而觉得冷的。虽然觉得冷，但病属于热，实在不是寒。其病热郁结甚重，反而恶寒，得寒则加重，得暖则稍好，是因为暖则腠理疏通，阳气得以散发，怫热稍退，所以稍好。寒则腠理闭密，阳气怫郁，热转甚，所以病加重。上下内外周身皆然。世俗因此妄称寒病，误用热药投治，危害很多。假如因为热药使怫热稍散而稍好，药力尽则病反而加重。减轻则微，加重则甚。世俗没有觉悟，只说服药获效，药力尽而病加重，因而加意继续服用，由此各种热病都产生了。
阳热发作则郁结甚于上部，所以多见目昏眩、耳聋鸣响、上壅癫疾。上热甚而下热微，世俗之辈又说是肾水衰弱，不能制约心火，妄称虚热。却不知道养水泻火，应该用寒药，反而用热药想养肾水，并使心火胜退，因而造成祸害不少。能不谨慎吗？
（战栗）
战栗：动摇，是火的征象。阳动阴静，水火相反，所以厥逆拘禁，屈伸不便，是寒病。栗，是寒冷。有人说寒战是脾寒，是不明白变化之道。这是由于心火热盛，亢极而战，反而兼有水化来制约它，所以寒栗。然而寒栗，是由火盛似水，实在不是兼有寒气。所以用大承气汤泻下，多有燥粪，下后热退，则战栗痊愈。或者普通人冒犯极寒而战栗的，是由于寒主闭藏，阳气不能散越，则怫热内生。就像冬天寒冷而地中反暖一样。
有人说：冬天，阳气在内而阴气在外，地上寒而地中暖，夏天则与此相反，这是真理。假如冬至是地阴极，而生阳上升，至夏天则阳在上而阴在地中，当地上热而地中寒是可以的。奈何夏至是天阳极，而生阴下降，至冬天则入地反暖，地上反寒呢？或者说：冬后阳升而出，则阴降而入，夏后阳降而入，则阴升而出，这是妄意。如冬至子正一阳升，而得到复卦（《易》地雷复卦），至于巳月则阴绝，而六阳备齐，是故得到纯乾卦（八纯乾）；夏至午正则一阴生，而得到姤卦（天风姤），至于亥月则阳绝，而六阴备齐，是故得到纯坤卦（八纯坤），至于冬至则阳复生。然而子后面南，午后面北，看卦之爻，则子后阳升，午后阴降很明显。怎么能反说冬后阴降，而夏后阳降呢？
所谓四时天气，都是随运气兴衰而变化。然而岁中五运之气，风、暑、燥、湿、寒各主七十三日五刻，合起来为期一年。岁中六部的主位，自大寒至春分属木，所以温和多风；春分至小满属君火，所以暄暖；小满至大暑属相火，所以炎热；大暑至秋分属土，所以多湿阴云雨；秋分至小雪属金，所以凉而物燥；小雪至大寒属水，所以寒冷。那么难道是由阴阳升降于地之内外造成的吗？
地中的寒暖，《内经》说：火热主出行，寒水主闭藏。所以天气热，则地气通泄而出行，所以地中寒，就像人出汗后体凉；天气寒则地凝冻而闭塞，气难通泄，所以怫郁而地中暖。《内经》说：“人之伤于寒也，则为病热。”又如水本寒，寒极则水冰如地，而冰下的水反不寒，冰浓则水温，这就是闭藏之道。或大雪加冰，闭藏之甚，则水大温，而鱼乃死矣，所以子正一阳生，而至于正月寅，则三阳生，而得到泰卦（地天泰）。泰，是通利而非否塞。午正一阴生，而至于七月申，则三阴生，而得到否卦（天地否）。否，是阻塞而非通泰，然而否极则泰，泰极则否。所以六月泰极，则地中至寒；十二月否极，则地中至暖。那么地中寒暖，明显可见。所以知道人冒于寒，而内为热的，也是有的。
有人问：人冬天阳气在内而热，夏天阴气在内而寒，为什么呢？答曰：世俗已经错误很久了！
一身之气，都随四时五运六气兴衰，而没有相反的。观察脉候，明显可知。如夏月心火生而热，则其脉滑数洪大而长，烦热多渴，难道是寒吗？其余脉候都如此。
或者普通人极度恐惧而战栗的，是由于恐为肾志，其志过度，则劳伤本脏，所以恐则伤肾，肾水衰则心火自甚，而为战栗。又如酒苦性热，养于心火，所以饮之过多，则心火热甚，而为战栗。世俗称之为酒禁。
《内经》说：“阳并于阴，阴则实而阳明虚，阳虚故寒栗而鼓颔也。”注解说：“阳并于阴，是说阳气入于阴分。阳明胃脉也，所以不足则恶寒战栗而鼓颔振动。”然而阳明经络在表，而主肌肉，而气并于里，所以说阳明虚。
又《内经》说：“夫疟之始发也，阳气并于阴，当是时阳虚阴实，而外无阳气，故先寒栗也。阴气逆极，则阳复出之，阳与阴复并于外，则阴虚而阳实，故先热而渴。”然而阴气逆极，则复出之阳，是说阳为表，而里为阴。其气复出，而并之于表，不是说阴寒之气出于表，而反为阳热。
又《内经》说：“夫疟气者，并于阳则阳胜，并于阴则阴胜。阴胜则寒，阳胜则热。”然而气并于阳而在于表，所以说阳胜；气并于阴而在于里，所以说阴胜，这是表里阴阳的虚实，不是寒热阴阳的胜负，只是阳气的出入而已。
如伤寒病日深，表证已罢，而热入于里，若欲作大汗，则阳气必须出于外，郁极乃发，而阳热大作于里，亢则害，承乃制，所以为战栗；而后阳气出于表，则蒸热作而腠理开，大汗泄而病气已矣！或者战栗无汗而痊愈的，必定因为发汗吐下亡津液过多，则不能作汗，但热退气和而痊愈。或者不战栗而汗解的，虽然因为日深表热不罢，内外俱热，阳不并阴，而外气不衰，里无亢极，所以无害承乃制，则无战栗。或者不战栗而亦无汗痊愈的，阳不并阴而气液虚损所致，所以各种战栗，是表的阳气与邪热并甚于里，热极而水化制约它，所以寒栗。虽然如此，因为是热极于里，乃是火极而似水化！
（惊）
惊：心脏突然跳动而不安宁，火主于动，所以心火热盛。虽然如此，只是热极于里，乃是火极似水则喜惊。反兼肾水之恐，是亢则害承乃制的缘故。所谓恐则喜惊，是恐则伤肾而水衰，心火自甚，所以喜惊。
（惑）
惑：疑惑，犹豫，浊乱，而意志不专一。像火参差而惑乱。所以火实则水衰，失志而惑乱。志，是肾水之神。
（悲）
悲：是金肺之志。金本燥，能使物燥的是火。心火主热，喜痛，所以悲痛苦恼，是心神烦热躁乱，而非清净。所以悲哭而五液俱出，是火热亢极，而反兼水化制约的缘故。五脏，是肝、心、脾、肺、肾。五脏之志，是怒、喜、悲、思、恐。悲，一作忧。如果志过度则劳，劳则伤本脏。凡五志所伤都是热。
如六欲，是眼、耳、鼻、舌、身、意。七情，是喜……
When pathogenic qi wanders through the four limbs, causing swelling of the entire body and face, it appears to be due to Spleen deficiency but is actually not. In treating edema (swelling) and abdominal distension, bitter-pungent cold-natured herbs should be used as the principal agents, with a strong emphasis on promoting urination and defecation. The Classics state: "For fullness in the middle jiao, treat from within." If so, how can this be attributed to Spleen Earth deficiency? This view directly contradicts the *Suwen*. The Classics state: "All dampness-induced swelling and fullness belong to Spleen Earth." It also says: "Taiyin governs swelling." Furthermore: "Excess dampness leads to loose stools; in severe cases, it causes urinary obstruction and swelling. These all refer to excess damp-heat of Taiyin Spleen Earth." Additionally, the Classics state: "All abdominal distensions and enlargements belong to Heat." And: "All swelling, pain, soreness, fright, and agitation belong to Fire." It also states: "Excess heat leads to swelling." These all indicate excess-heat of Heart Fire. How can one claim that Spleen deficiency fails to control Kidney Water, leading to excess? Therefore, various forms of edema are caused by the combination of dampness and heat. Just as in the sixth month when damp-heat is excessive and all things flourish, the phenomenon of edema is clearly visible. Thus, the ancients formulated treatments using bitter-pungent cold-natured herbs. Pungency disperses stagnation, bitterness dries dampness, and cold clears heat. With the unblocking of bowels and urine, dampness is removed, stagnation dissipates, heat recedes, and qi harmonizes, resulting in recovery.
Those who falsely attribute edema to Spleen deficiency failing to control Kidney Water merely argue that frequent purging causes this condition and that there is an accumulation of fluids. They fail to realize that the hot toxicity of Croton seed (Badou) depletes the yang qi of Kidney Water, causing Heart Fire and Spleen Earth to become hyperactive. When dampness and heat contend, they cause qi stagnation and blockage, leading to difficult urination and edema. In such cases, purging is appropriate because bitter-pungent cold herbs can resolve damp-heat stagnation and blockage. This is similar to early purging in Cold Damage (Shanghan), where heat penetrates inward to form chest binding (Jie Xiong); here, cold-natured formulas like Xiaoxin Tang or Wan should be used for purging. Similarly, if Cold Damage is mistakenly treated with hot-toxic purgatives like Croton seed, worsening the heat, then cold-natured formulas like Tiaowei Chengqi Tang should be used for purging. As for the silver powder (Yinfen) remedies circulated among the people, which cure edema, it is because they effectively open up stagnation and blockage. However, one must be cautious not to overuse them and cause harm! Moreover, silver powder can damage teeth. This is because its toxic fumes affect the stomach and intestines, and the spirit, blood qi, and grain essence cannot overcome the toxicity. Consequently, the toxic fumes travel along the meridians upward to the tender and thin gingiva, causing harm. The spaces between the upper and lower teeth are traversed by the Hand and Foot Yangming Stomach meridians. When using such drugs, one must first secure and protect the spleen and stomach! Some claim that generalized yin-edema accompanied by aversion to cold is purely a cold syndrome. This is incorrect. The Classics state: "The arrival of Shaoyin君火 (Ministerial Fire) manifests as fright, confusion, aversion to cold, shivering, weeping, laughing, and delirious speech." See the discussion on aversion to cold and shivering below.
(Mao)
Mao: Dizziness or clouding of consciousness. When heat qi is excessive, turbidity confuses the mind, leading to dizziness and mental cloudiness.
(Yu)
Yu: Frustration or depression (Fuyu). It refers to stagnation, obstruction, and blockage where qi flow is not smooth. This is described as heat becoming excessive, closing the pores (Couli), and causing qi stagnation. Like fire smelting objects, extreme heat causes fusion where separation is impossible; thus, heat stagnation leads to blockage and lack of smooth flow. Although cold water governs closure and storage, the current attribution to heat occurs because when fire-heat reaches extreme hyperactivity, it counteracts itself by adopting the transformation of water.
(Zhong Zhang)
Zhong Zhang: Swelling and distension. When heat dominates internally, qi stagnates, leading to swelling. Excessive yang-heat causes abdominal distension. Fire governs growth and flourishing, manifesting prominently in shape and appearance; rising brightness and舒展 prosperity are all images of swelling and distension.
(Bi Zhi)
Bi Zhi: Nasal congestion. Zhi means blockage. Fire governs swelling; thus, when heat pathogens lodge in the Yangming meridian, nasal swelling causes blockage. Some argue that since cold governs closure, nasal congestion must be cold. This is erroneous. It is because yang qi is excessive in the upper body; when lying on one side, the upper nostril remains patent while the lower becomes blocked. This is due to the crossing of Yangming meridians: the left meridian injects into the right nostril, and the right into the left. Therefore, wind-heat stagnation affecting the left side may cause blockage in the right nostril. Laypeople, unaware of this meridian crossing, see the upper nostril clear and the lower blocked when lying down, and wrongly suspect cold. The principle of patency and blockage corresponds to the expansion and contraction of Lung Metal.
(Qiu)
Qiu: Flowing clear mucus from the nose. According to the principles of the Five Elements, when subtle, elements exhibit their own transformations; when excessive, they exhibit the transformation of the element that conquers them ("Ghost/Thief" qi). Thus, the Classics say: "Hyperactivity causes harm; succession brings restraint." The I Ching states: "Nothing dries things more than fire." Using fire to refine metal, extreme heat transforms it into water; when the body is extremely hot, sweat is produced; water is soft and compliant, but extreme cold turns it to ice like earth. Earth governs damp-yin clouds and rain, remaining quiet; but when earth-dampness is excessive, it turns to sudden torrents, fierce winds, and overflowing rain. Wood governs mild warmth and flourishing; excessive wind turns cool and causes breakage. Metal governs coolness; extreme autumn coolness makes things dry. All these illustrate that when extremes are reached, the conquering element's transformation appears to restrain the excess. Therefore, excessive liver-heat produces tears; excessive heart-heat produces sweat; excessive spleen-heat produces saliva; excessive lung-heat produces nasal discharge; excessive kidney-heat produces spittle. The Classics state: "Heat in the nose produces turbid mucus." Any phlegm, saliva, mucus, or spittle that is thick and turbid is caused by extreme fire-heat scorching fluids. Some claim Qiu is due to lung-cold; this is wrong. They observe clear runny nose, sneezing, nasal congestion, and worsening in cold, and conclude it is cold. They do not realize that cold damaging the skin and hair closes the pores, trapping extreme heat and frustration, worsening the disease.
(Nv)
Nv: Epistaxis (nosebleed). Yang-heat frustration invades the Foot-Yangming meridian and ascends. Extreme heat causes blood to move recklessly, resulting in epistaxis.
(Xue Yi)
Xue Yi: Hemorrhage flowing upward. The Heart nourishes blood; thus, extreme heat causes blood excess and reckless movement. Some claim vomiting purple clotted blood indicates cold; this is wrong. It is not due to cold coagulation, but rather extreme heat scorching the blood to make it thick and turbid. Since heat is excessive, the water-element restrains it, mixing red and black to form purple.
(Xue Xie)
Xue Xie: Bleeding from the bowels or bladder. Heat pathogens lodge in the Lower Jiao, causing blood in stool or urine.
(Lin)
Lin: Dysuria characterized by painful, difficult urination. Heat pathogens lodge in the Bladder, causing stagnation and inability to excrete. Some say dysuria with difficulty is heat, while enuresis (involuntary urination) is cold. This is mistaken. Extreme heat lodging in the Kidney region and invading the Foot-Jueyin Liver meridian causes extreme stagnation at the anterior orifice (Ting Kong). Qi and blood cannot circulate freely, leading to flaccidity and numbness, rendering the spirit ineffective. Consequently, fluids seep into the Bladder, and urine is lost involuntarily. The Classics state: "The eyes see with blood, ears hear with blood, hands grasp with blood, palms hold with blood, feet walk with blood, zang organs secrete with blood, and fu organs move qi with blood." Blood follows qi; when qi and blood circulate smoothly, the spirit is clear and responsive. It is said: "Qi and blood are the spirit of humans; they must be carefully nourished." Therefore, functions improve with practice as qi and blood flow; obstruction weakens them. If extreme heat causes stagnation, qi and blood cannot circulate, the spirit loses function, and abilities decline based on the severity of stagnation. Thus, eye stagnation impairs vision; ear stagnation impairs hearing; nose stagnation impairs smell; tongue stagnation impairs taste. Flaccidity and bone bi syndromes, and loss of other functions, are all due to heat-stagnation. Zhang Zhongjing discusses extreme heat in Shaoyin disease: "Incontinence, delirium, and fixed staring eyes indicate the Kidney is failing first." The *Lingshu* states: "The Kidney governs the two yin orifices." When water deficiency allows frustrated heat to lodge, the two yin orifices stagnate, causing flaccidity and loss of control, proving the heat syndrome. Thus, although folk theories call it "cold lin," they use cold herbs like Ulmus bark, Scutellaria, Buckwheat, Poria, Akebia stem, Elsholtzia, Prunus seeds, and Gardenia. Though the theory is wrong, the formula works because they misunderstand the dynamics of qi transformation. Some claim treating lin with warm herbs like Fennel, Alpinia, Talcum, and wine cures it, implying it was cold. However, these are key diuretics. Although wine and Alpinia are warm, Fennel is warm and Talcum is cold; together they open stagnation, promote qi-fluid circulation, disperse heat, and cure the disease.
(Bi Mi)
Bi Mi: Commonly written as Bi, referring to constipation with difficult passage. Heat consumes fluids, causing hard feces and dry, tight constriction of the Large Intestine. Alternatively, loose stools with difficulty passing occur when dry-heat is outside the intestines and damp-heat is inside. This shares meaning with tenesmus discussed under "Lower Urgency."
(Shen Re Wu Han)
Body heat with aversion to cold indicates heat in the exterior. Pathogenic heat is superficial; the pathogen fears the righteous qi, so fever presents with aversion to cold. Claims that aversion to cold always mean exterior cold, or that body heat with aversion to cold means heat in the skin and cold in the marrow, are errors. Zhang Zhongjing’s method states: "In diseases without yang, cold prevails; do not induce sweating." He also says: "For body heat and aversion to cold, use Mahuang Tang to induce sweating. Once sweat is released and heat gone, the body cools and heals." Thus, how can it be cold? Similarly, heat-induced abscesses with aversion to cold are due to pathogenic heat in the exterior. However, sweating is contraindicated. Zhang Zhongjing states: "Sweating in carbuncle patients induces pus formation." Generally, irritability, thirst, preference for cold, and aversion to heat indicate heat disease. There is also the principle of "hyperactivity causes harm; succession brings restraint," where extreme heat may feel cold. Although feeling cold, the disease is heat, not cold. When heat stagnation is severe, aversion to cold occurs; cold worsens it, while warmth alleviates it slightly. Warmth opens pores, disperses yang qi, reduces frustration-heat, and provides slight relief. Cold closes pores, traps yang qi, increases heat, and worsens the disease. This applies throughout the body. Laypeople mistakenly diagnose cold and use hot herbs, causing great harm. If hot herbs temporarily relieve frustration-heat, the disease worsens once the drug effect wears off. Minor improvement is followed by major worsening. Unaware, people continue taking them, generating various heat diseases.
Yang-heat flare-ups cause severe stagnation above, leading to dizziness, deafness, tinnitus, and upper congestion epilepsy. Upper heat excess with lower heat deficiency is often falsely attributed by laypeople to Kidney Water deficiency failing to control Heart Fire, labeled as deficient heat. Not knowing that nourishing water and draining fire requires cold herbs, using hot herbs to nourish Kidney Water and suppress Heart Fire causes significant disaster. One must be cautious!
(Zhan Li)
Zhan Li: Trembling and shivering, an image of Fire. Yang moves, Yin rests; Water and Fire oppose each other. Thus, reversal, rigidity, and difficulty moving indicate cold disease. Shivering implies cold. Claiming chills are Spleen-cold shows ignorance of transformation. This results from extreme Heart Fire trembling due to hyperactivity, counteracting itself with Water transformation, hence cold shivering. Cold shivering arises from fire resembling water, not actual cold. Purging with Dachengqi Tang often expels dry feces; after purging, heat recedes, and shivering resolves. Alternatively, ordinary people shivering from extreme cold experience cold governing closure, preventing yang dispersion, causing internal frustration-heat, like ground warmth in winter.
Some argue: In winter, yang is inside, yin outside; ground is cold, underground warm. Summer is opposite. This is true. At Winter Solstice, earth-yin is extreme, generating rising yang; by Summer, yang is above, yin below, making surface hot and underground cold. But at Summer Solstice, heaven-yang is extreme, generating descending yin; by Winter, yin enters the ground, making it warm again, while surface is cold. Or claiming yang rises out after winter and descends in after summer is speculation. At Winter Solstice (Zi hour), one yang rises, reaching Fu hexagram; by Si month, yin ends, six yangs complete, reaching Pure Qian. At Summer Solstice (Wu hour), one yin is born, reaching Gou hexagram; by Hai month, yang ends, six yins complete, reaching Pure Kun. By Winter Solstice, yang returns. Facing south after Zi, north after Wu, observing hexagram lines, it is clear yang rises after Zi and yin descends after Wu. How can one say yin descends after winter and yang descends after summer?
Seasonal weather follows the rise and fall of Yong Qi (Vital Qi). In a year, the five movements (Wind, Summer-heat, Dryness, Dampness, Cold) each govern 73 days and 5 ke, totaling one year. The six main positions: Da Han to Chun Fen belongs to Wood, hence mild and windy; Chun Fen to Xiao Man belongs to Jun Fire, hence warm; Xiao Man to Da Shu belongs to Xiang Fire, hence hot; Da Shu to Qiu Fen belongs to Earth, hence damp and cloudy; Qiu Fen to Xiao Xue belongs to Metal, hence cool and dry; Xiao Xue to Da Han belongs to Water, hence cold. Thus, is it caused by yin-yang rising/falling inside/outside the earth?
Regarding underground temperature: The Classics state fire-heat governs movement, cold-water governs closure. When weather is hot, earth qi vents outward, making underground cold (like cooling after sweating). When weather is cold, earth freezes and closes, qi cannot vent, causing frustration and underground warmth. The Classics say: "Humans injured by cold develop heat diseases." Water is naturally cold; extreme cold makes it ice, yet water beneath ice is not cold; thicker ice means warmer water, illustrating closure. Heavy snow and ice, extreme closure, make water very warm, killing fish. Thus, at Zi hour one yang is born, reaching Yin month three yangs are born, attaining Tai hexagram (Earth Heaven Tai), meaning smooth flow, not blockage. At Wu hour one yin is born, reaching Shen month three yins are born, attaining Pi hexagram (Heaven Earth Pi), meaning blockage, not smoothness. Yet Pi extreme becomes Tai, Tai extreme becomes Pi. So in sixth month Tai extreme, underground is coldest; in twelfth month Pi extreme, underground is warmest. Underground temperature changes are evident. Thus, humans exposed to cold may develop internal heat.
Question: Why is the interior warm in winter and cold in summer? Answer: Laypeople have been wrong for long. Body qi follows seasonal Yong Qi rise/fall without opposition. Pulse diagnosis clarifies this. In summer, Heart Fire generates heat; pulse is slippery, rapid, large, and long; symptoms include irritability, heat, and thirst. Is this cold? Other pulses are similar.
Ordinary people trembling from extreme fear: Fear is the will of the Kidney. Excessive fear damages the organ, weakening Kidney Water, allowing Heart Fire to dominate, causing tremors. Alcohol is bitter and hot, nourishing Heart Fire; excessive drinking causes extreme Heart Fire and tremors, known as "wine prohibition."
The Classics state: "Yang merges with Yin, Yin becomes excess, Yangming becomes deficient. Yang deficiency causes cold shivering and jaw quivering." Commentary: "Yang merging with Yin means yang qi entering yin divisions. Yangming is the Stomach meridian; insufficiency causes aversion to cold, shivering, and jaw quivering." Although Yangming meridians are superficial and govern muscles, qi merging inward makes it "Yangming deficiency."
The Classics state regarding Malaria: "At onset, yang merges with yin; yang is deficient, yin excess, no yang externally, hence initial chills. When yin qi reverses extremely, yang re-emerges, merging with yin externally; yin becomes deficient, yang excess, hence initial heat and thirst." "Yang emerging" means yang is exterior, yin is interior. Qi re-emerging to the exterior does not mean cold qi becomes hot.
The Classics state: "Malarial qi merging with yang makes yang dominant; merging with yin makes yin dominant. Yin dominance is cold; yang dominance is heat." Merging with yang (exterior) is yang dominance; merging with yin (interior) is yin dominance. This refers to interior-exterior yin-yang deficiency/excess, not cold-heat victory/defeat, but simply yang qi entry/exit.
In deepening Cold Damage, exterior signs cease, heat enters interior. To produce heavy sweating, yang must exit outward. Extreme stagnation releases, causing massive interior yang-heat. Hyperactivity causes harm; succession brings restraint, hence shivering. Then yang exits to exterior, steaming heat opens pores, heavy sweat releases, and pathogenic qi ends. Shivering without sweat recovery occurs due to excessive fluid loss from sweating/vomiting/purging, preventing sweat production; heat recedes, qi harmonizes, and recovery occurs. Recovery without shivering and with sweating happens when exterior heat persists, interior-exterior both hot, yang does not merge with yin, exterior qi is robust, interior lacks extreme hyperactivity, so no "succession/restraint" mechanism triggers shivering. Recovery without shivering and without sweating occurs due to yang not merging with yin and qi/fluid deficiency. Thus, all shivering results from exterior yang merging with pathogenic heat in the interior; extreme heat triggers water transformation, causing cold shivering. Although it seems cold, it is extreme interior heat, fire extreme resembling water transformation.
(Jing)
Jing: Sudden heart palpitation and restlessness. Fire governs movement, so extreme Heart Fire causes this. Although it is extreme interior heat, fire extreme resembling water causes fright. It counteracts with Kidney Water fear due to "hyperactivity causes harm; succession brings restraint." Fear damages Kidney, depleting water, allowing Heart Fire to dominate, hence fright.
(Huo)
Huo: Doubt, hesitation, turbidity, and scattered will. Like fire flickering, causing confusion. When fire is excess, water is deficient, will is lost, and confusion ensues. Will is the spirit of Kidney Water.
(Bei)
Bei: Grief, the will of Metal/Lung. Metal is naturally dry; fire causes dryness. Heart Fire governs heat and pain; grief and suffering reflect vexed, hot, restless heart spirit, not clarity. Crying and five fluids exiting result from extreme fire-heat counteracting with water transformation. The five zang organs are Liver, Heart, Spleen, Lung, Kidney. Their wills are Anger, Joy, Grief, Thought, Fear. Grief is also called Worry. Excessive will causes labor, damaging the organ. All five will injuries involve heat.
The six desires are Eye, Ear, Nose, Tongue, Body, Mind. The seven emotions are Joy...