有小腹结急之证，或唾红，或鼻衄，此皆滞血作热之明验也。用药不止于柴胡、黄
芩，当以川芎、白芷、桃仁、五灵脂、甘草佐之。大便秘结者，于中更加大黄、浓
蜜，使滞血一通，黑物流利，则热不复作。东垣云∶发热昼少而夜多，太阳经中尤
甚。昼病则在气，夜病则在血，是足太阳膀胱血中浮热，微有气也。既病患大小便
如常，知邪气不在脏腑，是无里证也。外无恶寒，知邪气不在表也。有时而发，有
时而止，知邪气不在表，不在里，在经络也。夜发多而昼发少，是邪气下陷之深也。
此杂证当从热入血室而论，泻血汤主之。丹溪治阴虚发热者，于血药四物汤亦分阴
阳，血之动者为阳，芎、归主之。血之静者为阴，生地黄、芍药主之。若血之阴不
足，虽芎、归辛温，亦在所不用。若血之阳不足，虽姜、桂辛热，而亦用之。与泻
火之法，有正治，有从治，皆在临机应变。饮酒发热者，缘酒性大热有毒，遇身之
阳气本盛，得酒则热愈炽，刚而又刚，阴气破散，阳气亦亡，故难治矣。然耗之未
至于亡者，则犹可治。一富家子二十余岁，四月间病发热，脉之浮沉皆无力而虚，
热有往来，潮作无时，间得洪数之脉，随热进退，因知非外感之热，必是饮酒留毒
在内，今因房劳气血虚乏而病作。问之果得其情，遂用补气血药加葛根以解酒毒，
服一帖微汗，反懈怠，热如故，因思是病气血皆虚，不禁葛根之散而然也。必得鸡
矩子，方可解其毒，偶得干者少许，加于药中，其热即愈。治酒肉发热，青黛、瓜
蒌仁、姜汁。又有服金石辛热者，甘草、乌豆汤下。火邪者，艾汤下。冷冻饮料食者，
干姜汤下。炙爆者，茶清、甘草汤下。三消、诸失血后、蓐劳、久痢、诸虚复发热
者，皆非美证。有当直攻其发者，有不当专治其热者，因他病而发为热者也，当随
证用药，不可一概求之。其他诸证作热，当自治其本病，即于本证药中，加入退热
药。元戎谓∶参苏饮治一切发热，皆能作效，不必拘其所因。谓中有风药解表，有
气药和中，则外感风寒及内积痰饮并可用也。而合四物汤名茯苓补心汤，尤能治虚
热，则此方乃虚实表里兼治之剂，然不可过。如素有痰饮者，俟热退即以六君子汤
调之。素阴虚者，俟热退即用三才丸之属调之。
治各有五∶一治曰和，假令小热之病，当以凉药和之。和之不已，次用取。二
治曰取，为热势稍大，当以寒药取之。取之不已，次用从。三治曰从，为势既甚，
当以温药从之，为药气温也。味随所为，或以寒因热用。味通所用，或寒以温用。或
以汗发之不已，又用折。四治曰折，为病势极甚，当以逆制之。逆制之不已，当以
下夺之。下夺之不已，又用属。五治曰属，为求其属以衰之，缘热深陷在骨髓间，
无法可出，针药所不能及，故求其属以衰之。求属之法，是同声相应，同气相求。
经曰∶陷下者灸之。夫衰热之法，同前所云，火衰于戌，金衰于辰之类是也。如或
又不已，当广其法而治之。譬如孙子之用兵，若在山谷则塞渊泉，在水陆则把渡口，
在平川广野，当清野千里。塞渊泉者、刺俞穴，把渡口者、夺病发时前，清野千里
者、如肌羸瘦弱，宜广服大药以养正。治热以寒，温而行之有三，皆因大热在身，
止用黄 、人参、甘草，此三味者，皆甘温，虽表里皆热，燥发于内，扪之肌热于
外，能和之，汗自出而解矣。此温能除大热之至理一也。热极生风，乃左迁入地，补
母以虚其子，使天道右迁顺行，诸病得天令行而必愈二也。况大热在上，其大寒必伏
于内，温能退寒，以助地气，地气者，在人乃胃之生气，使真气旺三也。
【诊】脉浮大而无力为虚。沉细而有力为实。沉细或数者死。病热有火者生，
心脉洪是也。无火者死，沉细是也。浮而涩，涩而身有热者死。热而脉静者，难治。
脉盛，汗出不解者死。脉虚，热不止者死。脉弱，四肢厥，不欲见人，食不入，利
下不止者死。
有一种小腹拘急结聚的病证，或者唾血，或者鼻出血，这都是瘀血导致发热的明确证据。用药不能只局限于柴胡、黄芩，应当用川芎、白芷、桃仁、五灵脂、甘草来辅助治疗。如果大便秘结，在此基础上加入大黄、浓蜂蜜，使瘀血通畅，黑色的瘀血顺利排出，那么发热就不再发作。李东垣说：发热白天轻而晚上重，在太阳经（足太阳膀胱经）中尤为严重。白天发病是在气分，晚上发病是在血分，这是足太阳膀胱经血中有浮热，伴有轻微的气分病变。既然病人大小便正常，就知道邪气不在脏腑，这就是没有里证（内脏病变）。体表没有恶寒，就知道邪气不在表（肌表）。有时发作，有时停止，知道邪气既不在表，也不在里，而是在经络中。晚上发作多而白天发作少，说明邪气下陷得深。这种杂病应当按照“热入血室”（热邪侵入血室）来论治，主方用泻血汤。朱丹溪治疗阴虚发热者，在使用补血基础方四物汤时也要区分阴阳，血液中具有动性特征的是阳，由川芎、当归主导；血液中具有静性特征的是阴，由生地黄、芍药主导。如果是血的阴分不足，虽然川芎、当归辛温，也在不使用之列。如果是血的阳分不足，虽然干姜、肉桂辛热，也会使用它们。这与泻火的方法相比，有正治法（逆病势而治），有从治法（顺病势而治），都在于临机应变。因饮酒引起发热的人，是因为酒性大热有毒，遇到身体阳气本盛的人，得到酒后热势更加炽盛，刚上加刚，阴气破散，阳气也亡失，所以难治。然而耗损还没有达到亡失程度的，还可以治疗。有一个富家子弟二十多岁，四月间生病发热，脉象浮取沉取都无力且虚，发热有往来感，潮热发作没有定时，偶尔出现洪数之脉，随热势进退，因此知道这不是外感引起的发热，一定是饮酒留下的毒邪留在体内，现在因为房劳导致气血虚乏而发病。询问后果然证实了情况，于是用补气血的药物加上葛根来解酒毒，服用一帖后微微出汗，反而感到懈怠，热势依旧，于是思考这个病气血都虚，承受不住葛根的发散作用所致。必须得到鸡距子，才可以解除其毒，偶然得到少许干品，加在药中，热势随即痊愈。治疗因吃酒肉引起的发热，用青黛、瓜蒌仁、姜汁。又有服用金石类辛热药物引起发热的，用甘草、乌豆汤送服。火邪引起的发热，用艾叶汤送服。食用冷冻饮料食物引起的发热，用干姜汤送服。食用炙烤爆炒食物引起的发热，用茶清、甘草汤送服。消渴病（三消）、各种失血之后、产后劳损（蓐劳）、久痢、各种虚证再次发热者，都不是好证候。有的应当直接攻伐引起发热的病因，有的不应当专门治疗发热，而是因为其他疾病引发的发热，应当根据伴随症状用药，不可一概而论。其他各种病症引起的发热，应当治疗其根本疾病，即在治疗本证的药物中，加入退热药。元戎说：参苏饮治疗一切发热，都能见效，不必拘泥于发热的成因。认为方中含有风药可以解表，含有理气药可以和中，那么外感风寒及内积痰饮都可以使用。如果合用四物汤名为茯苓补心汤，尤其能治疗虚热，那么这个方子是虚实表里兼治的药剂，但是不可过量服用。如素有痰饮的人，等热退后用六君子汤调理。素体阴虚的人，等热退后用三才丸之类的药物调理。
治疗发热有五种方法：第一种治法叫“和”，假如是轻微发热的病，应当用凉药调和它。调和无效，接着用“取”法。第二种治法叫“取”，因为热势稍大，应当用寒药攻取它。攻取无效，接着用“从”法。第三种治法叫“从”，因为病势已经很严重，应当用温药顺从其势，因为药性是温的。药味随着病情需要，或者以寒药治热病（寒因热用）。药味通用于所治之证，或者以温药治寒病（寒以温用，此处原文似有脱误或特指反佐，依文意理解为顺应病势）。或者用发汗法治疗无效，又用“折”法。第四种治法叫“折”，因为病势极甚，应当用逆制法对抗它。逆制无效，应当用“下夺”法（泻下攻逐）。下夺无效，又用“属”法。第五种治法叫“属”，意思是寻求疾病的本源以削弱它，因为热邪深陷在骨髓之间，无法排出，针药所不能到达，所以寻求其本源以削弱病势。求属的方法，就是同声相应，同气相求。医经说：下陷的病症用灸法。衰减热邪的方法，如同前面所说的，火衰于戌时，金衰于辰时之类。如果这样还不停止，应当广开思路进行治疗。譬如孙子用兵，如果在山谷就堵塞水源，在水陆交界处就扼守渡口，在平原旷野，就要实行千里焦土政策。堵塞水源，是指针刺腧穴；扼守渡口，是指在病发之前截断病势；实行千里焦土政策，是指如果肌肉消瘦瘦弱，宜广泛服用大补药物以养护正气。用寒药治疗热病，采用温服的方法，有三种道理：都是因为大热在身，只用黄芪、人参、甘草这三味药，这三味药都是甘温的，虽然表里皆热，燥热发于内，摸起来肌肤外面也热，但可以用甘温药调和它，汗自然出来而病愈了。这是“温能除大热”的根本原理之一。热极生风，乃是左迁入地（五行理论中的方位变化），补母以使其子虚弱，使天道右迁顺行，各种疾病得天令运行而必愈，这是第二个道理。况且大热在上，其大寒必然潜伏在内，温药能退寒，以助地气，地气在人身上就是胃的生气，使真气旺盛，这是第三个道理。
【诊】脉象浮大而无力为虚证。脉象沉细而有力为实证。脉象沉细或数的预后不良，主死。患热病而有火（脉象有神/有力）的预后良好，心脉洪大即是此类。无火的预后不良，脉象沉细即是此类。脉象浮而涩，涩而身体有热的预后不良，主死。发热而脉象平静的，难治。脉象盛大，出汗后热不退的预后不良，主死。脉象虚弱，热势不止的预后不良，主死。脉象微弱，四肢厥冷，不想见人，饮食不进，腹泻不止的预后不良，主死。
There is a syndrome characterized by urgency and binding in the lower abdomen, or spitting of blood, or epistaxis; these are clear evidence that stagnant blood causes fever. Medication should not be limited to Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix); instead, Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Taoren (Persicae Semen), Wulingzhi (Trogopterori Faeces), and Gancao (Glycyrrhizae Radix et Rhizoma) should be used as adjuvants. If constipation is present, Dahuang (Rhei Radix et Rhizoma) and thick honey are added to promote the passage of stagnant blood; once the black turbid matter is smoothly discharged, the fever will cease. Dongyuan stated: Fever is milder during the day and more severe at night, especially in the Taiyang Channel (Foot-Taiyang Bladder Channel). Daytime illness pertains to Qi, while nighttime illness pertains to Blood; this indicates floating heat within the Blood of the Foot-Taiyang Bladder Channel, accompanied by slight Qi involvement. Since the patient's urination and defecation are normal, it is known that the pathogenic factor is not in the Zang-Fu organs, meaning there is no interior syndrome. The absence of aversion to cold on the exterior indicates that the pathogenic factor is not in the exterior. The intermittent nature of the fever indicates that the pathogenic factor is neither in the exterior nor in the interior, but in the Collaterals. Frequent nighttime attacks and rare daytime attacks indicate deep sinking of the pathogenic factor. This miscellaneous disease should be treated according to "Heat Entering the Blood Chamber" (Re Ru Xue Shi), with the primary formula being Xiexue Tang (Blood-Draining Decoction). Danxi, when treating Yin-deficiency fever, differentiated Yin and Yang even within the foundational blood-nourishing formula Siwu Tang (Four Substances Decoction): the dynamic aspect of Blood is Yang, governed by Chuanxiong and Danggui (Angelicae Sinensis Radix); the static aspect of Blood is Yin, governed by Shengdihuang (Rehmanniae Radix) and Shaoyao (Paeoniae Radix). If Yin-blood is insufficient, although Chuanxiong and Danggui are acrid and warm, they should not be used. If Yang-blood is insufficient, although Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus) are acrid and hot, they may be used. Compared with fire-draining methods, there are direct treatments (Zhengzhi) and following treatments (Congzhi), all depending on clinical flexibility. For fever caused by alcohol consumption, it is because wine has a great heat and toxicity; when encountered by a person whose Yang Qi is naturally abundant, the heat becomes even more blazing, adding rigidity to rigidity, causing Yin Qi to scatter and Yang Qi to perish, making it difficult to treat. However, if depletion has not reached the point of perishing, it is still treatable. A wealthy young man in his twenties fell ill with fever in April. His pulse was weak and deficient upon both superficial and deep palpation. He experienced alternating fever and tidal fever without fixed timing, occasionally presenting a surging and rapid pulse that advanced and retreated with the fever. Thus, it was determined that this was not an external contraction fever, but rather residual toxin from alcohol retained internally, triggered now by Qi and Blood deficiency due to sexual exhaustion. Inquiry confirmed this. Consequently, Qi- and Blood-tonifying herbs were administered with Gegen (Puerariae Lobatae Radix) to resolve alcohol toxicity. After one dose, slight sweating occurred, followed by lethargy, and the fever persisted. It was reasoned that since both Qi and Blood were deficient, the patient could not tolerate the dispersing action of Gegen. Only Jiju Zi (Callicarpos Fructus) could resolve the toxicity. A small amount of dried Jiju Zi was accidentally obtained and added to the prescription, after which the fever immediately subsided. For fever caused by consuming meat and alcohol, Qingdai (Indigo Naturalis) and Gualou Ren (Trichosanthis Semen) with Ginger Juice are used. For fever caused by ingesting mineral-based acrid-hot medicines, Gancao and Wudou (Sojae Semen Praeparatum) decoction is taken. For fire-pathogen fever, Muguyin (Mugwort Decoction) is taken. For fever caused by consuming frozen drinks or foods, Ganjiang (Zingiberis Rhizoma) decoction is taken. For fever caused by roasted or fried foods, Chaqing (Tea Infusion) and Gancao decoction are taken. Fever recurring after Sanxiao (Three Consumptions/Thirst Disorders), various hemorrhages, postpartum consumptive disease (Rulao), chronic dysentery, or other deficiency syndromes is not a favorable condition. Some cases require direct attack on the cause of fever; others do not require specific treatment for the fever itself, as the fever arises from another disease. Treatment must follow the accompanying symptoms and cannot be generalized. For other fevers arising from various syndromes, the root disease should be treated primarily, adding antipyretic herbs to the base prescription. Yuanrong stated: Shen Su Yin (Ginseng and Perilla Decoction) is effective for all types of fever, regardless of etiology. It contains wind-dispelling herbs to release the exterior and Qi-regulating herbs to harmonize the middle, making it suitable for both external wind-cold contraction and internal accumulation of phlegm-fluids. When combined with Siwu Tang, it is named Fuling Buxin Tang (Poria Heart-Nourishing Decoction), which is particularly effective for deficiency fever. Thus, this formula treats both deficiency/excess and interior/exterior simultaneously, but should not be overused. For those with pre-existing phlegm-fluids, Liu Junzi Tang (Six Gentlemen Decoction) should be used for regulation after the fever subsides. For those with pre-existing Yin deficiency, Sancai Wan (Three Capabilities Pill) or similar formulas should be used for regulation after the fever subsides.
There are five methods of treating fever:
1. The method of "Harmonizing" (He): For mild fever, cool herbs should be used to harmonize. If harmonization fails, proceed to the method of "Taking" (Qu).
2. The method of "Taking" (Qu): For slightly intense fever, cold herbs should be used to purge/take. If purging fails, proceed to the method of "Following" (Cong).
3. The method of "Following" (Cong): For severe conditions, warm herbs should be used to follow the pathogen's trend, as the herbs are warm. Flavors adapt to the situation; sometimes cold herbs are used for heat (Han Yin Re Yong). Sometimes flavors are adapted to the treatment; or warm herbs are used for cold (Han Yi Wen Yong - *Note: Text implies adapting flavor to condition*). If diaphoresis fails, proceed to the method of "Breaking" (Zhe).
4. The method of "Breaking" (Zhe): For extreme severity, counter-control (Ni Zhi) should be used. If counter-control fails, use "Downward Purging" (Xia Duo). If downward purging fails, proceed to the method of "Belonging" (Shu).
5. The method of "Belonging" (Shu): This seeks the root essence to diminish the disease. Because heat has sunk deeply into the marrow, where no exit exists and acupuncture/herbs cannot reach, one seeks its belonging to weaken it. The method of seeking belonging is based on "like responds to like" and "same qi seeks same." The Classics state: "Sinking conditions are treated with moxibustion." The method of diminishing heat follows the principle that Fire declines at Xu hour and Metal declines at Chen hour. If this is insufficient, broaden the therapeutic approach. Like Sun Tzu using military strategy: in valleys, block springs; at water-land junctions, guard ferry crossings; in open plains, implement scorched earth tactics. Blocking springs refers to needling Shu points; guarding ferry crossings refers to intercepting the disease before onset; scorched earth tactics refer to administering major tonic drugs extensively to nourish Zheng Qi when muscles are emaciated.
Treating heat with cold, administered warmly, has three rationales: All involve using only Huangqi (Astragali Radix), Renshen (Ginseng Radix et Rhizoma), and Gancao. These three are sweet and warm. Although there is heat in both interior and exterior, with dryness generating internally and skin feeling hot externally, these sweet-warm herbs can harmonize, causing spontaneous sweating and resolution. This is the first profound truth of "warmth eliminating great heat." Second, extreme heat generates wind, moving left into the earth; tonifying the mother empties the son, allowing the Heavenly Dao to move right and proceed in order, ensuring recovery under the influence of Heaven's command. Third, since great heat is above, great cold must lie hidden within. Warm herbs dispel cold and assist Earth Qi. Earth Qi in humans is the generating Qi of the Stomach, strengthening True Qi.
[Diagnosis] A pulse that is floating, large, and powerless indicates deficiency. A pulse that is sunken, fine, and forceful indicates excess. A sunken, fine, or rapid pulse indicates death. Patients with fever who have "Fire" (vitality/pulse strength) survive; a Hong (Surging) Heart Pulse is an example. Those without "Fire" die; a sunken, fine pulse is an example. A floating and choppy pulse, or a choppy pulse with body heat, indicates death. Fever with a quiet pulse is difficult to treat. A full pulse with sweating that does not resolve the fever indicates death. A deficient pulse with unceasing fever indicates death. A weak pulse with cold limbs, aversion to people, inability to eat, and unceasing diarrhea indicates death.