温热郁于气分为伏热，郁于血分为伏火，通称伏邪，热与火，未有不当清凉者也。当其伏邪外溃在表，法
宜辛凉开达，使热从表泄，则发表法亦清凉法也。伏邪内结在里，法宜苦寒通降，使火从下泄，则攻里法亦清
凉法也。伏邪在半表半里，法宜双方和解，使热从表泄，火从里泄，则和解法亦清凉法也。若在表已得汗而热
不退，在里已下而热不解，在半表里已和解而热犹不净，或本来有热无结，则惟以清凉直折，以整肃其火而
已，故清凉法可济发表攻里和解之不逮，四者之用，可合而亦可分，温热病当清凉者十之六七，则清凉法不可
不细讲也。凡用清凉方法，必先辨其为伏热，为伏火。热属气分，为虚而无形（俗称浮游火），如盛夏酷暑炎
蒸，虽挥汗淋漓，一遇凉风而即解，故人身之热，气清即退。至其清热之法，首用辛凉继用轻清者，所以清肃
气分之浮热也。终用甘寒者，所以清滋气分之燥热也。火属血分，为实而有物（俗称实火），其所附丽者，
非痰即滞，非滞即瘀，非瘀即虫，但清其火，不去其物，何以奏效，必视其附丽者为何物，而于清火诸方加入
取消痰滞瘀积虫等药，效始能捷。如燔柴炙炭，势若燎原，虽沃以水，犹有沸腾之恐慌，必撤去柴炭而火始熄。
故凡清火之法，虽以苦寒直降为大宗，而历代医方，往往有清火兼消痰法，清火兼导滞法，清火兼通瘀法，清
火兼杀虫法者，皆所以清化火之所附丽者也。若无所附丽之伏火，但为血郁所化者，自以清其络热宣其气机为
第一要义。而有时苦寒复甘寒法者，甘苦化阴，以存胃肠之津液，使苦寒不致化燥，苦寒复酸寒法者，酸苦泄
肝，善通孙络之积血（会报云∶酸味，能通微丝血管之积血），使络热转出气分而解。苦寒复咸寒法者，咸苦
达下，一则清利内肾之溺毒，一则清镇冲气之上逆，一则清通外肾之败精也。总而言之，凡温热病宜于辛凉开
达者，早用苦寒直降，即为误遏，冰伏其邪而内陷；宜于苦寒直降者，但用轻清甘寒，只能清热，不能退火。
虽然，火散则为热，热聚则为火，火与热只在聚散之间，故清热与泻火，可分而亦可合；但其先后缓急之间，
所用方法，界限必须厘清耳。试为胪举其方略∶
一、辛凉开达，其法有二∶一为宣气达卫，使伏邪从气分而化，卫分而解。兼风者透风于热外，刘氏桔
梗汤、加味栀豉汤二方最灵而稳；挟湿者渗湿于热下，五叶芦根汤、藿朴夏苓汤二方亦轻而灵；俾风湿不与热
相搏，从或汗或 而外解，则伏热势孤，自易整肃。一为透营泄卫，使伏邪从营分而透，转气分而解。毒盛者
清营解毒，加减银翘散（医原方）最妙，羚地清营汤（验方传信方）、犀角大青汤、凉血解毒汤、犀地桑丹汤
（樊师验方）四方亦可选用；挟秽者透营辟秽，清芳透邪汤（徐洄溪医案方）、加味翘荷汤磨冲太乙紫金丹，
二方最灵，即一起舌绛咽干，甚有脉伏肢冷之假象，亦不外此二方加减；次与五
味消毒饮加紫金片，清解余秽。俾毒与秽从疹斑而解，或从战汗而解。间有邪盛正虚，不能一战而解者，法宜
益胃透邪，七味葱白汤加西洋参鲜茅根，服后停一二日，再战汗而解。但战汗出后，肺气空虚，其人虽倦卧不语，
肤冷一昼夜，却非脱症，待气还自温暖如常矣。余方详载发表篇，参看可也。
二、轻清化气，王孟英所谓展气化以轻清，如栀、芩、蒌、苇等味是也。又谓伏气温病，自里出表，先
从血分而后达气分，初起多舌润无苔，但诊其脉，软而或弦，或弦而微数，口未渴而心烦恶热；夜甚无寐，或
斑点隐隐，即宜投以清解营热之药，迨伏邪从气分而化，苔始渐布，然后再清其气分可也。然其气分之所以不
清者，湿热居多，痰热次之，病之为肿为喘，为痞为闷，为懊 ，为咳嗽，为呃逆，为四肢倦懈，为小便黄赤，
为便溏不爽，皆由于此，总以轻清化气为首要。其清气分湿热，如叶氏新加栀豉汤（光杏仁十粒，生苡仁三钱，
飞滑石钱半，白通草一钱，浙苓皮三钱，淡香豉钱半，焦栀皮一钱，鲜枇杷叶三钱）加减芦根饮（活水芦根一
两，光杏仁、冬瓜子、生苡仁、鲜枇杷叶各三钱，白蔻仁三分冲，以上皆天士验方）、芦根通橘汤（活水芦根一
两，川通草一钱，广橘皮一钱，鲜枇杷叶五钱，生姜皮五分，淡竹茹钱半。此外台偶方）、六花苇茎汤（旋复
花三钱，滁菊花钱半，川朴花八分，豆蔻花、佛手花各五分，代代花二分，苇茎一钱，生苡仁、冬瓜子各四钱，
廉臣验方）之类。其轻清气分痰热，如陈氏清肺饮（疫痧草方）蒌杏橘贝汤（栝蒌皮钱半，光杏仁三钱，蜜炙
橘红一钱，川贝母三钱，桔梗一钱，鲜枇杷叶三钱，冬瓜子三钱，冬桑叶钱半。叶天士验方）、新加桑菊饮（廉
臣验方）、枇杷叶饮子（外台方）加岩制川贝（顾氏医镜方）之类。此皆能清化肺气，通调水道，下输膀胱，
俾气分伏热，上能从咯痰而出，下能从小便而出。吴茭山曰∶凡
气中有热者，当用清凉薄剂。吴鞠通曰∶治上焦如羽，非轻不举。王孟英曰∶用药极轻清极平淡者，取效更捷。
皆属此类。
三、甘寒救液，其法有二∶一为清养气液，如金匮麦门冬汤、千金麦冬汤、清燥救肺汤（喻嘉言验方）、叶
氏养胃汤、沙参杏仁汤（南沙参、甜杏仁、川贝各三钱，鲜枇杷叶四钱，雅梨汁、青蔗浆各一瓢冲）、润肺悉尼
膏（以上皆叶天士验方）、参燕麦冬汤（吉林参一钱，龙芽燕八分，麦冬三钱，奎冰四钱。江笔花医镜方）
之类。一为清养血液，如千金生地黄煎、清燥养荣汤（吴氏温疫论方）、叶氏竹叶地黄汤、叶氏加减复脉汤（皆
天士验方）、顾氏八汁饮（甘蔗汁、藕汁、梨汁、芦根汁、西瓜汁、鲜生地汁、鲜茅根汁各一酒杯，鲜荷叶汁
三匙。晓澜验方）之类。此皆温热大病后，劫伤气津血液，善后调养之良方。总之温热诸病，未经汗下和解而
化燥者，火盛则燥也，当用苦寒清火为主；已经汗下和解而化燥者，液涸则燥也，当以甘寒滋燥为主；此其大
要也。
四、苦寒直降，即叶天士所谓苦寒直清里热也。黄芩汤（伤寒论方）、栀子黄芩汤（河间六书方）二方
最轻，黄连解毒汤（外台方）较重，准绳三黄石膏汤（内科准绳类方）尤重，当察伏火之浅深轻重，对证选用。
凡温热病之宜于苦寒者，切忌早用甘寒，盖因苦寒为清，甘寒为滋，自时医以鲜地鲜斛元参麦冬等之清滋法，
认作清泄法，于是热益壮，神益昏，其弊由甘寒清滋之药，得大热煎熬，其膏液即化为胶涎，结于脘中，反致
伏火不得从里而清泄，从此为闭为厥，为痉为癫，甚则为内闭外脱，变症蜂起者，多由于此。
五、清火兼消痰者，因伏火熏蒸津液，液郁为痰，故兼用化痰药以分消之。法宜苦辛开泄，如小陷胸汤、
黄芩加半夏生姜汤（皆伤寒论方）、石膏大青汤（千金方）、黄连温胆汤
（观聚方要补方）、连朴饮、昌阳泻心汤（王氏霍乱论方）、加味小陷胸汤、加减半夏泻心汤、加味连茹橘半
汤（皆医原方）之类，皆可选用。其法与苦寒清泄有别，清泄是直降，一意整肃伏火；开泄是横疏，兼能清化
痰浊；分际最宜斟酌。叶天士所谓舌白不燥，或黄白相兼，或灰白不渴，慎不可乱投苦泄，虽有脘中痞痛，宜
从苦辛开泄是也。
六、清火兼导滞者，因温热病最多夹食一症也。王孟英曰∶凡治温热病必察胸脘，如拒按者，即舌绛神
昏亦宜开化。其方如枳实导滞汤、三黄枳术丸、枳实导滞丸、陆氏润字丸之类，皆可酌用。栀朴枳实汤（仲景
方）冲生萝卜汁，方亦灵稳。
七、清火兼通瘀者，因伏火郁蒸血液，血被煎熬而成瘀，或其人素有瘀伤，不得不兼通瘀法以分消之。
如黄连解毒合犀角地黄汤、加减小柴胡汤、增损小柴胡汤、四逆散合白薇汤之分消瘀热，皆可对证酌用。此即
叶天士所谓宿血在胸膈中，舌色必紫而暗，扪之潮湿，当加散血之品于清火法中，如琥珀、丹参、桃仁、丹皮
等，否则瘀血与伏火相搏，阻遏正气，遂变如狂发狂之症也。
八、清火兼杀虫者，因伏火在胃，胃热如沸，蛔动不安，因而脘痛烦躁昏乱欲死者，名曰蛔厥，但清其
胃，略兼杀虫之药，蛔厥自愈。清中安蛔汤（姜汁炒川连二钱，黄柏钱半，枳实二钱，乌梅三个，川椒三十粒。
伤寒广要方）、犀角黄连汤（犀角一钱，小川连钱半，青木香五分，乌梅三个。外台方）二方最效。惟有下症
者，宜用三黄泻心汤加青木香、枣儿槟榔、胡连等攻下之。
九、清络宣气者，所以清其血热，灵其气机，使无形者令其转旋，有形者令其流畅也。盖因温热伏邪，
内舍于营，盘踞络中，其血必郁而热，其气亦钝而不灵，凡春夏温病晚
发，秋冬伏暑晚发，邪伏深沉者，类多如此。此即王孟英所谓邪伏深沉，不能一齐外出，虽治之得法，而苔退
舌淡之后，逾一二日，舌复干绛，苔复黄燥，正如抽蕉剥茧，层出不穷，不比外感温暑，由卫及气，自营而血
也，且每见有变为痈肿者。徐洄溪云∶凡伏邪留于隧络，深则入于脏腑骨髓之中，无从发泄，往往上为发颐肺
痈，中为肝痈痞积，下为肠痈便毒，发于皮肉则为 疹疮疡，留于关节则为痛痹拘挛，注于足胫则为鹤膝足痿，
此等证候，皆络瘀为之也。精气旺则不发，至血气偶虚，或有所感触，虽数年之久，亦有复发者。其病俱属有
形，煎丸之力，太轻则不能攻邪，太重则反伤其正，当用外治之法，以透毒散瘀，内服丸散，以消其痰火，化
其毒涎，或从咯吐而出，或从二便而出，而以轻清宣透芳香通灵之煎剂，以托其未透之伏邪，内外之症皆然，
医者均所当知也。观此二则，辨论络中结邪之病理，发明殆尽。但其间用药最难，此等络瘀之伏火，非芩连所
能清，非参 所能托，惟有用轻清灵通之剂，渐渐拨醒其气机，宣通其络瘀，庶邪气去而正气不与之俱去；若一
涉呆钝，则非火闭即气脱，非气脱即液涸矣，选药制方，可不慎之又慎欤。
以余所验，清宣肺络，首推清宣瘀热汤（活水芦笋、鲜枇杷叶各一两，旋复花三钱包煎，真新绛一钱，青
葱管二寸，广郁金磨汁四匙冲。常熟曹仁伯医案验方）最灵，其次六花绛复汤（滁菊花二钱，新银花钱半，藏
红花三分，豆蔻花、佛手花各五分，旋复花三钱，真新绛一钱，青葱管三寸冲）、五皮绛复汤（白蔻皮六分，
陈香橼皮五分，雅梨皮三钱，丹皮钱半，紫荆皮钱半，旋复花三钱，新绛一钱，青葱管三寸冲。以上皆廉臣验
方）方亦轻稳。惟胸痹气急痰多者，宜用蒌薤绛复汤（栝蒌皮二钱，干薤白三枚，桂枝二分，仙半夏
钱半，浙苓三钱，旋复花五钱，新绛钱半，青葱管五寸，春砂壳七分。徐守愚医案验方）。清宣包络，首推石
氏犀地汤、加减服蛮煎二方，其次晋三犀角地黄汤（犀角汁四匙，鲜生地汁二瓢，同冲，青连翘三钱，生甘草八
分。王氏古方选注方）、加味清宫汤（元参心二钱，连翘心一钱，竹叶卷心二钱，莲子心五分，犀角汁四匙，
竹沥、梨汁各一瓢，鲜石菖蒲汁五匙，和匀同冲。吴氏温病条辨方）方亦清灵。清宣肝络，首推二仁绛复汤
（桃仁九粒，柏子仁钱半，归须钱半，新绛一钱，旋复花三钱，青葱管三寸冲。天士验方）、新加绛复汤二方
为主。气滞挟湿者，四七绛复汤（仙露夏钱半，川朴花八分，紫苏旁枝一钱，赤苓三钱，白前二钱，旋复花三
钱，新绛一钱，青葱管五寸冲。徐守愚医案验方）化湿宣络。血虚气郁者，首推四物绛复汤（细生地三钱，归
须一钱，赤芍钱半，抚芎五分，新绛一钱，旋复花三钱，青葱管三寸冲）。其次鱼胶绛复汤（墨鱼骨三钱，
真阿胶二钱，真新绛钱半，旋复花三钱，青葱管三寸）养血濡络。或用活血通络汤（归须三钱，川芎钱半，酒
炒白芍一钱，秦艽钱半，冬桑叶三钱，鸡血藤胶一钱，广橘络二钱。雷少逸时病论方）荣筋舒络。络伤血溢者，
羚地清营汤，清络止血（以上各方均沈樾亭验方传信方），孙氏五胆墨（熊胆汁、牛胆汁、猪胆汁、青鱼胆汁
各一分，羊胆汁二分，当门子五厘，陈京墨研粉六钱，和捣成锭，每重三分，金箔为衣。孙文垣历验秘方）尤为
神妙；又次，四汁绛复汤（鲜生地汁一瓢，生藕汁两瓢，童便五瓢，陈京墨汁五匙，同冲，真新绛八分，旋复
花三钱，葱须二分。廉臣验方）亦灵而稳。络瘀化胀者，三虫二甲汤（羌螂虫一对，青糖一钱拌炒 虫五只，
酒炒九香虫三只，生鳖甲五钱，炒川甲一钱，桃仁钱半，蜜炙延胡钱半，归须二钱，五灵脂钱半，净楂肉三钱。
叶天士验方）、开郁通络饮二方最灵。络燥发痉者，犀
羚镇痉汤（陆定圃验方）、羚麻白虎汤（邴味清验方）、犀羚白虎汤（王孟英验方）三方最效，轻则新加桑菊
饮亦验。
若阳邪亢极厥深热深之候，其人昏厥四逆，自利酱粪，虽急当清络宣气，救逆存阴，如羚地清营汤、犀地
温热之邪郁结于气分称为伏热，郁结于血分称为伏火，统称为伏邪。热与火，没有不应当用清凉法治疗的。当伏邪向外溃散在体表时，治法宜用辛凉宣透发散的方法，使热邪从体表宣泄，那么发表法也就是清凉法。伏邪内结在体内时，治法宜用苦寒通降的方法，使火邪从下部排泄，那么攻里法也就是清凉法。伏邪在半表半里之间时，治法宜用和解的方法，使热邪从体表宣泄，火邪从体内排泄，那么和解法也就是清凉法。如果在体表已经发汗但热不退，在体内已经攻下但热不解，在半表半里已经和解但热仍未清，或者本来就有热而无结滞，那么就只用清凉法直接折损火热，以整肃火邪罢了。所以清凉法可以弥补发表、攻里、和解法的不足，这四种方法的作用，可以合用也可以分开使用。温热病需要用到清凉法的占十分之六七，所以清凉法不可不详细讲解。
凡是使用清凉方法，必须先辨别是伏热还是伏火。热属于气分，表现为虚而无形（俗称浮游火），就像盛夏酷暑炎热蒸腾，虽然挥汗如雨，一遇到凉风就能缓解，所以人身的热象，只要气机清爽热就会退。至于清热的方法，首先用辛凉药，继用轻清药，这是为了清肃气分的浮热。最后用甘寒药，这是为了清润气分的燥热。火属于血分，表现为实而有物（俗称实火），它所依附的东西，不是痰就是积滞，不是积滞就是瘀血，不是瘀血就是寄生虫。只清除火邪，而不去除它依附的病理产物，怎么能奏效呢？必须看它依附的是什么东西，而在清火的方剂中加入消除痰、滞、瘀、积、虫等药物，疗效才能迅速。就像柴草燃烧像炭一样猛烈，火势若燎原，即使泼水，仍有沸腾的恐慌，必须撤去柴炭火才会熄灭。所以凡清火的方法，虽然以苦寒直降为主要手段，但历代医方中，往往有清火兼消痰法、清火兼导滞法、清火兼通瘀法、清火兼杀虫法的，这都是为了清化火所依附的病理产物。如果没有依附物的伏火，只是由血郁转化而成的，自然以清络热、宣畅气机为第一要义。有时采用苦寒配合甘寒的方法，甘苦化合能化生阴液，以保存胃肠的津液，使苦寒药不至于化燥；苦寒配合酸寒的方法，酸苦能泄肝，善于疏通孙络中的积血（会报说：酸味，能疏通微丝血管中的积血），使络热转出气分而解；苦寒配合咸寒的方法，咸苦能下达下焦，一则清利肾脏的溺毒，二则清镇冲脉之气上逆，三则清通外肾的败精。总而言之，凡温热病适宜用辛凉开达法的，如果早用苦寒直降，就是误用遏制之法，会使邪气冰伏而内陷；适宜用苦寒直降法的，如果只用轻清甘寒，只能清热，不能退火。
虽然如此，火散开就成为热，热聚集就成为火，火与热只在聚散之间，所以清热与泻火，可以分开也可以合并；但在先后缓急之间，所用的方法，界限必须厘清。试列举其方略如下：
一、辛凉开达，此法有两种：一是宣畅气机通达卫分，使伏邪从气分化解，从卫分解除。兼夹风邪的，将风邪透出于热邪之外，刘氏桔梗汤、加味栀豉汤两方最灵验稳妥；兼夹湿邪的，将湿气渗利于热邪之下，五叶芦根汤、藿朴夏苓汤两方也轻灵有效；使得风湿不与热邪相搏结，从汗或战汗而外解，那么伏热之势孤立，自然容易整肃。二是透达营分泄出卫分，使伏邪从营分透出，转至气分而解。毒盛的，清营解毒，加减银翘散（出自《医原》）最妙，羚地清营汤（验方传信方）、犀角大青汤、凉血解毒汤、犀地桑丹汤（樊师验方）四方也可选用；兼夹秽浊的，透营辟秽，清芳透邪汤（徐洄溪医案方）、加味翘荷汤磨冲太乙紫金丹，两方最灵验，即使出现舌绛咽干，甚至有脉伏肢冷的假象，也不外乎这两方加减；随后用五味消毒饮加紫金片，清解余留的秽浊。使得毒与秽从疹斑而解，或从战汗而解。间或有邪盛正虚，不能一战而解的，治法宜益胃透邪，用七味葱白汤加西洋参、鲜茅根，服用后停一二日，再战汗而解。但战汗出后，肺气空虚，其人虽然疲倦卧倒不语，皮肤冷一昼夜，却不是脱证，待气机回复自然会温暖如常。其他方剂详细记载在发表篇，可以参考。
二、轻清化气，王孟英所说的展气化以轻清，如栀子、黄芩、瓜蒌、芦苇等药味是。他又说伏气温病，从里出表，先从血分而后达气分，初起多舌润无苔，只诊察其脉，软而或弦，或弦而微数，口不渴而心烦恶热；夜间加重无法入睡，或有斑点隐隐，就应投用清解营热的药物，等到伏邪从气分化解，苔才开始逐渐布满，然后再清气分即可。然而气分之所以不清，多是湿热，其次是痰热。病表现为肿、喘、痞、闷、懊憹、咳嗽、呃逆、四肢倦怠松懈、小便黄赤、大便溏薄不爽，都由于此，总以轻清化气为首要。其清气分湿热，如叶氏新加栀豉汤（光杏仁十粒，生苡仁三钱，飞滑石钱半，白通草一钱，浙苓皮三钱，淡香豉钱半，焦栀皮一钱，鲜枇杷叶三钱）、加减芦根饮（活水芦根一两，光杏仁、冬瓜子、生苡仁、鲜枇杷叶各三钱，白蔻仁三分冲，以上皆天士验方）、芦根通橘汤（活水芦根一两，川通草一钱，广橘皮一钱，鲜枇杷叶五钱，生姜皮五分，淡竹茹钱半。此外台偶方）、六花苇茎汤（旋复花三钱，滁菊花钱半，川朴花八分，豆蔻花、佛手花各五分，代代花二分，苇茎一钱，生苡仁、冬瓜子各四钱，廉臣验方）之类。其轻清气分痰热，如陈氏清肺饮（疫痧草方）、蒌杏橘贝汤（栝蒌皮钱半，光杏仁三钱，蜜炙橘红一钱，川贝母三钱，桔梗一钱，鲜枇杷叶三钱，冬瓜子三钱，冬桑叶钱半。叶天士验方）、新加桑菊饮（廉臣验方）、枇杷叶饮子（外台方）加岩制川贝（顾氏医镜方）之类。这些都能清化肺气，通调水道，下输膀胱，使得气分伏热，上能从咯痰而出，下能从小便而出。吴茭山说：凡气中有热者，当用清凉薄剂。吴鞠通说：治上焦如羽，非轻不举。王孟英说：用药极轻清极平淡者，取效更捷。都属于此类。
三、甘寒救液，此法有两种：一是清养气液，如金匮麦门冬汤、千金麦冬汤、清燥救肺汤（喻嘉言验方）、叶氏养胃汤、沙参杏仁汤（南沙参、甜杏仁、川贝各三钱，鲜枇杷叶四钱，雅梨汁、青蔗浆各一瓢冲）、润肺悉尼膏（以上皆叶天士验方）、参燕麦冬汤（吉林参一钱，龙芽燕八分，麦冬三钱，奎冰四钱。江笔花医镜方）之类。二是清养血液，如千金生地黄煎、清燥养荣汤（吴氏温疫论方）、叶氏竹叶地黄汤、叶氏加减复脉汤（皆天士验方）、顾氏八汁饮（甘蔗汁、藕汁、梨汁、芦根汁、西瓜汁、鲜生地汁、鲜茅根汁各一酒杯，鲜荷叶汁三匙。晓澜验方）之类。这些都是温热大病后，劫伤气津血液，善后调养的好方子。总之温热诸病，未经汗、下、和解而化燥的，是火盛导致燥，当用苦寒清火为主；已经经过汗、下、和解而化燥的，是津液枯竭导致燥，当以甘寒滋燥为主；这是大概要领。
四、苦寒直降，即叶天士所说的苦寒直清里热。黄芩汤（伤寒论方）、栀子黄芩汤（河间六书方）两方最轻，黄连解毒汤（外台方）较重，准绳三黄石膏汤（内科准绳类方）尤重，应当观察伏火的浅深轻重，对证选用。凡温热病适宜用苦寒的，切忌早用甘寒，因为苦寒为清，甘寒为滋，自从时医以鲜地黄、鲜石斛、元参、麦冬等的清滋法，认作清泄法，于是热更壮盛，神志更昏沉，其弊病在于甘寒清滋的药，得大热煎熬，其膏液就化为胶涎，结于脘中，反而致使伏火不得从里清泄，从此变为闭证、厥证、痉证、癫证，甚至变为内闭外脱，变症蜂起，大多由于此。
五、清火兼消痰，因伏火熏蒸津液，津液郁结成为痰，所以兼用化痰药以分消之。治法宜苦辛开泄，如小陷胸汤、黄芩加半夏生姜汤（皆伤寒论方）、石膏大青汤（千金方）、黄连温胆汤（观聚方要补方）、连朴饮、昌阳泻心汤（王氏霍乱论方）、加味小陷胸汤、加减半夏泻心汤、加味连茹橘半汤（皆医原方）之类，都可选用。此法与苦寒清泄有别，清泄是直降，一意整肃伏火；开泄是横疏，兼能清化痰浊；分寸最宜斟酌。叶天士所谓舌白不燥，或黄白相兼，或灰白不渴，慎不可乱投苦泄，虽有脘中痞痛，宜从苦辛开泄是也。
六、清火兼导滞，因温热病最多夹杂食积这一症。王孟英说：凡治温热病必察胸脘，如拒按的，即使舌绛神昏也宜开化。其方如枳实导滞汤、三黄枳术丸、枳实导滞丸、陆氏润字丸之类，都可酌情选用。栀朴枳实汤（仲景方）冲生萝卜汁，方也灵验稳妥。
七、清火兼通瘀，因伏火郁蒸血液，血被煎熬而成瘀，或其人素有瘀伤，不得不兼通瘀法以分消之。如黄连解毒合犀角地黄汤、加减小柴胡汤、增损小柴胡汤、四逆散合白薇汤之分消瘀热，都可对证酌情选用。这就是叶天士所谓宿血在胸膈中，舌色必紫而暗，摸上去潮湿，应当加散血的品于清火法中，如琥珀、丹参、桃仁、丹皮等，否则瘀血与伏火相搏，阻遏正气，遂变成如狂发狂的症状。
八、清火兼杀虫，因伏火在胃，胃热如沸，蛔虫动不安，因而脘痛烦躁昏乱欲死的，名叫蛔厥，只清其胃，略兼杀虫的药，蛔厥自愈。清中安蛔汤（姜汁炒川连二钱，黄柏钱半，枳实二钱，乌梅三个，川椒三十粒。伤寒广要方）、犀角黄连汤（犀角一钱，小川连钱半，青木香五分，乌梅三个。外台方）两方最效。惟有下症的，宜用三黄泻心汤加青木香、枣儿槟榔、胡连等攻下的。
九、清络宣气，是用来清血热，灵通气机，使无形的令其转旋，有形的令其流畅。盖因温热伏邪，内舍于营，盘踞络中，其血必郁而热，其气亦钝而不灵，凡春夏温病晚发，秋冬伏暑晚发，邪伏深沉的，大多如此。这就是王孟英所谓邪伏深沉，不能一齐外出，虽治之得法，而苔退舌淡之后，过了一二日，舌又干绛，苔又黄燥，正如抽蕉剥茧，层出不穷，不比外感温暑，由卫及气，自营而血也，且每见有变为痈肿的。徐洄溪说：凡伏邪留于隧络，深则入于脏腑骨髓之中，无从发泄，往往上为发颐肺痈，中为肝痈痞积，下为肠痈便毒，发于皮肉则为疹疮疡，留于关节则为痛痹拘挛，注于足胫则为鹤膝足痿，这些证候，都是络瘀造成的。精气旺则不发，至血气偶虚，或有所感触，虽数年之久，也有复发的。其病俱属有形，煎丸之力，太轻则不能攻邪，太重则反伤其正，当用外治之法，以透毒散瘀，内服丸散，以消其痰火，化其毒涎，或从咯吐而出，或从二便而出，而以轻清宣透芳香通灵之煎剂，以托其未透之伏邪，内外之症皆然，医者均所当知也。观此二则，辨论络中结邪之病理，发明殆尽。但其间用药最难，此等络瘀之伏火，非芩连所能清，非参芪所能托，惟有用轻清灵通之剂，渐渐拨醒其气机，宣通其络瘀，庶邪气去而正气不与之俱去；若一涉呆钝，则非火闭即气脱，非气脱即液涸矣，选药制方，可不慎之又慎欤。
根据我的经验，清宣肺络，首推清宣瘀热汤（活水芦笋、鲜枇杷叶各一两，旋复花三钱包煎，真新绛一钱，青葱管二寸，广郁金磨汁四匙冲。常熟曹仁伯医案验方）最灵验，其次六花绛复汤（滁菊花二钱，新银花钱半，藏红花三分，豆蔻花、佛手花各五分，旋复花三钱，真新绛一钱，青葱管三寸冲）、五皮绛复汤（白蔻皮六分，陈香橼皮五分，雅梨皮三钱，丹皮钱半，紫荆皮钱半，旋复花三钱，新绛一钱，青葱管三寸冲。以上皆廉臣验方）方也轻稳。惟胸痹气急痰多的，宜用蒌薤绛复汤（栝蒌皮二钱，干薤白三枚，桂枝二分，仙半夏钱半，浙苓三钱，旋复花五钱，新绛钱半，青葱管五寸，春砂壳七分。徐守愚医案验方）。清宣包络，首推石氏犀地汤、加减服蛮煎两方，其次晋三犀角地黄汤（犀角汁四匙，鲜生地汁二瓢，同冲，青连翘三钱，生甘草八分。王氏古方选注方）、加味清宫汤（元参心二钱，连翘心一钱，竹叶卷心二钱，莲子心五分，犀角汁四匙，竹沥、梨汁各一瓢，鲜石菖蒲汁五匙，和匀同冲。吴氏温病条辨方）方也清灵。清宣肝络，首推二仁绛复汤（桃仁九粒，柏子仁钱半，归须钱半，新绛一钱，旋复花三钱，青葱管三寸冲。天士验方）、新加绛复汤两方为主。气滞挟湿的，四七绛复汤（仙露夏钱半，川朴花八分，紫苏旁枝一钱，赤苓三钱，白前二钱，旋复花三钱，新绛一钱，青葱管五寸冲。徐守愚医案验方）化湿宣络。血虚气郁的，首推四物绛复汤（细生地三钱，归须一钱，赤芍钱半，抚芎五分，新绛一钱，旋复花三钱，青葱管三寸冲）。其次鱼胶绛复汤（墨鱼骨三钱，真阿胶二钱，真新绛钱半，旋复花三钱，青葱管三寸）养血濡络。或用活血通络汤（归须三钱，川芎钱半，酒炒白芍一钱，秦艽钱半，冬桑叶三钱，鸡血藤胶一钱，广橘络二钱。雷少逸时病论方）荣筋舒络。络伤血溢的，羚地清营汤，清络止血（以上各方均沈樾亭验方传信方），孙氏五胆墨（熊胆汁、牛胆汁、猪胆汁、青鱼胆汁各一分，羊胆汁二分，当门子五厘，陈京墨研粉六钱，和捣成锭，每重三分，金箔为衣。孙文垣历验秘方）尤为神妙；又次，四汁绛复汤（鲜生地汁一瓢，生藕汁两瓢，童便五瓢，陈京墨汁五匙，同冲，真新绛八分，旋复花三钱，葱须二分。廉臣验方）也灵验稳妥。络瘀化胀的，三虫二甲汤（羌螂虫一对，青糖一钱拌炒 虫五只，酒炒九香虫三只，生鳖甲五钱，炒川甲一钱，桃仁钱半，蜜炙延胡钱半，归须二钱，五灵脂钱半，净楂肉三钱。叶天士验方）、开郁通络饮两方最灵。络燥发痉的，犀羚镇痉汤（陆定圃验方）、羚麻白虎汤（邴味清验方）、犀羚白虎汤（王孟英验方）三方最效，轻则新加桑菊饮也验。
Heat-warmth pathogens stagnating in the Qi level are called latent heat (Fu Re, latent heat), and those stagnating in the Blood level are called latent fire (Fu Huo, latent fire). Collectively they are referred to as latent pathogenic factors (Fu Xie, latent pathogens). Heat and fire are invariably treated with cooling methods. When latent pathogens erupt outward to the exterior, the treatment principle should be pungent-cool dispersal and unblocking, allowing heat to dissipate from the exterior; thus, exterior-releasing methods also constitute cooling methods. When latent pathogens knot inward to the interior, the treatment principle should be bitter-cold draining and descending, allowing fire to exit from below; thus, purgative methods for the interior also constitute cooling methods. When latent pathogens reside at the half-exterior half-interior level, the treatment principle should be harmonizing both sides, allowing heat to dissipate from the exterior and fire to exit from the interior; thus, harmonizing methods also constitute cooling methods. If sweating has been achieved at the exterior but heat persists, or purgation has been performed on the interior but heat remains unresolved, or harmonization has been applied at the half-exterior half-interior but heat is not yet cleared, or if there is originally heat without knotting, then one should solely employ direct cooling to subdue the fire, thereby regulating the fire. Therefore, cooling methods can supplement the deficiencies of exterior-releasing, interior-purgative, and harmonizing methods. The functions of these four categories can be used together or separately. In heat-warmth diseases, ten out of six or seven cases require cooling methods; hence, cooling methods must be studied in detail.
Whenever using cooling methods, one must first distinguish whether it is latent heat or latent fire. Heat belongs to the Qi level, presenting as deficient and formless (commonly known as floating fire), similar to the intense heat of midsummer; although profuse sweating occurs, relief comes immediately upon encountering cool wind. Thus, bodily heat subsides when Qi becomes clear. Regarding heat-clearing methods, one first uses pungent-cool agents, followed by light-clearing ones, to clear and purify floating heat in the Qi level. Finally, sweet-cold agents are used to clear and moisten dryness-heat in the Qi level. Fire belongs to the Blood level, presenting as excess and having substance (commonly known as solid fire). Its attachments are either phlegm or stagnation; if not stagnation, then blood stasis; if not blood stasis, then parasites. Merely clearing the fire without removing its attachments cannot achieve efficacy. One must identify what the fire attaches to and add herbs that eliminate phlegm, stagnation, stasis, accumulation, and parasites to the fire-clearing formulas for swift results. It is like burning wood and charcoal; the intensity resembles a prairie fire. Even if water is poured on it, panic from boiling remains until the wood and charcoal are removed, and only then does the fire extinguish. Therefore, while bitter-cold direct descending is the mainstay of fire-clearing methods, historical medical formulas often include methods of clearing fire while resolving phlegm, guiding out stagnation, promoting blood circulation, or killing parasites. These all serve to clear and transform the attachments of fire. For latent fire without attachments, generated merely from blood stagnation, the primary principle is naturally to clear collateral heat and promote Qi mechanism movement. Sometimes, combining bitter-cold with sweet-cold allows sweet-bitter to generate Yin, preserving stomach and intestinal fluids, preventing bitter-cold from causing dryness. Combining bitter-cold with sour-cold allows sour-bitter to drain the Liver, effectively unblocking accumulated blood in sun collaterals (Huibao states: Sour flavor can unblock accumulated blood in capillaries), allowing collateral heat to transfer to the Qi level and resolve. Combining bitter-cold with salty-cold allows salty-bitter to reach downward, clearing damp-toxin in the internal kidney, calming rebellious Chong Qi, and clearing stale essence in the external kidney.
In summary, for heat-warmth diseases suitable for pungent-cool dispersal, early use of bitter-cold direct descending constitutes erroneous suppression, freezing the pathogen and driving it inward. For those suitable for bitter-cold direct descending, using only light-clearing sweet-cold clears heat but does not reduce fire. Although fire dispersed becomes heat, and heat condensed becomes fire, fire and heat differ only in condensation and dispersion; thus, heat-clearing and fire-draining can be separated or combined. However, the sequence and urgency must have clear boundaries. The strategies are listed as follows:
1. Pungent-Cool Dispersal and Unblocking involves two methods: First, promoting Qi and reaching the Wei (Defensive) level, allowing latent pathogens to transform from the Qi level and resolve from the Wei level. If accompanied by Wind, vent Wind outside the Heat; Liu's Jiegeng Decoction and Modified Zhichi Decoction are most effective and stable. If accompanied by Dampness,渗 (percolate) Dampness below the Heat; Wuye Lugeng Decoction and Huoxia Xieling Decoction are also light and agile, ensuring Wind-Damp does not contend with Heat, allowing resolution via sweat or battle-sweat, leaving latent heat isolated and easy to regulate. Second, venting Ying (Nutritive) level and releasing Wei level, allowing latent pathogens to emerge from the Ying level, transfer to the Qi level, and resolve. If toxicity is severe, clear Ying and detoxify; Modified Yinqiao San (from *Yi Yuan*) is excellent. Lingdi Qingying Tang (Verified Formula from *Chuanxin Fang*), Xijiao Daqing Tang, Liangxue Jiedu Tang, and Xidi Sangdan Tang (Master Fan's verified formula) are also selectable options. If accompanied by turbidity, vent Ying and dispel turbidity; Qingfang Touxie Tang (from Xu Huixi's medical case) and Jiawei Qiaohe Tang mixed with Taiyi Zijin Dan are most effective. Even if tongue crimsonity and throat dryness occur, or false signs of pulse hiding and cold limbs appear, these two formulas with modifications suffice. Subsequently, Wuwei Xiaodu Yin plus Zijin Pian clears residual turbidity, allowing toxin and turbidity to resolve via macules or battle-sweat. In rare cases of pathogen excess and righteous Qi deficiency where single-resolution fails, the method should benefit the Stomach and vent pathogens; Qiwei Congbai Tang plus American Ginseng and fresh Mugwort Root is used. After administration, pause for one or two days, then resolve via battle-sweat. Post battle-sweat, Lung Qi is empty; though the patient lies tired and silent with cold skin for a day and night, this is not collapse. Warmth returns normally as Qi recovers. Other formulas are detailed in the Exterior-Releasing Chapter.
2. Light-Clearing Transformation of Qi refers to Wang Mengying's concept of expanding Qi transformation with light-clearing agents, such as Gardenia, Scutellaria, Trichosanthes, and Reed Rhizome. He stated that latent warmth-disease emerges from interior to exterior, starting from Blood level to Qi level. Initially, the tongue is moist without coating; pulse is soft, possibly wiry or slightly rapid; mouth is not thirsty but mind is vexed and aversion to heat exists; symptoms worsen at night with insomnia, or faint macules appear. At this stage, herbs clearing Ying-level heat should be administered. Once latent pathogens transform from Qi level and coating spreads, then clear the Qi level. However, unclear Qi level is mostly due to Damp-Heat,其次 (secondarily) Phlegm-Heat. Symptoms like swelling, panting, fullness, oppression, restlessness, cough, hiccups, limb fatigue, yellow-red urine, and loose stool stem from this. Light-clearing Qi transformation is paramount. For clearing Qi-level Damp-Heat, examples include Ye's New Modified Zhichi Decoction, Modified Lugeng Yin, Lugeng Tongju Tang, and Liuhua Weijing Tang. For clearing Qi-level Phlegm-Heat, examples include Chen's Qingfei Yin, Lou Xing Ju Bei Tang, New Modified Sangju Yin, and Pipa Ye Yinzi plus Yanzhi Chuanbei. These clear and transform Lung Qi, regulate water passages, transport downward to Bladder, allowing Qi-level latent heat to exit via sputum or urine. Wu Jiaoshan said: For heat in Qi, use light cooling decoctions. Wu Jutong said: Treating Upper Jiao is like feathers; only lightness lifts. Wang Mengying said: Extremely light, clear, and bland medicines yield faster results. All belong to this category.
3. Sweet-Cold Rescue of Fluids involves two methods: First, clearing and nourishing Qi fluids, such as Jin Gui Maidong Tang, Qianjin Maidong Tang, Qingzao Jiufei Tang (Yu Jiayan's verified formula), Ye's Yangwei Tang, Shashen Xingren Tang, Runfei Xini Gao, and Shenyan Maidong Tang. Second, clearing and nourishing Blood, such as Qianjin Shengdijian, Qingzao Yangrong Tang (Wu's Wen Yi Lun), Ye's Zhuye Dihuang Tang, Ye's Modified Fumai Tang, and Gu's Bazhi Yin. These are excellent post-treatment regimens for heat-warmth major diseases that have depleted Qi, fluids, and Blood after sweating, purging, or harmonizing. Generally, heat-warmth diseases becoming dry without prior sweating/purging/harmonizing are due to excessive fire causing dryness, requiring bitter-cold fire-clearing as primary. Those becoming dry after such treatments are due to fluid exhaustion causing dryness, requiring sweet-cold moisturizing as primary. This is the general principle.
4. Bitter-Cold Direct Descending refers to Ye Tianshi's "bitter-cold directly clearing interior heat." Huangqin Tang (*Shanghan Lun*) and Zhizi Huangqin Tang (*Hejian Lishu*) are lightest; Huanglian Jiedu Tang (*Waitai Fang*) is heavier; Sansheng Sanhuang Shigao Tang (*Neike Zhunsheng*) is heaviest. Select based on depth and severity of latent fire. For heat-warmth diseases suitable for bitter-cold, strictly avoid early sweet-cold. Bitter-cold clears; sweet-cold nourishes. Since contemporary physicians mistake sweet-nourishing herbs (fresh Rehmannia, Dendrobium, Scrophularia, Ophiopogon) for clearing-draining methods, heat intensifies, spirit clouds, and fluids turn into sticky saliva obstructing the epigastrium, preventing latent fire from clearing internally. This leads to closure, syncope, spasms, mania, or internal closure with external collapse. Such complications often arise from this error.
5. Clearing Fire while Resolving Phlegm addresses latent fire steaming fluids into phlegm. Use bitter-pungent opening and draining, such as Xiao Xianxiong Tang, Huangqin Banxia Shengjiang Tang, Shigao Daqing Tang, Huanglian Wendan Tang, Lianpo Yin, Changyang Xiexin Tang, etc. This differs from bitter-cold direct descending; descending targets fire directly, while opening-draining disperses horizontally and clears phlegm-turbidity. Balance is crucial. Ye Tianshi warned against indiscriminate bitter-draining for white, non-dry tongues or gray-white non-thirsty tongues, even with epigastric pain; instead, use bitter-pungent opening-draining.
6. Clearing Fire while Guiding Out Stagnation addresses food retention common in heat-warmth diseases. Wang Mengying advised checking chest/epigastrium; if tender to pressure, use opening-transforming methods even with crimson tongue and clouded spirit. Formulas include Zhishi Daozhi Tang, Sanhuang Zhizhu Wan, Zhishi Daozhi Wan, and Lu's Runzi Wan. Zhipo Zhishi Tang mixed with fresh Radish Juice is also effective.
7. Clearing Fire while Promoting Blood Circulation addresses blood stasis formed by latent fire frying blood or pre-existing stasis. Combine Huanglian Jiedu Tang with Xijiao Dihuang Tang, modified Chaihu Tangs, Sini San with Baiwei Tang, etc., to drain stasis-heat. Ye Tianshi noted purple-dark wet tongues indicate chest diaphragm stasis; add blood-dispersing herbs like Amber, Salvia, Peach Kernel, Moutan Bark to fire-clearing methods. Otherwise, stasis contends with latent fire, blocking righteous Qi, leading to manic symptoms.
8. Clearing Fire while Killing Parasites addresses stomach heat boiling causing Ascaris agitation (Hui Jue). Clear stomach heat and slightly add anti-parasitic herbs. Qingzhong Anhui Tang and Xijiao Huanglian Tang are most effective. For constipation indications, use Sanxiexixin Tang plus Aromatic Acorus, Areca Nut, Coptis for purgation.
9. Clearing Collaterals and Promoting Qi clears Blood heat and revitalizes Qi mechanism, making formless Qi rotate and formless Blood flow. Latent pathogens lodging in Ying and collaterals cause blood stagnation-heat and dull Qi. Late-onset spring/summer warmth or autumn/winter summerheat often present this way. Wang Mengying described deep-seated pathogens re-emerging after initial improvement. Xu Huixi noted deep-seated pathogens in tunnels/collaterals manifesting as abscesses, tumors, joint pain, or leg wasting depending on location. These are caused by collateral stasis. Strong Essence/Qi prevents manifestation; weakness or contact triggers recurrence. Treatments involve external therapies for toxin/stasis and internal pills/powders for phlegm-fire/toxic saliva, aided by light-clearing aromatic decoctions to support unvented pathogens. Medication selection is critical; standard bitter-cold or tonics fail here. Only light, agile, penetrating formulas gradually awaken Qi and unblock collaterals without damaging righteous Qi. Stagnant drugs risk fire-closure or Qi/fluid collapse.
Based on experience, for clearing/promoting Lung collaterals, Qingxuan Yure Tang is best, followed by Liuhua Jiangfu Tang and Wupi Jiangfu Tang. For chest bi with shortness of breath/phlegm, Louxie Jiangfu Tang is indicated. For clearing/promoting Pericardium, Shi's Xidi Tang and Modified Fuman Jian are top choices, followed by Jinshan's Xijiao Dihuang Tang and Jiawei Qinggong Tang. For clearing/promoting Liver collaterals, Erren Jiangfu Tang and Xinjia Jiangfu Tang are primary. For Qi stagnation with Dampness, Siqi Jiangfu Tang transforms Dampness. For Blood deficiency with Qi depression, Siwu Jiangfu Tang is preferred, followed by Yuji Jiangfu Tang for nourishing. Huoxue Tongluo Tang benefits sinews. For collateral injury with bleeding, Lingdi Qingying Tang and Sun's Wudan Mo are miraculous. Si Zhi Jiangfu Tang is also effective. For collateral stasis causing distension, San Chong Er Jia Tang and Kaiyu Tongluo Yin are best. For collateral dryness causing spasms, Xiling Zhenjing Tang, Lingma Baihu Tang, and Xiling Baihu Tang are most effective; mild cases respond to Xinjia Sangju Yin.
For extreme Yang pathogen causing deep cold and heat, with coma, cold limbs, and bloody diarrhea, urgently clear collaterals, promote Qi, save counterflow, and preserve Yin using Lingdi Qingying Tang, Xidi...