凡伏气温热。至春感温气而发。至夏感暑气而发。一发即渴不恶寒。反潮热恶热。心烦谵语。咽干舌燥。皮肤隐隐
见斑。甚则手足螈 。状如惊痫。仲景所谓热结在里。表里俱热。白虎加人参汤主之是也。但要辨其便通者。但须
外透肌腠。内清脏腑。新加白虎汤为主。柴芩清膈煎亦可酌用。便闭者。急以攻里泻火为首要。白虎承气、犀连承
气二汤为主。夹痰者。陷胸承气汤、加味凉膈煎选用。夹食者。枳实导滞汤选用。夹血瘀者。桃仁承气汤选用。夹温
毒者。解毒承气汤选用。若血虚者。养荣承气汤选用。气血两亏者。陶氏黄龙汤选用。
凡温病伏暑将发。适受风寒搏束者。此为外寒束内热。一名客寒包火。但要辨表急。里急。寒重热重。外寒重而表
证急者。先解其表。葱豉桔梗汤加减。伏热重而里证急者。先清其里。柴芩清膈煎加减。
凡病患素体虚寒。而吸热冒暑。此为标热本寒。只宜轻清治标。标邪一去。即转机而用温化温补
等剂。庶免虚脱之虞。
凡口燥舌干。苔起芒刺。咽喉肿痛。脘满腹胀。按之痛甚。渴思冰水。小便赤涩。得涓滴则痛甚。大
便胶闭。或自利纯青水。臭气极重。此皆里真热之证据。惟通身肌表如冰。指甲青黑。或红而温。六脉细小
如丝。寻之则有。按之则无。吴又可所谓体厥脉厥是也。但必辨其手足自热而至温。从四逆而至厥。上
肢则冷不过肘。下肢则冷不过膝。按其胸腹。久之又久则灼手。始为阳盛格阴之真候。其血必瘀。营卫不通。故
脉道闭寒而肌肤如冰。治宜先用烧酒浸葱白紫苏汁出。用软帛浸擦胸博四肢。以温助血脉之营运。内治宜
桃仁承气汤急下之。通血脉以存阴液。然病势危笃如斯。亦十难救一矣。
【荣斋按】里真热而表假寒，就是“阳证似阴”。戈存橘《伤寒补天石》卷上，阐述得比较详细，可以互证。他
说∶“阳证似阴者，乃火极似水也。盖伤寒热甚，失于汗下，阳气亢极，郁伏于内，反见胜己之化于外；故其
身凉手足逆冷而乍温，状若阴证。大抵唇焦，舌燥，能饮水浆，小便赤色，大便闭结，设或外有稀粪水流出，
内有燥屎结聚，此乃旁流，非冷利也。再审其有屁极臭者，是也。其脉虽沉，按之必数滑有力，或时燥热，不
欲被衣，或扬手掷足，或谵语有力，此阳证也；轻则四逆散合小柴胡汤，重则白虎，合解毒。潮热便实，用大
柴胡，燥实，坚硬痞满全具，用大承气汤。”
凡是伏气温热病，到了春季感受温邪而发作，到了夏季感受暑邪而发作。一旦发作就出现口渴、不恶寒的症状，反而表现为潮热、恶热，心烦意乱、胡言乱语，咽喉干燥、舌面燥裂，皮肤隐隐约约出现斑疹，严重时手足抽搐，症状像惊风癫痫一样。这就是张仲景所说的“热结在里，表里俱热”，应当用白虎加人参汤（Gypsum and Ginseng Decoction）来主治。但是必须辨别大便通畅的情况：如果大便通畅，只需让邪气从肌表透发，从脏腑内部清解，以新加白虎汤（Modified Baitu Decoction）为主方；柴芩清膈煎（Bupleurum and Scutellaria Decoction to Clear the Diaphragm）也可以酌情使用。如果大便闭结，急迫地以攻下里实、泻除火邪为首要任务，以白虎承气汤（Baitu Chengqi Decoction）和犀连承气汤（Rhinoceros Horn and Coptis Chengqi Decoction）两方为主。兼夹痰浊的，选用陷胸承气汤（Xianxiong Chengqi Decoction）或加味凉膈煎（Modified Liangge Decoction）。兼夹食积的，选用枳实导滞汤 (Zhi Shi Daozhi Decoction)。兼夹血瘀的，选用桃仁承气汤 (Tao Ren Chengqi Decoction)。兼夹温毒的，选用解毒承气汤 (Jiedu Chengqi Decoction)。如果是血虚体质，选用养荣承气汤 (Yangrong Chengqi Decoction)。气血两虚的，选用陶氏黄龙汤 (Tao's Huanglong Decoction)。
凡是温病或伏暑即将发作时，恰好受到风寒束缚的，这叫做外寒束内热，又名客寒包火（External Cold Binding Internal Heat）。但必须辨别是表证急迫还是里证急迫，是寒邪重还是热邪重。如果是外寒重且表证急迫，先解除表邪，用葱豉桔梗汤（Scallion, Fermented Soybean, and Platycodon Decoction）加减治疗。如果是伏热重且里证急迫，先清解里热，用柴芩清膈煎加减治疗。
凡是病人素体虚寒，又吸入热邪、冒受暑气的，这叫标热本寒（Superficial Heat with Root Cold），只宜用轻清之法治疗标证。标邪去除后，随即转为使用温化、温补等方剂，这样才可以避免虚脱的危险。
凡是口燥舌干，舌苔起芒刺，咽喉肿痛，胃脘胀满腹部膨隆，按压时疼痛剧烈，想喝冰水，小便赤红涩痛，仅得点滴尿液则疼痛加剧，大便胶固闭塞，或者自行泻下纯青色稀水，臭气极重，这些都是里真热（True Heat in the Interior）的证据。然而全身肌肤体表如冰般寒冷，指甲青黑或发红温热，六脉细小如丝，轻取可得，重按则无，这就是吴又可所说的“体厥脉厥”（Body Jue and Pulse Jue）。但必须辨别其手足是从发热变为温和，还是从四肢逆冷变为厥冷，上肢冷不超过肘部，下肢冷不超过膝部，按压其胸腹，久而久之感觉灼手，这才是阳盛格阴（Excess Yang Repelling Yin）的真候。此时血液必然瘀滞，营卫不通，所以脉道闭塞寒冷而肌肤如冰。治疗应当先用烧酒浸泡葱白和紫苏，榨出汁液，用软布浸擦胸背和四肢，以温通助血脉运行。内治宜用桃仁承气汤急下之，以通血脉保存阴液。然而病情危重到如此地步，十个人中也难救活一个。
【徐荣斋按】里真热而表假寒，就是“阳证似阴”（Yang Syndrome Resembling Yin）。戈存橘在《伤寒补天石》卷上阐述得比较详细，可以互相印证。他说：“阳证似阴，乃是火极似水。因为伤寒热势极盛，失于发汗或攻下，阳气亢极，郁伏于体内，反而在外表现出克制自己的水性特征；所以身体凉爽、手足逆冷但偶尔转温，症状像阴证。大致观察嘴唇焦枯、舌面干燥、能饮水浆、小便颜色赤红、大便闭结，如果外有稀粪水流出，内有燥屎结聚，这是‘旁流’（Paradoxical Diarrhea），不是冷利。再审查是否有极其臭屁排出，即可确认。其脉象虽然沉，但重按必定数滑有力，或者时而燥热、不想穿衣，或者扬手掷足、胡言乱语声音有力，这些属于阳证；轻症用四逆散合小柴胡汤，重症用白虎汤合解毒承气汤。如果有潮热、大便实证，用大柴胡汤；如果燥实、坚硬痞满俱全，用大承气汤。”
Whenever latent warm-heat disease (Fuwen Wenre) occurs due to contracting warm pathogens in spring or summer pathogens in summer, once it erupts, it presents with thirst and aversion to cold absent, but rather tidal fever, aversion to heat, mental restlessness, delirium, dry throat, dry tongue, faintly visible macules on the skin, and in severe cases, convulsions of the hands and feet resembling epilepsy. This corresponds to Zhang Zhongjing’s description of "heat accumulation in the interior, heat in both exterior and interior," which should be treated primarily with Baitu Jia Renshen Tang (Gypsum and Ginseng Decoction). However, one must differentiate based on bowel movements: if stools are unobstructed, the pathogen should be vented through the muscle layer and cleared from the internal organs; Xinjia Baitu Tang (Modified Gypsum Decoction) is the primary formula, while Chaiqin Qingge Jian (Bupleurum and Scutellaria Decoction to Clear the Diaphragm) may be used酌情 (as appropriate). If stools are obstructed, urgent purgation of the interior and draining of fire is paramount; Baitu Chengqi Tang (Gypsum and Rhubarb Decoction) and Xilian Chengqi Tang (Rhinoceros Horn and Coptis Decoction) are the main formulas. For cases complicated by phlegm, Xianxiong Chengqi Tang (Chest-Trapping Purgative Decoction) or Jiawei Liangge Jian (Modified Cooling Diaphragm Decoction) are selected. For food stagnation, Zhishi Daozhi Tang (Immature Bitter Orange Decoction to Guide Out Stagnation) is selected. For blood stasis, Tao Ren Chengqi Tang (Peach Kernel Purgative Decoction) is selected. For warm-toxin complications, Jiedu Chengqi Tang (Detoxifying Purgative Decoction) is selected. For blood deficiency, Yangrong Chengqi Tang (Nourishing Glory Purgative Decoction) is selected. For dual deficiency of qi and blood, Tao Shi Huanglong Tang (Mr. Tao’s Yellow Dragon Decoction) is selected.
When warm disease or latent summerheat is about to erupt but is simultaneously constrained by wind-cold, this is termed "external cold binding internal heat" (Ke Han Bao Huo). One must differentiate whether the exterior syndrome is urgent or the interior syndrome is urgent, and whether cold or heat is predominant. If external cold is heavy and exterior symptoms are urgent, release the exterior first using Congchi Jiegeng Tang (Scallion, Fermented Soybean, and Platycodon Decoction) with modifications. If latent heat is heavy and interior symptoms are urgent, clear the interior first using Chaiqin Qingge Jian with modifications.
For patients with a constitutionally deficient and cold body who inhale heat and contract summerheat, this is "superficial heat with root cold" (Biao Re Ben Han). Only light and clearing methods should be used to treat the superficial pathogen. Once the superficial pathogen is eliminated, transition to warming transformation and warming tonification formulas to avoid the risk of collapse.
Symptoms such as dry mouth and tongue, prickly tongue coating, swollen and painful throat, epigastric fullness and abdominal distension with severe pain upon pressure, craving for ice water, red and scanty urine causing severe pain even with drops, sticky constipation, or spontaneous passage of pure black watery stool with extremely foul odor, are all evidence of true heat in the interior (Li Zhen Re). However, the entire body surface feels like ice, nails are cyanotic or red and warm, and the six pulses are fine as silk, palpable lightly but vanishing under pressure. This is what Wu Keyi called "body jue and pulse jue" (Ti Jue Mai Jue). One must distinguish whether the extremities went from hot to warm, or from cold limbs to jue (coldness); upper limb coldness does not exceed the elbow, lower limb coldness does not exceed the knee. Pressing the chest and abdomen reveals burning heat after prolonged contact. This is the true manifestation of excess yang repelling yin (Yang Sheng Ge Yin). Blood stasis is certain, and Ying and Wei circulation is blocked, causing the pulse channels to close and skin to feel icy. Treatment should initially involve soaking scallion whites and perilla in liquor, extracting the juice, and wiping the chest, back, and limbs with soft cloth to warm and assist blood circulation. Internally, Tao Ren Chengqi Tang should be used urgently to purge, unblocking vessels to preserve yin fluids. However, given the critical nature of the condition, only one in ten might survive.
[Commentary by Xu Rongzhai]: True heat in the interior with false cold on the exterior is "yang syndrome resembling yin." Ge Cunju detailed this in Volume 1 of *Shanghan Butianshi* (Supplement to the Stone of Heaven for Cold Damage), which can serve as mutual verification. He stated: "Yang syndrome resembling yin is essentially extreme fire resembling water. In cold damage, when heat is excessive and sweating or purging was neglected, yang qi becomes hyperactive and depressed internally, manifesting externally as its controlling element (water); thus, the body feels cool, limbs are cold but occasionally warm, resembling yin syndrome. Generally, cracked lips, dry tongue, ability to drink fluids, red urine, and constipation are key. If loose watery stool flows out externally while dry feces accumulate internally, this is 'paradoxical diarrhea' (Pang Liu), not cold diarrhea. Also, check for extremely foul-smelling flatulence. Although the pulse may be deep, pressing reveals rapid, slippery, and forceful qualities. Signs of internal heat include aversion to covering, throwing hands and legs about, and forceful delirium—these indicate yang syndrome. Mild cases use Sini San combined with Xiaochaihu Tang; severe cases use Baitu Tang combined with Jiedu Chengqi Tang. With tidal fever and solid stool, use Da Chaihu Tang; with severe dryness, hardness, and fullness, use Da Chengqi Tang."