脉 脉洪大而数。或燥疾而急。来往紧大坚实者。为火。左寸洪滑为心火。洪数为小肠火。
左关弦大而长为肝火。弦小而数为胆火。左尺沉数为肾膀胱火。右寸浮数为肺火。洪大而数
为大肠火。右关洪数为胃火。洪实为脾火。右尺沉数为命门火。沉微为命门火衰。浮数为三
焦火。沉细浮数为阴虚火动。六部脉洪有力者易治。反沉难细者难治。脉诀云∶脉浮弦而数
为发热。洪数为烦热。滑数为心下壅热。弦紧而数为寒热往来。沉细数疾为热兼寒。寸紧数
。尺沉微。为上热下寒。浮紧而滑。为外热内寒。轻手微迟。重按紧滑。为外寒内热。两寸
浮大而数。热在心肺。两关弦滑而数。热在肝脾。两尺洪实。或沉数。皆为热在下焦。右寸
关洪实。热在脾肺。右关滑数。溢过寸口。为热在胃口。主呕吐。六脉短涩而数。或沉细而数。皆
热在阴分。洪大而长。或浮洪滑数。皆为热在阳分。经曰∶脉至而从。按之不鼓。诸阳皆然
。王注云∶病热而脉数。按之不鼓动。乃寒盛格阳而致之。非热也。形症是寒。按之而脉气
击于指下盛者。此为热盛拒阴。而生病。非寒也。又曰推而内之。外而不内。身有热也。伤
寒论曰∶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。与难经云∶覆溢相乘。及浮损小沉实大之义相同。皆诊法之至要。于热症大宜
症 按丹溪云∶素问病机一十九条。属火者五。而河间推展其说。火之致病者甚多。深合内
经之意。其曰诸病喘呕吐酸暴注下迫转筋。小便混浊。腹胀大。鼓之有声。痈疽疮疡。瘤气结
核。吐下霍乱。瞀郁肿胀。鼻塞鼽衄。血溢血泄。淋闭身热。恶寒战栗。或悲笑谵妄。衄
血污之病。皆少阴君火之火。乃心小肠之气所属也。若瞀 暴喑。冒昧燥扰。狂越骂詈。惊骇
肿疼酸。气逆冲上。禁栗如丧神守。嚏呕疮疡。喉痹耳鸣。及聋。呕涌。溢食不下
。目昧不明。暴注 。暴病暴死。皆少阳（相火）之热。乃心胞络
三焦之气所属也。原病式云∶诸风掉眩。属于肝火之动也。诸痛痒疮疡。属于心火之用也。
诸湿肿满。属于脾火之胜也。诸气愤郁病痿。属于肺火之升也。此皆火之为病。
出于脏腑者然也。若夫五志之交攻。七情之妄动。其火随起。如大怒则火起于肝。醉饱则火
起于脾。房劳则火起于肾。悲哀动中。则火起于肺。心为君火。自焚则死矣。辨疑录云∶人
禀五行各一。惟火有二。有君相之分。君不主令。相火代之。寄于肝肾之内。附于脾肺之间
。凡诸经动者。皆属于火。起于肝。谓之风火。生于脾。谓之痰火。入于气为无根之火。动
于肾为消阴伏火。存于心肺。入于血分。为有余之火。散于各经。为浮游之火。故曰火者化
也。善行数变。莫测其机。经又曰∶诸寒之而热者。取之阴。注云∶取之阴者，所以补肾水
之不足。而制心火之有余也。东垣云∶发热之症、有元气虚损。而热有五脏。热有内中外热
。是故轻手扪之而热。热在皮毛血脉也。心肺主之。重按至骨。蒸手而热。热在筋骨也。
肾肝主之。不轻不重而热。热在肌肉也。脾主之。又云∶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。烦躁。是阳气下陷入阴中也。名为热入血室。昼夜不分
。
是重阳无阴也。亟泻其阳。峻补其阴。难经云∶重阳者狂。六脉洪实。宜以苦寒药泻之。重
阴者癫。六脉沉微。宜以甘温药补之。仲景云∶病患身大热反欲近衣者。此热在皮肤。寒在
骨髓也。身大寒。反不欲近衣者。此寒在皮肤。热在骨髓也。治宜详别。
治 戴氏云∶火之为病。其害甚大。其变甚速。其势甚彰。其死甚暴。何者。盖能燔灼飞走
。蓦越烧烁。于物莫能御之。游行于三焦虚实之两途。曰君火者。心火也。可以湿伏。可以
水灭。可以直折。惟黄连之属可以制之。曰相火者。龙火也。不可以水湿。不可以直折。从
其性而伏之。惟黄柏之属。可以降之。噫，泻火之法。岂止如此。虚实多端。不可不察。以
脏气加之。如黄连泻心火。黄芩泻肺火。芍药泻脾火。柴胡泻肝火。知母泻肾火。柴胡黄芩
泻三焦火。木通泻小肠火。石膏泻胃火。黄柏泻膀胱火。此皆苦寒之味。能泻有余之火耳。
若饮食劳役。内伤元气。火不两立。为阳虚之病。以甘温之剂降之。如参术归 之属。若
心火亢极。郁热内实。为阳狂之病。以寒咸之剂折之。如硝黄之属。若肾水受伤。真阴失
守。无根之火妄炎。为阴虚之病。以壮水之剂制之。如黄柏地黄玄参之属。若右尺命门火衰
。为阳脱之病。以温热之剂制之。如姜附之属。若胃虚过食冷物。郁遏阳气于脾土之中。为
火郁之病。以升散之剂发之。如升麻葛根之属。又治法云∶小热之气。凉以和之。大热之气
。寒以取之。甚热之气。汗而发之。发之不尽。则逆取之。又云∶暴热病在心肺。积热病在
肾肝。虚热不能食。自汗。气短。属脾虚。以甘寒温而行之。实热能食。口干舌燥。便难。
属胃实。以辛苦大寒药下之。火郁而热。乃心火下陷脾土。抑而不伸。五心烦热。宜汗之发之
。心神烦乱。血中伏火。蒸蒸然不安。宜镇心火。朱砂安神丸治之。骨蒸劳热。乃五脏齐损
病。憔悴发热。盗汗失血。宜滋阴养血。苟不明此诸火热之病。施治何所根据。故集其略以
备参考。庶免实实虚虚之祸也。
方 三补汤治实热实火通用。虚者不宜。
黄芩（酒炒二钱五分） 黄连（姜汁炒一钱五分） 黄柏（盐酒炒二钱五分）
上作一服。水煎。食远热服。兼有他症。根据后加减。
心火实热。加生地黄。麦门冬（各一钱五分）、生甘草（五分），加黄连（一钱）
肝火实热。加川芎（一钱）、赤芍药（一钱）、龙胆草（一钱五分）、大黄（三钱）。
脾火实热。加白芍药（一钱）、山栀（一钱五分）。
肺火实热。加石膏、天门冬（各一钱五分）、桑白皮（一钱）、山栀（一钱五分）。
肾火。加熟地黄、知母（各一钱五分）、玄参（一钱）、泽泻（八分）、减芩连。
小肠火加木通（二钱）、活石（一钱五分）、甘草梢（五分）、赤茯苓（一钱）。
胆火。加柴胡（一钱五分）、竹茹（八分）、青皮（七分）。
胃实火轻者。加石膏、知母（各二钱）、甘草（七分）、粳米（一钱五分）。甚者。加大黄（三
钱或五钱）、芒硝（一钱）。
大肠火。加当归（一钱五分）、连翘、槐实（各一钱五分）。
膀胱火。加泽泻（一钱）、白茯苓（一钱五分）、细辛（五分）。
三焦火。加连翘、防风、荆芥、山栀（各一钱五分）。
命门火盛。以四制黄柏丸降之。火衰。以茸附丸温之。
郁火。去芩柏，加香附、山栀（各一钱五分）、青黛、川芎（各一钱）。
心肝肺热甚。两目红肿疼痛。加赤芍药、川芎（各一钱）、当归、生地黄（各一钱五分）、龙胆
草、甘菊花（各一钱二分）、防风、荆芥、薄荷（各七分）。
心火亢极。胃肝火盛。狂乱谵妄。加石膏（二钱）、山栀（一钱五分）、大黄（三钱或五钱）、芒
硝（一钱），即三黄石膏汤也。
中上二焦火热。凉膈散主之。本方去黄连、黄柏，加山栀、连翘、大黄（各二钱）、朴硝、
薄荷、甘草（各七分）。
上焦火热。喉痛喉痹。舌肿口疮。加山豆根（一钱五分）、玄参（一钱）、桔梗、甘草（各八分）。
阳明火盛攻上。头面肿。或腮颊肿。牙龈肿。齿痛。加升麻（五分）、白芷（八分）、防风（
一钱）、细辛（五分）、石膏（二钱），去黄柏一半。
少阳火盛。耳肿痛。颈项肿痛。加川芎（一钱）、柴胡（一钱五分）、夏枯草、牛蒡子、连翘
（各一钱五分）、防风（八分）、甘草、青皮（各五分）。
太阳火盛。头痛痰盛。加石膏（二钱）、升麻（五分）、羌活（一钱）、半夏、南星（胆制各一
钱五分）、川芎（一钱）、本方各减半。
热结下焦。大小便秘不通。加山栀、木通（各一钱五分）、大黄（三钱或五钱）、甘草梢（五
分）。
肠风脏毒下血。痔漏等症。皆胃与大肠素有积火。及风热所致。加槐实（胆制）、荆芥、防风
（各一钱二分）、生地黄、当归（各一钱五分）、地榆、连翘、人参、白术（各一钱），补而清之。
五淋赤白浊。小便秘涩。皆心肺与小肠膀胱。素有郁火复因外邪所触。骚动其火。所致。加
木通、赤茯苓（各一钱五分）、车前子、泽泻、郁李仁、甘草梢（各钱）、大黄（三钱）、血淋尿
血。加当归、生地黄、地榆（各一钱五分）、发灰（五分）、牛膝（一钱）。
气淋气秘。加木香（五分）、青皮（一钱）、木通（一钱五分）、乌药（八分）。
癫痫狂妄。属痰与火。实者。本方对二陈汤。加南星、竹沥、姜汁、先服十数剂。清其痰。后用
牛黄琥珀丸主之。虚者。先用十全一补汤。减去川芎、官桂，加麦门冬、酸枣仁、黄连
（各一钱）、远志（五分），滋培其血气。后亦用牛黄琥珀丸主之。（丸方见后附方内）。
妇人产后惊风搐搦。语言恍惚。治亦同上。但不去川芎、官桂，加防风、天麻、白芷（各一钱）
以上加减法亦大概耳。临症斟酌。方能尽变通之妙。按先贤云∶凡火盛者骤用寒凉。必须温
散。火急甚者。必缓之。生甘草兼泻兼缓。虚者。参 甘草亦可用。人壮气实。火盛癫狂者
可用。前法正治。或硝水、冰水与之。虚火狂者。姜汁、竹沥制之。若根据前法正治立死。
又有补阴则火自降之说。炒黄柏生地之类。经曰∶壮火之主。以制阳光是也。噫。虚实施治
。相背千里。吉凶之机。应若影响。可不深思而明辨哉。
又方 调中散火汤治症热发热。虚火通用。
人参 黄 （蜜炙各八分） 当归 白芍药 白术（各一钱） 甘草（四分） 柴胡（六分） 升麻
（五分） 葛根 防风 羌活 黄芩（七分）
上作一服。姜枣煎。食远服。兼有他症。根据后加减。
阴虚发热。加麦门冬、黄柏、知母、地骨皮（各一钱），倍柴胡。
手心发热。加山栀、香附（各一钱）、川芎、白芷（各七分）。
虚热不能食。自汗气短。加茯苓、陈皮（各八分）。
天明时发热。加麦门冬、地骨皮（各八分）、倍柴胡。
肺经发热。按之热在皮毛。日西甚。加石膏、知母、地骨皮（各一钱）。
心经发热微。重按之。热在血脉。日中甚。加麦门冬、黄连（各一钱）。
肝经发热。重按至肉下骨上热。寅卯甚。倍柴胡，加青皮（七分）。
上焦发热。加知母、天门冬、麦门冬（各一钱）、保定肺气。
中焦发热。属脾虚、倍参术，加陈皮、白茯苓（各一钱）。
下焦发湿热。或膀胱有火邪。加汉防己、龙胆草、黄柏（各一钱）。
蒸蒸发热。昼夜不退者。加知母、秦艽、牡丹皮、地骨皮（各一钱）、柴胡倍用。
昼则发热。夜则安静。四君子汤。加麦门冬、胡黄连、秦艽、地骨皮（各等分）。
夜则发热烦躁。昼则安静。四物汤对小柴胡汤。一二服愈。
凉血解除五心烦热。四物汤。加麦门冬、连翘、山栀、薄荷。
脉象：脉象洪大且数，或干燥急促而急迫，往来紧大坚实者，属于火证。左寸脉洪滑为心火，洪数为小肠火；左关脉弦大而长为肝火，弦小而数为胆火；左尺脉沉数为肾与膀胱火；右寸脉浮数为肺火，洪大而数为大肠火；右关脉洪数为胃火，洪实为脾火；右尺脉沉数为命门火，沉微为命门火衰；浮数为三焦火，沉细浮数为阴虚火动。六部脉象洪大有力者易治，反见沉难细者难治。《脉诀》说：脉浮弦而数为发热，洪数为烦热，滑数为心下壅热，弦紧而数为寒热往来，沉细数疾为热兼寒。寸脉紧数、尺脉沉微，为上热下寒；浮紧而滑，为外热内寒；轻取微迟，重按紧滑，为外寒内热。两寸脉浮大而数，热在心肺；两关脉弦滑而数，热在肝脾；两尺脉洪实，或沉数，皆为热在下焦；右寸关脉洪实，热在脾肺；右关脉滑数，溢出寸口，为热在胃口，主呕吐。六脉短涩而数，或沉细而数，皆热在阴分；洪大而长，或浮洪滑数，皆为热在阳分。《内经》说：脉至而从，按之不鼓动，诸阳经皆如此。王冰注解说：病热而脉数，按之不鼓动，乃寒盛格阳所致，并非真热。症状表现为寒，按之脉气击于指下盛大者，此为热盛拒阴而生病，并非寒证。又说：推而内之，外而不内，身有热也。《伤寒论》说：寸口脉微为阳气不足，阴气上入阳中，则洒淅恶寒；尺脉弱为阴气不足，阳气下陷入阴中，则发热。这与《难经》所说的覆溢相乘，以及浮损小沉实大的意义相同，都是诊法的关键所在，对于热症尤为适宜。
症状：据朱丹溪所说，《素问·病机十九条》中属火的有五类，而刘河间推展其说，火致病的情况非常多，深合《内经》之意。他说：各种疾病如喘促、呕吐、酸水、暴注下迫、转筋、小便混浊、腹胀大、叩之有声、痈疽疮疡、瘤气结核、吐泻霍乱、瞀郁肿胀、鼻塞鼽衄、血溢血泄、淋闭身热、恶寒战栗、或悲笑谵妄、衄血污秽之病，都属于少阴君火之火，是心与小肠之气所属。若出现瞀闷、暴喑、冒昧燥扰、狂越骂詈、惊骇肿疼酸、气逆冲上、禁栗如丧神守、嚏呕疮疡、喉痹耳鸣及聋、呕涌、溢食不下、目昧不明、暴注、暴病暴死，都属于少阳（相火）之热，是心包络与三焦之气所属。《原病式》说：各种风病掉眩，属于肝火之动；各种痛痒疮疡，属于心火之用；各种湿肿满，属于脾火之胜；各种气愤郁病痿，属于肺火之升。这些都是火由脏腑产生的病变。至于五志交攻、七情妄动，火随之而起。如大怒则火起于肝，醉饱则火起于脾，房劳则火起于肾，悲哀动中则火起于肺。心为君火，自焚则死矣。《辨疑录》说：人禀受五行各一，惟独火有二种，有君相之分。君火不主令，相火代之。相火寄于肝肾之内，附于脾肺之间。凡诸经动者，皆属于火。起于肝的，称为风火；生于脾的，称为痰火；入于气的，为无根之火；动于肾的，为消阴伏火；存于心肺的，入于血分的，为有余之火；散于各经的，为浮游之火。所以说“火者化也”，善行数变，莫测其机。《内经》又说：诸寒之而热者，取之阴。注解说：取之阴，是为了补肾水之不足，以制约心火之有余。李东垣说：发热之症，有元气虚损而热的，有五脏之热，有内中外热。所以轻手扪之而热，热在皮毛血脉，由心肺主之；重按至骨，蒸手而热，热在筋骨，由肾肝主之；不轻不重而热，热在肌肉，由脾主之。又说：昼则发热，夜则安静，是阳气自旺于阳分；昼则安静，夜则发热烦躁，是阳气下陷入阴中，名为热入血室；昼夜不分，是重阳无阴，亟需泻其阳，峻补其阴。《难经》说：重阳者狂，六脉洪实，宜用苦寒药泻之；重阴者癫，六脉沉微，宜用甘温药补之。张仲景说：病患身大热反欲近衣者，此热在皮肤，寒在骨髓；身大寒反不欲近衣者，此寒在皮肤，热在骨髓。治疗应当详细辨别。
治法：戴氏说：火之为病，其害甚大，其变甚速，其势甚彰，其死甚暴。为什么呢？盖因它能燔灼飞走，蓦越烧烁，于物莫能御之，游行于三焦虚实之两途。曰君火者，即心火，可以湿伏，可以水灭，可以直折，惟黄连之属可以制之；曰相火者，即龙火，不可以水湿，不可以直折，从其性而伏之，惟黄柏之属可以降之。唉，泻火之法，岂止如此？虚实多端，不可不察。结合脏气而言，如黄连泻心火，黄芩泻肺火，芍药泻脾火，柴胡泻肝火，知母泻肾火，柴胡黄芩泻三焦火，木通泻小肠火，石膏泻胃火，黄柏泻膀胱火。这些皆是苦寒之味，能泻有余之火罢了。若是饮食劳役，内伤元气，火不两立，为阳虚之病，以甘温之剂降之，如参术归之类。若心火亢极，郁热内实，为阳狂之病，以寒咸之剂折之，如硝黄之类。若肾水受伤，真阴失守，无根之火妄炎，为阴虚之病，以壮水之剂制之，如黄柏地黄玄参之类。若右尺命门火衰，为阳脱之病，以温热之剂制之，如姜附之类。若胃虚过食冷物，郁遏阳气于脾土之中，为火郁之病，以升散之剂发之，如升麻葛根之类。又有治法说：小热之气，凉以和之；大热之气，寒以取之；甚热之气，汗而发之。发之不尽，则逆取之。又说：暴热病在心肺，积热病在肾肝。虚热不能食，自汗，气短，属脾虚，以甘寒温而行之；实热能食，口干舌燥，便难，属胃实，以辛苦大寒药下之。火郁而热，乃心火下陷脾土，抑而不伸，五心烦热，宜汗之发之；心神烦乱，血中伏火，蒸蒸然不安，宜镇心火，朱砂安神丸治之。骨蒸劳热，乃五脏齐损病，憔悴发热，盗汗失血，宜滋阴养血。苟不明此诸火热之病，施治何所根据？故集其略以备参考，庶免实实虚虚之祸也。
方剂：三补汤治实热实火通用，虚者不宜。
黄芩（酒炒二钱五分）、黄连（姜汁炒一钱五分）、黄柏（盐酒炒二钱五分）。
以上作一服，水煎，食远热服。兼有他症，根据后文加减。
心火实热，加生地黄、麦门冬（各一钱五分）、生甘草（五分），加黄连（一钱）。
肝火实热，加川芎（一钱）、赤芍药（一钱）、龙胆草（一钱五分）、大黄（三钱）。
脾火实热，加白芍药（一钱）、山栀（一钱五分）。
肺火实热，加石膏、天门冬（各一钱五分）、桑白皮（一钱）、山栀（一钱五分）。
肾火，加熟地黄、知母（各一钱五分）、玄参（一钱）、泽泻（八分），减芩连。
小肠火，加木通（二钱）、活石（一钱五分）、甘草梢（五分）、赤茯苓（一钱）。
胆火，加柴胡（一钱五分）、竹茹（八分）、青皮（七分）。
胃实火轻者，加石膏、知母（各二钱）、甘草（七分）、粳米（一钱五分）。甚者，加大黄（三钱或五钱）、芒硝（一钱）。
大肠火，加当归（一钱五分）、连翘、槐实（各一钱五分）。
膀胱火，加泽泻（一钱）、白茯苓（一钱五分）、细辛（五分）。
三焦火，加连翘、防风、荆芥、山栀（各一钱五分）。
命门火盛，以四制黄柏丸降之；火衰，以茸附丸温之。
郁火，去芩柏，加香附、山栀（各一钱五分）、青黛、川芎（各一钱）。
心肝肺热甚，两目红肿疼痛，加赤芍药、川芎（各一钱）、当归、生地黄（各一钱五分）、龙胆草、甘菊花（各一钱二分）、防风、荆芥、薄荷（各七分）。
心火亢极，胃肝火盛，狂乱谵妄，加石膏（二钱）、山栀（一钱五分）、大黄（三钱或五钱）、芒硝（一钱），即三黄石膏汤也。
中上二焦火热，凉膈散主之。本方去黄连、黄柏，加山栀、连翘、大黄（各二钱）、朴硝、薄荷、甘草（各七分）。
上焦火热，喉痛喉痹，舌肿口疮，加山豆根（一钱五分）、玄参（一钱）、桔梗、甘草（各八分）。
阳明火盛攻上，头面肿，或腮颊肿，牙龈肿，齿痛，加升麻（五分）、白芷（八分）、防风（一钱）、细辛（五分）、石膏（二钱），去黄柏一半。
少阳火盛，耳肿痛，颈项肿痛，加川芎（一钱）、柴胡（一钱五分）、夏枯草、牛蒡子、连翘（各一钱五分）、防风（八分）、甘草、青皮（各五分）。
太阳火盛，头痛痰盛，加石膏（二钱）、升麻（五分）、羌活（一钱）、半夏、南星（胆制各一钱五分）、川芎（一钱），本方各减半。
热结下焦，大小便秘不通，加山栀、木通（各一钱五分）、大黄（三钱或五钱）、甘草梢（五分）。
肠风脏毒下血，痔漏等症，皆胃与大肠素有积火，及风热所致。加槐实（胆制）、荆芥、防风（各一钱二分）、生地黄、当归（各一钱五分）、地榆、连翘、人参、白术（各一钱），补而清之。
五淋赤白浊，小便秘涩，皆心肺与小肠膀胱，素有郁火复因外邪所触，骚动其火，所致。加木通、赤茯苓（各一钱五分）、车前子、泽泻、郁李仁、甘草梢（各钱）、大黄（三钱）。血淋尿血，加当归、生地黄、地榆（各一钱五分）、发灰（五分）、牛膝（一钱）。
气淋气秘，加木香（五分）、青皮（一钱）、木通（一钱五分）、乌药（八分）。
癫痫狂妄，属痰与火。实者，本方对二陈汤，加南星、竹沥、姜汁，先服十数剂，清其痰。后用牛黄琥珀丸主之。虚者，先用十全一补汤，减去川芎、官桂，加麦门冬、酸枣仁、黄连（各一钱）、远志（五分），滋培其血气。后亦用牛黄琥珀丸主之。（丸方见后附方内）。
妇人产后惊风搐搦，语言恍惚，治亦同上。但不去川芎、官桂，加防风、天麻、白芷（各一钱）。
以上加减法亦大概耳，临症斟酌，方能尽变通之妙。按先贤云：凡火盛者骤用寒凉，必须温散。火急甚者，必缓之。生甘草兼泻兼缓，虚者，参、甘草亦可用。人壮气实，火盛癫狂者可用。前法正治，或硝水、冰水与之。虚火狂者，姜汁、竹沥制之。若根据前法正治立死。又有补阴则火自降之说，炒黄柏生地之类。《内经》曰：壮火之主，以制阳光是也。唉，虚实施治，相背千里，吉凶之机，应若影响，可不深思而明辨哉。
又方：调中散火汤治症热发热，虚火通用。
人参、黄芪（蜜炙各八分）、当归、白芍药、白术（各一钱）、甘草（四分）、柴胡（六分）、升麻（五分）、葛根、防风、羌活、黄芩（七分）。
以上作一服，姜枣煎，食远服。兼有他症，根据后文加减。
阴虚发热，加麦门冬、黄柏、知母、地骨皮（各一钱），倍柴胡。
手心发热，加山栀、香附（各一钱）、川芎、白芷（各七分）。
虚热不能食，自汗气短，加茯苓、陈皮（各八分）。
天明时发热，加麦门冬、地骨皮（各八分），倍柴胡。
肺经发热，按之热在皮毛，日西甚，加石膏、知母、地骨皮（各一钱）。
心经发热微，重按之，热在血脉，日中甚，加麦门冬、黄连（各一钱）。
肝经发热，重按至肉下骨上热，寅卯甚，倍柴胡，加青皮（七分）。
上焦发热，加知母、天门冬、麦门冬（各一钱），保定肺气。
中焦发热，属脾虚，倍参术，加陈皮、白茯苓（各一钱）。
下焦发湿热，或膀胱有火邪，加汉防己、龙胆草、黄柏（各一钱）。
蒸蒸发热，昼夜不退者，加知母、秦艽、牡丹皮、地骨皮（各一钱），柴胡倍用。
昼则发热，夜则安静，四君子汤，加麦门冬、胡黄连、秦艽、地骨皮（各等分）。
夜则发热烦躁，昼则安静，四物汤对小柴胡汤，一二服愈。
凉血解除五心烦热，四物汤，加麦门冬、连翘、山栀、薄荷。
[Fire Heat, Mania and Delirium (Appendix), Tidal Fever with Yin Deficiency and Fire Movement (Appendix), Upper Part, Lower Part, Sores and Ulcers]
Pulse: A pulse that is surging (Hong) and rapid (Shu), or dry and urgent, coming and going tight, large, and solid indicates Fire. A surging and slippery pulse at the left Cun position indicates Heart Fire; a surging and rapid pulse indicates Small Intestine Fire. A wiry (Xian), large, and long pulse at the left Guan position indicates Liver Fire; a wiry, small, and rapid pulse indicates Gallbladder Fire. A deep (Chen) and rapid pulse at the left Chi position indicates Kidney and Bladder Fire. A floating (Fu) and rapid pulse at the right Cun position indicates Lung Fire; a surging, large, and rapid pulse indicates Large Intestine Fire. A surging and rapid pulse at the right Guan position indicates Stomach Fire; a surging and solid pulse indicates Spleen Fire. A deep and rapid pulse at the right Chi position indicates Mingmen Fire; a deep and minute (Wei) pulse indicates Mingmen Fire Decline. A floating and rapid pulse indicates Sanjiao Fire; a deep, fine, and floating-rapid pulse indicates Yin Deficiency with Fire Movement. If the pulses in all six positions are surging and forceful, it is easy to treat; if they are contrary, deep, difficult, and fine, it is difficult to treat. The *Mai Jue* states: A floating, wiry, and rapid pulse indicates fever; a surging and rapid pulse indicates vexatious heat; a slippery and rapid pulse indicates stagnation-heat in the epigastrium; a wiry, tight, and rapid pulse indicates alternating chills and fever; a deep, fine, rapid, and hurried pulse indicates heat combined with cold. A tight and rapid pulse at the Cun position with a deep and minute pulse at the Chi position indicates upper heat and lower cold. A floating, tight, and slippery pulse indicates exterior heat and interior cold. A slightly slow pulse on light palpation with a tight and slippery pulse on heavy palpation indicates exterior cold and interior heat. A floating, large, and rapid pulse at both Cun positions indicates heat in the Heart and Lungs; a wiry, slippery, and rapid pulse at both Guan positions indicates heat in the Liver and Spleen; a surging and solid pulse, or deep and rapid pulse at both Chi positions, indicates heat in the Lower Jiao. A surging and solid pulse at the right Cun and Guan positions indicates heat in the Spleen and Lungs; a slippery and rapid pulse at the right Guan position overflowing past the Cun Kou indicates heat in the stomach opening, manifesting as vomiting. A short, choppy, and rapid pulse, or a deep, fine, and rapid pulse in all six positions, indicates heat in the Yin aspect; a surging, large, and long pulse, or a floating, surging, slippery, and rapid pulse, indicates heat in the Yang aspect. The *Classic* states: When the pulse arrives following the disease, but does not throb upon pressure, this applies to all Yang channels. Wang Bing's commentary notes: In cases of febrile disease with a rapid pulse, if it does not throb upon pressure, it is caused by severe Cold repelling Yang, and is not true heat. If symptoms indicate cold, but the pulse qi strikes the fingers vigorously upon pressure, this is due to excessive Heat rejecting Yin, causing illness, and is not cold. It also states: Pushing inward, if the exterior does not yield inward, there is heat in the body. The *Treatise on Cold Damage* states: A faint pulse at the Cun Kou indicates insufficient Yang Qi; when Yin Qi enters the Yang center, it causes shivering and aversion to cold. A weak pulse at the Chi position indicates insufficient Yin Qi; when Yang Qi sinks into the Yin center, it causes fever. This is consistent with the meaning of "Fu and Yi interacting" and the principles of floating-damaged-small and deep-solid-large pulses in the *Classic of Difficult Issues*, which are essential diagnostic methods, particularly suitable for heat syndromes.
Symptoms: According to Zhu Danxi, among the Nineteen Pathomechanisms in the *Su Wen*, five belong to Fire, and Liu Hejian expanded upon this theory, noting that Fire causes many diseases, deeply aligning with the *Nei Jing*. He stated: Various diseases such as panting, vomiting, acid regurgitation, sudden diarrhea with tenesmus, muscle spasms, turbid urination, abdominal distension with drum-like sound, carbuncles, sores, ulcers, tumors, phlegm nodules, vomiting and diarrhea cholera, dizziness and depression, swelling, nasal congestion, rhinorrhea, epistaxis, hematemesis, hematochezia, strangury with fever, aversion to cold and trembling, or weeping/laughing delirium, and bloody discharges, all belong to the Ministerial Fire of Shaoyin, which is associated with the Qi of the Heart and Small Intestine. If there is dizziness, sudden aphonia, confusion, dryness and agitation, mania, cursing, fright, swelling, pain, soreness, rebellious Qi rushing upward, trembling as if losing spiritual control, sneezing, vomiting, sores, ulcers, throat obstruction, tinnitus, and deafness, vomiting and gurgling, overflow of food without swallowing, blurred vision, sudden diarrhea, sudden illness, and sudden death, these all belong to the Heat of Shaoyang (Ministerial Fire), which is associated with the Qi of the Pericardium and Sanjiao. The *Yuan Bing Shi* states: Various wind diseases with tremors and vertigo belong to the movement of Liver Fire; various pains, itching, sores, and ulcers belong to the function of Heart Fire; various dampness, swelling, and fullness belong to the excess of Spleen Fire; various Qi rebellion, depression, and flaccidity diseases belong to the rising of Lung Fire. These are all diseases caused by Fire originating from the Zang-Fu organs. As for the mutual attack of the Five Emotions and the reckless movement of the Seven Emotions, Fire arises accordingly. For example, great anger causes Fire to arise in the Liver; drunkenness and overeating cause Fire to arise in the Spleen; sexual exhaustion causes Fire to arise in the Kidneys; sorrow moving the center causes Fire to arise in the Lungs. The Heart is the Sovereign Fire; if it burns itself, death ensues. The *Bian Yi Lu* states: Humans inherit one of each of the Five Elements, but Fire has two types, distinguished as Sovereign and Ministerial. The Sovereign Fire does not govern commands; the Ministerial Fire takes its place. It resides within the Liver and Kidneys and attaches to the Spleen and Lungs. Movements in all meridians belong to Fire. Arising from the Liver, it is called Wind-Fire; born from the Spleen, it is called Phlegm-Fire; entering Qi, it is Rootless Fire; moving in the Kidneys, it is Yin-consuming Hidden Fire; residing in the Heart and Lungs and entering the Blood aspect, it is Excess Fire; scattering through the meridians, it is Wandering Fire. Thus it is said, "Fire is transformation." It moves quickly and changes unpredictably. The *Classic* again states: For those who are treated with cold remedies yet remain hot, treat the Yin. The commentary explains: Treating the Yin means tonifying the insufficiency of Kidney Water to restrain the excess of Heart Fire. Li Dongyuan stated: Febrile diseases include heat due to Yuan Qi deficiency, heat of the Five Zang, and internal, middle, and external heat. Therefore, heat felt on light palpation is in the skin and vessels, governed by the Heart and Lungs; heat felt steaming upon heavy palpation to the bone is in the sinews and bones, governed by the Kidneys and Liver; heat felt neither lightly nor heavily is in the muscles, governed by the Spleen. He also stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang aspect; quietness during the day and fever/agitation at night indicates Yang Qi sinking into the Yin, named Heat Entering the Blood Chamber; fever and quietness indistinguishable between day and night indicates Double Yang with no Yin, requiring urgent draining of Yang and vigorous tonification of Yin. The *Classic of Difficult Issues* states: Double Yang leads to mania; with surging and solid pulses in all six positions, bitter-cold herbs should be used to drain it. Double Yin leads to epilepsy; with deep and minute pulses, sweet-warm herbs should be used to tonify it. Zhang Zhongjing stated: If a patient has high body heat but desires to wrap themselves in clothes, the heat is in the skin and the cold is in the marrow; if the body is very cold but does not desire clothes, the cold is in the skin and the heat is in the marrow. Treatment requires careful differentiation.
Therapeutic Methods: Dai Shi stated: The harm of Fire diseases is great, the changes are rapid, the manifestation is obvious, and death can be sudden. Why? Because it can scorch and fly, leap and burn, nothing can resist it, wandering through the two paths of deficiency and excess in the Sanjiao. The Sovereign Fire, i.e., Heart Fire, can be subdued by dampness, extinguished by water, and directly折 (broken/restrained); only herbs like Huanglian can control it. The Ministerial Fire, i.e., Dragon Fire, cannot be subdued by dampness or water, nor directly broken; it must be subdued according to its nature; only herbs like Huangbai can descend it. Alas, the method of draining fire is not limited to this. There are many aspects of deficiency and excess that must be examined. Considering Zang Qi: Huanglian drains Heart Fire, Huangqin drains Lung Fire, Shaoyao drains Spleen Fire, Chaihu drains Liver Fire, Zhimu drains Kidney Fire, Chaihu and Huangqin drain Sanjiao Fire, Mutong drains Small Intestine Fire, Shigao drains Stomach Fire, Huangbai drains Bladder Fire. These are all bitter-cold flavors capable of draining excess Fire. However, if diet and labor injure the Yuan Qi, and Fire and Yang cannot coexist, it is a disease of Yang Deficiency, treated with sweet-warm agents to descend it, such as Renshen, Baizhu, Danggui. If Heart Fire is extremely hyperactive with stagnant heat and interior excess, it is a disease of Yang Mania, treated with cold-salty agents to break it, such as Xiaoshi and Dahuang. If Kidney Water is injured and True Yin is lost, with Rootless Fire flaming recklessly, it is a disease of Yin Deficiency, treated with agents to strengthen Water to control it, such as Huangbai, Dihuang, Xuanshen. If Mingmen Fire at the right Chi is declining, it is a disease of Yang Collapse, treated with warm-hot agents to control it, such as Jiang and Fuzi. If Stomach deficiency leads to excessive consumption of cold foods, suppressing Yang Qi within the Spleen Earth, it is a disease of Fire Stagnation, treated with ascending-dispersing agents to emit it, such as Shengma and Gegen. Another treatment method states: For slight heat Qi, use coolness to harmonize it; for major heat Qi, use cold to resolve it; for severe heat Qi, use sweating to emit it. If emission is incomplete, then use counter-treatment. It also states: Sudden heat diseases are in the Heart and Lungs; accumulated heat diseases are in the Kidneys and Liver. Deficient heat with inability to eat, spontaneous sweating, and shortness of breath belongs to Spleen Deficiency, treated with sweet-cold and warm agents. Excess heat with ability to eat, dry mouth and tongue, and difficult defecation belongs to Stomach Excess, treated with bitter-acrid major-cold purgatives. Fire stagnation with heat occurs when Heart Fire sinks into Spleen Earth, suppressed and unable to extend, causing five-palm heat; it should be emitted via sweating. Vexed mind with hidden fire in the blood, feeling steamingly uneasy, requires calming Heart Fire, treated with Zhusha Anshen Wan. Bone-steaming consumptive fever is a disease where all Five Zang are damaged, manifesting as emaciation, fever, night sweats, and blood loss; it requires nourishing Yin and tonifying Blood. If one does not understand these various Fire Heat diseases, how can treatment have a basis? Thus, I have collected the essentials for reference, to avoid the disaster of treating excess as excess and deficiency as deficiency.
Formulas: Sanbu Tang treats general excess heat and excess fire; it is not suitable for deficiency.
Huangqin (wine-fried 2.5 qian), Huanglian (ginger juice-fried 1.5 qian), Huangbai (salt-wine fried 2.5 qian).
Take as one dose, decoct in water, take hot far from meals. For accompanying symptoms, modify according to the following.
Heart Fire Excess Heat: Add Shengdihuang, Maidong (each 1.5 qian), Sheng Gancao (0.5 qian), add Huanglian (1 qian).
Liver Fire Excess Heat: Add Chuanxiong (1 qian), Chishao Yao (1 qian), Longdan Cao (1.5 qian), Dahuang (3 qian).
Spleen Fire Excess Heat: Add Baishao Yao (1 qian), Shanzhi (1.5 qian).
Lung Fire Excess Heat: Add Shigao, Tiandong (each 1.5 qian), Sangbaipi (1 qian), Shanzhi (1.5 qian).
Kidney Fire: Add Shudihuang, Zhimu (each 1.5 qian), Xuanshen (1 qian), Zexie (0.8 qian), reduce Huangqin and Huanglian.
Small Intestine Fire: Add Mutong (2 qian), Huoshi (1.5 qian), Gancao Shao (0.5 qian), Chifuling (1 qian).
Gallbladder Fire: Add Chaihu (1.5 qian), Zhuru (0.8 qian), Qingpi (0.7 qian).
Stomach Excess Fire (Mild): Add Shigao, Zhimu (each 2 qian), Gancao (0.7 qian), Jingmi (1.5 qian). Severe: Add Dahuang (3 or 5 qian), Mangxiao (1 qian).
Large Intestine Fire: Add Danggui (1.5 qian), Lianqiao, Huaishi (each 1.5 qian).
Bladder Fire: Add Zexie (1 qian), Baifuling (1.5 qian), Xixin (0.5 qian).
Sanjiao Fire: Add Lianqiao, Fangfeng, Jingjie, Shanzhi (each 1.5 qian).
Mingmen Fire Excess: Descend with Sizhi Huangbai Wan. Fire Decline: Warm with Rongfu Wan.
Stagnant Fire: Remove Huangqin and Huangbai, add Xiangfu, Shanzhi (each 1.5 qian), Qingdai, Chuanxiong (each 1 qian).
Excessive Heat in Heart, Liver, and Lungs with red, swollen, painful eyes: Add Chishao Yao, Chuanxiong (each 1 qian), Danggui, Shengdihuang (each 1.5 qian), Longdan Cao, Ganhua Ju (each 1.2 qian), Fangfeng, Jingjie, Bohe (each 0.7 qian).
Heart Fire Extremely Hyperactive, Stomach and Liver Fire Excess with mania and delirium: Add Shigao (2 qian), Shanzhi (1.5 qian), Dahuang (3 or 5 qian), Mangxiao (1 qian), which is Sanhuang Shigao Tang.
Heat-Fire in Middle and Upper Jiao: Main formula is Liangge San. Remove Huanglian and Huangbai from this formula, add Shanzhi, Lianqiao, Dahuang (each 2 qian), Puxiao, Bohe, Gancao (each 0.7 qian).
Upper Jiao Heat-Fire with sore throat, throat obstruction, swollen tongue, and mouth ulcers: Add Shandougen (1.5 qian), Xuanshen (1 qian), Jiegeng, Gancao (each 0.8 qian).
Yangming Fire Excess attacking upwards with head/face swelling, or cheek/jaw swelling, gum swelling, toothache: Add Shengma (0.5 qian), Baizhi (0.8 qian), Fangfeng (1 qian), Xixin (0.5 qian), Shigao (2 qian), remove half of Huangbai.
Shaoyang Fire Excess with ear swelling/pain, neck/swelling: Add Chuanxiong (1 qian), Chaihu (1.5 qian), Xiakucao, Niubangzi, Lianqiao (each 1.5 qian), Fangfeng (0.8 qian), Gancao, Qingpi (each 0.5 qian).
Taiyang Fire Excess with headache and profuse phlegm: Add Shigao (2 qian), Shengma (0.5 qian), Qianghuo (1 qian), Banxia, Nanting (each gall-treated 1.5 qian), Chuanxiong (1 qian), halve all ingredients of this formula.
Heat Knot in Lower Jiao with constipation of urine and stool: Add Shanzhi, Mutong (each 1.5 qian), Dahuang (3 or 5 qian), Gancao Shao (0.5 qian).
Intestinal wind and visceral toxin bleeding, hemorrhoids and fistulas: All caused by accumulated fire in Stomach and Large Intestine and wind-heat. Add Huaishi (gall-treated), Jingjie, Fangfeng (each 1.2 qian), Shengdihuang, Danggui (each 1.5 qian), Diyü, Lianqiao, Renshen, Baizhu (each 1 qian), tonify and clear.
Five Stranguries with red/white turbidity and difficult urination: Caused by stagnant fire in Heart/Lungs and Small Intestine/Bladder agitated by external pathogens. Add Mutong, Chifuling (each 1.5 qian), Cheqianzi, Zexie, Yuliren, Gancao Shao (each 1 qian), Dahuang (3 qian). For blood strangury and hematuria: Add Danggui, Shengdihuang, Diyü (each 1.5 qian), Fenhui (0.5 qian), Niuxi (1 qian).
Qi Strangury and Qi Constipation: Add Muxiang (0.5 qian), Qingpi (1 qian), Mutong (1.5 qian), Wuyao (0.8 qian).
Epilepsy, mania, and delirium belonging to Phlegm and Fire. Excess type: Combine this formula with Erchen Tang, add Nanting, Zhuli, Jiangzhi, take first dozen doses to clear phlegm. Then main formula is Niuhuang Hupo Wan. Deficiency type: First use Shiquan Yibu Tang, remove Chuanxiong and Guigui, add Maidong, Suanzaoren, Huanglian (each 1 qian), Yuanzhi (0.5 qian) to nourish Qi and Blood. Then also use Niuhuang Hupo Wan. (Pill formula see appendix later).
Postpartum convulsions and twitching in women with vague speech: Treat similarly, but do not remove Chuanxiong and Guigui, add Fangfeng, Tianma, Baizhi (each 1 qian).
The above modifications are general guidelines; clinical judgment is required to master flexibility. According to ancient sages: For severe Fire, sudden use of cold-coolants must be accompanied by warm dispersal. For extremely urgent Fire, it must be slowed. Raw Gancao clears and slows; for deficiency, Renshen and Gancao can also be used. For robust individuals with strong Qi and severe Fire mania, it can be used. The aforementioned orthodox treatment involves giving nitre water or ice water. For deficient Fire mania, ginger juice and bamboo sap are used to control it. If orthodox treatment based on the previous methods is applied immediately, death will follow. There is also the theory that tonifying Yin causes Fire to descend naturally, such as fried Huangbai and Dihuang. The *Classic* says: "The master of vigorous Fire controls the sunlight." Alas, treatment for deficiency and excess are worlds apart; the mechanism of auspiciousness and danger responds like an echo. Can one not think deeply and distinguish clearly?
Another Formula: Tiaozhong Sanhuo Tang treats symptomatic fever and heat, generally for deficient fire.
Renshen, Huangqi (honey-fried each 0.8 qian), Danggui, Baishao Yao, Baizhu (each 1 qian), Gancao (0.4 qian), Chaihu (0.6 qian), Shengma (0.5 qian), Gegen, Fangfeng, Qianghuo, Huangqin (0.7 qian).
Take as one dose, decoct with Ginger and Jujube, take far from meals. For accompanying symptoms, modify according to the following.
Yin Deficiency Fever: Add Maidong, Huangbai, Zhimu, Digupi (each 1 qian), double Chaihu.
Palmar Heat: Add Shanzhi, Xiangfu (each 1 qian), Chuanxiong, Baizhi (each 0.7 qian).
Deficient Heat with inability to eat, spontaneous sweating, shortness of breath: Add Fuling, Chenpi (each 0.8 qian).
Fever at dawn: Add Maidong, Digupi (each 0.8 qian), double Chaihu.
Lung Meridian Fever: Heat felt in skin upon pressure, worse in evening: Add Shigao, Zhimu, Digupi (each 1 qian).
Heart Meridian Mild Fever: Heat felt in vessels upon heavy pressure, worse at noon: Add Maidong, Huanglian (each 1 qian).
Liver Meridian Fever: Heat felt below muscle to bone upon heavy pressure, worse at Yin/Mao hours: Double Chaihu, add Qingpi (0.7 qian).
Upper Jiao Fever: Add Zhimu, Tiandong, Maidong (each 1 qian) to stabilize Lung Qi.
Middle Jiao Fever: Belongs to Spleen Deficiency, double Renshen and Baizhu, add Chenpi, Baifuling (each 1 qian).
Lower Jiao Damp-Heat or Bladder Fire Evil: Add Hanfangji, Longdan Cao, Huangbai (each 1 qian).
Steaming Fever unceasing day and night: Add Zhimu, Qinjiao, Mudanpi, Digupi (each 1 qian), double Chaihu.
Fever during day, quiet at night: Sijunzi Tang, add Maidong, Huhuanglian, Qinjiao, Digupi (equal parts).
Fever and agitation at night, quiet during day: Siwu Tang combined with Xiaochaihu Tang, cured in 1-2 doses.
Cool Blood to relieve five-palm heat: Siwu Tang, add Maidong, Lianqiao, Shanzhi, Bohe.