火，阴虚火动难治。火郁当发，看何经，轻者可降，重者则从其性而升之。实火
可泻，黄连解毒之类；
虚火可补，小便降火极速。凡气有余便是火，不足者是气虚。火急甚重者，必缓之以生
甘草，兼泻兼缓，参术亦可。人壮气实火盛颠狂者，可用正治，或硝黄冰水之类；人虚火盛
狂者，以生姜汤与之，若投冰水正治，立死。有补阴即火自降，炒黄柏、生地黄之类。凡火
盛者，不可骤用凉药，必兼温散。
可发有二，风寒外来者可发，郁者可发。气从左边起者，乃肝火也；气从脐下起者，乃
阴火也；气从脚起入腹如火者，乃虚之极也。盖火起于九泉之下，多死。（一法）用附子末，津
调，塞涌泉穴，以四物汤加降火药服之，妙。阴虚证本难治，用四物汤加炒黄柏，降火补阴
，龟板补阴，乃阴中之至阴也。四物加白马胫骨，降阴中火，可代黄连、黄芩、黄连、黄芩
、栀子、大黄、黄柏降火，非阴中之火不可用。生甘草缓火邪；木通下行，泻小肠火；人中
白泻肝火，须风露中二三年者；人中黄大凉，治疫病须多年者佳。
中气不足者，味用甘寒，山栀子仁大能降火从小便泄去，其性能屈曲下降，人所不知，
亦治痞块中火邪。
入方
左金丸 治肝火。一名回令丸。
黄连（六两，一本作芩） 吴茱萸（一两或半两）
上为末，水丸或蒸饼丸。白汤五十丸。
〔附录〕诸热瞀 ，暴喑冒昧，躁扰狂越，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， ，暴疡，暴死，五
志七情过极，皆属火也。火者有，曰君火，人火也；曰相火，天火也。火内阴而外阳，主乎
动者也。故凡动，皆属火。以名而言，形质相生，配于五行，故谓之君；以位而言，生于虚
无，守位禀命，因动而见，故谓之相。肾肝之阴，悉其相火。东垣曰∶相火，元气之贼火，
与元气不相两立，一胜则一负。然则如之何则可使之无胜负乎？周子曰∶神发知矣。五性感
动而万事出，有知之后，五者之性，为物所感，不能不动。谓之动者，即《内经》五火也。
相火易起五性，厥阳之火相扇，则妄动矣。火起于妄，变化莫测，无时不有，煎熬真阴，阴
虚则病，阴绝则死。君火之气，经以暑与热言之。相火之气，经以火言之，盖表其暴悍酷烈
，有甚于君火者也。故曰∶相火，元气之贼。周子又曰∶圣人定之以中正仁义而主静。朱子
亦曰∶必使道心常为一身之主，而人心每听命焉，此善处乎火者。人心听命于道心，而又能
主之以静，彼五火将寂然不作。而相火者惟有俾补造化，而为生生不息
之运用尔，何贼之有？
附方
东垣泻阴火升阳汤 治肌热烦热，面赤食少，喘咳痰盛。
羌活 甘草（炙） 黄 苍术（各一两） 升麻（八钱） 柴胡（两半）人参 黄芩（各七钱） 黄连
（酒炒，半两） 石膏（半两，秋深不用）
上 咀。每服一两或半两，水煎。此药发脾
胃火邪，又心胆肝肺膀胱药也，泻阴火，升发阳气，荣养气血者也。
升阳散火汤 治男子妇人四肢发热，肌热，筋痹热，骨髓中热发，困热如燎，扪之烙手
。此病多因血虚而得之，或胃虚过食冷物，抑遏阳气于脾土，火郁则发之。
升麻 葛根 独活 羌活（各半两） 防风（二钱半）柴胡（八钱） 甘草（炙，三钱） 人参 白芍
（各半两） 甘草（生，二钱）
上 咀。每服半两或一两，水煎，稍热服。
地骨皮散 治浑身壮热，脉长而滑，阳毒火炽发渴。
地骨皮 茯苓（各半两） 柴胡 黄芩 生地黄 知母（各一两） 石膏（二两） 羌活 麻黄（各七
钱半，有汗并去之）
上 咀。每服一两，入姜煎。
黄连解毒汤 见暑类。
火证中，因阴虚导致火动者，难以治疗。对于火郁之证，应当采用发散的方法，需辨别病变所属的经络；病情轻浅的可以用降火法，病情严重的则应顺从其火热之性而用升散法。实火可以采用泻法，如使用黄连解毒汤之类的方剂；虚火可以采用补法，小便通畅能极速降低火势。凡是气有余就会化为火，气不足则是气虚。对于火势急迫且严重的患者，必须用生甘草来缓和药性，既泻火又缓急，人参、白术也可以使用。身体强壮、气实火盛而出现癫狂症状的人，可以使用正治法（寒凉直折），或者使用芒硝、大黄、冰水等寒凉之物；若是虚火旺盛导致的狂症，应用生姜汤给予患者，如果误投冰水进行正治，患者会立即死亡。通过补益阴液，火势自然下降，可使用炒黄柏、生地黄之类的药物。凡是火势旺盛的，不可骤然使用寒凉药物，必须兼用温散之法。
可以发散的病机有两种：风寒外袭者可以发散，火郁内结者也可以发散。气从身体左侧发起的，是肝火；气从脐下发起的，是阴火；气从脚部发起并上行入腹如火烧般的，是极度虚损的表现。这种火起于九泉之下（极深之处），多会导致死亡。（另一种治疗方法）使用附子末，以唾液调和，塞入涌泉穴，同时服用四物汤加入降火药物，效果奇妙。阴虚证本来难治，可用四物汤加入炒黄柏，以降火补阴；龟板能补阴，属于阴中之至阴。四物汤加白马胫骨，可降阴中之火，可以替代黄连、黄芩、栀子、大黄、黄柏来降火，但非阴中之火不可使用这些苦寒之品。生甘草能缓和火邪；木通引热下行，泻小肠之火；人中白能泻肝火，须经过风露吹打二三年以上的为佳；人中黄大凉，治疗疫病最好选用多年的。
中气不足的患者，用药味道宜用甘寒，山栀子仁能大幅降低火势并通过小便排出，其药性能够屈曲下降，这是人们所不知道的，也能治疗痞块中的火邪。
【入方】
左金丸：治疗肝火。又名回令丸。
组成：黄连（六两，另一版本作黄芩）、吴茱萸（一两或半两）。
制法与用法：上药研为细末，用水泛丸或蒸饼做丸。每次五十丸，白开水送服。
〔附录〕各种热证导致的昏闷、突然失音、神志昏迷、烦躁扰乱、狂越妄动、骂詈惊骇、肿胀疼痛酸楚、气逆冲上、战栗惊恐如同丧失神守、喷嚏呕吐、疮疡、喉痹、耳鸣及耳聋、呕吐溢食不下、视物不明、急性腹泻、暴发性疮疡、猝死，以及五志七情过度激动，都属于火证。火分为两类：称为君火的，是人火；称为相火的，是天火。火内里属阴而外表属阳，主要主宰运动。所以凡是运动变化，都归属于火。从名称而言，形质相生，配合五行，所以称为君；从位置而言，生于虚无，坚守本位禀受命令，因运动而显现，所以称为相。肾和肝的阴分中，都蕴藏着相火。李东垣说：相火是元气的贼害，火与元气不相容，一方胜则另一方负。那么怎样才能使它们没有胜负呢？周敦颐说：神发出知觉后，五性受到外界事物的感应而不能不动。所谓动，就是《内经》所说的五火。相火容易兴起，与五性厥阳之火相互扇动，就会妄动。火起于妄念，变化莫测，无时不在，煎熬真阴，阴虚就会生病，阴绝就会死亡。君火之气，经典中以暑和热来表述。相火之气，经典中以火来表述，大概是为了表明其暴悍酷烈，比君火更甚。所以说：相火是元气的贼害。周敦颐又说：圣人确立中正仁义而以静为主。朱熹也说：必须使道心常作为一身之主，而人心每每听命于它，这是善于处理火的方法。人心听命于道心，又能以静为主导，那么五火将寂静不作。而相火就只有辅助造化，成为生生不息的运用罢了，哪里还有贼害之说？
【附方】
东垣泻阴火升阳汤：治疗肌肉发热、烦热、面色红赤、食欲减少、气喘咳嗽痰多。
组成：羌活、炙甘草、黄芪、苍术（各一两）、升麻（八钱）、柴胡（一两半）、人参、黄芩（各七钱）、黄连（酒炒，半两）、石膏（半两，深秋时节不用）。
制法与用法：上药切碎。每次服用一两或半两，水煎服。此药能发散脾胃火邪，也是心、胆、肝、肺、膀胱的药，能泻阴火，升发阳气，荣养气血。
升阳散火汤：治疗男女四肢发热、肌肉发热、筋痹热、骨髓中发热，困倦燥热如火燎，触摸时烫手。此病多因血虚所致，或因胃虚过食冷物，遏制阳气于脾土，导致火郁，故用发散法。
组成：升麻、葛根、独活、羌活（各半两）、防风（二钱半）、柴胡（八钱）、炙甘草（三钱）、人参、白芍（各半两）、生甘草（二钱）。
制法与用法：上药切碎。每次服用半两或一两，水煎，稍热时服用。
地骨皮散：治疗浑身壮热，脉象长而滑，阳毒火炽导致口渴。
组成：地骨皮、茯苓（各半两）、柴胡、黄芩、生地黄、知母（各一两）、石膏（二两）、羌活、麻黄（各七钱半，若有汗则去掉麻黄）。
制法与用法：上药切碎。每次服用一两，加入生姜煎服。
黄连解毒汤：见暑类章节。
In fire syndromes, those caused by Yin deficiency leading to hyperactive fire are difficult to treat. For Fire Stagnation (Huo Yu), dispersing methods should be employed; one must identify the affected meridian. In mild cases, descending methods can be used; in severe cases, one should follow the nature of the fire and use ascending/dispersing methods. Excess Fire (Shi Huo) can be purged, using formulas such as Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity); Deficient Fire (Xu Huo) can be tonified, and unobstructed urination rapidly reduces fire. Whenever Qi is in excess, it transforms into Fire; when Qi is insufficient, it is Qi Deficiency. For cases where Fire is urgent and severe, raw Gancao (Glycyrrhizae Radix et Rhizoma) must be used to moderate the action, combining purging and moderating effects; Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) may also be used. For robust individuals with abundant Qi and excessive Fire presenting with mania or epilepsy, direct treatment (Zheng Zhi, using cold/cooling agents to subdue heat) can be applied, or substances like Xiaoshi (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), and Bing Shui (Ice Water) may be used. However, for patients with excessive Deficient Fire causing mania, Ginger Decoction (Shengjiang Tang) should be administered; if ice water is mistakenly used for direct treatment, death will occur immediately. By nourishing Yin, Fire naturally descends; this can be achieved with Chao Huangbai (Fried Phellodendri Cortex) and Shengdihuang (Rehmanniae Radix). In cases of vigorous Fire, cooling drugs should not be used abruptly; warming and dispersing methods must be combined.
There are two indications for dispersing: external contraction of Wind-Cold can be dispersed, and internal Fire Stagnation can also be dispersed. If Qi rises from the left side, it is Liver Fire; if Qi rises from below the navel, it is Yin Fire; if Qi rises from the feet and enters the abdomen feeling like fire, it indicates extreme Deficiency. Such Fire rising from the "Nine Springs" (extreme depths) often leads to death. (Alternative method): Use Fuzi powder (Aconiti Lateralis Radix Preparata), mixed with saliva, and apply it to Yongquan acupoint (KI 1); simultaneously administer Siwu Tang (Four Substances Decoction) added with Fire-descending herbs, which is effective. Yin Deficiency syndromes are inherently difficult to treat; Siwu Tang (Four Substances Decoction) added with fried Huangbai (Phellodendri Cortex) can descend Fire and tonify Yin. Guiban (Testudinis Carapax et Plastrum) tonifies Yin and belongs to the "Supreme Yin within Yin." Siwu Tang (Four Substances Decoction) added with Baima Jinggu (Equini Tibia Bone) can descend Fire within Yin, serving as a substitute for Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), Dahuang (Rhei Radix et Rhizoma), and Huangbai (Phellodendri Cortex); however, these bitter-cold herbs should only be used for Fire within Yin. Raw Gancao (Glycyrrhizae Radix et Rhizoma) moderates Fire pathogenic factors; Mutong (Akebiae Caulis) directs heat downward and drains Small Intestine Fire; Renzhongbai (Calcinatus Urinae Hominis) drains Liver Fire and should be exposed to wind and dew for two to three years; Renzhonghuang (Carbonized Human Faeces) is extremely cooling and is best used for treating Epidemic Diseases (Yi Bing) if aged for many years.
For patients with insufficient Middle Qi, flavors should be sweet and cold. Shan Zhizi Ren (Gardeniae Semen) greatly descends Fire and excretes it via urine; its property allows it to descend through twists and turns, a fact unknown to many, and it also treats Fire pathogens in Pi Kuai (Plaque masses).
[Formulas]
Zuojin Wan (Left Metal Pill): Treats Liver Fire. Also known as Huiling Wan.
Ingredients: Huanglian (Coptidis Rhizoma) (6 liang, another version says Huangqin [Scutellariae Radix]), Wuzhuyu (Evodiae Fructus) (1 liang or half liang).
Preparation and Administration: Grind into powder, make pills with water or steamed bread dough. Take 50 pills with warm water.
[Appendix] Various heat syndromes causing dizziness and confusion (Mao), sudden aphonia, coma, restlessness, mania, cursing, fright, swelling, pain, soreness, rebellious Qi rushing upward, trembling and fear as if losing spiritual control, sneezing, vomiting, sores and ulcers, throat obstruction (Hou Bi), tinnitus, and deafness, vomiting and overflow, inability to eat, blurred vision, acute diarrhea, sudden sores, sudden death, and the extreme excess of the Five Emotions and Seven Affects all belong to Fire. Fire is categorized into two types: Jun Huo (Ministerial Fire/Imperial Fire), which is Human Fire; and Xiang Huo (Assistant Fire), which is Heavenly Fire. Fire is Yin inside and Yang outside, primarily governing movement. Therefore, anything involving movement belongs to Fire. In terms of name, form and substance generate each other, corresponding to the Five Elements, hence called Jun (Emperor); in terms of position, it arises from emptiness, maintains its station receiving commands, and manifests through movement, hence called Xiang (Minister). The Yin of the Kidney and Liver both contain Xiang Huo (Assistant Fire). Li Dongyuan stated: Assistant Fire is the thief of Yuan Qi (Original Qi); Fire and Yuan Qi are incompatible; when one wins, the other loses. So how can we prevent this rivalry? Zhou Dunyi said: Spirit gives rise to consciousness. When the Five Natures are moved by external things, they cannot remain still. This movement refers to the Five Fires mentioned in the Neijing. Assistant Fire easily arises; when coupled with Jue Yang Fire of the Five Natures, it moves recklessly. Fire arises from delusion, changes unpredictably, exists at all times, and fries True Yin. Yin deficiency leads to disease, and Yin exhaustion leads to death. The Qi of Jun Huo (Imperial Fire) is described in classics as Summer Heat and Heat. The Qi of Xiang Huo (Assistant Fire) is described simply as Fire, indicating its violent, fierce, and cruel nature, which is more severe than Imperial Fire. Thus it is said: Assistant Fire is the thief of Original Qi. Zhou Dunyi further said: The Sage establishes correctness, justice, benevolence, and righteousness, and emphasizes Stillness. Zhu Xi also said: One must ensure that Dao Xin (Mind of the Way) is always the master of the body, while Ren Xin (Human Mind) obeys it; this is how to properly manage Fire. When the Human Mind obeys the Mind of the Way and is governed by Stillness, the Five Fires will become silent. Then Assistant Fire will only assist creation, functioning in endless generation, having no thieving nature.
[Attached Formulas]
Dongyuan Xie Yin Huo Sheng Yang Tang (Dongyuan's Decoction to Drain Yin Fire and Raise Yang): Treats muscle fever, vexatious heat, red face, poor appetite, asthma, cough, and profuse phlegm.
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma), Huangqi (Astragali Radix), Cangzhu (Atractylodis Rhizoma) (each 1 liang), Shengma ( Cimicifugae Rhizoma) (8 qian), Chaihu (Bupleuri Radix) (1.5 liang), Renshen (Ginseng Radix), Huangqin (Scutellariae Radix) (each 7 qian), Huanglian (Coptidis Rhizoma) (wine-fried, 0.5 liang), Shigao (Gypsum Fibrosum) (0.5 liang, do not use in late autumn).
Preparation and Administration: Cut into pieces. Take 1 liang or 0.5 liang per dose, decoct in water. This formula disperses Spleen and Stomach Fire pathogens; it also acts on the Heart, Gallbladder, Liver, Lung, and Bladder. It drains Yin Fire, raises and disperses Yang Qi, and nourishes Qi and Blood.
Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction): Treats fever in the four limbs of men and women, muscle fever, heat in tendon bi, heat in bone marrow, and oppressive heat like burning, where touching feels scalding. This condition often results from Blood Deficiency, or from Stomach Deficiency and overconsumption of cold foods, which suppresses Yang Qi in the Spleen Earth, causing Fire Stagnation; thus, dispersing is used.
Ingredients: Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Duhuo (Angelicae Pubescentis Radix), Qianghuo (Notopterygii Rhizoma et Radix) (each 0.5 liang), Fangfeng (Saposhnikoviae Radix) (2.5 qian), Chaihu (Bupleuri Radix) (8 qian), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) (3 qian), Renshen (Ginseng Radix), Baishao (Paeoniae Radix Alba) (each 0.5 liang), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) (2 qian).
Preparation and Administration: Cut into pieces. Take 0.5 liang or 1 liang per dose, decoct in water, and take slightly warm.
Digupi San (Digut皮的 Powder): Treats whole-body high fever, long and slippery pulse, Yang Toxin with blazing Fire causing thirst.
Ingredients: Digupi (Lycii Cortex), Fuling (Poria) (each 0.5 liang), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Shengdihuang (Rehmanniae Radix), Zhimu (Anemarrhenae Rhizoma) (each 1 liang), Shigao (Gypsum Fibrosum) (2 liang), Qianghuo (Notopterygii Rhizoma et Radix), Mahuang (Ephedrae Herba) (each 7.5 qian, remove Mahuang if sweating is present).
Preparation and Administration: Cut into pieces. Take 1 liang per dose, decoct with ginger.
Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity): See section on Summer Heat.