日三四五发者,谓之发热。寅卯太阳表也,桂枝麻黄;巳午少阳柴胡。
热在外也,若翕翕覆热而不炽,即风寒怫郁阳气所致。
热在内也,若火之蒸灼然而热,即阳气下陷入阴中,热先自里而表。
表里俱热,则半表半里也,但热有轻于纯在表者也。
不治症
阴阳俱虚,热不止者死。
下利热不止者死。
汗后复热而脉躁疾,狂言不能食,名曰阴阳交死,乃肾虚感邪,则阴邪与真阳交合,伏入于
心包络之间,先用三黄泻心汤加参附三服,和其心包。病若静,次用知母麻黄汤三服,开泄心包
之邪,又次用竹叶石膏汤,复其津液。
无时而歇,非比发热时发时止。
烦热与发热,二者俱表也。
曰病患烦热汗出而解;又曰发热已解,半日许复烦,再与桂枝汤;又曰,服桂枝反烦不解,
先刺风池、风府,再与桂枝。
发汗不入格病不解,宜再汗,汗后再伤风寒而热,宜再汗。
汗后温温而热,脉弦小而数,有余热也,宜和解之。
汗后温温而热,脉静身无痛处,虚热也,宜平补之。
汗后温温而热,或渴,或胸满,或腹急,有里证,脉沉数,宜下之。
风邪干卫,自汗表虚,脉浮而无力,桂枝和之。
暑邪干卫,中 自汗,恶寒身热而渴,脉虚,白虎主之。
湿邪干卫,多汗而厥,脉濡沉,此其风湿甚者,白虎加苍术。
风湿自汗,脉弦,宜葳蕤汤,彻其热也。
寒渐入里,传而为热,亦使自汗。
以上皆表邪未解也。
漏不止而恶风自汗亡阳,脉沉细,宜桂附汤温经,此表之虚也。
阳明发热,其汗如雨,则胃汁内干,急下之,下迟津液内涸,黑斑而死。
自汗脉沉数有力,宜下之。
柔 自汗,脉沉,宜小续命,散其风邪。
霍乱自汗,脉细紧,宜四逆回阳也。
少阴病反自汗,脉沉细,宜四逆汤,补其肾也。
一天发作三四次的,称为发热。寅时和卯时对应太阳经表证,可用桂枝汤或麻黄汤;巳时和午时对应少阳经证,用柴胡剂。
热在体表,如果感觉像鸟羽覆盖般的闷热而不剧烈,这是风寒郁遏阳气所致。
热在体内,如果像火蒸灼那样炽热,这是阳气下陷进入阴分,热势先从内部发于体表。
表里都热,属于半表半里证,但热度比完全在体表的要轻。
不治之症
阴阳两虚,发热不止的,预后不良(死)。
腹泻且发热不止的,预后不良(死)。
发汗后再次发热,脉象躁动疾速,胡言乱语不能进食,名为“阴阳交”,属死证。这是由于肾虚感受邪气,阴邪与真阳交合,潜伏在心包络之间。先用三黄泻心汤加人参、附子服用三剂,以调和心包络。若病情安定,再用知母麻黄汤服用三剂,以开泄心包络的邪气,接着再用竹叶石膏汤,以恢复津液。
一天发作一次,时间在未时到申时之间停止,属于阳明经证,可以用攻下法,因为热已入胃的缘故。
没有固定时间间歇,不像发热那样时发时止。
烦热与发热,两者都属于表证。
说病患烦热出汗后病解;又说发热已解,半天左右又出现烦热,再给予桂枝汤;又说,服用桂枝汤反而烦热不解,先针刺风池穴、风府穴,再给予桂枝汤。
发汗后病邪未除,应当再次发汗;发汗后又受风寒而发热,应当再次发汗。
发汗后微微发热,脉象弦小而数,是余热未尽,宜用和解法。
发汗后微微发热,脉象平静身体无疼痛处,是虚热,宜用平补法。
发汗后微微发热,或者口渴,或者胸满,或者腹部拘急,有里证,脉象沉数,宜用攻下法。
风邪侵犯卫分,自汗出且表虚,脉浮而无力,用桂枝汤调和。
暑邪侵犯卫分,自汗出,恶寒身热且口渴,脉虚,用白虎汤主治。
湿邪侵犯卫分,多汗且四肢厥冷,脉濡沉,这是风湿较重的情况,用白虎加苍术汤。
风湿导致自汗,脉象弦,宜用葳蕤汤,以清除其热。
寒气逐渐入里,传变而为热,也导致自汗。
以上皆属于表邪未解的情况。
汗漏不止且恶风自汗导致亡阳,脉象沉细,宜用桂附汤温通经脉,这是表虚证。
阳明经发热,汗如雨下,则胃中津液内干,急需攻下;攻下迟缓则津液枯竭,出现黑斑而死。
自汗且脉象沉数有力,宜用攻下法。
柔痓导致自汗,脉象沉,宜用小续命汤,疏散风邪。
霍乱导致自汗,脉象细紧,宜用四逆汤回阳救逆。
少阴病反见自汗,脉象沉细,宜用四逆汤,以补肾。
Episodes occurring three to five times a day are termed *fa re* (fever). The Yin and Mao hours correspond to the Taiyang exterior syndrome, for which Guizhi Tang (Cinnamon Twig Decoction) or Mahuang Tang (Ephedra Decoction) are indicated; the Si and Wu hours correspond to the Shaoyang syndrome, for which Chaihu preparations are used.
When heat is in the exterior, if it feels like a mild, covering warmth without being intense, this is caused by Wind-Cold stagnating and obstructing Yang Qi.
When heat is in the interior, if it is scorching hot like steaming fire, this is due to Yang Qi sinking into the Yin, with heat originating from the interior and manifesting in the exterior.
When both exterior and interior are hot, it is a Half-Exterior Half-Interior syndrome, but the heat is milder than that purely in the exterior.
Incurable Syndromes
If Yin and Yang are both deficient and fever persists, the prognosis is fatal.
If diarrhea occurs with persistent fever, the prognosis is fatal.
If fever recurs after sweating, accompanied by a restless and rapid pulse, delirious speech, and inability to eat, it is named "Yin-Yang Jiao" (Intertwining of Yin and Yang), which is fatal. This results from Kidney deficiency allowing pathogenic factors to invade, where Yin pathogens combine with True Yang, lodging between the Pericardium Collaterals. Initially, Sanhuang Xiexin Tang (Three Yellows Draining the Heart Decoction) plus Renshen (Ginseng Root) and Fuzi (Aconite Lateralis Radix Preparata) should be administered for three doses to harmonize the Pericardium. If the condition stabilizes, Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction) should be given for three doses to vent the pathogens from the Pericardium. Subsequently, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used to restore Body Fluids.
An episode occurring once a day, ceasing between Wei and Shen hours, belongs to the Yangming syndrome and can be treated with purgation, as the heat has entered the Stomach.
The cessation of symptoms occurs at irregular intervals, unlike fever which comes and goes periodically.
Fan re (restless heat) and fa re (fever) both belong to exterior syndromes.
It is stated that when a patient experiences restless heat and sweating, the disease resolves; it is also stated that after fever resolves, if restlessness returns after half a day, Guizhi Tang should be administered again; furthermore, if administering Guizhi Tang fails to resolve the vexation, Fengchi (GB20) and Fengfu (GV16) acupoints should be needled first, followed by Guizhi Tang.
If sweating does not resolve the stubborn disease, another course of sweating is appropriate; if wind-cold invades again after sweating causing fever, another course of sweating is appropriate.
After sweating, if there is slight heat with a wiry, small, and rapid pulse, it indicates residual heat, and harmonization is appropriate.
After sweating, if there is slight heat with a calm pulse and no body pain, it is deficient heat, and gentle tonification is appropriate.
After sweating, if there is slight heat, or thirst, or chest fullness, or abdominal urgency, indicating interior signs, with a deep and rapid pulse, purgation is appropriate.
When Wind pathogens invade the Defensive level, causing spontaneous sweating and exterior deficiency with a floating and weak pulse, Guizhi Tang should be used to harmonize.
When Summerheat pathogens invade the Defensive level, causing spontaneous sweating, aversion to cold, body heat, and thirst with a deficient pulse, Baihu Tang (White Tiger Decoction) is the primary treatment.
When Dampness pathogens invade the Defensive level, causing excessive sweating and cold extremities with a soggy and deep pulse, this indicates severe Wind-Dampness, and Baihu Tang plus Cangzhu (Atractylodis Rhizoma) is indicated.
For Wind-Dampness causing spontaneous sweating with a wiry pulse, Weirui Tang (Juncus Decoction) is appropriate to clear the heat.
Cold gradually entering the interior and transforming into heat also causes spontaneous sweating.
All the above cases involve unresolved exterior pathogens.
If sweating leaks continuously with aversion to wind and spontaneous sweating leading to collapse of Yang, with a deep and fine pulse, Guifu Tang (Cinnamon and Aconite Decoction) should be used to warm the meridians; this is an exterior deficiency syndrome.
In Yangming fever, if sweating is profuse like rain, the Stomach fluids are internally dried up, requiring urgent purgation; delayed purgation leads to exhaustion of fluids, appearance of black spots, and death.
Spontaneous sweating with a deep, rapid, and forceful pulse requires purgation.
For Rouji (soft spasm) causing spontaneous sweating with a deep pulse, Xiao Xuming Tang (Minor Continuation of Life Decoction) is appropriate to disperse Wind pathogens.
For Huoluan (cholera-like disorder) causing spontaneous sweating with a fine and tight pulse, Sini Tang (Frigid Extremities Decoction) is appropriate to restore Yang.
In Shaoyin disease, spontaneous sweating appearing contrary to expectation, with a deep and fine pulse, Sini Tang is appropriate to tonify the Kidney.