寒热病，凡阴虚者难治。久病恶寒，当用解郁。恶寒，阳虚也，用人参、黄 之类，甚者少加附子，以行参、
之气。背恶寒甚者，脉浮大无力者，是阳虚。虚劳冬月恶寒之甚，气实者可下，亦宜解表，用柴胡、葛根。用苍
术恐燥。阴虚发热，四物汤加炒柏，兼气虚者，加人参、白术、黄 ；阳虚发热，补中益气汤；湿痰夜发热，三补丸
加白芍药；气虚发热，参苏饮。久病阴虚气郁，夜热∶酒芍药（一两二钱） 香附（一两） 苍术（五钱） 片芩（三
钱） 甘草（一钱半） 蒸饼为丸服。发热有休止，或夜发昼止，昼发夜止，或巳午间发，或申未间发，小柴胡
加参、术；渴加栝蒌根。如脉弱服前药不减，补中益气汤倍加参、 、归、术，多服自愈。
发热恶寒宜解表，发热用柴胡，恶寒用苍术。气稍虚，骨蒸发热，或发寒，大便涩，脉实，能食，大便利则热除，柴
胡饮子。气实表热能食，脉弦无汗，而能睡者，或痰积寒
热，小柴胡汤。一人六月得患恶寒，大便结燥，不敢见风，人肥实，起居如常，大承气汤。一妇人恶寒，用苦
参、赤小豆各一钱为末，齑水吐后，用川芎、苍术、南星、酒芩，酒曲糊丸服之。一男子年二十三，因饮酒发热，用
青黛、栝蒌仁，研入姜汁，日饮数匙，三日而愈。一人，天明时发微寒便热至晚，两腋汗出，手足热甚，则胸满拘
急，大便实而能食，似劳怯病者，脉不数，但弦细而沉，询知因怒气得者，但用大柴胡汤，惟胸背拘急不除，后用二陈
汤加羌活、防风、黄芩、红花。进士周本道年三十余，得畏寒病，服附子数百而病甚，求治，脉弦而似缓，予以江茶
入姜汁、香油些少，吐痰一升许，减绵太半，及与防风通圣散去大黄、芒硝，加地黄，百余帖而安。周甚喜，予曰∶未
也燥热，已多血伤，亦深须淡食以养胃，内观以养神，则水可生而火可降，彼方勇于仕进，一切务外，不守禁忌。予
曰∶若多与补血凉药亦可稍安，内外不静，肾水不生，附毒必发病，安之后官于婺城巡夜，胃寒非附子不可疗，而性怕
生姜，只得猪腰子作片，煮附子三帖愈。予曰∶可急归，知其附毒易发，彼以为迂。半年后，果疽发背而死。一人年
二十余，九月间发热头痛，妄言见鬼，医与小柴胡汤十余帖，而热愈甚。其形肥，脉弦大而数，左大甚，遂作虚治
之。以人参、白术为君，茯苓、芍药为臣，黄 为佐，加附子一片为使，与二帖证不减。或言脉数大，狂热，又大渴，
附子恐误。予曰∶虚甚，误投寒凉之药，人肥，而左大于右，事急矣，非附子一片，行参、术，乌能有急救乎？再
与一帖，乃去附子而作大剂，与五十余帖，得大汗而愈，自又补养两月，气体犹未安。一男子年十九，凡农作不惮
劳，忽一日大发热而渴，恣饮水数碗，次早热退，目不识
人，言谬误自言，腹肚不能转侧，饮食不进，身转掉不能。又至二日来告急。脉两手涩而大，右为甚，于气海灸三十
壮，用白术二钱、黄 二钱、熟附一片、陈皮半钱，与十帖不效，反增发微渴，余证仍在，却进少粥，此气豁和
而血未应也。于前药去附子，加酒归以和血，因有热加人参一钱半，与三十帖而安，郑兄年二十余，秋初发热，口渴妄
言，病似鬼邪。八日后，两脉洪数而有力，形肥而白，筋骨稍露，脉搏手，必凉药所致，此劳倦病，温补自安。已得柴
胡七八帖矣，未效，因与黄 附子汤，冷与饮之，三帖后，微汗得睡，脉亦软，后又继之，以黄 白术汤调补十日安，
又加陈皮，与半月复旧。吕亲善饮不固，且好色，年半百，一日大恶寒，发战，渴不多饮，脉大而弱，右关稍实
略数，重则涩，盖酒热内郁，由表实而下虚也。以黄 倍干葛煎汤与之，尽五六帖，大汗而安。一妇人虚羸盗汗，恶
寒，用吴茱萸鸡子大，酒三升浸半日，煮服。面寒面热，面寒，是胃热，寒郁热也；面热，是火起，困郁而热也。人
有病，面上忽见红点者，多死。
寒热病，凡是阴虚体质的患者难以治愈。久病出现怕冷的症状，应当使用疏解郁滞的方法。怕冷，属于阳气虚弱，应使用人参、黄芪等药物，病情严重的少量加入附子，以推动人参、黄芪的药力运行。背部特别怕冷的，脉象浮大但无力，这是阳气虚弱。虚劳病在冬季特别怕冷的，如果气机壅实可以使用攻下法，也适宜使用解表法，选用柴胡、葛根。使用苍术恐怕过于燥烈。阴虚导致的发热，用四物汤加炒黄柏；兼有气虚的，加入人参、白术、黄芪；阳虚导致的发热，用补中益气汤；湿痰导致的夜间发热，用三补丸加白芍药；气虚导致的发热，用参苏饮。久病导致阴虚且气机郁滞，夜间发热的方剂：酒浸芍药（一两二钱）、香附（一两）、苍术（五钱）、黄芩（三钱）、甘草（一钱半），用蒸饼做成药丸服用。发热有间歇，或者夜间发作白天停止，白天发作夜间停止，或者在巳时午时之间发作，或者在申时未时之间发作，用小柴胡汤加人参、白术；口渴的加瓜蒌根。如果脉象虚弱，服用前面的药物没有减少，用补中益气汤加倍加入人参、黄芪、当归、白术，多服用自然痊愈。
发热怕冷适宜解表，发热用柴胡，怕冷用苍术。气稍微虚弱，骨蒸发热，或者发冷，大便干涩，脉象实，能进食，大便通畅后热邪自除，用柴胡饮子。气实、表热、能进食、脉弦、无汗而且能睡觉的，或者是痰积导致的寒热，用小柴胡汤。有一人六月患病怕冷，大便干结，不敢见风，身体肥壮结实，起居如常，用大承气汤。有一妇人怕冷，用苦参、赤小豆各一钱研末，用醋水催吐后，用川芎、苍术、天南星、黄芩（酒制），酒曲糊丸服用。有一男子二十三岁，因为饮酒发热，用青黛、瓜蒌仁，研磨后加入姜汁，每天喝几匙，三天痊愈。有一人，天亮时发轻微怕冷随后发热直到晚上，两腋下出汗，手足非常热，然后胸满拘急，大便实而能进食，像虚劳怯弱病的样子，脉不数，只是弦细而沉，询问得知是因为怒气引起的，只用大柴胡汤，只有胸背拘急没有消除，后来用二陈汤加羌活、防风、黄芩、红花。进士周本道三十多岁，得了畏寒病，服用了数百粒附子导致病情加重，求治，脉象弦而似缓，我给他江茶加入少许姜汁、香油，让他吐出痰液约一升，绵衣减去一半，然后给予防风通圣散去掉大黄、芒硝，加入地黄，一百多帖后安定。周非常高兴，我说：“还没好，体内仍有燥热，已经造成阴血损伤，也必须清淡饮食以养胃，内省以养神，这样肾水才能生而心火才能降。”他正勇于仕途进取，一切务外，不遵守禁忌。我说：“如果多给补血凉药也可以稍微安定，内外不静，肾水不生，附子的毒性必定会引发疾病。”后来他在婺城巡夜当官，胃寒非附子不可治疗，但他性格害怕生姜，只得用猪腰子切片，煮附子三帖而愈。我说：“可以赶快回家，知道他的附子毒性容易发作。”他认为我迂腐。半年后，果然因疽发背而死。有一人二十多岁，九月间发热头痛，胡言乱语见鬼，医生给小柴胡汤十余帖，而热势更甚。他身体肥壮，脉象弦大而数，左脉尤其大，于是按虚证治疗。以人参、白术为君药，茯苓、芍药为臣药，黄芪为佐药，加一片附子为使药，给两帖证候不减。有人说脉数大，狂热，又大渴，附子恐怕误事。我说：“虚损严重，误投寒凉药物，身体肥壮，而左脉大于右脉，情况紧急了，不用一片附子来推动人参、白术，怎么能有急救的效果呢？”再给一帖，然后去掉附子改为大剂量，给五十多帖，得大汗而痊愈，自己又补养两个月，体质仍未安定。有一男子十九岁，凡农作不怕劳累，忽然一天大发热而口渴，恣意饮水几碗，第二天早上热退，眼睛看不见人，言语谬误自言自语，腹部不能转侧，饮食不进，身体颤抖不能动弹。又到第二天来告急。两手脉象涩而大，右脉更甚，在气海穴灸三十壮，用白术二钱、黄芪二钱、熟附子一片、陈皮半钱，给十帖无效，反而增发轻微口渴，其余证候仍在，却进少粥，这是气已调和而血未应的缘故。在前药中去掉附子，加酒当归以和血，因为有热加人参一钱半，给三十帖而安定。郑兄二十多岁，秋初发热，口渴胡言乱语，病像鬼邪。八日后，两脉洪数而有力，身体肥壮而白，筋骨稍露，脉搏应手，一定是凉药所致，这是劳倦病，温补自然安定。已经吃了七八帖柴胡汤，未见效，因此给黄芪附子汤，冷着给他喝，三帖后，微汗得睡，脉也变软，后来又继续服用，用黄芪白术汤调补十日安定，又加陈皮，给半月恢复旧观。吕亲善饮酒不节制，且好色，年近半百，一天大恶寒，发抖，口渴但不多饮，脉大而弱，右关脉稍实略数，重按则涩，这是酒热内郁，由表实而下虚引起。用黄芪倍量干葛煎汤给他，喝完五六帖，大汗而安。有一妇人虚羸盗汗，怕冷，用吴茱萸鸡蛋大小，酒三升浸泡半天，煮服。面寒面热，面寒，是胃热，寒郁热所致；面热，是火起，困郁而热所致。人有病，面上忽然出现红点的，大多死亡。
In diseases of cold and heat, those with Yin deficiency are difficult to treat. For chronic illness accompanied by aversion to cold, one should use methods to resolve stagnation. Aversion to cold indicates Yang deficiency; use Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix). In severe cases, add a small amount of Fu Zi (Aconiti Lateralis Radix Praeparata) to promote the action of Ren Shen and Huang Qi. Severe aversion to cold in the back, with a pulse that is floating, large, and forceless, indicates Yang deficiency. In consumptive disorders, severe aversion to cold in winter: if Qi is excess, purgatives may be used; alternatively, exterior-resolving methods are suitable, using Chai Hu (Bupleuri Radix) and Ge Gen (Puerariae Lobatae Radix). Cang Zhu (Atractylodis Rhizoma) is feared for being too drying. For fever due to Yin deficiency, use Si Wu Tang (Four Substances Decoction) plus fried Bai Hu (Phellodendri Cortex); if Qi deficiency is also present, add Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Huang Qi (Astragali Radix). For fever due to Yang deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). For night fever due to damp-phlegm, use San Bu Wan (Three Tonics Pill) plus Bai Shao (Paeoniae Radix Alba). For fever due to Qi deficiency, use Shen Su Yin (Ginseng and Perilla Drink). For chronic Yin deficiency with Qi stagnation causing night fever: Jiu Shao Yao (Wine-processed Paeoniae Radix) 1 liang 2 qian, Xiang Fu (Cyperi Rhizoma) 1 liang, Cang Zhu (Atractylodis Rhizoma) 5 qian, Pian Qin (Scutellariae Baicalensis Radix) 3 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) 1.5 qian; make pills with steamed wheat cake dough and take.
Fever with paroxysms: occurring at night and stopping during the day, or vice versa; occurring between Si-Wu hours (9 AM - 1 PM) or Shen-Wei hours (3 PM - 7 PM): use Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma); if thirsty, add Gua Lou Gen (Trichosanthis Radix). If the pulse is weak and previous medicines do not reduce symptoms, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with increased amounts of Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma); taking it for a long time will lead to self-healing.
For fever with aversion to cold, exterior resolution is appropriate: use Chai Hu (Bupleuri Radix) for fever, and Cang Zhu (Atractylodis Rhizoma) for aversion to cold. If Qi is slightly deficient, with bone-steaming fever or chills, dry stool, excess pulse, ability to eat, and fever resolving after free bowel movements, use Chai Hu Yin Zi (Bupleurum Drink). If Qi is excess, with exterior heat, ability to eat, wiry pulse, no sweat, and ability to sleep, or for cold-heat alternating due to phlegm accumulation, use Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Case 1: A man contracted aversion to cold in June, with dry constipation, fear of wind, robust physique, and normal daily routine. Use Da Cheng Qi Tang (Major Order the Yellow Decoction).
Case 2: A woman with aversion to cold: use Ku Shen (Sophorae Flavescentis Radix) and Chi Xiao Dou (Vigna umbellata Seed), each 1 qian, powdered; induce vomiting with vinegar water, then use Chuan Xiong (Ligustici Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Nan Xing (Arisaematis Rhizoma Preparatum), and Huang Qin (Scutellariae Baicalensis Radix wine-processed); make pills with yeast paste.
Case 3: A 23-year-old man developed fever from drinking alcohol. Use Qing Dai (Indigo Naturalis) and Gua Lou Ren (Trichosanthis Semen), ground and mixed with ginger juice; drink several spoonfuls daily; cured in three days.
Case 4: A person had slight chills at dawn followed by fever until evening, sweating in both axillae, extreme heat in hands and feet, then chest fullness and stiffness, solid stool, ability to eat, resembling consumptive disease. Pulse was not rapid, but wiry, thin, and deep. Inquiry revealed onset due to anger. Use Da Chai Hu Tang (Major Bupleurum Decoction). Chest and back stiffness remained unresolved; later treated with Er Chen Tang (Two Cured Things Decoction) plus Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Huang Qin (Scutellariae Baicalensis Radix), and Hong Hua (Carthami Flos).
Official Zhou Bendao, over 30 years old, suffered from aversion to cold. He took hundreds of Fu Zi (Aconiti Lateralis Radix Praeparata) pills, worsening his condition. Seeking treatment, his pulse was wiry and seemingly slow. I gave him Jiang Cha (River Tea) with a little ginger juice and sesame oil to induce vomiting of about one sheng of phlegm. His cotton clothes were reduced by half. Then I prescribed Fang Feng Tong Sheng San (Wind-Barrier Universal Release Powder) without Da Huang (Rhei Radix et Rhizoma) and Mang Xiao (Natrii Sulfas), adding Di Huang (Rehmanniae Radix). After more than 100 doses, he stabilized. Zhou was very pleased. I said, "Not yet. Dry-heat remains, and blood yin has been damaged. You must eat bland foods to nourish the stomach and practice introspection to nourish the spirit, so that Kidney Water can generate and Heart Fire can descend." He was ambitious in his career, focused on external affairs, and ignored taboos. I said, "If given more blood-nourishing and cooling medicines, he might stabilize slightly. But with internal and external unrest, Kidney Water will not generate, and Fu Zi toxicity will inevitably manifest." Later, he served as a night patrol officer in Wucheng. His stomach cold required Fu Zi for treatment, but he feared Sheng Jiang (Zingiberis Rhizoma Recens). Thus, he sliced pork kidneys, boiled them with Fu Zi for three doses, and was cured. I said, "Return home immediately; your Fu Zi toxicity is prone to flare up." He thought me pedantic. Half a year later, he died from a carbuncle on the back.
Case 5: A man in his twenties had fever, headache, delirium, and hallucinations in September. The physician gave Xiao Chai Hu Tang (Minor Bupleurum Decoction) for over ten doses, but fever worsened. He was fat, with a wiry, large, and rapid pulse, especially on the left. Treated as deficiency: Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) as sovereign, Fu Ling (Poria), Shao Yao (Paeoniae Radix) as minister, Huang Qi (Astragali Radix) as assistant, and one piece of Fu Zi (Aconiti Lateralis Radix Praeparata) as envoy. Two doses showed no improvement. Some argued that with a rapid/large pulse, high fever, and intense thirst, Fu Zi was dangerous. I said, "Deficiency is severe. Mistakenly using cold/cool medicines, combined with obesity and left pulse larger than right, is critical. Without one piece of Fu Zi to move Ren Shen and Bai Zhu, how can there be emergency rescue?" Gave one more dose, then removed Fu Zi and made a large formula. Over 50 doses led to profuse sweating and cure. Self-nourishment continued for two months, constitution still unstable.
Case 6: A 19-year-old man, unafraid of labor in farming, suddenly had high fever and thirst, drank several bowls of water freely. Next morning fever subsided, blindness, delirious speech, inability to turn abdomen, anorexia, tremors. Urgent call on second day. Pulses both sides were choppy and large, right worse. Moxibustion 30 cones on Qi Hai (CV6). Use Bai Zhu (Atractylodis Macrocephalae Rhizoma) 2 qian, Huang Qi (Astragali Radix) 2 qian, Shu Fu Zi (Prepared Aconiti Lateralis Radix) 1 piece, Chen Pi (Citri Reticulatae Pericarpium) 0.5 qian. Ten doses ineffective, slight thirst increased, other symptoms persisted. Consumed little rice gruel. This indicates Qi harmonized but Blood not responding. Remove Fu Zi from previous formula, add Jiu Dang Gui (Wine-processed Angelicae Sinensis Radix) to harmonize Blood. Add Ren Shen (Ginseng Radix) 1.5 qian due to heat. Thirty doses led to stability.
Brother Zheng, over 20, had fever and thirst with delirium in early autumn, resembling possession. After eight days, pulses were surging, rapid, and forceful. Fat, white complexion, visible bones/tendons, pulse felt under fingers. Likely caused by cooling medicines. This is fatigue-labor disease; warm tonification brings peace. Already took 7-8 doses of Chai Hu (Bupleuri Radix) without effect. Prescribed Huang Qi (Astragali Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata) Tang, served cold. After three doses, slight sweat, slept well, pulse softened. Continued treatment. Used Huang Qi Bai Zhu Tang (Astragalus and Atractylodes Decoction) for ten days to stabilize, added Chen Pi (Citri Reticulatae Pericarpium), recovered fully in half a month.
Relative Lu, indulged in alcohol and lust, nearly 50 years old. One day severe aversion to cold, shaking, thirst but little desire to drink. Pulse large and weak, Right Guan slightly excess and rapid, heavy pressure choppy. Caused by internal stagnation of alcohol-heat, exterior excess with interior deficiency. Prescribed Huang Qi (Astragali Radix) with double amount of Gan Ge (Puerariae Lobatae Radix) decoction. Finished 5-6 doses, profuse sweat, stabilized.
A woman with emaciation, night sweats, and aversion to cold: Use Wu Zhu Yu (Evodiae Fructus) size of a chicken egg, soaked in 3 sheng of wine for half a day, boiled and taken.
Facial cold and heat: Facial cold is Stomach heat, cold stagnating heat. Facial heat is Fire arising, constrained and generating heat. If a patient suddenly shows red spots on the face, death is likely.