热无休止。曰发热。风寒客于太阳。有即发热者。有至一二日。始发热者。然必兼恶风恶寒。头痛身疼等症。
方为太阳发热。宜汗之。类方注云。太阳发热。寒时亦热。热时亦寒也。金鉴云。翕翕表热。蒸蒸里热。
俱有自汗症。表热自汗。宜桂枝解肌。里热自汗。宜凉膈承气。不可误治。当审其尿之白赤。舌之润燥为别。
愚按∶表热自汗。畏风恶寒。里热自汗。则不恶风寒。尤当认别。
邵评∶辨表热里热。分汗清下三法为治。
此风寒客于营卫。非比寒热之恶寒。虽身大热。亦恶寒也。发热无汗恶寒为表实。
宜麻黄汤。发热有汗恶寒为表虚。宜桂枝汤。
邵评∶以有汗无汗。辨表虚表实。
金鉴云。发热恶寒。发于阳。表也。有汗桂枝。无汗麻黄。无热恶寒。发于阴。里也。有汗
桂枝加附子汤。无汗宜麻黄附子细辛汤。
邵评∶以有热无热。辨发于阴发于阳。
头痛虽属三阳。惟太阳独多。故头痛专主表。太阳头痛。必兼恶寒发热。表解自除。
阳明头痛。在额前目鼻等处。无汗为表症。宜葛根汤加白芷、葱白等汗之。若自汗。
不恶寒。反恶热。大便实。小便赤。当以阳明里症治之。承气汤。少阳头痛。在头角耳根。脉弦数。口苦是也。
小柴胡去参。加川芎。有痰。如栝蒌。（参准绳）
发热没有停止的时候，称为“发热”。风寒之邪侵袭太阳经，有的立即发热，有的过了一两天才开始发热。但必定同时伴有怕风、怕冷、头痛、身体疼痛等症状，这才算是太阳经的发热，应当用发汗法治疗。《类方注》说：太阳经发热，在感到寒冷时也发热，在感到发热时也寒冷。《医宗金鉴》说：像鸟羽覆盖般的体表发热（翕翕表热），像蒸笼般的体内发热（蒸蒸里热），都伴有自汗症状。体表发热伴自汗，宜用桂枝汤解肌发表；体内发热伴自汗，宜用凉膈散或承气汤清热攻下，不可误治。应当通过观察小便颜色白赤、舌苔润燥来加以辨别。
我按语认为：体表发热伴自汗，会有畏风、恶寒的表现；体内发热伴自汗，则不会恶风恶寒，尤其需要仔细辨认。
邵评：辨别表热和里热，分别采用发汗、清热、攻下三种方法进行治疗。
这是风寒之邪客居于营卫之间，不同于单纯的寒热往来中的恶寒。虽然身体大热，仍然会感到恶寒。发热、无汗、恶寒属于表实证，宜用麻黄汤。发热、有汗、恶寒属于表虚证，宜用桂枝汤。
《医宗金鉴》说：发热且恶寒，是病发于阳，病位在表。有汗用桂枝汤，无汗用麻黄汤。不发热而恶寒，是病发于阴，病位在里。有汗用桂枝加附子汤，无汗宜用麻黄附子细辛汤。
风邪损伤卫气则表现为恶风，都属于表证。只是恶风比恶寒程度轻一些罢了。
头痛虽然涉及三阳经，但只有太阳经最多见。所以头痛主要主表证。太阳经头痛，必定兼有恶寒、发热，表证解除后头痛自然消除。阳明经头痛，部位在前额、眼睛、鼻子等处。无汗属于表证，宜用葛根汤加入白芷、葱白等药物发汗。如果自汗，不恶寒，反而恶热，大便干结，小便色赤，就应当以阳明经里证治疗，使用承气汤。少阳经头痛，部位在头角、耳根，脉象弦数，口苦，就是这种情况。用小柴胡汤去掉人参，加入川芎。如果有痰，加入栝蒌。（参考《准绳》）
Fever without cessation is termed "fever" (Fe Re). When Wind-Cold pathogens invade the Taiyang channel, fever may appear immediately or after one to two days. However, it must be accompanied by symptoms such as aversion to wind, aversion to cold, headache, and body ache. Only then is it considered Taiyang fever, which should be treated with diaphoresis (Han Zhi - inducing sweating). *Lei Fang Zhu* states: In Taiyang fever, there is heat during chills and chills during heat. *Yi Zong Jin Jian* states: "Xi Xi" (fluffy-like) exterior heat and "Zheng Zheng" (steaming-like) interior heat both present with spontaneous sweating (Zi Han). For exterior heat with spontaneous sweating, Guizhi Tang (Cinnamon Twig Decoction) should be used to resolve the muscle layer; for interior heat with spontaneous sweating, Liangge San (Cooling the Diaphragm Powder) or Chengqi Tang (Order the Qi Decoction) should be used to clear heat and purge accumulation. Misdiagnosis must be avoided. Differentiation should be made by observing whether urine is white or red and whether the tongue coating is moist or dry.
My commentary: Exterior heat with spontaneous sweating is accompanied by fear of wind and aversion to cold. Interior heat with spontaneous sweating is not accompanied by aversion to wind or cold. This distinction requires careful recognition.
Shao's Commentary: Differentiating between exterior heat and interior heat dictates the use of three treatment methods: diaphoresis, clearing heat, and purging.
This refers to Wind-Cold pathogens lodging in Ying (Nutrient) and Wei (Defensive) levels. It differs from the aversion to cold seen in alternating chills and fever. Even if the body is very hot, there is still aversion to cold. Fever with no sweat and aversion to cold indicates an Exterior Excess pattern, treated with Mahuang Tang (Ephedra Decoction). Fever with sweat and aversion to cold indicates an Exterior Deficiency pattern, treated with Guizhi Tang (Cinnamon Twig Decoction).
Shao's Commentary: Differentiating between presence and absence of sweat distinguishes between Exterior Deficiency and Exterior Excess.
*Yi Zong Jin Jian* states: Fever with aversion to cold indicates onset on Yang, located in the exterior. With sweat, use Guizhi Tang; without sweat, use Mahuang Tang. Absence of fever with aversion to cold indicates onset on Yin, located in the interior. With sweat, use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite); without sweat, use Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction).
Shao's Commentary: Differentiating between presence and absence of fever distinguishes between onset on Yin and onset on Yang.
Wind pathogen damaging Wei Qi results in aversion to wind. Both are exterior patterns, but aversion to wind is milder than aversion to cold.
Although headache involves the Three Yang channels, it is most common in the Taiyang channel. Therefore, headache primarily indicates an exterior pattern. Taiyang headache must be accompanied by aversion to cold and fever; once the exterior is resolved, the headache disappears. Yangming headache occurs in the forehead, eyes, and nose. Absence of sweat indicates an exterior pattern, treated with Gegen Tang (Kudzu Decoction) plus Baizhi (Angelicae Dahuricae Radix) and Congbai (Allii Fistulosi Bulbus) to induce sweating. If there is spontaneous sweating, no aversion to cold, but rather aversion to heat, solid stool, and red urine, it should be treated as a Yangming interior pattern using Chengqi Tang (Order the Qi Decoction). Shaoyang headache occurs at the temples and ear roots, characterized by a wiry and rapid pulse and bitter taste in the mouth. Use Xiaochaihu Tang (Minor Bupleurum Decoction), removing Renshen (Ginseng Radix), and adding Chuanxiong (Ligustici Chuanxiong Rhizoma). If phlegm is present, add Gualou (Trichosanthis Fructus). (Refer to *Zhun Sheng*)