火症之脉。洪数为顺。细数无力则凶。亦有火盛之极。而脉反沉。小伏匿者。即大易。所谓干之上九
亢龙有悔者。是也。脏腑之中。火从何来。气之不得其平为之也。有实火。有虚火。有相火。有燥火。
有湿热之火。又有郁火。猛烈之火。无名之火。皆不可以不察也。何谓实火。心火燔灼。胃火助之。元气未
损。真精未亏。或因饮酒之蕴热。或因暴热之外侵。目赤。喉痛。胸满。气喘。宜用黄连清心汤。柴胡泻肝汤。
黄芩清肺汤之类。若是虚火。东垣之论。确不可易。东垣曰。饮食所伤。劳倦所损。或气高而喘。身热而烦。
症似白虎。但脉来洪大。虚而不长。不可以实火投治。当有补中益气汤。补其中气则自愈
矣。倘以实火治之。立见危殆。又有相火者。生于虚无。寄于肝肾之间。乃元气之贼。无时而不熬煎真阴。
阴虚则病。阴绝则死。急用滋阴地黄汤。填补真阴。务使水壮而火息。一切凉药。毫不可施。至若燥火者。肠胃涩滞。
津血不充。大便常闭。先用脾约丸润之。后用地黄固本之剂。若用芩连栀柏。百
剂无功。湿火者。湿生乎热。热生乎湿。湿热相生。遂成胀满。或痿与臌。从而
生焉。故有大便久秘。及更衣则又溏泄。热在肠胃之外故秘。湿在肠胃之中故溏。宜用柴苓汤加黄柏玄参之类。
不可因其泄泻。禁其寒凉。若夫猛烈之火。或从右胁起。或从脐下起。或从足底起。皆为疠症。丹溪以为不可
骤用凉药。恐其扑之而愈张。抑之而愈扬。先以甘草煎汤。兼泻兼缓。俟其猖狂少定。量其虚实治之。亦一法也。
郁火者。腹中作痛。肌表热。四肢热。摸之烙手。此因过食生冷。郁遏阳气于脾土之宜用清阳散火汤。无名之火
一发。即不识人。或狂言失志。或直视声鸣。或手足螈 。或闭目无言。或发
数日而终者。或一发便脱者。或卧枕而逝。人不及知者。既无经络之可寻。
又无脉症之可据内经所谓暴病暴死。皆属于火者是也。可不审乎。（按人身肝火最烈燔灼无忌善治者先平肝
火而余脏之火自缓也）
黄连清心汤
当归 白芍 生地 麦冬 山栀 连翘 甘草 薄荷
柴胡泻肝汤
柴胡 甘草 当归 川芎 青皮 山栀 连翘 龙胆草
黄芩清肺汤
荆芥 薄荷 黄芩 山栀 连翘 麦冬 白芍 桔梗 甘草 桑皮
滋水地黄汤
熟地 山药 白茯 丹皮 山萸 泽泻 麦冬 白芍 玄参
清阳散火汤
山栀 黄芩 白芍 白芷 紫苏 川芎 枳壳 桔梗 甘草 白茯
火证（以火热为主要病机的病证）的脉象，洪大且数（快）为顺证。若脉细数而无力，则为凶兆。也有火势极盛，但脉象反而沉伏、细小隐匿的情况，这属于《易经》中所谓“亢龙有悔”的道理。
在脏腑之中，火从何而来？是由于气机失去平衡所致。有实火，有虚火，有相火，有燥火，有湿热之火，还有郁火、猛烈之火、无名之火，这些都不可以不仔细辨别。
什么是实火？心火炽盛，胃火助势，元气未受损，真精未亏损。或因饮酒蕴积内热，或因暴热外邪侵袭。症状见目赤、喉痛、胸满、气喘。适宜使用黄连清心汤、柴胡泻肝汤、黄芩清肺汤等方剂。
如果是虚火，李东垣的论述确实不可更改。李东垣说：饮食所伤，劳倦所损，出现气高而喘，身热而烦，症状看似白虎汤证，但脉来洪大却虚弱而不长实，不可以按实火治疗。应当用补中益气汤，补益其中气则自然痊愈。倘若按实火治疗，立刻就会见到危险。
又有相火，生于虚无，寄居于肝肾之间，是元气的贼寇，无时无刻不在煎熬真阴。阴虚则生病，阴绝则死亡。急需使用滋阴地黄汤，填补真阴，务必使水壮而火息，一切寒凉药物，丝毫不可施用。
至于燥火，肠胃涩滞，津血不充，大便常闭结。先用脾约丸润肠通便，后用地黄固本之剂。如果使用黄芩、黄连、栀子、黄柏等苦寒药，百剂也无效。
湿火者，湿生乎热，热生乎湿，湿热相生，遂成胀满，或痿证与鼓胀随之产生。因此有大便久秘，以及排便时又溏泄的情况。热在肠胃之外故便秘，湿在肠胃之中故溏泄。适宜用柴苓汤加黄柏、玄参之类。不可因其泄泻，就禁止使用寒凉药物。
至于猛烈之火，或从右胁起，或从脐下起，或从足底起，都属于疠症（此处指病情危重急骤之症）。朱丹溪认为不可骤然使用凉药，恐怕压制它反而使其更张狂，抑制它反而使其更飞扬。先用甘草煎汤，兼施泻法与缓法，等待其猖狂之势稍定，再衡量其虚实进行治疗。这也是一种方法。
郁火者，腹中作痛，肌表发热，四肢发热，摸上去烫手。这是因为过食生冷，导致阳气郁遏于脾土。适宜用清阳散火汤。
无名之火，一发即不识人，或狂言失志，或直视声鸣，或手足抽搐，或闭目无言。有的发作数日后终了，有的一发便脱证，有的卧枕而逝，人来不及知道。既然没有经络可寻，又没有脉症可据，《内经》所谓“暴病暴死，皆属于火”说的就是这种情况。能不审慎吗？（按：人身肝火最烈，燔灼无忌，善于治疗的人先平肝火，其余脏腑的火自然缓解。）
黄芩清肺汤
荆芥、薄荷、黄芩、山栀、连翘、麦冬、白芍、桔梗、甘草、桑皮
滋水地黄汤（原文为滋阴地黄汤，方名处写滋水地黄汤，此处依方名修正或保留原意，通常指六味地黄加减，此处列出药材）
熟地、山药、白茯、丹皮、山萸、泽泻、麦冬、白芍、玄参
Pulse patterns in Fire Syndrome (diseases where heat-fire is the primary pathogenic factor) should be surging and rapid, which indicates a favorable prognosis. If the pulse is fine, rapid, and forceless, it indicates an ominous sign. There are also cases where fire is extremely abundant, yet the pulse appears sunken, minute, and hidden; this corresponds to the principle of "the exalted dragon has regrets" from the *I Ching* (Book of Changes).
Where does fire originate within the zang-fu organs? It arises when qi loses its balance. There is excess fire, deficiency fire, ministerial fire, dryness-fire, damp-heat fire, as well as constrained fire, fierce fire, and nameless fire; all these must be carefully distinguished.
What is excess fire? Heart fire blazes fiercely, assisted by stomach fire, while original qi remains undamaged and true essence unimpaired. It may result from accumulated heat due to alcohol consumption or invasion by sudden external heat pathogens. Symptoms include red eyes, sore throat, chest fullness, and asthma. Formulas such as Huanglian Qingxin Tang (Coptis Decoction to Clear the Heart), Chaihu Xiegan Tang (Bupleurum Decoction to Drain the Liver), and Huangqin Qingfei Tang (Scutellaria Decoction to Clear the Lung) are appropriate.
If it is deficiency fire, Li Dongyuan's discussion is indeed irrefutable. Li Dongyuan stated: Injury from diet and damage from overwork can lead to high-pitched breathing with asthma, body heat with irritability. The symptoms resemble those treated by Baihu Tang (White Tiger Decoction), but the pulse is surging and large yet deficient and not long/full. It should not be treated as excess fire. Instead, Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) should be used; tonifying middle qi will lead to spontaneous recovery. If treated as excess fire, danger will appear immediately.
There is also ministerial fire, which arises from emptiness and resides between the liver and kidneys. It is the thief of original qi, constantly simmering true yin. Yin deficiency leads to disease, and yin exhaustion leads to death. Urgently use Ziyin Dihuang Tang (Nourish Yin Rehmannia Decoction) to fill true yin, ensuring that water becomes strong and fire subsides. All cooling medicines must absolutely not be applied.
Regarding dryness-fire, the intestines and stomach are obstructed, fluids and blood are insufficient, and constipation is common. First use Pi Yue Wan (Spleen-Restricting Pill) to moisten, followed by Rehmannia-based formulas to consolidate the root. Using bitter-cold herbs like Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex) will yield no results even after hundreds of doses.
Damp-fire arises because dampness generates heat, and heat generates dampness; they produce each other, leading to distension and fullness, or flaccidity syndrome and drum-like abdominal distension. Thus, there may be prolonged constipation followed by loose stools during defecation. Heat outside the intestines and stomach causes constipation, while dampness inside causes loose stools. Chai Ling Tang (Bupleurum and Poria Decoction) added with Huangbai (Phellodendri Cortex) and Xuanshen (Scrophulariae Radix) is suitable. Do not prohibit cold-natured medicines simply because of diarrhea.
As for fierce fire, whether originating from the right hypochondrium, below the umbilicus, or the soles of the feet, it belongs to severe acute conditions (li zheng). Zhu Danxi believed that cooling medicines should not be used abruptly, fearing that suppressing it would make it more rampant and restraining it would make it rise higher. First, decoct licorice soup to combine purgative and moderating effects. Wait until its ferocity subsides slightly, then treat according to deficiency or excess. This is another method.
Constrained fire presents with abdominal pain, surface heat, and limb heat, feeling burning to the touch. This is caused by excessive consumption of raw and cold foods, which constrains yang qi within the spleen and earth. Qingyang Sanhuo Tang (Clear Yang Disperse Fire Decoction) is appropriate.
Nameless fire, upon onset, causes loss of consciousness, delirious speech, loss of memory, staring gaze with vocalizations, convulsions of hands and feet, closed eyes with silence, death after several days of发作, immediate collapse upon onset, or death while lying on a pillow without others knowing. Since there are no meridians to trace and no pulse-symptom correlation to rely on, this aligns with the *Neijing* statement: "Sudden diseases and sudden deaths all belong to fire." Can one fail to examine this carefully? (Note: Liver fire in the human body is the fiercest, blazing without restraint. Skilled practitioners first pacify liver fire, and the fire in other organs naturally subsides.)
Huanglian Qingxin Tang (Coptis Decoction to Clear the Heart)
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Bohe (Menthae Haplocalycis Herba)
Chaihu Xiegan Tang (Bupleurum Decoction to Drain the Liver)
Chaihu (Bupleuri Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Longdancao (Gentianae Radix)
Huangqin Qingfei Tang (Scutellaria Decoction to Clear the Lung)
Jingjie (Schizonepetae Spica), Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Maidong (Ophiopogonis Radix), Baishao (Paeoniae Radix Alba), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Sangpi (Mori Cortex)
Zishui Dihuang Tang (Nourish Water Rehmannia Decoction)
Shudi (Rehmanniae Radix Preparata), Shanyao (Dioscoreae Rhizoma), Baifu (Poria), Danpi (Moutan Cortex), Shanzhuyu (Corni Fructus), Zexie (Alismatis Rhizoma), Maidong (Ophiopogonis Radix), Baishao (Paeoniae Radix Alba), Xuanshen (Scrophulariae Radix)
Qingyang Sanhuo Tang (Clear Yang Disperse Fire Decoction)
Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba), Baizhi (Angelicae Dahuricae Radix), Zisu (Perillae Folium), Chuanxiong (Ligustici Chuanxiong Rhizoma), Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Baifu (Poria)