一风寒郁热
阳气自内达外，喜畅达而恶遏闭。若风寒外袭，则阴凝之气，足以闭固腠理，
而表阳不宣，则郁而为热也。证见头项强痛，恶风汗出，脉浮缓者为伤风。兼体痛
而恶寒无汗，脉浮紧者为伤寒。治宜解肌发表，得汗则热泄而愈。（此乃表阳受郁。）
一饮食郁热
饮食停滞中脘，则脾胃之阳气被其遏抑，不能宣通，亦郁而成热。证见头痛发
热，如伤寒而身不痛，恶食欲吐，嗳腐吞酸，胸口饱闷，或胀痛，气口脉滑大，甚
或沉伏。治宜消导。（此乃里气受郁。）
一为痰饮郁热
痰饮所在之处，气被阻滞，郁而成热，理同食滞。证见恶风自汗似伤寒，但头
不痛，项不强，或头痛而作止无常，胸膈不快，恶心，气上冲，目下如灰色，或烟
黑，脉弦滑。治宜除痰。
一为瘀血郁热（痈疽同）
理同痰饮。证见小便利，大便黑，小腹脐或胸胁急结，按之痛，或两足厥冷，
或吐红鼻衄，不渴，即渴亦嗽水不咽，脉必涩。治宜行血。柴胡、黄芩、川芎、
白芷、桃仁、五灵脂、甘草，便结加大黄、浓蜜，利出黑物愈。疮毒则脉弦数恶寒，
饮食如常，而有痛处。
一为水湿郁热
水湿由外感者，理同风寒，由内伤者，理同痰饮。证见身重，或重痛不可转侧，
骨节掣痛，屈伸不利，汗出恶风，不欲去衣，头如裹，声如从瓮中出，脉迟缓。治
宜利湿。
一为肝气郁热
恚怒不发，止自摧抑，则肝气不宣，郁而成热，妇人最多此证。证见胸胁胀痛，
或飧泄，面青，手足冷，太息不乐，脉沉弦。木郁则达之，宜逍遥散。（见郁。）
一为脾气郁热
或劳倦气散，或思虑气结，或饥饿气馁，中气因而衰微，不能营运，或滞于中，
或陷于下，而郁滞成热。证见怠惰嗜卧，行动喘乏，四肢困倦，（此劳倦饥馁伤。）或时自
言自语，不知首尾，（此思虑伤。）夜分即热，（气行里亲下，滞陷愈甚也。）天明暂缓，（气外出上升，郁
陷得略解也。此初郁病证）。或昼夜不解，（郁久则热甚，不分昼夜矣）。或日出气暄则热，天阴夜
凉则缓，（郁热又久，则气耗散，愈热愈耗，愈耗愈热。昼动阳浮，故加烦热，动散静存，故天阴夜凉则缓。缘
初则郁热而生火，继则火发而热剧，终则火壮而气耗。节次如此，乃病成而变之理，不可不知）。五心烦热，甚
则肌肉筋骨如烧。此李东垣所谓阳虚发热也。（此症《内经》名阴虚发热。阴字当内字看，东垣名
阳虚发热，阳字当气字看，合二说言之，是内气虚发热也）。与上条阳虚发热，戴阳格阳症不同。盖
此为中焦之阳，彼为下焦之阳，彼格阳是内寒而外热，此则内外皆热而无寒。戴阳
是上热而下寒，此则热反下陷而无寒，故不同也。治宜培补中气。气旺则滞者运，
气升则陷者举矣。（五脏郁证，止举肝脾，余当于郁证门求之。）劳倦者，加酸味以敛其浮越。
上疏发热之理，至热分脏腑、经络、三焦、昼夜、血气、虚实，详后。
一热分脏腑经络
东垣云∶五脏有邪，各有身热，其状各异。（脉皆洪数，而有浮沉之别。）以轻手扪之则
热，重按之则不热，（王海藏谓∶皮肤如火燎，重按则不甚热。然则东垣所云不热，非全不热也，特不甚热耳。
下仿此。）是热在皮毛血脉也。在皮毛者属肺热，申酉尤甚。（肺金气旺时也。）症见喘咳，洒淅恶寒，
轻者泻白散，重者凉膈散、白虎汤、地骨皮散之类治之。白晴赤，烦渴，黄芩一物
煎汤，丹溪清金丸，即黄芩为末，粥丸。二方泻肺中血分之火，泻白散泻肺中气分
之火。在血脉者属心热，日中益甚。症见烦心，掌中热，以黄连泻心汤泻丁，导赤
散泻丙，火腑丹（见淋）丙丁俱泻，朱砂安神丸（见烦躁）、清凉饮子（见伤燥）之类治之。
重按至筋骨之分，则热蒸手极甚，轻摸之则不热，是热在筋骨间也。在筋者（肌肉之下，
骨之上也）属肝热，寅卯间甚。（或寅申间发。）症见胸胁满闷，便难，转筋，多怒善惊，四肢
困热，筋痿不能起床，泻青丸、柴胡饮（见虚损）之类治之。或当归龙荟丸（见胁痛）、左金丸。
在骨者属肾热，亥子尤甚，骨蒸，酥酥然如虫蚀，困热不任，亦不能起
于床，滋肾丸（见小便不通）、六味地黄丸（见虚损）主之。轻扪重按俱不热，不轻不重按之而热，
是热在肌肉也，属脾热，遇夜尤甚。（脾阴土，夜属阴。）症见怠惰嗜卧，四肢不收，无气
以动。实热，以泻黄散、调胃承气汤（见大便不通）治之。虚热，以人参黄 散、补中益
气汤（见气）治之。胃中热则消谷，令人悬心，（心神被火灼，故悬悬不宁也。）善饥，脐以上皮热，
（胃居脐上也。）肠中热则出黄如糜，（糜粥也。）脐以下皮热。（肠居脐下也。）由是推之，肝胆热，
则胁亦热，心肺热，则胸背亦热，肾热，则当腰亦热矣。两手太热，如在火中，为
骨厥，灸涌泉穴三壮立愈。手足心热，栀子、香附、苍术、白芷、半夏、川芎、为
末，神曲糊丸。五心烦热，火郁脾中，火郁汤。三物黄芩汤（见烦躁）治妇人四肢烦热。
热时发时止，知不在表，（在表则常热也。）大小便如常，知不在里，非表非里，是在经
络也。
一热分三焦
热在上焦，咽干口烂，栀子、黄芩。热在中焦，心烦口渴，黄连、芍药。热在
下焦，便闭溺赤，黄柏、大黄。
一热分昼夜血气（详恶寒篇末）
昼热夜静，是阳邪（即热邪）自旺于阳分也。（阳分者表也、腑也、气也。阳邪在阳分，遇阳时故热
作。）昼静夜热，是阳邪下陷于阴分也。（观热入血室症，日轻夜重可见。详《伤寒·少阳篇》。）昼夜俱
热，烦躁，是重阳无阴，当亟泻其阳，峻补其阴。昼热在气分，柴胡饮（见虚损、）白虎
汤，以泻气中之火。（阴虚者不宜用。）夜热在血分，地骨皮散、清凉饮子（见伤燥），以泻血中之火。
一热分虚实
血肉充盛，皮毛荣润，阴有余而热，及能食而热，口苦干燥，大便难，
脉洪盛者为实热。骨痿肉燥，筋缓血枯，皮聚毛落，阴不足而热，及不能食而热，
气短脉虚者，为虚热。
一、风寒郁热
阳气从体内向体表运行，喜欢通畅舒展而厌恶被遏制闭阻。如果风寒之邪从外部侵袭，阴寒凝滞之气足以闭塞腠理（皮肤毛孔及其间隙），导致表阳不能宣发，从而郁结化为热证。症状表现为头项强痛，怕风且有汗，脉象浮缓的，属于伤风。兼有身体疼痛、怕冷且无汗，脉象浮紧的，属于伤寒。治疗应当采用解肌发表的方法，出汗后热邪泄出即可痊愈。（这是表阳受到郁遏。）
二、饮食郁热
饮食停滞在中脘（胃脘部），脾胃的阳气被其遏制抑制，不能宣通，也会郁结而成热。症状表现为头痛发热，像伤寒但身体不痛，恶食想吐，嗳气带有腐臭味，吞酸水，胸口饱闷，或者胀痛，气口脉滑大，甚至沉伏。治疗应当采用消食导滞的方法。（这是里气受到郁遏。）
三、痰饮郁热
痰饮停留的地方，气机被阻滞，郁结而成热，道理同于食积停滞。症状表现为怕风自汗类似伤寒，但头部不痛，项部不强硬，或者头痛发作停止无常，胸膈不适，恶心，气上冲，眼下呈现灰色或烟黑色，脉象弦滑。治疗应当采用祛除痰饮的方法。
道理同于痰饮。症状表现为小便通利，大便色黑，小腹、脐周或胸胁部位急迫结聚，按压时疼痛，或者两脚厥冷，或者吐血、鼻出血，口不渴，即使口渴也是只含水漱口而不咽下，脉象必定涩滞。治疗应当采用活血化瘀的方法。药用柴胡、黄芩、川芎、白芷、桃仁、五灵脂、甘草，若大便干结加大黄、浓蜂蜜，排出黑色粪便即愈。若是疮毒，则脉象弦数、怕冷，饮食如常，但有疼痛部位。
五、水湿郁热
水湿由外感引起的，道理同于风寒；由内伤引起的，道理同于痰饮。症状表现为身体沉重，或者重痛无法转身侧卧，骨节牵拉疼痛，屈伸不利，出汗怕风，不想脱衣，头部像被包裹一样，声音好像从瓮中发出，脉象迟缓。治疗应当采用利湿的方法。
六、肝气郁热
愤怒情绪无法发泄，只能自我压抑，导致肝气不能宣发，郁结而成热，妇女最多见此证。症状表现为胸胁胀痛，或者完谷不化的泄泻，面色青，手脚冷，叹气且不快乐，脉象沉弦。木郁应当疏达它，宜用逍遥散。（详见“郁”证章节。）
七、脾气郁热
或者是劳倦导致气机涣散，或者是思虑导致气机结滞，或者是饥饿导致气馁，中气因此衰微，不能正常运化，或者停滞在中焦，或者下陷于下焦，从而郁滞成热。症状表现为怠惰嗜睡，行动时气喘乏力，四肢困倦。（这是劳倦和饥饿损伤所致。）或者时常自言自语，不知前后首尾。（这是思虑损伤所致。）半夜发热，（因为气行于里靠近下部，滞陷更严重。）天亮时暂缓，（因为气外出上升，郁陷得到略微缓解。这是初起郁热的病证。）或者昼夜不解，（郁久则热甚，不分昼夜了。）或者日出时气温升高则发热，天阴夜凉时缓解，（郁热又久，则气耗散，越热越耗，越耗越热。白天活动阳气浮越，所以加重烦热，动静结合静存，所以天阴夜凉时缓解。因为起初是郁热而生火，接着是火发而热剧，最后是火壮而气耗。阶段如此，是病成而变化的道理，不可不知道。）五心烦热，严重时肌肉筋骨像火烧一样。这是李东垣所说的阳虚发热。（此症在《内经》中名为阴虚发热。“阴”字当作“内”字看，李东垣名为阳虚发热，“阳”字当作“气”字看，综合两种说法而言，是内气虚发热。）这与上一条所述的阳虚发热、戴阳格阳症不同。这是因为此为中焦之阳，彼为下焦之阳；彼处格阳是内寒而外热，此处则是内外皆热而无寒。戴阳是上热而下寒，此处则是热反下陷而无寒，所以不同。治疗应当培补中气。气旺盛则停滞者得以运化，气升举则下陷者得以提升。（五脏郁证，这里只列举了肝脾，其余应当在郁证门中寻求。）劳倦者，加酸味药以收敛其浮越之气。以上论述了发热的原理，至于热分脏腑、经络、三焦、昼夜、血气、虚实，详见后文。
李东垣说：五脏有邪气，各有身热，形状各异。（脉象都洪数，但有浮沉的区别。）轻手触摸则热，重按则不热，（王海藏说：皮肤如火烧，重按则不太热。那么李东垣所说的不热，并非完全不热，只是不太热罢了。下文仿照此例。）这是热在皮毛血脉。在皮毛的属于肺热，申时酉时尤其严重。（肺金气旺的时候。）症状表现为喘咳，洒淅恶寒，轻的用泻白散，重的用凉膈散、白虎汤、地骨皮散之类治疗。白睛红赤，烦躁口渴，单用黄芩煎汤，丹溪清金丸，即黄芩研末，米粥制丸。这两方泻肺中血分之火，泻白散泻肺中气分之火。在血脉的属于心热，日中时分更加严重。症状表现为心烦，掌心热，用黄连泻心汤泻丁（心属火，数为丁），导赤散泻丙（小肠属火，数为丙），火腑丹（见淋证）丙丁俱泻，朱砂安神丸（见烦躁）、清凉饮子（见伤燥）之类治疗。重按至筋骨之分，则热气蒸腾到手极甚，轻摸则不热，这是热在筋骨间。在筋的（肌肉之下，骨之上）属于肝热，寅时卯时之间严重。（或者寅申之间发作。）症状表现为胸胁满闷，排便困难，转筋，多怒易惊，四肢困热，筋痿不能起床，用泻青丸、柴胡饮（见虚损）之类治疗。或者当归龙荟丸（见胁痛）、左金丸。在骨的属于肾热，亥时子时尤其严重，骨蒸，酥酥然像虫蚀，困热难忍，也不能起床，用滋肾丸（见小便不通）、六味地黄丸（见虚损）主治。轻扪重按都不热，不轻不重按之而热，这是热在肌肉，属于脾热，遇夜尤其严重。（脾属阴土，夜属阴。）症状表现为怠惰嗜睡，四肢不收，没有力气活动。实热，用泻黄散、调胃承气汤（见大便不通）治疗。虚热，用人参黄芪散、补中益气汤（见气）治疗。胃中有热则消谷善饥，让人心中悬空不安，（心神被火灼烧，所以悬悬不宁也。）容易饥饿，脐以上皮肤热，（胃位于脐上。）肠中有热则排出黄色如糜状物，（糜粥也。）脐以下皮肤热。（肠位于脐下也。）由此推断，肝胆热，则胁部也热，心肺热，则胸背部也热，肾热，则腰部也热了。两手太热，像在火中，称为骨厥，灸涌泉穴三壮立即痊愈。手足心热，用栀子、香附、苍术、白芷、半夏、川芎，研为末，神曲糊丸。五心烦热，火郁脾中，用火郁汤。三物黄芩汤（见烦躁）治疗妇人四肢烦热。热时发时止，知道不在表，（在表则常热也。）大小便如常，知道不在里，非表非里，是在经络。
九、热分三焦
热在上焦，咽干口烂，用栀子、黄芩。热在中焦，心烦口渴，用黄连、芍药。热在下焦，便秘尿赤，用黄柏、大黄。
十、热分昼夜血气（详恶寒篇末）
昼热夜静，是阳邪（即热邪）自旺于阳分。（阳分指表、腑、气。阳邪在阳分，遇到阳时故发热。）昼静夜热，是阳邪下陷于阴分。（观察热入血室症，日轻夜重可见。详见《伤寒论·少阳篇》。）昼夜俱热，烦躁，是重阳无阴，应当紧急泻其阳，峻补其阴。昼热在气分，用柴胡饮（见虚损）、白虎汤，以泻气中之火。（阴虚者不宜用。）夜热在血分，用地骨皮散、清凉饮子（见伤燥），以泻血中之火。
十一、热分虚实
血肉充盛，皮毛荣润，阴有余而热，以及能食而热，口苦干燥，大便难，脉洪盛者为实热。骨痿肉燥，筋缓血枯，皮聚毛落，阴不足而热，以及不能食而热，气短脉虚者为虚热。
1. Heat Stagnation due to Wind-Cold
Yang Qi moves from the interior to the exterior; it prefers free flow and dislikes obstruction and closure. If wind-cold pathogens invade from the exterior, the yin cold coagulating qi is sufficient to close the cou-li (skin pores and interstices), causing the exterior Yang to fail in its dissemination, thereby stagnating and transforming into heat. Manifestations include stiffness and pain in the head and neck, aversion to wind with sweating, and a floating, moderate pulse, which indicates Wind Injury. Accompanied by body pain, aversion to cold, no sweating, and a floating, tight pulse, it indicates Cold Injury. Treatment should employ muscle-relaxing and exterior-releasing methods; upon sweating, the heat dissipates and recovery occurs. (This is exterior Yang being stagnant.)
2. Heat Stagnation due to Dietary Retention
When food and drink stagnate in the Zhongwan (epigastrium), the Yang Qi of the Spleen and Stomach is suppressed and inhibited, unable to circulate freely, thus also stagnating and generating heat. Manifestations include headache and fever, resembling Cold Injury but without body pain; aversion to food with nausea; belching with a putrid odor; acid regurgitation; chest fullness and oppression, or distending pain; the Qi Kou pulse is slippery and large, or even deep and hidden. Treatment should employ digestion-promoting and stagnation-resolving methods. (This is interior Qi being stagnant.)
3. Heat Stagnation due to Phlegm-Fluids
Wherever Phlegm-Fluids reside, Qi is obstructed, stagnating and generating heat; the principle is the same as food retention. Manifestations include aversion to wind with spontaneous sweating, resembling Cold Injury, but without headache or neck stiffness; or headache that comes and goes irregularly; discomfort in the chest and diaphragm; nausea; rising Qi; grayish or smoky-black discoloration under the eyes; and a string-taut, slippery pulse. Treatment should employ phlegm-resolving methods.
4. Heat Stagnation due to Blood Stasis (Same Principle for Carbuncles and Sores)
The principle is the same as Phlegm-Fluids. Manifestations include clear urination, black stools, urgency and binding in the lower abdomen, umbilical region, or hypochondrium, painful upon pressure; or cold extremities; or hematemesis and epistaxis; absence of thirst, or if thirsty, only rinsing the mouth without swallowing; and a choppy pulse. Treatment should employ blood-invigorating methods. Use Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Tao Ren (Persicae Semen), Wu Ling Zhi (Trogopterori Faeces), and Gan Cao (Glycyrrhizae Radix et Rhizoma). If stool is constipated, add Da Huang (Rhei Radix et Rhizoma) and thick honey; recovery follows the passage of black matter. For toxic sores, the pulse is string-taut and rapid with aversion to cold, diet remains normal, but there is a painful area.
5. Heat Stagnation due to Water-Dampness
Water-dampness caused by external contraction follows the principle of wind-cold; that caused by internal injury follows the principle of phlegm-fluids. Manifestations include heavy body, or heavy pain preventing turning over; pulling pain in joints; difficulty in flexion and extension; sweating with aversion to wind; reluctance to remove clothing; sensation of the head being wrapped; voice sounding as if coming from an urn; and a slow pulse. Treatment should employ dampness-draining methods.
6. Heat Stagnation due to Liver Qi
Unexpressed anger, merely suppressed internally, causes Liver Qi to fail in dissemination, stagnating and generating heat. This condition is most common in women. Manifestations include distending pain in the chest and hypochondrium; or diarrhea with undigested food; greenish complexion; cold hands and feet; sighing and unhappiness; and a deep, string-taut pulse. When Wood is stagnant, it should be dispersed; Xiao Yao San (Free Wanderer Powder) is appropriate. (See "Stagnation" chapter.)
7. Heat Stagnation due to Spleen Qi
Whether due to fatigue causing Qi dispersion, worry causing Qi knotting, or hunger causing Qi deficiency, the Middle Qi becomes weak and unable to transport and transform normally. It may stagnate in the middle or sink to the lower jiao, leading to stagnation and heat generation. Manifestations include lethargy and desire to sleep; panting and fatigue upon movement; and tired limbs. (This is damage from fatigue and hunger.) Or speaking to oneself at times, unaware of context. (This is damage from worry.) Fever at midnight, (as Qi travels inward toward the lower part, stagnation and sinking become more severe.) Relief at dawn, (as Qi moves outward and upward, stagnation and sinking are slightly relieved. This is early-stage stagnation heat.) Or fever persisting day and night, (prolonged stagnation leads to intense heat, regardless of time.) Or fever worsening when the sun rises and warmth increases, easing when the sky is cloudy and night is cool, (prolonged stagnation heat consumes Qi; the more heat, the more consumption; the more consumption, the more heat. Daytime activity floats Yang, aggravating vexatious heat; stillness preserves Qi, hence easing on cloudy nights. Initially, stagnation heat generates fire; subsequently, fire erupts intensifying heat; finally, strong fire consumes Qi. These stages represent the transformation of disease, a principle not to be ignored.) Five-palm heat; severely, muscles and bones feel like burning. This is what Li Dongyuan calls Yang Deficiency Fever. (In *Nei Jing*, this symptom is named Yin Deficiency Fever. "Yin" here should be read as "Interior". Li Dongyuan names it Yang Deficiency Fever, where "Yang" refers to "Qi". Synthesizing both views, it is Interior Qi Deficiency Fever.) This differs from the aforementioned Yang Deficiency Fever and Dai Yang/Ge Yang syndromes. Here, it involves Middle Jiao Yang; there, Lower Jiao Yang. Ge Yang is interior cold with exterior heat; here, interior and exterior are both hot without cold. Dai Yang is upper heat with lower cold; here, heat sinks downward without cold. Thus, they differ. Treatment should tonify Middle Qi. When Qi is vigorous, stagnation is transported; when Qi ascends, sinking is lifted. (For Five Zang stagnation syndromes, only Liver and Spleen are listed here; seek others in the Stagnation chapter.) For fatigue, add sour-flavored herbs to astringe floating Yang. The above discusses the principles of fever generation. Regarding heat differentiated by Zang-Fu, meridians, San Jiao, day/night, Qi/Blood, and deficiency/excess, see below.
8. Heat Differentiated by Zang-Fu and Meridians
Li Dongyuan said: When pathogens affect the Five Zang, each presents with fever, varying in appearance. (Pulses are all surging and rapid, but differ in depth.) Light palpation reveals heat; heavy pressure does not. (Wang Haizang stated: Skin feels like burning, but heavy pressure reveals less heat. Thus, Li Dongyuan's "no heat" means not completely absent, but less intense. The following follows this logic.) This indicates heat in the skin, hair, and vessels. Heat in the skin/hair belongs to Lung Heat, worsening during Shen and You hours (when Metal Qi is prosperous). Symptoms include wheezing and coughing, shivering with aversion to cold. Mild cases use Xie Bai San (Drain White Powder); severe cases use Liang Ge San (Cool the Diaphragm Powder), Bai Hu Tang (White Tiger Decoction), or Di Gu Pi San (Lycium Root Bark Powder). Red sclera, vexation, and thirst are treated with decocted Huang Qin (Scutellariae Radix) alone, or Danxi Qing Jin Wan (Danxi Clear Metal Pill), made of Huang Qin powder mixed with congee pills. Both formulas drain Fire from Lung Blood level; Xie Bai San drains Fire from Lung Qi level. Heat in vessels belongs to Heart Heat, worsening at noon. Symptoms include vexation and heat in palms. Use Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Heart) to drain Ding (Heart/Fire); Dao Chi San (Direct the Red Powder) to drain Bing (Small Intestine/Fire); Huo Fu Dan (Fire Organ Pill - see Strangury) drains both Bing and Ding; Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill - see Vexation) or Qing Liang Yin Zi (Cooling Drink - see Dryness Injury) are used. Heavy pressure to sinews and bones causes intense heat radiating to the hand; light touch reveals no heat. This indicates heat between sinews and bones. Heat in sinews (below muscle, above bone) belongs to Liver Heat, worsening during Yin and Mao hours (or Yin-Shen hours). Symptoms include chest/hypochondriac fullness, difficult defecation, tendon spasms, irritability and fright, hot/tired limbs, tendon flaccidity preventing getting out of bed. Use Xie Qing Wan (Drain Green Pill) or Chai Hu Yin (Bupleuri Drink - see Deficiency Damage); or Dang Gui Long Hui Wan (Angelica Dragon Bile Pill - see Hypochondriac Pain) or Zuo Jin Wan (Left Metal Pill). Heat in bones belongs to Kidney Heat, worsening during Hai and Zi hours. Symptoms include bone-steaming fever, a tingling sensation like insect erosion, unbearable heat/tiredness, inability to rise from bed. Use Zi Sheng Wan (Nourish Kidney Pill - see Urinary Obstruction) or Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia - see Deficiency Damage). Light and heavy pressure reveal no heat; moderate pressure reveals heat. This indicates heat in muscle, belonging to Spleen Heat, worsening at night. (Spleen is Yin Earth; night is Yin.) Symptoms include lethargy, desire to sleep, limp limbs, lack of energy to move. Excess heat is treated with Xie Huang San (Drain Yellow Powder) or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction - see Constipation). Deficiency heat is treated with Ren Shen Huang Qi San (Ginseng and Astragalus Powder) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction - see Qi). Heat in the Stomach promotes digestion, causing hunger and a feeling of emptiness/vexation in the heart (Heart Spirit scorched by Fire, hence unsettled). Hunger with heat above the umbilicus (Stomach is above the umbilicus). Heat in the Intestines causes yellow, porridge-like stools (porridge-like consistency); heat below the umbilicus (Intestines are below the umbilicus). From this, we deduce: Liver/Gallbladder heat implies hypochondriac heat; Heart/Lung heat implies chest/back heat; Kidney heat implies lumbar heat. Excessive heat in both hands, feeling like fire, is called Bone Jue; mooring Yongquan (KI 1) three moxa cones brings immediate cure. Heat in palms and soles is treated with Zhi Zi (Gardeniae Fructus), Xiang Fu (Cyperi Rhizoma), Cang Zhu (Atractylodis Rhizoma), Bai Zhi, Ban Xia (Pinelliae Rhizoma), Chuan Xiong, powdered and pillified with Shen Qu (Massa Medicata Fermentata) paste. Five-palm heat, Fire stagnant in Spleen, uses Huo Yu Tang (Stagnant Fire Decoction). San Wu Huang Qin Tang (Three Ingredient Scutellaria Decoction - see Vexation) treats four-limb vexatious heat in women. Fever that comes and goes indicates it is not in the Exterior (Exterior heat is constant). Normal urination/defecation indicates it is not in the Interior. Neither Exterior nor Interior, it is in the Meridians.
9. Heat Differentiated by San Jiao
Heat in Upper Jiao: dry throat, ulcerated mouth. Use Zhi Zi (Gardeniae Fructus), Huang Qin. Heat in Middle Jiao: vexation, thirst. Use Huang Lian (Coptidis Rhizoma), Shao Yao (Paeoniae Radix). Heat in Lower Jiao: constipation, dark urine. Use Huang Bo (Phellodendri Cortex), Da Huang.
10. Heat Differentiated by Day/Night and Qi/Blood (See End of Aversion to Cold Chapter)
Day fever, night quiet: Yang Pathogen (i.e., Heat Pathogen) prospers in Yang divisions. (Yang divisions refer to Exterior, Fu Organs, Qi. Yang Pathogen in Yang division, encountering Yang time, causes fever.) Day quiet, night fever: Yang Pathogen has sunk into Yin divisions. (Observe Heat Entering Blood Chamber syndrome: lighter by day, heavier by night. See *Shang Han Lun · Shao Yang Chapter*.) Fever day and night with vexation: Double Yang without Yin. Urgently drain Yang and vigorously tonify Yin. Day fever in Qi level: Chai Hu Yin, Bai Hu Tang, to drain Fire in Qi. (Not suitable for Yin Deficiency.) Night fever in Blood level: Di Gu Pi San, Qing Liang Yin Zi, to drain Fire in Blood.
11. Heat Differentiated by Excess and Deficiency
Abundant flesh and blood, lustrous skin and hair, excess Yin with heat, ability to eat with heat, bitter taste, dry mouth, difficult defecation, surging/full pulse indicate Excess Heat. Withered bones, dry flesh, relaxed sinews, depleted blood, contracted skin, fallen hair, insufficient Yin with heat, inability to eat with heat, shortness of breath, deficient pulse indicate Deficiency Heat.