世间发热类伤寒者数种。治各不同。伤寒伤风及寒疫也。则用仲景法。温病及瘟疫也。则用河间法。此皆
论外感者也。今人一见发热。皆认作伤寒。率用汗药以发其表。汗后不解。又用表药以凉其肌。柴胡凉膈白虎
双解等汤。杂然并进。若是虚证。岂不殆哉。自东垣出。而发内伤补中益气之论。此用气药以补气之
不足者也。至于劳心好色。内伤真阴。真阴既伤。则阳无所附。
故亦发热其人必面赤烦躁。口渴引饮。骨痛脉数而大。或尺数而无力者是也。惟丹溪发明补阴之说。以四物汤
加黄柏知母。此用血药以补血之不足者也。世袭相因。屡用不效何耶。盖因阴字认不真。误以血为阴耳。当作
肾中之真阴。即先天也。内经曰。诸寒之而热者。取之阴。诸热之而寒者。取之阳。所谓求其属也。王太仆先生
注云。大寒而盛。热之不热。是无火也。大热而盛。寒之不寒。是无水也。又云。倏忽往来。时发时止。是无
火也。昼见夜伏。夜见昼止。时节而动。是无水也。当求其属而主之。无火者。宜益火之源。以消阴翳。无水
者。宜壮水之主。以镇阳光。必须六味八味二丸。出入增减。以补真阴。屡用屡效。若泥黄柏知母苦寒之说。必
致损伤脾阴而毙者。不可胜举。大抵病热作渴。饮冷便秘。此属实热。人皆知之。或恶寒发热。引衣蜷卧。四肢
逆冷。大便清利。此属真寒。人亦易知。至于烦扰狂越。不欲近衣。欲坐卧泥水中。此属假热之证。其甚者。
烦极发燥。渴饮不绝。舌如芒刺。两唇燥裂。面如涂朱。身如焚燎。足心如烙。吐痰如涌。喘急大便秘结。小
便淋沥。三部脉洪大而无伦。当是时也。却似承气证。承气入口即毙。却似白虎证。白虎下咽即亡。若用二
丸。缓不济事。急以加减八味丸料一斤。内肉桂一两。以水顿煎五六碗。水冷与饮。诸证自退。翌日
必畏寒脉脱。是无火也。当补其阳。急以附子八味丸料。煎服自愈。此证与脉俱变其常。而不以常法治之者
也。若有产后。及大失血后。阴血暴伤。必大发热。亦名阴虚发热。此阴字正谓气血之阴。若以凉药正治
立毙。正所谓象白虎汤证。误服白虎汤必死。当此之时。偏不用四物汤。有形之血。不能速化。几
希之气。所宜急固。须用独参汤。或当归补血汤。使无形生出有形来。此阳生阴长之妙用。不可不知也。或问
曰。子之论则详矣。气虚血虚。均是内伤。何以辨之。予曰。悉乎子之问也。盖阴
虚者。面必赤。无根之火。载于上也。若是阳证。火入于内。面必不赤。其口渴者。肾水干枯。引水自救也。
但口虽渴。而舌必滑。脉虽数而尺必无力。甚者尺虽洪数。而按之必不鼓。此为辩耳。虽然若问其人曾服过凉
药。脉亦有力而鼓指矣。戴复庵云。服凉药而脉反加数者。火郁也。宜升宜补。切忌寒凉。犯之必
死。临证之工。更宜详辨。毫厘之差。柱人性命。慎哉慎哉。
世间发热症状类似伤寒的有好几种。治疗方法各不相同。如果是伤寒、伤风以及寒疫，就使用张仲景的方法。如果是温病和瘟疫，就使用刘河间的方法。这些都是在论述外感病。现在的人一见到发热，都认为是伤寒，轻易地使用发汗药来发散表邪。发汗后病情没有解除，又用解表药来清解肌热。柴胡汤、凉膈散、白虎汤、双解散等方剂混杂使用，同时并进。如果是虚证，这样治疗岂不危险吗？自从李东垣出现，提出了内伤及补中益气的理论。这是使用补气药来补充气的不足。至于那些用心过度、纵欲好色，导致内伤真阴的人，真阴既然受伤，那么阳气就无所依附。所以也会发热，这种人必定面色红赤、烦躁不安、口渴想喝水、骨痛、脉象数而大，或者尺脉数而无力，就是这种情况。只有朱丹溪阐明了补阴的理论，使用四物汤加入黄柏、知母。这是使用补血药来补充血的不足。世人沿袭这种做法，屡次使用却不见效，为什么呢？大概是因为对“阴”字的认识不真切，错误地把血当作阴了。应当理解为肾中的真阴，也就是先天之本。《内经》说：“各种用寒凉药治疗热证而热不退的，要取法于阴；各种用温热药治疗寒证而寒不除的，要取法于阳。”这就是所说的探求疾病的根本属性。王太仆先生注释说：“大寒且盛，用温热药治疗却不回暖的，是无火（命门火衰）；大热且盛，用寒凉药治疗却不退热的，是无水（肾阴亏竭）。又说：忽冷忽热，时发时止的，是无火；白天发作晚上潜伏，晚上发作白天停止，按时节发作的，是无水。应当探求其根本属性并主治之。无火的，应当益火之源，以消除阴翳；无水的，应当壮水之主，以镇制阳光。必须使用六味地黄丸、八味肾气丸两种丸剂，根据情况出入增减，来补益真阴，屡次使用屡次见效。如果拘泥于黄柏、知母苦寒的说法，必然会导致损伤脾阴而死的情况，数不胜数。大体上，生病发热作渴，喜欢喝冷饮，大便干结，这属于实热，人们都知道。如果有恶寒发热，拉着衣服蜷缩而卧，四肢逆冷，大便清稀通畅，这属于真寒，人们也容易知道。至于烦躁扰乱、狂乱超越，不喜欢靠近衣物，想要坐在泥水中，这属于假热证。严重的，烦闷至极而发燥，口渴饮水不停，舌头像有芒刺一样，嘴唇干燥开裂，面色像涂了朱砂，身体像被火烧灼，脚心像被烙铁烫过，吐痰如涌出，气喘急促，大便秘结，小便淋漓不畅，三部脉象洪大而无伦次。在这个时候，看起来像是承气汤证，但承气汤入口就会死亡；看起来像是白虎汤证，但白虎汤下咽就会亡故。如果使用六味、八味丸，缓不济急。紧急情况下，用加减八味丸料一斤，其中加入肉桂一两，用水急煎五六碗，冷却后给患者饮用，各种症状自然消退。第二天必定会出现畏寒、脉微欲绝的症状，这是无火的表现，应当补其阳气，紧急使用附子八味丸料煎服即可自愈。这种病症与脉象都改变了常态，不能用常规方法治疗。如果有产后，以及大量失血后，阴血突然受伤，必定会大发热，这也叫阴虚发热。这里的阴字正指的是气血之阴。如果用凉药正治，立刻致死。这正是所谓的象白虎汤证，误服白虎汤必死。在这个时候，偏偏不用四物汤，因为有形之血不能迅速化生，几希之气，适宜紧急固护。必须使用独参汤，或者当归补血汤，使无形之气生出有形之血。这是阳生阴长的妙用，不可不知道。有人问：您的论述已经很详细了。气虚和血虚，都是内伤，如何辨别呢？我说：您的问话很周全啊。大概是阴虚的人，面色必定红赤，这是无根之火上浮于头面所致。如果是阳证，火入于体内，面色必定不红赤。那些口渴的人，是肾水干枯，引水自救。只是口虽然渴，但舌苔必定滑润，脉象虽然数，但尺脉必定无力。严重的，尺脉虽然洪大数急，但按下去必定不鼓指。这就是辨别的要点。虽然如此，如果询问此人曾经服用过凉药，脉象也可能有力且鼓指。戴复庵说：服用凉药后脉象反而更加数急的，是火郁结在内。应当升提，应当补益，切忌寒凉药物，触犯它必然致死。临证治疗的医生，更应该详细辨别。毫厘之间的差错，就会断送人性命，谨慎啊，谨慎啊。
There are several types of fever in the world that resemble Taiyang disease (Taiyang disease, a syndrome caused by pathogenic factors invading the Taiyang channel). Their treatments differ. For Taiyang disease, wind-strike, and cold epidemic, one should use the methods of Zhang Zhongjing. For warm diseases and pestilential diseases, one should use the methods of Liu Wansu. These all discuss exogenous pathogens. Nowadays, people see fever and immediately assume it is Taiyang disease, rashly using diaphoretic medicines to release the exterior. If the fever persists after sweating, they then use exterior-releasing medicines to cool the muscles. Decoctions such as Chaihu Tang (Bupleurum Decoction), Liangge San (Cooling the Chest Powder), Baihu Tang (White Tiger Decoction), and Shuangjie San (Double-Resolving Powder) are mixed and administered simultaneously. If this is a deficiency syndrome, would not such treatment be perilous? Since Li Dongyuan emerged, he proposed theories on internal injury and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). This uses qi-tonifying medicines to supplement insufficient qi. As for those who overwork their minds and indulge in sexual activity, causing internal injury to True Yin, once True Yin is damaged, Yang has no foundation to attach to. Thus, fever also occurs. Such individuals must present with red face, irritability, thirst with desire to drink, bone pain, and a rapid and large pulse, or a rapid but forceless pulse at the Chi position. Only Zhu Danxi elucidated the theory of tonifying Yin, using Siwu Tang (Four Substances Decoction) added with Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). This uses blood-nourishing medicines to supplement insufficient blood. The world follows this precedent, yet repeated use yields no effect. Why? It is because the understanding of "Yin" is inaccurate, mistakenly identifying blood as Yin. It should be understood as the True Yin within the Kidney, which is the Pre-heaven Essence. The *Neijing* states: "For various heat conditions treated with cold remedies that do not resolve, seek the Yin; for various cold conditions treated with hot remedies that do not resolve, seek the Yang." This is called seeking the root affiliation. Master Wang Taipu annotated: "When severe cold prevails and warming does not generate warmth, there is no Fire. When severe heat prevails and cooling does not reduce heat, there is no Water." He further stated: "Sudden alternations of cold and heat, occurring intermittently, indicate no Fire. Manifesting during the day and subsiding at night, or vice versa, occurring seasonally, indicates no Water." One must seek the root affiliation and treat accordingly. For no Fire, one should benefit the source of Fire to dissipate yin shadows; for no Water, one should strengthen the master of Water to suppress excessive yang. One must use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill), adjusting them according to circumstances to tonify True Yin, achieving consistent efficacy. If one adheres rigidly to the bitter-cold nature of Huangbai and Zhimu, it will inevitably damage Spleen Yin and lead to death, a phenomenon too numerous to recount. Generally speaking, fever with thirst, preference for cold drinks, and constipation belongs to Excess Heat, which everyone knows. Aversion to cold with fever, curling up holding clothes, cold limbs, and clear loose stools belong to True Cold, which is also easily recognized. However, restlessness, mania, aversion to clothing, and desire to sit in mud or water belong to False Heat syndromes. In severe cases, extreme irritability and dryness, incessant thirst, tongue like thorns, cracked lips, face painted with cinnabar, body burning like fire, soles of feet scorched, profuse phlegm, urgent panting, severe constipation, scanty dysuria, and boundless surging pulses at all three positions occur. At this time, it resembles Chengqi Tang (Gastrointestinal Purging Decoction) syndrome, but if Chengqi Tang enters the mouth, death ensues instantly. It resembles Baihu Tang syndrome, but if Baihu Tang is swallowed, death follows immediately. If Liuwei or Bawei pills are used, they act too slowly to save the emergency. Urgently, use one jin of Jiabian Bawei Wan formula material, adding one liang of Rougui (Cinnamon Bark), decoct rapidly in water to yield five or six bowls. Cool the liquid and administer it; symptoms will naturally recede. The next day, chills and absent pulse will appear, indicating no Fire. One must tonify Yang urgently with Fuzi Bawei Wan (Aconite Eight-Ingredient Pill) decoction, and recovery will follow spontaneously. This syndrome and pulse deviate from norms and cannot be treated with standard methods. After childbirth or massive blood loss, sudden injury to Yin-blood causes high fever, also named Yin-deficiency fever. Here, "Yin" refers precisely to the Yin of Qi and Blood. Using cold medicines for direct treatment leads to immediate death. This mimics Baihu Tang syndrome; misusing Baihu Tang causes death. At this moment, Siwu Tang must not be used, because substantial blood cannot be generated quickly. The slight Qi should be urgently consolidated. One must use Dushen Tang (Single Ginseng Decoction) or Danggui Buxue Tang (Angelica Tonify Blood Decoction) to allow formless Qi to generate substantial Blood. This is the subtle application of Yang generating Yin, which must not be ignored. Someone asked: Your discussion is detailed. Qi deficiency and Blood deficiency are both internal injuries; how to distinguish them? I said: Your question is thorough. In Yin deficiency, the face must be red due to Rootless Fire floating upward. In Yang syndromes, Fire enters inward, and the face is not red. Those with thirst have dried-up Kidney Water seeking self-rescue through drinking. Although thirsty, the tongue must be slippery; although the pulse is rapid, the Chi pulse must be forceless. In severe cases, even if the Chi pulse is surging and rapid, pressing it reveals no pulsation. This is the distinction. However, if the patient has taken cold medicines, the pulse may become forceful and striking. Dai Fu'an said: If the pulse becomes more rapid after taking cold medicines, it is Fire stagnation. One should lift and tonify, strictly avoiding cold medicines; violating this leads to death. Practitioners must discriminate carefully. A difference of a hair's breadth can cost a life. Be cautious, be cautious.