薛己曰。阳虚则外寒。阴虚则内热。阳盛则外热。阴盛则内寒。寒热往来。此乃阴阳相胜也。夫阴气并于阴。则发
寒。阳气并于阳。则发热。寸口脉微为阳不足。阴气上入阳中则恶寒。尺脉弱为阴不足。阳气下入阴中则发热。阳不足
则先寒后热。阴不足则先热后寒。阴阳不归其分。则寒热交争也。又上盛则发热。下盛则发寒。阳胜则乍热。阴胜则乍
寒。阴阳相胜。虚实不调。故邪气更作。而寒热往来。或乍寒乍热也。少阳胆者。肝之腑。界于表里之间。阴阳之气易
乘。故寒热多主肝胆经症。以小柴胡汤加减治之。若只见寒热。起居如常。久而不愈。及大病后元气未复。悉属阴虚生
热。阳虚生寒。宜八珍汤。甚者十全大补汤。有宿食为病。亦令寒热。保和丸。食积既消。而寒热尚作者。肝邪乘脾。
所胜侮所不胜也。异功散加柴胡、山栀。
张涣曰。寒热症。有头疼汗出者。有呕吐不食者。有憎寒而反饮水者。有壮热而反饮汤者。有筋骨疼痛者。有因食
积。寒而腹中痛。热而腹中鸣者。
鳌按。此寒热并作。乃自为一症。故有一日两三度发。或五六度发者。非如疟之休止有时也。其疟症寒热。另
详疟门。
曾氏曰。骨蒸热者。身体虚羸。遇晚而发。有热无寒。醒时渴汗方止。此乃疳病之余毒。传作骨蒸。或腹内有癖块。
有时微痛。用化癖丸。先治脾虚宿滞。次以柴胡饮为治。仍忌鸡酒羊面毒物。
鳌按。汤氏治骨蒸热。用生犀散、地骨皮散、七宝散、金莲饮子。殊为妥协。存参。
有小儿热症。用表里药后。其热俱退。既乃复热者。为余热也。推其原。乃表里俱虚。而阳浮于外。阴伏于内。所
以又发热。宜用温平药和其里。则体热自除。钱氏白术散去木香加扁豆水煎。及黄 六一汤、安神散。自然平复。
龚信曰。热有作止。每日应时而发。谓之潮热。如潮信之不失其期也。钱氏云。假如潮热。是一脏实。一脏虚。而
内发虚热也。法当补母而泻本脏。则愈。且如日中发潮热者。心虚也。脉为心之母。则宜先补肝。肝实而后泻心。心得
母气。则内平而潮热愈也。医见潮热。妄谓其实。乃以硝黄诸冷药下之。下既多矣。不能禁约。而津液内竭。纵取一时
之瘥。鲜不成疳病而身瘦也。曾氏法遇潮热症。先以百解散发表。次以当归散治之。脉实者。以大柴胡下之。虚浮数者。
以百解散微汗之。若潮热而呕者。小柴胡和解之。
王肯堂曰。余热者。谓寒邪未尽。传经之遗热也。仁斋曰。伤寒汗下后而热又来。乃表里俱虚。气不归元。阳浮于
外。不可再用凉药。盖热去则寒起。古人戒之。法当和胃。使阳气收敛。其热自止。宜参苓白术散。
薛己说：阳气虚弱则体表发冷，阴液不足则体内发热，阳气亢盛则体表发热，阴气偏盛则体内发冷。寒热交替出现，这是阴阳相互克胜的结果。如果阴气聚集于阴分，就会引发寒冷；阳气聚集于阳分，就会引发发热。寸口脉微弱表示阳气不足，阴气上侵阳分就会感到恶寒；尺部脉弱表示阴气不足，阳气下陷阴分就会发热。阳气不足的人通常先感到寒冷随后发热，阴气不足的人通常先感到发热随后发冷。如果阴阳不能各守其位，就会发生寒热交争。另外，上部邪气盛则发热，下部邪气盛则发冷；阳气胜则突然发热，阴气胜则突然发冷。由于阴阳相胜、虚实不调，所以邪气更替发作，导致寒热往来，或者忽冷忽热。少阳胆经是肝的腑，位于表里之间，阴阳之气容易乘虚而入，所以寒热症状多属于肝胆经的病证。用小柴胡汤加减来治疗。如果只见到寒热症状，起居如常，久治不愈，以及大病之后元气尚未恢复，这些都归属于阴虚生热、阳虚生寒。适宜用八珍汤，严重的用十全大补汤。如果有宿食致病，也会导致寒热，可用保和丸。如果食积已经消除，但寒热仍然发作，这是肝木邪气乘袭脾土，即“所胜侮所不胜”（强凌弱）的表现。可用异功散加柴胡、山栀。
张涣说：寒热病症中，有的伴有头痛出汗，有的伴有呕吐不能进食，有的憎恶寒冷却反而想喝水，有的高热却反而想喝热汤，有的筋骨疼痛，有的因为食积，遇冷时腹中疼痛，遇热时腹中鸣响。
沈金鳌按语：这种寒热同时并作的情况，是自成一类的病症，所以可能一天发作两三次，或者五六次。不像疟疾那样有固定的休止时间。关于疟疾的寒热症状，另在疟疾门类中详细论述。
曾氏说：骨蒸热，表现为身体虚弱消瘦，傍晚时分发作，只有发热没有恶寒，醒来时口渴出汗才停止。这是疳病的余毒，传变成为骨蒸。或者腹内有癖块，有时轻微疼痛。用化癖丸治疗。先治疗脾虚导致的宿食停滞，再用柴胡饮治疗。同时忌食鸡肉、酒类、羊肉、面条等发物。
沈金鳌按语：汤氏治疗骨蒸热，使用生犀散、地骨皮散、七宝散、金莲饮子，非常妥当。供参考。
有些小儿热症，在使用解表和清里的药物后，热势全部消退，随后又复发的，称为余热。推究其原因，是因为表里俱虚，阳气浮越于外，阴气潜伏于内，所以再次发热。适宜用温和平和的药物调和里气，体热自然消除。可用钱乙的白术散去木香加扁豆水煎服，以及黄耆六一汤、安神散，自然就能平复。
龚信说：热势有发作和停止，每天按时辰发作，称为潮热，就像潮水涨落一样不失期约。钱乙说：假如是潮热，是一个脏腑实证，一个脏腑虚证，从而在内产生虚热。治法应当补母脏而泻本脏，病就好了。例如中午发作潮热的，是心气虚。脉为心之母（肝属木，心属火，木生火，故肝为心之母），所以应当先补肝，待肝实之后再泻心。心得到母脏的滋养，内部平衡，潮热就会痊愈。医生见到潮热，错误地认为是实证，就用芒硝、大黄等寒凉药攻下。攻下过多，导致正气不能固摄，津液在内枯竭，即使暂时取得好转，很少有不变成疳病且身体消瘦的。曾氏的方法遇到潮热症，先用百解散发表，再用当归散治疗。脉象实的，用大柴胡汤攻下；脉象虚浮数的，用百解散微发其汗。如果潮热伴有呕吐的，用小柴胡汤和解。
王肯堂说：余热，是指寒邪未尽，传入经络后遗留的热邪。仁斋说：伤寒经过发汗或攻下治疗后，热势又起，这是因为表里俱虚，气不归元，阳气浮越于外，不可再用凉药。因为热去则寒起，古人对此有戒律。治法应当调和胃气，使阳气收敛，热势自然停止。适宜用参苓白术散。
Xue Ji stated: When Yang Qi (Vital Energy) is deficient, there is exterior cold; when Yin Essence is deficient, there is interior heat; when Yang is excessive, there is exterior heat; when Yin is excessive, there is interior cold. Alternating chills and fever result from the mutual overcoming of Yin and Yang. If Yin Qi aggregates in the Yin aspect, it manifests as cold; if Yang Qi aggregates in the Yang aspect, it manifests as heat. A faint pulse at the Cun Kou (Cun position) indicates insufficient Yang; when Yin Qi ascends into the Yang region, aversion to cold occurs. A weak pulse at the Chi position indicates insufficient Yin; when Yang Qi descends into the Yin region, fever occurs. Insufficient Yang typically presents with initial chills followed by fever; insufficient Yin typically presents with initial fever followed by chills. When Yin and Yang fail to remain in their proper divisions, a struggle between cold and heat ensues. Furthermore, excess in the upper jiao causes heat, while excess in the lower jiao causes cold. Yang dominance leads to sudden heat, while Yin dominance leads to sudden cold. Due to the mutual overcoming of Yin and Yang and the disharmony of deficiency and excess, pathogenic factors alternate in onset, resulting in alternating chills and fever, or intermittent cold and heat. The Shaoyang Gallbladder channel is the fu-organ of the Liver, situated between the exterior and interior, making it susceptible to invasion by Yin and Yang pathogens; thus, chills and fever symptoms are predominantly associated with the Liver and Gallbladder channels. Treatment involves modifying Xiao Chai Hu Tang (Minor Bupleurum Decoction). If only chills and fever are present, with normal daily activities, persisting for a long time without cure, or occurring after a major illness when Yuan Qi (Primal Qi) has not yet recovered, these all belong to heat generated by Yin deficiency and cold generated by Yang deficiency. Ba Zhen Tang (Eight Treasure Decoction) is appropriate; for severe cases, Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) is used. If retained food causes the disease, chills and fever may also occur; Bao He Wan (Preserve Harmony Pill) is indicated. If chills and fever persist after the food stagnation has resolved, this is due to Liver pathogen attacking the Spleen, representing "the overacting insulting the non-overacting" (strong bullying the weak). Yi Gong San (Extraordinary Power Powder) added with Chai Hu (Bupleuri Radix) and Shan Zhi (Gardeniae Fructus) should be used.
Zhang Huan stated: In chills and fever syndromes, some present with headache and sweating, some with vomiting and anorexia, some with aversion to cold but a desire to drink water, some with high fever but a desire to drink hot soup, some with pain in the sinews and bones, and some due to food stagnation, experiencing abdominal pain when cold and abdominal borborygmus when hot.
Shen Jin'ao commented: This simultaneous occurrence of chills and fever constitutes a distinct syndrome. Therefore, it may occur two or three times a day, or five or six times. It differs from malaria, which has specific intervals of remission. Malarial chills and fever are discussed in detail under the Malaria category.
Zeng Shi stated: Gu Zheng Re (Bone-steaming Fever) is characterized by emaciation and weakness, onset in the evening, fever without chills, cessation only upon waking with thirst and sweating. This is the residual toxicity of Gan Disease (Infantile Malnutrition), transforming into bone-steaming. Alternatively, there may be masses in the abdomen causing slight pain occasionally. Hua Pi Wan (Mass-Resolving Pill) is used. First treat Spleen deficiency with retained stagnation, then treat with Chai Hu Yin (Bupleurum Drink). Avoid toxic foods such as chicken, alcohol, mutton, and noodles.
Shen Jin'ao commented: Tang Shi treated bone-steaming fever using Sheng Xi San (Raw Rhinoceros Horn Powder), Di Gu Pi San (Lycium Bark Powder), Qi Bao San (Seven Treasures Powder), and Jin Lian Yin Zi (Golden Lotus Infusion), which was highly appropriate. For reference.
In some pediatric heat syndromes, after using exterior-releasing and interior-purging medicines, the heat subsides completely, only to recur later. This is called residual heat. Tracing the origin, it is due to both exterior and interior deficiency, with Yang floating outward and Yin hiding inward, causing recurrent fever. Mild and neutral medicines should be used to harmonize the interior, and the body heat will naturally resolve. Qian Yi's Bai Zhu San (Atractylodes Macrocephala Powder) with Mu Xiang removed and Dou (Vigna unguiculata) added, decocted in water, along with Huang Qi Liu Yi Tang (Astragalus Six-to-One Decoction) and An Shen San (Spirit-Calming Powder), will naturally restore balance.
Gong Xin stated: Heat that comes and goes, occurring at specific times daily, is called tidal fever, resembling the tide that never misses its schedule. Qian Yi said: Regarding tidal fever, it arises when one zang-organ is excess and another is deficient, generating internal deficient heat. The method is to tonify the mother organ and drain the affected organ to achieve cure. For example, tidal fever occurring at noon indicates Heart deficiency. Since the Pulse (Liver/Wood) is the mother of the Heart (Fire), one should first tonify the Liver. After the Liver becomes sufficient, then drain the Heart. Once the Heart receives qi from its mother, internal equilibrium is restored, and the tidal fever resolves. Physicians who see tidal fever and mistakenly assume it is excess, using cold purgatives like Xiao Shi (Mirabilite) and Da Huang (Rhei Radix et Rhizoma), cause excessive purging. This fails to secure the constitution, depletes internal fluids, and although temporary relief may be achieved, it rarely fails to result in Gan Disease and emaciation. Zeng Shi's method for tidal fever is to first use Bai Jie San (Hundred Resolutions Powder) to release the exterior, then treat with Dang Gui San (Angelica Sinensis Powder). If the pulse is excess, use Da Chai Hu Tang (Major Bupleurum Decoction) to purge; if the pulse is deficient, floating, and rapid, use Bai Jie San to induce mild sweating. If tidal fever is accompanied by vomiting, use Xiao Chai Hu Tang to harmonize.
Wang Kentang stated: Residual heat refers to lingering heat transmitted through the meridians after the cold pathogen has not fully dissipated. Ren Zhai stated: After sweating or purging in Shang Han (Cold Damage), if heat returns, it is because both exterior and interior are deficient, Qi does not return to its root, and Yang floats outward. Cold medicines should not be used again. As heat leaves, cold arises; the ancients warned against this. The method is to harmonize the Stomach, allowing Yang Qi to converge, so the heat stops naturally. Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is appropriate.