恶寒发热，亦是病证，不必有一病，然亦不必无一病。东垣以降，其说颇繁，迄至明人，愈精愈凿，遂失之
支离，眩惑后学。今摘其明约易知者，余不具录。但此所举，皆是属内因者。如外感寒热，既载在《伤寒》等各篇，
仍不复及。
总说 人之寒热往来者，其病何也？此乃阴阳相胜也。阳不足，则先寒后热；阴不足，则先热后寒。又
上盛则发热，下盛则发寒。皮寒而燥者，阳不足；皮热而燥者，阴不足。皮寒而寒者，阴盛也；皮热而热者，
阳盛也。热发于下，则阴中之阳邪也；热发于上。则阳中之阳邪也。寒起于
上，则阳中之阴邪也；寒起于下，则阴中之阴邪也。寒而颊赤多言者，阳中之阴邪也（按∶寒而颊赤上，疑脱
“热而颊赤多言者，阳中之阳邪也，”十三字）。热而面青多言者，阴中之阳邪也；寒而面青多言者，阴中之阴邪
也。若不言者，不可治也。阴中之阴中者，一生九死；阳中之阳中者，九生一死。阴病难治，阳病易医。（《中
藏》）
营卫受气于中，中有所阻，则营虚发热，卫虚恶寒，故气血饮食痰皆能为寒热者，质此。（《医津一筏》）
寒热往来 夫寒气并于阴则发寒，阳气并于阳则发热，阴阳二气，虚实不调，故邪气更作寒热往来也。
脉紧而数，寒热俱发，必当上乃愈（按∶此三句本出《脉经》，“上”字彼作“下”，宜从）。脉急如弦者
（按∶“如”当与“而”通），邪入阳明。（《病源论》）
往来寒热有期者，疟也；无期者，诸病也。有伤寒邪在少阳，及妇人病伤寒热入血室，而往来寒热者。有衰
弱人，阴阳之气并虚，相为胜复而往来（详《伤寒·平脉篇》“病有洒淅恶寒”条中），病后产后多有之。有郁
抑而致者，如寡妇尼姑，独阴无阳，欲火炽于中，则内热；不得遂而气郁于里，不外达，则表寒；久之郁热得伸，
则表热是也。有宿食结滞者，轻则消导，重则下之。（《医碥》）
寒热有昼夜之分《金匮大要论》云∶夜发寒者从，夜发热者逆；昼发热者从，昼发寒者逆。从逆之兆，
亦在乎审明。（《中藏》）
夜寒者，阴气（即寒邪）旺于阴分（为里，为脏，为血）；昼寒者，阴邪加于阳分；昼夜俱寒者，重阴也。
（与《发热篇》热分昼夜条对看，更详味下条自明）。按阳虚则畏寒而恶阴，故旦安而暮乱（至夜则寒也）；阴虚
则畏热而恶阳，故
夜宁而朝争（昼则热也），此正虚之候也。阳邪实者，遇阳而愈旺，故朝热而暮轻，阴邪实者，逢阴而更强，故
夜寒而昼减，此邪实之候也。阳虚而阴邪乘于阳分，则气行阳二十五度而病发，故日寒而夜息；阴虚而阳邪陷于
阴分（即血分也），则气行阴二十五度而病发，故夜热而昼凉（观疟疾或日发或夜发，可见矣），此正虚挟邪之候
也。其有昼夜俱热甚者，为重阳无阴；昼夜俱寒甚者，为重阴无阳；昼寒夜热者，为阴阳交错也。其有久病虚弱，
无分昼夜，作止不时者，以正气不能支持，而阴阳相乘，胜复无常也。（若壮实人初病见此，又为邪正相攻，不
时扰动之故，观伤寒少阳证往来寒热，初无定期，可见矣。）（《医碥》）
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（观热入血室证日轻夜重，可见）。昼夜俱热烦躁，是重阳无阴，当亟泻其阳，
峻补其阴。（同上）
丹溪论昼夜发热，昼重夜轻，口中无味，为阳虚；午后发热，夜半则止，口中知味，为阴虚。阳全阴半，
阳得以兼阴，阴不得以兼阳也。至于或昼或夜，或作或止，不时而发者，此脾胃气血俱虚，大气不宁之证，不
可拘于昼夜之候也。阳虚责在胃，阴虚责在肾。盖饥饱伤胃，劳役则兼伤脾，阳气虚矣。房劳伤肾，竭力则伤
肝，阴血亏矣。（《医通》）
热多在于午后夜分，羸瘦脉数弦，属阴虚，久则为骨蒸。以肾主骨，肾阴虚极，相火独炽而然也。（《六
要》）
寒热有外伤内伤之别 外伤寒邪之证，与饮食失节，劳役形质之病，及内伤饮食，俱有寒热。举世尽将
内伤饮食失节劳役不足之病，作外伤寒邪表实有余之证，反泻其表，枉死
者岂胜言哉，皆由不别其寒热耳，今细为分解之。外伤寒邪，发热恶寒，寒热并作，其热也翕翕发热，又谓之
拂拂发热。发于皮毛之上，如羽毛之拂，明其热在表也，是寒邪犯高之高者也。皮肤毛腠者，阳之分也，是卫
之元气所滋养之分也，以寒邪乘之，郁遏阳分，阳不得伸，故发热也。其面赤，鼻气壅塞不通，心中烦闷，稍似
袒裸，露其皮肤，已不能禁其寒矣。其表上虚热，止此而已。其恶寒也，虽重衣下幕，逼近烈火，终不能御其寒，
一时一日，增加愈甚，必待传入里作下证乃罢，其寒热齐作，无有间断也。其内伤饮食不节，或劳役所伤，亦
有头痛项强腰痛，与太阳表证微有相似，余皆不同，论中辨之矣。内伤不足之病，表上无阳，不能禁风寒也，此
则常常有之，其躁热发于肾间者，间而有之，与外中寒邪，略不相似。其恶风寒也，盖脾胃不足，荣气下流而
乘肾肝、此痿厥气逆之渐也。若胃气平常，饮食入胃，其荣气上行，以输于心肺，以滋养上焦之皮肤腠理之元气
也。既下流，其心肺无所禀受，皮肤间无阳，失其荣卫之外护，故阳分皮毛之间虚弱，但见风见寒，或居阴寒处，
无日阳处，便恶之也。此常常有之，无间断者也。但避风寒及温暖处，或添衣被温养其皮肤，所恶风寒，便不见
矣。是热也，非表伤寒邪皮毛间发热也，乃肾间受脾胃下流之湿气，闭塞其下，致阴火上冲，作蒸蒸而躁热，上
彻头顶，旁彻皮毛，浑身躁热作，须待袒衣露居近寒凉处即已，或极热而汗出亦解。彼外伤恶寒发热，岂有汗出
者乎，若得汗则病愈矣。以此辨之，岂不如黑白之易见乎。（《辨惑论》）
恶风概略 内伤恶寒有五∶一为阳衰表虚，一为阴乘阳位，一为阳气郁陷，一为热盛气散，一为肺被火
刑。（《医碥》）
恶寒有阳虚阳郁之异，阳虚者，宜补而温之，阳郁者，宜开发上焦，以开阳明之气，丹溪所谓久病恶寒，
当用解郁是也。（《金匮翼》）
阳虚恶寒 （体虚受寒）阳虚之脉，必沉细而微弱，无论浮沉，按之无神，独不带数者是也。体凉面白，
头不疼，口不渴，洞房重帏，无风亦怯，心虚惊悸，胆怯多疑，自汗无寐，神倦懒言，饮食如常，喜热恶冷，皆
系元阳虚极之证。在天谓之严寒，在人谓之真寒，非大用温补不治。（《百问》）
阳虚则恶寒，用参、 之类，甚者加附子少许，以行参、 之气。（《丹溪》）
余子元病恶寒战栗，持捉不定，两手皆冷汗浸淫，虽浓衣炽火，不能解。撄宁生即与真武汤，凡用附六枚。
一日病者忽出，人怪之。病者曰∶吾不恶寒，即无事矣。或以问撄宁生。生曰∶其脉两手皆沉微，余无表里证，
此盖体虚受寒，亡阳之极也。初皮表气隧为寒邪壅遏，阳不得伸而然也。是故血隧热壅，须用硝黄；气隧寒壅，
须用桂附。阴阳之用不同者，无形有形之异也。（《医史》）
热实恶寒 凡脏腑实热或虚热不清，其热而反兼寒化者有之，有淅淅恶寒之象，然见风寒，亦未必如
阳虚之畏怯，或初则恶而久自平常。其证燥渴饮冷，大便秘结，小便短涩，痰嗽咽干，口破目赤，六脉洪大或沉
数，按之有力者，为实热，如阴虚血少，脉必数涩无力。虽有恶寒之外证，惟从清散诸热为主，此证总由阳邪
内亢，逼阴于外，内热外寒，辛温大忌，甘凉自安。（《百问》）
《原病式》曰∶病热甚而反觉自冷，此为病热，实非寒也。或曰∶往往见有得热药而少愈者，何也？予曰∶
病热之人，其气炎上，郁为痰饮，抑遏清道，阴气不升，病热尤
甚，积痰得热，亦为暂退，热势助邪，其病益深。（《格致余论》）（按∶刘朱二家本诸运气篇。《统旨》曰∶
恶寒属热，此理无庸惑也。然热证服热药而少愈者，亦惟病之轻者耳；若热深者，得热则反增其病，决无可
愈之理。且热病轻而服热药，虽曰小愈，然不久必复作。或者不察，谓药力之未到，恶寒辄发，热药辄投，愈投
而火愈炽，病益深矣。甚则阳亢阴绝，不可收救，戒之戒之。）
夏英公之常饵乌、附，常御绵帐。不知湿痰积中，抑遏阳气，不得外泄，身必恶寒。经曰∶亢则害，承乃
制。又刘河间曰∶火极似水。故见此证，当治以咸寒，佐以甘温，视标本之先后，正邪之虚实，孰缓孰急，为之
正法。何至类用乌、附、丹剂、僭燥之药，抱薪救火，屠刽何异。古人治战栗，有以大承气汤下之而愈者。恶寒
战栗，明是热证，亦是因久服热药而得之者，但有虚实之分耳。进士周本道，年近四十，得恶寒证，服附子数
日而病甚，求余治。诊其脉弦而似缓，遂以江茶入姜汁、香油些少，吐痰一升许，减绵大半。又与通圣散，去麻
黄、大黄、芒硝，加当归、地黄，百余帖而安云云。又蒋氏妇，年五十余，形瘦面黑，六月喜热恶寒，两手脉
沉而涩，重取似数，以三黄丸下以姜汁，每三十粒，三十帖微汗而安。（《局方发挥》）
一妇身冷脉微，食沸热粥饭，六月重衣，以狐帽蒙其首，犹觉寒，泄注不止，常服姜、附、硫黄、燥热之剂，
仅得平和，稍用寒凉，其病转增，三年不愈。戴人诊其两手脉皆如 绳有力，一息六七至。《脉诀》曰∶六数七极
热生多。以凉布搭心，次以新汲水淋其病处，妇乃叫杀人。不由病者，令人持之，复以冷水淋，其三四十桶，大
战汗出，昏困一二日，而向之所恶皆除。此法华元化已曾用，惜无知
者。（《十形三疗》）
御史钱昕夫人，病恶寒，日夜以重裘覆其首，起跃入沸汤中，不觉。医以为寒甚。翁持之曰∶此痰火上腾，
所谓阳极似阴者，非下之，火不杀。下经宿而撤裘，呼水饮之，旬日气平乃愈。（《医史橘泉翁传》）
薛立斋治一人，内热作渴，大便秘结，畏风寒，手足逆冷。此内真热而外假寒，以黄连解毒汤治之愈，后用
地黄丸壮水之主，以镇阳光。（《大还》）（当考出典）
发热概略 发热者，热之发现于肌表者也。凡病多发热，热生于火，火本于气（丹溪谓气有余便是火，
其义可见），其理不外气乖与气郁二端。气乖有三∶一曰阳亢发热，一曰阴虚发热（血虚同），一曰阳虚发热。
气郁有七∶一风寒郁热，一饮食郁热，一为痰饮郁热，一为瘀血郁热，一为水湿郁热（以上五证，各门既载之，
故兹不拈出），一为肝气郁热，一为脾气郁热。（《医碥》）（按∶《金匮翼》分为劳倦、火郁、血虚、阳浮、
痰积、瘀血、骨蒸及食积酒毒八类，与此稍似。）
热有真假 盛启东云∶治热须辨真假。夫真热则发热恶寒，脉数有力，按之更实，烦躁口渴，大便燥，
小便赤涩，或利臭积，发言壮厉，不欲近衣者是也，亲乎表者宜发散，亲乎里者宜通泄。假热亦发热恶寒，而
足必不热，脉大而虚，按之微弱，身虽炽热而不躁不渴，或见虚狂躁渴而不能引饮，发过顷之即止，终不及声
高骂詈者也。经曰寒热有真假，治法有逆从，此之谓也。（《医通》）
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。（《医碥》）
凡暴热不止，脉滑数，或洪盛，皆为实热，宜随表里孰轻孰重而清理之。或脉虽沉而按之实坚者，为里实，
必用苦寒下夺之。若热久不止，脉来虚数无力，服调补药不应，饮食无味，或至夜烦渴，或反加干咳者，此必阴
血受伤，当以血药调补其阴，则阳热自化。阴阳虚盛之机，不可不审而急为转关也。（《医通》）
发热所起 阴不足则阳偏，阳偏则发热。若热从背起，或从手足，渐渐遍身，口舌干燥，思欲引水，
时时躁闷。此由阴气亏少，少水不能灭盛火，盖诸阳起四末，循行于背，阴不能敛阳，所以发热，或昼发而夜宁，
或夜发而至旦即轻，其脉虚疾而小（按∶原处芍药黄 汤，用芍药、黄 、甘草、青蒿）。热从腹起，上循胸腋，
绕颈额，初似温温，渐至大热，发作无时，遇饥愈剧，中脘不利，善食而瘦，面色苍，肌肉不泽，口唇干燥。此
由脾气素弱，曾于他病瘥后，误投热药，入于脾，脾热则消谷引食，善消肌肉，其脉濡弱而疾（按∶原处参橘丸，
用橘皮、麦门、人参）。热自腹中，或从背膂，渐渐蒸热，日晡则剧，至夜渐退，或寐而汗出，小便或赤，或白
而浊，甚则频数尿精，夜梦鬼交，日渐羸瘦。此由思虑太过，心气耗弱，阳气流散，精神不收，及阴无所使，治属
虚劳（按∶原处大建中汤）。若自腰以上发热，极则汗出，出已则凉，移时如故，复加昏冒，腹中膨满，其气上
攻，时时咳嗽，嗽引胁下牵痛，睡中惊悸，其脉弦急带疾。此由外寒搏客，内冷相合，寒则气收，而水液聚而不行，
恶寒发热，也是一种病证，不一定对应某一种特定的疾病，但也不一定没有对应的疾病。从李东垣以后，关于这方面的论述颇为繁杂，到了明代医家手中，虽然更加精细却趋于穿凿附会，于是变得支离破碎，迷惑了后学。现在我只摘录其中明确、简约、容易理解的内容，其余的不详细记录。这里所列举的，都是属于内因导致的病证。至于外感引起的寒热，既然已经在《伤寒论》等各篇中记载过，就不再重复提及。
总说：人出现寒热往来的症状，这是什么病呢？这是阴阳相互胜负的结果。阳气不足，就会先感到寒冷然后发热；阴气不足，就会先感到发热然后发冷。又比如上部邪气盛则发热，下部邪气盛则发冷。皮肤寒冷且干燥的，是阳气不足；皮肤发热且干燥的，是阴气不足。皮肤寒冷且身体寒冷的，是阴气盛；皮肤发热且身体发热的，是阳气盛。热从下部发出，是阴分中的阳邪；热从上部发出，是阳分中的阳邪。寒从上部发起，是阳分中的阴邪；寒从下部发起，是阴分中的阴邪。寒冷时脸颊发红且多言的，是阳分中的阴邪（按语：此处“寒冷而脸颊红”疑有脱漏，原文可能缺失了“热而脸颊红多言者，为阳分中的阳邪”这十三字）。发热时面色青且多言的，是阴分中的阳邪；寒冷时面色青且多言的，是阴分中的阴邪。如果不说话，则是难治之症。阴中之阴证，一生九死；阳中之阳证，九生一死。阴病难治，阳病易医。（出自《中藏经》）
营气和卫气的气血来源于中焦脾胃，如果中焦有所阻滞，就会导致营气虚弱而发热，卫气虚弱而恶寒，所以气血、饮食、痰饮都能导致寒热往来，道理就在这里。（出自《医津一筏》）
寒热往来：寒气并入阴分则发冷，阳气并入阳分则发热，阴阳二气虚实不调，所以邪气交替发作，表现为寒热往来。脉象紧而数，寒热同时发作，病情必定向上发展才能痊愈（按语：这三句原本出自《脉经》，其中“上”字在《脉经》中作“下”，应当遵从“下”字）。脉象急如弦一样紧绷的，说明邪气已传入阳明经。（出自《诸病源候论》）
寒热往来有固定时间的，是疟疾；没有固定时间的，是其他各种疾病。有的伤寒邪气停留在少阳经，以及妇女患伤寒热邪陷入血室，会出现寒热往来。有的体质衰弱之人，阴阳之气都虚弱，相互胜负交替而出现寒热往来（详见《伤寒论·平脉篇》“病有洒淅恶寒”条中），病后和产后多见这种情况。有的是因为情志抑郁所致，如寡妇、尼姑等，独阴无阳，欲火在中炽盛，则产生内热；愿望不得满足而气机郁结于体内，不能向外发散，则表现为表寒；久而久之，郁结的热得以舒展，则表现为表热。有的是因为宿食停滞结聚，轻则用消导法，重则用泻下法。（出自《医碥》）
寒热有昼夜之分：《金匮要略大要论》说：夜间发冷的为顺证，夜间发热的为逆证；白天发热的为顺证，白天发冷的为逆证。顺证和逆证的征兆，也在于仔细审察明确。（出自《中藏经》）
夜间发冷，是因为阴气（即寒邪）旺盛于阴分（指里、脏、血）；白天发冷，是因为阴邪侵犯阳分；昼夜都发冷，是重阴的表现。（与《发热篇》中热分昼夜的条文对照阅读，再细细体味下一条自然明白）。按：阳气虚则畏寒而厌恶阴气，所以早晨安宁而傍晚混乱（到了夜晚就发冷）；阴气虚则畏热而厌恶阳气，所以夜晚安宁而早晨争竞（白天就发热），这是正气虚弱的征候。阳邪实证的人，遇到阳时阳气更旺，所以早晨发热而傍晚减轻；阴邪实证的人，遇到阴时阴邪更强，所以夜间发冷而白天减轻，这是邪气实盛的征候。阳气虚弱而阴邪乘虚侵入阳分，那么气行于阳分二十五周次时发病，所以白天发冷而晚上缓解；阴气虚弱而阳邪陷入阴分（即血分），那么气行于阴分二十五周次时发病，所以夜间发热而白天凉爽（观察疟疾或白天发作或夜间发作，就可以明白了），这是正气虚弱兼夹邪气的征候。如果有昼夜都严重发热的，是重阳无阴；昼夜都严重发冷的，是重阴无阳；白天冷晚上热的，是阴阳交错。如果有久病体弱，不分昼夜，发作停止没有定时的，是因为正气不能支撑，阴阳相互乘袭，胜负无常。（如果是壮实人初病见此症状，又是邪正相攻，不时扰动的缘故，观察伤寒少阳证寒热往来，起初也没有定期，就可以明白了。）（出自《医碥》）
白天发热晚上安静，是阳邪（即热邪）自然旺盛于阳分（阳分指表、腑、气。阳邪在阳分，遇到阳时，所以发热发作）；白天安静晚上发热，是阳邪下陷于阴分（观察热入血室证白天轻晚上重，就可以明白）。昼夜都发热且烦躁，是重阳无阴，应当紧急泻其阳热，峻补其阴液。（同上）
朱丹溪论述昼夜发热，白天重晚上轻，口中无味，属于阳虚；午后发热，半夜停止，口中知味，属于阴虚。阳全阴半，阳可以兼摄阴，阴不能兼摄阳。至于有时在白天有时在夜晚，有时发作有时停止，不时发作的，这是脾胃气血都虚弱，大气不宁的病证，不可拘泥于昼夜的症状。阳虚的责任在胃，阴虚的责任在肾。因为饥饱失调伤胃，劳役过度则兼伤脾，导致阳气虚。房事劳累伤肾，竭力则伤肝，导致阴血亏虚。（出自《医学入门》）
热多在午后和夜半时分，身体消瘦，脉象数而弦，属于阴虚，久了就成为骨蒸。因为肾主骨，肾阴虚极，相火独自炽盛所致。（出自《六要》）
寒热有外伤和内伤的区别：外伤寒邪的病症，与饮食失节、劳役形体损伤的疾病，以及内伤饮食，都有寒热的表现。世人全都将内伤饮食失节、劳役不足的病，当作外伤寒邪、表实有余的证候，反而使用泻表的方法，枉死者岂能说得完呢？这都是因为没有辨别清楚寒热的原因，现在详细为你们分解。外伤寒邪，发热恶寒，寒热同时发作，其热势像羽毛轻轻拂动一样发热，又称为拂拂发热。这种热发于皮毛之上，像羽毛拂动一样，说明热在表，这是寒邪侵犯高处的体表。皮肤毛窍，是阳分的领域，是卫气元气所滋养的区域，寒邪趁虚而入，郁遏阳分，阳气不能伸展，所以发热。患者面赤，鼻气壅塞不通，心中烦闷，稍微有点像裸露身体，露出皮肤，已经不能忍受寒冷了。这种表上的虚热，仅此而已。至于恶寒，即使穿厚衣、放下帘幕、靠近烈火，终究不能抵御寒冷，一天比一天加重，必须等到寒邪传入里部形成里实证后才能停止，寒热齐作，没有间断。内伤饮食不节，或劳役所伤，也有头痛项强腰痛，与太阳表证略有相似，其余都不同，论中已经辨析过了。内伤不足的病，表上没有阳气，不能禁受风寒，这是常常存在的。那种躁热发自肾间的，偶尔才有，与外感寒邪完全不同。至于恶风恶寒，大概是因为脾胃不足，荣气下流而乘袭肾肝，这是痿厥气逆的开端。如果胃气正常，饮食入胃，荣气上行，输送到心肺，以滋养上焦皮肤腠理的元气。既然荣气下流，心肺就没有禀受，皮肤间没有阳气，失去了荣卫的外在保护，所以阳分皮毛之间虚弱，只要见到风、见到寒，或者居住在阴寒处、没有阳光的地方，就会感到厌恶。这是常常存在的，没有间断的。只要避开风寒及温暖处，或者添加衣被温养皮肤，所厌恶的风寒感觉就会消失。这种热，不是表受寒邪在皮毛间发热，而是肾间受到脾胃下流的湿气闭塞在下，导致阴火上冲，产生蒸蒸而躁热，上彻头顶，旁彻皮毛，浑身躁热发作，必须等到解开衣服裸露身体靠近凉处才停止，或者极度发热出汗后也会解除。那外感恶寒发热，怎么会有出汗的呢？如果得汗则病愈了。以此辨别，岂不是像黑白一样容易看见吗？（出自《辨惑论》）
恶风概略：内伤导致的恶寒有五种：一是阳衰表虚，二是阴乘阳位，三是阳气郁陷，四是热盛气散，五是肺被火刑。（出自《医碥》）
恶寒有阳虚和阳郁的不同，阳虚的，适宜补益而温之；阳郁的，适宜开发上焦，以开通阳明之气，这就是朱丹溪所说的久病恶寒，应当用解郁的方法。（出自《金匮翼》）
阳虚恶寒（体虚受寒）：阳虚的脉象，必定沉细而微弱，无论浮取还是沉取，按之无神，唯独不带数象的就是。身体凉，面色白，头不疼，口不渴，在深室重帷之中，无风也害怕，心虚惊悸，胆怯多疑，自汗失眠，精神疲倦懒言，饮食正常，喜热恶冷，这些都是元阳极度虚弱的证候。在天称为严寒，在人称为真寒，不用大剂量的温补药是不能治愈的。（出自《百问》）
阳虚则恶寒，用人参、黄芪之类，严重的加少许附子，以通行人参、黄芪之气。（出自《丹溪心法》）
余子元患恶寒战栗，手持捉不定，两手冷汗浸淫，即使穿厚衣烧大火，也不能缓解。撄宁生立即给予真武汤，用了六枚附子。一天病人忽然出门，人们感到奇怪。病人说：“我不再怕冷了，就没事了。”有人以此问撄宁生。撄宁生说：“他的脉两手都沉微，没有其他表里证候，这大概是体虚受寒，亡阳到了极点。起初皮表气隧被寒邪壅遏，阳气不能伸展所致。所以血隧热壅，需要用硝石、大黄；气隧寒壅，需要用桂枝、附子。阴阳的作用不同，是因为无形和有形的区别。”（出自《医史》）
热实恶寒：凡是脏腑实热或虚热不清，其热反而兼有寒化的情况，会有淅淅恶寒的现象，然而见到风寒，也未必像阳虚那样畏惧怯懦，或者起初恶寒后来自己变平常。其证见燥渴饮冷，大便秘结，小便短涩，痰嗽咽干，口破目赤，六脉洪大或沉数，按之有力的，为实热，如阴虚血少，脉必数涩无力。虽然有恶寒的外证，只以清散各种热为主，此证总由阳邪内亢，逼迫阴气于外，内热外寒，辛温药是大忌，甘凉药自然安适。（出自《百问》）
《原病式》说：病热很重反而觉得自身冷，这是病热，实在不是寒。有人说：往往见到服用热药后稍微好转的，为什么呢？我说：患热病的人，其气炎上，郁结为痰饮，抑制阻碍清道，阴气不升，病热尤其严重，积痰得到热药，也是暂时退去，热势助长邪气，病更加深入。（出自《格致余论》）（按语：刘河间、朱丹溪两家本于运气篇。《统旨》说：恶寒属热，这个原理无需疑惑。然而热证服热药而稍愈的，也只是病轻的情况；如果热深，得热则反而增加病情，绝对没有痊愈的道理。而且热病轻而服热药，虽然说是小愈，但不久必然复发。有的人不考察，认为药力未到，恶寒就发作，热药就投用，越投用火势越炽盛，病越深。甚至导致阳亢阴绝，不可收拾，切记切记。）
夏英公经常服用乌头、附子，经常住在绵帐中。不知道湿痰积聚在中焦，抑制阳气，不能向外宣泄，身体必然恶寒。经书说：亢盛则有害，承制才能平衡。又说刘河间说：火极似水。所以见到这种证候，应当用咸寒治疗，佐以甘温，视标本的先后，正邪的虚实，孰缓孰急，制定正规治法。何至于类同使用乌头、附子、丹剂、僭燥的药物，如同抱薪救火，与屠刽有什么区别。古人治疗战栗，有用大承气汤泻下而痊愈的。恶寒战栗，明明是热证，也是因为久服热药而得的，只是有虚实之分罢了。进士周本道，年近四十，患恶寒证，服用附子几天后病情加重，求我治疗。诊其脉弦而似缓，于是用江茶加入姜汁、香油少许，吐出痰一升左右，减去一半的绵衣。又给予通圣散，去掉麻黄、大黄、芒硝，加入当归、地黄，一百多帖后安定。还有蒋氏妇，五十多岁，形体瘦面色黑，六月天喜欢热怕冷，两手脉沉而涩，重取似乎数，用三黄丸加姜汁送服，每三十粒，三十帖后微汗而安。（出自《局方发挥》）
一个妇人身体冷脉微，吃沸热的粥饭，六月天穿厚衣，用狐皮帽蒙住头，仍然觉得冷，泄泻不止，常服姜、附、硫黄、燥热之剂，仅得平和，稍用寒凉，病情转增，三年不愈。戴人诊其两手脉都像弹绳有力，一息六七至。《脉诀》说：六数七极热生多。用凉布搭在心口，接着用新汲水淋在患处，妇人叫喊杀人。不由病人控制，让人按住她，再用冷水淋，倒了三四十桶，大战汗出，昏困一二日，之前所厌恶的症状都除去了。这种方法华元化已经用过，可惜无人知晓。（出自《十形三疗》）
御史钱昕夫人，患恶寒，日夜用厚裘覆盖头部，跳进沸水中也不觉得烫。医生认为是寒甚。翁持之说：这是痰火上腾，所谓阳极似阴，不下之，火不能灭。下药过夜后撤去裘衣，呼叫喝水，十天气息平稳才痊愈。（出自《医史橘泉翁传》）
薛立斋治疗一人，内热作渴，大便秘结，畏风寒，手足逆冷。这是内真热而外假寒，用黄连解毒汤治疗痊愈，后用六味地黄丸壮水之主，以镇阳光。（出自《大还》）（当考证出处）
发热概略：发热，是热显现于肌表。凡病大多发热，热生于火，火本于气（朱丹溪说气有余便是火，这个道理可见），其理不外乎气乖和气郁两个方面。气乖有三种：一是阳亢发热，二是阴虚发热（血虚相同），三是阳虚发热。气郁有七种：一是风寒郁热，二是饮食郁热，三是痰饮郁热，四是瘀血郁热，五是水湿郁热（以上五证，各门既已记载，故这里不提出），六是肝气郁热，七是脾气郁热。（出自《医碥》）（按语：《金匮翼》分为劳倦、火郁、血虚、阳浮、痰积、瘀血、骨蒸及食积酒毒八类，与此稍有类似。）
热有真假：盛启东说：治热必须辨别真假。真热则发热恶寒，脉数有力，按之更实，烦躁口渴，大便燥，小便赤涩，或利臭秽积垢，发言壮厉，不欲近衣，这是亲乎表者宜发散，亲乎里者宜通泄。假热也发热恶寒，但脚一定不热，脉大而虚，按之微弱，身虽炽热但不躁不渴，或见虚狂躁渴但不能引饮，发过一会儿就停止，终不及声高骂詈。经书说寒热有真假，治法有逆从，说的就是这个。（出自《医学入门》）
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。（出自《医碥》）
凡是暴热不止，脉滑数，或洪盛，皆为实热，适宜随表里孰轻孰重而清理。或者脉虽沉但按之实坚的，为里实，必须用苦寒下夺之法。如果热久不止，脉来虚数无力，服调补药不应，饮食无味，或至夜烦渴，或反加干咳的，这一定是阴血受伤，应当用血药调补其阴，则阳热自然化解。阴阳虚盛的机理，不可不审察并急于转机。（出自《医学入门》）
发热所起：阴不足则阳偏胜，阳偏胜则发热。如果热从背部发起，或从手足发起，渐渐遍及全身，口舌干燥，想喝水，时时躁闷。这是由于阴气亏少，少水不能灭盛火，盖诸阳起于四末，循行于背，阴不能敛阳，所以发热，或昼发而夜安宁，或夜发而至旦即轻，其脉虚疾而小（按：原处芍药黄芪汤，用芍药、黄芪、甘草、青蒿）。热从腹部发起，上循胸腋，绕颈额，初似温温，渐至大热，发作无时，遇饥饿更剧烈，中脘不利，善食而瘦，面色苍，肌肉不泽，口唇干燥。这是由于脾气素弱，曾在其他病好后，误投热药，入于脾，脾热则消谷引食，善消肌肉，其脉濡弱而疾（按：原处参橘丸，用橘皮、麦门冬、人参）。热自腹中，或从背膂，渐渐蒸热，日晡时加剧，至夜渐退，或寐而汗出，小便或赤，或白而浊，甚则频数尿精，夜梦鬼交，日渐羸瘦。这是由于思虑太过，心气耗弱，阳气流散，精神不收，及阴无所使，治属虚劳（按：原处大建中汤）。若自腰以上发热，极则汗出，出已则凉，移时如故，复加昏冒，腹中膨满，其气上攻，时时咳嗽，嗽引胁下牵痛，睡中惊悸，其脉弦急带疾。这是由于外寒搏客，内冷相合，寒则气收，而水液聚而不行，
Chills and fever are also pathological conditions; they do not necessarily correspond to a single specific disease, nor do they necessarily lack a corresponding disease. Since Li Dongyuan, discussions on this topic have been quite complex, and by the time of Ming dynasty physicians, although more refined, they became overly pedantic and fragmented, confusing later learners. I now excerpt only those that are clear, concise, and easy to understand, omitting the rest. The examples cited here all belong to internal causes. As for exogenous cold-heat patterns, since they are already recorded in chapters such as *Shanghan Lun* (Treatise on Cold Damage), they will not be repeated.
General Discussion: What is the pathology behind alternating chills and fever? It results from the mutual overcoming of Yin and Yang. When Yang Qi is insufficient, chills precede fever; when Yin is insufficient, fever precedes chills. Furthermore, excess in the upper jiao leads to fever, while excess in the lower jiao leads to chills. Cold skin with dryness indicates insufficient Yang; hot skin with dryness indicates insufficient Yin. Cold skin accompanied by bodily coldness indicates Yin excess; hot skin accompanied by bodily heat indicates Yang excess. Heat arising from below indicates Yang pathogen within Yin; heat arising from above indicates Yang pathogen within Yang. Cold originating from above indicates Yin pathogen within Yang; cold originating from below indicates Yin pathogen within Yin. Chills with red cheeks and excessive talking indicate Yin pathogen within Yang (Note: "Cold with red cheeks" likely has a textual omission; the original text probably lacked the thirteen characters "Fever with red cheeks and excessive talking indicates Yang pathogen within Yang"). Fever with a blueish complexion and excessive talking indicates Yang pathogen within Yin; chills with a blueish complexion and excessive talking indicates Yin pathogen within Yin. If the patient does not speak, it is difficult to treat. Yin-Yin syndrome has one survivor out of ten deaths; Yang-Yang syndrome has nine survivors out of ten deaths. Yin diseases are hard to treat; Yang diseases are easier to cure. (*Zhongzang Jing*)
Ying (Nutritive) and Wei (Defensive) Qi derive from the Middle Jiao. If there is obstruction in the Middle Jiao, Ying deficiency leads to fever, and Wei deficiency leads to aversion to cold. Therefore, disorders of Qi and Blood, diet, and phlegm can all cause alternating chills and fever; this is the principle involved. (*Yi Jin Yi Fa*)
Alternating Chills and Fever: When Cold Qi merges into Yin, chills occur; when Yang Qi merges into Yang, fever occurs. Due to the imbalance of deficiency and excess in Yin and Yang Qi, pathogens alternate, causing alternating chills and fever. A tight and rapid pulse with simultaneous chills and fever indicates the condition must resolve upward to heal (Note: These three sentences originate from *Mai Jing*; the character "upward" is written as "downward" in *Mai Jing*, so "downward" should be followed). A pulse tense like a string indicates the pathogen has entered the Yangming channel. (*Zhubing Yuanhou Lun*)
Alternating chills and fever with a fixed schedule is malaria; without a fixed schedule, it is various other diseases. Some cases involve Shaoyang syndrome where cold pathogen remains in the Shaoyang channel, or women with cold damage where heat enters the Blood Chamber, resulting in alternating chills and fever. In frail individuals, both Yin and Yang Qi are deficient, leading to alternating chills and fever due to mutual overcoming (see detailed discussion in *Shanghan Lun · Pingmai Pian* under "Patient feels chilly and afraid of cold"). This is common after illness and postpartum. Some cases result from emotional depression; for example, widows or nuns, having only Yin without Yang, have blazing desire-fire internally causing internal heat; unfulfilled desires lead to Qi stagnation internally, unable to diffuse outward, causing exterior cold; over time, the stagnant heat is released, manifesting as exterior heat. Some cases involve retained food stagnation; mild cases require digestion-promoting methods, severe cases require purgation. (*Yi Que*)
Chills and Fever with Diurnal Variation: *Jingui Dayao Lun* states: Nighttime chills are a favorable sign (Cong); nighttime fever is unfavorable (Ni). Daytime fever is favorable; daytime chills are unfavorable. The signs of favorability and unfavorability depend on careful examination. (*Zhongzang Jing*)
Nighttime chills occur because Yin Qi (i.e., Cold Pathogen) is prosperous in the Yin division (Interior, Zang organs, Blood). Daytime chills occur because Yin pathogen attacks the Yang division. Chills throughout day and night indicate Heavy Yin. (Compare with the section on fever diurnal variation in *Refre Pian* for further clarity.) Note: Yang deficiency leads to aversion to cold and fear of Yin, so morning is peaceful and evening is chaotic (chills at night); Yin deficiency leads to fear of heat and aversion to Yang, so night is peaceful and morning is contentious (fever during day). These are signs of Righteous Qi deficiency. In Yang Excess syndromes, encountering Yang times makes the pathogen stronger, so morning fever and evening relief; in Yin Excess syndromes, encountering Yin times makes the pathogen stronger, so night chills and day relief. These are signs of Pathogenic Excess. When Yang is deficient and Yin pathogen invades the Yang division, illness manifests when Qi circulates through the Yang division twenty-five times, hence daytime chills and nighttime relief. When Yin is deficient and Yang pathogen sinks into the Yin division (i.e., Blood division), illness manifests when Qi circulates through the Yin division twenty-five times, hence nighttime fever and daytime coolness (observable in malaria occurring daily or nightly). These are signs of Righteous Deficiency with夹杂 Pathogen. Severe fever day and night indicates Heavy Yang without Yin; severe chills day and night indicate Heavy Yin without Yang; daytime chills and nighttime fever indicate Yin-Yang interlacing. In chronic weakness without diurnal distinction, with irregular onset and cessation, it is because Righteous Qi cannot sustain itself, and Yin and Yang attack each other with unpredictable fluctuations. (If seen in robust individuals at the onset of illness, it is due to struggle between Pathogen and Righteous Qi, causing intermittent disturbance; observe Shaoyang syndrome in cold damage where alternating chills and fever initially have no regular schedule.) (*Yi Que*)
Daytime fever with nighttime quietness indicates Yang Pathogen naturally prospering in the Yang division (Yang division refers to Exterior, Fu organs, Qi. Yang Pathogen in Yang division encounters Yang times, so fever arises). Daytime quietness with nighttime fever indicates Yang Pathogen sinking into the Yin division (observable in Heat Entering Blood Chamber syndrome where symptoms are lighter by day and heavier by night). Fever and irritability throughout day and night indicate Heavy Yang without Yin; urgently purge Yang heat and vigorously tonify Yin. (Ibid.)
Danxi discussed fever: Daytime heavy, nighttime light, with tasteless mouth indicates Yang deficiency. Afternoon fever stopping at midnight, with normal taste, indicates Yin deficiency. With full Yang and half Yin, Yang can encompass Yin, but Yin cannot encompass Yang. Cases occurring randomly day or night, intermittently, indicate deficiency of Spleen-Stomach Qi and Blood, and instability of Great Qi; these should not be confined to diurnal patterns. Yang deficiency responsibility lies in the Stomach; Yin deficiency responsibility lies in the Kidney. Irregular eating harms the Stomach; labor harms the Spleen, leading to Yang Qi deficiency. Sexual exhaustion harms the Kidney; overexertion harms the Liver, leading to Yin Blood deficiency. (*YiTong*)
Heat mostly occurring in afternoon and midnight, with emaciation and wiry-rapid pulse, belongs to Yin deficiency; prolonged, it becomes bone-steaming fever. Since Kidney governs bones, extreme Kidney Yin deficiency causes Ministerial Fire to blaze alone. (*Liu Yao*)
Distinction between External Injury and Internal Injury in Chills and Fever: External injury by Cold Pathogen, dietary indiscretion, physical overwork, and internal injury by diet all present with chills and fever. The world generally mistakes internal injuries from diet, indiscretion, and overwork for external cold injury with exterior excess, treating them by purging the exterior, leading to countless wrongful deaths. This stems from failing to distinguish the nature of chills and fever. Now, I will analyze them in detail. External cold injury presents with fever and aversion to cold, occurring simultaneously. The fever is like feathers brushing (Xi Xi Re or Fu Fu Re), arising on the skin and hair pores, indicating heat in the exterior; this is Cold Pathogen attacking the high exterior. Skin and pores are the domain of Yang, nourished by Wei Qi Yuan Qi. Cold pathogen invades, suppressing Yang Qi, preventing its extension, thus causing fever. Patients may have red faces, nasal congestion, mental restlessness, feeling slightly naked, unable to tolerate cold even with exposed skin. This superficial false heat ends here. Regarding aversion to cold, even with thick clothes, curtains, and proximity to fire, one cannot ward off the cold. It worsens daily until the pathogen transmits to the interior forming interior excess syndromes, then stops. Chills and fever occur together without interruption. Internal injury from undigested food or overwork may also present with headache, stiff neck, and back pain, slightly resembling Taiyang exterior syndrome, but otherwise different, as analyzed in the treatise. Internal deficiency diseases lack Yang Qi on the exterior, making them unable to withstand wind and cold; this is constant. Occasional heat arising from the Kidney area differs slightly from external cold injury. Aversion to wind and cold occurs because Spleen-Stomach deficiency causes Ying Qi to flow downward, attacking Liver and Kidney, a precursor to flaccidity and reversal cold. If Stomach Qi is normal, food enters the Stomach, Ying Qi flows upward to Heart and Lung, nourishing the Qi of the upper jiao skin and pores. Since Ying Qi flows downward, Heart and Lung receive nothing; skin lacks Yang Qi, losing Ying-Wei protection. Thus, Yang Qi in skin and pores is weak; seeing wind or cold, or staying in dark/cold places without sunlight, causes aversion. This is constant and uninterrupted. Avoiding wind/cold, staying warm, or adding clothes relieves the aversion. This heat is not exterior cold-induced fever in skin/pores, but dampness from Spleen-Stomach downward flow blocking the lower body, causing Yin Fire to rush upward, creating steaming irritant heat penetrating head and skin. Relief comes from exposing oneself to cool air or sweating profusely. Does external cold injury with chills/fever cause sweating? No, sweating indicates recovery. Distinguishing them is as easy as distinguishing black from white. (*Bian Huo Lun*)
Overview of Aversion to Wind: Internal injury aversion to cold has five types: 1. Yang decline and exterior deficiency; 2. Yin invading Yang position; 3. Yang Qi depression and sinking; 4. Heat excess dispersing Qi; 5. Lung punished by Fire. (*Yi Que*)
Aversion to cold differs between Yang deficiency and Yang depression. Yang deficiency requires tonification and warming; Yang depression requires opening the upper jiao to vent Yangming Qi, as Danxi said: long-term aversion to cold requires resolving depression. (*Jingui Yi*)
Yang Deficiency Aversion to Cold (Body Weakness with Cold Invasion): Yang deficiency pulse is deep, fine, and weak, lacking spirit upon pressing, without rapidity. Body is cool, face pale, no headache, no thirst, fearful even in deep rooms without wind, palpitations, timidity, suspicion, spontaneous sweating, insomnia, fatigue, reluctance to speak, normal appetite, preference for hot/cold aversion. All are signs of extreme Primordial Yang deficiency. In heaven called severe cold; in humans called true cold. Requires large doses of warming tonics to cure. (*Bai Wen*)
Yang deficiency causes aversion to cold; use Ginseng and Astragalus. Severe cases add small amounts of Aconite to move the Qi of Ginseng and Astragalus. (*Danxi*)
Yu Zi Yuan suffered from chills and tremors, unable to hold still, hands soaked in cold sweat. Thick clothes and fires did not help. Ying Ningsheng prescribed Zhen Wu Tang using six pieces of Aconite. One day the patient went out unexpectedly. People were surprised. Patient said: "Once my aversion to cold ceases, I am fine." Asked Ying Ningsheng, he replied: "His pulse was deep and faint in both hands, with no other exterior-interior signs. This is body weakness with cold invasion, extreme loss of Yang. Initially, skin and Qi tunnels were blocked by Cold Pathogen, preventing Yang extension. Thus, blood tunnel heat blockage needs Nitre and Rhubarb; Qi tunnel cold blockage needs Cinnamon and Aconite. Yin and Yang uses differ due to formless vs. formed distinctions." (*Yi Shi*)
Heat Excess Aversion to Cold: Visceral excess heat or unresolved deficiency heat may manifest with cold-like symptoms, appearing chilly. However, unlike Yang deficiency fearfulness, it may start with aversion but become normal later. Symptoms include dry thirst craving cold drinks, constipation, scanty dark urine, phlegm cough with dry throat, mouth ulcers, red eyes, surging or deep-rapid pulses strong upon pressing, indicating Excess Heat. In contrast, Yin deficiency/Blood deficiency pulses are rapid, choppy, and weak. Despite exterior aversion to cold, treatment focuses on clearing and dispersing heat. This pattern is caused by Yang Pathogen rising internally, forcing Yin outward, resulting in internal heat and exterior cold. Acrid-warm herbs are strictly contraindicated; sweet-cool herbs bring peace. (*Bai Wen*)
*Yuan Bing Shi* states: Severe heat patients feeling cold internally are suffering from heat, not cold. Someone asked: Why do some improve slightly with hot herbs? I say: Heat patients have flaming Qi, stagnating into phlegm-fluids, obstructing clear pathways, preventing Yin ascent, worsening heat. Phlegm temporarily retreats with heat, but heat aids the pathogen, deepening the disease. (*Gezhi Yulun*) (Note: Liu Hejian and Zhu Danxi based this on Luck Theory. *Tongzhi* says: Aversion to cold belonging to heat is logical and needs no doubt. However, slight improvement with hot herbs only happens in mild heat cases; in deep heat, hot herbs worsen the condition, never curing it. Mild heat treated with hot herbs may seem better briefly but recurs soon. Unobservant doctors think medicine hasn't taken effect, continue giving hot herbs, intensifying fire and deepening disease, potentially leading to Yang hyperactivity and Yin exhaustion, irrecoverable. Beware!)
Duke Xia Ying often consumed Aconite and Typha pollen, living in silk tents. Unaware that damp-phlegm accumulated in the middle, suppressing Yang Qi from diffusing outward, causing body aversion to cold. Classic says: Hyperactivity causes harm; control brings balance. Liu Hejian said: Extreme fire resembles water. Thus, treat with salty-cold herbs assisted by sweet-warm, considering root/branch priority and excess/deficiency of Zheng/Xie. Why use Aconite, Typha, dan pills, and drying drugs, akin to adding fuel to fire or acting like executioners? Ancients cured tremors with Da Cheng Qi Tang purgation. Aversion to cold and tremors are clearly heat syndromes, often caused by long-term hot herb use, differing only in excess/deficiency. Scholar Zhou Bendao, nearly forty, had aversion to cold. After taking Aconite for days, condition worsened. I diagnosed wiry-slow pulse. Used Jiang tea with ginger juice and sesame oil, vomited one sheng of phlegm, reduced silk clothing by half. Then gave Tong Sheng San, removing Ephedra, Rhubarb, Mirabilite, adding Angelica and Rehmannia. Over a hundred doses brought stability. Also, Lady Jiang, fifty-plus, thin black-faced, preferring heat/hating cold in June, deep-choppy pulse seeming rapid on heavy press. Given San Huang Wan with ginger juice, 30 pills per dose, 30 doses brought slight sweating and stability. (*Ju Fang Fa Hui*)
A woman with cold body and faint pulse ate boiling porridge, wore heavy clothes in June, covered head with fox hat, still felt cold, with continuous diarrhea. She took Ginger, Aconite, Sulfur, and hot drugs, achieving only mild stability; any cold drug worsened her condition. She remained ill for three years. Dai Ren found her pulses firm like a rope, 6-7 beats per breath. *Mai Jue* says: Six rapid/seven extreme indicates much heat. Placed cool cloth on heart, then splashed fresh water on lesions. Woman screamed. Held down, splashed with cold water, 30-40 buckets. Profuse sweating, unconscious for 1-2 days, all previous aversions removed. Hua Yuanhua used this method before, unfortunately unknown. (*Shi Xing San Liao*)
Madrigate Qian Xin's wife suffered aversion to cold, covering head with thick fur day and night, jumping into boiling water unaware. Doctors thought severe cold. Weng Chi said: This is Phlegm-Fire rushing up, extreme Yang resembling Yin. Must purge, or fire won't die. After purging overnight, removed fur, called for water, recovered in ten days with calm Qi. (*Yi Shi Ju Quan Weng Zhuan*)
Xue Lizhai treated a man with internal heat/thirst, constipation, fear of wind/cold, cold limbs. This is internal true heat with external false cold. Treated with Huang Lian Jie Du Tang, cured. Later used Di Huang Wan to strengthen Water Master to suppress Yang Light. (*Da Hai*) (Source to be verified)
Overview of Fever: Fever is heat manifesting on the muscle surface. Most diseases involve fever; heat generates from Fire, Fire originates from Qi (Danxi said: Excess Qi is Fire, illustrating this principle). The mechanism involves Qi deviation and Qi stagnation. Qi deviation has three types: 1. Yang hyperactivity fever; 2. Yin deficiency fever (same as Blood deficiency); 3. Yang deficiency fever. Qi stagnation has seven types: 1. Wind-Cold stagnating heat; 2. Diet stagnating heat; 3. Phlegm-Fluid stagnating heat; 4. Blood Stasis stagnating heat; 5. Water-Dampness stagnating heat (these five are covered in other sections, so omitted here); 6. Liver Qi stagnating heat; 7. Spleen Qi stagnating heat. (*Yi Que*) (Note: *Jingui Yi* classifies into eight categories: Fatigue, Fire Stagnation, Blood Deficiency, Yang Floating, Phlegm Accumulation, Blood Stasis, Bone Steaming, Food/Wine Toxicity, somewhat similar to this.)
True vs. False Heat: Sheng Qidong said: Treating heat requires distinguishing true/false. True heat presents with fever/aversion to cold, rapid-strong pulse, deeper pressure reveals solidity, irritability/thirst, dry stool, dark/scanty urine, or foul diarrhea, loud speech, dislike of clothing. Exterior-proximate cases need dispersion; interior-proximate cases need purgation. False heat also presents with fever/aversion to cold, but feet are not hot, pulse is large-empty, weak on pressure. Body hot but not irritable/thirsty, or false madness/thirst unable to drink, subsides quickly after onset, voice not loud/cursing. Classic says: Heat has true/false, treatment has reverse/follow. This is what is meant. (*YiTong*)
Excess vs. Deficiency Heat: Abundant flesh/blood, lustrous skin/hair, Yin excess with heat, able to eat with heat, bitter/dry mouth, difficult stool, surging pulse indicates Excess Heat. Bone atrophy, dry flesh, lax tendons, depleted blood, gathered skin, fallen hair, Yin deficiency with heat, unable to eat with heat, shortness of breath, empty pulse indicates Deficiency Heat. (*Yi Que*)
Sudden persistent fever with slippery-rapid or surging pulse indicates Excess Heat; clear based on exterior/interior severity. Deep pulse solid upon pressing indicates Interior Excess; must use bitter-cold purgation. Persistent fever with empty-rapid-weak pulse, unresponsive to tonics, tasteless food, nighttime thirst/irritability, or dry cough indicates Yin Blood injury; tonify Yin with Blood herbs, Yang heat will transform. Must carefully examine Yin/Yang excess/deficiency mechanisms and urgently shift the course. (*YiTong*)
Origin of Fever: Yin insufficiency leads to Yang bias; Yang bias causes fever. Heat starting from back or limbs, spreading gradually, dry mouth/tongue, craving water, frequent irritability. Caused by Yin Qi deficiency, little water cannot extinguish盛 fire. Yang Qi starts from extremities, circulates on back; Yin cannot contain Yang, hence fever. Day fever/night peace, or night fever/morning light, pulse empty-rapid-small (Note: Original location Shaoyao Huangqi Tang uses Peony, Astragalus, Licorice, Artemisia). Heat starting from abdomen, moving up chest/axilla, around neck/forehead, initially warm, becoming hot, irregular onset, worse with hunger, epigastric discomfort, polyphagia with emaciation, sallow face, dull muscles, dry lips. Caused by weak Spleen Qi, mistakingly given hot herbs after other illnesses, entering Spleen. Spleen heat digests food eagerly, consumes muscles. Pulse soft-weak-rapid (Note: Original location Shenju Wan uses Tangerina, Ophiopogon, Ginseng). Heat from abdomen or back spine, gradual steaming heat, worse at dusk, fading at night, sweating during sleep, urine red/cloudy/frequent/sperm emission, dreams of intercourse, gradual emaciation. Caused by excessive thinking, Heart Qi consumption, Yang Qi dissipation, Spirit unrestrained, Yin unsupported. Treatment belongs to Consumption Disease (Note: Original location Da Jian Zhong Tang). Heat from waist up, extreme sweating, cooling after sweat, returning to normal, then dizziness, abdominal distension, Qi attacking upward, frequent cough, rib pain牵引, nocturnal palpitations, wiry-rapid-pulse. Caused by external cold clashing, internal cold combining. Cold contracts Qi, fluid gathers and stagnates,