内化成饮，医以热药攻寒，寒未已而复增客热，阴寒内闭，拒阳于外而不得入，逼阳上行，发而为热，散而为汗，
汗多亡阳，心气内虚，故令惊悸，治属饮
家，温而利之。若热起骨间烦疼，手足时时微冷，旦起体凉，日晚即发，背膂牵急，或骨节凸起，足膝酸弱。
此由邪热加阴，蓄留骨髓，髓得热则稀，髓稀则骨中空虚，阳入于阴，阴虚则水少，脂液干枯，热蒸骨软而凸，
其脉沉细，治属骨蒸。若自胸以上至头发热，口鼻气塞，时如烟熏，目涩，咽燥口干，唾如凝脂，时咳毛竦，
大便不利，小便赤黄。此由肺气不调，邪热乘客，上焦不降，其脉疾大。先与桔梗汤，热不退，与五味子汤。
（《鸡峰》）（按∶桔梗汤，用桔、参、甘、麦门、小麦。五味子汤，用柴、半、五味、芩、茯、姜、枣。考
以上所说，盖不是《指迷方》文。）
阴虚发热 荣卫不调，阴阳痞隔。若阳气虚，阴气盛，则生寒冷之病。今阴气虚，阳气实，故身体五
脏皆生热，其状翕翕而热，唇口干，小便赤也。（《病源论》）
经曰∶阴虚而发热（按∶《调经论》曰∶阴虚则内热。盖丹溪误忆也）。夫阳在外为阴之卫，阴在内为阳
之守。精神外驰，嗜欲无节，阴气耗散，阳无所附，遂致浮散于肌表之间而恶热也。实非有热，当作阴虚治之，
而用补养之法可也。（《格致余论》）
阴虚发热证，难治。（《丹溪》）
阴虚发热，是阴血自伤，不能制火，阳气升腾而为内热，乃阳旺也。故其脉数而无力，属心肾。经曰∶脉
大而无力，为阳虚，脉数而无力，为阴虚。（《杂着》）
阴虚，谓肾水虚也。火性本上炎而外现，得水以制之，则离交于坎，龙潜于渊，内蕴而为神明，下济而成
交泰。若阴亏水虚，则柴干火烈而焚灼为灾矣（或由色欲损精，或由泻利亡阴，或由燥热伤液，皆能致之也）。
此之火炎，乃由水虚所致，与阳亢而阴未亏者不同。证见口干体瘦，食少懒
倦，头痛时作时止，遗精盗汗，骨蒸肉烁，唇红颧赤，咳嗽痰血，久成痨瘵。治宜甘润之剂，滋水以制火。若误
用苦寒，则火被寒郁，其怒发愈烈矣。血虚发热，或由吐衄便血，或由产后崩漏一切失血所致，证见烦躁，面目
黑，渴饮不止。证类白虎，惟脉不长不实，浮大而重按全无为异耳，误服白虎必危，治宜滋阴补血。若阳并虚，
兼用气药，血脱补气，阳生阴自长也。（《医碥》）
阳虚发热（寒极似热） 内伤发热，是阳气自伤，不能升达，降下阴分而为内热，乃阳虚也。故其脉
大而无力，属肺脾。（《杂着》）
劳倦发热者，积劳成倦，阳气下陷，则虚热内生也。其证身热心烦，头痛恶寒，懒言恶食，脉洪大而空，
状类伤寒。切戒汗下，但服补中益气汤一二服，得微汗则已。非正发汗，乃阴阳气和，自然汗出也。（《金匮
翼》）（按∶此本于东垣。）
璜溪隐者治一人得热病，虽祁寒，四肢亦以水浸手，握冰轮转。众以为热。曰∶此寒极似热，非真热也。
治以附子辛热之剂而愈。（《大还》）
阳亢发热（火郁） 阴阳水火，原自和平，不热不寒，是谓正气，一有乖违，不无偏胜。经曰阳胜则热，
此为亢阳之火，证见烦渴燥结，小便赤涩，六脉洪数，治宜寒凉（有因浓酒浓味蕴酿而成者，有炎令燥气感触
而致者，有五志过极心火亢暴者）。（《医碥》）
恶热固为阴气之虚，而胃中有实火者，亦有恶热之证。予每见夫多酒浓味之人，饮食喜冷，浓衣则烦，此
由热邪内积于胃之所致也。（《统旨》）
若忽然暴热，又无表证，脉数有力，是火郁。（《六要》）
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。（《医碥》）
肿毒热（劳发）若脉弦数或紧，头身俱痛而一处痛甚者，是肿毒热。（《六要》）
劳发，其人元气寡弱，素有痰火，结核于胯缝或腋下或臂膊上，略有动作劳伤，则一时硬肿疼痛，兼寒作热，
状似伤寒，其脉弦数无力。若腿缝有核肿者，俗呼为腿劳发。若腋下有核及臂膊有核肿者，有无核而作寒热者，
此皆谓劳发证也。盖因气血虚弱，劳役所致。斯劳发之名，乃世俗传袭之言耳，非正病名也。不可汗，不可下，
但宜补血养气，滋阴降火，清痰和解之剂，其病自瘳矣。待候周时，轻者则不服药，自然微汗而解也。（《岭南卫
生方·附录》）（按∶原举发热八证，痰证、食积、虚烦、香港脚、疮毒、瘀血、劳发、痘疹是。又《杂着》曰∶
南方人称发热为劳发。盖谓劳苦而发热，乃名同而实异。）
潮热 潮热有作有止，如潮水之来，不失其时，一日一发。若日三五发者，即是发热，非潮热也。有虚有
实。惟伤寒日晡发热，乃胃实，别无虚证。其余有潮热者，当审其虚实。若大便坚涩，喜冷畏热，心下 然，睡
卧不着，此皆气盛，所谓实而潮热也，凉膈散、大柴胡辈下之。若胃气消乏，精神憔悴，饮食减少，日渐 羸，
病虽暂去，而五心常有余热，此属虚证，宜逍遥散、小柴胡等加减。有每遇夜身发微热，病患不觉，早起动作无事，
饮食如常，既无别证可疑，只是血虚，阴不济阳，朝用加味逍遥散，暮用六味丸。不应，用当归补血汤、加减八
味丸。（《医通》）
手足热 常仲明之妻，每遇冬寒，两手热痛。戴人曰∶四肢者，诸阳之本也。当夏时散越而不痛，及
乎秋冬收敛则痛。以三花神佑丸大下之，热遂去。（《十形三疗》）
手足心热，属热郁。（《丹溪》）
平人手足常热，冬不加绵，非壮也，乃三阴经之虚。急断酒色，培养真阴，不尔成痿。酒客有此，是火盛，
防痈疽。（《六要》）
手足心热及夜热，有虚有实，不得执定阴虚。（一筏）
发热死候 若发热，而脉反沉细或数疾无力者，病脉相反也死。病热有火者生，心脉洪是也。浮而涩，
涩而身有热者死。热而脉静者，难治。脉盛，汗出不解者死。脉虚，热不止者死。脉弱，四肢厥，不欲见人，食
不入，利下不止者死。（《医通》）
治恶寒诸方 治阳虚恶寒之方。
人参（二钱） 黄 （炒三钱） 白术（一钱五分） 当归（一钱） 附子 肉桂（各五分） 甘草（炙二分）
空心午后煎服。（《百问》）
桂枝加人参附子汤，治阳虚腠理不固，恶寒自汗，其脉浮虚。
桂枝 白芍（各一两半） 甘草（炙一两） 附子（炮半个） 人参（一两半）
每服五钱，生姜三片，枣一枚，水煎服。（《金匮翼》）
治发热诸方 升阳散火汤，治男子妇人四肢发困热，肌热，筋骨间热，表热如火燎于肌肤，扪之烙手。
夫四肢属脾，脾者土也，热伏地中，此病多因血虚而得之也。又有胃虚，过食冷物，郁遏阳气于脾土之中，并
宜服之。
升麻 葛根 独活 羌活 白芍药 人参（以上各五钱）
甘草（炙） 柴胡（以上各三钱） 防风（二钱五分） 甘草（生二钱）
上件 咀，如麻豆大，每服秤五钱，水二盏，煎至一盏去渣，大温服无时，忌寒凉之物。（《辨惑论》）
当归补血汤，治肌热燥热，困渴引饮，目赤面红，昼夜不息，其脉洪大而虚，重按全无。《内经》曰脉虚
血虚，又云血虚发热。证象白虎，惟脉不长实有辨耳，误服白虎汤必死。此病得之于饥困劳役。
黄 （一两） 当归（酒洗二钱）
上件 咀，都作一服，水二盏，煎至一盏，去渣温服，空心食前。（同上）
泻血汤，治发热昼少而夜多，太阳经中尤甚，昼病则在气，夜病则在血，是足太阳膀胱血中浮热，微有气也。
既病患大小便如常，知邪气不在脏腑，是无里证也。外无恶寒，知邪气不在表也。有时而发，有时而止，知邪气
不在表、不在里，知在经络也。夜发多而昼发少，是邪气下陷之深也。此杂证，当从热入血室而论之。
生地黄（酒洗炒） 熟地黄 蒲黄 丹参（酒炒） 当归（酒洗去土） 汉防己（酒洗炒） 柴胡（去芦）
甘草梢（炙） 羌活（以上各一两） 桃仁（去皮三钱汤浸）
上为粗末，每服五钱，水一盏半，煎至一盏去渣，空心温服。（《兰室》）
加味逍遥散，治有一等郁证似疟者，其寒热与正疟无异，但其人口苦，呕吐清水或苦水，面青胁痛，耳鸣
脉涩。
柴胡 芍药 丹皮 陈皮 茯神 当归 白术 贝母（各一钱） 薄荷（七分） 黄连（五分，每一两，用
吴茱萸二钱，水拌炒焦色合用。）（《医通》）（按∶此方专于解热，故次于此。原文无加味字，今据《观聚
方》补入。）
饮邪在体内化生，医生用热性药物攻逐寒邪，但寒邪未除又增添了客居的热邪。阴寒在内闭阻，排斥阳气于体表之外使其无法入内，逼迫阳气上行，从而引发发热，阳气外散则出汗。汗出过多导致亡阳，心气在内虚弱，因此出现惊悸症状。此证属于饮病范畴，治疗应温阳并利水。
如果热感从骨间发起，伴有烦痛，手足时常微微发冷，早晨起床时身体凉爽，到了傍晚就发作，背部脊柱牵拉拘急，或者骨节凸起，足膝酸软无力。这是由于邪热侵入阴分，蓄积停留在骨髓中。骨髓受热则变得稀薄，骨髓稀薄则骨骼中空虚，阳气进入阴分，阴虚则津液减少，脂液干枯，热气蒸腾使骨头变软而凸起。其脉象沉细，治疗属于骨蒸劳热范畴。
如果从胸部以上直至头发部位发热，口鼻气息堵塞，时常感觉像被烟熏一样，眼睛干涩，咽喉干燥口干，唾液像凝固的油脂，时常咳嗽且毫毛竖起，大便不通畅，小便颜色赤黄。这是由于肺气不调，邪热客居其中，上焦之气不能下降。其脉象疾速洪大。先给予桔梗汤，如果热不退，再给予五味子汤。（出自《鸡峰》）（按语：桔梗汤，由桔梗、人参、甘草、麦门冬、小麦组成。五味子汤，由柴胡、半夏、五味子、黄芩、茯苓、生姜、大枣组成。考证上述所说内容，大概不是《指迷方》的文字。）
阴虚发热：营卫不调，阴阳痞塞阻隔。如果阳气虚弱，阴气旺盛，就会产生寒冷的病症。现在阴气虚弱，阳气充实，所以身体五脏都产生热，症状表现为翕翕发热（如羽毛覆盖般的微热），嘴唇和口干，小便赤红。（出自《诸病源候论》）
经典记载说：阴虚而发热（按语：《素问·调经论》说：阴虚则内热。大概是朱丹溪记忆有误）。阳气在外作为阴气的护卫，阴气在内作为阳气的守备。精神向外驰散，嗜欲没有节制，阴气耗散，阳气无所依附，于是浮散于肌表之间而感到恶热。这实际上并不是真的有实热，应当当作阴虚来治疗，采用补养的方法即可。（出自《格致余论》）
阴虚发热，是阴血自我损伤，不能制约火气，阳气升腾而产生内热，这是阳旺的表现。所以其脉象数而无力，归属于心和肾。经典说：脉大而无力，为阳虚；脉数而无力，为阴虚。（出自《杂著》）
阴虚，指的是肾水虚弱。火的本性是向上炎烧并向外显现，得到水的制约，则离火交于坎水，龙潜于深渊，内部蕴藏成为神明，向下济助而成交泰之象。如果阴亏水虚，就像柴干火烈而焚烧成灾（这可能是由于色欲损伤精气，或者由于泻利丢失阴液，或者由于燥热损伤津液，都能导致这种情况）。这种火炎，是由于水虚所致，与阳亢而阴未亏损的情况不同。症状见到口干身体消瘦，饮食少，懒倦，头痛时作时止，遗精盗汗，骨蒸肉烁，嘴唇红颧骨赤，咳嗽痰中带血，久则形成痨瘵。治疗宜用甘润的药物，滋补肾水以制约火气。如果误用苦寒药物，则火被寒气郁遏，其暴怒发作会更加猛烈。血虚发热，或者由于吐血衄血便血，或者由于产后崩漏等一切失血所致，症状见到烦躁，面目发黑，口渴饮水不止。证候类似白虎汤证，只是脉象不长实，浮大而重按完全无力的不同罢了，误服白虎汤必定危险，治疗宜滋阴补血。如果阳气也虚弱，兼用补气药，血脱时补气，阳气生发则阴血自然生长。（出自《医碥》）
阳虚发热（寒极似热）：内伤发热，是阳气自我损伤，不能升达，降下进入阴分而产生内热，这是阳虚。所以其脉象大而无力，归属于肺脾。（出自《杂著》）
劳倦发热者，积累劳累导致疲倦，阳气下陷，则虚热内生。其症状身体发热心烦，头痛恶寒，懒言恶食，脉象洪大但空虚无根，状类伤寒。切忌发汗和下法，只服用补中益气汤一两副，得到微微出汗就好了。这不是真正的发汗，而是阴阳之气调和，自然出汗。（出自《金匮翼》）（按语：此法本源于李东垣。）
璜溪隐者治疗一人患热病，虽然天气严寒，四肢却像用水浸泡手一样，握着冰球转动。众人认为是热证。他说：这是寒极似热，不是真热。用附子辛热的药物治疗而痊愈。（出自《大还》）
阳亢发热（火郁）：阴阳水火，原本平和，不热不寒，这叫正气，一旦有违背，无不偏胜。经典说阳胜则热，这是亢阳之火，症状见到烦渴燥结，小便赤涩，六脉洪数，治疗宜用寒凉药物（有的因浓酒厚味酝酿而成，有的因炎热季节燥气感触而致，有的因五志过极心火亢暴所致）。（出自《医碥》）
恶热固然是阴气虚弱，但胃中有实火的人，也有恶热的证候。我常见那些多饮酒、吃厚味的人，饮食喜冷，穿厚衣服就烦躁，这是由于热邪积聚在胃中所导致的。（出自《统旨》）
如果忽然暴热，又没有表证，脉数有力，这是火郁。（出自《六要》）
肝气郁热：愤怒不发泄，只能自我压抑，则肝气不宣通，郁结而成热，妇人最多有此证。症状见到胸胁胀痛，或者飧泄面青，手足冷，叹息不乐，脉象沉弦。木郁则通达它，宜用逍遥散。（出自《医碥》）
肿毒热（劳发）：如果脉象弦数或紧，头身都痛且有一处痛得厉害的，这是肿毒热。（出自《六要》）
劳发，其人元气寡弱，素有痰火，结核于胯缝或腋下或臂膊上，略有动作劳伤，则一时硬肿疼痛，兼有寒热交替，状似伤寒，其脉象弦数无力。如果腿缝有核肿者，俗称为腿劳发。如果腋下有核及臂膊有核肿者，有无核而作寒热的，这些都称为劳发证。大概是因为气血虚弱，劳役所致。这个“劳发”的名称，乃是世俗传袭的说法，并非正式的病名。不可发汗，不可攻下，只宜用补血养气、滋阴降火、清痰和解的药物，病自然会痊愈。等待一周时间，轻者甚至不服药，也会自然微汗而解。（出自《岭南卫生方·附录》）（按语：原列举发热八证，分别是痰证、食积、虚烦、香港脚、疮毒、瘀血、劳发、痘疹。另外《杂著》说：南方人称发热为劳发。大概是指劳苦而发热，乃同名而实异。）
潮热：潮热有发作有停止，像潮水一样，不失其时，一天发作一次。如果一天发作三五次，那就是普通发热，不是潮热。有虚有实。只有伤寒日晡时分发热，是胃实，没有其他虚证。其余有潮热的，应当审查其虚实。如果大便坚硬涩滞，喜冷畏热，心下痞满，睡卧不安，这些都是气盛，所谓实而潮热，用凉膈散、大柴胡汤等攻下。如果胃气消乏，精神憔悴，饮食减少，日渐消瘦，病虽暂时去除，而五心常有余热，这属于虚证，宜用逍遥散、小柴胡汤等加减。有每遇夜晚身体发微热，病患自己不觉察，早起活动无事，饮食如常，既然没有其他可疑证候，只是血虚，阴不能济助阳，早晨服用加味逍遥散，晚上服用六味丸。无效，用当归补血汤、加减八味丸。（出自《医宗金鉴·医学入门》或相关汇编，此处标《医通》）
手足热：常仲明的妻子，每逢冬天寒冷，两手热痛。戴人（张从正）说：四肢是诸阳之本。在夏天时阳气发散而不痛，等到秋冬收敛时就痛。用三花神佑丸大力攻下，热遂去。（出自《十形三疗》）
普通人手足常热，冬天不加棉衣，不是壮热，而是三阴经虚弱。急忙戒断酒色，培养真阴，否则会成为痿证。喝酒的人有此症状，是火盛，预防痈疽。（出自《六要》）
手足心热及夜热，有虚有实，不得固执地认为是阴虚。（出自《一筏》）
发热死候：如果发热，而脉象反而沉细或数疾无力的，是病脉相反，主死。病热而有火气的生，心脉洪大就是这类。脉浮而涩，涩而身体有热的死。热而脉静的，难治。脉盛，汗出不解的死。脉虚，热不止的死。脉弱，四肢厥冷，不想见人，吃不进东西，腹泻不止的死。（出自《医通》）
治疗恶寒的各种方剂：治疗阳虚恶寒的方剂。
人参（二钱） 黄芪（炒三钱） 白术（一钱五分） 当归（一钱） 附子 肉桂（各五分） 甘草（炙二分）
空腹午后煎服。（出自《百问》）
桂枝加人参附子汤，治疗阳虚腠理不固，恶寒自汗，其脉浮虚。
桂枝 白芍（各一两半） 甘草（炙一两） 附子（炮半个） 人参（一两半）
每次服用五钱，生姜三片，枣一枚，水煎服。（出自《金匮翼》）
治疗发热的各种方剂：升阳散火汤，治疗男子妇人四肢发困热，肌热，筋骨间热，表热如火燎于肌肤，摸上去烫手。
四肢属脾，脾属土，热伏在地中，此病多因血虚而得。又有胃虚，过食冷物，郁遏阳气于脾土之中，都适宜服用。
升麻 葛根 独活 羌活 白芍药 人参（以上各五钱）
甘草（炙） 柴胡（以上各三钱） 防风（二钱五分） 甘草（生二钱）
以上药材切碎，如麻豆大小，每次称五钱，水两盏，煎至一盏去渣，大温服随时，忌寒凉之物。（出自《辨惑论》）
当归补血汤，治疗肌热燥热，困渴引饮，目赤面红，昼夜不息，其脉洪大而虚，重按全无。《内经》说脉虚血虚，又说血虚发热。证象类似白虎汤证，只是脉不长实有区别罢了，误服白虎汤必死。此病得之于饥困劳役。
黄芪（一两） 当归（酒洗二钱）
以上药材切碎，都作一服，水两盏，煎至一盏，去渣温服，空腹食前。（同上）
泻血汤，治疗发热昼少而夜多，太阳经中尤其严重，昼病则在气，夜病则在血，是足太阳膀胱血中浮热，微有气。既然病患大小便如常，知道邪气不在脏腑，是无里证。外无恶寒，知道邪气不在表。有时发作有时停止，知道邪气不在表、不在里，知道在经络。夜发多而昼发少，是邪气下陷之深。此杂证，当从热入血室来论述。
生地黄（酒洗炒） 熟地黄 蒲黄 丹参（酒炒） 当归（酒洗去土） 汉防己（酒洗炒） 柴胡（去芦）
甘草梢（炙） 羌活（以上各一两） 桃仁（去皮三钱汤浸）
以上为粗末，每次五钱，水一盏半，煎至一盏去渣，空腹温服。（出自《兰室秘藏》）
加味逍遥散，治疗有一类郁证似疟疾者，其寒热与正疟无异，但其人口苦，呕吐清水或苦水，面青胁痛，耳鸣脉涩。
柴胡 芍药 丹皮 陈皮 茯神 当归 白术 贝母（各一钱） 薄荷（七分） 黄连（五分，每一两，用吴茱萸二钱，水拌炒焦色合用。）（出自《医通》）（按语：此方专于解热，故列于此。原文无加味字，今据《观聚方》补入。）
Yin fluid transforms into phlegm-fluid (Phlegm-Fluid). The physician uses hot-natured drugs to attack the cold, but before the cold is resolved, guest heat (Guest Heat) is added. Yin-cold closes internally, repelling Yang to the exterior so it cannot enter, forcing Yang to ascend, manifesting as fever, and dispersing as sweat. Excessive sweating leads to loss of Yang Qi (Loss of Yang), internal deficiency of Heart Qi (Heart Qi Deficiency), thus causing palpitations and fright. This syndrome belongs to the category of Phlegm-Fluid disorders; treatment should involve warming and promoting diuresis.
If heat arises from between the bones accompanied by irritability and pain, with hands and feet occasionally slightly cold, body temperature cool upon rising in the morning but developing fever in the evening, tension and stiffness in the back and spine, or protrusion of bone joints, and soreness and weakness in the feet and knees: this is caused by pathogenic heat invading Yin, accumulating and remaining in the bone marrow. When bone marrow receives heat, it becomes thin; when bone marrow is thin, the bones become hollow and empty. Yang enters Yin; Yin deficiency leads to scanty fluids, dryness of adipose tissue and fluids, and heat steaming causes bones to soften and protrude. The pulse is deep and fine. Treatment falls under the category of Bone-steaming Consumption (Bone-steaming).
If heat extends from above the chest to the hair, with blocked breath through mouth and nose, a sensation as if smoked by smoke, dry eyes, dry throat and mouth, saliva resembling congealed fat, occasional coughing with bristling hairs, constipation, and dark yellow urine: this is due to dysfunction of Lung Qi (Lung Qi Dysfunction), with pathogenic heat lodging there, causing Upper Jiao (Upper Burner) Qi to fail to descend. The pulse is rapid and large. Administer Jiegeng Tang (Platycodon Decoction) first; if heat does not subside, administer Wuweizi Tang (Schisandra Decoction). (From *Jifeng*) [Note: Jiegeng Tang consists of Jiegeng, Renshen, Gancao, Maimendong, Xiaomai. Wuweizi Tang consists of Chaihu, Banxia, Wuweizi, Huangqin, Fuling, Shengjiang, Dazao. Examination suggests the above text is likely not from *Zhimi Fang*.]
**Yin Deficiency Fever**: Ying and Wei (Nutritive and Defensive) are unregulated, Yin and Yang are obstructed. If Yang Qi is deficient and Yin Qi is excessive, cold syndromes arise. Now, if Yin Qi is deficient and Yang Qi is substantial, heat generates in all five Zang organs. The presentation is a mild fever (like feathers covering), dry lips and mouth, and red urine. (From *Bingyuan Lun*)
The Classics state: "Yin deficiency leads to fever." [Note: *Tiaojing Lun* states: "Yin deficiency results in internal heat." It seems Danxi misremembered.] Yang resides outside as the guard of Yin; Yin resides inside as the keeper of Yang. When spirit wanders outward and desires are unrestrained, Yin Qi dissipates, leaving Yang without attachment, causing it to float and scatter between the muscle surfaces, leading to aversion to heat. This is not actual excess heat; it should be treated as Yin deficiency using tonifying and nourishing methods. (From *Gezhi Yulun*)
Yin deficiency fever syndrome is difficult to treat. (From *Danxi*)
Yin deficiency fever implies self-injury of Yin Blood (Yin Blood Injury), failing to control Fire, causing Yang Qi to ascend and generate internal heat, representing Yang exuberance. Thus, the pulse is rapid but forceless, belonging to the Heart and Kidney. The Classics state: "A pulse that is large but forceless indicates Yang deficiency; a pulse that is rapid but forceless indicates Yin deficiency." (From *Zazhe*)
Yin deficiency refers to Kidney Water (Kidney Water) deficiency. Fire naturally flares upward and manifests externally; controlled by Water, Li Fire interacts with Kan Water, Dragon hides in the abyss, storing divinity internally and assisting downward to achieve harmony. If Yin is deficient and Water is scant, it is like dry firewood and fierce flames causing disaster (this may result from sexual excess damaging Essence, diarrhea losing Yin, or dry-heat injuring fluids). This flaming fire is caused by Water deficiency, differing from Yang hyperactivity where Yin is not yet deficient. Symptoms include dry mouth, emaciation, poor appetite, lassitude, intermittent headache, seminal emission, night sweats, bone-steaming, flesh-melting, red lips and malar flush, cough with blood-streaked sputum, eventually forming Tuberculosis (Laozai). Treatment requires sweet and moistening agents to nourish Water to control Fire. Misusing bitter-cold drugs will suppress Fire with Cold, causing it to rage more violently.
Blood deficiency fever may result from hematemesis, epistaxis, melena, postpartum metrorrhagia, or any blood loss. Symptoms include irritability, blackened face and eyes, and incessant thirst. The presentation resembles Baihu Tang syndrome, except the pulse is not long and solid, but floating, large, and completely empty upon heavy pressure. Misusing Baihu Tang is dangerous; treatment should nourish Yin and tonify Blood. If Yang is also deficient, add Qi-tonifying herbs. For blood loss, tonifying Qi helps Yang generate, which in turn grows Yin. (From *Yiqi*)
**Yang Deficiency Fever** (Cold extreme resembling heat): Internal injury fever occurs when Yang Qi is self-injured and cannot ascend, sinking into the Yin level to generate internal heat, representing Yang deficiency. Thus, the pulse is large but forceless, belonging to Lung and Spleen. (From *Zazhe*)
Fatigue-induced fever results from accumulated labor causing exhaustion, with Yang Qi sinking, generating internal deficiency heat. Symptoms include fever, irritability, headache, aversion to cold, reluctance to speak, anorexia, and a flooding pulse that is empty. It resembles Taiyang disease. Sweating and purging are strictly contraindicated. Only administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) one or two doses; slight sweating indicates resolution. This is not true sweating, but natural sweating resulting from the harmonization of Yin and Yang. (From *Jinkui Yi*) [Note: Based on Dongyuan/Li Dongyuan.]
A hermit at Huangxi treated a patient with a febrile disease. Despite severe cold, the patient immersed their hands in water and rolled ice balls. Others considered it heat. He said: "This is cold extreme resembling heat, not true heat." Treated with acrid-hot Aconite formulas, the patient recovered. (From *Dahuan*)
**Yang Hyperactivity Fever** (Fire depression): Yin-Yang and Water-Fire are originally peaceful, neither hot nor cold, called Healthy Qi. Any deviation leads to excess. The Classics state: "Yang excess leads to heat." This is hyperactive Yang Fire. Symptoms include irritability, thirst, dryness, constipation, dark scanty urine, and flooding-rapid pulses. Treatment requires cooling agents. (Causes include rich wine and food, summer heat-dryness, or extreme emotions causing Heart Fire hyperactivity.) (From *Yiqi*)
Aversion to heat is indeed due to Yin deficiency, but those with excess Fire in the Stomach also experience aversion to heat. I often see people who drink heavily and eat rich foods, preferring cold food/drink, feeling irritable in thick clothes; this is caused by heat pathogens accumulating in the Stomach. (From *Tongzhi*)
Sudden violent heat without exterior signs and a rapid, forceful pulse indicates Fire depression. (From *Liuyao*)
**Liver Qi Depression Heat**: Unexpressed anger suppressed internally causes Liver Qi stagnation,郁 transforming into heat. This is common in women. Symptoms include distending pain in the chest and hypochondrium, diarrhea with green stool, cold hands and feet, sighing, depression, and a deep-wiry pulse. For Wood depression, promote dispersion; use Xiaoyao San (Free and Easy Wanderer Powder). (From *Yiqi*)
**Swelling-Toxin Heat** (Labor Fever): If the pulse is wiry-rapid or tight, with head and body pain concentrated in one area, it is Swelling-Toxin Heat. (From *Liuyao*)
Labor Fever: The person has weak Yuan Qi (Original Qi) and chronic Phlegm-Fire, forming nodules in the groin, axilla, or arm. Slight movement or strain causes sudden hard swelling and pain, alternating chills and fever, resembling Taiyang disease. The pulse is wiry-rapid but forceless. Nodules in the leg crease are俗称 "Leg Labor Fever." Nodules in the axilla/arm or chills/fever without nodules are all classified as Labor Fever Syndromes. Caused by Qi-Blood deficiency and overwork. "Labor Fever" is a secular term, not a formal disease name. Do not sweat or purge. Use formulas to tonify Blood and Qi, nourish Yin, descend Fire, clear Phlegm, and harmonize. The illness will resolve spontaneously. Wait one week; mild cases may resolve with slight sweating even without medication. (From *Lingnan Weisheng Fang*) [Note: Original lists eight fever types: Phlegm, Food Stagnation, Deficiency Irritability, Beriberi, Sores, Blood Stasis, Labor Fever, Smallpox. *Zazhe* notes Southerners call fever "Labor Fever," implying labor-induced fever, same name different reality.]
**Tidal Fever**: Tidal fever comes and goes like the tide, occurring once daily. Occurring 3-5 times daily is ordinary fever, not tidal fever. It can be deficiency or excess. Only in Taiyang disease, afternoon fever indicates Stomach Excess, with no deficiency type. For other tidal fevers, examine deficiency vs. excess. Hard dry stool, preference for cold, aversion to heat, epigastric fullness, restless sleep indicate Qi excess (Excess Tidal Fever); purge with Liangge San or Da Chaihu Tang. Withered Stomach Qi, mental fatigue, reduced appetite, emaciation, residual heat in the five centers (palms, soles, chest) indicate Deficiency Syndrome; modify Xiaoyao San or Xiao Chaihu Tang. Nighttime low-grade fever, asymptomatic during day, normal diet, only Blood deficiency failing to support Yang: morning Jiawei Xiaoyao San, evening Liuwei Wan. If ineffective, use Danggui Buxue Tang or Jiawei Bawei Wan. (From *Yitong*)
**Hand and Foot Heat**: Chang Zhongming's wife had hot, painful hands in winter. Dairen (Zhang Congzheng) said: Limbs are the root of all Yang. In summer, Yang disperses and there is no pain; in autumn/winter, Yang converges and pain occurs. Purged vigorously with Sanhua Shenyao Wan, heat resolved. (From *Shixing Sanliao*)
Heat in palms and soles belongs to Heat Depression. (From *Danxi*)
Normal people with constantly warm hands/feet, not needing cotton in winter, do not have strong heat, but Three-Yin channel deficiency. Immediately stop alcohol and sex, cultivate True Yin, otherwise发展为 Wei syndrome (Flaccidity). Drinkers with this have Fire excess, watch for abscesses. (From *Liuyao*)
Heat in palms/soles and nighttime fever can be deficiency or excess; do not rigidly assume Yin deficiency. (From *Yifa*)
**Fever Death Signs**: If fever is present but the pulse is instead deep-fine or rapid-forceless, the disease and pulse contradict, indicating death. Fever with Fire signs indicates life (e.g., flooding Heart pulse). Floating-and-choppy, or choppy with fever, indicates death. Fever with quiet pulse is difficult to treat. Full pulse with unresolved sweating indicates death. Empty pulse with persistent fever indicates death. Weak pulse with cold limbs, aversion to people, inability to eat, and continuous diarrhea indicates death. (From *Yitong*)
**Formulas for Treating Aversion to Cold**: Formula for Yang deficiency aversion to cold.
Renshen (2 qian), Huangqi (stir-fried 3 qian), Baizhu (1.5 qian), Danggui (1 qian), Fuzi, Rougui (each 0.5 qian), Gancao (roasted 0.2 qian). Decoct and take on an empty stomach in the afternoon. (From *Baiwen*)
Guizhi Jia Renshen Fuzi Tang (Cinnamon Twig Decoction plus Ginseng and Aconite), treats Yang deficiency with insecure interstices, aversion to cold, spontaneous sweating, floating-empty pulse.
Guizhi, Shaoyao (each 1.5 liang), Gancao (roasted 1 liang), Fuzi (processed half), Renshen (1.5 liang). Take 5 qian per dose, with 3 slices of Shengjiang and 1 Dazao, decoct in water. (From *Jinkui Yi*)
**Formulas for Treating Fever**: Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction), treats men and women with limb heaviness/heat, muscle heat, heat between sinews/bones, surface heat burning like fire on skin, hot to touch.
Limbs belong to Spleen (Earth); heat lies hidden in the earth. This disease often results from Blood deficiency. Also suitable for Stomach deficiency with cold food intake suppressing Yang Qi in Spleen Earth.
Shengma, Gegen, Duhuo, Qianghuo, Shaoyao, Renshen (each 5 qian).
Gancao (roasted), Chaihu (each 3 qian), Fangfeng (2.5 qian), Gancao (raw 2 qian).
Chop ingredients to hemp-seed size. Take 5 qian per dose, decoct in 2 cups water to 1 cup, remove dregs, take warm at any time. Avoid cold foods. (From *Bianhuo Lun*)
Danggui Buxue Tang (Angelica Tonify Blood Decoction), treats muscle heat, dry heat, fatigue/thirst, red eyes/face, continuous day/night, flooding-large but empty pulse, empty upon heavy pressure. *Neijing* states: empty pulse means Blood deficiency; also Blood deficiency fever. Presentation resembles Baihu Tang syndrome, distinguished by pulse not being long/solid. Misusing Baihu Tang is fatal. Caused by hunger, fatigue, overwork.
Huangqi (1 liang), Danggui (wine-washed 2 qian).
Chop, decoct in 2 cups water to 1 cup, take warm on empty stomach before meals. (Same source)
Xiexue Tang (Drain Blood Decoction), treats fever less by day, more by night, especially in Taiyang channel. Day illness relates to Qi, night to Blood; floating heat in Foot-Taiyang Bladder Blood with slight Qi involvement. Normal urination/defecation indicates pathogen not in Zang-Fu (no interior syndrome). No aversion to cold indicates pathogen not in exterior. Intermittent onset indicates pathogen in channels, not exterior/interior. More night attacks indicate deep sinking of pathogen. Treat this miscellaneous syndrome as Heat entering the Blood Chamber.
Shengdihuang (wine-washed/fried), Shudihuang, Puhuang, Danshen (wine-fried), Danggui (wine-washed/cleaned), Hanfangji (wine-washed/fried), Chaihu (de-budded), Gancao shao (roasted), Qianghuo (each 1 liang), Taoren (skin removed, 3 qian, soaked in decoction).
Make coarse powder. Take 5 qian, decoct in 1.5 cups water to 1 cup, take warm on empty stomach. (From *Lanshi*)
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), treats depression-like malaria, chills/fever identical to true malaria, but with bitter taste, vomiting clear/bitter water, green face, hypochondriac pain, tinnitus, choppy pulse.
Chaihu, Shaoyao, Danpi, Chenpi, Fushen, Danggui, Baizhu, Beimu (each 1 qian), Bohe (0.7 qian), Huanglian (0.5 qian, stir-fried with 2 qian Wuzhuyu per 1 liang until scorched). (From *Yitong*) [Note: Added "Modified" based on *Guanju Fang*; original lacks this character.]