夫疮之始发，于阴于阳，岂有定规，调护失宜，致令阴阳偏胜，即有变生之患。如
毒之初起，筋挛骨痛之时，经曰∶此寒气之肿，八风之变，当以表散之，使邪易散，
而毒易消。不知治此，再以内疏之剂，敷以寒凉，或食冷物，使疮毒内陷，阴极而
方生，阳气渐闷，令人烦闷，谵语微渴，其脉沉细而数，治宜补中益气汤，而加温暖
之药治之，斯为上工矣。
张景岳曰∶阴极反能躁热，乃内寒而外热，即真寒假热也。假热者，水极似火
也。凡痈疽有原素禀虚寒，偶感邪气而然者；有过于劳倦而致者；有过于酒色而致
者；有过于七情而致者；有原非火证，因误服寒凉而致者。凡真热本发热，而假热
亦发热，其证则亦面赤躁烦，亦为大便不通，小便赤涩，或为气促，咽喉肿痛，或
为发热，脉见紧数等证，昧者见之，便以为热，妄投寒凉，下咽必毙。不知身虽有
热，而里寒格阳，或虚阳不敛者，多有此证，但其内证而口虽干渴，必不喜冷，即
喜冷者，饮亦不多，或大便不实，或先硬后溏，或小水清频，或阴枯黄赤，或气短
懒言，或色黯神倦，或起倒如狂，而禁之则止，自与登高骂詈者不同，此虚狂也。或
斑如蚊迹，而浅红细碎，自与紫赤热极者不同，此假斑也。凡假热之脉，必沉细迟
弱，或虽浮大紧数，而无力无神，此乃热在皮肤，寒在脏腑，所谓恶热非热，实阴
证也。凡见此内颓内困等证，而但知清凉攻邪败毒，则无有不死，急当四逆、八味、
回阳汤之类，倍加附子填补真阳，以引火归原，但使元气渐复，则热必退藏而病自
愈，所谓火就燥者，即此义也。故凡见身热脉数，按之不鼓击者，此皆阴盛格阳，即非热也。
东垣曰∶面赤目赤，烦躁引饮，脉七八至，按之则散者，此无根之火也。以姜
附汤加人参主之。
仲景曰∶治少阴证，面赤者，以四逆汤加葱白主之。
《外台秘要》曰∶阴盛发躁名曰阴躁，欲坐井中，宜以热药治之。
疮疡在发病之初，属于阴证还是阳证，并没有固定的规律。如果调护不当，导致阴阳偏盛，就会产生变证的祸患。例如毒邪初起，出现筋脉拘挛、骨骼疼痛的时候，经书说：这是寒气引起的肿胀，是八风邪气变化的结果，应当用解表发散的方法治疗，使邪气容易消散，毒邪容易消除。如果不这样治疗，反而使用内疏的药剂，外敷寒凉药物，或者食用生冷食物，会导致疮毒内陷，阴气极盛之后才生发阳气，阳气逐渐被遏制，使人感到烦闷、胡言乱语、轻微口渴，脉象沉细而数，治疗适宜用补中益气汤，并加入温热的药物来治疗，这才是高明的医生。
张景岳说：阴气极盛反而会出现躁热，这是内寒外热，也就是真寒假热。假热，是水气极盛似火。凡是痈疽，有的原本体质虚寒，偶然感受邪气而致病；有的因为过度劳累而致病；有的因为过度酒色而致病；有的因为过度七情（喜怒忧思悲恐惊）而致病；有的原本不是火证，因为误服寒凉药物而致病。凡是真热本来就会发热，假热也会发热，其症状也是面色红赤、烦躁不安、大便不通、小便赤涩，或者气促、咽喉肿痛，或者发热，脉象紧数等症状。愚昧的人看到这些，就认为是热证，胡乱投予寒凉药物，药咽下去必然致死。不知道身体虽然有热，但是里寒格拒阳气，或者虚阳不能收敛，多有这种症状，但是里面的证候显示，虽然口干燥渴，一定不喜欢冷饮，即使喜欢冷饮，喝得也不多，或者大便不成形，或者先干后稀，或者小便清长频数，或者阴部干枯黄赤，或者气短懒言，或者面色晦暗精神疲倦，或者坐立不安如发狂状，但制止后就停止，这与登高骂人的情况不同，这是虚狂。或者斑疹像蚊子叮咬的痕迹，颜色浅红细碎，这与紫红色热极的情况不同，这是假斑。凡是假热的脉象，一定是沉细迟弱，或者虽然浮大紧数，但是无力无神，这是热在皮肤，寒在脏腑，所说的恶热并非真热，实际上是阴证。凡是见到这种内颓内困等证候，如果只知道用清凉攻邪败毒的方法，就没有不死的，急当使用四逆汤、八味丸、回阳汤之类，加倍加入附子填补真阳，以引火归原，只要元气逐渐恢复，那么热势必然退藏而病自然痊愈，所说的“火就燥”，就是这个道理。所以凡是见到身热脉数，按压时不鼓击有力的，这都是阴盛格阳，就不是热证。
At the initial stage of a sore or ulcer, whether it manifests as a Yin syndrome or a Yang syndrome has no fixed rule. Improper care and nursing can lead to an imbalance of Yin and Yang, resulting in complications. For instance, when the pathogenic toxin first arises, accompanied by tendon spasms and bone pain, the Classics state: "This is swelling caused by Cold Qi, a variation of the Eight Winds." It should be treated with exterior-releasing and dispersing methods so that the pathogen can be easily scattered and the toxin easily eliminated. If this approach is not taken, but instead internal purgatives are used, cold-cooling herbs are applied externally, or cold foods are consumed, the toxin may sink inward. When Yin reaches its extreme, Yang begins to emerge, but Yang Qi is gradually stifled, causing irritability, delirium, slight thirst, and a deep, fine, and rapid pulse. The appropriate treatment is Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added warming herbs; this constitutes the practice of a skilled physician.
Zhang Jingyue stated: "When Yin reaches its extreme, it may paradoxically manifest as restlessness and heat. This is internal Cold with external Heat, known as True Cold and False Heat." False Heat is like Water reaching its extreme resembling Fire. Regarding carbuncles and sores, some arise because the patient's constitution was originally deficient and Cold, accidentally contracting pathogenic factors; some result from excessive fatigue; some from excessive sexual activity or alcohol consumption; some from emotional excesses (Seven Emotions); and some were originally not Heat syndromes but resulted from the mistaken administration of Cold-Cooling herbs. Both True Heat and False Heat involve fever. The symptoms include redness of the face, restlessness, constipation, dark and scanty urination, shortness of breath, sore throat, or fever, with a tight and rapid pulse. Ignorant practitioners seeing these signs assume it is a Heat syndrome and recklessly administer Cold-Cooling herbs, which will inevitably cause death upon ingestion. They fail to realize that although the body feels hot, it is due to Internal Cold repelling Yang, or deficient Yang failing to consolidate. In such cases, despite dry mouth and thirst, the patient will not prefer cold drinks; even if they do, they drink little. Other internal signs may include loose stools, or hard stools followed by loose ones, clear and frequent urination, dryness and yellow-red discoloration of the genitals, shortness of breath and reluctance to speak, dull complexion and mental fatigue, or restless behavior resembling madness but stopping when restrained—distinct from the aggressive cursing seen in true mania. Rashes may appear like mosquito bites, pale red and fine, distinct from the purple-red rashes of extreme Heat; this is False Rash. The pulse in False Heat is typically deep, fine, slow, and weak; or if floating, large, tight, and rapid, it lacks force and spirit. This indicates Heat on the skin surface but Cold in the Zang-Fu organs. What appears as aversion to heat is not true Heat, but actually a Yin syndrome. If one encounters these signs of internal collapse and distress, and only knows to use cooling methods to attack pathogens and eliminate toxins, death is inevitable. One must urgently use formulas such as Sini Tang (Frigid Extremities Decoction), Bawei Wan (Eight-Ingredient Pill), or Huiyang Tang (Restore the Yang Decoction), doubling the dosage of Fuzi (Prepared Aconite Root) to tonify True Yang and guide Fire back to its source. Once Yuan Qi (Original Qi) gradually recovers, the false heat will retreat, and the disease will heal spontaneously. This illustrates the principle that "Fire follows dryness." Therefore, whenever fever and a rapid pulse are present, but the pulse does not feel robust upon pressure, this indicates Yin Excess repelling Yang, and it is not a Heat syndrome.
Li Dongyuan stated: "Redness of the face and eyes, irritability, desire for drinking, a pulse rate of seven or eight beats per breath, which scatters upon pressure, indicates Rootless Fire." This should be treated with Jiangfu Tang (Ginger and Aconite Decoction) supplemented with Renshen (Ginseng Radix).
Zhang Zhongjing stated: "For Shaoyin syndrome presenting with facial redness, treat with Sini Tang (Frigid Extremities Decoction) plus Congbai (Scallion White)."
The *Waitai Miyao* (Secret Essentials of the Outer Palace) states: "Restlessness caused by Yin Excess is called Yin Restlessness. The patient may wish to sit in a well. It should be treated with Hot herbs."