海藏云∶夜热属阴,四顺饮之类,此血热在夜也。《脉经》云∶小肠有宿食,
尝暮发热,明日复止。此宿食夜热也。〔薛〕治一小儿亥子时发热,形气倦怠,面
黄懒食,流涎饮汤。用益黄散而愈。后复发,服前药及清热之剂,病发不时,嗜卧
露睛,作渴少食,大便频黄。此脾虚而肝木胜之,兼元气下陷也。用补中益气汤,
佐以地黄丸而愈。又治一小儿夜间发热腹胀。此脾虚肝盛。朝用五味异功散,夕用
四味肥儿丸,热止,乃朝用六味地黄丸,夕用异功散而痊。〔钱〕朱监簿子五岁,
夜发热,晓即如故。众医有作伤寒治者,有作热治者,以凉药解之不愈,其候多涎
而喜睡,他医以铁粉丸下涎,其病益甚,至五日,大引饮。钱曰不可下之,乃取白
术散一两,煎药汁三升,使任意取足服。朱生曰饮多不作泻否。钱曰无生水不作泻,
纵多,不足怪也,但不可下耳。朱生曰先治何病。钱曰止泻、治痰、退热、清神,
皆此药也。至晚服尽,钱视曰更可服三升,又煎白术散三升,服尽得稍愈,第三日
又服白术散三升,其子不渴无涎,又投阿胶散二服而安。〔汤〕风痰热,晚热早凉,
吃水无时,此候乃痰作潮而生风热,即宜金星丸下之,或气弱者不可下,宜夺命散
以控下涎,次服惺惺散,加南星、白附子。
四顺饮(见里热) 益黄散(见脾) 补中益气汤(见虚热) 地黄丸(见肾)
异功散(见吐泻) 四味肥儿丸(见疳) 白术散(见渴)
金星丸 治风热结聚,喉内痰鸣,喘粗咳嗽,面红腮肿,咽膈壅塞,发热狂躁多渴。
郁金末 雄黄(另研。各一分) 腻粉(半分) 巴豆(七枚,去油)
上为末,米醋糊丸,麻子大。薄荷腊茶下。
夺命散(见惊) 惺惺散(见痘)
四物二连汤 治血虚劳,五心烦热,昼则明了,夜则发热,胁肋并一身尽热,日晡
肌热。
当归 生地黄 白芍药 川芎 黄连 胡黄连(各等分)
上,水煎服。
张元素(号海藏)说:夜间发热属于阴证,可用四顺饮等方剂治疗,这是血分有热在夜间发作的表现。《脉经》记载:小肠内有积滞的食物,常常傍晚发热,第二天早上又停止。这是宿食引起的夜间发热。
薛己治疗一个患儿,在亥时和子时(晚上9点至凌晨3点)发热,形体和精神疲倦,面色发黄,食欲不振,流口水且想喝热水。使用益黄散治疗后痊愈。后来病情复发,服用之前的药物及清热药剂,导致发病时间不规律,嗜睡且眼睛半睁(露睛),口渴但吃得少,大便次数多且颜色偏黄。这是脾虚而肝木之气过盛,兼有元气下陷所致。使用补中益气汤,配合地黄丸治疗而痊愈。
又治疗一个患儿夜间发热伴腹部胀满。这是脾虚肝盛。早晨服用五味异功散,晚上服用四味肥儿丸,热退后,改为早晨服用六味地黄丸,晚上服用异功散,最终痊愈。
钱乙治疗朱监簿的儿子,五岁,夜间发热,天亮后就像正常人一样。其他医生有的按伤寒治疗,有的按热证治疗,用凉药解表清热无效。患儿的症状是多涎液且喜欢睡觉,其他医生用铁粉丸来降痰涎,病情反而加重。到了第五天,患儿大量饮水。钱乙说不可用泻下法,于是取白术散一两,煎成药汁三升,让患儿随意饮用直到满足。朱监簿问:“喝多了会不会腹泻?”钱乙说:“没有生水就不会腹泻,即使喝得多也不必奇怪,只是不可用泻下法罢了。”朱监簿问:“先治疗什么病?”钱乙说:“止泻、治痰、退热、清神,都靠这个药。”到晚上服完,钱乙观察后说可以再服三升,于是又煎白术散三升,服完后病情稍有好转。第三天又服用白术散三升,患儿不再口渴也没有痰涎,又服用两服阿胶散后安定下来。
汤某治疗风痰热证,表现为晚上发热早晨凉爽,随时想吃水。这种候象是痰邪引发潮热并产生风热,应当立即用金星丸泻下;如果气虚者不可泻下,宜用夺命散来控制下行痰涎,随后服用惺惺散,加入南星、白附子。
四顺饮(见里热章节) 益黄散(见脾章节) 补中益气汤(见虚热章节) 地黄丸(见肾章节) 异功散(见吐泻章节) 四味肥儿丸(见疳章节) 白术散(见渴章节)
金星丸:治疗风热结聚,喉内痰鸣,呼吸急促咳嗽,面红腮肿,咽喉膈部壅塞,发热狂躁多渴。
配方:郁金末、雄黄(单独研磨,各一分)、腻粉(半分)、巴豆(七枚,去油)。
制法:以上药物研为细末,用米醋糊制成丸剂,大小如麻子。用薄荷腊茶送服。
四物二连汤:治疗血虚劳损,五心烦热,白天神志清醒,夜间发热,胁肋及全身均感发热,下午申时肌肉发热。
配方:当归、生地黄、白芍药、川芎、黄连、胡黄连(各等分)。
用法:以上药物用水煎服。
Zhang Yuansu (styled Haizang) stated: Night fever belongs to the Yin category; formulas such as Sishun Yin are applicable, indicating blood heat manifesting at night. The *Mai Jing* records: "When there is retained food in the small intestine, fever often occurs in the evening and subsides by the next morning." This refers to night fever caused by retained food.
Xue Ji treated a pediatric patient who developed fever during the Hai and Zi hours (9 PM to 3 AM), presenting with fatigue in form and spirit, sallow complexion, poor appetite, drooling, and a desire to drink warm fluids. The condition was cured using Yihuang San. Later, the condition recurred; after taking the previous medication and heat-clearing agents, the fever became irregular, accompanied by lethargy, eyes half-open (Luojing), thirst, reduced food intake, and frequent yellow stools. This indicated Spleen deficiency with Liver Wood overacting, combined with sinking of Yuan Qi. It was cured using Buzhong Yiqi Tang, assisted by Dihuang Wan.
He also treated a pediatric patient with night fever and abdominal distension. This was due to Spleen deficiency and Liver excess. In the morning, Wuyi Yigong San was administered, and in the evening, Siwei Fei'er Wan was given. After the fever subsided, Liuwei Dihuang Wan was taken in the morning and Yigong San in the evening, leading to recovery.
Qian Yi treated the five-year-old son of Supervisor Zhu, who had night fever that resolved by dawn. Other physicians treated it as Taiyang disease or heat syndrome, using cooling herbs without success. The symptoms included excessive salivation and sleepiness. Another physician used Tiefen Wan to reduce phlegm-saliva, but the condition worsened. By the fifth day, the child drank large amounts of water. Qian Yi said purgation was contraindicated. He took Baizhu San (one liang), decocted it into three sheng of liquid, and allowed the child to drink freely until satisfied. Mr. Zhu asked, "Will drinking too much cause diarrhea?" Qian Yi replied, "Without raw water, diarrhea will not occur; even if he drinks a lot, it is not surprising, but purgation must be avoided." Mr. Zhu asked, "Which disease should be treated first?" Qian Yi answered, "Stopping diarrhea, treating phlegm, reducing fever, and clearing the spirit are all achieved by this medicine." By evening, the dose was finished. Qian Yi examined the child and said another three sheng could be taken. He decocted another three sheng of Baizhu San, which led to slight improvement after consumption. On the third day, another three sheng of Baizhu San were administered; the child no longer felt thirsty nor had phlegm-saliva. Two doses of Ejiao San were then given, resulting in stability.
Tang treated wind-phlegm-heat syndrome, characterized by night fever and morning coolness, with constant desire for water. This pattern arises from phlegm generating tidal fever and wind-heat. Jinxing Wan should be used immediately for purgation; if Qi is deficient, purgation is contraindicated. Instead, Duoming San should be used to control the downward expulsion of phlegm-saliva, followed by Xingxing San added with Nanxing and Baifuzi.
Sishun Yin (see Interior Heat chapter) Yihuang San (see Spleen chapter) Buzhong Yiqi Tang (see Deficiency Heat chapter) Dihuang Wan (see Kidney chapter) Yigong San (see Vomiting and Diarrhea chapter) Siwei Fei'er Wan (see Gan Syndrome chapter) Baizhu San (see Thirst chapter)
Jinxing Wan: Treats wind-heat accumulation, phlegm-rattling in the throat, rapid breathing and coughing, red face and swollen cheeks, obstruction in the throat and diaphragm, fever, mania, restlessness, and excessive thirst.
Ingredients: Powder of Curcuma aromatica (Yujin), Realgar (Xionghuang, separately ground, each 1 fen), Calomel (Nifen, 0.5 fen), Croton seed (Badou, seven seeds, oil removed).
Preparation: Grind the above ingredients into powder, bind with rice vinegar paste into pills the size of hemp seeds. Administer with mint and aged tea infusion.
Duoming San (see Convulsion chapter) Xingxing San (see Smallpox chapter)
Siwu Erlian Tang: Treats blood-deficiency consumptive disease, heat sensation in the five centers (palms, soles, and chest), clarity during the day, fever at night, heat in the hypochondrium and throughout the body, and muscle heat in the late afternoon (Shen hour).
Ingredients: Angelica sinensis (Danggui), Rehmannia glutinosa (Sheng Dihuang), Paeonia lactiflora (Baishaoyao), Ligusticum chuanxiong (Chuanxiong), Coptis chinensis (Huanglian), Picrorhiza scrophulariiflora (Huhuanglian) (all in equal proportions).
Administration: Decoct in water and take orally.