虚热者，因患后平复，血气未匀，四体羸弱，时多发热，治宜调气补虚，其热
自退，如钱氏白术散、异功散、四君子汤、之类，或未退，人参生犀散治之。〔杨〕
虚则面色青白，恍忽神缓，口中清冷，嘘气软弱，泄泻多尿，夜出虚汗，宜惺惺散。
〔薛〕又有喜热恶寒，乍凉乍温，怫郁惊惕，上盛下泄，屈体而卧，睡而露睛，手足
指冷等证。〔曾〕虚热，因病后发热无时，一日三五次者，此客热乘虚而作，先以
胃苓汤加黄 末，温米清汤调服，次投钱氏白术散，或固真汤带凉服，及用温盐汤
参入凉水，送下黑锡丹固守元气。海藏云∶风热邪热，四君子汤加生姜、荆芥、
煎。云岐云∶小儿客热在内，先用导赤散，次用益黄散。薛氏，以虚实分属表里，
及热盛拒阴、寒盛格阳、血虚气虚发热等证，俱仲景东垣诸圣医辨证妙法，宜详
玩而熟记之，则虚热似实热之证，庶几不至误认而全活众矣。〔钱〕朱监簿子五岁，
忽发热。医曰此心热也，腮赤而唇红，烦躁引饮，遂用牛黄丸三服，以一物泻心汤
下之。来日不愈，反加无力而不能食，又下之，便利黄沫。钱曰心经虚而有留热在
内，必被凉药下之，致此虚劳之病也，钱先用白术散生胃中津液，次以生犀散治之。
朱曰大便黄沫如何？曰胃气正，即泻自止，虚热也。朱曰医用泻心汤如何？钱曰泻
心汤者，黄连一物耳，黄连性寒，多服则利，能寒脾胃也。坐久，众医至，皆曰实
热。钱曰虚热，若实热，何以泻心汤下之不安，又加面黄颊赤，五心烦躁，不食而
引饮。医曰既虚热，何大便黄沫？钱笑曰，便黄沫者，服泻心汤多故也。钱与胡黄
连丸，治愈。郑人齐郎中者，家好收药散施，其子忽脏热，齐自取青金膏三服并一
服饵之，服毕，至三更，泻五行，其子困睡。齐言子睡多惊，又与青金膏一服，又
泻三行，加口干身热。齐言尚有微热未尽，又与青金膏。其妻曰，用药十余行未安，
莫生他病否，召钱氏至。曰已成虚羸，先用前白术散时时服之，后服香瓜丸，十三
日愈。嘉靖甲寅，敬臣之女年十二，患脾胃素弱，自夏入秋，时泻时止，小腹微
痛，至八九月间，遂成疳积之证，发热凡二十余日不止，汗泄热解，汗已复热，自
中脘至小腹膨胀坚直，大便溏，气喘咳嗽作嗳，俱昼轻夜重，彻夜烦躁不睡，鼻塞
眼暗 语。其母以为必死矣。立斋先生诊之曰，脉浮大而无根，此大虚证也，非独
参汤不可。乃用参一两，加熟附三分、煨生姜三片，日进二剂，仍并渣煎服之，大
下疳积，其气则腥，腹渐宽，热渐减，脉渐敛，然手犹寻捻不已，鼻孔出血。先生
曰，此肝证也，煎六味丸料与之，一服如脱。乃昼服独参姜附汤，夜服六味丸料，
脉渐有根，诸证渐退。先此手足恒热，至是乃始觉寒，先生喜曰，此病邪尽退，而
真气见矣。然犹饮食不进，乃单用六君子汤加炮姜，遂能食，咳嗽独甚，与补中益
气汤，嗽遂止，夜始有睡。凡弱女之得生，皆先生力也，向非先生卓有定见，专治
其本而其末自愈，则为丘中之骨，必矣！敬书施疗之颠末，以告同患此者，幸无所
误。亦推展先生一念之仁于万一云尔。王敬臣书。
惺惺散（方见痘疹） 钱氏白术散（方见渴） 异功散（方见吐泻） 人参生犀散（见后条）
固真汤（见慢惊） 黑锡丹（见杂病头痛）
当归补血汤 治肌热躁热目赤，面红烦渴，昼夜不息，其脉洪大而虚，重按全无，
此脉虚血虚也，若误服白虎汤，必死，宜此主之。
黄 （三钱） 当归（一钱）
上，水煎服。
补中益气汤 治中气虚弱，体疲食少，或发热烦渴等证。
人参 黄 （各八分） 白术 甘草 陈皮（各五分） 升麻 柴胡（各二分） 当归（三分）
上，姜枣水煎，空心午前服。
加味逍遥散 去牡丹皮山栀即逍遥散。治肝脾血虚等证。
当归 甘草（炙） 芍药（酒炒） 茯苓 白术（炒） 柴胡（各一钱） 牡丹皮 山栀（炒。各七分）
上，水煎服。
愚按∶前方，若乳母肝脾血虚，内热寒热，遍身搔痒，肢体作疼，头目昏
重，怔忡颊赤，口燥咽干。或发热盗汗，食少不寐。或口舌生疮，耳内作痛，胸
乳腹胀，小便不利，致儿为患，尤宜用之。又治妇人阴虚发热，儿饮其乳以致患
疮者。
虚热，是指疾病初愈、身体尚未完全恢复时，由于气血尚未调和，四肢形体瘦弱，时常出现发热的症状。治疗应当以调理气机、补益虚损为主，发热自然消退。可选用钱乙的白术散、异功散、四君子汤等方剂；如果发热仍未退去，可用人参生犀散治疗。〔杨氏〕虚证表现为面色青白，神情恍惚且精神倦怠，口中感觉清冷，呼吸气息微弱无力，伴有泄泻和尿多，夜间出虚汗，适宜使用惺惺散。〔薛氏〕又有喜欢温暖而厌恶寒冷，体温忽凉忽温，情绪烦躁易惊，上部邪盛而下部泄泻，身体蜷曲而卧，睡眠时眼睛半睁（露睛），手足指端发冷等症状。〔曾氏〕虚热，是指病后发热没有固定时间，一天发作三到五次的情况，这是外来的客热乘虚而入所致。先服用加入黄柏末的胃苓汤，用温热的米汤调服；随后投予钱氏白术散，或者将固真汤放凉后服用；以及用温盐水掺入凉水，送服黑锡丹以固守元气。海藏说：风热或邪热，可用四君子汤加生姜、荆芥煎服。云岐说：小儿体内有客热，先用导赤散，再用益黄散。薛氏认为，应根据虚实来区分表里，以及热盛格阴、寒盛格阳、血虚气虚发热等证候，这些都是张仲景、李东垣等历代圣医辨证的高明方法，应当仔细研读并熟记于心，这样对于虚热类似实热的证候，才不至于误诊从而保全生命。〔钱乙〕朱监簿的儿子五岁，突然发热。医生说是心热，因为面颊红、嘴唇红，烦躁且想喝水，于是用了三服牛黄丸，并用一物泻心汤送下。第二天病情未愈，反而更加无力且不能进食，又用了泻下药，导致大便排出黄色泡沫状物质。钱乙说：这是心经虚而有余热在内，必然被寒凉攻下的药物所伤，导致了这种虚劳的病证。钱乙先用白术散滋生胃中的津液，接着用生犀散治疗。朱监簿问：大便为什么是黄色泡沫？钱乙答：胃气恢复正常，腹泻自然会停止，这是虚热的表现。朱监簿问：医生为什么要用泻心汤？钱乙答：泻心汤不过是黄连一味药罢了，黄连性寒，多服会导致腹泻，能损伤脾胃。坐了一会儿，其他医生都到了，都说这是实热。钱乙说这是虚热，如果是实热，为什么用了泻心汤攻下后病情不安定，反而增加了面色黄、两颧红、五心烦热、不想吃东西却想喝水的症状？医生说：既然是虚热，为什么大便是黄色泡沫？钱乙笑着说：大便呈黄色泡沫，是因为服用了太多泻心汤的缘故。钱乙给予胡黄连丸，治愈了疾病。郑地有一位齐郎中，家里喜欢收集药粉施舍给人，他的孩子忽然内脏发热，齐郎中自己取青金膏三服并喂了一次。服药完毕后，到了三更天，孩子腹泻五次，陷入困倦沉睡。齐郎中说孩子睡觉多惊悸，又给了一服青金膏，又腹泻三次，加上口干身热。齐郎中说还有微热未尽，又给了青金膏。他的妻子说：用药十多次都不见好，会不会生出别的病呢？于是请来了钱乙。钱乙说：已经形成了虚羸之证，先用前面的白术散时时服用，后来服用香瓜丸，十三天后痊愈。嘉靖甲寅年，王敬臣的女儿十二岁，患有脾胃素来虚弱，从夏天进入秋天，时而腹泻时而停止，小腹轻微疼痛，到了八九月间，便成了疳积的证候，发热二十多天不止，出汗后热退，汗止后又发热，从肚脐上脘到小腹膨胀坚硬挺直，大便稀溏，气喘咳嗽打嗝，都是白天轻晚上重，彻夜烦躁不睡觉，鼻塞眼暗语声低微。她的母亲认为必死无疑。立斋先生诊察说：脉象浮大而无根，这是大虚证，非独参汤不可。于是用人参一两，加熟附子三分、煨生姜三片，每天进两剂，连同药渣一起煎服，结果排出了大量的疳积之物，气味腥臭，腹部逐渐变宽，热势逐渐减退，脉象逐渐收敛，但是手仍然不停地抓捻。先生说：这是肝的证候，煎六味地黄丸的药料给她喝，一服之后就像解脱了一样轻松。于是白天服用独参姜附汤，晚上服用六味地黄丸药料，脉象逐渐有了根底，各种症状逐渐消退。在此之前手脚一直发热，到现在才开始觉得冷，先生高兴地说：这是病邪全部退去，而真气显现了。然而饮食仍然不进，于是单用六君子汤加炮姜，便能进食，但咳嗽特别严重，给予补中益气汤，咳嗽随即停止，夜里才开始有睡眠。这个虚弱女孩能够存活，都是先生的功劳啊，如果不是先生卓有定见，专门治疗其根本而末节自愈，那就必定成为丘中之骨了！谨记录施治的始末，以此告知同样患此病的人，希望不要误诊。也是推广先生的一念仁慈于万一罢了。王敬臣书。
当归补血汤：治疗肌热躁热、目赤、面红、烦渴，昼夜不停，脉象洪大而虚，重按全无，这是脉虚血虚的表现，如果误服白虎汤，必死无疑，适宜用此方主治。
黄芪（三钱） 当归（一钱）
以上药材，加水煎服。
补中益气汤：治疗中气虚弱，身体疲倦、食量减少，或发热、烦渴等证候。
人参 黄芪（各八分） 白术 甘草 陈皮（各五分） 升麻 柴胡（各二分） 当归（三分）
以上药材，用姜枣水煎，空腹且在午前服用。
加味逍遥散：去掉牡丹皮、山栀即为逍遥散。治疗肝脾血虚等证候。
当归 甘草（炙） 芍药（酒炒） 茯苓 白术（炒） 柴胡（各一钱） 牡丹皮 山栀（炒。各七分）
以上药材，加水煎服。
愚者按：前面的方子，如果乳母肝脾血虚，出现内热、寒热往来、遍身瘙痒、肢体疼痛、头目昏重、怔忡、面颊红、口燥咽干。或者发热盗汗、食少失眠。或者口舌生疮、耳内作痛、胸乳腹胀、小便不利，从而导致婴儿患病，尤其适宜使用此方。又治疗妇人阴虚发热，婴儿饮用其乳汁而导致患疮的情况。
Deficient heat refers to the condition occurring after recovery from illness, when blood and qi are not yet harmonized, limbs and body are emaciated, and fever occurs frequently. The treatment should focus on regulating qi and tonifying deficiency, after which the fever will naturally subside. Formulas such as Qian's Baizhu San (Atractylodes Macrocephala Powder by Qian Yi), Yigong San (Yi Gong Powder), and Sijunzi Tang (Four Gentlemen Decoction) may be used; if the fever does not recede, Rensheng Shengxi San (Ginseng and Rhinoceros Horn Powder) can be employed. [Yang] Deficiency manifests as a bluish-white complexion, vague spirit with sluggishness, a cold sensation in the mouth, weak and soft breathing, diarrhea with frequent urination, and night sweats due to deficiency. Xingxing San (Xingxing Powder) is suitable. [Xue] There are also symptoms of preferring warmth and fearing cold, alternating coolness and warmth, irritability with fright, excess heat above and diarrhea below, curling up while lying down, sleeping with eyes partially open (exposed eyes), and cold fingers and toes. [Zeng] Deficient heat refers to fever without fixed timing after illness, occurring three to five times a day; this is external pathogenic heat taking advantage of deficiency to arise. Initially, Weiling Tang (Weiling Decoction) added with Huangbai powder (Phellodendron Bark) should be taken, mixed with warm rice water for administration. Subsequently, Qian's Baizhu San or Guzhen Tang (Guzhen Decoction) taken cool can be administered. Additionally, Heixi Dan (Black Tin Pill) can be taken with warm salt water mixed with cool water to consolidate primordial qi. Haicang stated: For wind-heat or pathogenic heat, Sijunzi Tang added with Shengjiang (Fresh Ginger) and Jingjie (Schizonepeta) can be decocted. Yunqi stated: For infantile internal pathogenic heat, Daochi San (Daochi Powder) should be used first, followed by Yihuang San (Yihuang Powder). Xue believed that deficiency and excess should be differentiated according to exterior and interior, and conditions such as heat excess repelling yin, cold excess repelling yang, and fever due to blood or qi deficiency are all subtle methods of syndrome differentiation by Zhang Zhongjing, Li Dongyuan, and other sages. These should be carefully studied and memorized, so that deficient heat resembling excess heat will not be misdiagnosed, thereby saving lives. [Qian Yi] The son of Supervisor Zhu, aged five, suddenly developed fever. A physician said it was heart heat because his cheeks were red, lips were red, he was irritable and thirsty. Thus, Niuhuang Wan (Calculus Bovis Pills) were given three doses, washed down with Yiwu Xiexin Tang (One-Ingredient Xiexin Decoction). The next day, the condition did not improve; instead, weakness increased and appetite was lost. Another purgative was given, resulting in yellow frothy stools. Qian Yi said: This is deficiency of the Heart channel with lingering heat inside, inevitably caused by injury from cold and purgative medicines, leading to consumptive disease. Qian Yi first used Baizhu San to generate fluids in the stomach, then treated it with Shengxi San. Zhu asked: Why are the stools yellow and frothy? Qian Yi replied: When stomach qi recovers, diarrhea will stop naturally; this is deficient heat. Zhu asked: Why did the physician use Xiexin Tang? Qian Yi replied: Xiexin Tang consists only of Huanglian (Coptidis Rhizoma). Huanglian is cold in nature; excessive intake causes diarrhea and damages spleen and stomach. After sitting for a while, other physicians arrived, all stating it was excess heat. Qian Yi said it was deficient heat. If it were excess heat, why would the condition worsen after purging with Xiexin Tang, accompanied by yellow face, red malar flush, five-palm heat, anorexia with thirst? The physician asked: If it is deficient heat, why are the stools yellow and frothy? Qian Yi smiled and said: Yellow frothy stools are due to excessive consumption of Xiexin Tang. Qian Yi prescribed Huhuanglian Wan (Huhuanglian Pills), which cured the disease. Qi Langzhong from Zheng, whose family liked to collect and distribute medicinal powders, had a child who suddenly developed internal organ heat. Qi took Qingjin Gao (Green Gold Ointment), three doses plus one additional dose. After finishing the medication, at midnight, the child had five diarrheal episodes and fell into a sleepy coma. Qi said the child slept with much fright and gave another dose of Qingjin Gao, resulting in three more diarrheal episodes, dry mouth, and fever. Qi said there was still residual mild heat and gave Qingjin Gao again. His wife said: After more than ten doses, there is no improvement; could it cause other diseases? So Qian Yi was summoned. Qian Yi said: It has become a state of deficiency and emaciation. First, administer Baizhu San frequently, then Xianggua Wan (Melon Pill). The child recovered in thirteen days. In the Jiayin year of Jiajing, Wang Jingchen's daughter, aged twelve, suffered from inherent spleen and stomach weakness. From summer to autumn, she had intermittent diarrhea and slight lower abdominal pain. By August and September, she developed malnutrition syndrome (ganji), with continuous fever for over twenty days. Fever subsided with sweating but returned after sweating stopped. Her abdomen from Zhongwan (CV12) to lower abdomen became distended, hard, and straight. Stools were loose, accompanied by panting, coughing, belching, all worse at night than during the day. She was restless all night and could not sleep, with nasal congestion, dim vision, and low voice. Her mother thought she would surely die. Lizhai examined her pulse and found it floating, large, and rootless, diagnosing it as a severe deficiency syndrome requiring Dushen Tang (Single Ginseng Decoction). He used Ren Shen (Ginseng Radix et Rhizoma) 1 qian, plus Shu Fuzi (Prepared Aconite Lateralis Radix) 3 fen and Wei Shengjiang (Baked Fresh Ginger) 3 slices, administered two doses daily, including the dregs. Large amounts of ganji material were expelled with a fishy odor. The abdomen gradually widened, fever decreased, and pulse became more contained. However, her hands continued to pick and grasp incessantly. Mr. Li said: This is a liver syndrome. He decocted Liuwei Wan (Six-Ingredient Pill) ingredients for her. One dose brought relief like shedding a burden. Then, Dushen Jiangfu Tang was taken by day, and Liuwei Wan ingredients by night. The pulse gradually gained root, and various symptoms receded. Previously, her hands and feet were always hot; now she began to feel cold. Mr. Li rejoiced, saying: This indicates pathogenic factors have completely retreated, and true qi has appeared. However, she still could not eat. Single Liujunzi Tang (Six Gentlemen Decoction) added with Pao Jiang (Baked Ginger) was used, enabling her to eat. Cough became severe, so Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was given, stopping the cough. She finally slept at night. The survival of this weak girl was entirely due to Mr. Li's efforts. If not for his firm judgment and focus on treating the root, leaving the branches to heal themselves, she would certainly have become bones in the grave! I record the details of this treatment to inform others suffering from similar conditions, hoping they avoid error. This is also an attempt to extend Mr. Li's benevolence. Written by Wang Jingchen.
Danggui Buxue Tang (Angelica Sinensis Blood-Tonifying Decoction): Treats muscle heat, restlessness, red eyes, red face, thirst, unceasing day and night. The pulse is flooding and large but empty, disappearing upon heavy pressure, indicating pulse deficiency and blood deficiency. If Baihu Tang (White Tiger Decoction) is mistakenly taken, death is certain; this formula is indicated.
Huangqi (Astragali Radix) (3 qian) Danggui (Angelicae Sinensis Radix) (1 qian)
Decoct with water and take orally.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction): Treats middle qi deficiency, fatigue, poor appetite, or fever with thirst.
Renshen (Ginseng Radix et Rhizoma) Huangqi (Astragali Radix) (each 8 fen) Baizhu (Atractylodis Macrocephalae Rhizoma) Gancao (Glycyrrhizae Radix et Rhizoma) Chenpi (Citri Reticulatae Pericarpium) (each 5 fen) Shengma (Cimicifugae Rhizoma) Chaihu (Bupleuri Radix) (each 2 fen) Danggui (Angelicae Sinensis Radix) (3 fen)
Decoct with fresh ginger and jujube, take on an empty stomach before noon.
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder): Removing Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus) yields Xiaoyao San. Treats liver and spleen blood deficiency.
Danggui (Angelicae Sinensis Radix) Gancao (Glycyrrhizae Radix et Rhizoma) (roasted) Shaoyao (Paeoniae Radix Alba) (wine-fried) Fuling (Poria) Baizhu (Atractylodis Macrocephalae Rhizoma) (stir-fried) Chaihu (Bupleuri Radix) (each 1 qian) Mudanpi (Moutan Cortex) Zhizi (Gardeniae Fructus) (stir-fried, each 7 fen)
Decoct with water and take orally.
Commentary: The aforementioned formulas are particularly suitable if the nursing mother suffers from liver and spleen blood deficiency, presenting with internal heat, alternating chills and fever, generalized pruritus, limb pain, heavy head and dizzy vision, palpitations, malar flush, dry mouth and throat. Or fever with night sweats, poor appetite, insomnia. Or mouth and tongue ulcers, earache, chest and breast distension, difficult urination, causing illness in the infant. It also treats women with yin deficiency fever, where the infant contracts sores through breastfeeding.