凡病鲜有不发热者，而内伤外感，其大关键也，已各立门，详其治法。此又立
发热门者，重在内伤，示人治热之都例也。《明医杂着》云∶世间发热症类伤寒者数
种，治各不同。张仲景论伤寒、伤风，此外感也。因风寒之邪感于外，自表入里，
故宜发表以解散之，此麻黄、桂枝之义也。以其感于冬春之时，寒冷之月，实时发
病，故谓之伤寒。而药用辛热以胜寒。若时非寒冷，则药当有变矣。如春温之月，
则当变以辛凉之药，如夏暑之月，则当变以甘苦寒之药。故云伤寒不即病，至春变
温，至夏变热，而其治法必因时而有异也。又有一种冬温之病，谓之非其时而有其
气。盖冬寒时也，而反病温焉，此天时不正，阳气反泄，用药不可温热。又有一种
时行寒疫，却在温暖之时，时行温暖，而寒反为病，此亦天时不正，阴气反逆，用
药不可寒凉。又有一种天行温疫热病，多发于春夏之间，沿门阖境相同者，此天地
之疠气，当随令参气运而施治，宜用刘河间辛凉甘苦寒之药，以清热解毒。以上诸
症，皆外感天地之邪者。若夫饮食劳倦，为内伤元气，此则真阳下陷，内生虚热。
故东垣发补中益气之论，用人参、黄 等甘温之药，大补其气，而提其下陷，此用
气药以补气之不足也。又若劳心好色，内伤真阴，阴血既伤，则阳气偏胜，而变为
火矣。是谓阴虚火旺劳瘵之症。故丹溪发阳有余阴不足之论，用四物加黄柏、知母，
补其阴而火自降，此用血药以补血之不足者也。益气补阴，皆内伤症也，一则因阳
气之下陷，而补其气以升提之，一则因阳火之上升，而滋其阴以降下之，一升一降，
迥然不同矣。又有夏月伤暑之病，虽属外感，却类内伤，与伤寒大异。盖寒伤形，
寒邪客表，有余之症，故宜汗之。暑伤气，元气为热所伤而耗散，不足之症，故宜
补之。东垣所谓清暑益气者是也。又有因时暑热，而过食冷物以伤其内，或过取凉
风以伤其外，此则非暑伤人，乃因暑而自致之之病，治宜辛热解表，或辛温理中之
药，却与伤寒治法相类者也。凡此数症，外形相似，而实有不同。治法多端，不可
或谬，故必审其果为伤寒、伤风、及寒疫也，则用仲景法。果为温病及瘟疫也，则
用河间法。果为气虚也，则用东垣法。果为阴虚也，则用丹溪法。如是则庶无差误
以害人矣。今人但见发热之症，一皆认作伤寒外感，率用汗药以发其表，汗后不解，
又用表药以凉其肌，设是虚证，岂不死哉。间有颇知发热属虚，而用补药，则又不
知气血之分，或气病而补血，或血病而补气，误人多矣。故外感之与内伤，寒病之
与热病，气虚之与血虚，如冰炭相反。治之若瘥，则轻病必重，重病必死矣。可不
畏哉。内外伤辨，人迎脉大于气口为外感，气口脉大于人迎为内伤。外感则寒热齐
作而无间，内伤则寒热间作而不齐。外感恶寒，虽近烈火不能除；内伤恶寒，得就
温暖而必解。外感恶风，乃不禁一切风寒；内伤恶风，唯恶夫些少贼风。外感证显
在鼻，故鼻气不利而壅盛有力；内伤证显在口，故口不知味而腹中不和。外感则邪
气有余，故发言壮厉，先轻而后重；内伤则元气不足，故出言懒怯，先重而后轻。
外感头痛，常常而痛；内伤头痛，时止时作。外感手背热，手心不热；内伤手心热，
手背不热。东垣辨法，大要如此。有内伤而无外感，有外感而无内伤，以此辨之，
则判然矣。若夫内伤外感兼病而相合者，则其脉证并见而难辨，尤宜细心求之。若
显内证多者，则是内伤重而外感轻，宜以补养为先。若是外证多者，则是外感重而
内伤轻，宜以发散为急。此又东垣未言之意也。东垣云∶五脏有邪，各有身热，其
状各异，以手扪摸有三法∶以轻手扪之则热，重按之则不热，是热在皮毛血脉也；
重按至筋骨之分则热，蒸手极甚，轻摸之则不热，是热在筋骨间也；轻手扪之则不
热，重手加力按之亦不热，不轻不重按之而热，是热在筋骨之上，皮毛血脉之下，
乃热在肌肉也。此谓三法，以三黄丸通治之。细分之则五脏各异矣。肺热者，轻手
乃得，微按全无，瞥瞥然见于皮毛上，为肺主皮毛故也。日西尤甚，乃皮毛之热也。
其证必见喘咳，洒淅寒热，轻者泻白散，重者凉膈散、白虎汤之类治之，及地黄地
骨皮散。（海藏云∶皮肤如火燎，而以手重取之不甚热，肺热也。目白睛赤，烦躁引饮，单与黄
芩一物汤。丹溪青金丸、黄芩末粥丸，亦名与点丸，伐脾肺火，此二方泻肺中血分之火。
泻白散泻肺中气分之火。）心热者，心主血脉，微按至皮肤之下，肌肉之上，轻手乃得。微按至皮
毛之下则热，少加力按之则全不热，是热在血脉也。日中大甚，乃心之热也。其证烦心心痛，掌
中热而哕，以黄连泻心汤、导赤散、朱砂丸、安神丸、清凉散之类治之。（《千金》地黄丸、门
冬丸、清心丸、火腑丹。导赤
散泻丙，泻心汤泻丁，火腑丹丙丁俱泻。）脾热者，轻手扪之不热，重按至筋骨又不热，不轻
不重，在轻手重手之间，此热在肌肉，遇夜尤甚。其证必怠惰嗜卧，四肢不收，无气
以动。以泻黄散、调胃承气汤，治实热用之。人参黄 散、补中益气汤，治中虚
有热者用之。肝热者，按之肌肉之下，至骨之上，乃肝之热，寅卯间尤甚，其脉弦。
其证四肢满闷，便难，转筋，多怒多惊，四肢困热，筋痿不能起于床。泻青丸、
柴胡饮之类治之。两手脉弦者，或寅申发者，皆肝热也，俱宜用之。（当归龙荟丸、回金
九、佐金丸。）肾热者，轻按之不热，重按之至骨，其热蒸手，如火如炙，其人骨酥酥然，
如虫蚀其骨，困热不任，亦不能起于床。滋肾丸、六味地黄丸主之。以脉言之，则
轻按之如三菽之重，与皮毛相得，洪大而数者，肺热也。如六菽之重，与血脉相得，
洪大而数者，心热也。如九菽之重，与肌相得，洪大而数者，脾热也。如十二菽之
重，与筋相得，洪大而数者，肝热也。按之至骨，举指来疾，洪大而数者，肾热也。
有表而热者，谓之表热。无表而热者，谓之里热。故苦者以治五脏，五脏属阴而居
于内。辛者以治六腑，六腑属阳而在于外。故曰内者下之，外者发之。又宜养血益
阴，身热自除。以脉言之，浮数为外热，沉数为内热。浮大有力为外热，沉大有力
为内热。昼则发热，夜则安静，是阳气自旺于阳分也。昼则安静，夜则发热烦躁，
是阳气下陷入阴中也，名曰热入血室。昼则发热烦躁，夜亦发热烦躁，是重阳无阴，
当亟泻其阳，峻补其阴。昼热则行阳二十五度，柴胡饮子。夜热则行阴二十五度，
四顺饮子。平旦发热，热在行阳之分，肺气主之，故用白虎汤以泻气中之火。日晡
潮热，热在行阴之分，肾气主之，故用地骨皮散以泻血中之火。白虎汤治脉洪，故
抑之，使秋气得以下降也。地骨皮散治脉弦，故举之，使春气得以上升也。气分热，
柴胡饮子、白虎汤。血分热，清凉饮子、桃仁承气汤。（牵牛，味辛烈，能泻气中之湿热，不能除
血中之湿热。防己，味苦寒，能泻血中之湿热，又能通血中之滞塞）骨肉筋血皮毛阴足，
而热反胜之，是为实热。骨痿、肉燥、筋缓、血枯、皮聚毛落，阴不足而有热疾，是为虚热。能食
而热，口舌干燥，大便难者，实热也。以辛苦大寒之剂下之，泻热补阴。经云∶阳
盛阴虚，下之则愈。脉洪盛有力者是已。不能食而热，自汗气短者，虚热也。以甘
寒之剂泻热补气。经云∶治热以寒，温而行之。脉虚弱无力者是已。《金匮》云∶热
在上焦者，因咳为肺痿。热在中焦者，为坚。热在下焦者，为尿血，亦令淋 不通。
《灵枢》云∶肘前热者，腰以上热。手前独热者，腰以下热。肘前独热者，膺前热。
肘后独热者，肩背热。臂中独热者，腰腹热。肘后以下三四寸热者，肠中有虫。掌
中热者，腹中亦热。又云∶胃足阳明之脉盛，则身以前皆热。又云∶胃中热则消谷，
令人悬心善饥，脐以上皮热。肠中热则出黄如糜，脐以下皮热。盖胃居脐上，故胃
热则脐以上热。肠居脐下，故肠热则脐以下热。如肝胆居胁，肝胆热则当胁亦热。
肺居胸背，肺热则当胸背亦热。肾居腰，肾热则当腰亦热。可类推也。上焦热，身
热脉洪，无汗多渴者，宜桔梗汤。易老法，凉膈散减大黄、芒硝，加桔梗同为舟楫
之剂，浮而上之，治胸膈中与六经热。以手足少阳之气，俱下膈络胸中，三焦之气
同相火游于身之表，膈与六经乃至高之分，此药浮载亦至高之剂。故施于无形之中，
随高而走，去胸膈中及六经之热也。三焦热用药大例∶上焦热，栀子、黄芩。中焦
热，小便不利，黄连、芍药。下焦热，黄柏、大黄。上焦热，清神散、连翘防风
汤、凉膈散、龙脑饮子、龙脑鸡苏丸、犀角地黄汤。中焦热，小承气汤、调胃承气
汤、洗心散、四顺清凉饮、桃仁承气汤、泻脾散、贯众散。下焦热，大承气汤、五
苓散、立效散、八正散、石韦散，四物汤、三才封髓丹、滋肾丸。通治三焦甚热之
气，三黄丸、黄连解毒汤。暴热者，病在心肺。积热者，病在肾肝。暴热者，宜《局
方》雄黄解毒丸。积热者，宜《局方》妙香丸。暴者上喘也，病在心肺，谓之高喘，
宜木香金铃子散。上焦热而烦者，宜牛黄散。有病久憔悴，发热盗汗，谓之五脏齐
损，此热劳骨蒸之病也。瘦弱虚损，烦喘，肠 下血，皆蒸劳也。治法宜养血益阴，
热自能退，此谓不治而治也。钱氏地黄丸主之。黄连解毒汤，治大热甚烦躁，错语
不得眠。加防风、连翘为金花丸，治风热。加柴胡治小儿潮热。与四物相合各半，
治妇人潮热。阴覆乎阳，火不得伸，宜汗。经曰∶体若燔炭，汗出而散是也。脉弦
而数，此阴气也。宜风药升阳，以发火郁，则脉数峻退矣。凡治此病脉数者，当用
黄柏，少加黄连、柴胡、苍术、黄 、甘草，更加升麻。得汗则脉必下，乃火郁则
发之意也。男妇四肢发热，肌肉热，筋痹热，骨髓中热，如火燎火烧，扪之令人亦
热。四肢主属脾，脾者土也。热伏地中，此病多因血虚而得。又因胃虚过食冷物，
冰水无度，郁遏阳气于脾土中。经曰∶火郁则发之，柴胡升阳汤。五心烦热，是火
郁于地中，四肢、土也，心火下陷在脾土之中，故宜升发火郁，以火郁汤主之。手
足心热，用栀子、香附、苍术、白芷、半夏、川芎末之，神曲糊丸。两手大热为骨
厥，如在火中，可灸涌泉穴三壮立愈。《素问》帝曰∶人有四肢热，逢风寒如炙如火
者何也？岐伯曰∶是人者，阴气虚，阳气盛。四肢者，阳也，两阳相得，而阴气虚
少，少水不能灭盛火，而阳独治，独治者，不能生长也，独胜而止耳。逢风如炙如
火者，是人当肉烁也。仲景有三物黄芩汤，治妇人四肢烦热。小儿 后余热不退，
痂不收敛，大便不行，是谓血燥，则当以阴药治之，因而补之，用清凉饮子通大便
而泻其热。洁古云∶凉风至而草木实，夫清凉饮子，乃秋风彻热之剂也。伤寒表邪
入于里，日晡潮热，大渴引饮，谵语狂躁，不大便，是胃实，乃可攻之。夫胃气为
热所伤，以承气汤泻其上实，元气乃得周流，承气之名，于此具矣。今世人以苦泄
火，故备陈之。除热泻火，非甘寒不可，以苦寒泻火，非徒无益，而反害之。故有
大热脉洪大，服苦寒剂而热不退者，加石膏。如症退而脉数不退，洪大而病有加者，
宜减苦寒加石膏。如大便软或泄者，加桔梗，食后服。此药误用，则其害非细，用
者旋旋加之。如食少者，不可用石膏，石膏善能去脉数，如病退而脉数不退者，不
治。肌热燥热，目赤面红，烦渴引饮，日夜不息，脉浮大而虚，重按全无，为血虚
发热，症似白虎，唯脉不长实为辨也。误服白虎必危，宜当归二钱，黄 一两，水
煎服。有肾虚火不归经，游行于外而发热者，烦渴引饮，面目俱赤，遍舌生刺，两
唇黑裂，喉间如烟火上冲，两足心如烙，痰涎壅盛，喘急，脉洪大而数无伦次，按
之微弱者是也。宜十全大补汤，吞八味丸。或问燥热如此，复投桂、附，不为以火
济火乎。曰心包络相火附于右尺命门，男子以藏精，女子以系胞，因嗜欲竭之，而
火无所附，故厥而上炎。桂、附与火同气也，而其味辛，能开腠理，致津液通气道，
据其窟宅而招之，同气相求，火必下降矣。且火从肾出者，是水中之火也。火可以
水折，而水中之火，不可以水折，故巴蜀有火井焉，得水则炽，得火则熄，则桂、
附者，固治相火之正药欤。杨仁斋云∶凡壮热烦躁，用柴胡、黄芩、大黄解利之。
其热乍轻而不退，盖用黄芩、川芎、甘草、乌梅作剂，或用黄连、生地黄、赤茯苓
同煎，临熟入灯心一捻主之，其效亦速。盖川芎、生地黄皆能调血，心血一调，其
热自退。其人脉涩，必有漱水之症，必有呕恶痰涎之证，必有两脚厥冷之证，亦必
凡是疾病，很少有不发热的，而内伤与外感，是其中的关键所在，（前文）已经各自设立门类，详细论述了治疗方法。这里又设立发热门，重点在于内伤，向人们展示治疗发热的一般法则。《明医杂着》说：世间发热的病症，类似伤寒的有好几种，治疗方法各不相同。张仲景论述的伤寒、伤风，属于外感病。因为风寒邪气从外部侵袭，由表入里，所以适宜用发表的方法以解散邪气，这就是麻黄汤、桂枝汤的意义。因为这些病感受于冬春寒冷之时，随即发病，所以称为伤寒。用药应当用辛热之药来战胜寒邪。如果时值非寒冷季节，那么药物就应当有所变化。如春季温热之时，就应当改用辛凉的药物；夏季暑热之时，就应当改用甘苦寒的药物。所以说，伤寒如果不即时发病，到了春天会变为温病，到了夏天会变为热病，其治疗方法必然因时节不同而有差异。又有一种冬温病，称为“非其时而有其气”。冬天本是寒冷时节，却反而发生温病，这是天时不正，阳气反而泄露，用药不可用温热之品。又有一种时行寒疫，却在温暖的时候发生，时行温暖之气，而寒反成为致病因素，这也是天时不正，阴气反而逆乱，用药不可用寒凉之品。又有一种天行温疫热病，多发生于春夏之间，一家一户、一乡一境都相同的，这是天地间的疠气，应当随节气参合运气学说而施治，适宜使用刘河间（刘完素）的辛凉甘苦寒药物，以清热解毒。以上诸症，都是外感天地邪气的情况。至于饮食劳倦，损伤元气，这属于内伤，此时真阳下陷，内生虚热。所以李东垣提出补中益气的理论，用人参、黄芪等甘温药物，大补元气，并提升下陷之气，这是用补气药来补充气的不足。又如劳心过度、房事不节，损伤真阴，阴血既然受损，则阳气偏胜，从而变为火邪。这被称为阴虚火旺的劳瘵病症。所以朱丹溪提出“阳有余阴不足”的理论，使用四物汤加黄柏、知母，滋补阴血而火自降，这是用补血药来补充血的不足。益气与补阴，都属于内伤病症，一种是因为阳气下陷，通过补气以升提它；一种是因为阳火上炎，通过滋阴以降下它，一升一降，截然不同。又有夏季伤暑的病，虽然属于外感，却类似内伤，与伤寒大不相同。寒邪伤人形体，寒邪客居体表，属于有余之证，所以适宜发汗。暑邪伤人元气，元气被热邪所伤而耗散，属于不足之证，所以适宜补益。这就是李东垣所说的清暑益气法。又有因时令暑热，而过食冷物损伤内部，或过度贪凉风损伤外部，这并非暑邪伤人，而是因为暑热而自己导致的病，治疗适宜用辛热解表，或辛温理中的药物，这与伤寒的治疗方法相似。所有这些病症，外形相似，但实质不同。治疗方法多种多样，不可有丝毫差错，所以必须审察清楚究竟是否为伤寒、伤风及寒疫，如果是，就用张仲景的方法。如果是温病及瘟疫，就用刘河间的方法。如果是气虚，就用李东垣的方法。如果是阴虚，就用朱丹溪的方法。这样才差不多没有差错而危害人。现在的人只见发热症状，一律认作伤寒外感，轻易使用发汗药以发散表邪，发汗后病不解，又用解表药以清肌热，如果是虚证，岂不死人？偶尔有人颇知发热属虚，而使用补药，却又不知气血的区别，或是气病而补血，或是血病而补气，误人多矣。所以外感与内伤，寒病与热病，气虚与血虚，如同冰炭相反。治疗如果出错，轻病必重，重病必死。能不畏惧吗？辨别内伤与外感，人迎脉大于气口脉为外感，气口脉大于人迎脉为内伤。外感则恶寒发热同时发作且无间歇，内伤则恶寒发热交替发作且不整齐。外感恶寒，即使靠近烈火也不能缓解；内伤恶寒，得到温暖就能解除。外感恶风，是不禁受一切风寒；内伤恶风，只厌恶那一点点贼风。外感病症表现在鼻部，所以鼻气不利且壅盛有力；内伤病症表现在口部，所以口不知味且腹中不和。外感则邪气有余，所以说话声音壮厉，先轻而后重；内伤则元气不足，所以说话懒怯，先重而后轻。外感头痛，常常疼痛；内伤头痛，时止时作。外感手背热，手心不热；内伤手心热，手背不热。李东垣的辨证方法，大体如此。有内伤而无外感，有外感而无内伤，以此辨别，则判然分明。如果是内伤外感兼病而相合，则脉证并见而难以辨别，尤其应当细心探求。如果内证表现多的，则是内伤重而外感轻，适宜以补养为先。如果外证表现多的，则是外感重而内伤轻，适宜以发散为急。这又是李东垣未言明的意旨。李东垣说：五脏有邪，各有身热，症状各异，用手触摸有三种方法：以轻手抚摸则觉热，重按则不热，这是热在皮毛血脉；重按至筋骨部位则觉热，蒸手极甚，轻摸则不热，这是热在筋骨间；轻手抚摸则不热，重手加力按也不热，不轻不重按之而觉热，这是热在筋骨之上，皮毛血脉之下，即热在肌肉。这叫三法，用三黄丸通治。细分则五脏各不相同。肺热者，轻手乃得，微按全无，瞥瞥然见于皮毛上，因为肺主皮毛的缘故。傍晚尤甚，这是皮毛之热。其证必定见到喘咳，洒淅寒热，轻者用泻白散，重者用凉膈散、白虎汤之类治疗，以及地黄地骨皮散。（海藏说：皮肤如火燎，而以手重取之不甚热，是肺热。目白睛赤，烦躁引饮，单用黄芩一物汤。丹溪青金丸、黄芩末粥丸，也叫点丸，伐脾肺火，这两个方子泻肺中血分之火。泻白散泻肺中气分之火。）心热者，心主血脉，微按至皮肤之下，肌肉之上，轻手乃得。微按至皮毛之下则热，少加力按则全不热，这是热在血脉。中午最甚，这是心之热。其证烦心心痛，掌中热而哕，用黄连泻心汤、导赤散、朱砂丸、安神丸、清凉散之类治疗。（《千金》地黄丸、门冬丸、清心丸、火腑丹。导赤散泻丙，泻心汤泻丁，火腑丹丙丁俱泻。）脾热者，轻手抚摸不热，重按至筋骨又不热，不轻不重，在轻手重手之间，此热在肌肉，遇夜尤甚。其证必定怠惰嗜卧，四肢不收，无气以动。用泻黄散、调胃承气汤，治实热用之。人参黄芪散、补中益气汤，治中虚有热者用之。肝热者，按之肌肉之下，至骨之上，乃肝之热，寅卯间尤甚，其脉弦。其证四肢满闷，便难，转筋，多怒多惊，四肢困热，筋痿不能起于床。用泻青丸、柴胡饮之类治疗。两手脉弦者，或寅申时发作的，都是肝热，都适宜用这些方剂。（当归龙荟丸、回金九、佐金丸。）肾热者，轻按之不热，重按至骨，其热蒸手，如火如炙，其人骨酥酥然，如虫蚀其骨，困热不堪，也不能起于床。用滋肾丸、六味地黄丸主治。从脉象来说，轻按如三菽之重，与皮毛相得，洪大而数的，是肺热。如六菽之重，与血脉相得，洪大而数的，是心热。如九菽之重，与肌相得，洪大而数的，是脾热。如十二菽之重，与筋相得，洪大而数的，是肝热。按之至骨，举指来疾，洪大而数的，是肾热。有表而热的，称为表热。无表而热的，称为里热。所以苦味药用来治五脏，五脏属阴而居于内。辛味药用来治六腑，六腑属阳而在于外。所以说内者下之，外者发之。又适宜养血益阴，身热自然消除。从脉象来说，浮数为外热，沉数为内热。浮大有力为外热，沉大有力为内热。白天发热，夜晚安静，是阳气自旺于阳分。白天安静，夜晚发热烦躁，是阳气下陷入阴中，名叫热入血室。白天发热烦躁，夜晚也发热烦躁，是重阳无阴，应当紧急泻其阳，峻补其阴。白天热则行阳二十五度，用柴胡饮子。夜晚热则行阴二十五度，用四顺饮子。平旦发热，热在行阳之分，肺气主之，所以用白虎汤以泻气中之火。日晡潮热，热在行阴之分，肾气主之，所以用地骨皮散以泻血中之火。白虎汤治脉洪，所以抑之，使秋气得以下降。地骨皮散治脉弦，所以举之，使春气得以上升。气分热，用柴胡饮子、白虎汤。血分热，用清凉饮子、桃仁承气汤。（牵牛，味辛烈，能泻气中之湿热，不能除血中之湿热。防己，味苦寒，能泻血中之湿热，又能通血中之滞塞）骨肉筋血皮毛阴足，而热反胜之，是为实热。骨痿、肉燥、筋缓、血枯、皮聚毛落，阴不足而有热疾，是为虚热。能食而热，口舌干燥，大便难者，是实热。用辛苦大寒之剂下之，泻热补阴。经云：阳盛阴虚，下之则愈。脉洪盛有力者是已。不能食而热，自汗气短者，是虚热。用甘寒之剂泻热补气。经云：治热以寒，温而行之。脉虚弱无力者是已。《金匮》说：热在上焦者，因咳为肺痿。热在中焦者，为坚。热在下焦者，为尿血，亦令淋沥不通。《灵枢》说：肘前热者，腰以上热。手前独热者，腰以下热。肘前独热者，膺前热。肘后独热者，肩背热。臂中独热者，腰腹热。肘后以下三四寸热者，肠中有虫。掌中热者，腹中亦热。又说：胃足阳明之脉盛，则身以前皆热。又说：胃中热则消谷，令人悬心善饥，脐以上皮热。肠中热则出黄如糜，脐以下皮热。盖胃居脐上，故胃热则脐以上热。肠居脐下，故肠热则脐以下热。如肝胆居胁，肝胆热则当胁亦热。肺居胸背，肺热则当胸背亦热。肾居腰，肾热则当腰亦热。可类推也。上焦热，身热脉洪，无汗多渴者，宜桔梗汤。易老法，凉膈散减大黄、芒硝，加桔梗同为舟楫之剂，浮而上之，治胸膈中与六经热。以手足少阳之气，俱下膈络胸中，三焦之气同相火游于身之表，膈与六经乃至高之分，此药浮载亦至高之剂。故施于无形之中，随高而走，去胸膈中及六经之热也。三焦热用药大例：上焦热，栀子、黄芩。中焦热，小便不利，黄连、芍药。下焦热，黄柏、大黄。上焦热，清神散、连翘防风汤、凉膈散、龙脑饮子、龙脑鸡苏丸、犀角地黄汤。中焦热，小承气汤、调胃承气汤、洗心散、四顺清凉饮、桃仁承气汤、泻脾散、贯众散。下焦热，大承气汤、五苓散、立效散、八正散、石韦散，四物汤、三才封髓丹、滋肾丸。通治三焦甚热之气，三黄丸、黄连解毒汤。暴热者，病在心肺。积热者，病在肾肝。暴热者，宜《局方》雄黄解毒丸。积热者，宜《局方》妙香丸。暴者上喘也，病在心肺，谓之高喘，宜木香金铃子散。上焦热而烦者，宜牛黄散。有病久憔悴，发热盗汗，谓之五脏齐损，此热劳骨蒸之病也。瘦弱虚损，烦喘，肠 下血，皆蒸劳也。治法宜养血益阴，热自能退，此谓不治而治也。钱氏地黄丸主之。黄连解毒汤，治大热甚烦躁，错语不得眠。加防风、连翘为金花丸，治风热。加柴胡治小儿潮热。与四物相合各半，治妇人潮热。阴覆乎阳，火不得伸，宜汗。经曰：体若燔炭，汗出而散是也。脉弦而数，此阴气也。宜风药升阳，以发火郁，则脉数峻退矣。凡治此病脉数者，当用黄柏，少加黄连、柴胡、苍术、黄芪、甘草，更加升麻。得汗则脉必下，乃火郁则发之意也。男妇四肢发热，肌肉热，筋痹热，骨髓中热，如火燎火烧，扪之令人亦热。四肢主属脾，脾者土也。热伏地中，此病多因血虚而得。又因胃虚过食冷物，冰水无度，郁遏阳气于脾土中。经曰：火郁则发之，柴胡升阳汤。五心烦热，是火郁于地中，四肢、土也，心火下陷在脾土之中，故宜升发火郁，以火郁汤主之。手足心热，用栀子、香附、苍术、白芷、半夏、川芎末之，神曲糊丸。两手大热为骨厥，如在火中，可灸涌泉穴三壮立愈。《素问》帝曰：人有四肢热，逢风寒如炙如火者何也？岐伯曰：是人者，阴气虚，阳气盛。四肢者，阳也，两阳相得，而阴气虚少，少水不能灭盛火，而阳独治，独治者，不能生长也，独胜而止耳。逢风如炙如火者，是人当肉烁也。仲景有三物黄芩汤，治妇人四肢烦热。小儿 后余热不退，痂不收敛，大便不行，是谓血燥，则当以阴药治之，因而补之，用清凉饮子通大便而泻其热。洁古说：凉风至而草木实，夫清凉饮子，乃秋风彻热之剂也。伤寒表邪入于里，日晡潮热，大渴引饮，谵语狂躁，不大便，是胃实，乃可攻之。夫胃气为热所伤，以承气汤泻其上实，元气乃得周流，承气之名，于此具矣。今世人以苦泄火，故备陈之。除热泻火，非甘寒不可，以苦寒泻火，非徒无益，而反害之。故有大热脉洪大，服苦寒剂而热不退者，加石膏。如症退而脉数不退，洪大而病有加者，宜减苦寒加石膏。如大便软或泄者，加桔梗，食后服。此药误用，则其害非细，用者旋旋加之。如食少者，不可用石膏，石膏善能去脉数，如病退而脉数不退者，不治。肌热燥热，目赤面红，烦渴引饮，日夜不息，脉浮大而虚，重按全无，为血虚发热，症似白虎，唯脉不长实为辨也。误服白虎必危，宜当归二钱，黄芪一两，水煎服。有肾虚火不归经，游行于外而发热者，烦渴引饮，面目俱赤，遍舌生刺，两唇黑裂，喉间如烟火上冲，两足心如烙，痰涎壅盛，喘急，脉洪大而数无伦次，按之微弱者是也。宜十全大补汤，吞八味丸。或问燥热如此，复投桂、附，不为以火济火乎。曰心包络相火附于右尺命门，男子以藏精，女子以系胞，因嗜欲竭之，而火无所附，故厥而上炎。桂、附与火同气也，而其味辛，能开腠理，致津液通气道，据其窟宅而招之，同气相求，火必下降矣。且火从肾出者，是水中之火也。火可以水折，而水中之火，不可以水折，故巴蜀有火井焉，得水则炽，得火则熄，则桂、附者，固治相火之正药欤。杨仁斋说：凡壮热烦躁，用柴胡、黄芩、大黄解利之。其热乍轻而不退，盖用黄芩、川芎、甘草、乌梅作剂，或用黄连、生地黄、赤茯苓同煎，临熟入灯心一捻主之，其效亦速。盖川芎、生地黄皆能调血，心血一调，其热自退。其人脉涩，必有漱水之症，必有呕恶痰涎之证，必有两脚厥冷之证，亦必
Translation:
For all diseases, there are few that do not present with fever. The key distinction lies between internal injury (Neishang) and external contraction (Waigan), which have been categorized separately with detailed treatment methods discussed previously. Here, a chapter on "Fever" is established to emphasize internal injuries, demonstrating general principles for treating fever. *Mingyi Zazhuo* states: Among the various febrile conditions in the world, several resemble Taiyang disease (Shanghan). Their treatments differ. Zhang Zhongjing's discussion of Taiyang disease and wind-stroke refers to external contractions. Because pathogenic factors of wind and cold invade from the exterior, moving from the surface inward, it is appropriate to use methods that release the exterior to disperse them; this is the rationale behind Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). Since these illnesses occur during the cold months of winter and spring and manifest immediately upon exposure, they are termed Taiyang disease. Medications should be pungent and hot to overcome the cold. However, if the season is not cold, the medications must change. In the warm months of spring, pungent-cool medications should be used; in the hot months of summer, sweet-bitter-cold medications should be employed. Thus, it is said that if Taiyang disease does not manifest immediately, it may transform into Warm Disease (Wenbing) in spring or Heat Disease in summer, and its treatment must vary according to the season. There is also a condition called Winter Warmth, described as "having the qi of another season at the wrong time." Although winter is cold, warmth illness occurs instead; this indicates improper heavenly timing where yang qi leaks abnormally, so warming medications should not be used. Another condition is seasonal cold epidemic, occurring during warm times when warmth prevails but cold becomes pathogenic due to improper heavenly timing and rebellious yin qi; cooling medications should not be used. Additionally, there are epidemic heat diseases caused by pestilential qi of heaven and earth, often spreading throughout households and regions during spring and summer. Treatment should follow the seasonal qi and luck cycles, utilizing Liu Hejian's (Liu Wansu's) pungent-cool, sweet-bitter-cold medications to clear heat and resolve toxicity. All the above conditions result from external contraction of heaven-and-earth pathogenic factors.
In contrast, dietary irregularities and overexertion cause internal injury to primordial qi, leading to the sinking of true yang and the generation of internal deficiency heat. Therefore, Li Dongyuan proposed the theory of tonifying middle qi and raising yang, using sweet-warm medications such as Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) to greatly tonify qi and lift the sinking qi; this uses qi-tonifying herbs to address qi insufficiency. Furthermore, mental overwork and excessive sexual activity injure true yin. Once yin blood is damaged, yang qi becomes hyperactive and transforms into fire. This is known as deficiency-fire hyperactivity in consumptive disease (Laozai). Zhu Danxi proposed the theory of "hyperactive yang and insufficient yin," using Siwu Tang (Four Substances Decoction) plus Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to nourish yin, causing fire to subside naturally; this uses blood-nourishing herbs to address blood insufficiency. Tonifying qi and nourishing yin both belong to internal injuries. One addresses sinking yang qi by tonifying and lifting it; the other addresses rising yang fire by nourishing yin to descend it. One lifts, one descends; they are fundamentally different.
There is also Summerheat Injury occurring in summer. Although it is an external contraction, it resembles internal injury and differs greatly from Taiyang disease. Cold injures the form; cold pathogens lodge in the exterior, representing an excess syndrome, so sweating is indicated. Summerheat injures qi; primordial qi is damaged and scattered by heat, representing a deficiency syndrome, so tonification is indicated. This is what Li Dongyuan referred to as clearing summerheat and benefiting qi. There are also cases where, due to seasonal summerheat, one consumes excessive cold foods damaging the interior, or seeks excessive cool winds damaging the exterior. These are not illnesses caused directly by summerheat, but self-induced conditions due to summerheat. Treatment requires pungent-hot exterior-releasing or pungent-warm middle-regulating medications, similar to Taiyang disease treatment. All these conditions appear similar externally but differ实质上. Treatments are diverse and must not be erroneous. One must ascertain whether it is Taiyang disease, wind-stroke, or cold epidemic to apply Zhongjing's methods; whether it is Warm Disease or plague to apply Hejian's methods; whether it is qi deficiency to apply Dongyuan's methods; or whether it is yin deficiency to apply Danxi's methods. Only then can errors harming patients be avoided.
Currently, people see only fever and assume it is always Taiyang disease or external contraction, rashly using diaphoretic drugs to release the exterior. If fever persists after sweating, they use cooling exterior-releasing drugs. If it is a deficiency syndrome, would this not be fatal? Occasionally, some recognize fever as deficiency and use tonics, yet fail to distinguish between qi and blood, treating qi disorders with blood tonics or blood disorders with qi tonics, misleading many. Thus, external contraction vs. internal injury, cold disease vs. heat disease, qi deficiency vs. blood deficiency are like ice and charcoal. If treated incorrectly, mild diseases become severe, and severe diseases become fatal. Should one not fear this?
To differentiate internal injury from external contraction: Renying pulse larger than Qikou pulse indicates external contraction; Qikou pulse larger than Renying pulse indicates internal injury. External contraction presents with simultaneous chills and fever without interval; internal injury presents with alternating chills and fever irregularly. External contraction involves aversion to cold that cannot be relieved even by proximity to fire; internal injury involves aversion to cold that resolves with warmth. External contraction involves aversion to wind, intolerant of all wind and cold; internal injury involves aversion to wind, sensitive only to slight drafts. External contraction signs manifest in the nose, causing nasal congestion and forceful breathing; internal injury signs manifest in the mouth, causing loss of taste and abdominal discomfort. External contraction has excess pathogenic qi, resulting in loud speech starting soft and becoming strong; internal injury has deficient primordial qi, resulting in weak speech starting strong and becoming soft. External contraction headache is constant; internal injury headache comes and goes. External contraction causes heat in the back of the hand but not the palm; internal injury causes heat in the palm but not the back of the hand. These are the main points of Li Dongyuan's differentiation. Cases exist with only internal injury or only external contraction; distinguishing them clarifies the diagnosis. If both internal and external factors coexist, pulses and symptoms appear together, making differentiation difficult, requiring careful inquiry. If internal signs predominate, internal injury is heavy and external contraction light; tonification and nourishment should take priority. If external signs predominate, external contraction is heavy and internal injury light; dispersing and releasing should be urgent. This is an implication not explicitly stated by Dongyuan.
Dongyuan stated: Each of the five zang organs has pathogenic heat with distinct manifestations. Palpation reveals three methods: Light palpation yields heat, heavy pressure yields no heat → heat is in skin/hair and vessels. Heavy pressure to sinews/bone yields intense heat, light touch yields no heat → heat is in sinews/bones. Light touch yields no heat, heavy pressure yields no heat, moderate pressure yields heat → heat is in muscles (between sinews/bones and skin/vessels). These three methods are generally treated with Sanhuang Wan (Three Yellows Pill). Differentiated by organ: Lung heat is detected lightly, disappears with slight pressure, visible on skin because lung governs skin. Worse in evening, heat in skin. Symptoms include panting/coughing, chills/shivering. Mild cases use Xiebai San (Drain White Powder); severe cases use Liangge San (Cool Diaphragm Powder) or Baihu Tang (White Tiger Decoction), or Dihuang Digupi San (Rehmannia and Bark of Ground Tree Bark Powder). (Haizang said: Skin feels like burning fire but deep pressure is not very hot = Lung heat. Red whites of eyes, irritability, thirst → single herb Huangqin Decoction. Danxi's Qingjin Wan or Huangqin Porcelain Pill suppress spleen/lung fire, draining blood-level heat in lungs. Xiebai San drains qi-level heat in lungs.) Heart heat is governed by heart vessels. Slight pressure below skin/above muscle detects heat. Heat in vessels. Worst at noon, heart heat. Symptoms: vexing heart, chest pain, hot palms, hiccups. Treated with Huanglian Xiexin Tang (Coptis Decoction to Drain the Heart), Daochi San (Directing Red Powder), Zhusha Wan (Cinnabar Pill), Anshen Wan (Calming Spirit Pill), or Qingliang San (Cooling Clearing Powder). (Qianjin's Dihuang Wan, Mendong Wan, Qingxin Wan, Huofu Dan. Daochi San drains Bing [Small Intestine], Xiexin Tang drains Ding [Heart], Huofu Dan drains both.) Spleen heat: Light touch no heat, heavy pressure to bone no heat, moderate pressure detects heat in muscles. Worse at night. Symptoms: lethargy, desire to lie down, limbs unresponsive, lack of qi to move. For excess heat: Xiehuang San (Drain Yellow Powder) or Tiaowei Chengqi Tang (Regulate Stomach and Direct Downward Decoction). For middle deficiency with heat: Renshen Huangqi San or Buzhong Yiqi Tang (Tonify Middle and Benefit Qi Decoction). Liver heat: Pressure below muscle to above bone detects liver heat. Worst at Yin/Mao hours (3-7 AM), pulse wiry. Symptoms: limb fullness/stuffiness, difficult defecation, tendon cramping, anger/fright, limb heat, tendon weakness unable to rise from bed. Treated with Xieqing Wan (Drain Green Pill) or Chaihu Yin (Bupleurum Drink). Wiry pulse in both hands or onset at Yin/Shen hours indicates liver heat. (Danggui Longhui Wan, Huijin Jiu, Zuojin Wan.) Kidney heat: Light pressure no heat, heavy pressure to bone yields intense heat like fire. Bones feel sore/weak, like insects biting bones, unbearable heat, unable to rise. Treated with Zishen Wan (Nourish Kidney Pill) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Pulse differentiation: Light pressure (weight of 3 beans) matching skin, surging/rapid = Lung heat. Weight of 6 beans matching vessels, surging/rapid = Heart heat. Weight of 9 beans matching muscle, surging/rapid = Spleen heat. Weight of 12 beans matching sinews, surging/rapid = Liver heat. Pressure to bone, rapid return, surging/rapid = Kidney heat.
Heat with exterior signs is Exterior Heat; heat without exterior signs is Interior Heat. Bitter flavors treat five zang (yin, interior). Pungent flavors treat six fu (yang, exterior). Thus, interior heat is purged downward, exterior heat is released outward. Nourishing blood and benefiting yin removes body heat naturally. Pulse: Floating-rapid is exterior heat; sunken-rapid is interior heat. Floating-large-forceful is exterior heat; sunken-large-forceful is interior heat. Fever by day, quiet by night = Yang qi flourishing in yang divisions. Quiet by day, fever/vexation by night = Yang qi sinking into yin, named "Heat Entering Blood Chamber". Fever/vexation by day and night = Extreme Yang without Yin, urgently drain Yang and tonify Yin. Day fever moves through 25 Yang degrees → Chaihu Yinzi. Night fever moves through 25 Yin degrees → Sishun Yinzi. Dawn fever, heat in Yang division, governed by Lung qi → Baihu Tang to drain qi-level fire. Afternoon tidal fever, heat in Yin division, governed by Kidney qi → Digupi San to drain blood-level fire. Baihu Tang treats surging pulse, suppressing it to allow Autumn qi to descend. Digupi San treats wiry pulse, lifting it to allow Spring qi to ascend. Qi-level heat: Chaihu Yinzi, Baihu Tang. Blood-level heat: Qingliang Yinzi, Taoren Chengqi Tang. (Qianniu pungent/acrid, drains damp-heat from qi, not blood. Fangji bitter/cold, drains damp-heat from blood, unblocks blood stasis.) When yin of bone/flesh/sinew/blood/skin is sufficient but heat dominates, it is Excess Heat. Bone atrophy, flesh dryness, tendon laxity, blood depletion, skin shriveling/hair loss with heat disease is Deficiency Heat. Eating well with heat, dry mouth/tongue, difficult stool = Excess Heat. Use acrid/bitter/great-cold purgatives to drain heat and tonify yin. Classic: "Yang excess, yin deficiency, purgation cures." Surging-forceful pulse confirms this. Poor appetite with heat, spontaneous sweating, short breath = Deficiency Heat. Use sweet-cold agents to drain heat and tonify qi. Classic: "Treat heat with cold, administer warm." Weak-pulseless confirms this. *Jingui Yaolue*: Heat in upper jiao causes cough and Lung萎 (Flaccidity). Heat in middle jiao causes hardness. Heat in lower jiao causes hematuria and strangury obstruction. *Lingshu*: Heat in front of elbow = heat above waist. Heat in front of hand = heat below waist. Heat only in front of elbow = heat in chest front. Heat only in back of elbow = heat in shoulder/back. Heat in arm = heat in waist/abdomen. Heat 3-4 cun below back of elbow = worms in intestines. Heat in palm = heat in abdomen. Stomach Meridian of Foot-Yangming abundance = heat along front of body. Stomach heat digests food, causes hanging heart/hunger, heat above navel. Intestinal heat causes yellow mushy stool, heat below navel. Stomach is above navel, so stomach heat heats above navel. Intestines are below navel, so intestinal heat heats below navel. Liver/Gallbladder in flanks, heat there heats flanks. Lung in chest/back, heat there heats chest/back. Kidney in waist, heat there heats waist. Inferable similarly. Upper jiao heat, body heat, surging pulse, no sweat, much thirst → Jiegeng Tang. Yi Lao's method: Liangge San minus Dahuang/Mangxiao, add Jiegeng as boat/pilot agent to float upward, treating chest/diaphragm and six meridians heat. Shaoyang qi descends through diaphragm to chest; Sanjiao qi travels with Ministerial Fire on body surface. Diaphragm/six meridians are highest parts; this drug floats to highest part, removing heat from chest/diaphragm and six meridators. General Sanjiao heat meds: Upper jiao heat → Zhizi, Huangqin. Middle jiao heat, dysuria → Huanglian, Shaoyao. Lower jiao heat → Huangbai, Dahuang. Upper jiao heat formulas: Qingshen San, Lianqiao Fangfeng Tang, Liangge San, Longnao Yinzi, Longnao Jisu Wan, Shuijiao Dihuang Tang. Middle jiao heat formulas: Xiao Chengqi Tang, Tiaowei Chengqi Tang, Xixin San, Sishun Qingliang Yin, Taoren Chengqi Tang, Xiepi San, Guanzhong San. Lower jiao heat formulas: Da Chengqi Tang, Wuling San, Lixiao San, Bazheng San, Shiwei San, Siwu Tang, Sancai Fengsui Dan, Zishen Wan. General for severe Sanjiao heat: Sanhuang Wan, Huanglian Jiedu Tang. Sudden heat = disease in Heart/Lung. Accumulated heat = disease in Kidney/Liver. Sudden heat → Ju Fang Xionghuang Jiedu Wan. Accumulated heat → Ju Fang Miaoxiang Wan. Sudden upper panting = High Panting, disease in Heart/Lung → Muxiang Jinlingzi San. Upper jiao heat with vexation → Niuhuang San. Chronic emaciation, fever, night sweats = Five Zang total damage, Heat Labor/Bone-steaming disease. Emaciation, deficiency, vexing panting, bloody diarrhea = Steaming Labor. Treatment: Nourish blood, benefit yin, heat retreats naturally ("treating by not treating"). Qian's Dihuang Wan. Huanglian Jiedu Tang treats severe heat/vexation, delirium, insomnia. Add Fangfeng/Lianqiao → Jinhua Wan (Wind-Heat). Add Chaihu → Pediatric tidal fever. Combined half-half with Siwu Tang → Female tidal fever. Yin covering Yang, fire cannot extend → Sweating indicated. Classic: "Body like burning charcoal, sweat disperses it." Wiry-rapid pulse = Yin qi. Use wind drugs to raise Yang and vent fire stagnation, rapidly reducing rapid pulse. For rapid pulse in this disease, use Huangbai, add small amounts of Huanglian, Chaihu, Cangzhu, Huangqi, Gancao, plus Shengma. Sweating causes pulse to drop, meaning "venting fire stagnation." Men/women limb heat, muscle heat, tendon bi heat, marrow heat, like fire burning, touching feels hot. Limbs governed by Spleen (Earth). Heat hidden in earth, often due to blood deficiency. Also due to Stomach deficiency, excessive cold food/water, stifling Yang qi in Spleen Earth. Classic: "Vent fire stagnation" → Chaihu Shengyang Tang. Five-center heat = fire stagnating in earth. Limbs = Earth. Heart fire sinks into Spleen Earth → Raise/Vent fire stagnation → Huoyu Tang. Palm/sole heat → Zhizi, Xiangfu, Cangzhu, Baizhi, Banxia, Chuanxiong powder, Shenqu paste pill. Extreme hand heat = Bone Jue, like in fire, mo Yongquan point 3 moxibustions cures instantly. *Suwen* Emperor: Why limbs hot, feeling like roasting/fire when encountering wind/cold? Qibo: Yin qi deficient, Yang qi abundant. Limbs are Yang. Two Yangs combine, Yin deficient. Little water cannot extinguish great fire, Yang rules alone. Alone ruling cannot grow, only wins temporarily. Encountering wind like roasting = flesh wasting. Zhongjing's Sanwu Huangqin Tang treats female limb vexing heat. Post-smallpox residual heat, scabs not healing, constipation = Blood Dryness. Treat with yin drugs, tonify, use Qingliang Yinzi to unblock stool and drain heat. Jiuguo: Cool wind arrives, plants fruit. Qingliang Yinzi is autumn wind clearing heat agent. Taiyang exterior pathogen enters interior, afternoon tidal fever, great thirst, delirium/manic agitation, constipation = Stomach Excess, can be purged. Stomach qi injured by heat, Chengqi Tang drains upper excess, allowing primordial qi to circulate freely, hence name "Chengqi" (Supporting Qi). People today use bitter to drain fire, so I state this clearly. Removing heat/draining fire requires Sweet-Cold, not Bitter-Cold. Bitter-cold draining fire is useless and harmful. Great heat, surging-large pulse, bitter-cold fails to reduce heat → Add Shigao (Gypsum). Symptoms subside but pulse remains rapid/surging/worsening → Reduce bitter-cold, add Shigao. Soft stool/diarrhea → Add Jiegeng, take after meals. Misuse harms significantly; add gradually. Low appetite → Do not use Shigao. Shigao removes rapid pulse. If symptoms subside but pulse remains rapid, untreatable. Muscle heat/dry heat, red eyes/face, vexing thirst, day/night ceaseless, floating-large-deficient pulse, empty on heavy pressure = Blood Deficiency Fever. Resembles Baihu Tang pattern, distinguished by pulse not long/excess. Mistaken Baihu Tang use is dangerous. Use Danggui 2 qian, Huangqi 1 liang, decoct. Kidney deficiency, fire not returning to channel, wandering exterior causing fever, vexing thirst, red face/tongue, tongue prickles, black cracked lips, throat like smoke/fire rising, sole heat like branding, phlegm-saliva congestion, panting, surging-rapid chaotic pulse, weak on pressure → Shiquan Dabu Tang, swallow Bawei Wan. Question: Such dry-heat, adding Gui/Fu, isn't it adding fire to fire? Answer: Pericardium Ministerial Fire attaches to Mingmen (Right Chi). Men store essence, women connect to uterus. Depletion by desires leaves fire without attachment, rebelling upward. Gui/Fu share nature with fire, pungent flavor opens pores, promotes fluids/qi channels, occupies nest to attract fire. Same nature attracts, fire descends. Fire from Kidney is Fire in Water. Fire can be broken by water, but Fire in Water cannot. Bashu has Fire Wells: water makes them burn, fire makes them extinguish. Thus Gui/Fu are correct medicines for Ministerial Fire. Yang Renzhai: Severe heat/vexation → Chaihu, Huangqin, Dahuang to resolve. Heat slightly lighter but persists → Huangqin, Chuanxiong, Gancao, Wu Mei decoction, or Huanglian, Shengdihuang, Chifuling decoct, add Dengxin (Juncus) before finishing. Effect fast. Chuanxiong/Shengdihuang regulate blood. Once Heart blood regulated, heat retreats. Pulsing choppy →必有 rinsing water symptom, vomiting/phlegm, cold feet symptoms.