潮热有作有止，若潮水之来，不失其时，一日一发。若日三五发，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，所谓实而潮热者
也。轻宜参苏饮，重则小柴胡汤。若气消乏，精神憔悴，饮食减少，日渐 羸，虽
病暂去而五心常有余热，此属虚证。宜茯苓补心汤、十全大补汤、养荣汤之类。
病后欠调理者，八珍散主之。有潮热似虚，胸膈痞塞，背心疼痛，服补药不效者，
此乃饮证随气而潮，故热随饮而亦潮，宜于痰饮门求之。外有每遇夜身发微热，病
人不觉，早起动作无事，饮食如常，既无别证可疑，只是血虚阴不济阳，宜润补之。
茯苓补心汤。候热稍减，继以养荣汤、十全大补汤。脉滑，肠有宿食，常暮发热，明
日复止者，于伤饮食门求之。湿痿夜热，以黄芩、黄柏、黄连、白芍药为末粥丸。
潮热者，黄芩、生甘草。辰戌时发加羌活。午间发黄连。未时发石膏。申时发柴胡。
酉时发升麻。夜间发当归梢。有寒者，加黄 、参、术。分昼夜例见前发热门。
经曰∶恶寒战栗，皆属于热。又曰∶战栗如丧神守，皆属于火。恶寒者，虽当
炎月，若遇风霜，重绵在身，如觉凛凛战栗，如丧神守，恶寒之甚也。《原病式》
曰∶病热证而反觉自冷，此为病热，实非寒也。或曰往往见有服热药而愈者何也？
曰∶病热之人，其气炎上，郁为痰饮，抑遏清道，阴气不升，病势尤甚。积痰得热，
亦为暂退，热势助邪，其病益深。或曰寒势如此，谁敢以寒凉药与之，非杀而何。
曰∶古人遇战栗之证，有以大承气汤下燥粪而愈者。恶寒战栗，明是热证，但有虚
实之分耳。昼则恶寒，是阴气上溢于阳分也。夜则恶寒，是阴血自旺于阴分也。有
卫气虚衰，不能实表，温分肉而恶寒者，丹溪用参、 之类，甚者加附子少许，以
行参 之气是也。有上焦之邪隔绝荣卫，不能升发出表而恶寒者，丹溪治一女子，
用苦参、赤小豆为末， 水吐后，用川芎、苍术、南星、黄芩、酒曲糊丸是也。有酒
热内郁，不得泄而恶寒者，丹溪治一人形瘦色黑，平生喜饮酒，年近半百，且有别
馆，一日大恶寒战，且自言渴，却不能饮，其脉大而弱，唯右关稍实，略类弦，重
取则涩，以黄 一物，与干葛同煎与之，尽黄 二两，干葛一两，脉得小，次日安。
六月大热之气，反得大寒之病，气难布息，身凉脉迟，何以治之？曰∶病有标本，
病热为本，大寒为标，用凉则顺时而失本，用热则顺本而失时，故不从标本，而从
乎中治。中治者何？用温是已。然既曰温，则不能治大寒之病。治大寒者，非姜附
不可，若用姜附，又似非温治之例。然衰其大半乃止，脉得四至，余病便无令治之
足矣。虽用姜附，是亦中治也，非温而何。经曰∶用热远热，虽用之不当，然胜至
可犯，亦其理也。丹溪治色目妇人，年近六十，六月内常觉恶寒战栗，喜炎火御绵，
多汗如雨，其形肥肌浓，已服附子十余帖，浑身痒甚，两手脉沉涩，重取稍大，知
其热甚而血虚也。以四物去川芎，倍地黄，加白术、黄 、炒黄柏、生甘草、人参，
每服一两重。方与一帖，腹大泄，目无视，口无言，知其病势深，而药无反佐之过
也。仍用前药，热炒与之。盖借火力为向导，一帖利止，四帖精神回，十帖全安。
又治蒋氏年三十余，形瘦面黑，六月喜热恶寒，两手脉沉而涩，重取似数。以三黄
丸下之，以姜汤每服三十粒，二十帖，微汗而安。妇人先病恶寒，手足冷，全不发
热，脉八至，两胁微痛，治者便作少阳治之。阳在内伏于骨髓，阴在外致使发寒，
治当不从内外，从乎中治也。宜以小柴胡调之，倍加姜枣。脾胃之虚，怠惰嗜卧，
四肢不收，时值秋燥令行，湿热少退，体重节痛，口舌干，食无味，大便不调，小
便频数，不嗜食，食不消，兼见肺病，洒淅恶寒，气惨惨不乐，面色恶而不和，乃
阳气不伸故也。升阳益胃汤主之。背恶寒是痰饮。仲景云∶心下有留饮，其人背恶
寒，冷如冰。治法，茯苓丸之类是也。身前寒属胃。经云∶胃足阳明之脉气虚，则身
以前皆寒栗。治法宜针，补三里穴是也。手足寒者，厥也。掌中寒者，腹中寒。鱼
上白肉有青血脉者，胃中有寒。理中之类治之。黄 补胃汤，治表虚恶贼风。上焦
不通，则阳气抑遏，而皮肤分肉无以温之，故寒栗。东垣升阳益胃汤，用升发之
剂开发上焦，以伸阳明出外温之也。丹溪吐出湿痰，亦开发上焦，使阳气随吐升发
出外温之也，故寒栗皆愈。
【振寒】谓寒而颤振也。经云∶阳明所谓洒洒振寒者，阳明者午也，五月盛阳之阴也，
阳盛而阴气加之，故洒洒振寒也。此当泻阳者也。又云∶寒气客于皮肤，阴气盛，
阳气虚，故为振寒寒栗。此当补阳者也。又云∶厥阴在泉，风淫所胜，病洒洒振寒，
治以辛凉。又云∶阳明司天之政，清热之气，持于气交，民病振寒。四之气，寒雨
降，病振栗。治视寒热轻重，多少其制。六脉中之下得弦细而涩，按之无力，腹中
时痛，心胃相控睾隐隐而痛，或大便溏泄，鼻不闻香臭，清浊涕不止，目中泪出，
喘喝痰嗽，唾出白沫，腰沉沉苦痛，项背胸胁时作痛，目中流火，口鼻恶寒，时时
头痛目眩，苦振寒不止，或嗽或吐，或呕或哕，则发躁蒸蒸而热，如坐甑中，必得
去衣居寒处，或饮寒水则便如故。其振寒复至，或气短促，胸中满闷而痛，如有膈
咽不通，欲绝之状。甚则口开目瞪，声闻于外，而泪涕痰涎大作，其发躁方过，而
振寒复至。或面白而不泽者，脱血也。悲愁不乐，情惨意悲，健忘，或善嚏，此风
热大损寒水，燥金之复也。如六脉细弦而涩，按之空虚，此大寒证也，亦伤精气，
以辛甘温热润之剂，大泻西北二方则愈。
【寒痹】帝曰∶人身非衣寒也，中非有寒气也，寒从中生者何？岐伯曰∶是人多痹气也，
阳气少阴气多，故身寒如从水中出。帝曰∶人有身寒，汤火不能热，浓衣不能温，
然不冻栗，是为何病？岐伯曰∶是人者，素肾气胜，以水为事，太阳气衰，肾脂枯
不长，一水不能胜两火。肾者水也，而生于骨，肾不生则髓不能满，故寒甚至骨也。所以
不能冻栗者，肝一阳也，心二阳也，肾孤脏也，一水不能胜二火，故不能冻栗，名
曰骨痹，是人当挛节也。治法当求之痹门。
【气分寒】桂枝加附子汤，桂枝加芍药、人参新加汤。
【血分寒】巴戟丸、神珠丸。
【三焦寒】上焦寒∶陈皮、浓朴、藿香、胡椒，理中丸、铁刷汤、桂附丸。
中焦寒，白术、干姜、丁香，大建中汤、二气丹、附子理中丸。
下焦寒，肉桂、附子、沉香，八味丸、还少丹、天真丹。海藏云∶下焦寒，四
逆例。干姜味苦，能止而不行，附子味卒，能行而不守，泄小便不通。二药皆阳，气
化能作小便。若姜、附、术三味，内加茯苓以分利之为佳。附生用而不炮，则无火
力，热则行而不止，兼以水多煎少，则热直入下焦。
【五脏寒】五脏寒方∶肝寒，双和汤。心寒，定志丸、菖蒲丸。脾寒，益黄散。肺寒，小
青龙汤。肾寒，八味丸。通治大寒，四逆汤、大已寒丸、沉香桂附丸。
王太仆云∶小寒之气，温以和之。大寒之气，热以取之。甚寒之气，则下夺之。
夺之不已，则逆折之。折之不尽，则求其属以衰之。东垣云∶治寒以热，凉而行之
有三，北方之人，为大寒所伤，其足胫胀，乃寒胜则浮，理之然也。若火灸汤浴，必
脱毛见骨，须先以新汲水浴之，则时见完复矣。更有大寒冻其面或耳，若近火汤，
必脱皮成疮，须先于凉房处浴之，少时以温手熨烙，必能完复。此凉而行之，除其
大寒之理一也。大寒之气，必令母实，乃地道左迁入肺，逆行于天，以凉药投之，使
天道右迁而顺天令，诸病得天令行而必愈二也。况大寒在外，其大热伏于地下者，
乃三焦包络天真之气所居之根蒂也。热伏于中，元气必伤，在人之身乃胃也，以凉
药和之，则元气充盛而不伤三也。
潮热表现为定时发作、定时停止，如同潮水涨落一样准时，通常一天发作一次。如果一天发作三到五次，那就是发热，而不是潮热。潮热有虚证和实证之分，只有伤寒病中在日晡时（下午3-5点）发热，属于胃腑实热，没有其他虚证的情况。其余出现潮热的情况，应当辨别其虚实：如果大便干结涩滞，喜欢冷饮、畏惧热邪，心下痞满不适，睡眠不安稳，这些都属于气机亢盛，也就是所谓的实证潮热。病情轻的适宜用参苏饮，重的则用小柴胡汤。如果气机消损乏力，精神憔悴，饮食减少，身体日渐消瘦，虽然疾病暂时缓解但五心（两手心、两足心及心胸）常有余热，这属于虚证。适宜使用茯苓补心汤、十全大补汤、养荣汤之类的方剂。病后缺乏调理的，以八珍散为主治。有的潮热看似虚证，但胸膈痞塞，背心疼痛，服用补药无效，这是痰饮水湿随气机升降而引发的潮热，所以热势也随水饮而起伏，应当在痰饮门的论述中寻求治疗方法。此外，有的人每到夜晚身体微微发热，病人自己并不察觉，早起活动如常，饮食正常，既然没有其他可疑的症状，这只是血虚导致阴不能济助阳，适宜滋润补益。可用茯苓补心汤。待热势稍减后，继以养荣汤、十全大补汤。脉象滑利，肠中有宿食停滞，常在傍晚发热，第二天早晨又停止的，应当在伤饮食门的论述中寻求治疗方法。湿痿引起的夜间发热，用黄芩、黄柏、黄连、白芍药研末，煮粥为丸服用。治疗潮热，主药用黄芩、生甘草。如果在辰时或戌时发作，加羌活；午间发作加黄连；未时发作加石膏；申时发作加柴胡；酉时发作加升麻；夜间发作加当归梢。如果有恶寒症状，加黄芪、人参、白术。分昼夜发热的体例见前文“发热”门。
经典记载：“恶寒战栗，都归属于热证。”又说：“战栗如同丧失神志主宰，都归属于火邪。”恶寒的表现是，即使在炎热的月份，如果遇到风霜侵袭，穿着厚重的棉衣，仍然觉得凛冽寒冷、战栗不止，如同丧失神志主宰一般，这是非常严重的恶寒。《原病式》说：“患有热证却反而感觉自身寒冷，这是患的热病，实际上并不是寒证。”有人问：“为什么往往见到服用热性药物而痊愈的呢？”回答说：“患热病的人，其热气炎上，郁结成为痰饮，阻滞清窍，导致阴气不能上升，病势更加严重。积存的痰饮得到热气的帮助，也会暂时消退，但热势会助长邪气，使病情更加深入。”有人问：“寒势如此严重，谁敢用寒凉药物治疗他，这不是害死他吗？”回答说：“古人遇到战栗的证候，有用大承气汤攻下燥屎而痊愈的案例。恶寒战栗，明明是热证，只是有虚实的区别罢了。”白天恶寒，是阴气上溢于阳分；夜间恶寒，是阴血在阴分旺盛。有卫气虚衰，不能充实肌表，温煦肌肉而导致恶寒的，丹溪先生用人参、黄芪之类，严重的加少许附子，以通行参、芪之气。有上焦邪气隔绝营卫，不能升发透出体表而导致恶寒的，丹溪先生治疗一名女子，用苦参、赤小豆研末，用水催吐后，再用川芎、苍术、南星、黄芩、酒曲糊成丸药服用。有酒热内郁，不得宣泄而导致恶寒的，丹溪先生治疗一个形体瘦弱、面色黑、平生喜欢饮酒、年近半百且有别馆的人，一天突然极度恶寒战栗，且自述口渴，却不能饮水，其脉象大而弱，只有右关脉稍实，略微带弦象，重按则涩，用黄芪一味药，与干葛同煎服用，服完二两黄芪、一两干葛后，脉象变得细小，第二天就安好了。六月大热的气候，反而得了大寒的病，气难呼吸，身凉脉迟，怎么治疗呢？回答说：“病有标本之分，病热是本，大寒是标，用凉药则顺应时令却违背了病本，用热药则顺应了病本却违背了时令，所以不遵从标本，而从乎中道治疗。什么叫中道治疗？就是用温法。既然是温法，就不能治愈大寒的病。治疗大寒的病，非姜、附不可，如果用姜、附，又似乎不符合温治的体例。然而，只要祛除大半病邪就停止，脉象恢复至每息四至，剩下的病就不再专门治疗也就足够了。虽然用了姜、附，这也是中道治疗，不是温法又是什么呢？经典说：‘用热药要避开热令’，虽然使用不当，但在邪气极盛时可以犯禁，也是其中的道理。”丹溪先生治疗一位眼疾妇女，年近六十，六月里常觉得恶寒战栗，喜欢烧火取暖穿棉衣，多汗如雨，她形体肥胖肌肉丰厚，已经服用了十余帖附子，浑身瘙痒严重，两手脉象沉涩，重按稍大，知道她热甚而血虚。用四物汤去掉川芎，加倍地黄，加白术、黄芪、炒黄柏、生甘草、人参，每服一两重。刚给了一帖药，腹中大泻，目不能视，口不能言，知道她病势深重，且药没有反佐之过。仍用前面的药，炒热后给她服用。借助火力作为向导，一帖腹泻停止，四帖精神恢复，十帖全愈。又治疗蒋氏，三十多岁，形体瘦弱面色黑，六月喜欢热怕冷，两手脉象沉而涩，重按似数。用三黄丸攻下，每次用姜汤送服三十粒，二十帖后，微汗出而安。妇人先患恶寒，手足冷，完全不发热的，脉象八至，两胁微痛，医者便当作少阳病治疗。阳气在内伏于骨髓，阴气在外致使发寒，治疗应当不从内外，而从乎中道治疗。适宜用小柴胡汤调和，加倍生姜、大枣。脾胃虚弱，倦怠嗜卧，四肢无力不收，正值秋燥令行，湿热稍退，体重关节疼痛，口舌干燥，进食无味，大便不调，小便频数，不想吃东西，食物不消化，兼见肺病，洒淅恶寒，心情凄惨不乐，面色不和，这是阳气不能伸展的缘故。宜用升阳益胃汤主治。背部恶寒是痰饮所致。仲景说：“心下有留饮，其人背部恶寒，冷如冰。”治法，用茯苓丸之类。身前寒冷属胃。经典说：“足阳明胃经气虚，则身前皆寒栗。”治法适宜针灸，补三里穴。手足寒冷，是厥证。手掌心寒冷，是腹中寒。手鱼际上白肉处有青血脉的，是胃中有寒。用理中汤之类治疗。黄芪补胃汤，治疗表虚恶贼风。上焦不通，则阳气被抑遏，皮肤分肉无法温煦，所以寒栗。东垣先生的升阳益胃汤，用升发之剂开发上焦，以伸展阳明经气外出温煦。丹溪先生吐出湿痰，也是开发上焦，使阳气随呕吐升发出外温煦，所以寒栗都痊愈了。
【振寒】指寒冷而颤抖。经典说：“阳明经所说的洒洒然振寒，阳明对应午时，五月是盛阳中的阴气，阳气盛而阴气加之，所以洒洒然振寒。”这应当泻阳。又说：“寒气客居皮肤，阴气盛，阳气虚，所以为振寒寒栗。”这应当补阳。又说：“厥阴在泉，风淫胜复，病洒洒然振寒，治以辛凉。”又说：“阳明司天之政，清热之气持于气交，民众病振寒。四之气，寒雨降，病振栗。”治疗视寒热轻重，调整剂量。六脉中下部得弦细而涩，按之无力，腹中时常疼痛，心胃相互牵引至睾丸隐隐作痛，或大便溏泄，鼻不闻香臭，清浊涕不止，眼中流泪，喘喝痰嗽，吐出白沫，腰部沉重痛苦，项背胸胁时常作痛，眼中如火，口鼻恶寒，时时头痛目眩，苦于振寒不止，或咳或吐，或呕或哕，则发躁蒸蒸而热，如坐蒸笼中，必须脱衣居住在寒冷处，或饮冷水才舒服。振寒再次发作，或气短促，胸中满闷而痛，如有膈咽不通，欲绝的状态。严重时张口瞪眼，声音传于外，泪涕痰涎大作，发躁刚过，振寒又至。或者面色白而无光泽的，是脱血。悲伤愁苦不乐，神情凄惨意悲，健忘，或善嚏，这是风热大损寒水，燥金复气的表现。如果六脉细弦而涩，按之空虚，这是大寒证，也伤精气，用辛甘温热润之剂，大泻西北二方之气则愈。
【寒痹】黄帝问：“人身并非因为穿衣少而寒，体内也没有寒气侵入，为什么寒气从内生呢？”岐伯说：“这个人多有痹气，阳气少阴气多，所以身体寒冷如同从水中出来。”黄帝问：“有人身体寒冷，汤火不能使其温暖，厚衣不能使其暖和，但不冻得战栗，这是什么病？”岐伯说：“这种人素来肾气胜，从事水性工作，太阳气衰，肾脂枯不长，一水不能胜两火。肾属水，主骨，肾不生则髓不能满，所以寒甚至骨。之所以不能冻得战栗，是因为肝为一阳，心为二阳，肾为孤脏，一水不能胜二火，所以不能冻得战栗，名叫骨痹，这种人应当关节拘挛。”治法应当在痹门中求取。
【三焦寒】上焦寒：陈皮、浓朴、藿香、胡椒，理中丸、铁刷汤、桂附丸。中焦寒：白术、干姜、丁香，大建中汤、二气丹、附子理中丸。下焦寒：肉桂、附子、沉香，八味丸、还少丹、天真丹。海藏先生说：“下焦寒，参照四逆汤例。”干姜味苦，能止而不行，附子味辛（注：原文‘卒’通‘辛’），能行而不守，用于泄小便不通。二药皆属阳，气化能产生小便。若姜、附、术三味，内加茯苓以分利之为佳。附子生用而不炮制，则无火力，热则行而不止，兼以水多煎少，则热直入下焦。
【五脏寒】五脏寒方：肝寒，双和汤。心寒，定志丸、菖蒲丸。脾寒，益黄散。肺寒，小青龙汤。肾寒，八味丸。通治大寒，四逆汤、大已寒丸、沉香桂附丸。王太仆说：“小寒之气，用温和之法治之。大寒之气，用热性药治之。甚寒之气，则用攻下法夺之。夺之不已，则用逆折之法。折之不尽，则求其所属以衰减之。”东垣先生说：“治寒以热，凉而行之有三种情况。北方之人，为大寒所伤，其足胫胀，乃寒胜则浮，理所当然。如果用火灸汤浴，必脱毛见骨，须先用新汲水沐浴，则可见完好恢复。更有大寒冻结其面或耳，若靠近火汤，必脱皮成疮，须先在凉房处沐浴，稍后用温手熨烙，必能完好恢复。这是凉而行之，除去大寒的道理之一。大寒之气，必令母实，乃地道左迁入肺，逆行于天，用凉药投之，使天道右迁而顺天令，诸病得天令行而必愈，这是其二。况且大寒在外，其大热伏于地下者，乃三焦包络天真之气所居之根蒂。热伏于中，元气必伤，在人之身乃胃也，用凉药和之，则元气充盛而不伤，这是其三。”
Tidal fever (Chao Re) manifests with regular onset and cessation, much like the tide, occurring without missing its time, typically once a day. If it occurs three to five times a day, it is classified as fever (Fa Re), not tidal fever. Tidal fever can be of deficiency (Xu) or excess (Shi) nature. Only in Shang Han (Cold Damage) disease, fever occurring at the Ding-Shi hour (9 PM - 1 AM, though text implies afternoon/waning yang context often associated with Yangming, here specified as 'Ri Bu' which usually means 3-5 PM, i.e., Shen hour) belongs to Stomach Excess (Wei Shi), with no other deficiency patterns involved. For other cases of tidal fever, one must examine for deficiency or excess: if there is dry and constipated stool, preference for cold drinks, aversion to heat, epigastric fullness and discomfort (Xin Xia Man Ran), and restless sleep, these all indicate Qi excess, known as excess-type tidal fever. For mild cases, Can Su Yin (Ginseng and Perilla Decoction) is suitable; for severe cases, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used. If there is Qi depletion and fatigue, mental exhaustion, reduced appetite, and gradual emaciation, although the acute illness may have temporarily subsided, the "five hearts" (palms, soles, and chest) remain hot, this belongs to deficiency syndrome. Suitable formulas include Fu Ling Bu Xin Tang (Poria Decoction to Tonify the Heart), Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), or Yang Rong Tang (Nourishing the Blood Decoction). For post-illness lack of regulation, Ba Zhen San (Eight Treasure Powder) is the main treatment. In cases where tidal fever appears like deficiency but presents with chest and diaphragm stuffiness, back pain, and no response to tonifying medicines, this is due to fluid retention (Yin Zheng) moving with Qi, causing heat to fluctuate with the fluids; thus, one should seek treatment methods in the Phlegm-Fluids section. Additionally, some patients experience slight fever at night, which they do not perceive; upon waking and moving, they are fine, eating normally, with no other suspicious symptoms. This is merely blood deficiency failing to nourish Yang, requiring moistening and tonification. Use Fu Ling Bu Xin Tang. After the heat subsides slightly, continue with Yang Rong Tang or Shi Quan Da Bu Tang. A slippery pulse indicates retained food in the intestines; if there is evening fever that stops by morning, seek treatment in the Food Retention section. For night fever due to Damp Atrophy, use Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), and Bai Shao Yao (Paeoniae Radix Alba) powdered and made into pills with porridge. For tidal fever, Huang Qin (Scutellariae Radix) and Sheng Gan Cao (Raw Glycyrrhizae Radix) are primary. Add Qiang Huo (Notopterygii Rhizoma et Radix) if it occurs at Chen or Xu hours; add Huang Lian (Coptidis Rhizoma) at Wu hour; add Shi Gao (Gypsum Fibrosum) at Wei hour; add Chai Hu (Bupleuri Radix) at Shen hour; add Sheng Ma (Cimicifugae Rhizoma) at You hour; add Dang Gui Shao (Radix Angelicae Sinensis Cauda) at night. If accompanied by aversion to cold, add Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma). The differentiation of day/night fever is detailed in the Fever section.
The Classics state: "Aversion to cold and shivering all belong to Heat." It also states: "Shivering as if losing spiritual control all belongs to Fire." Aversion to cold manifests as, even in hot months, upon encountering wind and frost, wearing heavy cotton clothes, one still feels biting cold and shivers uncontrollably, as if losing spiritual control, indicating severe aversion to cold. *Yuan Bing Shi* says: "Having a heat syndrome but feeling cold internally indicates heat disease, not actual cold." One might ask: "Why do many cases recover after taking hot-natured medicines?" The answer is: "In heat diseases, Qi flares upward, condensing into phlegm-fluids, obstructing the clear pathways, preventing Yin Qi from ascending, worsening the condition. Accumulated phlegm, aided by heat, may temporarily recede, but heat exacerbates the pathogen, deepening the illness." Another asks: "If cold is so severe, who dares to use cold-natured medicines? Would that not kill them?" The reply is: "Ancients treated shivering syndromes by purging dry feces with Da Cheng Qi Tang (Major Order the Qi Decoction) and achieving cure. Aversion to cold and shivering are clearly heat syndromes, differing only in deficiency or excess." Daytime aversion to cold indicates Yin Qi overflowing into the Yang aspect; nighttime aversion to cold indicates Yin Blood flourishing in the Yin aspect. If Wei Qi (Defensive Qi) is deficient and weak, unable to secure the exterior and warm the muscles, leading to aversion to cold, Danxi used Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix); in severe cases, a small amount of Fu Zi (Aconiti Lateralis Radix Praeparata) was added to promote the movement of Ren Shen and Huang Qi. If pathogens in the Upper Jiao block Ying and Wei, preventing their emergence to the exterior, causing aversion to cold, Danxi treated a young woman by using Ku Shen (Sophorae Flavescentis Radix) and Chi Xiao Dou (Vigna Semen Rubrum) powdered, inducing vomiting with water, then administering Wan Xiong (Ligustici Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Nan Xing (Arisaematis Rhizoma), Huang Qin (Scutellariae Radix), and Jiu Qu (Medicated Leaven) as honeyed pills. If internal stagnation of wine-heat causes aversion to cold, Danxi treated a thin, dark-complexioned man near fifty who loved drinking. He suddenly experienced severe aversion to cold and shivering, complained of thirst but could not drink. His pulse was large and weak, with the Right Guan position slightly solid and string-like, rough upon heavy pressure. He prescribed Huang Qi (Astragali Radix) alone, decocted with Ge Gen (Puerariae Lobatae Radix). After consuming two taels of Huang Qi and one tael of Ge Gen, the pulse became smaller, and he recovered the next day. In the intense heat of June, he contracted severe cold, with difficulty breathing, cool body, and slow pulse. How to treat? Disease has root (Ben) and branch (Biao). Heat is the root; severe cold is the branch. Using cold medicines follows the season but ignores the root; using hot medicines follows the root but ignores the season. Therefore, one does not follow root or branch, but treats via the "Middle Method." What is the Middle Method? It is using Warmth. However, if called "Warm," it cannot treat severe cold. Treating severe cold requires Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata). Using them seems contrary to the "Warm" method. Yet, stopping when the pathogen is largely reduced, and the pulse returns to four beats per breath, suffices. Using Jiang and Fu Zi is also the Middle Method, effectively Warmth. The Classic says: "Avoid hot medicines during hot seasons." Although generally inappropriate, when pathogenic force is extreme, violation is permissible. Danxi treated a sixty-year-old woman with eye issues who felt severe aversion to cold and shivering in June, preferring fire and cotton, sweating profusely. She was obese with thick flesh, had taken over ten doses of Fu Zi, suffered severe itching, and had deep, choppy pulses that became larger upon heavy pressure. Recognizing severe heat and blood deficiency, he used Si Wu Tang (Four Substances Decoction) removing Chuan Xiong, doubling Di Huang (Rehmanniae Radix), adding Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qi (Astragali Radix), fried Huang Bo (Phellodendri Cortex), Sheng Gan Cao (Raw Glycyrrhizae Radix), and Ren Shen (Ginseng Radix), each dose weighing one tael. After one dose, she had severe diarrhea, blindness, and muteness. Recognizing deep pathology and lack of counter-agent in the prescription, he repeated the formula but served it hot, using heat as a guide. After one dose, diarrhea stopped; after four doses, spirit returned; after ten doses, full recovery. He also treated a thirty-something man, thin and dark, who preferred heat and feared cold in June. Pulses were deep and choppy, rapid upon heavy pressure. He purged him with San Huang Wan (Three Yellows Pill), administered with Ginger Decoction, thirty pills per dose. After twenty doses, mild sweating led to recovery. A woman initially had aversion to cold, cold limbs, no fever, pulse eight beats, slight hypochondriac pain. The physician treated it as Shaoyang disease. With Yang trapped in the marrow and Yin on the exterior causing cold, treatment should not focus on interior/exterior but on the Middle Method. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with increased Ginger and Jujube. Spleen/Stomach deficiency leads to lethargy, desire to lie down, and limp limbs. During autumn dryness, as damp-heat recedes, heaviness and joint pain occur, mouth/throat dryness, tastelessness, irregular bowels, frequent urination, anorexia, indigestion, combined with Lung symptoms, chilliness, depression, and sallow complexion. This is due to Yang Qi failing to extend. Use Sheng Yang Yi Wei Tang (Raise Yang and Benefit Stomach Decoction). Back aversion to cold is due to phlegm-fluids. Zhongjing stated: "Retained fluids in the heart region cause back aversion to cold, cold as ice." Treat with Fu Ling Wan (Poria Pill). Anterior body cold belongs to the Stomach. The Classic states: "Deficiency of Foot-Yangming Stomach channel Qi causes cold and shivering of the anterior body." Treat with acupuncture, tonifying Zu San Li (ST36). Cold hands and feet indicate Jue (Cold Extremities). Cold palms indicate abdominal cold. Blue veins on the hypothenar eminence indicate Stomach cold. Treat with Li Zhong Tang (Regulate the Middle Decoction). Huang Qi Bu Wei Tang (Astragalus Decoction to Tonify the Stomach) treats exterior deficiency with aversion to thieving wind. Upper Jiao obstruction inhibits Yang Qi, preventing warming of skin and muscles, causing shivering. Dongyuan's Sheng Yang Yi Wei Tang uses ascending agents to open the Upper Jiao, extending Yangming Qi outward to warm. Danxi’s induction of vomiting for damp-phlegm also opens the Upper Jiao, allowing Yang Qi to rise and warm, curing shivering.
[Zhèn Hán] Refers to cold with trembling. The Classic states: "Yangming refers to 'shivering cold.' Yangming corresponds to Noon, May is Yin within abundant Yang. Abundant Yang plus Yin causes shivering cold." This requires draining Yang. It also states: "Cold qi lodging in the skin, with excess Yin and deficient Yang, causes shivering cold." This requires tonifying Yang. It further states: "Jueyin in the lower position, wind dominance causes shivering cold; treat with pungent-cool." And: "Yangming governing heaven, cooling qi holds at the qi intersection, people suffer shivering cold. Fourth Qi, cold rain falls, suffering shivering chills." Treatment depends on severity. Lower part of six pulses shows string-taut, fine, and choppy, powerless upon pressure, intermittent abdominal pain, heart/stomach pain radiating to testicles, loose stools, anosmia, runny nose, tearing, wheezing cough with white foam, heavy sore waist, pain in neck/back/chest/flanks, burning eyes, aversion to cold in mouth/nose, headache/dizziness, persistent shivering, cough/vomit/hiccups, followed by restlessness and steaming heat, sitting in a steamer, needing to undress and sit in cold places or drink cold water for relief. Recurring shivering, shortness of breath, chest fullness/pain, sensation of blocked throat, nearly dying. Severe cases: mouth open, eyes staring, loud voice, profuse tears/snot/phlegm. Restlessness passes, shivering returns. Pale face indicates blood loss. Sadness/depression, forgetfulness, sneezing indicates wind-heat damaging Kidney Water and Dryness Metal rebound. Fine, string-taut, choppy pulses, empty upon pressure, indicate severe cold damaging essence/qi. Treat with pungent-sweet-warm-moistening agents, draining Northwest energies to cure.
[Hán Bì] Emperor asked: "Body is not cold from clothing, nor is there external cold invasion, why does cold arise internally?" Qibo answered: "This person has much Bi Qi (Obstruction Qi), little Yang Qi, much Yin Qi, hence body cold as if emerging from water." Emperor asked: "Someone is cold, soup/fire cannot warm, thick clothes cannot heat, yet does not shiver, what disease is this?" Qibo answered: "This person has strong Kidney Qi, engages in water-related work, Taiyang Qi declines, Kidney marrow dries up. One Water cannot overcome Two Fires. Kidney is Water, generates bone. If Kidney fails, marrow is insufficient, hence cold reaches bone. Why no shivering? Liver is one Yang, Heart is two Yangs, Kidney is solitary organ. One Water cannot overcome Two Fires, hence no shivering. Named Bone Bi, prone to joint contraction." Treat according to Bi section.
[Qi Fen Han] Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Prepared Aconite Root), Guizhi Jia Shaoyao Renshen Xinjia Tang (Cinnamon Twig Decoction plus Peony and New Ginseng Formula).
[Xue Fen Han] Bajie Wan (Morinda Pill), Shenzhu Wan (Divine Pearl Pill).
[San Jiao Han] Upper Jiao Cold: Chen Pi (Citri Reticulatae Pericarpium), Hou Po (Magnoliae Officinalis Cortex), Huo Xiang (Agastaches Herba), Hu Jiao (Piperis Longi Fructus), Lizhong Wan (Regulate the Middle Pill), Tie Shua Tang (Iron Brush Decoction), Gui Fu Wan (Cinnamon and Aconite Pill). Middle Jiao Cold: Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Jiang (Zingiberis Rhizoma), Ding Xiang (Eugeniae Flos), Da Jian Zhong Tang (Great Establish the Middle Decoction), Er Qi Dan (Two Qi Elixir), Fuzi Lizhong Wan (Aconite Regulate the Middle Pill). Lower Jiao Cold: Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Praeparata), Chen Xiang (Aquilariae Lignum Resinatum), Bawei Wan (Eight Ingredients Pill), Huan Shao Dan (Return to Youth Elixir), Tianzhen Dan (Heavenly Innocence Elixir). Haizang said: "Lower Jiao cold follows Si Ni Tang (Frigid Extremities Decoction) pattern." Gan Jiang (Zingiberis Rhizoma) is bitter, stops but does not move; Fu Zi (Aconiti Lateralis Radix Praeparata) is acrid, moves but does not retain, used for urinary obstruction. Both are Yang, promoting Qi transformation to produce urine. Adding Fu Ling (Poria) to Jiang, Fu, and Zhu aids separation and drainage. Raw Fu Zi lacks fire power; if heated, it moves uncontrollably. With more water and less decoction, heat enters Lower Jiao directly.
[Wu Zang Han] Formulas for Five Zang Cold: Liver Cold, Shuang He Tang (Double Harmony Decoction). Heart Cold, Ding Zhi Wan (Settle Spirit Pill), Chang Pu Wan (Acorus Pill). Spleen Cold, Yi Huang San (Benefit Yellow Powder). Lung Cold, Xiao Qing Long Tang (Minor Green Dragon Decoction). Kidney Cold, Bawei Wan (Eight Ingredients Pill). General treatment for severe cold, Si Ni Tang (Frigid Extremities Decoction), Da Yi Han Wan (Great Eliminate Cold Pill), Chen Xiang Gui Fu Wan (Aquilaria, Cinnamon, and Aconite Pill). Wang Taipu said: "Minor cold is harmonized with warmth. Major cold is taken with heat. Severe cold is drained downward. If draining fails, suppress it inversely. If suppression fails, seek its affiliation to weaken it." Dongyuan said: "Treating cold with heat, administered cool, has three reasons. Northerners injured by severe cold have swollen calves; cold excess causes floating, naturally so. Moxibustion/baths would cause hair loss/exposed bone; must bathe in fresh water first for recovery. Severe cold freezing face/ears requires bathing in cool rooms before warming to prevent skin peeling/sores. This is 'administering cool' to remove severe cold, reason one. Severe cold requires strengthening the Mother element. Earth moves left to Lung, reverses Heaven. Cool medicines make Heaven move right, following Heavenly commands, curing diseases, reason two. Severe cold outside hides great heat underground, root of San Jiao/Bao Luo true Qi. Heat hidden damages Yuan Qi (Stomach). Cool medicines harmonize, enriching Yuan Qi without damage, reason three."