温热为伏火症，本不当用温燥，然初起客寒包火，搏束过甚，致伏邪不能外达，不得不暂用温散法，如刘氏
苏羌饮、局方芎苏散之类；亦有湿遏热伏，抑郁太甚，致伏邪不能外出，不得不暂用辛燥法，如藿香正气散、
九味羌活汤之类；一经寒散热越，湿开热透，即当转用他法，以速清其伏邪，此在表兼寒兼湿之当用温燥法也。
更有初起夹水气症，在表时不宜纯用辛凉发散，若纯用辛凉，则表必不解而转见沉困；有里症不可遽用苦寒，
若早用苦寒，则里热内陷，必转加昏蒙；此水气郁遏伏邪，阳气受困，宜于发表清里药中加温燥之品以祛水气，如藿
香、浓朴、半夏、苍术、草果、豆蔻、广皮、赤苓等品，皆可对症酌用，迨水气去，郁遏开，然后议攻议凉，
则无不效者矣。又有夹冷食伤胃，往往有脉沉肢冷者，若胸膈痞满，舌苔白浓，益为食填膈上之明证，即当用温
化燥削，如加味平胃散（戴北山验方）、沉香百消曲（道藏方）、绛矾丸（张氏医通方）之类，甚则用吐法以
宣之，如椒盐汤、生萝卜汁等，使膈开而阳气宣达，然后伏邪外溃，或当解表，或当清里，自无误治矣。此在
里夹水夹食之当用温燥法也。此等兼症夹症，每用温燥药见功者，遂相讼清热泻火之非，归咎于冰伏凉遏之弊，
不知温热乃其本气，兼夹乃其间气也，岂可拘执兼症夹症之用温燥法见功，遂并其温热本症之当用清凉而一概抹
煞也耶。更有并无兼症夹症，而邪深入里，失于攻下，而热深厥深，反欲拥被向火，凛凛恶寒，身冷肢厥，而
二三处独见火症，如目大小 赤，舌苔黄黑燥，小便黄赤涩痛，大便稀黄极臭，或下利鲜血，此皆热深阳郁之象，
当以温燥通郁为主，佐以辛凉透热，如新定达原饮、加减藿朴夏苓汤之类，使里气通而郁阳发，反大热而烦渴，
即转机而用清用下，以收全功者甚多。至若本系温热伏邪，因其人平素阳虚，或年已衰老，医用发表攻里太过，
至汗出不止，呕利俱作，四肢微厥，脉微恶寒者，不得不暂用温燥扶阳，如胃苓汤合半硫丸之温运脾阳，术附
汤合半硫丸（皆吴氏温病条辨方）之温固命阳；但须知虽属阳虚，却从热症来而阴必亏，半硫桂附，亦不可过用，
当佐以护阴药为妙，如归 建中汤、参附养荣汤之类，皆可酌用。总之此症温补略缓及温补不到必死，或过用温补，
阳虽回而阴竭亦死，此处不可不斟酌至当也。又如湿温湿热方伏于膜原，未经传变之时，胸膈必多痰滞，有见其
烦躁而过用知膏芩连者，有因其作渴而遽用生地麦冬者，有病者自认火症而恣啖冷水西瓜梨荠太早者，皆能抑
郁阳气，壅闭伏
火；火遏于中下二焦，停痰滞于上焦，每见恶寒胸痞，甚则烦躁昏谵，宜先以宣导痰滞为主，如加味二陈汤、
藿朴二陈汤、吴氏导痰汤、三子导痰汤之类，痰滞通则伏火之症发现，随其传变以施凉解攻利之剂，乃有效也。
以上温补温化二法，非治温热正病，特救药误食误耳。总之温热诸症中，惟湿温一症，其病情半阴半阳，其病
原水火互结，其病状反复变迁，不可穷极，在上焦如伤寒，在下焦如内伤，在中焦或如外感，或如内伤，至其
变症则有湿痹、水气、咳嗽、痰饮、黄汗、黄胆、肿胀、疟疾、痢疾、淋症、带症、便血、疝气、痔疮、痈脓等
症，其间宜清凉芳烈者固多，宜温化燥渗者亦不少，方法已详温热即是伏火篇。若夫病后调理，凡属湿温湿热
当以扶阳为法，温健胃阳如香砂理中汤、六君子汤之类，温升脾阳如补中益气汤、参胡三白汤之类。然亦有病
后化燥，有当用甘凉濡润者，或有用酸甘化阴者，全在临症者活法机变也。谨述宜温燥诸症，条列于下∶
温热兼寒，新凉外束之候∶头痛身热，恶寒无汗，甚或肩背腰痛，或膝胫痛，口虽不渴，间有烦躁口苦，
便溏不爽，小便黄热，舌苔滑白，或两边白中淡黄。
温热兼湿，湿遏热伏之候∶凛凛恶寒，甚或足冷，头目胀痛昏重，如裹如蒙，身痛不能屈伸，身重不能转
侧，肢节肌肉疼而且烦，腿足痛而且酸，沉困嗜睡，胸膈痞满，渴不引饮，或竟不渴，午后先寒后热，状若湿
疟；舌苔白腻，或白滑而浓，或白苔带灰兼粘腻浮滑，或白带黑点而粘腻，或兼黑纹而粘腻，甚或舌苔满布，
浓如积粉，板贴不松。
温热夹水，停积胸脘之候∶胸脘满痛，按之则软，略加揉按，漉漉有声，甚则肠下抽痛，干呕短气，或腰
重足肿，下利溺少，甚或沉困昏愦；舌苔滑白，间有转黄转黑而胖滑，或满舌黄黑，半边夹一二条白色，或舌
尖舌本俱黄，中间夹一段白色。
温热夹冷食，填塞膈脘之候∶恶食吞酸，嗳气胀满，欲吐不吐，呕逆痞闷，甚或脉沉肢冷，舌苔白浓，微
间淡黄。
温热夹虚，凉泻太过之候∶气少息促，声颤无力，语不接续，喜向里睡，汗出恶寒，呕利俱作，四肢微厥，
甚或两足冷甚，舌色淡红圆浓，或淡晦少神，或舌青胖嫩。
温热夹痰，冷遏太过之候∶头目昏眩，胸膈痞闷，按之不痛，口吐涎沫。懊 烦躁，甚或神昏如迷，舌苔
白滑黄滑不等。
温热病属于伏火证，本来不应当使用温燥药物。然而，在疾病初起时，若因客寒包裹火热，束缚过甚，导致伏邪不能向外透达，就不得不暂时采用温散法，例如刘氏的苏羌饮、局方的芎苏散等方剂；也有因湿邪遏制热邪潜伏，郁结太甚，致使伏邪无法外出的情况，也需暂时采用辛燥法，如藿香正气散、九味羌活汤等方剂；一旦寒邪消散、热邪外越，或湿邪开通、热邪透发，就应立即转换治法，以迅速清除体内的伏邪，这是在表证兼有寒邪和湿邪时应当使用温燥法的情况。
更有初起夹杂水气证的，在表证阶段不宜单纯使用辛凉发散药，如果纯用辛凉，则表证必然不解，反而出现沉重困倦的症状；若有里证，不可急于使用苦寒药，如果过早使用苦寒药，则里热会内陷，必然转为神志昏蒙；这是水气郁遏伏邪，阳气受困的表现，应当在发表清里的药物中加入温燥之品以祛除水气，如藿香、厚朴、半夏、苍术、草果、豆蔻、广陈皮、赤茯苓等药材，均可根据症状酌情选用，待水气去除，郁遏解开后，再议攻下或清热之法，这样没有不奏效的。
又有夹杂冷食伤胃的，往往出现脉沉、四肢冰冷的症状，如果胸膈痞满，舌苔白厚腻，更是食物填塞膈上的明显证据，就应当使用温化燥消的方法，如加味平胃散（戴北山验方）、沉香百消曲（道藏方）、绛矾丸（张氏医通方）等方剂，严重时甚至使用吐法来宣通上焦，如椒盐汤、生萝卜汁等，使膈部开通而阳气宣达，然后伏邪向外溃散，此时再根据情况解表或清里，自然不会误治。这是在里证夹杂水气和食积时应当使用温燥法的情况。
这类兼症夹症，每用温燥药见效，于是人们便争论清热泻火法的错误，归咎于冰伏凉遏的弊端，却不知道温热才是其本气，兼夹只是其间气，岂可拘泥于兼症夹症使用温燥法见效，就将温热本症应当使用清凉法的情况一概抹杀呢？
更有并无兼症夹症，但邪气深入里部，失于攻下，导致热深厥深，反而想要拥被向火，凛凛恶寒，身体冰冷，四肢厥逆，而在二三处却出现火症表现，如眼睛红赤，舌苔黄黑干燥，小便黄赤涩痛，大便稀黄极臭，或下利鲜血，这都是热深阳郁的现象，应当以温燥通郁为主，佐以辛凉透热，如新定达原饮、加减藿朴夏苓汤等方剂，使里气通畅而郁阳发散，反而出现大热烦渴，这时转机使用清热或攻下法，以收全功的情况很多。
至于原本就是温热伏邪，因为患者平素阳虚，或年事已高，医生使用发表攻里药太过，导致汗出不止，呕吐腹泻并作，四肢微厥，脉微恶寒的，不得不暂时使用温燥扶阳法，如胃苓汤合半硫丸以温运脾阳，术附汤合半硫丸（均为吴氏《温病条辨》方）以温固命门之阳；但必须知道虽然属于阳虚，却是从热症而来，阴液必然亏损，半硫丸及桂枝、附子也不可以过量使用，应当佐以护阴药物为妙，如当归建中汤、参附养荣汤等方剂，均可酌情选用。总之，此症温补略缓及温补不到必死，或者过用温补，阳气虽回但阴竭亦死，此处不可不斟酌得当。
又如湿温湿热之邪伏于膜原，未经传变之时，胸膈多有痰滞，有的见其烦躁而过用知母、石膏、黄芩、黄连者，有的因其口渴而遽用生地、麦冬者，有的病人自认火症而恣意饮用冷水、西瓜、梨、荠菜太早者，都能抑制郁遏阳气，壅闭伏火；火邪郁遏于中下二焦，停痰阻滞于上焦，常见恶寒胸痞，甚则烦躁昏谵，宜先用宣导痰滞为主，如加味二陈汤、藿朴二陈汤、吴氏导痰汤、三子导痰汤等方剂，痰滞通则伏火之症显现，随其传变施以凉解攻利之剂，才有效。
以上温补、温化二法，并非治疗温热正病，特救药误、食误而已。总之在温热诸症中，只有湿温一症，其病情半阴半阳，其病原水火互结，其病状反复变迁，不可穷尽，在上焦如伤寒，在下焦如内伤，在中焦或如外感，或如内伤，至其变症则有湿痹、水气、咳嗽、痰饮、黄汗、黄疸、肿胀、疟疾、痢疾、淋症、带症、便血、疝气、痔疮、痈脓等症，其间宜用清凉芳烈者固然多，宜用温化燥渗者也不少，方法已在《温热即是伏火篇》中详述。若夫病后调理，凡属湿温湿热，当以扶阳为法，温健胃阳如香砂理中汤、六君子汤等方剂，温升脾阳如补中益气汤、参胡三白汤等方剂。然而也有病后化燥，应当使用甘凉濡润者，或有使用酸甘化阴者，全在于临症医生的灵活机变。谨述适宜温燥的各症，条列如下：
温热兼寒，新凉外束之候：头痛身热，恶寒无汗，甚或肩背腰痛，或膝胫痛，口虽不渴，间有烦躁口苦，便溏不爽，小便黄热，舌苔滑白，或两边白中淡黄。
温热兼湿，湿遏热伏之候：凛凛恶寒，甚或足冷，头目胀痛昏重，如裹如蒙，身痛不能屈伸，身重不能转侧，肢节肌肉疼而且烦，腿足痛而且酸，沉困嗜睡，胸膈痞满，渴不引饮，或竟不渴，午后先寒后热，状若湿疟；舌苔白腻，或白滑而浓，或白苔带灰兼粘腻浮滑，或白带黑点而粘腻，或兼黑纹而粘腻，甚或舌苔满布，浓如积粉，板贴不松。
温热夹水，停积胸脘之候：胸脘满痛，按之则软，略加揉按，漉漉有声，甚则肠下抽痛，干呕短气，或腰重足肿，下利溺少，甚或沉困昏愦；舌苔滑白，间有转黄转黑而胖滑，或满舌黄黑，半边夹一二条白色，或舌尖舌本俱黄，中间夹一段白色。
温热夹冷食，填塞膈脘之候：恶食吞酸，嗳气胀满，欲吐不吐，呕逆痞闷，甚或脉沉肢冷，舌苔白浓，微间淡黄。
温热夹虚，凉泻太过之候：气少息促，声颤无力，语不接续，喜向里睡，汗出恶寒，呕利俱作，四肢微厥，甚或两足冷甚，舌色淡红圆浓，或淡晦少神，或舌青胖嫩。
Wenre (Warm Heat) disease belongs to the category of Fu Huo (Hidden Fire) syndrome, and theoretically, warm-drying methods should not be used. However, at the initial stage, if external cold wraps around internal fire, causing excessive binding that prevents the hidden pathogen from reaching the exterior, it is necessary to temporarily employ warm-dispersing methods, such as Liu's Su Qiang Yin (Perilla and Notopterygium Decoction) or Ju Fang Xiong Su San (Angelica and Perilla Powder); similarly, if dampness suppresses heat, causing severe depression that hinders the outward release of the hidden pathogen, it is necessary to temporarily use acrid-warming methods, such as Huo Xiang Zheng Qi San (Patchouli Regulating Qi Powder) or Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction). Once the cold dissipates and heat escapes, or dampness opens and heat penetrates, the treatment must shift to rapidly clear the hidden pathogen. This describes the indication for using warm-drying methods when the exterior is complicated by cold and dampness.
Furthermore, in cases where water qi (fluid retention) complicates the initial presentation, pure acrid-cool dispersants should not be used during the exterior phase; doing so will fail to resolve the exterior and may lead to heaviness and lethargy. If interior symptoms are present, bitter-cold herbs should not be used hastily; premature use of bitter-cold substances causes interior heat to sink inward, leading to mental confusion. This indicates that water qi is suppressing the hidden pathogen and confining Yang Qi. In such cases, warm-drying agents should be added to formulas that release the exterior and clear the interior to dispel water qi. Herbs such as Huo Xiang (Patchouli), Hou Po (Magnolia Bark), Ban Xia (Pinellia Rhizome), Cang Zhu (Atractylodes Rhizome), Cao Guo (Black Cardamom), Dou Kou (Tsaoko Fruit), Guang Pi (Tangerine Peel), and Chi Ling (Polyporus with Hostwood) can be selected according to the specific presentation. After the water qi is eliminated and the suppression is resolved, one may then consider purgative or cooling treatments, which will invariably prove effective.
In cases complicated by cold food injuring the Stomach, symptoms such as a deep pulse and cold limbs often appear. If accompanied by chest and epigastric fullness and obstruction, along with a thick white tongue coating, this clearly indicates food stagnation filling the diaphragm. Treatment should employ warm transformation and drying reduction, using formulas such as Jia Wei Ping Wei San (Modified Pingwei Powder, Dai Beishan's verified prescription), Chen Xiang Bai Xiao Qu (Agarwood Hundred-Reduction Pill, Daozang formula), or Jiang Fan Wan (Crimson Alum Pill, Zhang Shi Yi Tong formula). In severe cases, emetic methods may be used to ventilate the upper jiao, such as Pepper-Salt Soup or Raw Radish Juice, to open the diaphragm and allow Yang Qi to circulate freely. Subsequently, as the hidden pathogen erupts outward, one may choose to release the exterior or clear the interior, avoiding therapeutic errors. This describes the indication for using warm-drying methods when the interior is complicated by water and food stagnation.
Because these complicated syndromes respond well to warm-drying drugs, some argue against clearing heat and draining fire, attributing failures to the弊 (drawback) of ice-like freezing and cool suppression. They fail to realize that Wenre (Warm Heat) is the fundamental nature of the disease, while complications are secondary factors. One cannot rigidly adhere to the efficacy of warm-drying methods for complications and thereby deny the necessity of cooling methods for the fundamental Warm Heat syndrome.
Moreover, in cases without complications, if the pathogen has deeply penetrated the interior due to neglected purgation, resulting in "deep heat with deep cold extremities" (Re Shen Jue Shen), the patient may paradoxically desire to wrap themselves in blankets near fire, experiencing intense aversion to cold, cold body and limbs, yet showing signs of fire in two or three areas, such as red eyes, yellow-black dry tongue coating, yellow-red painful urination, foul-smelling loose yellow stools, or bloody diarrhea. These are signs of deep heat and constrained Yang Qi. The primary treatment should be warm-drying to unblock constraint, assisted by acrid-cool herbs to vent heat, using formulas like Xin Ding Da Yuan Yin (Newly Formulated Daren Yin) or Jia Jian Huo Po Xia Ling Tang (Modified Patchouli, Magnolia, Pinellia, and Polyporus Decoction). This allows interior Qi to flow and constrained Yang to emerge. If this results in high fever and thirst, indicating a turning point, switching to clearing or purging methods often achieves complete recovery.
Regarding patients with fundamental Warm Heat hidden pathogens who have constitutive Yang deficiency or are elderly, if physicians overuse exterior-releasing or interior-purging methods, leading to incessant sweating, vomiting and diarrhea, slight cold extremities, and a faint pulse with aversion to cold, it becomes necessary to temporarily use warm-drying methods to support Yang. For example, Wei Ling Tang combined with Ban Shu Wan (Half-and-Half Pill) warms and moves Spleen Yang; Shu Fu Tang combined with Ban Shu Wan warms and secures Mingmen (Gate of Life) Yang. However, since Yang deficiency here stems from a heat syndrome, Yin is inevitably deficient. Ban Shu Wan, Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Root) must not be overused. It is advisable to assist with Yin-nourishing herbs, such as Dang Gui Jian Zhong Tang (Angelica Build-the-Middle Decoction) or Shen Fu Yang Rong Tang (Ginseng and Aconite Nourishing Nutrient Decoction). In summary, if warming and tonifying are too slow or insufficient, death ensues; if overused, Yang may return but Yin exhaustion leads to death. Careful deliberation is essential.
Similarly, when Damp-Warmth or Damp-Heat pathogens lie dormant in the Membrane Source (Mo Yuan) before transmission, phlegm stagnation often accumulates in the chest and diaphragm. Overusing Zhi Mu (Anemarrhena), Shi Gao (Gypsum), Huang Qin (Scutellaria), and Huang Lian (Coptis) for irritability, or using Sheng Di Huang (Rehmannia Root) and Mai Dong (Ophiopogon Tuber) for thirst, or patients consuming cold water, watermelon, pear, and shepherd's purse too early due to self-diagnosis of fire syndrome, all suppress Yang Qi and obstruct hidden fire. Fire is constrained in the Middle and Lower Jiao, while phlegm stagnates in the Upper Jiao, manifesting as aversion to cold and chest fullness, potentially progressing to irritability, confusion, and delirium. The priority is to guide out phlegm stagnation using formulas like Jia Wei Er Chen Tang (Modified Two-Chen Decoction), Huo Po Er Chen Tang, Wu's Dao Tan Tang (Guiding Phlegm Decoction), or San Zi Dao Tan Tang. Once phlegm stagnation clears, the hidden fire symptoms become apparent, and treatment can proceed with cooling or purging based on transmission patterns.
The aforementioned warming-tonifying and warming-transforming methods are not for treating the primary Warm Heat disease but specifically to correct errors in medication or diet. Among all Warm Heat syndromes, only Damp-Warmth presents with half-Yin half-Yang characteristics, a pathology of water-fire interaction, and unpredictable, recurring manifestations. In the Upper Jiao, it resembles Shang Han (Cold Damage); in the Lower Jiao, it resembles Nei Shang (Internal Injury); in the Middle Jiao, it may resemble either Exogenous or Endogenous disorders. Complications include Damp Bi (Obstruction Syndrome), Water Qi, Cough, Phlegm-Fluids, Yellow Sweat, Jaundice, Swelling, Malaria, Dysentery, Lin Syndrome (Dysuria), Leukorrhea, Hematochezia, Hernia, Hemorrhoids, and Carbuncles. While many require cooling and aromatic-aggressive methods, many also require warming, drying, and leaching methods, as detailed in the chapter "Warm Heat is Essentially Hidden Fire." For post-illness recovery involving Damp-Warmth or Damp-Heat, the principle is to support Yang: warming and strengthening Stomach Yang with Xiang Sha Li Zhong Tang (Amomum and Amomum Regulating Middle Decoction) or Liu Jun Zi Tang (Six-Gentlemen Decoction); warming and ascending Spleen Yang with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) or Shen Hu San Bai Tang. However, if the post-illness state transforms into dryness, sweet-cool moistening or sour-sweet Yin-generating methods are appropriate. Clinical flexibility is key.
The following lists syndromes suitable for warm-drying methods:
1. Warm Heat complicated by Cold, bound by new coolness externally: Headache, fever, aversion to cold, absence of sweat, possibly shoulder/back pain or knee/shin pain. Thirst may be absent, but occasional irritability and bitter taste occur. Stools are loose and unsatisfactory, urine is yellow and hot. Tongue coating is slippery white, or white on edges with pale yellow in the center.
2. Warm Heat complicated by Dampness, with dampness suppressing and heat hiding: Intense aversion to cold, possibly cold feet. Head and eyes feel distended, painful, heavy, dizzy, as if wrapped or covered. Body pain prevents bending/stretching; body heaviness prevents turning. Limb joints and muscles ache and irritate; legs and feet hurt and ache. Heaviness and drowsiness, chest/epigastric fullness. Thirst without desire to drink, or no thirst. Afternoon onset of chills followed by fever, resembling Damp Malaria. Tongue coating is white and greasy, or white slippery and thick, or white with gray mixed with sticky floating slipperiness, or white with black spots and stickiness, or with black lines and stickiness. Sometimes the entire tongue is coated, thick like accumulated powder, stiff and tight.
3. Warm Heat complicated by Water, stagnant in chest/epigastrium: Chest/epigastric fullness and pain, soft upon pressure. Slight rubbing produces gurgling sounds. Severe cases have intestinal cramping pain, dry retching, shortness of breath, heavy waist, swollen feet, loose stools with scanty urination, or severe lethargy and coma. Tongue coating is slippery white, occasionally turning yellow/black and puffy/slippery, or entirely yellow/black with white strips on one side, or yellow at tip and root with a white segment in the middle.
4. Warm Heat complicated by Cold Food, blocking diaphragm/epigastrium: Aversion to food, acid regurgitation, belching, bloating, urge to vomit but unable, retching, fullness and oppression. Possibly deep pulse and cold limbs. Tongue coating is white and thick, slightly pale yellow.
5. Warm Heat complicated by Deficiency, due to excessive cooling/purging: Shortness of breath, rapid breathing, trembling voice, weakness, inability to speak continuously, preference for sleeping facing inward, sweating with aversion to cold, vomiting and diarrhea together, slight cold extremities, possibly very cold feet. Tongue color is pale red, round and thick, or pale/dull lacking spirit, or blue-green, puffy, and tender.
6. Warm Heat complicated by Phlegm, due to excessive cold suppression: Dizziness, chest/epigastric oppression, non-tender upon pressure, salivation. Restlessness and irritability, possibly mental confusion/coma. Tongue coating varies between white slippery and yellow slippery.