郁火宜发。发则火散而热泄。轻扬如葱、豉、荷、翘、升达如升、葛、柴、芎。对证酌加数味以发散之。《内
经》所谓身如燔炭。
汗出而散也。透疹斑如角刺、蝉衣芦笋西河柳叶。疹斑一透。郁火自从外溃矣。实火宜泻。轻则栀、芩、连、柏。
但用苦寒以清之。重则硝、黄、龙荟。必须咸苦走下以泻之。虚火宜补。阳虚发热。宜以东垣补中益气为主药。李
氏所谓甘
温能除大热是也。阳浮倏热。宜以季明六神汤为主药。张氏所谓解表已复热。攻里热已复热。利小便愈后复热。
养阴滋清。热亦不除。元气无所归着。保元、归脾以除虚热是也。阴虚火旺。由心阴虚者。阿胶黄连汤为主药。由肝
阴虚者。丹地四物汤为主药。由脾阴虚者。黑归脾汤为主药。由肺阴虚者。清燥救肺汤为主药。由肾阴虚者。知柏
地黄汤为主药。由冲任阴虚者。滋任益阴煎为主药。若胃未健者。则以先养胃阴为首要。西参、燕窝、银耳、白毛石
斛、麦冬等品。是其主药。惟阴火宜引。破阴回阳为君。附、姜、桂、是其主药。或佐甘咸如炙草、童便。或佐介潜
如牡蛎、
龟版。或佐镇纳如黑锡丹。或佐交济如磁朱丸。或若娜气如坎气、蚧尾。或佐敛汗如五味、麻黄根。皆前哲所谓引
火归源。导龙入海之要药。
【廉勘】阴火者。命门中之元阳也。一名元气。又名真火。视之不见。求之不得。附于气血之内。宰乎气血
之先。而其根本所在。即道经所谓丹田。《难经》所谓命门。《内经》所谓七节之旁。中有小心。阴阳阖辟存乎此。呼
吸出入系乎此。无火而能令百体皆温。无水而能令百体皆润。此中一线未绝。则生气一线未亡。非解剖法所能
知。非显微镜所能窥。故古昔大医。诊病决死生者。不视病之轻重。而视元气之存亡。元气不伤。虽病甚不
死。元气或伤。虽病轻亦死。而其中又有辨焉。有先伤元气而病者。此不可治者也。有因病而伤元气者。此不
可不预防者也。亦有因误治而伤及元气者。亦有元气虽伤未甚。尚可保全者。全在临证时。于四诊中细心详审
也。病至阴火上升。元阳外越。有猝中证。有久病证。猝中多阳被阴逼。不走即飞。久病多阴竭阳厥。非枯则
槁。药一误投。祸不旋踵。至若方药。俞氏滋补剂中。法已大备。兹不赘述。
郁火应当用发散的方法治疗。发散后，郁结的火邪得以疏散，热邪随之泄出。药性轻扬升散的，如葱白、豆豉、荷叶、连翘；升达透发的，如升麻、葛根、柴胡、川芎。根据具体证候酌情加入几味药物以发散郁火。《黄帝内经》所说的“身体像燃烧的炭一样发热，通过出汗而消散”，指的就是这种治法。对于透发疹斑，可用角刺（皂角刺）、蝉蜕、芦笋、西河柳叶等。疹斑一旦透发，郁结的火邪自然从体表溃散排出。
实火应当用泻下的方法治疗。病情较轻的，用栀子、黄芩、黄连、黄柏。只需使用苦寒性质的药物来清泻火热。病情较重的，用芒硝、大黄、芦荟。必须使用咸苦走下行的药物来泻下实火。
虚火应当用补益的方法治疗。如果是阳虚导致的发热，应以李东垣的补中益气汤为主药。这就是李氏所说的“甘温能够除大热”的道理。如果是阳气浮越导致的突然发热，应以季明六神汤为主药。张氏所说的：解表后复热、攻里后复热、利小便后愈而复热，以及养阴滋清后热仍不除，这是因为元气无所依附归着，此时应用保元汤、归脾汤来消除虚热。
阴虚火旺的情况，若由心阴虚引起，以阿胶黄连汤为主药；由肝阴虚引起，以丹皮地黄四物汤为主药；由脾阴虚引起，以黑归脾汤为主药；由肺阴虚引起，以清燥救肺汤为主药；由肾阴虚引起，以知柏地黄汤为主药；由冲任二脉阴虚引起，以滋任益阴煎为主药。如果胃气尚未健运，则应先将养胃阴作为首要任务，西洋参、燕窝、银耳、白毛石斛、麦冬等药物，是其主要用药。
唯独阴火（真寒假热之火）应当用引火归源的方法治疗。以破阴回阳为君药，附子、干姜、肉桂是其主药。或者佐以甘咸之品如炙甘草、童便；或者佐以介类潜阳之品如牡蛎、龟板；或者佐以镇纳之品如黑锡丹；或者佐以交通心肾之品如磁朱丸；或者佐以纳气之品如坎气（脐带）、蛤蚧尾；或者佐以敛汗之品如五味子、麻黄根。这些都是前代名医所说的“引火归源、导龙入海”的重要药物。
【廉勘按语】所谓的阴火，就是命门中的元阳。又名元气，又名真火。它看不见，摸不着，附着在气血之内，主宰在气血之前。它的根本所在，就是道经所说的丹田，《难经》所说的命门，《黄帝内经》所说的第七椎旁有小心之处。阴阳的开合存于此，呼吸的出入系于此。没有火却能令全身温暖，没有水却能令全身滋润。这里的一线生机未绝，则生命之气一线未亡。这不是解剖学所能知晓的，也不是显微镜所能窥探的。所以古代伟大的医生，在诊病判断生死时，不看病的轻重，而看元气的存亡。元气如果不伤，即使病很重也不会死；元气如果受伤，即使病很轻也会死亡。其中又有辨别：有先伤元气而后发病的，这是不可治的；有因病而损伤元气的，这是不可不预防的；也有因误治而损伤元气的；也有元气虽伤但不严重，尚可保全的。全凭临证时在四诊中细心详审。病至阴火上升，元阳外越，有猝然中风的证候，有久病的证候。猝中多是阳气被阴邪逼迫，不走散即飞越；久病多是阴液枯竭导致阳气厥逆，不是干枯就是槁木。药物一旦误投，灾祸立刻降临。至于方药，俞氏的滋补剂中，治疗方法已经非常完备，此处不再赘述。
Depressed fire should be treated by dispersing. Dispersal allows the stagnant fire to scatter and heat to dissipate. For light, ascending, and diffusing actions, use scallion (Cong Bai), fermented soybean (Dou Chi), lotus leaf (He Ye), and forsythia (Qiao); for ascending and penetrating actions, use cimicifuga (Sheng Ma), pueraria (Ge Gen), bupleurum (Chai Hu), and ligusticum (Xiong). Add a few appropriate herbs based on the specific syndrome to disperse it. As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "The body feels like a burning charcoal; it is resolved through sweating." This refers to this method of treatment. To vent rashes and macules, use hawthorn thorn (Jiao Ci), cicada slough (Chan Yi), reed rhizome (Lu Sun), and west river willow leaves (Xi He Liu Ye). Once the rashes and macules are vented, the depressed fire naturally溃s from the exterior.
Excess fire should be treated by purging. For mild cases, use gardenia (Zhi), scutellaria (Huang Qin), coptis (Lian), and phellodendron (Bo). Simply use bitter-cold herbs to clear the heat. For severe cases, use mirabilite (Xiao), rhubarb (Huang), and aloe (Lun Hui). Salty-bitter herbs that descend must be used to purge the excess fire downward.
Deficiency fire should be treated by tonifying. If fever is due to yang deficiency, Li Dongyuan's Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be the principal formula. This aligns with Li's principle that "sweet-warm substances can eliminate great heat." If sudden heat is due to floating yang, Jiming Liushen Tang (Master Ji's Six-Spirit Decoction) should be the principal formula. As Zhang stated: fever recurring after releasing the exterior, recurring after purging the interior, recurring after promoting urination post-recovery, or heat persisting despite nourishing yin and clearing heat—these occur because yuan qi (original qi) has no place to reside. In such cases, Baoyuan Tang (Preserve the Origin Decoction) and Guipi Tang (Restore the Spleen Decoction) are used to eliminate deficiency heat.
In cases of yin deficiency with hyperactive fire: if caused by heart yin deficiency, Ejiao Huanglian Tang (Donkey-Hide Gelatin and Coptis Decoction) is the principal formula; if caused by liver yin deficiency, Dan Di Siwu Tang (Moutan and Rehmannia Four-Substance Decoction) is the principal formula; if caused by spleen yin deficiency, Hei Guipi Tang (Black Restore the Spleen Decoction) is the principal formula; if caused by lung yin deficiency, Qingzao Jiufei Tang (Clear Dryness and Rescue the Lungs Decoction) is the principal formula; if caused by kidney yin deficiency, Zhibai Dihuang Tang (Anemarrhena, Phellodendron, and Rehmannia Pill) is the principal formula; if caused by Chong and Ren vessel yin deficiency, Zi Ren Yiyin Jian (Nourish Ren and Benefit Yin Decoction) is the principal formula. If the stomach function is not yet robust, nourishing stomach yin must be the primary priority. Western ginseng (Xi Shen), bird's nest (Yan Wo), white fungus (Yin Er), white hair stone dendrobium (Bai Mao Shihu), and ophiopogon (Mai Dong) are the principal herbs.
However, for yin fire (false fire), the method of guiding fire back to its source should be employed. The strategy is to break yin cold and return yang, using aconite (Fu Zi), dried ginger (Gan Jiang), and cinnamon bark (Gui Zhi) as the principal herbs. These may be supplemented with sweet-salty substances like roasted licorice (Zhi Cao) or child's urine (Tong Bian); or with shell/turtle substances for anchoring yang like oyster shell (Mu Li) or turtle plastron (Gui Ban); or with sedating substances like Black Tin Pill (Hei Xi Dan); or with substances that harmonize heart and kidney like magnetite and cinnabar pill (Ci Zhu Wan); or with substances that grasp qi like umbilical cord (Kan Qi) and gecko tail (Jie Wei); or with substances that stop sweating like schisandra (Wu Wei Zi) and ephedra root (Mahuang Gen). All these are essential herbs described by ancient masters as "guiding fire back to its source" and "leading the dragon into the sea."
[Lian's Commentary]: What is called yin fire is actually the primordial yang within the Mingmen (Gate of Life). It is also known as yuan qi (original qi) or true fire. It cannot be seen or touched. It resides within blood and qi, governing them prior to their manifestation. Its root lies where Daoist texts call the Dantian (Elixir Field), the *Nanjing* (Classic of Difficult Issues) calls the Mingmen, and the *Neijing* describes as the "small heart" beside the seventh vertebra. Yin-yang opening and closing exist here; inhalation and exhalation depend on here. Without fire, it warms all parts of the body; without water, it moistens all parts of the body. As long as this single thread of life remains unbroken, the vital energy is not exhausted. This cannot be understood through anatomy nor perceived through microscopes. Therefore, great physicians of antiquity, when diagnosing diseases and determining life and death, did not look at the severity of the illness but at the presence or absence of yuan qi. If yuan qi is undamaged, even severe illness will not lead to death; if yuan qi is damaged, even mild illness can lead to death. There are distinctions within this: some suffer yuan qi damage first and then develop disease; these are incurable. Some develop disease first and then damage yuan qi; prevention is essential here. Others damage yuan qi through mis-treatment. Some have damaged yuan qi but not severely, allowing for preservation. Success depends entirely on careful examination during the four diagnostic methods at the bedside. When yin fire rises and primordial yang escapes outward, there are sudden stroke syndromes and chronic disease syndromes. Sudden strokes often involve yang being forced by yin, leading to dispersion or flight. Chronic diseases often involve yin exhaustion leading to yang collapse, resulting in desiccation or withering. A single error in medication leads to immediate disaster. Regarding prescriptions, Yu's tonifying formulas already cover extensive methods, so further elaboration is omitted.