《活人》云∶发热恶寒者，太阴也；身热汗出 然者，阳明也；脉细头痛呕而发热
问∶阴证有发热者，何也？
答曰∶太阴、厥阴皆不发热，只少阴有发热二条，仲景谓之反发热也。少阴始得之，发
热脉沉者，麻黄附子细辛汤主之。少阴病下利清谷，里寒外热，手足厥逆，脉不出者，通脉四逆
汤主之。断云∶大抵阴证发热，终是不同，须脉沉细，或下利，手足厥。另有阴躁发热，欲
坐井中一条。此例当在少阴条下。
仲景云∶吐利汗出，发热恶寒，四肢拘急，手足厥逆，四逆汤主之。又云∶吐利，小便
复利而大汗出，下利清谷，内寒外热，脉微欲绝者，四逆汤主之。病发热头痛，身体不痛疼，当
救里，四逆汤主之。下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。大汗出，热不去
，内拘急，四肢疼，又下利厥逆而恶寒者，四逆汤主之。
阴阳二结，寒热不同，为躁一也。盛暑烁金，严冬凝海是也。
举阳证经云∶其脉浮而数，能食不大便者，此为实，名阳结；其脉沉而迟，不
能食
，宜理中丸主之。叔和云∶弦冷肠中结。洁古云∶脉沉弦，不能食而不大便，则为阴冷结也
举阳证 假令阳病者，太阳之标不解，复入于本，发热恶寒而渴，五苓散主之。
是湿热在下，故令秘而不通。余证不通者，随经而治之。若阴证不通者，脉迟细，浮中沉不一，
阴气已盛，阳气欲绝，小盒饭自利，而色白反不通者，阴无以化，凝泣枯涸，如水之结冰，
津液不行，故闭而不通也，当用热药主之。阴得阳而化，津液乃行，所以便也。大不可用利
小便之药利之，四逆汤加茯苓是也，与仲阳硫黄丁香豆蔻散，内有滑石同意。大抵非茯苓、
滑石二药利小便也，盖二味引热药下行，不入他经，为效速也。
经云∶阳明中寒者不能食，小便不利，手足然 汗出，欲作痼瘕，即是中寒，与此同意
。《
曰∶肾主大小二便难。阴阳二证，在其中矣！
成无己云∶阴阳相杂为之和，阴阳相离为之结。火亦有下收字处，以其心虚也。
仲景真武汤加减例云∶小便自利者，去茯苓一味。四逆散加减法∶小便不利者，加茯苓
。小柴胡加减法，小便不利者，加茯苓。（《活人》云∶阴证腹痛，小便不利者，真武汤也。）
《活人》云∶若阴证加以小便不通，及阴事缩入小腹，绞痛欲死者，更以脐下二寸石门
穴，大假急灸之，仍须与返阴丹、当归四逆加吴茱萸生姜汤，慎勿与寻常利小便药也。寻常利小
便药，多用冷滑之剂。此是阴毒瓦斯在小腹所致也，当知。
仲景风湿相搏，骨节疼烦，不得屈伸，近则痛转剧，汗出短气，小便不便，恶风不欲去
衣，或身肿者，甘草附子汤主之。
海藏云∶加茯苓尤佳。发汗病不解，反恶寒者，虚也，芍药甘
海藏云∶加大黄 尤佳。若腹痛者，尤宜此汤。仲景云∶阳明中寒者不能食，小便不利
，手足 然汗出，欲作痼瘕，即是中寒也。
《活人书》说：发热且恶寒的，属于太阴病；身体发热、出汗连绵不断的，属于阳明病；脉象细弱、头痛、呕吐且发热的……
答：太阴和厥阴通常都不发热，只有少阴病有两条条文提到发热，张仲景称之为“反发热”。少阴病初起，出现发热且脉象沉的，用麻黄附子细辛汤主治。少阴病出现下利清谷（泻下未消化的食物），表现为里寒外热，手足冰冷逆冷，脉搏摸不到的，用通脉四逆汤主治。总结说：大抵上阴证的发热，终究是不同的，必须伴有脉象沉细，或者下利，手足厥冷。另有阴躁发热，想要坐在井中的条文。这个例子应当归在少阴病的条目下。
张仲景说：呕吐、下利、出汗，发热且恶寒，四肢拘挛紧急，手足厥冷的，用四逆汤主治。又说：呕吐、下利，小便反而通畅且大汗出，下利清谷，内寒外热，脉微细几乎要断绝的，用四逆汤主治。患发热头痛，但身体不疼痛的，应当先救里，用四逆汤主治。下利清谷，里寒外热，出汗且手足厥冷的，用通脉四逆汤主治。大汗出，热势不退，体内拘急，四肢疼痛，又伴有下利、厥冷和恶寒的，用四逆汤主治。
阴阳二气的郁结，寒热性质不同，但表现为烦躁是一样的。就像盛夏酷热能熔化金属，严冬寒冷能使海水凝结一样。
引用阳证经文的说法：脉象浮而数，能进食但大便不通的，这是实证，名叫阳结；脉象沉而迟，不能进食的，宜用理中丸主治。王叔和说：脉弦表示肠中有冷结。李东垣（洁古）说：脉象沉弦，不能进食且不大便的，就是阴冷结。
举阳证的例子：假使是阳病，太阳表的邪气未解，又传入本经，出现发热、恶寒且口渴的，用五苓散主治。
如果是湿热在下焦，所以导致便秘不通。其他原因导致的不通，根据经络辨证治疗。如果是阴证导致的大便秘结，脉象迟而细，浮中沉三部脉象不一致，阴气已经亢盛，阳气将要断绝，本来应该自利（腹泻），但如果颜色发白反而便秘不通的，这是因为阴气无法气化，津液凝滞枯涸，就像水结冰一样，津液不能运行，所以闭塞不通。应当使用热性药物来主治。阴证得到阳气的温煦才能气化，津液才能运行，所以大便得以通畅。绝对不可以使用利尿的小便药来通利，比如四逆汤加茯苓，这与张元素（东垣）的硫黄丁香豆蔻散，以及其中含有滑石的用意是一致的。大概并不是靠茯苓、滑石这两味药来利尿，而是这两味药能引导热药下行，不进入其他经络，从而见效迅速。
经文说：阳明中寒的人不能进食，小便不利，手足濈然汗出，想要形成痼瘕，这就是中寒，与此处的道理相同。《难经》说：肾主管大小便困难。阴阳两种证候，都包含在其中了！
成无己说：阴阳相互混杂称为和谐，阴阳相互分离称为郁结。火也有向下收敛的地方，因为心气虚弱。
张仲景真武汤加减的例子说：小便自利的，去掉茯苓一味。四逆散加减法：小便不利的，加茯苓。小柴胡汤加减法，小便不利的，加茯苓。（《活人书》说：阴证腹痛，小便不利的，用真武汤。）
《活人书》说：如果阴证加上小便不通，以及生殖器收缩入小腹，绞痛欲死的，再用脐下两寸的石门穴，用大艾炷急灸，同时必须给予返阴丹、当归四逆加吴茱萸生姜汤，千万不要给普通的利尿药。普通的利尿药，多用寒凉滑利之剂。这是由于阴毒之气在小腹所致，应当知晓。
张仲景说：风湿相搏，骨节疼痛烦扰，不能屈伸，靠近则疼痛加剧，出汗短气，小便不便，怕风不想脱衣，或者身体浮肿的，用甘草附子汤主治。
张元素（海藏）说：加茯苓尤其好。发汗后病不解，反而恶寒的，是虚证，芍药甘草汤……
张元素（海藏）说：加大黄尤其好。如果有腹痛的，尤其适宜用此汤。张仲景说：阳明中寒的人不能进食，小便不利，手足濈然汗出，想要形成痼瘕，这就是中寒。
The *Huoren* (Book of Living People) states: Fever accompanied by aversion to cold belongs to Taiyin disease; body heat with continuous sweating belongs to Yangming disease; fine pulse, headache, vomiting, and fever...
Question: Why is there fever in Yin syndromes?
Answer: Taiyin and Jueyin typically do not present with fever. Only Shaoyin disease has two clauses mentioning fever, which Zhang Zhongjing refers to as "counterfeit fever" (Fan Re Fa). In the early stage of Shaoyin disease, if fever occurs with a deep pulse, it is treated with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). If Shaoyin disease presents with diarrhea of undigested food, internal cold with external heat, cold extremities, and an imperceptible pulse, Tongmai Sini Tang (Pulse-Returning Sini Decoction) is indicated. In summary: Generally, fever in Yin syndromes is distinct; it must be accompanied by a deep and fine pulse, or diarrhea, and cold extremities. There is another clause regarding irritability due to Yin and fever, where the patient desires to sit in a well. This example should be categorized under Shaoyin disease.
Zhang Zhongjing states: Vomiting, diarrhea, sweating, fever with aversion to cold, spasticity of the four limbs, and cold extremities are treated with Sini Tang (Frigid Extremities Decoction). He also states: Vomiting and diarrhea, with urination becoming frequent and profuse sweating, diarrhea of undigested food, internal cold with external heat, and a faint pulse nearly disappearing are treated with Sini Tang. For fever and headache without body pain, the interior should be rescued first using Sini Tang. Diarrhea of undigested food, internal cold with external heat, sweating with cold extremities are treated with Tongmai Sini Tang. Profuse sweating with persistent heat, internal spasticity, limb pain, accompanied by diarrhea, cold extremities, and aversion to cold are treated with Sini Tang.
The obstruction of Yin and Yang Qi differs in cold and heat nature, yet both manifest as irritability. This is like scorching summer heat melting metal or severe winter cold freezing the sea.
Citing the classics on Yang syndromes: A floating and rapid pulse with ability to eat but constipation indicates excess, named Yang Jie (Yang Obstruction); a deep and slow pulse with inability to eat is treated with Lizhong Wan (Regulate the Middle Pill). Wang Shuhe states: A wiry pulse indicates cold obstruction in the intestines. Li Dongyuan (Jiegu) states: A deep and wiry pulse with inability to eat and constipation indicates Yin Cold Obstruction.
Taking Yang syndrome as an example: If a Yang disease occurs, and the exterior pathogen of Taiyang does not resolve but enters the interior, presenting with fever, aversion to cold, and thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated.
If damp-heat is in the lower jiao, it causes constipation. Other causes of obstruction are treated according to the meridian. If constipation is caused by a Yin syndrome, with a slow and fine pulse, inconsistent pulses at superficial, middle, and deep levels, excessive Yin Qi, and impending exhaustion of Yang Qi, although self-diarrhea is expected, if the stool is white and constipated instead, it is because Yin cannot transform, leading to stagnation and drying of fluids, similar to water freezing. Fluids fail to circulate, causing blockage. Hot-natured medicines should be used. When Yin receives Yang warmth, transformation occurs, fluids circulate, and defecation resumes. It is absolutely forbidden to use diuretics for this purpose. For instance, Sini Tang added with Fuling (Poria), which shares the same principle as Zhang Yuansu’s Liuhuang Dingxiang Doukou San (Sulfur, Clove, and Cardamom Powder) containing Huashi (Talcum). Essentially, it is not Fuling and Huashi that promote urination, but rather they guide the hot medicines downward, preventing them from entering other meridians, thus ensuring rapid efficacy.
The classics state: Yangming cold-dampness prevents eating, causes difficult urination, and leads to sweat on the hands and feet, potentially forming a mass; this is cold-dampness, consistent with the above principle. The *Nanjing* (Classic of Difficult Issues) states: The Kidney governs difficulties in bowel and bladder movements. Both Yin and Yang syndromes are included herein!
Cheng Wuji states: Harmony arises when Yin and Yang mix; obstruction arises when they separate. Fire also has a downward gathering aspect due to Heart deficiency.
Regarding the modification of Zhang Zhongjing’s Zhenwu Tang: If urination is spontaneous, remove Fuling. Regarding Si Ni San: Add Fuling for difficult urination. Regarding Xiao Chaihu Tang: Add Fuling for difficult urination. (*Huoren* states: For abdominal pain in Yin syndrome with difficult urination, use Zhenwu Tang.)
*Huoren* states: If Yin syndrome is accompanied by urinary retention and retraction of the genitalia into the lower abdomen with agonizing pain, moxibustion should be urgently applied to the Shimen (Stone Gate) acupoint, located two cun below the umbilicus, using large moxa cones. Simultaneously, Fanyin Dan (Return-Yang Pill) and Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Frigid Extremities plus Evodia and Fresh Ginger) must be administered. Do not use ordinary diuretics. Ordinary diuretics often use cold and slippery agents. This is caused by Yin toxic qi in the lower abdomen; one must understand this.
Zhang Zhongjing states: Wind-dampness combing causes painful joints, inability to flex or extend, worsening pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with reluctance to remove clothes, or bodily swelling. These are treated with Gancao Fuzi Tang (Licorice and Aconite Decoction).
Zhang Congzheng (Haicang) states: Adding Fuling is especially good. If sweating fails to resolve the disease and aversion to cold worsens, it is deficiency; Shaoyao Gancao Tang (Peony and Licorice Decoction)...
Zhang Congzheng (Haicang) states: Adding Dahuang (Rhubarb) is especially good. If abdominal pain is present, this decoction is particularly suitable. Zhang Zhongjing states: Yangming cold-dampness prevents eating, causes difficult urination, and leads to sweat on the hands and feet, potentially forming a mass; this is cold-dampness.