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The original treatise of *Shanghan Lun* states: "Considering that diseases arise urgently, it is difficult to find key treatments in haste. Therefore, I have recompiled various methods regarding what can and cannot be treated. Compared to the chapters on the Three Yin and Three Yang meridians, these are easier to understand. Moreover, sometimes conditions extend beyond just the Three Yin and Three Yang, appearing in the sections on 'what may be given' and 'what may not be given'."

Zhang Zhongjing said: "In Shaoyin disease (disease of the Shaoyin meridian), if the pulse is fine, deep, and rapid, the pathology is interior; sweating should not be induced."

He also said: "In Taiyang disease (disease of the Taiyang meridian), if the pulse is floating and tight, according to the method, there should be body pain, and sweating should be induced to resolve it. However, if the cunian (尺) pulse is slow, sweating should not be induced. How do we know this? Because Ying Qi (defensive-nutritive qi) is insufficient and blood is scant." Pang Shi said: "Regarding the previous Yangming disease where the pulse was slow, with profuse sweating and slight aversion to cold, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. We do not blame insufficiency of Ying Qi here; rather, the chi pulse being large and slow indicates it must be soft, tight, and slow, so sweating is contraindicated, and Xiaojianzhong Tang (Minor Construct the Middle Decoction) is appropriate." Guo Yong said: "Guizhi Tang is originally for resolving the muscle layer without disturbing the meridians, hence it was used in the previous Yangming syndrome. Mahuang (Ephedrae Herba) induces sweating and disturbs the meridians." Chang Shi said: "Xiaochaihu Tang (Minor Chaihu Decoction) can be used." Guo Yong said: "In Shanghan, if the yang pulse is choppy and the yin pulse is wiry, according to the method, there should be acute abdominal pain. First give Xiaojianzhong Tang; if not cured, then give Xiaochaihu Tang. These two medicines can be used synergistically." Thus, Pang Shi further stated: "For any disease with a tight pulse, there must be no sweat; only when the pulse is soggy and tight is there sweat. Do not mistakenly use Guizhi Tang; Jianzhong Tang is appropriate."

He also said: "In Shaoyin disease, if the pulse is faint, sweating should not be induced because it leads to the loss of Yang Qi. (Another version reads: soggy and weak.)" Pang Shi said: "If sweating is induced, it will lead to cold limbs, irritability, and inability to sleep." Chang Shi said: "Fuzi Tang (Aconite Decoction) can be used."

He also said: "If the pulse is soggy and weak, with the weak position reversed at the guan (middle) section, the soggy position reversed at the dian (top/cun) section, the faint position reversed at the upper part, and the choppy position reversed at the lower part: Faint indicates insufficiency of Yang Qi; choppy indicates lack of blood. If Yang Qi is faint, wind-stroke with sweating leads to contrary irritability; choppy indicates lack of blood, leading to cold limbs and chill. Inducing sweating when Yang Qi is faint causes irritability and insomnia." Guo Yong said: "Xiaojianzhong Tang is appropriate."

He also said: "If there is moving Qi in the right side, sweating should not be induced. Inducing sweating leads to epistaxis (nosebleed) and thirst, bitter vexation in the heart, and vomiting water upon drinking." Pang Shi said: "'Moving Qi' refers to deficiency and rebellious Qi movement in the heart and abdomen. If sweating is mistakenly induced, first administer Wuling San (Poria Decoction), followed by Zhuye Tang (Bamboo Leaf Decoction)." Zhu Shi said: "Whenever the pulse is soggy and weak, sweating is contraindicated; whenever there is moving Qi in the heart, abdomen, above, below, left, or right, sweating is contraindicated; whenever the pulse is active, rapid, faint, or weak, sweating is contraindicated. All such cases are suitable for Xiaojianzhong Tang. For those with irritability, Zhuye Tang is appropriate." Guo Yong said: "For all cases of moving Qi where sweating is contraindicated, Linggui Zhigan Dazao Tang (Poria, Cinnamon Twig, Licorice and Jujube Decoction) is appropriate."

He also said: "If there is moving Qi in the left side, sweating should not be induced. Inducing sweating leads to dizziness, continuous sweating, and twitching of muscles (jin ti rou tiao)." Pang Shi said: "This is a counter-indication and difficult to treat. First take Fuling Baizhu San (Poria and Atractylodes Macrocephala Powder); once sweating stops, continue with Xiaojianzhong Tang." Zhu Shi agrees. Guo Yong said: "Continuous sweating and muscle twitching are signs of fluid exhaustion; Fuling Tang is not appropriate."

He also said: "If there is moving Qi in the upper jiao, sweating should not be induced. Inducing sweating causes Qi to rush upward to the Wei level, centering at the heart." Pang Shi said: "Ligen Tang (Li Root Decoction) governs this." Zhu Shi agrees. Chang Shi said: "Ben Tun Tang (Roving Pig Decoction) can be used."

He also said: "If there is moving Qi in the lower jiao, sweating should not be induced. Inducing sweating leads to anhidrosis, severe mental restlessness, painful bone joints, vertigo, aversion to cold, vomiting after eating, and food failing to pass forward. (One version says food fails to digest.)" Pang Shi said: "First take Daju Pi Tang (Large Tangerine Peel Decoction); once vomiting stops, take Xiaojianzhong Tang." Zhu Shi agrees. Chang Shi said: "Chaihu Guizhi Tang (Chaihu and Cinnamon Twig Decoction), Fuling Tang, or Xiaobanxia Tang (Minor Banxia Decoction) can be used." Guo Yong said: "Daju Pi Tang, Fuling Tang, and Xiaobanxia Tang can all be used to stop vomiting. After vomiting stops, if mental restlessness, bone joint pain, and aversion to cold persist, take Chaihu Guizhi Tang, followed by Xiaojianzhong Tang."

He also said: "If the throat feels closed, sweating should not be induced. Inducing sweating leads to hematemesis (vomiting blood), impending collapse of Qi, cold hands and feet, a desire to curl up, and inability to self-warm." Pang Shi said: "Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) governs this." Chang Shi said: "For throat closure, Xiaochaihu Tang can be used. If hematemesis occurs after sweating, Baiye Yiye Tang (Mugwort and Bloodwort Decoction, from *Jinkui Yaolue*) is indicated. For faint Qi, cold limbs, and curled posture, Danggui Sini Tang (Angelica Sinensis and Cinnamon Twig Decoction) can be used."

He also said: "For any pulse presenting as rapid, active, faint, or weak, sweating should not be induced. Inducing sweating leads to difficult defecation and dryness in the abdomen. (One version adds: difficult defecation and dryness in the bladder cavity.) The stomach becomes dry and irritable. Although the appearance is similar, the root source is different." Guo Yong said: "Xiaojianzhong Tang is appropriate."

He also said: "If the pulse is soggy and weak, with weakness reversed at the guan section, soggy reversed at the dian section, wiry reversed at the upper part, and faint reversed at the lower part: Wiry represents abnormal Yang movement; faint represents Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicate deficiency; sweating is contraindicated. Inducing sweating leads to cold stiffness that cannot recover spontaneously." Chang Shi said: "Danggui Sini Tang can be used."

He also said: "If coughing is severe, with frequent expectoration of saliva and foam, the throat will surely be dry, urination will be difficult, and there will be hunger-like vexation in the heart. It occurs intermittently, resembling malaria but with chills only and no fever. In deficiency with chills, inducing sweating while coughing leads to curling up with fullness and hardness in the abdomen. (One version says: curling up with heart pain.)" Chang Shi said: "Chaihu Ganjiang Guizhi Tang, Xiao Qinglong Tang (Minor Blue Dragon Decoction), or Lizhong Wan (Regulate the Middle Pill) can be used." Guo Yong said: "*Mai Jing* combines the above two syndromes into one. I believe that starting from 'severe coughing' describes the severe cough syndrome, while above 'severe coughing' describes the non-coughing or non-severe syndrome. The pulses for both syndromes are soggy and weak. Cough syndromes often involve interior cold; Xiaojianzhong Tang, Lizhong Wan, or Fuzi Tang should be used to gently warm."

He also said: "If the pulse in Jueyin is tight, sweating should not be induced. Inducing sweating leads to chaotic voice, hoarse throat, flaccid tongue, and inability to speak." Guo Yong said: "Tightness in the Jueyin meridian draws the tongue and testicles, causing tongue retraction and scrotal contraction. If the pulse is slow, the tongue becomes flaccid and speech is impaired. Therefore, for a tight Jueyin pulse, sweating is contraindicated, fearing the pulse may become slow. For a tight Jueyin pulse, Sini Tang (Four Reversal Decoction) is appropriate; for a slow pulse, Xiaojianzhong Tang is appropriate. Some suggest Baihu Tang or Xiaochaihu Tang, which are all inappropriate."

He also said: "For various counter-indications, inducing sweating makes mild conditions difficult to cure and severe conditions result in delirium. Those with dizziness die. (One version says: delirium, dizziness, and chaos of essence lead to death.) Life will be hard to preserve."

He also said: "In Taiyang disease, after eight or nine days, resembling malaria, with fever and aversion to cold, more heat than cold, no vomiting, normal bowel and bladder function, occurring two or three times a day: if the pulse is slightly slow and smooth, recovery is imminent. If the pulse is faint with aversion to cold, this indicates deficiency of both Yin and Yang; sweating should not be induced again." Chang Shi said: "Xiaochaihu Tang can be used." Guo Yong said: "It is also appropriate to first take Xiaojianzhong Tang."

He also said: "In Taiyang disease, with fever, aversion to cold, and more heat than cold. (*Qianjin Yifang* says more cold than heat): if the pulse is faint and weak, this indicates absence of Yang; sweating is contraindicated." Chang Shi said: "Xiaochaihu Tang can be used." Guo Yong said: "Gancao Ganjiang Tang is also appropriate."

He also said: "Those with dry throats should not be sweated." Chang Shi said: "Xiaochaihu Tang can be used."

He also said: "Patients who have lost blood should not be sweated. Inducing sweating leads to chills and tremors." Chang Shi said: "Xiaochaihu Tang plus Shaoyao and Dihuang (Peony and Rehmannia) can be used."

He also said: "Patients prone to nosebleeds should not be sweated. Sweating will cause depression of the arteries above the forehead, urgent pulse, fixed staring eyes, inability to move them, and insomnia." Chang Shi said: "Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) can be used."

He also said: "Profuse sweaters subjected to heavy sweating will suffer from恍惚 (mental confusion) and heart disorder. After urination, there will be pain in the genitalia. Yuyuliang Wan (Hematitum Pill) is appropriate. (The formula is missing in the original text.)" Chang Shi said: "Simply taking Yuyuliang stone, calcined and powdered, is also acceptable." Guo Yong said: "Yuyuliang should not use the shell; saying 'calcined powder' implies using the shell."

He also said: "Patients with strangury should not be sweated. Sweating will certainly lead to hematuria." Chang Shi said: "Zhuling Tang (Polyporus Decoction) or Shaoyao Dihuang Tang can be used."

He also said: "Patients with sores/ulcers, even if they have body pain, should not be sweated. Sweating will lead to spasms (Jing). Chang Shi said: "Xiaochaihu Tang can be used. For spasms, Gegen Guizhi Tang (Kudzu and Cinnamon Twig Decoction) is used." Guo Yong said: "Refer more closely to the chapter on treating spasms."

He also said: "Diarrhea with undigested food should not be sweated. Sweating will certainly lead to abdominal distension." Guo Yong said: "Warm the interior first, then treat according to the syndrome."

He also said: "Coughing with free urination, or incontinence, should not be sweated. Sweating will lead to cold extremities and reversal." Guo Yong said: "If sweating is mistakenly induced, Gancao Ganjiang Tang or Danggui Sini Tang is appropriate."

He also said: "In Shanghan, from one or two days to four or five days, if there is cold reversal (Jue), there will definitely be fever. Previous cold reversal will later turn to heat; deeper cold reversal means deeper heat, shallower cold reversal means shallower heat. Cold reversal should be treated with purgation, but if sweating is mistakenly induced, it will certainly cause oral ulceration and redness." Guo Yong said: "This has been seen in the discussion and questions on cold reversal in the Jueyin volume."

He also said: "In Shanghan, if the pulse is wiry and fine, with headache and fever, it belongs to Shaoyang. Shaoyang disease should not be sweated." Chang Shi said: "Xiaochaihu Tang can be used."

He also said: "In Shanghan, with headache, mild fever (like feathers covering), resembling wind-stroke, with slight spontaneous sweating and spontaneous vomiting: purging increases vexation and mental discomfort like hunger; inducing sweating leads to spasms, stiff body difficult to flex and extend; moxibustion leads to jaundice and inability to urinate; cauterization leads to coughing and spitting phlegm." Chang Shi said: "Xiaochaihu Tang, Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction), Yinchen Hao Tang (Artemisiae Scopariae Decoction), or Xiao Qinglong Tang can be used." Guo Yong said: "Use each according to the syndrome. Headache, fever, and sweating: Xiaochaihu Tang. Mental vexation and frequent vomiting: also Xiaochaihu Tang. Spasms and stiff body: Guizhi Jia Gegen Tang. Inability to urinate with coughing/phlegm: Xiao Qinglong Tang. Jaundice from moxibustion: Yinchen Hao Tang."

He also said: "When Taiyang and Shaoyang diseases occur together, with stiffness and pain in the head and neck, occasional dizziness or vertigo, occasional sensation of chest binding, and fullness/hardness below the heart: sweating is contraindicated. One should needle the first interspace of Dazhui, Feishu, and Ganshu. Inducing sweating leads to delirium and wiry pulse. If delirium persists for five or six days, needle Qimen."

He also said: "Taiyang disease treated with sweating leads to spasms." Guo Yong said: "The original text states: Taiyang disease with excessive sweating leads to spasms."

He also said: "In Shaoyin disease, with coughing, diarrhea, and delirium, this is due to coercion by fire Qi. Urination will certainly be difficult, caused by forcing sweat from Shaoyin." Chang Shi said: "Guizhi Qu Shaoyao Jia Shuji Muli Longgu Jiunv Tang (Cinnamon Twig Decoction minus Peony plus Chinese Tallow Tree Bark, Oyster Shell and Fossilized Bones for Saving from Peril Decoction) can be used. For difficult urination, Wuling San."

He also said: "In Shaoyin disease, with cold reversal but no sweat, forcing sweating will disturb the blood. It is unknown from which channel it exits; it may exit from the mouth/nose or eyes. This is called 'Lower Cold and Upper Exhaustion,' which is difficult to treat." Chang Shi said: "Shaoyao Dihuang Tang can be used." Guo Yong said: "Moxibustion should still be applied to Sanyinjiao and Yongquan acupoints. Sanyinjiao is difficult to locate; Yongquan is particularly effective."

Wang Shuhe said: "Inducing sweating in winter will certainly lead to vomiting and diarrhea, rotting of the mouth, and sores. (*Qianjin Yifang* agrees)."

He also said: "Profuse sweating with heat, inducing sweating also leads to spasms." Guo Yong said: "The character 'jian' (firm) should be read as 'jing' (spasm). As stated before: excessive sweating leads to spasms."

He also said: "If a patient's pulse is rapid, indicating heat, they should digest food well, yet they vomit instead. This is because the physician induced sweating, making Yang Qi faint and Diaphragm Qi deficient, resulting in a rapid pulse. Rapid pulse indicates guest heat, which cannot digest food; the stomach is deficient and cold, causing vomiting." Chang Shi said: "Xiaobanxia Tang or Wenzhong Tang can be given."

He also said: "In Shanghan, after four or five days, if the pulse is deep, with vexation, wheezing, and fullness: a deep pulse indicates interior pathology; sweating is contraindicated. Fluids escape outward, leading to difficult defecation. Exterior deficiency and interior excess, prolonged, lead to delirium." Chang Shi said: "Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice and Gypsum Decoction) can be used. For deep pulse, interior excess, and delirium, Tiaowei Chengqi Tang (Stomach-Regulating Cathartic Decoction) is appropriate."

He also said: "Shanghan has five types, all belonging to heat diseases. Same disease, different names; same pulse, different meridians. Although all are injured by wind, individuals have chronic diseases, so the same method cannot be used. If a person is chronically injured by wind and then re-injured by heat, wind and heat clash, leading to Fengwen (Wind-Warmth disease): limbs fail to receive commands, headache, body heat, constant sweating without resolution. Treatment focuses on Shaoyin and Jueyin; sweating is contraindicated. Sweating leads to delirium, muttering, internal vexation, restlessness preventing sleep, fearfulness, chaotic vision, and lack of spirit. If treatment involves re-inducing sweating, death results; this is killing the patient by the physician. (From *Yi Lü*)" Zhu Shi said: "Fengwen should not be sweated; Weihui Tang (Jade Bamboo Decoction) is appropriate." Guo Yong said: "Zhang Zhongjing considers Fengwen and Shiwen as bad outcomes of the four types of Shanghan. *Nanjing* considers Shiwen as one of the five types of Shanghan; both belong to Shanghan. See the Fengwen section for details."

He also said: "Shanghan Shiwen (Damp-Warmth): the person is chronically injured by dampness, leading to damp accumulation. Damp and heat clash, leading to Shiwen. The patient suffers from reverse cold in both calves, abdominal fullness, chest compression, head and eye pain, and delirium. Treatment focuses on Foot-Taiyin; sweating is contraindicated. Sweating leads to inability to speak, deafness, unawareness of pain location, bluish body, and changed complexion. This is called 'Zhong Ming' (Heavy Obscuration). Death results; this is killing the patient by the physician. (From *Yi Lü*)" Zhu Shi said: "Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Lancea Decoction)."

He also said: "Shiwen often presents with profuse sweating; the pulse is soggy and weak in the Yang position, and small and hot in the Yin position."

Pang Shi said: "Sweating when it should not be done leads to desiccation of fluids and death."