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Zhao Sizhen stated: A detailed examination of Zhang Zhongjing's sweating-inducing decoctions reveals varying degrees of potency. For instance, the Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), Qing Long Tangs (Green Dragon Decoctions), Ge Ban Tang (Half-Combined Decoction), and Yue Bi Tang (Yuebi Decoction) each possess distinct gradations. Regarding the two sweating-inducing formulas for Shaoyin disease (Disease of the Lesser Yin), although both utilize Ma Huang (Ephedrae Herba) and Fu Zi (Aconiti Lateralis Radix Praeparata), there are differences in dosage adjustments and intensity. Thus, the addition of Xi Xin (Asari Radix et Rhizoma) denotes a heavier formula, while the addition of Gan Cao (Glycyrrhizae Radix et Rhizoma) denotes a lighter one, reflecting the principles of Xi Xin's acrid dispersal and Gan Cao's sweet moderation.

In the first syndrome, since Shaoyin inherently lacks heat manifestations, the emergence of fever is termed "counter" (fan). This fever arises because the pathogen is in the exterior, requiring diaphoresis, yet the deep pulse indicates an interior yin condition requiring warming. Therefore, Fu Zi is used to warm the meridians, Ma Huang to disperse cold, and Xi Xin is added to facilitate the resolution of heat through sweating; this constitutes a potent sweating agent.

In the second syndrome, since there is no interior cold requiring warming nor interior heat requiring purging, the rationale for using Ma Huang and Fu Zi is that the pulse remains deep, qualifying it as Shaoyin disease, and the body retains fever, allowing for exterior-releasing medication. Furthermore, having contracted the disease only two or three days prior, the pathology is still shallow and slightly milder than the previous syndrome. Consequently, rather than emphasizing specific pulse and symptom details, it merely states "mild diaphoresis." Hence, Xi Xin is removed and Gan Cao is added, constituting a mild sweating agent. If the pulse were not deep, the body not feverish, and no other symptoms present, there would be no patient, and thus no need for medication.

Zhang Zhongjing originally divided these into two syndromes to distinguish the heaviness and lightness of sweating agents. However, *Ren Shu* (The Book of Human Life) removed the phrase "no [other] symptoms" from the second syndrome and changed it to "once observed." In Shaoyin disease with heat but without yang syndromes, such as described in the classics: mental restlessness with inability to sleep, throat sores with loss of voice, cough with vomiting and thirst, dry mouth and throat, abdominal distension with constipation—these numerous syndromes certainly cannot be treated by Ma Huang Fu Zi Gan Cao Tang, a sweating agent.

Moreover, I have heard that Ma Huang Fu Zi Xi Xin Tang is used for Shaoyin disease presenting with a deep pulse and counter fever. Conversely, Zhang Zhongjing employed Si Ni Tang (Frigid Extremities Decoction) for Taiyang disease (Disease of the Greater Yang) presenting with fever and a counter-deep pulse. Both scenarios are termed "counter." Zhang Zhongjing stated: "When a disease begins with fever and headache, and the pulse is counter-deep, if it does not improve, and body pain persists, one should rescue the interior,适宜 Si Ni Tang." This syndrome appears in the Taiyang chapter. He also stated: "In Shaoyin disease, upon initial onset, if there is counter fever and a deep pulse, use Ma Huang Fu Zi Xi Xin Tang." This syndrome appears in the Shaoyin chapter. Carefully analyzing the Taiyang disease with fever and headache, the pulse should theoretically be floating; the fact that it is counter-deep contrasts with the Shaoyin disease where a deep pulse should theoretically lack heat, yet here there is counter-heat. Zhang Zhongjing uses "counter" in both cases to denote abnormality. Essentially, the Taiyang pulse resembles Shaoyin, and the Shaoyin syndrome resembles Taiyang; hence they are called "counter," and their treatments must differ.

Upon deep investigation, although both present with a deep pulse and fever, the presence of headache classifies it as Taiyang disease. Yang syndromes should exhibit a floating pulse; the failure to float is due to chronic interior deficiency-cold and the decline of righteous qi. With accompanying body pain, rescuing the interior is appropriate to strengthen internal righteousness, forcing pathogens outward; indeed, Gan Jiang (Zingiberis Rhizoma) and Sheng Fu Zi (Aconiti Radix) can also induce sweating to resolve the condition. Had the interior not been deficient and cold, a floating pulse would be seen, fitting the Taiyang Ma Huang Tang syndrome.

Similarly, although both present with a deep pulse and fever, the absence of headache classifies it as Shaoyin disease. Yin syndromes should lack heat; the presence of counter-heat indicates cold pathogens in the exterior that have not transmitted inward, causing heat via stagnation of skin and pores. Since there is no heat in the interior, Ma Huang and Xi Xin are used to release exterior heat, while Fu Zi warms the Shaoyin meridians. Had the cold pathogens entered the interior, there would be no exterior heat, and symptoms like vomiting, diarrhea, and cold extremities would appear, fitting the Shaoyin Si Ni Tang syndrome.

From this perspective, superficial exterior pathogens with counter-fever represent a milder deviation, whereas the decline of righteous qi with a counter-deep pulse represents a more severe deviation. Thus, Si Ni Tang is not inferior in weight to Ma Huang Fu Zi Xi Xin Tang. It further demonstrates that prepared Fu Zi paired with Ma Huang provides tonification within dispersion, while raw Fu Zi paired with Gan Jiang provides dispersion within tonification. The subtlety of Zhang Zhongjing's intent is profound. Alas, treating common diseases with standard methods is known to all. However, when syndromes or pulses change, ambiguity often arises; attempting to apply standard methods in such cases leads to confusion. As discussed by Zhang Zhongjing regarding Taiyang and Shaoyin syndromes, although deep pulse and fever are identical, the etiology and treatment differ. These anomalies in treating excess syndromes reveal the profound subtleties of medical practice, which is why they are mentioned together.