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[Quivering of Muscles and Trembling of Flesh]

What is "quivering of muscles and trembling of flesh"? It needs to be elucidated. In cold damage disease, headache, body ache, aversion to cold, and fever are inevitable symptoms. However, "quivering of muscles and trembling of flesh" (muscle twitching) is a rare symptom that occurs only after excessive sweating or profuse sweating. The *Neijing* states: "The function of Yang Qi, when refined, nourishes the spirit; when soft, it nourishes the tendons." Excessive sweating leads to withered and scanty body fluids, extreme deficiency of Yang Qi, and loss of nourishment for muscles and tendons. Thus, there is a quivering sensation; "trembling" refers to muscle twitching.

In Taiyang disease, if the pulse is weak, there is sweating and aversion to wind, Da Qing Long Tang (Great Blue Dragon Decoction) must not be administered. If taken in error, it causes cold limbs, quivering of muscles, and trembling of flesh, which constitutes a therapeutic deviation. In Taiyang disease, after sweating, if the illness does not resolve despite sweating, and the patient still has fever, dizziness, body tremors, and feels as though they want to fall to the ground, Zhen Wu Tang (True Warrior Decoction) should be used. If there is pulsation on the left side, sweating is contraindicated; if sweating is induced, it leads to dizziness, incessant sweating, and quivering of muscles. From this, we see that quivering of muscles and trembling of flesh results from excessive sweating causing the loss of Yang Qi, making Yang deficiency evident. Although this is a deviation caused by mis-treatment, it belongs to exterior deficiency due to Yang loss from sweating, and can be treated by warming the meridians and benefiting Yang. There are also cases where vomiting, purging, or sweating cause both interior and exterior deficiency, leading to these symptoms; such cases cannot be equated with those resulting solely from excessive sweating. The Classics state: "After vomiting and purging in cold damage, followed by sweating, leading to empty irritability and a very faint pulse; after seven or eight days, epigastric fullness and hardness, pain under the ribs, Qi rushing up to the throat, dizziness, and tendon quivering, which eventually becomes flaccidity syndrome over time." This is a severe deviation. In Taiyang disease, after sweating and subsequent purging, causing both interior and exterior deficiency, if moxibustion (burning needle) is added, leading to chest irritability, greenish-yellow complexion, and skin tremors, it is difficult to treat. This is also a severe deviation. How can sweating, vomiting, and purging be neglected?

[Heat Entering the Blood Chamber]

What is "heat entering the blood chamber"? It needs to be elucidated. "Chamber" refers to a room, a place where things can stay. The human "blood chamber" is the place where Ying (Nutritive) blood stays and meridians converge, which is the Chong Mai (Penetrating Vessel). The Chong Mai is one of the Eight Extraordinary Vessels. It originates below the kidney, emerges at Qichong (ST30), runs alongside the Foot-Yangming Stomach Meridian, ascends flanking the navel to the chest where it disperses, and serves as the Sea of the Twelve Regular Meridians. Wang Bing stated: "The Chong is the Sea of Blood," meaning blood from all meridians converges here. In men, it circulates to generate essence; in women, it transforms upward into milk and downward into menstruation. The *Neijing* states: "When the Ren Mai is unobstructed and the Chong Mai is vigorous, menstruation arrives on time." Wang Bing said: "Yin is quiet; when the sea is full, blood flows out," meaning the Chong Mai is vigorous like a full sea. From this, it is clear that the Chong Mai is the blood chamber.

Pathogenic factors of cold damage enter women via the meridians, while in men, they transmit via the Yangming channel. Since the Chong Mai and the collaterals of Shaoyin originate in the kidney, when women contract pathogens, Taiyang pathogenic factors follow the meridians and enter the Chong Mai, connecting with the Foot-Yangming. In men, internal heat in Yangming allows entry. When the Chong Mai receives heat, blood will move recklessly. In men, this manifests as bleeding from below and delirium; in women, it manifests as the onset of menstruation. Yangming disease presenting with bleeding and delirium indicates heat entering the blood chamber; this refers to men, not just women. When women suffer from cold damage, whether menstruation is just beginning or has just ended, it is because Qi and Blood are deficient during the menstrual period, the uterine chamber is open, and pathogens take advantage of the deficiency to enter. The *Lingshu* states: "Pathogens cannot injure the body alone without existing deficiency."

In women, heat entering the blood chamber may require treatment to heal, or it may heal spontaneously; the situations vary. If a woman suffers from Wind Strike with fever and aversion to cold, and menstruation begins, after seven or eight days, the fever subsides, the pulse slows, the body feels cool and harmonious, but there is fullness under the chest and ribs resembling Jie Xiong (Chest Binding) syndrome, accompanied by delirium, this is heat entering the blood chamber. One should puncture Qi Men (LR14) to drain excess according to the timing. If menstruation has just ceased, this is heat entering the blood chamber, and the blood must be congealed, causing symptoms resembling malaria with periodic occurrences; Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used. These two cases require treatment to heal.

If a woman suffers from cold damage with fever, and menstruation begins, she is lucid during the day but delirious at night, seeing ghosts, this is heat entering the blood chamber. Do not violate the Stomach Qi or the Upper and Middle Jiao; it will heal spontaneously. This is a case that heals without treatment. Delirium indicates severe pathogenic factors, so why does it heal without treatment? Fullness under the chest and ribs, resembling Jie Xiong and delirium, indicates pathogenic factors lingering and binding in the chest and ribs; one must puncture Qi Men to drain the excess. Chills and fever resembling malaria with periodic occurrence indicate blood stagnation; Xiao Chai Hu Tang is needed to disperse it. Both cases have lingering pathogens and require treatment. However, if fever coincides with the onset of menstruation, with lucidity by day and delirium by night, since menstruation has started, there are no lingering pathogens inside. As long as one does not interfere recklessly, the heat dissipates with the blood, and it will heal spontaneously. The Classics state: "If blood flows down spontaneously, healing follows." Therefore, do not violate the Stomach Qi or the Upper and Middle Jiao; it will heal spontaneously. "Reckless interference" refers to mistakenly treating delirium as Yangming Interior Excess and using purgatives, thereby violating Stomach Qi. Here, there is no chest/rib pathology, so puncturing Qi Men would violate the Middle Jiao. Here, there is no blood congealment, so using Xiao Chai Hu Tang would violate the Upper Jiao. Xiao Chai Hu Tang has a dispersing action that disturves Wei (Defensive) Qi, which originates from the Upper Jiao; disturbing Wei Qi violates the Upper Jiao. Puncturing Qi Men disturbs Ying (Nutritive) Qi, which originates from the Middle Jiao; disturbing Ying Qi violates the Middle Jiao. The *Mai Jing* states: "Do not violate the Stomach Qi or the Upper and Middle Jiao." Does this refer only to herbs and not acupuncture? This is likely the reasoning.