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There are three types of Shaoyang-like malaria patterns in Shanghan (Cold Damage) disease that require detailed differentiation: namely, Heat Entering the Blood Chamber, Yangming Disease, and Taiyang Disease. (This refers to heat pathogen entering the blood chamber in women, as well as syndromes of the Yangming and Taiyang meridians.)

In the case of Taiyang Disease, presenting with sweating and a flooding pulse, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) should be used. (Zhang Zhongjing stated: In Taiyang disease lasting eight or nine days, resembling malaria with more heat than cold, and normal bowel and bladder functions, Guizhi Mahuang Ge Ban Tang is indicated.)

In the case of Yangming Disease, suddenly recurring like malaria without vomiting, with normal bowel movements but fluctuating fever. If the pulse is deficient and floating, Guizhi Tang (Cinnamon Twig Decoction) is appropriate; if the pulse is excess, Xiaochengqi Tang (Minor Order the Qi Decoction) is indicated. (Zhang Zhongjing stated: When a patient experiences irritability and heat, relief after sweating, followed by recurrence resembling malaria worsening at dusk, it belongs to Yangming. An excess pulse indicates purgation is needed, while a floating-deficient pulse indicates diaphoresis is needed. For purgation, Chengqi Tang formulas are suitable; for diaphoresis, Guizhi Tang is suitable.)

In cases where heat pathogen enters the blood chamber in women causing blood stasis, Dihuang (Rehmanniae Radix) should be added to Chaihu Tang (Bupleurum Decoction). (Zhang Zhongjing stated: In women suffering from Wind-Cold, after seven or eight days, with alternating chills and fever, menstruation having just ceased, and blood coagulation presenting like malaria, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated.)

When both Yin and Yang pulses at the Cun Kou (Radial Artery) are tight, it indicates that both the Upper Jiao (Upper Burner) and Lower Jiao (Lower Burner) are affected by pathogens. (Zhang Zhongjing stated: Tightness in both Yin and Yang pulses at the Cun Kou indicates pathogenic factors affecting the Upper Jiao and turbid pathogens affecting the Lower Jiao.)

Clear pathogens attacking the upper part are termed "Jie" (Clean), while turbid pathogens attacking the lower part are termed "Hun" (Turbid). (Zhang Zhongjing stated: Clear pathogens affecting the upper part are called Jie; turbid pathogens affecting the lower part are called Hun.)

If the Yin aspect is attacked by pathogens, internal shivering and coldness will inevitably occur, accompanied by cold feet and knees, and incontinence of urine and feces. (It is also stated: Attack on the Yin leads to internal shivering. Furthermore, turbid pathogens affecting the lower part cause Yin qi to shiver, resulting in cold extremities and involuntary discharge of urine and feces.)

If the Yang aspect is attacked by pathogens, stiffness of the neck and nape will inevitably occur, along with fever, headache, and spasms of the neck. (Attack on the Yang leads to fever, headache, stiff neck and nape, lower back pain, and soreness of the calves.)

These conditions are caused by injury from fog and dew moisture; treatment must be carefully tailored to the specific syndrome.

There are four distinct patterns presenting with excessive sleepiness: Fengwen (Wind-Warmth), Huhuo (Huoxuo Disease), Chaihu Syndrome, and Shaoyin Disease. One must observe the physical signs and symptoms to distinguish them.

Fengwen presents with body heat and spontaneous sweating. (Zhang Zhongjing stated: In Fengwen, the pulse is floating in both Yin and Yang positions, with spontaneous sweating, heavy body, excessive sleepiness, and snoring breath.)

Chaihu Syndrome presents with fullness in the hypochondrium and stiffness/spasms of the neck. (Zhang Zhongjing stated: In Yangming Wind-Strike, with a string-taut, floating, and large pulse, shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, lethargy, yellowing of the whole body and eyes, difficulty urinating, and tidal fever, Xiao Chaihu Tang is indicated.)

Shaoyin Disease presents with spontaneous diarrhea and a desire only to sleep. (Zhang Zhongjing stated: In Shaoyin Disease, the primary symptom is a desire to sleep; this meridian pattern is the most difficult to differentiate and treat among the Six Meridians, requiring careful examination. However, there are cases without sleepiness. Zhang Zhongjing stated: In Shaoyin Disease, if the patient feels nausea without vomiting and irritability, desires to sleep, and after five or six days develops spontaneous diarrhea with thirst, it belongs to Shaoyin. No formula was listed by Zhang Zhongjing for this specific description. He also stated: If the Shaoyin pulse is faint, fine, and deep, with a desire to sleep, sweating without irritability, and a desire to vomit, progressing to spontaneous diarrhea after five or six days, the appearance of irritability and inability to sleep indicates a fatal prognosis. Furthermore, if there is mental irritability preventing sleep, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated.)

The sleepiness associated with Huhuo disease follows various pathways. (Zhang Zhongjing stated: In Huhuo Syndrome, the patient is silent and desires to sleep, yet cannot sleep when closing their eyes; Xixin Kushen Tang (Arisaema and Sophora Decoction) is indicated. Additionally, the *Yufan Jing* describes a pattern of Combined Three-Yang Disease: with a floating-large pulse prominent at the Guan position, a desire to sleep, and sweating upon closing the eyes.)