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In cases where a heat disease is about to produce profuse sweating but instead presents with chills and rigors,
the ancients considered that among the hundred diseases, only Typhoid (Shanghan) was called a "major disease," which is what colloquially referred to as the "sweat disease." The classics refer to "profuse sweating" not as spontaneous sweating caused by pathogenic heat flowing out in large amounts, but rather as follows: after Yang Qi has been constrained, heated, and stagnant, once it obtains release, dispersion, and unblocking, it steams and produces sweat; this is termed "profuse sweating." It is called a major disease because the Qi of constrained heat and pathogenic toxins has stagnated to an extreme degree before manifesting as sweat, hence the term "profuse sweating." Therefore, the classics state: "When the great Qi (pathogenic factor) has departed, the illness is resolved."

When the righteous Qi at the exterior and pathogenic heat both intensify within the interior, and excessive heat reaches its peak, it may paradoxically undergo a transformation resembling Water to restrain it; thus, cold trembling occurs instead. ("Transformation" refers to the natural processes of creation and change.)
The classics state: "When Shaoyin [Kidney/Ministerial Fire] Qi arrives, it causes fright, or aversion to cold with rigors, delirium." This indicates that these conditions arise from the arrival of Shaoyin Ministerial Fire and Heat Qi. Furthermore, the classics say: "Various cases of locked jaws, tremors, and loss of spiritual control all belong to Fire." The commentary notes: "This is due to heat acting internally." "Locked jaw" (Jin) is commonly written as "Jin" (clamping), referring to bodily shaking and movement. This describes locked jaws, cold tremors, and paradoxical chills. The classics state: "Excess leads to harm; restraint brings balance." This explains the principle of the Five Elements: when subtle, it adheres to its original transformation; when excessive and hyperactive, it paradoxically adopts the transformation of the element that overcomes it to restrain the excess. Laozi said: "The Way of Heaven is like drawing a bow; it lowers what is high." This is that principle. The classics state: "Water is characterized by stillness and compliance." Meaning it is quiet and non-action-oriented, merely complying with the nature of things. Its form does not contend with other things, making it extremely compliant. Water is inherently cold; when cold reaches its extreme, water freezes like earth, yet can bear weight. The classics also say: "When Water Qi mobilizes, hail and snow occur." This means when Water-Cold is hyperactive to the extreme, it paradoxically resembles the transformation of Earth (which controls Water); this is called "paradoxical transformation." Thus, when illness reaches extreme cold, the body may feel rigid and full. Earth governs dampness, cloud and rain, and tranquility; when rain-dampness becomes excessive, it scatters violently, which is a paradoxical adoption of Wind-Water Qi to restrain Earth-Dampness. Hence, the classics state that spasm results from extreme dampness but paradoxically resembles a Wind-strong condition. Wood governs growth and prosperity in Spring; its Qi is moist, its root is Wind. When Wind is strong, it paradoxically turns cool and causes destruction, adopting Metal's transformation to restrain its root. Thus, when Wind pathology is extreme, there is dryness and astringency inside and out, skin cracking and peeling, and paradoxically, Qi and Blood circulation becomes dry and astringent with tendon spasms and flaccidity; this is a paradoxical adoption of Metal's transformation. Metal governs Autumn and belongs to Yin; its Qi is cool. When coolness reaches its extreme, the weather becomes clear, and things paradoxically become dry. Nothing is drier than Fire; thus, when Metal is extreme, it paradoxically adopts Fire's transformation to restrain it. In illness, if blood is deficient and Dry-Metal transformation is extreme, heat paradoxically appears. Nothing is drier than Fire. In summer, when Fire is abundant and heat is extreme, the weather may become murky, yet things paradoxically become moist as fluids are produced, trees exude sap, and the human body, when extremely hot, paradoxically sweats. Fire refining Metal, extreme heat transforms into Water; this is Fire reaching extremity and paradoxically adopting Water's transformation to restrain it. Thus, when illness heat is extreme, five types of dampness may appear. Women may suffer from leukorrhea dripping, cold limbs, aversion to cold with rigors, or paradoxical cold pain. Laypeople directly call leukorrhea a cold disease, and associate aversion to cold with rigors with Yin-Cold; lay physicians do not understand this. Heavenly Dao and creation follow principles: mild illness conforms to its original transformation (Cold shows Water transformation, Heat shows Fire transformation). Severe illness paradoxically resembles the transformation of the element that overcomes it. For example, extreme cold resembles Wet Earth, and extreme heat resembles Cold Water. Alas! In the most severe cases of the hundred diseases, symptoms paradoxically resemble their opposites. Lay physicians fail to seek the fundamental Qi of the illness, suspecting variously without knowing the true source. Forced to do so, they treat based on the illusory signs of paradoxical transformations, inadvertently aggravating the illness and harming life frequently. Consequently, the world claims that when illness reaches critical extremity, Yin and Yang reverse and cannot be distinguished. Little do they know that by deducing from the principles of Luck and Creation, no matter how myriad the changes, the essence remains one. How could there be distinctions of difficulty? Therefore, the classics state: "The Way of Root and Branch is concise yet extensive, small yet large; knowing one allows understanding the harm of a hundred diseases." The classics further state: "One who speaks well of beginnings must consider endings; one who speaks well of near things must know far things." This is having the supreme numbers and the Way without confusion, which is called enlightenment. Thus, Laozi said: "Without looking out the window, one sees the Heavenly Way; without stepping outside, one knows the World. The farther one goes out, the less one knows." This is the difference between knowing the essential and not knowing the essential. The ancient sages said: "Paradoxical yet conforming to the Dao." This means the ancient sages' Heavenly Principle and Great Dao align, while ordinary worldly minds are opposite. However, the ancient sages' Dao does not separate from the mundane; it encompasses the mundane and enters it. It is also said that the mundane separates itself from the Dao because ordinary people cannot align with the Dao. The mundane has forms, while the Dao is originally formless. Just like the changes of the Five Elements: when subtle, it keeps constancy, and the original transformation reveals itself; this is the formed mundane, where transformation reveals itself. When severe, it paradoxically resembles the transformation of the overcoming element; this is formless, paradoxical yet conforming to the Dao, called Change. It takes change from the form of the original transformation and paradoxically reveals the overcoming transformation. The ways of change are manifold; this is merely the external change of subtle versus severe. Thus, the Immortal Classics say: "The Great Dao seems unlike anything; Great Virtue seems insufficient." It hides its original form internally and paradoxically changes into the overcoming transformation externally, appearing formless, thus being paradoxical yet conforming to the Dao. If viewed through the Eye of Dao, one seeks the interior; if viewed through worldly eyes externally, one follows forms and shifts, never grasping the essence. Therefore, the Sacred Texts discuss heavenly and earthly changes, aligning with the Dao and leaving no dissatisfaction for the mundane. But compiling formulas and theories based on worldly views deviates from the principle, catering only to worldly hearts. This causes later generations to follow explanations, mistakenly thinking themselves enlightened, while remaining ignorant of the profound truths of the Sacred Texts. Patients suffer innocently, meeting untimely deaths. Sigh! What a pity. As the classics state: "Yang excess leads to heat, Yin excess leads to cold." Laypeople directly interpret this as Yang-Heat Qi excess causing fever, and Yin-Cold Qi excess causing cold; this is the original intent of the classics. Here, it discusses the deficiency and excess of Righteous Qi of Yin-Yang in the interior and exterior. It states that when Righteous Qi is in excess, there is no illness; when not in excess, there is illness. Thus, the classics say: "Yin excess leads to Yang pathology; Yang excess leads to Yin pathology. Yang excess leads to heat; Yin excess leads to cold." This means the Righteous Qi of Exterior Yang is not ill, while the Righteous Qi of Interior Yin is deficient and susceptible to illness. Conversely, if Interior Yin Righteous Qi is in excess, it is not ill; if Exterior Yang Righteous Qi is deficient, it becomes ill. These describe heat located in the parts of Exterior-Interior and Yin-Yang. However, if the pathological excess is in the interior, it is Yang excess and Yin deficiency; the illness should present with fever. Thus, fever indicates heat in the interior. In Yang excess and Yin deficiency, purgation leads to recovery, while diaphoresis leads to death. If Exterior Heat is present but the Interior is harmonious, the illness should present with aversion to cold; this is Yin excess and Yang deficiency. Diaphoresis leads to recovery, while purgation leads to death. Therefore, heat in the exterior is Yin excess and Yang deficiency; the mentioned "cold" of aversion to cold is indeed cold. Heat in the interior is Yang excess and Yin deficiency; the mentioned "heat" of fever is indeed heat. Thus, in Typhoid, exterior heat causes aversion to cold and requires diaphoresis; interior heat causes fever and requires purgation. The classics also state: "Repeated cold leads to heat, repeated heat leads to cold." This does not mean that extreme cold pathologically transforms into heat. "Repeated" here implies two stages of aversion to cold. First, exterior heat with aversion to cold constitutes one cold; if Interior Yang-Harmony and Righteous Qi emerge to the exterior, another stage of aversion to cold occurs. This is "repeated cold," which paradoxically results in no aversion to cold but rather fever. If Exterior Righteous Yang Qi merges with pathogenic heat into the interior, it constitutes two stages of fever; paradoxically, there is no fever but rather locked jaws and cold rigors. This paradoxically describes Yang-Harmony and Wei Qi merging into the Exterior Yang portion, where the pathological Qi's excess is Yang excess. If Pathological Qi and Wei Qi merge excessively into the Interior Yin portion, it is Yin excess. This again discusses the merging of Righteous Qi and pathogenic heat in Exterior-Interior Yin-Yang, expressed as deficiency and excess. When pathogenic heat is in the exterior, there is aversion to cold and heat; when it merges with Interior Wei Qi in the exterior, there is paradoxical irritability and heat. When pathogenic heat is solely in the interior, there is fever; when Exterior Righteous Qi merges with pathogenic heat in the interior, there is paradoxical cold rigors. Thus, the classics state: "Yang deficiency leads to exterior cold; Yin deficiency leads to interior heat." This refers to cases without merging. Righteous Qi is deficient and receives pathogenic heat, hence termed deficiency. It also states: "Yang excess leads to exterior heat; Yin excess leads to interior cold." This refers to cases with merging. Regarding the division of Exterior-Interior Yin-Yang, depending on where pathogenic heat resides, the Harmonious Righteous Yang Wei Qi merges with pathogenic heat, becoming the site of illness. Righteous Qi turns substantial and not deficient. Hence, the classics speak of "excess." The classic *Neijing·Malaria Treatise* states: "When Yang Qi merges into Yin, at that time, Yang is deficient and Yin is abundant, with no Qi on the exterior, hence first comes cold trembling. When Yin Qi reverses to the extreme, it emerges back into Yang. Yang and Yin merge again on the exterior, leading to Yin deficiency and Yang abundance, hence first comes heat and thirst." It also says: "Merging into Yang leads to Yang excess; merging into Yin leads to Yin excess. Yin excess leads to cold; Yang excess leads to heat." This discusses the deficiency and excess of Heat Qi in Exterior-Interior Yin-Yang, not the deficiency and excess of Cold-Heat Yin-Yang. Thus, the classics state: "Illness in Yang presents with heat and rapid pulse; illness in Yin presents with cold and quiet pulse." When Qi merges inward and there is no Qi outward, cold rigors occur; the pulse cannot become rapid, becoming deep, fine, nearly imperceptible, quiet, or invisible. Malaria arises when pathogenic heat merges with Wei Qi; it stops when they do not merge. Thus, the classics state: "When Wei Qi separates, the illness rests; when Wei Qi gathers, the illness returns." It also says: "Yin deficiency and Yang abundance lead to heat; when declining, Qi returns inward, leading to cold." This only discusses that non-merging of Exterior-Interior Yin-Yang Qi is deficiency, while merging is excess. The Qi causing the illness is essentially Heat. Laypeople do not understand this, directly interpreting "Yin excess leads to cold" from the classics, failing to grasp the meaning that heat illness paradoxically presenting with aversion to cold and rigors is not a Yin-Cold illness. This error has persisted for a long time. True Yin-Cold illnesses present with slow, fine pulses, no irritability or thirst, clear urine, foul vomiting/diarrhea, inability to flex/extend, cold limbs with locked joints, body cold without heat, no aversion to cold, and no rigors. Thus, the classics state: "People often have Qi pathology; Yang is scarce, Yin is abundant, hence the body feels cold as if emerging from water." It also says: "A person feels cold; hot water and fire cannot warm them, thick clothing cannot warm them, and they do not shiver." This is Yin-Cold illness, described simply as feeling cold without shivering. Yang moves, Yin is still; thus, the classics state: "Rigors and movement are caused by Yang-Heat Fire Qi." Paradoxical coldness occurs because "Excess leads to harm; restraint brings balance." Extreme Heat-Fire paradoxically resembles Cold Water. Thus, patients with cold rigors paradoxically feel thirsty, and those with miscellaneous diseases and cold rigors often have dry feces. When healthy individuals are exposed to cold and shiver, Cold governs storage and closure. External exposure to Cold causes internal Heat constraint. Exterior Yang-Harmony and Wei Qi, forced inward by external Cold, cause Yang to merge into Yin, resulting in cold rigors. Extreme fear causes rigors; the classics state that the Five Emotions at excess damage the corresponding Zang organs, and Fear corresponds to Kidney. Thus, the classics state: "Fear injures the Kidney." When Kidney is injured and deficient, Heart Fire naturally becomes excessive and hot. The classics also state: "Fear causes Qi to descend." Yang governs movement and expansion; thus, the emotion of Joy (Heart Fire) makes body and mind expansive. Yin governs storage; thus, the emotion of Fear (Kidney Water) makes body and mind contracted. Fear causes Kidney deficiency and Heart excess-heat. Righteous Qi stores and sinks into the interior; this is also Yang merging into Yin, causing cold rigors. After drinking alcohol, locked jaws and rigors occur because intestinal-stomach alcohol-heat has not dissipated, while surface alcohol power has faded. Yang-Heat easily accumulates and enters the interior. Thus, even slight cold exposure causes Yang to merge into Yin, resulting in cold rigors. When desiring to sweat but experiencing cold rigors, Typhoid progresses deeply, exterior signs cease, and heat accumulates in the interior, causing fever. If Exterior-Interior Righteous Qi merges into the interior, Fire-Heat becomes boundless, paradoxically causing cold rigors. Yang-Heat Qi in the Yin portion, reversing to the extreme, emerges as Yang, causing irritability and profuse sweating.
What the world calls "Jiao Yang" (Crossing Yang) is not Yin-Cold crossing into Heat to become Yang-Heat, but rather constrained heat accumulating in the interior, stagnating to the extreme, then crossing out to the Exterior Yang portion. This is "Jiao Yang," followed by sweating. If constraint stagnates excessively and cannot cross to the exterior, stagnation does not release, misfortune does not turn to fortune. Righteous Qi becomes depleted, Yin Qi perishes first, then Yang Qi perishes last, leading to death. When desiring to sweat, if the pulse suddenly becomes deep and fine or invisible, it is because Exterior Righteous Yang Qi has merged into the interior. Crossing Yang with agitation and coma occurs because interior heat stagnates to the extreme, attempting to emerge. Due to constraint, Yang Qi cannot exit at the extreme; Qi becomes chaotic, Spirit departs, and restlessness ensues. Whenever sweating is about to occur, regardless of illness severity, whether recently purged or purgation signs are incomplete, always regulate with Li Ge San (Cool the Chest Powder). For severe cases, use Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity). If two to three days post-purgation, or unpurged, with abdominal fullness, irritability, thirst, deep-solid pulse, and purgation signs, use San Yi Cheng Qi Tang (Three-One Bowel-Relieving Decoction) to purge. For malignant trends, add Huang Lian Jie Du Tang to purge. If rigor was ineffective, post-rigor sweating is ineffective, or slight rigors occurred multiple times but major rigors failed to produce sweat, it is because merging was not intense and illness progression was slow. Generally, use San Yi Cheng Qi Tang, or add Huang Lian Jie Du Tang to purge, to dissipate constrained heat and resolve stagnation. The general rule states: "Floating pulse prohibits purgation." In Typhoid, if interior signs exist and pulse is deep, purging resolves interior signs; if interior signs persist and pulse gradually floats, but after one or two days sweat cannot emerge, interior signs are constrained, release is not vigorous, and illness is resolving, use San Yi Cheng Qi Tang to mildly purge. Among these purgable cases, some recover with sweating and bowel movement after gaining stool; some experience sudden release of constraint after medication, sweating first then having bowel movements; some have bowel movements following sweat, where discharge harmonizes Qi and restores health without further purgation. Those who die without effective sweating or crossing are due to extreme interior heat unable to release. Thus, one commonly uses cold-natured herbs or purges constrained heat to avoid mistaking sweating for the cure, which would allow pathogenic heat to consume Yin Qi and cause death. If sweating occurs without rigors, it is because fluids are not exhausted and Yang does not merge into Yin. If rigors occur without sweating but self-heal, it is because fluids are already depleted. Due to prior diaphoresis, emesis, purgation, or spontaneous sweating/vomiting/diarrhea, fluid loss was excessive, leading to fluid exhaustion. No fluids remain to produce sweat; health returns through Qi harmony alone. If no rigors, no sweat, but self-heals, it is because Yang does not merge into Yin (no rigors) and fluids are depleted (no sweat).
Laypeople do not understand, directly naming aversion to cold and rigors as Yang-Heat Qi deficiency and Yin-Cold excess, treating accordingly, causing much harm.