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The patient feels intense heat in the body but desires to keep clothing on; this indicates that heat is at the skin level (superficial) while cold is at the bone marrow level (deep). The patient feels intense cold in the body but does not desire to keep clothing on; this indicates that cold is at the skin level (superficial) while heat is at the bone marrow level (deep).

These conditions belong to internal causes, not external contraction, nor are they related to the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). The disease resides in the physical form and trunk, not involving the Zang-Fu organs, nor invading the meridians. Therefore, there are no Six Meridian (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) pulse and syndrome patterns to rely upon, and it is not constrained by the seasonal climate's cold or heat. This disease lies only in the bone marrow, not in the skin. The terms "skin" and "bone marrow" regarding cold and heat here refer to the seasonal climate, not the disease location. The two uses of the character "body" (Shen) refer to the body being subject to the current season. If referring to disease location, one could not say that the bone marrow is not part of the body. Wind-Cold pathogens acquired suddenly have no fixed form. Some present with fever and aversion to cold, some with heat inside the bones and cold in the Zang-Fu, some with cold hands and feet but heat in the intestines and stomach, some with cold inside and out, and some with heat in both exterior and interior. This is caused by the gradual accumulation of pathogens in the bone marrow, hence having no fixed form. The cold from Cold Damage (Shanghan) and Wind Strike (Zhongfeng) is the pathogenic qi of the season; thus, those who contract it fear and dislike it. However, this extreme heat and cold are the righteous qi of the season. Since the disease is not exogenous, the patient actually desires it. The fever from Cold Damage and Wind Strike is the body's own Yang Qi, which can contend with Cold Qi. But the cold and heat in the bone marrow are gradually accumulated latent pathogens; thus, even when encountering the season's extreme cold or heat, they cannot be eliminated. When the season is extremely hot, the body desires extra clothing; when the season is extremely cold, the body desires to be naked. This is because the disease is in the bone marrow, differing from diseases affecting Ying and Wei (Nutritive and Defensive Qi). The treatment method should employ Liuwei Wan (Six-Ingredient Rehmannia Pill) and Bawei Wan (Eight-Ingredient Aconite Pill) to tonify the True Yin and True Yang in the Kidney, so that the accumulated heat and stubborn cold in the bone marrow may gradually subside. The water-attack method attributed to Yuan Hua and Si Bo can only serve as a topic for discussion and should not be followed.

Q: "Why does a patient experience shivering aversion to cold followed by fever?" A: "When the Yin pulse is deficient, Yang moves to follow it; when the Yang pulse is deficient, Yin moves to invade it." Q: "What is meant by Yang deficiency?" A: "If the Cun (inch) position of the pulse is faint, it is called Yang deficiency. When Yin Qi ascends into the Yang region, it causes shivering aversion to cold." Q: "What is meant by Yin deficiency?" A: "If the Chi (cubit) position of the pulse is weak, it is called Yin deficiency. When Yang Qi sinks down into the Yin region, it causes fever."

The previous condition was in the bone marrow, so the symptoms were fixed and immobile; this condition is in the meridians, so the cold and heat alternate repeatedly. However, this differs from the alternating cold and heat caused by external contraction, and from the chattering teeth and trembling seen in Malaria (Nüe Ji). Diseases causing aversion to cold and fever due to external contraction must present with excess pulses; diseases causing aversion to cold and fever due to internal causes present entirely with deficient pulses. Seeing deficient pulses means that the cold is indeed Deficient Cold, and the heat is also Deficient Heat. The Cun position is governed by Yang. A faint Cun pulse indicates a lack of Yang, meaning the Yang pulse is deficient; thus, the Yin-Cold from the Lower Jiao ascends to invade the Yang position, causing shivering aversion to cold. The Chi position is governed by Yin. A weak Chi pulse indicates Blood deficiency, meaning the Yin pulse is deficient; thus, the Empty-Yang from the Upper Jiao sinks into the Yin region, causing fever. The Yin and Yang Qi of the human body are mutually rooted, yet Yang is primary. Therefore, if the Yang pulse is faint, the Yin pulse will also be weak. Initially, Yin invades Yang causing aversion to cold; when Yin is unbalanced, Yang cannot be secured, leading subsequently to Yang following Yin and causing fever. Since Yang is invaded by Yin, the Yang pulse shows deficiency, and the Yin pulse does not show excess. Although Yang is faint, it can still generate heat and will not remain solely in aversion to cold, still adhering to the principle that Yang paths are solid and Yin paths are empty. If Yang collapses, Yin cannot exist alone; therefore, treatment must urgently support Yang. The formula Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) has the greatest efficacy in this regard.

If the patient's pulse is faint and choppy, this is iatrogenic injury. Profuse sweating followed by repeated purgation leads to loss of Blood (Wang Xue). The patient should experience aversion to cold, followed by continuous fever without cessation. In the height of summer heat, the patient desires thick clothing; in the depth of winter cold, the patient desires to be naked. The reason is that faint Yang causes aversion to cold, and weak Yin causes fever. The doctor induced sweating, making Yang faint, and performed severe purgation, making Yin weak. In the fifth month, Yang Qi is at the exterior, and the Stomach is cold and deficient. Because internal Yang is faint and cannot overcome the cold, the patient desires thick clothing. In the eleventh month, Yang Qi is in the interior, and the Stomach is vexed and hot. Because internal Yin is weak and cannot overcome the heat, the patient desires to be naked. Furthermore, the slow and choppy Yin pulse confirms the loss of Blood.

Chills preceding fever, with faint Yang and weak Yin, presents symptoms identical to the above. The previous case's cause was deficiency in the blood vessels; this case's cause was reckless use of sweating and purging methods, resulting in blood loss and a faint-choppy pulse. The four sentences about summer describe the state during the onset of cold and heat. Initially, there is aversion to cold; even in midsummer, the patient desires thick clothing. Subsequently, there is fever; even in deep winter, the patient desires to be naked. This is a hypothetical scenario; do not interpret "continuous without cessation" as spanning across winter and summer seasons. After discussing the doctor's erroneous sweating and purging, re-explaining the previous point is superfluous.

This clause can be divided into four syndromes: 1. Alternating cold and heat incessantly like malaria is one syndrome. 2. Internal Yang deficiency, presenting only with aversion to cold without fever, desiring thick clothing despite peak summer heat, is another syndrome. 3. Internal Yin weakness, presenting only with fever without aversion to cold, desiring to be naked despite deep winter cold, is another syndrome. 4. Experiencing these states continuously through winter and summer, feeling cold in peak summer and hot in deep winter, is another syndrome. These variations depend on the thickness or thinness of the Original Qi (Yuan Qi), determining the depth of the cold and heat manifestations.