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Fever may arise from Yang Qi sinking into the Yin aspect, or from Yang Qi floating on the exterior. When Yang sinks into Yin, the heat manifests from the Yin aspect reaching the Yang aspect; it resembles the fever of malaria (Malaria), but is essentially different. This is due to the contention between Yin and Yang, where Yang is trapped in Yin, resulting in fever without chills. If one solely uses diaphoretic drugs (Diaphoretics) to release the exterior, the medicinal force will dissipate through the Yang aspect, making it impossible to enter the Yin aspect to guide the Yang pathogen out. In such cases, Sun Simiao's Chaihu Meilian San (Bupleurum and Picrorhiza Decoction) is appropriate. The logic is that Wumei (Chinese Plum Fruit) and Huanglian (Coptis Rhizome) restrain Chaihu (Bupleuri Radix), guiding it into the Yin aspect to expel the pathogen to the Yang side, thereby eliminating the pathogen. (See "Differentiation of Various Fevers in Children".)

When Yang floats on the exterior, it indicates deficiency in both the interior and exterior, with Yang Qi failing to return to its root and floating outward. In this case, Liushen San (Six-God Powder) decocted with Oryza Sativa Germ (Jingmi, Rice Kernel) should be used. This harmonizes Stomach Qi, allowing Yang Qi to return inward, and the body temperature naturally cools. (See "The Raft for Nurturing Infants".) These two conditions differ: one is related to external contraction (External Contraction), and the other to internal injury (Internal Injury). Clinicians must examine them carefully.

Chaihu Meilian San consists of: Chaihu (Bupleuri Radix) and Qianhu (Peucedani Radix), each 3 qian; Huhuanglian (Picrorhizae Rhizoma) and Wumei (Chinese Plum Fruit), each 1 qian. The herbs are chopped. Take 1 qian of the mixture, along with one cup of children's urine (Tongbian), one pig stomach (Zhudu), one pig spinal cord (Zhujisuin), and half a qian of leek root white (Jiu Gen Bai). Decoct together and take warm at any time.

Liushen San consists of: Sijunzi Tang (Four Gentlemen Decoction) plus Shanyao (Dioscoreae Rhizoma), Biandou (Lablab Album Seed) soaked in ginger water, shelled and stir-fried; Wei Jiangsheng (Prepared Ginger); and Dazao (Zizyphi Fructus).

Wang Mengying was meticulous in his reading and possessed unique insight. For instance, in discussing Yu Huaxi's treatment of night fever, he alone identified errors made by predecessors. This is detailed in "Selected Cases of Ancient and Modern Medicine" and is recorded here in full.

Yu Huaxi treated a woman in her forties who suffered from fever at night which subsided in the morning, accompanied by constant five-palm heat (Five-palm Heat). After six months, Yu palpated her pulse: all six positions were rapid, deep, hidden, and firm; superficial pressure elicited no response. He prescribed Dongyuan's Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction). After four doses, the fever reduced by more than half, and she felt significantly clearer and more comfortable in the chest. Two additional doses cleared the fever completely. Subsequently, using Siwu Tang (Four Substances Decoction) added with Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex), with a small amount of stir-fried Ganjiang (Zingiberis Rhizoma Recens) as an assistant, she took over twenty doses and recovered.

My commentary: Night fever with a rapid pulse indeed indicates Yin deficiency. However, because the pulse was deep, hidden, and firm, with no response to superficial pressure, Shengyang Sanhuo Tang was effective, and the treatment concluded with Yin-nourishing drugs. Nevertheless, if Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) or Shengdi (Rehmanniae Radix), Shudi (Rehmanniae Radix Preparata), Tiandong (Asparagi Radix), and Maidong (Ophiopogonis Radix) were used, they would certainly fail. The brilliance lies in combining Xiong (Chuanxiong Rhizoma) and Gui (Angelicae Sinensis Radix) with Zhimu and Huangbai, and employing the counter-treatment method of stir-fried Ganjiang. Wang Mengying stated: The heat resides in the Blood aspect. Mismanaged for half a year, the heat became deeper and more concealed, hence the pulse and symptoms appeared thus. Using Shengyang Sanhuo represents the principle of "dispersing fire stagnation" (Fire Stagnation). Later, using stir-fried Ganjiang to assist Siwu Tang and Zhimu/Huangbai served as a specific formula for diseases in the Blood aspect. This differs from the treatment of heat generated by Yin deficiency, which requires Yin-nourishing methods; misapplying either leads to harm.

Jiang's annotations and Yu's discussions lack clarity, which explains why mediocre practitioners discuss herbs rather than disease patterns.

Feng Chuzhan said: Tidal fever (Tidal Fever) has Yin and Yang distinctions. Tidal fever occurring at dawn, from Yin hour to Shen hour, corresponds to the circulation of Yang Qi for twenty-five degrees, when all Yang meridians are active. The heat is in the Yang-circulating aspect, governed by Lung Qi. Tidal fever occurring at dusk (Ribu), from Shen hour to Yin hour, corresponds to the circulation of Yin Qi for twenty-five degrees, when all Yin meridians are active. The heat is in the Yin-circulating aspect, governed by Kidney Qi. The former is treated by clearing the Lung, the latter by nourishing the Kidney. If tidal fever is caused by Qi deficiency, Renshen (Ginseng Radix), Huangqi (Astragali Radix), and Shufu (Aconiti Lateralis Radix Preparata) are used, illustrating that "warmth can eliminate great heat." If tidal fever is caused by blood dynamics issues, Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba), and Gupi (Lycii Cortex) are used, illustrating that "nourishing Yin retreats Yang." His discussion on tidal fever is quite detailed. As stated in Shanghan Lun (Treatise on Cold Damage Disorders): "Ribu tidal fever" occurs because the Yangming channel governs the Shen, You, and Xu hours. Therefore, stating that Yang circulation is governed by Lung Qi and Yin circulation by Kidney Qi is a generalized statement and should not be taken rigidly.