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The *Classic of Internal Medicine* states: "Yang deficiency generates external cold." It never mentions fever. External cold is contrasted with "Yin deficiency generating internal heat." In this context, the fever arises because Yang Qi fails to hide and store itself; it is not like fire burning with fuel (which has a root), but rather a flame without a root, known as the "Fire of Dragon and Thunder" (Longlei Huo).

The manifestations of this syndrome include: body heat, pale yellow tongue coating, dry mouth, floating teeth, yet no desire to drink water; the pulse is floating, large, and fills the finger pads, but feels empty and forceless upon deep pressure; the facial complexion is dull and bleak, with slight redness on the cheeks in the afternoon (this is called *Daiyang* or "Floating Yang"); speech is weak; appetite is poor with chest fullness; and stool may also be dry and constipated. If cool/cold-natured formulas are mistakenly administered, there may initially seem to be no harm, but soon the condition will definitely worsen. To treat this syndrome, one must follow its nature to seek treatment, using **Bawei Wan** (Eight-Ingredient Pill / Jin Gui Shen Qi Wan) taken cold. This is because Yin cannot generate without Yang, and Yang cannot attach without Yin. Using **Liujunzi Tang** (Six-Ingredient Rehmannia Decoction) to guide Qi back to the Kidney, and using Cinnamon Twig (*Guizhi*) and Aconite Root (*Fuzi*) to guide Fire back to its source, while taking it cold applies the principle of "treating heat with cold" (using cold administration for hot-natured drugs, i.e., *Re Yin Han Yong*).

I once saw a woman who developed high fever after a miscarriage, with a yellow tongue coating and a large pulse, dry mouth, and no bowel movement for many days. The physician looked only at the superficial symptoms, failing to distinguish between true and false conditions, and prescribed **Baihutang** (White Tiger Decoction) in large doses. Consequently, her bowels moved and the fever subsided slightly, causing great joy among her family. At that time, I had no medical reputation. Hearing their account, I wished to examine her personally and went with them. I said, "In my opinion, this is 'Ge Yang Yu Shang' (Gridlock of Yang in the Upper Jiao/True Cold False Heat). The prescription from yesterday must not be taken again; warm tonification is necessary to achieve efficacy." They asked, "If it is indeed a deficiency syndrome, why did the bowels move and the fever subside after taking medicine yesterday?" I replied, "This constipation is like water freezing solid in winter ponds; the passage was merely a tiny crack. The hyperactive Yang was forced out by the cold-natured herbs. The reduction in fever was also due to the cooling effect temporarily retreating the pathogen. Although the pulse appears floating and large, it is soft like cotton wadding. Urgently administering Bawei Wan might still be too late." They did not believe me. When the physician returned for a follow-up, seeing some initial relief, he continued with the previous formula, adding Ophiopogon Tuber (*Maidong*) and Schisandra Fruit (*Wuweizi*). After another dose, the patient's eyes stared fixedly, she picked at the bedclothes, and she died within a day and night. The regret was irreparable!

Whenever Summerheat Qi prevails, from Minor Heat (*Xiaoshu*) to the Sanfu period, the heat is intense enough to melt stones and flow metal. If before Mid-Autumn Festival, the scorching sun remains strong, residual Summerheat persists. People exposed to this environment sweat profusely, depleting their spirit and essence. Pathogenic factors enter through the mouth and nose, lying latent in the *Moyuan* (Membrane Source). Immediate onset is termed Injury by Summerheat (*Shangshu*) or Collapse by Summerheat (*Zhongshu*), which has been briefly discussed previously. If it does not manifest during the season but lies dormant until early winter, or until the Winter Solstice when Yang begins to recover, it is named Latent Summerheat (*Fushu*).

Its manifestations include: body heat or limb heat, or cough with blood-stained sputum; contracting new cold or suffering from epistaxis and bleeding gums; the Summerheat pathogen has entered the Blood level; mental restlessness and insomnia; profuse sweating; shortness of breath and weakness; a pulse fine as a silk thread, unyielding under heavy pressure; thirst craving frozen beverages; and turbid, reddish urine. Even in cold months, when wearing heavy fur coats, cool/cold-natured formulas should generally be used, combined with Lung-tonifying herbs such as **Shengmaibaihutang** (Lifegiving Pulse and White Tiger Decoction); or herbs like Calcined Gypsum (*Shihui* - note: text says Shihui usually implies Shi Gao, but here likely refers to Talcum *Huashi* given context, however WHO term for 滑石 is Talcum), Forsythia Fruit (*Lianqiao*), Platinum Juice (*Baijin Zhi*), Honeysuckle Dew (*Yinhua Lu*), Watermelon Rind (*Xigua Cui*), White Akebia Stem (*Baitongcao*), Glehnia Root (*Beishashen*), and Ophiopogon Tuber (*Maidong*), etc., can also be adopted. If the latent pathogen has entered the Blood level, only Coptis Rhizome (*Huanglian*) can cure it; auxiliary herbs suitable for addition include Moutan Bark (*Danpi*), White Peony Root (*Baishao*), and Fresh Rehmannia Root (*Xianshengdi*), mixed according to symptoms.

A man surnamed Zhou, over thirty years old, suffered from body heat in early winter, sweating like rain, with no hunger or intake of food, his body so weak he could not sit up. One physician used Dragon Bone (*Longgu*), Oyster Shell (*Muli*), Angelica Sinensis (*Danggui*), and Rehmannia Root (*Dihuang*) to nourish blood and secure/astringe, but the condition worsened daily. I was invited to examine him. His facial complexion was dull and lacked spirit, and his pulse was fine and nearly imperceptible. I asked if he desired frozen drinks. He answered, "I want to, but my family forbids it." I then had someone pour out his urinal; the urine was odorous and red. The patient also stated he had been unable to sleep peacefully for ten days and nights. I said, "This is a case of Latent Summerheat. Ginseng Root (*Renshen*) must be included in the formula." The family declined, citing financial inability. I said, "It can be omitted, but unless you wait a month, he will not be able to walk or stand." They replied, "To ensure safety is our hope; rising late is acceptable." The formula used was **Baihutang** (White Tiger Decoction), added with: Glehnia Root (*Beishashen*, 4 qian) and Ophiopogon Tuber (*Maidong*, 2 qian). After one dose, sweating ceased, and he slept soundly through the night. By midday, all ailments vanished miraculously. He subsequently recovered after a month of recuperation.

Ignorant practitioners often mistake this syndrome for Yang-deficiency Yin-cold patterns and use warm tonics, leading to immediate disaster. Reading this section makes the distinction clear.