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The *Mai Jing* (Pulse Classic) states: A pulse that is large but forceless upon pressure indicates Yang deficiency; a pulse that is rapid but forceless indicates Yin deficiency. A forceless pulse signifies deficiency, while a forceful pulse signifies excess.

Regarding fever: "Fever" refers to heat accumulating between the skin and muscles, resulting in a sensation of heat. It appears similar to tidal fever (Chao Re) and alternating chills and fever (Han Re), but differs essentially. Tidal fever occurs at specific times without deviation; alternating chills and fever involve chills followed sequentially by fever. In contrast, general fever has no fixed time of onset. Among febrile conditions resembling cold damage (Shang Han), there are several types with distinct treatments; distinguishing between external contraction (Wai Gan) and internal injury (Nei Shang) is crucial. Zhang Zhongjing's discussion on cold damage and wind strike pertains to external contractions. Since wind-cold pathogens invade from the exterior and move inward, treatment should focus on inducing sweating to disperse the pathogen; this is the rationale behind Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). These illnesses typically occur in spring and winter during cold months, manifesting immediately after exposure, hence termed "cold damage," treated with acrid-hot herbs to overcome cold. If the season is not cold, the medication must change. In warm spring months, acrid-cool herbs should be used; in hot summer months, sweet-bitter-cold herbs are appropriate. Thus, it is said that cold damage contracted in winter may not manifest immediately but transforms into warm disease (Wen Bing) in spring or heat disease (Re Bing) in summer, requiring treatment adjustments based on the season. Another condition is winter-warm disease, where abnormal weather prevails. Although winter is cold, plague-like diseases occur due to improper heavenly timing and leakage of Yang Qi; thus, warming herbs are contraindicated. Another type is seasonal cold epidemic occurring in warm weather; despite warmth, cold causes illness due to rebellious Yin Qi from improper timing, making cooling herbs contraindicated. Yet another is pandemic plague, where heat diseases frequently occur in spring and summer, affecting entire households and regions uniformly. This stems from pestilential Qi of heaven and earth; treatment should follow seasonal and cosmic cycles, utilizing Liu Hejian’s acrid-cool and sweet-bitter-cold herbs to clear heat and resolve toxicity. All above conditions result from external contraction of heaven-and-earth pathogens.

If diet irregularity or overwork injures Yuan Qi (Primal Qi), causing true Qi to sink and generating internal deficient heat, Li Dongyuan proposed the theory of tonifying middle and augmenting Qi, using sweet-warm herbs like Renshen (Ginseng Radix et Rhizoma) to greatly tonify Qi and lift sinking Qi, addressing Qi insufficiency with Qi-tonifying herbs. Conversely, mental overexertion or sexual indiscretion injures True Yin; once Yin Blood is damaged, Yang becomes relatively excessive and transforms into fire, leading to consumptive disease (Lai Zhai) characterized by Yin deficiency and hyperactive fire. Zhu Danxi proposed that "Yang is often in excess, Yin is often insufficient," prescribing Siwu Tang (Four Substances Decoction) plus Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to nourish Yin, thereby subduing fire, addressing blood insufficiency with blood-nourishing herbs. Tonifying Qi and nourishing Yin both belong to internal injury patterns. One involves sinking Yang Qi, treated by tonifying and lifting Qi; the other involves rising Yang Fire, treated by nourishing Yin to descend it. One lifts, one descends—completely different approaches. Summerheat injury also exists; though an external contraction, it resembles internal injury and differs significantly from cold damage. Cold damage injures the form/body, with cold pathogens lodging in the exterior, representing an excess syndrome treated by sweating; summerheat injures Qi, depleting Yuan Qi through heat dispersion, representing a deficiency syndrome treated by tonification, as seen in Li Dongyuan’s Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction). Additionally, consuming cold foods during summer heat damages the interior, or seeking excessive coolness damages the exterior; these are self-inflicted due to summer heat rather than direct summerheat pathogen injury. Treatment requires acrid-hot exterior-resolving or acrid-warm middle-regulating herbs, similar to cold damage protocols. Although these syndromes appear similar externally, their natures differ, demanding diverse treatments without confusion. Therefore, one must ascertain if it is cold damage, wind strike, or cold epidemic, then apply Zhang Zhongjing’s methods; if warm disease, heat disease, or warm epidemic, apply Liu Hejian’s methods; if Qi deficiency, apply Li Dongyuan’s methods; if Yin deficiency, apply Zhu Danxi’s methods. This prevents errors and saves lives. Modern practitioners often mistake all fevers for external cold damage, hastily using diaphoretic drugs. If fever persists after sweating, they use cooling exterior-resolving drugs. For deficiency syndromes, this is fatal. Some recognize fever as deficiency and use tonics but fail to distinguish Qi from Blood, tonifying Blood for Qi deficiency or tonifying Qi for deficiency diseases, causing much harm. External contraction vs. internal injury, cold vs. heat, Qi deficiency vs. Blood deficiency are like ice and charcoal. Misdiagnosis turns mild illness severe and severe illness fatal. Caution is essential.

Diagnostic Criteria:
1. Cold damage fever: Cold pathogens enter the Wei (Defensive) level, contending with Yang Qi, causing external heat. Yang governs the exterior; obstructed by cold, it fails its function, causing heat. The pulse is tight and forceful, indicating external cold injuring Wei Qi. Treatment focuses on the exterior.
2. Summerheat injury fever: Fire pathogens injure the Heart, depleting Yuan Qi, with heat pathogens lodging internally, causing fever and profuse sweating. Qi is insufficient to move the pulse, resulting in a deficient, slow, forceless pulse, indicating external heat injuring Ying (Nutritive) Blood. Treatment focuses on the interior.
3. Internal injury fever: Self-injury of Yang Qi prevents its ascent, causing it to sink into the Yin level, generating internal heat (Yang deficiency). The pulse is large and forceless, associated with the Lung and Spleen.
4. Yin deficiency fever: Self-injury of Yin Blood fails to control fire, allowing Yang Qi to ascend (Yang hyperactivity). The pulse is rapid and forceless, associated with the Heart and Kidney.
5. Post-illness Qi and Blood deficiency leads to consumptive weakness, with tidal fever, night sweats, spontaneous sweating, or dry heat without sweat. Laypeople often use Gudupi (Cortex Lycii Radicis) and Chaihu (Radix Bupleuri) with little effect, worsening the condition. For men with Blood deficiency, sweating, and tidal fever, use Renshen Yangrong Tang (Ginseng Nourishing Youth Decoction). For Qi deficiency with sweating and tidal fever, use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). For Blood deficiency with no sweat and tidal fever, use Fuling Buxin Tang (Poria Nourishing Heart Decoction). For combined Qi and Blood deficiency with no sweat and tidal fever, use Xiaoyao San (Free and Easy Wanderer Powder). For cough and hemoptysis, use Renshen Wuweizi San (Ginseng and Schisandra Powder), Guzheng Tang (Bone-steaming Decoction), or Qinggu San (Clear Bones Powder). These are sacred remedies for consumptive fever.

Formulas:
Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction): Treats limb fever in men and women, burning heat in bones and muscles, feeling hot to touch. Often caused by Blood deficiency or stomach deficiency from excessive cold food, suppressing Yang Qi in the Spleen and Stomach. Fire suppression requires dispersal.
Raw Licorice Root (Er qian), Saposhnikovia Root (Er qian wu fen), Honey-fried Licorice Root (San qian), Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Angelicae Pubescentis Radix (Duhuo), Notopterygii Rhizoma et Radix (Qianghuo), White Peony Root (Baishao), Ginseng Radix et Rhizoma (Renshen) (each Wu qian), Bupleuri Radix (Chaihu) (Ba qian).
Crush ingredients, add three slices of fresh ginger, decoct in water. Avoid raw, cold, and cooling foods for about a month.

Siwu Erlian Tang (Four Substances and Two Lianas Decoction): Treats Blood deficiency, consumptive fever, five-palm heat, clarity during day and fever at night. Heat resides in the Blood level.
Angelicae Sinensis Radix (Danggui), Ligusticum Chuanxiong Rhizoma (Chuanxiong), White Peony Root (Baishao), Rehmanniae Radix Preparata (Shengdihuang), Coptidis Rhizoma (Huanglian), Picrorhizae Rhizoma (Huhuanglian).
Crush into one dose, decoct in water.

Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink): Treats fever with dry mouth, red and scanty urine, quiet at night, fever during day. Heat resides in the Qi level.

Jiajian Xiaoyao San (Modified Free and Easy Wanderer Powder): Treats tidal fever at Zi and Wu hours (midnight and noon).
Picrorhizae Rhizoma (Huhuanglian), Ophiopogonis Radix (Maidong), Scutellariae Radix (Huangqin), Cortex Lycii Radicis (Gudupi), Gentianae Macrophyllae Radix (Qinjiao), Akebiae Caulis (Mutong), Plantaginis Semen (Cheqianzi).
Crush into one dose, soak in clear water, decoct with Juncus effusus (Dengxincao).

Jiajian Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction): Treats deficiency with heat in palms and soles. Add to the base formula.
Cyperi Rhizoma (Xiangfu), Coptidis Rhizoma (Huanglian), Peucedani Radix (Qianhu).

Chai Ling Tang (Bupleurum and Wuling Decoction): Treats fever from pathogen transmission to half-exterior/half-interior, internal injury fever, and miscellaneous fevers.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Wuling San (Five-Ingredient Powder with Poria).

Biejia Yin (Softshell Turtle Drink): Treats incomplete recovery of strength post-illness, lingering pathogenic heat, sexual exhaustion, and all bone-steaming night sweats.
Cheloniae Carapax et Plastrum (Biejia), Gentianae Macrophyllae Radix (Qinjiao), Bupleuri Radix (Chaihu), Cortex Lycii Radicis (Gudupi), Aurantii Fructus (Zhiqiao), Anemarrhenae Rhizoma (Zhimu), Angelicae Sinensis Radix (Danggui), Mume Fructus (Wumei).
Crush ingredients, add three slices of fresh ginger and seven each of peach and willow tips. Take on an empty stomach before noon and before bed. Decoct residue again. Avoid alcohol, sexual indulgence, greed, vinegar, fishy smells, roasted/fried foods, taro, yam, pepper, wet dough, and heating substances. Same for men and women.