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Ulcerative sores presenting with fever and irritability, or resulting from excessive bleeding, or profuse discharge of pus after ulceration, or excessive sweating leading to the loss of Yang Qi, or excessive purgation leading to the loss of Yin fluids, result in the consumption and dispersion of Yin blood. At this point, Yang Qi has no foundation to rely upon and floats and scatters between the muscle and skin layers; this is not due to Fire (excess heat). If there is fever accompanied by insomnia, it indicates Blood deficiency (Xue Xu), treated with Shengyu Tang (Sage-Enhancing Decoction). If accompanied by incessant sweating, it indicates Qi deficiency (Qi Xu), urgently treated with Dushen Tang (Single Ginseng Decoction). If there is fever and irritability with muscle twitching and tendon tremors (Rou Ji Jin Ti), it indicates a deficiency of both Qi and Blood, treated with Bazhen Tang (Eight-Treasure Decoction). If there is extreme thirst and redness of the face, with a洪大 (Hóng Dà - large and surging) pulse that is empty upon pressure, it indicates Yin deficiency fever (Yin Xu Fa Re), treated with Danggui Buxue Tang (Angelica Sinensis Decoction for Nourishing Blood). If there is slight fever of the limbs, irritability with facial redness, and a 沉而微 (Chén ér Wēi - deep and faint) pulse, it indicates agitation caused by Yin excess repelling Yang (Yin Sheng Fa Zao), treated with Sijunzi Tang (Four Gentlemen Decoction) added with Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite Root).

Li Dongyuan stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang aspect; quietness during the day and fever at night indicates Yang Qi sinking into the Yin aspect; if there is fever both day and night, it indicates Extreme Yang without Yin (Chong Yang Wu Yin), requiring vigorous tonification of Yin. Therefore, Wang Taipu said: If there is severe cold that does not respond to warming treatment, it indicates the absence of Fire (Wu Huo), and one should treat the Heart (and Kidney); if there is severe heat that does not respond to cooling treatment, it indicates the absence of Water (Wu Shui - Kidney Yin); if heat comes and goes intermittently, suddenly appearing and disappearing, it also indicates the absence of Water, and one should assist the Kidney. Thus, an excess of Heart generates heat, while an abundance of Kidney generates cold; Kidney deficiency causes cold to move within, and Heart deficiency causes heat to be retained internally. Furthermore, if cold cannot be dispelled, it is due to the lack of Water (Kidney Yin); if heat cannot be cleared, it is due to the lack of Fire (Kidney Yang). If heat resolves quickly with treatment, the responsibility lies in Heart deficiency; if cold resolves quickly with treatment, the responsibility lies in Kidney weakness. Practitioners should deeply contemplate these principles.

Case Record 1:
Wu Songyue, Censor of Caojiang, experienced high fever after his back sore healed. He was mistakenly diagnosed with excess internal fire and administered a dose of bitter-cold herbs, which exacerbated the chills and fever, leading him to desire a cold water bath. His pulse was floating and large but completely empty upon deep pressure. I stated: This is Yang Qi deficiency with floating Yang on the surface, representing rootless Fire. I urgently prescribed Liujunzi Tang (Six-Gentlemen Decoction) with one piece of Fuzi (Prepared Aconite Root). He recovered after one dose.

Case Record 2:
The wife of Shen Zhenchuan, a Chunyuan (scholar), developed acne and boils on her face during the summer month. After seeking coolness and being exposed to wind, her face and eyes became swollen. Two days later, her left arm became painful and swollen, with urticaria resembling erysipelas. Swollen lumps appeared on her back, flanks, thighs, and other areas. The skin color was not red, but pain was severe, causing her to cry out day and night. She had alternating chills and fever, no appetite, and had taken Xianfang Huoming Yin (Immortal Life Preserving Elixir) and formulas for moving Qi and resolving toxicity. Her condition worsened. Her Liver pulse was floating and choppy, and her Spleen pulse was wiry and weak. This indicated stagnation of Ying (Nutritive) Qi in the Liver and Spleen meridians, with Wind pathogen invading the collaterals due to deficiency. Initially, she took Bazhen Tang (Eight-Treasure Decoction) added with Huangqi (Astragalus Root), Chaihu (Bupleurum Root), and Qingpi (Aged Tangerine Peel) for several doses, after which the swelling gradually turned red. Then, she took Shiquan Dabu Tang (Ten-Tonics Great Tonifying Decoction) added with Jinyinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), Longdancao (Gentiana Root), and Beimu (Fritillaria Bulb) for over ten doses. The two swellings on her flanks and legs ulcerated, discharging about a bowl of pus, and the remaining lumps gradually flattened. She continued taking Shiquan Dabu Tang for over a month until she stabilized. Had they focused solely on expelling Wind and attacking toxicity, failure would have been inevitable.

Case Record 3:
A scholar suffered from Liuzhu (flowing deposits/abscesses), with fever, thirst, headache, spontaneous sweating, and a large pulse that was powerless upon pressure. This indicated Qi and Blood deficiency with Cold. I treated him with Shiquan Dabu Tang (Ten-Tonics Great Tonifying Decoction) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), but his symptoms worsened. I continued using the previous formula but added one qian of Fuzi (Prepared Aconite Root). After four doses, all symptoms subsided. I then removed the Fuzi and added Rougui (Cinnamon Bark) for over twenty doses, gradually restoring Qi and Blood. Later, due to mental exertion, he developed fever and aversion to cold with reduced appetite. This indicated further injury to the Spleen and Stomach and sinking of Yuan (Original) Qi. I used Buzhong Yiqi Tang (Middle-Boosting Qi-Rescuing Decoction) with one qian of Fuzi. After two doses, the fever ceased and appetite improved. I then continued to greatly tonify Yuan Qi until he recovered. Later, due to unsuccessful examinations and frustration, combined with physical labor, his diet decreased daily, and his form and Qi declined. He presented with expectoration, thirst, headache, aversion to cold, intermittent fever, and irregular episodes. I again used Buzhong Yiqi Tang for several doses. His symptoms gradually improved, and his Yuan Qi recovered. I then removed the Fuzi and added five fen of Rougui (Cinnamon Bark). After over a hundred doses, he was cured.

Case Record 4:
A man had a back sore that failed to heal, with dark and scanty urine, body swelling, fever, dry mouth, fatigue, and a rapid, large pulse that was powerless. I used Renshen (Ginseng Root), Huangqi (Astragalus Root), Danggui (Angelica Sinensis Root), Baizhu (Atractylodes Rhizome), Shudihuang (Rehmannia Root Prepared), Chuanxiong (Ligusticum Rhizome), Shaoyao (Peony Root), Chenpi (Tangerine Peel), Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), Zhigancao (Honey-fried Licorice Root), and Rougui (Cinnamon Bark) to tonify Yuan Qi and guide Fire back to its source. However, the pulse and symptoms worsened initially, indicating that the medicinal power had not yet reached the disease site. After two more doses, symptoms suddenly receded. I then removed Rougui and administered several more doses until he recovered. This case occurred because Yuan Qi had not been supplemented earlier.