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When the epidemic pathogen steams out from the interior to the exterior, during the initial onset of alternating chills and fever, spontaneous sweating (Zihan) often occurs, sometimes even profuse and unceasing. This condition should not be simply diagnosed as Exterior Deficiency (Biaoxu). If accompanied by headache and body pain, treatment should primarily focus on releasing the exterior (Jiebiao), using herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix). If accompanied by irritability and thirst, treatment should primarily focus on directly clearing heat in the Yangming channel (Yangming Zhi Re), using formulas like Baihu Tang (White Tiger Decoction). If there is both heat and accumulation/obstruction, treatment should primarily focus on breaking up the obstruction, using formulas like Xianxiong Tang (Chest-Collapsing Decoction) or the three Chengqi Decoctions (San Chengqi Tangs). Only after repeated sweating or purging treatments, when the pathogen has completely retreated, the pulse is deficient, the tongue lacks coating, urination and defecation are clear and normal, and there are no signs of heat inside or outside, can one treat it as a deficiency syndrome to astringe sweat. This is because in epidemics, sweating indicates an exit for the pathogen, and cases requiring astringent treatment for sweat are relatively rare.

When spontaneous sweating (Daohan) occurs at the initial stage of an epidemic, it indicates that the pathogen is located in the half-exterior, half-interior (Banbiao Banli) region. If accompanied by fullness and oppression in the chest and hypochondrium, Daoyin Yin (Daren Decoction) should be used; if there is no fullness or oppression, Xiaochaihu Tang (Minor Bupleurum Decoction) should be used. After sweating or purging, if high fever has subsided but night sweats (Daohan) persist, this indicates incomplete clearance of residual pathogens. Formulas such as Xiaochengqi Tang (Minor Cactus Decoction), Xiao Xianxiong Tang (Minor Chest-Collapsing Decoction), or Wu's Chengqi Yangying Tang (Wu's Cactus Nourishing Nutrient Decoction) can be used to clear the latent residual pathogens, after which the night sweats will naturally cease.

Regardless of whether the epidemic is in its initial, progressing, or terminal stage, the occurrence of Zhanshan (Shivering Sweat) is generally considered a favorable sign. "Shivering" signifies the struggle between healthy qi and the pathogen, while "sweating" signifies healthy qi driving the pathogen out. However, there is a distinction between complete penetration and incomplete penetration. In cases of complete penetration, sweating is profuse and continuous; after sweating, the body becomes cool, there is no thirst, the tongue coating is clean, urination and defecation are clear, and there is no obstruction or painful knotting in the chest, abdomen, or hypochondrium. This constitutes a complete resolution via shivering sweat. Otherwise, if residual pathogens remain and fever recurs, some patients may resolve through subsequent shivering sweat episodes; some may require three or four episodes of shivering sweat to resolve; some may have only one episode of shivering sweat and cannot repeat it, requiring repeated purging to eliminate the pathogen; some may be unable to produce further shivering sweat and succumb to lethargy and death. Ultimately, the outcome depends on the strength of the patient's original qi (Benqi).

During the phase of shivering sweat, medication should not be administered. Administering tonics will stop the shivering but prevent thorough sweating, leaving the pathogen behind to cause harm; administering excessive sweating or purging methods will lead to collapse due to deficiency. One should allow the shivering sweat to proceed thoroughly before observing the pulse and symptoms to determine treatment. During the pre-shivering phase, providing warm water or broth can help induce sweating. During shivering sweat, the pulse may temporarily cease; do not be alarmed, as the pulse will reappear after the sweating episode. Generally, a floating pulse (Fu Mai) during shivering sweat is auspicious, indicating the pathogen emerging to the exterior. Changes such as deficient, scattered, minute, or soggy pulses may occur; in such cases, prepare Danshen Tang (Single Ginseng Decoction) in anticipation, to prevent collapse. For those with limited means, rice water can serve as a substitute, but it must be confirmed after the shivering sweat that the pathogen is cleared and qi is about to collapse before use.

After shivering sweat, quiet spirit indicates good prognosis, while confusion and restlessness indicate danger; fine breathing indicates good prognosis, while coarse and short breathing indicates danger; a flaccid tongue unable to speak indicates death; sunken eye sockets indicate death; fixed or rolling eyes indicate death; upward staring eyes and opisthotonos (back arching) indicate death; numbness of the body and inability to take fluids or food indicate death.

Although shivering sweat is generally a favorable sign, it can also indicate either good or bad outcomes. The occurrence of shivering sweat is indeed due to appropriate treatment, leading to the retreat of the pathogen and recovery of healthy qi, but it cannot be forced. I have observed cases where potent diaphoretics failed to induce sweat, yet cold water induced it; cases where purgatives induced shivering sweat; cases where blood-cooling and blood-invigorating agents induced shivering sweat; and cases where fluids-generating and qi-nourishing agents induced shivering sweat. These situations vary widely. It must be understood that shivering sweat is the natural result of the harmony of yin and yang and the free flow between the interior and exterior; it cannot be artificially forced.