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Internal injury fever refers to a condition where the Yang Qi is self-injured and cannot ascend and reach its proper place, instead descending into the Yin aspect to generate internal heat; this is due to Yang deficiency. Therefore, the pulse is large but forceless, and the pathology belongs to the Lung and Spleen. Yin deficiency fever refers to a condition where the Yin Blood is self-injured and cannot control Fire, causing Yang Qi to ascend vigorously to generate internal heat; this is due to relative Yang excess. Therefore, the pulse is rapid but forceless, and the pathology belongs to the Heart and Kidney. The Classics state: "A pulse that is large but forceless indicates Yang deficiency; a pulse that is rapid but forceless indicates Yin deficiency." A forceless pulse indicates deficiency, while a forceful pulse indicates excess.

I opine that for fever caused by Yang deficiency, it is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise and tonify Yang Qi; for fever caused by Yin deficiency, it is appropriate to use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to cultivate and tonify Yin Blood. In general discussion of these two syndromes, although they are distinguished by Yin/Yang and Qi/Blood, in reality, both are caused by insufficient Yang Qi of the Spleen and Stomach. This type of fever belongs to a state where both the physical form and Zheng Qi are deficient. Therefore, I prohibit the use of Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), fearing they will further injure Yang Qi!

The Grand Secretary Li Xu'an had a student who gifted him Kanli Wan. He happily took it. I said, "The previous pill contains Huangbai and Zhimu, which may not be suitable for you to take." The Neijing states: "Strong fire consumes Qi, mild fire generates Qi." Currently, your Liver and Kidney pulses are rapid and forceless. You should nourish the source of transformation, rather than purge Fire and injure Qi. He did not believe me and took it for two months. His Spleen Qi gradually weakened, the fever became more severe, urination became difficult and stagnant, and both hypochondria swelled and hurt. He considered it to be carbuncle toxin. I said, "This is caused by deficiency of the Liver and Kidney meridians and deficiency Fire!" It is best to tonify these two meridians. Thus, he took Buzhong Yiqi Tang in the morning and Liuwei Dihuang Wan in the evening, after which all symptoms completely resolved. I have seen patients with inherently weak Spleen and Stomach, Yin deficiency of the Liver and Kidney, and fever, who all took Shimei Guben Wan along with herbs like Huangbai and Zhimu. This反而 (instead) drains True Yang, leading to infertility. Can one not be cautious?

Shanghan fever occurs when Cold Evil enters the Wei (Defensive) level and contends with Yang Qi, generating external heat. Yang Qi governs the exterior; when injured by Cold and losing its function, it manifests as fever. The pulse is tight and forceful, indicating that external Cold Evil has injured the Wei Qi. Treatment focuses on the exterior.

I opine that if the aforementioned conditions change repeatedly and treatment is inappropriate, life can be lost in an instant. Generally, Cold Evil enters from the exterior to the interior. Although treatment methods differ among the Three Yang meridians (Taiyang, Yangming, Shaoyang), one must not rigidly adhere to the number of days. There are cases where the pathogen remains confined to one meridian without transmitting to others. I once treated a man from Chenhu who suffered from Shanghan. He lay supine for a month and was deaf. I surmised that the disease remained in the Shaoyang meridian, hence the hypochondriac pain preventing turning over and the deafness. I administered Xiaochaihu Tang (Minor Bupleurum Decoction) with Shanzhi (Gardeniae Fructus). After one dose, he could turn his body. Pus and blood erupted from the internal ulceration at the Weili area, and he regained hearing in his ears. Shaoyang belongs to Wind-Wood, and Wind-Wood can generate worms/parasites; thus, it is clearly in the Shaoyang.