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In cold damage (Shanghan), fever refers to heat accumulating and obstructing at the skin level, allowing it to dissipate. This is similar yet distinct from tidal fever (Chao Re) and alternating chills and fever (Han Re).

The term "Xi Xi Fever" (翕翕发热) clearly indicates that the heat is exterior. Therefore, Guizhi Tang (Cinnamon Twig Decoction) is used to induce sweating and disperse the pathogen.

The term "Zheng Zheng Fever" (蒸蒸发热) clearly indicates that the heat is interior. Therefore, Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) is used to purge and cleanse the interior heat.

Fever belonging to the exterior syndrome results from wind pathogens lodging in the skin, causing an obstruction of Yang Qi.

[Text fragment: Fevers belonging to the half-exterior/half-interior...] ...and subsides. The pathogen reaches outward... at the half... Yang. No... Fuzi Xixin [Aconite Root and Asarum]... heat. Classic says... reduced by sweat. Delirious speech and inability to eat is named Yin-Yang Jiao (Yin-Yang Intersection). Intersection implies death. This is also a contraindication for fever. How can it be treated uniformly with ordinary fever? Physicians...

*Huoren Shu* (Book of Living People) states: Fever accompanied by aversion to cold belongs to the Taiyang (Greater Yang) channel. Taiyang disease must present with fever and aversion to cold. Because Taiyang governs Qi, warming the skin and muscle layers... aversion to cold... for warmth... Tang slightly... Chengqi [Decoction].

Jing Yue (Zhang Zhongjing) states: In Taiyang syndrome, if after sweating there is no aversion to cold but only aversion to heat, it is an excess condition. One should harmonize the Stomach Qi, preferably using Tiaowei Chengqi Tang. In Taiyang disease, after three days... fever, Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment. Sweating is contraindicated; if sweating is induced, delirium will occur. If the patient has no thirst and slight exterior heat remains, Xiao Chaihu Tang plus Guizhi (Cinnamon Twig) is indicated. This... body heat not... ceased. Body... heat fighting... purging... Yes. Di... Yin syndromes have... fever... heat in... does not subside... Tang treats it.

Cold damage with vexatious heat (Fan Re) is similar to but distinct from simple fever. Fever involves heat obstructing at the muscle surface, occurring intermittently. Vexation involves... vexation and... of vexation... Tang. Vexatious pain... vexation. With pulse... purgation.

In cold damage, coating on the tongue generally occurs because the tongue is the orifice of the Heart, corresponding to the Fire element of the South, and should naturally be red and lustrous. After three days of cold damage, a membrane appears on the tongue, white and slippery like... Qi transmitting to the interior... all tongue... hypochondrium... below... Zang organs... then the coating on the tongue becomes non-slippery and rough. The Classics state: If cold damage persists for seven to eight days without resolution, heat binds in the interior, presenting with heat in both exterior and interior, occasional aversion to wind, severe thirst, dryness and vexation of the tongue, and a desire to drink several liters of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. This indicates that heat has consumed the body fluids, and the Stomach juices are dried up. If heat accumulates in the Stomach, the tongue turns yellow, indicating deep-seated heat pathogens. *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: If the tongue is yellow and purgatives have not yet been used, applying purgation will cause the yellow coating to disappear. If the tongue color turns black, it signifies extreme heat. *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) states: Death ensues in heat diseases when the tongue is dry and black. Since the Heart is the sovereign organ opening into the tongue, and black is the color of the Kidney appearing on the Heart (Fire), while the Kidney is Water, the extreme heat causes mutual destruction (Water overcoming Fire excessively), thus indicating certain death. Observing the mouth and tongue reveals the favorable or unfavorable course of the disease.

Song verse states: When digestion is normal but diarrhea occurs, and a white coating appears on the tongue, pain connecting the navel and drawing to the genital tendons indicates Zang Jie (Organ Knotting), which is originally incurable and fatal. Absence of Yin syndromes. Also stated: Tongue coating in great heat is difficult to treat; diarrhea, abdominal pain, vomiting, and aversion to cold accompany it. Restlessness, hardness in the hypochondrium, and fullness in the center, along with six signs of Zang Jie, should be observed. Tight pulses at Cun and Chi positions, hot breath and dryness in the mouth, cold feet with curled posture, runny nose, and a slippery coating on the tongue indicate that one should not treat rashly. Or, after seven to eight days, slight heat, warm hands and feet... must desire... person restless... fullness. Not... wetness reason.