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For those who fall ill due to hard work and excessive fatigue, symptoms often include headache, fever, aversion to cold (Ehan), soreness and pain in the bones and legs, slight thirst, anhidrosis (no sweat), or spontaneous sweating (Zihan - sweating without exertion or heat). The pulse may be floating, large, and powerless, yet often tight and rapid. This is a syndrome of labor-induced cold invasion, which Li Dongyuan referred to as internal injury (Neishang). It is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Buyin Yiqi Jian (Nourish Yin and Augment Qi Decoction), or Wufu Yin (Five Blessings Drink) and similar formulas. This illustrates the principle that "sweet-warm herbs can eliminate great heat," referring specifically to such cases. If the pathogenic factor is strong with no sweat, and the pulse is surging and rapid, requiring harmonization treatment, one should use various Chaihu Yin (Bupleurum Decoction) preparations from the new formula Sanzhen series.

1. Regarding the syndrome of labor-induced cold invasion, people generally associate it only with those engaged in arduous physical labor. They fail to realize that anyone driven by fame and profit, unable to assess their own limits, exhausting their mental and physical energy to the point of contracting Shanghan (Cold Damage), belongs to this category. Therefore, when the body is fatigued but the spirit is not, it is considered mild fatigue. However, if both the spirit and the body are exhausted, leading to internal and external fatigue where both form and spirit are depleted, the condition is severe. Most contemporary cases of Shanghan belong to this type. For mild cases, harmonization is used as described above; for severe cases, urgent rescue of the root is required, selecting from the subsequent tonifying formulas listed below. Only then might there be efficacy. If the cause is unknown and indiscriminate treatment is applied, focusing solely on attacking the pathogen, errors are inevitable. This falls under the category of labor-fatigue internal injury, with detailed explanations provided in this section.

Zhang Zhongjing stated: "When Yang is deficient, there is aversion to cold; when Yin is weak, there is fever." This indicates that chills and fever can stem from deficiency. He said: "Because the person's constitution is originally deficient, they experience shivering." This shows that shaking sweats (Zhanhan) are all caused by deficiency. He said: "Deafness and inability to hear indicate deficiency of Yang Qi." He said: "A red face resembling 'floating Yang' (Daiyang) indicates insufficiency of Yin essence." He said: "Without Yang, sweat cannot be produced; thus, the body will be cold and the pulse slow." He said: "Exogenous heat (Ke Re) failing to digest food indicates deficiency-cold in the Stomach." He said: "If the patient has a rapid pulse, which typically indicates heat and should lead to good appetite, but instead vomits, it is because sweating has weakened Yang Qi and depleted Qi in the Diaphragm, resulting in a rapid pulse. This rapid pulse represents exogenous heat, which fails to digest food due to deficiency-cold in the Stomach, hence vomiting occurs." He said: "Deficiency leads to Zhengsheng (repetitive, low-volume speech), meaning speech is disordered and incoherent." He said: "Body curling up, aversion to cold, and diarrhea indicate Jue Ni (cold extremities) caused by cold Qi." He said: "A faint pulse at the Chi position indicates interior deficiency. When both exterior and interior become solid and fluids harmonize, spontaneous sweating will occur, leading to recovery." He said: "A cunited pulse (Cu Mai) with cold extremities warrants moxibustion, as a Cu pulse is not necessarily caused by heat." He said: "Headache and vomiting warrant warm methods, as some headaches are attributed to Yin syndromes." He said: "Transitioning from constipation to diarrhea with fever and sweating indicates 'Yin without Yang.'" He said: "A deep pulse at the Shaoyin position, where fever persists after sweating accompanied by cold extremities, diarrhea, and aversion to cold, requires urgent warming." He said: "Those with chronic loose stools should not receive Zhizi Tang (Gardenia Decoction), due to interior deficiency and cold in the lower Jiao." He said: "In Yangming disease, if the patient cannot eat, attacking the heat will cause hiccups; this is because the Stomach is deficient and cold. Drinking water will also induce hiccups." He said: "White urine indicates deficiency-cold in the Lower Jiao." He said: "Spontaneous diarrhea without thirst indicates the absence of Fire (Yang Qi) in the Zang organs." He said: "When pathogens invade Yin levels, internal trembling occurs because exterior Qi is deficient and interior Qi fails to secure itself." He said: "Excessive sweating causing the patient to cross their hands over the heart, experiencing palpitations and a desire for pressure, indicates loss of Yang (Wang Yang)." He said: "If the disease does not resolve after sweating, and aversion to cold worsens, it is due to deficiency." He said: "If the pulse is tight at both Yin and Yang positions but accompanied by sweating, it indicates loss of Yang."

1. Various deficiency pulses are discussed in previous volumes.
1. Deficiency syndromes contraindicating sweating and purgation methods are discussed in previous volumes.
1. Excess and deficiency patterns of the Exterior, Interior, and Five Zang organs are detailed in Volume 1, *Chuanzhong Lu · Bian Zheng* (Records of Transmission and Loyalty · Differentiation of Excess and Deficiency); these should be consulted mutually.