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Zhang Zhongjing stated in the "Treatise": The pulse at the Cun Kou (inch position) is floating and tight. Floating indicates wind, and tight indicates cold. Wind damages the Wei Qi (Defensive Qi), and cold damages the Ying Blood (Nutritive Blood). When both Ying and Wei are diseased, it causes severe pain in the bones and joints; this should be treated with sweating methods.

It is also said: When the Three Yang meridians (Taiyang, Yangming, Shaoyang) are all affected by disease, but the pathogen has not yet entered the Fu organs, it can be cured by inducing sweating. For details, see the Six Meridian syndromes mentioned earlier.

It is also said: In Taiyang disease, if the pulse is floating and tight, there is no sweat, fever, and body pain, and after eight or nine days the condition remains unresolved with exterior symptoms still present, sweating should be induced. According to this syndrome, although it is described in terms of the Taiyang meridian, diseases of the Yangming and Shaoyang meridians that remain unresolved for a long time should also be dispersed via sweating. However, since the Taiyang meridian is the exterior of the Three Yang and governs the external manifestations of the whole body, it is specifically cited here.

It is also said: In Taiyang disease, characterized by headache, fever, body ache, lower back pain, joint pain, aversion to wind, anhidrosis, and wheezing, Ma Huang Tang (Ephedra Decoction) should be used as the primary treatment.

It is also said: If the pulse is floating and rapid, sweating may be induced, and Ma Huang Tang (Ephedra Decoction) is appropriate.

It is also said: In combined diseases of Taiyang and Yangming, if there is wheezing and chest fullness, the pathogen is in the exterior. Purging is contraindicated; instead, Ma Huang Tang (Ephedra Decoction) should be used.

It is also said: In Yangming disease, if the pulse is floating, there is no sweat, and there is wheezing, inducing sweating will lead to recovery, and Ma Huang Tang (Ephedra Decoction) is appropriate.

It is also said: In Taiyang disease, if there is stiffness and tension in the nape and back, no sweat, and aversion to wind, Ge Gen Tang (Pueraria Decoction) is appropriate.

It is also said: In combined diseases of Taiyang and Yangming, spontaneous diarrhea will occur, and Ge Gen Tang (Pueraria Decoction) should be used.

It is also said: In Taiyang Wind Strike syndrome, if the pulse is floating and tight, there is fever and aversion to cold, body pain, anhidrosis, and irritability, Da Qing Long Tang (Major Blue Green Dragon Decoction) should be used.

It is also said: In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind Strike. In Taiyang disease, if there is headache, fever, sweating, and aversion to wind, Gui Zhi Tang (Cinnamon Twig Decoction) should be used.

It is also said: In Taiyang disease, if the exterior syndrome is unresolved and the pulse is floating and weak, resolution via sweating is indicated, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.

It is also said: In Taiyang disease, if the pulse is slow, there is profuse sweating, and slight aversion to cold, the exterior syndrome is unresolved; sweating may be induced, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.

It is also said: If the illness resembles malaria with fever occurring around late afternoon (Shi hour), it belongs to Yangming. If the pulse is floating and deficient, sweating should be induced, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.

It is also said: In Taiyin disease, if the pulse is floating, sweating may be induced, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.

It is also said: In Jueyin syndrome, if there is diarrhea, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Use Si Ni Tang (Frigid Extremities Decoction) to warm the interior and Gui Zhi Tang (Cinnamon Twig Decoction) to attack the exterior.

It is also said: After diarrhea, if there is body pain and bowel movements and urination are normal, urgent rescue of the exterior is required; Gui Zhi Tang (Cinnamon Twig Decoction) should be used to induce sweating. This indicates that body pain serves as evidence of an exterior syndrome, thus requiring dispersal.

It is also said: After sweating resolves Shang Han (Cold Damage), if restlessness returns after half a day and the pulse is floating and rapid, sweating may be induced again, and Gui Zhi Tang (Cinnamon Twig Decoction) should be used.

It is also said: In Shaoyin disease, if upon initial onset there is contrary fever and a deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) should be used. Note: Although the pulse is deep, the presence of fever indicates this is an exterior syndrome of the Yin meridians; thus, warming and dispersing with this formula is appropriate.

It is also said: If Taiyang disease does not resolve and transitions to Shaoyang, presenting with hardness and fullness under the costal margin, dry retching, inability to eat, alternating chills and fever, and a deep-tight pulse, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be given.

It is also said: For vomiting accompanied by fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.

It is also said: In Yangming disease, if there is tidal fever, loose stools, normal urination, and chest/hypochondriac fullness, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.

It is also said: Yin syndromes should not have sweating. If only the head sweats, it is known not to be Shaoyin; Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given.

It is also said: In Two-Yang combined disease, when Taiyang disease was initially treated with sweating, but the sweat was incomplete, leading to transition to Yangming with continued slight sweating and no aversion to cold: if Taiyang symptoms persist, purging is contraindicated as it is adverse; in such cases, mild sweating may be induced.

Note: Zhang Zhongjing's clauses regarding exterior sweating are numerous. Here, only the essential twenty-four syndromes are presented to illustrate the principles of appropriateness, from which the general idea can be grasped. The sweating agents he used were either Ma Huang (Ephedra) or Gui Zhi (Cinnamon Twig); this is the excellent method for warming and dispersing initial cold pathogens. Later physicians, fearing Ma Huang and Gui Zhi as strange substances, dare not use them, while others offer forced interpretations claiming these were designed only for direct invasion of Yin-cold in mid-winter, unaware that they are most suitable for Yin-excess pathogens in all seasons. Alas, since Zhang Zhongjing, there has been no other Zhang Zhongjing; this reveals the essence of medicine.

1. For exterior syndromes of various meridians, if sweating is incomplete, it cannot truly be called "sweating." Because the pathogen is not fully expelled, the patient will likely have persistent fever, feeling restless and irritable, or experiencing soreness in the four limbs, and unease in sitting or lying down, due to incomplete sweating. How is this known? By observing a pulse that remains tight and skin that is dry and sweatless during fever; this is the syndrome, and sweating should still be induced. If, however, sweating is thorough yet fever persists, or fever worsens after sweating, this is what is called "Yin-Yang Intersection" (Yang-Yang Jiao), where soul and spirit separate, indicating a dire omen.

2. There are three reasons for incomplete sweating: First, if the pathogen is in the meridians, sinews, and bones, but sweat only emerges from the skin and hair pores, this means the pathogen is deep while sweating is shallow; Wei Qi is resolved but Ying Blood is not, constituting one type of incompleteness. Second, if ten parts of pathogen are met with only five parts of sweat, this means the pathogen is heavy while sweating is light, constituting the second type. Third, if the cold pathogen has just departed but the condition is not clear, and sudden exposure to wind and dew occurs, causing re-invasion due to deficiency, this means new and old pathogens follow each other, constituting the third type. In such cases, careful differentiation is required, and sweating should be repeated according to severity.

3. There are four reasons for fever recurring after recovery: First, if the pathogen has just scattered but Stomach Qi is not cleared, leading to overeating, this is called "Food Relapse" (Shi Fu), which is the first type. Second, if the exterior pathogen has just resolved and the body was not significantly deficient, but excessive caution led to the addition of warming and tonifying herbs, this is "Mis-tonification Relapse," the second type. In these two cases, as stated, "food enters Yin and generates Qi in Yang," causing Stomach Qi to close again and Yang pathogen to gather; since the exterior pathogen has recurred, sweating is still appropriate. Third, if the new illness has just healed but care is neglected, or Spleen Yin is injured by labor, leading to recurrent fever, this is called "Labor Relapse" (Lao Fu), the third type. Fourth, if sexual impropriety leads to re-infection, this is called "Female Labor Relapse" (Nv Lao Fu), the fourth type. In these latter two cases, as stated, "when Yin is deficient, Yang must encroach"; treatment may involve tonification or sweating, depending on changes and urgency, distinguishing between deficiency and excess.

The Treatise states: After Shang Han (Cold Damage) has healed, if fever recurs, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used. If the pulse is floating, resolution via sweating is appropriate. If the pulse is deep and solid, resolution via purging is appropriate.

1. The method of inducing sweating should follow nature and not be abrupt. Simply administering herbal decoctions to keep the body warm allows for a steady, slight perspiration. Over time, circulation reaches the hands and feet uniformly, permeating the whole body, so that no pathogen remains undispersed. If forced abruptly, causing sweat like a shower, Wei Qi may reach its destination quickly while Ying Qi fails to circulate fully, leaving areas unprotected, and potentially severely damaging Yuan Qi (Original Qi); this is not a good method. I once witnessed a child ill with disease; his parents, cherishing him greatly and desiring quick recovery, covered him with heavy quilts under warm conditions, and even pressed their bodies onto him. The child cried out from extreme heat. The parents said, "Not enough yet; more sweat must come." After a long time, they removed the covers, but he died from collapse of Yang. They knew only that sweating was harmless, not realizing that forced sweating can kill; this is a warning against coercive sweating. Others, whose pathogen was not severe, or who had deficiency, advanced age, or weakness, were harmed because doctors failed to observe these signs, knowing only that exterior syndromes require release, and thus dispersed too much; or, after ineffective dispersion, continued to disperse repeatedly, causing harm. Some had their pathogen expelled but suffered great damage to Stomach Qi, unable to eat, becoming emaciated and listless; this is a warning against excessive sweating. If sweating is excessive, leading to immediate collapse of Yang, with cold body and shivering, or Qi depletion and coma, one should immediately brew Du Shen Tang (Single Ginseng Decoction) and drink about one liang. For severe cases, Si Wei Hui Yang Yin (Four-Ingredient Decoction to Restore Yang) should be used urgently to reverse the condition; otherwise, rescue may be impossible.

1. There are pulses contraindicating sweating. As stated in the *Shang Han Lun*: In Taiyang disease, if there is fever and aversion to cold, with more heat than cold, and the pulse is weak, this indicates absence of Yang, and sweating is contraindicated. A wiry pulse indicates Yang movement; a micro pulse indicates Yin-cold; upper excess and lower deficiency suggest a desire for warmth. Micro-wiry pulse indicates deficiency; sweating is contraindicated, as it would cause chills and prevent self-recovery. In Shang Han, on the fourth or fifth day, if the pulse is deep with wheezing and fullness, deep indicates interior location; sweating is contraindicated. Sweating depletes Jin Ye (Body Fluids), leading to difficult defecation and delirious speech. In Shaoyin disease, if the pulse is micro, sweating is contraindicated due to risk of Yang collapse. In Shang Han, if the pulse is micro with aversion to cold, this indicates dual deficiency of Yin and Yang; further sweating, vomiting, or purging are contraindicated. If the Chi (cun) pulse is weak and powerless, sweating and purging are strictly forbidden. If the Chi pulse is slow, sweating is contraindicated due to insufficient Ying Qi and blood deficiency.

Jing Yue stated: Based on the above pulses contraindicating sweating, we can understand Zhang Zhongjing's main intent. Therefore, in treating Shang Han, whenever the pulse is weak, deep, fine, or powerless, arbitrary sweating must be avoided. However, to eliminate exterior pathogens, sweating is necessary. Zhang Zhongjing says those with weak pulses should not sweat. Since a weak pulse is not Yang, cold-cooling herbs are inappropriate; since cold pathogens are in the exterior, purging is inappropriate. So, apart from sweating, what other method treats this exterior pathogen? One must realize that warming the center dispels cold, and strengthening the master Qi drives away invaders. Is not Zhang Zhongjing's meaning fully revealed in his words? Those who are enlightened should comprehend this mentally. Moreover, in exterior contraction diseases with weak pulses, sweat is hardest to produce, and pathogens hardest to resolve. Why? Because Yuan Qi cannot support and expel; even if attempted, no sweat occurs, pathogens remain unresolved, and further sweating increases deficiency, leading immediately to danger and death. Sweat originates from Blood, transformed by Ying Qi; Ying Qi originates from Qi, generated by Middle Qi (Zhong Qi). There is no case of strong Ying Qi with deficient Middle Qi, nor of weak Ying Qi producing effective sweat. The pulse is the external manifestation of Ying Qi. If the pulse is weak, Yuan Qi is known to be deficient; the more deficient the Yuan Qi, the harder it is to resolve pathogens. Thus, Yang syndromes most fear Yin pulses, precisely for this reason. Therefore, in treating such cases, when encountering weak pulses and Zheng Qi (Upright Qi) failing to overcome pathogens, one must rapidly consolidate the root to prevent deepening, specifically assisting Middle Qi to support the expulsion of exterior pathogens. Only when Zhen Yuan (True Yuan) gradually fills will the pulse become robust, transforming from fine/deep to slippery/large, from powerless to spirited, ensuring Yin pulses transform into Yang pulses and Yin syndromes into Yang syndromes. At this time, as Yuan Qi gradually fills, it signals the return of Zheng Qi and retreat of pathogens, a favorable omen of impending sweating and resolution. Thus, methods for treating exterior pathogens include: dispersing when appropriate, harmonizing when appropriate, and regulating/nourishing Ying and Wei when appropriate. If pathogens are excess and there is no sweat, dispersing is appropriate; if there is sweat but fever persists, harmonizing is appropriate; if Yuan Qi is deficient and pathogens cannot retreat, saving the root and waiting for spontaneous resolution/sweating is appropriate. These are the three secrets of expelling pathogens and the perfect method. Now, mediocre physicians see only the exterior, not the interior; they disregard the Yin/Yang of syndromes and the deficiency/excess of pulses, believing only that cold-cooling reduces fever and dispersing resolves the exterior. They do not know that once Yuan Yang collapses, disaster follows instantly like crumbling earth. They kill with a flip of the hand, remaining unawakened throughout life; truly, they are the lowest stupidity, unchangeable. Can such people be called physicians?

There are syndromes contraindicating sweating. As stated in the *Shang Han Lun*: When sweating is indicated, purging is adverse; when purging is indicated, sweating is adverse. In diarrhea with undigested food, attacking the exterior is contraindicated; sweating will certainly cause abdominal fullness due to severe depletion of Body Fluids. Individuals prone to sweating should not be made to sweat. Those with Yang deficiency must not undergo repeated sweating. Those with frequent nosebleeds should not sweat. Those who have lost blood should not sweat. Patients with stranguria (Lin syndrome) should not sweat; sweating will certainly cause hematuria. Those with dry throat should not sweat. Those with blockage in the throat should not sweat; sweating will cause hematemesis and Qi exhaustion. Those with heavy body and palpitations should not sweat. Patients with sores/ulcers, despite body pain, should not sweat; sweating will cause spasms. Those coughing with free urination, or urinary incontinence, should not sweat; sweating will cause cold reversal in the four limbs. Those with moving Qi (Dong Qi) should not sweat. (The meaning of Dong Qi is detailed in the following treatise on purging.)