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④ Medicinal anesthetics, drastic tonics, massage, acupuncture therapy (referring to Traditional Chinese Medicine here), and all folk remedies, as well as all Chinese and Western tonics, should be contraindicated. (Patients must absolutely not purchase and indiscriminately consume tonics sold in the market without the doctor's permission.) 10. Fever due to Yang Deficiency: This type of fever mostly occurs after profuse sweating, severe purgation, and violent vomiting and diarrhea. Over a long period, the body's Yang Qi is completely exhausted. In children, it often develops after vomiting and diarrhea syndromes, or following smallpox and measles, or due to congenital weakness, food stagnation, excessive use of attacking/draining drugs, or overconsumption of cold-natured medicines. In TCM pediatrics, this is called Slow Convulsion (Man Jing Feng). The most visible symptoms include: emaciation of the whole body, extremely thin neck, dry and sparse hair with alopecia, skin rough like scales, and even coma, panting, spiritless eyes, persistent fever, alternating chills and fever, bluish-yellow complexion, dry and cracked lips bleeding but aversion to cold water, very cool exhaled breath, diarrhea, cold sweat, undigested food in stool, cold limbs, opisthotonos, insomnia, frequent chronic diarrhea, or dry cough. All these symptoms belong to critical conditions. Whenever fever persists for a long time without subsiding, or arises from vomiting and diarrhea, it belongs to "Lone Yang Floating Outward" (Yin deficiency leading to Yang floating). It is essential to use dried ginger, cinnamon twig, aconite root, ginseng root, astragalus root, atractylodes macrocephala rhizome, white peony root, and prepared rehmannia root to nourish the root, so that a thread of Primordial Yang can be salvaged. Zhuang Yikui's book *Fu You Bian* excels in warm-tonifying therapies. I have treated fever due to Yang deficiency in both adults and children for over forty years with miraculous effects; this method is worthy of emulation. If this condition is treated purely with Western medicine, it is absolutely ineffective; physicians must bear this in mind. There are also cases where children frequently develop fever, temporarily resolving after releasing the exterior, only to recur; temporarily resolving after purging the interior, only to recur; or persisting despite nourishing Yin. These are signs of floating Yang with no fixed abode. Treating with Si Jun Zi Tang (Four Gentlemen Decoction) plus yam and lablab bean is often effective, without needing aconite or cinnamon. If white ulcers appear in the mouth and edema occurs, the condition is even more critical.

The above-mentioned skin fever is roughly divided into ten types. Different pathogens require different treatments; a slight error leads to great deviation, which every physician knows. However, regarding fever syndromes, they are particularly related to 1. Sweating, 2. Epistaxis, 3. Urination and defecation, and 4. Tongue coating. I will explain them separately below, in detail.

1. Sweating is roughly divided into four types: inducing sweating, spontaneous sweating, night sweating, and shivering sweating.

① Inducing sweating uses dispersing drugs to evaporate body fluids and open the Exterior Yang, allowing Exterior Cold pathogenic factors (note the character "Cold") to resolve through sweating. For initial Shang Han (Cold Damage) disease presenting with headache, body ache, and aversion to cold, dispersing methods are appropriate. For a certain type of Wen Bing (Warm Disease) presenting with spontaneous sweating, aversion to cold, and fever, releasing the exterior is also appropriate (e.g., using schizonepeta spike and saposhnikovia root). Antiperspirants should not be used; once the exterior is resolved, sweating stops naturally. Using gui zhi tang (Cinnamon Twig Decoction) as the main treatment for this condition is a major error because cinnamon twig is too drying and may cause epistaxis. Schizonepeta spike, saposhnikovia root, kudzu root, mint herb, and patchouli herb are most suitable for releasing the exterior. (However, herbs clearing internal heat, such as forsythia fruit and honeysuckle flower, should be combined.) For Shang Han in deep winter, inducing sweating with ephedra stem and notopterygium root is correct. During outbreaks of Warm Disease, if there is internal stagnant heat constrained by external cold (common during sudden weather changes, e.g., late spring or deep autumn), simultaneous release of exterior and clearance of interior is indicated, with particular attention to releasing the exterior. (Schizonepeta and saposhnikovia clear exterior heat; honeysuckle and forsythia clear upper jiao internal heat; this is the standard method for early-stage Warm Disease.) This explains the rationale for drug-induced sweating.

② Spontaneous sweating and night sweating (colloquially known as "deficient sweating"). Although there is a theory that spontaneous sweating relates to Yang deficiency and night sweating to Yin deficiency, in patients with chronic illness (note "chronic illness"; spontaneous sweating in initial Shang Han or Warm Disease does not fall under this category), these phenomena generally require careful balancing of tonifying Yang (e.g., ginseng, astragalus) and tonifying Yin (e.g., rehmannia root, prepared rehmannia root, white peony root) to reverse the declining trend. Cases of "profuse sweating causing Yang collapse" or "lone Yang floating outward" indicate impending dispersion of Yuan Qi (Yang collapse syndrome), referred to by Western medicine as "death sweat" (distinct from profuse sweating caused by overdose of diaphoretic drugs described below). Such cases require large doses of ginseng, aconite, cinnamon, white peony, and prepared rehmannia to greatly tonify Yin and Yang. (Tonifying Yang to stop sweating must be combined with tonifying Yin, otherwise Yang has no anchor.) Additionally, methods using shell/turtle substances to subdue floating Yang (e.g., oyster shell, softshell turtle carapace, tortoise plastron) are necessary to save life. (Another case involves profuse sweating due to overdose of diaphoretic drugs, which can cause cardiac arrest and death within moments. Overdose of Chinese herbs like ephedra or notopterygium, or Western antipyretics like antipyrine, often causes this danger. Note that Western antipyretics differ from TCM diaphoretics; their sweating is a side effect. Physicians must not mistake antipyrine for a diaphoretic. In such dangerous sweating scenarios, intravenous cardiac stimulants in Western medicine are essential. Do not forget this.) Furthermore, TCM shell/turtle substances for treating deficient sweating are remarkably effective and reliable; scholars should pay attention to this.

③ Shivering sweating occurs when the pathogen seeks resolution through sweating. Before this resolution, the patient experiences extreme agitation, resembling madness, screaming, crying, laughing, dancing wildly, and terrifying states. Or there is whole-body trembling, restlessness, stopped pulse, and rapid breathing (pulse returns after sweating), followed by continued sweating. Or there is profuse sweating, immediately clearing the interior and exterior, resulting in a calm pulse and cool body. This shivering sweating represents the struggle between pathogenic factors and righteous Qi internally and externally. Once sweating occurs, the pathogen has an exit, which is a good omen for the dissolution of solid pathogenic factors in Warm Disease and Shang Han, marking a major turning point in the disease process. Sometimes, after shivering sweating, if pathogens remain, another episode occurs for resolution. More critically, if shivering occurs without sweating (excess pathogen, deficient righteous Qi), one must wait for epistaxis. (If rashes appear and vanish instantly, accompanied by high fever, shortness of breath, and critical signs, it is difficult for them to reappear; epistaxis offers a chance of rescue, for similar reasons.) Or resolution may come after repeated use of clearing and purging drugs. The most dangerous scenario is after one episode of shivering, if righteous Qi cannot overcome the pathogen, and no further shivering sweating occurs, the patient becomes mentally disoriented, groping at clothes and beds, falling into deeper coma, and dying. (This critical sign often results from inherent weakness or prolonged severe illness exhausting Yuan Qi.) This is a general overview of shivering sweating. Most shivering sweating arises from failure to induce sweating or purge during the disease course, leading to prolonged stalemate between pathogen and righteous Qi, eventually resolving naturally. The timing varies. Some occur after purgatives cause diarrhea; some after drinking large amounts of cold water (I have personally seen cases after eating watermelon or ice cream); some after taking cooling, blood-invigorating, and fluid-generating herbs. When the pathogen is about to resolve, slight assistance triggers this mechanism. This type of sweating resolution cannot be forced but is undoubtedly a good sign of interior-exterior clarity. (Families often panic upon encountering this; physicians should explain it in detail.) During shivering sweating, tonics, diaphoretics, harmonizers, and cooling drugs must absolutely not be administered. Only steady nursing and offering warm water to assist body fluids are appropriate. If righteous Qi is severely deficient with unceasing profuse sweating, and diagnosis confirms risk of collapse, Du Shen Tang (Single Ginseng Decoction) may be given (or inject Western cardiac stimulants to prevent death from sweat collapse, but do not misdiagnose).

2. Epistaxis: Nasal bleeding, excluding retrograde menstruation (colloquially "reverse flow") and habitual epistaxis in women, is outside the scope of this topic and is briefly omitted. Here, we clarify epistaxis in febrile diseases. Generally, bleeding phenomena result from upward movement of Blood Heat, closely related to Lung Heat. This type of epistaxis often occurs when Warm Disease patients take excessive dispersing drugs, or mistakenly take diaphoretics and hot drugs (when the pathogen is no longer in the exterior), forcing heat upward. (Gui Zhi Tang is particularly culpable; I have seen Warm Disease patients die with bleeding from mouth and nose after mistakenly taking cinnamon twig. Be cautious.) In critical cases of maculopapular rashes appearing and vanishing instantly, with high fever, coma, and shortness of breath, if epistaxis occurs after administering heat-clearing and detoxifying drugs, it is a good omen. When rashes are trying to emerge externally but are suddenly constrained by cold (external wind-cold or internal cold from drinking cold water), toxins gather inward, presenting critical signs. At this point, attempting to force rashes out again has less than one in a hundred chances. One must urgently administer forsythia, honeysuckle, and rhinoceros horn (substituted in modern practice) to salvage the situation. If epistaxis occurs now, it indicates the pathogen has an exit, offering hope for survival. (Continuing with heat-clearing and venting drugs can lead to recovery; otherwise, survival is unlikely.) Also, in prolonged Warm Disease where pathogens have entered the interior and clearing/purging was neglected, epistaxis is also a good omen (indicating the pathogen has an exit, similar to shivering sweating). This must be known.

3. Urination and Defecation: Diagnosis must distinguish between Excess and Deficiency patterns.

① First, explain Excess pattern urination and defecation. For Excess fever syndromes (see sections on heat), such as Shang Han and Warm Disease, once diagnosed, note the quantity, presence/absence, and color of stool. Generally, when heat is in the exterior (not yet entered the interior), urination and defecation are unaffected, normal like healthy people. As gastrointestinal changes occur (TCM calls this transmission of meridians or progression), the two excretions become crucial for diagnosis. Extremely dry stool, constipation for several days, abdominal pain, or diarrhea of extremely foul-smelling loose stool, or multiple diarrheal episodes per day (TCM: Heat binding with peripheral flow), black oily stool (most dangerous bloody stool), pus-and-blood-like stool (dysentery with abnormal tenesmus), white stool (lack of bile, common in gallstones and hernias, TCM: Hypochondriac pain), or green stool (common in children, also Gallbladder Heat) are all Excess patterns. (Often accompanied by tidal fever, not an exterior syndrome.) Purging agents are indicated. (Chinese herbs: rhubarb root and mirabilite; Western herbs: calomel and saline cathartics can be used酌情. But these laxatives have different mechanisms; do not use blindly.) Delaying purgation misses the therapeutic window, potentially harming nerves (coma, delirium, mania) or extending inflammation to the peritoneum (intestinal perforation, bleeding, ulceration, inducing peritonitis, abdominal swelling, incurable), leading to immediate danger. Thus, upon seeing intestinal dryness and binding, prompt purgation is essential; do not adhere rigidly to theories of preserving fluids or delaying purgation. However, in Warm Disease with reverse transmission where pathogens enter the Pericardium, purgatives must not be used recklessly; refer to Warm Disease explanations. Regarding Excess urination: yellow or red urine, scanty or frequent/incontinent (remember "febrile disease"), extremely turbid sediment (white powder-like), or even anuria with mental confusion (uremia) are all Excess Heat. (Must correlate with stool and systemic symptoms. While diuretics are applied, the key focus remains clearing Large Intestine Excess Heat via purgation. Once intestinal heat is removed, urination improves naturally. Do not forget this. However, if heat is not in the intestine, e.g., heat closing the Dan Zhong, do not purge stool, as this punishes the innocent. [Appendicitis, nephritis, urinary stones sometimes require surgery, which is not covered here.])

② Next, explain Deficiency pattern urination and defecation. Deficiency stool is mostly loose or frequent (several times a day). (Some chronic dysentery Excess cases turn into Deficiency, with pus-like stool and mild abdominal pain daily; do not treat as Excess, must strongly tonify Primordial Yang for hope of cure.) Or undigested food in stool, watery diarrhea (if intestinal tuberculosis, often originating from lung disease, difficult to treat). Urine is usually clear, white, smooth, or incontinent. Another Deficiency urine type is extremely scanty, dark red, and pungent; this is Yang deficiency failing to transform, not to be mistaken for Excess Heat. For example, in severe edema with extreme weakness, only strong Primordial Yang tonification can restore urination. Refer to Zhao's medical records in the Edema section of Miscellaneous Diseases for clarity. Without other heat signs, yet with scanty dark urine, this is known only through experience. These conditions are mostly chronic illnesses (TCM: Spleen Deficiency or Kidney Diarrhea), mostly lacking exterior heat (though some have deficient heat), pulse is mostly powerless, spirit is mostly clear, body is emaciated. Diagnosis is not difficult, avoiding misidentification. However, a specific case of chronic diarrhea with Yang deficiency (common in children, colloquially Slow Convulsion) presents with "Lone Yang Floating Outward" (no equivalent symptom in Western books, pending verification). The interior becomes increasingly cold-deficient, while the surface becomes increasingly dry-hot. Even with prolonged fever, rough skin, gradual opisthotonos, upward-rolling eyes, locked jaw, scattered Qi, and death. Pulse is fine and minute, urination is free. Though easy to diagnose, this condition cannot be cured by ordinary spleen-tonifying (atractylodes, yam) or anti-diarrheal (poppy shell) drugs alone. Large doses of ginseng, astragalus, white peony, and prepared rehmannia are required, possibly adding aconite, cinnamon, and dried ginger, assisted by strong Spleen-Kidney tonics, to be effective. Any hesitation or ambiguity by the physician leads to errors. (Incompetent doctors, seeing exterior heat, dare not use Yang-tonifying drugs, how can they help?) Hence, I explain this in detail. Regarding urination, Deficiency patterns mostly present with clear urine, enuresis, or retention (Qi deficiency edema with very little urine). One must find the source and apply tonics, not generally use diuretics. (Severe uterine tumors compressing the urethra causing difficulty urinating is excluded.) Regarding anti-diarrheal drugs, TCM texts list them in the Astringent category. Besides poppy shell (outer skin of opium fruit) having astringent effects, others like red kaolin, yuyuliang, and chebula fruit are less effective than Western drugs like bismuth subnitrate, tannalbin, tannic acid, and opium powder. (Opium powder is toxic to children and should not be used.) Of these, the latter group is indeed effective and specific (especially for chronic diarrhea). However, for the Yang-deficient chronic diarrhea described above (colloquially Morning Diarrhea, Kidney Diarrhea, Cockcrow Diarrhea, Loose Stool Consumption, Pediatric Spleen Deficiency Wind, Slow Convulsion), Western anti-diarrheals offer only temporary relief and no heat-reducing effect. Fundamental treatment requires Chinese herbs: ginseng, honey-fried astragalus, aconite, cinnamon, dried ginger, psoralea fruit, mulberry silk pupa, atractylodes, white peony, prepared rehmannia, yam, and poppy shell. (Poppy shell originated abroad and was included in Ben Cao Gang Mu later.) Only these can reduce fever, stop diarrhea, and save life. The marvel is that these hot drugs can reduce stubborn deficient-consumption exterior heat and stop diarrhea. Resultantly, fever subsides, diarrhea stops, strength increases, and health restores.

I have tested this for forty years with near-perfect success, amazed by its divine efficacy. Trying Western tonics and strengtheners for this severe condition cannot achieve such results. I dare make this assertion, though my learning is shallow. I wish readers to explore the scientific principles here. I also hope Western medicine takes note to supplement its deficiencies, thereby obtaining a complete curative method for this chronic deficient diarrhea. Would that not be excellent? (Combined use of Chinese and Western medicines yields faster effects.)

4. Tongue Coating: Tongue coating in febrile diseases is most important, so I briefly explain it. Generally, in initial Shang Han with pathogen in the exterior, the tongue often has no coating. In heat diarrhea and early Warm Disease, there is often a thin, white, slippery coating or no coating. In short, no coating or only a thin white slippery coating indicates the initial stage of pathogenic heat; purgatives should not be used immediately. If the coating gradually becomes yellow, greasy, and thick, pathogenic heat is entering the interior. If dry yellow, soy-sauce yellow, black, or cracked, interior heat is extremely盛. Corroborated by other signs (e.g., dry stool), it is time to use purgatives. This describes the most common tongue coatings. If fever is due to Deficiency (see heat sections), even if there is coating, it must be treated as deficient heat. Physicians must not rely solely on tongue coating and forget the Excess/Deficiency nature of the disease. (This paragraph should be listed under Diagnostics and correlated with pulse and symptoms for accuracy.)

5. Pain: Pain refers to the sensation of discomfort in a part of the body. The pathology of this pain should be simply explained. TCM has a generalized definition and treatment principle for pain: "Pain implies obstruction; freedom from obstruction means no pain." Though simple, this concept is profound. This sign correlates with Western inflammation, so I explain it in conjunction.