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Xu Shuwei said: Zhang Zhongjing stated, for instance, if the Cun (inch) pulse is faint, it is named Yang insufficiency. When Yin Qi invades the Yang region, one experiences shivering and aversion to cold. If the Chi (cubit) pulse is weak, it is named Yin insufficiency. When Yang Qi sinks into the Yin region, fever occurs. This refers to the condition arising from the disease's original nature. It is also stated that faint Yang leads to aversion to cold, while weak Yin leads to fever. This is because excessive sweating by physicians caused Yang to become faint, and severe purgation caused Yin to become weak; this refers to iatrogenic illness. Generally speaking, when Yin is insufficient, Yang follows inward and sinks, resulting in fever; when Yang is insufficient, Yin takes advantage of the deficiency to occupy the Yang position, resulting in aversion to cold. Because Yin and Yang fail to remain in their respective positions, cold and heat contend with each other, leading to simultaneous fever and aversion to cold.

Liu Wansu, in *Yuan Bing Shi* (Original Causes of Disease), stated: Body heat with aversion to cold indicates pathogenic heat at the Exterior. Pathogenic heat at the Exterior is superficial; the pathogen fears the Healthy Qi, so the manifestation is fever accompanied by aversion to cold. Some say aversion to cold is due to Cold pathogen at the Exterior; some say body heat with aversion to cold means heat is in the Skin and Cold is in the Marrow. Both are erroneous. The method of Zhang Zhongjing states: If there is no Yang syndrome (e.g., faint pulse), Cold diseases must not be treated with diaphoresis. It also states that for body heat with aversion to cold, Ma Huang Tang should be used to induce sweating. After sweat is discharged, heat dissipates, the body cools, and recovery ensues. Thus, how could there be a Cold pathogen? The general principle is: restlessness, polydipsia, preference for cold, and aversion to heat indicate Heat diseases. There is also the principle of "Excess causes harm, restraint brings balance," where extreme Heat may paradoxically feel cold. Although feeling cold, the pathology is truly Heat, not Cold. If Heat is severely constrained and manifests as aversion to cold, worsening with cold and improving slightly with warmth, it is because warmth unblocks the Cou Li (pores/skin texture), allowing Yang Qi to disperse and slightly reducing the constrained Heat. Conversely, Cold closes the Cou Li, causing Yang Qi to be constrained and Heat to intensify, thus worsening the disease. This applies to the upper, lower, interior, exterior, and whole body. Laypeople mistakenly call this a Cold disease and erroneously administer Hot medicines, causing great harm.

It is further stated: "Yin excess leads to Cold, Yang excess leads to Heat." This refers to Interior Qi combining with pathogenic Heat at the Exterior, resulting in Yang excess and fever; or Exterior Qi combining with pathogenic Heat at the Interior, resulting in Yin excess and chills. Due to deficient Exterior Qi and hyperactive Interior Heat, following the rule of "Excess causes harm, restraint brings balance," chills occur paradoxically. Fundamentally, this is a Heat disease, not a Cold disease. In cases of Taiyang disease presenting with alternating chills and fever, pathogenic Heat is at the Exterior and superficial, fearing Healthy Qi, hence aversion to cold; pathogenic Heat is at the Interior and deep, being extremely strong and fearless, hence no aversion to cold but aversion to heat. The continuous advance and retreat between Interior and Exterior result in alternating chills and fever. This Qi does not bias toward either Interior or Exterior, differing from Malaria, and the chills and fever are milder.

Commentary: These several discussions mention the mutual overacting of Yin and Yang in miscellaneous diseases, and the phenomenon where extreme Fire/Heat mimics Water/Cold, illustrating the example of "Excess causes harm, restraint brings balance." However, Liu Hejian's citation of Taiyang fever and alternating chills contradicts Zhang Zhongjing and Cheng Wuji's *Ming Li Lun*. Zhao Sizhen elaborated: *Ming Li Lun* states that alternating chills and fever result from the struggle between Pathogenic Qi and Healthy Qi. When Pathogenic Qi enters, if Healthy Qi does not struggle against it, only fever occurs without chills; if they struggle, both chills and fever arise. Generally, Cold pathogen is Yin, Heat pathogen is Yang; Interior is Yin, Exterior is Yang. When Pathogenic Qi lodges in the Exterior, if it is a Cold pathogen struggling with Yang, it manifests as Cold; when entering the Interior, if it is a Heat pathogen struggling with Yin, it manifests as Heat. If Pathogenic Qi is between Exterior and Interior, struggling with Yang externally causes Cold, and struggling with Yin internally causes Heat. Since the Exterior and Interior are not fixed, and internal/external boundaries are fluid, chills and heat come and go, occurring three to five times daily, or up to ten-plus times in severe cases. The theory of Yin-Yang mutual overacting, where Yang insufficiency leads to chills then fever, and Yin insufficiency leads to fever then chills, applies only to miscellaneous diseases where Yin and Yang Qi overact upon themselves, and cannot be applied to Taiyang disease. This discussion is very precise and aligns deeply with Zhang Zhongjing's intent. It not only clarifies doubts in *Huo Ren Shu* but can also be read in conjunction with the previous chapter.

Furthermore, Liu Hejian claimed that aversion to cold is Cold at the Exterior, or that body heat with aversion to cold means heat in the Skin and Cold in the Marrow, which are errors. *Huo Ren Shu* also interpreted this as Interior-Exterior. Zhao Sizhen commented: Examining Zhang Zhongjing's treatise, he distinguishes only between Skin and Marrow, not using terms like Exterior-Interior. This is because Skin, Vessels, Flesh, Tendons, and Bone are considered external combinations of the Zang-Fu organs in *Su Wen*, governing the exterior and filling the body. Only Zang and Fu organs can be termed Interior. Thus, Skin is the superficial part above the Marrow, and Marrow is the deep part below the Skin. This differs from the principle that Meridians belong to the Exterior and Zang-Fu belong to the Interior. Moreover, Zhang Zhongjing placed this syndrome at the beginning of the Taiyang Chapter, clearly indicating it is an Exterior syndrome. Therefore, in individuals constitutionally weak and prone to Cold, contracting pathogens and developing fever, the superficial Heat cannot overcome deep-seated Cold, causing external fear of cold and desire for clothing; this is "Heat in the Skin, Cold in the Marrow," requiring Acrid-Warm medicines. Conversely, in robust individuals constitutionally prone to Heat, or wine drinkers, upon initial contraction, Cold has not yet transformed into Heat; Yin pathogen closes off latent Heat externally, condensing Yin outside while Heat constrains inside, causing internal vexation and aversion to clothing; this is "Cold in the Skin, Heat in the Marrow," requiring Acrid-Cool medicines. Once sweating resolves the Exterior and restores harmony, this is the subtle point Zhang Zhongjing did not explicitly state. If Skin were Exterior and Marrow were Interior, then the bone-joint pain in Ma Huang Tang syndrome would constitute a disease with both Exterior and Interior aspects. Since this is not the case, although people know Zhang Zhongjing's *Shang Han Lun* as the ancestor of formulas, they fail to read it as a Qin-Han era text, leading to ambiguity regarding its fundamental principles. Later generations, relying on its benefits, compiled Shang Han formula discussions, often losing the original meaning or engaging in forced interpretations. Since this discussion focuses on miscellaneous diseases, it merely cites examples. Zhao Sizhen's clarification indeed grasps the essence. Furthermore, the *Huang Di Zhen Jing* discusses examples such as Skin Cold-Heat, Muscle Cold-Heat, and Bone Cold-Heat. Thus, Zhang Zhongjing's distinction between pathogenic location in the Skin versus Marrow, though aiming to exhaust variations in syndromes, has its own origins.