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Li Dongyuan stated: Zhang Zhongjing, in discussing syndromes of fever and spontaneous sweating due to internal or external deficiency, strictly forbids the use of diaphoresis (sweating therapy). If a miscellaneous disease caused by improper diet or overwork presents with fever, spontaneous sweating, and exterior deficiency, and is mistakenly identified as an excess condition, using Ephedrae Herba (Mahuang, 麻黄) to induce heavy sweating will further deplete the exterior.

Commentary: In Zhang Zhongjing's discussion on Shaoyin Cold Damage (Shanghan), there are more than thirty clauses indicating conditions where diaphoresis is contraindicated, including cases with dual prohibitions, such as alternating chills and fever accompanied by blood deficiency and qi weakness. How much more so for miscellaneous diseases? Misdiagnosis leads to adverse reactions, causing rapid disaster, as stated: "One error may prolong life for a while, but two errors will shorten it."

Li Dongyuan recorded: The nephew of Hanlin Academician Feng, named Li Tong, suffered from cold damage with red eyes, irritability, thirst, and a pulse rate of seven to eight beats per breath. Upon deep palpation, the pulse did not surge forcefully. The *Neijing* states: "When the pulse appears compliant on the surface but does not surge upon pressure, this applies to all yang meridians." This indicates Yin excess repelling Yang to the exterior, presenting as false heat rather than true heat. Treatment with warming agents containing Dried Ginger (Ganjiang) and Prepared Aconite Root (Fuzi) resulted in sweating and recovery (see *Shixiao Fang*).

Note: This case is similar to Wang Haizang's treatment of maniacal speech, macules, fever with a deep and fine pulse, indicative of a Yin syndrome. Li Dongyuan also treated cases of lower limb flaccidity, coldness in the buttocks and perineum, foul-smelling genital sweat, and seminal emission; and another case where the pulse was deep, rapid, and forceful, indicating fire郁 (stagnation) internally forcing Yin outward, presenting as Yang excess rejecting Yin, treated with bitter-cold purgatives. These illustrate the subtle signs of Water and Fire and the sophistication of pulse-syndrome-treatment correlations. Wang Bing (styled Taipu) remarked that recording these residual effects of Water and Fire reveals their principles; thus, they are recorded here for encouragement.

*Cishi Nanzhi* states: Generalized body heat initially stems from the Taiyang meridian; pathogenic factors moving from exterior to interior begin as formless invasions.

Commentary: In Zhang Zhongjing's treatise on cold damage, fever can occur in all three Yin meridians, varying in severity. Zhao Sizhen noted that fever occurs in all three Yang meridians. For example, in Shaoyin disease, vomiting and diarrhea with warm extremities and fever indicate survival; generalized heat in hands, feet, and body suggests heat in the Bladder leading to hematochezia; Chaihu Si Ni San contains Bupleuri Radix (Chaihu) for treating fever; Jueyin disease starting with cold limbs followed by fever and diarrhea implies self-resolution of diarrhea; a rapid pulse with slight fever and sweating indicates impending recovery; facial redness, slight fever, vertigo, vomiting, and fever are treated with Xiao Chai Hu Tang; and Taiyang wind-strike causing painful limbs confirms that fever exists in all three Yin meridians. However, cold damaging the Yin meridians resulting in fever is considered an adverse reaction.

Coldness in hands and feet combined with bilateral hypochondriac heat like fire initially stems from the Shaoyang meridian; pathogenic factors moving from interior to exterior begin with有形 (formative) accumulation.

The *Neijing* states: After excessive drinking or full meals, engaging in sexual activity causes essence to accumulate in the Spleen without dispersing. The interaction between alcohol qi and grain qi generates intense internal heat, causing generalized body heat and dark urine.

Irregular diet and起居 (daily routine) injure the Yin. Pathogens entering the Six Fu organs cause body heat, insomnia, and upper respiratory distress (wheezing/calling).

*Huo Ren Shu* states: Food stagnation causes headache, rapid pulse, and fever. If the Renying pulse on the left hand is peaceful and the body lacks pain, it confirms this diagnosis.

*Cishi Nanzhi* states: Both Renying and Qikou pulses are tight and vigorous, or large and solid upon lifting and pressing, accompanied by fever, aversion to cold, abdominal discomfort, and excessive salivation, indicating simultaneous internal and external injury.

Note: The above distinguishes internal injury from external contraction (see Internal Injury section).

The *Neijing* states: Fever, wiry-rapid pulse, shivering without aversion to cold characterizes Dan Malaria.

*Jingui Yaolue* states: Fever, body ache, and a complexion resembling smoked yellow indicate Dampness; generalized body ache, fever worsening at dusk indicates Wind-Dampness; sweating with body heat indicates Wind pathogen.

*Huo Ren Shu* states: Phlegm in the Zhongwan area causes aversion to cold, fever, aversion to wind, spontaneous sweating, floating Cunkou pulse, and chest stuffiness. Symptoms resemble cold damage but differ by the absence of headache and neck stiffness.

Sun Shang stated: Deficiency vexation resembles cold damage, with fever, non-floating/non-tight pulse, no aversion to cold, only fever/vexation, and no headache. Hongjiao (Beriberi) causes hard stool, swollen/painful legs, either swollen/shiny or withered/thin calves. During attacks, symptoms include fever, aversion to cold, vomiting, and nausea, resembling cold damage.

*Nan Jing* states: Fever, aversion to cold, and floating-rapid pulse characterize Warm Disease; body heat, headache, spontaneous sweating, somnolence, floating-slippery Yang pulse, and weak-soft Yin pulse characterize Wind-Warmth.