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When a carbuncle or sore first appears and has not yet suppurated, the presence of fever and aversion to cold is due to the stagnation of Ying (Nutrient) and Wei (Defensive) Qi, obstruction of the meridians, and stimulation by the toxin of the lesion. After ulceration, when pus and blood are profusely discharged, deficiency inevitably follows. The Classics state: "When Yang is deficient, there is aversion to cold; when Yin is weak, heat arises." This refers to this situation. Zhu Danxi stated: "Aversion to cold is not caused by external cold, but by the deficiency and decline of Wei Qi, which fails to warm the muscles and skin, leaving the Cou Li (interstices and pores) empty, resulting in aversion to cold; additionally, pathogenic factors in the Upper Jiao may block the ascent and descent of Ying and Wei Qi, causing them to float on the exterior and induce aversion to cold." Li Dongyuan stated: "Aversion to cold at night with calmness during the day indicates that Yin Blood is flourishing in the Yin aspect; aversion to cold throughout the day and night without fever indicates excessive Yin and absence of Yang; one should drain the Yin and vigorously tonify Yang. Calmness at night with aversion to cold during the day indicates excess Yin overflowing into the Yang aspect; fever during the day with calmness at night indicates Yang flourishing in the Yang aspect; calmness during the day with fever at night indicates Yang sinking into the Yin aspect, termed 'Heat entering the Blood Chamber'; fever and irritability throughout the day and night indicate excessive Yang and absence of Yin; one should urgently clear Yang and vigorously tonify Yin." Wang Bing's commentary notes: "Fever with a rapid pulse that does not throb under heavy pressure indicates Cold excess repelling Yang, not true Heat. Symptoms and signs appearing cold but with a pulse that beats forcefully under the fingers indicate severe Heat rejecting Yin, not Cold. If the pulse is floating, rapid, and weak with aversion to cold, it is Yang deficiency, suitable for Qi tonification. If the pulse is choppy with fever, it is Blood deficiency, suitable for Blood tonification. Fever before noon suggests Qi deficiency; fever after noon suggests Blood deficiency. Floating, rapid pulse with fever and pain indicates pathogen in the Exterior, suitable for dispersing. Deep, rapid pulse with fever and pain indicates pathogen in the Interior, suitable for purging.

Another method involves palpation to assess heat depth using five degrees of pressure: heat felt with light pressure on the skin and hair indicates Lung Heat; slightly heavier pressure on the muscles indicates Spleen Heat; further pressure on the vessels indicates Heart Heat; heavy pressure below the vessels between muscles and bones indicates Liver Heat; extreme pressure on the bone level with steaming heat like fire, accompanied by bone soreness as if eaten by insects, severe fatigue, inability to bear the body's weight, and inability to rise from bed, indicates Kidney Heat. Another method correlates the twelve meridians with the twelve two-hour periods to deduce fever patterns and treat accordingly, which is invariably effective.

Xue Lizhai stated: Carbuncle and sore fever with irritability, or excessive bleeding, profuse pus discharge, excessive sweating leading to collapse of Yang, or excessive purgation leading to collapse of Yin, causes consumption of Yin Blood, leaving Yang unrooted and floating on the muscle surface, which is not Fire. Fever with insomnia indicates Blood deficiency, treated with Shengyu Decoction. Accompanied by incessant sweating indicates Qi deficiency, urgently treated with Dushen Decoction. Fever, irritability, muscle twitching, and tendon tremors indicate Qi and Blood deficiency, treated with Bazhen Decoction. Thirst, red face, and a flooding pulse that is empty upon pressure indicate Yin deficiency fever, treated with Danggui Buxue Tang. Slight limb fever, irritability, red face, and a deep, faint pulse indicate Yin excess with false agitation, treated with Sijunzi Decoction plus Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite). Li Dongyuan stated: Fever during the day with calmness at night indicates Yang flourishing in the Yang aspect. Calmness during the day with fever at night indicates Yang sinking into Yin. Fever throughout day and night indicates excessive Yang and absence of Yin, requiring vigorous Yin tonification. Thus, Wang Taipu said: Severe cold that does not respond to cold medicines indicates lack of Water (Kidney Yin); intermittent heat that comes and goes indicates lack of Water, requiring assistance to the Kidney. Excess Heart Fire generates heat; excess Kidney Qi generates cold. Kidney deficiency causes internal cold; Heart deficiency causes internal retention of heat. If heat cannot overcome cold, it indicates lack of Fire (Heart Yang); if cold cannot overcome heat, it indicates lack of Water (Kidney Yin). Failure to resolve cold lies in lack of Water; failure to resolve heat lies in lack of Fire. Brief duration of heat symptoms blames Heart deficiency; brief duration of cold symptoms blames Kidney weakness. Practitioners must deeply comprehend this.

Wang Shengzhi stated: When carbuncles and sores have profusely discharged pus and blood, the priority must be massive tonification of Qi and Blood. Even if other syndromes exist, they should be treated secondarily. Therefore, fever and aversion to cold after ulceration of abscesses belong to severe Qi and Blood deficiency. If the left hand pulse is insufficient, Blood-tonifying herbs should outweigh Qi-tonifying ones; if the right hand pulse is insufficient, Qi-tonifying herbs should outweigh Blood-tonifying ones. One must absolutely avoid exterior-releasing methods to prevent the disaster of 'deficiency inducing deficiency.' Thus, Li Dongyuan stated: The Seven Emotions can all stir Fire; heat in different meridians varies and requires distinct treatments.

Dai Yuan Shi stated: Before ulceration, severe aversion to cold with high fever, delirium, and hallucinations; or after significant pus discharge, persistent high fever, seems difficult to treat. The expulsion of pus is akin to sweating in Taiyang syndrome; if high fever persists after sweating, it becomes a complicated disease. Furthermore, patients with abscesses who have lost excessive pus and blood suffer from dried-up fluids and frequent thirst. Even with fever and restlessness, one must not treat recklessly. Use formulas that nourish Ying and generate fluids. If high fever persists, it is difficult to treat.

Li Dongyuan stated: Carbuncle and sore fever with aversion to heat, incessant thirst, irritability, muscle heat, desire to remove clothing, flooding pulse that is empty upon pressure, or eye pain and dry nose, are not indications for Baihu Tang. This is irritability due to Blood deficiency, primarily treated with Danggui Buxue Tang.

Zhang Jingyue stated: Palpating heat involves three methods: heat felt with light touch but not with heavy pressure indicates heat in the skin and vessels; intense heat felt only with heavy pressure down to the bones, but not with light touch, indicates pathogen in the muscles and bones; heat felt with neither light nor heavy pressure specifically indicates heat in the muscles, between the skin/vessels and the bones.

Zhang Zhongjing stated: A deficient pulse indicates Blood deficiency; Blood deficiency generates cold, indicating insufficient Yang.

He also stated: A faint Cunkou (radial artery at the wrist) pulse indicates Yang insufficiency, allowing Yin Qi to enter the Yang region, causing shivering aversion to cold. A weak Chichi pulse indicates Yin insufficiency, allowing Yang Qi to sink into the Yin region, causing fever.

He also stated: Yang deficiency leads to exterior cold; Yin deficiency leads to interior heat. Yang excess leads to exterior heat; Yin excess leads to interior cold.

He also stated: Excess Yang results in body heat without sweat (indicating exterior excess pathogen). Excess Yin results in profuse sweating and body cold (indicating Yang deficiency).

He also stated: Fever with aversion to cold originates in Yang; absence of fever with aversion to cold originates in Yin. Extreme cold with sweating results in a body cold as ice.

The Classics state: Yin excess injures Yang; Yang excess injures Yin. Yang excess produces heat; Yin excess produces cold.

Zhang Zhongjing stated: Cold pathogen in the Exterior必然 causes body heat and no sweat due to closure of the skin and hair.

He also stated: Cold pathogen lodging in the meridians必然 causes body pain, stiffness, or soreness because the pathogen disrupts Ying Qi and impedes blood vessels.

He also stated: Regarding headache from exterior cold, four meridians are involved. The Foot-Taiyang meridian is the longest, flanking the vertex, accounting for most headaches. The Foot-Yangming ascends to Touwei, and the Foot-Shaoyang ascends to the temples. The Three Yin meridians do not cause headaches as they return at the neck. However, the Jueyin meridian meets the Du Meridian at the vertex, governing all Yang, thus causing headaches. Only Taiyin and Shaoyin lack headache syndromes. Jueyin headache is rare, occurring only with vomiting of saliva/phlegm and no internal heat, indicating direct invasion, requiring warming treatment.

He also stated: Exterior cold often causes aversion to cold because injury to cold induces aversion to cold, just as food injury induces aversion to food.

He also stated: The Taiyang meridian starts from the inner canthus, ascends to the vertex, descends the neck, flanks the spine, and runs along the waist. Pathogen in Taiyang必然 causes aversion to cold and fever, accompanied by head/neck pain, stiff back/spine, or knee soreness.

He also stated: The Yangming meridian starts below the eyes, follows the face and nose, and runs through the chest and abdomen. Pathogen in Yangming必然 causes fever with slight aversion to cold, accompanied by eye pain, dry nose, and insomnia.

He also stated: Shaoyang is the Half-Exterior Half-Interior meridian, circling the ears and running from the shoulder down the costal region. Pathogen in Shaoyang必然 causes fever with deafness, hypochondriac pain, bitter taste, vomiting, or alternating chills and fever.

He also stated: Slight body heat with incessant sweating, without body ache or stiffness, and a non-tight/rapid pulse, indicates the heat is not in the Exterior.

He also stated: Syndromes resembling exterior invasion but lacking aversion to cold, preferring heat, and having no exterior signs, indicate heat excess in the Interior.

He also stated: Exterior excess manifests as fever, body pain, aversion to heat with clothing removal, or aversion to cold with shivering. Cold binding the Exterior causes no sweat; Fire excess in the Exterior causes sores. Migratory red pain indicates Heat in Ying and Wei; stiffness and soreness indicate Cold in the meridians.

He also stated: Yang excess causes heat and aversion to heat; Yin excess causes pain, knotting, and cold. Qi excess causes rough breathing and loud voice/strong demeanor. Blood excess causes coagulation, pain, and hardness.

He also stated: Exterior excess manifests as profuse sweating, muscle trembling, fear of cold, limb numbness, dim vision, photophobia, deafness, and vertigo.

He also stated: Yang deficiency is Fire deficiency, manifesting as lack of spirit, blackouts, dizziness, and aversion to cold. Yin deficiency is Water deficit, manifesting as blood loss, Dai Yang (floating Yang), and bone-steaming tidal fever.

He also stated: If a patient has high body heat but desires to cover up with clothes, the heat is superficial while the cold is profound. If the body is very cold but the patient refuses to cover up, the cold is superficial while the heat is profound. Severe internal heat may also present with aversion to cold; this must be differentiated by correlating pulse and symptoms.

He also stated: Yang pathogen in the Exterior causes exterior heat; Yin pathogen in the Exterior causes exterior cold. Yang pathogen in the Interior causes interior heat; Yin pathogen in the Interior causes interior cold. Pathogen between Half-Exterior and Half-Interior without fixed location causes alternating chills and fever.

He also stated: Fever from exterior pathogen indicates exterior heat without interior heat, suitable for warm dispersal. Fever from interior pathogen indicates interior heat radiating outward, suitable for clearing.

He also stated: Yang insufficiency allows Yin to enter Yang, causing aversion to cold (Yin excess producing cold), suitable for warming. Yin insufficiency allows Yang to sink into Yin, causing fever (Yang excess producing heat), suitable for clearing.

He also stated: Alternating chills and fever result from Yin-Yang struggle. Yin excess causes cold; Yang excess causes heat. Heat is Yang, Cold is Yin; Exterior is Yang, Interior is Yin. Exterior pathogens clashing with Yang cause chills; interior pathogens clashing with Yin cause heat/restlessness. Pathogens between Half-Exterior and Half-Interior clash with Yang externally (causing cold) and Yin internally (causing heat), moving in and out, resulting in alternating chills and fever. This is a Half-Exterior Half-Interior syndrome. Thus, cold excess implies more cold; heat excess implies more heat. Assessing the trend of cold and heat reveals the depth of the pathogen.

The Classics state: Yang deficiency causes aversion to cold; Yin weakness causes fever.

Zhongjing stated: The exterior is Yang and Exterior. Cold is a Yin pathogen. When the Exterior is deficient and invaded by Cold, it is named Yin Excess and Yang Deficiency. Yang fails to warm the skin and defend the exterior, causing emptiness. Even in a sealed room, the patient covers themselves, called aversion to cold. Yin excess and Yang deficiency resolve with sweating; thus, aversion to cold belongs to the Exterior. False heat in the skin causes naked irritability, called aversion to heat, not aversion to cold. Seeing aversion to cold indicates cold in the skin; urgently administer sweet and acrid agents.

He also stated: Cold stagnating in the Cou Li causes closure and fever, feeling hot to the touch, but this heat is only in the skin with no interior heat, named Exterior Disease with Interior Harmony. The Neijing discusses this: Wind-Cold invasion makes hair stand erect and skin close, causing heat, requiring sweating. It also states: "Body burning like charcoal resolves with sweating." The Treatise on Warm Diseases states: Injury by Cold leads to heat disease; profuse sweating resolves the heat. (These points apply to carbuncles and sores complicated by exterior invasion.)