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At the initial stage of a sore or ulcer, whether it manifests as a Yin syndrome or a Yang syndrome has no fixed rule. Improper care and nursing can lead to an imbalance of Yin and Yang, resulting in complications. For instance, when the pathogenic toxin first arises, accompanied by tendon spasms and bone pain, the Classics state: "This is swelling caused by Cold Qi, a variation of the Eight Winds." It should be treated with exterior-releasing and dispersing methods so that the pathogen can be easily scattered and the toxin easily eliminated. If this approach is not taken, but instead internal purgatives are used, cold-cooling herbs are applied externally, or cold foods are consumed, the toxin may sink inward. When Yin reaches its extreme, Yang begins to emerge, but Yang Qi is gradually stifled, causing irritability, delirium, slight thirst, and a deep, fine, and rapid pulse. The appropriate treatment is Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added warming herbs; this constitutes the practice of a skilled physician.

Zhang Jingyue stated: "When Yin reaches its extreme, it may paradoxically manifest as restlessness and heat. This is internal Cold with external Heat, known as True Cold and False Heat." False Heat is like Water reaching its extreme resembling Fire. Regarding carbuncles and sores, some arise because the patient's constitution was originally deficient and Cold, accidentally contracting pathogenic factors; some result from excessive fatigue; some from excessive sexual activity or alcohol consumption; some from emotional excesses (Seven Emotions); and some were originally not Heat syndromes but resulted from the mistaken administration of Cold-Cooling herbs. Both True Heat and False Heat involve fever. The symptoms include redness of the face, restlessness, constipation, dark and scanty urination, shortness of breath, sore throat, or fever, with a tight and rapid pulse. Ignorant practitioners seeing these signs assume it is a Heat syndrome and recklessly administer Cold-Cooling herbs, which will inevitably cause death upon ingestion. They fail to realize that although the body feels hot, it is due to Internal Cold repelling Yang, or deficient Yang failing to consolidate. In such cases, despite dry mouth and thirst, the patient will not prefer cold drinks; even if they do, they drink little. Other internal signs may include loose stools, or hard stools followed by loose ones, clear and frequent urination, dryness and yellow-red discoloration of the genitals, shortness of breath and reluctance to speak, dull complexion and mental fatigue, or restless behavior resembling madness but stopping when restrained—distinct from the aggressive cursing seen in true mania. Rashes may appear like mosquito bites, pale red and fine, distinct from the purple-red rashes of extreme Heat; this is False Rash. The pulse in False Heat is typically deep, fine, slow, and weak; or if floating, large, tight, and rapid, it lacks force and spirit. This indicates Heat on the skin surface but Cold in the Zang-Fu organs. What appears as aversion to heat is not true Heat, but actually a Yin syndrome. If one encounters these signs of internal collapse and distress, and only knows to use cooling methods to attack pathogens and eliminate toxins, death is inevitable. One must urgently use formulas such as Sini Tang (Frigid Extremities Decoction), Bawei Wan (Eight-Ingredient Pill), or Huiyang Tang (Restore the Yang Decoction), doubling the dosage of Fuzi (Prepared Aconite Root) to tonify True Yang and guide Fire back to its source. Once Yuan Qi (Original Qi) gradually recovers, the false heat will retreat, and the disease will heal spontaneously. This illustrates the principle that "Fire follows dryness." Therefore, whenever fever and a rapid pulse are present, but the pulse does not feel robust upon pressure, this indicates Yin Excess repelling Yang, and it is not a Heat syndrome.

Li Dongyuan stated: "Redness of the face and eyes, irritability, desire for drinking, a pulse rate of seven or eight beats per breath, which scatters upon pressure, indicates Rootless Fire." This should be treated with Jiangfu Tang (Ginger and Aconite Decoction) supplemented with Renshen (Ginseng Radix).

Zhang Zhongjing stated: "For Shaoyin syndrome presenting with facial redness, treat with Sini Tang (Frigid Extremities Decoction) plus Congbai (Scallion White)."

The *Waitai Miyao* (Secret Essentials of the Outer Palace) states: "Restlessness caused by Yin Excess is called Yin Restlessness. The patient may wish to sit in a well. It should be treated with Hot herbs."