Library

There are cases of cold injury that do not immediately transform into heat. In some instances, heat appears one or two days after the onset of cold. In others, there is no heat at all following the cold injury. This pattern is most common in *Shanghan* (Cold Damage Disease), though it may occur in other conditions as well. Treatment should be administered according to the specific syndrome.

In cases of deficiency with chronic aversion to cold, the patient may feel coldness within the bones and muscles, or perceive cold rising from the lower body. If this persists for weeks or months, it is appropriate to treat it using *Fuzi* (Aconite Lateralis Radix Praeparata) as the sovereign herb.

After the "Three Xiao" (Sanxiao, referring to polydipsia, polyphagia, and polyuria), various hemorrhagic disorders, postpartum exhaustion (*Yulao*), or chronic dysentery, fever arising from these deficiencies is generally an unfavorable sign. In some cases, direct treatment of the fever is required; in others, the fever should not be treated specifically, as it arises secondary to another disease. Antipyretic herbs should be added to the formula treating the primary condition.

Additionally, some patients experience slight fever every night without being aware of it themselves. Upon waking and moving about, they function normally, eat well, and present no other suspicious symptoms. This is due to blood deficiency where Yin fails to control Yang. It is suitable to use moistening and tonifying methods. Mix *Shensu Yin* (Ginseng and Perilla Decoction) in a proportion of two parts with *Siwu Tang* (Four Substance Decoction) in one part. This mixture is named *Fuling Buxin Tang* (Poria Tonifying Heart Decoction). Once the fever subsides slightly, continue with *Yangrong Tang* (Nourishing Vigor Decoction) or *Shiquan Dabu Tang* (Complete Great Tonification Decoction).

For those suffering from heat caused by ingesting mineral-based pungent-hot substances, administer with *Gancao Wudou Tang* (Licorice and Black Soybean Decoction). For fire pathogenic factors, administer with *Ai Ye Tang* (Mugwort Leaf Decoction). For dietary stagnation, administer with *Ganjiang Tang* (Dried Ginger Decoction). For heat from roasted/grilled foods, administer with *Zhike Gancao Tang* (Immature Bitter Orange and Licorice Decoction).

(Attached: Deficiency Restlessness)
Tidal fever has two types: excess-type tidal fever and deficiency-type tidal fever. Only in *Shanghan* (Cold Damage Disease) does fever occurring at *Ribu* (late afternoon, 3-5 PM) indicate stomach excess heat without deficiency signs.

For other cases of tidal fever, one must examine whether it is excess or deficiency. If tidal fever is accompanied by hard, difficult defecation, preference for cold and aversion to heat, epigastric fullness/discomfort, and restless sleep, this indicates Qi excess, known as excess-type tidal fever. Mild cases are suitable for *Shensu Yin* (Ginseng and Perilla Decoction); severe cases require *Xiaochaihu Tang* (Minor Bupleurum Decoction).

If tidal fever is accompanied by depleted Qi, fatigue, emaciation, reduced appetite, and gradual wasting, even if the acute illness has passed but the five centers (both palms, both soles, and the chest) retain residual heat, this belongs to deficiency syndromes. Suitable formulas include *Fuling Buxin Tang* (Poria Tonifying Heart Decoction), *Shiquan Dabu Tang* (Complete Great Tonification Decoction), and *Yangrong Tang* (Nourishing Vigor Decoction). For patients lacking proper recovery management after illness, *Bazhen San* (Eight Treasures Powder) is the primary treatment.

Some cases of tidal fever appear deficient but present with chest/diaphragm oppression and back pain, failing to respond to tonifying medicines. This is due to fluid retention (phlegm-fluid) following Qi dynamics, causing heat to fluctuate with the fluids. One should seek remedies within the category of treating fluid retention.

After various sweating therapies, or vomiting and diarrhea from Huoluan (Cholera-like disorder), if excessive loss of body fluids leads to dryness of the internal organs, deficiency restlessness can occur. This is because insufficient Yin-blood fails to control Yang, leading to Yang hyperactivity, resulting in deficiency heat and restlessness. The appropriate formula is *Shensu Yin* (Ginseng and Perilla Decoction), removing *Zisu* (Perilla Leaf), increasing the dosage of *Renshen* (Ginseng Root), and adding *Mamendong* (Ophiopogon Tuber) half a qian. For restlessness with thirst, use *Renshen Tang* (Ginseng Decoction) alone. If accompanied by difficulty urinating, use *Chunze Tang* (Spring Spring Decoction). If accompanied by heart meridian heat and agitation, use *Chensha Wuling San* (Cinnabar and Five-Ingredient Poria Powder). For restlessness with vomiting and poor appetite, use *Jupi Tang* (Tangerine Peel Decoction). For restlessness with restless sleep, use *Wendan Tang* (Warm Gallbladder Decoction). For extreme restlessness with high fever, use *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction). For deficiency restlessness due to blood deficiency presenting with the aforementioned symptoms, use *Fuling Buxin Tang* (Poria Tonifying Heart Decoction).

Furthermore, there is a condition where upon contracting illness, the patient experiences aversion to cold but no body ache or headache, only restlessness and heat. This is also called deficiency restlessness. At this stage, neither interior nor exterior attack methods should be used, as doing so would inevitably deplete vital energy. Use *Shensu Yin* (Ginseng and Perilla Decoction), removing *Zisu* (Perilla Leaf) and increasing *Renshen* (Ginseng Root), or add *Shigao* (Gypsum Fibrosum) half a qian. If unresolved, use *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction). For cases combining the above symptoms, select from the previously mentioned formulas. For patients who are severely deficient and should not receive purely cooling agents, use *Fuling Buxin Tang* (Poria Tonifying Heart Decoction).