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This volume begins by discussing aversion to cold. Generally, Taiyang disease (disease of the Taiyang channel) must present with fever and aversion to cold. Patients with aversion to cold should absolutely not be excessively covered with clothes or bedding, nor brought near fire sources; otherwise, cold and heat will contend with each other, causing the pulse channels to sink and hide, making the patient's coldness even more unbearable. Simply remove the covers and fire sources, and simultaneously administer herbs that harmonize the exterior, and the aversion to cold will naturally cease. In women, aversion to cold should especially not be treated by bringing them near fire; otherwise, cold qi may enter the abdomen, causing stagnation in the Blood Chamber (uterus), which cannot be cured by acupuncture or herbs.

(63) Inquiry into Aversion to Cold
There are two types of aversion to cold: one accompanied by fever originates from Yang channels; one without fever originates from Yin channels. Those originating from Yang channels are suitable for releasing the exterior, with a pulse that is necessarily floating and rapid, belonging to the patterns of Guizhi Tang (Cinnamon Twig Decoction), Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Green Dragon Decoction), Mahuang Tang (Ephedra Decoction), and Qinglong Tang (Green Dragon Decoction). Those originating from Yin channels are suitable for warming the interior, with a pulse that is necessarily deep and fine, belonging to the patterns of Lizhong Tang (Regulate the Middle Decoction) and Jianzhong Tang (Establish the Middle Decoction); if it is Shaoyin disease with aversion to cold and curling up, frequent self-irritation, but no desire for thick clothing, Dachi Hu Tang (Major Rhubarb Decoction) can be used to purge. If there is slight fever and slight aversion to cold, it belongs to Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction). If aversion to cold appears after sweating, it is due to deficiency, indicating both Yin and Yang are deficient, and emesis or purgation should not be used again. If the face becomes red and hot after sweating, it indicates the condition is about to resolve, and Guizhi Mahuang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction) is suitable.
After severe purgation in Shanghan (Cold Damage) followed by sweating, if there is epigastric fullness and obstruction (Pi) and aversion to cold, the exterior pattern has not resolved. One must not attack the Pi; instead, resolve the exterior first. Once the exterior is resolved, then attack the Pi. To resolve the exterior, use Guizhi Tang; to attack the Pi, use Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Purging Decoction). Although Taiyang, Yangming, and Shaoyin all have aversion to cold, essentially, Taiyang disease always has aversion to cold, whether fever has appeared or not. Yangming patterns generally require purgation, except when aversion to cold occurs due to cold pathogen in the channels, combined with Taiyang as an exterior pattern, which requires sweating. If after emesis or purgation, the disease persists for seven to eight days, heat is bound internally, both interior and exterior are hot, and there is occasional aversion to cold, this is a Baihu Tang (White Tiger Decoction) pattern.
Another question: There are cases of sweating with aversion to cold, sweating profusely with slight aversion to cold, and only head sweating with slight aversion to cold. What is the cause? Zhang Zhongjing said: In Taiyang disease, if the patient has fever, sweating, aversion to cold, no vomiting, but only epigastric fullness, this is due to the physician's erroneous purgation; if there is epigastric fullness accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Heart-Purging Decoction) governs. In Yangming disease, if the pulse is slow, sweating is profuse, and there is aversion to cold, the exterior has not resolved, and sweating is permissible, using Guizhi Tang. If only the head sweats with slight aversion to cold, it belongs to Shaoyang, and Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable.
Another question: What causes aversion to cold in the back? There are two patterns of back aversion to cold: In San Yang combined disease, back aversion to cold is accompanied by numbness in the mouth, dry mouth, and dry tongue; in Shaoyin disease, back aversion to cold is accompanied by a normal sensation in the mouth. For numbness in the mouth, dry mouth/tongue, and back aversion to cold, Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) governs; for a normal mouth sensation and back aversion to cold, Fuzi Tang (Aconite Decoction) governs, along with moxibustion. (Zhang Zhongjing said: In Shaoyin disease, within one or two days, if the mouth feels normal and there is back aversion to cold, moxibustion should be applied, and Fuzi Tang governed.)

(64) Inquiry into Wind Aversion
Wind aversion (E Feng) occurs when the Defensive Qi (Wei Qi) is invaded by deficient winds of the four seasons. The patient should sweat and have a slow pulse. Repeatedly administering Guizhi Tang or Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction) until the body is slightly moist for several days should lead to spontaneous resolution. Another case involves Taiyang disease where excessive sweating leads to Yang depletion and continuous leakage of sweat; due to deficient Defensive Qi and wind aversion, the meridians should be warmed. If the patient has wind aversion, difficulty urinating, slight stiffness in the four limbs making flexion and extension difficult, Guizhi Jia Fuzi Tang (Cinnamon Twig plus Aconite Decoction) is indicated. If Shanghan presents on the fourth or fifth day with body heat, wind aversion, neck stiffness, hypochondriac fullness, warm hands/feet, and thirst, Xiaochaihu Tang is indicated. When Wind-Dampness contends, causing painful joints, pulling pain preventing movement, sweating, shortness of breath, dysuria, wind aversion with reluctance to remove clothes, or slight edema, Gancao Fuzi Tang (Licorice and Aconite Decoction) governs.

(65) Inquiry into Shanghan Without Sweat
The *Jiayi Jing* states: In heat diseases, if the pulse is often restless and vigorous without sweat, this is the extreme of Yang pulses and indicates death; if the pulse is vigorous and restless but sweat appears, it indicates life. Generally, in Shanghan, if both Ying (Nutrient) and Wei (Defensive) levels are diseased, there is no sweat. Mahuang Tang, Gegen Tang (Kudzu Root Decoction), Da Qinglong Tang (Major Green Dragon Decoction), and Congchi Tang (Scallion and Fermented Soybean Decoction) can be selected. If Shanghan persists despite taking decoctions without sweating, it indicates death. Using the method for Wind Strike, fumigation can be employed: heat the ground with charcoal, sweep away the fire, sprinkle water, and spread a mixture of silkworm sand (Can Sha), cypress leaves (Bai Ye), peach leaves (Tao Ye), and bran. Lay a mat over this, place the patient on top, cover warmly; in summer, use a single sheet. Sweat will appear shortly. Once sweat reaches the soles of the feet, stop it with warm powder and move the patient to bed. Silkworm sand, peach leaves, and cypress leaves are most effective; either alone or in combination works. Bran helps increase sweat but is optional. Shanghan can also result from Qi deficiency failing to produce sweat. Zhang Zhongjing said: Floating and slow pulse indicates lack of Yang and inability to sweat, causing body itching; Guizhi Mahuang Ge Ban Tang governs. Yangming disease typically has much sweat; if there is no sweat and a sensation like insects crawling under the skin, it is due to chronic deficiency, and Shu Fu Tang (Atractylodes and Aconite Decoction) or Huangqi Jianzhong Tang (Astragalus Establish the Middle Decoction) is suitable.

(66) Inquiry into Spontaneous Sweating
There are seven patterns of no sweat in Shanghan and nine patterns of spontaneous sweating. Taiyang Shanghan, Gang Jing (Stiff Spasm), Taiyin, Shaoyin, Jueyin, Yin Yi (Yin Transformation), and Winter Yangming diseases all have no sweat. (Note: Shaoyin patterns without sweat resemble Mahuang Tang patterns, but the pulse differs: Shaoyin is micro and fine. Also, sweating indicates weak Yang. Thus, Zhang Zhongjing said: Yin patterns do not have sweat; if the pulse is tight on both sides yet sweating occurs, it is Yang depletion belonging to Shaoyin.)
The nine sweating patterns are:
1. Wei Disharmony Spontaneous Sweating: If the viscera are healthy but the patient has intermittent fever and spontaneous sweating that does not resolve, it is Wei disharmony. Sweating before the onset resolves it; Guizhi Tang governs. In Taiyang disease with fever and sweating, this is weak Ying and strong Wei. To rescue from wind pathogen, use Guizhi Tang. If the patient constantly sweats, it means Ying Qi is harmonious but discordant externally because Wei Qi does not harmonize with Ying Qi. Since Ying moves in the vessels and Wei moves outside, re-sweating harmonizes them.
2. Wind Strike Spontaneous Sweating: Taiyang disease with fever, sweating, wind aversion, and slow pulse is Wind Strike, governed by Guizhi Tang. If there is neck/back stiffness with sweating and wind aversion, Guizhi Jia Gegen Tang governs. If sweating with thirst, Wuling San (Five-Ingredient Powder with Poria) governs; if no thirst, Linggan Jiangzhi Tang (Poria, Licorice, Ginger, and Jujube Decoction) governs. Note: Guizhi Tang is difficult to use carefully. If the pulse is floating and weak, take Guizhi Tang; if restlessness occurs without the typical pulse/symptoms, do not repeat. If sweating with frequent urination, do not give Guizhi Tang. If Taiyang spontaneous sweating with limb stiffness and difficulty moving, and dysuria, add Fuzi to Guizhi Tang. If frequent urination, do not give Guizhi Fuzi Tang; use Shaoyao Gancao Tang (Peony and Licorice Decoction). If mistakenly using Guizhi Fuzi Tang causes dry throat, restlessness, cold limbs, and vomiting, give Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang. Once limbs warm, give Shaoyao Gancao Tang to extend legs. If stomach disharmony causes delirium, give Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) until slight stooling stops delirium. Shaoyao Gancao Tang treats floating pulse, spontaneous sweating, frequent urination, wind, warmth generating slight heat, deficiency causing calf cramps, and fluid shortage; do not misuse Guizhi.
3. Fengwen (Wind-Warmth) Spontaneous Sweating: Taiyang disease with fever, thirst, and no aversion to cold is Warm Disease. If sweating makes the body burning hot, it is named Fengwen. Fengwen has floating pulses on both sides, spontaneous sweating, heavy body, somnolence, snoring, and difficulty speaking; Zhirui Tang (Polygonatum Decoction) governs.
4. Shi (Dampness) Spontaneous Sweating: As per *Nan Jing*, dampness causes persistent sweating. Kidney governs dampness; kidney entering heart causes unstoppable sweating.
5. Zhongshu (Summerheat) Spontaneous Sweating: Taiyang Zhongre (Heat in Taiyang) causes sweating, wind aversion, body heat, and thirst; Baihu Tang governs.
6. Yangming Spontaneous Sweating: No aversion to cold, aversion to heat, and continuous sweating belong to Yangming. If sweating is profuse with thirst, do not give Wuling San because stomach dryness exists and Zhu Ling Tang would further drain fluids. Profuse sweating with delirium indicates dry feces; Tiaowei Chengqi Tang governs. However, if urination is free, fluids are exhausted internally; do not purge, use honey suppository (Mi Jian Dao). If Yangming sweating with slow pulse and slight aversion to cold, exterior is unresolved; Guizhi Tang governs. Yangming typically has sweating and floating pulse; if no sweat and wheezing, release exterior with Mahuang Tang.
7. Wang Yang (Yang Depletion) Spontaneous Sweating: Excessive sweating in Taiyang causes leakage and wind aversion; warm meridians with Guizhi Jia Fuzi Tang. Tight pulses on Cun/Chi with sweating in Shanghan indicate Yang depletion belonging to Shaoyin, likely with sore throat, vomiting, diarrhea, internal cramping, limb pain, cold limbs, and aversion to cold; Sini Tang (Frigid Extremities Decoction) governs. Use warm powder to stop profuse sweating. If profuse sweating continues with wind aversion, restlessness, and inability to lie down, first take Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes, and Oyster Shell Decoction), then Xiao Jianzhong Tang (Minor Establish the Middle Decoction).
8. Rou Jing (Soft Spasm) Spontaneous Sweating: Taiyang disease with fever, deep/fine pulse, head shaking, jaw clenching, opisthotonos, sweating without aversion to cold is Rou Jing; Xiao Xuming Tang (Minor Continuation of Life Decoction) governs.
9. Huoluan (Colic-Restlessness) Spontaneous Sweating: Vomiting, diarrhea, sweating, fever, wind aversion, limb stiffness, and cold limbs; Sini Tang governs.
Note: Shaoyin usually has no sweat, but reverse spontaneous sweating can occur (cold limbs, cold sweat on forehead/back indicates Yang depletion). Yangming usually has sweat, but reverse no sweat can occur.

(67) Inquiry into Head Sweating
When the exterior is excess and interior is deficient, pores do not open, Yang Qi ascends, and sweat appears on the head. Head sweating indicates dryness of the five viscera, emptiness of the Bladder/Uterus, and scanty fluids. Do not purge; purging causes double deficiency.
Patterns of head sweating:
1. After 5-6 days of Shanghan, head sweating, slight aversion to cold, cold hands/feet, epigastric fullness, anorexia, hard stool, and fine pulse indicate Yang Micro-Binding (Yang Wei Jie), having both exterior and interior aspects. Deep pulse indicates interior. Sweating indicates weak Yang. Pure Yin Binding would have no exterior signs. This is half-exterior, half-interior. Even with deep/tight pulse, it is not Shaoyin because Yin patterns do not sweat. Xiaochaihu Tang governs.
2. After 5-6 days, post-sweat/purge, chest/hypochondriac fullness with slight binding, dysuria, thirst without vomiting, only head sweating, alternating chills/fever, and irritability indicate unresolved exterior. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) governs.
3. Only head sweating, no body sweat up to the neck, dysuria, and thirst for drinks indicate stasis-heat in the interior leading to jaundice. Wuling San and Yinyin Tang (Artemisia Decoction) govern.
4. Post-Yangming purge, external heat, warm hands/feet, no Chest Bind, mental restlessness, hunger but inability to eat, only head sweating: Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) governs.
5. Epigastric tightness/fullness, no high heat, head sweating: Fuling Tang (Poria Decoction) governs. Zhang Zhongjing said: Epigastric tightness, no high heat, only head sweating indicates Water Binding in Chest/Hypochondrium. Xiaobanxia Jia Fuling Tang (Minor Pinellia plus Poria Decoction) governs.
6. Yangming disease with bleeding and delirium indicates Heat Entering the Blood Chamber. Only head sweating: puncture Qimen (LR14) to drain excess. Sweat indicates resolution. Delirium with sweating indicates dry feces; wait for the meridian cycle to pass before purging. Early purging causes speech disorder due to exterior excess and interior deficiency.

(68) Inquiry into Headache
Headache is a Yang pattern. Taiyang headache with fever, aversion to cold, and no sweat uses Mahuang Tang; with sweat uses Guizhi Tang. If headache is severe ("like breaking") regardless of prior sweating, Lianxu Congbai Tang (Scallion White Decoction) is used; if ineffective, Gegen Congbai Tang (Kudzu and Scallion White Decoction) governs. String-tight and fine pulse with headache/fever belongs to Shaoyang; do not sweat, use Xiaochaihu Tang. Yangming headache, no aversion to cold, aversion to heat, due to stomach excess: Tiaowei Chengqi Tang governs. Zhang Zhongjing said: Shanghan with constipation for 6-7 days, headache with heat: give Chengqi Tang. If urine is clear, the pathogen is still in the exterior; sweat it. If headache leads to nosebleed, Guizhi Tang governs. Taiyin and Shaoyin meridians do not reach the head; only Jueyin (Liver/Gallbladder) reaches the head. Thus, Taiyin/Shaoyin rarely have headaches. Zhang Zhongjing has one Jueyin pattern: Wuzhuyu Tang (Evodia Decoction) for dry heaving, spitting saliva, and headache. Generally, three Yang meridians cause most headaches. Sun Simiao said: Yang Shanghan has body heat and headache; Yin Shanghan has no high heat or headache. Sudden headache with chest fullness, chills/fever, and tight/small pulse indicates phlegm-fluid above the diaphragm; use Gengti Powder (Thladiantha Powder) with warm water to induce vomiting of phlegm. Headache with nasal congestion and irritability belongs to Dampness patterns (cold-damp in head); insert Gengti powder into the nose.

(69) Inquiry into Body Pain (Itching Attached)
Taiyin, Shaoyin, and Jueyin all have body pain; distinguish by exterior signs and pulse. Taiyang exterior unresolved with floating/tight pulse requires sweating. If Chi pulse is slow, do not sweat due to insufficient Ying Qi/blood; nourish first with Xiao Jianzhong Tang. If floating pulse, Mahuang Tang governs. Taiyang Dampness with whole-body pain, fever, jaundice, dysuria: Wind-Damp contention, whole-body heaviness/pain; Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) governs. If deep pulse with spontaneous diarrhea and body pain, it is a Yin pattern; urgently save the interior with Sini Tang, Fuzi Tang, or Zhenwu Tang (True Warrior Decoction). (Note: Diarrhea with body pain requires saving interior; normal stool with body pain requires saving exterior.) Heavy body, stiff back, abdominal colic, throat obstruction, feeling like being beaten: treat as Yin Du (Yin Toxin). After sweating, if body pain persists with deep/slow pulse, use Guizhi Jia Shaoyao Shengren Xinjia Tang (New Added Cinnamon Twig plus Peony, Ginger, and Ginseng Decoction) or Xiao Jianzhong Tang. If Huoluan vomiting/diarrhea stops but body pain remains, small dose of Guizhi Tang resolves it. *Jingui Yaolue* says: Chan Jia (Skin Disease Patient) with body pain cannot sweat; sweating causes spasms. Itching: Floating/slow pulse indicates lack of Yang and inability to sweat, causing itching. Taiyang 7-8 days, micro pulse, aversion to cold indicates dual Yin/Yang deficiency; do not sweat/purge/vomit. Xiaochaihu Tang governs. If re-sweated causing Qi deficiency and deafness, Suo Wu Re Ren (those without prior heat) use Shaoyao Gancao Fuzi Tang; Suo You Re Ren (those with prior heat) use Huangqi Jianzhong Tang. Red face with heat indicates unresolved condition due to lack of slight sweat; body itches, use Guizhi Mahuang Ge Ban Tang.

(70) Inquiry into Muscle Twitching, Dizziness, and Trembling
Taiyang disease unresolved after sweating, with fever, palpitations, dizziness, and trembling wanting to fall to the ground belongs to Zhenwu Tang. Excessive sweating causes tremors; deficient/thin patients get this from slight sweating. Zhenwu Tang governs all. For severe wasting, remove Shaoyao or use less; for heat patterns fearing heat-inducing herbs, remove Fuzi. Adjust according to the formula. After Shanghan emesis/purge, if epigastric fullness, Qi rushing to chest, dizziness upon standing, deep/tight pulse, and sweating causes meridian disturbance with trembling, Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) governs. If Shanghan requires sweating but Dong Qi (Moving Qi) is on the left, do not sweat; sweating causes dizziness, sweating, muscle twitching, which is adverse and difficult to treat. First take Fangfeng Baizhu Muli Tang.