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(When the disease) manifested, there was headache, swelling behind both ears, extending upward to Chengling (BL9), and downward to Tianyou (TE16). I was urgently invited to examine the patient. As I happened to be out, another surgeon was consulted, who diagnosed it as an ear pillow carbuncle (Erzhen Yong), a very critical condition. A formula for expelling wind and resolving toxicity was administered. Consequently, the tendons and collaterals in the back of the head and shoulder blades became more spasmodic and contracted. The patient suffered from dryness, thirst, restlessness, and oppression, with urination scanty and burning like fire. When I arrived, the patient was exhausted and unable to support himself. Palpation revealed a pulse that was flooding (Hong) and rapid (Shu) abnormally. It was determined that there was heat in the interior, with pathogenic factors in the Yangming and Shaoyang channels. This was due to excessive sweating in a Yin-deficient constitution, causing Fire to ascend, further aggravated by wind-dispersing herbs. Chaihu should not be used. Huangqin (Scutellariae Radix) and Shigao (Gypsum Fibrosum) were used as Sovereign herbs; Xian Dihuang (Rehmanniae Radix Recens) and Gan Dihuang (Rehmanniae Radix Preparata) as Ministers; Huashi (Talcum) and Sheng Gancao (Glycyrrhizae Radix et Rhizoma Recens) as Assistant herbs; Lianqiao (Forsythiae Fructus) and Mutong (Akebiae Caulis) as Envoys. A large dose was administered. The next day, swelling and pain decreased. The swollen area remained red. One he (approx. 50g) of Ludou (Phaseoli Semen Mungo) was added to the previous formula, after which swelling and pain completely subsided. Finally, Daochi San combined with Liuyi San was administered, leading to recovery.

Xu Lingtai stated: The methods of treating diseases do not exceed two ends: sweating (Han) and purging (Xia). Purging harms the body, and its danger is immediately apparent; thus, neither doctors nor patients dare to use it lightly. However, those who die from excessive sweating leading to collapse of Yang (Wang Yang) account for two or three out of ten. Although they die, people are unaware of it. Why? Whenever people suffer from Wind-Cold disorders, they mutually warn each other to keep warm rather than cool. Patients cover themselves heavily, and doctors say that medication must induce sweating for resolution. Therefore, patients seek sweating, considering it natural. In autumn and winter, being too warm causes little harm. But in midsummer and early autumn, when the weather is hot and dry, Wei Qi (Defensive Qi) opens and dissipates easily. If one closes doors and windows, wears heavy clothes, and takes dispersing agents, it will inevitably lead to continuous profuse sweating and collapse of Yang. Furthermore, in external contraction diseases, before sweating occurs, there must be irritability, oppression, and aversion to heat. After profuse sweating, Wei Qi is entirely exhausted, leading to Yang deficiency and aversion to cold. The initial covering was merely endured. At this stage, even if one wishes to uncover, it is impossible; the more covered, the more one sweats. The more one sweats, the colder one becomes, until sweat flows like oil and extremities become cold, at which point the disease is incurable. Death occurs with clear spirit and no pain. Patients, doctors, and bystanders do not understand why death occurred suddenly, only staring at each other in horror. In short, sick people should not be too cool, nor too warm; under normal circumstances, sweating should not be induced. Only during medication, slight sweating is appropriate. Zhang Zhongjing's method for taking Guizhi Tang states: "After taking the decoction, cover warmly to induce slight sweating; do not let it flow like water." This is the rule. If collapse of Yang is not severe, it can still be rescued. Methods such as Zhenwu Tang, Lizhong Tang, and Sini Tang in *Shanghan Lun* can be consulted. If exhaustion is complete, there is no remedy. Also, during intense summer heat, if patients stay upstairs or near stoves, healthy people standing there sweat profusely. Sick people will sweat constantly; even if they do not suffer collapse of Yang, they will die from exhaustion of Yin. If relocation is impossible, one must choose a cooler place; otherwise, tonics cannot save them.

Pei Zhaoqi said: A scholar suffered from severe illness and chronic deficiency. Later, he ate heavily and took large doses of Qi- and Blood-tonifying herbs daily for weeks or months. He should have recovered. Instead, his appetite suddenly decreased, he felt cold all over, and had spontaneous and night sweats continuously day and night. Several famous doctors treated him with Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Preparata), Renshen (Ginseng Radix et Rhizoma), and Huangqi (Astragali Radix). The more he sweated, the colder he felt. Even increasing Renshen and Huangqi to one liang (approx. 37.5g) was ineffective. I used Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) as Sovereign herbs; Cangzhu (Atractylodis Rhizoma) and Banxia (Pinelliae Tuber) as Ministers; Huanglian (Coptidis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus Rotundus), Houpo (Magnoliae Officinalis Cortex), Fuling (Poria), Guizhi (Cinnamomi Ramulus), and Fumai (Tritici Levis Fructus) as Assistants/Envoys. After one dose, sweating stopped, and aversion to cold disappeared. Subsequently, Ren Shen Da Bu Pi Wan was prescribed. Within a month of regulation, he recovered. Generally, after severe illness and chronic deficiency, although Stomach Qi may be strong, Spleen Qi remains weak. Digestion is difficult despite increased intake. Continuous tonic decoctions cause Damp-Heat to stagnate in the Middle Jiao, leading to sudden loss of appetite, excessive sweating, and chills. The body's defensive Qi originates from the Stomach. If the Stomach is blocked by Phlegm-Saliva, defensive Qi cannot distribute to the skin and hair or fill the interstices. Ancients said: Phlegm in Zhongwan (CV12) causes chills; stagnant Spleen Dampness causes sweating. This is what they meant. Regarding the use of Qianghuo and Fangfeng for excessive sweating: since the interstices are open, Wind pathogens invade vacuity. Wind must be expelled first for sweating to stop. Regarding the use of Huanglian for chills: this chills is not Deficiency-Cold, but Cold caused by Damp-Heat generating Phlegm. Clearing Dampness stops sweating. After severe illness, one must never recklessly administer drugs. Regardless of whether the prescription is correct, caution is needed. Yuan Qi (Original Qi) relies on Wei Qi (Stomach Qi); Wei Qi relies on Grain Qi. After severe illness, the body is distant from Grain Qi; it prefers food and dislikes medicine. This is normal. At this time, one should feed preferred foods to nourish Stomach Qi. When Stomach Qi is robust, Yuan Qi is also robust. There is supreme tonification within non-tonification. Why use disagreeable substances that hinder Stomach Qi? Modern doctors, misunderstanding this, often diagnose Qi and Blood deficiency after prolonged illness and prescribe massive tonics consisting of Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Gouqi (Lycii Fructus), Gushi (Psoraleae Fructus), Shanyao (Dioscoreae Rhizoma), Congrong (Cynomorii Herba), Renshen, Huangqi, Fuling, Baizhu (Atractylodis Macrocephalae Rhizoma), etc., either as decoctions or pills, without restraint. Some experience reduced appetite, diarrhea, vomiting, or distension after taking them. Some develop chest fullness, inability to eat, and other symptoms. Named as tonifying, they actually harm. One must beware!

Pei Zhaoqi treated a Xiaolian (degree holder) who, while a student, suffered from disturbance due to moving and youthful indulgence. In late autumn and early winter, he had afternoon fever but ignored it. Pei palpated the pulse and found all six positions extremely deficient and rapid, which alarmed him. He prescribed Renshen 5 qian, Guizhi, Fuzi, Danggui, and Baizhu 2 qian each, advising immediate administration to avoid danger. The patient hesitated. Soon, he sweated profusely, extremities became cold, eyes spun, spirit fatigued, and he could not speak lying down. He then urgently took the previous medicine for five or six doses, increasing Renshen to over 1 liang. The condition stabilized slightly, but the pulse was nearly imperceptible. The next day, the pulse remained similar, and sweating continued hourly. Pei stayed overnight, using Renshen 1 liang, Fuzi half piece, and Huangqi 2 liang decocted separately to cook the medicine. After four administrations, sweating persisted. It was past midnight, and no pharmacy was available. Desperately, he boiled the dregs again to meet the emergency. After Zi hour (11 PM - 1 AM), Yang generated, Stomach Qi returned. After eating two bowls of porridge and some meat, sweating gradually stopped, and the pulse recovered order. At dawn, fresh Renshen was purchased to continue treatment, leading to recovery.

Li noted: This is an extreme case of spontaneous sweating. Not only is Yang deficient, but Yin is also severely damaged. Purely using Renshen, Huangqi, Guizhi, and Fuzai has the drawback of bias. Adding Danggui to Renshen is particularly inappropriate. It was the sweet and bland nature of the herb dregs that restored Stomach Qi. Combined with porridge aiding Stomach Qi, sweating ceased. This was not due to Renshen, Huangqi, Guizhi, or Fuzi.

Xu Lingtai stated: The Classics say, "Those who lose blood should not sweat; those who lose sweat should not bleed." Blood belongs to Yin; thus, excessive sweating is exhaustion of Yin. Therefore, the treatment for sweating must use herbs that cool the Heart and astringe the Lung. Why? The Heart governs Blood, and Sweat is the fluid of the Heart; thus, clearing Heart Fire is necessary. Sweat exits through the skin and hair, which are governed by the Lung; thus, astringing Lung Qi is required. This is the direct treatment. However, if sweating is too severe, Yin ascends and exhausts, and Dragon-Leopard Fire from the Kidneys rises with Water. If cooled with cold/bitter herbs, the Fire flares up. One must use large doses of Renshen and Fuzi assisted by salty-descending agents like Tongbian (Urine of Children) and Muli (Ostreae Concha). A bowl of frozen beverage reaches the Lower Jiao directly, guiding True Yang downward. Then Dragon-Leopard Fire returns to its position, and sweating stops. This is vastly different from sweating due to exhaustion of Yin. Thus, treatments for exhaustion of Yin and Yang are distinct, and the turning point is instantaneous. When Yang is inactive, use Yin herbs to stop sweating. When Yang is active, use Yang herbs. Longgu (Fossilia Ossis Mastodi), Muli, Huangqi, and Wuweizi (Schisandrae Fructus) are astringents usable in both cases. If doctors can distinguish the boundary between exhaustion of Yin and Yang, medication will be error-free. How to differentiate? Sweating from exhaustion of Yin: body fears heat, hands and feet are warm, skin is hot, sweat is hot, taste is salty, thirst with preference for cold drinks, coarse breathing, flooding and solid pulse. Sweating from exhaustion of Yang: body fears cold, hands and feet are cold, skin is cool, sweat is cold, taste is bland and slightly sticky, no thirst with preference for hot drinks, faint breathing, floating, rapid, and empty pulse. Ordinary Zheng Han (Correct Sweat), Re Han (Hot Sweat), Xie Han (Pathogenic Sweat), and Zi Han (Spontaneous Sweat) do not fall into these categories. Few know this principle. Regarding sweating alone, debates are endless, lacking definite views, leading to many misdiagnoses.

He also said: Sweating generally results from restless Heart Fire; it is mostly Heat, rarely Cold. People now use Yang-tonifying methods, which is a biased view, stemming from ignorance of which channel the sweat fluid belongs to, misleading many. Sweating from exhaustion of Yang is Flying Away of Yang and emptiness of the Lower Jiao, a critical condition requiring Renshen and Fuzi to restore Yang. It is very different from spontaneous and night sweating. Doctors ignore this, treating them as one disease, causing infinite delay, which is laughable.

You Zaijing said: A person sweated profusely on the head after eating salty food, but not after eating bland food. Palpation showed the Heart pulse alone was large and firm. Questioned: Do you feel dry and desire water? Answered: Yes, my tongue prickles every morning upon waking. I realized the reason for head sweating is excessive Heart Fire, which Water cannot overcome. Salty taste belongs to Water and can descend Fire. When Fire and Water contend, if Fire is strong and Water weak, Water cannot overcome Fire and instead overflows outward. Since it exits the head: Water naturally moistens downward, while Fire nature ascends. Provoked by Fire, Water follows Fire's transformation. Eating bland food does not cause this because salty taste is surging and draining (Yin), while bland taste is seeping and draining (Yang). Yang follows Yang, not clashing, allowing it to follow its seeping nature and descend.