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Pulse is deep, indicating the pathogen is in the interior. If sweating method is used in error, body fluids will escape, leading to difficult defecation; exterior deficiency and interior excess, over time, will result in delirium (incoherent speech due to mental disturbance). (Discussion found under "Delirium"). Pulse is floating and tight, which typically presents with body pain and should be resolved by sweating. However, if the cun-guan-chi pulse at the chi position is slow, sweating must not be induced. How do we know this? Because Ying Qi (Nutritive Qi) is insufficient and blood is scant. (The *Liu Ren Shu* states: First administer Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) added with Huangqi (Astragali Radix); if the chi pulse remains slow, take another dose, then take one of Guizhi Tang (Cinnamon Twig Decoction), Chaihu Tang (Bupleurum Decoction), or Yuebi Tang (Ephedra Decoction), using small doses to harmonize the condition until recovery.)

Xu Shimiao recorded: A fellow townsman, Mr. Qiu, suffered from Shanghan (Cold Damage) with fever, headache, restlessness, and thirst. The pulse was floating and rapid but forceless, while the lower chi position was slow and weak. I said: Although this resembles a Mahuang Tang (Ephedra Decoction) pattern, the slow chi pulse indicates, as Zhang Zhongjing stated, "If the chi pulse is slow, Ying Qi is insufficient, Qi and Blood are slightly deficient, and sweating should not be induced." I administered Jianzhong Tang (Construct the Middle Decoction) added with Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix) for him to drink. The next day, the pulse remained unchanged. His family prepared the medicine urgently, urging me day and night to induce sweating, leaving me little room to refuse. I endured it, using only Jianzhong Tang to harmonize Ying Qi. By the fifth day, the chi pulse became distinct and responsive, so I administered Mahuang Tang (Ephedra Decoction). After two doses, the patient went into a frenzy, then gradually settled, slept briefly, and finally sweated profusely. Indeed, this matter is difficult. Although Zhang Zhongjing said "do not avoid morning or night, treat immediately," physicians must also consider exterior-interior deficiency-excess and wait for the appropriate timing. If one does not follow the sequence and seeks temporary relief, damaging the Zang-Fu organs and shortening life, what value is there? The *History of the Southern Dynasties* records that Fan Yun suffered from Shanghan and feared he would miss Emperor Wu's celebration of receiving the Nine Bestowals. He summoned Xu Wenbo for diagnosis and asked earnestly, "Can I recover immediately?" Wenbo replied, "Recovery is easy, but I fear you will not rise again after two years." Yun said, "If I hear the Dao in the morning, I can die content in the evening, let alone two years." Wenbo heated the ground, spread peach leaves, set up a mat, and placed Yun upon it. In an instant, sweat flowed and the illness resolved; warm powder was applied. The next day, he indeed recovered, and Yun was very pleased. Wenbo said, "There is no need to be pleased; two years later, you will indeed pass away." This method of inducing sweating prematurely still shortens life, let alone disregarding exterior-interior conditions and timing, seeking quick results? I often see patients' families unable to endure the illness, urging sweating within three or four days, day and night. Physicians who follow their wishes rarely avoid failure. Therefore, I write this as a warning.

Shaoyin disease with fine, deep, rapid pulse indicates the pathogen is in the interior; sweating is contraindicated. Shaoyin disease with a faint pulse is contraindicated for sweating because it leads to Yang collapse. Pulse is soft and weak; weakness appears at the Guan position, softness at the Dian (Cun) position, faintness at the upper part, and choppy at the lower part. Faintness indicates insufficient Yang Qi; choppy indicates lack of Blood. With deficient Yang Qi, after wind-stroke induces sweating, restlessness occurs instead. Choppy pulse indicates lack of Blood, leading to cold limbs and cold sensation. With deficient Yang Qi, sweating causes restlessness and inability to sleep. Moving Qi on the right side is contraindicated for sweating; sweating causes epistaxis and thirst, heart vexation, and vomiting water after drinking. Moving Qi on the left side is contraindicated for sweating; sweating causes dizziness, continuous sweating, tremors of muscles and sinews. Moving Qi above is contraindicated for sweating; sweating causes Qi rushing upward, centered at the heart. Moving Qi below is contraindicated for sweating; sweating causes absence of sweat, severe heart vexation, bone joint pain, aversion to cold with eyes closed, vomiting food after eating, obstruction of grain flow, and throat blockage. Sweating is contraindicated; it causes hematemesis, faint Qi, cold extremities, desire to lie down exhausted, and inability to self-warm. Pulses that are rapid, moving, and weak are contraindicated for sweating; sweating causes difficult defecation and dry abdomen (or difficult urination and dry bladder), stomach dryness, and vexation. The forms appear similar, but origins differ. Pulse is soft and weak; weakness at Guan, softness at Dian, wiry at upper, faint at lower. Wiry indicates Yang movement, faint indicates Yin cold, upper excess and lower deficiency, desiring warmth. Faint and wiry indicates deficiency; sweating is contraindicated, causing chills and inability to recover. Cough becomes severe, frequent spitting of saliva, dry throat, difficult urination, hunger-vexation in the heart, intermittent attacks resembling malaria with cold but no heat, deficiency with chills. Sweating for cough leads to curling up, abdominal fullness, and hardness. Tight Jue pulse is contraindicated for sweating; sweating causes disordered voice, hoarse throat, flaccid tongue, and inability to speak. For all adverse conditions, sweating makes mild cases hard to cure and severe cases result in disordered speech, dizziness, and death (or delirium, dizziness, and chaotic vision), making survival unlikely.

Taiyang disease lasting eight or nine days resembles malaria, with fever and aversion to cold, more heat than cold. If the patient does not vomit and bowel/bladder functions remain normal, occurring two or three times a day, and the pulse is faint with aversion to cold, this indicates both Yin and Yang deficiency; further sweating is contraindicated. Taiyang disease with fever, aversion to cold, more heat than cold, and faint pulse indicates absence of Yang; sweating is contraindicated. Dry throat is contraindicated for sweating. Blood loss is contraindicated for sweating; sweating causes chills and trembling. Patients prone to epistaxis are contraindicated for sweating; sweating causes depression of the forehead, tight pulse, staring gaze without eye movement, and insomnia. Patients prone to sweating are contraindicated for sweating; sweating causes mental confusion and vagueness, pain in the genitalia after urination; Yuyuliang Wan (Hematite Pill) is suitable (formula missing). Patients with Lin syndrome are contraindicated for sweating; sweating causes blood in urine. Patients with chronic sores, even with body pain, are contraindicated for sweating; sweating causes spasms. Diarrhea is contraindicated for sweating; sweating causes abdominal distension. Cough with clear urination or urinary incontinence is contraindicated for sweating; sweating causes cold reversal of four limbs. Cold damage from one to two days to four to five days: if there is cold reversal, fever must follow; previous cold reversal means subsequent fever. Deeper cold reversal implies deeper heat; milder cold reversal implies milder heat. Cold reversal should be treated with purgation, but if sweating is used in error, mouth ulcers and redness occur. Cold damage with wiry-fine pulse, headache, and fever belongs to Shaoyang. Shaoyang is contraindicated for sweating. Cold damage with headache, mild fever resembling wind-stroke, constant slight sweating, and spontaneous vomiting: purgation increases vexation and heart discomfort like hunger. Sweating causes spasms and stiff body difficult to flex/extend. Moxibustion causes jaundice, inability to urinate, and eventually cough with sputum. Concurrent Taiyang and Shaoyang disease with stiff neck/headache, dizziness, occasional chest binding, and epigastric hardness is contraindicated for sweating. Taiyang disease treated with sweating leading to spasms. Shaoyin disease with cough, diarrhea, and delirium results from fire therapy coercion; urination will be difficult due to forced sweating of Shaoyin. Shaoyin disease with cold reversal and no sweat, forcibly induced sweating moves Blood; unknown exit route, possibly from mouth/nose or eyes, called Lower Cold and Upper Exhaustion, most difficult to treat.

*Yong Lei Ling Fang* states: There are four difficulties in sweating for Shanghan. Fever, headache, sweating present but not anhidrosis, aversion to wind but not aversion to cold: inducing sweating leads to non-stop sweating (Leak Wind) or occasionally spasms; this is the first difficulty regarding exterior patterns. Fever, headache, slow chi pulse indicates Ying deficiency and blood scarcity, contraindicated for sweating; fever, headache, wiry-fine pulse belongs to Shaoyang, contraindicated for sweating, sweating causes delirium; this is the second difficulty regarding pulse patterns. Moving Qi on left: contraindicated for sweating, causes dizziness, continuous sweating, muscle tremors. Moving Qi on right: contraindicated for sweating, causes epistaxis, thirst, heart vexation, vomiting water. Moving Qi above: contraindicated for sweating, causes Qi rushing and heart palpitations. Moving Qi below: contraindicated for sweating, causes anhidrosis, heart vexation, bone pain; this is the third difficulty regarding interior patterns. Spring allows sweating but not heavy sweating as Yang Qi is still slight; Winter avoids heavy sweating as Yang Qi is hidden; sweating causes vomiting, diarrhea, mouth ulcers, and sores; this is the fourth difficulty regarding seasonal timing.

Yun Qizi says: Taiyang pattern requires headache and stiff neck for sweating; requires fever and aversion to cold for sweating; requires floating pulse for sweating.

*Liu Ren Shu* says: Faint pulse or slow chi pulse is contraindicated for releasing the exterior. Patients who should sweat but have epistaxis or hematochezia are contraindicated for releasing the exterior. Complicated diseases are contraindicated for releasing the exterior. Women with menstruation onset are contraindicated for releasing the exterior. Fengwen (Wind-Warmth) is contraindicated for releasing the exterior. Shiwen (Damp-Warmth) is contraindicated for releasing the exterior. Deficiency vexation is contraindicated for releasing the exterior. Patients with pulsating Qi in the abdomen (left/right/up/down) are contraindicated for releasing the exterior.

Taiyang disease with dry throat, dripping epistaxis, or difficult urination should not be sweated. If already sweated, do not re-sweat. Unless the above contraindications exist, even if previously sweated, if pathogens remain, re-sweating may be necessary. Failure to sweat when indicated leads to Jaundice. This condition arises from Wind-Cold injury, where Yang Qi sinks inward and combines with Cold-Fluid rising through meridians. Sweating should have been used to expel pathogens; physician's omission causes Jaundice. Spleen governs muscles and four limbs; Cold-Damp combined with internal Heat causes Jaundice. Sweating when inappropriate leads to Blood Stasis and Dry Fire. Nourishing fluids is superior, but sweating destroys them; toxin harasses extreme Yang, invading Yin, causing dry Blood stasis in the chest. Excessive sweating when indicated opens pores, causing continuous leakage, leading to stiff limbs difficult to flex/extend.