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Any disease rarely occurs without fever. The key distinction between internal injury (Neishang) and external contraction (Waigan) lies in the pulse: if the Renying pulse (pulse at the carotid artery in the neck) is larger than the Qikou pulse (pulse at the radial artery in the wrist), it indicates external contraction; if the Qikou pulse is larger than the Renying pulse, it indicates internal injury. In external contraction, aversion to cold (Ehan) and fever (Fare) occur simultaneously without interval; in internal injury, they alternate and are not synchronized. Aversion to cold due to external contraction cannot be relieved even by approaching a fierce fire, whereas aversion to cold due to internal injury can be resolved by seeking warmth. Aversion to wind (Efeng) in external contraction implies intolerance to all kinds of wind and cold, while in internal injury, it refers only to sensitivity to slight drafts. External contraction manifests in the nose, causing nasal congestion with forceful breathing; internal injury manifests in the mouth, leading to loss of taste and abdominal disharmony. Due to excess pathogenic factors in external contraction, speech is loud and vigorous, starting light and becoming heavy; due to deficiency of healthy qi (Yuanqi) in internal injury, speech is lazy and timid, starting heavy and becoming light. Headache in external contraction is constant; in internal injury, it comes and goes. Hand dorsum heat with cool palms indicates external contraction; palm heat with cool hand dorsum indicates internal injury. These are the main points of differentiation by Li Dongyuan. Cases with internal injury but no external contraction, or vice versa, are clearly distinguished by these criteria. However, when internal injury and external contraction coexist, their pulses and symptoms appear together, making differentiation difficult, requiring careful investigation. If internal injury symptoms predominate, internal injury is severe and external contraction is mild; nourishment should be prioritized. If external contraction symptoms predominate, external contraction is severe and internal injury is mild; dispersing and harmonizing should be urgent. This is an implicit meaning not explicitly stated by Li Dongyuan.

(Winter-warmth [Dongwen], Warm-pathogen disease [Wenbing], Cold-epidemic [Hanyi], Heat-disease [Rebing], Damp-warmth [Shiwen], Wind-warmth [Fengwen], Cholera-like disorder [Huoluan], Spasm [Jing], Food stagnation [Shangshi], Deficiency vexation [Xufan], Phlegm [Tan], Beriberi [Xianggangjiao], Internal abscess [Neiyong], Blood stasis [Xuxue])

It is commonly believed that Phlegm-fluid retention [Tanyin], Beriberi [Xianggangjiao], Deficiency vexation [Xufan], and four other conditions resemble Shaoyang disease (Shanghan). Wang Shuhe also included Spasm [Jing], Dampness [Shi], and Cholera-like disorder [Huoluan] as resembling Shaoyang disease in the *Treatise on Cold Pathogenic Diseases* (*Shanghan Lun*). However, comparing their manifestations reveals more than just these. The cases of internal injury from overwork resembling Shaoyang disease have been discussed previously. Here, we differentiate Winter-warmth [Dongwen] and similar diseases from Shaoyang disease as follows: After Frost's Descent [Shuangjiang], if one contracts cold weather and becomes ill, it is Shaoyang disease (Floating-tight pulse without sweat indicates Shaoyang disease; Floating-slow pulse with sweat indicates Wind-injury [Shangfeng]). If after Frost's Descent, the weather should be cold but is warm, and one falls ill due to thin clothing exposing them to cold, it is called Winter-warmth [Dongwen] (Skin eruption due to seasonal qi, or heat lingering from Shaoyang disease encountering further warmth, is called Warm-toxin [Wendu]). In spring, when the weather is mild, if someone has high fever, thirst, and no aversion to cold, it is Warm-pathogen disease [Wenbing] (Using acrid-warm diaphoretics would ruin the case). If the weather remains cold with ice and snow, and one contracts cold, it is also called Shaoyang disease. Between the third and eighth months, if sudden cold strikes and causes illness, it is called Seasonal Cold-Epidemic [Shixing Hanyi]. After Summer Solstice [Xiazhi], during hot weather, if someone has high fever, irritability, thirst, and no aversion to cold, it is Heat-disease [Rebing]. Heat-disease resembles Summerheat [Zhongshu], but Heat-disease has a full pulse, while Summerheat has a deficient pulse. In summer, if there is headache, delirium, spontaneous sweating, slight body heat, cold legs below the knees, heavy limbs, and chest/abdominal fullness, it is Damp-warmth [Shiwen]. This occurs when dampness injury combines with Summerheat, creating damp-heat conflict; diaphoresis is contraindicated. If headache, body heat, and spontaneous sweating resemble Shaoyang disease, but both Cun and Chi pulses are floating, body is heavy, the person is silent and sleepy, breathes snoringly, speaks with difficulty, and limbs are flaccid, it is Wind-warmth [Fengwen]; diaphoresis is contraindicated. Vomiting and diarrhea with headache, body pain, aversion to cold, and fever, or cessation of vomiting/diarrhea followed by fever, is Cholera-like disorder [Huoluan]. Body heat with cold feet, stiff neck, aversion to cold, intermittent head heat, red face and eyes, head tremor, sudden jaw lock, and opisthotonos is Spasm [Jing]. Aversion to cold without sweat is Yang-Spasm [Gangjing]; aversion to wind with sweat is Yin-Spasm [Roujing]. Lying on back with open eyes is Yang-Spasm; lying on stomach with closed eyes is Yin-Spasm. Floating-tight-rapid pulse is Yang-Spasm; sinking-thin-choppy pulse is Yin-Spasm. Dry mouth/thirst is Yang-Spasm; normal mouth sensation is Yin-Spasm. Yang-Spasm is easy to treat; Yin-Spasm is difficult. Headache and fever like Shaoyang disease but without body pain, with a tight/full Qi-kou pulse on the right hand, short/slippery Right Guan pulse, and normal Left hand pulse, indicates Food stagnation [Shangshi]. Accompanied by epigastric stuffiness, belching with sour taste, aversion to food odor, desire to vomit without success, or incomplete vomiting. If food stagnation combines with cold, both Renying and Qi-kou pulses are large, with vexation and heat resembling Shaoyang disease, but pulse is not floating-tight, no headache/body pain, no aversion to cold. Vexation with headache that ceases when vexation ceases is Deficiency vexation [Xufan]. Aversion to cold, fever, aversion to wind, spontaneous sweating, chest fullness, qi rushing to throat causing dyspnea, resembling Shaoyang disease but without headache/stiff neck, with irregular headache and tight-but-not-large pulse, indicates Phlegm [Tan]. Phlegm in Upper Jiao shows sinking-slippery or sinking-hidden Cun pulse; Phlegm in Middle Jiao shows slippery-large Right Guan pulse; Qi stagnation shows sinking-slippery pulse; combined with food shows short-slippery pulse. Wiry-slippery pulse indicates Phlegm-fluid retention [Tanyin]; wiry-predominant indicates Fluid retention [Yin]; sinking-wiry indicates Suspended fluid [Xuanyin] or internal pain. Large pulses at Left/Right Guan or floating-large at Guan, or dark circles under eyes like smoke, are signs of Phlegm. Fever, aversion to cold, headache, joint pain, nausea/vomiting, resembling Shaoyang disease, but starting from feet with swollen/painful ankles/knees, either swollen or emaciated legs, and hard stool, is Beriberi [Xianggangjiao]. The *Treatise on Cold Pathogenic Diseases* states: Floating-rapid pulses usually indicate fever and chills; if there is pain but diet is normal, it indicates pus accumulation (Internal abscess [Neiyong]). *Suwen* states: Fullness in Liver, Kidney, or Lung indicating excess leads to swelling. Wang Bing notes: "Full" means full pulse qi; "Swelling" means abscess. Generally, cough with hidden chest pain, rough skin on chest, chills, rapid pulse, dry throat without thirst, frequent expectoration of foul-smelling turbid saliva, and long-term expectoration of rice-pus-like material indicates Lung Abscess [Feiyong]. Heavy lower abdomen, painful on pressure, frequent urination resembling strangury, sweating with aversion to cold, rough skin, tense abdominal wall, slippery-rapid pulse indicates Intestinal Abscess [Changyong]. Hidden epigastric pain intolerable to touch, sinking-thin Stomach pulse, and reverse-full Renying pulse indicates Epigastric Abscess [Weiyuan Yong]. Internal injury vs. external contraction is distinguished by Renying and Qi-kou pulses. Internal injury has flat Renying and full Qi-kou; Epigastric Abscess has reverse-full Renying. Mistaking this for Shaoyang disease is common; early differentiation is crucial. A maiden from Qian family in Jingkou had intestinal abscess fever, treated as Shaoyang disease by quacks, starved for ten days, and died. Only upon death did she expel liters of pus. Alas, how can one neglect reading Zhang Zhongjing's works? Fever resembling Shaoyang disease, but following trauma from falling/hitting, or intense anger/shouting, with free urination, slight thirst, and tender pain in epigastrium/hypochondrium/umbilicus intolerable to touch, indicates Blood stasis [Xuxue]. Overwork, hunger/fullness, emotional injury, or sexual excess can cause blood stasis. My friend Miao Zhongchun took excessive tonic pills, developed persistent fever, worsened by cooling herbs, nearly died. I treated him for Blood stasis. While brewing, he smelled the aroma, drank it, fever subsided, and he passed a bucket of black stool the next day, recovering fully. Shaoyang disease has its own Blood stasis syndrome; this text discusses miscellaneous diseases mimicking Shaoyang disease through blood stasis.