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The *Huoren* (Book of Living People) states: Fever accompanied by aversion to cold belongs to Taiyin disease; body heat with continuous sweating belongs to Yangming disease; fine pulse, headache, vomiting, and fever...

Question: Why is there fever in Yin syndromes?

Answer: Taiyin and Jueyin typically do not present with fever. Only Shaoyin disease has two clauses mentioning fever, which Zhang Zhongjing refers to as "counterfeit fever" (Fan Re Fa). In the early stage of Shaoyin disease, if fever occurs with a deep pulse, it is treated with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). If Shaoyin disease presents with diarrhea of undigested food, internal cold with external heat, cold extremities, and an imperceptible pulse, Tongmai Sini Tang (Pulse-Returning Sini Decoction) is indicated. In summary: Generally, fever in Yin syndromes is distinct; it must be accompanied by a deep and fine pulse, or diarrhea, and cold extremities. There is another clause regarding irritability due to Yin and fever, where the patient desires to sit in a well. This example should be categorized under Shaoyin disease.

Zhang Zhongjing states: Vomiting, diarrhea, sweating, fever with aversion to cold, spasticity of the four limbs, and cold extremities are treated with Sini Tang (Frigid Extremities Decoction). He also states: Vomiting and diarrhea, with urination becoming frequent and profuse sweating, diarrhea of undigested food, internal cold with external heat, and a faint pulse nearly disappearing are treated with Sini Tang. For fever and headache without body pain, the interior should be rescued first using Sini Tang. Diarrhea of undigested food, internal cold with external heat, sweating with cold extremities are treated with Tongmai Sini Tang. Profuse sweating with persistent heat, internal spasticity, limb pain, accompanied by diarrhea, cold extremities, and aversion to cold are treated with Sini Tang.

The obstruction of Yin and Yang Qi differs in cold and heat nature, yet both manifest as irritability. This is like scorching summer heat melting metal or severe winter cold freezing the sea.

Citing the classics on Yang syndromes: A floating and rapid pulse with ability to eat but constipation indicates excess, named Yang Jie (Yang Obstruction); a deep and slow pulse with inability to eat is treated with Lizhong Wan (Regulate the Middle Pill). Wang Shuhe states: A wiry pulse indicates cold obstruction in the intestines. Li Dongyuan (Jiegu) states: A deep and wiry pulse with inability to eat and constipation indicates Yin Cold Obstruction.

Taking Yang syndrome as an example: If a Yang disease occurs, and the exterior pathogen of Taiyang does not resolve but enters the interior, presenting with fever, aversion to cold, and thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated.

If damp-heat is in the lower jiao, it causes constipation. Other causes of obstruction are treated according to the meridian. If constipation is caused by a Yin syndrome, with a slow and fine pulse, inconsistent pulses at superficial, middle, and deep levels, excessive Yin Qi, and impending exhaustion of Yang Qi, although self-diarrhea is expected, if the stool is white and constipated instead, it is because Yin cannot transform, leading to stagnation and drying of fluids, similar to water freezing. Fluids fail to circulate, causing blockage. Hot-natured medicines should be used. When Yin receives Yang warmth, transformation occurs, fluids circulate, and defecation resumes. It is absolutely forbidden to use diuretics for this purpose. For instance, Sini Tang added with Fuling (Poria), which shares the same principle as Zhang Yuansu’s Liuhuang Dingxiang Doukou San (Sulfur, Clove, and Cardamom Powder) containing Huashi (Talcum). Essentially, it is not Fuling and Huashi that promote urination, but rather they guide the hot medicines downward, preventing them from entering other meridians, thus ensuring rapid efficacy.

The classics state: Yangming cold-dampness prevents eating, causes difficult urination, and leads to sweat on the hands and feet, potentially forming a mass; this is cold-dampness, consistent with the above principle. The *Nanjing* (Classic of Difficult Issues) states: The Kidney governs difficulties in bowel and bladder movements. Both Yin and Yang syndromes are included herein!

Cheng Wuji states: Harmony arises when Yin and Yang mix; obstruction arises when they separate. Fire also has a downward gathering aspect due to Heart deficiency.

Regarding the modification of Zhang Zhongjing’s Zhenwu Tang: If urination is spontaneous, remove Fuling. Regarding Si Ni San: Add Fuling for difficult urination. Regarding Xiao Chaihu Tang: Add Fuling for difficult urination. (*Huoren* states: For abdominal pain in Yin syndrome with difficult urination, use Zhenwu Tang.)

*Huoren* states: If Yin syndrome is accompanied by urinary retention and retraction of the genitalia into the lower abdomen with agonizing pain, moxibustion should be urgently applied to the Shimen (Stone Gate) acupoint, located two cun below the umbilicus, using large moxa cones. Simultaneously, Fanyin Dan (Return-Yang Pill) and Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Frigid Extremities plus Evodia and Fresh Ginger) must be administered. Do not use ordinary diuretics. Ordinary diuretics often use cold and slippery agents. This is caused by Yin toxic qi in the lower abdomen; one must understand this.

Zhang Zhongjing states: Wind-dampness combing causes painful joints, inability to flex or extend, worsening pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with reluctance to remove clothes, or bodily swelling. These are treated with Gancao Fuzi Tang (Licorice and Aconite Decoction).

Zhang Congzheng (Haicang) states: Adding Fuling is especially good. If sweating fails to resolve the disease and aversion to cold worsens, it is deficiency; Shaoyao Gancao Tang (Peony and Licorice Decoction)...

Zhang Congzheng (Haicang) states: Adding Dahuang (Rhubarb) is especially good. If abdominal pain is present, this decoction is particularly suitable. Zhang Zhongjing states: Yangming cold-dampness prevents eating, causes difficult urination, and leads to sweat on the hands and feet, potentially forming a mass; this is cold-dampness.