A deep pulse indicates the pathogen is in the interior; if sweating is induced in error, body fluids will escape excessively, leading to difficult defecation. The exterior becomes deficient while the interior becomes excess; over time, this may result in delirium (incoherent speech due to mental confusion). (See discussion under "Delirium".)

A floating and tight pulse typically presents with body pain and should be treated by inducing 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, administer another dose, then take Guizhi Tang (Cinnamon Twig Decoction), Chaihu Tang (Bupleurum Decoction), or Yuebi Tang (Ephedra and Magnolia Bark Decoction) in small doses to harmonize the condition, and the patient will recover.)

Xu Yishi once treated a fellow townsman, Qiu Sheng, who suffered from Shanghan (Cold Damage) with fever, headache, restlessness, and thirst. Although his pulse was floating and rapid, it was forceless, and the pulses below the guan position were slow and weak. I said: "Although this resembles a Mahuang Tang (Ephedra Decoction) pattern, the slow and weak chi pulse indicates, as Zhang Zhongjing stated, 'If the chi pulse is slow, Ying Qi is insufficient, and Qi and Blood are slightly depleted; sweating must not be induced.' I prescribed 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 decoction urgently, urging me day and night to induce sweating, leaving me little room to refuse. I endured their pressure, using only Jianzhong Tang to harmonize Ying and Wei (Defensive Qi). By the fifth day, the chi pulse finally became responsive. I then administered Mahuang Tang, two doses. After taking them, the patient went mad, but soon calmed down, slept briefly, and then sweated profusely, recovering completely. Indeed, I have come to know that this matter is truly difficult. Although Zhang Zhongjing said, 'Do not avoid morning or night, treat immediately,' physicians must also consider the exterior-interior deficiency-excess patterns and wait for the appropriate timing. If one does not follow the proper sequence and seeks temporary relief without regard for order, damaging the Zang-Fu organs and shortening life span, what value is there?"

The *History of the Southern Dynasties* records that Fan Yun contracted Shanghan and feared he would miss Emperor Wu's celebration of the Nine Bestowals. He summoned Xu Wenbo for diagnosis and asked earnestly, "Can I recover immediately?" Wenbo replied, "Recovering immediately is very easy, but I fear you will not rise again after two years." Yun said, "I heard the Way in the morning and could die content in the evening; how much more so for two years?" Wenbo heated the ground, spread peach leaves, set up a mat, and placed Yun upon it. In an instant, Yun sweated and recovered. Warm powder was applied. The next day, he indeed recovered and was very pleased. Wenbo said, "There is no need to be pleased." Two years later, Yun indeed died. This method of inducing sweating even accelerated his lifespan; how much more so for those who disregard exterior-interior deficiency-excess, do not wait for the proper time, and seek quick results? I often see patients' families unable to tolerate the illness, urging sweating day and night within three or four days. Physicians who comply with these desires rarely avoid failure. Therefore, I write this as a warning.

Shaoyin disease with a fine, deep, and rapid pulse indicates the pathogen is in the interior; sweating must not be induced. Shaoyin disease with a faint pulse cannot be treated with sweating because it leads to Yang collapse. A pulse that is soft and weak, where the weak quality is found at the guan position, the soft quality at the dian (cun) position, the faint quality at the upper part, and the choppy quality at the lower part. Faintness indicates insufficient Yang Qi; choppy indicates lack of Blood. If Yang Qi is faint, wind-stroke causes sweating followed by irritability; choppy indicates lack of Blood, leading to cold limbs and cold sensations. If Yang is faint, inducing sweating causes irritability and inability to sleep. If "moving qi" (abdominal pulsations) is on the right, sweating must not be induced; inducing sweating causes epistaxis and thirst, heart distress, and vomiting water after drinking. If moving qi is on the left, sweating must not be induced; inducing sweating causes dizziness, incessant sweating, tremors of muscles and twitching of flesh. If moving qi is above, sweating must not be induced; inducing sweating causes Qi rushing upward, centered at the heart. If moving qi is below, sweating must not be induced; inducing sweating causes absence of sweat, severe heart distress, painful bone joints, aversion to cold in the eyes, vomiting food after eating, obstruction of grain flow, and throat blockage. Sweating must not be induced; inducing sweating causes hematemesis, faint Qi, cold extremities, desire to lie down, and inability to warm oneself. Any pulse that is rapid-moving yet weak and faint should not be treated with sweating; inducing sweating leads to difficult defecation and dry abdomen (or difficult urination and dry bladder). Stomach dryness and irritability occur; although the manifestations seem similar, their origins differ. A pulse that is soft and weak, weak at guan, soft at cun, wiry at the upper part, and faint at the lower part. Wiry indicates Yang movement; faint indicates Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicates deficiency; sweating must not be induced. Inducing sweating causes chills and inability to recover. Coughing worsens, with frequent spitting of saliva, dry throat, difficult urination, and hunger-like heart distress, occurring intermittently like malaria but with cold and no heat, presenting as deficiency with chills. Inducing sweating in coughing leads to curling up, abdominal fullness, and hardness. A tight Jue pulse cannot be treated with sweating; inducing sweating causes voice disorder, hoarseness, tongue flaccidity, and inability to speak. For all adverse conditions, inducing sweating makes mild cases difficult to cure and severe cases fatal (delirium, dizziness, chaotic vision), threatening life.

Taiyang disease lasting eight or nine days, resembling malaria with fever and aversion to cold, more heat than cold, no vomiting, clear and normal bowel movements, occurring two or three times a day, with a faint pulse and aversion to cold, indicates both Yin and Yang are deficient; further sweating must not be induced. Taiyang disease with fever, aversion to cold, more heat than cold, and a faint pulse indicates absence of Yang; sweating must not be induced. Dry throat contraindicates sweating. Loss of blood contraindicates sweating; inducing sweating causes chills and trembling. Patients prone to epistaxis cannot be treated with sweating; sweating causes depression of the forehead, tight pulse, staring gaze, and insomnia. Patients prone to sweating cannot be treated with sweating; inducing sweating causes mental confusion and post-urination genital pain; Yuyuliang Wan (Hematite Pill) is indicated (formula missing). Patients with chronic strangury cannot be treated with sweating; inducing sweating causes blood in stool. Patients with chronic sores, despite body pain, cannot be treated with sweating; inducing sweating causes spasms. Diarrhea contraindicates sweating; inducing sweating causes abdominal distension. Cough with normal urination or incontinence contraindicates sweating; inducing sweating causes cold reversal of the four limbs.

In Shanghan, from one to four days, if Jue (cold limbs) occurs, fever will follow; previous Jue implies subsequent fever. Deeper Jue corresponds to deeper heat; milder Jue corresponds to milder heat. If purgation is indicated but sweating is induced instead, mouth sores and redness will result. Shanghan with wiry-thin pulse, headache, and fever belongs to Shaoyang; Shaoyang contraindicates sweating. Shanghan headache, slight fever resembling wind-stroke, with spontaneous slight sweating and self-induced vomiting, if treated with purgation, increases irritability and inner distress; if treated with sweating, causes spasms, stiff body, and difficulty bending/straightening; if fumigated, causes jaundice, urinary retention, and eventually coughing with sputum. Concurrent Taiyang and Shaoyang disease with stiff neck/headache, dizziness, occasional chest binding sensation, and epigastric hardness contraindicates 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 Shaoyin sweating. Shaoyin disease with Jue and no sweat, if forcibly sweated, disturbs Blood, which may exit via mouth, nose, or eyes; this is called Lower Jue and Upper Exhaustion, the most difficult to treat.

*Yong Lei Qian Fang* states there are four difficulties in inducing sweating for Shanghan. First, external signs: Fever and headache with sweating rather than anhidrosis, aversion to wind rather than cold, yet treated with sweating, leading to unceasing sweat (Lou Feng) or spasms. Second, pulse differentiation: Fever and headache with slow chi pulse indicate deficient Ying and scant Blood, contraindicating sweating; fever and headache with wiry-thin pulse belong to Shaoyang, contraindicating sweating (inducing sweating causes delirium). Third, internal signs: Moving qi on the left contraindicates sweating (causes dizziness, muscle twitching); on the right (epistaxis, thirst, irritability, vomiting water); above (Qi rushing to heart); below (no sweat, irritability, bone pain). Fourth, seasonal timing: Spring allows mild sweating as Yang is weak; winter forbids heavy sweating as Yang is hidden (inducing sweating causes vomiting, diarrhea, mouth ulcers, sores).

Yun Qizi states: Taiyang patterns require headache and stiff neck, fever and aversion to cold, and floating pulse before sweating can be induced.

*Liu Ren Shu* states: Faint pulse or slow chi pulse contraindicates sweating. Patients requiring sweating but experiencing epistaxis or bleeding contraindicate sweating. Complicated diseases (Huai Bing) contraindicate sweating. Women with menstruation onset contraindicate sweating. Wind-Warmth contraindicates sweating. Damp-Warmth contraindicates sweating. Deficiency irritability contraindicates sweating. Patients with abdominal pulsations anywhere contraindicate sweating. Taiyang with dry throat, severe epistaxis, or difficult urination contraindicates sweating. Already-sweated patients should not be re-sweated. Without these contraindications, even if previously sweated, if pathogens remain, re-sweating is appropriate. Failure to sweat when indicated leads to Jaundice caused by Wind-Cold injuring Yang, causing Yang to sink internally and Cold-Damp to ascend in meridians; sweating should have cleared the pathogen. Spleen governs muscles and limbs; Cold-Damp combining with internal Heat causes Jaundice. Sweating when inappropriate leads to Blood stasis and Dry Fire. Moistening fluids is superior; sweating destroys them, allowing toxicity to disturb extreme Yang and invade Yin, causing dry Blood to accumulate in the chest. Excessive sweating opens pores, causing unceasing leakage, leading to stiff limbs and difficulty moving.