Treatment Principles: In spring and summer, it is appropriate to use the sweating method. When inducing sweat, one should ensure that sweat appears uniformly on the hands and feet, with a slight moist appearance, lasting for about the time it takes to eat a meal; this is optimal. One must not allow excessive sweating like a flowing stream. If the pathogen is not resolved, the sweating method may be repeated. However, excessive sweating will inevitably lead to the loss of Yang Qi (Yang Energy); if Yang Qi is deficient, repeated sweating is contraindicated. When taking herbal decoctions to induce sweat, stop once the symptoms are relieved (Zhong Bing), without necessarily finishing the entire dose. For conditions indicated for sweating, if decoctions are unavailable, pills or powders may be used, provided that sweating occurs as a sign of resolution, although using decoctions tailored to the syndrome is superior.

In Taiyang Disease (Disease of the Taiyang Channel) where exterior symptoms persist and the pulse is floating and weak, the exterior should be resolved via sweating; if the pulse is floating and rapid, sweating may be induced. In Yangming Disease (Disease of the Yangming Channel), if the pulse is slow, there is profuse sweating, and slight aversion to cold, the exterior remains unresolved, and sweating may be induced. Generally, if the pulse is floating and large, and the patient reports only constipation, purgation is a major error; if constipation is due to excess, sweating can resolve it by returning fluids to the stomach. Why? Because a floating pulse indicates the disease is in the exterior, which should be treated by sweating. In Shanghan (Cold Damage), if the pulse is weak rather than string-tight, thirst will occur; if fire therapy is applied, delirium will result. Weakness with fever and a floating pulse requires resolution through sweating, leading to recovery upon sweating. If a patient experiences irritability and heat, relief follows sweating; if symptoms resemble malaria with afternoon fever (Ri Bu Suo), it belongs to Yangming Disease; a floating and deficient pulse indicates sweating is needed. Spontaneous sweating indicates harmonious Ying Qi (Nutritive Qi) but disharmony between Ying and Wei Qi (Defensive Qi); since Ying circulates within the vessels and Wei outside, re-inducing sweat restores harmony. If internal organs are healthy but there is intermittent fever and spontaneous sweating, it is due to disharmonious Wei Qi; sweating before the onset of fever resolves it.

If Taiyang Disease persists with heat accumulating in the Bladder, causing manic behavior, spontaneous bleeding may resolve it. If the exterior remains unresolved, interior attack is contraindicated until the exterior is first resolved. In Taiyin Disease, a floating pulse allows for sweating. In Shanghan, if there is no bowel movement for six to seven days with headache and fever, Chengqi Tang (Mannite Decoction) may be given; if urine is clear (or stool green), the disease is in the exterior, requiring sweating. Headache may lead to epistaxis. In cases of diarrhea, abdominal fullness, and body pain, warm the interior first, then treat the exterior. After diarrhea, if body pain persists but bowel movements normalize, urgently treat the exterior.

Taiyang Zhong Feng (Wind Strike in Taiyang) presents with headache, fever, sweating, and aversion to wind-cold. A floating-yang and weak-yin pulse indicates spontaneous heat and sweating. Symptoms include chills, wind aversion, mild fever, nasal congestion, and dry retching. This pattern of weak Ying and strong Wei causes sweating; Gui Zhi Tang (Cinnamon Twig Decoction) is indicated. If downward treatment causes Qi to rush upward, Gui Zhi Tang is used. If initial Gui Zhi Tang administration causes vexation, puncture Fengchi (GB20) and Fengfu (GV16) before administering Gui Zhi Tang again. If needle therapy causes cold invasion at the puncture site with red nodules, leading to Ben Tun (Running Piglet) with Qi rushing from the lower abdomen to the heart, moxibustion on the nodules plus Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon) is indicated. If downward treatment causes slight wheezing with an unresolved exterior, Gui Zhi Jia Hou Po Zi Yin Tang (Cinnamon Twig Decoction with Added Magnolia Bark and Apricot Kernel) is suitable.

A floating and tight pulse indicates Wind injuring Wei Qi and Cold injuring Ying Qi, causing joint pain; sweating is indicated. In Shanghan, failure to sweat with a floating-tight pulse may cause epistaxis. Floating pulse with no sweat and wheezing indicates Taiyang Disease. Floating-tight pulse with no sweat, fever, and body pain persisting for eight to nine days requires repeated sweating. Mild relief after medication followed by vexation, closed eyes, or severe epistaxis indicates resolution due to intense Yang Qi. A floating pulse indicates an exterior condition treatable by sweating. Taiyang Disease with headache, fever, body ache, lumbar pain, joint pain, wind aversion, no sweat, and wheezing, or combined Taiyang-Yangming disease with wheezing and chest fullness, or Yangming Zhong Feng with a merely floating pulse and no other symptoms, all fall under Ma Huang Tang (Ephedra Decoction). Shaoyin Disease presenting with fever and a deep pulse initially is treated with Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction). Shaoyin Disease on the second or third day with no specific symptoms is treated with Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) for mild sweating. Taiyang Zhong Feng with floating-tight pulse, fever, chills, body pain, no sweat, and irritability is treated with Da Qing Long Tang (Great Blue Dragon Decoction). If the pulse is weak with sweating and wind aversion, Da Qing Long Tang is contraindicated as it causes cold limbs and muscle twitching. Shanghan with a floating-slow pulse, heaviness without pain, and intermittent lightness, without Shaoyin signs, may be treated with Da Qing Long Tang.

Shanghan with unresolved exterior and fluid retention in the Heart Below, presenting with dry retching, fever, cough, asthma, thirst, diarrhea, dysphagia, urinary difficulty, or lower abdominal fullness, is treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). If thirst develops after taking Xiao Qing Long Tang for cough and mild asthma with fever, it indicates resolving cold.

Taiyang Disease with stiffness in the neck and back (Jing Jing) and sweating with wind aversion is treated with Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction with Added Kudzu Root). With no sweat and wind aversion, Ge Gen Tang (Kudzu Root Decoction) is used. Combined Taiyang-Yangming disease with spontaneous diarrhea but no vomiting is treated with Ge Gen Tang; with vomiting but no diarrhea, Ge Gen Jia Ban Xia Tang (Kudzu Root Decoction with Added Pinellia) is used. If Taiyang Disease treated incorrectly with downward methods leads to persistent diarrhea with a surging pulse (indicating unresolved exterior) and wheezing with sweating, Ge Gen Huang Qin Huang Lian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) is indicated.

Yangming Zhong Feng with string-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac pain, dry nose, inability to sweat, lethargy, jaundice, difficult urination, tidal fever, and hiccups, with swelling around the ears, is treated with acupuncture for minor improvement, then Xiao Chai Hu Tang (Minor Bupleurum Decoction) if the pulse remains floating after ten days. Taiyang Disease after ten days with a floating-thin pulse and lethargy indicates resolved exterior; if chest fullness and hypochondriac pain persist, Xiao Chai Hu Tang is used. Alternating chills and fever, chest/flank fullness, poor appetite, irritability, and vomiting, or variations thereof, indicate Xiao Chai Hu Tang. Shanghan with body heat, wind aversion, neck stiffness, flank fullness, warm extremities, and thirst also indicates Xiao Chai Hu Tang. Shanghan with fever, slight chills, joint pain, slight vomiting, and partial chest binding, with unresolved exterior symptoms, is treated with Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction).

Floating pulse with urinary difficulty, mild fever, and polydipsia is treated with Wu Ling San (Five-Ingredient Powder with Poria), promoting urination and inducing mild sweating.

Zhang Zhongjing’s writings are profound. For sweating syndromes: Taiyang Zhong Feng uses Gui Zhi Tang; with wheezing, Gui Zhi Jia Hou Po Zi Yin Tang; Jing Jing with sweating and wind aversion uses Gui Zhi Jia Ge Gen Tang; malaria-like episodes twice or thrice daily use Gui Zhi Ma Huang Ge Ban Tang (Half-Half Decoction of Cinnamon Twig and Ephedra); twice daily use Gui Zhi Er Ma Huang Yi Tang (Two Parts Cinnamon Twig, One Part Ephedra Decoction); weak pulses use Gui Zhi Yue Bi Yi Tang (Two Parts Cinnamon Twig, One Part Yuebi Decoction). For Shang Feng with Jing Jing, no sweat, and wind aversion, Ge Gen Tang is used; for wind aversion, no sweat, and wheezing, Ma Huang Tang is used; with added irritability, Da Qing Long Tang is used. This demonstrates comprehensive management of sweating syndromes.

Huoren Shu (Book of Vitality): Shanghan with floating-tight pulse, rigidity, chills, no sweat, more cold than heat, pale face, back pain, and cold extremities is a Ma Huang Tang pattern. Shanghan with floating-slow pulse, large cun and weak chi, spontaneous sweating, body heat, headache, wind aversion, more heat than cold, bright face, irritability, and warm extremities is a Gui Zhi Tang pattern. Shanghan has a tight-severe pulse; Shang Feng has a floating-slow pulse. Shanghan has no sweat; Shang Feng has sweat. Shanghan fears cold but not wind; Shang Feng fears wind but not cold. Taiyang Disease always features floating pulse, fever, and wind/cold aversion. Fearing cold means aversion even without wind; fearing wind means aversion when exposed to wind. All Six Channels can suffer from Shang Feng or Shanghan with varying symptoms. Taiyang: floating pulse with sweat is Zhong Feng; tight pulse without sweat is Shanghan. Yangming: hunger is Zhong Feng; anorexia is Shanghan. Shaoyang: deafness, red eyes, chest fullness, and irritability is Zhong Feng; bitter taste, dry throat, and vertigo is Shanghan. Three Yin Shang Feng presents mainly with limb pain. Shanghan showing cold pulse with fever, wind aversion, irritability, and warm extremities but a floating-tight pulse indicates Zhong Feng signs with Shanghan pulse. Shanghan showing wind pulse with more cold than heat, no irritability, and slightly cold extremities but a floating-slow pulse indicates Shanghan signs with Zhong Feng pulse. (Shang Feng encountering cold or Shanghan encountering wind suggests Da Qing Long Tang syndrome.)

Lou Quanshan: Exterior release in Shanghan must follow symptom severity. Zhang Zhongjing uses sweating methods like Ma Huang Tang, Gui Zhi Tang, and Da Qing Long Tang, and harmonizing methods like Xiao Qing Long Tang, Gui Zhi Ma Huang Ge Ban Tang, Bai Hu Tang, Gui Zhi Yue Bi Yi Tang, and Chai Hu Gui Zhi Tang. Later practitioners failed to distinguish pathogen depth and herb potency, leading to premature death or relapse due to post-sweat deficiency. For mild cases, harmonization is preferred to balance Ying and Wei and promote fluid circulation. Danxi used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) for exterior Shanghan; Haizang used Shen Shu Tang, Bai Zhu Tang, and Jiu Wei Qiang Huo San (Nine-Ingredient Notopterygium Powder). These harmonize without depleting True Qi. For Shanghan unresponsive to herbs, steam therapy using mulberry leaves, peach leaves, bran, and silkworm droppings on heated floors induces sweating. Apply warm powder after sweating stops.

For common cold with headache, chills, and rigidity, decoct green onion root, ginger, tangerine peel, tea, and white plum. Inhale steam and drink hot. Alternatively, use green onion and fermented soybean paste, or Perilla Decoction. A "Seven-Boiling Water" method involves repeatedly boiling water in a red-hot pot to enhance therapeutic properties; drinking this induces effective sweating. For Shanghan with no sweat, soak feet in a mixture of Sea Clam Powder, Aconite, and Pangolin Scales in hot water up to the knees until sweating occurs. Repeat every one to two days until cured.