External fever is a general term for a group of acute diseases with fever as the main evidence caused by external evils such as the six evil spirits and plague, and is a common and frequent disease in clinical practice. It is equivalent to a variety of acute infectious and contagious diseases in modern medicine. Typhoid fever, warm diseases, epidemics, etc. recorded in the literature of the past generations are all in the category of external fever. As external fever is a serious threat to human life, medical practitioners have accumulated a wealth of experience in long-term practice, forming a number of etiological doctrines, such as the six perversions, seasonal qi, voodoo, hostile qi, poisonous evil, etc. How to harness the complexity, grasp the essence of the examination of the cause, to explore the cause of the disease, the disease mechanism, and then guide the treatment, is a difficult problem in front of Chinese medicine practitioners, the author tries to make a brief description of the role of the internal and external view of disease in the dialectic of external fever. The author tries to make a brief description of the role of the internal and external causal disease concept in the dialectic of external fever. The etiology of external fever can be divided into three major categories, namely external, internal and non-internal causes, from the “Internal Classic” to contemporary times. The internal causes often determine the pathogenic tendency and the direction of the transformation of the pathogenic evidence type, while the internal and external causes, such as diet, labor and rest, the seven emotions, trauma, etc., have a predisposing and aggravating effect on the pathogenesis, and affect the transformation of evil and deficiency and the course of the disease, the internal and external causes play a more important role in the development and prognosis of external fever compared to the external causes. 1 external causes: six perversions: six perversions that is wind, heat, heat, humidity, dryness, cold, the general term for six kinds of external disease, wind, heat, heat, heat, humidity, dryness, cold is nature’s six kinds of climate change, the normal climate change is called “six qi”, when the natural climate changes abnormally, or when the human body resistance to decline, the normal six qi into six perversions and attack the human body, leading to the occurrence of external diseases. When the natural climate changes abnormally, or when the body’s resistance decreases, the normal six qi become six perversions and attack the human body, leading to external diseases. The name of “six perversions” was firstly mentioned in Song Chen Wuzhe’s “Three Causes of Extreme Diseases – Volume 2”, where he said: “The six perversions are cold, summer, dryness, humidity, wind and heat”. The six sexes are the main cause of external fever, and together with the seasonal qi, they constitute the indispensable causative factors of external fever. The four seasons are considered to be abnormal, such as spring when it is warm but cold, summer when it is hot but cool, and autumn when it is cool but hot, and so on, “not its time but its gas”, which can lead to “many similar diseases of the young and the old “such as” the evidence of the treatment of the standard rules of the “typhoid”: “time gas, is the day of the epidemic plague gas epidemic, where the four seasons of the order is not correct, there is this gas line. If people feel it, it is similar to young and old and sick, and can be infected in people.” Fuyi: also known as Fuyi, “Su Wen – angry Tong Tian Lun” said “winter injury in the cold, spring will be warm disease.” In Suwen Jin Kui Zhen Shu said: “Those who hide in the essence will not get warm in spring” is the theoretical source of the doctrine of voodoo. Jin Wang Shuhe created the name of “volatile qi” in “The Book of Plain Pulse” and raised the issue of the location of “cold poison” in the “Typhoid Case”. It is said that “those who are in and immediately sick are called typhoid; those who are not immediately sick, the cold poison is hidden in the skin and becomes warm in spring, and becomes summer sick in summer, and the summer sickness is hotter than warm”. Jin Yuan Liu Wansu believes that voodoo warmth is present in all four seasons, not only in spring and summer, expanding the scope of voodoo warmth, but voodoo is not outside of the six obscenities, no specificity of disease, so it is gradually diluted in recent times. Hostile qi: also known as perverse qi, miscellaneous qi, harsh qi, is a type of strongly contagious disease, hostile qi cause disease theory originated in Chao Yuanfang, formed and perfected in Wu Youke. The “Treatise on the Origin of Diseases and the Hormones of Warm Diseases” says: “When people get sick with hostile qi, the qi will turn to be infectious and even destroy the door.” The “Treatise on Warm Epidemics – Original Disease” says: “Epidemics feel the hostile qi of heaven and earth …… this qi comes, no matter how young or old, strong or weak, those who touch it are sick.” The “hostile qi theory” believes that hostile qi is a disease-causing evil qi other than the six qi, which enters from the mouth and nose and causes disease when there is a deficiency of positive qi, and one qi becomes a disease by itself, with various diseases and selective disease positions. Wu’s theory is invaluable and has been respected by later generations of doctors. In a broad sense, the plague caused by hostile qi also belongs to the category of external fever, but the outbreak of plague in different years and seasons has its own pathogenic characteristics, so the treatment should be different from the general external fever. Poisonous evil: The term poisonous evil is not recorded in classical Chinese medical literature, but there are more descriptions of poison. For example, “Su Wen – Anger Tong Tian Lun” cloud: “Although there is a big wind harsh poison, not the ability to harm.” In the Treatise on the Origin of Diseases and Sores, there is a record that “this is caused by the wind and the air, and it becomes hot and poisonous”; and in the book “The Golden Horoscope”, it is said that “poison is the evil that is not resolved.” The term “poisonous evil” has different meanings, but it is generally believed that [1, 2] poisonous evil is an external evil that exists widely in nature and has toxic effects on the body after invasion, and is the direct cause of many acute febrile diseases and is a common causative factor of warm diseases. Externally received toxic evil is contagious and is a pathogenic substance that is highly invasive and prone to cause critical symptoms and specific local signs, and is a special warm evil that reaches a certain level [3, 4]. 2 Internal factors Body constitution: refers to the metabolic, functional and structural peculiarities of the human body formed during growth, development and aging on the basis of its innate composition. Somatic factors are internal factors in the occurrence of diseases. The Nei Jing is the theoretical source of the doctrine of physique in Chinese medicine. The Nei Jing not only notes the differences of individuals, but also makes several classifications of human physique from different perspectives, such as the “Yin and Yang of the Twenty-Five People” in the Ling Shu, and the “Su Wen – Theory of Different Methods and Directions”, which states that the five directions in the southeast, northwest, and central regions have different physiques and are susceptible to different diseases due to different geographical environments and climates and different living habits of the inhabitants. Later generations of medical practitioners in the “Nei Jing” on the basis of the discussion of the physique continued to play, for example, Zhu Danxi “Ge Zhi Yu Lun” said: “Where the shape of people, long than short, big than small, fat than thin, people’s color, white than black, tender than pale, thin than thick. In addition, fat people more wet, thin people more fire, white lung gas deficiency, black kidney deficiency. Form and color are different, the internal organs are also different, although the same external evidence, the treatment is very different”. The Qing dynasty doctor Wu Dehan in the “medical science series – jin pao jue after” said: “to know easy wind for the disease, table gas is weak; easy cold for the disease, Yang Qi is weak; easy heat for the disease, Yin Qi is weak; easy injury to food, the spleen and stomach will be deficient, easy labor injury, Zhong Qi will be lost”. It can be said that the physique determines the susceptibility of individuals to certain disease-causing factors and the tendency of the disease mechanism to change after illness. Therefore, the identification of symptoms in TCM includes identifying the physical strength and weakness, detecting the deficiency of qi and blood, and determining the strength and weakness of yin and yang, so that the diagnosis is accurate and the medicine is targeted. Persistent disease: refers to old diseases that are delayed, as opposed to new diseases. The recurrence and aggravation of certain chronic illnesses are related to external sensation, or the onset of disease due to external sensation, or the interaction with external causes of disease and the development of a new disease. For example, external wind-cold and wind-heat can induce phlegm-drink, thus often inducing croup and asthma, the symptoms of which are external wind-cold (or wind-heat) and internal phlegm-drink. The same external disease often causes aggravation or death due to persistent illnesses, such as influenza A (H1N1), which attacks the lungs and causes respiratory failure, and the chance of death is even higher if the person is already suffering from persistent illnesses (including diabetes, chronic obstructive pulmonary disease, etc.) after infection. Five internal evils: The so-called “five internal evils” refer to the changes in the physiological functions of qi, blood, fluids and internal organs during the development of disease, resulting in five pathological states similar to those caused by external evils such as wind, cold, dampness, dryness and fire. Since the disease starts from within and is not caused by external evil, it is called the “five evils”. The five internal evils play an important role in the onset of external fever and the development of the disease, playing a prerequisite or internal role in the onset of the disease and guiding the external evil in the progress of the disease. The idea of considering disease as a product of the combination of internal and external pathogenic factors, i.e., the internal and external pathogenic view of disease, originated in the Nei Jing, and the internal and external pathogenic view of disease in the Nei Jing is mainly reflected in: 1. Or born in yin, or born in yang. If it is born in Yang, it is born from rain, wind, cold and heat: if it is born in Yin, it is born from food and drink, yin and yang, happiness and anger”. The external causes of evil are divided into two categories: yin and yang, and the doctrine of yin and yang is used to further explain the pathogenic characteristics of yang and yin evils. For example, in the “Spiritual Pivot: The Beginning of All Diseases”, it is said that “wind and rain hurt the upper part of the body, while clear dampness hurts the lower part of the body”, that is, the qi of the sky hurts the upper part of the body, and the qi of the earth attacks the lower part of the body, which is yin; the onset of external evil is internal to the five organs. Such as “Su Wen – Yin and Yang should be the great theory” said: “the sky of the evil, feeling is harmful to the five organs”. Wu Kun notes: “Wind, cold, summer, humidity, dryness and heat, not its place, is the evil of the sky. Wind into the liver, cold into the kidneys, heat into the heart, moisture into the spleen, dryness into the lungs, is harmful to the five viscera”. Liver and spring correspond to each other, wind qi passes through the liver, wind evil hurts the liver, so there are many liver diseases in spring; liver is open to the eyes, the main tendons, so its disease has more symptoms of eyes and tendons. 2 external evil cause disease must have the foundation of the deficiency: such as the “spiritual pivot hundred diseases began to birth chapter”: “wind and rain cold heat, not deficiency, evil can not hurt people alone. …… this must be because of the wind of the evil, and its body shape, the two deficiencies get, is the guest of its form, …… which in the deficiency of evil, because of the time of day, and its body shape, with reference to the virtual reality, the great disease is formed”. The “Su Wen 遺篇”: “The righteousness exists within, the evil cannot dry up”. 3 days and people corresponding, the two deficiencies are susceptible to disease: “Suwen eight Zheng Shen Ming Discourse on the twenty-sixth”: “the moon is born when the blood gas began to essence, guard gas began to travel; the moon Guo full blood gas solid, muscle firm, the moon Guo empty, then muscle reduction, meridian deficiency, guard gas to go, the shape alone, is due to the time of day and regulate blood gas also …… Qibo said. Eight positive, so waiting for the eight winds of deficiency evil to the time. The four seasons, so divided into spring, autumn, winter and summer where the gas, in order to regulate the time also, the eight positive deficiency of evil, and avoid the do not offend. To the body’s deficiency, and meet the sky’s deficiency, the two deficiency feeling, its gas to the bone, into it is hurt five Tibetan, work wait to save it, can not be hurt, it is said that the day taboo can not be ignored.” Third, the connotation of the internal and external view of disease Summarizing the connotation of the internal and external view of disease, mainly including three aspects: the positive deficiency of the evil multiplied, the gas has a definite surrender; internal and external combination of evil, the same gas seek each other; evil has from the transformation, the right qi for this. 1 is deficient in evil multiplication, gas has a fixed house: is deficient in evil multiplication is due to the human body qi blood yin and yang decline, the normal physiological function of the decline, resulting in external evil invasion and disease, different nature of external evil and specific endowment of the internal organs easily together, and more from the deficiency of the dirty qi invasion, that is, the so-called deficient place by evil, gas has a fixed house. For example, “Su Wen – the evaluation of fever” cloud: “the evil of the pile, its gas will be deficient”, “Ling Shu – the evil of the internal organs disease shape” cloud: “evil in the people, or in the yin, or in the Yang, up and down, around, there is no constant, why? …… in the people also, the party multiplied by the time of deficiency”. In the pair of contradictions between deficiency and evil multiply, deficiency dominates, the strength and weakness of the positive qi, such as whether to determine the susceptibility to external evil, the same feeling of external evil also due to the different deficiencies of the positive qi and different nature, different severity of the disease, such as “typhoid” in the six meridians for the disease are typhoid, and with the positive qi and internal organs of the deficiencies and differences in the endowment of the Sun, Yangming, Shaoyang evidence and the three yin straight in the different, the same sun typhoid There are also the differences between the meridian evidence, internal organs evidence and external cold internal drink evidence. It is true that the “Golden Guide to Medicine” cloud: “six gas of the evil, although the same sense of people, people suffer from the disease and different why? Cover the shape of people have thick and thin, the gas has the strength and weakness, the organs have cold and heat, the evil suffered, each from their own dirty gas and transformation, so the disease varies.” Qi has a definite shedding reflects the selective location of the disease caused by the external evil, and the relationship between the external evil and the endowment of the body’s internal organs and qi and blood, reflecting the idea of “heaven and man corresponding”. For example, in Suwen Cough Theory, it is said that “each of the five organs suffers from disease at its own time, and each of them is transmitted to the other at a different time. People and heaven and earth, so each of the five organs to treat the time, feeling the cold will be affected by disease, micro is a cough, and even is a leak for pain. In autumn, the lungs are affected first, in spring, the liver is affected first, in summer, the heart is affected first, in winter, the spleen is affected first, and in winter, the kidneys are affected first”. 2. Internal and external evil together, with the same qi: Internal and external evil together refers to the combination of internal evil and external evil such as the six sexes that cause disease. The internal evils include wind, heat, cold, dryness, phlegm, dampness, poison, drink and stasis, etc. The external evils include the six evils, the air of the season and the pathogens such as air pollution, dust, insect mites, pollen and chemical odors. The combination of internal and external evils has a certain pattern, mainly manifested as “the same qi seeking each other”, such as people who have internal cold, are prone to feel external cold, forming a combination of two cold evils and prone to congested nose, cough, asthma and other symptoms. The idea of internal and external combined evil causing disease has been put forward in the Nei Jing, such as the “Ling Shu – evil qi viscera disease form” cloud “form cold cold drink then hurt the lungs, with its two cold feeling each other, both external and external injury, so the qi reverse and upper qi”. On the pathogenic characteristics of the same gas, “medical science series – jin pao jue after the chapter” is more comprehensive, which said: “to know easy wind for the disease, table gas is weak, easy cold for the disease, Yang Qi is weak, easy heat for the disease, Yin Qi is weak, easy to hurt food, the spleen and stomach will lose, easy labor injury, the middle qi will be lost.” 3 evil has from the transformation, righteousness for this: evil has from the transformation refers to the external evil attack on the human body, with the body’s deficiency, yin and yang, dryness and wetness of different and transformation of disease, for example, dryness and heat of the body, feel cold and wet yin evil, it is easy to wet into dryness, cold into heat, and also such as different body feeling wind evil, can have wind-cold, wind-heat, wind-damp, wind-fire and other different nature of the assimilation, so many diseases begin with the end of the same, change, as described in the medical zong jinjian. As the “Medical Zong Jin Jian” said: “Although people feel the evil, because of their different shapes and organs, or from the cold, or from the heat, or from the deficiency, or from the real, so many ends are not the same. For example, if the external wind-heat is relieved by relieving the table, but the cough remains irritating, Chinese medicine believes that the reason for this is that before the external sensation, there was already a deficiency of positive qi and internal depression of liver fire, and the use of relieving drugs hurt yin and depleted qi, resulting in the depletion of lung qi and liver fire attacking the lungs, and wood fire punishing gold, resulting in liver cough. The internal and external view of disease is a specific manifestation of the etiology of the holistic view of the etiology of the disease. The correct use of this concept to guide the dialectic of external fever can provide a more comprehensive understanding of external fever and more accurate guidance for legislative prescription. 1 objective and comprehensive understanding of external fever: the internal and external view of disease has a significant significance in overturning the traditional concept of understanding the seemingly simple external fever, traditional textbooks believe that the cause of wind and fever is simply external wind and fever, which leads people only from external wind and cold wind and fever to argue the cause, seek countermeasures, to prevent and regulate, and the results are often unsatisfactory, the reason is that the external wind and fever is actually a group of syndromes caused by internal and external It is influenced by many factors inside and outside the human body, by the natural climate, environment, humanities and society, and the patient’s diet, mood and illness. The late famous Chinese medicine master Jiao Shude once said: “Chinese medicine is the treatment of people”, a word that has broken the mystery of Chinese medicine treatment. The correct use of the internal and external causal view of disease to guide the identification of external fever can provide a more comprehensive understanding of the disease, the diseased human body, the reasons for the disease and its many related links. Generally speaking, at the beginning of the disease, the external cause is often the main cause and becomes the primary cause, but as the disease progresses, the primary cause will assimilate and dissimilate with the strength of the internal positive energy and the different endogenous causative factors, and the primary cause will become the secondary cause. ③ Then analyze the cause of the disease and transformation. For example, if there is a deficiency of positive qi in the internal cause and the five internal evils, it is necessary to identify which is the primary and which is secondary, and if there is wind and dampness in the external cause, which is the primary evil? Is there any external wind and cold from heat to fire, or from cold to drink? Does the righteousness turn into fire? Does it produce cold? Zhang Jinyue’s “Classics – Diseases” points out that “Qi lies in people, and if it is harmonious, it is positive Qi, and if it is not harmonious, it is evil Qi.” And Dai Sigong’s “The Theory of Fire and Yang Movement of Qi” also says, “Qi and fire are only one thing, but the change of movement and static is transformed into one”, which shows that in the microscopic field, positive qi has a double meaning, and positive qi itself can transform into evil qi. After the above three steps are completed, the etiology of the current stage of the disease is analyzed and summarized, and then the process of identification is completed by identifying the nature and location of the disease and guiding the legislative prescriptions accordingly, so that the prescriptions will not be biased. The basis for determining the treatment in TCM is the identification of the disease. With a comprehensive understanding of the nature of the disease, the location of the disease, the potential of the disease, the intermingling of the disease and the evil, and the dissimilation of the disease, the treatment can be determined by formulating the rules of treatment, of which the greater impact on the determination of the treatment is the identification of the nature of the disease. It is the most discursive and programmatic content in the identification of evidence. In the author’s opinion, the connotation of pathology should be the cold and heat, deficiency and reality, yin and yang properties of the disease. One of them is “Su Wen – General Commentary on Deficiency and Actuality”: “If the evil energy is strong, it is actual, and if the essence is taken away, it is deficient”, which can be characterized as actual evidence if the evil energy is strong as the main aspect of the contradiction, and at the same time the righteous energy is not deficient. The second is the “Spiritual Pivot – Treatise on True Evil”: “If Yang wins, it is heat; if Yin wins, it is cold”, and on the basis of the identification of deficiency, cold and heat, the identification of yin and yang is a natural conclusion, with heat confirming that the evidence is mostly Yang and yin deficiency mostly Yin. Since the nature of the disease has been identified, the legislation and prescription can be said to be logical, cold is hot, hot is cold, deficiency is real, real is deficiency, deficiency is real, both real and deficiency, hot and cold mismatch, internal and external combination of evil, and the treatment of its sequence of priorities. Typical case: Li××15 years old, first seen on August 31, 2007, complaining of recurrent itchy and runny nose for 2 years and 4 days again. Two years ago in autumn, he was allergic to outside wind-borne pollen due to exertion, resulting in sneezing and runny nose, itchy nose and eyes, and tearing. This attack occurred 4 days ago, due to the recurrence of rhinitis caused by over-eating fatty, sweet and thick flavors and staying up late to feel the wind and cold, and the effect of taking Karetan and Shuanghuanglian oral solution was not obvious. Both parents have a history of allergic diseases. The patient has a history of allergy to pineapple and sea shrimp and a history of urticaria. Identification: the cause of the disease is external wind, internal heat due to over-eating fat and sweet, staying up late injures qi and yin, allergic body, internal wind due to heat and deficiency, internal heat is the main cause of wind, yin is the second, from the transformation of external evil, external wind from heat to fire, the disease is located in the lung and liver, the overall pathogenesis is wind-heat disturbance, liver and lung heat, nasal deafness, treatment: dispel wind and clear the orifices, clear the lung and calm the liver, the proposed formula: 25 grams each of red and white peony, 15 grams of scutellaria baicalensis, 15 grams of Radix Scutellariae, 15 grams of Radix Scutellariae. On September 3, 2007, the patient reported that after taking the medicine, the heat had subsided, the nasal itching and runny nose had greatly decreased, the bowels were clear, and the head weight of the bitter mouth and dry throat had been largely removed, and the tongue was still slightly red. The original prescription removed gardenia and added Lulutong 10 grams to help clear the ligament, followed by three doses, no follow-up consultation afterwards, until the follow-up visit in October 2008, reported that all symptoms were cured after taking three doses of the medicine, and no rhinitis attack for one year. In this case, the body is endowed with liver heat and wind, plus fat, sweet and thick flavors to help the heat, stay up all night and work to hurt the qi and yin, the internal and external factors are combined, the evil is strong and not very deficient, the total nature of the disease is heat and real, so it can be allowed to clear the diarrhea and attack, in the formula of scutellaria, gardenia, ground, double flower vine and other products to clear liver heat, directly break the liver meridian wind and fire, accompanied by nourishing yin and softening the liver of red peony, wu mei; evacuate the external wind of Fang Feng, Xin Yi, dahurica, good at removing liver wind of cicada, so that Cang Er Zi to induce medicine to return to the The combination of all the medicines can benefit the Qi. This is an important element of the etiology and pathology of Chinese medicine, which contains the idea of materialistic dialectics, and plays an important and irreplaceable role in guiding the identification and treatment of complex diseases in various disciplines, such as external fever, which has not yet been widely appreciated. References [1] Wang Haiting, Zhu Jiancai. The concept of poisonous evil and evil poison. Shandong Journal of Traditional Chinese Medicine, April 2007, Vol. 26, No. 4: 225-227. [2] Gu Xiaohong, Zhao Zhanrong, Discussion on the treatment of toxicity in warm diseases [J] – Journal of Beijing University of Traditional Chinese Medicine 1994, 17(6):11~13. [3] Lv Wenliang, Reanalysis of the concept of “toxicity” in warm diseases [J] – Research in Traditional Chinese Medicine, 1998,14(1)2~3・ [4] Xie Yingzhen, Gao Ying, Zou Yihuai. Experimental discussion on the pathogenesis of poisonous evil and the characteristics of the symptoms. Journal of Beijing University of Traditional Chinese Medicine 2001, 24(1):11-13.