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Guo Yong stated: Physicians often make errors when discussing warm diseases (Wenbing). This is because they treat "warmth" as a distinct disease entity, failing to consider that cases where cold pathogenic factors were contracted in winter and manifested in spring are called warm diseases. Additionally, cases where no cold was contracted in winter, but the individual naturally contracted wind-cold or warm qi in spring, are also termed warm; furthermore, instances where non-seasonal qi in spring infects people causing epidemic diseases are also referred to as warm. These three types of "warm" conditions are fundamentally different.

The *Suwen* states: "If cold is injured in winter, warm disease will inevitably occur in spring." It further states: "For all cases of Shaoyang disease transforming into warmth, those manifesting before the Summer Solstice are called warm disease." These statements refer specifically to warm diseases resulting from the transformation of Cold Damage (Shanghan). Their severity is lighter than typical Cold Damage heat diseases but heavier than spring warm diseases caused by natural contraction in spring. Their treatment methods differ entirely from those for Cold Damage. In some cases, there was no cold injury in winter, but illness occurred in spring due to self-contracted wind-cold; initially, there is no cold toxin as the root cause, so it cannot be called Cold Damage, but rather named warm disease. Another scenario involves the prevalence of non-seasonal qi in spring affecting people, where symptoms among young and old are similar; this constitutes an epidemic formed by warm qi, hence termed plague/epidemic (Wenyi). Plague diseases generally do not transmit through meridians, so the number of days is not rigidly adhered to; treatments such as inducing sweating, vomiting, or purging can be applied flexibly according to symptoms. The warm disease contracted spontaneously in spring after no winter cold injury is treated similarly to plague but is milder.

One might ask: Why is there no ancient specific name for the warm disease contracted spontaneously in spring? The answer is: Suppose one contracts wind-cold spontaneously in spring and develops fever, aversion to cold, headache, and body pain. Since it is neither Cold Damage nor epidemic qi, if it is not named warm disease due to the spring warm qi, what should it be called? Just as summer diseases caused by winter contraction are called heat diseases, while those not caused by winter contraction are called summerheat, the situation in spring is analogous. The *Huoren Shu* (Book of Vitality) under the formula Weirui Tang states: "Treats wind-warmth, also treats winter-warmth, and mid-spring wind-strike with Cold Damage," indicating this is the appropriate medication.

Question: How to distinguish between winter contraction and spring contraction? Answer: Cases involving meridian transmission are due to winter contraction and are treated using Cold Damage protocols. Cases without meridian transmission are due to spring contraction and are treated using warm qi protocols. I will elaborate separately below various physicians' formulas and discussions to clarify. However, ancient texts lack specific treatment laws for spring warm diseases; the laws for plague/epidemic can be applied concurrently.

The *Huoren Shu* states: "Cold damage in spring is called warm disease. Those who contracted cold in winter, with mild severity, manifesting before the Summer Solstice, are diagnosed with warm disease, arising from the warming qi of spring." Guo Yong commented: This refers to warmth derived from Cold Damage, i.e., what the *Suwen* calls "all cases of Shanghan transforming into warm disease." Its treatment is the same as for Cold Damage. Hence, Zhu Shi (Zhu Gong) annotated: "It is not merely plague/epidemic."

He further stated: "Treating warm disease differs from winter Cold Damage and summer heat disease because the heat is lighter." Guo Yong commented: This refers to spring warm disease not derived from Cold Damage. If Cold Damage transforms into warmth, its heat is lighter than summer heat disease but heavier than winter Cold Damage. Winter Cold Damage is mild; when it manifests in spring as warm disease, it becomes heavier; summer heat disease is even more severe. Zhu Shi annotated: "In early and late spring and autumn, yang qi resides within, making the condition slightly milder; even without medication, it may resolve spontaneously in five to six days." From this inference, the spring warm disease mentioned here refers to warmth not derived from Cold Damage.

He further stated: "Shengma Jieji Tang is excellent. For heavy heat, Xiaochaihu Tang is primary. For no thirst with slight external heat, use Xiaochaihu Tang plus Guizhi. For cough, use Xiaochaihu Tang plus Wuweizi. For irritability, thirst, solid pulse, and constipation, use Dachaihu Tang to mildly relieve stagnation. For deficiency irritability, use Zhuye Tang, administered sequentially." This is the method for treating spring warm disease. Cases where Cold Damage transforms into warmth follow Cold Damage treatment protocols. Treatment for plague/epidemic is identical to spring warm disease, merely adding anti-epidemic herbs.

He further stated: "When symptoms among young and old in a year are similar, this is plague/epidemic. All four seasons have irregular qi; spring and summer may have cold spells, autumn and winter may have warm spells. When people contract epidemic pestilence qi, illnesses across all ages appear similar. This is the qi of the season, commonly known as 'heavenly travel' (Tianxing). Treatments include Laojun Shenming San, Wuchengzi Yinghuo Wan, Shengsanzi, and Baidu San." Guo Yong commented: This describes the treatment for spring warm disease transforming into epidemic. If summer summerheat transforms into epidemic, autumn pestilence transforms into epidemic, or winter cold transforms into epidemic, they cannot be treated identically; each must be treated according to its season. Moreover, similarity in symptoms among all ages defines an epidemic; whether malaria-like, dysentery-like, throat disease-like, or red eye-like, these are all epidemics. They are defined as not caused by personal exposure but by seasonal epidemic qi.

He further stated: "If spring should be warm but is suppressed by cool qi, the pathology is attributed to the Liver; treat with Shengma Jieji Tang. If summer should be hot but is suppressed by cold qi, the pathology is attributed to the Heart; select Shegan Tang or Banxia Guizhi Gancao Tang. If autumn should be cool but is suppressed by excessive heat, the pathology is attributed to the Lung; heat and warmth contend, leading many to suffer malaria; use Baihu Jia Cangzhu Tang, decoct Yinchen Tang to regulate Wuling San. If winter should be cold but is suppressed by excessive warmth, latent cold transforms into warmth; use Weirui Tang. Earth has no fixed name, being named due to fire; treatment should be selected according to the affected meridian." This outlines the treatment for warm qi in the four seasons; plague/epidemic treatments are consistent with this.