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My clan had a wet nurse who, after suffering from *Shanghan* (Cold Damage) for seven or eight days, developed macules. Her skin was burning hot like fire, her pulse was surging (*Hong*), rapid (*Shu*), and firm (*Lao*). She felt vexed, full, and uncomfortable in her heart. Soon, the macules turned red-black. Her family was extremely alarmed. I said, "This is *Wendu* (Warm Toxicity). *Wendu* is the most severe among diseases, and considering her advanced age, it is indeed worrying." Zhang Zhongjing said, "In *Shanghan*, if the pulse is surging and rapid, and the Yin pulses are solid and large, and this is compounded by damp-heat, it transforms into *Wendu*. *Wendu* is the most severe, hence macules and rashes appear. There is discomfort under the heart, stifling oppression." Therefore, I administered *Shengma Xuanshen Tang* (Cimicifugae Rhizoma and Scrophulariae Decoction) to her. She took it four or five times day and night. The macules receded, and she recovered.

Commentary: Hua Tuo said that on the fifth day of *Shanghan*, the pathogen is in the abdomen; on the sixth day, it is in the stomach. Once it enters the stomach, purgation can be used. However, if the heat toxin has not yet entered the stomach and purgation is applied prematurely, the heat will enter the stomach vacuously, causing the stomach lining to rot. Yet, once heat enters the stomach, it must be purged again so that no heat remains in the stomach. If the stomach is full/excess, this disease occurs, with a mortality rate of three deaths for every one survival. If the heat is mild, red macules appear; if severe, black macules appear. Those with red macules have a mortality rate of five out of ten; those with black macules have a mortality rate of nine out of ten. This depends on the strength of the patient's constitution. When the patient reaches the critical day, if purgation is not applied in time, the heat cannot be vented, leading to stomach rot and macule eruption. This is an ominous sign. If purgation is too early, heat enters the stomach vacuously; if too late, heat enters but cannot be vented. One must seize the opportunity and not miss the timing, so that even mild cases might be cured.

In the year Jiachen, a salt merchant moored his boat by the river and contracted *Shanghan*. He suffered from chest and diaphragm oppression, with pain radiating to both sides below the umbilicus, unbearable in intensity, and unable to eat or drink. I diagnosed him and said, "This is not *Jie Xiong* (Binding Chest), but *Zang Jie* (Organ Binding), which is incurable." In *Zang Jie*, the Cun pulse is floating, and the Guan pulse is fine, small, deep, and tight, with white tongue coating remaining. If pain radiates to the lower abdomen, death ensues. Zhang Zhongjing said, "If pain radiates to the lower abdomen, indicating invasion of the Yin meridians, death results." The next day, pain did radiate to the lower abdomen, and he died at noon.

A merchant named Liu from Yuzhang contracted *Shanghan*. He had fever, bitter taste in the mouth, dry throat, abdominal fullness, ability to eat, but closed bowels. The physician treated it as Yangming disease and summoned me for consultation. We sat together. I asked the physician, "Why do you judge this as Yangming?" The physician replied, "Zhang Zhongjing states that Yangming Wind Strike presents with bitter taste, dry throat, and abdominal fullness. It also says that in Yangming disease, ability to eat indicates Wind Strike, while inability to eat indicates Cold Damage. Furthermore, Shaoyang-Yangming presents with vexation in the stomach and difficulty defecating. Considering these three aspects, it is entirely a Yangming syndrome." I said, "The Yangming pulse is long and solid. In Wind Strike, there must be spontaneous sweating. Although the symptoms resemble Yangming, the pulse is instead rapid, and there is no sweat. Can it truly be treated as Yangming?" The physician had no response. I said, "In my view, this is *Yang Jie* (Yang Binding). The course of the disease has now reached sixteen days. Tomorrow, the condition will worsen. I will treat you then." The family was suspicious and undecided. The next day, the illness indeed flared up severely, and they urgently summoned me. I said, "This is the Yang Jie syndrome. Zhang Zhongjing said, 'There are Yin Binding and Yang Binding pulses. How to distinguish them?' The answer is: A pulse that is floating and rapid, with ability to eat but constipation, is excess and named Yang Binding. A pulse that is deep and slow, with inability to eat, heavy body, and loose stools, is named Yin Binding. The crisis is expected on the fourteenth day. Now, on the seventeenth day, the crisis has occurred, matching the prognosis." Thus, I administered *Da Chaihu Tang* (Greater Bupleurum Decoction). After two doses, the illness was cured.

Commentary: Zhang Zhongjing said, "When the pulse comes rushing like a chariot canopy, it is named Yang Binding; when it comes rolling like feeling a long bamboo pole, it is named Yin Binding. 'Rushing like a chariot canopy' indicates a floating and rapid quality. Zhang Zhongjing was adept at using imagery. So why does Yang Binding worsen on the 17th day? Why does Yin Binding worsen on the 14th day? Because 17 corresponds to the numbers of Old Yang and Young Yang, and 14 corresponds to Old Yin and Young Yin. The number of Old Yang is nine, and Young Yang is seven. Seven plus nine equals sixteen; advancing one more number gives seventeen. The way of Yang numbers is circular, and Yang numbers are odd, hence seventeen. The number of Old Yin is six, and Young Yin is eight. Eight plus six equals fourteen. It does not advance further because Yin governs stillness, its way is often lacking, and Yin numbers are even. Such waxing and waning, growth and decline, cannot escape the constraints of time and numerical cycles."