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Wu Defu contracted Shanghan (Cold Damage) in the spring of the Wushen year. He first experienced aversion to cold, followed by fever. His neck tendons were stiff and tight, and his legs were curled up and unable to extend. The physician intended to use herbs like Mahuang (Ephedrae Herba) to relieve the neck stiffness, and also planned to use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite Root) to treat the leg curling. I said: Neither is the correct treatment. This is a disease caused by epidemic qi, classified as "Qingjin Qianyin" (Green Tendon Pulling). Prescribed Chaihu Dihuang Tang (Bupleurum and Rehmannia Decoction), after three doses the illness resolved.

The commentary states: Pang Anchang discussed how different seasons' exposure to aberrant qi leads to damp-toxin affecting the zang-fu organs and yin-yang. In spring it is named "Qingjin Qian" (Green Tendon Pulling); in summer, "Chimai Can" (Red Vein Gathering); in autumn, "Baiqi Li" (White Qi Cat); in winter, "Heigu Wendu" (Black Bone Warm Toxin); and during the last eighteen days of each season, it is called "Huangrou" (Yellow Flesh). As the toxic qi settles in the head and neck, it causes the green tendons to pull and tighten, resulting in initial aversion to cold followed by fever, and legs curled up unable to extend. This refers to such cases. Epidemic diseases vary in scale; some spread throughout the world, others affect only a village, and some infect only one household. All arise from the stagnation of cosmic qi transforming into aberrant qi. When humans are afflicted by this, if they can properly care for themselves and manage their condition, they may avoid death.

A distant relative suffered from Shanghan. Other physicians treated him as a Yin syndrome, administering Liuhuang (Sulfur) and Fuzi (Prepared Aconite Root) in succession. After ten days, he developed severe abdominal distension and passed pus and blood, sometimes resembling red bean juice. The physicians still treated it as Shaoyin syndrome and administered Taohua Tang (Peach Kernel Decoction) again. Upon examination, I said: There has been much mismanagement. The exterior and interior are both deficient, allowing heat qi to enter the intestines and stomach through the deficiency, and further administration of drying-hot drugs resulted in passing pus and blood. Consequently, I prescribed Meijian San (Plum Decoction Powder), and after several doses, he recovered.

In the fifth month of the Gengxu year, Li suffered from Shanghan. Symptoms included fever, headache, absence of sweating, and whole-body pain. The pulse was floating, large, and tight. I prescribed Mahuang Tang (Ephedra Decoction). After several doses, no sweat appeared. Multiple applications of Zhang Miao's steaming method for inducing sweat also failed. I instructed him to puncture the Yangming meridian points. After a short while, sweat appeared all over his body. Within a moment, that evening his body became cool and the illness receded.

The commentary states: The *Ci Re Lun* (Treatise on Puncturing Heat) says: For heat diseases starting with arm pain, puncture Yangming to induce sweating. It also says: Puncture yang meridians until bleeding occurs in droplets the size of soybeans, and the disease will resolve. This refers to acupuncture therapy. The Yangming point is located on the medial side of the thumb, near the corner of the nail, where the Hand-Yangming meridian originates. Needles may be inserted to a depth of one fen (cun) using the same-body measurement method, retained for one breath. Generally, for Shanghan heat diseases where sweating is difficult to achieve, there is no method more effective than acupuncture. Zhongjing stated: For treating warm diseases, fifty-nine acupoints may be used. The *Suwen* states: For severe cases, perform the "Fifty-nine Stabs." Details are found in the annotations.