Library

Wenbing (Warm Disease), Fengwen (Wind-Warmth), and various syndromes of Shi (Dampness). The pathogenic factors all enter through Ying (Nutritive) and Wei (Defensive). Therefore, Zhang Zhongjing refers to them all as Taiyang Disease (Disease of the Taiyang/Bladder channel). Hence, they are appended at the end of Taiyang Disease.

In Taiyang Disease, those presenting with fever, thirst, and aversion to cold absent are termed Wenbing (Warm Disease).
Taiyang Disease refers to the symptoms mentioned in the first chapter, such as stiffness and pain in the head and neck. Because the pathogen enters via Ying and Wei, and the manifestations belong to the Taiyang channel, it is called Taiyang Disease. However, when the pathogen is in Taiyang, although there are initial exterior signs and fever, there is no thirst yet; moreover, fever must be accompanied by aversion to cold. Only when the pathogen transmits to Yangming and the Taiyang signs resolve will there be fever, sweating, and absence of aversion to cold. When the pathogen enters the interior of Yangming, causing heat and dryness in the stomach fu-organ, only then does the symptom of thirst desire for water appear. This is the normal progression of Zhongfeng (Wind Strike) and Shanghan (Cold Damage). Here, since there are Taiyang manifestations, it indicates the pathogen is still in Taiyang, not Yangming. Because fever occurs simultaneously with thirst, and there is no aversion to cold, it is called Wenbing. "Wen" (Warm) refers to the pathogenic factor of warm weather. In winter, there is Cold pathogen; however, throughout the four seasons, there are also out-of-season cold air, which, if contracted, is called Shanghan. In spring, there is Wind pathogen; however, throughout the four seasons, there are also out-of-season wind, which, if contracted, is called Zhongfeng. After spring warmth arrives, before Summer Solstice, the weather is already hot but not yet scorching. Contracting this warm, muggy, and steaming qi results in Wenbing. This is called Chunwen (Spring Warmth). If there is unseasonable warmth during winter, contracting it results in Dongwen (Winter Warmth). In autumn, when the air should be crisp and cool due to its肃 (desiccating/clearing) nature, encountering unseasonable hot, muggy qi results in Qiuwen (Autumn Warmth). Only that which arises at the end of spring and beginning of summer corresponds to the appropriate seasonal pathogen. Thus, both *Shengqi Tongtian Lun* (Treatise on Living Qi and Heaven's Connection) and *Yinyang Yingxiang Lun* (Treatise on Yin-Yang Correspondences) in the *Neijing* state: "If injured by Cold in winter, one will inevitably suffer from Warm Disease in spring." The scripture's statement that winter injury by Cold leads to spring Warm Disease is likely using the changes of heaven and earth across the four seasons to metaphorically illustrate the relationship between human Yin-Yang and Zang-Fu organs, reflecting the principle of consistency between Heaven and Humanity. It does not mean that being injured by Cold in winter directly transforms into Warm Disease in spring. The meaning of "Winter Injury by Cold" is seen in the first symptom entry; I will not elaborate further here. This section serves as the origin of Wenbing, establishing its name and classification, describing the initial manifestations upon contraction, which are no different from the initial stages of Zhongfeng and Shanghan, yet no treatment method is established at this point. However, the specific treatment methods are ultimately absent. Was it simply forgotten or never formulated when the laws were originally established? Or has it been lost due to the passage of time, resulting in missing bamboo slips? I fear it was not entirely forgotten, nor completely lost. I suspect that when Wang Shuhe compiled the text, he may have mixed it within the Six Channels' syndrome treatments without being able to distinguish it clearly. I do not know how Zhang Zhongjing ordered it originally. From the late Han Dynasty to the Western Jin Dynasty, the time gap was not ancient; how could it have been so thoroughly lost? It is largely believed that Wang Shuhe disrupted the order. Since his compiled book became popular, Zhang Zhongjing's original texts were discarded and lost. For two thousand years, although famous physicians emerged successively, none could verify and correct this, leading later generations to believe Zhang Zhongjing excelled in treating Shanghan but not Wenbing. Alas! Zhang Zhongjing is the Sage of Medicine; surely his talent did not end here? Now, reasoning based on principles, regarding this section, Zhang Zhongjing's intent seems to be: When the pathogen is in Taiyang, identifying Wenbing by the presence of thirst and absence of aversion to cold distinguishes it from Zhongfeng and Shanghan. His focus lies precisely in these symptoms. Thirst is caused by Warm pathogen; the absence of aversion to cold, given it is not Yangming disease, is also caused by Warm-Heat pathogen, hence the name Wenbing. Although Wen pathogen presents with Taiyang exterior signs like head and neck stiffness, requiring exterior resolution, the simultaneous presence of fever, thirst, and absence of aversion to cold indicates that clearing and resolving Heat is necessary. Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) are both acrid-warm medicines. Mahuang Tang can only induce sweating to vent the Yin pathogen of Shanghan, but cannot treat Wenbing; Guizhi Tang can only disperse the Yang pathogen of Zhongfeng, but also cannot treat Wenbing. Not only can they not treat Wenbing, their warm-natured properties may actually assist the pathogen. Therefore, at the onset of symptoms, Da Qinglong Tang (Major Green Dragon Decoction) for cooling resolution is used as the primary formula for treating Wenbing, serving as a major pillar. However, this is suitable only for those without sweating. For those with fever, thirst, absence of aversion to cold, and spontaneous sweating, further sweating is inappropriate; thus, the method of Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Mason Jar Decoction) applies. For those without exterior signs, presenting only with heat, thirst, and absence of aversion to cold, the pathogen has entered Yangming, where Baihu Tang (White Tiger Decoction) is applicable. As for complications from erroneous sweating, purging, etc., the methods for erroneous sweating, vomiting, and purging found in the Zhongfeng and Shanghan chapters can be deduced and adapted.
If real-heat symptoms of Yangming are observed, indicating Heat pathogen entering the Fu organs, there will naturally be yellow or black tongue coating, dryness, cracking, prickles, delirium, coma, and mania, verifying the Chengqi Tang (Gut-Clearing Decoction) syndromes in the Yangming chapter. If transmission to Yin channels occurs, presenting with Yin-Cold reversal syndromes, the various warming meridian methods in the Three Yin chapters can be referenced. The reason there is only the initial entry without itemized treatment methods is likely because the contracted pathogens vary, and the excesses of the Six Qi differ, leading to distinct initial syndromes and varying treatment approaches. Regarding subsequent complicated syndromes and syndromes resulting from erroneous treatment transmitting to Yin channels, the meridians, Zang-Fu organs, Cold-Heat, and Deficiency-Excess patterns are no different from Zhongfeng and Shanghan, allowing for similar therapeutic strategies. People unaware of this reason believe Zhang Zhongjing's methods for Wenbing consist only of these two entries, lamenting the lack of subsequent treatment examples as lost remnants. What a pity!

If after inducing sweating, the body becomes burning hot, it is named Fengwen (Wind-Warmth). In Fengwen disease, the pulse is floating at all positions (Cun, Guan, Chi); there is spontaneous sweating; the body feels heavy; there is excessive sleepiness; breathing during sleep is necessarily snoring; and speech is difficult. If erroneously treated with purgatives, there will be difficulty urinating, fixed staring, and loss of bowel/bladder control. If erroneously treated with fire therapy, mild cases present with yellowish discoloration; severe cases resemble convulsive epilepsy with periodic spasms. If treated with moxibustion/fumigation, one error may prolong life slightly, but a second error will hasten death.
This means that although there were Taiyang signs and sweating was induced, after sweating, Wind-Cold should have resolved. If the body remains burning hot after sweating, it is neither Zhongfeng nor Shanghan. It is a syndrome of simultaneous contraction of Wind pathogen and Warm Qi, hence named Fengwen. Wind is the pathogen of Spring; Warmth is the climate of early Summer. At the end of Spring and beginning of Summer, Wind pathogen has not receded, and Warm Qi begins to arrive. Because the Kidney Water (associated with Winter) was injured, it cannot properly nourish True Yang, leading to leakage of Essence and sweat, causing the failure of Zang Yang. By Spring, the Shaoyang Liver and Gallbladder cannot distribute Yang Qi to the skin, resulting in weak defensive Yang and loose interstices, allowing Wind and Warm Qi to combine and form Fengwen disease. Hence, "Winter injury by Cold leads to Spring Warm Disease."
However, the pulse in Fengwen differs from Wind-Cold. In Shanghan, Cold injures Ying, penetrating deeply, so the pulse is tight at all positions. In Zhongfeng, Wind injures Wei, affecting only Yang Qi, so the pulse is floating at Yang positions and weak at Yin positions. In Fengwen, Wind injures Wei Qi, making the Yang pulse float; Warm-Heat injures Yin Fen, making the Yin pulse also float. The "Yin and Yang" of the pulse, as described in *Bian Mai Pian* (Differentiating Pulse Chapter) regarding "tight pulse at all positions," refers to superficial (Yang) and deep (Yin) palpation. Here, "floating at both Yin and Yang pulses" refers to Cun (Yang) and Chi (Yin), i.e., anterior to Guan (Yang) and posterior to Guan (Yin). A floating Yang pulse indicates Wind injuring Wei, pores not closing, leading to spontaneous sweating—consistent with the earlier concept of "Yang floating causes spontaneous heat, Yin weak causes spontaneous sweating." A floating Yin pulse indicates Heat injuring Yin Fen; Warm pathogen steams and scorches, causing oppression, dizziness, and mental clouding, leading to heaviness and sleepiness, with snoring during sleep. Difficulty speaking is not due to tongue stiffness or aphonia, but rather mental clouding preventing speech. In such cases, since there is spontaneous sweating, Ma Huang Tang is inappropriate for further sweating, and Guizhi Tang is inappropriate for warm resolution and sweat retention. Cooling resolution is required, such as Guizhi Er Yuebi Yi Tang. With Fengwen pathogen in the meridians, interior excess is absent, so purgation is unsuitable. Erroneous purgation leads to interior deficiency and pathogen sinking, causing Taiyang Warm pathogen to enter the Taiyang Fu organ (Bladder), where Heat attacks the Bladder, leading to urinary obstruction and difficulty urinating. Fixed staring and loss of bowel/bladder control indicate the exhaustion of Foot-Taiyang Bladder channel Qi. Initially, Heat causes urinary obstruction; finally, Bladder Qi exhaustion causes incontinence. *Suwen: Zhen Yao Jing Zhong Lun* states: "When the Taiyang pulse terminates, eyes roll back, opisthotonos, spasms, color turns white, sweat appears, and death follows." Moreover, Warm-Heat pathogen should not be treated with Fire to add Heat. Erroneous fire therapy allows Fire to boost Wind and Heat to ride the Fire's momentum. Mild cases result in internal stagnation of Fire-Heat causing jaundice ("stagnant Heat in the interior causes jaundice" per Yangming chapter). Severe cases cause mental confusion and mania, resembling fright-induced epilepsy. *Taiyin Yangming Lun* notes that Yangming has abundant Qi and Blood; when pathogen invades, Heat generates; extreme Heat repels Fire. In the previous Shanghan chapter, even adding acupuncture to Taiyang Cold causes fright; how much more so for Wenbing? Fire applied to Wenbing fills the interior and exterior, permeating Zang-Fu, muscles, sinews, bones, and tendons, causing frequent spasms. Spasms (*Chi Zong*) refer to twitching of sinews and bones, pulling of ten fingers, stiffness of arms, and involuntary turning of the body. Using fire fumigation to induce sweating violates medical principles and taboos, termed "reverse treatment." One reverse treatment may be incurable but delay death; a second reverse treatment accelerates demise. The harm of Fire reversal in Wenpathogen invasion is thus; by analogy, acrid-warm treatments must also be scrutinized carefully.

The appearance resembles Shanghan, but the pulse is not wiry-tight but weak. Weakness implies thirst; if treated with Fire, delirium ensues. Weakness with fever: if the pulse floats, resolve the exterior; sweating should occur for recovery.
This describes Wenbing mimicking Shanghan. "Resembling Shanghan" means the presentation appears similar, with head/neck stiffness, fever, body ache, aversion to cold, and anhidrosis, yet it is not truly Shanghan. The pulse differs from Shanghan's wiry-tightness, appearing weak instead. "Weak" means fine, soft, and forceless. Similar to patients with macules/purpura who often show extremely fine, rapid, and soft pulses despite having dry mouth, scorched tongue, dental plaque, red eyes, fever, and delirium—a mismatch between pulse and syndrome. Thus, weakness implies thirst because, although the pulse seems weak, the pathogenic Heat is abundant internally, causing Stomach Heat and thirst. Given the intense Heat and apparent Shanghan-like anhidrosis, erroneous use of Fire therapy to induce sweating causes the Warm pathogen to merge with Fire, intensifying Heat, leading to Stomach Heat, mental clouding, and incoherent speech, becoming a severe, difficult-to-treat condition. If the previously mentioned pulse shifts from weak to floating while the body remains febrile, it indicates the pathogen returning to the exterior and reverting to Taiyang. Exterior-resolving methods should be used, and recovery follows with sweating.

Symptoms resemble Guizhi Tang syndrome, but without headache or neck stiffness. The Cun pulse is slightly floating. There is chest fullness and hardness, with Qi rushing up to the throat, obstructing respiration. This indicates Cold-Phlegm in the Chest. Vomiting is indicated; Gua Di San (Melon Sepal Powder) is appropriate.
This describes Wenbing mimicking Zhongfeng. Explanation is found under the Pi Syndrome (Fullness Syndrome) entry.