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Spring's warm diseases, summer's heat diseases, autumn's malaria and dysentery, winter's cold qi invasion and coughing, are all caused by the abnormal qi of the four seasons, collectively named as Shanghan (Cold Damage). Those who suffer from labor and hardship, when exposed to the abnormal wind, cold, summer-heat, and dampness of these four seasons, thus develop this illness. When a person is injured by cold pathogen, heat becomes stagnant within; if shallow, it manifests early as Spring Warmth; if not manifesting in spring but re-exposed to summer-heat, it develops into Summer Heat Disease in summer; if not manifesting in summer but re-exposed to dampness, it transforms into Malaria and Dysentery in autumn; if not manifesting in autumn but re-exposed to cold, it becomes Shanghan in winter. Thus, the qi of Shanghan is the deepest. However, whether Shanghan or warm-heat diseases, upon onset, there must be fever, aversion to cold, pain in the head and nape, and stiffness in the waist and spine, because on the first day the pathogen is in the Taiyang Meridian (Foot-Taiyang Bladder Channel). Although *Neijing* states that the first day being in Taiyang is the normal progression of transmission, there are cases where Taiyang syndrome symptoms persist until recovery without transmission. In such cases, only sweating methods should be used, such as Shengma Tang (Cimicifuga Decoction), Jiemi Tang (Muscle-Releasing Decoction), Bidu San (Poel-Pushing Powder), Wuji San (Five Accumulations Powder), etc. Dispersing the pathogen leads to recovery. Generally, if the patient has intense heat, using acrid-warm medicines will surely aggravate the disease. Currently, Mr. Liu Hejian has independently created acrid-cool preparations, combining Fangfeng Tongsheng San (Siler-Guiding Through-All Powder) with Yiyuan San (Benefiting Origin Powder), each taken 5–7 qian, boiled in one medium bowl of water with over ten slices of fresh ginger, over twenty roots of scallion whites, and a pinch of fermented soybeans (Douchi). After boiling for five or seven times, strain the dregs, divide into two doses. First, have the patient drink most of it; after a moment, induce vomiting by stimulating the throat with a hairpin, expelling the previously ingested medicine. Due to this single emesis, the couli (skin pores) open, sweat flows throughout the body, then the remaining medicine is taken warm, accompanied by sour vinegar and spicy porridge, leading to immediate recovery.

For resolving exterior pathogens, treating Shanghan, warmth, and damp-heat diseases, there are two treatment approaches. During times of peace, people are mostly quiet and leisurely, happy and unlabored. Stillness belongs to Yin; even using warm agents to release the exterior and induce sweating can achieve recovery. However, during times of turmoil, when Mars behaves abnormally, wars frequently erupt, famines follow, taxes and corvée are heavy, and fire-related disturbances are rampant (belonging to Yang), internal fire invades further. Doctors who do not understand these changing circumstances and still use acrid-warm medicines are acting contrary to human nature. In such times, only Liu Hejian's acrid-cool agents should be used; for conditions within three days, eight or nine out of ten recover. I have used these medicines for over forty years to treat countless cases of resolving exterior pathogens, Shanghan, warmth, summer-heat stroke, and latent heat, not to boast, but to demonstrate the errors of subsequent generations in misusing medicines.

I have seen worldly physicians use Shengma Tang and Wuji San to resolve exterior pathogens and treat Shanghan and warm epidemics, often resulting in patients going mad, speaking deliriously, suffering from epistaxis or hematochezia, panting and chest fullness, mental restlessness and depression, and relapse due to exertion. These syndromes, unless inherent to Shanghan itself, arise because acrid-warm agents failed to resolve the exterior, causing heat to intensify. For resolving exterior pathogens, Shanghan, and seasonal epidemic diseases, one must first deduce the principles of heaven and earth's cold and heat to guide treatment. In southern border regions where heat prevails, acrid-cool agents are suitable for releasing the exterior; in northern regions where cold prevails, acrid-warm agents are suitable. In months of Wu and Wei (summer), where summer-heat is prevalent, acrid-cool resolution is suitable; in months of Zi and Chou (winter), where freezing occurs, acrid-warm resolution is suitable. For young and strong individuals with robust qi, acrid-cool resolution is suitable; for the elderly with declining qi, acrid-warm resolution is suitable. For patients contracting illness due to cold exposure or eating cold food, acrid-warm resolution is suitable; for those due to labor and summer-heat exposure, acrid-cool resolution is suitable. For patients with irritable temperaments, acrid-cool resolution may be used; for those with gentle temperaments, acrid-warm resolution may be used. For patients with floating and large pulses in both hands, acrid-cool resolution is suitable; for those with slow and delayed pulses, acrid-warm resolution is suitable. Such diseases cannot be treated uniformly. Adhering strictly to cold-cool or acrid-warm methods indicates a lack of flexibility.

The earth has north and south distinctions, time has cold and heat variations, humans have decline and vigor differences, pulses have floating and sinking qualities, prescriptions have warm and cool properties, and dosages vary. These must not be confused. Patient contraindications must be known.

In the past, someone contracted a plague in spring and traveled over a hundred li by donkey cart within three days; upon alighting, they were unconscious and died several days later. Another person drank excessively, suffered internal and external pathogenic invasion, had headache and fever resembling Shanghan; traveling sixty to seventy li by horseback home between the third and fourth day, they arrived with severe joint pain and died in a stupor. I witnessed these personally. Similar cases need not be recounted. Regarding plague, Shanghan, heat diseases, summer-heat stroke, wind-cold, and alcohol injury, vehicle or horse transport causing jarring and shaking is strictly forbidden. Movement belongs to the transformation of Fire; stillness belongs to Water. Stillness is Yin, movement is Yang; Yang represents heat, Yin represents cold. If the pathogen disturbs internally and is further disturbed externally, it causes extreme disturbance. How can the human spirit withstand this? Therefore, sick travelers should use boats or litters to avoid external disturbance, preventing disease aggravation.

Furthermore, in cases of Shanghan, seasonal qi, or plague, if there is no bowel movement for six or seven days, hardness below the heart, and tight fullness in the abdomen and flanks, only Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction) should be used to purge. For intestinal and gastric accumulated heat, never use Croton Seed (Badou) or Apricot Kernel (Xingren), which are hot and highly toxic. Even if one or two pills cause five to seven bowel movements, yin qi will inevitably be damaged, fluids dried up, dryness and heat increased, leading to jaundice, delirium, running wildly, macules/toxins, bloody stools, and restlessness. Mild cases lead to relapse due to exertion; severe cases may result in death. Rare recoveries are mere luck and should not be set as a standard. Thus, newly recovered Shanghan patients must avoid pork, fish, mixed fruits, strong wine, wet noodles, bathing, and sexual intercourse. Violating this causes recurrence. Those who cherish their bodies must be cautious.

Similarly, in the first and second lunar months, when human qi rises and plagues rage, headaches or joint pains often occur first. These resemble Shanghan, seasonal qi, summer-heat stroke, wind-dampness, and alcohol intoxication. Do not hastily use highly toxic drugs like Badou. In the spring of Yuanguang era, Li Pingshan, an academician in the Capital, contracted plague with headache, fever, dry mouth, and dark scanty urine. As he loved drinking, the physician gave him Jiuzheng Wan (Alcohol Syndrome Pill) containing Badou, causing diarrhea more than ten times. The next day, headache and other symptoms persisted. The physician, failing to recognize the condition, administered acrid-warm exterior-releasing agents, placed him on a heated kang bed, and forced him to drink scallion-vinegar soup to induce sweating. Unbeknownst to them, various exogenous heat pathogens overlapped and erupted, causing yellow eyes, skin macules, tidal blood loss, severe panting and fullness. Later, attempts to use Chengqi Tang to purge were too late! To this day, debates continue, yet few realize the fault lies with hot medicines, often blaming Chengqi Tang alone. Those using Chengqi Tang did not realize the critical state of the disease and continued medication due to unclear understanding of classics; this is indeed blameworthy. However, critics who do not blame Jiuzheng Wan are also culpable. Plague at the exterior should not be purged, let alone with Badou pills! After Badou damage, adding acrid-warm agents is doubly harmful! Only a sage like Confucius could clarify that Ye Chang was innocent and Weisheng Gao was not truly upright. One must not spend years studying *Neijing*, but merely follow public opinion to praise or criticize. Such people are reckless critics. Those who do not truly understand principles but rashly judge are rejected by gentlemen.

According to my discussion, there are six prohibitions for Shanghan qi. 1. At the onset, resembling alcohol or food injury, prohibit drastic purging. 2. When sweating is indicated, consider seasonal cold/heat and bedding thickness; prohibit bathing, heated kang beds, heavy quilts, hot porridge, and burning needle moxibustion. 3. When sweating is indicated, analyze pulse speed/slowness; use acrid-cool agents; prohibit reckless use of hot medicines. 4. When purging is indicated, carefully select purgatives based on syndrome; prohibit Badou and Silver Powder Pills. 5. Prohibit car/horse transport for distant patients. 6. After profuse sweating, prohibit miscellaneous foods, desires, worry, and labor. Therefore, maintain cool rooms and beds to avoid exogenous heat; ensure bright, clean spaces to observe changes like macules or jaundice. Follow the patient's dietary preferences (cool or warm). Keep them clear and undisturbed, resting without labor. Use acrid-warm or acrid-cool as appropriate. Observe minutely, without rigid adherence. If the patient desires water, do not forbid it. After drinking, frequently massage the abdomen to relieve subcardiac stagnation. Massaging Zhongwan (CV12) for too long causes pain. If the patient feels pain and suspects fluid retention, stop pressing. Failing to prohibit when necessary leads to danger or death; prohibiting when unnecessary leads to similar outcomes. Today's scholars are bound by vulgar opinions, closing their minds to correct theories. Lu Xiangxian once said: "The world originally has no trouble; mediocrity creates it." I say: "Zhengqi (Upright Qi) is originally undisturbed; mediocre doctors make it chaotic."