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Written by Lu Yanzhen (courtesy name Zixian) of Chongming
Revised and proofread by Xin Yunchu of Shaoxing

Discussion on Spring-Warmth Disease

I have examined the statement in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "If one is injured by cold in winter, one will inevitably suffer from warmth disease in spring." It also states: "If one fails to store essence in winter, one will inevitably suffer from warmth disease in spring." Although these two statements differ in expression, their underlying principle is consistent, with the emphasis lying in "storing essence." Winter governs storage, and the Kidney also governs storage. If a person can embody the storing nature of winter to preserve Yang qi and store essence, then the body will not injure itself, and how could cold easily harm the body? Therefore, the chapter *Si Qi Tiao Shen Da Lun* (Great Treatise on Regulating the Spirit According to the Four Seasons) says: "Those who go against the Qi of Winter damage the Kidneys, resulting in insufficient energy provided for Spring growth; those who go against the Qi of Spring damage the Liver, resulting in insufficient energy provided for Summer flourishing; those who go against the Qi of Summer damage the Heart, resulting in insufficient energy provided for Autumn收敛 (convergence); those who go against the Qi of Autumn damage the Lungs, resulting in insufficient energy provided for Winter storage." These discussions start from the perspective of diseases arising in Spring but ultimately return to the function of Winter storage. It can be seen that by storing according to the seasons to preserve essence, the growth, flourishing, convergence, and storage of the four seasons are each governed by the five Zang organs, alternating and transporting without bias or excess, thereby conforming to the climate of the year. However, for those who are overworked and have excessive desires, Yang qi leaks out, and Yin fluid (Kidney Water) is depleted first, making them susceptible to seasonal pathogens. It has long been said that the most deficient places are where pathogens reside. Moreover, Spring is the beginning of the year, and Winter is the end. The generation in Spring relies on the sealing and storing in Winter. Observing nature, when all Yang is above and one Yang is below, the weather is severe cold, yet well water is warm; when all Yang is above and one Yin is below, the weather is hot, yet well water is cool. This is the mechanism of Yin-Yang waxing and waning, and the opening and closing of heaven and earth. The human body is a small universe. If one can conform to heavenly timing and maintain solidity, then Kidney Qi will be充盈 (full) internally, and the Yang qi of the Mingmen (Gate of Life) and Sanjiao (Triple Burner) will be sufficient to secure the Couli (pores) and protect the skin and hair. Even during the time of Spring's ascending and leaking, if the true Qi within the body is full inside and outside and does not become exhausted due to the leakage of ascending Qi, then even if there is cold pathogen, how can it invade internally? Wang Shuhe of the Jin Dynasty said: "Cold toxin hides in the skin and muscles, transforming into warmth disease in Spring and heat disease in Summer." This led later scholars to refute it. Why not say instead: "People whose Kidney essence cannot be stored are prone to warmth disease in Spring and heat disease in Summer," which would delve deeper into medical principles? Even regarding the sentence in the *Neijing*, "If one is injured by cold in winter, one will inevitably suffer from warmth disease in spring," commentators generally believe that during Winter closure, cold toxin lies hidden in the Kidneys, and the disease does not manifest immediately. In Spring, when Yang Qi leaks greatly, the internally hidden cold pathogen reaches the exterior along with the ascending Qi. Later scholar Qian Tianlai strongly opposed this view. He argued that "injured by cold in winter" refers to injuring the Water organ (Kidney) in winter, which is synonymous with "failing to store essence in winter," and should not be misunderstood as cold pathogen. Cold is a killing and fierce Qi; once it enters the body, illness occurs immediately. It is unlike Damp-Heat or Dampness pathogens, which can lie latent within the body. Furthermore, the Kidney is the root of life and is of utmost importance. How could cold pathogen enter the body, remain harmless, and only manifest in Spring? By inference, it is evident that the pathology of warmth disease stems from the failure to store Kidney essence. Since the Kidney loses its storing function, Kan Water (Kidney Yin) is depleted first, and the Shaoyang's mild fire transforms entirely into vigorous fire, interacting and blazing with the warmth Qi of Spring. However, it must also be triggered by a slight external cold invasion. Therefore, at the onset, symptoms resemble Taiyang Shanghan (Cold Damage) such as headache, body ache, fever, and aversion to cold. Compared to Shanghan, the transmission is faster, especially in children. Because children's constitutions are purely Yang, Yang combining with Yang makes infection easier, potentially leading to macules, pustules, convulsions, or tetany. However, this "warmth" differs from epidemic pestilence. Epidemic pestilence is caused by abnormal noxious Qi, occurring in all four seasons, whereas this warmth disease occurs exclusively in Spring, hence named "Spring-Warmth." Regarding treatment methods, one should generally use pungent-cool clearing and resolving approaches, pre-emptively protecting Yin fluids, and strictly avoid pungent-warm ascending and dispersing agents that might stir up Wind-Yang. If one can adapt to clinical situations and prescribe appropriate medicines, one deserves the title of a life-saving physician. Thus, presumptuously presenting these analyses for discussion, fellow practitioners may criticize or forgive me based on this text!