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Treatment for the initial stage of warm disease (Wen Bing), characterized by headache, soreness and pain in the joints of the whole body, high fever of the skin and muscles, slight aversion to cold on the back, absence of sweating, and a floating and slippery pulse.

Bohe Ye (Menthae Haplocalycis Folium, Mint Leaf) - 4 qian
Chantui (Cicadae Periostracum, Cicada Slough) - 3 qian (remove feet and earth impurities)
Sheng Shigao (Gypsum Fibrosum, Raw Gypsum) - 6 qian (crushed into fine powder)
Gancao (Glycyrrhizae Radix et Rhizoma, Licorice Root) - 1.5 qian

The *Shanghan Lun* (Treatise on Cold Damage Disorders) states: "Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), with fever and thirst, and no aversion to cold, is called Warm Disease. If after inducing sweating, the body becomes burning hot, it is called Wind-Warmth (Feng Wen). In Wind-Warmth, the pulse is floating at all three positions (cun, guan, chi), there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring during respiration, and difficulty in speaking." This is the outline provided by Zhang Zhongjing for discussing Warm Diseases. Although the outline is detailed, it does not explicitly state the formula for treating Warm Diseases. Upon repeated and careful observation, one realizes that the *Shanghan Lun* originally contains formulas for treating Warm Diseases, and even explicitly mentions them; those who merely browse may not notice. Section 61 states: "After inducing sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be used again. If there is sweating accompanied by wheezing, without significant heat, Mahuang, Xingren, Gancao, and Shigao can be used as the main treatment." Since this condition was not resolved after sweating, it must have been treated with acrid-warm herbs to induce sweating for a condition that did not originally present with aversion to cold. This corresponds to what the Warm Disease outline calls "if sweating has already been induced" (meaning forcing sweat in Warm Disease using acrid-warm herbs). The sweating accompanied by wheezing and lack of significant heat corresponds to what the Warm Disease outline calls "if sweating has already been induced, the body becomes burning hot," and subsequently described as "spontaneous sweating, excessive sleepiness, and snoring." Snoring occurs during sleep, and wheezing occurs upon waking. Since this condition was previously mishandled with acrid-warm herbs to induce sweating, Zhang Zhongjing feared that physicians might see the spontaneous sweating and mistakenly diagnose it as a Guizhi Tang pattern. Therefore, he specifically warned: "Do not use Guizhi Tang again; instead, treat with Mahxing Ganshi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction)." This section echoes the Warm Disease outline; reading them together makes the connection clear. However, Mahxing Ganshi Tang is indeed an effective formula for the initial stage of Warm Disease. My reason for not using Mahuang (Ephedra) but using Bohe (Mint) and Chantui (Cicada Slough) in releasing-the-exterior formulas was discussed in detail in my explanation of Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction); I will not repeat it here.

Currently, there are many books discussing Warm Diseases, but truth and falsehood are mixed, which only serves to confuse. Based on the *Neijing* (Inner Canon of the Yellow Emperor) and Zhang Zhongjing's theories, and interspersed with my own insights, I believe the general outline of Warm Diseases should be divided into three categories. I will discuss each category in detail below, so that treatments can be applied according to specific paths, avoiding errors.

The first is Spring-Warmth (Chun Wen). This condition arises from a mild external contraction in winter that does not cause immediate illness. The contracted pathogen lies dormant between the membrane source (Mo Yuan, the space between the interior and exterior), blocking the collaterals and preventing free circulation, thereby secretly generating internal heat. When spring arrives and yang energy rises, the internally accumulated heat has a tendency to stir. If further mildly contracted with external pathogens, they interact and suddenly erupt, causing heat in both the interior and exterior. This is what the *Neijing* refers to as "Winter injury by cold leads to Warm Disease in Spring." It is appropriate to treat this with my proposed Liangjie Tang (Cooling and Resolving Decoction). For severe heat, treat with my proposed Hanjie Tang (Cold Resolving Decoction). For cases with sweating, Zhongjing's Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) or my proposed Hejie Tang (Harmonizing and Resolving Decoction) with added Shigao (Raw Gypsum) is suitable. If it occurs during the summer months, it is named Summer-Warmth (Shu Wen), with even more severe heat. If at the onset there is a surging, long pulse, thirst, and a preference for cold water, a large dose of Baihu Tang (White Tiger Decoction) or my proposed Xianlu Tang (Immortal Dew Decoction) is appropriate.

The second is Wind-Warmth (Feng Wen). This is still an external contraction of wind and cold, but because the season has warmed, the external pathogenic qi has transformed into warmth. Therefore, it is not called Cold Damage (Shang Han) or Wind Injury (Shang Feng), but Wind-Warmth, which is what the *Shanghan Lun* refers to as Wind-Warmth disease. However, this condition may occur in early spring, late spring, or even summer and autumn. Treatment should vary according to the seasonal changes in cold and heat, combined with pulse diagnosis. If in early spring or late autumn, when the climate is between cold and warm, and at onset there is no aversion to cold, only a floating pulse without heat signs, my proposed Qingjie Tang (Clearing and Resolving Decoction) with 1-2 qian of Mahuang (Ephedra) or Zhongjing's Daqinglong Tang (Major Green Dragon Decoction) is suitable. If during hot summer days, the pulse is floating and surging, use my proposed Liangjie Tang or Hanjie Tang. If there is sweating, use my proposed Hejie Tang, or add Shigao (Raw Gypsum) as appropriate.

The third is Damp-Warmth (Shi Wen). This condition often results from humid and muggy summer weather. During continuous rainy days, dampness enters the upper jiao through respiration, obstructing the great qi (Zong Qi) in the chest. This causes Ying (Nutritive) and Wei (Defensive) qi to fail to circulate smoothly. The surface feels constrained like an external contraction, but it is not actually an external contraction. The tongue coating is white, slippery, and greasy, slightly grayish. One should use herbs that release the muscle layer and promote urination to allow dampness to exit via sweat and urine, such as my proposed Xuanjie Tang (Ventilating and Resolving Decoction). Zhongjing's Zhuling Tang (Polyporus Decoction), with Ejiao (Donkey-hide Gelatin) removed and Lianqiao (Forsythia Fruit) added, is also usable. As for damp-heat accumulating over time leading to Yangming Fu organ excess, some treat with Baihu Tang (White Tiger Decoction) plus Cangzhu (Atractylodes Rhizome), which is also a good formula. I, however, use Baihu Tang, replacing Zhimu (Anemarrhenae Rhizoma) with Huashi (Hualshi, Talcum), or omitting Jingmi (Oryzae Semen, Rice) and substituting it with Sheng Yimi (Coicis Semen, Raw Coix Seed). Regarding the statement "If winter storage of essence fails, Warm Disease will occur in spring," although explicitly stated in the *Neijing*, this condition is actually contained within Wind-Warmth and Spring-Warmth. Generally, those with internal deficiency are prone to external contractions, and those with yin deficiency and internal heat accumulation are particularly susceptible to Warm Diseases. Therefore, whether in Wind-Warmth or Spring-Warmth accompanied by yin deficiency, during the stages of releasing the exterior, clearing and resolving, or purging downward, it is appropriate to assist with yin-nourishing herbs. Examples include Sheng Shanyao (Dioscoreae Rhizoma, Raw Yam), Sheng Dihuang (Rehmanniae Radix, Raw Rehmannia), Xuanshen (Scrophulariae Radix, Figwort Root), Ejiao (Donkey-hide Gelatin), and Sheng Jizihuang (Galli Ovi Vitellus, Raw Egg Yolk), which can be used as appropriate. Alternatively, qi-tonifying herbs may be used concurrently, such as adding Renshen (Ginseng Radix) to Baihu Tang or using Renshen in Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Indeed, when Renshen is used with cooling and moistening herbs, it not only tonifies qi but greatly nourishes yin.

The above discussion covers the general outline of Warm Diseases and their initial treatment methods. Detailed symptoms and flexible treatment adjustments based on specific conditions are prepared in the subsequent case records. Epidemic diseases (Yi Bing), caused by pestilential qi of heaven and earth and spreading through contagion, are completely different from Warm Diseases.

In the formula, Bohe Ye (Mint Leaf) should be tender and green. Its stem is suitable for regulating qi; if used for inducing sweating, its efficacy is halved. If the color is not green but dull, its efficacy is further reduced. If truly tender green leaves are used, 3 qian in the formula is sufficient.

Bohe (Mint) has a scent similar to Bingpian (Borneolum Syntheticum, Borneol) and is excellent at penetrating orifices. Its power reaches internally to the zang-fu organs and sinews/bones, and externally to the couli (pores/skin texture), allowing it to treat bone and joint pain in Warm Diseases. To say it is light and clear and only induces sweat on the skin is to underestimate Bohe.

Removing the feet from Chantui (Cicada Slough) means removing the two large front legs. These legs are very hard and have a breaking/opening force. If used to remove nebulae or resolve sores, keeping the legs is better. If used for inducing sweating, they should be removed, as we do not want the breaking force in the process of releasing the exterior.

Chantui (Cicada Slough) is slightly cool in nature and bland in taste; it is originally not an acrid-dispersing herb, yet it can induce sweating because "skin reaches skin" (using the insect's exoskeleton to target human skin). This is a miraculous herb for inducing sweating, especially best for those with weak constitutions who cannot tolerate strong exterior-releasing herbs. Furthermore, Warm Diseases often accompany urticaria (Yin Zhen); Chantui is particularly good at pushing urticaria outward.

Shigao (Raw Gypsum) is slightly cold in nature, as explicitly stated in the *Shennong Bencao Jing*. Although it is a mineral drug, it is actually very mild. Moreover, its texture is heavy; 6 qian is only a large pinch. Its cooling power is equivalent to about 3 qian of Zhimu (Anemarrhenae Rhizoma), but its fire-clearing power is double that, because it is cooling and dispersing. I have observed that later generations' formulas for treating Warm Diseases dare to use only 5-6 qian of Shigao only when Yangming Fu excess sets in. How can such people claim to understand Shigao! However, it must be used raw to be safe; calcined Shigao used up to 1 liang would cause harm. Additionally, the condition governed by this formula may occasionally present with slight aversion to cold on the back. This is a sign of heat郁结 (stagnation) in the interior failing to reach the exterior, not true aversion to cold. In Baihu Tang (White Tiger Decoction) patterns, this is also common; using Shigao to vent the heat resolves the aversion to cold.

Question: External pathogens attacking the Taiyang meridian cause aversion to cold, while those attacking the Yangming meridian cause fever without aversion to cold. In spring and summer, the climate is warm, so external pathogens do not resonate with cold-water but with dry-metal, entering directly through the Yangming meridians at the front of the body, thus becoming Warm Disease. Most later discussions on Warm Disease follow this theory. Why does the Warm Disease outline in the *Shanghan Lun* begin with "Taiyang Disease"? Answer: At the initial stage of Warm Disease, the pathogen is often in the Taiyang meridian, but it transforms into Yangming very quickly.

I once treated a man in his twenties. During midsummer night sleep, due to the cool night air, he woke up shivering under a single blanket. Feeling lazy, he went back to sleep. Soon he woke up shivering again. In the morning, he felt slightly chilly. By Si hour (9-11 AM), he felt intense heat in both interior and exterior, accompanied by wheezing and shortness of breath. His pulse was surging, long, and floating. I administered Qingjie Tang (Clearing and Resolving Decoction), increasing Shigao (Raw Gypsum) to 1.5 liang, and added Niu Bang Zi (Arctii Fructus, Burdock Fruit) - stir-fried and crushed - 3 qian. After taking the medicine, he sweated and recovered. From this, we see that initially, did he not contract Taiyang? Yet it was not exclusively Taiyang. The reason he felt cold was due to thin bedding. The climate itself was not cold; thus, the pathogen affected him not only in Taiyang but also in Yangming. Moreover, at that time, people generally had internal heat accumulation, hence the rapid transformation to Yangming. However, this discussion pertains to Wind-Warmth. If Winter-contracted pathogens manifest in Spring or Summer, there are often cases unrelated to Taiyang. Therefore, the *Shanghan Lun* Warm Disease outline specifically states: "Wind-Warmth disease," clarifying its difference from the Warm Disease caused by "Winter injury by cold leading to Spring Warmth." Also, Xingren (Apricot Seed) and Niu Bang Zi (Burdock Fruit) both descend lung qi and stop wheezing. Xingren is warm, while Niu Bang Zi is cool. For Cold Damage wheezing, Xingren is used; for Warm Disease, warm herbs are unsuitable, so Niu Bang Zi is substituted.

Appendix:
Letter from Sun XX of Yanshan, Zhili:
In the spring of 1925, a man came to Tianjin to learn carpentry. Due to his frail constitution and the hot weather, he contracted Warm Disease. I examined him. His pulse was floating, rapid, and slippery; his tongue coating was thick, white, and dense; he experienced frequent drowsiness. I prescribed Qingjie Tang (Clearing and Resolving Decoction), using 1 liang of Shigao (Raw Gypsum). Because his pulse was rapid, I added 5 qian of Xuanshen (Figwort Root). One dose cured the illness.
In mid-spring of the same year, three daughters of Yu XX all developed epidemic rashes (Wen Zhen). I examined them and prescribed Qingjie Tang (Clearing and Resolving Decoction) with added Lianqiao (Forsythia Fruit), Sheng Dihuang (Raw Rehmannia), and Huashi (Talcum). They recovered. Others suffering from this condition at the same time were in dangerous situations. Only my prescription achieved immediate results.