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Phlegm Retention, Food Stagnation, Jiaqi (Beriberi), Deficiency Heat with Irritability, and Internal Abscesses

1. There are five patterns that resemble Taiyang syndrome (Taiyang exterior syndrome): headache, fever, aversion to wind and cold. In Phlegm Retention (stagnation of phlegm-fluids in the body), the head and neck do not feel stiff or painful; instead, there is chest fullness, difficult breathing, and rebellious Qi rushing up to the throat. In Food Stagnation (accumulation of undigested food), the body has no pain, but there is epigastric stuffiness, flatus, belching with a sour taste. In Jiaqi (a disease caused by damp-evil descending to the lower limbs characterized by swelling or atrophy of the legs), the feet, knees, and calves are swollen and painful, or they become dry and emaciated with difficult defecation. In Deficiency Heat with Irritability (mental restlessness due to Yin deficiency and internal heat), there is only slight fever and irritability, without exterior or interior signs. In Internal Abscesses (ulcerative lesions within the Zang-Fu organs), the patient can eat; one must carefully examine the cause of pain: Lung Abscess presents with panting, cough, chest pain radiating from the lungs, and expectoration of sticky, foul-smelling purulent sputum; Stomach Abscess presents with severe stomach pain that cannot be touched; Intestinal Abscess presents with swelling and hardness in the lower abdomen, rough skin like scales on the body, abdominal urgency, frequent urination resembling strangury, which requires careful differentiation during diagnosis.

[Note] The so-called "Five Patterns Resembling Cold Damage" initially resemble Taiyang Exterior Syndrome. The first is Phlegm Retention, presenting only with chest fullness, dyspnea, Qi rebelling to the throat, without stiffness or pain in the head and neck, differing from Cold Damage. The second is Food Stagnation, presenting only with no body pain, epigastric stuffiness, flatus, belching, acid regurgitation, differing from Cold Damage. The third is Jiaqi, starting in the feet, with swelling and pain in the feet, knees, and calves, or dry swelling and pain termed Dry Jiaqi, with hard and difficult stool, differing from Cold Damage. The fourth is Deficiency Heat with Irritability, presenting only with fever and irritability, without exterior or interior signs, differing from Cold Damage. The fifth is Internal Abscess, whose symptoms closely resemble Cold Damage, but the diet remains normal, and there are specific sites of abscess pain, differing from Cold Damage. If there is dull pain in the chest, or panting/coughing, expectorating sticky and foul sputum, it is Lung Abscess. If there is stomach pain that cannot be touched, it is Stomach Abscess. If there is heavy pain in the lower abdomen, frequent urination resembling strangury, and rough skin like scales, it is Intestinal Abscess.

Winter Warmth, Cold Plague, and Epidemic Plague

2. Spring warmth, summer heat, autumn coolness, and winter cold are the normal seasonal climatic laws. Injury by these regular climates results in standard diseases; injury by abnormal climates occurring out of season leads to epidemic disasters. Winter should be cold but becomes warm, causing Winter Warmth disease; Spring should be warm but becomes cold, causing Cold Plague disease; Epidemic Plague is transmitted among people of all ages, requiring identification of the annual Qi to treat with sweating or purging methods.

[Note] Winter contracting Cold Damage, Spring contracting Wind Strike, Summer contracting Heat Stroke, and Autumn contracting Malaria are all common diseases of the four seasons' regular climates. If Spring should be warm but is cold, Summer should be hot but is cool, Autumn should be cool but is hot, Winter should be cold but is warm, this is having the Qi out of season, leading to epidemic disasters. Winter should be cold but is warm, causing Cold Damage-like illness, named Winter Warmth. Spring should be warm but is cold, causing Cold Damage-like illness, named Cold Plague. If the Qi of a certain time is irregular, affecting both young and old who infect each other, it is named Epidemic Plague. To treat these diseases, one must identify the excess or deficiency of the Annual Qi, the overcoming and recovery of the Six Excesses (Six Evils), the strength or weakness of the person, and the cold or heat of the Zang-Fu, assessing severity to use either sweating or purging methods. For mild cases, Liu Wensu's Shuangjie San (Double Release Powder) is used; for severe cases, Li Gao's Ersheng Jiuku Wan (Two Sages Saving Bitterness Pill) is used, treating according to the pattern.

Warm Disease and Heat Disease

3. Injury by Cold in Winter leads to Warm Disease in Spring; Heat Disease in Summer is often due to early depletion of Yin. Pulse is floating, with headache, fever, thirst, and absence of aversion to cold, which are the etiological features. If there is no sweat, Liu Wensu's Liangjie Method (Double Release Method) may be used; if there is sweat, clearing or purging methods should be sought early. If treatment is delayed, confusion, mania, and various heat syndromes will arise; if there are no obvious exterior/interior signs, treatment should follow the Six Meridians with flexible judgment, leading to recovery.

[Note] The *Neijing* states: Injury by Cold in Winter leads to Warm Disease in Spring, becoming Heat Disease in Summer. Heat Disease belongs to the category of Cold Damage. "Injury by Cold in Winter" means contracting normal mild Cold in Winter without immediate illness. "Early depletion of Yin" refers to those who fail to store Essence in Winter, or those who work hard, sweating excessively and losing internal/external security, thereby damaging Kidney Yin in Winter, leaving Yang-Heat unopposed. Thus, upon encountering minor pathogens in Spring, internal heat is triggered, burning fiercely and uncontrollably. Hence, the disease presents with thirst and no aversion to cold. For initial illness with no sweat and exterior signs, Liu Wensu's Liangjie Tang (Double Release Decoction) method can be applied. For those with sweat and intense internal heat, clear or purge, urgently draining Yang-Heat to save Yin; if neglected, confusion and mania will appear, making it too late to treat. "No signs" refers to the absence of obvious exterior/interior signs; treatment should follow the Six Meridians with flexible adjustment, ensuring recovery.

Wind-Warmth

4. Wind-Warmth originates from contracting Spring Wind. Mistaken sweating leads to scorching heat and fluid depletion. When both Yin and Yang pulses are floating, speech is difficult; the body feels heavy, there is somnolence, and snoring breath. Mistaken purging leads to staring eyes and urinary incontinence or oliguria. Fire therapy causes jaundice, clonic spasms, and fright. Weiru Tang combined with Guizhi Tang and Baihu Tang is used; one mistake delays death, two mistakes ensure it.

[Note] Those injured by Cold in Winter who do not immediately fall ill, then contract Spring Cold, are diagnosed with Warm Disease; those contracting Spring Wind are diagnosed with Wind-Warmth. Wind-Warmth presents with sweat and should not be treated with sweating. Mistaken sweating aids Fire-Evil, causing body heat like fire, continuous sweating, difficulty speaking, heaviness, somnolence, and snoring. Wind-Warmth presents with floating Yin and Yang pulses and should not be treated with purging. Mistaken purging traps heat in the Bladder, exhausting fluids, causing staring eyes and urinary issues. With intense Wind-Damp-Heat, mistaken fire fumigation forces sweat, leading to Fire-Excess and Fluid-Depletion, causing jaundice, spasms, and epilepsy. Wind-Warmth should not be sweated or purged; the main formula is Weiru Tang. If the pulse is deficient with profuse sweat, Guizhi Tang combined with Renshen Baihu Tang is used. "One mistake delays, two mistakes kill" means one error may delay death, but sweating followed by purging, or purging followed by fire therapy, constitutes a second error, accelerating death.

Warm Malaria

5. Warm Malaria is contracted from Wind in Winter; Cold-Evil hides in the Marrow. In Spring, the Evil cannot emerge. Encountering Summer Heat scorches the marrow and consumes muscle. Or, exertion opens the Couli (pores), allowing Evil to exit with sweat, generating heat. As heat declines, Qi returns, causing cold. The syndrome resembles Warm-Thermal diseases, and treatment is similar.

[Note] The *Neijing* states: Warm Malaria is contracted from Wind in Winter; Cold-Evil hides in the Marrow. In Spring, Yang-Qi is still weak, so the Evil cannot exit spontaneously. Encountering great Summer Heat scorches brain marrow and consumes muscles, opening Couli. Or, exertion allows Evil to exit with sweat. Exit leads to Yin-Deficiency and Yang-Excess, generating heat. Decline leads to Qi returning, entering leads to Yang-Deficiency and Yin-Excess, generating cold later. Its syndrome is the same as Warm-Thermal diseases, and treatment is also the same.

Damp-Warmth

6. Warmth complicated by Dampness is Damp-Warmth. Symptoms include body heaviness, chest fullness, headache, delirium, profuse sweat, and cold calves. Treat with Baihu Tang plus Cangzhu and Fuling.

[Note] Warmth complicated by Dampness is named Damp-Warmth. Symptoms include body heaviness, chest fullness, headache, delirium, profuse sweat, and cold calves. Baihu Tang plus Cangzhu and Fuling is appropriate, addressing both Warmth and Dampness.

Zhongye, Warm-Toxicity, and Wind-Damp

7. Warmth contracting Ye (Heat Stroke) is Zhongye; contracting Toxicity is Warm-Toxicity. Syndromes resemble Warm-Thermal diseases but with more intense heat. Injury by Dampness followed by exposure to Wind is Wind-Damp, presenting with fever, body heaviness, and pulling pain.

[Note] Zhongye is Heat Stroke. Warm-Thermal disease contracting Summer-Heat is named Warm-Toxicity Syndrome; treatment is the same as Warm-Thermal, but heat is more severe. Damp-Injury contracting Wind is named Wind-Damp; symptoms are fever, body heaviness, and pulling pain, detailed in the "Body Pain" section. Zhongye is detailed in the "Summer-Heat" section.

Jing Syndrome (Spasm)

8. Jing Syndrome presents with opisthotonos, head shaking, trismus, stiff and spasmodic neck/back, difficulty turning, fever in the upper body, cold feet, and red face/eyes. One must distinguish between Gang-Jing (Rigid Spasm) and Rou-Jing (Flaccid Spasm) for complete treatment.

[Note] Wind, Damp, and Cold evils combine to form Jing Syndrome. Symptoms include opisthotonos, head shaking, trismus, stiff/spasmodic neck/back, difficulty turning, upper body heat, foot cold, and red face/eyes. Treatment must distinguish between Rigid and Flaccid types to cure. Wind-Damp excess with sweat is Rou-Jing (Flaccid Spasm). Wind-Cold excess without sweat is Gang-Jing (Rigid Spasm). Both are primarily treated with Xiao Xuming Tang. For Gang-Jing, remove Fuzi; for Rou-Jing, remove Mahuang. For Exterior Excess, remove Renshen and Fuzi, add Qianghuo and Duhuo. For Interior Excess, remove Renshen and Fuzi, add Mangxiao and Dahuang. Severe cases use Gegen Tang or Guizhi Jia Gegen Tang to release the exterior. This is the general principle for treating Jing Syndrome; details are in the "Jing Syndrome" section.