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Wen Mang (Warm Malaria) arises when the heat pathogen from Shang Han (Cold Damage) has not yet subsided, and the patient is again exposed to cold, transforming into Wen Mang; or it may transform into Wen Mang after the disease has progressed through stages, resulting in lingering alternating chills and fever. All these cases are caused by the struggle between cold and heat pathogens. Treatment should primarily focus on dispersing cold and resolving heat, combined with the use of Jia Jian Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). If heat symptoms predominate, increase the dosage of Chai Hu (Bupleuri Radix); if cold symptoms predominate, increase the dosage of Gui Zhi (Cinnamomi Ramulus), or alternatively use Chai Hu Ge Gen San (Bupleurum and Pueraria Powder) to disperse cold, and Shi Gao (Gypsum Fibrosum) and Zhi Mu (Anemarrhenae Rhizoma) to resolve heat.

Shi Xing (Seasonal Epidemic Cold) refers to abnormal climatic conditions: spring should be warm but is cold, summer should be hot but is cool, autumn should be cool but is hot, and winter should be cold but is warm. This is due to the prevalence of irregular, adverse qi of the four seasons during their respective periods. Consequently, throughout the year, people of all ages suffer from similar illnesses, which is attributed to the Qi of Shi Xing. The external symptoms resemble those of Shang Han, so treatment should focus on releasing the exterior, combined with Sheng Ma Ge Gen Tang (Ephedra and Kudzu Root Decoction). However, Shi Xing is akin to an external common cold, whereas Wen Yi (Plague Epidemic) involves internal toxic pathogens.

Han Yi (Cold Epidemic) is a sudden exposure to cold out of season, also belonging to the category of Shi Xing. The *Shang Han Li* states: "From after the Spring Equinox to before the Autumn Equinox, if there is sudden cold weather, it is classified as a seasonal cold epidemic." Symptoms include aversion to cold and wind, headache, and body heat. Treatments may include Xiao Feng Bai Jie San (Wind-Dispersing Hundred-Resolution Powder) or Liu Shen Tong Jie San (Six-Spirit Unblocking Resolution Powder) with modifications. Generally, this disease resembles Wen Bing (Warm Diseases) and Shu Bing (Summerheat Diseases), but the therapeutic principles differ. The heat in Wen Bing and Shu Bing originates internally, whereas the pathogen in Han Yi is cold that suppresses Yang Qi, making it an external contraction. Therefore, treatment should focus on releasing the exterior. In contrast, Wen Bing and Shu Bing involve both exterior and interior patterns.

Wen Xie (Warm Pathogen) enters from the upper jiao (mouth and nose), first attacking the Lung. If the condition deteriorates reversely, it transmits to the Pericardium. The Lung governs Qi and belongs to Wei (Defensive Qi); the Heart governs Blood and belongs to Ying (Nutritive Qi). Differentiating between Ying and Qi levels is similar to Shang Han, but the treatment methods are vastly different. The pathogen in Shang Han lingers at the exterior before transforming into heat and entering the interior, whereas the heat transformation in Wen Xie is most rapid. Before transmitting to the Pericardium, the pathogen remains in the Lung. Since the Lung governs Qi and connects with the skin and hair, it is said to be at the exterior. In the initial stage at the exterior, use mild acrid-cool agents. If accompanied by Wind, add Bo He (Menthae Haplocalycis Herba) and Niu Bang Zi (Arctii Fructus); if accompanied by Dampness, add Lu Gen (Phragmitis Rhizoma) and Hua Shi (Talcum). Alternatively, vent the Wind outside the Heat, or drain the Dampness below the Heat, so that the pathogens do not struggle with the Heat, leaving them isolated. Otherwise, Wind carrying Warmth generates Dryness, causing the clear orifices to become dry because the essence of Water cannot nourish the upper regions; this is called the mutual depletion of two Yangs. When Dampness combines with Warmth, steaming and stagnation occur, obscuring the upper orifices, causing obstruction; this is turbid pathogen harming the clear. The illness resembles Shang Han, but differentiation is made thus: Shang Han often presents with changing symptoms, while Wen Re (Warm-Thermal diseases) remain in one level for a long time.

As previously mentioned, using acrid-cool to disperse Wind and sweet-bland to drive out Dampness, if the disease persists, it indicates the pathogen is gradually entering the Ying level. Heat in the Ying level consumes Blood, causing mental restlessness, worse at night with insomnia, or faint macules appearing under the skin. Immediately remove Qi-level drugs. If entering from Wind-Heat, use Xi Jiao (Rhinocerotis Cornu) and Zhu Ye (Bambusae Folium); if entering from Damp-Heat, use Xi Jiao and Hua Lu (Flower Dew), incorporating them into blood-cooling and heat-resolving formulas. If irritability and constipation occur, Jin Zhi (Charred Human Feces) can be added; for the elderly or those with chronic cold constitutions, Ren Zhong Huang (Human Manure processed with bamboo) is used instead. Urgently focus on venting the macules. If macules appear but heat does not subside, it indicates the loss of Stomach Yin. Treat with sweet-cold methods; severe cases use Yu Nu Jian (Jade Woman Decoction), mild cases use Pear Skin and Sugarcane Juice. If the person has inherent Kidney Yin deficiency, even if the lower jiao is not yet affected, anxiety arises. Verify via the tongue; add salty-cold herbs to sweet-cold formulas to secure areas not yet invaded, preventing easy penetration. If the pathogen lingers in the Qi level without transmitting, hope for resolution via Battle Sweat (Zhan Han). The method benefits the Stomach, allowing fluids to mix with sweat, reaching the pores, opening the interstices, and expelling the pathogen via sweat. After resolution, Stomach Qi is empty, causing skin coldness for a day and night; as Qi returns, warmth normalizes. Since battle sweat resolves the pathogen, leaving righteous Qi deficient, Yang escapes with cold, causing gradual skin coldness; this is not necessarily Collapse Syndrome. Allow the patient to rest comfortably to nourish recovering Yang; attendants must not panic or call frequently, disturbing the Yuan Shen (Original Spirit). Check the pulse: if weak, soft, and slow, despite fatigue and silent lying down with sweaty cold skin, it is not collapse. If the pulse is rapid, restless, unable to lie down, with cold sweaty skin, it is Qi Collapse. If pathogen excess and righteous deficiency prevent single-resolution, waiting one or two days for another battle sweat may lead to recovery.

Regarding Qi-level diseases not transmitting to Blood but lingering in the Three Burners, it resembles Shaoyang disease in Shang Han. There, harmonize half-exterior/half-interior; here, separate and eliminate upper and lower tendencies, modifying methods per symptoms, such as using Xing Ren (Armeniacae Semen Amarum), Pu Huo (Magnoliae Officinalis Cortex), Ling Zhu (Poria), etc., or Wen Dan Tang (Warm Gallbladder Decoction) for draining. Since still in Qi level, battle sweat resolution is possible. Generally, discuss Qi after Wei (Defensive), and Blood after Ying (Nutritive). For Wei, induce sweating; for Qi, clear heat; for Ying, vent heat to turn it back to Qi, using Xi Jiao, Xuan Shen (Scrophulariae Radix), Ling Yang Jiao (Capricornis Cornu), etc. Entering Blood risks consuming and agitating blood; directly cool blood and dissipate stasis using Sheng Di Huang (Rehmanniae Radix), Mu Dan Pi (Moutan Cortex), E Jiao (Colla Corii Asini), Chi Shao (Paeoniae Radix Rubra), etc. Otherwise, ignoring urgency leads to errors. In our Wu region, Dampness harms widely. Those with pale faces need Yang protection; excessive Dampness weakens Yang. Use cooling methods, but stop at 60-70% intensity to avoid overcooling, which might fail because removing Damp-Heat also weakens Yang. Those with dark complexions need Yin protection. At 60-70% cooling, if heat decreases and body feels cold, do not assume deficiency-cold and tonify; the fire may be extinguished but embers remain. Examine carefully before slight tonification. Wine drinkers have internal Dampness; external pathogens combine with it. In Yang-excess constitutions, Stomach Dampness is common; in Yin-excess, Spleen Dampness is common; both transform into Heat similarly. Saving Yin in Heat diseases is easy; unblocking Yang is difficult. Saving Yin relies on fluids and sweat, not blood; unblocking Yang relies on promoting urination, not warming. This differs from miscellaneous diseases.

If the Three Burners cannot resolve externally, internal binding occurs in the Yangming Stomach and Intestines. Purging is necessary, regardless of Qi/Blood distinction. In Shang Han, internal heat consumes fluids, requiring strong purgatives; here, internal Dampness requires gentle purgatives. In Shang Han, loose stool means pathogen exhaustion, no more purging; in Wet-Warmth, loose stool means pathogen remains, wait until stool hardens before cautious purging, as dry stool indicates no Dampness. The epigastrium is central; tenderness or fullness requires bitter-draining due to proximity to abdomen. Verify via tongue: yellow or turbid coating allows Xiao Xian Xiong Tang (Minor Chest-Harmonizing Decoction) or Xie Xin Tang (Drain the Epigastrium Decoction). White non-dry, yellow-white mixed, or gray-white non-thirsty coatings forbid bitter-draining. If exterior unresolved and interior bound, or Qi stagnation, use opening-draining methods like Xing Ren, Kou Ren (Amomi Fructus), Ju Pi (Citri Reticulatae Pericarpium), Jie Geng (Platycodonis Radix) to move Qi to the Lung. Light bitter-sweet, mobile herbs suffice.

Yellow/turbous coating needs roots; smooth coating indicates formless Damp-Heat and deficiency, forbidding previous methods. Fullness/pain above navel indicates interior pathogen, likely no exterior signs. Yellow/dark/gray/yellow-black or cracked tongues require purging, e.g., Xiao Cheng Qi Tang with Bing Lang (Arecae Semen), Qing Pi (Citri Reticulatae Pericarpium Viride), Zhi Shi (Aurantii Fructus), Yuan Ming Fen (Mirabilite), Shou Wu (Polygoni Multiflori Radix). Absence of these signs warns against purging, considering Taiyin Damp-fullness, Cold-Damp pain, or Qi distension. Thin slippery yellow coating allows clearing heat/releasing exterior; thin dry coating indicates fluid injury, forbidding heavy bitter herbs, using sweet-cold light agents.

Heat transmitting to Ying shows crimson tongue. Initial crimson with yellow/white indicates residual Qi pathogen; release Wei and vent Ying. Pure bright crimson indicates Pericardium involvement; use Xi Jiao, Fresh Sheng Di Huang, Lian Qiao (Forsythiae Fructus), Yu Jin (Curcumae Radix), Shi Chang Pu (Acori Tatarinowii Rhizoma). Delayed cases or phlegm-Heart deficiency with trapped heat require Niu Huang Wan (Calculus Bovis Pill) or Zhi Bao Dan (Precious Treasure Pill) to open closure, preventing coma/spasms. Crimson tongue with dry center indicates Heart/Stomach Fire consuming fluids; add Huang Lian (Coptidis Rhizoma) and Shi Gao. Irritation/thirst with dry center/red sides/yellow-white center indicates Upper Jiao Qi Heat, not Blood; use Liang Ge San (Cool the Diaphragm Powder) for formless heat, avoiding cloying blood herbs. Crimson tongue looking dry but moist to touch indicates fluid deficiency with Damp-Heat steaming, impending turbid-phlegm blocking Pericardium.

Heat transmitting to Ying/Blood with prior chest diaphragm blood stasis causes purple-dark tongue; add blood-dispersing herbs like Hu Po (Electrum), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Tao Ren (Persicae Semen), Mu Dan Pi. Otherwise, stasis-heat obstructs Zheng Qi, causing mania. Purple-swollen tongue indicates Wine Toxic attacking Heart; purple-dry/dull indicates Kidney/Liver color flooding, difficult to treat. Crimson tongue with sticky non-coating indicates turbid Qi; add aromatic dispellers. Crimson tongue stiff-to-protrude indicates Phlegm blocking root/Internal Wind. Crimson-shiny tongue indicates Stomach Yin death; urgently use sweet-cool moistening agents. Crimson-dry tongue indicates Fire harassing Ying; cool blood/clear fire is key. Crimson with white/yellow spots indicates impending mouth ulcers; large red dots indicate Heat-Toxin attacking Heart; use Huang Lian and Jin Zhi. Crimson-dull-dry-withered tongue indicates Kidney Yin exhaustion; urgently save with E Jiao, Ji Zi Huang (Galuli Album), Di Huang (Rehmanniae Radix), Tian Dong (Asparagi Radix), lest exhaustion be incurable. Crimson-center-only tongue indicates Stomach Heat burning Heart Ying; add Heart-clearing herbs to Stomach-clearing formulas, else spreading to tip causes fluid dryness/Fire excess. Crimson-dry tip indicates Heart Fire flaming upward; use Dao Chi San (Direct the Flow Powder) to drain the Fu organ.

Thick dry white coating indicates Stomach Dryness/Qi injury; add Gan Cao (Glycyrrhizae Radix et Rhizoma) to Kidney-nourishing herbs for sweet-retention/fluid-return. Thin white coating indicates Exterior Wind-Cold; disperse. Dry thin white coating indicates Lung Fluid injury; add Mai Dong (Ophiopogonis Radix), Hua Lu, Lu Gen juice for upper-region clearing. White coating with crimson base indicates Damp-suppressing Heat; first drain Damp/vent Heat to prevent drying, then transform from interior to exterior for moisture. Initial dry tongue without coma requires nourishing Righteous Qi with slight pathogen-expelling herbs; coma indicates internal depletion, incurable. Any tongue with prickles indicates extreme Upper Jiao Heat; wipe with green cloth dipped in cold mint water. Disappearing prickles are mild; recurring are dangerous. Moist tongue with extreme stuffiness indicates Spleen Dampness. Scratch marks/blood require inquiry; do not assume dryness, treat as Dampness. Clear spirit with swollen tongue unable to exit mouth indicates Spleen Damp/Stomach Heat transforming into Internal Wind/toxicity extending to mouth; add Da Huang (Rhei Radix et Rhizoma) to formula to reduce swelling.

Sticky thick white coating with foul saliva and sweet taste indicates Pi Dan (Spleen Dysentery/Damp-Heat accumulation); use Sheng Tou Cao (Houttuyniae Herba) for aromatic-acrid dispersion. Mold-like coating indicates old food retention with turbid Qi; urgently open-drain, else middle jiao closure. Non-thirsty cold limbs indicate Yin-binding; thirst/fever indicates Stomach Dryness, do not purge. Dry requires sweet-cold benefiting Stomach; moist requires sweet-warming supporting Middle. Reason: exterior present, interior absent.

Black slippery tongue indicates Water overcoming Fire (Yin syndrome); warm it. Shortened tongue indicates Kidney Qi exhaustion, difficult; save with Ren Shen (Ginseng Radix) and Wu Wei Zi (Schisandrae Fructus). Black dry tongue indicates fluid exhaustion/Fire blazing; urgently drain South (Heart) and tonify North (Kidney). Dry with thick center indicates Earth Dry/Water Exhausted; urgently purge with salty-bitter. Pale red/colorless or dry/unlustrous tongue indicates Stomach Fluid injury/Qi failing to generate fluid; use Zhi Gan Cao Tang (Honey-Fried Licorice Decoction), avoid cold-cool meds.

White powder-like slippery tongue with purple-crimson edges indicates Plague entering Mu Yuan (Oasis/Middle Layer), not yet Stomach Fu; urgently resolve, do not let it sink into dangerous pathology. This tongue indicates severe prognosis. Macules/Rashes: check chest/back. Large skin points are Macules (Ban); hidden/cloud-like or small granules are Rashes (Zhen). Better few than many. Red macules = Stomach Heat; Purple = Extreme Heat; Black = Rotting Stomach. Combine with external symptoms. Spring/Summer dampness often causes rashes. Light red, cool limbs, non-thirsty, non-rapid pulse indicates Deficiency/Yin Macule. Few chest points, red face/cold feet, or clear undigested food diarrhea indicates Yin Excess repelling Yang upward; warm it. Small purple macules = Pericardium Heat; Large purple = Stomach Heat. Bright black macules = Heat/Toxin excess, usually fatal, but resolvable if Qi/Blood sufficient. Dark dull black = Death. Black with surrounding red indicates trapped Fire; use heavy cooling/venting, sometimes turning red/resolvable. Mixed macules/rashes indicate varied pathogens; drain according to location. Macules mostly Blood-related; Rashes mostly Qi-related. Both show exterior pathogen; clear spirit indicates exterior resolution/interior harmony. Coma upon eruption indicates Righteous defeat/pathogen sinking or Stomach Fluid exhaustion.

White papules (Pi) crystal-like indicate Lung Damp-Heat injury; pathogen out but Qi/Fluid exhausted; tonify with sweet herbs. If not prolonged, Damp-stagnant in Wei level, incomplete sweating; regulate Qi level. White like dead bone indicates Qi/Fluid exhaustion, ominous.

After tongue diagnosis, examine teeth. Teeth are surplus of Kidney; gums are network of Stomach. Heat either dries Stomach Fluid or consumes Kidney Fluid. Blood from both meridians affects them. Deep disease moves blood, forming clots above. Yang blood is purple like dried lacquer; Yin blood is yellow like soybean paste. Yang blood appearance: stabilize Stomach. Yin blood appearance: save Kidney. Soybean-paste color is dangerous; treatable if symptoms not adverse, otherwise difficult. Reason: Yin exhausted below, Yang rebellious above.

Teeth shiny/dry like stone indicate severe Stomach Heat. No sweat/aversion to cold indicates Wind excess; use acrid-cool to drain Stomach/induce sweat. Like dead bone indicates Kidney Fluid exhaustion, difficult. Upper part moist/lower dry indicates Water not ascending/Heart Fire flaming; urgently clear Heart/save Water until moist. Grinding teeth indicates Damp-Heat transforming into Wind/Spasm. Only grinding indicates Stomach Heat moving along collaterals. Grinding with weak pulse/symptoms indicates Stomach deficiency/no grain nourishment; also grinding. Reason: deficiency prefers fullness. Tongue root stiff/jaw locked indicates Wind-Phlegm blocking collaterals or impending spasm; rub with sour substance to open (Sour enters sinews, Wood drains Earth).

Teeth tartar like gray cake indicates Stomach Qi powerless/Fluid lost/Damp-Turbidity dominant, often fatal. Bleeding gums painful indicate Stomach Fire rushing; painless indicate Dragon Fire (Ministerial Fire) internal blazing. Blackened teeth without tartar = Death. Blackened with tartar = Kidney Heat/Stomach劫 (plunder); gently purge or use Yu Nu Jian to clear Stomach/save Kidney.

Women with Warm diseases same as men, but often pre/post-partum or menstruation onset/interruption. Pre-partum: ancient texts use Si Wu Tang (Four Substances Decoction) modifications to protect fetus, fearing harm. Extreme heat: apply cold well-water mud/blue cloth on abdomen for protection. Assess pathogen resolvability; if blood-nourishing herbs ineffective, re-evaluate, do not stick rigidly. Step-by-step protect fetal origin, fear damaging Righteous/Sinking Pathogen. Post-partum: caution with bitter-cold to protect lost Yin. Assess if pathogen resolves from Upper/Middle; slight symptomatic use acceptable. Avoid Lower Jiao; treat as deficiency-cold constitution. Do not violate "tonify deficiency/exacerbate excess" prohibitions. Post-partum blood/Qi boiling creates voids; pathogen sinks into deficiency, difficult to treat. Menstruation onset/interruption: pathogen sinking into Blood Chamber. Shaoyang Shang Han details this; no need to repeat. Frequent movement differs from standard Shang Han. Zhang Zhongjing's Xiao Chai Hu Tang extracts sunk heat, Ginseng/Jujube support Stomach Qi (Chong Mai belongs to Yangming), suitable for deficiency. If Heat-Blood binding, follow Tao's Xiao Chai Hu Tang minus Ginseng/Jujube plus Sheng Di Huang, Tao Ren (Persicae Semen), Cha Rou (Crataegi Fructus), Mu Dan Pi, or Xi Jiao. If intrinsic Blood binding severe, lower abdominal fullness/pain: mild puncture Qi Men; severe Xiao Chai Hu Tang minus sweet herbs plus Yan Hu Suo (Corydalis Rhizoma), Gui Wei (Angelicae Sinensis Radix), Tao Ren; add Rou Gui Xin (Cinnamomi Cortex) for Cold; Xiang Fu (Cyperi Rhizoma), Chen Pi, Zhi Ke for Qi stagnation. Heat-sinking Blood Chamber often presents delirium/mania; distinguish from Yangming Stomach Excess. Blood binding causes heavy body, unlike Yangming agility. Reason: Yin is heavy/turbid; collateral blockage causes side/chest/back stiffness. Removing pathogen/uncollateralizing fits disease. Prolonged cases ascend to Pericardium, chest pain (Tao's Blood Binding Chest). Wang Haizang's Gui Zhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) plus Hai Ge (Arcaea Concha), Tao Ren aims simultaneous resolution of exterior/interior/upper/lower. Ingenious formula, recorded for study.