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Those cases that are particularly severe, some physicians who originally lack medical skills can nevertheless bewitch people. Whenever they encounter seasonal diseases (acute exogenous febrile diseases caused by abnormal qi of the four seasons), they will invariably say that the cold pathogen has not dispersed, so how can tonification be used? If one uses tonifying herbs to trap the pathogen inside, it is like closing the door to drive away a thief.

Where does this statement come from? It is baseless nonsense and heretical talk. There is another group who say: "If we follow these pulse signs and symptoms, it is indeed deficiency, and tonification should be employed. However, since the pathogen is not yet cleared, we must wait until it is clear before using medication." How can they know that if the righteous qi cannot recover, the pathogen will inevitably deepen day by day, making it impossible to clear? If the primordial yang cannot support itself, respiratory complications will arise; how can we delay further? These are people who do not know life from death.

Another group says: "This is fundamentally a deficiency syndrome, why not tonify? Use seven or eight fen of Ginseng Radix et Rhizoma (Renshen, 人参), controlled by Qingpi (Green Tangerine Peel) and Chenpi (Aged Tangerine Peel), and there will naturally be no harm." They only know the name of tonification but lack its substance. This is trivial playacting; what benefit does it bring to safety and danger? Yet they still think they are restraining themselves by combining purging and tonifying? These are people who do not understand weight and measure. Even if occasionally someone proposes an unconventional view advocating tonification, it is only when the condition is critical that they say, "Tonify quickly, tonify quickly." When a horse reaches the cliff, it is too late to pull the reins. If tonification fails to help, they will then claim, "There is no case of a Shanghan patient dying after using Ginseng." Thus, the theory that Shanghan cannot be treated with tonification becomes firmer, and the confusion of the masses becomes unbreakable. Even with the eloquence of Zhang Yi and Su Qin, it cannot be refuted.

The pathogen of Shanghan enters from the outside, and the disease varies in depth and severity, which ultimately depends on the strength of the host's righteous qi (Zhengqi, 正气). Therefore, those with strong righteous qi, even if infected, have mild conditions because the pathogen cannot penetrate deeply; those with weak righteous qi, even if lightly infected, become severely ill because the middle deficiency prevents self-consolidation. This is the interplay between exterior and interior, where pathogen and righteous qi compete for victory. Victory of righteous qi leads to survival; victory of pathogen leads to death. If one considers the pathogen as excess and righteous qi as deficiency but fails to consolidate the root, how can one hope for success? Moreover, tonification treats deficiency, not excess; why speak of tonification trapping cold pathogens? Tonification nourishes the middle, not the exterior; why speak of closing the door to drive away thieves? Even if we say strong bandits have entered the hall, those with weak righteous qi are busy avoiding the pathogen; how dare they close the door?

If one can close the door, it implies the host is still strong. The thief, hearing the host is strong, will surely retreat; if not, he will be captured. Calling this "catching the thief," is there any impropriety? The principles of disease and human affairs are the same; there is no case where righteous qi wins while the pathogen remains. Thus, for every step the righteous qi advances, the pathogen retreats. Calling this "internal support" (Neituo, 内托) or "expelling the pathogen," is there any impropriety? Furthermore, consider Zhang Zhongjing's Xiaochaihu Tang (Minor Bupleurum Decoction), which combines Ginseng Radix et Rhizoma (Renshen, 人参) and Bupleuri Radix (Chaihu, 柴胡); or Li Dongyuan's Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), which combines Ginseng Radix et Rhizoma (Renshen, 人参), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Cimicifugae Rhizoma (Shengma, 升麻), and Bupleuri Radix (Chaihu, 柴胡). One disperses the pathogen, the other consolidates the root. This is expelling within consolidating, and consolidating within expelling. Is this not different from "tonifying to close the door"? (From *Jingyue Quanshu*)

Three Meanings of Incomplete Sweating
Incomplete sweating has three causes: First, when the pathogen is in the meridians and sinews/bones, but sweat only appears on the skin/hair level, this means the pathogen is deep while the sweat is shallow; the Wei Qi (Defensive Qi) is resolved but the Ying Qi (Nutritive Qi) is not. This is the first type of incompleteness. Second, when ten parts of pathogen result in only five parts of sweat, this means the pathogen is heavy while the sweat is light. This is the second type. Third, when the cold pathogen has just left but is not fully cleared, and one suddenly exposes oneself to wind, causing re-infection due to deficiency, this is the succession of new and old pathogens. This is the third type. (From *Jingyue Quanshu*)

Three Methods of Resolving the Exterior in Shanghan
Shanghan is a critical illness. Treating Shanghan is difficult. The difficulty lies in not understanding the principles and missing the key point. The key point is solely the differentiation between righteous qi and pathogenic factors. If one knows the deficiency or excess of righteous qi and the superficiality or profundity of the pathogen, the matter is settled. Cold pathogen enters from the exterior via the surface, and must exit from the exterior via the surface. Therefore, anyone suffering from Shanghan must achieve sweating to resolve. When righteous qi overcomes the pathogen, the pathogen enters shallowly, indicating strong Yuan Qi (Primordial Qi); when the pathogen overcomes righteous qi, the infection is deep, indicating weak Yuan Qi. Since pathogens vary in depth, exterior-resolving methods vary; since righteous qi varies in deficiency or excess, attacking or tonifying methods vary. These three exterior-resolving methods must be discussed. What are the three exteriors? Generally, for shallow pathogens, expel them at the fence (skin/hair), dispersing in the skin/hair; for gradually deeper pathogens, expel them at the window/door (meridians), dispersing in the meridians; for deeper pathogens, expel them in the hall/chamber (zang-fu organs), dispersing in the zang-fu organs. Thus, for shallow and excess conditions, direct dispersion and expulsion are suitable and not difficult; for deficient and deep conditions, supportive dispersion is needed; by strengthening the host, the pathogen will inevitably disperse. Let us briefly list examples: Such as Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), Rensu Yin (Ginseng and Perilla Drink), Qianghuo Tang (Notopterygium Decoction), Magui Yin (Ephedra and Cinnamon Drink), etc., are all single agents for expelling external pathogens, acting on the muscle-surface. Such as Xiaochaihu Tang (Minor Bupleurum Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), San Chaihu Yin (Three Bupleurum Drink), Si Chaihu Yin (Four Bupleurum Drink), etc., all consider both pathogen and righteous qi, acting on the meridians. Again, such as Linyin Jian (Nourish Yin Decoction), Dawenzhong Yin (Great Warming the Middle Drink), Liuwei Huiyang Yin (Six-Ingredient Return Yang Drink), Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction), etc., all establish the middle and expel the pathogen, acting on the zang-fu organs. Alas! Who does not know using dispersing herbs to disperse in the skin, muscles, and meridians? But few know dispersing in the zang-fu organs. Who does not know dispersing with dispersing methods? But few understand the subtlety of "dispersing without dispersing." Because ancients did not mention this, I specially elucidate the essence of expelling pathogens thus. (From *Jingyue Quanshu*)

Tonifying the Middle to Disperse the Exterior
Tonification is used to tonify the middle; why can it also disperse the exterior? Generally, Yang deficiency is Qi deficiency. If Qi is deficient in the middle, how can it reach the exterior? Without tonifying Qi, can the muscles resolve the exterior? Whenever the pulse is weak and forceless, or the two Cun positions are short and small with many cold signs, this is the presentation. This is Yang-deficiency Shanghan. Yin deficiency is Blood deficiency. If Blood is deficient internally, how can it transform into fluids? Without tonifying Essence, can sweat be generated? Whenever the pulse is floating and hollow (Kou), unreliably full, or the two Chi positions have no root with many heat signs, this is the presentation. This is Yin-deficiency Shanghan. However, although tonification is applied, dosage must be carefully considered. It is like drinking wine: if one can drink one spoonful but is given one sheng, of course, they will be overwhelmed. If one can drink one dou but is given only one ge, it is like an ant trying to shake a large tree. (From *Jingyue Quanshu*)

Cold-Cooling to Disperse the Exterior
The method of "Han Zhong" (Cooling the Interior) is used to clear fire; why can it also disperse the exterior? Generally, Yang excess and Yin deficiency mean Water deficiency and Fire excess. If Water is dried up in the meridians, how can sweat be produced? It is like a dry pot cracking red-hot; where does moisture come from? By adding water, steam rises abundantly, and Qi transformation reaches everywhere. Sweat is also generated from Water, similarly. As discussed previously, tonifying Yin and Yang assists Essence and Qi; here, using Water to assist Fire employs cold-cooling herbs. Tonification supplements the insufficiency in the middle; assisting (Ji) controls the excess of Fire. All these can resolve the exterior, their efficacy seeming similar, but whether to use cold or warm, their applications differ greatly. This must be distinguished. (From *Jingyue Quanshu*)

Six Essentials and Five Taboos of Sweating
Sweat is transformed from fluids, exits via Yang, and originates from Yin. If the skin and hair pores are closed, and Ying and Wei Qi do not circulate, without acrid-dispersing herbs, the Yuan Fu (Pores) will not open, and sweat will not emerge. This is the first essential. If internal fire flares, drying blood and depleting fluids, without cooling herbs, Yin blood will not nourish, and sweat will not emerge. This is the second essential. If Yin pathogen is firmly closed, preventing Yang Qi from reaching, without acrid-warm herbs, condensation will not open, and sweat will not emerge. This is the third essential. If Ying and Wei Qi are insufficient, and the root is internally deficient, without vigorous tonification, blood and Qi will not fill, and sweat will not emerge. This is the fourth essential. If the pathogen is in the Upper Jiao, blocking the Yang channels, without inducing vomiting, clear Qi will not ascend, and sweat will not emerge. This is the fifth essential. If the pathogen enters the Yangming, and Stomach Qi is congested, without purgative methods, turbid Qi will not descend, and sweat will not emerge. This is the sixth essential. All these are ways to induce sweating, known as the Six Essentials. What are the Five Taboos? First, for heat in the exterior where there is no internal excess fire, cold-cooling herbs are strictly taboo. Cold causes Yin pathogen to stagnate and not disperse; the pathogen deepens daily, Yang declines daily, and failure to sweat leads to death. Second, for those with inherently weak Yuan Qi, unable to overcome the pathogen, consuming herbs are strictly taboo, especially fearing tonification. Consuming reduces righteous Qi daily; not tonifying allows pathogen to strengthen daily; failure to sweat leads to death. Third, for internal knotting of excess pathogen and internal flaming of latent fire, warm-tonifying herbs are strictly taboo. Warmth increases dryness; tonification makes the knot harder; failure to sweat leads to death. Fourth, for middle deficiency and weak Qi, dispersing herbs are strictly taboo. Dispersing causes Qi collapse; Qi collapse prevents sweating and prevents the retention of sweat, leading to death. Fifth, for conditions not involving Yangming excess pathogen, purgative methods are strictly taboo. Purging causes loss of Yin; Yin deficiency allows Yang pathogen to sink deeply; failure to sweat leads to death. These are the Five Taboos. Knowing the Six Essentials and avoiding the Five Taboos encompasses all treatment methods for Shanghan. (From *Jingyue Quanshu*)

Differentiation: Sexual Intercourse Does Not Necessarily Indicate Yin Syndrome
Yin syndrome refers to cold pathogen directly entering the Three Yin meridians. This is because the Three Yang govern Qi, and when Qi is weak and powerless to reject cold, it occurs. Nowadays, people assume that any illness contracted after sexual intercourse is a Yin syndrome, regardless of pulse and symptom differentiation, naming it Yin syndrome. This causes patients' families to hide the truth, which is laughable. Illness contracted after sexual exhaustion involves deficiency and pathogen invasion; it can present as Yang syndrome or Yin syndrome, not necessarily entirely Yin. (From *Jiren Bian*)

Whenever sexual activity precedes the onset of Shanghan, physicians are often confused by the label "Yin syndrome," often administering Sini Tang (Frigid Extremities Decoction) and similar formulas, hastening sudden death and driving the patient to irreversible extreme Yin. Generally, illness contracted after sexual exhaustion is only slightly more severe than usual: fever may be extreme, aversion to cold may be extreme, headache may be extreme. This is because Yin deficiency allows Yang to invade; it is not comparable to Yin excess with absence of Yang. (Yu Jiayan)

Common people believe that Shanghan contracted after sexual intercourse is a Yin syndrome and universally use Ginger (Shengjiang, 生姜) and Aconite (Fuzi, 附子). They fail to realize that those engaging in sex have already depleted Yin; using Ginger and Aconite further exhausts Yin, which is dangerous. Zhang Zhongjing used Ginger and Aconite for Shanghan in cases of direct cold pathogen invasion, described as "no fever, aversion to cold, originating from Yin," which does not refer to sexual exhaustion. Someone asked: How to treat heat disease contracted after sexual exhaustion? I say: Those engaging in sex have already depleted Yin; heat pathogen sinks in due to deficiency, similar to "heat entering the blood chamber" in women. Clearing heat and nourishing Yin is the treatment method. (From *Yitang Sanji*)

Dietary Appropriateness and Taboos
For Shanghan, dietary restrictions have appropriate and inappropriate aspects. If a Shanghan patient continues to eat, it is because the pathogen is still in the exterior and has not penetrated deeply. As it penetrates slightly deeper, into the half-exterior half-interior, appetite gradually decreases. Once it enters the chest, diaphragm, and stomach opening, eating stops completely. Once the pathogen is in the Stomach, the stomach opening feels no hunger. Therefore, lack of appetite in Shanghan, whether for ten or twenty days, is not worrying. Do not force food; forcing food aids the pathogen. If Shanghan has just healed and Stomach Qi is awakening, one must not indulge in food; indulgence causes food relapse. These are the taboos. Regarding appropriateness: For those with fatigue-induced internal injury who accidentally contract cold pathogen, fever will occur. This is not true Shanghan with external pathogen sinking inward. Although there is external fever, internally there is hunger, and they often desire food. Why do mediocre physicians, seeing only fever, say "starvation won't kill a Shanghan patient," and forbid food regardless of deficiency or excess? I often see patients wanting food but being denied, and instead given harsh, cold-cooling herbs. Their hungry intestines are stripped; the deficient become more deficient. When Stomach Qi collapses, they lose appetite. Trying to save them then is futile. I often use food as medicine and have saved many; I have seen many die from food restriction, so I explain this in detail. If a patient constantly feels hungry and asks for food, it indicates the pathogen is not in the Zang organs, and the Stomach is empty. This must not be forbidden. However, one should not indulge. Observing this helps differentiate deficiency and excess, which is significant and should not be ignored. (From *Jingyue Quanshu*)

*Neijing* states that humans receive Qi from grain. Grain enters the Stomach and transmits to the Lung; all Zang and Fu organs receive Qi. If grain is not taken, Qi declines in half a day and diminishes in one day. A healthy person not eating dies in seven days. Thus, food is indispensable for humans daily. For manic insanity arising from Yang, restricting food cures it. *Neijing* has only this one instance of temporary food restriction; there is no explicit text forbidding food elsewhere. In Zhongjing's *Treatise*, the first instruction for Guizhi Tang (Cinnamon Twig Decoction) is to drink thin rice gruel to assist medicinal power. Learning is most refined in Changsha (Zhang Zhongjing); disease is most serious in Shanghan; yet he does not forbid food. Other books only forbid grain for Gan Huoluan (Dry Cholera); there is no other language forbidding food. I think for the six climatic pathogens, if pathogen is excess and interior is solid, phlegm-Qi is congested, damp-heat causes fullness, or retained food causes bloating, even if food is offered, it cannot be forced; if the patient does not want to eat, why forbid it? If the pathogen is light and the disease is not in the Stomach, and the Stomach is hungry and desires food, then food can be given. Yet physicians, upon initial fever, without assessing the condition, immediately forbid grain. Even postpartum women and infants with slight exterior signs are sent to starvation; grain and soup are not allowed in, and if not cured in seven days, fasting continues. Even if the patient is extremely hungry and begs for food, prevention is strict. Often, Stomach Qi is severely damaged, mild disease becomes severe, and harsh drugs are still administered. Those with solid constitution may luckily survive; those with deficient constitution often face danger. Humans rely on Stomach Qi for life; medicines also rely on Stomach Qi for transportation. If Stomach Qi is exhausted, medicinal properties do not act. Only when Yin and Yang are about to collapse do they suggest giving grain, but by then the patient hates the smell of food and cannot swallow. I say: If the patient is not hungry, food need not be given; if hungry and desiring food, it should not be forbidden. Know that if Grain Qi fills the interior, Essence wins and pathogen retreats. Only eat small amounts, do not let yourself get full. Previously, Zhang Huiqing wrote on dietary appropriateness in Shanghan, strongly criticizing food restriction; Ke Yunbo also criticized contemporary physicians for arbitrarily forbidding grain, causing great harm. Now in Weiyang and other places, unknown is the originator; habituated without scrutiny, they merge everything into one discussion, unbreakable. I therefore borrow the intent of predecessors to elucidate this, hoping worthy men of the land will emerge to lead, correcting the confusion of customs, perhaps embodying Heaven's virtue of loving life, and not leaving people to disaster. (From *Chiya Yi'an*)

Essentials of Treatment Methods
Zhongjing's treatment methods are all based on *Neijing*. Note: Qibo said: "Treatment plans must distinguish Yin and Yang. Treat Yin diseases by addressing Yang, treat Yang diseases by addressing Yin. Determine the interior and exterior, each guarding its position. Exterior is treated externally, interior is treated internally. From exterior to interior, treat the exterior; from interior to exterior, regulate the interior. From interior to exterior becoming prominent externally, first regulate the interior, then treat the exterior; from exterior to interior becoming prominent internally, first treat the exterior, then regulate the interior. If interior and exterior are unrelated, treat the main disease. Mild cases are regulated, moderate cases are balanced, severe cases are seized/cleared. Cold, heat, warm, cool, reduce according to category, following what is beneficial. This is the great principle." In Zhongjing's *Treatise*, "fever with aversion to cold originates from Yang, no fever with aversion to cold originates from Yin" is the distinction of Yin and Yang. Yang diseases use Baihu Tang (White Tiger Decoction) and Chengqi Tang (Cathartic Decoctions) to preserve Yin; Yin diseases use Fuzi (Aconite) and Wuyu (Evodia) to support Yang. Exterior is treated with Mahuang (Ephedra) and Guizhi (Cinnamon Twig) for the surface; interior is treated with Xiaoshi (Sodium Sulfate) and Huanglian/Huangqin (Scutellaria/Phellodendron) or Da Huang (Rhubarb) for the interior. Regarding exterior-interior, deficiency-excess, exterior-heat interior-cold, releasing the exterior, harmonizing the exterior, attacking the interior, saving the interior, disease has depth, treatment has sequence, formulas have weight. Thus, determining interior/exterior, each guards its position. Taiyang and Yangming concurrent disease requires slight sweating; Taiyang and Yangming combined disease uses Mahuang Tang (Ephedra Decoction); this is treating the exterior for pathology moving from exterior to interior. Yangming disease, fever and sweating, no aversion to cold, aversion to heat, uses Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction); this is regulating the interior for pathology moving from interior to exterior. After sweating, unresolved, steaming fever, pathology moves from interior to exterior becoming prominent externally, uses Tiaowei Chengqi Tang (Regulate the Stomach Cathartic Decoction); this is first regulating the interior. Exterior unresolved with epigastric fullness, pathology moves from exterior to interior becoming prominent internally, must first release the exterior, then attack the interior; this is first treating the exterior, then regulating the interior. Unrelated interior/exterior means disease is in half-exterior half-interior; Da Xiao Chaihu Tang (Major and Minor Bupleurum Decoctions) treat the main disease; this is "mild cases regulated." Moderate cases balanced use Baihu, Zhizi Chi, Xiao Chengqi, etc. Severe cases seized use Da Chengqi, Xianxiong, Didang, etc. "Observe pulse and signs, know what deviation occurred, treat according to method" refers to cold, heat, warm, cool, reducing according to category, following benefits. Also, sweating, vomiting, purging originate from Qibo, while diuresis, clearing fire, regulating tonification are complete. "With pathogen, soak form to produce sweat; in skin, sweat and disperse; excess, disperse and purge." These are the three sweating methods. "Fullness in middle, purge internally; blood excess, drain." These are the two purging methods. "High, cause to vomit"; "Low, draw to exhaust," meaning diuresis. "Violent, press and collect," is clearing fire. "Qi deficiency, guide and lift," is regulating tonification. Pathogen in skin/hair, not yet damaging form, so Mahuang Tang (Ephedra Decoction) is made for urgent sweating to disperse; pathogen enters muscles, damaging form, so Guizhi Tang (Cinnamon Twig Decoction) with thin rice gruel is made to resolve muscles. This is soaking form to produce sweat. If pathogen and righteous qi contend, interior and exterior both excess, cold and heat alternate, so Da Qinglong Jia Shigao Tang (Major Green Dragon Plus Gypsum Decoction) is made to purge fire. This is dispersing and purging. Vomiting agents include Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) and Gengti (Melon Peduncle), distinguishing chest deficiency/excess; purgatives include Da/Xiao Chengqi (Major/Minor Cathartic), Tiaowei, Didang, distinguishing Qi/Blood depth; diuretics include Zhu Ling (Polyporus), Zhenwu (True Warrior), extreme cold/heat difference; clearing fire includes Shigao (Gypsum), Huangqin (Scutellaria), Huanglian (Coptis), difference in weight; Yang Qi deficiency, add Renshen (Ginseng) to Fuzi (Aconite) and Wuyu (Evodia) to guide Yang; Yin Qi deficiency, add Renshen (Ginseng) to Baihu (White Tiger) and Xiexin (Drain Epigastrium) to guide Yin. All methods are orderly. Questioned by Qibo, former sages and latter sages, their principles are one. (Ke Yunbo)

The outline of Shanghan relies most on Yin and Yang. Error here leads to death. There are pure Yang syndromes and pure Yin syndromes, requiring definite differentiation and separate treatment. There are also half-Yin half-Yang syndromes, where warming leads to Yin victory, heating leads to Yang victory; or today Yin is seen, tomorrow Yang is seen; today Yang is seen, tomorrow Yin changes. Among ordinary people, this syndrome is most common, only discernible by the wise. However, changing from Yin to Yang is mostly auspicious; changing from Yang to Yin is mostly ominous. ○ Disease of the Three Yang meridians, if only exterior signs appear, interior must not be attacked. Either release exterior, slightly resolve, warm disperse, cool disperse, or warm middle and support interior for non-dispersing dispersion, or tonify Yin and assist Yang for cloud-steaming rain-transforming dispersion. (Zhang Jingyue)

Whenever Wind-Cold is initially contracted, regardless of meridian, it is always an exterior syndrome, and must be sweated. Even Shaoyin can be sweated, such as in Mahuang Fuzi Xixin Gancao Tang (Ephedra, Aconite, Asarum, and Licorice Decoction). As transmission goes deeper, regardless of meridian, it is always an interior syndrome, and must not be sweated. Even Taiyang must not be sweated, such as in Didang Tang (Di Dang Decoction) or Wuling San (Five-Ling Powder). Knowing this allows one to speak of exterior/interior, avoiding the stubborn theory that Three Yang are definitely exterior and Three Yin are definitely interior. (Wei Litong)

Yangming Meridian has three urgent purging methods to save Jin Ye (Body Fluids): one, excessive sweating drains fluids outward; two, abdominal fullness binds fluids internally; three, dull eyes indicate fluids dried up internally. Shaoyin Meridian has three urgent purging methods to save Kidney Water: one, original meridian water exhausted; two, Wood pathogen surges Water; three, Earth pathogen overwhelms Water. ○ Treating Yin syndrome focuses on saving Yang; treating Shanghan focuses on saving Yin. Even if Shanghan has Yang deficiency requiring treatment, one must see if the patient's flesh and blood are abundant, and if the Yin division can accept Yang herbs, before returning Yang. If the face is dark, tongue black, body like withered firewood, a mass of pathogenic fire burning internally,