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... As Li Mingzhi stated: "Winter injury by cold" occurs when winter exhibits the characteristics of spring (winter acting as spring). When it is warm in winter, fire is excessive and water is deficient. Since water is deficient, the element controlled by water (Earth) acts recklessly and becomes excessive; the element that generates water (Metal) suffers disease and becomes insufficient; the element that controls water (Wood) insults it, leading to excessive fire. Fire and Earth combine their virtues, with damp-heat assisting each other, thus forming Warm Disease (Wen Bing). However, according to Li Mingzhi's statement, this refers to contracting warmth immediately upon exposure in winter, not latent cold, nor transformation from cold. Otherwise, there would be no such syndrome as "Winter Warmth." Once Winter Warmth exists, there must be this climate and consequently this syndrome. Through his words, one can fully understand Winter Warmth, establishing an unshakable theory. If applied to discuss Spring Warmth, it would mislead for generations. The *Classic* states: "Violating the Qi of winter causes Shaoyin [Kidney] to fail to store; failing to store allows Cold Evil to enter." Injury to the skin and muscles, lying latent in the bone marrow, reveals that winter is the time for storing essence. Only by violating the Qi of winter does the Qi of the Shaoyin meridian fail to close; encountering non-seasonal warmth causes the pores to open. Sudden return of severe cold inevitably causes injury. Thus, the injured party is still Cold Evil. Because previously opened by warmth, it seems to prefer cold, and the injury is slight, so it does not manifest immediately but lies latent in Shaoyin. Yet why does it manifest in spring rather than winter? Because Water is prosperous in winter, evil lies latent in the meridians, bowing its head and daring not resist; stagnation over time transforms into heat. When spring commands arrive, opening the pores, Yang Qi leaks outward, Kidney Water is internally deficient, Liver Wood should sprout, but who encourages it? Who nourishes it? With the source of generation cut off, how can Wood rely on it to grow? What remains in the body is warmth, hence called Warm Disease. Therefore, I consider his discussion on winter contraction of warmth incorrect, while this discussion on winter latent cold is most precise. ○ Generally, the onset of Warm Disease is mostly due to sudden cold; the onset of Heat Disease is more severe when combined with Summerheat. Heat Disease exits via the Yangming channel, while Warm Disease exits via the Shaoyang channel. Although the involved meridians differ, they generally do not depart from Yangming and Shaoyang, depending on the seasonal Qi. ○ Yu Jiayan in *Shanglun* discusses Warm Disease... I believe Warm Disease has no Yin-Yang distinction. Why? Winter warmth first opens the pores, allowing Cold Evil to invade, as stated: "Where evil gathers, Qi must be deficient." Only those who do not store essence become deficient; deficiency allows Cold Evil to damage the meridians. The meridians must involve Shaoyin because the Shaoyin Zang is inherently deficient. However, the initial injury is slight, and in winter, Cold Water rules with strong authority, so slight evil dares not contend. But just as one cannot tolerate another snoring beside one's bed, the vital energy is obstructed, and essence is secretly consumed. By spring, strong Wood grows, but Water is insufficient to support it. Initially presenting as warmth in spring, with Wood excess and Water deficiency, the stagnant ascending energy causes Fire to blaze, resulting in Warm Disease. The injured factor is Cold; the manifested disease is Warmth; the latent site is Shaoyin; the eruptive site is Shaoyang. Thus, the disease is necessarily Yang without Yin, treatment must use Cold herbs and avoid Hot ones, with Huangqin Tang as the primary formula. Therefore, Jiayan's argument that Warm Disease has both Yin and Yang, similar to using Pungent-Hot herbs for the Three Yin meridians in Cold Damage, I say is incorrect. No, it is not so. ○ A disciple asked: "The injury is by Cold, why does the disease become Warm?" I answered: "Is Cold Damage not a disease of Cold? Why does it become hot? Cold stagnates in the Ying level, becoming intense heat in one or two days; how much more so after lying latent inside for dozens of days?" Since the evil injured the muscles, how did it enter Shaoyin? It is precisely because failing to store essence causes Shaoyin to be diseased first; thus, what is injured is Shaoyin. Spring belongs to Wood, so it emerges from within. Regardless of whether it combines with Taiyang or Yangming, it invariably passes through Shaoyang. Why? Because Shaoyang governs the spring command. Since it involves Shaoyin, why does Zhang Zhongjing specifically mention Taiyang disease? Because Taiyang and Shaoyin are exterior-interior pairs, so fever manifests as Taiyang disease. Since there is no aversion to cold, clearly there is no exterior syndrome, so the heat naturally comes from within, without external evil stagnation. However, Zhongjing also mentions Tai-Shao combined disease, observing fever without aversion to cold, or accompanied by deafness and hypochondriac fullness; he mentions San-Yang combined disease because a large pulse belongs to Yangming, and excessive sleep indicates heat gathering in the Gallbladder. He does not specify methods, generally taking Huangqin Tang as the main treatment. Yet Jiayan says that releasing the exterior three or five times fails to remove exterior symptoms; purging the interior three or five times fails to remove interior symptoms; thinking it is in the exterior, yet seeming in the interior; thinking it is in the interior, yet seeming in the exterior. This is similar to Epidemic Toxin contracting Heaven-Earth-Human Dampness, Heat, and Corpse Qi, entering mouth and nose, confusing the Triple Burner; it has nothing to do with Spring Warmth. I mention this to dispel the confusion of later learners. ○ A disciple again asked: "Does Spring Warmth occasionally have one or two exterior symptoms?" I said: "Yes. Diseases of latent Qi, although contracted in winter, how can we guarantee that Wind Evil does not injure the person when the latent Qi is about to erupt but has not yet done so? However, when combined with external contraction, headache and aversion to cold must precede persistent fever; this is new evil drawing out old evil. Or alternating chills and fever, headache with vomiting, followed by high fever after slight improvement; this is righteous Qi being deficient again, causing the latent eruption to be heavier. In summary, without exterior symptoms, Huangqin Tang is the main treatment; with external contraction, Chaihu must be added, or light resolution using channel-specific herbs; sweating methods are absolutely contraindicated. Thus Zhongjing said: 'After sweating, if the body burns with heat, it is named Fengwen.' This means mistakenly using Pungent-Hot herbs, which pungently disperse and plunder Yin, while increasing heat to assist Yang, making the heat fiercer and pulses floating. With such critical conditions, as well as mistaken purgation and moxibustion, strict warnings are given. Apart from Huangqin Tang, there is no other treatment method." (Zhou Yuzai)

Warm Disease, heat emerges from within, presenting with fever and thirst, without aversion to cold; Fengwen presents with internal and external heat superimposed, spontaneous sweating, heaviness of the body, and excessive sleep. There is a distinction in severity and life/death outcomes. Physicians must take the presence or absence of sweat as the key to differentiation, and the possibility or impossibility of sweating as the major principle of rescue. Since the Jin and Tang dynasties, numerous sages have emerged, discussing endlessly, seemingly failing to recognize what Warm Disease and Fengwen are. Wang Ji stated there are three types of Spring Warmth; Wu Shou stated Fengwen is a deteriorated state of Cold Damage; Yun Qizi stated that diseases persisting past the meridian stages despite sweating and purging are Warm Diseases. All these originated from Wang Shuhe's statement that contracting different Qi changes the disease, and one should treat based on the deteriorated state. A disease that fails to heal due to mistreatment is called a deteriorated state (Huai Bing). Can Warm Disease and Fengwen, erupting during the spring command, be considered deteriorated states? If one must wait until the disease persists past the meridian stages to identify it as Warm Disease, then those with Warm Disease would have no chance of survival. Moreover, the *Neijing* states that Warm Disease is Heat Disease. Speaking of body heat, it is called Heat; speaking of the season, it is called Warmth. Thus it says: "All diseases transforming from Cold Damage into Warmth occur before the Summer Solstice as Warm Disease; after the Summer Solstice as Summerheat Disease." Wang Shuhe did not say Fengwen is more severe than Warm Disease, but that Summerheat Disease heat is more severe than Warmth. He also said: "In the fifth and sixth months, if restrained by cold, Heat Disease becomes severe." I fear that heat erupting in summer may not necessarily be more severe than heat erupting in spring; and cold contracted in summer is certainly not more severe than heat erupted in spring. Zhu Fengyi said: "Before the Summer Solstice, fever with aversion to cold, headache, body pain, and floating-tight pulse constitute Warm Disease." This mistakes pre-Solstice Cold Damage for Warm Disease. Li Dongyuan said: "Winter injury by cold, winter acting as spring. Not cold but warm, fire exceeds water. The command of Cold Water reappears in spring, strong Wood grows, thus becoming Warm Disease." This mistakes winter injury by warmth, returning to cold in spring, as Warm Disease. Fengyi further stated: "Fengwen is treated in Shaoyin and Jueyin, sweating is contraindicated." This statement indeed supports the *Classic* and formulated the six formulas for Fengwen, which Tao Jian'an followed. However, only Gualou Gen Tang is appropriate. For the other formulas like Weirui and Zhimu decoctions, using Weirui, Zhimu, Shigao, and Baiwei is good, but why use Mahuang and Qianghuo (sweating herbs)? Why combine Baizhi and Shengma (Yangming herbs)? Why mix Muxiang and Nanting (pungent-dry herbs)? Is it to treat Fengwen together with Warm Disease, Epidemic Warmth, and Winter Warmth? If Fangji Tang uses Fangji and Baizhu, is it not mistaking Fengwen for Damp-Warmth? Wang Haicang said: "Weirui Tang contains Mahuang, it should not be used; Baizhu Tang should be used instead." Then can Baizhu Tang truly treat Fengwen? Liu Hejian used Cold herbs to treat Heat Disease, aligning with the *Neijing*'s meaning of drinking cold water, pricking, wearing cold clothes, dwelling in cold places, until the body feels cold. However, he made no distinction between Warm Disease and Fengwen. Furthermore, wanting to treat all variations of Cold Damage with thirty formulas, and all Heat treatments with purgation alone, is somewhat crude. Pang Anchang advocated harmonizing, focusing on the period around the Summer Solstice, primarily using harmonizing methods, which roughly captures the essence of treating Shaoyang and Jueyin. Perhaps he saw the difficulty in treating Fengwen and delayed to await changes; however, for cases of imminent danger, there is no rescue. So, is Fengwen untreatable? I say: It depends on early differentiation! Treatment must not be reversed; reversal leads to deterioration, and deterioration is incurable. The *Laci Re Lun* states: "Even if the disease has not erupted, if redness is seen, prick it; this is called treating before disease." It also states: "When heat is severe, use fifty-nine pricks." Zhongshi's Qinglong and Baihu formulas are divine! Applying this logic allows endless application. Generally, treating Warm Disease requires adding significant cooling to dispersing methods; treating Fengwen must not add significant dispersing to cooling methods." (Cheng Fusheng)

"Winter injury by cold, spring must contract Warmth" emphasizes winter failure to store essence. Generally, those who are fatigued and lustful have long depleted Yin essence. Entering spring, the interior Qi leaks greatly, Wood and Fire ignite internally, and the blazing force erupts directly from within. Initially presenting with high fever, vexation, dry mouth, and dry tongue, the primary treatment is to preserve fluids. Huangqin Tang solidifies Yin and expels evil, embodying this principle. Secondly, when internal Warmth evil desires to erupt and external new evil adds to it, Congchi Tang is the quickest method. Regarding delays due to negligence, or due to Qi dryness and fluid depletion, or causing Yin injury and fluid exhaustion, rescue methods include Renshen Baitu Tang, Huanglian Ejiao Tang, Yunnv Jian, and Fu Mai Fa; others include treating spasms and convulsions with Sweet herbs to soothe Liver, treating coma and closure with aromatic openings, treating Phlegm-Heat with Wendan Tang, and treating Blood Stasis with blood-invigorating methods. ○ Wind is the Yang Qi of Heaven, Warmth is the pathogen transforming into Heat. Two Yangs scorching, first injuring the Upper Jiao. Various changing conditions all center on the Hand Three Yin meridians as the source of disease. Head distension, sweating, body heat, and coughing must appear together. One should first use mild Pungent-Cold agents to clear and resolve. Strongly avoid Pungent-Warm dispersants that plunder fluids. If Taiyin lacks the power of descending and transforming, rescue measures include Sugarcane juice, Reed rhizome, Yuzhu, and Maidong; if Bitter-Cold sinking damages the stomach appetite, and Yangming loses its sequential governance, rescue measures include Fu Mai and Jianzhong formulas. This condition suddenly changes into spasms/convulsions, or slowly changes into deficiency consumption; the governing formulas always prioritize Sweet herbs, combining Cold and Warm according to the physician's adaptability. (*Lin Zheng Zhi Nan*)

Warmth evil enters from above, first attacking the Lung, and reversely transmitting to the Pericardium. Lung governs Qi and belongs to Wei (Defensive); Heart governs Blood and belongs to Ying (Nutritive). Differentiating Ying, Wei, Qi, and Blood is similar to Cold Damage, but regarding treatment methods, it differs. The evil of Cold Damage lingers at the exterior, then transforms into heat and enters the interior; Warmth evil transforms into heat most rapidly. Before transmitting to the Pericardium, the evil remains in the Lung. Lung governs Qi and connects to skin and hair. Initially use mild Pungent-Cold agents; if complicated by Wind, add Bohe and Niubang; if complicated by Dampness, add Lugen and Huashi. Either vent Wind outside the Heat, or drain Dampness below the Heat, so it does not clash with Heat, inevitably isolating it. Otherwise, Wind carrying Warmth creates Dryness, clear orifices will dry up, the Qi of Water cannot ascend to nourish, and two Yangs mutually plunder. Dampness combining with Warmth steams and obstructs upwards, blocking the clear orifices, turbid evil harming clarity. The disease resembles Cold Damage, but Cold Damage has many variable syndromes, whereas Warmth, even if prolonged, remains in one meridian without shifting. ○ Previously mentioned Pungent-Cold dispersing Wind, Sweet-Bland driving Dampness. If the disease does not resolve, it is gradually entering the Ying level. Ying level receiving heat plunders Blood, disturbing the Spirit, causing night waking and insomnia, or faint rashes. Immediately withdraw Qi-level herbs. If entering from Wind-Heat, use Xijiao and Zhuye; if entering from Damp-Heat, use Xijiao and Flower Dew in Blood-Cooling and Heat-Clearing formulas. If adding restlessness and constipation, Jinzi can be added; for elderly or constitutionally cold persons, Renzhonghuang substitutes it. Urgently resolve the rash is essential. If rash erupts but heat does not resolve, Stomach fluids are exhausted. Primary treatment is Sweet-Cold; severe cases like Yunnv Jian, mild cases like Pear skin and Sugarcane juice. If the person's Kidney Water is chronically deficient, although not yet reaching the Lower Jiao, anxiety arises first. Verify with the tongue. Add Salty-Cold to Sweet-Cold. Ensure securing areas not yet invaded by evil, fearing invasion. If the evil lingers in the Qi level throughout, one may hope for Battle Sweat to vent the evil. Method should benefit the Stomach, allowing evil to exit with sweat, heat reaches pores, evil exits with sweat. After resolution, Stomach Qi is empty, skin may feel cold for a day and night. Wait for Stomach Qi to return, naturally warming as usual. Because battle sweat resolves, evil retreats and Righteous Qi is deficient, Yang leaks with sweat, hence gradual skin cold. At this time, let the patient rest peacefully, awaiting Yang Qi recovery. Do not startle or call out, disturbing the Primordial Spirit. Only examine the pulse. If weak, soft, and slow, although tired and silent, sweating and cold skin, it is not Collapse Syndrome; if pulse is rapid and urgent, restless and unable to lie down, it is Collapse Syndrome. More importantly, when Evil is excessive and Righteous Qi deficient, unable to resolve in one battle, stopping one or two days, then battling sweat erupts and heals; this must be known. ○ Again discussing Qi diseases not transmitting to Blood level, but evil lingering in Triple Burner, similar to Shaoyang disease in Cold Damage. That resolves half-exterior/half-interior; this divides and eliminates upper/lower tendencies, changing methods according to syndrome, such as Xing, Po, Ling, or Wendan Tang draining. Because it remains in Qi level, one can still hope for the portal of battle sweat or the mechanism of malaria conversion. ○ Generally, view it as: after Wei, speak of Qi; after Ying, speak of Blood. In Wei, sweating is acceptable; arriving at Qi, only then clear Heat; newly entering Ying, still can vent heat back to Qi level for resolution, such as Xijiao, Xuanshen, Lingyang; already entered Blood, fear consuming and moving Blood, urgently need Cooling Blood and Nourishing Blood, such as Shengdi, Mudanpi, Ejiao, Chishao. If not following the method of urgency, fear making mistakes upon action. Moreover, our Wu region Dampness harms people most widely. For those with white complexion, must protect Yang Qi; Dampness excess leads to Yang weakness. Method should be Cooling, but stop at 60-70%, do not exceed, fearing once Damp-Heat is gone, Yang also becomes weak. For those with dark complexion, must protect Fluids. Cooling to 60-70%, often heat decreases and body feels cold; do not immediately claim Deficiency-Cold and suddenly administer tonics, fearing although stove smoke is extinguished, embers still have fire. Must observe carefully and meticulously, give little by little, beware of reckless advancement. ○ Also, wine drinkers have inherent internal Dampness. External evil enters interior, clashing with it. In Yang-prosperous bodies, Stomach Dampness is abundant; in Yin-excess bodies, Spleen Dampness is considerable. However, their transformation into Heat is the same. Treating Heat Disease to save Yin is relatively easy; communicating Yang is most difficult. Saving Yin is not about tonifying Blood, but nourishing Fluids and managing Sweat; communicating Yang is not about warming, but about promoting urination. ○ Again discussing Triple Burner evil not resolving from exterior must form interior knotting. Where is the interior knotting? Yangming Stomach and Large Intestine. Purging method is necessary. But Cold Damage Heat evil in interior plunders fluids, purging should be fierce; this case mostly has internal Dampness clashing, purging should be mild. Cold Damage loose stool means evil is exhausted, do not purge again; Damp-Warmth loose stool means evil is not exhausted, must have hard stool, do not attack again, as dry feces indicate no Dampness. Again, the human body, epigastrium is above abdomen, located in middle, pressing causes pain, or spontaneous pain, or fullness, should use Bitter Draining, as it is near the abdomen. ○ Women suffering Warmth are same as men, but often involve pre/post-natal periods and menstrual flow starting/stopping. For pre-natal disease, ancients used Siwu Decoction modifications, fearing evil harms pregnancy. If heat is extreme, use well-bottom mud, blue cloth soaked in cold water covering abdomen, all are protecting fetus intentions, but look at where evil can be resolved. Using Blood-greasy herbs ineffective, must examine, do not be stubborn. However, must step-by-step protect fetal origin, fearing Righteous damage and evil sinking. As for post-partum, medical books say cautiously use Bitter-Cold, fearing injuring Yin. But also distinguish if evil can resolve from Upper/Middle, slightly follow syndrome using them, no harm, just do not offend Lower Jiao. And belonging to deficient body, treat like deficient person with evil, moreover post-partum is when Blood-Qi boils, having many empty spaces, evil easily sinks inward by deficiency, difficult to treat. ○ Again if menstrual flow starts/stops, evil sinks into Shaoyang Blood Chamber. Zhongjing established Xiaochaihu Tang to extract sunk Heat evil, Ginseng and Jujube support Stomach Qi, because Chong Meridian belongs to Yangming. This is suitable only for deficiency. If Heat evil sinks, clashing with Blood, follow Tao's Xiaochaihu removing Ginseng/Jujube, adding Shengdi, Taoren, Hawthorn flesh, Mudanpi or Xijiao etc. If original channel Blood stasis, lower abdomen full/painful, use this formula removing Sweet herbs adding Yanhu, Guowei, Taoren etc., Qi stagnation add Xiangfu, Chenpi, Zhike etc. However, Heat sinking Blood Chamber syndrome often has delirium like madness, similar to Yangming Stomach Heat, this pathology must be distinguished. (*Zhinan Xuke*)

How is Warm Disease? The *Classic* says: "Not aversion to cold but thirsty is it." Not aversion to cold, knowing no Cold Evil at exterior; saying thirsty, knowing Kidney Water is dried up. Generally because the person has internal Fire, touching Cold Evil in winter. Because there is Fire inside, Cold Evil cannot penetrate deep, lying latent in skin and muscles. From winter to spring, time passes long, Fire is constrained by Cold, Kidney Water is boiled dry. Jia Wood is Yang Wood, relying on Gui Water to generate. Since Kidney Water is dried up, when strong Wood is prosperous, there is no root for generation and nourishment, thus fever and thirst. Haicang said new evil calls out old evil, which is incorrect. If further affected, exterior should have aversion to cold. I use Dihuang Tang to nourish Kidney Water, Chaihu to soothe Wood stagnation, responding instantly. (*Zhao Shi Yi Guan*)

*Neijing* discusses Cold Damage but contrary fever has three meanings: There is immediate onset, saying "Man injured by Cold, then becomes Heat Disease"; There is delayed onset, saying "Winter injury by Cold, Spring must contract Warmth"; There is changing name with time, saying "All diseases becoming Warmth from Cold Damage, before Summer Solstice is Warm Disease, after Summer Solstice is Summerheat Disease." For Warmth/Summerheat, immediate onset need not discuss. All diseases becoming Warmth from Cold Damage, although due to winter Cold Damage, the root is actually planted in the person's stagnant Fire. *Neijing* says: "Storing Essence, Spring does not contract Warmth." This clarifies the source of Winter injury by Cold, Spring Warmth. Before Summer Solstice Warm Disease, after Summer Solstice Summerheat Disease. This clarifies Winter failure to store Essence, Summer also contracts Warmth. Man injured by Cold, becomes Heat Disease, is constant. This to Spring/Summer disease, by