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Utilizing the aroma of fragrant substances is to vigorously eliminate turbid filth. Zhang Zhongjing authored *Shanghan Lun* (Treatise on Cold Damage) to clarify the regular patterns of winter cold, spring warmth, and summer-autumn summerheat; naturally, he could not merge them into epidemic diseases to avoid confusing standard treatment methods. However, the profound principles were fully contained within the pulse diagnosis section. Wang Shuhe failed to carefully analyze this, and ultimately, what was referred to as "epidemic" still belonged to the regular diseases of cold damage, warm damage, and summerheat damage. The irregular qi of the four seasons, when contracted, causes disease, but initially it is not called an epidemic. Only when death occurs due to the illness, and the qi of the illness mixes with the qi of the corpse to form irregular qi, does it become an epidemic. Therefore, during times of famine and war, epidemics prevail, mostly peaking in the transition between spring and summer. This is because warm, summerheat, dampness, and heat qi interlock and mutually steam; people within this environment have no gap to avoid it. Those afflicted sweat profusely like "po han" (soul sweat). The qi of one sick person is sufficient to fill a room, let alone spreading door-to-door across a region. Various foul odors, when received by humans, affect the upper and lower parts similarly, and diseases follow their kind, which is an inevitable trend. For example, what is commonly called "Big Head Plague" refers to swelling of the head, face, cheeks, and jaw like a gourd; "Toad Plague" refers to throat obstruction with loss of voice and swollen neck tendons; "Melon Rind Plague" refers to high chest and raised ribs, vomiting fluid resembling blood; "Lump Plague" refers to widespread redness and swelling of the body with lumps like tumors; "Intestine Twisting Plague" refers to abdominal borborygmus, dry retching, and watery diarrhea without relief; "Soft Leg Plague" refers to clear white loose stools and heavy legs difficult to move; pediatric smallpox is also particularly common. Regarding these above-mentioned epidemic syndromes, if the treatment methods are not understood, all are attributed to fate, which is truly lamentable! Generally speaking, warm diseases, epidemics, smallpox, and rashes were not transmitted in ancient times; I am fortunate to have glimpsed a fragment of Zhang Zhongjing's teachings. His *Pulse Method Chapter* states: "When both yin and yang pulses at the cunkou position are tight, pain extends to the navel with throbbing, and life will be hard to preserve." These two hundred and sixty-nine characters elucidate profound principles, completely unlike matters found in Shanghan, but rather discussing the gateway for epidemic pathogens to enter and the general overview of transformed diseases. The main idea of the chapter is that human nasal qi connects with heaven; thus, fog and dew pathogens in the yang aspect are called "clear pathogens," entering from the nose upwards into the yang. Upon entry, they cause fever, headache, stiff neck, and cervical spasms, which exactly matches the popular descriptions of Big Head Plague and Toad Plague. Human oral qi connects with earth; thus, water and soil pathogens in the yin aspect, being turbid flavors from diet, enter from the mouth and tongue downwards into the yin. Upon entry, the person first experiences internal shivering, cold feet and knees, involuntary urination and defecation, heaviness in defecation, and severe navel pain, which exactly matches the popular descriptions of Intestine Twisting Plague and Soft Leg Plague. However, pathogens entering from the nose and mouth must first pour into the middle jiao, then distribute up and down. Thus, when the middle jiao receives pathogens and remains untreated, the stomach becomes turbid, Ying and Wei (nutritive and defensive qi) do not circulate, and blood coagulates and stagnates. The resulting transformations correspond to the popularly known Melon Rind Plague and Lump Plague, which are similar to Yang Du (Yang Toxicity) causing carbuncles and pus, or Yin Du (Yin Toxicity) causing bluish-purple discoloration over the whole body. These are pathogens located in the three jiaos. If the pathogens of the three jiaos mix into one, with internal and external blockage, and organ qi steaming and steaming, causing oppression in the upper jiao, then oral ulcers and gum erosion occur. If Wei Qi (defensive qi) flows forward first, driven by heat, wandering through meridians and organs, it results in carbuncles and pus; if Ying Qi (nutritive qi) flows forward first, attracting external pathogens, causing sneezing, hoarseness, and throat blockage, with heat stagnating and unable to flow, it results in bloody stool resembling pig liver. However, because Ying and Wei gradually connect, it is not a critical condition. If the yang of the upper jiao and the yin of the lower jiao do not connect, then Spleen qi cannot operate independently in the middle, leading to the pouring down of five fluids, closure failure of the lower jiao, and difficulty preserving life. Shanghan pathogens travel first along the back of the body, then the front, then the sides, entering from the exterior framework; Epidemic pathogens travel directly along the central pathway, distributing through the three jiaos. The upper jiao is clear yang, so clear pathogens enter from above; the lower jiao is turbid yin, so turbid pathogens enter from below; the middle jiao is the boundary of yin and yang, so all clear and turbid pathogens must distinguish themselves here. In severe cases, the three jiaos mix; extreme ascent leads to descent, and extreme descent leads to ascent. Thus, those with hoarse voice, throat blockage, oral ulcers, and gum erosion may again present with bloody stool resembling pig liver; it is not fixed to only affecting the upper/middle or middle/lower. Shanghan pathogens are in the exterior framework, so releasing the exterior disperses them; Epidemic pathogens act in the central pathway, so releasing the exterior does not disperse them. When Shanghan pathogens enter the Stomach fu, causing abdominal fullness and hard stool, purgation is contraindicated; Epidemic pathogens are in the three jiaos, scattered and unrestrained, so purgation causes re-aggregation. What connection does this have with the various methods for treating Shanghan exterior and interior? Treatment method: Before illness, pre-drinking aromatic substances prevents pathogen entry, which is the best approach; once pathogens have entered, expelling filth is the primary principle. The upper jiao is like mist, so elevate and expel it, combined with detoxification; the middle jiao is like fermentation vat, so dredge and expel it, combined with detoxification; the lower jiao is like a drain, so drain and expel it, combined with detoxification. Once Ying and Wei are connected, pursue and extract the pathogen using momentum, do not allow it to secretly proliferate. Someone asked: Spring, summer, and autumn vapors form epidemics; is Winter Warmth not an epidemic? I say: Excessive warmth in winter causes Kidney qi to fail to store, contracting disease upon exposure, which is identical to Spring Warmth caused by failing to store essence. At this time, there is spring but no winter, and the three qi can intermingle and steam to form epidemics; however, if north wind suddenly arises, the vapor disappears. Therefore, in the southeast, few suffer from regular Shanghan in winter, but many suffer from Winter Warmth and smallpox; in the northwest, regular Shanghan occurs in autumn, winter, and spring, with no epidemics or smallpox. Why? Northwest land is high and dry; even in spring and summer, qi struggles to rise, let alone in freezing winter; Southeast land is low and wet, an area of fog and dew, caves of snakes and dragons. Its warm and hot qi, dispersed by wind, is bearable; if there is no wind morning or evening, fish in water and lice in clothes would fly about, let alone humans. Vapors originally contain various filths, added to illness qi and corpse qi, affecting young and old alike upon contact. At this time, north wind is unattainable, so the qi accumulates and becomes violent. Although there is gentle breeze, it only sends heat, it cannot resolve coolness. Wang Shuhe believed that summer should be very hot but instead is very cold constitutes epidemic; how could he know that great cold is precisely the sign of epidemic qi dissipating? (Yu Jiayan)

*Shuowen Jiezi* says: Epidemic means the people all get sick, caused by malevolent ghosts bringing disaster. *Liji* (Book of Rites) says: In the first month of spring, the former kings covered bones and buried skeletons, precisely because in this month heaven qi descends and earth qi ascends, fearing that the foul qi of exposed bones might harm people, so they were buried. It is said that humans exist within the intersection of qi, like fish in water, unable to tolerate even a trace of impurity. If ash is thrown into rivers and lakes, or oil into ponds, few fish survive. How is receiving epidemic qi different? (Lin Beihai)

First, distinguish Qi: Wind-cold qi enters from outside to inside; early in the disease, there is no foul odor touching people, waiting several days until transmitting to yang fu syndromes, it only produces rotting smell, not corpse smell. Epidemic qi steams out from the center to the exterior; early in the disease, there is already a foul odor touching people, light cases fill the bed curtains, heavy cases steam the whole room, and it specifically produces corpse smell, not rotting smell, because human body organs, blood, qi, and body fluids produce fragrance when receiving living qi, and stench when receiving decaying qi. Epidemic is decaying qi; humans receive it, and it naturally steams out from organs to skin surface. Blood, qi, and body fluids encounter steaming and decay, and upon decay, overflow. Overflow has degrees of abundance or scarcity, and filling has degrees of proximity or distance. The Five Elements originally each have specific odors: Wood smells musky, Metal smells fishy, Heart smells scorched, Spleen smells fragrant, Kidney smells putrid. When the smell is correct, it can be named by pointing. If Epidemic, it is the miscellaneous qi of heaven and earth, not musky, fishy, scorched, fragrant, or putrid; its touch on humans is indescribable, only those with discernment can identify it. Once clearly identified, treatment will not be confused. Knowing it is Epidemic, not Shanghan, then for exterior syndromes like headache and fever, one must not mistakenly use acrid-warm dispersants; for interior syndromes like yellow tongue, irritability, and thirst, where clearing or purging is indicated, one must not hesitate.

Second, distinguish Color: Wind-cold governs contraction; contraction leads to tension, so colors are often tense and smooth/shiny. Epidemic governs steaming and scattering; scattering leads to looseness, so colors are often loose, slow, dirty, and dull. Humans receiving vapor have body fluids overflowing to the face, between head and eyes, so often dirty and stagnant, like grease or like smoke staining. What looks repugnant to the eye are all colors of Epidemic.

Third, distinguish Tongue: Wind-cold on the exterior usually has no coating; if there is a white coating, it is thin and slippery. Gradually transmitting to the interior, it changes from white to yellow, from yellow to dry, from dry to black. Epidemic, upon seeing headache and fever, immediately has a white coating on the tongue, thick and not slippery, or color mixed with pale yellow, or coarse like accumulated powder; if transmitting channels and entering the Stomach, it mixes with two or three colors. There are also white coatings that are dry and black coatings that are not dry. Generally, when epidemic pathogens enter the Stomach, tongue coating resembles Wind-cold, due to accompanying dampness, not becoming dry. Only when on the exterior, the white coating is thick, differing from Shanghan. Being able to distinguish this, not using acrid-warm dispersants when on the exterior, and using cooling purgatives when entering the interior, this is correct.

Fourth, distinguish Spirit: Wind-cold pathogens injuring people make the heart know the suffering, but spirit remains clear; such as headache and chills/fever, one knows it oneself; only when transmitting to interior and entering Stomach does spirit become confused with delirious speech. Because Wind-cold is the righteous qi of heaven and earth, human qi conflicts with it before disease forms, so its qi does not confuse human spirit. Epidemic onset makes people's spirit and demeanor abnormal, mostly irritable, or like mad/drunk, disturbed and startled; asking what hurts, they do not know. Occasionally, some have clear spirit and self-control, but mostly sleep restlessly, seeing things when closing eyes; this is the root of delirium. Because Epidemic is the evil qi of heaven and earth, injuring humans and objects alike, its qi specifically confuses human spirit.

Fifth, distinguish Pulse: Epidemic pulse, after transformation, is quite similar to Wind-cold, but at onset, it is vastly different. Wind-cold enters from skin and hair; in one or two days, pulse is mostly floating, or accompanied by tight, slow, or large, but all floating. Until transmitting to interior, it ceases to be floating, and its rate is clear and distinct. Epidemic transforms from the central pathway, emerging from interior to exterior; in one or two days, pulse is mostly deep. Until emerging from interior to exterior, pulse ceases to be deep, or accompanied by wiry or large, but all non-floating, and its rate is vague and indistinct. At onset, pulse is deep and slow; do not diagnose as Yin-Cold. Deep means pathogen is in interior; slow means pathogen is in yin aspect. Pulse appearance is same as Yin-Cold, but qi/color, tongue coating, and spirit differ. Or rapid but weak; do not diagnose as deficiency. Because heat vapor scatters, pulse cannot beat strongly against fingers; one should only clear heat, not tonify qi. Different causes of disease lead to same pulse but different diagnoses.

Seasonal Epidemic combined with Cold intensifies disease severity; combined with Wind, it facilitates disease resolution. Because Cold governs coagulation and stagnation, epidemic pathogens remain internally depressed; depression increases disease severity. Wind governs roaming and spreading, so epidemic pathogens are externally dispersed; dispersion reduces disease severity.

Seasonal Epidemic differs in resembling Malaria, transforming into Malaria, or combining with Malaria, and medications differ. Resembling Malaria: alternating chills and fever, occurring two or three times a day, or once a day without fixed time. Common in early Seasonal Epidemic. Transforming into Malaria: After sweating and purging for Seasonal Epidemic, residual pathogens remain unresolved, chills and fever recur, transforming into Malaria pattern. Common in late Stage Seasonal Epidemic. Combining with Malaria: Simultaneous occurrence of Cold-Heat seasonal epidemic and Malaria, symptoms include periodic chills and fever, full Malaria syndrome, but more heat than cold, dry thirst, and confusion. Common in Autumn. The reason is that epidemic pathogens occupy Mo Yuan (Membrane Source), wanting to exit exterior but unable to penetrate, wanting to sink interior but lacking space, thus presenting half-exterior half-interior syndromes. Treatment should prioritize Da Yuan Yin (Reach the Origin Decoction) plus Chai Hu (Bupleuri Radix).

Seasonal Epidemic and Malaria are not far apart. Epidemic is combination of Dampness and Warmth qi; Malaria is combination of Wind, Cold, Summerheat, and Dampness qi; their pathogens are mixed and impure, similar. Malaria pathogens horizontally connect Mo Yuan; Seasonal Epidemic also occupies Mo Yuan; the location of receiving pathogens is similar. But Seasonal Epidemic's Warmth qi erupts, becoming excessive Yang, so indications for purging and clearing are many; Malaria's Summerheat qi lies dormant, becoming stagnant, so indications for diffusing and draining are many. Thus, early Seasonal Epidemic uses Da Yuan Yin, while early Malaria uses Qing Pi Yin (Clear Spleen Decoction); ingredients are largely similar. However, their transmission differs greatly in speed and severity.

Seasonal Epidemic must resolve through sweating and purging. Spleen deficiency prevents exterior sweating and interior tolerance of purging. Or sweating occurs, but qi escapes with sweat; purging occurs, but qi escapes downward. Treating this: Do not force sweating; releasing exterior must support Yuan Qi and nourish righteousness, e.g., Renshen Baidu San (Ginseng Detoxifying Powder); do not lightly purge; attacking interior must consolidate qi and generate fluids, e.g., Huanglong Tang (Yellow Dragon Decoction). Exterior symptoms have little difference, except pulse is tender to pressure. However, pathogens advance and retreat; when disease advances and pathogens expand, pulse may feel strong upon pressing, do not adhere rigidly; must combine qi/color, spirit, and pulse-symptoms. Yellowish complexion, tired spirit, short breath, palpitations, and tinnitus are signs of Spleen deficiency and weak Middle Qi.

Seasonal Epidemic complicated by Spleen deficiency is difficult to treat; complicated by Kidney deficiency is even harder. Seasonal Epidemic belongs to Heat syndromes; Kidney deficiency causes cold hands and feet. Seasonal Epidemic belongs to Excess pathogens; Kidney deficiency causes dizziness, palpitations, and weak waist/knees. Within Kidney deficiency, one must examine Yang vs. Yin deficiency: Epidemic pathogens require sweating and purging to resolve; Yang deficiency, once sweated/purged, shows collapse symptoms; Yin deficiency, once sweated/purged, shows exhaustion symptoms; must observe carefully at all times. When on exterior, if abnormal lower back pain, frequent urination, weak calves/thighs appear, add Renshen (Ginseng Radix et Rhizoma) to exterior formulas; Yang deficiency add Duzhong (Eucommiae Cortex), Yin deficiency add Shudi (Rehmanniae Radix Praeparata) to care for Kidney qi. If entering interior, purging must primarily use Huanglong Tang; clearing must primarily use Renshen Baihu Tang (Ginseng White Tiger Decoction). If repeated clearing/purging increases heat, tongue dry without coating or black coating grows longer with clearing, or dry coating becomes drier with purging, and observing no Excess pathogens in Yangming, treat with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Zhimu (Anemarrhenae Rhizoma) and Haba (Phellodendri Cortex). This is what is meant by "cold does not cure cold, blame lack of water; strengthen the master of water to control sunlight." If still ineffective, combine with Shengmai San (Generate Pulse Powder) to nourish water source; or combine with Siwu Tang (Four-Substance Decoction) to benefit blood sea. With such raging heat, a cup of water cannot save; must prepare large decoctions, medicinal ingredients in taels, liquid in dou, to be effective. (Dai Linjiao)

Shanghan pathogens transmit from exterior to interior; Warm-Heat pathogens transmit from interior to exterior; Yi Li (Plague) pathogens emerge from Yangming central pathway according to exterior-interior excess-deficiency, not following meridian transmission sequence, thus cannot be exhausted in one outbreak. (*Zhangshi Yitong*)

Epidemic pathogens enter from mouth and nose, thus often carrying Yangming syndromes, because Hand Yangming belongs to Large Intestine, exterior-interior related to Lung, opening at nose; Foot Yangming belongs to Stomach, opening at mouth. Cases incurable are due to Lower Yuan deficiency. (Miu Zhongchun)

Shanghan enters from exterior to interior, so Shaoyang syndrome indicates worsening disease; Seasonal Epidemic emerges from center to exterior, so Shaoyang syndrome indicates improving disease. Both verified by deafness. ○ Disease ending at Shaoyang resolves with deafness healing; Disease ending at Yangming resolves with macules appearing; Disease ending at Taiyang resolves with spontaneous sweating, wild sweating, or battle sweating. (*Yican*)

Epidemic is essentially Shanghan, merely external pathogen disease, but contracting seasonal qi with similar age/duration is called Epidemic. Ancient saying: Epidemic develops from spring warmth qi,郁热 (stagnant heat) reaches exterior from interior, initially not cold damaging exterior; treatment differs from regular Shanghan. This theory seems reasonable but is actually incorrect. If Epidemic were not an exterior syndrome, why must it resolve through sweating? Thus I say: Initially receiving Cold pathogen, then triggering upon re-exposure, this is logical. Seasons have cold/heat, syndromes have yin/yang; attributing to syndrome/season is acceptable, denying cold damages exterior is unacceptable. ○ Ancient saying: Plague diseases are mostly in Three Yang, rarely in Three Yin. However, do not be rigid; if Yin syndrome/Yin pulse appears, it is Three Yin disease. Must differentiate and treat. ○ For treating Shanghan/Epidemic exterior syndromes, early infection requires rapid sweating, meaning sweating should not be delayed. However, method of sweating must observe deficiency/excess of Yuan Qi and Pathogen Qi: If exterior syndrome established but Yuan Qi not too depleted, acrid-neutral agents can disperse; if mixed syndromes, observe cold/heat/warm/cool, treat appropriately; if body very hot but pulse weak, sweating unlikely, must detail tonification methods and treat accordingly. If ignoring root/branch and forcibly dispersing, Ying depletion leads to death. ○ For treating Shanghan/Epidemic, emesis is suitable if Upper Jiao has stagnation, food/phlegm knotting chest-diaphragm preventing pathogen dispersion, or Cold pathogen/turbid qi sinking diaphragm causing痞 (fullness) or pain; emesis is indicated. Emesis contains dispersing intent. If Middle Qi deficient/cold, pulse weak/powerless, or short breath/virtual irritability/restlessness, emesis is contraindicated. Use emetic herbs, stop when hitting target, do not finish dose. ○ For treating Shanghan/Epidemic, clearing/draining is suitable: Fire excess needs clearing, Qi excess needs moving, Food stagnation needs digesting, Phlegm abundance needs resolving, all called clearing/draining. When stagnation goes, Qi moves, exterior pathogen resolves. This suits Excess pathogens, not Deficiency syndromes. For Deficiency with Excess, slight combination is acceptable, weighing pros/cons appropriately. ○ For treating Shanghan/Epidemic, purging is suitable only for Yangming Excess pathogens with constipation/abdominal fullness, or constitutionally strong Qi/Stomach Qi. If stool not passing for days but no fullness, or not eating for days but abdomen soft, Yangming Stomach fu lacks Excess pathogens, do not blindly purge to drain Middle Qi. Among errors, purging is most harmful, do not ignore. ○ For treating Shanghan/Epidemic, warming is suitable because Cold pathogen stagnates, Yang cannot overcome Yin, warming is needed to move and restore. Cold in meridians (exterior) needs warm dispersal; Cold in zang organs (Yang deficiency) needs warm tonification or warm middle. Using warming method, observe if exterior heat but interior no heat = false heat, warm not cool; disease hot but Yuan Qi deficient = false heat, warm not cool. True heat is obvious, false heat is hard to distinguish. Mostly Excess is true heat, Deficiency is false heat. Mistaking true/false harms people deeply. ○ Tonification method for Shanghan/Epidemic differs from attacking/dispersing. Attacking/dispersing removes Excess pathogens, force is strong, effect fast,见效 in 1-2 doses; if not effective, usage is poor. Tonification supplements deficiency, force is gentle, effect slow, observe tolerance or slight agreement for efficacy, mild cases 2-3 doses, severe 10+ doses to see result. Ignoring this, expecting quick effect in 1-2 doses, quacks arise, confusion ensues, total effort wasted. (Zhang Jingyue)

Ancients spoke of "Wen" (Warmth) not "Wen" (Plague), specifically the "Wen" spoken of is same as "Wen", thus "Wen" and "Wen" are one disease is clear. Later generations added [notes],