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The *Zhu Shi Quan Sheng Ji* states: From after Frost's Descent (Shuangjiang) to before Spring Equinox (Chunfen), the weather is severely cold, water freezes and the ground hardens. If one encounters this killing energy and falls ill immediately, it is called Zheng Shanghan (True Cold Damage). Although it is winter, if the weather is warm and illness occurs due to pathogenic invasion, it is called Dongwen (Winter Warmth). After the Spring Equinox, if the weather is warm and illness occurs due to pathogenic invasion, it is called Wenbing (Warm Disease). Even if Spring Equinox has arrived, if the weather remains cold and someone falls ill due to cold invasion, it is also Shanghan. After Summer Solstice (Xiazhi), when the heavenly heat is intense, if one contracts a pathogen and falls ill with a flooding pulse (Hongmai), it is called Rebing (Heat Disease). Between the fourth, fifth, sixth, seventh, and eighth months, if there is sudden severe cold and one falls ill upon contraction, it is a Shixing Hanyi (Seasonal Cold Epidemic). If the seasonal climate is abnormal throughout the four seasons, causing illness where young and old present similar symptoms and transmission occurs, this is named Shiqi (Seasonal Qi), which is equivalent to Shiyi (Seasonal Epidemic). This is not comparable to Shanghan. It is also said that if cold pathogens are contracted in winter but do not cause immediate illness, they lie dormant in the body and transform into Wenbing in spring and Rebing in summer. Both Wenbing and Rebing are transformations of latent cold from winter. Once transformed, they can no longer be referred to as cold. Additionally, there are Fengwen (Wind Warmth) and Shiwen (Damp Warmth), both presenting with fever and symptoms resembling Shanghan; thus, physicians generally refer to them all as Shanghan. The reason for this general term is that the progression of fever and transmission are similar. However, the medication used differs completely. These several types were not discussed by Zhang Zhongjing and fall outside the categories of Jing (Spasm), Shi (Dampness), and Ye (Heat Stroke); they must be distinguished carefully.

Wang Kentang treated a pregnant woman who contracted Wenbing during the transition between spring and summer. She suffered from headache, fever, aversion to cold was absent, and thirst. Before treatment could be administered, she miscarried, losing an immeasurable amount of blood. She became dizzy and nearly fainted. Wang prescribed Mai Men Dong (Ophiopogon Root) in large quantities, decocted with Dan Zhu Ye (Lophatherum Leaf) and Xiang Chi (Fermented Soybean), to be drunk frequently. Sweating ensued, and she recovered. This utilized the method for treating post-illness relapse due to overexertion.

Zhang Luyu treated Mr. Xu Yu, whose constitution was inherently Yin-deficient with abundant fire, and who had a history of Pi Yue (Spley Restriction) with bloody stools. In October, he contracted Dongwen, presenting with fever and sore throat. Internal medicine physicians administered herbs such as Ma Huang (Ephedra), Xing Ren (Apricot Seed), Ban Xia (Pinellia), Zhi Ke (Aurantium Fructus), and Ju Pi (Tangerine Peel). Consequently, he developed wheezing and counterflow qi, unable to lie down even leaning on support. His voice became hoarse and weak, his head and face red and hot, and his hands and feet cold. The Cun and Guan positions of the right wrist showed a deficient, large, slightly rapid pulse. This indicated Heat damaging the Qi aspect of the Hand Taiyin Lung Meridian. Treatment with Yu Zhu (Polygonatum Rhizome) and Gan Cao (Licorice) failed. Zhang then prepared Zhu Fu Tang (Pig Skin Decoction), one bowl, heated via water bath, and administered small amounts frequently. After three days, his voice cleared, and pain ceased upon completion of the dose.

He also treated the wife of Zheng Molin, who had a history of rectal bleeding. At seven months pregnant, during the time when Lung Qi nourishes the fetus, she contracted Dongwen. She suffered from cough, sore throat like needle pricks, and profuse lower bleeding resembling a flood. Her pulse was smaller, weaker, and more rapid than usual. This indicated Heat damaging the Blood aspect of the Hand Taiyin Lung Meridian. Two doses of Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) stopped the bleeding. Then, Huang Lian was removed, and Yu Zhu, Jie Geng (Platycodon Root), and Ren Zhong Huang (Human Feces Honeycomb) were added. Four doses brought stability.

He also treated Huang Yikuan, who had suffered from Fengwen for over ten days. He presented with high fever, coma, difficulty speaking, spontaneous diarrhea with black loose stools, black dry tongue coating, cracked lips, and coal-like discoloration of the nose. Previously, several doses of dispersing and digesting herbs had been mistakenly used, worsening irritability and thirst. Zhang Shiwen stated: "This originates from latent Qi stagnating and erupting, compounded by Wind, resulting in Fengwen. The pulse of Fengwen is naturally floating because Heat has lain dormant in Shaoyin, transforming via Fire, and emerging in Taiyang, constituting Lianggan (Double Exposure). Changes occur most rapidly. Fortunately, he is young and strong, having passed the critical third and sixth day periods. Although critical, the ascending nature of Wind herbs stimulated the Yuan Qi throughout the body, converting it to Fire and consuming True Yin. Thus, the Shaoyin pulse cannot remain internalized, appearing floating. Examining Master Zhang Zhongjing, there is no specific treatment method listed, but within the Shaoyin examples, there is a case of saving Heat and preserving Yin using Chengqi (Gut Purging) methods. We can borrow this to swiftly sweep away long-dormant pathogens. Observing that his nasal breathing is not stertorous indicates the source of Kidney Water is not exhausted; we need not fear vertical staring or incontinence." Physician Hu Chenfu from Xi County was present, and together they decided to use Liang Ge San (Cool the Upper Chamber Powder) plus Ren Zhong Huang and Sheng Di Huang (Rehmannia Root). After ingestion, three episodes of loose black stool occurred, but the tongue coating remained unmoistened and thirst persisted. This was like pouring a cup of water on a burning cartload of fire. A larger dose of Liang Ge San was used, increasing Da Huang (Rhubarb) to two taels, combined with Huang Lian and Xi Jiao (Rhinoceros Horn). Only after three doses did the heat clear. Subsequently, only fluids-generating and thirst-quenching medicines were used in large quantities until recovery.

He also treated the wife of Lu Zhongxing, in her early twenties. In mid-winter, she contracted cough. Half a month later, the fever subsided slightly. On the fifth day of the new year, coughing doubled, accompanied by spontaneous sweating, fatigue, dry painful throat. By New Year's Eve, she suddenly experienced mild aversion to cold and fever. The next day, abdominal pain and spontaneous diarrhea developed, with cold hands and feet and extreme sore throat. Three days later, she coughed up pus and blood. Zhang palpated her pulse: lightly felt slightly rapid, deeply still not rapid; Cun position seemed moving but soft, Chi position disappeared under slight pressure. Assessing pulse and symptoms, cold and heat were indistinguishable, resembling the Ma Huang Sheng Ma Tang (Ephedra and Asarum Decoction) pattern in Zhang Zhongjing's Jueyin examples. Initially, it was Dongwen, not severely damaging, so cough decreased gradually over half a month. However, forcing herself to handle year-end affairs led to excessive labor, damaging Spleen and Lung Qi, causing cough to worsen again. Suddenly, at full moon night, aversion to cold and fever appeared, followed by diarrhea and Jue Ni (Cold Extremities) the next day. This was likely due to body laxity during illness and subsequent cold invasion. Heat damaged internally, cold invaded externally; cold closed heat, preventing external dispersion, forcing it inward causing diarrhea, transmitting to Shaoyin and Jueyin, leading to throat obstruction and expectoration of pus and blood. Although different from diarrhea after severe purgation in Shanghan or heat damage, the mixture of cold and heat is identical. Ma Huang Sheng Ma Tang was administered. One dose resulted in slight sweating, warming of extremities, and cessation of diarrhea. Next day, pulse harmonized. Subsequently, Yi Gong San (Wonderful Skill Powder) and Sheng Mai San (Generate the Pulse Powder) were taken together; several doses brought stability.

Scholar Xu stated: My friend Wang Yanlong, serving as Granary Official in Piling, in late summer, suffered from excessive sweating on chest and neck, cold feet, and delirium. Physicians did not understand and administered mixed drugs for ten days. I palpated him: pulse was Ru (Soft) anterior to Guan, Shu (Rapid) posterior to Guan. I said: Treat as Shiwen (Damp Warmth). First received Summer Heat, then Dampness. The *Nan Jing* states: The pulse of Shiwen is Ru and weak in Yang positions, small and urgent in Yin positions. Ru and weak in Yang positions indicate Dampness clashing with Summer Heat; small and urgent in Yin positions indicate Summer Heat steaming Dampness. Summer Heat and Dampness clashing is named Shiwen. First use Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction), then Bai Hu Jia Cang Zhu Tang (White Tiger Plus Atractylodes Macrocephala Decoction). Headache receded, feet warmed, sweat stopped, cured in three days. This syndrome belongs to Zei Xie (Thief Pathogen). Mismedication leads to death. Someone asked: What is Thief Pathogen? I said: *Nan Jing* mentions five pathogens: Shi (Excess), Xu (Deficiency), Zheng (Correct), Wei (Minor), Zei (Thief). Coming from behind is Xu Xie; coming from ahead is Shi Xie; coming from the organ one cannot overcome is Zei Xie; coming from the organ one can overcome is Wei Xie; originating from self disease is Zheng Xie. Also: Assuming Heart disease, contracting Summer Heat is Zheng Xie; contracting Dampness is Zei Xie. Now Heart first received Summer Heat, then Dampness attacked. Water overcomes Fire, coming from the organ one cannot overcome, hence called Zei Xie. It is the most severe of the five pathogens.

Zhang Luyu treated Fan Zhenlin. During great heat, he suffered from cold extremities and diarrhea. Six pulses were Xian (Wiry), Xi (Fine), Kou (Hollow), Chi (Slow), vanishing upon pressure. Tongue pale white, center black moist without coating. Breath from mouth and nose slightly cold, Yang retracted into abdomen, essence slippery like ice. Inquiry revealed origin: sleeping on ground during day caught cold; that night seminal emission occurred twice. Suddenly felt head swelling like a mountain, fainted upon sitting up, limbs cold, abdominal pain, diarrhea, nausea, muttering nonsense. Similar to Shiwen. Physicians mistook it for food stagnation and cold invasion, giving dispersing and digesting herbs. After ingestion, sweat poured from chest, neck, and head; back felt colder, lower body icy. Fainted several times a day. This is Yin Cold carrying Summer Heat entering Hand and Foot Shaoyin. Due to extreme deficiency of True Yang in Kidney, unable to generate heat. Prescribed Si Ni Jia Ren Shen Tang (Counterflow Plus Ginseng Decoction): Ren Shen (Ginseng) 1 tael, Shu Fu Zi (Prepared Aconite) 3 qian, Pao Jiang (Baked Ginger) 2 qian, Zhi Gan Cao (Honey-fried Licorice) 2 qian. Administered day and night, six doses in three days. Determined Yang would return at Yin hour on fourth day. That day, ginger and aconite were stopped, switching to Bao Yuan Wan (Preserve Origin Pill): Ren Shen 5 qian, Huang Qi (Astragalus) 3 qian, Zhi Gan Cao 2 qian, Mai Men Dong 2 qian, Wu Wei Zi (Schisandra) 1 qian, to clear deficient Yang above diaphragm. Four doses improved appetite. Switched to Sheng Liu Wei Wan (Six Ingredient Pill with Rehmannia) plus Mai Dong and Wu Wei Zi, using Shu Di Huang (Prepared Rehmannia) 8 qian per dose to save draining Water of Lower Jiao, balancing Yin and Yang, restoring spirit.

Yu Jiayan treated Huang Qiqian. In spring, he contracted Warmth. Head and face very red. Yu said: An octogenarian, lower origin deficient and exhausted, Yang floats upward, combining with exterior pathogens. This is Dai Yang (Floating Yang) syndrome. Yang already floats to head and face; those unaware may apply exterior dispersants, causing solitary Yang to fly away, leading to imminent danger. Only Tao Jian'an's method is excellent: use Ren Shen and Fu Zi to gather Yang back to lower origin, adding Cong Bai (Green Onion White) to penetrate exterior and scatter pathogens. Follow method, recover quickly. Do not delay. He was shocked by this unconventional view, changed doctors, took exterior dispersants. Instantly Yang surged, skin goosefleshed, then shivering teeth-chattering, body froze and burst, dying instantly.

Yu Jiayan treated Jin Jian. Chunwen (Spring Warmth) had lasted over twenty days. High fever unrelenting, delirious speech, dry skin, stiff chest, curled tongue, cracked lips, curled body, cold feet, bowel/bladder slightly open, partial thirst, dark stagnant complexion. Previous methods of sweating, purging, harmonizing, and warming failed repeatedly. Yu said: This syndrome is no different from Lianggan Shanghan. *Nei Jing* originally said death on sixth day. Because Chunwen does not transmit meridians, although pathogen lingers, life can be extended until Yuan Qi exhausts. Observing Yin and Yang syndromes mixed, treating Yang hinders Yin, treating Yin hinders Yang, matching Lianggan pathology. Zhang Zhongjing had no specific method, only stating in preface that releasing exterior and attacking interior are fundamentally different. Following this intent, use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to resolve exterior Yin-Yang pathogens simultaneously. Indeed, sweat penetrated skin, heat cleared completely. Then use Fu Zi Xie Xin Tang (Aconite Bitter Heart Decoction) to resolve interior Yin-Yang pathogens simultaneously. Indeed, chest softened, consciousness returned, symptoms retreated. Next day requested porridge, required no further medicine. Only two doses saved a life from nine deaths. Joyous.

Zhen notes: This prescription is clever, unfortunately pulse image not recorded. However, reading Jiayan's Chunwen treatise, he claims success easily and mocks those afraid to use Fu Zi for heat, irritability, and dryness. Thus, pulse discussion might be unnecessary? He also says: Chunwen from Winter failing to store Essence may not initially show micro-rapid pulse. Only by not using Ma Huang Fu Zi Xi Xin or Ma Huang Fu Zi Gan Cao formulas does it deteriorate to micro-rapid pulse, where sweating, purging, and warming fail. Unique insight. Zhou Yuzai also said: General principles of Warm Epidemics rely on symptoms, not solely on pulse; one must have observed this to claim it.

A man traveled far in summer, fatigued, returning with Heat syndrome. Dysentery with pus and blood, body burning hot, black dry tongue, night delirium. Lin Beihai examined him: This is Yangming Bing (Yangming Disease), should not be treated as dysentery. But pulse is scattered, intermittent, resembling shrimp swimming, likely untreatable. Family insisted on medication. Lin said: Yangming Heat is severe, must quickly resolve toxin. Ancients would urgently purge to preserve True Yin Qi. However, this case originates from fatigue, Yang pathogen burning internally, pulse lacks Yin. If purged abruptly, toxin remains, Yin cuts off, death is inevitable. Reluctantly gave Yin-nourishing meds for a chance. Used Shu Di Huang 1 tael, assisted by Sheng Di Huang, Mai Men Dong, Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Gan Cao, Gou Qi Zi (Goji Berry). Warned family: Recovery depends on sweating. After ingestion, heat did not decrease, delirium worsened, but bloody dysentery stopped, slight sweat appeared briefly then ceased. Lin palpated: pulse connected clearly, flooding and rapid, beating fingers. Joyfully said: He will live. Still used previous formula, removed Sheng Di Huang, added Yu Rou (Cornus Fruit), Dan Pi (Moutan Bark), Shan Yao (Dioscorea), Suan Zao Ren (Ziziphus Seed). Taken six doses, delirium and heat unchanged. Family wanted change, Lin refused. Two days later, pulse gathered and rounded. Used Si Shun Qing Liang Yin Zi (Four Smooth Cooling Drink) plus Shu Di Huang 1 tael, Da Huang 5 qian. Passed black stool, symptoms resolved. Two days later, sudden recurrence of wild delirium, fever, panting, thirst. Family panicked, believing death certain. Lin laughed: Did you forget my words? Recovery comes with sweat. This is because after purging, Yin Qi arrived, but nothing stirred it, so Ying and Wei did not harmonize, no sweat generated. Without sweat, empty pathogen cannot exit, boiling internally recurs. Disease entered via Yang, must resolve via Yang. Prescribed Bai Zhu (Atractylodes Macrocephala) 1 tael, Gan Jiang (Dried Ginger) 3 qian, Gan Cao 1 qian, Dang Gui and Bai Shao 3 qian each. Finished dose, sweat poured, slept soundly till dawn, illness largely healed.

Zhen notes: Difficulty lies in beginning and end. Beginning pulse resembles shrimp swimming; applying Zhang Jingyue's theory of solid disease/deficient pulse using Ren Shen, Bai Zhu, Gan Jiang, Fu Zi would cause death. End fever recurrence; applying Wu Youke's theory of residual pathogen in Stomach using Bai Hu Tang or Cheng Qi Tang would endanger. Case insights and medication excellent. Survival due to Yin nourishment stopping dysentery, pulse responding. Middle six doses, delirium/heat unchanged, fortunate no cold extremities, especially no aphonia or refusal to eat, due to gathering/rounded pulse. However, Bai Zhu 1 tael and Gan Jiang 3 qian for wild fever/panting/thirst is hard to trial lightly.

Jiang Zhonglian from Huizhou, exposed to cold with fever, temples swollen like large cups, arm lumps numerous, no eating/bowel movement, wild agitation, thirst. Pulse floating, rapid, disordered. Physicians treated as Shanghan toxicity. Gao Gugeng said: Error. This is Dryness driving Wind generation. Used large dose Shu Gan Yi Shen Tang (Soothe Liver Enrich Kidney Decoction), Shu Di Huang increased to approx. 2 taels. Five doses reduced swelling, bowel moved. Ten doses cleared heat, appetite returned. Then Bu Zhong Yi Qi Tang (Tonify Middle Augment Qi Decoction) plus Mai Dong and Wu Wei Zi, regulated and cured.

Zhen notes: Today's so-called Shanghan is mostly Warmth diseases. Zhang Zhongjing said: Taiyang Bing with fever, thirst, no aversion to cold is Wenbing. Since Heat signs appear in Taiyang, Ma Huang Tang and Gui Zhi Tang are absolutely contraindicated, distinct from Shanghan. *Nei Jing* says: Heat diseases are all categories of Shanghan. Refers to all sudden heat illnesses should be viewed via Shanghan examples. Two sayings seem different; examining meaning, difference lies only in Taiyang, rest is same. Warmth diseases only investigate San Jiao, ignore Liu Jing (Six Meridians), this is absurd talk. Zhang Zhongjing's Six Meridians encompass all diseases; how can Shanghan category be completely separate? Ye Tianshi cases say: Warm pathogen enters via mouth/nose, this is inaccurate. Zhang Zhongjing clearly states: Latent Qi eruption. Li Mingzhi and Wang Andao both say: Winter injury by cold, latent pathogen eruptates from inside. How to confuse with Wu Youke's *Wen Yi Lun*? Only Shanghan focuses on Foot meridians; Warmth involves many Hand meridians. e.g., Fengwen cough/snoring, Rebing coma/delirium, or loose sticky stool, all manifest Hand Taiyin Lung, Hand Jueyin Pericardium, Hand Yangming Large Intestine. Severe cases: throat swelling, limb twitching, confusion like drunkenness, restlessness, scorched teeth/dry tongue, macules, parotitis. Pathogen distributes widely, no longer traceable by Six Meridians, hence Six Meridians method not used. Based on my experience, initial stages often involve exterior pathogens, still suitable for dispersing: Fang Feng (Saposhnikovia), Ge Gen (Kudzu), Chi (Fermented Soybean), Bo He (Mint), Niu Bang Zi (Arctium), Xing Ren, Hua Shi (Talc), Lian Qiao (Forsythia). Sweating indicates light disease, no sweat indicates heavy. If macules, add Chan Tui (Cicada Slough), Jie Geng, Lu Gen (Reed Rhizome), Xi He Liu (Tamarisk Twig). If phlegm, add Tu Bei Mu (Fritillaria Thunbergii), Tian Chong (Silkworm), Gua Lou (Trichosanthes), Ju Hong (Tangerine Peel). If Yangming signs, Bai Hu or Cheng Qi; Shaoyang signs, Xiao Chai Hu Tang minus Ren Shen/Ban Xia, add Hua Fen (Glehnia), Zhi Mu (Anemarrhena); Shaoyin signs, Huang Lian E Jiao Tang, Zhu Ling Tang, Zhu Fu Tang. All follow Zhang Zhongjing's Six Meridides established methods effectively. However, Warmth diseases' San Yin syndromes often die, unlike Shanghan. Because those who failed to store Essence in winter, as Dongyuan said, Kidney Water internally exhausted, who nourishes? Only large dose Yin nourishment aided by Heat clearing may save. Yin nourishment: Er Di (Two Rehmannias), Er Dong (Two Ophiopogons/Polygonatums), E Jiao, Dan Pi, Yuan Shen (Scrophularia), Human Milk, Sugarcane Juice, Pear Juice. Heat clearing: San Huang (Three Rheum/Coptis/Scolecodendron), Shi Gao (Gypsum), Xi Jiao, Da Qing Ye (Isatis Leaf), Zhi Mu, Lu Gen, Mao Gen (Imperata Rhizome), Jin Zhi (Willow Juice), Snow Water, Watermelon, Yin Hua Lu (Honeysuckle Dew), Si Gua Zhi (Luffa Juice). Select according to syndrome. Warm herbs for San Yin meridians are unsuitable for Warmth diseases; occasionally Zhen Wu Tang or Li Zhong Tang used, one or two in hundred. Generally, Warmth diseases fear unrelenting fever, spasm/Jue Ni, coma/confusion. Also sudden dizziness, or clear mind with intermittent wild speech, often unpredictable changes. Such cases confuse most, unlike Yang syndrome/Yin pulse, retracted Yang, curled tongue, grasping air, seeing ghosts, which are easier to identify as critical. Key is distinguishing Deficiency/Excess; true distinction allows treatment. Must not rely on Liu Hejian or Wu Youke methods. Those who meticulously study Zhang Zhongjing's *Shanghan Lun* will find profound wisdom. Regarding Ye Tianshi's discussion on Warmth: if pathogen transmits to Pericardium, shaking Sovereign, spirit confused, diffuse pathogen resists attack, clear orifices blocked, collaterals obstructed, if resolving phlegm/clearing fire fails, use Ju Fang Zhi Bao Dan (Bureau Formula Treasure Pill), or Zi Xue (Purple Snow), or Niu Huang Wan (Calculus Bovis Pill), following Yu's theory of aromatic elimination of turbidity opening orifices. Truly surpasses former sages, avoiding risks of heavy medications where one spoon error is irreversible. This gentleman's intelligence is indeed unsurpassable. Though selected cases few, methods complete, sufficient to guide learners.