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There are also cases in summer where illness is caused by cold. Accidentally encountering violent storms and heavy rain, failing to add clothing in time, or sleeping at night without covering oneself properly, or walking on the road and being exposed to wind and cold, can all lead to cold syndromes. This is not the appropriate seasonal climate but rather the appearance of such cold qi, termed Cold Epidemic (Han Yi). The treatment method differs from Summerheat Syndromes (Shu Zheng), primarily utilizing formulas such as Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) and Baidu San (Dispel Toxin Powder), focusing on acrid dispersal and harmonization. One must not exclusively use diaphoretic drugs. This discussion was expounded by Mr. Li Dongyuan from the *Ten Books* (*Shi Shu*). Previous medical texts rarely mentioned it; however, this represents only one out of a hundred scenarios. Applying one rule to a hundred cases, treating possibilities as certainties, is incorrect.

Lin's Note: Cold Epidemics often occur in years when Metal and Water Qi fail to consolidate. Human Qi responds to this, with pores opening while cold Qi closes them. Epidemics are irregular, pernicious Qi from Heaven and Earth, which are difficult to dispel rapidly. They differ from Wind-Cold pathogens, which can be resolved with a single sweating therapy. Treatment should preferably employ warm dispersing herbs such as Perilla Leaf (Zisuye), Cinnamon Twig (Guizhi), Apricot Seed (Xingren), and Licorice Root (Gancao). One must further observe whether Dampness or Wind is concurrent and adjust treatment accordingly. When Su Dongpo was in Huangzhou, he used Shengsan Zi (Holy Dispersion Pill) to treat epidemics with great efficacy; this is also a formula for Cold Epidemic complicated by Dampness. Later, during the Xuanhe era in Yongjia, countless people died after taking this formula because the formula for Cold Epidemic was mistakenly applied to Warm Epidemics (Wen Yi).

*Mai Jue Ju Yao* (Essentials of Pulse Diagnosis) states: Summerheat injures Qi, therefore the pulse presents as Empty (Xu), Wiry (Xian), Fine (Xi), Scallion-Stalk (Kou), or Delayed (Chi), with no other characteristics omitted.

Liu Fushen (Liu Wansu) stated: Summerheat pulses are Empty and weak, powerless upon pressure. Pulses that are Hidden (Yin), Wiry, Fine, Scallion-Stalk, or Delayed are all Summerheat pulses. An Empty pulse with body heat results from Summerheat injury; an Empty and slight pulse is indicative of this. Cold diseases transmit through meridians, so the pulse changes daily; Warm-Heat diseases do not transmit through meridians, so the pulse remains unchanged. For Cold diseases, Floating and Full pulses with strength are easy to treat; Scallion-Stalk and Fine pulses without strength are difficult to treat; absence of pulse is untreatable. However, this is not the case for Warm-Heat diseases. In Warm diseases, there may be no pulse in one or two positions; in Summerheat-Heat diseases, there may be no pulse in three or four positions. This is due to suppression by Fire pathogen causing the pulse to hide internally, not its absolute absence. It does not hinder the disease process, and attacking it is relatively easy. If a physician is startled by the pulse and flees in ignorance, prescribing Acrid-Cold medicines according to classics, once the Fire dissipates and the pulse returns, the disease cures itself. What benefit is there in mere panic? The key lies in detailed differentiation. Generally, Warm-Heat diseases may remain confined to one or two meridians throughout, without transmitting to others. In these meridians, the pulse may be Full and Rapid (Hong Shu), while other meridians show weak and Hidden pulses. Regulating according to the meridians will cause the Full pulse to normalize and the Hidden pulse to reappear, signaling recovery.

In the third month of Dingwei year during the Wanli reign, I resided in the capital, serving in the Imperial Granary. Suddenly, my fellow official from the Ministry of Personnel, Liu Puting, rode over reporting critical illness. I visited his residence, where colleagues surrounded him, having already prepared funeral arrangements. He had been delirious, scratching clothes, and sleepless for seven or eight days. Wu Siquan from the Imperial Medical Bureau, a renowned physician, treated him along with several other doctors. Upon palpation, I found only the Guan position pulses Full and Large, while all others were Hidden. I prescribed Zhuyegashitang (Bamboo Leaf and Gypsum Decoction). The gentlemen exclaimed in surprise, "Dr. Wu has already decocted Fuzi Lizhong Tang (Aconite and Ginger Decoction to Restore the Middle). Why such opposite approaches?" I questioned them. They replied, "Dr. Wu said Yang syndrome with Yin pulse necessitates Aconite." I said, "The bilateral Guan pulses are Full and Large; this is a Yang pulse. The other meridians are suppressed by Fire, not Yin pulse." Dr. Wu argued fiercely. I stood firm in my diagnosis. The gentlemen followed my advice. After one dose, by dusk, the delirium and scratching ceased, and he slept briefly. Checking his pulse again, the Full ones normalized, and the Hidden ones reappeared. The gentlemen looked at each other and said, "This is truly Zhang Zhongjing reborn." Subsequent treatment with Acrid-Cool medicines led to full recovery. When pulse and symptoms align, differentiation is easy; when they contradict, it is difficult. Only with clear pulse diagnosis can one differentiate syndromes; only with accurate syndrome identification can one prescribe medicine. One must examine with humility and care, never clinging to preconceived notions and experimenting with various drugs, risking life in an instant. Be cautious!

Lin's Note: Pulses in Warm and Summerheat diseases are often Hidden, but rarely completely absent. If one examines the non-Hidden positions in one or two areas, they will likely be Full and Rapid. Even if not Full and Rapid, careful palpation reveals strength. In early stages, one must distinguish Cold from Heat within Blood and Qi. *Suwen: Yin-Yang Yingxiang Dalun* states: Left and Right are the pathways of Yin and Yang. Water and Fire are the manifestations of Yin and Yang. This discusses the ascending and descending of Blood, Qi, Yin, and Yang. Regarding Zang Qi, Liver Wood ascends on the left, Lung Metal descends on the right. Regarding pulse body, Left belongs to Blood, Right belongs to Qi. In diagnosing exterior contraction pulses, Cold Damage (Shang Han) often manifests strongly in the Left position because Cold injures Form, specifically tangible Ying Blood. Warm and Summerheat diseases often manifest strongly in the Right position because Heat injures Qi, specifically intangible Wei Qi. These are the manifestations of Water and Fire, and the lateral distribution of Blood and Qi, which must be observed. However, if Dampness is severe and Heat is mild, one should not rigidly adhere to this rule.

Furthermore: Blood, Qi, Yin, and Yang interweave and utilize each other; their principles are profound and subtle, beyond complete verbal description. Since Li Dongyuan's *Bian Gan Lun*, it was forcibly divided: Left as Renying (Person Welcome) and Right as Qikou (Qi Gate). Renying larger than Qikou indicates Exterior Contraction; Qikou larger than Renying indicates Internal Injury. However, the "Exterior Contraction" referred to here implies Wind-Cold, while "Internal Injury" implies Dietary Injury. Because Cold injures Form and Blood, the pulse is strong on the Left; Food injures the Stomach Fu, so the pulse is strong at the Right Guan. Later physicians misunderstood this, believing that all Exterior Contractions result in Left-strong pulses and all Internal Injuries result in Right-strong pulses, confusing Blood and Qi, and obscuring Yin and Yang. Although Wang Andao discussed this earlier and Wu Youke later, entrenched habits are hard to break, leading to inverted Cold/Heat treatments and premature death. How rare it is to avoid this! If Cold Damage transmits to Yangming, a Solid and Large Right Guan pulse indicates dry stool filling the Stomach Fu, requiring purgation. If Warm/Summerheat sinks into Yin meridians, a Rapid and Large Left Guan-Chi pulse indicates latent Heat in Liver and Kidney combusting with external Heat, often untreatable. Therapeutic flexibility depends on the practitioner; one must not be dogmatic. Left-large indicates Wind-Cold; Right-large indicates Warm-Summerheat. However, in early Wind-Cold, Floating-Tight pulses are strong on the Left; in early Warm-Summerheat, Full-Rapid pulses are strong on the Right. This too must be carefully observed.