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Having received your presentation of the book *Jiu Shi Yao Lue* (Essentials for Saving Lives in Emergencies), I have long intended to return it to you so that it may be published. However, there are difficulties. Once published and disseminated, people will surely believe it deeply; if there are any errors, they will lead to widespread misunderstanding and misguidance. Therefore, it is essential that upon first encountering both Cold Syndrome (Han Zheng) and Heat Syndrome (Re Zheng), physicians can clearly understand them at a glance, thereby saving lives and preserving health.

Take the book *Jiu Shi Yao Lue* as an example: its method of syndrome differentiation strictly follows the original text of Wang Mengying's *Huo Luan Lun* (Treatise on Cholera), merely deleting complexity to simplify, without any unauthorized alteration. In *Huo Luan Lun*, Wang Mengying stated that Heat Syndromes are common, while Cold Syndromes are rare, accounting for only one or two out of ten cases. Mengying’s viewpoint was based on certain evidence: for instance, patients with Heat Syndromes often perceive premonitory signs such as a sensation of fire flowing in the eyes and burning heat in the anus several days before onset; thus, symptoms after onset would naturally follow.

However, tracing back to the years 1862–1864 (the first three years of the Tongzhi reign), when I practiced in Meili Town, Changshu, and later moved to Dangkou Town, these areas were densely populated. From April to August/September, Cholera (Huo Luan) swept through households door by door. I treated dozens of patients daily, ranging from ten to thirty. I witnessed the onset of symptoms: vomiting and diarrhea, invariably accompanied by cold limbs (Zhi Leng), cold sweat sticky to the touch, pulse hidden and unobtainable (Mai Fu), extreme restlessness and thirst, sunken skin wrinkles, and in severe cases, sunken eyes and loss of voice. Although some cases responded to Bai Hu Tang (White Tiger Decoction) as Heat Syndromes, they did not necessarily show fire-like signs before onset, nor did all post-onset cases exhibit eye-fire sensations or anal burning. Similarly, cases responding to Li Zhong Tang (Regulate the Middle Decoction) or Si Ni Tang (Frigid Extremities Decoction) as Cold Syndromes were not necessarily free of restlessness and thirst, nor were their mental states always calm; their presentations could resemble Heat Syndromes.

Mengying’s differentiation of Cold and Heat syndromes recorded in his book is indeed extremely concise. Yet, I have observed village doctors who, seeing cold limbs and a hidden pulse, disregarded questions about thirst and tongue color, blindly administered Si Ni Tang, resulting in recovery from Cholera. Conversely, I have seen patients with cold limbs and hidden pulses, yet exhibiting extreme restlessness, thirst, ability to drink, and a full manifestation of fire-heat, who died after receiving Bai Hu Tang and Di Jiang Shui (Earth Spring Water). Thirty years of personal experience lead me to doubt the claim that "Heat Sha (Sha Disease) always shows fire signs before onset." The statement that "once aromatic opening agents are used, heat signs emerge," followed by treatment according to Heat Sha, is most accurate. Specifically, heat signs may not appear in every household; the presence of a few items is sufficient as evidence.

Generally, Heat Syndromes involve external constraint by Dampness (Shi Xie), while Cold Syndromes belong to Yin-Cold blocking Yang Qi. Aromatic opening agents such as Xing Jun San, Hong Ling Dan, Su He Wan, Zi Xue, and Yu Shu Dan should be urgently selected upon disease onset if the pulse is hidden, limbs are cold, or sweating is profuse. Although there are differences between Clearing-Opening (Qing Kai) and Warming-Opening (Wen Kai) methods, even if Wen Kai agents like Su He Wan are used for Heat Syndromes, efficacy can be achieved. Using warm treatments for heat seems like adding fuel to a fire; however, by developing the constrained Qi, the fire-heat can be vented. Thus, "treating heat with heat" can also revive the dying. If Qing Kai agents are used for Cold Syndromes, Yin-Evil becomes stagnant and obstructive, rendering opening agents ineffective and causing harm.

In general, during the initial stage, regardless of Cold or Heat, aromatic opening agents should be used universally. After opening, treatment should proceed based on observed symptoms, ensuring recovery for those destined to live. When dispensing medicine, it is advisable to prepare the aforementioned Warming-Opening drugs to allow Fire-Heat Qi to penetrate outside the Dampness, and to promote the smooth circulation of Yin-Stagnant Qi. Then, provide a condition sheet specifying: after taking the opening agent, if the heat signs described in the book appear, it is Heat Sha. For mild cases, administer Liu Yi San (Six-to-One Powder) mixed with Di Jiang Shui intermittently; for severe cases, administer Li Zhong Bai Hu Tang, Bai Hu Tang, or Zhu Ye Shi Gao Tang. The prescriptions should be listed on the condition sheet. If the cold signs described in the book appear, administer Li Zhong Tang, Fu Zi Li Zhong Tang, Wu Zhu Yu Tang, or Si Ni Tang. The prescriptions should also be listed on the condition sheet. Alternatively, the condition sheet itself can serve as wrapping paper attached to the opening medicine.

The most objectionable practice is arbitrary naming, such as Jiao Chang Sha (Intestine-Twisting Sha), Lan Hou Sha (Rotting Throat Sha), Diao Jiao Sha (Hanging Leg Sha), and Bie Luo Sha (Shrivelled Snail Sha). In severe Cholera, skin wrinkles inevitably shrivel. The *Classic of Difficult Issues* states: Wei Qi (Defensive Qi) warms the muscles, fills the skin, plumps the interstices, and controls opening and closing. Since Cholera causes Wei Qi obstruction, it naturally leads to unwarmed muscles and cold limbs, unfilled skin and shrivelled wrinkles, and loss of control over opening/closing leading to profuse sweating. All diseases manifest uniformly. For example, immersing hands in water for a long time causes dampness to constrain and Wei Qi to block, resulting in shrivelled wrinkles. Yet, falsely creating names like "Shrivelled Snail" or "Hanging Leg" confuses physicians whose insight is not firm. Without a standard for clinical judgment, believing that each year has its own seasonal disease, one fails to realize that the term "Cholera" encompasses everything. Any physician who studies this thoroughly and distinguishes accurately can achieve perfect results. These are my humble opinions, presented respectfully despite my ignorance.