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In general, when treating Shanghan (Cold Damage) or Wenyi (Warm Epidemics) with warming and tonifying methods, it is because cold pathogens are stagnant, and Yang Qi fails to overcome Yin. Without warming, movement cannot occur; without warming, recovery of Yang Qi is impossible. If cold qi resides in the meridians, it is because the pathogen is at the exterior level, and warming dispersal is appropriate, as detailed previously. If cold qi resides in the Zang organs, it is due to deficiency of Yang Qi; either warming and tonification or merely warming the Middle Jiao is indicated. However, the principle for using warming methods is to observe: if there is heat on the outside but no heat inside, this is false heat, and warming is indicated rather than cooling. If the disease presents with heat signs but the Yuan Qi (Original Qi) is deficient, this is also false heat, and warming is indicated rather than cooling. True heat is easily known by everyone. It is only false heat that is difficult to distinguish. For false heat, unless sweet-warming herbs are used, the heat will not subside; how much more so for true cold, which needs no further explanation. Generally, excess patterns often present true heat, while deficiency patterns often present false heat. Therefore, treating excess patterns often requires cooling agents, while treating deficiency patterns often requires warming agents. Failure to distinguish between true and false can cause significant harm. Furthermore, regarding the differentiation of true cold with false heat, excess patterns can have both cold and heat. Deficiency patterns can also have both cold and heat. To claim that all excess patterns are hot and all deficiency patterns are cold is rigid and erroneous. However, for excess patterns with cold, only warming dispersal is suitable, without need for tonification. For deficiency patterns with heat, only regulating and tonifying is suitable, and one must fear cold-cooling agents. Cold-cooling agents lack life-generating properties and tend to damage Yuan Qi. If cold-cooling agents are used to treat deficiency patterns, the heat may not subside, and although temporary use might be acceptable, prolonged use will inevitably damage the Spleen and Stomach and lead to critical conditions. Since fever is present but cold agents are unsuitable, labeling it generally as false heat is not excessive.

1. In cases of Shanghan with fever, where the Mingmen (Gate of Life) Yang is deficient, accompanied by aversion to cold, body pain, vomiting, or dysentery, with weak pulse and deficient Qi, such that the exterior syndrome cannot resolve, Da Wen Zhong Yin (Great Warming the Middle Decoction) or Li Yin Jian (Regulating Yin Decoction) must be used. If Shanghan presents with body heat, and there is cold in the Heart and Lungs, accompanied by vomiting, hiccups, and coughing, or abdominal fullness and wheezing, with only cold pathogen and no deficiency, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is appropriate. If Yin-pattern Shanghan presents with spontaneous diarrhea, deep pulse, body pain, fever, abdominal pain, and cold extremities, with only cold pathogen and no Yuan Qi deficiency, warming medicines should be used, specifically Si Ni Tang (Frigid Extremities Decoction). If cold is in the Taiyin channel, presenting with abdominal pain, vomiting, and dysentery, or distension and cold extremities, due to Spleen and Stomach deficiency-cold with unresolved pathogen, Wen Wei Yin (Warming the Stomach Infusion) or Li Zhong Tang (Regulate the Middle Decoction) is appropriate. If Shanghan occurs within one or two days, with pathogen in the Taiyang channel or Shaoyin channel, presenting with aversion to cold in the back and unresolved exterior syndrome, Fu Zi Li Yin Jian (Aconite Regulating Yin Decoction) is appropriate. In Zhang Zhongjing’s texts, Fu Zi Tang (Aconite Decoction) is used. If Wind-Cold is at the exterior and Yin-Cold is in the interior, presenting externally with body heat but internally with unceasing diarrhea and dysentery, or with vomiting/nausea or abdominal pain due to dysentery, this indicates sinking of Middle Qi, causing the exterior pathogen to sink deeper, making resolution impossible. One must quickly use Wei Guan Jian (Stomach Gate Decoction) or Da Wen Zhong Yin. In any case of Shanghan where there is severe deficiency of Yin and Yang, impending failure of Yuan Qi, and inability to resolve the pathogen, Liu Wei Hui Yang Yin (Six-Ingredient Return Yang Infusion) is indispensable. However, if there is a sense of severe deficiency and severe cold, this formula should be used immediately. Waiting until failure occurs may be too late. In cases of Yin Excess repelling Yang, with true cold inside and false heat outside, symptoms must include red head and face, dry mouth with scorched tongue, mouth ulcers and sore throat, irritability, wheezing, mania, or body heat like fire, or appearance of deficiency spots and mosquito-bite-like marks all over the body, or Yin Jaundice with urine resembling golden juice. Although these external signs exist, the pulse is weak and powerless, and there may be vomiting/nausea, diarrhea, aversion to cold in the back and abdomen, shortness of breath resembling asthma, lethargy with loss of consciousness, panic and fear, or fever without thirst. Even if speech is delirious, the Qi is rapid and voice is faint; even if the body is restless and manic, movements are weak, and stopping them halts the behavior. These are all signs of internal deficiency and external excess, true cold with false heat. One must use Li Yin Jian, or Liu Wei Hui Yang Yin, Da Wen Zhong Yin, Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill), etc., in large doses to preserve life. If floating deficiency fire causes sore throat, heat, and restlessness, preventing the intake of hot drinks, soak the medicine well water and administer cold. This uses the property of false cold to resolve the false heat of the Upper Jiao, while utilizing the true heat nature of the herbs to save the true cold of the Lower Jiao. This is a truly miraculous method for returning Yang and reviving the dead. For those whose Blood and Qi are originally deficient and suitable for tonification, however, if excessive warming and tonification leads to increasing confusion and persistent difficult-to-resolve irritant heat, this indicates solitary hyperactivity of Yang pathogens and absence of Yin Qi, resulting in heat within deficiency. One should switch to nourishing Yin, using Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) added with Huang Qin (Scutellaria Root) and Mai Dong (Ophiopogon Tuber), or Yi Chai Hu Yin (One Bupleurum Infusion) added with Zhi Mu (Anemarrhena Rhizome). This is the method of ten parts tonifying and one part clearing. Effect is seen after one dose, its efficacy is miraculous. Practitioners must be flexible and understand this principle best.