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Heterogeneous pathogens refer to the situation where a person, having contracted an initial illness that has not yet resolved, is subsequently infected by a different pathogen. When these two pathogens combine, they transform into other diseases. If the pulse is vigorous in both yin and yang positions (cun and chi), this is the pulse of Shanghan (Cold Damage). The Nan Jing states: "The pulse of Shanghan is vigorous in both yin and yang, tight and choppy." The Classics state: "A vigorous pulse accompanied by cold body indicates Shanghan; this occurs when the heat from a previous illness has not subsided, and cold is contracted again. Cold and heat contend, transforming into Wen Nue (Warm Malaria)."

If the yang pulse (cun) is floating and slippery, and the yin pulse (chi) is soggy and weak, this indicates a subsequent contraction of wind, transforming into Feng Wen (Wind-Warmth). This results from the previous heat not subsiding followed by wind contraction. The Nan Jing states: "The pulse of Zhong Feng (Wind Strike) is floating and slippery at the yang position, and soggy and weak at the yin position. Wind exploits the heat, thus transforming into Feng Wen."

If the yang pulse is surging and rapid, and the yin pulse is solid and large (the Zhao edition adds the character 'geng' meaning 'further'), this indicates a subsequent contraction of warm-heat, transforming into Wen Du (Warm-Toxin). Wen Du is the most severe among these diseases. This results from the previous heat not subsiding followed by warm-heat contraction. Yang governs the exterior, yin governs the interior; surging, rapid, solid, and large are all heat signs. Two heats combining transform into Wen Du. Because both interior and exterior are hot, the disease is most severe.

If the yang pulse is soggy and weak, and the yin pulse is string-like and tight, this indicates a subsequent contraction of warm qi, transforming into Wen Yi (Warm Epidemic). (Zhao edition note: another version reads 'Nue'). This is because winter cold injury later manifests as Wen Bing (Warm Disease); the pulse variations and symptoms, and their treatments, are as described previously. This results from the previous heat not subsiding followed by warm qi contraction. Warm and heat combining transform into Wen Yi.

Generally, when people have illnesses, if they do not treat them promptly and instead endure them hoping for spontaneous recovery, they will develop stubborn, chronic diseases.

Whenever one feels unwell, medical attention must be sought immediately. If time is delayed, pathogens will penetrate deeply, making them difficult to cure. The Qian Jin Fang states: "Whenever there is slight discomfort, feeling unlike normal, one must inform a doctor early; if one endures without treatment, hoping for self-recovery, within moments it becomes a chronic disease." This is what is meant.

In children and women, the condition becomes even more severe.

Children's qi and blood are not fully developed; women's blood chamber (Xue Shi) is prone to disease. Any pathogen received by them easily spreads and proliferates.

When seasonal qi is discordant, early diagnosis and treatment are required. One should trace the source of the pathogen; while it remains in the Cou Li (skin texture and interstitial spaces), timely treatment rarely fails to cure.

Cou Li refers to the sites where body fluids excrete and where skin textures intersect. The Gui Zhi Yao Lue states: "Cou is where the San Jiao connects and distributes primordial true qi, the place where blood and qi pour; Li refers to the textures of skin and zang-fu organs." When pathogens lodge in the skin, they are superficial and easy to disperse; if treated timely, they rarely fail to heal. The Jin Gui Yu Han states: "As long as vital signs persist, and appearance/form shows no disease, and pathogens have not entered the Cou Li, timely use of acupuncture and herbs, along with proper regulation entrusted to a good physician, ensures healing."

If patients endure suffering and delay reporting until days later, pathogens enter the Zang organs, becoming hard to control. This is the key precaution for families with sick members.

Pathogens in the skin belong to Yang externally and are easy to treat; pathogens penetrating inward belong to Yin internally and are difficult to treat. The Nei Jing states: "A skilled healer treats at the hair/skin level first, then muscle/skin, then sinews/vessels, then Six Fu organs, then Five Zang organs. Treating Zang organ diseases, half recover, half die." Formerly, Duke Huan of Qi neglected minor skin ailments, leading to bone marrow disease. Families with sick members must certainly take precautions.

When preparing decoctions, one should not avoid morning or night. Upon detecting illness, treatment should begin immediately, regardless of time, facilitating easier recovery.

The Qian Jin Fang states: "Upon feeling unwell, treatment must begin immediately. Continue decoctions and food until recovery, breaking the toxic force, leading to natural healing."

If recovery is slow, the disease will transmit and transform. Although one wishes to eliminate it, efforts will likely be futile.

Transmission follows regular patterns; transformation is irregular. Transmission refers to movement along meridians, e.g., Taiyang transmitting to Yangming; transformation refers to irregular changes, e.g., Yang syndrome transforming into Yin syndrome. Once pathogens transmit and transform, the disease depth increases. The Ben Cao states: "When disease momentum forms, half may be cured; when disease momentum passes, life is hard to save."

If medication is not taken according to method, or if one willfully disobeys the physician, treatment should cease.

The Nei Jing states: "One bound by ghosts/spirits cannot be spoken to regarding high virtue; one who abhors needles and stones cannot be spoken to regarding skillful techniques. If a patient refuses treatment, the disease will not be cured, and treatment will yield no merit."

Generally, Shanghan diseases mostly arise from Wind-Cold.

Historically, diseases caused by Wind Strike and Shanghan were collectively termed Shanghan. The Qian Jin Fang states: "Shanghan originates from Wind-Cold, entering the Cou Li, contending with essence and qi, causing imbalance in Ying and Wei, blocking the whole body, resulting in disease."

Initially, Wind-Cold affects the exterior; once entering the interior, it cannot dissipate on its own.

This refers to progression from skin to meridians, then to zang-fu organs.

There is no case where proper warming and covering fails to dissipate [pathogens].

When Wind-Cold initially lodges in the skin, administering decoctions with appropriate warming and dispersing properties ensures no pathogen remains undissipated.

If the syndrome does not warrant purgation but one intends to attack internally, one must first resolve the exterior before purging.

Resolving the exterior first, then purging, prevents further transmission of pathogens.

If the exterior is resolved but internal pathogens remain, and it is not a full/excess condition, yet chills and fever persist, the disease is not eliminated.

Even if exterior signs have ceased, if the interior is not severely full and hard, purging is not indicated. This is because pathogens have not consolidated into excess; purging would cause interior deficiency, leaving pathogens unresolved, still generating chills and fever.

If the exterior is resolved but internal pathogens remain, presenting with severe fullness and excess, hardness, and dry feces, purging is naturally indicated. Even after four or five days, this will not cause harm.

External absence of exterior signs, combined with internal hardness and fullness, indicates all conditions for purging are met. The Wai Tai Mi Yao states: "Exterior harmonized, interior diseased, purging leads to cure." Once purging indications are present, one need not adhere strictly to the number of days.

If purging is inappropriate but performed anyway, interior deficiency allows heat to enter, leading to diarrhea with heat, irritability, and numerous other transformations. Mild cases become critical; severe cases result in death.

Improper purging: for mild diseases, symptoms change and become hard to treat; how much more so for severe ones?

In Yang-excess and Yin-deficiency, sweating causes death, purging leads to recovery. In Yang-deficiency and Yin-excess, sweating leads to recovery, purging causes death.

Exterior is Yang, interior is Yin. In Yin deficiency, Yang pathogens inevitably gather. Yang-excess pathogens entering the Fu organs due to interior deficiency constitute Yang-excess/Yin-deficiency. The Classics state: "Weak chi pulse is named Yin insufficiency." When Yang qi sinks into Yin, fever occurs—this is the case. Purging removes internal heat, leading to recovery; conversely, sweating depletes fluids, causing death. In Yin pulse insufficiency, Yang follows; in Yang pulse insufficiency, Yin attacks. Yin pathogens attacking exterior deficiency, lodging in Ying and Wei, constitute Yang-deficiency/Yin-excess. The Classics state: "If cunkou pulse is faint, it is named Yang insufficiency." When Yin qi enters Yang, shivering and aversion to cold occur—this is the case. Sweating disperses exterior cold, leading to recovery; conversely, purging depletes righteous qi, causing death. The Classics state: "Originally requiring sweating but performing purging is contrary therapy. Originally requiring purging but performing sweating is also contrary therapy."

Thus, how can Shen Dan be mistakenly used for sweating, or Gan Sui recklessly used for purging? Treatments for deficiency and excess differ by a thousand miles; the mechanism of auspiciousness and peril responds like shadow to form or echo to sound. Is it something to be taken lightly!

Shen Dan is a sweating herb. Gan Sui is a purgative herb. If sweating/purging is appropriate, there is auspiciousness; if inappropriate, there is peril. The response is like shadow following form or echo responding to sound.

Moreover, if Gui Zhi Tang is swallowed in Yang-excess, death ensues (Zhao edition reads 'ji' meaning 'immediately'); if Cheng Qi Tang enters the stomach in Yin-excess, death follows.

Gui Zhi Tang is a sweating formula. Cheng Qi Tang is a purgative formula. The Jin Gui Yu Han states: "Forcing sweating when not indicated deprives the body of fluids, leading to withering and death; forcing purging when not indicated causes intestinal洞泄 (洞泄 means severe diarrhea/loose stools), incontinence of urine and stool, leading to death."

The crux of life and death lies in an instant; watching life end, there is no time to count days.

Improper administration of decoctions brings immediate disaster; how could there be time to count days?

This involves the interweaving of Yin-Yang and deficiency-excess, where signs are subtle; the opposition of sweating, vomiting, and purging methods brings rapid disaster. Physicians with shallow knowledge, ignorant of disease origins, make errors in treatment, causing patient death, attributing it to fate. To this day, vengeful souls fill the underworld, corpses fill the wilderness. Would benevolent people not grieve seeing this! Generally, in Liang Gan Bing (Double-Contraction Disease) where exterior and interior are simultaneously affected, treatment has a sequence. Resolving exterior and attacking interior are fundamentally different. Obsessed and deluded individuals claim Shen Dan and Gan Sui can be mixed and drunk to simultaneously resolve exterior and interior. Their words are clever and seemingly plausible, but their logic violates principles. The wise act with caution and deliberation; the foolish act decisively and hastily. How can the changes of safety and danger be deceptive! Scholars of the world pursue the glory of gathering and learning but ignore the peril of collapse. Only the enlightened can protect the root, taking examples from themselves. What distance is there?

In Liang Gan Bing occurring simultaneously, intending to become incurable, physicians must carefully deliberate, examine the sequence, and treat step-by-step. Reckless aggressive treatment seeking quick effects inevitably leads to collapse.

Generally, for sweating, decoctions should be taken warm. Although formulas state three doses daily, if the disease is severe and unresolved, the interval should be shortened, completing three doses within half a day. If the medicine conflicts with the disease, sensations will arise immediately. For severe diseases, observe throughout day and night. If, after one dose, symptoms persist, administer the original decoction again. Some may not sweat after three doses; only then do they resolve. If no sweat occurs after three doses, it is a fatal disease.

Sweating medicines must be taken warm to facilitate dispersion. Three doses daily maintain continuous medicinal power. If disease severity is slightly higher, urgent administration is needed to break intense heat; one must not be bound by the original formula. If medicine and disease are mismatched, one knows upon ingestion: e.g., in those with excessive Yin, cooling medicines generate cold reversal; in those with excessive Yang, warming agents trigger heat toxicity. This is 'having sensations'. 'Shi' refers to a full cycle (24 hours). Taking one dose over 24 hours, then observing transmission: if symptoms persist, repeat the original decoction to induce sweat. If three doses fail to resolve and no sweat occurs, pathogens are excessive, decoctions are insufficient, leading to major disease. The Qian Jin Fang states: "Heat disease with restless, vigorous pulse and no sweat is the extreme of Yang pulses; fatal."

Generally, in Seasonal Qi diseases, by the fifth or sixth day, if thirsty and wanting water but unable to drink much, do not give it. Why? Because internal heat is still low, unable to digest it, giving it creates further pathology. By the seventh or eighth day, if extremely thirsty and wanting water, give it according to symptoms (Zhao edition adds 'er' meaning 'and'). Give sparingly, never to excess. If they can drink one dou, give five sheng. If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccups, do not give it. (Zhao edition adds 'ye' meaning particle). Sudden profuse sweating indicates spontaneous recovery.

Heat in the Upper Jiao causes Xiao Ke (Consumption-Thirst), meaning heat consumes fluids, Upper Jiao dries, causing thirst. Intense heat can consume water; low heat cannot. Forced drinking leads to fluid retention and various diseases. By the seventh or eighth day, Yang prevails, temperature rises, approaching resolution, great thirst often occurs. Still, give sparingly to moisten Stomach qi; do not force drinking.

If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccups, it indicates internal fluid retention not dispersing; do not give more. Suddenly, Yang qi opens, water qi disperses, emerging externally as profuse sweat, resolving the disease.

Generally, if a patient can drink water, it indicates impending recovery. Those ignorant of disease hear that drinking water aids recovery; for slight thirst, they force drinking, causing disaster, which is incalculable. (Zhao edition adds 'ye').

Slight thirst indicates low internal heat. Forcing water leads to indigestion, creating various fluid diseases.

Generally, in Jue disease with rapid, moving pulse, if the pulse becomes slower after taking medicine; if the floating-large pulse decreases; if restlessness turns to calmness, these are all signs of recovery.

Rapid-moving pulse indicates pathogen in Yang; slowing after medicine indicates Yang pathogen resolving. Floating-large pulse indicates pathogen in Exterior; decreasing indicates Exterior pathogen dispersing. Initial restlessness is due to pathogen disturbance; calmness after medicine indicates medicine overcoming disease. These are all recovery signs.

Generally, treating Wen Bing, one can needle fifty-nine acupoints.

The fifty-nine points are used to drain heat-warmth from all meridians. The Zhen Jing states: "For heat diseases, select fifty-nine points from Yang meridians, needle to drain heat and induce sweat; tonify Yin and supplement deficiency." The so-called fifty-nine pricks: three on each inner and outer side of hands, twelve total; one between each finger, eight total; feet similarly; one cun inside hairline, three on each side, six total; three cun inside hairline, five on each side, ten total; one each in front/behind ears, below mouth, one in neck, six total; one at vertex, one at Xinhui, one at hairline, one at Lianquan, two Fengchi, two Tianzhu. Also, the Nei Jing states: "Fifty-nine Heat Shu points, five rows on head. Five per row drains rebellious heat from all Yang." Dazhu, Ying Shu, Quepen, Bei Shu (eight points) drain chest heat; Qichong (Suwen reads Qiejie), Zusanli, Shangjuxu, Xiajuxu (eight points) drain Stomach heat; Yunmen, Bitong (likely referring to specific thigh points), Weizhong, Suikong (eight points) drain limb heat; five beside each Zang Shu (ten points) drain Zang heat. All fifty-nine points are lateral to heat.

Furthermore, there are 365 acupoints on the body. Thirty-nine are harmful to moxa; seventy-nine are disastrous to needle. Both involve piercing the Marrow.

There are 365 points corresponding to the year. Contraindications for moxibustion and needling are at places where flesh is thin and bones separate, or where blood vessels are deficient and few, involving piercing the Marrow.

Generally, Si Sun (Four Damages) pulse indicates death in three days. A healthy person breathes four times per pulse beat; if the patient's pulse beats once per four breaths, it is named Si Sun. Wu Sun (Five Damages) pulse indicates death in one day. Healthy person breathes five times per pulse beat; if patient's pulse beats once per five breaths, it is named Wu Sun. Liu Sun (Six Damages) pulse indicates death in one moment (shi). Healthy person breathes six times per pulse beat; if patient's pulse beats once per six breaths, it is named Liu Sun.

Absence of Qi in Four Zang organs corresponds to Si Sun; absence in Five Zang organs corresponds to Wu Sun; absence in Five Zang and Six Fu organs corresponds to Liu Sun.

Vigorous pulse with cold body indicates Shanghan; weak pulse with hot body indicates Shangshu (Summerheat Injury).

The Nei Jing states: "Pulse is the residence of Blood. Vigorous pulse means vigorous Blood; weak pulse means weak Blood. Cold injures Blood; pathogen merges with Blood, making Blood excess and Qi deficiency, hence Shanghan presents with vigorous pulse and cold body. Heat injures Qi; pathogen merges with Qi, making Qi excess and Blood deficiency, hence Shangshu presents with weak pulse and hot body."

Vigorous pulse in both Yin and Yang positions, profuse sweating, unresolved, indicates death.

Vigorous pulse in Yin and Yang positions should resolve with sweating; if sweating does not resolve it, pathogens overcome internally, righteous Qi escapes externally, hence death. The Nei Jing states: "Sweating with still restless/vigorous pulse indicates death." The Qian Jin Fang states: "Heat disease with sweat but still restless/vigorous pulse is the extreme of Yang pulses; fatal."

Weak pulse in both Yin and Yang positions, persistent heat, indicates death.

Weak pulse in Yin and Yang indicates weak True Qi; persistent heat indicates victorious Pathogen. The Nei Jing states: "Warm disease with severe deficiency is fatal."

Pulse alternating between intermittent and rapid indicates death.

Indicates severance of Primordial Ying and Wei Qi.

Pulse like a turning cord indicates death on that day.

Tight and non-soft, indicating lack of Stomach Qi, hence death within the day.

Delirium and妄语 (wild speech), slight body heat, floating-large pulse, warm hands and feet indicate survival. Cold limbs, deep-thin pulse indicate death within one day.

Delirium and wild speech are Yang diseases. Slight heat, floating-large pulse, warm limbs indicate pulse-disease correspondence. Cold limbs, deep-thin pulse indicate Yang disease showing Yin pulse, pulse-disease non-correspondence, hence death within one day. The Nan Jing states: "Pulse not matching disease, disease not matching pulse, is a fatal disease."

These above are the syndromes and signs of Shanghan and Heat Diseases.