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Yu Chang said: When a sage king governs the world, there is no excessive Yang in spring, no latent Yin in summer, no chilling wind in autumn, and no bitter rain in winter. Consequently, the people suffer no premature death or plague, and all things are free from disease and pestilence. The Qi of Great Harmony fills heaven and earth; how could there be such a thing as epidemic plague (Wenyi)? However, the *Rites of Zhou* prescribes the Nuo dance to drive away epidemics, managed by the Fangxiang Shi, indicating that epidemics have existed since ancient times. When the villagers performed the Nuo ritual, Confucius wore his court robes to show sincerity and reverence. This was likely because the giant statues used as Nuo deities merely imitated their forms; the sages filled this space with righteous Qi, causing the epidemic Qi to dissipate secretly. This is the practical achievement of nurturing and sustaining life. In ancient times, on New Year's Day, people drew clear spring water to drink aromatic medicines; on the Shangsi Festival, they gathered orchids to scent themselves, both practices aiming to cleanse filth.

In the Later Han Dynasty, Zhang Zhongjing wrote the *Treatise on Cold Damage* (*Shanghan Lun*) to clarify the normal diseases of winter cold, spring warmth, and summer/autumn heat. Naturally, he could not merge epidemic diseases into these conventional methods. However, the profound principles were fully contained within the pulse methods. Wang Shuhe did not carefully analyze them but instead claimed that contracting cold twice transforms into an epidemic. He also stated that when spring should be warm but is extremely cold, summer should be hot but is extremely cool, autumn should be cool but is extremely hot, and winter should be cold but is extremely warm. This phenomenon of having the Qi of one season in another causes illness among people of all ages with similar symptoms throughout the year; this is called the Qi of the Time Course (Shixing Zhi Qi). He further stated that the toxicity of Winter Warmth (Dongwen) is vastly different from cold damage. Winter warmth has sequences and overlaps, varying in severity, requiring different treatments. He also claimed that between the Spring Equinox and the Autumn Equinox, sudden cold spells are all called "Time Course Cold Epidemic" (Shixing Hanyi). Essentially, this labels the epidemics of spring, summer, and autumn as cold epidemics, and those of winter as true epidemics. Thus, it was said that in March and April, sudden cold occurs when Yang Qi is still weak and suppressed by cold, resulting in mild heat symptoms; in May and June, Yang Qi is strong but suppressed, resulting in severe heat symptoms; in July and August, Yang Qi is declining and suppressed, resulting in slight heat symptoms.

Later generations adopted this view and expanded its meaning, claiming that spring feels clear pathogenic factors affecting the Liver, summer feels cold pathogenic factors affecting the Heart, autumn feels hot pathogenic factors affecting the Lung, and winter feels warm pathogenic factors affecting the Kidney. Like the alternating notes of Xun and Chi instruments, this madness spread through the world. Alas! Did epidemic pathogens arrive by cold suppressing Yang Qi, exploiting its weakness, and entering directly into the Zang organs of spirit, vitality, and soul? People have misunderstood this for a long time. Others argue that epidemic pathogens have no form, sound, or smell, allowing for fixed timing and prescriptions, which is why everyone falls ill regardless of age, while only one or two out of a hundred contract cold damage. If treatment does not unblock the interior, the exterior cannot be released; if it does not induce battle sweating (Zhanhan), the disease will not resolve. The more one describes it, the further from the truth. Ultimately, the referred "epidemic" remains the standard diseases of cold damage, warmth damage, and heat damage. Unblocking the interior reveals premature purgation; inducing battle sweating reveals missed exterior release. These errors only expose one's own deficiencies.

Pathogenic factors of the four seasons cause disease upon contraction, initially not called "epidemic." Only when death occurs from the disease, and the Qi of the sick and corpses mixes with the irregular Qi, does it become an epidemic. Just as chicken plague kills chickens, swine plague kills pigs, and cattle/horse plague kills cattle and horses, humans are no different. Therefore, during famines and wars, epidemics prevail, especially at the transition of spring and summer. The Qi of warmth, summer-heat, heat, and dampness interweave and steam each other. People within this environment have no gap to avoid it. Those affected sweat profusely; one person's disease Qi can fill a room. Especially when beds are adjacent and houses are connected, the jointly brewed Qi, combined with corpse insects outside and rotting flesh on roads, burning wood to cover bodies, and casting corpses into ditches and cliffs—all sorts of foulness—mixes with the pure Qi of heaven above and corrupts the Qi of soil and water below. Humans who receive this, following the principle of "like attracts like," inevitably fall ill.

For example, the so-called "Big Head Plague" (Datou Wen) involves swelling of the head, face, cheeks, and jaw like a gourd. The "Toad Plague" (Xama Wen) involves throat obstruction, loss of voice, and swollen neck tendons. The "Melon Rind Plague" (Guanang Wen) involves high chest and rising ribs, vomiting blood-like fluid. The "Lump Plague" (Geda Wen) involves widespread redness and swelling, with lumps like tumors. The "Intestine Twisting Plague" (Jiaochang Wen) involves abdominal rumbling, dry retching, and watery diarrhea without relief. The "Soft Leg Plague" (Ruanjiao Wen) involves clear urine and white stool, with heavy legs difficult to move. Pediatric smallpox is also common. For these epidemic conditions, if the treatment method is unknown, victims resign themselves to fate, which is truly lamentable. Generally, ancient texts lacked transmission on epidemic plagues and pox, lacking sage guidance to correct errors, thus falling into Wang Shuhe's pitfalls. It would be better than worldly guesses based on symptoms, which might allow understanding by name. Fortunately, I have glimpsed a fragment of Zhang Zhongjing's wisdom. In the *Ping Mai Pian* (Chapter on Pulse Assessment), he states: "When both Yin and Yang pulses at the Cun position are tight, clear pathogenic factors attack the Upper Jiao, and turbid pathogenic factors attack the Lower Jiao." Clear factors attacking above are named "Jie" (Pure); turbid factors attacking below are named "Hun" (Turbid). Attack on Yin causes internal trembling. With deficient superficial Qi and insecure interior Qi, pathogens enter the Yin. Attack on Yang causes fever, headache, stiff neck, neck spasm, lower back pain, and leg soreness. This is known as Yang being struck by fog and dew. Hence, clear factors attack above, turbid factors attack below. Yin strike causes trembling, cold feet and knees, and involuntary urination/defecation. With slightly deficient superficial Qi and slightly urgent interior Qi, the Three Jiaos become confused, and interior/exterior communication stops. Upper Jiao stagnation leads to organ Qi steaming each other, causing mouth ulcers and gum erosion. Middle Jiao dysfunction leads to Stomach Qi rushing upward, Spleen Qi failing to transform, turbidity in the Stomach, blocked Ying and Wei Qi, and stagnant blood flow. If Stomach Qi flows forward, urine becomes dark yellow, combats heat, acts as a vehicle for heat, travels through meridians and organs, and where heat passes, abscesses and pus form. If Yin Qi flows forward, Yang Qi is slightly inverted, Yin has no command, external pathogens enter internally, sneezing expels them, voice and throat become blocked, cold inversion chases heat, heat suppresses it, blood coagulates and exits downward, resembling pig liver. If both Yin and Yang invert, Spleen Qi is isolated and weak, five fluids pour downward, Lower Jiao fails to close, clear stool feels heavy, frequent difficult defecation occurs, umbilical cramping and shallow pain arise, and life is endangered. These 269 characters elucidate profound principles, entirely unrelated to cold damage, but rather discussing the entry portal and general transformation of epidemic pathogens—the "red script and green characters," the treasure talisman of creation, unrecognized by people.

The main idea of the chapter is: Human nose Qi connects with Heaven; thus, Yang struck by fog/dew is clear pathogenic factors entering Yang via respiration, causing fever, headache, stiff neck, and spasm, matching the popular descriptions of Big Head and Toad Plagues. Human mouth Qi connects with Earth; thus, Yin struck by soil/water is turbid dietary flavors entering Yin via mouth/tongue, causing internal trembling, cold limbs, involuntary excretion, heavy clear stool, and umbilical pain, matching the descriptions of Intestine Twisting and Soft Leg Plagues. However, pathogens entering via nose/mouth must first settle in the Middle Jiao, then distribute up and down. Thus, Middle Jiao infection leads to dysfunction. Middle Jiao dysfunction causes stomach turbidity, blocked Ying/Wei Qi, and stagnant blood. Its manifestations appear in the Middle Jiao, corresponding to popular Melon Rind and Lump Plagues, which are akin to Yang Toxicity abscesses and Yin Toxicity whole-body cyanosis. These are pathogens located in specific Jiaos. If Three Jiao pathogens mix into one, blocking interior/exterior, steaming organ Qi, and stagnating Upper Jiao, mouth ulcers occur. If Wei Qi flows forward, heat travels meridians/organs, causing abscesses. If Ying Qi flows forward, named guest pathogens, sneezing blocks throat, heat suppression causes bloody stool like pig liver. Since Ying/Wei gradually connect, it is not critical. If Upper Jiao Yang and Lower Jiao Yin do not connect, Spleen Qi in the middle cannot operate alone. Five fluids pour down, Lower Jiao fails to close, and life is endangered.

Cold damage pathogens travel the back, then front, then sides of the body, entering from the exterior. Epidemic pathogens travel the central pathway, distributing through the Three Jiaos. Upper Jiao is Clear Yang, so clear pathogens enter from above. Lower Jiao is Turbid Yin, so turbid pathogens enter from below. Middle Jiao is the boundary of Yin/Yang, where clear/turbid separate. Severe cases confuse the Three Jiaos; extreme ascent leads to descent, extreme descent leads to ascent. Thus, throat blockage and mouth ulcers accompany bloody stool like pig liver. It is not that upper/middle misses lower, or lower/misses upper. Cold damage pathogens are on the exterior, so releasing the exterior disperses them. Epidemic pathogens are in the central pathway, so releasing the exterior fails. Cold damage pathogens enter the Stomach/Fu organs, causing fullness and hard stool, allowing purgation. Epidemic pathogens are in the Three Jiaos, scattered and unrestrained; purgation causes re-aggregation. How does this relate to cold damage exterior-interior methods? Why remain confused for millennia? Let us use sage words to correct past errors.

Treatment: Before illness, pre-drink aromatic righteous Qi medicine to prevent pathogen entry (superior method). Once entered, removing filth is the primary principle. Upper Jiao is like mist; lift and remove it, plus detoxify. Middle Jiao is like fermentation vat; dredge and remove it, plus detoxify. Lower Jiao is like a drain; drain and remove it, plus detoxify. Once Ying/Wei connect, pursue and extract pathogens forcefully, preventing hidden proliferation.

Q: Summer/Autumn steam creates epidemics; is Winter Warmth not an epidemic? A: Excessive warmth in winter causes Kidney Qi to fail to store, leading to illness, identical to Spring Warmth from failing to store Essence. At this time, there is spring but no winter; three Qi interact to create epidemics. However, sudden north winds evaporate this steam. Northwest lands are high and dry; even spring/summer Qi struggles to rise, let alone winter freezing. Southeast lands are low and wet, areas of fog/dew and dragons/snakes. Their warm Qi spreads with wind, tolerable. Without wind day or night, fish in water and lice in clothes fly about; how much more so for humans? Steam contains filth, plus disease/corpse Qi. Young and old alike contracting it show identical symptoms. North winds are unavailable here, so Qi accumulates and becomes violent. Even warm breezes only send heat, not coolness. What brings peace and wealth in prosperous times brings evil and filth in war and famine. Wang Shuhe considered summer coldness as epidemic; little did he know that extreme cold is actually the sign of epidemic dissipation. Thus, intense epidemics are best endured in the North. The *Classic of Poetry* expresses hatred for bad men by wishing to cast them into the North to extinguish their flame. This analysis is precise.