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Qibo said: The four limbs are the root of all Yang meridians. When Yang Qi is excessive, the four limbs become solid and strong, thus enabling one to climb high. The Yellow Emperor asked: What causes those who discard their clothes and run? Qibo replied: Because heat is rampant in the body, they wish to discard clothes and run about. The Yellow Emperor asked: What causes those who speak nonsensically, curse, show no respect for kinship or strangers, and do not desire food, leading them to run wildly?

Zhang Xugu stated: The four limbs receive their Qi from the Spleen and Stomach. The Stomach is the sea of the Zang-Fu organs, and the Yangming Meridian circulates Qi through the three Yang meridians; therefore, the four limbs are the root of all Yang meridians. When pathogenic factors are excessive in the Stomach and Qi is solid in the four limbs, one can climb high. Heat rampant in the body causes discarding clothes and running; pathogenic factors disturb the Shen (Spirit), causing anger and impulse, leading to nonsensical speech and cursing. Excess pathogenic factors in the Stomach cause lack of desire for food, while excess strength in the four limbs leads to wild running. This is the syndrome of Dachengqi Tang (Major Order the Qi Decoction). If the pathogen involves the meridians, the pulse will be slippery and large; purgation can lead to survival. If the pathogen involves the Zang organs, the pulse will be deep and fine. Zhang Zhongjing stated: In Yang diseases, if Yin pulses are seen, death occurs. Thus, even if there are indications for purgation, it should not be used.

Wang Shixiong noted: Misadministration of hot tonic medicines in warm diseases can also produce these symptoms. For meridian-stage syndromes, Baihu Tang (White Tiger Decoction) may be applicable; a deep and fine pulse may also result from heat pathogen obstruction. If the physique is robust and the syndrome is excess, purgation can lead to survival; one cannot generally judge inevitable death solely based on the presence of Yin pulses. Whenever heat pathogen is obstructed, the pulse is often fine, soft, slow, or choppy. After clearing heat according to the syndrome, the pulse naturally becomes slippery and rapid. This differs from deficiency cases in internal injuries where taking cooling medicines causes the pulse to become more rapid.

Wang commented: For Dachengqi Tang syndrome, Zhang Zhongjing stated: A wiry pulse indicates survival; a choppy pulse indicates death. Huixi stated: A wiry pulse still holds a chance of survival, though not guaranteed; a choppy pulse implies certain death. I have observed slippery and large pulses where purgation could be used without hesitation, and also wiry pulses combined with choppy qualities that were cured by purgation. In cases of profuse sweating, Baihu Tang (White Tiger Decoction) can be used.

The *Suwen* (Basic Questions), "Shengqi Tongtian Lun" states: Affected by summerheat sweating, vexation leads to panting and loud breathing; in quietness, there is excessive talking.

Wu Jutong explained: Summerheat is a Fire pathogen, sharing the same Qi as the Heart. When the Heart is forced by pathogen, sweating and vexation occur. The character "vexation" (Fan) contains Fire and Page, indicating Heart Qi unrest and a face resembling smelting fire. Panting and loud breathing occur because Fire overcomes Metal (Lung). Summerheat obstructs the clear Qi in the chest, causing a desire to sigh and stretch. If the pathogen does not expand outward but hides internally in the Heart, the patient appears quiet. The Heart governs speech; with summerheat in the Heart, even in quietness, the patient desires to talk incessantly.

The *Suwen*, "Cizhi Lun" states: Qi excess with cold body results from Cold Damage (Shanghan); Qi deficiency with hot body results from Summerheat Damage (Shangshu).

Lin Guanzi stated: Although it says "cold body," it actually refers to fever. One must grasp this through mental comprehension.

Wang Shixiong noted: Although there is fever, there is still aversion to cold, unlike Shangshu which features aversion to heat; hence it is called "cold body."

Wu Jutong stated: This distinguishes Shanghan from Shangshu. The classic text is so clear; why do people treat warm and summerheat diseases with methods for cold diseases?

Wang Shixiong noted: Not only is it distinct that Cold damages the Form and Summerheat damages the Qi, but Cold is a Yin pathogen (even with red stoves, warm rooms, lamb wine, and fox furs, contracting fire disease proves Cold is not a Yang pathogen; Cold often combines with Fire), while Summerheat is a Yang pathogen (even with conditions involving cooling off and drinking cold liquids mixed with Yin-Cold, these are human-caused combined injuries, not the natural state of weather). This is like water and fire not射 (clashing/complementing). The classic states: Heaven is cold, earth freezes; Heaven is hot, earth is warm. It also states: The rise and fall of Yin and Yang manifest in Cold and Summerheat. The logic is extremely clear, yet later scholars seek far when the way is near, unaware of errors in theory and medication.

Gan commented: "Obtained from" traces the origin of illness to clarify etiology. Shanghan and Shangshu are two major outlines in the *Neijing*, discussed from a perspective of opposition. Cases like "Wind damage in Spring generates loose stools in Summer" discuss the four seasons. Yu Jia Yan added "Dryness damage" to the *Neijing*, showing that all Qi pathogens can cause disease. Ancient sages and later scholars have analyzed this clearly. Why do modern practitioners treat all infections with Shanghan medicines, ignoring Warm, Summerheat, Dryness, and Damp diseases? This is ignorant!

The *Suwen*, "Relun Pian" asks: After heat disease subsides, why does residual heat sometimes remain? Qibo replies: Residual heat in all diseases occurs because one forces eating when heat is severe. In such cases, although the disease has declined, heat is hidden. The Qi of grain conflicts with residual heat, combining two heats, causing residual heat. How to treat residual heat? Observe deficiency and excess, regulate reversal and normalcy, and the disease will surely heal. What are the dietary prohibitions for heat disease? When heat disease slightly improves, eating meat causes relapse; overeating causes residual heat. These are the prohibitions.

Ye Tianshi stated: Sweating due to food relapse, labor relapse, or sexual activity relapse will inevitably lead to collapse of Yang Qi and death.

Zhang Xugu explained: This refers to early recovery where residual heat remains in meridians and blood/Qi uncleaned. Food aids Qi, combining with residual heat to reignite. Eating meat causes disease relapse; overeating grains leaves pathogen lingering, making cure difficult. One must guard the mouth, using light, bland, thin porridge for gradual nourishment.

The *Suwen*, "Lunji Chichi Pian" states: Skin at the Chi position is very hot, and the pulse is vigorous and restless; this is Wenbing (Warm Disease). If the pulse is vigorous and slippery, the pathogen is about to exit.

Wu Jutong stated: The classic distinction of Wenbing is clear. Why do people call it Shanghan and treat it with methods for the three Yin meridians of foot Shanghan? Zhang Huiqing's *Leijing* fragmented the classic text, confusing chapters, due to lack of careful deduction. Very hot Chi skin indicates Fire scorching Essence. Vigorous and restless pulse indicates Essence boiling under Fire. Vigorous and slippery pulse indicates pathogen mechanism moving outward.

The following section describes methods for diagnosing Wenbing.

The *Suwen*, "Pingren Qixiang Lun" states: Three beats per exhalation and three beats per inhalation, with restlessness. Hot Chi skin indicates Wenbing; non-hot Chi skin with slippery pulse indicates Fengbing (Wind Disease); choppy pulse indicates Bi Syndrome.

Wu Jutong explained: Six to seven beats per breath cycle with restless imagery. If Chi skin is hot, it is Wenbing. Wenbing injures Jin (Fluids) of Lung Metal and Kidney Water. Chi pulse belongs to Kidney; Chi acupoint belongs to Lung. Heat here indicates Wenbing. Non-hot with slippery pulse indicates Wind. Wind attacks Yang first. Chi is Yin, so it is not hot. Restless and choppy pulse indicates excess Qi and deficient Blood, resulting in Bi Syndrome.

The *Suwen*, "Yuban Lunyao" states: Wenbing with extreme deficiency leads to death.

Wu Jutong explained: In Wenbing, if Jing and Blood are extremely deficient, there is no Yin to overcome Heat, leading to death.

The *Suwen*, "Rebing Pian" states: On the third day of heat disease, if the Qi Kou pulse is calm and the Ren Ying pulse is restless, treat the various Yang meridians using the Fifty-Nine Acupoints needling method to drain heat and induce sweating. Solidify Yin to supplement insufficiency.

Wu Jutong explained: Restless Ren Ying pulse indicates pathogen in the Upper Jiao. Treating Yang meridians drains Yang pathogen;畅通 Yang Qi induces sweating. Solidifying Yin supplements insufficiency because Yang excess leads to Yin decline. Draining Yang allows Yin to settle, thus "solidifying Yin." Draining Yang excess supplements Yin insufficiency.

Wang Shixiong noted: The principle of medication is the same.

It further states: "Solidify Yin to supplement insufficiency" is the crucial outline for treating warm-heat diseases. Heat diseases always consume Yin. If consumption is incomplete, life is possible; if complete, Yang has no attachment and collapses, leading to death. Truly understanding this phrase covers half the treatment logic.

Wang Shixiong noted: If consumption is incomplete, there is a glimmer of hope. If exhausted and Yin is depleted, it is like dry seedlings with dead roots. Even heavy rain would not help.

Wang commented: Ye Tianshi emphasized preserving Jin (Fluids). Examining this classic passage reveals the rationale. Why use ascending, warming, and drying drugs recklessly, severely injuring fluids?

If body heat is severe but both Yin and Yang pulses are calm, do not needle. For those suitable for needling, act quickly; if no sweat, use draining methods. "Do not needle" indicates signs of death.

Wu Jutong stated: Yang syndrome with Yin pulse means do not needle.

On the seventh or eighth day of heat disease, if panting and wiry pulse appear, urgently needle; sweat will self-emerge. Superficially needle between the thumb and index finger.

Wu Jutong explained: Panting indicates Lung Qi excess; wiry pulse indicates Wind and Fire agitation. Superficial needling between the thumb (Shaoshang point) drains Lung heat. Opening Lung heat-bi induces sweating.

On the seventh or eighth day, if pulse is minute and small, urine blood occurs, and mouth is dry, death occurs within 1.5 days. If the pulse is intermittent (Dai), death occurs in one day.

Wu Jutong explained: Pathogen enters Lower Jiao, forcing blood out via urine (hematuria). Kidney Essence is exhausted, Yin fluids cannot ascend, causing dry mouth. Minute/small pulse indicates not only Yin Essence exhaustion but also Yang Qi depletion, clearly indicating death. If the pulse is solid, it is treatable.

After sweating in heat disease, if the pulse remains restless, panting recurs, and fever returns, do not needle the skin. Severe panting indicates death.

Wu Jutong explained: Heat not reduced by sweat indicates Metal受克 by Fire. Panting suggests source of transformation is failing, leading to death. However, some cases are treatable.

In heat disease, if the patient feels no pain, is deaf, cannot control movements, has a dry mouth, intense Yang heat, yet significant Yin cold sensation, the heat is in the marrow. This is incurable and fatal.

Wu Jutong explained: No pain indicates weak Zheng Qi unable to fight pathogen. Deafness indicates Yin injury and Essence depletion. Inability to control movements indicates exhausted Zheng Qi. Dry mouth and intense heat indicate solitary Yang pathogen excess. Significant Yin cold indicates pathogen deeply entered Yin division; external cold is apparent, but heat is in marrow. Hence, death/incurable. Cases where Yin Essence is not completely depleted may rarely survive.

If after sweating, the pulse remains extremely restless, this is the extreme of Yin pulse, indicating death. If pulse becomes calm after sweating, survival is indicated.

Wu Jutong explained: Restless pulse after sweat indicates extreme Yin deficiency, hence death. Although needling is contraindicated, proper administration of sweet-cool medicines may save the patient.

If pulse is vigorous and restless without sweat in heat disease, this is the extreme of Yang pulse, indicating death. If pulse is vigorous/restful but becomes calm after sweating, survival is indicated.

Wu Jutong explained: Restless pulse without sweat indicates extreme Yang excess. Extreme Yang leaves no room for Yin, hence death. This differs slightly from Yin-Yang both calm. This condition can still be treated with large doses of urgent Yin-nourishing medicine, potentially saving the patient. Even with sweat, if Yang pulse is vigorous, pathogen is strong and Zheng Qi weak, but Zheng Qi still fights. Retaining one part of fluid retains one part of life. Crucial is retaining fluids properly. If Yin-Yang are both calm, pathogen enters Lower Jiao Yin division, Zheng Qi has no defense intent, leaving fate to pathogen; death is inevitable.

There are nine conditions in heat disease where needling is contraindicated:
1. No sweat, red cheeks, and hiccups indicate death.
Wang Shixiong noted: No sweat and red cheeks suggest Yang excess. Hiccups (E'ni) result from failure of Lung and Stomach Qi to descend. Yang commentary: This is an excess syndrome, causing facial redness, not just cheeks, leading to upward rebellion. Light, clear, resolving agents might cure it, yet the classic deems it incurable. Perhaps it means Heat pathogen is blazing while Kidney Yang is failing, Yang has no root, and deep disease manifests as hiccups. Yang commentary: Cheeks belong to Kidney. Redness indicates floating Yang escaping upward. Combined with hiccups, syndrome and color match, indicating imminent collapse, hence incurable. Hiccups likely rise from Lower Jiao, caused by Winter failure to store Essence. Pulse would differ from Upper Jiao Yang excess.

2. Diarrhea with severe abdominal fullness indicates death.
Wang Shixiong noted: Abdominal fullness requires draining. If diarrhea occurs but fullness worsens, pathogen remains while Yin collapses downward, similar to heat not reducing with sweat, hence death. Chen Yuan Gong stated: Panting, fullness, fixed gaze, delirium, and diarrhea appearing together are incurable. If any symptom is absent, survival is possible. Use Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Baishao (White Peony Root) each 30g, Shigao (Gypsum Fibrosum) 15g, Zhuru (Bambusae Caulis in Recens) 9g, named Wantuo Tang (Rescue Collapse Decoction). Administer urgently when collapse is impending.

3. Blindness with persistent heat indicates death.
Wu Jutong explained: Blindness indicates scattered Essence and collapsing Qi. Classic states: Scattered Essence causes diplopia. Collapsing Qi causes blindness. Persistent heat continues to scorch Essence and injure Qi, leading to death.
Wang commented: This blindness corresponds to "Depletion of Yin causes blindness" in *Nanjing*. Yin exhaustion with persistent heat leads to death.

4. Elderly and infants with heat and abdominal fullness indicate death.
Wang Shixiong noted: Abdominal fullness requires draining. Elderly and infants cannot tolerate strong draining. Without drainage, heat has no outlet. Bodies lacking Yin fluids in old age/weakness will dry up immediately, hence death.

5. No sweat, vomiting, and lower bleeding indicate death.
Wang Shixiong noted: No sweat forces heat inward. Upward invasion of clear pathways causes vomiting. Pressing/scorching Ying Blood causes lower bleeding. Dual loss of Yin fluids indicates death.

6. Tongue ulceration with persistent heat indicates death.
Wu Jutong explained: Deep Yang pathogen causes Fire of Yin and Yang to knot in Blood division. Kidney Water fails to ascend, causing tongue base ulceration. If heat subsides, survival is possible; persistent heat indicates death.
Wang commented: This tongue ulceration stems from deficient Yang in Kidney, deemed incurable, differing greatly from Lung/Stomach blazing heat with oral ulcers.

7. Cough with epistaxis, no sweat, or sweat not reaching feet indicates death.
Wu Jutong explained: Cough and epistaxis indicate pathogen closing Lung collaterals, invading clear pathways. Sweat allowing pathogen exit leads to survival; otherwise, source of transformation fails.
Wang Shixiong noted: Sweat not reaching feet indicates Lung Qi failing to descend, also a sign of failing source of transformation.

8. Marrow heat indicates death.
9. Heat with spasms indicates death. Back arching, convulsions, and teeth grinding.
Wu Jutong explained: Marrow heat indicates pathogen entering deepest level, reaching Kidney. Heat with spasms indicates pathogen entering deepest level, reaching Liver.

This section lists death signs of heat disease to prohibit needling, as needling ensures death. However, while needling is contraindicated, drug therapy may cure. Needling drains and unblocks, opening heat closure fastest. Nourishing Yin to preserve fluids is key. Yang commentary: These two phrases are the essence of treating warmth. This is the weakness of needling and the strength of decoctions.

Wang commented: Reviewing the nine death conditions, most stem from Yin exhaustion. Wu Shi's words hit the mark.