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The Master said in the *Treatise on Cold Damage*: For diseases caused by latent pathogenic factors (latent qi), one must use inference to diagnose them. Within this month, there may be an outbreak of latent qi. If one previously had latent qi, it is necessary to examine the pulse. If the pulse is weak and faint, there should be throat pain that feels like an injury, but this is not Hou Bi (a disease characterized by severe sore throat and obstruction). The patient says: "Indeed, there is severe throat pain." Although so, now there is also a desire for diarrhea.

Zhang Luyu stated: In winter, cold pathogenic factors are contracted and lie hidden in the meridians, to erupt in spring; hence it is said that one must use inference to diagnose. "Within this month" refers to the period around the Spring Equinox. If the pulse is weak and faint, it indicates that the person's primordial essence is deficient. The pathogen will certainly not erupt from the Yang meridians but from the Yin meridians. Since the Shaoyin meridian runs along the throat, when the latent pathogen begins to erupt, the heat must rise upward, thus causing throat pain resembling an injury. The Kidney governs opening and closing; since the heat pathogen in the meridians cannot vent outward, it will inevitably attack inward, leading to diarrhea subsequently.

Zhang Xugu stated: This clause teaches how Zhongjing distinguishes warm diseases caused by winter-lodged cold pathogens erupting in spring, which should be diagnosed through mental inference. Just as within this month, if one is about to suffer from a latent qi disease, there will be symptoms without the corresponding seasonal climate. When the illness does not match the seasonal qi, one can know that the cause is the eruption of old latent qi. If one has old latent qi, one must carefully examine the pulse to determine where the pathogen emerges. If the pulse is weak and faint, it indicates that although the pathogen has transformed into heat, it has not yet left the Shaoyin meridian. It follows the meridian upward and burns, causing throat pain resembling an injury. However, this is not Hou Bi caused by external pathogens entering internally, but rather throat pain caused by internal heat attempting to vent outward. Why? If one contracts wind pathogens in spring, the pulse will be floating and wiry-rapid, preceded by exterior signs such as fever and aversion to cold. Now, with a weak and faint pulse, it is not an external contraction. Instead, the presence of throat pain confirms it is internal latent heat erupting—symptoms present without the corresponding seasonal qi. As latent heat rises and cannot disperse outward, it will inevitably move downward. Hence, it is indeed throat pain. Although so, there is now also a tendency toward diarrhea. However, there are cases complicated by external contractions; by carefully examining the pulse and signs, one can distinguish them according to this method. Observing Zhongjing’s labeling of pulses for Wind Strike, Cold Damage, Summerheat, etc., they align with the *Classic of Difficult Issues* (*Nan Jing*). Only the *Nan Jing* states that the pulse of warm diseases moves through various meridians, without specifying which meridian is activated. One takes the pulse at the location of the affected meridian. This means that warm diseases initially arise from latent pathogens circulating with Qi and Blood through the meridians. When the pathogen erupts, it is unknown from which meridian it originates. After eruption, treatment follows the meridian where the pathogen resides. Since its eruption has no fixed location, there is no fixed pulse manifestation to indicate it. Now, Zhongjing further teaches examining the pulse to identify the meridian of eruption. For example, a weak and faint pulse indicates the pathogen has not left Shaoyin, and symptoms like throat pain and diarrhea must be present. This perfectly complements the *Nan Jing*. Thus, the text below states that when pathogens emerge from the Three Yang meridians, heat intensity is great, and the pulse is floating and large, reaching above the Guan position. This shows that the pulse changes with the syndrome, and the syndrome manifests with the pulse. Since eruption has no fixed location, there are no fixed syndromes; since there are no fixed syndromes, there are no fixed pulses. Hence, the *Nan Jing* does not label specific pulse manifestations. From this, we see that it is vastly different from external pathogens that have fixed syndromes and pulses. Therefore, Zhongjing’s view is consistent with the *Nan Jing*.

Shaoyin disease, characterized by a faint and fine pulse and a desire only to sleep. On the second or third day, if there is throat pain, Gancao Tang (Licorice Decoction) may be given; if it does not improve, Jiegeng Tang (Platycodon Decoction) is given.

Zhang Luyu stated: When Yin pathogens cause disease, their eruption is necessarily sudden. Thus, when latent qi erupts in Shaoyin, throat pain invariably occurs. Zhongjing therefore treats it with a mild method. Gancao (Licorice Root) is sweet in flavor and has the mildest nature. It is selected to treat the most acute cases of warm disease erupting from Shaoyin latent qi. Sweetness first enters the Spleen; when Spleen Qi is relaxed, the momentum of Yin Fire is also moderated. Moreover, raw Gancao can drain fire. Therefore, it is used alone without other herbs to achieve a focused effect. If it does not improve, it indicates that the latent pathogen’s eruption is vigorous, and the mild method is insufficient to address the urgency. Adding Jiegeng (Platycodon Root) lifts and carries the pathogen, allowing the Yin pathogen erupted into the Yang aspect to dissipate entirely through the Yang aspect, preventing it from sinking back into the Yin aspect. If treatment is slightly inappropriate, and Yin fluids are consumed by heat pathogens, even using drugs to clear heat and save Yin may come too late.

Ye Tianshi stated: Warm-heat diseases in spring and summer necessarily spread from the interior to the exterior. Wang’s Note: This specifically refers to diseases caused by latent qi.

You Zhuowu stated: Shaoyin belongs to Yin, and cold pathogens also belong to Yin. Yin encountering Yin allows for concealment without eruption. Therefore, pathogens of Cold Damage pass from Taiyang sequentially into the Three Yin meridians; whereas pathogens of Warm Diseases transmit from Shaoyin out to the Three Yang meridians.

Zhang Xugu stated: When Wind-Cold externally closes Shaoyin causing throat pain, Zhongjing used Banxia San (Pinellia Powder) with acrid-warm methods to open and drain. Here, Shaoyin latent heat erupts internally, burning upward along the meridian to cause throat pain. Although acrid-warm opening methods are unsuitable, cooling medicines should not be used to suppress its outward venting trend. Therefore, Gancao (Licorice Root) is used for its sweet and neutral nature to harmonize the Middle and guide the pathogen outward. If it does not improve, Jiegeng (Platycodon Root) is added to unblock Qi upwards. Yang’s Comment: Based on this, the dosage of Jiegeng should be light. Generally, pain arises because Fire is constrained and cannot vent outward. Unblocking Qi allows Fire to vent outward, and the pain stops naturally. Pathogens of Cold Damage enter from the exterior to the interior, starting at Taiyang and then reaching Shaoyin. Pathogens of Warm Diseases exit from the interior to the exterior, starting at Shaoyin and then emerging at Taiyang. Historically, failing to distinguish origins and flows has led to confused sequencing of clauses and mixed-up descriptions of Cold Damage and Warm Diseases.

Gan’s Note: Diseases caused by latent qi all develop from the interior outward, not limited to just Spring Warmth. Generally, the Qi of the four seasons all have instances of lying latent for a long time before erupting; this must be known.

Shaoyin disease, with diarrhea, throat pain, chest fullness, and vexation, is primarily treated with Zhufu Tang (Pig Skin Decoction).

Zhang Luyu stated: Diarrhea, throat pain, chest fullness, and vexation indicate that although the Shaoyin latent pathogen erupts in the Yin meridians, it is actually a Heat syndrome. The pathogenic heat fills the upper, lower, middle, and interior, leaving nowhere untouched. Cold purgative medicines must not be used. Zhufu Tang is established to moisten Shaoyin dryness, similar in intent to using black donkey skin. For slight Yang deficiency, Fuzi (Aconite Root) is used to warm the meridians; for Yin exhaustion, Zhufu (Pig Skin) is used to moisten dryness. Both share the intent of dispersing pathogens. Comparing them reveals much insight.

Shaoyin disease, persisting for two to three days or more, with vexation in the heart and inability to lie down, is primarily treated by Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).

Zhou Yuzai stated: Before the latent pathogen erupts, body fluids have already been secretly consumed. Now, after two or three days, although Yin Fire does not rise and symptoms like throat pain are absent, the presence of heart vexation and insomnia indicates Yin fluid consumption. Therefore, Huangqin (Scutellaria Root) and Lianzi (Coptis Rhizome) are used to remove heat, while Ejiao (Donkey-Hide Gelatin) and Shaoyao (Peony Root) nourish Yin, achieving both goals.

Shaoyin disease, with diarrhea for six or seven days, accompanied by cough, vomiting, thirst, vexation, and inability to sleep, is primarily treated by Zhuling Tang (Polyporus Decoction). Yang’s Comment: This case likely involves retained fluid retention, hence the prescription.

Zhang Xugu stated: Here, there is no throat pain. The pathogen travels directly from the Lung to the intestines and stomach, causing diarrhea. After six or seven days without stopping, heat sinks downward and cannot vent outward. Reversing into the Lung causes cough and vomiting; attacking the Heart causes vexation, thirst, and insomnia, because both the Heart and Lung connect to the Shaoyin meridians. Zhuling Tang is used to promote urination and nourish Yin. Nourishing Yin allows heat to leave with the urine; promoting urination stops diarrhea and resolves vexation and thirst.

Shaoyin disease, developing over two or three days, with dry mouth and throat, requires urgent purgation, preferably using Dachengqi Tang (Major Order the Qi Decoction).

Zhang Luyu stated: Eruption of latent qi in Shaoyin is the most urgent, differing from the transmittal heat syndromes of Cold Damage. Within just two or three days of onset, dry mouth and throat appear. Delaying purgation until the fifth or sixth day would result in withering and difficult treatment. Therefore, urgent purgation is needed to rescue the blazing Kidney Water. ○ Note on the Three Urgent Purgations of Shaoyin: One belongs to extreme hyperactivity of transmittal heat pathogens; one belongs to heat pathogens transferring to the Stomach Fu; one belongs to warm diseases originating in Shaoyin. All are critical conditions requiring immediate rescue of nearly exhausted Kidney Water, sharing the same source but different branches with the Three Urgent Purgations of Yangming.

Zhang Xugu stated: The previous five clauses all involve pathogens remaining in Shaoyin, with varying degrees of severity and虚实 (deficiency/excess). Furthermore, transmission to other meridians leads to endless variations. Observing Zhongjing’s formulation of prescriptions according to syndromes and his precise differentiation and treatment reveals profound principles beyond words.

Taiyang disease, with fever, thirst, and no aversion to cold, is classified as Warm Disease.

Guo Baiyun stated: Winter cold injury erupting as warm disease in spring; or contracting wind-warm Qi spontaneously in spring without winter cold injury, is also called Warm.

Wang Shixiong’s Note: Spontaneous contraction of warm diseases was not discussed by Zhongjing; details are found in Ye’s works, Volume 3.

Wang Andao stated: Since warm diseases are like this, heat diseases are also like this. Therefore, those without thirst and with aversion to cold are not warm-heat diseases. If warm-heat diseases present with aversion to wind or cold, it indicates a new contraction of Wind-Cold superimposed on the condition.

Zhou Yuzai stated: Warm diseases erupt from latent pathogens inside. Once they reach the exterior, both interior and exterior become hot. As heat intensity strengthens, constrained pathogens consume fluids, causing thirst upon eruption. The exterior originally has no pathogen constraint, and the interior prefers cold, hence no aversion to cold. By the third to fifth day, abdominal fullness or diarrhea may occur, representing this syndrome. This is greatly different from Cold Damage, which starts at the exterior and moves to the interior. However, it still relates to Taiyang because no other meridian symptoms are apparent, clarifying that it emanates from Shaoyin affecting both interior and exterior.

Ye Tianshi stated: Fever with thirst indicates warm-heat pathogens reaching the exterior from the interior. If mistaken for an exterior condition and treated with sweating, the disaster is incalculable.

Shen Yaofeng stated: Although this clause does not mention the pulse, referring to the next clause, the Chi position pulse must be floating.

Zhang Xugu stated: The eruption of warm diseases has no fixed location. The exterior of Shaoyin is Taiyang. When heat pathogens exit the interior to the exterior, Taiyang disease with fever and headache appears. No aversion to cold proves it is not an external pathogen. Thirst indicates heat erupting from the interior. Zhongjing specifically labels this as warm disease from internal latent heat to prevent misdiagnosis as Taiyang Wind-Cold. The reason Shaoyin Warm Disease is not separately labeled is that the latent qi clause already clarified throat pain and diarrhea as the initial presentation of Shaoyin warm disease.

Wang Shixiong’s Note: Xiaojuan Wang Xiecheng stated: Wu’s *Systematic Differentiation of Warm Diseases · Upper Jiao Chapter* first cites the *Treatise on Cold Damage*: "Taiyang disease, only aversion to heat, no aversion to cold, and thirst, is named Warm Disease, treated with Guizhi Tang." However, checking the *Treatise on Cold Damage*, these words are absent. If truly from Zhongjing, errors should be corrected. If Wu mistakenly recorded it, correction is essential. I believe it is not a mistake. Yu Shi once said: Zhongjing treated warm syndromes using Guizhi Tang for any exterior-releasing medication, indicating slight sweating rather than profuse sweating. You Zaijing’s *Reading Records* states: This is Yu Shi’s speculation, not Zhongjing’s original principle. Ju Tong claimed to escape the circle of Cold Damage but unknowingly fell into Jiayan’s trap. Not willing to be inferior, he arbitrarily altered the original text, fabricating sage teachings to attach himself to the orthodox lineage, unaware of his crime in slanderizing sages and misleading the world. It is lamentable.

Wang’s Note: Ju Tong wrote with determination to criticize the evils of ascending, dispersing, warming, and drying agents. His merit is significant. However, there are many points open to discussion. Mengyin’s book removes flaws and preserves virtues, making him a true friend who corrects Ju Tong.

If after sweating, the body becomes scorching hot, it is named Fengwen (Wind-Warm). Fengwen disease presents with floating pulses at both Yin and Yang positions, spontaneous sweating, heavy body, excessive sleepiness, snoring breath, and difficulty speaking. If wrongly treated with purgation, there will be difficulty urinating, staring gaze, and fecal/urinary incontinence. If wrongly treated with fire therapy, mild cases show yellowing of the skin; severe cases resemble convulsions or epilepsy with occasional spasms. If treated with fire moxibustion, one error may prolong life slightly, but a second error accelerates death.

Zhang Yinan stated: Named "Warm," it erupts from accumulated cold transforming into heat. Acrid-cool dispersal is suitable. Yang’s Comment: This statement is incorrect; it is not the treatment method for this syndrome. The clause lacks the words "Taiyang Disease," indicating no exterior pathogen. Why use acrid-cool dispersal? Mild sweating leads to resolution. If acrid-warm medicines are wrongly used, and after sweating the body becomes scorching hot, it is named Fengwen. Sweating leaks Yin fluids, making Wind-Heat pathogens stronger, causing the body to feel like burning. Pulses floating at both Yin and Yang positions indicate Wind-Heat pathogens exiting the interior to the exterior. Wind-Heat damages Qi, causing sweating, heaviness, and sleepiness. Yang’s Comment: This syndrome easily causes sweating; the mention of spontaneous sweating in the text need not result from erroneous acrid-warm dispersal. Lung Qi connects to the nose and governs skin/hair. With Wind-Heat at the exterior, breathing snores. The Heart governs speech, the Lung governs sound. Lung heat injury causes difficulty speaking. This results from excessive Wind-Heat consuming Yin Qi. Wrongful purgation further depletes Yin fluids posteriorly and causes urinary difficulty anteriorly. Fluid damage causes the Officer of the Cistern (Bladder) to lose control, leading to incontinence. The Foot-Taiyang meridian enters the eye system and exits the nape. Internal fluid loss prevents eye movement, causing staring gaze. Adding fire therapy creates intense Wind-Fire, disturbing Spleen Earth, causing jaundice. Severe fire therapy scatters spirit, resembling惊痫 (startle-epilepsy) with spasms. One error may delay death; a second error (fire moxibustion) accelerates it. Yang’s Comment: Commentators assume this clause follows the previous one. Actually, the previous clause is the outline of Warm Disease; this clause is not continuous with it. Wang’s Note: Yang’s critique is excellent. However, since the disease is named Fengwen and the pulse is floating, combining it with acrid-cool methods is not excessive. Spontaneous sweating does not necessarily stem from erroneous exterior treatment, though such cases exist. Later, Baibu Jia Renshen Tang uses Gypsum, which is also acrid and sweet.

Shen Yaofeng stated: Ancients often used "warm" and "heat" interchangeably. Physicians should focus on pulse and syndrome to prescribe, not rigidly adhere to names. The *Nan Jing* states: "The pulse of heat diseases is floating at both Yin and Yang." This clause states: "Fengwen disease, pulse floating at both Yin and Yang." The pulses are identical. Triple-Yang combined disease features desire to sleep and heavy body difficult to turn. This clause shares heavy body and sleepiness. Heat disease combined syndromes are primarily treated with Baihu Tang. Although this clause lacks a primary prescription, it seems appropriate to model treatment after Baihu Tang.

Zhang Xugu stated: Exterior pathogens of Taiyang, after sweating, should have fever subsiding and body cooling. Now, heat pathogens erupt from Shaoyin. Having emerged outward, heat should be cleared. Mistakenly inducing sweating damages fluids and Qi, aiding the pathogen, causing greater scorching heat. This stirs Liver Wind and agitates Warm pathogens, hence named Fengwen. The pathology involves floating Yang outward and overflowing heat, causing floating pulses at both Yin and Yang. Fluid leakage causes persistent spontaneous sweating. Qi deficiency and spirit confusion cause heaviness and sleepiness. Internal wind surges upward, blocking orifices, causing snoring and speech difficulty. This clearly shows it is not an externally contracted Wind pathogen. "Wrongly treated with purgation" refers to cases without prior erroneous sweating, not sweating followed by purgation. Generally, pathogens lie in Shaoyin, burning heat and drying water, causing dry throat/mouth, requiring urgent purgation. Here, heat has emerged to Taiyang, leaving Shaoyin empty. Purgation damages Yin, causing urinary difficulty, staring gaze, and incontinence, leading to Qi collapse. If subjected to sweating, purgation, and fire therapy, external fire aids internal heat, steaming jaundice. Severe cases involve heart disturbance resembling startle-epilepsy and intense Liver Wind spasms—all signs of deterioration. Mere fire moxibustion (one error) may prolong life; sweating, purgation, and further error accelerate death.

Wang Shixiong’s Note: Winter and Spring Warmths initially attacking Hand-Taiyin are called Fengwen, being inhaled warm wind. This latent internal eruption worsened by erroneous sweating is also called Fengwen, being internally moved deficient wind. However, Fengwen in the Lung should only be cleared and resolved. Mistaking it for an exterior condition and using acrid-hot medicines to sweat can also cause spontaneous sweating, sleepiness, snoring, and speech difficulty.

Gan’s Note: Snoring relates Lung and Kidney, mother and son organs suffering together. Spontaneous sweating indicates Yin failing to hold inward and Heart fluids escaping outward. It is not necessarily solely a Shaoyin meridian syndrome.

After taking Guizhi Tang, if profuse sweating occurs, followed by unresolved severe vexation and thirst, and a flooding pulse, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is primarily indicated.

Zhang Luyu stated: This was originally a warm-heat disease, mistaken for Wind damaging the Defensive layer, leading to the administration of Guizhi Tang. If Wind damaged the Defensive layer, sweating after medication would lead to mild resolution. Not knowing this was originally warm-heat, the mistaken use of Guizhi Tang resulted in a flooding pulse, profuse sweating, and unresolved vexation/thirst. If Ephedra were wrongly used, it would become as dangerous as the previous clause. Guizhi treats Wind entering from outside; Gypsum treats Heat erupting from inside. Thus, Baihu Tang is the specific formula for Heat pathogens, specifically clearing internal steaming heat, not treating heat in the meridians. Profuse sweating damages fluids; adding Ginseng rescues fluids, resolving vexation and thirst.

You Zhuowu stated: Warm pathogens cannot be cured by dispersal. Even with exterior signs, acrid-warm methods are inappropriate. Guizhi Tang is designed for Cold Damage exterior syndromes with interior harmony. Warm disease pathogens erupt from the interior, while the exterior is unaffected. Mistaken use of Guizhi only aids the pathogen and consumes fluids. Frozen cold transforming into heat has already robbed Shaoyin Essence. Using acrid-hot substances cuts off the root and promotes collapse. Some argue Shaoyin has Cold as root and Heat as branch, and pathogens entering require warmth to disperse. However, in warm disease eruption, Cold has transformed to Heat. Its tendency to exit does not require guidance to emerge spontaneously. Those that do not emerge must have exhausted Yin Essence. Otherwise, how could they fail to emerge?

Wang Shixiong’s Note: My great-great-grandfather said: Wind-Cold diseases can be cured by sweating with Guizhi Tang. If fever intensifies after sweating, it is Fengwen disease; "Warm" means Heat. Later generations failed to study this carefully, calling Fengwen a post-sweating deteriorated condition, how rigid! The disease is fundamentally Heat; adding Guizhi’s acrid-hot nature forces fluids out as sweat. Fluid loss makes heat more intense, causing severe vexation/thirst and flooding pulse. Linking with the previous clause, it discusses one syndrome. Treating with Baihu Jia Renshen Tang aligns with the *Inner Classic*’s principle: treating Wind and Heat excess with Sweet-Cool methods. Also, *Correcting Errors in Medical Forest* states: Never seen a single case of fever with sweating cured by Guizhi Tang; this is also a warm disease.

Combined disease of Taiyang and Shaoyang, with spontaneous diarrhea, is treated with Huangqin Tang (Scutellaria Decoction); if vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Plus Pinellia and Fresh Ginger Decoction) is primarily indicated.

Zhang Luyu stated: Huangqin Tang is the main formula for warm diseases, essentially Guizhi Tang with Guizhi replaced by Huangqin and Ginger removed. Guizhi treats exterior Wind-Cold; Huangqin treats interior Wind-Heat. This is an unchangeable rule. Ginger’s acrid dispersal is unsuitable for warm-heat, hence removed. At the onset of warm disease, Huangqin Tang should be used primarily to clear heat. In Cold Damage transmitting to Shaoyang, heat gradually enters the interior, allowing Huangqin to assist Chaihu in resolving it. This is the sequence of exterior-interior and cold-heat.

Zhou Yuzai stated: Explicitly mentioning Taiyang and Shaoyang, why not use medicines for both meridians? It is not Cold Damage. Cold Damage moves from exterior to interior; this erupts from interior to exterior. Without an exterior sign, how do we know it involves Taiyang and Shaoyang? Symptoms may include hypochondriac fullness, headache, bitter taste with desire to drink, or immediate heat without aversion to cold. Thus, it cannot be called exterior. Combined diseases in Cold Damage are all exterior diseases. Here, not only is there no exterior, but there are interior signs like diarrhea. Cold Damage’s coordinated heat diarrhea must result from transmittal, unlike this immediate diarrhea. Why does Warm Disease cause immediate diarrhea? External eruption is recent, internal constraint is deep. If the person’s Middle Qi is originally deficient, how can all pathogen vent outward at once? It must move downward causing diarrhea.

Wang Shixiong’s Note: Shaoyang Gallbladder Wood, carrying rampant Fire, causes vomiting (upward rushing) and diarrhea (downward pressing). Why must Middle deficiency cause diarrhea, and fluid accumulation cause vomiting? Banxia and Shengjiang specifically resolve fluid constraints. If heat is intense, substitute with Lianqin (Coptis) and Rudu (Skullcap). Yang’s Comment: This annotation is precise, surpassing the previous note.

Combined disease of the Three Yang meridians, with a floating and large pulse reaching above the Guan position, desire to sleep, and sweating when eyes are closed.