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In the initial stage of epidemic febrile diseases (Yi Zheng, 疫证), there are manifestations resembling those of Taiyang (Taiyang disease, 太阳病) and Yangming (Yangming disease, 1. 太阳经受邪所致的病证; 2. 阳明经受邪所致的病证) patterns in Cold Damage (Shanghan, 伤寒). However, headache in Taiyang and Yangming patterns does not reach the intensity of being split apart, whereas in epidemic febrile diseases, the headache is as if split open, so severe that lifting the head is difficult. In Cold Damage, there is typically no sweating, whereas in epidemic febrile diseases, there is no sweating on the lower body but sweating on the upper body, with sweating on the head being particularly profuse. The head is the summit of all Yang meridians; Fire has a nature of flaming upward. When toxic heat lodges internally, it boils the fluids of the five Zang organs, causing hot qi to ascend, similar to the dew formed by steaming under a cover. Therefore, sweating on the head is uniquely excessive. This is another instance where the pain is similar but the sweating is distinct. Some cases resemble Shaoyang (Shaoyang disease, 少阳经受邪所致的病证) with vomiting, while others resemble Taiyin (Taiyin disease, 太阴经受邪所致的病证) with spontaneous diarrhea. Vomiting in Shaoyang pattern is accompanied by hypochondriac pain; vomiting in epidemic febrile disease occurs without hypochondriac pain. This is due to latent toxins within, with pathogenic fire invading the Stomach, causing toxic vapors to rush upward, resulting in frequent vomiting. Spontaneous diarrhea in Taiyin pattern is accompanied by abdominal fullness; spontaneous diarrhea in epidemic febrile disease occurs without abdominal fullness. The Large Intestine is the official organ of transmission and conduction. When heat pours into the Large Intestine, some patients pass foul-smelling fecal matter, some have clear liquid flowing from the side, and some may defecate dozens of times a day. This is another instance where symptoms differ but the underlying pathology is the same.

I often argue that Heat Epidemic (Re Yi, 热疫) is not Cold Damage. Cold Damage does not manifest macules (Ban, 斑) or papules (Zhen, 疹). Someone might ask: It is true that Heat Epidemic is not Cold Damage. But regarding the statement that Cold Damage does not manifest macules and papules, why did the ancients say that if heat in Cold Damage has not yet entered the Stomach, premature purgation allows heat to enter the empty Stomach, thus causing macules; and if heat has already entered the Stomach but purgation is not immediate, preventing heat from venting, macules also appear? What does this mean? I say: The ancients subsumed warm-heat diseases under Cold Damage. Thus, the *Neijing* states: "Febrile diseases are a category of Cold Damage." The *Nanjing* distinguishes five types of Cold Damage, and the *Shanghan Lun* differentiates five treatment methods for them. Since it is stated that heat enters the Stomach, even if it is not a warm-heat disease, it is cold pathogen transforming into heat, so cooling and resolving formulas such as Baihu Tang (White Tiger Decoction), Sanhuang Tang (Three Yellows Decoction), and Huaban Jiedu Tang (Macule-Resolving and Toxin-Expelling Decoction) can be used. Modern people fail to understand this principle, thereby misleading themselves and others. Regarding the distinction between macules and papules: large lesions are called macules, small ones are called papules. Red color indicates extreme Stomach heat, with a mortality rate of nine out of ten; purple-black color indicates rotting of the Stomach, with a mortality rate of nine out of ten. My judgment of life and death, however, does not depend on the size or purple-black color of the macules, but solely on whether their appearance is loose and floating (Song Fu, 松浮) or tight and bound (Jin Shu, 紧束)! If macules appear loose, lively, and floating on the skin surface, red like cinnabar dots on paper or black like ink on skin, this indicates that the toxin is loose and actively emerging externally; even if purple-black and confluent, survival is possible. If they appear small like millet grains, tight and bound with roots, like a needle piercing through a shoe or an arrow hitting the target, this indicates that the toxin is rooted and firmly knotted; even if not purple-black, death will occur. If one can carefully examine and weigh these signs, applying divine discernment between looseness/floatiness and tightness/binding, and deciding life and death at the moment of clinical presentation, then one will believe that my words are not erroneous.