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The pathogenic factor of latent warm disease is essentially the cold pathogen contracted in winter. The reason why the human body is injured by it lies fundamentally in the deficiency of Kidney Qi, which allows the cold pathogen to enter and take residence. When it reaches outward driven by the ascending Yang Qi of spring, it is also because the Kidney Qi stirs secretly that it can drum up the pathogen to transform into heat and emerge. If a person's Kidney Yang is deficient and weak, the pathogenic mechanism becomes frozen like ice, often presenting symptoms of being half-transformed and half-latent, desiring to reach outward but unable to do so. For instance, external heat manifestations may be blazing intense, or even signs of coma with delirium and convulsions with cold limbs may have appeared, yet there are still latent pathogens in the Shaoyin meridian that have not fully transformed into heat, remaining stagnant in the Yin aspect. At this time, judging from the external heat signs, there is already the danger of heat disturbing the Jueyin (Liver/Pericardium), and drugs for clearing and purging heat cannot be delayed. However, the internally latent pathogen, due to the internal weakness of Kidney Qi, cannot transform and reach outward. If only cooling and purging drugs are used, the pathogenic mechanism will become even more stagnant; if warming and transforming drugs are used, it would be like carrying firewood to save a fire. In this dilemma, internally the Yin fluids will dry up, and externally the pathogenic heat will cover and close [the mind]. Delaying for one or two days makes it irretrievable. Such conditions are the most dangerous and severe presentations among warm diseases. Even with utmost efforts to rescue, it remains a risky attempt at success. Physicians must explain the situation clearly in advance to avoid suspicion and blame. In this condition, the pathogen is latent in Shaoyin. Yu Jiayan (Yu Shi) imitated Zhang Zhongjing's treatment principles for Shaoyin disease, using Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) and Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) to vent the pathogen, adding Shengdi Huang (Rehmanniae Radix) to nourish Yin and support healthy Qi, an intention that was quite appropriate. However, since the warm pathogen has moved, there must be external heat signs; in severe cases, pathogenic heat covers and sinks, showing signs of convulsions and cold limbs. At this time, Mahuang, Fuzi, and Xixin—powerful hot drugs—cannot be administered abruptly. Yet without such powerful warming drugs, how can the deep-seated cold of Shaoyin be stirred? Treatment should follow their intent but alter the formulation, such as using Douchi (Fermented Soybean) processed with Mahuang juice, and Shengdi Huang processed with Fuzi juice. Meanwhile, drugs for calming the Liver and extinguishing wind to treat the branch symptoms should still be included according to the specific presentation. Only in this comprehensive manner can success be achieved.

Attached Case: My student Jin Shiru, in early March of the Wuxu year, suffered from a seasonal epidemic cold. Initially, he had aversion to cold and fever. After taking one dose of diaphoretic drugs, he did not sweat to resolve the exterior, but the heat intensity decreased, his expression became dull and sluggish, he lay tiredly wanting to sleep, was deaf, occasionally irritable, his feet were cold up to the knees, fingertips, ears, and nose tip were all cold, urination and defecation were obstructed, the lower back and spine were stiff and hard, unable to turn over, the pulse was slow, fine, and weak, he vomited and felt nauseous unable to take water or food, only chewing pickled ginger provided slight relief, and the tongue coating was thick, dry, and slightly gray. This was caused by a new contraction triggering latent pathogens, while Kidney Yang was first depleted and unable to push the pathogen out by transforming it into heat, thus the pathogenic mechanism remained frozen and unexposed; the heat that had already transformed sank inward into Jueyin, threatening convulsions and cold limbs; the condition was extremely critical. Zhao Jingyi went first and used Zhizi (Gardeniae Fructus), Chidouchi (Red Fermented Soybean), Guizhi (Cinnamomi Ramulus), Lingyangjiao (Saigae Tataricae Cornu), combined with the Zuojin method, resulting in free urination, warm feet, and cessation of vomiting; however, upon my arrival, other symptoms remained unchanged, and the pathogen still did not move. We discussed using Mahuang and Fuzi combined with Yangshen (American Ginseng) and Shengdi Huang to support healthy Qi and push out the pathogen, and I happened to arrive, ordering immediate decoction and administration. After two doses, the Chi position of the pulse began to appear wiry, but the dullness of spirit and stiffness/pain of the waist and spine remained the same. I proposed using Mahuang-processed Douchi, Fuzi-processed Da Shengdi Huang, Guizhi-processed Baishao (Paeoniae Radix Alba), combined with Renshen (Ginseng Radix), Niuxi (Achyranthis Bidentatae Radix), Xuanshen (Scrophulariae Radix), Danhuangqin (Scutellariae Radix), Lingyangjiao, and Shengmuli (Ostreae Concha), modifying as needed. After three doses, because the tongue coating was thick gray and dry, Dahuang (Rhei Radix et Rhizoma) was added. After taking it, he suddenly experienced chills and shivering followed by profuse sweating (Zhanhan), the waist and spine instantly relaxed, followed by large bowel movement, releasing interior heat, and his spirit became clear. He recovered after one month of conditioning. Regarding this case, looking at the aspect of the pathogen deeply latent and not yet transformed into heat, only warming and supporting methods are suitable, strictly avoiding cold and cool herbs; however, given the convulsions, coma, and dry gray tongue coating, if heat is further assisted, it will inevitably sink into Jueyin, leading to coma, mania, and closure, which would be incurable. Looking at the aspect where the pathogen has moved and transformed into heat, only clearing and purging are suitable, enduring no warmth and dryness; yet with a slow, fine pulse, dull spirit, cold form, and obstruction of meridians and fu-organs, if only cooling and transforming methods are used exclusively, the latent Shaoyin pathogen will not exit, dragging on for days, inevitably leading to internal collapse and Jue-Tuo syndrome, moving further away from life. After repeated deliberation, there is no principle of winning with a unilateral approach. Reluctantly, adopting Yu Shi's method to treat the root, combined with clearing and purging methods to treat the branch, pushing out the pathogen while resolving heat. Fortunately, thanks to the Shaoyin Qi being assisted and extending, all pathogens in meridians and organs, whether transformed or not, took advantage of the stirring of Kidney Qi to reach outward together. Thus, once Zhanhan occurred and stool passed, all exterior and interior ailments seemed to vanish.

Mr. Fan Yangkui's son from Huangcun Bridge, in the summer of the Wuxu year, suffered from San-Nue (every-third-day malaria). By early August, he took antimalarial drugs to stop it. Beyond the 20th day, he suddenly had seminal emission and diarrhea several times, then developed chills and fever resembling daily Nue. First chills, then fever; when external heat became intense, the bones and joints of the lower body remained cold, requiring another episode of chills and shivering, followed by drinking a bowl of hot porridge, before sweating could resolve the condition. By early September, it had recurred more than ten times. One day, just as he was about to drink porridge to assist sweating, he suddenly suffered dizziness and dim vision, cold sweat, and cold limbs, appearing as if collapsing, stabilizing only after a long time. Thereafter, he remained bedridden, though stomach appetite was not too bad, lingering without recovery. When I visited to diagnose, it was mid-October. I said that previously, San-Nue was due to Summerheat-Dampness pathogen. Its recurrence after cure indicated the triggering of latent Shaoyin pathogens, emerging due to the deficiency of a new Shaoyang illness; and because Kidney Yang was first depleted and unable to push out the pathogen, chills worsened daily while heat intensity did not increase significantly. This required warming the meridians and pushing out the pathogen method, using Guizhi Tang (Cinnamon Twig Decoction) plus Renshen, Danggui (Angelicae Sinensis Radix), Shengdi Huang, and Niuxi processed with Fuzi juice, still modifying with Chaihu (Bupleuri Radix), Douchi, and Huangqin (Scutellariae Radix) for over ten doses. During this period, various symptoms of palpitations, fright, and convulsive tremors appeared repeatedly, so Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) plus Lingyangjiao were added, treating according to symptoms until recovery. At the time of the malaria recurrence, other physicians still used standard formulas for Summerheat-Dampness, taking twenty to thirty doses, with no change in condition. The patient himself said he would not recover, having delirious speech every night. The family suspected spirits, and doctors could not fathom the source of the disease. The reason was that recent physicians, while not bound by Wu Youke's Muyuan theory, were stuck in Wu Jutong's Sanjiao theory, completely unaware of the principle of latent Shaoyin pathogens manifesting along meridians. Thus, encountering such cases, they felt uncertain, light cases dragged into severity, severe cases had no remedy, seen frequently in recent years. Alas!