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Chapter: Ping Mai Fa (Methods of Pulse Diagnosis) in the Treatise on Cold Damage records: The Master said, "Disease caused by latent qi can be anticipated through careful observation. Within this month, there may be latent pathogenic factors. If one originally harbors latent pathogenic factors, pulse diagnosis is necessary. If the pulse is faint and weak, the patient will experience throat pain as if injured, but this is not Hou Bi (sore throat with redness, swelling, and ulceration). The patient states, 'Indeed, there is severe pain in the throat.' Even so, diarrhea is now desired."

Liu Baozhi's commentary: When warm pathogens transform into heat and move internally, the pulse should be rapid and large. The appearance of a faint and weak pulse here indicates that righteous qi is too weak to expel the pathogen, resulting in a picture of pathogenic stagnation without external release. Heat failing to reach the exterior floats upward along the meridians, causing throat pain, because the Shaoyin meridian traverses the throat. In the Treatise on Cold Damage, the clauses regarding Shaoyin disease originally include symptoms of diarrhea and throat pain, which share this same principle. Generally, prolonged heat stagnation corrupts yin fluids; thus, not only does throat pain occur, but diarrhea also arises.

I further comment: This clause serves as evidence for warm pathogens lying latent within the Shaoyin meridian.

Zhang Xugu stated: Observing Zhang Zhongjing's labeling of pulses for wind-stroke, cold damage, summer-heat, etc., they align with the Classic of Difficult Issues (Nan Jing). Only the Nan Jing states that the pulse of warm diseases travels through various meridians, making it unclear which specific meridian is activated. This implies that initially, warm pathogens follow the circulation of qi and blood through the meridians; upon manifestation, it is unknown from which meridian they emerge, as their onset has no fixed location, hence no fixed pulse pattern can be identified. Now, Zhang Zhongjing teaches examining the pulse to distinguish the meridian of pathogenic activation: for instance, a faint and weak pulse indicates the pathogen has not left the Shaoyin, moving up and down with the meridian, inevitably presenting with throat pain and diarrhea, perfectly corroborating the Nan Jing. The following text discusses pathogens emerging into the Three Yang, where heat intensity peaks and the pulse becomes floating and large, extending to the Guan position; this demonstrates that the pulse changes with the syndrome, and the syndrome manifests through the pulse. Since there is no fixed pulse at the onset, the Nan Jing does not specify pulse images. Thus, compared to exogenous pathogens with fixed syndromes and pulses, these are indeed distinct.

Shaoyin disease (characterized by a faint and fine pulse and a desire to sleep), appearing two to three days after onset, with throat pain, may be treated with Gancao Tang (Licorice Decoction); if unrelieved, Jiegeng Tang (Platycodon Decoction) is given.

Zhang Xugu commented: For throat pain caused by wind-cold externally closing the Shaoyin, Zhang Zhongjing used Banxia San (Pinellia Powder), employing acrid-warm methods to open and drain. Here, however, latent heat within the Shaoyin flares up internally, burning along the meridian to cause throat pain. Although acrid-warm opening methods are unsuitable, cooling medicines should also be avoided to prevent suppressing the pathogen's outward movement. Therefore, only Gancao (Licorice Root), a sweet and緩 (moderating) herb, is used to guide the pathogen outward; raw usage also clears fire. If unrelieved, it indicates fire stagnation preventing exit; adding Jiegeng (Platycodon Root) opens lung qi, stopping pain naturally. Cold damage proceeds from exterior to interior, starting with Taiyang then reaching Shaoyin; warm diseases proceed from interior to exterior, starting with Shaoyin then emerging to Taiyang.

Shen Zonggan stated: Diseases caused by latent qi develop from inside out, not limited to Spring-Warmth (Chun Wen). Essentially, qi of all four seasons can lie latent and erupt later; this must be understood.

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

Zhang Luyu commented: Although the disease originates in a Yin meridian, it is essentially a heat syndrome. Diarrhea, throat pain, chest fullness, and vexation indicate pathogenic heat filling everywhere above, below, and in between. Since cold-purgative methods are inappropriate, Zhufu Tang was established to moisten Shaoyin dryness, similar in intent to using black donkey hide. For deficient yang, Fuzi (Aconite Root) warms the meridians; for exhausted yin, Zhufu (Donkey-Hide Skin) moistens dryness; both possess the intent of dispersing pathogens. Comparing them yields significant insight.

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

Zhou Yuzai commented: Before latent pathogens manifest, body fluids have already been secretly consumed. After two or three days, although yin-fire does not rise and symptoms like throat pain are absent, mental vexation and insomnia indicate yin fluid depletion. Thus, Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) clear heat, while Ejiao (Donkey-Hide Gelatin) and Baishao (White Peony Root) nourish yin, treating both deficiency and excess.

Liu Baozhi's commentary: The above three Shaoyin disease clauses do not conform to transmitted heat pathogens; they are undoubtedly caused by latent pathogens.

Shaoyin disease presenting with diarrhea for six or seven days, accompanied by cough, vomiting, thirst, mental vexation, and insomnia, is primarily treated by Zhuling Tang (Polyporus Decoction).

Zhang Xugu commented: Diarrhea lasting six or seven days indicates heat sinking downward without external penetration. Rebelliously affecting the lungs causes cough and vomiting; invading the heart causes vexation, thirst, and insomnia, because both the Heart and Lung connect to the Shaoyin meridian. Zhuling Tang is used to promote urination and nourish yin; nourishing yin allows heat to depart with urination, and promoting urination stops diarrhea, resolving vexation and thirst.

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

Zhang Luyu commented: Latent qi erupting in Shaoyin has the most urgent progression, differing from transmitted heat in cold damage. Dry mouth and throat appearing merely two or three days after onset, if delayed until five or six days for purgation, would lead to extreme withering. Hence, urgent purgation is needed to save the roasting Kidney water. Regarding the three urgent purgation clauses for Shaoyin: one belongs to extreme transmitted heat, one to heat transferring to the Stomach Fu, and one to warm-heat originating in Shaoyin; all are critical emergencies requiring immediate rescue of nearly exhausted Kidney water, sharing the same origin but different branches with the three urgent purgation methods of Yangming.

Liu Baozhi's commentary: This is undoubtedly latent qi. If it were transmitted heat, counting from the initial illness, it would not present so early; if counting from transmission to Shaoyin, dry mouth and throat would not appear so suddenly.

Taiyang disease presenting with fever, thirst, and aversion to cold being absent is defined as Warm Disease (Wen Bing).

Wang Andao stated: If warm disease presents thus, heat disease is the same. Therefore, absence of thirst with aversion to cold indicates it is not a warm-heat disease. If warm-heat disease presents with aversion to wind or cold, it is due to new invasion of wind-cold superimposed on existing conditions.

Shen Yaofeng commented: Although this clause mentions no pulse, comparing it with subsequent clauses, the Chi (Cun-Kuan-Guan-Chi) position must be floating.

Zhang Xugu commented: Warm disease onset has no fixed location. The exterior of Shaoyin is Taiyang; when heat pathogens emerge from interior to exterior, Taiyang disease symptoms like fever and headache appear. Absence of aversion to cold confirms it is not a new contraction. Thirst arises from internal heat generation. Zhang Zhongjing feared misdiagnosis as Taiyang cold-damage or wind-strike, hence specifically labeling it as warm disease caused by internal latent heat. The omission of labeling Shaoyin warm disease is because the latent qi clauses already clarified throat pain and diarrhea as initial Shaoyin warm disease manifestations.

Wang Mengyin cited Wang Xiecheng: Wu Juztong's *Treatise on Warm Diseases* (Wenbing Tiaobian), Upper Jiao Chapter, quotes the *Treatise on Cold Damage*: "Taiyang disease, characterized by aversion only to heat, no aversion to cold, and thirst, is named Warm Disease, treated with Guizhi Tang (Cinnamon Twig Decoction)."

However, checking the *Treatise on Cold Damage*, these words are absent. If truly from Zhang Zhongjing, textual errors should be辨析 (analyzed). If Wu Juztong misremembered, correction is essential. I believe it is not a misremembering. Yu Jia Yan once stated that Zhang Zhongjing used Guizhi Tang for all exterior treatments of warm syndromes to indicate slight sweating without excessive diaphoresis. You Zai Jing's *Reading Records* argues this is Yu's speculation, not Zhang's original doctrine. Wu Juztong claimed to transcend cold damage frameworks yet fell into Yu's trap, unwilling to be inferior, thus arbitrarily altering texts, presenting them as sage teachings, unwittingly insulting sages and misleading the world.

If after inducing sweating, the body becomes scorching hot, it is named Wind-Warmth (Feng Wen). Wind-Warmth presents with floating pulses at both Yin and Yang positions, spontaneous sweating, heaviness of the body with excessive drowsiness, snoring breath, and difficulty speaking.

If mistakenly treated with purgatives, urination becomes difficult, eyes stare fixedly, and incontinence occurs. If mistakenly treated with fire therapy, mild cases show yellowing; severe cases resemble convulsions or epilepsy with periodic spasms. Fire fumigation: one error may prolong life slightly; a second error accelerates death.

Zhang Xugu commented: For Taiyang exogenous pathogens, sweating should resolve fever and cool the body. Here, heat originates from Shaoyin; clearing heat is correct, but mistaken sweating damages fluids and qi, aiding pathogen strength, causing scorching heat and stirring Liver Wind, agitating warm pathogens—hence named Wind-Warmth. Pathogenesis involves floating deficient yang and overflowing heat, causing floating pulses at Yin and Yang positions; fluid loss causes continuous sweating; qi deficiency and spirit confusion cause body heaviness and drowsiness; internal wind movement obstructs orifices, causing snoring and speech difficulty, proving it is not exogenous wind. Mistaken purgation refers to cases not previously sweated, not purging after sweating. Mistaken fire劫 (coercion): mild cases damage Ying-Qi with heat, causing blood stasis and yellowing; severe cases generate wind from intense heat, causing convulsions. Generally, pathogens latent in Shaoyin burn water and dry fluids, requiring urgent purgation; once heat emerges to Taiyang, Shaoyin is empty. Purgation injuring yin leads to difficult urination, staring, and incontinence, indicating qi collapse. Fire attack before sweating/purging adds external fire to internal heat, causing yellowing; severe cases involve heart disturbance resembling epilepsy and intense Liver wind spasms—all bad omens. Fire fumigation alone might prolong life slightly after one error; sweating, purging, and another error accelerate death.

After taking Guizhi Tang, if heavy sweating ensues followed by unresolved severe vexation and thirst with a洪大 (surging-large) pulse, Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is indicated.

Liu Baozhi's commentary: Guizhi Tang treats wind damaging Wei (Defensive) level, suitable for exterior pathology with interior harmony, inducing slight sweat for resolution. Here, warm pathogens originate internally; mistaken use of Guizhi aids pathogens and consumes fluids, causing heavy sweating, severe thirst, and intensified heat. Baihu (White Tiger) clears heat and relieves vexation; Ren Shen (Ginseng Root) rescues depleted yin fluids.

Taiyang and Shaoyang combined disease presenting 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 used.

Zhang Luyu commented: Huangqin Tang is the main formula for warm diseases, derived from Guizhi Tang by replacing Guizhi with Huangqin and removing Shengjiang. Guizhi addresses exterior wind-cold; Huangqin addresses interior wind-heat; Shengjiang's acrid dispersion is unsuitable for warm-heat, hence removed.

Zhou Yuzai commented: Explicitly mentioning Taiyang and Shaoyang, why not use herbs for both meridians? Because it is not cold damage. How do we know? Lack of aversion to cold and immediate heat rule out cold damage. Why mention Taiyang and Shaoyang? Symptoms like hypochondriac fullness, headache, or bitter taste with thirst belong to these meridians. True combined cold damage should show exterior signs; here, lacking exterior signs but having diarrhea indicates interior pathology. Unlike cold damage with heat-associated diarrhea arising from transmission, this diarrhea occurs immediately. Prolonged internal stagnation of warm pathogens in those with insufficient Middle Qi cannot fully vent externally; downward flow causing diarrhea is a natural progression.

Wang Mengyin commented: Shaoyang Gallbladder Wood, carrying fire, runs rampant; vomiting is upward rebellion, diarrhea is downward pressure. Why assume Middle Deficiency causes diarrhea or fluid accumulation causes vomiting? Banxia and Shengjiang open fluid knots; if heat is intense, replace with Lian (Huanglian) and Ru (Zhuru/Bamboo Shavings).

Combined disease of the Three Yang, with floating and large pulse extending to the Guan position, drowsiness, and sweating upon closing eyes.

Zhou Yuzai commented: At combined disease of Three Yang, pathogenic heat is turbid and solid, hence floating and large pulse. Originally, Shaoyin disease shows large Chi pulse; now emerging from interior to exterior, floating and large pulse appears at Guan, hence "extending to Guan." Although pulse appears in Yang positions, Shaoyin root remains uncleared; drowsiness reflects Shaoyin syndrome, while night sweats reflect Shaoyang syndrome. Taiyang pulse is floating, Yangming pulse is large, and Guan is Shaoyang position, hence combined disease of Three Yang.

Liu Baozhi's commentary: Spring-Warmth differs from heat disease because sweating occurs only upon closing eyes, unlike the continuous profuse sweating of heat disease.

Yang Suyuan commented: This clause connects with Wind-Warmth (scorching heat after sweating); initially this disease, mistaken sweating leads to Wind-Warmth.

Commentary: Treatment proposed by Miu Zhongchun uses Baihe (Lily Bulb) 1 liang, Maidong (Ophiopogon Tuber) 5 qian, Zimu (Anemarrhena Rhizome), Huafen (Trichosanthes Root) Baishao (White Peony Root) each 2 qian, Biejia (Turtle Shell) 3 qian, Zhigancao (Prepared Licorice Root) 1 qian, Zhuye (Bamboo Leaf) 50 pieces.

*Jingui Yaolue* states: Warm Malaria presents with normal-like pulse, no chills but only fever, painful joints, occasional vomiting, treated with Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction).

You Zhuowu commented: This differs from *Neijing* discussions on malaria. *Neijing* explains etiology; this details pulse and symptoms. Dan Malaria and Warm Malaria both lack chills, featuring only fever and vomiting, but etiologies differ. Dan Malaria stems from pre-existing Lung heat compounded by external cold, creating exterior cold-interior heat syndrome; internal Yin deficiency prevents struggle with Yang, hence no chills. Warm Malaria involves pathogens latent in Shaoyin, erupting in Spring/Summer as latent qi moving outward; accumulated cold transforms into heat, hence no chills. Pulse like normal indicates non-exogenous origin. Painful joints and vomiting indicate heat emerging from Shaoyin, settling in Kidney's paired organ, and merging upward with Yangming. Baihu's sweet-cold clears heat; Guizhi guides pathogen according to momentum.

Wang Mengyin commented: Yu Shi stated Zhang Zhongjing's discussion on malaria notes string-rapid pulses indicate much heat, further explaining string-rapid implies wind generation; persistent heat consumes fluids generating wind, Wood insults Earth, transmitting heat to Stomach. This cannot be treated solely with medicine; dietary management is needed to curb intense heat, such as pear juice or sugarcane syrup, to quench thirst and generate fluids, aligning with *Neijing*'s principle: treat internal wind with sweet-cold.

*Treatise on Cold Damage* states: Yangming disease, with floating-tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, no aversion to cold but aversion to heat, and body heaviness. If sweated, restlessness, mental confusion, and delirium occur. If fire needles added, fright, irritability, and insomnia result. If purged, stomach empties, rebellious qi moves diaphragm, causing chest discomfort. With tongue coating, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If pulse is floating with fever, thirst for water, and difficult urination, Zhuling Tang is indicated.

Zhou Yuzai commented: Floating-tight is cold damage pulse; why heat disease? Onset in Summer, no aversion to cold but aversion to heat. Why focus on Yangming? Summer damp-heat steams upward, pathogens originate from Stomach; abdominal fullness and panting are Yangming symptoms. Yet dry throat/bitter taste suggests Shaoyin? Yangming is the exit path, Shaoyin the storage site, hence combined symptoms. Why floating-tight in Yangming heat? Strong floating force indicates intense heat. Ignorance leads to acrid-warm sweating, consuming fluids, causing madness; fire-coercion dries Yin-blood, causing panic insomnia; purging injures Yin, causing stomach deficiency and pathogen sinking, chest discomfort; all result from mistreatment. How to rescue? Sliding tongue coating indicates lingering exterior pathogen; Zhizi clears heat, Chidao removes pathogen—correct method. Thirst for water, dry mouth/tongue indicates major fluid injury; Baihu Tang clears heat, Ren Shen boosts Yuan Qi. If tight pulse vanishes leaving floating, with fever/thirst/difficult urination, heat enters Bladder; Zhuling clears heat and thirst. Cold damage difficult urination stems from Qi level; heat disease difficult urination stems from Blood level. Deep stagnation and long-term fluid consumption require Ejiao (nourishing blood) and Huashi (clearing heat); Baizhu is unnecessary.

Shen Yaofeng commented: Before mistreatment, Baihu Tang was the primary indication.

Yangming disease with profuse sweating and thirst contraindicates Zhuling Tang, as profuse sweating causes Stomach dryness; Zhuling Tang further promotes urination.

Zhou Yuzai commented: Thirst with difficult urination warrants Zhuling Tang, but profuse sweating is a contraindication. This aligns with cold damage entering Fu organs prohibiting frequent urination. Pathogens exiting Yangming have already劫 (robbed) fluids; profuse sweating further depletes them. How much fluid remains for further loss? Use Baihu Jia Renshen to clear heat; as fluids return, urination normalizes.

Combined disease of Three Yang, with abdominal fullness, body heaviness, difficulty turning, insensitivity of mouth, facial grease, delirium, and urinary incontinence. Sweating causes delirium; purging causes sweating on forehead and cold extremities. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) is indicated. (Wang Shizhong notes: "Sweating causes delirium" likely misses a "severe" character before purging.)

Zhang Xugu commented: This clause indicates heavier heat pervading Three Yang, causing abdominal fullness, body heaviness, and immobility. Insensitivity of mouth means loss of taste; turbid stagnation in Stomach steaming causes facial grease. Intense heat causing spirit confusion leads to delirium and incontinence. Without mistreatment, spontaneous sweating indicates Baihu Tang (Wang Shizhong notes: Zhongchun suggested adding Baihe). This is inverted syntax, meaning "spontaneous sweating" distinguishes it from mistaken sweating. If mistakenly sweated, delirium results (Wang Shizhong notes: Baihu Jia Renshen Tang might rescue); if purged, forehead sweating indicates绝汗 (terminal sweat). Cold extremities indicate impending Yang collapse, termed "second error accelerates death," untreatable by Baihu.