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It was previously said that there is no tonification method for Shanghan (Cold Damage), because both Shanghan and seasonal epidemics are external pathogens. However, contracting cold pathogen involves only Wind-Cold, which is the upright Qi of Heaven and Earth; even so, one might still worry about it causing fullness and stagnation, making tonification inadvisable. Now, contracting epidemic Qi involves the toxic miasma of Heaven and Earth. If tonification is used, it will obstruct and envelop the toxin, causing the evil fire to burn more fiercely. Therefore, erroneous tonification causes harm even greater than in Shanghan; this describes the general rule. Regarding variations, however, there are cases requiring tonification: for instance, if the disease has persisted for a long time without timely purgation, leading to near-collapse of form and spirit; or if the body was already deficient due to prolonged illness; or if there was prior severe exertion; or if an elderly person is depleted. In all these cases, tonification and purgation should be combined. If using tonification alone exacerbates deficiency symptoms, urgent and potent tonification is indicated (Deficiency syndromes are discussed in various chapters and will not be repeated here). After tonification, if deficiency symptoms subside slightly, one must strictly avoid further tonification (See earlier text: If deficiency symptoms disappear after purgation, presuming deficiency and arbitrarily using tonics is a major contraindication. Whenever tonics are used, if there is no improvement on the same day, it indicates that tonification is not indicated. Ginseng is the supreme agent for benefiting Yuan Qi and the miraculous elixir for opening Stomach Qi; its effect is immediate upon ingestion. If after administering Ginseng, Yuan Qi does not return and Stomach Qi does not rotate, do not claim that Ginseng lacks efficacy; rather, it is due to improper administration. One must immediately change the strategy. Indiscriminate continued use will inevitably worsen complications; if complications worsen and one continues to administer it, death will ensue.

The Yin and Yang syndromes of Shanghan are discussed in medical texts as opposing concepts. Whenever Yang syndromes are discussed, Yin syndromes follow. Readers may assume that both Yin and Yang syndromes exist universally in the world. Consequently, during clinical practice, holding these two syndromes in mind leads to hesitation and uncertainty, easily resulting in misdiagnosis. Some physicians, without distinguishing pulse and symptoms, merely observe that a patient keeps many young women, visits brothels, falls ill after sexual intercourse, or engages in intercourse while sick. Upon hearing such details, they suspect a Yin syndrome. Little do they know that when a disease is about to manifest, whether for monks, nuns, widows, virgins, bachelors, or eunuchs, the pathological momentum is irresistible and has nothing to do with sexual desire. Even if a man keeps many young women, frequents prostitutes, falls ill after sex, or has sex while ill, at this moment, if the epidemic pathogen erupts from the Membrane Source (a location between the exterior and interior), causing Qi stagnation and Fire depression, fever may inevitably occur. Ultimately, it remains a Yang syndrome, what relation does it have to a Yin syndrome? Moreover, they fail to realize that true Yin syndromes are extremely rare in the world, whereas Yang syndromes mimicking Yin are common every day.

To explore the reason behind this: regardless of whether Shanghan or Wen Yi (Warm Epidemic) transmits to the Stomach house, internal obstruction of Yang Qi prevents it from distributing outward, leading to cold extremities, known as "Yang Jue" (Yang Reversal/Cold Extremities due to Heat). It is also said: slight reversal implies slight heat; deep reversal implies deep heat. In cases of deep reversal, cold may extend beyond elbows and knees, with a deep and faint pulse; in severe cases, the whole body becomes ice-cold, and the pulse is faint and nearly imperceptible. Despite differences in severity, all belong to Yang Jue. Since these phenomena are ubiquitous, failing to grasp the essence leads to numerous misidentifications. Furthermore, since Wen Yi often resembles Shanghan, and lacking the essential understanding, confusion is easy. Wen Yi is a heat disease; it never results from contracting cold, so where would Yin come from? This is point one. Having treated hundreds of Wen Yi patients, only two or three cases of true Shanghan were encountered; this is point two. Having treated hundreds of true Shanghan patients, only two or three true Yin syndromes were encountered; this is point three. Synthesizing past experiences, unless one has treated many people, how could one recognize it at a glance? Is Yin syndrome a common disease in the world? Observing contemporary physicians specializing in Shanghan, over several years, perhaps one encounters a true Yin syndrome. Why suspect Yin syndrome merely upon seeing Shanghan symptoms, especially when most cases are Wen Yi, not Shanghan?