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A question was raised: "You stated that Shanghan (Cold Damage) and Shi Yi (Epidemic Febrile Disease) are as different as heaven and earth. Yet, you now utilize San Chengqi Tang (Three Cathartic Decoctions), as well as Taoren Chengqi Tang (Peach Kernel Cathartic Decoction), Didang Tang (Definite Confrontation Decoction), Yinchen Hao Tang (Artemisia Capillaris Decoction), etc., which are all formulas for treating Shanghan. Since you use these formulas, the syndromes must be identical. Why do your statements differ?" The answer is: "Shanghan necessarily has a cause of external contraction, such as wearing thin clothes in wind and dew, forcing oneself into water, taking off clothes in the wind, or bathing under an eaves. At that moment, one feels goosebumps on the skin, followed by stiffness and spasm of the four limbs, aversion to wind and cold. Subsequently, headache and body pain occur, with fever and aversion to cold. A floating and rapid pulse, or a tight pulse without sweat, indicates Shanghan; a slow pulse with sweat indicates Shangfeng (Wind Injury). Shi Yi, at its onset, originally lacks such a cause of common cold. One suddenly feels chilly and shivering, followed by fever without aversion to cold. However, there are cases triggered by contact with certain factors, such as irregular eating, overwork, excessive worry, or qi stagnation, which can stir up the pathogenic factor and promote its eruption. Most cases arise spontaneously without such triggers; only one or two out of ten are promoted by triggers. Furthermore, Shanghan resolves with a single sweating episode, whereas Shi Yi, even after dispersing efforts, does not resolve with sweat. Shanghan is not contagious, while Shi Yi is contagious. The pathogen of Shanghan enters through the hair pores (Hao Qiao); the pathogen of Shi Yi enters through the mouth and nose. Shanghan manifests immediately upon infection, whereas Shi Yi manifests after a long period. For Shanghan, resolving via sweating occurs early; for Shi Yi, it occurs late. Medication for Shanghan can induce immediate sweating; for Shi Yi, sweating occurs naturally only after internal resolution, and cannot be anticipated. Shanghan is resolved through ordinary sweating, whereas Shi Yi is resolved through Zhan Han (Battle Sweat). In Shanghan, the appearance of macules indicates severe disease; in Shi Yi, it indicates improvement. Shanghan involves pathogens affecting the meridians, transmitting from meridian to meridian; Shi Yi involves pathogens residing internally and overflowing into the meridians, without transmission between meridians. Shanghan onset is abrupt; Shi Yi often lingers for two or three days, gradually worsening, or lingers for five or six days before suddenly worsening. At the onset, Shanghan prioritizes releasing the exterior, whereas Shi Yi prioritizes draining and unblocking. There are numerous differences. The similarity lies in that both Shanghan and Shi Yi can transmit to the Stomach. At this stage, they converge, hence the use of Chengqi Tang (Cathartic Decoction) group formulas to guide the pathogen out. In summary, Shanghan and Shi Yi start differently but end similarly. The pathogen of Shanghan transmits directly from the muscle layer to the interior, like clouds passing through the vast sky, originally rootless. Its transmission method always advances and never retreats; thus, after purgation, recovery is immediate. The pathogen of Shi Yi initially hides in the Mo Yuan (Membrane Source), deeply rooted. Upon eruption, it merges with Ying Wei (Nutritive and Defensive Qi). Wherever the exogenous pathogen passes, Ying Wei is inevitably injured; due to this injury, it is termed 'Kui' (Ulceration/Rupture). However, without rupture, transmission cannot occur; without transmission, the pathogen cannot exit; without pathogen exit, the disease does not heal. After purgation in Shi Yi, many cases do not resolve immediately. Why? Because epidemic pathogens often transmit simultaneously to the interior and exterior. If half transmits outward, the pathogen in the muscles cannot immediately reach the muscle surface. After purgation, when the interior qi flows freely, the exterior qi also becomes smooth. The pathogen previously depressed in the muscles can then fully erupt to the muscle surface, either as macules or sweat, leading to immediate recovery. This method does not exist in Shanghan after purgation. Although it is said they are ultimately similar, upon detailed comparison, they remain different.

Another question was raised: "Shanghan contracts the Zheng Qi (Upright Qi) of Heaven and Earth, while Shi Yi contracts the Li Qi (Perverted Qi) of Heaven and Earth. Since the qi differs, why are the same drugs used in Chengqi Tang?" The answer is: "Wind-cold and epidemic pathogens stand in opposition to the Zhen Qi (True Qi) of our body. Once attached, qi becomes stagnant and fire accumulates. Qi, fire, and pathogen mix into one, transforming together, losing their original nature, and becoming pathogenic entities. As long as the goal is to expel them, what difference does it make whether the pathogen is the same or different? Suppose early Shanghan is a Yin pathogen, governing closure and causing no sweat; Shangfeng is a Yang pathogen, governing opening and causing profuse sweat. Initially, there is a distinction between Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction), because the contracted pathogen has not yet transformed. When transmitted to Shaoyang (Lesser Yang), Chaihu (Bupleurum Root) preparations are used universally. When transmitted to the Stomach organ, Chengqi Tang (Cathartic Decoction) is used universally. At this stage, the distinction between wind and cold disappears. Extending this logic, we know that when epidemic pathogens transmit to the Stomach, the treatment method is no different."