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1. The *Da Lun of the Six Origins and Correct Records* (Liuyuan Zhengji Dalun) states: In years of Chen and Xu, during the first Qi phase, people are prone to epidemic warm diseases. In years of Mao and You, during the second Qi phase, severe epidemics occur, and people may die suddenly; by the final Qi phase, the disease manifests as warm disease. In years of Yin and Shen, during the first Qi phase, warm diseases begin to arise. In years of Chou and Wei, during the second Qi phase, warm febrile epidemics spread widely, affecting both distant and nearby areas equally. In years of Zi and Wu, during the fifth Qi phase, the disease manifests as warm disease. In years of Ji and Hai, during the final Qi phase, the disease manifests as warm febrile epidemics.

Discussing the Five Movements and Six Qi (Wu Yun Liu Qi) is to investigate the origin of warm diseases. The warmth of each year varies in onset time and severity, resulting from the interaction of Si Tian (Guest Qi governing the first half of the year), Zai Quan (Guest Qi governing the second half of the year), Zhu Qi (Fixed Qi representing the constant seasonal climate pattern), and Ke Qi (Variable Guest Qi changing annually). This can be understood by carefully studying the commentaries on the *Su Wen* (Basic Questions); thus, no further elaboration is needed here. According to Wu Youke, warm diseases are not cold damage (Shanghan); warm diseases are more common than cold damage, which is a very insightful view. However, his claim that "having the qi of one season at the wrong time" invites criticism for being inconsistent. Generally, when the climate is harmonious and the harvest is abundant, the heavenly qi is peaceful, and the people's qi is balanced; even in years where outbreaks should be severe, they remain mild. Conversely, after years of famine, war, or fire, even in years where outbreaks should be mild, they become severe. This follows the natural laws of reason and numbers, and there is nothing strange about it.

2. The *Da Lun of Yin and Yang Correspondence to Phenomena* (Yinyang Yingxiang Dalun) states: Unregulated joy and anger, and excessive exposure to cold and heat, make life unstable. Therefore, extreme Yin transforms into Yang, and extreme Yang transforms into Yin. Thus it is said: If one is injured by cold in winter, one will surely suffer from warm disease in spring.

The previous section generally discussed diseases caused by Si Tian Qi; this section below specifically discusses the causes of human illness.

Carefully examining the works of various masters since the Song and Yuan dynasties, none distinguished clearly between warm diseases and cold damage. For example, Pang Anchang’s *Zu Bing Lun*, Zhu Gong’s *Huo Ren Shu*, Han Zhihe’s *Wei Zhi*, Wang Lu’s *Zheng Zhi*, Liu Wansu’s *Shanghan Yijian* and *Shanghan Zhige*, and Zhang Congzheng’s *Shanghan Xinjing* either used methods for treating cold damage to treat warm diseases, or mistook warm and summer-heat diseases for cold damage. Suspecting that the methods of Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) were unusable, they established new formulas such as Fangfeng Tongsheng San (Saposhnikovia Powder for Universal Relief), Shuangjie Tongsheng San (Double-Resolution Powder for Universal Relief), and Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), even adding bitter-cold herbs to acrid-warm ones. Wang Andao辨析ed this most thoroughly in his *Suhui Ji*; I will not debate it here. Regarding the most detailed discussions on warm diseases, none surpasses the three families: Zhang Jingyue, Wu Youke, and Yu Jiayan. Among contemporary physicians, these three are most revered. Let me briefly state their views: Zhang Jingyue and Yu Jiayan focused heavily on the character "cold," ignoring the phrase "thus it is said" and the preceding lines "extreme Yin transforms into Yang, extreme Yang transforms into Yin." Zhang’s theories and prescriptions completely conflated warm diseases with cold damage, claiming warm disease is cold damage, following old precedents without genuine insight, which is hardly worth discussing. Yu’s theory, while analytical, mixed in Shaoyin and Jueyin syndromes of cold damage in the middle sections, and his prescriptions relied on acrid-warm exterior-releasing and acrid-hot interior-warming methods, causing significant harm. Even diligent scholars are prone to occasional errors; how can we blame later generations for lacking guidance and inadvertently causing death? Learning is indeed difficult! Wu Youke truly distinguished between "cold" and "warm." His observed cases did not require acrid-warm, acrid-hot, or sweet-warm drugs. However, he did not understand the principle of latent pathogenic qi (Fuqi) causing disease. He failed to distinguish between immediate-onset cold damage and latent pathogens manifesting as warm disease in spring. Consequently, he directly asserted that the origin of warm-heat was not due to wind-cold invasion. Instead of blaming his own lack of understanding, he blamed the classics. I trace the biases of these three: Zhang confusedly cited texts on cold damage to prove warm-heat, because after cold damage transforms into heat, the classics also call it "heat disease." Unable to analyze, Zhang mistook warm disease for cold damage. Yu opened with "spring warm disease"; in early spring, many observed cases had cold symptoms, so he mistook cold damage for warm disease. Wu lived during the chaotic times of famine and war under the Chongzhen Emperor, seeing only warm epidemics, so he directly refuted the classic text "injured by cold in winter, warm disease in spring." They all held their own views without integrating them comprehensively. I note that latent pathogenic qi causing disease, such as spring warm disease, winter cough, and warm malaria, is clearly stated in the *Neijing*. There are also cases not due to latent qi but due to the prevailing Qi of the Si Tian season, as mentioned in the *Liuyuan Zhengji*. These two are normal patterns of reason and numbers. Additionally, there are cases of "wrong season having its qi," such as the Liqi (pestilential qi) described by Wu Youke, which are variations. Only physicians skilled in distinguishing normal from abnormal patterns can remedy them appropriately.

3. The *Zhenyan Lun of the Golden Casket* (Jingui Zhenyan Lun) states: Essence is the root of the body; therefore, those who preserve their essence will not suffer from warm disease in spring.

The *I Ching* (Book of Changes) says: Treading on frost, one knows solid ice is coming. Sages warn early and are cautious in details. The *Liji* (Book of Rites) says: Preparation ensures success. The classics say: The superior physician treats disease before it arises; the sage governs chaos before it occurs. This section should be read alongside the *Yueling* (Monthly Ordinances) and cross-referenced with the previous point on "winter cold injury." It implies that winter cold leads to spring warm disease, but those who preserve essence can avoid it. Thus, the first chapter of the *Su Wen*, *Shanggu Tianzhen Lun* (Discourse on Heavenly Truth in Antiquity), explains the generation, growth, and depletion of yin essence in men and women. The second chapter, *Siqi Tiaoshen Dalun* (Great Discourse on Regulating Spirit with the Four Qi), teaches spring nourishment to support summer growth, summer growth to support autumn harvesting, autumn harvesting to support winter storage, and winter storage to support spring generation. Those who preserve essence can ward off all illnesses, not just warm disease. The *Jingui* states that when the primordial true qi of the five zang organs flows freely, the person is healthy. Why did Yu fail to understand this? He treated "winter cold injury" as one large text, "not preserving essence" as another, and "not preserving essence while injured by cold" as a third, forcibly fragmenting the original text of *Shanghan Lun* to fit his theory, falling into the trap of over-anxiety leading to forced interpretations. The phrase "not preserving essence" must be interpreted flexibly; it does not refer solely to sexual excess. Any human activity that disturbs essence counts. Even if winter weather should be cold but yang qi fails to hide and instead disperses like spring, causing peach and plum trees to bloom out of season, this also constitutes failing to preserve essence.

4. The *Relun Pian* (Chapter on Heat Discussion) states: For those who contract cold damage and develop warm disease, those occurring before the Summer Solstice are called warm disease; those after are called summer-heat disease. Summer-heat should be treated by allowing sweat to flow; do not stop it.

Warm is the gradual development of summer-heat. Before the Summer Solstice corresponds to spring conditions. Spring warmth allows yang qi to disperse; if yin essence is insufficient to support it, warm disease results. After the Summer Solstice, warmth intensifies into heat; intense heat moves dampness, and the struggle between heat and dampness creates summer-heat. "Wu" (do not) is a prohibitive term. Not stopping the sweat of summer-heat disease is the treatment method for summer-heat.

5. The *Cizhi Lun* (Discourse on Acupuncture and Vital Qi) states: Abundant qi with cold body indicates cold damage; deficient qi with hot body indicates summer-heat injury.

This distinguishes cold damage from summer-heat. The classic language is clear; why do people today use cold-damage methods for warm and summer-heat diseases?

6. The *Shengqi Tongtian Lun* (Discourse on Sheng Qi Connecting to Heaven) states: Due to summer-heat, there is sweating; if vexed, there is panting and shouting; if quiet, there is excessive talking.

Summer-heat contains fire, which is urgent and dispersing, causing spontaneous sweating. Fire shares the same qi as the Heart, leading to vexation (the character 'fan' 烦 contains 'fire' and 'head', indicating heart-mind unrest and a face burning like fire). Vexation leads to panting and shouting because fire controls metal (Lung), causing panting, and stagnates the clear qi in the chest, prompting shouting and groaning. If the pathogen does not manifest outwardly but hides in the Heart, the patient appears quiet; since the Heart governs speech, summer-heat in the Heart causes incessant self-talk even when quiet.

7. The *Lun Ji Zhenchi Pian* (Chapter on Discussing Diseases and Diagnosing by Arm Skin) states: If the skin of the forearm is very hot and the pulse is rapid and restless, it is warm disease; if the pulse is rapid and slippery, the pathogen is about to exit.

This section onwards describes methods for diagnosing warm disease.

The classics distinguish warm disease so clearly; why do people today insist it is cold damage and use methods for warm disease of the three foot-yin meridians of cold damage? Zhang Jingyue’s *Leijing* fragmented the classic text and confused the chapters due to lack of careful analysis. Hot forearm skin and pulse indicate fire scorching essence; rapid and restless pulse indicates essence boiling from fire; rapid and slippery pulse indicates the pathogen turning outward.

8. The *Rebing Pian* (Chapter on Febrile Disease) states: On the third day of febrile disease, if the Cun Kou pulse is calm and the Ren Ying pulse is restless, needle the fifty-nine points of the Yang meridians to drain heat and induce sweat, tonify Yin to supplement deficiency. If body heat is high but both Yin and Yang pulses are calm, do not needle; if needling is possible, act quickly—if no sweat, use draining methods. "Do not needle" indicates signs of death. On the seventh or eighth day, if there is wheezing and a wiry pulse, needle urgently; sweat will appear spontaneously, needle shallowly at the web between the thumb and index finger. On the seventh or eighth day, if the pulse is minute and small, and the patient has hematuria and dry mouth, death occurs within a day and a half; if the pulse is intermittent, death occurs in one day. If sweat has occurred but the pulse remains restless, with panting and recurrent fever, do not needle the skin; severe panting indicates death. On the seventh or eighth day, if the pulse is not restless, or restless but not scattered and rapid, sweat within three days; if no sweat after three days, death on the fourth day; if no sweat has occurred, do not needle the cou-li (interstices).

If febrile disease involves loss of pain sensation, deafness, inability to control limbs, dry mouth, extreme yang heat, and apparent yin cold, the heat is in the marrow; this is incurable and fatal.

If sweat has occurred but the pulse remains rapid and full, this is the extreme of yin pulse; fatal. If sweat occurs and the pulse becomes calm, survival is possible. If the pulse remains rapid and full without sweat, this is the extreme of yang pulse; fatal (Although extreme yang pulse is a sign of death, it differs slightly from simultaneous yin-yang stillness. This condition can sometimes be saved by massive doses urgently tonifying yin. Since sweat has occurred but yang pulse is extremely restless, the pathogen is strong and righteous qi weak, but righteous qi still struggles. Retaining even a bit of righteous qi preserves life, provided the method is correct. However, if yin and yang are both still, the pathogen has deeply entered the lower jiao yin aspect, and righteous qi has no will to resist, leaving fate to the pathogen; death is inevitable). If the pulse is rapid and restless but becomes calm after sweating, survival is possible.

There are nine types of febrile disease unsuitable for needling: 1. No sweat, red malar flush, and hiccups indicate death. 2. Diarrhea with severe abdominal distension indicates death. 3. Blurred vision with persistent fever indicates death. 4. Elderly and infants with fever and abdominal distension indicate death. 5. Profuse sweating, vomiting, and hematochezia indicate death. 6. Ulceration of the tongue base with persistent fever indicates death. 7. Cough with epistaxis, no sweat, or sweat not reaching the feet indicate death. 8. Marrow heat indicates death. 9. Fever with spasms (opisthotonos, convulsions, trismus) indicates death. None of these nine should be needled.

If the Taiyang meridian color reflects on the cheekbones, it is febrile disease; if seen simultaneously with Jueyin meridian signs, death occurs within three days.

If the Shaoyang meridian color reflects on the cheeks, it is febrile disease; if seen simultaneously with Shaoyin meridian signs, death occurs within three days.

This section lists signs of death in febrile disease to prohibit needling, as needling would likely cause death. Although needling is contraindicated, some cases may recover with herbal medicine. Needling drains and unblocks, opening heat-pathogen closure quickly, but tonifying yin to retain yang is its weakness, whereas decoctions excel in this regard.

On the third day, if Cun Kou is calm and Ren Ying is restless, the pathogen is shallow and in the upper jiao; thus, needling Yang meridians drains yang pathogen. When yang qi flows, sweat follows. Tonifying yin supplements deficiency because yang excess leads to yin deficiency; draining yang allows yin to rest in its proper position. Thus, draining yang excess is equivalent to supplementing yin deficiency. (Tonifying yin to supplement deficiency is the crucial principle in treating warm-heat. Febrile diseases always consume yin; if consumption is incomplete, life continues; if complete, yang has no attachment and collapses, leading to death. Understanding this principle covers half the treatment logic. Treatment strategies in this discussion stem from this point.)

High body heat with calm yin and yang pulses indicates mismatch between pulse and syndrome (yang syndrome with yin pulse); hence, do not needle.

On the seventh or eighth day, wheezing with a wiry pulse indicates lung qi excess (wheezing) and wind-fire agitation (wiry). Shallow needling at the thumb web drains lung qi. Opening lung heat-bi allows sweat. The thumb web is Shaoshang (LU-11), the Jing-well point of the Lung meridian.

On the seventh or eighth day, a minute and small pulse indicates pathogen deepening into the lower jiao blood level, forcing blood into urine (hematuria). Kidney essence is exhausted, and yin fluids cannot ascend, causing dry mouth. A minute and small pulse indicates not only yin essence exhaustion but also yang qi exhaustion; death is evident. If the pulse is forceful, it is treatable; see later methods.

After sweating, if the pulse remains restless and wheezing, recurrence of fever is predicted. Heat does not subside with sweat; fire controlling metal causes wheezing. Metal受 fire control, depleting the source of Lung qi; death ensues. Rare cases may be treatable; see later methods.

Loss of pain sensation indicates righteous qi decline and inability to fight pathogen. Deafness indicates yin injury and essence depletion. Inability to control limbs indicates exhaustion of true qi. Dry mouth and extreme heat indicate sole dominance of yang pathogen. "Apparent yin cold" uses "cold" to mean "deficiency," referring to deficiency-cold in the lower jiao yin aspect. In patients with yin essence depletion and signs of true qi collapse, persistent pathogenic heat will exploit this emptiness. Thus, heat in the marrow is fatal. Cases with yin decline and yang excess but intact true qi may still be treatable; see later methods.

After sweating, if the pulse remains rapid and full, this is extreme yin deficiency; fatal. Although needling is contraindicated, appropriate herbal therapy may save the patient; see later methods.

Rapid, full pulse without sweat indicates extreme yang excess. Extreme yang leaves no room for yin; fatal. However, appropriate herbal intervention may save the patient; see later methods.

No sweat with malar flush indicates pathogen excess unresolved. Hiccups indicate spleen yin pathology. Simultaneous yin and yang pathology makes treating one hinder the other; fatal. Diarrhea with severe abdominal distension indicates severe spleen yin pathology and simultaneous yin-yang involvement. Blurred vision indicates scattering of essence and collapse of qi. Classics state: Scattered essence causes diplopia; collapsed qi causes blindness. Persistent heat scorches essence and damages qi; death is inevitable. Elderly and infants have depleted solitary yang or immature yang. Contracting warm-heat yang disease plus yin disease of abdominal distension leads to death even before severe distension. No sweat indicates excess pathogenic yang; vomiting indicates declining righteous yang. Hematochezia indicates deep pathogen unable to exit, forcing yin collateral blood downward, causing dual yin-yang injury. Ulceration of the tongue base involves Kidney, Gallbladder, and Heart meridians connecting to the tongue. Deep yang pathogen causes yin-yang fire to knot in the blood level, preventing Kidney water from ascending. If heat subsides, survival is possible; if persistent, death occurs. Cough with epistaxis indicates pathogen closing Lung collaterals, blocking clear pathways. Sweat allows pathogen exit and survival; otherwise, Lung source dies. Marrow heat indicates pathogen reaching the deepest Kidney level. Fever with spasms indicates pathogen reaching the deepest Liver level. Although these nine are unsuitable for needling, later sections provide treatments, and some may survive. Taiyang color on cheekbones indicates febrile disease; Hand Taiyang connects to cheekbones and intersects Foot Taiyang. Taiyang belongs to Water; water boiling from fire causes red color. Simultaneous Jueyin appearance (Wood) means Water is counter-controlled by Fire, Metal fails to generate Wood and instead generates Fire, leaving no place for Water; death is swift. Shaoyang color on cheeks indicates febrile disease; Hand Shaoyang exits ear, passes Guest Master point, intersects cheek, meets Eye corner, and intersects Foot Shaoyang. Shaoyang belongs to Minister Fire; fire color at intersection indicates febrile disease. Simultaneous Shaoyin appearance (Emperor Fire) means two fires blaze, Water cannot withstand; death within three days.

9. *Ping Re Bing Lun* (Discourse on Evaluating Heat Diseases): The Yellow Emperor asked: A patient with warm disease sweats but fever returns immediately, pulse is rapid and restless, does not subside with sweat, speaks deliriously, and cannot eat. What is the disease name? Qibo replied: The disease is named Yin-Yang Intersection (Yin Yang Jiao); intersection means death.

Human sweat originates from grain, which generates essence. When pathogen and essence struggle in flesh and bone and sweat occurs, the pathogen retreats and essence prevails. If essence prevails, the patient should eat and not recur with fever. Recurrent fever is pathogen; sweat is essence. Now, sweating followed immediately by fever indicates pathogen victory. Inability to eat means essence has no support. Disease lingering implies imminent death. Furthermore, *Relun* states: Sweating with persistent rapid pulse indicates death. Here, pulse does not correspond with sweat, meaning the body cannot overcome the disease; death is certain. Delirium indicates loss of Zhi (Will/Shen); loss of Will indicates death. Seeing three signs of death and no sign of life, even if recovery seems possible, death is certain.

The meaning is clear; classics declare certain death, yet with proper herbal treatment, survival is possible, illustrating the difference between acupuncture and pharmacology; see later sections.

10. *Ci Re Pian* (Chapter on Acupuncture for Heat Diseases) states: Liver heat disease presents with yellow urine first, abdominal pain, lethargy, and fever. During heat struggle, delirium and惊 (fright) occur, hypochondriac fullness and pain, restlessness of hands and feet, and inability to lie down. Symptoms worsen on Geng/Xin days, resolve with profuse sweat on Jia/Yi days. If qi rebels, death occurs on Geng/Xin days. Needle Foot Jueyin and Shaoyang meridians. Rebellion causes headache, dizziness, and pulsation rushing to the head.

Liver disease presenting with yellow urine first: Liver meridian connects to genitalia; Liver governs free flow. Liver dysfunction loses its dispersing function, causing yellow urine. Abdominal pain and lethargy result from Wood disease attacking Earth (Spleen). Heat struggle is intense pathogenic heat fighting righteous qi. Delirium and fright involve Hand Jueyin Pericardium; both Jueyin share similar qi, so Hand Jueyin is affected during struggle. Hypochondriac pain occurs because Liver meridian runs along the sides of the body. Restlessness and insomnia occur because Liver governs Wind, Wind affects extremities, and Wood disease attacks Earth (Spleen governs limbs). Liver heat draws True Yin from Shaoyin Kidney; yin injury causes agitation. Geng/Xin (Metal) days control Wood, worsening symptoms. Jia/Yi (Wood) days are prosperous for Liver, allowing sweat and recovery. Qi rebellion means severe disease defying recovery logic; death occurs on days controlled by the pathogen. Needling Foot Jueyin (Zang) and Shaoyang (Fu) treats organ disease by draining its paired fu organ. Headache and upward movement occur because Liver governs ascending; extreme disease causes upward rebellion.

The logic for worsening on Geng/Xin days applies similarly to other zang organs.

11. Heart heat disease presents initially with unhappiness, followed by fever after several days. During heat struggle, sudden heart pain, vexation, oppression, frequent vomiting, headache, flushed face, and anhidrosis occur. Symptoms worsen on Ren/Gui days, resolve with profuse sweat on Bing/Ding days. If qi rebels, death occurs on Ren/Gui days. Needle Hand Shaoyin and Taiyang meridians.

Heart disease presenting with unhappiness: Pericardium, named Danzhong, resides below the Heart and acts on behalf of the Sovereign. Classics state Danzhong is the Official of Envoy, governing joy; heart disease causes unhappiness. Sudden heart pain results from pathogen-righteous qi struggle during heat conflict. Vexation arises because Heart governs Fire; oppression occurs because Danzhong qi is stagnant. Vomiting is associated with Liver disease; both Jueyin share qi, and Danzhong suffers on behalf of the Heart, so Liver symptoms appear after intense heat struggle. Pathogen in the diaphragm often causes vomiting. Headache results from Fire rising. Flushed face is the color of Fire. Anhidrosis occurs because sweat is the fluid of the Heart; heart disease blocks sweat passage.

12. Spleen heat disease presents initially with heavy head, cheek pain, vexation, bluish complexion, desire to vomit, and fever. During heat struggle, lower back pain prevents bending or stretching, abdominal distension, diarrhea, and...