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The pulse is tight and choppy (this is because the Metal of Dryness governs contraction, hence the pulse appears tight and choppy), or floating and wiry, or hollow and deficient. Furthermore, a wiry pulse indicates Wind-Dryness; a surging pulse indicates Heat-Dryness; a slow pulse indicates Earth-Dryness; a choppy pulse indicates Blood-Dryness; a delayed pulse indicates Cold-Dryness.

Lei Shaoyi stated: The classics state "if one is injured by Cold in winter, one will inevitably suffer from Warmth diseases in spring," which teaches that there are latent pathogens causing illness. Regarding being injured by Cold in winter, if severe, it manifests immediately as Shanghan (Cold Damage); if mild, it does not manifest immediately. The pathogen lies dormant in the skin and muscles, or hides in the Shaoyin channel. When Yang Qi opens and dissipates in spring, an external pathogen may suddenly invade, stirring up the latent pathogen to cause disease. There are also rare cases where it is triggered without external invasion. Those with pathogens lying in the skin and muscles are those who labored and sweated during winter; those with pathogens hiding in the Shaoyin are those who failed to conserve essence and suffered internal kidney deficiency during winter. This is what the ancients meant when they said, "the most deficient place is where evil resides." Why did Liu Songfeng, Chen Pingbo, and other scholars claim there is no such thing as a latent pathogen? This is a crime against the classics; how can one escape this blame?

He further stated: I once read Jiebin's book, which claims that Warmth diseases are identical to Shanghan. Keyi's book claims that Warmth diseases are identical to Plagues. Little do they know that Shanghan results from contracting Cold pathogens in winter, while Plagues result from contracting pestilential Qi from heaven and earth. Compared to latent Warmth diseases, these are vastly different; how can they be compared? Tracing the origin of Warmth diseases, the root cause is contracting Cold in winter, which lies dormant and unmanifested, later transforming into Heat. It must wait until after the Spring Equinox, when the weather warms and Yang Qi expands, for the latent pathogen to move from within and reach the exterior, resulting in heat in both the interior and exterior. Symptoms include thirst with desire to drink, aversion to heat rather than cold, and a pulse that becomes stronger upon deep pressure. In this disease, there is no Wind-Cold on the exterior, so acrid-dispersing methods are unsuitable, and one must strictly avoid acrid-warm or acrid-cool methods. If dispersing methods are mistakenly used, complications will arise like swarms of insects. For example, if there is no sweating at the onset, only cooling methods to vent the pathogen should be used; if there is sweating, methods to clear heat and preserve fluids should be used. If the pulse is surging, large, and rapid, accompanied by high fever and delirium, this indicates Heat in the Sanjiao (Triple Burner), and cooling methods to purge heat should be employed. If the pulse is deep and solid, accompanied by thirst, delirium, and a dry tongue coating, this indicates Heat in the Stomach Fu organ, and moistening purgatives to save fluids should be used. Warmth diseases strictly prohibit acrid-warm diaphoresis; inducing sweat leads to delirious speech and a restless pulse, which is incurable. However, death occurs if there is high fever without sweat; death also occurs if fever worsens after sweating with a restless pulse; death occurs if there is high fever but the pulse is surprisingly fine and small with cold extremities; death also occurs if convulsions, coma, and confusion appear with a hurried, knotted, deep, or intermittent pulse. Physicians must know this.

Cheng Xi stated: Investigating why Liu Songfeng and Chen Pingbo claimed there is no latent pathogen, the reason lies in their adherence to specific texts. One clung to the phrase "winter injury due to sweat" in the *Yunji Qiqian*, and the other to Qian Yi's text regarding "winter injury to the Cold-Water organ." Little did they realize that both sides only considered one aspect, completely ignoring the teachings regarding injuries in spring, summer, and autumn. Although these two gentlemen possessed high intellectual capacity, they were misled. Instead of correcting these errors, they supported them. No wonder later physicians uniformly referred to these as sudden infections, recklessly using dispersing herbs such as Qianghuo, Fangfeng, Mahuang, and Guizhi to force sweat and deplete fluids, leading to fatal mistakes. This blame must fall on the originators of these theories.

Chen Lianfang stated: When one sweats, the pores open, allowing Cold pathogens to enter through the sweat; thus, it remains an injury by Cold in winter. Why change "Cold" to "Sweat"?

The *Jianzhong Jinjian* (Golden Mirror of Medicine) stated: The *Neijing* says that all Heat diseases belong to the category of Shanghan. This does not mean they are merely similar to Shanghan, but that they belong to the same category of disease. Shanghan gets its name from injuring the seasonal Cold. Warmth and Heat diseases also change their names according to the season. The classics state: "Injury by Cold in winter leads to Heat disease." This refers to illness occurring in season. The classics state: "Injury by Cold in winter leads to Warmth disease in spring." This refers to illness occurring out of season. The classics state: "For those who contract Shanghan and develop into Warmth, those before the Summer Solstice suffer from Warmth, and those after the Summer Solstice suffer from Shu (Summer Heat)." Shu means Heat. This refers to illness occurring in season. Therefore, before the Autumn Equinox, all can be named Heat diseases; after the Autumn Equinox, all can be named Shanghan. This is how Xuanyuan, Qibo, and Zhang Zhongjing established the definitions of Shanghan, Warmth, and Heat diseases. The classics further say: "Those who store Essence will not suffer from Warmth in spring," explaining the reason for not getting ill when out of season. The classics say: "Failure to store Essence in winter leads to Warmth disease in spring," explaining the reason for inevitable illness when out of season. From this, we know that Shanghan pathology depends not on whether Essence is stored or not, but simply on contact with the pathogen. Unlike Warmth/Heat diseases, where storing Essence prevents illness and failing to store it causes illness. Those who can store Essence, even if occasionally exposed to pathogens, whether Warmth or Summer Heat, will have milder illness; those who cannot store Essence, even with slight exposure, will have severe illness. The difference is slight. However, if one specifically argues that failure to store Essence in winter, without any external infection, constitutes a primary Shaoyin disease with internally generated Heat, this contradicts Zhang Zhongjing's principles on Warmth diseases. In his treatise, Zhongjing only states that initial Taiyang disease with fever, thirst, and aversion to cold is called Warmth disease, distinguishing it from Shanghan. He did not mean that Taiyang Cold does not enter from the exterior, nor that it arises solely from internally generated Heat in the Shaoyin.

He further stated: The so-called latent pathogen disease refers to the normal Qi of the four seasons, not the abnormal pathogens of the four seasons, nor the unusual pestilential pathogens. Regarding latent pathogens, for instance, if one contracts Winter Wind-Cold, the severe cases injure Ying and Wei and manifest immediately, named Fengzhong (Wind Strike) or Shanghan; the mild cases lie dormant in the skin and muscles and manifest later, named Warmth disease. Therefore, the distinction between seasonal Qi and latent pathogen diseases must not be overlooked.

Yang Ruhou stated: Zhang Zhongjing, in writing the *Shanghan Lun*, placed Warmth disease on equal footing with Wind and Cold, establishing three major categories. Carefully studying Zhongjing's textual style reveals methods to distinguish Warmth disease beyond Shanghan and Fengzhong. "Fever" indicates the pathogen is in the muscle layer; "aversion to cold is absent" indicates the pathogen is not in the skin and hair; "thirst" indicates Heat originating from within. Because Cold contracted in winter does not manifest immediately, but transforms into Warmth in spring, after transformation, the Cold has turned to Heat and can no longer be called Cold. Zhongjing explained this himself, calling it Warmth disease. Any Heat originating from within is encompassed by the term "Warmth disease." This is the true nature of Warmth-Heat diseases, which do not come from the exterior. A close study of Zhongjing's text reveals the origin of Warmth disease, while the distinctions from Shanghan and Fengzhong are implied.

Zhou Yuzai stated: Warmth diseases have no Yin-Yang differentiation; thus, the disease is purely Yang without Yin, and medications must be cold in nature, avoiding heat.

Ke Yunbo stated: For those who contract Shanghan and develop into Warmth, although it stems from winter Shanghan, the root actually lies in the person's stagnant Fire.

He further stated: The Liver and Gallbladder are the source of generating Warmth; the Yangming is the gathering place of forming Warmth.

Yang Lisshan stated: Eight or nine out of ten cases of Wind-Cold pathogens initially attack the Taiyang channel; eight or nine out of ten cases of Warmth pathogens travel directly through the central pathway and originate in the Yangming channel.

He further stated: Shanghan transmits from the exterior to the interior, so interior symptoms are exterior pathogens invading inward; Warmth disease moves from the interior to the exterior, so exterior symptoms are interior pathogens floating outward. He further stated: Although Warmth disease and Shanghan are different, the treatment methods in the latter stage (clearing or purging) are not significantly different; however, the treatment methods in the initial stage (dispersing the exterior) are worlds apart.

He further stated: In Shanghan, one dose of diaphoresis resolves the exterior pathogen; in Warmth disease, one dose of diaphoresis intensifies the interior pathogen. Mahuang Tang, Guizhi Tang, and Qinglong Tang, when used for Shanghan, never fail to save lives; when used for Warmth disease, they never fail to cause death.