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The syndrome differentiation method of Wei (Defensive), Qi, Ying (Nutritive), and Xue (Blood) was first applied by Zhang Zhongjing. For instance, Article 53 of the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) explicitly states: "When a patient frequently sweats spontaneously, this indicates that the Ying Qi is harmonious, but the exterior is discordant because the Wei Qi does not harmonize with the Ying Qi." Therefore, Shi Yisen said: "The Taiyang chapter already includes Wei, Ying, Qi, and Blood; one cannot extract Wei, Ying, Qi, and Blood from the scope of Taiyang." Ye Tianshi held the same view on this issue. Thus, although followers of the Ye school engaged in deliberate fabrications and disregarded facts to rival Zhang Zhongjing's theory (such as Ju Tong, Zhu Bin, and Wang Tingzhen insisting that the *Shanghan Lun* only discusses narrow-sense Shanghan), Ye Tianshi acknowledged that Zhang Zhongjing also used Wei, Ying, Qi, and Blood to differentiate external contractions. Consequently, Ye Tianshi only emphasized that the treatment methods for Wenbing (Warm Diseases) are "greatly different" from those for Shanghan, while the differentiation of Wei, Ying, Qi, and Blood is "the same" as in Shanghan. However, this actually contains an obvious error. Because Ye Tianshi's sequence of depth in the "four levels" is "after Wei comes Qi, after Ying comes Xue," meaning Wei is the shallowest, Qi is slightly deeper, and entering Ying is heavier. The Ying-level lesions described by Ye Tianshi are clearly more severe than Qi-level diseases. Therefore, if Wei-level disease transmits to Qi first, then to Ying, gradually worsening, it is considered Shun Chuan (sequential transmission); if Wei-level disease directly enters Ying with sudden worsening, it is Ni Chuan (reverse transmission). Thus, in treatment, Ye Tianshi advocated, "Even when entering Ying, one can still penetrate the heat back to Qi." In contrast, the depth sequence of Wei, Ying, Qi, and Blood in the *Shanghan Lun* places Ying before Qi, where Ying-level disease is lighter than Qi-level disease. Thus, in Taiyang disease, the Jing (meridian/exterior) stage involves injuries to Ying or Wei, or both; only the Fu (organ/interior) stage uses Wuling San to treat Qi level and Didang Tang to treat Blood level. This shows that Ying and Wei tend toward the exterior and are shallow, while Qi and Blood govern the interior and are deep. Therefore, when pathogenic factors are in Taiyang, Ying-level disease can occur from the beginning, and Zhang Zhongjing primarily used Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei. In the *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases), Wu Jutong used Guizhi Tang as the primary formula for early-stage Wenbing with aversion to wind and cold. However, Ye Tianshi's Ying-level disease could fundamentally not be treated with this formula. This demonstrates that Ye Tianshi's differentiation of Wei, Ying, Qi, and Blood differs from Zhang Zhongjing's. Later warm disease practitioners adopted Wei, Ying, Qi, and Blood as the guideline for differentiating febrile diseases, following Ye Tianshi's method, so Ying-level disease is considered heavier than Qi-level disease. This method was created by Ye Tianshi, yet he insisted that "differentiating Ying, Wei, Qi, and Blood is the same as Shanghan," which cannot withstand scrutiny.

III. Treatment Methods Differ Only Slightly

"Qing dynasty physicians such as Ye Tianshi, Wang Mengying, and Wu Jutong indeed advocated that Wenbing and Shanghan are opposed."① Ye Tianshi's statement in the *Wenre Lun* (Treatise on Warm Heat) that Wenbing treatment methods are "greatly different" from Shanghan reflects this advocacy. However, in reality, the treatment methods differ only slightly, not greatly. Although Shanghan and Wenbing schools have many differences in understanding external febrile diseases, their discussion of treatment methods only diverges at the initial stage. We know that Shanghan has broad and narrow meanings. Broad-sense Shanghan includes Wenbing. Although the *Shanghan Lun* is brief and incomplete regarding Wenbing principles and methods, it opened the door for clearing heat and nourishing Yin to treat febrile diseases, serving as the foundation for the development of later Wenbing schools. Since the Wenbing included in broad-sense Shanghan and the Wenbing mentioned by Ye and Wu refer to the same object, although ancient and modern treatment methods vary in detail, their principles are consistent. Therefore, essential formulas for treating warmth by warm disease practitioners, such as Baihu Tang (White Tiger Decoction) and Chengqi Tang (Descending Qi Decoction), all originate from the *Shanghan Lun*. Regarding narrow-sense Shanghan, although initially opposed to Wenbing, after transforming into heat, the treatment methods become completely consistent. Jin Shoushan stated: "The difference between Shanghan and Wenbing treatment lies mainly in the initial appearance of exterior syndromes; after transforming into heat, both should be cooled and resolved, with little variation."④ Tao Jian'an also said that for Wenbing, "exterior syndromes are not treated like proper Shanghan, but interior syndromes are the same." This shows that even for narrow-sense Shanghan, after heat transforms and transmits to the interior, the treatment is no different from Wenbing. To claim that Shanghan always emphasizes saving Yang and Wenbing always emphasizes saving Yin is an illusion. The saying "Zhang Zhongjing's Shanghan focuses on saving Yang, Ye and Wu's Wenbing focuses on saving Yin" is merely a later interpretation. In fact, the *Shanghan Lun* also highly values preserving body fluids. Since the object is the same, correct handling implies that principles are generally consistent, and they cannot always follow two completely different paths. Therefore, it is acceptable to say that there are significant differences in using cooling or warming drugs at the initial stage of narrow-sense Shanghan versus Wenbing. However, it is incorrect to broadly state that Shanghan and Wenbing treatment methods are largely different. [Date/User Info omitted]

IV. Wenbing Also Involves Many Transmissions

Shanghan practitioners prefer to call external febrile diseases Shanghan, while warm disease practitioners prefer to call them Wenbing; this is a habit of old-time physicians. But for the same disease and the same object, unless influenced by drug treatment or other reasons, its transmission must develop according to its own certain laws. There is no logic that calling it Shanghan means more transmissions, while calling it Wenbing means fewer transmissions. The dispute between Cold and Warmth lies in etiology. As the old TCM doctor Chen Suseng said, the dispute over etiological views is essentially a "dispute over medication methods" (*Wenre Guankui*). These disputes are nothing more than to prove the correctness of one's own treatment proposals, not to say that objectively there exist two types of febrile diseases, Cold and Warmth, developing according to different laws. Even stepping back, Ye Tianshi said, "Shanghan often has complicated changes; after Warmth persists for a long time, it remains in one meridian without moving, using this to differentiate." Yet he also said, "If the Sanjiao cannot resolve from the exterior, it must lead to interior knotting. Where is this interior knotting? It is in the Yangming Stomach and Intestines." This itself is contradictory. However, worshippers of Ye Tianshi always interpret it forcibly. For example, Zhang Xugu said: "Shanghan is first received in this meridian; since the meridian is long, it transmits and changes often. Warm pathogens are first received in the hand meridians; since hand meridians are short, they transmit and change less." This sounds as if the Hand-Taiyin Lung Meridian never has cold syndromes, and cold pathogens only injure foot meridians. Similarly, Zhou Xuehai said: "Cold pathogens are constricting; they enter gradually, changing manifestation with each stage, hence many complications; Warm pathogens are opening; heavy gates are wide open, so early illness often involves two or three meridians, and after two transmissions, the six meridians are exhausted, hence few complications." Ye Tianshi's words cannot justify themselves. To whitewash contradictions and make explanations convincing is certainly not easy. Thus, the theories of Zhang and Zhou do not satisfy later generations. The *Wenbingxue* (Science of Warm Diseases) states that Zhang Xugu's explanation for "Shanghan having many transmissions and Wenbing having few" is very forced and hardly convincing. It also believes Zhou Xuehai's view is not entirely accurate because "if early Wenbing symptoms involve two or three meridians, the condition is mostly serious and complex, and syndrome evolution is also diverse. How can this be considered few complications? Therefore, Zhou's reasoning is insufficient." Discussing only merits and ignoring flaws, speaking only of jade and ignoring stones, has almost become the tradition of commentators on the *Wenre Lun*. Thus, the editors of *Wenbingxue*, while dissatisfied with Zhang and Zhou's annotations, did not criticize Ye Tianshi's original text at all. This is similar to criticizing only Wang Shuhe's methods for certain articles in the *Shanghan Lun*, which is indeed a good way to avoid accusations of forgetting one's ancestors. However, this makes the *Wenre Lun* give people an illusion of being flawless gold and jade. In reality, according to Ye Tianshi himself, early Wenbing starts in the Hand-Taiyin; reverse transmission enters the Pericardium, sequential transmission enters Yangming, it can linger in the Sanjiao, and deficiency leads to internal sinking into Shaoyin (actually all six meridians can be involved). Since it is not unchanging, who can teach people to use this as a basis for judging whether it is Shanghan or Wenbing?! Those who say the argument of many vs. few transmissions is an empirical talk, I consider it the most baseless theory. Xie Songmu once refuted this, which can be said to resonate with my thoughts.

V. Early Use of Blood-Invigorating Drugs Is Not Necessarily Wrong

Ye Tianshi strictly divided the use of drugs according to Wei, Ying, Qi, and Blood levels. He said: "After Wei comes Qi, after Ying comes Xue. In Wei, sweating is permissible; only when reaching Qi can one clear heat; even when entering Ying, one can still penetrate heat back to Qi... Entering Xue fears consuming and agitating blood... Otherwise, failing to follow the method of urgency and slowness, one worries about making mistakes upon acting." According to the saying "only when reaching Qi can one clear heat," needless to say, using blood-invigorating drugs for exterior syndromes, even Qi-clearing drugs should not be used abruptly. But in reality, this is not so. The Cinnamon Twig and Peony Root in Guizhi Tang are both Blood-level drugs. Wu Jutong surprisingly used it as the primary formula in the *Wenbing Tiaobian*, which itself illustrates the contradiction between Ye and Wu's theories. Later critics criticized Wu Jutong's use of Guizhi Tang mainly for accusing him of using warmth to treat warmth. I argue that according to Ye Tianshi's theory, he should also be criticized for using blood-invigorating drugs too early, violating the instruction to follow the order of urgency and slowness. However, using blood-invigorating drugs in the Wei level cannot be said to be a fault. Exterior syndromes of Shanghan can use blood-invigorating drugs, and exterior syndromes of Wenbing may well do so too. Ye Tianshi established this strict rule, which itself does not conform to the principle of "Seeing liver disease, knowing it transmits to the spleen, one should first strengthen the spleen." Since seeing Wei-level syndrome and knowing it will step-by-step deepen into Qi, Ying, and Blood levels, why must one wait until Qi to clear heat? Why not follow the principle of treating the spleen when seeing liver disease, preemptively treating Qi and Ying, preventing Qi and Ying syndromes from appearing, and resolving them at the Wei level? "Old Jiang's treatment of Wenbing does not stick to 'after Wei comes Qi, after Ying comes Xue' or 'only when reaching Qi can one clear heat' adaptive therapy, but advocates treating before the syndrome appears."⑤ This treatment proposal is very inspiring, but for those superstitious about Ye Tianshi's theory, it is unimaginable. Zhu Weiju once said: "Medicine as an art excels in rescuing reversals." If Ye Tianshi's theory guides the treatment of warm diseases, its effect in intercepting and reversing is still unsatisfactory. Why must we prostrate ourselves, trembling with fear, unable to cross the boundary! Pushing out the old to bring in the new and continuously improving efficacy is a requirement proposed by the development of the times. We must diligently explore in both theory and practice. Theoretically, one should not adhere to conservatism or cling to one school's theory; clinically, one must start from reality to avoid narrowing the path of medication. In the past, Nie Yuntai treated intestinal typhoid (damp-warmth) by using Rhubarb and blood-invigorating drugs from the beginning, achieving good results. Recent studies show that "using blood-invigorating and stasis-resolving, purgative, and heat-clearing and detoxifying methods to treat 52 cases of epidemic hemorrhagic fever resulted in complete cure, especially the early application of blood-invigorating and stasis-resolving drugs, which increases phagocytic cell capacity and enhances reticuloendothelial system activity, potentially benefiting microcirculation improvement and preventing disseminated intravascular coagulation."⑥ These examples illustrate that using blood-invigorating drugs in the early stage of warm diseases is definitely not "making a mistake upon acting." On the contrary, knowingly that Wei will transmit to Qi but not treating Qi, knowing that Qi will enter Blood but not treating Blood beforehand, waiting for Qi-level syndromes to appear before using Qi-level drugs, and waiting for Blood-level syndromes to appear before using Blood-level drugs—this method of administering drugs trailing behind the lesion—is often called by proponents "treating the syndrome with the corresponding drug," which is syndrome differentiation and treatment. In reality, it does not conform to the principle of "superior doctors treat disease before it arises," and thus does not truly conform to the spirit of syndrome differentiation and treatment.

VI. Removing Qi-Level Drugs Upon Ying-Level Heat Is Not Necessary

The *Wenre Lun* states: "When Ying level receives heat, blood fluid is robbed, heart-mind becomes unsettled, sleeplessness worsens at night, or spots appear faintly; immediately remove Qi-level drugs. If falling in from wind-heat, use Rhinoceros Horn and Bamboo Leaf type drugs; if falling in from damp-heat, use Rhinoceros Horn and Flower Dew type drugs, incorporated into cool-blood and heat-clearing formulas." This text is theoretically self-contradictory and clinically inconsistent with reality, fundamentally insufficient as a guide. Blindly believing in it and interpreting it forcibly may inevitably invite the ridicule of "being confused and unreachable." Looking at the *Wenre Lun*, so-called Wei-level drugs refer to Mint and Burdock Seed types; so-called Qi-level drugs refer to Bamboo Leaf and Flower Dew products; so-called Ying-level drugs refer to Rhinoceros Horn and Scrophularia types; so-called Blood-level drugs refer to Rehmannia Root and Moutan Bark substances (in reality, Ying and Blood level drugs are hard to distinguish, e.g., Ye Tianshi commonly uses Rehmannia Root to clear Ying). While Ye Tianshi warns against immediately removing Qi-level drugs, he simultaneously teaches using Bamboo Leaf and Flower Dew, etc., Qi-level drugs. How obvious is the inability of his theory to justify itself! Furthermore, Ye Tianshi said, "Even when entering Ying, one can still penetrate heat back to Qi." What is meant by "even when entering Ying, one can still penetrate heat back to Qi" is that while using Ying-clearing drugs, one continues to use Qi-level drugs such as Honeysuckle, Forsythia, Scutellaria, and Coptis, hoping that the pathogenic heat entering Ying still penetrates out through the Qi level to resolve. The reason Shenxi Dan (Divine Calamity Pill) used by Ye Tianshi for heat entering Ying and Blood contains so many Qi-level drugs like Honeysuckle, Forsythia, Scutellaria, and Trichosanthes Root is precisely for this reason. The reason Qingying Tang (Clear Ying Decoction) used by Wu Jutong for pathogenic heat entering Ying also uses so many Qi-level drugs like Honeysuckle, Forsythia, Ophiopogon, Bamboo Leaf, and Coptis is for the same reason. If Ying-level heat requires immediately removing Qi-level drugs, how can one explain and understand the drug method of "penetrating heat back to Qi"? From the above, it is evident that the two statements "penetrating heat back to Qi" and "immediately removing Qi-level drugs" are difficult to coexist. Furthermore, looking at medical cases in *Linzheng Zhinan·Wenre Men* (Guide to Clinical Practice·Warm Heat Section), for Wenbing showing Ying-level syndromes, whether latent qi erupts from within or new contraction enters from outside, whether Qi-level pathogenic heat initially transmits to Ying or Qi-Ying heat intensity is burning both, Ye Tianshi never removed Qi-level drugs. For example, Case of Mao, age 60, the pathogenesis is warm pathogen heat entering Ying; treatment uses Rehmannia Root, Ophiopogon, Apricot Kernel, Curcuma Juice, Stir-fried Chinese Fritillary Bulb, and Tangerine Peel. This single case is sufficient to show that the theory of "immediately removing Qi-level drugs" disconnects theory from practice. There are many such cases in the Warm Heat section. For example, Case of Ma involves Shaoyin latent pathogen; treatment still uses Bamboo Leaf and Forsythia, hoping to penetrate blood-borne latent pathogen heat back to Qi. A certain case involves Qi-Blood burning both; treatment uses Anemarrhena, Gypsum, and Bamboo Leaf to clear Qi heat. Case of Old Woman Chen involves heat in Ying; treatment also uses Forsythia, Bamboo Leaf, Polygalae Root, Polygala Root, and Acorus, etc., Qi-level drugs. Conversely, when pathogen initially enters Ying, Ye Tianshi sometimes does not use a single Ying-level drug, but entirely uses Qi-clearing drugs. For example, a certain case involves Spring Warmth, crimson tongue, evidence of Ying heat, but the drugs used are Bamboo Leaf Heart, Anemarrhena, Trichosanthes Root, Talcum, Raw Licorice, and Pear Skin, six flavors, none belonging to Ying-level drugs. The author believes: After Ying level receives heat and blood fluid is robbed, one cannot continue to use only Qi-level drugs; one must consider Ying level and appropriately add Ying-clearing and cool-blood crystals; this is necessary. But immediately removing Qi-level drugs is unnecessary. Ye Tianshi treats this way but says that way. The *Wenre Lun*, within a short space, is so often contradictory that later generations suspect that when Gu Jingping recorded and wrote *Wen Zheng Lun Zhi* (Treatise on Warm Syndrome Differentiation), it did not fully conform to Ye Tianshi's original intent. If later generations insist that every sentence of the *Wenre Lun* represents Ye Tianshi's true intent, then Ye Tianshi cannot escape blame.

VII. Damp-Warmth Has No Mechanism to Transform into Malaria

In the process of treating Wenbing and damp diseases, predecessors sometimes encountered original diseases that were lingering and tricky. Later, occasionally due to the patient contracting malaria again, as the malaria was cured, the original disease also healed. Thus, it was mistakenly believed that the original disease transformed into malaria. Furthermore, since malaria differentiation includes dampness and warmth, they became convinced that damp-warmth disease could transform into malaria. The *Wenre Lun* states: "...Because it is still in the Qi level, one can still hope for its portal of battle sweat and mechanism of transforming into malaria." And *Linzheng Zhinan* states: "Warm pathogen combined with rain and dampness, externally contending becomes malaria." (Case Wu in Malaria Section) "This damp-warmth external qi becomes malaria" (Case Cao in the same book). By reading these texts together, we can accurately understand Ye Tianshi's viewpoint. Zhang Xugu believed that for damp-warmth disease, as long as one expands its Qi mechanism, using "Apricot, Magnolia, Wendan Decoction types, pungent-pungent sweet-bitter to facilitate ascending-descending and turn Qi mechanism, opening the portal of battle sweat, becoming the head of transforming into malaria." Wang Mengying believed that the phrase "mechanism of transforming into malaria" originally refers to Qi mechanism being unblocked, the disease then transforms into malaria, thus killing the pathogen. Obviously, such interpretations generated from the text are passing on errors. Damp-warmth is damp-warmth, malaria is malaria; there is no possibility of mutual transformation between these two diseases. People with modern medical knowledge understand the absurdity of this predecessor's recognition, so now everyone adopts the explanation of "transforming into a malaria-like state." This clever change in wording shows that later generations' understanding is more correct than predecessors', reflecting annotators' worship of Ye Tianshi. But this later generation's knowledge cannot explain the true intent of Ye Tianshi's original text. Ye Tianshi said damp-warmth can transform into malaria; Zhang and Wang said damp-warmth would transform into malaria. This is a wrong understanding of disease by predecessors. Without pointing this out realistically and clearly, beginners will inevitably still be influenced by this theory. Therefore, the theory of damp-warmth transforming into malaria is indeed a flaw in the *Wenre Lun*.

VIII. Tongue Spikes Are Not All Due to Extreme Upper Jiao Heat