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It is also said: "Then, are Shengdi (Rehmanniae Radix) and Shihu (Dendrobii Caulis) never to be used? This is not the case. After taking two or three doses of Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Shigao (Gypsum Fibrosum), when the fever subsides, the body becomes cool, the spirit clears, and the pulse calms—reaching this auspicious state described by the eight characters 'fever subsides, body cools, spirit clears, pulse calm'—the patient has passed the critical danger zone. However, at this time, fluids are depleted, yin essence is damaged, and the primal yin (the most fundamental yin qi of the human body) cannot be quickly restored. Only by consuming thin porridge and soft rice can the stomach's appetite slightly open. At this point, using Shengdi to nourish yin and Shihu to protect the stomach, and slowly planning for convalescence, these are important medicines. The only thing that must adhere to an unchangeable principle is the timing and sequence of their administration."

In a medical case from the "Warm Diseases" section of *Lin Zheng Zhi Nan Yi An* (Clinical Guide to Medical Cases), involving a patient surnamed Xi, Ye Tianshi believed that ancient methods were entirely based on nourishing yin and clearing heat, imitating Liu Hejian's method of "lightly administering heavy/turbid medicines," so as not to be blocked by upper jiao heat obstruction, allowing the root of the lower jiao to stand firm, hoping that irritability and steaming heat would naturally subside. If one uses carbonized Shudi (Rehmanniae Radix Preparata), carbonized Yuanzhi (Polygalae Radix), Dan Congrong (Cistanches Caulis), Chuanduan (Dipsaci Radix), and Wuweizi (Schisandrae Fructus)—medicines that tonify the kidney and astringe—they will cause stagnation and trap the pathogen, leading to untreatable conditions. Switching to Shengdi for nourishing yin takes advantage of its sweet, cold, and juicy nature, making it easy to replace Shudi; if Shudi is burned into charcoal, it becomes a inferior method for nourishing yin.

The method of nourishing yin originates from Zhu Danxi. However, in treating warm-heat diseases, Zhu Danxi did not use any formula specifically for nourishing yin; he advocated using Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex) to descend fire, stating that these should not be used unless it is fire within the yin. Whether this view is correct is left aside for now, but Zhu Danxi's intent can be inferred. Therefore, Wu Jutong's (Wu Tang, courtesy name Peiheng, known as Wu Shi or Tianshi) method of nourishing yin was not purely inherited from Zhu Danxi; he adopted ancient theories but omitted half of them, applying them to pathological mechanisms where nourishing yin was inappropriate, which inevitably led to absurdity and failure.

Ye Tianshi used light acrid-cool formulas to treat warm diseases invading the lung. For ordinary colds, this might suffice, but for Feizhang (here referring to pneumonia), light formulas are powerless. Thus, Lu Jiuzhi stated:

"If it were as Ye said, then the so-called warm-heat diseases would merely be minor colds, commonly known as minor wind-heat or minor wind-warmth, such as red eyes, swollen cheeks, throat blockage, or toothache. These could be cured immediately with light acrid-cool formulas. But why, after just a few days, does the pathogen suddenly enter the pericardium, becoming a severe illness leading to death? If the disease enters the heart and causes death within a few days, it certainly cannot be treated merely with light acrid-cool formulas as he claimed. Moreover, why, according to his words, does the disease not heal immediately with light acrid-cool formulas?"

Those who can be cured by light acrid-cool formulas are limited to what Mr. Jiuzhi called "minor wind-heat" and "minor wind-warmth." Those that light acrid-cool formulas cannot cure are conditions like Feizhang. Using light formulas to govern all warm diseases is why Ye Tianshi and Wu Tang have caused endless harm. Mr. Jiuzhi used Gegen Qinlian Tang (Kudzu and Scutellaria Decoction) to treat warm diseases; this can only treat typhoid fever (intestinal typhoid), not Feizhang. Therefore, Master Yuanlei (Zhang Qigong) said:

"Mr. Jiuzhi's harsh criticism of Wu Tang is indeed well-founded, but using Gegen Qinlian Tang as the main formula for warm diseases cannot be considered a definitive conclusion. Observing the symptoms of warm-heat and wind-warm diseases, apart from Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) and Baihu Tang (White Tiger Decoction), there are hardly any appropriate formulas."

Master Yuanlei used these two formulas to treat the warm diseases and wind-warm diseases mentioned by Zhang Zhongjing, which was indeed firm, excellent, and unshakable; using Ma Xing Shi Gan Tang to treat Feizhang in Ye-style warm diseases also coincided perfectly without gap.

In Chapter 7 of *Jin Gui Yao Lue* ("Pulse, Symptoms, and Treatment of Lung萎, Lung Abscess, Cough, and Upper Qi Disease"), there are three entries regarding Feizhang:

"Upper qi [respiratory distress], panting, and restlessness belong to Feizhang, intending to develop into Fengshui [wind-water edema]; sweating will cure it."

"Coughing with upper qi [respiratory distress] indicates Feizhang. If the patient's eyes appear as if they are protruding and the pulse is floating and large, Yuebi Jia Banxia Tang (Yuebi Decoction plus Pinellia) should be used. (Master Yuanlei notes: 'This symptom complex corresponds to bronchiolitis and pneumonia. Expectoration and breathing are extremely difficult, and edema easily forms. This is due to pulmonary circulatory congestion caused by respiratory difficulty, leading to systemic acute congestion. Yuebi Tang consists of Ephedra, Gypsum, Pinellia, Ginger, Jujube, and Licorice.')”

"Feizhang, coughing with upper qi, irritability, panting, and a floating pulse indicate water retention below the heart; Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction plus Gypsum) should be prescribed."

"Upper qi, facial edema, shoulder-respiration, and a floating-large pulse indicate a condition beyond treatment; if accompanied by diarrhea, it worsens significantly. (Note: Commentators also interpret this section as Feizhang. Danbo Yuanjian states that no previous school defined Feizhang as a specific later syndrome. Examining the text below, it says 'Feizhang coughs with upper qi' and 'coughs with upper qi, this is Feizhang.' From this, it is clear that it refers to what later generations called Xiasou [gasping cough] and Xiaosou [wheezing cough]. Chao Yuanyang stated: 'When phlegm and qi strike each other, moving with coughing and breathing, producing gasping sounds, it is called Xiasou.' *Benshi Xu Fang* stated: 'Xiaosound resembles the sound of sawing wood.' Master Yuanlei notes: 'The symptoms of Xiasou and Xiaosou correspond to bronchial asthma, bronchitis, and bronchopneumonia.')”

Examining old theories, Feizhang encompasses more than just pneumonia. Classifying pneumonia under Feizhang fits both logic and facts; equating Feizhang directly with pneumonia is illogical. Therefore, my use of Feizhang to name pneumonia is merely a hypothetical term.

The treatment of Feizhang focuses on Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum). Both formulas in *Jin Gui* for treating Feizhang use Mahuang and Shigao as principal herbs. Mr. Zhang Taiyan wrote an article on the treatment of pneumonia, which is exceptionally brilliant. I excerpt it as follows:

"Pneumonia is part of Shanghan (Cold Damage) and Wenbing (Warm Diseases). If it is Feizhang, Yuebi Jia Banxia Tang is suitable. If cough, fever, and panting are not severe, those without sweat should use Xiao Qinglong Jia Shigao Tang, and those with sweat should use Ma Xing Shi Gan Tang; these are not standard indications. However, one must observe if the pulse is floating-large and forceful, or floating-tight and forceful, before confidently using them. Otherwise, the treatment must change. Generally, if there is cough and fever without critical signs, but after a few days sudden high fever occurs with panting, and the pulse becomes weak, with staring eyes and grasping at empty air (loss of spirit), this indicates that although the lungs are filled with pathogens, the pulse is hollow, blood stasis is obstructive, and the heart is failing. I have seen Western medicine treat this with cardiotonics, resulting in clear spirit, cessation of panting, gradual subsidence of fever, and recovery. Initially suspecting coincidence, further inquiry revealed a method: focusing on strengthening the heart works even without treating panting or cough. In *Shanghan Lun*, this condition should be treated primarily with Zhenwu Tang (True Warrior Decoction) plus Ganjiang (Dried Ginger), Wuweizi (Schisandrae Fructus), and Xixin (Asari Radix et Rhizoma). If the spirit is not overturned, staring and grasping will cease; if blood vessels are regulated, fever will subside. In Yu Jiayan's case of Patient Zhao, the cough was strained, fever remained high, pulse was rapid and weak, skin was dry and rough. Doctors used Heliu (likely a local herb) and Xijiao (Rhinocerotis Cornu), failing to resolve exterior and interior pathogens, and allowing heat to invade the pericardium directly, causing extreme madness and palpitations, ten times worse than gastric excess delirium. The body became like smoked meat, eyes stared, head shook, indicating heart failure. Yet, he concluded that Ma Xing Shi Gan Tang should be used. (Songmu notes: The case in *Yuyi Cao* roughly states: 'Late in winter, the Third Clerk of Grand Secretary Zhao suffered from Shanghan. Medications failed, and the condition became critical. First, Baihu Tang was given, slightly reducing fever. Next, Renshen Baihu Tang was given, but fever intensified. Desperately seeking doctors, I was summoned. Hearing his strained cough and feeling a rapid, weak pulse with persistent high fever, dry skin, lethargy, and loss of appetite, I told the Grand Secretary: "This disease is difficult to cure, but I will try my best to succeed, to repay your trust." I prescribed Zhang Zhongjing's Ma Xing Shi Gan Tang. The Grand Secretary agreed. His female companion, not understanding Mandarin and curious about my background, insisted on using local famous practitioners' prescriptions. They used Heliu, but the exterior was not resolved; they used Xijiao, but the interior was not resolved. Heat invaded the heart directly, causing madness ten times worse than gastric delirium. Doctors declared the heart irrecoverable. Soon, yang remained alone, shape like smoke, hair straight, head shaking, becoming a sign of heart failure. This mystery remains unresolved for millennia, who knew that Ma Xing Shi Gan Tang is the great medicine for saving crises and correcting madness! Although it is said Shanghan transmits through Foot meridians and not Hand meridians, often Foot meridians involve Hand meridians. Physicians are confused even with Foot meridian transmissions, let alone combined cases. Foot meridians are like Northwest, Hand meridians like Southeast; distances differ, flight is impossible, but seizing opportunities to invite pathogens and occupy strategic points is possible. Now, the patient has concurrent disease of Foot Taiyang Bladder and Foot Yangming Stomach meridians, already hard to bear. Adding pathogens from these two meridians attacking Hand Taiyin Lung meraxon makes it unbearable. Hand Taiyin Lung governs qi of the whole body. When qi flows, sweat appears; when qi closes, sweat is blocked. Previous sweating failed, leading to dry skin. Is this not because Lung governs skin and hair, Lung qi is blocked, fluids do not flow, and there is no moisture? Like someone with nasal congestion, people say Lung qi is unclear, blocking the nose, making pathogens enter easily. Upon external contraction, one should anticipate transmission from Foot to Hand meridians, unblock Lung qi, allow sweat to expel pathogens, and call it wise. This disease involves Foot Taiyang and Foot Yangming. Foot Taiyang pathogen penetrates chest from back; Foot Yangming pathogen penetrates back from chest. Lung is the canopy covering chest and back. Even Qian Gongsu, with no lung issues, had urgent cough. How could a body with chronic unclear Lung qi withstand pathogens from two meridians? Furthermore, Hand meridians connect closely, so transmission between Hand meridians is easiest. Thus, using Ren Shen invited Lung pathogens to attack the heart directly, just as using Gegen for Foot Taiyang pathology invites pathogens to Yangming. Otherwise, Shanghan pathogens lingering past stages would only invade Jueyin Pericardium, not directly attack the heart.' According to Jiayan's case, statements like 'Shanghan transmits Foot not Hand,' 'invading Hand Taiyin Lung,' 'unblocking Lung qi,' 'Lung pathogens attacking heart,' and 'invading Jueyin Pericardium' resemble Tianshi's arguments. I suspect Tianshi's Warm Disease theory originated from Jiayan, with clues hidden subtly.) Then one can treat cases with tight pulses and abundant blood. If the pulse is weak, relaxation occurs, and blood naturally becomes stagnant. Ma Xing Shi Gan Tang only increases stagnation and deficiency; it is definitely not the treatment. Even someone as clear-sighted as Mr. Yu did not realize this. Since his medication was not administered,世人 could not verify his error. Some cite Ye's theory of 'warm pathogens invading Lung,逆传 (reverse transmission) to Pericardium' to explain the pathology. However, if there is no blood stasis, even if heat attacks the heart, it only causes restlessness and insomnia, treatable with Zhichi Zhizi Tang (Gardenia and Fermented Soybean Decoction), Zhuling Tang (Polyporus Decoction), or Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction). Where are the critical signs of staring and delirium? (Songmu notes: Old Master calls blood stasis obstruction pulmonary circulatory congestion in pneumonia; staring and grasping, loss of spirit, is Ye's reverse transmission to Pericardium. Pathologies are connected, not superficial. If there are respiratory symptoms, respiratory drugs are needed. Zhichi Zhiling Tang scratches an itch from outside the boot. Cardiotonics promote blood flow to dissipate congestion and cannot be compared to Zhichi Zhiling Tang.) If blood is not stagnant, the responsibility lies solely with the Lung, fitting Xiao Qinglong Tang and Yuebi Tang. If blood is stagnant, it endangers Shaoyin, requiring responsibility on the Heart, fitting Zhenwu Tang. Zhang Zhongjing's formulation of Zhenwu Tang was meticulous and transcended common paths. People only use it for elderly deficiency panting, rarely seeing its use in external contraction coughs, until now realizing its brilliance.

Note: Mahuang can dilate peripheral vessels to dissipate congestion. The Old Master's claim that Mahuang is detrimental to blood stasis is not accurate. If the pulse is weak, combining it with Zhenwu Tang prevents harm. I have seen patients with Feizhang and weak pulses treated with Chinese Ma Xing Shi Gan Tang and Western cardiotonics, recovering through integrated therapy. Even if efficacy is attributed solely to cardiotonics, it shows Mahuang does not harm the body. The Old Master evaluated the Zhao case in *Yuyi Cao* (quoted in *Treatment of Pneumonia*), saying the slight fever reduction from Baihu Tang was temporary suppression, doing no good to the disease. I believe that for Feizhang, taking only Zhenwu Tang, while promoting blood flow, does no good to the disease itself. It must be assisted by anti-inflammatory and antitussive Ma Xing Shi Gan Tang for rapid effect. The main ingredient of Zhenwu Tang is Fuzi (Aconiti Lateralis Radix Preparata), which contemporary doctors fear. Thus, Mr. Huashifu once replaced Fuzi with Liushen Wan (Six-God Pill). Liushen Wan contains Chan Su (Toad Venom), which has significant cardiotonic effects, though slower. ... Analyzing Wind-Cold and Discussing Warmth -- Questioning the Theory of Warm Pathogens

The debate between Shanghan and Wenbing has been contentious for a long time. Can this major issue in TCM theory, characterized by intense controversy and public interest, be resolved by adopting a "cellular anatomy" approach? This seems worth attempting. Guided by this understanding, this article proposes using "Wind-Cold" (common cold) as the basic unit of disease to analyze the issues of etiology and nomenclature in the Cold-Warm debate.

I. Regarding Etiology

Regarding the distinction between Shanghan and Wenbing, Shi Yiren's opinion is: "If chills are mild and fever is severe, with thirst, it is 'Wenbing'; conversely, if chills are severe and fever is mild, without thirst, it is 'Shanghan.'" As is well known, the differentiation of Wind-Cold (common cold) is broadly divided into two types: Wind-Cold type and Wind-Heat type. The former is habitually called Minor Shanghan, and the latter Minor Wind-Warmth. The basis for distinguishing Cold from Warm mainly comes from analyzing symptoms: whether chills outweigh fever and there is no thirst, or fever outweighs chills and there is slight thirst (of course, there are differences in pulse characteristics such as floating-tight or floating-rapid). Shanghan physicians encountering Wind-Cold type colds say they are caused by Cold pathogens, hence calling them Minor Shanghan, and thus primarily treat with Acrid-Warm Exterior-Releasing methods. Wenbing physicians encountering Wind-Heat type colds say they are caused by Warm pathogens, hence calling them Minor Wind-Warmth, and thus primarily treat with Acrid-Cool Exterior-Releasing methods. Such syndrome differentiation and treatment are both correct. However, from an etiological perspective, stating that the cause of Wind-Cold type colds is Cold pathogens and Wind-Heat type colds is Warm pathogens ignores the body's stress response. Inferring cause from effect, relying on subjectivity, and attributing the interaction between pathogens and the body entirely to external factors is actually incorrect (and inconsistent; for example, Lei Shaoyi believed that Wind-Warmth and Spring-Warmth were all caused by Cold pathogens).

Wind-Cold is one of the external contraction diseases. The first sentence of the argument in *Jing Yue Quan Shu · Wind-Cold* is: "Wind-Cold disease originates from external contraction." Shi Yiren said: "For those with a predisposition of internal heat (increased body temperature), contracting an external pathogen will inevitably result in Wenbing; for those with a predisposition of low internal heat (decreased body temperature), contracting an external pathogen will inevitably result in Shanghan. Readers should not take these words lightly." (*TCM Shanghan and Wenbing*). The "syndrome" in syndrome-based etiology search is essentially the reaction between the pathogen and the body. As Shi stated, the determining factor for the cold or heat presentation of Wind-Cold colds is primarily the internal factor, not the external factor. This is similar to the principle that thin people tend to have fire and fat people tend to have dampness, which is mainly determined by the body's constitution.

Modern medicine knows that the cause of Wind-Cold is viruses. Wu Youke collectively referred to invisible pathogenic microorganisms as Liqi (pestilential qi), believing that chicken plague affects chickens, swine plague affects pigs, each disease having its own specific Liqi. Because Liqi is diverse, it is also called Zaqi (miscellaneous qi). From Wu's etiological viewpoint, the cause of Wind-Cold is a specific Wind-Cold Liqi. TCM calls it Wind-Cold Liqi, Western medicine calls it Wind-Cold virus. The names differ, but the reality is the same. Thus, as Zhu Weiju said: "Neither Cold nor Warmth is the source of disease." Climate imbalance is merely a precipitating factor. The true pathogen is tangible Liqi evil, i.e., Wind-Cold Liqi. However, since Liqi-induced disease is closely related to climate changes, if the climate is suitable for the reproduction of a certain Liqi, people are prone to that disease; if unsuitable, people rarely suffer from it. Additionally, Wind-Cold is often precipitated by exposure to wind, rain, cold, or fatigue. In ancient times, when science was undeveloped and Liqi was invisible, it was inevitable to mistake precipitating factors for causes. Thus, ancients believed the cause of Wind-Cold was Wind evil or Cold evil (external factors), while "where evil gathers, qi must be deficient" (internal factor). Internal and external combine, and the disease arises. Therefore, treatments for Wind-Cold include Acrid-Warm Exterior-Releasing, Acrid-Cool Exterior-Releasing, Qi-Tonifying Exterior-Releasing, and Yin-Nourishing Exterior-Releasing. These methods are effective because they are based on analyzing the body's reactive state, not relying on drugs that kill or inhibit Cold or Warm pathogens. Precisely because this syndrome-based etiology search and differentiated treatment are effective in practice, the etiology of external diseases has become traditionally attributed to the abnormality of the Five Qi (Cold, Summer-Heat, Dryness, Dampness, Wind). However, discussing external etiology cannot focus only on the Five Qi and ignore Liqi. Removing the crucial intermediate link of Liqi-induced disease inevitably leads to mistaking precipitating factors for causes.

II. Regarding Warm Pathogens