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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When Yin reaches its extreme, it transforms into Yang; when Yang reaches its extreme, it transforms into Yin." In the onset of miasma disease (Zhang Disease), the weather is hot, and the human body also becomes hot. There is often dryness and thirst in the upper jiao, with irritability and heat in the chest and heart; this represents "redundant Yang" (excessive Yang). However, the tip of the nose feels cool, and the waist and feet suffer from cold pain, indicating that Yin is hidden within. Furthermore, extreme cold generates heat, and extreme heat generates cold. Therefore, at the initial stage of miasma disease, there is invariably high fever; but as the disease appears to recede, the skin over the entire body feels as cold as ice. If physicians do not understand this principle, and seeing fever, irritability, black tongue coating, red face, red eyes, and a rapid pulse, they diagnose it as a major heat syndrome, they will use bitter-cold descending herbs such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma). The more these are administered, the worse the condition becomes. After taking several doses, the heat in the upper jiao has not descended, while cold in the middle jiao arises. This may lead to transformation of symptoms, phlegm stagnation, hiccups, or cold extremities with diarrhea. With all these symptoms appearing simultaneously, survival rates are virtually zero. Even worse, seeing irritability and excessive drinking, some use Baihu Tang (White Tiger Decoction) or Shigao Tang (Gypsum Decoction); seeing black tongue coating, constipation, and dark urine, some use Daxiehu Tang (Major Bupleurum Decoction) or Chengqi Tang (Order the Qi Decoction). Upon swallowing these medicines, patients may immediately go mad and die, or suddenly die due to phlegm obstruction, facing imminent peril within moments. Thus, it is known that miasma disease does not necessarily kill people instantly; rather, the physician causes death. Bitter-cold descending herbs such as Tianhuafen (Trichosanthis Radix), Mutong (Akebiae Caulis), Huashi (Talcum), Cheqianzi (Plantaginis Semen), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), Yuanmingfen (Natrii Sulfas), and Shengdihuang (Rehmanniae Radix) should also not be used lightly. Physicians must exercise caution to avoid harming patients.

Someone asked: "Miasma disease arises from deficiency-cold of the Spleen and Stomach combined with external contraction of aberrant pathogenic factors. The treatment method must first support the righteous Qi and harmonize the body. The formulas used, such as Zhengqi San (Righteous Qi Powder), Yangwei Tang (Stomach-Nourishing Decoction), and Buhuanjin Hejie San (Non-Exchanging Gold Harmonizing Powder), all contain Pingwei San (Pingwei Powder). It is said that Pingwei San was used by ancients to treat 'Dunfu' (thickening and accumulation) of the Spleen and Stomach, implying the meaning of 'leveling' or 'flattening,' hence the name 'Pingwei.' It is not a tonic for the Spleen and Stomach. Why is it used? Moreover, the pulse in miasma disease is wiry (Xian). Using Pingwei San when the pulse is wiry seems to violate Dongyuan’s (Li Dongyuan) warning against 'making deficiency more deficient.' Why is this so?" I replied: "In regions where miasma occurs, there are many mountains, and the terrain is low and thin. During clear weather, the hot air steams upward, generating moisture from the ground; during rainy seasons, the ground is damp. Humans living here frequently walk on wet soil. The *Neijing* states: 'Grain Qi connects to the Spleen.' Dampness injures the interior of the Spleen. Therefore, Spleen and Stomach deficiency is mostly caused by Yang floating upwards and Yin-dampness injuring downwards, unlike internal injury diseases which are primarily caused by improper diet and fatigue. Using Pingwei San to remove Spleen dampness is appropriate. Cangzhu (Atractylodis Rhizoma) in the formula dries dampness without closing the interstices, facilitating sweating; Chenpi (Citri Reticulatae Pericarpium) resolves phlegm and directs Qi downward; Chunghoupo (Magnoliae Officinalis Cortex) warms the middle, directs Qi downward, regulates phlegm, and aids digestion; Gancao (Glycyrrhizae Radix et Rhizoma) harmonizes the middle Qi and benefits the Spleen and Stomach. Therefore, Li Daizhi selected them as essential herbs for treating miasma. If one argues that a wiry pulse indicates internal injury, specifically Liver Wood overacting on Spleen Earth, suggesting tonification of the Spleen and suppression of the Liver without removing dampness, thus violating the 'make deficiency more deficient' rule, they fail to realize that the wiry pulse in miasma disease is the natural wiry pulse of malaria-type conditions, indicating pathogens in the half-exterior and half-interior, arising from phlegm generated by dampness. Therefore, using Pingwei San is not contraindicated; precisely, we wish to utilize its ability to warm the middle and dispel dampness."