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Wu Shangshi's elder brother had a constitution that was inherently slender. In summer, he contracted a warm disease (Wenbing). When I went to diagnose him, Old Man Jin Mailun accompanied me. According to the account, at noon yesterday, he first experienced chills followed by fever, headache with sweating, burning heat that did not subside, thirst and vexation, inability to sleep peacefully at night, and extreme physical fatigue and weakness. Upon examining him in bed, his pulse was deficient, floating, large, and rapid. His tongue showed no coating, and upon palpation, it felt dry like a wooden board. I was startled and said: This syndrome is Chunwen Lianggan (Spring Warmth with simultaneous Taiyang and Shaoyin involvement), which is extremely critical and urgent. Zhong Jing stated: Fever with thirst but no aversion to cold indicates a warm disease; if after sweating, the body becomes even more burning hot, it is called Fengwen (Wind-Warmth). The *Neijing* states: Injury by cold in winter leads to warmth disease in spring. Failure to store essence in winter leads to warmth disease in spring. Having been injured by cold and failing to store essence, with simultaneous onset of illness, it is called Lianggan (Dual Involvement). In cases of Shanghan (Cold Damage) or epidemics, where heat is excessive and the tongue is dry, this usually appears only after one five-day period (Yi Hou). Here, the illness has lasted only one day, yet the tongue is already dried up, fully demonstrating that Kidney Water was originally deficient. Winter cold injury caused pathogenic factors to lie latent in the Shaoyin channel, secretly absorbing Kidney True Essence and plundering its treasures. Thus, as soon as fever appeared, fluids could not ascend to moisten, resulting in a dry tongue. The *Re Lun* chapter states: On the first day of Shanghan, if both Taiyang and Shaoyin channels are diseased, symptoms include headache, dry mouth, and fullness/vexation; this is diagnosed as Lianggan, which is incurable. By analogy, it is indeed difficult to initiate treatment. Therefore, I prescribed Shudi (Prepared Rehmannia Root) 1 liang, Danggui (Angelica Sinensis) 3 qian, Liaodou (Soybeans) 5 qian, Yuzhu (Polygonatum Odoratum Rhizome) 5 qian, and Gancao (Licorice Root) 1 qian. After writing the prescription, I told Maiweng: Throughout my career, when treating Shaoyin diseases where internal collapse precedes external contraction by Taiyang, such critical conditions of Shanghan-Chunwen Lianggan, I initially followed Zhang Jingyue's new formulas, using Liyin Tang to support Yin and expel pathogens, often achieving success. However, in this case, since fluids are exhausted, administering Jiang (Ginger) and Fuzi (Aconite) again would cause immediate loss of Yin. Thus, I merely adopted his principle and assisted it with Guangqi Senior's Fengwen Tang. Although this is a temporary expedient, it represents painstaking effort. Maiweng said: Good. He took the medicine, the heat subsided, spirit calmed, and the tongue slightly regained moisture. Sha Shen (Glehnia Root), Maidong (Ophiopogon Tuber), Nvzhenzi (Ligustrum Fruit), and Shihu (Dendrobium Stem) were added, followed by Fumai Tang (Pulse-Recovering Decoction) and Zuogui Wan (Left Restoring Pill), leading to gradual recovery.

An Bo notes: The phrase "extreme physical fatigue" is inappropriate, as everyone suffers fatigue with exogenous diseases.

Brother Zheng Jinkang resided as a guest in Qiankou, teaching at the Wang residence. I visited for diagnosis at the invitation of the host. During our meeting, he said: My younger brother is ill; please take a look. I asked how many days the illness had lasted. He replied: It started yesterday, with fever persisting until now. I said: This is a Gan Zheng (Exogenous Syndrome). The Wang residence is very close to his home, so I went with him. On the way, we discussed that many people were suffering from exogenous syndromes recently, and one must examine the tongue coating. If the coating is greasy and thick at the onset, the pathogen is deep-seated and difficult to cure. Upon arriving at the room, the patient came out for examination. Asked to extend his tongue, it was dry, devoid of coating, and smooth like a mirror surface. I said: It is perilous. Brother Jin was surprised and asked why. I explained: Just now I mentioned that the severity of exogenous syndromes depends on the thickness of the tongue coating. Unexpectedly, your brother's tongue has absolutely no coating, bright and mirror-like. Seeing this at the onset of illness is a very bad omen. Brother Jin said: You said thin coating means mild illness; now with no coating, you consider it perilous. Why? I then recounted the condition of Wu Shangshi's brother and the treatment used, prescribing the same method. I also told him: If the medicine takes effect, it will be auspicious; otherwise, it will be hard to save. He thought my words were too harsh, changed to another doctor, and the condition worsened day by day. By the sixth day, the situation became critical, and my prediction proved correct. They wanted to invite me again. Fearing I might refuse, they entrusted Brother Jiasheng to persuade me. I said: It is not that I am unwilling to go, but his illness is fundamentally severe. Even if he took my medicine, efficacy is not guaranteed, let alone the delay. The *Neijing* states the danger of Lianggan lies on the sixth day. Now that time has arrived. Even if Lu Bian (Lu Guo and Bian Que) were reborn, they could do nothing. Brother Jiasheng said: It is indeed difficult, but since they are brothers and close friends of mine, and they seek help in their emergency, please make one trip to fulfill our friendship. Reluctantly, I ordered a carriage. As we approached the door, his condition had become critical.

An Bo notes: Both cases presented tongues without coating. While exogenous diseases can manifest as Yin patterns, one must ask if the patient normally lacks tongue coating. If the constitution is naturally like this, it does not fall under this category.

A student asked: Shuhe's preface states that cold toxins hide in the skin and muscles. Considering the skin and muscles are superficial, how can pathogens reside there for months before disease manifests? I answered: Yu Jia Yan said, cold pathogens enter through the skin and muscles; for those who work hard, pathogens hiding in the skin and muscles is possible. But for those consuming rich foods, whose essence is not stored in winter, their cold pathogens may even hide in the bone marrow. Cheng Fusheng said: "Hiding in skin and muscles" should be read as "hiding in bone marrow." Zhou Yu Zai said: Violating the Qi of winter causes Shaoyin not to store; due to non-storage, cold pathogens enter, injuring the skin and muscles, and lying latent in the bone marrow. Observing these three statements together, saying "injured by skin and muscles" is acceptable, but saying "hidden in skin and muscles" is not. Another question arose: The preface also states that by spring, it transforms into a warm disease. Yu Jia Yan considered the character "transform" (Bian) strange and shocking, while Zhou Yu Zai said it was excellent. Who is correct? I answered: The *Neijing* discusses latent Qi diseases, such as "Winter injury by cold leads to warmth disease in spring," "Spring injury by wind leads to undigested stool diarrhea in summer," "Summer injury by heat leads to malaria in autumn," "Autumn injury by dampness leads to cough in winter," etc., none of which use the word "transform." Similarly, "Summer heat with no sweat leads to wind-malaria in autumn" does not use "transform." Those instances calling it "transform," such as "Transformations of rich food causing carbuncles on feet," "Violating spring Qi causes Shaoyang not to generate, Liver Qi internally transforms," or "Violating it injures the Liver, causing cold transformation in summer," refer to pathological changes. For example, excess transforming to deficiency, or heat transforming to cold, can be called "transform." However, Chunwen originates from winter cold injury, manifesting in spring; although the manifestation differs, the source is the same, so it cannot strictly be called "transform." The classic also says: "Autumn Yang injured by dampness, rising upward causes cough, developing into flaccidity and cold extremities." Why not uniformly follow the classic's intent and say "manifests as warm disease in spring"? Is that not correct? Another question: The classic says "Failure to store essence in winter leads to warmth disease in spring." Does this mean children, maidens, widows, and widowers never get warm disease? I answered: The classic's language is holistic and requires intuitive understanding. The phrase "failure to store essence in winter" refers to heavenly timing, not specifically human affairs. Consider the phrase "If heaven is bright, sun and moon are not clear"; the meaning is visible. Within a day, brightness in morning and darkness at night constitutes storing essence. Within a year, generation in spring and storage in winter also constitute storing essence. If nights were not dark and winters did not store, could beings avoid premature death or disease? Xuan Qi established two examples here: "Winter injury by cold leads to warmth disease in spring," and "Winter failure to store essence leads to warmth disease in spring." Cold is the proper Qi of winter; people know to avoid it, so fewer fall ill. However, when winter Yang opens and leaks, weather warms and thunder occurs, this is excessive Qi, and many fall ill. This is my speculation, but reasoning suggests it is likely correct. Another question: Liu Songfeng claimed that the *Neijing*'s "Winter injury by cold, spring warmth disease" was altered in *Yunji Qiqian* to "Winter injury by sweat," implying that excessive warmth in winter causes sweating, leading to warmth disease in spring, whereas severe cold in winter prevents epidemics because it aligns with seasonal correctness. Is replacing "cold" with "sweat" valid? I answered: This is a creative theory, seemingly reasonable. But how can the maxims of the *Neijing* be casually altered?