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From after Frost's Descent until before Spring Equinox, anyone who falls ill immediately upon exposure to frost and dew and internal contraction of cold wind is diagnosed with Shanghan (Cold Damage). The treatment methods, except for those involving Summerheat-Dampness and Malaria, all follow the principles of treating Shanghan.

After the Beginning of Spring, if there is no sudden severe cold or ice/snow, yet someone suffers from high fever and illness, this belongs to Warm Disease (Wenbing), where spring Yang qi expands outward and latent winter cold transforms into warmth. Four regular patterns correspond to Spring Warmth: Shaoyang ruling the Heaven in a specific year during the first Qi; Taiyang ruling the Heaven during the first Qi; Yangming ruling the Heaven during the final Qi; and Taiyin ruling the Heaven during the second Qi, all of which involve Warm Disease. Abnormal cases that do not follow these regular patterns cannot be predicted by standard rules but must be adjusted according to seasonal changes.

The *Neijing* states: "If one is injured by cold in winter, one will surely suffer from Warm Disease in spring." Li Dongyuan explains: "Winter injury by cold" refers to autumn-like weather occurring in winter. When it should be cold but is warm, Fire qi prevails while Water (Kidney) is deficient. With Kidney Water depleted, Earth (which Water controls) acts recklessly and becomes excessive; Metal (which produces Water) is insufficient; Wood (which controls Fire) insults Fire, causing Fire excess. Fire and Earth combine, assisting each other with Damp-Heat, thus forming Warm Disease. It does not manifest in winter but in spring because Cold-Water qi occupies the Mao position (East), holding authority, and severe cold commands reappear in spring. Pores open, Shaoyin (Kidney) fails to store, and due to sexual exhaustion or labor, Yang qi leaks externally while Kidney Water depletes internally. In spring, when Yang should generate and leak outward, who encourages it? Who nourishes the depleted internal Kidney Water? Both factors cut off the source of generation, leaving Wood without support. What remains in the body is Heat. As seasonal Wood grows strong, Warm Disease results.

The *Shanghan Lun* states: "Taiyang disease with fever, thirst, and aversion to cold absent is Warm Disease." Explanation: Taiyang disease involves floating pulse, stiffness/pain in the head and neck, and back rigidity. Those injured by cold should have aversion to cold. If there is no aversion to cold but thirst exists, the pathogen has transferred to Yangming, the exterior syndrome has resolved, and the pathogen has entered the interior. Since there is no aversion to cold, it is not a Shanghan syndrome. Although it resembles Yangming, its co-occurrence with Taiyang signs means it is not Yangming of the Shanghan type. Thus, it is determined to be Warm Disease.

The *Huoren Shu* states: Before Summer Solstice, fever, aversion to cold, headache, body pain, and a floating-tight pulse indicate Warm Disease. Shanghan in spring is called Warm Disease. Mild cases of winter cold injury may manifest as Warm Disease before Summer Solstice, triggered by spring's warming qi (this is distinct from Epidemic Warmth). Treating Warm Disease differs from winter Shanghan or summer Heat Disease because the heat intensity is lighter. (In early spring and late autumn, Yang qi resides inside, making the condition milder; even without medication, self-healing often occurs within five to six days.) Shengma Tang, Jiexi Tang, and Chaihu Guizhi Tang are most effective. For severe heat, Xiaochaihu Tang is primary. For non-thirsty patients with slight external heat, add Guizhi to Xiaochaihu Tang. For cough, add Wuweizi to Xiaochaihu Tang. For irritability, thirst, fever, and absence of aversion to cold, administer Zhuye Shigao Tang sequentially. Mahuang Tang, Guizhi Tang, and Da Qinglong Tang are only reliably used in Northwest China year-round. In warmer regions like Jianghuai, they are only suitable in winter and early spring. From late spring to before Summer Solstice, modifications to Guizhi Tang, Mahuang Tang, and Da Qinglong Tang are necessary. According to the *Huoren Shu*, there are two types of Warm Disease: those treated with Shengma Tang/Jiexi Tang represent true Shanghan Taiyang syndrome (aversion to cold, no thirst), named Warm Disease merely due to the warm season; those treated with Zhuye Shigao Tang represent Zhang Zhongjing's "thirst without aversion to cold" Warm Disease. Careful distinction is required. However, Warm Disease characterized by no aversion to cold and thirst occurs in all seasons, not just spring.

**Warm Toxin (Wendu)**
A洪-numerous pulse on the Yang (superficial) side and a solid-large pulse on the Yin (deep) side, when encountering warm-heat qi, transforms into Warm Toxin (Cheng Wuji notes: Previous heat remains, compounded by new warm-heat infection. Yang governs exterior, Yin governs interior;洪-numerous and solid-large all indicate heat. Two heats combining form Warm Toxin).

The *Huoren Shu* states: Macules appearing with cough in early spring constitute Warm Toxin.

Wu Ke states: Abnormal warmth in winter is called Winter Warmth, a type of epidemic qi. If macules appear, it is also called Warm Toxin, resulting from epidemic qi. Furthermore, complicated Shanghan with洪-numerous Yang pulse and solid-large Yin pulse, upon encountering warm-heat qi, becomes Warm Toxin, which is the most severe. This is because prolonged unresolved heat combines with new warm-heat invasion. For those without sweat, Sanhuang Shigao Tang induces sweating. For those with spontaneous sweating, Renshen Baitou Tang is primary. For irritability, fever, delirium, and insomnia, combine Baitou Tang with Huanglian Jiedu Tang. If exterior heat is intense, add Chaihu. For internal fullness and constipation, use Sanhuang Xiexin Tang to purge, or Da Chaihu Tang plus Mangxiao. If macules resemble brocade patterns, prognosis is poor; treat with Renshen Huaban Tang, Yuanshen Shengma Tang, Heigao, or Daqing Siwu Tang (see Macule section for formulas).

If sweating fails to resolve the condition and the body feels burning hot, it is Fengwen (Wind-Warmth). Symptoms include floating pulse, spontaneous sweating, heaviness of the body, and excessive sleepiness (Lou Quanshan notes: This disease is not limited to spring, hence a separate category).

**Diagnosis**
Hot skin at the Chi position with a large, rapid, and restless pulse indicates Warm Disease. Essence is the root of the body; those who preserve their essence will not contract Warm Disease in spring.

**Acupuncture**
For treating Warm Disease, fifty-nine acupoints may be needled. Cheng Wuji notes: These include three points on each inner/outer aspect of both hands (12 total); one point between each of the five fingers (8 total); similarly on the feet; six points one cun below the hairline, three fen lateral to the midline; Huiyin at the vertex; Lianquan at the hairline; Fengchi (2 points); Tianzhu (1 point). The *Neijing* states: If Qikou is still and Renying is restless, needle; if both are still, do not needle. Renying refers to the carotid artery near the larynx. Wang Bing annotates the *Suwen*: Needling five rows on the head disperses rebellious Yang heat (Midline: Shangxing, Zonghui, Qian Ding, Baihui, Houding; Second row lateral: Chengguang, Tongtian, Luoque, Yuzhen; Third row lateral: Linqi, Mucuang, Zhengying, Chengling, Naokong). Dazhu, Yingshu, Quepen, and Beishu (8 points) drain chest heat. Qijie, Zusanli, Shangjuxu, and Xiajuxu (8 points) drain stomach heat. Yunmen, Guyuan, Weizhong, and Suikong (8 points) drain limb heat. Five points beside the Back-Shu points of the five Zang organs (10 points: Pohu, Shen tang, Hunmen, Yishe, Zhishi) drain Zang heat.

**Appendix**
Yunqizi states: If Shanghan persists after sweating or purging, crossing meridians without resolution, it is also Warm Disease. The classic states: Pulse movement in Warm Disease occurs across various meridians; identify the affected meridian and treat accordingly.
- Taiyang syndrome persisting post-treatment with floating pulses at Cun and Chi: Taiyang Warm Disease.
- Fever and eye pain persisting with long pulses: Yangming Warm Disease.
- Hypochondriac pain persisting with wiry pulses: Shaoyang Warm Disease.
- Abdominal fullness and dry throat persisting with deep-fine pulses: Taiyin Warm Disease.
- Dry mouth/tongue and thirst persisting with deep pulses: Shaoyin Warm Disease.
- Irritation, fullness, and testicular retraction persisting with faint-slow pulses: Jueyin Warm Disease.
Thus, treat based on the meridian and syndrome. Macules indicate Warm Toxin.

Wang Ji states: There is a degree difference between Wen (Warmth) and Re (Heat). Zhang Zhongjing says: Encountering Wen qi causes Warm Disease; encountering further Warm-Heat qi causes Warm Toxin, which is heavier. Simple winter cold manifesting in spring without other pathogens is Warm Disease (mild). If Warm Disease recurs with Wen qi, it becomes Warm Toxin (moderately severe). The *Shanghan Li* calls recurrent Wen qi "Epidemic Warmth." Cases arising in spring without prior winter cold are "Spring Warmth," analogous to winter Cold, autumn Damp, or summer Summerheat. Thus, spring Warm Disease has three origins: 1. Winter cold manifesting in spring; 2. Recurrent Wen qi complicating existing Warm Disease; 3. Direct infection of Spring Warmth qi. All are termed Warm Disease; distinguish by etiology, not nomenclature.

**Shengma Jiexi Tang Formula**: Treats Shanghan, Warm Disease, epidemic headaches, and high fever.
Ge Gen (1 liang), Mahuang (de-node, decocted, 7 qian 5 fen), Huang Qin, Shao Yao (each 0.5 liang), Guixin, Gancao (roasted, each 2 qian 5 fen). Crush herbs. Take 4 qian per dose with 1.5 cups water and one jujube, boil to 0.8 cup. Take three times daily. If unresolved after three days and pulse is floating, repeat to induce sweat; if pulse is deep-solid, purge.

**Shengma Gegen Tang**: Treats adults and children with seasonal epidemics, headache, fever, and pre/post eruption of sores/rashes.
Shengma, Shao Yao, Gancao (each 2 qian 5 fen), Gan Ge (3 qian). One dose with 2 cups water and 3 slices ginger, boil to 1 cup. Take anytime.

**Chaihu Shengma Tang**: Treats epidemic fevers with aversion to wind, headache, body ache, nasal congestion, dry throat, cough, and thick sputum.
Chaihu (remove sprouts), Gan Ge, Jingjie (remove stems), Chi Shao Yao, Shi Gao (each 1 qian 5 fen), Qian Hu (remove sprouts), Shengma, Sangbaipi, Huang Qin (each 1 qian). One dose with 2 cups water, 3 slices ginger, and 20 fermented soybeans, boil to 1 cup. Take anytime.

**Sanhuang Shigao Tang**
Shi Gao (4 qian), Huang Qin, Huang Lian (each 2 qian), Huang Bo, Shan Zhi Ren (each 1 qian 5 fen), Xiang Chi (100 grains), Mahuang (2 qian, 3 qian if cold), Gancao (1 qian). One dose with 2 cups water, boil to 1 cup, strain, drink warm, cover with blankets to induce sweat for cure.