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Heat reaches the exterior and severely damages the Wei Qi (Defensive Qi), thus failing to resist wind and cold. This is distinct from Shang Feng (Wind Strike) characterized by aversion to wind, and Shang Han (Cold Damage) characterized by aversion to cold. Merely, deficiency of Wei Qi leads to aversion to wind, while deficiency of Ying Qi (Nutritive Qi) leads to aversion to cold. Furthermore, Wen Bing (Warm Diseases) and Re Bing (Heat Diseases) may also initially present with exterior syndromes before transmitting inward. This occurs because constrained heat originates internally and reaches the exterior; heat stagnates in the Cou Li (skin pores and interstices) without being able to vent outward, subsequently returning inward to form a syndrome amenable to purgation. This differs from Shang Han, which begins at the exterior.

Some individuals fail to comprehend this principle and seek a Floating-Tight pulse (Fu Jin Mai) in the warm and heat diseases of spring and summer, which is indeed negligent. It must be understood that "Tight" is a pulse indicating cold; it appears only when cold pathogenic factors are present and does not appear otherwise. The occurrence of a Tight pulse in Wen Bing or Re Bing is due to secondary exposure to sudden cold from abnormal climatic factors, or excessive internal injury caused by consuming cold food. Is this their inherent nature?

Alternatively, some lack knowledge of pulse morphology; upon perceiving a Wiry pulse (Xian Mai), they mislabel it as Tight and diagnose it as Cold, administering inappropriate treatment. Often, pulses that are vigorous and forceful also exhibit a Wiry quality; how can one mistake them for Tight and diagnose Cold?

The pulses of Wen Bing and Re Bing are typically located at the level of the muscles rather than being superficially floating, and the Right Hand pulse is often stronger than the Left Hand pulse. This is indeed due to constrained heat residing internally. If the Left Hand pulse is strong or floating, it indicates secondary exposure to wind and cold; otherwise, it is not Wen Bing or Re Bing, but a disease caused by sudden exposure to wind and cold. In cases of Wen Bing or Re Bing without secondary exterior exposure, although exterior signs may occasionally appear, interior syndromes predominate; thus, thirst is rarely absent. At this stage, the treatment method should primarily focus on clearing interior heat, accompanied by resolving the exterior. There are also instances where treating the interior resolves the exterior spontaneously.

I frequently observe that when physicians treat warm-heat diseases, even if they mistakenly use purgation for the interior, there is usually no severe harm. However, if they mistakenly use diaphoresis (sweating methods) for the exterior, the resulting complications are incalculable. This sufficiently demonstrates that the heat originates from within and extends outward.

Among these, those who suffer severe harm from mistaken purgation are suffering from Yi Zheng (Epidemic Patterns) struck by sudden cold in spring and summer, where the pathogen resides purely in the exterior and has not entered the interior. Therefore, they cannot be discussed together with Wen Bing or Re Bing.

Since the world conflates Wen Bing and Re Bing under the term Shang Han, people often cling to the character "Cold" to seek a Floating-Tight pulse and employ warm-hot medications. Such practices confuse names with reality and endanger lives; how can such nomenclature not be corrected?

Furthermore, medical texts often discuss Four Seasons Shang Han, categorizing the warm and heat diseases of spring and summer alongside the cold damage of autumn and winter without distinction. However, the cold damage of autumn and winter is True Shang Han, whereas the cold damage of spring and summer is Han Yi (Cold Epidemic). These are distinct from Wen Bing and Re Bing and should not be treated identically. Alas, this malpractice has existed for a long time.

Nevertheless, regarding the method of purging the interior for Shang Han versus Wen Bing/Re Bing, if the goal is indeed to eliminate heat with cold herbs, there is no need to seek difference. However, the method of releasing the exterior must absolutely differ. Moreover, Shang Han directly injuring the Yin Channels, or Tai Yang (Greater Yang) channel involvement where heat does not constrain but transmits to Yin channels becoming a Cold Syndrome requiring warming, is vastly different from Wen Bing and Re Bing. How can such conditions be treated recklessly?

Some know one aspect but not the other, claiming that Zhang Zhongjing's exterior-releasing formulas are now unusable, while purgatory formulas are usable. Oh, what is the rationale behind what is usable and what is not?

If one can discern the etiology, correct the nomenclature, examine the pulse morphology, and formulate appropriate treatments, would there be any impropriety? As for diseases caused by epidemic abnormal qi, or those transformed by secondary exposure to different pathogens, one must observe the timing and specific pathogenic factors, referring to the methods of Shang Han and Warm-Heat Diseases for modification and treatment. One must especially avoid indiscriminately using Zhang Zhongjing's formulas for immediate-onset Shang Han to treat all cases.