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[Background Information]
Book: Zhengzhi Zhunsheng · Shanghan (Compendium of Medical Treatment · Cold Damage)
Author: Wang Kentang
Dynasty: Ming
Chapter: Autumn Malaria / Epidemic where Long and Short, Old and Young Have Similar Symptoms
Category: Shanghan (Cold Damage)

[Original Text Processing]

Summer injury by summerheat leads to autumn malaria. If both Yin and Yang pulses are full and strong, and the Yin pulse is more prominent, it transforms into Warm Malaria. In any case of Shanghan transforming into a complicated disease (Huai Bing), if the previous heat has not subsided, the Yin and Yang pulses are full and strong, and there is a secondary contraction of cold pathogen, it also transforms into Warm Malaria. Symptoms include alternating chills and fever, bitter taste in the mouth, and fullness in the chest and hypochondrium. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Shaoyao (Peony Root) and a small amount of Guizhi (Cinnamon Twig) is indicated. If heat predominates, double the dosage of Chaihu (Bupleurum Root); if cold predominates, double the dosage of Guizhi. If heat is severe accompanied by irritability and thirst, Renshen Baihu Tang (Ginseng White Tiger Decoction) with a small amount of Bo Gui (Thin Cinnamon Twig) is indicated. If there is only heat without chills, do not use Guizhi; but if there is any cold, a small amount of Guizhi must be added as an assistant. If heat predominates, combine Xiao Chai Hu Tang with Baihu Tang (White Tiger Decoction). If there is much phlegm with heat, combine Xiao Chai Hu Tang with Er Chen Tang (Two Aged Decoction). If appetite is poor and stomach Qi is weak, add Baizhu (Atractylodes Rhizome). If there is epigastric stuffiness, add Zhishi (Immature Bitter Orange) and Huanglian (Coptis Rhizome). If the pulse is deficient, double the dosage of Renshen (Ginseng Root). If thirsty, remove Banxia (Pinellia Tuber) and add Gualougen (Trichosanthes Root) as indicated. If evil heat accumulates internally with constipation and hard stools, and the pulse is slippery, large, and forceful, Da Chai Hu Tang (Major Bupleurum Decoction) is used to purge. If it has already transformed into malaria, one should seek treatment principles among miscellaneous diseases.

Spring should be warm but is cold; Summer should be hot but is cool; Autumn should be cool but is hot; Winter should be cold but is warm. This is qi appearing out of season. Therefore, throughout the year, the illnesses of people of all ages are often similar, which is called Seasonal Epidemic Disease (Shi Xing Yi Bing). According to Shuowen Jiezi, "Yi" (Epidemic) means many people are sick simultaneously, derived from the phonetic component 'Yi' (Service), now abbreviated. Erya Shiming explains: "Li" (Plague) is like a whetstone; epidemic qi spreads and harms people like a whetstone grinds objects. "Yi" is synonymous with "Yi" (Service), implying spirits serving and moving incessantly. Later authors named conditions such as Warm Epidemic, Cold Epidemic, Seasonal Qi, and Big Head Shanghan, but they are all essentially epidemics. Commonly called "Wenbing" (Warm Disease), this is a corruption of "Wenbing," causing confusion between name and reality. According to Shanghan Li, if the heat of Shanghan has not subsided and one encounters wind-cold-dampness again, it transforms into various diseases. How can it become Warm Disease? It says if one encounters warm-heat again, it becomes Warm Toxicity; if one encounters warm qi again, it becomes Warm Epidemic. Thus, only encountering warm qi twice results in two different diseases. Moreover, an epidemic is specifically caused by contracting non-seasonal qi, affecting everyone similarly. For example, if winter should be cold but is very warm, and people contract winter-warmth and fall ill, this is called Warm Epidemic. If spring and summer should be warm-hot but are very cold, and people contract sudden cold and fall ill, this is called Cold Epidemic. Why wait for a second encounter with different qi? The text here says encountering warm qi again transforms into Wen Pi (likely a typo for Wen Yi/Epidemic), meaning Shanghan transforms into another disease upon encountering different qi again. Transforming into another disease upon encountering different qi does not necessarily mean everyone gets the same illness, so how can it be called an epidemic? Shanghan Li states that a floating pulse that is soggy and weak, and a deep pulse that is string-tight, is the pulse of Warm Epidemic. Huoren Shu annotates this pulse under the Winter-Warm section, merging Warm Epidemic and Winter-Warm into one disease. This fails to realize that Winter-Warm is specifically contracting non-seasonal qi, whereas Warm Epidemic is Shanghan encountering different qi again. How can they be merged? Since this principle is unclear, I write this for the wise. I believe contracting warm-heat becomes Warm Toxicity, and contracting warm qi becomes Warm Epidemic; this is merely a difference in severity. However, the character "Yi" (Epidemic) is suspected to be an error, possibly meant to be "Ji" (Disease). If it were "Yi," then why would Winter-Warm affect an entire family with similar symptoms? Only when an entire family has similar symptoms can it be called an epidemic. Furthermore, this is Shanghan heat not yet subsided, encountering warm qi again; how could it reach the level of contagious similarity within a family?

Warm Epidemic:
If the floating pulse is soggy and weak, and the deep pulse is string-tight, and one further encounters warm qi, it transforms into Warm Epidemic. This is because winter injury by cold develops into Warm Disease; the pulse changes and treatment methods are as stated above. (Cheng Wuji notes: The previous heat has not subsided, and warm qi is contracted again; warm-heat combines to form Warm Epidemic.)
(Danxi's view): When everyone suffers from the same illness, it is a Heavenly Movement Seasonal Epidemic. Some cases require tonification, some require dispersal, some require descending.
Formula: Dahuang (Rhubarb Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Renshen (Ginseng Root), Jiegeng (Platycodon Root), Fangfeng (Saposhnikovia Root), Huashi (Talcum), Xiangfu (Cyperus Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Renzhonghuang (Indigofera Tinctoria Leaf Processed in Bamboo Tube). Grind into powder, mix with paste made from yeast, and make pills. Take 50-70 pills per dose. Administer with decoctions based on Qi, Blood, or Phlegm patterns. For Qi deficiency, administer with Sijunzi Tang (Four Gentlemen Decoction); for Blood deficiency, with Siwu Tang (Four Substances Decoction); for excessive phlegm, with Er Chen Tang; for severe heat, administer with child's urine mixed with the medicine.
(Bencao records): Fenqing (Clarified fermented human urine), harvested in the twelfth lunar month from Danzhu (Light Green Bamboo) with the green skin removed, soaked and pressed for juice, treats Heavenly Movement Heat Mania, Heat Diseases, poisoning, malignant sores, and mushroom poisoning. Soak Zaojiao (Tamarisk Pod) and Ganshe (Sugarcane) in the juice to treat Heavenly Movement Heat Diseases.
(Danxi's view): To resolve all calamities, use Fencacao (Licorice Root) five liang, finely cut and slightly stir-fried. Mix with unfermented wine according to the patient's capacity, grind together, filter, and take warm. Soon, profuse diarrhea will occur, expelling toxins. Even if extremely thirsty, do not drink water, as drinking water makes rescue difficult.
Chaihu Shigao Tang: Treats Seasonal Warm Epidemic with high fever, aversion to wind, headache, body pain, nasal congestion, dry throat, chest/epigastric irritability and fullness, alternating chills and fever, phlegm-stuffiness cough, and thick sticky sputum.
Ingredients: Chaihu (Bupleurum Root), Shigao (Gypsum Fibrosum - weight missing), Chi Shaoyao (Red Peony Root), Qianhu (Peucedani Radix), Gan Ge (Puerariae Radix) (each 15 liang), Shengma (Cimicifugae Rhizoma) (25 liang), Huangqin (Scutellariae Radix), Sangbai (Mori Cortex) (each 37.5 liang), Jingjie Sui (Schizonepeta Spike) (37 liang). Crush. Take 5 qian per dose with one lamp of water, three slices of Shengjiang (Fresh Ginger), and over ten grains of Douchi (Fermented Soybean). Decoct to 70%, filter, and take hot. Children divide into three doses, adjusting for age. These three formulas are suitable for cases with predominant heat and interior heat. Note: The treatment of Warm Epidemic is the same as Yang-pattern Shanghan. However, the classic "Warm Epidemic" refers to Warm Disease, so refer to the Warm Disease sections for treatment.

Cold Epidemic:
Huoren Shu states: In a year, if diseases occur where those who did not get sick previously now show similar symptoms in old and young, this is Seasonal Qi, commonly called Heavenly Movement. Laojun Shenming San, Wuchengzi Yinghuo Wan, Shengsanzi, and Baidu San are used regardless of the number of days or depth of the disease, applying emesis or purgation according to the syndrome. Thus, Shengsanzi does not distinguish between Yin/Yang or Exterior/Interior.
Laojun Shenming San:
Ingredients: Baizhu (Atractylodes Macrocephala Rhizome) (1 qian), Jiegeng (Platycodon Root) (2.5 qian), Fuzi (Prepared Aconite Lateralis Radix, black skin removed), Xixin (Asari Root) (each 1 liang), Wutou (Aconitum Carlevari Bulb) (4 liang, prepared, skin and tip removed). Grind the five herbs into coarse powder, sew into a silk bag, and wear it. Those living in villages who wear it will have no illness. If an epidemic occurs, take one Fangcunbi (approx. 2.7g) with warm wine, cover to induce sweating. If vomiting occurs, the illness resolves. If 3-4 days have passed, take 3 Cunbi, boil in one bowl of water until boiling vigorously, divide into three doses.
Shengsanzi: Su Dongpo's preface is fully recorded in Huoren Shu. During toxic outbreaks, those using Shengsanzi do not distinguish Yin/Yang, taking continuously until cured. It cannot be compared to Shanghan. If an epidemic spreads, cook a pot at dawn. Regardless of age or status, each takes one cup, preventing seasonal qi from entering.
Ingredients: Caodoukou (Cardamom Seed), Zhuling (Polyporus), Shichangpu (Acori Tatarinowii Rhizoma), Fuling (Poria), Liangjiang (Galangal Rhizome), Duhuo (Angelica Pubescens Root) (remove rhizome), Fuzi (Prepared Aconite Lateralis Radix, skin and navel removed), Mahuang (Ephedrae Herba) (remove roots), Houpo (Magnolia Bark) (remove bark, ginger-processed), Ben Cao (Ligustici Wallichii Rhizoma et Radix), Shaoyao (Peony Root), Zhike (Aurantii Fructus Immaturus) (bran-fried, pith removed), Chaihu (Bupleuri Radix), Zexie (Alismatis Rhizoma), Xixin (Asari Radix et Rhizoma), Fangfeng (Saposhnikoviae Radix) (remove fork and rhizome), Baizhu (Atractylodis Macrocephalae Rhizoma), Huoxiang (Pogostemonis Herba), Banxia (Pinelliae Rhizoma Preparatum), Wuzhuyu (Evodiae Fructus) (rinse with water), Cangzhu (Atractylodis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.5 liang). Crush. Take 5 qian per dose with 1.5 lamps of water, decoct to 80%, filter, and take hot. Re-decoct the dregs and take on an empty stomach. The above two formulas are suitable for epidemics with predominant cold and exterior syndromes. Note: Cold Epidemic syndromes must match Yin-pattern Shanghan to use these hot medicines. Claiming efficacy regardless of Yin/Yang or Exterior/Interior is absolutely false. Later generations, overly trusting Su Dongpo, used Shengsanzi, killing countless people. Alas, one must be cautious!

Wu [Jutong]: Cold Epidemic is caused by sudden cold from Heaven. In any season, if sudden wind-cold occurs and people fall ill immediately after exposure, it is called Cold Epidemic. Its symptoms are the same as standard Shanghan, but the sudden cold is milder. Treatment: If initially presenting with headache, increased chills, stiffness, vomiting, nausea, epigastric stuffiness, food stagnation, or abdominal pain without fever, Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with minor modifications is indicated. If fever has started, Shiwei Xiong Su San (Ten-Ingredient Ligusticum and Perilla Powder) to induce sweating is indicated. If body/joint pain accompanies fever, Renshen Qianghuo San (Ginseng and Notopterygium Powder) with Congbai (Green Onion White), Gegen (Puerariae Radix), and Shengjiang (Fresh Ginger) to induce sweating is indicated, or Shenzhu Tang is also acceptable. If spontaneous sweating occurs, do not sweat again; Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) is indicated. If heat persists or other syndromes develop, treat according to standard Shanghan sections.

Pang [Anshi]: Bingyuan records that after the Start of Spring, without extreme cold or ice/snow, if people suffer from high fever, this belongs to Spring Yang qi emerging outward, transforming Winter latent cold into Warm Disease. From After Spring Equinox to Before Autumn Equinox, if there is sudden cold, it is all Seasonal Cold Epidemic. In March/April, if sudden cold occurs, Yang qi is still weak, suppressed by cold, so heat symptoms are mild. In May/June, Yang qi is abundant, suppressed by cold, so heat symptoms are severe. In July/August, Yang qi is declining, suppressed by cold, so heat symptoms are slight. These illnesses resemble Warm Disease and Summer Heat Disease, but treatments differ. Initial treatment uses massage ointments and moxibustion; acupuncture uses Cui Wenxing's Jieisan Decoction. Cure follows sweating. If unresolved, sweat again on day 3. If profuse sweating fails to resolve, do not sweat again. On day 4, take Lilu Wan (Veratrum Pill) for mild emesis. If Lilu Wan fails to induce emesis, take Chixiaodou Guiti San (Adzuki Bean and Melon Pedicle Powder) to vomit. If resolved but symptoms persist, use acupuncture again. If unresolved by day 6, heat has entered the Stomach; administer Jizi Tang (Egg Decoction) to purge. This works nearly 100% of the time, provided one carefully observes timing and syndrome. Food stagnation resembles seasonal illness with fever/headache; purge food stagnation quickly. Seasonal illness requires waiting 6-7 days before purging. Seasonal illness: Day 1 in Skin, Day 2 in Fascia, Day 3 in Muscle, Day 4 in Chest, Day 5 enters Stomach, then purge. If heat is in the Stomach and you purge exterior heat, evil heat enters the Stomach via deficiency; however, you must purge again. Failure to purge often leads to gastric rotting and macules. Red macules indicate 5 deaths to 1 life; black macules indicate 10 deaths to 1 life, depending on constitution strength. Delaying purging causes heat retention, gastric rotting, and macules. If illness presents without fever but with delirium, restlessness, and loss of mental control, treatment falls under Wuling San (Five-Ingredient Powder with Poria) patterns. This is recorded by Chao Yuanfang. Regarding Seasonal Cold Epidemic, it resembles Warm/Summer Heat Disease but differs in treatment. Warm Disease lacks massage/moxibustion; there are also Winter-Warm sores/pox, Four Seasons Zang-Fu Yin-Yang Poisons, and Five Types of Heat Diseases after Summer Solstice. Due to intense summer heat requiring cooler herbs, treatments differ.

Cui Wenxing Jieisan Decoction: Treats Seasonal Qi disharmony and Shanghan fever.
Ingredients: Jiegeng (Platycodon Root), Xixin (Asari Root) (each 4 liang), Baizhu (Atractylodes Macrocephala Rhizome) (8 liang), Wutou (Aconitum Carlevari Bulb) (1 jin). Grind fine. For Shanghan, take 1.5 qian (or 5 Qianbi); if no effect, slightly increase until cured. For Seasonal Qi disharmony, take 1.5 Qian (or 5 Zhu bi). Expel evil, reduce illness. One dose suffices. This is universal for Seasonal Cold Epidemic; healthy people can take it preventively against cold. All taken with wine.

Lilu San: Prevents Warm Epidemic (i.e., Qianjin Chisan).
Ingredients: Lilu (Veratri Radix), Zhi Zhu (Daphne Genkwa Flower), Ganjiang (Zingiberis Rhizoma) (each 1 liang), Mudanpi (Moutan Cortex), Zaojiao (Gleditsiae Sinensis Fructus) (each 1 liang 6 zhu), Xixin (Asari Radix et Rhizoma) (18 zhu), Fuzi (Prepared Aconiti Lateralis Radix), Guizhi (Cinnamomi Ramulus), Zhusha (Cinnabar) (prepared separately, each 6 liang). Grind into powder, place one Fangcunbi in a crimson bag. Men wear on left arm, women on right arm. Wear when feeling illness approaching.

Chixiaodou Guiti San (See formula above).
Jizi Tang: Treats Seasonal Qi with severe heat, delirium, and urge to run.
Ingredients: Sheng Jizi (Raw Chicken Egg) (7 eggs), Mangxiao (Natrii Sulfas) (1 liang). Use well water (Jinghua Shui) one large sheng. Add ingredients, stir 1000 times, remove foam, take in one dose. Stop when bowel movement is rapid.

Prevention Methods:
Xionghuang Wan: Prevents epidemic infection.
Ingredients: Xionghuang (Realgar) (1 liang, ground), Chixiaodou (Adzuki Bean) (roasted), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Guijianyu (Eucommiae Cortex - *Note: Guijianyu is usually Prunus Spinosa branch, text says Eucommia but context implies defensive herb, likely Prunus Spinosa Ramulus*), (each 2 liang). Grind fine, make honey pills size of paulownia seeds. Take 5 pills daily on empty stomach with warm water. No infection even sharing clothes with patients.

Huoren cites Wuchengzi Yinghuo Wan: Prevents epidemics, evil qi, ghosts, tigers, wolves, snakes, venomous insects, weapons, blades, thieves, and misfortune.
Ingredients: Yinghuo (Firefly), Guijianyu (Pruni Spinosae Ramulus) (remove skin), Jili (Tribuli Fructus) (each 1 liang), Xionghuang (Realgar), Xihuang (Orpiment) (each 2 liang), Fanshi (Alumen) (1 liang, roasted until liquid gone), Lingyangjiao (Saigae Tataricae Cornu), Guihui (Testudinis Carapax et Plastrum Ash), Tiechui Bing (Iron Hammer Handle - iron part charred) (each 1.5 liang). Grind nine ingredients into powder. Mix with egg yolk and one rooster comb. Make almond-sized pellets. Place 5 pills in a triangular crimson bag. Wear on left arm or hang on door.
Methods to prevent Seasonal Epidemic transmission:
Grind Xionghuang (Realgar) with water and apply to nose. Or wrap 5 qian of Ming Xionghuang in silk and tie to top of head. Or apply good sesame oil to nostrils. Or crush bugs from peach leaves, mix with cool water, and take. Or soak Chixiaodou (Adzuki Bean) with glutinous rice in water vat, use water daily. Or soak Guanzhong (Cyrtomii Rhizoma) in water.

Four Seasons Non-Seasonal Qi:
Seasonal Qi is the violent, epidemic qi of Heaven. When seasonal commands are incorrect, this qi circulates. If contracted, old and young suffer similarly, and it is contagious. It resembles Shanghan, but Shanghan is caused by cold, whereas this is epidemic qi, not comparable to simple cold. Treatment must focus on dispelling epidemic qi and supporting righteous Qi. If unresolved for days with heat transmission, consult Shanghan complication sections. Only dispersing herbs differ. Dispersing decoctions like Huoxiang Zhengqi San, Xiong Zhi Xiang Su San, Shishen Tang, Renshen Baidu San, Shiwei Xiong Su San, etc., can be selected.

Spring Warmth:
Huoren Shu: Spring should be warm; if clear Qi is suppressed, pathology lies in Liver. Symptoms: fever, headache, vertigo, vomiting, similar across ages. Use Shengma Gegen Tang (Ephedra and Kudzu Decoction), Jiemi Tang (Muscle-Releasing Decoction, universal for four seasons), Baidu San.
Tao [Hongjing]: From After Spring Equinox to Before Summer Solstice, no aversion to cold but thirst indicates Warm Disease. Use acrid-cool herbs to mildly release muscle layer; do not induce heavy sweating. If interior syndrome appears, use cold-cool herbs to urgently purge; do not mistake sweating or purging. Recognize that exterior syndrome here differs from standard Shanghan, and interior treatment differs.

Summer Warmth:
Huoren Shu: Summer should be hot; if cold Qi suppresses, pathology lies in Heart. Symptoms: fever, headache, abdominal fullness, diarrhea, similar across ages. Use Lizhong Tang (Regulate the Middle Decoction), Shegan Tang (Belamcanda Decoction), Banxia Gancao Tang.
Tao [Hongjing]: After Summer Solstice, headache, fever, no aversion to cold, thirst is Warm Disease; more severe is Heat Disease. Use only acrid-cool herbs to release muscle; avoid heavy sweating. If interior syndrome appears, urgently purge. Exterior syndrome differs from standard Shanghan; interior treatment is the same.

Autumn Warmth:
Huoren Shu: Autumn should be cool; if great heat suppresses, pathology lies in Lung. Damp-heat struggles, people suffer jaundice, cough, wheezing. Use Jinfei Cao San (Boiling Herb Powder), Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Decoction). Jaundice/yellowing uses Yinchin Wuling San (Artemisia Capillaris Five-Ingredient Powder).
Tao [Hongjing]: From Autumn Equinox to Before Frost Descent, headache, fever, no aversion to cold, body pain, short urine is Damp Disease. Use acrid-cool herbs plus drying agents to release muscle; avoid sweating. If interior syndrome appears, purge. Exterior syndrome differs from standard Shanghan.

Winter Warmth:
Huoren Shu: Winter should be cold but is warm; suppression affects Kidney. Use Rui Yu Tang (Reed Catnip Decoction).
Danxi: Winter Warmth is qi appearing out of season. In deep winter, gentlemen should conserve, but instead disperse outward. Use tonics combined with exterior-releasing herbs.
Method to make Renzhonghuang: Leave nodes at both ends of a bamboo tube. Drill a hole in one node. Insert Gancao (Licorice Root). Seal with bamboo peg. In winter, immerse in manure pit for one month. Remove and dry. Treats Warm Toxicity. Use alone with tonics and exterior herbs.

Huoren Shu cites Zhang Zhongjing: Winter Warmth toxicity is vastly different from Shanghan. Shanghan is caused by cold Qi; Winter Warmth by warm Qi; Cold Epidemic by sudden cold suppressing people, not mere exposure. Treatments differ. Cold/hot/warm/cool agents vary. Do not拘泥 (stick rigidly) to days; apply sweating, emesis, or purgation according to syndrome. Generally: Treat Heat with Cold (administer warm); Treat Warm with Cool/Cold (administer cool); Treat Cold with Hot (administer cool); Treat Clear/Cool with Warm/Hot (administer warm). Aim for balance; do not exceed. This is the major principle.

Shenxiao Waxue Tang (Appendix): Treats undifferentiated Yin/Yang Shanghan and spreading Seasonal Epidemic Evil Qi. Acts like hot water melting snow. Efficacy is immense.
Ingredients: Cangzhu (Atractylodis Rhizoma) (firm, roasted, peeled), Ganjiang (Zingiberis Rhizoma) (prepared), Gancao (Glycyrrhizae Radix et Rhizoma) (roasted, each 6 liang), Houpo (Magnoliae Officinalis Cortex) (peeled, ginger-processed), Fangfeng (Saposhnikoviae Radix) (tender), Baishaoyao (Paeoniae Radix Alba) (peeled), Gegen (Puerariae Radix) (each 4 liang). Crush. Take 4 qian with 2 zhong of water, decoct to 1 zhong, filter, take hot. Anytime. Shortly after, eat ginger/scallion soup, avoid wind, sit/lie down. Mild perspiration cures. If epidemic is spreading, best taken in morning. Daily maintenance: 2 qian with 1 lamp of water, decoct to 80%.