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Typhoid fever (Shanghan) presents with both true and false manifestations. Yang syndromes (Yang Zheng, patterns characterized by heat and excess) may masquerade as Yin syndromes (Yin Zheng, patterns characterized by cold and deficiency), and Yin syndromes may masquerade as Yang syndromes. If these are not distinguished clearly, death will ensue immediately upon ingestion of medication; how can one not be cautious? Pure Yin syndromes are naturally easy to understand, and pure Yang syndromes are naturally recognizable. It is only in cases where true signs are masked by false ones, or false signs conceal the truth, that the patient is already in a critical state between life and death. Heaven uses this to observe the goodness or wickedness of human hearts: if there is even a single thought of goodness, danger can turn into safety; if there is no repentance, life may be lost. Alas, ignorant people do not know this and instead blame the sick for their clumsiness, which is truly lamentable.

Although so, diseases manifesting as resembling Yang but not being Yang, or resembling Yin but not being Yin, represent the subtlety of Heavenly Dao. However, distinguishing these features resembling Yin or Yang is the method of medical practice. How can one use the warnings of Heaven merely as a shield against slander for physicians? One must realize that the difficulty in treating such diseases lies in the confusion between true and false; one must not be blinded by appearances and ignore the truth, thereby allowing patients to die without rescue. Therefore, beyond discussing various categories of disease, I re-examine and distinguish the true and false aspects of Typhoid fever where Yin syndromes resemble Yang and Yang syndromes resemble Yin.

When a Yang syndrome presents with false Yin signs, there will necessarily be body heat accompanied by cold hands and feet, and Jue-ni (reversal cold). The mouth will certainly be dry, yet the pulse will paradoxically be fine and minute (Xi Wei). For such conditions, one should judge based on symptoms rather than solely on the pulse. Observe the color of the tongue coating—whether yellow, white, red, or crimson. In true heat syndromes, the tongue surface will be rough like thorns; it will be either yellow or red, or black or gray. By using this criterion, there will be no error. Urgently administer Da Cheng Qi Tang (Major Order the Qi Decoction) to purge, or Da Chai Hu Tang (Major Bupleurum Decoction) to harmonize. Within these two formulas, one must select based on the severity of abdominal pain; thus, there will be no deviation or mistake.

In Yin syndromes masquerading as true heat, the body may occasionally have fever, the abdomen may occasionally hurt, hands and feet may occasionally experience reversal cold, and thirst and throat swelling often occur. Administering cooling medicines induces vomiting, and administering warming medicines also induces vomiting. This is due to severe Yin cold repelling Yang qi upwards, presenting as false heat above and true cold below. The prescription should be Bai Tong Tang (White Passage Decoction) added with Ren Shen (Ginseng Radix) and Fu Zi (Aconite Lateral Root Preparata). Decoct and administer cold. After one dose, the illness will vanish as if lost. However, one must also examine the tongue: the coating must be white and slippery, absolutely not dry, and absolutely lacking prickly projections. This allows for clear distinction. If these conditions are thoroughly understood within one's mind, how could one ever cause harm by treatment? My transmission of this knowledge stems from a heart filled with compassion and pity. By sharing my teachings with the world, errors will surely cease. I wish for wide dissemination and printing to comfort my spirit in the heavens.

Chunyu Yi, known as the Earl of Taicang, transmitted this east of Mount Yan. The time was two days after June in the Wuchen year of the Kangxi reign.