Library

(Also known as "Guest Cold Enveloping Fire", commonly called "Cold Warmth").

[Etiology] Internal latent warm pathogens emerge, while new external cold binds the exterior. The condition presents as excess or deficiency. Excess pathogens mostly occur in the membrane source (Memorandum Yuan) of the Shaoyang channel; deficiency pathogens mostly occur in the blood and yin aspects of the Foot-Shaoyin kidney. One must examine the etiology and distinguish it into Shaoyang Warm Disease, Hand-Shaoyin Heart Warm Disease, and Foot-Shaoyin Kidney Warm Disease to clarify boundaries.

[Symptoms] If the warm pathogen at the membrane source is triggered by spring cold, initially there is pain in the head and body, aversion to cold, and anhidrosis. Subsequently, chills and fever resembling malaria appear, bitter taste, hypochondriac pain, and in severe cases, red eyes, deafness, chest diaphragm fullness with desire to vomit. Once transmitting to the Yangming channel and erupting externally, there must be burning heat, vexation, extreme thirst with desire to drink, aversion to cold ceases but aversion to heat begins, and even delirium. Faint rashes may appear on the chest and diaphragm, constipation, and dysuria. The tongue coating is initially rough and white like powder, with red edges and tips, or red tongue body with thin white coating. Later, the tongue becomes red with prickles, yellow and thin greasy in the center; severely, red edges with yellow center showing black spots. If the warm pathogen lies latent in the Shaoyyin channel, triggered by new spring cold: In the blood aspect, initially slight aversion to wind and cold, body pain, anhidrosis, followed by burning heat with spontaneous sweating, vexation, insomnia, or drowsiness, red face and lips, restlessness of hands and feet, delirium, mutism, or low-pitched speech with laughter. Pathogen sinks into the Jueyin Liver, resembling convulsive epilepsy, with frequent spasms, cold limbs, and burning sensation upon palpation of chest and abdomen. Tongue coating is initially red base with floating white, later bright red, severely purple-crimson with little fluid. In the Yin aspect, initial slight aversion to cold, body pain, anhidrosis are similar, but face has oily sheen, heat at Chi pulse position, dry mouth and teeth, irritability,狂言 (mad speech), waist pain as if broken, heavy pain in lower abdomen. Males have nocturnal emission and spermatorrhea; females have profuse leukorrhea, urine red and astringent, thick and sticky resembling hematuria, combined with Jueyin Liver disease, Qi rushing up to strike the heart, frequent syncope, spasm after syncope recovery, then syncope again, muscle twitching, severe upward gaze or strabismus, curled tongue and contracted scrotum. Tongue coating is initially purple-crimson and round, later swollen and tender, yellow-black at root, finally deep purple-red, dry or scorched, severely purple, dry, dull, color like pig kidney.

[Pulse] Left pulse is wiry-tight; right pulse is wiry-slippery-rapid. This is external cold clashing with internal heat. As stated in *Neijing*: "Winter injury by cold leads to Warm Disease in Spring." As stated in *Shanghan Lun*: Sunyang disease with fever and thirst, without aversion to cold, is Warm Disease, commonly called Cold Warmth. If the right pulse is surging-full and restless, while the left is fine-wiry and rapid, this corresponds to *Neijing*: "Winter failure to store essence leads to Warm Disease in Spring." Severe deficiency in Warm Disease leads to death. This is also Yu Xi Chang's statement: injured by cold and failing to store essence, manifesting simultaneously in Spring.

[Treatment] For membrane source latent pathogens triggered by new spring cold, treatment should be acrid-cool releasing the exterior, using Congchi Jiegeng Tang to first resolve external cold. Once external cold resolves, both exterior and interior become hot, heat knots internally. Treatment should be bitter-acrid opening and draining, using Chaiqin Qingge Decoction to resolve both exterior and interior heat. If heat remains intense with faint rashes, use Xinjia Baihu Tang, adding fried Niu Bang Zi and Da Qing Ye (each 3 qian) to rapidly vent rashes. After rashes vent, if only empty vexation, nausea, palpitations, and insomnia remain, phlegm-heat disturbs internally. Use Haoqin Qingge Decoction removing Guang Pi, adding Bei Shu Mi (3 qian) and Chen Sha dyed Deng Xin Cao (30 branches) to lightly clear residual heat. If rashes are vented but high fever and delirium persist, with constipation and dark scanty turbid urine, heat knots in the Small Intestine Fire Fu. Urgently give Xiao Chengqi Tang removing Chuan Pu, adding Chuan Lian and Mu Tong (each 1 qian) to clear and descend Small Intestine heat knot, so bowels and urine unblock and spirit clears. With chest fullness and much phlegm, use Xianxiong Chengqi Tang, adding Yi Yuan San (4 qian wrapped) and Dan Zhu Ye (2 qian) for vigorous purgation. After purgation, when heat retreats and body cools, use *Jingui Yaolue* Maidong Tang (original Maidong, Bei Shu Mi each 3 qian; Xiyangshen, Xian Banxia each 1 qian; Sheng Gancao 6 fen; Da Hongzao 2 pieces), adding Sheng Guya (1 qian) and Guang Ju Bai (8 fen) to nourish Stomach Yin and awaken Stomach Qi for aftercare. For Shaoyin latent Warm Disease suddenly triggered by spring cold, first use acrid-cool assisted by sweet-moistening methods,酌情 using Qiwei Congbai Tang and Jiawei Weirui Tang to resolve new pathogens attacking from outside. Then advance to sweet-cold re-bitter-draining methods,酌情 using Xidi Qingluo Yin and Daochi Qingxin Tang to clear latent blood heat. If phlegm confuses clear orifices causing mental clouding, urgently give Daimao Yujin Tang to clear and diffuse pericardium phlegm-fire. If still comatose and mute after administration, urgently use Xiling Sanzhi Yin to clear and diffuse heart orifice collateral phlegm-stasis-heat, mixed with Zhibao Dan or Niuhuang Gao. Obstruction will naturally open. After opening, if internal Liver Wind moves, traversing sinews causing hand-foot spasms, urgently use Lingjiao Gouteng Tang to extinguish Liver Wind and stabilize spasms. Only Yin aspect latent heat entering the Essence Chamber is deeper than heat entering Blood Chamber. Desire fire and latent fire steaming together lead to instant Yin exhaustion and death, commonly called Jia Yin Warm Disease. Avoid rash exterior-releasing drugs; urgently clear interior and save Yin. Tao Shi Xiaoyao Tang (Xiyangshen, Zhimu each 3 qian; Xian Shengdi 1 liang; Chen Sha 5 fen wrapped; Fei Huashi 3 qian; Sheng Gan Xi Shao 8 fen; Jiu Gen Bai 2 pieces; Liang Tou Jian 40 grains, lightly stir-fried with salt water wrapped and decocted; first decoct Xijiao 1 qian, Qing Zhupi 1 liang as water substitute; if urination drops painful, add Du Niuxi 3 qian, Dangmenzi 3 li mixed) urgently drains steaming fire to preserve Yin fluids. Follow with Jiawei Zhibai Dihuang Tang (Zhimu 3 qian, Chuan Bai 5 fen, Yurou 1 qian, Shanyao, Zhe Ling each 3 qian, Danpi, Zexie each 1.5 qian; Xijiao juice, Tongbian each 1 cup mixed; first decoct Shudi 8 qian sliced as water substitute) to nourish Yin and descend fire, harmonizing Heart and Kidney. Then Ganlu Yin modified (Dan Tiandong, Ti Maidong each 2 qian; Shengdi, Shudi each 4 qian; Huo Shihu 3 qian; Sheng Yuzhu 4 qian; Chao Ju Bai 8 fen; Jian Lanye 3 qian). Finally Kanqi Qianlong Tang to nourish Ren Yin and anchor floating Yang. If fluids exhausted and wind moves, urgently give Ejiao Jizihuang Tang to nourish Yin and extinguish wind to calm spasms. However, such extreme deficiency is often untreatable; even if saved, only one or two out of ten recover.

[Xiu's Note] Spring Warmth with cold, initially use Congchi Jiegeng Tang, acrid-cool opening exterior to resolve external contraction, most stable. If not opened, how can exterior cold resolve? Once exterior cold resolves, latent heat can erupt externally. Heat exiting via Shaoyang Gallbladder channel causes rashes; use Xinjia Muzei Jian adding Niu Bang Zi, Lianqiao to vent rashes. Heat exiting via Yangming Stomach channel causes macules; use Xinjia Baihu Tang adding Niu Bang Zi, Lianqiao to vent macules. Once macules and rashes vent, interior heat reaches exterior, pulse calms, and patient recovers. If not, intestinal-rectum accumulation heat exists; select various Chengqi Tangs to urgently attack and preserve fluids, leading to quick recovery. This is the treatment for excess-type latent qi Spring Warmth. For deficiency-type Spring Warmth latent in Shaoyin blood/Yin aspects, Yin-blood is damaged, Liver Wind easily moves. Avoid rash use of Chaihu, Gegen, Jingjie, Fangfeng to ascend Yang and rob Yin. Yin deficiency causes internal wind to move upwards to Brain House causing head shaking/syncope, or horizontally to sinews causing spasms. If initial heat is constrained by cold and not diffused, use Lianqiao Zhichi Tang removing Kou Fen, adding fresh Congbai, Su Bohe to lightly clear and diffuse. Once Qi spreads and heat vents, with blood deficiency and fluid dryness, follow with Qingzao Yangying Tang adding Yegugen, Xian Maogen, sweet-cool moistening to regulate. Later, deficiency exceeds pathogen, focus on nourishing Yin and retreating heat, e.g., Ejiao Huanglian Tang. Do not purely use bitter-cold to severely injure healthy Qi. This is treatment for deficiency-type latent qi Spring Warmth. Mr. Yu clarified deficiency/excess, treating according to syndrome, focusing on heat entering Essence Chamber for deficiency, a key method for lower deficiency. Although Jia Yin Shanghan is difficult, Jia Yin Warm Disease often leads to rapid death. Success depends on accurate differentiation at initial diagnosis, precise medication, agile thinking, and flexible response to rescue such critical conditions.

[Lian's Review] Spring Warmth with cold often has more new contraction and less latent qi. Often due to abnormally warm spring weather, inhaling warm pathogens, first latent in Lung, suddenly triggered by violent cold. This is Mr. Ye's statement: "Warm pathogens enter from above, first affecting Lung." Initially headache, fever, slight aversion to cold, anhidrosis. Imitating Zhang Zipai's method, Yinqiao San slightly adding Mahuang, acrid-cool opening Lung to vent Wei. Once Wei vents and exterior resolves, Lung heat erupts externally. Qi transformation turns dry, no longer aversion to cold but aversion to heat, cough, vexation-thirst, yellow urine. Must promote Qi transformation with light-clearing, using Ye's He Xing Shi Gan Tang modified (Bohe, Xingren, Shigao, Sheng Gancao, Sangye, Lianqiao, Gualou Pi, Jiao Zhipi). Entering Ying level, mental vexation, little sleep, rapid pulse, red tongue, still possible to vent Ying and drain heat, returning to Qi level to resolve. Mainly Ye's Xi Di Yuan Shen Tang (Xijiao, Xian Shengdi, Yuanshen, Lianqiao, Sangye, Danpi, Zhuyexin, Shichangpu). Entering Blood, deep crimson tongue, red eyes, scorched lips, irritability, insomnia, night delirium, even coma. Fear consuming blood and injuring Heart, must cool blood and drain fire. Tao's Daochi Xiexin Tang modified (Chuanlian, Xijiao, Xiandi, Chishao, Danpi, Ziqin, Xishen, Fushen, Zhimu, Maidong, Shanzhi, Mutong, Yi Yuan San, Dengxin). For coma/muteness, add Zhibao Dan or Wangshi Xinding Niuhuang Qingxin Wan, aromatic opening orifices to clear internal obstruction and spirit. This vents Wei, clears Qi, vents Ying, cools Blood, allowing upper Jiao pathogenic heat to resolve externally. If not resolving externally, it knots in intestines-rectum. Differentiate severity/urgency, select Yu's various Chengqi methods to purge. For latent qi Spring Warmth, heat reaches exterior from inside, both exterior-interior hot, thus mostly Three Yang combined disease. Yu's Congchi Jiegeng Tang adding Zhimu, Huangqin removes both exterior-interior heat. Later, exterior heat mild, interior heat strong, use various Chengqi methods, bitter-cold agents to drain. After purgation, if both exterior-interior deficient, fluid dryness/vexation-thirst, severe case use Zhang's Zhuye Shigao Tang, mild case use Gu's Baxian Yuye, clear deficient heat to generate fluids.

[Rongzhai's Note] Mr. Zhang Xichun, author of *Zhongzhong Canxi Lu*, had unique insights on "Spring Warmth" treatment. Based on over 30 years of clinical practice, his findings are worthy of emulation. His formulas "Qingjie Tang", "Liangjie Tang", "Hanjie Tang" were tested clinically with good results. Reproduced below: "When cold Qi attacks humans, severe cases become ill immediately (Winter Shanghan); mild cases suffer slight cold invasion, do not become ill immediately, invade from skin into Sanjiao fat membranes, blocking Qi transformation ascent/descent, secretly generating internal heat. When internal heat accumulates deeply, combined with Spring returning Yang and slight external contraction stimulating heat, heat emerges from inside becoming Warm Disease, i.e., latent qi becoming Warmth. Regarding treatment, many Qing dynasty famous doctors said this condition should not induce sweating, but one must still differentiate based on pulse/syndrome phenomena. If pulse shows excess heat but remains in floating layer, with headache and white coating, still use sweat-inducing agents, acrid-cool to induce sweat, e.g., Bohe, Lianqiao, Chan Yi, assisted by heat-clearing drugs. My proposed 'Qingjie', 'Liangjie', 'Hanjie' three formulas can be selected based on disease severity. If disease starts with severe exterior-interior heat, surging-full pulse, white or yellow coating, use Baihu Tang adding Lianqiao, Maogen; this treatment does not aim for sweating, but after taking medicine, spontaneous sweat occurs and disease resolves, or even without sweat, disease resolves because cold-cooling agents combined with light-clearing dispersing agents naturally expel internal heat from pores to skin surface. This is the general treatment for 'Winter injury by cold, Spring Warm Disease'. For those who failed to store essence in Winter, their Warm Disease may result from sudden cold contraction. Generally, Warm Disease patients have internal accumulated heat; in Spring, slight external contraction causes sudden heat eruption. Those failing to store essence must have Yin deficiency, generated heat accumulates in Zang-Fu. After eruption, pulse is mostly rapid, breathing slightly panting, coating slightly white, fluids short or dry-yellow, or coating gradually black like spots, thirst with desire to drink, or reaching Yin level, tidal fever increases; at initial stage with white coating, sweat resolution is possible, but must assist with Yin-nourishing drugs. I commonly use Lianqiao, Bohe each 3 qian, Yuanshen, Shengdi each 1 liang, decoct and take, sweat indicates cure. If medicine taken, sweat wants to come but cannot, use white sugar water to deliver ~1 fen Aspirin, sweat comes. Or single use Yuanshen, Shengdi decocted water to deliver Aspirin, also induces sweat. If heat transmitted inside, yellow coating, pulse rapid-forceful but hard on pressure, not surging-slippery like Yangming excess heat. This is Yin-deficiency heat-excess image, treat with Baihu Jia Renshen Tang replacing Zhimu with Shengdi, Jingmi with Sheng Shanyao. Above is treatment for 'Winter failure to store essence, Spring Warm Disease'." Attached: Qingjie Tang Formula ── Bohe Ye 4 qian, Chan Yi 3 qian, Sheng Shigao ground 6 qian, Gancao 1.5 qian ── treats early Warm Disease, headache, whole body joint pain, skin fierce heat, back slight aversion to cold, anhidrosis, floating-slippery pulse. Liangjie Tang ── Qingjie Tang doubled Shigao ── treats Warm Disease feeling heat in both exterior-interior, surging-pulse with floating. Hanjie Tang ── Sheng Shigao crushed 1 liang, Zhimu 8 qian, Lianqiao 1.5 qian, Chantui de-footed 1.5 qian ── treats whole body fierce heat, heart heat and thirst, white coating turning yellow, surging-slippery pulse, or still headache, whole body stiffness.