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(Fengwen Shanghan, also known as Fengwen Jianhan. Commonly referred to as "Wind-Cold wrapping Fire.")

[Etiology] It belongs to latent heat diseases (Fuwen Bing). It is triggered by contracting cold wind; or it erupts suddenly due to warm weather where Wind-Cold causes internal heat to stagnate. The former is caused by latent pathogenic factors (Fuqi), and the latter by new contraction (Xingan). Since the etiologies differ, the severity of the disease conditions varies significantly.

[Symptoms] When triggered by cold wind acting on latent warmth: Initially, there must be headache, fever, slight aversion to wind and cold. Subsequently, high fever, spontaneous sweating, thirst without aversion to cold, cough, irritability, and intense heat in the skin of the forearm (Chifu) occur. In severe cases, snoring, excessive sleepiness, difficulty speaking, symptoms resembling convulsions (Jingxian), and a face reddened as if scorched by fire appear. The tongue coating is initially thin white with red and dry edges and tip, then becomes red tongue body with yellow coating, or even deep red without coating. When bound by Wind-Cold acting on Warm-Heat: Initially, headache, fear of wind, aversion to cold, and anhidrosis occur. Subsequently, fever, cough, irritability, thirst, spontaneous sweating, sore throat, and swollen throat appear. The tongue coating is white, dry, and red at the edges; in severe cases, it becomes white, dry, and prickly, or turns from white to yellow.

[Pulse] If the right Cun pulse is floating and surging (Fuhong), and the left pulse is wiry and moderate (Xianhuan), this indicates that a new contraction has stirred up latent qi. This is what Zhang Zhongjing described as: "After sweating, if the body burns with heat, it is named Fengwen." In severe cases, both Cun and Chi pulses are floating and surging, vigorous and restless, indicating external wind stirring internal heat. This corresponds to Zhang Zhongjing's description: "Shanghan not resolving after seven or eight days, occasional aversion to wind, dryness on the tongue, great thirst and irritability, desiring to drink several liters of water," which signifies heat accumulation internally with heat in both exterior and interior. If the right pulse is floating and rapid (Fushu), and the left pulse is wiry and tight (Xianjin), this indicates external cold binding internal heat. This corresponds to Zhang Zhongjing's description: "Irritability, thirst, slight aversion to cold on the back." After sweating, if the pulse turns floating, surging, and forceful, this corresponds to Zhang Zhongjing's description: "After taking Guizhi Tang and sweating profusely, if great irritability and thirst remain unresolved, and the pulse is surging and large."

[Treatment] For cold wind triggering latent heat: First administer Congchi Jiegeng Tang to lightly clear and disperse wind to release the exterior. Then administer Xinjia Baihu Tang to use acrid-cool properties to drain heat and clear the interior. If interior heat is extremely abundant and signs of wind stirring and convulsions (Yongzhi) have appeared, quickly administer Lingjiao Gouteng Tang to use sweet-salty calming properties to extinguish wind. Finally, administer Renshen Baihu Tang added with fresh Shihu (Dendrobium), pear juice, and sugarcane juice to use sweet-cold properties to rescue fluids for follow-up care. For Wind-Cold binding internal heat: First administer Xinjia San'ao Tang, reducing the dosage of Mahuang and heavily adding Niubangzi to slightly disperse Wind-Cold to release the exterior. Then administer Lianqiao Zhichi Tang added with tender Sangya (Mulberry sprouts) and fresh Zhuye (Bamboo leaves) to lightly drain Warm-Heat pathogens to clear the interior. During this process, if there is much phlegm, add Danzhuli (Bamboo sap) (two ladles) and Shengjiangzhi (Ginger juice) (two drops, mixed evenly, taken together). If there is food stagnation, add Sheng Luobozhi (Radish juice) (two large ladles) and Zhishi Zhi (Immature Bitter Orange juice) (two small ladles, mixed evenly, taken together). If rashes appear, add Chao Niubangzi (Fried Arctii Fructus) (3 qian) and Huoshui Lusun (Living Reed Shoots) (1 liang). If there is a sore throat, add Jinguolan (Tinosporae Radix) (1 qian), Annanzi (Annamite Nut) (3 pieces), and Zhi Yueshi (Prepared Borax) (5 fen). For throat insufflation, use Jiawei Bingpeng San (Bingpian 1 fen, Pengsha 1 qian, Fenghua Xiao, Shandougen, Qingdai, Danfan, Niuhuang each 2 fen; most effective for throat insufflation; if phlegm and saliva obstruct, use a goose feather dipped in Tung oil and a little Saojiao powder to induce vomiting; if the throat has formed an abscess, puncture the affected area with a throat needle to drain pus, and it will heal naturally when the pus is clean). The general principle is to regulate the Lung and Stomach.

[Xiu's Commentary] Fengwen occurs in all four seasons but is most severe in spring. New contraction enters through the mouth and nose and invades the Triple Burner internally; latent qi often hides in the Membrane Source (Moyuan) or resides internally in the Ying level. For these two conditions belonging to the Lung and Stomach, following Dr. Yu's syndrome differentiation and treatment will naturally yield results. If pathogens hide in the Moyuan, after initial mild sweating, although the Wind-Cold exterior pathogens are resolved, the latent pathogens in the Moyuan still wish to exit but cannot do so immediately. Symptoms must include alternating chills and fever like malaria, chest and diaphragm fullness/stuffiness, mental restlessness (Aonao), vomiting, and loss of appetite. Quickly use Chaihu Dayuan Yin to open and reach the Moyuan, causing latent pathogens to溃散 externally and heat to penetrate outward. At this time, differentiate whether it is Dry-Heat, then use Xinjia Baihu Tang with acrid-cool and sweet-cold properties to clear and drain; if it is Damp-Heat, use Zengjian Huanglian Xiexin Tang with bitter-acrid and bland-draining properties to clear and promote urination. If there are indications for purgation, differentiate their severity and urgency, and酌情 use various Chengqi methods to guide and exhaust them. If pathogens reside internally in the Ying level, the condition is more urgent than latent pathogens in the Moyuan. Initially use Congchi Jiegeng Tang; after acrid-cool sweating, although exterior pathogens are resolved and temporarily heat subsides with coolness of the body, heat in the chest and abdomen remains. Subsequently, high fever with spontaneous sweating, irritability, insomnia, fluctuating clarity of consciousness, nighttime delirium, rapid pulse, and crimson tongue appear. In severe cases, limb coldness and sunken pulse occur. Urgently clear and penetrate Ying-level heat to transfer latent heat to the Qi level. Once Qi is unblocked and Wei Qi dissipates, resolution may occur via rashes or via violent sweating. Mild cases use Dai Mao Yujin Tang; severe cases use Xi Di Qingluo Yin; both can be selected. Critical cases use Zixue Dan or Xingjun San, which have proven efficacious like spirits.

[Lian's Review] Latent warmth originates from within, while Wind-Cold attacks from without, forming a pattern of internal heat and external cold. I have treated many such cases. Severe cases use Maxing Shigan Tang added with Lianqiao, Niubangzi, Sangye, and Danpi. Mild cases use Sangju Yin added with Mahuang, but the dosage of Mahuang is extremely light, approximately 2 to 3 fen only. Only its light and ascending nature is utilized to vent the Lung and penetrate the exterior, with efficacy as immediate as striking a drum. Regrettably, Wu Jutong advocates using Guizhi Tang to resolve the muscle layer for Wind-Cold aversion at the onset of Warm diseases. Does he not know that Guizhi is acrid and hot, scorching the Ying level, and thus contraindicated in Warm diseases? Huixi's commentary on Ye Tianshi's medical cases states: "For Fengwen patterns, taking Guizhi and Shengjiang will inevitably cause hematemesis, and even aphonia." Had Wu seen this? No wonder Mengyin ridiculed him for falsifying the sages and misleading the world. Jutong also claims that sweating is contraindicated in Warm diseases, and resolving the muscle layer is preferred. Reading the *Shanghan Lun*, in the clause "If the patient's viscera have no other disease," it says "sweating leads to cure"; in the clause "The patient often sweats spontaneously," it says "must induce sweating to lead to cure," and both primarily use Guizhi Tang. This shows Guizhi Tang is a formula for inducing sweating in Wind-Cold, not for treating external cold binding internal heat. Wang Dachang stated that Jutong's *Wenbing Tiaobian* uses Guizhi Tang as the primary formula for treating Warm diseases, which is highly debatable. Indeed, this is not unjustified.

[Rongzhai's Commentary] Zhang Wanxiang in *Wenshu Yizhi* said: "Treating Fengwen by Triple Burner: Weiru Tang, Weijing Tang, Yinqiao San, and Baihu Tang are Upper Burner formulas; Huangqin Tang extracts Shaoyin pathogens and expels them along with the Lung, also an Upper Burner formula; Zhibao Dan, Zixue, and Niuhuang Wan, aromatic orifices-opening agents, are Heart Palace formulas, and since Heart and Lung belong to the Upper Burner, they are Upper Burner formulas. Liangge San acts from Upper Burner to Middle and Lower Burners. For yellow, slippery, thick tongue coating with much phlegm, use Xiangbei (Fritillariae Thunbergii Bulbus), Louren (Trichosanthis Fructus), or Tingli Dazao Tang, all are Lower Lung formulas. What Ye Tianshi meant by 'contraindicated for purgation' refers to not using Chengqi Tang. When encountering patterns with concurrent Shaoyin pathogens, I add Chaihu; for headaches due to Blood deficiency, Xiong Gui Tang is invariably effective. For Fengwen with food stagnation, I also do not use digestive-promoting herbs, because Wind can digest grain; even greasy and rich flavors merely produce excess phlegm, so removing phlegm suffices; forcing digestive herbs into the prescription constitutes an error. Furthermore, in Ye's cases regarding Fengwen damaging Yin fluids, Shengdi, Ejiao, Maidong, Baishao, Zhigancao, and sugarcane juice are used, or sometimes Shashen, Maidong, and Yuzhu; the main gist always relies on Sweet herbs. If Acrid-Warm exterior-releasing or rigid-dry digestive herbs are used, they inevitably damage Yin fluids; sudden transformation into spasms and convulsions, or slow transformation into consumptive diseases, are all due to neglecting the Yin aspect. Dr. Zhang was a person during the Jiaqing, Daoguang, Xianfeng, and Tongzhi reigns of the Qing Dynasty (1796–1870), residing in Ximachi Tou, Shaoxing; Mr. Cao Bingzhang called him: 'A senior predecessor in Shaoxing for treating Shanghan and Wenshu, rich in medical experience.' (See Summary of Zhang's *Wenshu Yizhi*). This theory is Dr. Zhang's summary of experience in treating Fengwen and is certainly reliable."