Library

(Winter-warmth, also known as "Guest Cold Enveloping Fire," is commonly referred to as "Cold Warmth.")

[Etiology] In early winter, when the weather is sunny and warm, the climate is warm and dry; hence, the tenth lunar month is commonly called "Little Spring." When the body inhales this warm qi, the pathogenic factor first attacks the Lung. If the disease develops after contracting cold wind, it is classified as a new contraction (Xin Gan), characterized by a superficial and mild condition. However, if winter-warmth triggers the internal eruption of latent summer-heat, it is classified as latent qi disease (Fu Qi), characterized by a deep and severe condition. It is essential to first distinguish whether it is winter-warmth combined with cold or winter-warmth combined with latent summer-heat to clarify the boundaries. This is a necessary step in seeking the root cause during clinical practice.

[Symptoms] In cases of winter-warmth combined with cold, initial symptoms include headache, fever, nasal congestion, runny nose, cough with air rebellion, dry throat, and phlegm stagnation. Initially, there may be aversion to wind and chills, but these soon give way to aversion to heat without chills, accompanied by mental restlessness, thirst, and potentially toothache, sore throat, chest fullness, and hypochondriac pain. The tongue coating is initially white and turns yellow later, with the edges and tip gradually becoming red. Visually, the tongue may appear moist, but tactilely it feels scalding. In cases of winter-warmth combined with latent summer-heat, symptoms begin immediately with headache, high fever, cough, mental restlessness, and thirst. There may be anhidrosis with aversion to wind, or spontaneous sweating with aversion to heat. Although sore throat occurs initially, it is followed by diarrhea. Severe cases present with red eyes, red lips, hemoptysis, purulent stools, cold limbs, chest oppression, coma, delirium, or mutism resembling corpse-like rigidity. Convulsions and spasms of the extremities may occur, resembling epilepsy. The chest and abdomen feel burning hot, with dry constipation and short, dark, painful urination. In extreme cases, men may experience seminal emission, while women may suffer from excessive leukorrhea or metrorrhagia. There may also be rebellious cough, hiccups, or syncope due to rebellious qi. The tongue is often bright red or deep red, sometimes purple-red and dry, with prickles, cracks, or black/gray spots.

[Pulse] A floating, slippery, and rapid pulse on the right hand, and a floating, wiry, and slightly tight pulse on the left hand, correspond to Zhang Shiwen's description: winter-warmth contracted first, then constrained by severe cold externally, commonly known as "cold enveloping fire." A distinctly rapid pulse at both Cun positions, or a deep, wiry, slight, and rapid pulse at both Guan and Chi positions, indicates that new-contracted winter-warmth has triggered latent summer-heat. As stated in the *Nei Jing*, this is a case where yin qi is damaged first, leaving yang qi to flare alone, representing a severe syndrome of winter warm-dryness.

[Treatment] For winter-warmth combined with cold: (Xu Rongzhai notes: Winter-warmth combined with cold is a minor syndrome.) Start with Congchi Jiegeng Tang (Scallion and Fermented Soybean Decoction with Plumeless Millet Head), adding Gualou Pi (Trichosanthes Peel, 2–3 qian) and Chuanbeimu (Fritillaria Cirrhosa Bulb, 3–5 qian) to release the exterior with acrid-cool methods that ventilate the Lung. Once the exterior is resolved and cold eliminated, for hypochondriac pain and hemoptysis, use Sangdan Xiebai Tang (Morus and Moutan Decoction to Drain White Lung), adding Dijin (Lysimachia), Zhu Li (Bamboo Sap), and Lizhi (Pear Juice, each 2 ladles, taken mixed) to drain fire, clear metal, and protect the Lung. For sore throat and toothache, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), removing Banxia (Pinellia), and adding Zhi Yueshi (Prepared Borax, 4–5 fen), Qingruoye (Indigofera Leaf, 3–5 qian), Daqingye (Isatis Leaf, 4–5 qian), and Yuanshen (Scrophularia Root, 3–4 qian). Apply Jiawei Bingpeng San (Modified Ice and Boron Powder) externally via insufflation. Use acrid-sweet-salty-moistening methods to regulate the Lung and Stomach, concluding with Qixian Yuyin Tang (Seven Fresh Yin-Nourishing Decoction) to nourish fluids for recovery.

For winter-warmth combined with latent summer-heat: (Xu Rongzhai notes: Winter-warmth combined with latent summer-heat is a major syndrome.) The condition is more late-onset and severe than autumn-dryness latent summer-heat. For initial anhidrosis and aversion to wind, use acrid-cool methods to vent pathogens. For blood deficiency, use Qiwei Congbai Tang (Seven-Ingredient Scallion White Decoction); for yin deficiency, use Jiajian Weirui Tang (Modified Asparagus Decoction), allowing yin qi to overflow externally, inducing slight sweating to resolve the exterior. Once the exterior is resolved and latent summer-heat collapses internally, if sore throat, diarrhea, dry mouth, and dry tongue occur, the latent summer-heat has sunk into the Shaoyin Heart and Kidney. Use Zhufu Tang (Pig Skin Decoction), adding Jizi Bai (Egg White, 2 units), Xian Maogen (Fresh Imperata Rhizome, 1 liang), and Qinan Xiang Zhi (Aquilaria Juice, 4 spoons, mixed) to save yin with sweet-salty methods and clear heat. If mental cloudiness, delirium, or mutism occur, the latent summer-heat has sunk into the Hand-Jueyin Pericardium. If phlegm confuses the clear orifices, use Daimao Yujin Tang (Acanthosiasis and Curcuma Decoction) to open and vent; if blood stasis blocks the heart orifice, use Xijiao Qingluo Yin (Rhino Horn Clearing Collateral Drink) to open and vent; if phlegm and stasis mutually obstruct the clear orifices, use Xiling Sanzhi Yin (Rhinoceros Horn and Antelope Horn Three Juices Drink) to open and vent. If convulsions and syncope occur simultaneously, resembling epilepsy, the latent summer-heat has sunk into the Foot-Jueyin Liver. Use Lingjiao Gouteng Tang (Antelope Horn and Uncaria Decoction) plus Xuexue (Purple Crystal) to extinguish wind and open orifices for emergency rescue. For red eyes, red lips, hemoptysis, and purulent stools, use Jiawei Baitouweng Tang (Modified Pulsatilla Decoction), adding Zhuru (Bamboo Shavings), Dijin (each 5 qian), Daqingye (Isatis Leaf), Chuhua (Chrysanthemum Morifolium), and Baigen (Imperata Rhizome, 2 liang) to clear the Liver and strengthen the Intestines. For seminal emission/dreams in men and excessive leukorrhea/metrorrhagia in women, the latent summer-heat has sunk into the Chong and Ren vessels. Use Ziren Yiyin Jian (Nourish Ren and Benefit Yin Decoction), adding Cu Chao Baishao (Vinegar-fried White Peony Root, 4 qian), Dong Baiwei (White Peony Root of East, 5 qian), Chen Ejiao (Aged Donkey-Hide Gelatin, 3 qian), and Qing Tongbian (Clear Child Urine, 1 cup, mixed) to clear and nourish the Chong and Ren vessels to seal and secure them. If severe rebellious cough, hiccups, or syncope occur, the latent summer-heat carries rebellious qi upward. Use Xinjia Yunu Jian (Newly Added Jade Woman Decoction) to clear the Liver and suppress rebellion for descending and grasping. Once rebellion subsides and qi descends, conclude with Qinggan Yishen Tang (Clear Liver and Nourish Kidney Decoction) to nourish and anchor. For burning chest/abdomen, constipation, and red urine, the latent summer-heat is bound internally in the Stomach and Intestines. Use Yangrong Chengqi Tang (Nourish Prosperity and Succeed Qi Decoction) to moisten dryness and drain heat with mild purgation. If yin fluids are exhausted, use Zhangshi Jichuan Jian (Zhang’s River-Crossing Decoction) removing Shengma (Cimicifuga), adding Xue Geng (Snow Broth, decocted as water substitute) to increase fluids, moisten intestines, and slide downward. These methods are designed for yin deficiency with abundant fire. (Xu Rongzhai notes: Above are treatments for winter-warmth combined with latent summer-heat in yin-deficient, fire-abundant constitutions.) For obese individuals with dampness, even if contracting winter-warmth and latent summer-heat, dampness often constrains and hides heat. The method should be aromatic venting and bland leaching, warming transformation and clearing ventilation. Use Dajupi Tang (Major Tangerine Peel Decoction) removing Gu Gui (Cinnamon Twig) and Binglang (Areca Seed), adding Jiao Shanzhi (Charred Gardenia), Qing Lianqiao (Green Forsythia, each 3 qian), Huoshuo Lusun (Living Reed Shoots, 2 liang), Dengxin (Juncus, 5 fen), and Bei Xixin (Asarum, 2 fen, decocted as water substitute) to open dampness and vent heat. Subsequently use Zengjian Huanglian Xiexin Tang (Modified Coptis Heart-Draining Decoction) for bitter descent and acrid unblocking, sweet-bland leaching to regulate. For food stagnation with constipation, add Zhishi Daozhi Wan (Immature Bitter Orange and Digestive Pill) for mild purgation. For phlegm-saliva flooding upward, add Kongyan Dan (Control Phlegm Pill) to purge downward. Conclude with Xiangsha Erchen Tang (Aromatic Amomum and Two-Chen Decoction) adding Huangcao Chuanhu (Dendrobium, 3 qian), Xian Shichangpu (Fresh Acorus, 1 qian), Ban Chao Sheng Guya (Stir-fried Raw Barley Sprouts, 3 qian), and Jinju (Kumquat, 2 pieces) to warm and strengthen Stomach qi for recovery. If dampness clears and dryness arrives, with insufficient Lung-Stomach yin qi, use Jingui Maidong Tang (Golden Casket Ophiopogon Decoction) adding Xian Daolu (Fresh Rice Dew, 1 liang) and Zhe Jiang (Sugarcane Juice, 2 ladles, mixed) to clear and nourish qi and fluids for recovery. If initial spontaneous sweating and aversion to heat occur, immediately clear and resolve latent summer-heat using Zhuye Shigao Tang removing Banxia, adding Yegugen (Wild Garlic Root, 2 liang), Xian Maogen (Fresh Imperata Rhizome, 1 liang, peeled), and Dengxin (Juncus, 5 fen), following the previous formula. However, winter-warmth has many variable syndromes; refer in detail to the treatments of various warmth diseases.

[Xiu’s Commentary] When winter follows spring’s timing, bringing unseasonable warmth, illness caused by contracting this qi is named Winter-Warmth. It is drier and hotter than Spring-Warmth syndromes. Luo Qianfu advocated Yangdan Tang (Guizhi Tang plus Huangqin/Coptis), adding Jiegeng (Plumeless Millet Head) and Weirui (Asparagus). Zhang Shiwen advocated Yangdan Tang plus Mahuang (Ephedra) and Shigao (Gypsum). Both treat conditions where winter-warmth was contracted first, then constrained by wind-cold, presenting external cold and internal heat. For warmth pathogens entering from above and cold food ingested internally, he advocated Yindan Tang (Yangdan Tang from *Qianjin Fang* plus Ganjiang/Dried Ginger) to treat external heat and internal cold. However, these methods apply only to patients with a constitution inherently cold who suddenly contract winter-warmth. For those with inherent yin deficiency, Huangqin and Shigao may be used, but Ganjiang and Rougui (Cinnamon Bark) must not be used recklessly. Mr. Yu’s syndrome differentiation and treatment are detailed and clear, and his prescriptions are precise. He can be considered the orthodox authority on winter-warmth treatment.

[Lian’s Verification] Predecessors generally stated that winter mostly features proper Shanghan (Cold Damage) syndromes. Based on my extensive clinical experience, this is not entirely true. Most cases are winter-warmth combined with cold, i.e., guest cold enveloping fire, attacking the Lung first. Mild cases use Sangju Yin (Mulberry Leaf and Chrysanthemum Drink): Shuang Sangye (Frost-treated Mulberry Leaf) and Weijing (Reed Stem, each 2 qian), Chu Juhua (Chrysanthemum), Guang Xingren (Apricot Kernel), Qing Lianqiao (each 1.5 qian), Su Bohe (Perilla Mint), Jiegeng, and Sheng Gancao (Raw Licorice, each 0.8 fen). Add Mahuang (Honey-fried Ephedra, 0.3–0.7 fen) and Gualou Pi (Trichosanthes Peel, 2–3 qian). Or use Sangxing Qingfei Tang (Mulberry Leaf and Apricot Kernel Lung-Clearing Decoction): Shuang Sangye, Gualou Pi, Honey-fried Pipaye (Loquat Leaf, each 3 qian), Guang Xingren, Chuanbei, Chao Niubang (each 2 qian), Guidouling (Adenophora), and Jiegeng (each 1 qian). Add Xian Congbai (Fresh Scallion White, 3 pieces) and Dan Xiangchi (Light Fermented Soybean, 3 qian). Severe cases use Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) or Yebibo Jia Banxia Tang (Yebibo Decoction plus Pinellia), modified according to symptoms. Occasionally, Da Qinglong Tang (Major Green Dragon Decoction) or Xiao Qinglong Tang (Minor Green Dragon Decoction) plus Shigao is used. Viewing from Huxinshi’s perspective that winter sees many lung diseases, the main principle is acrid-cool opening of the Lung. For patients with rich diet constitutions, yin deficiency, and abundant fire, where warm-dryness injures the Lung, mild cases of wind-fire-toxins use Wu’s Puji Xiaodu Yin (Universal Benefit Detoxification Drink) modified: Su Bohe (1 qian), Yinhua (Honeysuckle), Lianqiao, Niubang (each 2 qian), Xian Daqing (Fresh Isatis), Gualou Pi, Chuanbei, Qingruoye (each 3 qian), Yuanshen (2–3 qian), Jin Suoshi (Gold Lock Key, 0.8 fen), Chonglou Jinxian ground juice (4 spoons, mixed). First decoct Sheng Laifu (Raw Radish, 2 liang) and Sheng Ganlan (Raw Olive, 3 pieces) as water substitute. Use acrid-cool light-clearing methods to detoxify; apply Jiawei Bingpeng San externally. Severe cases of rotting white membranous throat use Yangyin Qingfei Tang (Nourish Yin Clear Lung Decoction): Xian Shengdi (Fresh Rehmannia, 1 liang), Yuanshen (8 qian), Maidong (Ophiopogon, 6 qian), Chuanbei, Baishao, Danpi (each 4 qian), Su Bohe (3 qian), Sheng Gancao (2 qian), decocted with Dong Xueshui (Winter Snow Water). Add Zhi Yueshi (Prepared Borax, 0.6–0.8 fen) and Jizi Bai (Egg White, 2 units). Use acrid-cool sweet-moistening methods to prevent putrefaction; apply Lanhou Xilei San externally. These are all methods treating the Lung to clear the throat. If winter-warmth combines with late-onset latent summer-heat, the pathogen has been hidden long and deep, damaging yin fluids first and dulling qi mechanism. Treatment focuses on cooling blood, clearing fire, ventilating qi, and venting pathogens, with ventilating qi being paramount. Without ventilated qi, blood heat cannot be cleared, nor latent fire resolved. Ventilating qi cannot be achieved by Xiangsu San alone, nor supported by Renshen (Ginseng). It relies on acrid-cool aromatic venting and light-clearing agile agents, using fresh herbs extensively. Select drugs discussed by Zhang Shiwen in the Autumn-Dryness chapter, match them to symptoms, and combine into formulas. Gradually revive the qi mechanism, clear-vent the blood collaterals, and search-out latent pathogens to achieve efficacy. Any rash advancement leads to fire closure or qi collapse; qi collapse leads to fluid exhaustion. Success depends entirely on the clinician comprehensively assessing all syndromes alongside pulse and tongue diagnosis, not relying on a single symptom.