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The discourse on "Shengqi Tongtian and Fog/Dew" (Vital Energy Connecting with Heaven and the Influence of Fog and Dew) is located after the section on the addition and subtraction of the Six Qi in *Shenzhu San* (Divine Efficacy Powder).

Bian Que stated: If a patient's pulse beats four times during one exhalation and four times during one inhalation (eight beats per respiration), the disease is about to worsen. A surging and large pulse accompanied by vexation and fullness indicates excess pathogenic factors; a deep and fine pulse indicates abdominal pain; a slippery pulse indicates injury from heat pathogens; and a choppy pulse indicates contraction of fog and dew pathogens.

Zhang Zhongjing stated: From the solar term of Frost Descent until before the Spring Equinox, any illness caused by exposure to frost and dew, resulting in cold pathogens invading the body, is termed *Shanghan* (Cold Damage).

Haizang (Wang Haogu) stated: Frost, dew, clear and damp qi from prolonged rain, mountain mists, and barrier vapors are all termed *Qingxie* (Clear Pathogens). Some contract pathogens externally due to thin clothing, some internally due to an empty stomach, and some both internally and externally due to thin clothing and an empty stomach simultaneously. The severity varies according to individual constitution, depending solely on the deficiency or excess of the person's original qi (*Benqi*). Does not only internal cold, drinking cold liquids, or mistakenly taking cooling medicines lead exclusively to *Yinzheng* (Yin Syndromes)? Cases that are severe and incurable occur because the deficient person already has latent Yin cold inside, and additionally contracts cold from outside. With both internal and external pathology, they become incurable.

The tight pulse mentioned by Zhang Zhongjing can be found under the entries of Xu Xueshi (Xu Shuwei).

He further stated: When both the Yin (Chi position) and Yang (Cun position) pulses at the Cun Kou (Radial Artery) are tight, according to the principle, this indicates that Qingxie (Clear Pathogens) have attacked the Upper Jiao, and Zhuoxie (Turbid Pathogens) have attacked the Lower Jiao. Qingxie attacking the upper part is called "Jie" (Pure); Zhuoxie attacking the lower part is called "Hun" (Turbid). When the Yin aspect is attacked by pathogens, chills must occur internally. This is because the exterior Qi is slightly deficient and the interior Qi fails to maintain its post, allowing pathogens to enter the Yin. When the Yang aspect is attacked by pathogens, it necessarily results in fever, headache, stiffness of the neck and occiput, spasms of the neck, lower back pain, and soreness of the shins. This is what is meant by contracting the qi of fog and dew. Thus, it is said that Qingxie attacks the upper, and Zhuoxie attacks the lower.

When Yin Qi is affected by chills, there is cold reversal in the feet and knees, and abnormal urination or defecation. This reflects slight deficiency of exterior Qi and slight urgency of interior Qi, causing the Three Jiao to mix chaotically, with no communication between interior and exterior. The Upper Jiao becomes stagnant and depressed, and Zang-Fu Qi薰 (fumes/interacts) with each other, leading to oral ulcers and damaged gums. If the Middle Jiao loses its governance, Stomach Qi rebels upward, Spleen Qi fails to transform, turbidity forms in the Stomach, Ying and Wei (Nutritive and Defensive) Qi do not flow smoothly, and blood coagulates and stagnates. If Chong Qi flows forward smoothly, urine will be red, stool red-yellow, clashing with heat pathogens. Relying on heat as a vehicle, it wanders through meridians and collaterals, entering and exiting the Zang-Fu organs. Where heat is obstructed, carbuncles and pus form. If Yin Qi flows forward smoothly, Yang Qi becomes厥逆 (rebellious/cold extremities) and weak, leaving Yin without direction. Exogenous pathogens enter internally, expelled via sneezing, but accompanied by hoarseness and throat obstruction. Cold厥 and heat chase each other; oppressed by heat, blood flows downward, resembling pig liver. Both Yin and Yang Qi are 厥逆, Spleen Qi is isolated and weak, the Five Fluids pour downwards, the Lower Jiao fails to close, leading to a sensation of heaviness in defecation, frequent difficult bowel movements, and shallow pain in the umbilical and abdominal regions. Life will be difficult to save.