[Background Information]
Book: Shanghan Zhengzhi Zhunsheng (Standard for Diagnosis and Treatment of Cold Damage)
Author: Wang Kentang
Dynasty: Ming
Chapter: Autumn Malaria / Epidemic when Illnesses in All Ages are Similar within a Year
Category: Cold Damage

Summer injury by summerheat leads to malaria in autumn. When the pulses at all three positions (Cun, Guan, Chi) are full and vigorous, if the Yin pulse (Chi position) is particularly prominent, it transforms into Warm Malaria (a type of malaria characterized by severe heat with mild chills or only heat without chills). In cases where Cold Damage has deteriorated into a complex condition (Huabing), and the previous heat has not subsided, yet cold pathogen is contracted again causing both Yin and Yang pulses to be full and vigorous, it also transforms into Warm Malaria. The symptoms manifest as alternating chills and fever.

For symptoms of bitter taste in the mouth and fullness/distension in the chest and hypochondrium, Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Shaoyao (Peony Root) and a small amount of Guizhi (Cinnamon Twig) is indicated. If heat predominates, double the dosage of Chaihu (Bupleurum Root); if cold predominates, double the dosage of Guizhi (Cinnamon Twig). If heat is extreme accompanied by irritability and thirst, Renshen Baihu Tang (Ginseng White Tiger Decoction) with a small amount of Bo Gui (Thin Cinnamon/Cassia Bark, here referring to Guizhi for its warming and transforming properties rather than strong heat) is indicated. If there is fever without chills, Guizhi (Cinnamon Twig) should not be used. If chills are present, a small amount of Guizhi (Cinnamon Twig) must be added as an adjunct. For cases with predominant heat, combining Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Baihu Tang (White Tiger Decoction) is indicated. For cases with excessive phlegm and heat, combining Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Er Chen Tang (Two-Cured Decoction) is indicated. If appetite is poor and stomach Qi is weak, add Baizhu (Atractylodes Macrocephala Rhizome); for epigastric fullness/stuffiness, add Zhishi (Immature Bitter Orange) and Huanglian (Coptis Rhizome); for deficient pulse, double the dosage of Renshen (Ginseng Root); for thirst, remove Banxia (Pinellia Tuber) and add Gualougen (Trichosanthes Root). If pathogenic heat accumulates internally with constipation and hard stools, and the pulse is slippery, large, and forceful, Da Chaihu Tang (Major Bupleurum Decoction) is used to purge. If the condition has already transformed into malaria, treatment should follow the principles for miscellaneous diseases.

If spring should be warm but turns cold, summer should be hot but turns cool, autumn should be cool but turns hot, and winter should be cold but turns warm, this represents having the qi of one season in another. Consequently, illnesses among people of all ages within a year tend to be similar; this is known as a seasonal epidemic (Shixing Yibing). According to *Shuowen Jiezi*, "when the people are all sick," it is called Yi (Epidemic), derived from the phonetic component Yi (Service/Labor), now simplified to Yi. *Erya - Shiming* states: "Li (Miasma/Pestilence) means grinding/sharpening." The pathogenic qi spreads and affects people like a whetstone injuring objects. "Yi" implies "Yi" (Service/Routine), suggesting the movement of spirits or forces that do not cease. Later authors named conditions such as Wen Yi (Warm Epidemic), Han Yi (Cold Epidemic), Shiqi (Seasonal Qi), and Datou Shanghan (Big Head Cold Damage), but these essentially all fall under the category of Yi (Epidemic). The common term Wenbing (Plague Disease) is an error for Wenbing (Warm Disease), leading to confusion between name and reality.

According to *Shanghan Li* (Example of Cold Damage): When the heat of Cold Damage has not subsided, encountering wind-cold-dampness again causes each to transform into a different disease. How could it become Warm? Since it is stated that encountering warmth again transforms it into Wendu (Warm Toxin), and encountering warm qi again transforms it into Wenyi (Warm Epidemic), this suggests that only the recurrence of warmth leads to two distinct diseases. Moreover, Yi (Epidemic) specifically refers to contracting non-seasonal qi, affecting everyone similarly. For instance, if winter should be cold but turns extremely warm, and people contract Dongwen (Winter Warmth) and fall ill, this is called Wenyi (Warm Epidemic). If spring and summer should be warm/hot but turn extremely cold, and people contract sudden cold and fall ill, this is called Hanyi (Cold Epidemic). Why wait for a second encounter with abnormal qi? The text mentions encountering warm qi again transforming into Wenpi (likely a typo for Yi/Epidemic), implying Cold Damage transforms due to a second encounter with abnormal qi. However, transformation due to a second encounter does not necessarily mean everyone gets the same illness, so how can it be called an epidemic? *Shanghan Li* states: "Yang pulse is soft and weak, Yin pulse is string-tight; this is the pulse of Wenyi (Warm Epidemic)." *Huangdi Bashiyi Nan Jing* (often referred to as *Huo Ren Shu* commentary contextually) annotates this pulse under the Dongwen (Winter Warmth) section, merging Wenyi and Dongwen into one disease. This is incorrect. Dongwen is specifically contracting non-seasonal qi, whereas Wenyi is Cold Damage encountering abnormal qi again. They cannot be merged. This principle is unclear, hence written for wise scholars to consider. I believe contracting warmth-heat leads to Wendu (Warm Toxin), and contracting warm qi leads to Wenyi (Warm Epidemic); there is a distinction in severity. The character "Yi" (Epidemic) is likely an error and should probably be "Ji" (Disease/Sickness). If it were "Yi", then how could Dongwen (Winter Warmth) involve a whole family being sick similarly? Only when a family or community shows similar contagious illness can it be termed an epidemic. Furthermore, this describes Cold Damage heat not subsiding, followed by contracting warm qi, which does not reach the level of familial contagion.

Wenyi (Warm Epidemic)
When the Yang pulse is soft and weak and the Yin pulse is string-tight, encountering warm qi again transforms it into Wenyi (Warm Epidemic). This is because winter injury by cold manifests as Wenbing (Warm Disease); the pulse changes and treatments are as previously described. (Cheng Wuji's annotation: The previous heat has not subsided, and warm qi is contracted again; warmth and heat combine to form Wenyi.)

Danxi: When everyone falls ill similarly, it is Tianxing Shiyi (Heavenly Movement Seasonal Epidemic). Some cases require tonification, some require dispersing, and some require descending.
Herbs: Dahuang (Rhubarb Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Renshen (Ginseng Root), Jiegeng (Platycodon Root), Fangfeng (Saposhnikovia Root), Huashi (Talcum), Xiangfu (Cyperus Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Renzhonghuang (Human Manure Cake). Processed into pills with Qu paste (fermented grain cake). Take 50-70 pills per dose, administered with decoctions based on Qi, Blood, or Phlegm differentiation. For Qi deficiency, administer with Sijunzi Tang (Four Gentlemen Decoction); for Blood deficiency, with Siwu Tang (Four Substances Decoction); for excessive phlegm, with Erchen Tang (Two-Cured Decoction); for severe heat, with child's urine mixed with the medicine.
Bencao (Commentary on Materia Medica): Fenqing (Feces Clear Liquid), bamboo juice from pale bamboo cut in December (removing green skin) treats Tianxing Rekuan (Heavenly Movement Fever/Mania), Reji (Heat Disease), poisoning, malignant sores, and mushroom toxicity. Soak soap pods and sugarcane in this juice to treat Tianxing Reji.
Danxi: Resolves all disasters/diseases. Use Fugan (Licorice Root) 5 liang, finely cut and lightly fried. Grind with unadulterated wine according to the patient's capacity. Strain and take warm. Profuse diarrhea will occur shortly, expelling toxins. Even if extremely thirsty, do not drink water; drinking makes rescue difficult.

Chaihu Shigao Tang (Bupleurum and Gypsum Decoction): Treats Shixing Wenyi (Seasonal Warm Epidemic), high fever, aversion to wind, headache, body ache, nasal congestion, dry throat, chest/epigastric irritability/fullness, alternating chills and fever, phlegm-solid cough, thick sticky sputum/nasal discharge.
Ingredients: Chaihu (Bupleurum Root), Shigao (Gypsum Fibrosum), Chishao (Red Peony Root), Qianhu (Peucedani Radix), Gan Ge (Puerariae Radix) [15 liang each]; Shengma (Cimicifugae Rhizoma) [25 liang]; Huangqin (Scutellaria Root), Sangbai (Mori Cortex) [37.5 liang each]; Jingjie Sui (Schizonepeta Spike) [37 liang]. Crush herbs. Take 5 qian per dose with 1 cup water, 3 slices ginger, >10 fermented soybeans. Decoct to 70%, strain, and take hot. Children divide into three doses, adjusting for size/age. Time不限. These three formulas suit cases with predominant heat and interior involvement. Note: Treatment of Wenyi is similar to Yang-pattern Cold Damage. However, the classic "Wenyi" refers to Wenbing (Warm Disease); refer to Wenbing sections.

Hanyi (Cold Epidemic)
*Huo Ren Shu* says: Illnesses occurring within a year where old and young are uniformly affected constitute the Qi of Seasonal Movement, commonly called Tianxing (Heavenly Movement). Laojun Shenming San, Wuchengzi Yinghuo Wan, Shengsanzi, and Baidu San can be used regardless of duration or depth, employing emesis or purgation as indicated. Thus, Shengsanzi does not distinguish between Yin/Yang or Exterior/Interior.

Laojun Shenming San
Baizhu (Atractylodes Macrocephala Rhizome) 1 qian, Jiegeng (Platycodon Root) 2.5 qian, Fuzi (Prepared Aconite Lateral Root) [processed], Xixin (Asarum Root) [1 liang each], Wutou (Aconitum Carlexicum Root) [4 liang, processed]. Coarsely powder the five herbs. Sew into silk bags to wear. If no disease prevails in the neighborhood, good. If epidemic occurs, take 1 fangcun bi (square inch measure) with warm wine, cover to induce sweat. Vomiting indicates recovery. If 3-4 days have passed, take 3 cun bi, boil in 1 bowl water until boiling vigorously, divide into three doses.

Shengsanzi
Preface by Su Neihan found in *Huo Ren Shu*. During toxic epidemics, use Shengsanzi without distinguishing Yin/Yang patterns. Continuous administration leads to recovery; it cannot be compared to Cold Damage. During epidemic outbreaks, boil a pot at dawn. Regardless of age/status, each takes one cup, preventing seasonal qi invasion.
Ingredients: Caodoukou (Cardamom Seed), Zhuling (Polyporus), Shichangpu (Acorus Rhizome), Fuling (Poria), Liangjiang (Galangal Rhizome), Duohuo (Angelica Pubescens Root), Fuzi (Prepared Aconite), Mahuang (Ephedra Herb), Houpo (Magnolia Bark), Bencao (Ligusticum Rhizome), Shaoyao (Peony Root), Zhiqiao (Aurantii Fructus), Chaihu (Bupleurum Root), Zexie (Alisma Rhizome), Xixin (Asarum Root), Fangfeng (Saposhnikovia Root), Baizhu (Atractylodes Macrocephala Rhizome), Huoxiang (Pogostemon Herb), Banxia (Pinellia Tuber), Wuzhuyu (Evodia Fruit), Cangzhu (Atractylodes Lancea Rhizome), Gancao (Licorice Root) [0.5 liang each]. Crush herbs. Take 5 qian with 1.5 cups water, decoct to 80%, strain, take hot. Re-boil dregs, take on empty stomach. These two formulas suit Cold Epidemic with exterior predominance. Note: Hanyi patterns must align with Yin-pattern Cold Damage to justify prior hot herbs. Claiming efficacy regardless of Yin/Yang or Exterior/Interior is false. Blind faith in Su Dongpo led to many deaths via Shengsanzi. Caution is essential!

Wu: Hanyi (Cold Epidemic) is caused by sudden cold heaven-sent. Throughout the four seasons, if sudden cold/wind strikes and illness follows immediately, it is Hanyi. Symptoms resemble Zheng Shanghan (Typical Cold Damage) but are milder. Treatment: If initial headache, increased chills, stiffness, nausea/vomiting, epigastric stuffiness, food stagnation, or abdominal pain without fever, use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with minor modifications. If fever has appeared, use Shiwei Xiong Su San (Ten-Ingredient Cyperus and Perilla Powder) to induce sweating. If body/joint pain with fever, use Renshen Qianghuo San (Ginseng and Notopterygium Powder) plus Congbai (Green Onion White), Gegen (Pueraria Root), Shengjiang (Fresh Ginger) to sweat. Shenzhu Tang is also acceptable. If spontaneous sweating exists, avoid further sweating; use Jiwei Qianghuo Tang instead. If heat persists or transforms, follow Zheng Shanghan protocols.

Pang: *Bingyuan* records: After Lichun (Start of Spring), without sudden severe cold or ice/snow, if people have high fever, this is Chunshi Yangqi Fa Wai (Spring Yang Qi emerging externally), transforming Dongshi Fuhan (Winter latent cold) into Wenbing (Warm Disease). From Chunfen (Spring Equinox) to Qiufen (Autumn Equinox), sudden cold constitutes Shixing Hanyi (Seasonal Cold Epidemic). March-April sudden cold: Yang Qi is weak, suppressed by cold, fever is mild. May-June: Yang Qi is strong, suppressed by cold, fever is severe. July-August: Yang Qi declines, suppressed by cold, fever is slight. Illness resembles Wenbing/Shubing (Summer Heat Disease) but treatment differs. Initial treatment: Massage oils, moxibustion, acupuncture for dispersion/sweating. If unresolved after 2 days, needle. If still unresolved after 3 days, re-sweat. If profuse sweating fails, do not re-sweat. Day 4: Licilu Wan (Veratrum Pill) for mild vomiting. If no vomit, Chixiaodou Guiti San (Adzuki Bean and Melon Peduncle Powder) to vomit. If resolved but incomplete, needle again. Day 6: Heat enters Stomach, use Jizi Tang (Chicken Egg Decoction) to purge. Success rate high. Observe timing carefully. Food stagnation with fever/headache requires rapid purging. Seasonal illness waits 6-7 days to purge. Pathogen progression: Day 1 Skin, Day 2 Dermis, Day 3 Muscle, Day 4 Chest, Day 5 Stomach (then purge). Purging internal heat while external heat enters void causes Stomach rot and macules. Red macules: 5 die, 1 lives. Black macules: 10 die, 1 lives. Depends on strength. Delayed purging causes Stomach rot/macules. If no fever but delirium, restlessness, loss of mental control, treat within Shuiwu Ling San pattern. This is recorded by Chao Yuanfang. Note: Pang's view on Hanyi similarity to Wenbing/Shubing but different treatment is valid. Wenbing lacks massage/moxa; Dongwen has sores/pox; Four Seasons Zang-Fu Yin-Yang Poisons; Summer Heat after Solstice involves 5 heat diseases using cooler meds, hence different treatment.

Cui Wenxing Jie San (Dispersion Powder): Treats Shiqi Buhe (Seasonal Qi Disharmony) and Shanghan Fever.
Jiegeng (Platycodon Root), Xixin (Asarum Root) [4 liang each], Baizhu (Atractylodes Macrocephala Rhizome) [8 liang], Wutou (Aconitum Carlexicum Root) [1 jin]. Fine powder. For Shanghan, take 1.5 qian/bi; increase slightly if ineffective until cured. For Shiqi Buhe, take 1.5 qian/zhu bi to repel evil/save patients. One dose suffices. Universal for Shixing Hanyi. Prophylactic use with wine is best for repelling cold.

Licilu San (Veratrum Powder): Repels Wenyi (Warm Epidemic) (i.e., Qianjin Chisan).
Licilu (Veratrum Album Rhizome), Zhizhu (Daphne Genkwa Flower), Jiangjiang (Dried Ginger) [1 liang each]; Mudanpi (Moutan Cortex), Zaojiao (Gleditsia Sinensis Spine/Fruit) [1.6 zhu each]; Xixin (Asarum Root) [18 zhu]; Fuzi (Prepared Aconite), Guizhi (Cinnamon Twig), Zhusha (Cinnabar) [6 liang each, separately ground]. Powder, place 1 fangcun bi in crimson bag, wear on left arm (men) or right arm (women). Detects impending illness...

Chixiaodou Guiti San (See Formula)
Jizi Tang (Chicken Egg Decoction): Treats Shiqi Resheng (Seasonal Qi Excessive Heat), delirium, restlessness.
Raw Chicken Egg (7), Mangxiao (Natrii Sulfas) [1 liang]. Mix in 1 sheng well water, stir 1000 times, skim foam, take in one dose. Stop when loose stool occurs.

Imperial Methods
Xionghuang Wan (Realgar Pill): Prevents epidemic transmission.
Xionghuang (Realgar) [1 liang, ground], Chixiaodou (Adzuki Bean) [fried], Danshen (Salvia Root), Guijianyu (Cornus Branch) [2 liang each]. Honey-pill size of paulownia seed. Take 5 pills on empty stomach with warm water daily. Safe even sharing clothes/bedding with patients.

Huo: Wuchengzi Yinghuo Wan (Wuchengzi Firefly Pill): Repels epidemic diseases, foul qi, ghosts, tigers, wolves, snakes, insects, weapons, blades, thieves, misfortune.
Yinghuo (Firefly), Guijianyu (Cornus Branch) [1 liang each]; Xionghuang (Realgar), Cihuang (Orpiment) [2 liang each]; Fanshi (Alumen) [1 liang, calcined]; Lingyangjiao (Antelope Horn), Guihui (Tortoise Ash), Tiechuibing (Iron Hammer Handle tip, burnt) [1.5 liang each]. Nine ingredients powdered. Mix with egg yolk and rooster comb. Form triangular crimson bags containing 5 pills. Wear on left arm or hang at door.

Formulas to Prevent Epidemic Transmission
Grind Xionghuang (Realgar) with water, apply to nose. Or wrap 5 qian Ming Xionghuang (Clear Realgar) in silk, tie to top of head. Alternatively, apply fine sesame oil to nose.
Alternatively, crush insects from peach leaves, mix with cool water, ingest.
Alternatively, soak Chixiaodou (Adzuki Bean) with glutinous rice in water vat, use water daily.
Alternatively, soak Guanzhong (Cyrtomium Rhizome) in water, use.

Four Seasons Non-Seasonal Qi
Shiqi (Seasonal Qi) refers to heavenly epidemic virulent qi circulating. Abnormal seasonal commands generate this qi. Contracting it causes similar illnesses across ages and contagion. It resembles Shanghan (Cold Damage) but originates from Yi Qi (Epidemic Qi), not cold; thus, not discussed together. Treatment focuses on dispelling epidemic qi and supporting healthy Qi. If heat persists/transmits over days, follow Shanghan Bianzheng (Cold Damage Transformation Patterns) guidelines. Dispersing herbs differ. Options include Huoxiang Zhengqi San, Xiong Zhi Xiang Su San, Shishen Tang, Renshen Baidu San, Shiwei Xiong Su San, etc.

Chunwen (Spring Warmth)
*Huo Ren* says: Spring should be warm; if clear qi is suppressed, pathology lies in Liver. Symptoms: fever, headache, vertigo, vomiting, similar across ages. Use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction), Jieji Tang (Release Muscle Decoction), or Baidu San universally.
Tao says: Post-Chunfen to Pre-Xiazhi, no aversion to cold but thirst indicates Wenbing (Warm Disease). Use acrid-cool herbs to mildly release muscle; avoid heavy sweating. Interior signs require cold-cool herbs to purge urgently; avoid erroneous sweating/purging. Recognize that exterior patterns differ from Zheng Shanghan and interior treatments.

Xiawen (Summer Warmth)
*Huo Ren* says: Summer should be hot; if cold qi suppresses, pathology lies in Heart. Symptoms: fever, headache, abdominal fullness, spontaneous diarrhea, similar across ages. Use Lizhong Tang (Regulate Middle Decoction), Shegan Tang (Belamcanda Decoction), Banxia Gancao Tang (Pinellia and Licorice Decoction).
Tao says: Post-Xiazhi, headache/fever, no aversion to cold but thirst is Wenbing (Warm Disease); more severe is Rebings (Heat Disease). Use acrid-cool herbs to release muscle; avoid heavy sweating. Interior signs require urgent purging. Exterior patterns differ from Zheng Shanghan; interior treatment is same.

Qiuwen (Autumn Warmth)
*Huo Ren* says: Autumn should be cool; if great heat suppresses, pathology lies in Lung. Damp-heat interaction causes Dan disease (jaundice/yellowing), cough, wheezing. Use Jinfei Cao San (Boiling Herb Powder), Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Decoction). For jaundice, use Yinchin Wuling San (Artemisia Capillaris Five-Ingredient Powder).
Tao says: Post-Qiu to Frost Descent, headache/fever, no aversion to cold, body ache, short urine indicates Shibing (Damp Disease). Use acrid-cool herbs with drying agents to release muscle; avoid sweating. Interior signs require purging. Exterior patterns differ from Zheng Shanghan.

Dongwen (Winter Warmth)
*Huo Ren* says: Winter should be cold; if great warmth suppresses, pathology lies in Kidney. Use Weirui Tang (Polygonatum Decoction).
Danxi says: Dongwen arises from non-seasonal qi. In deep winter, gentlemen should conserve; outward emission occurs. Use tonics with exterior-releasing herbs.
Ren Zhonghuang Formula: Bamboo tube with nodes intact, hole drilled, fill with Gancao (Licorice Root), plug with bamboo/wood nail. Place in manure pit in winter for one month, dry. Treats Wendu (Warm Toxin). Use alone with tonic/exterior herbs.
*Huo Ren* cites Zhang Zhongjing: Dongwen toxin differs greatly from Shanghan. Shanghan results from cold qi; Dongwen from warm qi; Hanyi from sudden cold oppression (not mere exposure). Treatments differ. Cold/Hot/Warm/Cool agents vary. Do not fixate on days; sweat/vomit/purge as indicated. Principle: Treat heat with cold (administer warm); treat warmth with cool/cold; treat cold with hot (administer cool); treat cool with warm/hot. Aim for balance; do not exceed. This is the major method.

Shenxiao Woxue Tang (Miraculous Snow-Melting Decoction) (Appendix): Treats undifferentiated Yin/Yang Shanghan and transmitted epidemic foul qi. Effect like pouring soup on snow. Efficacy incalculable.
Cangzhu (Atractylodes Lancea Rhizome, firm, roasted/scraped), Jiangjiang (Dried Ginger, roasted), Gancao (Licorice Root, honey-fried) [6 liang each]; Houpo (Magnolia Bark, peeled/ginger-processed), Fangfeng (Saposhnikovia Root, tender), Baishaoyao (White Peony Root, peeled), Gan Ge (Pueraria Root) [4 liang each]. Crush herbs. Take 4 qian with 2 zhong water, decoct to 1 zhong, strain, take hot anytime. Shortly after, eat ginger/scallion soup. Avoid wind/rest quietly. Mild perspiration indicates cure. If epidemic spreading, take one dose at dawn. Maintenance: 2 qian with 1 cup water, decoct to 80%.