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I have received an email that begun with this:

その後、お元気にお過ごしですか。

My immediate thought was その後ってどの後, after which I proceeded to be further confused by the rest of the sentence. I'm guessing it means something like "How have you been (since I last sent you an email)", but the lack of a past tense throws me off.

What does this mean and what would be a polite response to it? And if it does refer to the past, why is there no past tense?

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"How have you been" is not a past tense either, it's called "present perfect". As well as the English translation, the original sentence is referring to the present state that is a consequence of the event (その as in その後). That's why it's not a past tense.

As for how to response to it, I'd recommend おかげさまで 元気です. When you somehow don't want to reply positively, おかげ様と言いたいところですが、あまり調子がよくありません could work, though I don't hope you use it.

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