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Question: How did the term "Shanghan" (Cold Damage) originate?
Wang Shuhe, in compiling Zhang Zhongjing's writings, stated: During winter, the cold is severe, and all things are deeply hidden. A gentleman who maintains strict protection will not be injured by cold. Those who are exposed to it are said to have contracted Shanghan. Exposure to the Qi of the four seasons can cause illness. Shanghan is considered the most toxic because it embodies the most fierce and killing Qi.

Question: Why is Shanghan also called "Rebing" (Heat Disease)?
Suwen (Plain Questions), Chapter 31 states: Rebing (Heat Disease) belongs to the category of Shanghan.
It further states: When a person is injured by cold, they develop a febrile disease. Therefore, Suwen refers to it as Rebing. In Chapter 32, there are names for Liver Heat Disease, Heart Heat Disease, Spleen Heat Disease, Lung Heat Disease, and Kidney Heat Disease, along with their symptoms and acupuncture treatment methods.

Question: Why is it said that "Shanghan has five types"?
Nanjing (Classic of Difficult Issues), Chapter 58 states: Shanghan has five types: Zhongfeng (Wind Strike), Shanghan (Cold Damage), Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing (Warm Disease). Why does one etiology have five names?
Guo Yong stated: All these diseases result from injury by cold, and their manifestation as heat is consistent. However, the five names arise from the variations of the four seasons. In winter, there are two patterns: Wind-Cold. Thus, in winter, it is called Zhongfeng or Shanghan; in spring, it is called Wenbing; in summer, it is called Shubing (Summerheat Disease), also known as Rebing; in autumn, it is called Shiwen. These all result from secondary exposure to the abnormal Qi of the four seasons, hence the different names. Generally speaking, they are all called Shanghan or Rebing. Therefore, Wang Bing's assertion that their onset is caused by Shanghan is correct. They are called Rebing because their symptoms are all characterized by heat.

Question: Why is it called Wenbing (Warm Disease)?
Suwen, Chapter 3 states: If one is injured by cold in winter, one will inevitably suffer from Wenbing in spring. Thus, Wang Shuhe relayed Zhang Zhongjing's words: If illness occurs immediately after exposure, it is named Shanghan. If it does not occur immediately, the cold toxin hides in the skin and muscles, transforming into Wenbing in spring and Shubing in summer. Shubing involves heat that is more intense than that of Wenbing. Therefore, hardworking people often suffer from warm-heat diseases in spring and summer, caused by exposure to cold in winter, not by the Qi of epidemic spread (Shixing Zhi Qi). The Rebing mentioned in Suwen refers to diseases of the four seasons, all characterized by heat. Later generations called Shubing "Rebing" because the Qi of summer is the hottest among the four seasons.

Question: What is the Qi of Epidemic Spread (Shixing Zhi Qi)?
Wang Shuhe relayed Zhang Zhongjing's words: Yin-Yang Da Lun (Great Treatise on Yin and Yang) states: Spring Qi is mild, Summer Qi is hot, Autumn Qi is cool, and Winter Qi is icy. This is the order of the righteous Qi of the four seasons. If spring should be warm but is instead severely cold, summer should be hot but is instead severely cool, autumn should be cool but is instead severely hot, or winter should be cold but is instead severely warm, this is an occurrence of climate out of season. When people contract this non-seasonal Qi, throughout the year, the illnesses affecting both young and old tend to be similar. This is the Qi of Epidemic Spread.

Question: What does Suwen mean by the alternating injury of the Five Zang organs by the Qi of the four seasons?
Zhang Zhongjing and Wang Shuhe stated: Climate may fail to arrive when expected, arrive early when not expected, or arrive excessively. All these form pathogenic Qi, which is also a type of epidemic spread.
Guo Yong stated: Chao Yuanfang in *Zhubing Yuanhou Lun* (Source Book of Diseases and Syndromes) categorized Shanghan, Shiqi (Seasonal Qi), Wenbing, and Rebing into four types: Shanghan corresponds to winter, Shiqi corresponds to epidemics, Wenbing corresponds to spring, and Rebing corresponds to summer. Although each contains dozens of manifestations, their syndrome differentiation and treatment are not far apart.

Question: Do ancient texts refer to the phenomenon where everyone gets the same disease in a given year as "Shixing"?
Guo Yong stated: This was called "Sui Lu" (Annual Dew/Exposure) in ancient times. "Shixing" refers to contracting disease due to the loss of seasonal harmony. Why is it called "Sui Lu"? Lingshu (Spiritual Pivot), Chapter 79 states: On the day of Winter Solstice, wind and rain coming from the south are called "Xu Feng" (Empty Wind), which are harmful winds. If they arrive at midnight, people are asleep and avoid them, so fewer people get sick that year. If they arrive during the day, people are lax and susceptible, leading to widespread illness. This is what Huangdi referred to as the reason why everyone gets the same disease in a year. This is distinct from contracting disease due to loss of seasonal harmony, hence it is specifically called "Sui Lu".

Question: What is the difference between Shanghan and Sui Lu?
Guo Yong stated: Sui Lu refers to treacherous winds and empty pathogens. Shanghan contracted due to Sui Lu is severe and often fatal. Shanghan contracted due to the imbalance of cold and warmth in the four seasons is milder and less likely to be fatal. Ancient texts discussed Sui Lu, but from Bian Que (Yue Ren) and Zhang Zhongjing onwards, it was no longer mentioned. Even today, those who die from encountering Sui Lu are not distinguished by society and are simply called to have suffered from Shanghan or Shixing.

Question: Some consider Shanghan and Wenyi (Warm Pestilence) to be identical. What is your view?
Sun Simiao stated: *Duanju* records: It was traditionally believed that Shanghan is a difficult-to-treat disease, while Shixing Wenyi is a disease of toxic vapors. However, in discussing treatment, distinctions were not made between the Qi of Shanghan and Shixing Wenyi. It was said that "Shanghan" is a refined term used by scholars, while "Tianxing Wenyi" is a colloquial term used by commoners, without clarifying the differences in the diseases. Examining various classics reveals significant differences. Since the diseases differ, the formulas and theories must be distinguished. Therefore, I briefly outline the essentials.

Question: Why is Shanghan referred to as "Zubing" (Sudden Disease)?
Guo Yong stated: There is no such theory. Zhang Zhongjing wrote in his preface: He compiled the *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases) into sixteen volumes. However, the title was mistakenly written as "Zubing." Later scholars followed this error, even claiming that death could occur within six or seven days, thus calling it Zubing. This explanation is incorrect. Due to laziness in copying ancient texts, characters were often abbreviated. For example, "Shu" (book) might combine two characters, "Za" (miscellaneous) might be written as "Shu," or further abbreviated to "Zu." Thus, "Zubing" actually refers to "Zabing" (Miscellaneous Diseases). When Liu Xiang of the Han Dynasty collated secret imperial books, he noted instances like writing "Zhao" as "Xiao" or "Qi" as "Li," resulting from character abbreviation. This is no different from mistaking "Zabing" for "Zubing." Currently, ten volumes of *Shanghan Lun* remain, while the *Zabing Lun* has been lost.