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Q: In the context of cold damage (Shanghan), when the three Yang meridians are affected, what is the pattern of transmission? The *Suwen* (Plain Questions), Chapter 31, states: On the first day of cold damage, the Taiyang meridian (Foot-Taiyang Bladder Meridian) is affected, resulting in headache, stiffness of the neck and occiput, and rigidity of the lower back and spine. On the second day, the Yangming meridian (Foot-Yangming Stomach Meridian) is affected. Since Yangming governs the flesh, and its channels run alongside the nose and connect to the eyes, symptoms include fever, eye pain, dryness of the nose, and inability to lie down comfortably. On the third day, the Shaoyang meridian (Foot-Shaoyang Gallbladder Meridian) is affected. As Shaoyang governs the Gallbladder, and its channels follow the hypochondrium and connect to the ears, symptoms include pain in the chest and hypochondrium, and deafness. If the channels of the three Yang meridians are all affected by the pathogen, but the disease has not yet entered the Zang organs, it can be cured by inducing sweating (Diaphoresis).

Q: When the three Yin meridians are affected, what is the pattern of transmission? The *Suwen* states: On the fourth day, the Taiyin meridian (Foot-Taiyin Spleen Meridian) is affected. Its channels distribute in the stomach and connect to the throat, causing abdominal fullness and dryness of the throat. On the fifth day, the Shaoyin meridian (Foot-Shaoyin Kidney Meridian) is affected. Its channels pass through the kidney, connect to the lungs, and attach to the root of the tongue, causing dry mouth, dry tongue, and thirst. On the sixth day, the Jueyin meridian (Foot-Jueyin Liver Meridian) is affected. Its channels encircle the genitalia and connect to the liver, causing mental restlessness, fullness, and retraction of the scrotum.

Q: Can the Shaoyin stage be treated with purgation? Zhang Zhongjing states: When the three Yin meridians are all affected and the pathogen has entered the Fu organs, it can be cured by purgation (Purgative Therapy).

Q: Are the methods of sweating or purgation determined by the meridian involved or by the number of days since onset? Guo Yong states: The number of days corresponds to the meridians. Generally, disease acquisition follows both regular patterns and variations. If the meridian involved does not correspond to the day count, it represents a variation. Following the regular pattern makes treatment easier; dealing with variations makes understanding more difficult. However, variations should be judged based on symptoms, while regular patterns can be inferred from the day count. Therefore, the *Suwen* further states: If the duration is less than three days, sweating may be used; if it is three days or more, purgation may be used. This refers to the standard approach.

Q: Why do medical classics state that death often occurs between the sixth and seventh days? Guo Yong states: By the sixth or seventh day, the transmission has covered all meridians, and both Yin and Yang qi are affected. Thus, severe cases result in death. The *Suwen* states: When the three Yin and three Yang meridians, along with the five Zang and six Fu organs, are all affected, and the Ying (Nutritive) and Wei (Defensive) qi cease to circulate, death occurs due to the blockage of the five Zang organs. This is exactly what is meant. Therefore, the classics also state: The method of treatment is to unblock the channels of each organ. Once unblocked, the disease will decline. Conversely, if the five Zang organs remain blocked, death ensues; if their channels are unblocked, the disease declines.

Q: Why do medical classics state that recovery usually takes ten days or more? Guo Yong states: This refers to cases where cold damage follows the regular pattern without variation. The *Suwen* states: For those not suffering from simultaneous contraction of cold (Lianggan Yu Han), on the seventh day, the Taiyang disease begins to recede, and the headache slightly improves. On the eighth day, the Yangming disease recedes, and body heat slightly subsides. On the ninth day, the Shaoyang disease recedes, and hearing slightly returns. On the tenth day, the Taiyin disease recedes, abdominal fullness subsides to normal, and appetite returns. On the eleventh day, the Shaoyin disease recedes, thirst stops, abdominal distension ceases, tongue dryness resolves, followed by sneezing. On the twelfth day, the Jueyin disease recedes, the scrotum relaxes, lower abdominal tension slightly eases, and the vital qi is completely expelled, leading to daily improvement. This is why recovery typically occurs after ten days. (Zhang Zhongjing notes: Below "thirst stops on the eleventh day," there is no mention of "no abdominal distension"; below "vital qi is expelled on the twelfth day," there is a description of "the patient's spirit being clear and bright.")

Q: What if the patient does not recover after twelve days? Zhang Zhongjing states: If more than thirteen days have passed without intermittent relief, and both the Cun (Inch) and Chi (Cubit) pulses are sunken and imperceptible, the condition is critical. If the patient contracts another pathogen, transforming into a different disease, treatment should follow the protocols for complicated diseases (Huaibing). If the pulse shows excess in both Yin and Yang positions, and the patient contracts cold again, it transforms into Warm Malaria (Wen Nue); if the Yang pulse is floating and slippery, and the Yin pulse is soggy and weak, and wind is encountered again, it transforms into Wind-Dampness; if the Yang pulse is surging and rapid, and the Yin pulse is solid and large, and warm-heat is encountered again, it transforms into Warm-Toxicity, which is the most severe condition; if the Yang pulse is soggy and weak, and the Yin pulse is string-tight and fast, and warm qi is encountered again, it transforms into Warm Epidemic (Wen Yi). This arises because winter cold damage manifests as Warm Disease later. The pulse changes, syndromes, and formulas are as described above. (Pang Anchang suggests that Wen Yi should be understood as Damp-Warmth.)

Q: On the first day of cold damage, the Taiyang meridian is affected. (Wang Bing notes: Ju means great/large.) Why is it called "Ju Yang"? The *Suwen* states: Ju Yang is the leader of all Yang meridians (all Yang meridians belong to it). Its channels connect to the Fengfu point (GV16), making it the master of Qi for all Yang meridians. The *Ping Re Lun* also states: Ju Yang governs Qi, so it is the first to be attacked by pathogens.

Q: What is "simultaneous contraction of cold" (Lianggan Yu Han)? The *Suwen* states: When humans contract cold, they develop febrile disease. Even if the fever is severe, death does not necessarily follow. However, those who suffer from simultaneous contraction of cold will inevitably die. On the first day, Taiyang and Shaoyin are both affected, causing headache, dry mouth, and mental restlessness/fullness. On the second day, Yangming and Taiyin are both affected, causing abdominal fullness, body heat, anorexia, and delirious speech. On the third day, Shaoyang and Jueyin are both affected, causing deafness, scrotal retraction, and cold limbs, inability to take food or fluids, and unconsciousness. Death occurs on the sixth day.

Q: The *Suwen* also mentions death on the third day. Why? Guo Yong states: This refers to the death on the sixth day mentioned earlier. Why? In simultaneous contraction of cold, both Yin and Yang, exterior and interior meridians transmit simultaneously. By the third day, the transmission through the six meridians of Yin and Yang is complete. At this time, the patient cannot take food or fluids and is unconscious. The five Zang organs are fully damaged, the six Fu organs are blocked, and Ying and Wei qi have lost sensation. After this state persists for three more days, death occurs. The Emperor had doubts, hence the repeated inquiry. Qibo replied: At this time, the Qi of the Yangming meridian has not yet completely exhausted, so death occurs three days later. Thus, the text says: Yangming is the head of the twelve meridians, possessing abundant blood and Qi. Therefore, even when unconscious, it takes three days for its Qi to exhaust, leading to death. Unconsciousness is a sign of simultaneous contraction of cold and transmission of Yin and Yang on the third day. Yangming, as the head of the meridians, has abundant blood and Qi to nourish the other meridians. The blood and Qi that have already dispersed into the other meridians dissipate as their respective meridians fail. The blood and Qi remaining in Yangming require another three days to exhaust. Thus, we know that on the sixth day, the first three days cover the transmission through Yin and Yang meridians, and the next three days exhaust Yangming Qi, totaling six days. Scholars who read the classics mistakenly believe that death on the sixth day is due to a second round of transmission through Yin and Yang; if Yin and Yang could still transmit, death would not occur. The theory of death on the third day posits that Yangming blood and Qi exhaust due to the pathogen, which contradicts the six-day theory and is significantly erroneous.

Q: Why does cold damage transmit only through the Foot Yin and Yang six meridians? Sun Simiao states: Humans have five Zang organs. The channels of the Heart and Lung originate in the ten fingers of the hands. The channels of the Liver, Kidney, and Spleen originate in the ten toes of the feet. Pathogenic wind-toxin originates from the earth. The cold, heat, wind, and dampness of the earth transform into vapors. The feet constantly tread upon the ground, so when people are afflicted, it is always through the feet. Guo Yong states: This is Sun Simiao’s theory regarding wind-toxin. The mechanism of contracting cold damage is no different.

Q: In cold damage affecting the three Yang meridians, can transmission be observed? Zhang Zhongjing states: On the first day of cold damage, the Taiyang meridian is affected. If the pulse is calm, it indicates no transmission. If the patient frequently desires to vomit, or is restless and irritable, and the pulse is rapid and urgent, it indicates transmission. He also states: On the second or third day of cold damage, if Yangming and Shaoyang syndromes do not appear, it indicates no transmission.

Q: Can transmission in the three Yin meridians be observed? Zhang Zhongjing states: On the third day of cold damage, the pathogen in the three Yang meridians is exhausted, and the three Yin meridians should be affected. If the patient can eat and does not vomit, it indicates that the three Yin meridians are not affected by the pathogen. If not affected, there is no transmission.

Q: Which Zang and Fu organs do the six meridians belong to? Guo Yong states: The Foot-Taiyang meridian belongs to the Bladder; the Foot-Yangming meridian belongs to the Stomach; the Foot-Shaoyang meridian belongs to the Gallbladder. These three Fu organs are Yang. The Foot-Taiyin meridian belongs to the Spleen; the Foot-Shaoyin meridian belongs to the Kidney; the Foot-Jueyin meridian belongs to the Liver. These three Zang organs are Yin. Yang represents the Exterior, and Yin represents the Interior. Therefore, Foot-Taiyang and Foot-Shaoyin are exterior-interior pairs (Bladder and Kidney); Foot-Yangming and Foot-Taiyin are exterior-interior pairs (Stomach and Spleen); Foot-Shaoyang and Foot-Jueyin are exterior-interior pairs (Liver and Gallbladder).

Q: I wish to hear about the origins of the six meridians. Guo Yong states: They originate from the *Lingshu*, but detailed explanation is beyond the scope here. One may refer to Zhu’s *Huoren Shu*. It briefly states: The Foot-Taiyang Bladder meridian originates at the inner canthus of the eye, ascends to the head, connects to the Fengfu point (GV16), divides into four pathways, descends the neck, and runs along the back with the main and branch channels (six paths total), serving as the meridians of the body. The Taiyang meridian is the master of Qi for all Yang meridians. If attacked by cold pathogens, it must cause fever and aversion to cold. Since the head, neck, waist, and spine are areas traversed by the Foot-Taiyang meridian, symptoms such as headache, neck/back stiffness, and body ache, accompanied by floating pulses at Cun, Guan, and Chi positions, indicate Taiyang meridian involvement. This is a general overview.

Q: How about the Yangming meridian? Zhu states: The Foot-Yangming Stomach meridian originates at the nose, runs alongside the nose, connects to the eyes, descends through the pharynx, divides into four pathways, and runs up and down the abdomen with the main and branch channels (six paths total), providing structural support to the body. Since all Yang meridians are in the exterior, and Yangming governs the muscles and connects to the nose, patients exhibit fever, eye pain, nasal dryness, and insomnia. If the pulses at Cun, Guan, and Chi are long, it indicates Yangming meridian involvement.

Q: How about the Shaoyang meridian? Zhu states: The Foot-Shaoyang Gallbladder meridian originates at the outer canthus of the eye, connects to the ears, divides into four pathways, descends to the clavicular fossa (Quepen), follows the hypochondrium, and runs up and down with the main and branch channels (six paths total), governing the joints and circulating Qi through the three sectors. Patients present with chest/hypochondriac pain and deafness, or bitter taste, dry throat, alternating chills and fever, and vomiting. If the pulses at Cun, Guan, and Chi are wiry, it indicates Shaoyang meridian involvement.

Q: How about the Taiyin meridian? Zhu states: The Foot-Taiyin Spleen meridian is the head of the three Yin meridians. Its channels distribute in the spleen and stomach and connect to the throat. Patients present with abdominal fullness and dry throat. If the pulses at Cun, Guan, and Chi are deep and fine, it indicates Taiyin meridian involvement.

Q: How about the Shaoyin meridian? Zhu states: The Foot-Shaoyin Kidney meridian originates below the little toe, slants toward the center of the foot, with a branch entering the heel, ascending to the posterior medial aspect of the thigh, passing through the kidney, and connecting to the bladder. The straight branch ascends from the kidney through the liver and diaphragm, enters the lungs, and attaches to the root of the tongue. Heat pathogens enter the Zang organs and flow into the Shaoyin meridian. Shaoyin governs the Kidney, which dislikes dryness, leading to thirst and desire to drink. Additionally, after sweating, vomiting, or purging, the Zang-Fu organs are empty, and body fluids are depleted; residual heat in the Kidney also causes thirst. Thus, patients present with dry mouth, dry tongue, and thirst. If the pulses at Cun, Guan, and Chi are deep, it indicates Shaoyin meridian involvement.

Q: How about the Jueyin meridian? Zhu states: The Foot-Jueyin Liver meridian. "Jue" means exhaustion. The *Lingshu* states that Hai hour corresponds to the left Foot-Jueyin, and Xu hour to the right Foot-Jueyin. With both Yin energies exhausted, it is called Jueyin. Exhaustion of Yin is associated with the dark moon (Hui), emergence of Yin with the new moon (Shuo). Jueyin signifies the exhaustion of Yin. Its channels encircle the genitalia and connect to the root of the tongue. If the channels do not nourish, tendons become tight, pulling the tongue and testicles, resulting in cyanotic lips, curled tongue, and scrotal retraction. When patients present with mental restlessness/fullness and scrotal retraction, and the pulses at Cun, Guan, and Chi are faint and slow, it indicates Jueyin meridian involvement.

Q: What are the pulse characteristics of the six meridians? Zhang Zhongjing states: Floating pulses at Cun, Guan, and Chi indicate Taiyang involvement; Long pulses indicate Yangming involvement; Wiry pulses indicate Shaoyang involvement; Deep and Fine pulses indicate Taiyin involvement; Deep pulses indicate Shaoyin involvement; Faint and Slow pulses indicate Jueyin involvement.

Q: What is the meaning of Yangming and Jueyin? The *Suwen*, Chapter 74, asks: What is meant by Yangming? Qibo answers: The combination of two Yangs. What is meant by Jueyin? Qibo answers: The intersection and exhaustion of two Yins.