Library

The treatment principles of Shanghan (Cold Damage), if one grasps the general outline, are as easy as picking up a mustard seed. If one seeks complexity in many divergent paths, the result will be fragmented and broken, like trying to find a ferry crossing while wading through the sea.

It essentially comes down to pulse diagnosis, symptoms, and medical theory. In Shanghan disease, pulses that are Floating (Fu), Large (Da), Moving (Dong), Rapid (Shu), or Slippery (Hua) are considered Yang pulses; those that are Deep (Chen), Choppy (Se), Weak (Ruo), Wiry (Xian), or Minute (Wei) are considered Yin pulses. However, the principles of pulse diagnosis are profound; how can modern people reach such a level? The pulse is neither blood nor Qi; it is the pathway through which Ying (Nutritive) Qi circulates, representing the great creation of both Pre-heaven and Post-heaven origins, boundless and inexhaustible. Wang Shuhe stated in his *Mai Jing* (Pulse Classic) that "the pulse is difficult to discern under the fingers," which is truly insightful words. Those today who boast of mastering pulse diagnosis can only speak of it but not practice it correctly. In my old age, I specialize in diagnosing and treating via the Floating, Middle, and Deep pulse positions, inspecting Yin and Yang, Exterior and Interior, Deficiency and Excess, Cold and Heat, seeing them as clearly as if viewing the lungs and liver, leaving no room for the true nature of the disease to escape.

Since it is called Shanghan, it means Cold Evil enters from the exterior to injure the interior. Its entry has degrees of depth and sequence, moving from the Exterior to the Interior: first invading the skin and muscles, then entering the sinews, bones, stomach, and intestines. Inferring from this is not difficult. Originally, when Wind-Cold first invades, it often affects the Taiyang Bladder Channel (Foot-Taiyang Bladder Meridian) first. This channel has Cold as its root and Heat as its manifestation, thus presenting with aversion to wind, aversion to cold, headache, and fever. This is because Cold stagnates in the hair follicles and skin, constituting an Exterior Syndrome. If it were in other channels, these symptoms would not appear. If the pulse is Floating and Tight, with no sweating, it is Shanghan (Cold Damage); use Mahuang Tang (Ephedra Decoction) to induce sweating for resolution. If the pulse is Floating and Slow, with sweating, it is Shangfeng (Wind Strike); use Guizhi Tang (Cinnamon Twig Decoction) to disperse the pathogen, resolving when sweating stops.

If there is no headache or aversion to cold, and the pulse is not Floating, this indicates the Exterior Syndrome has ceased and the pathogen is in the middle. "Middle" refers to the Half-Exterior Half-Interior region, which is the domain of the Yangming Stomach Channel and Shaoyang Gallbladder Channel. The pulse is neither Floating nor Deep, located between muscle and bone, beneath the skin. There are two possibilities here: If the pulse is slightly Surging (Hong) and Long, it is a Yangming pulse; external symptoms include eye pain, dry nose, and insomnia; use Gegen (Kudzu Root) to resolve the muscle layer. If the pulse is Wiry and Rapid, it is a Shaoyang pulse; symptoms include chest and hypochondriac pain, deafness, alternating chills and fever, vomiting, and bitter taste in the mouth. Upon observing these symptoms and pulse, use Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize. This is because the Yangming and Shaoyang channels do not follow their root or manifestation exclusively but rather follow the Zhong Qi (Middle Qi).

Beyond this stage, the pathogen enters the Interior transforming into Heat and Excess. The pulse is not Floating but Deep; a Deep pulse requires pressing until the sinew and bone level to detect. If the pulse comes Deep, Solid, and Forceful, external symptoms include aversion to neither wind nor cold but rather aversion to heat, delirious speech, extreme thirst, tidal fever with spontaneous sweating, waving hands and throwing legs about, removing clothes and blankets, and constipation for five to six days. This clearly indicates Heat entering the Interior causing Dryness and Excess in the stomach and intestines. For mild cases, use Daxiehu Tang (Major Bupleurum Decoction); for severe cases, select among the Three Chengqi Decoctions (San Chengqi Tang). Once stool passes, the heat subsides. If the pulse is Deep, Slow, and Forceless, this is a Yin pulse indicating a True Cold Syndrome directly attacking the Yin Channels. Symptoms include no headache, no body heat, initial aversion to cold, cold limbs, shivering and curling up, no thirst, accompanied by abdominal pain, vomiting, diarrhea, salivation, or a face pale as if scraped by a knife. This is Cold directly invading the Yin Channels, not transmitted from Yang channels, so it does not fall under the treatment category of transmitted Heat Syndromes. One must further observe external symptoms: for mild cases, use Lizhong Tang (Regulate the Middle Decoction); for severe cases, use Jiangfu Sini Tang (Ginger and Aconite Decoction to Reverse Collapse) to warm and dispel cold. Regarding these critical junctures, I shall elaborate further.

Taiyang is the Exterior of Yang Syndromes. Yangming is the Interior of Yang Syndromes. Shaoyang lies between the Two Yangs and the Three Yins. Taeyin, Shaoyin, and Jueyin reside in the Interior, collectively termed Yin Syndromes. However, all Three Yin channels present with Deep pulses; the subtlety lies in distinguishing forcefulness versus forcelessness under the fingers. Forceful indicates Yang, Excess, and Heat; forceless indicates Yin, Deficiency, and Cold, which is most appropriate. The syndromes of the Three Yang channels have been discussed previously and are not repeated here. Regarding Heat Syndromes transmitted to the Three Yin channels, although the pulse principles are clear, the discussion was incomplete; I now re-examine and verify them. Abdominal fullness and dry throat belong to Taiyin; dry tongue and mouth belong to Shaoyin; irritability, fullness, and contraction of the genitals belong to Jueyin. These three are all Heat Syndromes transmitted from Yang channels to Yin channels. If the pulse is Deep, Solid, and Forceful, one should urgently attack the Interior using purgation. If after purgation diarrhea persists and body pain remains, and the pulse reverses to become Deep, Fine, and Forceless, one should rescue the Interior using warming methods. This is a method of flexibility.

Heat Syndromes transmitted to the Three Yin channels and True Cold Syndromes directly attacking the Three Yin channels both present with Deep pulses, but they are distinguished by forcefulness versus forcelessness; the symptoms differ, and treatments vary accordingly. This is the major principle. Previously mentioned, Zheng Yangming disease involves excessive Wind and strong Qi in its own channel, with a Deep, Solid, and Forceful pulse, due to pathogenic Heat entering the Stomach Fu organ causing dry fecal matter. This section refers to Fu-organ diseases belonging to the Interior; it demonstrates the miraculous efficacy of treating Excess Syndromes and the profundity of pulse diagnosis. It is kept secret and not discussed with ordinary people.

Now, the Floating, Middle, and Deep pulses are listed in three diagrams, with notes on syndrome differentiation and treatment methods below each diagram, enabling practitioners to know syndromes through pulses and understand treatment through syndromes, bridging the gap from coarse to refined, serving as a standard for future generations.