Library

Huangdi said: "Currently, all febrile diseases belong to the category of Shanghan (Cold Damage)." Qibo replied: "When humans are injured by cold pathogens, they develop febrile diseases." When the Taiyang meridian (Greater Yang) is affected, there is pain in the head and neck, and stiffness in the waist and back. When the Yangming meridian (Yang Brightness) is affected, there is body heat, eye pain, dry nose, and inability to lie down. When the Shaoyang meridian (Lesser Yang) is affected, there is chest pain and deafness. If the meridians of the Three Yang are all affected by disease, but the pathogen has not yet entered the Zang organs, it can be cured by sweating (diaphoresis). This refers to the exterior syndromes of the Three Yang meridians that have not yet entered the interior; therefore, only diaphoresis is needed. It is also said: When the Taiyin meridian (Greater Yin) is affected, there is abdominal fullness and dry throat. When the Shaoyin meridian (Lesser Yin) is affected, there is dry mouth, dry tongue, and thirst. When the Jueyin meridian (Terminal Yin) is affected, there is vexation and abdominal fullness, and contraction of the scrotum. If the Three Yin and Three Yang, as well as the Five Zang and Six Fu organs, are all diseased, leading to the stagnation of Ying and Wei (Defensive and Nutritive Qi) and the blockage of the Zang and Fu organs, death will ensue. This refers to the situation where Yang pathogens transmit into the Three Yin meridians and the condition does not resolve. It is also said: If the duration is less than three days, sweating may be used; if the duration is more than three days, purgation may be used. Saying "less than three days" does not rigidly adhere to the number of days, but indicates that the exterior syndrome is still present; saying "more than three days" also does not rigidly adhere to the number of days, but indicates that the interior syndrome follows. According to this, these refer to the Yang syndromes of the transmission of Shanghan, not the pure Yin syndromes where cold directly invades the Three Yin meridians without fever. Zhang Zhongjing, in order to supplement the deficiencies of the *Neijing* (Inner Canon), wrote the *Shanghan Lun* (Treatise on Cold Damage), elucidating that cold pathogens can injure the Yang meridians and cause transmitted febrile diseases; how could it be that cold pathogens cannot injure the Yin meridians and cause direct invasion Yin syndromes? Thus, he detailed the Six Meridians, noting the symptoms, pulse, and treatment under each clause, distinguishing which are exterior, which are interior, which are transmitted febrile diseases, and which are cold diseases from direct invasion of the Yin meridians, yet naming them all under *Shanghan Lun*. Therefore, he established the theory for Zheng Shanghan (True Shanghan) of winter and the season, using Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) for releasing the exterior, Sanyichengqi Tang (Three Yi Chengqi Decoction) for attacking the interior, and Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonizing and resolving both exterior and interior when both are present. There were only the treatment methods for winter True Shanghan, without mentioning the syndromes of spring, summer, and autumn. However, the implicit meaning within is to understand heat from cold, summer from winter, and the climate of Nanfang (the South) from Changsha. Releasing the exterior and attacking the interior should be based on the syndrome; cold, heat, warmth, and coolness should follow the season; observing the young and old, distinguishing strong and weak constitutions, selecting appropriate formulas through analogy and detailed reasoning, one can extend the treatment of winter Shanghan to cover Spring Warmth and Summer Heat syndromes. Those who do not understand this principle, seeing that Yin and Yang syndromes are in the same volume of *Shanghan Lun*, treat Yin and Yang syndromes indiscriminately. Even those who clearly distinguish Yin and Yang mistakenly use the Mahuang Tang and Guizhi Tang of Zhang Zhongjing, intended for winter in the North, to treat people in the South during spring, summer, and autumn, causing febrile diseases to be wrongly treated with warm-hot substances, resulting in myriad complications. Or, because the exterior pathogen is not dispersed and evil sweat has not emerged, causing restlessness and irritability, they mistakenly recognize this as interior heat restlessness and instead use cold-cool substances, leading to the exterior pathogen remaining trapped. Fortunately, Tao Jian'an and Wang Yutai elucidated that Zhang Zhongjing's Yin and Yang syndromes are separate lines of treatment. However, the errors and omissions in the original notes of *Shanghan Lun* have not yet been corrected and clarified. Furthermore, under Mahuang Tang and Guizhi Tang, it is not detailed that these formulas are for treating places like Hebei and Changsha; even in winter, the Jiangzhe region requires careful examination. Nor is it noted that direct invasion Yin cold syndromes occur mainly in northern winters, while they are extremely rare in the Jiangzhe southeast. The diseases currently prevalent in the southeast are caused by exposure to wind and dew at dawn and dusk, leading to depression and fever, anhidrosis, and aversion to cold. This is Shanghan caused by sudden exposure to non-seasonal pathogens, acquired from the outside, without interior heat. Therefore, Baidu San (Resolving Toxins Powder) and Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction) should be used to disperse the exterior with acrid-warm substances, and bitter-cold substances should not be used abruptly. There are cases of accumulated heat inside, bound by external cold pathogens, where new cold condenses existing heat, resulting in syndromes with both exterior and interior manifestations. Externally, there is fever and sweating; internally, there is wheezing, vomiting, and thirst. In spring, this is called Fengwen (Wind-Warmth); in summer and autumn, it is called Shure (Summer-Heat). This is obtained during hot seasons while resting, representing a Zhongshu (Summerheat) febrile disease with exterior pathogen. Shuangjie San (Double Resolution Powder) and Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) should be used to disperse the exterior and clear heat. If accompanied by food stagnation in the middle Jiao, Baoping Weisan (Stomach-Pacifying Stomach-Clearing Powder) should be used to digest food and harmonize the stomach. There are also cases of accumulated heat inside, without external cold binding, lacking exterior symptoms such as aversion to cold, body pain, headache, waist and back pain, cold feet, stiffness, and inability to turn over, but presenting with cracked lips, thirst, vexation, desire to drink, profuse sweating, aversion to heat, delirium, and constipation—these are interior heat syndromes. This is obtained during hot seasons through activity, representing a Zhongre (Mid-Heat) or Danre (Blazing-Heat) disease without exterior pathogen. Baihu Tang (White Tiger Decoction), Liangge San (Cooling Diaphragm Powder), Sanhuang Jusheng Tang (Three Yellows Great Victory Decoction), and Daochi Banjie Tang (Half-Half Guide Red Urine Decoction) should be used; if there are indications for purgation, Sanyichengqi Tang should be used. Understanding these three categories allows for the orderly treatment of febrile diseases with exterior pathogens, febrile diseases with interior pathogens, and febrile diseases with both exterior and interior pathogens.