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The "Shanghan Jie" (Commentary on Cold Damage) written by Pang Anshi is the result of thirty years of dedicated study. I extensively consulted various schools of thought, repeatedly cross-referenced and integrated them, and only dared to compile those that were determined to be feasible. In past practices of pulse diagnosis and syndrome differentiation, as well as prescribing decoctions, I have gained considerable knowledge of their practical efficacy. I dare not act lightly or recklessly, lest I cause harm to people's lives. Since Wang Shuhe, there have been few physicians who could clearly and detailedly distinguish between the four types of warm diseases and the signs of deteriorating conditions. Consequently, medical practitioners uniformly treated these conditions as Shanghan (Cold Damage) and applied sweating or purging methods. Shanghan encompasses four categories corresponding to Metal, Wood, Water, and Fire, and possesses principles for both sweating and purging therapies. When affected by pathogenic factors that transform into the four types of warm diseases, treating warm diseases with sweating and purging methods intended for Shanghan will inevitably lead to death. Even when applying sweating and purging to Shanghan, errors may occur; how much more so for those ignorant of warm diseases? Over half of the deaths in the world are unjustified, which is indeed true. The state has meticulously reviewed and corrected medical texts, leaving nothing incomplete, except for treatments regarding these deteriorating conditions caused by pathogenic factors, which have not yet had time to be widely expanded. My humble intention in presenting these brief ideas is to enable every household to read prescriptions and apply them easily, allowing for symptom-based regulation so that pulse and breath become naturally clear, eliminating the need to seek out mediocre and crude physicians, thereby avoiding premature death.

If one were to ask Sun Simiao: "In current times, days and months are short, medicinal potency is light and deficient, people are cunning and deceitful, illnesses contracted are severe, hence medication dosages are large." He also stated: "Deliberately repeating medication usage yields greater force." From Sun Simiao to now, the time elapsed is vast, yet medicines have become lighter and less potent. Why is this? I speculate that during the Tang Dynasty, following the An Lushan Rebellion, regional military governors became arrogant and unruly. Until the Five Dynasties period, the circulation of medicinal materials from all directions was scarce. Thus, physicians rarely used decoctions but instead favored boiled powders (Zhusan). Furthermore, in recent eras, people's desires have deepened, and epidemic diseases have increased, making medication extremely costly. As days and months grow shorter and earth veins thinner, the production of herbs decreases. How do I know this? I often see in common households the prescription records left by distant ancestors, noting past events. For instance, records from the Guangshun era indicate that two thousand beans of Crotonis Fructus (Badou, 巴豆) were worth twenty-two hundred coins, proving that medicinal circulation was poor. Moreover, warm epidemics are not recorded in the *Rites of Zhou*; smallpox and measles originated in the Wei and Jin dynasties; Hongxiangjiao (Jiaogongjiao, a type of beriberi/foot swelling) began in the late Jin dynasty. Thus, we know that as times become more recent, natural disasters increase, and medication costs rise. Minerals like Shi (Lapis Lazuli, 石) and Cengqing (Azurite, 曾青), which were major drugs used by ancients to treat various stubborn masses and accumulations, are now lacking even in the homes of nobles and high officials; one can imagine the scarcity among the common people. During the Huangyou era, Ginseng Radix et Rhizoma (Renshen, 人参) cost four thousand five hundred coins per two thousand units, while Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) traditionally cost ten to several dozen coins per liang. Now, prices have risen to four or five hundred coins. Although producing regions remain connected like a ribbon, farmers cultivate seedlings for substantial profit, indicating that earth veins are thinning and herb production is minimal.

Given the long periods of heavenly and earthly turmoil, thin earth veins, low production, and frequent disasters, how could one not regretfully resort to boiled powders instead of decoctions? Therefore, contemporary skilled physicians are luckier than ancient or average ones in treating diseases. If one asks about the difference between modern and ancient measuring vessels and weights: the general principle is that three ancient sheng equal one modern sheng, and three ancient liang equal one modern liang. Despite this, common people do not strictly follow this method when using ancient formulas and cannot adjust them themselves. For example, stating that one piece of Aconiti Lateralis Radix Praeparata (Fuzi, 附子) equals half a liang, where one qian and three fen constitutes one piece, causes confusion. How can this conform to popular custom? I mention that in the Dahé era of the Tang Dynasty, Xu wrote the *Jiyao Fang* (Essential Formulas for Relief), citing: "Weights differ from previous dynasties, and measures differ slightly from the current time." Recently, it was recompiled and revised, not only ensuring balanced additions and subtractions but also standardizing weights. It further states: "The currently revised sixty-three chapters and six hundred and sixty-six formulas are compiled into six volumes, with steles erected in various commanderies to record these formulas for public reference." It also says: "Coinciding with the Holy Era and the year Dahé, it is named *Dahé Jiyao Fang*." The full text is recorded below, having been memorialized and approved for distribution by imperial decree. This text was destroyed by war and fire. My family possesses a version written in vermilion and black ink by Tang people, but the paper is rotten and incomplete, making it difficult to identify Xu's official title and name. I do not know if the Chongwen libraries of our dynasty possess this copy. I believe that adjusting ancient formulas should follow Xu's methods to align with modern measures, perhaps merely increasing the number of pieces or grains for common use. Thus, the sequence of Zhang Zhongjing's ancient formulas allows for halving dosages, as detailed in Shaoyao Tang (Peony Decoction). Tao Hongjing stated: "Human bodies differ in size across ages; zang-fu organs and qi-blood also vary. One should judge medicinal weights by intent, referencing ancient examples and matching dosage amounts. One part may become two parts, or two zhu may become one liang; using a cup instead of a sheng is acceptable." If one calculates precisely, such as in the ancient Chengqi Tang (Gastrointestinal Regulating Decoction), where water is scant and herbs are abundant, how should it be adjusted? Therefore, the Zhusan in *Shenghui Fang* are essentially ancient decoctions; why calculate every amount precisely? Treatment must have basis, and verification lies with those experienced in practice, who dare to adjust freely. If one asks why heavy summer heat, being more severe than warm diseases, should use repeated formulas yet often employ boiled powders: I say that in summer, spontaneous sweating occurs frequently, and couli (skin pores) open easily. The Classics state: "When heaven is hot and earth is warm, river waters boil over," hence boiled powders are used. For severe cases, notes under decoction syndromes state: "Do not prepare as boiled powder." There are many such cases; I briefly outline the general idea. The proverb goes: "For plowing, ask the servant; for weaving, ask the maid." Scholars may favor this art but lack deep mastery. Amidst court jealousy and criticism, where nitpicking prevails, I fear my foolish words may be misunderstood. I humbly request your consideration.