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Pang Anshi said: The *Suwen* (Basic Questions) states: The three months of winter are called "closing and storing" (Bi Cang). At this time, water freezes and the earth cracks; one should not disturb the Yang Qi. It also states: The warmth of spring there brings about the heat of summer; the severity of autumn there brings about the anger (cold) of winter. Therefore, the severe cold of winter is the source of killing and harsh Qi. Thus, a gentleman who is good at preserving life should, during times of severe cold, reside in well-sealed rooms to avoid invading cold pathogens. Those who ride swiftly, carry heavy loads, or engage in excessive sexual activity are all those who endure hardship. When Yang Qi is closed and stored, disturbing it causes it to become stagnant and then disperse into the Cou Li (interstitial spaces), forcing fluids to soak through. If combated by cold, the skin and Cou Li become tight, and cold pathogens mix with Ying (Nutritive) and Wei (Defensive) Qi. At this time, those with strong constitution recover as Qi flows smoothly; those with weak constitution develop disease as pathogens attach. Those who fall ill immediately present with headache, body ache, hot skin, and aversion to cold, named Shang Han (Cold Damage). Those who do not fall ill immediately harbor cold pathogens between the skin and muscles. When Yang Qi arises in spring and summer, the cold pathogens combat with Yang Qi between Ying and Wei. Their symptoms are no different from those who fell ill immediately in winter. If changed by the warm Qi of spring, it is named Wen Bing (Warm Disease). If changed by the summer heat Qi, it is named Re Bing (Heat Disease). If changed by the empty winds of the eight seasonal transitions, it is named Zhong Feng (Wind Strike). If changed by summer dampness, it is named Shi Bing (Damp Disease). If changed by the combat of Qi movement, wind, and heat, it is named Feng Wen (Wind Warmth). The root of these diseases lies in contracting cold in winter, manifesting differently according to the season. Therefore, great physicians collectively call them Shang Han. Among them, Shu Bing (Summer Heat Disease), Shi Wen (Damp Warmth), and Feng Wen have different prognoses and distinct manifestations, requiring specific treatments.

Pang Anshi said: Heavenly cold injures the body by first damaging Yang Qi. Foot-Taiyang (Bladder Meridian) governs the Qi of all Yang meridians. Its channel runs alongside the spine, penetrates the Back-Shu points of the Zang-Fu organs, and enters the brain. Thus, disease begins with Taiyang involvement. Because its channel connects the Back-Shu points of the Zang-Fu, diseases exhibit transmission patterns among Zang-Fu. Since Yang meridians are affected first, the disease sequentially transmits to Yin meridians. Yang governs generation; thus, Foot-Taiyang Water transmits to Foot-Yangming Earth, and Earth transmits to Foot-Shaoyang Wood, representing minor pathogens. Yin governs destruction; thus, Wood transmits to Foot-Taiyin Earth, Earth to Foot-Shaoyin Water, and Water to Foot-Jueyin Wood. By the sixth or seventh day, transmission reaches Foot-Jueyin Liver. Wood Qi inevitably overacts on Spleen Earth. If the Spleen suffers again from thief pathogens, the Zang-Fu organs face danger. If Ying and Wei circulation stops, accompanied by deafness, retraction of the scrotum, and unconsciousness, death ensues. One must urgently administer Chengqi Tang (Cassia Decoction) to purge (see Purge Syndrome section for formula); this may save one out of five deaths. Do not hesitate like saving a drowning person; if the patient cannot swallow liquids or medicine, it is hopeless. The *Suwen* states: Spleen heat disease endangers the five Zang organs. It also states: Earth failure with Wood overacting leads to death. If transmission reaches Jueyin on the sixth/seventh day, and the pulse is slightly slow and floating, with symptoms resembling malaria (alternating chills and fever), recovery is certain. Guizhi Mahuang Ge Ban Tang (Half-Size Decoction of Cinnamon Twig and Ephedra) should be used to harmonize (see Sweating Syndrome section for formula). A slightly slow and floating pulse indicates Spleen-Stomach pulses, meaning the Spleen Qi is no longer suppressed, pathogens have no place to reside, adversity turns to prosperity, Ying and Wei will recover, Water rises and Fire descends. After chills and fever occur, profuse sweating resolves the condition. Before profuse sweating, patients often experience dizziness, like the gloom before rain after a long drought. After rain, vegetation revives, and things become clear, which the *Yuce* calls a auspicious sign of changing Yang.

Wang Shuhe said: Land varies in temperature and altitude; objects differ in rigidity and softness; diet and residence vary accordingly. Thus, the Yellow Emperor inquired widely, and Qibo established four methods of treatment to instruct later generations and clarify misunderstandings. Practitioners must examine both aspects.

Pang Anshi said: Only a master with flexible wisdom could achieve this. For example, Guizhi Tang (Cinnamon Twig Decoction) works effectively in all seasons for people in the northwest. In the warmer Jianghuai region, it is only suitable for winter and spring. From late spring to before Summer Solstice, Huangqin (Scutellaria Root) should be added to Guizhi, Mahuang, and Qinglong formulas. After Summer Solstice, Zhimu (Anemarrhena Rhizome), Daqing (Isatis Leaf), Shigao (Gypsum Fibrosum), and Shengma (Cimicifuga Rhizome) should be added to Guizhi Tang to induce sweating. For epidemic cold pathogens or patients with chronic deficiency-cold, ancient formulas are used without modification. Although Baihu Tang (White Tiger Decoction) is suitable after Summer Solstice, it is not intended for new-onset summer heat diseases but rather for resolving exterior conditions after sweating, as it cannot expel exterior pathogens. In deep winter or early spring, if a patient becomes manic and restless due to improper sweating or purging, treat as internal heat regardless of the season. In southern regions without frost or snow, where cold does not invade directly, and local Qi does not store, insect toxins and mountain miasmas arise; these require different treatments. Within a prefecture, mountain dwellers live in Yin-accumulating areas with ice/snow even in midsummer. Their Cou Li are closed, making them resistant to pathogens and long-lived; their illnesses are mostly Zhong Feng (Wind Strike) or Zhong Han (Cold Strike). Plain dwellers live in Yang-accumulating areas where grass grows in winter. Their Cou Li are loose, making them susceptible to pathogens and short-lived; their illnesses are mostly Zhong Shi (Damp Strike) or Zhong Shu (Summer Heat Strike). Individuals vary in constitutional strength and chronic conditions (cold/heat). Shang Han can trigger chronic diseases, independent of new pathogenic factors. Those with chronic cold tend toward Yang deficiency/Yin excess or Yin Du (Yin Toxin). Those with chronic heat tend toward Yang excess/Yin deficiency or Yang Du (Yang Toxin).

Pang Anshi said: In the four seasons, cold, heat, dryness, dampness, wind, and fire interact, causing various diseases, which must be anticipated. Dietary preferences (five flavors, meat/fish/vegetables/fruits) with extreme tastes, or habitual use of mineral/plant medicines, contribute to disease. The five Zang organs vary in size, position, firmness, and alignment; the six Fu organs vary in size, length, thickness, and tension, predisposing individuals to lifelong diseases. Changes in social status (noble to lowly, rich to poor, sudden joy/sorrow, separation/grief, fear/anger) cause internal injury. "Noble to lowly" is named Tuo Ying (Depletion of Ying); "Rich to poor" is named Shi Jing (Loss of Jing). Sudden joy/sorrow or joy turning to sorrow deplete Jing and weaken the body, damaging spirit and ambition. Rich to poor causes emaciation and tendon contraction; proud and lazy rich people lose Jing. Separation from loved ones scatters the Hun (Ethereal Soul); unfulfilled desires exhaust the Yi (Intellect); worry burdens the Shen (Spirit); resentment hardens the Will (Zhi); depression blocks flow; rage causes confusion; fear causes instability; excessive joy scatters Qi without storage. These are internal injuries, not external pathogens. Good physicians must inquire thoroughly to locate the diseased Zang-Fu and meridians. Poor physicians fail to understand, leading to chaotic Qi/Blood and untreatable conditions.

Pang Anshi said: Yin/Yang deficiency/excess refers to more than just pulse positions. Ying and Wei are Exterior Yang; Stomach and Intestines are Interior Yin. Cold pathogens combing within Ying and Wei cause fever and aversion to cold, with floating-large pulses at Cun and Chi positions, and minimal internal restlessness. Mild irritability, preference for warm drinks, and aversion to cold indicate Yang deficiency/Yin excess; sweating cures it, while purging kills. If cold pathogens combat internally, causing Yang excess/Yin deficiency, extreme Yin transforms to Yang, cold generates heat, and heat enters the interior. Heat toxin dries fluids, forming dry feces. Externally, no aversion to cold; internally, steaming fever, agitation, delirium. Pulses are floating-slippery-rapid, or full-solid. Even if pulse is slow post-sweating but forceful on pressure, with abdominal fullness and wheezing, this is Yang excess/Yin deficiency; purging cures it, while sweating kills. Zhang Zhongjing's three types of Yangming disease represent Yang excess/Yin deficiency. The *Tiao Jing Lun* states: Yang deficiency causes exterior cold; Yin deficiency causes interior heat; Yang excess causes exterior heat; Yin excess causes interior cold. If Yin alone is excessive and Yang suddenly fails, limbs turn cold, umbilical pain, body pain like being beaten, cyanosis, vomiting/diarrhea, thready-almost-invisible pulse: this is Yin Du (Yin Toxin). Urgently moxa below the navel and administer acrid-hot herbs to restore Yang, leading to continuous sweating and resolution. If Yang alone is excessive and Yin suddenly fails, restlessness, mania, red face, sore throat, skin spots like brocade, bloody/yellow diarrhea, full-slippery-rapid pulse: this is Yang Du (Yang Toxin). Use acupuncture to drain heat and administer bitter-sour herbs to restore Yin, leading to continuous sweating and resolution.

Pang Anshi said: Pathogens disrupting Yin/Yang Qi require sweating to preserve True Tian Zhen (Heavenly Purity). The *Suwen* states: Acrid-sweet dispersing is Yang (e.g., Guizhi, Gancao, Xixin, Ginger/Jujube, Fuzi) restores Yang Qi. Sour-bitter draining is Yin (e.g., Kushen, Daqing, Tingli, Vinegar, Ai) restores Yin Qi. Sour-bitter drugs that reduce heat and restore Yin should induce slight sweating followed by purging. The classic says: "Sweat first, then purge; excess cases survive."

Hua Tuo's method states: Shang Han begins with Wind-Cold entering Cou Li, competing with Essence-Qi, causing Ying-Wei stagnation. On days 1-2, Qi is in pores/skin, causing headache, aversion to cold, fever, stiff back. This is Exterior syndrome; sweating cures it.

Pang Anshi said: When inducing sweat, cover the upper body normally and the lower body with thick clothes, as legs/feet sweat slowly. Half-body sweating means unresolved disease. If symptoms persist post-sweating, repeat sweating 2-3 times within three days until legs/feet sweat. If unresolved, purge. If still unresolved post-purge, exterior-interior pathogens are weakened; observe pulse/symptoms for seven days for proper sweating. Do not re-sweat if: initial fever/cold now becomes high fever/agitation without cold; pulse changes from floating-large to full-solid or deep-thin-rapid; consciousness changes from calm to delirious. This is Stomach Excess/Yang Excess; re-sweating kills; purging is required. Treat Yang excess immediately regardless of day count. If illness lasts >3 days, Qi floats upward, blocking chest/diaphragm, causing headache/chest fullness/phlegm; vomiting cures it.

Pang Anshi said: For deficiency/newborns unable to vomit, use Zhishi San (Immature Bitter Orange Powder): Zhishi fine powder, mixed with rice water, 2 qian per dose, 3-4 times daily. For deficiency-cold with cold limbs/weak pulse, add 1 liang Guizhi to 2 liang Zhishi, powder, and take as above.

After 5-6 days, Qi knots in Zang-Fu, causing abdominal fullness, heaviness, bone/joint pain; purging cures it. If urine is scant, palms/soles/armpits dry, do not purge yet; observe carefully to avoid damaging Stomach Qi with random herbs. (Above explains Hua Tuo's methods.)