Library

I have often pondered that to write books and establish theories, one must have ten thousand volumes in mind and keep the brush free from dust, only then can one form a unique school of thought. Readers of later generations who study ancient texts must resonate with the minds of the ancients to speak without error. Mr. Ke Yunbo of Cixi annotated Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) in six volumes, and further authored two volumes of *Shanghan Lun Yi* (Wings to the Treatise on Cold Damage), elucidating hidden meanings and exploring unique secrets. His clear and detailed discrimination made the obscure medical cases of Zhongjing, which had remained unclear for millennia, suddenly clear. Through observing Mr. Ke's annotations, later generations could understand the subtleties of Zhongjing's teachings; his merit is indeed immense. However, as it has been widely circulated and reprinted many times, errors in meaning and characters (such as "fish" and "pig" confusions) are common. Readers who fail to comprehend them thoroughly often leave them on high shelves. My teacher, Mr. Ren Hongbo, presented me with a handwritten copy of *Shanghan Fazhu* (Ancestral Method of Treating Cold Damage) by his ancestor, Yue Gong. Upon viewing it, I found it to be essentially Mr. Ke's *Shanghan Lun Yi*, but with careful corrections of errors, removing redundancy while retaining simplicity, and fully rectified without flaw. I therefore copied and read it, finding that its classification by meridians follows Mr. Ke's approach. Those engaged in this field should carefully comprehend it to grasp its essence, thereby distinguishing right from wrong and forming independent judgments, avoiding the弊端 of blind following. Alas! Mr. Ke is a meritorious figure for Zhongjing; is Mr. Ren's contribution to Mr. Ke's work any less? Thus, I record this.

Recorded in the early spring of the Ren Yin year, the 22nd year of Daoguang, at Chu Jing Shan Fang.
Respectfully recorded by my junior student, Tao Guanyong.

According to Zhongjing's own preface, he wrote the *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases), comprising sixteen volumes. Thus, *Shanghan* and *Zabing* were not originally divided into two separate books. Any clauses not pertaining to cold damage share the same meaning as miscellaneous diseases. For instance, head and neck stiffness in Taiyang, stomach excess in Yangming, bitter taste, dry throat, and dizziness in Shaoyang, abdominal fullness with vomiting and diarrhea in Taiyin, desire to sleep in Shaoyin, and qi rushing up to strike the heart in Jueyin—these symptoms represent the syndromes governed by the Six Meridians, not exclusively cold damage of the Six Meridians. They are outlines for various diseases managed by each meridian, not legislation solely for cold damage. Observing the outlines of the five meridians, they all refer to internal symptoms; only the Taiyang outline is established for exterior injury by cold pathogens. While outlines of the five meridians generally refer to heat syndromes, only the Taiyin outline is established for interior injury by cold pathogens. However, even if Taiyang summerheat causes fever and chills, or Taiyin heat injury causes abdominal pain and diarrhea, these do not depart from the fixed principles that Taiyang governs the exterior and Taiyin governs the interior. It is evident that the syndrome differentiation of the Six Meridians encompasses both cold damage and miscellaneous diseases. Since Taiyang governs the exterior, its outline legislates for external invasions. Therefore, Wang Shuhe attributed Zhongjing's combined treatise entirely to cold damage, unaware that Zhongjing explicitly stated his book was not solely for cold damage. Hence, in the Taiyang chapter, clues for various diseases are clarified item by item, more detailed than in other chapters. He states: "Taiyang disease, whether fever has already appeared or not, must involve aversion to cold, body pain, vomiting, and reverse flow, with pulse tightness in yin and yang positions; this is named Cold Damage." This establishes a specific outline for Cold Damage. Not only is it an outline for Taiyang Cold Damage, but also the general outline for Cold Damage across the Six Meridians does not exceed this. Observing that Zhongjing uniquely distinguishes names in the Taiyang chapter as Cold Damage, Wind Strike, Summerheat, Damp Bi, and Warm Disease, while not differentiating others, one can infer the consistent logic from this partial example. Other conditions such as Chest Binding, Organ Binding, Yang Binding, Yin Binding, Stasis Heat, Jaundice, Heat Entering the Blood Chamber, delirium, and mania-like behavior—whether caused by cold damage or not, amidst this complexity—allow us to contemplate the purport of combining cold damage and miscellaneous diseases. Generally, outside of cold damage, there are numerous miscellaneous diseases, incalculable in number. Thus, the Six Meridians were established to categorize them. Within cold damage, miscellaneous diseases are most prevalent, with internal and external factors mixed, and deficiency and excess presenting together. Therefore, combining cold damage and miscellaneous diseases allows one to see clarity within confusion; this is a crucial method. Wang Shuhe did not understand this purport. He claimed that Wind, Warmth, and Summerheat should be discussed separately; then why are Wind Strike and Warm Disease combined with cold damage? If these three syndromes are caused by cold damage and similar to it, appearing here, why are Wind Strike (not caused by cold damage) and Warm Disease (not similar to cold damage) not established separately? Huoluan (Huo Luan) is a disorder of the Liver meridian; Yin-Yang Exchange and relapse after recovery due to overexertion result from injury to sinews and bones, belonging to Jueyin; why establish separate chapters? Wang Shuhe placed the three Taiyang syndromes at the beginning and various Jueyin syndromes at the end, initiating the trend for later generations to classify symptoms by category. Did he not know that Zhongjing's concise laws encompass hundreds of diseases within the Six Meridians, unable to escape them? One seeks the root in the Six Meridians, not the branches in disease names. Wang Shuhe disrupted Zhongjing's original collection with personal opinions, reorganizing chapters on sweating and non-sweating after relapse. For example, weak pulse appearing at Guan position, Ru pulse at the top, Wei pulse above, Se pulse below—how can these be called "reverse"? Do Ru, Ruo, Wei, and Se pulses have fixed locations? Such matters need not be debated in detail. His so-called "Great Law" states: Spring and summer suit sweating; winter suits vomiting; autumn suits purging. If the time does not arrive, should one wait? Furthermore, methods like promoting urination, clearing fire, warming tonification, and harmonizing are omitted. Thus, people today praise Zhongjing for only sweating, vomiting, and purging methods, due to this error. The four seasons are common to all, but illness varies by individual. Sweating, vomiting, and purging are applied according to disease. Laws are established to treat disease, not to treat seasons. Since this erroneous "Great Law" arose, later generations adopted pedantic views on seasonal medication. Discussants of Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) claim they are suitable for winter cold and forbidden in other seasons. Discussants of Baihu Tang (White Tiger Decoction) claim suitability for summer and strict prohibition after Autumn Equinox and before Start of Summer. This violates the principle: "First consider the annual qi, do not harm the harmony of heaven." The contrary use of cold, heat, warm, and cool properties is common in dietary habits. Zhongjing formulated prescriptions based on symptoms, not season-determined dosages. One must know that Zhongjing's treatment methods are based on the *Neijing* (Inner Canon). As Qibo said: "Treatment formulas must distinguish yin and yang. Yang diseases are treated by nourishing yin; yin diseases by supporting yang. Determine interior and exterior, each guarding its domain. Exterior diseases are treated externally; interior diseases internally. From exterior to interior, treat the exterior first; from interior to exterior, regulate the interior first. From interior to exterior with severity in exterior, regulate interior then treat exterior; from exterior to interior with severity in interior, treat exterior then regulate interior. If interior and exterior are unrelated, treat the primary disease. Minor disorders are regulated; moderate ones balanced; severe ones subdued. Cold, heat, warm, and cool are used to reduce according to their nature, following what is beneficial." This is the Great Law. Zhongjing inherited this completely, making it explicit. The text states: "Fever with aversion to cold originates from Yang; no fever with aversion to cold originates from Yin." This distinguishes yin and yang. For Yang diseases, Baihu Tang and Chengqi Tang are formulated to preserve yin; for Yin diseases, Fuzi (Aconite Root) and Zhuyu (Cornus Fruit) support yang. Exterior treatments use Mahuang Tang and Guizhi Tang; interior treatments use Mangxiao (Niter) and Dahuang (Rhubarb Root). Regarding exterior deficiency with interior excess, exterior heat with interior cold, releasing the exterior, harmonizing the exterior, saving the interior, attacking the interior—diseases have depth, treatments have sequence, and formulas have weight. This determines interior/exterior and guards domains. Taiyang-Yangming concurrent disease requires mild sweating; Taiyang-Yangming combined disease uses Mahuang Tang—treating the exterior when disease moves from exterior to interior. Yangming disease with fever, sweating, no aversion to cold, but aversion to heat uses Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction)—regulating the interior when disease moves from interior to exterior. After sweating, if disease persists with steaming fever, it is interior-to-exterior severity; Tiaowei Chengqi Tang regulates the interior first. If exterior is unresolved but epigastric fullness exists, it is exterior-to-interior severity; resolve exterior first, then attack fullness—treating exterior first, regulating interior later. Unrelated interior/exterior indicates half-exterior/half-interior disease; Xiaochaihu Tang (Minor Bupleurum Decoction) and Dachaihu Tang (Major Bupleurum Decoction) treat the primary disease. This corresponds to regulating minor disorders, balancing moderate ones using Baihu Tang, Zhizi Chi Tang, Xiao Chengqi Tang; subduing severe ones using Da Chengqi Tang (Major Cathartic Decoction), Xiongxin Tang (Chest-Binding Decoction), Didang Tang (Thoroughly Overcoming Decoction). "Observe pulse and symptoms, know the deviation, treat accordingly" refers to using cold/heat/warm/cool to reduce according to nature, following benefits. If constrained by seasons to limit methods, or limited to three methods to treat disease, one would be helpless against changing conditions. Moreover, sweating, vomiting, and purging originate from Qibo, yet methods like promoting urination, clearing fire, and tonification are included. Qibo said: "For pathogenic factors, steep the body to induce sweat; for those in skin, release via sweat; for excess, disperse and purge." This is the sweating method. "For fullness in middle, purge from within; for blood heat, lacerate." This is the purging method. "For high positions, cause upward expulsion"—this is vomiting. "For low positions, guide to exhaustion"—this is draining. "For obstructed urination with fierce qi, press and collect"—this is clearing fire. "For qi deficiency, draw and lift"—this is tonification. Pathogens in hair/skin have not injured form; thus Zhongjing created Mahuang Tang to urgently sweat and release exterior. Pathogens entering muscles have injured form; thus Guizhi Tang with thin hot porridge resolves muscle layer—steeping body to sweat. When pathogen and righteous qi contend, interior/exterior are excess, cold/heat intermingle; thus Da Qinglong Tang (Major Green Dragon Decoction) adds Shigao (Gypsum) to Mahuang/Guizhi to purge fire—dispersing and purging. Vomiting agents include Zhizi Chi Tang and Goudi San, distinguishing chest deficiency/excess. Purging agents include Da/Xiao/Tiaowei/Didang Tangs, distinguishing qi/blood depth. Diuretics include Zhu Ling Tang (Polyporus Decoction) and Zhenwu Tang (True Warrior Decoction), with extreme cold/heat differences. Fire-clearing agents include Shigao, Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), with light/heavy distinctions. For yang deficiency, Renshen (Ginseng Root) is added to Fuzi/Wuzhuyu to guide yang; for yin deficiency, Renshen is added to Baihu/Xie Xin Tangs to guide yin. Methods are orderly, verified by Qibo without error. Former and latter sages share the same principle. I have doubts: Zhongjing stated "Ping Mai Bian Zheng" (Leveling Pulse and Differentiating Syndromes) for *Shanghan Zabing Lun*, implying pulse and syndrome were not separated. Leveling pulse occurs within syndrome differentiation. Diseases have yin/yang; pulses match yin/yang. "Fever with aversion to cold originates from Yang; no fever with aversion to cold originates from Yin" describes disease yin/yang, fitting at the start. Pulses with large, floating, slippery, rapid qualities are Yang; sinking, choppy, weak, string-taut, minute are Yin—pulse yin/yang. This clause should follow. Wang Shuhe claimed to collect Zhongjing's old theories and record symptoms/pulses, implying he established separate pulse methods. In Taiyang chapter: "Floating pulse indicates exterior disease; floating-tight pulse suggests body pain; floating-rapid pulse suggests resolution via sweating." These pulse clauses are not in the Bianmai Pingmai chapter, showing Wang Shuhe's collection was incomplete, missing Zhongjing's old format. Inferring from this, clauses like "Cunkou floating indicates exterior," "Cunkou floating-tight," "floating-rapid" were extracted from such places. Clauses on Yin/Yang binding exist between Yangming Wind Strike/Cold Injury; shivering chills with returning fever exist in Shaoyang alternating chills/fever sections; pulse tightness in yin/yang may belong to Shaoyin; yin-yang combat may occur during cold damage pulse knotting/depression. If Zhongjing collected pulse methods separately, there might be upper/lower distinctions, lacking leveling/differentiation distinctions. Names "Ping" and "Bian" are Wang Shuhe's compilation of various sayings, aligning with Zhongjing's "each inheriting family skills." People know Preface/Examples are Wang Shuhe's text, but ignore that his book replaced Zhongjing's, focusing only on cold damage. Of sixteen volumes, much was discarded, and Six Meridian texts are mixed. Is it still Zhongjing's original collection? Though my view may be wrong, observe the *Neijing* quotes in the Preface/Examples; sentences are added, words changed. He dared alter Qibo's classics, let alone Zhongjing's theories. To know true Zhongjing, examine brushwork clause by clause. Just as Kaogong Ji differs from Zhou Li, and Chu Sheng's writings differ greatly from Sima Qian's, people regard *Jingui Yaolue* as Zhongjing's miscellaneous disease treatise, akin to saying Confucius resembles a sage, but only Zengzi is unassailable.