Library

The classic states: Cold damages the form, cold damages the skin and hair, cold damages the blood, and cold damages the Ying (Nutritive Qi). However, cold governs closure and storage, causing the Couli (skin pores and interstices) to close tightly. The Yang Qi is constrained and cannot circulate freely, stagnating internally to generate heat. Therefore, the body becomes hot, dry, and anhidrotic (without sweat). Thus, the classic says: "When humans are injured by cold, it manifests as a febrile disease." It also states: "All febrile diseases belong to the category of Shanghan (Cold Damage)." The *Neijing* (*Inner Canon*) directly refers to them as "Febrile Diseases," indicating the pathological heat throughout the body; whereas Zhang Zhongjing directly refers to them as "Shanghan," indicating the external pathogenic cold. This distinction separates the injuries caused by Wind, Cold, Summerheat, and Dampness, as their primary treatments differ. Hence, only "Shanghan" is mentioned, not broadly "Febrile Disease." The harm caused by cold pathogens is immense; therefore, all internal and external injuries that manifest as febrile diseases with sweating are collectively termed "Shanghan." They are also called "Da Bing" (Great Illness), signifying their significant harm. Furthermore, those occurring in Spring are called Wenbing (Warm Disease), in Summer Rebing (Heat Disease), in Autumn Shibing (Damp Disease), and in Winter Shanghan. "Shanghan" is named according to the seasonal weather changes—Spring warmth, Summer heat, Autumn dampness, Winter cold—to clarify the severity of diseases in different seasons and the nuances of treatment. Broadly speaking, they are one and the same, not implying a fundamental difference between external injuries and internal diseases. Some claim that cold pathogens lie dormant in the skin, flesh, and bones during Winter, transforming into Warm Disease in Spring, Heat Disease in Summer, Damp Disease in Autumn, and proper Shanghan in Winter. Or, one may contract cold but develop internal constrained heat; if the heat is mild, illness does not occur immediately. Later, when Yang heat shifts, or upon re-infection, it becomes a febrile disease. This does not mean the latent cold transforms into heat. The classic says: "Injured by cold in Winter, one will surely suffer from Warm Disease in Spring." This aligns with this principle. There are also cases where contracting cold immediately results in a febrile disease, due to contracting abnormal and chaotic Qi of the four seasons, changes in Qi dynamics, injury from various internal and external pathogens, transformation from other diseases, or contagion from others. These are treated by categorizing and addressing symptoms accordingly. The classic's discussion on the transmission through the Six Channels outlines the general pattern of external cold leading to febrile disease and the essential methods of treatment. The great principle states: "On the first day of Shanghan, the Taiyang channel receives the pathogen, resulting in headache and stiffness of the neck and spine." This refers to the Foot-Taiyang Bladder Channel. Thus, the classic states that on the fifth day, the Foot-Shaoyin Kidney Water acts as its interior-exterior pair. To say it is the Hand-Taiyang channel is incorrect. These are the syndromes of the Six Channels. To claim based on this that Shanghan does not transmit to the Hand channels is also incorrect. Did one not carefully read the *Re Lun* (*Treatise on Febrile Diseases*), which states that all Zang and Fu organs can be diseased? The *Ci Re Pian* (*Chapter on Acupuncture for Heat*) also discusses heat diseases of the Five Zang organs. It is simply that febrile diseases occur more frequently in the Foot channels, while involvement of the Hand channels is less common and milder, often appearing as minor concurrent syndromes with the Foot channels. For treatments involving sweating or purging, one only distinguishes between exterior and interior, so the Hand channels are not mentioned separately but are subsumed under the Foot channels. In acupuncture, however, tonification and reduction are applied to the specific meridians of each Zang organ and Hand/Foot channels.

On the second day, the Yangming channel receives the pathogen, resulting in fever, eye pain, nasal dryness, and insomnia.
On the third day, the Shaoyang channel receives the pathogen, resulting in hypochondriac pain and deafness.
On the fourth day, the Taiyin channel receives the pathogen, resulting in abdominal fullness and dry throat.
On the fifth day, the Shaoyin channel receives the pathogen, resulting in dry eyes, dry tongue, and thirst.
On the sixth day, the Jueyin channel receives the pathogen, resulting in vexation, abdominal fullness, and contraction of the genitals.
To claim that transmission to the Hand-Jueyin Pericardium Sanjiao (Triple Burner) leads to the balance of Water and Fire and recovery, or that transmission to the Foot-Jueyin Liver channel leads to the failure of Earth and the attack of Wood resulting in death, is absurd talk. This passage describes the syndrome of the Foot-Jueyin Liver channel.

The great principle states: "For the first three days, the disease involves the Three Yang channels and is at the exterior, so sweating therapy is appropriate."
Sweating releases the heat; when the fever subsides and the body cools, recovery occurs.
"For the last three days, the disease involves the Three Yin channels and is at the interior, so purging therapy is appropriate."
Purging eliminates interior heat, allowing the constrained heat to dissipate and circulate freely. Recovery occurs with sweating and harmonized Qi. There are also cases where interior heat is exhausted via purging, no sweating occurs, yet Qi harmonizes and recovery ensues. To say "for the first three days, cold is at the exterior" is incorrect. These are all heat syndromes.

If the disease has not resolved, after another cycle, it begins to wane. On the seventh day, the Taiyang disease wanes (from here on, it refers to the natural decline of the disease); the head and neck pain improves slightly. On the eighth day, the Yangming disease wanes; body fever improves slightly. On the ninth day, the Shaoyang disease wanes; hearing returns slightly. On the tenth day, the Taiyin disease wanes; body fever improves slightly, but abdominal fullness remains as before. On the eleventh day, the Shaoyin disease wanes; thirst stops, abdominal fullness ceases (meaning the abdomen is no longer distended), tongue dryness persists, followed by sneezing. On the twelfth day, the Jueyin disease wanes; the genitals relax, the lower abdomen descends slightly, and the "Da Qi" (great pathogenic heat) disperses completely. The illness is cured (Chou, meaning recovered).
This is a general statement. One need not rigidly adhere to this timeline for Shanghan, but rather use it to understand the various syndromes and treat them according to the principles.