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The *Yin Yang Da Lun* (Great Treatise on Yin and Yang) states: The climate of spring is mild, summer is hot and humid, autumn is cool and clear, and winter is cold and piercing. This is the sequence of the normal qi of the four seasons. In winter, when it is severely cold, all things hide deeply. A gentleman who can secure and close his pores will not be injured by cold. Those who are exposed to and offend against the cold are said to have contracted Shanghan (Cold Damage). Injuries caused by the qi of the four seasons can all lead to disease, but among them, Shanghan is the most severe because it constitutes the most lethal and destructive qi. If one contracts cold and falls ill immediately, it is named Shanghan. If one does not fall ill immediately, the cold toxin hides in the skin and muscles; when spring arrives, it transforms into Wenbing (Warm Disease); when summer arrives, it transforms into Rebing (Heat Disease). Rebing refers to heat that is extreme and heavier than Wenbing. Therefore, hardworking people often suffer from warm-heat diseases in spring and summer, all caused by contracting cold in winter, not by the qi of seasonal epidemics.

If the cold toxin hides in the skin and muscles, it transforms into Wenbing in spring; if it hides in the bone marrow, it transforms into Rebing in summer. (The text omits the intermediate stage between hiding in the skin/muscles and the bone marrow, which is a missing slip.) The *Neijing* (Inner Canon) says: "Injury by cold in winter leads to Wenbing in spring." It also says: "Violating the qi of winter storage causes Shaoyin (Lesser Yin) to fail to store, and the Kidney qi sinks alone." This means that during winter, when the climate is unevenly warm and cold, during warm periods, a person's pores are not firm. If sudden severe cold arrives, it depresses and closes the abnormal qi inside. At this time, the meridians of Shaoyin circulate outward and cannot retreat to store tightly, inevitably receiving the pathogen. However, the true yang stored in the Kidneys, if sunk within, itself does not receive the pathogen; only the meridians of Shaoyin receive it. Thus, those with abundant true yang are not harmed by pathogens; even if infected, the qi moves and dissipates. Only those who fail to store essence first violate the command of winter hibernation and storage, allowing pathogens to invade the meridians and bone marrow. When the warm-heat qi of spring and summer stirs internally, warm-heat diseases erupt.

Li Dongyuan (Li Mingzhi) said: "Winter injury by cold" occurs because winter follows the order of spring (it should be cold but is warm). In winter, fire prevails and water is deficient. Since water is deficient, earth overacts. Fire and earth combine their virtues, thus causing Wenbing. The reason it does not manifest in winter but in spring is that cold water resides in the Mao sector (East/Wood), holding power, and the great cold command reappears in spring. The pores open and leak. Shaoyin fails to store, compounded by sexual exhaustion. Hardworking people leak yang externally, and Kidney water is deficient internally. Wood should generate, but yang has already leaked externally; who will inspire vitality? Kidney water is exhausted internally; who will nourish? These two conditions coexist. The source of generation and transformation is cut off; how can wood grow? What remains in the body is heat. The season strengthens, and wood grows, thus causing Wenbing.

Whenever there is a seasonal epidemic, spring should be warm but is instead severely cold; summer should be very hot but is instead very cool; autumn should be cool but is instead very hot; winter should be cold but is instead very warm. This is having the qi of a different season at the wrong time. Therefore, throughout the year, the illnesses of young and old are mostly similar. This is the qi of seasonal epidemics.

Shanghan is contracting the austere and killing qi of heaven, where cold offends cold, necessarily passing through the icy phase. Seasonal epidemics contract the damp-earth stagnant qi, where dampness offends dampness, necessarily passing through the damp-earth phase. Yangming Stomach meridian is the origin of Ying (Nutritive) and Wei (Defensive) qi. Initially, both Ying and Wei are diseased, meridians are indistinguishable, Sanjiao (Triple Burner) is mixed, and internal and external communication is blocked. Thus, the disease erupts suddenly and violently, unlike Shanghan which transmits sequentially through meridians. The earth is the total return of filth and turbid evil, accepting everything normally. When the abnormal qi of heaven reaches its extreme, the filth and turbid evil received normally must also erupt swiftly with the times. Or, if winter is excessively warm, the killing command does not act, and spring becomes severely cold. Or, in midsummer, damp-heat and filth qi steam together, suddenly generating wind from extreme heat, entering while sweat pores close and reject, preventing toxic pathogens from excreting, causing disease regardless of age. This is the qi of seasonal epidemics.

From Frost Descent until Spring Equinox, anyone who touches frost and dew, has weak constitution, suffers middle-cold, and falls ill immediately, is called Shanghan.

(This implies: If not weak, even with wind-cold, harm cannot occur.)

Non-seasonal warmth in winter is called Dongwen (Winter Warmth). The toxin of Dongwen is greatly different from Shanghan, varying in severity and requiring different treatments.

Dongwen occurs when it should be severely cold but is instead very warm. East wind blows, pores open, suddenly severe cold comes, clothing is thin, cold depresses the pathogen, and illness erupts immediately. Because the contracted qi is not the seasonal warm qi, it is said to be greatly different from Shanghan. If it does not erupt immediately, hiding in the skin, it enters and injures blood vessels, erupting as Wenbing in spring; hiding in meridians, it enters and injures bone marrow, erupting as Rebing in summer.

From Start of Winter, if there is no violent severe cold, no ice or snow, yet someone suffers high fever, this belongs to spring yang qi emerging from winter latent cold, transforming into Wenbing.

"Spring yang qi emerges in winter before its time; latent cold transforms into Wenbing": This means non-seasonal abnormal warm qi, suppressed by external cold, erupts as Wenbing in spring.

From Spring Equinox until before Autumn Equinox, if violent cold occurs in the sky, it is all Shixing Hanyi (Seasonal Cold Epidemic). Its symptoms resemble Wenbing and Rebing, but treatment differs.

This describes non-seasonal violent cold. Although similar to warm-heat, the source and destination are vastly different. Latent qi erupts from inside out, requiring bitter-cold herbs to drain internally. Violent cold is contracted from outside, requiring acrid-sweet herbs to resolve externally. Hence, treatment differs.

Any injury by cold results in heat disease. Even if heat is intense, death does not ensue. If one contracts cold on two levels (Lianggan) and falls ill, death is certain.

If Cun and Chi pulses are both floating, Taiyang (Greater Yang) is diseased. Eruption occurs on days 1-2. Because its meridian connects to Fengfu, headache, stiff neck, and back stiffness occur.

If Cun and Chi pulses are both long, Yangming (Bright Yang) is diseased. Eruption occurs on days 2-3. Because its meridian flanks the nose and connects to the eyes, fever, eye pain, dry nose, and inability to sleep occur.

If Cun and Chi pulses are both wiry, Shaoyang (Lesser Yang) is diseased. Eruption occurs on days 3-4. Because its meridian follows the hypochondrium and connects to the ears, hypochondriac pain and deafness occur.

For these three meridians, if diseased but not yet entered the Fu organs, sweating can disperse it.

If Cun and Chi pulses are both deep and fine, Taiyin (Greater Yin) is diseased. Eruption occurs on days 4-5. Because its meridian spreads in the stomach and connects to the throat, abdominal fullness and dry throat occur.

If Cun and Chi pulses are both deep, Shaoyin (Lesser Yin) is diseased. Eruption occurs on days 5-6. Because its meridian penetrates the Kidney, connects to the Lung system and tongue root, dry mouth, dry tongue, and thirst occur.

If Cun and Chi pulses are both faint and slow, Jueyin (Terminal Yin) is diseased. Eruption occurs on days 6-7. Because its meridian follows the genitalia and connects to the Liver, irritability, fullness, and testicular contraction occur.

For these three meridians, if diseased and already entered the Fu organs, purgation can resolve it.

The transmission of Shanghan along meridians cannot originally be measured by days. These six meridians' diseases are merely examples. Crude physicians, failing to observe the mechanism, often assume sweating is needed on days 3-4 and purgation on days 6-7, harming many. If latent qi erupts as Wenbing, can one sweat on day 3-4? If disease transmits to Jueyin on day 6-7, can one purge? Such distinctions must be recognized. ○ Whenever "Cun Chi" is mentioned, Guan is included, understood without saying.

If Lianggan (two-level contraction) occurs, on day 1 Taiyang is diseased, simultaneously with Shaoyin, causing headache, dry mouth, irritability, fullness, and thirst. On day 2 Yangming is diseased, simultaneously with Taiyin, causing abdominal fullness, fever, aversion to food, and delirious speech. On day 3 Shaoyang is diseased, simultaneously with Jueyin, causing deafness, testicular contraction, and cold limbs. If unable to drink fluids and unconscious, death occurs on day 6. If all Three Yin and Three Yang, Five Zang and Six Fu are diseased, Ying and Wei cease to circulate, Zang and Fu blockage leads to death.

If both Yin and Yang syndromes appear upon getting sick, and transmission involves both Yin and Yang meridians, pathogenic qi fills and overwhelms. According to method, death occurs on day 3. But only if fluids are not taken and consciousness is lost, indicating Ying/Wei cessation and Zang/Fu blockage, does death follow after another three days when Yangming meridian qi finally perishes.

If not Lianggan, no transmission, no added abnormal qi, on day 7 Taiyang disease wanes, headache lessens. Day 8 Yangming disease wanes, fever rests slightly. Day 9 Shaoyang disease wanes, hearing slightly returns. Day 10 Taiyin disease wanes, abdomen reduces, appetite returns. Day 11 Shaoyin disease wanes, thirst stops, tongue dries, then sneezing occurs. Day 12 Jueyin disease wanes, scrotum relaxes, lower abdomen softens, great qi departs, patient spirit refreshes.

No transmission, no added abnormal qi, pathogenic qi exhausts, righteous qi recovers, recovery date is expectable. Yet this is general principle, do not rigidly adhere. If additional abnormal qi adds to the disease, it is disease within disease, not limited by days.

If beyond thirteen days, no interval, and Cun/Chi pulses sink, it is critical danger.

Sinking pulses indicate righteous qi deficiency, unable to carry pathogen out. Passing the meridian period without relief is indeed critical.

If further affected by abnormal qi, transforming into other diseases, treat according to Huazheng (Ruined Syndrome) principles.

If pulse Yin/Yang both excess, re-contracting cold transforms into Wen Nue (Warm Malaria).

Yang pulse floating/slippery, Yin pulse soft/weak, encountering wind transforms into Fengwen (Wind Warmth).

Yang pulse surging/rapid, Yin pulse solid/large, encountering warm-heat transforms into Wendu (Warm Toxicity). Wendu disease is heaviest.

Yang pulse soft/weak, Yin pulse wiry/tight, encountering warm qi transforms into Wenyi (Warm Epidemic).

These result from winter cold injury erupting as Wenbing. Pulse changes, syndromes, and prescriptions are as stated.

Syndromes and pulses all transform into heat; acrid-warm releasing methods must not be reused. Prescriptions are as stated.

All Shanghan diseases mostly arise from wind-cold. Initially wind-cold in the exterior, entering interior does not dissipate. None dissipate merely by covering with warmth. This is not within standard syndrome treatment.

To attack internally, one must first release the exterior, then purge.

If exterior is resolved but interior stagnation remains, if not major fullness, cold/heat may still arise, disease persists. If major fullness, major excess, hardness, and dry feces exist, purgation can naturally remove them. Even if four-five days pass, no disaster ensues.

Purging without major fullness/excess generates cold/heat transformations. Wait for major fullness/excess/hardness/dry feces before purging. Delaying to four-five days causes no harm.

If purging is inappropriate but performed, interior deficiency allows heat entry,協热 (collateral heat) diarrhea, irritability, etc., countless transformations. Light cases become critical, heavy cases die.

Yang excess/Yin deficiency: Sweating kills, purging heals. Yang deficiency/Yin excess: Sweating heals, purging kills.

Yang occupying Yin position is Yang excess/Yin deficiency, so purgation allowed, sweating forbidden. Yin occupying Yang position is Yang deficiency/Yin excess, so sweating allowed, purgation forbidden. This is "Exterior disease, Interior harmonious; Interior disease, Exterior harmonious." Generally, Exterior excess/Interior deficiency with pathogen entering Fu: sweating kills, purging heals. Interior excess/Exterior deficiency with pathogen depressed in meridians: purging kills, sweating heals.

Thus, how can Shendan (potent diaphoretic) be mistakenly issued? How can Gansui (potent purgative) be recklessly attacked? Treatment of deficiency/excess differs by a thousand miles. Mechanism of fortune/misfortune responds like shadow/form. Is it easy? Once Guizhi Tang enters the throat, Yang excess leads to death. Once Chengqi Tang enters the stomach, Yin excess leads to demise. Life/death hinges on an instant. Observing the whole body leaves no time to count days. This is the interlacing of Yin/Yang deficiency/excess. Signs are subtle. Opposite actions of sweating/vomiting/purging bring rapid disaster. Physicians shallow in skill, ignorant of disease source, cause patient death, claiming it is their due. Benevolent ones seeing this, would not they grieve?

"Guizhi Tang enters throat, Yang excess dies; Chengqi Tang enters stomach, Yin excess perishes" generally states the significance of sweating/purging, using these as examples. It does not mean misusing these two decoctions inevitably leads to untreatable death.

For Lianggan diseases occurring together, treatment has priority. Releasing exterior and attacking interior are fundamentally different. Those confused by heat and madness claim Shendan and Gansui can be drunk together, resolving exterior and removing interior. This sounds clever but violates principle. Wise acts cautiously; foolish acts decisively and quickly. Changes in safety/danger, how can they be deceptive?

Lianggan are all heat pathogens, but treatment has priority. Releasing exterior and attacking interior are distinct. This view is correct and clear. Why did Fengyi (Wang Lv) mistake it for rescuing the interior?

When sweating, take herbal medicine warm. Although prescription says three doses daily, if disease is severe and unresolved, shorten intervals, finishing three doses in half a day. If medicine clashes with disease, even if some sensation arises, if after one dose syndrome persists, continue taking the same decoction. Some do not sweat until three doses are taken. If no sweat occurs, it is a death case.

For seasonal qi diseases, by day 5-6, if thirsty for water but drinking little, do not give much. Why? Stomach heat is still slight, cannot digest it. Giving more water creates new disease.

By day 7-8, if greatly thirsty for water, still give according to syndrome. Give moderately, do not force excessive intake.

If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccuping, do not give. Sudden profuse sweating indicates self-healing.

Any disease where one can drink water indicates impending healing. Those ignorant hear "drinking water heals," and for slight thirst, force-feed water, causing disaster irreparable.

The above four items concern warm-heat pathogens of spring/summer, hence seasonal qi diseases allow water. Not comparable to winter Zheng Shanghan.

Any disease with Jue pulse (extreme reversal) moving/rapid, after taking medicine pulse becomes slower, pulse floats/large then decreases, initial restlessness then calmness, are all healing signs.

"Jue pulse moving/rapid" means the pulse is moving/rapid; do not link to previous sentence.