Library

The treatment principles for Cold Damage (Shanghan) and Warm Diseases (Wenbing) differ significantly between the North and the South. In the North, the Qi transformation of Heaven and Earth is predominantly dry. The human body's respiration and interstices (Couli, 腠理 - pores and muscle intervals) are also influenced by dryness. When Dryness governs, the climate is cool and crisp, causing contraction; thus, treatment often requires nourishing Blood to relax sinews. In the South, the Qi transformation of Heaven and Earth is predominantly damp. The human body's respiration and interstices are influenced by dampness. When Dampness governs, the climate is turbid and stagnant; thus, treatment often requires clearing Blood to strengthen sinews.

Furthermore, Southerners moving to the North often suffer from Malaria (Nüe, 疟疾) and Dysentery (Li, 痢疾); Northerners moving to the South often suffer from Cold Damage and Warm Diseases. This occurs because the water-damp pathogenic factors in the interstices of Southerners are constrained by the Northern climate, preventing them from being evaporated and excreted through sweating, leading them to penetrate into the blood vessels. Qi stagnation and Blood stasis result in Malaria; Qi sinking and Blood溃散 (scattering/rupture) result in Dysentery. Conversely, Cold latent in the Lower Jiao (Lower Burner, 下焦) is stirred up by Southern Earth Qi, rising and ascending. It may overflow into the Triple Burner (Sanjiao, 三焦) or disperse into the meridians. If Cold is excessive while the Middle Jiao (Middle Burner, 中焦) lacks Heat, it triggers Cold Damage due to Lower Jiao Cold. If Middle Jiao accumulated Heat erupts simultaneously, it results in Warm Disease caused by latent Cold and Heat.

In such cases, even if there are new exterior manifestations, heavy diaphoresis (sweating therapy, 发汗) is contraindicated. For Malaria and Dysentery, harmonizing Blood and promoting Qi circulation to transform Dampness should be used. For Cold Damage, mild clearing and descending is appropriate. For Warm Diseases, clearing first followed by warming and descending is indicated.

One might ask: "You previously argued that Malaria and Dysentery should be treated with diaphoresis to vent pathogens; now you say heavy sweating is unsuitable even for new exterior signs. Why?" I reply: "Southern Malaria and Dysentery stem from Summer-Heat and Dampness latent since summer, manifesting in autumn. At that time, Damp-Heat steams and boils, and the interstices are open. If Wei Yang (Defensive Yang, 卫阳) is not strengthened to resist exterior pathogens, pathogenic factors will flood in continuously, and the disease cannot heal. However, upon arriving in the North, the air is dry and skin pores constrict; the source of pathogens is cut off. Therefore, treatment should focus on resolving internally. One must not force sweating against the natural Qi flow, which would empty the exterior and secretly damage True Yuan (True Origin/Essence, 真元). Does this mean no sweating at all? No, it simply means avoiding strong acrid-warm formulas to force sweating."

"What about Cold Damage and Warm Diseases?" I reply: "These inevitably involve profuse sweating, but this is not achieved through dispersing agents. By using warming/descending or clearing methods, slight dispersion guides the pathogens, waiting for the right time for spontaneous sweating. If one forces sweating, Qi moves but pathogens do not exit; sweat comes out but heat does not recede, leading to complicated diseases (Huabing, 坏病). Whose fault is this? Generally, complicated diseases arise from treating the upper while neglecting the lower, or treating Qi while neglecting Blood."