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[Outline] Zhang Zhongjing said: In Taiyin disease, if the pulse is floating, sweating therapy may be applied; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.

[Commentary] Zhu Gong said: After sweating therapy for a Taiyin syndrome, if chills and fever persist as before, one must examine the pulse. If the pulse is floating and rapid, or surging and large, it indicates that the exterior syndrome still exists, and exterior-releasing therapy can be used again, such as with Guizhi Tang (Cinnamon Twig Decoction) or Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction). Physicians, seeing that sweating or purging has already been performed, hesitate to use exterior-releasing therapy again when chills and fever recur; this is an error. Generally, a floating pulse indicates the pathogen is at the exterior; releasing the exterior will surely lead to recovery.

Li Zhongzi said: This occurs because either the exterior pathogen has not been fully cleared, or the pathogen has transmitted inward, or the pathogen invades internally taking advantage of deficiency. Thus, even after sweating, the disease remains.

Zhang Congzheng said: A floating pulse indicates the disease is at the exterior. Even if sweating has already occurred, or spontaneous sweating has happened, if the pulse remains floating, it means wind-heat at the exterior has not been fully resolved, and sweating can be performed again.

Wang Lü said: I once read Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), which states regarding Taiyin disease: "Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the zang organs; it should be warmed, and Si Ni Tang (Frigid Extremities Decoction) type formulas are suitable." Regarding Shaoyin disease, it states: "In Shaoyin disease, within one or two days of onset, if the mouth feels neutral and there is aversion to cold on the back, moxibustion should be applied. In Shaoyin disease, with body pain, cold hands and feet, bone and joint pain, and a deep pulse, Fuzi Tang (Aconite Decoction) is the primary treatment. In Shaoyin disease with diarrhea, Baotong Tang (White Onion Decoction) is used. In Shaoyin disease with diarrhea and a faint pulse, administer Baotong Tang. If diarrhea does not stop, accompanied by cold extremities, absence of pulse, dry heaving, and irritability, use Baotong Jia Zhuchidan Tang (Baotong Decoction with Pig Bile). In Shaoyin disease with diarrhea of undigested food, interior cold with exterior heat, cold extremities, and a pulse so faint it seems absent, yet the body feels no aversion to cold and the face appears red, or with abdominal pain, dry heaving, sore throat, or cessation of diarrhea with unpalpable pulse, Tongmai Si Ni Tang (Pulse-Returning Si Ni Decoction) is indicated. In Shaoyin disease with a deep pulse, urgent warming is required using Si Ni Tang (Frigid Extremities Decoction)." Regarding Jueyin disease, it states: "With cold extremities and a fine, nearly absent pulse, Danggui Sini Tang (Angelica Sinensis Decoction for Frigid Extremities) is used. After profuse sweating or severe diarrhea leading to cold extremities, Si Ni Tang (Frigid Extremities Decoction) is used." Observing these discussions by Zhang Zhongjing, it is clear that the Three Yin stages (Taiyin, Shaoyin, Jueyin) of Shanghan certainly involve cold syndromes and are suitable for warm-hot agents. However, upon reading Liu Shouzhen's works, he stated: "When Shanghan pathogenic heat is at the exterior, fu organ diseases are Yang; when pathogenic heat is at the interior, zang organ diseases are Yin. The vulgar misconception that there are distinct cold and hot yin-yang syndromes has misled people for a long time. Cold diseases exist, but they do not refer to Shanghan. Cold diseases belong only to miscellaneous diseases and cannot constitute Shanghan. Moreover, the qi of sweat is yang-heat qi, not something yin-cold can produce. Although Zhang Zhongjing mentions Si Ni Tang syndromes, these treat cases where exterior heat and interior harmony were mistakenly purged too early with cold medicines, causing exterior heat to enter the interior and resulting in persistent diarrhea, or cases of spontaneous diarrhea due to exterior heat and interior cold. Urgent use of warm medicines like Si Ni Tang stops diarrhea and harmonizes the interior, followed by urgent release of the exterior. Therefore, some Zhang Zhongjing Si Ni Tang syndromes are later treated with Chengqi Tang (Gardenia and Rhubarb Decoction) purgatives. From this, it follows that Shanghan is explicitly described in classics as a heat disease, not a cold one. The 'Three Yin syndromes' mentioned in classics refer to pathogenic heat residing in the zang and interior; since zang and interior are Yin, purging heat is required. Two chapters in *Suwen* discussing Shanghan heat diseases are named 'Heat,' containing no theory of cold. Deduced from the principles of luck and transformation in *Suwen* and *Lingshu*, these are indeed heat diseases, certainly not cold. Based on Liu Shouzhen's argument, Shanghan, whether at the exterior or interior, and regardless of the Three Yang or Three Yin stages, is uniformly heat, absolutely without cold. Cheng Wuji's annotations merely explain the text slightly without clarifying why it is heat or cold. He likely believed Shanghan always transmits through meridians, thus assuming all Six Meridian transmissions result in heat syndromes, believing heat cannot transform into cold, and therefore dared not distinguish otherwise. If it were inherent cold of the zang, how could one see only cold and not heat when heat pathogens transmit deeply into the interior? Would the warm-hot medicines used not aid the transmitting heat pathogen? If it were external cold pathogen, it would have already become heat in the Three Yang stages; how could it turn cold upon reaching the Three Yin? If Cheng had studied this deeply, he would have explained the rationale. Since Zhang Zhongjing wrote *Shanghan Lun*, everyone reveres it. Later generations, unable to decide between plausible and implausible interpretations, claim either that true Shanghan no longer exists in the world, or that modern people suffer from internal injury, or that all warm medicines in the Treatise are used for transmitting heat pathogens because the Three Yin meridians belong to Yin. Others claim every instance of the character 'cold' in the Treatise should be read as 'heat'; such errors have reached absurdity. They fail to realize that in Three Yang diseases, when cold pathogen is in the Taiyang meridian, cold stifles yang qi, causing stagnation and transformation into heat. Although yang qi is the righteous qi of the body, once stifled into pathogen, using Mahuang (Ephedra) to release the exterior expels cold, opening the pores and venting stifled heat, leading to recovery via sweating. If sweating fails to resolve it, heat cannot escape outward and must enter inward, transmitting to Yangming or Shaoyang, or entering the fu organs. As for Three Yin diseases, why are some cold and some hot? Generally, when cold pathogen injures the person, sometimes it stifles heat in Taiyang before transmitting sequentially to the Yin meridians; sometimes Taiyang does not transmit to Yangming or Shaoyang but directly to the Three Yin; sometimes the cold pathogen does not start from the Three Yang but directly injures the Yin meridians; sometimes starting from Taiyang, it enters Shaoyin before stifling heat, presenting solely as Shaoyin syndrome; sometimes entering Shaoyin immediately from Taiyang, while Taiyang is not entirely uninjured; sometimes direct injury leads immediately to transformation from cold to heat, or starting as cold and ending as heat. Stifled heat transmitting through meridians and transforming heat results in heat syndromes; direct injury to Yin meridians and immediate entry from Taiyang to Shaoyin result in cold syndromes. When Taiyang is not entirely uninjured, Shaoyin pulse and symptoms appear alongside Taiyang marker symptoms. Starting as cold and finally transforming to heat presents first with cold symptoms then heat symptoms. This is why Three Yin diseases present as either cold or hot. Careful examination of the chapters on the Three Yin meridians reveals this logic. Why do some transmit, some suffer direct injury, some enter immediately, and some go from cold to heat? Because pathogenic qi is violent and sudden, lacking fixed patterns, and its transmission is irregular. Hence, the classic says: Pathogens injuring humans have no constancy; some strike Yang, some strike Yin. Liu Shouzhen did not speak wildly to shock people; rather, he conflated Warm diseases and Summerheat diseases with Shanghan. Since Zhang Zhongjing's formulas often do not correspond to Warm/Summerheat treatments, he overlooked warm agents and routinely used cold-cool ones. By categorizing Shanghan strictly as heat without cold, he labeled Si Ni Tang as a cold medicine, misunderstanding syndromes of exterior heat with interior harmony, and those of exterior heat with interior cold causing spontaneous diarrhea. He claimed warming the interior stops diarrhea and urgently releases the exterior, and that cold diseases are merely miscellaneous diseases. Alas! Zhang Zhongjing's *Shanghan Lun* was specifically composed for Shanghan contracted immediately upon exposure to cold, not for non-immediate Warm or Summerheat diseases. Thus, cold syndromes of the Three Yin occur, necessitating the use of warm agents. Although cold medicines mistakenly purging into interior cold is possible, can we say interior cold arising spontaneously without such mistake is impossible? It is unknown that cold syndromes frequently seen in Yin meridins originate from cold pathogens, not from direct injury by Yang meridians, nor from entering quickly from Yang meridians before heat stifling occurs. Even if caused by mistaken cold purgation, it is rare. Did Zhang Zhongjing create various warm agents solely for mistaken cold purgation? Furthermore, in cases of simultaneous exterior and interior cold, where is the text urging urgent exterior release? The syndrome of interior cold with exterior heat is caused by cold pathogen invading internally, forcing yang qi outward, or false yang qi manifesting as exterior heat; it is not true heat pathogen. Moreover, Zhang Zhongjing treats interior cold with warm medicines without addressing exterior heat in such cases, revealing his therapeutic intent. If urgent exterior release were truly indicated, would he not state it clearly after the interior harmonizes? *Neijing* describes Three Yin diseases as uniformly heat, stating the norm; Zhang Zhongjing describes them as mixed cold and heat, stating the variation. Both proceed without contradiction. If students understand that Three Yin meridians inherently have cold syndromes caused by cold pathogens, the original intent of Zhang Zhongjing's methods becomes clear. Zhang Zhongjing also said: Diseases presenting with fever and aversion to cold arise from Yang; those without fever but with aversion to cold arise from Yin. Those arising from Yang heal in seven days; those arising from Yin heal in six days. 'No fever, aversion to cold' indicates it is not stifled heat of Yang meridians. 'Arising from Yin' indicates it did not transmit from Yang meridians. 'Healing in six days' indicates it did not start from Taiyang but began counting from the day of Yin meridian onset. Zhang Zhongjing further said: In Shanghan, if cold extremities appear from day one to four or five, fever will inevitably follow. If cold extremities last five days, fever lasts five days; if on the sixth day cold extremities return but do not, the disease heals itself. If cold extremities last four days, fever lasts three days, then cold extremities return for five days, the disease progresses. Can Shanghan presenting with cold extremities before fever be caused by heat pathogens transmitting deeply? Many people today present with various cold symptoms from the onset, with no heat; this is direct injury to Yin meridians and immediate entry into Yin. If one cannot fathom Zhang Zhongjing's intent and rigidly adheres to the saying that all cold injuries become heat diseases for treatment, few would avoid premature death.