（此系仲景原文）
四时八节。二十四气。七十二候决病法。
立春正月节。斗指艮。（艮者。土木之气。主湿与风。位居东北。不配脏腑。）
雨水正月中。指寅（寅为少阳相火之气。主热。配三焦。此直格中之说。愚谓寅为阳木。主风。配胆。位居于东。
以其中有丙火之气。故又主热。）
惊蛰二月节。指甲。（甲属木。主风配胆。又兼土化。主湿。）
春分二月中。指卯。（卯为阳明燥金之气。配大肠此亦直格中之说。愚谓卯为阴木。主风配肝。位居正东。因其与酉
金相冲。故例从阳明。兼主燥气。）
清明三月节。指乙。（乙属木。主风配肝。又兼金化。主燥。）
谷雨三月中。指辰。（辰为太阳寒水之气配小肠此亦直格中之说。愚谓辰为阳土。主湿。配胃。以其中兼癸水之气。
故又主寒。）
（琥）按以上春三月人病伤寒。当由风湿热三气居多。况乎地之初气。厥阴风木。虽起于大寒节。至立春雨水惊蛰。
正当其令。其二之气。少阴君火。又当春厘清明谷雨之时。则是春月之病。虽因于寒。纯是风热其间有病燥者。此系兼
化之气。人于二三月时。或有之又人于正月初为湿土之交。二月节。遇湿土之化。三月中。当湿土之令。病湿者亦自不
少。可见为风为热。为燥为湿。多由寒气中来。岂得但认以为寒而误治之哉。今夫以一日之间。旦晚每多异气。如能洞
悉气宜。则医之为道。庶不远矣。
立夏四月节。斗指巽（巽属木。主风。位居东南。不配脏腑。）
小满四月中。指巳。（巳为厥阴风木之气。配包络此直格中之说。愚谓巳为阳火。主热。配小肠。位居于南。以其与
亥水相冲。亥中有甲木之气。故亦主风。）
芒种五月节。指丙（丙属火。主热。配小肠。又兼水化。主寒。）
夏至五月中。指午。（午属火主暑气配心。）
小暑六月节指丁。（丁属火。主暑气。配心。又兼木化。主风。）
大暑六月中指未。（未为太阴湿土之气。配肺。此亦直格中之说。愚谓未为阴土。主湿配脾。）
（琥）按以上夏三月人病伤寒。当由暑热风湿之气居多。惟五月节斗指丙。丙从辛化而生寒。其病者终以寒为标。
热为本。至于地之二气。少阴君火。终于立夏四月节。其时之病。多风热。三之气。太阴湿土。正当小满芒种夏至小暑
之时。其时之病。多风热暑湿。四之气。少阳相火又起于大暑六月中。故其时之病纯是湿热。但以寒为名也。
立秋七月节。斗指坤。（坤属土。主湿气。位居西南不配脏腑）
处暑七月中。指申。（申为少阳相火之气。主大热配胆。此直格中之说。愚谓申为阳金。主燥配大肠。位居于西。以
其与寅相冲。寅中有丙火之气。故主大热。）
白露八月节。指庚（庚属金。主燥气。配大肠）
秋分八月中。指酉。（酉为阳明燥金之气。配胃。此亦直格中之说。愚以酉为阴金。主燥。配肺位居正西。）
寒露九月节。指辛（辛属金。主燥气。配肺。又兼水化。主寒。）
霜降九月中。指戌。（戌为太阳寒水之气。配膀胱。此亦直格中之说。愚以戌为阳土。主湿。配胃。以其与辰相冲。
辰中有癸水之气。故又主寒。）
（琥）按以上秋三月人病伤寒。当由燥热湿三气居多。惟九月中寒气已甚。然其病。亦兼燥气与湿。至于地之四气。
少阳相火。正当立秋处暑白露之时。五之气阳明燥金。又当秋分寒露霜降之令。乃知秋病多燥热。如认以为寒误矣。
立冬十月节斗指干（干属金。主燥气。位居西北。不配脏腑。）
小雪十月中。指亥（亥为厥阴风木之气。配肝此直格中之说。愚以亥为阳水。主寒。配膀胱。以其中有甲木之气。
故又主风。）
大雪十一月节指壬。（壬属水。主寒气。配膀胱。又兼木化。主风。）
冬至十一月中。指子（子为少阴君火之气。主暑配肾。此亦直格中之说。愚以子为阴水。主寒配肾。以其冲动午火。
故又主暑气。）
小寒十二月节指癸（癸属水主寒气配肾又从火化。故主热。）
大寒十二月中。指丑（丑属土。主湿气。配脾。）
（琥）按以上冬三月人病伤寒。当由风寒之气居多。然地之五气。阳明燥金。终于立冬十月节。其病多燥。燥亦风
热。从木火也。惟地之终气。太阳寒水。正当小雪大雪冬至小寒之时。其时为正伤寒。然细推小雪十月中。斗指亥其兼
气主风。大雪十一月节指壬。其化气亦主风。冬至十一月中。其冲气主暑。小寒十二月节。其化气又主热。乃知其时之
病。又兼风热。至大寒十二月中。厥阴风木之气复起。况斗柄又指丑。丑为湿土。人病风湿。在所不免以是知冬月之正
伤寒。亦不专于寒也。
二十四气节有十二。中气有十二。五日为一候。气亦同合。有七十二候。决病生死。此须洞解之也。（按以上正文。
今仲景全书中。列于阴阳大论云云前。伤寒准绳中。序之于皆当按斗历占之之下。诸家注伤寒论。遂删此段正文。殊为
脱略。愚今纂注之于伤寒例首。从全书也。）
（琥）总按上时节气候决病法。此仲景伤寒论一部纲领。以故为例之首。至王叔和反以脉法列于前者。此撰次之僭
也。推前人立法之意以伤寒一证。寒邪之气。自外而伤于人。则人在气交之中。同是受寒。当分四时之不同。盖春之寒。
必兼温气而至。夏之寒。必兼暑气而至。秋之寒。必兼燥气而至。长夏四季之寒。必兼湿气而至。惟冬之寒为正寒。正
寒之气。其时病者。不能即解。寒不解则热愈深。三时之寒为暴寒。暴寒之气其时病者易于解散。寒易散。故其热有重
有轻。
大抵病兼异气。必因乎时。药有异宜。亦因乎时。即如一人。于冬月患病。其初伤大寒之气。既病一二日后。寒气
忽解。天道大温。则病患之气。亦随时而异。用药之道。不无少差。所以伤寒之称。一名时气。知时知气。斯医之为道。
可判然于胸中矣。
阴阳大论云。春气温和。夏气暑热。秋气清凉。冬气冷冽。此则四时正气之序也。（按内经有阴阳应象大论。其中无
春夏秋冬四语。想此是仲景自立之论。而叔和又参以己意之辞。内经本论中语云。天有四时五行。以生长收藏以生寒暑
燥湿风。愚以仲景所云温和者。即是风气。其令为春而主生。云暑热者。即是暑气。其令为夏而主长。云清凉者。即是
燥气。其令为秋而主收。云冷冽者。即是寒气。其令为冬而主藏。其不言湿气者。已具于四季之中。而生长收藏之道备
焉。故云四时正气之序。此论仲景实本内经之意。所以王氏直序为阴阳大论云云也。）
冬时严寒。万类深藏君子固密。则不伤于寒。触冒之者。乃名伤寒耳。（此承上文而言。冬气冷冽而为寒。则其令主
藏。养生君子。亦宜效万物而深藏固密者。居处周密也。处不周密。则触冒严寒之气。所以谓之伤寒。）
其伤于四时之气。皆能为病。（春风夏暑秋燥冬寒。此谓四时之气。成注以秋气为湿。误矣。愚以湿气。即具于长夏
及四季之中。此言四时之气。皆能为病不独冬时之有伤寒也。）
以伤寒为毒者。以其最成杀厉之气也。（喻嘉言云。入一毒字。便开过端。殊不知伤寒之人。寒盛于外。热深于内。
发而为斑黄。为吐衄为狐惑。为口舌糜烂。为肺痿呕脓。为发颐肿溃。非毒而何。最。聚也。杀厉者。寒气肃杀暴厉。
谓伤寒之毒。纯是杀厉之气聚成也。）
中而即病者。名曰伤寒（病。疾之甚也。言有寒疾而甚者。名曰伤寒。所以仲景辨伤寒。凡六经之证。皆曰病也。
下文云。不即病者。言有寒疾而不甚也。王安道以不即病者。过时而发于春夏。方其受寒之时。其人不觉有疾。误矣）
不即病者。寒毒藏于肌肤。至春变为温病。至夏变为暑病。（内经热论云。凡病伤寒而成温者。先夏至日者为病温。
后夏至日者为病暑。又生气通天论。阴阳应象论皆云。冬伤于寒。春必病温。推内经之意。以寒自伤于冬至春则寒气转
而为温。至夏则温气又转而为暑。所以同是外来之邪。不得仍以正伤寒名之也。且考内经上文云。春伤于风。邪气留连。
乃为洞泄。则是冬时所伤寒邪之气。亦必着人肤腠肌肉之间。留连成疾。积久不愈。至春令大温。遂变而成温病。内经
中不言留连者。乃省文也。其云至夏变为暑病。此与经旨相悖。更考内经下文云夏伤于暑。秋必 疟。是疟者。不即病
之暑。其即病者。乃夏时自伤之暑也。引经断论。黄帝岐伯皆云暑自夏伤。至仲景独云暑由寒变。若云可变。将秋时之
疟。亦由冬寒变成。有是理乎。所以方中行起而削之。喻嘉言起而非之也。）
暑病者。热极。重于温也。（夏暑之气。重于春温若人感其气而成病。则不论温暑。各有轻重。不可拘也。）
是以辛苦之人。春夏多温热病者。皆由冬时触寒所致非时行之气也。（此承上文君子固密不伤于寒而言。是以辛苦之
人。因冬时不能固密。春夏多温热病。且言其病非时行之气。皆由触寒所致。内经未闻有冬伤于寒。夏必病热之语。斯
言如出之仲景。为可削矣。）
凡时行者。春时应暖而反大寒。夏时应热而反大凉。秋时应凉而反大热。冬时应寒而反大温。此非其时而有其气。
是以一岁之中。长幼之病多相似者。此则时行之气也。（大寒。补亡论作大凉。金克木也。大凉。外台秘要中作大冷水克
火也。秋时大热。火克金也。冬时大温。每与湿气并行。土克水也，凡此者。皆贼邪之气。故云非其时而有其气。非时
之气。感受必同。所以一岁之中。凡四时之病。长幼多相似也。愚谓以上时行之气。不过是四时热病。皆伤寒之类。春
时应暖而反大寒。人因其暖。不料其寒。则为春伤寒。既伤之后。暖气仍回。同温病也。夏时应热而反大凉。人因其热。
不觉其凉。凉中即有寒气则为夏伤寒。既伤之后。热气仍回。同暑病也。秋时应凉而反大热。人亦因其热。不御其凉。
则为秋伤寒。既伤之后。凉郁其热。同燥病也。冬时应寒而反大温。人又因其温。反忘其寒。则为冬伤寒。既伤之后。
寒包其温。非真寒也。巢元方以一岁之中。病无长幼。率多相似。为天行病。且以春温寒疫之证指之。即天行温疫病。
俗又从疾。通名瘟疫。昔医如朱奉议。孙真人。许学士。庞安时常器之辈。皆相承其说。不觉其非。至吴又可始作温疫
论二卷。言天地间。别有一种异气触人。乃名温疫。又喻嘉言复作尚论篇。详论温疫以破大惑。乃知仲景所言。不过四
时所行不正之气。即内经云伤寒之类是也。）
夫欲候知四时正气为病。及时行疫气之法。皆当按斗历占之。（四时正气。即上第三节云四时之气也。时行疫气。即
上节云时行之气也。成注既言时行之气。又言温与疫者。误也。温即冬时应寒而反大温之温下文云冬温是也。况此节正
文无温字。若言是春温。误之误矣。疫即三时反寒反凉之气。下文云寒疫是也。按此温疫。并非大瘟大疫。予于上文已
明言之。占测也。候也。成注云占前斗建。审其时候之寒温。察其邪气之轻重。言当按斗柄所指之节气而测候之也之指
下文伤寒冬温寒疫等证而言。又按成注云占前斗建可见四时八节决病法。当在阴阳大论之前。）
九月霜降节后。宜渐寒向冬大寒。至正月雨水节后。宜解也。所以谓之雨水者。以冰雪解而为雨水故也。至惊蛰二
月节后。气渐和暖。向夏大热。至秋便凉。（成注云。此为四时之正气。）
从霜降以后。至春分以前。凡有触冒霜露。体中寒即病者。谓之伤寒也。（体中寒伤。寒缵论作体虚中寒甚通夫寒为
冬月之正气。正气何能伤人。其为寒中者因其人体气先虚故也。中字作伤字解。莫认作中寒之中。盖中寒是冷证。伤寒
是热证不可混也。）
九月十月。寒气尚微为病则轻。十一月十二月。寒冽已严为病则重。正月二月。寒渐将解。为病亦轻此以冬时不调。
适有伤寒之人。即为病也。（按此节仲景书系正文成氏例改作注。故诸家纂仲景书者屡屡削之。成注云。此为四时正气。
中而即病者也。）
其冬有非节之暖者。名曰冬温冬温之毒与伤寒大异。冬温复有先后。更相重沓。亦有轻重。为治不同。证如后章。
（成注云此为时行之气。即前第九节云冬时应寒而反大温者是也。冬温虽与伤寒异。然亦不过是伤寒之类。寒有寒毒。
则温有温毒。一句便了。其云复有先后更相重沓者。明系叔和杂入之语。故喻嘉言注云。此与仲景之文无涉也。喻氏复
云。证如后章其意盖指篇后温疟风温温毒温疫为言。此无识之最者也。愚因删去使无增后学之疑。）
从立春节后。其中无暴大寒。又不冰雪。而有人壮热为病者。此属春时阳气。发于外。冬时伏寒变为温病。（诸家本
皆无外字。觉辞意不贯。今从准绳伤寒例增入。成注云此为温病也。王宇泰云。此是外邪唤出内邪。乃冬伤于寒所致。）
从春分以后至秋分节前。天有暴寒者。皆为时行寒疫也。（此亦时行之气即前第九节云。春时反寒夏时反凉者是也。
(This is the original text of Zhang Zhongjing)
The method for determining diseases based on the Four Seasons, Eight Solar Terms, Twenty-Four Solar Terms, and Seventy-Two Pentads.
Lichun (Start of Spring), first month solar term: The Big Dipper points to Gen. (Gen represents the Qi of Earth and Wood, governing Dampness and Wind, located in the Northeast, not corresponding to Zang-Fu organs.)
Yushui (Rain Water), middle of the first month: The Big Dipper points to Yin. (Yin is the Qi of Shaoyang Ministerial Fire, governing Heat, corresponding to the Sanjiao. This is a direct correspondence theory; I believe Yin is Yang Wood, governing Wind, corresponding to the Gallbladder, located in the East. Because it contains the Qi of Bing Fire, it also governs Heat.)
Jingzhe (Awakening of Insects), second month solar term: The Big Dipper points to Jia. (Jia belongs to Wood, governing Wind, corresponding to the Gallbladder, and additionally possesses Earth transformation, governing Dampness.)
Chunfen (Spring Equinox), middle of the second month: The Big Dipper points to Mao. (Mao is the Qi of Yangming Dryness Metal, corresponding to the Large Intestine. This is also a direct correspondence theory; I believe Mao is Yin Wood, governing Wind, corresponding to the Liver, located due East. Because it clashes with You Metal, it follows Yangming by example and additionally governs Dryness.)
Qingming (Clear and Bright), third month solar term: The Big Dipper points to Yi. (Yi belongs to Wood, governing Wind, corresponding to the Liver, and additionally possesses Metal transformation, governing Dryness.)
Guyu (Grain Rain), middle of the third month: The Big Dipper points to Chen. (Chen is the Qi of Taiyang Cold Water, corresponding to the Small Intestine. This is also a direct correspondence theory; I believe Chen is Yang Earth, governing Dampness, corresponding to the Stomach. Because it additionally contains the Qi of Gui Water, it also governs Cold.)
(Hu's Commentary: Regarding the above three months of Spring, when humans contract Shanghan disease, it is mostly due to Wind, Dampness, and Heat. Moreover, the initial Qi of the earth, Jueyin Wind-Wood, although starting from the Dah Han (Great Cold) solar term, reaches its peak during Lichun, Yushui, and Jingzhe. Its secondary Qi, Shaoyin Sovereign Fire, coincides with Chunfen, Qingming, and Guyu. Thus, diseases in spring, although originating from Cold, are essentially Wind-Heat mixed within. If there is Dryness pathology, this is due to transformed Qi. In the second and third months, Dryness may occur; in the first month, it is the transition of Wet Earth; in the second month solar term, it encounters Wet Earth transformation; in the third month, it is in command of Wet Earth. Thus, Dampness diseases are also numerous. It can be seen that Wind, Heat, Dryness, and Dampness often arise from Cold. How can one mistakenly treat them solely as Cold? Even within a single day, morning and evening climates differ greatly. If one thoroughly understands the appropriateness of Qi, the Way of Medicine will be well grasped.
Lixia (Start of Summer), fourth month solar term: The Big Dipper points to Xun. (Xun belongs to Wood, governing Wind, located in the Southeast, not corresponding to Zang-Fu organs.)
Xiaoman (Grain Buds), middle of the fourth month: The Big Dipper points to Si. (Si is the Qi of Jueyin Wind-Wood, corresponding to the Pericardium. This is a direct correspondence theory; I believe Si is Yang Fire, governing Heat, corresponding to the Small Intestine, located in the South. Because it clashes with Hai Water, and Hai contains Jia Wood Qi, it also governs Wind.)
Mangzhong (Grain in Ear), fifth month solar term: The Big Dipper points to Bing. (Bing belongs to Fire, governing Heat, corresponding to the Small Intestine, and additionally possesses Water transformation, governing Cold.)
Xiazhi (Summer Solstice), middle of the fifth month: The Big Dipper points to Wu. (Wu belongs to Fire, governing Summer Heat, corresponding to the Heart.)
Xiaoshu (Minor Heat), sixth month solar term: The Big Dipper points to Ding. (Ding belongs to Fire, governing Summer Heat, corresponding to the Heart, and additionally possesses Wood transformation, governing Wind.)
Dashu (Major Heat), middle of the sixth month: The Big Dipper points to Wei. (Wei is the Qi of Taiyin Damp-Earth, corresponding to the Lung. This is also a direct correspondence theory; I believe Wei is Yin Earth, governing Dampness, corresponding to the Spleen.)
(Hu's Commentary: Regarding the above three months of Summer, when humans contract Shanghan disease, it is mostly due to Summer Heat, Heat, Wind, and Dampness. Only in the fifth month solar term, when the Big Dipper points to Bing, does Bing transform from Xin to generate Cold. For those ill, Cold is ultimately the manifestation, while Heat is the root. As for the earth's secondary Qi, Shaoyin Sovereign Fire, ending at Lixia in the fourth month, diseases at that time are mostly Wind-Heat. The tertiary Qi, Taiyin Damp-Earth, coincides with Xiaoman, Mangzhong, Xiazhi, and Xiaoshu, where diseases are mostly Wind-Heat, Summer Heat, and Dampness. The quaternary Qi, Shaoyang Ministerial Fire, begins in Dashu in the sixth month, so diseases at that time are purely Damp-Heat, though named under Cold.
Liqiu (Start of Autumn), seventh month solar term: The Big Dipper points to Kun. (Kun belongs to Earth, governing Dampness, located in the Southwest, not corresponding to Zang-Fu organs.)
Chushu (Limit of Heat), middle of the seventh month: The Big Dipper points to Shen. (Shen is the Qi of Shaoyang Ministerial Fire, governing Great Heat, corresponding to the Gallbladder. This is a direct correspondence theory; I believe Shen is Yang Metal, governing Dryness, corresponding to the Large Intestine, located in the West. Because it clashes with Yin, and Yin contains Bing Fire Qi, it governs Great Heat.)
Bailu (White Dew), eighth month solar term: The Big Dipper points to Geng. (Geng belongs to Metal, governing Dryness, corresponding to the Large Intestine.)
Qiufen (Autumn Equinox), middle of the eighth month: The Big Dipper points to You. (You is the Qi of Yangming Dryness Metal, corresponding to the Stomach. This is a direct correspondence theory; I believe You is Yin Metal, governing Dryness, corresponding to the Lung, located due West.)
Hanlu (Cold Dew), ninth month solar term: The Big Dipper points to Xin. (Xin belongs to Metal, governing Dryness, corresponding to the Lung, and additionally possesses Water transformation, governing Cold.)
Shuangjiang (Frost Descent), middle of the ninth month: The Big Dipper points to Xu. (Xu is the Qi of Taiyang Cold Water, corresponding to the Bladder. This is a direct correspondence theory; I believe Xu is Yang Earth, governing Dampness, corresponding to the Stomach. Because it clashes with Chen, and Chen contains Gui Water Qi, it also governs Cold.)
(Hu's Commentary: Regarding the above three months of Autumn, when humans contract Shanghan disease, it is mostly due to Dryness, Heat, and Dampness. Only in the ninth month is Cold very strong, yet the disease still involves Dryness and Dampness. As for the earth's quaternary Qi, Shaoyang Ministerial Fire, coinciding with Liqiu, Chushu, and Bailu; and the quinary Qi, Yangming Dryness Metal, commanding Qiufen, Hanlu, and Shuangjiang, we know Autumn diseases are mostly Dryness-Heat. Mistaking them for Cold would be an error.
Lidong (Start of Winter), tenth month solar term: The Big Dipper points to Qian. (Qian belongs to Metal, governing Dryness, located in the Northwest, not corresponding to Zang-Fu organs.)
Xiaoxue (Minor Snow), middle of the tenth month: The Big Dipper points to Hai. (Hai is the Qi of Jueyin Wind-Wood, corresponding to the Liver. This is a direct correspondence theory; I believe Hai is Yang Water, governing Cold, corresponding to the Bladder. Because it contains Jia Wood Qi, it also governs Wind.)
Daxue (Major Snow), eleventh month solar term: The Big Dipper points to Ren. (Ren belongs to Water, governing Cold Qi, corresponding to the Bladder, and additionally possesses Wood transformation, governing Wind.)
Dongzhi (Winter Solstice), middle of the eleventh month: The Big Dipper points to Zi. (Zi is the Qi of Shaoyin Sovereign Fire, governing Summer Heat, corresponding to the Kidney. This is also a direct correspondence theory; I believe Zi is Yin Water, governing Cold, corresponding to the Kidney. Because it clashes with Wu Fire, it also governs Summer Heat.)
Xiaohan (Minor Cold), twelfth month solar term: The Big Dipper points to Gui. (Gui belongs to Water, governing Cold Qi, corresponding to the Kidney, and transforms into Fire, thus governing Heat.)
Dahan (Great Cold), middle of the twelfth month: The Big Dipper points to Chou. (Chou belongs to Earth, governing Dampness, corresponding to the Spleen.)
(Hu's Commentary: Regarding the above three months of Winter, when humans contract Shanghan disease, it is mostly due to Wind and Cold. However, the earth's quinary Qi, Yangming Dryness Metal, ends at Lidong in the tenth month, causing Dryness diseases. Dryness is also Wind-Heat, belonging to Wood and Fire. Only the terminal Qi of the earth, Taiyang Cold Water, coincides with Xiaoxue, Daxue, Dongzhi, and Xiaohan, representing true Shanghan. Yet, carefully deducing: Xiaoxue in the tenth month, Big Dipper points to Hai, its concurrent Qi governs Wind; Daxue in the eleventh month, Big Dipper points to Ren, its transforming Qi also governs Wind; Dongzhi in the eleventh month, its clashing Qi governs Summer Heat; Xiaohan in the twelfth month, its transforming Qi governs Heat. Thus, diseases at that time also involve Wind-Heat. By Dahan in the twelfth month, Jueyin Wind-Wood Qi rises again, and the Big Dipper points to Chou, which is Wet Earth. Humans contracting Wind-Damp disease is inevitable. Thus, true Shanghan in Winter is not exclusively Cold.
There are twelve Solar Terms and twelve Middle Qi within the Twenty-Four Solar Terms. Five days constitute one Pentad, with Qi matching, totaling Seventy-Two Pentads. Determining life and death from these requires thorough understanding. (Note: The above main text is listed before "Yin Yang Da Lun" in Zhang Zhongjing's complete works, and in "Shanghan Zhunsheng," it is placed under "All should be determined by observing the Dipper Calendar." Various commentators on "Shanghan Lun" deleted this section, which is a significant omission. I have now annotated it at the beginning of "Shanghan Li," following the complete work.)
(Hu's General Commentary: The above methods for determining diseases based on seasonal climate are the outline of Zhang Zhongjing's "Shanghan Lun," hence placed at the start of "Li." Wang Shuhe erroneously placed Pulse Methods before this, showing presumptuous editing. Deduced from the intent of predecessors regarding Shanghan: Cold pathogenic factors attack from outside. Humans exist within the intersection of Qi and receive Cold similarly, but must distinguish seasonal differences. Spring Cold comes with Warmth; Summer Cold comes with Summer Heat; Autumn Cold comes with Dryness; Late Summer/Four Seasons Cold comes with Dampness. Only Winter Cold is True Cold. True Cold lingers, leading to deeper Heat if not resolved. The Cold of the other three seasons is Violent Cold, which resolves easily, resulting in varying degrees of Heat.
Generally, diseases involving abnormal Qi depend on the season. Medicinal suitability also depends on the season. For instance, a person falling ill in Winter initially suffers Great Cold. After one or two days, if the Cold resolves and Heaven becomes warm, the patient's condition changes accordingly. The approach to medication must adjust slightly. Hence, Shanghan is also called Shi Qi (Seasonal Qi). Knowing the time and Qi allows one to clearly understand the Way of Medicine.
"Yin Yang Da Lun" states: Spring Qi is mild and harmonious; Summer Qi is hot and sultry; Autumn Qi is cool and clear; Winter Qi is cold and piercing. This is the order of the Righteous Qi of the Four Seasons. (Note: "Neijing" has "Yin Yang Ying Xiang Da Lun," but lacks these four phrases. This appears to be Zhang Zhongjing's own theory, later modified by Wang Shuhe. "Neijing" states: Heaven has Four Seasons and Five Elements, generating Cold, Heat, Dryness, Dampness, and Wind through Growth, Flourishing, Harvesting, and Storage. I interpret "mild and harmonious" as Wind Qi, commanding Spring and governing Growth; "hot and sultry" as Summer Heat Qi, commanding Summer and governing Flourishing; "cool and clear" as Dryness Qi, commanding Autumn and governing Harvesting; "cold and piercing" as Cold Qi, commanding Winter and governing Storage. Dampness is omitted because it is inherent in the Four Seasons, completing the cycle of Growth, Flourishing, Harvesting, and Storage. Thus, it is called the order of Righteous Qi. Zhang Zhongjing's theory is based on "Neijing," which is why Wang Shuhe titled it "Yin Yang Da Lun.")
In Winter, severe cold causes all things to hide deeply. A gentleman who remains secure and dense will not be injured by Cold. Those who expose themselves to it are said to have contracted Shanghan. (This continues the previous argument. Winter Qi is cold and piercing, commanding Storage. Cultivated individuals should emulate nature by hiding deeply and remaining secure/dense, living in sheltered places. If not secure, they expose themselves to severe Cold, hence termed Shanghan.)
Injury by the Qi of the Four Seasons can all cause disease. (Spring Wind, Summer Heat, Autumn Dryness, Winter Cold—these are the Qi of the Four Seasons. Cheng Wuji's commentary incorrectly identifies Autumn Qi as Dampness. I believe Dampness is present in Late Summer and the Four Seasons. Here, saying the Qi of the Four Seasons causes disease means it is not only Winter Shanghan.)
Calling Shanghan "toxic" is because it forms the most intense Killing and Severe Qi. (Yu Jiayan says: Using the word "toxin" opens a new premise. Little do they know that in Shanghan patients, Cold is excessive externally, while Heat is deep internally. Manifesting as macules, jaundice, vomiting blood, fox confusion, oral ulcers, lung abscesses with pus, swollen parotids, etc., how is this not toxicity? "Most" means gathering. "Killing and Severe" refers to the austere and violent nature of Cold Qi. It means the toxin of Shanghan is purely formed by gathered Killing and Severe Qi.)
Those who contract Cold and immediately fall ill are named Shanghan. (Illness implies severity. Having a severe Cold illness is named Shanghan. Thus, Zhang Zhongjing analyzes Shanghan, stating all Six Meridian syndromes are "illnesses." The following text says "not immediately ill," implying a less severe Cold illness. Wang Andao erred in claiming "not immediately ill" refers to onset in Spring/Summer after the season passed, thinking the person felt no illness upon contraction.)
Those who do not immediately fall ill: Cold toxin hides in the skin and muscles. By Spring, it transforms into Wenbing (Warm Disease); by Summer, it transforms into Shubing (Summer Heat Disease). ("Neijing: Re Lun" states: All illnesses becoming Warm from Shanghan are Wenbing if before Summer Solstice, and Shubing if after. "Sheng Qi Tong Tian Lun" and "Yin Yang Ying Xiang Lun" both state: Winter injury by Cold leads to Wenbing in Spring. Deduced from "Neijing": Cold from Winter to Spring transforms into Warmth; by Summer, Warmth transforms into Heat. Thus, although both are external pathogens, they cannot still be called True Shanghan. Furthermore, "Neijing" earlier states: Spring injury by Wind, pathogen lingers, leading to diarrhea. Thus, Winter Cold pathogen must adhere to skin, pores, and muscles, lingering to form disease, persisting until Spring warmth transforms it into Wenbing. "Neijing" omits "lingering" for brevity. Its statement "transforms into Shubing by Summer" contradicts the classics. Examining "Neijing" later: Summer injury by Summer Heat leads to Malaria in Autumn. Malaria is the non-immediate Summer Heat; immediate Summer Heat is self-inflicted in Summer. Citing classics, Huangdi and Qibo state Summer Heat originates from Summer injury. Zhang Zhongjing alone states Summer Heat transforms from Cold. If transformation is possible, does Autumn Malaria also transform from Winter Cold? Is this logical? Thus, Fang Zhongxing deleted it, and Yu Jiayan refuted it.)
Shubing (Summer Heat Disease): Heat is extreme, heavier than Wenbing. (Summer Heat Qi is heavier than Spring Warmth. If illness results from contracting it, whether Wen or Shu, each has its own severity; one should not be rigid.)
Therefore, hardworking people suffer more Warm-Heat diseases in Spring and Summer, all caused by touching Cold in Winter, not by Seasonal Pathogenic Qi. (This follows the "gentleman remains secure" argument. Hardworking people, failing to remain secure in Winter, suffer Warm-Heat diseases in Spring/Summer. It states this is not Seasonal Pathogenic Qi, but caused by touching Cold. "Neijing" never mentions "Winter injury by Cold leads to Summer Heat." If this statement came from Zhang Zhongjing, it should be deleted.)
Any Seasonal Epidemic occurs when Spring should be warm but is extremely cold; Summer should be hot but is extremely cool; Autumn should be cool but is extremely hot; Winter should be cold but is extremely warm. This is having the Qi out of season. Therefore, throughout the year, young and old suffer similar illnesses. This is the Seasonal Pathogenic Qi. (Extreme Cold, "Bu Wang Lun" writes Extreme Cool, Metal overcomes Wood. Extreme Cool, "Waitai Miyao" writes Extreme Cold Water overcoming Fire. Autumn Extreme Heat, Fire overcomes Metal. Winter Extreme Warmth, often accompanied by Dampness, Earth overcomes Water. These are all Robber Evil Qi, hence "Qi out of season." Out-of-season Qi affects everyone similarly, so illnesses across seasons affect young and old similarly. I believe the above Seasonal Pathogenic Qi are merely Four Seasons Heat Diseases, all categories of Shanghan. Spring should be warm but is cold: people rely on warmth, fail to expect cold, contracting Spring Shanghan. After injury, warmth returns, resembling Wenbing. Summer should be hot but is cool: people rely on heat, unaware of coolness; coolness contains Cold, contracting Summer Shanghan. After injury, heat returns, resembling Shubing. Autumn should be cool but is hot: people rely on heat, failing to guard against coolness, contracting Autumn Shanghan. After injury, coolness suppresses heat, resembling Dryness disease. Winter should be cold but is warm: people rely on warmth, forgetting cold, contracting Winter Shanghan. After injury, Cold wraps Warmth, not true Cold. Chao Yuanfang considered illnesses affecting all ages similarly as Tianxing Bing (Heavenly Transmission Disease), specifically Chunwen and Hanyi syndromes, i.e., Tianxing Wenyi Bing. Commoners call it Wenyi. Physicians like Zhu Fengyi, Sun Simiao, Xu Xueshi, Pang Anshi, Chang Qizhi inherited this view, unaware of its error. Until Wu Youke wrote "Wenyi Lun" (Treatise on Pestilential Fevers), stating a unique abnormal Qi exists in heaven and earth that touches humans, naming it Wenyi. Later, Yu Jiayan wrote "Shanglun Pian," detailing Wenyi to dispel confusion. We now know Zhang Zhongjing referred only to abnormal Qi moving in the Four Seasons, i.e., the category of Shanghan mentioned in "Neijing.")
To observe diseases caused by Righteous Qi of the Four Seasons and methods for Seasonal Epidemic Qi, one must determine them by observing the Dipper Calendar. (Four Seasons Righteous Qi refers to the Qi of the Four Seasons mentioned in Section 3. Seasonal Epidemic Qi refers to the Seasonal Pathogenic Qi mentioned in the previous section. Cheng Wuji's commentary conflates Seasonal Pathogenic Qi with Warmth and Plague, which is incorrect. Warmth is the warmth when Winter should be cold but is warm, mentioned below as Dongwen. Moreover, this section's main text lacks the character "Warm." If referring to Chunwen, it is doubly wrong. Plague refers to Cold/Cool Qi in the Three Seasons, mentioned below as Hanyi. Note: This Wenyi is not a major plague. I clarified this above. "Zhan" means divination/prediction. "Hou" means observation. Cheng's note says: Observe the Dipper's construction, examine the season's cold/warmth, inspect the pathogen's severity. Meaning: One should predict based on the solar term indicated by the Dipper handle. "Zhi" refers to the following syndromes: Shanghan, Dongwen, Hanyi, etc. Also, Cheng's note says "observe Dipper construction," implying the Eight Solar Terms method should precede "Yin Yang Da Lun.")
After Frost Descent in September, it gradually becomes colder towards Winter. From Great Cold to after Rain Water in January, it should thaw. Hence it is called Rain Water, because ice and snow melt into rain water. By Awakening of Insects in February, the air gradually warms towards Summer's Great Heat. By Autumn, it becomes cool. (Cheng's note: This is the Righteous Qi of the Four Seasons.)
From Frost Descent until before Spring Equinox, anyone exposed to frost and dew who contracts Cold and falls ill is said to have Shanghan. (Contracting Cold injury. "Han Zuàn Lùn" writes "Body deficient, struck by Cold." Cold is the Righteous Qi of Winter; how can Righteous Qi harm? Those struck by Cold do so because their body Qi was previously deficient. "Zhong" here means injury, not the "Zhong" in Zhonghan. Zhonghan is a Cold syndrome; Shanghan is a Heat syndrome; do not confuse them.)
September and October: Cold Qi is slight, illness is mild. November and December: Cold is severe, illness is heavy. January and February: Cold gradually thaws, illness is also mild. This is due to improper Winter conditions, encountering Shanghan individuals, who then fall ill. (Note: This section is main text in Zhang Zhongjing's book. Cheng's example changed it to commentary, so various compilers of Zhang's works repeatedly deleted it. Cheng's note: This is the Righteous Qi of the Four Seasons, striking and immediately causing illness.)
If there is unseasonable warmth in Winter, it is named Dongwen (Winter Warmth). The toxin of Dongwen is vastly different from Shanghan. Dongwen has sequence and overlap, with varying severity and treatment, as detailed in the following chapter. (Cheng's note: This is Seasonal Pathogenic Qi, i.e., Winter should be cold but is warm. Although Dongwen differs from Shanghan, it is still a category of Shanghan. Cold has Cold toxin, so Warmth has Warmth toxin—a simple sentence. The phrase "sequence and overlap" is clearly inserted by Wang Shuhe. Yu Jiayan noted: This is irrelevant to Zhang Zhongjing's text. Yu further stated: "Syndromes as in the following chapter" likely refers to Wen Nü, Feng Wen, Wen Du, Wen Yi at the end of the chapter, which is the most ignorant interpretation. I therefore deleted it to avoid confusing future students.)
After Lichun, if there is no sudden severe cold or ice/snow, but someone suffers high fever, this belongs to Spring Yang Qi emerging outward, with Winter latent Cold transforming into Wenbing. (Previous editions lacked the character "Outward," making the meaning disjointed. Added here from "Zhunsheng Shanghan Li." Cheng's note: This is Wenbing. Wang Yutai said: This is external evil awakening internal evil, caused by Winter injury by Cold.)
From after Spring Equinox until before Autumn Equinox, if Heaven brings sudden cold, it is all Seasonal Cold Epidemic. (This is also Seasonal Pathogenic Qi, i.e., Spring should be warm but is cold, Summer should be hot but is cool.)