然不曰春寒夏凉病而曰寒疫者。此是外寒之气。郁其温热故也。按前第九节又云。秋时反热。此与冬温病相似。其不曰
秋热病。而亦曰寒疫者。可见秋时之气。亦寒郁其热也。愚以此等病即是伤寒之类。俗云四时伤寒是也。成注云。此是
疫气。夫冬温独非疫邪。大抵时行之反气皆是疫。何也。气与时反。人不及备所以病无长幼。率多相似。如徭役之役。
字从 者。乃省文也。此非若正气之伤人。必待体虚而后中也。）
三月四月。或有暴寒。其时阳气尚弱。为寒所折病热犹轻。五月六月阳气已盛。为寒所折。病热则重。七月八月阳
气已衰。为寒所折病热亦微。其病与温。及暑病相似。但治有殊耳。（成注云是数者。以明前斗历之法。占其随时气候。
发病寒热轻重不同。愚按是数者三字。此总结上文伤寒冬温温病寒疫等证之辞。愚又按前第十节云。按斗历而占四时正
气为病则是冬月伤寒春月伤风。夏月伤暑与湿。秋月伤燥。皆正气也。正气为病。不但伤寒。兹则但言。伤寒。及时行
之气。可见仲景之论。非全书矣。又按本节云寒疫轻重。以三四五六七八月。阳气盛衰立论。其言亦不可拘。即如十月
为纯阴。阳气已敛。斯时为寒所折其病竟不发热者邪。倘其人病中寒。或不发热。若是伤寒吾恐其病热。比之五六月时
其势更盛。难言轻矣。王宇泰云要在辩其病源寒热温三者之异则用药冷热之品味判然。此指通章之伤寒温病热病而言盖
暑病即热病也。）
十五日得一气。于四时之中。一时有六气四六名为二十四气也。（成注云节气十二。中气十二。共二十四气。）
然气候亦有应至而不至。或有未应至而至者。或有。至而太过者皆成病气也。（成注云疑漏或有至而不去一句。愚以
至而不去即在应至而不至之中。盖谓新气应至而旧气不去也。夫旧气不去。即是新气应至而不至。是二言何以相别邪。
当如内经云气至而反始明。今即就成注所引金匮中言证之。冬至之后。甲子夜半。少阳起。少阳之时。阳始生。天得温
和。其言以得甲子。而天未温和者。此为应至而不至也。其言以未得甲子。天得温和者。此为未应至而至也。其言以得
甲子。而天温如盛夏五六月时者。此为至而太过也。其言以得甲子。而天大寒不解者此为至而不去。即至而反是也。金
匮中不言反者。以冬至之交。温气尚微寒气得令。故虽少阳始生。当温而寒。难以言反。只得以不去二字代之。终不若
反字之义更明。按内经云。至而不至。来气不及也。愚谓至而不去。即在来气不及之中。未至而至。来气有余也。愚谓
至而太过。即在来气有余之中。又云至而和。则平。至而甚。即太过则病至而反者病。至而不至者病。未至而至者病。
故曰皆成病气也。）
但天地动静。阴阳鼓击者。各正一气耳。（天之体主动。为阳。地之形主静为阴。虽有动静之分。然阴阳之气。鼓击
于四时而不息者。寒热温凉。各正一气也。）
是以彼春之暖。为夏之暑。彼秋之忿。为冬之怒（成注云。春暖为夏暑。从生而至长也。秋忿为冬怒。从肃而至杀
也）
是故冬至之后。一阳爻升。一阴爻降也。夏至之后一阳气下。一阴气上也。（冬至十一月中。斗建子。阳生于子。冬
至之后。一阳之气始生。六阴之气渐敛。成注云于卦为复。言阴气已极。阳气得复也。爻者。交也。乃阴阳之气相交易
之义。夏至五月中。斗建午阴生于午夏至之后。一阴之气始生。六阳之气渐敛。成注云。于卦为 。言阳气已极。阴气
得遇也。内经云。冬至四十五日。阳气微上。阴气微下。夏至四十五日。阴气微上。阳气微下。成注引以相证极是。愚
按冬至以前为纯阴。纯阴者。六阴俱升也。然已交子月得中气。一阳之气初升。则一阴之气先降。故不曰六而曰一也午
为一阴。言阴气至子月而极。故先降。夏至仿此。）
斯则冬夏二至。阴阳合也。春秋二分。阴阳离也。（成注云阳生于子。阴生于午。是阴阳相接。故曰合。阳退于酉。
秋分八月中斗建酉阴退于卯。春分二月中斗建卯是阴阳相背。故曰离。内经曰气至之谓至。气分之谓分。至则气同。分
则气异即离合之义也。愚按上正文云。春秋二分。为阴阳离。成注云。是阴阳相背。故曰离。夫阴阳岂有离背之理。但
历家以冬夏二至。为日至南至北。春秋二分。为日离南离北。日循黄道而行。至春秋分。日行中天。缠于赤道。当黄赤
二道之交。其时昼夜等分。不寒不暑。阴阳和平。二气相交而各半。言六阴六阳之气。于地之上下。各分其三。而无偏
也。若然。则是离字之义当作丽。乃阴阳各施其半。两相附丽之意。此即周子所云阴根阳。阳根阴。五气布四时行之谓
欤。）
阴阳交易。人变病焉。（天地阴阳之气。既相交错。而春夏秋冬。四时于焉更易。斯人气亦随之而变迁。苟不得其养。
则诸病生焉。）
此君子春夏养阳。秋冬养阴顺天地之刚柔也。（成注引内经云。春夏养阳。以凉以寒。秋冬养阴以温以热。所以然者。
从其根故也。）
小人触冒。必婴暴疹。须知毒烈之气。留在何经。而发何病。详而取之。（婴。加也。又触也。疹与 同。疹者。善
嗜为病可见小人。不若君子之善于调养。既感外来之邪。兼之饮食不节。而成暴病。夫病既曰暴。须知其触冒四时风寒
暑湿当作燥之气。必然毒烈。此即四时之伤寒也。其有病不甚暴。邪气留连。而不愈者。当详取其毒烈之气。留在何经。
而发何病也。）
是以春伤于风。夏必飧泄。夏伤于暑。秋必 疟。秋伤于湿。（湿在夏季之月。与暑气同行。按此湿字。当作燥。）
冬必咳嗽。冬伤于寒。春必病温。此必然之道。可不审明之。（春三月风气用事。春伤于风。风气通于肝。肝邪有余。来
侮脾土。留连至夏暑湿之气相并。当为餐泄之证。餐泄者。水谷不化而完出也。夏三月暑气用事。夏伤于暑。暑当与汗
皆出。勿止。若夏伤暑而汗不出。留连至秋。清凉之气。搏其暑热。当为 疟之证。 疟者。寒热往来之久疟也。秋三
月燥气用事。秋伤于燥。燥亦火之余气。火乘肺金。留连至冬。复与外寒相触。当为咳嗽之证。冬三月寒气用事。冬伤
于寒。寒气通于肾。肾失闭藏之令。内郁所伤之寒。久而成热。留连至春。更遇外来之温气。引出内郁之热邪。因而成
温病也。是则触冒四时之正气。留连致疾。势所必然。医者所当详审而责治之也。）
伤寒之病逐日浅深。以施方治。今世人伤寒。或始不早治。或治不对病。或日数久淹困乃告医医人又不根据（外台秘
要中作知）次第而治之。则不中病皆宜临时消息制方。无不效也。今搜采仲景旧论。录其证候。诊脉声色。对病真方。
有神验者。拟防世急也。又土地温凉高下不同。物性刚柔。餐居亦异。是故黄帝与四方之问。岐伯举四治之能。以训后
贤。开其未悟者。临病之工宜须两审也。（此二节于上下文不相贯。外台秘要中系王叔和之论。外台序诸论伤寒凡八家。
以仲景为第一家。则序阴阳大论云云也。其第二家。则序王叔和曰。伤寒之病逐日浅深云云也。又曰。夫表和里病。下
之而愈。汗之则死。里和表病。汗之而愈下之则死云云。至安危之变。岂可诡哉。此亦序王叔和之论也。愚按唐时王焘
着外台方论。实节取上古诸家之说。其因伤寒例。杂入叔和之语居多。故特序曰王叔和云云也。夫叔和当日。既云搜采
仲景旧论真方。其于撰次伤寒论时。何不曰。此系仲景论。此为仲景方也。标题不明间附己意。以致玉石难分。深为可
恨。）
凡伤于寒。则为病热。热虽甚。不死（此承上文春伤于风之节而言。推仲景之意。以四时之气。皆能伤人。其留连
不愈者。已为餐泄 疟咳嗽温病矣。其有病暴而不留连者。即为四时伤寒之病。故特举一凡字该之。若但论冬月之伤寒。
则不日凡矣或问于春何以云寒。殊不知春风中。寒气偏多。所以仲景辩太阳病先言中风条也。夏月暑气大行。早晚间时
有雷雨阴湿之寒。所以洁古论中暑。为静而得之。其证头疼身热无汗。亦伤寒也。秋月燥气固胜。早晚间每多雾露清凉
之气。五行家以秋属金。金体本凉而其气亦同寒也。至冬月寒水用事。不待更解。凡此四时之中。皆有伤寒之病。其实
非寒而皆为热。成注引内经云。风寒客于人。使人毫毛毕直。皮肤闭而为热是伤寒为热病也。又引针经云。热多者易已。
是热虽甚。不死也。）
若两感于寒而病者。必死。（两感病见下文。其义已注前第一卷热论中。）
尺寸俱浮者太阳受病也当一二日发。以其脉上连风府。故头项痛腰脊强。尺寸俱长者阳明受病也。当二三日发。以
其脉挟鼻络于目。故身热目疼鼻干不得卧。尺寸俱弦者。少阳受病也。当三四日发。以其脉循胁络于耳。故胸胁痛而耳
聋。
此三经皆受病未入于腑者。可汗而已。尺寸俱沉细者。太阴受病也。当四五日发。以其脉布胃中。络于嗌。故腹满
而嗌干。尺寸俱沉者。少阴受病也。当五六日发。以其脉贯肾。络于肺系舌本。故口燥舌干而渴。尺寸俱微缓者。厥阴
受病也。当六七日发。以其脉循阴器络于肝。故烦满而囊缩。
此三经皆受病。已入于腑可下而已。（以上论六经受病。与内经热论中文。大同小异。热论云一日二日。上却云一二
日二三日。其论更觉圆活。又热论云脏上却云腑。热论无此三经皆受病。已入于腑。可下而已三句。上却从而补之。非
仲景孰能引经作论。如此其切当邪。第其于每经之首。必先言脉者。此与经旨大悖。夫伤寒以识证为先。而辩脉次之。
识证者何。如病患头项痛。腰脊强。即知其为太阳病也。目疼鼻干。即知其为阳明病也。胸胁痛耳聋。即知其为少阳病
也既识其证。则某病见某证。当显某脉。不宜某脉。某脉则吉。某脉则凶。此为最要之诀。今则云尺寸俱浮者。太阳受
病也。夫浮脉。岂可以定太阳病邪抑太阳病。岂止一浮脉邪。愚即就仲景论浮脉一二条言之。有云阳明病。脉浮无汗而
呕。宜发汗则愈。宜麻黄汤。又云太阴病。脉浮者可发汗宜桂枝汤。又云少阴中风脉阳微阴浮者为欲愈。厥阴中风。脉
微浮为欲愈。不浮为未愈惟少阳病无浮脉。然其云三阳合病脉必浮大上关上则少阳亦在其中。以是而知阴阳六经。皆有
浮脉也。更即就仲景论太阳病脉一二条言之。一云太阳病。发热汗出恶风。脉缓者为中风。又云太阳病。或已发热。或
未发热。必恶寒体痛呕逆。脉阴阳俱紧者。名曰伤寒。又云伤寒一日。太阳受之。脉若静者为不传。颇欲吐。若烦躁。
脉数急者。为传也。又云太阳病。发热恶寒。热多寒少。脉微弱者。此无阳也。不可发汗。又云太阳病。身黄脉沉结。
少腹硬。小便不利者。为无血也云云。又云。太阳病下之。其脉促。不结胸者。此为欲解也。又云脉紧者为咽痛。脉弦
者必两胁拘急。脉细数者头痛未止。脉沉者必欲呕。脉沉滑者协热利。凡此者。皆太阳之脉也。举一太阳以概其余。是
上文言尺寸俱长。俱弦。俱沉细。俱沉。俱微缓。与受病之经。皆不相合。吾恐叔和在当日虽善切脉。苟不问病家所苦。
但据尺寸以测受病之经。不无误矣。识者谓伤寒例中。凡言脉处。皆叔和所增入。即如以平脉辩脉法。反作第一卷。列
于伤寒例前。亦此意也。近医程子郊倩。议叔和云。彼见经文上无有脉法。遂恣意杜撰。不知热病之脉。经文已于后篇
评热论。补出脉躁疾三字矣。又云热病为阳。其加三阴经以沉微细缓之脉。则是阳病见阴脉者死矣。经文何以云热虽甚
不死。此等处关系岂小。且与平脉论自相背谬。喻氏尚论及此。独置而不言。何其恕也。）
若两感于寒者。一日太阳受之。即与少阴俱病。则头痛。口干烦满而渴。二日阳明受之。即与太阴俱病。则腹满身
热。不欲食谵语。三日少阳受之。即与厥阴俱病。则耳聋囊缩而厥。水浆不入。不知人者六日死。若三阴三阳。五脏六
腑。皆受病。则营卫不行腑脏不通则死矣（成注云。阴阳俱病。表里俱伤者为两感。故其受病。则阴阳两证俱见其传经。
亦阴阳两经俱传也。六日死。义详见前第一卷热论中。愚按上单传之病。先太阴而后少阴。此则先少阴而后太阴何也。
王宇泰云。逆传之说。犹未尽善。盖太阳与少阴。阳明与太阴。少阳与厥阴。脏腑相合。阴道从阳，譬之妯娌。但以夫
年为次。不以己齿为序也。）
其不两感于寒更不传经不加异气者至七日。太阳病衰头痛少愈也。八日阳明病衰。身热少歇也。九日少阳病衰。耳
聋微闻也。十日。太阴病衰。腹减如故。则思饮食。十一日。少阴病衰。渴止。舌干已而嚏也。十二日厥阴病衰囊纵少
腹微下。大气皆去病患精神爽慧也。（上注俱见前第一卷热论中。按内经热论。无更不传经。不加异气二句喻嘉言云。八
字系叔和增入。推叔和之意。欲为下文更感异气。变为温疟风温温毒温疫等证章本。因添此八个字。大乱仲景原论遗旨。
However, it is not called "spring cold and summer cool disease" but "cold epidemic" (Han Yi), because the external cold qi condenses and obstructs the warm and hot qi within. According to Section 9 mentioned earlier: "In autumn, there is contrary heat." This is similar to winter warmth disease (Dong Wen). It is not called "autumn heat disease" but also called "cold epidemic," which shows that in autumn, the climate is also characterized by cold condensing heat. I believe these diseases are of the same category as cold damage (Shang Han), commonly referred to as "four-season cold damage." Cheng Wuji's commentary states: "This is epidemic qi." Is winter warmth not an epidemic pathogen? Generally, any counter-seasonal qi constitutes an epidemic. Why? Because the climate contradicts the season, people are unprepared, so patients of all ages present with similar symptoms. Like corvée labor, the character "epidemic" (Yi) derives from "labor" (Yi), being a shorthand. This differs from injury by righteous qi, which requires bodily deficiency to take hold.)
In the third and fourth months, sudden cold may occur. At this time, yang qi is still weak; when折 (broken/restricted) by cold, the resulting heat manifestation is mild. In the fifth and sixth months, yang qi is abundant; when restricted by cold, the heat manifestation is severe. In the seventh and eighth months, yang qi is declining; when restricted by cold, the heat manifestation is slight. These conditions resemble warm disease (Wen Bing) and summerheat disease (Shu Bing), but their treatments differ. (Cheng Wuji comments: These phrases clarify the method of using the Dipper calendar to predict seasonal climates, showing that the severity of cold and heat varies. I consider "these several cases" to summarize the preceding discussions on cold damage, winter warmth, warm disease, and cold epidemic. Furthermore, Section 10 states: "By observing the Dipper calendar to diagnose illnesses caused by the four seasons' righteous qi, we find: winter brings cold damage, spring brings wind injury, summer brings summerheat and dampness, and autumn brings dryness—all caused by righteous qi." Righteous qi causes illness not only as cold damage; here, only "cold damage" and "seasonal epidemic qi" are mentioned, suggesting Zhang Zhongjing's treatise is not complete. Also, regarding the severity of cold epidemic based on the waxing and waning of yang qi from the third to eighth months, this view should not be rigidly applied. For instance, the tenth month is pure yin, with yang qi concealed. If restricted by cold then, would there be no fever? If one suffers from cold invasion without fever, if it is cold damage, I fear the pathology might be more intense than in the fifth or sixth months, making it difficult to call it mild. Wang Yutai said: The key lies in distinguishing the source as cold, heat, or warmth; thus, the choice of cooling, warming, or neutral herbs becomes clear. This refers generally to cold damage, warm disease, and heat disease discussed throughout the chapter, where summerheat disease is essentially heat disease.)
Every fifteen days yields one qi. Within the four seasons, each season has six qis, totaling twenty-four qis (Jieqi). (Cheng Wuji notes: There are twelve Jieqi and twelve Zhongqi, making twenty-four in total.)
However, climatic conditions may arrive late, arrive early, or arrive excessively; all such anomalies become pathogenic qi. (Cheng Wuji suspects a missing phrase "or arrives and does not depart." I believe "arrives and does not depart" is included in "should arrive but does not." It means new qi should arrive but old qi remains. Old qi remaining implies new qi has not arrived; how do these two statements differ? One should understand it as stated in the *Neijing*: "Qi arrives and reverses its origin." Now, verifying with the quote from *Jingui Yaolue* cited in Cheng's commentary: After the Winter Solstice, at midnight on the Jiazi day, Shaoyang qi begins. During Shaoyang time, yang qi starts to generate, and the weather becomes warm. The text says, "Obtaining Jiazi but the weather is not warm," which is "should arrive but does not." "Not obtaining Jiazi, yet the weather is warm," is "not yet due but arrives early." "Obtaining Jiazi, but the weather is as hot as midsummer (fifth/sixth months)," is "arrives excessively." "Obtaining Jiazi, but severe cold persists," is "arrives and does not depart," i.e., "arrives and reverses." *Jingui* does not use "reverse" because at the Winter Solstice transition, warm qi is faint and cold qi is dominant; although Shaoyang begins, it is cold instead of warm, so "reverse" is hard to apply, hence "does not depart" is used. However, "reverse" is clearer. According to the *Neijing*: "Arrives but does not arrive indicates insufficient incoming qi." I consider "arrives and does not depart" within "insufficient incoming qi." "Not yet due but arrives early indicates excessive incoming qi." I consider "arrives excessively" within "excessive incoming qi." It also says: "Arrives harmoniously, then is normal; arrives severely, i.e., excessively, then illness occurs; arrives and reverses, illness; arrives but does not arrive, illness; not yet due but arrives early, illness." Thus, all become pathogenic qi.)
It is merely heaven and earth moving and still, with yin and yang striking each other, each establishing its own qi. (Heaven's form is active, belonging to yang; Earth's form is static, belonging to yin. Although distinct in movement and stillness, yin and yang qi strike each other continuously through the four seasons—cold, heat, warmth, and coolness—each establishing its own qi.)
Therefore, the warmth of that spring becomes the summerheat of summer; the sternness of that autumn becomes the anger of winter. (Cheng Wuji comments: Spring warmth leads to summer heat, progressing from growth to flourishing. Autumn sternness leads to winter anger, progressing from肃 (solemnity/cleansing) to killing.)
Thus, after the Winter Solstice, one yang line rises, and one yin line descends. (Winter Solstice is in the middle of the eleventh month, with the Dipper pointing to Zi. Yang is born at Zi. After the Winter Solstice, one yang qi begins to generate, and the six yin qis gradually converge. Cheng Wuji notes: In hexagrams, this is Fu (Return), meaning yin qi is exhausted, and yang qi returns. Yao means intersection, signifying the exchange of yin and yang qi. Summer Solstice is in the middle of the fifth month, with the Dipper pointing to Wu. Yin is born at Wu. After the Summer Solstice, one yin qi begins to generate, and the six yang qis gradually converge. Cheng Wuji notes: In hexagrams, this is Gou (Coming to Meet), meaning yang qi is exhausted, and yin qi meets. The *Neijing* states: Forty-five days after Winter Solstice, yang qi slightly ascends, yin qi slightly descends; forty-five days after Summer Solstice, yin qi slightly ascends, yang qi slightly descends. Cheng's citation for verification is excellent. I observe that before Winter Solstice is pure yin, meaning six yin lines ascend. However, upon entering the Zi month and receiving the central qi, one yang qi initially rises, so one yin qi must first descend. Hence, it says "one" rather than "six." Wu represents one yin, meaning yin qi reaches its extreme in the Zi month and thus descends first. Summer Solstice follows this logic.)
This is why the Winter and Summer Solstices represent the union of yin and yang, while the Spring and Autumn Equinoxes represent their separation. (Cheng Wuji comments: Yang is born at Zi, yin at Wu; they connect, hence "union." Yang retreats to You (Autumn Equinox, eighth month, Dipper points to You); yin retreats to Mao (Spring Equinox, second month, Dipper points to Mao); they turn away from each other, hence "separation." The *Neijing* says: Qi arriving is "Zhi" (Solstice); qi dividing is "Fen" (Equinox). Zhi means qi is same; Fen means qi is different, explaining union and separation. I note the main text says: Spring and Autumn Equinoxes are yin-yang separation. Cheng says: They turn away, hence separation. How can yin and yang separate? Historians define Winter/Summer Solstices as sun reaching south/north extremes, and Spring/Autumn Equinoxes as sun departing south/north. Sun moves along the Ecliptic; at Equinoxes, it crosses the Celestial Equator, where Ecliptic and Equator intersect. Day and night are equal, neither cold nor hot, yin and yang are peaceful, interacting equally. Six yin and six yang qis divide above and below Earth, each taking half, without bias. If so, "separation" (Li) should mean "adherence" (Li), implying yin and yang share halves and adhere to each other. This aligns with Zhou Dunyi's saying: "Yin roots in yang, yang roots in yin," describing the distribution of five qis across four seasons.)
Yin and yang exchange, causing human transformation and illness. (Since heavenly and earthly yin and yang qi intermingle, and the four seasons change accordingly, human qi also shifts. If not nourished properly, various diseases arise.)
Therefore, gentlemen nourish yang in spring and summer, and nourish yin in autumn and winter, conforming to the hardness and softness of heaven and earth. (Cheng Wuji cites the *Neijing*: Nourish yang in spring/summer using cool/cold; nourish yin in autumn/winter using warm/hot. This is done to follow their roots.)
Petty people who touch and offend [the elements] will surely suffer sudden rashes. One must know which meridian the toxic and fierce qi resides in and what disease it triggers, examining carefully to treat it. (Ying means to add or touch. Zhen is synonymous with ban. Rashes indicate diseases arising from indulgence. Petty people, unlike gentlemen, lack good self-care. Having contracted external pathogens and combined with dietary irregularities, they develop sudden illnesses. Since the illness is "sudden," one must know it was triggered by the four seasons' wind, cold, summerheat, dampness, or dryness, which are necessarily toxic and fierce—this is the four-season cold damage. If the illness is not sudden, but the pathogen lingers without resolving, one must carefully examine which meridian holds the toxic qi and what disease it causes.)
Thus, wind injury in spring leads to undigested stool diarrhea (Sun Xie) in summer; summerheat injury in summer leads to malaria (Nüe) in autumn; dampness injury in autumn (Note: Dampness accompanies summerheat in summer months. Here, "dampness" should likely be read as "dryness") leads to cough in winter; cold injury in winter leads to warm disease (Wen Bing) in spring. This is the inevitable way; can it not be examined clearly? (In the three spring months, wind qi dominates. Spring wind injury affects the Liver, which communicates with wind. Excess Liver evil attacks Spleen Earth. Lingering into summer, combined with summerheat and dampness, it causes Sun Xie (undigested stool diarrhea). In the three summer months, summerheat qi dominates. Summerheat injury should be released via sweat. If sweat does not occur and it lingers into autumn, cool air combats summerheat, causing Nüe (malaria with alternating chills and fever). In the three autumn months, dryness qi dominates. Autumn dryness injury involves dryness as residual fire, attacking Lung Metal. Lingering into winter, contacting external cold, it causes cough. In the three winter months, cold qi dominates. Winter cold injury affects the Kidney, which communicates with cold. Kidney fails to store, internal cold condenses and turns to heat over time. Lingering into spring, encountering external warmth, it draws out internal heat, causing warm disease. Thus, offending four-season righteous qi and lingering to cause disease is inevitable. Physicians must examine and treat diligently.)
The progression of cold damage deepens daily, requiring corresponding prescriptions. Nowadays, people with cold damage either fail to treat early, receive incorrect treatment, or delay seeking help until debilitated. Physicians then fail to treat according to sequence, failing to hit the target. One must adjust formulas temporarily based on circumstances, ensuring efficacy. I have now collected Zhang Zhongjing's old theories, recording his signs, pulse diagnosis, voice/color observations, and authentic prescriptions against specific diseases that show miraculous effects, intending to prepare for worldly emergencies. Furthermore, land temperatures vary by latitude and altitude; material natures differ in hardness and softness; diet and residence also vary. Thus, Huangdi asked about the four directions, and Qibo demonstrated four treatment methods to instruct later generations and enlighten the unaware. Practitioners facing illness must double-check. (These two sections seem disconnected from the context. In *Waitai Miyao*, this is attributed to Wang Shuhe. *Waitai* prefaces eight schools of cold damage theory, listing Zhongjing first, citing the *Yin Yang Da Lun*. The second school cites Wang Shuhe: "Cold damage progresses daily..." and "If exterior is harmonious and interior diseased, purging cures, sweating kills; if interior is harmonious and exterior diseased, sweating cures, purging kills..." Regarding life and death changes, how can they be诡 (deceitful)? This is also Wang Shuhe's discourse. I believe Wang Tao of the Tang Dynasty compiled *Waitai Fanglun* by excerpting ancient theories, inserting much of Shuhe's words into the *Shanghan Li*. Hence the preface "Wang Shuhe says." When Shuhe said he collected Zhongjing's old theories and true prescriptions, why did he not label them clearly as "Zhongjing's theory/formula" during compilation? Ambiguous titles mixed with his own ideas make distinguishing jade from stone difficult, which is regrettable.)
Any injury by cold results in a heat disease. Even if the heat is severe, it is not fatal. (This continues the section on spring wind injury, inferring Zhongjing's intent: four-season qi can injure humans. Lingering cases become Sun Xie, Nüe, cough, or warm disease. Sudden cases are four-season cold damage. Hence "any" is used. If discussing only winter cold damage, "any" would not be used. Question: Why mention cold in spring? Unknowingly, spring winds contain much cold. Hence Zhongjing discusses Wind Strike in the Taiyang chapter first. In summer, summerheat prevails, but morning/evening thunderstorms bring cold/dampness. Jiuguo described summerheat stroke as acquired statically, with headache, body heat, and no sweat—also cold damage. In autumn, dryness wins, but morning/evening fogs bring cool air. Five Elements associate autumn with Metal, which is inherently cool and similar to cold. In winter, Water/Cold dominates, needing no explanation. Thus, all four seasons have cold damage diseases. Actually, they are not cold but heat. Cheng cites *Neijing*: Wind-cold invading makes hair stand erect, skin pores close, generating heat—thus cold damage is heat disease. Cites *Zhenjing*: More heat means easier recovery—thus even severe heat is not fatal.)
If affected by cold in both yin and yang meridians (Liang Gan), death is certain. (Liang Gan disease is detailed below; its meaning was noted in Volume 1, *Re Lun*.)
If the Cun and Chi pulses are both floating, Taiyang is affected, manifesting in one or two days. Its vessels connect to Fengfu, causing head/neck pain and stiff back/spine. If Cun and Chi pulses are both long, Yangming is affected, manifesting in two or three days. Its vessels flank the nose and connect to the eyes, causing body heat, eye pain, nasal dryness, and inability to sleep. If Cun and Chi pulses are both wiry (Xian), Shaoyang is affected, manifesting in three or four days. Its vessels follow the flanks and connect to the ears, causing chest/flank pain and deafness.
These three meridians are affected but have not entered the Fu organs; they can be cured by sweating. If Cun and Chi pulses are both deep and fine, Taiyin is affected, manifesting in four or five days. Its vessels spread in the stomach and connect to the throat, causing abdominal fullness and dry throat. If Cun and Chi pulses are both deep, Shaoyin is affected, manifesting in five or six days. Its vessels penetrate the Kidneys and connect to the Lung system and tongue root, causing dry mouth/tongue and thirst. If Cun and Chi pulses are both faint and slow (Huan), Jueyin is affected, manifesting in six or seven days. Its vessels follow the genitalia and connect to the Liver, causing irritability, fullness, and retracted testicles.
These three meridians are affected and have entered the Fu organs; they can be cured by purging. (The above discussion on six-meridian involvement is largely similar to *Neijing Re Lun*. *Re Lun* says "day one, day two," whereas here it says "one or two days," making the argument more flexible. *Re Lun* mentions Zang, here it mentions Fu. *Re Lun* lacks the sentence "These three meridians are affected, having entered the Fu organs, can be cured by purging"; here it is added. Only Zhongjing could cite classics so aptly. However, stating the pulse first for each meridian contradicts the classic principle. Cold damage prioritizes symptom recognition over pulse differentiation. Recognizing symptoms: Head/neck pain/stiff back indicates Taiyang; eye pain/nasal dryness indicates Yangming; flank pain/deafness indicates Shaoyang. Once identified, one knows which pulse corresponds to which disease, which is auspicious, and which is ominous. This is the crucial secret. Now it says "Cun and Chi floating indicates Taiyang." Can floating pulse alone define Taiyang? Does Taiyang only present with floating pulse? Consider Zhongjing's few examples of floating pulse: Yangming disease, floating pulse, no sweat, vomiting—suitable for sweating, Ma Huang Tang. Taiyin disease, floating pulse—suitable for sweating, Gui Zhi Tang. Shaoyin wind strike, superficial pulse weak, deep pulse floating—indicates recovery; Jueyin wind strike, faint floating pulse—indicates recovery; non-floating means not recovered. Only Shaoyang lacks floating pulse, but in Three-Yang combined disease, pulse is large and floating above Guan, including Shaoyang. Thus, all six meridians can have floating pulse. Consider Taiyang pulse examples: Taiyang disease, fever, sweating, aversion to wind, slow pulse—Wind Strike. Taiyang disease, fever or not, aversion to cold, body pain, vomiting, tight pulse on both sides—Cold Damage. Cold damage day one, Taiyang affected, quiet pulse means no transmission; desire to vomit, irritability, rapid pulse means transmission. Taiyang disease, fever/chills, more heat less cold, faint pulse—no Yang, do not sweat. Taiyang disease, yellow body, deep knotted pulse, hard lower abdomen, difficult urination—blood stasis. Taiyang disease purged, hurried pulse, no Chest Bind—indicating resolution. Tight pulse—sore throat; wiry pulse—flank stiffness; fine rapid pulse—headache persists; deep pulse—vomiting; deep slippery pulse—heat-collateral diarrhea. All these are Taiyang pulses. Taking Taiyang as representative, the previous statements about long, wiry, deep-fine, deep, and faint-slow pulses do not match the affected meridians. I fear Shuhe, despite skilled pulse diagnosis, erred by measuring meridians solely by Cun-Chi without asking patient complaints. Scholars believe pulse mentions in *Shanghan Li* were added by Shuhe. Placing *Ping Mai Bian Mai Fa* as Volume 1 before *Shanghan Li* supports this. Physician Cheng Xiaoqiao criticized Shuhe: Seeing no pulse methods in the text, he fabricated them, unaware that *Ping Re Lun* already added "rapid/agitated pulse." He also noted heat disease is Yang; adding deep/fine/slow pulses to Yin meridians makes Yang disease show Yin pulse, indicating death. Yet the text says "severe heat is not fatal." These discrepancies are significant and contradict *Ping Mai Lun*. Yu Lianshan ignored this in *Shanglun*; how lenient!)
If affected by cold in both yin and yang: On day one, Taiyang is affected, simultaneously with Shaoyin, causing headache, dry mouth, irritability, fullness, and thirst. On day two, Yangming is affected, simultaneously with Taiyin, causing abdominal fullness, body heat, anorexia, and delirious speech. On day three, Shaoyang is affected, simultaneously with Jueyin, causing deafness, retracted testicles, and cold limbs. Inability to drink water and loss of consciousness lead to death on day six. If all three Yin and three Yang meridians, and Zang and Fu organs are affected, Ying and Wei cease to circulate, Zang and Fu blockage leads to death. (Cheng Wuji comments: Yin and Yang both diseased, exterior and interior both injured is Liang Gan. Symptoms appear in both Yin and Yang. Transmission occurs in both Yin and Yang meridians. Death on day six is explained in Vol 1 *Re Lun*. I note single transmission goes Taiyin then Shaoyin, but here Shaoyin precedes Taiyin. Wang Yutai said: Reverse transmission theory is incomplete. Taiyin-Shaoyin, Yangming-Taiyin, Shaoyang-Jueyin are paired Zang-Fu. Yin pathways follow Yang, like sisters-in-law, ordered by husband's age, not own teeth.)
If not Liang Gan, not transmitting, and not affected by alien qi: By day seven, Taiyang disease declines, headache lessens. By day eight, Yangming disease declines, body heat rests. By day nine, Shaoyang disease declines, hearing slightly improves. By day ten, Taiyin disease declines, abdomen reduces to normal, appetite returns. By day eleven, Shaoyin disease declines, thirst stops, tongue dryness resolves, sneezing occurs. By day twelve, Jueyin disease declines, testicles relax, lower abdomen softens, great qi departs, patient regains mental clarity. (Previous notes are in Vol 1 *Re Lun*. *Neijing Re Lun* lacks "not transmitting, not affected by alien qi." Yu Jiayan said these eight characters were added by Shuhe to introduce subsequent chapters on warm malaria, wind-warmth, warm toxin, and warm epidemic, disrupting Zhongjing's original intent.)