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(From Chapter 31 of *Suwen*)

The chapter "Re Lun" (Discussion on Heat) in the *Neijing* is the root of Shanghan (Cold Damage). Zhang Zhongjing authored the *Shanghan Lun* (Treatise on Cold Damage), and its theory of Six Meridian transmission was deduced and expanded from the text of this chapter. Therefore, anyone treating Shanghan must first study the *Neijing Re Lun*, and then read Zhongjing's *Shanghan Lun*. In this way, one's learning will have a source and flow, and one's mind will have a master. Thus, disregarding my own limitations, I provide an explanation, hoping that those dedicated to this path will know their allegiance upon opening the scroll.

Huangdi asked: Now, all heat diseases belong to the category of Shanghan. (Shanghan originally belongs to heat diseases; other conditions such as Warmth and Summerheat are also heat diseases. As stated in the *Nanjing*, "Shanghan has five types," which indicates the intent of Huangdi's question here: since no heat disease is greater than Shanghan, all current heat diseases are considered categories of Shanghan. Wang Bing's commentary claims that warm-heat diseases arise from cold damage in winter, transforming around the time of Summer Solstice. Is it true that the root of these heat diseases lies dormant in the previous winter? Even if similar statements exist in the *Shanghan Lun*, they do not align with the purport of this scripture. Furthermore, considering Huangdi's phrasing at the time, why did he not say "transformed by Shanghan" or simply "caused by Shanghan," but rather "categories of Shanghan"? The purport should be understood according to my annotation. Ma Shi's commentary is also unclear, so it is not recorded here.) Some recover, some die. Those who die usually do so within six or seven days, while those who recover usually do so after ten days. Why is this? I do not understand the resolution; I wish to hear the reason.

Qibo replied: Juyang (i.e., Taiyang/Sunshine Meridian) is the leader of all Yang meridians. Its vessels connect to the Fengfu acupoint. (According to the *Tu Jing*, the Fengfu acupoint is located one cun inside the hairline at the vertex, within the depression of the large tendons. It is an acupoint on the Du Meridian and has no direct relation to the Taiyang Meridian. The scripture mentions it because the Taiyang Meridian runs alongside the Du Meridian.) Therefore, it governs the Qi of all Yang meridians. (Ma Shi commented: The Foot-Taiyang Bladder Meridian begins at the Jingming acupoint, connects upward to the Fengfu acupoint of the Du Meridian, and travels from the head and neck to the back and feet. All Yang meridians of the body and limbs belong to it, comprising 126 acupoints, truly governing the Qi of all Yang meridians.) When humans are injured by cold pathogens, they develop febrile diseases. Even if the heat is severe, death does not occur. (This sentence corresponds to "recoveries happen after ten days.") However, those suffering from Lianggan (Simultaneous Invasion) by cold will inevitably die. (This sentence corresponds to "deaths happen within six or seven days.")

Huangdi said: I wish to hear the manifestations. (This asks about the manifestations of heat caused by the transmission of Shanghan along the meridians.) Qibo said: On the first day of Shanghan, the Juyang meridian receives the pathogen. (The Shanghan pathogen transmits from the exterior to the interior. Taiyang is the most exterior layer, so when cold pathogens injure the exterior, Taiyang is affected first on the first day. The *Shanghan Lun* states: "When both Cun and Chi pulses are floating, Taiyang is diseased, manifesting on the first or second day." This shows that the onset of Shanghan cannot be rigidly bound to specific days. Note: Below this in the *Shanghan Lun* is the phrase "its vessels connect to Fengfu".) Therefore, headache, stiff neck, and rigidity of the waist and spine occur. (The Foot-Taiyang meridian enters the brain from the vertex, emerges to descend the nape, runs along the medial shoulder, and reaches the middle of the waist via the spine. Hence, symptoms of headache, stiff neck, and spinal rigidity appear. The scripture does not mention fever here because there is a stage in Taiyang disease before fever manifests.) On the second day, the Yangming meridian receives the pathogen. Yangming governs the flesh. (Yangming is the middle layer of the exterior; thus, if Taiyang pathogens remain unresolved, they transmit to Yangming on the second day. The *Shanghan Lun* states: "Yangming disease manifests on the second or third day." Subsequent meridians are described similarly.) Its vessels run alongside the nose and connect to the eyes. Therefore, body heat, eye pain, dry nose, and inability to lie down occur. (Body heat, eye pain, and dry nose indicate febrile disease. The pathways of the Six Meridians are detailed in the following diagram.) On the third day, the Shaoyang meridian receives the pathogen. Shaoyang governs the Gallbladder. (Shaoyang is the interior layer of the exterior; thus, its transmission follows subsequently.) Its vessels circulate along the flanks and connect to the ears. Therefore, hypochondriac pain and deafness occur. (Clearly, this is also a manifestation of febrile disease.) When the collaterals of the Three Yang meridians are all diseased, but the pathogen has not entered the Zang organs, it can be cured by sweating. (Note: The character "Zang" (Storehouse/Organ) is written as "Fu" (Cavity/Viscera) in the *Shanghan Lun*, which is excellent. Quan Yuanqi and Yang Shangshan later followed this. Li Dongyuan said: This "Zang" does not refer to the Five Zang organs, but to the concept of storing things; leaving it as "Zang" is also acceptable. Ma Shi commented: This refers to the subsequent Three Yin meridians, as Three Yin belong to the Five Zang, hence the term "Zang." This argument is flawed. Cheng Wuji's commentary on the *Shanghan Lun* states: Pathogens in the Three Yang meridians cause disease in the exterior, requiring sweat therapy. However, Three Yang pathogens can also enter the Fu organs; if they enter the Fu organs, purge therapy is indicated. Thus, "those not yet entering the Fu organs can be cured by sweating." 'Yi' means stop/end, indicating the decline of the febrile condition.) On the fourth day, the Taiyin meridian receives the pathogen. (Taiyin is the exterior layer of the interior. If sweat therapy was neglected and pathogens persist, they transmit from Shaoyang to Taiyin.) The Taiyin vessels distribute into the stomach and connect to the throat. Therefore, abdominal fullness and dry throat occur. (Cheng's commentary states: Spleen meridian stagnation generates heat.) On the fifth day, the Shaoyin meridian receives the pathogen. (Shaoyin is the middle layer of the interior.) The Shaoyin vessels penetrate the Kidneys, connect to the Lungs, and tie to the root of the tongue. Therefore, dry mouth, dry tongue, and thirst occur. (Cheng's commentary states: Pathogens transmitting to the interior cause heat to deepen.) On the sixth day, the Jueyin meridian receives the pathogen. (Jueyin is the interior layer of the interior.) The Jueyin vessels circulate along the genitalia and connect to the Liver. Therefore, vexation, fullness, and contraction of the scrotum occur. (The deeper the disease, the more extreme the heat. Who says Shanghan is a cold condition? Note: Below this in the *Shanghan Lun* are the three sentences: "If these three meridians are all diseased and have entered the Fu organs, they can be cured by purging." Cheng's commentary states: For Three Yin pathogens in the meridians, sweat therapy is still appropriate; thus, "those entering the Fu organs can be cured by purging.") If the Three Yin and Three Yang, and the Five Zang and Six Fu organs are all diseased, and Ying and Wei circulation stops, and the Five Zang qi mechanisms are blocked, death occurs. (At this time, Yin and Yang, and the Six Meridians are all diseased, and the Zang and Fu organs are deeply heated. Purge therapy should be used to drain heat. If sweat therapy was initially neglected, urgent combined sweat and purge therapy is needed to avoid death. If sweat is indicated but not given, or purge is indicated but not given, the pathogenic factors in the meridians remain unresolved, and the excess in the Stomach Fu is not removed. Consequently, the Yin and Yang of Ying and Wei cannot circulate, and the Qi and Blood of the Five Zang cannot flow unimpeded, leading inevitably to death. This is what is meant by "death occurs within six or seven days.")

Regarding those who did not suffer from Lianggan (Simultaneous Invasion): (This continues from above, referring to conditions transmitted sequentially along the meridians, which were not initially Lianggan. However, even if heat becomes extreme, slight negligence in treatment can lead to death. Here, we discuss cases without Lianggan and with milder heat.) On the seventh day, the Juyang disease declines, and headache slightly improves. (This refers to the initial pathogen affecting Juyang. If heat was mild, it did not transmit to other meridians; if heat was severe and transmitted, any remaining pathogen was still in Juyang. By the seventh day, compared to the onset, heat must decline, and symptoms like headache improve. Annotations for subsequent meridians follow this pattern.) On the eighth day, Yangming disease declines, and body heat slightly subsides. (The character "yi" (recover) is changed to "xie" (rest/subside) in the *Shanghan Lun*.) On the ninth day, Shaoyang disease declines, and deafness slightly improves (hearing returns slightly). On the tenth day, Taiyin disease declines, abdominal fullness reduces to normal, and appetite returns. On the eleventh day, Shaoyin disease declines, thirst ceases, abdominal fullness resolves, tongue dryness disappears, and sneezing occurs. (Shaoyin vessels connect to the Lungs; sneezing indicates lung heat is vented, and Yin and Yang are harmonious.) On the twelve days, Jueyin disease declines, the scrotum relaxes, lower abdominal tension subsides, and the great pathogenic heat dissipates. The illness is nearly resolved. ("Da Qi" refers to the great heat pathogen. After twelve days, it dissipates, and the illness ends. This explains "recovery happens after ten days." It also illustrates "even if heat is severe, death does not occur.")

Huangdi said: How should it be treated? (Asking for treatment methods due to deaths from mismanagement mentioned earlier.) Qibo said: Treatment requires differentiating and unblocking the vessels of each Zang organ. The disease will decline daily. If the duration is less than three days, it can be cured by sweating. If the duration is three days or more, it can be cured by draining (purging/clearing). (This describes treatment principles. Generally, before three days, pathogens are in the exterior, hence sweating; after three days, pathogens often enter the interior, hence draining. This unblocks the meridian vessels of the Zang and Fu, reducing the febrile condition. I note that sweat and purge therapies in the *Shanghan Lun* should not be rigidly bound to days. Wang Bing commented: Even if many days have passed, if exterior signs exist and the pulse is large, floating, and rapid, sweating is still appropriate. Even if few days have passed, if interior signs exist and the pulse is deep, fine, and rapid, purging is required. Practitioners must examine pulse and signs to avoid errors. The day counts in this chapter should not be rigidly applied.)

Huangdi said: After heat disease has healed, residual symptoms sometimes persist. What is the cause? (Meaning heat has not fully cleared, lingering in the Zang and Fu.) Qibo said: Residual symptoms occur because food is forced during peak heat. In such cases, the disease has declined, but heat remains hidden. (The hidden heat is the residual heat.) Because grain Qi clashes with internal heat, the two heats combine, causing residuals. (The "two heats" refer to the hidden heat and the heat from newly ingested grain Qi interacting.)

Huangdi said: Good. How to treat residuals? Qibo said: Observe deficiency and excess, regulate contrary and compliant approaches. (Contrary refers to standard treatment, using cold to treat heat; Compliant refers to reverse treatment, using heat to treat heat—here implying adjusting therapy based on syndrome differentiation.) This ensures recovery.

Huangdi said: What are the dietary prohibitions for heat disease? Qibo said: When heat disease slightly improves, eating meat causes recurrence (relapse). Eating too much causes residuals (lingering heat is mild, relapse is severe). These are the prohibitions.

Huangdi said: For Lianggan by cold, how do the pulses correspond to the disease manifestations? (Pulse correspondence refers to reactions of the Three Yin and Three Yang meridians.) Qibo said: In Lianggan by cold, on the first day, Juyang and Shaoyin are simultaneously diseased, causing headache (Juyang), dry mouth, and vexation/fullness (Shaoyin). (*Shanghan Lun* adds: thirst). On the second day, Yangming and Taiyin are simultaneously diseased, causing abdominal fullness (Taiyin), body heat (Yangming), anorexia (Taiyin), and delirious speech (Yangming). On the third day, Shaoyang and Jueyin are simultaneously diseased, causing deafness (Shaoyang), scrotal contraction, and cold extremities (Jueyin). Inability to take fluids and loss of consciousness lead to death on the sixth day. (This demonstrates the corresponding nature of Yin-Yang meridians and simultaneous exterior-interior disease.)

Huangdi said: The Five Zang are injured, Six Fu are blocked, Ying and Wei do not circulate. Why does death occur three days after this state? (Huangdi doubts that Lianggan Shanghan differs from single transmission, where death waits until six or seven days. Qibo states that by the third day, Zang, Fu, Ying, and Wei are at extreme hyperthermia, suggesting immediate death. Why wait another three days?) Qibo said: Yangming is the chief of the Twelve Meridians, possessing abundant Qi and Blood. Loss of consciousness occurs due to extreme heat. After three days, Yangming Qi exhausts, leading to death. (As the chief of Twelve Meridians, abundant Qi and Blood in Yangming mean severe heat in other meridians. Extreme heat causes unconsciousness. Initially, although heat is severe, Yangming's primal Qi remains, preventing immediate death. After three more days, Yangming's primal Qi exhausts, unable to withstand the pathogenic heat of other meridians, hence inevitable death.)

Any Shanghan transforming into Warmth: If occurring before Summer Solstice, it is Warm Disease; if after Summer Solstice, it is Summerheat Disease. Summerheat disease involves sweating; do not stop the sweat. (Heat diseases change with seasons: Winter-Cold, Spring-Warmth, Summer-Heat, Autumn-Malaria. Each is named based on seasonal Qi injury. "Shanghan transforming into Warmth" means heat disease originating in winter is Shanghan; if originating in spring before Summer Solstice, it becomes Warm Disease due to warming weather; if after Summer Solstice, it becomes Summerheat Disease due to intense heat. Both have seasonal timing. Summerheat causes profuse sweating; "do not stop sweat" means do not hastily use astringents to stop sweat, nor use diaphoretics to force sweat. This is the method of clearing Summerheat and resolving the muscle layer. Summerheat treatment is detailed in the Summerheat section; Warmth treatment is in Volume 13.)