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[Background Information]
Book: Shanghan Zhengzhi Zhunsheng (Standard of Diagnosis and Treatment of Cold Damage)
Author: Wang Kentang
Dynasty: Ming
Chapter: General Examples / Differences of Cold Damage in Four Seasons (1/2)(1/2)
Category: Cold Damage

(The differences of cold damage in four seasons, transmission and transformation, general principles of sweating and purging, indications for sweating, contraindications for sweating, indications for purging, contraindications for purging, indications for vomiting, contraindications for vomiting, recovery and resolution, death syndromes, Yin and Yang, exterior and interior, cold damage and miscellaneous diseases, syndrome differentiation, miscellaneous discussions, brief on observing complexion.)

The *Yin Yang Da Lun* states: The Qi of spring is mild and harmonious; the Qi of summer is hot and sultry; the Qi of autumn is cool and clear; the Qi of winter is cold and biting. This is the sequence of the upright Qi of the four seasons. In winter, severe cold causes all things to hide deeply. If a gentleman can secure and close his pores, he will not be injured by cold. Those who are exposed to and offend against it are named as having *Shanghan* (Cold Damage). However, injury by the Qi of any season can cause disease (i.e., the epidemic Qi mentioned below). *Shanghan* is called toxic because it forms the most lethal and destructive Qi. If illness occurs immediately upon infection, it is called *Shanghan*. If illness does not occur immediately, the cold toxin hides in the skin and muscles, transforming into *Wenbing* (Warm Disease) in spring and *Shubing* (Summerheat Disease) in summer. *Shubing* involves extreme heat, more severe than *Wenbing*. (*Neijing* states: Diseases acquired before the Summer Solstice are called *Wenbing*; those acquired after are called *Shubing*. Both originate from cold injury, hence Imperial Physicians generally refer to them as *Shanghan*.) Therefore, hardworking people often suffer from warm-heat diseases in spring and summer, caused by cold exposure in winter, not by "epidemic Qi". (*Huoren Shu* states: Fever, aversion to cold, headache, body heaviness, joint pain, and a surging pulse in summer indicate this. Winter cold injury triggered by summer heat causes heat disease.) Epidemic diseases refer to situations where spring should be warm but is extremely cold, summer should be hot but is extremely cool, autumn should be cool but is extremely hot, and winter should be cold but is extremely warm. Having such Qi out of season causes many people of all ages to fall ill with similar symptoms; this is the epidemic Qi. (This distinguishes between *Shanghan* and epidemic Qi.) To predict illnesses caused by the upright Qi of the four seasons or epidemic Qi, one must consult the Dipper Calendar (ancient astronomical instrument for determining solar terms).

**Method for Determining Disease based on Four Seasons, Eight Festivals, Twenty-Four Solar Terms, and Seventy-Two Pentads:**
Li Chun (Start of Spring), first month festival, Dipper points to Gen; Yushui (Rain Water), middle of first month, Dipper points to Yin.
Jingzhe (Awakening of Insects), second month festival, Dipper points to Jia; Chunfen (Spring Equinox), middle of second month, Dipper points to Mao.
Qingming (Clear and Bright), third month festival, Dipper points to Yi; Guyu (Grain Rain), middle of third month, Dipper points to Chen.
Lixia (Start of Summer), fourth month festival, Dipper points to Xun; Xiaoman (Grain Buds), middle of fourth month, Dipper points to Si.
Mangzhong (Grain in Ear), fifth month festival, Dipper points to Bing; Xiazhi (Summer Solstice), middle of fifth month, Dipper points to Wu.
Xiaoshu (Minor Heat), sixth month festival, Dipper points to Ding; Dashu (Major Heat), middle of sixth month, Dipper points to Wei.
Liqiu (Start of Autumn), seventh month festival, Dipper points to Kun; Chushu (End of Heat), middle of seventh month, Dipper points to Shen.
Bailu (White Dew), eighth month festival, Dipper points to Geng; Qiufen (Autumn Equinox), middle of eighth month, Dipper points to You.
Hanlu (Cold Dew), ninth month festival, Dipper points to Xin; Shuangjiang (Frost Descent), middle of ninth month, Dipper points to Xu.
Lidong (Start of Winter), tenth month festival, Dipper points to Qian; Xiaoxue (Minor Snow), middle of tenth month, Dipper points to Hai.
Daxue (Major Snow), eleventh month festival, Dipper points to Ren; Dongzhi (Winter Solstice), middle of eleventh month, Dipper points to Zi.
Xiaohan (Minor Cold), twelfth month festival, Dipper points to Gui; Dahan (Major Cold), middle of twelfth month, Dipper points to Chou.
(Twenty-four solar terms include twelve "Zhongqi" (mid-term Qi) and twelve "Jieqi" (festival Qi). Each pentad lasts five days. Understanding these seventy-two pentads is essential for determining life and death in disease.)

After Frost Descent in September, weather gradually cools until Major Cold in winter, then thaws after Rain Water in January. Hence "Rain Water," as ice and snow melt into rain. After Awakening of Insects in February, climate warms towards summer heat, cooling in autumn. (This is the upright Qi of four seasons.) From Frost Descent to Spring Equinox, anyone offended by ice/snow who falls ill immediately has *Shanghan*. In Sept/Oct, cold is slight, so illness is mild; in Nov/Dec, cold is severe, so illness is heavy; in Jan/Feb, cold wanes, so illness is mild. This results from improper regulation in winter leading to immediate *Shanghan*. (This is immediate illness from upright Qi.) Non-seasonal warmth in winter is called *Dongwen* (Winter Warmth). Its toxicity differs greatly from *Shanghan*. *Dongwen* varies in timing and severity, requiring different treatments (see later chapters). (This is epidemic Qi. "Winter should be cold but is warm." Regular occurrences involve Shaoyin, Yangming, or Jueyin ruling heaven at specific phases. Irregular cases require flexible judgment.) After Start of Spring, without sudden severe cold or ice, if someone has high fever, it is spring Yang expanding outward, transforming winter latent cold into *Wenbing*. (*Neijing*: Winter cold injury leads to spring warmth disease. External pathogen awakens internal pathogen. Regular occurrences involve Shaoyin, Taiyang, Yangming, or Taiyin ruling heaven at specific phases. Irregular cases require flexible judgment.) From Spring Equinox to before Autumn Equinox, sudden cold indicates epidemic cold plague. In Mar/Apr, Yang is weak, so heat is mild; in May/Jun, Yang is strong, so heat is heavy; in Jul/Aug, Yang declines, so heat is slight. Symptoms resemble *Wenbing* and *Shubing*, but treatment differs. (Key is distinguishing cold, heat, and warmth etiologies to determine drug temperature.) Every fifteen days yields one Qi. Six Qi per season make twenty-four Qi. Climate may arrive early, late, or excessively, causing disease. (*Suwen*: Arrival matching expectation is harmony; arrival without expectation is deficiency; non-arrival is excess. *Jingui Yaolue*: Similar variations exist. After Winter Solstice, Jiazi night marks Shaoyang rise. Warmth arriving before Jiazi is "early arrival"; lack of warmth after Jiazi is "late arrival"; persistent cold after Jiazi is "non-departure"; excessive heat after Jiazi is "excessive arrival.") Heaven and Earth move via Yin-Yang interaction, establishing distinct Qi. Spring warmth becomes summer heat; autumn austerity becomes winter anger. After Winter Solstice, Yang rises, Yin descends; after Summer Solstice, Yang descends, Yin rises. These are Yin-Yang conjunctions at solstices and separations at equinoxes. Yin-Yang exchange causes human disease. Gentlemen nourish Yang in spring/summer and Yin in autumn/winter, following Heaven and Earth's rigidity/flexibility. Commoners offending nature suffer violent rashes. One must identify which meridian holds toxic Qi and what disease arises. Thus: Spring wind injury leads to summer undigested diarrhea; summer summerheat leads to autumn malaria; autumn dampness leads to winter cough; winter cold leads to spring warmth disease. This is inevitable. Treat *Shanghan* daily according to depth. (*Classic*: <3 days, sweat; >3 days, purge.) Modern patients delay treatment or receive incorrect treatment, worsening condition. Doctors must adjust formulas dynamically. I collect Zhang Zhongjing’s old theories, recording syndromes, pulses, colors, and effective formulas for emergencies. (Wang Shuhe’s efforts made Zhongjing’s work known after a millennium.) Land varies in warmth/cold and elevation; materials vary in hardness/softness; diet/lifestyle differ. Huangdi asked about four regions; Qibo taught four treatments. Physicians must examine both context and pathology. (Pang Anchang noted Guizhi Tang works well in NW China year-round, but only in winter/spring in Jianghuai. Add Huangqin in late spring/pre-summer; add Zhimu, Daqing, Shengma, Shigao in summer. For epidemic cold or chronic deficiency-cold, use original formulas unchanged. Baihu Tang is for post-sweat exterior resolution, not new summerheat. Post-sweat mania requires treating internal heat, ignoring season. Southern regions lack frost/snow; earth Qi doesn't store; insect toxins/miasmas occur; different methods apply. Mountain dwellers live in Yin accumulation, cold pores, long life, prone to wind-cold. Plain dwellers live in Yang accumulation, warm pores, short life, prone to warmth-summerheat.)

Wang Lu stated: Cold injury causes immediate illness (*Shanghan*) or delayed illness (*Wen/Shu*). Immediate illness happens at infection time; delayed illness happens in spring/summer. Though origins are similar, categories differ, so treatments must not mix. Confusing names with treatments harms descendants, blaming Zhongjing. This is like blaming Boyi for wells or Suiren for fire. Zhongjing’s formulas were for immediate *Shanghan*, not delayed *Wen/Shu*. Knowing this prevents discarding valuable methods. Using *Shanghan* methods for *Wen/Shu* is borrowing, not original intent. However, these methods can treat miscellaneous diseases too. Claiming Zhongjing’s laws cover all *Shanghan/Wen/Shu* is confusing source and stream. Zhongjing’s book shows 70-80% Yin meridian cold syndromes, while delayed *Wen/Shu* are purely heat. How can they become cold? Later doctors mixing *Shanghan/Wen/Shu* suspect warming agents. Han Zhihe found Guizhi Tang difficult, citing era differences, but missed that Zhongjing targeted immediate *Shanghan*. His *Weizhi* focused on *Wen/Shu* as *Shanghan*, ignoring immediate *Shanghan*. He treated pre-summer solstice chest fullness, vomiting, etc., as *WenShu*, linking them to Yin cold syndromes, creating "Warming Middle" methods. Actually, Zhongjing’s Yin cold syndromes are winter immediate *Shanghan*. Matching them to spring/summer *WenShu* is absurd. Chest fullness/vomiting likely stem from cold food, sudden cold, or overuse of cold drugs. Han Zhihe said "cold needs warming" but didn't seek the cause. Zhu Fengyi’s *Huoren Shu* clarified Yin cold syndromes but mixed *Shanghan/WenShu*, combining transmitted heat and immediate cold syndromes, claiming Yangming needs purging and Shaoyin needs warming. This contradicts itself, as Shaoyin heat shouldn't be warmed. This theory harmed many. Cheng Wuji’s commentary praised terminology but missed immediate Yin cold syndromes. Liu Wansu also treated *WenShu* as *Shanghan*, omitting immediate *Shanghan*. His辛凉 (Acrid-Cool) dispersants aimed to prevent misdiagnosis of wind-cold but confused Guizhi/Mahuang usage. His *Yuanbingshi* suggested adding cold drugs to Mahuang/Guizhi in summer to prevent jaundice/rashes. Pang Anchang and Zhu Fengyi agreed. But Zhongjing didn’t intend these for summer heat. Cold trapping exterior closes pores,郁 (depresses) Yang into heat; only Acrid-Warm opens pores. Wind injuring exterior loosens pores but blocks Zheng Qi flow, causing fever; Acrid-Sweet-Warm expels pathogen, closing pores naturally. No cold drugs needed because cold-wind is exterior during cold weather. Later doctors doubted Acrid-Warm drugs in spring/summer, adding cold drugs. This misunderstanding led to confusion. If Zhongjing prescribed for *WenShu*, he would have different methods. Lost methods cause confusion. Knowing Zhongjing targeted immediate *Shanghan* clarifies why Mahuang/Guizhi are used. Except for transmitted heat, direct Yin injury or Sunyang non-depressed cold syndromes fit these formulas. Spring/summer aversion to wind/cold resembling *Shanghan* are usually new wind-cold infections, not delayed winter injuries. Or, *WenShu* emerging triggered by new wind-cold. Zhongjing: "Taiyang disease with fever, thirst, no aversion to cold is Wenbing." Thus, *Wenbing* lacks aversion to cold but has thirst. Aversion to cold without thirst is not *Wenbing*. *Shubing* resembles *Wenbing* but worsens over time; lacks aversion to cold, has thirst. Spring/summer exterior signs make Guizhi/Mahuang risky; don't cling to "exterior release ignores heat." Use Acrid-Cool dispersants cautiously. Misuse causes mania, rashes, epistaxis. Occasional success in spring/summer is luck, not rule. Using Baidu San, Susu Yin, etc., for all seasons is pragmatic compared to reckless Mahuang/Guizhi use, but still limited to acute wind-cold, not delayed *WenShu*. Using them for *WenShu* harms. Zhongjing used warming drugs for Yin meridians due to necessity and timing. Treating Yin cold as miscellaneous disease neglects Zhongjing’s benevolence. Recent scholars emphasized cold-cooling, neglecting warm agents, fearing Zhongjing’s book yet unable to discard it. Some call it obsolete, suitable only for past eras (calm/water vs. chaotic/fire). If we understand Zhongjing targeted immediate *Shanghan*, Guizhi/Mahuang have their place, and warm agents aren't negligible. If Zhongjing’s laws covered all, would epidemic cold/plague/warm-malaria/wind-warm use Six Meridian formulas? *Shanghan Example* says Winter Warmth differs from *Shanghan*; Cold Plague differs from Warm/Summerheat. Thus, Zhongjing had separate methods for these, now lost. Wang Shuhe compiled scattered texts, great merit, but mixed his views and miscellaneous topics, confusing jade with stone. Organizing by *Example*, Six Meridians, Similar Syndromes, Recovery, Diagnostics, Contraindications, Misc. Topics would clarify. I intended this but lacked time; recorded here for future.

**On Cold Damage, Warm Disease, and Heat Disease:**
Disease has etiology, name, and manifestation. Distinguishing etiology, naming correctly, and observing manifestation are prerequisites for treatment. *Shanghan* is named by etiology; *Wenbing/Shubing* by season and manifestation. All originate from cold, hence sometimes grouped under *Shanghan*. Etymologically similar, but treatments differ. *Shanghan* occurs after Frost Descent to before Spring Equinox, delaying onset until spring/summer. Immediate *Shanghan* happens in cold weather, cold pathogen at exterior closing pores; requires Acrid-Sweet-Warm (Guizhi/Mahuang). *Wenbing/Shubing* occur in warm weather, heat郁 (depressed) internally reaching exterior, no exterior cold; requires Acrid-Cool, Bitter-Cold, or Sour-Bitter (e.g., Shuijie San, Dahuang Tang, Qianjin Tang, Fangfeng Tongsheng San). Immediate *Shanghan* has aversion to wind/cold due to exterior pathogen/injury. Delayed *Wenbing/Shubing* has aversion to wind/cold only if newly infected by wind-cold. Without new infection, no aversion to wind/cold. Zhongjing: "Taiyang fever, thirst, no aversion to cold is Wenbing."