Library

Shanghan (Cold Damage), Ganhan (Sensation of Cold), Zhonghan (Strike of Cold), as well as Waigan (External Contraction) and Neishang (Internal Injury), differ significantly in deficiency and excess, and their treatment methods are vastly different. If texts fail to elucidate these details thoroughly, how can later learners distinguish them? Misapplication of treatments leading to death would be unbearable.

Shanghan refers to the disease contracted immediately after exposure to cold in winter. Although the killing cold of winter is severe, if one occasionally fails in care, it can invade the body. However, at this time, Yang Qi is closed and stored, and the Middle Qi (Spleen and Stomach Qi) is not extremely deficient, so how can external pathogens penetrate deeply? Therefore, the body develops high fever, and the pathogen enters from the exterior to the interior, transmitting through the meridians step by step. A skilled practitioner disperses the external pathogens and harmonizes Ying and Wei (Nutritive and Defensive Qi), and the illness resolves itself. Does it necessarily have to wait for the pathogen to transmit through the six Foot meridians before concluding the course?

Ganhan occurs when external cold is slight, but during the season when Yang Qi ascends and floats on the surface, and our own Zheng Qi (Upright Qi) is very weak, making us susceptible to sensation by cold. The body may have slight fever or no fever, the six pulses are powerless, and spirit is fatigued. It should be treated with warming methods to regulate, and the illness will heal spontaneously.

As for Zhonghan, it arises because the person's Yuan Yang (Primordial Yang) in the middle jiao is extremely depleted, and upon encountering violent cold pathogens, they strike directly into the middle. Symptoms include cold extremities, faint respiration, physical fatigue, deep and fine pulses, weak speech, no fever, or even if there is slight fever, the patient does not desire to remove coverings. At this moment, if urgent and potent warming and tonifying methods are not used to preserve the Yuan Yang, the remaining Primordial Yang will dissipate, and demise will be easy. The text states: "It is appropriate to urgently warm; delay means no rescue." Therefore, Baizhu Fuzi Tang (Atractylodes Macrocephala and Prepared Aconite Decoction), Renshen Fuzi Tang (Ginseng and Prepared Aconite Decoction), Lizhong Tang (Regulate the Middle Decoction), and Sini Tang (Reverse the Cold Decoction) are all established for such conditions.

Regarding Waigan and Neishang, pulse diagnosis must be clarified. An enlarged Renying pulse at the left Guan position indicates Waigan. However, within Waigan, differentiation from Neishang is crucial. In Waigan, aversion to cold persists even near a fierce fire; in Neishang, aversion to cold resolves with warmth. In Waigan, nasal breathing is obstructed; in Neishang, taste perception is lost. Waigan involves excess pathogens, hence speech is loud and vigorous; Neishang involves deficiency of Yuan Qi, hence speech is lazy and timid. Waigan headache is constant and unceasing; Neishang headache comes and goes. Waigan presents with heat on the back of the hands; Neishang presents with heat in the palms. Pulse diagnosis holds that an enlarged Qikou pulse at the right Guan position indicates Neishang, specifically referring to dietary injury, which is an excess syndrome suitable for resolution/digestion methods. Regarding treatment principles in texts stating "Waigan is rare, Neishang is common, only warming and tonifying are needed, no dispersing," this refers to internal injury of Yuan Qi, not dietary accumulation. The syndromes are as different as heaven and earth; how should practitioners decide? Thus, dietary injury should be distinguished as excess, and fatigue injury as deficiency. This aligns with the meaning in Nei Jing (Inner Canon) that diet and fatigue damage the Spleen and Stomach. However, Neishang from fatigue implies deficiency of Middle Qi; Waigan in deficient persons, if delayed slightly, invariably involves the interior without just the exterior, and contracting disease inevitably harms Zheng Qi. Initial illness requires distinguishing internal and external; prolonged illness converges into a single deficiency. Therefore, those with high fever, surging rapid forceful pulses, uncovering clothes, coarse breathing, incessant speech, thirst preferring cold drinks, are all excess. Those without fever or with slight fever, deep fine wiry slow powerless pulses, feeling cold even under inner layers, weak speech, slight thirst preferring hot drinks or no thirst, are all deficiency. Excess constitutes Yang syndromes and exogenous diseases; deficiency constitutes Yin syndromes and endogenous diseases.