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The Way of Heaven flourishes when it encounters the era, and affairs become prominent when they meet the timing; this is a constant principle from ancient to modern times, originating from nature. Furthermore, it is said that after the decline and extinction of Confucian classics, various heterodox theories arose like bees, confusing the Dao of the Six Channels (Liu Jing), just as red and purple confuse the orthodox color vermilion, making it impossible to reach a compromise. Emperor Xiaowu (Emperor Wu of Han) selected and employed talented individuals, dismissed the errors of the hundred schools of thought, and thus the Dao of the Six Channels began to be clarified. Since the Han Dynasty, annotations and expositions have been complex and confused, especially in medical books. Moreover, medicine governs human life and death, and its significance is particularly heavy; it is likely beyond the reach of petty wisdom.

In the past, the Yellow Emperor and Qibo answered questions on difficult issues, exploring the Way of Heaven above, the geography below, and human nature in the middle, leaving laws for ten thousand generations as a realm of longevity for the people, hence named *Suwen* (Basic Questions). Thus, Mr. Liu Shouzhen (Liu Wansu), fearing that these cultural texts would fall to the ground and that people would suffer premature death, investigated the principles of heaven and earth, yin and yang, rigidity and softness, waxing and waning, examined the suitability of wind qi, blood vessels, cold, and heat in human life, and wrote essays one by one, all citing *Suwen*, first marking the root source of disease, then prescribing formulas and medicines. His annotated works consist of four: First, clarifying the creation of heaven and earth, discussing the prosperity and decline of transformation, titled *Yaozhi Lun* (Treatise on Key Principles), one volume, totaling 36,753 characters. Second, distinguishing Sovereign, Minister, Assistant, and Courier roles, determining the reversal and compliance of odd and even formulas, also composing *Xuanming Lun* (Treatise on Manifestation), one volume, totaling 8,903 characters. Third, annotating the transmission of the Six Channels of Cold Damage, *Zhige* (Direct Grid), one volume, totaling 17,009 characters. Fourth, selecting the essay "Zhi Zhen Yao Da Lun" (Essential Requirements of the Most True), discussing pathogenesis and qi suitability, writing *Xuanji Yuanbing Shi* (Original Formulas of Mysterious Mechanisms), one fascicle, totaling over 20,000 words. Additionally, after Mr. Liu's passing, fearing that mediocre doctors did not know the key points, he collected sixty urgent and effective prescriptions within *Xuanming Lun*, divided into six categories, also named *Zhige*. In total, over 80,000 words, which can be called diligent.

Shouzhen said: "Since ancient times, only Zhang Zhongjing's writings established ninety-seven methods for Cold Damage, combined with 113 formulas, yet later learners could not take them as their model. For example, if a person suffers from Wind Injury (Shang Feng), Guizhi Tang (Cinnamon Twig Decoction) is used to resolve the muscle layer; if suffering from Cold Damage (Shang Han), Mahuang Tang (Ephedra Decoction) is used to induce sweating. If Wind Injury is wrongly treated with Mahuang Tang, it will cause neck stiffness and flaccidity; if Cold Damage is wrongly treated with Guizhi Tang, it will cause panic, mania, and macules. Or if these two medicines are misused, death is certain. Therefore, Zhang Zhongjing said: 'When Guizhi Tang enters the throat, if Yang is excessive, death ensues; when Chengqi Tang enters the stomach, if Yin is excessive, death ensues.' This is what Shouzhen worried about, fearing the misuse of Mahuang and Guizhi, so he prescribed Shuangjie San (Double Release Powder). Regardless of Wind Injury or Cold Damage, internal and external pathogens can all be treated; even those harmed by incorrect sweating methods will not suffer harm. In this way, correcting the弊 (弊端 - drawbacks) of misleading people is already considerable. Zhang Zhongjing prescribed Dachengqi Tang (Major Order the Qi Decoction), Xiaochengqi Tang (Minor Order the Qi Decoction), and Tiaoweichengqi Tang (Regulate the Stomach Order the Qi Decoction), each having its appropriate indications. For severe heat, Dachengqi Tang governs; for mild heat, Xiaochengqi Tang governs; for abdominal pain and hard stool, Tiaoweichengqi Tang governs. Shouzhen again feared that there were three types of Chengqi formulas, worrying about the risk of over-treatment or under-treatment, so he created Sanyi Chengqi Tang (Three-One Order the Qi Decoction) to summarize them. He also considered that Zhang Zhongjing's books were profound and obscure, difficult for shallow learners to understand, so he pruned the branches and vines, extracted the roots, removed seven or eight tenths, and summarized the 397 methods and 113 formulas into 32 medicines, making them easy to consult. Seeing this book is like seeing the shadow of the form, without obstacles; obtaining it allows one to treat oneself according to symptoms, let alone doctors. Furthermore, besides *Shanghan Lun* (Treatise on Cold Damage), Zhang Zhongjing had no discussions on miscellaneous diseases, which was already complete in his books; therefore, Shouzhen first discussed the errors in *Shanghan Lun*.

Thus, all internal and external injuries have diseases caused by sweat exposure, named Re Bing (Heat Disease), collectively called Shanghan (Cold Damage). Now, Spring Warmth, Summer Heat, Autumn Coolness, Winter Cold, follow the weather of the four seasons, the severity of infection, and the varying degrees of treatment; speaking together, they are one. Winter latent cold evil hides between the muscles; by spring it becomes Wen Bing (Warm Disease), by summer Shu Bing (Summerheat Disease), by autumn Shi Bing (Dampness Disease), and by winter Zheng Shanghan (True Cold Damage). Exposing oneself to cold qi in winter causes internal fu re (stagnant heat); if mild and not causing illness, until future yang-heat changes, or if infected again, it becomes Re Bing. The classic says: 'Winter injury by cold leads to Warm Disease in Spring,' which is also its meaning. However, those Yin syndromes are merely miscellaneous diseases, ultimately not Sweat Diseases (Han Bing - diseases related to sweating/cold constraint), thus Shanghan Sweat Diseases speak directly of Heat Disease, not mentioning Cold. Three Yin syndromes involve pathogenic heat in the interior of the zang organs; since zang are interior and yin, purgation should be used. *Suwen* has three chapters: Cila Re (Acupuncture for Heat), Ping Re Lun (Evaluation of Heat Treatise), and Re Lun (Heat Treatise), discussing heat without mentioning cold, which is not meaningless. Outside of Re Lun, *Suwen* has no other discussion of Shanghan syndromes. Re Lun states: 'Heat diseases are all of the category of Cold Damage.' It also says: 'When humans are injured by cold, they become diseased with heat.' The annotation says: 'Cold is the qi of winter.' During winter's severe cold, all things hide deeply and securely, not injured by cold. Those who touch and offend it are named Shanghan. Being injured by the qi of the four seasons can all cause disease; considering Shanghan as toxic, it is the most lethal qi. If one contracts it and falls ill immediately, it is named Shanghan; if not ill immediately, the cold toxin hides in the muscles, lingering for a long time, transforming into Heat Disease, hence saying Heat Disease is of the category of Cold Damage.

Ancient sages instructed that Yin and Yang are Exterior and Interior; this is a major program of this channel, only Zhang Zhongjing deeply grasped its purport. Later, Zhu Gong compiled *Huo Ren Shu* (Book for Saving People), interpreting the two characters Yin and Yang as Cold and Heat; this is a great error! *Suwen* speaks of the Yin and Yang of human zang-fu: zang are Yin, fu are Yang. Also, the Yin and Yang of the four seasons are all recorded in scriptures; internal and external correspondences are all Exterior and Interior, is this true? The Six Combinations (Liu He) are the unions of the Twelve Meridians: Taiyin and Yangming are one combination, Jueyin and Shaoyang are one combination, Shaoyin and Taiyang are one combination; hand and foot meridians are called the Six Combinations. Exterior and Interior: all Yang meridians are Exterior, all Yin meridians are Interior. Verifying this, Shouzhen's words are not false. However, fearing that common people do not realize the error in Zhu Gong's *Huo Ren Shu*, I briefly cite one aspect of the Six Channels' transmission in Shanghan to clarify it. Gong's book says: 'When Shanghan strikes the disease, the pores are cold, entering the Yin channels; the pulse is not fine and subtle, bypassing the Three Yang.' For Cold in the Three Yin, if mild, Lizhong Tang (Regulate the Middle Decoction) is used; if slightly cold or with diarrhea, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) is used. If Yin Poison is deep, the disease is critical, the six pulses adhere to the bone, floating reveals them, pressing makes them vanish; use the Scallion Ironing Method at the navel. After moxibustion of three to five hundred moxa cones, if hands and feet are not warm, it is incurable. Shouzhen said: 'For the first three days, Three Yang diseases are in the Exterior, so they should be sweated out; for the last three days, Three Yin diseases are in the Interior, so they should be purged. The transmission of the Six Channels are all Heat syndromes, not Cold diseases.' *Suwen* says: 'If Shanghan is less than three days, it can be cured by sweating; if more than three days, it can be cured by purging.' From this, Shouzhen's theory conforms to *Suwen*, while Gong's book is far off. Again, regarding the syndrome of cold body and faint pulse, extreme Yang Jue (Reversal): Gong's book says: 'Patient has cold body, pulse is deep, fine, and rapid, sometimes Zhengsheng (slurred speech), nails and face are cyan and black, Yin Poison is deep. If taking cooling medicines, thirst becomes worse, restlessness increases, must urgently take acrid-hot medicines. If hands and feet become warm, continue taking previous hot medicines to assist. If Yin qi scatters and Yang qi returns, gradually reduce hot medicines to regulate.' Shouzhen said: 'After purging Shanghan, heat does not recede, accumulated heat is inside, Yang Jue is extreme, until Yang qi is constrained and cannot circulate to the body surface and limbs, causing whole-body cyan and cold. If urgently purged, residual Yin abruptly perishes, Yang qi exhausts and death occurs; if not purged, also death. At this moment, use Liangge San (Cool Diaphragm Powder) or Jiedu Yangyin Taiyang (Detoxify and Nourish Yin to Retreat Yang). Only if accumulated heat gradually scatters, will heart and abdomen become warm again, and pulse naturally regenerate. When pulse becomes strong, only then can Sanyi Chengqi Tang be used to purge.' Shouzhen again worried about the theory of Two Simultaneous Infections (Lianggan) in Heat, verifying with *Suwen*: 'Excess causes harm, succession brings control.' This precisely refers to extreme Yang Jue, unable to circulate to limbs, causing cold body and faint pulse. This briefly cites one or two ends; the rest can be understood by analogy. Gong's book was popular in the contemporary world, and he was a famous doctor of the generation, yet his errors were so great; how much more so for other trivial, chaotic, and unorthodox sayings, which cannot be fully believed! Regarding children, Yan Xiaozhong said: 'For all childhood eruptions, the nursing mother must guard her diet, not letting the child go hungry. And upon contracting wind-cold, it returns to the Kidney, turning black and becoming difficult to treat. Spring and Summer diseases are favorable; Autumn and Winter diseases are unfavorable. In Winter, Kidney is prosperous and Cold is strong, mostly returning to Kidney to turn black. If wrongly purged, interior becomes deficient, mostly returning to Kidney. This directly treats eruptions as Cold.' Shouzhen said: 'Yan Xiaozhong did not detail Qian's original formulas. For black sinking macules and rashes, using Niuli Gao (Ox Plum Paste) and Baixiang Wan (Hundred Fragrance Pill), purging with cold medicines, often results in recovery; without rescue, death is certain. Is it not clear that this is Heat! The classic says: 'All pain, itching, ulcers, and sores belong to Heart Fire.' And for black sinking macules and rashes, there is invariably abdominal fullness, wheezing, urgency, and red, scanty, obstructed urination; is this not caused by extreme Heat! This is why Yan Xiaozhong lost Qian's intent. Shouzhen's distinction such as this can be called the mirror of physicians. Learners should study its arguments carefully, do not rashly claim that Shanghan has Yin Poison syndromes and immediately administer Jiang Fu (Ginger and Aconite) medicines, making excess more excess and deficiency more deficient, damaging the insufficient and benefiting the surplus, thereby misleading people, is this not unjust! Every time I read Cheng Dizhong's Preface: 'Like traveling at night, lost in darkness, not knowing where to go. Meeting bright lamps and torches, the correct path is clear; this is the purpose of writing Medical Mirror.'

However, the secular world dislikes Cold and likes Heat; there is probably a reason for this. Shouzhen said: 'For mild diseases, using hot medicines to forcibly force open development, mistakenly hitting and gaining effect has occurred. For example, suffering from Wine Heat Toxicity, and drinking hot wine to treat it, allowing stagnation to open and qi-fluids to circulate freely; this is called treating Heat with Heat, and there are recoveries. Secular people are confused by mild diseases easily recovering, thinking severe diseases are the same; little do they know that missing the mark causes harm. Treating Heat Disease with hot medicines is like a proud ruler receiving a flattering minister's indulgence; disaster leads to destruction, unaware of the minister's evil, only enjoying their shared pleasures, causing Heat to intensify, leading to Yang Jue, cold body and faint pulse, reversing Yang to Yin, dying without realizing it. As for various Heat transformation syndromes, nine out of ten are damaged, none different. For example, unremitting diarrhea, stagnant heat in the interior, if using fire moxas and ironing, none would not be pleased. This is why the secular world likes Heat and dislikes Cold, thus nourishing the errors of Gong's book.'

Furthermore, Shouzhen said: 'When Heat disease is severe, following standard treatment but not receding, either due to lack of cooling, or failure to purge, or ironing, smoking, and moxibustion, causing extreme Heat and delirious Yang Jue. One must absolutely not use Yinfen (Calomel) and Badou (Croton Seed) hot and highly toxic pill medicines to purge, which instead deplete Yin qi and exhaust fluids, causing Heat to intensify, leading to Ao Nao (restlessness), wheezing and fullness, Jie Xiong (Chest Binding), abdominal pain, unremitting diarrhea, bleeding, hematochezia, or strangury and retention, panic, mania, and delirium; Heat syndromes arise like bees, too numerous to list. Thus becoming masses and firm accumulations, misleading people is frequent. Yet worldly sentiments do not know the physician's fault, failing to fully investigate Shouzhen's miraculous effects.'

I once heard Shouzhen say: 'Orthodox Treatment (Zheng Zhi) uses Cold to treat Heat, and Heat to treat Cold. For mild diseases, this can be done; for critical diseases, one must follow Counter-Treatment (Fan Zhi). Its Counter-Treatment is also called Following Treatment (Cong Zhi), because the medicinal qi follows the pathogenic qi. Thus, using Heat to treat Heat, and Cold to treat Cold, is called Counter-Treatment. Using Heat to treat Heat does not mean the pathogenic Heat is severe and more hot-natured medicines are used; rather, it means cold-natured medicines are taken with hot adjuvants. Because pathogenic Heat is severe, and medicinal Cold is severe, rejecting the medicinal Cold, the Cold attack cannot enter; Cold and Heat contend, and the disease worsens. Therefore, using cold medicines, one adds hot adjuvants to take them, ensuring medicinal qi and pathogenic qi do not conflict. The medicine is originally cold; after taking it hot, once the heat constitution is eliminated, the cold nature emerges, and thus the pathogenic qi heals accordingly. The rest follow this pattern. However, the method of Orthodox Treatment is like a sovereign punishing a minister's fault, going against the minister's nature to punish him; thus, if Heat is not severe, treating with Cold goes against the pathogenic qi, and the disease heals itself. The method of Counter-Treatment is like a minister remonstrating with a sovereign's error, following the sovereign's nature to please him; initially it complies, finally it opposes, able to admonish the sovereign to remove evil and return to orthodoxy. Wang Bing said: 'Treating minor disease is like saving a fire; fire gets wood and burns, gets fire and blazes, gets water and extinguishes. Treating dampness is like saving Dragon Fire; fire gets dampness and burns, gets water and blazes. Human fire, if not driven away, extinguishes itself.' This is called the method of good physicians. Both Opposing Treatment (Ni Zhi) and Following Treatment (Cong Zhi) are medicines contrary to nature; how could patients not dislike them? It is the struggle between medicine and disease that solidifies the qi. However, saving ten out of ten is not the physician's merit, attributing it to fate. Like cold body and faint pulse, never realizing accumulated heat is inside; if using Liangge or Jiedu medicines to regulate, none would not dislike it. Again, regarding chronic conditions lasting years, never understanding stagnant heat in the interior; if using Chengqi cold medicines to purge, none would not fear it. Even if recovered, one cannot avoid fear and aversion. Deaths caused by severe disease and weak medicine power are also unaware that saving a cartload of burning wood with a cup of water is wrong, only blaming the cooling medicine. These two cases have no other reason; it is that worldly people lack clarity on right and wrong, disliking Cold and liking Heat.'