欲识伤寒之义者，先正伤寒之名。《百问》云，冬曰伤寒，春曰温病，夏曰热病，通而言之为伤寒者何哉？
盖邪之所凑，其气必虚。冬月阳气不密，以致寒邪触犯，其即发而为病者，名曰伤寒；其不即发，至春感温气
而发者，名曰温病；至夏感热气而发者，名曰热病。温热虽发于春夏，而其受病之因，隔冬寒毒藏于肌骨，
而自里发之，故通而言之为伤寒也。仲景伤寒立论，万世典也；河间温暑补方，三时用耳；至于传经直中，分
别阴阳杂证，乃丹溪之独见，伤寒大义如此。然西北风高，伤寒者多；东南地燠，内伤者多，是以东垣又作《内
外伤论》以辨之。伤寒之书，至此可谓全且备矣。奈何今之医者，或读伤寒一二，而不理会杂病内伤，或窃内伤
杂病一二，而不理会伤寒！主伤寒者，专一发散；主内伤者，专一温补，内外莫辨，杀人惯矣。陶节庵曰∶医
者不可一日不读伤寒，以活心源。愚谓读伤寒而不读三子之书，亦不足以活心源。噫！三世四家之书，缺一不
可。
万历丙子初夏序
诸风掉眩乃肝木，
掉，摇也；眩，昏乱旋运也。由风木旺甚生火，风火属阳，阳主乎动，两动相搏为之旋转。
痛痒疮疡心火属；
人近火气者，微热则痒，热甚则痛，肘近则灼而为疮，皆火之用也。痒者美疾也，故火旺于夏而万物蕃美。
或云∶痛为实，痒为虚。非谓虚为寒也，正谓热之微甚也。痒得爬而解者，爬令皮肤辛辣而属金化，辛能散故
也。疮疡属热而出浓水，犹肉果热极，则腐溃而为水，反兼水之化也。
湿肿满本脾土经，
地之体也，土湿过极，则痞塞肿满。物湿亦然，故长夏属土，则庶物隆盛也。
气 郁痿肺金伏；
。谓 满也；郁，谓奔迫也；痿，谓手足痿弱无力以运动也。大抵肺主气，病则其气 满奔迫，不能上
升。至于手足痿弱，不能运动，由肺金本燥，燥之为病，血衰不能荣养百骸，故指得血而能摄，足得血而能步，
秋金旺则雾气蒙郁，而草木萎落，病之象也。萎，犹痿也。
寒之收引肾水乡，
收敛引急，寒之用也，故冬寒则拘缩矣。
五运主病枢要目。
诸暴强直，支痛里急，筋缩 戾，本足肝胆二经厥阴风木之气。
暴，卒也；强直，坚劲也；支痛，支持也。谓坚固支持，筋缩不柔而痛也。 ，缩也；戾，乖戾也。谓筋
缩里急乖戾失常而病也。然燥金劲切，木病反兼金化，由亢则害，承乃制也。况风能胜湿而为燥也，风病势甚
而成筋缓者，燥之甚也，故甚者皆兼于燥也。
诸病喘呕及吐酸，暴注下迫转筋难；小便混浊血溢泄，瘤气结核疡疹斑；痈疽吐下霍乱证， 郁肿胀鼻塞
干；鼽衄淋秘身发热，恶寒战栗惊惑间；笑悲谵妄衄蔑污，腹胀鼓之有声和；少阴君火手二经，真心小肠气之
过。
喘，火气甚则气盛而息粗也。呕，胃膈热甚火炎之象也。吐酸，木味为酸，如饮食热则易于酸矣。暴注、
卒泻，火性速故也。下迫，里急后重也，火燥能令下焦急迫也。转筋，热燥于筋而自转也。小便混浊，寒则水
清，热则水浊。溢，血出于上窍；泄，血出于下窍。瘤气、赤瘤、丹瘭，热气胜也；结核，热气郁结。疡，有
头小疮也；疹，浮小瘾疹也。痈，浅而大；疽，深而恶。吐下霍乱，热甚气则传化失常，或下水谷不及变化。
，胸膈愤闷，或引背痛也。郁，热极则腠理郁结，而气道不通也。肿胀，阳热大甚，则肿满 胀。鼻塞，
寒主收敛，故阳气不通。鼽，鼻出清涕。衄，鼻出血。淋，热客膀胱。秘，大便涩滞，热能耗液故也。发热恶
寒，邪在表也。战栗，火热过极，反兼水化。恐则伤肾，水衰故也。惊，心卒动而不宁。惑，昏惑而志不
一。笑，火盛喜发。悲，火盛凌金，金不受制故发悲。谵，多言也，心热神乱，则言妄出。妄，狂妄也，心热
神昏，则目有所见。蔑污，鼻出紫黑血也。腹胀鼓，热甚则气盛胀满如鼓。
与强直积饮滞，霍乱中满诸隔痞；体重吐下肿痿，肉如泥之按不起；太阴湿土二足经，脾与从中胃之气。
，痉也。强直，谓强项也。太阳经中湿。令人项强，有刚柔之分。积饮，留饮也，痞，否也，谓气不升
降也。隔，阻滞也，肠胃湿甚则传化失常。中满，湿则令人中焦满也。吐下霍乱，谓肠胃湿饮相兼故也。体重，
清阳为天，浊阴为地，湿土为病，体重宜也。 肿，湿胜于下也。肉如泥，按之不起，湿胜于身也。
诸热瞀 筋惕惕，悸动搐搦 极；暴喑冒昧躁扰狂，骂詈惊骇气上逆； 肿疼酸嚏呕疮，喉痹耳鸣聋欲闭；
呕涌溢食下不能，目昧不明 翳；或禁栗之如丧神，暴病暴死暴注利；少阳相火手二经，心胞络与三焦气。
瞀，神昏而气浊也。 ，热令肌肉跳动。暴喑，卒哑也，火盛克金，不能发声。冒昧，昏愦也。躁扰，
热盛于外，手足不宁也。狂，谓乖越礼法而失常也，或登高弃衣，热极故也。骂詈，言之恶也，心火热极，则
发恶言也。惊骇，君火化同，气逆冲上，火气炎也。 肿，热胜于内也。疼酸，火盛制金，不能平木。嚏，鼻
中因痒而喷作声，人以纸捻扰鼻而嚏作，扰动属火，鼻属肺金故也。喉痹，热客上焦。耳鸣，热冲听户。聋，
水衰火盛，气道闭塞。呕涌不下，热盛火炎之象。目昧，热极则昏。 肉跳也。禁，冷也。栗，战栗也。如
丧神守，火极而似水化也。暴病死，火性速也。
诸涩枯涸闭，干劲揭皴起，阳明之燥金，肺与大肠气。
涩，遍身涩不滑泽也；枯，不荣生也；涸，不通流也；干，不滋润也；劲，不柔和也；皴揭，皮肤开裂。皆
血液病耳。
上下水液出清冷， 瘕 疝坚痞病；腹满急痛利白清，食已不饥吐利腥；屈伸不便与厥逆，厥逆禁固太阳
经；肾与膀胱为寒水，阴阳标本六气里。
上下水出清冷，寒则水自澄清。 ，气聚之积，或聚或散无有常处也。瘕，血结之块，盖由女子月水沉滞，
久而成瘕也，亦有热者，当
以标本明之。 疝，足厥阴受寒，则阴肿也。坚痞腹满急痛，如水寒则冰硬如地。下利清白，水寒则清净明白。
食已不饥，胃寒则不能消谷。吐利腥秽，水甚不能制火，肺金自盛，故水腥也。屈伸不便，厥逆禁固，谓手足蜷
挛而冷。
To understand the meaning of Shanghan (Cold Damage), one must first clarify its nomenclature. The *Baiwen* (Hundred Questions) states: Winter is called Shanghan, Spring is called Wenbing (Warm Disease), and Summer is called Rebing (Heat Disease). Why are they collectively referred to as Shanghan?
Generally, where pathogenic factors gather, the body's righteous qi (Zheng Qi) must be deficient. In winter, if yang qi is not secure, cold pathogens may invade. If illness manifests immediately, it is named Shanghan; if it does not manifest immediately but occurs in spring after being affected by warm qi, it is named Wenbing; if it occurs in summer after being affected by heat qi, it is named Rebing. Although Wenbing and Rebing manifest in spring and summer, their etiology lies in cold toxins from the previous winter hiding in the muscles and bones, emerging from within. Therefore, they are collectively termed Shanghan. Zhang Zhongjing’s establishment of Shanghan theory is a classic for all generations; Liu Hejian’s supplementation of formulas for Wenshu (Warmth and Heat) applies only to the three seasons; regarding the transmission of disease through meridians versus direct invasion, and distinguishing yin-yang mixed syndromes, these are Zhu Danxi’s unique insights. Such is the grand principle of Shanghan. However, in the northwest where winds are high, many suffer from Shanghan; in the southeast where the land is hot and humid, many suffer from Neishang (Internal Injury). Thus, Li Dongyuan wrote the *Neiwai Shangbian Huo Lun* (Treatise on Differentiating Internal and External Injuries) to distinguish them. Books on Shanghan have thus become comprehensive and complete. Regrettably, modern physicians either read only a fragment of Shanghan texts without understanding mixed diseases and internal injuries, or steal fragments of internal injury knowledge without understanding Shanghan! Those focusing on Shanghan specialize solely in dispersing methods; those focusing on internal injuries specialize solely in warming and tonifying methods. Failing to distinguish between external and internal causes has often led to fatal errors. Tao Jie’an said, "A physician must read Shanghan daily to activate the source of the heart." I believe that reading Shanghan without reading the works of these three masters (Liu, Li, Zhu) is insufficient to activate the source of the heart. Alas, the works of these three generations and four masters are indispensable.
Preface in Early Summer of Bingzi Year of Wanli Era
Various wind diseases causing tremors and dizziness belong to Liver Wood.
"Tiao" refers to trembling/shaking; "Xuan" refers to vertigo or chaotic spinning. This arises because excessive Liver Wood generates Fire. Wind and Fire both belong to Yang, and Yang governs movement. When two moving forces collide, rotation occurs.
Pain, itching, sores, and ulcers belong to Heart Fire.
When humans are near fire, slight heat causes itching, intense heat causes pain, and close proximity causes burning sores; these are all functions of Fire. Itching is considered a manifestation of healthy vitality; thus, when Fire is prosperous in summer, all things flourish beautifully. Some say: pain indicates excess syndrome, itching indicates deficiency syndrome. This does not mean deficiency equals Cold, but rather refers to the degree of Heat. Itching resolves with scratching because scratching induces a pungent sensation in the skin, transforming into Metal nature; Pungency can disperse. Sores and ulcers involve Heat producing pus, similar to how fruit rots into water when excessively heated, thereby assuming the transformation of Water.
Dampness-induced swelling and fullness belong to Spleen Earth Meridian.
The earth's nature is dampness. When dampness is excessive, it causes obstruction, swelling, and fullness. Objects behave similarly when wet. Thus, Late Summer belongs to Earth, and all things grow luxuriantly.
Qi stagnation, constraint, and flaccidity belong to Lung Metal latent state.
"Man" refers to distension; "Yu" refers to urgency/pressure; "Wei" refers to weakness and inability to move the limbs. Generally, the Lung governs Qi. When diseased, Qi becomes distended and urgent, failing to ascend. Regarding limb weakness and immobility, this stems from Lung Metal's dry nature. Pathogenic Dryness causes blood deficiency, failing to nourish the hundred bones. Hence, fingers grasp when nourished by blood, and feet walk when nourished by blood. When Autumn Metal is prosperous, mist obscures, and grass/trees wither and fall, mirroring pathological signs. "Wei" (wither) is synonymous with "Wei" (flaccid).
Cold's contracting and pulling nature belongs to Kidney Water region.
Contraction and tension are functions of Cold; hence, winter cold causes bodily stiffness and curling.
These are the key principles of diseases governed by the Five Movements.
Sudden rigidity, supporting pain, interior urgency, and tendon contraction/deviation originate from the Foot Liver and Gallbladder meridians (Jueyin Wind-Wood qi).
"Bao" means sudden; "Qiangzhi" means stiff and strong; "Zhitong" means supporting pain. It implies rigid support, non-flexible tendons causing pain. "Luan" means contraction; "Li" means deviation/abnormality. It refers to tendons contracting, interior urgency, and abnormal deviation causing disease. However, Dry Metal is sharp; Liver disease may assume Metal transformation due to the principle that "excess leads to harm, and control follows." Moreover, Wind overcomes Dampness to create Dryness. If Wind disease becomes severe leading to flaccid tendons, it is extreme Dryness. Thus, severe cases often involve Dryness.
Various diseases involving wheezing, vomiting, and sour regurgitation; sudden diarrhea, tenesmus, and muscle cramps; turbid urine, bleeding, and discharge; tumors, phlegm nodules, sores, rashes; carbuncles, dysentery, vomiting/diarrhea, Huoluan (cholera-like disorder); chest oppression, swelling, nasal congestion, dryness; rhinorrhea, epistaxis, strangury, constipation, fever; aversion to cold, shivering, fright, confusion; laughter, grief, delirium, purple-black nasal blood; abdominal distension sounding like a drum; Shaoyin Ministerial Fire involves Hand Shaoyin Heart and Hand Taiyang Small Intestine meridians, representing disorders of the True Heart and Small Intestine qi.
Wheezing: Excessive Fire qi leads to abundant Qi and coarse respiration. Vomiting: Image of extreme Heat/Fire in Stomach and Diaphragm. Sour regurgitation: Wood flavor is sour; food heated easily turns sour. Sudden diarrhea/stooling: Due to the rapid nature of Fire. Tenesmus: Interior urgency and heaviness in rectum; Fire-Dryness makes lower jiao urgent. Muscle cramps: Heat-Dryness twists the tendons. Turbid urine: Cold makes water clear, Heat makes it turbid. Yi (overflow): Bleeding from upper orifices; Xie (leak): Bleeding from lower orifices. Tumors, red tumors, erysipelas: Excess Heat. Phlegm nodules: Heat constraint accumulation. Yang (pustule): Small sore with head. Zhen (rash): Superficial small rash. Yong (abscess): Shallow and large. Ju (gangrene/necrosis): Deep and malignant. Vomiting/diarrhea/Huoluan: Extreme Heat disrupts transportation/transformation, or undigested food/water passes through. Pi (glomus/oppression): Chest/diaphragm oppression, possibly radiating to back. Yu (constraint): Extreme Heat blocks pores and Qi pathways. Swelling/distension: Extreme Yang-Heat causes swelling. Nasal congestion: Cold governs contraction, blocking Yang Qi. Qiu (clear runny nose): Clear mucus from nose. Nv (epistaxis): Nosebleed. Lin (strangury): Heat in Bladder. Mi (constipation): Difficult stool; Heat consumes fluids. Fever/aversion to cold: Pathogen in exterior. Shivering: Extreme Fire assumes Water transformation. Fear injures Kidney; Water deficiency causes this. Jing (startle): Heart moves suddenly/restlessly. Huo (confusion): Mental fog and lack of focus. Laughter: Excess Fire promotes joy. Grief: Excess Fire insults Metal; Metal cannot withstand control, so grief arises. Zhan (delirious speech): Excessive talking; Heart Heat confuses Spirit, causing wild speech. Wang (madness): Wild behavior; Heart Heat confounds Spirit, causing visual hallucinations. Mie Wu (purple-black nasal blood): Purple-black blood from nose. Abdominal distension like drum: Extreme Heat causes Qi abundance and distension.
As well as rigidity, retained fluid, stagnation; Huoluan, middle-fullness, various obstructions/glomuses; heavy body, vomiting/diarrhea, swelling/flaccidity, flesh like mud unresponsive to pressure; Taoyin Damp-Earth involves Foot Taiyin Spleen and Foot Yangming Stomach meridians, representing Spleen and Stomach qi from the Middle Jiao.
Jing (spasm): Convulsion. Qiangzhi: Neck stiffness. Dampness in Taiyang meridian causes neck stiffness, divided into Gang (rigid) and Rou (flexible). Ji Yin (retained fluid): Stagnant fluid. Pi (blockage): Obstruction, meaning Qi fails to ascend/descend. Ge (obstruction): Blockage; excessive dampness in intestines/stomach disrupts transformation. Zhongman (middle fullness): Dampness causes fullness in Middle Jiao. Vomiting/diarrhea/Huoluan: Caused by combination of intestinal dampness and fluid. Heavy body: Clear Yang is Heaven, Turbid Yin is Earth; Damp-Earth disease naturally causes heaviness. Fu Zhong (edema): Dampness prevailing below. Flesh like mud, unresponsive to pressure: Dampness prevailing in the body.
Various Heat diseases causing mental clouding, tendon twitching; palpitations, convulsions to extremes; sudden aphonia, confusion, restlessness/madness, cursing, fright, rebellious Qi ascending; edema, pain/soreness, sneezing, vomiting, sores; throat obstruction, tinnitus, deafness wanting closure; vomiting/gurgling, inability to swallow, blurred vision, nebulae; or rigidity/shivering as if losing spiritual guard, sudden illness/death, sudden diarrhea; Shaoyang Ministerial Fire involves Hand Shaoyang Sanjiao and Hand Jueyin Pericardium meridians, representing Pericardium and Sanjiao qi.
Mao (mental clouding): Spirit confused, Qi turbid. , Heat causes muscle twitching. Bao Yin (sudden aphonia): Sudden loss of voice; Fire excess conquers Metal, preventing sound production. Mao Mei (confusion): Mental obtundation. Zao Rao (restlessness): Heat excess externally, limbs restless. Kuang (madness): Violating rituals/norms; climbing high/discarding clothes due to extreme Heat. Ma Li (cursing): Evil speech; Heart Fire extreme causes foul language. Jing Hai (fright): Ministerial Fire transforms similarly, Qi rebels upward, Fire flares. , Heat excess internally. Teng Suan (pain/soreness): Fire excess controls Metal, failing to calm Wood. Ti (sneeze): Sound produced by itch in nose; irritating nose with paper twig causes sneeze; irritation belongs to Fire, nose belongs to Lung Metal. Hou Bi (throat obstruction): Heat in Upper Jiao. Er Ming (tinnitus): Heat rushes to auditory orifice. Long (deafness): Water deficiency, Fire excess, Qi pathway blocked. Ou Yong bu xia (vomiting/gurgling unable to swallow): Image of Heat excess/Fire flare. Mu Mei (blurred vision): Extreme Heat causes dimness. , Muscle jumping. Jin (rigidity/cold): Cold. Li (shivering): Trembling. Ru Sang Shen Shou (like losing spiritual guard): Extreme Fire resembles Water transformation. Bao Bing Si (sudden death): Fire nature is rapid.
Various dryness, withering, drying up, blockage, stiffness, cracking/rough skin belong to Yangming Dry-Metal, involving Lung and Large Intestine qi.
Se (roughness): Body rough, not smooth. Ku (wither): Not nourished/living. He (dry up): Flow obstructed. Gan (dry): Not moistened. Jin (stiff): Not flexible. Cun Jie (cracking/peeling): Skin splitting. All are Blood diseases.
Clear/cold discharge of fluids above and below, masses, hernias, hard glomuses; abdominal fullness/urgent pain, clear/white diarrhea, no hunger after eating, vomiting/diarrhea with fishy odor; difficulty bending/stretching, reversal cold, reversal cold with confinement belong to Taiyang Meridian; Kidney and Bladder are Cold-Water, Yin-Yang root/branch, Six Qi interior.
Clear/cold fluid discharge: Cold makes water clear. , Accumulation of Qi, gathering/scattering irregularly. Jia (mass): Blood clot mass, often from stagnant menstruation in women becoming chronic; some are Heat, distinguished by root/branch. , Hernia: Foot Jueyin Cold causes scrotal swelling. Hard glomus, abdominal fullness/urgent pain: Like water freezing hard as earth. Clear/white diarrhea: Cold water is clear/pure. No hunger after eating: Stomach Cold fails to digest grains. Fishy vomiting/diarrhea: Water excess fails to control Fire, Lung Metal self-prospers, hence fishy water. Difficulty bending/stretching, reversal cold/confinement: Curling limbs and coldness.