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I once read Zhang Zhongjing's *Treatise on Cold Damage Diseases* (*Shanghan Lun*). In the section on Taiyin disease, it states: "Spontaneous diarrhea without thirst belongs to Taiyin. This is because there is cold in the zang organs. It should be treated with warming methods; Sini Decoction (Four Reversal Decoction) is appropriate." In the section on Shaoyin disease, it states: "Shaoyin disease, developing within one or two days, with a normal mouth and tongue, and aversion to cold on the back, should be treated with moxibustion; Fuzi Tang (Aconite Decoction) governs it." "Shaoyin disease, with body pain, cold hands and feet, bone and joint pain, and a deep pulse, is governed by Fuzi Tang." "Shaoyin disease with diarrhea is governed by Baitong Tang (White Tongue Decoction)." "In Shaoyin disease with diarrhea and a faint pulse, administer Baitong Tang; if diarrhea does not stop, accompanied by reversal cold, absence of pulse, dry retching, and irritability, Baitong Jia Zhuyedanhuang Tang (Baitong Decoction plus Pig Gallbladder Bile Decoction) governs it." "Shaoyin with clear undigested food in stool, internal cold with external heat, cold hands and feet, pulse faint and nearly absent, yet the body shows no aversion to cold, and the person has a red face, or abdominal pain, or dry retching, or sore throat, or diarrhea stops but pulse does not emerge, is governed by Tongmai Sini Tang (Pulse-Resuscitating Sini Decoction)." "In Shaoyin disease with a deep pulse, urgently warm it; Sini Tang is appropriate." In the section on Jueyin disease, it states: "Cold hands and feet with a fine and nearly absent pulse are governed by Danggui Sini Tang (Angelica Sinensis Decoction for Reversal Cold)." "After profuse sweating, or severe purgation, resulting in cold extremities, Sini Tang governs it." Observing these discussions by Zhang Zhongjing, it follows that the Three Yin diseases (Taiyin, Shaoyin, Jueyin) of cold damage must have cold syndromes and are suitable for treatment with warming agents.

Later, when I read the works of Liu Wansu (courtesy name Shouzhen), he stated: "When pathogenic heat from cold damage is in the exterior, fu organ diseases are Yang; when pathogenic heat is in the interior, zang organ diseases are Yin. The vulgar erroneously claim there are distinct syndromes of cold, heat, Yin, and Yang, misleading people for a long time. Cold diseases exist, but they do not refer to 'Han Bing' (the generalized term for febrile diseases transmitted via sweating). Cold diseases belong only to miscellaneous diseases and can never constitute 'Han Bing'. Moreover, the qi that generates sweat in nature is Yang-heat qi, not something Yin-cold can produce." Although Zhang Zhongjing has indications for Sini Tang, those are for treating cases where exterior heat exists with interior harmony, but were mistakenly treated too early with cold-purgative herbs, causing exterior heat to enter the interior and resulting in persistent diarrhea; or for cases of self-induced diarrhea due to exterior heat and interior cold, requiring urgent warming of the interior with Sini Tang. Once diarrhea stops and interior harmony is restored, the exterior syndrome should be urgently resolved. Thus, after indications for Sini Tang in Zhang Zhongjing's work, there are instances of using Chengqi Tang (Descending Qi Decoction) for purgation. Therefore, the Classics explicitly state that cold damage is a heat disease, not a cold one. The Three Yin syndromes mentioned in the Classics refer to pathogenic heat residing in the zang organs and the interior; since zang organs and the interior are Yin, purging the heat is required. The *Suwen* discusses cold damage febrile diseases in two chapters, both titled "Re" (Heat), containing no theory on cold. Inferring from the principles of fate and transformation in various chapters of the *Suwen* and *Lingshu*, these are indeed heat diseases, certainly not cold. Observing Liu Shouzhen's arguments, it follows that cold damage, regardless of whether the pathogen is in the exterior or interior, and whether it involves the Three Yang or Three Yin, is uniformly a heat syndrome, absolutely devoid of cold.

These two theories differ. In judging right from wrong, one must be correct. Thus, I repeatedly investigated and questioned the meanings of both sides, unable to reach a conclusion for a long time, becoming so exhausted in spirit and energy that I could not let go. I considered this to be the general principle of cold damage. If this principle is unclear, then thousands of words are insufficient as models for later learners, let alone the endless harm inflicted upon people's lives. I thought that Cheng Wuji's commentary must have some insights, so I sought answers through his text. However, he merely explained briefly along with the text, never explicitly stating why there is heat or why there is cold. This was not because he did not want to say it, but likely because he believed that cold damage always involves transmission through the meridians, leading him to suspect that all transmissions through the Six Meridians result in heat syndromes, and that heat cannot transform into cold. Hence, he dared not distinguish them. If cold is inherent to the zang organs, how can it appear exclusively as cold, without heat, when hot pathogens transmit deeply into the interior? Furthermore, would the use of warming herbs not aid the transmitting heat pathogens? If cold is an external pathogenic factor, it would have already transformed into heat in the Three Yang meridians. How could it become cold upon reaching the Three Yin meridians? If Cheng Shi had pondered this deeply, he would surely have realized the reason.

Since Zhang Zhongjing wrote the *Treatise on Cold Damage Diseases*, no one has neglected it without revering it. Until debates on similarities and differences arose, like fishermen rushing to the abyss and woodcutters to the mountains (indicating straying from the true path), it is no wonder later generations could not decide at the ambiguous juncture. Thus, some claimed there are no true cold damage diseases in the current era; others argued that diseases contracted today are all internal injuries; and ignorant individuals went so far as to say that all warming medicines in the *Treatise* are used for heat pathogens transmitted through meridians because the Three Yin meridians belong to Yin. Even more absurd was the claim that every instance of the character "cold" in the treatise should be read as "heat". Alas! Have the drawbacks of degeneration reached such a point? I then cleared my mind and contemplated deeply. One day, it suddenly became clear as if I had gained enlightenment, though I dared not assert its correctness. I tentatively present it here for correction by those who possess the Way.

Regarding the diseases of the Three Yang, when cold pathogens reside in the Taiyang meridian, cold constrains Yang qi, which becomes unsmooth and transforms into heat. Although Yang qi is the righteous qi of the human body, once constrained, it becomes pathogenic. Using Mahuang Tang (Ephedra Decoction) to release the exterior and expel cold allows the couli (pores) to open and constrained heat to vent, resulting in cure through sweating. If sweating does not resolve the condition, the heat cannot vent outward and must enter the interior. Thus, it transmits to Yangming or Shaoyang, or enters the fu organs. As for the diseases of the Three Yin, why are some cold and some heat? Generally, when cold pathogens injure the human body, sometimes heat is constrained in the Taiyang meridian before sequentially transmitting to the Yin meridians; sometimes Taiyang does not transmit to Yangming or Shaoyang but directly transmits to the Three Yin meridians; sometimes cold pathogens do not start from the Yang meridians but directly injure the Yin meridians; sometimes although starting from Taiyang, heat is not yet constrained, and it immediately enters Shaoyin, showing only Shaoyin syndromes; sometimes starting from Taiyang, it immediately enters Shaoyin, while Taiyang is still injured; sometimes direct injury leads immediately to entry, and cold transforms into heat, or starts as cold and ends as heat. Those resulting from constrained heat transmitting to Yin, or transforming from cold to heat, are heat syndromes. Those directly injuring the Yin meridians, or entering Shaoyin immediately from Taiyang, are cold syndromes. When Taiyang cannot avoid injury, Shaoyin pulse and syndromes will co-occur with Taiyang manifest symptoms. When starting as cold and eventually transforming into heat, cold syndromes appear first, followed by heat syndromes. This is why the diseases of the Three Yin are sometimes cold and sometimes heat. If one carefully studies and interprets the various clauses in the Three Yin meridian chapters, the principles will emerge.

Why are there cases of transmission, direct injury, immediate entry, or initial cold followed by heat? This is because pathogens strike violently and suddenly, lacking fixed patterns, and their transmission and transformation are irregular. Thus, the Classics state: "Pathogens invading humans have no constancy; some invade Yang, some invade Yin." Liu Shouzhen was a scholar of exceptional caliber. Did he enjoy proposing heterodox theories to shock people? Probably because he categorized Warm Disease and Summerheat as Cold Damage, and Zhang Zhongjing's formulas often did not correspond to Warm Disease and Summerheat, he overlooked warming agents and universally employed cold-cooling herbs. Because he judged all cold damage as heat without cold, he claimed that Zhang Zhongjing's Sini Tang was established for cases where cold herbs were mistakenly used to purge, leaving exterior heat with interior harmony, or for cases of exterior heat with interior cold causing self-diarrhea. He further stated that after warming the interior to stop diarrhea, the exterior should be urgently resolved. He also claimed cold diseases belong only to miscellaneous diseases. Alas! Zhang Zhongjing's *Treatise on Cold Damage Diseases* was specifically composed for "Shanghan" (cold damage occurring immediately upon exposure to cold), not for "Wenshu" (warm diseases and summerheat occurring after a latent period). Therefore, there are frequently cold syndromes in the Three Yin, which explains the use of warming agents. Since the disease is cold and the season is cold, using warming agents is indeed appropriate. Later generations, unaware of this meaning, seek further away and argue more rigidly. If they understood this, it would be like Cook Ding carving an ox, moving precisely at the joints.

Moreover, while cases of interior cold caused by mistaken purgation with cold herbs certainly exist, can we say that interior cold arising spontaneously without such mistake is impossible? Little do they know that the frequent appearance of cold syndromes in the Yin meridians originally stems from cold pathogens directly injuring these meridians without passing through the Yang meridians, or from Taiyang failing to constrain heat before immediately entering these meridians. Although some may result from mistaken purgation with cold herbs, this is rare. Were the various warming agents used by Zhang Zhongjing established solely for mistaken purgation? Furthermore, in cases of exterior-interior cold-heat syndromes, is there ever mention of urgently resolving the exterior? The syndrome of interior cold with external heat occurs when cold pathogens invade internally, forcing Yang qi to the exterior, or when deficient Yang qi manifests as external heat itself, not true pathogenic heat. Observing that Zhang Zhongjing treats interior cold with warming herbs without addressing the external heat in such cases reveals his therapeutic intent. If urgent resolution of the exterior were truly indicated, would he not clearly state it after the interior harmonizes? Moreover, if Three Yin cold diseases were merely miscellaneous diseases, why are they recorded in the *Treatise on Cold Damage Diseases* to confuse later generations? Why do the clauses in the Jueyin chapter each begin with the word "Shanghan" (Cold Damage)?

The *Neijing* describes Three Yin diseases as uniformly heat, stating the norm. Zhang Zhongjing describes Three Yin diseases as including both cold and heat, stating the variation. They run parallel without contradiction. Later generations claiming cold damage originally has no cold syndromes fail to understand variation despite knowing the norm. However, those in the world who strictly adhere to the *Formulary of the Bureau* and favor warming agents can often preserve patients with cold syndromes without other issues. Their adherence is biased, but their treatment of this specific aspect is correct. If students of medicine understand that Three Yin diseases inherently include syndromes caused by cold pathogens, the original intent behind Zhang Zhongjing's created methods can be clearly understood, preventing deviation by other theories.

Someone asked: "Diseases of cold damage must involve constrained heat in Yang meridians before transmitting to Three Yin. Now you claim direct injury to Yin meridians leads to immediate entry and cold syndromes. What is your evidence?" I replied: "Based on Zhang Zhongjing. Zhang Zhongjing said: 'Diseases with fever and aversion to cold originate in Yang; diseases without fever and with aversion to cold originate in Yin. Those originating in Yang heal in seven days; those originating in Yin heal in six days.' Calling it 'no fever and aversion to cold' indicates it is not constrained heat in Yang meridians. Calling it 'originating in Yin' indicates it did not transmit from Yang meridians. Calling it 'heals in six days' indicates it did not start in Taiyang, but counting begins from the day the disease manifested in the Yin meridians." Zhang Zhongjing also said: "In cold damage, from one or two days to four or five days, if reversal cold occurs, fever must follow. If reversal cold lasts five days, fever also lasts five days. If on the sixth day reversal cold returns, but does not, the patient heals. If reversal cold lasts four days, fever lasts three days, and reversal cold returns for five days, the disease progresses." Getting cold damage without fever, presenting immediately with reversal cold, could this be caused by heat pathogens transmitting deeply? Nowadays, many people present with various cold syndromes from the onset, with no heat whatsoever. This is direct injury to Yin meridians and immediate entry. If one cannot fathom Zhang Zhongjing's mind but执 (clings) to the saying that all cold damage results in heat diseases for treatment, few will avoid premature death.