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Yu Chang stated: Taiji moves to generate Yang, and remains still to generate Yin. Yang's movement is ceaseless, while Yin's stillness has its regularity. When the two Qi (vital energies) intersect, human life begins; when they separate, death occurs; when they become biased, disease arises; and when they deviate from harmony, illness becomes severe. The sages were concerned about this and established medicine to adjust the bias and impurity, restoring balance and peace, thereby allowing people to live long lives. Observing the discussion on human Yang Qi in the *Shengqi Tongtian Lun* (Treatise on the Connection between Vital Energy and Heaven), which compares it to heaven and the sun, if it loses its proper function, lifespan is shortened and brilliance is obscured. Although Yin diseases are not explicitly discussed here, the mechanism of Yin diseases can be clearly understood.

However, in the era of the Three Sovereigns, the social condition was like spring, with gentle Yang Qi presiding and Yin stillness undisturbed. Therefore, whenever the *Neijing* (Inner Canon) mentions Yin diseases, it only hints at the beginning without elaborating fully. Later, due to political deviations, the舒展 (expansive) nature of Yang turned into Yin's grim severity. Heavenly Yang Qi became blocked, and earthly Yin Qi obscured brightness. "Obscuring brightness" refers to turbid Yin Qi covering the Yangming Qi. As the *Book of Songs* describes: "Rivers boil over, mountain peaks collapse, high banks become valleys, deep valleys become mounds." Consequently, diseases among the people increased, and many died prematurely. People investigated but could not understand the cause of such premature deaths.

At the end of the Han Dynasty, Zhang Zhongjing wrote ten volumes of *Shanghan Lun* (Treatise on Cold Damage) to treat Yang diseases transmitted through meridians, and six volumes of *Zubing Lun* (Treatise on Sudden Diseases) to treat sudden Yin diseases, aiming to prevent illness among the people. However, *Zubing Lun* was lost during his lifetime. Was it because scholars of that era failed to deeply comprehend its principles? Was *Jingui Yufan* discarded and not collected, while versions circulating among the common people suffered from war and fire? After Zhang Zhongjing, many talents emerged, yet none vigorously promoted his profound work. Only Han Zhihe made slight discoveries in the category of "Zhonghan" (Sudden Cold Invasion), teaching people to urgently use Fuzi (Aconite Root) and Ganjiang (Dried Ginger). He can be considered a disciple of Zhang Zhongjing.

Since the advent of medicine, only constant laws were discussed. Zhang Zhongjing also discussed variable conditions. People were astonished and opposed, which was inevitable. Over a thousand years later, Han Zhihe's views as a folk doctor were no longer as influential as Zhang Zhongjing's calls from high places. Moreover, scholars like Zhu Danxi and Jiezhai advocated valuing Yin and despising Yang, stating "Yang is abundant, Yin is deficient," "Yang is often in excess, Yin is often insufficient," and "Yin Qi is hard to form and easy to lose, leading to early aging." They formulated pills to nourish Yin, heavily emphasizing Yin. Who would not consider this supreme truth? However, they merely imitated others without unique insight. Yet, physicians revered them as masters. Even if *Zubing Lun* had survived, it would have been ignored just like *Shanghan Lun*. Alas! In times of peace, everything is harmonious. In times of chaos, disasters abound. If rulers governed by valuing Yin and despising Yang, the state would fail. If doctors treated by valuing Yin and despising Yang, they would treat incorrectly. This cannot be a universal principle.

I review Zhang Zhongjing's *Shanghan Lun*, highlighting cases where Yin disease signs appear and urgent return of Yang is required. My disciples now know what to prioritize. Now, I wish to pass on the golden needle (secret knowledge) and speak openly. The *I Ching* says: "Understanding the way of day and night allows one to know that day is Yang, where all Yin hides. Night is Yin, where all Yin reveals itself, and ghosts feed at night. All mountain spirits and water monsters display endless tricks until cockcrow, when they hide completely." Although night is not over at cockcrow, the time belongs to Heavenly Yang. Since Heavenly Yang opens, the long night does not last, and dawn approaches. From this, we see a glimpse of the indescribable nature of Yin diseases. Who can illuminate the truth like burning a rhino horn?

Buddha spoke of 444 diseases, with Earth, Water, Fire, and Wind each accounting for 111. Thus, all 444 diseases are Yin diseases. Heaven and Earth manifest forms and images, not solely biased toward Yin. However, all five elements arise from Earth. Water adheres to Earth, containing Fire within it, and Wind within Fire. Humans borrow these four elements to form bodies, and illnesses arise from their interaction. Metal is hard and rigid, resisting harmony, so it is excluded from the four major elements in this context. Cases without hope require cultivating the Western Pure Land. People only know Earth Qi is still and undisturbed; when earthquakes occur, they are shocked. Small movements bring disasters; large movements bring kalpas (cosmic cycles of destruction). During a kalpa, all有形 (form-bearing) things perish. Why doesn't the world destroy quickly despite Earth's movement? Because Xuanzhen Zhenwu guards the North, subduing dragons and snakes, preventing them from rising. Thus, Earth moves but Water remains still; Water still, then Fire and Wind within remain still.

For syndromes of Yin excess and Yang exhaustion, Zhang Zhongjing uses Zhenwu Tang to rescue deviation. Is this not based on this principle? At Xu-Hai hours (9-11 PM), chaos prevails. It is not Heaven mixing with Earth, but Earth Qi adding to Heaven causing confusion. The four wheels of Earth, Water, Fire, and Wind rotate simultaneously, with thunder and lightning shaking the heavens. Space is搅毁 (destroyed/mixed) into one region. How tragic must Yin diseases be in flesh-and-blood bodies? Zen Buddhism speaks of white waves surging, kalpa fires blazing, and the great thousand worlds destroying. Isn't this the image of the dissolution of the four elements?

Earth Qi adds to Heaven only up to the Desire Realm and Form Realm, not the Formless Realm. In the Upper Eight Scenes, at Trayastrimsa Heaven, myriad saints pay homage; in Tushita Inner Court, deities listen to Dharma. Each removes intermediate existence (antarabhava) and manifests circular light on the crown, directly connecting to the Neither-Perception-Nor-Non-Perception Realm. Entering the Buddha Realm, one sees the great thousand worlds like a fruit in the palm. What kalpa can affect this? Kalpas affect heavens until Zi hour (11 PM-1 AM), when opening occurs, Yin descends, and High Yang reappears. By Chou hour (1-3 AM), Yin returns entirely to Earth, space clears, and Yin-Yang separate. Sun, moon, and stars attach to Heaven; mountains, rivers, and seas attach to Earth. Qi of the Five Heavens scatters among stars; Qi of Nine Earths connects with mountains and marshes. Clear and peaceful, vast and broad, myriad species gradually sprout. Remaining violent turbid Yin in heavenly gaps stretches thousands of zhang, falling straight down, destroying life without leaving a trace. After Heaven opened and Earth formed, the lingering grimness of Yin is still terrifying. Only by Yin hour (3-5 AM) does mixed inferior Qi return to harmony. Heavenly light descends, Earthly virtue ascends. Famous trees and fine plants bear fruit. Light-sound humans eat the fruit and do not ascend, thus enabling life and reproduction, forming the three realms of Heaven, Earth, and Humanity.

This principle relates to human life and health, most grand and significant. Confucians ignore it; physicians rarely hear of it. I often see patients where Yin pathogen erupts violently, attacking clear pathways, showing aversion to cold, abdominal pain, diarrhea, vomiting, profuse sweating, muscle twitching, and tendon tremors. I immediately close the gate, employing Zhenwu's guarding method, preventing Dragon-Lei Qi from soaring. Following Zhang Zhongjing's secret methods, patients recover. If untreated initially, turbid Yin entering from the chest causes throat swelling, tongue protrusion, eye bulging; from the back, neck veins enlarge, head and neck feel icy, turning blue-purple before death. Is this not the disaster of Earth Qi adding to Heaven?

Suddenly administering Fuzi and Ganjiang, pure Yang medicines, drives out Yin pathogens downward through yin orifices. This is equivalent to swiftly sweeping turbid Yin back to Earth. One must drive out all Yin from Yang spaces to achieve rebirth, equivalent to cleansing heavenly remnants to restore harmony. Practicing Zhang Zhongjing's methods for thirty years, treating nearly a hundred patients, every case responded well. Though a temporary expedient, it can serve as a permanent standard. Medicine lacks this, truly an omission. I establish this humble theory to begin. Future authors may find value in it.

On Key Methods for Differentiating Zhonghan Syndromes
Sudden Zhonghan is a critical and urgent syndrome of weak Yang and excess Yin. The *Classic* states: "Excess Yin generates internal cold." Due to rebellious Qi moving upward, cold accumulates in the chest without dispersing. Without dispersal, warm Qi leaves, leaving only cold. Cold coagulates blood, blocking vessels. The pulse is large, forceful, and choppy, hence Zhonghan. The *Neijing* says this. To synthesize Zhang Zhongjing's interpretation of the *Neijing*, I dare to speak.

The *Classic* says excess Yin generates internal cold, then mentions Zhonghan. Does internal cold arise first, followed by external cold invasion? It says blood coagulation blocks vessels, then mentions large, forceful, choppy pulses. Does external cold cause the large pulse? Does vessel closure cause the choppy pulse? There is a major doubt here. First, the body's defensive Yang is strong. Taiyang guards the back, Yangming the front, Shaoyang the sides. Why does cold bypass the Three Yang and strike Shaoyin directly? Rebellious Qi accumulates in the chest, causing stomach cold. Stomach cold allows ingestion of cold food and inhalation of cold air into the stomach. The Kidney is the gate of the Stomach. External cold breaches the gate, striking Shaoyin Kidney directly. This is Zhonghan, hidden in the *Neijing*.

Second, although called Zhonghan, a large/forceful/choppy pulse suggests it is not a sudden disease. Sudden Zhonghan should have a faint pulse. The *Neijing* generally discusses Shanghan and Zhonghan pulses as large/forceful/choppy. Zhang Zhongjing distinguishes Shanghan (heat disease) from Zhonghan (cold disease). Shanghan pulses are typically floating, rapid, active, slippery (Yang), or deep, choppy, weak, string-taut, faint (Yin). Yang diseases showing Yin pulses indicate death. Yin diseases being sudden should not show Yang pulses. Large/forceful/choppy involves two Yang and one Yin, implying urgency. This is also hidden in the *Neijing*.

Zhang Zhongjing considers deep/choppy/weak/string-taut/faint as Yin pulses. For Shanghan transmitting to Shaoyin, he says "faint and thin." For Zhonghan striking Shaoyin, he says only "faint," not "thin." Faint indicates weak Yang; thin indicates weak Yin. Cold transmitting to Kidney makes Yang/Yin loss uncertain. But Zhonghan involves only Yang loss, not Yin loss, so the pulse should not be thin. If thin, Yin was already deficient internally, how could it be excessive?

In Shanghan, only Shaoyin has a faint pulse. Taiyang Bladder is the Fu organ of Shaoyin. Seeing faint pulse and aversion to cold, Zhang Zhongjing treats Shaoyin immediately with Fuzi and Ganjiang. Faint pulse and aversion to cold indicate weak Yang. The *Book of Songs* says: "The moon is faint, the sun is faint, the people below are very sorrowful." Heavenly Yang should not be faint, so Human Yang certainly should not be. With Kidney Yin excess and Yang weakness, cold generates internally. Adding external cold breaches the gate, burying Yang inside (death) or forcing it outside (rapid death). Hence, Zhang Zhongjing calls it a sudden disease.

Human flesh and blood are Yin. At conception, a point of True Yang is born before the body, stored in both Kidneys, generating Yuan Qi (Original Qi). It is the source of vital energy and protects against Six Evils (external pathogens). Like a lamp in a dark room, it enables sight and hearing, and supports movement. Ancients braved snow and cold for poetry or merit, surviving without internal cold arising from external cold. Nourishing先天 (Pre-heaven Essence) with后天 (Post-heaven Qi) ensures longevity. Otherwise, weak Yang leads to excess Yin, which further weakens Yang. Sudden external cold with standard treatment rarely saves anyone. This is the essence of sudden disease.

True Yang in Kidneys is balanced by Water, contained by Earth, and dormant unless discharged. Hand-Foot Yang serves it, circulating to protect skin and pores. Spleen Yang mimics Heaven's vigor, digesting food and distributing fluids. Chest Yang mimics the Sun's control, illuminating and dispelling Yin. When these three are abundant, Kidney True Yang rests peacefully. Some live to eighty with vitality. Even with sexual excess or impotence, life continues. But when external, upper, or middle Yang declines, Yin gains power. Skin becomes cold and stiff, defensive Yang fails. Food digestion fails, causing vomiting/diarrhea/bloating, Spleen Yang fails. Chest obstruction occurs, Chest Yang fails. Drawing sealed Yang from Earth/Water to act causes red face, dry skin, and Chu Zhong (deficiency cold syndrome). Can it last long without Zhonghan?

Eight Difficulties in Medicating Zhonghan
1. Cold strikes Shaoyin, burying weak Yang, cracking skin, no sweat, losing spirit. Urgently use Fuzi, Ganjiang, add Congbai (Scallion White) to disperse cold, add Pig Bile to guide into Yin. Fear drug strength insufficient, use moxibustion/warming compresses externally and internally. Delay slightly, and it is too late. Difficulty one.

2. If True Yang is originally disturbed, pores loose, Yin excess forces Yang outward, sweating profusely, stiff neck/back. Use Fuzi, Ganjiang, Pig Bile, but DO NOT add Congbai or moxa. Fear aiding dispersion, causing Qi loss with sweat, preventing Yang return. Stop sweating, suddenly advance drugs, protect pores. Otherwise Yang may escape again. Difficulty two.

3. Using Fuzi/Ganjiang to overcome Yin and restore Yang is like cavalry breaking siege, raising flags to gather scattered Yang. Those who don't understand add more herbs, diluting the powerful effect, causing delay and failure. Difficulty three.

4. Add Danggui (Angelica Sinensis) and Rougui (Cinnamon Bark) to nourish Ying (Nutritive) Blood, as cold first injures Ying. Otherwise, drugs only affect Wei (Defensive) Qi, missing the target. Pathogen remains, victory impossible. Difficulty four.

5. Add Renshen (Ginseng) and Gancao (Licorice) to support Yuan Qi and transport resources. Without them, Fuzi/Ganjiang's ferocity harms the upper body. Difficulty five.

6. After 2-3 doses, if Yangming recovers, movement lightens, spirit improves, add Huangqi (Astragalus), Baizhu (Atractylodes), Wuweizi (Schisandra), Baishao (White Peony) for balanced Yin-Yang tonification. Do not stop. Heavy Yin yielding to Yang is like a prodigal returning; instability remains. Neglecting follow-up ruins progress. Difficulty six.

7. Using group drugs to nourish Yin/protect Yang: if patient has chronic phlegm-heat, Yang emerging changes from Yin to cold. Invisible Yin-cold disperses, but visible cold-phlegm blocks orifices. It won't turn hot quickly. Avoid Niuhuang (Calculus Bovis), Zhuli (Bamboo Sap), and all cooling agents. Using cold meds for chronic phlegm-heat lets Yin dominate, Yang agitates, ruining progress. Difficulty seven.

8. After balancing, show intent to lay down arms. For stubborn phlegm in meridians, use sweet-cold to aid Qi and open blockages. Avoid pungent-hot which aids heat/blockage. Pungent-hot was used out of necessity; once Yang is stable, nourish Yin. Don't seek glory and create trouble. Leaving drugs after disease cures causes new issues. Difficulty eight.

I briefly outline the pathology and eight difficulties. Skilled practitioners can clarify and practice this. Rash or rigid users will fail; ignorant patients will fear meds. Combining with Yin Disease Theory, I ask wise eyes to elucidate, so everyone understands sudden disease, acting calmly. Is this not a great blessing for humanity?

On Zhu Danxi's Description of Zhonghan
Danxi said: Zhonghan is sudden cold exposure, immediate violent onset. Patients have loose pores, whole body affected, meridians indistinguishable, no heat to dissipate, warming/tonifying resolves it. This is severe Stomach deficiency. Untreated, death is near. Method: Warm/disperse Lizhong Tang, add Fuzi for severe cases. His insight exceeds ordinary levels. However, he also said: For sudden heaven-earth cold or raw food injury with exterior pathogen but no interior damage, use Zhang Zhongjing's method. If accompanied by interior damage, use Buzhong Yiqi Tang plus dispersing drugs, first using Renshen/Astragalus to support Zheng Qi. This shows Danxi, following Dongyuan, is still outside Zhang Zhongjing's walls, unaware of its richness.

On Dai Yuanli's Description of Zhonghan
Dai Yuanli said: Zhonghan is exposure to killing Qi, eating ice/cold fruits. Pulse is deep/thin, hands/feet cold, breath weak, body tired. Even with fever, no thirst, lethargic speech. If mistaken for heat disease and given these drugs, mild becomes severe, severe becomes fatal. Rapid Ren Mai pulse, drinking water, restlessness indicate heat disease. Cold and heat are like water and fire, cannot be treated same. Mistake kills. Students beware. Yuanli was a top Ming dynasty doctor. He glimpsed Zhonghan's main idea but missed depth. He didn't say "treating heat disease with cold method kills," but "heat disease taking cold drugs kills," confusing subject/object. Among these two elders, none spoke of Zhonghan. I praise Yuanli's contribution.

[Three Laws]
1. Treating sudden Yin-cold disease with cooling drugs results in almost no survival. Such deaths are caused by the doctor.
2. Treating sudden cold disease without true insight, even using pungent-hot drugs slowly or controlled, delays action. Time waits for no one; patient dies suddenly. This is the doctor's fault.
3. A doctor curing one Yin disease avoids a kalpa disaster. This is natural law. Those failing to cure sudden disease seeking to avoid disaster will fail. Good people, choose your art wisely.