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The auspicious deities (Xishen, spirits bringing joyous events) of spring, summer, autumn, and winter correspond to the Earthly Branches Xu, Chou, Chen, and Wei respectively. This utilizes the nourishing Qi (vital energy) of the Five Elements (Wood, Fire, Earth, Metal, Water), calculated by passing through three Earthly Branches. For example, in spring, Xu is the auspicious deity; thus, the first month is at Xu, the second at Hai, and the third at Zi. The other seasons follow this pattern. If such a pulse is found in the pulse diagnosis, without violating other normal pulse patterns, it indicates that joyful events will occur. The pulses of all four seasons must manifest with Stomach Qi (the reflection of spleen-stomach digestive function in the pulse), because the Five Elements all rely on Earth (spleen-stomach) to exert their functions. The pulses of the whole body also emerge at the Qikou (Cunkou, radial artery at the wrist) only after passing through the Stomach pulse. For instance, the spring pulse is primarily Xian (String-like, straight and long like pressing a zither string). All six positions (three on each hand: Cun, Guan, Chi) must be moderate and unhurried, neither tight nor rapid. The Stomach pulse should be slightly Xian but overall gentle (Huan). Xian represents spring, while Huan represents the root. If the six pulses do not violate this rule, it predicts joyful events within a month. If seen on the day of Xu in the first month, Hai in the second month, and Zi in the third month, the event will occur within ten days. However, if the Stomach pulse carries both Xian and Mao (Feather-like, floating and soft) qualities, it indicates disaster. The summer pulse is primarily Hong (Surging, abundant at the start and declining at the end like a wave). All six pulses should be faint yet large, not scattered or floating, not slippery or rapid. The Stomach pulse should be slightly Hong but gentle. Hong represents summer, and Huan is the fundamental pulse. If the six pulses are unviolated, joyful events will occur within a month; if the pulse appears within ten days, the event will happen within ten days. The autumn pulse is primarily Mao. The Stomach pulse is light on top, carrying Mao quality but gentle, and must have a root (strength when pressed deeply). This type of pulse is difficult to distinguish. Similar to the seasonal pulses, if it feels light like wind or Qi, it is contrary to disaster, not an auspicious pulse. Only if it is neither floating nor light, coming slowly and gently, appearing like an autumn pulse upon light pressure, but returning uniformly upon heavy pressure,不散 (not scattering) when pressed and not light when lifted, is it an auspicious pulse. The timing of these events follows the same method as spring and summer. The winter pulse is easiest to identify; if the Stomach pulse is Chen (Deep) and does not strike the fingers, it is correct.

Diseases sometimes hang life and death on the tip of a hair, deciding survival in an instant. Between life and death lies the skill or clumsiness of the physician. A skilled physician brings recovery as quickly as turning a wheel; a clumsy physician makes the administered medicine more dangerous than a white blade. Shanghan (Cold Damage disease) not only attacks people rapidly but is also a difficult condition for physicians to treat. The ancients said: On the first and second days, the pathogen is in the skin; on the fourth and fifth days, it transmits to the Zang-Fu organs. Therefore, when in the skin, sweating (Han method) can be used; when transmitted to the Zang-Fu, purgation (Xia method) can be used. Scholars of the world revere this as a fixed theory, yet they fail to realize that people have deficiency and excess conditions, so diseases have severity levels; depending on severity, transmission speed varies. Sometimes after two or three days, the pathogen remains in the skin; sometimes after just two or three days, it has already transmitted to the Zang-Fu. Good physicians should examine the pulse and determine the location of the disease. I have summarized four errors in treating Shanghan: First, foolishness. Shanghan begins in the skin and then transmits to the Zang-Fu. When in the skin, use sweating; when in the Zang-Fu, use purgation. If one fails to distinguish Yin and Yang, interior and exterior, using purgation when sweating is indicated, or sweating when purgation is indicated, misadministering drugs leads to death. This is the first error of foolishness. Second, lack of precision. When Shanghan transmits to the Zang-Fu, symptoms are manifold and change endlessly, impossible to fully investigate. Toxin in the Liver cannot be treated by soothing the Spleen; toxin in the Heart cannot be treated by soothing the Lungs. Treatment of the five Zang organs follows this principle. Physicians decide which Zang organ is affected, prescribe formulas and herbs accordingly, and expect immediate recovery. If one does not know the source and flow of the disease, nor its transmission, and misadministers drugs hoping for accidental correctness, even slight errors lead to imminent death. This is the second error of imprecision. Third, timidity. Shanghan heat-toxin transmits to the five Zang organs, attacking healthy Qi. The toxin is abundant like smoke and fog, scorching the Sanjiao (Triple Burner), causing critical illness, loss of appetite. Physicians mistakenly attribute this to deficient Stomach Qi and refuse to use draining and unblocking methods, leading to death. For patients with Shanghan heat-toxin who cannot eat, have constipation, and yellow-red urine, one must first determine which Zang organ is affected, urgently use draining/unblocking drugs to remove the toxin. As the disease subsides, appetite returns, and health is restored. This is the third error of timidity. Fourth, violence/rashness. Regarding treatment methods for Shanghan, given the errors of foolishness and timidity, cases of imprecision and lack of detail are hard to discuss. I spoke of timidity to warn future scholars whose minds are unclear and insight insufficient, who strive only to avoid timidity and rashly use transforming drugs, harming lives. This is my fourth error of rashness. Future scholars who understand these four errors can grasp the general principles of treating Shanghan. Regarding where Yang Du (Yang Toxin) resides and where Yin Du (Yin Toxin) focuses, transmission to the five Zang organs results in different Zang syndromes; penetration into the six Fu organs results in different Fu syndromes. Among those that attack rapidly, only two types of infection are particularly severe. I now list a few syndrome and pulse manifestations, hoping others may understand the transmission from this.

On the first day, Juyang (Taiyang/Greater Yang) channel is affected. The Juyang pulse originates from the inner canthus, goes up to the forehead and vertex, enters the brain, descends the neck, runs along the arm interior, flanks the back, and reaches the waist. In the hand, it corresponds to the Small Intestine; in the foot, to the Bladder. Thus, there is stiffness and pain in the head, neck, waist, and back. The pulse should be rapid, numerous, and floating/scattered, like after a fresh bath or like wind blowing, with the left Chi position slightly tight and rapid.

On the second day, Yangming channel is affected. Yangming governs the flesh. Its pulse flanks the nose and connects to the eyes. Thus, there is body heat, eye pain, dry nose, and inability to sleep. The pulse also passes through the abdomen and back, up to the head and neck. In the hand, it corresponds to the Large Intestine; in the foot, to the Stomach. Diagnosis reveals a rapid, numerous, and floating pulse. Upon gradual pressing, it feels connected to the interior. Since Yangming is the master of tendons and sinews, and the Stomach pulse is affected, it gradually moves inward. Although the six pulses are floating and rapid, the Stomach pulse at one finger position is slightly Hong and rapid.

On the third day, Shaoyang (Lesser Yang) channel is affected. Inquiry about the pulse shows it running along the hypochondrium and connecting to the ears. Thus, there is chest and hypochondriac pain and deafness. It originates from the outer canthus, goes up to the corner of the head, and descends behind the ear. The pulse should be rapid, numerous, and smooth, reaching six or seven beats per breath cycle or more, with the Liver pulse showing slightly more rapidity. These three Yang channels being diseased belong to the exterior, so their pulses are rapid, numerous, and floating. Since they have not entered the Zang-Fu, only sweating is required.

On the fourth day, Taiyin (Greater Yin) channel is affected. The Taiyin pulse spreads in the stomach, connects to the throat, enters the stomach, goes up through the diaphragm, flanks the pharynx, connects to the root of the tongue, and disperses under the tongue. The pulse should be rapid, numerous, Hong, and large, with bone-force (depth/strength), and the Stomach pulse is slightly larger.

On the fifth day, Shaoyin (Lesser Yin) channel is affected. The direct branch of its pulse rises from the Kidney through the Liver and Diaphragm, enters the Lung, runs along the throat, and flanks the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst. The pulse is most Hong and large, reaching six or seven beats per breath cycle or more. The Heart pulse is faintly palpable, coming and going uniformly.

On the sixth day, Jueyin (Terminal Yin) channel is affected. The Jueyin pulse ascends from the foot along the genitalia, reaches the lower abdomen, and pierces through the diaphragm. Thus, there is irritability, fullness, and contraction of the scrotum. The pulse is rapid, numerous, and long. If Ying and Wei (Nutritive and Defensive Qi) stop circulating among the three Yin and three Yang, five Zang and six Fu, and the five Zang become blocked, death ensues. Generally, before the third day, the three Yang channels are affected, the pulse is in the exterior, and sweating is appropriate. After the third day, the three Yin channels are affected, the pulse is in the interior, and purgation/drainage is appropriate. If after three days, the pulse is rapid, numerous, and large, with interior and exterior appearing identical, neither sweating nor purgation should be used; only resolving and unblocking medicines should be used to clear the middle.

On the first and second days, if the pulse Qi is rapid and numerous, treat with warm, acrid, dispersing medicines to induce sweating for recovery. The formula must also contain exterior-resolving agents; do not use purely hot medicines. After sweating, the pulse should be calm, soft, neither rapid nor numerous, resembling the pulse of a frail elderly person: faintly continuous upon light pressure, and faintly present without deficiency upon heavy pressure, indicating natural peace. If the rapid/numerous quality persists after sweating, it is difficult to treat. If accompanied by a Jie (Knotted) pulse, the condition becomes critical or fatal. The Jie pulse is rapid, numerous, and suspended/extreme, bead-like, but not smooth, differing from the Hua (Slippery) pulse; it flows through the fingers sequentially like drops of water starting. However, early Shanghan (day 1-2) presents with increasing chills and high fever, with a light and floating pulse. If there are no chills, but severe headache, burning body heat, red face and eyes, bursting eye vessels, constipation, and dark urine, with six pulses being Hong, large, and having bone-force, it is called Rebing (Heat Disease). Even in early stages, sweating is not induced. The treatment for Shanghan differs from Rebing only in the first one or two days.

After the third and fourth days, treat similarly to Rebing. On days one and two, if the pulse is minute, small, neither rapid nor numerous, neither floating nor scattered, but only deep, soft, and thin, the sweating medicine should be extremely warm and acrid. If the Spleen/Stomach pulse is moist and deep, it indicates cold invasion, often transforming into a Yin syndrome. Yang Du Shanghan presents with red face, headache, burning body heat, mental restlessness, dizziness, and stiff neck/back. The pulse should be Hong, large, and have bone-force.

Shanghan with irritability and constant drinking: if the pulse is solid and Hong but not rapid, it is caused by Phlegm-Toxin. If Hong and large but not solid, it indicates Heart and Spleen receiving toxin.

After Shanghan, if chills and fever have subsided but a lump remains in the abdomen, unbearable in pain, suddenly moving to the leg surface, this is residual Qi in the Liver. The pulse Qi is Hong and long; the Liver pulse flows smoothly over the left foot. Clear the blood.

On the fourth and fifth days, heat-toxin rushes upward, causing chest oppression and fullness, high fever, persistent headache, constipation, and phlegm-solidity in the chest. The pulse should be solid at Cun and Guan, while Chi is light as if absent; the Heart pulse burns upward.

Heat-toxin in the Liver causes anger, fragmented tendon/muscle pain, confusion, aversion to people, distension in both hypochondria, restless hands/feet, and inability to sleep. The right Guan pulse should be biased large, urgent, and long. Heat-toxin in the Heart causes headache, irritability, red face, stiff tongue, slow speech, sudden heart pain, vomiting, delirium, desire to run into water, and loss of spirit. The left pulse at one finger position is biased large. If the tongue is stiff and urgent, expertly needle both sides of the tongue to release bad blood; do not needle the center. Heat-toxin in the Spleen causes fragmented muscle pain, aversion to food smell, urge to vomit, whole-body fever, dry/cracked lips, pulsing at the lip margins, or cyanotic/black ring around lips. Severe cases have lower back pain, abdominal fullness, and cheek pain. The right Guan Spleen pulse at one finger position is biased large, like other pulses.

Heat-toxin in the Lungs rushes to the throat, causing chest/lung congestion and blockage, high fever, red or red-and-white face, wheezing/coughing unable to take deep breaths. The right Cun position pulse is biased large and floating.

Heat-toxin in the Kidneys causes lower back and spine pain, spinal stiffness, no headache. If thirsty and drinking frequently, severe cases have stiff neck. Feet feel cold, unwilling to speak. The pulse should be slightly light-floating and lightly tight at the left Chi position.

Shanghan, heat-toxin attacking Liver and Heart, toxin abundance rushing to Lungs, blood reversing with Qi, causing epistaxis, hematemesis, or even bleeding from ears and eyes. The pulse should be Hong, large, and flaming upward, like flowing water, opening/closing, gathering/scattering intermittently. This is a sign of blood loss. Heat-toxin internally injuring Liver and Heart, losing control of blood, toxin steaming to Lungs, blood flowing with Qi into skin, causing red macules (Ban). Whole-body high fever, heavy/headache, sleeping as if another spirit surrounds the body in confusion. The pulse is large but knotted/unresolved; heavy pressure reveals faint bone-force, like cloth wrapped tightly. This is a sign of macule eruption. Shanghan/Rebing with cough, sitting/lying wheezing/restlessness: right Cun/Guan pulse should be Hong, large, and floating-rapid. Shanghan, intense heat-toxin scorching Sanjiao, attacking skin, causing orange-yellow discoloration of the whole body. Pulse is similar to macule eruption but deeper, treated like Jaundice.

Rebing Jie Xiong (Knotting Chest) presents with anterior chest blockage, a hard lump in the chest that does not dissipate, whole-body fever, headache, dark-red face, salivation, constipation with heat, coma/unconsciousness. Resembles Fushu (Hidden Summerheat). Lung pulse should be Hong, large, with bone-force, but solid and not floating. Fushu pulse is knotted and deep.

Shanghan/Rebing on days five or six, worsening due to laxative use, passing purple-black stool, disease intensity unchanged, mental haze, lower abdominal distension, delirium, unconsciousness, possibly abdominal lumps hard and undissipated. Pulse is Jie (knotted) and Fu (deep). This is toxin attacking blood, accumulation of evil matter in abdomen. Nine out of ten die.

Yin Du Shanghan presents with cold limbs/hands/feet, blue face, colorless lips, limb weakness, internal chilling, severe cases close eyes and lose consciousness. Pulse should be minute, fine, and deep; heavy pressure reveals softness without bone-force. If Kidney pulse is minute, fine, and sinking/pulsing deeply, it is severe.