Library

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) discusses both Wind (*Feng*) and Jue (*Jue*) together. Later generations failed to examine this carefully, generally naming acute conditions characterized by sudden collapse or violent syncope as "Zhong Feng" (Wind Strike), and merely naming conditions with cold extremities as "Jue". How inverted is this understanding! The classics state: "In cases of sudden Jue, the patient loses the ability to speak." It also states: "When blood and Qi rush upward together, it results in Da Jue (Great Jue); Da Jue leads to sudden death. If Qi returns, the patient lives; if it does not return, the patient dies." Furthermore, it states: "When the meridians of Hand-Shaoyin, Foot-Shaoyin, Hand-Taiyin, Foot-Taiyin, and Foot-Yangming are all exhausted, the body's pulses may move, but the form becomes insensible, resembling a corpse; this is sometimes called Shi Jue (Corpse Jue)." From these records, it is clear that "Jue" refers not only to cold extremities. The method for differentiation is as follows: Quietness without convulsions indicates Jue; agitation with extension and convulsions indicates Wind; a faint pulse with a cold body indicates Jue; a floating pulse with a warm body indicates Wind. Wind represents an excess of pathogenic factors, often injuring the meridians and collaterals. Jue represents a deficiency of healthy Qi, or sudden collapse due to Qi stagnation or food retention, purely caused by external pathogens. When the clinical presentation is excess, it is termed Zhong Feng. When Qi is deficient and invaded by external pathogens, with a weak constitution but intense pathology, it is named Feng Jue. When there is absolutely no external pathogen, and both the constitution and pathology are deficient, it is named Bao Jue (Sudden Jue). Additionally, conditions of sudden collapse due to Qi, food, or malevolent influences can be named Zhong Qi (Qi Strike), Zhong E (Evil Strike), or Zhong Shi (Food Strike), and can also be referred to as Qi Jue, Shi Jue, or Shi Jue. In this way, the intent of the classics becomes clear. With Wind and Jue distinguished, the endless debates regarding "pseudo-Wind Strike" syndromes can cease.

(From Li Nian'e's abridged edition)

The methods for treating Shang Han (Cold Damage) are unpredictable in their variations. Among them, the excellence in theoretical exposition surpasses none compared to Zhang Zhongjing. The excellence in herbal prescription should yield to Tao Jie'an (Tao Hua). Regarding the detailed explanations of complex nuances, what more can I say? However, there is something I cannot refrain from discussing: the abundance of categories makes it difficult for students to grasp. Tao Jie'an said: "Once you grasp the general principles, it is as easy as picking up a mustard seed; it lies only in Pulse, Syndrome, and Principle. Seeking too many divergent paths leads to fragmentation, like crossing the sea looking for a ferry." By "Pulse and Syndrome," we mean Exterior/Interior, Yin/Yang, Deficiency/Excess, Cold/Heat. By "Principle," we mean following the constant laws and understanding the changes. By "divergent paths," we refer to the sprawling and redundant medical texts. Inspired by these words, I have summarized them into six methods: Sweating (Han), Vomiting (Tu), Purging (Xia), Warming (Wen), Clearing (Qing), and Tonifying (Bu).

The Sweating method treats Exterior syndromes, but it has three types: First, Warm Dispersal. When cold prevails, and the Yin-predominant organs lack sufficient Yang Qi, the Exterior remains unresolved. Even if there is high fever, acrid-warm herbs must be used. Second, Cool Resolution. When heat is blazing, causing dryness in the Interior and Exterior, and Yin Qi fails to nourish, sweating cannot occur naturally; acrid-cool herbs should be used. Third, Balanced Resolution. When the disease lies between Yin and Yang, neither warming nor cooling is appropriate; one should use balanced methods to resolve the Exterior.

The Vomiting method treats disorders in the Upper Jiao. Vomiting contains the intent of dispersal and can remove excess from the chest. As the classics state: "For disorders above, induce vomiting to expel them."

The Purging method attacks the Interior. There are five degrees of purging: Pi (stagnation/fullness) involves Qi; Zao (dryness) involves Blood. When all four signs (Pi, Man, Zao, Shi) are present, aggressive purging is suitable. If only Man (fullness), Zao (dryness), and Shi (excess) are seen, purging should be milder. If only Pi (stagnation) and Shi (excess) are present, purging should be even gentler, whether moving blood stasis or draining fluid retention; severity and urgency vary according to the syndrome.

The Warming method warms the Middle/Interior. If the zang organs harbor cold pathogens, failure to warm will lead to death. Qi belongs to Yang; Qi deficiency leads to cold, so warming is equivalent to tonifying. It is also called the "Rescue the Interior" method because Yang deficiency is critical and requires immediate intervention.

The Clearing method clears Heat. If there is Heat without accumulation, it is not a case for purging. If not cleared, how will the Heat dissipate? Residual pathogens after purging should also be cleared.

The Tonifying method tonifies Deficiency. Ancients discussed this in detail, yet modern practitioners fear it and do not use it, leaving those with Shang Han complicated by deficiency to wait passively for death, which is deeply regrettable! For instance, if repeated sweating fails to resolve the condition, it is because Yin fluids cannot reach the surface. People know sweat belongs to Yang and that raising Yang can resolve the Exterior, but they do not know that sweat is born from Yin, and nourishing Yin can promote sweating. Similarly, if internal Heat persists despite repeated clearing, it is due to Yin insufficiency. People know cold-natured herbs can reduce fever, but they do not know that strengthening Water (nourishing Yin) can extinguish Fire. Furthermore, when Healthy Qi is deficient and Pathogenic Factors are rampant, leading to prolonged illness, tonifying Healthy Qi removes the Interior disorder, and warming the Middle scatters the Pathogen; this situation typically presents with a faint Yin-type pulse. The *Shanghan Lun* states: "Yin syndromes presenting with Yang pulses indicate survival; Yang syndromes presenting with Yin pulses indicate death." Everyone reveres this statement but few explain its meaning. Those with robust Healthy Qi often show Yang pulses; those with deficient Healthy Qi often show Yin pulses. Yang manifestations in symptoms represent false excess; Yin manifestations in pulses represent true deficiency. Chen stated: "When examining Yin syndromes, regardless of the presence or absence of Heat, rely solely on the pulse for medication; this is secure. Regardless of whether the pulse is floating/sinking or large/small, if it feels powerless under the finger and vanishes upon heavy pressure, it indicates hidden Yin." Thus, while people know sinking/small pulses are Yin pulses, they fail to realize that floating/large pulses can also be Yin pulses. Therefore, although Shang Han has myriad variations, the concepts of Deficiency and Excess serve as the guiding principle. If Healthy Qi prevails, recovery occurs; if Pathogenic Factors prevail, death ensues. Those with robust Healthy Qi, even if infected by severe pathogens, suffer mild disease. Those with deficient Healthy Qi, even if infected by slight pathogens, suffer severe disease. Cases where Qi is excess and disease arises are cured by purging; even without medication, the disease resolves after the natural course, requiring no worry. The only thing to worry about is complications with deficiency. Alas, mediocre and shallow practitioners, failing to distinguish Deficiency and Excess, see only fever and immediately resort to purging. Purging in deficiency leads inevitably to death. They claim "there is no tonification method for Shang Han," which is extremely erroneous! Have they not observed Zhang Zhongjing's 397 methods, among which over 100 treat deficiency-cold? Of his 113 prescriptions, over 80 contain Renshen (Ginseng Radix), Fuzi (Aconite Lateralis Radix Praeparata), or Guizhi (Cinnamon Twig). Dongyuan (Li Dongyuan), Danxi (Zhu Danxi), and Jie'an (Tao Hua) also utilized formulas such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Huiyang Fanben Tang (Restore Yang and Return to Origin Decoction), and Wenjing Yiyuan Tang (Warm Meridians and Benefit Source Decoction). They did not neglect tonification; how can one say there is no tonification method for Shang Han?