Library

According to the *Suwen: Shengqi Tongtian Lun* (Treatise on the Connection between Human Life and Heaven in the Basic Questions), it is said: Since ancient times, the connection between humans and heaven has been the root of life, which lies in Yin and Yang. Within the universe and the six directions, the Qi of the nine regions (referring to internal organ distributions), nine orifices, five Zang organs, and twelve joints are all connected with Heavenly Qi. Life activities are categorized into five (Five Elements), and Qi dynamics are divided into three (Three Yin and Three Yang). If one frequently violates these principles, pathogenic factors will harm the body; this is the foundation of longevity. From this discussion, we see that human Yuan Qi (Original Qi) connects with heaven; if nurtured properly, how can disease arise? However, diseases have causes and origins. Treating according to the origin makes healing easier.

The *Suwen: Yinyang Yingxiang Dalun* (Great Treatise on the Correspondence between Yin-Yang and Phenomena) states: Heaven has four seasons and Five Elements, which govern growth, flourishing, gathering, and storage, thereby generating Cold, Heat, Dryness, Dampness, and Wind. Humans have five Zang organs that transform into five Qi, generating Joy, Anger, Sorrow, Grief, and Fear. It also says: Exposure to dew and wind leads to cold and heat disorders. Thus, injury by wind in spring, with lingering pathogenic factors, results in severe diarrhea (Dongxie); injury by summerheat in summer leads to malaria (Nüe) in autumn; injury by dampness in autumn causes upward counterflow coughing, developing into Phlegm-Jue (Tan-Jue); injury by cold in winter leads to Warm diseases (Wenbing) in spring. The Qi of the four seasons alternately harms the five Zang organs; this is the etiology of the four seasonal Qi.

Yellow Emperor clearly explained that Spring-Warmth originates from Winter-Cold. Although the climate and symptoms are similar, the original text did not include Summerheat. When Zhang Zhongjing of the Han Dynasty wrote the *Shanghan Lun* (Treatise on Cold Damage Disorders), he expanded on the *Neijing* theory: Injury by the Qi of the four seasons can cause disease. Among them, the most lethal is the killing Qi. Immediate onset after injury is called Shanghan (Cold Damage). Non-immediate onset involves Cold toxicity hiding in the skin and muscles, transforming into Wenbing in spring and Shubing (Summerheat Disease) in summer. Shubing is more intense in heat than Wenbing. Since this theory emerged, later practitioners of Qihuang medicine have revered it. If true, this implies a sole focus on Cold as the pathogen. These three diseases differ in duration but share Cold as the root. Hence, later physicians proposed "Four-Season Shanghan," even using Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) to treat Warm-Heat syndromes, causing much harm. Experts like Tao Jian'an analyzed the three diseases clearly but remained rooted in Cold, failing to break free from tradition. How can one blame mediocre doctors?

I argue that Dao generates heaven and earth through one Qi, and the Five Elements through two Qi. The five Qi have their functions, with Water and Fire being paramount. Water and Fire can generate and destroy. If Zhongjing’s view holds, Water monopolizes power while Fire becomes void and useless. I believe winter cold diseases are exclusively due to Cold dominance, which is unchangeable. In spring, Yang Qi gradually expands, pores open, and clothing changes. Weather fluctuates between warm and cold, with frequent winds. Humans contracting cold directly into the zang-fu organs develop Warm diseases, which could be named "Spring Cold." This is distinct from Winter Cold. Moreover, after the Summer Solstice, blazing fire flows, steaming and scorching people. Diseases resembling Shanghan are caused by Summerheat-Fire, unrelated to Winter Cold. Attributing them to accumulated Winter Cold is erroneous.

Revisiting the *Shengqi Tongtian Lun*: "Therefore, Yang Qi resides above to defend the exterior. Due to Cold, it should move like a door pivot; if daily life is disturbing, Shen Qi (Spirit Qi) floats." Due to Summerheat, sweating occurs; restlessness leads to panting and loud breathing; stillness leads to excessive talking; the body feels like burning charcoal, resolving when sweat appears. This clearly distinguishes Cold and Summerheat etiologies and Water and Fire syndromes, serving as an eternal medical ancestor. What confusion remains?

Why does the *Neijing* state that Warmth roots in Cold? According to the *Shanhai Jing*, the Gui tree (Cassia) is called Zhaoyao, with leaves two chi long; the Sang tree (Mulberry) is called Divinü, with a trunk circumference of fifty chi. Ancient times saw floods overflowing mountains, vegetation blocked, and heaven and earth shrouded in gloom. Yangming Qi was unexpanded, so Cold prevailed, and Yuan Qi was scarce. Even in midsummer, there was no metal-melting heat. Later, with the development of civilization and distribution of Five Elements, Water and Fire powers balanced. Today, spring rains bring lingering cold, severe enough to require fur clothing. In Jin dynasty records, Summerheat cases were rare, and malaria was absent, proving Yin dominance. How much more so in prehistoric times? This explains why the *Neijing* links Warmth to Cold. Why did Zhongjing extend this to include Summerheat? This is superfluous. Ancients ate raw meat and wore grass, with simple diets and no heating tools. Later generations enjoyed roasted meats and fermented wines, indulging in desires and labor, which ignite flames and favor Summerheat invasion. It is plausible that ancient times had more Cold diseases and fewer Summerheat diseases, whereas today both are heavy, with Summerheat being more severe. Therefore, I specifically propose: Shanghan is contracted from Winter's severe cold; Wenbing from Spring's mild cold; Shubing exclusively from Summer's intense heat. They are as incompatible as ice and charcoal, or sky and spring water; Water and Fire each hold their command. Treatment requires hot decoctions for one and cool decoctions for the other, targeting specific pathways. To attribute all to Cold is to cling to one aspect while ignoring another. After deep reflection, compelled to act, I dare to overturn ancient precedents to awaken future generations, dispelling delusion and suffering, accepting the charge of overstepping.

Lin notes: The *Suwen: Shengqi Tongtian Lun* mentions spring wind injury leading to diarrhea, summer heat injury leading to autumn malaria, autumn dampness injury leading to cough and Wei-Jue (Flaccidity-Jue), and winter cold injury leading to spring warmth. This illustrates the mechanism of latent Qi across seasons and the mutual root of Yin and Yang. Spring wind is Yang pathogen; lingering leads to Yin-type diarrhea. Autumn dampness is Yin pathogen; counterflow leads to Yang-type cough. Summer heat is Yang pathogen; manifesting in autumn as Yin-type malaria. Winter cold is Yin pathogen; manifesting in spring as Yang-type warmth. This shows Yin-Yang mutual overcoming. Six Excess pathogens harm the body due to insecure Yin-Yang. The *Jinkui Zhenyan Lun* states: Essence is the root of the body. Those who conserve essence do not get Warm diseases in spring. Those who do not sweat in summer heat will develop wind-malaria in autumn. This proves Qi and Blood originate from Essence. Winter favors storage and solid Yin; desire depletes Essence, causing Yin deficiency and Yang pathogen invasion (Warm diseases). Summer favors dispersion; inhibiting sweating traps Summerheat, which clashes with autumn wind to cause malaria. Yin-Yang opening/closing follows seasonal norms. Extending from winter/summer, spring/autumn latent Qi can be inferred. The *Yinyang Yingxiang Lun* repeats latent Qi because Six Excess pathogens also stem from emotional imbalance, where Zang-transformed Qi become internal thieves. This clarifies the meaning of latent pathogens.

Furthermore, the *Suwen: Relun* states: All current heat diseases belong to the category of Shanghan. Bian Que (Yueren) in *Nanjing Chapter 58* says: Shanghan includes five types: Zhongfeng (Wind Strike), Shanghan, Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing. Their names differ, proving Shanghan is a general term in ancient classics. In the *Taiyang Pian* of Zhang Zhongjing’s work, fever with sweating, aversion to wind, and slow pulse is Zhongfeng. Aversion to cold, fever, body pain, vomiting, and tight pulses are Shanghan. Fever with thirst and no aversion to cold is Wenbing. Post-sweating burning heat and floating pulses are Fengwen (Wind-Warmth). The differentiation of Cold and Warm symptoms is clear. The treatment principles have profound meaning. Unfortunately, books were lost in wars. Wang Shuhe edited them, preserving only Shanghan treatments, while Warm and Summerheat texts were largely lost. One cannot use Wang’s preface to claim Zhongjing confused Cold and Warm. The *Neijing*’s link of Warmth to Cold means Cold suppresses Heat (Kan trigram meaning). One need not invoke prehistory. Wenbing is not merely spring cold; Shubing is not solely summer heat. To understand latent Warm/Summerheat, one must study the *Neijing* carefully to avoid confusion.