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The *Yin Yang Da Lun* (Great Treatise on Yin and Yang) states: The Qi of spring is mild and harmonious, the Qi of summer is hot and sultry, the Qi of autumn is cool and clear, and the Qi of winter is biting cold. This is the order of the correct Qi of the four seasons. In winter, when severe cold prevails and all things are deeply hidden, if a gentleman lives with meticulous care, he will not be injured by cold; those who violate and expose themselves to it are then called suffering from Shanghan (Cold Damage). However, being injured by the Qi of the four seasons can all lead to disease. By spring, this transforms into Wenbing (Warm Disease); by summer, it transforms into Shubing (Summerheat Disease), where Shubing refers to extreme heat that is more severe than Warm Disease. Therefore, for those who work hard, warm-heat diseases are common in spring and summer, all caused by exposure to cold during winter, not by the Shixing Zhiqi (Seasonal Epidemic Qi). Whenever there is Shixing (Seasonal Epidemic), it means spring should be warm but is instead severely cold, summer should be hot but is instead severely cold, autumn should be cool but is instead severely hot, and winter should be cold but is instead severely warm. This is having the Qi out of season. Thus, throughout the year, the illnesses of young and old are often similar; this is the Shixing Zhiqi (Seasonal Epidemic Qi). (Same as *Zhongjing Bingyuan*, *Duanju*, and *Qianjin Fang*)

Wang Shuhe said: For Shanghan (Cold Damage) disease, prescriptions should be administered according to the daily progression and depth of the illness. Nowadays, people who contract Shanghan either do not treat it early enough, or the treatment does not match the syndrome, or they delay until they are exhausted before consulting a physician. If the physician also does not know the proper sequence of treatment, the disease will not be cured. They merely adjust prescriptions on the spot, which are invariably ineffective. I have now searched through Zhang Zhongjing's ancient theories, recorded his syndromes, pulse diagnosis, voice and complexion observations, and true prescriptions matched to diseases that have shown miraculous efficacy, intending to prepare for emergencies in the world. Furthermore, land varies in elevation, leading to differences in cold and warmth; the nature of materials differs in hardness and softness, and dietary habits and dwellings also vary. Therefore, Huangdi asked questions regarding the four directions, and Qibo demonstrated the abilities of four treatments to instruct later generations and enlighten those who are not yet awakened. Physicians facing illness must carefully examine both aspects. (Same as *Duanju* and *Qianjin Fang*)

He also said: If the exterior is harmonious but the interior is diseased (alternatively described as Excess Yang and Deficiency Yin), using purgation will lead to recovery, while using sweating will lead to death. If the interior is harmonious but the exterior is diseased (alternatively described as Deficiency Yang and Excess Yin), using sweating will lead to recovery, while using purgation will lead to death. Thus, Shen Dan Wan (Divine Elixir Pill) must not be mistakenly used to induce sweating, and Gansui (Kansui Root) must not be recklessly used to attack internally. (Shen Dan Wan is found in this volume under Cui Shi's section, consisting of six herbs; Gansui is found in the Water Drainage Powder in Volume 3 under the Section on Seasonal Madness, consisting of Gansui and two other herbs, originating from *Qianjin Fang*). The treatments for exterior and interior differ by a thousand miles; the mechanism of auspiciousness and peril reacts as swiftly as shadow follows form or sound follows echo. Therefore, if Guizhi Tang (Cinnamon Twig Decoction) is swallowed and the exterior is already harmonious, it will cause death. (Guizhi Tang is in this volume under Zhongjing's Day Count section, composed of five herbs including Cinnamon Twig). The interweaving of deficiency and excess in the interior and exterior presents subtle symptoms; the opposite effects of sweating, vomiting, and purging bring rapid disaster. Those with shallow and narrow medical skills make errors in treatment, causing patients to perish, yet they attribute it to fate.

Furthermore, when Lianggan Bing (Double-Feeling Disease) occurs simultaneously, treatment has a specific sequence. Releasing the exterior and attacking the interior are fundamentally different. Yet, those who are deluded and mistaken claim that Shen Dan Wan and Gansui can be taken together to resolve the exterior and remove the interior. Their words are clever and seem reasonable, but in reality, they contradict logic. How can the changes of safety and danger be deceived! When a patient has fever and aversion to cold, it originates in the Yang; without fever but with aversion to cold, it originates in the Yin. For origins in Yang, one may attack the exterior; for origins in Yin, one should warm the interior. To release the exterior, use Guizhi Tang (Cinnamon Twig Decoction); to warm the interior, use Sini Tang (Frigid Extremities Decoction). (Sini Tang is in Volume 2 under the Section on Insomnia due to Cold Damage. Note: Volume 2 does not contain Sini Tang; the three-herb formula is found in the Section on Difficulty in Urination, which contains Si Ni San [Frigid Extremities Powder] with modifications.)

Hua Tuo said: At the beginning of Shanghan (Cold Damage), on the first day, the pathogen is in the skin; applying ointments and moxibustion will lead to recovery. If it does not resolve, on the second day, it is in the flesh; one can use iron warming and take Jieji San (Muscle-Releasing Powder) to induce sweating, which leads to recovery. If it does not resolve, on the third day, it is in the muscles; inducing sweating again will lead to recovery. If it still does not resolve, stop; do not induce sweating again. By the fourth day, it is in the chest; taking Lilu Wan (Veratrum Pill) to induce mild vomiting leads to recovery. If the condition worsens and Lilu Wan cannot induce vomiting, take Xidou Guiti San (Adzuki Bean and Melon Citron Powder) to induce vomiting. Observe if the patient has not yet regained consciousness; once conscious, apply acupuncture using another method. (Lilu Wan is currently considered damaging and is not recorded; Guiti San is at the end of the volume in Miscellaneous Treatments, from Fan Wang's prescription of two herbs). On the fifth day, it is in the abdomen; on the sixth day, it enters the Stomach. Once in the Stomach, purgation can be used. If toxic heat is outside the Stomach and purgation is used prematurely before it enters, the heat will enter the Stomach via the deficiency, rotting the Stomach lining. However, for Heat Entering the Stomach disease, one must wait for the heat to exit; it must not remain in the Stomach. If the Stomach has Excess Heat causing this condition, three deaths for every one life; such cases rarely recover. If the Stomach is deficient and heat enters, rotting the Stomach, mild heat manifests as red macules, while severe heat manifests as black macules. Red macules indicate five deaths for every one life; black macules indicate ten deaths for every one life. This simply discusses the strength of the person and the difficulty of the disease, differing only in efficacy. If the patient passes days without timely purgation, the heat cannot be drained, and death ensues.

If a patient has no fever but experiences delirium, restlessness, and speech incongruous with their spirit, do not force sweating with fire methods. Instead, administer Wuling San (Five-Ingredient Powder with Poria) one cun-bi, mixed with water. (Wuling San is referred to by Zhongjing as Zhu Ling San, found in Volume 2 under the Section on Cold Damage and Wind Strike; *Qianjin Yi Fang* lists five ingredients). Force drinking about one sheng of fresh well water; if one and a half sheng up to two sheng is better, stimulate the throat with a finger to induce vomiting. The disease will heal immediately upon vomiting. If vomiting does not occur quickly, this type of disease is difficult to treat; do not force water, as stagnant water will knot in the epigastrium. Use other emetic drugs instead, ensuring they match the syndrome; otherwise, it becomes critical. If this disease is not urgent, using Zhu Ling San to induce vomiting and resolve the exterior will likely hasten death. It is better to first vomit out the toxin and follow with acupuncture.

He also said: In spring and summer, avoid excessive vomiting and purgation; in autumn and winter, avoid excessive sweating. For the sweating method, in winter and early spring during severe cold, Shen Dan Wan (Divine Elixir Pill) is suitable, or one can apply ointments and use moxibustion. Do not cover heavily; instead, take Liuwu Qing San (Six-Ingredient Green Powder). (Qing San is in Miscellaneous Treatments, Fan Wang's six-ingredient formula). Cuī Wénxíng's Duzhang San (Barrier-Crossing Powder, four ingredients from Fan Wang in Miscellaneous Treatments), Chi San (Red Powder, seven ingredients from Fan Wang in Miscellaneous Treatments, originally from Hua Tuo), and Xuejian (Snow Decoction, three ingredients from *Gujin Luyan Fang* in Miscellaneous Treatments) are also good. If repeated sweating fails to resolve the condition, provide decoctions; for excess patterns, transition to purgation. If the pulse is calm in the morning and restless in the evening, it indicates an Excess Pi Mass (accumulation); if calm in the morning and restless in the evening is not present, it is not a Pi Mass. Transitioning to purgative decoctions can be done early, but give small amounts frequently, avoiding excessive purgation.

Diseases involving deficiency and vexation with heat resemble Shanghan (Cold Damage), but there is no aversion to cold and no body pain, so it is known not to be Shanghan. Sweating is contraindicated. There is no headache and the pulse is not tight and rapid, so it is known not to be an Interior Excess pattern; purgation is contraindicated. Thus, neither interior nor exterior can be attacked. If the physician forces attack, depletion and death will surely follow. For various deficiency vexations, one should only use Zhuye Tang (Bamboo Leaf Decoction). (Zhuye Tang is in Volume 3 under the Section on Seasonal Deficiency Vexation, from Wen Zhong's formula). For vomiting, use Chupi Tang (Tangerine Peel Decoction); if one dose is ineffective, repeat. (Chupi Tang is in Volume 2 under the Section on Vomiting and Hiccups due to Cold Damage, four ingredients from *Shenshi Fang*). This physician's prescriptions are highly effective when used frequently. After Shanghan (Cold Damage), deficiency vexation is also suitable for this decoction. (Same as Zhongjing and *Qianjin Fang*).

Chen Linqiu said: Someone asked, "If one takes herbal decoctions continuously to induce sweating, but no sweat comes out, what should be done?" The answer was: Medical classics state that continuous sweating with no sweat output leads to death. I consider steaming could be used, similar to the method for steaming Wind Strike. Introducing moist steam from the outside will inevitably induce sweating. Later, I asked Zhang Miao. Zhang Miao said: "Once, someone worked to exhaustion, sweated, and lay on a bamboo mat, catching cold from the chill. He suffered only from cold and curling up. Various physicians gave pills, powders, and decoctions. Within four days, eight sweating treatments were attempted, but no sweat came out. Zhang Miao ordered the floor to be heated and peach leaves spread for steaming. Immediately, profuse sweating occurred. He was powdered thoroughly while in bed. Then, bowel movements became smooth, and he recovered. Subsequently, multiple sweating treatments using this method resulted in sweating." Human constitutions naturally vary in their ability to sweat; it is not just the disease that causes this. Steaming invariably induces sweating. (Same as *Duanju* and *Qianjin Fang*. Steaming method is in this volume under Cui Shi's Day Count section; Ruan Henan Fa has Peach Leaf Decoction fumigation, detailed in Volume 3 under Seasonal Diseases, Wen Zhong's formula, Zhi Taisu Fa).

Fan Wang discussed: "Huangdi asked Qibo: 'When a person is injured by cold and gets sick, why does it turn into heat?' Qibo answered: 'Extreme Yin transforms into Yang; severe cold generates heat, and severe heat generates cold.' 'For all diseases with fever, aversion to cold, and floating-hong pulse, sweating is appropriate. However, if the person has recently lost blood or is post-major illness...'" (Text incomplete here).

The *Jiu Juan* (Nine Chapters) states: Huangdi said: There are nine signs of death in Shanghan (Cold Damage) and Rebing (Heat Disease) (*Taisu* says nine conditions unsuitable for acupuncture). First: No sweat, red cheeks on the temples, and hiccups indicate death (*Taisu*: No sweat, red temple cheeks, hiccups = death. Note: *Ling Shu · Re Bing Lun* states red temple cheeks and hiccups = death). Second: Diarrhea with severe abdominal fullness indicates death (Severe may mean yellow). Third: Unclear vision with unrelenting heat indicates death. Fourth: Elderly and infants with Heat Disease and abdominal fullness indicate death. Fifth: No sweat, vomiting blood indicates death. Sixth: ... Seventh: ... Eighth: ... Ninth: Fever with spasms indicates death. Heat Disease spasms involve opisthotonos, convulsions, and lockjaw. On the 7th or 8th day of Heat Disease, if the pulse is minute and faint, and the patient has bloody stool and dry mouth, but sweat comes out while the pulse remains rapid and strong, this is the extreme of Yin pulses, indicating death. If sweat comes out and the pulse becomes quiet, life is preserved. If the pulse is consistently rapid and strong without sweat, this is the extreme of Yang pulses, indicating death. If the pulse is rapid and strong but sweat comes out, life is preserved. (*Jia Yi Jing*, *Taisu* agree. Wang Shi notes: Guan Fa means sudden pouring or soaking. Initially no sweat, later like sudden heavy rain soaking and draining Yang Qi).

*Duanju* discusses: Ancient and modern traditions call Shanghan (Cold Damage) a difficult-to-treat disease. Tianxing Wenyi (Seasonal Warm Plague) is toxic Qi. But commentators do not distinguish between Shanghan and Tianxing Wenyi as different Qi, claiming Shanghan is the term for scholars and Tianxing Wenyi is the term for villagers, failing to discuss the differences in disease. Examining various classics...

*Qianjin* discusses: Humans live between Heaven and Earth; fate encounters times of obstruction and smoothness, auspiciousness and peril, regret and remorse, bitterness and joy, safety and danger, anger and pleasure, love and hate, existence and destruction, worry and fear, concern and anxiety. Daily plans for survival number in the thousands, and strategies arise constantly to pass each day. Thus, Heaven has no year without cold and heat; humans have no day without worry and joy. Therefore, the virtue of establishing extremes cannot be abandoned. Although it cannot be abandoned, one can govern it with Dao. Secondly, worthy men are good at preserving life, knowing moderation, moving with the times, and thus achieving security. When Heaven and Earth have these miasmas, one uses things born of Heaven and Earth to prevent them. This is called knowing the method, so disease cannot invade. However, since treatment is necessary, continue until recovery, advance soups and foods, break the toxic heat, and naturally heal. One must not let the pathogenic qi remain free to attack arbitrarily and wait for death with folded hands; this is an error. Now, collecting extensively from various classics into upper and lower volumes, providing comprehensive preparations, those who love life can study them in detail.

Also, Shanghan (Cold Damage) disease originates from Wind-Cold, entering the Couli (interstices), competing with Essence-Qi, blocking Ying and Wei, obstructing circulation. On days 1-2, the Qi is in the orifices and skin, filling the chest and heart, causing headache and chest fullness; vomiting should lead to recovery. After day 5, the Qi sinks and knots in the Zang organs, causing abdominal distension, heavy body, and painful joints; purgation should lead to recovery.

It is also said: Summer [should not allow reckless sweating/purgation].

Although it is said that observing the disease over accumulated days shows the source has knotted, it cannot be removed by further sweating or muscle-releasing. One must diagnose the pulse and save/rescue according to the current situation to avoid disaster. One must not rigidly stick to the sequence, losing the key opportunity and causing harm. For Shanghan (Cold Damage) within three days, sweating is indicated if caused by exposure to wind, removing clothes, sleeping uncovered at night, leading to undissipated Cold-Damp, slight difficulty in movement, headache, warm body, and a solid-large pulse; in this case, vomiting or purgation can be used, but sweating is contraindicated.

Also, for minor illnesses where one feels slightly unwell compared to usual, one must speak up early. If endured silently without treatment, hoping for spontaneous recovery, within moments it becomes a chronic disease. Small matters, treated early in time, rarely fail to heal. Patients endure for days, then complain; once Evil Qi enters the Zang, it is hard to control. Even Bian Que would be powerless. Carbuncles, ulcers, and Ding swellings are especially urgent; this is essential for self-care.

Also, when preparing decoctions, do not avoid morning/evening or auspicious/inauspicious days. As soon as illness is felt, treat immediately, regardless of time, for easier recovery. Take medicine according to the method; if one willfully violates the master's instructions, do not bother treating.

Also, for those contracting Seasonal Qi disease, on days 5-6, if thirsty and wanting to drink, but unable to drink much, do not give water. Why? Because internal heat is still insufficient to digest it, and giving it would create more disease. By days 7-8, if extremely thirsty and wanting to drink, still give according to the syndrome, but do not let them drink excessively. If they can drink one dou, give five sheng. If after drinking, the abdomen becomes full, urination is difficult, or there is wheezing or hiccups, do not give more. If after drinking, sudden sweating occurs, the disease is healed. A patient who can drink water desires recovery (from Volume 9).

*Jingxin Lu* discusses: Errors in treating Shanghan (Cold Damage) bring disasters as easily as turning over a hand. Hence the proverb: "Not treating a disease oneself gains average medical results," discussing this illness. Its symptoms are similar: Shanghan Rebing (Cold Damage Heat Disease), Fengwen Shibing (Wind-Warmth Damp Disease), Yindu Yangdu (Yin-Toxin Yang-Toxin), Redu Wenyi (Heat-Toxin Warm Plague), Tianxing Jieqi (Seasonal Qi), death and life differ, forms and symptoms also differ; careful examination is required. (From Volume 2).