Library

How to distinguish between Shanghan (Cold Damage) and Shangfeng (Wind Strike)? The pulse in Shanghan is tight and choppy, while the pulse in Shangfeng is floating and moderate. Shanghan presents with aversion to cold, whereas Shangfeng presents with aversion to wind. Shangfeng involves spontaneous sweating, while Shanghan involves no sweating. The Yang meridians involve the Bladder, Stomach, and Gallbladder. The Yin meridians are located in the Spleen and Kidney and connect to the Liver. Pulses can be floating, long, string-taut, deep, fine, minute, or slow. In diagnosis, one must first distinguish between exterior and interior. If a Yin disease presents with a Yang pulse, there is hope for survival; if a Yang disease presents with a Yin pulse, death ensues.

Shanghan is a severe illness, where life and death hang in the balance, requiring treatment that adapts to changing circumstances. If a patient with Shanghan exhibits fever, aversion to cold, lower back pain, and stiffness of the spine, it indicates the disease is in the Taiyang Meridian (Greater Yang). If the body is hot, eyes hurt, nose is dry, and sleep is impossible, it indicates the disease is in the Yangming Meridian (Yang Brightness). If there is pain in the chest and hypochondrium, deafness, bitter taste in the mouth, dry tongue, alternating chills and fever, and vomiting, it indicates the disease is in the Shaoyang Meridian (Lesser Yang). If there is abdominal fullness, dry throat, naturally warm hands and feet, spontaneous diarrhea without thirst, or abdominal fullness with intermittent pain, it indicates the disease is in the Taiyin Meridian (Greater Yin). If there is irritability and fullness, and retraction of the genitals, it indicates the disease is in the Jueyin Meridian (Terminal Yin). If the patient curls up while lying down, has aversion to cold, or has a dry tongue and mouth, it indicates the disease is in the Shaoyin Meridian (Lesser Yin). If there is tidal fever, spontaneous sweating, delirium, thirst, aversion to heat rather than cold, throwing off clothes and bedding, flailing arms and legs, yellowing of the skin, macules, mania, or constipation for five to six days, it indicates the disease is in the Yangming Fu-organ (Stomach/Intestines). If the pulse and symptoms are unclear, mistakenly using Ephedra Decoction (Mahuang Tang) can cause excessive sweating and loss of Yang energy; mistakenly using Chengqi Decoction can lead to incontinence of stool; mistakenly using Ginger and Aconite can cause bleeding and madness. This is because cold-natured medicines consume Stomach Qi, acrid-hot medicines damage sweat fluids, and dry-hot medicines assist pathogenic heat. No act by quacks is more deadly than this. The pathogen of Shanghan indeed has no fixed form. If it enters the Qi level of the Yang meridians, it starts with Taiyang, and the pulse will be floating, easily felt with light pressure. If it enters the Blood level of the Yin meridians, it starts with Shaoyin, and the pulse will be deep, only felt with heavy pressure. A floating pulse, whether forceful or not, reveals the deficiency or excess of the exterior. A deep pulse, whether forceful or not, reveals the cold or heat of the interior. A medium-pressure pulse, whether forceful or not, reveals the urgency of the exterior and interior conditions. Pulses vary in floating, deep, deficiency, and excess, while symptoms change unpredictably. The method of treatment is to first distinguish between exterior/interior, deficiency/excess, cold/heat, and root/branch. The initial disease is the root, subsequent diseases are the branch. Treat the urgent condition first; this is the primary principle. Ask about symptoms to know the exterior, examine the pulse to know the interior. It all lies in flexibility; do not be bound by the number of days since onset. If Taiyang symptoms are present, treat Taiyang directly. If Shaoyin symptoms are present, treat Shaoyin directly. If true cold is present, treat true cold directly. If even one or two symptoms are present, make a judgment; it is not necessary for all symptoms to be present. How should one proceed? This is flexibility. Clarify what is similar but different, and differentiate what appears correct but is incorrect. For conditions in the exterior, use sweating to disperse them. For conditions in the interior, use purging to drain them. For conditions above, induce vomiting to expel them. For sinking conditions, lift and raise them. For conditions harmonizing from the middle, resolve them through harmonization. For conditions directly striking the Yin meridians, use warming and tonification. When resolving the exterior, do not attack the interior. Even if many days have passed, if there are exterior symptoms and a floating pulse, dispersion is still appropriate. Failing to understand this, attacking the interior is contraindicated. The Classics state: One error may prolong the disease, two errors hasten death. If the exterior is resolved but interior symptoms remain, do not attack the exterior. Even if few days have passed, if there is interior heat and a deep, solid pulse, urgent purging is required. Failing to understand this, disaster occurs instantly. The Classics state: If pathogenic heat is not removed, adding dry-heat is like carrying firewood to save a fire. If directly striking the Yin meridians, it is a true cold syndrome: no fever, aversion to cold, no thirst, suitable for warming and tonification, strictly avoiding cold-natured medicines. Failing to understand this, death comes quickly. Yin syndromes resembling Yang syndromes should be treated with warming; Yang syndromes resembling Yin syndromes should be treated with purging. Yang toxicity should be purged according to severity; Yin toxicity should be warmed according to urgency. Yang mania should be purged; Yin collapse should be warmed. Yellowing due to damp-heat should be drained and purged; yellowing due to blood disorders should be cleared and purged. Macules should be cleared and purged. Delirium should be purged and cleared. Fullness and stagnation should be reduced and purged. Chest binding should be resolved and purged. Taiyang symptoms resembling Shaoyin should be warmed; Shaoyin symptoms resembling Taiyang should be sweated. Epistaxis should be resolved and stopped. Wheezing should be sweated or purged. Cough should be drained or resolved. True Shanghan requires major sweating and major purging. Cold injury requires minor sweating and minor purging. Injury from labor with cold invasion requires warming and dispersing. Warm-heat diseases require minor resolution and major purging. These are the general principles. There are cases where the same meridian disease is treated with either hot or cold medicines. For example, Shaoyin syndrome may be treated with cold medicines like Baihu Tang (White Tiger Decoction) or Sini San (Four Reversal Powder), or with hot medicines like Sini Tang (Four Reversal Decoction) or Zhenwu Tang (True Warrior Decoction). Quacks hesitate and doubt, unable to administer treatment. Alas! Only by accurately identifying Shanghan symptoms and mastering its formulas and pulses can one be a good physician. Thus, cold medicines treating Shaoyin indicate transmitted interior heat; hot medicines treating Shaoyin indicate direct strike true cold. Differentiate the pulse to determine the meridian, identify symptoms to prescribe medicine. Truly knowing it is an exterior condition, sweat it. Truly knowing it is interior heat, purge it. Truly knowing it is a direct strike to Yin meridians, warm it. By sweating thus, purging thus, and warming thus, if Mahuang Tang or Chengqi Tang fail, Jiangfu Lizhong Wan (Ginger, Aconite, and Licorice Pill) will surely succeed. How can the disease escape? However, one must distinguish severity, urgency, age, constitution, chronic vs. acute onset, pregnancy/postpartum status, and menstruation in young women. Generally, Shanghan during childbirth differs from treatment in men. Without pregnancy/postpartum issues, treatment is similar. For women and young girls, if menstruation has just started or ended, and chills and fever resemble malaria, it is Heat Entering the Blood Chamber. Harmonize the exterior and interior. Chronic disease persisting beyond the meridian stage is a corrupted syndrome; new onset is initial disease. Elderly people have declining Qi and Blood; young people have robust Qi and Blood. Slow progression indicates mild disease; rapid progression indicates severe disease. Cold medicines taken hot, hot medicines taken cool, neutral medicines taken warm. Chills and sweating are divided into four types; understand the prosperity and decline of pathogenic and righteous factors. Four types of Shanghan-like diseases are treated according to standard examples. Students should study these carefully.