伤寒所致。太阳 、湿、 、三种。宜应别论。以为与伤寒相似。故此见之。
、当作痉。传写之误也。 者、恶也。非强也。内经曰。肺移热于肾。传为柔 。
柔、为筋柔而无力。 、谓骨痉而不随。痉者、强也。千金以强直为 。经曰。颈项强
急。口噤。背反张者。 。即是观之。 为痉字明矣。
太阳病。发热无汗。反恶寒者。名曰刚 。
千金曰。太阳中风。重感寒湿。则变 。太阳病。发热无汗。为表实。则不当恶寒。
今反恶寒者。则太阳中风。重感于寒。为 病也。以表实感寒。故名刚 。
王宇泰云。热郁愈甚。则兼燥化而无汗。血气不得宣通。大小筋俱受热害而强
直。故曰刚 也。
太阳病。发热汗出。不恶寒者。名曰柔 。
太阳病。发热。汗出。为表虚。则当恶寒。其不恶寒者。为阳明病。今发热。汗出。
而不恶寒者。非阳明证。则是太阳中风。重感于湿。为柔 也。表虚感湿。故曰柔 。
王宇泰云。湿胜者。自多汗出。
太阳病。发热。脉沉而细者。名曰 。
太阳主表。太阳病。发热。为表病。脉当浮大。今脉反沉细。既不愈。则太阳中风。
重感于湿而为 也。金匮要略曰。太阳病。其证备。身体强。KT KT 然。脉反沉迟。此为
。栝蒌桂枝汤主之。
太阳病。发汗太多。因致 。
太阳病。发汗太多。则亡阳。内经曰。阳气者。精则养神。柔则养筋。阳微不能养
筋。则筋脉紧急而成 也。
张卿子云。可见亦不必因重感寒湿。
病、身热。足寒。颈项强急。恶寒。时头热。面赤。目脉赤。独头面摇。卒口噤。背
反张者。
病也。
太阳中风。为纯中风也。太阳伤寒。为纯伤寒也。皆不作 。惟是太阳中风。重感
寒湿。乃变为 也。身热足寒者。寒湿伤下也。时头热面赤。目脉赤。风伤于上也。头
摇者。风主动也。独头摇者。头为诸阳之会。风伤阳也。若纯伤风者。身亦为之动摇。
手足为之搐搦。此皆内挟寒湿。故头摇也。口噤者。寒主急也。卒口噤者。不常噤也。有
时而缓。若风寒相搏。则口噤而不时开。此皆加之风湿。故卒口噤也。足太阳之脉。起
于目内 。上额。交巅上。其支别者。从巅入络脑。还出别下项。循肩膊内。挟脊。抵腰中。
下贯臀以下。至足。风寒客于经中。则筋脉拘急。故颈项强急。而背反张也。
张卿子云。此论 状。
活人书云。 病外证。发热。恶寒。与伤寒相似。但其脉沉迟弦细。而项背反张。为
异耳。
太阳病。关节疼痛而烦。脉沉而细者。此名湿痹之候。其人小便不利。大便反快。但
当利其小便。
金匮要略曰。雾伤皮腠。湿流关节。疼痛而烦者。湿气内流也。湿同水也。脉沉而
细者。水性趣下也。痹、痛也。因其关节烦疼。而名曰湿痹。非香港脚之痹也。内经曰。
湿胜则濡泄。小便不利。大便反快者。湿气内胜也。但当利其小便。以宣泄腹中湿气。
古云。治湿之病。不利小便。非其治也。
或云。甘草附子汤。麻黄连翘赤小豆汤。
湿家之为病。一身尽疼。发热。身色如似熏黄。
身黄如橘子色者。阳明瘀热也。此身色如似熏黄。即非阳明瘀热。身黄发热者。栀
子柏皮汤主之。为表里有热。则身不疼痛。此一身尽疼。非伤寒客热也。知湿邪在经而
使之。脾恶湿。湿伤则脾病而色见。是以身发黄者。为其黄如烟熏。非正黄色也。
徐氏云。此本湿热症。而论不言热。无治法。或治以白术附子汤。甘草附子汤。桂
枝加桂等药。恐与湿热病不宜。
张卿子云。湿热。即栀子柏皮汤证也。此白术附子汤症。
湿家其人但头汗出。背强。欲得被覆向火。若下之早。则哕胸满。小便不利。舌上
如
苔者。以丹田有热。胸中有寒。渴欲得水。而不能饮。则口燥烦也。
湿家有风湿。有寒湿。此寒湿相搏者也。湿胜则多汗。伤寒则无汗。寒湿相搏。虽
有汗而不能周身。故但头汗出也。背、阳也。腹、阴也。太阳之脉。挟脊。抵背。太阳
客寒湿。表气不利而背强也。里有邪者。外不恶寒。表有邪者。则恶寒。欲得被覆向火
者。寒湿在表而恶寒也。若下之早。则伤动胃气。损其津液。故致哕而胸满。小便不利。
下后里虚。上焦阳气。因虚而陷于下焦。为丹田有热。表中寒乘而入于胸中。为胸上有
寒。使舌上生白苔滑也。脏燥。则欲饮水。以胸上客寒湿。故不能饮。而但口燥烦也。
或云。小陷胸汤。甘草附子汤。小便不利。五苓散。理中去姜加术。选用。
又云。小便利者。桂枝加附子。理中加茯苓。茯苓白术汤。选用。
湿家。下之。额上汗出。微喘小便利者。死。若下利不止者。亦死。
湿家发汗则愈。金匮要略曰。湿家身烦疼。可与麻黄。加术四两。发其汗为宜。若
妄下。则大逆。额上汗出而微喘者。乃阳气上逆也。小便自利。或下利者。阴气下流也。
阴阳相离。故云死矣。内经曰。阴阳离缺。精气乃绝。
问曰。风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不止。医云。此可发汗。
汗之不愈者。何也。答曰。发其汗。汗大出者。但风气去。湿气在。是故不愈也。若治
风湿者。发其汗。但微微似欲汗出者。风湿俱去也。
值天阴雨不止。明其湿胜也。内经曰。阳受风气。阴受湿气。又曰。伤于风者。上
先受之。伤于湿者。下先受之。风湿相搏。则风在外。而湿在内。汗大出者。其气暴。暴
则外邪出。而里邪不能出。故风去而湿在。汗微微而出者。其气缓。缓则内外之邪皆出。
故风湿俱去也。
王宇泰云。麻黄白术汤。桂枝附子汤。风湿宜汗。桂枝加白术。黄 防己汤。
张卿子云。风湿相搏。法当汗出而解。正如前条麻黄加术。使微微蒸发。表里气和。
风湿俱去。若成注似以表言风。以里言湿。则不可。
湿家病。身上疼痛。发热。面黄而喘。头痛鼻塞而烦。其脉大。自能饮食。腹中和。
无病。病在头中寒湿。故鼻塞。内药鼻中。则愈。
病有浅深。证有中外。此则湿气浅者也。何以言之。湿家不云关节烦疼。而云身上
疼痛。是湿气不流关节。而外客肌表也。不云发热身似熏黄。复云发热面黄
而喘。是湿不干于脾。而薄于上焦也。阴受湿气。则湿邪为深。今头痛鼻塞而烦。是湿
客于阳。而不客于阴也。湿家之脉。当沉细。为湿气内流。脉大者。阳也。则湿不内
流而外在表也。又以自能饮食。胸腹别无满痞。为腹中和。无病。知其湿气微浅。内药
鼻中。以宣泄头中寒湿。
王宇泰云。瓜蒂散。
病者。一身尽疼。发热。日晡所剧者。此名风湿。此病伤于汗出当风。或久伤取冷
所致也。
一身尽疼者。湿也。发热。日晡所剧者。风也。若汗出当风而得之者。则先客湿而
后感风。若久伤取冷得之者。则先伤风而后中湿。可与麻黄杏仁薏苡仁甘草汤。见金匮
要略中。
黄氏云。太阳湿家病。与太阳伤寒相似。其不同者。湿脉沉而细也。湿脉与痉脉亦
有相似者。而证则不同。湿则身疼。痉则身不疼也。
赵氏云。头疼。发热。背强。身痛。与伤寒相似。其不同者。脉而沉细。头汗。面
黄。能饮食也。夫太阳伤寒。脉必浮盛。今脉沉细。面黄。头汗。其为湿也明矣。湿家
能饮食
者。为病在经。而不干于里也。大便反快而小便滞者。亦经络涩滞。不能施化所致也。
太阳中热者。 是也。其人汗出恶寒。身热而渴也。
汗出恶寒。身热而不渴者。中风也。汗出恶寒。身热而渴者。中 也。白虎加人参
汤主之。见金匮要略中方。
太阳中 者。身热、疼、重、而脉微弱。此亦夏月伤冷水。水行皮中所致也。
经曰。脉虚身热。得之伤暑。身热。脉微弱者。 也。身体疼重者。水也。夏时暑
热。以水灌洗而得之。一物瓜蒂散主之。见金匮要略中。
王宇泰云。瓜蒂一物散。或云五苓散。
太阳中 者。发热、恶寒。身重而疼痛。其脉弦细芤迟。小便已。洒洒然毛耸。手
足逆冷。小有劳。身即热。口开。前板齿燥。若发汗。则恶寒甚。加温针。则发热甚。
数下之则淋甚。
病有在表有在里者。有表里俱病者。此则表里俱病者也。发热恶寒身重疼痛者。表
中也。脉弦细芤迟者。中暑脉虚也。小便已。洒洒然毛耸。手足逆冷者。太
阳经气不足也。小有劳。身即热者。谓劳动其阳。而 即发也。口开。前板齿燥者。重
有热也。内经曰。因于暑汗。烦则喘喝。口开。谓喘喝也。以喘喝不止。故前板齿干燥。
若发汗以去表邪。则外虚阳气。故恶寒甚。若以温针助阳。则火热内攻。故发热甚。若
下之以除里热。则内虚而膀胱燥故淋甚。
徐氏云。此条无治法。东垣以清暑益气汤主之。所谓发千古之秘也。
王宇泰云。中 、中暑、中热。名虽不同实一病也。若冬伤于寒。至夏而变为热病
者。此则过时而发。自内达表之病。俗谓晚发是也。又非暴中暑热新病之可比。或曰新
中暑病脉虚。晚发热病脉盛。
张氏云。清邪中上。浊邪中下。风寒湿者。地之气。系浊邪。所以俱中足经。惟暑
乃天之气。系清邪。所以中手少阴心经也。其证多与伤寒相似。但证与脉不同耳。伤寒
虽恶寒发热。初病未至于烦渴。中 不然。初病即渴。且伤寒之脉浮盛。中暑之脉虚弱。
或弦细芤迟者有之。经曰。脉盛身寒。得之伤寒。脉虚身热。得之伤暑。此之谓也。
汪氏云。以证言之。伤寒恶寒。伤热恶热。以脉言之。伤寒脉盛。伤暑脉虚。且暑脉
虚细。与湿痉之脉有相似者。而证则不同。暑则自汗而渴。湿则不渴。痉则身不疼也。
The diseases caused by Cold Damage include three types: Taiyang disease (Taiyang syndrome), Shī disease (Dampness disease), and Jìng disease (Spasm disease). They should be discussed separately because they resemble Cold Damage, hence they are presented here.
"Jing" (Spasm) is a transcription error for "Chi" (a term for severe illness or spasm). "Chi" implies a malignant condition, not merely stiffness. The *Nei Jing* states: "When Lung heat transfers to the Kidney, it transmits into Rou Chi (Soft Spasm)." Rou Chi refers to sinews that are soft yet weak; Chi refers to bones that are stiff and unresponsive. Jìng disease refers to rigidity. The *Qian Jin Fang* defines rigidity as Chi. Classics state: neck stiffness, trismus (lockjaw), and opisthotonos constitute Chi disease. Thus, it is clear that "Chi" is synonymous with "Jing."
In Taiyang disease, if there is fever, anhidrosis (absence of sweating), and aversion to cold, it is named Gang Jing (Yang Spasm/Rigid Spasm).
The *Qian Jin Fang* states: If Taiyang Wind Strike is compounded by Cold-Dampness, it transforms into Spasm. In Taiyang disease, fever without sweat indicates Exterior Excess, which typically does not involve aversion to cold. The presence of aversion to cold indicates that Taiyang Wind Strike has been compounded by Cold, resulting in Spasm. Because it is an Exterior Excess condition complicated by Cold, it is called Gang Jing.
Wang Yutai explains: When heat stagnation becomes severe, it combines with Dryness, leading to anhidrosis. Qi and Blood cannot circulate freely, causing both large and small sinews to suffer heat damage and become rigid. Hence, it is called Gang Jing.
In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is named Rou Jing (Yin Spasm/Soft Spasm).
In Taiyang disease, fever with sweating indicates Exterior Deficiency, which usually involves aversion to cold. Absence of aversion to cold suggests Yangming disease. However, fever with sweating but no aversion to cold is not typical Yangming; rather, it is Taiyang Wind Strike compounded by Dampness, resulting in Rou Jing. Because it is an Exterior Deficiency condition complicated by Dampness, it is called Rou Jing.
Wang Yutai notes: Those with excessive Dampness naturally tend to sweat profusely.
In Taiyang disease, if there is fever and the pulse is deep and fine, it is named Spasm disease.
Taiyang governs the Exterior. Fever in Taiyang disease indicates an Exterior condition, where the pulse should be floating and large. A deep and fine pulse indicates the condition is unresolved, suggesting Taiyang Wind Strike compounded by Dampness has transformed into Spasm. The *Jin Gui Yao Lue* states: When Taiyang disease symptoms are complete, accompanied by body rigidity and a deep, slow pulse, it is Spasm disease. It is treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction).
If Taiyang disease is treated with excessive sweating, Spasm may result.
Excessive sweating in Taiyang disease leads to the loss of Yang Qi. The *Nei Jing* states: Yang Qi nourishes the Spirit in its refined aspect and nourishes the Sinews in its gentle aspect. Weak Yang Qi fails to nourish the sinews, leading to tension and Spasm.
Zhang Qingzi remarks: This shows that it is not necessarily caused by compounding Cold-Dampness.
Symptoms of Spasm disease include: body heat, cold feet, neck stiffness, aversion to cold, intermittent head heat, facial redness, reddened eye vessels, isolated head tremor, sudden trismus, and opisthotonos. These indicate Spasm disease.
Pure Taiyang Wind Strike or pure Taiyang Cold Damage do not cause Spasm. Only when Taiyang Wind Strike is compounded by Cold-Dampness does it transform into Spasm. Body heat with cold feet indicates Cold-Dampness injuring the lower body. Intermittent head heat, facial redness, and reddened eye vessels indicate Wind injuring the upper body. Head tremor occurs because Wind is active in nature. Since the head is the meeting point of all Yang meridians, Wind injures Yang. Pure Wind injury would cause whole-body trembling and limb convulsions; however, here only the head trembles due to internal Cold-Dampness. Trismus occurs because Cold causes contraction. Sudden trismus implies intermittent locking, unlike the constant locking seen in Wind-Cold struggle. The Foot-Taiyang Bladder Meridian originates at the inner canthus, crosses the forehead, meets at the vertex, enters the brain, emerges to descend the nape, runs along the shoulder blades, flanks the spine, reaches the loins, descends through the buttocks to the foot. When Wind-Cold lodges in the meridian, sinews and vessels become constrained, causing neck stiffness and opisthotonos.
Zhang Qingzi states: This section describes the manifestations of Spasm disease.
The *Huo Ren Shu* notes: The exterior signs of Spasm—fever and aversion to cold—resemble Cold Damage. The difference lies in the deep, slow, wiry, and fine pulse, and the presence of opisthotonos.
In Taiyang disease, joint pain with irritability and a deep, fine pulse is termed Shi Bi (Dampness Bi). The patient has difficult urination and loose stools. Treatment should focus on promoting urination.
The *Jin Gui Yao Lue* states: Mist injures the skin and pores; Dampness flows into joints. Pain and irritability indicate internal Dampness flow. Dampness is similar to Water; a deep and fine pulse reflects Water's tendency to flow downward. Bi means pain. Due to painful joints, it is called Dampness Bi, distinct from podagra-type Bi. The *Nei Jing* states: Excess Dampness leads to loose stools. Difficult urination and loose stools indicate internal Dampness excess. Promoting urination dissipates abdominal Dampness. Ancient texts say: Treating Dampness without promoting urination is incorrect. Some suggest Gancao Fuzi Tang (Licorice and Aconite Decoction) or Mahuang Lianqiao Xiaodou Tang (Ephedra, Forsythia, and Soybean Decoction).
Patients with chronic Dampness experience generalized body pain, fever, and a yellowish complexion resembling smoke staining.
A bright orange-yellow complexion indicates Yangming Stagnant Heat. A smoke-stained yellow indicates this is not Yangming Stagnant Heat. For yellow skin with fever, Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) is used, indicating interior-exterior heat. Generalized pain rules out pathogenic heat from Cold Damage. This is caused by Dampness in the meridians. The Spleen dislikes Dampness; when injured, the Spleen manifests color changes, leading to a smoky yellow hue rather than a true yellow.
Xu Shi comments: This is essentially a Damp-Heat pattern, though heat is not explicitly discussed, nor is a treatment given. Using Baizhu Fuzi Tang, Gancao Fuzi Tang, or Guizhi Jiagui Tang might be unsuitable for Damp-Heat. Zhang Qingzi clarifies: Damp-Heat corresponds to Zhizi Bipi Tang. The Baizhu Fuzi Tang case is different.
Chronic Dampness patients may exhibit only head sweating, back stiffness, and a desire to cover up near fire. Premature purging leads to hiccups, chest fullness, difficult urination, and a white slippery coating on the tongue. This results from Heat in the Dan Tian (Lower Jiao) and Cold in the Chest (Upper/Middle Jiao). The patient desires water but cannot drink, causing dry mouth and irritability.
This represents Cold-Dampness binding. While Dampness causes sweating and Cold prevents it, their combination allows only head sweating. The Back is Yang, the Abdomen is Yin. The Taiyang meridian runs along the spine and back. External Cold-Dampness obstructs Taiyang Qi, causing back stiffness. Internal pathogens do not cause aversion to cold; external ones do. Desire for warmth indicates external Cold-Dampness. Premature purging damages Stomach Qi and fluids, causing hiccups, chest fullness, and urinary difficulty. Post-purging Interior Deficiency causes Upper Jiao Yang Qi to sink into the Lower Jiao (Dan Tian Heat), while external Cold invades the Chest (Chest Cold), producing a white slippery tongue coating. Visceral dryness causes thirst, but Chest Cold-Dampness prevents drinking, resulting in dry mouth and irritability. Options include Xiao Xianxiong Tang, Gancao Fuzi Tang, Wuling San for difficult urination, or Lizhong Tang with Ganjiang and Baizhu. If urination is normal, Guizhi Jia Fuzi Tang, Lizhong Tang with Fuling, or Fuling Baizhu Tang may be used.
If a Dampness patient is incorrectly purged, leading to sweating on the forehead, slight wheezing, and free urination, it is a fatal sign. Similarly, unremitting diarrhea is fatal.
Dampness patients recover with sweating. The *Jin Gui Yao Lue* states: For Dampness with body pain, use Mahuang plus four liang of Baizhu to induce mild sweating. Incorrect purging is a major error. Forehead sweating and wheezing indicate rebellious Yang Qi. Free urination or diarrhea indicates sinking Yin Qi. Separation of Yin and Yang leads to death, as stated in the *Nei Jing*: "When Yin and Yang separate, essence and qi perish."
Question: Wind-Dampness binding causes generalized pain, resolved by sweating. Why does sweating fail during rainy weather? Answer: Profuse sweating expels Wind but leaves Dampness behind. To treat Wind-Dampness, induce only a slight, continuous perspiration so both Wind and Dampness are expelled.
Rainy weather indicates Dampness excess. The *Nei Jing* states: Yang receives Wind, Yin receives Dampness. Wind affects the upper body first; Dampness affects the lower body first. In Wind-Dampness binding, Wind is external, Dampness internal. Profuse sweating is violent, expelling external pathogens but trapping internal ones. Mild sweating is gentle, allowing both external and internal pathogens to exit.
Wang Yutai suggests Mahuang Baizhu Tang, Guizhi Fuzi Tang, or Guizhi Ji Baizhu Tang. Zhang Qingzi agrees that mild sweating via Mahuang Jia Baizhu Tang harmonizes the interior and exterior, expelling both pathogens. Cheng Wuji’s interpretation distinguishing Wind as exterior and Dampness as interior is incorrect.
Dampness patients with body pain, fever, yellow face, wheezing, headache, nasal congestion, irritability, and a large pulse who can eat normally have a peaceful abdomen. The pathology is Cold-Dampness in the head, causing nasal congestion. Nasal medication cures it.
This is a superficial Dampness pattern. Lack of joint pain indicates Dampness is in the muscles/skin, not joints. Yellow face and wheezing indicate Dampness affects the Upper Jiao, not the Spleen. Nasal congestion indicates Dampness in Yang meridians, not Yin. A large pulse indicates Exterior location, contrary to the deep-fine pulse of internal Dampness. Normal appetite confirms mild, superficial Dampness. Nasal administration disperses Cold-Dampness in the head. Wang Yutai suggests Genti San (Melon Tip Powder).
Rheumatism patients with generalized pain, fever, and worsening in the late afternoon have Wind-Dampness. Etiology includes sweating exposed to wind or prolonged exposure to cold. Generalized pain indicates Dampness; afternoon fever exacerbation indicates Wind. Sweating-then-wind implies Dampness first, then Wind. Prolonged cold exposure implies Wind first, then Dampness. Treat with Mahuang Xingren Yiyi Ren Gancao Tang (see *Jin Gui Yao Lue*).
Huang Shi notes: Taiyang Dampness resembles Taiyang Cold Damage but differs by the deep-fine pulse. Although Damp and Spasm pulses may seem similar, symptoms differ: Dampness causes pain, Spasm does not.
Zhao Shi notes: Headache, fever, back stiffness, and body pain resemble Cold Damage. Differences include deep-fine pulse, head sweating, yellow face, and preserved appetite. Taiyang Cold Damage has a floating-excess pulse. Deep-fine pulse, yellow face, and head sweating confirm Dampness. Preserved appetite indicates pathology is in the meridians, not the interior. Loose stools and sluggish urination result from meridian obstruction impairing transformation.
Taiyang Zhong Re (Summerheat-Heat) is also known as Ye disease. Symptoms include sweating, aversion to cold, body heat, and thirst.
Sweating, aversion to cold, body heat, but no thirst indicates Wind Strike. Sweating, aversion to cold, body heat, and thirst indicate Ye disease. Treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
Taiyang Zhong Ye (Summerheat-Ye) presents with body heat, pain, heaviness, and a weak pulse. It results from drinking cold water in summer, causing water to linger in the skin.
Classics state: Weak pulse with body heat indicates Summerheat. Body heat with weak pulse is Ye disease. Body pain and heaviness indicate Water retention. Caused by washing with cold water during summer heat. Treat with Yiwu Gudi San (Single-Melon Tip Powder). Wang Yutai suggests Yiwu Gudi San or Wuling San.
Taiyang Zhong Ye presents with fever, aversion to cold, body heaviness and pain, wiry/fine/hollow/slow pulse. After urination, chills and piloerection occur, with cold extremities. Slight exertion triggers fever. Mouth opens, and anterior teeth are dry. Sweating worsens aversion to cold. Moxibustion worsens fever. Purging worsens strangury.
This is a simultaneous Exterior-Interior disease. Fever, aversion to cold, heaviness, and pain are Exterior. Wiry/fine/hollow/slow pulse indicates Summerheat deficiency. Chills after urination and cold limbs indicate Taiyang Qi deficiency. Exertion triggering fever indicates Yang disturbance activating Summerheat. Open mouth and dry teeth indicate intense heat. The *Nei Jing* states: Summerheat causes sweating; irritation causes panting. Open mouth indicates panting. Continuous panting dries the teeth. Sweating depletes exterior Yang, worsening cold. Moxibustion adds fire, worsening heat. Purging depletes interior, drying the Bladder, worsening strangury.
Xu Shi notes: No treatment is given here. Dong Yuan uses Qingshu Yiqi Tang, revealing an ancient secret.
Wang Yutai states: Zhong Ye, Zhong Shu, and Zhong Re are names for the same disease. Winter Cold transforming into Summer Heat is a delayed onset disease ("Late Onset"), distinct from acute Summerheat. Acute Summerheat has a weak pulse; Late Onset has a strong pulse.
Zhang Shi states: Clear pathogens affect the upper; turbid pathogens affect the lower. Wind, Cold, and Dampness are Earth Qi (turbid), affecting Foot meridians. Summerheat is Heaven Qi (clear), affecting the Hand-Shaoyin Heart meridian. Symptoms resemble Cold Damage but differ in pulse. Cold Damage has aversion to cold/fever without initial thirst; Zhong Ye has immediate thirst. Cold Damage pulse is floating-excess; Zhong Ye pulse is weak, wiry, fine, hollow, or slow. Classics state: Strong pulse with cold indicates Cold Damage; weak pulse with heat indicates Summerheat.
Wang Shi states: Clinically, Cold Damage fears cold; Heat/Summerheat fears heat. Pulserly, Cold Damage has a strong pulse; Summerheat has a weak pulse. Summerheat’s weak-fine pulse resembles Dampness/Spasm, but symptoms differ: Summerheat has spontaneous sweating and thirst; Dampness has no thirst; Spasm has no body pain.