（赵本论前有四时八节、二十四气、七十二候、决病法）
阴阳大论云∶春气温和，夏气暑热，秋气清凉，冬气冷（赵本作“冰”）冽，此则四时正气之序也。
春夏为阳，春温夏热者，（医统本有“以”字）阳之动，始于温，盛
于暑故也。秋冬为阴，秋凉而冬寒者，以阴之动，始于清，盛于寒故也。
冬时严寒，万类深藏，君子固密，则不伤于寒。触冒之者，乃名伤寒耳。
冬三月纯阴用事，阳乃伏藏，水冰地坼，寒气严凝，当是之时，善摄生者，出处固密，去寒就温，则不
伤于寒。其涉寒冷，触冒霜雪为病者，谓之伤寒也。
其伤于四时之气，皆能为病。
春风、夏暑、秋湿、冬寒，谓之四时之气。
以伤寒为毒者，以其最成杀厉之气也。
热为阳，阳主生；寒为阴，阴主杀。阴寒为病，最为肃杀毒厉之气。
中而即病者，名曰伤寒；不即病者，寒毒藏于肌肤，至春变为温病，至夏变为暑病。暑病者，热极重于温也。
《内经》曰∶先夏至日为温病，后夏至日为暑病。温暑之
病，本伤于寒而得之，故太（熊校记∶大医汪本大改太，非）医均谓之伤寒也。
是以辛苦之人，春夏多温热病，（赵本有“者”字）皆由冬时触寒所致，非时行之气也。凡时行者，
春时应暖，而复（赵本作“反”）大寒；夏时应大（赵本无“大”字）热，而反大凉；秋时应凉，而反大
热；冬时应寒，而反大温。此非其时而有其气，是以一岁之中，长幼之病多相似者，此则时行之气也。
四时气候不正为病，谓之时行之气。时气所行为病，非暴厉之气，感受必同，是以一岁之中，长幼之病多相似也。
夫欲候知四时正气为病，及时行疫气之法，皆当按斗历占之。
四时正气者，春风、夏暑、秋湿、冬寒是也。时行者，时行之气是也。温者，冬时感寒，至春发者是也。
疫者，暴厉之气是也。占前斗建，审其时候之寒温，察其邪气之轻重而治之，故下文曰∶
九月霜降节后，宜渐寒，向冬大寒，至正月雨水节后，宜解也。所以谓之雨水者，以冰雪解而为雨水故
也。至惊蛰二月节后，气渐和暖，向夏大热，至秋便凉。
冬寒、春温、夏热、秋凉，为四时之正气也。
从霜降以后，至春分以前，凡有触冒霜露，体中寒即病者，谓之伤寒也。九月十月，寒气尚微，为病则
轻；十一月十二月，寒冽已严，为病则重；正月二月，寒渐将解，为病亦轻。此以冬时不调，适有伤寒之人，即
为病也。（赵本医统本“九月十月，……即为病也”作注，非。）
此为四时正气，中而即病者也。
其冬有非节之暖者，名曰（赵本作“为”）冬温。冬温之毒，与伤寒大异，冬温复有先后，更相重沓，
亦有轻重，为治不同，证如后章。
此为时行之气，前云∶冬时应寒而反大温者是也。
从立春（医统本作“秋”）节后，其中无暴大寒，又不冰雪，而有人壮热为病者，此属春时阳气，发
于冬时伏寒，变为温病。
此为温病也。《内经》曰∶冬伤于寒，春必病温。
从春分以后，至秋分节前，天有暴寒者，皆为时行寒疫也。三月四月，或有暴寒，其时阳气尚弱，为寒所
折，病热犹轻；五月六月，阳气已盛，为寒所折，病热则重；七月八月，阳气已衰，为寒所折，病热亦微。其
病与温及暑病相似，但治有殊耳。
此为疫气也。是数者，以明前斗历之法，占其随时气候，发病寒热轻重不同耳。
十五日得一气，于四时之中，一时有六气，四六名为二十四气也。（赵本无“也”字）
节气十二，中气十二，共二十四。《内经》曰∶五日谓之候，三候谓之气，六气谓之时，四时谓之岁。
然气候亦有应至而（赵本作“仍”）不至，或有未应至而至者，或有至而太过者，皆成病气也。
疑漏或有至而不去，此一句按《金匮要略》曰∶有未至而至，有至而不至，有至而不去，有至而太过，
何故也。师曰∶冬至之后，甲子夜半，少阳起。少阴（医统本作“阳”）之时，阳始生，天
得温和，以未得甲子，天因温和，此为未至而至也；以得甲子，
而天未温和，此为至而不至也；以得甲子，（医统本有“而”字）天大寒不解，此为至而不去也；以得甲子，而
天温如盛夏五六月时，此为至而太过也。《内经》曰∶至而和则平，至而甚则病，至而反
者病，至而不至者病，未至而至者病。即是观之，脱漏明矣。
但天地动静，阴阳鼓击者，各正一气耳。
《内经》曰∶阴阳者，天地之道。清阳为天，动而不息；浊阴为地，静而不移。天地阴阳之气，鼓击
而生，春夏秋冬，寒热温凉，各正一气也。
是以彼春之暖，为夏之暑；彼秋之忿，为冬之怒。
春暖为夏暑，从生而至长也；秋忿为冬怒，从肃而至杀也。
是故冬至之后，一阳爻升，一阴爻降也。夏至之后，一阳气下，一阴气上也。
十月六爻皆阴，坤卦为用，阴极阳来，阳生于子。冬至之后，一阳爻升，一阴爻降，于卦为复，言阳气
得复也。四月六爻皆阳，乾卦为用，阳极阴来，阴生于午。夏至之后，一阳气下，
一阴气上，于卦为 ，言阴则（医统本作“得”）遇阳也。《内经》曰∶
冬至四十五日，阳气微上，阴气微下；夏至四十五日，阴气微上，阳气微下。
斯则冬夏二至，阴阳合也；春秋二分，阴阳离也。
阳生于子，阴生于午，是阴阳相接，故曰合。阳退于酉，阴退于卯，是阴阳相背，故曰离。《内经》曰∶
气至之谓至，气分之谓分。至则气同，分则气异。
阴阳交易，人变病焉。
天地阴阳之气，既交错而不正，人所以变病。《内经》曰∶阴阳相错而变由生也。
此君子春夏养阳，秋冬养阴，顺天地之刚柔也。
《内经》曰∶养生者必顺于时，春夏养阳，以凉以寒；秋冬
养阴，以温以热。所以然者，从其根故也。
小人触冒，必婴暴疹。须知毒烈之气，留在何经，而发何病，详而取之。
不能顺四时调养，触冒寒温者，必成暴病。医者当在意审详而治之。
是以春伤于风，夏必飧泄；夏伤于暑，春（赵本作“秋”）必病（医统本作“ ”）疟；秋伤于湿，
冬必咳嗽；冬伤于寒，春必病温。此必然之道，可不审明之。
当春之时，风气大行。春伤于风，风气通于肝，肝以春适王，风虽入之，不能即发，至夏肝衰，然后
始动。风淫末疾，则当发于四肢。夏以阳气外盛，风不能外发，故攻内而为飧泄。
飧泄者，下利米谷不化，而色黄。当秋之时，湿气大行。秋伤于湿，湿则干于肺，肺以秋适王，湿虽入之，
不能即发，至冬肺衰，然后湿始动也。雨淫腹疾，则当发为下利。冬以阳气内固，湿气不能下行，故上逆
而为咳嗽。当夏之时，暑气大行，夏伤于暑，夏以阴为主内，暑虽入之，势未能动，及秋阴出，而阳
为内主，然后暑动搏阴而为 疟。 者二日一发，疟者一日一发。当冬之时，寒气大行，冬伤于寒，冬以阳
为主内，寒虽入之，势未能动，及春阳出而阴为内主，然后寒动搏阳而为温病。
是感冒四时正气为病必然之道。
伤寒之病，逐日浅深，以斯方治。
《内经》曰∶未满三日者，可汗而已；其满三日者，可泄而已。
今世人伤寒，或始不早治，或治不对病，或日数久淹，困乃告医。医人又不根据次第而治之，则不中病。皆
宜临时消息制方，无不效也。今搜采仲景旧论，录其
证候诊脉声色，对病真方，有神验者，拟防世急也。
仲景之书，逮今千年而显用于世者，王叔和之力也。
又土地温凉，高下不同；物性刚柔，餐居亦异。是（赵本有“故”字）黄帝兴四方之问，岐伯举四治之
能，以训后贤，开其未悟者。临病之工，宜须两审也。
东方地气温，南方地气热，西方地气凉，北方地气寒。西北方高，东南方下。是土地温凉、高下不同
也。东方安居食鱼，西方陵居华食，南方湿处而嗜酸，北方野处而食乳。是餐居之异也。东方治宜砭石，西
方治宜毒药，南方治宜微针，北方治宜灸 。是四方医治不同也。医之治病，当审其土地所宜。
凡伤于寒，则为病热，热虽甚，不死。
《内经》曰∶风寒客于人，使人毫毛毕直，皮肤闭而为热，是伤寒为病热也。《针经》曰∶多热者易
已，多寒者难已，是热虽甚不死。
若两感于寒而病者，必死。
表里俱病者，谓之两感。
尺寸俱浮者，太阳受病也，当一二日发。以其脉上连风府，故头项痛，腰脊强。
太阳为三阳之长，其气浮于外，故尺寸俱浮，是邪气初入皮肤外在表也，当一二日发。风府穴名也，项
中央太阳之脉，从巅入络脑，还出别下项，是以上连风府。其经循肩膊内侠脊、抵腰中，故病头项痛、腰脊强。
尺寸俱长者，阳明受病也，当二三日发。以其脉侠（赵本作“夹”）鼻、络于目，故身热、目疼、鼻
干、不得卧。
阳明血气俱多，尺寸俱长者，邪并阳明，而血气淖（熊校记∶
而血气HT 溢也，汪本HT 改淖，按HT 为潮正字，汪本原误）溢也。太阳受邪不已，传于阳明，是当二三日发。其
脉侠鼻者，阳明脉起于鼻交 中，络于目。阳明之脉，正上 ，（医统本作“ ”）还出系目
系。身热者，阳明主身之肌肉。《针经》曰∶阳明气盛，则身以前皆热；目疼鼻干者，经中客邪也；不得卧
者，胃气逆不得从其道也。《内经》曰∶胃不和，则卧不安。
尺寸俱弦者，少阳受病也，当三四日发。以其脉循胁络于耳，故胸胁痛而耳聋。
《内经》曰∶阳中之少阳，通于春气。春脉弦，尺寸俱弦者，知少阳受邪也。二三日阳明之邪不已，传于
少阳，是当三四日发。胸胁痛而耳聋者，经壅而不利也。
此三经皆受病，未入于腑者，可汗而已。
三阳受邪，为病在表，法当汗解。然三阳亦有便入腑者，入腑则宜下，故云未入于腑者，可汗而已。
尺寸俱沉细者，太阴受病也，当四五日发。以其脉布胃中，络于嗌，故腹满而嗌干。
阳极则阴受之，邪传三阳既遍，次乃传于阴经。在阳为在表，在阴为在里。邪在表则见阳脉，邪在里
则见阴脉。阳邪传阴，邪气内陷，故太阴受病而脉尺寸俱沉细也。自三阳传于太阴，是当四五日发也。邪入
于阴，则渐成热，腹满而嗌干者，脾经壅而成热也。
尺寸俱沉者，少阴受病也，当五六日发。以其脉贯肾，络于肺，系舌本，故口燥舌干而渴。
少阴肾水也，性趣下。少阴受病，脉尺寸俱沉也。四五日太阴之邪不已，至五六日则传于少阴也，是
少阴病当五六日发。人伤于寒，则为病热，谓始为寒，而终成热也。少阴为病，
口燥舌干而渴，邪传入里，热气渐深也。
尺寸俱微缓者，厥阴受病也，当六七日发。以其脉循阴器、络于肝，故烦满而囊缩。
缓者，风脉也。厥阴脉微缓者，邪传厥阴，热气已剧，近于风也。当六七日发，以少阴邪传于厥阴。烦
满而囊缩者，热气聚于内也。
此三经皆受病，已入于腑，可下而已。
三阴受邪，为病在里，于法当下。然三阴亦有在经者，在经则宜汗，故云已入于腑者，可下而已。经曰∶
临病之工，宜须两审。
若两感于寒者，一日太阳受之，即与少阴俱病，则头痛、口干、烦满而渴；二日阳明受之，即与太
阴俱病，则腹满身热、不欲食、谵语；三日少阳受之，即与厥阴俱病，则耳聋，囊缩而厥，水浆不入，不知
人者，六日死。若三阴三阳、六脏六腑皆受病，则荣卫不行；腑脏（赵本作“脏腑”）不通，则死矣。
阴阳俱病、表里俱伤者，为两感。以其阴阳两感，病则两证俱见。至于传经，则亦阴阳两经俱传也。始得
一日，头痛者太阳，口干烦满而渴者少阴；至二日则太阳传于阳明，而少阴亦传于太阴，身热谵语者阳明，
腹满不欲食者太阴；至三日阳明传于少阳，而太阴又传于厥阴，耳聋者少阳，囊缩而厥者厥阴，水浆不入，
不知人者，胃气不通也。《内经》曰∶五脏已伤，六腑不通，荣卫不行，如是之后，三日乃死，何也？岐伯
曰∶阳明者十二经脉之长也，其血气盛，故云不知人。三日其气乃尽，故死矣。谓三日六经俱病，荣卫之气，
不得行于内外，腑脏之气不得通于上下，至六日腑脏之气俱尽，荣卫之气俱绝，则死矣。
其不两感于寒，更不传经，不加异气者，至七日太阳病衰，头痛少愈也；八日阳明病衰，身热少歇也；九
日少阳病衰，耳聋微闻也；十日太阴病衰，腹减如故，则思饮食；十一日少阴病衰，渴止舌干，已而嚏也；十
二日厥阴病衰，囊纵，少腹微下，大气皆去，病患精神爽慧也。
六日传遍，三阴三阳之气皆和，大邪之气皆去，病患精神爽慧也。
若过十三日以上不间，尺寸（赵本作“寸尺”）陷者，大危。
间者，瘳也。十二日传经尽，则当瘳愈。若过十三日以上不瘳，尺寸之脉沉陷者，即正气内衰，邪气独
胜，故云大危。
若更感异气，变为他病者，当依旧（赵本作“后”）坏证病（赵本作“病证”）而治之。若脉阴阳俱盛，
重感于寒者，变为（赵本作“成”）温疟。
(The Zhao edition has a discussion on the four seasons, eight solar terms, twenty-four solar terms, seventy-two pentads, and disease diagnosis methods before the main text.)
The *Treatise on Yin and Yang* states: The qi of spring is mild and warm, the qi of summer is hot and sultry, the qi of autumn is cool and clear, and the qi of winter is cold and biting (Zhao edition reads "ice"). This is the order of the correct qi of the four seasons.
Spring and summer belong to Yang. The reason for spring warmth and summer heat is that the movement of Yang begins with mildness and reaches its peak with heat. Autumn and winter belong to Yin. The reason for autumn coolness and winter cold is that the movement of Yin begins with clarity/coolness and reaches its peak with cold.
During winter, when the weather is severely cold and all things are deeply hidden, gentlemen who maintain their solidity and closeness will not be injured by cold. Those who touch or offend it are named as having *Shanghan* (Cold Damage).
In the three months of winter, pure Yin qi is in charge, and Yang qi is latent and hidden. Water freezes and the earth cracks; the cold qi is severe and condensed. At this time, those who are good at preserving life keep their movements and rest solid and close, avoiding cold and seeking warmth, so they will not be injured by cold. Those who venture into coldness and suffer from frost and snow, becoming ill, are called suffering from *Shanghan*.
Any injury to the qi of the four seasons can cause disease.
Spring wind, summer heat, autumn dampness, and winter cold are called the qi of the four seasons.
It is said that *Shanghan* is toxic because it most forms a killing and fierce qi.
Heat belongs to Yang, and Yang governs generation; Cold belongs to Yin, and Yin governs destruction. Illness caused by Yin-cold is the most肃杀 (solemnly killing) and toxic qi.
Those who are struck by it and immediately fall ill are named *Shanghan*; those who do not immediately fall ill have the cold toxin hidden in their skin and muscles. By spring, it transforms into *Wenbing* (Warm Disease); by summer, it transforms into *Shubing* (Summerheat Disease). *Shubing* involves heat that is extremely severe, heavier than *Wenbing*.
The *Neijing* (Inner Canon) says: Diseases occurring before the Summer Solstice are called *Wenbing*; those after the Summer Solstice are called *Shubing*. Both *Wenbing* and *Shubing* originate from an initial injury to cold, which is why ancient physicians uniformly call them *Shanghan*.
Therefore, hardworking people often suffer from warm and hot diseases in spring and summer. These are all caused by touching cold during winter, not by the qi of the season (*Shixing zhi qi*). Whenever there is a seasonal epidemic, it means that spring should be warm but is instead very cold; summer should be very hot but is instead very cool; autumn should be cool but is instead very hot; winter should be cold but is instead very warm. Having the qi of one season in another season causes illness among people of all ages in a year to be similar. This is the qi of the season (*Shixing zhi qi*).
Illnesses caused by abnormal climate of the four seasons are called the qi of the season. Diseases caused by the movement of seasonal qi are not as violent as epidemic qi, but the symptoms upon infection are identical, hence illnesses among people of all ages in a year are mostly similar.
To observe and know the diseases caused by the correct qi of the four seasons and the methods for seasonal epidemic qi, one must consult the Dipper Calendar (astronomical calendar).
The correct qi of the four seasons refers to spring wind, summer heat, autumn dampness, and winter cold. Seasonal epidemic refers to the qi of the season. *Wen* (Warmth) refers to contracting cold in winter and manifesting in spring. *Yi* (Epidemic) refers to violent and fierce qi. By calculating the previous Dipper construction and examining the cold and warmth of the time, and observing the severity of the pathogenic qi, treatment can be administered. Hence, the following text states:
After the Frost Descent solar term in September, the weather should gradually become cold, reaching extreme cold towards winter. After the Rain Water solar term in January, the ice and snow should melt. It is called Rain Water because ice and snow melt into rain water. After the Awakening of Insects solar term in February, the air gradually becomes warm, approaching extreme heat towards summer, and becomes cool in autumn.
Winter cold, spring warmth, summer heat, and autumn coolness are the correct qi of the four seasons.
From after Frost Descent until before Spring Equinox, anyone who touches frost and dew and falls ill with internal cold is called suffering from *Shanghan*. In September and October, the cold qi is still slight, so the illness is mild; in November and December, the cold is severe, so the illness is heavy; in January and February, the cold gradually resolves, so the illness is also mild. This is due to irregularity in winter, where someone happens to contract cold and thus falls ill. (The Zhao and Yitong editions treat "September and October... thus falls ill" as a commentary, which is incorrect.)
This refers to the correct qi of the four seasons, where illness occurs immediately upon contraction.
If there is unseasonable warmth in winter, it is named *Dongwen* (Winter Warmth). The toxicity of *Dongwen* is greatly different from *Shanghan*. *Dongwen* has sequences and overlaps, with varying degrees of severity and different treatments, as detailed in subsequent chapters.
This refers to the qi of the season, specifically the case mentioned earlier: "winter should be cold but is instead very warm."
After the Beginning of Spring solar term (Yitong edition reads "Autumn"), if there is no sudden severe cold and no ice or snow, yet someone suffers from high fever, this belongs to the Yang qi of spring stimulating the latent cold of winter, transforming into *Wenbing*.
This is *Wenbing*. The *Neijing* says: Injury to cold in winter leads to *Wenbing* in spring.
From after the Spring Equinox until before the Autumn Equinox, any sudden cold in the sky belongs to seasonal cold epidemic (*Shixing Han Yi*). In March and April, there may be sudden cold; since the Yang qi is still weak, being restrained by cold results in lighter heat symptoms; in May and June, Yang qi is abundant, being restrained by cold results in heavier heat symptoms; in July and August, Yang qi is declining, being restrained by cold results in slight heat symptoms. These illnesses are similar to *Wenbing* and *Shubing*, but the treatments differ.
This refers to epidemic qi. These cases illustrate the method of the Dipper Calendar to predict changing climates and determine the varying degrees of cold, heat, and severity of onset.
Every fifteen days yields one Qi. In the four seasons, each season has six Qis, totaling twenty-four Qis. (Zhao edition lacks "ye".)
There are twelve Jieqi (Solar Terms) and twelve Zhongqi (Major Solar Terms), totaling twenty-four. The *Neijing* says: Five days constitute one Hou (Pentad); three Hous constitute one Qi; six Qis constitute one Shi (Season); four Shis constitute one Sui (Year).
However, climatic conditions may fail to arrive when expected, or arrive early, or arrive excessively, all of which become pathogenic qi.
(Suspected omission: Or there may be arrival without departure. According to the *Jingui Yaolue*: There is what does not arrive but comes, what arrives but does not come, what arrives but does not depart, and what arrives but is excessive. Why? The Master said: After Winter Solstice, at midnight on the Jiazi day, Shaoyang qi rises. During the time of Shaoyin, Yang begins to generate, and the heaven becomes warm. Because the Jiazi day has not yet arrived, yet the heaven is already warm, this is "does not arrive but comes"; because the Jiazi day has arrived, yet the heaven is not warm, this is "arrives but does not come"; because the Jiazi day has arrived, yet the heaven remains severely cold, this is "arrives but does not depart"; because the Jiazi day has arrived, yet the heaven is as warm as midsummer, this is "arrives but is excessive." The *Neijing* says: Arrival with harmony is normal; arrival with excess is disease; arrival contrary to expectation is disease; arrival without coming is disease; non-arrival with coming is disease. From this, the omission is clear.)
It is merely that heaven and earth move and rest, and Yin and Yang strike each other, each establishing its own correct qi.
The *Neijing* says: Yin and Yang are the way of heaven and earth. Clear Yang becomes heaven, moving ceaselessly; Turbid Yin becomes earth, remaining static. The Yin and Yang qi of heaven and earth strike each other to generate spring, summer, autumn, and winter, cold, heat, warmth, and coolness, each establishing its own correct qi.
Therefore, the warmth of that spring becomes the heat of that summer; the fierceness of that autumn becomes the anger/cold of that winter.
Spring warmth turning to summer heat is from growth to flourishing; autumn fierceness turning to winter anger is from肃杀 (solemn killing) to destruction.
Thus, after Winter Solstice, one Yang line rises, and one Yin line descends. After Summer Solstice, one Yang qi descends, and one Yin qi ascends.
In the tenth month, all six lines are Yin, and the Kun hexagram is active. When Yin reaches its extreme, Yang returns, and Yang is born at Zi (Winter Solstice). After Winter Solstice, one Yang line rises, and one Yin line descends, forming the Fu hexagram, meaning Yang qi is restored. In the fourth month, all six lines are Yang, and the Qian hexagram is active. When Yang reaches its extreme, Yin returns, and Yin is born at Wu (Summer Solstice). After Summer Solstice, one Yang qi descends, and one Yin qi ascends, forming the Gou hexagram, meaning Yin meets Yang. The *Neijing* says: Forty-five days after Winter Solstice, Yang qi slightly ascends, and Yin qi slightly descends; forty-five days after Summer Solstice, Yin qi slightly ascends, and Yang qi slightly descends.
Thus, Winter and Summer Solstices represent the union of Yin and Yang; Spring and Autumn Equinoxes represent the separation of Yin and Yang.
Yang is born at Zi, Yin is born at Wu; this is the connection of Yin and Yang, hence called Union. Yang retreats at You, Yin retreats at Mao; this is the opposition of Yin and Yang, hence called Separation. The *Neijing* says: Arrival of Qi is called Zhi; division of Qi is called Fen. Zhi implies same Qi, Fen implies different Qi.
When Yin and Yang exchange and interact, humans change and fall ill.
When the Yin and Yang qi of heaven and earth intersect and become irregular, humans undergo changes and fall ill. The *Neijing* says: When Yin and Yang cross, transformation arises.
This is why gentlemen nourish Yang in spring and summer, and nourish Yin in autumn and winter, following the rigidity and softness of heaven and earth.
The *Neijing* says: Those who preserve life must follow the times. Nourish Yang in spring and summer using cool and cold methods; nourish Yin in autumn and winter using warm and hot methods. The reason is to follow the root.
Those who offend and touch [the elements] will surely suffer from sudden rashes. One must know which meridian the toxic and fierce qi stays in, and what disease it triggers, examining carefully to treat it.
Those who cannot adjust according to the four seasons and offend cold and warmth will surely develop sudden illnesses. Physicians must pay attention to examine and treat them carefully.
Therefore, injury to wind in spring leads to undigested diarrhea (*Sunxie*) in summer; injury to summerheat in summer leads to malaria in autumn (Zhao edition reads "Autumn"); injury to dampness in autumn leads to cough in winter; injury to cold in winter leads to *Wenbing* in spring. This is the inevitable way, how can one not examine it clearly?
During spring, wind qi prevails. Injury to wind in spring: Wind qi connects to the Liver. The Liver is prosperous in spring. Although wind enters, it does not immediately manifest. By summer, the Liver declines, and then it moves. Wind excess affects the extremities, so it should manifest in the four limbs. In summer, Yang qi is externally abundant, so wind cannot emit externally; thus, it attacks internally causing *Sunxie*.
*Sunxie* refers to diarrhea with undigested grain, yellow in color. During autumn, dampness qi prevails. Injury to dampness in autumn: Dampness interferes with the Lungs. The Lungs are prosperous in autumn. Although dampness enters, it does not immediately manifest. By winter, the Lung qi declines, and then dampness moves. Rain/damp excess causes abdominal disease, so it manifests as diarrhea. In winter, Yang qi is internally secured, so dampness cannot descend; thus, it rebels upward causing cough. During summer, summerheat qi prevails. Injury to summerheat in summer: Summer is primarily Yin internally. Although summerheat enters, its power cannot move. By autumn, Yin emerges, and Yang dominates internally. Then summerheat moves and combats Yin, causing malaria. Malaria occurs either every two days or every day. During winter, cold qi prevails. Injury to cold in winter: Winter is primarily Yang internally. Although cold enters, its power cannot move. By spring, Yang emerges, and Yin dominates internally. Then cold moves and combats Yang, causing *Wenbing*.
This is the inevitable way of illness caused by contracting the correct qi of the four seasons.
The disease of *Shanghan* progresses daily in depth; treat it with corresponding formulas.
The *Neijing* says: If less than three days have passed, it can be cured by sweating; if three days or more have passed, it can be cured by purging.
Nowadays, people suffering from *Shanghan* either do not treat it early enough, or treat it incorrectly, or delay until they are exhausted before consulting a physician. Physicians then fail to treat according to the sequence, failing to cure the disease. One must formulate prescriptions based on temporary circumstances, and there will be no ineffectiveness. Now, collecting Zhang Zhongjing's old theories, recording his symptoms, pulse diagnosis, voice and complexion, and true formulas against diseases that show miraculous effects, to prepare for worldly emergencies.
Zhang Zhongjing's book has been prominent and used in the world for a thousand years, thanks to Wang Shuhe.
Furthermore, land varies in warmth and cold, height and depth; material nature varies in rigidity and softness, and diet and residence also differ. Thus, the Yellow Emperor raised questions about the four directions, and Qibo presented abilities for four types of treatment, to instruct later generations and enlighten the unawakened. Practitioners facing illness must examine both aspects.
Eastern lands are warm, southern lands are hot, western lands are cool, northern lands are cold. Northwest is high, southeast is low. This is the difference in land warmth/cold and height/depth. Easterners live comfortably and eat fish; westerners live on hills and eat fine food; southerners live in wet areas and crave sour tastes; northerners live in the wild and consume milk. This is the difference in diet and residence. Treatment in the east suits bi-shi (stone needles); treatment in the west suits toxic drugs; treatment in the south suits fine needles; treatment in the north suits moxibustion. This is the difference in medical treatment across the four directions. Physicians treating disease must examine what is suitable for the land.
All injuries to cold result in heat disease. Even if the heat is severe, death does not occur.
The *Neijing* says: Wind and cold invading the person cause all hairs to stand erect, skin pores to close, resulting in heat. This is why *Shanghan* presents as heat disease. The *Zhenjing* (Needle Canon) says: Those with much heat heal easily; those with much cold heal with difficulty. Thus, even if heat is severe, death does not occur.
If one suffers from *Lianggan* (Double Contraction) from cold, death is certain.
When exterior and interior are both diseased, it is called *Lianggan*.
If the Cun and Chi pulses are both floating, the Taiyang channel is diseased, manifesting on the first or second day. Because its channel connects to the Fengfu point, headache, neck stiffness, and back/spine rigidity occur.
Taiyang is the head of the Three Yang channels; its qi floats on the exterior. Thus, Cun and Chi pulses are floating, indicating pathogenic qi has just entered the skin and exterior. Manifestation occurs on the first or second day. Fengfu is an acupoint name. The Taiyang channel in the center of the neck enters the brain from the vertex, emerges separately, and descends the neck, thus connecting to Fengfu. Its channel runs along the shoulder blades, medial to the spine, reaching the waist. Hence, disease presents as headache, neck stiffness, and back/spine rigidity.
If the Cun and Chi pulses are long, the Yangming channel is diseased, manifesting on the second or third day. Because its channel runs alongside the nose and connects to the eyes, body heat, eye pain, nasal dryness, and inability to sleep occur.
Yangming has abundant blood and qi. Long Cun and Chi pulses indicate pathogenic qi merging with Yangming, causing blood and qi to overflow. If Taiyang pathogen persists, it transmits to Yangming, manifesting on the second or third day. The channel running alongside the nose: Yangming channel starts beside the nose, crossing at the junction, and connects to the eyes. The Yangming channel goes up to the forehead, emerges, and connects to the eye system. Body heat: Yangming governs the muscles of the body. The *Zhenjing* says: When Yangming qi is abundant, the front of the body is hot. Eye pain and nasal dryness: pathogenic qi in the channel. Inability to sleep: Stomach qi rebels and cannot follow its proper path. The *Neijing* says: When the stomach is disharmonious, sleep is restless.
If the Cun and Chi pulses are wiry, the Shaoyang channel is diseased, manifesting on the third or fourth day. Because its channel follows the hypochondrium and connects to the ears, chest/hypochondriac pain and deafness occur.
The *Neijing* says: Shaoyang within Yang connects to Spring qi. Spring pulse is wiry. Wiry Cun and Chi pulses indicate Shaoyang pathogen. If Yangming pathogen persists after two or three days, it transmits to Shaoyang, manifesting on the third or fourth day. Chest/hypochondriac pain and deafness: channel obstruction and lack of flow.
For these three channels, if diseased but not yet entering the Fu organs, sweating can cure it.
Three Yang pathogen indicates disease in the exterior, requiring sweating. However, Three Yang can also directly enter the Fu organs; if entering Fu, purging is required. Hence, "not yet entering Fu" implies sweating can cure it.
If the Cun and Chi pulses are deep and fine, the Taiyin channel is diseased, manifesting on the fourth or fifth day. Because its channel spreads in the stomach and connects to the throat, abdominal fullness and throat dryness occur.
When Yang reaches its extreme, Yin takes over. After pathogen transmits through all Three Yang, it next transmits to Yin channels. Exterior corresponds to Yang; Interior corresponds to Yin. Pathogen in exterior shows Yang pulses; pathogen in interior shows Yin pulses. Yang pathogen transmitting to Yin causes internal sinking, so Taiyin disease presents with deep and fine Cun and Chi pulses. Transmission from Three Yang to Taiyin manifests on the fourth or fifth day. Pathogen entering Yin gradually generates heat. Abdominal fullness and throat dryness: Spleen channel obstruction generating heat.
If the Cun and Chi pulses are deep, the Shaoyin channel is diseased, manifesting on the fifth or sixth day. Because its channel pierces the Kidney, connects to the Lungs, and ties to the root of the tongue, dry mouth, dry tongue, and thirst occur.
Shaoyin is Kidney Water, tending downward. Shaoyin disease presents with deep Cun and Chi pulses. If Taiyin pathogen persists for four or five days, by the fifth or sixth day it transmits to Shaoyin. Thus, Shaoyin disease manifests on the fifth or sixth day. Injury to cold results in heat disease, meaning starting as cold but ending as heat. Shaoyin disease with dry mouth, dry tongue, and thirst indicates pathogen transmitted to interior, with heat growing deeper.
If the Cun and Chi pulses are slightly slow, the Jueyin channel is diseased, manifesting on the sixth or seventh day. Because its channel follows the genitalia and connects to the Liver, irritability, fullness, and testicular retraction occur.
Slow is the Wind pulse. Slightly slow Jueyin pulse indicates pathogen transmitting to Jueyin, with severe heat nearing Wind. Manifests on the sixth or seventh day, as Shaoyin pathogen transmits to Jueyin. Irritability, fullness, and testicular retraction: Heat gathering internally.
For these three channels, if diseased and already entering the Fu organs, purging can cure it.
Three Yin pathogen indicates disease in the interior, requiring purging. However, Three Yin can also remain in the channels; if in channels, sweating is appropriate. Hence, "already entering Fu" implies purging can cure it. The Classic says: Practitioners facing illness must examine both aspects.
If suffering from *Lianggan* (Double Contraction) from cold: On day one, Taiyang is diseased, simultaneously with Shaoyin, causing headache, dry mouth, irritability, fullness, and thirst. On day two, Yangming is diseased, simultaneously with Taiyin, causing abdominal fullness, body heat, aversion to food, and delirious speech. On day three, Shaoyang is diseased, simultaneously with Jueyin, causing deafness, testicular retraction, and cold limbs, inability to take fluids, and unconsciousness. Such patients die on the sixth day. If all Three Yin and Three Yang, Six Zang and Six Fu organs are diseased, Ying and Wei circulation stops; Fu and Zang communication ceases, leading to death.
Yin and Yang both diseased, exterior and interior both injured, is called *Lianggan*. Due to double contraction of Yin and Yang, both sets of symptoms appear. Regarding transmission, both Yin and Yang channels transmit. On day one, headache indicates Taiyang; dry mouth, irritability, fullness, and thirst indicate Shaoyin. By day two, Taiyang transmits to Yangming, and Shaoyin transmits to Taiyin. Body heat and delirium indicate Yangming; abdominal fullness and aversion to food indicate Taiyin. By day three, Yangming transmits to Shaoyang, and Taiyin transmits to Jueyin. Deafness indicates Shaoyang; testicular retraction and cold limbs indicate Jueyin. Inability to take fluids and unconsciousness indicate Stomach qi blockage. The *Neijing* says: When the Five Zang are damaged, Six Fu are blocked, and Ying and Wei do not circulate, death occurs three days later. Why? Qibo said: Yangming is the leader of the Twelve Channels, with abundant blood and qi, hence unconsciousness. After three days, its qi exhausts, hence death. Meaning: On day three, all six channels are diseased; Ying and Wei cannot circulate internally and externally; Fu and Zang qi cannot communicate above and below. By the sixth day, Fu and Zang qi exhaust, and Ying and Wei qi sever, leading to death.
If not *Lianggan* from cold, and no further transmission or addition of foreign qi: By day seven, Taiyang disease wanes, headache subsides slightly. By day eight, Yangming disease wanes, body heat rests slightly. By day nine, Shaoyang disease wanes, hearing improves slightly. By day ten, Taiyin disease wanes, abdominal fullness decreases to normal, appetite returns. By day eleven, Shaoyin disease wanes, thirst stops, tongue dries, followed by sneezing. By day twelve, Jueyin disease wanes, scrotum relaxes, lower abdomen sinks slightly, great qi departs, and the patient regains mental clarity.
Transmission completes in six days; Qi of Three Yin and Three Yang harmonizes, great pathogenic qi departs, and the patient regains mental clarity.
If after thirteen days the condition does not improve, and Cun and Chi pulses sink, it is critical danger.
"Jian" means recovery. After twelve days, transmission ends, and recovery should occur. If after thirteen days there is no recovery, and Cun and Chi pulses sink, it indicates internal decline of righteous qi and dominance of pathogenic qi, hence critical danger.
If contracting foreign qi again, transforming into other diseases, treat according to the previous complicated syndrome patterns. If pulses of Yin and Yang are both full, and contracting cold again, it transforms into Wenmalaria.