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*Shanghan Lun* (Treatise on Cold Damage) generally follows the intent of the Great Sage, and no other medical works can compare with it. Therefore, Huangfu Mi of the Jin Dynasty stated in the preface to *Jiayi Zhenjing* (Classical Acupuncture): Yi Yin, possessing the talent of a sage, compiled and utilized *Shennong Bencao Jing* (Divine Farmer's Materia Medica) to create decoctions; Zhang Zhongjing of the Han Dynasty discussed and expanded upon these decoctions, writing over ten volumes, which proved highly effective when used; Wang Shuhe, the Imperial Physician of recent times, meticulously compiled Zhang Zhongjing's remaining theories, which are all applicable. Thus, Zhang Zhongjing based his work on Yi Yin's methods, and Yi Yin based his on the classics of *Shennong Bencao Jing*. How could one say it does not follow the intent of the Great Sage? Zhang Zhongjing has no biography in the *Book of Han*, but appears in *Mingyi Lu* (Record of Famous Physicians): He was from Nanyang, named Ji, with Zhongjing as his courtesy name. He was recommended as a Xiaolian (Filial and Incorrupt Candidate) and rose to the office of Prefect of Changsha. Initially, he studied medicine under Zhang Bozu of his same commandery. People of the time said that his discernment and application of subtle principles surpassed his teacher. His written treatises feature refined and profound language, and simple yet detailed methods, which are beyond the reach of those with shallow knowledge and limited experience. Eight hundred years have passed since Zhang Zhongjing, and only Wang Shuhe has been able to study it. Among those in between, such as Ge Hong, Tao Hongjing, Hu Qia, Xu Zhicai, and Sun Simiao, none lacked talent; they merely became famous masters in their own right and did not further clarify and propagate this learning. During the Kaibao era, Gao Jichong, the Military Governor, once compiled and submitted records, but the text contained errors and inconsistencies and had never been critically corrected. Although kept in imperial libraries through successive dynasties, it lacked collation. This caused physicians throughout the world to be largely unaware of it. The State decreed that Confucian scholars should collate medical books, and I, Chen Qi, was subsequently selected for this task. Considering that among the urgent matters of all diseases, none is more urgent than cold damage, we have now first collated Zhang Zhongjing's *Shanghan Lun* in ten volumes, comprising twenty-two chapters, covering three hundred and ninety-seven methods outside of symptom patterns, removing duplicates, and establishing one hundred and twelve formulas. We now request its promulgation and distribution.

Gao Baoheng, Right Praise and Goodness Official of the Crown Prince; Sun Qi, External Director of the Department of State Affairs for Reclamation; Lin Yi, Middle Director of the Department of State Affairs for Seals and Collator of the Secret Pavilion, respectfully submit.

Q: What is meant by saying that pulses have Yin and Yang?
A: Pulses that are large (Da), floating (Fu), rapid (Shu), moving (Dong), or slippery (Hua) are called Yang pulses. Pulses that are deep (Chen), choppy (Se), weak (Ruo), wiry (Xian), or minute (Wei) are called Yin pulses. If a Yin disease presents with Yang pulses, the prognosis is good (life); if a Yang disease presents with Yin pulses, the prognosis is poor (death).

The *Neijing* (Inner Canon) states: The subtlety lies in the pulse, which must not be neglected. Its examination has a principle, starting with Yin and Yang. Its beginning has regularity, arising from the Five Phases (Wu Xing). Here we first discuss: The Yin and Yang of pulses exist because pulses start from Yin and Yang. There are five Yang pulses and five Yin pulses because pulses arise from the Five Phases. The path of Yang is often abundant; the five pulses—large, floating, rapid, moving, slippery—are compared to the normal pulse (Ping Mai). Being excessive, they are called Yang. The path of Yin is often deficient; the five pulses—deep, choppy, weak, wiry, minute—are compared to the normal pulse. Being insufficient, they are called Yin. In cold damage disease, if the pathogen is at the exterior (Biao), Yang pulses appear; if the pathogen is at the interior (Li), Yin pulses appear. When a Yin disease presents with Yang pulses and indicates life, it means the pathogen is moving from the interior to the exterior, desiring to resolve through sweating. For example, in Jueyin wind strike, a slight floating pulse indicates impending recovery; if not floating, it has not recovered. When a Yang disease presents with Yin pulses and indicates death, it means the pathogen has moved from the exterior to the interior, with righteous Qi deficient and pathogenic Qi victorious. For instance, delirious speech,妄语 (confabulation/hallucinations), and a deep, fine pulse indicate death. The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: Diseases where pathogens remain at the exterior can be cured; those entering the interior result in death. This is what is meant.

Q: Pulses have Yang Jie (Yang Knotting/Constriction) and Yin Jie (Yin Knotting/Constriction). How are they distinguished?
A: A pulse that is floating and rapid, with the ability to eat but constipation, is an Excess pattern, named Yang Jie. It is expected to worsen on the seventeenth day. A pulse that is deep and slow, with inability to eat, heavy body, and hard stool, is named Yin Jie. It is expected to worsen on the fourteenth day.

Jie (Knotting) refers to Qi being locally constrained, preventing the mixing of Yin and Yang Qi. Yin contains Yang, and Yang contains Yin; harmony arises from their mixture, while knotting arises from their separation. Floating and rapid are Yang pulses; ability to eat but constipation indicates interior excess. Because Yang Qi is constrained and Yin Qi cannot mix with it, this is named Yang Jie. Deep and slow are Yin pulses; inability to eat and heavy body indicate Yin disease. When a Yin disease presents with Yin pulses, diarrhea is expected; however, hard stool here occurs because Yin Qi is constrained and Yang Qi cannot mix with it, thus named Yin Jie. Regarding the days: In cold damage, Day 1 is Taiyang, Day 2 is Yangming, Day 3 is Shaoyang, Day 4 is Taiyin, Day 5 is Shaoyin, Day 6 is Jueyin. By Day 6, the transmission of meridians is complete, and recovery is expected on Day 7. If not recovered by Day 7, it is called "re-transmission" (Zai Chuan Jing). "Re-transmission" means transmitting again starting from Taiyang; by Day 12, reaching Jueyin completes the second cycle, and recovery is expected on Day 13. If not recovered by Day 13, it is called "passing the meridian" (Guo Jing), meaning passing beyond the Taiyang meridian, continuing sequentially. Yang Jie belongs to Fire; by Day 17, it transmits to Shaoyin Water. Water controls Fire; once the Fire pathogen dissipates, recovery occurs. Yin Jie belongs to Water; by Day 14, it transmits to Yangming Earth. Earth controls Water; once the Water pathogen dissipates, recovery occurs. If the pathogenic knotting is severe, and Water cannot control Fire, nor Earth control Water, then the condition will worsen. The *Neijing* states: One Hou (five-day period) late implies worsening; two Hou late implies severity; three Hou late implies danger.

Q: Symptoms include chills (Saxi Ehan) followed by fever. What is the cause?
A: When Yin pulses are deficient, Yang Qi moves to join them; when Yang pulses are deficient, Yin Qi invades them. Q: What is meant by Yang deficiency?
A: For example, if the Cun Kou (radial artery at the wrist) pulse is minute (Wei), it is named Yang deficiency. Yin Qi ascends into the Yang region, causing chills. Q: What is meant by Yin deficiency?
A: For example, if the Chi pulse is weak (Ruo), it is named Yin deficiency. Yang Qi sinks and enters the Yin region, causing fever.

One Yin and one Yang constitute the Dao (Way); biased Yin or biased Yang constitutes disease (Ji). If Yin is biasedly deficient, Yang can join it; if Yang is biasedly deficient, Yin can invade it. Yang deficiency causes Yin Qi to ascend into the Yang region, resulting in chills; this is Yin excess leading to cold. Yin deficiency causes Yang Qi to sink into the Yin region, resulting in fever; this is Yang excess leading to heat.

If Yang pulses are floating and Yin pulses are weak, there is Blood deficiency. Blood deficiency leads to tendon tension.

Yang represents Qi, and Yin represents Blood. A floating Yang pulse indicates strong Wei Qi (Defensive Qi); a weak Yin pulse indicates weak Ying Qi (Nutritive Qi). The *Nanjing* (Classic of Difficult Issues) states: Qi warms (Xu), Blood moistens (Ru). Blood deficiency fails to moisten the sinews and collaterals, hence tendon tension.

A deep pulse indicates weak Ying Qi.

The *Neijing* says: The pulse is the residence of Blood. Pulse excess indicates Blood excess; pulse deficiency indicates Blood deficiency; this is the norm. A deep pulse indicates internal deficiency of Ying Blood.

A floating pulse with sweat droplets flowing like pearls indicates declining Wei Qi.

The *Zhenjing* (Acupuncture Classic) states: Wei Qi warms the muscles, fills the skin and hair, thickens the interstices (Cou Li), and governs opening and closing. A floating pulse with sweat like pearls indicates loose interstices and dysfunctional opening/closing, indicating external decline of Wei Qi. Floating primarily observes Wei Qi, while deep primarily observes Ying Qi; using floating and deep to distinguish the decline of Ying and Wei is logical.

However, decline is more severe than weakness. Hence, we speak of "weak" for Ying and "declining" for Wei, because sweat like pearls indicates external escape of Yang Qi, making the Wei pathology more severe than the Ying pathology.

In cases of weak Ying Qi, applying burning needle therapy causes blood flow stagnation, leading to increased fever and restlessness.

Wei is Yang, Ying is Yin. Burning needles augment Yang but damage Yin. Weak Ying Qi indicates Yin deficiency. The *Neijing* states: Yin deficiency generates internal heat. While suffering from internal heat, adding burning needles to tonify Yang causes not only the combination of two heats blocking Ying Blood flow but also external fever and internal restlessness.

A pulse that is "Ai Ai" (abundant/profuse), resembling a chariot canopy, is named Yang Jie.

"Ai Ai" like a chariot canopy is large yet gentle and undulating. It indicates Yang Qi constrained externally, failing to harmonize and mix with Yin Qi.

A pulse that is "Lei Lei" (accumulated/string-like), resembling touching a long bamboo pole, is named Yin Jie.

"Lei Lei" like touching a long pole is continuous and stiff. It indicates Yin Qi constrained internally, failing to harmonize and mix with Yang Qi.

A pulse that is "Pie Pie" (light/flickering), resembling fat floating on soup, indicates weak Yang Qi.

Light and floating indicates weak Yang.

A pulse that is "Ying Ying" (lingering/thin), resembling a spider's thread, indicates declining Yang Qi.

"Ying Ying" implies sluggishness, like something difficult to pull. Resembling a spider's thread indicates extreme fineness. "Wei" (minute) indicates weak Yang; "Xi" (fine) indicates declining Yang. The *Mai Yao* (Pulse Essentials) states: "Wei" indicates Qi obstruction (Pi), which has not yet reached decline.

The *Neijing* states: "Xi" indicates little Qi; regarding extreme fineness as Yang decline is appropriate.

A pulse that is "Mian Mian" (continuous/soft), resembling lacquer pouring out and stopping, indicates loss of Blood.

"Mian Mian" is continuous and soft. Resembling lacquer pouring out and stopping means large initially, then fine. The *Zhengli Lun* states: Tian Shu opens, essence shifts, Qi changes, Yin and Yang intersect, Stomach harmonizes, and the pulse is born; this is the regeneration of the pulse. Yang Qi arrives first, Yin Qi arrives later; thus, the front part of the pulse represents Yang Qi, and the rear part represents Yin Qi. When the pulse comes, large at the front and fine at the rear, it indicates Yang Qi excess and Yin Qi deficiency, thereby indicating blood loss.

A pulse that is slow (Huan) with occasional pauses before resuming is named Jie (Knotted). A pulse that is rapid (Shu) with occasional pauses before resuming is named Cu (Surging). A pulse indicates Cu when Yang is excess and Jie when Yin is excess; these are all pathological pulses.

Four breaths per cycle is a Normal Pulse. Three breaths per cycle is Chi (Slow). Slightly faster than Chi is Huan (Relaxed). Six breaths per cycle is Shu (Rapid). Occasional stops indicate that Yin and Yang Qi cannot succeed each other. Yang movement is fast; Yin movement is slow. Observing slowness relates to Yin; if Yin Qi is excessive and Yang cannot succeed it, the pulse is slow with occasional stops. Observing speed relates to Yang; if Yang Qi is excessive and Yin cannot succeed it, the pulse is rapid with occasional stops. In cold damage, Jie Dai pulses stop beating and cannot self-recover, indicating death. These Jie and Cu pulses, however, represent only Yin-Yang imbalance with occasional stops, not total collapse. Thus, they are called pathological pulses.

Yin and Yang struggling against each other is named Dong (Moving). Yang Dong causes sweating; Yin Dong causes fever. Cold form and aversion to cold indicate injury to the San Jiao (Triple Burner).

"Dong" results from Yin-Yang struggle. When Yin and Yang struggle and become deficient, "Dong" occurs. Yang Dong indicates Yang deficiency, hence sweating; Yin Dong indicates Yin deficiency, hence fever. If there is no sweating, but fever accompanied by cold form and aversion to cold, the San Jiao is injured. The San Jiao is the special envoy of Yuan Qi (Original Qi), governing Qi movement in Yang. Injury to the San Jiao blocks Yang Qi, making it weak, leading to cold body and aversion to cold. The *Jingui Yaolue* states: Blocked Yang Qi causes cold body. The Classics state: Weak Yang causes aversion to cold.

If a rapid pulse appears at the Guan (Bar) position, without head or tail above or below, about the size of a bean, trembling vigorously, it is named Dong.

The *Mai Jing* (Pulse Classic) states: Yang exits, Yin enters, with the Guan as the boundary. The Guan is the center of Yin and Yang. If a rapid pulse appears at the Guan, without head or tail, bean-sized, and trembling, it indicates Yin and Yang Qi struggling, hence named Dong.

If Yang pulses are floating, large, and soft (Ru), and Yin pulses are floating, large, and soft, and Yin and Yang pulses are equal in magnitude, it is named Huan (Moderate/Slack).

Yang pulse refers to Cun Kou (Cun position); Yin pulse refers to Chi position. Equal above and below without bias indicates harmonious and moderate Yin and Yang Qi, unlike Chi Huan (Slow-Slack) which involves pathogens. Bias in Yin and Yang leads to Jie or Cu; struggle leads to Dong; harmony leads to Huan. Students must know this.

A pulse that is floating and tight is named Xian (Wiry). Xian resembles a bowstring, firm upon pressure. A Jin (Tight) pulse (Zhao edition reads "Yin") resembles a twisting rope, changing constantly.

The *Mai Jing* states: Xian and Jin are similar. Xian is considered deficient; thus, although tight like Xian, it remains firm upon pressure. Firmness indicates insufficiency. The Classics state: Xian implies reduction (Jian); Jin implies excess. Feeling it like a twisting rope without scattering. The *Jingui Yaolue* states: A pulse tight like a twisting rope indicates retained food.

A pulse that is Xian and Da (Large), where Xian implies Jian (Reduction/Loss), and Da implies Kou (Hollow), indicates Jian leads to Cold, and Kou leads to Deficiency. Cold and Deficiency combined is named Ge (Leather). In women, it indicates miscarriage or uterine bleeding; in men, blood loss or seminal emission.

Xian implies Jian; Jian implies Cold. Cold here refers to scanty Yang Qi. Da implies Kou; Kou implies Deficiency. Deficiency here refers to insufficient Blood. (Note: The commentary clarifies that Xian/Jian/Cold relates to Qi scarcity, while Da/Kou/Deficiency relates to Blood scarcity, not just isolated Qi or Blood lack. The original text may have errors regarding repetition of characters). "Ge" implies both Cold and Deficiency, causing Qi and Blood to reform abnormally, deviating from normal standards. Men presenting with it suffer true Yang decline and failure to secure internally, leading to blood loss or seminal emission. Women presenting with it suffer Yin Blood deficiency and failure to nourish, leading to miscarriage or uterine bleeding.

Q: Why do some patients shiver and then sweat, resolving the illness?
A: A pulse that is floating and tight, but hollow upon deep pressure (Kou), indicates underlying deficiency. Hence, shivering and sweating occur. The patient is inherently deficient, causing shivering. Because the pulse is floating, sweating will lead to resolution.

Floating is Yang, Tight is Yin, Hollow is Deficiency. Struggle between Yin and Yang causes shivering. As the pathogen exits, it struggles with Righteous Qi. Due to inherent deficiency, shivering occurs. If Righteous Qi prevails, shivering ensues, followed by fever and profuse sweating for resolution.

If the pulse is floating and rapid, but not hollow upon pressure, the patient is not inherently deficient. If self-resolution occurs, there will be sweating without shivering.

Floating and Rapid are Yang. Inherent Excess and Yang Victory prevent the pathogen from struggling with Righteous Qi, hence no shivering.

Q: Why do some patients resolve without shivering but with sweating?
A: A pulse that is large, floating, and rapid indicates resolution without shivering but with sweating.

Yang excess causes heat; Yin excess causes cold; Yin-Yang struggle causes shivering. Large, floating, and rapid pulses are all Yang. With total Yang victory, there is nothing for Yin to struggle against, hence no shivering.

Q: Why do some patients resolve without shivering and without sweating?
A: A naturally minute pulse indicates previous use of sweating, vomiting, purgatives, or blood loss, resulting in internal lack of fluids (Jin Ye). This allows Yin and Yang to self-harmonize, leading to spontaneous recovery without shivering or sweating.

A minute pulse indicates weak pathogenic Qi. With weak pathogenic Qi and weak Righteous Qi, the pulse is minute. Having undergone sweating, vomiting, purging, Yang loss, or blood loss, the interior lacks fluids, preventing sweat production. Recovery occurs through Yin-Yang harmony.

Q: On the third day of cold damage, if the pulse is floating, rapid, and minute, and the patient's body is cool and comfortable, what does this mean?
A: This indicates impending resolution, occurring at midnight. Resolution via floating pulse involves mild sweating; resolution via rapid pulse involves appetite return; resolution via minute pulse involves profuse sweating.

Day 3 of cold damage is when Yang retreats and Yin advances. If the patient is hot with a large floating-rapid pulse, the pathogen is transmitting. If the body is cool and the pulse floating-rapid-minute, the pathogen is not transmitting and is resolving. Resolution at midnight occurs because Yang is born at Zi hour (midnight). Floating pulse indicates mild sweating and external dispersion of pathogen; rapid pulse indicates appetite return and Stomach Qi harmony; minute pulse indicates profuse sweating and weak pathogen.

Q: How to distinguish whether a pulse disease will recover or not?
A: If the Cun Kou, Guan, and Chi positions show equal size, floating/deep, and slow/rapid characteristics, even if cold-heat symptoms persist, the pulse indicates Yin-Yang peace. Even if severe, recovery will occur.

Equal pulses in the three positions indicate harmonized Righteous Qi. Any residual pathogen poses no threat. At Lixia (Start of Summer), obtaining a Hong Da (Surge-Large) pulse is its proper position. If the patient suffers body pain and heaviness, sweating is required. If the next day pain/heaviness ceases, sweating is unnecessary. If spontaneous sweating occurs, resolution happens the next day. Why? Because a Surge-Large pulse at Lixia is the seasonal pulse, explaining the phenomenon. This applies to all four seasons.

A pulse responding to the season indicates internally secured Righteous Qi. Even with external pathogen invasion, mild sweating leads to resolution. The *Neijing* states: Those whose pulses follow the Four Seasons' order face no other complications.

Q: How to determine when a disease started and when it will heal?
A: For example, if illness begins at midnight, it heals at noon the next day; if it begins at noon, it heals at midnight. Why? Noon onset, midnight healing: Yang resolves by receiving Yin. Midnight onset, noon healing: Yin resolves by receiving Yang.

Noon onset involves Yang contraction; midnight onset involves Yin contraction. Yang disharmony resolves by receiving Yin (midnight healing); Yin disharmony resolves by receiving Yang (noon healing). The Classics state: Use Yang to harmonize Yin, use Yin to harmonize Yang.

Cun Kou pulse floating indicates Exterior; deep indicates Interior; rapid indicates Fu organs; slow indicates Zang organs. A slow pulse indicates Zang involvement.

The Classics state: All Yang pulses (floating/rapid) indicate Fu organ involvement; all Yin pulses (slow/choppy) indicate Zang organ involvement.

Fu Yang pulse floating and choppy, while Shao Yin pulse is normal (Ru Jing), indicates Spleen disease, typically presenting with diarrhea. How do we know? If the pulse were floating and large, it would indicate Qi excess and Blood deficiency. However, Fu Yang pulse floating and choppy indicates Spleen Qi insufficiency and Stomach Qi deficiency. Shao Yin pulse wiry and floating is considered a balanced pulse (Ru Jing). If it were slippery and rapid, pus in stool would be expected.

Fu Yang is the Stomach pulse. Floating and choppy indicates Spleen-Stomach insufficiency. Interpreting floating as Qi excess and choppy as Blood deficiency is incorrect.

The Classics state: Floating and large pulse indicates Qi excess and Blood deficiency. If the pulse were floating and large, this would apply. But Fu Yang pulse floating and choppy indicates Stomach deficiency (floating) and Spleen cold (choppy). Spleen-Stomach deficiency-cold fails to digest grain and separate water, leading to diarrhea. Shao Yin is the Kidney pulse. Kidney is the child of Lung and mother of Liver. Floating is Lung pulse, Wiry is Liver pulse. Shao Yin pulse wiry and floating indicates mutual generation of mother and child, hence "balanced." Slippery and rapid indicates lingering heat in the Lower Jiao, corrupting blood flow into pus, hence pus in stool.

Cun Kou pulse floating and tight: Floating indicates Wind, Tight indicates Cold. Wind injures Wei Qi; Cold injures Ying Qi. Both Ying and Wei are diseased, causing bone and joint pain. Sweating therapy is indicated.

The *Mai Jing* states: Wind injures Yang, Cold injures Yin. Wei is Yang, Ying is Yin; Wind is Yang, Cold is Yin; they injure according to their kind. The *I Ching* says: Water flows to dampness, fire goes to dryness. Wei affected by Wind becomes hot; Ying affected by Cold becomes painful. With both Ying and Wei diseased, bone/joint pain occurs. Ma Huang Tang should be administered to induce sweating for cure.