Library

The *Neijing* (Inner Canon) states: Heaven has four seasons and five elements, which are used for growth, flourishing, gathering, and storing, thereby generating the five climatic factors: cold, heat, dryness, dampness, and wind. These five qi originally serve to transform and generate all things; when humans contract diseases from them, it is either due to an occasional bias in heavenly qi or a lack of harmony in human qi. The *Nan Jing* (Classic of Difficult Issues) states: There are five types of Shanghan (Cold Damage), including Zhongfeng (Wind Strike), Shanghan, Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing (Warm Disease). When these five pathogens affect humans, the ancients all referred to them as Shanghan. Therefore, Zhang Zhongjing, in his treatises, also subsumed them under Shanghan, and systematically discussed the syndromes and treatments for Zhongfeng, Shanghan, Wenbing, Dampness, and Ye (Summerheat Injury), following the same lineage as the *Neijing* and *Nan Jing*. Although the methods were not fully perfected, the nomenclature was established. The *Yinfu Jing* (Scripture of the Dark Talisman) states: Heaven has five thieves [referring to the controlling relationships of the five elements]; those who perceive them prosper. Later scholars failed to perceive this, leading to increasing debates and obscuring the profound truths. Some equated Shanghan with Warmth, others equated Warmth with Shanghan; some merged Epidemic diseases into Wind-Warmth, others merged Wind-Warmth into Epidemics; some were unaware of diseases caused by latent qi, while others were unaware of externally contracted warmth; some did not even recognize the term "Shu" (Summerheat). This is truly lamentable! My grandfather first analyzed this in his casual writings. Now, I, Xiong, presuming my own ignorance, take the texts of Xuanyuan, Qibo, and Zhang Zhongjing as the warp, and the arguments of Ye Tianshi, Xue Xue, and other experts as the weft, compiling the *Wenre Jingwei* (A Classic on Warm Diseases) in five volumes. In the annotations, I select the best parts from past sages and occasionally add my own limited insights, clearly marking them with "Xiong An" (Xiong's Note) to distinguish them. This aims to enable readers to first clearly understand the names of Warmth, Summerheat, Dampness, and Heat diseases in their minds, so that when they extensively study various books, they will not be confused but will know how to select and discard. I dare not arrogantly display my opinions to cover up the achievements of past sages; rather, I offer this for discussion with those knowledgeable in medicine, hoping you will not ridicule my ignorance.

Written by Wang Shixiong of Haining at Qianzhai in the second month of spring, Renzi year, Xianfeng 2nd Year.

The *Suwen · Shengqi Tongtian Lun* says: If one is injured by cold in winter, one will inevitably suffer from Warm Disease in spring.
Zhang Zhongjing said: In winter, when severe cold prevails and all things hide deeply, if gentlemen maintain their solidity and closeness [protect their body], they will not be injured by cold.
Xiong's Note: Those who fall ill immediately after injury are suffering from Shanghan; those who do not fall ill immediately are suffering from Warmth/Heat diseases.
Zhang Xugu said: Winter cold lies latent in the Shaoyin channel, stagnates and transforms into heat, and when spring yang qi rises, it erupts outward; this is an Excess syndrome.
The *Jingui Zhenyan Lun* says: Essence is the root of the body. Therefore, those who store essence well will not suffer from Warmth in spring.
Wang Qiyuan said: When essence and qi lie latent, yang does not rise recklessly, so there is no Warmth disease in spring.
You Zhuowu said: Being injured by cold in winter is the cause of Warmth disease in spring; however, failing to store essence in winter is the source of contracting cold during winter.
Wu Jutong said: Failing to store essence does not solely refer to sexual excess; any human activity that can shake one's essence counts. Even if the weather in winter should be cold, if yang qi does not hide but instead vents out like in spring, resulting in abnormal blooming of peaches and plums, this is also such a case.
Zhang Xugu said: The classics discuss Warmth diseases as having two origins: those that lie latent internally and erupt outward, and those formed by external contraction according to the season. Among those erupting from internal latency, there are both Excess and Deficiency syndromes. The previous passage refers to an Excess syndrome, while this passage refers to a Deficiency syndrome.
The *Re Lun Pian* says: For all diseases turning into Warmth due to Shanghan, those occurring before the Summer Solstice are called Warm Disease, and those occurring after the Summer Solstice are called Summerheat Disease. Summerheat should resolve with sweating; do not stop the sweat.
Wang Qiyuan said: This defines based on the intensity of heat. When yang heat is not yet vigorous, it is called Warmth; when yang heat is extremely vigorous, it is called Summerheat.
Yang Shangshan said: Winter injury by cold results in mild cases erupting as Warmth disease before the Summer Solstice, and severe cases erupting as Summerheat disease after the Summer Solstice.
Lin Guanzi said: Since the true qi of Shaoyin is deficient, pathogenic factors must penetrate deeply, stagnate for a long time, transform into heat, and emerge from within. The *Shanghan Xuli* states: Summerheat disease is hotter than Warmth; thus, Summerheat disease is essentially a Heat disease.
Shen Yaofeng said: There are five types of Shanghan, and Rebing (Heat Disease) is just one of them; the discussions on the others have been lost.
Zhang Xugu said: Here, "all diseases becoming Shanghan" does not refer exclusively to winter cold. Generally, cold pathogens transforming into heat can occur at any time.
Xiong's Note: The *Maiyao Jingwei Lun* states: The warmth of spring is the basis for summer heat. Warmth is indeed Wen (Warmth), the gradual onset of heat. However, since it is not hot before summer arrives, the disease is still called Warmth. When it first attacks the Lung, it is an external contraction of Warmth pathogens. After the Summer Solstice, it gradually becomes hot, hence the disease is named Summerheat. Specifically, the minor heat solar term is in the sixth lunar month, and major heat is in the middle of the sixth month, corresponding to minor and major cold after the Winter Solstice. Thus, Summerheat disease is Heat disease. However, Zhang Zhongjing named external heat diseases in summer "Ye," distinguishing them from latent Qi Heat diseases. The *Shuowen* states: Ye means Summerheat injury. The *Book of Han · Annals of Emperor Wu* states: During a great summer drought, many people died of Ye. Therefore, Shu, Re, and Ye are all names for the single qi of summer. Later generations, failing to investigate, spread wild talk, discussing Taiji and prior heaven principles. While not without distinction, this has nothing to do with clinical conditions and instead confuses medical theory.
Gan's Note: This describes the normal pattern, yet there are Heat diseases in spring and Warmth diseases in summer. Warmth is the mild form of Heat; Heat is the severe form of Warmth. Hence, ancients often used them interchangeably.
The *Cire Pian* says: Patients with Liver Heat disease first experience yellow urine, abdominal pain, excessive sleeping, and fever. When heat contends [pathogen vs. healthy qi], they may speak wildly and startle easily, experience flank fullness and pain, restlessness in hands and feet, and inability to lie down peacefully. Symptoms worsen on Geng/Xin days, resolve with profuse sweating on Jia/Yi days, and death occurs on Geng/Xin days if qi rebels. Treat by needling the Foot Jueyin and Foot Shaoyang channels. If qi rebels, headache and dizziness occur due to pulse qi rushing to the head.
Wu Jutong said: In Liver disease, yellow urine appears first because the Liver channel connects to the genitalia. Also, the Liver governs free flow; Liver disease causes loss of this function, leading to yellow urine. Abdominal pain and lethargy result from Wood pathology attacking Spleen Earth. Heat contention means pathogenic heat is strong and contending with healthy qi. Wild speech and startling indicate Hand Jueyin Pericardium disease. Since both Jueyin channels share similar qi, heat contention affects the Hand Jueyin as well. Flank fullness and pain occur because the Liver channel runs along the sides of the body, and the flank is a key pathway. Restlessness and inability to sleep arise because the Liver governs Wind, and wind invades the extremities. Furthermore, Wood pathology attacks Earth; the Spleen governs the limbs. Liver heat draws upon the true yin of the Kidney (Shaoyin); yin damage causes agitation and insomnia. On Geng/Xin Metal days, Wood is controlled, so symptoms worsen. On Jia/Yi Wood days, Wood is prosperous, so sweating leads to recovery. "Qi rebellion" refers to severe illness where the course is unfavorable; thus, death occurs on days when the affected element is overcome. Needling both Jueyin and Shaoyang treats the Zang organ disease by draining its paired Fu organ. Rebellion causing headache below the head occurs because the Liver governs ascending; extreme illness causes upward movement. The logic for worsening on Geng/Xin days applies similarly to other organs.
Heart Heat disease patients first feel unhappy, developing fever after several days. When heat contends, they experience sudden heart pain, vexation, oppression, frequent vomiting, headache, red face, and anhidrosis. Symptoms worsen on Ren/Gui days, resolve with profuse sweating on Bing/Ding days, and death occurs on Ren/Gui days if qi rebels. Treat by needling the Hand Shaoyin and Hand Taiyang channels.
Wu Jutong said: In Heart disease, unhappiness arises because the Pericardium, named Danzhong, resides below the heart and acts on behalf of the monarch. The classic states Danzhong is the official of the minister, from which joy and pleasure emanate. Heart disease causes unhappiness. Sudden heart pain occurs because all excess pain involves pathogen-healthy qi contention; heat contention causes sudden heart pain. Vexation stems from the Heart governing Fire. Oppression arises from stagnant Qi in Danzhong. Vomiting relates to Liver disease; Wood and Fire share similar qi, so severe heat manifests Liver pathology. Additionally, pathogens residing above the diaphragm often cause vomiting. Headache results from Fire rising. Red face reflects the color of Fire. Anhidrosis occurs because sweat is the fluid of the Heart; heat closure and fluid depletion prevent sweating.
Zhang Xugu said: The vital yang qi of the human body roots in the Kidneys, originates in Liver Wood, generates Fire, Earth, Metal, Water, and back to Wood, cycling endlessly to ensure peace and safety. Pathogens lying latent in blood and qi move with this vital yang qi; intense movement triggers disease. However, the eruption has no fixed location depending on where the qi flows. Thus, the *Nan Jing* states that the pulse of Warmth disease travels through various channels, making it hard to identify which channel is active. As discussed by Zhang Zhongjing, eruptions may occur in Yin or Yang channels, aligning with the *Nan Jing*. The *Neijing*, listing organs in the order of generation (Liver, Heart, Spleen, Lung, Kidney), clarifies that pathogens follow the generation of qi. Within this variability, there is inherent logic, corroborating the *Nan Jing* and Zhang Zhongjing, further demonstrating the continuous lineage from Xuanyuan, Qibo, Bian Que, and Zhang Zhongjing.
Spleen Heat disease patients first experience heavy head, cheek pain, mental distress, bluish complexion, desire to vomit, and fever. When heat contends, they experience lower back pain preventing flexion and extension, abdominal fullness, diarrhea, and chin pain. Symptoms worsen on Jia/Yi days, resolve with profuse sweating on Wu/Ji days, and death occurs on Jia/Yi days if qi rebels. Treat by needling the Foot Taiyin and Foot Yangming channels.
Wu Jutong said: In Spleen disease, heaviness of the head occurs because the Spleen belongs to Dampness, and Earth nature is heavy. The classic states dampness envelops the head, hence Spleen disease causes heavy head. The cheek corresponds to the Shaoyang region. Earth and Wood have a competitive relationship; Spleen disease manifests Wood pathology. Mental distress occurs because the Spleen channel connects to the Heart. Bluish complexion and desire to vomit also indicate Wood pathology. Lower back pain preventing movement occurs because Spleen disease impairs the Stomach's ability to function independently; Yangming governs joint flexibility, so pain prevents flexion/extension. Abdominal fullness and diarrhea are primary Spleen channel diseases. Chin pain also indicates Wood pathology.
Lung Heat disease patients first experience chills, goosebumps, aversion to wind and cold, yellow tongue coating, and fever. When heat contends, they experience wheezing and coughing, pain radiating to the chest, back, and sternum, inability to take deep breaths, unbearable headache, sweating followed by chills. Symptoms worsen on Bing/Ding days, resolve with profuse sweating on Geng/Xin days, and death occurs on Bing/Ding days if qi rebels. Treat by needling the Hand Taiyin and Hand Yangming channels; bleeding until bean-sized drops appear brings immediate relief.
Wu Jutong said: In Lung disease, aversion to wind/cold occurs because the Lung governs qi and skin/hair. Lung disease causes qi stagnation, failing to protect the skin/hair. Yellow tongue coating results from Lung qi failing to transform, leading to damp-heat accumulation. Zhang Xugu added: If initially contracted from external pathogens rather than internal heat, the coating would be white. Wheezing indicates extreme qi stagnation. Coughing results from Fire overcoming Metal. The chest/back area is governed by heavenly qi. The Lung governs heavenly qi; extreme Lung qi stagnation causes pain. "Radiating" implies unpredictability. Inability to breathe deeply indicates heat closing the Lung. Unbearable headache results from stagnant heavenly qi and trapped heat rushing upward to the brain. Stagnant heat opens pores, causing sweating; temporary heat release leads to chills. Referencing Zhang's notes.
Kidney Heat disease patients first experience lower back pain and soreness, bitter thirst with frequent drinking, and fever. When heat contends, they experience neck pain and stiffness, thigh coldness and soreness, heat in the soles of the feet, reluctance to speak, and if rebellious, dizzy neck pain. Symptoms worsen on Wu/Ji days, resolve with profuse sweating on Ren/Gui days, and death occurs on Wu/Ji days if qi rebels. Treat by needling the Foot Shaoyin and Foot Taiyang channels.
Wu Jutong said: In Kidney disease, lower back pain occurs first because the waist is the mansion of the Kidneys, and the Kidney channel penetrates the spine, meeting the Du vessel at Changqiang. The thigh coldness/soreness relates to the Kidney channel entering the heel and moving up the calf, as does the Taiyang channel. Soreness results from heat consuming fluids. Bitter thirst and frequent drinking occur because the Kidneys govern the five fluids and dislike dryness; heat disease damages fluids, causing dryness and thirst. Neck pain and stiffness occur because the Taiyang channel enters the brain from the crown and descends to the neck; severe Zang disease transferring to the Fu organ causes this. Thigh coldness represents extreme heat manifesting as cold. Heat in the soles occurs because the Kidney channel starts below the little toe and moves toward Yongquan point in the sole; severe disease causes heat. Reluctance to speak reflects helplessness. Upward rebellion of pathogens causes worse neck pain and dizziness, a condition difficult to describe. Referencing Zhang's notes.
Liver Heat disease patients show redness on the left cheek first. Heart Heat disease patients show redness on the forehead first. Spleen Heat disease patients show redness on the nose first. Lung Heat disease patients show redness on the right cheek first. Kidney Heat disease patients show redness on the chin first. Even if the disease has not erupted, needling those showing redness is called "Treating Disease Before It Arises."
Zhang Xugu said: This details how Five Zang Heat pathogens manifest visibly on the face before eruption. The left cheek, forehead, nose, right cheek, and chin correspond to the Qi of Liver, Heart, Spleen, Lung, and Kidney respectively. The fact that color appears before symptoms confirms that pathogens lie latent in blood and qi, moving unnoticed with circulation. This corroborates the *Nan Jing*: "The pulse of Warmth disease travels through various channels, unknown which is active." Thus, eruption follows the generation of qi. Seeing facial color changes allows skilled physicians to identify the site of pathogen movement and needle/drain it early, reducing pathogenic force and lightening the disease. This aligns with the *Nan Jing*: "Treat according to the location of the channel," representing the superior physician's "Treating Disease Before It Arises." Medication principles can be inferred similarly.
To treat various Heat diseases, drink cold water, then apply acupuncture. One must wear cold clothing, reside in cool places, and continue until the body feels cool and heat subsides.
Zhang Xugu said: Because long-latent pathogens generate heat from within, treatment must first involve drinking cold water to drive heat from the interior, followed by needling to vent from the exterior. Then, wearing cold clothes and residing in cool places ensures heat removal.
Xiong's Note: Modern practitioners who do not read the *Neijing* treat all Warmth, Heat, Summerheat, and Epidemic diseases identically to Shanghan, prohibiting cold drinks, thickening clothing/bedding, and closing windows, leading to many deaths. I have witnessed this frequently. However, drinking cold liquids requires moderation; excess causes fluid retention, edema, vomiting, and diarrhea. Post-recovery, water may exude from fingers and toe webs. Quickly administer: Coix Seed (Yi Yi Ren) 3 liang, Poria (Fu Ling) 3 liang, Atractylodes Macrocephala (Bai Zhu) 1 liang, Plantago Seed (Che Qian Zi) 5 qian, Cinnamon Bark (Gui Xin) 1 qian, named "Qu Shi Bao Tuo Tang" (Dampness-Expelling Preservation Decoction). Taking ten doses consecutively prevents toe detachment. This is known as "Toe-Detaching Shanghan" and must be known. If cold drinks are consumed in large amounts but sweating is also profuse, there will be no sequelae.
Taiyang channel pulse, with redness shining on the zygomatic bone, indicates Heat disease. If the shine has not intersected [with internal pathogens], saying "if sweat is obtained now, wait for the appropriate time," it resolves. If competing with Jueyin pulse signs, death occurs within three days; the Heat disease connects internally to the Kidney.
Zhang Xugu said: This clarifies the syndrome of external contraction interacting with latent pathogens, differing slightly from the "Simultaneous Cold Damage" in the *Re Lun Pian*. In simultaneous cold damage, external and internal pathogens strike simultaneously, causing dual illness and inevitable death. Here, if external contraction strikes first and latent pathogens erupt later, survival is possible. If they erupt simultaneously, death occurs within three days. "Taiyang channel pulse" means the pathogen affects the Taiyang channel, causing headache, stiff neck, and back stiffness on the first day. "Redness on zygomatic bone" means bright red color appears on the cheekbones. The cheekbone is the root of bone, governed by the Kidneys. Latent heat in the Kidneys has moved, traveling through nutritive blood to manifest on the cheek. "Shine not intersected... wait for time" means the external pathogen on the Taiyang channel and the latent heat in nutritive blood have not yet combined. Obtaining sweat now resolves the external pathogen ("within three days, use sweating"). The internal latent pathogen erupts later, resolving when the Zang qi is prosperous (e.g., Kidney Heat resolving with sweating on Ren/Gui days). This also aligns with "needling when color appears, called Treating Disease Before It Arises." If competing with Jueyin signs, both Kidney and Liver have internal heat, combining with external Taiyang pathogen, making resolution impossible. Compared to simultaneous cold damage, death is faster (within three days). Simultaneous cold damage starts in channels and takes six days for Stomach qi to exhaust before death. Here, Heat disease connects to Kidneys, destroying the root, causing rapid death.
Shaoyang channel pulse, with redness shining on the front of the cheek, indicates Heat disease. If the shine has not intersected, saying "if sweat is obtained now, wait for the appropriate time," it resolves. If competing with Shaoyin pulse signs, death occurs within three days.
Zhang Xugu said: Previously, Liver Heat showed redness on the left cheek; Liver is Jueyin, Gallbladder is Shaoyang, they are exterior-interior partners. External pathogen affects Shaoyang channel, while Liver latent heat shines on the cheek. If external and internal pathogens have not intersected, sweating resolves the exterior, and internal heat resolves when Zang qi is prosperous. If competing with Shaoyin signs, Liver heat connects to Kidney heat, making external/internal pathogens combine and hard to resolve, causing death within three days. Generally, if external and internal pathogens erupt sequentially without combining, rescue is possible. The key phrase is "shine not intersected." The subsequent disease name "Yin-Yang Intersection" implies the shine has intersected. The text only cites Taiyang and Shaoyang, omitting Yangming and Taiyin combinations. I speculate that Yangming Fu organs can be treated with purgation, avoiding certain death. Unlike Taiyang, Shaoyang, and Jueyin, where pathogens combine with no exit, leading to certain death.
The *Ping Re Bing Pian* asks: Emperor: There is a Warmth patient whose fever returns immediately after sweating, with rapid and restless pulse unrelieved by sweat, accompanied by wild speech and inability to eat. What is the disease name? Qibo: It is called Yin-Yang Intersection; intersection means death.
Ye Tianshi said: Intersection means yin fluids leaking outward and yang pathogens sinking inward.
You Zhuowu said: Intersection does not mean communication, but disorder. Yin and Yang become disordered and irreparable; attacking yin makes yang resist entry, attacking yang makes yin block passage. Thus, intersection means death. Guo claimed it is simultaneous cold damage, but simultaneous cold damage is concurrent Yin-Yang illness, not Yin-Yang intersection.
Zhang Xugu said: Yin and Yang qi naturally intersect and generate each other. Now, due to rampant pathogens, external Yang-pathogen and internal Yin-pathogen merge, cutting off the root healthy qi. Hence, Yin-Yang Intersection. "Intersection means death" refers to pathological merging, not healthy interaction. Below explains the rationale using metaphors of clothing and artifacts.
Humans sweat because sweat is generated from grain, and grain is transformed from essence. Now, if sweat occurs while pathogens contend in flesh and bone, it means pathogens are retreating and essence is victorious. If essence is victorious, the patient should be able to eat and not relapse into fever. Relapsing fever indicates pathogen victory. Sweat indicates essence loss. Now, sweating followed immediately by fever indicates pathogen victory. Inability to eat means essence has no support. If the disease lingers, life is imperiled instantly. Furthermore, the *Re Lun* states: Death occurs if pulse remains rapid and vigorous after sweating. Now, the pulse does not correspond to the sweat, indicating the body cannot overcome the disease; death is clear. Wild speech indicates loss of Will (Zhi); loss of Will means death. Now seeing three death signs and no life sign, even if seeming recovered, death is certain.
Zhang Xugu said: "Sweat from grain, grain from essence" means original essence transforms grain into fluids, emitting sweat; pathogens exit with sweat, retreating as essence wins. Winning essence allows eating to transform grain; expelled pathogens mean no fever. Relapsing fever means pathogens remain. Sweating merely depletes essence, hence fever returns; essence retreats, pathogens win. Inability to eat means essence lacks support ("Bi" means reliance). Though the disease lingers, life ends quickly. Ancient theory: "Death if pulse vigorous after sweat" precisely means essence retreats and pathogens remain. If pathogens leave and essence remains, pulse calms. Now pulse and sweat mismatch, meaning essence cannot overcome pathogens; death is clear. Wild speech (loss of Will) is death sign one. Fever return after sweat (essence retreat, pathogen win) is death sign two. Pulse-sweat mismatch is death sign three. Seeing three death signs, no life sign, certain death even if seemingly recovering.
Xiong's Note: Warmth conditions mistakenly treated as Shanghan, with reckless sweating, often present this syndrome.