Library

(1) The *Yin-Yang Da Lun* (Great Treatise on Yin and Yang) states: "The Qi of spring is mild, the Qi of summer is hot and sultry, the Qi of autumn is cool and clear, and the Qi of winter is icy cold. This is the order of the correct Qi of the four seasons." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "Spring and summer belong to Yang; the warmth of spring and heat of summer occur because the movement of Yang begins with mildness and reaches its peak in heat. Autumn and winter belong to Yin; the coolness of autumn and cold of winter occur because the movement of Yin begins with coolness and reaches its peak in cold."

(2) "In winter, when severe cold prevails, all things are deeply hidden. If a gentleman (one who knows how to preserve health) keeps his exterior secure, he will not be injured by cold. Those who are exposed to it are said to have contracted Cold Damage (Shanghan)." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "During the three months of winter, pure Yin governs, and Yang is hidden and stored. Water freezes and the earth cracks; the cold Qi is severe and condensed. At this time, those who are good at preserving their health keep themselves secure whether at home or abroad, avoiding cold and seeking warmth, so they are not injured by cold. Those who venture into the cold, exposing themselves to frost and snow and falling ill, are called suffering from Cold Damage (Shanghan)."

(3) "Being affected by the Qi of the four seasons can all cause disease." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "Spring wind, summer heat, autumn dampness, and winter cold are called the Qi of the four seasons."
Lu Jiuzhi stated: "Zhang Zhongjing's original text first emphasizes the four characters 'Qi of the four seasons.' Thus, it is obvious that the *Treatise on Cold Damage* does not only discuss winter Cold Damage but also discusses warm, hot, damp, and dry diseases of spring, summer, and autumn. Why must one say that Zhang Zhongjing only knew of cold? Zhang Zhongjing originally knew of warm and hot diseases. To claim that Zhang Zhongjing only discussed cold, and then to argue that Wang Shuhe mixed warm diseases into the text, claiming Zhang Zhongjing's treatise was confused by Wang Shuhe, truly reveals what kind of mind he has. Others are not worth mentioning, but Huang Kunzai, who claims to be unparalleled since ancient times, is even more laughable."

(4) "Considering Cold Damage as toxic is because it forms the most lethal and destructive Qi." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "Heat belongs to Yang, and Yang governs generation; cold belongs to Yin, and Yin governs destruction. Illness caused by Yin-cold is the most severe toxic and destructive Qi."
Wang Puzhuang stated: "Cold is originally correct Qi, yet it possesses lethal toxicity. It not only causes illness in winter but also in spring and summer, so treatment cannot be delayed."
Liu Zhongmai stated: "The word 'toxic' means harmful. *Bo Ya* says toxic means evil. *Rites of Zhou · Heavenly Officials* records: 'Physicians manage medical decrees, gathering toxic substances for medical use.' The *Treatise* says considering Cold Damage as toxic, merely implying its harmful nature. Furthermore, in the *I Ching · Shi Hexagram*, it says 'using this toxin to govern the world, and the people follow,' and in *Laozi*, 'ting zhi, du zhi' (governing/nourishing), the meaning of 'du' in *I Ching* should be interpreted as governing, while in *Laozi* it means 'nurturing.' Later scholars who considered the word 'toxic' in this treatise as a linguistic error truly had limited insight."

(5) "Those who are struck by cold and immediately fall ill are named Cold Damage (Shanghan)." (*Shanghan Li*, Preface to Shanghan)
Wang Puzhuang stated: "This refers to the patterns treated by Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction)."

(6) "Those who do not immediately fall ill harbor the cold toxin in the skin and muscles. By spring, it transforms into Warm Disease (Wenbing); by summer, it transforms into Summerheat Disease (Shubing). Summerheat disease is hotter and more severe than Warm Disease." (*Shanghan Li*, Preface to Shanghan)
Wang Puzhuang stated: "Pang Anchang said: 'During severe cold, those who run, carry heavy loads, or labor are hardworking people. When Yang Qi is closed and stored, disturbing them causes Yang to stagnate and erupt in the interstices, forcing fluids to soak out. Bound by cold, the interstices become tight. The cold toxin mixes with Ying and Wei, and the disease forms. For those who do not fall ill immediately, the cold toxin hides in the skin and muscles. When Yang Qi arises in spring and summer, it fights with the toxin. Transforming due to spring warmth is called Warm Disease (Wenbing); transforming due to summer heat is called Heat Disease (Rebing); transforming due to summer damp-heat is called Damp-Warmth (Shiwen). Since the root of the disease comes from contracting cold in winter, it is collectively called Cold Damage (Shanghan).'
Lu Jiuzhi stated: "Pang's explanation suffices to prove the evidence of the five types of Cold Damage mentioned in *Nan Jing*."

(7) "Therefore, hardworking people often suffer from warm and hot diseases in spring and summer, all caused by contracting cold in winter, not by the epidemic Qi of the season." (*Shanghan Li*, Preface to Shanghan)
Lu Jiuzhi stated: "This states that Warm Disease and Heat Disease are not epidemics, but are all caused by contracting cold, hence all are named Cold Damage (Shanghan). Reading these two sentences, Zhang Zhongjing clearly informs people that warm diseases are included in the *Treatise on Cold Damage*. Later generations, not knowing this was Zhang Zhongjing's words, suspected Wang Shuhe wrote them himself, acting as if Zhang Zhongjing had never said them, thus deleting them. Then refuting them. If they had seen *Waitai Miyao*... [Note: *Waitai Miyao* lists eight sources for Shanghan discussions, including *Yin-Yang Da Lun*, Wang Shuhe, Hua Tuo, etc. The words of *Yin-Yang Da Lun* are the text of *Shanghan Li*. Also, *Zhoubing Yuanhou Lun* and *Qianjin Fang* cite *Shanghan Li* text as 'Jingyan' (Scriptural words), meaning *Shanghan Li* in Sui and Tang dynasties was originally Zhang Zhongjing's text] ...they would have laughed silently at themselves.
Wang Bingheng stated: "Cold Damage (Shanghan) is the general name for external contractions; the *Treatise on Cold Damage* is a book comprehensively discussing external contractions."
Wang Yongjia stated: "*Nan Jing* says Cold Damage includes five types, so ancients called all five external contractions Cold Damage. The *Treatise on Cold Damage* contains methods for treating wind, warmth, dampness, etc. Thus, it is not solely about one type of Cold Damage."
Wang Mengying stated: "Wu Jutong claimed that since Song and Yuan dynasties, people did not understand that Zhang Zhongjing's book was specifically designed for Cold Damage. Mr. Wu simply hadn't read the *Treatise on Cold Damage*. Dozens of commentators on *Shanghan* considered it a book solely on Cold Damage, hence always feeling it was fragmented and forced. Examining the discussion of wind, cold, warmth, dryness, and dampness causing disease, ancients all called it Cold Damage, hence *Nan Jing* says 'Cold Damage has five,' and Zhang Zhongsheng named his book *Shanghan*. With such main outlines unclear, how could one casually write a book?"
Yang Zhaoli stated: "Dozens of commentators on *Shanghan* considered it a book solely on Cold Damage, hence often fragmented and impractical. Only *Chongqing Tang Suibi* pointed out it is a book comprehensively discussing external contractions, making the whole picture of the *Treatise on Cold Damage* appear, which aligns with Yaofeng's view."

(8) "Whenever there is an epidemic movement, spring should be warm but is unexpectedly very cold; summer should be hot but is unexpectedly very cool; autumn should be cool but is unexpectedly very hot; winter should be cold but is unexpectedly very warm. This is having the Qi of another season at the wrong time. Therefore, throughout the year, the illnesses of young and old are mostly similar. This is the Qi of seasonal epidemic movement." (*Shanghan Li*, Preface to Shanghan)
Zhang Luyu stated: "Cold Damage is contracting the肃杀 (severe/drying) Qi of heaven and time; attacking cold with cold first injures Kidney Water. Seasonal epidemic movement is contracting the stagnant steaming Qi of wet earth; attacking dampness with dampness first injairs Spleen Earth. Yangming Stomach is the source of Ying and Wei. Initially, both Ying and Wei are diseased, meridians are indistinguishable, Sanjiao is mixed, interior and exterior are blocked, so the disease erupts suddenly, unlike Cold Damage which transmits step-by-step through meridians. The earth is the total return of filth and turbidity, accepting everything normally. When extreme abnormal weather occurs, the accumulated filth necessarily erupts swiftly. Or winter is too warm, the drying command fails, leading to extreme cold in spring; or midsummer humid heat and filth steam together, suddenly extreme heat generates wind, pores close, toxins cannot vent, causing disease. Old and young are equally affected; this is the seasonal epidemic Qi."
Wang Puzhuang stated: "When the four seasons lose their correct Qi, disease inevitably occurs immediately, and young and old are mostly similar, hence called 'seasonal movement' (Shixing)."
Lu Jiuzhi stated: "This refers to epidemics, not just warm or hot diseases. Regarding the opening statement 'should be warm but is extremely cold,' there is cold epidemic within it. Did Zhang Zhongjing not know about epidemics?"

(9) "If there is unseasonable warmth in winter, it is named Winter Warmth (Dongwen). The toxin of Winter Warmth is greatly different from Cold Damage." (*Shanghan Li*, Preface to Shanghan)
Zhang Luyu stated: "Winter Warmth occurs when the season demands severe cold but is instead very warm. East winds arrive, skin and interstices become open. Suddenly severe cold arrives, but clothes are thin. Cold traps the pathogen, and the disease erupts immediately; this is Winter Warmth. Because it contracts non-seasonal warm Qi, it is said to be greatly different from Cold Damage. If it does not erupt immediately, hiding in the skin, it enters and damages blood vessels, erupting as Warm Disease in spring; hiding in meridians, it enters and damages bone marrow, erupting as Heat Disease in summer."

(10) "After the Beginning of Spring solar term, if there is no sudden severe cold, nor ice or snow, yet someone suffers from high fever, this belongs to Spring Yang Qi erupting from latent winter cold, transforming into Warm Disease." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "This is Warm Disease. *Neijing* says: 'If injured by cold in winter, one will surely get Warm Disease in spring.'"

(11) "Therefore, injuring oneself to wind in spring leads to undigested stool diarrhea in summer; injuring oneself to summerheat in summer leads to malaria in autumn; injuring oneself to dampness in autumn leads to cough in winter; injuring oneself to cold in winter leads to Warm Disease in spring. This is the inevitable way, can it not be carefully examined?" (*Shanghan Li*, Preface to Shanghan)
Wang Puzhuang stated: "This cites *Suwen* to clarify that the correct Qi of the four seasons can linger and cause disease, with the intent specifically focusing on spring warmth. Wind is the rising Qi of spring. Undigested stool diarrhea (Sunxie) is loose stool. Malaria (Nuè) is intermittent fever occurring every two days; Qibo attributed it to open pores and interstices allowing autumn Qi to invade internally, connecting horizontally to the membrane source, causing periodic accumulation and eruption. Dampness is early autumn cool air with occasional light rain. Wind, summerheat, dampness, and cold were originally correct Qi, so some did not fall ill immediately. Summer diarrhea represents descent after peak ascent; autumn malaria represents accumulation after peak dispersion; winter cough represents ascent after peak descent; spring warm disease represents dispersion after peak accumulation. Hence, it is called the inevitable way."

(12) "If pulse Yin and Yang are both full, and one is re-injured by cold, it transforms into Warm Malaria (Wen Nue)." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "Pulse Yin and Yang both full is the pulse of Cold Damage. *Nan Jing* says: 'The pulse of Cold Damage is full and tense/choppy at both Yin and Yang positions.' The classic says: 'Full pulse with cold body, contracted from Cold Damage.' This is the previous illness. Before the heat subsides, being re-injured by cold, cold and heat struggle, transforming into Warm Malaria."
Wang Sanyang stated: "Yin and Yang both full is the Cold Damage pulse. After thirteen days, cold has transmitted to the interior, transforming into Heat Disease, pulse should be deep and rapid. Seeing the Cold Damage pulse again implies re-injury by external cold. Cold and heat struggle, hence called transforming into Warm Malaria."

(13) "If Yang pulse is floating and slippery, and Yin pulse is soggy and weak, and one is further encountered by wind, it transforms into Wind-Warmth (Fengwen)." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "This is previous heat not yet resolved, encountering wind. *Nan Jing* says: 'The pulse of Wind Strike is floating and slippery at Yang, soggy and weak at Yin.' Wind riding on heat causes transformation into Wind-Warmth."

(14) "If Yang pulse is surging and rapid, and Yin pulse is solid and large, and one is further encountered by warm heat, it transforms into Warm Toxicity (Wendu). Warm Toxicity is the most severe among diseases." (*Shanghan Li*, Preface to Shanghan)
Cheng Wuji stated: "This is previous heat not yet resolved, encountering warm heat. Yang governs exterior, Yin governs interior. Surging, rapid, solid, and large are all heat. Two heats combine to transform into Warm Toxicity. Because interior and exterior are both hot, it is the most severe disease."
Wang Puzhuang stated: "This Warm Toxicity is the same as Yang Toxicity and Yin Toxicity in *Jingui Yaolue*. Surging and rapid indicate Qi heat; solid and large indicate Blood heat. Warm heat Qi carrying toxicity enters Yangming, transforming into Warm Toxicity; all rashes and macules belong to this category. If the toxin sinks and lies hidden, it is untreatable, hence called the most severe disease."

(15) "If Yang pulse is soggy and weak, and Yin pulse is string-taut and tight, and one is further encountered by warm Qi, it transforms into Warm Epidemic (Wenyi)." (*Shanghan Li*, Preface to Shanghan)
Wang Puzhuang stated: "Warm Epidemic is Damp-Warmth. (Note: Damp-Warmth here refers to Damp-Warmth Epidemic, not the Damp-Warmth among the five types of Cold Damage in *Nan Jing*). The Qi of seasonal movement is not outside cold, heat, dryness, and dampness. Cold transforms into Warm Malaria, heat into Warm Toxicity, dryness into Wind-Warmth, dampness into Warm Epidemic. Thus *Zong Bing Lun* lists four types of warm diseases, directly equating Warm Epidemic with Damp-Warmth. Soggy and weak indicate heavenly dampness affecting the upper, hence seen in Yang pulse; string-taut and tight indicate earthly dampness affecting the lower, hence seen in Yin pulse. Warm Qi is excessive heat earlier than season in spring/summer, steaming earthly dampness. Contracted after Cold Damage, it accumulates into symptoms of body heat, profuse sweating, and unresolved condition. This Qi is easily contagious, causing similar illnesses in young and old, hence named Epidemic. Named Warm Epidemic to distinguish from Cold Epidemic. Cold Epidemic must include cold-damp; Warm Epidemic must include damp-heat. This is the general outline."

(16) "Taiyang disease, with fever, thirst, and no aversion to cold, is Warm Disease." (*Bian Taiyang Bing Mai Zheng Bing Zhi*)
Cheng Wuji stated: "Fever, thirst, and no aversion to cold indicate Yangming. This is Taiyang receiving pathogen, known as Warm Disease, not Cold Damage. Accumulated warmth becomes heat, hence fever, thirst, and no aversion to cold."
Pang Anchang stated: "Warmth and heat have degrees of severity. Thus Zhang Zhongjing said: 'Encountering warm Qi leads to Warm Disease; encountering warm heat leads to Warm Toxicity.' Heat is heavier than warmth. If only injured by cold in winter, erupting in spring without other pathogens, it is named Warm Disease (slightly lighter); if Warm Disease is ongoing and encounters warm Qi again, transforming into Warm Disease (heavier); *Shanghan Li* names re-encountering warm Qi as Warm Epidemic. Also, those not injured by winter cold but getting Warm Disease in spring, specifically contracting spring warm Qi, can be named Spring Warmth (Chunwen), similar to winter cold, autumn damp, or summer heat. Thus, spring warm disease has three types: 1. Winter cold erupting in spring as Warm Disease; 2. Ongoing Warm Disease encountering warm Qi again or mixing with re-contracted warm Qi; 3. Not injured by winter cold nor re-encountering warm Qi, but contracting spring warm Qi directly. All three can be named Warm Disease; no need for separate names, just know the different origins."
Zhang Yunqi stated: "Cold Damage not cured by sweating/purging, passing the meridian stage, with symptoms persisting, is also Warm Disease. Classic says: 'Pulse of Warm Disease travels through various meridians; unknown which moves, treat according to location.' E.g., Taiyang disease after sweating/purging, pulse floating at cun/guan/chchi is Taiyang Warm Disease; body heat/eye pain, pulse long is Yangming Warm Disease; chest/hypochondriac pain, pulse string-taut is Shaoyang Warm Disease; abdominal fullness/throat dryness, pulse deep/fine is Taiyin Warm Disease; mouth dry/thirst, pulse deep is Shaoyin Warm Disease; irritability/fullness/genital retraction, pulse faint/slow is Jueyin Warm Disease. Treat according to meridian and symptom. E.g., rash emergence is Warm Toxicity."
Ke Yunbo stated: "Warm Disease has heat inside and out, distinguishing it from Wind Strike and Cold Damage's aversion to cold and fever. This clause does not expound *Neijing*'s 'winter cold, spring warmth' principle, but generally describes Taiyang Warm Disease symptoms. Interpreting it only as Spring Warmth loses Zhang Zhongjing's intent. Taiyang meridian can be diseased in all four seasons, not just winter; human Warm Disease need not stem from Cold Damage; warm disease can occur in all seasons, not just spring. Extending this, all six meridians have Warm Disease, not just Taiyang."

(17) "If after sweating, the body is burning hot, it is named Wind-Warmth. In Wind-Warmth disease, pulse Yin and Yang are both floating, spontaneous sweating, body heaviness, excessive sleepiness, snoring breath, difficulty speaking. If purged incorrectly: urine difficult, staring gaze, incontinence. If fire therapy applied: slight yellowing, severe like convulsions/epilepsy with twitching. If smoke-fired: one reversal delays death, two reversals hastens death." (*Bian Taiyang Bing Mai Zheng Bing Zhi*)
Huang Baochen stated: "Fever/aversion to cold is Taiyang pattern; fever/thirst/no aversion to cold is Yangming pattern. Now Taiyang disease shows Yangming symptoms immediately without cold turning to heat, indicating Taiyang Warm Disease, not Cold Damage. *Neijing*: 'Those who do not store essence in winter get Warm Disease in spring'; 'Injured by cold in winter, get Warm Disease in spring.' Originally internal Yin deficient, external Yang constrained, latent pathogen ferments, transforms to heat early. In spring, meeting external pathogen, heat responds internally, causing fever/thirst/no aversion to cold. Should use cold/cool herbs with Taiyang exterior drugs for slight sweat. Using acrid-warm drugs for heavy sweating makes internal heat flourish. Thus, after sweating, body burns hot, light disease becomes heavy, forming Wind-Warmth. Wind-Warmth pulse floating indicates Taiyang Wind Strike aspect; body heaviness/excessive sleepiness indicates Shaoyin danger from combined heat. Kidney heat congesting Lung causes snoring; Kidney heat harassing Heart causes speech difficulty. Severe heat damages fluid. Incorrect purging exhausts water source, urine difficult, Shaoyin Qi failing, unable to nourish Taiyang pulse (staring gaze), unable to control Bladder Qi (incontinence). Fire therapy adds fire to fire: slight yellowing from heat steaming earth; severe convulsions/twitching from heat attacking heart/wind generation. Yellow darkening with black center resembles smoke-fire. Purging is one reversal; fire is second. One reversal delays; two reversals hastens death. Physicians must be cautious!"
Wang Mengying stated: "Winter/Spring Warmth attacking Hand-Taiyin Lung is called Wind-Warmth (inhaled); this latent pathogen erupting from incorrect sweating is also called Wind-Warmth (internal virtual wind). Wind-Warmth in Lung should only be cleared/resolved. Incorrectly using acrid-hot drugs for sweating causes spontaneous sweating, sleepiness, snoring, speech difficulty. See my case of Lady Liang in *Wangshi Yi'an Xupian*."
Lu Jiuzhi stated: "The 'incorrect purging' of that time referred to Croton seed pills (Badou Xiaowan), thus damaging Yin further, as Croton seed is also a warm-hot drug."

(18) "Taiyang Zhongre (Summerheat Stroke) is also called Re (Heatstroke). The person sweats, is averse to cold, has body heat and thirst." (*Jingui Yaolue* treats with Baihu Jia Renshen Tang) (*Bian Taiyang Bing Mai Zheng Bing Zhi*)
Zhou Yuzai stated: "Winter cold injuring people is named Zhonghan (Mid-Cold); summer heat injuring people is named Zhongre (Mid-Heat). This is external heat, hence 'Zhong', different from latent cold erupting as Heat Disease. Both use Baihu Tang because injury is in Qi, governed by Metal, disease is Heat. Metal disease affects mother/son (Kidney/Lung), similar to latent Qi in Shaoyin erupting via Yangming. Both use the same decoction. Not distinguished by winter latent vs. summer direct injury, nor by thirst difference. Formula uses Ginseng Baihu Tang because..."