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III. Identifying Taiyang Disease as a Lung Meridian Syndrome Contradicts the General Principles of Yin-Yang Theory

The Six-Meridians differentiation is a precursor to the Eight Principles (Ba Gang) differentiation, and the Eight Principles concepts within the Six Meridians are all relative. Regarding exterior and interior: Yang governs the exterior, and Yin governs the interior. Therefore, in the *Nei Jing · Re Lun* (Treatise on Febrile Diseases), the Six Meridians designate the Three Yang meridians as governing the exterior and the Three Yin meridians as governing the interior. However, the Six Meridians in the *Re Lun* focus primarily on meridian theory, whereas the *Shang Han Lun* (Treatise on Cold Damage) follows this precedent and develops it further. Zhang Zhongjing adhered to the spirit that "the Three Yin and Three Yang meridians, the Five Zang organs and Six Fu organs can all be affected by disease," linking meridians with their associated Zang and Fu organs for syndrome differentiation and treatment. Thus, "Taiyang disease syndromes are based on pathology of the Six Fu organs, while Taiyin disease syndromes are based on pathology of the Five Zang organs" (*Shang Han Lun Shi Yi*). Consequently, the specific content of Six-Meridians differentiation was greatly enriched compared to before. Regarding meridians and organs, organs belong to the interior, and meridians govern the exterior; therefore, all Six Meridians have exterior manifestations. Among the Three Yang, Taiyang is exterior, and Yangming is interior. Regarding Taiyang specifically, Taiyang meridian disease is exterior, while Taiyang fu-organ disease is interior. Focusing solely on Taiyang meridian disease, the Mahuang Tang syndrome is exterior, while the Guizhi Tang syndrome belongs to the interior. "Furthermore, the Three Yin serve as the interior of the Three Yang, yet the Three Yang also possess their own exterior and interior" (*Shang Han Guan Zhu Ji*). It is evident that the concepts of exterior and interior in the *Shang Han Lun* are all relative. Because Zhang Zhongjing considered Yang meridians to have Taiyang as the exterior, and Taiyang meridian disease as the exterior, he emphasized the exterior over the interior in the Taiyang chapter, using "floating pulse, stiffness and pain in the head and nape, and aversion to cold" as the main syndrome and pulse outline for Taiyang meridian disease. In contrast, for the Three Yin, he used interior syndromes as the outline. "Lung governs the exterior" is stated from the perspective of the Five Zang organs, not from the perspective of the Six Meridians or the overall Zang-Fu system. Some people confuse these relative concepts, claiming that the Lung governs the exterior while the Bladder does not. This viewpoint is difficult to accept because the Lung is a Zang organ and the Bladder is a Fu organ. If discussing from the perspective of Zang and Fu, Fu organs should govern the exterior and Zang organs should govern the interior. Thus, identifying Taiyang disease as a Lung meridian syndrome risks confusing the relative nature of exterior and interior concepts, which contradicts Zhang Zhongjing's general principle that Six Fu organs (Yang) govern the exterior and Five Zang organs (Yin) govern the interior.

Regarding deficiency and excess: The path of Yang is excess, and the path of Yin is deficiency; thus, the Three Yang are excess and the Three Yin are deficiency. However, among the Three Yang, Yangming is excess, and Taiyang is deficiency. Therefore, in the Taiyang chapter, Zhang Zhongjing first presents the Guizhi Tang (Chen Xiuyuan regarded Guizhi Tang as a tonic rather than a diaphoretic) and lists many clauses prohibiting sweating, repeatedly emphasizing the warning against sweating. This sufficiently shows that because Taiyang represents "excess containing deficiency," its treatment focuses on harmonizing Ying and Wei (nutritive and defensive qi) rather than forcibly inducing sweat. Conversely, because Yangming represents "excess containing excess," the Yangming chapter uses "stomach house excess" (Wei Jia Shi) as its outline, presents Chengqi Decoctions first, and contains the most discussions on purgation methods. This indicates that for Yangming disease, Zhang Zhongjing emphasizes attacking fu-organ excess without being permissive. The situation in the Six Meridians where excess still contains distinctions of deficiency and excess, and deficiency contains distinctions of excess and deficiency, is similar to the relativity of exterior and interior meanings and completely conforms to the principle that Yin and Yang are infinitely divisible.

Regarding cold and heat: Yin belongs to cold, and Yang belongs to heat; thus, the Three Yang govern heat, and the Three Yin govern cold. However, among the Three Yang, Yangming is heat, and Taiyang is cold. Therefore, Taiyang legislation employs warming and dispersing methods, while Yangming primarily uses cold purgation. Since those with heat containing cold and heat containing heat still allow for further distinction of cold and heat, Taiyang meridian disease has a "Warm Disease" syndrome type; the Yangming chapter includes treatments with Mahuang Tang and Guizhi Tang. Comparing with the Three Yin, the cold of Taiyang is "cold within heat," so only the acrid-warm properties of Mahuang Tang and Guizhi Tang are used. The cold of Shaoyin is "cold within cold," so large-hot herbs like Aconite (Fuzi) and Ginger (Ganjiang) are used. By the same logic, those with cold containing cold (Shaoyin) still have differences between cold transformation and heat transformation; therefore, those with cold containing heat (Taiyin) should naturally still allow for further distinction of cold and heat. Unfortunately, many clauses of the *Shang Han Lun* are lost, and the few remaining in the Taiyin chapter make the syndromes of Taiyin warm diseases unknowable. However, based on Zhang Zhongjing's general principles, Taiyin disease should not be devoid of heat syndromes nor purely cold.

From the above analysis, it is proven that to avoid misunderstanding the relativity of Eight Principles concepts in the Six Meridians, one cannot identify Taiyang disease as a Lung meridian syndrome. Otherwise, Zhang Zhongjing's Six-Meridians differentiation method, which specifically applies Yin-Yang theory for syndrome differentiation, would contradict Yin-Yang theory everywhere.

IV. Zhang Zhongjing’s Treatise Follows the Precedent of *Nei Jing* Using Foot Meridians to Encompass Hand Meridians

Zhang Xichun said: "Although the *Shang Han Lun* is divided into chapters by Six Meridians, there are six meridians each for the hands and feet, making twelve meridians in reality. Since there are twelve hand and foot meridians, why does the *Shang Han Lun* only divide them into six? According to the *Nei Jing*'s discussion of the twelve meridians, whenever a meridian is mentioned without specifying whether it is a hand or foot meridian, it refers to the foot meridian. When referring to a hand meridian, it explicitly states 'such-and-such hand meridian.' This is because human foot meridians are long and hand meridians are short; foot meridians are large and hand meridians are small. The foot meridians can originally encompass the hand meridians; merely mentioning the foot meridians often implies the hand meridians within them. The division of the *Shang Han Lun* into six meridian chapters follows this precedent of the *Nei Jing*, embedding hand meridians within foot meridians. Those who interpret the *Shang Han Lun* as referring only to foot meridians have not understood the profound meaning of Zhang Zhongjing's work." (*Yi Xue Zhong Zhong Can Xi Lu*). I agree with this view because, looking at the *Nei Jing* and *Shang Han Lun*, this statement aligns with facts. The *Re Lun* discusses six meridians, seemingly only foot meridians, but explicitly states "the Three Yin and Three Yang, the Five Zang and Six Fu organs can all be affected." The *Shang Han Lun* mentions phrases like "dry stool in the stomach" and "because there is dry stool in the stomach," which illustrate that the Six Meridians include the Twelve Meridians. Furthermore, many physicians historically attributed Shaoyin to Kidney meridian deficiency-cold syndromes, while simultaneously not denying that Shaoyin heat-transformation syndromes belong to hand meridians. This clarifies the precedent of foot meridians encompassing hand meridians and the principle that Eight Principles concepts are relative. By analogy, one can assume the other five meridians follow suit. Of course, this means Yang encompasses Yang and Yin encompasses Yin, not Yang encompassing Yin or vice versa.

Based on the above analysis, it is clear that among the Six Meridians, the interior, exterior, heat, and excess aspects maintained by the organs of the Three Yin meridians should be the Lung. If one wishes to unify the Six Meridians and the Four Levels (Wei, Qi, Ying, Xue) differentiation methods, the Wei-level syndrome of Warm Diseases could be subordinated to Taiyin disease. Subordinating it to the scope of Taiyang disease feels contradictory. Now, identifying Taiyang disease as a Hand Taiyin Lung meridian syndrome introduces numerous theoretical flaws, which are too numerous to enumerate.

References
1. Shi Jiazhen, "Preliminary Exploration of the Pathology of the Six Meridians in Shang Han Lun," Chinese Journal of Traditional Chinese Medicine, 5, 1965.
2. Liu Puxi, "Discussion on the Pathogenesis of Common Syndromes of Taiyang Disease," Zhejiang Journal of Traditional Chinese Medicine, 1, 1980.

Chapter 5: Exploration of Various Deficiency Syndromes of Yangming Disease in the *Shang Han Lun*

The Jing-meridian syndrome belonging to Baihu Tang and the Fu-organ syndrome belonging to Chengqi Tang are merely two common syndrome types of Yangming disease. "'Yangming disease is characterized by stomach house excess'—this clause serves as the outline for Yangming disease." This statement is acceptable when referring to these two common syndrome types. However, if one concludes that Yangming disease consists entirely of excess syndromes with no deficiency syndromes, this greatly misses Zhang Zhongjing's core methodology. Because Yangming disease has deficiency syndromes not only in internal injury miscellaneous diseases but also in external febrile diseases. There are many clauses in the *Shang Han Lun* discussing Yangming deficiency syndromes, which can be verified one by one. Given that there are rarely specialized discussions on Yangming deficiency syndromes in the *Shang Han Lun*, I venture to explore this topic.

I. Causes of Various Deficiency Syndromes in Yangming Disease

1. Yang Deficiency with Middle Cold: Clause 197 states: "In Yangming disease, inability to eat; attacking the heat will cause hiccups. The reason is that the stomach is deficient and cold. Because the person is fundamentally deficient, attacking the heat will inevitably cause hiccups." This is caused by deficiency of Stomach Yang and direct invasion of cold pathogens, generally termed Yangming Middle Cold Syndrome. Zhang Zhongjing discussed this syndrome repeatedly in clauses 195, 196, 228, 229, etc. Because this is a deficiency-cold Yangming disease, he earnestly warned: do not mistakenly attack the heat, nor heavily induce sweat; otherwise, "loss of Yang, delirium, and short pulse indicate death" (Clause 216).

2. Stomach Heat Damaging Fluids: Clause 248 states: "Floating and hollow pulse; floating indicates Yang, hollow indicates Yin. Floating and hollow interacting, Stomach Qi generates heat, its Yang is severed." The *Shang Han Lun Lecture Notes* state that this clause describes "the pulse and syndrome of Yangming Stomach heat and fluid deficiency." At this point, the hollow pulse is already present, and the damage to Yangming Qi and fluids has become the primary contradiction. Although almost similar to Baihu Tang syndrome, the latter is mainly due to hyperactive Yang-heat and is excess; this one is due to fluid deficiency and Yang severance, and is deficiency. They are different. Compared to the following mis-treatment transformation syndrome, the latter has superficial excess of dryness accumulation, while this one has Stomach heat without Fu-organ excess. They should be distinguished, but both are deficiency. This is Yangming deficiency-heat syndrome.

3. Transformation due to Mis-treatment: Clause 186 states: "In Taiyang disease, if sweat is induced, if purged, or if urination is promoted, this leads to loss of body fluids, dryness in the stomach, and subsequent transformation into Yangming." Clause 184 states: "Shaoyang-Yangming occurs after inducing sweat and promoting urination, leading to dryness and excess in the stomach, vexation, and difficulty defecating." These two clauses describe Yangming disease transformed from Taiyang and Shaoyang diseases due to mis-treatment. The reason for transforming into Yangming is that mis-treatment consumes fluids, causing interior deficiency in Yangming, allowing pathogens to transmit inward. Thus, it is a deficiency syndrome characterized by deficiency of the Stomach Fu organ, exhaustion of internal fluids, and pathological drying. However, this deficiency syndrome often leads to excess due to deficiency, and knotting due to dryness, becoming a syndrome of root deficiency and branch excess. At this time, with Yin deficiency and fluid exhaustion, even if there is difficulty defecating, purgation must not be used; otherwise, fluids will be further depleted, the disease will not resolve, and the disaster of treating deficiency as deficiency is inevitable. This is Yangming deficiency with central excess syndrome.

4. Yang Deficiency Failure to Control: Clause 247 states: "When the Yang pulse is floating and sweating is slight, it is self-harmonization. When sweating is excessive, it is too much. When the Yang pulse is solid, inducing sweat results in excessive output, which is also too much. Too much means Yang is severed in the interior, fluids are lost, and the stool becomes hard." The pathology of leading to excess due to deficiency in this clause is the same as above. However, a faint Yang pulse with excessive sweating indicates Yang deficiency failing to control, leading to fluid damage, with a different cause. If the Yang pulse is solid and sweating is induced excessively, Yang escapes through sweat, which is also a transformation due to mis-treatment. This is also a Yangming disease with deficiency containing excess.

5. Post-illness Righteous Qi Deficiency: Clause 235 states, "In Yangming disease, spontaneous sweating, or if sweat is induced, and urination is free, this is exhaustion of internal fluids. Even if hard, it cannot be purged." Yangming disease easily depletes fluids; post-illness deficiency of righteous Qi and damage to fluids is natural. From Zhang Zhongjing establishing guiding methods while prohibiting sweating and purging, and not using clearing heat methods, this clause fits well as a Yangming deficiency syndrome of post-illness heat retreat, righteous Qi deficiency, fluid dryness, and constipation. Clinically, in the late stage of febrile diseases, "Stomach House Excess" syndromes due to pathogen retreat, righteous Qi deficiency, intestinal withering, and fluid dryness are quite common. Compared to transformation due to mis-treatment, the former often involves unresolved external pathogens, while this one is purely fluid dryness and knotting.

II. Syndromes and Treatments of Various Deficiency Syndromes in Yangming Disease

There are three deficiency types of Yangming Jing-meridian disease:

1. Qi and Fluid Dual Deficiency Syndrome: Clause 201 states: "In Yangming disease, sweating is usually abundant; conversely, no sweating, and the body feels like insects crawling under the skin, this is due to long-term deficiency." This is Yangming disease with long-term Stomach Qi deficiency and no dryness accumulation. Because the Stomach is the source of generation for Ying and Wei, Stomach deficiency leads to Ying and Wei deficiency. When both are deficient, there is a lack of source for sweat production. Thus, the current no-sweating and itching involve both fluid insufficiency and the loss of warming and transforming power due to Stomach Yang deficiency. Guizhi Jia Huangqi Tang can be used at this time. If mistakenly using Mahuang preparations, inducing heavy sweat, or heavily inducing sweat, it will lead to loss of Yang, and possibly, as discussed in Clause 216, result in death with symptoms like delirium and short pulse.

2. Yin Deficiency with Heat Syndrome: As described in Clause 248, this is a Jing-meridian syndrome of Stomach Yin deficiency with accompanying heat. If Yin fluids are deficient but Yang pathogens are still strong, presenting with hollow and large pulse, severe thirst unrelieved by drinking, sweating, aversion to cold, and body heat, then Baitu Jia Renshen Tang should be used. If deficiency signs are obvious and the pulse is scattered and large, increase the dosage of Ginseng. If the disease is in the late stage, although Yuan Qi is damaged and fluids are insufficient, residual heat is not too strong, then Zhuye Shigao Tang is suitable. If Stomach Yin deficiency is severe and residual heat has retreated, then Yiewei Tang from *Wen Bing Tiao Bian* can be used.

3. Yang Deficiency with Cold Syndrome: Clause 196 states: "In Yangming disease, if affected by cold, inability to eat, urination is unfavorable, continuous sweating on hands and feet, this desires to form Gu Jia (solid mass), definitely stool is hard initially and loose later. The reason is cold in the stomach, water and grain are not separated." This is a syndrome of Stomach Yang deficiency with accompanying cold. If vomiting after eating food is the main syndrome, then according to Clause 245: "Wuzhuyu Tang governs it." If cold pathogens are strong, with diarrhea and floating Yang syndrome, then according to Clause 228: "Sini Tang governs it."

There are also three deficiency types of Yangming Fu-organ disease:

1. Dry Knotting Syndrome with Fluid Depletion and Heat: The dry knotting syndromes transformed from Taiyang and Shaoyang mis-treatments mentioned above not only lead to excess due to deficiency and deficiency due to excess, with mutual causality, but also mostly accompany unresolved pathogenic heat. At this time, excess and deficiency symptoms appear mixed, making treatment difficult. Zhang Zhongjing discussed this in clauses 217, 219, etc., stating: "String-like pulse indicates survival, choppy pulse indicates death." After using Xiao Chengqi Tang, "if tomorrow there is still no bowel movement, and the pulse becomes faint and choppy, it is interior deficiency, difficult to treat, and Chengqi Tang should not be given again." This is correct. However, for choppy pulse and interior deficiency, deficiency must be tonified, and excess must be removed. None of the Chengqi Decoctions in the *Shang Han Lun* are suitable. It seems appropriate to refer to later Warm Disease school works and酌情 use Hugwei Chengqi, Zengye Chengqi, or Xinjia Huanglong Fang, rather than limiting oneself to finding treatments only in the *Shang Han Lun*.

2. Dry Knotting Sign with Fluid Depletion and Blood Stasis: Fluid depletion can cause dry knotting, and dry knotting can also cause stasis-heat. Or, when dry feces cannot pass in the stomach and one cannot eat to fullness, careless diet, forcing food or overeating, causes food stagnation to generate heat. Besides pulse slowing and abdominal fullness, it can cause vexation, dizziness, and jaundice, i.e., dry-stasis jaundice. At this time, Zhigao Faxian Jian should be used to moisten and guide out stasis. Referencing *Jin Gui Yao Lue*, this is easy to understand. Because this syndrome is easily mistaken for excess syndrome and purged, Clause 200 states: "Yangming disease, pulse slow, cannot eat to fullness, after eating feels vexed and dizzy, urination is difficult, this desires to form Grain Jaundice. Even if purged, abdominal fullness remains as before. The reason is the slow pulse." However, commentators mostly view this clause as Taiyin disease, with various opinions, leaving Zhang Zhongjing's profound meaning unclear. Hence, my article "Clarification of Clause 200 of Shang Han Lun" and the views in *Ran Zhu Shang Han Lun* are largely consistent with mine.

3. Dry Knotting Syndrome with Fluid Depletion and Pathogen Retreat: Constipation due to post-illness righteous Qi deficiency is also caused by intestinal withering and fluid dryness, but no longer accompanies pathogenic heat. Although there are partial symptoms of Yangming Fu-organ disease such as difficulty defecating, abdominal fullness, and inability to eat to fullness, only moistening and guiding should be used, not purging. Clause 208 states: "Yangming disease, originally spontaneous sweating, doctor heavily induces sweat again. Disease has resolved, yet still slightly vexed and unsettled, this must be due to hard stool. Due to loss of fluids, dryness in the stomach, causing hard stool. One should ask how many times urine passes per day. If originally three or four times, now twice, thus stool will exit soon. Now urine frequency is low, because fluids should return to enter the stomach, thus knowing stool will surely exit soon." This means Zhang Zhongjing believed that gradual decrease in urination during the recovery phase of Yangming disease indicates recovery of fluids, showing stomach fluids are not shunting to the bladder. Based on this, one can judge "stool will exit soon." This is Zhang Zhongjing's experience, so no treatment is needed. Of course, some cooling and moistening substances can be taken. But if "urine is free, this is exhaustion of internal fluids," because stomach fluids shunt to the bladder, self-recovery of bowel movement is difficult. At this time, Honey Suppositories, Gourd Root, or Pig Bile should be used to guide, promoting renewal and accelerating recovery.

III. Discussion on Various Deficiency Syndromes in Yangming Disease

Generally speaking, Yangming disease is mostly excess, which cannot be denied; Yangming disease has deficiency syndromes, which must not be ignored. This is the same for both Shanghan and miscellaneous diseases. Further explanation is provided below:

1. From the Yin-Yang theory principle of "Yang path is excess, Yin path is deficiency," Six-Meridian diseases designate Three Yang as excess and Three Yin as deficiency. However, the Eight Principles concepts in the Six Meridians contain the principle of relativity. Therefore, regarding the Three Yang, Taiyang is deficiency, and Yangming is excess. Because Taiyang is deficiency, Zhang Zhongjing first presented Guizhi Tang in the Taiyang chapter and listed many clauses prohibiting sweating, repeatedly reviewing the warning against sweating, explaining that Taiyang is the deficiency of the Three Yang. Thus, treatment emphasizes harmonizing Ying and Wei rather than forcibly inducing sweat. Because Yangming is excess, Zhang Zhongjing first presented Chengqi Tang in treating Yangming disease, and had the most discussions on purgation, detailing purgation methods most thoroughly, explaining that Yangming disease is the excess of the Three Yang. Thus, treatment emphasizes attacking Fu-organ knots without being permissive. Going further, Taiyang disease can also consider Jing-meridian syndrome as deficiency and Fu-organ syndrome as excess. Jing-meridian syndrome can consider Mahuang Tang syndrome as excess and Guizhi Tang syndrome as deficiency; Fu-organ syndrome can consider Wuling San syndrome as deficiency and Didang Tang syndrome as excess. Yangming disease can be viewed similarly. Therefore, I believe: regarding Yangming Jing and Fu syndromes for deficiency/excess, Jing syndrome is deficiency, Fu syndrome is excess. Regarding Jing syndrome alone, Baihu Tang syndrome is excess, Zhuye Shigao Tang syndrome is deficiency. Regarding Fu syndrome alone, all Chengqi Tang syndromes are excess, Zhigao Faxian Jian and Honey Suppository categories are deficiency.