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This volume discusses the meridians. In treating cold damage (Shanghan), one must first understand the meridians. Without understanding the meridians, one wanders blindly without knowing where the pathogenic qi resides. Often, when the disease is in the Taiyang meridian, treatment is mistakenly directed at the Shaoyin meridian; when the syndrome belongs to the Jueyin meridian, treatment is wrongly applied to harmonize the Shaoyang meridian. The cold pathogen remains unremoved, and the true qi suffers damage. Moreover, cold damage diagnosis relies heavily on external signs; questioning the patient before pulse-taking is the most accurate method. Sun Simiao said, "Diagnosing through inquiry and distinguishing the depth of the disease is called a skillful physician." If patients report fever and aversion to cold, headache and stiffness of the head and neck, and stiffness of the lower back and spine, we know the disease is in the Taiyang meridian. If they report body heat, eye pain, nasal dryness, and inability to lie down, we know the disease is in the Yangming meridian. If they report hypochondriac pain, deafness, bitter taste in the mouth, dry tongue, alternating chills and fever, and vomiting, we know the disease is in the Shaoyang meridian. If they report abdominal fullness, dry throat, naturally warm hands and feet, or spontaneous diarrhea without thirst, or abdominal fullness with intermittent pain, we know the disease is in the Taiyin meridian. If they report desire to drink but aversion to cold, or dry mouth and tongue, we know the disease is in the Shaoyin meridian. If they report irritability, abdominal fullness, and retraction of the genitals, we know the disease is in the Jueyin meridian. Then, by taking the pulse, we distinguish whether the disease is in the exterior or interior, whether it is deficiency or excess, and decide whether to use sweating or purging methods. The ancients said that diagnosing through inquiry makes one an average practitioner, while diagnosing through pulse-taking makes one a lower-level practitioner. If one is ignorant of the branching collaterals of the meridians, arbitrarily guessing diseases by pressing the Cun and Chi positions, how could one understand those who sit in the bright hall and guard the golden orchid secrets?

Foot-Taiyang Bladder Meridian
Fengfu (DU16) Acupoint: One on each side, dividing into four channels from here.
Bladder: Weighs nine taels and two zhu, nine cun long and wide, holds nine sheng and nine he of urine.
Weizhong (BL40) Acupoint: Refers to the acupoint in the center of the popliteal crease behind the knee.
Foot-Taiyang Bladder Meridian. (The Kidney and Bladder are internally-externally related, so the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian are paired as interior-exterior.) It starts from the inner canthus of the eye, ascends to the head, connects to the Fengfu point, and divides into four channels. It descends to the nape of the neck and runs along the back via six main and branch channels. The Taiyang meridian governs the qi of all yang meridians. If struck by cold pathogen, it inevitably causes fever and aversion to cold. This is because the head, neck, waist, and spine are areas traversed by the Taiyang meridian. Now, with headache, body ache, stiff spine, and floating pulses at both Cun and Chi positions, we know the Taiyang meridian is affected. (*Ling Shu* states: The Foot-Taiyang meridian originates at the inner canthus, crosses the vertex, its branch goes from the vertex to the supraorbital ridge; its straight branch enters the brain from the vertex, emerges, descends separately to the nape, follows the shoulder blade, runs inside the paraspinal muscles to the waist, enters to connect with the intestines, and attaches to the bladder. Its branch from the waist descends alongside the spine through the buttocks into the popliteal fossa; another branch separates inside the popliteal fossa, passes through the scapula, runs inside the spine, crosses the hip joint, follows the lateral aspect of the thigh, meets in the popliteal fossa, descends through the calf muscle, exits behind the lateral malleolus, follows the Jinggu point, to the lateral side of the little toe.)

Foot-Yangming Stomach Meridian
Daying (ST5) Acupoint: Located one cun and one fen anterior to the angle of the jaw in the bony depression where the artery beats; also found below the mouth opposite the shoulders.
Chengjiang (CV24) Acupoint: Located in the depression below the lower lip.
Renying (ST9) Acupoint: Located one cun and five fen lateral to the laryngeal prominence, where the arterial pulse is palpable.
Quepen (ST12) Acupoint: Also known as Tiangai, located in the depression below the clavicle.
Stomach: Weighs two jin and fourteen liang, holds two dou of grain and one dou five sheng of water; it is the sea of water and grain.
Spleen: Connects to the spleen.
Futu (ST32) Acupoint: Located six cun above the knee on the medial side; some say seven cun above the knee.
Biguan (ST31) Acupoint: Located in the junction posterior to Futu above the knee.
Qichong (ST30) Acupoint: Located one cun above the inguinal ligament (Shuxi) under Guilai, where the artery beats; also described as on both sides of the pubic hair.
Below the knee, three cun down is the location of Zusanli (ST36); Zusanli is three cun below the knee.
Foot-Yangming Stomach Meridian. (The Spleen and Stomach are internally-externally related, so the Foot-Taiyin Spleen Meridian and Foot-Yangming Stomach Meridian are paired as interior-exterior.) It starts from the nose, flanks the nose, connects to the eyes, descends to the pharynx, and divides into four channels. Along with six main and branch channels, it runs up and down the abdomen, governing the body. Since all yang meridians are in the exterior, and Yangming governs the muscles and connects to the nose, patients present with body heat, eye pain, nasal dryness, and inability to lie down. With long pulses at both Cun and Chi positions, we know the Yangming meridian is affected.
(*Ling Shu* states: The Foot-Yangming meridian originates at the nose, crossing the bridge of the nose, adjacent to the Taiyang meridian, descending along the lateral nose, entering the upper gums, emerging to flank the mouth, encircling the lips, crossing Chengjiang, following the mandible behind the chin, exiting Daying, following Jiache, ascending anterior to the ear, passing Guest Master, following the hairline to the forehead. Its branch from Daying descends to Renying, follows the throat, enters Quepen, descends through the diaphragm, attaches to the stomach, and connects to the spleen. Its straight branch from Quepen descends along the medial breast, flanks the umbilicus, enters Qichong. Its branch starts from the stomach, descends inside the abdomen, meets Qichong, then descends to Biguan, reaches Futu, goes below the kneecap, follows the lateral tibia, descends to the dorsum of the foot, and enters between the toes of the second digit. Another branch separates three cun below the knee, enters between the toes of the second digit. Another branch separates on the dorsum of the foot, enters between the big toes, and emerges at their ends.)

Foot-Shaoyang Gallbladder Meridian
Qichong (ST30) Acupoint: On both sides of the pubic hair, where the arterial pulse is palpable.
Gallbladder: Located between the short lobes of the liver, weighs three taels and three zhu, holds three he of bile juice.
Foot-Shaoyang Gallbladder Meridian. (The Liver and Gallbladder are internally-externally related, so the Foot-Jueyin Liver Meridian and Foot-Shaoyang Gallbladder Meridian are paired as interior-exterior.) It originates at the outer canthus of the eye, connects to the ear, and divides into four channels. It descends to Quepen, follows the hypochondrium, and with six main and branch channels, manages the flow of qi in the three jiao. Thus, patients present with hypochondriac pain and deafness. (*Huang Di Zhen Jing* states: Pathogens in the liver cause pain in both hypochondria; also: Gallbladder distension causes pain under the hypochondrium, bitter taste in the mouth, and frequent sighing.) Or there may be bitter taste and dry throat, or alternating chills and fever with vomiting. With wiry pulses at both Cun and Chi positions, we know the Shaoyang meridian is affected.
(*Ling Shu* states: The Foot-Shaoyang meridian originates at the outer canthus, ascends to the corner of the head, descends behind the ear, follows the neck, runs anterior to the Hand-Shaoyang meridian, reaches the shoulder, crosses behind the Hand-Shaoyang meridian, enters Quepen. Its branch descends from behind the ear into the ear, emerges anterior to the ear, and reaches the outer canthus. Another branch separates from the outer canthus, descends to Daying, merges with the Hand-Shaoyang at the cheekbone, descends the neck, merges with Quepen, descends into the chest, pierces the diaphragm, connects to the liver, attaches to the gallbladder, follows the hypochondrium, exits Qichong, surrounds the pubic region, and enters the hip joint. Its straight branch from Quepen descends into the axilla, follows the chest, passes the costal margin, merges with the hip joint, follows the lateral thigh, exits the lateral knee, runs anterior to the fibula, descends to the end of the fibula, exits anterior to the lateral malleolus, follows the dorsum of the foot, and emerges at the tip of the fourth toe. A separate branch from the dorsum of the foot enters the big toe, follows the interosseous space, and emerges at its end.)

Foot-Taiyin Spleen Meridian
Root of the Tongue: Refers to the base of the tongue.
Gate of the Pharynx: Weighs ten liang, serves as the connection to the stomach.
Stomach: Connects to the stomach.
Spleen: Weighs two jin and three liang, shaped like a horse's hoof, white inside; the stomach cavity resembles earth. The qi of the meridians converges in the center to circulate the vital spirit qi; it is the residence of intention.
Ascends along the anterior medial aspect of the thigh.
Foot-Taiyin Spleen Meridian is the chief of the three yin meridians. Its vessels distribute to the spleen and stomach and connect to the pharynx. Thus, patients present with abdominal fullness and dry throat. With deep and fine pulses at both Cun and Chi positions, we know the Taiyin meridian is affected.
*Ling Shu* states: The Foot-Taiyin meridian originates at the tip of the great toe, follows the medial white skin margin of the toe, passes behind the metatarsophalangeal joint, ascends anterior to the medial malleolus, ascends along the medial calf bone, crosses anterior to the Jueyin meridian, ascends along the anterior medial thigh, enters the abdomen, attaches to the spleen, connects to the stomach, pierces the diaphragm, flanks the pharynx, connects to the root of the tongue, and spreads under the tongue. Its branch separates from the stomach, ascends through the diaphragm, and pours into the heart.

Foot-Shaoyin Kidney Meridian
Kidneys: Two in number, resembling red beans joined and curved, attached outside the spinal muscles, wrapped in fat, white inside and black outside, responsible for storing essence.
Foot-Shaoyin Kidney Meridian. Its vessel originates below the little toe, slants towards the sole of the foot. The divergent branch enters the heel, ascends to the posterior medial thigh, pierces the kidney, and connects to the bladder. The straight branch ascends from the kidney through the liver and diaphragm, enters the lungs, and connects to the root of the tongue. When heat pathogens enter the zang organs and flow into the Shaoyin meridian, since Shaoyin governs the kidney, and the kidney dislikes dryness, thirst and desire to drink occur. Furthermore, after sweating, vomiting, or purging, the zang-fu become empty and fluids depleted; residual heat in the kidney also causes thirst. Thus, patients present with dry mouth and tongue and thirst. With deep pulses at both Cun and Chi positions, we know the Shaoyin meridian is affected.
*Ling Shu* states: The Foot-Shaoyin meridian originates below the little toe, slants towards the sole, emerges below RanGu, follows posterior to the medial malleolus, diverges into the heel, ascends along the medial calf, emerges at the medial leg, ascends the posterior medial thigh, pierces the spine, attaches to the kidney, and connects to the bladder. Its straight branch ascends from the kidney through the liver and diaphragm, enters the lungs, follows the throat, and flanks the root of the tongue. Its branch emerges from the lungs, connects to the heart, and pours into the chest.

Foot-Jueyin Liver Meridian
Ascends along the medial calf.
Follows the lateral dorsum of the foot.
Dian: The top of the head is called Dian.
Hangsang: The fleshy parts on both sides of the uvula. *Ling Shu* states: Hangsang is the outlet for distributing qi.
Liver: Weighs four jin, four liang, and seven qian, with lobes resembling split wooden armor; each has branch vessels advancing inward to emit yang-harmonizing qi; it is the palace of Wei.
Foot-Jueyin Liver Meridian. Jue means "end." *Ling Shu* states: Hai corresponds to the left Foot-Jueyin, Xu to the right Foot-Jueyin. When both yins end, it is called Jueyin. The end of yin is darkness (Hui), and the emergence of yin is the new moon (Shuo). Jueyin signifies the end of yin. Its vessel circles the genitalia and connects to the root of the tongue. If the vessel does not nourish, tendons become tight; tight tendons pull the tongue and testicles, causing blue lips, curled tongue, and retracted genitals. Whenever patients present with irritability, abdominal fullness, and retracted scrotum, with slightly slow pulses at both Cun and Chi positions, we know the Jueyin meridian is affected.
(*Ling Shu* states: The Foot-Jueyin meridian originates at the pubic hair on the great toe, ascends along the lateral dorsum of the foot, one cun from the medial malleolus, eight cun above the ankle, crosses posterior to the Taiyin meridian, ascends the medial calf, follows the medial thigh, enters the pubic region, circles the genitalia, reaches the lower abdomen, flanks the stomach, attaches to the liver, connects to the gallbladder, pierces the diaphragm, distributes in the hypochondrium, follows the posterior throat, enters Hangsang, connects to the eye system, ascends to the forehead, and meets the Du meridian at the vertex. Its branch from the eye system descends into the cheek, circles inside the lips. Another branch separates from the liver, pierces the diaphragm, and pours into the lungs.)

(1) Inquiry: On the first or second day of cold damage, with fever, aversion to cold, headache, stiff neck and spine, and floating pulses at both Cun and Chi positions.
This is disease of the Foot-Taiyang Bladder Meridian. (Zhang Zhongjing stated: The time for Taiyang disease to resolve is from Si to Wei hours.) For Taiyang disease with headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is indicated. (Formula 1) For mild cases, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is given alone. (Formula 31) For Taiyang disease with headache, fever, no sweating, and aversion to cold, Mahuang Tang (Ephedra Decoction) is indicated. (Formula 20) For mild cases, Guizhi Mahuang Ge Ban Tang (Equal Half Dose of Cinnamon Twig and Ephedra Decoction) is given alone. (Formula 2) Both Mahuang Tang and Guizhi Tang are dispersing formulas, correctly distinguishing yin and yang; caution is essential. Zhang Zhongjing said, "Those without sweat should not take Guizhi Tang; those with sweat should not take Mahuang Tang." Always remember this to avoid errors. Nowadays, people see fever and headache and immediately induce sweating, failing to recognize that closed pores require Mahuang, while open pores require Guizhi. The treatments for cold damage and wind strike differ. The ancients said: For those with sweat, release the muscles; for those without sweat, induce sweating.

(2) Inquiry: On the second or third day of cold damage, with body heat, eye pain, nasal dryness, inability to lie down, and long pulses at both Cun and Chi positions.
This is disease of the Foot-Yangming Stomach Meridian. (Zhang Zhongjing stated: The time for Yangming disease to resolve is from Shen to Xu hours.) On the second day of cold damage, if the Yangming meridian is affected, sweating may be induced, but this is not Zheng Yangming (True Yangming). (Zheng Yangming presents with body heat, sweating, aversion to heat rather than cold, thus purging is appropriate.) Now, stating that transmission to the Yangming meridian occurs on days one or two, with body heat, eye pain, nasal dryness, and inability to lie down, and long pulses, this is Taiyang-Yangming which can be treated by releasing the exterior. If there is no sweat and aversion to cold persists, Shengma Tang (Cimicifuga Decoction) is indicated. (Miscellaneous Formula) If there is sweat and slight aversion to cold, the exterior is unresolved, and Guizhi Tang is indicated. (Formula 1) If there is no sweat, floating pulse, and wheezing, Mahuang Tang is given. (Formula 20) ○ Further inquiry: Why are there three types of Yangming among the twelve meridians? There is Taiyang-Yangming, Shaoyang-Yangming, and Zheng Yangming. Taiyang-Yangming arises when a primary Taiyang disease, due to sweating, purging, or diuresis, depletes fluids, causing dryness in the stomach, leading to transmission to Yangming. (Taiyang-Yangming involves constipation with easy urination, termed "Spleen Confinement.") Shaoyang-Yangming arises when transmission to Shaoyang is followed by sweating and diuresis, causing dryness and excess in the stomach and difficulty in defecation. Zheng Yangming arises when the patient originally has abundant wind and strong qi. All three Yangming types generally require purging, except when aversion to cold indicates cold pathogen in the meridian combined with Taiyang, which belongs to the exterior and requires sweating. Generally, Taiyang-Yangming combination presents with large and long pulses, and external signs of headache, backache, muscle heat, eye pain, and nasal dryness. Large pulses indicate Taiyang; long pulses indicate Yangming. Headache and backache indicate Taiyang; muscle heat, eye pain, and nasal dryness indicate Yangming. If aversion to cold persists, Shengma Tang induces sweating. If there is no aversion to cold but aversion to heat, and stool is not constipated, Baihu Tang (White Tiger Decoction) resolves and benefits. If there is no aversion to cold but aversion to heat, constipation, or delirium, it belongs to Stomach Excess, and Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Magnolia Bark Decoction) is used to purge. (Formula 43) ○ Further inquiry: What is the difference between He Bing (Combined Disease) and Bing Bing (Concurrent Disease) in the three yang meridians? Pulse large and long, with headache, backache, muscle heat, eye pain, and nasal dryness constitutes He Bing. When Taiyang disease is first acquired, sweating is induced, but the sweat is incomplete, leading to transmission to Yangming, followed by slight spontaneous sweating and absence of aversion to cold, this is Bing Bing. All three yang meridians have He Bing, but the three yin meridians do not; this must be known. When Taiyang symptoms cease, only tidal fever, continuous sweating on hands and feet, difficult defecation, and delirium remain, purging cures it; Dachengqi Tang (Major Order the Qi Decoction) is indicated. (Formula 41) If Taiyang symptoms persist, purging is contraindicated; instead, Guizhi Mahuang Ge Ban Tang induces slight sweating. If the face is red, yang qi is constrained in the exterior; it should be resolved using fumigation. If sweating is incomplete, yang qi is constrained and cannot disperse; failure to sweat causes restlessness, unknown pain locations, shortness of breath, and sitting posture, due to incomplete sweating. Re-administering Mahuang Tang to induce sweating cures it. How do we know sweating was incomplete? By the choppy pulse.

(3) Inquiry: On the third or fourth day of cold damage, with hypochondriac pain and deafness, or bitter taste and dry tongue, or alternating chills and fever with vomiting, and wiry pulses at both Cun and Chi positions.
This is disease of the Foot-Shaoyang Gallbladder Meridian. (Zhang Zhongjing stated: The time for Shaoyang disease to resolve is from Yin to Chen hours.) If Taiyang disease does not resolve and transfers to Shaoyang, with hardness and fullness under the hypochondrium, dry retching, inability to eat, and alternating chills and fever, emesis and purging are not yet appropriate. If the pulse is wiry and tight, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula. (Formula 29) Wiry-thin pulse, headache, and fever belong to Shaoyang. When Shaoyang is affected, with bitter taste, dry throat, and vertigo, Xiaochaihu Tang releases the exterior; sweating is contraindicated. (Among Zhang Zhongjing's Shaoyang formulas, only Xiaochaihu Tang releases the exterior.) Inducing sweating causes delirium; delirium belongs to the stomach. If the stomach harmonizes, recovery occurs; if not, irritability and restlessness ensue, and Tiaowei Chengqi Tang is indicated. This belongs to Shaoyang-Yangming.

(4) Inquiry: On the fourth or fifth day of cold damage, with abdominal fullness, dry throat, naturally warm hands and feet, or spontaneous diarrhea without thirst, or abdominal fullness with intermittent pain, and deep, fine pulses at both Cun and Chi positions.
This is disease of the Foot-Taiyin Spleen Meridian. (Zhang Zhongjing stated: The time for Taiyin disease to resolve is from Hai to Chou hours.) In cold damage, hands and feet are usually slightly cold; if naturally warm, it relates to Taiyin. Spontaneous diarrhea without thirst belongs to Taiyin. Abdominal fullness with intermittent pain belongs to Taiyin. Spontaneous diarrhea without thirst indicates cold in the zang organs; warming is required. Sini Tang (Frigid Extremities Decoction) and Lizhong Tang (Regulate the Middle Decoction) are indicated. (Formulas 75 and 74) If abdominal fullness is accompanied by a floating pulse, Guizhi Tang induces slight sweating. (Formula 1) For abdominal pain, Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony) is indicated. (Formula 12) For severe pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb) is indicated. (Formula 13) ○ The ancients asked why Taiyin disease on the fourth day, located in the chest and diaphragm, could be cured by emesis. The answer is: Not so. For Taiyin syndrome with large pulse, chest fullness, and much phlegm, emesis is appropriate. For large pulse without emesis indications, sweating suffices. Generally, exterior conditions are treated by sweating, interior by purging, upper by inducing vomiting, and lower by draining. Genti (Thistle Fruit) and Zhichi (Gardenia and Fermented Soybean Decoction) are used according to the syndrome, not restricted by days.

(5) Inquiry: On the fifth or sixth day of cold damage, with deep pulses at both Cun and Chi positions, or dry mouth and tongue with thirst, or neutral taste in the mouth with aversion to cold.
This is disease of the Foot-Shaoyin Kidney Meridian. (Zhang Zhongjing stated: The time for Shaoyin disease to resolve is from Zi to Yin hours.) For Shaoyin disease with dry mouth and tongue, urgent purging is required; Dachengqi Tang is indicated. (Formula 41) If there is no thirst, no dry mouth and tongue, but a deep pulse, urgent warming is required; Sini Tang is indicated. (Formula 75) Taiyin and Jueyin do not present with aversion to cold; only Shaoyin does. This must be known. For Shaoyin disease acquired within one or two days, with neutral taste in the mouth and aversion to cold on the back, moxibustion and Fuzi Tang (Aconite Decoction) are indicated. Generally, Yangming cold damage requires purging, while Shaoyin requires warming. However, Zhang Zhongjing stated that for Shaoyin disease with dry mouth and throat, urgent purging is needed. This is because Shaoyin governs the kidney and connects to the root of the tongue; when heat pathogens enter the zang and flow into the Shaoyin meridian, kidney fluids dry up, and the throat scorches, causing dry mouth, throat, and thirst. Urgent purging is necessary, unlike Yangming where purging can be delayed. Although, Yangming also has a condition: fever with profuse sweating requires urgent purging. Yangming belongs to the stomach; profuse sweating dries stomach fluids, requiring urgent purging.

(6) Inquiry: On the sixth or seventh day of cold damage, with irritability, abdominal fullness, and retracted genitals, with slightly slow pulses at both Cun and Chi positions.
This is disease of the Foot-Jueyin Liver Meridian. (Zhang Zhongjing stated: The time for Jueyin disease to resolve is from Chou to Mao hours.) For Jueyin disease, a slightly floating pulse indicates impending recovery; non-floating indicates no recovery. Xiaojianzhong Tang (Minor Construct the Middle Decoction) is indicated. (Formula 37)
If the pulse is floating and slow, the genitals will not retract; external signs include fever and aversion to cold resembling malaria, indicating impending recovery. Guizhi Mahuang Ge Ban Tang is indicated. (Formula 2) If both Cun and Chi pulses are deep and short, the retracted genitals indicate toxin entering the zang organs; Chengqi Tang is used to purge. (Formula 42) ○ Generally, in cold damage, the zang-fu transmit sequentially; yang meridians are affected first, then transmitted to yin meridians. Since yang governs life, Taiyang Water transmits to Foot-Yangming Earth, and Earth transmits to Foot-Shaoyang Wood, representing minor pathogens. Yin governs killing; thus Wood transmits to Foot-Taiyin Earth, Earth to Foot-Shaoyin Water, and Water to Foot-Jueyin Wood. By the sixth or seventh day, transmission reaches Jueyin Liver Wood, whose qi necessarily overacts on Spleen Earth. If the spleen receives this thief pathogen again, the five zang and six fu become exhausted and critical, Ying and Wei circulation stops, deafness and genital retraction occur, loss of consciousness leads to death. Rapid purging with Chengqi Tang can save one in five deaths. The ancients said: Heat disease in the spleen endangers the five zang; also: Earth failure and Wood attack lead to death. If transmission to Jueyin occurs on the sixth or seventh day, and the pulse becomes slightly slow and floating, indicating Spleen-Stomach pulse, we know the spleen qi is intact and no longer subjected to overacting. The pathogen has no place to reside; extreme stagnation turns to prosperity, Ying and Wei will recover, water rises and fire descends, chills and fever arise, and recovery comes with profuse sweating.