Library

Shanghan Lun (Treatise on Cold Damage) discusses cold damage, while Jingui Yaolue (Essential Prescriptions of the Golden Cabinet) discusses miscellaneous diseases; together they constitute Zhang Zhongjing's complete medical system. Shanghan Lun gained prominence because Cheng Wuji provided the first commentary, followed by more than fifty other physicians who added annotations, allowing it to be widely disseminated and clarified throughout the realm. In contrast, Jingui Yaolue is rarely discussed. Although commentators such as Zhao Liang and Xu Bin have annotated it, its text is archaic and obscure. Due to centuries of transmission, bamboo slips were misplaced and fragments lost, resulting in many doubts and missing passages. Errors were copied and propagated, leading later scholars to regard it as remote and impractical, relegating it to obscurity. Today, I have reorganized the disordered sections, supplemented the残缺 (incomplete/missing parts), extensively collected various books, and provided detailed annotations, so that these two works may coexist. It is hoped that future practitioners will not be misled by vulgar theories, but will understand that Zhang Zhongjing was capable of treating not only cold damage but also miscellaneous diseases.

Humans inherit the constant principles of the Five Elements (Wu Xing, Wood, Fire, Earth, Metal, Water) and grow through the influence of wind and Qi. Wind and Qi can generate all things, yet they can also harm them, just as water can float a boat or capsize it. If the Yuan Zhen Qi (Primal True Qi) of the five Zang organs flows smoothly, the person remains peaceful and harmonious. External Ke Qi (Guest Qi) and Xie Feng (Evil Wind), if they penetrate the body, often lead to death. The myriad diseases do not exceed three categories: First, pathogenic factors invade the meridians and enter the Zang organs, constituting an internal cause (Nei Yin); Second, the four limbs and nine orifices experience transmission via blood vessels, leading to obstruction and blockage, constituting an external cause (Wai Zhong) from skin exposure; Third, injuries from sexual excess, metal weapons, or insects and beasts. Analyzing these three aspects exhausts the origins of disease. If one carefully nourishes and guards against pathogenic factors, preventing evil wind from invading the meridians, even if pathogens initially affect the meridians before spreading to the Zang organs, immediate treatment can resolve it. When the limbs feel heavy and stagnant, methods such as Dao Yin (guiding and pulling exercises), Tu Na (breathing regulation), acupuncture, and topical massage should be employed to prevent the closure of the nine orifices. Furthermore, one should avoid legal troubles, animal attacks, and sexual depletion, and regulate diet regarding temperature and the five flavors (Sour, Bitter, Sweet, Pungent, Salty), ensuring the physical form does not weaken, so that pathogens cannot enter the Cou Li (interstitial spaces). Cou refers to the places where San Jiao (Triple Burner) connects and Yuan Zhen Qi meets, where blood and Qi are infused. Li refers to the texture and structure of the skin and Zang organs.

[Note] This chapter serves as the outline of the entire book. Previous editors mistakenly placed it as the second chapter, disrupting the order. It is now placed at the beginning to govern the main ideas.

[Annotation] "Wu Chang" (Five Constants) refers to the Five Elements. The Qi of the Five Elements includes Wind, Summer Heat, Dampness, Dryness, and Cold; their flavors are Sour, Bitter, Sweet, Pungent, and Salty. Humans receive these to form their bodies, so the Zang organs interact with these flavors and Qi daily. It says "Wind Qi" rather than "Five Qi" because Wind encompasses the other four. Wind permeates the four seasons like Ren (Benevolence) permeates the four virtues, hence "growing through Wind Qi." However, since Wind Qi can both generate and harm, this is because the Main Qi Zheng Feng (Upright Wind) comes from its proper direction and nurtures all things, whereas Ke Qi Xie Feng (Guest Evil Wind) comes from the opposing direction and harms all things. Humans exist within the intersection of Heaven and Earth Qi; their survival or harm is like water floating or capsizing a boat. The Heavenly Five Qi become the Zang organs' Yuan Zhen Qi in humans. If they flow smoothly and generate each other, even Guest Evil Wind cannot harm, and the person remains harmonious. If not smooth, Guest Evil Wind enters through gaps, often causing death. The causes of death, though numerous, fall into three main categories: First, deficiency in the center allows meridian pathogens to enter the Zang organs, called Nei Suo Yin (Internal Cause); Second, strength in the center prevents organ involvement despite pathogen exposure, affecting only the exterior, limbs, and orifices with vessel obstruction, called Wai Suo Zhong (External Strike); Third, injuries from sex, weapons, or animals, which are neither internal nor external causes induced by deficiency/excess, called Bu Nei Wai Yin (Neither Internal Nor External Cause). Analyzing these three covers all disease origins. If one carefully nourishes shape and Qi, preventing Guest Evil Wind from invading meridians, even if pathogens strike the meridians before reaching the Zang organs, timely treatment ensures recovery. When limbs feel heavy but orifices are not closed, Dao Yin, Tu Na, acupuncture, and massage can cure. Avoiding legal issues, animal attacks, and sexual depletion, and regulating diet so the five flavors are appropriate and shape/Qi do not weaken, prevents all diseases from entering the Cou Li. Cou is the void space of the body, the pathway for blood and Qi, and the channel for San Jiao to connect Yuan Zhen. Li is the orderly arrangement of skin and organs.

[Note] Zheng Feng (Upright Wind) comes from the eight directions according to season, possessing generating and gentle characteristics. Xie Feng (Evil Wind) comes from the opposing direction, possessing overcoming and fierce characteristics. For example, if East Wind should blow but West Wind blows, "after" refers to the passed time.

[Collected Annotations] Zhao Liang said: Humans exist in the Qi intersection, inheriting Earth's rigidity and softness to form the five Zang organs and hundred bones; inheriting Heaven's Yin and Yang to form the Qi of the six Jing (Channels). When shape and Qi unite, Shen Ji (Spirit Mechanism) activates, driving Gu Qi (Grain Qi) in and out, aligning with heavenly degrees, rising and falling, responding to four seasons, governing the body, called Yuan Zhen. External infections are Ke Qi. Ling Shu states: False Evil cannot injure alone; it must find bodily deficiency to inhabit. Heaven and Human Qi each have upright and non-upright states. Upright human Qi repels evil; non-upright allows evil to invade. Upright Heaven Qi aids growth; non-upright harms. Non-upright human Qi results from seven emotions disturbing the interior, irregular diet, sexual excess, or injury from weapons/animals, all sufficient to cause disease. Non-upright Heaven Qi results from irregular four seasons and abnormal eight winds, sufficient to harm all things.

Question: What does "Superior physicians treat disease before it arises" mean? Teacher said: Treating disease before it arises means seeing liver disease, knowing it transmits to the spleen, and thus first strengthening the spleen. If the spleen is prosperous in the four seasons and resists evil, do not tonify. Average physicians do not understand transmission; seeing liver disease, they fail to strengthen the spleen and only treat the liver. For liver disease, tonification uses sour herbs, assistance uses scorched bitter herbs, and benefit uses sweet herbs to regulate. Sour enters the liver, scorched bitter enters the heart, sweet enters the spleen. The spleen can control the kidney. If kidney Qi is weak, water does not move. If water does not move, heart fire becomes prosperous. If heart fire is prosperous, it damages the lung. If the lung is damaged, metal Qi does not move. If metal Qi does not move, liver Qi becomes prosperous. If liver Qi is prosperous, liver disease heals. This is the subtlety of treating the liver by tonifying the spleen. This method applies to liver deficiency, not liver excess. The classic says: Do not make deficiency more deficient or excess more excessive; tonify insufficiency, reduce excess. This is the principle. Other organs follow this rule.

[Annotation] This follows the previous section on the three causes of disease to explain treatment. Superior physician (Shang Gong) refers to excellent doctors; average physician (Zhong Gong) refers to ordinary doctors. Yi Bing (Already Diseased) is the manifested disease; Wei Bing (Not Yet Diseased) is the potential disease. If current liver disease exists, this is Yi Bing; liver disease transmitting to the spleen later is Wei Bing. Excellent doctors know liver disease transmits to the spleen. Seeing liver disease, they first assess seasonal prosperity/decline and spleen earth deficiency/excess. If season is prosperous and spleen is solid, they know it won't accept liver evil and need not tonify the spleen, directly treating the existing liver disease. If season is declining and spleen is deficient, they know liver will transmit to spleen, first tonifying the un-diseased spleen while treating the diseased liver. Ordinary doctors do not understand seasonal dominance and five-organ transmission. Seeing liver disease, they only purge the diseased liver, failing to tonify the un-diseased spleen. Superior doctors also know that liver deficiency does not transmit to spleen deficiency but instead accepts lung evil. Thus, for liver and spleen deficiency, use sour to enter the liver and tonify the diseased liver; use scorched bitter to enter the heart and assist the undiseased heart; use sweet to enter the spleen and benefit the deficient spleen. This makes fire generate earth, and earth control water. Weak water leads to strong fire; strong fire controls metal. Controlled metal does not attack wood, so liver disease heals. This is the principle of "Hyperactivity brings disaster, succession brings control; control generates transformation, transformation prevents disease," known as treating across two or three organs. Hence, "this is the subtlety of treating liver by tonifying spleen." However, this applies only to liver deficiency, not excess. Average doctors do not understand deficiency/excess; purging deficiency is "making deficiency deficient"; tonifying excess is "making excess excessive." This is incorrect. Superior doctors know deficiency/excess, tonify insufficiency, reduce excess. This is correct. The other four organs follow this method. The character "Shang" (harm) should be read as "Zhi" (control).

[Collected Annotations] Xu Bin said: Suppose there is liver meridian disease; liver wood overcomes spleen earth, knowing evil will transmit to the spleen meridian. Treatment should prioritize strengthening the spleen. This is strengthening the spleen before it is diseased, called treating disease before it arises. Not worrying about the primary organ's deficiency but fearing endless transmission leading to deeper illness, strengthening the spleen is urgent.

Cheng Lin said: The classic says: Disperse what is light, reduce what is heavy, clarify what is declining. "Following" means seizing the opportunity. Treating disease before it arises means treating the undiseased organ, not the undiseased person. Seeing liver disease, first strengthen the spleen. If earth is prosperous, it controls water; if water doesn't move, fire becomes strong and controls metal. Metal cannot interfere with wood, so liver disease heals. This is the method of treating liver by tonifying spleen, i.e., treating disease before it arises.

Gao Shishi said: Strengthening the spleen specifically controls water, making fire strong and metal weak. If liver is not controlled, it heals. The logic is subtle, hence "this is the subtlety of treating liver by tonifying spleen."

Question: Patients show facial complexion changes. What is the explanation? Teacher said: If the nose tip is blue/green, there is abdominal pain; those suffering from cold die (or: abdominal cold, suffering pain die). If the nose tip is slightly black, there is fluid retention. If yellow, there is cold above. If white, there is blood loss. If slightly red and not in season, death ensues. Eyes fixed straight and round indicate Spasm Disease (Jing Bing), which is untreatable. Also, blue indicates pain, black indicates劳损 (consumption/overwork), red indicates wind, yellow indicates difficult defecation, and bright/clear color indicates retained fluid.

[Annotation] Facial complexion reveals disease prognosis because five Qi enter the nose and store in the five Zang organs, their essence flourishing externally on the face. Color refers to green, red, yellow, white, black. Qi refers to the luster of the five colors. Harmonious color and Qi, having both color and luster, belong to healthy people. As the classic says: Green like kingfisher feathers, red like chicken combs, yellow like crab roe, white like pig fat, black like crow feathers—these indicate life. Disharmonious color and Qi, varying depth or luster, belong to patients. As the classic says: Floating and moist indicate exterior; deep and turbid indicate interior. Observe floating/deep to know depth; observe dull/moist to judge outcome; observe scattered/clumped to know new/old; observe upper/lower distribution to locate disease. Rough and bright, or deep and dull, indicate severe disease; unclear and unmotivated indicate mild disease. Color without Qi, dry and lusterless, is the color of the dead. As the classic says: Green like indigo leaves, yellow like loess soil, red like clotted blood, white like dry bone, black like soot—these are death colors. The nose is the Ming Tang (Bright Hall). A luminous Ming Tang indicates no disease. But here, green indicates abdominal pain, severe nasal cold indicates death; black indicates fluid/consumption, yellow indicates upper cold/lower heat/difficult urination; bright face indicates retained fluid; white indicates blood loss; red indicates heat/wind. If appearing in winter, it is out of season and fatal. Fixed, round eyes like fish eyes indicate Spasm Disease, untreatable. This is the general rule of complexion diagnosing; details are in Neijing.

Teacher said: If a patient speaks silently but likes sudden shouts, the disease is in the joints. If speech is hoarse and unclear, the disease is in the chest/diaphragm. If speech is murmuring, thin, and long, the disease is in the head (one version says abdomen).

[Note] "Silent speech" means silence. If hating speech, it is heart disease. Liking sudden shouts means not hating speech and preferring to shout, indicating the disease is external, hence "disease in joints." Hoarse and unclear speech obstructs breath, indicating "disease in chest/diaphragm." Murmuring, thin, and long speech implies fear of rapid breathing disturbing the interior, indicating "disease in abdomen."

Teacher said: Breathing with shoulder movement indicates chest fullness/stiffness. Breathing drawing Qi upward from the chest indicates cough. Breathing with open mouth and shortness of breath indicates Lung萎 (Lung Flaccidity) with saliva/phlegm.

[Annotation] Xi (Breath) is one inhalation and exhalation. Yao Jian (Shaking shoulders) means raising shoulders. Xin Zhong Jian (Stiffness in heart/chest) means chest fullness. Breathing moving the body to raise shoulders with chest Qi rebellion is Asthma (Chuan Bing). Breathing drawing chest Qi up with throat itching/blockage is Cough (Ke Bing). Breathing with open mouth, unable to continue breath, resembling asthma but without shoulder raising, is Shortness of Breath (Duan Qi Bing). Lung Qi fullness with excess evil is Asthma; Lung Qi inability to continue breath is deficiency-type Shortness of Breath. Deficiency asthma may lack continuous breath; excess shortness of breath may have chest fullness. Lung Qi rebellion always involves cough. Coughing with phlegm is Sou. Continuous coughing with saliva indicates Lung Flaccidity, not simple cough.

Teacher said: Slight rapidity in inhalation indicates disease in the Middle Jiao. If excess, purging cures it; if deficiency, it is untreatable. In Upper Jiao, inhalation is hurried (Cu); in Lower Jiao, inhalation is distant/long (Yuan). All are difficult to treat. Trembling during respiration is untreatable.

[Note] This continues discussing asthma divided by Three Jiaos, distinguishing treatable from untreatable. Asthma is a lung disease; lungs govern Qi and respiration. Rapid respiration is asthma. Equal rapidity in inhale/exhale suggests disease in respiration itself, blocking ascending/descending Qi, indicating Middle Jiao asthma. Hurried exhale, long inhale relates to exhaling (Heart/Lung), indicating Upper Jiao asthma. Long exhale, short inhale relates to inhaling (Kidney/Liver), indicating Lower Jiao asthma. Excess asthma means excess evil; middle excess causes abdominal fullness/hard stool, purging is curable. Deficiency asthma means depleted righteous Qi; middle deficiency causes soft abdomen/loose stool, purging is intolerable, difficult to treat. Trembling during respiration indicates shape and Qi cannot support each other; untreatable regardless of excess/deficiency. "Slight rapidity" means Cu (hurried) equals Duan (short); Yuan (distant) equals Chang (long). Mentioning only inhalation is elliptical, implying equal shortness, long exhale/short inhale, or short exhale/long inhale.

Teacher said: Cun Kou pulse movement follows the prosperous season. For example, when Liver is prosperous, color is green. Each season follows its corresponding color. If Liver color is green but turns white, or pulse/color appears out of season, disease is present.

[Annotation] Cun Kou generally refers to the three positions on both wrists. Pulse movement follows four seasons and depends on five Zang organs. Movement during the prosperous season is a normal pulse. If Liver is prosperous in Spring, color should be green, pulse should be Xian (Wiry). This is non-disease color/pulse. If color turns white, pulse turns Fu (Floating), this is out-of-season, indicating disease. Four seasons follow this rule.

[Collected Annotations] You Yi said: Prosperous season means Qi is abundant when the time arrives, pulse moves accordingly, and color responds. E.g., Liver prosperous in Spring, pulse wiry, color green, is normal. This applies to all seasons. If color should be green but is white, it is out-of-season color. Not only Liver disease, but Lung would also be diseased.

Question: There is "arriving before time," "not arriving at time," "arriving but not leaving," and "arriving but excessive." What does this mean? Teacher said: After Winter Solstice, at midnight on the Jia Zi day, Shao Yang Qi begins. During Shao Yang time, Yang begins to grow, and weather becomes warm. If weather is warm before Jia Zi day, this is "arriving before time." If Jia Zi day has passed but weather is not warm, this is "not arriving at time." If Jia Zi day has passed but severe cold persists, this is "arriving but not leaving." If Jia Zi day arrives but weather is as hot as midsummer, this is "arriving but excessive."

[Annotation] After Winter Solstice, at midnight on Jia Zi day, Shao Yang Qi begins, weather warms gradually—this is normal. Warmth before Jia Zi is "arriving before time." Qi arrives early, indicating excess incoming Qi. After Jia Zi, Yang grows, but weather isn't warm—"not arriving at time." Qi should arrive but doesn't, indicating insufficient incoming Qi. Severe cold persisting after Jia Zi is "arriving but not leaving." Qi should leave but doesn't, indicating excessive outgoing Qi. Overly warm weather is "arriving but excessive." Qi arriving excessively indicates excessive incoming Qi. Excess means Qi floods, attacking the element it cannot overcome and riding over the element it overcomes. Insufficiency means Qi presses, causing the overcome element to act wildly, harming the generated element, and being attacked by the non-overcome element. This matches Neijing: "Carefully await the time, Qi can be expected." Others follow this.

Teacher said: Patient's pulse: Fu (Floating) at the front (Cun position) indicates Exterior disease; Fu at the back (Chi position) indicates Interior disease. Lower back pain, back stiffness, inability to walk, accompanied by shortness of breath and extreme fatigue.

[Annotation] Fu pulse is a sign of Empty Wind. Fu at Cun (front of Guan) indicates Exterior disease. Fu at Chi (back of Guan) indicates Interior disease. Empty Wind in Exterior causes lower back pain, back stiffness, inability to walk. Empty Wind in Interior causes shortness of breath and extreme fatigue.

Question: Classic says: Jue Yang travels alone. What does this mean? Teacher said: This is Yang without Yin, hence called Jue Yang.

[Annotation] Yin and Yang traveling together is Smooth (Shun); traveling alone is Rebellious (Ni). Jue means Rebellious. Rebellious Yang traveling alone is Yang without Yin, hence Jue Yang.

[Collected Annotations] Li said: Jue Yang is Yang Jue. Neijing says: Yang deficiency below causes Cold Jue; Yin deficiency below causes Hot Jue. Jue Yang traveling alone represents Yang without Yin.

Gao Shishi said: This is Yang without Yin, called Jue Yang. Classic says: Yin deficiency below causes Hot Jue. Emperor asked: How does Hot Jue occur? Qibo said: Yin deficiency allows Yang to enter; Yang entering causes Stomach disharmony; Stomach disharmony depletes Essence Qi; depleted Essence Qi fails to nourish limbs. Kidney Qi declines daily, Yang dominates alone. This is Yang without Yin, hence Jue Yang traveling alone.

Question: Cun pulse is Chen (Deep) Da (Large) and Hua (Slippery). Chen indicates Excess (Shi), Hua indicates Qi. Excess and Qi contend. Blood and Qi entering Zang causes death; entering Fu causes recovery. This is Cu Jue (Sudden Syncope). What does this mean? Teacher said: Blue lips/mouth, cold body indicates entering Zang, leading to death. Warm body, spontaneous sweating indicates entering Fu, leading to recovery.

[Note] The eighteen characters "Cun pulse Deep Large Slippery, Deep is Excess, Slippery is Qi, Excess and Qi contend" are grammatically awkward and likely interpolations. The character "Xue" (Blood) in "Blood and Qi entering Zang" should be "Jue" (Syncope) to match Cu Jue, likely a copying error.