Library

The discussions on *Shanghan* (Cold Damage) by Zhang Zhongjing are excerpts of key points, observed under the fingers during pulse diagnosis. Pulse differentiation distinguishes Yin and Yang, and separates Exterior from Interior. There are over a hundred types of symptoms throughout the body. First, discuss the Taiyang (Greater Yang) channel: Fever and aversion to cold must be clearly distinguished. If the pulses at the Cun, Guan, and Chi positions are merely floating, accompanied by headache and body pain, this is a syndrome of releasing the muscle layer with fever, which requires careful analysis. If there is sweating and aversion to cold, *Guizhi Tang* (Cinnamon Twig Decoction) is appropriate; if there is no sweating and aversion to cold, use *Mahuang Tang* (Ephedra Decoction). If there is body heat, yellow eyes, and dry nose, with a long and restless pulse that cannot remain stable for even a moment, it indicates severe disturbance.

Yangming (Bright Yang) channel syndromes are primarily observed below the eyes. The pulse presents with aversion to cold and spontaneous sweating (or aversion to wind), indicating middle-cold. When the pathogen transmits to Shaoyang (Lesser Yang), hypochondriac pain occurs; if accompanied by alternating chills and fever, deafness, bitter taste in the mouth, dry tongue, floating pulse, and vomiting, *Chaihu Jiebiao* (Bupleurum Exterior-Resolving) should be used without hesitation.

If abdominal pain, sore throat, warm hands and feet, spontaneous diarrhea without thirst, and intestinal discomfort occur, and the pulse is deep and fine, *Lizhong Tang* (Regulate the Middle Decoction) or *Sini Tang* (Frigid Extremities Decoction) should be used. If the Taiyang pulse is large and floating, the exterior syndrome still exists. Shaoyin (Lesser Yin) disease has a deep pulse, which must be carefully recognized; dry mouth and tongue are its signs. If accompanied by aversion to cold, use *Sini Tang*; if there is dry mouth and throat, it indicates excessive Gallbladder fire. Heat qi circulates among the Zang-Fu organs; *Chengqi Tang* (Purgative Decoction) attacks urgently, acting as effectively as a divine remedy.

Jueyin (Terminal Yin) disease presents with testicular retraction, abdominal fullness, and irritability; slight sweating belongs to the Liver channel, truly so. If aversion to cold penetrates into the abdomen, urgent treatment is required to prevent life-threatening damage.

Examine the pulse to differentiate Yin and Yang, and separate Exterior from Interior. For exterior syndromes with aversion to cold but acute pain, and a floating pulse requiring diaphoresis, the command should be cautious and delayed. *Da Qing Long Tang* (Major Blue Dragon Decoction), *Mahuang Tang*, and *Guizhi Tang* can be used together. In summer, add *Shengma* (Cimicifugae Rhizoma) and *Huangqin* (Scutellariae Radix); *Zhimu* (Anemarrhenae Rhizoma) and *Shigao* (Gypsum Fibrosum) are also used jointly. Do not assist heat to cause jaundice and macules; physicians find such cases difficult to treat.

In autumn or winter, or when spring Qi is excessive, if heat is severe, *Chaihu* (Bupleuri Radix) medicine must be used. The exterior syndrome does not have aversion to cold but aversion to heat; palm sweat flows, and fluids descend. The stomach is dry, the throat is parched, defecation is difficult, the intestines are full, there is delirium, and urine is red. Abdominal pain causes restlessness; blocked Qi and Blood lead to frequent panting. A deep, fine, slippery, and rapid pulse indicates suitability for purgation; administering Yuan Yang (primordial Yang) agents will not result in error. It is also heard that the Three Causes theory allows for sweating and purging methods; Taiyang and Shaoyin diseases both present surprising complexities.

Shaoyin fever with Taiyang floating pulse: after using *Shaoyao Gancao Tang* (Peony and Licorice Decoction) slightly, one need not rush. *Fuzi* (Aconiti Lateralis Radix Praeparata), *Gancao* (Glycyrrhizae Radix et Rhizoma), and *Ezhu* (Curcumae Rhizoma) administered induce slight sweating, which is truly invaluable.

Epistaxis or lower bleeding constitutes a deteriorated patient condition. Post-menstrual Wind-Warmth or Damp-Warmth syndromes, with empty irritability and acute abdominal pain, should never be treated with sweating methods by physicians, lest they deserve censure.

Carefully analyze stagnation diseases caused by the Three Causes; do not let mediocre doctors prescribe randomly. Taiyang abdominal fullness with intermittent pain is treated with *Guizhi Shaoyao Dahuang Tang* (Cinnamon Twig, Peony, and Rhubarb Decoction). Shaoyin sore throat with dry mouth, abdominal fullness, anorexia, and dry stool, suddenly followed by clear water diarrhea and epigastric pain disturbing the essence, urges the urgent use of *Chengqi Tang*. Why pray vainly to spirits?

If the pulse remains deficient, fine, and floating, with aversion to cold, vomiting, and scanty urination/defecation, ancients warned against using *Chengqi Tang*. If you insist on prescribing it, it is lamentable. However, if both exterior and interior syndromes appear, or if there has been no bowel movement for six or seven days, and there is sweating with headache like a splitting face, using *Chengqi Tang* would be a mistake (Note: Original text says "physician has spiritual efficacy," but context implies contraindication or high risk; literal translation provided). Epigastric fullness, anorexia, hard stool, floating pulse, continuous sweating on the head and face, slight aversion to cold, and cold hands and feet are best treated with *Xiao Chaihu Tang* (Minor Bupleurum Decoction). Treat according to the syndrome; do not linger.

If there is body heat but a desire to cover up, or body heat without covering, this indicates Exterior Heat and Interior Cold. Exterior heat is suitable for *Guizhi Tang*, further treated with modified *Chaihu*. Cold in the skin, heat in the bones: *Baihu Jia Ling* (White Tiger plus [Fuling/Cangzhu]) must not be ignored. Use *Guizhi* and *Mahuang* each half liang, sequentially until recovery (or using Ziwan).

If there are cold extremities, umbilical and abdominal pain, cold sweat, vomiting, difficulty in urination, thirst, irritability, sore throat, and body pain as if beaten by a staff, and the six pulses are deep and absent, this is named Yin Du (Yin Toxin) without doubt. Use *Baizhu Fuzi Zhengyang Tang* (Atractylodes, Prepared Aconite, and Correct Yang Decoction) to restore Yang and return Yin, which is truly miraculous. Moxibustion on Qihai and Guanyuan acupoints should be abundant; apply hot compress urgently to the navel. After warming, extremities become slightly warm, Yang returns, and natural sweating occurs due to cold expulsion.

Another syndrome is named Yang Du (Yang Toxin): delirious speech and妄言 (delusions), do not laugh. Red face, dry throat, yellow diarrhea, and a pulse that is floating, slippery, surging, and hurried. *Tingli* (Descurainiae Semen) and vinegar, black as tile; *Zhizi Ren Tang* (Gardenia Seed Decoction) should be taken early. These medicines are especially suitable for selection. After heavy sweating resolves, take with warmth. Ask if the patient has tidal fever, delirium as if speaking to ghosts, grasping at bedclothes, which is alarming. This often results from ineffective or improper emesis. Several days of constipation with abnormal complexion: after purgation, if the pulse becomes floating, the patient survives. If the pulse is hollow, deep, or choppy, and solid, purging is the true excellent method.

Yin resembles Yang, Yang resembles Yin. Body irritability and heat without desire to drink water is named Yin Excess blocking Yang Heat. *Pili Dansha* (Thunderbolt Cinnabar) should be handled with caution. Cold extremities are simply called Jue (Reversal). Differentiate cold and heat sequentially. Cold Jue is slow; heat Jue involves no desire to drink. *Sini Tang* and *Lizhong Tang* are superb. Cold Jue with midday irritability and heat, deep pressure reveals a choppy pulse, tossing limbs and insomnia: *Baihu Tang* and *Da Chengqi Tang* require discernment by gentlemen. There are more than ten other differentiation patterns. Ascariasis Jue involves long worms; *Wumei Wan* (Mume Pill) and *Lizhong Wan* can attack it.

Another syndrome is Yin-Yang Yi (Yin-Yang Transmission): body heaviness and spontaneous Qi decline. Yin Du causes internal twisting pain, visual disturbances, and internal rupture. Women suffer waist and knee pain connected to abdominal pain; toxin qi intersects with severe Hongjiao (Charley Horse/Gout). Burned rat feces and *Zhuru* (Bambusae Caulis in Taenia) decoction, or dried ginger and bamboo shavings, can treat it.

Yang deficiency and Yin excess: purging leads to death. Yang excess and Yin deficiency: sweating is the ancestor (principle). Day 1: headache, body pain, dry mouth, irritability, Shaoyin attack. Day 2: abdominal fullness, body heaviness, heat, delirium, anorexia, ominous. Day 3: deafness, frequent Jue, inability to swallow liquids, empty soul. This is Lianggan Shanghan (Double Exposure Cold Damage); Zhang Zhongjing records it as untreatable in some contexts. But following the channels to separate Exterior and Interior, distinguishing Yin and Yang has divine efficacy.

Floating and tight pulse with headache, limb stiffness, aversion to cold, no sweating, more cold than heat, pale and disreputable complexion, waist and abdominal pain, cold extremities: this is the general outline of Shanghan. Prescribe according to the disease; do not imitate mediocre doctors who are hard to understand.

Cun large, Chi weak, later floating; spontaneous sweating, body heat, and headache. More cold than heat, do not hide; recognize severe aversion to wind. Cold extremities, shiny and floating face: recognize Shanghan and treat according to syndrome. *Huoren* (Living Person) formulas need not worry. Severe fever, aversion to cold, and dryness; warm extremities, tidal pulse, floating and urgent: these are initially Shanghan or Shangfeng (Wind Injury) pulses. Advise physicians to be careful. More cold than heat, do not hide.

*Daqing*, *Mahuang*, *Guizhi* syndromes: fever, aversion to cold, cold mouth/pulse, whole body pain in all joints. Worry about heat because it is caused by cold injury. Modify *Mahuang* and *Daqing*. Summerheat syndrome shares similarities with internal heat. Although the pulse is floating, the disease adds thirst. Phlegm reversal with aversion to cold: *Ju Pi Tang* (Tangerine Peel Decoction); *Baihu* and *Wuling* additions are excellent.

Aversion to cold and fever before Summer Solstice; headache and heart pain like frying. Warm disease pulse must be floating, tight, and strong; this is named Han Nue (Cold Malaria) transmitted by ancients. Modified *Chaihu* and *Wuling San* (Five-Ling Powder). Warm limbs cannot be retrieved; panting, insomnia, and mental dreams. *Jiang Ling Fangji Gegen Tang* (Ginger, Poria, Stephania, and Kudzu Decoction); if thirst is severe, *Gua Jiang Tang* (Melon and Ginger Decoction) can be used. Disease is the same for young and old; this is named Wen Yi (Warm Plague), do not exhaust the discussion. First, take this powder lightly; sequentially attack according to other symptoms. This is the true profound principle of physicians; future learners must master it thoroughly.