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Whenever one is injured by cold, a heat disease occurs. Even if the heat is severe, death will not ensue (The *Neijing* states: "When wind and cold invade the human body, causing all hair follicles to stand erect and skin pores to close, heat results; this is why cold injury causes heat." The *Zhenjing* states: "Those with much heat are easily cured; those with much cold are difficult to cure." Thus, even severe heat does not lead to death. This is discussed in detail in the *Suwen: Relun* chapter and should be studied carefully.) However, if one suffers from "Lianggan" (simultaneous infection of exterior and interior meridians) due to cold, death is inevitable (Simultaneous involvement of exterior and interior is called Lianggan).

If the pulse at both Cun and Chi positions is floating, it indicates Taiyang meridian disease. It typically manifests on the first or second day because its channel connects to the Fengfu acupoint, leading to headache, neck stiffness, and lower back/spine rigidity (Taiyang has abundant blood but scarce Qi and is the head of the three Yang meridians; its Qi floats outward, hence the floating pulse at Cun and Chi, indicating pathogenic factors have just entered the skin and surface. It manifests within one or two days. Fengfu is an acupoint name located in the center of the nape. The Taiyang channel enters the brain from the vertex, emerges, descends separately along the nape, thus connecting to Fengfu. Its course runs through the shoulders and arms, parallel to the spine, reaching the waist; therefore, pathology presents as headache, neck stiffness, and spinal rigidity).

If the pulse at both Cun and Chi positions is long, it indicates Yangming meridian disease. It typically manifests on the second or third day because its channel flanks the nose and connects to the eyes, leading to fever, eye pain, nasal dryness, and inability to sleep (Yangming has abundant blood and Qi; a long pulse at Cun and Chi indicates pathogens merging into Yangming with overflowing blood and Qi. If Taiyang pathology persists and transmits to Yangming, it manifests on the second or third day. The channel flanking the nose refers to the Yangming channel originating at the nose, crossing the forehead, and connecting to the eyes. Yangming governs the muscles of the body; the *Zhenjing* states: "When Yangming Qi is excessive, the anterior part of the body becomes hot." Eye pain and nasal dryness result from pathogens lodging in the channels. Inability to sleep occurs because Stomach Qi rebels and fails to follow its normal pathway. The *Neijing* states: "When the Stomach is disharmonious, sleep is disturbed.")

If the pulse at both Cun and Chi positions is wiry (Xian), it indicates Shaoyang meridian disease. It typically manifests on the third or fourth day because its channel follows the hypochondrium and connects to the ears, leading to chest and hypochondriac pain and deafness (The *Neijing* states: "Shaoyang within Yang corresponds to Spring Qi; it has less blood and more Qi, and the Spring pulse is wiry." A wiry pulse at Cun and Chi indicates Shaoyang invasion. If Yangming pathology persists from days 2-3 and transmits to Shaoyang, it manifests on days 3-4. Chest/hypochondriac pain and deafness result from channel obstruction and stagnation. Gao Wenzhuang's edition reads: "The pulse enters the brain from the vertex, connects to the Kidney, emerges, descends separately along the spine to the waist." Generally, transmission from Taiyang to Jueyin proceeds from exterior to interior, requiring sequential use of sweating and purging methods. Some cases bypass the Three Yang and directly involve Taiyin, Shaoyin, or Jueyin; see later sections for treatment based on the specific meridian).

For diseases involving these three meridians that have not yet entered the Fu organs, they can be resolved by inducing sweating (Pathogens in the Three Yang affect the exterior, so the method is sweating. However, the Three Yang can also directly enter the Fu organs; if they do, purging is indicated. Hence, "not yet entering the Fu organs" implies sweating. Note: The character "Fu" (Organ) in the *Suwen* is written as "Zang" (Viscera); this is logically superior as Fu is Yang and Zang is Yin. Moreover, transmission to Yangming implies entering the Fu organ).

If the pulse at both Cun and Chi positions is deep and fine, it indicates Taiyin meridian disease. It typically manifests on the fourth or fifth day because its channel spreads in the Stomach and connects to the throat, leading to abdominal fullness and dry throat (When Yang reaches its extreme, Yin is affected. After pathogens traverse the Three Yang, they transmit to the Yin meridians. Exterior involvement shows Yang pulses; interior involvement shows Yin pulses. Yang pathogens transmitting to Yin cause internal sinking, resulting in Taiyin disease with deep/fine pulses. Transmission from Three Yang to Taiyin occurs on days 4-5. Pathogens entering Yin gradually generate heat. Abdominal fullness and dry throat result from Spleen channel stagnation generating heat).

If the pulse at both Cun and Chi positions is deep, it indicates Shaoyin meridian disease. It typically manifests on the fifth or sixth day because its channel penetrates the Kidney, connects to the Lung, and attaches to the root of the tongue, leading to dry mouth, dry tongue, and thirst (Shaoyin belongs to Kidney Water, which tends downward; Shaoyin disease presents with deep pulses at Cun and Chi. On day 5, if Taiyin pathogens persist, they transmit to Shaoyin by days 5-6. Humans injured by cold develop heat diseases, meaning cold initially transforms into heat. Dry mouth/tongue and thirst in Shaoyin disease indicate pathogens entering the interior and heat intensifying. The *Huoren Shu* states: "The text mentions 'Shaoyin on days 1-2' referring to cases where pathogens enter Shaoyin immediately without passing through the Three Yang." Generally, Shanghan manifesting in Yang meridians involves Taiyang; manifesting in Yin meridians involves Shaoyin. For illnesses lasting 1 to 12-13 days where Taiyang symptoms persist, treat Taiyang. If Shaoyin symptoms appear at onset, treat Shaoyin directly rather than starting with Juyang (Taiyang). Cold invading Taiyang causes fever and aversion to cold; invading Shaoyin causes aversion to cold without fever).

If the pulse at both Cun and Chi positions is slightly slow (Huan), it indicates Jueyin meridian disease. It typically manifests on the sixth or seventh day because its channel follows the genitalia and connects to the Liver, leading to irritability/fullness and contraction of the scrotum (Slow is the Wind pulse. A slightly slow Jueyin pulse indicates pathogens have transmitted to Jueyin with intense heat approaching Wind characteristics. Manifestation on days 6-7 occurs because Shaoyin pathogens transmit to Jueyin. Irritation/fullness and scrotal contraction result from heat gathering internally. [Lou] notes: "Fanman" refers to lower abdominal irritation. The following text says "On day 12, Jueyin disease declines, scrotum relaxes, lower abdomen slightly descends," meaning the previous scrotal contraction now allows slight descent due to lower abdominal irritation).

For diseases involving these three meridians that have already entered the Fu organs, they can be resolved by purging (Pathogens in the Three Yin affect the interior, so the method is purging. However, Three Yin can also remain in the Jing (channels); if in the channel, sweating is indicated. Hence, "already entered the Fu organs" implies purging. The *Neijing* states: "Physicians must examine carefully." These two sentences regarding "entering Fu organs" may be misplaced from the Yangming section, as the *Suwen* states: "If all Three Yin and Three Yang, Five Zang and Six Fu are diseased, Ying and Wei cease to circulate, and Five Zang become blocked, death ensues." The Three Yin meridians utilize sweating, purging, and warming methods, not just purging).

If suffering from Lianggan (simultaneous exterior-interior cold infection):
Day 1: Taiyang is affected, simultaneously with Shaoyin, causing headache, dry mouth, irritability, fullness, and thirst.
Day 2: Yangming is affected, simultaneously with Taiyin, causing abdominal fullness, fever, anorexia, and delirious speech.
Day 3: Shaoyang is affected, simultaneously with Jueyin, causing deafness, scrotal contraction, and cold limbs. If the patient cannot ingest fluids/water and loses consciousness, death occurs on day 6.
If all Three Yin and Three Yang, Five Zang and Six Fu are affected, Ying and Wei cease to circulate, and Zang-Fu communication stops, leading to death (Simultaneous Yin-Yang disease and exterior-interior damage is called Lianggan. Both syndromes appear together. Regarding transmission, both Yin and Yang meridians transmit simultaneously. Day 1 headache is Taiyang; dry mouth/irritability/thirst is Shaoyin. By day 2, Taiyang transmits to Yangming, and Shaoyin transmits to Taiyin; fever/delirium is Yangming; abdominal fullness/anorexia is Taiyin. By day 3, Yangming transmits to Shaoyang, and Taiyin transmits to Jueyin; deafness is Shaoyang; scrotal contraction/cold limbs is Jueyin; inability to ingest fluids/unconsciousness is Stomach Qi blockage. The *Neijing* states: "After five Zang are damaged and six Fu are blocked, with Ying/Wei ceasing to circulate, death occurs three days later." Why? Qibo answers: "Yangming is the leader of the twelve meridians, with abundant blood and Qi. Unconsciousness persists for three days until its Qi is exhausted, then death occurs." By day 3, all six meridians are diseased, blocking Ying/Wei externally/internally and Zang/Fu vertically/horizontally. By day 6, Zang/Fu Qi and Ying/Wei Qi are exhausted, leading to death. Note: Taiyin can transmit to Shaoyin, but Shaoyin cannot transmit to Taiyin (reverse transmission); thus, this theory is flawed. Taiyang (Bladder) and Shaoyin (Kidney) are paired; Taiyin (Spleen) and Yangming (Stomach) are paired; Shaoyang (Gallbladder) and Jueyin (Liver) are paired. Yin follows Yang, like sisters-in-law ranking by husband's age, not their own).

Shanghan on Day 1: Taiyang is affected. If the pulse is quiet, transmission does not occur. If there is a desire to vomit, or restlessness/irritability with a rapid/urgent pulse, transmission occurs (Taiyang governs the exterior; Day 1 affects Taiyang, expected to transmit to Yangming on Day 2. If pulse Qi is weak, it does not transmit. Stomach channel invasion causes vomiting. Cold pathogens transmitting inward transform into heat. Desire to vomit, irritability, and rapid/urgent pulses indicate Taiyang cold transforming into heat and transmitting to Yangming).

Shanghan on Days 2-3: If Yangming and Shaoyang symptoms are absent, transmission does not occur (Absence of Yangming/Shaoyang symptoms on days 2-3 indicates pathogens remain in Taiyang).

Shanghan on Day 3: The Three Yang meridians' disease is exhausted, and the Three Yin meridians should be affected. If the patient can eat and does not vomit, it indicates the Three Yin meridians are not affected (On Day 4, exterior pathogens transmit inward; disharmony prevents eating/vomiting. Since the opposite occurs, transmission to Yin is ruled out; pathology remains in Yang).

Q: Shanghan on Day 3, pulse is floating, rapid, and slight; the patient's body is cool and peaceful. What is this?
A: This indicates the disease is resolving. Resolution occurs at midnight. Floating pulse resolving implies slight sweating; rapid pulse resolving implies appetite returns; slight pulse resolving implies profuse sweating. On Day 3, if the Shaoyang pulse becomes small, the disease is about to resolve (See discussion on bitter taste and dry tongue).

If not Lianggan, no transmission, and no additional pathogenic factors:
Day 7: Taiyang disease declines; headache lessens.
Day 8: Yangming disease declines; fever subsides slightly.
Day 9: Shaoyang disease declines; hearing improves slightly.
Day 10: Taiyin disease declines; abdominal distension resolves, appetite returns.
Day 11: Shaoyin disease declines; thirst stops, tongue dryness resolves, sneezing occurs.
Day 12: Jueyin disease declines; scrotum relaxes, lower abdomen descends slightly, vital Qi disperses, patient regains mental clarity.

Taiyang headache resolving after 7+ days occurs because the meridian cycle is complete. To prevent further transmission, needle the Foot-Yangming meridian to stop transmission and promote recovery.

On days 6-7, if the pulse is large, accompanied by great irritability, locked jaw, silence, and restlessness, resolution is imminent.

Shanghan on days 6-7 with no significant fever but irritability/restlessness indicates Yang departing to enter Yin.

If illness persists beyond 13 days without improvement (Jian means recovered), and Cun/Chi pulses sink, it is a critical danger.

If re-infected with different pathogens causing other diseases, treat according to the original compromised syndrome patterns. If both Yin and Yang pulses are full/excessive, and re-infected with cold, it transforms into Wenre (Warm Malaria) (Full/Cun-Chi pulses: alternating hot/cold favors Xiao Chai Hu Tang; cold-first favors adding Guizhi; cold-only favors Chai Hu Jia Gui Jiang Tang; heat-only favors Bai Hu Jia Guizhi Tang. With sweating, thirst, red urine, miasma history, or水土不服 (acclimatization issues)/vomiting, use Wu Ling San). If Yang pulse is floating/slipping and Yin pulse is soft/weak, and exposed to wind, it transforms into Fengwen (Wind-Warmth) (Fengwen features limb flaccidity, headache, fever, spontaneous sweating, unresolved state, panting, floating Cun-Chi pulses, lethargy/sleepiness; treat Shaoyin/Jueyin, avoid sweating). If Yang pulse is洪数 (Surging/Rapid) and Yin pulse is solid/large, exposure to warmth transforms it into Wendu (Warm-Toxin), the most severe disease (Wendu causes macules/rash). If Yang pulse is soft/weak and Yin pulse is wiry/tight, exposure to warm Qi transforms it into Wenyi (Warm Plague), originating from winter cold injuring leading to Warm Disease; pulse variations and treatments follow (see later sections).

Dai Shi says: Shanghan first attacks Taiyang and transmits sequentially; this is a generalization. Variations exist: some attack Yang and immediately affect Shaoyin; some involve food stagnation affecting Spleen/Taiyin causing immediate abdominal fullness/pain; some do not follow channels, e.g., directly attacking Yangming at onset. Not all start with Taiyang. Some remain in one meridian; some transmit only 1-2 meridians. Do not rigidly adhere to sequence; treat according to symptoms. Most Shanghan present with exterior signs. Zhang Zhongjing said: Many days with exterior signs still require sweating; few days with interior signs require purging.

Hai Shi says: Taiyang (Water of Yang within Yang) is the head of Three Yang, capable of sequential and skipping transmission. Yangming (Earth of Yang within Yang) is the master of Central Earth, receiving but not expelling. Transmission from Taiyang to Yangming is sequential. Shaoyang (Wood of Yang within Yang) transmits up to Yangming and down to Taiyin; transmission from Taiyang to Shaoyang is skipping transmission. Taiyin (Earth of Yin within Yin) transmits up to Shaoyang (smooth) or down to Shaoyin (reverse). Transmission from Taiyang to Taiyin is erroneous purging transmission. Shaoyin (Water of Yin within Yin) transmits up to Taiyin (smooth) or down to Jueyin (reverse); transmission from Taiyang to Shaoyin is exterior-to-interior transmission. Jueyin (Wood of Yin within Yin) transmits up to Shaoyin (excess) or again to Taiyin (self-recovery).

Hai Shi further states: Taiyang (Juyang) is the head of all Yang. Bladder channel disease with thirst indicates transmission to its home meridian (Chuanben). Transmission to Yangming (Stomach Earth) is sequential, caused by incomplete sweating, diuresis, and residual pathogens penetrating inward. Transmission to Shaoyang (Gallbladder Wood) is skipping, caused by failing to use Mahuang Tang for initial floating/no-sweat presentation. Transmission to Taiyin (Spleen Earth) is erroneous purging, caused by using purgatives instead of Guizhi Tang for initial slow/sweating presentation, leading to abdominal pain/heavy limbs. Transmission to Shaoyin (Kidney Water) is exterior-to-interior, caused by urgent need for sweating but using purgatives instead, preventing sweat release. Transmission to Jueyin (Liver Wood) is sequential degree transmission, as Jueyin ascends via Du Mai to connect with Taiyang.

Wu Shi says: Shanghan Six Meridian diseases, whether Yin/Yang, deficiency/excess, cold/heat, are all due to exogenous pathogens. The *Neijing* states "Cold injury causes heat" describing the norm, not variation. Zhang Zhongjing covers both norm and variation. Yang pathogen transmission is normal; Yin pathogen transmission is variation. Normal Yang transmission sequence: Day 1-2 Taiyang, Day 2-3 Yangming, Day 3-4 Shaoyang, Day 4-5 Taiyin, Day 5-6 Shaoyin, Day 6-7 Jueyin. Day 7 completes the cycle, resolving with sweat. No resolution by Day 7 is "Re-Jing"; Day 14 is "Guo-Jing". Unresolved Guo-Jing leads to Huai Bing (Complicated Disease). Hua Tuo stated: Day 1 Skin, Day 2 Flesh, Day 3 Muscle, Day 4 Chest, Day 5 Abdomen, Day 6 Stomach (Interior). Treatments: Sweat for Skin, Harmonize for Muscle, Emetic for Chest, Purge for Interior/Abdomen. *Shanghan Fu* agrees: Days 1-2 Release Exterior, Days 3-4 Harmonize, Days 5-6 Purge if solid. These are general rules for norms, not variations. Cold injury has no fixed rule; it can strike Yin or Yang. Texts mention Day 1-2 fever/deep pulse as Shaoyin; Day 1-2 mouth discomfort/back aversion to cold as Shaoyin. These are direct strikes to Yin meridians, variations. *Huoren Shu* states: Cold entering from back strikes Taiyang or Shaoyin; from face strikes Yangming, etc., not exclusively Taiyang. Also, pathogens may stay in one meridian, skip meridians, transmit once then stop, or move from Foot to Hand meridians, or change due to medication errors. Thus, texts say: Day 1 Taiyang, quiet pulse = no transmission; rapid/restless pulse = transmission. Days 2-3 absence of Yangming/Shaoyang symptoms = no transmission. Taiyang with floating/tight pulse, pain, fever, unresolved after 7-8 days = exterior remains, sweat it. Shaoyin with dry mouth/throat after 2-3 days = purge urgently with Dachengqi Tang. These ignore day counts. Shouzhen asked: Who dares purge with Dachengqi on Day 2-3? Sages speak generally. Taiyang has most transmissions. Heat pathogens transmit when deficiency exists; strong channels resist. Taiyang (Water) to Yangming (Earth) is Wife to Husband (Minor Evil). Yangming (Earth) to Shaoyang (Wood) is Wife to Husband (Minor Evil). Shaoyang (Wood) to Taiyin (Earth) is Husband to Wife (Tiger Evil). Taiyin (Earth) to Shaoyin (Water) is Husband to Wife (Tiger Evil). Shaoyin (Water) to Jueyin (Wood) is Mother to Son (Deficiency Evil). Taiyang (Water) skipping to Shaoyang (Wood) is Mother to Son (Deficiency Evil). Taiyang (Water) skipping to Taiyin (Earth) is Minor Evil/Erroneous Purging. Taiyang (Water) to Shaoyin (Water) is Dual Yin-Yang transmission (Lianggan). Taiyang (Water) to Jueyin (Wood) is Mother to Son (Deficiency Evil/Head-to-Tail Transmission). Shanghan ending at Jueyin Liver is "Tail" (Jue means end). Righteous Qi recovers, pathogens resolve, Water rises/Fire descends, chills/fevers occur, profuse sweat resolves. If Righteous Qi fails, pathogens persist, Yin excess causes cold limbs, curled tongue, deafness, scrotal contraction, unconsciousness, and death. Zhao Shi says: Yang meridian pathogens are easier to treat; Yin meridian transmission is dangerous due to Yang deficiency/Yin excess and Righteous deficiency/Pathogen excess. Erroneous purging/internal sinking, sweating deficiency, or cross-meridian complications lead to critical states. Essential to read Zhang Zhongjing to understand legislative intent; otherwise, confusion arises. Study examples thoroughly to avoid errors. Relying on fixed formulas without understanding principles leads to mistakes. Xu Shi said: Read Zhongjing's book, use his methods, but do not rigidly stick to his formulas. Scholars should ponder every word. Tao Shi refutes the vulgar theory that "Shanghan transmits only Foot meridians, not Hand meridians." Qi gathers at Danzhong at dawn, flows through Hand-Taiyin Lung, then distributes. One meridian imbalance affects all. Foot meridians dominate Winter (Taiyang/Shaoyin), followed by Spring (Shaoyang/Jueyin) due to Wind-Wood. Earth (Yangming/Taiyin) is affected by all seasons. Exterior pathogens transmitting inward return to Spleen/Stomach, forming dry feces treated with Chengqi Tang. Hand meridians govern Summer/Autumn, so they are less affected in Winter. Foot meridians cover specific directions (Northeast). *Relun* states: Winter cold injury manifests as Shanghan; Spring as Wenbing; Summer as Wenyi (most severe). Zhang Zhongjing said: Without Extraordinary Vessels, there is no Shanghan, as they attach to Foot meridians, not Hand. Thus, cold injures Foot meridians. Long Summer heat diseases involve Hand meridians due to Fire/Water balance. Medications often drain excess rather than tonify Foot meridions, balancing the system. General principle: Foot meridians mentioned first. However, Hand meridian transmission exists. *Cishi Nan Zhi* describes: Days 5-6, confusion, mutism, sleeping speech, red eyes, dry lips/tongue, no thirst, swallowing porridge but refusing water, fine/rapid non-surging pulses, no epigastric fullness/abdominal distension, normal bowels/bladder, or appearing drunk after 10 days. Physicians mistakenly purge with Chengqi Tang. This is heat transmitting to Hand-Shaoyin Heart. Origin: Taiyang Wind-Strike. Wind (Yang) injures Wei, drying Yin Blood. Heat accumulates in Bladder (Ren), reverses to Bing (Small Intestine), siblings Bing/Ding transmit to Heart. Heart fire scorches Lung (clear/vacuous), causing confusion. Treat with Zhizi Huangqin Huanglian Tang. If pulse in Bing, use Daochi San; if in Heart, use Xiexin Tang. Avoid Liangge San (Qi/Blood herb). If Left Cun pulse is deep/sliding/forceful, use Xijiao Dihuang Tang. If no Xijiao, substitute Shengma (Yangming blood-heat herb). If pulse forceful superficial/deep, both Bing/Ding have heat; use half Daochi, half Xiexin. This case: Bladder transmits to Bing, Foot to Hand, Down to Up, Bing to Ding, Exterior to Interior, Ren (Kan) to Ding (Li), Skipping transmission, Fu to Zang. *Huoren* says "Foot not Hand" is incomplete. Follow pulse and symptoms, not rigid sequences.