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(The differences of Cold Damage in the four seasons, transmission and transformation, general principles of sweating and purging, indications for sweating, contraindications for sweating, indications for purging, contraindications for purging, indications for emesis, contraindications for emesis, resolution of disease, death syndromes, Yin and Yang, exterior and interior, Cold Damage and miscellaneous diseases, differentiation of similar syndromes, miscellaneous discussions, brief overview of observing complexion)

The *Treatise on Yin and Yang* states: The climate of spring is mild, the climate of summer is hot and humid, the climate of autumn is cool, and the climate of winter is cold and biting. This is the sequence of the normal Qi (vital energy) of the four seasons. In winter, when it is severely cold, all things hide deeply. If a gentleman can keep his body secure and closed (solidify the defensive Qi), he will not be injured by cold; however, if one exposes oneself to or violates the cold, it is then called Cold Damage (Shanghan). Nevertheless, injury by the Qi of the four seasons can all cause disease (i.e., the epidemic Qi mentioned below). Cold Damage is termed "poison" because it forms the most lethal and destructive pathogenic factor. Those who contract it and fall ill immediately are said to have Cold Damage. Those who do not fall ill immediately harbor the cold toxin in their skin and muscles; when spring arrives, it transforms into Warm Disease (Wenbing); when summer arrives, it transforms into Summerheat Disease (Shubing). Summerheat disease is more severe in heat than Warm Disease. (*Neijing* states: Diseases acquired before the Summer Solstice are called Warm Disease; those acquired after the Summer Solstice are called Summerheat Disease. Both Warm Disease and Summerheat Disease originate from injury by cold, hence the Imperial Physicians generally refer to them as Cold Damage.) Therefore, hardworking people often suffer from warm-heat diseases in spring and summer, all caused by violating cold in winter, not by the "epidemic Qi." (*Huoren Shu* states: Fever, aversion to cold, headache, heavy body, and painful joints with a surging pulse in summer indicate this condition. Injury by cold in winter, triggered by summerheat Qi, develops into heat disease.) Whenever there is epidemic Qi, it refers to situations where spring should be warm but is excessively cold, summer should be hot but is excessively cool, autumn should be cool but is excessively hot, and winter should be cold but is excessively warm. Because the climate does not match the season, illnesses among people of all ages in that year tend to be similar; this is what is called epidemic Qi. (This section distinguishes between Cold Damage and seasonal epidemic Qi.) To understand the methods for diseases caused by normal seasonal Qi and epidemic Qi, one must consult the astronomical calendar (Doulì).

**Method for Determining Disease Based on Four Seasons, Eight Festivals, Twenty-Four Solar Terms, and Seventy-Two Pentads:**
Li Chun (Start of Spring), first month festival, Dipper points Gen; Yu Shui (Rain Water), first month middle, Dipper points Yin.
Jing Zhe (Awakening of Insects), second month festival, Dipper points Jia; Chun Fen (Spring Equinox), second month middle, Dipper points Mao.
Qing Ming (Clear and Bright), third month festival, Dipper points Yi; Gu Yu (Grain Rain), third month middle, Dipper points Chen.
Li Xia (Start of Summer), fourth month festival, Dipper points Xun; Xiao Man (Grain Buds), fourth month middle, Dipper points Si.
Mang Zhong (Grain in Ear), fifth month festival, Dipper points Bing; Xia Zhi (Summer Solstice), fifth month middle, Dipper points Wu.
Xiao Shu (Minor Heat), sixth month festival, Dipper points Ding; Da Shu (Major Heat), sixth month middle, Dipper points Wei.
Li Qiu (Start of Autumn), seventh month festival, Dipper points Kun; Chu Shu (End of Heat), seventh month middle, Dipper points Shen.
Bai Lu (White Dew), eighth month festival, Dipper points Geng; Qiu Fen (Autumn Equinox), eighth month middle, Dipper points You.
Han Lu (Cold Dew), ninth month festival, Dipper points Xin; Shuang Jiang (Frost Descent), ninth month middle, Dipper points Xu.
Li Dong (Start of Winter), tenth month festival, Dipper points Qian; Xiao Xue (Minor Snow), tenth month middle, Dipper points Hai.
Da Xue (Major Snow), eleventh month festival, Dipper points Ren; Dong Zhi (Winter Solstice), eleventh month middle, Dipper points Zi.
Xiao Han (Minor Cold), twelfth month festival, Dipper points Gui; Da Han (Major Cold), twelfth month middle, Dipper points Chou.
(Twenty-four solar terms include twelve "Jie" (terms) and twelve "Zhong Qi" (middle Qi). Every five days constitute one "Hou" (pentad). The logic applies equally to Qi and Hou. Understanding these seventy-two pentads is essential for determining life and death in disease.)

After Frost Descent in September, the weather gradually becomes cold until Major Cold in winter. After the Rain Water term in January, ice and snow melt into rain, and the cold dissipates. Hence it is called "Rain Water." By the Awakening of Insects term in February, the climate becomes gradually warm, trending toward the great heat of summer; by autumn, it turns cool. (These are the normal Qi of the four seasons.) From Frost Descent until before the Spring Equinox, anyone who exposes themselves to ice and snow and falls ill due to internal cold is diagnosed with Cold Damage. In September and October, the cold air is still slight, so the illness is mild. In November and December, the cold is severe, so the illness is heavy. In January and February, the cold is gradually resolving, so the illness is light. This occurs when one fails to regulate properly during winter, leading to immediate onset of Cold Damage. (This refers to immediate onset of Cold Damage due to normal seasonal Qi.) If there is unseasonable warmth in winter, it is called Winter Warmth (Dongwen). The toxicity of Winter Warmth is vastly different from Cold Damage. Winter Warmth has early and late occurrences, with varying severity and treatment, detailed in subsequent chapters. (This is epidemic Qi. As stated earlier, "winter should be cold but is warm.") There are three regular patterns for Winter Warmth: the fifth Qi of Shaoyin ruling heaven, the final Qi of Yangming ruling heaven, and the final Qi of Jueyin ruling heaven. Irregular patterns cannot be predicted and must be adjusted according to time. After the Start of Spring term, if there is no sudden severe cold or ice/snow, yet someone suffers from high fever, it belongs to Warm Disease transforming from latent winter cold due to the outward expansion of spring Yang Qi. (*Neijing*: "Injury by cold in winter leads to Warm Disease in spring.") There are four regular patterns for Spring Warmth: the first Qi of Shaoyin, Taiyang, and Yangming ruling heaven, and the second Qi of Taiyin ruling heaven. Irregular patterns require adjustment based on time. From the Spring Equinox until before the End of Autumn term, sudden cold spells constitute an epidemic cold plague (Shixing Hanyi). In March and April, when Yang Qi is weak, cold suppression results in milder heat. In May and June, when Yang Qi is strong, cold suppression results in heavier heat. In July and August, when Yang Qi is declining, cold suppression results in milder heat. These symptoms resemble Warm Disease and Summerheat Disease, but treatments differ. (This distinguishes epidemic cold from Cold Damage; the key is distinguishing the pathogen as cold, heat, or warm, which dictates the temperature nature of the herbs.) Every fifteen days yields one Qi. In each season, there are six Qi, totaling twenty-four Qi. However, climates may arrive early, late, or excessively, creating pathogenic factors. (*Suwen*: Huangdi asks about Qi arriving on time, late, or excessively. Qibo explains that timely arrival is harmony; late arrival is deficiency; early arrival is excess. *Jingui Yaolue*: Mentions early arrival, late arrival, lingering Qi, and excessive Qi. The Master says: After Winter Solstice, on the Jiazi day at midnight, Shaoyang Qi rises. If the weather warms before Jiazi, it is "early arrival." If it remains cold after Jiazi, it is "late arrival." If cold persists long after Jiazi, it is "lingering Qi." If it becomes as hot as midsummer after Jiazi, it is "excessive Qi.") Heaven and earth move and rest, Yin and Yang interact, each maintaining its own Qi. Thus, spring's warmth becomes summer's heat, and autumn's severity becomes winter's anger. After Winter Solstice, one Yang line rises and one Yin line descends; after Summer Solstice, one Yang line descends and one Yin line rises. This is the convergence of Yin and Yang at the solstices and their separation at the equinoxes. Through the interaction of Yin and Yang, humans change and become ill. Therefore, gentlemen nourish Yang in spring and summer, and Yin in autumn and winter, following the heaven-earth rigidity and flexibility. Commoners who violate these rules suffer from violent rashes. One must determine which meridian holds the toxic Qi and what disease it causes, examining carefully to treat effectively. Thus: Wind injury in spring leads to undigested diarrhea in summer; Summerheat injury in summer leads to malaria in autumn; Dampness injury in autumn leads to cough in winter; Cold injury in winter leads to Warm Disease in spring. This is the inevitable way; it must be clearly understood. For Cold Damage, prescriptions must be applied according to the daily progression of the disease. (Scripture states: If less than three days, cure by sweating; if more than three days, cure by purging.) Nowadays, people with Cold Damage either delay treatment, receive incorrect treatment, or wait until they are critically ill before seeking help. Doctors then fail to treat according to the stages, missing the mark. One must adjust prescriptions dynamically to ensure efficacy. Here, we collect Zhang Zhongjing's old theories, recording syndromes, pulse diagnosis, voice, and complexion, along with authentic prescriptions for specific diseases that have proven miraculous, to meet urgent needs. (Zhang Zhongjing's works have been prominent for a millennium largely due to Wang Shuhe.) Furthermore, land varies in warmth, coolness, altitude, and texture; materials vary in rigidity and flexibility; diet and residence differ. Thus, the Yellow Emperor asked questions about the four directions, and Qibo presented healing methods for the four regions to instruct later generations. Practitioners must double-check these factors. (Pang Anchang said: Only a master like Wang Shuhe could achieve this. For example, Guizhi Tang is effective year-round in the northwest. In the warmer Jianghuai region, it is only suitable for winter and spring. From late spring to pre-summer solstice, Huangqin should be added to Guizhi Tang, Mahuang Tang, and Qinglong Tang. From summer solstice onwards, Zhimu, Daqingye, Shengma, and Shigao should be added to Guizhi Tang for sweating. For epidemic cold or chronic deficiency-cold, use standard ancient formulas without modification. Although Baihu Tang is suitable post-summer solstice, it is mainly for post-sweating exterior release if summerheat transforms from recent cold exposure; Baihu Tang alone cannot expel exterior pathogens. Some patients in deep winter or early spring develop mania after sweating/purging; this should be treated as internal heat, ignoring seasonal constraints. Southern regions without frost/snow do not suffer from external cold invading; earth Qi does not store, insects release toxins, and miasmas arise; different treatments apply. Also, mountain dwellers live in yin-accumulating areas with ice/snow even in midsummer; their pores close, protecting them from pathogens, leading to longevity. Illnesses are mostly wind-stroke or cold-strike. Plain/delta dwellers live in yang-accumulating areas with grass in winter; their pores open, making them susceptible to pathogens, leading to shorter lifespans. Illnesses are mostly warm-strike or summerheat-strike.)

Wang Lu stated: Cold injury has immediate onset and delayed onset. Immediate onset occurs at the time of infection; delayed onset occurs later in spring or summer. Immediate onset is called Cold Damage; delayed onset is called Warm or Summerheat diseases. Although Cold Damage, Warm Disease, and Summerheat Disease differ in category, their origin (etiology) is the same. Hence, they are collectively called Cold Damage. However, because their categories differ, treatments must not be confused. Confusing treatment based on nomenclature would harm future generations and lead to the abandonment of Zhang Zhongjing's methods. This is like blaming Boyi for falling into a well or Suiren for a fire. Zhang Zhongjing's laws and formulas were specifically designed for immediate Cold Damage, not for delayed Warm/Summerheat diseases. If later generations understood that Zhang's book was for immediate cases, they would regret the loss of his methods rather than abandon them due to fear of incompetent doctors' errors. Modern practitioners borrowing Cold Damage methods for Warm/Summerheat diseases are merely using them incidentally, not following Zhang's original intent. However, these methods can be borrowed for any miscellaneous disease. Moderns believe Zhang's methods cover both Cold Damage and Warm/Summerheat diseases. This confuses the stream with the source. Let me prove this: In Zhang's book, 70-80% of Shaoyin, Shaoyang, and Taiyin syndromes are cold, whereas delayed Warm/Summerheat diseases are purely heat. How can they become cold? Later generations treating Zhang's book as universal led to suspicion of warming agents. Han Zhihe found Guizhi Tang difficult to use, attributing it to changing times, but failed to realize Zhang's focus on immediate Cold Damage. His *Wei Zhi Lun* treats Warm/Summerheat as Cold Damage, ignoring immediate Cold Damage. He misinterpreted pre-summer solstice symptoms (chest fullness, vomiting, cold limbs) as Warm/Summerheat, similar to Zhang's Shaoyin cold syndromes, and created "Warming Middle" methods. Zhang's Shaoyin cold syndromes were for immediate winter Cold Damage. Applying these to spring/summer Warm/Summerheat is erroneous. I believe chest fullness/vomiting result from internal cold food, sudden cold exposure, or overuse of cold medicines, or dual cold injury. Han Zhihe prescribed warming without investigating the cause of cold; understanding the cause reveals Warm/Summerheat lacks cold syndromes. Zhu Fengyi's *Huoren Shu* clarified many aspects of Zhang's work, recognizing that Cold Damage entering Yin meridians causes cold syndromes. However, he also failed to recognize Zhang's focus on immediate cases, mixing Cold Damage and Warm/Summerheat discussions. He combined transmitted heat syndromes with immediate cold syndromes, suggesting Yangming requires purging and Shaoyin requires warming. This is contradictory: if Shaoyin involves transmitted heat, can it be warmed? Especially for Warm/Summerheat Shaoyin, warming is contraindicated. Zhu's theory caused widespread harm. Cheng Wuji's commentary praised Zhang's terminology but missed the nuance of immediate cold syndromes and the original legislative intent, leading to superficial interpretation. Liu Wansu also treated Warm/Summerheat as Cold Damage, omitting immediate Cold Damage. His辛凉 (pungent-cool) dispersal formulas corrected errors in treating wind-stroke/Cold Damage but retained confusion regarding Guizhi/Mahuang. He argued that pungent-hot herbs like Mahuang/Guizhi must be cooled in summer to prevent jaundice/rashes. This view, shared by Pang Anchang and Zhu Fengyi, misunderstands Zhang. Zhang did not intend these formulas for summer heat. Recognizing that Guizhi/Mahuang are not for Warm/Summerheat resolves doubts. Cold initially attacks the exterior, closing pores and trapping Yang Qi, causing heat; thus, pungent-warm herbs are needed to open pores and release heat (Mahuang Tang). Wind injury loosens pores but traps pathogen, damaging Zheng Qi and causing heat; pungent-sweet-warm herbs disperse the pathogen and restore pore closure (Guizhi Tang). No cooling herbs were added because the pathogen was in the exterior during cold weather. Later generations, confused by the heat of these herbs in spring/summer, suggested adding cooling herbs. This stems from misunderstanding the rationale. If Zhang formulated for Warm/Summerheat, he would not have done this. His methods were lost, causing confusion. Knowing Zhang's book targets immediate Cold Damage clarifies why Mahuang/Guizhi are used. Except for transmitted heat, direct Yin meridian injuries and non-heat-trapped Taiyang injuries transforming into Yin cold syndromes fit these formulas. In spring/summer, wind/cold symptoms resembling Cold Damage are usually new acute infections, not delayed winter injuries. Or, Wind/Cold triggers latent heat, causing Warm/Summerheat. Zhang states: "Taiyang disease with fever, thirst, and no aversion to cold is Warm Disease." Thus, Warm Disease should feature thirst, not aversion to cold. Summerheat disease is similar to Warm Disease but more severe. While some spring/summer cases have exterior signs, Guizhi/Mahuang should be used cautiously. Do not rigidly follow "releasing exterior ignores heat." Use pungent-cool dispersal instead. Misuse leads to mania, rashes, jaundice, and epistaxis. Occasional success in spring/summer is accidental; do not make it a rule. Moderns use Baidu San, Susu Yin, etc., indiscriminately. While not ideal, it is safer than misusing Mahuang/Guizhi in summer. However, these formulas only treat acute wind/cold in spring/summer, not delayed Warm/Summerheat diseases. Using them for the latter is harmful. Zhang uses warming herbs in Yin meridians because the pathology demands it and timing is appropriate. Excluding Yin cold syndromes from Zhang's scope betrays his benevolence. Recent scholars prioritize cooling, neglecting warming herbs, claiming modern "fire" eras don't suit ancient "water" methods. This is questionable. Understanding Zhang's focus on immediate cases validates the use of Guizhi/Mahuang and warming herbs. If Zhang's methods covered all epidemics, would Six Meridian formulas treat Wind-Warmth and Malaria? *Shanghan Li* states Winter Warmth differs from Cold Damage. Epidemic cold differs from Warm/Summerheat. Thus, Zhang had specific methods for these, now lost. Wang Shuhe compiled Zhang's scattered works, a great merit, but mixed his own views and miscellaneous pulses/diseases at the beginning, confusing jade with stone. If he had placed Zhang's words first and appended his own, confusion would be avoided. I intended to reorganize the book: *Shanghan Li* first, then Six Meridians, similar diseases, post-recovery, diagnostics, methods, contraindications, errors, etc., attaching relevant miscellaneous items and deleting irrelevant ones. This would clarify the law and distinguish truth from falsehood. Lacking time, I record this for the future.

**On Cold Damage, Warm Disease, and Heat Disease:**
There are etiology, disease name, and disease manifestation. Identifying the cause, naming correctly, and observing form are prerequisites for treatment. Cold Damage is named by etiology; Warm/Heat diseases are named by season and manifestation. All originate from cold injury, leading some to call them all Cold Damage. While the cause is the same, treatment cannot be uniform. Cold Damage occurs between Frost Descent and Spring Equinox, often delaying onset until spring/summer due to trapped heat. Immediate Cold Damage occurs in cold weather, with cold pathogen in the exterior closing pores; pungent-sweet-warm herbs are necessary (Guizhi/Mahuang Tangs). Warm/Heat diseases occur in warm weather, with internal heat reaching the exterior and blocking pores, without exterior cold; pungent-cool, bitter-cold, or sour-bitter herbs are required. Thus, Guizhi/Mahuang Tangs (treating exterior only) are unsuitable, while formulas like Shuijie San, Dahuang Tang, Qianjin Tang, and Fangfeng Tongsheng San (treating interior and exterior) are applicable. Immediate Cold Damage has aversion to wind/cold due to exterior pathogen damaging surface Qi. Delayed Warm/Heat diseases have aversion to wind/cold only if newly superimposed with wind/cold damaging surface Qi. Without new wind/cold, there is no aversion to wind/cold. Hence Zhang states: "Taiyang disease with fever, thirst, and no aversion to cold is Warm Disease."