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Shanghan (Cold Damage), is the general term for exogenous diseases; *Treatise on Cold Damage* (*Shanghan Lun*) is a book that comprehensively discusses exogenous diseases.

(Note) The *Classic of Difficult Issues* (*Nan Jing*) states: "Shanghan includes five types." Thus, these five types of exogenous diseases were all referred to as Shanghan by ancient people. *Treatise on Cold Damage* contains methods for treating wind, warm, summerheat, and dampness pathogens, indicating that it does not exclusively discuss one type of Shanghan.

*Treatise on Cold Damage* states: In Taiyang disease (disease pattern of the Bladder channel), whether fever has already appeared or not, there will definitely be aversion to cold, body pain, vomiting, and reversal of qi, with pulse tightness at both yin and yang positions (cun and chi). This is named Shanghan. This is the typical Zheng Shanghan (True Cold Damage) disease pattern.

(Note) There is no case of Shanghan without fever. The phrase "has not yet developed fever" here refers to the time before the heat manifestation appears, when symptoms such as aversion to cold appear first. This is what is meant by "aversion to cold without fever originates from Yin." Cold belongs to Yin pathogen, so it often presents with aversion to cold first, followed by fever. Pulse tightness at both yin and yang positions means the cun and chi pulses are both tight. The tight pulse resembles the image of fullness in the center of the Kan trigram (☵), which represents cold water. Therefore, the pulse in Shanghan must be tight. If fever has already appeared, the tight pulse must also be floating, which can be deduced.

In Taiyang disease, if there is headache, fever, body ache, lower back pain, joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, Mahuang Tang (Ephedra Decoction) should be used as the primary treatment. This is the treatment method for Zheng Shanghan.

(Note) Cold pathogen condenses and blocks, causing stagnation and excess in the exterior qi, resulting in anhidrosis, wheezing, and aversion to wind and cold. Mahuang Tang is a formula for warming, dispersing, and inducing sweating. If used mistakenly in cases other than Zheng Shanghan, it could lead to the disaster of Yang collapse.

Shanghan occurs in all four seasons. If the corresponding pulse and symptoms are present, the corresponding medicine should be used. As the proverb says: "Prescribe medicine according to the syndrome," this statement is profound! For patients with milder disease severity and slightly weaker constitution, Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Zisu (Perillae Folium), and Baizhi (Angelicae Dahuricae Radix) can all be used to replace Mahuang (Ephedrae Herba). If cold pathogen injures the exterior while heat pathogen lies latent within, cooling agents must be added to the warming and dispersing formulas, following the principle of Zhang Zhongjing's Da Qing Long Tang (Major Green Dragon Decoction).

(Note) Shanghan occurs in all seasons, but during the three months of winter, Cold Water rules, making the cold more intense than in the other three seasons. Therefore, ancients called Shanghan contracted and immediately manifesting in winter "Zheng Shanghan," not implying that Shanghan does not occur in spring, summer, or autumn. If physicians can clearly differentiate syndromes, their medication will naturally not be constrained by the season.

Shanghan refers to cold injuring the exterior and the pathogen lodging in the exterior. If a person's Yang qi is inherently deficient and unable to defend against external pathogens, the external cold can directly enter the interior and invade the zang organs, named Zhong Han (Mid-Cold). This is because Yang deficiency leads to Yin excess. Although Yin is excessive, warming and dispersing methods are contraindicated. Since Yang qi is already deficient, sweat comes out easily; mistakenly administering warming and dispersing drugs will accelerate the danger. It is urgent to use Sheng Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) to restore Yang and break Yin. This is the treatment method.

(Note) Yang deficiency leads to Yin excess; thus, Yin is not truly excessive, but appears so due to Yang deficiency. Therefore, Zhong Han does not necessarily occur only in deep winter; it can also happen in midsummer. In the past, some cured such cases but did not attribute them to Yang deficiency and drinking cold fluids, nor to midsummer cold injury, but rather considered them "Yin Summerheat" obtained from stillness. This self-deception and deceiving others is lamentable. Using Ginger and Aconite to restore Yang and break Yin is akin to the military strategy of strengthening the host and weakening the guest.

The "Zhong Feng" (Wind Strike) in *Treatise on Cold Damage* is one of the five types of Shanghan in *Nan Jing*, which corresponds to "Shang Feng" (Wind Injury) in later generations. Essentially, the characters "Shang" (Injure) and "Zhong" (Strike/Mid) have similar meanings, as seen in phrases like "Wind injures Wei Qi" and "Cold injures Ying Blood." Later generations believed that cold pathogen in the exterior is Shanghan, while cold pathogen entering the interior is Zhong Han, leading to the suspicion that Shang is mild and Zhong is severe. However, this merely distinguishes whether the pathogen is in the exterior or interior. Why would interior-entering cold be heavier than exterior-located cold? It is actually because the original Yang is already deficient, allowing the invading cold to penetrate directly. Releasing the exterior to induce sweating treats the branch (symptoms); the pathogen is not light. Warming the interior to restore Yang treats the root (cause); the pathogen is not necessarily heavy. Differentiating disease into root and branch makes the root heavy, not because the pathogen itself is heavy. Understanding this, we see that Yue Ren (Qin Yueren) and Changsha (Zhang Zhongjing) referring to Wind as Zhong implies Cold as Shang.

(Note) Later generations distinguished "Shang Feng" (Wind Injury) as exogenous wind pathogen and "Zhong Feng" (Wind Stroke) as sudden collapse due to deficient wind, so the names of the two diseases do not mix. However, the meaning of "Shang" and "Zhong" feels increasingly disparate in terms of severity. Therefore, ignorant people stick to Yue Ren and Changsha saying Wind is Zhong, not realizing it is just Shang Feng, and even cite sudden collapse and falling as mutual evidence, which is erroneous.

Since Wind pathogen injuring humans is one of the five types of Shanghan, how could it be a minor illness! Moreover, Wind has no fixed nature; it differs not only among the four seasons but also among the four directions. Dryness and humidity vary, rain and clear skies differ greatly, and Wind-Cold and Wind-Heat change in an instant. Upon infecting humans, treatment methods differ. Zhang Zhongjing's Guizhi Syndrome (Cinnamon Twig Pattern) is Wind-Cold disease; after sweating, if the body becomes burning hot, it is Wind-Heat disease. However, ancients often knew of Wind-Cold but not Wind-Heat. *Treatise on Cold Damage* also states: After taking Guizhi Tang, if profuse sweating occurs followed by severe irritability and unrelenting thirst, with a surging-large pulse, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) should be used. Viewing these together, is this not mistakenly using Wind-Cold medicine to treat the transformed syndrome of Wind-Heat disease? Even in the Han Dynasty it was like this, let alone later generations!

(Note) Modern people view Shang Feng as a minor illness. Those with headache and fever are said to have "Severe Shang Feng," unaware that Shang Feng is exactly the Zhong Feng mentioned by Yue Ren and Changsha. Unclear disease origins explain why there is overuse of warming-drying drugs depleting fluids, and premature use of tonifying drugs trapping pathogens, prolonging until becoming consumption, yet blaming it on "Shang Feng not waking up." Alas, it is the physician who is not awake.

Wind-Heat is the same as Wind-Warmth. It occurs in all seasons, especially in winter and spring. Changsha said: If after sweating the body becomes burning hot, it is Wind-Warmth. This means Wind-Cold disease can be cured by Guizhi Tang inducing sweat; if sweating makes the heat more burning, it is Wind-Warmth disease. Warmth means heat. Later generations failed to study this in detail and claimed Wind-Warmth is a damaged disease after sweating, which is too rigid. The disease is originally heat; adding the acrid-warmth of Guizhi causes fluids to be forced out by heat, leading to profuse sweating. Loss of fluids makes heat more burning, causing severe irritability, thirst, and surging-large pulse. These two clauses seem to discuss one syndrome, primarily using Bai Hu Jia Ren Shen Tang, which aligns with the *Inner Classic* principle: "For wind and heat excess, treat with sweet-cold." Only Mr. Xiangyan (Ye Tianshi) uniquely perceived its subtlety, stating that Wind-Warmth first attacks the Lung, affecting Wei Qi first then Qi level. Treatment initially uses acrid-cool, followed by sweet-cold. His insights are superlative, opening the eyes of the world for millennia.

(Note) In *Treatise on Cold Damage*, the clause "patient's zang organs have no other disease, sweating cures it" and the clause "patient constantly sweats, re-sweating cures it" both prescribe Guizhi Tang. This shows Guizhi Tang is a sweating agent for Wind-Cold, merely milder than Mahuang Tang. *Inner Classic* explicitly states "Acrid and Sweet disperse and are Yang"; how can it treat Wind-Heat disease? Furthermore, those claiming Guizhi Tang stops sweating, Mr. Yao Feng has already refuted this error.

(Correction) Recently, I saw Mr. Wu of Huaiyin's *Systematic Identification of Warm Diseases* (*Wen Bing Tiao Bian*), using Guizhi Tang as the first formula for treating Warm diseases, which is even more debatable.

(Publication) *Correcting Errors in Medical Forest* (*Yi Lin Gai Cuo*) states: "I have never seen Guizhi Tang cure a single case of fever with sweating." Prefect Yang Suyuan strongly disagreed, stating he treated Wind injuring Wei Qi patterns, cured with half a dose of Guizhi Tang. Xiong notes: What *Correcting Errors* describes are Warm-Heat patterns. If Wind-Cold injures Wei Qi, how can one not follow the Sage's method? Even in Ye Tianshi's records under the Cough section, the first few clauses on Wind Injury are all variations of *Treatise on Cold Damage*.

As for Zhong Feng (Wind Stroke), *Inner Classic · Treatise on Living Qi and Heavenly Counterattack* calls it Xu Xie (Deficient Evil), meaning deficiency exists first, then evil strikes. *Treatise on Evaluating Excess and Deficiency* states that fat and noble people suffer from Gao Liang (rich food) diseases. Later scholars' theories focusing on Phlegm, Fire, Qi, and Deficiency all stem from this. Carefully analyzing the classic text, True Zhong Feng is indeed caused by deficient evil striking, and cannot be simply regarded as an Excess pattern. Lei Zhong Feng (Category Wind Stroke) is brewed from rich and sweet foods, and cannot be generally regarded as a Deficiency pattern. One must adjust treatment based on the excess or deficiency of the syndrome, and there will be no omission in treating hundred diseases! How about Zhong Feng?

(Note) Whenever there are syndromes of great deficiency, great excess, deficiency mixed with excess, excess mixed with deficiency, mostly deficiency with little excess, or mostly excess with little deficiency, each school's theory has profound meaning. Neither should be discarded nor adhered to rigidly; the key lies in appropriate application by the user.

Diseases contracted from Wind-Heat in winter and spring are named Wind-Warmth, as辨析ed earlier. If injured by Cold in winter, and when spring energy releases, latent Qi transforms into Heat and emerges, it is named Chun Wen (Spring Warmth), also called Wen Bing (Warm Disease). The pathogen moves from interior to exterior, so there is fever and thirst, but no aversion to cold. However, some may erupt carrying new Wind-Cold infection; although there is aversion to wind and cold, there must be thirst. Mistaken sweating will bring unspeakable disaster. After Changsha, those who understood this meaning include only Mr. Guo Baiyun, Liu Shouzhen, Wang Andao, Zhang Shiweng, Zhou Yuza, and Ye Xiangyan. Their books must be read.

(Note) Wen (Warmth) is the gradual stage of Heat. Latent Cold transforms into Heat, causing dry mouth and thirst, hence named Wen. All warming-dispersing and drying-hot medicines must not be touched. How can a worthy man like Yu Jia Yan mistakenly point to Spring Shanghan in *Medical Canon Corrected* as Warm Disease? Although the treatment was legal, the theoretical stance was largely erroneous. Mr. Jingchuan criticized him correctly, while Yu Xingzhai and Mao Daku praised him enthusiastically, which unfortunately misleads future generations.

Cold injured in winter, lying latent in Shaoyin, emerging before Summer Solstice, is named Wen Bing (Warm Disease); if emerging after Summer Solstice, it is named Re Bing (Heat Disease). Because weather is still warm before Summer Solstice, and hot after Summer Solstice, diseases are named according to the season. Although names differ, the disease is the same, so ancients often used Warm and Heat interchangeably. *Inner Classic* states those after Summer Solstice day are Bing Shu (Summerheat Disease), also because炎暑 (blazing heat) rules after Summer Solstice, hence named Bing Shu. Furthermore, in Heaven it is Heat, on Earth it is Fire, its nature is Summerheat, so Summerheat is Heat. However, this Bing Shu is due to latent Cold transforming into Heat, whereas contracting Summerheat pathogen through inhalation has the same name but different cause.

(Note) Naming diseases with Warm and Heat seems merely to distinguish seasonal Qi. However, named Warm, coolness can cure; named Heat, coldness brings recovery. By looking at the name, the treatment method leaves nothing to be desired. Thus, not minding being named similarly to Cold-Damage Warmth or Inhaled Summerheat precisely shows people the principle of different paths leading to the same goal. Is this not the exquisite analysis of meaning by ancient sages?

Summer season belongs to Fire, sunlight is most fierce, heavenly time is hot. Humans contracting this Qi are named Shang Shu (Summerheat Injury), also called Zhong Shu (Mid-Summerheat). The character Shu (Summerheat) contains Sun (Ri), called Yan Shu (Blazing Summerheat) or Ku Shu (Bitter Summerheat), all referring to the fire of the scorching sun. The Sun is the ancestor of all Yangs; when the sun rises, small fires lose their light. Using a Yang Sui (fire lens) to catch sunlight, fire can be generated instantly. *Inner Classic* says: "When Year Fire is excessive, blazing summerheat spreads." If there are long sunny days in the three winters, Dry-Fire diseases arise, let alone Summer heat! Yet Changsha named Mid-Heat as Ye (Heat Stroke), not Shu, to distinguish it from the latent Qi Summerheat disease emerging after Summer Solstice. Also, *Shuo Wen*: Ye means Shang Shu. Therefore, Shu, Re, and Ye are all Qi of the scorching sun. Later generations ignorant of this led to many divergent theories, truly showing ignorance of cold and heat. Shu is Li Fire; Li trigram is empty in the middle, so Shu pulse is also deficient. Shu injures Qi, so Qi deficiency with body heat is Shang Shu, known as "Strong Fire consumes Qi." Shu is Yang pathogen. Heavenly Qi connects to the nose; the nose is the orifice of the Lung; Lung governs skin and hair. Thus, Shu pathogen enters the Lung via the nose. Lung scorched by Fire causes profuse sweating, similar to Wind injuring Wei Qi, differentiated by thirst or no thirst. Thirst indicates Dryness. Nothing dries things more than Fire. Hence, in Warm-Heat diseases, Changsha highlights the character "Thirst" as the standard. Mr. Jiayan said: Ancients considered Dry-Heat as Summerheat, grasping the essence.

(Note) Shu contains Sun (Ri); Sun is Fire in Heaven, so Ri is above. Han (Cold) contains Bing (Ice); Bing is Water in Earth, so Bing is below. Shu is Yang pathogen, easily entering Heart Meridian; Han is Yin pathogen, first attacking Bladder. Heaven and Earth differ, each following its kind. Those who consider Shu as Yin pathogen are like sitting in a well looking at the sky, failing to see the sun's face.

Damp Earth prospers in all four seasons, with Chang Xia (Long Summer) being its proper command. Damp earth and humid heat combine, so Summerheat and Dampness Qi easily merge. Humans contracting this are named Shi Wen (Damp-Warmth), also called Shi Re (Damp-Heat), i.e., Summerheat-Dampness combined disease, one of the five types of Shanghan, detailed in *Nan Jing* regarding pulse and syndrome. Ignorant people indulge in speculation, claiming Damp combined with Heat begins to be named Shu. Then, what would Damp combined with Cold be named? Heaven cold and Earth frozen, Heaven hot and Earth warm, are the opposition of Yin and Yang. If Shu must be Damp-Heat combined to be Shu, what Qi combines with Han to make Han? In years of extreme drought, melting metal and scorching stone, crops wither, rivers crack, wells dry up—what else but call it Ku Shu (Bitter Summerheat)? Dampness has no fixed form; it can combine with Wind, Cold, or Summerheat. Therefore, treating Dampness requires observing its combination; treating Summerheat requires examining whether Dampness is concurrent, leaving no regret. However, Damp-Heat diseases are most numerous, transformations are easy, and treatment is difficult. Only Mr. Xiangyan's methods can be described as unprecedented. Students should regard them as golden rules.

(Note) Shu and Shi are both one of the Five Qi. Shu belongs to Fire, Shi belongs to Earth, occupying one of the Five Elements respectively. Fire and Earth combine virtue, so Shu and Shi easily combine, which is normal logic. If saying Shu contains Dampness, it splits one element into two; if saying Damp-Heat combined becomes Shu, it merges two Qi into one. Does this mean unknown Five Element principles and unheard Five Qi names? Self-deception and deceiving others, nothing is worse than this.

Wen Bing, Re Bing, and Shi Wen Bing, if treated improperly, easily lead to death. Continuous spread becomes Yi Li (Epidemic Pestilence). Just as treating bandits improperly leads to many thieves becoming roaming bandits. Due to Heat Qi, Disease Qi, and Corpse Qi tangling together, they become Toxic Pestilence Qi forming Epidemic. Is it really another kind of abnormal Qi between Heaven and Earth? Therefore, Epidemics spread only in densely populated urban areas. In remote mountains and sparsely populated places, there are never major epidemics. If it were another kind of abnormal Qi, why would it choose locations? Its prevalence after war and famine is because deaths from war and famine also occur in densely populated areas. Human Qi is hottest. Mr. Ji Xiaolan's miscellaneous poem says: "Ten thousand households' smoke and fire warm the clouds, melting away the ancient ice of Tianshan Mountain." Self-note: Since Dihua established prefectures and counties, infant smallpox is the same as inland. That place's climate is extremely cold, but in recent years it has gradually become like inland due to abundant human Qi. Ah! Mr. Ji's words hit the mark. In ancient times, there was no smallpox; it started in Han Dynasty. Now, almost everyone gets it. Why? Population grows daily, Earth Qi heats daily. Thus, ancients feared Shanghan most, while modern times have more Warm-Heat. Fe Jianzhong treating smallpox with Epidemic methods, isn't that a unique insight for millennia? The key to treating Epidemics lies in six characters: Clearing Heat, Resolving Toxicity, and Ventilating Qi. Ventilating Qi is especially the priority. Without ventilated Qi, Heat cannot be cleared, and Toxicity cannot be resolved. Asking the masters, is this correct?

(Note) Although Warm Disease can become Epidemic, treating Warm Disease and Epidemic differs. Wu Keyou conflating them for treatment is somewhat rough, and unaware that Summerheat-Heat can also cause Epidemic. In the Jiazi year of Qianlong, the capital suffered Summerheat Epidemic, countless died of heat. Xu Houshan's *Liuya Waibian* mentioned this. Later, Yu Shiyu specialized in discussing Heat Epidemic, pitying his book didn't circulate widely.

(Correction) The method of Ventilating Qi applies not only to medication. Clothing and bedding should be clean; diet should be bland; bedroom spacious; windows open; attendants not crowded; lights few; gentle breeze blows, Epidemic Qi naturally dissipates. Opposite actions make Heat Qi and Turbid Qi support Epidemic Qi. Patients and physicians should recognize this.

(Publication) Smallpox is Epidemic Qi. Wan Mizhai and Wang Xunchen knew this; Rash is Epidemic Qi, known only by Yu Shiyu, hence his book titled *One Gain from Epidemic Rash*. Treating Epidemic specifically uses large doses of Shi Gao (Gypsum Fibrosum). Mr. Xiaolan witnessed its miraculous skill and recorded it in *Notes from the Yorwei Studio*. During Daoguang era, Jiang Bihua of Gui'an followed this method. *Medical Mirror* records treating a local epidemic with rash, using 14 jin of Gypsum until rash emerged, sighing that Master Yu's way is not lonely. Previously staying in Dong'ou, encountering many Warm patterns, local custom forbade grain food for patients, eating only sweet potatoes. I said: When Warm Evil first emerges, how can one eat solid spleen-tonifying and Qi-nourishing foods? Locals thought it was tradition and didn't listen. Moreover, physicians preferred warming and tonifying drugs, leading to successive deaths, none surviving. People called it Heavenly Traveling Seasonal Epidemic. I sighed: This Epidemic is brewed by medicine, not Heaven having abnormal Qi, but Humans having abnormal treatment. Should name this disease "Medicine Epidemic." Arriving in Yihuang, Prefect Yang Suyuan stated Jiangxi Feishang was similar. Thus, in the vast world, frequent epidemics, I fear those brewed by medicine exceed the two places I've seen and heard. Compared to cultivating bandit troubles, this is an accurate metaphor.

Cold, Summerheat, Dryness, Dampness, and Wind are the Five Elements' Qi combining with Five Zang and moving through Four Seasons. Only Fire prospers in Summer, specifically called Shu (Summerheat). Shu contains Sun (Ri), clarifying it is the Qi of the scorching sun blazing above. However, the warmth of the three seasons is none other than the light of the Li Sun, so it cannot be called Shu, hence the name Six Qi. Actually, Fire is the flame of Shu, just as Water is the substance of Cold. It is not an additional Qi outside the Five Qi. The reason human Fire diseases are particularly numerous is that Wind, Cold, Dryness, and Dampness can all transform into Fire, and excessive movement of Five Emotions all generate Fire. Mr. He Baozhi discussed this in detail. I believe these cannot be called Shu, so the Sage added the character Fire under the Five Qi, its meaning is profound. If discussing Five Elements, speaking of Shu includes Fire, yet physicians often don't know this, hence repeated explanation.

(Note) Mr. He's discussion on Fire: Danxi said "Excess Qi is Fire," this is one Fire, treatment should be cooling; "Qi deficiency also stagnates into Fire," Dongyuan's so-called Yang deficiency fever, this is another Fire, treatment should be sweet-warm to tonify Qi, slightly assisted by sweet-cool to drain Fire. External contraction of Summerheat-Heat-Dryness Qi increases internal Qi heat, this is one Fire, treatment should be sweet-moist and cooling. External contraction of Wind-Cold-Dampness Qi closes exterior and generates heat, this is also one Fire, treatment should be acrid-warm dispersing. Internal injury from spicy-hot food causes Fire to blaze with heat, this is one Fire, should use bitter-cold agents to digest. Internal injury from cold-raw food suppresses Fire, making it angry, this is another Fire, treatment should be acrid-hot agents to digest. Kidney Water deficiency causes Lower Jiao Fire to flare upward, this is one Fire, treatment should be Liu Wei Wan (Six Flavor Pill) etc. to tonify Water and control Fire. This is Water dried up and Fire flaming syndrome, upper and lower both hot. Physicians using Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Prepared Aconite Root) always say "Guide Fire Back to Source," not knowing where to guide it, causing cruel heat in Middle and Upper, scorching Three Yin, killing like flies, bringing great disaster. Kidney Yin excess forces floating Fire to rise, this is another Fire, treatment should be Ba Wei Wan (Eight Flavor Pill) etc. to guide Fire back to source. This is Lower Cold and Upper Heat syndrome, so using Fu Zi and Gui Zhi to tonify Fire, must not be mistakenly given to Yin deficiency syndromes.

(Correction) Above discusses Six Qi.
Observing the character "Lao" (Consumption/Overwork), one can obtain the method for treating Consumption. Moreover, *Nan Jing* and *Jin Gui* discuss it most precisely, *Li Xu Yuan Jian* elaborates in detail. Reading these three books leaves no omitted meaning. Although pulse is large...