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(Commentary: At the beginning of each chapter in the *Shanghan Lun* (Treatise on Cold Damage Diseases), the character "Bian" (Differentiation/Discernment) is prefixed. The absence of this character in the current *Jin Gui Yu Han Yao Lue* (Essentials from the Golden Cabinet and Jade Box) is likely due to deletion by later editors. The *Waitai Miyao* (Secret Essentials of the Outer Palace), in its formulas for treating malaria, quotes Zhang Zhongjing's *Shanghan Lun*, where each item begins with phrases such as "Bian Malaria Disease" and "Bian Malaria Pulse," which serves as sufficient evidence.)

Thirteen Discourses (The number "three" should be "five".) Three Sections on Pulse and Symptoms (All versions read "two sections," but "three" should be adopted.)

Question: What is the principle behind a superior physician (Shanggong) treating disease before it arises?

[Xu] In medicine, there are major critical points that cannot be addressed solely by focusing on a single disease. In the first volume, Zhongjing specifically highlights dozens of aspects to establish treatment methods. This discusses the principle of the mutual overcoming of the Five Elements (Wu Xing), where diseases inevitably transmit sequentially; therefore, one must prepare in advance to prevent transmission. [Wei] This section comprehensively indicates that various diseases should be planned for early on, rather than waiting until the disease is established to treat it, which would lead to regret. Treating in advance requires less effort and yields greater success. This is akin to the merit of "bending the chimney and moving the firewood" (preventing disaster before it happens), which should be valued above "scorched heads and broken foreheads" (remedying after damage has occurred). Mentioning the Liver first is because the Qi of the four seasons begins in Spring, and the Qi of the Five Zang Organs also begins with the Liver. The *Book of Documents* (*Hong Fan*) states that following the correct path at the start ensures order without error; thus, the Liver is cited first as a standard. [Zhu] Sweet flavor enters the Spleen and can also soothe the Liver, harmonizing both organs so they do not overcome each other.

Note: Zhao Shi detailed the辨析 (differentiation) of the principles of "Pungent tonification" in the *Neijing* and "Sour tonification" by Zhongjing. This stems from content relied upon by You Shi; due to length, it is not fully recorded.

Humans inherit the Five Constants (Five Elements) and grow relying on Wind and Qi. ("Bin" is written as "Bing" in Zhou's edition.)

Note: The *Book of Rites* (*Yueji*) says, "Guide the movement of the Five Constants." The commentary notes: "The Five Constants refer to the Five Elements." The *Liyun* chapter states: "Therefore, humans are the virtue of Heaven and Earth, the intersection of Yin and Yang, the meeting of spirits, and the essence of the Five Elements." It further says: "Humans are the heart of Heaven and Earth, the beginning of the Five Elements." Yang Shangshan, in his commentary on the *Taisu Jing*, states: "Wind Qi and Air Qi are the same. Slow-moving is called Qi, fast-moving is called Wind. Human birth occurs by sensing Wind and Air Qi; human illness occurs due to Wind and Air Qi. Thus, Wind is the leader of a hundred diseases." The *Jiyun* under the character "Ban" says: "It is also a name for numbers. Do not violate the King's Law." This generally refers to not violating the King's laws to incur punishments like tattooing, nose-cutting, or castration. The *Baihu Tong* states: "Violating the King's law leads to execution by the Fangbo." My elder brother said: "Exhaustion" refers to the meaning in the *Neijing* of "exhausting essence through desire." Additionally, the *Yizong Jinjian* holds that the internal cause involves deficiency in the center, the external cause involves excess in the center, and the non-internal/non-external cause is neither central interior nor exterior. Xu Shi believes that the three sentences "fitting into meridians and collaterals" correspond to the previous paragraph on internal causes; the four sentences "limbs just feeling heavy and stagnant" correspond to the previous paragraph on external causes; and the two sentences "moreover, do not violate the King's law" correspond to the previous paragraph on sexual activity, all of which are correct. However, examining the sentence "regulate food and drink regarding cold, heat, bitter, sour, pungent, and sweet," it seems that below "sexual activity," the characters "food and drink" might have been omitted. Otherwise, does that sentence imply irregularities in food and drink? Viewing it this way, the upper and lower parts correspond well, and it aligns with pathology. The five sentences following "moreover, do not violate the King's law" all correspond to the previous paragraph on sexual activity.

Furthermore, Kitamura Naohiro stated: "Food and drink" refers to clothing and diet. The *Ling Shu* chapter *Shi Chuan* says: "Diet and clothing should also adapt to cold and heat," which supports this view. This interpretation is correct. (Kojima Hisamasa noted: In the *Golden Seventy Treatise* translated by the Indian monk Didi from the Chen dynasty, it is stated: 'Three sufferings: one based internally, one based externally, one based on heaven.' This also discusses the three causes, somewhat similar to the scripture's intent.)

Question: The patient's complexion appears on the face. ("Chest above" is written as "Chest middle" in Zhou and Leiju editions.)

Note: Wei Shi said: "The nose is the opening of the Lung and governs the primal Qi of the whole body. The Qi of the Five Zang Organs is all received from the Lung, and the true color of the Five Zang Organs must emerge at the tip of the nose along with the entry and exit of Qi. This is why the tip of the nose can verify the true color of the Five Zang Organs." This explanation differs from You Shi's view but should be preserved as an alternative interpretation. The *Tan Yin Pian* (Discourse on Phlegm-Fluids) states: "Inter-diaphragmatic retained fluid, the person wheezes and feels full, the epigastrium is hard and obstructed, and the complexion is dark." This elucidates the current section. Furthermore, cases of yellow complexion and white complexion were attributed by Shen, Wei, and Zhu to the nose. Checking the *Qianjin Fang*: "The discourse says: A slightly white tip of the nose indicates loss of blood; if slightly red and not during the proper season, death ensues. Patients with a white complexion all suffer from loss of blood." It also says: "Observing a patient's nose tip being yellow indicates difficulty in urination according to method." These seem to be the basis for the three scholars.

Master said: The patient speaks with a silent voice.

Note: "Yin" (mute) should be interchangeable with "Mo" (silent). The *Rites of Zhou* (*Dian Tong Zhi*) states: "Faint voice Mo." Zheng Xuan's commentary: "Mo means the voice is small and indistinct."

Master said: Breathing accompanied by shoulder movement indicates hardness in the chest/heart.

Note: Zhao Shi said: "This is Zhongjing's method of observing disease through respiration, mentioned alongside the subsequent point on inhalation, merely to present an aspect." Xu's commentary is based on this. Shen Shi believed this distinguishes between panting with phlegm-Qi, lung distension, and lung flaccidity. While plausible, it is not as precise as Wei Shi's. However, Wei Shi's interpretation of "saliva/froth" may be incorrect. Shen Shi said: "Heat in the Lung scorches the leaves, Qi becomes weak and unaroused, body fluids transform into saliva, which overflows upward to the mouth, causing spitting of saliva/froth." This seems reasonable. Generally, what ancients called "mo" is modern phlegm-saliva, not necessarily white froth. (Refer to *Fei Fei* and *Tan Yin Pian*.) Also, the differentiation between phlegm-cough and lung flaccidity in the *Yizong Jinjian* is inadequate.

Furthermore, Xu Shi commented on the complexion section: "Inspection values the dynamics of Shen Qi (Spirit Qi)." This is a profound statement. One should ponder deeply when inspecting breath.

Master said: Inhalation is slight and rapid.

Note: Zhu Shi used the sentences about Upper Jiao and Lower Jiao as footnotes for untreatable deficiency, which is erroneous. Also, the term "tendons and vessels" in Wei Shi's commentary should be deleted.

Master said: When the Cun Kou pulse moves...

Note: In this section, the preceding text discusses pulse without mentioning color, and the following text discusses color without mentioning pulse; this is a rhetorical device of mutual implication (huwen), concluding with the phrase "color and pulse not corresponding to the season."

Question: There is "arrival before time" and "failure to arrive at time." (Above "is failure to arrive at time," Yu edition and Leiju edition both have these words.)

[Xu] This discusses the arrival of weather having excess or deficiency. Although it does not explicitly mention medicine, the idea of adapting measures to circumstances is included. (You Shi's commentary in *Jiyi* omits nineteen characters: "and the sky has already warmed, or having obtained Jiazi, the sky instead remains unwarmed, and having obtained Jiazi.")

Question: The Cun pulse is deep, large, and slippery. (*Mai Jing* does not set up Q&A; under "Cu Jue" (Sudden Syncope), it adds "loss of consciousness"; the character "Kou" is absent; "He Shang" includes the character "Wen".)

Note: This section is titled "Ping Cu Shi Jue Mai Zheng" (Normal vs. Sudden Corpse-like Syncope Pulse and Symptoms) in *Mai Jing*. (Chao Yuanfang records it under "Shi Jue Hou".) The original note under "Shi Jue" in *Za Liao Fang* says: "Pulse and symptoms see Volume 1." Xu Shi believes this section likely describes the disease treated by Bian Que for the Crown Prince of Guo. Also, the *Su Wen* chapter *Yang Ming Mai Jie Pian* states: "Jue Ni connecting to Zang results in death; connecting to Jing results in survival."

Question: If the pulse disappears and enters the Zang, death ensues.

Note: My elder brother said: Previous commentaries on this section are overly speculative. It likely continues the previous section to elaborate further. "Mai" (Pulse) refers to blood vessels, a shorthand for blood and Qi. Examining dictionaries, "Tuo" (disappear/vanish) is a modal particle indicating possibility ("perhaps" or "maybe") and should be viewed as such to be appropriate. "Tuo" originally implies external collapse; saying "Tuo" while describing "entering" is inconsistent. The *Su Wen* chapter *Fang Sheng Shuai Lun* states: "Pulse disappearance is incomplete, diagnosis lacks constant practice." Wu Kun commented: "The pulse may not be visible." This corroborates the point. The *Wu Zi Li Shi Pian* states: "If one fails, one is laughed at by feudal lords." The *History of Later Han* (*Li Tong Zhuan*) states: "If the matter has not yet occurred, perhaps disaster can be avoided." Song Dynasty's Zhao Delin in *Hou Qing Lu* states: "Tuo means 'can' or 'you'; it denotes an indefinite term." People of Han and Jin often said "Tuo ruhe" (Perhaps how?), meaning "or perhaps." Hu Sansan in his commentary on *Tong Jian* states: "Tuo means 'or'." He also said: "Tuo is a term for uncertainty." All these serve as examples.

Question: What are the Eighteen Yang Diseases? ("Ren" is written as "Ren" in Leiju edition.)

[Zhou] This summarizes the diseases recorded in the *Neijing*, dividing them into Yin and Yang, fully addressing interior/exterior, combining upper/lower and interior/exterior to establish theory. Thus, meridians become clear, fu-organs distinct, and causes evident, preventing them from being scattered and difficult to trace. For example, San Yang (Three Yang) are external; diseases like headache involve six syndromes, each having its own meridian and manifesting its own meridian's symptoms. Three multiplied by six equals eighteen. The same applies to San Yin (Three Yin) located internally. Each of the Five Zang Organs has eighteen, totaling ninety diseases. Their manifestations are documented in the *Ling Shu*, discussing Heart pulse leading to convulsions, etc. As for the Six Fu Organs? Fu organs reside internally and connect to meridians. Therefore, pathogens in Fu organs connect externally to meridians; their injury is shallow, and dispersal is easy, unlike the depth and severity of Zang organ diseases. Hence, it is said to be "minor." The *Neijing* categorizes their diseases, while Zhongjing consolidates them into 108 diseases, likely based on the number six of the Fu organs. In total, there are 234 diseases, encompassing interior and exterior. The human body covers upper, lower, interior, and exterior. Regarding the so-called Clear/Turbid and Large/Small Pathogens: one is mist/dew, the other is earthy turbidity. Those originating from Heaven tend upward; those from Earth tend downward. The leader of a hundred diseases harms human Yang; the肃杀 (chilling/killing) energy harms human Yin. Entering via the mouth constitutes internal injury, causing fever, abdominal pain, wheezing, vomiting, and distension. Removing the old without bringing in the new achieves nothing. [Wei] Generally, Yang diseases are those outside the shell of the body, while Yin diseases are those inside the shell.

Note: This section is divided into two parts. The first part lists the number of diseases based on meridians and Zang/Fu organs. (Cheng's calculation was wrong; Zhou's is correct. ○ *History of Later Han* (*Guo Yu Zhuan*): "Skills of pulse diagnosis and subtle observations," also unclear in meaning.) The second part discusses the Five Pathogens in three segments. First, naming based on nature. (Wind moves swiftly and changes frequently; its nature is seen in *Qianjin*). Then repeatedly showing where it strikes. The remaining meaning concludes with extreme cold and extreme heat, which is comprehensive. However, commentators on Large and Small Pathogens offer convoluted explanations, missing the scripture's intent. They fail to see that the three segments correspond to each other: Large Pathogen refers to Wind, Small Pathogen refers to Cold, making the meaning clear. Zhou Shi's explanation is excellent. Wind scatters broadly, hence called Large; Cold is urgent/tight, hence called Small. Moreover, Wind harms people most frequently, while Cold is slightly less, which may explain their names. Wind is light and ascending, so it strikes the exterior first, causing floating pulse; Cold is fierce and bold, so it strikes the interior directly, causing tight pulse.

Furthermore, the *Su Wen* chapter *Tai Yang Yang Ming Lun* states: "Those injured by Wind are affected from above first. Those injured by Dampness are affected from below first." The *Ling Shu* chapter *Bai Bing Shi Sheng Pian* states: "Wind and Rain injure the upper, Clear Dampness injures the lower." The *Bian Mai Fa* states: "When Cun Kou pulse Yin and Yang are both tight, the method dictates Clear Pathogen strikes the Upper Jiao, Turbid Pathogen strikes the Lower Jiao." All have different wording but similar intent. Tao Hongjing's *Ben Cao Xu Li* states: "Although the origins of disease are manifold, they all relate to Pathogens. 'Pathogen' refers to abnormality, meaning it is not the normal state of the human body. Wind, Cold, Summer-heat, Dampness, hunger, fullness, labor, and rest are all pathogens, not just ghostly qi and epidemics." With this statement, the meaning of "Pathogen" in this section becomes clear.

My elder brother said: Lu Wenchao's *Zhong Shan Zha Ji* details the differentiation of the character "Ren"; reference is advised.

When a chronic disease (Gu Ji) is compounded by an acute disease (Cu Bing).

Note: *Shuo Wen*: "Gu means long-standing disease." (Jigu Ge printed Song edition writes HT, an error.) The *Yizong Jinjian* cites Zhao's commentary, which originally came from Zhou Shi.

Master said: Diseases of the Five Zang Organs heal when they obtain [what they favor].

Note: You Shi cites the *Zang Qi Fa Shi Lun*, *Xuan Ming Wu Qi Pian*, and *Wu Wei Pian* as evidence; reference is advised. Cheng Wuji's commentary on the "Chu Zhong" (Removing Middle) section of the *Jue Yin Pian* states: "If Stomach Qi is exhausted, obtaining [favorable condition] will definitely cause fever. If no fever occurs, Stomach Qi remains. It is feared that extreme cold transforms into heat; due to sudden heat coming and then going, enabling eating, this is not Chu Zhong." The *Jin Gui Yao Lue* states: "Patients who usually cannot eat but suddenly crave food will definitely develop fever." Cheng Wuji interpreted "crave" (Si) as "eat."

Regarding all diseases located in the Zang.

Note: The Zhu Ling Tang in this section is merely borrowed for illustrative purposes (to allow举一反三 - inferring other cases from one). Xu, Shen, and Zhu adding the formula is a deep error.

[Additional Commentary] This chapter reveals the general principles of syndrome differentiation and treatment by Zhongjing, with the greatest importance lying in the first and second chapters. Deeply analyzing its intent reveals three meanings. Firstly, the human body is governed by the Zang and Fu organs; thus, discussing disease logic must begin with the Zang and Fu. This is the teaching passed down from Xuanyuan and Qibo, which Zhongjing places at the beginning as a model for posterity. This is the first meaning. Secondly, the broad categories of disease are only two: Internal Injury and External Contraction. The first chapter focuses on Internal Injury, the second on External Contraction. Placing them side by side shows that disease does not exceed these two ends. This is the second meaning. Thirdly, the key to treatment lies in preventing minor issues from becoming major. "Drilling wood to make fire" (metaphor for prevention) is warned against by sages. Thus, the first chapter mentions treating disease before it arises, and the next section says: "Before it transmits to the Zang, treat it immediately," and "Do not let the nine orifices become blocked," all indicating the meaning of seeing the small to detect the excessive. This is the third meaning. Are these three meanings not the gateway for physicians entering the field? Other sections differentiate color, sound, breath, correspondence of color and pulse, and sequence of pulse; diagnostic methods are complete. Diseases arising suddenly require observation of auspicious/inauspicious signs. Internal cause diseases have specific numbers; external contraction diseases have specific rules. Zang organ diseases have conditions of favorability and aversion, which are also guidelines for differentiation. As weather waxing and waning corresponds to the human body, its principles must be discussed. Treatment methods first show prevention, then distinguish depth/shallowness, then discuss exterior/interior and new/old disease, establishing a necessary sequence. The final chapter reveals the secrets of purgative and guiding agents. Thus, the examples of syndrome differentiation and treatment fall within the scope of this chapter. This chapter is truly the great canon and fundamental law of physicians.