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Chapter 58 asks: How many types are there of Shanghan (Cold Damage), and do their pulses change?
The response states: There are five types of Shanghan: Zhongfeng (Wind Strike), Shanghan, Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing (Warm Disease); the suffering symptoms of each differ.
Suwen discusses wind and heat extensively in its chapters on Wind and Heat, so how could it omit a chapter on Cold? The opening of the Chapter on Heat states that all current heat diseases belong to the category of Shanghan. Since it is called "category of Shanghan," it implies the existence of a specific treatise on Shanghan; unfortunately, Volume 7 was lost in war, which also shows that ancient medical classics used "Shanghan" as a general term for exogenous diseases. Yue Ren (Qin Yueren/Bian Que) feared that future generations would confuse Cold and Warmth, so he proposed the theory of "Five Types of Shanghan" to distinguish their pulse and syndrome characteristics. Hua Shi's interpretation that "bian" (change) should be read as "bian" (distinguish) is correct.

The pulse of Zhongfeng is floating and slippery at the Yang position (Cun) and soggy and weak at the Yin position (Chi).
Zhongfeng refers to Wind-Cold directly injuring the muscle-cou li (interstitial spaces). Wind has no fixed form; if biased towards cold, it transforms into cold. The pathogenic factors of Wind-Cold enter the muscles directly and injure Ying Blood. When Ying Blood is injured, the blood vessels become weak, and the pulse movement must be slow. Floating at the Cun position indicates Wei Yang escaping outward; weakness at the Chi position indicates injury to Ying Blood. However, only when fever spontaneously arises, sweat flows out, aversion to cold and wind, nasal congestion with roaring, and dry retching occur, can these be considered the definitive syndromes and pulses of Wind-Cold invading the cou li. The statement "Wind injures Wei, Cold injures Ying" is incorrect. In reality, Cold injures Wei, and Wind injures Ying. One might ask: Xu Xueshi stated in his Fabi Lun that Wind injures Wei and Cold injures Ying, and Cheng Wuji and subsequent scholars followed this. Why do you alone assert that Cold injures Wei and Wind injures Ying? I reply: Cold is the primary qi of the Taiyang channel. Taiyang Yang originates from Zhiyin and fills the skin and hair. This layer of skin and hair is where Wei Qi resides. If Wei Yang is deficient, it attracts external Cold, causing the pores to close without sweat; thus, we say Cold injures Wei. Wind belongs to Jueyin Liver Wood among the Six Qi; Jueyin governs Ying Blood. If Blood is deficient, it attracts external Wind. Although Ying Blood travels with Wei Qi, fundamentally, the skin-hair layer is governed by Wei, while the muscle layer is the dwelling of Ying. When Wind enters the muscles, Ying fails to guard Wei, causing Wei Qi to leak out resulting in spontaneous sweating; thus, we say Wind injures Ying. Moreover, Zhang Zhongjing uses Mahuang Tang when there is no sweat, clearly indicating it treats Wei Qi; he uses Guizhi Tang when there is sweat, clearly indicating it harmonizes Ying Blood. How can they be confused? Another question arises: Having clarified that Mahuang treats Cold injuring Wei and Guizhi treats Wind injuring Ying, why does Zhang Zhongjing state in the Bian Mai Pian: "If the Cun position pulse is floating and tight, floating indicates Wind, tight indicates Cold; Wind injures Wei, Cold injures Ying; both Ying and Wei are diseased, causing severe pain in bones and joints, requiring diaphoresis." Is this not clear evidence of Wind injuring Wei and Cold injuring Ying? I reply: This chapter derives from Neijing's principle that "Cold injures the form, Heat injures Qi; Yang pathogens injure Yang, Yin pathogens injure Yin," speaking generally of Yin and Yang Qi, not implying that Guizhi specifically treats Wind injuring Wei or Mahuang specifically treats Cold injuring Ying. Reading requires integration, not rigidity. Here, "Wind injuring Ying" means the Wind-Cold pathogen strikes directly into the Ying level, forcing Wei Qi to escape outward, thereby injuring Ying. If it were Fengwen (Wind-Warmth) pathogen, it first attacks the Wei level; Wei governs Qi, and Heat injures Qi. Regarding "Cold injuring Wei," it does not mean it doesn't injure Ying; rather, Cold blocks the exterior Wei Qi causing anhidrosis, which also involves constricting Ying Blood. This aligns with the Neijing principle that "Heat injures Qi, Cold injures Form." If one cannot distinguish Cold from Heat and clings to the phrase "Wind is a Yang pathogen injuring Wei," using the warming and harmonizing Guizhi Tang to treat Fengwen would be a grave error. One must be cautious.

Note: This discussion defines Zhongfeng as Wind-Cold entering the cou li, belonging to exogenous diseases. However, the Zhongfeng discussed in Jingui Yaolue includes differentiation into Zhong Fu (Invasion of the Viscera), Zhong Zang (Invasion of the Organs), and Zhong Xue Mai (Invasion of the Collaterals), which differs from the above and must not be confused. The pulse for Zhong Fu is often floating, with five colors manifesting on the face, accompanied by aversion to wind and cold, stiffness, and numbness. It may affect the front, back, or sides of the body. The disease is in the exterior, often affecting the four limbs. Even if hemiplegia occurs with immobile limbs, copious phlegm-saliva, and thunderous breathing, the eyes can still see, and the mouth can speak, and there are exterior Six Channel manifestations. For Zhong Zang, the disease is interior, often obstructing the nine orifices. Thus, flaccid lips with urinary/fecal retention indicate Spleen involvement; inability to speak indicates Heart involvement; deafness indicates Kidney involvement; nasal congestion indicates Lung involvement; and blurred vision indicates Liver involvement. For Zhong Xue Mai, the disease is at the half-exterior/half-interior level, lacking Six Channel exterior signs and internal obstruction of bowels/bladder, presenting only with facial deviation and unilateral pain. If the body collapses and cannot be controlled, deafness, blindness, open mouth and closed eyes, hand release with incontinence, aphonia, and snoring sleep occur, this represents the collapse syndrome where the root is uprooted and the pivot of Yin and Yang fails to interact, making it difficult to treat. These share the same name but differ in presentation, requiring distinction.

The pulse of Shanghan is full and tight-choppy in both Yin and Yang positions.
Shanghan refers to Cold injuring the Taiyang superficial surface. Hua Yuanhua stated: On the first day of Shanghan, the pathogen is in the skin; on the second day, in the flesh; on the third day, in the muscle; on the fourth day, in the chest; on the fifth day, in the abdomen; on the sixth day, it enters the Stomach. This indicates that the initial Wind-Cold pathogen enters through the skin and pores, suppressing Ying Qi and binding it within the meridians, resulting in a pulse that is full, floating, tight, and choppy in both Yin and Yang positions, accompanied by anhidrosis. Definitive signs include stiff neck and head, fever, body ache, lower back pain, joint pain, aversion to wind and cold, and wheezing. The Qi transformed in the Taiyang Bladder circulates from the Qi Sea along the Chong and Ren channels, crosses the diaphragm into the Lungs, and exits via the nose as exhaled air. Another portion of this Qi moves internally through the Sanjiao fatty membranes, exits via the Qi Streets, follows the muscles, reaches the skin and hair, serving as the defensive exterior Qi. People know about breath exiting the nose but ignore that Qi also exits through every pore. When nasal breath exits, all pore Qi expands; when nasal breath enters, all pore Qi contracts. If pore Qi cannot exit externally, it turns inward, obstructing the Lungs, leading to wheezing via the nose and throat. Thus, when Cold injures the superficial surface, the defensive Qi of the skin and hair cannot exit, turning inward and obstructing upwards to cause wheezing. Inside the skin and hair are muscles; when Cold invades the muscles, the whole body aches. When the pathogen invades the Taiyang meridians, head, neck, and lower back pain occur. The muscle inside the skin is commonly called subcutaneous fat; between layers of fat are textures called cou li; deeper inside is lean meat. Tendons grow at both ends of the lean meat, connecting with the bone. Thus, when the pathogen invades the lean meat, it enters the tendons, causing joint pain, as stated in Neijing: "All tendons attach to the joints." By releasing the exterior, the Cold pathogen moves from inside to outside and resolves through sweat; hence, Zhang Zhongjing uses Mahuang Tang.

The pulse of Shiwen is soggy and weak at the Yang position and small and rapid at the Yin position.
Shiwen is a Warm Disease caused by the combination of Summerheat and Dampness. There are three causes. First, contracting Summerheat then Dampness, where Heat is suppressed by Dampness, results in a pulse that is soggy and weak at the Yang position (Dampness contending with Summerheat) and small and rapid at the Yin position (Summerheat steaming Dampness). This is the Shiwen mentioned in this chapter. Second, if a person is chronically injured by Dampness, leading to epigastric fullness, and Damp-Heat contend, Shiwen develops with symptoms of cold calves, abdominal distension with chest pressing, headache, eye pain, and delirium. Treatment focuses on the Foot-Taiyin Spleen channel, and diaphoresis is contraindicated. This is the Shiwen described in Wang Shuhe's Maiching. Third, encountering the stagnant Qi of the season between Spring Equinox and Autumn Equinox, when Shaoyin Ministerial Fire, Shaoyang Ministerial Fire, and Taiyin Damp Earth act together. Heaven is naturally hot, enhanced by solar Summerheat; Earth is naturally damp, carrying terrestrial moisture. These three Qi interact intermittently. When dispersed, Wind moves within, overcoming Dampness and resolving stagnation, causing no distress. When combined, Heavenly Heat descends and Earthly Moisture ascends. Humans in this Qi intersection suffer from inflammation and steaming with no escape. Pathogens enter via nose and mouth, settling in the Spleen and Stomach. Symptoms include soggy-weak pulse, white or crimson-based tongue coating, vomiting, dry mouth unable to drink, soft yet full chest, tidal fever, sweating with slight cooling followed by recurrent heat. This is Yu Chang's description of Shiwen caused by the convergence of three Qi. Although causes differ, the disease mostly affects Foot-Yangming Stomach and Foot-Taiyin Spleen due to resonance of Damp-Earth Qi. Exterior diseases of these two channels often involve Hand-Shaoyang Sanjiao; interior diseases often involve Hand-Jueyin Pericardium, because Shaoyang and Jueyin both govern Ministerial Fire. Understanding this guides treatment.

The pulse of Rebing is floating in both Yin and Yang positions; floating and slippery upon light pressure, scattered and choppy upon deep pressure.
Rebing generally refers to Warm-Heat diseases involving latent pathogens and exogenous factors. A pulse floating in both Yin and Yang indicates heat due to excess Yang, as per Jin Gui Yao Lue. Slippery upon light pressure indicates Yang excess externally; scattered and choppy upon deep pressure indicates Yin deficiency internally. Warmth is the gradual onset of Heat; Heat is the extreme of Warmth; essentially they are one, but differences in interior/exterior and mild/severe must be distinguished. Latent Warm Disease involves Winter Yang Heat being suppressed by severe Cold, hiding between muscle and bone. In Spring, triggered by Spring Yang Qi, the Heat pathogen emerges internally, damaging Yin fluids. This corresponds to Zhang Zhongjing's description in Shanghan Lun of "fever with thirst and no aversion to cold" as Warm Disease. Exogenous Wind-Warmth occurs due to winter warmth failing to store essence or spring warmth causing Wind to transform into Heat, presenting with floating pulse, aversion to wind, fever, and cough. If latent Qi exists internally and is stimulated by external Wind-Heat, the two Yangs combine, injuring Wei Qi first. Mistaken use of acrid-warm dispersants leads to burning heat, heaviness, excessive sleepiness, snoring, spontaneous sweating, staring gaze, incontinence, and convulsions. This corresponds to the Wind-Warmth in Shanghan Lun caused by mistaken sweating, purging, or fire therapy, representing exogenous disease combined with latent Qi. Wang Andao stated that Warm-Heat disease pulses are mostly in the muscle layer, not very floating, and often stronger on the right than left due to trapped heat internally. If stronger or floating on the left, it indicates concurrent Wind-Cold; otherwise, it is not Warm-Heat disease but acute Wind-Cold. This is a fixed theory. Why? Suwen Yin Yang Ying Xiang Da Lun states: Left and Right are the pathways of Yin and Yang; Water and Fire are the signs of Yin and Yang. Blood is Yin, Water is Yin; Qi is Yang, Fire is Yang. From the pulse body perspective, Left belongs to Blood (Yin); Right belongs to Qi (Yang). This reflects the left-right nature of Blood and Qi, and the signs of Water and Fire. Wind-Heat is a Yang pathogen, first injuring formless Qi; Wind-Cold is a Yin pathogen, first attacking formed Blood. This aligns with Neijing's "Cold injures Form, Heat injures Qi." Recognizing this, one knows Wind-Heat injures Wei and Wind-Cold injures Ying, avoiding the error of using Guizhi for Warm-Heat based solely on Xu Xueshi's "Wind injures Wei," which could lead to premature death.

Note: No one has elucidated the theory of latent Qi; let me attempt to explain. Suwen Yin Yang Ying Xiang Da Lun states: Extreme Yin transforms into Yang; extreme Yang transforms into Yin. Thus: Injury to Cold in Winter leads to Warm Disease in Spring; Injury to Wind in Spring leads to undigested stool diarrhea in Summer; Injury to Summerheat in Summer leads to Malaria in Autumn; Injury to Dampness in Autumn leads to Cough in Winter. This passage emphasizes "Extreme Yin transforms into Yang; extreme Yang transforms into Yin." It shows that Heaven and Earth Yin-Yang pathogens resonate with human Qi transformation, not that Cold changes to Heat or vice versa. "Winter injury to Cold, Spring Warm Disease": At Winter Solstice, Yang begins to generate, and human Yang Qi becomes abundant internally. Severe Winter Cold kills life force, entering skin and cou li. Internal latent Yang Heat is suppressed by Cold toxins, penetrating deep into marrow. In Spring, as Yang Qi grows, shallow latent pathogens dissipate with Spring Yang; deep latent pathogens, if blocked by Wind-Cold or damaged by desires, have their internal stagnant Yang triggered by external pathogens. Once released, interacting with Heavenly Yang Heat, two heats interfere, causing Warm Disease; extreme Warmth becomes Heat Disease. This is Extreme Yin transforming into Yang. "Summer injury to Summerheat, Autumn Malaria": At Summer Solstice, Yin begins to generate, and human Yin Qi becomes abundant internally. Summerheat is a Yang pathogen; external Yang flare-up makes internal Qi deficient and cold. Combined with greed for coolness and cold drinks damaging True Yang, in Autumn when Yin Qi grows, internal latent Yin pathogen wants to exit while external Yang Summerheat wants to enter. Yin and Yang contend, causing alternating chills and fever Malaria. This is Extreme Yang transforming into Yin. "Spring injury to Wind, Summer diarrhea; Autumn injury to Dampness, Winter cough" relates to mutual overacting of Yin and Yang above and below. Throat governs Heavenly Qi; Pharynx governs Earthly Qi. Yang receives Wind; Yin receives Dampness. Those injured by Wind are affected upward first; those injured by Dampness downward first. Yang diseases move up to extreme then down; thus Spring Wind injury leads to Summer diarrhea. Wind is Yang pathogen, diarrhea is Yin disease; this is Extreme Yang transforming into Yin. Yin diseases move down to extreme then up; thus Autumn Dampness injury leads to upward counterflow cough. Dampness is Yin pathogen, cough is Yang disease; this is Extreme Yin transforming into Yang. Wherever pathogens gather, Qi must be deficient. Divine Qi, Blood, and Meridians originate from Essence. Preserving Essence secures Blood and Qi internally, preventing external invasion. Jingui Zhen Yan Lun states: Essence is the root of the body. Therefore, those who preserve Essence do not get Warm Disease in Spring. Health preservers must be cautious.

The pulse of Wenbing runs through various meridians; one does not know which meridian is activated, so diagnose according to the affected meridian.
Wenbing refers to Plague/Epidemic diseases. Ancient texts lacked the character "Wen," using it interchangeably with "Wen" (Warmth). Yi (Plague) means service/corvee, spreading like labor duties. It is common after wars or natural disasters, infecting cities, towns, or villages. It is caused by Heaven and Earth pestilential Qi, unmeasurable by normal logic and untreatable by standard methods. Suwen lost chapters mention acupuncture for five plagues. Pang Anchang described treatments for Green Tendon Cord, Red Vein KT, Yellow Flesh Follow, White Qi狸, Black Bone Warmth, and Five Colors. Plague diseases are mostly warm-heat biased, rarely cold-biased. However, Bingyuan records that after Spring Equinox before Autumn Equinox, sudden cold causes seasonal Cold Plague. Initial Cold Plague presents with chills, fever, anhidrosis, red face, headache, and stiff neck, caused by open pores closed by Cold. Unlike Shanghan, it is contagious. It appears more in Metal-Water years when Metal and Water fail to store, causing humans and objects to respond with Cold Plague. Dongpo's Shengsanzi treats Cold Plague combined with Dampness. Modern Wu Keyang discussed Plague as Warm-Heat combined with Dampness, characterized by corpse-like odor, dull greasy complexion, deep crimson tongue base, powder-like coating, mental confusion, palpitations, strong right pulse with vague rate, all signs of Damp-Heat contention, treated with Dayuan Yin to reach the募原 (Mu Yuan/Cribriform Form). Yu Shiyu's Qingwen Baidu San uses heavy Gypsum to treat Plague caused by Summerheat. Yue Ren anticipated this, stating Wenbing pulses run through various meridians, unknown which is activated, diagnosing by location. This intent is profound. Huang Kunzai's interpretation using Suwen Relun's daily transmission (Day 1 Taiyang... Day 6 Jueyin) requiring daily diagnosis is flawed. Transmission of meridians refers to healthy Qi transmitting sequentially, returning in seven days, a fixed cycle, not pathogen transmission. Pathogen transmission depends on Taiyang unresolved, entering Yang or Yin, regardless of time or sequence. Transmission to Yangming shows Yangming signs; to Shaoyang shows Shaoyang signs; to Three Yin shows Three Yin signs. Shanghan Lun states: If Yangming and Shaoyang signs are absent on days 2-3 of Shanghan, it has not transmitted. Pathogens transmit based on meridian Qi deficiency, applying to Zhongfeng, Shanghan, and Rebing. Why does Yue Ren specify unique pulses for other conditions but for Wenbing say "unknown which meridian activated, diagnose by location"? Clearly referring to Heaven and Earth pestilential Qi unmeasurable by normal logic. Huang's reckless discussion is highly erroneous.

Regarding Shanghan: Some recover with sweating and die with purging; some die with sweating and recover with purging. Why?
Response: In Yang deficiency and Yin excess, sweating leads to recovery, purging leads to death. In Yang excess and Yin deficiency, sweating leads to death, purging leads to recovery.
Shanghan is a general term for these five diseases. But why does Shanghan sometimes recover with sweating and die with purging, or recover with purging and die with sweating? Generally, external Cold attack is Yin excess, treatable by sweating but not purging; internal blazing Heat is Yang excess, treatable by purging but not sweating. Wang Shuhe's Preface to Shanghan states: "Guizhi swallowed, Yang excess leads to death; Chengqi entering stomach, Yin excess leads to demise," illustrating this principle.

How to observe Hanre (Cold-Heat) diseases?
Response: Pi Hanre (Skin Cold-Heat): Skin cannot touch the mat, hair burns, nose dries, no sweat. Ji Hanre (Muscle Cold-Heat): Skin hurts, lips and tongue dry, no sweat. Gu Hanre (Bone Cold-Heat): Body finds no rest, sweat pours continuously, tooth roots dry and painful.
Observing Hanre means identifying the location of alternating chills and fever. Pi Hanre indicates pathogen is shallowest, in the skin. Lung governs skin and hair, opens to the nose. Thus, pathogen in skin prevents contact with objects, hair becomes dry and brittle, nose withers. Lack of sweat indicates disharmony of Ying and Wei. Ji Hanre: Muscle lies beneath skin. Pathogen enters muscle via skin, causing skin pain. Spleen governs muscle, opens to the mouth. Thus, muscle pathology affects lips and tongue. Gu Hanre: Bone lies within muscle. Pathogen in bone is deepest, causing global discomfort. Kidney governs bone and fluids; teeth are surplus of bone. Thus, bone disease causes Kidney fluid leakage as sweat, and teeth become dry and painful.

Note: This section is from Linghu Hanre Pian, distinct from the previous five Shanghan types, yet all involve meridian Qi pathology. Treating with collaterals of Three Yang and Shaoyin expels pathogens. Though different from Shanghan, the hierarchy of skin, muscle, and bone meridian Qi is consistent. Yue Ren placed this after the five Shanghan types to show that internal injury miscellaneous diseases differ from exogenous presentations and must not be mistreated.