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Because wind-cold pathogenic factors easily damage the body's Yang Qi (Yang Energy), all main prescriptions in *Shanghan Lun* (Treatise on Cold Damage Disorders)—except for special cases where cold transforms into dryness-heat requiring cool and moistening treatments—mostly adhere to the principles of warming Yang and preserving Body Fluids (Jin Ye).

Based on my clinical experience, I have observed that diseases involving "Cold Damage transmitting through the Six Meridians" are gradually decreasing, which may be related to changes in natural climate conditions; I am unaware of how it is in the severe cold regions of the north. Only a very small number of people contract Cold Damage with meridian transmission during the winter cold season, but the manifestations are mostly limited to the "Exterior Syndromes" of the Foot Triple-Yang Meridians, or the pathogen enters the "Fu-Organ Interior" of the Foot Triple-Yang Meridians and stops there. Thus, I believe that wind-cold pathogenic factors do not easily cross the boundary of the Foot Triple-Yang Meridians to enter the Foot Triple-Yin Meridians; in reality, cases transmitting to the Foot Triple-Yin Meridians are extremely rare. I often see patients whose constitutions are inherently "Yin-Cold," who suddenly suffer from cold weather exposure or cold dietary intake, leading to direct invasion of the Yin Meridians (without passing through the Exterior Syndromes of the Triple-Yang Meridians, they "directly strike" the Yin Meridians). Common symptoms include: sudden onset, abdominal pain and diarrhea, even downy stool containing undigested food, cramping abdominal pain, cold limbs, pale complexion, or a dull bluish-green facial hue, and whole-body shivering. In mild cases, the pulse is deep, thin, slow, and choppy; in severe cases, the pulse is faint and nearly imperceptible. Treatment should aim to restore Yang and rescue from collapse.

I frequently encounter such cases. When lacking Chinese herbal medicine for emergency rescue, I use Western medicine: mixing 1mg of Epinephrine Hydrochloride with 0.5mg of Atropine Sulfate. Using a No. 5 needle, I select three acupoints for injection, administering one-third of the dosage to each point. First, I inject into the bilateral Yinlingquan (SP9) points at a depth of 0.8 cun; then, I inject into the Qihai (CV6) point at a depth of 0.3 cun. This method has saved many lives, rapidly restoring Yang and rescuing from collapse. After treatment via intracutaneous/intramuscular injection of drugs into acupoints, rapid effects are generally achieved within ten minutes. This is most suitable for treating sudden Yang collapse and "direct strike" Yin-Cold emergencies, as the patient's Qi and Blood have not yet been damaged; once the drug volatilizes and restores Yang, the disease is cured.

If a patient has been ill for many days, and the transmission through the Six Meridians of Cold Damage leads to Jue syndrome (cold extremities) and diarrhea due to transmission to the Foot Triple-Yin Meridians, their Yuan Yang (Primal Yang) has already been damaged. In such cases, one should still select formulas like Sini Tang (Four Reversal Decoction) to restore Yang, or combine this with moxibustion therapy.

The differentiation and prescription methods of the "Six Meridians of Cold Damage" are not only used for treating Cold Damage disorders. By studying the theories, methods, and formulas of the "Six Meridians," one can draw inspiration to develop new prescriptions and therapeutic principles for other diseases. For example, the diagnostic and therapeutic methods in *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) were derived by borrowing the principles of *Shanghan Lun* and incorporating the opposing viewpoints of "Cold" and "Warm." For detailed content on "Cold Damage transmitting through the Six Meridians," please refer to *Shanghan Lun*.

(III) Summer Heat

Summer Heat: During midsummer, the weather is hot, and summer heat steams intensely. Laboring under the scorching sun, working in high-temperature environments, or traveling long distances can all lead to "Heat Stroke." Common symptoms include: high fever throughout the body, headache, irritability, thirst preferring cold drinks, sensation of heat radiating from the body with sweating, and even fainting with loss of consciousness. Treatment should employ pungent-cool and sweet-moistening methods.

There are also cases caused by inherent deficiency of Yuan Qi combined with infection of summer-heat and dampness. Symptoms include: aversion to cold and fever, shortness of breath, spontaneous sweating, headache, and soreness/weakness in the limbs. The pulse indicates insufficient positive movement; treatment should tonify Qi, regulate dampness, and clear summer heat.

(IV) Dampness

Dampness: Late summer is dominated by dampness. Dampness is a Yin pathogenic factor with sticky, heavy, and turbid characteristics. Symptoms of Dampness invading the exterior include: whole-body fever and heaviness, soreness and weakness in the four limbs and joints, nasal congestion and difficulty breathing, and hoarse speech. Treatment should use warm bathing methods to disperse the exterior and regulate dampness.

Spleen Earth prefers dryness and dislikes dampness. In individuals with abundant internal dampness, spleen invasion by dampness leads to internally generated dampness, or excessive worry damages the spleen, causing loss of healthy transportation and generating internal dampness. Symptoms of internal dampness include: fatigue in the four limbs, poor appetite and indigestion, feeling of fullness and discomfort in the epigastrium and abdomen varying in severity, loose stools, or difficult urination even leading to edema. The right pulse at the Cun Kou (Radial Artery) should be deep and choppy; for dampness in the interior, treatment should strengthen the spleen and promote diuresis to remove dampness.

(V) Dryness

Dryness: Autumn is governed by Metal, and the air is relatively dry. If autumn experiences prolonged drought without rain, dryness becomes more severe. Individuals with Lung deficiency constitutions are prone to illness from dryness pathogens. Symptom manifestations include: headache, body heat, mental restlessness, dry nose and throat, sore throat, and dry cough. Severe cases may present with constipation, scanty urine, dry tongue, and desiccated teeth without fluids. Treatment should nourish Yin and moisten dryness, assisted slightly by pungent-cool herbs. If there is no exterior syndrome, the sour-sweet method to transform Yin can be added.

(VI) Fire

Fire: The intense heat of midsummer belongs to Fire. Summer is when Yang Qi reaches its peak; Yang Qi shines brightly and ascends. Fire nature tends upward, leading to various inflammatory conditions. The Classics state: "All rebellious qi rushing upward belongs to Fire; all restlessness, mania, and deviation belong to Fire; all heat, confusion, and convulsions belong to Fire." Any disease manifesting upward rebellion, extreme heat causing confusion and convulsions, or mental agitation and madness belongs to "Fire" pathology. Since Fire pathology is numerous and involves various diseases, one must distinguish the nature of different "Fires." For floating Fire due to Yin deficiency, nourish Yin and anchor Yang to extinguish Fire; for excess Fire hyperactivity, use bitter-cold herbs to directly suppress Fire; for constrained Fire in the exterior or interior, use dispersing and unblocking methods to scatter Fire; for slight Fire, use cooling and transforming methods to descend Fire.

XVII. Insights from Clinical Practice

The previous chapter briefly discussed the differentiation of the Five Zang and Six Fu Organs regarding Wind, Cold, Summer Heat, Dampness, Dryness, and Fire, aiming to introduce beginners to the perspective of Syndrome Differentiation and Treatment.

For detailed syndrome differentiation and treatment, please refer to modern medical texts. Due to the current era of diverse schools of thought and emerging experts, modern medical texts have gathered the wisdom of ancient and contemporary sages, providing highly detailed classification of various diseases, truly comprehensive and well-prepared.

Based on my diagnostic and treatment experience, I believe that for various diseases, one should not formulate treatment plans solely based on Cun Kou pulse images.

For instance, before I understood the mechanism of the "Twelve Meridians," I treated patients relying entirely on famous ancient and modern prescriptions from medical books. In terms of efficacy, some patients responded while others did not, with an efficiency rate of only 60%. This illustrates that "prescriptions" must align with the patient's Pathogenesis (Bing Ji) to be effective; if the prescription does not match the pathogenesis, it will not work. Even the prescriptions of Zhang Zhongjing, the Medical Sage, are praised by all; if administered without matching the pathogenesis, they will not be effective. If contrary to the pathogenesis, adverse reactions may even occur. Therefore, the energy exerted by herbs and formulas must exactly match the patient's etiology, i.e., it must be the "true prescription" targeting the specific condition.

Currently, my treatment relies entirely on the principles of the Twelve Meridians as guidance. Before examining the patient's pulse, my mind is blank (though possessing basic TCM knowledge), with no preconceived treatment plans or methods. After diagnosis through Observation, Auscultation/Olfaction, Inquiry, and Palpation, I derive methods to regulate Yin and Yang by combining the positive and negative movement laws of the Twelve Meridians. Over the years in clinical practice, utilizing this bidirectional, positive-negative cyclic movement mechanism, combined with the excess or deficiency of Yin-Yang pulses, I have achieved satisfactory results in diagnosis and treatment, whether using acupuncture, massage, or Chinese herbal formulas. The efficiency rate exceeds 90%. Practical evidence proves that using the movement laws of the "Twelve Meridians" as clinical guidance has immeasurable practical value.

Most patients' pulses and symptoms are variable. Some patients have "identical pulse images" but different symptoms; others have "identical symptoms" but different pulses. Clinicians with extensive experience share this insight. Thus, since patients' pulses and symptoms are unpredictable, the "herbal prescriptions" used for treatment should not follow rigid rules. Prescriptions strictly defined by dogma, whether for Chinese herbs or acupuncture point combinations, only adapt to a portion of patients and cannot fit all. Therefore, I most respect the "flexible prescription" that changes its treatment method according to the dynamic variations of the "Twelve Meridians." Pre-determined "symptom-targeted prescriptions" are secondary—serving as reference options for clinical selection. Only this conforms to the principle of seeking truth from facts in clinical syndrome differentiation. This "flexible prescription," changing with the Twelve Meridians' dynamics, is my insight from years of exploring Twelve Meridians theory and will remain my general guideline for future practice. However, the true "prescription" fitting every patient cannot be predetermined. If readers ask about this most reasonable treatment "formula," it lies within the "mechanism of the Twelve Meridians." The Classics state: "The Twelve Meridians are the basis of human life, the cause of disease formation, the means of treatment, and the origin of disease manifestation." Therefore, one should deeply study the positive and negative mechanisms of the Twelve Meridians to obtain the "true opportunity" for regulation.

This book contains several case studies of diseases treated with acupuncture and herbs. Although these cases represent my superficial understanding during the exploration of Twelve Meridians theory, one can partially comprehend the mysteries of the "Twelve Meridians" from them. Since the mechanism of the Twelve Meridians is formless and imageless, similar to our Daoist discussion of "Dao," it can only be perceived intuitively and is hard to convey verbally. Therefore, a low-level understanding of Twelve Meridians theory yields "low-level effects"; a medium-level understanding yields "medium-level effects"; and a high-level understanding yields "high-level effects." As former sages said, "Divinity and clarity depend on the individual."

XVIII. Examples of Ancient Sages Diagnosing Renying and Maikou Pulses for Ascending/Descending Movements

Regarding examples of diagnosing the "Renying Pulse": In the original preface of *Shanghan Lun*, Medical Sage Zhang Zhongjing stated: "Pressing the Cun without reaching the Chi, holding the wrist without reaching the foot, Renying and Fuyang—the three positions are not consulted together."

Furthermore, in the Guilin Ancient Edition of *Shanghan Zabing Lun · Ping Mai Fa Pian*, Master Zhongjing said: "It is normal for the Renying pulse to be large and the Fuyang pulse to be small. If Renying and Fuyang are equal, it is reverse; if Renying is weaker than Fuyang, it is greatly reverse. The reason is that Stomach Qi ascending moves at Renying, and Stomach Qi descending moves at Fuyang. Strong ascending force is called 'large'; weak descending force is called 'small.' Reversing this is abnormal; great reversal leads to death."

The above fully illustrates that Medical Sage Zhang Zhongjing deeply understood that the "Foot Yangming Stomach Meridian" undergoes ascending and descending movements. Thus, to diagnose the energy of Stomach Qi ascending, one palpates the "Renying Acupoint artery" on both sides of the neck; to diagnose the energy of Stomach Qi descending, one palpates the "Fuyang Acupoint artery" on both feet. Both Renying and Fuyang belong to the "Foot Yangming Stomach Meridian," enabling the diagnosis of the meridian's ascending and descending prosperity or decline.

*Suwen · Yuji Zhenzang Lun Pian* states: "Spring pulse is like a string. How is it a string? Qibo replied: 'The Spring pulse corresponds to the Liver, East Wood, the beginning of all things. Thus, its Qi comes soft, light, void, and slippery, straight and long, hence called 'string.' Opposite to this indicates disease. The Emperor asked: How is it opposite? Qibo said: 'If its Qi comes solid and strong, this is called Excess, disease in the Exterior; if its Qi comes not solid but weak, this is called Deficiency, disease in the Interior.' 'Summer pulse is like a hook. How is it a hook? Qibo said: 'The Summer pulse corresponds to the Heart, South Fire, the flourishing growth of all things. Thus, its Qi comes vigorous and departs declining, hence called 'hook.' Opposite to this indicates disease. The Emperor asked: How is it opposite? Qibo said: 'If its Qi comes vigorous and departs vigorous, this is called Excess, disease in the Exterior; if its Qi comes not vigorous but departs vigorous, this is called Deficiency, disease in the Interior.'

'Autumn pulse is like floating. How is it floating? Qibo said: 'The Autumn pulse corresponds to the Lung, West Metal, the harvest of all things. Thus, its Qi comes light, void, and floating, coming urgent and departing scattered, hence called 'floating.' Opposite to this indicates disease. The Emperor asked: How is it opposite? Qibo said: 'If its Qi comes hairy with a firm center and empty sides, this is called Excess, disease in the Exterior; if its Qi comes hairy and weak, this is called Deficiency, disease in the Interior.' 'Winter pulse is like camp [deep]. How is it camp? Qibo said: 'The Winter pulse corresponds to the Kidney, North Water, the storage of all things. Thus, its Qi comes deep and firm, returning to camp, hence called 'camp.' Opposite to this indicates disease. The Emperor asked: How is it opposite? Qibo said: 'If its Qi comes like bouncing stones, this is called Excess, disease in the Exterior; if its departure is rapid, this is called Deficiency, disease in the Interior.'

Based on the above discussion of Spring, Summer, Autumn, and Winter pulse images, only the Liver pulse mentions the "coming" aspect without explaining the "departing" aspect. However, for the Heart, Lung, and Kidney pulses, both "coming" and "departing" diagnostics are explained. These seasonal pulse transformations refer to diagnosing the arteries at both Cun Kou positions. Without experiencing certain "Gong State" manifestations, it would be difficult for me to fully comprehend the "coming and departing" pulse principles discussed in *Suwen · Yuji Zhenzang Pian*. What is meant by "Coming"? It is the positive movement pulse wave phenomenon. What is meant by "Departing"? It is the negative movement pulse wave phenomenon. Based on these two examples, it can be proven that ancient sages valued diagnosing positive and negative incoming/outgoing pulse waves. My research on the Twelve Meridians also focuses on positive and negative incoming/outgoing mechanisms, consistent with ancient pulse diagnosis principles. However, there is a slight difference: the pulse movements on the left and right sides are "opposing" ascending/descending and incoming/outgoing. I specifically list the Yin-Yang "Positive/Negative" Pulse Wave Table below, which should be referenced alongside the "Gong State Manifestation Table" to clarify the circular mechanism of the Twenty Meridians on the left and right.

Table of Positive and Negative Pulse Waves of Maikou and Renying Arteries

Hand-Foot Three Yin Meridians Positive Movement: The Qi and Blood fluctuations excited during the operation of Hand-Foot Three Yin Meridians moving from Foot to Abdomen and Chest to Hand, reflected in the Maikou (Coming) pulse image.
Hand-Foot Three Yin Meridians Negative Movement: The Qi and Blood fluctuations excited during the operation of Hand-Foot Three Yin Meridians moving from Hand to Chest and Abdomen to Foot, reflected in the Maikou (Departing) pulse image.

Hand-Foot Three Yang Meridians Positive Movement: The Qi and Blood fluctuations excited during the operation of Hand-Foot Three Yang Meridians moving from Hand to Head and Head to Foot, reflected in the Renying (Departing) pulse image.
Hand-Foot Three Yang Meridians Negative Movement: The Qi and Blood fluctuations excited during the operation of Hand-Foot Three Yang Meridians moving from Foot to Head and Head to Hand, reflected in the Renying (Coming) pulse image.

The Left Maikou pulse diagnoses the positive and negative movement pulses of the left Hand and Foot Three Yin Meridians; the Right Maikou pulse diagnoses the positive and negative movement pulses of the right Hand and Foot Three Yin Meridians; the Left Renying pulse diagnoses the positive and negative movement pulses of the left Hand and Foot Three Yang Meridians; the Right Renying pulse diagnoses the positive and negative movement pulses of the right Hand and Foot Three Yang Meridians. One compares the magnitude, strength, and weakness of the pulse wave energy released by Maikou and Renying to distinguish one-fold, two-fold, three-fold differences, as well as Yin-Yang excess or deficiency.

Pulse diagnosis is the doctor's sensory awareness of the patient's positive and negative pulse wave movements. Therefore, the physician must calm the mind and breath, concentrate spirit, carefully differentiate, memorize, and intuitively perceive the patient's imbalance or uniqueness, which is the location of the lesion. Whether using acupuncture, massage, or Chinese/Western medicine, treatment must start from balancing the Yin and Yang meridians up/down and left/right. If the four aspects of Yin-Yang, or the four arterial balances of left/right Maikou and Renying, are regulated, it constitutes "Superior Physician Balancing Qi," and the disease will be dispelled.

XIX. Brief Discussion on the Connection Between Twelve Meridians and Western Medicine

I believe that the positive and negative incoming/outgoing movement principles of the human "Twelve Meridians" are not only the "original fundamental principles" of TCM but also those of Western Medicine. For example, the blood circulation motion described in modern medicine as output from the "Left Ventricle via Arteries" belongs to the energy manifestation promoted by the "positive movement function" of the human body's left "Twelve Meridians"; the blood circulation motion described as input into the "Left Atrium via Veins" belongs to the energy manifestation promoted by the "negative/reverse movement function" of the human body's left "Twelve Meridians." For brevity, it can be inferred similarly that the blood circulation motions of the "Right Ventricle" and "Right Atrium" are also the same as the left side.

Similarly, the opposing inhalation/exhalation gas exchange functions of the nose, pharynx, trachea, and lungs; the opposing expansion/contraction and ascending/descending peristaltic functions of the intestinal and gastric digestive tract; the coordinated dual innervation activities of sympathetic and parasympathetic nerves of the Five Zang and Six Fu Organs; the mutual exchange blood circulation functions of arteries and veins in the limbs and body; and the opposing diastolic/systolic pressure ascending/descending functions measured by a "blood pressure cuff"—all are various opposing functional phenomena caused by the positive and negative incoming/outgoing energy movements of the human "Twelve Meridians."

The positive and negative movement mechanisms of the "Twelve Meridians" resonate with modern Western medical theories. However, modern medicine only studies the "microscopic" level of human "tangible and substantial" opposing physiological and pathological phenomena, discovering all microscopic biological derivatives from normal cell tissues or abnormal bacterial tissues, but fails to understand from a "macroscopic" perspective that the root cause of all biochemical origins lies in the "formless and imageless positive and negative movements" of the "Twelve Meridians" being "balanced" or "imbalanced."

Therefore, adjusting the human "Twelve Meridians" to reach harmony is the most fundamental treatment policy, so Western medicine also needs to understand the truth of the TCM "Twelve Meridians."

XX. Case Studies of Diagnosis and Acupuncture Therapy Following Twelve Meridians Mechanisms

(I) Case One

Yan xx, Male, 67 years old, Farmer. Visited on June 10, 1980. Family introduced that the patient had a sudden onset of illness. After ineffective treatment by local doctors, he was carried to the hospital. On the way, the patient fell into a coma resembling death, was brought back home, and later revived, requesting my treatment.