典藏书目

Huangdi's *Neijing* (Inner Canon of the Yellow Emperor) and Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) are the sacred scriptures of Chinese medical classics in our country. However, their language is concise while their meaning is profound; without carefully analyzing the full text, concentrating one's mind to comprehend it, and inferring other instances from one example, it is rare to glimpse its profound mysteries. If one takes passages out of context or allows literal interpretation to obscure the true intent, a slight initial error will lead to a massive discrepancy in the final result.

The *Suwen: Re Lun* (Plain Questions: Discussion on Heat) states: "When humans are injured by cold, they develop febrile diseases; even if the fever is severe, death does not occur." This "febrile disease" refers to a syndrome pattern, not a specific disease name, indicating that cold damage immediately causes fever. Generally, when cold pathogens press upon the skin and muscles, the Yang Qi cannot diffuse and emerge, but instead becomes constrained and depressed, resulting in febrile symptoms. The manifestation is heat at the surface (biao) while the root is cold (ben); since Yin Essence has not been damaged and Yang Qi remains strong, death does not occur.

Regarding febrile diseases that are more severe than warm diseases, the *Lingshu: Re Bing* (Spiritual Pivot: Heat Diseases) states: "If the eyes cannot see clearly and the fever does not cease, death ensues; if the base of the tongue rots and the fever does not cease, death ensues; if the marrow is hot, death ensues; if there is fever accompanied by spasms, death ensues." Generally, blindness due to heat with unceasing fever indicates the decline of Liver Qi; rotting of the tongue base with unceasing fever indicates excess pathogenic factors in the Heart; extreme heat leading to dried-up marrow indicates exhaustion of Kidney Qi; fever with spasms indicates wind stirring and tendon tension. The reason for this is that extreme heat spreads like a prairie fire generating wind; wind and fire multiply each other, leading to the depletion of essence and blood, how can one not die?

The *Suwen: Shui Re Xue Lun* (Plain Questions: Discussion on Water and Heat Acupoints) states: The Yellow Emperor asked, "Why do people injured by cold transmit into heat?" Qibo answered, "Extreme cold generates heat." This means that once exterior cold transforms into heat, the heat enters the interior; interior heat stagnates and knots, thereby forming a heat disease.

The *Suwen: Ci Re Lun* (Plain Questions: Puncturing Heat) states: "For severe cases, the fifty-nine punctures method is used, either to drain heat from the Yang meridians, or to drain heat from the chest, or to drain heat from the stomach, or to drain heat from the four limbs, or to drain heat from the five zang organs." This also refers to heat diseases undergoing transmission.

The *Suwen: Jin Gui Zhen Yan Lun* (Plain Questions: True Words on the Golden Casket) states: "Essence is the root of the body. Therefore, those who preserve their essence will not suffer from warm diseases in spring." The *Suwen: Ping Ren Qi Xiang Lun* (Plain Questions: Image Analysis of Normal People) states: "If during one exhalation the pulse beats three times, and during one inhalation the pulse also beats three times, and is rapid, with heat in the chi position, this indicates a warm disease." The *Suwen: Lun Ji Chi* (Plain Questions: Discussing Diseases by Inspecting the Arm) states: "If the skin in the chi position is very hot and the pulse is vigorous and rapid, this is a warm disease." The *Suwen: Yu Ban Lun Yao* (Plain Questions: Discussion on Jade Slips and Essentials) states: "Those suffering from warm disease with extreme deficiency will die." These passages concern the naming of warm diseases and their diagnostic methods.

The *Suwen: Yin Yang Ying Xiang Da Lun* (Plain Questions: Great Discussion on Yin-Yang Correspondences) states: "Injury by cold in winter leads to warm disease in spring." The *Re Lun* states: "All diseases that become warm after shanghan are called warm disease if they occur before the Summer Solstice, and summerheat disease if they occur after the Summer Solstice." The *Shanghan Li* states: "If the disease does not manifest immediately, cold toxicity hides in the skin and muscles; by spring it becomes warm disease, and by summer it becomes summerheat disease. Summerheat disease is characterized by extreme heat, heavier than warm disease." This discusses the pathology of latent qi (fu qi).

For shanghan contracted and manifesting immediately, the cause of fever is indeed cold; for shanghan that does not manifest immediately but transmits into warm disease or summerheat disease, the cause is also cold. Thus, the *Re Lun* states: "Current heat diseases all belong to the category of shanghan."

The *Suwen: Ci Zhi Lun* (Plain Questions: Discussion on Puncturing Qi) states: "Qi deficiency with body heat is called 'contrary' (fan)." It further states: "Qi deficiency with body heat results from injury by summerheat." Generally, qi deficiency implies insufficient Yang Qi; insufficient Yang Qi should result in coldness of the body. To have body heat instead, the pulse qi should be vigorous; if the pulse is not vigorous yet the body is hot, the syndrome contradicts the pulse, hence it is called 'contrary'. Cold injures the form (xing), heat injures qi; summerheat is heat, so injury by summerheat leads to qi deficiency and body heat.

The *Shanghan Lun* states: "Taiyang disease, with fever and thirst, and no aversion to cold, is called warm disease." Thus, the distinction between warm disease and shanghan lies in the presence of fever, thirst, and absence of aversion to cold.

The *Shanghan Lun* states: "After sweating therapy, if the body feels scorching hot, it is named Feng Wen (Wind-Warmth). In Feng Wen disease, the pulse is floating in both yin and yang positions, there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring breath, and difficulty speaking. If purgatives are mistakenly used, there will be difficulty urinating, fixed staring, and loss of bowel/bladder control. If fire therapy is mistakenly applied, mild cases turn yellow; severe cases resemble convulsive epilepsy with intermittent spasms, appearing as if scorched by fire. One mistake may prolong the illness; two mistakes accelerate the time of death." This describes the symptoms of bad disease (huai bing) resulting from mismanagement of Feng Wen.

The *Shanghan Lun* states: "Taiyang middle heat, i.e., Ye (summerheat stroke), presents with sweating, aversion to cold, body heat, and thirst." It further states: "Taiyang middle Ye, with body heat, pain, and heaviness, and a weak pulse, is caused by injuring cold water in summer, causing water to circulate in the skin." It also states: "Taiyang middle Ye, with fever, aversion to cold, body heaviness and pain, and a string-taut, fine, hollow, or slow pulse; after urination, there is a chill with hair standing on end, cold hands and feet, and slight exertion causes body heat; opening the mouth reveals dry front teeth. If sweating is induced, aversion to cold worsens; if moxibustion/heat needles are added, fever worsens; frequent purging worsens strangury." This explains that middle heat and middle Ye are different names for the same disease, summerheat stroke. Since the syndromes differ, the treatment methods vary accordingly.

All the above citations are what warm disease studies should explore deeply to uncover origins. People often confuse shanghan and warm disease, treating heat diseases according to shanghan fever patterns. They mistakenly believe 'severe heat does not kill,' recklessly using acrid-warm formulas like Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) without effect. Instead of blaming their own lack of medical precision, they blame the ancients for poor legislation, turning the sages' compassionate intent into a tool for killing. Is this not slanderous?

Because the profound and hidden is difficult to understand, exploration is hard, leading to many misunderstandings. With many misunderstandings, plausible but false theories arise, increasing confusion. How can future learners explore? Therefore, amidst confused theories, we select those suitable as stepping stones for exploration and discuss them below, enabling learners to know what to adopt and reject.

Guo Baiyun of the Song Dynasty wrote *Shanghan Buwang Lun* (Supplemental Lost Treatise on Cold Damage), incorporating views from *Qianjin Fang*, *Huo Ren Shu*, and scholars Pang and Chang, supplementing those consistent with Zhang Zhongjing, hence the title 'Supplementing the Lost.' Zhu Xi's postscript notes that it categorizes content clearly for easy understanding, making the origins of ancient sage-medical ways accessible. Readers were amazed, considering it a rare book; its elucidation of mysteries was supreme.

Liu Hejian of the Jin Dynasty authored *Shanghan Zhige Lunfang* (Direct Grid Theory and Formulas for Cold Damage) and *Shanghan Linben Xinfa Leicui* (Collection of Core Methods for Cold Damage). He expressed unique insights on treating warm-heat diseases, pioneering ideas previously unexpressed, hence later generations attribute the theory of 'dominant fire' to him.

Li Dongyuan's theory is renowned for emphasizing Spleen and Stomach, but his disciple Wang Haogu compiled *Cishi Nan Zhi Ji* (Collection of Difficult Matters to Know). This work aligns with Huangdi and Qibo's classics, fits Bian Que's canons, and matches Wang Shuhe's texts, revealing Zhang Zhongjing's secret teachings that are hard for others to know, thus named 'Difficult to Know.'

Ge Cunju of the Ming Dynasty wrote *Shanghan Butian Shi* (Stone for Mending Heaven in Cold Damage), comprehensively discussing various external contraction diseases. Its scope is broad, principles detailed, and it reveals implicit meanings of Zhang Zhongjing, achieving a feat akin to Nuwa mending the sky.

Yu Genchu of the Qing Dynasty wrote *Tongsu Shanghan Lun* (Popular Treatise on Cold Damage), published recently by He Lianchen. Its attributes are rich, categories clear, and its differentiation, treatment, and prescriptions are highly practical. Without extensive experience and lifelong dedication, such achievement would be impossible. 'External contraction' was generally called 'shanghan' in ancient colloquialism, hence the book's title.

The aforementioned works are all original, innovative, and established distinct schools. Although breaking old molds, they still conform to canonical principles and elucidate the practical significance of the broad sense of *Shanghan Zabing Lun*. Their contribution to Zhang Zhongjing is significant. Those seeking the origins of warm disease studies must pay attention to them.

Additionally, Wang Andao of the Yuan Dynasty wrote *Yijing Suhui Ji* (Collection of Tracing Back Medical Classics). Although he erroneously believed Zhang Zhongjing's *Shanghan Lun* was solely for immediate-onset shanghan and not for delayed-onset warm or summerheat diseases, he systematically distinguished between warm disease and shanghan, making it a valuable reference for research.