典藏书目

Zhao Sizhen said: I have long suspected that the concepts of *hebing* (combined disease) and *bingbing* (consecutive disease) are difficult to clarify, so I will tentatively explain them. The term *hebing* refers to a condition where two Yang meridians or three Yang meridians are simultaneously affected by pathogenic factors, without the process of disease transmission; whereas *bingbing* refers to a condition where one Yang meridian is first affected, and subsequently transmits to another meridian, indicating the occurrence of disease transmission. For example, in the case of Taiyang-Yangming *bingbing*, if the combination is not yet fully transmitted, it indicates that the transmission has not crossed the boundary, and exterior symptoms still exist. This corresponds to what Zhang Zhongjing described as "Taiyang syndrome unrelieved, redness of the face, oppression of Yang Qi in the exterior unable to vent, irritability, and shortness of breath." In such cases, diaphoresis (sweating method) should still be employed, using Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Volume Decoction). If the combination is complete, it indicates that transmission has occurred. This corresponds to Zhang Zhongjing's description of "Taiyang syndrome resolved, tidal fever, sweating of hands and feet, hard stool, and delirium." The treatment method should then be purgation (downward draining), using Chengqi Tang (Gut-Clearing Decoction). From this, we know that if transmission occurs, the pathogen enters the Fu organs; if not, it does not. Therefore, when discussing Taiyang-Yangming *hebing*, Zhang Zhongjing only lists the three syndromes mentioned earlier; but when discussing Taiyang-Yangming *bingbing*, he details its potential for transmission.

Furthermore, when the three Yang meridians combine (*hebing*), they all present with diarrhea. For Taiyang-Yangming *hebing*, Zhang Zhongjing primarily prescribes Gegen Tang (Kudzu Decoction); for Taiyang-Shaoyang *hebing*, Huangqin Tang (Scutellaria Decoction); and for Shaoyang-Yangming *hebing*, Chengqi Tang (Gut-Clearing Decoction). As for Taiyang-Shaoyang *bingbing*, the symptoms include stiffness and pain in the head and neck, dizziness, a sensation like chest binding (Jie Xiong), and hardness below the heart. Acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) should be employed, and neither diaphoresis nor purgation should be used. Taiyang-Yangming *bingbing* has been discussed above. However, in cases of San Yang (Three Yang) *hebing*, Zhang Zhongjing does not mention "aversion to cold on the back"; although there is a separate mention of "dry mouth and throat, vexation, and slight aversion to cold on the back," this belongs to Taiyang syndrome, not San Yang *hebing*. If the three Yang meridians combine with the three Yin meridians, it is called "Liang Gan" (Double Contraction), so there are no cases of *hebing* involving the three Yin meridians.

Note: The syndromes and treatments for San Yang *hebing* can be found in the Yangming Chapter of the Shanghan Lun (Treatise on Cold Damage).

Zhao Sizhen stated: According to Zhang Zhongjing's discussion, in winter, one contracts cold pathogens which lie dormant in the skin and muscles without immediate onset. When spring arrives, the warming Qi transforms this latent cold into heat. The term "transform" (Bian) means alteration. At this point, the latent cold changes according to the Qi of spring and summer into warmth or heat. Once transformed, it can no longer be referred to as cold. Thus, Zhang Zhongjing's statement that warm diseases do not present with aversion to cold becomes understandable. However, the *Huren Shu* (Book for Saving Lives) states that in warm disease, "Yang heat is not yet abundant and is constrained by cold." How can it be said that latent cold, having already transformed into warmth, is still constrained by cold? Furthermore, regarding hot diseases, it states "Yang heat is abundant, and cold cannot constrain it," implying it should not be referred to as cold again. Essentially, because Yang heat is abundant in spring and summer, the transformed latent cold is no longer true cold and cannot constrain Yang heat. Additionally, there are instances where cold pathogens damage Yang Qi; these refer to epidemic cold plagues (Shi Xing Han Yi). Zhang Zhongjing defined this as: "After the Spring Equinox and before the Autumnal Equinox, sudden cold weather is called an epidemic cold plague." In the third and fourth lunar months, Yang Qi is still weak; when damaged by cold, the resulting fever is mild. In the fifth and sixth months, Yang Qi is abundant; when damaged by cold, the resulting fever is severe. In the seventh and eighth months, Yang Qi is declining; when damaged by cold, the resulting fever is also mild. Thus, the discussion of Yang Qi abundance and decline in relation to seasonal months is consistent between epidemic cold plagues and warm-hot diseases. However, the discussion of sudden cold versus latent cold that has already transformed is contradictory. If names are not correct, words do not flow smoothly. Zhang Zhongjing further stated: "The disease resembles warm and summer-heat diseases, but the treatment differs significantly. The key lies in distinguishing the disease source; the differences among cold, heat, and warmth dictate whether the medicinal properties used should be cooling or warming."

Respectfully noted: Wang Andao, in *Shanghan Lifa Kao* (Study on the Legislative Principles of Cold Damage), stated: When reading Zhang Zhongjing's works, one must seek the intent behind his legislative principles; otherwise, doubt and belief will mix, leading to understanding one aspect while hindering another. Cold damage includes cases that manifest immediately, termed "Shanghan" (Cold Damage), and those that do not manifest immediately, termed "Wen" (Warm Disease) and "Shu" (Summer-Heat Disease). Although their categories differ, their origin is the same. In Zhang Zhongjing's book, cold syndromes of the three Yin meridians account for seventy to eighty percent of the heat syndromes. How could the non-immediate Wen and Shu diseases, which are purely heat, become cold? By carefully examining the cold syndromes of the three Yin meridians, one will realize my words are not baseless. Some argue that the cold syndromes of the three Yin meridians were originally miscellaneous diseases added by Wang Shuhe; others claim these cold syndromes resulted from erroneous treatment with cold medicines. Such views are incorrect. What Wang Shuhe added were merely chapters like *Bian Mai* (Differentiating Pulse), *Ping Mai* (Assessing Pulse), and discussions on diaphoresis and purgation. The Six Meridian Disease chapters were certainly not written by Wang Shuhe. It is true that in the Jueyin chapter, entries regarding diarrhea, vomiting, and hiccups were indeed appended by Wang Shuhe due to the presence of Jue Ni (Reversal Cold), even attaching similar cases without Jue Ni. Regarding variable syndromes caused by medicinal error, Taiyang meridian cases are most common. Even among Yin meridian cases, some may turn cold due to erroneous use of cold medicines, but surely not to such a large extent. It is precisely because later scholars treated Zhang Zhongjing's entire work as applicable to both Shanghan and Wen/Shu that they doubted and dared not use various warming agents. Han Zhihe felt that Guizhi Tang (Cinnamon Twig Decoction) was difficult to use, attributing it to differences between ancient and modern times, but failed to realize that Zhang Zhongjing's book was originally established for immediate-onset Shanghan. Moreover, his work *Weizhi* (Subtle Principles) exclusively treats Wen/Shu as Shanghan, omitting immediate-onset Shanghan entirely. This is putting the cart before the horse and failing to grasp the essence of Zhang Zhongjing's scholarship. He viewed symptoms occurring before the Summer Solstice—such as chest fullness, vomiting, qi obstruction, borborygmus, abdominal pain, body stiffness, and cold extremities—as Shanghan, claiming they shared pulse logic with Zhang Zhongjing's Yin meridian syndromes despite different presentations, and thus established a "Warming Middle" method. In my view, since these symptoms differ from Zhang Zhongjing's Yin meridian descriptions, they are internal injury miscellaneous diseases, not Wen/Shu diseases. Comparing Zhang Zhongjing's Yin meridian syndromes with spring-summer Wen/Shu diseases is absurd. Although Han Zhihe lacked clarity on internal injury theories at the time and encountered an outbreak of Wen/Shu diseases, his approach was understandable. However, if it were not internal injury, it would not just be sudden cold invasion. He simply stated it was cold requiring warming, without investigating the cause. Investigating the cause reveals that Wen/Shu inherently lacks cold syndromes; any cold presentation stems from internal injury or sudden cold invasion. Liu Shouzhen later also treated Wen/Shu as Shanghan, omitting immediate-onset Shanghan. His辛凉 (Acrid-Cool) dispersing formulas were established to correct lay errors in treating wind-stroke and cold damage, yet he too harbored doubts about the usability of Guizhi and Mahuang. Failing to understand why Zhang Zhongjing established these formulas for specific indications and timings, Liu wrote in *Yuan Bing Shi*: "In summer heat, using hot drugs like Guizhi and Mahuang for diaphoresis requires adding cold drugs; otherwise, excessive heat causes jaundice or macules." Little did he know that Zhang Zhongjing never intended to use Guizhi or Mahuang Tang in summer. If one realizes that Guizhi and Mahuang are not agents for Wen/Shu, all doubts will melt away. Why? When cold initially invades the exterior, it opens the pores and constrains Yang Qi, generating heat. Only acrid-warm drugs can open the pores to vent this heat, hence the establishment of Mahuang Tang. When wind pathogens invade the exterior, they loosen rather than close the pores. However, since the pathogen resides in the exterior, the body's righteous Qi is injured and cannot circulate freely, causing fever. Acrid-sweet-warm drugs are needed to disperse the pathogen, allowing the pores to seal naturally, hence the establishment of Guizhi Tang. Cold drugs are not added because the wind-cold is in the exterior during cold weather, necessitating warmth to counteract it. Later scholars, unaware of Zhang Zhongjing's intent, were confused by the heat of Guizhi and Mahuang, fearing violation of spring-summer Qi, and thus proposed adding cold drugs. This addition stems from a lack of understanding. If Zhang Zhongjing had formulated for Wen/Shu, he would not have done so; he surely had other methods, though lost to history. If one understands that *Shanghan Lun* is specifically for immediate-onset Shanghan, the appropriate use of Mahuang and Guizhi becomes clear. Excluding transmitted heat diseases, direct invasion of Yin meridians and Taiyang cases without constraint that transmit to Yin meridians all have their place, removing doubts about cold-induced errors. If in spring and summer one encounters aversion to wind/cold with or without sweat, these are likely new cases of sudden wind-cold in spring/summer, not delayed manifestations from winter injuries. Otherwise, it might be Wen/Shu about to erupt triggered by new wind-cold, or wind-cold stirring long-constrained heat, leading to Wen/Shu eruption. Zhang Zhongjing stated: "Taiyang syndrome with fever, thirst, and no aversion to cold is Warm Disease." This implies Warm Disease should feature thirst, not aversion to cold; aversion to cold without thirst is not Warm Disease. Although Zhang Zhongjing did not explicitly discuss Summer-Heat Disease, it is similar to Warm Disease but worsens over time. Its lack of aversion to cold and presence of thirst are identical. Although spring and summer may present with aversion to cold/wind exterior symptoms, Guizhi and Mahuang Tangs should rarely be used lightly. Do not cling to the saying "dispersing exterior does not avoid heat." Using acrid-cool dispersing methods is more appropriate. Imprudent general use inevitably leads to mania, macules, jaundice, and epistaxis, yielding no benefit. Occasionally, using Guizhi/Mahuang in spring/summer may succeed due to their acrid-dispersing power hitting the mark by chance, but this should not be regarded as standard practice. Later scholars applied general dispersing formulas indiscriminately across seasons for wind-stroke and cold damage. While not orthodox, this is safer than recklessly using Mahuang/Guizhi which causes complications. Zhang Zhongjing used warming drugs for Yin meridian diseases due to necessity and timing. Dismissing all Yin cold syndromes as miscellaneous diseases betrays Zhang Zhongjing's benevolence and misleads future generations. Since early masters did not clarify the distinction in treating Shanghan vs. Wen/Shu, favoring cooling agents and neglecting warming ones, later students hesitate to rely on Zhang Zhongjing yet cannot discard him as the ancestor of legislation. Understanding that Zhang Zhongjing legislated for immediate-onset cases clarifies that Guizhi/Mahuang are not necessarily difficult to use, and warming agents should not be neglected. If Zhang Zhongjing's laws applied to all epidemic, cold plague, warm malaria, and wind-warm cases, would they all be treated with Six Meridian formulas? Zhang Zhongjing said: "Winter warm toxins differ greatly from Shanghan, with different treatments." And: "Cold plague resembles warm and summer-heat diseases, but treatment differs." Thus, Wen/Shu, epidemics, warm malaria, and wind-warm diseases must have distinct treatments, now lost. His mentions of differing treatments and specific pulse/syndrome/formula variations for warm malaria, wind-warm, warm toxin, and warm epidemic imply these methods existed but were lost. They definitely cannot be treated uniformly with Six Meridian Shanghan formulas. *Suwen* states "injury by cold results in heat disease," describing constant principles, not variations. Zhang Zhongjing describes varying cold and heat, covering constants and variations without omission. Zhang Zhongjing elaborated on what ancients omitted, greatly benefiting humanity; how can it be partially discarded?

As noted above, these arguments complement each other and greatly aid the understanding of Zhang Zhongjing. However, regarding Shanghan, sudden death diseases, and epidemic cold plagues, why do deviations occur even when pulse and syndrome match? Generally, after transmission, variations are numerous, resembling miscellaneous diseases. Thus, although Zhang Zhongjing and Wang Shuhe's compilations have mixed categories, the syndromes' root and branch differ, and treatments vary flexibly. Similar syndromes require different treatments, causing confusion. If one seeks the underlying meaning and unifies observation, syndromes will clarify, and treatments will be accurate. One must study the classics thoroughly and consult other books when in doubt. For instance, Zhao's commentary on *Huren Shu* notes many ambiguities in both *Huren Shu* and Zhang Zhongjing's text. Take Baibu Tang (White Tiger Decoction): Zhang Zhongjing says it is contraindicated if the exterior is unresolved, yet Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) lists both "aversion to wind" and "aversion to cold." Is this not contradicting the rule? Actually, "slight aversion to wind" appears only on the back and is less severe than general aversion to wind. "Intermittent aversion to wind" implies occasional chills, indicating the exterior syndrome is light, unlike previous cases with floating pulse, fever, and complete lack of sweating. Coupled with high fever and intense thirst, Baibu Tang is undoubtedly indicated. Another example: Zhang Zhongjing discusses Taiyang disease lasting eight or nine days, resembling malaria with fever and chills, more heat than cold. If the patient does not vomit and bowel movements are normal, occurring 2-3 times a day with a slightly slow pulse, recovery is expected. If the pulse is faint with aversion to cold, both Yin and Yang are deficient, and diaphoresis, purgation, or emesis are contraindicated. If the face shows redness, resolution is not imminent; inability to produce slight sweat causes itching, warranting Guizhi Mahuang Ge Ban Tang. Zhang Zhongjing's intent is to treat the "eight-nine days... malaria-like... more heat than cold" as the current state, while the following text offers predictive advice for prevention. This should be read in three parts. 1. "No vomiting, normal bowels, intermittent发作, floating-slow pulse": Interior is harmonious, pathogen is weakening, Yin-Yang balanced, indicating spontaneous recovery without drastic sweating. 2. "Faint pulse, aversion to cold": Yin-Yang deficiency, requiring warming. 3. "Red face, itching, needs slight sweat": Requires diaphoresis via Ge Ban Tang. *Huren Shu* fails to parse the text correctly, applying Ge Ban Tang to the "no vomiting/normal bowels" section (which indicates recovery) and omitting the contraindications for sweating/vomiting/purgation, thereby using the wrong drug for the wrong syndrome. This illustrates Zhang Zhongjing's precise textual style. Scholars must repeatedly examine the text to grasp the intent and rules, ensuring accurate treatment. Zhao once said: "In Zhang Zhongjing's book, a single character difference leads to vastly different treatments." Readers must seek meaning in every word. Let us encourage each other.