典藏书目

Wang Haogu (styled Haicang) stated: It is true that people have established methods for treating Shanghan (Cold Damage) and prescriptions for treating Zabs (Miscellaneous Diseases). However, this is not the whole truth. I assert that there are also prescriptions for treating Shanghan and methods for treating Zabs. "Prescription" is essentially "method"; is there any difference between them? The key lies in comprehensively understanding the differentiation of meridians, exterior-interior relationships, and zang-fu organs. How could there be two distinct principles? Because the intellectual capacity of later generations did not match that of the ancients, Shanghan and Zabs were divided into two categories. Consequently, some practitioners excelled in one area but lacked proficiency in the other. When the state selected officials by dividing them into seven departments, it led to scholarship becoming narrower with greater specialization and techniques becoming coarser despite being more focused.

Let us discuss the two categories of Shanghan and Zabs. Shanghan enters from the exterior to the interior; therefore, the method should first treat the exterior pathogen and then the interior syndrome. Zabs originate from the interior and manifest externally; thus, the method should first treat the internal organs and then the external manifestations. As for conditions where the interior and exterior do not interfere with each other, one should primarily treat the main disease. The methods are fundamentally the same; why must they be divided into two? Generally speaking, the external manifestations of Zabs are inseparable from the Exterior syndrome, while the internal pathology of Shanghan is inseparable from the Interior syndrome. For Exterior syndromes, sweating methods are used; for Interior syndromes, purgative methods are employed; for Middle Jiao syndromes, harmonizing methods are applied. These are immutable principles. The properties of cold, heat, warmth, and coolness of medicines are contained within these methods.

Dai stated: Among Shanghan and Zabs, there are correct Shanghan diseases and mixed Shanghan diseases. Mixed Shanghan diseases cannot be treated using methods for correct Shanghan. For instance, if a patient's symptoms vary, presenting both cold and heat signs, with Yin and Yang manifestations clearly visible, one should first address the major aspects among them, and subsequently treat the remaining minor symptoms. However, one must not use purely hot or purely cold formulas. For example, if a patient presents with vomiting, thirst, and irritability/fever, and after administering Xiaochaihu Tang (Minor Bupleurum Decoction), the vomiting, thirst, and irritability cease, but diarrhea persists, one might conclude Xiaochaihu Tang was incorrect because the vomiting and thirst stopped. Conversely, if one considers Xiaochaihu Tang correct, then the diarrhea should not have occurred. Similarly, if a patient presents with vomiting, diarrhea, and cold extremities, and after administering Jiangfu Tang (Ginger and Aconite Decoction), these symptoms cease, but fever, thirst, delirium, and unconsciousness appear, one might argue Jiangfu Tang was wrong because the initial symptoms resolved. If Jiangfu Tang were correct, the subsequent fever and delirium should not have appeared. This illustrates that although mixed Shanghan may not show obvious simultaneous cold and heat signs as described above, Yin contains Yang and Yang contains Yin, lying latent without immediate manifestation. If medication is biased, it will cause one aspect to decline while the other flourishes. Physicians must repeatedly examine and recognize conditions where doubts arise, avoiding focusing on one aspect at the expense of another, to achieve perfection.

The Three Yang syndromes include He Yang (Combined Yang) and Chun Yang (Pure Yang); the Three Yin syndromes include Sheng Yin (Abundant Yin) and Chun Yin (Pure Yin). "He Yang" refers to what the classics call "He Bing" (Combined Disease). "Chun Yang" refers to the classic description: "Pulse is vigorous and large in both Yin and Yang positions; sweating does not resolve the condition, indicating a fatal prognosis." It also states: "In cases of sweating or taking herbal decoctions, some patients fail to sweat and die." This occurs when Yang-heat is extreme and Yin qi is exhausted, preventing the production of sweat. Both scenarios involve Yang without Yin, hence termed "Pure Yang."

"Sheng Yin" in the Three Yin includes Shaoyin disease characterized by body pain, cold hands and feet, bone and joint pain, and a deep pulse, treated with Fuzi Tang (Aconite Decoction). This indicates that coldness in the hands and feet, body pain, and deep pulse signify excessive cold in the Yin aspect. "Chun Yin" includes Shaoyin disease with aversion to cold, curled-up posture, diarrhea, and cold extremities, which is considered incurable due to the absence of Yang. If cold pathogens lodge in the Three Yin meridians, extreme cold generates heat, transmitting to the Yangming stage. Pathogens lingering in the Three Yin are generally cold, so warming and sweating methods are appropriate. If extreme cold transforms into heat, cold purgatives become suitable. Generally, the Three Yin and Three Yang can all directly receive pathogens, not merely transmitting from the Taiyang meridian. Thus, the classics state: "Yangming resides in the center, belonging to Earth, the gathering place of all things, where transmission ceases." For example, if Taiyang pathogens enter the Stomach, they do not transmit to Yangming; if Yangming pathogens enter the Stomach, they do not transmit to Shaoyang; if Shaoyang pathogens enter the Stomach, transmission stops. However, if Three Yin diseases directly receive pathogens and transform into heat entering the Stomach, the classics state: "In Shanghan, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin disease typically causes jaundice; however, if urination is free, jaundice will not develop. After seven or eight days, if the stool becomes hard, it becomes a Yangming disease." This is an example of Taiyin pathogens transmitting to Yangming. Another example: In Shaoyin disease, if abdominal distension and constipation occur after six or seven days, urgent purgation is required using Dachengqi Tang (Major Order the Qi Decoction); this is Shaoyin pathogens entering the Fu organs. The classics state: "Diarrhea accompanied by delirium indicates dry feces; Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated." This is Jueyin pathogens entering the Fu organs. Cases of Three Yin transforming into heat and entering the Fu organs are common and must be carefully observed.

One type is "Yi Yang Zhong Han" (Cold striking one Yang meridian). The Sixteen Syndromes of Shanghan mention: "Shanghan with a floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold, and leg cramping." This indicates pathogens striking the Bladder meridian causing deficiency-cold, treatable with Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). If a physician mistakes this for Yangdan syndrome and administers Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior, it is an error. The patient develops cold extremities, dry throat, vexation, and vomiting. At this point, Gancao Ganjiang Tang (Licorice and Ginger Decoction) should be prepared to restore Yang. Once the cold extremities resolve and feet warm up, Shaoyao Gancao Tang (Peony and Licorice Decoction) should be prepared to relax the tendons. If stomach qi disharmony leads to delirium, a small amount of Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) may be given. If excessive sweating and moxibustion/needle burning are added, Sini Tang (Recover the Extremities Decoction) is indicated. Observing Zhang Zhongjing's treatment of such "Hua Bing" (Transformed/Damaged Disease) reveals a method of sweating first, then purging. Another example: Diarrhea with undigested food, interior cold with exterior heat, and body pain require urgent treatment of the interior using Sini Tang. Once diarrhea stops, interior harmony is restored, and excretion normalizes, urgent treatment of the exterior with Guizhi Tang follows. This is a method of warming the interior first, then releasing the exterior. Sun Zhao stated: Originally Yang-heat diseases, if excessively purged or vomited by physicians, may transform into Yin diseases, requiring warming treatments. Conversely, originally Yin diseases, if excessively warmed, may lead to excess heat in the stomach or dry stools with delirium, requiring purgation.

Medical texts sometimes refer to "Taiyang Meridian Disease," "Taiyin Meridian Disease," "Shanghan," or "Zhongfeng" (Wind Strike). Sometimes only "Jue" (Cold Extremities) or "Xiali" (Diarrhea) are mentioned, or simply "Bing" (Disease). Mentioning a specific meridian implies pathogens struck that meridian, indicating not just Shanghan patterns but also mixed diseases. Referring to "Shanghan" without specifying a meridian implies non-mixed diseases affecting all six meridians, not restricted to one. The same applies to Zhongfeng. References to "Xiali," "Jue," or general patient names indicate that these symptoms can appear across various Shanghan, Zhongfeng, and Zabs patterns in the six meridians. Wang Shuhe, in compiling his classification, placed certain syndromes under specific meridians, leading to inaccuracies. For instance, diarrhea with delirium and dry feces treated with Xiao Chengqi Tang was placed under Jueyin diarrhea by Wang Shuhe, but symptomatically belongs to Yangming. Such errors cause later generations to rigidly adhere to the six meridians and arbitrarily distinguish cold and heat, deviating from the sage's way.

A skilled healer must carefully differentiate whether pathogens are transmitting from Taiyang or directly striking various meridians. One must assess if there are untreated patterns or those resulting from improper sweating, vomiting, purging, fire therapy, water therapy, chest binding, jaundice, blood stasis, fullness, diarrhea, or cold extremities. For patterns resembling Zhongfeng, Shanghan, or Zabs, one need not be confined to the six meridians but should distinguish between Exterior and Interior. Generally, all six meridians have Exterior and Interior aspects. If Exterior signs exist, sweating is indicated; if Interior signs exist, purgation is indicated. If both Exterior and Interior signs are present, purgatives combined with sweating agents may be used, adjusted based on the proportion of Exterior vs. Interior pathology. For half-Exterior half-Interior conditions, harmonization is used. This is the treatment for transmitting diseases. For Zabs with cold in the Exterior, acrid-warm sweating is used; for cold lodged in the Interior, intense heat remedies are applied. This clarifies the distinction between Exterior and Interior, with no other complexities.

Generally, if new symptoms appear after initial medication, these are "Hua Bing" (Transformed Disease), as described in classics regarding post-vomit, post-sweat, or post-purge states. Remedies must address the transformed pathology. If symptoms remain unchanged after medication, the disease has not receded, and further dosage may be needed, following similar sweating or purging protocols. Du Qingbi stated: Yang-heat diseases are difficult to treat due to varied transmission and transformation, whereas Yin-cold diseases do not transmit and have fixed treatment methods. Yan Ren'an stated: When treating others' Shanghan, one must investigate prior symptoms and medications. If symptoms are mixed, prioritize severe ones over mild ones. For transmitting pathogens, there are three methods: sweating for skin-level pathogens, harmonizing for those between exterior and interior, and purging for interior pathogens. This treats inward progression. For deficient individuals engaging in intercourse or irregular diet, interior deficiency allows pathogens to strike internally, requiring warming dispersal rather than sweating. Classics state: "Striking Yin by pathogens causes internal trembling." Weak exterior qi and unguarded interior qi allow pathogens to strike Yin. When interior qi is unguarded and pathogens strike, weak Zheng Qi causes trembling. Classics state: "Cold injures Ying (Nutrient) Blood. Cold congeals blood, stopping circulation, leading to disconnected limb qi and blood, causing Jue (cold extremities), cold body, and aversion to wind/cold." Fuzi and Ganjiang are appropriate here. If cold retreats but heat-toxin attacks internally, causing blurred vision, clear watery diarrhea, and abdominal fullness, urgent purgation is needed. This describes Shaoyin treatment. If cold retreats but extremities remain cold, fluctuating between hot and cold, with abdominal pain and dysuria, Sini San (Bupleurum Powder) is indicated. This reflects Shaoyin transmission similarities to Taiyang.

Treating Shanghan requires precise syndrome differentiation. Matching pulse and syndrome facilitate identification; mismatching requires careful assessment of urgency. Neither syndrome nor pulse alone suffices; both must align for optimal care. Expert physicians may treat critical cases relying solely on syndrome or solely on pulse. For example, classics state: "Floating-large pulse, epigastric hardness, and heat indicate Interior organ involvement; purge it, do not sweat." This contradicts standard exterior-sweating pulse indications. A Cu (Rapid-intermittent) pulse usually indicates excess Yang, but if accompanied by diarrhea, wheezing, and sweating, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, Coptis Decoction) is used. If cold extremities accompany a Cu pulse, it indicates collapse, requiring moxibustion/warming, contradicting the excess Yang indication. Yangming disease with a slow pulse, no aversion to cold, and sweating indicates Dachengqi Tang usage, contradicting the general rule that slow pulses indicate cold. Shaoyin disease initially presenting with fever and deep pulse requires Mahuang Xixin Fuzi Tang (Ephedra, Asarum, Aconite Decoction) for mild sweating, contradicting the rule that deep pulses indicate Interior disease. Here, "no aversion to cold" is key. Although classics warn against Guizhi in excess Yang, if delirium accompanies aversion to cold, Guizhi Tang must first resolve the exterior before purging, distinguishing exterior presence from absence. This illustrates Zhang Zhongjing's method of prioritizing syndrome over pulse.

Classics state: "Jie Xiong (Chest Binding) requires purgation; if the pulse is floating, purgation is contraindicated." This contrasts with cases of 7-8 days fever where a floating-rapid pulse permits purgation. Delirium, tidal fever, and slippery-fast pulses indicate Xiao Chengqi Tang. If, after one sheng dose, no bowel movement occurs the next day and the pulse becomes faint and choppy, further Chengqi administration is forbidden. This differs from cases where gas passage indicates readiness for purgation. Fever, aversion to cold, weak pulse, and delayed chi pulse contraindicate sweating, differing from typical exterior sweating indications. This illustrates Zhang Zhongjing's method of prioritizing pulse over syndrome.

Pulses reveal disease depth and inevitability. Agile physicians who integrate pulse and syndrome diagnosis face no difficulties. Medical subtlety lies herein.

When classics mention specific Yin/Yang diseases, one must discern ambiguities and clarify diagnoses before prescribing to avoid errors. Classics state: "Fever with aversion to cold originates in Yang; no fever with aversion to cold originates in Yin." For Shanghan, whether fever has started or not, aversion to cold is constant, along with body pain, vomiting, and tight pulses. Subsequent fever indicates origin in Yang. Initial lack of fever resembles origin in Yin, but differs by headache and stiff neck, which are absent in Yin. Aversion to cold with curling up and tight-deep pulse indicates origin in Yin. Yang origins permit sweating; Yin origins require warming the interior.

Shaoyin disease with deep pulse and initial fever resembles Taiyang but differs: fever is not intense, and headache is absent.

Shaoyin abdominal pain and diarrhea resemble Taiyin but differ: Taiyin lacks thirst, Shaoyin has thirst; hand/foot temperature varies (warm vs. cold).

Wenbing (Warm Disease) and Jingbing (Spasm) resemble Taiyang but differ: Jingbing has deep-thin pulse; Wenbing lacks aversion to wind/cold and features thirst.

Shanghan resembles Zhongfeng (Wind Strike): Zhongfeng lacks thirst, Shanghan has thirst. Shanghan resembles Dongwen (Winter Warmth): Shanghan has floating-tight pulse; Dongwen does not.

Epidemic contagion resembles Shanghan: Epidemics lack floating pulse; Shanghan has floating pulse.

Taiyang Zhongshi (Dampness) resembles Taiyang Shanghan: Dampness has deep-thin pulse. Response: Pulses may seem similar, but Jingbing differs (no body pain vs. dampness body pain).

Summerheat pulse is empty-thin, weak, string-thin, hollow, or slow, resembling Jing and Damp pulses. However, symptoms differ: Summerheat features spontaneous sweating and thirst; Dampness lacks thirst but has body pain; Jingbing lacks body pain.

Taiyang Zhongfeng with Cold Pulse uses Daqinglong Tang. Resembles Taiyang Shanghan but differs: Zhongfeng with cold pulse has vexation; Mahuang pattern lacks vexation.

Taiyang Shanghan with Wind Pulse uses Daqinglong Tang. Resembles Cold-Damp but differs: Pulse is floating-slow; Cold-Damp is deep-thin-subtle. Classics state "No Shaoyin Interior Syndrome" because Taiyang and Shaoyin are exterior-interior pairs; current pulse/syndrome belong to Taiyang Exterior, hence no Shaoyin Interior involvement.

Xiaoqinglong Tang resembles Xiaochaihu Tang but differs: Xiaoqinglong lacks alternating chills/fever and hypochondriac fullness/pain, presenting instead with dry retching, fever, and cough due to unresolved exterior and fluid retention in the heart/lower burner. Though some symptoms overlap, the absence of half-exterior/half-interior pathology distinguishes them.