尝闻治身犹治兵。治兵者，必精孙吴之韬略，然后能侦虚实，谙奇正，而施攻守之方，治身者，
必洞岐黄之奥旨，然后能察寒热，知标本，而施调剂之法。如舍昔人之着述而谈医，犹舍孙吴之兵
法而贾勇也，鲜有济矣。予观昔人之着，惟伤寒最详。但说愈详，而施之者愈溷。经候何以传变，
阴阳何以运递，愚者暗于临证，智者逞于创奇。不知张仲景、郭白云诸君尽生平之力，而笔之于书，
岂无所见。惟执一说而不究大全，斯妙义当前而莫睹矣。予少好医道，尝叹疾之有伤寒，犹兵之有
侵轶也，呼吸存亡，瞬息生死。因博求古今伤寒书，得陶氏节 六集，如所云明理论、家秘、琐言
与杀车槌、一提金、截江网者。凿乎通天地，和阴阳，调血脉，分营卫，即虚邪贼风，防之有法，
临证施之，毫发不爽。诚回生之精义，仁寿之妙道也。故梓之以广其传焉。
时万历壬子岁夏月朔日太医院学生李存济题
客有过予而问之曰∶甚矣，伤寒之深奥，桂枝、麻黄二汤之难用也，服之而愈者，才一二；不
愈而变重者，尝八九。仲景立法之大贤也，何其方之难凭，有如此哉！今人畏而不用，以参苏饮、
和解散等平和之剂而代之，然亦未见其妙也。子盍与我言之。予曰∶吁，难言也，请以经语证之。
经曰∶冬气严寒，万类潜藏，君子固密，则不伤于寒。触冒之者，乃名伤寒耳。其伤于四时皆能为
病，以伤寒为毒者，以其最成杀厉之气也。中而即病，名曰伤寒；不即病者，其寒毒藏于肌肤，至
春变为温病，至夏变为暑病。暑病者，热极重于温也。以此言之，伤寒者，乃冬时感寒
即病之名。桂枝、麻黄二汤，为当时之伤寒设，与过时之温暑者，有何预焉？夫受病之原则同，亦
可均谓之伤寒。所发之时既异，治之则不可混也。请略陈之。夫春温、夏热、秋凉、冬寒者，四时
之正气也，以成生长收藏之用。风亦因四时之气，而成温凉寒热也。若气候严寒，风亦凛冽。天道
和煦，风亦温暖。冬时坎水用事，天令闭藏，水冰地冻，风与寒相因，而成杀厉之气。人触冒之，
腠理郁塞，乃有恶风恶寒之证。其余时月，则无此证也。仲景固知伤寒乃冬时杀厉之气所成，非比
他病可缓，故其为言特详于此书而略于杂病也。倘能因名以求其实，则思过半矣。不幸此书传世久
远，遗帙颇多。晋太医令王叔和得于散亡之余，诠次流传，其功博矣。惜乎以己论混经，未免穿凿
附会。成无己氏因之，顺文注释，并无缺疑正误之言，以致将冬时伤寒之方，通解温暑，遗祸至今
而未已也。温暑必别有方，今皆失而无征也。我朝宋景濂学士尝叹《伤寒论》非全书，得其旨哉！
盖伤寒之国中人，必先入表。表者何？即足太阳寒水之经。此经行身之后，自头贯脊，乃有头疼脊强，
恶寒之证。在他经，则无此证矣。况此经乃一身之纲维，为诸阳之主气，犹四通八达之衢，治之一
差，其变有不可胜言者矣。故宜此二汤发散表中寒邪，经曰辛甘发散为阳者是也。若以此汤通治春
温夏热之病，则误之甚矣。曰∶伤寒发于冬时，已闻命矣。邪之在表，为太阳经也。一经而有二药
之分又何耶？曰∶在经虽一，然则有荣卫之分焉。寒则伤荣，证乃恶寒发热而无汗，脉浮紧。盖浮
为在表，紧为伤寒，有寒则见，无寒则不见也。当用麻黄汤轻扬之剂发而去之，寒邪退而汗出表和
而愈矣。曰∶紧脉固为矣。脉之缓者，亦用桂枝汤又何耶？曰∶风则伤卫，卫伤则自汗。缘太阳受
风，不能卫护，腠理疏而汗泄，所以脉见浮缓也。脉虽浮缓，其受寒则一，故亦宜桂枝辛温之药解
散寒邪，腠理闭而汗止表和而愈。又有荣卫俱伤者，二汤又难用也，故复设大青龙汤。然此药难用，
非庸俗得而识也。曰∶温暑既无方法，治之则将奈何？脉证与伤寒有何分别？曰∶温暑虽殊，亦冬
时感受寒邪而不即散，在人身中伏藏，历二三时之久，天道大变，寒化为热。人在气交之中，亦随
天地之气而化。观仲景以即病之伤寒与温暑时令为之名，岂无异哉！治之之方，亦必随时以
用辛凉苦寒矣。安得概用冬时治寒辛温之方乎？今无其方者，盖散亡之也。经既称变为温，变为热，
则已改易冬时之寒为温热矣，方亦不容不随时改更也。夫温病欲出，值天时和煦，自内达表，脉反
见于右关不浮紧而微数。曰，恶寒否乎？曰∶伤寒自冬月风寒而成，外则有恶寒恶风之证。既名为
温，则无此证矣。曰∶然则子之言何所据乎？曰∶据乎经耳。经曰∶太阳病，发热、不恶寒而渴者，
温病也。不恶寒则病非因外来，渴则明其自内达表。曰∶春夏之病，亦有头疼恶寒、脉浮紧者何也？
曰∶此非冬时所受之寒，乃冒非时暴寒之气耳。或温暑将发，又受暴寒，虽有恶寒脉浮之证，未若
冬时之甚也，宜辛凉之药通其内外而解之，断不可用桂枝之剂矣。曰∶温热与伤寒治之不同，既闻
命矣。敢问伤寒之在三阳则为热邪，既传三阴则为阴证矣，法以热治，固其宜也。三阴篇以四逆散
凉药以治四逆，大承气汤以治少阴，其故又何耶？呜呼，此盖叔和以残缺之经作全书诠次，将传经
阴证与直中阴经之阴证混同立论，所以遗祸至今而未已也。姑略陈之。盖风寒之国中人也无常，或
入于阴，或入于阳，皆无定体，非但始太阳终厥阴也。或自太阳始，日传一经，六日至厥阴，邪气
衰不传而愈者，亦有不罢再传者，或有间经而传者，或有传二三经而止
者，或有终始只在一经者，或有越经而传者，或有初入太阳，不作郁热便入少阴而成真阴证者，或
有直中阴经而成寒证者，缘经无明文，后人有妄治之失。若夫自三阳传次三阴之阴证，外虽有厥逆，
内则热邪耳。若不发热，四肢便厥冷而恶寒者，此则直中阴经之寒证也。自叔和立说之混，使后人
蒙害者伙矣。夫太阳受邪，行尽三阳气分，传次三阴血分，则热入深矣。热入既深，表虽厥冷，真
热邪也。经云∶亢则害，承乃制。热极反兼寒化也。若先热后厥者，传经之阴证也。经云∶厥深热
亦深，厥微热亦微是也。故宜四逆散、承气汤，看微甚而治之。如其初病便厥，但寒无热，此则直
中阴经之寒证也，急宜四逆辈以温之。经云∶发热恶寒者，发于阳也；无热恶寒者，发于阴也。尚
何疑哉！又有日传二经为两感者，传经未终而毙矣。病有标本，治有逆从，岂可概论之乎？曰∶阴
证之不同，已闻命矣。尝读刘守真书云∶伤寒无阴证，人伤于寒则为热病，热病乃汗病也。造化汗
液，皆阳气也。遍考《内经》、《灵枢》诸篇，并无寒证，乃杂病也，叔和误入之耳。守真高明之
士，亦私淑仲景者，而议论之异又何耶？曰∶虽守真之明达，盖亦因《伤寒论》以桂枝、麻黄
汤通治寒暑之误而有是说。故叮咛云∶天道温热之时，用桂枝汤必加凉药于其中，免致黄生斑出之
患。若知此汤自与冬时即病之伤寒设，不与过时之温暑设，则无此论矣。观其晚年悟道，着《病机
气宜保命集》，其中羌活汤辛凉之药，以治非时伤寒，其妙如神，足可补仲景之遗亡，何其高哉！
夫《内经》言伤寒即为热病而无寒者，语其常也。仲景之论有寒有热者，言其变也。合常与变而无
遗者也。所谓道并行而不悖，而反相为用也。此其所以为医家万世之准绳标的也欤。客唯而退，遂
请着其说于上云。
我常听说，治理身体如同治理军队。治理军队的人，必须精通孙武、吴起的兵法韬略，然后才能侦察敌军的虚实，通晓奇正变化的战术，从而实施进攻或防守的策略；治理身体的人，必须透彻理解岐伯、黄帝医学的深奥旨意，然后才能辨别寒热病机，知晓疾病的标本缓急，从而施用调理调和的方法。如果舍弃前人的著作而空谈医术，就像舍弃孙武、吴起的兵法而仅凭匹夫之勇去作战一样，很少能取得成效的。
我看前人的著作，只有《伤寒论》论述得最为详尽。但是，论述越是详细，应用的人反而越加混乱。经络的传变规律为何？阴阳的运化递进如何？愚笨的人在临证时昏昧不明，聪明的人却喜欢标新立异。他们不知道张仲景、郭雍（白云）等先生耗尽毕生精力，将其著书立说，难道没有深刻的见解吗？只是拘泥于一种说法而不探究全面的大义，导致精妙的医理就在眼前却无法察觉。
我年轻时喜好医道，曾感叹疾病中的伤寒，就像军队遭受入侵劫掠一样，呼吸之间关乎存亡，瞬息之间决定生死。因此广泛搜求古今关于伤寒的书籍，得到了陶华（节庵）的六集著作，如其中所说的《明理论》、《家秘》、《琐言》，以及《杀车槌法》、《一提金方》、《截江网》等。这些内容通达天地之理，调和阴阳，调理血脉，区分营卫之气，即使是虚邪贼风，也有防范的方法；在临证时施用，毫厘不差。这确实是起死回生的精妙义理，仁德长寿的奇妙大道啊。所以刻印它来广泛传播。
时间是万历壬子年夏月初一，太医院学生李存济题写。
有位客人拜访我并问道：“伤寒的道理太深奥了，桂枝汤和麻黄汤太难使用了。服用后痊愈的，才有一两个；不愈反而病情加重的，常常有八九个。张仲景是制定法规的大贤人，为什么他的方剂如此难以凭借呢？现在的人害怕使用这些方剂，用参苏饮、和解散等平和的药剂来代替它们，然而也没有看到什么奇妙的效果。您为什么不给我讲讲其中的道理呢？”
我说：“唉，这很难说清楚，请让我用经典经文来证明吧。经文说：‘冬季气候严寒，万物潜藏，君子应当固密腠理，这样就不会受寒邪伤害。触犯寒邪的，才叫做伤寒。’寒邪侵犯人体，四季都能致病，但认为伤寒最毒，是因为它形成了最肃杀厉烈的邪气。感受寒邪后立即发病的，名叫伤寒；没有立即发病的，寒毒潜伏在肌肤之中，到了春天变为温病，到了夏天变为暑病。暑病的火热程度比温病更重。由此说来，伤寒，是指冬季感受寒邪立即发病的病名。桂枝汤、麻黄汤这两首方剂，是为当时的即时伤寒所设，与过时的温病、暑病有什么关系呢？虽然受病的原则相同，也可以统称为伤寒。但发作的时间既然不同，治疗方法就不可以混淆。请让我简要陈述一下。
春天的温、夏天的热、秋天的凉、冬天的寒，这是四时的正气，用来完成生长收藏的功能。风也是随着四时的气候，而形成温、凉、寒、热的变化。如果气候严寒，风也凛冽。如果天道温和煦暖，风也温暖。冬季坎水当令，天令闭藏，水结冰地冻，风与寒相互结合，形成肃杀厉烈的邪气。人触冒这种邪气，腠理郁结闭塞，就会出现怕风、怕冷的症状。在其他季节，就没有这种症状。张仲景确实知道伤寒是由冬季肃杀厉烈的邪气形成的，不像其他病可以缓慢治疗，所以他在这本书中对此论述特别详细，而对杂病则论述简略。如果能通过名称来探求其实质，那么对医理的理解就超过一半了。
不幸的是，这本书流传久远，散佚很多。晋代太医令王叔和在散失残存的文献中搜集整理，加以编排流传，他的功劳很大。可惜他用个人的见解混杂了经文，未免有些穿凿附会。成无己氏沿袭这种做法，顺着文句进行注释，并没有提出缺疑或纠正错误的言论，导致将冬季伤寒的方剂，普遍解释为适用于温病和暑病，遗留祸患至今未止。温病和暑病必定另有方剂，如今都失传而没有证据了。我朝学士宋濂（景濂）曾感叹《伤寒论》不是全书，他真是领悟了其中的旨意啊！
大概伤寒侵入国人，必须先侵入体表。表是什么？就是足太阳寒水经。这条经脉行于身后，从头贯穿脊柱，所以会出现头痛、项背强直、怕冷的症状。在其他经脉，就没有这种症状。况且这条经脉是一身的纲维，是诸阳之主气，就像四通八达的道路枢纽，治疗上稍微出差错，其变化就有说不完的危害了。所以适宜用这两首方剂发散体表的寒邪，经文说‘辛甘发散为阳’就是这个意思。如果用这两首方剂通用治疗春温夏热之病，那就错误得很严重了。
客人问：“伤寒发于冬季，我已经听明白了。邪气在体表，属于太阳经。一条经脉为什么有两种药物（桂枝汤、麻黄汤）的区别呢？”
我说：“在经脉方面虽然相同，然而却有营气和卫气的区别。寒邪伤及营气，症状表现为怕冷、发热且无汗，脉象浮紧。浮表示病在表，紧表示伤寒，有寒邪就出现紧脉，无寒邪就不出现。应当用麻黄汤这种轻扬的发散药剂，发散出去，寒邪退去，汗出表和，病就好了。
客人问：“紧脉确实是这样的。脉象缓和的，为什么也用桂枝汤呢？”
我说：“风邪伤及卫气，卫气受伤就会自汗。因为太阳经受风邪侵袭，不能卫护体表，腠理疏松而汗液外泄，所以脉象表现为浮缓。脉象虽然浮缓，但其感受寒邪的本质是一样的，所以也适宜用桂枝汤这种辛温的药物解散寒邪，腠理闭合，汗止表和，病就好了。又有营卫俱伤的，这两首方剂又难单独使用，所以又设立了大青龙汤。然而这个药难用，不是平庸世俗之人所能认识的。
客人问：“温病和暑病既然没有方法，治疗又将怎么办呢？脉证与伤寒有什么区别呢？”
我说：“温病和暑病虽然不同，也是冬季感受寒邪而没有立即散发，在人体内潜伏，经过两三个季节之久，天道发生巨大变化，寒邪转化为热邪。人在气交之中，也随着天地之气而变化。看张仲景以即病之伤寒与温暑时令作为病名，难道没有区别吗？治疗的方剂，也必须随时使用辛凉苦寒的药物。怎么能一概使用冬季治寒的辛温方剂呢？如今没有这些方剂，是因为散失了。经文既然称‘变为温’，‘变为热’，说明已经改变了冬季的寒邪为温热了，方剂也不容不随时改变。
温病欲向外透发，正值天时温和煦暖，从内部达于体表，脉象反而见于右关部，不浮紧而是微数。问：有恶寒的症状吗？答：伤寒自冬月风寒而成，外部有恶寒、恶风的症状。既然名为温病，就没有这种症状了。
客人问：“那么您的言论有什么依据呢？”
我说：“依据经文罢了。经文说：‘太阳病，发热、不恶寒而口渴的，是温病。’不恶寒说明病非因外来，口渴说明病自内达表。
我说：“这不是冬季所受的寒邪，乃是冒犯了非时节的暴寒之气。或者是温暑即将发作，又受到暴寒侵袭，虽然有恶寒、脉浮的症状，但不像冬季那样严重，适宜用辛凉的药剂通利内外而解表，绝对不可用桂枝汤这类药剂了。
客人问：“温热病与伤寒的治疗方法不同，我已经听明白了。敢问伤寒在三阳经则为热邪，既传入三阴经则为阴证了，用法以热治寒，固然适宜。但三阴篇中用四逆散这种凉药来治疗四肢厥逆，用大承气汤来治疗少阴病，这是什么缘故呢？”
我说：“唉，这大概是王叔和以残缺的经文当作全书进行编排，将传经而来的阴证与直中阴经的阴证混同立论，所以遗留祸患至今未止。姑且简要陈述一下。大概风寒侵入人体没有定规，有的入于阴经，有的入于阳经，都没有固定的形体，不仅仅是始于太阳终于厥阴。有的自太阳开始，每天传一经，六天传到厥阴，邪气衰退不再传变而痊愈的；也有不罢休再传的；有的跳过一经而传的；有的传两三经而停止的；有的始终只在一经的；有的越经而传的；有的初入太阳，不作郁热便直接入少阴而成真阴证的；有的直中阴经而成寒证的。因为经文没有明文规定，后人妄加治疗造成失误。
至于自三阳传次至三阴的阴证，外部虽有四肢厥逆，内部则是热邪。如果不发热，四肢就厥冷而且怕冷，这就是直中阴经的寒证。自从王叔和建立这种混杂的说法，使后人蒙受危害的人很多了。太阳经受邪，行尽三阳气分，传次至三阴血分，热邪就深入了。热邪既已深入，表面虽然四肢厥冷，本质却是真热邪。经文说：‘亢盛则有害，顺承则制约。’热极反而兼见寒化的假象。如果是先发热后厥逆的，是传经的阴证。经文说：‘厥逆越深，热邪越深；厥逆轻微，热邪轻微。’所以适宜用四逆散、承气汤，根据病情的轻重来治疗。如果是初病就厥逆，只有寒象没有热象，这就是直中阴经的寒证，急需四逆汤类方剂来温补。经文说：‘发热恶寒的，发于阳经；无热恶寒的，发于阴经。’还有什么可怀疑的呢！
又有每天传两经的，称为两感病，传经未完成人就死了。病有标本，治疗有逆从，怎么能一概而论呢？
客人说：“阴证的不同，我已经听明白了。曾经读刘完素（守真）的书说：‘伤寒没有阴证，人伤于寒就成为热病，热病就是汗病。造化汗液，都是阳气的作用。遍考《内经》、《灵枢》各篇，并没有寒证，那是杂病，是王叔和误收进去的。’刘守真是高明的人士，也是私淑张仲景的人，为什么议论会有差异呢？”
我说：“虽然刘守明明智通达，大概也是因为《伤寒论》被误用桂枝、麻黄汤通用治疗寒暑之病，而有这种说法。所以他叮咛说：‘在天道温热的时候，用桂枝汤必须在其中加入凉药，以免导致发黄生斑的祸患。’如果知道这两首方剂是自与冬季即病的伤寒所设，不与过时的温暑病所设，就没有这种论说了。看他晚年悟道，撰写《病机气宜保命集》，其中用羌活汤这种辛凉的药剂，来治疗非时节的伤寒，其妙效如神，足以弥补张仲景遗亡的内容，多么高明啊！
《内经》说伤寒即为热病而无寒，是讲它的常理。张仲景的论述有寒有热，是讲它的变局。结合常理与变局而没有遗漏的，这就是所谓的‘道并行而不悖，反而互相为用’。这大概就是成为医家万世的准则目标的原因吧。”客人点头退下，于是请求我将这些学说写在上面。
I have often heard that treating the body is like managing an army. One who manages an army must be proficient in the military strategies of Sun Wu and Wu Qi, so as to reconnoiter the enemy's strength and weakness, understand the tactics of orthodox and unorthodox maneuvers, and thereby implement offensive or defensive measures. One who treats the body must thoroughly comprehend the profound principles of Qibo and Huangdi (the Yellow Emperor), so as to distinguish cold and heat pathogenesis, know the root and branch of diseases, and thereby apply methods of regulation and harmonization. To discuss medicine while discarding the writings of predecessors is like engaging in battle with mere bravery while abandoning the military arts of Sun Wu and Wu Qi; such a person will rarely succeed.
In reviewing the works of predecessors, I find that only the *Treatise on Cold Damage* (*Shanghan Lun*) is discussed in the greatest detail. However, the more detailed the discussion, the more confused its application becomes. Why do meridians transmit changes? How do Yin and Yang circulate and transition? The foolish are ignorant when facing clinical cases, while the clever indulge in creating novelty. They fail to realize that masters such as Zhang Zhongjing and Guo Yunbai devoted their entire lives to writing these books, surely possessing profound insights. It is merely that adhering rigidly to one view without investigating the comprehensive whole causes subtle meanings to remain invisible before one's eyes.
In my youth, I was fond of medical arts and often lamented that among diseases, *Shanghan* (Cold Damage) is like an invasion by troops: life and death hang in the breath, and existence perishes in an instant. Therefore, I extensively sought ancient and modern texts on *Shanghan*, obtaining the six collections of Tao Hua (Jie'an). These include his *Mingli Lun* (Theory of Clarifying Principles), *Jiami* (Family Secrets), *Suoyan* (Trivial Remarks), as well as the *Sheche Chui Fa* (Method of Killing the Cart Hammer), *Yiti Jin Fang* (One Lift Gold Formula), and *Jiejiang Wang* (Net Intercepting the River). These contents penetrate the principles of Heaven and Earth, harmonize Yin and Yang, regulate blood vessels, and differentiate Ying (Nutritive) and Wei (Defensive) qi. Even against empty evils and thieving winds, there are methods of prevention; when applied clinically, they are accurate to the hair's breadth. Indeed, these are the exquisite principles for reviving the dead and the wondrous Dao for benevolence and longevity. Thus, I had them printed to widely disseminate them.
Dated on the first day of the summer month in the Renzi year of the Wanli era, Li Cunji, Student of the Imperial Medical Academy, inscribed this.
A guest visited me and asked, "The profundity of *Shanghan* is indeed great, and the use of Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) is difficult. Those who recover after taking them are but one or two out of ten; those who do not recover and whose conditions worsen are eight or nine out of ten. Zhang Zhongjing was a great sage in establishing laws; why are his formulas so unreliable? People today fear using them and replace them with mild agents such as Rensu Yin (Ginseng and Perilla Drink) and Jiehe San (Harmonizing Powder), yet no miraculous effects are seen. Would you explain this to me?"
I said, "Alas, it is difficult to explain. Let me prove it with canonical texts. The Canon states: 'In winter, the air is severely cold, and all things hide. If the gentleman keeps himself secure and closed, he will not be injured by cold. Those who violate this are named as having *Shanghan*.' Cold pathogens can cause disease in all four seasons, but *Shanghan* is considered the most toxic because it forms the most severe and lethal energy. If illness occurs immediately upon exposure, it is called *Shanghan*; if it does not occur immediately, the cold toxin hides in the skin and muscles, transforming into Wenbing (Warm Disease) in spring and Shubing (Summer Heat Disease) in summer. Shubing involves heat more intense than that of Wenbing. From this perspective, *Shanghan* refers specifically to the disease name for contracting cold and falling ill immediately during winter. Guizhi Tang and Mahuang Tang were established for *Shanghan* occurring at that time; what relevance do they have to delayed-onset Wenbing and Shubing? Although the principle of contracting disease is the same and they may be collectively termed *Shanghan*, since the time of onset differs, the treatment cannot be mixed. Let me briefly elaborate.
Spring warmth, summer heat, autumn coolness, and winter cold are the righteous energies of the four seasons, facilitating growth, flourishing, harvesting, and storage. Wind also assumes warm, cool, cold, or hot characteristics according to the seasonal qi. If the climate is severely cold, the wind is biting. If the heavenly way is gentle and warm, the wind is mild. In winter, Kan Water dominates, and the heavenly command is closure and storage; water freezes and earth hardens. Wind and cold combine to form lethal energy. When humans encounter this, pores become obstructed, leading to aversion to wind and cold. Such symptoms do not exist in other seasons. Zhang Zhongjing certainly knew that *Shanghan* is formed by the lethal energy of winter, unlike other diseases that allow for slow progression; thus, his discussion in this book is particularly detailed regarding this condition and brief regarding miscellaneous diseases. If one can seek the reality through the name, one will have grasped more than half of the understanding.
Unfortunately, due to the long transmission of this book, many scrolls have been lost. Wang Shuhe, Grand Master of Medicine in the Jin Dynasty, collected the scattered remnants, edited them, and allowed them to circulate; his merit was vast. Alas, he mixed his own theories with the canon, inevitably resorting to forced interpretations. Cheng Wuji followed suit, annotating the text literally without pointing out omissions or correcting errors. This led to the widespread misinterpretation of winter *Shanghan* formulas as applicable to Wenbing and Shubing, causing harm that continues to this day. Wenbing and Shubing must have distinct formulas, which are now lost and unverified. Scholar Song Lian (Jinglian) of our dynasty once lamented that the *Treatise on Cold Damage* is not a complete work; he truly grasped its essence!
Generally, when *Shanghan* invades the human body, it must first enter the exterior. What is the exterior? It is the Foot-Taiyang Bladder Meridian of Hand-Taiyin (Note: Standard TCM terminology is Foot-Taiyang Bladder Meridian). This meridian runs along the back, from the head through the spine, resulting in symptoms of headache, stiff neck/back, and aversion to cold. Other meridians do not present these specific symptoms. Moreover, this meridian is the framework of the body and the master of all Yang qi, like a major intersection of roads. A slight error in treatment leads to consequences too numerous to recount. Therefore, it is appropriate to use these two decoctions to disperse cold pathogens from the exterior, as the Canon states: 'Pungent and sweet dispersing constitutes Yang.' Using these decoctions to universally treat Spring Warmth and Summer Heat would be a grave error.
Guest: "I have heard that *Shanghan* originates in winter. The pathogen is in the exterior, belonging to the Taiyang meridian. Why are there two different medicines (Guizhi Tang and Mahuang Tang) for one meridian?"
Me: "Although the meridian is the same, there is a distinction between Ying (Nutritive) and Wei (Defensive) qi. Cold injures Ying, presenting with aversion to cold, fever, and absence of sweating, with a floating and tight pulse. Floating indicates the exterior; tight indicates cold damage. The presence of cold manifests as a tight pulse; its absence does not. One should use Mahuang Tang, a light and ascending formula, to disperse and eliminate the pathogen. As the cold recedes and sweat appears, the exterior harmonizes, and the patient recovers.
Guest: "I understand the tight pulse. Why is Guizhi Tang used when the pulse is moderate/relaxed?"
Me: "Wind injures Wei. When Wei is injured, spontaneous sweating occurs. Because the Taiyang meridian is affected by wind, it fails to protect the exterior; the pores become loose, and sweat leaks out, resulting in a floating and moderate pulse. Although the pulse is floating and moderate, the underlying contraction of cold is the same; thus, Guizhi Tang, a pungent-warm medicine, is suitable to dissipate the cold. Once pores close and sweating stops, the exterior harmonizes, and recovery ensues. There are cases where both Ying and Wei are injured, making the use of either of the two previous decoctions difficult; therefore, Da Qinglong Tang (Major Green Dragon Decoction) was established. However, this medicine is difficult to use and is not understood by mediocre practitioners.
Guest: "Since there are no methods for Wenbing and Shubing, how should they be treated? How do their pulses and symptoms differ from *Shanghan*?"
Me: "Although Wenbing and Shubing differ, they both originate from cold contracted in winter that was not immediately dispersed. The cold hides within the body for two or three seasons until the heavenly way undergoes drastic change, transforming cold into heat. Humans exist within the interaction of Qi and transform along with Heaven and Earth. Observe that Zhang Zhongjing named immediate-onset *Shanghan* differently from seasonal Wenbing and Shubing; is there no difference? Treatments must utilize pungent-cool and bitter-cold herbs according to the season. How can one generally use winter pungent-warm formulas? The current lack of formulas is due to their loss. Since the Canon states 'transforms into Warm' and 'transforms into Heat,' the winter cold has changed into warm-heat; consequently, formulas must also change with the times.
When Wenbing desires to emerge, coinciding with mild weather, it moves from interior to exterior. The pulse may appear at the Right Guan position, not floating and tight, but slightly rapid. Question: Is there aversion to cold? Answer: *Shanghan* results from winter wind-cold, presenting externally with aversion to cold and wind. Since it is named Wenbing, these symptoms are absent.
Guest: "On what basis is your statement?"
Me: "Based on the Canon. The Canon states: 'Taiyang disease, characterized by fever, absence of aversion to cold, and thirst, is Wenbing.' Absence of aversion to cold indicates the disease is not exogenous; thirst indicates the pathology moves from interior to exterior.
Guest: "Why do diseases in spring and summer sometimes present with headache, aversion to cold, and a floating-tight pulse?"
Me: "This is not the cold contracted in winter, but rather exposure to sudden cold of improper timing. Or, Wenbing/Shubing is about to erupt, and sudden cold is encountered again. Although there are signs of aversion to cold and floating pulse, they are not as severe as in winter. Pungent-cool herbs should be used to unblock the interior and exterior and resolve the condition; Guizhi Tang must absolutely not be used.
Guest: "I understand that the treatment of warm-heat differs from *Shanghan*. May I ask: *Shanghan* in the Three Yang meridians becomes heat pathogen; once transmitted to the Three Yin meridians, it becomes a Yin syndrome. Treating with heat is appropriate. However, in the Three Yin chapter, Sini San (Four Counterflow Powder) is a cooling formula used for Si Ni (cold limbs), and Dachengqi Tang (Major Order the Qi Decoction) is used for Shaoyin disease. What is the reason?"
Me: "Alas, this is likely because Wang Shuhe compiled the incomplete canon as a complete work, conflating transmitted Yin syndromes with direct-entry Yin meridian syndromes, causing harm that persists today. Let me briefly explain. The entry of wind-cold into the body has no fixed pattern; it may enter Yin or Yang meridians without a fixed structure, not necessarily starting at Taiyang and ending at Jueyin. Some start at Taiyang, transmitting one meridian per day, reaching Jueyin on the sixth day; if the pathogen weakens, transmission stops and recovery occurs. Others continue transmitting. Some skip meridians; some stop after two or three meridians; some remain in one meridian throughout; some jump meridians. Some enter Taiyang initially, do not generate stagnant heat, but directly enter Shaoyin to form true Yin syndrome. Others directly strike the Yin meridians forming cold syndromes. Due to the lack of explicit text, later practitioners made erroneous treatments.
Regarding Yin syndromes transmitted from Three Yang to Three Yin: although the exterior presents with cold limbs (Jue Ni), the interior contains heat pathogen. If there is no fever, and limbs are cold with aversion to cold, this is a cold syndrome of direct entry into Yin meridians. Since Wang Shuhe's confusing theory, many have suffered. When Taiyang is invaded, pathogen exhausts the Qi level of Three Yang and transmits to the Blood level of Three Yin; heat enters deeply. Deep heat may present with cold limbs on the exterior but is essentially true heat. The Canon says: 'Excess causes harm, subordination brings control.' Extreme heat may manifest with false cold transformation. If fever precedes cold limbs, it is a transmitted Yin syndrome. The Canon states: 'The deeper the cold limbs, the deeper the heat; the milder the cold limbs, the milder the heat.' Thus, Sini San and Chengqi Tangs should be used based on severity. If cold limbs occur at the onset of illness, with only cold and no heat, it is a direct-entry Yin cold syndrome; Sini Tang category formulas should be urgently used to warm. The Canon states: 'Fever with aversion to cold originates in Yang; no fever with aversion to cold originates in Yin.' What doubt remains?
There are also cases of daily transmission to two meridians, called Liang Gan (Double Contraction), where death occurs before transmission completes. Diseases have root and branch; treatments have counter and conforming approaches. How can they be generalized?
Guest: "I understand the differences in Yin syndromes. I once read Liu Wansu (Shouzhen) stating: 'There are no Yin syndromes in *Shanghan*; injury by cold becomes heat disease, and heat disease is sweating disease. Sweat creation relies on Yang qi. Scanning the *Neijing* and *Lingshu*, there are no cold syndromes; those are miscellaneous diseases erroneously included by Wang Shuhe.' Shouzhen was a brilliant scholar and a private disciple of Zhongjing; why his divergent opinion?
Me: "Although Shouzhen was insightful, his view likely stemmed from the misuse of Guizhi and Mahuang Tangs in the *Treatise* to universally treat cold and heat. Hence his warning: 'During warm-heavenly times, if Guizhi Tang is used, cooling herbs must be added to prevent jaundice and macules.' If one knows these formulas were established for immediate winter *Shanghan* and not for delayed Wenbing/Shubing, this argument would not exist. In his later years, realizing the Dao, he wrote *Bingji Qi Yi Baoming Ji*. There, he used Qianghuo Tang, a pungent-cool formula, to treat improper-time *Shanghan*, with miraculous efficacy, supplementing Zhongjing's losses. How profound!
The *Neijing* states *Shanghan* is heat disease without cold, describing the norm. Zhongjing's discussion includes both cold and heat, describing variations. Combining norm and variation leaves no omission. This is the Dao running parallel without contradiction, mutually reinforcing. This is why it serves as the eternal standard for physicians." The guest nodded and withdrew, requesting that I write these theories down.