典藏书目

The *Shanghan Lun* (Treatise on Cold Damage) states: "Fever accompanied by thirst and aversion to cold absent is termed Wenbing (Warm Disease). Later generations abbreviated the character 'Zheng' (Syndrome/Pattern) and added the grass radical to write 'Wen' (Plague), which means the same as Wen." Just as the 'Zheng' in Bingzheng (Disease Syndrome) was simplified to 'Zheng', later the speech radical was omitted and the disease radical added to write 'Zheng' (Symptom). Similarly, 'Zhi Xia' (Stagnant Downward Flow), used by ancients to refer to dysentery with pus and blood in stool, likely because diarrhea was called 'Xia Li' (Downward Flowing Diarrhea), later had the disease radical added to become 'Li' (Dysentery). In summary, the characters for 'Wen' (Plague), 'Li' (Dysentery), and 'Zheng' (Symptom) did not exist in ancient times; they were alterations made by later generations. One should not, due to these textual changes, treat Warm Disease (Wenbing) and Plague (Wen) as two different diseases with distinct etiologies. If it were claimed that winter latent cold transforms into warm-heat conditions in spring or summer, and non-seasonal warmth is termed Warm Epidemic (Wenyi), then if this were true, the syndromes and pulses should differ. Otherwise, during treatment, how would one know the etiological origins are different? If pulses and syndromes differ and etiologies vary, new formulas, theories, and treatments should be established. In that case, what purpose do existing pulse-syndrome-treatment methods serve? The more branches one adds, the more confused the intent becomes, causing learners to suffer from confusion over multiple paths. 'Wen' (Warmth) is the beginning of heat; 'Re' (Heat) is the end of warmth. Warmth and heat form a single continuum from start to finish; thus, Rebing (Heat Disease) is synonymous with Wenbing (Warm Disease). It is also called 'Yi' (Epidemic) because it spreads door-to-door like corvée labor, affecting everyone equally. Now, the character is written as 'Yi' by adding the disease radical. It is also called Shiyi (Seasonal Epidemic) or Shiqi (Seasonal Qi) because it arises from contracting the pathogenic qi of the season. Due to its malicious nature, it is also called Yili (Epidemic Miasma). Ultimately, resolution occurs through sweating, hence in the Yan-Ji region, it is called Hanbing (Sweat Disease). Additionally, there are Fengwen (Wind-Warmth) and Shiwen (Damp-Warmth), which are concurrent syndromes of Warm Disease complicated by external contractions. Though named differently, their underlying pathology is identical. However, in recent times, many call conditions 'Yi', and writings on Wenyi omit none of these statements. Subsequently, regarding the *Shanghan Li* (Example of Cold Damage) and various scholarly discussions concerning Wenyi, much contains errors that may confuse future students. Therefore, I have collected them all to correct them.

The *Yinyang Dalun* (Great Treatise on Yin and Yang) states: "Spring qi is mild and warm, summer qi is hot and sultry, autumn qi is cool and clear, winter qi is cold and piercing. This is the order of the upright qi of the four seasons. In winter, severe cold causes all things to hide deeply. The gentleman maintains his integrity and secrecy, thus avoiding injury by cold. Those who violate this are named as having Shanghan (Cold Damage). Injury by the qi of the four seasons can all cause disease. Cold damage is considered the most toxic because it forms the most killing and malignant qi. If illness occurs immediately upon injury, it is named Shanghan. If it does not occur immediately, the cold toxin hides in the skin and muscles. By spring, it transforms into Wenbing (Warm Disease); by summer, it transforms into Shubing (Summer Heat Disease). Shubing involves extreme heat, heavier than Wenbing."

Cheng Wuji's commentary on the *Neijing* states: "Illness occurring before the Summer Solstice is Wenbing; after the Summer Solstice is Shubing. Both Wenbing and Shubing originate from Shanghan."

[Correction]: According to my analysis: The twelve meridians and the eight extraordinary vessels are nothing but Ying and Wei (Nutritive and Defensive) Qi and Blood, distributed throughout the body to nourish the hundred bones. Thus, Tianzhen Yuanqi (Innate Primal Qi) exists everywhere; where it is absent, there is numbness and insensitivity. The mechanism of creation operates without pause; if it stops, collapse and death ensue. However, pathogens such as Wind, Cold, Summer Heat, and Dampness stand in opposition to the body's Ying and Wei. Once disturbed, illness and suffering arise. If not eliminated, danger or death follows. The text above mentions that injury by winter severe cold leads to immediate illness named Shanghan, while delayed illness transforms into Wenbing in spring and Shubing in summer. Yet, injury by Wind and Cold results in mild cases of Ganmao (Common Cold) and severe cases of Shanghan. Even Ganmao, the mildest form of Wind-Cold injury, presents with headache, body pain, limb stiffness, nasal congestion, heavy voice, phlegm-cough, asthma, aversion to cold, and fever. It manifests immediately and cannot be hidden. Winter severe cold is no trivial matter; how could it lie dormant and manifest only after a season has passed? Furthermore, which cases manifest immediately? Which do not? Which immediate cases present with splitting headaches, body pain like being beaten, aversion to cold, stiff neck, burning fever, asthma, vomiting, convulsions, rapid and numerous pulses, and restlessness? Such cases, if mistreated hastily, lead to death. Which delayed cases show no sensation upon contraction, remain asymptomatic until spring or summer, with normal diet, sleep, expression, voice, and breath prior to onset, yet once manifested, the severity rivals Shanghan? Moreover, Wind-Cold always enters via the exterior, injuring Ying and Wei. Why is one so oblivious—feeling nothing and hiding unknowingly—while the other is so spiritual—manifesting immediately? Though originating from the same source, they diverge completely, separated by heaven and earth. Is there no explanation? Since there is none, we know the origin of Warm-Heat is not caused by Wind-Cold invasion. Also, claiming cold toxin hides in the skin and muscles is flawed. 'Ji' refers to muscle surface, 'Fu' to superficial skin. Every pore and hair follicle is traversed by Ying and Wei meridians. Even slight Wind-Cold cannot linger; it causes immediate illness. How much less could severe, killing cold qi, entering at the shallowest skin level, remain concealed? By this reasoning, such a scenario is impossible. The general principle for treating exogenous pathogens requires distinguishing interior and exterior clearly. If the pathogen has not entered the Fu organs, it remains in the Jing meridians and can be resolved by sweating. If it has entered the Fu organs, it is in the interior and can be resolved by purging. If cold toxin truly hid in the skin and muscles, even if delayed, the pathogen remains in the exterior, requiring dispersing methods to resolve via sweat. Later generations treating Warm-Heat diseases, if they cling to the notion of exterior pathogens in the skin and muscles and use dispersing methods, will achieve neither benefit nor harm!

Every disease has an etiology before presenting with symptoms. Correlating etiology and symptoms establishes the disease name, verified by pulse diagnosis, before treatment can be discussed. For instance, Shanghan and Zhongshu (Summer Heat Strike) are named after their pathogenic factors. Currently, Rebing (Heat Disease) is named after its syndrome. Regarding the Shubing mentioned above, calling it Rebing allows for ambiguity. If named Shubing, 'Shu' is the pathogen; unless one contracts summer heat in midsummer, it cannot be called Shubing. Referring to Shubing implies the syndrome of Xiangru Yin (Mosla Decoction). How can these be confused? Generally, heavy pathogenic contraction leads to severe illness and high fever; light contraction leads to mild illness and low-grade fever. The degree of heat depends on the severity of the pathogen. In February-March and August-September, severe cases with unceasing high fever leading to death from mistreatment do occur. In May-June, mild cases with low-grade fever often heal spontaneously. Wenbing occurs in all seasons, but is most common in midsummer, followed by spring and autumn, and least in winter. Seasonality determines the frequency of disease, not the severity of heat.

Therefore, hardworking people often suffer Warm-Heat diseases in spring and summer, caused by winter cold exposure, not by seasonal epidemic qi. Seasonal epidemic qi occurs when spring should be warm but is severely cold, summer should be hot but is cool, autumn should be cool but is hot, and winter should be cold but is warm. This is "having the qi out of season," causing similar illnesses among young and old throughout the year. This is seasonal epidemic qi.

However, climate may fail to arrive when expected, arrive excessively, or arrive prematurely. These create pathogenic qi.

[Correction]: Spring warmth, summer heat, autumn coolness, and winter cold are the norms of the four seasons, varying slightly with wind, rain, clouds, and sun. If spring should be warm but is cold, it must be rainy. If autumn should be cool but remains hot, it must be sunny. The unpredictability of weather and the variation of cold and heat are natural phenomena of heaven and earth, not necessarily epidemics. An epidemic is caused by Tianli Zhi Liqi (Malignant Qi of Heaven and Earth). Liqi is neither cold, nor heat, nor warmth, nor coolness, nor a mix of seasonal qi. It is a unique type of malignant qi found mostly in years of war and famine, occasionally in other years, though less severe. The aforementioned similarity of illnesses among young and old refers to seasonal epidemic qi. Though not explicitly called an epidemic, the concept is implied. People mistakenly believe that mixed seasonal qi causes epidemics, failing to realize that despite variations in seasonal qi, the resulting diseases remain rooted in their original sources. For example, in January and February, weather should be warm, but due to wind and rain, it remains cold. Diseases contracted range from mild Ganmao to severe Shanghan, treated accordingly. Spring cold is never as severe as winter killing cold, so medication dosage varies. This corresponds to "arriving late" and "lingering too long." Similarly, in August and September, sudden cold arrives early. Diseases resemble those of spring cold. Late autumn cold is still less severe than winter killing cold. This is "arriving early." Extreme winter cold is "excessive arrival," causing immediate Shanghan. Excessive summer rain cooling the heat is "insufficient arrival." Severe drought is "excessive arrival." Excess causes severe illness; insufficiency causes mild illness. Regarding Summer Heat injury, the pathology is the same regardless. What difference does this make from the order of upright seasonal qi? Treatment relies solely on Xiangru Yin.

Non-seasonal warmth in winter is called Dongwen (Winter Warmth).

[Correction]: This is "arriving early." Note: Winter cold injury transforming into Warm Disease in spring differs from Winter Warmth caused by non-seasonal warmth in winter. One contracts winter cold, the other winter warmth. One disease, two names, with opposite natures (cold vs. warm). How could their pulses, syndromes, and treatments be similar? The Four Qi are the separation and union of Yin and Yang. Yin and Yang are the ascending and descending of one Qi. Ascending reaches its peak and descends; descending reaches its peak and ascends. At the extremes of ascent and descent, Yin and Yang separate. Separation leads to hyperactivity (Kang), and hyperactive qi causes disease. Hyperactive qi is the severe cold of winter and severe heat of summer. When ascent fails and descent fails, Yin and Yang unite. Union brings harmony (He). Harmonious qi does not cause disease. Harmonious qi is the warmth of spring and coolness of autumn. Thus, when Yin reaches its extreme, Yang comes to harmonize, creating warmth. When Yang reaches its extreme, Yin comes to harmonize, creating coolness. This is the way of Ji Ji (Completion/Intersection). The *I Ching* says: "One Yin and one Yang constitutes the Dao." Deviation into Yin or Yang constitutes disease. Following the Dao prevents disease. Spring cold and autumn heat are biased qi of winter and summer. If contracted, they certainly cause illness, but this is merely cold injury or summer heat strike, not an epidemic. If summer is cool and winter is warm, one obtains the harmonious qi of spring and autumn. Could harmony cause disease? We see Shanghan and Zhongshu, but never injury by warmth or coolness. Warmth and coolness do not necessarily cause disease; how can they be called epidemics?

From the Spring Equinox to the Autumn Equinox, sudden cold spells constitute Seasonal Cold Epidemic (Shixing Hanyi). In March and April, sudden cold occurs when Yang Qi is still weak; suppressed by cold, the feverish aspect is mild. In May and June, Yang Qi is strong; suppressed by cold, the feverish aspect is severe. In July and August, Yang Qi is declining; suppressed by cold, the feverish aspect is mild. The illness resembles Warmth and Summer Heat but differs slightly.

[Correction]: Sudden cold occurs in all seasons. Winter injury by severe killing cold is named Shanghan and is the most severe. Cold in other seasons is mild, causing mild illness. Comparing the three non-winter seasons, slight Wind-Cold in midsummer causes even milder illness. Severity of cold correlates with severity of illness and heat. Winter is heaviest, followed by decreasing severity in other seasons, reaching minimum in summer. This is logical. The text claims Yang Qi is weak in March-April (mild fever), strong in May-June (severe fever), and declining in July-August (mild fever). Conversely, in winter, Yang Qi is hidden; suppression by cold should result in even milder fever. This contradicts the claim that summer cold injury is severe and winter cold injury is mild. It is logically inconsistent. Sudden cold in spring, summer, and autumn is identical to winter Ganmao. Treatment is the same. It should only be called Ganmao, not separately named Cold Epidemic. Adding "Epidemic" to this name is superfluous.