典藏书目

[Wang Kentang's Commentary] Shaoyin, Shaoyang, and Taiyin (Three Yin meridians) diseases involve pathogenic factors transmitted via meridian transmission (pathogens spreading sequentially from one meridian to another) and those caused by internal infection (direct invasion of pathogens into the interior without passing through the Yang meridians). Transmission refers to pathogens entering from the Taiyang (Greater Yang) meridian sequentially. Internal infection refers to direct invasion of the Three Yin meridians, not spreading step-by-step from the Yang meridians, but resulting from cold exposure and consumption of cold drinks or food, which damages the Stomach Qi (vital energy of the stomach). The pulse and symptoms are roughly similar to those of external contraction in Shanghan (Cold Damage), but careful differentiation reveals distinct differences. However, these belong to miscellaneous diseases (Zabing), not the heat diseases of Shanghan caused by cold invasion.

Generally, pathogens arise either from Yin or from Yang. Those arising from Yang result from wind, rain, cold, and summer-heat. Those arising from Yin result from diet, living conditions, and emotional fluctuations such as joy, anger, etc. Zhang Zhongjing stated: "Fever accompanied by aversion to cold indicates onset in the Yang; absence of fever with aversion to cold indicates onset in the Yin." In cases of internal infection involving the Three Yin, there is typically no fever throughout. If fever occurs, it is what Zhang Zhongjing termed "contrary fever" (Fan Re). Examining the phrase "at the beginning" clarifies this. Internal infection remains confined to a single meridian without further transmission. Why does it not transmit? Because Yang Qi is dynamic while Yin Qi is static; thus, Yang meridians transmit while Yin meridians do not. If discussing according to the framework of the Three Yin and Three Yang in Shanghan, transmission involves only the exterior-interior relationships of the meridians. Moreover, when Wind-Cold and the Six Excesses invade humans, they may strike the Yang meridians or enter the Yin collaterals. Who comes first, who comes second? How can one exclusively regard the Taiyang meridian as the starting point of pathogen invasion? Therefore, all meridians can be invaded. However, invasions starting from Taiyang are more common than others. Generally, even if heat pathogens originate within the Three Yin, they will eventually transmit to the Yangming (Yang Brightness) meridian before subsiding. Cold invasion of the Three Yin meridians never transmits further; this is why there are no combined diseases in the Three Yin.

[I recount my own experience] I once read Zhang Zhongjing's *Treatise on Cold Damage* (*Shanghan Lun*). In the Taiyin chapter, it states: "Spontaneous diarrhea without thirst belongs to Taiyin because of cold in the Zang organs; therefore, it should be warmed, and formulas like Sini Tang (Four Counterflow Decoction) are appropriate." In the Shaoyin chapter, it states: "Shaoyin disease, occurring one or two days after onset, with a normal mouth (no bitterness or dryness) and aversion to cold in the back, should be treated with moxibustion and Fuzi Tang (Aconite Decoction)." "Shaoyin disease with body pain, cold hands and feet, bone and joint pain, and a deep pulse is treated with Fuzi Tang." "Shaoyin disease with diarrhea is treated with Baitong Tang (White Onion Decoction)." "Shaoyin disease with diarrhea and a faint pulse is given Baitong Tang; if diarrhea persists, leading to cold limbs, absent pulse, dry heaving, and irritability, Baitong Jia Zhuyedanhuang Tang (Baitong Tang plus Pig Gallbladder Bile Decoction) is used." "Shaoyin diarrhea with undigested food, interior cold with exterior heat, cold limbs, faint and nearly imperceptible pulse, yet the body feels no aversion to cold, and the face is red, or with abdominal pain, dry heaving, sore throat, or cessation of diarrhea with absent pulse, is treated with Tongmai Sini Tang (Pulse-Recovering Four Counterflow Decoction)." "Shaoyin disease with a deep pulse requires urgent warming with Sini Tang." In the Jueyin chapter, it states: "Cold limbs and a fine, nearly absent pulse are treated with Danggui Sini Tang (Angelica Sinensis Counterflow-Warming Decoction)." "Profuse sweating or severe diarrhea leading to cold limbs is treated with Sini Tang." Observing these statements, it is clear that Three Yin diseases in Shanghan must involve cold syndromes suitable for warm-hot remedies.

Later, reading Liu Shouzhen's (Liu Wansu's) works, he stated: "Pathogenic heat in the exterior and Fu organs constitutes Yang pathogenic heat; pathogenic heat in the interior and Zang organs constitutes Yin pathogenic heat. Laypeople mistakenly believe there are distinct cold and hot Yin-Yang syndromes, misleading people for a long time. Cold diseases exist, but they do not refer to Hanbing (sweating diseases/external febrile diseases). Cold diseases are limited to miscellaneous illnesses and cannot be classified as Hanbing. Furthermore, the Qi that generates bodily fluids is Yang-Heat Qi, not something produced by Yin-Cold. Although Zhang Zhongjing has Sini Tang indications, these treat cases where exterior heat and interior harmony were mistaken for cold and purged too early with cold herbs, causing exterior heat to enter the interior and persistent diarrhea; or cases of exterior heat and interior cold with spontaneous diarrhea, where Sini Tang is urgently used to warm the interior. Once diarrhea stops and the interior harmonizes, the exterior is then resolved. Thus, after Sini Tang indications, Chengqi Tang (Garlic Decoction) purgatives follow. Consequently, Shanghan Hanbing texts explicitly mention heat diseases, not cold diseases. When scriptures mention Three Yin syndromes, it is because pathogenic heat is in the Zang and interior, which are Yin, requiring purgation of heat. The *Suwen* (Basic Questions) has two chapters on Shanghan heat diseases titled 'Re Bing' (Heat Disease), mentioning no cold. Reasoning from the *Suwen* and *Lingshu* (Spiritual Pivot) regarding Yungu (Luck and Transformation) principles, it is indeed heat disease, certainly not cold." From Liu Shouzhen's argument, it appears that Shanghan, whether in the exterior or interior, and regardless of the Three Yang or Three Yin, is uniformly heat, with absolutely no cold.

These two theories differ, and one must be correct. I repeatedly investigated and questioned their meanings but could not resolve them for a long time. Even until mentally exhausted and qi depleted, I did not abandon the effort, believing this was the general principle of Shanghan. Without understanding this principle, thousands of words would not serve as models for future learners, let alone prevent harm to people's lives. I assumed Cheng Wuji's commentary must have some insights, so I sought them there. However, he merely explained the text superficially and never clearly stated why it is heat or why it is cold. This was not because he didn't want to say, but because he believed Shanghan always involves meridian transmission, suspecting that all transmissions across the Six Meridians result in heat syndromes, and since heat does not transform into cold, he dared not distinguish otherwise.

If we consider it cold originating from the Zang itself, how can one see only cold and no heat when heat pathogens transmit deeply into the interior? Would the warm-hot medicines used not aid the heat pathogens of meridian transmission? If we consider it cold from external pathogens, by the time it reaches the Three Yang, it has already become heat. How could it turn to cold upon reaching the Three Yin? If Cheng had pondered this deeply, he would have realized the reason. Since Zhang Zhongjing wrote *Shanghan Lun*, no one has neglected it without revering it. But when debates on similarities and differences arose, seekers went to the abyss like fishers, and woodcutters to the mountains. No wonder later generations could not decide between plausible and implausible interpretations. Some claimed true Shanghan disease does not exist today; others said current diseases are all internal injuries. Ignorant people even claimed that all warm medicines in *Shanghan Lun* are used for meridian-transmitted heat because the Three Yin belong to Yin. The most absurd claim was: "Any mention of 'cold' in the text should be read as 'heat'." Alas, how far has the decline reached!

Thus, I cleared my mind and contemplated deeply. Suddenly, it became clear as if I had an epiphany, though I dared not be certain of its correctness. I tentatively present it here for correction by those with the Way.

Regarding Three Yang diseases, when cold pathogens are in the Taiyang meridian, cold stagnates Yang Qi, causing obstruction and generating heat. Although Yang Qi is righteous Qi in the body, once obstructed, it becomes pathogenic. Using Mahuang (Ephedra) to release the exterior expels cold, opening the pores and venting stagnant heat, leading to cure through sweating. If sweating does not occur and the condition does not resolve, the heat cannot escape outward and must enter the interior, transmitting to Yangming or Shaoyang (Lesser Yang), or entering the Fu organs.

As for Three Yin diseases, why are some cold and some hot? Generally, when cold pathogens injure humans, sometimes they cause stagnant heat in Taiyang before transmitting sequentially to Yin meridians; sometimes Taiyang does not transmit to Yangming or Shaoyang but directly to the Three Yin; sometimes cold pathogens do not start from Yang meridians but directly injure Yin meridians; sometimes starting from Taiyang, without sufficient time for heat stagnation, they enter Shaoyin, presenting only Shaoyin symptoms; sometimes starting from Taiyang, they enter Shaoyin immediately, while Taiyang remains uninjured; sometimes direct injury leads immediately to heat transformation, starting as cold but ending as heat. Cases of stagnant heat transmitting to Yin or cold transforming to heat constitute heat syndromes. Cases of direct Yin injury or immediate entry from Taiyang to Shaoyin constitute cold syndromes. When Taiyang is inevitably injured, Shaoyin pulse/symptoms appear alongside Taiyang marker diseases. When starting as cold and ending as heat, cold symptoms appear first, followed by heat symptoms. This explains why Three Yin diseases can be either cold or hot. By carefully studying the various clauses in the Three Yin chapters, the rationale emerges.

Why do some transmit via meridians, some suffer direct injury, some enter immediately, and some go from cold to heat? Pathogens strike suddenly and unpredictably, and their transmission is irregular. Hence, the classics state: "Pathogens invading humans have no constancy; some strike Yang, some strike Yin."

Liu Shouzhen was a scholar of exceptional caliber. Did he enjoy making异说 (heterodox theories) to shock people? Probably not. He likely equated Wenbing (Warm Diseases) and Shubing (Summer-heat Diseases) with Shanghan. Since Zhang Zhongjing's formulas often did not match Warm/Summer-heat treatments, he omitted warm-hot agents and routinely used cold-cool ones. By categorizing all Shanghan as heat without cold, he argued that Zhang Zhongjing's Sini Tang was a cold formula, mistakenly treating exterior heat with interior harmony, or establishing it for exterior heat with interior cold diarrhea. He also claimed that warming the interior to stop diarrhea and urgently resolving the exterior, and stating cold diseases are only miscellaneous illnesses, were errors. Alas! Zhang Zhongjing's *Shanghan Lun* was specifically written for Shanghan contracted immediately upon cold exposure, not for non-immediate Warm/Summer-heat diseases. Therefore, Three Yin cold syndromes exist, and warm-hot agents are used because the disease is cold and the season is cold; their use is appropriate. Later generations, unaware of this, seek further away and dig deeper into misconceptions. If they understood this, it would be like Cook Ding carving an ox—moving precisely along the natural joints.

For instance, if cold herbs are mistakenly used to purge, causing interior cold, this is unavoidable. But can we say interior cold arising without such mistake is impossible? We must realize that cold syndromes frequently seen in Yin meridians originally result from cold pathogens directly injuring these meridians bypassing Yang, or from Taiyang failing to generate heat before entering directly. Cases due to mistaken purging with cold herbs are rare. Were the warm-hot agents Zhang Zhongjing used primarily established for mistaken purging? And did exterior heat with interior cold cases always require urgent exterior resolution? The syndrome of interior cold with exterior heat is actually cold pathogens invading internally, forcing Yang Qi outward, or deficient Yang Qi manifesting as false exterior heat, not true heat pathogens. Zhang Zhongjing treated interior cold with warm medicines without addressing the exterior heat in such cases, revealing his intent. If urgent exterior resolution were required, would he not have explicitly stated it after the interior harmonized?

Furthermore, if Three Yin cold diseases are miscellaneous illnesses, why are they recorded in *Shanghan Lun* to confuse later generations? Why do the Jueyin chapter clauses begin with the word "Shanghan"? The *Neijing* describes Three Yin diseases as uniformly heat, representing the norm. Zhang Zhongjing describes them as mixed heat and cold, representing variations. They coexist without contradiction. Later generations claiming Shanghan has no cold syndromes know the norm but ignore the variation.

However, those who strictly adhere to Bureau Formulas and favor warm-hot agents often survive cold syndromes. This is not without reason; although their theory is biased, it treats this specific syndrome. If learners understand that Three Yin inherently has cold syndromes caused by cold pathogens, Zhang Zhongjing's original intent becomes clear, preventing deviation by other theories.

Someone asked: "Shanghan diseases must transmit from Yang meridian stagnant heat to Three Yin. Now you claim direct Yin injury and immediate entry lead to cold syndromes. What is your evidence?" I replied: "Evidence from Zhang Zhongjing." Zhang Zhongjing said: "Disease with fever and aversion to cold originates in Yang; disease without fever and with aversion to cold originates in Yin. Originating in Yang heals in seven days; originating in Yin heals in six days." "Without fever and with aversion to cold" indicates it is not Yang stagnant heat. "Originating in Yin" indicates it did not transmit from Yang meridians. "Healing in six days" indicates it did not start from Taiyang but began counting from the day of Yin meridian onset. Zhang Zhongjing also said: "In Shanghan, jue (cold limbs) appearing between day 1-5 implies subsequent fever. If jue lasts five days and fever lasts five days, and on day 6 jue returns, the patient heals. If jue lasts four days, fever three days, and jue returns for five days, the disease progresses." Can getting Shanghan and immediately developing jue without prior fever be attributed to deep-transmitted heat pathogens? Many modern patients present with cold syndromes from the onset without any fever; this is direct Yin injury and immediate entry. If one fails to comprehend Zhang Zhongjing's intent and rigidly adheres to "all cold damage results in heat disease," few will avoid premature death.