The “Treatise on Cold Damage” (Shang Han Lun) is the first comprehensive book in China that integrates theory, law, prescriptions, and medicines for syndrome differentiation and treatment. It is both a summary of the theories and experiences of predecessors and a recreation of the academic theories of Traditional Chinese Medicine (TCM).
However, many people say that after reading the “Treatise on Cold Damage” for a long time, they ultimately find it useless, believing that its clinical effects are not as obvious as described in the book. This is mainly due to some people’s insufficient understanding of the “Treatise on Cold Damage,” leading to a misinterpretation of its principles. Today, I bring you an excerpt of the simplified version of the “Treatise on Cold Damage,” which is very simple and understandable even for those without a background in TCM, making it worth collecting!
Simplified Explanation of the Treatise on Cold Damage
First Method of Pulse Diagnosis
1. Question: What does it mean to differentiate between yin and yang pulses? Answer: Generally speaking, pulses that are large, floating, rapid, moving, and slippery are considered excess pulses, belonging to yang; while pulses that are deep, rough, weak, wiry, and faint are considered deficient pulses, belonging to yin. When yin conditions present with yang pulses, it indicates that the righteous qi is overcoming the pathogenic factors, suggesting a good prognosis; conversely, when yang conditions present with yin pulses, it indicates that the righteous qi is unable to overcome the pathogenic factors, often indicating a critical condition.
2. Question: How can we differentiate between yang and yin obstruction pulses? Answer: If a patient has a floating and rapid pulse, can eat but has constipation, this indicates a dry heat pathogen obstructing internally, known as yang obstruction. Approximately on the seventeenth day, the condition will worsen. If a patient has a deep and slow pulse, cannot eat, feels heavy, and has hard stools, this indicates a cold pathogen obstructing internally, known as yin obstruction. It is estimated that by the fourteenth day, the condition will worsen.
3. Question: What is the reason for a patient experiencing both chills and fever? Answer: When yin is insufficient, yang qi can take advantage, leading to fever; when yang is insufficient, yin qi can take advantage, leading to chills. Question: What is yang deficiency? Answer: For example, if the cun pulse is faint, it indicates yang deficiency; when yang is deficient, yin qi can take advantage, leading to excess cold. Question: What is yin deficiency? Answer: If the chi pulse is weak, it indicates yin deficiency; when yin is deficient, yang qi can take advantage, leading to heat, resulting in fever.
4. If a patient has a floating cun pulse and a weak chi pulse, it indicates that yang qi is floating externally while yin blood is deficient internally. The defensive yang is weak and cannot secure the exterior, leading to profuse sweating; the deficient yin blood cannot nourish the tendons and vessels, resulting in muscle spasms. If the patient has a deep pulse, it indicates that the nutritive qi is weak. If a person with weak nutritive qi is treated with moxibustion, it will further damage the nutritive yin and promote yang heat, leading to fever and agitation.
5. A pulse that is large and strong, resembling a cover on a cart, indicates that yang qi is excessively strong, known as yang obstruction pulse; a pulse that is strong and continuous, like touching a long rod, indicates that yin qi is excessively strong, known as yin obstruction pulse. A pulse that is light and floating, resembling oil floating on soup, indicates weak yang qi. A pulse that is extremely fine, resembling spider silk, indicates weak yin qi. A pulse that is soft and weak, large in front and small in back, resembling lacquer dripping down, indicates a sign of severe blood loss and empty blood vessels.
6. A pulse that beats slowly, sometimes stopping and then resuming, is called a knot pulse. A pulse that beats quickly, sometimes stopping and then resuming, is called a rapid pulse. A rapid pulse is caused by excess yang, while a knot pulse is caused by excess yin; both are pathological pulse signs.
7. The pulse is the interaction of yin and yang qi, and the inability of the pulse qi to circulate through the three regions is due to this. If the cun region shows a pulse, it indicates that yang is deficient and cannot secure the exterior, leading to sweating; if the chi region shows a pulse, it indicates that yin is deficient and yang is taking advantage, leading to fever; if there is neither sweating nor fever, but the patient feels cold, this indicates that the yang qi of the three burners is injured and cannot reach the exterior. The shape of the pulse is fast, only seen in the guan region, with no head or tail, resembling a bean, shaking unpredictably, which is called a pulse.
8. If the cun pulse is floating and large, and the chi pulse is also floating and large, with both pulses equal, this indicates a harmonious state of yin and yang qi, known as a slow pulse, which is the pulse of a healthy person.
9. A pulse that is floating and tight is called a wiry pulse; however, the wiry pulse is straight and resembles a bowstring, not moving when pressed; while the tight pulse resembles a tightly twisted rope, moving when pressed. This is the distinction between the two.
10. A pulse that is wiry and large, wiry but weak in the middle, indicates a sign of declining yang qi; large but weak in the middle, indicating a hollow pulse, is a sign of blood deficiency. Declining yang qi leads to cold, while blood deficiency leads to a hollow pulse; when both wiry and hollow pulses are present, this is called a leather pulse. If women exhibit this pulse, it is often due to miscarriage or bleeding; if men exhibit this pulse, it is often due to blood loss or loss of essence.
11. Question: Some patients experience chills followed by sweating, and after sweating, the illness resolves. What is the reason for this? Answer: This type of patient has a floating and tight pulse, indicating a clear exterior condition, but when pressed deeply, it is empty, indicating insufficient righteous qi. Insufficient righteous qi, when trying to expel the pathogen, must contend with the pathogen, leading to chills. Because the pulse is floating, it indicates that the righteous qi is expelling the pathogen, so sweating should lead to recovery. If the pulse is floating and rapid, and pressing deeply does not reveal emptiness, it indicates that the righteous qi is not deficient. When the righteous qi is abundant, it can expel the pathogen, and the pathogen cannot contend with the righteous qi, so only sweating occurs, and the exterior pathogen resolves without chills.
12. Question: Some patients sweat naturally without experiencing chills and recover. What is the reason for this? Answer: This type of patient must have a weak pulse. This is because the patient has previously sweated, or has undergone vomiting, or has had diarrhea, or has lost blood, leading to a deficiency of body fluids, insufficient sources for sweating; however, the pathogenic qi has also weakened. At this time, as long as yin and yang can harmonize, the patient can recover without experiencing chills or sweating.
13. Question: A patient with cold damage for three days has a floating and weak pulse, does not have a fever, and feels cold. What is the reason for this? Answer: This is a sign that the illness is about to resolve, and the time of resolution is likely at midnight. If the pulse is floating and the illness resolves, it indicates that the righteous qi is expelling the pathogen, so the patient should sweat profusely and recover; if the pulse is rapid and the illness resolves, it indicates that the stomach qi is strong, and the patient should be able to eat; if the pulse is weak and the illness resolves, it indicates that the pathogenic qi has weakened, so the patient will definitely sweat profusely and recover.
14. Question: How can we determine if a disease has healed? Answer: If the pulses at the cun, guan, and chi regions are equal in size, floating, sinking, slow, and rapid, this indicates a harmonious state of yin and yang. At this time, even if symptoms such as fever and chills have not resolved, and the condition seems severe, recovery is still possible.
15. The teacher said: If a patient has a large pulse at the beginning of summer, this is a pulse that should be seen in summer. At this time, if the patient experiences severe body pain, sweating should be used for treatment; if the next day the body is no longer painful, then sweating is not needed; if the patient sweats profusely, the illness will resolve the next day. Why is this said? Because a large pulse seen at the beginning of summer is the pulse of the season. The pulse can respond to the season, indicating that the righteous qi is sufficient and can adapt to seasonal changes, thus indicating that the illness should heal. The pulse in other seasons can be inferred similarly.
16. Question: For some diseases, how can we predict the time of recovery based on the onset time? Answer: If a disease occurs at midnight, it can be healed by noon the next day; if it occurs at noon, it will improve by midnight. This is because noon is yang, and midnight is yin; when yang is not harmonious with yin, they will harmonize, so if the disease occurs at noon, it will resolve by midnight; if yin is not harmonious with yang, they will also harmonize, so if the disease occurs at midnight, it can be healed by noon the next day.
17. A floating pulse at the cun indicates an exterior condition, while a sinking pulse indicates an interior condition; a rapid pulse indicates a condition in the organs, while a slow pulse indicates a condition in the viscera. If a slow pulse appears, it indicates a condition in the viscera.
18. A floating and rough pulse at the fu yang indicates a disease in the spleen, which should lead to diarrhea. How do we know this? If the pulse is floating and large, it indicates qi excess and blood deficiency; now the fu yang pulse is not floating and large, but floating and rough, indicating spleen and stomach weakness, so diarrhea should occur. The normal pulse of the shaoyin is a floating and wiry pulse, indicating that the shaoyin channel is harmonized, so the shaoyin pulse is normal. If the shaoyin pulse is seen as slippery and rapid, it indicates that the pathogenic heat is trapped internally, and symptoms of purulent blood in the stool should appear.
19. A floating and tight pulse at the cun indicates that the wind pathogen is invading the exterior, while a tight pulse indicates that the cold pathogen is binding the exterior. The simultaneous appearance of both indicates a wind-cold invasion of the exterior. The wind pathogen can harm the defensive qi, while the cold pathogen can harm the nutritive qi. If both the nutritive and defensive qi are affected, joint pain will occur due to the wind-cold invading the exterior and the qi not flowing smoothly, so sweating should be used for treatment.
20. A slow and relaxed pulse at the fu yang indicates that the stomach qi is harmonized and there is no disease. If the fu yang pulse is floating and rapid, the floating indicates that the stomach qi is damaged, and the rapid indicates that the spleen qi is disturbed; these signs indicate damage to both the spleen and stomach. This is not due to the spleen and stomach being originally weak, but rather due to the doctor mistakenly using purgatives. Mistaken purging leads to damage to the spleen qi, and the nutritive and defensive qi sinks inward, thus the rapid pulse becomes weak while the floating pulse remains. Since the spleen is weak and cannot transform, the stools become hard, leading to belching and reduced symptoms; the pulse remains floating, indicating that the pathogenic qi is trapped in the stomach, so the patient feels hungry but cannot digest food, leading to tidal fever and thirst. If the rapid pulse turns to slow and matches the pre-illness pulse, and the patient feels hungry and can eat, this indicates that the spleen and stomach functions have returned to normal. If the patient’s pulse remains rapid, it indicates that the pathogenic heat is lingering, and over time, it will lead to sores.
21. The teacher said: A patient with a weak and rough pulse is a sign of a disease caused by the doctor’s mismanagement. Due to the mistaken use of harsh sweating medicines, the yang qi becomes weak, and repeated use of harsh purgatives damages the yin fluids, leading to both yin and yang being deficient. Therefore, the patient feels cold and then experiences fever, and the fever and chills do not cease. In summer, when the weather is hot, the patient wants to wear more clothes; in winter, when the weather is cold, the patient wants to expose their body. This is because both yin and yang are damaged; the weak yang qi leads to cold sensitivity, while the insufficient yin blood leads to fever. In May, the weather is in the height of summer, and the yang qi tends to the exterior, while the internal yang is weak and cannot overcome the yin cold, so the patient wants to wear more clothes; in November, the weather is in the height of winter, and the yang qi sinks inward, while the internal yin is weak and cannot overcome the internal heat, leading to stomach heat and a desire to reduce clothing and be naked. Additionally, the weak chi pulse is further strong evidence of insufficient nutritive blood.
22. A pulse that is floating and large indicates that the floating is due to the pathogenic qi in the exterior, and the large indicates that the pathogenic qi is excessive. A floating and hard pulse under the heart indicates two situations: if the heat pathogen has formed a solid mass internally, with symptoms such as hard stools, purgation should be used for treatment, and sweating should not be used; if the internal mass has not formed and the condition is still in the exterior, then sweating should be used first, and purging should not be done first, nor should diuretics be used. Because excessive urination will further damage the fluids, leading to hard stools. The exterior condition should be treated with sweating; if sweating is thorough, the pathogen will be expelled with the sweat, leading to the resolution of heat and recovery; if sweating is not thorough, the heat will not be expelled, and the fluids will be damaged, leading to constipation. If a slow pulse appears, it indicates cold, and purgation must be used cautiously.
23. A pulse that is floating and large, with sweating like oil, persistent shortness of breath, inability to drink soup, numbness, and loss of consciousness, indicates a pulse on the verge of death. To determine which organ’s qi has first failed, one can judge based on other symptoms. If the head sweats and the patient is short of breath, this indicates that the lung qi has failed; if the yang heat is dominant, the skin color is smoky, and the eyes are staring and shaking, this indicates that the heart qi has failed; if the lips are cyanotic, the limbs tremble and shake, this indicates that the liver qi has failed; if the area around the mouth is bluish-black, with cold sweat and yellowish skin, this indicates that the spleen qi has failed; if there is incontinence of urine and feces, with chaotic speech and staring eyes, this indicates that the kidney qi has failed. Additionally, for a specific organ, there can be a distinction between yin failure or yang failure, which can be judged from post-mortem manifestations. If the yang qi fails first and the yin qi fails later, the body will turn blue after death; if the yin qi fails first and the yang qi fails later, the body will turn red, and the armpits and heart area will still be warm.
24. A floating and large pulse at the cun, with floating indicating weak yang qi floating externally, and large indicating internal cold, indicates that the internal cold is severe and the yang is floating externally, which is a sign of deficiency. The doctor mistakenly uses purgation, which is a serious treatment error. After purging, the yang qi becomes even weaker, the internal cold becomes more severe, and the internal cold stagnates, obstructing the qi mechanism in the intestines, leading to intestinal sounds. The doctor does not understand this principle and instead uses cold water to induce sweating, causing the cold water qi to clash, resulting in a change in the condition.
25. A floating fu yang pulse indicates that the floating is due to deficiency, and the deficiency indicates that the stomach is not harmonized, leading to qi reversal in the stomach, which causes symptoms of qi reversal and obstruction. If the pulse is slippery, it indicates that the stomach is weak and cold drinks are stagnant, leading to hiccups. These are all mistakes made by the doctor, who treats deficiency with methods for excess, and uses purgation to forcefully expel the pathogenic factors, leading to exhaustion of the stomach qi. If the pulse is floating and the nose is dry, it will inevitably lead to nosebleeds.
26. Generally, a floating and rapid pulse is often seen in exterior conditions, accompanied by symptoms of fever and chills. If there is also pain in a specific area of the body, and the diet is normal, this indicates a local abscess or swelling.
27. A floating and slow pulse, with a flushed face, accompanied by cold shivering throughout the body, should lead to sweating and recovery by the sixth or seventh day. If there is no sweating and instead there is fever, the recovery date will be delayed. This is because the patient’s pulse is slow, indicating insufficient internal yang. When the internal yang is weak, it cannot vaporize the fluids to produce sweat, and the pathogen becomes trapped in the muscle surface, leading to fever without sweating, which must be accompanied by skin itching, thus prolonging the recovery time.
28. A pulse that is tight in all three regions, with the cun pulse tight indicating that the clear pathogens are in the upper burner, and the chi pulse tight indicating that the dampness is in the lower burner. The light and clear pathogens in the upper burner harm the upper burner, hence called clear; the heavy and turbid pathogens in the lower burner harm the lower burner, hence called turbid. Clear pathogens harm the upper and exterior, leading to symptoms of fever, headache, neck stiffness, waist pain, and leg soreness; turbid pathogens invade the lower and interior, leading to symptoms of cold chills in the heart, cold feet and knees, incontinence, etc. These are all due to weak exterior qi, and the internal qi cannot guard against the invasion of external pathogens. Whether the pathogenic factors invade the upper due to weak exterior or invade the lower due to weak interior, both can cause chaos in the three burners, leading to a lack of communication between the exterior and interior. If the upper burner’s pathogenic qi is stagnant and obstructed, internal heat will scorch the upper, leading to oral and gum ulceration. If the middle burner is not harmonized, it will affect the spleen and stomach’s ability to transform and transport, leading to stomach qi rising, spleen losing its function, and the generation and transport of nutritive and defensive qi being disrupted, thus the nutritive and defensive qi cannot communicate, and the blood vessels will not flow smoothly. At this time, if the defensive qi first becomes smooth, the internal stagnant pathogenic heat will leak out with the defensive qi, leading to yellowish or red urine, or through the meridians or organs, wherever the pathogenic heat passes, due to the scorching of the pathogenic heat, abscesses will occur; if the nutritive yin first becomes smooth, then the defensive qi will become weak, and the yin will have no function, leading to the external pathogens invading, and the internal qi will resist, leading to symptoms such as sneezing, difficulty in producing sound, and throat obstruction. If the external cold qi clashes with the internal reverse qi without generating heat, the blood will be forced by heat, leading to symptoms of blood in the stool resembling pig liver. If both yin and yang are exhausted, the middle burner’s spleen qi will decline, causing body fluids to leak downward, leading to frequent bowel movements with a feeling of heaviness in the lower abdomen, making it difficult to preserve life.
29. A tight pulse at both the cun and chi regions, accompanied by nasal congestion and runny nose, breathing through the mouth, dry lips, fatigue, cold feet, and slippery tongue coating, indicates that both the exterior and interior are ill, with a mix of deficiency and excess, with cold pathogens obstructing the muscle surface and yang deficiency leading to internal cold. At this time, treatment should be carefully considered, distinguishing between the emphasis on exterior and interior, and handled appropriately, avoiding random medication. If the patient has chills and fever, with nausea and a desire to vomit, this indicates that the exterior cold is predominant, and the condition is more severe in the exterior, so the treatment should focus on resolving the exterior while considering the interior; if the patient has abdominal pain and diarrhea, this indicates that the interior cold is more severe, and the interior condition is urgent, so the treatment should first save the interior and then treat the exterior, or warm the interior and resolve the exterior simultaneously. After seven or eight days, if there is slight fever and the hands and feet become warm, this is a good sign of recovery; if there is instead a high fever, this indicates that the righteous qi is declining and the pathogenic qi is strong, making the illness more difficult to treat.
30. A pulse that is tight in all three regions, accompanied by vomiting and diarrhea, indicates an internal excess of cold pathogens. If the tight pulse does not resolve, it indicates that the pathogenic qi is still strong, and the illness has not resolved; if the tight pulse has dissipated and the pulse has turned to a gentle one, this indicates that yang has recovered and yin has retreated, and the illness will soon resolve. If the pulse changes from tight to slow, and by the sixth or seventh day, the patient does not want to eat, this indicates a lingering internal water and drink condition, and the illness has not resolved; if the appetite returns to normal, this indicates that the middle yang has recovered, and the water and drink will be eliminated, indicating that the illness is improving. After six or seven days, if the pulses at the cun, fu yang, and shaoyin are all normal, and the patient exhibits severe agitation, clenched jaws, inability to speak, and restless hands and feet, this is a good sign of the righteous and pathogenic qi contending, indicating that the pathogenic qi will retreat; if the patient’s pulse is harmonized as usual, with abnormal agitation, slight swelling of the eyelids, and yellowing of the eyes, this is also a sign that the illness will improve.
31. A pulse that is floating and rapid indicates a pulse sign of wind pathogen harming the exterior. The floating indicates that the wind pathogen is in the exterior, and the rapid indicates that the defensive yang is insufficient. Wind is a yang pathogen, and when yang is abundant in the exterior, it leads to fever; when the defensive yang is insufficient, it cannot warm the flesh, leading to chills. The insufficiency of the defensive yang is also bound by wind and cold, so the body feels as if cold water has been poured over it, leading to a fear of cold.
32. A pulse that is floating and slippery indicates that the floating is due to heat in the exterior, and the slippery indicates that the pathogenic qi is strong. The simultaneous presence of floating and slippery pulses indicates an extreme state of yang heat. If the patient’s pulse changes from floating and slippery to rapid, accompanied by fever and sweating that does not resolve, this indicates that the yang heat is extremely excessive, the circulation of qi and blood has lost its normal state, and the yin fluids are about to dry up, indicating a severe condition.
33. In cases of cold damage, cough, and shortness of breath, if the pulse appears chaotic and rootless, and there are signs of severe bone sinking, this indicates that the original qi is about to disperse, and the organ qi is about to fail, which is a sign of death.
Second Method of Pulse Diagnosis
1. Question: The human pulse has three regions: cun, guan, and chi, which reflect the interdependence and maintenance of yin and yang. The pulse’s beating is closely related to the nutritive and defensive qi and lung qi. Within the human body, the flow of nutritive and defensive qi and blood circulates with the breath, moving up and down, spreading throughout the body, hence the pulse’s beating. Humans correspond with heaven and earth, and the changes in the four seasons and climate will inevitably affect people, thus the pulse changes with the seasons, presenting various forms. For example, in spring, the pulse is wiry; in autumn, it is floating; in winter, it is sinking; in summer, it is large. Additionally, the patient’s pulse can vary in size, even within the same time frame, often changing unpredictably. Furthermore, the pulse in the chi and cun regions can be uneven, sometimes showing short pulses or long pulses; the upper and lower pulses can differ, with some having a pulse present and others having no pulse. Moreover, when a person becomes ill, the pulse will change, sometimes showing a fast pulse, sometimes a slow pulse, sometimes floating, and sometimes sinking. All of these can easily confuse people, leading them to lose their principles. Please elaborate on this, teacher, so that it can be clear and understandable. The teacher replied: What you are asking is indeed a fundamental issue in medicine. The pulse has three regions, which are cun, guan, and chi. The flow of nutritive and defensive qi and blood is as accurate as measuring length and weight. Therefore, the kidney pulse is sinking, the heart pulse is large, the lung pulse is floating, and the liver pulse is wiry; these are the normal pulses of each organ and will not have the slightest error. Following the breath, the flow of the human body’s nutritive and defensive qi circulates, completing a cycle in the time of a water clock. In the time of two water clock units, it completes a full cycle. Therefore, by examining the cun pulse, one can observe the body’s deficiency and excess, observe changes in the illness, and understand the predominance and decline of yin and yang. If one feels the wind pathogen, the pulse will appear floating and weak; if one feels the cold pathogen, the pulse will appear tight and firm; a sinking pulse indicates water and drink stagnation; a rapid pulse indicates excessive heat; a rapid pulse indicates excessive heat. If the pulse does not correspond to the symptoms, one must understand the source of the changes. The different pulses at the cun, guan, and chi regions indicate different diseases. An overly strong pulse is pathological, while an insufficient pulse is also pathological. In summary, the pathogenic qi is not invisible; if one thoroughly investigates its source, one can find the root of the disease. Therefore, it is necessary to examine whether the disease is in the exterior or interior, distinguish whether it is in the upper burner, middle burner, or lower burner, and clarify the location of the pathogenic qi invasion, diagnosing and inferring the prosperity and decline of the organs. If one grasps these, one will have unique and profound insights. Therefore, I will record them in detail to pass on to knowledgeable individuals.
2. The teacher said: The pulse follows the flow of the breath. When first pressing the pulse, if the pulse comes quickly and goes slowly, this is because the breath is exhaled quickly and inhaled slowly, which is called internal deficiency and external excess. When first pressing the pulse, if the pulse comes slowly and goes quickly, this is because the breath is exhaled slowly and inhaled quickly, which is called internal excess and external deficiency.
3. Question: A skilled doctor can know the condition through observing the patient’s complexion, an average doctor can know the condition through inquiry, while a less skilled doctor can only know the condition through pulse diagnosis. Please provide guidance, teacher. The teacher replied: If the family of the patient comes to ask the doctor, saying that the patient has a high fever and body pain but can sleep naturally. Upon arriving at the patient’s home and examining the pulse, if it is sinking and slow, one can know that the disease is about to heal. How do we know this? This is because the patient’s fever and body pain are symptoms of an exterior condition, and the pulse for an exterior condition should be floating and large; now the pulse is seen as sinking and slow, indicating that the exterior condition has yielded to an interior pulse, thus indicating that the pathogenic qi has weakened and the disease is about to heal. If the patient complains of sudden abdominal pain but can sit calmly, and the pulse is floating and large, one can also know that the disease will heal. How do we know this? This is because the patient’s abdominal pain indicates an interior condition, and the pulse for an interior condition should be sinking and fine; now the pulse is floating and large, indicating a yin condition presenting with a yang pulse, which is a sign of the righteous qi overcoming the pathogenic qi, thus indicating that the disease will heal.
4. The teacher said: When the family of the patient comes to ask the doctor, saying that the patient has a very high fever. The next day, when the doctor arrives at the patient’s home and sees the patient sleeping peacefully against the wall, this indicates that the heat has already retreated. At this time, even if the pulse has not yet adjusted, one can assert that the disease has already healed. If the patient is sleeping against the wall, and when the doctor arrives, the patient does not suddenly sit up in surprise but stares at the doctor, speaking hesitantly and stammering, and when examined, the patient swallows saliva, this indicates that the patient is pretending to be ill. If the patient’s pulse is normal, the doctor can deliberately say that this illness is very serious and that the patient should take purgatives and emetics, and must needle and moxibustion dozens or hundreds of acupoints to scare the patient, so that they can heal.
5. When the doctor examines the pulse, if the patient yawns, this indicates that there is no illness. If the patient moans while the doctor examines the pulse, this indicates that there is an illness. If the patient speaks slowly and is not agile, this indicates a wind disease; if the patient shakes their head while speaking, this indicates pain in the interior; if the patient moves slowly, this indicates a strong and urgent change in the tendons; if the patient is hunched over, this indicates shortness of breath; if the patient cannot sit upright, this indicates back pain; if both hands protect the abdomen, as if cradling an egg and unwilling to let go, fearing touch, this indicates abdominal pain.
6. The teacher said: For the disease of hidden qi, one must always pay attention to observation, and be vigilant to discover the patient in time for early treatment. If there has indeed been hidden pathogenic qi, one should examine it early. If the pulse is weak, it will lead to severe throat pain, as if it were an injury, which is not a throat obstruction. The patient says: The throat indeed hurts. Even so, they now want to have diarrhea.
7. Question: What is the pulse like when a person is in fear or shock? The teacher replied: The pulse appears as if pressing a silk thread, thin and continuous, while the patient’s face loses color and appears pale.
8. Question: If a person does not drink water, leading to fluid deficiency, what is the pulse like? The teacher replied: The pulse is rough, and the lips and mouth are dry.
9. Question: What is the pulse like when a person feels shame? The teacher replied: The pulse is floating, and the face color alternates between red and white.
10. Question: The “Nanjing” says: What does it mean when the pulse has three beans heavy and six beans heavy? The teacher replied: When the doctor presses the pulse with a finger, if it feels like the weight of three small beans, it indicates the lung qi pulse; if it feels like the weight of six small beans, it indicates the heart qi pulse; if it feels like the weight of nine small beans, it indicates the spleen qi pulse; if it feels like the weight of twelve small beans, it indicates the liver qi pulse; if the pulse is felt only when pressing to the bone, it indicates the kidney qi pulse. If the patient has diarrhea, and the cun, guan, and chi pulses cannot be felt, but the chi pulse occasionally shows a slight beating with each breath, this indicates that the kidney qi has not yet been exhausted; if the pulse is felt once per breath, this indicates a difficult-to-treat condition.
11. Question: What does it mean when the pulse has mutual dominance, horizontal and vertical, and order and disorder? The teacher replied: Each season has its normal pulse, and the qi of the five organs corresponds to it, thus there are spring wiry pulses, summer large pulses, autumn floating pulses, and winter sinking pulses. If the qi of the organs interacts, it can lead to pathological pulses. For example, if the summer pulse should be large but is instead sinking, this indicates that kidney water is overpowering heart fire; if the spring pulse should be wiry but is instead floating, this indicates that lung metal is overpowering liver wood, which is called horizontal. If the organ qi overpowers the other, for example, if the winter pulse should be sinking but is instead large, this indicates that heart fire is overpowering kidney water; if the autumn pulse should be floating but is instead wiry, this indicates that liver wood is overpowering lung metal, which is called vertical. If the autumn pulse is seen as sinking, this indicates that kidney water is overpowering lung metal; if the spring pulse is seen as large, this indicates that heart fire is overpowering liver wood, which is called reverse.
12. Question: What does it mean when the pulse has pathogenic qi harming the body? The teacher replied: The pulse showing wiry, tight, floating, slippery, sinking, and rough is a pathological pulse caused by pathogenic qi harming the body, reflecting the changes in the meridians due to pathogenic qi invasion.
13. Question: What does it mean when the pulse shows disaster? The teacher replied: If a patient has both the pulse of the sun and the symptoms of the sun, and the pulse corresponds to the symptoms, then after preparing the decoction for treatment, if the patient suddenly experiences severe vomiting or diarrhea, and abdominal pain occurs, but the doctor does not observe these symptoms during the examination, this sudden change is called disaster. Another question: What causes the vomiting and diarrhea? The teacher replied: It may be due to the previous medication, which only now takes effect, thus causing vomiting, diarrhea, and other symptoms, resulting in unexpected changes.
14. Question: How does the liver pulse in the east manifest? The teacher replied: The liver, belonging to wood, is also called jueyin; its pulse is weak, wiry, and long, which is the normal pulse of the liver. If the liver is ill and shows a weak pulse, it indicates that the disease will heal. If it is simply a wiry pulse, the prognosis is poor. Why? Because the pulse is straight like a bowstring, indicating liver damage, thus knowing the prognosis is poor.
15. The heart pulse in the south, how does it manifest? The teacher replied: The heart belongs to fire, also called shaoyin; its pulse is large and long, which is the normal pulse of the heart. If the heart is ill and shows a large pulse, it indicates that the disease will heal. If the pulse comes weak and goes large, this is an abnormal phenomenon, called “reverse,” indicating an internal condition. If the pulse comes small and goes large, this is called “cover,” indicating an exterior condition. If the pulse is floating and weak, it indicates sweating. If the pulse is sinking and weak, it indicates that there is no communication, leading to no urination. At this time, if there is no sweating in the head, the illness can still be treated; if there is sweating, it indicates a fatal condition.
16. The lung pulse in the west, how does it manifest? The teacher replied: The lung belongs to metal, also called taiyin; its pulse is floating like hair, which is the normal pulse of the lung. If the lung is ill and shows this pulse, or shows a slow pulse, it indicates that the disease will heal. If a rapid pulse appears, the disease will worsen. Why? Because a rapid pulse indicates that the southern fire is excessive, and fire overcomes western metal, leading to abscesses, which is a difficult-to-treat condition.
17. Question: In February, if a hair-like floating pulse is seen, how can it be predicted that death will occur in autumn? The teacher replied: In February, the pulse should be weak, but if a hair-like floating pulse appears, it indicates that death will occur in autumn. February is the time when liver qi is at its peak, and the liver belongs to wood; the pulse should be weak, but if a hair-like floating pulse appears, it indicates that the lung pulse is present, and lung belongs to metal, which overcomes wood, thus predicting death in autumn. The pulse of other seasons can be inferred similarly.
18. The teacher said: When diagnosing the pulse of an obese person, if the pulse is floating, one should seek the cause of the floating; when diagnosing the pulse of a thin person, if the pulse is sinking, one should find the root cause of the sinking. This is because the pulse of an obese person should be sinking, but if it is floating, it is an abnormal pulse, so the cause should be investigated.
19. The teacher said: If the cun pulse does not reach the guan, it indicates that yang is exhausted above; if the chi pulse does not reach the guan, it indicates that yin is exhausted below; these are signs of untreatable conditions, and death is certain. If one wants to predict the patient’s time of death, one can calculate it based on the seasonal laws and the diseases that counteract each other.
20. The teacher said: A pulse that shows disease while the external appearance shows no disease is called a walking corpse, indicating that the organ qi has been exhausted. If the patient suddenly becomes dizzy and collapses, losing consciousness, they will die prematurely. If the external appearance shows illness while the pulse is normal, this is called internal deficiency, caused by a lack of qi from food and drink, and although the body is suffering, it poses no danger.
21. Question: What does it mean when the pulse comes large and strong, then suddenly sinks, resembling a pearl turning? The teacher replied: A sinking pulse is a pure yin sign, while a large and strong pulse is a pure yang sign. Yin is the foundation of pre-heaven, while yang is the foundation of post-heaven. The combination of yin and yang leads to abundant qi and blood, flowing rapidly, thus the pulse is slippery, and the guan and chi pulses must naturally balance. If the guan pulse is not balanced and is slightly sinking, this indicates that the yangming is not yet severe, and the diet is still acceptable; if the chi pulse is not balanced and is slightly floating and tight, this indicates that the shaoyin is excessively strong, and the patient will definitely experience sweating in the inner thighs and dampness in the genital area.
22. Question: I was once asked how a tight pulse is produced. The teacher replied: If sweating is excessive, or if vomiting is induced, leading to lung deficiency and cold, it can cause a tight pulse; if a coughing patient drinks cold water, leading to cold drinks stagnating, it can also produce a tight pulse; if a patient has a deficiency cold diarrhea due to internal cold in the stomach, it can also lead to a tight pulse.
23. The cun pulse with excessive defensive qi is called high; the excessive nutritive qi is called zhang; the equal excess of nutritive and defensive qi is called gang. Weak defensive qi is called weak; weak nutritive qi is called low; the equal weakness of both is called loss. Harmonized defensive qi is called slow; harmonized nutritive qi is called late; the equal harmony of both is called sinking.
24. A slow and relaxed pulse at the cun indicates that the defensive qi is harmonized, and the defensive qi is abundant externally, so the person’s skin color is bright and shiny, the voice is clear and high, and hair grows abundantly; a slow pulse indicates that the nutritive and defensive qi is harmonized, and the blood is abundant, so the person’s bone marrow grows, blood vessels are full, and muscles are firm and strong. Yin and yang promote each other, and the flow of nutritive and defensive qi is smooth, leading to a strong and healthy body without illness.
25. A slippery and tight pulse at the fu yang indicates that the stomach has an excess pathogen, while the tight indicates that the spleen has an excess pathogen. The mutual attack of the spleen and stomach pathogens harms each other, similar to holding a knife’s edge, thus causing injury.
26. A floating and large pulse indicates that the floating is due to wind pathogens, and the large indicates that the pathogenic qi is excessive. A floating and large pulse seen at the chi indicates that the righteous qi is deficient below, and the pathogenic qi closes the lower burner, leading to urinary obstruction, which is called “closure”; a floating and large pulse seen at the cun indicates that the righteous qi is deficient above, and the pathogenic qi obstructs the upper burner, leading to vomiting, which is called “obstruction.”
27. A fu yang pulse that is floating and rough indicates that the middle burner is blocked, and the food cannot be digested, leading to vomiting; the rough indicates that the organ qi is internally blocked, and the spleen is weak and cannot transport, thus the food cannot be ingested, which is also called closure.
28. A pulse that is floating and large indicates that the floating is due to wind pathogens, and the large indicates that the pathogenic qi is excessive. The wind pathogen and the righteous qi clash; the light pathogen invades the muscle surface, leading to skin rashes and itching, called “leak wind”; the heavy wind pathogen lingers and does not leave, leading to skin ulceration and scabbing.
29. A pulse that is weak and slow indicates that the defensive qi is weak, and the slow indicates that there is cold in the nutritive. The nutritive is blood; if the blood is cold, it will lead to fever; the defensive is qi; if the qi is insufficient, it will lead to fullness in the stomach, although feeling hungry, the patient cannot eat.
30. A fu yang pulse that is large and tight indicates that the large is due to deficiency, and the tight indicates that the cold is excessive; the righteous qi is deficient while the yin cold pathogen is excessive, leading to symptoms such as diarrhea, which is more difficult to treat.
31. A cun pulse that is weak and slow indicates that the weak is due to insufficient yang qi, and the slow indicates that there is excess qi in the stomach, leading to symptoms such as belching, sour regurgitation, inability to eat, and fullness in the chest and abdomen.
32. A fu yang pulse that is floating and tight indicates that the floating is due to qi deficiency, and the tight indicates that the cold is excessive; qi deficiency leads to abdominal distension, and excessive cold leads to abdominal cramping. The combination of qi deficiency and excessive cold leads to intestinal sounds, and the movement of qi in the abdomen causes the stagnant qi in the chest to descend. If the shaoyin pulse is not present, it indicates that the deficiency cold qi is trapped in the lower burner, which can lead to swelling and pain in the external genitalia.
33. A cun pulse that is weak and rough indicates that the weak is due to insufficient defensive qi, and the rough indicates that the nutritive qi is insufficient. The deficiency of the defensive and nutritive qi leads to the three burners losing their support, resulting in numbness and loss of sensation. Insufficient nutritive qi leads to severe body pain and difficulty speaking; weak defensive qi cannot protect the exterior, leading to cold sensitivity and frequent yawning. When both the defensive and nutritive qi are deficient, the three burners lose nourishment, and if the upper burner fails, it leads to sour regurgitation; if the middle burner fails, it cannot digest food; if the lower burner fails, it leads to incontinence.
34. A fu yang pulse that is sinking and rapid indicates that the sinking indicates that the pathogenic qi is solid in the interior, and the rapid indicates heat; heat can digest food and drink, making treatment easier. If the pulse is not sinking and rapid but sinking and tight, it indicates that the internal cold is excessive, which is a difficult-to-treat condition.
35. A cun pulse that is weak and rough indicates that the weak indicates insufficient defensive qi, and the rough indicates insufficient nutritive qi. If the defensive qi is weak, the complexion will be sallow; if the nutritive qi is insufficient, the complexion will be bluish. The nutritive qi is like the roots of a tree, while the defensive qi is like the branches and leaves; if both are deficient, the roots and branches will wither, leading to symptoms such as cold sensitivity, shivering, coughing with qi reversal, and spitting out foul-smelling pus and phlegm.
36. A fu yang pulse that is floating and hollow indicates that the floating is due to weak defensive qi, and the hollow indicates that the nutritive qi is damaged. The decline of the nutritive and defensive qi leads to an inability to nourish the body, resulting in weight loss, rough skin, and even dry skin resembling scales.
37. A cun pulse that is weak and slow indicates that the weak is due to insufficient defensive qi, which cannot secure the exterior, leading to empty muscles; the slow indicates that the stomach qi is abundant, and the stomach qi is sufficient to digest food and absorb moisture. Food entering the stomach can generate nutritive and defensive qi, and the moisture absorbed by the stomach is transported to the meridians, leading to blood generation. Although the nutritive qi is abundant, if the defensive qi is weak, it cannot protect the muscle surface externally, nor can it secure the blood internally, leading to symptoms of blood collapse.
38. A fu yang pulse that is weak and tight indicates that the tight is due to internal cold, and the weak is due to qi deficiency. The combination of weak and tight indicates that the spleen and stomach are weak and cold, leading to shortness of breath.
39. A shaoyin pulse that is weak and rough indicates that the weak is due to yin deficiency, and the yin deficiency leads to heart fire rising, thus slightly causing heart agitation; the rough indicates that there is little blood, and the deficiency of yin blood leads to poor circulation, which cannot warm the limbs, leading to coldness in the limbs.
40. A fu yang pulse that is hidden and not visible indicates that the spleen yang is weak. The spleen is unable to transform, and the essence of food and drink cannot nourish the body, leading to coldness and hard skin.
41. A shaoyin pulse that is not present indicates that the kidney qi is exhausted, and the essence and blood are insufficient. If the kidney yin is exhausted, it cannot subdue the yang, leading to the yang qi rising, obstructing the chest, and the ancestral qi being blocked, causing blood to stagnate in the heart. If the yang qi retreats downward, the yang qi descends, leading to heat in the lower body and the inner thighs; the conflict between yin and yang leads to stagnation of both qi, resulting in coldness and numbness in the body, losing sensation, resembling a corpse, which is called corpse qi, and should be treated with needling at the qimen and juxie acupoints.
42. A cun pulse that is weak and a chi pulse that is tight indicates that the weak is due to weak yang qi, and the tight indicates that the internal cold is excessive. The excessive internal cold leads to weakness and sweating in the patient.
43. Generally speaking, a cun pulse that is weak indicates yang deficiency, a moist pulse indicates blood deficiency, a weak pulse indicates yin deficiency with heat, and a tight pulse indicates cold. If yang is deficient and blood is deficient, and is also invaded by cold pathogens, qi and blood cannot circulate internally and externally, leading to mild symptoms such as tightness in the mouth, inability to speak, and cold shivering; severe symptoms may include coldness in the limbs, dizziness, and loss of consciousness. The root cause lies in the stomach being weak and unable to receive food, and the spleen being weak and unable to transform, leading to an inability to nourish the body externally and internally.
44. Question: Why is the moist and weak pulse suitable for all eleven organs? The teacher replied: The moist and weak pulse is the pulse of harmonized stomach qi, and the five organs and six bowels rely on stomach qi for nourishment, so the moist and weak pulse is suitable for all eleven organs.
45. Question: How do we know if the disease has entered the bowels? How do we know if the disease has entered the organs? The teacher replied: If the yang pulse is seen as floating or rapid, it indicates that the disease has entered the bowels; if the yin pulse is seen as slow or rough, it indicates that the disease has entered the organs.
Examples of Cold Damage
1. The four seasons, eight festivals, twenty-four solar terms, and seventy-two seasonal divisions determine the method of diagnosing diseases. The beginning of spring is the first month, the rainwater is the middle of the first month, the awakening of insects is the second month, the spring equinox is the middle of the second month, the clear and bright is the third month, the grain rain is the middle of the third month, the beginning of summer is the fourth month, the grain full is the middle of the fourth month, the grain in ear is the fifth month, the summer solstice is the middle of the fifth month, the minor heat is the sixth month, the major heat is the middle of the sixth month, the beginning of autumn is the seventh month, the end of heat is the middle of the seventh month, the white dew is the eighth month, the autumn equinox is the middle of the eighth month, the cold dew is the ninth month, the frost descent is the middle of the ninth month, the beginning of winter is the tenth month, the minor snow is the middle of the tenth month, the major snow is the eleventh month, the winter solstice is the middle of the eleventh month, the minor cold is the twelfth month, and the major cold is the middle of the twelfth month. The “Yin-Yang Great Theory” states: In spring, the weather is warm; in summer, the weather is hot; in autumn, the weather is cool; in winter, the weather is cold. This is the normal change of seasonal weather. In winter, the severe cold causes all living beings to hide deeply, and those who understand health preservation can adapt to the natural characteristics and protect themselves, thus not being harmed by cold pathogens. If one inadvertently encounters cold pathogens, this is called cold damage. The qi of the four seasons can harm people and cause diseases, but cold damage is the most severe and lethal of all pathogens, thus causing the most harm.
2. If a disease occurs immediately after encountering a pathogen, it is called cold damage. If a disease does not occur immediately after encountering a pathogen, and the cold toxin is hidden within the skin, and the disease occurs in spring, it becomes a warm disease; if it occurs in summer, it becomes a summer disease. The so-called summer disease is a condition that is more severe than a warm disease. Therefore, people who work hard in spring and summer often suffer from warm diseases, not because they have encountered seasonal pathogens, but because they have been affected by cold pathogens in winter, which have been hidden.
3. The so-called seasonal pathogens refer to abnormal climatic conditions, such as when the weather in spring should be warm but is instead very cold, when the weather in summer should be hot but is instead cool, when the weather in autumn should be cool but is instead very hot, and when the weather in winter should be cold but is instead unusually warm. If people encounter seasonal pathogenic qi, regardless of gender or age, they will develop similar symptoms, which is called seasonal disease.
4. If one wants to know the rules of diseases caused by normal seasonal weather and those caused by abnormal seasonal epidemic qi, one can calculate according to the calendar. Generally speaking, after the frost descent in the ninth month of the lunar calendar, the weather should gradually become cold. Gradually, as winter approaches, it becomes extremely cold, and only around the rainwater in the first month does the cold gradually dissipate. This is called the “rainwater” because the ice and snow melt and turn into rainwater. By the time of the awakening of insects in February, the weather gradually warms up, leading to summer heat, and by autumn, the weather becomes cool again. From the frost descent to the spring equinox, if one encounters frost, snow, or mist, and feels cold after encountering cold pathogens, this is called cold damage. In September and October, the cold is still relatively light, leading to mild illness; in November and December, the cold is severe, leading to more serious illness; in January and February, as the cold gradually dissipates, the illness also becomes milder. These are all symptoms of improper adjustment in winter, coinciding with the encounter of cold pathogens, leading to immediate illness. If there is an abnormal warmth in winter, leading to illness, this is called winter warmth. The pathogenic qi of winter warmth is fundamentally different from cold damage. The onset of winter warmth can be early or late, or overlap, and the severity of the illness can vary, thus the treatment methods will also differ, and its symptoms will be described in the following chapters.
5. After the beginning of spring, if there is no sudden severe cold weather and no ice or snow, but high fever occurs, this is due to the yang qi of spring rising, provoking the cold pathogens hidden in winter, transforming into a warm disease.
6. From the spring equinox to the autumn equinox, if the weather suddenly becomes cold, leading to illness, these are all seasonal cold epidemics. In March and April, sometimes the weather suddenly becomes cold; at this time, the human yang qi is still relatively weak, and if harmed by cold pathogens, the warm disease is still relatively mild. In May and June, the human yang qi is already strong, and if cold pathogens are encountered, the resulting warm disease will be severe. In July and August, the human yang qi weakens again, and if cold pathogens are encountered, the resulting warm disease will also be mild. This type of disease is similar to warm disease and summer disease, but the treatment will differ.
7. Throughout the year, every fifteen days is a solar term, with six solar terms in each season, totaling twenty-four solar terms. Generally speaking, the weather should correspond to the solar terms. However, the changes in weather are exceptionally complex; sometimes the solar term arrives, but the weather does not; sometimes the weather arrives before the solar term; sometimes the weather arrives on time but is excessive, all of which can become pathogenic qi that causes illness. However, the yin and yang qi mutually promote each other, each receiving a qi. Therefore, the weather will change from the warmth of spring to the heat of summer; from the coolness of autumn to the cold of winter. After the winter solstice, the yin qi is at its peak, and when yin reaches its extreme, yang is born, thus the yang qi begins to rise, and the yin qi begins to descend. Similarly, after the summer solstice, the yang qi is at its peak, and when yang reaches its extreme, yin is born, thus the yang qi begins to descend, and the yin qi begins to rise. Thus, at the winter and summer solstices, yin and yang qi are in harmony; at the spring and autumn equinoxes, yin and yang qi are separated. When the yin and yang transition, if a person cannot adapt, they will become ill. Therefore, those who understand health preservation should nourish yang in spring and summer, and nourish yin in autumn and winter, to adapt to the changes in the natural world. Those who do not understand health preservation cannot adapt to the changes in the natural world, encountering seasonal pathogenic qi, leading to acute warm diseases. If one wants to know which fierce pathogenic qi invades which meridian and causes what disease, one must conduct a detailed examination to arrive at a correct conclusion. Therefore, if one encounters wind pathogens in spring, they will develop diarrhea in summer; if they encounter summer heat, they will develop malaria in autumn and winter; if they encounter damp pathogens in autumn, they will develop cough in winter; if they encounter cold in winter, they will develop warm diseases in spring. This is the normal rule, and physicians must deeply investigate and understand.
8. Cold damage is a disease that gradually develops from shallow to deep, so treatment should be based on the development of the disease. Nowadays, people suffering from cold damage often do not seek timely treatment, or the treatment is not appropriate, or they delay for a long time until the condition becomes critical before seeking medical help. If the doctor does not follow the rules and order in treatment, of course, there will be no effect. If the doctor can prescribe treatment according to the changes in the disease, there will be no failure to achieve results. Now I have collected and organized the original writings of Zhang Zhongjing, recording his symptoms and methods of diagnosing diseases, as well as effective prescriptions, to meet the urgent needs of society.
9. Additionally, the regions have different temperatures and altitudes, and the properties of objects vary between hardness and softness, and people’s diets and lifestyles are also different, so the symptoms and treatment methods should also differ. Therefore, the Yellow Emperor raised the issue of different treatment methods for residents of different regions, and Qibo listed four different treatment methods and their effects, such as stone needles, poisons, micro-needles, and moxibustion, to teach future generations of knowledgeable individuals and inspire those who do not know how to adapt. Doctors diagnosing diseases must carefully observe each case.
10. Generally, encountering cold pathogens will lead to febrile diseases. Although the fever may be severe, it will not lead to death. However, if both the exterior and interior meridians simultaneously encounter cold pathogens and become ill, it is easy to lead to death.
11. A floating pulse at both the chi and cun indicates that the sun is affected by pathogens, often developing illness within one or two days. This is because the sun meridian connects to the wind palace, running through the head, neck, and spine, thus leading to symptoms such as headache, neck stiffness, and tightness. The term “disperse” means to scatter. “Luo” refers to the burning of fluids, and also implies that the pathogenic qi is difficult to eliminate. Needling this point can relieve the above-mentioned ailments, hence the name. It has the function of promoting circulation and clearing the three burner heat.
The chi and cun pulses are both long, indicating that the yangming is affected by pathogens, often developing illness within two or three days. This is because the yangming meridian starts near the nose and runs under the eyes, leading to symptoms such as body heat, eye pain, and dry nose, making it difficult to sleep. The chi and cun pulses are both wiry, indicating that the shaoyang is affected by pathogens, often developing illness within three or four days. This is because the shaoyang meridian runs through the chest and ribs, entering and exiting the ears, leading to symptoms such as chest and rib pain and deafness. The sun, yangming, and shaoyang meridians are affected by illness in the meridians, and the pathogenic qi has not yet entered the bowels, so sweating can cure them. The chi and cun pulses are both sinking and fine, indicating that the taiyin is affected by pathogens, often developing illness within four or five days. This is because the taiyin meridian is connected to the stomach and runs through the throat, leading to symptoms such as abdominal fullness and throat dryness. The chi and cun pulses are both sinking, indicating that the shaoyin is affected by pathogens, often developing illness within five or six days. This is because the shaoyin meridian passes through the kidneys, connects to the chest, and links to the root of the tongue, thus the shaoyin disease shows dry tongue and thirst. The chi and cun pulses are both weak and slow, indicating that the jueyin is affected by pathogens, often developing illness within six or seven days. This is because the jueyin meridian surrounds the genitalia and belongs to the liver, leading to symptoms such as agitation and retraction of the scrotum. The taiyin, shaoyin, and jueyin meridians are affected by illness, and the pathogenic qi has entered the stomach and bowels, so purgation can cure them.
12. As for the two-pathogen disease, it refers to the simultaneous invasion of the yin and yang meridians by cold pathogens. For example, on the first day, the sun is affected by pathogens, and the shaoyin becomes ill simultaneously, presenting with headache, dry mouth, agitation, abdominal fullness, and thirst; on the second day, the yangming is affected by pathogens, and the taiyin becomes ill simultaneously, presenting with abdominal fullness, body heat, loss of appetite, and delirium; on the third day, the shaoyang is affected by pathogens, and the jueyin becomes ill simultaneously, presenting with deafness, retraction of the scrotum, cold limbs, inability to drink soup, and loss of consciousness; approximately six days later, death will occur. If all three yin and three yang, as well as the five organs and six bowels, are affected by pathogens, leading to the stagnation of the nutritive and defensive qi, and the organs are not communicating, death is certain.
13. If the patient does not have a two-pathogen disease, has not transmitted the disease, and has not encountered new pathogenic qi, by the seventh day, the sun disease will decline, and the headache will improve; by the eighth day, the yangming disease will decline, and the fever will slightly retreat; by the ninth day, the shaoyang disease will decline, and hearing will gradually recover; by the tenth day, the taiyin disease will decline, and abdominal fullness will lessen, returning to normal, and the patient will want to eat; by the eleventh day, the shaoyin disease will decline, and thirst will cease, the dry tongue will disappear, and sneezing will occur; by the twelfth day, the jueyin disease will decline, and the retracted scrotum will relax, the lower abdomen will ease, the pathogenic qi will be expelled, and the patient will feel refreshed.
14. If after thirteen days the condition continues to develop, and the pulses at the cun, guan, and chi regions are all sinking and not visible, the prognosis is dire.
15. If other pathogenic qi is encountered, leading to other diseases, treatment should be based on the subsequent bad symptoms. If the cun and chi pulses are both tight and strong, and cold pathogens are encountered, it will transform into warm malaria. If the cun pulse is floating and slippery, and the chi pulse is moist and weak, and wind pathogens are encountered, it will transform into wind warmth. If the cun pulse is large and rapid, and the chi pulse is solid and large, and warm heat is encountered, it will transform into warm toxin. Warm toxin is the most severe type of disease. If the cun pulse is moist and weak, and the chi pulse is wiry and tight, and warm pathogens are encountered, it will transform into warm epidemic. These are all diseases that transform from cold pathogens encountered in winter into warm diseases. In summary, it is essential to carefully examine the transformed symptoms, establish treatment based on the symptoms, and treat according to the symptoms.
16. Generally, when people become ill, they often do not seek timely medical attention, but instead endure and hope to recover by chance, resulting in stubborn and difficult-to-treat diseases. This is especially true for children and women. Therefore, once one encounters improper seasonal qi and feels unwell, they should promptly inform the doctor, identify the cause in time, and treat it while the pathogen is still on the surface and the condition is still mild, which can often lead to recovery. If the patient hides and endures, and seeks a doctor after many days, the pathogenic qi has already penetrated the organs, making treatment difficult. This is a key point that families with sick individuals should pay attention to. When preparing decoctions, one should not be bound by time, nor avoid morning and evening; upon discovering the illness, regardless of morning or evening, one should immediately prepare the decoction and take the medicine for treatment, making it easier to recover. If there is any delay, the disease will transform, and even if one wishes to cure it, it will be impossible. Additionally, if the medication does not follow the rules and is taken arbitrarily against medical advice, it is better not to treat at all.
17. Generally, cold damage is often caused by encountering wind and cold. Wind and cold begin to invade the muscle surface, gradually entering the interior; once the pathogenic qi enters the interior, it becomes difficult to resolve. Therefore, if wind and cold are present on the surface, they should be treated promptly with sweating to resolve the exterior, and after taking the medicine, appropriate covering with clothing and bedding should be done to keep the body warm and induce sweating, allowing the pathogenic qi to dissipate. If the rules of treatment for exterior and interior are not followed, and purgation is performed at the same time as the onset of illness, it will lead to changes in the condition. Therefore, if the exterior condition has not yet resolved, one should first resolve the exterior; only after the exterior is resolved can one use purgation methods. If the exterior condition has resolved but the interior condition has not, generally purgation can be used. However, if the internal mass has not formed and there are no signs of fullness, purgation should not be performed; if purgation is performed too early, the illness cannot be resolved. If the exterior condition has resolved but the internal mass is severe, and hard stools have formed in the intestines, leading to signs of fullness, purgation should be used to remove the hard stools; once the hard stools are removed, the illness can be cured. If purgation cannot be performed, and purgation is recklessly performed, leading to damage to the righteous qi, and the pathogenic heat enters internally, causing various changes such as heat-induced diarrhea and agitation, the number of mild changes will increase, and severe changes may lead to death.
18. Symptoms of excessive yang heat and deficiency of yin fluids, if treated with sweating methods, will lead to death; if treated with purgation methods, it will lead to recovery. If the external cold is excessive and the defensive yang is obstructed, treatment with sweating methods will lead to recovery, while treatment with purgation methods will lead to death. If one understands these principles, how could one mistakenly use divine elixirs to induce sweating? How could one recklessly use gan sui to induce purgation? The treatment of deficiency and excess is worlds apart, and the changes in the auspiciousness and danger of diseases are closely related to treatment. Proper treatment can expel pathogens and cure diseases; improper treatment can instead promote the patient’s death. The appropriateness of treatment and the changes in the auspiciousness and danger of diseases can truly be said to be inseparable, like a shadow following a sound. Thus, it can be seen how difficult it is to treat diseases! Moreover, if a person with excessive yang heat takes gui zhi decoction, they will die; if a person with excessive yin cold takes cheng qi decoction, they will die. The key to life and death occurs in an instant, and even in a very short time, one can see the patient die. These symptoms of yin and yang deficiency and excess, which are complex and intertwined, exhibit extremely subtle differences; if sweating and purging are reversed, disaster will immediately follow. Some doctors with shallow medical skills and narrow knowledge examine patients in a confused manner, not knowing the root of the disease, and when they treat, they make mistakes, leading to the patient’s death, yet they absurdly claim that the patient should die. Thus, the souls of the wronged block the roads of the underworld, and corpses pile up in the wilderness. How can compassionate people not feel heartbroken upon seeing this?