Original Text

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In the case of Taiyang disease, the pulse is floating, with a strong pain in the head and neck, and aversion to cold.C1

This line outlines the Taiyang disease and serves as a general guideline for exterior diseases..The term Taiyang refers to the Taiyang meridian, specifically the Foot Taiyang Bladder Meridian. The Foot Taiyang Bladder Meridian and the Foot Taiyang Bladder organ are interconnected; the Taiyang organ resides in the lower jiao, but its qi circulates through the Taiyang meridian to the body surface, warming the skin, resisting external pathogens, and protecting the body surface. This physiological function is why it is referred to as Wei Qi (Defensive Qi). Do not separate Wei Qi from Taiyang Qi. Wei Qi is a distinctive concept in Traditional Chinese Medicine (TCM), and ancient physicians placed great importance on Ying Qi (Nutritive Qi) and Wei Qi.

Wei Qi operates in a regular pattern within the human body, completing fifty circulations in a day and night cycle. During these fifty circulations, Wei Qi circulates in the Yang during the day for twenty-five cycles and in the Yin at night for twenty-five cycles. When dawn arrives, people awaken, and their eyes open, hence it is said that opening the eyes represents Yang, while closing the eyes represents Yin. When Yang Qi becomes active, Wei Qi ascends to the head and descends along the Taiyang meridian, indicating that Wei Qi must now engage with the Taiyang meridian. This transition from Yin to Yang allows Wei Qi to circulate along the Yang pathway, starting from the Foot Taiyang. These concepts are discussed in the “Neijing” and “Nanjing”. Why discuss the organs, meridians, and the movement of Ying and Wei Qi and blood and fluids? These are physiological substances in the human body, and without considering them, TCM would be incomplete. Taiyang Qi is also Wei Qi. Taiyang Qi governs all six meridians, regulates Ying and Wei, warms the flesh, nourishes the skin, controls opening and closing, and defends the exterior, which is fundamentally inseparable from Wei Yang Qi.

Due to the significant role of Taiyang Qi, it is referred to as the Great Yang or Taiyang. The Taiyang represents a substantial Yang Qi that governs the Yang Qi surrounding the body’s surface.

Regarding the Taiyang’s role in the exterior, the “Lingshu: Ying Wei Sheng Hui” states:.“Taiyin governs the interior, while Taiyang governs the exterior.”.The exterior refers to the surface. The “Lingshu: Ben Zang” states:.The Kidney connects with the Sanjiao and Bladder. The Sanjiao and Bladder correspond to the skin and hair..The Kidney is the root of Yin and Yang, so diseases caused by disharmony of Yin and Yang will ultimately affect the Kidney. The Kidney connects with the Sanjiao and the Bladder. The Bladder is known as the water chamber; the Sanjiao is the pathway for water and food, the origin and end of qi..The Sanjiao releases qi to warm the muscles, thus the Yang Qi of the Kidney circulates through the Sanjiao and Bladder to the skin and hair..The Yang Qi in the skin and hair is derived from the Yang Qi of the Kidney distributed through the Bladder and Sanjiao. This indicates an external response, where the internal qi and fluids are rooted within and respond externally. Since both the Bladder and Sanjiao contain fluids, the qi reaching the skin and hair is not merely qi; it also contains moisture. When external wind and cold pathogens obstruct Yang Qi, it signifies that the fluids within the skin and hair are also blocked, hence sweating is necessary to expel the wind and cold pathogens. Japanese physicians believe that Ma Huang Tang (Ephedra Decoction) induces sweating to resolve water toxicity.

The human body is a whole, and the functions of the organs assist each other. The “Lingshu: Ben Shu” states:.“Shaoyang belongs to the Kidney, which connects with the Lung, hence the two organs are interrelated.”.This indicates that the Kidney belongs to the Lung, connecting with the Bladder, and through the communication of the Sanjiao, the two organs are interrelated. Therefore, the Taiyang’s role in the exterior and the support of Shaoyin Yang Qi are inseparable. Why must Taiyang and Shaoyin be interrelated? Without achieving the Yin and Yang relationship, it becomes challenging for Taiyang to govern the exterior; it lacks sufficient strength. Only by relying on the innate Yuan Yang Qi of the Kidney can such a substantial Yang Qi be achieved.

Furthermore, let us examine the “Lingshu: Jue Qi” regarding the concept of qi. What is qi?.“The upper jiao develops, dispersing the flavors of the five grains, moistening the skin and filling the body, like the dew that nourishes, this is called qi.”.As previously mentioned, Taiyang Qi must receive support from the Kidney to govern the exterior. However, without the innate Kidney Qi, the acquired water and grain qi, and the respiratory qi, it is also ineffective. The “Lingshu: Jue Qi” states:.“The upper jiao develops, dispersing the flavors of the five grains.”.Only when a person breathes in the heavenly Yang Qi, and the heavenly Yang Qi combines with the water and grain qi, does it transform into energy, allowing it to moisten the skin and fill the body, like the dew that nourishes, this is called qi..Thus, the Yang Qi that warms the flesh, nourishes the skin, controls opening and closing, and defends the exterior, contains both the innate Kidney Qi and the acquired water and grain qi, as well as the respiratory qi.

According to previous explanations, heavenly qi refers to respiratory qi, earthly qi refers to water and grain qi, and human qi refers to the innate Kidney Qi. This is the cooperative effect of the three types of qi: heaven, earth, and humanity. Therefore, without the Lung’s dispersing function and the Stomach’s nourishing function, Taiyang Qi would lack a source and continuity, thus failing to exert its effects. Why is there shortness of breath in Taiyang disease? Because Taiyang Qi contains Lung Qi, and the pathogenic qi affects the Lung Qi’s dispersal, leading to impaired Lung Qi. Why is there dry retching and vomiting in Taiyang disease? Because Taiyang Qi contains Stomach Qi, and the pathogenic qi affects the Stomach Qi’s downward movement, leading to impaired Stomach Qi. Why is there fever with a submerged pulse? Because Taiyang Qi contains Shaoyin Kidney Qi. Therefore, we must adopt a holistic perspective; the physiological functions of the human body are interconnected. The Taiyang’s governance of the exterior, the Lung’s governance of the skin and hair, and the Sanjiao’s warming of the flesh are all consistent; they should not be viewed as independent and unrelated.

Next, let us discuss the Taiyang meridian. According to TCM theory, meridians objectively exist in the human body. Acupuncturists select acupoints based on the meridians; needling a specific point treats the disease of that meridian. In the past, I worked in education at the Hangu Farm (West Seven Points) and visited the poor farmers daily to treat patients. One child named Chen, aged fourteen, had a high fever. When I arrived without any medicine, I followed the methods in the “Shanghan Lun” and needled Fengchi (GB20), Fengfu (GV16), Dazhui (GV14), and Quchi (LI11). To my surprise, after needling, he began to sweat, and the fever subsided. How can one say that the Taiyang governs the exterior and that the meridians are unrelated? Zhang Zhongjing’s recommendation to needle Dazhui, Feishu (BL13), Gan Shu (LV14), and Qimen (LR14) is reasonable; it emphasizes the connection between the organs, meridians, and channels. The Taiyang meridian is the longest of the Yang meridians, and it has the most acupoints. Additionally, the Taiyang meridian runs parallel to the Du Mai (Governing Vessel), which is the overseer of the Yang meridians. Therefore, only the Taiyang meridian can effectively conduct Yang Qi and govern the exterior. At the same time, the Bladder is the chamber of water; water can transform into qi, and qi can move water, thus it can govern the exterior.

Is the Taiyang meridian merely a single line? Some people oppose the idea that the six meridians in the “Shanghan Lun” are based on the meridian theory, arguing:.“How can there be a disease along just that one line?”.In fact, that one line is its main trunk, akin to the main line of a railway. The larger is the meridian, the smaller is the collateral, and within the collateral, there are subsidiary collaterals, forming a network throughout the body! Therefore, the Taiyang can be divided into three aspects: the Taiyang of the body, the Taiyang of the meridian, and the Taiyang of the organ. The Taiyang of the body refers to the Taiyang that governs the exterior, while the Taiyang of the meridian refers to its meridian, and the Taiyang of the organ refers to the Bladder’s qi transformation function. The Taiyang of the body, the Taiyang of the meridian, and the Taiyang of the organ collectively refer to Taiyang. According to various interpretations, sometimes the focus is on the Taiyang of the organ, and sometimes on the Taiyang of the meridian; in reality, they are all part of a whole. The “Yizong Jinjian” introduced the concepts of the Taiyang of the body, the Taiyang of the meridian, and the Taiyang of the organ to make the “Shanghan Lun” easier to understand. It is precisely because of the Taiyang of the organ that the meridian pathogens can transmit to the organ, as the meridian and organ are interconnected, like the roots and branches of a tree, forming a single entity.

Since Taiyang governs the exterior, when external pathogenic qi invades the body, it first affects the Taiyang. The righteous qi resists the pathogenic qi at the body surface, and the disease location is at the body surface. This series of pathological changes is called exterior syndrome. The first symptom of exterior syndrome is.the floating pulse..Placing the pulse pattern of floating pulse, strong pain in the head and neck, and aversion to cold in the first position indicates its importance. Why is the pulse floating? Because the righteous qi resists the pathogenic qi at the surface, the Ying and Wei qi and blood move outward, resulting in a floating pulse. This floating term has several meanings. First, from the pulse perspective, a floating pulse is like wood floating on water; a floating pulse only travels along the surface of the flesh. Second, from the pathological perspective, why is the pulse floating? Here it reflects the Taiyang exterior syndrome. Since the pathogenic qi initially invades the body surface, the righteous qi begins to resist, and the qi and blood move outward, resulting in a floating pulse. This is what we often emphasize: a floating pulse indicates an exterior syndrome! Regardless of how long the illness lasts, as long as the pulse remains floating, it reflects that the qi and blood are moving outward, indicating that the pathogenic qi is still at the surface and has not been resolved. The floating pulse indicates a Yang exterior disease, and thus, purgative formulas like Chengqi Decoction should not be used.

How to determine if it is a floating pulse? The methods of pulse diagnosis include lifting, pressing, and searching. The layers of the human body are divided from the surface to the interior into skin, flesh, pulse, tendons, and bones, known as the five bodies. The light touch is called the lifting method, which means to feel the pulse at the surface, then press down to the flesh, then to the tendons, and finally to the bones, known as lifting, pressing, and searching. The lifting method should be used. The pulse has its truth, called floating and submerged, rising and falling, and lateral movement must follow the rules.

The second symptom of exterior syndrome is the main symptom. The first is headache and neck stiffness; headache and neck stiffness are two symptoms that are organically related. The head is the meeting point of all Yang, where all Yang meridians converge, but each meridian has its emphasis: Yangming is in the forehead, Shaoyang is at the temples, and Taiyang is in the head and neck. The head is the common point of the three Yang, while the head and neck are the specific area of Taiyang. Although all three Yang meridians can cause headaches, only headache and neck stiffness belong exclusively to Taiyang, which is its uniqueness. This neck stiffness (jiàng) is pronounced as neck stiffness (qiáng) as well. What does stiffness mean? It indicates that the Taiyang meridian is not functioning properly. Since the meridians have a function of unblocking, it is called meridian transport. The “Lingshu: Ben Zang” states: .“The meridians are responsible for circulating blood and qi, nourishing Yin and Yang, moistening tendons and bones, and benefiting joints.”.The meridians are responsible for circulating blood and qi, nourishing tendons and bones, and facilitating smooth flow.

Since the Taiyang exterior is affected by pathogens, it inevitably impacts its meridian’s ability to resist pathogens, hence the Taiyang exterior syndrome is also called Taiyang meridian syndrome. When the Taiyang meridian is affected by pathogens, the primary reflecting area is the neck, followed by tightness in the back and tightness in the waist. When the Taiyang meridian’s transport is impaired, the back of the neck becomes tense, indicating that movement, looking around, and bending the neck become somewhat uncomfortable, resulting in a feeling of tightness. Some commentators believe that stiffness indicates rigidity, which is incorrect and would lead to a misdiagnosis of spasm disease.

The second symptom is aversion to cold. The word “and” is a conjunction that connects the previous symptoms and emphasizes their significance. Whenever Zhang Zhongjing describes symptoms following the word “and,” such as “no sweating and restlessness” or “no sweating and shortness of breath,” they all hold certain importance. Why is there aversion to cold? Because the pathogenic qi harms the Taiyang Qi, preventing Wei Qi from warming the skin, hence the aversion to cold.

The outline of the exterior syndrome in the “Shanghan Lun” does not mention fever; it only mentions aversion to cold. Exterior syndrome should also have fever because Yang Qi is obstructed. When the Taiyang Qi is harmed by pathogenic qi, Yang Qi must resist the pathogenic qi at the surface, and the opening and closing functions are impaired, leading to Yang Qi being obstructed, which should result in fever. Why does the outline of the “Shanghan Lun” not mention fever? When the pathogenic qi harms the body, it first harms Wei Yang, thus aversion to cold is certain to appear. From the perspective of subjective symptoms, aversion to cold will definitely appear before fever. After the exterior Yang is harmed, the Yang Qi, Ying Wei, and blood must actively resist the pathogenic qi at the body surface. After Yang Qi becomes obstructed, fever will occur. However, clinically, there are cases where aversion to cold occurs simultaneously with fever. In ancient times, there were no thermometers, so symptoms were recorded based on the patient’s complaints, hence the emphasis on aversion to cold. Therefore, exterior syndrome should have fever in addition to aversion to cold.

This is the outline of Taiyang disease and also the outline of exterior syndrome. In the future, whenever Taiyang disease is mentioned, whether in the Taiyang chapter or in other chapters, it should include the main pulse and main symptoms of exterior syndrome, namely floating pulse, headache, neck stiffness, aversion to cold, and fever.

Original Text

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Taiyang disease, with fever, sweating, aversion to wind, and a slow pulse, is called wind stroke.C2

Under the general outline of Taiyang disease, two syndromes are further divided: one is the Taiyang wind stroke syndrome, and the other is the Taiyang cold damage syndrome. The general outline discusses commonalities, while wind stroke and cold damage discuss individual characteristics. The word “wind stroke” (zhòng) is pronounced as “zhòng” (重). Following the description of the first line, since it is Taiyang disease, the pulse is floating and slow. Wind stroke indicates that the wind pathogen has harmed the Taiyang exterior..The word “zhòng” is equivalent to the word “harm” (伤), and has the same meaning as the word “harm” in cold damage. However, wind stroke is somewhat lighter than cold damage. Wind is a Yang pathogen; after harming the body, the disease location is relatively superficial, affecting the Wei level without reaching the Ying level. Since the Taiyang wind Yang pathogen harms the Wei Yang Qi, it is a Yang pathogen harming Yang Qi, hence the fever symptoms are more pronounced.

Wei and Ying are physiologically coordinated and support each other. Wei circulates externally, while Ying circulates internally; Wei belongs to Yang while Ying belongs to Yin. Wei is external and protective, while Ying is internal and defensive, and both support each other. When the wind pathogen resides in Wei Yang, the pathogenic qi of Wei becomes stronger, which is called Wei strong. From the perspective of righteous qi, when the pathogenic qi of Wei becomes strong, its own function is affected, and it cannot protect and secure Ying Yin. From the perspective of pathogenic qi, the characteristic of wind pathogens is that they are prone to movement and change, causing an opening and leaking effect, which forces Ying Yin to be unable to guard internally, resulting in sweating. Fever and sweating are interconnected symptoms. The wind Yang pathogen harms the Wei Yang Qi, causing the fever to be more rapid than in cold damage, where the cold pathogen obstructs the Wei Yang Qi, and only after a certain degree of obstruction does fever occur. Due to fever, the wind pathogen, and the opening and leaking of Yang pathogens, along with the instability of Wei Qi, sweating occurs. Based on clinical observations, sweating in wind stroke is not excessive, and cannot be compared to the profuse sweating seen in Yangming heat syndrome; it only moistens the skin. As a clinical physician, when encountering patients with cold and fever, it is essential to perform pulse diagnosis and feel whether their skin is dry or moist. If the skin is hot and dry, it indicates fever without sweating; if there is fever and the skin is moist with sweat, it indicates fever and sweating, both of which are characteristics of wind stroke.

Aversion to wind refers to fear of wind, which also includes aversion to cold. The aversion to wind in wind stroke is less severe than the aversion to cold in cold damage; it is a fear of wind that can be alleviated by wearing more clothes or covering with a blanket. Cold damage does not work this way; even with these measures, the aversion to wind and cold cannot be alleviated. Why is there aversion to wind? Firstly, it is harmed by wind pathogens; in wind stroke, there is aversion to wind, while in cold damage, there is aversion to cold. Secondly, being harmed by wind pathogens, the wind pathogen is at the surface, and Wei Qi is not functioning properly, leading to aversion to wind.

The pulse is slow, indicating that the pulse is relatively slow and not tense or forceful, which is different from the tight pulse seen in cold damage. Why does a slow pulse appear? Because of sweating, Ying Yin leaks outward. In summary, the floating pulse reflects the disease at the Taiyang exterior, while the slow pulse reflects the disharmony of Ying and Wei, with Ying Yin leaking outward. Later generations named this condition Taiyang wind stroke exterior deficiency syndrome.

Based on the symptoms of fever, sweating, aversion to wind, and a slow pulse, one can diagnose it as Taiyang disease wind stroke. Is there a headache? Yes, because the first line has already mentioned it.

From clinical observations, Zhang Zhongjing’s arrangement of these symptoms is very scientific. All patients with Taiyang disease wind stroke first experience fever, and during the fever, there will be sweating, and the body will feel moist. At this time, the patient feels uncomfortable due to the damp heat and will throw off the blanket or unbutton their clothes, but upon encountering cool air, they will experience aversion to wind.

Original Text

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Taiyang disease, whether there is fever or not, must have aversion to cold, body pain, vomiting, and a pulse that is tight in both Yin and Yang, is called cold damage.C3

This line discusses Taiyang disease cold damage..Taiyang disease.is still connected to the first line..Whether there is fever or not.the word “or” is an indeterminate term; .must have aversion to cold.the word “must” is a definite term. One is indeterminate, and the other is definite..Body pain.indicates whole-body pain; .vomiting.indicates severe dry retching, not vomiting..The pulse is tight in both Yin and Yang.Yin and Yang represent the cun, guan, and chi positions; cun is Yang, chi is Yin, and guan encompasses both, meaning that the entire pulse, including cun, guan, and chi, is floating and tight.

The cold damage disease occurs on the basis of the Taiyang disease outline, with aversion to cold being more pronounced, hence the terminology differs. In Taiyang wind stroke, fever is placed first, while in cold damage, aversion to cold is placed first. As for fever, cold damage certainly also has fever, but.whether there is fever or not is an uncertain tone.

Why must there be aversion to cold? Because cold pathogens belong to Yin, which harm Yang Qi the most; when Wei Yang Qi is harmed, the external protection is lost, hence the symptoms of aversion to cold become very pronounced. The aversion to cold in wind stroke also includes aversion to wind, but its degree is lighter and can be alleviated, while the aversion to cold in cold damage cannot be alleviated, even if the room is warm, and the blankets are thick, and the clothes are many, it still remains.

In comparison, the disease location of Taiyang cold damage is deeper than that of wind stroke; the wind pathogen in Taiyang wind stroke only harms Wei, subsequently affecting Ying Qi, leading to disharmony of Ying and Wei; the cold pathogen in Taiyang cold damage not only harms Wei but also harms Ying, making it more severe than Taiyang wind stroke, hence the aversion to cold is also more pronounced.

It is precisely because Taiyang cold damage harms both Ying and Wei, combined with the cold nature of the pathogen, it can cause stagnation of Ying and Wei qi and blood, hence there will be body pain, and the pain symptoms are more pronounced.

The pulse is tight in both Yin and Yang; the pulse of cold damage is seen as floating and tight. Floating indicates the Taiyang exterior. Tight indicates three types of diseases: one is cold, hence cold damage should have a tight pulse; two is pain, as cold damage has whole-body pain, and the next line mentions headache, body pain, waist pain, and joint pain, which are primarily characterized by pain, hence it should have a tight pulse; three is fullness, as when the pathogenic qi is strong, it is full, and cold damage meets this characteristic, hence it should have a tight pulse.

Yin and Yang refer to the cun pulse, chi pulse, and guan pulse, which are all encompassed within. The pulse being tight in both Yin and Yang indicates that the cun, guan, and chi pulses should all show floating and tight pulses; missing any one of them is unacceptable. Because cold damage is an exterior excess syndrome, its pulse reflects as floating and tight, which aligns with the characteristics of exterior excess syndrome. If the chi pulse is not tight, or is slow, weak, or faint, as the chi pulse should be observed internally, these pulse patterns reflect internal deficiency, possibly due to deficiency of Ying Qi, blood, or Kidney Qi. Although it is cold damage, if the chi pulse does not rise and does not show floating and tight, it indicates a cold damage with internal deficiency, and Ma Huang Tang should not be used. These issues will be discussed in later lines. Only when a typical exterior excess syndrome pulse appears can Ma Huang Tang be used to induce sweating.

Ancient physicians placed great importance on pulse diagnosis. The “Shanghan Lun” discusses the importance of pulse diagnosis in differentiation; when diagnosing, the pulse must have evidence..When pressing the cun, it must reach the chi; when holding the hand, it must reach the foot..When pressing the cun pulse, it must be compared with the chi pulse; after observing the hand pulse, one must also check the patient’s foot Yang pulse and Tai Chong pulse.

The above two lines discuss the Taiyang wind stroke syndrome and the Taiyang cold damage syndrome, which are further divided under the general outline. These two lines should be understood in conjunction. First, Taiyang wind stroke is primarily characterized by fever, while Taiyang cold damage is primarily characterized by aversion to cold; Taiyang cold damage is.must have aversion to cold., while wind stroke has fever first; the aversion to cold in Taiyang cold damage is heavier than the aversion to wind in Taiyang wind stroke and cannot be alleviated. Second, Taiyang wind stroke has sweating, and during fever, there will be sweating, and the skin will feel moist; Taiyang cold damage also has fever, but it is burning hot without sweating, and the skin is dry. Third, Taiyang wind stroke has a floating and slow pulse; Taiyang cold damage has a floating and tight pulse, and both the cun pulse, chi pulse, and guan pulse are floating and tight, with tight indicating cold, pain, and fullness.

Through the comparison of symptoms, we can draw the following conclusions: in terms of the nature of the pathogenic qi, cold pathogens belong to Yin, while wind pathogens belong to Yang. However, it is essential not only to emphasize the external causes but also to consider the individual’s constitution. The individual’s constitution varies between deficiency and excess; when harmed by external pathogens, there are also differences in strength and weakness. Weaker individuals are more prone to wind stroke, known as exterior deficiency syndrome; stronger individuals are more prone to cold damage, known as exterior excess syndrome. The key distinguishing point between the two is one has sweating, and the other does not; the one with sweating is wind stroke, while the one without sweating is cold damage. Although there are other distinguishing points, the primary distinction remains sweating and no sweating.

Wind stroke and cold damage represent exterior deficiency syndrome and exterior excess syndrome, respectively. Only by clearly distinguishing between them can treatment be appropriately administered. If Taiyang disease wind stroke is treated as Taiyang disease cold damage, and there is already sweating, using Ma Huang Tang to induce sweating can easily lead to loss of Yang; if the Ma Huang Tang syndrome is mistakenly treated with Gui Zhi Tang, which contains ingredients that nourish Ying, such as jujube and Bai Shao, it can lead to further obstruction, potentially evolving into the syndrome of “no sweating and restlessness” requiring Da Qinglong Tang.

Original Text

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After one day of cold damage, if the pulse is quiet, it indicates no transmission; if there is a desire to vomit, and if there is restlessness, and the pulse is rapid, it indicates transmission.C4

After one day of cold damage, if the pulse is quiet, it indicates no transmission; if there is a desire to vomit, and if there is restlessness, and the pulse is rapid, it indicates transmission.

Original Text

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After two to three days of cold damage, if the Yangming and Shaoyang syndromes do not appear, it indicates no transmission.C5

The following discusses the differentiation between transmission and non-transmission. After the pathogenic qi invades the exterior, it is not static; it will change. The result of the struggle between righteous and pathogenic qi is that some pathogenic qi does not transmit, while some pathogenic qi does transmit. How to determine whether it is transmission or non-transmission? This is a crucial diagnosis in clinical practice, as it helps physicians take the initiative and actively seek ways to treat.

After one day of cold damage,.cold damage.includes both wind stroke and cold damage exterior diseases; .one day.indicates the initial stage, where the external wind and cold pathogens have just invaded the body surface. At this point, which meridian is primarily affected?.Taiyang is affected..After the Taiyang is affected, does it remain in the Taiyang meridian, or does it develop into Yangming, Shaoyang, or other meridians? This is a necessary question to understand..If the pulse is quiet, it indicates no transmission; if the pulse is rapid, it indicates transmission; the terms “pulse is quiet” and “pulse is rapid” are contrasting phrases..If the pulse is quiet, it means the pulse is not rapid. This is the first method to judge transmission and non-transmission—pulse diagnosis.

If there is a desire to vomit, and if there is restlessness (the “Shanghan Lun” annotations state “dry and restless”), it indicates signs of transmission..The words “desire” and “if” indicate a potential future occurrence of these symptoms..Restlessness reflects Yang heat. When the exterior wind and cold pathogens invade and transform into heat, restlessness will appear. According to the six meridian differentiation,.restlessness often reflects heat in the Yangming meridian..The desire to vomit indicates a tendency to vomit, often seen in Shaoyang syndrome. In summary, whether it is restlessness or a desire to vomit, regardless of which appears in the future, the pathogenic qi has already left the Taiyang, either moving to Shaoyang or Yangming, indicating transmission inward..If the pulse is rapid, it indicates transmission; the rapid pulse is the already existing pulse, indicating that the floating pulse has transformed into a rapid pulse, signifying that the wind and cold pathogens have transformed into heat and have transmitted inward, hence it is called transmission. From this line, the manifestation of transmission primarily reflects the pulse transformation and the accompanying symptoms.

If the pulse is quiet, it indicates non-transmission; this is also a possibility, often a good sign. One possibility is that the Taiyang disease has not transmitted inward, but still exists; another possibility is that the pathogenic qi has weakened, and there is no strength to transmit inward, allowing for resolution and potential recovery.

The following line continues from.one day of cold damage.indicating that after one day of cold damage, if the Yangming and Shaoyang syndromes do not appear,.it indicates no transmission..The “two to three days” mentioned here is merely an example and is not limited to the second and third days. What are Yangming and Shaoyang syndromes? This must be understood in conjunction with the previous line regarding the “desire to vomit” and “restlessness.” Yangming syndrome is characterized by.restlessness.and Shaoyang syndrome is characterized by.the desire to vomit..For the diagnosis of transmission and non-transmission, it is primarily understood through differentiation, which is scientific. One must not mechanically assume that one day corresponds to Taiyang, two days to Yangming, and three days to Shaoyang. If signs of transmission appear, or if the pulse indicates transmission, then it is transmission; if the pulse is quiet, and there are no signs of Yangming’s “restlessness” or Shaoyang’s “desire to vomit,” regardless of how many days have passed, it is still.non-transmission..After the body surface is invaded by pathogens, whether it is wind stroke or cold damage, the development of the disease and the struggle between righteous and pathogenic qi can be reflected through transmission and non-transmission..Why is there non-transmission? Because the righteous qi is strong against the pathogenic qi, preventing it from transmitting. Why does transmission occur? Because the righteous qi is weak against the pathogenic qi, and the pathogenic heat is more intense.

Original Text

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Taiyang disease, with fever and thirst, but no aversion to cold, is classified as a warm disease.C6

The following discusses two types of syndromes: one is warm disease, and the other is wind warmth. The “Shanghan Lun” discusses the narrow definition of cold damage, primarily focusing on wind and cold external invasion. Here, the introduction of wind warmth and warm disease serves as a category of Taiyang disease, which holds significant diagnostic value.

The sixth line discusses warm disease. Warm disease differs from the wind and cold external invasion of Taiyang disease. Both wind stroke and cold damage do not present with thirst; however, if thirst occurs, it indicates that the pathogenic qi has reached the Yangming or Shaoyang levels. In other words, only when the pathogenic qi enters and transforms into heat does thirst appear.

Warm disease is not like this. Warm disease is caused by a warm heat pathogen, which can appear in the initial stage of Taiyang disease, also referred to as the Wei level, leading to symptoms of thirst and other signs of heat pathogens harming Yin and fluids, which is its characteristic. Additionally, because it is a warm heat pathogen, not a wind and cold pathogen, there is no aversion to cold. Based on clinical observations, there may be slight aversion to cold in the early stages of warm disease, but the duration is short, and the symptoms are mild.

TCM’s understanding of warm disease includes several aspects: first, .“In winter, if one is harmed by cold, they will inevitably fall ill in spring due to warm disease.”.Warm disease is caused by latent pathogens. This means that although one was exposed to cold pathogens in winter, the illness did not manifest but remained latent. With the arrival of spring’s Yang Qi or some external factors, the body’s Yang Qi transforms into heat, leading to warm heat phenomena. Second, .“If one does not store essence in winter, they will inevitably fall ill in spring due to warm disease.”.This indicates that insufficient Yin essence in the body will lead to excess Yang heat, and when exposed to pathogens, it will transform into heat, resulting in warm heat phenomena. Third, .“Illnesses that transform into heat before the summer solstice are called warm diseases, while those that transform into heat after the summer solstice are called summer heat diseases.”.Before the summer solstice, diseases that transform into heat are called warm diseases, while those that transform into heat after the summer solstice are called summer heat diseases. During the Qing Dynasty, the understanding of warm disease progressed further, recognizing that warm disease is primarily caused by warm heat invading the lungs, resulting in damage to the Taiyin Lung Meridian, referred to as Taiyin warm disease. Heat pathogens inevitably harm Yin, with Taiyin being the primary focus.

In summary, although the terminology differs, the understanding is consistent. Warm disease is caused by warm heat pathogens, which can most harm Yin Qi and fluids. Zhang Zhongjing held this view. Because warm pathogens consume fluids and transform into heat rapidly, fever and thirst occur. Due to the intensity of heat, aversion to cold is mild or even absent. Confusing warm disease with cold damage often leads to misdiagnosis of warm disease, such as using Ma Huang or Gui Zhi to treat warm disease, resulting in many erroneous medical cases. Warm disease is a condition where warm heat harms Yin; using Ma Huang or Gui Zhi, which are pungent and warm medicines, not only fails to treat warm pathogens but also exacerbates heat and harms Yin, leading to endless complications.

In the old society, around April, I treated a warm disease patient in Dalian. The previous physician prescribed Jiuwei Qianghuo Decoction, and after taking it, the patient experienced profuse sweating, severe headache, and persistent high fever, speaking nonsense. Clearly, the treatment was incorrect. Therefore, warm heat harming Yin and wind and cold harming Yang are entirely different. Zhang Zhongjing introduced warm disease and wind warmth after discussing wind and cold because these diseases share some similarities with Taiyang disease, such as headache and fever, and may initially present with slight aversion to cold. However, they are caused by warm pathogens and will exhibit thirst and other signs of Yin damage, so they must not be confused.

If sweating has already occurred, and the body feels burning hot, it is classified as wind warmth. Wind warmth is a more severe condition than warm disease because it combines warm heat with wind, hence it is called wind warmth. The wind warmth pathogen is also a type of pathogen that causes warm disease.

If sweating has already occurred, it indicates that there was a previous exterior syndrome. Wind warmth also has symptoms similar to Taiyang disease, such as fever and headache. If it is a case of wind and cold external invasion, after sweating, the fever will subside, and the exterior will resolve. However, if wind warmth is treated as a typical wind and cold external invasion and treated with sweating methods, it will lead to a burning sensation in the body, feeling as if it is being scorched by fire. This indicates that using pungent and warm sweating methods to treat wind warmth not only fails to reduce the fever but actually increases it.

What are the symptoms of wind warmth? First, there is a change in the pulse, .the pulse is floating in both Yin and Yang.because the wind warmth pathogen is combined with the pathogen, hence it is floating but not tight, which distinguishes it from Taiyang cold damage..There is spontaneous sweating, as the wind warmth pathogen forces the fluids to leak outward, leading to sweating..Body heaviness reflects the obstruction of Yang Qi due to heat. Cold damage causes whole-body pain because cold pathogens harm Yang, leading to stagnation of qi and blood. The wind warmth pathogen obstructs Yang Qi, causing the Yang heat to become excessive, resulting in body heaviness. The symptoms of body heaviness are similar to those seen in Da Qinglong Tang syndrome..Excessive sleepiness, snoring, and difficulty speaking are caused by the influence of the wind warmth pathogen on the heart and lungs. When the heart spirit is disturbed, it leads to excessive sleepiness and mental dullness, resulting in excessive sleepiness, which indicates a tendency towards mental confusion. The heart governs speech, and when its function is affected, it leads to difficulty in speaking. These symptoms are quite severe.

For wind warmth disease, only sweet, cold, and cool substances should be used to clear heat and nourish Yin; there are no other methods. If not treated this way, .if purged, it will harm Yin, leading to difficulty in urination..If the liver and kidney Yin are harmed, it will lead to direct vision, where the eyeballs do not move properly. These are all dangerous signs..Loss of urination refers to the two excretions; large urination refers to defecation, while small urination refers to urination. The second edition of the “Shanghan Lun” holds this view, but Pang Anshi’s “Shanghan Zongbing Lun” believes that loss of urination refers to enuresis, not including defecation. Is there a contradiction here? Earlier, it was stated that there is difficulty in urination, while later it mentions enuresis; in reality, both situations can occur. If purging harms the fluids, when it is time to urinate, there will be difficulty in urination. At the same time, if mental confusion and excessive sleepiness occur, the lower jiao’s Kidney loses its ability to control urination, leading to enuresis at inappropriate times.

If there is fire, the skin may appear slightly yellow. In ancient times, physical therapies such as moxibustion and hot compresses were often used to induce sweating and reduce fever, known as fire therapy. Wind warmth disease is inherently caused by heat pathogens; if fire therapy is mistakenly applied, it adds fire to fire, causing the skin to appear slightly yellow, as if it has been smoked..If it becomes severe, it can resemble convulsions, leading to sudden seizures; if the heat pathogen harms the Yin of the heart and liver, it becomes even more serious, leading to symptoms similar to convulsions. Seizures are a pediatric syndrome in ancient times, primarily characterized by convulsions, twitching, pulling, trembling, and other symptoms..If it is subjected to fire therapy, this is a case of compounding errors. Fire therapy is also an ancient method of inducing sweating, known as the sweating method, typically involving digging a pit, heating it, filling it with peach leaves, covering it with a mat, and having the person lie on top to induce sweating. Alternatively, one could heat a kiln and have the person enter to be steamed. I once taught this to Korean students, and they mentioned that this custom still exists in Korea..One mistake can still allow for some time to recover, but if the Yin is severely damaged, and fire therapy is applied again, it leads to a second mistake, which can shorten a person’s life and lead to death..To add a note, later generations used Yin Qiao San to treat Taiyang warm disease, inheriting this from the “Shanghan Lun.” Yin Qiao San treats Taiyang warm disease, with a rapid pulse, fever, and frequent thirst..Warm disease and wind and cold are different; in treatment, one is cold and the other is hot, and they must not be confused. In our Shanghan research group, an elderly doctor named Chen Shenwu once told us about a child with measles who died due to the erroneous use of Gui Zhi Tang, which truly exemplifies the saying, “If Gui Zhi is used improperly, it leads to death due to excessive Yang.” Similarly, if wind and cold external invasion is mistakenly treated with Yin Qiao San, Sang Ju Yin, and other pungent and cool medicines, it will obstruct Yang Qi, preventing the exterior pathogen from resolving and leading to transmission.

The lines in the “Shanghan Lun” may appear ordinary, but their connotations are profound. I hope everyone can connect the content while studying, savor it carefully, and learn to seek understanding in the unspoken.

Original Text

07

If there is fever and aversion to cold, it arises from Yang; if there is no fever and aversion to cold, it arises from Yin. Those arising from Yang recover in seven days, while those arising from Yin recover in six days, as Yang is counted as seven and Yin as six.C7

This line differentiates between Yin and Yang, cold and heat. The “Jin Kui Yao Han” places this line at the beginning of Taiyang disease, serving as a general outline for the six meridian differentiation in the “Shanghan Lun.” The “Shanghan Su Yuan Ji” also arranges it this way. Last year, we participated in a national textbook on the “Shanghan Lun” compiled by several brother institutions in Hubei, and this line was also placed at the forefront. Why is it arranged this way? Because this line captures the essence of the six meridian differentiation. The six meridian differentiation is essentially the differentiation of Yin and Yang, composed of three Yin and three Yang, governed by Yin and Yang.

This line succinctly captures the principles of Yin and Yang, cold and heat in the six meridians.

If there is fever and aversion to cold, it arises from Yang; the patient has both fever and aversion to cold, indicating a Yang syndrome, which is also a symptom of the Yang meridian. One can also say that arising from Yang means arising from Taiyang. The exterior symptoms of Taiyang disease are fever and aversion to cold; aversion to cold indicates that Yang Qi has been harmed by pathogenic qi, while fever reflects that Yang Qi is strong enough to resist the pathogenic qi. Among these two symptoms, one represents pathogenic qi, and the other represents righteous qi, but the righteous qi is in a proactive position; Yang Qi can resist the pathogenic qi, leading to fever. This indicates that the disease arises from Yang rather than from Yin. By analogy, Yangming disease has steaming fever, while Shaoyang disease has alternating chills and fever; all three Yang meridian diseases primarily feature fever as the main symptom, hence they are called Yang meridian diseases.

If there is no fever and aversion to cold, it arises from Yin; this indicates that Yang is deficient, leading to cold pathogens, and Yang Qi cannot actively combat the pathogenic qi, hence there is no fever, only aversion to cold, indicating that the disease arises from Yin meridians. Does Shaoyin disease have aversion to cold? Yes, aversion to cold and body curling, not only aversion to cold but to the extent of curling up; hands and feet are cold.

Those arising from Yang recover in seven days, while those arising from Yin recover in six days; the significance is not great, as the principle is that Yang is counted as seven and Yin as six. As the outline of the three Yin and three Yang, adding these two sentences narrows its meaning.

The original text does not propose corresponding treatment methods; the “Wai Tai Mi Yao” provides a supplement:.“If the disease has fever and aversion to cold, it arises from Yang, and for Yang, one should attack the exterior;”.“If there is no fever and aversion to cold, it arises from Yin, and for Yin, one should warm the interior.”.For exterior attack, use Gui Zhi Tang, and for warming the interior, use Si Ni Tang..This material is provided for reference.

Original Text

08

Taiyang disease, if headache persists for seven days or more, it will resolve on its own, as the pathogenic qi has run its course. If one wishes to induce transmission, needle the Foot Yangming to prevent the qi from transmitting, thus achieving recovery.C8

This line should be viewed in conjunction with lines C4 and C5 regarding transmission.

Taiyang disease indicates exterior syndrome, which will present with headache and neck stiffness. Here, headache is used as an example. If the illness persists for seven days or more, it will resolve on its own, as the pathogenic qi has run its course.

The phrase “run its course” and “headache persists for seven days or more” should be understood together; otherwise, it may lead to misconceptions. Some commentators believe that on the first day, the pathogenic qi is in Taiyang, on the second day in Yangming, on the third day in Shaoyang, on the fourth day in Taiyin, on the fifth day in Shaoyin, on the sixth day in Jueyin, and on the seventh day back to Taiyang, completing a full cycle, and thus the illness resolves. This interpretation is incorrect. From the perspective of “headache persists for seven days or more,” the exterior syndrome remains present, and the pathogenic qi has always been in the Taiyang meridian. The phrase “run its course” does not refer to transmission; rather, it indicates that the pathogenic qi has completed its course in the Taiyang meridian, referring specifically to the Taiyang meridian, not to Yangming, Shaoyang, or others. Why does the illness resolve after seven days? This is not easy to understand. There is an old saying: “Seven days brings recovery;” the body’s righteous qi has a recovery period every seven days. Many diseases in medicine are treated in seven-day cycles. Some commentators believe that Taiyang disease is a disease of Yang Qi, and seven is a Yang number; once Yang Qi is restored, the illness resolves. This is an experience accumulated through practice.

If one wishes to induce transmission, needle the Foot Yangming to prevent the qi from transmitting, thus achieving recovery..If the Taiyang disease has not resolved after seven days and is to transmit, how should one proceed? One should take measures that are both therapeutic and preventive, using acupuncture to needle the acupoints of the Foot Yangming meridian to prevent the pathogenic qi of the Taiyang from transmitting to another meridian, thus achieving recovery.

Why needle the Foot Yangming? Why not needle the Foot Shaoyang? Commentators have provided vague explanations for this question. In fact, there are two layers of meaning. First, the Taiyang pathogenic qi has a tendency to transmit to Yangming; needling the Foot Yangming is a way to intercept and prevent transmission, thus achieving recovery. Second, whenever the Taiyang pathogenic qi is about to transmit to other meridians, whether to Yangming or Shaoyang, one should needle the Foot Yangming. The commonly used acupoint is Zusanli (ST36), located three inches below the knee between the two tendons, which is a strong acupoint. The Stomach meridian is the root of postnatal life; with Stomach Qi, one lives; without Stomach Qi, one dies. Observing color and pulse must consider whether there is Stomach Qi..Wherever the pathogenic qi gathers, its qi must be deficient; if the Taiyang meridian’s pathogenic qi is unresolved and is about to transmit inward, needling the Foot Yangming can invigorate Stomach Qi, allowing the righteous qi to resist the pathogenic qi effectively, thus preventing transmission.

Original Text

09

When Taiyang disease is about to resolve, it is best to do so between the hours of Si and Wei.C9

This line discusses the unified relationship between human Yang Qi and the Yang Qi of the natural world..Taiyang disease, when it is about to resolve, is best between the hours of Si and Wei..This statement should be interpreted flexibly..The phrase “when it is about to resolve” does not imply that the Taiyang disease resolves at this time; it carries a tone of negotiation, but this time is favorable for Taiyang Qi. Taiyang is the leader of all Yang, and the hours of Si, Wu, and Wei are when the Yang Qi of the natural world is at its peak. The Yang Qi in the human body also becomes vigorous, and the pathogenic qi will retreat, which is beneficial for alleviating Taiyang disease. If possible, Taiyang disease often resolves during this time. In my youth, I learned TCM and observed that some elderly physicians had a high level of diagnostic skill, being able to predict when diseases would worsen or improve. This indicates that these theories are quite scientific.

Original Text

10

In cases of wind stroke, if the exterior resolves but residual symptoms remain, it will recover in twelve days.C10

This line is relatively simple..Wind stroke.includes not only Taiyang wind stroke but also Taiyang cold damage..When the exterior resolves, it indicates that the treatment has been effective, and the exterior pathogen has been eliminated..However, if residual symptoms remain, such as sneezing, clear nasal discharge, and body aches, it indicates that the exterior syndrome has not completely resolved. At this point, there is no need to take medicine, as the major pathogenic factor has been resolved; it is merely the righteous qi that has not yet recovered..It will recover in twelve days, as after a few more days, the righteous qi will restore, and the illness will resolve. The mention of twelve days is merely a rough estimate.

Classics as the foundation, clinical practice as the essence
The path of medicine is long, but do not forget your original intention
Persistence is difficult, but you are not alone

[Knowledge Increase]

The sequence of Zhang Zhongjing’s six meridian differentiation: Taiyang → Yangming → Shaoyang → Taiyin → Shaoyin → Jueyin

Taiyang disease

Yangming disease

Shaoyang disease

Taiyin disease

Shaoyin disease

Jueyin disease

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