1. The Treatise on Cold Damage – The Soul of Traditional Chinese Medicine The “Treatise on Cold Damage” (Shang Han Lun) is a work authored by Zhang Zhongjing during the late Han Dynasty. Zhang Zhongjing, also known as Zhang Ji, was born in Nanyang, and lived approximately from 150 to 219 AD. Witnessing the widespread epidemics and heavy casualties of his time, he was inspired by the sentiment of “grieving over the past losses and the inability to save those who died young,” which led him to write this book with the noble aspiration of “saving people and benefiting the world.” Traditional Chinese Medicine (TCM) has continuously developed and improved since the Qin and Han dynasties, accumulating a wealth of medical literature. Ban Gu summarized the two major categories of medical texts in the “Book of Han” as “Medical Classics” and “Formulas.” These can be considered monumental works throughout history. In the category of “Medical Classics,” there are the “Huangdi Neijing” (Yellow Emperor’s Inner Canon) in 18 volumes, the “Huangdi Waijing” (Yellow Emperor’s Outer Canon) in 37 volumes, and other works such as the writings of Bian Que and the Bai family. These texts primarily discuss the physiological and pathological changes of blood vessels, meridians, and the organs in relation to yin and yang. They also list treatment methods such as acupuncture and herbal decoctions. Therefore, the content of this book is very similar to the foundational theories of modern TCM. In the category of “Formulas,” there are works like “Formulas for the Twelve Diseases of the Five Zang and Six Fu Organs,” “Formulas for the Sixteen Diseases of Wind, Cold, and Heat,” “Formulas for the Sixteen Diseases of the Five Zang and Six Fu Organs with Hernia,” “Formulas for the Twelve Diseases of the Five Zang and Six Fu Organs with Jaundice,” “Nineteen Volumes on Women and Infants,” and “Thirty-Two Volumes on Decoction Methods.” These texts not only focus on disease patterns but also elaborate on the properties and compatibility of herbs, laying the foundation for the use of compound formulas in clinical practice. Zhang Zhongjing inherited the academic achievements of the “Medical Classics” and “Formulas,” promoting the clinical value of the six meridian differentiation (liujing bianzheng) and establishing a treatment system based on principles, methods, formulas, and medicines. While inheriting these traditions, he also combined his own experiences and insights, achieving both innovation and development. He discussed both cold damage and miscellaneous diseases together, using both decoctions and acupuncture, breaking the limitation of the “Suwen” (Plain Questions) which only differentiated cold damage. The essence of Zhang Zhongjing’s six meridian differentiation is based on the physiological and pathological changes of the body’s organs, meridians, and the qi and blood, using the laws of disease onset related to yin and yang, exterior and interior, cold and heat, deficiency and excess as the guiding principles. Therefore, regardless of whether it is cold damage, miscellaneous diseases, or their complex interrelations, they can all be summarized without omission using the six meridian differentiation method. After the establishment of the theory of six meridian differentiation by Zhang Zhongjing, TCM gained a weapon to compete with Western medicine and established itself in an invincible position. It is worth mentioning that the “Treatise on Cold Damage” was able to select the most effective medicines and the most appropriate dosages from thousands of herbs, forming formulas with the highest efficacy and remarkable contributions, which is difficult to achieve in other medical systems. For example, the Gui Zhi Decoction consists of only five herbs, which have unique effects of releasing the exterior and dispelling wind, harmonizing the nutritive and defensive qi, regulating the spleen and stomach, and balancing yin and yang. However, the composition and dosage are very strict. If the dosage of Shao Yao exceeds that of Gui Zhi, it is no longer called Gui Zhi Decoction but Gui Zhi Jia Shao Yao Decoction, which is used for treating abdominal fullness and pain in Taiyin disease; if the dosage of Gui Zhi exceeds that of Shao Yao, it is called Gui Zhi Jia Gui Decoction, which treats the “Beng Tun” syndrome of qi rushing upwards to the chest. This shows that the book is strict in both the selection of herbs and dosages, which is why it is called a classic formula. In fact, classic formulas have characteristics of standardization, scientificity, and practicality. From the above, it can be seen that the pioneer of differentiation and treatment is Zhang Zhongjing, whose influence in the field of TCM is profound. Figures such as Wang Shuhe from the Jin Dynasty, Sun Simiao from the Tang Dynasty, Liu, Li, Zhu, and Zhang from the Jin and Yuan periods, and Ye Tiandi and Wu Ju Tong from the Qing Dynasty all revered the teachings of Zhongjing, leading to their own achievements. According to statistics, among TCM classics, the “Treatise on Cold Damage” has the most commentaries, reflecting diverse interpretations and forming a grand view, enriching the teachings of Zhongjing and promoting the continuous development of TCM scholarship. Classic TCM texts such as the “Neijing” and “Nanjing” are difficult to comprehend without mastering the teachings of the “Treatise on Cold Damage.” Therefore, I believe that the “Treatise on Cold Damage” is the soul of TCM, and this is a matter of necessity, reason, and fact, so there is no doubt about it.2. Exploring the Origins of the Treatise on Cold Damage Chen Shijie stated: The “Treatise on Cold Damage and Miscellaneous Diseases” is indeed the ancestor of countless formulas. Since the time of Wang Shuhe, many versions have been lost or confused over the years. In the early Song Dynasty, the emperor ordered the officials to compile and verify three texts: the “Treatise on Cold Damage”; the “Essentials of the Golden Chamber”; and the “Golden Chamber’s Jade Box Classic.” The preface of the “Essentials of the Golden Chamber” states: “Zhang Zhongjing compiled the ‘Treatise on Cold Damage and Miscellaneous Diseases’ into sixteen volumes, but today only the ten volumes of the ‘Treatise on Cold Damage’ are transmitted, and the miscellaneous diseases are not seen in the text, or are only recorded in the formulas of various schools.” Hanlin scholar Wang Zhu found three volumes of Zhongjing’s “Essentials of the Golden Chamber” in the library, which discusses cold damage at the top, miscellaneous diseases in the middle, and includes formulas for treating women at the bottom. However, there are cases where there are symptoms but no formulas, or formulas but no symptoms, which makes it difficult to treat diseases. Now, this book has been compiled and arranged according to the symptoms and formulas, making it convenient for use in urgent situations.” Analyzing the statement from the Song officials, “arranging formulas according to symptoms,” we can see that the original structure and framework of the “Treatise on Cold Damage” and the “Essentials of the Golden Chamber” are both organized in a way that discusses cold damage at the top and lists formulas below. The Song officials, for the sake of convenience in urgent situations, referred to the Tang version of Sun Simiao’s “Treatise on Cold Damage” and modified the original structure of symptom-formula separation. To illustrate the fact that Sun Simiao modified the “Treatise on Cold Damage,” we can refer to the text of the “Qian Jin Yi Fang” Volume Nine: “The old method of symptom-formula is obscure, leading to confusion for the less intelligent. Readers find it difficult to articulate, and the moderate-minded are discouraged from thinking, causing the pain of premature death in the community, which is lamentable. Now, by arranging symptoms and formulas together, comparisons can be made, and it is easier to understand in urgent situations. Although the formulas are old, they are newly promoted.” From this, it can be seen that the original structure of the “Treatise on Cold Damage” with symptoms first and formulas later was changed to a structure where symptoms and formulas are arranged together, which was pioneered by Sun Simiao. When the Song officials, Lin Yi and others, compiled the “Treatise on Cold Damage,” they inherited Sun’s principle of “symptoms and formulas arranged together,” which is evident. Therefore, we can conclude that Zhang Zhongjing’s work underwent three major changes throughout its historical development: the first was the compilation and organization by Wang Shuhe during the Jin Dynasty; the second was the advocacy of the principle of symptoms and formulas arranged together by Sun Simiao during the Tang Dynasty; and the third was the compilation and annotation by Song officials such as Lin Yi, who followed the Tang version’s principle of “symptoms and formulas arranged together” and applied it to the “Essentials of the Golden Chamber.” For these reasons, I believe that the Tang and Song versions of the “Treatise on Cold Damage” are no longer the original versions compiled by Wang Shuhe, but have undergone significant adjustments and changes. The only version that remains close to the original appearance of Wang Shuhe’s compilation, without being influenced by the Tang and Song dynasties’ “symptoms and formulas arranged together” principle, is likely the currently existing “Essentials of the Golden Chamber.” Although this book has also undergone Song officials’ annotations, they carefully “followed the old version without daring to change it. Now, according to the preface of the Song officials, it can be confirmed that the “Essentials of the Golden Chamber” shares the same structure as the “Treatise on Cold Damage” but has a different name, allowing for mutual reference and preventing future losses, demonstrating their deep concern for helping people. A detailed examination shows that it is indeed the work of Wang Shuhe. The state ordered Confucian scholars to correct medical texts, and we first corrected the “Treatise on Cold Damage,” then completed this classic, which has a total of eight volumes, following the old titles, totaling twenty-nine sections and one hundred and fifteen formulas.” From the preface of the Song officials, we can understand the following: First, the “front and back” of this book refers to the structure of symptoms first and formulas later, which is the structure organized by Wang Shuhe, not from the hands of the Six Dynasties or Tang people; second, the Song officials recognized this book as indeed authored by Zhang Zhongjing, so it can be compared with the versions they annotated, differing only in name; third, this book can be mutually referenced with the annotated versions, allowing for mutual verification, which was set up to prevent future losses; fourth, the Song officials took a cautious attitude towards the content of this book, believing that “its text may differ from the ‘Treatise on Cold Damage,’ but its meaning is in accordance with the teachings of the sages, and they did not dare to make arbitrary changes, hence both versions are preserved.” This indicates that they did not alter the true meaning of the original text. Therefore, the Song version of the “Treatise on Cold Damage” contains both the reformed version with symptoms first and formulas later, and also preserves the original appearance of symptoms first and formulas later. This “preserving both versions” reflects their painstaking efforts. The book has a total of eight volumes, following the old titles, totaling twenty-nine sections and one hundred and fifteen formulas. From the above “following the old titles,” it indicates that the text of this book has not been altered, thus it closely resembles the original compilation by Wang Shuhe. However, the first volume contains phrases like “between the two organs of raw and cooked,” and the second person pronoun “Zhang Zhongjing said,” which are clearly the writings of later physicians and should not be mixed with the main text.3. Examples of the Literary Style of the Treatise on Cold Damage The “Treatise on Cold Damage” is a monumental work of differentiation and treatment, known for its concise language and profound meaning, with intricate implications. Yan Qi stated: “Its words are precise and profound, its methods are simple yet detailed.” Studying and researching the characteristics of the literary style of the “Treatise on Cold Damage” is the key to unlocking the secrets of Zhongjing’s treasure, and it has certain practical significance. Therefore, I will humbly analyze three literary styles of the “Treatise on Cold Damage”: “guest and host borrowing,” “deficiency and excess reversing,” and “comparative invention,” to help readers understand the medical concepts and improve their differentiation and treatment skills. 1. Guest and Host Borrowing
This is a literary style known as “borrowing the guest to establish the host.” “Borrowing” means to assist, and “establishing” means to affirm. It refers to using the effects of the guest text to promote the host text, making it prominent and outstanding, thus ensuring accurate differentiation and treatment.
For example, in Article 70 (same as Zhao’s version), the first half states, “After sweating, if there is aversion to cold, it is due to deficiency…” The description of symptoms and formulas is brief, thus belonging to the “guest text” meaning. The second half states, “If there is no aversion to cold but only heat, it is due to excess. One should harmonize the stomach qi and use the Decoction for Harmonizing the Stomach.” The content described here, with complete differentiation and treatment, highlights the differentiation thought, thus belonging to the “host text” meaning.
This text has a total of 27 characters, with 9 characters as “guest text” and 18 characters as “host text.” If only the 18 characters of the host text were written, it would make the reading dull. Adding the 9 characters of the guest text enhances the effect, making the text concise yet profound. First, it uses the deficiency symptom to highlight the host text’s excess symptom, making it naturally flow and ensuring certainty; second, it can also use the “excess” to illustrate the “deficiency,” reversing the roles of host and guest, thus allowing the two issues to mutually verify and complement each other, making it endlessly enjoyable.
Another example is in Article 71, where the first half states, “In the case of Taiyang disease, after sweating… when the stomach qi is harmonized, one recovers,” which has symptoms but lacks pulse, thus belonging to the “guest text.” The second half, with pulse and symptoms both complete, undoubtedly belongs to the “host text.”
The literary style of “guest and host borrowing” in this article is superior to that of Article 70. First, it corrects the common practice of physicians who, upon seeing dryness and thirst in the throat, hastily use moistening herbs. Second, it clearly points out that the thirst due to water retention in the lower jiao is a result of qi not transforming fluids.
In clinical practice, the use of moistening herbs to treat thirst caused by water retention is often seen. For example, a patient, Zhang XX, experienced thirst and wanted to drink, but after drinking, he was still thirsty, with a throat that felt painful yet not painful, as if something was stuck, and with difficulty urinating, the pulse was deep and wiry, and the tongue coating was slippery. I diagnosed it as a case of cold qi and untransformed fluids, and prescribed a formula of 30 grams of Fu Ling, 12 grams of Gui Zhi, 15 grams of Ze Xie, 10 grams of Bai Zhu, and 15 grams of Zhu Ling.
This formula was taken for only 6 doses, and the urination became smooth, and the illness was completely cured. This demonstrates that Zhongjing’s approach to thirst due to “dryness in the stomach” avoids the common pitfall of using moistening herbs, suggesting the treatment of thirst and difficulty urinating with the Wu Ling San formula.
The guest text is written appropriately, while the host text takes a unique approach, addressing the common misconception of transforming dryness into fluid accumulation, highlighting the subtlety of the treatment, leaving readers in awe.
2. Deficiency and Excess Reversing
“Deficiency” does not mean emptiness, but rather a literary style that contains meaning within. “Excess” is the opposite of deficiency, a straightforward writing style that is clear and unambiguous. For example, in Article 23, under the premise of “sweating two to three times a day,” three outcomes are listed, and Zhongjing uses the deficiency-excess contrast in writing. The first outcome is: “If the pulse is weak and slow, it indicates a desire to recover”; the second outcome is: “If the pulse is weak and there is aversion to cold, both yin and yang are deficient”; the third outcome is: “If the complexion shows heat… the body must itch.” In this case, Zhongjing writes symptoms and briefly mentions the pulse, which is not the same as the previous two sections. This is not an oversight by Zhongjing, but rather a deliberate choice to use a “deficiency” writing style after writing “excess,” which must attract attention and provoke thought.
The ancients said, “Though it is silent, it speaks louder than words.” From the symptoms of fever and body itch in Taiyang disease, the pulse must be floating, indicating a desire to emerge, which is more evocative than a straightforward description.
Now let’s discuss the reversing literary style. “Reversing” and “affirming” are opposites. Zhongjing’s writing layout sometimes approaches from the front and sometimes from the back. In any writing that includes both affirming and reversing, the reversing side often achieves a more brilliant effect than the affirming side.
For example, in Article 159, “If a patient with cold damage takes decoctions and has persistent diarrhea, with a feeling of fullness under the heart, and takes the Xiao Jian Zhong Decoction…” The above 18 characters contain both symptoms and treatment, belonging to the affirmative writing style. “If other medicines are taken and diarrhea persists, the physician should use the Li Zhong Decoction, which is very effective. The Li Zhong Decoction is for the middle jiao, and this diarrhea is in the lower jiao, so the red stone fat and Yu Yu Liang Decoction should be used; if it still does not stop, one should promote urination.” This 47-character section is the opposite of the affirmative writing style, as Zhongjing attempts to extend the various pathological changes and treatment methods related to “fullness under the heart” and “diarrhea.”
This “reversing” writing style peels away a layer, revealing another layer, allowing for detailed discussion and thorough analysis without being constrained by the affirmative writing style.
Both “affirming” and “reversing” are inseparable, so Zhongjing’s “reversing” writing also supplements the shortcomings of the “affirming” writing. Because differentiation methods are diverse, one cannot remain in a single mode.
3. Comparative Invention
The “comparative” literary style is a method of arranging and comparing two formulas for analysis and research, mutually inventing insights.
For example, in Article 12, the symptoms of “Taiyang Wind” in the Gui Zhi Decoction and Article 13’s symptoms of “Taiyang Disease” in the Gui Zhi Decoction seem very similar, but after comparison, we find that Article 12 is titled “Taiyang Wind,” while Article 13 only mentions “Taiyang Disease” without the term “wind.” By arranging and comparing, it becomes clear that the Gui Zhi Decoction in Article 12 is limited to Taiyang Wind, while Article 13, lacking the term “wind,” indicates that the Gui Zhi Decoction can treat all exterior symptoms of Taiyang Disease with sweating and aversion to wind. Thus, the narrow and broad definitions of the Gui Zhi Decoction are clearly visible, achieving the goal of differentiation and treatment.
Articles 93, 94, and 95 are arranged in parallel, analyzing three different mechanisms of sweating without the use of medicine. Article 93’s “sweating due to deficiency” can be attributed to deficiency; Article 94’s “sweating due to struggle” is due to the evil being resolved externally; and Article 95’s “spontaneous sweating” is due to the strong defensive qi and weak nutritive qi, preventing the evil from leaving. By comparing these three types of sweating, it guides the vitality of differentiation thinking.
In summary, Zhongjing’s literary styles, whether guest and host, deficiency and excess, reversing, or comparative, are all based on the duality of reasoning, embodying the dialectical thought of differentiation. Thus, the writing is concise yet profound, with endless intricacies.
As for other literary styles such as “interspersed narration” and “inversion,” I will not elaborate on them.4. Discussion on the Title of the Treatise on Cold Damage The original name of the “Treatise on Cold Damage” was “Treatise on Cold Damage and Miscellaneous Diseases” or “Treatise on Cold Damage and Sudden Diseases.” Shortly after its publication, it was lost due to wars and was not fully preserved. Later, during the Western Jin Dynasty, the chief physician Wang Shuhe collected and organized it, allowing it to be passed down to the present day. In the third year of the Jia You era of the Song Dynasty (1057 AD), in August, the emperor established a medical book correction bureau in the editing institute. In the second year of the Zhi Ping era (1065 AD), Gao Baoheng, Sun Qi, Lin Yi, and other Confucian officials were ordered to correct medical texts, considering that “among all diseases, none is more urgent than cold damage.” Therefore, they first corrected the ten volumes of the “Treatise on Cold Damage,” completing it in mid-January of the third year of the Zhi Ping era and publishing it to the world.
The “Treatise on Cold Damage” consists of ten volumes and twenty-two sections, originally linking cold damage and miscellaneous diseases organically, mutually permeating and utilizing each other. Since the Song Zhi Ping edition was published, it has been misunderstood as a specialized work solely discussing cold damage, while the miscellaneous diseases were thought to be entirely included in the “Essentials of the Golden Chamber.” This view has been passed down to this day.
However, it is important to note that cold damage and miscellaneous diseases can only be discussed together to reflect their inseparable relationship. If miscellaneous diseases are separated from cold damage, it would greatly deviate from the intention of Zhongjing’s writing.
This is because there are few cases of pure cold damage, while many cases are mixed with miscellaneous diseases. Therefore, discussing cold damage without addressing miscellaneous diseases is not comprehensive enough. Moreover, considering the differences in gender, strength, age, and the nature of the pathogens, although the pathogens may be the same, the onset of diseases can differ.
If the differentiation of miscellaneous diseases is not clear, one cannot clarify the treatment of cold damage. Additionally, there are cases where a person suffers from another disease before contracting cold damage, leading to a mix of internal and external injuries, making it difficult to achieve consistency. Therefore, one cannot use cold damage as a single form of onset to encompass the origins of all diseases.
Ke Yunbo deeply understood this, stating: “Among cold damage, there are the most miscellaneous diseases, with deficiency and excess presenting together, thus combining cold damage and miscellaneous diseases is the key method.”
I believe Ke’s statement is very accurate. Importantly, the six meridian differentiation was originally established for various diseases, not solely for cold damage, thus allowing for the differentiation of diseases to clarify cold damage, rather than suggesting that cold damage is the only disease. His argument broadens perspectives.
Therefore, the “Treatise on Cold Damage” combines cold damage and miscellaneous diseases to highlight the strengths of the six meridian differentiation. If cold damage and miscellaneous diseases are treated as two separate topics, I believe it is incompatible with Zhongjing’s teachings. If one uses this separated mindset to guide their studies, it may lead to a diminished understanding, thus losing the larger picture for smaller details.
The purpose of studying the “Treatise on Cold Damage” is to enhance differentiation and treatment skills and to master the treatment principles of methods, formulas, and medicines. This is to “focus on the big picture,” so that one can achieve the state of “though not curing all diseases, one can see the source of the disease.”
I have been engaged in TCM for over fifty years, and in summary, the opportunity for the “Treatise on Cold Damage” to treat external heat diseases is only about one-third, while it treats internal miscellaneous diseases about seventy percent of the time. This is a fact that speaks for itself.
The term “cold damage” also has broad and narrow meanings. The broad meaning of cold damage, as stated in the “Treatise on Cold Damage,” is: “Those who are sick due to cold exposure are called cold damage; those who are not immediately sick but have cold toxins hidden in their skin, which transform into warm diseases in spring and summer, are also considered cold damage.” The “Zhou Hou Fang” also states: “It is said that all warm and hot diseases are types of cold damage.” This belongs to the broad definition of cold damage.
The narrow definition of cold damage, as stated in the “Treatise on Cold Damage,” is: “In winter, when it is extremely cold, all things are deeply hidden, and if a gentleman remains secretive, he will not be harmed by the cold. Those who are exposed to it are called cold damage.” This refers to the narrow definition of cold damage.
The “Treatise on Cold Damage” not only names the book after cold damage but also discusses various heat diseases such as cold damage, wind, dampness, and summer heat, indicating that it is broadly defined as cold damage without doubt. However, upon analyzing its content, it is evident that Zhongjing’s focus remains on the narrow definition of cold damage. How can this be seen? Let us look at the arrangement of Zhongjing’s articles: the first article discusses the outline of Taiyang disease, the second discusses the pulse symptoms of Taiyang disease with wind, the third discusses the pulse symptoms of Taiyang disease with cold damage, and the fourth does not mention the pulse symptoms of warm diseases but instead discusses transmission issues. It is not until the sixth article that the situation of warm diseases is mentioned. From the connection of the articles, the second can connect to the Gui Zhi Decoction in the twelfth article; the third can connect to the Ma Huang Decoction in the thirty-fifth article. This writing style is called “head and tail looking at each other,” forming a complete system of differentiation and treatment. Only the sixth article on warm diseases lacks a clear connection to other articles. Therefore, the writing on warm diseases has a beginning but no end, and lacks corresponding treatment methods. This reflects that Zhongjing can only treat warm diseases as a guest, not as a host. Some scholars advocate for the unification of cold and warm, but this is merely a personal opinion and should be discussed separately, rather than being mixed together. 5. My Views on the Six Meridians and Meridian Theory In studying the essence of the six meridians in the “Treatise on Cold Damage,” two completely different understandings and opinions have emerged. One understanding acknowledges that the “Treatise on Cold Damage” inherits the six meridian differentiation method from the “Suwen: Heat Theory,” using the physiological and pathological changes of the meridians and organs as the basis for differentiation. The other understanding, however, argues that the six meridians in the “Treatise on Cold Damage” are not the same as those in the “Heat Theory” but are instead a unique creation of Zhang Zhongjing, unrelated to the meridian theory.
The debate between these two opinions has been intense. I believe that when studying classical medical texts, one should firmly stand on the basis of historical materialism, using dialectical thinking to understand and analyze issues, thus avoiding the errors of metaphysical, subjective, and one-sided idealism.
Those who advocate the “non-meridian” theory do not acknowledge the historical connection between the “Treatise on Cold Damage” and the “Heat Theory.” They go to great lengths to discredit the existence of the six meridians. However, if the structure of the six meridians is destroyed, the entire framework of the “Treatise on Cold Damage” collapses. They completely misunderstand the objective laws of the physiological and pathological changes of the organs and meridians during disease onset. We believe that the emergence of the “Treatise on Cold Damage” is a summary of the development of TCM in our country. Therefore, its origins and connections have traces of medicine from the Qin and Han periods, and it contains inherited content, such as Zhongjing’s references to the “Suwen,” “Nine Volumes,” “Eighty-One Difficulties,” and “Yin Decoction Theory,” which is a good illustration.
The Ming Dynasty scholar Lü Fu said that the ten volumes of the “Treatise on Cold Damage” were compiled by Zhang Zhongjing using the theories from the “Suwen: Heat Theory” and the “Yin Decoction.” The Japanese scholar Tanba Motoyuki also stated: “Yin and Yang, the Five Elements, were often discussed by Han Confucians. The Five Zang and Six Fu, the meridians, are recorded in the “Records of the Grand Historian” and the “Book of Han,” and since Zhongjing was born at the end of the Han Dynasty, how could he have discarded them?”
I believe Lü Fu’s words express the academic origins and continuity of the “Treatise on Cold Damage”; Tanba’s words indicate the close historical relationship between the two texts, making it impossible not to inherit the meridian theory. Their understandings reflect the brilliance of historical materialism and dialectical materialism.
Those who advocate the “non-meridian” theory have replaced the meridian theory with many conceptual terms such as “six diseases,” “syndromes,” “stages,” “surface,” “control theory,” and “system theory.” In doing so, they have kicked the meridian theory out of TCM theory. They do not understand that when evil qi invades the human body, it first affects the meridians before gradually entering the interior. Therefore, the “Suwen: Skin Theory” states: “All twelve meridian vessels are part of the skin. Therefore, the beginning of all diseases must first arise from the skin. If the evil enters, it opens the pores, and if it stays, it transmits to the meridians; if it stays, it transmits to the organs, accumulating in the intestines and stomach.”
Thus, it can be seen that the meridians are the body that receives the evil and the pathway through which it enters. The meridian theory is profound, and its unique theory cannot be dismissed lightly. In fact, the meridians play various roles in the human body, such as connecting, communicating, transforming, and promoting. Anyone who believes that TCM theory possesses a holistic view and dialectical method cannot proceed without the meridian theory.
The “Suwen: Heat Theory” states: “The great yang is the source of all yang, and its pulse connects to the wind palace, thus it governs all yang qi.” The Fengfu point is located one inch into the hairline at the back of the head, and the great vessel is the meeting point of the governing meridian and the yang wei, which can oversee all yang’s authority. Therefore, the great yang can “govern the six meridians, control the nutritive and defensive qi, regulate the pores, and open and close, protecting the exterior.” This is closely related to its meridians.
We believe that the Taiyang meridian is the material basis for the exterior, thus when the Taiyang is affected, the meridian is the first to be ill. The “Treatise on Cold Damage” states: “If both pulses are floating, the Taiyang is affected, and it will manifest within one or two days, as its pulse connects to the wind palace, thus causing pain in the head and stiffness in the back.” This illustrates that the physiological and pathological changes of the Taiyang are all related to its meridians.
The beginning of medicine is based on the teachings of Qi and Huang. When we discuss meridians and clarify qi and blood, we are following the teachings of Qi and Huang, with arguments and evidence to support it. To attempt to eliminate the meridians from the “Treatise on Cold Damage” is indeed astonishing!
The Taiyang meridian not only governs the exterior but also prominently connects with the organs, as the Taiyang meridian is linked to the bladder. If the evil in the meridian is not resolved, and the evil qi enters the interior, it can lead to bladder organ syndromes.
For example, in Article 124, it states: “If the Taiyang disease persists for six or seven days with exterior symptoms still present, the pulse is weak and deep, and there is no chest tightness. If the person becomes delirious, it indicates heat in the lower jiao, and the lower abdomen will feel full. If there is blood in the urine, it will recover.” Therefore, Wu Youke noted: “In cases of cold damage, if the Taiyang disease does not resolve, the evil transmits to the organ, causing heat to accumulate in the bladder, leading to delirium, and if there is blood, it will recover.”
Article 71 states: “If the Taiyang disease occurs after sweating, and if the pulse is floating, urination is difficult, and there is slight heat and thirst, the Wu Ling San is indicated.” This syndrome of floating pulse, difficult urination, and slight heat and thirst is due to water evil accumulating in the bladder, preventing the Taiyang from transforming, thus leading to thirst and difficulty urinating. The Taiyang meridian syndrome has distinctions between harming the nutritive and defensive qi; the Taiyang organ syndrome has differences between blood and qi diseases. This fully reflects the internal connection of the Taiyang meridian and organ, as well as the systemic and regular nature of the diseases arising from this meridian. However, the Taiyang meridian also connects with the kidney, belonging to the bladder; the foot Shaoyin meridian penetrates the spine and belongs to the kidney, linking the two meridians. Thus, the Taiyang and Shaoyin form a relationship of yin and yang, constituting the transformation mechanism of “if it is solid, it is Taiyang; if it is deficient, it is Shaoyin.” For example, in Article 293, it states: “In Shaoyin disease, after eight or nine days, if the whole body and limbs are hot, it indicates heat in the bladder, and there will be blood in the urine.”
Qian Huang noted: “If the whole body and limbs are hot, it is due to the foot Shaoyin kidney evil transmitting to the foot Taiyang bladder.” The kidney and bladder are one exterior and one interior, thus the evil in the organs transmits to the interior, returning from yin to yang, as the Taiyang governs the exterior, hence the whole body and limbs are hot. The heat evil in the bladder forces the blood to flow erratically, thus there will be blood in the urine.”
Article 301 states: “In Shaoyin disease, if it begins with fever and the pulse is deep, the Ma Huang, Xi Xin, and Fu Zi Decoction is indicated.” In this case, the examination of the fever indicates that the cold evil is on the exterior, while the deep pulse indicates that the yin cold is in the interior. The exterior is the foot Taiyang bladder; the interior is the foot Shaoyin kidney. The kidney and bladder are one exterior and one interior, thus forming a unity, treating both exterior and interior simultaneously.”
Therefore, it can be seen that the connections of the six meridian theory can analyze the Taiyang disease’s meridian syndrome; the transmission of evil into the interior can lead to organ syndromes; and the transformation of yin and yang cold and heat can be reflected in the symptoms of the Taiyang and Shaoyin, embodying the profound meaning of Zhang Zhongjing’s statement: “Meridians and organs, yin and yang communicate, the mysterious and subtle changes are difficult to fully grasp.”
Those who advocate the “non-meridian” theory deny the existence of the six meridians, thinking they have freed themselves from the constraints of the meridians, but in fact, they have done the opposite. Whether in terms of pathology, the connection of the meridians and organs, or differentiation and treatment, they will inevitably be confused and unable to grasp the connotations and objective laws of yin and yang differentiation.
Huangdi said: “The meridians are what can determine life and death, treat all diseases, and regulate deficiency and excess; they must be interconnected.” He also said: “In the life of a person, the formation of diseases, and the treatment of diseases, all arise from this.”
The meridian theory is so important that we should strive to explore and enhance it, allowing TCM to continue to develop.
For the healthy development of TCM theory and the study of cold damage, I present my views in the spirit of open discussion, and I welcome everyone’s guidance!6. The Six Meridian Outlines of the Treatise on Cold Damage In recent years, some colleagues, in the spirit of open discussion, have raised objections to the six meridian outlines of the “Treatise on Cold Damage,” arguing that the content of the six outlines is too narrow and does not serve as a proper outline. They even go so far as to say that the theory of the six meridian outlines is a constraint on the study of the “Treatise on Cold Damage” that must be broken. This issue is quite serious, making readers ponder deeply. If there are subjective and one-sided aspects, I hope to be corrected.
When ancient people wrote books, they often had a system of outlines, and the chapters and sections within the book must be governed by certain theoretical principles, allowing readers to grasp the essence, as if holding a net with order.
Therefore, having an outline in a book is a natural occurrence. If an author writes without a clear perspective, without discussing the literary style, and presents the content in a flat manner without outlines, it would be like chewing wax; although it is a book, it is not sufficient to be considered a book. If one wishes to achieve the goal of “writing to convey the Dao” and become a classic, such words would be empty talk. The “Treatise on Cold Damage” is a monumental work that combines medical knowledge and literary elegance, with concise and precise language. Although Zhongjing does not explicitly state the outlines, reading the book is like drinking water; one knows the cold and warmth as they enter.
So, what is the meaning of the outline? The “Book of Documents” states: “If the net is in the outline, it has order and is not chaotic.” Han Feizi also said: “A good net maker pulls its outline, not capturing every single point before obtaining it.” From this, it can be inferred that the outlines in any book have the significance of governing and guiding. The “Treatise on Cold Damage” not only reflects Zhongjing’s correct understanding of the laws of disease progression but also embodies a structure that leads and organizes, with a clear hierarchy, connections before and after, and mutual references, which the ancients referred to as “the scales and armor are dense.”
So, where is the outline of the “Treatise on Cold Damage” reflected? Currently, there are two main understandings of the outline: one advocates using the six meridians as the differentiation outline, arguing that Zhongjing’s differentiation methods are always within the scope of the six meridians. This view is supported by the majority of TCM practitioners in the country. The other faction, including a minority of practitioners in the country and the ancient formula school in Japan, believes that Zhongjing’s differentiation outline is not the six meridians but rather yin and yang; as long as one can differentiate between yin and yang, the issues of exterior and interior, cold and heat, deficiency and excess can be easily resolved. This has formed two schools of thought in the study of cold damage: one focusing on the six meridians and the other on yin and yang.
We believe that the “Treatise on Cold Damage” indeed has aspects where yin and yang serve as the outline, such as in the “Differentiation of Pulse” where the pulse is large, floating, rapid, moving, and slippery, which are all yang; while the pulse is deep, thin, weak, wiry, and subtle, which are all yin. It can be seen that Zhongjing uses yin and yang as the outline to govern the differentiation of pulse. In the “Taiyang Disease” section, Article 7 states: “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.” This again uses yin and yang as the outline to govern the overall differentiation. In the “Taiyang Disease” middle section, Article 58 states: “If a disease involves sweating, vomiting, purging, or loss of blood and fluids, if yin and yang are harmonized, it will naturally recover.” Here, Zhongjing again uses yin and yang as the outline to summarize the major treatment principles.
Thus, it seems that yin and yang can replace the six meridians as the outline of the “Treatise on Cold Damage.” However, while yin and yang serve as the overarching principle, they are not entirely sufficient.
Why is this? Because the TCM theory of yin and yang is based on materialism; since things have forms, yin and yang must correspond to forms. If it corresponds to humans, then the five organs are yin, and the six fu organs are yang; blood is yin while qi is yang; the nutritive qi is yin while the defensive qi is yang. Therefore, the “Treatise on Cold Damage” associates Taiyang with the bladder, Yangming with the stomach, and Shaoyang with the gallbladder, thus establishing the differentiation system of the six meridians. If there were no objective existence of the organs and meridians, then yin and yang would have no forms to correspond to. Without the skin, how could the hair attach? It would be impossible to carry out differentiation and treatment. Thus, yin and yang cannot exist independently of material forms. Later generations of practitioners who do not recognize this principle attempt to separate yin and yang from the six meridians. However, if yin and yang lack the material foundation of the six meridians, then Zhongjing’s methods of differentiation and treatment cannot be implemented.
The “Treatise on Cold Damage” is known for having 397 methods; without an outline, readers would find it difficult to grasp. Therefore, Zhongjing meticulously established outlines for each of the six meridians to govern them, opening the door to understanding, highlighting the key points, and reflecting the pulse and symptom characteristics and main pathogenesis of the diseases in this classic. This is recognized by prominent figures in the study of cold damage, such as Xue Ling Tai, Ke Yunbo, and others, and is followed by many scholars in later generations.
Unfortunately, some colleagues, due to a lack of in-depth analysis of the significance of the outlines, have raised objections to the theory of outlines, claiming that the Taiyang disease outline does not mention the term “fever,” thus denying the theory of the six meridian outlines. This indicates that these colleagues lack a systematic study of Zhongjing’s teachings and Ke’s annotations, and they are even more confused about why Zhongjing did not include fever in the outline. Zhongjing mentioned in Article 3: “In Taiyang disease, there may or may not be fever, but there must be aversion to cold.” It is clear that he uses the word “may” for fever and “must” for aversion to cold. Zhongjing believes that fever is a later symptom, thus it is not included in the outline. Ke Yunbo pointed out: “Taiyang is the great yang, and yang diseases must have fever; the outline does not mention it because it may not have fever at the onset of the disease.” This statement deeply resonates with Zhongjing’s intentions.
Those who deny the outline argue that the content of the six meridian outlines is too simplistic and cannot encompass all the “symptoms of the six meridians.” This shows that these colleagues have not grasped the concept and significance of the “outline.” The “outline” is like the net’s rope, symbolizing the most important part of things. Anyone who casts a net must first pull its outline to ensure order. The outline must be raised before the details can be expanded; it is said that “one does not need to capture every single point before obtaining it.” This principle is well articulated by Ke Yunbo, who stated that Zhongjing selects the most appropriate pulse and symptoms to mark the outlines of the six meridians. If it does not meet the criteria of “most appropriate,” then it is better to have fewer than to have many. If one requires that all pulses and symptoms be reflected in the outline, then what can be called an “outline”?
As for the claim that the outline is a “shackle” on the study of the “Treatise on Cold Damage,” this is even more alarmist. The outline serves to highlight the key points, and it is a good practice in writing; how can it lead to confusion?
Therefore, after emphasizing the significance of the six meridian outlines, Ke Yunbo further pointed out: “Readers must remember the outlines to examine the location of the disease; however, the visible outlines are only the front, and readers must also discern the underlying structure, exploring the surrounding details to fully understand the beauty of the methods.” Ke’s insights not only highlight the outlines for examining the location of the disease but also guide readers from the front to the underlying structure, distinguishing the different levels of outlines and details, proposing specific methods for differentiation. His profound understanding and precise discussion are truly remarkable.
Historically, many scholars have supported the theory of outlines. Their studies of the “Treatise on Cold Damage” have not been constrained by the outlines, and they have achieved notable results, which is a well-known fact. Therefore, the notion of the outline being a “shackle” can be dismissed.
In summary, the outline plays a key role in guiding and governing. In any scientific research, writing, and discourse, the outline must be emphasized first, allowing the meaning to be implemented. The “Treatise on Cold Damage” has an outline for each of the six meridians, akin to raising a flag to indicate direction, which is of utmost importance. Yet it has faced such criticism, which is perplexing.
The “Treatise on Cold Damage” is valuable for its practical guidance. We should conduct theoretical research while also validating it through clinical practice. For this reason, I will briefly express my views on the significance of the Taiyang disease outline in guiding clinical practice. “Taiyang” refers to the foot Taiyang bladder meridian. The “Suwen: Heat Theory” states: “The great yang is the source of all yang, and its pulse connects to the wind palace, thus it governs all yang qi.” Therefore, the Taiyang has the function of governing the six meridians, controlling the nutritive and defensive qi, and managing the body’s exterior.
Whenever wind, cold, or other evils invade the exterior, the Taiyang is the first to be affected. At this time, the righteous and evil qi are contending at the exterior, thus the symptoms outlined in the first article state: “The disease of Taiyang is characterized by a floating pulse, headache, stiffness in the neck, and aversion to cold.”
Ke Yunbo believes: “Observing the five meridian outlines, all point to internal symptoms, while the Taiyang outline is set for wind and cold affecting the exterior.” The floating pulse is a reflection of the evil invading the exterior, and the qi and blood resisting the evil. Therefore, the floating pulse is the outline of the exterior symptoms. The symptoms of “headache and stiffness in the neck” are the outline symptoms of the exterior. The reason for elevating these pulses and symptoms to the level of an outline is precisely because they have practical guiding significance for clinical differentiation.
Now, let us first discuss the outline pulse of the Taiyang disease, which is the floating pulse. The floating pulse is well-known to indicate exterior conditions, but recognizing it as the outline pulse of the exterior is not always emphasized. In this article, the pulse is discussed first, followed by the symptoms, reflecting the spirit of differentiation based on pulse. For example, if a patient presents with headache and aversion to cold, it seems to be an exterior condition. However, if the pulse is not floating but rather deep and slow, it would be difficult to assert that it is a Taiyang disease, and thus one would not adopt the method of sweating to resolve the exterior. Even if the floating pulse is present at the cun and guan positions, if the chi pulse is not floating, according to Zhongjing’s indications, sweating should not be applied. The strictness of the floating pulse as the outline is worthy of our attention.
Therefore, if the pulse at the cun position is floating, regardless of the disease or duration, one should first consider whether the disease is due to unresolved exterior evil or if various ailments have arisen due to unresolved exterior evil, and this must be taken seriously to avoid errors.
I have both experience and lessons regarding the floating pulse indicating exterior conditions. I remember treating a patient with headache and fever, and upon checking the pulse, it was floating, which should indicate an exterior condition. The treatment should have been to resolve the exterior and induce sweating, allowing the wind and cold to disperse, thus alleviating the fever and restoring comfort. However, due to my failure to grasp the significance of the floating pulse indicating exterior conditions, I mistakenly used some cold and cooling herbs, which further obstructed the yang qi, preventing the exterior evil from escaping, resulting in persistent fever and misdiagnosis. Such situations are not limited to personal experiences, hence I wish to share this with the world.
After this lesson, I understood the significance of the Taiyang disease pulse outline, and I gained a personal understanding of the clinical value of the floating pulse indicating exterior conditions.
Next, let us discuss the outline symptoms of the Taiyang disease. The appearance of “headache and stiffness in the neck” is related to the obstruction of qi and blood in the meridians after the Taiyang is affected by evil. The “Ling Shu: Internal Organs” states: “The meridians are responsible for circulating blood and qi, nourishing yin and yang, moistening the muscles and bones, and benefiting the joints.” The Taiyang meridian runs through the brain and neck, thus when the Taiyang is affected, it can lead to headache and stiffness in the neck. Ke Yunbo pointed out: “All three yang meridians have headache symptoms, and all six meridians affected by cold have aversion to cold, but only the Taiyang has headache and stiffness in the neck.” This is because the Taiyang is the master of all yang, and the head is the meeting point of all yang, while the neck is the meeting point of the Taiyang. Therefore, if the pulse is floating, with aversion to cold and fever, but there is no headache or stiffness in the neck, it can be concluded that it is not a Taiyang disease; if there is headache but no stiffness in the neck, it is also not a definitive Taiyang condition.
Thus, the symptoms of “headache and stiffness in the neck” being the outline symptoms of Taiyang disease are indeed credible. As for “aversion to cold,” it reflects the pathological response of the defensive yang being injured, unable to warm the skin. According to scholars, any symptom that appears after the word “and” is a key issue, such as “no sweating and panting” for “panting,” and “no sweating and restlessness” for “restlessness.” Therefore, in this article, the “aversion to cold” in the symptoms of “headache and stiffness in the neck” becomes a key symptom in the outline.
The ancients said: “For every bit of aversion to cold, there is a corresponding exterior symptom.” Therefore, whenever aversion to cold is observed, one should consider treating it from the exterior. For example, in Article 164, it states: “After a major purge in cold damage, if sweating is repeated, and there is fullness under the heart, with aversion to cold, it indicates that the exterior has not resolved.” This article emphasizes that after repeated sweating and purging, “one cannot attack the fullness; one must first resolve the exterior, as the person still has aversion to cold, and the exterior has not yet resolved.” This illustrates the important position of “aversion to cold” in differentiation.
In summary, the pulse outline and symptom outline of Taiyang disease are indeed precious, and their practical value should not be underestimated. However, it should also be noted that the pulse and symptoms are not isolated but are closely interconnected. For example, when the pulse is floating, there should also be the main symptoms of headache and stiffness in the neck or aversion to cold. Furthermore, studying the six meridian outlines should also consider other articles and pulse symptoms, thus grasping the outlines while delving deeper, which will be more beneficial for differentiation and treatment. In addition to the theory of the six meridian outlines, there are also theories such as the three outlines of the tripod and Shen Jin’ao’s “Outlines and Essentials of Cold Damage.” Although their structures and contents differ, they all acknowledge the existence of outlines in the “Treatise on Cold Damage.” Therefore, the argument that “the outline is not an outline” is merely a distraction, and it seems that this can be put to rest.
