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The Treatise on Cold Damage (Shang Han Lun) has produced countless famous doctors and has also perplexed many aspiring students. Without mastering the Treatise on Cold Damage, one cannot truly become a TCM practitioner. How can one master the Treatise on Cold Damage? Memorize the original text, grasp specific formulas and patterns, understand Zhang Zhongjing’s original intent. These are the three steps to mastering the Treatise on Cold Damage.
1Memorize the Original Text
It is essential to memorize the original text; merely memorizing is not enough.Anyone who wants to learn TCM from me, whether they are my graduate students, apprentices, or students I have taught, must start by memorizing the Treatise on Cold Damage.If you are unwilling to memorize the Treatise on Cold Damage, do not say you want to learn TCM. Learning TCM requires studying the Treatise on Cold Damage, and the first step is to memorize the original text. Without memorization, it is impossible to truly understand the Treatise on Cold Damage. Initially, it is okay to remember without understanding; as long as you memorize it, you will eventually understand. If you cannot memorize it, claiming to understand is useless; if you open the book to understand and cannot retain it, you will not be able to apply it clinically (do patients wait for you to flip through books or phones during consultations???). If you remember the 379th clause, “For those who vomit and have a fever, Xiao Chai Hu Decoction is indicated,” you can already use it. When you see a patient with fever and vomiting, just use Xiao Chai Hu Decoction, even if you haven’t fully understood it yet; you can gradually come to understand it. The Treatise on Cold Damage consists of aphoristic clauses, with the pattern followed by the formula; once you memorize the original text, you can use it. Once you use it effectively, your interest and confidence in learning will naturally increase. Many people struggle with TCM because they do not master the Treatise on Cold Damage, and the reason they do not master it is that they are unwilling to put in the hard work to memorize it. They always want to understand first, hoping that understanding will lead to memorization, but the result is often counterproductive, preventing them from advancing and leaving them wandering outside the door of TCM for a lifetime.I studied the Treatise on Cold Damage seriously for six years. The first three years were because I needed to take the entrance exam for the Hubei University of Traditional Chinese Medicine’s graduate program in the Treatise on Cold Damage, and most of my time was spent memorizing it, to the point where I could recite the original text upon mentioning the clause number and vice versa. After being admitted to the graduate program, I studied the Treatise on Cold Damage for another three years under my esteemed teachers Li Peisheng and Mei Guoqiang. After starting my career, I taught the Treatise on Cold Damage at the Graduate School of the China Academy of Chinese Medical Sciences and Beijing University of Chinese Medicine, dedicating my life to learning, teaching, and applying the Treatise on Cold Damage.Nowadays, many people look down on rote memorization, believing that one should understand before memorizing, or even think that memorization is unnecessary because what needs to be remembered can be solved with smart devices; with a phone, everything can be found at any time. However, being a doctor is a labor-intensive job, and most of the knowledge must be memorized first. Classic texts must be memorized, the properties, meridian affiliations, effects, indications, contraindications, methods of use, and dosages of Chinese herbs must be memorized, the composition, dosages, effects, indications, and preparation methods of formulas must be memorized, and the pathways and acupuncture points must be memorized. If you cannot memorize these, you cannot be a doctor.Understanding is not unnecessary, but memorization must come first.
2Grasping Specific Formulas and Patterns
The Treatise on Cold Damage consists of clauses that primarily discuss the relationship between patterns and formulas. Below, I will discuss some clauses related to the Gui Zhi Tang (Cinnamon Twig Decoction) pattern as an example. For Taiyang Wind, Yang is floating and Yin is weak; when Yang is floating, heat is self-released, and when Yin is weak, sweating occurs; with aversion to cold, aversion to wind, fever, nasal congestion, and dry vomiting, Gui Zhi Tang is indicated. (12)For Taiyang disease, if the exterior symptoms have not resolved and the pulse is floating and weak, sweating should be induced, and Gui Zhi Tang is appropriate. (42)For Taiyang disease, if Gui Zhi Tang is taken initially and the patient becomes agitated without resolution, first needle Fengchi and Fengfu, then Gui Zhi Tang will cure. (24)If Gui Zhi Tang is taken and there is profuse sweating with a strong pulse, continue with Gui Zhi Tang as before; if the symptoms resemble malaria and recur in one day, profuse sweating must resolve, and Gui Zhi Tang with two doses of Ma Huang is indicated. (25)For Taiyang disease, after purging, if the Qi rises, Gui Zhi Tang can be used, following the previous method; if it does not rise, it must not be used. (15)For Taiyang disease, if three days have passed and sweating has been induced, if there is vomiting, purging, or warming needle treatment, and it still does not resolve, this is a serious condition, and Gui Zhi Tang should not be used. Observe the pulse and symptoms to determine what is wrong and treat accordingly. Gui Zhi is primarily for resolving the exterior; if the pulse is floating and tight, and there is fever without sweating, it should not be used. One must always recognize this to avoid mistakes. (16)The Treatise on Cold Damage is mainly composed of such clauses. The clauses do not exhibit the characteristics of the six meridian differentiation nor the differentiation and treatment characteristics; they only present patterns and formulas.The vast majority of the clauses follow the same format, with the pattern presented first and the formula following, linking the pattern and formula in the same clause. This is the pattern-formula relationship.The main content of these clauses is the pattern and formula, discussing the applicability of the pattern and formula.For a formula, the degree of correlation with the pattern can be categorized as follows:1. Some patterns have a specific applicability level, meaning they can achieve the effect of the formula resolving the pattern, indicated by “主之”;2. Some patterns have a general applicability level, indicated by “宜”;3. Some patterns have a possible applicability level, indicated by “可与”;4. Some patterns have a non-applicability level, indicated by “不可与”.This is the main pattern of the clauses in the Treatise on Cold Damage.The above is a discussion of some clauses related to the Gui Zhi Tang pattern, focusing on the relationship between the pattern and Gui Zhi Tang, specifically which patterns can be treated with Gui Zhi Tang, which patterns are suitable for Gui Zhi Tang, which patterns can be used with Gui Zhi Tang, and which patterns cannot be used with Gui Zhi Tang.“Specific pattern-formula” refers to the specific correlation between the formula and the pattern, achieving the effect of the formula resolving the pattern, characterized by precision, speed, and efficiency.“Formula resolving the pattern” is commonly understood as the medicine resolving the illness, but this phrase is more suitable for describing the efficacy of Western medicine, as Western medicine treats diseases as units and uses drugs as treatment methods; TCM treats patterns as units and uses formulas as treatment methods, although it can also use herbs as treatment methods, such as single herbs, but this is rare.The pattern is the treatment target unit in TCM, while the formula is the treatment method unit in TCM.The degree of correlation between the pattern and formula determines the effectiveness of the treatment. The “specific pattern-formula” is the highest level of correlation between the pattern and formula, representing the best efficacy achievable in TCM, that is, the formula resolving the pattern, which is also the special effect.In the Treatise on Cold Damage, all formulas indicated by “主之” mostly belong to “specific pattern-formula,” which is the essence of pattern-formula. To learn the Treatise on Cold Damage, one must first grasp the “specific pattern-formula,” and then, based on the original intent of the Treatise on Cold Damage, continuously expand and explore the “specific pattern-formula” in conjunction with clinical practice. The more “specific pattern-formulas” one masters, the better the clinical efficacy.The core of the Treatise on Cold Damage is the pattern-formula, and the essence of the pattern-formula is the “specific pattern-formula.”
3Understanding Zhang Zhongjing’s Original Intent
First, let’s look at a case study of Gui Zhi Tang.
Patient Liu, male, 45 years old, presented with fever due to exposure to cold, with a temperature of 37.8 degrees Celsius, no sweating, aversion to cold, significant headache in the back, discomfort in the neck, nasal congestion with clear discharge, unformed stools, no sore throat, no thirst, pale tongue with teeth marks and thin white coating, and a floating weak pulse. He usually has loose stools and is prone to diarrhea.
Prescription: Gui Zhi 15g, Bai Shao (White Peony) 15g, Sheng Jiang (Fresh Ginger) 5 slices, Da Zao (Jujube) 12 pieces, Zhi Gan Cao (Honey-fried Licorice) 6g. One dose, using 1200ml of water, boil down to 600ml, and take in three warm doses. The temperature of the decoction should be slightly higher, with a mildly hot sensation. After taking the medicine, the patient should drink 200ml of hot thin porridge and cover with a quilt to sleep for 2 hours, resulting in slight sweating and recovery.
This patient has no sweating; how can Gui Zhi Tang be used?
This requires clarifying Zhang Zhongjing’s original intent.
Regarding the efficacy of Gui Zhi Tang, Zhang Zhongjing states in clause 16, “Gui Zhi is primarily for resolving the exterior; if the person has a floating tight pulse, fever without sweating, it should not be used.” This clearly indicates that the efficacy of Gui Zhi Tang is different from that of Ma Huang Tang (Ephedra Decoction) in inducing sweating. Without understanding the essence of “resolving the exterior,” one cannot truly learn to use Gui Zhi Tang.
So, what does “resolving the exterior” mean?
There are two explanations in various textbooks. One is “to eliminate the evil from the muscle surface”; the other is “to resolve the exterior and dispel wind, serving as a gentle agent for inducing sweating.” Neither explanation clarifies the true meaning of “resolving the exterior.”
I offer a definition: Resolving the exterior is a method of restoring the function of Ying and Wei by tonifying the Spleen and Stomach, thereby achieving the expulsion of evil through sweating.
Gui Zhi Tang is a typical representative of this method. The term “exterior” also refers to the muscles.
Compared to Ma Huang Tang, the Gui Zhi Tang pattern is deeper, as it pertains to the Spleen and Stomach, with the treatment goal being to tonify the Spleen and Stomach. Therefore, the essence of Gui Zhi Tang is to tonify the Spleen and Stomach while expelling external evils.
① From the perspective of formula composition, Gui Zhi Tang is a warm, pungent, and sweet formula, which not only has the effect of resolving the exterior and dispelling wind but also tonifies the middle burner and strengthens the Stomach Qi.
Gui Zhi is warm and pungent, which can resolve the exterior and dispel wind, warm the blood vessels, and also tonify the Spleen and Stomach. The Shennong’s Herbal Classic states, “It is indicated for cough, counterflow of Qi, throat obstruction, vomiting, and benefits the joints, tonifying the middle and benefiting Qi.”
Sheng Jiang is warm and pungent, which can assist Gui Zhi in dispelling evil and also warm the middle and strengthen the Stomach.
Zhi Gan Cao is sweet and neutral, benefiting Qi and tonifying the Spleen.
Da Zao is sweet and neutral, tonifying the Spleen and benefiting the Stomach, nourishing the Ying and blood.
Bai Shao is sour, bitter, slightly cold, nourishing blood and astringing the Ying. The Shennong’s Herbal Classic states, “It is indicated for evil Qi causing abdominal pain, dispelling blood stasis, breaking up cold and heat, stopping pain, benefiting urination, and tonifying Qi.”
All five medicinal ingredients in the formula have the effect of tonifying the Spleen and Stomach.
② After taking Gui Zhi Tang, it is required to drink hot thin porridge to nourish the Qi and tonify the Spleen and Stomach.
It can be seen that Gui Zhi Tang’s ability to resolve the exterior and dispel wind originates from harmonizing the Ying and Wei, and harmonizing the Ying and Wei originates from tonifying the middle burner. With a strong Spleen and Stomach and abundant Qi and blood, using Gui Zhi to regulate the Wei Qi will open the pores, allowing sweating to expel the evil; using Bai Shao to astringe the Ying Qi will protect the Ying from excessive sweating harming the Zheng Qi. When the Ying and Wei are harmonized, the pores open and close appropriately, allowing sweating to expel the evil, and when the evil is expelled, the pores close and sweating stops naturally.
Zhang Nan, in his work on the Treatise on Cold Damage, states: “This formula is based on the Spleen and Stomach to reach the Ying and Wei, circulating throughout the body, harmonizing the interior and exterior, balancing Yin and Yang, harmonizing Qi and blood, and unblocking the meridians.” Once we understand this principle, we can widely use Gui Zhi Tang.
It can be understood that a person with Spleen and Stomach deficiency who is exposed to cold evil will present with fever, sweating, aversion to wind, and a slow pulse, which is a typical manifestation of Taiyang Wind. This is the basic manifestation. Therefore, when encountering fever, sweating, aversion to wind, and a slow pulse, Gui Zhi Tang is indicated.
Conversely, even if there are no typical manifestations of Wind, if the patient exhibits signs of Spleen and Stomach deficiency while being exposed to cold evil, this is also an indication for Gui Zhi Tang. This is an explanation of clause 42.
Clause 42 of the Treatise on Cold Damage states: “For Taiyang disease, if the exterior symptoms have not resolved and the pulse is floating and weak, sweating should be induced, and Gui Zhi Tang is appropriate.”
For Taiyang disease, if the exterior symptoms have not resolved, the treatment principle should be to induce sweating. A floating weak pulse clearly does not suit the sweating induced by Ma Huang Tang; using Gui Zhi Tang to resolve the exterior is more appropriate. If the pulse is floating and tight, then Ma Huang Tang should be used. This is an example of judging the pathogenesis based on the pulse and selecting the treatment method. It should also be noted that if the floating weak pulse is accompanied by aversion to wind and sweating, using Gui Zhi Tang is undoubtedly correct; however, even if the floating weak pulse is accompanied by aversion to cold and no sweating, it indicates insufficient Zheng Qi, and using Ma Huang Tang to induce sweating should be approached with caution, while using Gui Zhi Tang to resolve the exterior is more prudent.
Understanding Zhang Zhongjing’s original intent is also a primary way to expand the “specific pattern-formula.” Based on the above understanding, imitating the examples in the Treatise on Cold Damage: for those with Spleen and Stomach deficiency who are exposed to cold evil, Gui Zhi Tang is indicated.
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