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Chapter 4 of 29
伤寒杂病论
The opening of this chapter lists the Dipper-pointer (the direction indicated by the handle of the Big Dipper constellation) patterns for the twenty-four solar terms: Beginning of Spring points to Gen, Rain Water points to Yin, Awakening of Insects points to Jia, Spring Equinox points to Mao, Pure Brightness points to Yi, Grain Rain points to Chen, Beginning of Summer points to Xun, Lesser Fullness points to Si, Grain in Ear points to Bing, Summer Solstice points to Wu, Lesser Heat points to Ding, Great Heat points to Wei, Beginning of Autumn points to Kun, End of Heat points to Shen, White Dew points to Geng, Autumn Equinox points to You, Cold Dew points to Xin, Frost's Descent points to Xu, Beginning of Winter points to Qian, Lesser Snow points to Hai, Great Snow points to Ren, Winter Solstice points to Zi, Lesser Cold points to Gui, and Great Cold points to Chou.
Among the twenty-four solar terms, there are twelve "nodes" and twelve "middle qi." Every five days constitutes one pentad, yielding seventy-two pentads throughout the year. The ancients believed that mastering this climatic rhythm helps in assessing the depth and prognosis of externally contracted diseases and must be thoroughly understood.
The Yin-Yang Great Discourse states: Spring weather is warm and mild, summer weather is hot, autumn weather is cool and crisp, and winter weather is cold and biting—this is the normal sequence of the four seasons' qi. In winter, severe cold prevails and all things hide deeply. Those who understand health preservation protect themselves carefully and will not be injured by cold qi; if one does encounter cold qi, it is called cold damage (disease caused by exposure to cold).
Qi from any of the four seasons can cause disease, but cold is given the greatest emphasis because the ancients regarded it as a killing, fierce qi. When cold is contracted and disease manifests immediately, it is called cold damage; when it does not manifest immediately and the cold toxin hides in the skin and flesh, it transforms into warm disease in spring and summer-heat disease in summer. The heat of summer-heat disease is more severe than that of warm disease. When laborers frequently suffer warm disease or heat disease in spring and summer, the ancients believed this resulted from encountering cold in winter and does not belong to epidemic qi (qi that appears outside its proper season, similar to seasonal epidemics).
The so-called epidemic qi refers to situations where spring should be warm but instead turns severely cold, summer should be hot but instead turns cool, autumn should be cool but instead turns hot, and winter should be cold but instead turns warm. When qi appears outside its proper season, people of all ages within a year may suffer from similar illnesses—this is epidemic qi.
From the Frost's Descent solar term in the ninth month onward, the climate should gradually turn cold, becoming colder through winter, and gradually releasing from the Rain Water solar term in the first month onward. The reason it is called "Rain Water" is that ice and snow melt into rain. After the Awakening of Insects solar term in the second month, the climate gradually warms, developing toward the great heat of summer, then turning cool again in autumn.
From Frost's Descent to before Spring Equinox, whenever one encounters frost and dew and contracts cold internally with immediate onset of disease, it is called cold damage. In the ninth and tenth months, when cold is still mild, the illness is relatively light; in the eleventh and twelfth months, when cold has become severe, the illness is relatively heavy; in the first and second months, as cold gradually releases, the illness is also relatively light. This is because winter care was improper, leading to contraction of cold and subsequent illness.
If there is unseasonably warm weather in winter, it is called winter warmth (warm disease triggered by abnormal winter warmth). The toxin of winter warmth differs greatly from cold damage. Winter warmth may also involve sequential, overlapping, and other complex situations; the conditions may be mild or severe, with different treatment methods, and the specific manifestations are detailed in subsequent chapters.
From the Beginning of Spring solar term onward, if there is no sudden cold or ice and snow, yet some people develop high fever and illness, this belongs to the rising of spring yang qi, which stirs the latent cold q i hidden from winter, transforming it into warm disease (externally contracted disease with predominantly warm-heat manifestations).
From the Spring Equinox to before the Autumn Equinox, if the weather suddenly turns cold, such cases all belong to seasonal cold epidemic (seasonal epidemic disease caused by cold). When sudden cold occurs in the third and fourth months, yang qi is still weak; when suppressed by cold, the disease heat is relatively mild. In the fifth and sixth months, yang qi is already flourishing; when suppressed by cold, the disease heat is relatively severe. In the seventh and eighth months, yang qi is already declining; when suppressed by cold, the disease heat is also relatively mild. These illnesses resemble warm disease, but the treatment principles differ.
Each fifteen days yields one solar term, and each of the four seasons contains six qi; four times six gives the twenty-four qi. However, there are situations where qi should arrive but does not, arrives earlier than expected, or arrives with excess—all of these may become disease-causing qi.
Heaven and earth move and rest; yin and yang surge and interact, each presiding over one qi. The warmth of spring can develop into the summer heat; the killing cool of autumn can develop into winter's severe cold. After the Winter Solstice, one yang line rises while one yin line descends; after the Summer Solstice, one yang qi descends while one yin qi rises. The Winter and Summer Solstices are times of yin-yang union, while the Spring and Autumn Equinoxes are times of yin-yang separation. As yin and yang alternate and shift, people may fall ill accordingly. Therefore, those who understand health preservation nourish yang in spring and summer and nourish yin in autumn and winter, conforming to the firmness and gentleness of heaven and earth; those who do not understand health preservation encounter abnormal climate and may suddenly fall ill. One must carefully examine which channel the virulent qi has lodged in, what disease may arise, and analyze it in detail.
Thus, when one is injured by wind qi in spring, stubborn diarrhea (diarrhea with undigested food) easily occurs in summer; when injured by summer-heat qi in summer, malaria easily occurs in autumn; when injured by damp qi in autumn, cough easily occurs in winter; when injured by cold qi in winter, warm disease easily occurs in spring. The ancients regarded these as inevitable patterns that must be carefully understood.
Cold damage disease varies in depth day by day, and treatment should be adjusted according to the disease's momentum. In today's world, people suffering from cold damage may not receive timely treatment at the onset, may receive treatment that does not match the pattern, or may delay for a long time and only seek a physician when critically ill. If the physician does not treat according to the order of transmission and transformation, it will be difficult to hit the mark. In all cases, one should deliberate and formulate prescriptions according to the specific circumstances at the bedside to achieve efficacy. Moreover, because regional warmth or coolness, terrain elevation, individual constitution, diet, and daily habits all differ, the Yellow Emperor raised questions about the four directions, and Qi Bo set forth the abilities of the four treatment methods to instruct later generations and enlighten those who had not yet awakened. Clinical physicians should examine both the weather and regional/individual factors.
When cold is contracted and the disease transmits through the channels, the manifestations are mostly heat patterns. Even if the heat is severe, the ancients did not consider it necessarily fatal; however, when dual infection by cold occurs (simultaneous attack of exterior and interior channels), the ancients considered the condition mostly critical.
Taiyang channel disease: Both cun and chi pulses are floating; onset occurs at approximately one to two days. Because the Taiyang channel connects upward to Fengfu, there is headache, neck pain, and stiffness and discomfort of the lower back and spine.
Yangming channel disease: Both cun and chi pulses are long; onset occurs at approximately two to three days. Because the Yangming channels border the nose and connect to the eyes, there is body heat, sweating, eye pain, nasal dryness, and inability to rest peacefully.
Shaoyang channel disease: Both cun and chi pulses are wiry; onset occurs at approximately three to four days. Because the Shaoyang channels course along the flanks and connect to the ears, there is chest and flank pain and deafness.
For diseases of these three yang channels, if the pathogen has not yet entered the bowels, the ancients held that the sweating method (releasing the exterior through diaphoresis) may all be used.
Taiyin channel disease: Both cun and chi pulses are deep and soft; onset occurs at approximately four to five days. Because the Taiyin channels spread over the stomach and connect to the throat, there is abdominal fullness and dryness of the throat.
Shaoyin channel disease: Both cun and chi pulses are deep and fine; onset occurs at approximately five to six days. Because the Shaoyin channel penetrates the kidneys, connects to the lungs, and ties to the root of the tongue, there is dryness of the mouth, dry tongue, and thirst.
Jueyin channel disease: Both cun and chi pulses are wiry and faint; onset occurs at approximately six to seven days. Because the Jueyin channel courses along the genitals and connects to the liver, there is oppression and fullness, and contraction of the scrotum.
For diseases of these three yin channels, if the pathogen has already entered the interior and involves bowel qi, the ancients held that the purging method (purging interior pathogens) may all be used.
If cold damage is still in the Taiyang channel with a floating, rapid pulse, fever, anhidrosis, and restlessness, the ancients considered Ephedra Decoction appropriate. This represents the classic formula for acrid-warm diaphoresis, embodying the treatment principle for Taiyang exterior excess pattern. Modern readers must not apply this formula according to the text without professional guidance.
This chapter serves as the general treatise on externally contracted diseases. Its core lies in establishing the overall framework of "normal seasonal qi—epidemic qi—latent pathogen onset—six-channel transmission."
Note: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and reflection. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a qualified physician promptly if you feel unwell.