shang han lun qian zhu (傷寒論淺注) Simplified Commentary on Cold Damage

https://www.amazon.com/Simplified-Commentary-Cold-Damage-Translation-ebook/dp/B0786LK1SJ/ref=sr_1_2?crid=3UIWZMF132EZI&keywords=shang+han+lun+qian+zhu&qid=1684132048&sprefix=shang+han+lun+qian+zhu%2Caps%2C286&sr=8-2

Simplified Commenrary on Cold Damage (1) is including only 120 lines( from line 1to line 120)
To understand shang han lun or this book, reading of 'Understanding of three yin and three yang (三陰三陽的理解)' on my blog may be helpful.
(https://bongsunhua.blogspot.kr/2016/10/understanding-of-three-yin-and-three.html)

Line 5.

太陽病發熱而渴不惡寒者為溫病若發汗已身灼熱者名風溫風溫為病脈陰陽俱浮自汗出身重多眠睡鼻息必鼾語言難出若被下者小便不利直視失溲若被火者微發黃色劇則如驚癇時瘈瘲若火熏之一逆尚引日再逆促命期.

Greater yang disease with heat effusion and thirst but without aversion to cold is termed warm disease. After promotion of sweating, if there is generalized scorching heat, this is called wind warm. When wind-warmth causes disease, this bears floating pulse at the Yin and Yang [position], spontaneous sweating, generalized heaviness, a tendency to sleep, the breath from the nose with a snoring sound, and difficult speech. If precipitation is used, this will cause inhibited urination, forward staring eyes, and fecal incontinence, if fire is used, there will be slight yellowing, and in acute cases there will be fright epilepsy, periodic tugging and slackening, and the skin will turn yellowish as if fumed by fire, one instance of adverse treatment will lengthen the time of disease and further adverse treatment will lead to the term of life.

且夫太陽病之即發者有中風傷寒之異. 至於不即發者《內經》謂：「冬傷於寒春必病溫.」為伏邪蘊釀成熱邪自內出其證脈浮頭項强痛故亦謂之太陽病. 但初起即發熱而渴不惡寒者須於中風傷寒之外區別為溫病. 治宜寒涼以解散順其性以導之如麻杏甘石湯之類若無頭項强痛之太陽病但見發熱而渴不惡寒之證是太陽底面少陰為病. 《內經》謂：「冬不藏精春必病溫」是也. 如心中煩不得臥者黃連阿膠湯主之. 稍輕者陽盛陰虛之人周身之經絡渾是熱氣布護治法只宜求之太陽署之裏陽明署之表. 如所云：「心中懊憹舌上胎者梔子豉湯主之.」「渴欲飲水口乾舌燥者白虎加人參湯主之.」「脈浮發熱渴欲飲水小便不利者猪苓湯主之.」之類切不可不特汗後身不涼靜用辛溫以發汗. 若醫者誤用辛溫之劑汗之其內蘊之熱得辛溫而益盛而且發汗已身反灼熱者是溫病為風藥所壞遂變重證. 名曰風溫.

Wind strike and cold damage, both of them belong to greater yang, occur immediately as soon as being contracted by evil qi, but they also have a difference. In case of not occurring immediately, Nei Jing says that if people are damaged by cold in winter, there will be warm disease in spring. Latent evil brews and then generates heat, the evil automatically comes out from the interior, the signs are floating pulse, stiffness and pain of the head and nape, and hence this is also called greater yang disease. Only when in the beginning there is heat effusion, thirst without aversion to cold, this is distinguished from wind strike and cold damage. It should be treated with cool acrid exterior resolution, according to the nature of the disease it should be treated with medicinal as like Ma Xing Gan Shi Tang family. In greater yang disease without stiffness and pain of the head and nape, if there is heat effusion, thirst but no aversion to cold, this is lesser yin disease which is the base of greater yang. In Nei Jing, this means that if essence [qi] is not stored in winter, this will cause warm disease in spring. Vexation in the heart with inability to sleep can be treated with Coptis and Ass Hide Glue Decoction (huang lian e jiao tang). A pattern slighter than this formula belongs to yang exuberance yin vacuity, Channels and network vessels of whole body are surrounded with heat qi, treatment method should relieve the interior of greater yang and the exterior of brightness yang. For example, anguish in the heart and fur on the tongue should be treated with Gardenia and Fermented Soybean Decoction (Zhi Zi Chi Tang), thirst with desire to drink water, dry mouth, and dry tongue should be treated with White Tiger Decoction Plus Ginseng (bai hu jia ren shen tang), floating pulse, heat effusion, thirst with desire to drink water, and inhibited urination should be treated with Polyporous Decoction (zhu ling tang). The promotion of sweating with acrid and warm medicinal should be never used. If a practitioner promotes sweating with acrid and warm medicinal erroneously, the heat congested in the interior will be more exuberant. After sweating, the body is not cooled and quiet but has scorching heat, this is because wind medicinal is used to warm disease and this makes an unidentified disease which is finally transformed to a serious pattern [illness]. This is called Wind Warmth.

What is wind warmth like? The pulse is floating in both yin cubit and yang inch, there is spontaneous sweating. It looks like greater yang wind strike, but chief manifestations are dangerous signs of lesser yin. Kidney governs the bones, heat is in the bones, so there is generalized heaviness. Heat enters yin-part, so there is clouded spirit and a tendency to sleep. Snoring sounds with breath from the nose is because kidney heat congests on the Lungs. The difficulty of speech is because kidney heat congests on the Heart, kidney channel is linked to the heart and lungs. Erroneous precipitation cause liquid and humor in lower to be drained, this leads to inhibited urination, and again, if liquid and humor in upper is drained, eye tie is tight and urgent, and there are forward staring eyes. After liquid and humor already being exhausted, kidney qi is also drained and is unable to retain greater yang qi, this cause fecal incontinence. It's dangerous. Applying of fire moxibustion or hot needle means that heat pattern is treated with heat method, this causes the decay of kidney [function] and signs which are seen when the kidney is attacked. Slight yellowing in skin is the color representing of earth restraining water. In acute cases heat gets hyperactive and attacks the heart, this presents like fright epilepsy. Extreme heat engenders wind and that causes periodic tugging and slackening. The skin looks like not only slight yellowing but also black-tinged yellowing as if burned by fire. Precipitations is one case of adverse treatment, applying of fire treatment is second, one time of adverse treatment will lengthen the duration of the disease and further adverse treatment will lead to shorten one's life span

This states warm disease of the greater yang disease, mistreatment [adverse treatment] can change it into Wind Warmth [disease].

COMMENTARY

1) when in the condition of kidney yin vacuity, an exterior pattern occurs, this is warm disease.

Warm disease has signs such as generalized heaviness and pain, aversion to heat, vexation and agitation, thirst, and so on. Since there is heat in the skin, this is treated with herbs such as shi gao (石膏) and ge gen (葛根) which are sweet and cool in nature and Sheng Di Huang (生地黃) which enriches yin.

Line 6.

病有發熱惡寒者發於陽也無熱惡寒者發於陰也發於陽七日愈發於陰六日愈. 以陽數七陰數六故也

An illness with heat effusion and aversion to cold is spring from yang takes seven days to recover. An illness with the absence of heat effusion and the presence of aversion to cold is spring from yin and takes six days to recover. This is because seven is yang number and six is yin number.

太陽底面即是少陰. 治太陽之病即宜預顧少陰二經標本寒熱不同醫者必先了然於心然後絲絲入扣.《內經》云：「太陽之上寒氣主之.」以寒為本以熱為標也. 又云：「少陰之上君火主之.」以熱爲本以寒為標也. 病有發熱惡寒者發於太陽之標陽也. 無熱惡寒者發於少陰之標陰也. 發於陽者七日愈發於陰者六日愈以陽數七陰數六故也.

The base of the greater yang is lesser yin. When treating greater yang disease, lesser yin should be considered in advance. The root-tip and cold-heat of the two channels are not same. Only after learning well this theory, practitioner can treat a patient logically, perfectly.

Nei jing says that above in greater yang, the cold qi rules it. Greater yang takes cold as root and heat as tip. And also says that above in lesser yin, sovereign [fire] rules it. Lesser yin takes heat as root and cold as tip. When an illness is characterized by heat effusion and aversion to cold, it is spring from tip-yang of greater yang. When an illness is characterized by the absence of heat effusion and the presence of aversion to cold, it is spring from tip-yin of lesser yin. In illness springing from yin, the patient recovers in six days, this is because seven is yang number and six is yin number.

This line states a general outline of yin and yang, cold and heat, and tip and root, and also determination of the recovery period according to the number of yin-yang. As for the difference of hand foot tip root, hand greater yang takes heat as tip, and is to be a mutual exterior-interior of the hand lesser yin. Heat effusion and aversion to cold spring from the tip-yang of the hand greater yang. Foot greater yang takes cold as root, and is to be a mutual exterior and interior with foot lesser yin. The absence of heat effusion and the presence of aversion to cold spring from the tip-yang of foot lesser yin.

[COMMATARY]

1) the sign of heat effusion and aversion to cold (發熱惡寒) springs from greater yang tip yang (太陽標陽), whereas, the sign of the absence of heat effusion and the presence of aversion to cold springs from lesser yin tip yin (少陰標陰).

Line 53.

傷寒脈浮緊不發汗因致衄者麻黃湯主之

If cold damage with pulse that is floating and tight is not treated with promotion of sweating, spontaneous external bleeding will occur, Ephedra Decoction (ma huang tang) governs.

前言邪從衄解一在八九日三陽熱盛服麻黃湯之後而解也. 一在太陽本經熱盛亦有不服麻黃湯可以自衄而解也.然二者皆於衄後而解亦有衄後而不解者不可不知.傷寒脈浮緊不發汗因致衄者其衄點滴不成流雖衄而表邪未解仍以麻黃湯主之俾元府通衄乃止. 此一節又補言衄後邪不解之證也.然邪解而脈微邪不解而脈浮以此為辨.

In the preceding line, it is mentioned that spontaneous external bleeding resolves evil, the one case is that on the eight or nine days three yang (三陽, greater yang, yang brightness, lesser yang) were exuberant and after taking of ma huang tang, the disease was resolved, and the other case is that the heat of greater yang root channel was exuberant and after spontaneous external bleeding, the disease was resolved without taking of Ephedra Decoction (ma huang tang). Both of the two cases were resolved after spontaneous external bleeding, and there is also the other case in which the disease is unresolved after spontaneous external bleeding, one should know this another case.

When the treatment of promotion of sweating is applied to cold damage with a floating and tight pulse and this gives rise to spontaneous external bleeding,; the spontaneous external bleeding is dripping down without running, in spite of spontaneous external bleeding, the exterior evil does not resolve, hence, if Ephedra Decoction (ma huang tang) is given to free sweat pores, spontaneous external bleeding will cease.

This line describes the pattern in which, after spontaneous external bleeding, evil has not resolved. Anyway when evil resolves, the pulse is faint, and when evil is unresolved, the pulse is floating, we can identify a pattern from this.

Line 54.

傷寒不大便六七日頭痛有熱者與承氣湯其小便清者知不在裏仍在表也當須發汗若頭痛者必衄宜桂枝湯

Cold damage with inability to defecate for six or seven days, headache, and heat effusions should be treated with Qi-Coordinating Decoction (cheng qi tang). If the urine is clear, we can know the disease is not in the interior, but is still in the exterior, and this should be treated with the promotion of sweating, and if there is still a headache, there will be spontaneous external bleeding, Cinnamon Twig Decoction (gui zhi tang) is appropriate.

以上兩言得衄而解又言得衄而仍不解大旨以汗之與血異名同類不從汗解必從血解既衄而不成衄者又當從汗而解之言之詳矣. 然衄證又當以頭痛為提綱以頭為諸陽之會督脈與太陽同起於目內眥邪熱盛則越於督脈而為衄也. 然頭痛病在上也而察其病機則在於下一曰大便一曰小便. 若傷寒不大便六日為經之氣已周七日又值太陽主氣之期頭痛有熱者熱盛於裏而上乘於頭與承氣湯上承熱氣於下以泄其裏熱.其頭痛有熱而小便清者知熱不在裏仍在表也當須發汗以麻黃湯泄其表熱.此一表一裏之證見俱見頭痛.若頭痛不已者勢必逼血上行而為衄此可於未衄之前以頭痛而預定之也.然猶有言之未盡者病在表者固宜麻黃湯至於病在肌腠其邪熱從肌腠而入經絡頭痛亦必作衄宜以桂枝湯於未衄之前而解之.

此一節以「頭痛者必衄」五字為主而言在裏在表在經之不同欲學者一隅而三反也.

總而言之桂枝與麻黃功用甚廣而桂枝湯更有泛應曲當之妙.

In the preceding lines, there is two cases, the one case is that a disease is resolved through spontaneous external bleeding, and the another case that a disease is not does not resolve after spontaneous external bleeding, the preceding lines explained in detail that sweat and blood are different in name and same in source, hence, if promotion of sweating fails to resolve a disease, the disease is resolved through spontaneous external bleeding, and whether spontaneous external bleeding has already happened or not, it should be treated again with sweating.

The pattern of spontaneous external bleeding is analyzed on the basis of headache, because the head is the confluence of the yang channels. Governor vessel with greater yang originates in inner canthus, excessive evil heat astrays to governor vessel causing spontaneous external bleeding. The headache is in the upper, whereas the phathomachanism is in the lower, the one is stool and the other is urine.

When inability to defecate has lasted for six days during which the qi of six channels turns one time or seven days when greater yang governs qi, there is headache and heat effusion, the heat rises up to the head because heat is exuberant in the interior, give Qi-Coordinating Decoction (cheng qi tang) to drain interior heat and downbear heat qi in the upward. If the urine is clear, we know the disease is not located in the interior, but is still in the exterior, and this should be treated by the promotion of sweating with Ephedra Decoction (ma huang tang) to discharge the exterior heat. The one is exterior pattern and the other is interior pattern, headache is present in both cases.

If the headache is incessant, the force of the heat distresses blood to rise up, resulting in spontaneous external bleeding, this can be prognosised by headache before spontaneous external bleeding appears. And there is something unwritten, a disease in the exterior is appropriate to be treated with Ephedra Decoction (ma huang tang), but, as here, in case a disease is in the interstices of the flesh, evil heat enters the channels and network through the interstices of the flesh, necessarily causing headache and spontaneous external bleeding, this should be resolved with Cinnamon Twig Decoction (gui zhi tang) before spontaneous external bleeding occurs.

This line considers the phrase “if there is still a headache, there will be spontaneous external bleeding’ as a key point. And mentioned that the disease could be is in the interior, exterior, or channel, and the results are different, one who is a learner has to infer ten from one.

In short, Cinnamon Twig (gui zhi) as well as ephedra (ma huang) can be used widely and Cinnamon Twig Decoction (gui zhi tang) can be applied variously.

Line 55.

傷寒發汗已解半日許復煩脈浮數者可更發汗宜桂枝湯

Promotion of sweating has already resolved cold damage, but, after half a day or so has passed, there is again vexation and a pulse that is rapid and floating, one can again promote sweating, Cinnamon Twig Decoction (gui zhi tang) is appropriate.

傷寒服麻黃湯以發汗服後汗出身涼為表邪已解. 至半日許復發熱而煩是表邪解而肌邪未解也. 又診其脈不見桂枝之浮弱仍見麻黃證之浮數者知非麻黃證未罷乃肌腠之邪不解動君火之氣而為煩所致.麻黃湯不可治煩可更易麻黃湯之竣而用啜粥調和之法以發其汗宜桂枝湯主之解肌以止煩.

此一節總結十五節病有在表在外之不同湯有麻黃、桂枝之各異而申言桂枝之用更宏也.

In cold damage, Ephedra Decoction (ma huang tang) is given to promote sweating, after taking of this, sweating with generalized coldness indicates that exterior evil has already resolved. And then half a day or so there is again heat effusion and vexation, this indicates that although exterior evil resolved but evil in the flesh has not yet resolved.

And in the pulse, the floating and weak pulse that is related with Cinnamon Twig (gui zhi) is not observed, but the floating and rapid pulse of ephedra (ma huang) appears, one should know that the pattern of ma huang tang is eliminated but the evil in the interstices of the flesh is unresolved, stirring the qi of sovereign fire, resulting in vexation. Ephedra Decoction (ma huang tang) is unable to treat vexation, this should be treated with mild medicinal and the method of harmonization with thin gruel, Cinnamon Twig Decoction (gui zhi tang) is appropriate to treat this through resolving the flesh and allaying vexation.

This line summarizes the 15 lines (38 to 55). The diseases in the exterior and in the outward are different, ma huang tang and gui zhi tang are different with each other, and the using of gui zhi is more wider than ma huang.

［柯韻伯云］桂枝湯本治煩服後外熱不解而內熱更甚故曰反煩. 麻黃證本不煩服湯汗出外熱初解而內熱又發故曰復煩凡曰麻黃湯主之桂枝湯主之者定法也. 服桂枝湯不解仍與桂枝湯；汗解後復發煩更用桂枝湯活法也. 服麻黃湯復煩可更用桂枝；服桂枝湯復煩者不得更用麻黃. 且麻黃脈證但可用桂枝湯更汗不可先用桂枝湯發汗此又活法中定法矣.

Ke Yun Bo says that Cinnamon Twig Decoction (gui zhi tang) originally treats vexation, but after taking of this, exterior heat is unresolved and internal heat gets more severe, hence it is said that “but there is vexed.” The pattern of ephedra (ma huang) originally does not have vexation, after taking of this, sweat issues and then the exterior gets to resolve at first, but internal heat occurs, hence, it is said that ‘there is vexation again.” Generally, what is said that ‘Ephedra Decoction (ma huang tang) governs’ and ‘Cinnamon Twig Decoction (gui zhi tang) governs’, is a fixed method (定法). Whereas, when, after taking of Cinnamon Twig Decoction (gui zhi tang), a disease has not yet resolved, it is suggested to give Cinnamon Twig Decoction (gui zhi tang) again, and when, after sweating resolves a disease, vexation occurs, Cinnamon Twig Decoction (gui zhi tang) is also suggested to be taken, those are an adapted method (活法).

After taking of Ephedra Decoction (ma huang tang), if vexation occurs, Cinnamon Twig (gui zhi) can be used again, but after taking of Cinnamon Twig Decoction (gui zhi tang), if vexation occurs, ephedra (ma huang) cannot be used again. And in case of the pattern of ephedra (ma huang), it is possible to promote sweating further with Cinnamon Twig Decoction (gui zhi tang), but from beginning, it is inappropriate to promote sweating with Cinnamon Twig Decoction (gui zhi tang). This is an adapted method in the middle of a fixed method.

Line 92.

病發熱頭痛脈反沉若不差身體疼痛當救其裏宜四逆湯

When an illness with heat effusion, headache, and the pulse that is sunken, has not improved, and [after the promotion of sweating], if there is no recovery and generalized pain still has not ceased, it is appropriate to relieve the interior. Counterflow Cold Decoction (si ni tang) should be used.

太陽病發熱頭痛痛在表則脈宜浮而反沉此正氣內虛也. 若既汗之不差其身體疼痛仍然不罷須知其表熱為外發之假陽脈沉為內伏之裏陰當憑脈以救其裏宜四逆湯.《內經》云：「太陽本寒而標熱.」此證見標證之發熱不見本證之惡寒以本寒之氣沉於內外無惡寒而內有真寒也. 此一節言病在表而得裏脈又當救其裏不必如上文之身疼痛而止救其表也. 太陽之氣外行於三陽而從表內行於三陰而從裏.今表證而得裏脈恐沉必兼微.

In greater yang disease with heat effusion and headache, if the pain is in the exterior, the pulse should be floating, but it is sunken. This means that the right qi is vacuity in the interior. After the promotion of sweating, if there is no recovery and generalized pain still has not ceased, one should know that the exterior heat is false yang effusing outward and the pulse that is sunken means the yin is hidden in the interior, so according to the pulse, one should relieve the interior and Counterflow Cold Decoction (si ni tang) is appropriate.

Nei Jing says; “The root of greater yang is cold and the tip of it is heat.”

In this pattern, heat effusion which is the tip pattern of treater yang appears and aversion to cold which is the root pattern of greater yang does not appear. Because the root cold falls inward, so aversion to cold is absent and there is true cold in the interior.

This line says that even though the disease is in the exterior, if the pulse belongs to the interior pattern, one should relieve the interior, and it is not necessary to relieve generalized pain.

In three yang the qi of the greater yang moves outward through the exterior and in three yin it moves inward through the interior. Now there is exterior pattern with yin pulse, the pulse will be sunken and faint.

Line 93.

太陽病先下而不愈因復發汗以此表裏俱虛其人因致冒冒家汗出自愈所以然者汗出表和故也裏未和然後復下之

When in greater yang disease, initial precipitation fails to bring about recovery and sweating is then promoted, and because of the two treatments there is dual exterior-interior vacuity, the person will be encumbered by veiling dizziness. Veiling dizziness patients will recover spontaneously after sweating. This is because sweating harmonizes the exterior. The interior is not yet harmonized, so afterwards one should precipitate.

太陽病當先發汗今先下之虛而不愈因復發汗以此汗下失度致表裏俱虛陰陽不相交接其人因致首如有所覆戴之象而為冒此陰虛於下而戴陽於上也. 冒家汗出自愈所以然者以陽加於陰得陰氣以和之汗出表和故也.蓋I表裏之氣本相通表和裏亦和不必復下.若審得裏未和然後復下之.

此一節應上文先發汗而復下之之意也.

In case of greater yang disease, one should first promote sweating, but precipitation is used first, which cause vacuity without recovery. And then the promotion of sweating is used again. The two treatments make the exterior and interior vacuous, and then which causes yin and yang not to connect with each other, therefore, the person is encumbered by veiling dizziness as like the head being covered with something. This is because yin vacuity in the lower and yang upcast in the upper. Sweating brings spontaneous recover to the veiling dizziness patients. Why this is so is that if yin is added to yang harmonization occurs. The exterior and interior qi originally connect with each other, so if the exterior becomes harmonized, the interior will be also harmonized, therefore it is not necessary to use precipitation.

If the interior has not yet harmonized, afterward, precipitation can be used.

This line corresponds to a case of first promotion of sweating and then precipitation