Shan Han Lun

Cold Damage

(Shang Han Lun)

Instructor: Dr. Kevin Hu, BayVan Clinic of Acupuncture and Chinese Medicine, Victoria




Part 1     Taiyang disease – symptom, syndrome, treatment – Introduction

Section 1   Essential features of Taiyang Disease

Section 2   Exterior Syndromes of Tai Yang diseases

1. Syndrome of wind attack

1) SD of Gui Zhi Tang

2) Contraindication of Gui Zhi Tang

3) Concurrent Patterns of Gui Zhi Tang

2. SD of cold attack

1) Ma Huang Tang Syndrome

2) Contraindication of sweating methods

3) complication –SD indicated by ge geng tang

Section 3. Interior syndromes of taiyang 


Part 2 Yang Ming Diseases

1. Outline

2. Etiology and parthenogenesis

3. Heat syndrome (meridian)

4. Excess syndrome (fu organ)

5. Transformed syndrome


Part 3  Shang Yang Diseases


 Class 1  

Instructor: Dr. Kevin Hu, BayVan Clinic of Acupuncture and Chinese Medicine, Victoria


– About the book

– Achievements

– Concept of Shang Han

– Concept of Liu Jing (six meridians)

– Methods of syndrome differentiation (in Shang Han Lun)

– Treatment principles/methods (in Shang Han Lun)


  1. About the book


Shang Han Za Bing Lun = Shang Han Lun + Jin Gui Yao Lue

伤寒杂病论 = 伤寒论 + 金匮要略

Author: Zhang zhong Jing, 150-219 AD, “saint of doctor”,


Book: written in 202 or 203 AD

Re-compiled: 220 to 235 AD

Compiled by government: 1065

first about clinic, diseases due cold, syndrome differentiation

Formulas #: 113

Herb #: 92


  1. Achievements

-syndrome: by six channels

-treatment(principle – formula– herbs) by syndrome

  • basic book:
  • shang han → wen bing


  1. Concept of Shang Han (伤寒)

-all diseases due to exogenous PF (Broad)

-diseases due to exogenous (wind) cold

– exterior excess SD due to cold (narrow)


  1. Concept of Liu Jing (six meridians,六经)

6 meridians = 12 meridians + zang/fu organs



  1. Methods of syndrome differentiation in Shang Han Lun

Liu Jin (six meridians) VS eight principle

Liu Jin VS zang fu

  1. Transmissions of Liu Jin

tai yang – shao yao – yang ming – tai yin – shao yin –jue yin  (– tai yang)


  1. Treatment principles/methods (in Shang Han Lun)

Reinforce zheng qi + eliminate xie qi

Part 1    Taiyang disease – symptom, syndrome, treatment

(bian tai yang bing mai zheng zhi)


  1. Physiology of Tai Yang

– fence (screen)

– regulate pores and sweating

– regulate water metabolism


qi of tai yang = qi of the superficial (location)

= defensive qi (function)


related organs: KI – KI yang (because UB relates to KI)

ST – send body f

LU — dispersing


Distribution of UB M: from eyes to head to nape along spine


  1. Pathology of Tai Yang


disease of tai yang: due to disharmony between ying (nutrient qi) and wei (defensive qi) caused exogenous PF attack


etiology: wind cold

pathogenesis: wind cold attack, APF and PF fight, disharmony between ying and wei

location: ext

Nature: (ext) cold


  1. Diagnosis and patterns of Tai Yang diseases

chief symptoms: aversion to cold, headache (stiff nape)

main pulse: floating

symptom of fu (organ): unsmooth urination

symptom of m: stiff nape/upper back


  1. Treatment principle of Tai Yang diseases

1) ext def (loose skin/loose) due to wind attack—gui zhi teng

2) ext exc due cold attack – ma huang tang

3) warm disease of tai yang


  1. Prognosis of Tai Yang diseases

– be cured

– transmission: development

yang damage

yin damage


– change into other diseases, caused by incorrect treatment

Section 1   Essential features of Taiyang Disease


Key points: tai yang diseases — concept,

SD patterns


treatment principle


Lecture content:

– physiology of tai yang, relation between tai yang and other zang fu organs;

– tai yang diseases: concept, SD patterns, diagnosis, treatment principle

– prognosis of tai yang diseases

1 .  Principle of SD of Tai Yang diseases (line 1-8, 10)


Key point: principle of tai yang diseases and SD patterns

Lecture content:

– principle symptoms/signs of tai yang diseases (L 1)

– SD patterns: wind damage, cold damage, warm disease. (L 2, 3, 6)

– occurrence from yang or yin (L7)

– transformation of t y disease (L 4, 5)

– prognosis (L8, 10)


  1. Essential symptoms/ signs of Tai Yang diseases


Line 1

In disease of the greater yang, the pulse is floating, the head and nape are stiff and painful, and [there is] aversion to cold.

太 陽 之 為 病 , 脈 浮 , 頭 項 強 痛 而 惡 寒 。


Etiology: wind cold attacking the ext

Pulse: floating (location)

Symptoms: stiff and painful, the head and nape, (location)

    aversion to cold. – wind cold attack, qi of the ext is restricted (nature)



  1) why no fever?  -Save space

                  – no fever

                  – “aversion to cold” is more important than “fever”

  2) two symptoms + one pulse: most important

  3) all together, indicating diseases of tai yang


  1. Patterns of Tai Yang diseases


-Principle symptoms and pulse of wind strike SD (L2)



When in greater yang disease [there is] heat effusion, sweating, aversion to wind, and a pulse that is moderate, it is called wind strike.

太 陽 病 , 發 熱 汗 出 , 惡 風 脈 緩 者 , 名 為 中 風 。


Etiology: wind cold

Symtom: fever –fight betw PF and APF,

Sweating – def qi can nto control pores,   +    wind

Aversion to wind –

Pulse: (floating) moderate:



  • disease of taiyang: two meanings: 1)symptom and signs of disease of taiyang;                                                             2) wind cold
  • most important symptom: sweating


clinical features:

fever first, but T is not high, little aversion to cold, but aversion to wind —- sweating


L 3

Greater yang disease, whether heat has effused or not, as long as there is aversion to cold, with generalized pain, retching counterflow, and yin and yang [pulses] both tight, is called cold damage

– Principle symptoms/signs of tai yang cold attack (L3)

etiology: wind cold attacking the exterior


fever:  if APF strong – fever and aversion to cold together

weak — aversion to cold first, then fever

aversion to cold (must) : wei qi restricted

body ache: m qi obstructed

vomiting: ST qi rising reversely

pulse: chun/chi pulse tense



– tense pulse- – no sweating

– clinic feature: fever comes late, aversion to cold first,

fever high, aversion to cold severe, skin dry warm

  • pathological feature: wind cold attacking the ext, skin tight, wei yang obstructed, ying (nutrient qi) obstructed

Class 2

Instructor: Dr. Kevin Hu, BayVan Clinic of Acupuncture and Chinese Medicine, Victoria

*Line 6

When in greater yang disease [there is heat effusion and thirst, without aversion to cold, [this] is warm disease.

If, after sweating has been promoted, there is generalized scorching heat, this is called wind-warmth. [When] wind-warmth causes disease, the yin and yang pulses are both floating, [there is] spontaneous sweating, generalized heaviness, a tendency to sleep, the breath [from the] nose will [make a] snoring [sound], and speech is difficult.

If precipitation has been used, [there is] inhibited urination, forward staring eyes, and fecal incontinence;

if fire has been used, [there is] slight yellowing, and in acute cases [there is] fright epilepsy, periodic tugging and slackening, and [the skin] appears 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.

太 陽 病 , 發 熱 而 渴 , 不 惡 寒 者 , 為 溫 病 。 若 發 汗已 , 身 灼 熱 者 , 名 曰 風 溫 (一种环病) 。 為 病 , 脈 陰 陽 俱 浮溫 (才关尺), 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 瘛 瘲 ; 若 火 熏 之 , 一 逆 尚 引 日 , 再 逆 促 命 期 。

[Key] Principle pulse/symptoms of tai yang warm disease, and transformed diseases due to maltreatment



Wind strikeCause: wind cold;

Key S:  fever, aversion to cold, no thirst

Sweating, moderate/sup P

T P:  disperse wind and relieve ext

Result: damage yang qi

Cold damageCause: wind cold;

Key S:  fever, aversion to cold, no thirst

No sweating, tense/sup P

T P:  induce sweating with the pungent/warm

Result: damage yin

Warm diseaseCause: warmth/heat; fever, no aversion to cold, rapid /sup P

T P:  relieve the ext with the pungent and cool

Result: damage yang?

  1. b) Transformed diseases due to maltreatment

By sweating (location: HT/LU)

High fever – body f damage, heat excessive

Sweating —  heat excessive, force body f out

Heavy body – heat damage body f and qi

Sleepy state – heat disturbing mind

Sound of nose — heat excessive in LU

Difficult speech — heat disturbing mind (HT)


By purging (location: KI)

Difficult urination — heat damage yin fluid

Eyes staring — head damaging yin and produce wind

Incontinency of B –


By firing (location : LV)

Slight jaundice —  heat+heat—LV/GB — bile

Convulsion/tremor – heat – LV wind


Section 2  Exterior Syndromes of Tai Yang diseases


  1. Syndrome of wind attack

Content: 1) SD of Gui Zhi Tang

2) Contraindication of GZT

3) Associated SD of GZT


1) SD of Gui Zhi Tang 

– chief symptoms, pathogenesis, treatment P, formula, compatibility, preparation, usage of GZT (12, 13)

– application of GZT (95, 24, 42, 44, 45, 57, 53, 54)


Line 12

In greater yang wind strike with floating yang and weak yin, floating yang is spontaneous heat effusion, and weak yin is spontaneous issue of sweat. If] there is [huddled aversion to cold, wetted aversion to wind, feather-warm heat effusion, noisy nose, and dry retching, Cinnamon Twig Decoction (gui zhi tang) governs.


[For] the preceding five ingredients, break the [first] three ingredients into small pieces and sue seven sheng of water. Boil over a mild flame to get three sheng and remove the dregs. Take one sheng at moderate temperature. Shortly after taking [the fist dose] drink approximately one sheng of hot, thin gruel to reinforce th strength of the medicinals. Warm [the body] by covering [with a blanket] for a short period, ideally until the whole body is moist, as if sweating very lightly. One cannot allow [the sweat] to flow like water, since the disease will not be eliminated [in this way]. If one dose [causes] sweating and the disease is diminished, cease taking further [dose]. One need not finish the whole packet. If sweating is absent, take another dose according to the previous method. If sweating is again absent, reduce the time between doses, finishing three doses in half a day. If the disease is severe, take [doses] throughout the whole day, and observe [the patient] the whole time. After finishing one packet, [if] the disease sings are still evident, take again. If sweating is absent, one can take up to two or three packets. Foods contraindicated [while taking the formula] include raw and cold foods, sticky and slimy foods, meat and noodles, the five acrids, liquor, milk products, and foods with a peculiar or spoiled flavor or odor.


[Key] Etiology, pathogeneses, syndrome and treatment —- wind attack




Yang floating – light touch, floating

Yin weak – press down, weak




病机 pathogenesis


Yang floating: fever, —- defensive qi strong


yin weak: sweating, —- nutrient qi weak, sweaking



主证 key symptoms


Aversion to cold: sweating—pores opening

          Wind: sweating – ying (nutrient weak)

Fever (low grade): fight

嗇嗇恶寒, 汗出窍开,遇寒则恶




辅证 other symptoms:


Stuffy nose — LU obstruction

Dry vomiting – ST qi up







gui zhi tang —- harmonize ying and wei

              disperse wind and relieve ext




– watery boiled rice

– cover, mild sweating

– stop when effect

– continue if without effect

– diet cautions


Line 13

[For] greater yang disease with headache, heat effusion, sweating, and aversion to wind, Cinnamon Twig Decoction Governs


[Key] main symptoms and treatment


Line 95 

When in greater yang disease [there is] heat effusion and sweating, this means weakness in the construction and strength in the defense, [which] consequently causes sweat to issue; to eliminate the evil wind, Cinnamon Twig Decoction is appropriate.


[Key] More about etiology and pathogenesis and symptoms and treatment






3) Concurrent Patterns of Gui Zhi Tang    


Line 14

When in taiyang disease (there is) stretched stiff nape and back, but also sweating and aversion to wind, it is treated with Gui Zhi Jia Ge Gen Tang.


gui zhi, ge geng, ma huang?, shao yao, sheng jiang, gan cao, da zao


[Key] syndrome of gui zhi plus ge geng tang

Gui Zhi Tang syndrome + blockage of meridian


Line 18

For panting patients suffering from ,Gui Zhi Tang.(pattern), it is best to add hou pu and xing zi (xing ren).


[Key]  synd of gui zhi plus hou po xing ren tang (1)

Gui zhi tang syndrome + asthma (chronic)


Line 43

When in taiyang disease, (there is) mild panting following precipitation, it means that the exterior has not resolved; (therefore,) Gui Zhi Jia Hou Pu Xing Zi Tang governs.

[Key] tai yang – purging – asthma ß treatment

gui zhi plus hou po xing ren tang


2. Syndrome of Cold Damage

1) Ma Huang Tang Syndrome

Line 35: main manifestations and treatment of syndrome of tai yang cold damage

When in greater yang disease [there is] headache, heat effusion, generalized pain, lumbar pain, joint pain, aversion to wind, absence of sweating, and panting, Ephedra Decoction governs.

Ma huang 9g, gui zhi 6g, gan cao 3g, xing ren (70 pieces )

Ma huang + 9 sheng (9 times 200 ml)  7 sheng, foam,
+ 3 herbs – 2.5 sheng


Line 46: further discussion on syndrome and treatment of TYCD and possible reaction after taking MHT

In greater yang disease, when a pulse that is floating and tight, absence of sweating, heat effusion, and generalized pain are unresolved after eight or nine days, the exterior pattern is still present and one should promote sweating.

After taking medicine, [the condition] should is slightly relieved, and the person is vexed and the eyes are heavy. If it is acute, there will be nose bleeding, which will bring about resolution [this] is so is because the yang qi is weighted) Ephedra Decoction governs.

SD/symptoms and possible reaction after taking ma huang tang

Reactions: mild: vexed and heavy eyes
Severe: bleeding

Line 47: release of TYCD by spontaneous bleeding

When in greater yang disease, the pulse is floating and tight, [and there is] heat effusion and absence of sweating, spontaneous external bleeding will bring about recovery.

2) Contraindication of sweating methods

Line 83

When the throat is dry, [one] cannot promote sweating.

Line 84

[With] strangury patients, one cannot promote sweating [because if] sweating is promoted there will be bloody excretions.

3) complication –SD indicated by ge geng tang (a)

Line 31

[In] greater yang disease with a stretched stiff nape and back, absence of sweating, and aversion to cold, Pueraria Decoction (ge gen tang) governs.

Pueraria 4 liang
Ephedra 3 liang (remove nodes)
Cinnamon twig 2 liang (remove bark)
Fresh ginger 3 liang (slice)
mix-fried licorice 2 liang
peony 2 liang
jujube 12 (broken)

Gui zhi tang + ge geng and ma huang

[For] the above seven ingredients, use one dou of water. First boil ephedra and pueraria (ge gen) to reduce [the water] by two sheng. Remove the white foam and add all the ingredients. Boil to get three sheng, remove the dregs, and take one sheng, warm Cover [with bedclothes] to obtain mild sweating. The remainder is as for Cinnamon Twig Decoction [with regard to ] rest and contraindications. [In fact,] all formulae based on Cinnamon Twig Decoction should be used according to this method.

Line 40

When in cold damage, the exterior has not resolved and [there is] water qi below the heart, with dry retching, heat effusion and cough, and possibly thirst or diarrhea, or dysphagia, or inhibited urination and lesser abdominal fullness, or panting, Minor Green-Blue Dragon Decoction governs.

Etiology: cold + water (qi)
Symptoms: dry vomiting — water attack ST
Fever –
Cough —water attack LU

Other possible S: thirst — water retention
Diarrhea —
Difficult urination – water accumulated in lower jia
Asthma — extcold + water attacking LU

T: XQLT – relieve ext, warm / resolve water

Ephedra 3 liang (remove nodes)
Peony 3 liang – bai shao
Asarum 3 liang – xi xin
Dried ginger 3 liang
mix-fried licorice 3 liang — gan cao
cinnamon twig (gui zhi, Cinnamomi Ramulus) 3 liang (remove bark)
schisandra (wu wei zi, Schisandrae Fructus) half sheng
pinellia (ban xia, Pinelliae Tuber) half sheng (washed)

Class 3

Instructor: Dr. Kevin Hu, BayVan Clinic of Acupuncture and Chinese Medicine, Victoria

  1. Interior syndromes of taiyang

Water accumulation

Line 71

When in greater yang disease, after sweating is promoted and great sweat, if there is dryness in the stomach, vexation and agitation with insomnia, and a desire to drink water, giving a small amount of water will harmonize the stomach qi so that recovery will ensue.

If the pulse is floating and there is inhibited urination, slight heat, and dispersion thirst, Poria (hoelen) five Powder (wu ling san) governs.


Transform qi and move water,  resolve the exterior.


Wu ling san


Zhu ling         Polyporus 18 zhu (remove skin)

Ze xie             Alisma (ze xie) 1 liang 6 zhu

Bai zhu          Ovate atractylodes (bai zhu) 18 zhu

Fu ling           Poria 18 zhu

Gui zhi           Cinnamon twig half liang ( remove bark)


For the above five ingredients, pound to a powder. Mix into a white rice cool decoction. Take the formula with a square-inch-spoon, three times a day. Drink copious amounts of warm water and when sweat issues, there will be recovery. Follow the previous method described of Cinnamom Twig Decoction (gui zhi tang) with regard to rest.


Key: two kinds of prognoses after profuse sweating;

Syndrome/symptoms and treatment→ water retention in triple jiao


Blood accumulation   

Line 106

When a greater yang disease is unresolved and heat binds in the bladder, the person is as if manic, and spontaneous blood descent will bring recovery. If the exterior has not been resolved, one should not yet attack, but should first resolve the exterior, When the exterior has been resolved and there is only tense bound lesser abdomen, one can attack, and therefore, Peach Kernel Qi-coordinationg Decoction (tao he cheng iq tang) is appropriate.


taoren            Peach kernel) 50 pieces (remove skin and tips)

da huang          Rhubarb 4

mang xiao      Mirabilite 2

gui zhi              Cinnamon twig 2

gan cao            Mix fried licorice 2


For the above five ingredients use seven sheng of water. Boil the first four ingredients to get two and a half sheng. Remove the dregs and add mirabilite (mang xiao). Again place on the fire and boil slightly. Remove from the fire and before eating take five ge warm, three times a dya. There should be slight diarrhea.

Yang Ming Diseases

Distinguishing Yang Ming (Diseases, Symptoms, Syndromes) + Treatment

  1. Outline

Essential features

Outward signs

Main pulse

  1. Etiology and pathogenesis
  2. Heat syndrome (meridian)

Zhi zi chi tang S

Bai hu tang S

Bai hu Jia (plus) renshen tang S

Zhu ling tang S

  1. Excess syndrome

Cheng qi tang

– tiao wei cheng qi tang

– xiao cheng qi tang

– da cheng qi tang

Moistening method

Purging methods

Forbiddance of purging

  1. Transformed syndrome


– yin cheng hao s

– zhi zi bo pi tang s

– mahuang lianqiao chixiao dou s

– jaundice due to cold

– pre-jaundice

– jaundice by firing method

Blood heat

  1. Differentiation

– wind attack VS cold attack

– deficiency VS excess

1. Outline

1)Essential features

L 180  In disease of yangming, the stomach domain is replete.

Key:  basic pathogeneses of yang ming

2) Outward signs

L 182  Question: What are the outward signs of yangming disease? Answer: (There is) generalized heat (effusion), (spontaneous) sweating and no aversion to cold, but aversion to heat.

Key: features of outward signs

2. Heat syndromes (channel)

Bai hu tang Syndrome

L 176

When in cold damage the pulse is floating and slippery, this (means there is) heat in the exterior and cold (note: should be heat) in the interior. Bai Hu Tang governs.
Key:  cold pathogen à heat :   fever without cold ß treatment

Bai hu teng:

Zhi mu 90 g

Shi gao 200g

Gan cao 30

Geng mi (120 he)

4. Excess syndrome – fu organ syndrome

1) Cheng qi tang

– tiao wei cheng qi tang

L 248

When taiyang disease (has lasted for) three days, and sweating is promoted (but there is) no resolution (of the disease) and (there is) steaming heat effusion, this belongs to the stomach, and Tiao Wei Cheng Qi Tang governs.
Key:  wrong treatment (tai yang) à fu shi of yang ming ß treatment

(damaging body f and add heat)

PFàST Heat

Gan cao 30

Meng xiao 100 ml

Da huang 60g

Boil at same time


– xiao cheng qi tang

L 213   (When) in yangming disease, the person is sweating copiously, because liquid and humor are issued outwards, the stomach becomes dry and the stool will be hard. With hard (stool), delirious speech will follow, and Xiao Cheng Qi Tang governs. If after one dose the delirious speech stops, no more should be taken.

Key: body f damage → hard stool + delirium ← treatment

(turbid heat disturbing upward)

Da huang 60g + hou po 30g + zhi shi 3 pieces,

Boil together; stop taking the herbs when bowels moved

– da cheng qi tang

L 220

When in drag over disease of the two yang, the taiyang disease has ceased and (there is) only tidal heat effusion, sweat streaming from the extremities, difficult defecation and delirious speech, precipitation will bring about recovery and (therefore,) Da Cheng Qi Tang is appropriate.

Key:  combination of two yang → fu shi of yang ming ← treatment


excess heat + “shi/faeces”

da huang 60g     boil later

hou po 250g

zhi shi 5 pieces

mang xiao 60 ml     mix with decoction

Part 3  Shao Yang Bing


Shao Yang = GB + San Jiao

1) Shu Xie ST/Intestines

2) transport qi/fluid (as a hub)

3) maintain water passage


1) Su Xie —- assist digestion of ST

2) store bile —- ministerial fire residing

San Jiao:

1) dominate various kinds of qi    (source: Ming Men; co-existence with: ST qi)

2) dredge water passage


PF → Tai Yang →  Shao Yang  Diseases



inner depression/stagnation of GB qi


dysfunction of San Jiao

Location:  half exterior and half interior (or that between the exterior and interior)


Nature: Heat



GB fire —- Bitter mouth, dry throat, blurred vision


PF  —- Struggle —- APF → alternative fever and cold

Meridians qi unsmooth → chest distress / hypochondriac region distress

Wood –attack– earth → poor appetite, tending vomiting

Pulse: wiry

1) → Shao Yang  Diseases

2) → Shao Yang  Diseases

1) + 2) → Shao Yang  Diseases


Harmonizing Shao Yang

Represent formula:

Shao Chai Hu Tang: chai hu, huang qin, ban xia, ren shen, sheng jiang, da za, gan cao


263   essential symptoms of SY SD

In disease of the shaoyang, (there is) a bitter taste in the mouth, dry throat, and dizzy vision.

PF —- Shaoyang —- physiologic fire in GB → pathogenic fire —- San Jiao disorder

Bile Fire


GB/LV —- LV/eyes

GB meridian —- eyes (inner corner)

Bitter mouth

dry throat

blurred vision




When in cold damage (that has lasted for) five or six days (or) wind strike, (there is) alternative (aversion to) cold and heat (effusion); (the person) suffers from fullness in the chest and rib-side, taciturnity沉默寡言with no desire for food or drink, heart vexation and frequent retching,or possibly (there is) vexation in the chest and no retching, or thirst or pain in the abdomen, or a hard glomus under the rib-side, or palpitations below the heart with inhibited urination, or absence of thirst with mild generalized heat, or cough; (then) Xiao Chai Hu Tang governs.


Main symptoms:fever/cold (alternated),


discomfort in chest/hypochndriac region,

poor appetite

-ST qi up-surge

-GB heat, ST def

Other symptoms:Or:

discomfort in heart but no vomiting;


abdominal pain;

palpitation, difficulty urination;

mass in hypochondriac region;

mild fever but no thirst

-Fire distb in chest, not in ST

-GB qi impair SP collaterals

-water retention

-shaoyang m qi stg, or water rt

-+exterior SD

pathogenesisGB stg/ST def + SJ dysfunction
Treatment p:Harmonize shao yang, drive PF to the superficial