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Externally contracted disease (cold damage in the broad sense) is caused by evils entering the body from outside. Since the greater yáng channel governs the exterior of the body, it is usually the first to be affected. For this reason, the discussion of greater yáng disease forms the first chapter of the Shāng Hán Lùn. External evils may enter other channels directly, but very often, externally contracted disease begins with the greater yáng contracting the evil. Greater yáng disease is much more varied in its manifestations than disease of any other channel. This is reflected in the fact that the lines devoted to greater yáng disease make up nearly half of the entire book.

In greater yáng disease, an evil invades the fleshy exterior. There are three basic forms of greater yáng disease—wind strike, cold damage (in the narrow sense), and warm disease—reflecting Zhāng Jī’s understanding that externally contracted disease is attributable to wind, cold, or warmth. Diseases attributed to external contraction of cold form the main body of information presented in this chapter. Warmth is accorded relatively insignificant status, since only one line of greater yáng disease deals with it.

Greater yáng disease arises when external evil invades the fleshy exterior and impairs the normal functioning of the defense qì. Wind strike is characterized by fever—or as we refer to it in this text, “heat effusion”—together with aversion to cold or wind, and spontaneous sweating; cold damage is characterized by heat effusion, aversion to cold, and absence of sweating; and warm disease is characterized by heat effusion, thirst, and mild aversion to wind and cold or, in some cases, absence of aversion to cold. Which of these three basic patterns occurs depends on the constitution of the patient and the nature of the evil.

In modern literature, exterior patterns are usually presented in a primary division of wind-heat and wind-cold. This represents a later development in the understanding of externally contracted disease. Neither of these terms occurs in the Shāng Hán Lùn.

Inappropriate treatment or lack of treatment can give rise to a transmuted pattern (变证 biàn zhèng) or cause the evil to shift into another channel. These changes depend on the type of inappropriate treatment, the patient’s constitution and the nature of the evil. Although greater yáng disease is associated with exterior patterns, many transmuted patterns are interior in nature. These patterns are varied in nature, as will be seen below, due to the combination of factors producing them.

If an exterior evil falls inward and binds with phlegm-rheum, stagnant food, or static blood, bind patterns may be observed, including water amassment, blood amassment, chest bind, and glomus patterns.

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