(1) Life and Academic Thought

Zhou Yang-jun , styled Yu Zai , was from Wu, Jiangsu. His exact birth and death dates are unknown. He was likely born in the late Ming Dynasty and primarily lived during the early Qing Dynasty, around the Shunzhi and Kangxi eras. Zhou initially pursued the imperial examinations, becoming a deputy tribute student, but repeatedly failed the exams. Around the age of forty, he abandoned Confucian studies to focus on medicine, delving into the teachings of Qi Huang and Zhang Zhongjing for over a decade, greatly advancing his knowledge. In the Xinhai year (1671), he traveled to the capital and gained fame as a physician.

Zhou studied under Lin Beihai , who taught him the Zhang He-teng treatise on treating summerheat diseases. Zhou regarded this work as "clarifying profound principles with precision, its minor flaws overshadowed by its great virtues, truly capable of awakening the ignorant for generations." Thus, Zhou's academic thought was deeply influenced by Zhang's teachings.

Since the Jin and Tang dynasties, physicians had considered cold-damage disease the most severe threat to public health. Zhou , through practice, realized that while cold-damage disease was serious, warm-heat and summerheat epidemics were even more devastating. He pointed out, "Among diseases, cold-damage is the most severe, but warm-heat is even more intense. Cold-damage occurs in a single season, while warm-heat and summerheat epidemics span three seasons, lasting longer and affecting more people." Therefore, he strongly advocated distinguishing the origins of warm febrile disease and cold-damage disease to avoid misdiagnosis. Zhou believed in the theory of latent pathogens for the onset of warm febrile disease, stating, "In winter, warm diseases first open the body's striae and interstices, allowing cold to invade. As the saying goes, 'Where pathogens gather, the qi must be deficient.'... What is injured is cold, what manifests is warmth, what lies latent is shaoyin , and what emerges is shaoyang . Thus, the disease must involve yang and exclude yin, and treatment must use cold and avoid heat, with Skullcap Decoction as the primary remedy." Since warm diseases manifest in spring, when wood is strong and water is deficient, the latent pathogens rise and spread, with fire qi blazing. The pathogens emerge from within, moving from the interior to the exterior, causing internal and external heat. As heat dominates, the pathogens deplete fluids, resulting in fever and thirst without aversion to cold. Warm diseases can arise spontaneously or be triggered by new pathogens. "When accompanied by external contraction, there must first be headache or aversion to cold, followed by persistent fever. This is the new contraction drawing out the old pathogen." Zhou's understanding of the etiology, pathogenesis, and onset of warm diseases greatly influenced later generations in their approach to the onset and initial treatment of spring warmth.

1. Distinguishing warm disease Rebing from cold-damage disease: Zhou believed that warm-heat and summerheat epidemics were more harmful than cold-damage disease. He strongly advocated clarifying the origins of warm febrile disease and cold-damage disease, emphasizing that "without understanding the source, the flow cannot be clear; without distinguishing the category, treatment cannot be appropriate." He opposed the contemporary practice of using warm-heat medicines to treat warm diseases, stating, "Using heat medicines is like adding fire to fire—who can discern the truth?" Zhou maintained the view that latent cold transforms into warmth in his understanding of warm disease Rebing. He further elaborated on the pathological mechanisms, symptomatic manifestations, and treatment methods compared to his predecessors. His treatments were primarily based on the cold-damage disease theory and the Jingui Yaolue , incorporating both Zhang Zhongjing's formulas and those of other renowned physicians throughout history. For high fever conditions, in addition to internal administration of cold-cooling decoctions, he also employed cold compresses to reduce temperature.
2. Distinguishing summerheat and Rebing, different in cause but similar in treatment: Zhou believes that the "Taiyang (EX-HN5) Zhongshu" and "Taiyang (EX-HN5) Zhongre" in the Jin Gui are summerheat disease. Although summerheat disease and Rebing both occur in summer, their causes are different, but their diagnosis and treatment are essentially the same. Zhou points out: "Shu comes from the outside and enters, while heat arises from internal accumulation, truly two different paths." Summerheat disease presents with weak pulse, body heat, extreme thirst, dry teeth, sweating, and panting, similar to internal heat, treated with White Tiger Decoction, and Ginseng is added for severe fluid consumption. Regarding the predecessors' division of summerheat into yin-yang, he offers his own view: "The summer heat syndrome, as mentioned in the Jin Gui, is the disease of dampness stroke and steaming heat. Jiegu and Dongyuan divided yin-yang based on activity and inactivity, considering active acquisition as yang, treated with White Tiger; inactive acquisition as yin, treated with Dashun, Lengxiang, and other formulas. How could they know that the intense summer heat has yang but no yin, and the difference between activity and inactivity is not significant? Only excessive consumption of cold fruits and foods and indulgence in sexual activities injure the taiyin and shaoyin, where hot medicines can be temporarily used. How can warm and hot flavors be considered as universal remedies?" Zhou 's understanding and treatment of summerheat syndrome still hold guiding significance today.
3. On the invasion of epidemic pathogens, it is the confusion of the triple energizer, and the treatment mainly focuses on cooling and detoxifying: Zhou holds the view of Wu You-ke. He believes: the filthy and evil qi in the world, when it becomes an epidemic, is extremely toxic. When people are infected, the triple energizer is confused, with no distinction between inside and outside, no separation of surface and interior, directly affecting the middle path. The theories of upper, middle, and lower, as discussed by Zhongjing, actually refer to the pulse of damp qi, only because the phrases like "internal and external blockage" seem similar to epidemics, but in reality, they are unrelated. As for the methods of treatment, whether to treat the upper or lower first, from inside or outside, can be understood based on the symptoms. I only follow the book of Wu You-ke as the main treatment, with the principle of treating based on symptoms, not solely relying on the pulse. Other symptoms are varied, but the main approach is to cool and detoxify.

(3) Main Works

Zhou authored Cold-Damage Disease Treatise with Three Annotations, Golden Chamber and Jade Pouch Classic with Two Annotations, Complete Book of Warmth and Epidemic Diseases, etc. The latter was completed in the year Kangxi Jiwei (1679) and is his representative work. Zhou observed that "in the world, true cold-damage diseases are very few, while similar diseases are many; cold syndromes are very few, while Rebing is numerous," "the difference between cold and warmth is as vast as heaven and earth, the treatment of cold and warmth is as opposite as ice and fire," fearing that people might mistakenly treat them with cold-damage disease methods, he wrote Complete Book of Warmth and Epidemic Diseases. Also, in the year Wu Wu (1678), a seasonal epidemic was prevalent, and a certain official Ding, sympathizing with the suffering of the people, ordered the urgent publication of the book to share with like-minded individuals. The book is Zhou 's compilation of Zhongjing's Cold-Damage Disease Treatise with Three Annotations, Supplement to the Golden Chamber, in addition to clarifying the scriptures on warm, heat, summerheat, and epidemic syndromes, collecting prescriptions and theories, not deviating from the sacred methods, but fitting the condition of the disease, each forming its own volume.

• Volume one is the theory and prescriptions of warm diseases, first discussing Zhongjing's main text, then the treatment of spring warmth, including wind-warmth, winter warmth, warm malaria, warm toxin disease treatments, three medical cases, spring warmth theory, warm febrile disease pulse theory, five warm disease prescriptions, and 29 collected prescriptions.
• Volume two is the theory and prescriptions of Rebing. First discussing Zhongjing's relevant articles on Rebing, then the treatment and prescriptions of summer heat collection and supplement, general discussion of warm and heat death pulse and death syndromes, including dampness warm disease, yang toxin eruptions, yin toxin eruptions, summer Rebing theory, four Rebing prescriptions, and 18 collected prescriptions.
• Volume three is the theory and prescriptions of summerheat disease, first discussing Zhongjing's articles, then the pulse theory of summerheat disease, distinguishing the differences between cold and summerheat, summerheat affecting two yangs, common summerheat, active summerheat, static summerheat, summerheat injury with water, internal injury with summerheat, latent summerheat, summerheat convulsion, summerheat sores, summer phthisis, summerheat sores, summerheat atrophy, twisted intestine cholera, cholera, dry cholera, general methods of taking medicine, Li Dong-yuan's theory of summerheat injuring stomach qi, Wang Yu-tai's revised Summerheat-Clearing Qi-Replenishing Decoction with modified methods for changing syndromes, Zhu Dan-xi's distinction between active and static summerheat, Fang Gu'an's theory, Wang An-dao's differentiation of summerheat stroke and heat stroke, including 13 medical cases. Summerheat disease mostly adopts Zhang He-teng's Complete Book of Summerheat Injury, the theory of summerheat disease is Zhou 's own writing, including two summerheat disease prescriptions, and 29 collected prescriptions.
• Volume IV is a treatise on pestilence prescriptions, beginning with the discussion of Wu You-keWenyi Lun, the nine transmissions of pestilence, and several common pestilence syndromes, such as swollen-head infection, neck-twisting pestilence, melon-pulp pestilence, Chinese wax myrtle bark pestilence, lump pestilence, intestinal-twisting pestilence, and pestilent flaccidity of the foot, accompanied by ten medical cases. The Wenyi Lun is appended with Mr. Lin Beihai's preface to Yu Jia-yan's treatise on pestilence, and Yu Jia-yan's Wenyi Lun, containing 16 pestilence prescriptions and an additional collection of 16 prescriptions. The Zhou family's discussion on pestilence primarily upholds the views of Wu You-keWenyi Lun, while disagreeing with Yu Jia-yan's theory of pestilence affecting the upper, middle, and lower regions.

Zhou Yang-jun is a follower of the theories of Fang and Yu, believing that only these two have grasped the essence of Zhang Zhongjing's teachings through the ages. Therefore, Zhou Yang-jun's research on cold-damage disease theory is based on the works of Fang and Yu. Where the annotations are incomplete, he delves into his own understanding, hoping to gain further insights and supplement the deficiencies. Hence, his work is titled Three Annotations on the Cold-Damage Disease Theory.