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Question: What is the general principle in treating Cold Damage (Shanghan)? Zhang Zhongjing said: Generally, diseases of Cold Damage arise from contracting Wind-Cold. Initially, the exterior is affected by Wind-Cold; if it penetrates inward, it will not dissipate on its own. There is no case where warming and covering fails to resolve it. If it does not fall within the scope of exterior syndrome treatment, and one intends to purge, one must first release the exterior before purging. If the exterior is resolved but internal stagnation remains, unless there is fullness and excess, cold and heat will persist, and the disease will not be cured. If the exterior is resolved but internal stagnation remains, and there is severe fullness, excess, hardness, and dry feces, purging may naturally be applied; even after four or five days, it will not cause harm. However, if purging is inappropriately applied when not indicated, interior deficiency with heat invasion occurs, leading to diarrhea with accompanying heat, restlessness, and various other complications, which are countless. In mild cases, the condition worsens; in severe cases, death is inevitable. Hua Tuo said: On the sixth day of Cold Damage, the pathogen enters the Stomach; only then can purging be applied. If toxic heat remains on the exterior and has not entered the Stomach, yet purging is applied prematurely, the heat will enter the Stomach vacuously, causing putrefaction of the Stomach. If the heat is mild, red macules appear; if severe, black macules appear. Guo Yong said: This discussion on the appropriateness of sweating and purging constitutes the general principle of treatment methods.

Question: What happens if sweating and purging are misapplied? Zhang Zhongjing said: In conditions of Excess Yang and Deficiency Yin, sweating leads to death, while purging leads to recovery. In conditions of Excess Yin and Deficiency Yang, sweating leads to recovery, while purging leads to death. Thus, how can Shen Dan Pill be mistakenly used for sweating, or Kansui Root (Gansui) be recklessly used for purging? The treatments for Deficiency and Excess differ by a thousand miles; the mechanism of fortune and misfortune responds like shadow and sound. Is it easy? Moreover, if Guizhi Tang is swallowed in an Excess Yang condition, death ensues; if Chengqi Tang enters the Stomach in an Excess Yin condition, death follows. The crux of life and death lies in an instant; observing the patient's state leaves no time to count days. This is the interweaving of Yin-Yang, Deficiency, and Excess; the signs are extremely subtle, and the contrary effects of sweating, vomiting, and purging bring disasters swiftly.

Question: When both exterior and interior are affected simultaneously, can sweating and purging be performed concurrently? Zhang Zhongjing said: In cases where both exterior and interior syndromes occur simultaneously, treatment must follow a sequence. Releasing the exterior and attacking the interior are fundamentally different. Those who are stubborn and deluded claim that Shen Dan Pill and Kansui Root can be mixed and drunk together to simultaneously release the exterior and remove the interior. Their words are clever and seem plausible, but their logic actually violates principles. The actions of the wise are always prudent and cautious; the actions of the foolish are decisive and rapid. How can the changes of safety and danger be deceptive?

Question: What is the truth behind the theory that Cold Damage heals spontaneously after seven days? Guo Yong said: Although ancient famous physicians also held this view, only Zhang Zhongjing and Sun Simiao did not adopt it. Xu Renze said: If one cannot fully distinguish and differentiate, and other doctors are rarely exquisite, it is better to let nature take its course than to treat erroneously. One should merely consume bland flavors, adapt to cold and warmth, manage temperature regulation, and endure for seven days; this is the best strategy. Among these, the only situation requiring medication rather than waiting passively is prolonged constipation, which temporarily requires laxation. Guo Yong considers this view sound, yet people contract diseases with varying severity. Fortunately, if the contraction is light and symptoms follow normal patterns, such a theory applies. But if the contraction is deep and severe, with atypical complications, death occurs upon the completion of seven days. Therefore, Zhang Zhongjing stated that when Qi of the seasons is discordant, early intervention is needed, and when pathogens are in the Couli (interstices), timely treatment is required. Sun Simiao said do not allow pathogenic qi to remain free and attack the body indiscriminately, waiting passively for death. Are not Xu's words and the saying "leaving illness untreated often yields average medical results" all expressions born of frustration?

Question: Regarding the view that harsh medicines should not be used in the initial stage of Cold Damage, what is your opinion? Guo Yong said: This can be considered the words of a good physician. I have often heard Chang Qizhi say this to beginners with shallow knowledge. Zhang Zhongjing's method is: if there is the syndrome, use the corresponding medicine. Now, if one speaks of Guizhi Syndrome or Mahuang Syndrome, it implies the use of Guizhi Tang and Mahuang Tang. However, ordinary people lack the scholarly insight of Zhang Zhongjing, so errors lie therein. How dare one completely use his medicines? Upon encountering Guizhi Syndrome, one must consider using a milder formulation of Guizhi; upon encountering Mahuang Syndrome, one must consider using a milder formulation of Mahuang. This is to anticipate potential errors in pulse and syndrome, preparing in advance, thereby not losing the general intent of Zhang Zhongjing. If one blindly uses Zhang Zhongjing's formulas solely based on his words, without self-assessment and careful consideration, acting decisively without doubt, this is what is meant by the foolish acting rapidly and decisively. Few escape error. As for Qinglong Tang, Chengqi Tang, Shizao Tang, Xianxiong Tang, etc., those with shallow learning should especially abstain from them. If one's medical understanding is truly profound, one should follow Zhang Zhongjing's words entirely, yet even then, one must heed the warnings regarding Chengqi Tang. Can one be unprudent?

Question: Some say that for Cold Damage, one should only treat based on symptoms. What is your view? Guo Yong said: Meridians come first, symptoms and pulses come second. Zhu Gong's *Huoren Shu* states: Treating Cold Damage without understanding meridians is like walking blindly in the dark, not knowing where the pathogenic qi resides. Often, disease is in the Taiyang channel, yet one attacks Shaoyin; the syndrome is Jueyin, yet one harmonizes Shaoyang. The cold pathogen is not removed, and the True Qi is destroyed. Furthermore, Cold Damage involves many external signs; questioning before palpating the pulse is most accurate. Sun Simiao said: Knowing through questioning and distinguishing depth of disease is called a skillful physician. Having identified the meridian, one then palpates the pulse to distinguish between exterior and interior, deficiency and excess, and apply sweating or purging accordingly. The ancients said that knowing through questioning makes one a middle-tier practitioner, while knowing through palpation makes one a lower-tier practitioner. Guo Yong said: The onset of Cold Damage is sudden and thus relatively easy to observe. Therefore, asking about external signs and palpating the Cun Kou (radial artery) is sufficient to locate the disease. For complex diseases that are difficult to know, one must follow the ancient way of measuring the extraordinary, which is not easily explained in a few words.

Question: If a person suffers from Cold Damage and has no decoction available, what should be done? Hua Tuo said: If there are no pills, powders, or decoctions, simply boil several taels of Bupleurum Root (Chaihu) alone. For Cold Damage or epidemic febrile diseases, it can be taken to induce sweating. If sweating does not resolve the condition after repeated attempts, a decoction should be given. For excess conditions, switch to purging, but give only a small amount, avoiding drastic purgation. Guo Yong said: This requires the ability to differentiate syndromes and is applicable only when one is traveling and lacks medicines. Generally, Chaihu is not suitable for Yin diseases.

Question: There are several types of Cold Damage; how should medicines be used if laypeople cannot distinguish them? Ge Hong said: If initially one feels headache and flesh-heat, with a surging pulse, on the first or second day, prepare Modified Congchi Decoction. Take a handful of Scallion White (Congbai) as wide as a tiger's mouth, one sheng of Fermented Soybean (Douchi), wrapped in silk. Boil in three sheng of water until one sheng remains. Drink in one dose to induce sweating. If no sweat, prepare again, adding three taels of Kudzu Root (Gegen). Boil in five sheng of water until two sheng remain. Divide into two doses. If no sweat, prepare again, adding three taels of Ephedra Herb (Mahuang), removing root and joints. All famous physicians' prescriptions use this method. There are many variations, widely used in Jiangnan. Guo Yong once saw places in the North lacking medicine; during Cold Damage epidemics, people in Qin drank Scallion Tea, and people in Jin drank Honey Tea. Though makeshift, some were effective. Later, few caused harm. Scallion tea seems reasonable; Honey tea's rationale is unclear to me.

Question: What about steaming therapy for inability to sweat? Chen Linqiu said: Medical classics state: If sweating is attempted repeatedly without success, it is a fatal disease. I pondered, steaming might work. Like the steaming method for Wind Stroke, exposing the body to moist heat externally induces sweating. Later, I asked Zhang Miao. Zhang Miao said: Someone worked to exhaustion, sweated profusely, slept on a thin mat, caught cold, suffered from chills and curling up. Various doctors gave pills, powders, and decoctions. Within four days, sweating was attempted eight times, but no sweat came out. Zhang Miao ordered burning peach leaves and steamed the patient with them. Immediately, profuse sweating occurred. Powder was applied in the blanket to dry the body completely before rising. The patient recovered. Subsequently, sweating was induced multiple times this way, and sweat always came out. Some people naturally find it hard to sweat, not just due to illness. Steaming ensures sweating. Fan Wang said: For various diseases with fever, aversion to cold, and floating-surge pulse, sweating is appropriate. Dust with warm powder, avoid wind exposure. If one needs sweating but has recently lost blood or suffered severe diarrhea, drastic sweating is contraindicated. Give small amounts of Guizhi Tang frequently, allowing moist skin and continuous slight sweating over days, and the condition will resolve spontaneously.

The above general principles of treatment are not confined to specific meridians, hence they are included in the preface of the General Catalog of Cold Damage. Now, following the discussions, they are placed after the preface. Other treatment methods are detailed in the respective chapters on meridians and syndromes.