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In the treatment of Shanghan (Cold Damage), if headache, aversion to cold and fever, stiffness and rigidity of the waist, neck, and spine, and a floating pulse are observed, this is a Exterior Syndrome. Regardless of the number of days since onset, the use of exterior-releasing herbs is undoubtedly indicated.

In the treatment of Shanghan, if deafness, hypochondriac pain, alternating chills and fever, vomiting with a bitter taste in the mouth, and a wiry and rapid pulse are observed, this is a Half-Exterior Half-Interior Syndrome. Regardless of the number of days since onset, the use of harmonizing herbs is undoubtedly indicated.

In the treatment of Shanghan, if headache and aversion to cold have completely subsided, and symptoms such as fear of heat, dry thirst, delirium, throwing off clothes and bedding, waving hands and kicking feet, mania, macules and jaundice, tidal fever with spontaneous sweating, constipation, scanty and dark urine, or distending and painful fullness from the chest through the umbilicus to the abdomen, along with a deep and forceful pulse, or panting and shortness of breath, are observed, this is a Heat Syndrome transmitted to the Interior. Regardless of the number of days since onset, the use of purgative and draining herbs is undoubtedly indicated.

In the treatment of Shanghan, if upon initial onset there is no headache, no body heat, but rather aversion to cold, cold limbs, abdominal pain with vomiting and diarrhea, foaming at the mouth, flow of cold saliva, shivering, a face pale as if scraped by a knife, curling up while pulling clothes close, absence of thirst, and a deep, slow, and deficient pulse, this is a True Cold Syndrome directly affecting the Yin Meridians. The urgent use of warming herbs is undoubtedly indicated. One must treat according to the exterior or interior nature of the manifested syndrome; do not indiscriminately administer decoctions, nor be constrained by the number of days. Unless one deeply understands the intent of Zhang Zhongjing, how could one reach this level?

Generally speaking, in Shanghan, pathogenic heat transmits from the Three Yang meridians to the Zang-Fu organs of the Three Yin, entering the interior marks the end of transmission, with no further transmission occurring; hence it is said that there is "no meridian transmission." If transmission occurs again, it refers to the Foot meridians transmitting to the Hand meridians.

"Xi Xi" (gentle/warm) fever indicates Exterior Heat, where wind-cold pathogens reside in the skin and are constrained externally, resulting in exterior heat without interior heat. In cases with no sweating and a floating-tight pulse, exterior-releasing methods are appropriate; in cases with sweating and a floating-slow pulse, muscle-relaxing methods are appropriate. "Zheng Zheng" (steaming) fever indicates Interior Heat, where yang pathogens sink into the yin, resulting in interior heat without exterior heat. In cases with a deep-solid pulse and thirst, purgation is appropriate. If exterior heat has not yet resolved and the pathogen transmits to the interior, but the interior has not yet formed an excess condition, both exterior and interior will be hot, and the pulse will likely be wiry and rapid; harmonization is appropriate. In Shaoyin disease, the pulse should be deep; if fever appears instead, it indicates the pathogen has not left the exterior, and Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is indicated. If fever, irritability, thirst, red urine, and a large-floating pulse appear, indicating simultaneous exterior and interior involvement, Wuling San (Five-Ingredient Powder with Poria) is used to promote diuresis. In cases of deficiency of both yin and yang with unceasing heat, or massive heat following sweating or purgation with a chaotic and restless pulse, or diarrhea with unceasing heat, these are all fatal conditions.