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Yang Jue (Cold Extremities due to Heat), the pulse is deep and forceful, abdominal pain with a sensation of heaviness in the anus, thick and sticky stool, red and scanty urine, or constipation; this indicates that heat occurred first followed by cold extremities. Although the four limbs are cold, the cold does not extend beyond the elbows or knees; this is Yang Jue caused by deep-seated heat, treated with Chengqi Tang (Cathartic Decoction) to purge.

Yin Jue (Cold Extremities due to Cold), the pulse is deep and weak, no thirst, severe pain in the four limbs, diarrhea, clear and colorless urine, aversion to cold, face pale as if scraped by a knife, cold extremities extending beyond the elbows and knees; this is Yin Jue, treated with Sini Tang (Frigid Extremities Decoction). When the two Yang meridians reach their end, it is called Jueyin (Terminal Yin). Generally, the Three Yin meridians do not transmit disease via the meridian sequence; if there is excess heat in the stomach, purgation is indicated. There is also the condition of "Shanghan Lianggan" (Simultaneous contraction of Taiyang and Shaoyin in Cold Damage), where the disease affects Juyang (Taiyang/Bladder) and Laoyin (Shaoyin/Kidney).

Generally, treating Shanghan requires first identifying the syndrome, carefully distinguishing Yin/Yang, Exterior/Interior, Deficiency/Excess, and Cold/Heat, then prudently applying methods such as sweating, vomiting, purging, warming, and harmonizing to avoid errors. First observe the eyes, then the mouth and tongue, then palpate from the chest/heart down to the lower abdomen for pain or fullness to guide medication. If both eyes are yellow, it indicates the disease is about to resolve. If the eyelids suddenly sink and the eyeballs stare fixedly, it is difficult to treat. Opening the eyes and wanting to see people belongs to Yang; closing the eyes and not wanting to see people belongs to Yin. If vision is unclear, the Shen Shui (Spirit Water/Clear Humor) is exhausted, unable to reflect objects, which is also difficult to treat.

Next, examine the mouth and tongue: white coating indicates heat; yellow coating indicates intense heat; black coating with prickles indicates death.

Then palpate the chest and heart: if painful and distended, and purgatives have not yet been used, the exterior pathogen remains in the Shaoyang portion; use Xiaochaihu Tang (Minor Bupleurum Decoction) with Zhike (Aurantii Fructus Immaturus) and Jiegeng (Platycodonis Radix) as the specific formula. If pressing the epigastrium causes severe fullness and pain, and purgatives have already been used, this is Jie Xiong (Chest Binding), treated with Xiantong Tang (Resolving Chest Binding Decoction), adjusted according to severity. Xiantong should be treated cautiously. If Jie Xiong presents with complete irritability, it is fatal.

If the lower abdomen feels hard and painful, press the tender area and ask about urination. If urination is free, it indicates blood stasis in the Lower Jiao; promote blood breaking using Tao Ren Chengqi Tang (Peach Kernel Cathartic Decoction) until dark stools are passed. If urination is obstructed, it indicates fluid retention; use Wuling San (Five-Ingredient Powder with Poria) plus Mutong (Akebiae Caulis) and Shanzhi (Gardeniae Fructus).

If fever, aversion to cold, headache, stiff neck/spine, and floating pulse appear, regardless of the number of days, it is a Taiyang Exterior Syndrome. Floating and tight pulse without sweat indicates Shanghan (Cold Damage); induce sweating. Floating and slow pulse without force with sweat indicates Shangfeng (Wind Strike); secure the exterior.

If limb pain, dry throat with thirst, no body heat, warm hands/feet, and deep forceful pulse appear, it is clearly a Taiyin Interior Syndrome transmitted by heat; purgation is indicated. If limb pain, spontaneous diarrhea without thirst, aversion to cold, cold extremities, and deep weak pulse appear, it is Taiyin directly contracting cold; warming is indicated.

If dry mouth/throat with thirst, delirium, aversion to heat, constipation, or slight passage of clear water with extreme thirst, and deep forceful pulse appear, it is clearly a Shaoyin Interior Syndrome transmitted by heat; purgation is indicated regardless of days. If limb pain, diarrhea/vomiting, aversion to cold, cold extremities, no thirst, and deep weak pulse appear, it is Shaoyin direct invasion, an interior cold Yin syndrome; urgent warming is indicated.

If tongue curling, scrotal retraction, thirst, no body heat, external cold extremities but internal excess heat, and deep slow forceful pulse or constipation appear, it is clearly a Jueyin syndrome transmitted by heat; purgation is indicated. If limb pain, diarrhea/vomiting, no thirst, aversion to cold, cold extremities, clear urine, and faint weak pulse appear, it is Jueyin direct invasion, a cold syndrome; urgent warming is indicated. Follow the medication principles of the Six Meridians described earlier.

All cases of dry thirst, constipation, mania/delirium, abdominal fullness with mild cold extremities, macules/hemorrhage, and forceful pulses are due to heat pathogens from the Three Yang transmitting to the Three Yin interior; purgation is indicated, adjusting dosage strength accordingly. For cold, urgent warming is required. If Shanghan transmits to two meridians on day one, it is Lianggan; if it transmits through all six meridians by day three, death ensues; further transmission stops at day six. For Lianggan manifesting on the exterior, use Mahuang Gegen Tang (Ephedra and Kudzu Decoction); for interior attack, use Tiaowei Chengqi Tang (Regulating the Stomach Cathartic Decoction). If treatment is incomplete, ask if the patient has pain. With free bowel/bladder movement, chest pain indicates Jie Xiong; absence of pain indicates Pi Qi (Stagnant Qi), caused by premature purgation. Without prior purgation, it is not Jie Xiong. It is exterior pathogen transmitting to the chest; although full/distended, exterior pathogen remains, not yet entering the Fu organs, belonging to Shaoyang; treat with Xiaochaihu Tang plus Zhike. If ineffective, add Xiao Xiantong Tang (Minor Resolving Chest Binding Decoction) to the base formula until cured. For severe pain, use Da Xiantong Tang (Major Resolving Chest Binding Decoction) to purge.