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At the onset of the disease, there is no fever, followed immediately by cold extremities (Jieling), or fullness in the chest and abdomen, vomiting, abdominal fullness and pain, diarrhea, and a fine and weak pulse. This is caused by cold invading the Yin meridians, constituting a True Yin Syndrome (Zhen Yin Zheng), not transmitted from the Yang meridians. It should be treated with warming methods immediately, without delay. The Classics state: "Fever with aversion to cold indicates onset in the Yang; absence of fever with aversion to cold indicates onset in the Yin." The appropriate treatment is Sini Decoction (Sini Tang).

Abdominal fullness and pain are all indicative of Yin Syndromes, differing only in severity, so treatment cannot be generalized. For abdominal pain accompanied by constipation, use Guizhi Shaoyao Decoction (Guizhi Shaoyao Tang). For severe abdominal pain, use Guizhi Dahuang Decoction (Guizhi Dahuang Tang). If there is spontaneous diarrhea with abdominal pain and clear, colorless urine, warming is indicated; choose between Lizhong Decoction (Lizhong Tang) or Sini Decoction based on severity. For mild cases, use Wuji Powder (Wuji San); for severe cases, use Sini Decoction.

In cases of absent pulse, use Tongmai Sini Decoction (Tongmai Sini Tang) to drive away Yin pathogenic factors and restore Yang Qi.

For Yindu Disease (Yindu Bing), characterized by cyanosis of the fingernails and toenails, with a deep, fine, and rapid pulse, use Sini Decoction. If the pulse is absent, use Tongmai Sini Decoction and Yindu Gancao Decoction (Yindu Gancao Tang). Apply moxibustion at Qihai (CV6) and Guanyuan (CV4), approximately 200-300 moxa cones, and warm the Shenque point (CV8) with scallion compresses. Simultaneously, administer mild Qi-tonifying herbs to unblock the interior and exterior and restore Yang Qi. If these measures fail, it is a death case.

Among all types of Cold Damage (Shanghan), Yin Syndromes are the most difficult to identify. While typical Yin Syndromes are easily recognized, atypical presentations are often missed. For instance, when a patient presents with no fever, cold extremities, a preference for quietness and silence, no thirst, diarrhea with abdominal pain, and a deep, fine pulse, everyone recognizes this as a Yin Syndrome. However, when symptoms include fever, flushed face, restlessness, removing clothing and blankets, desire for cold drinks, and a large pulse, people often fail to recognize them, misdiagnosing them as Yang Syndromes and erroneously administering cold-natured medicines, leading to many deaths. One must prescribe medication based on the pulse for utmost accuracy. Regardless of whether the pulse is floating, deep, large, or small, if it feels weak under the fingers and completely devoid of strength when pressed deeply to the bone, there is hidden Yin Cold. Cold-natured formulas must not be given. Immediately administer one dose of Wuji Powder to resolve exterior and interior cold, resulting in quick recovery. However, in cases of extreme Deep Cold (Chen Han), Ginger (Ganjiang) and Aconite (Fuzi) must be used to dispel it; this method should be kept secret. Even if the pulse appears large and forceful superficially, if it lacks strength upon heavy pressure, or feels completely empty upon deep pressing, it is a Yin Syndrome.

When treating Cold Damage, if the Chi position pulse is weak and powerless, sweating and purging methods are strictly contraindicated. Instead, use Xiaochaihu Decoction (Xiaochaihu Tang) to harmonize. For Yangdu Cold Damage (Yangdu Shanghan), where medication is ineffective, presenting with skin ulceration, shedding of skin on hands and feet, body red as cinnabar, eyes red as fire, extreme dryness and thirst, a large and forceful pulse, and unconsciousness, treat primarily with Sanhuang Shigao Decoction (Sanhuang Shigao Tang).

When diagnosing Cold Damage, one must ask about the location of pain, the patient's suffering and desires, diet, bowel movements, and any previous medications taken. If the patient vomits roundworms (Hui), even in the presence of high heat, cold-purgative drugs are contraindicated; violating this rule leads to death. This is because stomach cold causes roundworms to migrate upward into the diaphragm, indicating a dire prognosis. Immediately administer Lizhong Decoction with fried dried ginger (Pao Ganjiang) and two smoked plums (Wumei). Once the roundworms settle, use Xiaochaihu Decoction to reduce fever. This is because roundworms become quiet upon tasting sour flavors and calm upon encountering bitter ones.

In Cold Damage diagnosis, the presence of white froth in the mouth or excessive flow of cold saliva indicates Cold. Use Wuzhuyu Decoction (Wuzhuyu Tang), Lizhong Decoction, or Zhenwu Decoction (Zhenwu Tang) according to severity. Cold-natured medicines are strictly contraindicated. The same applies to miscellaneous diseases. Alternatively, use sweet-warm herbs to tonify Yuan Qi, such as Sijunzi Decoction (Sijunzi Tang) with one slice of Aconite. For Blood Deficiency, use Zhang Zhongjing's Bawei Pill (Bawei Wan).