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Zhang Zhongjing discussed Lianggan Shanghan (Two-Aspect Cold Damage) stating: "For those injured by cold and heat pathogens, even if severe, they will not die. However, for those suffering from Lianggan on Han (simultaneous invasion of exterior and interior by cold), the outcome is fatal." He further stated: "When Lianggan disease occurs simultaneously, treatment must follow a specific sequence; releasing the exterior and purging the interior are fundamentally different approaches." If it is said that death is inevitable, yet there is a sequence of treatment, why is this? Generally, this disease involves simultaneous transmission of the exterior and interior, affecting both zang and fu organs. Fewer than one in ten survive, hence the statement of fatality. Yet, would Zhang Zhongjing falsely mislead future generations with his own views? Thus, he proposed methods of releasing the exterior and purging the interior to encourage later physicians, hoping that in future ages, if a sage-like physician were to encounter such cases, humanity would not lose hope. This reveals Zhang Zhongjing's benevolent heart.

Shanghan (Cold Damage) does not distinguish between Yin syndromes and Yang syndromes, or Yin poison and Yang poison. Ultimately, patients with robust Zhenqi (True Qi / Vital Energy) are easier to treat, while those with deficient Zhenqi are difficult to treat. The proverb states, "Shanghan often kills those with deficiency in the lower jiao (lower abdomen/kidneys)." This is indeed true. Generally, when a patient's Yuanqi (Original Qi) is insecure and True Yang is incomplete, even a slight onset of disease can lead to a fatal trajectory. Why? For Yang syndromes, purgation is indicated; however, if Zhenqi is weak, purgation often leads to collapse of Zhengqi (Upright Qi). For Yin syndromes, warming is indicated; however, if Zhenqi is weak, warming may generate Ke Re (Guest Heat / Exogenous Heat). Therefore, physicians find it difficult to administer medication, not because the disease is incurable, but because the patient's constitution lacks the strength to withstand treatment. The Suwen (Classic of Difficult Issues) records Qibo saying: "Excess Yang results in fever, closed pores, coarse breathing, restlessness, absence of sweat despite heat, dry teeth, vexation, abdominal fullness leading to death; these patients can endure winter but not summer." ("Neng" means "endure"). "Excess Yin results in cold body, sweating, constant chilliness, frequent shivering and coldness, cold leading to Jue (Reversal/Cold extremities), Jue leading to abdominal fullness and death; these patients can endure summer but not winter." The Yellow Emperor asked, "How should these two be regulated?" Qibo replied, "If one understands the principles of Seven Losses and Eight Gains, these two can be regulated." Generally, excess Yang with no sweat characterizes Shanghan; excess Yin with cold body and sweat characterizes Fengzhong (Wind Strike). Both require understanding the principles of Seven Losses and Eight Gains. Specifically, women experience Tian Gui (Menstruation/Reproductive Essence) at age fourteen (2x7) and cease at forty-nine (7x7); men have abundant Jing (Essence) at sixteen (2x8) and cease at sixty-four (8x8). Women's menstruation arrives regularly, so the number seven implies loss/reduction; men's Jing should be full and not depleted, so the number eight implies overflow. In this manner, men and women remain healthy. With a healthy body and solid Zhenqi, even if invaded by cold pathogens, medication is easily administered. Thus, it is said that these two can be regulated. From this, we know that treating Shanghan prioritizes Zhenqi.