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Jiegu: In Shanghan (Cold Damage), the treatment of exterior and interior syndromes, purgation and diaphoresis differ. For exterior syndromes manifesting as aversion to wind or aversion to cold, diaphoresis should be employed (Haizang stated: for aversion to wind, use Baizhu San; for aversion to cold, use Shenzhu Tang). If there is excess Qi, ability to eat, constipation, and no exterior syndrome, purgation may be used.

Spring governs warmth and belongs to Wood; when the body is warm, diaphoresis should be used (Haizang: Shenzhu Tang). Summer governs growth and belongs to Fire; when the body is hot with irritability, vigorous dispersal is required (Haizang: Shenzhu Tang plus Huangqin Decoction). Late summer governs transformation and belongs to Earth; during the transition of the four seasons, diet should be regulated (Haizang: Sijunzi Tang). Autumn governs gathering and belongs to Metal; when the body is cool internally warm, mild purgation is indicated (Haizang: Tongge Wan, Jinhua Wan). Winter governs the Zang organs and belongs to Water; body heat with aversion to cold indicates heat on the exterior and cold on the interior; body cold with aversion to heat indicates heat on the interior and cold on the exterior (Haizang: for heat on the interior, use Tiaowei Chengqi Tang; for cold on the interior, use Tiaozhong Tang Wan).

Jiegu: Generally, Shanghan should be treated according to the ascending and descending, adverse and smooth, rigid and soft movements of Yin and Yang in the four seasons. When Qi ascends and floats, follow its nature to disperse it; when it gathers and stores, guide it downward. With sweating, fever, aversion to wind, and a floating, moderate pulse, Wind has injured the Wei (Defensive) level; use Guizhi Tang. Without sweating, with fever, aversion to cold, spontaneous aversion to cold without exposure to wind, and a tight floating pulse, Cold has injured the Ying (Nutritive) level; use Mahuang Tang. With sweating, fever, aversion to wind, and a tight floating pulse; or without sweating, with fever, aversion to cold, and a moderate floating pulse, this is called simultaneous injury to Ying and Wei; use Qinglong Tang or Guizhi Mahuang Banjian Tang. Without sweating, with fever, no aversion to wind/cold, and a deep, surging pulse, purgation is possible; further distinguish whether there is Jue (cold extremities) and treat based on the depth of cold and heat. With sweating, cold extremities, and a deep, faint pulse, this is named Yin Jue; use Sini Tang. Without sweating, with cold extremities and a deep, faint pulse, this is named Yang Jue; use Dachengqi Tang plus Nifen. If extremities are not cold, body is hot, both interior and exterior are Yang, and the Sanjiao (Triple Burner) Qi is unmoved, use cooling medicines for three to five doses, such as Huangqin Gancao Tang, Huangqin Baizhu Tang, Huangqin Cangzhu Tang, Huangqin Zhizi Tang, Lianqiao Yinzi, Xiaochaihu Tang, Bazheng San, Liangge San, Baihu Tang, Wuhuang San. These are medicines for the Upper, Middle, and Lower Jiao, to be selected appropriately. For Zhongshu (Heatstroke) with a deficient pulse, back aversion to cold, spontaneous sweating, and thirst, use Baihu Tang. For a cool body, tight pulse, and heat on the interior, urgent purgation is needed; dry mouth/throat and constipation are indicators. Without sweating, with high fever, diaphoresis is allowed; use Shengma Tang, Daqing Gao, Tianma Gao. With sweating, with high fever, use Guizhi Tang, Xingxing San, Jiexi Tang, Xiaochaihu Tang, Baizhu Fangfeng Tang, etc. When inducing sweating, consider the season's heat, dryness, dampness, wind, and cold, applying spring-cool, summer-cold, autumn-warm, winter-hot principles.

Qian Yi: For Shangfeng (Wind Strike) with sleepiness, hot breath, yawning, and irritability, disperse the exterior using Daqing Gao (this is an exterior syndrome). (Jiegu supplement: For children externally affected by Wind-Cold with stiffness, yawning, irritability, rough skin, and hot breath, disperse the exterior; use warming herbs in autumn/winter and cooling herbs in spring/summer.)

Daqing Gao Formula: Tianma, Qingdai (ground, 1 qian each), Baifuzi (raw, 1.5 qian), Xiewei (de-venomed, raw, 0.5 qian), Zhusha (ground), Tianzhuhuang (ground), Shexiang (each 1 yizi spoonful), Wushaoshe meat (soaked in wine, baked dry, powdered, 0.5 liang). Grind finely together, mix with raw honey to form a paste. Take half to one soap-bean size dose. For infants of medium age, dissolve with Jingmi Datong Niuhuang Gao and Bohe water. For children over five years old, take with Ganlu San.

Xionghuang Gao: Treats Shangfeng with warm-high fever and excessive drinking. Xionghuang (date-sized, ground, boiled in radish root water and vinegar until liquid is gone), Gancao powder, Chuantian Shao (each 3 qian), Hanshuishi (ground, 5 qian spoonfuls), Naobi (1 yizi spoonful), Zhusha (0.5 fen). Grind uniformly, refine with honey into a paste. Dissolve in Bohe soup, take half soap-bean size. The above formulas treat exterior syndromes like sleepiness, hot breath, yawning, irritability, for children under three who cannot speak.

Huoren: For common Feng Yong (Wind Obstruction) with fever, runny nose, phlegm cough, and irritability, use Xingxing San.

Xingxing San: Treats pediatric Wind-Heat, Shanghan seasonal qi, or rash fever. Jiegeng, Xixin, Renshen, Baizhu, Gancao, Gualougen, Baifuling, Chuanxiong (equal parts). Powder. Take 2 qian per dose, decoct with 2 slices of ginger and 2 mint leaves. Under three years old, divide into 4-5 doses. Effective for all pediatric Wind Strike or Wind-Heat.

Haizang: For Shanghan seasonal qi, Wind-Heat, phlegm obstruction cough, and Qi disharmony, use Sijunzi Tang plus Xixin, Gualou, Jiegeng (1 fen each), Jiang, Bohe decocted. Or add Fangfeng, Chuanxiong (1 fen each). If internal cold or treating in cold weather requiring dispersion, remove Gualou and add more Jiegeng. For deficiency sweating and night crying, add Maimendong. For Wind Strike with fever, headache, and rapid breathing, use Sijunzi Tang plus Chuanxiong, Fangfeng (equal parts), reduce Xixin and Qianghuo by half, decoct together.

Huoren: For throat discomfort, phlegm-solid cough, use Niuzi Tang.

Yunqizi: Ren Shen Qiang Huo San: Treats pediatric Cold Evil, epidemic plague, rash, headache, body pain, high fever, lethargy/speechlessness, dampness, irritability, phlegm-solid cough. Qianghuo, Duhuo, Chaihu, Renshen, Xiong (Chuanxiong), Zhike (stir-fried), Gancao (honey-roasted), Baifuling (peeled, 2 liang each), Qianhu, Jiegeng, Tianma (wine-soaked stir-fried), Digupi (0.5 liang each). Powder. Take 2 qian per dose, decoct with 1 cup water and little mint, strain, take warm anytime.

Qibao San: Treats seasonal qi dizziness and body heat. Children take with mother; adults may also take. Zi Su Ye, Xiangfu (stir-fried, 3 liang each), Chenpi, Gancao, Jiegeng, Baizhi, Chuanxiong (1 liang each). Cinnamon, decoct with Ginger and Jujube.

Haizang: Mahuang Huangqin Tang: Treats pediatric Shanghan without sweating, headache, body heat, aversion to cold. Mahuang, Chi Shaoyao, Huangqin (0.5 liang each), Gancao (roasted), Guizhi (2.5 qian each). Coarse powder, decoct in water.

Shengma Huangqin Tang: Treats Wind Strike with sweating, headache, fever, aversion to wind. Shengma, Gegen, Huangqin, Shaoyao (5.5 qian each), Gancao (1.5 qian). Cinnamon, take 2 qian per dose, decoct in water, take warm. The above Xingxing San etc. treat headache, fever, aversion to wind/cold exterior syndromes, designed for children over three who can speak. The first five formulas treat sweating/no-sweating, aversion to wind/cold. Formula 5 treats no-sweating/aversion to cold; Formula 6 treats sweating/aversion to wind.

Qian Yi: If Daqing Gao does not resolve the exterior and there are purgation indications, use Dahuang Wan. For high fever, incessant drinking, and good appetite, mild purgation is allowed; otherwise, do not purge (this is an interior syndrome). (Jiegu supplement: High fever, drinking, eating, constipation: use Dahuang Wan as powder. If stool is normal, strictly avoid purgation to prevent exterior heat driving inward causing Jie Xiong critical syndrome.)

Dahuang Wan: Treats Wind-Heat interior excess, hot breath, constipation/red urine, incessant drinking, purgation indications. Chuanxiong (0.5 liang), Hei Qianniu (0.5 liang, half raw half roasted), Dahuang (wine-steamed, 1 liang), Gancao (roasted, 2.5 qian). Fine powder, bind with thin paste into pills size of hemp seeds. Two years old: take 10 pills with warm honey water after milk. Stop when loose stools occur; increase dose if no effect.

Huoren: Forehead pain, body fever, yellow-red stool, abdominal heat: use Sishun San, Lianqiao Yin, Sanhuang Wan (see Youke Zhunseng Rash section). Body tidal fever, dull head/eyes, restlessness, red urine, constipation: severe heat, use Xixin San, Tiaowei Chengqi Tang (Xixin San see Rash section).

Forehead/body warm, white sour-smelling stool: food retention in Stomach, use Shuangsheng Wan (see Pediatric Food Accumulation section).

Jiegu: No high surface heat but difficult urination indicates Damp-Heat binding in Bladder; use damp-resolving herbs like Baizhu, Baifuling to promote urination, then heat subsides.

Yunqizi: Pediatric Shanghan with irritability, red/difficult urination, brown stool, red face/heat: use Daochi San.

Qian Yi: Wind Strike involving Zang organs: Heart involvement causes palpitations; Lung involvement causes chest distress, panting, gasping, long sighs, cough; Kidney involvement causes photophobia, due to deficiency of the Mother organ.

Wind Strike with cold hands: Spleen deficiency. Harmonize Spleen first, then disperse. Harmonize with Yihuang San, disperse with Daqing Gao (treats Yin Jue with sweating/faint pulse. For Yang Jue without sweating/sliding pulse, use Dachengqi Tang + Nifen). Wind Strike with spontaneous diarrhea: Spleen deficiency. Tonify Spleen first, then disperse. Tonify with Yihuang San, disperse with Daqing Gao. If unresolved, use Tiaozhong Wan. If purgation indications, use Dahuang Wan. After purgation, use Wenjing Wan.

Wind Strike with abdominal distension: Spleen deficiency. Tonify Lung to prevent asthma, then disperse, still tonify Spleen. Use Quzhang Taqi Wan. Disperse with Daqing Gao.

Wind Strike with vomiting/diarrhea (see Youke Zhunseng Vomiting/Diarrhea sections, Yihuang San, Baizhu San, disperse with Daqing Gao).

Tang Shi: Treats夾惊 (Concomitant Fright) Shanghan with extreme heat generating Wind, use Bohe San. Bohe Ye (0.5 liang), Qianghuo, Quanxie, Mahuang (remove roots/joints), Gancao (1.25 qian each), Tianzhuhuang, Jiangcan, Baifuzi (pounded, 2.5 qian each). Fine powder, take 1 qian, decoct 0.5 cup water to 1/3, add little Bamboo Sap.

Yunqizi: Exterior Cold damage closes skin causing intense heat, generating Wind/Fright/Tremors. Blood/Qi not solid, unable to resist pathogen, hence tremors. Normal bowel/bladder, hot breath: disperse with Daqing Gao.

Lung excess with Wind-Cold causes chest fullness, shortness of breath,急促 panting/cough. Disperse Lung first, then Wind-Cold. Disperse Lung with Xiebai San, disperse Wind with Daqing Gao. If only Cold damage (no chest fullness), Kidney deficiency causes photophobia: tonify Kidney with Dihuang Wan (use Dihuang Gao for exterior).

Post-purgation deficiency heat from excessive purgation: Stomach deficiency heat, weak drinking, generate fluids with Baizhu San. Pediatric internal heat binding, dry mouth/thirst, yellow body/heavy weight: use Baizhu San.

Tang Shi: Shanghan with thirst: use Baihu Tang.

Jiegu: High fever, drinking, eating, constipation: use Dahuang Wan as powder.

Above three formulas: Baizhu San treats deficiency thirst (post-purgation, poor appetite/Stomach deficiency). Baihu Tang and Dahuang Wan treat excess thirst (pre-purgation, eating, constipation).

Jiegu: Shanghan cough with clear water, gasping, long sighs: Lung deficiency, use Ejiao San. Face pale like dead bone: fatal. Body heat, cough/wheeze, phlegm: use Pianyin Wan (see Pediatric Cough section).

Ejiao San treats deficiency cough (gasping/long sighs). Pianyin Wan treats excess cough (phlegm/wheeze/fullness). If exterior syndrome with aversion to wind/cold and cough: use Xingxing San modified, Sijunzi Tang, Niuzi Tang.

Yin Jue / Yang Jue (see above).

Jiegu: High fever, incessant vomiting: Fuling Banxia Tang (Xiao Banxia Jia Fuling Tang, see Vomiting section).

Tang Shi: Shanghan vomiting: Zhike Banxia Tang. Zhike, Banxia (0.5 liang each). 1 cup water, 10 ginger slices, decoct to 0.5 cup. Under ten years: 5 doses.

Huoxiang Zhengqi San: Treats Shanghan vomiting. Huoxiang Ye, Houpo (processed), Banxia (processed), Gancao (roasted), Chenpi, Cangzhu (rice water soaked, equal parts). Cinnamon, take 2 qian, 0.5 cup water, 3 ginger slices, 1 jujube, decoct to 0.2, strain, take warm.

Jiegu: Severe vomiting requires purgation: Baixia Zi, Zhenzhu Wan, Xiaoji Wan (see Pediatric Food Accumulation section). Periodic tidal fever, chest fullness, shortness of breath, vomiting: Taozhi Wan (see Pediatric Heat Accumulation section).

Seven formulas treat Shanghan vomiting: First two treat Phlegm-Fluid; middle one treats Exterior; last four treat Interior. Taozhi Wan treats Interior Heat; others treat Exterior Cold.

Tang Shi: Shanghan spontaneous sweating: tonify deficiency, harmonize Yin/Yang, use Xiaojianzhong Tang minus Guizhi, add Huangqi, Renshen, Dihuang.

Huangqi (1 liang), Shaoyao (3 liang), Gancao, Renshen, Shudihuang (0.5 liang each). Cinnamon, take 2 qian, 0.5 cup water, decoct to 1/3, strain.

Pediatric Shanghan Manifestations: Headache, body pain, nasal congestion/runny nose, throat wheezing,洪数 pulses, red cheeks/dry eyes, goosebumps, mouth/nose discharge, red/yellow eyes, dry mouth, cough, blue Shan Gen (bridge of nose), sneezing.

Huoren: Head/eye pain, fear of people, aversion to cold: Shanghan syndrome.

Yunqizi: Sudden high fever, aversion to cold, cold limbs, cold ears/buttocks, hot nose breath: resembles Rash/Shanghan exterior. This is fetal Qi emergence, treat as Rash. Treating as Shanghan exterior is error.

Wu Shi: Six Meridian treatments for pediatric Shanghan are same, but distinguish from Tai Re, Jing Re, Xue Re, Ke Re, Han Re, Chao Re, Tan Re, Shi Re, Bian Fa Re, Douzhen Re, Shangfeng Re. All mimic Shanghan; discern clearly. Skin tender, Qi/Blood unstable, pulse/methods differ, medicine dosage lighter/smaller. Briefly recorded below.

Observe facial color first.

Inspect Tiger Mouth Pulse Veins: Male left, Female right index finger. 1st joint Initial Guan, 2nd Middle Guan, 3rd End Guan (Yin/Mao/Chen positions).

Initial Guan: mild. Middle Guan: severe. End Guan: critical. Purple: Fright-Heat. Red: Shanghan/Heat. White: Glandular Heat/Blood Deficiency. Green: Fright/Wind/Cold/Abdominal Pain/Tremors. Yellow: Milk/Food Injury/Spleen Deficiency. Black: Cold Evil/Poison/Deep Disease. Purple/Red/Green/Black penetrating End Guan: death.

Pulse taking: 4-5 yrs: 1 finger. 6-7 yrs: 2 fingers. 10+ yrs: 3 fingers. Pulse Classic: 4-5 yrs, 7-8 beats/respiration fine/rapid: auspicious. 9 beats: heat. 10 beats: exhaustion. 5 beats: cold. 4 beats: critical. 10 yrs: 5-6 beats: normal. Other heats (Tai/Jing/Ke/Xue/Tan/Han/Chao) see Youke Zhunseng.

Food/Milk Heat: Vomiting, undigested milk, sour breath. Food Injury: Epigastric fullness/hardness, belching/acid, aversion to food, Right Qi Kou pulse strong, palm hot/back cool, belly/back heat first.

Treat Food Injury Fever: Liu Junzi Tang main, add Shenqu, Maiya, Tangqiuzi, Renshen, Xiangfu. Excess: add Zhishi, Qingpi. Unresolved heat: add Chaihu, Huanglian/Huangqin. No heat: Xiangsha Baohe Wan.

Bian Fa (Transformation) Fever: Growth of Qi/Blood. Light: fever, fright, cold ears, slight sweat, white bubbles on lips, resolves in 3 days. Heavy: chills/fever, chaotic pulse, abdominal pain, crying, vomiting milk, resolves in 5 days.

Shangfeng Fever: Sleepiness, Spleen stagnation, yawning, stuffiness, nasal congestion/sneezing/clear discharge, hot breath, heavy cough, spontaneous sweating/aversion to wind. Ren Shen Qiang Huo San modified.

Shanghan: Aversion to cold, stiffness, fever (surface), day/night unceasing, resolves with sweat. Qian Yi: Men yellow face/heavy body; Women red face/panting/aversion to cold/hot breath/yawning/stiff neck. Generally, Shanghan: back of hand hot, palm cool, Left Yingchong pulse tight/strong. Other meridians see Six Meridian Fever examples. Medicine lighter. Distinguish Fright/Food Injury Shanghan.

Douzhen (Smallpox) Fever: Red cheeks, irritability, sneezing, dry eyes, yawning, fright, heavy body, ear/nose/hand/foot slightly cold, alternating cold/heat, restless sleep. Do NOT mistake for Shanghan and induce sweat with heavy covers.

High fever, rash not erupted: Shengma Gegen Tang. Weak Stomach/poor appetite: add Renshen, Baizhu, Baifuling. To penetrate spots: add Zicao Rong. Danxi warns against Gegen if red spots appear (fears superficial deficiency/spots rot). Qian Yi uses Sijunzi Tang + glutinous rice to boost Stomach Qi. Add Shengma/Zicao Rong to penetrate. Day 3 to feet: fully erupted. Uneven but red roots: no medicine needed. Day 5: pus formation. Plump/glossy pus: no medicine needed. Days 5-6 no pus: rescue with Renshen, Huangqi, Danggui as chief, plus Baizhu, Chenpi, Baizhi, Chuanxiong, Shaoyao, Fangfeng, roasted Gancao. Add Rougui 0.3-0.5 fen to guide blood/pus. Qi reversal/fullness: add Muxiang 0.2-0.3 fen. Nausea/vomiting: add Dingxiang 3 grains to open Stomach/raise toxin. Secret method, effective. Itchy/flaccid/chills/grinding teeth/cold limbs/vomiting/diarrhea: Interior/Exterior Qi deficiency. Add Roudoukou, Hesui 0.5 fen each, Shufuzi 0.2-0.5 fen. Or Shixuan Neituo San + these three. Pre-scabbing, warm head/cold feet, diarrhea/thirst, shortness of breath, cold limbs/restlessness, gasping/chills/no heat: Chen Shi Shierwei Yigong San. Cyan/dry/purple/depressed with heat: do not use above; use Bazhen Tang + Huangqi, Shengma, Zicao Rong, Shengdihuang. See Youke Zhunseng Rash. One formula: black rooster comb blood + white wine for un-erupted/no pus. Best. Itchy/scratched: burn Ru Xiang in room. Use Gui Deng Tang. Dark/black/cyan/depressed/no pus/coma/sweat/restless/thirst/distension/hoarse cry/no urination/defecation: hard to save. Outer black/inner red: severe. Outer white/inner black: very severe. Needle-hole black dot: hard to treat. Inner/outer plump/red: best. Simultaneous eruption or dense needle-head eruption: hard to treat. Discern carefully.