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The name "Lengma Sha" (Cold Numbness Sand/Sha) has been passed down in folk customs for a long time. Since I began practicing clinical medicine in the 18th year of the Daoguang era (1838), although I had heard of this disease name, I had never seen its symptoms, making it difficult to verify at that time. By the autumn of the 26th year of Daoguang (1846), this disease became prevalent on a large scale. It presented a picture of pure Yin-cold, without the slightest trace of Sha-hui (Sha-toxin or turbid damp-heat).

At the onset, patients would first experience distending pain in the wrists and abdomen, followed by severe vomiting and diarrhea occurring frequently and incessantly. This led to a sudden emaciation of flesh and muscles, sunken eyes, cold limbs, irritability and restlessness, and even spasms and clamping of the hands and feet, muscle cramps (Zhuanjin), numbness, complete absence of the six pulses, and profuse sweating resembling pearls (Pohan). In some cases, there were redness of the face and eyes, and extreme thirst with a desire to drink, yet the hands and feet remained cold. Although the exterior resembled a Yang syndrome (Heat pattern), it was actually due to excess Yin (Internal Cold Excess). Upon carefully reviewing the symptoms and consulting medical texts from the *Huangdi Neijing: Suwen* (Yellow Emperor's Inner Canon: Basic Questions) onwards, the ancient sages did not mention the term "Lengma Sha."

However, contemporary practitioners treated it based on the concept of "Sha," using formulas heavily loaded with herbs that release the exterior and vent toxins. If one considers the name, since it is called "Cold Numbness" and also "Sha," can there truly be a "Sha" without fever? The meaning of these three characters is indeed contradictory. To follow suit blindly and administer drugs recklessly is a grave lack of scrutiny. Such errors circulating in folklore are not surprising, but it is alarming that physicians also spread these misconceptions, failing to recognize what disease this is, and thus unable to know how to intervene and revive the dying! Because the limbs are numb and cold, they call it "Lengma Sha"; because of muscle cramps and limb stiffness, they call it "Diaojiao Sha" (Cramp-leg Sha). Folk rumors abound, lacking any precise reference.

Therefore, consulting Zhang Zhongjing’s *Shanghan Li* (Treatise on Cold Damage Examples), it is referred to as "Direct Invasion of the Yin Meridians" (Zhizhong Yin Jing); the *Jingui Yaolue: Stubborn Diseases Chapter* refers to it as "Yin Syndrome" (Yin Zheng), which corresponds to the "Muscle Cramp Huoluan" (Spasmodic Cholera) mentioned in medical books. Huoluan (Cholera/Vomiting and Diarrhea) implies sudden chaos and disorder arising instantaneously. If vomiting and diarrhea do not cease, critical changes arise, leading to an untreatable state. This disease must originate in individuals whose Yang Qi has been damaged by overwork and whose Mingmen True Yang has been depleted by sexual indiscretion. Overwork injures Spleen-Yang; sexual excess destroys Life-fire Yang. Consequently, pathogenic factors of Yin-cold and damp obscurity from the environment easily invade through these openings.

Regarding general treatment principles, one should avoid cold and use heat, dispel Yin-cold, and restore Yang, thereby supporting the critical and correcting the perilous. Examining Zhang Zhongjing’s *Shanghan Lun* and *Jingui Yaolue: Stubborn Diseases Chapter*, while containing profound insights, lacks detailed elaboration. Only Master Yu Chang (Yu Jiayan) alone entered the inner sanctum of Zhang Zhongjing’s teachings, perceiving their richness, and excelled particularly in elucidating Yin syndromes. Unfortunately, later generations became accustomed to them without noticing this nuance. Observing that such cases are frequent nowadays, with many dying within hours of onset, if medication is mistaken, how can one claim that physicians exist to save the world?

Yet, some mistake facial redness and eye redness for Yang syndrome; extreme thirst and desire to drink for Yang syndrome; scanty and difficult urination for Yang syndrome; absence of all six pulses for Yang syndrome; and deep, hidden pulses with Yin-restlessness and agitation for Yang-heat irritability. At such times, administering acrid-warm medicines fails to produce results, and instead, cold-cooling medicines are recklessly given. Little do they know that administering cold-cooling agents leads inevitably to death with no hope of rescue.

Therefore, not presuming upon my own shallow ignorance, and daring to show off my axe before Lu Ban (a metaphor for modestly presenting one's views before experts), I have cautiously annotated Yu’s "Eight Difficulties of Yin Syndromes." Knowing the painstaking effort of skilled physicians, I trust that those with discernment will understand. However, those with keen insight and true understanding will perceive the reality. Through mutual clarification and exposition, may the purport of the *Stubborn Diseases Chapter* become known to all, preventing future errors, which would surely be a great blessing for the people!