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Those who suffer from "Lianggan" (Double Exposure) due to cold pathogenic factors are in a critical, invariably fatal condition. For instance, on the first day, if both the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) meridians are affected, symptoms such as fever, aversion to cold, headache, dry mouth, restlessness, and thirst will occur; on the second day, if both the Yangming (Yang Brightness) and Taiyin (Greater Yin) meridians are affected, abdominal fullness, body heat, delirium (Zhenyu), inability to eat, and restless sleep will manifest; on the third day, if both the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are affected, hypochondriac pain, deafness, contraction of the scrotum, cold limbs, inability to take in fluids, and unconsciousness will appear. In summary, this represents simultaneous disease of both Yin and Yang, damage to both exterior and interior, obstruction of Qi communication between Zang and Fu organs, and blockage of Ying (Nutritive) and Wei (Defensive) essence circulation inside and outside. By the sixth day, when the Qi of all six meridians is exhausted, the condition becomes incurable.

Then, why does "Lianggan" occur? Taking the example of the first day with simultaneous Taiyang and Shaoyin involvement: The Taiyang meridian belongs to the Fu (Hollow) organs; pathogenic factors enter via the Shu (Transport) points on the back, which is commonly known. The Shaoyin meridian belongs to the Zang (Solid) organs; pathogenic factors enter via nasal respiration, which is less understood. Nasal Qi connects to Heaven; thus, formless cold Qi enters through the nose. The Kidney is the Water organ; like attracts like, so the Kidney receives the pathogen. As stated in the *Classic* (*Jing*): "Heavenly pathogenic factors, upon contact, harm the Five Zang organs." When both interior and exterior are simultaneously affected, and both Zang and Fu organs are diseased, treating the exterior is contraindicated by the interior disease, and purging the interior is contraindicated by the exterior disease. Since exterior and interior cannot be treated separately, it is said that Lianggan is incurable.

However, constitutional endowment varies in deficiency or excess, and the depth of pathogenic invasion differs. Those with deficiency constitution and deep invasion will inevitably die. Those with robust constitution and shallow invasion may still be treatable. If exterior symptoms predominate, resolve the exterior first; if interior symptoms predominate, purge the interior first. This implies treatment has a sequence, relying on flexible adaptation to changing conditions. If treatment is appropriate, harm is usually avoided.

Normally, Ying and Wei Qi circulate continuously without interruption. Once pathogenic factors invade internally, they obstruct Zheng Qi (Upright Qi), preventing normal flow, leading to stagnation and heat generation. Zhang Zhongjing stated: "If in the Exterior, induce sweating; if in the Meridians (Middle/Shaoyang), harmonize; if in the Interior, purge downward." Disperse pathogens according to their location, merely allowing pathogenic heat to recede and Zheng Qi to resume circulation. This is the standard established by ancient sages.

However, ancients were robust and could withstand such purgative treatments; modern people are weak and cannot endure such harsh manipulation. If Yuan Qi (Primal Qi) is injured by the disease and further injured by medicine, one should only aim for the "treatment of non-treatment" (restorative care). Moreover, the meridians—Three Yang and Three Yin—are distributed throughout the body. Where pathogenic factors gather, how can there be a fixed location? Huang Zhongli said: "Wind, Cold, and other Six Excesses injuring humans may enter Yang meridians or strike Yin collaterals. Who comes first? Who follows? How can we exclusively regard the Taiyang meridian as the starting point of pathogenic invasion?" Therefore, all meridians can receive pathogens, though Taiyang receives them most frequently, serving as a reference grade. Thus, select the seven formulas from Zhang Zhongjing’s Six Meridian patterns for initial dispersal. If Yin meridians are affected, transmission ceases; use previous formulas to warm meridians and disperse cold. Only if Yang meridians are affected initially use Ephedrae Herba (Mahuang, 麻黄) and Cinnamomi Ramulus (Guizhi, 桂枝) for exterior dispersal. If pathogens transmit to the Half-Exterior Half-Interior stage, use Xiao Chaihu Tang (Minor Bupleurum Decoction) to harmonize subsequently. If pathogens transmit to the Interior, purging is indicated; use Da Chaihu Tang (Major Bupleurum Decoction), Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction), etc., to purge downward. This outlines the general principles for treating true Shanghan (Cold Damage) involving Exterior, Middle, and Interior syndromes. Regarding Dongwen (Winter Warmth) disease, it arises from inappropriate climate ("having its Qi out of season"). In winter, severe cold should lead to closure and storage (of Yang Qi); instead, leakage occurs outward. Use tonifying herbs combined with exterior-releasing herbs, such as Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction).