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**Deficiency Irritability (Xu Fan)** presents with no pain in the head and body, absence of sweating, and a pulse that is not tight.

"Deficiency irritability" refers to irritability caused by emotional disturbances and desires leading to deficiency of Kidney Water, resulting in hyperactive Heart Fire; or irritability due to residual heat remaining after miscellaneous diseases; or irritability arising from labor overexertion causing Qi deficiency and hyperactive Fire; or irritability due to Yin deficiency triggering the movement of Ministerial Fire. These conditions resemble the initial stage of *Shanghan* (Cold Damage), with external fever present, but distinguished by the absence of head and body pain and a non-tight, non-rapid pulse. Even when caused by Yin deficiency, there may be aversion to cold, though not severe, and the pulse can be rapid but forceless. Generally, for post-illness weakness, emaciation, shortness of breath, irritability, and desire to vomit, use **Zhuye Shigao Tang** (Bamboo Leaf and Gypsum Decoction); for milder cases, use **Xiaochaihu Tang** (Minor Bupleurum Decoction). For phlegm-rebellion and nausea, use **Jupi Zhuru Tang** (Tangerine Peel and Bamboo Shavings Decoction). For Yin-pattern internal cold with external heat, limb and joint pain, dry mouth absent but constitution weak, use **Yindan Tang**. After taking cooling medicines, if the pulse becomes more large yet forceless, and heat intensifies with dryness and thirst, use **Danren Shen Tang** (Single Ginseng Decoction) or decoct **Renshen Huang** (Ginseng and Astragalus) to administer **Wuling San** (Five-Ingredient Poria Powder). For labor-induced Qi deficiency, use **Buzhong Yiqi Tang** (Tonify the Middle and Augment the Qi Decoction). For Yin deficiency, use **Siwu Tang** (Four Substances Decoction) plus **Zhimu** (Anemarrhena Rhizome) and **Huangbai** (Phellodendron Bark). For Spleen and Stomach weakness, use **Sanbai Tang**. For palpitations and abundant phlegm, use **Wendan Tang** (Warm the Gallbladder Decoction). For unsettled mind and spirit, use **Zhusha Anshen Wan** (Cinnabar Calming the Spirit Pill). For women newly postpartum with blood deficiency and irritability, use **Siwu Tang** plus **Renshen** (Ginseng), **Danzhuye** (Light Bamboo Leaf), **Maimendong** (Ophiopogon Tuber), and **Gancao** (Licorice Root). Exterior deficiency contraindicates sweating methods; interior deficiency contraindicates purgation methods; only mild and balanced formulas should be used for regulation. The *Qianjin Fang* states: Deficiency irritability must not be treated with excessive attack; once heat is removed, cold will arise. If heavy sweating or purging agents used for *Shanghan* are applied to deficiency irritability, severe cases lead to exhaustion of fluids and death, while mild cases lead to internal consumption, night sweats, and transformation into *Laozai* (Consumptive Disease). In *Shanghan*, those who have not undergone sweating, vomiting, or purging may experience irritability with chest fullness, diaphragmatic solidity, and烦热 (irritating heat); those who have already undergone these treatments may experience irritability with chest fullness, vexation, and inner restlessness (*Ao Nao*), as detailed in respective sections.

**Phlegm Patterns** present with no pain in the head and neck, presence of chills and fever, and a floating pulse at the Cun position.

Phlegm is transformed from body fluids; Wind injures the Lung, Dampness injures the Spleen, and turbid qi condenses to form it. External signs show a relaxed head and neck, with only chills and fever resembling *Shanghan*. Initial onset features chest and diaphragm fullness, Qi rushing up to the throat, and a floating Cun pulse as distinguishing features. With heat, use **Shensu Yin**, **Jinfecao San**, or **Chaihu Banxia Tang**; without heat, use **Erchen Tang** or **Wendan Tang**; the universal formula is **Daotan Tang** (Guide Out Phlegm Decoction). For phlegm knotting in the chest, use **Heding Dan** or **Zhigeng Erchen Tang**; for phlegm attacking upward causing recurrent headaches, use **Gua Di San** to induce vomiting.

**Food Stagnation** presents with fullness and oppression in the heart and abdomen.

External symptoms include headache, fever, and aversion to cold, completely resembling *Shanghan*. The distinction lies in the absence of body pain, abdominal fullness, belching, hiccuping, vomiting, and a strong, wiry Right pulse. The *Baizheng Ge* states: Headache with nausea but no body pain indicates food stagnation; headache with body pain indicates *Shanghan*. Food stagnant in the Upper Jiao, causing chest fullness, nausea, and desire to vomit, in excess patterns, is treated with **Gua Di San** to induce vomiting. Food stagnant in the Middle Jiao, causing distension and desire to vomit, with heat, is treated with **Erchen Tang** plus **Huanglian** (Coptis Rhizome), **Shengjiang** (Fresh Ginger), and **Wumei** (Mume Fruit), or Tao’s **Pingwei San**. Abdominal pain with desire for diarrhea is treated with **Weiling Tang**; if cold, with **Zhizhong Tang**. Heart and abdominal fullness/pain with constipation is treated with **Dachaihu Tang** to purge. There is also *Shanghan* complicated by food stagnation, called Taiyin Accumulation Pattern. With exterior signs, use **Huoxiang Zhengqi San** or **Wuji San** removing Danggui and Mahuang, adding Renshen and Ziyè; with both exterior and interior signs, use **Guizhi Jiada Huang Tang** (Cinnamon Twig Decoction Plus Rhubarb); when exterior signs have resolved and only interior excess fullness remains, use **Xiaochengqi Tang**. After purging in *Shanghan*, if there is no bowel movement for six to seven days, accompanied by irritating heat, abdominal fullness, and pain, it is due to retained food in the Stomach. If Cold complicates food stagnation, immediately presenting with vomiting, diarrhea, cold limbs, and Huoluan, urgently use **Lizhong Tang** plus Zhishi, or **Sini Tang** to rescue. When Spleen and Stomach are injured by complicated food stagnation, do not lightly use sweating or purging methods.

**Hongxiangjiao** (Foot Qi / Beriberi) presents with softness and weakness in the knees and shins.

"Foot Qi" refers to the four pathogenic factors (Wind, Cold, Summerheat, Dampness) steaming the feet, entering deeply along meridians into the Zang organs, developing gradually, unlike other pathogens that strike superficially and suddenly. External signs fully resemble *Shanghan*, with Six Meridian transmission, just like Taiyang headache and fever, progressing until Jueyin irritability, fullness, and testicular retraction. There are also combined and concurrent diseases. The distinction is initial softness, numbness, and bi-syndrome in the feet and knees, tendon spasms, and red swelling. If Taiyang signs appear with pain along the Jinggu point from the lateral malleolus to the lateral side of the little toe, disperse according to the predominant pathogen using **Mahuang Tang** plus **Fangfeng**, **Qianghuo**, **Xixin**, **Gegen**, **Baizhu**, **Fuling**, and **Fangji**, or **Baidu San** combined with **Bin Su San**. If Yangming signs appear with pain from the lateral thigh/knee down to the medial side of the middle toe, mildly purge according to the predominant pathogen using **Dachaihu Tang** plus **Qianghuo**, **Xixin**, and **Xingren**, or **Shengma Gegen Tang** combined with **Bin Su San**. If Shaoyang signs appear with pain in all toe joints, harmonize using **Xiaochaihu Tang** removing Banxia, adding **Fangfeng**, **Gegen**, **Xixin**, **Baizhu**, **Fuling**, **Maimendong**, **Ganjiang**, and **Xiaocao**. For Three-Yang combined disease with spasms and constipation, combine the previous three formulas with modifications, named **Zuojing Tang**. If specifically invading the Foot Taiyin Meridian, presenting with pain or edema on the medial thigh/knee and medial tip of the big toe, use ancient **Guifu Tang** plus **Fangji**, **Baizhu**, and **Fuling**. For Shaoyin Meridian, presenting with pain from the little toe connecting to the sole, medial thigh pain radiating to the chest, anorexia, black complexion, dysuria, and insensitivity in the lower abdomen, it is difficult to treat; rescue with **Bawei Wan** (Eight-Ingredient Pill). For Jueyin Meridian, presenting with pain from the big toe connecting to the medial side, umbilical/abdominal distension/pain, foot spasms, and dry retching, use **Yangzhen Dan**. If the three Foot Yin meridians show spasms, bi-syndrome, weakness, attacking upward to chest/hypochondrium/shoulder/back, downward to feet/knees, with hot soles, use **Huantui Wan**. Generally, Wind enters the Liver, causing sinew migration and pain, floating pulse, no sweat; treat with **Xiaxuming Tang** plus **Duhuo**. Wind-toxin swelling/pain: **Paifeng Tang**, **Bangling San**; Sinew tension pulling pain: **Ruxiang Ding Tong San**. Dampness enters the Spleen, causing heavy flesh, sudden falls upon walking, or edema; treat with **Chushi Tang**; if abundant phlegm, swallow **Qingzhou Baiwanzi** with this decoction. Summerheat enters the Heart, causing asthma, stifling, irritability, necessarily heat; treat with **Baidu San** plus **Dahuang**. Cold enters the Kidney, causing bone spasms and pulling pain, necessarily cold; treat with **Wuji San**, **Yeshi Tang** plus **Mugua**, universally **Qianjin Xuming Tang**, **Liuyin Yinzi**, **Wuyao Shunqi San**. For irritability, drink **Zhuli** (Bamboo Sap) alone; for constipation, use **Sanhe San** or **Xiyue Wan**; for toxic vapors rushing to the Heart causing pain, use **Suzi Jiangqi Tang** to deliver **Yangzheng Dan**, or decoct **Wuyu** to prick and inject Ginger Juice to rescue; death is imminent. In ordinary Spring/Summer, use **Bin Su San** plus **Chuanlianzi**; for hot/red swelling, use **Baidu San** plus **Mugua** and **Cangzhu**; in Autumn/Winter, use **Wuji San** plus **Mugua**, **Binglang**, **Niuxi**, and **Wuyu**. Most taboo is washing with tonifying decoctions and applying herbal pastes. Etiologies include Qi, diet, and mineral pills; this must be known.

**Blood Stasis** leads to confusion, forgetfulness, and manic behavior, with discomfort in the chest, hypochondrium, and lower abdomen.

Blood is the river system of the body, valued for flow rather than stagnation. Failure to sweat when indicated causes fluids to seep inward; sweating when inappropriate exhausts fluids inward; excessive diuresis causes Blood Heat transforming into malignant stasis; or pre-existing trauma, depression, or overconsumption of fried foods cause Blood Heat and stasis. Accumulated in the Upper Jiao: epistaxis, forgetfulness, coma (recovering slowly), or chest/hypochondrium/abdominal fullness/pain, delirium, and obtundation, called **Xue Jie Xiong** (Blood Knot Chest Syndrome). Accumulated in the Middle Jiao: head sweating, thirst, jaundice. Accumulated in the Lower Jiao: manic behavior, black stool, lower abdominal urgency/clumping, tenderness on pressure, with Kou and Se pulses. External signs of chills/fever fully resemble *Shanghan*. Taiyang signs manifest as manic behavior; Yangming signs as forgetfulness; Shaoyang signs as chills/fever resembling malaria. Generally, treat the Upper with **Xijiao Dihuang Tang** (Rhino Horn and Rehmannia Decoction); the Middle with **Taoren Chengqi Tang** (Peach Kernel and Rheum Decoction); the Lower with **Didang Tang** or Pills. However, only use Didang for heavy signs and rapid pulse; for light signs and faint pulse, universally use **Xijiao Dihuang Tang** plus **Qingpi**, **Huangqin**, **Huanglian**, **Dahuang**, or **Xiaochaihu Tang** plus **Taoren**, **Shengdi**, **Zhizi**, and **Yinchen**. This method applies to all blood disorders. In *Shanghan*, if purging with Chengqi fails and hardness/eating ability persists, it is blood stasis. Any disease worsening at night indicates blood stasis; thus, trauma resembles *Shanghan*.

**Sores and Toxins**: Diet remains normal; redness/swelling/pain is evident.

For carbuncles, ulcers, furuncles on the back, and any unnamed swellings/toxins, initial chills/fever fully resemble *Shanghan*. Distinction: *Shanghan* patients lose appetite, whereas toxin patients eat normally, and there are visible red/swollen/painful areas on the body. Do not blindly use sweating or purging; treat with surgical methods. "Liuzhu Shanghan" (Flowing Injection Cold Damage): "Liu" means flow; "Zhu" means stay. Qi/Blood flow, encountering Cold, becomes stagnant, forming nodules like piles of kernels (large as fist, small as plum), with initial chills/fever resembling *Shanghan*. Unulcerated: **Baidu San** combined with **Liangge San** plus **Jinyinhua** (Honeysuckle Flower). Ulcerated: **Tuoli San**. Do not treat as standard *Shanghan*. "Chige Shanghan" (Red Diaphragm Cold Damage): Red/swollen/painful chest/diaphragm, chills/fever resembling *Shanghan*, but not standard *Shanghan*; treat with **Jingfang Baidu San** combined with **Xiao Xiantong Tang**; if interior excess, use **Fangtong Tongsheng San**.

**Smallpox/Rash**: Buttocks and feet are cold initially.

For infants and adults suddenly presenting *Shanghan*-like symptoms, if smallpox/rash has not yet appeared and buttocks/middle toes are cold, treat according to the initial heat section of Smallpox protocols.

**Labor-induced Phlegm-Fire**: Awaits one week for resolution.

Those with chronic Phlegm-Fire, upon slight exertion, develop chills/fever resembling *Shanghan*. Mild cases resolve spontaneously after a week of rest; severe cases develop hard/lumpy swellings in neck/armpits/groin, which may subside but recur with exertion. Treatment: **Bawu Erchen Tang** plus fire-descending and harmonizing herbs.

**Exogenous Invasion**: Do not vent excessively.

Traditionally, "Shang" (Injury) was severe, "Ganmao" (Catch Cold) was mild. Now they are distinguished to prevent using heavy *Shanghan* formulas for mild Ganmao, causing complications. Cold invasion causes aversion to cold/pale face, but headache/fever are less severe than *Shanghan*, pulse often deep/slow. Wind invasion causes aversion to wind/nasal congestion, but fever is less severe than Wind injury, pulse often floating/rapid. Generally, for unfevered Cold: **Xiangsu San**; for Wind: **Suge Tang**, **Gu Cangjing San**. For fevered: **Jiuwei Qianghuo Tang** etc., taken hot until skin is slightly moist, then cured. For frail/chronically ill, add **Shengjiang** and **Chenpi** to original meds; Cold pattern: **Erchen Tang**; Wind pattern: **Sanbai Tang** with modifications. See Miscellaneous Diseases.

**Endogenous Injury**: Tonify and supplement concurrently.

Exogenous invasion complicated by endogenous injury: Chronic Wind/Cold exposure not yet manifested, triggered by diet/labor. External signs resemble *Shanghan*. Left Renying and Guan pulses are 1-2 times larger than Right Qikou, indicating heavy exogenous/light endogenous. Treat with **Jiuwei Qianghuo Tang** removing **Cangzhu**, **Shengdi**, using **Baizhu**, modified by Six Meridians. Spleen/Stomach endogenous injury + Cold exogenous: **Huoxiang Zhengqi San**, **Renshen Yangwei Tang**. Diet endogenous injury + Wind/Cold exogenous: **Pingwei San** plus **Huanglian**, **Zhishi**; constipation adds **Taoren**, **Dahuang**. Raw/cold endogenous injury + Wind/Cold exogenous: **Wuji San**. Endogenous injury complicated by exogenous: Prior diet/labor excess causing body pain/weakness, followed by Wind/Cold. Right Qikou/Guan pulses 1-2 times larger than Left Renying, indicating heavy endogenous/light exogenous. Treat with **Buzhong Yiqi Tang** or **Tiaozhong Yiqi Tang**, modified by Six Meridians. Mistaking for *Shanghan* and sweating heavily causes death. Sexual endogenous injury + Wind: **Yupingfeng San** or plus **Guizhi**, **Baishao**. Sexual endogenous injury + Cold: **Chuanxiong Tang**. Wind/Cold dual infection: **Yupingfeng San** combined with **Chuanxiong Tang**. Frail constitutions: Universally **Shiquan Dabu Tang**, lightly adding **Fangfeng**, **Qianghuo**, **Xixin**, **Baizhi**. Cold limbs: Add **Jiang**, **Fu**. Yin deficiency: **Bawu Tang** plus **Chenpi**, stir-fried **Ganjiang**; do not misuse drying Wind-Cold drugs, which further deplete Kidney Water. Endogenous deficiency with limb weakness/fever resembles *Shanghan*, but distinguished by night sweats, spermatorrhea, white turbidity. Endogenous Wei deficiency (aversion to wind) and Ying deficiency (aversion to cold) resemble *Shanghan*, but aversion disappears in closed rooms. Endogenous Yin deficiency with Fire movement: Aversion to cold is not true cold, aversion to heat is not true heat; distinguished by emaciation and forceless pulse. Endogenous extreme thirst/body heat with large pulse resembles Yangming White Tiger pattern, but pulse is forceless. Endogenous summer fatigue resembles exogenous Damp-Heat; fever/headache resembles Warmth/Summerheat. All above: **Buzhong Yiqi Tang**, **Siwu Tang**, or **Sijunzi Tang** with modifications. See Differentiation of Exogenous/Endogenous and Miscellaneous Diseases.

**Jie Yi** (Muscle/Joint Laxity): "Jie" means muscle dispersion; "Yi" means sinews failing to bind bones. Signs: pseudo-cold/pseudo-heat, lax limbs/joints, lethargy, painful irritation, poor appetite. Etiologies: Alcohol injury, Dampness, Wind/Cold, sexual excess, irregular menstruation. Resembles Sha disease but is not Sha. Treatment: Unblock Qi/Blood, open pores, regulate with endogenous/exogenous formulas. Mild cases: Scraping (Gua Sha), pricking ten fingers and Weizhong for bleeding. Sha disease resembling *Shanghan* see Miscellaneous Diseases/Gu Zhang.

The above discusses names of *Shanghan*-like conditions.

Traditionally, Phlegm-Fluid, Deficiency Irritability, Foot Qi, Food Stagnation, Sores/Toxins, Blood Stasis, Labor-induced, and Smallpox/Rash (8 conditions) were classified into 6 categories of *Shanghan*. Adding Ganmao and Labor Injury makes 10 categories. Ultimately, all hundred diseases resemble *Shanghan*; this must be known.

Standard *Shanghan* and *Shanghan*-like conditions are as described. What is transmitted *Shanghan*? It is heard that: Transmission to Yang meridians brings tidal fever, spontaneous sweating, constipation, dysuria, abdominal fullness, thirst, mania, delirium, even eruption of macules, hematemesis, asthma, climbing walls/roofs. Transformation to Yin meridians brings cold limbs, vomiting, diarrhea, no thirst, quiet curling, even sore throat, improper speech, desire to sit in wells/ground. Let me speak from the initial signs.