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(If the pathogen is) in the exterior, use Wuji Jiajiao San; (if it is) interior cold, use Lizhong Tang with Fuzi; (if) excessive cold leads to edema, Shu Fu Tang is excellent.

Contracting dampness causes dysfunction of both bowels and bladder, and a yellow hue stains the skin.
"Dampness" refers to water fluids. In the southeast, where the terrain is low, wind and rain invade the deficient body, and vapors rise from mountains and marshes, making people prone to contracting dampness. If dampness is in the meridians, there is fever at dusk and nasal congestion; if in the joints, there is generalized body pain; if in the zang-fu organs, clear and turbid qi mix causing loose stools, while urination becomes difficult, and the abdomen may be distended; when damp-heat struggles together, the whole body turns yellow like a smoky stain, with mild cases showing only slight yellowing of the face and eyes. Misusing purgatives leads to wheezing and hiccups, misusing diaphoresis leads to tetanus/spasm and death; only promoting urination is the best treatment, primarily using Wuling San or Chushi Tang. If urination is difficult but stool is loose, use Gancao Fuzi Tang; if bowel and bladder movements are normal without jaundice, use Shu Fu Tang; for body pain and nasal congestion, use Huangqi Jianzhong Tang; for solid fullness in the middle jiao with urinary retention, use Zhizhu Tang plus Tinglizi. Jaundice patterns are detailed later.

Damp Bi syndrome involves the combination of wind, cold, and dampness, with pain traversing the joints.
"Bi" means pain. In Taiyang disease, if the pulse is deep and fine, joints are painfully painful, skin is numb, and there is spontaneous sweating, use Fangji Huangqi Tang; if there is no sweating, Wuji Jiajiao San is the primary formula.
However, dampness exists in all four seasons; depending on whether it combines with wind, heat, or cold, modifications should be made according to symptoms. Ancient texts mention three types of damp diseases, but there are actually five.
Heavy contraction of cold and damp leads to tetanus/spasm, which can manifest as惊厥 (convulsions) during attacks;
Pure wind-strike or pure cold-strike in Taiyang disease does not cause tetanus/spasm. Only when wind-strike is followed by cold-strike, or wind-strike followed by dampness, can excessive sweating induce tetanus/spasm. Repeatedly inducing heavy sweating in Taiyang, or heavily sweating patients with dampness, can all cause tetanus/spasm. The external signs resemble cold-heat alternating like in cold damage, but the pulse is deep, slow, wiry, and thin; shaking head, exposing eyes, locked jaw, convulsions of hands and feet, stiff neck, and opisthotonos resembling epilepsy are characteristic. Unconsciousness throughout the day is an anomaly. Wind's nature is forceful, leading to Gang Jing (rigid tetanus); due to heavy contraction of cold, there is no sweating, suitable for Gegen Tang plus Qianghuo, Duhuo, and Fangfeng. Dampness's nature is slack, leading to Rou Jing (soft tetanus); due to prior wind-strike, there is sweating, suitable for Guizhi Tang plus Tianhuafen and Gegen. If phlegm obstructs and qi is abundant, use Nanxing, Banxia, and Baifuling to resolve phlegm, Zhishi, Chenpi, and Zisu to regulate qi; after phlegm resolves and qi flows smoothly, then treat rigid or soft tetanus respectively. The general formula is Xiao Xuming Tang; remove Fuzi if there is heat, remove Mahuang if there is spontaneous sweating. For rigid tetanus lasting two to three days, with upward gaze, high fever, chest fullness resembling Jie Xiong, constipation, curled legs, and inability to lie flat on the back, use Dachengqi Tang to purge. For mild cases, use Baidu San or Xiaochaihu Tang. For soft tetanus lasting two to three days without improvement, with profuse sweating, cold extremities, and tendon tension, use Fuzi Fangfeng Tang. For intermittent attacks, critical cases, use Fushu San. There is also tetanus where rigid and soft types are indistinguishable: body heat and delirium resemble rigid tetanus, slight cold extremities and loose stools resemble soft tetanus; use Xiao Xuming Tang plus Sheng Fuzi. After sweating and purging treatments, if there is alternating calmness and restlessness, and twitching of the left eye and left limbs, it is Shaoyang tetanus, treated with Xiaochaihu Tang plus Fangfeng. Also, in blood-deficient individuals, or those who suffered wind-strike with excessive sweating postpartum, or in broken-skin wind (tetanus) attacks, do not treat purely as wind; use Siwu Tang plus Fangfeng, or Bawu Tang removing Fuling, adding Huangqi, Qianghuo, and Fangfeng to rescue. For any tetanus, if the pulse scatters outwards like raindrops splashing, death is immediate. Also, staring upwards with opisthotonos, convulsions with sweat like pearls, or body arching one palm's width off the bed (two finger-widths for children), are all fatal signs. Tetanus caused by wind-heat, phlegm-fire, or deficiency is discussed in miscellaneous diseases.

Heavy contraction of cold changes into Wen Nue (warm malaria), which can be arrested if prolonged.
After sweating, vomiting, or purging in cold damage, if residual heat remains and is re-contracted by cold, it transforms into malaria; or if old heat persists after passing through channels and new six-excess pathogens are contracted, it transforms into malaria. All called Wen Nue because they present with heat preceding cold. If cold exceeds heat or is only cold, it is a transformation of Taiyang pathogen, use Chaihu Guijiang Tang. If heat exceeds cold or is only heat, with painful joints, it is a transformation of Yangming pathogen, use Baihu Tang plus Guizhi. If cold and heat are equal or heat precedes, it is a transformation of Shaoyang pathogen, use Xiaochaihu Tang. If thirsty, remove Banxia and add Tianhuafen and Zhimu. If cold and heat are severe with chills and persistent sweating, it is a combined disease of Taiyang and Yangming, use Guizhi Shigao Tang. If malaria worsens after taking this, it is a combined disease of the three yang channels; fearing transmission to yin channels, urgently use Guizhi Huangqin Tang. If transmitting to the yin aspect, attacking from Mao to Wu hours with vomiting and constipation, purge with Dachaihu Tang; attacking from Wu to You hours with abdominal fullness and constipation, purge with Dachengqi Tang; attacking from You to Yin hours with mania, forgetfulness, and black stool, mildly purge with Tao Ren Chengqi Tang; if purging is contraindicated, use Zhizi Shengma Tang. This distinguishes cold damage malaria from miscellaneous disease malaria. Occasionally involving phlegm and food stagnation with vomiting and anorexia, use Erchen Tang or Duijin Yinzi. For difficult urination, irritability, thirst, or maladaptation to miasma/water and soil, use Wuling San added with Huangqin and Chaihu. These types of malaria are not significantly different from miscellaneous diseases; if the condition persists and intensity slows, it can be arrested. For phlegm-fluid in the upper jiao wanting to vomit but unable, use Genti, Chi Xiaodou, and Xionghuang in equal parts powdered, taken with water (0.5 fen), stopping when vomited, or Quxie Wan is also good. For chronic cases, use Shengjin Dan or Laonue Wan to eliminate.

Fog and dew invading the lower jiao is called Hun (turbid); fog and dew invading the upper jiao is called Jie (clear).
A tight yin pulse indicates fog/dew turbid pathogen invading the Shaoyin portion of the lower jiao, hence called Hun. Due to exterior deficiency and interior weakness, the pathogen invades the yin causing shivering, cold lower legs and calves, incontinence, or abdominal pain with diarrhea; use Lizhong Tang or Sini Tang, hot herbs to disperse the pathogen. A tight or choppy yang pulse indicates fog/dew clear pathogen invading the Taiyang portion of the upper jiao, hence called Jie. Causing fever, headache, stiff neck, lumbar pain, and sore calves; use Jiuwei Qianghuo Tang plus Gaoben. If aversion to cold and nausea occur, use Huoxiang Zhengqi San or Wuji San, still adding Gaoben as appropriate. If both yin and yang pulses are tight, both upper and lower jiao are invaded; recovery requires the pulse to cease being tight after vomiting/diarrhea and hands/feet to become warm. If the pulse is slow after vomiting/diarrhea and appetite is absent, it is spleen-stomach deficiency with internal fluid retention; if yin and yang pulses are both tight, with breath exhalation, dry lips/mouth, curled posture, cold feet, runny nose, and slippery tongue coating, do not treat rashly. Furthermore, yang diseases ascending to the extreme descend, and yin diseases descending to the extreme ascend; both interfere with the middle jiao, causing chaos in the three jiao and blockage of internal/external qi, leading to mouth ulcers/sneezing above, and yellow urine/black tarry stool below. Excessive heat failing to transport spleen/stomach causes stasis of Ying and Wei leading to sores/abscesses; severe deficiency-cold weakens the spleen/stomach alone, failing to control the lower jiao, leading to heavy sensation in clear stool, umbilical throbbing pain, and death. The umbilicus is the source of vital qi; throbbing pain indicates exhaustion of vital qi.

Water syndromes often involve vomiting, coughing, and head sweating. If in the exterior, there is body heat and palpitations in the heart/chest; if in the interior, there is cool body and hard fullness in hypochondrium/abdomen.
Water is yin and cold. It arises from consuming raw/cold foods or excessive bathing. Those with internal heat will naturally dissipate it; those with internal cold will accumulate it. When exterior heat from cold damage combines with water qi, causing fever, palpitations, dry retching, coughing, lower abdominal fullness, and difficult urination, use Xiao Qinglong Tang. For half-exterior/half-interior patterns, only head sweating, no significant body heat, fullness below the heart with gurgling sounds upon pressure, called Water Jie Xiong, use Xiao Banxia Tang; severe cases, purge with Da Xianxiong Wan. Or if cold damage causes cold extremities with palpitations below the heart, dry retching, and hiccups, use Fuling Guigan Tang or Chifuling Tang. When interior cold combines with water qi, causing limb pain, abdominal pain, vomiting/diarrhea, and difficult urination, use Xuanwu Tang; severe cases forming masses with hard hypochondrium, use Shizao Tang. If exterior and interior signs appear together, thirst for water but vomiting immediately after drinking, called Water Ni (reverse), use Wuling San to promote diuresis. If the disease is in yang and should be sweated, but water washing traps heat, causing goosebumps, desire to drink but no thirst, use single Wenge powder mixed with boiling water (1 cun bi). If flowing into skin causing edema, select Musse Zeixie Tang, Wuling San, Fangji Huangqi Tang, or Shu Fu Tang.

Jaundice syndromes all involve thirst and head sweating. If caused by accumulated heat, there is difficult urination and abdominal distension; if caused by accumulated blood stasis, there is clear urination and urgent binding in the lower abdomen.
The Classics state: "When damp-heat interacts, the people suffer from Dan." Dan is jaundice, a condition of yang without yin. Although cold damage jaundice has various forms, all result from internal heat mistreated with warm herbs, excessive fire therapy, or failure to sweat/purge/promote urination, leading to blood heat in the Yangming channel manifesting true color on the skin, called Yu Re Fa Huang (stagnant heat causing jaundice). Head sweating, thirst, difficult urination, bright yellow color: use Yincheng Tang, Yincheng Sanwu Tang, or Tao Shi Yincheng Tang. For damp-heat stagnation causing jaundice with body pain, fever, and dull yellow color: use Yincheng Wuling San. For cold-damp jaundice, where Taiyang cold-damp is in the interior, excessive sweating removes cold leaving damp: use Mahuang Lian Yao Chi Xiao Dou Tang; for body pain/nasal congestion, urgently use the Genti nasal insufflation method described later, internally take Yincheng Wuling San; for severe headache, use Shenzhu San plus Yincheng. For dampness-caused jaundice with generalized pain, mistaken sweating causing yellow eyes: use Yincheng Wuling San, Zhizi Bapi Tang, or Fangji Huangqi Tang; for body irritability/pain, use Mahuang Tang plus Cangzhu. For wind-strike jaundice with hunger, dry nose, abdominal pain, tidal fever, cough: use Xiaochaihu Tang plus Yincheng; if hiccups, add Fuling; severe cases, use Dachaihu Tang plus Yincheng; for alternating cold/heat, use Xiaochaihu Tang plus Zhizi and Yincheng. For internal injury/cold jaundice with inherent spleen/stomach deficiency, or cold food stagnation, vomiting/fullness, or spontaneous diarrhea: use Lizhong Tang plus Yincheng, Zhishi, Qingpi; for abdominal distension, inability to eat fully, impending Grain Jaundice: use Wuling San plus Yincheng. For yin-pattern jaundice with cold extremities, deep pulse, or false agitation from yin excess: use Sini Tang plus Yincheng. For Jie Xiong jaundice with chest/heart fullness/hardness and tenderness: use Da Xianxiong Tang plus Yincheng. For Pi Qi jaundice with subcardiac fullness/hardness but no tenderness: use Banxia Xiexin Tang plus Yincheng; jaundice resolves when pi resolves. Generally, treating jaundice is similar to treating dampness: mild cases use diuresis/harmonizing, severe cases use strong purging; once urination flows, jaundice recedes. Not only is pulseless cunkou and cold nasal breath untreatable, but also smoke-blackened skin, head shaking, fixed gaze, black around the mouth, soft sweating with jaundice indicate spleen qi exhaustion. For initial jaundice, first rinse mouth with water, insufflate one character of Genti powder into the nose to expel yellow water, internally take Yincheng Wuling San or Jiuzheng Huanglian Wan, externally rub crushed ginger and Yincheng over the body. All jaundices have difficult urination, except blood stasis jaundice which has free urination.
Moreover, external signs of blood stasis and stagnant heat both include head sweating, thirst, and floating-rapid pulse. However, heat binding in the lower jiao consumes fluids causing difficult urination; blood binding in the lower jiao consumes blood but not fluids, hence urination is free. Treatment details follow under Blood Stasis.

The previous paragraph discussed the nomenclature of Zheng Shanghan (True Cold Damage).
Terms include: Shanghan (Cold Damage), Shangfeng (Wind Strike), Shangfeng Jian Han (Wind Strike with Cold), Shanghan Jian Feng (Cold Damage with Wind), Hebing (Combined Disease), Bingbing (Concurrent Disease), Lianggan (Double Contraction), Zhong Wulu (Mid Fog/Dew), Zhongshu (Heat Stroke), Rebing (Heat Disease), Wanfa (Late Onset), and Jing (Tetanus/Spasm). Five Damp Diseases: Fengshi (Wind-Damp), Shiwen (Damp-Warm), Hanshi (Cold-Damp), Zhongshi (Mid Dampness), Shidan (Damp Jaundice). Five Warm Diseases: Chunwen (Spring Warmth), Fengwen (Wind Warmth), Wenyi (Warm Plague), Wen Nue (Warm Malaria), Wendu Faban (Warm Toxic Eruption). Attached Water Syndromes and Jaundice Syndromes are the key points of Shanghan, thus mentioned together, totaling twenty-four types. Damp-warm accounts for half, demonstrating that damp-heat causes the most diseases.