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Wen Ge San (Clam Shell Powder) consists of five liang of Wen Ge (Clam Shell).
The above single herb is ground into a powder. Mix one qian bi (a measure equivalent to approximately 1-2 grams) with boiling water for oral administration, using five he (approximately 100 ml) of water.
[Commentary]
Wen Ge (Clam Shell) is the same as Wu Bei Zi (Galla Chinensis).

Phonetic Notation
Qiang Qun Yang Qie E Wu Qu Sheng Zhong Yin Zhong Se Yin Se Xi Yin Xi [Character] Yin Fu Ju Yin Ju Qu Shang Sheng Zi Yin Di Chuo Yu Chuo Tong Fu Fang Jiu Qie [Character] Yin Zhe Cha Yu Cha Tong Xie Yin Xie Jin Qu Yin Qie Ju Yin Ji Zhuan Yin Zhuan Wei Qu Sheng Shi Yu Zhi Tong Gan Yin Gan San Shang Sheng He Qu Sheng Ji Yin Ji Guan Yin Guan Geng Qu Sheng Pi Yin Fou [Character] Yin Ying Jing Yin Jing Lei Yin Lei Yang Shang Sheng Mi Yin Mi Yan Yin Yan Shuo Yin Shuo Ao Ying Kao Qie [Character] Yin Nong Zao Yin Sao Bu Bu Hu Qie Jing Yin Jing Xun Xin Gen Qie

The Taiyang (Greater Yang) channel governs Ying (Nutritive Qi) and Wei (Defensive Qi), which are the two pathways through which Wind (Wind Pathogen) and Cold (Cold Pathogen) initially enter the body. Wind injures Wei Qi (Defensive Qi), while Cold injures Ying Blood (Nutritive Blood). Wei Qi (Defensive Qi) is swift and vigorous, governing Qi that circulates outside the vessels; its function is dispersing and draining, belonging to Yang. It is easily invaded by pathogens, so invasion results in sweating, constituting a Deficient (Xu) pathogenic factor. Ying Blood (Nutritive Blood) is pure and concentrated, governing Blood that circulates inside the vessels; its structure is solid and dense, belonging to Yin. It is difficult to invade by pathogens, so invasion results in no sweating, constituting an Excess (Shi) pathogenic factor. Winter is indeed the season of Cold, but residual Cold in spring and early Cold in late autumn can also cause disease. As long as the symptom of no sweating and the Excess (Shi) pathogenic pattern are obvious, it can be called Shang Han (Cold Damage); it need not be limited strictly to mid-winter. However, Taiyang (Greater Yang) refers to the channels, and Bladder refers to the fu organs. Viewing from the channels to the fu organs, the channels are exterior and the fu organs are interior. In the previous chapter, Guizhi Tang (Cinnamon Twig Decoction) was used to resolve the muscle layer, treating the exterior syndrome of Wind injuring Wei Qi (Defensive Qi), but it did not address the interior of the Wei division. Therefore, Wuling San (Poria Powder) was established to assist Guizhi Tang (Cinnamon Twig Decoction) in harmonizing the interior of the Wei division. In this chapter, Mahuang Tang (Ephedra Decoction) is used to induce sweating, treating the exterior syndrome of Cold injuring Ying Blood (Nutritive Blood), but it does not address the interior of the Ying division. Therefore, Taohe Didang Fang (Peach Kernel and Di Dang Formula) is established to assist Mahuang Tang (Ephedra Decoction) in attacking the interior of the Ying division. Regarding improper use of sweating and purging methods: excessive use damages healthy Qi and causes Yang deficiency, while insufficient use leads to blazing heat that damages Yin fluids. Yang deficiency tends to manifest as Shaoyin (Lesser Yin) Yin-transformation syndromes because Taiyang (Greater Yang) and Shaoyin (Lesser Yin) are exterior-interior pairs. Yin fluid damage tends to manifest as Yangming (Yang Brightness) Yang-transformation syndromes because Taiyang (Greater Yang) and Yangming (Yang Brightness) transmit sequentially. Hence, this chapter also includes treatments with Sini Tang (Four Reversal Decoction) and Chengqi Tang (Ganglia-Resolving Decoction). Since the deficient pathogenic factors of Wind injuring Wei Qi (Defensive Qi) have been listed in the previous chapter, the excess pathogenic factors of Cold injuring Ying Blood (Nutritive Blood) are organized here in the middle chapter, allowing readers to grasp the general idea beforehand, so that clinical prescription will naturally avoid errors.

In Taiyang Disease (Taiyang Syndrome), whether fever has already appeared or not, there is invariably aversion to cold, body pain, vomiting and regurgitation, and a tight pulse at all three positions (Cun, Guan, Chi). This is named Shang Han (Cold Damage).
[Annotation]
Taiyang Disease (Taiyang Syndrome) refers to floating pulse, stiffness and pain in the head and nape, and aversion to cold mentioned in the first article of the previous chapter. Ying Blood (Nutritive Blood) is Yin within the Exterior. Cold is a Yin pathogenic factor. When Cold injures the human body, Ying Blood (Nutritive Blood) is affected due to resonance of similar natures. "Already fever" means Cold binds the skin and hair, closing the Xu Fu (Sweat Pores), causing Yang Qi to stagnate and generate heat. "Not yet fever" means Cold has just entered and has not yet stagnated to generate heat; fever will appear shortly. "Aversion to cold" occurs because the body is injured by Cold, hence aversion to it. "Invariably aversion to cold" means regardless of whether fever has appeared, aversion to cold is always present. Cold entering the channels causes body pain. Stomach Qi is bound externally by Cold and cannot disperse, causing vomiting and regurgitation. Cold nature is forceful and urgent, causing a tight pulse at all three positions. This follows the first article of the previous chapter regarding Taiyang Disease (Taiyang Syndrome), adding these specific pulses and symptoms, naming it Shang Han (Cold Damage). It serves as the outline for Shang Han (Cold Damage) diseases. Subsequent mentions of Shang Han (Cold Damage) refer to these specific pulses and symptoms.
[Collected Notes]
Fang Youzhi said: "Or" indicates uncertainty; "Invariably" indicates certainty. Saying "or" and "invariably" means the timing of fever varies, but aversion to cold appears inevitably immediately.
Yu Chang said: Zhang Zhongjing feared that patients with aversion to cold, body pain, vomiting, and no fever might be mistaken for Shaoyin (Lesser Yin) channel diseases. Thus, he clarified this statement at the beginning of the chapter to differentiate it.
Cheng Yingmao said: The tight pulse of both Yin and Yang positions in Shang Han (Cold Damage) is significantly different from the slow pulse of floating Yang and weak Yin seen in Feng Shang Wei (Wind Injuring Defensive Qi). Only when both symptoms and pulse match the reality can it be correctly named Taiyang Shang Han (Cold Damage of Greater Yang), distinct from Feng Shang Wei (Wind Injuring Defensive Qi).
Wei Litong said: Both Shang Han (Cold Damage) and Feng Shang Wei (Wind Injuring Defensive Qi) present with floating pulses, but the latter is floating and slow, while the former is floating and tight. Yang pathogens are expansive, hence slow; Yin pathogens are forceful and urgent, hence tight. Although both are floating indicating exterior location, the difference between slow and tight distinguishes Wind from Cold.

In Taiyang Disease (Taiyang Syndrome), characterized by headache, fever, body ache, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is the primary treatment.
[Annotation]
This elaborates on the symptoms following the previous article to propose the treatment. The Taiyang channel originates from the inner canthus of the eye, ascends to the forehead, intersects at the vertex, enters to connect with the brain, emerges again, descends separately along the neck, runs along the medial shoulder blade, flanks the spine to reach the waist, and ends at the little toe. When Cold pathogen lodges in the channel, Ying Blood (Nutritive Blood) becomes stagnant and sluggish, causing pain everywhere it affects. Diseases of Ying Blood (Nutritive Blood) involve aversion to cold; diseases of Wei Qi (Defensive Qi) involve aversion to wind. Here, Ying Blood (Nutritive Blood) disease mentions aversion to wind because wind movement generates cold; aversion to cold and wind go together. There is no case of aversion to cold without aversion to wind, or aversion to wind without aversion to cold. Therefore, Zhang Zhongjing often uses these terms interchangeably in describing Feng Shang Wei (Wind Injuring Defensive Qi) and Shang Han (Cold Damage). This shows that distinguishing between them lies not in aversion to cold versus wind, but in their severity. Absence of sweating occurs because the Excess (Shi) pathogenic factor of Cold seals the Cou Li (Interstitial Spaces/Pores); although fever exists, sweat does not come out, unlike the Deficient (Xu) pathogenic factor of Wind where fever accompanies spontaneous sweating. Yang Qi is constrained by Cold, reversing upward to cause wheezing. Mahuang Tang (Ephedra Decoction) is used to release the exterior and induce sweating, expelling pathogens and protecting healthy Qi.
[Collected Notes]
Cheng Wuji said: Cold injuring Ying Blood (Nutritive Blood) causes headache, body pain, lower back pain, extending to joint pain, due to impaired circulation of Ying Blood (Nutritive Blood) in the Taiyang channel.
Cheng Yingmao said: Headache and fever are common in Taiyang Disease (Taiyang Syndrome), but body ache, lower back pain, and joint pain indicate Cold injuring Ying Blood (Nutritive Blood); if Wind injured Wei Qi (Defensive Qi), these would not occur. Aversion to wind is common in Taiyang Disease (Taiyang Syndrome), but absence of sweating and wheezing indicate obstruction of Yang Qi; if Wind injured Wei Qi (Defensive Qi), these would not occur. By identifying similarities, differences are distinguished.
Shen Mingzong said: Taiyang pathogens enter via the skin and hair, stagnating and reversing Lung Qi, thus causing wheezing. Moreover, Cold governs contraction; injuring Ying Blood (Nutritive Blood) seals the Cou Li (Interstitial Spaces/Pores), so Mahuang Tang (Ephedra Decoction) is used to disperse them.