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When sores and toxins first appear, there must be alternating chills and fever; they should not be treated as Shanghan (Cold Damage). This is because the carbuncle toxin floats on the muscle surface, the pulse is also floating and rapid, the meridians are blocked by pathogenic factors, and the body also has fever. The heat-toxin resides on the exterior, and Yang Qi cannot defend the exterior, hence there is aversion to cold. The patient's diet and daily activities remain normal, or the pain is localized in one area; this is a disease of carbuncle and toxin. One must examine the head, face, body, hands, and feet; if there are painful areas, whether red and swollen, hard masses, or Ding poison (hardened carbuncles), they must be treated by surgeons.

Blood stasis syndromes resembling Shanghan occur because there are chills and fever. Generally, due to pre-existing phlegm-fire, or slight movements in the groin creases or axillae causing swelling, hardness, and pain, with a wiry, rapid, and forceless pulse, this is an abnormality. It is appropriate to regulate Qi, nourish blood, and invigorate blood circulation. If there is heat, one may nourish Yin, descend fire, or clear phlegm-heat.

Exhaustion-induced illnesses resemble Shanghan due to deficiency-cold and deficiency-heat. The person may suffer from fatigue due to overwork, or injury from the Seven Emotions, alcohol, or sexual excess, leading to mental exhaustion and dysfunction of Ying (Nutritive) and Wei (Defensive) Qi, resulting in aversion to cold, fever, and bone-joint pain. The pulse may be floating, knotted, deficient, and rapid; or wiry, choppy, deep, and tight; or bounding and firm; these are its manifestations. Treatment should observe whether it is Yin deficiency or Yang deficiency, upper damage or lower damage, and regulate according to the preferences of Zang-Fu organ Yin and Yang, generally seeking treatment within the category of Deficiency Consumption (Xu Lao).

For young children and adults who suddenly develop fever, aversion to cold, headache, body pain, red lips and face, sneezing, yawning, and vomiting, resembling Shanghan, one must not hastily apply sweating or purging methods. One must ask if they have had smallpox. If not, check if the sacrum, ear tips, and soles of the feet are all cold, and observe if there are red vascular threads behind the ears; then immediately refer to a specialist for treatment.

In treating Shanghan, one must distinguish between Yin and Yang syndromes. At the onset, if there is headache, body pain, fever, aversion to cold, and a floating, large pulse, it is a Exterior syndrome of the Yang meridians. Thereafter, if there is irritability, thirst, or constipation, it is a Heat syndrome transmitted from Yang meridians to Yin meridians. Even if the pulse is deep and hidden, it should not be indiscriminately treated as a Yin syndrome. At the onset, if there is colicky abdominal pain, cold extremities, cyanotic lips, and cold fingers, with a deep and hidden pulse, it is a Cold syndrome directly invading the Yin meridians.

First, if it was previously a Yang syndrome, but the person is constitutionally weak and cannot tolerate purgation, and the physician purges too heavily, causing sudden colicky abdominal pain, profuse diarrhea, and cold extremities, this is a Yang syndrome transforming into a Yin syndrome. It should be treated with warming methods.

Second, if it was previously a Yin syndrome, but the person has internal heat, and the physician tonifies too heavily, causing sudden irritability, thirst, and obstruction of urination and defecation, this is a Yin syndrome transforming into a Yang syndrome. It should be treated with resolving methods.

In treating Shanghan, one must distinguish Exterior and Interior; sweating and purging must not be erroneous. If the disease is in the Exterior but purged instead, pathogens enter the Interior exploiting the deficiency, causing mild epigastric fullness and chest binding, or severe intestinal sliding and profuse diarrhea; these are all bad outcomes from erroneous purging. If the disease is in the Interior but sweated instead, the Exterior becomes more deficient and the Interior more excessive, potentially causing macules and jaundice, or even Yang collapse; these are all bad outcomes from erroneous sweating.

In treating Shanghan, regardless of the number of days, if there is headache, body pain, aversion to wind and cold, and a floating, large pulse, it is an Exterior syndrome. Even if there is difficulty defecating and dysuria, one must first resolve the Exterior, then attack the Interior.

In treating Shanghan, regardless of the number of days, if there is abdominal pain, vomiting, and diarrhea, with a deep and weak pulse, it is an Interior syndrome. Even if there is aversion to wind and cold, one must first rescue the Interior, then resolve the Exterior.

In treating Shanghan, first inspect the eyes. If black and white are distinct, there is no heat inside. If vision is unclear, there is heat inside.

In treating Shanghan, inspect the lips and tongue. If lips are red, fresh, and moist, there is no heat inside. If lips are dry and parched, heat has entered the Interior. If the tongue coating is white and slippery, the Exterior has not resolved. If yellow, heat is gradually deepening. If black, heat is severe.

To induce sweating, verify true headache, true neck stiffness, and true wind-cold aversion before using decoctions to sweat; do not recklessly use water attacks or fire coercion methods.

To purge, verify no headache, no wind-cold aversion, truly hard stool, and truly full abdomen before using decoctions to purge; do not recklessly use pills.

Shanghan occurring after Frost Descent and before Spring Equinox is called True Shanghan, suitable for acrid-hot herbs to disperse. If occurring in Spring, it is called Warm Disease. If occurring in Summer, it is called Heat Disease, suitable for acrid-cool herbs to resolve. If entering the Interior, bitter-cold herbs are suitable to purge. If directly invading, acrid-hot herbs are suitable to warm. In other seasons, if casually contracted, observe the temperature changes, using either acrid-hot or acrid-cool, ensuring moderation.

When wind-cold initially injures the Taiyang meridian, acrid-warm dispersants like Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) must be used. If transmitting to Yangming or Shaoyang, acrid-cool resolvers like Gegen Qinpi Tang (Kudzu and Bark Decoction) or Chaihu Tang (Bupleurum Decoction) must be used. If evil enters the Stomach fu, bitter-cold purgatives like Chengqi Tang (Order the Qi Decoction) must be used. As evil moves from Exterior to Interior, medication shifts from warm to cool. If mismanagement causes heat to enter, purging must suitably use bitter-cold herbs.

When taking sweating medicines, do not overdo it; excess leads to Yang deficiency. If one dose produces no sweat, prepare another decoction; if still no sweat, this indicates exhaustion of Ying and Wei Qi. The method is to nourish Yin and support Righteous Qi, then sweat again. Three treatments without sweat indicate death.

When taking purgative medicines, if dry feces pass followed by loose stools, the condition is resolved. If only clear water passes once or twice without dry feces, and epigastric fullness remains, it is unresolved; purge again. If two or three doses fail to produce passage, this indicates dried-up intestines and stomach; purge to extract. If extraction fails to produce passage, death ensues.

In treating Shanghan, examine the chest and abdomen. Chest fullness with pain is Jie Xiong (Chest Binding). Chest fullness without pain is Pi Qi (Epigastric Fullness). If present without prior purging, it is transmitted pathogen. If present after purging, it is a bad outcome from erroneous purging. If caused by excessive drinking without prior purging, it is Water Qi.

In treating Shanghan, palpate abdominal pain and hardness. Pain and hardness in the abdomen indicate dry feces. Hardness and pain below the umbilicus indicate dry feces and Blood Stasis. Beating pain below the umbilicus rushing up to the heart is Ben Tun Qi (Running Piglet Qi). Bowel sounds with gas moving downward indicate impending diarrhea. Dry feces: difficult urination, lumps below umbilicus. Blood Stasis: free urination, pregnancy-like swelling below umbilicus.

In treating Shanghan, ask about thirst. Thirst without desire to drink indicates pathogen in the Exterior. Thirst with excessive drinking indicates severe internal heat. Holding water without swallowing indicates impending vomiting.

If Shanghan presents with fatal symptoms but the pulse is treatable, discard symptoms and follow the pulse: tonify deficiency, drain excess.

If Shanghan presents with fatal pulses but symptoms are treatable, discard the pulse and follow symptoms: resolve urgent Exterior, attack urgent Interior, clear heat, warm cold.

Hong Da (Surging Large), Fu Shuo (Floating Rapid), Dong Hua (Bounding Slippery) pulses are Yang pulses; suitable for Yang syndromes. If seen in Yin syndromes, it is ominous. Shen Se Ruo Xuan Wei (Deep Choppy Weak Wiry Micro) pulses are Yin pulses; suitable for Yin syndromes. If seen in Yang syndromes, it is ominous.

Sudden loss of pulse with coma in Shanghan headache/fever indicates impending sweating, like darkness before dawn; no medicine is needed.

Headache and fever in Shanghan are Yang syndromes; hot medicines must not be taken.

Taiyin syndrome: no headache, no fever. Shaoyin syndrome: counter-fever without headache. Jueyin syndrome: headache without fever.

Syndromes of Shanghan must not be abruptly tonified.

Loss of appetite in Shanghan must not be treated immediately with warm-tonifying Spleen/Stomach medicines.

Abdominal pain in Shanghan can also be Heat syndrome; do not indiscriminately use warm medicines; consult pulse and symptoms.

Spontaneous diarrhea in Shanghan requires distinguishing Yin/Yang; do not immediately use antidiarrheal or warm-tonifying medicines.

Cold extremities in Shanghan must be distinguished as Heat Jue or Cold Jue.

Vomiting roundworms in Shanghan contraindicates cold-cool medicines, even with high fever.

After taking purgatives, apply salt-fried bran warmed on the abdomen to promote movement and ease passage.

If vomiting occurs after taking medicine, drink half a cup of hot ginger juice to stop vomiting.

For Shanghan jaundice, rub whole body with fresh ginger. For chest/abdominal fullness, hardness, and pain, apply heated ginger dregs. Adding water is better.

For unceasing hematemesis in Shanghan, swallow crushed Jingmo (Beijing Inkstick) mixed with Chinese chive juice. Egg white can substitute.

For extreme, unresolved heat in Shanghan/Warm disease, brew Huanglian Tang (Coptis Decoction), chill in well water, soak blue cloth, apply to chest, replace slowly until heat subsides.

For severe abdominal pain in Shanghan, drink a cup of river water. If pain lessens, it is Heat; clear with cool medicines, urgently purge with cold medicines if clearing fails. If pain worsens with water, it is Cold; harmonize with warm medicines, urgently rescue with hot medicines if harmonizing fails.

For True Cold Yin syndrome direct invasion, or severe pain/pulselessness, or vomiting/diarrhea with Yuan Qi depletion/pulselessness, take equal parts fermented rice wine and ginger juice. Treatable if pulse returns; fatal if not.

For direct cold invasion of Yin meridians, with colic, vomiting/cold limbs, unconsciousness, inability to take medicine, or sudden pulse disappearance, crush San Cun Bai Fu Zi (Three-inch White Aconite Root) into a cake. Fill navel with 0.5 fen Moshe (Musk), place aconite cake on top, moxa/warm iron. Replace 2-3 cakes. Once slightly conscious, pour ginger juice, then administer Hui Yang Ji Jiu Tang (Restore Yang Emergency Rescue Decoction). If unconscious, moxa Guanyuan (CV4) and Qihai (CV6). Survival if extremities warm and sweating occurs.

Yin diseases in Shanghan, regardless of heat presence or pulse depth/size, if pulse feels forceless under finger or disappears with heavy pressure, is Yin disease. This is the best method.