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In the first three days of Shanghan (Cold Damage), the pathogenic factors affect the Taiyang (Greater Yang) channel, Yangming (Yang Brightness) channel, and Shaoyang (Lesser Yang) channel respectively; in the subsequent three days, they transmit to the Taiyin (Greater Yin) channel, Shaoyin (Lesser Yin) channel, and Jueyin (Terminal Yin) channel. If the pathogenic heat from the Taiyang channel transmits sequentially to the Three Yin channels, this is termed "transmission of disease" (Chuan Jing). This occurs because once pathogens enter the Yin channels, they tend to transform into heat; therefore, one must not use warming herbs simply because the disease has entered the Yin channels. The cold syndromes of the Three Yin channels have their own specific treatments detailed in sections regarding internal cold (Zhong Han) and Yin toxins (Yin Du); do not be confused by this.

Regarding the transmission of Shanghan: Yang channels are affected first, so the disease transmits sequentially to the Yin channels. Since Yang governs growth, Taiyang Water transmits to Yangming Earth, and Yangming Earth transmits to Shaoyang Wood, which constitutes a minor pathogen. Since Yin governs destruction, Shaoyang Wood transmits to Taiyin Earth, Taiyin Earth transmits to Shaoyin Water, and Shaoyin Water transmits to Jueyin Wood. By the sixth or seventh day, it should transmit to Jueyin Liver Wood. At this stage, Qi overacts on Spleen Earth, and if the Spleen suffers again from a "thief pathogen," all five Zang and six Fu organs will become distressed and critical. If Ying (Nutritive) and Wei (Defensive) Qi fail to circulate, leading to deafness, retraction of the scrotum, and loss of consciousness resulting in death, one should urgently administer Chengqi Tang (Cinnamon Twig and Rhubarb Decoction) to purge, offering a chance of survival in five out of ten cases. Ancients stated: "When Spleen heat affects the disease, the five Zang organs are endangered"; also, "When Earth fails and Wood attacks, death ensues." Upon transmission to Jueyin on the sixth or seventh day, if the pulse becomes slightly slow or slightly floating, it indicates the presence of Spleen-Stomach pulse qi. Thus, we know the Spleen Qi is intact and no longer subject to overacting, leaving no room for pathogens. As adversity turns to prosperity, Ying and Wei Qi will recover, Water ascends and Fire descends, leading to chills and high fever followed by profuse sweating and resolution.

On the first day of Shanghan, the Foot-Taiyang Bladder Channel is affected, causing headache, body heat, aversion to cold, and stiffness in the lower back and spine. On the second day, the Yangming Stomach Channel is affected, causing body heat, eye pain, nasal dryness, and inability to sleep. On the third day, the Shaoyang Gallbladder Channel is affected, causing hypochondriac pain, deafness, alternating chills and fever, vomiting, and bitter taste in the mouth. On the fourth day, the Taiyin Spleen Channel is affected, causing abdominal fullness and dry throat. On the fifth day, the Shaoyin Kidney Channel is affected, causing dry mouth, dry tongue, and thirst. On the sixth day, the Jueyin Liver Channel is affected, causing irritability and fullness, retraction of the genitals, curled tongue, and deafness. *Huoren Shu* (Book of Vitality) states: Pathogens of the Six Qi invade deficient channels; those contracted from the back enter the Taiyang or Shaoyin, while those contracted from the face enter the Yangming, etc. It is not necessary that all cases start with Taiyang and transmit sequentially through all channels. Sometimes cold pathogens remain confined to one channel or transmit only to one or two channels. One should not adhere rigidly to one pattern but verify based on pulse and external symptoms. For example, if a patient presents with a floating-tight pulse, stiff neck and head, fever, and aversion to cold, even if these persist daily beyond the typical transmission period, it remains solely a Taiyang pathology without transmitting to other channels. Other cases follow this logic.

First, true Shanghan (Zhen Shanghan) occurs from the Frost Descent solar term until the Spring Equinox. During this time, the weather is bleak, human pores are not tight, and lack of protection leads to cold injury. Cold Qi enters from the exterior to the middle, and from the middle to the interior. Because pathogens obstruct righteous Qi, stagnation generates heat. Master Zhang Zhongjing's treatment principles are: release via sweating for exterior patterns, harmonize for middle patterns, and purge for interior patterns, dispersing pathogens according to their location, aiming to restore righteous Qi as pathogens recede.

Second, from the Spring Equinox until the Summer Solstice, individuals suffering from headache and severe fever are diagnosed with Wenbing (Warm Disease). This arises from latent cold acquired in winter that did not manifest immediately but remained hidden in the skin and muscles, erupting in spring due to latent Qi.

Third, after the Summer Solstice, individuals suffering from headache and severe fever are diagnosed with Rebing (Heat Disease), also triggered by latent Qi from winter. The world generally calls this Shanghan. These two conditions share symptoms with Shanghan but differ in the absence of aversion to cold. Discussions state: Fever without aversion to cold characterizes Warm Disease.

Fourth, seasonal common colds may present with headache, aversion to cold, body ache, and fever; do not mistakenly treat them as Shanghan.

Fifth, epidemic diseases (Shi Xing Wen Yi) differ from Shanghan; people of all ages suffer similarly. One must first identify the annual Qi movement, recognize the seasonal cold or warmth, determine which channel is injured, and prescribe accordingly.

Sixth, Wind-Cold injury involves wind pathogens affecting the exterior, often damaging the Lung, leading to cough, hoarseness, and nasal congestion. Treatment focuses on this specific category.

Seventh, Wind-Dampness injury presents with spontaneous sweating, heavy body, panting, excessive sleepiness, and difficulty speaking.

Eighth, Damp-Warmth injury begins with dampness invasion followed by summerheat; dampness and heat struggle. Symptoms include chest fullness, severe fever, delirious speech, profuse sweating, and cold calves.

Ninth, Warm-Toxin results from cold toxins acquired in winter, manifesting in spring as urticaria, ulcerated rashes, cough, and irritability. The condition is severe.

Tenth, Wen-Nie (Warm Malaria) refers to Huai Bing (Broken Disease). What is Broken Disease? When Shaoyang pathogens are between the exterior and interior, improper use of sweating or purging depletes fluids, causing stomach dryness. Wood then overacts on Earth, inevitably leading to delirium and alternating chills and fever. One must identify the affected channel and treat accordingly.

Eleventh, for abdominal pain in cold patterns with a deep-rapid pulse, give a cup of cool water first; if pain subsides slightly, it is heat-related pain. Pain encircling the navel indicates dry feces. Pain accompanied by yellowing of the body and eyes and black stool indicates Blood Stasis (Xu Xue).

Twelfth, during the sixth or seventh day of cold patterns, without other conflicting signs, sudden unconsciousness with submerged or imperceptible pulses indicates impending sweating. Do not purge. Like rain following a long drought under dark skies, life revives after rain; this is an auspicious sign of Yang transformation.

Thirteenth, if Three Yang patterns remain unresolved with fever, irritability, and thirst, pathogens transmit inward to the Yin channels. A deep-solid pulse with external symptoms of no aversion to cold but aversion to heat, delirium, extreme thirst, tidal fever, spontaneous sweating, restlessness (throwing off covers), or cold limbs and constipation indicates transmitted heat patterns. Direct invasion of Yin channels by cold patterns must also be distinguished.

Fourteenth, Three Yin patterns present without headache or body heat. Initially, there is fear of cold, cold extremities, lethargy, no thirst, abdominal pain, vomiting and diarrhea, cold sweat, body pain, and a deep-slow-weak pulse.