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In the *Suwen* (Basic Questions), the Yellow Emperor asked: Heat diseases are all of the category of Cold Damage (Shanghan). Some recover, some die. Those who die do so within six or seven days, while those who recover take more than ten days. Why is this? Qibo replied: Juyang (Great Yang, i.e., Taiyang) is the leader of all Yang meridians. Its vessels connect to the Fengfu acupoint, thus it governs the Qi of all Yang meridians. When humans are injured by cold pathogens, they develop heat diseases. Even if the heat is severe, death will not occur. However, those who suffer from "Lianggan" (simultaneous contraction of cold on both exterior and interior) will inevitably die. The Emperor said: I wish to hear about their manifestations. Qibo said: On the first day, Juyang receives the pathogen, resulting in headache, stiffness of the neck and back, and pain in the waist and spine. On the second day, Yangming receives the pathogen. Yangming governs the muscles; its vessels run alongside the nose and connect to the eyes. Thus, there is body heat, eye pain, dry nose, and inability to lie down. On the third day, Shaoyang receives the pathogen. Shaoyang governs the Gallbladder; its vessels follow the costal region and connect to the ears. Thus, there is pain in the chest and hypochondrium, and deafness. When the meridians of the three Yang channels are all affected but the disease has not entered the Zang organs, it can be cured by sweating. On the fourth day, Taiyin receives the pathogen. Taiyin vessels distribute in the stomach and connect to the throat. Thus, there is abdominal fullness and dry throat. On the fifth day, Shaoyin receives the pathogen. Shaoyin vessels pass through the Kidney, connect to the Lung system and the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst. On the sixth day, Jueyin receives the pathogen. Jueyin vessels follow the genitalia and end at the Liver. Thus, there is irritability, fullness, and retraction of the scrotum. If the three Yin and three Yang, as well as the five Zang and six Fu organs, are all diseased, Ying and Wei Qi cease to circulate, and the five Zang organs become blocked, death ensues. For those not suffering from Lianggan, on the seventh day, the disease in Juyang declines, and the headache slightly improves. On the eighth day, the disease in Yangming declines, and body heat slightly subsides. On the ninth day, the disease in Shaoyang declines, and hearing slightly returns. On the tenth day, the disease in Taiyin declines, abdominal distension reduces to normal, and appetite returns. On the eleventh day, the disease in Shaoyin declines, thirst stops, fullness resolves, dry tongue heals, and sneezing occurs. On the twelfth day, the disease in Jueyin declines, the scrotum relaxes, the lower abdomen slightly descends, the great pathogenic qi departs, and the illness gradually cures.

The Emperor asked: How should it be treated? Qibo replied: Treatment requires unblocking the meridians of each respective organ. As the disease declines day by day, if the duration is less than three days, it can be cured by sweating; if the duration is three days or more, it can be cured by purging.

Again, the Emperor asked: What are the pulse and clinical manifestations for those with Lianggan? Qibo replied: In cases of Lianggan, on the first day, both Juyang and Shaoyin are diseased, presenting with headache, dry mouth, irritability, fullness, and thirst. On the second day, both Yangming and Taiyin are diseased, presenting with abdominal fullness, body heat, anorexia, and delirium. On the third day, both Shaoyang and Jueyin are diseased, presenting with deafness, scrotal retraction, cold extremities, inability to swallow fluids, and unconsciousness. Death occurs after six days.

The Emperor asked: The five Zang organs are damaged, the six Fu organs are blocked, Ying and Wei Qi do not circulate. After this, death occurs three days later. Why? Qibo replied: Yangming is the head of the twelve meridians, and its Qi and Blood are abundant. Therefore, the patient becomes unconscious. After three days, its Qi is exhausted, hence death. (From Volume 9; identical in *Jiayijing* and *Taisu*.)

Pathogenesis: On the first day of Cold Damage, the Taiyang channel is affected. Taiyang is the meridian of the Small Intestine and the chief of the three Yang channels, so it is affected first. Its vessels connect to the waist and spine and govern the head and neck. Therefore, on the first day of illness, there is pain in the head, neck, back, shoulders, waist, and spine.

Furthermore, on the second day of Cold Damage, the Yangming channel is affected. Yangming is the meridian of the Stomach and governs the muscles. Its vessels connect to the nose and enter the eyes. Therefore, on the second day, there is internal heat, dry nose, and insomnia. All Yang channels are on the exterior; when the exterior is initially attacked, the pathogen lies between the skin and hair. Thus, it can be cured by applying ointments, moxibustion, or inducing sweating. (From Volume 7.)

Zhang Zhongjing's *Shanghan Lun*: In Cold Damage during the first or second day, if there is palpitation and irritability, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is the primary formula. Ingredients: Guixin (Cinnamon Twig, 3 liang), Gancao (Licorice Root, prepared, 2 liang), Shengjiang (Fresh Ginger, 3 liang), Dazao (Jujube, 12 pieces, split), Jiaoyi (Maltose, 1 sheng), Shaoyao (Peony Root, 6 liang). Cut the above six ingredients. Add 7 sheng of water, decoct the first five ingredients to obtain 3 sheng, remove the dregs, add the maltose, and simmer gently over fire until dissolved. Take 1 sheng warm, three times a day. Patients prone to vomiting should not take Xiaojianzhong Tang due to its sweetness. Avoid Seaweed, Chinese Cabbage, and raw Green Onion. (*Qianjin Yifang* is identical; From Volume 3.)

(Note: Zhang Zhongjing's *Shanghan Lun* states that Mahuang Tang (Ephedra Decoction) should be used for Cold Damage on the first or second day. Saying Xiaojianzhong Tang is incorrect here; this formula only treats palpitation and irritability.)

Pathogenesis: On the third day of Cold Damage, the Shaoyang channel is affected. Shaoyang is the meridian of the Gallbladder. Its vessels follow the hypochondrium up to the neck and ears. Therefore, on the third day, there is pain in the chest and hypochondrium, and deafness. The transmission of disease among the meridians of the three Yang channels begins; since it has not entered the Zang organs, it can be resolved by sweating. (From Volume 7.)

Zhang Zhongjing's *Shanghan Lun*: Treating Taiyang disease for three days, if sweating fails to resolve the condition and there is steaming heat, it belongs to the Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) pattern. Ingredients: Gancao (Licorice Root, prepared, 3 liang), Mangxiao (Mirabilite, half sheng), Dahuang (Rhubarb Root, 4 liang). Cut the above three ingredients. Add 3 sheng of water, decoct the two items (Dahuang and Gancao) to obtain 1 sheng, remove the dregs, add Mangxiao, and boil gently until bubbling. Take warm in one dose. Tiaowei Chengqi Tang will cure it. Avoid Seaweed and Chinese Cabbage. (*Jingxinlu* is identical; From Volume 10. Note: Zhang Zhongjing's *Shanghan Lun* also allows Mahuang Tang on the third day; stating Tiaowei Chengqi Tang is incorrect here unless treating steaming heat after failed sweating on the third day.)

Pathogenesis: On the fourth day of Cold Damage, the Taiyin channel is affected. Taiyin is the meridian of the Spleen and the chief of the three Yin channels. It is known that before the third day, Yang channels were affected, then transmitted to Yin, affecting Taiyin. Its vessels connect to the Spleen and govern the throat. Therefore, on the fourth day, there is abdominal fullness and dry throat. The disease is located in the chest and diaphragm, so it can be cured by emesis.

Furthermore, on the fifth day of Cold Damage, the Shaoyin channel is affected. Shaoyin is the meridian of the Kidney. Its vessels pass through the Kidney, connect to the Lung system and the tongue. Therefore, on the fifth day, there is dry mouth, dry tongue, thirst, and desire to drink. The disease is located in the abdomen, so it can be cured by purgation. (Both from Volume 7.)

Zhang Zhongjing's *Shanghan Lun*: In Cold Damage on the fourth or fifth day, if there is body heat, aversion to wind, stiff neck, fullness under the ribs, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula. Ingredients: Chaihu (Bupleurum Root, half jin), Gualougen (Trichosanthes Root, 4 liang), Guixin (Cinnamon Twig, 3 liang), Huangqin (Scutellaria Root, 3 liang), Muli (Oyster Shell, 3 liang), Gancao (Licorice Root, prepared, 2 liang), Jiangjiang (Dried Ginger, 3 liang). Cut the above seven ingredients. Add 12 sheng of water, decoct to obtain 6 sheng, remove dregs, and decoct again to obtain 3 sheng. Take 1 sheng warm, three times a day. Initially, slight irritability may occur; covering warmly to induce sweating will lead to recovery. Avoid raw Green Onion, Seaweed, and Chinese Cabbage. (Fan Wang's formula is identical; From Volume 3. Zhang Zhongjing's *Shanghan Lun* names this Chaihu Jianggui Tang. Combined with Renshen, Gancao, Huangqin, Banxia, Shengjiang, and Dazao, these seven ingredients constitute Xiaochaihu Tang. *Yuhan Jing* and *Qianjin Yifang* are identical.)

Pathogenesis: On the sixth day of Cold Damage, the Jueyin channel is affected. Jueyin is the meridian of the Liver. Its vessels follow the genitalia and connect to the Liver. Therefore, on the sixth day, there is irritability, fullness, and scrotal retraction. This indicates that both Yin and Yang are diseased, and toxic factors are in the chest. Thus, it can be cured by purgation.

Furthermore, on the seventh day of Cold Damage, the Taiyang disease declines, and the headache slightly improves. According to the law of Cold Damage, the disease should slightly improve on the seventh day because the transmission through all Yin and Yang channels is complete. If after the seventh day the disease worsens and does not resolve, it indicates a recurrence of transmission (Rejing). Recurrence means the meridians of Yin and Yang have been affected again. (Both from Volume 7.)

Zhang Zhongjing's *Shanghan Lun*: Treating Cold Damage with constipation for six or seven days, accompanied by headache and fever, administer Chengqi Tang. If the urine is clear, it indicates the disease is not in the interior but remains in the exterior, requiring sweating. If there is headache, epistaxis (nosebleed) will likely occur; Guizhi Tang (Cinnamon Twig Decoction) is appropriate. Ingredients: Guizhi (Cinnamon Twig), Shaoyao (Peony Root, 3 liang each), Gancao (Licorice Root, prepared, 2 liang), Shengjiang (Fresh Ginger, 3 liang), Dazao (Jujube, 12 pieces, split). Cut the above five ingredients. Add 7 sheng of water, decoct to obtain 3 sheng, remove dregs. Take 1 sheng warm. Shortly after, drink 1 sheng of thin rice gruel to assist the medicinal power. Cover to induce slight sweating. Avoid raw Green Onion, Seaweed, and Chinese Cabbage. (*Jiyan Fang*, *Beiji Wenzhong*, and *Fan Wang* are identical. Zhang Zhongjing's *Shanghan Lun* states this formula can be taken when the disease is in the exterior on the sixth or seventh day.)

Furthermore, in Cold Damage on the fifth or sixth day, if there is vomiting and fever, the Chaihu Tang syndrome is complete. If purgatives were incorrectly administered, but the Chaihu syndrome persists, Chaihu Tang can still be given. Although purgation has occurred, it is not a counteraction. There will inevitably be chills followed by fever and sweating, leading to resolution.

Pathogenesis: On the eighth day of Cold Damage, the Yangming disease declines, and body heat slightly subsides. If the disease does not resolve by the eighth day, it may be due to repeated infection of the Yin and Yang meridians, or because toxic factors remain after sweating, emesis, or purgation, so symptoms persist.

Furthermore, on the ninth day of Cold Damage, the Shaoyang disease declines, and hearing slightly returns. If the disease does not resolve after the ninth day, it may be because the initial channel infection did not transmit, or transmission through the three Yang was completed but did not proceed to Yin, causing stagnation for several days. Alternatively, after transmission through all three Yin and three Yang is complete, a secondary contraction of cold occurs, leading to prolonged duration and changing symptoms. (From Volume 7.)

Zhang Zhongjing's *Shanghan Lun*: Treating Cold Damage on the eighth or ninth day where Wind-Dampness intertwines, causing body pain and irritability, inability to turn over, no vomiting, no thirst, and a floating, deficient, and choppy pulse after purgation, belongs to the Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) pattern. If the stool is hard and urination is free, it belongs to the Fuzi Baizhu Tang (Aconite and Atractylodes Macrocephala Decoction) pattern.

Guizhi Fuzi Tang Formula: Guixin (Cinnamon Twig, 4 liang), Fuzi (Prepared Aconite Root, 3 pieces, roasted and peeled), Shengjiang (Fresh Ginger, 3 liang), Gancao (Licorice Root, 2 liang, prepared), Dazao (Jujube, 12 pieces, split). Cut the above five ingredients. Add 6 sheng of water, decoct to obtain 2 sheng, remove dregs. Divide into three warm doses. Avoid raw Green Onion, pork, Seaweed, and Chinese Cabbage.

Fuzi Baizhu Tang Formula: Baizhu (Atractylodes Macrocephala Rhizome, 4 liang), Dazao (Jujube, 12 pieces), Gancao (Licorice Root, 1 liang, prepared), Shengjiang (Fresh Ginger, 2 liang), Fuzi (Prepared Aconite Root, 3 pieces, roasted, peeled, and cut into four). Cut the above five ingredients. Add 6 sheng of water, decoct to obtain 2 sheng, remove dregs. Divide into three warm doses. After the first dose, the body may feel numb. Half a day later, if the remaining dose is taken and the patient feels dizzy, do not be alarmed. This is because Fuzi and Baizhu move through the skin to expel water dampness which has not yet been cleared. Originally, one piece of Fuzi was used; now two are added, naming it Fuzi Tang. Avoid Green Onion, pork, Chinese Cabbage, Seaweed, peaches, plums, and sparrow meat. (*Qianjin Yifang* is identical; From Volume 11. Zhang Zhongjing's method suggests adding Guizhi 4 liang. This text presents one formula with two methods: removing Guizhi due to hard stool and free urination; adding Guizhi and Fuzi if stool is not hard and urination is difficult.)

Pathogenesis: On the tenth day of Cold Damage, the Taiyin disease declines, abdominal fullness reduces to normal, and appetite returns. On the eleventh day, the Shaoyin disease declines, thirst stops, fullness resolves, dry tongue heals, and sneezing occurs. On the twelfth day, the Jueyin disease declines, the scrotum relaxes, the lower abdomen slightly descends, the great pathogenic qi departs, and the illness gradually cures. (From Volume 7; identical in *Suwen*, *Taisu*, and *Jiayijing*.)

Zhang Zhongjing's *Shanghan Lun*: Treating post-emetic/purgative constipation lasting five to ten-plus days, with tidal fever in the late afternoon, no aversion to cold, talking alone as if seeing ghosts, and in severe cases, unconsciousness, grasping at clothes and bedrails, restlessness, slight wheezing, and only fever with delirium, belongs to the Dachengqi Tang (Major Order the Qi Decoction) pattern. Ingredients: Dahuang (Rhubarb Root, peeled, 4 liang), Chen Zhishi (Aged Immature Bitter Orange, roasted, 5 pieces), Mangxiao (Mirabilite, 3 he), Houpo (Magnolia Bark, half jin). Cut the above four ingredients. Add 10 sheng of water, decoct the first two (Zhishi and Houpo) to obtain 5 sheng, remove dregs, add Dahuang, decoct to obtain 2 sheng, remove dregs, add Mangxiao, boil for one or two boils. Divide into two doses. If bowel movement occurs after the first dose, stop taking it; the second dose need not be finished. (*Qianjin Fang* and *Qianjin Yifang* are identical; From Volume 5.)

Furthermore, if Taiyang disease has passed its stage for more than ten days, and after two or three purgations, the Chaihu syndrome persists on the fourth or fifth day, first administer Xiaochaihu Tang. If vomiting continues, urgency in the epigastrium (or relief of vomiting with slight comfort), and mild depression/irritability indicate the disease is unresolved. Dachengchaihu Tang (Major Bupleurum Decoction) can be administered to purge, leading to cure. Ingredients: Chaihu (Bupleurum Root, half jin), Huangqin (Scutellaria Root), Shaoyao (Peony Root, 3 liang each), Banxia (Pinellia Tuber, half jin, washed), Dazao (Jujube, 13 pieces, split), Shengjiang (Fresh Ginger, 5 liang), Zhishi (Immature Bitter Orange, 4 pieces). Cut the above seven ingredients. Add 12 sheng of water, decoct to 6 sheng, remove dregs, decoct again to obtain 3 sheng. Take 1 sheng warm, three times a day. One variant adds Dahuang 2 liang; currently, Dahuang is not added, lest it no longer be named Dachengchaihu Tang. Avoid mutton and maltose. Also treats epidemic febrile diseases. (*Qianjin Yifang* and *Zhouhou Beiji Fang* are identical.)

Furthermore, if Cold Damage persists for thirteen days without resolution, with fullness in the chest and hypochondrium, vomiting, tidal fever in the late afternoon, and slight diarrhea after the fever subsides, this is originally a Chaihu syndrome. Purging should not cause diarrhea; if it does, it is known that pill-based purgatives were used, which is incorrect treatment. Tidal fever indicates excess. First, administer Xiaochaihu Tang to resolve the exterior, then treat with Chaihu Jia Mangxiao Tang (Bupleurum Decoction plus Mirabilite). Ingredients: Chaihu (2 liang 16 zhu), Huangqin (Scutellaria Root), Renshen (Ginseng Root), Gancao (Licorice Root, prepared), Shengjiang (Fresh Ginger, 1 liang each), Banxia (Pinellia Tuber, 5 pieces), Dazao (Jujube, 4 pieces, split), Mangxiao (Mirabilite, 2 he). Cut the above eight ingredients. Add 4 sheng of water, decoct the seven ingredients to obtain 2 sheng, remove dregs, add Mangxiao, boil for one or two boils. Divide into two doses. If unresolved, prepare another batch. Avoid Seaweed, Chinese Cabbage, mutton, and maltose. (From *Yuhan Jing*. One variant: Mangxiao 3 he, Sangpiaoxiao (Mantis Egg Case) 5 pieces, Dahuang 4 fen, decoct in water to obtain 1.5 sheng, take 5 he warm, slight purgation leads to cure. Originally stated: take Chaihu Tang twice to resolve the exterior. Another variant adds Mangxiao, Dahuang, and Sangpiaoxiao.)