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It is stated: "Zhonghan" (Cold Strike) refers to cold pathogenic factors, which are lethal qi from heaven and earth. Once a person is invaded by them, the disease develops rapidly and critically; sudden exposure to such evil can lead to abrupt death.

This usually occurs due to severe deficiency of Stomach Qi, compounded by exposure to extreme cold. When Stomach Qi is deficient, Lung Metal cannot be nourished and thrived, causing the defensive qi of the skin and hair to fail first. When vital energy is weak, the exterior loses its protection, allowing cold pathogenic factors to easily enter from outside. This obstructs and blocks the yang qi of the whole body, preventing it from circulating, leading to cold extremities (Jue Ni), stiffness, and rigidity. Consequently, there is lockjaw (Kou Jin), staring eyes, blue-white complexion, spontaneous sweating leading to collapse of exterior qi, or dysentery leading to depletion of interior essence. At this stage, both interior and exterior are deficient, while cold pathogenic factors prevail alone. If treatment is delayed even slightly, the pulse becomes scattered and the patient dies.

Qibo said: "The three months of winter constitute the season of closure and storage. Water freezes and the earth cracks; one should not disturb the yang qi. Go to bed early and rise late, waiting for sunlight. This is the meaning of avoiding cold and seeking warmth." Cold is a lethal qi from heaven and earth; in heaven it manifests as cold, on earth as water, and in the human zang organs as the Kidney. Cold tends to strike the Kidney. If it strikes the Kidney, it causes spasms, cramps, pain, coma, and unconsciousness. The reason it is said that cold prefers to strike the Kidney, without mentioning other zang organs, is because laborers who endure hardship, suffer from irregular eating and overwork, do not avoid wind and snow, and expose themselves to severe cold may suddenly fall ill. This is because all five zang organs can manifest signs of Zhonghan.

If headache, fever, aversion to cold, and body pain appear first, this is Shanghan (Cold Damage). One should seek treatment methods within the framework of treating Shanghan. If a person suddenly faints, becomes confused and unaware, with tight teeth and lockjaw, resembling Zhongfeng (Wind Stroke), but the pulse is wiry-tight or deep-thin, then it is Zhonghan.

If one has pre-existing conditions such as blood deficiency with qi stagnation, entrenched cold, hemiplegia with numbness, spasmodic bi-syndrome and jue, or constitutes a xu-han (deficiency-cold) constitution: "Xu" refers to insufficient yang, and "Han" refers to excess yin. Insufficient yang generates the "Five Deficiencies" (Wu Xu); excess yin leads to the accumulation of cold qi. Once the Five Deficiencies arise, symptoms include thin and weak pulses, shortness of breath, diarrhea, and inability to eat. This condition differs from Shanghan disease. In Shanghan, pathogenic factors transmit sequentially along meridians, gradually moving from exterior to interior; even if heat is severe, it is not fatal. Humans take the Kidney as their root; only when the Kidney is injured by cold does the disease arise. Once Kidney Qi is deficient, cold pathogenic factors converge and combine, causing illness.

Generally, the pulse in Zhonghan must be slow (Chi); if complicated by wind, the pulse must be floating (Fu); if accompanied by dizziness, numbness, and dampness, the pulse is soggy (Ru), with swelling, fullness, and pain. The therapeutic principle is to avoid reckless use of emetic or purgative methods. Instead, one should tonify yang and dissipate yin/cold, warm the Dantian, and consolidate true qi.

As discussed by Yan Shi, within moments of Zhonghan, there may be complications of wind and dampness, with pulses and symptoms evolving mutually. The Classics state: "When the weakness of the body meets the emptiness of heaven's weather, and the two weaknesses interact, the qi attaches to the person and injures the five zang organs." Physicians saving them must not err recklessly; the urgency of the situation is clearly visible here. To seek rapid efficacy, the *Ju Fang* elaborates on theories; predecessors treated this with Fuzi Lizhong Tang. Their reasoning for using this medicine was apt. Essentially, warming the meridians dissipates cold and restores yang; tonifying Earth (Spleen/Stomach) harmonizes qi and strengthens the exterior. With abundant qi and complete form, spirit will not be depleted, and disease will not occur.