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True Shanghan (Cold Damage), rare in the world, is unknown to many mediocre physicians. Zhang Zhongjing, Shifan (secret medical texts), and Jie'an (Tao Hua) revealed its secrets; the secret of treating Shanghan is hard to find even in the Qianjin Fang (Thousand Gold Formulas). The formulas differ, and the methods are even more distinct.

Each season's Shanghan has its own examples. Only true Shanghan in winter differs from treatment in spring, summer, and autumn. Two excellent formulas for releasing the exterior and consolidating the exterior are used throughout the three winter months without other treatments.

True Shanghan and true wind-stroke: exterior excess and exterior deficiency strike differently. Exterior deficiency with spontaneous sweating and a floating-slow pulse has miraculous effects when dispersing pathogens and consolidating the exterior. Exterior excess with no sweating and a floating-tight pulse allows sweat to naturally loosen after raising yang and releasing the exterior. Aversion to cold on the back or fever on the back, headache and spine pain are generally described similarly; all belong to the Taiyang Bladder Meridian. Presence or absence of sweating must be distinguished; floating-slow or floating-tight pulses must also be differentiated. Spring, summer, and autumn have separate formulas; Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) is commonly used.

Spring warmth, summer heat, and autumn dampness require careful adjustment according to the season. Symptoms resemble winter cases, but depth and interior/exterior status are detailed in the pulse. Pulses can be floating or sunken; half-floating half-sunken indicates pathology lingering between exterior and interior. Forceful or forceless pulses indicate exterior excess or deficiency. Warmth or purgation methods should be carefully sought. Furthermore, sweating, vomiting, and purging methods should be applied without delay.

Lianggan Syndrome (Simultaneous Transmission of Two Channels) transmits daily across two channels. On the first day, Taiyang and Shaoyin connect; Kidney and Bladder pulses are large and floating, with dry mouth and headache as primary symptoms. On the second day, Yangming and Taiyin involve sunken-long pulses affecting Spleen and Stomach; eyes hurt, nose is dry, abdomen is full, spontaneous diarrhea causes discomfort. On the third day, Shaoyang and Jueyin diseases occur; Liver and Gallbladder pulses appear floating-wiry; deafness, hypochondriac pain, and testicular retraction suggest ancient practitioners deemed it untreatable, endangering life. (Formulas for Lianggan syndrome are found in the later supplement.)

Tao Jian'an leaked formulas, regardless of Yin-Yang Lianggan injury, using Chonghe Lingbao Yin (Harmonizing Spiritual Treasure Drink) universally. One dose resolves both aspects like snow melting in hot water. One must understand the quantity of exterior vs. interior diseases and treat sequentially with detail. If exterior disease is predominant and interior is mild, Mahuang Gegen Tang (Ephedra and Pueraria Decoction) is most effective. If exterior is slow and interior is urgent, attack the interior with Tiaowei Chengqi Tang (Regulate the Stomach and Purge the Bowels Decoction) urgently. Cold invading Yin meridians presents with no dry mouth, body ache, fever, and spontaneous diarrhea; sunken, fine, and forceless pulses indicate Huiyang Jijiu Tang (Restore Yang Emergency Rescue Decoction) is precise. It is said Lianggan has no cure, but one who knows the sequence finds hope.

Jie Xiong Syndrome (Chest Binding) varies in severity; search for Shuangjie Liu Yi Er Fang (Double Resolution Six-One Second Formula). Yangming syndrome involves insomnia, with dry nose and painful eyes as roots; Chai Ge Jie Ji Tang (Bupleurum and Kudzu Release Muscle Decoction) acts like sweet spring water for the thirsty. Deafness and tongue pain at the semi-exterior semi-interior level are cured quickly by Chaihu Shuangjie Tang (Bupleurum Double-Resolution Decoction). Abdominal pain and dry throat are cleared by Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction). Taiyang jaundice with head sweating is best treated with Yincheng Danggui Tang (Artemisiae Scopariae and Angelicae Sinensis Decoction). No fever with spontaneous diarrhea indicates Zang Cold, treated best with Jiawei Lizhong Tang (Modified Regulate the Middle Decoction).

Seasonal epidemic diseases with high fever require Liushentongjie Tang (Six Powers Universal Resolution Decoction). Difficulty urinating is treated with Daochi Yin (Guide Out Red Drink); lower jiao blood stasis relies on this principle. All lower-jiao syndromes and chest binding are clearly explained by Liuyishunqi Tang (Six-One Smooth Qi Decoction). Fever without headache, red face, and inability to swallow water are mistaken by mediocre doctors as heat diseases, whereas heart fire flooding upward causes Daiyang Syndrome (Floating Yang), often unrecognized; Fuyuan Tang (Restore Primordial Decoction) brings peace.

Sweat like pearls, eyes like fire, macules appearing with maniacal shouting—this is rarely recognized as Sanjiao disease; Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction) is suitable. Macule syndromes start with cough and vomiting; deafness and cold feet confirm the diagnosis. Do not induce sweating, or macules will worsen; Xiaoban Qingdai Yin (Eliminate Macules Cyan Blue Drink) should not be delayed.

Labor-induced cold syndrome is different; Tiaorong Yangwei Jinbuhuan (Regulate Nutritive Nourish Defensive Golden Unchanging) is invaluable. Internal injury of Qi and Blood with external cold should not be viewed as standard Shanghan. Sweating, fever, and thirst are best treated with Rushen Baitu Tang (Divine Tiger White Decoction). Food stagnation resembles Shanghan: fever without aversion to cold, retching, no body pain; do not doubt headache. JiaWei Tiaozhong Yin (Modified Regulate Middle Drink) suffices; if the Qi Kou pulse is tight and full, prevent progression. Clear urination and black stool indicate Taoren Chengqi Tang (Peach Kernel Purge Bowels Decoction) for heat pathogen transmitting inward causing blood stasis. Hematemesis and epistaxis have separate formulas; Shengdi Qinlian Tang (Rehmannia Scutellaria Coptis Decoction) is most appropriate.

Yin repelling Yang is complex to detail. Extreme Yin leads to Jue (collapse) with Daiyang (floating Yang) on the face. Pulse is forceless when near death; Jijiu Huiyang Fanben Tang (Emergency Restore Yang Return to Root Decoction) is needed. Inability to swallow water due to blood stasis requires Jiawei Xijiao Dihuang Tang (Modified Rhinoceros Horn and Rehmannia Decoction). True cold invasion and true Jue syndrome are treated continuously with Huiyang Jiuji Tang (Restore Yang Rescue Emergency Decoction). Yang toxin macules with surging-numerous pulses correspond to Sanhuang Jusheng Tang (Three Yellows and Sesame Decoction). Originally no heat, essence fails to interact with others; heat binding the Bladder should not be purged wrongly; Guiling Yinzi (Cinnamon Twig and Poria Drink) is truly extraordinary. Hardness and pain below the heart with clear water diarrhea, heat accumulation diarrhea baffles doctors; delirium and thirst require Shenre Huanglong Tang (Divine Yellow Dragon Decoction). Jaw stiffness and head shaking named Jing (Spasm) are managed with Ru Sheng Yin (Like Sage Drink) adjustments.

Post-illness lethargy is Baihe Bing (Lily Disease); Chaihu Baihe Tang (Bupleurum Lily Decoction) should not be overlooked. Yang collapse from excessive sweating causes headache, trembling, and disharmony; severe muscle twitching and palpitations are best soothed by Wenjing Yiyuan Tang (Warm Meridians Benefit Origin Decoction). Male/female relapse after illness and Yin-Yang exchange are treated with Xiaoyao Tang (Free and Easy Wanderer Decoction) for sunken-pulse conditions. Jiaqi Syndrome (Gout/Paralysis) resembles Shanghan; tonics and pills are forbidden. Summer heat injuring heat, cold injuring cold, floating wind and weak dampness define the pulse. Constipation, retching, and difficulty bending/straightening are preserved by Jiawei Xuming Tang (Modified Continue Life Decoction).

Cuo Kong Syndrome (Grasping at Empty Air) requires careful recognition; do not mistake it for Wind syndrome to avoid fatal errors. Grasping clothes and touching bed are diagnostic signs; hands crossing chest and failing to recognize people result from Liver heat injuring Lung; Shengyang Sanhuo Tang (Raise Yang Scatter Fire Decoction) is effective as spirit. Waking suddenly speaking, dreamlike confusion where spirit lacks mastery; though swallowing soup/porridge, the body remains immobile like drunkenness. Heart fire overcoming Lung via meridian transmission requires Xiexin Daochi Tang (Drain Heart Guide Out Red Decoction) urgently. Fever and thirst without headache, mental confusion and disordered speech, difficult urination and black stool indicate that misusing cooling medicines endangers life. Pathogen transmitting to Heart/Lung with blood stasis is best treated with Danggui Huoxue Tang (Angelica Invigorating Blood Decoction).

Phlegm-binding syndrome resembles Shanghan: alternating chills and fever, coma, dizziness. Saliva drainage from the anus confirms the sign; root lies in Seven Emotions internal damage, spirit leaving empty residence causing disordered speech. JiaWei Daotan Tang (Modified Great Phlegm Resolving Decoction) can be added. Datou Bing (Big Head Disease) is seasonal epidemic; neck swelling with aversion to cold and fever is boiled together. One dose of Qinlian Xiaodu Yin (Scutellaria Coptis Detoxification Drink) ensures safety from phlegm-fire throat obstruction. This is an eternal secret of sages; do not spread it casually unless you are a kindred spirit.