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(Changes in Cold Damage) There are twenty categories in total.

*Chushi Bingyuan* (Source of Diseases by Chao Yuanfang) on the syndrome of sweating in pediatric cold damage: The so-called cold damage refers to cold pathogenic factors invading the skin, struggling with blood and qi, causing the couli (pores) to become closed and dense, preventing the venting of qi, leading to accumulation and generation of heat. Therefore, headache, body pain, and high fever occur. As for sweating, it is due to deficiency of yang qi receiving the pathogen; the pathogen struggles with qi, causing fever. Simultaneously, yin qi is also deficient, and the pathogen takes advantage of this to invade the yin. With both yin and yang deficient, they cannot control the body fluids, thus sweating occurs during cold damage.

*Liu Ren Shu* (The Book of Sixty People) discusses the treatment methods for cold damage in children and adults: Generally, they are similar, but the dosages are slightly smaller, and the medicinal properties are cooler. Question: What is spontaneous sweating? Answer: This is spontaneous sweating caused by disharmony of Wei Qi (Defensive Qi). If a patient has no internal organ diseases but experiences recurrent fever and spontaneous sweating that does not resolve, it is due to disharmony of Wei Qi. Sweating before the onset of fever resolves the condition; this belongs to the Guizhi Tang (Cinnamon Twig Decoction) pattern. In Taiyang disease (Disease of the Bladder and Small Intestine Channels), fever with sweating indicates weak Ying Qi (Nutritive Qi) and strong Wei Qi, hence the sweating. To rescue from wind pathogen, Guizhi Tang is appropriate. It is also stated: When a patient constantly sweats spontaneously, it means the Ying Qi is harmonious. If Ying Qi is harmonious, the exterior is unharmonious. This is because Wei Qi does not harmonize with Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. Re-inducing sweating will restore harmony between Ying and Wei, leading to recovery. Spontaneous sweating due to wind injury belongs to Taiyang disease; fever, sweating, aversion to wind, and slow pulse belong to Wind Strike (Zhong Feng), which is treated with Guizhi Tang. It is further stated: In Taiyang disease, stiffness and discomfort in the nape and back, accompanied by spontaneous sweating and aversion to wind, should be treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root). For sweating with thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated. For those without thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is indicated. Although Zhang Zhongjing states that spontaneous sweating in cold damage uses Guizhi Tang, Guizhi Tang is difficult to use and requires careful consideration. For example, if wind injury causes spontaneous sweating and the pulse is floating and weak, assuming Guizhi Tang is appropriate, if after taking the decoction the signs of Guizhi Tang disappear but irritability arises, it should not be taken again. If cold damage causes spontaneous sweating with frequent urination, Guizhi Tang must absolutely not be given. Zhang Zhongjing says: In Taiyang disease, spontaneous sweating with stiff and cramped limbs that are difficult to flex or extend, especially if urination is difficult, can be treated by adding Fuzi (Prepared Aconite Root) to Guizhi Tang. If urination is frequent, Guizi Fuzi Tang (Cinnamon Twig and Aconite Decoction) must strictly be avoided; Shaoyao Gancao Tang (Peony and Licorice Decoction) is appropriate. If one mistakenly uses Guizhi Fuzi Tang to attack the exterior, resulting in dry throat, irritability, cold extremities, and vomiting, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be given to restore Yang Qi. Once the cold extremities resolve and feet warm up, Shaoyao Gancao Tang should be given again, allowing the legs to extend. If stomach qi disharmony leads to delirium (admonishing speech), Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is given. If stools are slightly loose, stop administration to cease delirium. This is because Shaoyao Gancao Tang treats floating pulse, spontaneous sweating, and frequent urination. Floating pulse at Cun Kou (Radial Artery) indicates wind, large pulse indicates deficiency; wind generates slight heat, deficiency causes cramping in both calves. Frequent urination with continued sweating indicates scanty body fluids; Guizhi Tang must not be misused. Shaoyao Gancao Tang should be used to tonify deficiency and dispel wind-heat. This generally treats cases where symptoms persist after mistakenly taking Guizhi Tang. In Yangming disease, there is spontaneous sweating without aversion to cold, but rather aversion to heat; natural sweating belongs to Yangming disease. If Yangming disease presents with profuse sweating and thirst, Zhuling Tang (Polyporus Decoction) must not be given, as profuse sweating dries the stomach, and Zhuling Tang would further promote urination. Thus, Zhang Zhongjing states: In Yangming disease with fever and profuse sweating, urgent purgation is required. In Yangming disease, if a person sweats profusely, body fluids exit externally, drying the stomach, leading to hard stools. Delirium indicates Tiaowei Chengqi Tang is appropriate. Although Yangming disease with profuse sweating requires urgent purgation, if urination is normal, this indicates exhaustion of internal body fluids; even so, purgation must not be used. Bowel movement must be induced via suppository method, specifically using Mi Jian Dao (Honey Suppository Method). In Yangming disease, sweating with slow pulse and slight aversion to cold indicates the exterior is not resolved; Guizhi Tang is appropriate. Yangming disease typically involves profuse sweating; if the pulse is floating, there is no sweating, and wheezing occurs, inducing sweating leads to recovery, indicating Mahuang Tang (Ephedra Decoction). Loss of Yang causing spontaneous sweating: In Taiyang disease, excessive sweating leads to continuous leakage of sweat, aversion to wind, requiring warming of the meridians; Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is appropriate. In cold damage, if both Chi (Cun and Chi positions) pulses are tight and sweating occurs, it indicates loss of Yang, belonging to Shaoyin disease, typically presenting with sore throat, vomiting, and diarrhea. If fever persists, internal cramping, limb pain, cold extremities, and aversion to cold occur, Sini Tang (Frigid Extremities Decoction) is indicated. For continuous profuse sweating, Wen Fen (Warm Powder) can be applied externally. If sweating continues profusely with aversion to wind, irritability, and inability to lie down, Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes, and Oyster Shell Decoction) should be taken first, followed by Xiaojianzhong Tang (Minor Construct the Middle Decoction). (All applicable formulas are seen in this section.)

*Liu Ren Shu* records Zhang Zhongjing's Guizhi Tang:
Guizhi (Cinnamon Twig), Shaoyao (Peony Root) (3 liang each), Gancao (Licorice Root) (2 liang).
Crush these into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water, 5 slices of Shengjiang (Fresh Ginger), and 2 dates. Decoct until 1 cup remains, strain, and take warm. Shortly after, drink 1 cup of hot thin porridge to assist the medicinal power. Cover with blankets for about one shi (two hours); mild whole-body sweating is ideal. Includes modification rules: Guizhi Tang is effective year-round for people in the northwest. In the Jianghuai region, it is suitable only in winter and spring. From late spring to before Summer Solstice, for Guizhi patterns, add 1 fen of Huangqin (Scutellaria Root), called Yangdan Tang. After Summer Solstice, for Guizhi patterns, add 0.5 liang of Zhimu (Anemarrhena Rhizome) and 1 liang of Shigao (Gypsum Fibrosum), or add 1 fen of Shengma (Cimicifugae Rhizome). If the patient is constitutionally deficient and cold, use the ancient formula without modifications. Warning: Guizhi Tang is the most difficult to use. Although it is said that unresolved exterior with floating pulse allows for sweating therapy using Guizhi Tang, it is only suitable when the patient has constant spontaneous sweating, normal urination frequency, warm hands and feet (or slightly cool fingertips that warm up quickly), mild irritability combined with aversion to cold. If the patient has no sweating, frequent urination or cold hands/feet, no aversion to cold, or is an alcohol drinker who dislikes sweet tastes, Guizhi Tang must strictly be avoided. Even if Guizhi pattern exists, if after taking the decoction the pattern disappears, do not administer again.

*Liu Ren Shu* records Zhang Zhongjing's Guizhi Jia Gegen Tang:
Guizhi (Cinnamon Twig), Gancao (Licorice Root) (1 liang each), Gegen (Kudzu Root) (2 liang), Shaoyao (Peony Root), Mahuang (Ephedra Herb) (1.5 liang each).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 4 slices of Shengjiang (Fresh Ginger), 1 date, and 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take. Cover to induce mild sweating.

*Liu Ren Shu* records Zhang Zhongjing's Wuling San:
Zhu Ling (Polyporus), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria) (peeled, weighed. Each 3 fen), Zexie (Alisma Rhizome) (1.1 liang), Guizhi (Cinnamon Twig) (peeled, 0.5 liang, not roasted).
Process each herb separately, crush and sieve into powder, mix well. Take 3 qian per dose, mixed with white boiled water. These herbs must be processed and weighed individually before mixing.

*Liu Ren Shu* records Zhang Zhongjing's Fuling Gancao Tang:
Fuling (Poria), Guizhi (Cinnamon Twig) (peeled. Each 2 liang), Gancao (Licorice Root) (roasted, 1 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water and 5 slices of Shengjiang (Fresh Ginger). Decoct until 0.8 cup remains, strain, and take warm.

*Liu Ren Shu* records Zhang Zhongjing's Guizhi Jia Fuzi Tang:
Guizhi (Cinnamon Twig) (peeled), Shaoyao (Peony Root) (1.5 liang each), Gancao (Licorice Root) (roasted, 1 liang), Fuzi (Prepared Aconite Root) (processed, peeled, 0.5 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 4 slices of Shengjiang (Fresh Ginger), 1 date, and 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take warm.

*Liu Ren Shu* records Zhang Zhongjing's Shaoyao Gancao Tang:
Baishaoyao (White Peony Root), Gancao (Licorice Root) (roasted. Each 2 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take warm.

*Liu Ren Shu* records Zhang Zhongjing's Gancao Ganjiang Tang:
Gancao (Licorice Root) (roasted, 4 liang), Ganjiang (Dried Ginger) (2 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water. Decoct until 0.8 cup remains, take in divided doses with reduced amounts.

*Liu Ren Shu* records Zhang Zhongjing's Tiaowei Chengqi Tang:
Gancao (Licorice Root) (1 liang), Mangxiao (Mirabilite) (1.1 liang), Dahuang (Rhubarb Root and Rhizome) (peeled, 2 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1 large cup of water. Decoct until 0.7 cup remains, strain, and take.

*Liu Ren Shu* records Zhang Zhongjing's Mi Jian Dao (Honey Suppository Method): Tu Gua Gen (Solomon's Seal Rhizome) and Da Zhu Dan Zhi (Large Pig Bile) can also be used as suppositories.
Mi (Honey) (4 liang).
Place this single ingredient in a copper vessel, simmer over low heat until it thickens like malt syrup. Stir continuously to prevent burning. While hot, shape into pills, rolling them into sticks about the thickness of a finger and two cun long. Shape while hot, as it hardens when cold. Make the tip sharp. Insert into the anus. Hold tightly with hand. Remove when defecation is desired.

*Liu Ren Shu* records Zhang Zhongjing's Mahuang Tang:
Mahuang (Ephedra Herb) (1.5 liang, remove joints), Guizhi (Cinnamon Twig) (1 liang), Gancao (Licorice Root) (roasted, 0.5 liang), Xingren (Apricot Seed) (35 pieces, remove skins and tips).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take warm. Cover to induce mild sweating. Porridge is not required. Modification rules: Medicines for cold damage and febrile diseases should have cool properties, not too warm. After Summer Solstice, Mahuang Tang must add 0.5 liang of Zhimu (Anemarrhena Rhizome), 1 liang of Shigao (Gypsum Fibrosum), and 1 fen of Huangqin (Scutellaria Root), because Mahuang Tang is hot-natured; summer use may cause jaundice and rashes. Only in winter and spring, or for patients constitutionally deficient and cold, is the original formula used without modifications.

*Liu Ren Shu* records Zhang Zhongjing's Sini Tang:
Gancao (Licorice Root) (2 liang, roasted), Ganjiang (Dried Ginger) (1.5 liang), Fuzi (Prepared Aconite Root) (1 piece, raw use).
Crush into pieces the size of hemp seeds. Take 4 qian per dose, add 1.5 cups of water. Decoct until 0.7 cup remains, strain, and take warm. Strong individuals add half a piece of Fuzi and 1.5 liang of Ganjiang.

*Liu Ren Shu* records Zhang Zhongjing's Wen Fen Method (Warm Powder):
Baizhu (Atractylodes Macrocephala Rhizome), Ben Cao (Ligusticum Chuanxiong Rhizome - Note: Text says 'Ben', likely Gaoben), Xiong Qiong (Ligusticum Wallichii Rhizome), Baizhi (Angelica Dahurica Root) (Equal parts).
Grind into fine powder. Mix 1 liang of powder with 3 liang of rice flour. Apply powder all over the body to stop sweating. Absence of Ben Cao is acceptable.

*Liu Ren Shu* records Fangfeng Baizhu Muli Tang:
Fangfeng (Saposhnikovia Root) (single stem, remove radicle), Muli (Oyster Shell) (stir-fried yellow), Baizhu (Atractylodes Macrocephala Rhizome) (Equal parts).
Grind into fine powder. Take 2 qian per dose, mixed with wine or rice drink. Take 2-3 times daily. Once sweating stops, take Xiaojianzhong Tang.

*Liu Ren Shu* records Zhang Zhongjing's Xiaojianzhong Tang:
Guizhi (Cinnamon Twig) (1.5 liang, peeled), Shaoyao (Peony Root) (3 liang), Gancao (Licorice Root) (1 liang), Jiaoyi (Malt Sugar) (0.5 sheng. If history of loose stools or vomiting, remove Jiaoyi).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water, 4 slices of Shengjiang (Fresh Ginger), and 1 large date. Decoct until 0.8 cup remains, strain, add approx. 2 spoons of Jiaoyi (Malt Sugar), re-decoct until dissolved, and take warm. Take 3 times daily, 2 times at night. If Chi pulse remains slow, prepare another dose, adding 1 qian of Huangqin (Scutellaria Root) powder.

Method for Preparing Malt Sugar Paste:
Nuomi (Glutinous Rice) (1 sheng, cleaned and washed), Damai Mai (Barley Flour) (6 liang).
Cook the glutinous rice like steaming. Steam until vapor penetrates thoroughly. Remove and pour into a basin. Add 1 he of barley flour and approx. 1 cup of water/broth. Mix well. Steam again until cooked. Pour back into the basin, mix thoroughly with barley flour. Place in a ceramic jar holding approx. 5 sheng. In winter, heat the jar; in spring, autumn, and summer, keep warm. In winter, add approx. 2 sheng of hot water to the jar. The water level above the rice should be approx. 3 finger-widths. Cover tightly with 3-5 layers of cloth and paper, then wrap in cotton or wadding. Keep near fire. In spring, autumn, and summer, keep at room temperature overnight. When rice floats on the water surface, squeeze through cloth to extract clear juice. Decoct in silver or earthenware vessel until a film forms on the surface. Stir continuously with a wooden sieve until it becomes a thick paste. Store in ceramic ware. In summer, place in a well to prevent souring.