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Cold damage (Shanghan) and miscellaneous diseases (Zabing) are divided into two categories in the world. The treatment of cold damage focuses on expelling pathogenic factors, whereas the treatment of miscellaneous diseases prioritizes nourishing and regulating the body. From this, we know that physicians specializing in cold damage hold fast to the methods of sweating (Han), purging (Xia), harmonizing (He), and resolving (Jie), without any thought of protecting the healthy qi (Zhengqi). Do physicians of miscellaneous diseases not have syndromes requiring the expulsion of pathogens? It is merely because they adhere rigidly to their own views and cannot be flexible, leading them to dare not use tonification for all deficiency and complicated syndromes of cold damage, and dare not use purgation for all exterior and excess syndromes of miscellaneous diseases. This is the common view, and patients would rather die than resent it. This is undoubtedly due to the long obscurity of the sage's teachings and the rampant spread of heretical theories. Therefore, it is necessary to break through this with the true principles of identifying symptoms and naming conditions at the entry level of *Shanghan Lun* (Treatise on Cold Damage), so that physicians of miscellaneous diseases may roughly understand the differentiation of meridians and fu organs, avoiding reckless actions. Would this not offer some benefit to the world? I shall tentatively discuss the general outlines of yin-yang transmission, direct invasion, winter-warmth (Dongwen), warm-heat (Wenre), and epidemic season (Shixing) as follows.

[Yin-Yang Transmission and Direct Invasion]
For example, after the Frost Descent solar term, if a patient has fever, headache, spontaneous sweating, and a floating-slow pulse, this is a syndrome of wind damaging the defensive layer (Wei Fen). Since wind is a yang pathogen, it only damages the defensive layer. When the defensive layer is damaged, the interstices become loose, causing spontaneous sweating; the body does not ache, breathing is not panting, and the pulse is not tight. If one observes aversion to cold and fever, headache, bone and joint pain, absence of sweating with panting, and a floating-tight pulse, this is a syndrome of cold damaging the nutritive layer (Ying Fen). Since cold is a yin pathogen, it directly damages the nutritive layer. When the nutritive layer is damaged, the interstices close tightly, causing absence of sweating with panting, body ache, bone and joint pain, and a pulse that is not soft. If one observes fever and aversion to cold, headache and body ache, inability to sweat accompanied by irritability, and a floating-tight pulse, this is a syndrome where wind and cold simultaneously damage both the nutritive and defensive layers. Wind is a yang pathogen that penetrates everywhere; its nature is active, and typically induces sweating. Cold is a yin pathogen that causes closure; its qi constricts and suppresses the interstices, preventing heat from escaping outward, so the heat steams inward causing irritability. The above are initial manifestations of the Taiyang Meridian (Taiyang Jing). There are three distinct methods represented by Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Da Qinglong Tang (Major Green Dragon Decoction).

If the pathogen enters the Yangming Meridian (Yangming Jing), aversion to cold disappears entirely, leaving only high fever, spontaneous sweating, and a floating-rapid pulse. Because Yangming connects internally to the Stomach (Wei), which is rich in qi and blood, when the pathogen enters its meridian, it steams the qi of food and fluids, resulting in sweating. However, one can distinguish based on appetite: ability to eat indicates a yang pathogen belonging to wind; inability to eat indicates a yin pathogen belonging to cold. If the pathogen enters the Shaoyang Meridian (Shaoyang Jing), there is alternating chills and fever, bitter taste in the mouth, and hypochondriac pain. Because this meridian resides halfway between exterior and interior, when the pathogen desires to enter, chills occur; when the healthy qi contends with it, fever occurs. Thus, only harmonization is suitable, and sweating, purging, and promoting urination are prohibited. Regarding its transmission, although there is a sequence, there is no fixed rule. Some transmit along the meridians, some skip meridians, some transmit through all six meridians, some stop after two or three meridians, some involve "offending the root" (Fan Ben), and some enter the fu organs. Some pathogen staying in Taiyang does not transmit to the Yangming meridian but enters the Yangming fu organ. Some transmit between Yangming meridian and fu organs. Some transmit from Shaoyang meridian to Yangming fu organ. Hence, Zhang Zhongjing distinguishes between Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. Some say Shaoyang does not reverse-transmit to Yangming. Little do they know that the Stomach is the commander of the twelve meridians, interconnected. Moreover, the Shaoyang meridian is external, while the Yangming fu organ is internal; what is there to call "reverse"?

Regarding transmission to yin meridians, some also transfer to the Stomach fu organ forming purgative syndromes. The Spleen (Pi) and Intestines are closely connected, making the transfer of cold and heat easiest. Shaoyin may present with diarrhea of clear water pure green, pain under the heart, and dry mouth. Jueyin may present with diarrhea and delirious speech. These are all syndromes of yin meridians entering fu organs. Shaoyin may also transfer heat to the Bladder (Pangguang) fu organ, causing heat throughout the body and limbs, and blood in urine. Jueyin may also turn out to Shaoyang with vomiting and fever, due to the adjacency of these two meridians. There are also cases turning out to Taiyang exterior syndromes, such as after diarrhea, with normal stool and body ache; this is the return of yang from the end of yin.

What is called "offending the root" refers to the Taiyang meridian pathogen entering the root of the Bladder. For instance, vexation, thirst desiring drink, vomiting immediately after drinking, and difficult urination constitute offending the root by wind damaging the defensive layer. Heat binding in the Bladder, with the patient acting like a madman or passing blood, constitutes offending the root by cold damaging the nutritive layer. Hence, Zhang Zhongjing differentiates Wuling San (Five-Ling Powder) and Taohé Chengqi Tang (Peach Kernel Decocted Qi-Replenishing Decoction). When evil heat enters the Stomach, one must investigate the origins of the three Yangming stages and treat with Sanshengqi Tang (Three Purge Decoctions) according to urgency. Yangming resides in the center, is the destination of all things, and transmits nowhere further; thus, purgation is appropriate here. However, one must wait until the accumulation is firm, so that all evil heat returns to the Stomach, before purging. If purged too early before accumulation is firm, syndromes such as chest binding (Jiexiong), fullness-hardness (Piying), and purging with heat follow, because the evil heat has not fully converged in the middle earth and takes the opportunity to enter internally causing complications. Hence, cold damage physicians warn: "Sweating should not be delayed too early; purging should not be done too late; if the exterior is not resolved, do not attack the interior."

When the pathogen is in Shaoyang and invades the Gallbladder (Dan) fu organ, there is chest fullness, fright, and vexation, difficult urination, heaviness of the whole body making turning difficult. Or if it enters the Blood Chamber (Xuèshì), the patient is lucid during the day but delirious at night as if seeing ghosts. All should be treated according to the syndrome. The key to this meridian lies entirely in the Stomach qi. Therefore, Renshen (Ginseng Radix) is essential in Xiaochaihu Tang (Minor Bupleurum Decoction). Zhang Zhongjing said, "If the stomach is harmonized, the disease cures; if not harmonized, there is vexation and palpitations." This is the main principle of this meridian.

Regarding transmission to the Three Yin, Taidou presents with abdominal fullness and intermittent pain; Shaoyin presents with abdominal pain, spontaneous diarrhea with tenesmus, difficult urination, and severely, dry mouth and pain under the heart; Jueyin presents with alternating cold and heat. More cold than heat indicates progression; more heat than cold indicates regression. Generally, heat pathogens transmitting through Shaoyin must enter via Taidou; Jueyin must enter via Shaoyin. This differs from yin syndromes where entering Taiyang does not transform into stagnant heat before entering Shaoyin. One must know that cold damage transmission syndromes are all heat pathogens. When the meridian pathogen is excessive and overflows into the extraordinary meridians, transmission occurs via the Yang Linking Vessel (Yangwei) to distribute among the Three Yang, and via the Yin Linking Vessel (Yinwei) to distribute among the Three Yin, unrelated to the sequence of the twelve meridians and zang-fu organs. The pathogen must start from the Taiyang meridian because in winter, Cold-Water governs, so there is no reason to attack other meridians first. However, if other meridians have original deficiency, or it is a combined disease, or skips meridians, or sinks into this meridian without further transmission, it differs from non-seasonal cold epidemics where the Three Yang are mixed. Generally, cold epidemics occur mostly in spring. In spring, Shaoyang governs, and wind-wood pathogen attacks Shaoyang first, while Taiyang and Yangming are external, so all three meridians are affected. Thus, formulas for treating colds, such as Xiangsu, Xiongsu, Shensu, Zhengqi, and Shishen, mix the three meridians indiscriminately. Observe that summer heat必然 damages the Pericardium (Xinbao), and autumn dryness必然 damages the Lung collaterals; this always relates to the governing ruler of the season.

If misdiagnosis leads to complicated syndromes, the manifestations are numerous and cannot be fully listed. For example, chest binding and fullness arise from mistakenly using exterior-resolving herbs allowing exterior pathogen to sink inward. Thus, the pulse must show floating in one area. Cold damaging Ying belongs to blood, and hard/painful cases are chest binding; wind damaging Wei belongs to qi, and non-painful cases are fullness. However, the basis of fullness often lies in internal phlegm-dampness accumulation, unlike chest binding which necessarily results from early purging allowing yang pathogen to sink inward. This explains why Xiaoxianxiong Tang (Minor Chest-Binding Decoction), Daxianxiong Tang (Major Chest-Binding Decoction), and five types of Xiexin Tang (Drain Epigastrium Decoctions) manage these treatments. As for Ao'ao (restlessness) syndromes, there is no binding to purge and no fullness to scatter; only Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) can open up the interior pathogen sinking in deficient persons, sweeping it away rapidly. Even for relapse due to labor or diet, adding Zhishi (Immature Bitter Orange Fruit) alone suffices. Warm-heat epidemics can also adopt this method.

Regarding yin syndromes, since there is no steaming heat pathogen, there is absolutely no mechanism for transmission. Even if there is a yin pathogen, yin is static and cannot transmit. Originally, the disease must begin in Shaoyin. Or if cold exposure and cold drinks damage the Spleen, it enters Taidou. Jueyin syndromes invariably arise from Shaoyin. Therefore, warming meridian herbs for Shaoyin heavily use Jiang (Ginger Rhizome), Fu (Aconite Lateral Root), and Sini Tang (Recovery Decoction). Jueyin, the wind-wood zang organ, harbors true fire internally; even with yin-cold, herbs like Yuzhu (Cornus Fruit) and Rougui (Cinnamon Bark) suffice. Danggui Sini Tang (Angelica Decoction for Cold Extremities) with Wuzhuyu (Evodia Fruit) replacing Rougui is sufficient; Jiang and Fu are unnecessary. However, in Zhang Zhongjing's Jueyin examples, Sini Tang treatments exist. One must know that Jueyin cold originates from Shaoyin deficiency-cold, hence Jiang and Fu are used to warm Shaoyin together. This is treating Kidney (Shen) and Liver (Gan) together. Even Taidou sometimes uses Sini Tang, due to Mingmen Fire decline failing to generate Earth, necessitating concurrent warming of Shaoyin. This is seeking the root in treatment.

The method of treating cold damage relies entirely on grasping the outline. Pathogens in the Three Yang require distinguishing meridian vs. fu organ; diseases entering the Three Yin require distinguishing transmission vs. direct invasion. Meridians belong to the exterior, suitable for external resolution; fu organs belong to the interior, requiring purgation. Transmission involves heat. Although there are syndromes of extreme yang resembling yin, such as cold extremities and spontaneous diarrhea, one must examine if there was prior fever and headache. If cold extremities and diarrhea appear after four to five days or several days, this is extreme yang pathogen, deep cold corresponding to deep heat. One must urgently clear the interior. Mistakenly giving warming herbs will cause death. But clearing requires method. One must know that in extreme yang resembling yin syndromes, the patient's root qi is necessarily deficient. Even when saving heat and preserving yin, one must guard against heat departing and cold arising. Occasionally, excessive sweating leads to yang collapse, or excessive purging leads to simultaneous yin and yang collapse; in such cases, slight warming tonification is permissible. However, once yang returns, change tactics; do not overdose to consume fluids. Furthermore, this differs from true yin disease. Interior cold may present with extreme yin resembling yang, fever, restlessness, etc. One must examine if initially there was no fever/headache, but vomiting clear water, curling up, cold feet, spontaneous diarrhea/abdominal pain, and small-weak pulse. If after four to seven days, sudden high fever, restlessness, desire to sit/lie in mud/water, thirst unable to swallow, and large-empty pulse unable to surge occur, this is false heat from yin excess repelling yang, a sign of yang collapse. Heavy use of Renshen (Ginseng) and Fuzi (Prepared Aconite Root) is unquestionable.

In acute cold strike with cold extremities and unconsciousness, this is severe deficiency of true yang with cold pathogen breaking through gates. Danxi said, "When the whole body receives pathogen, meridians are hard to distinguish." Only frequent administration of Bitong Tang (White Connective Decoction) and Tongmai Sini Tang (Pulse-Connecting Recovery Decoction) can restore life. There is also Shaoyin wind-strike, without fever, spontaneous sweating, cold extremities, vomiting, or diarrhea, but with chest fullness/discomfort, occasional hunger-like sensation in the heart, self-reported abdominal fullness but none on palpation, warm hands/feet, and small-weak-micro-floating pulses. This is yang pathogen in yin meridians, rarely recognized. Only Huangqi Jianzhong Tang (Astragalus Replenish Middle Decoction) with added Renshen and Shufu (Prepared Aconite) to warm and disperse is suitable. If complicated by food stagnation, the Qi Kou pulse is choppy or vague; give Zhishi Lizhong Tang (Immature Bitter Orange Regulate Middle Decoction). If hands/feet are slightly cold, add Fuzi. Mistakenly using dispersants causes death. Breaking qi and widening middle causes death. Digesting and purging causes death. Heavily using Sini Tang damages true yin, risking coughing and bleeding. Initially disregarded and entrusted to mediocre physicians, almost all who fall victim die.

[Winter-Warmth]
In winter, if weather is unusually warm and fever/cough appear, this is Winter-Warmth (Dongwen). Due to the storage command being violated, yang qi leaks excessively, Shaoyin fails to store, and abnormal seasonal qi injures the Shaoyin meridian. Yang qi emerging externally causes fever. Heat pathogen damaging qi causes cough. The meridian ascends to the throat, causing sore throat; descends to the abdomen, causing diarrhea in deep infection. Winter-warmth is residual qi of autumn dryness, hence dry throat, phlegm knotting, even hemoptysis, differing from wind-cold cough where sputum appears immediately. Cough causing head distension indicates fire qi ascending; severe cough causing organ pain indicates internal fire stagnation. Pulses may be empty-slow, empty-large-weak, or small-weak, due to heat damaging qi. If Kidney qi is originally deficient, the Chi pulse is micro-stringy, with evening chills/fever. If generally qi deficient, the Qi Kou pulse is empty-large, with body heat and slightly cold hands/feet. If previously injured by winter-warmth plus sudden cold, cold traps heat, causing high fever, headache, spontaneous sweating, panting/cough, floating pulse, micro-stringy superficially, soft-slippery mid-level, weak deep. Even with wind-cold, never rashly use wind-dispersing herbs to lift the pathogen. Mildly, heat worsens and cough intensifies; severely, it transforms into wind-warmth burning heat causing death. Never use acrid-dispersants, often causing throat obstruction, spitting pus/blood, blood in sputum, even hemorrhage, macules, or Huo-Huo syndrome, often untreatable. Never use qi-consuming herbs, often causing severe cough, body pain, hot face/cold feet, leading to critical condition. Only Jiajian Congbai Xiangchi Tang (Modified Scallion and Fermented Soybean Decoction) is suitable. If complicated by external wind-cold, add Qianghuo (Notopterygium Rhizome) and Zisu (Perilla Leaf). If cold is extreme causing irritability, add slight Mahuang (Ephedra) 5-7 fen and Shigao (Gypsum) 1 qian, or primarily Weirui Tang (Anemarrhena Decoction). Since this syndrome appears in winter, all physicians mistake it for cold damage, and many die from mistaken dispersants. Did you know that in Northwest regions, true wind-stroke and cold damage are most common, while winter-warmth is rare. Sometimes injury from heated kang beds occurs, or injury from heat followed by cold, treatable with Yebibo Tang (Sheep Beard Decoction) or Guizhi Er Yuebiyi Tang (Cinnamon Twig Two-Parts Sheep Beard One-Part Decoction). Because people there are robust and can withstand attacking herbs, unlike the frail constitution of Southeast. South of the Great Ridge, where yang qi constantly leaks, there is only miasma poison, no cold damage risk. Even traveling elsewhere and catching cold/wind, only Huoxiang Zhengqi Tang (Patchouli Correct Qi Decoction) is suitable. Mahuang and Qinglong (Da Qinglong Tang) must never be used. Mistaken use activates latent damp-miasma, causing persistent high fever and often death. Caution is essential.

[Warm Disease]
If touched by pathogen in winter, lying dormant in meridians, and activating with yang qi around Spring Equinox, it becomes Warm Disease (Wenbing). As Suwen says, "Winter injury by cold leads to spring warmth disease." Symptoms include no aversion to cold, only aversion to heat and great thirst. Pulses are numerous/excessive and turbid. Yuèrén said warm disease pulses move in various meridians, unknown which is active, definitely not like cold damage's floating-tight. Right Chi and Qi Kou pulses must double Renying pulse, certainly not comparable to Renying tightness. This syndrome strictly forbids sweating. Mistaken exterior dispersion causes restless heat, anhidrosis, agitation, and death. Because pathogen lies dormant in meridians, transforming into fire over time, heat emerges from interior to exterior. Must use acrid-cool to resolve exterior heat, bitter-cold to drain interior heat. Once interior qi flows, sweating occurs naturally. Some cure with massive sweating after Chengqi Tang; some with massive sweating after drinking water; some with Huangqin Tang (Scutellaria Decoction) or Congbai Xiangchi Tang; some with Gegen Huangqin Huanglian Tang (Kudzu Scutellaria Coptis Decoction) for fever/diarrhea; some with Liangge San (Cool Diaphragm Powder) for dry tongue/constipation. Hence the proverb: mistaking purging for warm-heat disease is not major harm; mistaking sweating is harmful.

Non-seasonal cold epidemics interspersed must be carefully diagnosed. Acute wind-cold initially causes aversion to cold without thirst; by day 2-3, heat damages fluids causing thirst, differing from warm-heat disease's immediate confusion/high fever/thirst. Pulses are mostly floating-excessive on left hand, differing from warm disease's right-side rapid-excessive. If right pulse is slippery-excessive or choppy/vague, it indicates food stagnation. Thus, treating cold epidemic prioritizes dispersing; if old stagnation exists, add Ju (Tangerine Peel), Ban (Pinellia), Zhishi (Immature Bitter Orange), Pò (Magnolia Bark); do not abuse interior drugs. If pathogen hasn't entered interior and purging is mistaken, it risks inviting thieves to destroy the home. Thus, treatment differs vastly from latent qi.

[Heat Disease]
Latent qi manifesting after Summer Solstice is Heat Disease (Rèbìng). Pathogen exploits summer fire stagnation, steaming from Shaoyin through Three Yang, differing from cold damage's step-by-step transmission. Some complicate with heatstroke (Zhongshu); treatment is same as heatstroke. Heatstroke, though violent heat toxin, stems from heat consuming Kidney water, sweat damaging Stomach juice, fire pressing Pericardium. Hence Baihu Tang's Zhimu cleans Shaoyin source, Shigao transforms Stomach heat, Gancao and Jingmi protect Pericardium and preserve Lung/Stomach qi, similar to heat disease pathogen lying in Shaoyin, heat damaging Stomach juice, fire pressing Pericardium. Thus, different diseases share treatment, allowing heat pathogen to dissipate. If heat toxin is extreme unresolved with abdominal fullness/qi excess, use Liangge San, Shuangjie San, Chengqi Tang, Jiedu Tang, combined with bitter-dry purgatives. Or Sanhuang (Three Yellows), Shigao, Zhizi Chi Tang to sweat. Methods must not be mild, doses not gentle, or they fail. Unlike cold damage waiting for Yangming Stomach excess before purging.

[Epidemic Season]
Seasonal epidemics are unusual diseases, occurring every few or decades, mostly after famine/war. Outbreaks affect entire villages, young and old alike—this is Major Epidemic. Sometimes isolated cases in few families—this is Common Epidemic. Like smallpox/measles appearing every 1-3 years, not prevalent enough to notice. Like Soft-Leg Plague mistaken for Hong Kong Foot; Neck-Twisting Plague mistaken for Sore Throat; Intestine-Twisting Plague mistaken for Stink-Toxin; Yangmei Plague mistaken for Carbuncle-Swelling; Black-Bone Plague mistaken for Poisoning; Melon-Rind Plague mistaken for Blood-Stasis Cold Damage. Only Geda Plague (household outbreak/death) and Datou Plague (sudden swelling/heat/foul air) dare not be named lightly. Common epidemic qi is damp-earth pathogen stagnation; treatment requires exterior-interior resolution, attacking based on pathogen location. Sun Simiao said: Epidemic cold not resolved in 3 days, take Congbai Xiangchi Tang with child's urine hot to sweat. If no sweat, repeat. Stop when sweat comes and heat leaves. If 3 doses fail and pulse floats, still exterior, use Baihu Tang. If interior signs appear, use Chengqi Tang/Jiedu Tang. If exterior-interior indistinct, use Liangge San/Shuangjie San. After sweating/purging if exterior returns, give Baihu Tang again. If interior returns, give Chengqi Tang again. If exterior-interior heat intense, use Sanhuang Shigao Tang or Sanhuang Zhizi Chi Tang to sweat. Some cured after 3-4 sweats/purgations; some relapse with high fever, allow re-sweating/re-purging. If pulse/syndrome are deficient, no more attacking; use Qingre Jiedu Tang, Renzhonghuang Wan/San (Human Waste Ash Pill/Powder). Unlike cold damage fear of early purging complications, or warm-heat prohibition of frequent purging. Generally, aim for heat removal/pathogen exhaustion, do not constrain deficiency. Only if lower origin deficient, need Shengliao Liuwei Dihuang Wan (Raw Six-Ingredient Rehmannia Pill) to tonify true yin to transform residual heat; do not rigidly follow above. For Major Epidemic, analyze symptoms per time/place; methods vary; cannot pre-plan. Above describes opening diagnostic doors for miscellaneous disease physicians; key points not elaborated.

Fan Kecheng, Prefect of Ministry of Rites in Huguang, stayed at Shiwo Nunnery in Jin Chang. Suffered cold damaging nutritive layer, aversion to cold for 3 days. Previously took 2 doses of dispersants. On 7th day, restless, pulses absent, cold extremities. Fang Yaozhen, ophthalmologist colleague, invited Shiwan to diagnose. Only Left Cun pulse trembled violently. Knew this was impending battle-sweat (Zhan Han). Ordered no medicine, only hot ginger soup to assist sweating. Mistaken medicine would cause persistent heat. Days later, Fan visited to thank and leave. Inquiry confirmed prediction: cured without medicine.

A boy surnamed [Name], latent qi manifested in peak summer. Son knelt begging treatment. At diagnosis, severe restlessness, pulses洪盛 (surging-excessive) and restless. Wife said: great thirst demanding water...