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In the treatment of Shanghan (Cold Damage), one must first observe the complexion, then palpate the pulse and inquire about symptoms, synthesizing these factors to determine life and death or auspiciousness and inauspiciousness. The complexions are Green, Yellow, Red, White, and Black, appearing on the facial skin, with their Qi resembling tangled threads or hair hidden beneath the dermis. The Five Zang organs correspond to five colors, and the Six Channels correspond to six colors, all manifesting on the face to align with the Five Elements. Mutual generation indicates auspiciousness; mutual overcoming indicates inauspiciousness. Moisture and nourishment indicate life; dryness and withering indicate death. From the Zhuntou (tip of the nose), Nianshou (root of the nose), Minggong (space between eyebrows), Faleng lines (nasolabial folds), and Renzhong (philtrum), there is Qi and color; moist and bright is auspicious, while dark and dry is inauspicious. One must also comprehensively examine according to the principles of generation and overcoming across the four seasons. Herein, the essentials of the five-color Shanghan are briefly listed below for reference. (This section is from *Yizong Bidu*, identical to Tao Jian'an's version.)

Green belongs to Wood, governs Wind, Cold, and Pain, and is the color of the Foot Jueyin Liver Channel.
When both the face and lips are green, it indicates Extreme Yin. If accompanied by tongue curling and testicular retraction, warming therapy should be urgently applied. In cases of Jia Yin Shanghan (Shanghan with concurrent Kidney Yang deficiency) presenting with lower abdominal pain, the face appears green. The *Neijing* states: "Green like a kingfisher feather indicates life; green like dried grass indicates death." Green mixed with Black or Red follows the principle of generation and indicates life; however, Green-White that is dry and withered follows the principle of overcoming and indicates death. When Spleen disease presents with Green Qi, it is difficult to treat.

Red belongs to Fire, governs Heat, and is the color of the Hand Shaoyin Heart Channel. In Shanghan, its appearance requires differentiation among the Three Yang channels and the Shaoyin channel. For instance, the Foot Taiyang Bladder Channel belongs to Water; its natural color under Cold is Black, but turns Red under Heat. The classics state: "Continuous full-face redness indicates Yang Qi stagnation in the exterior due to incomplete sweating; diaphoresis should be induced." If the pulse is Floating-Rapid, with exterior Heat, no sweat, and a bright Red complexion, this pattern applies. The classics mention that in Yangming disease, a fully Red face contraindicates purgation. "He" implies thoroughness; since exterior pathogens remain unresolved, interior purgation is forbidden. However, if Yangming excess-heat manifests as aversion to heat without aversion to cold, steaming fever, tidal fever at dusk, constipation, delirium, and a Red face, this is Excess-Heat in the interior, and purgation is permissible. If exterior and interior are both hot, with dry mouth/tongue craving water, a Surging pulse, and a Red face, but the interior is not yet solidified, downward-draining methods are temporarily contraindicated; instead, Renshen Baihu Tang (Ginseng White Tiger Decoction) should be used to harmonize. If Shaoyang channel Heat is half-exterior and half-interior, presenting with a Red face and Wiry pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) should be used to harmonize; purgation is forbidden. The classics state that in Shaoyin disease, with diarrhea of undigested food, interior Cold with exterior Heat, and a Red face, Sini Tang (Frigid Extremities Decoction) added with Congbai (Scallion Stalk) is indicated. This represents Extreme Interior Cold forcing floating Fire upward to the face, causing redness, which is not true Heat. Failure to distinguish this carefully and administering cooling agents will result in death. Additionally, in Jia Yin Shanghan, floating deficient Yang may rise, also causing a Red face, distinguished by cold feet and a Deep pulse. Cases of irritability, Red face, cold feet, Deep pulse, and inability to drink water indicate Extreme Yin and require warming. In chronic illness with deficient constitution, afternoon redness on the malar eminences indicates Yin Fire and should not be treated as Shanghan. However, the Qi of the Three Yang channels converges on the forehead. The pathway from the forehead to the vertex connecting to the brain is the Taiyang channel; from the forehead down to the nose and face is the Yangming channel; from the temporal angle down into and around the ear is the Shaoyang channel. Redness or swelling in these specific areas helps differentiate them. This distinction is crucial for Datan Shanghan (Big Head Plague). The *Neijing* states: "Heart Heat reddens the face first; Spleen Heat reddens the nose first; Liver Heat reddens the left cheek first; Lung Heat reddens the right cheek first; Kidney Heat reddens the chin first." Red mixed with Green or Yellow follows generation and is auspicious; Red mixed with Black follows overcoming and is inauspicious. Red Qi at Yintang (between eyebrows) or Zhuntou (nose tip) that is withered indicates death, while bright indicates life. Lung disease presenting with Red Qi is difficult to treat.

Yellow belongs to Earth, governs Dampness, and is the color of the Foot Taiyin Spleen Channel. Yellow bright like an orange indicates Heat; yellow dark like smoked yellow indicates Dampness. Yellow mixed with White or Red follows generation and is auspicious; Yellow mixed with Green follows overcoming and is inauspicious. Yellow Qi at Zhuntou, Nianshou, or Yintang that is bright and moist indicates disease resolution and good omens; dry and withered indicates death. Jaundice (eye yellowing) can also be a sign of impending recovery. In late summer, Yellow-White is auspicious, while Yellow-Green is inauspicious.

White belongs to Metal of the Lungs, governs deficiency of Qi and Blood, and is the color of the Hand Taiyin Lung Channel. Liver disease presenting with White is difficult to treat. Whiteness at Nianshou or Yintang that is withered is inauspicious; bright and moist is auspicious. White mixed with Black or Yellow follows generation and is auspicious; White mixed with Red follows overcoming and is inauspicious. A pale, spiritless white face in Shanghan results from excessive sweating or blood loss.

Black belongs to Water, governs Cold and Pain, and is the color of the Foot Shaoyin Kidney Channel. (This reflects blood stasis and decay due to Cold.) Black mixed with White or Green follows generation and is auspicious; Black mixed with Yellow follows overcoming and is inauspicious. Black Qi at Zhuntou, Nianshou, or Yintang that is withered indicates death; black with brightness indicates life. Black Qi extending from the eye corners (Yuwai) into the Taiyin region indicates death. Black Qi entering the mouth from the Faleng lines or Renzhong indicates death. Black Qi at the ears, eyes, mouth, or nose that is withered indicates death. Brightness at the face, Zhuntou, or Minggong indicates life; dullness and darkness indicate death. Black Qi on the forehead in Heart disease indicates death. Hua Tuo stated: "Complexion matching the condition is auspicious; mismatching is inauspicious." He also said: "If voice, color, or temperament deviates from normal, death ensues." These are general principles. (Above from *Yizong Bidu*.)

Green mixed with Black often indicates Cold and Pain; Green mixed with White indicates Deficient Wind. Jueyin Heat Jue (Blood Heat with stagnation and Qi obstruction) may present with cyanotic lips, face, and nails with a Hidden pulse, but careful examination reveals a pulse that is forceful when pressed to the bone. (The following five points are from Zhang Shiwang; those already in *Yizong Bidu* are omitted to avoid redundancy.)

A Red face generally indicates Heat, but differs in exterior/interior and deficiency/excess. Taiyang syndrome with headache, fever, wheezing, and Red face is an Exterior pattern. Yangming Fu-organ excess with profuse sweating and Red face is an Interior pattern. Yin Excess repelling Yang, and Jia Yin Shanghan, presenting with fever, headache, Red face, cold feet, Deep-Slow pulse, or Floating-Rapid weak pulse that disperses upon pressure (or Floating-strong forceful but Wiry-Slow upon pressure, or scattered rapid pulses with small amplitude), indicates Floating Yang rising. Treatment requires heavy acrid-warm medicines with sinking agents, administered in large doses rapidly to direct medicinal power to the Lower Jiao, slightly assisting with clearing the Upper Jiao to integrate floating Yang internally. In complicated Shanghan due to excessive sweating/purgation, depletion of Yuan Qi, and loss of slight Yang, a Red face with Dai Yang (floating Yang) occurs. Treatment requires warming, consolidating, and astringing, along with moistening, avoiding acrid-pungent herbs. Warming and tonifying the Lower Yuan is appropriate.
Note: Yin Excess repelling Yang and Yin Deficiency with Yang hyperactivity are distinct paths. Predecessors often conflated them under Yin disease, indiscriminately applying warming-tonifying methods, harming many patients.

A Yellow face governs Dampness; bright Yellow combines with Heat, dark Yellow combines with Cold, Yellow with Red indicates recovery, and pale Yellow with crab-claw patterns indicates parasite accumulation.
Yellow with floating luster indicates internal injury with blood stasis; Yellow-Black and rough indicates food retention. Yellow-Green-Black indicates extreme Spleen/Stomach decline, where Wood overcomes Earth without restraint. (This is long-term blood decay. Yellow is the color of combined blood and water. Depth distinguishes blood density; brightness/darkness distinguishes blood vitality.)

White governs Qi deficiency. (Same as *Yizong Bidu*, not repeated here.)

Black governs Kidney decline. A bluish-black hue in Shanghan indicates Yin Cold. Scorched black in chronic illness indicates Kidney Heat. Black at Shenting (GV24) the size of a finger, appearing at the positive Yang position, is a sign of sudden death. A grim, dull face indicates Shanghan; a bright, non-grim face indicates wind-cold injury. A brocade-like pattern indicates Yang Toxin. An oily, greasy face with wheezing and sweating indicates Foot Yangming Summerheat. A dusty, greasy face with shivering piloerection indicates Hand Shaoyin Summerheat. (Above Zhang Shiwang.)

Green governs fright; faded Green indicates fear and shock. Green with Red indicates Liver Fire; murky Green-Red indicates Stagnant Fire. (The following five points are from *Mairu*. Those in previous sections are omitted.)

Red governs Heat. A face reddened like mild intoxication, or shallow red on the cheeks, shifting and unstable, indicates Yin syndrome with Dai Yang (floating Yang). It must present with diarrhea of undigested food, clear or pale yellow urine, Deep-Slow pulse, or Floating-Rapid weak pulse dispersing on pressure. Despite irritability, fever, thirst, and desire to drink, the patient does not wish to swallow. Though the body feels very hot, it is not hot to touch, and the feet are necessarily cold. Another presentation involves Red face, irritability, sores/spines on the tongue shrinking like a lychee, profuse phlegm-saliva, wheezing, frequent urination, dry mouth craving water, cracked lips, sensation of smoke/fire rising in the throat, burning soles, Surging-Rapid pulse without order but forceful on pressure, and a scorching body. This is caused by Kidney deficiency failing to anchor Fire, making it the most difficult syndrome to differentiate. Since it arises from internal injury and develops gradually, it is like dry firewood burning itself. If Red face, Red eye vessels, body heat with cold feet, head heat with tremors, sudden jaw locking, and opisthotonos occur, it is Jing Syndrome (Spasm), caused by Cold-Damp-Wind damaging tendons internally, or Heat drying and tightening tendons in Heat diseases.

Yellow belongs to the Spleen, governing Damp-Heat and Food Retention. Dry Yellow indicates Fire in the Stomach; pale Yellow indicates deficient Stomach Qi. (Jaundice with short/scanty urine is Dan; jaundice with free urination and hard/painful lower abdomen is blood stasis jaundice, requiring purgation of stasis.)

White belongs to the Lungs, governing Qi-Blood deficiency and Cold. Even if deficient Fire exists, true Heat is impossible. White with Green indicates Cold coagulation of Qi and Blood; White with fatness indicates Phlegm; White with emaciation and bright red nails indicates Qi deficiency with Fire.

Black belongs to the Kidneys, governing Cold and Pain. Blue-Black indicates Yin Cold; scorched black with brittle teeth indicates Kidney Heat. All blue-black and gloomy appearances, regardless of new or old disease, indicate failure of Yang Qi to flourish.