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Or there may be delirium. Vomiting, with chills and fever occurring at irregular intervals. If the pulse is small and tight, treat with Da Chai Hu Tang (Major Bupleurum Decoction) to purge.

Phlegm-pattern Cold Damage resembles this: In Cold Damage with phlegm, the head and neck feel relaxed and smooth, there is external heat with aversion to cold, the cun position is floating, there is headache, the right hand pulse is rapid, the body does not ache, but the left hand side aches. Ren Ying (Left Guan) governs external wind-cold invasion; Qi Kou (Right Guan) governs internal dietary injury. Hence the distinction between left and right hands. If there is fullness and stuffiness in the Zhong Wan region, vomiting with fever, treat with Er Chen Tang (Two-Cured Decoction) added with Sheng Jiang (Fresh Ginger) and Wu Mei (Mume Fruit). If cold is predominant with slight heat, treat with Zhi Zhong Tang (Regulate the Middle Decoction) or Wu Ji San (Five Accumulations Powder). If there is abdominal fullness and pain, treat with Da Chai Hu Tang (Major Bupleurum Decoction) to purge. If there is chest and diaphragm excess leading to vomiting, indicating food retention in the upper jiao, induce vomiting with Gua Di San (Melon Seed Powder).

Symptoms of Cold Damage complicated by food retention: According to *Bing Yuan* (Source of Diseases), after purgation, if there is no bowel movement for six or seven days, accompanied by irritability, heat, abdominal fullness, and pain, this indicates dry feces in the stomach, also caused by retained old food.

Deficient irritability and Hong Jiao (Foot Qi / Beriberi): Deficient irritability from Cold Damage presents with no pain in the body or head, and a naturally peaceful pulse. It often involves heat obstruction leading to muscle cramps, aversion to food odor, and difficulty in defecation. Foot Qi presents with soreness and weakness in the legs. Initially, the legs and feet are weak, stiff, and numb, with joint spasms and soreness, or stubborn red swelling in the joints, thighs, and calves, which differs from Cold Damage. When Cold Damage transmits to the six foot meridians: in Tai Yang, there is headache and stiff neck, with soreness and heaviness in the lower back; in Yang Ming, there is dry mouth and nose, aversion to heat, and delirium; in Shao Yang, there is deafness, bitter taste, and hypochondriac pain; in Tai Yin, there is chest and abdominal fullness and stuffiness, with limb edema; in Shao Yin, there is cough, asthma, dark complexion, and sore throat; in Jue Yin, there is flaccidity and tendon contraction, with distending pain in the genitalia. Among the transmission of the six meridians, there are also He Bing (Combined Disease) and Bing Bing (Concurrent Disease). The external signs of Foot Qi are the same as those of Cold Damage. Whenever there is fever, restlessness, constipation, vomiting, retching, phlegm, and aversion to food, it arises from Heat; Heat is cured by purging, so careful inquiry is necessary. If the pulse is floating and wiry, it arises from Wind, and is cured by sweating. If the pulse is soggy and weak, it arises from Dampness, and is cured by promoting urination. If the pulse is surging and rapid, it arises from Heat, and is cured by purging. If the pulse is slow and choppy, it arises from Cold, and is cured by warming. The symptoms of Wind, Cold, Summer-heat, and Dampness differ: Wind causes wandering pain, Cold causes pain, Summer-heat causes heat and restlessness, and Dampness causes heaviness and sticking. There must be verifiable signs. The treatment principle emphasizes dredging and unblocking, but one must not overdose. Using tonic decoctions for washing is a major taboo for physicians. Nevertheless, as Foot Qi gradually deepens, continuous medicinal effort is required. Treatment must investigate the source: if triggered by wind-cold, resolve wind-cold; if caused by diet, digest food; if triggered by qi stagnation, regulate qi; if secondary to other diseases, treat the primary disease. Patients die from excess qi conditions, rarely from becoming deficient due to medication. Even with severe symptoms like wheezing, cough, qi rushing to the heart causing pain, vomiting, abdominal and hypochondriac distension, and stubborn numbness, these are dire prognoses. However, the principles remain: warm the cold, cool the heat, disperse the exterior, purge the interior, and support the severely deficient. These are immutable laws.

When pathogenic factors from Cold Damage transmit to Jue Yin, the pulse is slightly floating and relaxed, indicating that Spleen Qi is recovering and pathogens have no place to reside. Chills and fever occur, and sweating leads to resolution.

Exterior patterns of Cold Damage should be treated by sweating, not purging; Interior patterns should be purged, not sweated; Half-exterior, half-interior patterns should be harmonized, not sweated, vomited, or purged.

The transmission through the six meridians: Tai Yin, Shao Yin, and Jue Yin all belong to Yin patterns. Shao Yin corresponds to the Kidney; Jue Yin to the Liver; Tai Yin to the Spleen.

When humans contract Cold Damage, it becomes a Heat Disease, generally called Cold Damage by ancients. In the first three days, Ju Yang (Tai Yang), Yang Ming, and Shao Yang are affected. Heat is in the exterior, so sweat it out.

Cold Damage differs from Wind Strike. Disordered speech is Delirium (Zhen Yu), an excess condition; monotonous repetition of words is Zheng Sheng, a deficiency condition.

There are four types of adverse changes: it may transform into Damp Malaria, Wind-Warmth, Damp-Toxin, or Warm Epidemic. Sweating without stopping is called Lou Feng (Leaking Wind), another name for Wang Yang (Loss of Yang). Severe purgation damaging Yin blood is also called Wang Yang. Also, in Tai Yang disease, if Guizhi Tang pattern is mistakenly given Mahuang Tang, excessive sweating occurs, commonly called Tian Xing (Heavenly Travel/Epidemic). In Shi Wen (Damp-Warmth), sweating worsens the condition daily; worsening leads to death. In Wen Bing (Warm Disease), fever recurs after sweating, with a rapid, restless pulse unrelieved by sweat, delirium, and inability to eat, called Yin Yang Jiao (Yin-Yang Intersection); this is fatal. *Ping Re Lun* states: Fever, restless pulse, delirium, and inability to eat constitute "Three Deaths." Fever with rapid pulse and no sweat is Yang Ji (Extreme Yang); fatal. If sweat occurs but the pulse remains rapid, also fatal. Generally, post-sweat rapid pulse indicates death. Fever recurring after recovery is Yi Re (Lingering Heat). Relapse due to exertion after recovery is Lao Fu (Labor Recurrence). Relapse due to eating meat after recovery is Shi Fu (Food Recurrence). Floating, slow, or weak pulse with inability to sweat and itchy skin is Wu Yang (No Yang). Confused eyes and lack of spirit, with simultaneous vomiting and diarrhea, is Huo Luan (Cholera-like disorder). Nosebleed is Xu.

Guan pulse small, fine, deep, and tight, with a white slippery coating on the tongue, is Zang Jie (Organ Knotting); fatal and untreatable. Sores on the upper lip with worms eating the throat or organs is Huo (Confusion). Sores on the lower lip with worms eating the anus or genitals is Hu (Fox). Coughing and reverse flow of qi is Yue (Hiccups). Dry retching is Gan Ou. Pulses overcoming each other are Fu (Negative); Fu indicates death.

In combined disease of Yang Ming and Shao Yang, if the pulse is merely large and long, it indicates Stomach Qi and is favorable. If the pulse contains a wiry quality, it indicates Wood overacting on Earth, hence "Fu," leading to death.

For unfavorable conditions in Cold Damage, use methods to promote permeation and drainage. Scanty urination is permeation-drainage. Generally, frequent urination leads to difficult defecation. Urine is Sou. Loose stools in people indicate Cold-Damp. Cold, duck-dung-like loose stools indicate failure to separate clear and turbid. Hard stool indicates Heat-hardness. Cold causes loose stools; Heat causes foul stools. Intestinal Heat with diarrhea is Chang Gou (Intestinal Filth). Thirst with immediate vomiting upon drinking water is Shui Ni (Water Counterflow). Jaundice is Dan. *Nei Jing* says Dan is Heat; *Huo Ren Shu* equates Yellow with Dan. Southern summer dampness and heat cause Jaundice. Dan and Dan are synonymous, caused by Heat leading to yellow bile disease. Heart palpitations with chills are Ji. Jue Yin pattern mentions Jue Ni Zheng Zhong due to Water; treat Water. Foot Qi with lower abdominal numbness and palpitations; Shao Yang with vomiting, fever, chest/hypochondriac fullness, and dysuria; palpitations feeling like loss are Ao Nao (Regret/Restlessness). Mistaken purgation when sweating was indicated leads to Pi (Glomus) or Jie Xiong (Chest Binding) or Ao Nao. Mistaken sweating when purgation was indicated leads to Wang Yang, Delirium, Xia Jue Shang Jie (Lower Cold, Upper Exhaustion). Forcing sweat in Shao Yin moves blood, causing bleeding from anus, nose, ears, or eyes, called Xia Jue Shang Jie. "Mu zhong liao liao bu" means unclear vision, or Jing Bu He (Eyes not harmonious). Mouth and lower abdomen numbness refers to Skin Bu Ren (Skin insensitivity), meaning stubborn numbness. Body tremors are Rou Dun (Muscle Twitching). Pulsation below the umbilicus is Ben Tun (Running Piglet). Upper pathology uses Vomiting; lower pathology uses Purging. Left Guan is Ren Ying; Right Guan is Qi Kou. Pulse on dorsum of foot is Chong Yang; pulse above medial malleolus is Tai Xi. Below breast, near abdomen is Qi Men. One cun below umbilicus is Qi Hai; *Qian Jin Fang* says 1.5 cun from heart center. Two cun is Dan Tian; three cun is Guan Yuan. Blood is Ying; Qi is Wei. Xuan Fu is Sweat Pore. *Su Wen* notes labor sweat exposed to wind; commentary says Xuan Fu is sweat pore. Hand-foot convulsions are Chong Zhu. Two Yang meridans diseased simultaneously is He Bing. Sequential involvement of Yang meridians is Bing Bing. Simultaneous Yin-Yang involvement is Liang Gan. Limb disease is Mo Ji. Wind causes limbs to collapse.

Critical Cold Damage syndromes: Head shaking and fixed gaze, body like smoke-stained, indicates Heart Extinction. Lips turning blue, excessive sweating on limbs, indicates Liver Extinction. Fixed gaze, delirium, incontinence...

Diarrhea with aversion to cold and curling up, restlessness, and absence of pulse is untreatable. Diarrhea >10 times/day with excess pulse is adverse. Combined Shao Yang/Yang Ming diarrhea with large-long-wiry pulse is Fu (Negative), untreatable. Yang disease with Yin pulse is untreatable. Macules (Yang) with Yin pulse is untreatable. Dai (Intermittent) pulse is untreatable. Hematemesis/epistaxis with floating-large-firm pulse is untreatable. Yi (Transmission) with pulse leaving its channel, testicular swelling, colic, clenched hands/feet is untreatable. Cough/reverse qi with stopped pulse is untreatable. Delirium with deep-micro pulse and cold limbs is untreatable. Yin-Yang deficiency with persistent fever is untreatable. High fever after 7-8 days is difficult to treat. Tongue ulceration with fever, incessant sweat, or persistent cold limbs is untreatable. Diarrhea with fever, cold limbs, restlessness, insomnia is untreatable. Delirium, fixed gaze, asthma/fullness, or diarrhea is untreatable. Delirium (Yang) with Yin signs is adverse. Erratic pulse is untreatable. Macules turning dark, sallow face is untreatable. Macules with spontaneous diarrhea is untreatable. Yellow turning black is untreatable. Dry black tongue is untreatable. Sunken eyes is untreatable. Open mouth breathing, dry retching, bone pain is adverse. Incessant hiccups is untreatable. Epigastric fullness with coarse asthma is adverse. Cholera with asthma/distension/restlessness is untreatable. Mistaken purgation in Damp patient with forehead sweat, asthma, or dysuria/spontaneous diarrhea is untreatable. Forehead sweat with exterior-interior blockage and dysuria indicates Yang Collapse, untreatable. Abdominal fullness with hiccups and inability to urinate is untreatable. Massive abdominal fullness without evacuation is untreatable. Surging-tight-slippery pulse is particularly concerning. Zang Jie like Jie Xiong, white tongue coating, painful abdomen pulled by genitals, intermittent diarrhea is untreatable. Jie Xiong with added restlessness is untreatable. Zang Jue (Cold Jue) for 7-8 days, cold skin, restlessness, diarrhea, temporary relief is untreatable. Shao Yin vomiting/diarrhea, cold limbs, restlessness is untreatable. Cold limbs with diarrhea but ability to eat is Chu Zhong (Eliminated Middle), untreatable. Cold limbs, severe umbilical colic, fixed eyes is adverse. Jue Yin blue lips, curled tongue, black face, deafness, retracted testes is untreatable. Severe head/chest pain with cold limbs is untreatable. Yin/Yang Toxin after 6-7 days is untreatable. Hu Huo with dry throat, hoarseness, lip sores is untreatable. Red macules save 1 in 5; black macules save 1 in 10. Grasping at empty air is adverse.

General Theory: Sweat, purge, and vomit methods in Cold Damage must not rely lightly on pulse verification; question symptoms then check pulse. Tai Yang is the exterior of Yang patterns... Interior patterns... Contains Chai Hu... Purge... No... Yin... Sweat. Thus, days cannot be rigidly bound. Sun Simiao said: After Cheng Qi Tang produces stool, do not tonify, as heat will rebound with tonification; this refers to Excess Heat. Wang Shuhe said: Deficient Heat must not be cleared, or Cold will arise; this refers to Deficient Heat. Both sayings converge; thus, Excess and Deficiency must be distinguished. Cold, Heat, Warmth share reality but differ in name; Summer-heat, Dampness, Wind differ in type but can combine. Pathogens interact, other evils arise. Exterior has non-sweatable cases; Interior has non-purgable cases. Three Yin can be warmed/purged, but Heat patterns differ. Exterior-Interior simultaneous presentation differs from Half-Exterior. Summer-Heat/Warmth are hard to distinguish. Cold Damage/Wind Strike pulses/symptoms intermix. Yang Ming usually sweats, but may not; Shao Yin usually doesn't sweat, but may. Extreme Yin causes dryness; Extreme Heat causes cold limbs. Yang looks like Yin; Yin looks like Yang. A slight error leads to huge mistakes. Phlegm, Food Retention, Deficient Irritability, Foot Qi resemble Cold Damage. Without intuitive understanding and adaptability, how can one handle complexities? Confucius said: "One may discuss the Way, but not yet establish it; one may establish it, but not yet weigh circumstances." This applies here; it depends on human discretion.

Wei's *De Xiao Fang*, *Shang Han Cuo Yao Lun*: Sweating should cover hands and feet evenly for about an hour; profuse sweating is undesirable... Use vomiting as the limit. If little vomited and disease persists, repeat tomorrow. Weak patients should vomit less; if medicine is too strong, drink water to relieve. Water compress method: Fold cloth several times, soak in fresh water, wring slightly, place on chest. When hot, re-soak in cold water. Repeat many times daily. For high fever, immerse patient in water until fever subsides. Green Onion Moxibustion: Bundle green onions, tie like a cake, remove roots, keep 3 cun white part. Heat one side gently, place on patient's lower abdomen, iron over it to penetrate heat. Use 3-4 cakes until patient wakes, limbs warm, and sweat appears. Steaming method: Burn ground, sprinkle water, spread silkworm sand, cypress leaves, peach leaves, bran. Lay straw mat, patient lies on top, cover warmly. In summer, use single cloth. Sweat arrives quickly. When soles sweat, apply warm powder, move to bed. Silkworm sand, cypress, and peach leaves are most effective. Silkworm sand alone is acceptable.