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In general, the treatment of Shanghan (Cold Damage) follows the principle that pathogenic factors in the exterior should be dispersed, while those in the interior should be purged. This is a major guideline. However, the critical factor determining life and death in Shanghan lies entirely in the concepts of Deficiency (Xu) and Excess (Shi). Wherever pathogenic factors gather, the body's Qi must be deficient; thus, complications from Shanghan often arise when pathogens take advantage of such deficiency to invade. Contemporary physicians, failing to examine the balance of Deficiency and Excess, merely upon observing Shanghan, frequently assert that "Shanghan has no place for tonification," and arbitrarily employ methods to attack the pathogen. They fail to realize that cases cured by purging were originally not Deficient patterns; since the Righteous Qi was not deficient, the Pathogenic Factor could not harm it. When the disease course concludes and Qi recovers, the illness naturally subsides. Therefore, whether treated or not, recovery occurs; this demonstrates that the Pathogenic Factor itself is not formidable. It is only in cases of Shanghan complicated by Deficiency that one should be most apprehensive. If one does not adopt strategies to consolidate the Root and resist invasion, but instead recklessly attacks the pathogen with solitary measures, any dispersing or purgative agents will first enter the Stomach before reaching the meridians. Before the pathogen can affect the target, the Stomach Qi will already be damaged. Even if total collapse does not occur, will there not be further deficiency? As Yuan Qi becomes more deficient, the pathogen will penetrate deeper. Attacking again in a state of deficiency—what else can be expected but death? Hence, all deaths from Shanghan are inevitably due to the prior failure of Yuan Qi. This is a universal malpractice.

Therefore, in clinical practice, whenever one observes weak and spiritless pulses, deafness, trembling hands, mental fatigue, timidity of Qi, aversion to cold with a preference for dim environments, faint speech, and bluish-white complexion—all signs indicating insufficiency—one must prioritize protecting Yuan Qi. If the constitution is inherently deficient and one over-disperses the exterior, Yang collapse will ensue; if the Zang-Fu Qi is inherently deficient and one mistakenly purges the interior, Yin collapse will result. Those who commit these errors will surely die. For instance, if Yuan Qi is half-deficient while the pathogen is vigorous, one must weigh the severity and combine tonification with dispersion to achieve appropriateness. If Yuan Qi is severely deficient, even if the pathogen is vigorous, it must not be attacked; instead, one must carefully distinguish Yin and Yang and vigorously tonify Middle Qi. For example, if a person occasionally contracts Yin-Cold while generally healthy, and the pathogen has not penetrated deeply, presenting only with fever and body ache, a rapid but non-voluminous pulse, no internal heat signs, and an inherent constitutional weakness, one should use Liyin Decoction (Nourish Yin Decoction) added with Chai Hu (Bupleuri Radix), or added with Ma Huang (Ephedrae Herba), administered continuously for one or two doses. The effect is miraculous; this is the primary commonly used formula.

For other conditions: if the deficiency is in the Yang aspect, formulas such as Si Chai Hu Yin (Four Bupleuri Drink), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Bazhen Tang (Eight Treasure Decoction), Lizhong Tang (Regulate the Middle Decoction), or Wenwei Yin (Warm the Stomach Drink) should be employed. This represents the treatment of warming the middle to facilitate spontaneous dispersion. If the deficiency is in the Yin aspect, characterized by depletion of fluids and water insufficiency preventing sweating, one should use Buyin Yiqi Jian (Tonify Yin and Augment Qi Infusion), San Chai Hu Yin (Three Bupleuri Drink), Sanyin Jian (Three Yin Infusion), or Zuogui Yin (Left Restoring Drink). This embodies the treatment of strengthening Water to control Yang, transforming Essence into Qi. In cases of Yin Excess repelling Yang, presenting as True Cold and False Heat, one should use Dabu Yuan Jian (Great Tonification of the Origin Infusion), Yougui Yin (Right Restoring Drink), or the ingredients of Cui Shi Bawei Wan (Cui’s Eight-Ingredient Pill). This constitutes the treatment of guiding Fire back to its source.

Regarding patterns of Yin Excess and Yang Decline, where the body may feel hot but aversion to cold persists, accompanied by nausea/vomiting, diarrhea, a back feeling cold as ice, or cold extremities, these indicate extreme Yang deficiency. One must unhesitatingly use Dawenzhong Yin (Great Warming of the Middle Drink) or Liyin Jian (Nourish Yin Infusion). If, however, the pathogenic heat is intense and fluids are dried up, cool water may be used gradually to resolve the heat. If the exterior pathogen remains unresolved while the interior is closed and stagnant, mild resolving methods may be combined to gradually dispel the cold. If the pathogen is Excessive while the Righteous Qi is Deficient, creating a situation where the host cannot overpower the guest, if one can secure the Root and prevent rupture, the pathogen will resolve without battle. There is profound subtlety in this approach. Over fifty years, I have saved numerous lives using these principles. I record this cautiously as a standard for universal benefit.