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In the treatment of Shanghan (Cold Damage), one must first differentiate between Yang syndromes and Yin syndromes. If pathogenic factors fail to resolve in the Three-Yang meridians and transmit into the Three-Yin meridians, cold stagnation transforms into heat, thereby forming a Yang syndrome. Generally, at the onset, symptoms such as fever (Fever), headache (Headache), floating and tight pulse (Floating-Tight Pulse), and anhidrosis (Absence of sweating) are present. As the pathogen gradually penetrates deeper, it enters the Yin meridians. Since the pathogen originates from the Yang aspect, the deeper it goes, the more intense the heat becomes; thus, even when located in the Yin meridians, it is still classified as a Yang syndrome. The pulse will necessarily be deep, solid, and forceful (Deep-Solid-Forceful Pulse), and the symptoms will feature intense irritability and high fever (Irritability and High Fever). In such cases, one should attack the interior, employing either resolution or purgation methods as appropriate. How can it be called a Yang syndrome if there is no internal heat?

If, however, the onset lacks symptoms such as fever and headache, does not originate from transmission via Yang meridians, but directly invades the Yin aspect, the symptoms may include cold extremities (Cold Extremities), vomiting (Vomiting), abdominal pain with diarrhea (Abdominal Pain and Diarrhea), aversion to cold without thirst (Aversion to Cold and No Thirst), or a deep, weak, and powerless pulse (Deep-Weak-Powerless Pulse). These all indicate insufficiency of Primordial Yang and Yuan Qi (Primordial Energy), constituting true Yin syndromes. The Classic states: "Fever with aversion to cold arises from Yang; absence of fever with aversion to cold arises from Yin." This differentiates Yin and Yang based on whether transmission has occurred. Regarding the treatment of Yin and Yang syndromes, one must further distinguish deficiency and excess as follows:

First, in treating Shanghan, Yang syndromes generally require cooling and purging methods, while Yin syndromes require tonifying and warming methods; this is the general principle. However, discussing Yin and Yang in terms of meridians and zang-fu organs, Yin meridians can contain Yang syndromes, which are heat pathogens transmitted through meridians. Discussing Yin and Yang in terms of pulses and symptoms, Yang syndromes often contain Yin elements, which are deficient pathogens resembling Yang. It is easier to identify Yang within Yin than to discern Yin within Yang. For instance, symptoms such as fever, mania/restlessness (Mania and Restlessness), thirst, vexation (Vexation), preference for cold drinks, excessive water intake, hard stools, red urine, sore throat, mouth ulcers, coarse voice, rapid breathing, and a slippery, solid, and forceful pulse constitute true Yang syndromes. Conversely, if the body is hot but the pulse is weak and powerless, although the external signs resemble Yang, it is actually not a Yang syndrome.

Observing Tao Jie'an (Tao Hua): "Whenever there is fever, flushed face, restlessness, removal of clothes and blankets, cracked red lips and mouth, confused speech disregarding kinship, false mania, and false macules, along with a large pulse, people often fail to recognize them, mistaking them for Yang syndromes. They do not realize that Yin syndromes, regardless of presence or absence of heat, must be treated based on the pulse, which is most appropriate. Regardless of whether the pulse is floating or deep, large or small, if it feels powerless under the fingers and completely empty upon heavy pressure, it is a Yin pulse. Do not administer cooling medicines; doing so will surely cause death. Immediately administer Wuji San (Five Accumulations Powder) to resolve exterior and interior cold. In severe cases, add Shengjiang (Dried Ginger) and Fuzi (Prepared Aconite Root) to warm." He also stated: "When disease transmits from Yang to the Three-Yin, the pulse is always deep. The subtlety lies in distinguishing strength versus weakness under the fingers: strong indicates Yang, excess, and heat; weak indicates Yin, deficiency, and cold. This is Tao Jie'an's profound insight." However, in my view, most conditions that resemble Yang but are not true Yang—such as external heat, restlessness, slight thirst, and floating Yang (Floating Yang)—are not all Yin syndromes. One must observe if Primordial Yang is insufficient and Qi is deficient in the center. Even if there is external heat, it is false heat. If cooling and consuming medicines are used, the Middle Qi (Middle Qi) will deteriorate further. Once Middle Qi fails, pathogenic factors become stronger, and survival is unlikely. Therefore, when encountering such conditions, one must address the most urgent priority. People know the urgency lies in treating the disease, but fail to realize the greater urgency lies in preserving life. If Yuan Qi suddenly departs, the change is swift as a snapping string; breath changes occur, and rescue becomes impossible. Specific treatment examples are listed in the subsequent volume.

Second, the outline of Shanghan prioritizes Yin and Yang above all else. Errors here inevitably lead to death. There are pure Yang syndromes and pure Yin syndromes, which require definitive differentiation and separate treatment. There are also mixed Yin-Yang syndromes, where cold therapy reveals Yin dominance, or heat therapy reveals Yang dominance. Sometimes, a Yin syndrome appears today and a Yang syndrome tomorrow, or vice versa. Such cases are most common among ordinary people and are rigid like fixed beads on a string; only the wise can distinguish them. However, transformation from Yin to Yang is mostly auspicious, while transformation from Yang to Yin is mostly ominous, which requires careful observation.

Patients who keep their eyes open, prefer brightness, desire to see people, and speak much belong to Yang syndromes. Patients who keep their eyes closed, prefer darkness, do not wish to see people, and speak little belong to Yin syndromes.

The Treatise states: "When Yang is excess and Yin is deficiency, sweating causes death, purging leads to recovery. When Yang is deficiency and Yin is excess, sweating leads to recovery, purging causes death." It also states: "If Guizhi Tang (Cinnamon Twig Decoction) is swallowed, Yang excess leads to demise; if Chengqi Tang (Stomach-Clearing Decoction) enters the stomach, Yin excess leads to death." Note: Here, Yin and Yang refer to cold and heat. "Yang excess and Yin deficiency" means internal heat is surplus while external cold is mild. Pathogens must enter the Fu organs to generate heat; heat solidifies internally, constituting Yang excess. Thus, using warm herbs to induce sweating causes death. "Yang deficiency and Yin excess" means cold pathogens are surplus while accumulated heat is shallow. Pathogens strike the exterior due to wind-cold; cold binds externally, constituting Yin excess. Thus, recklessly using cold-purgative herbs causes death. Therefore, using Guizhi Tang in Yang excess leads to death, and using Chengqi Tang in Yin excess leads to death.