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This syndrome is caused by the external invasion of cold pathogenic factors. In severe cases, sudden fainting occurs; these all belong to the category of Shaoyin (Lesser Yin) directly struck by cold. Regarding the transmission and transformation of the disease, it cannot deviate from the principles of Shanghan (Cold Damage); therefore, what is presented here specifically covers only the initial stage of cold invasion.

*Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Symptoms of All Diseases) records: When a person is traveling and encounters biting winds, bitter rains, heavy frost, or snow, causing their clothes to become wet and soaked, cold qi enters the zang organs. This leads to the closure of yin qi internally and the severance of yang qi externally. Ying (Nutritive) and Wei (Defensive) qi become knotted and stagnant, ceasing to circulate freely, resulting in trismus (lockjaw), cessation of breath, and death. If treated early, when blood becomes warm and qi flows smoothly, life can be preserved. It is also stated that someone who has frozen to death can still be treated within one day; beyond this time, treatment is ineffective.

Cold is a lethal energy of heaven and earth. In heaven, it manifests as cold; on earth, as water; in the human body, it corresponds to the Kidney. Therefore, cold tends to injure the Kidney. When cold injures the Kidney, it often causes spasms, pain, coma, and unconsciousness. If accompanied by wind, dizziness occurs; if accompanied by dampness, swelling and pain result. Treatment should exclusively use warming agents; emetics and purgatives are contraindicated, as they constitute contrary treatments. Although cold naturally tends to affect the Kidney, all five zang organs can be injured by it. If cold invades the exterior of the meridians, it is easily dispersed; if it enters the interior, it is difficult to eliminate. Its pulse and symptoms are no different from Shanghan, differing only in severity. (*San Yin Fang*)

*Suwen* (Basic Questions) states: The three months of winter are called "closing and storing." Water freezes, and the ground cracks. One should not disturb yang qi, sleep early, rise late, and wait for sunlight. This expresses the intention of avoiding cold and seeking warmth. If one fails to regulate lifestyle properly and is exposed to cold, sudden dizziness, trismus with loss of voice, and rigid limbs may occur. (Note: *Yaojue* states: rigid body, trembling limbs.) There may be aversion to cold with shivering, or slight fever, flushed face, and profuse sweating. (*Yaojue* states: no sweat on the body. *Shen Shi Zun Sheng Shu* states: this syndrome definitely presents without sweat; if there is sweat, it is untreatable.) Generally, in Zhonghan (Strike Cold), the pulse must be slow and tight. If accompanied by wind, the pulse is floating, with dizziness and numbness. If accompanied by dampness, the pulse is soggy, with swelling, fullness, and pain. (*Jisheng Fang*)

Zhonghan refers to cold as a lethal energy of heaven and earth. When humans are affected, the disease progresses rapidly and dangerously. Sudden exposure to pathogens can cause abrupt cessation of life. This is due to extreme deficiency of Stomach qi combined with exposure to severe cold. Deficiency of Stomach qi prevents Lung metal from flourishing, causing the qi of skin and hair to fail first. Weak qi means the exterior lacks protection, allowing cold pathogens to enter easily. This suppresses and severs the body's yang qi, preventing its circulation, leading to cold extremities, rigidity, and immobility. Thus, there is trismus, staring eyes, and blue-white complexion, or spontaneous sweating leading to exterior collapse, or diarrhea leading to interior collapse. With both interior and exterior deficiency and overwhelming cold, any delay in treatment results in a scattered pulse and death. (*Qixiao Liangfang*)

Initial headache, body heat, aversion to cold, and body pain indicate Shanghan; seek treatment according to Shanghan methods. If there is sudden fainting, confusion, lack of consciousness, trismus, and lockjaw, resembling Zhongfeng (Wind Stroke), but the pulse is wiry-tight or deep-thin, it is Zhonghan. (Ibid.)

Zhonghan refers to suddenly contracting cold pathogenic factors in winter, leading to coma, trismus, limb spasms, aversion to cold, shivering, abdominal pain, and a floating-tight or expansive pulse. This is because the interstices (cou li) are internally loose, so the whole body is affected. Differentiation by meridian is unnecessary; warming and tonifying will resolve it naturally. (*Zhengzhi Dahuan*)

A slippery and solid pulse with warm hands and feet indicates a favorable prognosis; a deficient and knotted pulse with cold hands and feet indicates an unfavorable prognosis. (*Yunlin Shen Gou*)

Treatment Principles: For coma, loss of consciousness, cold pain in the umbilical/abdominal region, or Huoluan (Cholera-like disorder), Jiangfu Tang (Ginger and Aconite Decoction) is suitable. If accompanied by stabbing cold pain and vomiting, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) is suitable. For deficiency-cold with absence of yang, weak stomach with dry retching, and cold extremities, Fuchen Tang (Aconite and Agarwood Decoction) is suitable. (Note: Fuchen Tang is Si Ni Tang added with Chenxiang and Baizhu.) For frail individuals commonly affected by cold, presenting with abdominal distension, fluid retention, and nausea, Wuji San (Five Accumulations Powder) is suitable. If the above symptoms present with sweating, remove Mahuang from the formula. If cold is severe, add Fuzi. (*Ruyi Fang*)

For Zhonghan, initially administer Suhexiang Wan (Styrax Pill) mixed with wine. For mild cases, administer Wuji San added with Xiangfu and a small amount of Shexiang (Musk). For severe cases, use Jiangfu Tang. (*Yaojue*)

Zhonghan involves cold pathogens directly striking the Three Yin meridians. Zhonghan is more severe than Shanghan; if not treated urgently, death may occur within a day or night. If cold strikes Taiyin, there is pain at the Zhongwan point; Lizhong Tang or Huoxiang Zhengqi Jia Wei Lizhong Tang is indicated. If cold is severe with a deep-thin pulse and cold feet, add Fuzi, named Fuzi Lizhong Tang. If cold strikes Shaoyin, there is pain in the umbilical/abdominal region; Wuji San added with Wuzhuyu is indicated. If cold is severe with a deep pulse and cold feet, Si Ni Tang added with Wuzhuyu is indicated. If cold strikes Jueyin, there is pain from the lower abdomen to the genitalia; Danggui Sini Tang added with Wuzhuyu is indicated. In severe cases, double the dose of Fuzi. If cold is extreme with blue lips, cold extremities, absent pulse, and retracted testicles, apply Congyi method (Scallion moxibustion/ironing) or stir-fried Wuzhuyu ironing method, and moxa the umbilicus, Qihai, and Guanyuan points for 20-30 moxa cones. Recovery is possible when the pulse gradually returns and hands/feet become warm. If medicine is unavailable temporarily, quickly apply cold water to the four wrists, observe the cyanotic veins, puncture them with a three-edged needle to release blood, which can also cure the condition. Alternatively, pricking the tips of the ten fingers to bleed is effective. Or, decoct a single herb of Wuzhuyu and give it to drink to save the patient. (*Shanghan Yunyao*)

For those who are constitutionally weak and contract cold from the exterior, because their interstices are loose and internal qi/blood are damaged, cold pathogens strike directly inward without generating heat, causing cold extremities. Use Mahuang Fuxi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) or Wuji San. For Zhonghan and cold extremities caused by sexual exhaustion, Si Ni Tang and Sanjian Tang are indicated, along with external application of the Warm Umbilicus method. (*Ming Yi Zhi Zhang*) (Sanjian Tang is not recorded here; Warm Umbilicus method is described later.)

For sudden fainting and coma due to Zhonghan, first灌服 (force-feed) half a cup each of hot wine and ginger juice. After slight recovery, administer Lizhong Tang. (*Shoushi Baoyuan*)

Even if Zhonghan presents with dryness, heat, irritability, and thirst, decoct Lizhong Tang and administer it cold after cooling it in water. This is the method of "treating cold with cold" (using cold administration for cold pathology). Using cold-natured herbs would lead to immediate death. (*Gujin Yi Jian*)

Treatment requires warming the blood. To warm the kidney and resist cold, herbs such as Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), Chuanwu (Sichuan Aconite), and Tianxiong (Male Aconite) are used, assisted by Yangzheng Lingsha. These are indeed essential medicines. However, since cold damages Ying qi, knowing only to warm the kidney but not the blood may not yield perfect results. Therefore, Guigui (Cinnamon Bark) and Danggui (Angelica Sinensis) are superior blood-warming herbs. Otherwise, why did ancient physicians emphasize "cold constricts blood"? (*Zhizhi Fang*)

Emergency Formulas (Detailed in *Jiuji Xuanfang*, retaining only a few here): *Zhouhou Beiji Fang* treats falling into water in winter, with limbs frozen rigid, trismus, and only faint breath. Use a large vessel, fill with hot ashes, place in a bag, and apply to the heart area. Replace when cool. Once heart warmth restores, eyes move, mouth opens. Administer warm rice water slowly. Do not apply fire to the body before warming the heart, as cold and fire will clash, causing death. (*Waitai Miyao*)

For anyone frozen in winter, immediately give one or two mouthfuls of cold water, move to a warm place. Do not give hot soup. Giving hot substances or approaching fire immediately will cause death. Walking in snow/mud and approaching fire causes toes to fall off. (*Qixiao Liangfang*)

Warming and Dispersing Formulas (Post-illness Convalescence): Fuzi Lizhong Tang treats cold striking the five zang organs, trismus, rigid limbs, aphasia. A warrior guarding the border once fainted in heavy snow while looking out from his tent. Lin Ji, the accompanying physician, administered two doses of this medicine, and he woke up.
Da Fuzi (Pao, peeled, navel removed) Renshen Ganjiang (Pao) Gancao (Zhi) Baizhu (Equal parts)
Grind into powder. Take 4 qian per dose with 1.5 cups of water, decoct to 0.7 cups, strain. Take at any time. If trismus occurs, pry open mouth and灌服. (*San Yin Fang*)

Ganjiang Fuzi Tang treats sudden fainting due to Zhonghan, vomiting saliva/froth, resembling dark wind, limb spasms, trismus, cold extremities, or subsequent dryness/heat.
Ganjiang (Pao) Fuzi (Pao, peeled, navel removed)
Grind into powder. Take 4 qian per dose with 1.5 cups of water, decoct to 0.7 cups, strain. Take before meals. (Ibid.)

Fuzi Mahuang Tang treats cold-damp strike, fainting, weakness, rigid back/waist, trismus, turbid voice, abdominal distension, asthma, immobility.
Fuzi (Pao, peeled, navel removed) Mahuang (remove joints, boil in water) Baizhu Ganjiang Gancao (Zhi) Renshen (Equal parts)
Grind into powder. Take 4 qian per dose with 1.5 cups of water, decoct to 0.7 cups, strain. Take on an empty stomach. (Ibid.)

Zengwei Zhenwu Tang treats cold striking Shaoyin, lower abdominal pain, clear watery diarrhea, yin restlessness.
Baishao (wine-fried 3 qian) Baizhu (2 qian) Fuling (2 qian) Gancao (Zhi 1 qian) Renshen (2 qian) Fuzi (2 qian)
Grind one dose, decoct in water, take warm. (*Yiyue*)

Danggui Sini Tang treats cold striking Jueyin, lower abdominal pain radiating to genitals, gradual retraction of scrotum, cold extremities, wiry-thin pulse nearly absent, body arched like a bow.
Fuzi (3 qian) Gancao (3 qian) Ganjiang (3 qian) Danggui (2 qian) Wuzhuyu (2 qian)
Grind one dose, decoct in water, take warm. Cure is achieved with slight sweating. (Ibid.)

After severe illness, if all deficiency-cold syndromes are resolved but true yuan is severely damaged, neglecting convalescence and merely administering decoctions occasionally will not preserve essence/qi and may worsen the condition upon slight recovery. Ren Shen Gu Ben Tang is suitable. (Original prescription is mild.)
Renshen Huangqi Danggui Ganjiang Baizhu Fuling Chuanwu Rougui (*Yijing Huijie*)

Ironing Method Moxibustion Method: Zhonghan Ironing Method: Use 2 sheng of Wuzhuyu, slightly boiled in wine until moist, placed in a silk bag, steamed until very hot. Iron the chest/abdomen and palms/soles. Stop when qi flows smoothly and warmth is uniform. Repeated use is effective. (*Yishu Daquan*) (Note: This originates from *Shenghui Fang* treating Yin-toxin Shanghan with cold extremities. Also, ironing methods in *Shanghan Guangyao · Shaoyin Bing* are suitable for reference.)

Warm Umbilicus Method: Use Shexiang, Banxia, and Zaojia (each 1 zi weight) ground to powder, fill the umbilicus. Place thin slices of fresh ginger on top. Apply moxa on the ginger slice for 21-30 cones. Moxa Qihai and Guanyuan for 20 cones. Heat penetrates inward, forcing cold outward; yin retreats, yang recovers. (*Ming Yi Zhi Zhang*)

Moxibustion Points: Qihai (1.5 cun below umbilicus), Shiguan (2 cun below umbilicus), Guanyuan (3 cun below umbilicus) are all suitable. (*Danxi Xinfa · Appendix*)

Moxibustion for Zhonghan Yin Syndromes: Qihai is 1.5 cun below umbilicus, Dantian is 2 cun below, Guanyuan is 3 cun below. Moxa 14 cones. Survival is indicated if hands/feet become warm, umbilicus warms, pulse returns, consciousness is restored, and sweating occurs (from no sweat). Death is indicated if there is no warmth or consciousness. (*Yunlin Shen Gou*)