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Zhonghan (Cold Strike) and Shanghan (Cold Damage) are not the same disease. Shanghan involves pathogenic factors entering from the exterior and gradually penetrating deeper, whereas Zhonghan involves pathogenic factors striking directly into the interior organs. The etiology may be external invasion by chilling cold air or internal injury caused by raw and cold food. Onset is sudden with lockjaw (trismus) and aphonia, rigid limbs, and loss of consciousness; the pulse is deep, soft, and powerless. In such cases, Jiawei Lizhong Tang (Modified Cinnamon Twig and Atractylodes Decoction) can be used. The prescription consists of Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger), Rougui (Cinnamon Bark), Fuling (Poria), Chenpi (Citrus Reticulata Peel), Gancao (Licorice Root), and Xixin (Asarum), each at half liang. Additionally, add five large slices of ginger baked in ash. Take this decoction mixed with one and a half cups of ginger juice. Furthermore, stir-fry the ginger residue until extremely hot, wrap it in silk, and apply it as a hot compress to the abdomen, which has proven effective. If aversion to cold is severe, add Mahuang (Ephedra). If Fuzi (Prepared Aconite Root) is added, remove the skin and navel, and combine with ginger and ginger juice. However, if redness of the eyes appears, it indicates Fuzi toxicity; treat with fresh radish juice, or use Xijiao (Rhinoceros Horn - *Note: Substitute with Water Buffalo Horn in modern practice*), Gancao (Licorice Root), and Huanglian (Coptis Rhizome) for emergency rescue.

For emergencies of Zhonghan where medicine is unavailable, take a bundle of scallion whites (thick as a teacup mouth), roll tightly in paper, slice into pieces one finger-thick using a sharp knife, place on the umbilicus, and administer Lizhong Tang, Zhizhong Tang, Buzhong Tang, Jiangfu Tang, Sishun Tang, or Nixi Tang. These formulas treat Zhonghan of the five zang organs manifesting as lockjaw, aphonia, and limb rigidity, all showing efficacy.

There is also Tutou Fang (Expelling Vomiting and Diarrhea Formula) for diarrhea; Buzhong Tang plus 1 qian of Fuzi treats loose stools; adding 1 qian of Sharen (Amomum Fruit) treats undigested food; removing Baizhu and adding Fuzi creates Sishun Tang, treating cholera-like syndrome, abdominal pain, and cold extremities; removing Renshen and Baizhu and adding Fuzi creates Nixi Tang, treating Taiyin and Shaoyin/Yueyin syndromes presenting with no thirst, faint pulse nearly imperceptible, and cold extremities.

Huiyang Jiuku Dan (Yang-Restoring and Pain-Relieving Pill) treats early-stage Shanghan characterized by absence of headache and fever, but intense aversion to cold, cold extremities extending past elbows and knees, abdominal pain, or lockjaw.

Wuji San (Five Accumulations Powder, Raw Material Version) treats cold pathogen invasion causing headache, body ache, stiffness, spasms, aversion to cold, vomiting, or abdominal pain. It also treats Shanghan fever with stiff neck and head pain, acting quickly. Ingredients: Chenpi 1 qian, Houpo (Magnolia Bark), Jiegeng (Platycodon Root), Zhike (Bitter Orange Fruit), Baishao (White Peony Root), Fuling (Poria), Danggui (Angelica Sinensis), Ganjiang (Dried Ginger), Mahuang (Ephedra) each 8 fen; Baizhi (Angelica Dahurica), Chuanxiong (Ligusticum Rhizome) 0.5 liang. For swollen feet, add Wujia Pi (Acanthopanax Bark) and Dafupi (Areca Peel); for wind-bi (painful obstruction), add Qianghuo (Notopterygium Rhizome), Duhuo (Angelica Pubescens), and Fangfeng (Saposhnikovia Root); for lower back pain, add Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), and Xiaohuixiang (Fennel Fruit); for limb spasms, add Binglang (Betel Nut), Mugua (Chaenomeles Fruit), and Niuxi; for cough, add Xingren (Apricot Seed), Sangbaipi (Mulberry Root Bark), and Madou Ling (Aristolochia Root); for generalized body pain, add Rushen (Frankincense), Moyao (Myrrh), and Xixin; for difficult labor, add Shexiang (Musk) and Jiaogui (Cassia Twig). This medicine is pungent and warm, opening stagnation and dispersing accumulation.

Fangtong Tongsheng San (Wind-Protecting and Unblocking Supreme Harmony Powder, see Stroke chapter) is the supreme remedy for heat-dryness syndromes.
Shengliao Wuji San (Raw Material Five Accumulations Powder) is the supreme remedy for cold-dampness syndromes.
Shunqi San (see Stroke chapter), Pingqi San (see preceding text), Binglang San (see preceding text), Tongsheng San (see preceding text).

Additional Remarks:
Danxi stated: "Most cases of Zhonghan due to internal injury account for eight or nine out of ten; one must first use Renshen (Ginseng) and Huangqi (Astragalus Root) to support and anchor the Zhengqi (Upright Qi)." Dai Shi stated: "When the body suffers chilling cold and the mouth ingests raw/cold items, urgently warm the Zhongqi (Middle Jiao Qi)."
Xingxiang San (see Sudden Stroke chapter), Siqi Tang (see Qi Stagnation chapter).
Bawei Shunqi San (Eight-Ingredient Qi-Smooth Powder): Suitable for both stroke and food stagnation; administer this first to smooth the qi before treating wind or digesting food. Ingredients: Qingpi (Green Tangerine Peel), Chenpi (Tangerine Peel, both white pith removed), Xiangbaizhi (Aromatic Angelica), Tiantai Wuyao (Tiantai Litsea Fruit) each 5 fen, decocted together with Sijunzi Tang (Four Gentlemen Decoction).