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Qin Zi said: I wrote the book *Shanghan Dabai* (Great Clarity on Cold Damage), establishing twenty-seven general discussions and seventy-two symptom treatments within it. I also provided detailed explanations of Zhang Zhongjing's original texts, gathering them under each respective symptom section; the content is detailed and exhaustive. Now that I am writing about miscellaneous diseases in large prescriptions, why add more redundancy? However, in Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), "Zhonghan" (Direct Invasion of Cold) and "Shanghan" (Cold Damage) are named in the same volume. Although it has been noted that direct invasion into the Yin meridians constitutes a Yin syndrome, and transmission into the Yin meridians constitutes a Yang syndrome, later generations were unaware of this. They often confused Yang syndromes occurring in Yin meridians with Yin syndromes, mistakenly administering hot-natured agents, which led to untreatable conditions. I now name the cold syndrome directly invading the Yin meridians as "Zhonghan" (Direct Invasion of Cold), establishing it as a separate category. I name the heat syndrome caused by cold damaging the Yang meridians as "Shanghan" (Cold Damage), also establishing it as a separate category. This ensures clarity upon opening the book and prevents the error of misdiagnosing Yin and Yang.

[Symptoms of Shanghan] Headache, body pain, stiffness and rigidity of the waist and spine, aversion to cold, and fever are exterior syndromes of the Taiyang Meridian (Taiyang Channel). Eye pain, nasal dryness, insomnia, orbital pain, or dry mouth, or vomiting are exterior syndromes of the Yangming Meridian (Yangming Channel). Alternating chills and fever, bitter taste in the mouth, hypochondriac pain, deafness, and vomiting are half-exterior, half-interior syndromes of the Shaoyang Meridian (Shaoyang Channel). The above are all exterior syndromes of the Three Yang Meridians. If the heat pathogen in the Yang meridians does not resolve and transmits inward (to the interior), if aversion to cold and body pain remain but are accompanied by difficult urination, this is an interior syndrome of the Taiyang Meridian. If aversion to cold, body pain, and headache have completely resolved, the pulse is deep and rapid rather than floating, the skin is not hot, there is thirst with cracked lips, excessive water intake, red urine, and constipation, accompanied by tidal fever and delirious speech, and profuse sweating on the hands and feet, this is an interior syndrome of the Yangming Meridian. If there is dry mouth and throat, thirst with excessive water intake, or spontaneous diarrhea of pure clear water, hardness, pain, and fullness in the epigastrium, and constipation, this is an interior syndrome where the Yang pathogen has transmitted to the Shaoyin Meridian (Shaoyin Channel). If the hands and feet are naturally warm, or there is generalized jaundice, or abdominal fullness and solid pain, this is an interior syndrome where the Yang pathogen has transmitted to the Taiyin Meridian (Taiyin Channel). Restlessness and fullness, contraction of the genitals, diarrhea with delirium, abdominal pain, flatus, or cold extremities accompanied by fever, this is an interior syndrome where the Yang pathogen has transmitted to the Jueyin Meridian (Jueyin Channel). The above are all cases where heat pathogens from the Three Yang Meridians transmit to the Yin meridians to become interior syndromes. Although the meridians belong to Yin, the symptoms manifest as Yang syndromes. If symptoms appear simultaneously in two meridians at the onset, or all three meridians are affected, it is called "Hebing" (Combined Disease). If one meridian is diseased first and remains unresolved before another meridian shows symptoms, it is called "Bingbing" (Concurrent Disease). All these are symptoms of Shanghan.

[Etiology of Shanghan] When a person's couli (pores and interstices) are loose and sparse, and they accidentally encounter seasonal cold, which enters the muscle and surface, stagnates, and generates fever, this is the cause of Shanghan disease in winter. For individuals in hot seasons who have accumulated heat internally, if they are subjected to sudden unseasonal cold externally binding the skin and hair, it will also cause headache, body pain, aversion to cold, and fever. This is the cold-heat disease of the other three seasons.

[Pulse of Shanghan] Floating and large pulses indicate exterior conditions; deep and rapid pulses indicate interior conditions. A floating and tight pulse at the left Guan position indicates cold damaging the Taiyang Meridian. A surging and long pulse at the right Guan position indicates disease in the Yangming Meridian. A wiry and rapid pulse at the left Guan position indicates disease in the Shaoyang Meridian. A deep, rapid, solid, and large pulse indicates an interior syndrome of the Yangming Meridian. A deep, rapid, fine, and hurried pulse indicates interior heat of the Three Yin Meridians.

[Treatment of Shanghan] Headache, lower back pain, floating and tight pulse, no sweat, and aversion to cold indicate that cold has damaged the Ying (Nutritive) level of the Taiyang Meridian. Zhang Zhongjing used Mahuang Tang (Ephedra Decoction) in winter; my family secret formula uses [formula omitted in source]. If there is aversion to cold, body pain, fever, plus difficult urination, this indicates heat binding in the Bladder, an interior syndrome of the Taiyang Meridian. Zhang Zhongjing used Wuling San (Five-Ling Powder) in winter; my family secret formula uses Qianghuo Mutong Tang (Notopterygium and Akebia Decoction). Eye pain, nasal dryness, insomnia, and a wiry-long pulse indicate an exterior syndrome of the Yangming Meridian; diaphoresis should be induced. Ge Gen Tang (Kudzu Decoction) is used in winter, and Congbai Ge Gen Tang (Scallion Stem and Kudzu Decoction) in other months. Thirst with excessive water intake, fever day and night, and surging-rapid-long pulses in all six positions indicate a half-exterior, half-interior syndrome of the Yangming Meridian; clearing heat is indicated using Gange Shigao Tang (Kudzu and Gypsum Decoction). Dry mouth, yellow tongue coating, and deep-rapid-long pulses indicate a Fu-organ interior syndrome of the Yangming Meridian. If symptoms requiring purgation such as abdominal pain and constipation are absent, Liangge San (Cooling the Diaphragm Powder) is used to clear heat. If all purgative indications are present, one of the Three Chengqi Decoctions is selected. If chills and fever persist, along with bitter taste, deafness, vomiting, and chest fullness, the disease remains in the Shaoyang Meridian and has not entered the interior; Xiao Chaihu Tang (Minor Bupleurum Decoction) is used. If the Yang meridians do not resolve and transmit to the Three Yin meridians, it becomes a Yang syndrome in the Yin meridians. With dry mouth, throat, and thirst, but without abdominal distension or constipation, clearing interior heat is indicated. If there is abdominal distension and constipation, or spontaneous diarrhea of pure clear water, and hardness/pain in the epigastrium, heat has transmitted to Shaoyin. If purgative indications exist, Da Chengqi Tang (Major Order the Qi Decoction) or Xiao Chengqi Tang (Minor Order the Qi Decoction) is selected. When Yang pathogen transmits to Shaoyin, causing extreme dry mouth and throat with depletion of internal fluids, urgent purgation is necessary to preserve Jin-Ye (Body Fluids). If hands and feet are naturally warm, with fever, jaundice, and severe abdominal fullness/pain, heat has transmitted to Taiyin. Zhang Zhongjing did not use Chengqi formulas for this but established Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction). Since the Spleen of Taiyin is a purely Yin organ, and Taiyang pathogen transmits to Taiyin, Guizhi (Cinnamon Twig) treats the Taiyang exterior while Dahuang (Rhubarb) clears Taiyin interior heat. Restlessness, fullness, genital contraction, rapid pulse with cold extremities, initial fever followed by coldness, indicates "deep heat leads to deep coldness," with pathogen entering Jueyin. Zhang Zhongjing did not use strong purgation because initial fever followed by cold extremities contraindicates harsh purgation; thus, Xiao Chengqi Tang was established to indicate mild purgation. Wait for hands and feet to warm up before considering heat-clearing herbs. Note: Interior syndromes of Shanghan involve four meridians: Yangming, Shaoyin, Taiyin, and Jueyin. In Yangming, it is a Yang-meridian heat disease; in the Three Yin, it is a Yin-meridian heat disease. Therefore, purgatives for the Three Yin are slightly milder than for Yangming. If heat has transmitted internally but lacks purgative indications, even if heat is in a Yin meridian, only clearing is allowed, not purgation. For example, extreme heat in Hand-Shaoyin causing coma, muteness, drunkenness-like state, does not use Chengqi Tang but Daochi Banjie Tang (Half-Half Guide Outward Decoction) or Xiexin Tang (Drain Epigastrium Decoction). Thus, purgation requires definite signs: abdominal pain/distension, constipation, frequent flatus, inability to defecate despite urge, spontaneous sweating on hands/feet, non-hot skin, non-red face, and yellow-black dry tongue coating. If any headache, body pain, aversion to cold, fever, or lack of spontaneous sweating on extremities exists, exterior pathogen is not exhausted, and purgation is forbidden. Even if abdominal distension and constipation necessitate purgation, use Dachaihu Tang (Major Bupleurum Decoction) instead of Chengqi Tang. If Xiao Chengqi Tang is used, add Chaihu (Bupleurum), Genge (Kudzu), and Qianghuo (Notopterygium) to treat residual exterior symptoms of the Three Yang meridians. This clears interior heat while allowing exterior pathogen to ascend and disperse, preventing internal collapse. This method of purgation does not hinder the exterior pathogen; it appears to be purgation but is actually a harmonizing method. This chapter clarifies Yin and Yang syndromes separately, so only outlines are noted here; detailed treatments are in *Shanghan Dabai*.

Mahuang Tang (Ephedra Decoction): Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao). Tao’s addition: Chuanxiong Rhizoma (Chuanxiong), Saposhnikoviae Radix (Fangfeng), Notopterygii Rhizoma et Radix (Qianghuo).

Guizhi Tang (Cinnamon Twig Decoction): Cinnamomi Ramulus (Guizhi), Paeoniae Radix Alba (Baishao), Ephedrae Herba (Mahuang), Glycyrrhizae Radix et Rhizoma (Gancao). Tao replaced Mahuang with Puerariae Radix (Ge Gen).
Note: These two formulas are for treating winter Shanghan in Northwest China; unsuitable for the three seasons in the South.

Qianghuo Baidu San (Notopterygium Resolving Toxin Powder): Treats fever without sweat, replacing Mahuang Tang. Ingredients: Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Dahuricae Radix (Duhuo - *Note: Text says Du Huo*), Bupleuri Radix (Chaihu), Peucedani Radix (Qianhu), Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao), Chuanxiong Rhizoma (Chuanxiong). For dry mouth/thirst, remove Chuanxiong, substitute with Puerariae Radix (Ge Gen) to clear Yangming.

Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction): Notopterygii Rhizoma et Radix (Qianghuo), Scutellariae Radix (Huangqin), Saposhnikoviae Radix (Fangfeng), Atractylodis Rhizoma (Cangzhu), Chuanxiong Rhizoma (Chuanxiong), Rehmanniae Radix Preparata (Shengdi), Asari Radix et Rhizoma (Xixin), Angelicae Dahuricae Radix (Baizhi), Glycyrrhizae Radix et Rhizoma (Gancao). For dry lips/thirst, remove Chuanxiong and Xixin, replace Baizhi with Ge Gen. For chest fullness, remove Shengdi, add Aurantii Fructus (Zhiqiao).

Jiami Chonghe Tang (Family Secret Harmonizing Decoction): Treats spontaneous sweating with fever, replacing Guizhi Tang. Ingredients: Notopterygii Rhizoma et Radix (Qianghuo), Scutellariae Radix (Huangqin), Saposhnikoviae Radix (Fangfeng), Rehmanniae Radix Preparata (Shengdi), Angelicae Dahuricae Radix (Baizhi), Paeoniae Radix Alba (Baishao), Glycyrrhizae Radix et Rhizoma (Gancao). Add Chaihu for chills/fever; add Ge Gen and remove Baizhi for eye/orbital pain/thirst; add Akebiae Caulis (Mutong) for red urine; add Trichosanthis Radix (Tianhuafen) for thirst with phlegm; add Gypsum Fibrosum (Shigao) for thirst with excessive water intake; add Pinelliae Rhizoma Preparatum (Banxia) for vomiting; add Zhiqiao and Huanglian for stuffiness/fullness.
Among these three, Baidu San treats pure exterior pathogen in Taiyang; Chonghe Tang treats exterior pathogen with interior heat in Taiyang (harmonizing); Jiami Chonghe Tang treats Taiyang with sweating and persistent fever.

Qianghuo Mutong Tang: Notopterygii Rhizoma et Radix (Qianghuo), Akebiae Caulis (Mutong). Decoct together.

Gegen Tang (Kudzu Decoction): Puerariae Radix (Gegen), Cinnamomi Ramulus (Guizhi), Ephedrae Herba (Mahuang), Paeoniae Radix Alba (Baishao), Glycyrrhizae Radix et Rhizoma (Gancao). Tao replaces Mahuang with Cimicifugae Rhizoma (Shengma). Add Shigao for interior heat; add Chaihu for alternating chills/fever; add Qianghuo for aversion to cold/body pain; add Chuanxiong for headache. Removing Mahuang and Guizhi, adding Jingjie and Congbai creates Congbai Gegen Tang (Scallion Stem and Kudzu Decoction).

Gegen Shigao Tang (Kudzu and Gypsum Decoction): Puerariae Radix (Gegen), Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), Glycyrrhizae Radix et Rhizoma (Gancao). Add Ophiopogonis Radix (Maidong) and Lophatheri Herba (Zhuye) for restlessness; add Banxia for vomiting with phlegm; add Tianhuafen for烦渴 (restless thirst) with phlegm; add Mutong and Dengcaoxin (Lampwick Grass Tip) for astringent urination.

Xiao Chaihu Tang (Minor Bupleurum Decoction): Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Citri Reticulatae Pericarpium (Guangpi), Pinelliae Rhizoma Preparatum (Banxia), Glycyrrhizae Radix et Rhizoma (Gancao), Ginseng Radix (Renshen). Remove Renshen and add Coptidis Rhizoma (Chuanlian) and Zhiqiao for chest heat/stuffiness; remove Banxia and add Tianhuafen for thirst.

Liangge San (Cooling the Diaphragm Powder): Gardeniae Fructus (Shanzhi), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Chuanlian), Trichosanthis Radix (Tianhuafen), Forsythiae Fructus (Lianqiao), Menthae Haplocalycis Herba (Bohe), Platycodonis Radix (Jiegeng), Glycyrrhizae Radix et Rhizoma (Gancao).

Da Chengqi Tang (Major Order the Qi Decoction): Rheii Radix et Rhizoma (Dahuang), Natrii Sulfas (Mangxiao), Immaturus Trilobitae Citri Fructus (Zhishi), Magnoliae Officinalis Cortex (N Houpo). Removing Mangxiao yields Xiao Chengqi Tang.

Tiaowei Chengqi Tang (Regulate Stomach Order the Qi Decoction): Dahuang, Mangxiao, Gancao. Family secret adds Guangpi.

Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction): Cinnamomi Ramulus (Guizhi), Dahuang, Baishao, Gancao.

Daochi Banjie Tang (Guide Outward Half-Half Decoction): See Stroke section.

Exogenous Wind-Cold enters via pores and must exit via pores. Therefore, treating fever in Shanghan prioritizes releasing the exterior and resolving the muscles. The Taiyang Chapter states: If diaphoresis is incomplete at onset, the condition may transfer to Yangming and remain unresolved due to insufficient sweating; re-inducing diaphoresis will cure it. Body surface fever cannot subside without sweating. If sweat occurs but skin remains dry, sweating is incomplete, and fever persists. Continuous sweating is required for heat resolution. Applying Northern Mahuang/Guizhi formulas indiscriminately to Southern warm-heat diseases causes fire-closure and no sweat, worsening heat. If exterior pathogen causes irritability/heat and cooling herbs are mistakenly used, Stomach Yang is suppressed, preventing sweat distribution. If exterior pathogen coexists with internal phlegm/food stagnation, cooling herbs congeal Stomach Yang, preventing sweat. Everyone knows diaphoresis treats fever, but failure stems from ignorance of the true principle. Zhang Zhongjing’s first line uses Mahuang Tang for fever without sweat, wheezing, and qi reversal, adding Xingren to regulate Lung Qi. This implies that Lung Qi obstruction causes pore closure, preventing sweat; moistening Lung Qi is the key to diaphoresis. Guizhi Tang treats fever with sweat. Post-medication rice gruel aids efficacy, implying that empty/loose Stomach Qi facilitates sweat distribution. If sweat fails to dispel pathogen, Guizhi Tang resolves muscles and disperses pathogen; rice gruel assists Stomach Yang to distribute sweat and disperse pathogen. Thus, sweating syndromes allow rice gruel (no Stomach stagnation); non-sweating syndromes imply Stomach congestion (no rice gruel). Developing Stomach Qi and ascending Stomach Yang is the true key to diaphoresis. Regarding head-sweat: isolated head sweating with no body sweat indicates fluid retention and stasis-heat congealing in the Middle Jiao, blocking Stomach Yang and circulation. Treatment involves promoting Stomach Qi and unblocking collaterals. I modified Baidu San by adding Zhiqiao, Jiegeng, and Sangbaipi to promote Lung Qi, treating Wind-Cold congesting the Lung with wheezing, fever, and no sweat. This derives from Mahuang/Xingren Lung-regulating diaphoresis. Also, adding Zhishi, Houpo, Banxia, and Guangpi to Baidu San disperses Stomach stagnation and promotes Stomach Qi to treat phlegm/food stagnation in the Middle Jiao causing abdominal fullness, fever, and no sweat. This derives from the head-sweat section and Taiyang exterior syndrome with fluid retention under the heart, modified from Xiao Qinglong Tang. This reveals the true principle of acrid-dispelling fluid retention, promoting Stomach Yang, and distributing sweat, named Lipu Fabiao Tang (Lung-Regulating Exterior-Releasing Decoction) or Pingwei Fabiao Tang (Stomach-Pacifying Exterior-Releasing Decoction).