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Cold pathogenic factors injuring the human body, if there is no Qi stagnation transforming into fire (Huo Yu), directly present as cold reversal of the limbs (Ling Jue) due to middle jiao deficiency-cold. The cold enters along the meridians and gradually deepens; internal evil forces Yang Qi outward, only then does fever occur. If heat has been simmering for a long time, there is no longer any cold in the interior; how can one claim this transformed from a cold syndrome?

Wind-cold invading the interior has no fixed pattern; it may enter Yin meridians or Yang meridians. One must seek flexible methods within Yin-Yang differentiation, carefully examining the foot meridians at both the initial and terminal stages.

This chapter discusses eye diseases caused by Shang Han (Cold Damage). Shang Han is the ancestor of all hundred diseases, not exclusively limited to the eyes. By studying Mr. Zhang Zhongjing's writings and grasping their principles, treatment becomes manageable. Pursuing complex divergent paths leads to fragmentation. Below are briefly outlined some key points:

The Taiyang Meridian is the exterior of the exterior, running along the back of the body. When evil invades the skin and hair, it injures this meridian first, presenting with aversion to cold, aversion to wind, headache, and spinal pain. A floating and tight pulse without sweat indicates Shang Han (Cold Damage); treat with Mahuang Tang (Ephedra Decoction) to induce sweating; resolution occurs when sweat appears. A floating and moderate pulse with sweat indicates Shang Feng (Wind Injury); treat with Guizhi Tang (Cinnamon Twig Decoction); resolution occurs when evil disperses and sweat stops. Body heat arises because evil closes the Yuan Fu (pores/defensive gateways), preventing internal Qi from venting; this heat is generated internally, not directly transformed from wind-cold.

The Yangming Meridian is the interior of the exterior, running along the front of the body. Symptoms include fever, aversion to cold, slightly large and long pulse, dry nose, and insomnia. Treat with Gegen Tang (Kudzu Decoction) to resolve the muscle layer.

The Shaoyang Meridian is half-exterior and half-interior, running alongside the hypochondrium. Symptoms include deafness, hypochondriac pain, bitter taste in the mouth, alternating chills and fever, and wiry and rapid pulse. Treat with Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize. Beyond this stage, evil enters the Fu organs. If the pulse is deep and forceful, with aversion to neither wind nor cold but rather aversion to heat, accompanied by delirious speech, intense thirst, and constipation for six to seven days, it indicates heat entering the intestines and stomach, constituting typical Yangming disease. Mild cases use Dachaihu Tang (Major Bupleurum Decoction); severe cases use the Three Chengqi Decoctions (San Chengqi Tangs); recovery occurs upon bowel movement.

Beyond this, evil enters the Zang organs via Shaoyin, Taiyin, and Jueyin, becoming interior syndromes. Treatment should employ acrid-warm herbs targeting specific symptoms; cool and dispersing methods are contraindicated. If initially presenting with aversion to cold, cold reversal of hands and feet, tremors/shivering, fatigue with desire to lie down, absence of thirst, combined with abdominal pain, vomiting, diarrhea, salivation, pale face like scraped knife, no fever, and deep, slow, weak pulse, this is a Yin Syndrome. This did not transmit from Yang meridians. Mild cases use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction); severe cases use Jiuzhuan Dan (Nine-Turn Pill) or Huiyang Yin (Restore Yang Infusion) to warm; delay is inadvisable.

Outside these, there are false Yin and false Yang syndromes. For instance, Taiyang syndrome presents with headache and fever, but the pulse is deep instead of floating, resembling Shaoyin syndrome; thus, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is used. Shaoyin syndrome presents with deep pulse and fever despite typically being afebrile, resembling Taiyang syndrome; thus, Gancao Fuzi Ganjiang Tang (Licorice, Aconite, and Dried Ginger Decoction) is required. Yin syndrome causes cold reversal of limbs, yet Yang syndrome occasionally presents similarly; this distinguishes Sini Tang from Sini San (Frigid Extremities Powder). Yin syndrome involves diarrhea, yet Yang syndrome also presents with "leaky bottom" (heat binding with purgation flow); this distinguishes Lizhong Tang (Regulate the Middle Decoction) from Huanglong Tang (Yellow Dragon Decoction).

Furthermore, true Yin and true Yang deficiency causing fever resembles Shang Han. Aversion to cold with spontaneous sweating and chest/diaphragm fullness resolves with Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction). Red face, thirst, and irritability resolve with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill). Additionally, lower body aversion to cold with cold feet, or desire to drink followed by vomiting, is treated by adding Rougui (Cortex Cinnamomi), Fuzi (Radix Aconiti Lateralis Preparata), and Wuweizi (Fructus Schisandrae) to the previous formula; relief follows ingestion.

In summary, "Shang Han" refers to illness contracted immediately after exposure to severe winter cold. Evil enters via skin, hair, and meridians, then into Fu and Zang organs. Initially presenting with aversion to cold and fever, it ultimately transforms into a heat syndrome; such individuals inherently possess Fire (excess heat). "Zhong Han" (Mid-Cold) involves evil directly entering Zang and Fu organs, persistently presenting with aversion to cold without fever; such individuals inherently lack Fire. The Classic states: "Fever with aversion to cold originates in Yang. No fever with aversion to cold originates in Yin." Cold injures the Form; Heat injures Qi. One approach releases the exterior and attacks the interior; the other warms the middle and scatters cold. These two categories are clearly distinct. How can one maintain an equivocal view and confuse-treat those with chronic internal injury regarding true/false Yin-Yang and identical-symptom differentiations? Ophthalmologists suddenly encounter Shang Han but do not discuss it; experts discussing Shang Han are often pedantic. I hope you frequently comprehend this section, as stated: "Observe what is valued together, and occasionally read my book."