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Ten Admonitions on Cold Damage

(1) When a patient with cold damage presents with headache and fever, this is a Yang syndrome. Hot-natured medicines must not be administered.
Cold damage pathogens transmit through the Three Yin and Three Yang meridians, totaling six channels. In Taiyin disease, the head does not hurt and the body is not hot; in Shaoyin disease, there may be contrary fever without headache; in Jueyin disease, there may be headache without fever. Therefore, knowing that headache accompanied by fever indicates a Yang syndrome. If hot medicines are prescribed, rescue will inevitably fail.

(2) Cold damage should be treated by directly attacking the pathogenic toxic qi; tonification must not be used.
When pathogenic qi resides in the meridians, if it is attacked early according to the syndrome, recovery occurs in only three or four days. However, physicians wrongly claim that one must first support the healthy qi, thereby employing tonification. This causes the toxic qi to spread and intensify, leading to death.

(3) Patients with cold damage who have no appetite must not be given spleen-warming medicines.
Loss of appetite in cold damage is common, and patients will never die of hunger. Medicines such as Lizhong Wan (Regulate the Middle Pill) must not be lightly administered. If taken for a Yang syndrome, it will aggravate the heat, potentially leading to untreatable conditions.

(4) Abdominal pain in cold damage can also present as a heat syndrome; warm medicines must not be administered.
The Nan Jing states: "Pain belongs to excess." Thus, Zhang Zhongjing, in discussing abdominal fullness and pain, stated: "For severe pain, increase the dosage of Dahuang (Rhubarb Root)." The fact that Dahuang is increased for severe pain reveals the intent. Only when the body is cold and limbs are inverted with abdominal pain is it a Yin syndrome, requiring careful deliberation. It is often seen that physicians prescribe hot medicines for abdominal pain, causing death.

(5) Spontaneous diarrhea in cold damage requires distinguishing between Yin and Yang syndromes; one must not indiscriminately administer warming or antidiarrheal medicines.
In spontaneous diarrhea, cases where the body is not hot and hands and feet are warm belong to Taiyin. Cases where the body is cold and limbs are inverted belong to Shaoyin or Jueyin. Aside from these, cases with fever and diarrhea are all Yang syndromes. Treatment should follow Zhang Zhongjing's methods according to the syndrome. It is frequently observed that physicians cause death by administering warming or antidiarrheal medicines for diarrhea.

(6) Chest and hypochondriac pain and abdominal distension in cold damage must not be treated with moxibustion recklessly.
It is commonly seen in villages that patients with these symptoms use moxibustion due to lack of medicine. This often causes toxic qi to intensify with the fire, leading to distension, panting, and death. They do not know that chest and hypochondriac pain naturally belongs to Shaoyang, and abdominal distension naturally belongs to Taiyin. Aside from this, moxibustion is only suitable for Yin syndromes.

(7) Cold extremities in cold damage.
One must distinguish between Yin and Yang; one must not treat all cases as Yin syndromes. There are Yin Jue (cold reversal) and Yang Jue. Physicians rarely distinguish them correctly. Administering hot medicines for Yang Jue kills faster than using a blade. Generally, Yang diseases do not reach extreme heat, so they cannot induce Jue. As Zhang Zhongjing said, "The deeper the heat, the deeper the Jue." If heat is deep and hot medicines are given, there is no hope of survival. Observe if the patient had fever at onset; after three days, if heat has penetrated deeply, constipation is present, urine is red, or there is delirium and confusion, along with other heat signs but contrary cold extremities, it is definitely a Yang syndrome. One should urgently use Chengqi Tang (Gut-Purging Decoction) to purge. If at onset the body was not hot, stool is not constipated, the patient pulls clothes to cover themselves, or has diarrhea or frequent urination, without heat signs but with cold extremities, it is Yin Jue. Only then can Sini Tang (Frigid Extremities Decoction) be used. These two types of Jue are confusing because both pulses are deep. However, Yang Jue pulse is deep and slippery, while Yin Jue pulse is deep and weak. Additionally, in Yang Jue, fingers and toes occasionally become warm, whereas in Yin Jue, they remain constantly cold. This distinguishes them.

(8) Once cold damage pathogens have entered the interior, one must not lightly use diaphoretic medicines to induce sweating.
Cold damage syndromes require distinguishing exterior and interior. Fever with aversion to cold indicates an exterior syndrome, suitable for diaphoresis. Aversion to heat without aversion to cold indicates an interior syndrome. If physicians indiscriminately induce sweating, the sweat expelled is not pathogenic qi but healthy qi. The pathogenic qi remains unremoved, while healthy qi is depleted first, leading to many deaths. For half-exterior half-interior syndromes, and syndromes lacking clear exterior/interior distinction, purgation is contraindicated, as is diaphoresis. Treatment should simply follow the syndrome.

(9) Thirst and drinking water in cold damage indicate a desire for recovery; patients must not be allowed to drink excessively.
Patients with extreme thirst should be given water to dissipate heat, which is why Zhang Zhongjing considers drinking water a sign of impending recovery. People seeing this allow patients to drink freely. This leads to vomiting, hiccups, coughing and wheezing, diarrhea, edema, palpitations, fluid retention, and difficulty urinating. If a patient desires one bowl of water, only half a bowl should be given; small amounts given frequently is best.

(10) After initial recovery from cold damage, one must not overeat, exert oneself, eat mutton, engage in sexual intercourse, consume bone broths, or drink alcohol.
When the illness just resolves, the spleen and stomach are still weak. Overeating leads to indigestion and relapse, called food relapse. Qi and blood are still deficient; early exertion leads to relapse, called labor relapse. Eating mutton or engaging in intercourse during cold damage can cause immediate death. Consuming bone broths and alcohol causes recurrent illness. I often recall my father and grandfather dying of cold damage. I took Zhang Zhongjing's writings, studied them deeply for eight years, until I achieved great enlightenment. The meridians of Yin and Yang, disease syndromes, and drug properties became clear in my mind. Recently, people in the Jianghuai region, braving cold to flee bandits, contracted this disease frequently. Following Zhang Zhongjing's methods, I have saved hundreds of lives. I realize that cold damage originally has no malignant syndromes; they are caused by reckless medication. Mourning my ancestors killed by quacks, and lamenting that people of all statuses fail to understand this, entrusting their lives to incompetent practitioners, I now excerpt these harmful errors. Titled "Ten Admonitions on Cold Damage," these words are not intended as formal prose, but to be easily understood as a grave warning.