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Wan Mizhai treated a woman who had been ill for thirteen days. Her family came to seek medicine and reported her condition: initially suffering from headache, she had been unconscious and sleeping deeply for ten days, with phlegm rattling in her throat, cold hands and feet, and a stiff, rigid body. Wan Mizhai pondered: It was after the first day of the second month in the Xinyou year, with over a foot of snow on the ground. This woman’s primordial qi (vital energy) had always been weak; she must have contracted the illness due to traveling far. (The three Yin meridians run from the abdomen down to the feet.) Upon inquiry, it was confirmed that she had indeed traveled to a relative's house in the snow on the third day and fell ill upon returning. He said: "This is cold pathogen directly invading the Foot Shaoyin Kidney Meridian and Foot Jueyin Liver Meridian. Silence and preference for sleep indicate Kidney disease of the Foot Shaoyin; severe headache, cold extremities, rigidity, and phlegm rattle indicate Liver disease of the Foot Jueyin." He prescribed Shiquan Dabu Tang (Complete Ten Tonics Decoction), removing Rehmanniae Radix Preparata (Shu Di Huang) and Paeoniae Radix Alba (Bai Shao), and adding Asari Radix (Xi Xin), Pinelliae Rhizoma Preparatum (Ban Xia), and Zingiberis Rhizoma (Gan Jiang), giving three doses. Five days later, they returned to thank him, saying the illness was cured.

Wu Fuxian treated a man with Taiyang Shanghan (Cold Damage) presenting with headache, no fever, and dry retching with frothy saliva. The physician used Chuanxiong Rhizoma (Chuan Xiong) and Ligustici Rhizoma et Radix (Gao Ben), but it was ineffective. Wu Fuxian said: "This is a syndrome of Cold invading the Jueyin Meridian. Dry retching and frothy saliva occur because Jueyin Cold invades the Stomach upward; the headache arises because the Jueyin Meridian meets the Du Mai (Governor Vessel) at the vertex, and cold pathogen attacks upward along the meridian." He used Ginseng Radix et Rhizoma (Ren Shen) and Jujubae Fructus (Da Zao) to tonify Spleen Qi to prevent Liver Wood pathogenic influence, and Evodiae Fructus (Wu Zhu Yu) and Zingiberis Fructus (Sheng Jiang) to enter the Jueyin Meridian to disperse cold and stop vomiting. Once vomiting ceased, the headache naturally resolved. If there were no headache, it would belong to the Taiyin rather than Jueyin. (In direct invasion syndromes, only Shaoyin may present with counterfeiting fever.)

Another patient suffered from direct invasion of Cold into the Jueyin Meridian, with cold extremities, a fine pulse nearly imperceptible, and cyanotic fingernails, but without vomiting or diarrhea. He was given Sini Tang (Frigid Extremities Decoction). By the third day, his extremities warmed, nails turned red and warm, and the pulse became full, rapid, and forceful. This indicated the generation of Yang from extreme Yin. A cooling formula should have been administered. However, the family doubted the change from cold to hot medication within one day and refused to take it. By the ninth day, fever persisted, accompanied by dysentery with tenesmus and incessant thirst for water. Upon re-examination, Baitouweng San (Peony Root Powder) ingredients—Pulsatillae Radix (Baitouweng), Barkia Cortex (Qin Pi), Coptidis Rhizoma (Huang Lian), and Phellodendri Cortex (Huang Bo)—each two qian were prescribed. Symptoms improved after one dose and resolved after two. (True cold syndromes do not typically transform into drinking water and dysentery.)

Commentary: Cold limbs and hidden pulse suggest Yang Jue (Heat Jue). Cyanotic nails suggest impending Zhan Han (shivering sweat). The use of Sini Tang was erroneous but concealed. Refer to my case of Ling Erguan. (Ling Erguan is the nephew mentioned in the Heat Disease section.)

Wu Fuxian treated the mother of Wang Yecang, who suddenly experienced severe abdominal pain. Her pulses on both sides were wiry and tight. Erchen Tang (Two-Aged Phlegm Decoction) minus Licorice Root (Gan Cao), plus Cinnamon Bark (Rou Gui), Ginger Rhizome (Gan Jiang), and Aucklandiae Radix (Mu Xiang) failed to reduce the illness. The next day, alternating chills and fever occurred like malaria, with no rhythm. The pulse became rapid and frequent. The previous formula was modified with five qian of Ren Shen and two qian of Aconiti Lateralis Radix Preparata (Fu Zi), but it failed. Increasing Ren Shen to one liang and Fu Zi to five qian caused the pulse to gradually collapse. Wu Fuxian stated: "Shaoyin Cold invasion requires Ren Shen and Fu Zi. Its failure here is due to deep pathology and shallow medication." Four other physicians suggested different treatments: one proposed Aristolochiae Fructus (Zhi Shi) and Fritillariae Bulbus (Bei Mu); another Scorpion (Quan Xie) and Saposhnikoviae Radix (Fang Feng); another Jiwei Wan (Eight-Ingredient Pill); and another Ren Shen, Astragali Radix (Huang Qi) each eight fen, Rou Gui four fen, and Fu Zi three fen. Wu Fuxian said: "With diarrhea, using Zhi Shi is wrong; with extreme deficiency and sweating, using Quan Xie is wrong. These two know nothing of the disease. Jiwei Wan is for regulation, not acute crisis. Ren Shen, Huang Qi, Rou Gui, and Fu Zi are appropriate but insufficient—like pouring a cup of water on a cartload of firewood. Li Xin’s defeat serves as a warning." He prescribed four liang of Huang Qi decocted as water substitute, four liang of Ren Shen, and two liang of Fu Zi made into a paste. The patient had a flushed face (false spirit), bead-like sweat, collapsed six pulses, absent respiration, and locked jaw. Fortunately, the Taixi pulse remained. Using chopsticks to pry open the teeth, half a zhong was灌 (administered), followed by another half zhong later, guarding against sudden pulse emergence. Soon, pressing the Chi positions revealed a subtle pulse. "The pulse is returning; great improvement," he said. Another half zhong was given from noon to evening, until eyes opened, speech resumed, and porridge was desired. Subsequently, fear of cold, sore throat, and craving cold water appeared. Some suspected Fire. Wu said: "Fear of cold is true; craving cold is false. The Shaoyin Meridian passes through the throat; pathogen in the collateral causes sore throat. Now cold moves from Zang to Jing, indicating recovery." He added Platycodonis Radix (Jie Geng) and Gan Cao to the formula, stopping the pain. Thereafter, daily Ren Shen was one liang, Fu Zi three qian. After 100 days of regulation, she recovered. Post-recovery, she developed widespread rash and nodules with intense itching, insomnia, and sweating. Liujunzi Tang was used, with two liang of Huang Qi decocted to cook herbs, but ineffective for ten days. Wang consulted *Yixue Zhunsheng* Wind Rash section, which listed only wind-dispelling drugs, no tonics. Wu said: "Divine understanding lies in the practitioner; do not be dogmatic." He stuck to the original formula, resolving the issue in a few doses.

Ma Yuanyi treated Lu Jichen, who was critically ill. Pulses were deficient and minute, with spontaneous sweating, cold extremities, blue face and lips, and continuous hiccups. This indicated congenital deficiency of True Yang in Shaoyin with direct cold invasion. Yin-Cold surged horizontally, attacking the clear pathways above and the extremities laterally, extremely critical. With unceasing sweating, Deficient Yang was about to collapse. The method required Guifu Lizhong Tang (Cinnamon, Aconite, and Spleen-Tonifying Decoction) to dissipate Yin and secure Yang. Once Yang was settled, all Yin pathogens dispersed. Two doses taken overnight raised the pulse and stopped sweating. Five to six doses led to resolution.

Wu Yang treated Pan Shiqiang, eldest son of Pan Shi of Jieline. While working under a window early in the morning, he suddenly fell ill with headache and aversion to cold. All food taken from boiling pots felt cool to him; one-third thought it was cold. Others tasted it and found it scalding, yet his mouth and tongue were normal. In summer heat, he wore heavy fur coats, still feeling thin. Multiple physicians failed. Wu Yang was summoned. He said: "Deficiency below, deep cold invasion, knotted and unresolving. Prognosis is poor; even if curable, death will occur within three years." He eventually cured him with warming and tonifying agents, doubling the dosage of Ren Shen and Fu Zi compared to other herbs. He relapsed and died exactly three years later. (*Taihan Ji*)

Dou Cai treated a person with Fei Shanghan (Lung Cold Damage), alias. Symptoms included headache, fever, aversion to cold, cough, joint pain, and deep-tight pulse. Huagai San (Canopy Powder) and Huangqi Jianzhong Tang (Astragalus Middle-Joint Building Decoction) provided slight relief. On the fifth day, somnolence and delirium occurred, with slightly cold extremities, indicating Kidney Qi deficiency. Guan Yuan (CV4) was moxa-burned for 100 zhuang, and Jiangfu Tang (Ginger-Aconite Decoction) was administered. Sweat ensued, and he recovered.

Another patient with Shanghan presented with somnolence, delirium, and wiry-large pulses on all six positions. Dou Cai said: "Large pulse with somnolence is definitely not excess heat; it is pulse following chaotic Qi." He forcibly treated with fierce moxa-burning at Guan Yuan. Initially painful, by 70 zhuang, the patient slept without pain. By midnight (third watch), the patient opened eyes and desired food. Jiangfu Tang was given. After three days, Yuan Qi recovered, massive sweat ensued, and the patient resolved.

Another patient with Shanghan reached the eighth day with large-tight pulse, jaundice, purple spots, belching, and cold toes extending to the instep. This was a Taiyin syndrome, most severe and difficult to treat. Ming Guan (BL57? Note: Context implies specific moxa point, likely BL57 Chengshan or similar, but text says Ming Guan which often refers to ST25 or specific emergency points in Dou Cai's school, usually interpreted as a vital moxa point) was moxa-burned for 50 zhuang, Guan Yuan for 200 zhuang. Jin Ye Dan (Golden Liquid Pill) and Zhongru Fen (Cloud Milk Powder) were administered. Recovery occurred with sweat after four days.

Another patient with Shanghan reached the sixth day with wiry-tight pulse, fever, and spontaneous sweating. This was a Taiyin syndrome. Jin Ye Dan was taken first, and Ming Guan was moxa-burned. The patient refused moxibustion. Dou Cai noted: "Only Taiyin and Shaoyin Shanghan injure people fastest. Without early moxibustion, medicine is useless." The patient did not believe, bled from the bowels on the ninth day, and died.

Another patient with Shanghan reached the sixth day with mild jaundice. One physician gave Yinchen Tang (Artemisia Capillaris Decoction). The next day, jaundice deepened, turning the whole body yellow like gardenia. This was a Taiyin syndrome caused by mistakenly taking cooling medicines, leading to Liver Wood insulting Spleen Earth. Ming Guan was moxa-burned for 50 zhuang, and Yuye Dan (Residual Liquid Pill) was administered. Recovery occurred.

Another patient with Shanghan presented with immediate cold extremities and a rapid pulse (8-9 beats per breath). Physicians deemed it fatal. Dou Cai said: "This is Yin Du (Yin Toxin)." (Cold extremities with rapid pulse indicates Yin Toxin, accompanied by cyanotic nails, vomiting/diarrhea, and curled posture.) One bowl of Jiangfu Tang was given. Recovery occurred with sweat at midnight. If mistaken for heat due to rapid pulse and treated with cooling drugs, death would be certain.