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Jiegu: For exterior and interior syndromes of Shanghan (Cold Damage), if there are exterior signs such as aversion to wind and cold, exterior-releasing methods should be used (Haizang stated: for aversion to wind, use Baizhu San; for aversion to cold, use Shenzhu Tang). If the patient has robust qi, can eat, suffers from constipation, and lacks exterior signs, purgative methods may be employed.

Spring governs warmth and corresponds to Wood; when the body is warm, sweating should be induced (Haizang: use Shenzhu Tang). Summer governs growth and corresponds to Fire; when the body is hot with irritability, vigorous dispersal is required (Haizang: use Shenzhu Tang plus Huangqin Decoction). Late summer governs transformation and corresponds to Earth; during the transition between seasons, diet should be regulated (Haizang: use Sijunzi Tang). Autumn governs gathering and corresponds to Metal; when the body is cool but internally warm, mild purgation is indicated (Haizang: use Tongge Wan or Jinhua Wan). Winter governs the Zang organs and corresponds to Water; fever with aversion to cold indicates heat on the exterior and cold on the interior; coldness with aversion to heat indicates heat on the interior and cold on the exterior (Haizang: for interior heat, use Tiaowei Chengqi Tang; for interior cold, use Tiaozhong Tang Pills).

Jiegu: In all cases of Shanghan, treatment should be administered according to the ascending and descending, smooth and adverse, rigid and soft dynamics of Yin and Yang across the four seasons. When Qi ascends and floats, disperse it in accordance with its nature; when it stores, guide it downward. Sweating, fever, aversion to wind, and a floating, moderate pulse indicate Wind injuring the Wei (Defensive) level; use Guizhi Tang. No sweating, fever, aversion to cold, spontaneous aversion to cold without exposure to wind, and a floating, tight pulse indicate Cold injuring the Ying (Nutritive) level; use Mahuang Tang. Sweating, fever, aversion to wind, and a floating, tight pulse; or no sweating, fever, aversion to cold, and a floating, moderate pulse indicate simultaneous injury to Ying and Wei; use Qinglong Tang or Guizhi Mahuang Banxia Tang. No sweating, fever, absence of aversion to wind/cold, and a deep, surging pulse allow for purgation; further distinguish the presence or absence of Jue (cold extremities) and treat based on the depth of cold/heat. Sweating, cold extremities, and a deep, faint pulse constitute Yin Jue; use Sini Tang. No sweating, cold extremities, and a deep, faint pulse constitute Yang Jue; use Dachengqi Tang plus Nifen. If extremities are not cold, the body is hot, and both interior and exterior belong to Yang with unactivated Sanjiao (Triple Burner), use cooling medicines for three to five doses. Options include Huangqin Gancao Tang, Huangqin Baizhu Tang, Huangqin Cangzhu Tang, Huangqin Zhizi Tang, Lianqiao Yinzi, Xiaochaihu Tang, Bazheng San, Liangge San, Baihu Tang, and Wuhuang San. These represent upper, middle, and lower Jiao remedies; select appropriately. For Zhongshu (Summerheat) with a deficient pulse, back aversion to cold, spontaneous sweating, and thirst, use Baihu Tang. For a cool body, tight pulse, and interior heat, urgent purgation is needed; dry mouth/throat and constipation are indications. For no sweating and high fever, induce sweating with Shengma Tang, Daqing Gao, or Tianma Gao. For sweating and high fever, use Guizhi Tang, Xingxing San, Jieji Tang, Xiaochaihu Tang, or Baizhu Fangfeng Tang. When inducing sweating, consider seasonal variations (spring cool, summer cold, autumn warm, winter hot) relative to weather conditions.

Qian Yi: For Shangfeng (Wind Strike) with drowsiness, hot breath, yawning, and restlessness, disperse the exterior using Daqing Gao (this is an exterior syndrome). (Jiegu's supplement states: for children externally affected by Wind-Cold with stiffness, yawning, restlessness, rough skin, and hot breath, disperse the exterior; use warming herbs in autumn/winter and cooling herbs in spring/summer.)

Daqing Gao Formula: Tianma, Qingdai (ground, 1 qian each), Baifuzi (raw, 1.5 qian), Xiewei (de-venomed, raw, 0.5 qian), Zhusha (ground), Tianzhuhuang (ground), Shexiang (each 1 zi bi), Wushaoshe meat (soaked in wine, baked dry, powdered, 0.5 liang). Grind finely, mix with raw honey to form a paste. Dosage: half to one soap-bean size. For infants under one month, mix with Jingmi Datong Niuhuang Gao and dissolve in mint water. For children over five years, take with Ganlu San.

Xionghuang Gao: Treats Shangfeng with warm-high fever and excessive drinking. Xionghuang (size of small date, ground, boiled in radish root water and vinegar until dry), Gancao powder, Chuantianshao (each 3 qian), Hanshuishi (ground, 5 qian bi), Naobi (1 zi bi), Zhusha (0.5 fen). Grind uniformly, refine with honey into a paste. Dissolve half a soap-bean size in mint decoction. The above formulas are for dispersing exterior signs like drowsiness, hot breath, yawning, and restlessness, specifically designed for children under three who cannot speak.

Huoren: For common Wind obstruction with fever, nasal discharge, phlegm-cough, and thirst, use Xingxing San.

Xingxing San: Treats pediatric Wind-Heat, Shanghan seasonal pathogens, or fever from sores/rashes. Jiegeng, Xixin, Renshen, Baizhu, Gancao, Gualougen, Baifuling, Chuanxiong (equal parts). Powder. Dosage: 2 qian per dose, decoct with 2 slices of ginger and 2 mint leaves. For children under three, divide into four to five doses. This formula cures pediatric cases regardless of Wind Strike, Cold, or Wind-Heat.

Haizang: For Shanghan seasonal pathogens, Wind-Heat, phlegm obstruction, cough, and Qi disharmony, use Sijunzi Tang plus Xixin, Gualou, and Jiegeng (1 fen each), decocted with Shengjiang and Bohe. Add Fangfeng and Chuanxiong (1 fen each) if needed. If there is internal cold or cold weather requires dispersal, remove Gualou and add more Jiegeng. For excessive deficiency sweating and night crying, add Maidong. For Wind Strike with fever, headache, and rapid breathing, use Sijunzi Tang plus Chuanxiong and Fangfeng (equal parts), reduce Xixin and Qianghuo by half, and decoct together.

Huoren: For throat discomfort, phlegm-solidity, and cough, use Shuniuzi Tang.

Yunqizi: Ren Shen Qiang Huo San: Treats pediatric Cold Evil, plague/epidemic pathogens, sores/rashes, headache, body pain, high fever, lethargy/speechlessness, dampness, thirst, phlegm-solidity, and cough. Qianghuo, Duhuo, Chaihu, Renshen, Chuanxiong, Zhike (stir-fried), Gancao (honey-fried), Baifuling (peeled, 2 liang each), Qianhu, Jiegeng, Tianma (wine-soaked and stir-fried), Digupi (0.5 liang each). Powder. Dosage: 2 qian per dose, decoct with 1 cup water and a little mint, strain, and take warm at any time.

Qibao San: Treats seasonal pathogen causing dizziness and body heat. Children take it with their nursing mothers; adults may also take it. Ziye, Xiangfu (stir-fried, 3 liang each), Chenpi, Gancao, Jiegeng, Baizhi, Chuanxiong (1 liang each). Chew up, decoct with Jiang and Zao.

Haizang: Mahuang Huangqin Tang: Treats pediatric Shanghan with no sweating, headache, body heat, and aversion to cold. Mahuang, Chishaoyao, Huangqin (0.5 liang each), Gancao (honey-fried), Guizhi (2.5 qian each). Coarse powder, decoct in water.

Shengma Huangqin Tang: Treats Wind Strike with sweating, headache, fever, and aversion to wind. Shengma, Gegen, Huangqin, Shaoyao (5.5 qian each), Gancao (1.5 qian). Chew up, dosage 2 qian per dose, decoct in water, take warm. The aforementioned Xingxing San etc. are for dispersing exterior signs like headache, fever, and aversion to cold/wind, designed for children over three who can speak, allowing inquiry about symptoms. The first five formulas treat sweating/no-sweating and aversion to wind/cold generally. Formula 5 treats no-sweating and aversion to cold; Formula 6 treats sweating and aversion to wind.

Qian Yi: If Daqing Gao fails to resolve, and there are interior excess signs requiring purgation, use Dahuang Wan. High fever, incessant drinking, and good appetite allow for mild purgation; otherwise, do not purge (this is an interior syndrome). (Jiegu's supplement: High fever, drinking, eating, and constipation require Dahuang Wan as powder. If stool is normal, strictly avoid purgation to prevent exterior heat driving inward and causing dangerous Jie Xiong syndromes.)

Dahuang Wan: Treats Wind-Heat interior excess, hot breath, constipation/red urine, incessant drinking, and signs requiring purgation. Chuanxiong (0.5 liang), Heiqianniu (0.5 liang, half raw half stir-fried), Dahuang (wine-steamed, 1 liang), Gancao (honey-fried, 2.5 qian). Fine powder, bind with thin paste into pills the size of hemp seeds. Dosage: 10 pills for two-year-olds, taken with warm honey water after milk. Stop when loose stools occur; increase dose if no effect.

Huoren: Head/forehead pain, body fever, yellow-red stool, and abdominal heat are treated with Sishun San, Lianqiao Yin, or Sanhuang Wan (see Youke Zhunsheng Rash section). Body tidal fever, dull head/eyes, restless mind, red urine, and constipation indicate severe heat; treat with Xixin San or Tiaowei Chengqi Tang (Xixin San see Rash section).

Forehead/body warmth, white sour-smelling stool indicates food stagnation in Stomach; treat with Shuangsheng Wan (see Pediatric Food Accumulation section).

Jiegu: If no significant surface heat but difficulty urinating, it is Damp-Heat binding the Bladder; use damp-resolving herbs like Baizhu and Baifuling to promote urination, and the heat will subside.

Yunqizi: Pediatric Shanghan with vexatious heat, red/astringent urination, brown stool, and red-hot face is treated with Daochi San.

Qian Yi: Wind Strike affecting Zang organs causes palpitations; affecting Heart causes fright; affecting Lung causes chest oppression, panting, sighing, and cough; affecting Kidney causes photophobia. This follows the principle of tonifying the mother organ due to deficiency.

For Wind Strike with cold hands, Spleen deficiency is suspected; harmonize Spleen first, then disperse exterior. Use Yihuang San to harmonize Spleen and Daqing Gao to disperse exterior (treats Yin Jue with sweating/faint pulse; for Yang Jue with no sweating/slipping pulse, use Dachengqi Tang plus Nifen). For Wind Strike with spontaneous diarrhea, Spleen deficiency is suspected; tonify Spleen first, then disperse. Use Yihuang San and Daqing Gao. If unresolved, use Tiaozhong Wan. If purgation signs exist, use Dahuang Wan, followed by Wenjing Wan.

For Wind Strike with abdominal distension, Spleen deficiency is suspected; tonify Lung to prevent wheezing, then disperse exterior, and continue tonifying Spleen. Use Quzhang Taqi Wan. Disperse exterior with Daqing Gao.

For Wind Strike with vomiting/diarrhea (see Pediatric Vomiting/Diarrhea section; use Yihuang San, Baizhu San, and Daqing Gao).

Tang Shi: For Shanghan complicated by Fright with extreme heat generating Wind, use Bohe San. Boheye, Qianghuo, Quanxie, Mahuang (remove roots/joints), Gancao (1.25 qian each), Tianzhuhuang, Jiangcan, Baifuzi (processed, 2.5 qian each). Fine powder. Dosage: 1 qian, decoct with half cup water to one-third volume, add a little Zhuli.

Yunqizi: Exterior Cold binding pores causes intense heat, generating Wind and potential convulsions. Due to immature Qi/Blood unable to resist pathogens, convulsions occur. With normal bowel/bladder function and hot breath, disperse exterior using Daqing Gao.

If Lung is excessive with Wind-Cold, causing chest fullness, shortness of breath, asthma, and upward Qi, first disperse Lung (Xiebai San) then disperse Wind-Cold (Daqing Gao). If only Shanghan (no chest fullness) with Kidney deficiency causing photophobia, tonify Kidney with Dihuang Wan (use Dihuang Gao intermittently if exterior signs exist).

Post-purgation deficiency heat from excessive purgation leads to Stomach deficiency heat and weak thirst; promote Stomach fluids with Baizhu San. For pediatric interior heat with dry mouth/thirst, yellow body, and heavy weight, use Baizhu San.

Tang Shi: Shanghan with thirst is treated with Baihu Tang.

Jiegu: High fever, drinking, eating, and constipation are treated with Dahuang Wan as powder.

The above three formulas: Baizhu San treats deficiency-thirst post-purgation with poor appetite/Stomach weakness. Baihu Tang and Dahuang Wan treat excess-thirst pre-purgation with good appetite/constipation.

Jiegu: Shanghan cough with clear water vomiting, sighing, and long exhalations indicates Lung deficiency; use Ejiao San. Pale face like dead bone indicates fatal prognosis. Fever, coughing, wheezing, and phlegm are treated with Pianyin Wan (see Pediatric Cough section).

Ejiao San treats deficiency-cough with sighing/long exhalations. Pianyin Wan treats excess-cough with heavy phlegm/wheezing. For exterior signs with aversion to cold/wind and cough, use Xingxing San, modified Sijunzi Tang, or Shuniuzi Tang.

Yin Jue and Yang Jue (see above).

Jiegu: High fever with incessant vomiting is treated with Fuling Banxia Tang (Xiao Banxia Jia Fuling Tang, see Vomiting section).

Tang Shi: Shanghan with vomiting is treated with Zhike Banxia Tang. Zhike, Banxia (0.5 liang each). Decoct with 1 cup water and 10 ginger slices to half cup. Dosage for under ten years: five doses.

Huoxiang Zhengqi San: Treats Shanghan with vomiting. Huoxiangye, Houpo (processed), Banxia (processed), Gancao (honey-fried), Chenpi, Cangzhu (rice-water soaked, equal parts). Chew up. Dosage: 2 qian, decoct with half cup water, 3 ginger slices, 1 jujube, reduce to two-tenths, strain, take warm.

Jiegu: Severe vomiting requires purgation with Baibingzi, Zhenzhu Wan, or Xiaoji Wan (see Pediatric Food Accumulation section). Periodic tidal fever, chest fullness, shortness of breath, and vomiting are treated with Taozhi Wan (see Pediatric Heat Accumulation section). The seven formulas treat Shanghan vomiting: first two for Phlegm-Fluid, middle one for exterior syndrome, latter four for interior syndrome. Taozhi Wan treats interior heat vomiting; others treat exterior cold vomiting.

Tang Shi: Shanghan with spontaneous sweating requires tonifying deficiency and harmonizing Yin/Yang. Use Xiaojianzhong Tang minus Guizhi, plus Huangqi, Renshen, and Dihuang. Huangqi (1 liang), Baishaoyao (3 liang), Gancao, Renshen, Shudihuang (0.5 liang each). Chew up. Dosage: 2 qian, decoct with half cup water to one-third volume, strain, take.

Pediatric Shanghan Signs: Headache, body pain, nasal congestion/runny nose, throat wheezing, surging-rapid pulses, red cheeks/dry eyes, goosebumps, fluid from mouth/nose, red/yellow eyes, dry mouth, cough, blue mountain root, sneezing.

Huoren: Head/eye pain, fear of people, and aversion to cold indicate Shanghan.

Yunqizi: Sudden high fever, aversion to cold, cold limbs, cold ears/buttocks, and hot nasal breath in children resemble Shanghan exterior signs but may be early rash eruption (Taiqi). Treat as rash, not Shanghan. Treating as Shanghan exterior is an error.

Wu Shi: Six Meridian treatments for pediatric Shanghan are similar, but must distinguish from Tai Re, Jing Re, Xue Re, Ke Re, Han Re, Chao Re, Tan Re, Shi Re, Bianfa Fever, Douzhen Fever, and Shangfeng Fever, which all mimic Shanghan. Due to tender bodies, unsettled Qi/Blood, different pulse methods, and lighter/smaller dosages, key points are listed below.

Observe facial color first. Examine Tiger Mouth Pulse Veins: Index finger segments 1, 2, 3 correspond to Chu Guan, Zhong Guan, Mo Guan (Yin/Mao/Chen positions). Male left, female right. Vein at Chu Guan is mild; Zhong Guan is severe; Mo Guan is critical. Purple indicates Fright-Heat; Red indicates Shanghan-Heat; White indicates Gan-Heat/Blood Deficiency; Green indicates Fright/Wind/Cold/Abdominal Pain/Convulsions; Yellow indicates Milk/Food Injury/Spleen Deficiency; Black indicates Cold/Evil/Deep Disease. Purple/Red/Green/Black penetrating to Mo Guan indicates death.

Pulse diagnosis: Ages 4-5 use one finger; 6-7 use two fingers; over 10 use three fingers. Normal respiration for 4-5 years is 7-8 beats (fine-rapid is auspicious); 9 beats is Heat; 10 is Exhaustion; 5 is Cold; 4 is Critical. Age 10 is normal at 5-6 beats. Methods for various fevers are in Youke Zhunsheng.

Food/Milk Heat causes vomiting, undigested milk, sour breath. Food Injury causes epigastric hardness, belching, acid regurgitation, anorexia, strong Qi Kou pulse, hot palms, cool backs, and dorsal-back heat onset. Treat food-injury fever with Liu Junzi Tang base, adding Shenqu, Maiya, etc. For interior excess, add Zhishi, Qingpi. For unresolved heat, add Chaihu, Huanglian, or Huangqin. Without heat, use Xiangsha Baohe Wan.

Bianfa Fever grows Qi/Blood. Mild: fever, fright, cold ears, slight sweat, white bubbles on lips, resolves in 3 days. Severe: alternating chills/fever, chaotic pulse, abdominal pain, crying, anorexia, vomiting milk, resolves in 5 days.

Shangfeng Fever causes drowsiness, stiff Spleen, yawning, stuffiness, nasal congestion/sneezing, clear runny nose, hot breath, heavy cough, spontaneous sweating, wind-aversion. Use modified Renshen Qianghuo San. Differentiate carefully.

Shanghan causes cold-aversion, stiffness, fever (surface-level, day/night), resolving only with sweat. Qian Yi: Males have yellow face/heavy body; females have red face/panting/cold-aversion/hot breath/yawning/stiff neck. Generally, Shanghan shows hot backs, cool palms, and tight Shouren pulse on left. Other meridian diseases follow Six Meridian Fever examples with lighter dosages. Distinguish from Fright/Food Injury Shanghan.

Douzhen Fever: Red cheeks, irritability, sneezing, dry eyes, yawning, fright, heavy body, ear/nose/hand/foot coldness, alternating temp, sleep startles. Do not mistake for Shanghan or force sweat with heavy blankets.

High fever before rash eruption: Use Shengma Gegen Tang. Add Renshen, Baizhu, Baifuling for weak Stomach/poor appetite. Add Zicao Rong to penetrate spots. Danxi warns against Gegen if red spots appear to avoid superficial deficiency and spreading sores. Qian Yi uses Sijunzi Tang plus glutinous rice to boost Stomach Qi. Add Shengma/Zicao Rong to help eruption. Day 3 marks full eruption; if roots are red/vital, no medicine needed. Day 5 expects pus; if plump/shiny, no medicine needed. If no pus by day 5-6, rescue with Renshen, Huangqi, Danggui as chief, plus Baizhu, Chenpi, Baizhi, Chuanxiong, Baishaoyao, Fangfeng, Zhi Gancao. Add Rougui (0.3-0.5 fen) to guide blood and transform pus. For Qi reversal/fullness, add Muxiang (0.2-0.3 fen). For nausea/anorexia, add Dingxiang (3 grains) to open Stomach and raise toxin. These are secret effective methods. For itching/collapse/chills/grinding teeth/cold limbs/vomiting/diarrhea (exterior-interior deficiency), add Roudoukou, Hesui (0.5 fen each), Shufuzi (0.2-0.5 fen). Or use Shixuan Neituo San with these. For pre-scabbing with warm head/cold feet/diarrhea/thirst/panting/cold limbs/restlessness/sighing/chills/no heat, use Chenshi Shiwei Yigong San. For green-dry/purple-depressed with heat, use Bazhen Tang plus Huangqi, Shengma, Zicao Rong, Shengdihuang. See Youke Zhunsheng Rash section. Another method: chicken comb blood mixed with wine for non-erupting/non-pus cases. Burn frankincense in room for itching/scratching. Use Gui-class decoctions. Black/green-dry/purple-depressed/no pus/coma/excessive sweat/irritability/thirst/distension/hoarse cry/constipation are difficult to save. Outer black/inner red is severe; outer white/inner black is very severe; needle-hole black dots are hard to treat. Inner/outer fat-red is best. Simultaneous eruption or dense pinhead eruptions are hard to treat. Careful differentiation is essential.