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If a cold damage disease persists beyond nine days without resolution, it may be that initially only one meridian was affected and failed to transmit further; or it may have transmitted through the three Yang meridians but failed to enter the Yin meridians, causing stagnation for several days with persistent symptoms; or after transmission through both the three Yang and three Yin meridians is complete, a secondary contraction of cold occurs, termed "Liang Gan Shang Han" (Double Contraction Cold Damage), where both fu and zang organs are diseased, resulting in prolonged duration and altered clinical manifestations.

When a cold damage disease has passed its meridian stage yet remains unresolved, accompanied by a pulse that is instead deep and slow, and cold extremities, this indicates the absence of pulse at the lower body, separation of yin and yang qi, and pathogenic factors lodging in the collaterals of the Foot Shaoyin Kidney Meridian. Toxic heat steaming upward causes throat discomfort, pain, or ulceration.

When cold damage pathology remains in the exterior, whether due to lack of sweating therapy, incomplete resolution after sweating, or persistent fever following emesis or purgation, this is due to excessive toxic heat. Since the toxin has not dispersed while the exterior is deficient, heat-toxin exploits this deficiency to emerge on the skin, causing macules and pustules resembling brocade patterns. In severe cases, ulcers form in the throat, mouth, and entire body.

Generally, if sweating therapy is incorrectly applied during winter for cold damage, vomiting and diarrhea will inevitably occur, along with oral erosion and ulceration, because both interior and exterior are hot. Unchecked heat causes toxic vapors to scorch the Upper Jiao.

In cold damage with intense toxic heat, numerous sores often develop. Sores that are white or red, appearing on the skin with vesicles topped by white pus indicate mild toxicity. Those with purple-black bases hidden within the muscles indicate heavy toxicity. In extreme cases, sores appear in the five viscera and seven orifices. These sores resemble peas, hence the name.

Pea sores arising from cold damage are caused by heat-toxin. If dietary restrictions are observed, the sores heal, but residual toxins may remain even after scabs fall off, leading to visible scars or uneven skin texture. Therefore, medications for detoxification and scar removal should be applied.

On the fourth or fifth day of cold damage, if the pulse is deep and accompanied by wheezing and chest fullness, the deep pulse indicates interior pathology. Incorrectly applying sweating therapy causes fluid loss and constipation, resulting in exterior deficiency and interior excess. Prolonged conditions lead to delirious speech. Repeated sweating after initial sweating leads to Yang exhaustion and delirium; if the pulse becomes harmonious, death is avoided. In Yangming disease, bleeding accompanied by delirium indicates heat entering the Blood Chamber. With sweating only on the head, puncturing the Qimen (LR14) acupoint to drain excess is indicated. Generalized sweating signifies recovery. If a patient exhibits delirious speech and agitation, they should have fever and a surging-large pulse; however, if extremities are cold and the pulse is deep, fine, and weak, it is a fatal condition. Delirium with fever and surging-large pulse suggests survival; delirium with deep-fine-weak pulse and cold extremities indicates death.