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Shanghan (Cold Damage) is the general term for all external contraction diseases. Therefore, Zhang Zhongjing, the Medical Sage, authored the *Treatise on Cold Damage* (*Shanghan Lun*). Later scholars have highly regarded it as an essential book for treating conditions caused by the six climatic factors (Wind, Cold, Summer-heat, Dampness, Dryness, Fire).

The "combined syndromes" discussed here refer to situations where Cold pathogen combines with other pathogens, or other pathogens combine with Cold pathogen, resulting in the simultaneous onset of two pathogens. There are approximately twenty-one such syndromes, which are detailed below.

(Commonly known as Cold Wind-Cold; in Zhang Zhongjing's *Treatise on Cold Damage*, it is called Wind Strike.)

[Etiology] When contracting both Wind and Cold, if Cold is heavier than Wind, it is called Zheng Shanghan (Standard Cold Damage); if Wind is heavier than Cold, it is called Leng Shangfeng (Cold Wind-Cold). Leng Shangfeng occurs when a person suddenly suffers from cold wind, or first contracts Cold and subsequently suffers from Wind. It is more severe than common colds occurring in the four seasons, hence commonly known as Heavy Wind-Cold.

[Symptoms] Headache, feverish body sensation, aversion to wind and cold, nasal congestion with heavy voice, coughing with clear nasal discharge, profuse white, slippery, and thin sputum. Alternatively, spontaneous sweating with aggravated cough, or no sweating with wheezing. The tongue coating is white, thin, and slippery, or even white, slippery, and greasy.

[Pulse] In Shanghan, the left-hand pulse should be Floating-Tight (Fu Jin), but now it is instead Floating-Slow (Fu Huan); the right-hand pulse is Floating-Slippery (Fu Hua). This indicates a Wind-pulse appearing in Shanghan. As stated in the *Neijing* (Classic of Internal Medicine): "Those injured by Wind suffer first in the upper part." When Wind and Cold invade humans, the disease enters and resides in the Lung. This is a sign of injury to both Ying (Nutritive) and Wei (Defensive) Qi. The *Nanjing* (Classic of Difficult Issues) classifies it as one of the five types of Shanghan. The similarity and difference between this and Standard Shanghan lie in the meridian involvement: Standard Shanghan usually injures the Foot-Taiyang Meridian first, whereas Leng Shangfeng usually injures the Hand-Taiyin Meridian first.

[Treatment] For patients with spontaneous sweating and cough, first harmonize Ying and Wei to treat the cough, using Guizhi Jupi Tang (Cinnamon Twig and Tangerine Peel Decoction) plus Xingren (Almond Kernel, 3 qian, peeled and not ground) and Qianhu (Peucedani Radix, 2 qian). For patients with no sweating and wheezing, first diffuse Lung Qi to calm wheezing, using Xinjia San'ao Tang (New Modified Three-Ao Decoction) with modifications. Subsequently, for those with thin sputum and severe cough, use Xiao Qinglong Tang (Minor Blue Dragon Decoction) removing Mahuang (Ephedrae Herba), adding Xingren (Almond Kernel) and Juhong (Citri Reticulatae Pericarpium Rubrum) to resolve phlegm and stop cough. For those with profuse sputum and severe cough, use Yeshi Banxia Tang (Yin-Breast Decoction with Pinellia) to diffuse Lung Qi and calm wheezing. Patients must be instructed to strictly avoid sour, cold, and greasy foods so that the root of the disease may be eliminated. Failure to treat or mis-treatment often leads to chronic non-healing conditions, developing into Lung diseases: mild cases transform into Phlegm-Fluid or Phlegm-Fire, while severe cases transform into Feizhang (Lung Distension) or Feilao (Lung Consumption). These occurrences are frequent; doctors and patients alike must exercise caution.

[Xiu's Commentary] The syndrome of Leng Shangfeng was first elucidated in the *Neijing*, stating that Wind entering from outside causes chills, sweating, headache, heaviness of the body, and aversion to cold, treated at Fengfu (GV16). Secondly, in Zhang's *Treatise on Cold Damage*, it states: "Taiyang disease, with fever, sweating, aversion to wind, and slow pulse, is named Wind Strike"; and "Taiyang Wind Strike, with Yang-floating and Yin-weak pulse, Yang-floating indicates spontaneous heat, Yin-weak indicates spontaneous sweating, accompanied by chilly aversion to cold, shivering aversion to wind, warm-feeling fever, nasal roaring, and dry vomiting, is primarily treated with Guizhi Tang (Cinnamon Twig Decoction)." These are all what later generations call Wind-Cold diseases. Later scholars distinguished between Mao Feng (Encountering Wind), Shang Feng (Injured by Wind), and Zhong Feng (Struck by Wind), considering Mao Feng mild, Shanghan heavy, and Zhong Feng heaviest. Consequently, they confused the concept of "Wind as Middle" from Bian Que (Yue Ren) and Zhang Zhongjing with "Zhong Feng" caused by empty wind causing sudden collapse. Did they not know that in ancient texts, "Shang" (Injure) and "Zhong" (Strike/Middle) had similar meanings, as in "Wind injures Wei, Cold injures Ying"? Using only aversion-to-wind-with-sweating versus aversion-to-cold-with-no-sweating to distinguish Shangfeng from Shanghan is insufficient as definitive evidence. The clear distinction lies in: one has only headache and runny nose without body pain; the other has head and body pain, including waist and joints; one has Floating-Slow pulse, the other Floating-Tight pulse. Regarding sweating: Standard Shanghan indeed has no sweat, but Heavy Wind-Cold can also present with no sweat. Thus, Guizhi Tang is originally a formula for inducing sweating in Wind-Cold, merely milder than Mahuang Tang (Ephedra Decoction). Some claim it induces sweating when there is none and stops sweating when there is some; this equivocal statement is most misleading.

[Lian's Examination] Although the symptoms of Heavy Wind-Cold are numerous and complex, patients often pay little attention to them, and doctors become careless until the condition becomes difficult to treat, simply because they consider Wind-Cold a minor ailment. They do not realize that as long as cough persists, the root of the disease remains. Hence the proverb says, "For Wind-Cold cough, even an ordinary doctor suffices," and "Wind-Cold unawakened becomes Consumption." Ancient philosophers like Xu Lingtai wrote "On the Difficulty of Treating Wind-Cold," stating that Wind-Cold enters from skin and hair into the Lung. The Lung is a delicate organ: too cold condenses Wind Qi preventing expulsion; too hot burns Lung Yin causing bleeding; too damp generates Phlegm-Fluid; too dry consumes Body Fluids; too draining causes sweating leading to Yang deficiency; too astringent causes Qi closure and pathogen entrapment. Furthermore, people who view it as a trivial illness, fail to avoid Wind-Cold, and neglect diet, allow the pathology to deepen over years, resulting in Blood Syndromes, Feiwei (Lung Flaccidity), Asthma, or Debility, which are common. Observing this, mistreatment of Wind-Cold leading to severe consequences is consistent across ancient and modern times, explaining why chronic cough turning into Consumption appears frequently. I treat this syndrome by warning patients seriously, instructing them to observe dietary restrictions and avoid wind, prescribing my self-made Shufeng Zhisou Tang (Dispersing Wind and Stopping Cough Decoction): Jingjie Sui (Schizonepetae Spica, 1.5 qian), Su Bohe (Menthae Haplocalycis Herba, 1 qian), Guang Xingren (Prunus Armeniacae Semen, 2 qian), Guang Pi Hong (Citri Reticulatae Pericarpium Rubrum, 0.8 qian), Baibu (Stemonae Radix, 1.5 qian), Qing Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle, 0.6 qian), Ziwan (Asteris Radix, 2 qian), Baiqian (Cynanchi Stauntonii Radix, 1.5 qian). Repeated administration yields effective results. It is neither too hot, dry, nor draining, nor too cold, damp, nor astringent, so patients accept it willingly. Though the formula is plain, its efficacy is significant. However, for those addicted to gambling, excessive alcohol/sex, or stubborn in their ways, complete cure is difficult. Doctors must advise faithfully and guide them well.

[Rongzhai's Commentary] If, after three or four days of Heavy Wind-Cold, the aversion to wind and cold subsides, leaving fever, headache or generalized body pain, nasal congestion with heavy voice, cough, and profuse sputum, Mr. Nie Yuntai offers a Standard Formula for Heavy Wind-Cold. The prescription is: Huangqin (Scutellariae Radix, 2 qian), Baishao (Paeoniae Radix Alba, 2 qian), Lianqiao (Forsythiae Fructus, 3 qian), Xiang Bei (Fritillariae Thunbergii Bulbus, 3 qian), Chantui (Cicadae Periostracum, 1 qian), Zhuru (Bambusae Caulis in Taenia, 3 qian), Sangbaipi (Mori Cortex, 3 qian), Sangye (Mori Folium, 1.5 qian), Zhike (Aurantii Fructus Immaturus, 1 qian), Xingren (Prunus Armeniacae Semen, 3 qian), Pipaye (Loquati Folium, 3 qian, decocted in bag), Bohe (Menthae Haplocalycis Herba, 0.8 qian, infused, not decocted). Mr. Shen Zhonggui of Chongqing Seventh People's Hospital believes: "The overall effect of this formula is inducing sweating, resolving heat, suppressing cough, and expelling phlegm. It is indeed an excellent formula for Influenza (i.e., Heavy Wind-Cold); however, according to modern TCM medication principles, the inclusion of Baishao seems prominent, and it might be better to omit it." Mr. Shen also systematically described the etiology and symptom progression of Heavy Wind-Cold: "Heavy Wind-Cold is Influenza. Its pathogen is a filterable virus with an incubation period of one to three days. The onset is acute, with chills, fever, and generalized body pain, particularly severe in the back, head, and limbs. Body temperature rises rapidly (38°C–41°C). Upper respiratory tract inflammation develops quickly, manifesting as clear nasal discharge, dry cough, sore throat, sternal pain, conjunctival congestion, and general weakness. Hemogram shows leukopenia. Blood culture reveals no bacteria. Prognosis is good, with fever subsiding after about five days." The above refers to simple influenza. Another type is "simple influenza with complications," i.e., influenza secondary to suppurative bronchitis; this corresponds to the syndrome proposed by Mr. Yu Genchu: "If prolonged and unhealed, mild cases transform into Phlegm-Fluid, severe cases transform into Lung Distension."