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There are two types of syndromes. The first is the Cold-Water Insulting Earth syndrome (Han Shui Wu Tu Zheng). It presents with vomiting, diarrhea, abdominal pain, coldness of the hands and feet, spontaneous sweating of cold sweat, muscle twitching (Rou Tun Jin Ti), weak voice, poor appetite with epigastric fullness, especially cold soles, clear and white urine, a fat and tender tongue body, black and slippery coating (with black color appearing only in the center of the tongue), and a deep, faint pulse nearly imperceptible. These are all evidences of true interior cold. However, there is floating heat on the skin surface, which disappears upon heavy pressure; restlessness, thirst wanting to drink water but drinking little; dry mouth and sore throat; demanding water but being unable to drink when it arrives. This is rootless Yin fire, caused by excess Yin inside forcing Yang to the exterior, constituting the Ge Yang syndrome (Ge Yang Zheng) characterized by false exterior heat and true interior Yin-cold. The treatment method should be to warm and strengthen Spleen-Yang, using Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) to rescue it. The second is the Kidney-Qi Overwhelming Heart syndrome (Shen Qi Ling Xin Zheng). It presents with shortness of breath and rapid respiration, dizziness, palpitations, cold feet, clear urination, loose stools or diarrhea, scarcity of Qi making speech difficult, and gasping for breath if forced to speak. Although the coating is black reaching the tip of the tongue, the tongue body is floating, fat, and tender. These are all evidences of true interior deficiency-cold. However, there is occasional bleeding from the mouth and nose, dry mouth, floating teeth, a red and delicate complexion with whiteness, restlessness wanting to strip naked, or desire to sit/lie in mud or water. The pulse is floating and rapid, scattering upon heavy pressure, or floating and large filling the finger pads but hollow upon heavy pressure. This also belongs to rootless Yin fire, caused by exhaustion of Yin below and hyperfloating of Yang above, constituting the Dai Yang syndrome (Dai Yang Zheng) characterized by false upper heat and true lower deficiency-cold. The treatment method should be to nourish Yin and anchor Yang, using Jia Wei Jin Gui Shen Qi Tang (Modified Golden Chamber Kidney Qi Decoction) to rescue it. In summary, although complications of Shanghan (Cold Damage) manifest in hundreds of ways, they always revolve around the four characters: Exterior-Interior, Cold-Heat. The relationship between Exterior-Interior and Cold-Heat may not be consistent, but it ultimately adheres to the essence of this chapter. These ten points are the key techniques for distinguishing Exterior-Interior and Cold-Heat.

[Commentary by Xiu] This is the general principle for distinguishing Exterior-Interior and Cold-Heat. Beginners must read it repeatedly and memorize it firmly.

[Review by Lian] Distinguishing Exterior-Interior and Cold-Heat is not difficult. Even for false cold and false heat, if one can skillfully use a thermometer to measure the degree of fever and conduct precise tests, it is not hard to distinguish. The most difficult aspect is medication. For cold conditions, Rhinoceros Horn (Xijiao), Antelope Horn (Lingyang), and Calculus Bovis (Niuhuang) are used; for heat conditions, Radix Aconiti Preparata (Fuzi), Cinnamomi Cortex (Guirou), and Sulfur (Huanghuang) are used; for tonification, Ginseng Radix (Renshen) and Rehmanniae Radix Praeparata (Shudihuang) are used; for purgation, Rhei Radix et Rhizoma (Dahuang) and Natrii Sulfas (Mangxiao) are used. If fortunate enough to hit the pathogenesis accurately, even cautious doctors might criticize the potency as too strong; if unfortunate and death occurs, quacks are accused of murder, with accusations coming from all sides. Therefore, famous doctors often tend to avoid serious treatments and choose lighter ones.