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The manifestations of Shanghan (Cold Damage) include headache and pain in the head and nape, stiffness of the lower back and spine, muscle spasms and tightness of the body, fever on the surface with aversion to cold, absence of irritability, no spontaneous sweating, or possibly headache, heat in the muscles, dry nose, chest fullness with wheezing, slight coldness at the tips of the hands and feet, and a floating, rapid, and tight pulse. These are all indications of pathogenic heat remaining on the exterior, constituting syndromes suitable for diaphoresis using Mahuang Tang (Ephedra Decoction), or alternatively, using Fangji Tian Shui San (Fangji and Natrii Sulfas Powder), which is also excellent.

Shanghan causing body heat indicates heat in the exterior; thirst for drinking or yellow-red urine indicates heat in the interior; body heat with thirst, or yellow-red urine, indicates heat in both the exterior and interior; cool body without thirst and clear-white urine indicate no heat in either the exterior or interior. Body pain, spasms, surface heat with aversion to cold, and a floating pulse all indicate heat in the exterior. Thirst, delirium, abdominal fullness with solid pain, fever, and a deep pulse all indicate heat in the interior. Chest and hypochondriac stuffiness and pain, or vomiting with alternating chills and fever, and a pulse felt at the muscle level (neither floating nor deep), indicate pathogenic factors half in the exterior and half in the interior.

If the pulse is deep immediately upon onset of illness, with interior pathology and harmonious exterior, it is an internal injury. If the pulse is floating with exterior pathology and harmonious interior, it is an external injury. Disease located in the body, head, face, and four limbs is exterior disease; disease located within the chest and abdomen is interior disease.

Wind and cold are the beginnings of hundred diseases, representing the irregular qi of the four seasons and eight solar terms, and epidemic pestilential qi. Thus it is said: Spring qi is mild and warm, Summer qi is hot and sultry, Autumn qi is cool and clear, Winter qi is cold and icy; these are the regular qi of the four seasons. In winter, severe cold causes all things to hide deeply; if gentlemen maintain their solidity and closeness, they will not be injured by cold; those who expose themselves to it will be injured. If spring should be warm but is instead cold, summer should be hot but is instead cold, autumn should be cool but is instead hot, and winter should be cold but is instead warm, this is non-seasonal pathogenic qi. Therefore, regardless of status, people of all ages fall ill during the year. The disease begins on the first day with Juyang (Taiyang / Greater Yang) channel involvement, where the Bladder receives it. Juyang is the head of the three Yang channels, so it receives it first. On the second day, Yangming (Yang Brightness) channel is involved, received by the Stomach. On the third day, Shaoyang (Lesser Yang) channel is involved, received by the Gallbladder. Before entering the Zang-Fu organs, diaphoresis can be used. On the fourth day, Taiyin (Greater Yin) channel is involved, received by the Spleen. On the fifth day, Shaoyin (Lesser Yin) channel is involved, received by the Kidney. On the sixth day, Jueyin (Terminal Yin) channel is involved, received by the Liver. Once entering the Zang organs, purgation can be used. The classic states: If less than three days have passed, use diaphoresis; if more than three days have passed, use purgation. Thus, the sages discussed sweating and purging methods generally. Differentiating by pulse, if the pulse is deep and hidden on days three or four, purgation is also indicated; if the pulse is floating and slippery on days six or seven, diaphoresis can also be used.

Therefore, whether Shanghan transmission affects only the Foot meridians and not the Hand meridians remains unclear. Furthermore, the twelve meridians of the human body distribute up and down to the hands and feet, each having three Yin and three Yang, inheriting the qi of Heaven and Earth. Above Tianshu (CV25), it corresponds to Heaven's Yang; below Tianshu, it corresponds to Earth's Yin. The *Zhizhen Yao Da Lun* (Supreme Importance to the Great Treatise) states: Above the midpoint of the body, its qi is divided into three, belonging to the division of Heaven, governed by Heavenly Qi; below the midpoint of the body, its qi is divided into three, belonging to the division of Earth, governed by Earthly Qi. The commentary notes: Where there is Yin division, cold diseases belong here; where there is Yang division, heat diseases belong here. There are pathogenic factors from the eight solar terms that attack humans; Yang pathogenic factors transmit to Hand meridians, while Yin pathogenic factors transmit to Foot meridians. From where does the pathogen enter? It enters via Fengchi (GB20), located one inch and five fen lateral to the spinal column, which is the Shu-Stream point of the Foot Bladder Meridian. Spring and Summer correspond to Yang, Autumn and Winter correspond to Yin. The *Zhizhen Yao Da Lun* states: Cold, heat, warmth, and coolness, their flourishing and declining uses. In the four pivotal points, thus the movement of Yang begins with warmth and flourishes with heat; the movement of Yin begins with coolness and flourishes with cold. Spring, summer, autumn, and winter differ by their respective divisions. The *I Ching* (Book of Changes) states: Water flows to wetness, fire moves toward dryness. The *Re Lun* (Treatise on Heat Diseases) states: Heat diseases are all of the category of Shanghan. When humans are injured by cold, they develop heat diseases; even if the heat is severe, death does not ensue. The *Taiyin Yangming Lun* states: Yang receives wind qi, Yin receives dampness qi. The commentary notes: This is due to like qi seeking like. It also says: Those injured by wind receive it first in the upper part; those injured by dampness receive it first in the lower part. The commentary notes: Yang qi flares upward, hence receiving wind; Yin qi moistens downward, hence receiving dampness, essentially due to like qi combining. Thus, wind, heat, and fire are Yang; cold, dampness, and dryness are Yin. The *Ci Re Lun* (Treatise on Acupuncture for Heat Diseases) states: All five Zang organs have heat diseases. Liver heat disease: the left cheek becomes red first. Heart heat disease: the forehead becomes red first. Spleen heat disease: the nose becomes red first. Lung heat disease: the right cheek becomes red first. Kidney heat disease: the chin becomes red first. The *Jia Yi Jing · Re Lun* states: There are Hand and Foot Taiyin heat diseases, Hand and Foot Shaoyin heat diseases, and Hand and Foot Jueyin heat diseases. The *Re Lun* states: If the three Yin and three Yang channels, and the five Zang and six Fu organs are all diseased, Ying and Wei do not circulate, and the five Zang are blocked, then death occurs. It has never been heard that transmission affects only Foot meridians and not Hand meridians.

Mahuang Tang (Ephedra Decoction): Treats Shanghan with headache, fever, body pain, aversion to wind, no sweat, and wheezing. Also treats Taiyang disease with floating-tight pulse, no sweat, fever, body pain, unresolved after eight or nine days, with exterior syndrome persisting, still requiring diaphoresis. If the patient experiences irritability and closed eyes, epistaxis (nosebleed) will surely occur; epistaxis indicates heavy Yang qi.
Mahuang (Ephedrae Herba, 1.5 liang, remove joints) Guizhi (Cinnamomi Ramulus, 1 liang, remove bark) Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 liang, honey-fried, crushed) Xingren (Armeniacae Semen Amarum, 20 seeds, soaked, remove skin and tips)
Grind the above into powder. Take 3 qian per dose, decoct in 1.5 zhan of water until 0.8 zhan remains, remove dregs, take warm, at any time, cover with clothing to induce sweating.
For dampness disease with body discomfort and pain, and free urination, add Baizhu (Atractodis Macrocephalae Rhizoma, 4 fen) to induce slight sweating.

Guizhi Tang (Cinnamon Twig Decoction): Treats Shanghan with fever, aversion to cold, dry retching, and headache. Taiyang Zhongfeng (Wind Strike), with floating Yang and weak Yin, releases the muscle layer. Floating-tight pulse, nasal congestion/wheezing.
Guizhi (Cinnamomi Ramulus, 3 fen, remove bark) Shaoyao (Paeoniae Radix, 3 fen) Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen)
Crush the above to the size of hemp seeds. Take 5 qian per dose, decoct in 1.5 zhan of water with 3 slices of Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and 3 Zao (Jujubae Fructus, Jujube) until 0.7 zhan remains, take at any time.

Xiao Qinglong Tang (Minor Blue Dragon Decoction): Treats Shanghan where exterior syndrome has not resolved, fluid retention in the epigastrium, dry retching, fever with cough, or thirst, diarrhea, or dysuria, lower abdominal fullness, and wheezing.
Mahuang (Ephedrae Herba, remove joints, soak in boiling water to remove yellow juice, bake dry, 3 qian) Banxia (Pinelliae Rhizoma, wash in boiling water) Shaoyao (Paeoniae Radix) Xixin (Asari Radix et Rhizoma) Ganjiang (Zingiberis Rhizoma, Dried Ginger) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) Guizhi (Cinnamomi Ramulus, remove bark, each 3 fen) Wuweizi (Schisandrae Fructus, 2 qian)
Crush the above to the size of hemp seeds. Take 5 qian per dose, decoct in 1 large zhan of water with Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Zao (Jujubae Fructus, Jujube) until 0.5 zhan remains, take warm at any time.
For thirst, remove Banxia (Pinelliae Rhizoma), add Gualougen (Trichosanthis Radix, 3 qian). For mild diarrhea, remove Mahuang (Ephedrae Herba), add Yuanhua (Genkwa Flos, amount of a bean). For belching, remove Mahuang (Ephedrae Herba), add Fuzi (Aconiti Lateralis Radix Praeparata, 3 qian, processed) to open stagnant heat. For dysuria and lower abdominal fullness, remove Mahuang (Ephedrae Herba), add Fuling (Poria, 4 qian). For wheezing, remove Mahuang (Ephedrae Herba), add Xingren (Armeniacae Semen Amarum).

Da Chaihu Tang (Major Bupleurum Decoction)
Xiao Chaihu Tang (Minor Bupleurum Decoction)

Guiti San (Melon Seed Powder): Treats Shanghan where exterior syndrome has resolved, pathogenic heat enters the interior, knots in the chest, neck is not stiff, abdominal fullness prevents eating, limbs are slightly cold, and pulse is intermittently tight. Vomiting (emesis) is appropriate. The classic states: What is above, vomit it; what is below, purge it.
Guiti (Cucumeris Fructus, Melon Seed) Chixiaodou (Vigna Angularis, Red Bean) (equal parts)
Grind the above into powder. Use Xiangchi (Sojae Seminis Preparatum, Fermented Soybean, 0.5 he) boiled in 1.5 zhan of water to obtain 0.5 zhan of juice, mix with the powder. If vomiting does not occur, increase the dose.

Wuling Tang (Five-Ling Decoction, i.e., Wuling San): Treats Shanghan complicated by summerheat, after profuse sweating, stomach dryness, irritability and inability to sleep, floating pulse, dysuria, slight heat with irritability and thirst, as well as heat in both exterior and interior, drinking water leading to regurgitation (known as Shuini / Water Counterflow). Or when attacking the exterior fails to resolve, when sweating was indicated but purgation was wrongly used, resulting in unceasing diarrhea, floating pulse, unresolved exterior, and spontaneous diarrhea. Or for any retained fluid accumulation that does not disperse, water stagnating in the epigastrium. Also for simultaneous contraction of cold and dampness leading to confusion and irritability, Huoluan (Cholera-like disorder) with vomiting, diarrhea, and convulsions.
Zhuling (Polyporus, remove skin) Fuling (Poria, remove skin) Baizhu (Atractodis Macrocephalae Rhizoma, each 0.5 liang) Gui (Cinnamomi Ramulus, 1 fen, remove bark) Zexie (Alismatis Rhizoma, 1 liang)
Grind the above into powder. Take 2 qian per dose, mixed with hot water is best. Adding Hushi (Talcum, 2 liang) is very good. For wheezing, cough, irritability, and inability to sleep, add Ejiao (Colla Corii Asini, Donkey-Hide Gelatin, 0.5 liang, charred). In midsummer during great heat, mix with fresh water for immediate cure.