Urgent purgation (Ji Xia) and urgent warming (Ji Wen) are indicated because the disease condition is critical and liable to undergo transformation, unlike ordinary diseases which can be treated slowly. For instance, in Shaoyin disease (Disease of the Lesser Yin), if there is dry mouth and tongue with thirst, it is due to internal consumption by pathogenic heat, and the Kidney Water (Yin fluids of the Kidney) is about to be exhausted; therefore, urgent purgation is required to save the nearly exhausted Kidney fluids. In Shaoyin disease, if there is spontaneous diarrhea of pure clear water, hardness and pain in the epigastrium, dry mouth and thirst, urgent purgation is required. In Shaoyin disease, if there is abdominal distension, hardness, and pain, or periumbilical pain with constipation, this indicates Earth overacting on Water (Spleen/Stomach excess suppressing Kidney deficiency), and urgent purgation is required. In Yangming disease (Disease of the Greater Yang), if there is profuse sweating and high fever, fearing the drying of Stomach fluids, urgent purgation is required to preserve the Jin-Ye (Body Fluids). In Yangming disease, if there is abdominal fullness and pain, it indicates Earth Excess (Intestinal Heat-Excess), and urgent purgation is required. In febrile diseases, if vision is unclear and the fever does not cease, death is likely. Unclear vision indicates that Kidney Water has been exhausted and cannot illuminate objects, which is a critical state; urgent purgation should be employed. These five conditions all call for Dachengqi Tang (Major Order the Qi Decoction). There are two indications for urgent warming in Shaoyin disease: when internal cold is abundant and the Yang Harmony Qi is about to perish, urgent warming is required; when there is cold-fluid retention above the diaphragm in Shaoyin disease causing dry retching, which cannot be treated by emesis, urgent warming is required, using Sini Tang (Four Reversal Decoction). This demonstrates the efficacy of emergency rescue.

If the Biao (Branch/Surface) and Ben (Root/Interior) of Shanghan (Cold Damage) are not understood, it is like walking at night in the dark without seeing the path. The so-called Biao refers to the superficial or secondary aspects of the disease; the Ben refers to the root or primary aspect. The initial pathogen acquisition constitutes the Ben, while subsequent manifestations constitute the Biao. When Ben and Biao transmit together, treating the urgent aspect first is a good method. For example, if headache and aversion to cold occur initially, these are designated as Ben; if fever occurs subsequently, these are designated as Biao. This distinguishes the Ben and Biao of pathogen acquisition. This principle can be extrapolated to other cases. Regarding pulse Ben and Biao, for instance, floating and deep pulses constitute the Ben, while deficient and excess pulses constitute the Biao; this is the Ben and Biao of the pulse.

In general, when diagnosing Shanghan, one must first observe the eyes, noting if they are red or yellow. Redness indicates Yang Toxin; if the six pulses are surging and forceful with dry thirst, mild cases use Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction), while severe cases use Dachengqi Tang. Yellowing indicates Jaundice; if urination is difficult or reddish, accompanied by lower abdominal distension without pain, thirst, solid stool, and a deep, solid, and forceful pulse, it is Damp-Heat Jaundice. Mild cases use Yinchen Wuling San (Artemisia Capillaris and Five Ingredients Powder), while severe cases use Yinchen Tang (Artemisia Capillaris Decoction) to separate and drain the urine; once the urine becomes clear and white, recovery ensues, and the jaundice subsides. The Jie Fa (Snatching Method) is detailed before the Shachechui Fang (Kill Cart Hammer Prescription). Next, inspect the mouth and tongue for coating. If a slippery white coating is seen, the pathogen has not entered the interior but belongs to the Half-Exterior Half-Interior syndrome, suitable for Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize. If a yellow coating is on the tongue, it indicates pathogenic heat in the Stomach Fu organs, requiring purgation with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). Purgation is only appropriate if the stool is dry and solid, the pulse is deep and forceful, and there is great thirst. If the stool is not solid, the pulse is not deep, and there is only slight thirst, purgation is contraindicated; Xiaochaihu Tang is particularly suitable. If a black coating with prickles appears on the tongue, it indicates Kidney Water overcoming Heart Fire, with nine out of ten cases resulting in death; urgent purgation with Dachengqi Tang is undoubtedly required, as this represents extreme pathogenic heat. The Jie Fa is detailed before the Shachechui Fang.

Subsequently, palpate the chest, heart, down to the lower abdomen for tenderness. If pressing below the heart reveals hardness and pain, intolerable to touch, accompanied by dry thirst, delirious speech, solid stool, and a deep, solid, forceful pulse, it is a Jie Xiong (Chest Binding) syndrome. Urgently use Daxianxiong Tang (Great Chest-Breaking Decoction) added with Zhike (Aurantii Fructus) and Jiegeng (Platycodonis Radix) for purgation; treatment should be moderate according to the deficiency or excess of Yuan Qi (Primal Qi). If the chest and heart feel full and stifling but are not painful, the pathogen remains in the Exterior and has not entered the Fu organs; it is pathogenic qi filling the chest. Only Xiaochaihu Tang added with Zhike and Jiegeng is needed to treat the stifling sensation. If ineffective, one dose of Xiaoxianxiong Tang (Minor Chest-Breaking Decoction) combined with the base formula works miraculously. If pressing below the heart reveals distension without pain, it is Pi Man (Pi Fullness); use Xiexin Tang (Drain the Epigastrium Decoction) added with Zhike and Jiegeng. If pressing the lower abdomen causes pain, but urination is free, stool is black, possibly with body yellowing, delirious restlessness, dry thirst, and a deep, solid pulse, it is Xu Xue (Blood Stasis); use Tao Ren Chengqi Tang (Peach Kernel Order the Qi Decoction) until the black material is evacuated, then recovery occurs. If pressing the lower abdomen reveals distension without hardness or pain, and urination is difficult (strangury), use Wuling San (Five Ling Powder) with modifications to promote urination. Do not drain too vigorously, lest it deplete the Jin-Ye. If pressing the periumbilical area reveals hardness and pain, thirst with short, red urine, and solid stool, there are Dry Feces; use Dachengqi Tang for purgation. The Jie Fa is prepared before the Shachechui Fang.

Furthermore, inquire about the patency of urination and defecation, any pain, and what medicines have been taken, to ascertain the truth. Ensure every detail is clear, matching symptoms and pulses, so that administering purgatives involves no error.

In general, treating Shanghan, if vomiting of roundworms is observed, even with high heat, cooling medicines are contraindicated; violating this leads to death. This is because cold in the Stomach causes roundworms to ascend to the diaphragm, a sign of great ominousness, unknown to many. Urgently administer Paogan Lizhong Tang (Baked Ginger Regulate the Middle Decoction) with two Wu Mei (Mume Fructus) and ten Huajiao (Zanthoxyli Pericarpium). After the roundworms settle, use Xiaochaihu Tang to reduce the fever. Roundworms quiet upon tasting sour and remain calm upon tasting bitter.

In general, treating Shanghan, if there is irritability, thirst, and desire to drink, it is because internal fluids are exhausted, seeking external water for self-rescue. If greatly thirsty and desiring to drink one sheng, provide only one bowl; always leave them slightly unsatisfied, do not overindulge. If drinking excessively, water may stagnate below the heart, leading to Shui Jie Xiong (Water Chest Binding) and other syndromes. If it shoots into the Lungs, it causes panting and coughing; if retained in the Stomach, it causes dysphagia and hiccups; if overflowing into the skin, it causes edema; if accumulating in the Lower Jiao, it causes strangury; if seeping into the intestines, it causes diarrhea. All these are faults of excessive drinking. One must neither withhold water nor force it. The Classic states: "If one does not drink, it is not proper treatment; forcing drinking will cause other diseases to arise." This is precisely what is meant.

In general, treating Shanghan, if more than ten days have passed and exterior signs still warrant sweating, administer Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) to induce mild sweating. If ten days have passed and interior signs warrant purgation, Dachaihu Tang (Greater Bupleurum Decoction) may be used for purgation. Since Shanghan passing through its stages often leaves the Zheng Qi (Upright Qi) deficient, one fears that Mahuang Tang (Ephedra Decoction) and Chengqi Tangs are too harsh; misusing Mahuang may cause Wang Yang (Loss of Yang), and misusing Chengqi Tang may cause inability to tolerate the purge, hence this warning. If exterior signs are not yet resolved, but interior signs are urgent and purgation is unavoidable, Dachaihu Tang should be used to unblock both exterior and interior while treating moderately. For elderly, weak individuals with dual deficiency of Blood and Qi who have indications for purgation, Dachaihu Tang is also used for purgation without damaging Yuan Qi. However, for those in their prime with robust strength, this prohibition does not apply; treatment should adapt to the disease.

In general, treating Shanghan, if the Chi (Cun-Kuan-Chi) pulse is weak and forceless, sweating and purgation are strictly contraindicated; if the Cun (Inch) pulse is weak and forceless, emesis is strictly contraindicated; in both cases, Xiaochaihu Tang should be used to harmonize.

In general, treating Shanghan, after sweating or purgation, immediate tonification with Renshen (Ginseng Radix et Rhizoma) or heavy tonics is contraindicated; instead, modify Xiaochaihu Tang to harmonize. Heavy tonification allows the pathogen to gain support from the tonic, intensifying the heat and generating other syndromes. Hence it is said that there is no tonification method for treating Shanghan. However, if previous sweating or purgation resulted in extreme weakness with a forceless pulse, sweet-warm agents may be used for tonification; this is a good method. Cases of Cold Damage contracted from labor are not subject to the prohibition of tonification; use judgment in applying them.

In general, treating Shangshu (Summerheat Injury), like Shanghan, involves heat; misdiagnosis and mistreatment are harmful. Shanghan presents with external aversion to cold and a floating-tight pulse, whereas Shangshu presents without aversion to cold and with a deficient pulse; thus, treatments differ. The Classic states: "Pulse surging with body cold comes from Shanghan; pulse deficient with body heat comes from Shangshu." Treatment should utilize Xiaochaihu Tang added with Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma), or Renshen Baitu Tang (Ginseng White Tiger Decoction). If prolonged rainy weather causes dampness to prevail, Cangzhu Baitu Tang (Atractylodis Macrocephalae White Tiger Decoction) is used. If the Yuan Qi is inherently weak and the injury is severe, Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) is used for treatment.