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Wumei (300 fruits), Xixin (6 liang), Ganjiang (10 liang), Huanglian (1 jin), Danggui (4 liang), Fuzi (processed, 6 liang), Shujiao (de-sweated, 4 liang), Guizhi (6 liang), Renshen (6 liang), Huangbai (6 liang).

The above ten ingredients. Crush each separately, sift, and mix. Soak Wumei in vinegar overnight. Remove the pits. Mix with five sheng of rice and cook. Once the rice is cooked, pound it into a paste. Mix the medicinal powder with the rice paste until well combined, then place in a mortar. Add honey and pound two thousand times. Form pills the size of paulownia seeds. Take before meals, ten pills per dose with warm water, three times daily. Gradually increase to twenty pills per dose. Avoid raw, cold, slippery, and spoiled foods.

Cheng Wuji's commentary states: The Lung governs Qi. Lung Qi desires to consolidate, so sour flavors are urgently used to consolidate it; the sourness of Wumei consolidates Lung Qi. The Spleen desires relaxation, so sweet flavors are urgently used to relax tension; the sweetness of Renshen relaxes Spleen Qi. When Cold pathogen overflows internally, acrid flavors are used to moisten, and bitter flavors to firm. The acridity of Danggui, Guizhi, Shujiao, and Xixin moistens internal Cold. For excessive Cold pathogen, acrid-hot substances are given; the acrid-hot nature of Ganjiang and Fuzi defeats Cold. Roundworms move when encountering sweet flavors and settle when encountering bitter flavors; the bitterness of Huanglian and Huangbai settles the roundworms.

Hu notes: Cheng Wuji's commentary above is not crucial and may be deleted.

*Neitai Fangyi* states: Huijue (roundworm syncope) is often fatal. The patient's Yang Qi is weak and minute, and Zheng Yuan (vital energy) is depleted. Consequently, ingested food fails to transform into essence but instead transforms into roundworms. Roundworms are Yin insects; thus, we know that Yang is weak and Yin prevails. When Yin prevails, the limbs often become cold (Jue). If the patient is occasionally irritable and quiet, vomits after eating, or constantly spits bitter fluid and occasionally vomits roundworms, this is a roundworm syndrome. Additionally, abdominal pain with a floating and large pulse also indicates roundworm syndrome. Such cases require urgent treatment; failure to treat leads to death. Therefore, Wumei is used as the Sovereign herb; its sour taste subdues roundworms. Chuanjiao and Xixin are used as Ministers; their acridity kills parasites. Ganjiang, Guizhi, and Fuzi are used as Assistants to defeat Cold and warm the Middle Jiao. The bitterness of Huanglian and Huangbai settles the roundworms. The sweetness of Renshen and Danggui tonifies and moderates the Middle Jiao, serving as Envoys. Moreover, this roundworm affliction is more severe than Ascaris lumbricoides or other parasites; harsh purgative anthelmintics are unsuitable. Thus, a formula based on control and suppression is employed.

Hu notes: The above discussion is theoretically sound. However, the statement "abdominal pain with a floating and large pulse" refers to stomach heat causing vomiting of roundworms. Dai Yanli recorded a case of a patient with Yang toxicity, jaundice, mouth ulcers, sore throat, and vomiting of roundworms, who recovered using cold-natured medicines. Such syndromes should not be conflated with middle-Jiao Cold causing roundworm vomiting.

Chen of Wuling states: Wumei Wan specifically treats Huijue. The formula is named Wumei because all herbs in the formula are governed by Wumei. Why? Cold Qi rises directly from the Shaoyin/Yueyin level to rush against the Heart and Stomach. Roundworms have no choice but to rise to the diaphragm and vomit. Without acrid-warm herbs, the rebellious Qi cannot be gathered; if rebellious Qi is not gathered, roundworms cannot be subdued. Rebellious Qi stems from Zang Cold; therefore, a group of acrid-hot herbs must be used to overcome it. Fuzi, Shujiao, Ganjiang, Guizhi, and Xixin are all acrid-hot, but their functions differ. Fuzi dispels Yin and restores Yang; Shujiao kills parasites and benefits Fire; unprocessed Ganjiang is used for its heat to overcome Cold and its acridity to scatter rebellious Qi; Xixin is used to vent Cold pathogen from the Yin meridians, preventing it from entering the Zang via the meridians. Wood withers when meeting Guizhi; hence, Guizhi is used. But why not use Rougui (Cinnamon Bark)? Because Jueyin Wind-Wood diseases manifest with fright and terror; their nature rises from the depths of the Nine Origins, appearing urgent and violent—all characteristics of Wind. Guizhi treats various Wind conditions. Zang Cold implies extremely weak Yuan Qi; thus, Renshen is naturally included to tonify and assist warmth. Danggui is added because it enters the Jueyin meridian, nourishes Liver Blood, and its acrid-warm nature disperses internal Cold, serving as a guiding herb. The bitterness of Huanglian and Huangbai subdues roundworms, acting as a counter-treatment, completing the method of warming/tonifying with reverse assistance, all unified by the astringent Wumei. This is what is meant by a disciplined army.

If the patient has cold extremities, claims no chest binding (Jie Xiong), and has fullness and tenderness upon pressure in the lower abdomen, this is Cold Binding in the Bladder and Guanyuan area. (This clause describes Jueyin Middle-Cold with Cold Binding in the Lower Abdomen. The Jueyin meridian reaches the lower abdomen. Cold extremities indicate Yin-Cold pathogen striking directly inward. No chest binding rules out Yang-Heat. Lower abdominal fullness and tenderness: Cheng Wuji notes this is Lower Jiao Cold Binding. The Bladder and Guanyuan correspond to the lower abdominal region. ○ Note: Zhang Zhongjing provides no treatment method here. *Bu Wang Lun* by Pang Anshi suggests moxibustion at Guanyuan. According to *Tu Jing*, Guanyuan is located on the midline of the abdomen, three cun below the umbilicus, an intersection of the Three Foot Yin Meridians and Ren Mai. It treats pain below the umbilicus; moxibustion is effective, up to one hundred moxa cones. I believe moxibustion at Guanyuan will resolve the Cold Binding in the Bladder.)

[Image: Guanyuan Acupoint Diagram]

In Shanghan disease, if there is cold extremities for four days, followed by fever for three days, and then cold extremities again for five days, the disease progresses. There is more Cold than Heat, indicating declining Yang Qi, hence progression. (This clause describes Jueyin Middle-Cold where Yang Qi attempts to recover but fails to overcome Yin pathogen. Cold strikes Jueyin, the extreme of Yin. At the extreme of Yin, Yang should recover. Now, True Yang Qi cannot overcome Yin-Cold pathogen, resulting in initial cold extremities, then fever, then recurrence of cold extremities. More days of cold extremities mean disease progression. Chen of Wuling states: Pathogen and Healthy Qi cannot coexist. Pathogen is Cold/Yin; Healthy Qi is Heat/Yang. Yang dominance brings Heat; Yin dominance brings Cold. More Cold than Heat signifies Yang decline. If Yang declines and Yin pathogen remains, death is near. One should fear this. ○ Note: Zhang Zhongjing provides no treatment method here. *Bu Wang Lun* by Chang Qizhi suggests Si Ni Tang. It should only be used after Heat recedes, Cold advances, and cold extremities do not return to warmth.)

In Shanghan disease, after six or seven days, if the pulse is minute, extremities are cold, and there is irritability, moxa the Jueyin meridian. If cold extremities do not return, death ensues. (This is a fatal syndrome of Cold Jue. Cold strikes Jueyin; the taboo is cold extremities, the hope is warmth. A minute pulse and cold extremities in Shanghan should see Yang recovery and warmth by day four or five. By day six or seven, if Yang does not recover and irritability increases, Cheng Wuji notes: Yang deficiency leads to struggle; True Yang within the Zang is about to collapse, causing Shen Qi to float outward, resulting in irritability. These are accompanying symptoms of cold extremities. At this stage, herbal medicine is insufficient; urgent moxibustion on Jueyin is needed to restore Yang. If moxibustion fails to reverse cold extremities and Yang does not return, death occurs. ○ Note: Zhang Zhongjing does not specify the acupoint. *Bu Wang Lun* by Chang Qizhi suggests Taichong. Taichong is the Well/Ashu point of the Foot Jueyin meridian. Diagnosing Taichong pulse can determine life or death in men. The point is located two cun posterior to the first interdigital space, or one and a half cun in the depression. Moxa three cones. Chen of Wuling states: Moxa Jueyin points like Guanyuan and Qihai. Guanyuan was mentioned previously. Qihai is one and a half cun below the umbilicus, treating rising cold Qi below the umbilicus. Qihai is the sea of Qi for men. It treats deficient Zang Qi, insufficient True Qi, and chronic Qi disorders; all should be treated with moxibustion.)

[Image: Taichong and Qihang Acupoint Diagram]

In Shanghan disease, after six or seven days, if there is no diarrhea, but sudden fever accompanied by diarrhea occurs, and the patient sweats profusely without stopping, death ensues. This is due to having Yin but lacking Yang. (This is also a fatal syndrome of Jueyin Middle-Cold. I suspect missing text follows "six or seven days." Cold striking Jueyin by day six or seven should involve six or seven days of cold extremities. The omission of "cold extremities" is a textual gap. Cold extremities usually imply diarrhea. If absent, Chen of Wuling says: Yang Qi is not yet exhausted and can still resist the pathogen. If fever occurs, diarrhea should stop. Now, fever and diarrhea occur simultaneously, plus incessant sweating. We know this heat is not Yang recovery but Yang collapse. Hence, it accompanies diarrhea and sweating. Yin-Cold pathogen strikes inward (Yin); True Yang Qi collapses outward (No Yang). Having Yin but lacking Yang inevitably leads to death.)

In Shanghan disease, if the pulse is rapid with intermittent pauses (Cu Mai) and extremities are cold/reversed, moxibustion is indicated. (This clause describes Jueyin Middle-Cold where extreme Yin causes Cu Mai, suitable for moxibustion. Cu Mai is a rapid pulse with occasional pauses. This is typically a sign of extreme Yang. However, extreme Yin-Cold forces Yang Qi to collapse, also producing Cu Mai. Given the external symptom of cold extremities, even herbal decoctions may be ineffective. Urgent moxibustion is required to assist Yang Qi. ○ Note: Zhang Zhongjing does not specify the acupoint. *Bu Wang Lun* by Chang Qizhi suggests Taichong. Point details noted previously. ○ Question: At extreme Yin-Cold, the pulse should be slow or intermittent (Dai). Why is it rapid and Cu? Answer: Wang Haizang and Chen of Wuling state: There are many types of Si Ni (Four Extremities Cold). Dang Gui Si Ni Tang is certainly less hot than Si Ni Tang, and its warming power is less than Tong Mai, while being cooler than Si Ni San. The causes of Si Ni differ: some are Cold-induced, some Heat-induced. This case is Cold-Wind striking the blood vessels, leading to the establishment of Dang Gui Si Ni Tang. Cold-Wind striking blood vessels enters Ying Qi. Although Yin and Yang wish to connect smoothly, they cannot. Pathogen obstructs the meridians, Ying Qi does not flow; blood vessels must be unblocked. Danggui is acrid-warm, a Qi-moving herb in Blood, dispersing internal Cold and harmonizing Blood, thus serving as Sovereign. To unblock vessels, blood-borne pathogen must first be dispersed. Guizhi disperses Wind in Jueyin Blood aspect; Xixin vents Cold in Jueyin Blood aspect. They serve as Ministers. Shaoyao, Dazao, and Gancao harmonize Ying and Wei. No pulse can flow if Ying and Wei are not harmonized. Guizhi Tang treats Wei not harmonizing with Ying; this formula treats Ying not harmonizing with Wei. Dazao is used more than double the amount in Guizhi Tang because Dazao assists meridians to harmonize Yin/Yang and regulate Ying/Wei. Furthermore, pathogen merges into the Liver Meridian; Wood excess insults Earth. The use of Gancao and Dazao likely intends to strengthen Spleen Earth to resist insult. Tongcao, according to Ben Jing, unblocks the nine orifices, blood vessels, and joints. Since pathogen blocks the blood aspect, Tongcao enters the blood aspect to break obstruction. All other herbs rely on Tongcao's power to achieve unblocking. How magical is formula preparation!)

If the person has long-standing internal Cold, Dang Gui Si Ni Tang plus Wu Zhu Yu and Sheng Jiang Decoction is indicated. (This continues the previous clause. If the person has long-standing internal Cold, meaning chronic Cold accumulation within the Zang-Fu, use the previous formula adding Wu Zhu Yu (acrid-hot) to disperse accumulated Cold, and Sheng Jiang (acrid-warm) to circulate Yang Qi.)

Dang Gui Si Ni Tang Plus Wu Zhu Yu and Sheng Jiang Decoction Formula (This formula is collected from Volume Ten of Zhang Zhongjing's treatise here)

To the previous formula, add Wu Zhu Yu (2 sheng) and Sheng Jiang (half jin).

The above nine ingredients. Boil with six sheng of water and six sheng of clear wine to extract five sheng. Strain. Take warm, divided into five doses. (Alternative: four sheng water and four sheng wine each.)

Hu notes: The reason for adding clear wine to boil the above decoction is that wine is greatly hot in nature, sweet and acrid in taste. Haizang states it guides herbs through the meridians, similar to Fuzi. Its power moistens Liver dryness, unblocks blood vessels, and disperses Cold pathogen. For patients with long-standing internal Cold, it is highly suitable in the decoction.

Question: Why not use Si Ni Tang for long-standing internal Cold? Answer: The previous syndrome was essentially Blood Deficiency, with Wind-Cold striking the Jueyin meridian. In Shaoyin, there were no accompanying syndromes. Some say: In severe Yin Toxicity, the six pulses are only palpable deep to the bone, disappearing with light pressure, beating eight times or more per breath, or too fast to count—is this not Cu Mai? I believe True Yang Qi is inherently active; forced by Cold, it becomes rapid and Cu. This is inevitable logic. People only know that Yin syndrome pulses are minute, slow, or absent—this is the norm. Here, mentioning Cu Mai is the variation. Understanding both norm and variation allows one to speak of medicine.

If hands and feet are cold and the pulse is fine and nearly imperceptible, Dang Gui Si Ni Tang is indicated. (This clause describes Cold striking the Blood aspect of Jueyin. "Cold extremities" differs slightly from "Jue Ni" or "Jue Leng." Jue Ni/Leng implies Cold deeply entered the Zang, making extremities stiff and ice-cold. "Jue Han" means extremities are cold and the patient feels intense aversion to cold; this is Cold striking the meridians. Cheng Wuji notes: External deficiency of Yang Qi fails to warm the four extremities. Fine, nearly imperceptible pulse indicates Cold injuring Ying Blood. Cheng Wuji notes: Internal weakness of Yin Blood leads to poor pulse circulation. Dang Gui Si Ni Tang is given to assist Yang and generate Yin.)