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Zheng's Commentary: Regarding Shaoyin disease presenting with abdominal pain and difficulty in urination, this indicates cold pathogen congealing in the lower jiao, failing to transform the yin fluids of the lower jiao. Heavy limbs and spontaneous diarrhea indicate yang qi sinking downward, unable to reach the four extremities. Among these cases, there may be coughing, or diarrhea, or free urination; one must discuss them according to their specific manifestations and not confuse them as a single syndrome. The original text prescribes Zhenwu Tang (True Warrior Decoction), which is established for severe obstruction by cold-water retention. Scholars should not adhere rigidly to this formula; the key principle always lies in supporting yang qi and dispelling yin cold.

[Elucidation] In Shaoyin disease, abdominal pain results from excess cold within; difficulty in urination results from water failing to descend; heavy and painful limbs result from dampness invading externally; spontaneous diarrhea results from water overflowing internally. All these symptoms are caused by yang deficiency failing to transform qi. The primary action of Zhenwu Tang (True Warrior Decoction) is to warm the meridians and support yang qi, rather than to promote diuresis. When yang qi becomes robust, cold water naturally subsides.

Zhenwu Tang Formula (Corrected and Supplemented)

Poria (Fu Ling, *Poria cocos*) 3 liang, Peony (Shao Yao, *Paeonia lactiflora*) 3 liang, Atractylodes Macrocephala (Bai Zhu, *Atractylodes macrocephala*) 2 liang, Fresh Ginger (Sheng Jiang, *Zingiber officinale*) 3 liang (sliced), Processed Aconite Root (Fu Zi, *Aconitum carmichaelii*) 1 piece (processed, skin removed, broken into eight pieces). Take the above five herbs, add eight sheng of water, decoct to obtain three sheng, remove the dregs, and take seven ge warm, three times daily. If coughing occurs, add Schisandra Berry (Wu Wei Zi, *Schisandra chinensis*) half sheng, Asarum (Xi Xin, *Asarum heterotropoides*) 1 liang, Dried Ginger (Gan Jiang, *Zingiber officinale*) 1 liang. If urination is free, remove Poria. If diarrhea occurs, remove Peony, add Dried Ginger 2 liang. If vomiting occurs, remove Aconite Root, increase Fresh Ginger to half jin.

[Formula Analysis and Scope of Application] This formula possesses both warming and moving properties, harmonizing yin and yang, making it the first choice for warming yang and promoting water metabolism. Aconite Root is acrid and hot, strengthening kidney yang so that water has its master; Atractylodes Macrocephala is drying, strengthening the spleen so that water has its control; Fresh Ginger is acrid and dispersing, assisting Aconite Root to tonify yang, containing the intent of dispersing water while managing water; Poria is bland and leaching, assisting Atractylodes Macrocephala to strengthen the spleen, containing the function of promoting diuresis while controlling water. Since the kidney yang is deficient and kidney yin is also depleted, the combination of Aconite Root and Peony can return yang and preserve yin, yet the primary focus remains on returning yang and promoting water metabolism. The scope of application for this formula is broad. It is effective for abdominal pain, difficulty in urination, and diarrhea caused by kidney yang deficiency and cold-water retention; nephritis, edema, heart failure; and symptoms such as vertigo, palpitations under the heart, muscle twitching, and tendon spasms resulting from excessive sweating due to overuse of acrid-warm diaphoretics. The author has used it to treat coughing and asthma caused by kidney yang deficiency with water flooding transforming into phlegm, achieving satisfactory results.

16. In Shaoyin disease, if there is diarrhea with undigested food, interior cold with exterior heat, cold extremities, and a faint pulse nearly imperceptible, [the body] surprisingly does not feel aversion to cold, the person has a red complexion, or abdominal pain, or dry retching, or sore throat, or the diarrhea stops but the pulse does not emerge, Tongmai Sini Tang (Pulse-Reviving Decoction) is indicated (if the pulse emerges immediately, recovery ensues). Original Text 317

Zheng's Commentary: Regarding diarrhea with undigested food, red complexion, interior cold with exterior heat, cold extremities, and a faint pulse nearly imperceptible, these various pathological forms are all signs of critical danger. However, since the body surprisingly does not feel aversion to cold, yang qi still exists and has not yet severed from its root. If aversion to cold and heaviness of the body are severe, yang qi has already severed from its root and is difficult to召回. After administering Tongmai Sini Tang (Pulse-Reviving Decoction), if the pulse emerges gradually and becomes moderate, life is saved; if the pulse emerges suddenly and violently, death ensues.

[Elucidation] The Shaoyin disease described in this clause is actually a true cold with false heat syndrome, where yin excess repels yang to the exterior. All symptoms recorded in the original text are signs of critical danger. The faint pulse nearly imperceptible is more severe than the deep or fine-slow pulse seen in Sini Tang (Frigid Extremities Decoction) syndrome. The entire clinical presentation is more serious than in Sini Tang (Frigid Extremities Decoction) syndrome; therefore, double the amount of Dried Ginger and increase the dosage of Aconite Root in Sini Tang (Frigid Extremities Decoction) to urgently drive out interior cold and rescue the departing yang qi. Zheng stated: "After taking Tongmai Sini Tang (Pulse-Reviving Decoction), if the pulse emerges gradually and becomes moderate, life is saved; if the pulse emerges suddenly and violently, death ensues." This meaning is consistent with Clause 14.

Tongmai Sini Tang (Pulse-Reviving Decoction) Formula (Corrected and Supplemented)

Honey-fried Licorice Root (Zhi Gan Cao, *Glycyrrhiza uralensis*) 2 liang, Large Raw Aconite Root (Sheng Fu Zi, *Aconitum carmichaelii*) 1 piece (raw use, skin removed, broken into eight pieces), Dried Ginger (Gan Jiang, *Zingiber officinale*) 3 liang (strong individuals may use 4 liang). Take the above three herbs, add three sheng of water, decoct to obtain one sheng and two he, remove the dregs, divide into two warm doses. If the pulse emerges, recovery ensues. For red complexion, add nine stalks of Scallion Stem (Cong Bai, *Allium fistulosum*). For abdominal pain, remove Scallion Stem and add Peony 2 liang. For vomiting, add Fresh Ginger 2 liang. For sore throat, remove Peony and add Platycodon Root (Jie Geng, *Platycodon grandiflorus*) 1 liang. If diarrhea stops and pulse does not emerge, remove Platycodon Root and add Codonopsis Root (Ren Shen, *Panax ginseng* or *Codonopsis pilosula*) 2 liang. Administer only when the disease matches the formula.

[Formula Analysis and Scope of Application] This formula is essentially Sini Tang (Frigid Extremities Decoction) with doubled Dried Ginger and increased Aconite Root dosage. Its action is the same as Sini Tang (Frigid Extremities Decoction), but because the clinical presentation is more severe, the dosage is increased. Chen Xiuyuan said: "When yang qi cannot circulate, Sini Tang (Frigid Extremities Decoction) is suitable; when primordial yang is severely deficient, Fuzi Tang (Aconite Decoction) is suitable; when yin excess at the lower jiao repels yang upward, Baitong Tang (White Unblocking Decoction) is suitable; when yin excess internally repels yang externally, Tongmai Sini Tang (Pulse-Reviving Decoction) is suitable. Since vital qi has departed and death is imminent, how could a soft and slow herb like Licorice Root as the sovereign agent urgently call back scattered yang? Hence, double the Dried Ginger, yet still retain Licorice Root, fearing that after dispersion, the body cannot withstand the ferocity of Ginger and Aconite, thus borrowing Licorice Root to complete the success." This is an appropriate explanation. Its main function is treating Shaoyin repelling yang syndrome. The author treated a patient who initially had aversion to cold and fever, mistakenly diagnosed as an exterior excess syndrome, and took Mahuang Tang (Ephedra Decoction) without improvement. Body temperature was around 39°C; although febrile, there was no desire to drink; abdominal pain and cold lower limbs were present; the pulse was floating and large upon light pressure but absent upon heavy pressure; the tongue was pale with white coating. Thus, it was diagnosed as yin excess repelling yang. Treated with a large dose of Tongmai Sini Tang (Pulse-Reviving Decoction), taken for four doses, body temperature dropped to 37°C, and abdominal pain and cold lower limbs resolved. Subsequently, Fuzi Lizhong Tang (Aconite and Atractylodes Major Decoction) with modifications was used for regulation to consolidate efficacy, taken for ten doses before stopping.

17. In Shaoyin disease, if the pulse is deep, urgently warm it; Si Ni Tang (Frigid Extremities Decoction) is indicated. Original Text 323

Zheng's Commentary: Regarding Shaoyin disease presenting with a deep pulse, interior cold is severe. The method requires urgent warming to support yang, thereby avoiding disaster and death.

[Elucidation] The pulse in Shaoyin disease is originally fine and slow. Now, the faint pulse is not felt upon light pressure, and the fine pulse is nearly lost upon heavy pressure, hiding until becoming deep. This indicates cold pathogen deeply penetrating the interior, likely entering the zang organs. Symptoms such as heaviness of the body, desire to sleep, diarrhea, and cold extremities are included. This is indeed a sign of critical danger; the meaning of "urgently warm it" implies no delay. As Zheng said: "The method requires urgent warming to support yang, thereby avoiding disaster and death."

18. In Shaoyin disease, if food vomited immediately upon entering the mouth, the person feels nauseous and desires to vomit but cannot, initially having cold hands and feet and a string-tight and slow pulse, this indicates excess in the chest. Purging is contraindicated; emesis should be induced. If there is cold fluid above the diaphragm causing dry retching, emesis is contraindicated; warming is required; Si Ni Tang (Frigid Extremities Decoction) or similar formulas are indicated. Original Text 324

① Wenwen: Same as Yunyun, describing the sensation of desiring to vomit but not doing so, feeling uncomfortable in the chest.

Zheng's Commentary: Regarding vomiting immediately upon eating, there is a distinction between cold reversal and heat reversal. Here, with cold hands and feet and a string-tight and slow pulse, it is a sign of cold fluid reversing upward, not heat reversal. Since it belongs to cold reversal, the method should be warming the middle and descending rebellion. Thus, emesis and purging are contraindicated; treating with Si Ni Tang (Frigid Extremities Decoction) or similar formulas is an unchangeable truth through the ages.

[Elucidation] This section discusses the differentiation and treatment of phlegm-excess in the chest and cold-fluid above the diaphragm in Shaoyin disease. Zheng's discussion is not comprehensive; here is a clarification. Because solid pathogens like phlegm-fluid obstruct the chest, food vomits immediately upon entry; the sensation of nausea and desire to vomit without ability to do so indicates stubborn old phlegm; cold hands and feet indicate chest yang blocked by turbid phlegm, unable to reach the four extremities; the string-tight pulse governs phlegm-fluid, and string-tight combined with slow indicates phlegm-turbidity obstructing and yang qi failing to distribute; chest excess cannot be driven out by purgatives. The *Neijing* states: "For those high up, induce vomiting." Thus, emesis is indicated, as in Genti San (Thistle Powder) syndrome. However, the author uses dissolved Alum (Bai Fan, *Alumen*) orally, inducing vomiting of phlegm-fluid easily and effectively, superior to Genti San (Thistle Powder). If there is cold-fluid above the diaphragm causing dry retching, this belongs to cold-fluid due to yang qi failing to transform. For diseases of phlegm-fluid, warm herbs should harmonize; Si Ni Tang (Frigid Extremities Decoction) should be used to warm, so cold dissipates and stomach harmonizes; thus, emesis is contraindicated.

19. In Shaoyin disease, with diarrhea, faint and choppy pulse, vomiting and sweating, frequent bowel movements but small volume, warm the upper part and moxibustion should be applied. Original Text 325

② Frequent bowel movements but small volume: Many bowel movements but small quantity.

Zheng's Commentary: Regarding Shaoyin diarrhea with a faint pulse, yang qi is deficient. With a choppy pulse, yin blood is weak. Vomiting indicates yin qi reversing upward. Sweating indicates yang escaping outward. Frequent bowel movements indicate yang sinking downward. Moxibustion on the upper part follows the principle of treating lower disease by targeting the upper, to raise yang and prevent sinking.

[Elucidation] This section addresses using moxibustion to urgently rescue returning yang in cases of yin-blood deficiency with sweating leading to yang loss. Zheng's note is correct. Warming the upper part refers to Baihui GV20 (Baihui, *DU20*). Moxibustion on Baihui GV20 indeed raises yang and has reliable efficacy. For all diseases of yang deficiency with sinking, moxibustion on Baihui GV20 can be used, not only raising sunken yang but also facilitating communication between yin and yang. Although this syndrome involves both yin and yang deficiency, yang deficiency is urgent. If treating with decoctions, a formula balancing yin and yang, such as Sini Jia Renshen Tang (Sini Decoction plus Codonopsis Root), can be selected.

20. In Shaoyin disease, with vomiting and diarrhea, if hands and feet are not cold, but instead there is fever, death is avoided; if the pulse is absent, moxibustion on the Shaoyin meridian seven moxa cones should be applied. Original Text 292

① Moxibustion on Shaoyin: Moxibustion on acupoints along the Shaoyin meridian pathway. Seven moxa cones: One cone of moxa per application; seven cones means seven applications.

Zheng's Commentary: Regarding vomiting and diarrhea with non-cold hands and feet, yang has not yet perished. Fever, though in the category of non-death, indicates yang emerging outward; it must be urgently attracted. If fever accompanies sweating, it is perilous. Fortunately, there is no sweating, hence moxibustion is indicated, truly to assist yang.

[Elucidation] This section discusses recoverability via yang restoration in Shaoyin disease and moxibustion for absent pulse. Non-cold hands and feet with fever indicate the return of yang qi. Absent pulse, due to simultaneous vomiting and diarrhea causing sudden deficiency of righteous qi, results in temporary discontinuation of the pulse. Moxibustion on Taixi KI3 (Taixi, *KI3*) and Yongquan KI1 (Yongquan, *KI1*) of the Shaoyin meridian; to return yang and dispel yin, moxibustion on Guanyuan CV4 (Guanyuan, *CV4*) and Qihai CV6 (Qihai, *CV6*) can further restore yang and pulse. As Zheng said: "Moxibustion truly assists yang." For such cases, internal medicine and moxibustion can proceed together; decoctions like Si Ni Tang (Frigid Extremities Decoction) or similar can be selected.

21. In Shaoyin disease, with aversion to cold, curled body posture, diarrhea, and cold extremities, it is untreatable. Original Text 295

Zheng's Commentary: Regarding aversion to cold, curled body posture, and diarrhea, yang qi has sunk excessively. Seeing cold extremities indicates yang is about to exhaust. By law, it falls under untreatable cases. If urgently warmed, and hands/feet become warm, death might still be avoided. Although the original text says untreatable, physicians must not stand idle; there is a chance of accidental recovery.

[Elucidation] Pure yin without yang in Shaoyin disease is untreatable. Zheng said: "Although called untreatable, physicians must not stand idle; there is a chance of accidental recovery." The author believes that urgently administering large doses of Sini Tang (Frigid Extremities Decoction) or Baitong Tang (White Unblocking Decoction) might save one or two out of ten. Shu Chi Yuan said: "This syndrome has not yet reached sweating and high breathing; urgently administering Sini Jia Renshen Tang (Sini Decoction plus Codonopsis Root) might prevent death."

22. In Shaoyin disease, with vomiting, diarrhea, restlessness, and cold extremities, death ensues. Original Text 296

Zheng's Commentary: This clause relates to Wuzhuyu Tang (Evodia Decoction) syndrome. Why did it not say death previously, but now says death? It is because cold extremities are now seen.

[Elucidation] This clause is identical to Clause 12 Wuzhuyu Tang (Evodia Decoction) syndrome. Why did it not say death previously, but now says death? It must be that after unsuccessful treatment with Lizhong Tang (Atractylodes Decoction), Sini Tang (Frigid Extremities Decoction), and Baitong Tang (White Unblocking Decoction), restlessness worsened, and limbs became cold. Is there any alternative to death? This is what Zheng meant by "because cold extremities are now seen." Death is inevitable.

23. In Shaoyin disease, if diarrhea stops but vertigo occurs, and there are periodic sensations of dimness/blackout, death ensues. Original Text 297

① Zimao: Mao means covering the eyes as if with an object; here it refers to visual blackout and dizziness.

Zheng's Commentary: Diarrhea stopping should imply non-death. Why is this judged as death? Because of periodic vertigo and blackout. What is mao? It is yang attempting to escape from above. Books state: "If yang returns and diarrhea stops, life is saved; if yin exhausts and diarrhea stops, death ensues." Observing this clause, periodic vertigo and blackout indicate yang is about to depart but not yet gone. Urgently returning yang might save it. In summary, if yang returns and diarrhea stops, spirit is vigorous; if yin exhausts and diarrhea stops, spirit is exhausted. There is a significant difference.

[Elucidation] Although diarrhea stops, vertigo and periodic blackout indicate extreme danger of yin exhaustion below and yang attempting to escape above. Urgently administer large doses of yang-returning herbs, as Zheng said: "Yang is about to depart but not yet gone; urgently returning yang might save it."

24. In Shaoyin disease, with cold extremities, aversion to cold, curled body posture, absent pulse, no vexation but restlessness, death ensues. Original Text 298

Zheng's Commentary: Aversion to cold, curled body posture, and cold extremities are signs of extreme yang decline. Moreover, absent pulse indicates yang cannot reach the exterior. Combined with restlessness, vexation originates from the heart, restlessness from the kidney. Heart-kidney non-interaction causes this syndrome. Now seeing this, how can the person not die?

[Elucidation] Zheng's interpretation based on the original text is correct, concluding: "How can the person not die?" The author believes that in Shaoyin syndrome, as long as a trace of faint yang remains, there is a chance of regeneration. Physicians aiming to rescue the critical can use heavy doses of Tongmai Sini Tang (Pulse-Reviving Decoction) to save from death in one in ten thousand, fulfilling the physician's duty.

25. In Shaoyin disease, after six or seven days, if breathing is high/superficial, death ensues. Original Text 299

② Xi Gao: Refers to superficial breathing, inability to breathe deeply, or even more exhalation than inhalation.

Zheng's Commentary: If Xi Gao occurs in Yangming without involving Shaoyin, death can be avoided. But if in Shaoyin, Shaoyin is the root, where primordial true yang resides. True yang prefers concealment over exposure. Seeing Xi Gao now indicates kidney qi rushing upward, yin and yang severing, danger imminent, hence certain death. Also: How to distinguish Yangming from Shaoyin? Yangming shows stomach pulse strong against fingers, radial pulse deep and fine, oral heat, coarse breathing, mostly excess. Shaoyin shows radial pulse large and empty, or string-tight strong against fingers, blue-black nails/lips/tongue, enuresis, mostly pure yin without yang, hence known. There are also differences between new and chronic diseases and distinct pathological forms.

[Elucidation] Xi Gao differs between Yangming and Shaoyin. Yangming is mostly excess; Shaoyin is pure yin without yang. Shaoyin disease with Xi Gao indicates kidney qi cutting off below and lung qi escaping above, a sign of separation of upper and lower, hence certain death. If seen six or seven days prior, recognizing the subtle signs, treating with large doses of Tongmai Sini Tang (Pulse-Reviving Decoction) plus kidney-consolidating herbs might avoid death. Zheng's explanation of distinguishing Xi Gao in Yangming and Shaoyin guides clinical practice.

26. In Shaoyin disease, with faint, fine, deep pulse, only desiring to sleep, sweating without vexation, spontaneous desire to vomit, progressing to five or six days, spontaneous diarrhea, then restlessness and inability to sleep, death ensues. Original Text 300

Zheng's Commentary: Desiring to sleep turning into inability to sleep indicates severe yin-yang non-interaction. Added with restlessness and spontaneous diarrhea, how can it not be fatal?

[Elucidation] Faint, fine, deep pulse, only desiring to sleep, are the fundamental signs of Shaoyin. Sweating without vexation indicates external loss of yang; spontaneous desire to vomit indicates yin pathogen reversing upward. Up to this point, it is not yet a death case; urgently use Sini Tang (Frigid Extremities Decoction) or Baitong Tang (White Unblocking Decoction) to return yang and rescue. If neglected, reaching five or six days, as Zheng explained: "Severe yin-yang non-interaction, added with restlessness and spontaneous diarrhea, how can it not be fatal?" This is yang deficiency with departure, yin excess increasing, yin-yang severing leading to death.

27. If Shaoyin is inferior to Fuyang, it is favorable. Original Text 362 latter part

① Shaoyin inferior to Fuyang: Pulse smaller than Fuyang pulse. Shaoyin refers to Taixi KI3 (Taixi, *KI3*) pulse; Fuyang refers to Chongyang ST42 (Chongyang, *ST42*) pulse. Shaoyin inferior to Fuyang means Taixi KI3 (Taixi, *KI3*) pulse is smaller than Chongyang ST42 (Chongyang, *ST42*) pulse.

Zheng's Commentary: Shaoyin is the water organ, Fuyang is the earth organ. Now Shaoyin being inferior to Fuyang means earth is sufficient to control water. Even if water floods, earth binds it; water has its归宿, preventing catastrophic flow, hence favorable.

[Elucidation] Shaoyin is the Kidney Meridian, belonging to Water, its pulse at Taixi KI3 (Taixi, *KI3*); Fuyang is the Stomach Meridian, belonging to Earth, its pulse at Chongyang ST42 (Chongyang, *ST42*). Shaoyin inferior to Fuyang means spleen-stomach grain qi is still abundant. Although the disease is critical, righteous qi can still rise to resist pathogens, hence favorable, meaning the disease can turn from critical to safe.

Shaoyin [Later] Chapter

Syndromes where external pathogens move with fire are listed in this chapter, totaling seventeen methods (corrected and supplemented according to Shu's edition).

1. Shaoyin disease, time of resolution, from Zi to Yin hours. Original Text 291

Zheng's Commentary: Zi, Chou, Yin are the prosperous hours of Shaoyin. Whenever pathogenic qi declines, it resolves during prosperous hours. This is also the theory that evil cannot overcome righteousness.

[Elucidation] All six meridians have a "time of resolution" clause, generally resolving when the meridian's ruling qi is prosperous, gaining prosperous qi to resolve. This clause does not resolve during yin excess but uniquely resolves during yang generation, i.e., Zi-Chou-Yin hours (3 AM to 10 AM), because yang grows and yin diminishes, yang advances and yin retreats, precisely "yin resolves when obtaining yang." From this, it is clear that Shaoyin focuses on true yang.

2. Shaoyin disease, fine, deep, rapid pulse, disease is in the interior, sweating is contraindicated. Original Text 285

Zheng's Commentary: Shaoyin is the storehouse of hibernation, originally not in the category of sweating. One must examine whether it moves with fire or with water; between these two, the subtlety of medication is found. If moving with fire, sweating leads to yin loss; if moving with water, sweating leads to yang loss. This must not be ignored.

[Elucidation] This clause points out that fine, deep, rapid pulses are the pulse images of interior Shaoyin syndrome. Fine indicates blood deficiency, deep indicates interior location. Rapid pulse appearing with deep and fine, without fever, should not be mistaken for heat requiring diaphoresis. Zheng's discussion is clear and acceptable.

3. Shaoyin wind-stroke, pulse yang faint and yin floating indicates impending recovery. Original Text 290

Zheng's Commentary: Regarding Shaoyin wind-stroke, what exact pathological form appears, yet only saying yang faint and yin floating indicates recovery is incomprehensible. Moreover, wind-stroke differs in closure and collapse; in Shaoyin, it is a stroke of the zang organs, life and death hinge in an instant. One cannot make vague statements, fearing omission and error.

[Elucidation] This clause on Shaoyin wind-stroke only mentions yang faint and yin floating indicating recovery, ignoring symptom description. Pulse and symptoms must be inter-referenced for correct diagnosis. Thus Zheng said: "Wind-stroke differs in closure and collapse; in Shaoyin, it is a stroke of the zang organs, life and death hinge in an instant. One cannot make vague statements, fearing omission and error." Shu Chi Yuan also said: "What are the external symptoms? Without clarifying external symptoms, how can differentiation be made?" He also held skepticism towards this.