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Shaoyin disease presenting with vomiting and diarrhea, cold extremities, and severe restlessness bordering on death is primarily treated with Wuzhuyu Tang (Evodia Decoction).

Shaoyin disease presenting with vomiting, diarrhea, restlessness, and Si Ni (Four Reversals/Cold Extremities) indicates a fatal prognosis. "Si Ni" refers to coldness of the four limbs, encompassing both arms and legs. The text here specifies "hands and feet," referring specifically to fingers and palms, indicating that Yang Qi in the limbs is still present. Qibo stated: "The four extremities are the meeting points of Yin and Yang, and major pathways for Qi. The Si Jie (Four Streets) are the meridians where Qi converges. If collaterals are blocked, meridian flow is obstructed; if the four extremities are warm, Qi harmonizes." Therefore, Wuzhuyu Tang is used to warm the interior; once vomiting and diarrhea cease, restlessness is resolved. The Yin pathogenic factor, having entered the He-Sea points, now exits from the Jing-Well points via Yang Qi.

For dry retching, expulsion of saliva/phlegm, and headache, Wuzhuyu Tang is indicated. If there is no headache, Banxia Ganjiang Tang (Pinellia and Dried Ginger Decoction) is indicated.

Dry retching without expulsion of food indicates deficiency of Stomach Qi. Expulsion of only saliva/phlegm indicates Cold in the Stomach. Headache occurs because insufficient Yang Qi allows Yin-Cold to invade. Wuzhuyu Tang warms the middle and supplements Qi, raises Yang and disperses Cold, thereby resolving dry retching and pain. Dry retching and expulsion of saliva are two distinct syndromes and do not necessarily occur simultaneously.

Desire to vomit after eating belongs to the Yangming stage; Wuzhuyu Tang is indicated. If symptoms worsen after taking the decoction, the pathology resides in the Upper Jiao (Upper Burner).

Heat in the Stomach leads to rapid digestion and hunger; Cold in the Stomach prevents the reception of water and grain. Desire to vomit after eating confirms Stomach Cold. However, worsening after medication indicates that Phlegm-Fluid retention in the Upper Jiao is the issue; vomiting will resolve the condition naturally. This does not mean the decoction should not be taken. This differs from Yangming constipation where Chaihu Tang (Bupleurum Decoction) harmonizes Stomach Qi.

Wuzhuyu Tang Formula:
Evodiae Fructus (Wuzhuyu) (1 sheng, rinsed seven times with hot water)
Ginseng Radix et Rhizoma (Renshen) (3 liang)
Zingiberis Rhizoma Recens (Shengjiang) (6 liang)
Jujubae Fructus (Dazao) (12 pieces)

Boil in 7 sheng of water to obtain 2 sheng of liquid. Take 7 ge warm, three times daily.

Evodiae Fructus warms the middle and disperses Cold, resolving vomiting and diarrhea; Ginseng calms the Spirit and stabilizes the Will, stopping restlessness; Zingiberis Rhizoma Recens and Jujubae Fructus harmonize Ying and Wei (Nutritive and Defensive Qi), warming the extremities and curing headache.

Shaoyin disease with diarrhea and a faint pulse is treated with Baitong Tang (White Passage Decoction). If diarrhea persists, accompanied by cold extremities, absence of pulse, dry retching, and vexation, Baitong Jia Zhudanji Dan Tang (Baitong Decoction plus Pig Bile and Human Urine) is indicated. If the pulse suddenly emerges violently after ingestion, death ensues; if the pulse gradually returns weakly, survival is possible.

Diarrhea with a faint pulse indicates deficiency-cold in the Lower Jiao failing to control fluids. Baitong Tong Yang (passes Yang), tonifies deficiency, dispels Cold, and controls fluids. If diarrhea persists after administration, progressing to cold extremities and absent pulse, this indicates Extreme Yin repelling Yang. Dry retching and vexation indicate Yang attempting to penetrate but being blocked. Pig is a Water animal, associated with Shaoyin Kidney; Gallbladder is Jia Wood, associated with Shaoyang Liver. The treatment utilizes the bitter-cold nature of Pig Bile as a counter-agent (Fan Zuo), added to Baitong Tang, drawing Yang from Yin. Thus, the state of Extreme Yin repelling Yang transforms into the intersection of Water and Fire. A sudden violent pulse indicates solitary Yang moving alone, leading to death; a gradual, weak return of the pulse indicates the initial birth of Shaoyang Qi, leading to survival.

Baitong Tang Formula:
Allii Tuberosi Bulbus (Congbai) (4 stems)
Zingiberis Rhizoma (Ganjiang) (1 liang)
Aconiti Lateralis Radix Praeparata (Fuzi) (1 piece, peeled and raw)

Decoct these three ingredients in 3 sheng of water to obtain 1 sheng. Strain and take warm in two divided doses.

Baitong Jia Zhudanji Dan Tang Formula:
Add to the base formula: Human Urine (Ren Niao) (5 he), Pig Bile (Zhudanji Dan) (1 he).
Mix well and take warm in two divided doses. If Pig Bile is unavailable, it may be omitted.

Allii Tuberosi Bulbus is acrid-warm and white-stemmed; it unblocks Lung Qi to circulate Ying and Wei, dispersing pathogens and unblocking Yang Qi. It leads Zingiberis Rhizoma and Aconiti Lateralis Radix Praeparata into the Yangming channel to stop diarrhea and into the Shaoyin channel to generate pulse. Raw Aconiti Lateralis Radix Praeparata is used for its vigorous penetrating power. Although the main text does not mention Human Urine, the post-script states Pig Bile can be omitted because Human Urine is salty-cold, reaches the Lower Jiao directly, and also stops vexation and retching.

In cases of diarrhea with cold extremities and absent pulse, if moxibustion fails to warm the body and the pulse does not return, but slight panting appears, death ensues.

After diarrhea, if the pulse vanishes and extremities are cold, but the pulse occasionally returns and extremities become warm, survival is possible; if the pulse does not return, death ensues.

Since there is no vomiting or vexation, a counter-agent is not needed; administer Baitong Tang directly. External moxibustion on Shaoyin channels, as well as the Dantian and Qihai acupoints, may offer a slim chance of rescue.