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Shaoyin disease, when it first occurs, presents with no sweating, aversion to cold, and conversely fever with a deep pulse; Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is the primary treatment.

Taiyang governs the exterior; diseases originating in Yang channels typically present with fever. Shaoyin governs the interior; diseases originating in Yin channels should typically present only with internal heat. Now, upon initially contracting cold pathogenic factors, fever appears immediately. Although this resembles Taiyang disease, why is it classified under Shaoyin? The *Neijing* states: "Violating the Qi of winter storage causes Shaoyin to fail to store, leading to the solitary sinking of Kidney Qi." Thus, there is conversely fever and a deep pulse. The Kidney corresponds to the Kan trigram image. When the two Yins (Yin essence within Shaoyin) fail to store, the one Yang (Mingmen fire) loses its cover, allowing Yin pathogens to invade internally, causing the isolated Yang to scatter externally. When the disease is in the exterior and the pulse is floating, diaphoresis (inducing sweating) is indicated, which is evident. When the disease is in the exterior but the pulse is deep, diaphoresis cannot be omitted. However, a deep pulse indicates an interior condition. If one were to induce sweating contrary to this, body fluids would escape, leading to the loss of Yang and leaving Yin alone, which is perilous. Therefore, Ma Huang (Ephedrae Herba) opens the interstices (cou li), Xi Xin (Asari Radix et Rhizoma) disperses floating heat, but without Fu Zi (Aconiti Lateralis Radix Praeparata) to secure the Primordial Yang, once the heat dissipates, the cold will rise, and death will follow immediately. This person did not understand the principles of nourishing and storing, violated the Qi of winter, and injured the Kidneys, resulting in this syndrome. If one could avoid disturbing Yang, prevent the skin from opening and sweating, and shun cold for warmth, how could such a disaster occur? This clause implies symptoms of no sweating and aversion to cold.

In Shaoyin disease, after two or three days, if treated with Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) to induce slight sweating, it is because there are no interior syndromes after two or three days, hence only slight sweating is induced.

Stating that there are no interior syndromes implies the presence of exterior syndromes. By replacing Xi Xin with Gan Cao (Glycyrrhizae Radix et Rhizoma), it is described as inducing slight sweating. It must be understood that this clause involves slight aversion to cold and slight fever, hence slight sweating is induced. The *Suwen: Pi Bu Lun* states: "The Yin of Shaoyin, when entering the meridians, flows from the Yang portion into the meridians; when exiting, it enters the bones from the interior Yin." This syndrome and the Fuzi Tang syndrome are both exterior syndromes of Shaoyin. Fever with a deep pulse and no interior syndrome indicates flow from the Yang portion into the meridians; body and joint pain, cold hands and feet, aversion to cold on the back, and a deep pulse indicate entry from the interior Yin into the bones. Flowing from Yang into the meridians warrants the use of Ma Huang and Xi Xin; entering from Yin into the bones warrants the use of Ren Shen (Ginseng Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Shao Yao (Paeoniae Radix). With a harmonious mouth and no heat at the pivot, Fu Zi can be used.

Ma Huang Fu Zi Xi Xin Tang:
Ma Huang (Ephedrae Herba), Xi Xin (Asari Radix et Rhizoma) [each 3 liang]; Fu Zi (Aconiti Lateralis Radix Praeparata) [1 piece, processed and peeled].
Boil in 10 dou of water. First boil Ma Huang, reduce by 2 dou, remove the foam, then add the other herbs. Boil until 3 sheng remain, strain, and take 1 sheng warm, three times daily.

Ma Huang Fu Zi Gan Cao Tang:
Take the above formula, remove Xi Xin, and add Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 liang. Use 7 sheng of water. The decoction method is the same. This also reflects the intent of inducing slight sweating.

In Shaoyin disease, after eight or nine days, if the whole body and hands and feet are hot, it is because the heat is in the Bladder, and hematochezia or hematuria (bleeding from the lower orifices) will certainly occur.

This is a transmission from Zang (organ) to Fu (hollow organ), where Yin overcomes Yang. Qi pathology injuring Blood represents Yang overcoming Yin. This also shows the image of the Shaoyin pivot. Diseases originating in Yin heal in six days. On the seventh day, if the patient has slight fever and warm hands and feet, this indicates Yin emerging into Yang, signifying recovery. On the eighth day or later, if there is conversely high fever, it is because heat transfers from the Kidney to the Bladder. Bladder heat causes heat throughout the Taiyang meridians. Taiyang governs the exterior of the whole body and is the master of all Yang Qi. Hands and feet are the roots of all Yang Qi, hence the whole body and hands and feet become hot. The Taiyang meridians have abundant blood; when blood encounters heat, it moves rapidly. Yang diseases, rising to the extreme, descend; thus, bleeding from the urine occurs. This is a syndrome transmitting from interior to exterior, turning from Yin to Yang, which is easy to resolve; therefore, even with severe body heat, death does not ensue. Mild cases may be treated with Zhu Ling Tang (Polyporus Decoction), and severe cases with Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction). This differs from Taiyang heat binding in the Bladder with spontaneous bleeding, although the symptoms are similar, the etiology is different.

There are two types of Shaoyin transmitting to Yang syndromes: Abdominal distension with constipation after six or seven days indicates transmission to Yangming; whole body and hand-foot heat after eight or nine days indicates transmission to Taiyang.

"Diarrhea with pus and blood" refers to the stool; "heat in the Bladder causing bleeding" refers to urination.

In Shaoyin disease, cough with diarrhea and delirium results from being coerced by Fire Qi; urination will certainly be difficult due to the forced induction of sweating in Shaoyin.

Upper cough and lower diarrhea deplete body fluids, yet delirium does not indicate transmission to Yangming. The Kidney governs the five fluids, which enter the Heart to become sweat. In Shaoyin disease, fluids do not ascend, so Yin cannot produce sweat. When Shaoyin fever necessitates sweating with Ma Huang, Fu Zi must be used to secure the interior. How can one coerce sweating using Fire Qi? The Shaoyin meridian enters the Lung and emerges to connect with the Heart. The Lung governs voice, and the Heart governs speech. Fire Qi forcing the Lung and Heart causes cough and delirium. The Kidney governs the two lower orifices, manages the Lower Jiao, separates clear from turbid fluids, and渗 (seeps) them into the Bladder. Now, Shaoyin is invaded by pathogens and further harassed by Fire. The pivot lacks direction, the Large Intestine fails to separate clear from turbid, and the Bladder's water pathways are obstructed, resulting in diarrhea and difficult urination. If urination is smooth, the patient is treatable. This is due to Yin deficiency, hence difficult urination.

In Shaoyin disease, if there is only cold extremities without sweating, and one forcibly induces sweating, the blood will certainly be disturbed. It is unknown from which orifice the blood will exit; it may come from the mouth and nose, or from the eyes. This is called "Lower Cold and Upper Exhaustion," which is difficult to treat.

Yang Qi fails to reach the four limbs, causing cold extremities. Cold extremities indicate a lack of Yang, preventing sweat production. Forcibly inducing sweating affects the blood. Blood and sweat share the same origin but have different names. If sweat is not extracted, blood will be disturbed.

The previous case involved coercive sweating by Fire, damaging the Lung and Heart above and exhausting the Bladder below, remaining in the Qi level, so the harm was relatively light. Harsh diaphoretic agents damage the meridians and disturb the blood. If the Yin collaterals are damaged and bleeding flows downward, it might still be salvageable; if the Yang collaterals are damaged and bleeding flows upward, life cannot be restored. Such is the harm of reckless sweating.