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Shaoyin disease. After two or three days of onset, if the patient experiences mental restlessness (xin zhong fan) and inability to sleep (bu de wo), it should be treated with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).

The heat syndrome in Shaoyin may transmit from Yang meridians, or it may arise from cold pathogenic factors lingering for a long time and transforming into heat. "Two or three days or more" refers to the period from the second or third day up to the fifth, sixth, or even eighth or ninth day, where extreme cold transforms into heat. When the condition progresses to mental restlessness and insomnia, it indicates that heat qi is agitating internally and fully entering the blood level, thereby harming all Yin aspects. Generally, when cold in Yang meridians transforms, the heat returns to the Qi level or enters the Blood level; however, when cold in Yin meridians transforms, the heat directly enters the Blood level without returning to the Qi level. This is an experience verified through repeated clinical practice. Therefore, the bitter properties of Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix) are combined with the sweet properties of Ejiao (Asini Corii Colla), Shaoyao (Paeoniae Radix Alba), and Ji Zi Huang (Ovi Galli Albumen) to enter the blood level, generate Yin qi, and eliminate pathogenic heat. This aligns with Cheng Wuji's statement: "When Yang is in excess, use bitter substances to clear it; when Yin is deficient, use sweet substances to tonify it."

Huanglian Ejiao Tang Formula
Huanglian (4 liang), Huangqin (1 liang), Shaoyao (2 liang), Ejiao (3 liang), Ji Zi Huang (2 units).
Take the above five ingredients. Add 5 sheng of water, first decoct the first three ingredients until 2 sheng remains. Strain the dregs. Dissolve Ejiao completely while warm, then cool slightly. Add Ji Zi Huang and stir well to mix. Take 7 he of the decoction warm, three times daily.

Shaoyin disease characterized by Si Ni (cold extremities). The patient may also present with cough (ke), palpitations (ji), difficulty urinating (xiao bian bu li), abdominal pain (fu zhong tong), or diarrhea with a sensation of heaviness in the rectum (xie li xia zhong). It should be treated with Sini San (Four Counterflow Powder).

Si Ni refers to cold extremities. This is not Heat Jue (cold extremities due to deep heat); nor is it Taiyang disease where cold has just been acquired and entered Shaoyin before stagnating into heat. Shaoyin serves as the pivot of the Three Yin meridians, just as Shaoyang serves as the pivot of the Three Yang meridians. Pathogens advancing enter Yin, while retreating they move toward Yang. With pathogens residing here, there is a dynamic potential for advancement or retreat, moving up or down at different times. Consequently, symptoms may include cough, palpitations, difficulty urinating, abdominal pain, or diarrhea with rectal heaviness. For pathogens in the exterior, they can be guided out via dispersing methods; for those in the interior, they can be purged downward; for those between exterior and interior, harmonizing and distributing methods are used. "Distributing" implies resolving half from the exterior and half from the interior. Thus, Chaihu (Bupleuri Radix) with its acrid property lifts and guides pathogens outward, while Zhishi (Aurantii Fructus Immaturus) with its bitter property suppresses and resolves them inward. The ability to address both exterior and interior relies heavily on the function of the pivot mechanism. Therefore, Shaoyao (Paeoniae Radix Alba) with its sour property nourishes Yin, and Gancao (Glycyrrhizae Radix et Rhizoma) with its sweet property nourishes Yang. The name "Si Ni" is derived from the primary symptom it treats. The general principle of this formula resembles Xiao Chaihu Tang (Minor Bupleurum Decoction). Chaihu and Zhishi in Sini San correspond to Chaihu and Huangqin in Xiao Chaihu Tang; Shaoyao and Gancao in Sini San correspond to Renshen (Panacis Ginseng Radix) and Gancao in Xiao Chaihu Tang. Furthermore, Zhishi excels at clearing phlegm-fluids, while Gancao and Shaoyao harmonize Ying and Wei. Due to differences in Yin and Yang pathology, the medications differentiate between Qi and Blood effects. However, their functions in supporting healthy Qi, expelling pathogens, and harmonizing the exterior and interior make these two formulas functionally similar. Old theories claiming this formula treats "deep heat causing cold extremities" (Re Shen Fa Jue) are incorrect. If it were truly deep heat causing cold extremities, it would fall under the category requiring purgation ("Jue Ying Xia Zhi"), which this formula cannot treat.

Sini San Formula
Chaihu, Zhishi (broken, soaked in water, and dried after roasting), Shaoyao, Gancao (roasted).
Take the above four ingredients, each in ten parts. Pound and sieve them. Mix with rice water and administer one Fang Cun Bi (approx. 9 grams) per dose, three times daily.

Modifications
If coughing occurs, add Wuweizi (Schisandrae Fructus) and Ganjiang (Zingiberis Rhizoma) each in five parts. This modification also treats diarrhea.
Cheng Wuji stated: Lung cold with rebellious Qi causes cough. Wuweizi's sour astringency directs rebellious Qi downward, and Ganjiang's acridity disperses Lung cold. They simultaneously treat diarrhea because the Lung and Large Intestine are exterior-interior pairs. Upper cough and lower diarrhea share similar treatment principles.

If palpitations occur, add Guizhi (Cinnamomi Ramulus) in five parts.
Palpitations indicate excessive cold and blocked Heart vessels causing pulsation in the epigastrium. Guizhi is acrid and warm, enters the Heart meridian, and unblocks Yang Qi.

If difficulty urinating occurs, add Fuling (Poria) in five parts.
Difficulty urinating indicates water accumulation in the lower jiao. Fuling is sweet and bland, promoting diuresis through pore opening and fluid seepage.

If abdominal pain occurs, add Fuzi (Aconiti Lateralis Radix Praeparata) one piece, processed until cracked.
Abdominal pain indicates severe cold in the interior. Fuzi is acrid and warm, dispersing cold and relieving pain.

If diarrhea with rectal heaviness occurs, first decoct Xiebai (Allii Macrostemonis Bulbus) in 5 sheng of water using 3 sheng of Xiebai until 3 sheng remains. Strain. Add three Fang Cun Bi of Sini San powder to the decoction. Boil until 1.5 sheng remains. Divide into two warm doses. Rectal heaviness in diarrhea indicates cold stagnation in the lower jiao. Xiebai is acrid and warm, dispersing cold and unblocking Yang Qi.

Shaoyin disease with diarrhea lasting six or seven days, accompanied by cough, vomiting, thirst, mental restlessness, and insomnia. It should be treated with Zhu Ling Tang (Polyporus Decoction).

In Shaoyin cold damage, if diarrhea persists for six or seven days, the cold may transform into heat, and the Qi may rebel upward, causing cough, vomiting, thirst, mental restlessness, and insomnia. This is described as "extreme downward movement leading to upward reversal." Since the pathogen moves from below to above, it must still be guided out from below. Zhu Ling (Polyporus), Fuling (Poria), Zexie (Alismatis Rhizoma), and Huashi (Talcum) are sweet and bland herbs that descend, effectively guiding water and draining heat. However, since this is a Yin disease involving pathogenic heat, without the salty-cold nature of Ejiao (Donkey-Hide Gelatin) entering the Yin level, how could one harness these Yang-moving herbs to drain heat from the Yin and guide floating Qi downward?

Shaoyin disease with diarrhea, sore throat, chest fullness, and mental restlessness. It should be treated with Zhu Fu Tang (Pig Skin Decoction).

The Shaoyin meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lung, and follows the throat. A branch emerges from the Lung, connects to the Heart, and pours into the chest. When Yang pathogens transmit to Shaoyin, they cause diarrhea downward and sore throat, chest fullness, and restlessness upward. Heat qi fills the vessels, damaging the organ's Qi and consuming the Yin of the Heart and Lung. Pig skin (Zhu Fu) is sweet and cold; its flavor acts primarily on the Shaoyin meridian, nourishing Yin, clearing exogenous heat, and stopping sore throat, thus serving as the Sovereign herb. Adding Bai Mi (White Honey) soothes urgency and moistens dryness, resolving fullness and restlessness. Bai Fen (Rice Flour) is sweet and tonifies the Middle, while its warmth nourishes the organs, stopping diarrhea.

Zhu Fu Tang Formula
Zhu Fu (Pig Skin) 1 jin. Decoct in 1 dou of water until 5 sheng remains. Strain. Add Bai Mi (White Honey) 1 sheng and Bai Fen (Rice Flour) 5 he. Cook until fragrant, mix well. Divide into six warm doses.

Shaoyin disease with injury to the throat, formation of sores, inability to speak, and loss of voice. It should be treated with Ku Jiu Tang (Bitter Wine Decoction).

Shaoyin heat qi rushes upward along the meridian, injuring the throat and forming sores, leading to aphonia and voice loss. As Li Dongyuan stated, Shaoyin pathogens entering the interior connect with the Heart, combining with Fire to impair Metal (Lung, which governs voice). Therefore, Banxia (Pinelliae Rhizoma) is used for its acridity to dissipate nodulated heat and stop sore throat. Ji Zi Bai (Ovi Gallii Albumen) is sweet and cold, entering the Lung to clear heat and restore voice. Ku Jiu (Vinegar) is bitter and sour, reducing swelling and dispersing pathogenic toxins.

Ku Jiu Tang Formula
Banxia 14 pieces, washed and broken like dates. One egg, remove yolk. Place egg white in the shell, add Ku Jiu (vinegar), and put Banxia into the vinegar within the shell. Place the shell in a knife ring over fire. Boil three times. Strain. Gargle and swallow slowly. If not healed, prepare three more doses.

Shaoyin disease presenting with sore throat after two or three days. Give Gancao Tang (Licorice Decoction). If not relieved, give Jiegeng Tang (Platycodon Decoction).

This is the method for treating sore throat caused by heat transmitting to Shaoyin. Gancao Tang uses sweetness to relieve urgency and coldness to clear heat. If severe and unrelieved, acrid herbs must be used to disperse and sweet herbs to moderate. Gancao and Jiegeng (Platycodonis Radix) are combined, with sweetness predominating over acridity. This approach is appropriate for treating deficiency-heat from exogenous pathogens, balancing light and heavy treatments.

Gancao Tang Formula
Gancao 2 liang. Decoct in 3 sheng of water until 1.5 sheng remains. Strain. Take 7 he warm, twice daily.

Jiegeng Tang Formula
Jiegeng (1 liang), Gancao (2 liang).
Decoct the above two ingredients in 2 sheng of water until 1 sheng remains. Strain. Divide into two warm doses.

Shaoyin disease with sore throat. It should be treated with Banxia San Ji Tang (Pinellia Powder and Decoction).

For sore throat in Shaoyin disease, if sweetness fails to relieve urgency, acridity must be used to disperse. If coldness fails to clear heat, warmth must be used to vent. Exogenous pathogens in Shaoyin stagnate in the throat, unable to exit or enter. Using cold herbs would worsen stagnation; using acrid-warm herbs would open the stagnation. This reflects the Nei Jing principle: "For mild conditions, use contrary treatment; for severe conditions, follow the pathogen." Banxia San Ji Tang combines acrid and sweet flavors, with acridity prevailing, and possesses warm properties. It not only dispels exogenous cold but also vents stagnant heat in the throat.

Banxia San Ji Tang Formula
Banxia (washed), Guizhi (bark removed), Gancao (roasted), equal parts.
Pound and sieve each ingredient separately, then mix. Administer one Fang Cun Bi mixed with rice water, three times daily. If powder form is difficult to take, decoct in 1 sheng of water for seven boils. Add two Fang Cun Bi of powder. Boil three more times. Remove from heat, let cool slightly, and swallow slowly in small amounts.