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When cold pathogen invades the Shaoyin (Lesser Yin) channel, it executes its severe mandate, burying and suppressing the faint Yang qi. This results in frozen and cracked skin, absence of sweating, and loss of spirit governance. In such a critical situation, Fuzi (Aconite Lateralis Radix Praeparata) and Ganjiang (Zingiberis Rhizoma) must be urgently employed, with Congbai (Allii Tuberosi Bulbus) added to disperse cold, and Zhuyedanhuang (Porci Bile) added as a guiding agent to enter the Yin aspect. However, one may fear that the medicinal strength is insufficient. Therefore, combining Congwan (Scallion moxibustion/warming therapy) and Aiye (Moxa cone moxibustion), attacking from both inside and outside, is necessary to break the firm coagulation of cold; if there is even a slight delay, it will certainly be too late. This constitutes the first difficulty.

The Shaoyin channel corresponds to the Kidney organ. Whenever cold pathogen invades Shaoyin, it indicates that the True Yang of the Kidney is extremely deficient, and Yang lacks defensive capability, akin to an impregnable city wall without proper guards, allowing thieves to enter through the void. Thus, just as the gloomy and obstructive mist of heaven and earth cannot be cleared unless the sun shines brightly in the sky, when humans are afflicted by such pathogens, the disease first attacks the Taiyin (Greater Yin) channel, then spreads to Shaoyin, and further invades the Jueyin (Terminal Yin) channel. Consequently, symptoms such as vomiting and diarrhea, cold limbs, sunken eyes with fixed gaze, restlessness, absent pulse, sudden collapse of muscles, numbness of hands and feet, urgent tendon contraction and spasms, and even tongue retraction and testicular shrinkage appear simultaneously—the terminal syndromes of the three Yin channels manifest together. At this juncture, medication requires precise differentiation. Without relying on the pungent and hot, vigorous nature of Fuzi and Ganjiang, how can one drive away Yin cold and restore Yang? As stated in the *Neijing* (Classic of Internal Medicine): "Nourish the source of fire to eliminate the shadows of Yin." Adding Congbai helps unblock Yang and disperse cold, while Zhuyedanhuang guides the medicine into the Yin aspect. This precaution is taken because one fears that upon swallowing the hot-natured medicine, it might be rejected by the internal Yin cold, failing to enter directly or potentially being vomited out. If Zhuyedanhuang is unavailable, Huanglian (Coptidis Rhizoma) can be used as a substitute. This allows the pungent-hot medicinal properties to enter the Yin aspect and restore Yang. If nausea is impending, adding Shengjiangjiang (Fresh Ginger Juice) and a small amount of Xianqiao (Clam Shell powder) mixed into the decoction for oral administration is most expedient and effective. If there is congealing pain in the lower abdomen, this is also due to Qi stagnation in the Jueyin channel; external therapies like Congwan and Aiye can yield immediate effects.

If the patient's True Yang has been chronically deficient, and their Couli (pores/skin texture) have been chronically loose, with Yin cold flourishing internally forcing Yang to escape externally, resulting in profuse sweating resembling "Po sweat" (sweat associated with the Lung/Spirit), stiffness and rigidity of the spine and neck, this indicates the impending collapse of isolated Yang. When using Fuzi, Ganjiang, and Zhuyedanhuang, one must not add Congbai or Aiye, lest the dispersing action be too strong, causing Qi to escape with the sweat, preventing Yang from returning internally. One should apply powders to stop sweating and further protect the Couli. Otherwise, Yang may escape again. This constitutes the second difficulty.

Those who indulge in sexual activity without restraint inevitably deplete their True Yang; those who overwork have chronically loose Couli. Once Yin cold becomes excessive internally, it forces True Yang to escape externally, leading to profuse sweating, panting and rebellious Qi, and restlessness. The Jingqi (Meridian Qi) of the Taiyang channel and the Zangqi (Organ Qi) of the Shaoyin are on the verge of extinction, hence the stiffness of the spine and neck, and upward staring eyes. At this time, it is appropriate to use Fuzi, Ganjiang, and Zhuyedanhuang to enter the Yin aspect and restore Yang. However, given the profuse sweating and escaping Yang, methods involving Congbai and Aiye moxibustion must be avoided. Since Congbai has a dispersing nature, there is great fear that Qi will escape with the sweat, leaving the remaining trace of faint Yang unable to return internally. Urgently apply powders to stop sweating: use Muli (Ostreae Concha), Wubeizi (Galla Chinensis), and Mahuanggen (Ephedrae Radix et Rhizoma) ground into fine powder applied to the body. Further protect the Couli using herbs such as Huangqi (Astragali Radix), Guizhi (Cinnamomi Ramulus), Wuweizi (Schisandrae Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma). These ingredients perform major sealing and consolidating actions, preventing True Yang from escaping externally, much like rallying retreating troops and stabilizing the camp.

Previously, using Fuzi and Ganjiang to overcome Yin cold and restore Yang is likened to taking elite cavalry to charge through heavy encirclement, raising flags to signal, so that scattered Yang qi gathers towards the flag and reunites shortly. Those who do not understand this principle increase the number of herbs, mixing them into decoctions, which instead restricts the vigorous momentum of the primary herbs, leading to sluggishness and inefficacy. This constitutes the third difficulty.

Secondly, in the previous prescription, Danggui (Angelicae Sinensis Radix) and Rougui (Cinnamomi Cortex) must be added to regulate Ying blood, because cold pathogen invasion first damages Ying blood. Otherwise, the medicinal effect biases toward Wei (Defensive) level and fails to reach Ying (Nutritive) level, mismatching the pathology. If the pathogen is not fully expelled, victory is not assured. This constitutes the fourth difficulty.

Secondly, in the previous prescription, Renshen (Ginseng Radix) and Gancao (Licorice Root) must be added to regulate Yuan Qi, turn danger into safety, and secure the outcome. Otherwise, the fierce potency of Fuzi and Ganjiang will attack the upper jiao recklessly. This constitutes the fifth difficulty.

After two or three doses of the previous medicines, if the patient feels lighter movement and improved mental clarity, these are signs of the return of True Yang, becoming prominent. Then, add Huangqi, Baizhu (Atractylodis Macrocephalae Rhizoma), Wuweizi, and Baishao (Paeoniae Radix Alba)—a large group of herbs for balanced tonification of Yin and Yang—and do not cease treatment. For just as heavy Yin yields to sunlight, like a prodigal son returning home, the mind remains unstable at this stage. Failure to provide follow-up care will result in the failure of previous efforts. This constitutes the sixth difficulty.

Using a large group of herbs to nourish Yin and protect Yang: even if the person previously had Phlegm-Heat, it has now transformed into Cold due to the Yin pathogen. Although formless Yin cold has dissipated,有形 (formidable) Cold Phlegm blocking the orifices and tunnels cannot transform into Heat. Therefore, although Ganjiang and Fuzi may no longer be needed, Niuhuang (Bovaris Calculus) and Zhuli (Bambusae Caulis in Taenia) must absolutely not be used. If one prescribes cold-natured agents based on the history of Phlegm-Heat, Yin cold will regain dominance, Yang will become restless, and previous efforts will fail. This constitutes the seventh difficulty.

This refers to the state after balancing Yin and Yang: although Yang has returned, Yin has been injured. Even if the person previously had Phlegm-Heat, having contracted Yin-Cold disease, it has transformed into Cold. Although the Cold has gone, the Phlegm remains. Even if there are symptoms of coughing, rebellious Qi, thirst, red tongue, and desire to drink, one must not prescribe cold-cooling herbs based on these symptoms, nor continue using Jiang (Ginger) and Fu (Aconite). It is appropriate to use Maidong Tang (Ophiopogon Decoction) from the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), adding Wumei (Mume Fructus) and Baishao, employing the method of sweet-acid transformation to generate Yin, harmonize the Stomach, generate fluids, and coordinate Yin and Yang.

After using the balancing tonification method previously, the intention of laying down arms and promoting culture is shown. Thereafter, even if stubborn Phlegm remains accumulated in the meridians, only sweet-cold herbs that assist Qi and guide out blockage should be used; pungent-spicy herbs that aid Heat and cause obstruction should be avoided. Pungent-hot herbs were used initially out of necessity, utilizing their toxicity. Why seek merit and create trouble, leaving the disease gone but the medicine remaining, thereby generating other ailments and denying peace to the body? This constitutes the eighth difficulty.

The above eight points discuss the manifestations of Yin syndromes and the sequence of medication as expounded by Master Yu Chang. They are well-organized and logical. Only those who deeply grasp the subtle essence of Zhang Zhongjing’s methods can articulate such profound truths!

My commentary: In Yin syndromes, the absence of pulse in all six positions is originally a sign of certain death. If, after administering Sini Tang (Four Reversal Decoction) or other Yang-restoring medicines, the pathological mechanism gradually shifts, and the absent pulse returns, this indicates that Yin pathogen is receding and Yang is recovering. Although the illness is not fully cured, hope exists. However, if the pulse suddenly appears surging and large, but lacks spirit when pressed deeply, this is called "Sudden Emergence," which is highly inadvisable. Accompanied by chest and abdominal discomfort, rebellious Qi, or unresolved diarrhea, this is a sign of certain death. If medication is attempted, generously use large doses of Renshen and Fuzi, or Zhang Jingyue’s Fuzi Liyin Jian (Aconite Regulating Yin Decoction) plus Fuling (Poria) and Wuweizi, to prevent the last trace of Yang stored in the Mingmen (Gate of Life) from fleeing. If, after administration, the pulse calms, Qi levels, the abdomen feels relaxed, and sleepiness occurs, there is a chance of survival; otherwise, even divine medicine cannot save them. This applies not only to Yin syndromes but also to miscellaneous diseases: whenever pulse absence and cold limbs are followed by sudden pulse emergence, careful examination is required. Do not assume safety simply because the pulse has resumed. Physicians must examine carefully. Also, in early stages of Shanghan (Cold Damage), the pulse may be hidden (Fu) before emerging. The pulse should be surging, large, floating, and slippery to be normal. Fine, short, and choppy pulses are inappropriate. Why? Pulse Hidden (Fu) differs from Pulse Absent (Jue) followed by Sudden Emergence. A Fu pulse is solid and fleshy at the Chi position (cubital fossa); pressing firmly reveals it under the tendons against the bone, caused by pathogen depression and meridian obstruction leading to internal hiding. An Jue pulse is hollow and devoid of flesh at the Chi position; light pressure touches bone/tendon with no internal Qi, caused by Qi depletion and Blood stasis blocking flow, leading to interruption. Therefore, distinguishing Fu from Jue relies primarily on whether there is flesh/solidity at the Chi position, which is the most accurate method and should not be mistaken.

After sexual intercourse, lower abdominal pain is commonly referred to as "Wind" by laypeople, but it is actually a Yin syndrome. Sexual indulgence causes massive leakage of Essence and Qi, emptying the Yuan Sea (Root of Origin). One must immediately control breath and Qi, guarding the Guanyuan point. Although the "Dragon Cave" is empty, the Minister Fire remains strong, capable of resisting cold. If one remains mentally agitated and emotionally aroused, unable to self-control, the body's Yang qi relaxes throughout the joints, allowing cold pathogen to enter through gaps. Cold entering from below first attacks Jueyin, then Shaoyin, then Taiyin. Cold entering from above first attacks Taiyin, then Shaoyin, then Jueyin. The Jueyin channel corresponds to the Liver. Its pathway runs along the pubic region, surrounds the genitalia, enters the lower abdomen, spreads through the hypochondrium, pierces the diaphragm, follows the throat, and connects to the tongue. Thus, when cold pathogen enters, Liver collaterals stagnate, Qi knots and fails to move, causing lower abdominal pain radiating to the genitals, attacking the chest and epigastrium, salivation, cold extremities, cyanotic nails, body feeling like being beaten, and even death with the tongue protruding several inches. After death, limbs turn blue. Unaware people call it Wind. Wind belongs to East Wood (Jia/Yi), color blue, hence the error. It is actually Cold invading Jueyin. Jueyin is the interior of the three Yin channels, the deepest part of the five Zang organs, often resulting in death within a day or night. Regarding treatment principles, pungent-hot herbs like Jiang and Fu in large doses can dispel cold and restore Yang. However, since pathogen has deeply entered Jueyin, single pungent-hot herbs cannot cure it instantly. One must use bitter herbs to drain turbidity and pungent herbs to unblock Yang for rapid effect. I encounter this syndrome often and use Danggui Sini Tang (Danggui Reversal-Cold Decoction), adding Chuanlian (Coptidis Rhizoma), Xiaohui (Foeniculum Fructus), Xiebai (Allii Macrostemonis Bulbus), and Liangtoujian (Rhizoma Belamcandae), often curing it in one dose. After pain stops, use Jiang, Fu, Ling, Gan (Ginger, Aconite, Poria, Licorice) with minor bitter-pungent adjustments to settle. If lower abdominal pain is severe and medicinal strength is insufficient, external Congwan and Aiye moxibustion yields instant results. Improper treatment delaying time can cost lives; is this not significant?

Attached Formulas

Two Strokes
Renshen Guben Tang (Ginseng Root-Nourishing Decoction): Renshen, Tiantong, Maidong, Shengdi, Shudi
Renshen Shaoyao Tang (Ginseng Peony Decoction): Not detailed
Renshen Wendan Tang (Ginsense Calming Gallbladder Decoction): Banxia, Chenpi, Fuling, Gancao, Zhuru, Zhishi, Dazao, Renshen
Shisiwei Dajianzhong Tang (Fourteen-Ingredient Great Building Middle Decoction): Zhi Huangqi, Renshen, Chao Baizhu, Fuling, Zhi Gancao, Zhi Banxia, Danggui, Baishao, Shudi, Chuanxiong, Maidong, Roushoucong, Fuzi, Rougui, Shengjiang, Dazao

Three Strokes
Sanjia San (Three Shells Powder): Zhi Biejia, Chao Shanji, Chantui, Jiangcan, Duan Muli, Jinchong, Danggui, Baishao, Gancao
Xiao Chaihu Tang (Minor Bupleurum Decoction): Chaihu, Huangqin, Banxia, Renshen, Gancao, Shengjiang, Dazao
Xiao Chengqi Tang (Minor Order the Qi Decoction): Dahuang, Zhishi, Houpo
Xiao Xianxiong Tang (Minor Trap-in-the-Chest Decoction): Banxia, Huanglian, Gualou
Xiao Xuming Tang (Minor Rescue Life Decoction): Fangfeng, Guizhi, Mahuang, Xingren, Chuanxiong, Baishao, Renshen, Zhi Gancao, Huangqin, Fangji, Fuzi
Xiao Wenzhong Wan (Minor Warm Middle Pill): Baizhu, Fuling, Chenpi, Zhi Banxia, Gancao, Chao Shenqu, Sheng Xiangfu, Chao Kushen, Chao Huanglian, Cu Zhencha
Xiao Banxia Tang (Minor Pinellia Decoction): Banxia, Shengjiang
Dahuang Fuzi Tang (Rhubarb and Aconite Decoction): Dahuang, Fuzi, Xixin

Four Strokes
Niuhuang Wan (Calculus Bovis Pill): Niuhuang, Yujin, Xijiao, Huanglian, Zhusha, Shanzhi, Xionghuang, Huangqin, Zhenzhu, Bingpian, Shexiang (Note: Multiple formulas exist for Niuhuang Wan; this seeks Angong Niuhuang Wan)
Liu Junzi Tang (Six Gentlemen Decoction): Renshen, Baizhu, Fuling, Zhi Gancao, Banxia, Chenpi, Shengjiang, Dazao
Liuyi San (Six-to-One Powder): Huashi, Gancao
Liuhe Tang (Harmonizing Six Decoction): Huoxiang, Xingren, Jiang Banxia, Mugua, Baizhu, Baibiandou, Houpo, Sharen, Renshen, Zhi Gancao, Shengjiang, Dazao
Tianwang Buxin Dan (Emperor of Heaven Heart-Nourishing Pill): Renshen, Xuanshen, Danshen, Fuling, Jiegeng, Yuanzhi, Wuweizi, Danggui, Tiantong, Maidong, Baiziren, Chao Suanzaoren, Shengdi

Five Strokes
Yunü Jian (Jade Maiden Decoction): Sheng Shigao, Shudi, Maidong, Zhimu, Niuxi
Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction): Banxia, Huanglian, Huangqin, Ganjiang, Renshen, Zhi Gancao, Dazao
Baihu Tang (White Tiger Decoction): Sheng Shigao, Zhimu, Gancao, Jingmi
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction): Sheng Shigao, Zhimu, Gancao, Jingmi, Renshen
Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction): Sheng Shigao, Zhimu, Gancao, Jingmi, Guizhi
Baihu Jia Cangzhu Tang (White Tiger Plus Atractylodes Lancea Decoction): Sheng Shigao, Zhimu, Gancao, Jingmi, Cangzhu
Baitong Tang (White Pass Decoction): Congbai, Ganjiang, Fuzi
Baitouweng Tang (Peonyhead Decoction): Baitouweng, Huanglian, Huangbo, Qinpi
Sini Tang (Four Reversal Decoction): Gancao, Ganjiang, Fuzi
Guiqi Jianzhong Tang (Angelica and Astragalus Build the Middle Decoction): Danggui, Zhi Huangqi, Guizhi, Shaoyao, Zhi Gancao, Shengjiang, Dazao
Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction): Shengjiang, Banxia, Huanglian, Huangqin, Ganjiang, Renshen, Zhi Gancao, Dazao

Six Strokes
Zhibao Dan (Precious Treasure Pill): Xijiao, Daimao, Hupo, Zhusha, Xionghuang, Bingpian, Shexiang, Niuhuang, Anshixiang, Jinbo, Yinbo
Shaoyao Tang (Peony Decoction): Shaoyao, Huangqin, Danggui, Binglang, Huanglian, Dahuang, Muxiang, Rougui, Gancao
Anwei Wan (Stomach-Anchoring Pill): Wumei, Chuanjiao, Fuzi, Guizhi, Ganjiang, Huangbo, Huanglian, Chuanlianzi, Chenpi, Qingpi, Baishao, Renshen (Note: According to Chinese Medical Dictionary, Wumei Anwei Wan is Zhongjing's Wumei Wan. Later generations have another Anwei Wan, seemingly consistent with the formula meaning in this book, i.e., the formula recorded here, for reference)
Huiyang Jiujitang (Return Yang Emergency Rescue Decoction): Fuzi, Ganjiang, Rougui, Renshen, Chao Baizhu, Fuling, Jiang Banxia, Chenpi, Zhi Gancao, Wuweizi, Shengjiang, Shexiang
Daochi San (Guide Redness Powder): Shengdi, Mutong, Zhuye, Gancaoshao (One variant uses Huangqin instead of Gancao; another adds Dengxin)
Danggui Sini Tang (Angelica Reversal-Cold Decoction): Danggui, Shaoyao, Guizhi, Xixin, Zhi Gancao, Tongcao, Dazao