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Shao Yao (Radix Paeoniae Alba), add Jie Geng (Radix Platycodonis) one liang. If diarrhea stops but the pulse is not palpable, add Ren Shen (Radix Ginseng) two liang.

[Annotation] In the discussion regarding formulas that support Yang and suppress Yin: for cases of cold injury in the middle where Yang Qi is weak and cannot reach the exterior, Si Ni Tang (Cinnamon Twig, Aconite, and Licorice Decoction) is the primary treatment; for cases where both interior and exterior are cold with extreme deficiency of Yang Qi, Fu Zi (Prepared Radix Aconiti Lateralis Preparata) is the primary treatment; for cases where Yin is excessive below and repels Yang to the upper part, Bai Tong Tang (Scallion White Decoction) is the primary treatment; for cases where Yin is excessive inside and repels Yang to the outside, Tong Mai Si Ni Tang (Pulse-Returning Cinnamon Twig, Aconite, and Licorice Decoction) is the primary treatment. From this, it can be known that Si Ni Tang circulates and operates Yang Qi; Fu Zi warms and tonifies Yang Qi; Bai Tong Tang unblocks and communicates Yang Qi between the upper and lower parts; Tong Mai Si Ni Tang unblocks and communicates Yang Qi between the interior and exterior. Now, the pulse is faint and nearly absent, with cold in the interior and heat in the exterior; this indicates that Yin in the Kidney is excessively strong, repelling Yang to the exterior, hence this formula is indicated. By doubling Gan Jiang (Rhizoma Zingiberis Recens) and adding Gan Cao (Radix Glycyrrhizae Uralensis) to assist Fu Zi, and renaming it Tong Mai Si Ni Tang, it is because it greatly strengthens the Primordial Yang, governs both interior and exterior, and jointly attracts external heat back into the interior. At this time, the vital Qi has already dispersed, and death may occur in an instant; if soft and slow Gan Cao were used as the sovereign drug, how could it quickly call back the external Yang? Therefore, Gan Jiang is substituted. However, Gan Cao must be added in equal proportion to Gan Jiang, out of fear that after the dispersion of Yuan Qi, the fierce nature of Gan Jiang and Fu Zi cannot nourish and stabilize the Yuan Qi; this is what is meant by a "disciplined army." If there is facial flushing, add Cong Bai (Scallion White) to unblock the Yang repelled to the upper part. If there is abdominal pain, add Shao Yao to harmonize the Yin within. If there is vomiting or rebellious Qi, add Sheng Jiang (Fresh Rhizoma Zingiberis) to stop vomiting. If there is a sore throat, add Jie Geng to benefit the throat. If diarrhea stops but the pulse does not appear and Qi is deficient, double the dosage of Ren Shen to generate Yuan Qi and restore the pulse.

Bai Tong Tang treats Shaoyin disease presenting with diarrhea and a faint pulse; administer Bai Tong Tang. If diarrhea persists, accompanied by cold extremities, absence of pulse, dry heaving, and irritability, treat with Bai Tong Jia Zhu Dan Ji Tang (Scallion White Decoction plus Porcine Bile and Human Urine). If the pulse suddenly becomes prominent after taking the decoction, the patient will die; if the pulse gradually and continuously returns, the patient will survive.

Cong Bai (Scallion White) (4 stalks) Gan Jiang (Dried Ginger) (1 liang) Fu Zi (Raw Aconite Root, peeled, broken into eight pieces, 1 piece)

The above three ingredients are boiled in 3 sheng of water until 1 sheng remains. Strain the dregs and divide into two warm doses.

Bai Tong Jia Zhu Dan Ji Tang
Cong Bai (Scallion White) (4 stalks) Gan Jiang (Dried Ginger) (1 liang) Fu Zi (Raw Aconite Root, peeled, broken into eight pieces, 1 piece) Ren Niao (Human Urine) (5 he) Zhu Dan Zhi (Porcine Bile) (1 he)

The above five ingredients are boiled in 3 sheng of water until 1 sheng remains. Strain the dregs, add Zhu Dan Zhi and Ren Niao, mix well, and divide into two warm doses. If bile is unavailable, it may be omitted.

[Annotation] This formula is essentially Si Ni Tang with Gan Cao removed and Cong Bai added. It is named Bai Tong because Cong Bai can unblock Yang Qi. Gan Cao is removed because its action is slow; Ren Niao and Zhu Dan Zhi are added to follow their similar natures. After swallowing, the cold nature dissipates, and the hot nature immediately acts. The medication does not conflict with the condition but brings great benefit, thereby adjusting the rejection between Yin and Yang Qi and allowing the communication of Yin and Yang between the upper and lower parts.

Zhen Wu Tang treats Shaoyin disorders caused by Water-Qi, presenting with abdominal pain, diarrhea, heaviness and pain in the four limbs, and difficulty in urination. For patients who may also have cough or vomiting, or who have spontaneous urination but still suffer from diarrhea, this formula should be used with modifications.

Bai Zhu (Rhizoma Atractylodis Macrocephalae) (2 liang) Fu Ling (Poria) (2 liang) Bai Shao (Radix Paeoniae Alba) (2 liang) Da Fu Zi (Large Prepared Aconite Root, processed, 1 piece) Sheng Jiang (Fresh Ginger) (3 liang, sliced)

The above five ingredients are boiled in 8 sheng of water until 3 sheng remain. Strain the dregs and take 7 ge warm, three times daily.

If there is a cough, add Wu Wei Zi (Fructus Schisandrae Chinensis) half sheng, Xi Xin (Herba Asari) and Gan Jiang each 1 liang. If urination is spontaneous, remove Fu Ling. If there is diarrhea, remove Shao Yao and add Gan Jiang 2 liang. If there is vomiting, remove Fu Zi and increase Sheng Jiang so that the total amount reaches half jin.

[Annotation] Xiao Qing Long Tang treats exterior conditions unresolved with Water-Qi, representing a syndrome of Cold-Excess in both interior and exterior. Zhen Wu Tang treats conditions where the exterior is resolved but Water-Qi remains, representing a syndrome of Cold-Deficiency in both interior and exterior. Zhen Wu refers to the deity governing water in the North; naming the decoction after him implies the meaning of suppressing water. In the human body, the Spleen controls water, and the Kidney masters water. The Kidney is the gate of the Stomach; when water gathers, it follows its kind. If there is no Yang in the Kidney, although the pivot mechanism of the Spleen functions, the gate of the Kidney does not open. Although water desires to flow, lacking mastery and control, it overflows and moves recklessly, causing these symptoms. Using the pungent and hot nature of Fu Zi to strengthen the Primordial Yang of the Kidney ensures that water has a master. The bitter and drying nature of Bai Zhu establishes the Central Earth, ensuring that water has constraints. The pungent and dispersing nature of Sheng Jiang assists Fu Zi in tonifying Yang, embedding the intent of dispersing water within mastering water. The light and permeating nature of Fu Ling assists Bai Zhu in strengthening Earth, embedding the method of promoting urination within constraining water. Most ingeniously, the sour and astringent nature of Shao Yao reveals Zhang Zhongjing's subtle intent. Generally, Yang Qi in the body is rooted in Yin. If only pungent and hot herbs are used to tonify Yang without assisting with sour and astringent substances, there is a risk that True Yang may fly away and disperse. Using Shao Yao is to urgently gather Yang Qi and return it to Yin. From this, we can understand why, for those who mistakenly took Xiao Qing Long Tang leading to sweating and loss of Yang, Shao Yao is essential in Yang-tonifying formulas. However, Shao Yao is reduced in diarrhea because Yang does not scatter outward; Gan Jiang is added to warm the middle and overcome cold. When cold-water injures the Lung causing cough, Xi Xin and Gan Jiang are added to disperse cold-water; Wu Wei Zi is added to collect Lung Qi. If urination is spontaneous, Fu Ling is removed because although there is cold, water does not stagnate. If there is vomiting, Fu Zi is removed and Sheng Jiang is doubled because the pathology is not in the Lower Jiao but water stagnates in the Stomach. Thus, warming the Kidney to move water is unnecessary; instead, warming the Stomach to disperse water is appropriate, and Sheng Jiang functions to stop vomiting.

Dang Gui Si Ni Tang treats cold extremities and a fine pulse nearly absent; this formula is indicated. If the person has chronic cold within, add Wu Zhu Yu (Fructus Evodiae Officinalis) and Sheng Jiang.

Dang Gui (Radix Angelicae Sinensis) (3 liang) Gui Zhi (Ramulus Cinnamomi Cassiae) (3 liang) Shao Yao (Radix Paeoniae Alba) (3 liang) Xi Xin (Herba Asari) (2 liang) Tong Cao (Medulla Tetrapanacis) (2 liang) Gan Cao (Honey-fried Radix Glycyrrhizae Uralensis) (2 liang) Da Zao (Fructus Jujubae, split) (25 pieces)

The above seven ingredients are boiled in 8 sheng of water until 3 sheng remain. Strain the dregs and take 1 sheng warm, three times daily.

Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang
To the previous decoction, add Wu Zhu Yu half jin and Sheng Jiang 3 liang.

The above nine ingredients are boiled in 6 sheng of water and 6 sheng of clear wine until 5 sheng remain. Strain the dregs and divide into five warm doses.

[Annotation] In all Jueyin diseases, the pulse is faint and there is cold extremities, because Jueyin is the end of the Three Yin meridians. When Yin ends, Yang begins to generate. If affected by pathogenic factors, the Qi of Yin and Yang do not connect smoothly, resulting in a faint pulse and cold extremities. However, in the Jueyin organ, Ministerial Fire roams between them. Although the meridians are affected by cold, the organs do not immediately become cold; thus, those who first experience cold extremities will later develop fever. Therefore, at the initial stage of Cold Damage, when cold extremities and a fine pulse nearly absent are seen, one should not hastily diagnose it as Deficiency-Cold and use Gan Jiang and Fu Zi. This formula selects Gui Zhi Tang, with Dang Gui as the sovereign herb, because Jueyin governs the Liver, which is the Blood Chamber. Assisting with Xi Xin, which is extremely pungent, allows it to reach the Three Yin meridians, warming the meridians externally and the organs internally. Tong Cao is extremely penetrating, good at opening joints, connecting orifices internally and Ying-Qi externally. Doubling Da Zao follows the method of Jian Zhong Tang adding Yi Tang using sweet flavors. Removing Sheng Jiang prevents excessive pungency from rapidly scattering Qi. The will of the Liver dislikes urgency, and the spirit of the Liver desires dispersion. Combining sweet and pungent flavors satisfies the will and pleases the spirit. There is no case where the Jueyin spirit and will are satisfied yet the pulse remains faint and extremities remain cold. There is no need for the tonification of Ren Shen and Fu Ling, nor the harshness of Gan Jiang and Fu Zi. This distinguishes the treatment of Jueyin cold extremities from Taiyang and Shaoyin. If the person has chronic cold within, simple pungent-warm herbs cannot treat it simultaneously; therefore, add the pungent-hot Wu Zhu Yu and Sheng Jiang, and decoct with wine to assist Xi Xin in directly reaching the Jueyin organ, rapidly dispersing internal and external cold. This is another method for rescuing Jueyin from dual cold injury.

Wu Zhu Yu Tang treats Jueyin disease with dry heaving, vomiting of saliva/foam, and headache; Shaoyin syndrome with vomiting, diarrhea, cold extremities, and severe irritability; and Yangming disease with desire to vomit after eating.

Wu Zhu Yu (Evodia Fruit) (1 sheng) Ren Shen (Ginseng Root) (3 liang) Sheng Jiang (Fresh Ginger) (6 liang) Da Zao (Jujube, split) (12 pieces)

The above four ingredients are boiled in 7 sheng of water until 2 sheng remain. Take 7 ge warm, three times daily.

[Collected Annotations] Luo Qianfu said: Among Zhang Zhongjing's methods for rescuing Yang, Si Ni Tang for Shaoyin must use Gan Jiang and Fu Zi; Tong Mai Si Ni Tang doubles Gan Jiang and uses raw Fu Zi; Fu Zi Tang adds two raw Fu Zi. The reason is either to strengthen weak Yang to reach the exterior or to attract flying Yang to return inward. These are all because the True Yang of Shaoyin has lost its residence, making the restoration of Yang urgent. When treating Jueyin, however, Wu Zhu Yu is substituted, and previous herbs are removed, using only Ren Shen, Jiang, and Zao. This is because although Jueyin Liver Wood is the convergence of Two Yins, the True Qi of One Yang actually arises within it. If this vital Qi becomes deficient, the turbid Qi of the Three Yin meridians directly presses upon the Middle and Upper Jiao. Not only do all symptoms of the meridian manifest, but the healthy function of Yangming fails, leading to floating True Yang of Shaoyin, causing vomiting, diarrhea, cold extremities, severe irritability, and vomiting after eating. Wu Zhu Yu obtains the Qi of the East (Zhen Trigram), is pungent, bitter, and very hot, capable of reaching Liver depression, entering Jueyin directly, and descending the turbid Qi of excessive Yin, eliminating all Yin obscurity; it serves as the sovereign herb. Ren Shen possesses balanced Qi, is sweet, warm, and strongly tonifying, capable of connecting True Essence, saving life, and raising declining vital Qi, allowing sunlight to shine universally; it serves as the minister herb. Ginger and Jujube assist in harmonizing the Stomach and circulating to the four extremities. Thus, Zhen and Kun harmonize, Wood and Earth do not harm, the subtle function of One Yang is achieved, and the San Jiao is filled with generative Qi. How could any symptoms not recede? Zhang Zhongjing's methodology emphasizes consolidating Primordial Yang in Shaoyin and protecting Vital Qi in Jueyin. Students should ponder deeply to understand this.

Wu Mei Wan treats Jueyin disease with excessive thirst, sensation of Qi rushing up to the heart, burning pain in the heart, hunger without desire to eat, and vomiting roundworms after eating. It also treats chronic dysentery.

Wu Mei (Mume Fruit) (300 pieces) Xi Xin (Asarum Herb) (6 liang) Gan Jiang (Dried Ginger) (10 liang) Huang Lian (Coptis Rhizome) (1 jin) Dang Gui (Angelica Root) (4 liang) Fu Zi (Aconite Root) (6 liang) Shu Jiao (Sichuan Pepper, dried) (4 liang) Gui Zhi (Cinnamon Twig) (6 liang) Ren Shen (Ginseng Root) (6 liang) Huang Bo (Phellodendron Bark) (6 liang)

The above ten ingredients are separately pounded and sifted, then mixed. Soak Wu Mei in vinegar (Ku Jiu) overnight, remove pits, steam over rice (5 sheng of rice), pound into paste when cooked, mix with herbs, place in a mortar, and pound with honey 2,000 times until pills are the size of Sophora seeds. Take 10 pills before meals with water, three times daily, gradually increasing to 20 pills. Avoid cold, slippery, and foul-smelling foods.

[Collected Annotations] Ke Qin said: Among the Six Meridians, Jueyin is the most difficult to treat. Its root is Yin, its branch is Heat, its substance is Wood, and its function is Fire. One must subdue its dominant nature and address its cause, using astringents, dispersants, inverses, or followers as appropriate, regulating Middle Qi to achieve harmony. This is the method for treating Jueyin. Jueyin occurs when Two Yins converge, also called the Absolute Yin of Yang, and should theoretically have no Heat. However, its mechanism follows the logic of new moon and full moon; the end of Yin is the beginning of Yang. Thus, Heat in Jueyin disease is caused by Shaoyang. When Fire is prosperous, Water is deficient, causing excessive thirst, Qi rushing to the heart, and burning pain; excess Qi becomes Fire. When Wood overacts on Earth, there is hunger without desire to eat. Worms arise from Wind transformation; when hungry, the Stomach is empty, and roundworms emerge smelling food, causing vomiting of worms. Zhang Zhongjing's formulas generally use Sweet, Pungent, Bitter, and Sour as sovereigns, avoiding astringents, but here they are used because Jueyin governs the Liver. The *Hong Fan* states: "Wood is bending and straightening, producing Sour." The *Neijing* states: "Wood generates Sour, Sour enters the Liver." Using the highly sour Wu Mei as sovereign subdues its dominant nature. Pairing Huang Lian clears Heart Heat and removes pain; assisting with Huang Bo nourishes Kidney Yin and removes thirst, addressing the cause. Coptis and Phellodendron treat Jueyin Yang pathogens but are insufficient for Yin pathogens. Piper, Aconite, Asarum, and Ginger are all highly pungent; combined, they not only treat Jueyin Yin pathogens but also disperse Liver Qi, as the Liver desires dispersion. Adding Gui Zhi and Dang Gui addresses the Liver's storage of Blood. Mixing Cold and Hot creates disharmony in flavor and nature; Ren Shen is added to regulate Middle Qi. Soaking Wu Mei in vinegar seeks similar Qi; steaming with rice provides grain Qi. Making pills with honey and administering small amounts gradually treats the root slowly. Roundworms are insects formed by cold-damp and damp-heat; thus, the medicine mixes Cold and Hot. For chest irritability and vomiting worms, Coptis and Phellodendron are used according to the principle of "treating heat with heat" (using cold herbs in a specific context). Roundworms become quiet with Sour, subdued with Pungent, and descend with Bitter; this is indeed an excellent formula for expelling parasites. Chronic dysentery involves deficiency; regulating Cold and Heat and using Sour to astringe will stop dysentery naturally.

Chi Shi Zhi Yu Liang Tang treats persistent dysentery not stopping due to Large Intestine deficiency collapse, where taking Li Zhong Wan worsens the diarrhea.

Chi Shi Zhi (Halloysitum Rubrum, crushed) (1 jin) Yu Liang (Pyritum, crushed) (1 jin)

The above two ingredients are boiled in 6 sheng of water until 2 sheng remain. Strain the dregs and divide into three warm doses.

[Collected Annotations] Ke Qin said: Gan, Jiang, Ren, and Zhu can tonify the deficiency of Yuan Qi in the Middle Palace but are insufficient to secure the collapse of essence in the Lower Jiao. Since this diarrhea is in the Lower Jiao, Li Zhong Tang cannot achieve success. However, the insecurity of the Large Intestine is not the fault of the Stomach, and the failure of the gate to close is not the fault of the Spleen. Both stones are結 (condensed) from the essence of Earth; they solidify the Stomach and astringe the Intestines. Urgently treating the branch of the Lower Jiao actually cultivates the root of the Middle Palace. Note that this syndrome involves Earth deficiency but not Fire deficiency, so Gan Jiang and Fu Zi are unsuitable. If Dampness is severe and deficiency is not significant, and diarrhea persists, promoting urination is appropriate.

Bai Tou Weng Tang treats Jueyin Heat Dysentery with tenesmus, deep and string-taut pulse, and thirst with desire to drink water.

Bai Tou Weng (Pulsatilla Root) (3 liang) Huang Lian (Coptis Rhizome) (3 liang) Huang Bo (Phellodendron Bark) (3 liang) Qin Pi (Ash Bark) (3 liang)

The above four ingredients are boiled in 7 sheng of water until 3 sheng remain. Strain the dregs and take 1 sheng warm. If not cured, take another 1 sheng.

[Annotation] All Three Yin meridians have diarrhea syndromes. Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only Jueyin diarrhea belonging to Cold presents with cold extremities without thirst and passing undigested food; diarrhea belonging to Heat presents with excessive thirst, tenesmus, and pus/blood in stool. This Heat Dysentery with tenesmus is caused by Fire stagnation and Dampness steaming, with foul Qi rushing to the Large Intestine and Anus, causing heaviness and difficulty in expulsion, as described in the *Neijing* as sudden pouring and urgent straining. The sovereign herb is Bai Tou Weng, Cold, Bitter, and Pungent; the minister herb is Qin Pi, Cold, Bitter, and Astringent. Cold overcomes Heat; Bitter dries Dampness; Pungent disperses Fire stagnation; Astringent secures diarrhea with tenesmus. Assisting with Huang Lian clears Upper Jiao Fire to stop thirst. Directing Huang Bo to drain Lower Jiao Heat removes diarrhea. There are two treatments for Jueyin Heat Dysentery: for early stages, use this formula to dry with Bitter, disperse with Pungent, and secure with Astringent, which is the method of treating Heat with Cold; for chronic cases, use Wu Mei Wan's Sour to gather Fire, assist with Bitter-Cold, and mix with Warm-Tonics, which is the method of opposing and following, acting according to advantage, regulating Qi to achieve balance.