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The disease known as Yin-Yang Exchange (Yin Yang Yi) following a Shanghan (Cold Damage) illness is characterized by the patient having a heavy body, shortness of breath, urgency and pain in the lower abdomen, or spasms drawing into the genitalia, heat rushing up to the chest, heaviness of the head making it unwilling to be lifted, visual disturbances such as seeing spots before the eyes, and stiffness and cramping of the knees and calves. This should be primarily treated with Shao Kun San (Burning Underwear Powder).

To prepare Shao Kun San: Take the part of a woman's undergarment closest to the genitals, cut it off, and burn it to ash. Mix with water and administer one Fang Cun Bi (a square-inch measure) per dose, three times a day. When urination becomes smooth and the glans penis swells slightly, the patient will recover. If the patient is female, take the crotch part of a man's undergarment, burn it to ash, and use it.

I once treated a person who died because they engaged in sexual intercourse before their Shanghan illness had fully resolved; their life was hanging by a thread. I used Du Shen Tang (Single Ginseng Decoction) to mix with Shao Kun San. There were three or four cases where patients recovered after consuming more than one or two jin (approx. 500-1000g) of ginseng. Truly! One must not be rigid in the use of medicines.

Treating a case where a Shanghan illness has just healed, but Yin and Yang are not yet harmonized, and sexual intercourse leads to swelling of the yin (genitals) and severe abdominal colic in men, or urgency in the lower abdomen and pain connecting the waist, hips, and inner abdomen in women, this is named Yin-Yang Exchange. If a man whose illness has just healed engages in intercourse with a woman and contracts the disease, it is called Yang Exchange; if a woman whose illness has just healed engages in intercourse with a man and contracts the disease, it is called Yin Exchange. If it occurs between two men or two women, they do not exchange diseases with each other. It is called "Exchange" because Yin and Yang mutually influence each other, and the pathogenic toxin attaches to the person, changing their condition like exchanging clothes. The symptoms of this disease include: fever, heat rushing to the chest, heaviness of the head preventing it from being lifted, visual disturbances, stiffness and cramping of the four limbs, severe pain in the lower abdomen, and curling of hands and feet leading to death. Some may not die immediately; they suffer from urgency and pain in the lower abdomen, heat rushing to the chest, heaviness of the head, sensation of joints separating, slack and weak meridians, deficiency of blood and Qi, exhaustion of bone marrow, mental confusion, decreasing strength, inability to move from bed, requiring others to help them rise and walk, or dragging on for months or years until death. Suitable formulas to select from include Shao Kun San, Shu Fen Tang (Mouse Feces Decoction), Zhu Ru Tang (Bamboo Shavings Decoction), Qing Zhu Ru Tang (Green Bamboo Shavings Decoction), Gan Jiang Tang (Dried Ginger Decoction), and Dang Gui Bai Zhu Tang (Angelica and Atractylodes Macrocephala Decoction). (Zhang Yuansu [Hai Zang] stated: For heat patterns, use Shao Kun San or Zhu Pi Tang; for cold patterns, use Shu Fen Tang or Dang Gui Bai Zhu Tang. Regarding the Miao Xiang Wan (Wonderful Incense Pill) entry in the *Jiaozheng Fang* treating miscellaneous Yin-Yang Exchange diseases containing Rhinoceros Horn [now banned/replaced], Brain, and Musk, these treat heat patterns.)

Zhu Pi Tang treats labor relapse due to intercourse, testicular swelling, and unbearable abdominal colic.
Take one sheng (approx. 600ml) of scraped green bamboo skin, add three sheng of water, boil down to one sheng, strain out the dregs, and divide into two doses for immediate recovery.

Qing Zhu Ru Tang is suitable for women whose illness has not fully resolved and who have been disturbed, causing heat to rush to the chest, resulting in stiffness, cramping, and convulsions of the hands and feet resembling wind-stroke.
Gua Lou Gen (Trichosanthes Root) (1 liang / approx. 37.5g)
Qing Zhu Ru (Scraped Green Bamboo Shavings, half sheng; light bamboo is preferred)
Add two sheng of water to the above ingredients, boil down to one sheng and two he (approx. 24ml), strain out the dregs, and divide into two or three doses.

Miao Xiang Wan (Formula see Accumulated Heat section).

[From *Bai Yi Xuan Fang*] Treats labor relapse due to intercourse, swelling of the scrotum, or retraction into the abdomen, abdominal colic, or constipation. Take several earthworms, squeeze out the juice, and take it; it is effective.

[Zhang Yuansu/Hai Zang] If Yin-Yang Exchange is confirmed and a Yin pulse is found, treat according to the syndrome. If the pulse is in the Jueyin channel, administer Shao Kun San with Dang Gui Si Ni Tang (Angelica Cinnamon Twig Decoction). If the pulse is in the Shaoyin channel, administer Shao Kun San with Tong Mai Si Ni Tang (Pulse-Recovering Four Reversal Decoction). If the pulse is in the Taiyin channel, administer Shao Kun San with Si Shun Li Zhong Wan (Four Smooth Spleen-Harmonizing Pill). The medicines used should correspond to their respective channels, and efficacy will be rapid.

Shu Fen Tang treats Yin Exchange in men after Shanghan illness.
Jiu Bai Gen (White Root of Chinese Chive) (one handful)
Shu Fen (Mouse Feces, 14 grains, those pointed at both ends are best)
Add five sheng of water to the above two ingredients, boil down to half a sheng, strain out the dregs, boil again for three boils, and take warm for effect. If sweating does not occur, take another dose. It also regulates various types of labor relapse.

Dang Gui Bai Zhu Tang treats women whose illness has not fully resolved, who have been disturbed, resulting in urgent pain in the lower abdomen, inability to bear movement in the waist, hips, and four limbs, weakness in action, and fever.
Bai Zhu (Atractylodes Macrocephala Rhizome)
Dang Gui (Angelica Sinensis Radix)
Gui Zhi (Cinnamon Twig)
Fu Zi (Aconite Lateral Root, raw)
Gan Cao (Licorice Root)
Shao Yao (Peony Root)
Huang Qi (Astragalus Root)
Ren Shen (Ginseng Root) (each 2.5 qian / approx. 9.4g)
Sheng Jiang (Fresh Ginger) (half liang / approx. 18.75g)
Chop the above ingredients, decoct in water, take, and repeat after a meal period. Cover warmly to induce slight sweating for recovery.

Li Liangzuo's son suffered from a Taiyang pattern; the pulse at Cun, Guan, and Chi positions was floating and rapid, but forceless upon pressure. I observed his internal Yin deficiency and prescribed Shen Shu Jia Gan Jiang Tang (Atractylodes Formula with Dried Ginger). After recovery, the illness recurred. Upon examination, he appeared listless, keeping his head down and unwilling to speak. Suspecting excessive sexual activity, I asked if he had engaged in intercourse, predicting headache and dizziness. He agreed. I administered Da Jian Zhong Tang (Major Construct the Middle Decoction); after three or four doses, external Yang retreated inward, and the pulse became sinking and small, revealing Yin signs. I then administered pills containing Han Jiang (likely referring to a specific preparation or herb contextually linked to cold/deficiency), Shao Yao, and Hui Xiang (Fennel) for five or six doses. Within three days, approximately six or seven hundred pills were taken, and the pulse returned. Finally, I used Da Jian Zhong Tang again, leading to profuse sweating and resolution of the disease.

[From *Shan*] For Yin-pattern Shanghan caused by sexual indulgence, stir-fry Chen Pi (Tangerine Peel) in a hot pan until charred, cook with wine, filter, and drink the wine.