Library

The area where the fatty membranes of the Middle Jiao gather is where the Spleen resides; this is the Taiyin (Taiyang Meridian), as stated previously. The area where the fatty membranes of the Lower Jiao gather is where the Kidney resides, hence it is named Shaoyin (Lesser Yin Meridian). The Fu organ of Shaoyin is the Kidney, and the meridian of Shaoyin is the gathered fatty membrane itself. Because it connects with the gathering place of the Middle Jiao fatty membranes, external pathogenic factors can transmit from Taiyin to Shaoyin.

Original text from *Shanghan Lun*: "Shaoyin disease manifests as a faint and fine pulse, and a desire only to sleep."

Shaoyin diseases can be either cold or hot. Commentators state that if transmitted from Taiyin, it is the pathogen from Yangming and Shaoyang transmitting sequentially to Shaoyin, constituting a heat syndrome; whereas if an external pathogen directly strikes the True Yin, it constitutes a cold syndrome. However, through my clinical practice, I have come to know that the cold nature of Shaoyin disease is originally not direct strike, but transmission from Taiyang, representing a transmission between exterior and interior, and also between Fu organs (the Bladder), because the fatty membrane connected to the Fu organ of Taiyang naturally communicates with the fatty membrane enveloping the Kidney. Cases of direct strike occur when the Shaoyin suddenly becomes deficient, often due to consuming cold food and drink; these account for only one or two in a hundred, and their treatment methods should be discussed separately. As for the heat nature of Shaoyin disease, it does not necessarily come via meridian transmission; rather, it mostly arises from latent pathogenic qi transforming into heat and entering Shaoyin. What is called latent pathogenic qi refers to cases where external cold acquired previously was mild and did not cause immediate illness; the acquired cold qi lies latent within the Sanjiao fatty membranes, obstructing the ascending and descending of Qi transformation, thereby generating heat (Qi transformation generates heat due to obstruction, and latent qi combines with it to transform into heat). This often occurs when Shaoyin is deficient, allowing latent qi to take advantage of the deficiency and invade Shaoyin. This is precisely why cooling medicines should be used early in the onset of Shaoyin heat diseases.

Regarding the fact that regardless of whether the disease is cold or hot, the pulse is always faint and fine: this is indeed because the pulsation originates in the Heart, while the strength of the pulsation relates to the Kidney. The Heart and Kidney are the roots of Water and Fire. When the Qi of the Heart and Kidney mutually assist each other, the Qi transformation within the body naturally becomes robust; if the Qi of the Heart and Kidney separates, the Qi transformation within the body rapidly becomes exhausted. In patients with Shaoyin disease, the Kidney Qi is suppressed by external pathogens and cannot ascend to assist the Heart; therefore, regardless of whether the disease is cold or hot, the pulse image is faint, fine, and weak. The symptom of "desire only to sleep" occurs because the Qi of the Heart and Kidney do not intersect, leading to exhaustion of bodily Qi transformation and inevitable mental fatigue and laziness, causing the patient to frequently close their eyes to rest quietly. Furthermore, because Kidney Qi cannot reach the upper body to attract Heart Yang to descend, even though they close their eyes to rest, they cannot fall asleep, presenting the state of "desire only to sleep."

Original text from *Shanghan Lun*: "In Shaoyin disease, if there is a desire to vomit but no vomiting, irritability, and a desire only to sleep, and after five or six days spontaneous diarrhea accompanied by thirst occurs, it belongs to Shaoyin. Due to deficiency, the patient draws water to save themselves. If the urine is white, the signs of Shaoyin disease are complete. Urine is white because of deficiency-cold in the Lower Jiao, which fails to control water, thus causing the color to be white."

Zhang Gongduan said: "Shaoyang is the pivot of Yang, and Shaoyin is the pivot of Yin. In Shaoyin, the desire to vomit without vomiting occurs because Shaoyin contains both Water and Fire; the improper circulation of Water and Fire Qi up and down leads to this desire to vomit without actual vomiting. Shaoyang prefers vomiting because internal and external Qi travel through the Sanjiao membranes; when these membranes are obstructed, Qi finds it difficult to enter or exit, reversing into the Stomach and causing vomiting. After vomiting, Qi becomes slightly unobstructed, hence the preference for vomiting. This explains the difference between Shaoyin's desire to vomit and Shaoyang's preference for vomiting. Additionally, both Taiyin and Shaoyin present with spontaneous diarrhea. Shaoyin spontaneous diarrhea with thirst stems from the transformation of Shaoyin's inherent heat; Taiyin spontaneous diarrhea without thirst stems from the transformation of Taiyin's inherent dampness. If treating the excess heat of thirst in the Upper Jiao of Shaoyin without attending to the deficiency-cold of diarrhea in the Lower Jiao, the diarrhea will persist. Therefore, for diseases where Water and Fire are separated, one should use cold and hot medicines separately. For diseases where Water and Fire combine, it is acceptable to use cold and hot medicines together. The formulas in this treatise include those purely cold, purely hot, and those combining cold and hot, illustrating this principle."

—This section does not list treatment methods. Zhang believed that with excess heat above and deficiency-cold below, cold and hot medicines should be used. Inquiry: The Master replied: Use Sheng Di Huang (Rehmanniae Radix) 1 liang, Sheng Hang Shao (Paeoniae Radix Alba) 5 qian, Fu Zi (Aconiti Lateralis Radix Praeparata) 2 qian, Gan Jiang (Zingiberis Rhizoma) 2 qian, Xi Xin (Asari Radix et Rhizoma) 1 qian, totaling five flavors. Do not use Shi Gao (Gypsum Fibrosum). Note by Gao XX.

Original text from *Shanghan Lun*: "In Shaoyin disease, if the pulse is tight, and upon reaching the seventh or eighth day, spontaneous diarrhea occurs, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness of the pulse disappears, this indicates impending resolution. Although there is irritability and diarrhea, it will surely heal on its own."

Shaoyin contains both Water and Fire. The two kidneys represent Water; the Ministerial Fire generated by the Mingmen (Gate of Life) associated with the Kidneys represents the Fire in Shaoyin. External cold penetrating from Taiyang into Shaoyin merges with the Water Qi in Shaoyin, obstructing the Yuan Yang (Primordial Yang), resulting in a tight pulse. Tightness indicates Cold; it is a manifestation of Yin excess and Yang deficiency forcing Yang unable to distribute freely. When Yang Qi has accumulated for a long time, reaching the seventh or eighth day coincides with the ruling Qi periods of Taiyang and Yangming. The Fire of Mingmen, having accumulated excessively, erupts, forcing Yin Cold outward through diarrhea, and the previously tight pulse suddenly becomes faint. Originally, the tight pulse was caused by Yang being oppressed by Yin, presenting as wiry and forceful. The sudden faintness represents a change from tight to relaxed and moderate; it may not be extremely faint, but appears faint compared to the previous tightness. Moreover, the reversal of warmth in the hands and feet is undoubtedly a sign that Yuan Yang has returned. Treating cold diseases in Shaoyin primarily focuses on protecting Yuan Yang. At this time, irritability may occur, actually due to the eruption of Ministerial Fire occasionally floating upward. This further confirms the recovery of Yuan Yang, hence knowing it will surely heal.

Chen Xiuyuan said: "This describes Shaoyin resolving by obtaining Yang-heat Qi. Since I began practicing medicine, whenever I encountered critical conditions nearing death, I would invariably use potent medicines to rescue them. Suddenly, the patient would develop irritability and diarrhea. The family would complain and change doctors, and the new doctor would criticize the previous physician's errors, taking credit with ineffective remedies. I, however, suffered slander due to my earnest concern. It is truly difficult to be a renowned physician. When I was young and first read *Shanghan Lun Qian Zhu* (Annotated Brief Commentary on Shanghan Lun) to this point, I suspected Chen Xiuyuan's words were merely self-exoneration. Only after years of medical study and clinical experimentation did I realize his words were indeed truthful. Later, I saw Zhang Gongduan of Changde's *Shanghan Lun Hui Can*, which also affirmed Chen's words. He mentioned that I treated a patient who, after taking medicine, experienced painful diarrhea and irritability, followed by laughter resembling mania but not quite, recovering after several hours. This aligns with the principle of 'irritability and diarrhea healing spontaneously.' I believe that when encountering critical Shaoyin Yin-Cold syndromes and intending to use medicine to restore Yang, one should inform the family beforehand that following Yang restoration, symptoms of diarrhea and irritability often appear, thereby preventing suspicion."

Note by Zi XX: Several years ago, while in my hometown, I treated a Shaoyin cold syndrome. After medication, the patient experienced diarrhea and irritability before recovering. In December 1933, in Tianjin, I treated Yan XX for a Shaoyin cold syndrome. After prolonged treatment with Huixiang (Foeniculi Fructus), Gan Jiang, etc., without success, he sought my prescription. I advised him to take raw Liu Huang (Sulfur) the size of a jujube alone, taken before meals, three times daily. On the fifth or sixth day, he suddenly had diarrhea two or three times a day. Terrified, he asked me. I said: "This is the cold accumulation opening due to the heat of Liu Huang, exactly as described in *Shanghan Lun*: 'Although there is irritability and diarrhea, it will surely heal.' A few days later, the diarrhea stopped, and his illness healed."

Original text from *Shanghan Lun*: "In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, and the patient feels aversion to cold and curls up to lie down, but the hands and feet are warm, the condition is treatable."

Zhang Gongduan said: "The above three sections all describe Shaoyin Yin-Cold diseases. In the first two sections, the hands and feet are warm; in the third, the patient feels irritable and desires to remove clothing and blankets. All are signs of Yang recovery, indicating spontaneous healing or treatability. This shows that treating Shaoyin Cold Damage prioritizes Yang. Not only does seeing Yang pulse in Yin syndromes indicate life, but seeing Yang symptoms in Yin diseases also indicates ease of cure. The character 'Quan' (curling up) in the phrase 'aversion to cold and curling up' suffices to investigate the presence of internal Yin-Cold. Why? Generally, Yin-Cold diseases manifest with a curled body posture. The rationale relates to the Du Mai (Governor Vessel) and Ren Mai (Conception Vessel). The Du Mai governs all Yang meridians running along the back, while the Ren Mai governs all Yin meridians running along the chest and abdomen. Curling up in internal Yin-Cold involves extending the back's Yang to suppress Yin; extending the waist and chest in internal Yang-Heat involves extending the abdomen's Yin to assist Yang. Just as people spread their chests in hot weather and contract in cold weather, observing the extension of Yang for self-rescue reveals that curling up belongs to Yin-Cold. Thus, Yang excess leads to spasms, and Yin excess leads to curling up, which is logical. Regarding spontaneous irritability and desire to remove clothing/blankets, this indicates Yin is transformed by Yang, making it treatable."

Zhang's discussion on the mutual assistance of Du and Ren meridians to explain curling up in this section is quite detailed. Beyond Zhang's discussion, I have another insight. Inferring the principle of Kan-Li mutual assistance and Yin-Yang interdependence: when the Heart and Kidney intersect in humans, heat is generated (Heart-Kidney intersection supplements Yuan Yang, thus generating heat). This intersection often occurs during exhalation. During exhalation, the Heart necessarily descends, and the Kidney necessarily ascends (this can be verified through silent self-experience). This simultaneous ascent and descent achieves Heart-Kidney intersection. This is a natural benefit of respiration, assisting bodily heat generation (observe that people often feel cold when sleeping because breathing slows down, and heat generation instantly becomes insufficient; this is clear evidence). When people fear cold and curl up, it is their Heart and Kidney attempting to intersect to generate heat (a natural mechanism beyond conscious thought). Conversely, in heat diseases, the body often arches backward, indicating the Heart and Kidney wish to stay apart to prevent intersection from aiding heat.

Original text from *Shanghan Lun*: "In Shaoyin disease with vomiting and diarrhea, if the hands and feet are not cold, but instead feverish, the patient will not die. If the pulse is absent, moxa should be applied to Shaoyin points seven moxibustions."

Chen Xiuyuan stated: "One should moxa Taixi (KI3)." Zhang Gongduan stated: "One may also moxa Fuliou (KI7)." I, however, believe that if after moxa-ing Taixi the pulse still does not respond, one can then moxa Fuliou. During moxa application, both legs should be treated simultaneously. Taixi is located five fen behind the medial malleolus, in the artery above the calcaneus. Fuliou is located two cun above the medial malleolus, in the depression posterior to the large bone. These two points, like Taixi, are the sources of generating pulse in Shaoyin.