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Original text from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): In Shaoyin disease (a syndrome caused by pathogenic invasion of the Shaoyin meridians), occurring two to three days or more after onset, with vexation in the heart and inability to sleep, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary treatment.

"Two to three days or more" actually refers to the first day; speaking collectively of one, two, and three days implies the initial stage of the illness. Careful analysis of the text indicates that it is Shaoyin disease right from the onset, not transmitted from other meridians. Since this disease does not come from other meridians, but presents heat signs immediately upon onset, this is what was previously referred to as latent qi (pathogenic factors lying dormant in the body) transforming into heat and intruding into the Shaoyin meridian. Generally, after latent qi transforms into heat, it often erupts suddenly due to a slight external contraction. When it intrudes into its destination, it frequently takes advantage of pre-existing deficiency in the corresponding zang-fu organs. Therefore, the Shaoyin disease mentioned in this section belongs to the type of Shaoyin disease characterized by kidney deficiency combined with heat.

In the imagery of the *I Ching* (Book of Changes), Kan (representing Water/Kidney) above and Li (representing Fire/Heart) below form the Ji Ji hexagram (After Completion). Kan represents the Kidney located above, indicating that the Kidney should ascend to calm the Heart Fire; Li represents the Heart located below, indicating that the Heart should descend to warm the Kidney Water. In cases where the Kidney is inherently deficient, its True Yin Qi cannot ascend to calm the Heart Fire, leaving the Heart Fire prone to agitation. Thus, at the very beginning of Shaoyin disease, the Kidney Qi is blocked by latent qi, making it even harder for it to ascend and nourish the Heart. Consequently, while other symptoms have not yet manifested, the heart already suffers unbearable vexation from heat, leading to insomnia. Hence, Huanglian Ejiao Tang is indicated.

[Huanglian Ejiao Tang] Huanglian (Coptidis Rhizoma) 4 liang, Huangqin (Scutellariae Radix) 1 liang, Shaoyao (Paeoniae Radix Alba) 2 liang, Jizi Huang (Ovi Galli Albumen) 2 pieces, Ejiao (Colla Corii Asini) 3 liang.

These five ingredients are boiled in 5 sheng of water. First, decoct the first three ingredients to obtain 2 sheng of liquid, then strain out the dregs. Add Ejiao and melt it completely. Once the mixture has cooled slightly, add Jizi Huang, stir well until incorporated, and take 7 ge warm per dose, divided into three doses.

Huanglian is bitter and enters the Heart meridian; its cool nature clears heat. Therefore, it is used in heavy dosage to resolve the vexation arising in the heart. Huangqin is added as an adjunct to prevent heat in the heart from affecting the Lungs. Furthermore, since the Lung is the upper source of the Kidney, clearing the Lung also clears the Kidney. Shaoyao has both bitter and sour flavors; bitterness descends effectively, and sourness astringes effectively. It can restrain and descend floating Yang, guiding it back to its root. Its cool nature nourishes Yin, and it promotes urination. Thus, it nourishes Kidney Yin well and guides exogenous heat from the Kidneys out through urination. Ejiao nourishes Yin and has a property of anchoring/subduing; it enters the Kidney directly to generate Kidney Water. Jizi Huang contains secretions analogous to those of the adrenal medulla. Based on the principle of "like attracts like," it enters the Kidney directly to benefit Kidney Water. When Kidney Water is sufficient, it naturally overcomes heat and expels pathogens, thereby suppressing the reckless movement of Heart Fire, and the heart vexation heals itself.

A question arises: The outline explicitly states "vexation in the heart and inability to sleep." Since Heart and Kidney jointly belong to Shaoyin, if the Heat originates from the Heart's essence causing vexation, the person would also likely be unable to sleep. Although this might be considered Hand-Shaoyin disease, it can still be called Shaoyin disease. Why do you attribute the root cause solely to the Kidney, suggesting Kidney disease affects the Heart? The answer is: Any condition termed Shaoyin disease must present with a faint and thin pulse (Wei-Xi Mai), as clearly stated in the opening outline. If the disease originated in the Heart due to excessive internal heat causing vexation, the pulse would necessarily appear floating and surging (Fu-Hong Mai). However, although there is heat in the heart, the pulse remains faint and thin. (If the pulse were not faint and thin but changed, this fixed rule would be specified in the outline.) Therefore, it is known that the source of the disease lies not in the Heart but in the Kidney. It is further evident that the heart vexation and insomnia are indeed caused by Kidney disease affecting the Heart.

The disease described in this section originally involves early-stage Shaoyin disease without significant heat, so Huanglian Ejiao Tang is sufficient to clear the heat. However, if the duration is long and heat gradually increases, or if the Kidney meridian harbors latent heat exacerbated by latent qi, the heat becomes severe, resulting in heat in both Heart and Kidney. With robust heat filling the upper and lower parts, this decoction is no longer adequate. In such cases, I frequently use Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction), substituting Xuanshen (Scrophulariae Radix) for Zhimu (Anemarrhenae Rhizoma), Shanyao (Dioscoreae Rhizoma) for Jingmi (Oryzae Fructus Germinatus), and adding fresh Maogen (Imperatae Rhizoma) and raw Jizi Huang. This formula yields immediate results and has saved many lives; thus, I named it Kanli Hugen Tang (Kan-Li Mutual Root Decoction). The detailed dosage and preparation method are recorded below.

Sheng Shigao (Gypsum Fibrosum) 3 liang (finely powdered), Xuanshen 1 liang, Sheng Huai Shanyao 8 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 3 qian, Yetairen (Panax Ginseng Radix et Rhizoma) 4 qian, Xian Baimaogen (Imperatae Rhizoma) 6 liang (washed and chopped), Sheng Jizi Huang 3 pieces.

These six ingredients are processed together. First, boil the Maogen for three to four boils, strain out the dregs, and add the remaining five ingredients. Decoct to obtain three zhong of liquid. Take warm, divided into three doses. For each dose, mix in one Jizi Huang.

Rationale of the formula: The combination of Shigao and Renshen not only clears excess heat in the Shaoyin meridian but also rapidly restores True Yin during intense pathogenic heat. Maogen assists Kidney Qi in ascending to interact harmoniously with Heart Fire. Xuanshen is cool, moist, and light; it clears floating heat, thereby removing heart vexation. Its black color enters the Kidney, working synergistically with Jizi Huang to nourish Kidney Yin. This strengthens the Qi transformation of Shaoyin, enabling the expulsion of pathogens.

A question arises: Exogenous latent qi is usually contracted in winter and transforms into heat in spring following the rising Yang of spring; thus, warm diseases often result from latent qi transforming into heat. Since cold damage (Shanghan) mostly occurs in winter, why is there also latent qi transforming into heat? The answer is: There are two modes of latent qi transforming into heat. Latent qi contracted in winter lies dormant in the membranes of the Sanjiao (Triple Burner) and transforms into heat in spring with the rising Yang; this is the normal mode. However, latent qi contracted in winter may lodge in places that obstruct the ascending and descending Qi transformation in the abdomen. This obstruction generates heat, causing the latent qi to transform into heat as well; this is the variant mode. After transforming into heat, if triggered by a slight external contraction, and given that certain meridians may have pre-existing deficiencies, the pathogen intrudes into these meridians. This explains why latent qi transforming into heat also occurs in Shanghan diseases.