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16. After three days of Shanghan (Cold Damage), the pathogenic factors in the Three Yang meridians have been exhausted. The heat is slight, accompanied by irritability and restlessness, indicating the transmission of pathogens into the Yin meridians. If the patient can eat without vomiting, and presents with a fine pulse and clear urine, it indicates that the pathogens have not transmitted into the Yin meridians, and the disease will not progress further.

[Annotation] After three days of Shanghan, the involvement of the Three Yang meridians is complete, and theoretically, the Three Yin meridians should become involved. Although the body heat is slight, the presence of irritability and restlessness indicates that the pathogens have left the Yang meridians and entered the Yin meridians but have not yet resolved. However, if the patient can instead eat without vomiting, and presents with a calm and fine pulse along with clear urine, it signifies that the pathogens have not entered the Yin meridians. This is considered non-transmission, suggesting the condition is likely to heal spontaneously.

Pulse and Symptoms of Taiyin Meridian Affected by Yin Pathogens
17. When the Taiyin meridian is affected by Yin pathogens, the pulse is deep and slow. Symptoms include vomiting food, abdominal fullness, intermittent pain, naturally warm hands and feet, spontaneous diarrhea without thirst. The primary formula for treatment is Lizhong Tang (Regulate the Middle Decoction). If palpitations are present, add Fuling (Poria); if abdominal fullness is prominent, remove Baizhu (Atractylodis Macrocephalae Rhizoma) and add Fuzi (Aconiti Lateralis Radix Praeparata); if vomiting is severe, remove Baizhu and add Shengjiang (Zingiberis Rhizoma Recens). Even with severe vomiting or diarrhea, Baizhu should still be used; if there is thirst and desire for water, double the dosage of Baizhu to calm the spirit; if there is a sensation of Ben Tun (Rushing Pig) rising from below the umbilicus, remove Baizhu and substitute Guizhi (Cinnamomi Ramulus); if middle jiao cold is prevalent, double the dosage of Ganjiang (Zingiberis Rhizoma); for abdominal pain, double the dosage of Renshen (Ginseng Radix et Rhizoma). See the Taiyin chapter for details.

[Annotation] Taiyin affected by Yin pathogens refers to a cold syndrome where the pathogen transforms according to Yin characteristics. A deep and slow pulse is the typical pulse for Taiyin Yin pathogens. Vomiting food, abdominal fullness, and intermittent pain are signs of interior cold in the Taiyin meridian. Naturally warm hands and feet indicate that the pathogen has entered the Yin meridians. Spontaneous diarrhea without thirst indicates the absence of heat within the zang organs, making Lizhong Tang appropriate. If epigastric palpitations occur, add Fuling. For abdominal fullness, remove Baizhu and add Fuzi. For severe vomiting, remove Baizhu and add Shengjiang. Only in cases of severe vomiting or profuse diarrhea should Baizhu still be retained. If thirst and desire for water persist, increase the dosage of Baizhu. If there is a sensation of Ben Tun arising from below the umbilicus, remove Baizhu and use Guizhi instead. For prevalent middle jiao cold, double the dosage of Ganjiang. For abdominal pain, double the dosage of Renshen. Refer to the Taiyin chapter for details.

18. When the Taiyin meridian is affected by Yang pathogens, symptoms include dry throat and abdominal fullness with pain. If mistakenly treated with purgatives, leading to the sinking of pathogens into the Taiyin meridian, this may result in intermittent pain or severe, solid pain. Severe solid pain is treated with Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb). If the pulse is weak, the dosages of Dahuang (Rhei Radix et Rhizoma) and Shaoyao (Paeoniae Radix Alba) must be carefully assessed and adjusted.

[Annotation] Yang pathogens refer to heat syndromes in the Taiyin meridian where the pathogen transforms according to Yang characteristics. Dry throat indicates heat in the Taiyin meridian causing dryness of the pharynx. Abdominal fullness and pain are signs of excess (solid) conditions in the Taiyin meridian. Mistaken purgation refers to the erroneous use of purgative methods, causing pathogens to sink into the Taiyin meridian; in such cases, the severity of the condition must be distinguished. Intermittent pain refers to abdominal pain that comes and goes, which should be harmonized with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony Root). Severe solid pain refers to continuous abdominal fullness and pain, which should be purged with Guizhi Jia Dahuang Tang. If accompanied by Yangming stomach excess, Da Chengqi Tang (Major Order the Qi Decoction) is used for purgation. If the pulse is weak, one should exercise caution with the use of Dahuang and Shaoyao, adjusting the dosage downwards as these patients have weak stomach qi and are easily injured by strong medicinal forces. Refer to the Taiyin chapter for details.