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24. Yang Pathogen Heat Jue: The patient presents with cold extremities accompanied by fever, excessive thirst (Xiao Ke), a sensation of hot qi rushing upward causing heart/chest pain, irritability and abdominal fullness, retraction of the scrotum, and a dry, scorched, curled tongue. If the stool is hard and the patient's constitution can still tolerate purgation, Da Cheng Qi Tang (Major Order the Qi Decoction) may be used for purging. If Si Ni San (Frigid Extremities Powder) is confused with Si Ni Tang (Frigid Extremities Decoction), modifications should be made based on accompanying symptoms: add Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Wu Wei Zi (Schisandrae Chinensis Fructus, Schisandra Berry) for cough; the principle is the same for dysentery; add Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) for palpitations; add Fu Zi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) for abdominal pain; add Xie Bai (Allii Macrostemonis Bulbus, Garlic Bulb) for tenesmus; add Fu Ling (Poria, Poria Cocos) for difficult urination.

[Annotation] "Yang pathogen" refers to a heat syndrome where the pathogen in the Jueyin stage transforms into heat following the Yang aspect. "Jue" refers to cold extremities. When cold extremities are followed by fever, or fever by cold extremities, it is termed Heat Jue. Mild cold extremities indicate mild heat; deep cold extremities indicate deep heat. "Xiao Ke" (excessive thirst) refers to drinking much water but producing little urine. The sensation of hot qi rushing up to cause heart pain indicates fire pathogen carrying Liver Wood pathogen rebelling upward. "Irritability and fullness" refers to irritability and fullness in the lower abdomen. "Scrotal retraction" refers to the external genitalia shrinking into the abdomen due to heat burning the sinews. "Scorched and curled tongue" refers to a dry, scorched tongue coating with a curled tongue body. "Hard stool" refers to hard feces; if the patient can endure purgation, Da Cheng Qi Tang is appropriate. "Si Ni" refers to cold extremities. "Indistinguishable" implies that cold and heat-induced Jue are difficult to differentiate; in such cases, Si Ni San is suitable to soothe and unblock the Jueyin channel. If cold extremities do not resolve after administration, re-evaluate the cold-heat nature. Add Sheng Jiang and Wu Wei Zi for cough; these are also added for dysentery, hence "the same." Add Gui Zhi for epigastric palpitations; add Fu Zi for abdominal pain; add Xie Bai for dysentery with tenesmus; add Fu Ling for urinary retention. Refer to the Shaoyin and Jueyin chapters for details.

25. Shaoyin Syndrome of Interior Cold and Exterior Heat: The face is red, the body does not feel aversion to cold despite the interior cold, there are cold extremities, dysentery with undigested food in the stool, and a faint or imperceptible pulse. Tong Mai Si Ni Tang (Unblocking the Vessels Frigid Extremities Decoction) should be administered first. If dysentery stops but the pulse remains absent after taking Si Ni Tang, add Ren Shen (Ginseng Radix et Rhizoma, Ginseng Root); if the face is intensely red, add Cong Bai (Allii Fistulosi Bulbus, Green Onion Stem); add Shao Yao (Paeoniae Radix Alba, White Peony Root) for abdominal pain; add Jie Geng (Platycodonis Radix, Balloon Flower Root) for sore throat; add Sheng Jiang for vomiting.

[Annotation] In the Shaoyin syndrome of interior cold and exterior heat, facial redness without aversion to cold indicates floating Yang repelled outward (Ge Yang). Cold extremities, dysentery with undigested food, and a faint, nearly absent pulse indicate extreme Yin cold in the interior (Ji Han). Tong Mai Si Ni Tang is indicated. After administering Si Ni Tang, if dysentery ceases but the pulse does not return, add Ren Shen; if the face is red, add Cong Bai; add Shao Yao for abdominal pain; add Jie Geng for sore throat; add Sheng Jiang for vomiting. Refer to the Shaoyin chapter for details.