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Wuzhuyu (Evodiae Fructus) 1 sheng, Renshen (Ginseng Radix et Rhizoma) 3 liang, Shengjiang (Zingiberis Rhizoma Recens) 1 liang, Dazao (Jujubae Fructus) 12 pieces.
The above four ingredients are decocted with 7 sheng of water, reduced to 2 sheng, taken warm at 7 he per dose, three times a day.

[Collected Commentaries]
Luo Tianyi stated: In Zhang Zhongjing's methods, for Shaoyin disease, the emphasis is on consolidating the Primordial Yang; for Jueyin disease, the emphasis is on consolidating the Vital Qi. Although Jueyin Liver Wood is at the convergence of two Yin levels, the true Qi of the initial Yang actually arises within it. If this Vital Qi becomes deficient, the turbid Qi of the three Yin meridians will directly press upon the Middle and Upper Jiao. Not only will all syndromes of the meridian itself manifest, but the healthy transportation function of the Stomach (Yangming) will also fail, causing the True Yang of Shaoyin to float outward. Consequently, symptoms such as vomiting, diarrhea, cold extremities, restlessness and irritability to the point of death, and nausea after eating food will arise in various forms. Wuzhuyu (Evodiae Fructus), deriving from the Qi of the Zhen trigram of the East, is acrid, bitter, and extremely hot. It can penetrate Liver Wood depression, enter the Jueyin meridian directly, and descend the turbid Qi generated by excessive Yin. Therefore, it serves as the Sovereign herb. Renshen (Ginseng Radix et Rhizoma), imbued with balanced and righteous Qi, is sweet, warm, and strongly tonifying. It can connect with the True Essence, restore life, and elevate the dying Vital Qi. Therefore, it serves as the Minister herb. Ginger (Zingiberis Rhizoma Recens) and Jujube (Jujubae Fructus) harmonize the Stomach and circulate Qi to the four extremities. Thus, the Spirit and Virtue of Zhen harmonize, Wood and Earth do not harm each other, the subtle function of the Initial Yang is accomplished, and within the three Yin meridians, there is nothing but the Qi of continuous generation. Would any of these syndromes not recede?

Fang Youzhi stated: Vomiting damages Yang, while diarrhea depletes Yin. Cold extremities indicate Yin depletion leading to counterflow; restlessness and irritability indicate Yang damage leading to chaos. Evodia (Wuzhuyu) is acrid and warm, dispersing cold, warming the Stomach, and stopping vomiting; Ginseng (Renshen) is sweet and warm, benefiting Yang, consolidating the root, and tonifying the Middle; Jujube (Dazao) assists the Stomach and benefits the Spleen; Ginger (Shengjiang) is the sacred medicine for vomiting. Therefore, these four substances are necessary for warming the Middle and descending rebellious Qi.

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In Shaoyin disease, if there is vomiting, diarrhea, restlessness, and cold extremities, it is a fatal condition.

[Note]
This clause connects with the previous one to clarify its meaning, distinguishing between treatable and untreatable conditions. The vomiting, diarrhea, restlessness, and cold extremities here are identical to those in the previous clause. One is treated with Wuzhuyu Tang, while the other is declared fatal and untreatable. Why? Generally, in Shaoyin disease, restlessness (Zao) predominates over irritability (Fan); Zao belongs to Yin. In Jueyin disease, irritability (Fan) predominates over restlessness (Zao); Fan belongs to Yang. In Jueyin disease, cold extremities do not extend beyond the elbows and knees, indicating that slight Yang has not yet perished, so it is treatable. In Shaoyin disease, cold extremities cannot return to warmth, indicating solitary Yin without Yang transformation, so it is declared fatal.

[Collected Notes]
Cheng Yingmao stated: Restlessness and irritability arising from vomiting and diarrhea indicate the separation of Yin and Yang and subsequent chaos. Coupled with cold extremities, it shows Yang has perished; why would death not follow? Had warming of the Middle been known earlier, how could this have happened?
Zhang Lu stated: This clause is no different from the previous one. Why was the former treatable and this one untreatable? It must be that warming medicines were already used without success, and restlessness worsened, hence the prognosis of death.

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In Shaoyin disease, with aversion to cold, curled-up posture, and diarrhea, if the hands and feet are cold, it is untreatable.

[Note]
This elaborates on the reason why cold extremities are untreatable as mentioned in the previous clause. Aversion to cold and a curled-up posture, though belonging to Shaoyin syndrome, do not necessarily lead to death. However, if diarrhea persists and cold extremities do not recover, it indicates the presence of Yin without Yang. Even without vomiting, diarrhea, restlessness, or irritability, it remains untreatable.

[Collected Notes]
Yu Chang stated: With excessive Yin and absence of Yang, even using methods like Si Ni Tang to restore Yang from non-existence often fails; hence, it is termed untreatable.

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In Shaoyin disease, with cold extremities, aversion to cold, curled-up posture, absent pulse, irritability without restlessness, it is a fatal condition.

[Note]
This summarizes the preceding three clauses to explain fatal untreatable conditions. "Si Ni" refers to cold extremities extending beyond the elbows and knees without recovery. Exterior Yang deficiency causes aversion to cold. Yin governs flexion, causing a curled-up posture. An absent pulse indicates the extinction of Vital Qi. If there were irritability without restlessness, there would still be recoverable Yang. Now, with restlessness but no irritability, it indicates Yin without Yang, thus declared fatal.

[Collected Notes]
Cheng Yingmao stated: All Yin pathogenic factors are present, and the pulse is absent, indicating Yang has perished first. Restlessness without irritability means solitary Yin has no attachment and will exhaust itself. The Classic states: "Yin Qi, when quiet, stores the Spirit; when restless, it dissipates." Restlessness implies the Spirit of the Yin organs escapes externally; once escaped, death ensues. Had pulse-restoring methods to unblock Yang been used early, how could this have occurred?

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In Shaoyin disease, with diarrhea, a faint and choppy pulse, vomiting, and sweating, where there is frequent defecation but scant output, one should warm the upper region and apply moxibustion.

[Note]
A faint pulse indicates Yang deficiency. A choppy pulse indicates blood deficiency. Frequent trips to the toilet result from urgent diarrhea. Scant output indicates the urge to defecate but little passage. This corresponds to current conditions of Yang deficiency, blood deficiency, tenesmus, and diarrhea. Vomiting and sweating occur because Yin excess internally rebels upward causing vomiting. Yang deficiency fails to secure the exterior, causing sweating. One should warm the upper region and apply moxibustion.

[Collected Notes]
Cheng Yingmao stated: In Shaoyin disease with diarrhea, Yang deficiency is evident. With a faint and choppy pulse, not only is Yang deficient but Yin is also exhausted. Due to Yang deficiency, Yin pathogens rebel upward causing vomiting; due to Yin exhaustion, sweating and straining occur. Within this single method, one wishes to assist Yang and protect Yin simultaneously. Therefore, Si Ni Tang and Fu Zi are difficult to use. Only moxibustion at Baihui (GV20) on the vertex can warm the area. It substitutes for the Yang-assisting effects of Ginger and Aconite while acting superiorly, avoiding their acrid dispersion and lower drying effects. Thus, diarrhea stops without injuring Yin blood. This shows that in Shaoyin disease, one should not abandon warming just because it is difficult to use.
Wang Hu stated: Regarding this clause, Zhang Zhongjing did not specify which acupoint to moxa. *Mai Jing* says: Moxa Jueyin Shu. Chang Qizhi says: Moxa Taichong (LR3). Both are errors. Guo Yong says: Moxa Taixi (KI3), although a Shaoyin meridian point, is also an error. Zhang Zhongjing said: "Warm the upper." Fang Youzhi explained: "Upper" refers to the vertex, specifically Baihui (GV20). *Tu Jing* states: Also called San Yang Wu Hui, located 1.5 cun posterior to Qian Ding (GV21) at the center of the vertex. Originally used for pediatric rectal prolapse refractory to treatment; seven moxa cones may be applied. Applying it here lifts Yang to regulate Yin.

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In Shaoyin disease, if diarrhea stops but dizziness occurs, accompanied by periodic sensations of being enveloped or blinded, it is a fatal condition.

[Note]
If diarrhea stops in Shaoyin disease and the Stomach Qi harmonizes allowing appetite, with clear spirit and refreshing sensation, it indicates impending recovery. Now, if diarrhea stops but dizziness occurs, with periodic mental clouding and unconsciousness, it indicates Qi depletion and Spirit departure. Thus, despite the cessation of diarrhea, it remains a fatal prognosis.

[Collected Notes]
Fang Youzhi stated: Dizziness is commonly called vertigo or faintness. All Yang converges in the head. Diarrhea stopping with dizziness indicates Yang has no foundation and floats outward, scattering the Spirit and Qi, causing periodic self-envelopment; death is certain.
Zhang Xiju stated: The fatal nature of this clause is entirely seen in the dizziness and self-envelopment. If diarrhea stops without dizziness or envelopment, the interior is harmonized, and death would not occur.
Zhang Lu stated: Yin and Yang in the human body rely on each other for attachment. If Yin perishes below, the Yang gathering above in the head moves chaotically, causing dizziness and periodic envelopment. Yang escaping above leads to death. Thus, if Yang returns and diarrhea stops, life is preserved; if Yin exhausts and diarrhea stops, death ensues.
Wang Hu stated: Diarrhea stopping usually implies recovery. Now becoming a sign of death indicates not Yang returning but Yang escaping and fluids exhausting.

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In Shaoyin disease, after six or seven days, if respiration is high and shallow, it is a fatal condition.

[Note]
Shaoyin disease typically presents with desire to sleep and peaceful, smooth respiration. Now, high and rapid respiration indicates rebellion. Generally, patients bedridden with high, rapid respiration often die.

[Collected Notes]
Yu Chang stated: The phrase "six or seven days" reflects meticulous differentiation. Respiration becoming high after transmission to Shaoyin is vastly different from wheezing due to exterior patterns on days two or three in Taiyang.
Cheng Zhi stated: The Kidney is the source of Vital Qi. High respiration indicates Qi scattering into the chest and failing to return to the Sea of Qi; hence, fatal.
Cheng Yingmao stated: The Lung governs Qi, and the Kidney is the source of Vital Qi, serving as the gate of respiration, crucial for life and death. High respiration means Vital Qi has perished below and cannot be grasped; thus, breathing is merely exhalation above without inhalation. Death may manifest after six or seven days, but signs appear before. Since Shaoyin is affected, why was protection not prepared in advance to prevent the dispersion of True Yang? The strict prohibition of sweating followed by urgent warming in the text aims precisely at this!
Wei Litong stated: After seven days, high and rebellious respiration is similar to periodic envelopment; both represent upper depletion. One involves dizziness with Yang rising and not returning; the other involves high respiration with the root of Qi destroyed. They share the same principle but present differently; thus, Zhang Zhongjing prognosticates death for both.

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In Shaoyin disease, with a fine, deep, and rapid pulse, the disease is in the Interior; sweating should not be induced.

[Note]
Shaoyin disease presents with desire to sleep. If the pulse is fine, deep, and faint, the pathogen transforms from Cold. Now, with a fine, deep, and rapid pulse, the pathogen transforms from Heat. Even if fever exists, it is likely transitioning to Yangming. It is not comparable to early-stage Shaoyin disease with reverse fever, deep but non-rapid pulse, where Mahuang Fuzi Xixin Tang is indicated for sweating. Therefore, it is stated: The disease is in the Interior; sweating is contraindicated.

[Collected Notes]
Cheng Zhi stated: This warns against sweating when Heat pathogens are in the Interior. The normal Shaoyin pulse is faint and fine. A deep and rapid quality signifies Heat in the Interior. Sweating will disturb the channels and increase dryness-heat, leading to blood loss.
Zheng Zhongguang stated: A fine, deep, and rapid pulse indicates hidden Yang in the Interior; hence, the disease is in the Interior. This is a Heat pathogen transmitting inward; sweating is absolutely contraindicated. Sweating disturbs Jing Qi and causes blood loss. If Shaoyin fever presents with a deep pulse and no Interior symptoms, it is considered Exterior, and sweating is permissible. If the pulse is floating and slow, with Exterior Heat and Interior Cold, diarrhea with undigested food, the slowness indicates absence of Yang and Interior disease; one must not mistake floating for Exterior and induce sweating. One must know that within Yin, if Yang exists, deep pulses can sometimes be sweated; within Yang, if Yin exists, floating pulses may require warming. Here, the fine, deep, and rapid pulse indicates Heat in the Interior from Yang pathogens; thus, sweating is warned against.

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In Shaoyin disease, with cold extremities and no sweat, forcing sweating will inevitably disturb Blood. The bleeding may come from any orifice, either mouth and nose or eyes. This is called Lower Jue and Upper Exhaustion, and is difficult to treat.

[Note]
This clause clarifies that forcing sweat in Shaoyin Heat pathogens leads to Blood disturbance. Shaoyin disease with a fine, deep, rapid pulse plus cold extremities constitutes Heat Jue. Yin naturally does not sweat; even if there is no sweat, sweating should not be forced. Forcing sweat exacerbates Shaoyin Heat, causing it to boil fiercely, disturbing Blood in the primary meridian. Bleeding may occur from the mouth/nose or eyes. This is termed Lower Jue (Heat Jue in the Lower) and Upper Exhaustion (Blood exhaustion in the Upper), making it difficult to treat.

[Collected Notes]
Zhang Lu stated: Forcing sweat in Shaoyin disturbs Blood, which inevitably rebels upward through Yang orifices, as sweating agents are Yang herbs.
Cheng Yingmao stated: The five fluids are governed by the Kidney. Forcing sweat in Shaoyin reverses Qi throughout the body; Blood follows the rushing Qi and appears unexpectedly from unknown orifices.
Shen Mingzong stated: Shaoyin disease with cold extremities and no sweat indicates Interior disease. One should use Si Ni San to harmonize Yin and disperse pathogens; the disease will retreat, and cold extremities will resolve. How can one force sweat?
Wei Litong stated: Cold extremities with sweat indicate Internal Cold forcing Yang outward, representing Cold transformation. Yin pathogens with no sweat and cold extremities indicate Heat pathogens hidden in the Interior without externalizing, consuming Yin internally. This undoubtedly represents Heat transformation and Yang pathogens.

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In Shaoyin disease, with cough and diarrhea, and delirium, caused by Fire Qi coercing sweat, urination will certainly be difficult, due to forcibly demanding sweat from Shaoyin.

[Note]
Shaoyin belongs to the Kidney and governs Water. When Shaoyin is invaded and cannot govern Water, rebellion upward causes cough, and downward causes diarrhea. Pathogen transforming from Cold indicates Zhen Wu Tang syndrome; transforming from Heat indicates Zhu Ling Tang syndrome. Now, coerced by Fire Qi into sweating, the pathogen transforms from Heat and transmits to the Stomach, causing delirium. Internal exhaustion of Body Fluids causes difficult urination. All result from forcibly demanding sweat from Shaoyin. To rescue Yin, choose between Baihu Tang and Zhu Ling Tang.

[Collected Notes]
Fang Youzhi stated: "Qiang Ze" means excessive demand. Urine and sweat are both derived from Blood. Shaoyin has little Blood; coercing sweat steals Blood, causing urine to dry up, hence difficulty.

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In Shaoyin disease, after six or seven days of diarrhea, with cough, vomiting, thirst, irritability, and inability to sleep, Zhu Ling Tang governs.

[Note]
Generally, Shaoyin diarrhea with undigested food, cough, vomiting, and no thirst belongs to Cold-Fluid retention. Now, Shaoyin disease after six or seven days, with sticky/foul diarrhea, cough, vomiting, thirst, irritability, and insomnia, indicates Shaoyin Heat-Fluid pathology. Fluid and Heat contend: attacking upward causes cough, middle causes vomiting, downward causes diarrhea; Heat consumes Body Fluids causing thirst; Heat disturbs the Heart causing irritability and insomnia. Zhu Ling Tang should be used to promote urination and moisten dryness; both fluid and heat syndromes will resolve.

[Collected Notes]
Zhao Sizhen stated: Shaoyin cough with diarrhea, vomiting, thirst, irritability, and insomnia, along with Jueyin diarrhea with desire to drink water, are all transmitted Heat pathogens. Pulses must be fine, deep, and rapid; thus, Qing Li (clearing and draining) herbs like Huanglian and Huashi are used. Conversely, Shaoyin spontaneous diarrhea with thirst, desire to vomit but unable, heart irritability, desire to sleep, and white urine belong to Primary Meridian Yin-Cold. Pulses must be faint and deep; thus, Fuzi and Ganjiang are used to warm.
Wang Hu stated: Diarrhea, cough, vomiting, thirst, irritability, and insomnia—how do we know this is not Shaoyang or Yangming disease? If Shaoyang/Yangming presented these, it would be Interior Excess with string-taut, large, long pulses. Here, the pulse is faint and fine, confirming Shaoyin disease beyond doubt.
Lin Lan stated: Diarrhea implies pathogens gathering below. Why cough and vomiting? By day six or seven, thirst, irritability, and insomnia indicate strong transmitted pathogens attacking upward. Thirst leads to excessive drinking, causing water retention. Thus, Heat pathogens cannot resolve, and water accumulation recurs. Heat-transmitted diarrhea differs from simultaneous Yin-Cold vomiting and diarrhea. Vomiting with thirst: vomiting then thirst suggests pathogen resolving; thirst then vomiting suggests water retention. Considering water-cold attacking the Lung for cough, internal fluid retention is confirmed.
Shen Mingzong stated: Huanglian Ejiao Tang for irritability/insomnia is similar in symptoms but different in treatment. This clause involves Shaoyin Wind-Heat transmitting to Yangming causing diarrhea; Zhu Ling Tang drives water via Bladder to save Stomach Fluids. The other clause (Huanglian Ejiao Tang) lacks diarrhea, involving Kidney Water depletion; thus, it nourishes Yin and clears Fire to save Kidney Yin.
Wei Litong stated: Cough without sore throat, thirst without dry mouth, indicates that although Heat entered via transmission, mixed with Fluid retention prevents severe Heat. Though violent Heat rushes up causing cough/vomiting, it doesn't cause sore throat; obstruction causes thirst but not dryness. Combined with irritability/insomnia amidst Shaoyin's desire to sleep (Yang symptom in Yin syndrome), this confirms transmitted Heat mixed with Damp-Fluid. Lack of jaundice occurs because Shaoyin originally had diarrhea, preventing Damp retention and Heat accumulation. Thus, Heat mixed with Fluid retention is evident.

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In Shaoyin disease, with cold extremities, and optionally cough, palpitations, difficult urination, abdominal pain, or heavy sensation in defecation, Si Ni San governs.

[Note]
Generally, Shaoyin cold extremities belong to Yin excess failing to warm the exterior. However, some cases involve Yang constrained by Yin, unable to circulate, causing cold extremities. Hence, optional symptoms like cough, palpitations, difficult urination, abdominal pain, or heavy defecation occur. Now, with only cold extremities and no specific Cold/Heat symptoms, there is neither Cold to warm nor Heat to purge. One should only soothe and unblock Yang; thus, Si Ni San governs.

[Collected Notes]
Li Zhongzi stated: Medications for Shaoyin differ by Yin/Yang. For Yin-Cold with cold extremities, Ginger and Aconite are required. Although cold extremities are not extremely cold, fingertips may be slightly warm, or pulse not faint/deep, indicating Yang contained within Yin. Only due to Qi stagnation is there coldness. Chai Hu cools the exterior, Shaoyao clears the interior; though originally Liver/Gallbladder formulas, they are used in Shaoyin due to Water-Wood homology. Zhi Shi opens the Seven Gates, Gancao harmonizes the Three Jiao. Once Qi mechanism circulates, cold extremities resolve.
Cheng Zhi stated: Shanghan prioritizes Yang. Cold extremities show Yin advancing. Purging further sinks Yang. The Classic notes Heat pathogens transmitting to cold extremities are hardest to distinguish. If Cold deep in Interior, pulse would be faint/almost absent; if Heat deep in Interior, there would be no irritability/thirst. Here, Heat binds in Interior, preventing Yang from reaching limbs. This requires Harmonization, not Cold Purging. Si Ni San uses light herbs, demonstrating mild resolution and dispersion.
Cheng Yingmao stated: Initial cold extremities are neither Heat nor Deep Cold. Cough/palpitations/difficult urination suggest Water retention; abdominal pain/diarrhea suggest Cold coagulation. The added heavy sensation suggests Mother Qi stagnation in Duyang, losing meridian circulation.
Wang Hu stated: Si Ni San treats Yang pathogens transmitting into Yin meridians, resolving transmitted pathogens, not treating Yin-Cold. Extreme Yang Heat can mimic Yin syndrome (fine/weak pulse, soft speech, lethargy, cool limbs), but with constipation, frequent urination, dry teeth/tongue coating, Heat is hidden inside with fever. Hot herbs intensify internal Heat; Cold herbs bind Heat. The method is to harmonize Exterior, release Muscle, unblock Qi/Blood, eliminating Interior Heat. This is the purpose of Zhang Zhongjing's Si Ni San.