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[Formula Analysis]
The formula is named Sini San (Four Reversals Powder). Like Sini Tang (Cinnamon Twig, Aconite, and Licorice Decoction), it treats cold extremities (cold hands and feet); however, Sini Tang treats cold reversal caused by Yin-cold pathogenic factors, whereas this formula treats heat reversal caused by Yang-heat pathogenic factors. Heat reversal refers to a combined syndrome where pathogenic factors from the Three Yang meridians transmit to the Jueyin meridian. When the Taiyang and Jueyin meridians are involved simultaneously, Mahuang Shengma Tang (Ephedra and Asiasarum Decoction) or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) are indicated; when the Yangming and Jueyin meridians are involved simultaneously, Baihu Tang (White Tiger Decoction) or Dachengqi Tang (Major Order the Qi Decoction) are indicated. This formula addresses the simultaneous involvement of the Shaoyang and Jueyin meridians. Therefore, Chaihu (Bupleuri Radix) is used as the Sovereign herb to soothe the Yang of the Liver; Shaoyao (Paeoniae Radix Alba) is used as the Minister herb to drain the Yin of the Liver; Gancao (Glycyrrhizae Radix et Rhizoma Preparata) is used as the Assistant herb to moderate the Qi of the Liver; and Zhishi (Aurantii Fructus Immaturus) is used as the Envoy herb to break stagnation and direct rebellious Qi downward. With the aid of Chaihu, these three herbs can reach outward to the Yang of the Shaoyang and inward to the Yin of the Jueyin, thereby restoring the dispersing and descending functions of the Liver and Gallbladder, allowing the reversal of cold to be resolved. If cough or diarrhea occurs, it indicates pathogenic factors and fluid retention affecting the upper and lower body; add Wuweizi (Schisandrae Chinensis Fructus) and Ganjiang (Zingiberis Rhizoma) each in 5 fen to warm the middle and dissipate fluid retention. If palpitations occur, it indicates fluid retention suppressing the Heart; add Guizhi (Cinnamomi Ramulus) in 5 fen to unblock Yang and benefit the Heart. If urination is difficult, it indicates fluid accumulation in the Bladder; add Fuling (Poria) in 5 fen to promote urination and guide out fluid retention. If abdominal pain occurs, it indicates cold coagulation in the interior; add one Pao Fu Zi (Aconiti Lateralis Radix Praeparata), roasted until broken, to warm the middle and relieve pain. If diarrhea with a sensation of heaviness in the rectum occurs, first boil Xiebai (Allii Macrostemonis Bulbus) in five sheng of water using three sheng of the herb, reduce to three sheng, strain, then add three fangcunbi (square-inch spoonfuls) of the powder into the decoction, boil until reduced to one and a half sheng, and divide into two doses to be taken warm.

[Collected Explanations]
Fang Youzhi stated: The limbs of humans should be warm and gentle, which is considered favorable ("Shun"); thus, lack of warmth is termed "Ni" (Reversal). However, if there is merely a lack of warmth without reaching the state of cold reversal, it indicates that the heat pathogen has not yet penetrated deeply. Therefore, Chaihu is used to resolve the exterior, Zhishi to drain excess, Shaoyao to astringe, and Gancao to harmonize.

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In Shaoyin disease, if there is diarrhea but the diarrhea stops spontaneously, and although there is aversion to cold and curling up in bed, the hands and feet are warm, the condition is treatable.

[Annotation]
In Shaoyin disease, aversion to cold, cold reversal, and incessant diarrhea indicate an excess of Yin-cold. Now, since the diarrhea stops spontaneously and the hands and feet become warm on their own, even though symptoms of aversion to cold and curling up are present, this is a sign that Yin pathogens are receding and Yang energy is returning. Hence, it is said to be treatable.

[Collected Annotations]
Cheng Yingmao stated: In Shaoyin disease, if diarrhea stops spontaneously, the Yin-cold pathogen can be expelled downward without leading to collapse. Although there are unfavorable signs like aversion to cold and curling up, as long as the hands and feet are warm, it indicates that Yang Qi has the potential to recover; therefore, warming methods can be used to rescue it.

Shen Mingzong stated: Warm hands and feet indicate that the True Yang has not dispersed. One should urgently use formulas such as Baitong Tang (Alisma, Aconite, and Licorice Decoction) or Sini Tang to warm the meridians and dispel cold. Once the pathogen retreats, True Yang will recover; hence, it is said to be treatable.

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In Shaoyin disease, if there is aversion to cold and curling up, occasional spontaneous irritability, and a desire to remove clothing and bedding, the condition is treatable.

[Annotation]
Shaoyin disease characterized by aversion to cold and curling up is a Yin-cold syndrome. If there is occasional spontaneous irritability and a desire to remove coverings, this is a sign of Yang recovery and Yin recession; hence, it is said to be treatable.

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In Shaoyin disease, after two or more days, if there is mental restlessness in the heart and inability to sleep, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary treatment.

[Annotation]
This clause follows the previous one to explain the treatment. Shaoyin disease occurring after two or more days implies it may have reached four or five days. It means that while the patient initially presented with excessive sleepiness ("Dan Yu Mei") typical of early Shaoyin disease, by the fourth or fifth day, this changes to mental restlessness and insomnia. Furthermore, the absence of symptoms like diarrhea with undigested food, cough, or vomiting indicates this is not a cold syndrome, so Baitong Tang is not used; nor is it a fluid-retention syndrome, so Zhuling Tang is not used. It is a heat syndrome, so Huanglian Ejiao Tang is prescribed to prevent the Shaoyin system from being scorched by heat, leading to natural recovery.

[Collected Annotations]
Cheng Zhi stated: At two or three days, the pathogen is in the Shaoyin; by four or five days, it has transferred to the Yangming. Thus, there are no symptoms of vomiting, diarrhea, or cold reversal. The mental restlessness and inability to sleep result from Yangming heat disturbing the Shaoyin internally, causing insomnia. Treatment should primarily focus on clearing heat and nourishing Yin.