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Baitouweng San (Pulsatilla Decoction) consists of Baitouweng Radix (3 liang), Huanglian Rhizoma Coptidis (3 liang, remove the whiskers), Huangbai Cortex Phellodendri (3 liang, remove the bark), and Qinpi Cortex Fraxini (3 liang).
These four ingredients are decocted in seven sheng of water until three sheng remain. The dregs are strained off, and the liquid is taken warm, one sheng at a time. If not cured, administer another sheng.

[Formula Analysis]
Taiyin, Shaoyin, and Jueyin syndromes all present with diarrhea (Xiali). Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only Jueyin diarrhea differs: cold-type presents with cold limbs, no thirst, and diarrhea of undigested food; heat-type presents with excessive thirst (Xiaoke), diarrhea with a sensation of heaviness and tenesmus in the anus, and pus and blood in the stool. This heat-type diarrhea with tenesmus is caused by fire stagnation and dampness steaming, where turbid qi forces upon the large intestine, causing the anus to feel heavy and difficult to evacuate. This corresponds to what the *Neijing* calls "sudden violent diarrhea with urgent straining" (Baozhu Xiapo).
Baitouweng Radix is the sovereign herb, cold in nature with bitter and acrid flavors; Qinpi Cortex is the minister herb, cold in nature with bitter and astringent flavors. Cold clears heat, bitterness dries dampness, acridity disperses the stagnation of fire, and astringency stops the tenesmus and diarrhea; Coptidis Rhizome assists by clearing fire in the Upper Jiao, thus stopping thirst; Phellodendri Cortex acts as the envoy by draining heat from the Lower Jiao, thus eliminating diarrhea.
There are two approaches to treating Jueyin heat diarrhea: for early-stage cases, use the bitterness of this formula to drain fire, dry dampness with bitterness, disperse fire with acridity, and consolidate with astringency; this is the method of treating heat with cold. For chronic cases, use the sourness of Wumei Wan to collect fire, assisted by bitter-cold herbs and mixed with warm-tonic herbs; this follows the principle of opposing or following the disease pathogenesis, acting according to what is beneficial, harmonizing Qi to restore balance.

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In Shanghan (Cold Damage) presenting with diarrhea occurring more than ten times a day, if the pulse is unexpectedly excess-strong, it indicates a fatal prognosis.

[Annotation]
Shanghan with frequent diarrhea indicates deficiency of Zhengqi (Upright Qi); the pulse should be deficient. An unexpectedly excess pulse indicates excess of Xieqi (Pathogenic Qi). With deficient Zhengqi and excess Xieqi, death is indicated.

[Collected Notes]
Cheng Wuji states: Diarrhea indicates interior deficiency; the pulse should be weak and faint. An excess pulse means the disease overcomes the Zang organs, hence death. This is when the pulse does not match the disease.
Zheng Zhongguang states: An excess pulse indicates that the Stomach Qi has lost its gentle and moderate quality, revealing the True Zang pulse alone. This signifies excess pathogen and collapse of upright Qi.

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In Shanghan, after six or seven days, if there was previously no diarrhea but suddenly fever and diarrhea appear, accompanied by incessant sweating, it indicates a fatal prognosis due to Yin being present while Yang is absent.

[Annotation]
Six or seven days into Shanghan is when pathogens transmit to the Jueyin channel. If there were cold limbs without diarrhea, the Yin pathogen was not strong; fever at this stage would not necessarily be fatal. However, sudden onset of diarrhea after six or seven days, combined with fever and incessant sweating, indicates severe Yin cold internally and collapse of Yang externally. Thus, it is described as "Yin present, Yang absent," leading to a known fatal outcome.

[Collected Notes]
Fang Youzhi states: Fever with diarrhea indicates internal abundance of Yin cold, hence "Yin present." Incessant sweating indicates external extinction of Yang, hence "Yang absent."
Cheng Zhi states: This describes acute diarrhea with sweating as a sign of Yang collapse and death. After six or seven days without diarrhea, sudden fever and diarrhea leading to incessant sweating indicate complete exterior Yang and interior Yin, with True Yang perishing instantly.
Wang Hu states: Cold invading Jueyin by the sixth or seventh day should involve six or seven days of cold limbs; omitting mention of cold limbs is an ellipsis. If cold limbs occurred without diarrhea, Yang was not yet defeated and could resist the pathogen. By the time fever appears, even if diarrhea occurs, it should stop. Here, fever and diarrhea occur simultaneously, plus incessant sweating, indicating the fever is not a return of Yang but a collapse of Yang. Hence, it accompanies diarrhea and sweating.
Zhang Lingshao states: Jueyin disease with fever is not necessarily fatal, but three types of fever lead to death: restlessness preventing lying down, unrelenting cold limbs, and incessant sweating.

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Fever with cold limbs, progressing to diarrhea on the seventh day, is difficult to treat.

[Annotation]
This elaborates on the meaning of fever with cold limbs. If cold limbs resolve and diarrhea stops by the seventh day, self-recovery is possible. However, if fever and cold limbs persist for seven days with ongoing diarrhea, it is difficult to treat. The previous clause cited "Yin present, Yang absent" as fatal; this clause cites Yin excess with non-returning Yang as difficult to treat.

[Collected Notes]
Fang Youzhi states: Seven days of cold limbs followed by diarrhea indicates Yin excess and non-returning Yang.
Zhang Lu states: Cold limbs/diarrhea and fever are mutually exclusive tendencies. Persistent fever and cold limbs for seven days mean heat remains heat, and cold/diarrhea remains cold, with Yin and Yang deviating to extremes without coordination. Even without restlessness, it is difficult to treat. Treating heat worsens cold/diarrhea; treating cold/diarrhea worsens heat, potentially leading to total Yin-Yang exhaustion.

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Diarrhea with a deep and slow pulse, slight facial redness, mild body heat, and diarrhea of undigested food will likely resolve after the patient experiences vertigo/dizziness (Yumao) and sweating. The patient will have mild cold limbs. This is because the facial redness represents floating deficient Yang (Daiyang) due to lower deficiency.

[Annotation]
A deep and slow pulse with diarrhea of undigested food indicates interior Yin cold. Slight facial redness and mild body heat suggest exterior Yang heat. Interior Yin cold combined with exterior Yang heat can resolve through transformation by Yang. Before resolution, the patient must experience vertigo and sweating. This occurs because the floating deficient Yang on the face and the deficient Yin from diarrhea harmonize, leading to resolution. This is not Yin rejecting Yang at the top; thus, although dizzy, the cold limbs are mild, unlike severe dizziness and cold limbs in unresolved cases.

[Collected Notes]
Yu Chang states: Deep/slow pulse and diarrhea indicate interior cold; slight redness and mild heat indicate residual exterior pathogen, resolving via sweating. Daiyang syndrome always shows mild cold limbs, hiding a critical danger requiring unusual treatment methods. Among the Six Channels, only Shaoyin and Jueyin diarrhea are difficult to treat. Pathogens entering the interior cause deep diarrhea leading to cold limbs, and deep cold limbs leading to diarrhea. Thus, these channels detail diarrhea extensively, allowing therapeutic convergence.
Wang Hu states: Yumao refers to head/eye dizziness, indicating Yang Qi overcoming Cold pathogen, returning interior Yang, and harmonizing exterior, leading to resolution. Sweating indicates returned Yang, dispersed interior cold, and harmonized Ying-Wei, not forced sweating.

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Diarrhea of undigested food, interior cold with exterior heat, sweating, and cold limbs are treated with Tongmai Sini Tang (Pulse-Reviving Four Reversals Decoction).

[Annotation]
This continues the previous clause to provide treatment. Diarrhea of undigested food indicates interior cold; mild body heat indicates exterior heat. The previous clause had no-sweat, flushed face, allowing expectation of resolution via sweating. This clause has sweating and cold limbs, revealing Yang collapse. Thus, Tongmai Sini Tang is used to rescue Yang to overcome Yin.

[Collected Notes]
Fang Youzhi states: Diarrhea implies interior cold and failing Yin; exterior heat with sweating implies failing Yang. Tongmai Sini Tang rescues exterior and interior, unifies Blood-Qi, and restores Yin-Yang.
Yu Chang states: The previous clause diagnoses; this clause prescribes medication, illuminating each other. Note that Shaoyin disease with diarrhea of undigested food and red face already uses this method.
Wu Renju states: Heat-collateral diarrhea also presents with undigested food due to pathogenic heat failing to digest grains; differentiation lies in the pulse's Yin/Yang and deficiency/excess.

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Profuse sweating with persistent fever, abdominal cramping, limb pain, plus diarrhea, cold limbs, and aversion to cold are treated with Sini Tang (Four Reversals Decoction).

[Annotation]
Profuse sweating should eliminate fever. Persistent fever without other symptoms indicates lingering pathogen. Here, profuse sweating with persistent fever, plus cramping, limb pain, diarrhea, cold limbs, and aversion to cold, indicates Yang collapse at the exterior and severe Cold at the interior. Sini Tang is used to warm meridians, overcome Cold, restore Yang, and arrest sweating.

[Collected Notes]
Fang Youzhi states: Profuse sweating indicates Yang deficiency and insecure exterior; persistent fever indicates unremoved pathogen; abdominal cramping and limb pain indicate fluid loss and obstructed bone-Qi; diarrhea, cold limbs, and aversion to cold indicate Yang collapse and severe interior Yin-Cold.
Cheng Zhi states: After profuse sweating, diarrhea and cold limbs require urgent Yang restoration. Persistent fever risks flight of True Yang. Cramping, pain, diarrhea, cold limbs, and aversion to cold indicate pure interior Yin-Cold.
Cheng Yingmao states: Why is this not a fatal Yang collapse? Fatal collapse requires incessant sweating. Here, cramping and pain indicate sweating has stopped, Yang is not yet collapsed, and aversion to cold allows warming methods.

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Profuse sweating, or severe diarrhea with cold limbs, are treated with Sini Tang (Four Reversals Decoction).

[Annotation]
Profuse sweating with unrestrained sweat indicates Guizhi Jia Fuzi Tang syndrome. Severe unremitting diarrhea indicates Lizhong Jia Fuzi Tang syndrome. Here, profuse sweating plus severe unremitting diarrhea with cold limbs indicates Yang collapse externally and severe Cold internally, beyond the scope of Guizhi or Lizhong formulas. Sini Tang is urgently needed to restore Yang and overcome Yin, stopping sweat/diarrhea and reversing cold limbs, offering a chance of survival. These three clauses involve concurrent Jueyin and Shaoyin disease; due to severe Shaoyin Cold, they are treated primarily via Shaoyin protocols.

[Collected Notes]
Yu Chang states: Without conflicting exterior heat, interior Yin-Cold is clear. However, profuse sweating and diarrhea deplete Yin fluids. Yet, rescuing Yang is urgent here; only after Yang returns can Yin be slowly restored.

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Diarrhea with cold limbs and absent pulse: if moxibustion fails to warm the limbs and the pulse does not return, but slight panting occurs, it is fatal. After diarrhea, if the pulse is absent and limbs are cold, but the pulse returns and limbs warm within one full day (Zuishi), life is preserved; if the pulse does not return, death ensues.

[Annotation]
Diarrhea with cold limbs and absent pulse indicates Yin present, Yang absent. Although Fuzi and Sini Tang may be used, Yang may not return quickly; urgent moxibustion on Jueyin channels is needed to open Yang. Pulse return and warmth indicate life; non-return with panting indicates Qi exhaustion and Yang collapsing upward, indicating death.

[Collected Notes]
Fang Youzhi states: Panting is short-breathed and discontinuous, indicating Yang depletion.
Cheng Zhi states: In Shaoyin diarrhea with cold limbs and absent pulse, Baixin Tang causes rapid pulse emergence (death) or gradual continuity (life). In Jueyin diarrhea with cold limbs and absent pulse, moxibustion leads to pulse return within a day (life) or non-return (death). Seeking Yang requires finding a trace of continuity in the Kidneys to utilize warming moxibustion effectively.

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Shanghan with fever, diarrhea, cold limbs, and restlessness preventing lying down is fatal. Shanghan with fever, severe diarrhea, and unrelenting cold limbs is fatal.

[Annotation]
Shanghan with fever, diarrhea, and cold limbs, plus restlessness, indicates severe interior Cold disturbing isolated Yang. Alternatively, severe diarrhea and unrelenting cold limbs, even without restlessness, indicate exterior Yang scattering and interior Yang collapsing, both fatal.

[Collected Notes]
Cheng Wuji states: Fever indicates exterior pathogen; diarrhea/cold limbs indicate Yang deficiency; restlessness indicates disease overcoming Zang organs, hence fatal. *Jingui Yaolue* states: Six Fu organ Qi failure externally causes cold hands/feet; Five Zang organ Qi failure internally causes uncontrollable diarrhea. Severe fever, severe diarrhea, and unrelenting cold limbs indicate Fu/Zang Qi failure, hence fatal.
Cheng Zhi states: Jueyin fever alone is not fatal as it expels pathogen outward. But exterior fever with interior cold limbs, severe diarrhea, and restlessness indicates Yang scattering outward, hence fatal.
Zhang Lu states: Restlessness indicates kidney Yang escaping. Diarrhea with cold limbs is critical as limbs are the root of Yang. Added fever and restlessness show not only deficient Yang exposure but total depletion of True Yin, hence fatal.

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Vomiting with a weak pulse, free urination, mild body heat, and cold limbs are difficult to treat and managed with Sini Tang (Four Reversals Decoction).

[Annotation]
Jueyin vomiting with weak pulse usually involves loose stools. Free urination here, despite mild heat and cold limbs, indicates pathogen rebelling upward and lower Jiao deficiency-cold failing to secure, showing Yin advancing and Yang retreating. It is difficult to treat. Sini Tang is used to urgently strengthen Yang; Yang return offers hope for survival.

[Collected Notes]
Fang Youzhi states: Weak pulse suggests declining pathogen, but free urination indicates interior deficiency-cold. Hence, cold limbs make it difficult to treat. Mild heat allows Sini Tang to rescue Yang.
Cheng Zhi states: Vomiting with cold limbs requires warming the lower Jiao. Vomiting is rebellious pathogen; weak pulse and free urination show lower deficiency-cold. Mild heat suggests exterior Yang pathogen, but cold limbs indicate interior Yin excess threatening remaining Yang.
Wang Hu states: Most cold-limb/diarrhea cases involve loose stools. This case focuses on vomiting with free urination and cold limbs, indicating failure of front/back closure. Sini Tang uses Fuzi to scatter cold, direct rebellious Qi downward, assist Mingmen Fire, stop vomiting above, control urination below, and reverse cold limbs outside.

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Dry heaving with expulsion of saliva/phlegm and headache are treated with Wuzhuyu Tang (Evodia Decoction).

[Annotation]
Taiyin has regurgitation without vomiting; Shaoyin has desire to vomit without success, coughing and vomiting; Jueyin has cold-limb vomiting or vomiting with roundworms. Dry heaving is sound without matter; expelling saliva/phlegm means cold fluid follows the heave, caused by Jueyin Cold harassing the Stomach. Three Yang channels have headaches with fever; Taiyin and Shaoyin do not. Only Jueyin connects with the Du vessel at the vertex, causing headache without fever. This results from Shaoyang unresolved transmitting to Jueyin, with Yin pathogen rebelling upward, causing vomiting and headache. Wuzhuyu Tang treats the Jueyin root.

[Collected Notes]
Cheng Zhi states: Vomiting with headache requires warming the middle and directing rebellion downward.
Zhang Xiju states: Vomiting has sound and matter; spitting expels matter. Thus, there is dry heaving but no dry spitting. Here, dry heaving expels saliva/phlegm.

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Vomiting due to abscess pus should not be treated for vomiting; once the pus is exhausted, it heals spontaneously.

[Annotation]
Heart irritability with vomiting indicates interior heat; thirst with water-induced vomiting indicates retained water. Vomiting pus indicates internal abscess. Do not treat the vomiting; wait for pus expulsion. Abscess pus is foul matter trying to exit; treating vomiting opposes this mechanism, trapping heat internally and blocking exit, causing complications. Once pus is gone, heat leaves with it, and vomiting stops.

[Collected Notes]
Wang Hu states: Lung/Stomach abscesses arise from Wind-Cold in collaterals, pathogen stagnating in Lung or entering Stomach, transforming into heat. Extreme heat causes Qi/Blood stasis forming abscess. "Abscess" means obstruction, where heat-toxin gathers into pus.
Zheng Zhongguang states: Pathogenic heat rebels upward, forming internal abscesses like Lung or Stomach abscesses.

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Jueyin Wind Strike with a slightly floating pulse indicates impending recovery; non-floating indicates no recovery.

[Annotation]
Jueyin Wind Strike includes Shanghan. A slightly weak pulse is characteristic of Jueyin; floating is an exterior Yang pulse. Obtaining a floating pulse in Jueyin disease means the pathogen has returned to the exterior, indicating recovery. Non-floating (deep) indicates the pathogen remains interior, indicating no recovery.

[Collected Notes]
Cheng Wuji states: Floating pulse signals pathogen returning to exterior for sweating, hence "recovering." Non-floating means pathogen penetrates deeper, leading to varied complications, hence "not recovering."
Fang Youzhi states: Wind pulses should be floating. Since Jueyin is naturally slightly slow/non-floating, slight floating indicates pathogen returning to exterior, hence "recovering."

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Jueyin disease resolves between Chou and Mao hours (1:00 AM – 7:00 AM).

[Annotation]
Chou, Yin, and Mao hours are when Jueyin Wind-Wood Qi is dominant. When upright Qi gains dominance, pathogens retreat, and the disease resolves.

[Collected Notes]
Fang Youzhi states: Jueyin resolves starting from Yin/Mao; Shaoyang begins resolving from Yin/Mao. Yin is initial Yang movement with strong Yin; Mao is heaven-earth opening with Yin-Yang separation. Both channels prosper here, so their resolution starts and ends here.

Phonetic Guide
Zhuang: Zhai Jiang Qie
Zi: Ji Zhi Qie
Di: Pronounced Di
Shi: Same as Si
Suo: Should be Su
Yin: Yu Rong Qie
Bi: Pronounced Bi
Qing: Same as Qing
Qing: Qi Qing Qie
Zui: Zu Dui Qie