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[Formula Analysis]
This formula is the preceding Baitong Tang (White Connect Decoction) with the addition of human urine and pig bile. The addition of urine and bile follows their similar nature. After swallowing, the cold nature is eliminated, and the hot nature immediately takes effect. The medicinal properties do not conflict with the condition but bring great benefit, thereby regulating the rejection between Yin and Yang Qi and allowing the upper and lower Yin and Yang to communicate.

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Shaoyin disease (Disease of the Shaoyin channel/organ system), characterized by the desire to vomit but inability to do so, irritability, and a strong desire to sleep. By the fifth or sixth day, if spontaneous diarrhea accompanied by thirst occurs, it belongs to Shaoyin disease. Due to deficiency, the patient draws water for self-rescue. If the urine is white in color, the manifestations of Shaoyin disease are fully present. The whiteness of the urine is due to deficiency-cold in the Lower Jiao (Lower Burner: abdominal cavity below the umbilicus), which fails to control water metabolism, resulting in pale urine.

[Annotation]
Shaoyin disease presenting with the desire to vomit but inability to do so, mental restlessness, a desire to sleep, and spontaneous diarrhea with thirst after five or six days, belongs to the transmission pathogen of Shaoyin disease, representing a syndrome where both cold and heat signs may be present. If it were Shaoyin heat causing dryness and thirst, the desire to drink would result in red urine, indicating Shaoyin dryness-heat failing to generate body fluids and heat in the Lower Jiao. Here, however, the thirst from drawing water for self-rescue is due to Shaoyin deficiency-cold failing to transform fluids, indicating cold in the Lower Jiao. Thus, it can be seen that when Shaoyin disease manifestations are complete, thirst can be distinguished into two categories: cold and heat.

[Collected Annotations]
Cheng Wuji stated: The desire to vomit but inability to do so, along with irritability, indicates exterior pathogens transmitting inward. If there were abdominal fullness and pain, it would belong to Taiyin disease; since there is only a desire to sleep, it is known to belong to Shaoyin disease. When pathogens transmit to Shaoyin on the fifth or sixth day, spontaneous diarrhea without thirst indicates cold in the Middle Jiao, belonging to Taiyin; spontaneous diarrhea with thirst indicates cold in the Lower Jiao, belonging to Shaoyin. Kidney deficiency leads to dry water, causing thirst and the desire to draw water for self-rescue. Lower Jiao deficiency-cold causes white urine. Diarrhea with thirst and white urine clearly indicates this is not an interior heat syndrome.

Fang Youzhi stated: This repeatedly clarifies to warn people not to mistake irritability and thirst as solely heat syndromes, which would lead to misdiagnosis.

Cheng Yingmao stated: Irritability does not exclusively belong to Shaoyin disease, hence "desire to sleep" is pointed out for differentiation; thirst does not exclusively belong to Shaoyin disease, hence "white urine" is pointed out. It concludes with deficiency-cold in the Lower Jiao, teaching that diseases above should be treated from below. Upper deficiency without Yin nourishment stems from Lower deficiency without Yang warming. Both instances of "deficiency" derive from "cold." Furthermore, vomiting/diarrhea with thirst resembles Zhuling Tang syndrome, differentiated by the presence of "desire to sleep." In Zhuling Tang syndrome, urination is necessarily obstructed and urine red; drinking habits resemble Baitouweng Tang syndrome, where heat is cited as the cause, so urine is never white.

Lin Lan stated: Desire to vomit but inability, and irritability, indicate Yang deficiency with floating/rebellious Qi above. Desire to sleep, spontaneous diarrhea, and white urine indicate profound true cold within. Such thirst differs from thirst caused by dry mouth and tongue. If accompanied by abdominal fullness, constipation, and delirium, it should be treated as Yang pathogens transmitting inward. Since there is interior deficiency with spontaneous diarrhea and white urine, the deficiency-cold is evident. Mentioning the Lower Jiao shows that when Yin excess is below, Yang must be rejected above; one cannot mistakenly attack heat due to irritability and thirst.

Wang Hu stated: Viewed holistically, it resembles a heat syndrome, but white urine reveals it is a true cold syndrome. The "desire to sleep" differs from heat pathogens; sleep is likely not confused/cloudy, and respiration is rapid and fine. Stating it belongs to Shaoyin distinguishes it from non-Yang-pathogen thirst; this is thirst from internal fluid deficiency seeking self-rescue. Offering cold water would result in little intake. Careful observation of white urine confirms all Shaoyin deficiency-cold symptoms are present, ruling out heat pathogens.

Shen Mingzong stated: This differentiates Shaoyin deficiency-cold which appears like a heat syndrome. People generally know limb coldness indicates deficiency-cold, but few realize white urine is the definitive verification.

Wu Renju stated: Yangming disease's desire to vomit prevents sleep, whereas Shaoyin disease features a desire to sleep, illustrating the difference between excess and deficiency.

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Shaoyin disease, where food entering the mouth triggers immediate vomiting, a sensation of nausea in the heart/chest with desire to vomit but inability to do so. At the onset, if hands and feet are cold and the pulse is wiry and slow, this indicates excess in the Chest (Upper Jiao); purgation is contraindicated, and emesis should be induced. If there is cold-fluid retention above the diaphragm causing dry retching, emesis is contraindicated; warming is required, preferably using Sini Tang (Frigid Extremities Decoction).

[Note]
"Wenwen" should be read as "Wawa," describing the state of vomiting fluid.

[Annotation]
This elaborates on the previous case of "desire to vomit but inability," detailing pulse and symptoms to clarify treatment. Vomiting upon ingestion, chest nausea, and inability to vomit despite the urge, with persistent恶心 (nausea), is not Shaoyin deficiency-cold vomiting, but rather Cold-Excess vomiting in the Chest. Hence, the initial pulse is wiry and slow. Wiry indicates fluid retention; slow indicates cold. Cold hands and feet occur because Chest Yang is blocked by cold-fluid, preventing circulation to the limbs. Cold-excess in the Chest requires inducing vomiting to expel it upward; thus, purgation is forbidden. If there is cold-fluid above the diaphragm causing only dry retching without expulsion, this is Shaoyin deficiency-cold fluid, not Chest cold-excess fluid. Therefore, emesis is contraindicated; urgent warming is needed, suitable for Sini Tang, or Lizhong Tang with Dingxiang (Caryophylli Flos) and Wuzhuyu (Evodiae Fructus).

[Collected Annotations]
Cheng Zhi stated: This discusses Shaoyin fluid-retention vomiting caused by Kidney pathogens rebelling upward, requiring warming rather than emesis. "Desire to vomit but inability" is a sign of Yin pathogens rebelling upward. If at onset, pathogens have not deeply penetrated, and limbs are merely cold (not cold-extremities) with a wiry-slow pulse (not deep-fine), it indicates pathogen excess in the Chest, cold still in the Exterior/Yang aspect, requiring emesis, not purgation. Vomit involves matter; retching involves sound without matter; these must be distinguished. If cold-fluid above the diaphragm causes only dry retching, it is Yin-cold rebelling upward, requiring warming, not emesis. "Urgent warming" implies that failure to warm will lead to cold-extremities and pulseless conditions.

Cheng Yingmao stated: Cold in the Chest prohibits purgation. If it is excess pathogen, emesis allows Yang Qi to flow freely; thus, emesis acts as warming. If cold-fluid above the diaphragm causes dry retching, it is deficiency-cold rising from below, trapping fluid in the Chest, which is ultimately not a Chest disease itself. Directly warming the Lower Jiao with Sini Tang is appropriate.

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Shaoyin disease, with a faint, thin, and deep pulse, a desire only to lie down, sweating without irritability, and a subjective desire to vomit. By the fifth or sixth day, if spontaneous diarrhea occurs followed by irritability and agitation preventing sleep, death ensues.

[Annotation]
This expands on the previous section, detailing pulses and symptoms to explain the consequences of failing to warm urgently. A faint, thin, deep pulse with a desire to lie down indicates Shaoyin cold. Sweating without irritability indicates Shaoyin collapse of Yang. The subjective desire to vomit indicates Yin-cold pathogens rebelling upward, necessitating urgent warming. Neglecting this until the fifth or sixth day, compounded by spontaneous diarrhea, leads to irritability and agitation preventing sleep. This represents the disturbance and external floating of the True Yang in the Shaoyin Kidney, approaching extinction—a fatal syndrome. Even warming at this stage would be too late.

[Collected Annotations]
Fang Youzhi stated: Faint, deep, thin pulse and desire to lie down are the root Shaoyin disease. Sweating without feverish irritability indicates absence of Yang. Desire to vomit indicates unexpelled meridian pathogens. Spontaneous diarrhea indicates worsening organ disease. Further irritability and agitation preventing sleep indicate Yang nearing extinction and chaotic unrest.

Cheng Yingmao stated: Modern physicians hesitate to use warming methods until severe signs like aversion to cold, curling up, and cold extremities appear, unaware that warming is viable even at earlier stages. Some symptoms may not manifest fully before death. One must understand the core principles: Shaoyin disease always presents with a deep, faint, thin pulse—this signals the appropriateness of warming. Desire to lie down signals the appropriateness of warming. While sweating in Yang meridians prohibits warming, in Shaoyin it mandates urgent warming due to Yang collapse. Coupled with non-irritable desire to vomit (Yin rebellion), Zhenwu Tang and Sini Tang are as precious as three-year-old mugwort. Delaying treatment for five or six days transforms prior desire to vomit into diarrhea, prior lack of irritability into agitation, and prior desire to sleep into insomnia. Yang deficiency chaos and Yin excess intensify, leading inevitably to death.

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Shaoyin disease persisting for two or three days, progressing to the fourth or fifth day, presenting with abdominal pain, difficult urination, heavy/painful limbs, and spontaneous diarrhea, indicates water retention. If the patient also experiences cough, or difficult urination, or diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) is the primary treatment.

[Annotation]
In the Treatise, Heart-area water retention with fever, sweating, irritability/thirst, and difficult urination belongs to Wind-strike of the Taiyang channel, treated with Wuling San. Fever without sweating, dry retching, no thirst, and difficult urination belongs to Cold-damage of the Taiyang channel, treated with Xiao Qinglong Tang. Here, Shaoyin disease persists for days, leading to abdominal pain and diarrhea, indicating profound Yin-cold. If urination were normal, it would be pure cold without water, treated with Fuzi Tang. However, difficult urination, cough, or vomiting indicates Yin-cold combined with water retention. Water-cold attacking the exterior causes heavy/painful limbs; accumulating internally causes abdominal pain and diarrhea; stagnating in the Upper Jiao (chest/lungs) causes cough/wheezing/inability to lie flat; stagnating in the Middle Jiao (stomach) causes vomiting/diarrhea; stagnating in the Lower Jiao (bladder) causes difficult urination/hypogastric fullness. All these stem from Yin-cold water. Wuling San is excluded as it treats exterior-heat fluid; Xiao Qinglong Tang is excluded as it treats exterior-cold fluid. Thus, Zhenwu Tang is used to warm cold and control water.

[Collected Annotations]
Yu Chang stated: In the Taiyang chapter, cold-extremities, muscle twitching, and Yang collapse were treated with Zhenwu Tang. Here, Shaoyin water-dampness rebelling upward is still treated with Zhenwu Tang to suppress it. This shows Taiyang Bladder and Shaoyin Kidney, though Fu and Zang respectively, both govern cold-water. Pathogens in the Fu are Yang pathogens, utilizing Mahuang/Guizhi to form Qinglong Tang; pathogens in the Zang are Yin pathogens, utilizing Fuzi to form Zhenwu Tang.