Library

35. Yin poison (Yin Du, a syndrome characterized by extreme yin-cold pathogen) presents with extreme cold, cyanotic and black complexion, sore throat, cold limbs throughout the body, and aversion to cold. The body feels heavy, stiff, and painful, as if beaten by a club, with abdominal cramping that is hard as stone. There may be vomiting, dysentery, or irritability, or cold sweating. Treatment should prioritize warming and tonifying. If there is no sweat, use Huanyang San (Restore Yang Powder) to dispel yin-cold; urgently moxa Qihai (CV6) and Guanyuan (CV4).

[Note] "Yin poison" refers to a syndrome where yin-cold reaches its extreme. The blood vessels are invaded by yin-poison pathogens, hence the cyanotic and black complexion. Yin-poison attacks inwardly into the interior, causing sore throat and abdominal cramping pain. Yin-poison attacks outwardly on the exterior, causing cold limbs throughout the body, heaviness, stiffness, and pain as if beaten by a club. With only yin and no yang to transform it, yin stagnates, making the abdomen hard as stone. Vomiting, dysentery, irritability, or cold sweating are all signs potentially arising from deficiency of yang qi. Warming and tonifying should be prioritized in all cases. Si Ni Tang (Frigid Extremities Decoction) with added Ginseng Radix et Rhizoma (Renshen, 人参) is appropriate. If these symptoms are present and the patient has no sweat, Huanyang San (Restore Yang Powder) and Tuiyin San (Retract Yin Powder) are suitable. Use warming methods to induce sweating, thereby dispersing cold pathogens and extending yang qi. For any such case, urgent moxibustion on Qihai (CV6) and Guanyuan (CV4), three hundred moxa cones each, followed by herbal medication, will invariably lead to recovery.

1. Fever without fixed timing: mild fever like feathers covering the body (Xi Xi Re, 翕翕热); steaming fever rising like a cooking steamer (Zheng Zheng Re, 蒸蒸热). Exterior heat presents with clear urine; interior heat presents with dark urine. Exterior heat requires Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction); interior heat requires Liangge San (Cool the Diaphragm Powder) or Chengqi Tang (Assist the Qi Decoctions). Dryness, thirst, and irritability indicate Yang heat; cold limbs and dysentery with external heat belong to the Yin meridians. Yang heat is treated with clearing methods, such as Baihu Tang (White Tiger Decoction). Yin heat is treated with warming methods, using Si Ni Tang (Frigid Extremities Decoction) and Baitong Tang (White Through Decoction).

[Note] "Fever without fixed timing, Xi Xi heat" means fever without cessation, resembling the mild warmth of feathers covering the body, indicating exterior heat. "Cooking steamer rising, Zheng Zheng heat" means fever rising internally like steam from a cooking steamer, indicating interior heat. In exterior heat, the pathogen is not in the interior, so urine is clear; in interior heat, urine is dark. "Exterior requires Ma Gui" means for exterior heat with no sweat, Mahuang Tang (Ephedra Decoction) is indicated; with sweat, Guizhi Tang (Cinnamon Twig Decoction) is indicated. "Interior cooling uses Cheng" means for mild interior heat, Liangge San (Cool the Diaphragm Powder) is indicated; for severe interior heat, the three Chengqi Tangs (Assist the Qi Decoctions) are indicated. Fever accompanied by dry mouth, dry tongue, irritability, and thirst belongs to Yang meridian heat. Fever accompanied by cold limbs and dysentery with undigested food belongs to Yin meridian heat. Yang heat should be cleared, using Baihu Tang (White Tiger Decoction) and similar detoxifying formulas. Yin heat should be warmed, using Si Ni Tang (Frigid Extremities Decoction) and Baitong Tang (White Through Decoction).

[Commentary] Xi Xi heat and Zheng Zheng heat both involve sweating and are similar syndromes. Mistaking Xi Xi exterior heat for Zheng Zheng interior heat and using purgation leads to adverse reactions; mistaking Zheng Zheng interior heat for Xi Xi exterior heat and using diaphoresis damages healthy qi. Although Xi Xi heat involves sweating, palpation reveals only mild warmth, unlike Zheng Zheng heat where palpation reveals heat penetrating the hand. If differentiation is difficult due to similarity, examine whether the urine is clear or dark, and whether the tongue coating is moist or dry, to make a determination.