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(Zhang Zhongjing.)
(Sini refers to cold limbs. If two liang of Shengjiang (Dried Ginger) are added to the original formula, it becomes Tongmai Sini Tang (Pulse-Regulating Sini Decoction).)

Indicated for Cold Damage involving the Three Yin meridians (Sini Tang is the primary formula for Shaoyin disease, but it is commonly used for diseases of all Three Yin meridians. It may also be used in Taiyang syndrome when the pulse is deep), body pain, abdominal pain, diarrhea with undigested food, aversion to cold without thirst, and cold limbs; or conversely, no aversion to cold, red face, and irritability, presenting as internal cold with external heat; or dry retching, or sore throat, with a pulse that is deep, faint, fine, and nearly imperceptible. (Abdominal pain and spontaneous diarrhea indicate interior cold. Spontaneous diarrhea is common in Three Yin diseases; if the body is cool and the pulse calm and quiet, it is a favorable sign; if the body is hot and the pulse large, it is an unfavorable sign. Due to internal cold, there is aversion to cold and no thirst. The four limbs are the root of all Yang meridians; when cold invades, blood vessels become congealed and stagnant, and Yang Qi cannot disperse throughout the body, causing whole-body pain and cold hands and feet. Conversely, no aversion to cold, red face, and agitation indicate that excessive Yin cold repels Yang Qi to the exterior. Cold stagnating in the chest causes vomiting immediately after eating; cold-fluid retention in the diaphragm causes dry retching due to rebellious Qi; deficient Fire flaming upward causes sore throat; a deep pulse indicates that cold causes Qi to hide and store. Commentary: Shaoyin pulses can be deep, tight, or rapid, but Zhang Zhongjing generally describes them as faint and fine. This is because a deep pulse must be felt with heavy pressure, and tight or rapid qualities are found within the deep-fine context, unlike Yang syndromes which present as floating, large, tight, and rapid. Xue Shenzhai stated: People know that a rapid pulse indicates heat,)

Fuzi (Aconiti Lateralis Radix Praeparata, one piece. Raw use) Ganjiang (Zingiberis Rhizoma, one liang) Gancao (Glycyrrhizae Radix et Rhizoma, roasted, two liang). Take cold. If the face is red, indicating Yang repelled upward, add nine stalks of Congbai (Allii Fistulosum Bulbus) to unblock Yang (Yu Jiayan said: In individuals with deficient Yang, even if there are exterior signs, sweat still flows, and the hands and feet must be cold. Using exterior-releasing herbs immediately leads to collapse of Yang; not using them leaves the external pathogen unchecked. Therefore, treat with the aforementioned decoction plus Congbai). If there is abdominal pain, it indicates deficiency of True Yin; add Baishao (Paeoniae Radix Alba, two liang) to astringe Yin. If there is a sore throat, it indicates constriction of Yin Qi ascending; add Jiegeng (Platycodonis Radix, one liang) to benefit the throat. If diarrhea stops and the pulse does not emerge, add Renshen (Ginseng Radix, two liang) to assist Yang and tonify Qi and Blood. For vomiting, add Shengjiang (Zingiberis Rhizoma Recens, two liang) to...

This is a medicine for the Foot-Shaoyin Kidney meridian. When cold pathogens overflow internally, treat with sweet and hot substances. Thus, the great-hot agents Jiang (Ginger) and Fu (Aconite) are used to stimulate Yang Qi and scatter cold pathogens (Raw Fuzi can also release the exterior). Gancao (Licorice) is also a substance that tonifies the middle and scatters cold, and it serves to moderate the upward rebellion of Jiang and Fu (Gancao is the Sovereign herb, Ganjiang is the Minister herb, Fuzi is the Envoy herb). It must be taken cold because cold excess in the middle jiao would reject hot drinks. This corresponds to the Classic saying "treat heat with cold administration" (Re Yin Han Yong), and also "treat cold with hot substances, administered cool." (This is an unusual preparation and large dosage. The Liver and Kidney are distant locations; only large dosages can reach them. Zhang Zhongjing said: In Cold Damage, if the physician mistakenly uses purgatives, leading to subsequent diarrhea with undigested food, abdominal fullness, and body pain, urgently rescue the interior with Sini Tang. If bowel movements are normal and there is body pain, urgently rescue the exterior with Guizhi Tang. Generally, body pain still belongs to exterior syndrome; in emergencies, rescue the interior first, then resolve the exterior. The Jueyin chapter states: After profuse sweating, if heat persists, with internal cramping, limb pain, accompanied by diarrhea, cold limbs, and aversion to cold, Sini Tang governs. Commentary: In Jueyin syndrome, cold limbs and cyanotic nails with a deep-rapid pulse that is forceful upon pressure indicate Yang Jue (Cold Limb Syndrome due to Heat), which requires purgation, suitable for Dachengqi Tang. If the pulse is deep-slow and non-forceful upon pressure, it is Yin Jue, suitable for Sini Tang, and moxibustion should be performed urgently. Any transmitted heat pathogen causes Yang Jue, characterized by dark urine and warm limbs; direct invasion of true cold causes Yin Jue, characterized by contraction of the genitals and cold limbs. Cheng Jiaoqian said: The worldly belief that transmitted disease causes Heat Jue and direct invasion causes Cold Jue is very erroneous. Jue syndromes of the Three Yang meridians mostly result from failure to purge, constituting Heat Jue; Jue syndromes of the Shaoyin meridian all belong to Cold Jue. Regarding Heat Jue of the Yin meridians, Zhang Zhongjing's book has only one instance: "Cold damage, one to two days up to four or five days, when Jue occurs, there must be fever." If it were truly like the theory of transmitted pathogens, this would occur at four or five days, but why does the text mention one or two days? It is unknown what meridian's pathogen is so swift. When he says "Jue should be purged," it means purging the heat, not purging the Jue itself. One may purge when there is fever, but never purge when there is Jue. Tracing the cause, Jueyin and Shaoyang are one fu and one zang organ. Shaoyang is the end of the Three Yang; when Yang ends, Yin generates, hence the alternating cold and heat. Jueyin is the end of the Three Yin; when Yin ends, Yang connects, hence the winning and reversing of cold and heat. In such cases, do not discuss whether it comes from the Three Yang or originates in Jueyin; only discuss the proportion of heat versus Jue. More heat than Jue indicates Yang Jue; more Jue than heat indicates Yin Jue. If heat lingers and does not recede, Yang overcomes and Yin cannot recover, leading to throat obstruction and bloody stool. If Jue lingers and does not recede, Yin overcomes and Yang cannot recover, leading to Chu Zhong (stomach qi exhaustion) and collapse of Yang. Zhang Zhongjing harmonized these two treatments by combining the mechanism of Yin-Yang advancement and retreat. When Yang prevails, purging is suitable; Xiaochengqi Tang removes the cold Mangxiao (Mirabilitum) but retains the warm Houpo (Magnoliae Officinalis Cortex). In Jueyin, break Yang to move Yin. When Yin prevails, warming is suitable; even if there is Yang pathogen, upon seeing Jue and diarrhea, Wumei Wan (Mume Pill) is suitable, gathering pungent-hot substances with bitter-cold assistants. In Jueyin, break Yin to move Yang. Even with upper heat, such as thirst and Qi rushing to the heart mentioned at the beginning of the chapter, one need not worry about rejection. The principle of supporting Yang and suppressing Yin is subtle. Furthermore, Wumei Wan adds slight bitter-cold substances among sour-pungent liver-entering herbs to accept and guide downward the rebellious Yang pathogen. Named "Calming Ascaris," it actually calms the Stomach, thus also treating diarrhea. Seeing syndromes of diarrhea caused by Yin-Yang failing to connect smoothly, all such cases can be encompassed by this formula. The Classic states: Whenever Yin and Yang fail to connect smoothly, Jue occurs; cold reverse limbs are the manifestation. Fang Zhongxing said: The meridians of the Three Yin and Three Yang all connect at the hands and feet. Yin governs cold, Yang governs heat. If Yang Qi sinks internally and fails to connect smoothly with Yin Qi, cold reverse limbs occur. Appendix: Yu Jiayan discussed Guifu Wan, saying: Zang organs are Yin and can withstand pure Yang medicines; Fu organs are Yang and require one or two Yin substances to restrain their rebellious heat. The Classic...)

Adding Baizhu (Atractylodis Macrocephalae Rhizoma) and Dazao (Jujubae Fructus) to this formula creates Zhufu Tang (from *Jingui Yaolue*): Treats wind-dampness binding, causing bodily discomfort and pain; and cold-induced Jue with heart pain.
Removing Gancao from this formula creates Ganjiang Fuzi Tang (Zhang Zhongjing): Treats restlessness during the day and quietness at night after mistaken purgation and sweating, without vomiting or thirst, no exterior syndrome, deep-faint pulse, and no significant heat. (Daytime restlessness is false heat from disturbed deficient Yang; nighttime quietness, no vomiting/thirst, deep-faint pulse, and no significant heat indicate Yin Qi ruling alone and true interior cold. When Yin deficiency is extreme, Yang must Jue; when Yang deficiency is extreme, Yin must be restless. Jiang and Fu directly return Yang from Yin; one should not doubt this due to daytime restlessness). Also treats cold-induced Jue with dizziness and collapse, with or without sweat, or profuse spontaneous sweating. (In cold injury, stiffness, trismus, dizziness, absence of sweat or presence of spontaneous sweating indicates inherent deficiency of pores and weak Yang. Cold damage involves fever; cold injury does not. Why did Zhang Zhongjing detail Cold Damage but omit Cold Injury? Answer: Yang moves, Yin is still. When Yin cold condenses into heat, it follows Yang and transforms variably without fixed patterns, requiring detailed discussion. Non-febrile cases involve fixed Yin pathogens that do not transform, hence less detail needed. Wang Ang comments: Spontaneous sweating may imply concurrent Wind). Also treats external heat and restlessness due to Yin excess repelling Yang (Yin syndrome resembling Yang). Adding Danggui (Angelicae Sinensis Radix) and Rougui (Cinnamomi Cortex) to Jiangfu Tang, mixed with honey, creates Jiangfugui Tang (Yu Jiayan said: After taking Jiangfu Tang, take this subsequently. Since Jiangfu specifically returns Yang, and sudden cold injury first damages Ying-Blood, adding Danggui and Rougui expels Ying-pathogens, ensuring drug-disease correspondence). Adding Renshen and Gancao creates Jiangfuguishengantang, decocted with fresh ginger (Yu said: After the previous decoction, take this to tonify Qi and Blood). Removing Gancao and adding four stalks of Congbai creates Baitong Tang (Restoring Yang and unblocking Pulse). Adding human urine and pig bile creates Baitong Jia Ren Nao Zhu Dan Tang (Zhang Zhongjing. See later). Adding one liang of Renshen creates Sini Jia Renshen Tang (Zhang Zhongjing): Treats aversion to cold, faint pulse, recurrent diarrhea, and cessation of diarrhea with loss of fluids (Aversion to cold, faint pulse, and recurrent diarrhea indicate Yang deficiency and Yin excess. Cessation of diarrhea implies internal exhaustion of fluids, termed "loss of blood." Sini warms meridians and restores Yang; Renshen generates fluids and benefits blood). Adding six liang of Fuling (Poria) creates Fuling Sini Tang (Zhang Zhongjing): Treats persistent illness and irritability after sweating and purgation. (Excessive sweating collapses Yang and causes exterior deficiency; mistaken purgation collapses Yin and causes interior deficiency. Deficiency of Yin-Yang and Exterior-Interior generates irritability. Fuling and Renshen enter the Heart to remove vexation; Fuzi and Ganjiang enter the Kidney to resolve restlessness). Removing Ganjiang and adding three liang of Baishao creates Shaoyao Gancao Fuzi Tang (Zhang Zhongjing): Treats Cold Damage where sweating fails to resolve the condition, resulting in increased aversion to cold due to deficiency. (Sweating with unresolved exterior and aversion to cold, described as "increased," indicates Yang weakness from excessive sweating. Sweating indicates Ying deficiency; aversion to cold indicates Wei deficiency. Heavy tonification of Yin worsens aversion to cold; merely restoring Yang further depletes Yin. Thus, Fuzi restores Yang, while Baishao astringes Yin. This is the rescue method for dual deficiency of Ying and Wei. Li [Xue] said: Post-sweating Yang collapse with aversion to cold is exterior deficiency, treated with Shaoyao Fuzi Gancao Tang; post-purgation aversion to cold is interior deficiency, treated with Sini Tang; if exterior pathogen remains, fever accompanies it, treated with Chaihu Jia Guizhi Tang; if interior excess heat hides inside with Yang penetrating outside causing aversion to cold and hard stools, purgation is still required. *Shanghan Baiwen* states: Post-sweating aversion to cold implies deficiency; post-purgation fever implies excess). Removing Fuzi and using four liang of Gancao and two liang of Ganjiang creates Gancao Ganjiang Tang (Zhang Zhongjing): Treats Cold Damage with floating pulse, spontaneous sweating, frequent urination, mental vexation, mild aversion to cold, and cramped legs. Mistakenly attacking the exterior with Guizhi Tang leads to Jue, dry throat, irritability, and vomiting. This formula restores Yang. (Floating pulse, spontaneous sweating, frequent urination, and aversion to cold indicate insufficient Yang. Attacking the exterior severely damages Yang, leading to Jue and injury of Stomach fluids. Gancao benefits Qi, Ganjiang assists Yang. Fearing pungent-hot substances damage Yin, follow with Shaoyao Gancao Tang to benefit Yin-Blood and restore fluids. Although the syndrome approaches Shaoyin, Sini Tang is not used). If Jue resolves and feet warm, prepare Shaoyao Gancao Tang again to harmonize Yin, allowing the legs to extend: Shaoyao and Gancao, each four liang (Zhang Zhongjing. See Harmonizing Section separately). Adding Wuzhuyu (Evodiae Fructus) creates Zhuyu Sini Tang, treating abdominal pain in Jueyin and Shaoyin. Adding Danggui and Mutong creates Danggui Sini Tang: Treats cold-induced cold limbs with fine, nearly imperceptible pulse; and cold hernia in men and women, cold below the navel radiating to waist and hips. (Cold injuring Ying-Blood necessitates Danggui and Mutong to unblock blood vessels. Zhang Zhongjing's Danggui Sini Tang see later). Adding Yinchen (Artemisiae Scopariae Herba) creates Yichen Sini Tang: Treats Yin Jaundice. Adding Shengmai San and Chenpi creates Huiyang Fanben Tang: Treats Yin excess repelling Yang. Adding Guigui (Cinnamomi Ramulus), Liangjiang (Galangali Rhizoma), and Banxia (Pinelliae Tuber) creates Jiangshui San (Jiegu): Treats deficiency-cold watery diarrhea, cold sweat, faint pulse, and severe vomiting, an acute condition. (Jiangshui refers to watery stool, clear and cold. Also says: Decoct with Jiangshui...)