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Yin-cold syndrome is a condition where, traditionally, it was believed that cold pathogenic factors directly invade the interior, leading to cold reversal of the four limbs (Ji Ni), sudden exhaustion of Yang Qi, a sensation as if the body has been beaten with a staff, severe colicky pain in the abdomen, diarrhea with undigested food residues (Qing Gu), and a faint pulse nearly imperceptible (Mai Wei Yu Jue). In such emergencies, decoctions like Sini Tang (Four Reversal Decoction) or Lizhong Tang (Regulate the Middle Decoction) must be urgently administered to warm the interior, yet one still fears it may be too late. I have pondered that the human body is protected by Wei Qi (Defensive Qi), Ying Qi (Nutritive Qi), Zong Qi (Gathering Qi), Yuan Qi (Source Qi), Spring-rising Qi, and Grain-and-Water Qi. These various energies are nurtured together, originating from the Sanjiao (Triple Burner) and Mingmen (Gate of Life), serving as the source of continuous life processes. Why does a mere invasion of cold pathogen lead to such deep penetration? The truth is, this is not caused by external cold invading an intact body, but rather by an inherent lack of internal fire (Yang deficiency). The true essence of the Mingmen has already declined and exhausted. Even without exposure to cold, the Yin-cold manifestations are already present within the body; only upon accidental contact with cold does the condition manifest severely. Some attribute it to sudden collapse of Yang Qi, some to internal injury from raw/cold foods, and others to invasion by extreme cold. All these explanations address the branch (symptoms) but ignore the root (cause). Therefore, when Zhang Zhongjing selected formulas, he simply referred to "rescuing the interior" (Jiu Li), which reveals his intent. Moreover, in this syndrome, vital energy is depleted, and changes occur within moments. Without potent herbs like Shengjiang (Dried Ginger), Rougui (Cinnamon Bark), Renshen (Ginseng Root), and Fuzi (Aconite Root), it is impossible to restore the nearly extinct primal Yang. How can one still make excuses about external invasion?

Case 1: Shaoyin disease presenting with diarrhea of undigested food, cold reversal of hands and feet, and a faint pulse nearly imperceptible. However, the patient does not feel aversion to cold, and the face appears red (Mian Chi). There may also be abdominal pain, dry retching, sore throat, or cessation of diarrhea with non-palpable pulse. Treatment: Tongmai Sini Tang (Pulse-Resuscitating Four Reversal Decoction). Ingredients: Sheng Fuzi (Raw Aconite Root) 1 qian, Zhi Gancao (Honey-fried Licorice Root) 1 qian, Ganjiang (Dried Ginger) 1.5 qian. Take warm. Modifications: Add Congbai (Scallion Stem) for facial redness; add Baishao (White Peony Root) for abdominal pain; add Shengjiang (Fresh Ginger) for vomiting; add Jiegeng (Platycodon Root) for sore throat; add Renshen (Ginseng Root) if diarrhea stops but pulse remains absent.

Case 2: After sweating therapy for Shanghan (Cold Damage), the condition persists, and aversion to cold worsens. This indicates deficiency. Zhang Zhongjing prescribed Baishao (White Peony Root) 3 qian, Zhi Gancao (Honey-fried Licorice Root) 3 qian, and Pao Fuzi (Processed Aconite Root) 2 qian to tonify. Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) is also applicable.

Case 3: Following purgation and subsequent sweating for Shanghan, the patient experiences daytime irritability and insomnia, but quietness at night. There is no vomiting, no thirst, no exterior syndrome signs, a deep and faint pulse, and no significant fever. Treatment: Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) to warm the interior.

Case 4: Shanghan with Yin excess repelling Yang (Yin Sheng Ge Yang). The patient exhibits restlessness and heat sensation but refuses to drink water. The pulse is deep, and the extremities are cold. Sun Zhao treated this with Pili San (Thunderbolt Powder): one piece of Fuzi (Aconite Root), roasted until carbonized but retaining its nature, ground into powder, and taken with honey-water. Jie'an used Huiyang Fanben Tang (Return-Yang Restore-Root Decoction) with even better results. Li Dongyuan treated the nephew of Hanlin Academician Feng, who suffered from Yin excess repelling Yang Shanghan, presenting with red face, red eyes, irritability, excessive thirst, and a rapid pulse (7-8 beats per breath) that felt scattered upon pressure. He used Jiangfu Tang (Ginger-Aconite Decoction) supplemented with Renshen (Ginseng Root). After two doses, the patient sweated and recovered. This demonstrates the miraculous efficacy of divine medicine.

Case 5: Jia Yin Shanghan (Shanghan complicated by Kidney-Yang deficiency due to sexual activity). Initially caused by sexual desire, followed by cold invasion, leading to Yang deficiency and Yin excess. The six pulses are deep and hidden, with severe lower abdominal colic, cold reversal of limbs, and vomiting of clear fluid. Without this specific prescription, Yang cannot be restored. Prescription: Ren Shen (Ginseng Root) and Pao Jiang (Processed Dried Ginger) each 1 liang; Sheng Fuzi (Raw Aconite Root) 1 piece, broken into eight slices. Decoct in water and take in divided doses. Recovery is indicated by the reappearance of the pulse and warming of the body. Wu Shou stated: Fuzi (Aconite Root) is the essential herb for Yin syndromes. Whenever Shanghan transmits to the Three Yin meridians, or in cases of middle-cold with Yin complication, even if the body is hot but the pulse is deep, Fuzi must be used. If there is cold reversal, abdominal pain, deep-thin pulse, or even cyanotic lips and retracted testicles, urgent use is required. It has the power to dispel Yin and restore Yang, bringing the dead back to life. In recent times, practitioners often hesitate to use Fuzi for Yin-complicated Shanghan due to diagnostic uncertainty, waiting until Yin is extreme and Yang is exhausted, which is too late. Furthermore, in Jia Yin Shanghan, both interior and exterior are Yin, and Yang Qi suddenly declines. Urgent use of Renshen (Ginseng Root) is necessary to strengthen the vessels and boost Yuan Qi, assisted by Fuzi (Aconite Root) to warm the channels and disperse cold. Abandoning this approach leaves no means of rescue.

Note: Yin-cold syndromes cause harm rapidly. I have detailed them here so that clinicians pay close attention and do not neglect them.

Tongmai Sini Tang (Pulse-Resuscitating Four Reversal Decoction)
Sini Tang with double the amount of Gancao (Licorice Root).

Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction)
Ganjiang (Dried Ginger) 2 qian; Fuzi (Aconite Root) 3 qian.
Decoct in water and take.

Huiyang Fanben Tang (Return-Yang Restore-Root Decoction)
Shu Fuzi (Prepared Aconite Root); Ganjiang (Dried Ginger); Gancao (Licorice Root); Renshen (Ginseng Root); Maidong (Ophiopogon Tuber); Wuweizi (Schisandra Berry); Lacha (Winter Tea); Chenpi (Aged Tangerine Peel).

For patients with Dai Yang (False Heat on the face, appearing red like makeup), indicating lower deficiency: Add 7 stalks of Congbai (Scallion Stem) and a small amount of Huanglian (Coptis Rhizome). Decoct using clarified muddy water. Before administration, add 5 spoons of honey. Drink cold in one dose.

Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle)
Huangqi (Astragalus Root, honey-fried) 1.5 qian; Shaoyao (Peony Root, stir-fried) 2 qian; Rougui (Cinnamon Bark, peeled) 1 qian; Gancao (Licorice Root, honey-fried) 0.5 qian.
Decoct with Shengjiang (Fresh Ginger) and Dazao (Jujube). Strain the dregs, add 1 large spoon of Yitang (Maltose), boil briefly, and take. If there is loose stool/diarrhea or vomiting, omit Yitang.

Shenfu Tang (Ginseng and Aconite Decoction)
Renshen (Ginseng Root) 0.5 liang; Fuzi (Aconite Root, processed, peeled, navel removed) 1 liang.
Divide into three doses. Decoct with ginger water.