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Translation:

Commentary: Medical texts after the Song and Yuan dynasties all claim that pathogenic factors transmitted from the Three Yang meridians (Taiyang, Yangming, Shaoyang) into the Three Yin meridaries are exclusively heat syndromes. They assert that only the purgative method should be used. However, formulas in the *Shanghan Lun* (Treatise on Cold Damage) such as Sini Tang (Four Reversal Decoction), Baitong Tang (White Pass Decoction), and Lizhong Tang (Regulate the Middle Decoction) are [used for cold syndromes].

Some argue otherwise, claiming that as pathogens transmit sequentially into the Three Yin meridians, there are no cold syndromes at all. This is also incorrect. Why? Let us use an analogy: When a person contracts cold, they feel cold. The nature of cold... [text fragment] ...is sometimes mistaken for changes caused by erroneous medication. Whenever sweating or purging methods are misapplied, excessiveness damages righteous Qi and depletes Yang, while insufficiency allows heat to blaze and damage Yin. Depletion of Yang leads to symptoms transforming according to Yin (cold transformation) in Shaoyin; [excess heat] transforms into heat. Pain... Yin transformation... interior cold with exterior heat... Yang follows Yin transformation.

(Because the Spleen is the organ of damp earth and is purely Yin. When disease enters the Taiyin meridian, it transforms according to Yin [into cold] more often than according to Yang [into heat].)

What is meant by Taiyin pathogenic factors transforming according to Yin? The *Shanghan Lun* states: Abdominal fullness, vomiting food, spontaneous diarrhea without thirst, naturally warm hands and feet, and occasional spontaneous abdominal pain. This is appropriate for Lizhong Tang (Regulate the Middle Decoction).

What is meant by Taiyin pathogenic factors transforming according to Yang? The *Shanghan Lun* states: After sweating, abdominal pain remains unresolved; urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). It also states: Abdominal fullness and pain. Guizhi Jiadahuang Tang (Cinnamon Twig plus Rhubarb Decoction) is the primary treatment.

(The Kidney contains both Water and Fire. When pathogens injure its meridians, they may transform via Water into cold or via Fire into heat. Both syndromes share the characteristics of a deep, fine pulse and a desire to sleep.)

What is meant by Shaoyin pathogenic factors transforming via Water into cold? The answer is: A deep, fine, and faint pulse, desire to sleep, aversion to cold on the back, a neutral mouth (no bitterness or dryness), abdominal pain, diarrhea with undigested food, and clear white urine. This is when Shaoyin cold pathogens initially injure the body; there should be no fever, yet fever appears reversely because Taiyang Yang manifests externally. A deep pulse indicates that Shaoyin’s vital ascending energy cannot rise. Fear of Yin... Taiyang... Above is the method of communicating between Yin and Yang.

In Shaoyin disease, from onset up to two or three days, there are no interior symptoms. Thus, we know that the exterior heat of Taiyang cannot be resolved without sweating, yet we must fear that sweating will injure the Kidney... [Formula name missing]... Above is the method of mild sweating.

Cold extremities, vomiting and diarrhea, urination resumes, diarrhea with undigested food, interior cold with exterior heat, and a pulse so faint it is almost imperceptible: Sini Tang (Four Reversal Decoction) is suitable.

Interior cold with exterior heat, red face, or abdominal pain, or dry retching, or sore throat, cessation of diarrhea but absence of pulse, sweating with cold extremities: Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) is suitable. Shaoyin diarrhea... [fragment]...

After sweating and purging, if the condition is not resolved and irritability occurs: Fuling Sini Tang (Poria Four Reversal Decoction) is the primary treatment. In Shaoyin disease, if unrelieved after two or three days, progressing to four or five days, with abdominal pain and difficult urination: Zhenwu Tang (True Warrior Decoction) [text says Wu Tang, likely typo].

In Shaoyin disease, within two or three days, if the mouth is neutral and the back feels cold (because Taiyang Yang deficiency fails to combine with Shaoyin Minister Fire): Moxibustion should be applied.

○ Pain [fragment]

Shaoyin disease with vomiting and diarrhea (the Spirit Mechanism cannot intersect in the Middle Jiao), cold extremities (Middle and Upper Jiao Qi deficiency cannot reach the four limbs), irritability desiring death... Wuzhuyu Tang [inferred from context, text cuts off]. Above is the method of using warming agents.

What is meant by Shaoyin pathogenic factors transforming via Fire into heat? The answer is: A deep, fine, and rapid pulse, still desiring sleep but with internal vexation and external restlessness, or inability to sleep, heat in the mouth, diarrhea with clear water, small [fragment]...

In Shaoyin disease, if there is a sore throat after two or three days: Gancao Tang (Licorice Decoction) may be given. If not healed, Jiegeng Tang (Platycodon Decoction) is given.

In Shaoyin disease, if the throat is injured and ulcers form, preventing speech and voice: Kujiu Tang (Bitter Wine Decoction) is the primary treatment.

In Shaoyin disease, if there is a sore throat: Banxia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment.

In Shaoyin disease, if there is diarrhea, sore throat, chest fullness, and vexation: Zhufu Tang (Swine Skin Decoction) is the primary treatment.

In Shaoyin disease, if after two or three days there is internal vexation and inability to lie down: Huanglian Ejiao Tang (Coptis and Ass-Hide Gelatin Decoction) is the primary treatment.

In Shaoyin disease, if after six or seven days of diarrhea there is cough, vomiting, thirst, vexation, and inability to sleep: Zhuling Tang (Polyporus Decoction) [text says Zhu Ling Tang, variant for Zhuling] is the primary treatment.

In Shaoyin disease, from two or three days to four or five days, with abdominal pain and difficult urination...

Diarrhea with pus and blood: Taohua Tang (Peach Blossom Decoction) is the primary treatment.

All of the above employ the method of tonifying righteousness to rescue Yin.

In Shaoyin disease, if after two or three days there is dry mouth and tongue: Urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). Ke’s commentary notes: Heat rampant internally, thereby transferring to Yang...

In Shaoyin disease, if after six or seven days there is abdominal fullness and constipation: Urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). Ke’s commentary notes: Having had the disease for six or seven days, failure to resolve... Jin... Heart...

In Shaoyin disease, if there is spontaneous diarrhea of pure green water,必 (must) have pain in the epigastrium, and dry mouth/throat: Urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). Ke’s commentary notes: This is dry Earth and blazing Fire...

All of the above employ the method of attacking pathogens to rescue Yin.