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(Principal Formula) Governs it. (Zheng 81) In cases of exterior cold and interior heat, the pulse must be slippery with cold limbs, dry mouth and tongue. Thus, Shaoyin disease involves aversion to cold accompanied by [body heat], frequent restlessness, and a dislike for heavy clothing. Use Dachaihu Tang (Cinnamon Twig and Rhubarb Decoction) (Zheng 30) to purge, resulting in recovery. These are all supplementary discussions from Zhang Zhongjing.

This volume discusses Yin and Yang. Treating Shanghan (Cold Damage) requires recognizing both Yin and Yang syndromes. The hands and feet each have three Yin and three Yang meridians, totaling twelve meridians. Those on the back of the hand are Yang, belonging to the Exterior and Fu organs; those on the palm are Yin, belonging to the Interior and Zang organs. The foot meridians follow this pattern. Shanghan transmits only through the foot meridians, not the hand meridians. Suwen Re Lun also states that only the foot three Yin and three Yang meridians are affected. Chao Shi claims Taiyang belongs to the Small Intestine, which is incorrect. The Yang of the feet is Shao Yang within Yin; the Yin of the feet is Tai Yin within Yin. The three Yang meridians of the feet run from head to foot; the three Yin meridians of the feet run from foot to abdomen. Yang strives upward; Yin strives downward. Yang moves quickly; Yin moves slowly. Yang's nature is light; Yin's nature is heavy. Yin family pulses are heavy; Yang family pulses are light. Yang syndromes involve much speech; Yin syndromes are silent. Yang illness is quiet in the morning; Yin illness is peaceful at night. Yang deficiency leads to confusion in the evening; Yin deficiency leads to contention at night. Yin and Yang wax and wane, presenting different symptoms. However, when things reach an extreme, they reverse: changes in cold and heat mean excessive Yang transforms into Yin, and excessive Yin transforms into Yang. Yin syndromes resemble Yang; Yang syndromes resemble Yin. Excessive Yin blocks Yang, appearing similar yet distinct. One must clearly observe these changes and treat accordingly.

(Question 18) On Yin Syndromes
Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes. Taiyin refers to the Spleen meridian; Shaoyin refers to the Kidney meridian; Jueyin refers to the Liver meridian. ○ What is a Taiyin syndrome?
Taiyin is the Spleen meridian, primarily governing chest and diaphragm distension. Jiayi Jing states: Pathogens arising from Yang are contracted from wind, rain, cold, and heat; pathogens striking Yin are contracted from diet, dwelling, and emotional fluctuations. It further says: Rogue winds and empty evils affect Yang first; irregular diet and improper living habits affect Yin first. Affecting Yang enters the Fu organs; affecting Yin enters the Zang organs. Entering the six Fu organs causes body heat and occasional upward rebellion manifesting as wheezing; entering the five Zang organs causes fullness and obstruction, leading downward to undigested diarrhea, and over time to intestinal dysentery. ○ What is a Shaoyin syndrome?
Shaoyin is the Kidney meridian, primarily governing a faint and fine pulse, vexation, and a desire to sleep. Or spontaneous diarrhea with thirst. Another question asks: Why does Shaoyin disease appear on days one or two? It is said that during epidemics, if the interstices are cold, pathogens enter the Yin meridians directly without passing through the Three Yang meridians. Although Shanghan involves Three Yin and Three Yang, generally originating in Yang manifests as Taiyang disease, and originating in Yin manifests as Shaoyin disease. These two meridians are interior-exterior pairs and are most frequently affected. Yangming and Taiyin are less frequently affected. Shaoyang and Jueyin (Liver and Gallbladder meridians) are even rarer. For any illness lasting one to twelve or thirteen days, if Taiyang symptoms persist, treat only Taiyang. If Shaoyin symptoms appear immediately upon onset, attack Shaoyin directly; there is no need to wait for transmission from Taiyang. Cold pathogen entering Taiyang causes fever and aversion to cold; entering Shaoyin causes only aversion to cold without fever. For Cold damaging the Three Yin meridians, if mild, use Lizhong Tang (Regulate the Middle Decoction) (Zheng 74). If slightly cold or with cold-induced diarrhea, use Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction) (Zheng 55). Mild coldness in the fingertips is called "Qing" (pure/cold). This has not yet reached the severity for Sini Tang (Reverse the Extremities Decoction) because the disease is light; only Lizhong or Dried Ginger types should be taken. For severe cases, use Sini Tang (Zheng 75). For absent pulse, use Tongmai Sini Tang (Unblock the Vessels Sini Decoction) (Zheng 81). ○ What is a Jueyin syndrome?
Jueyin is the Liver meridian, primarily governing excessive thirst, Qi rushing upward, heart pain, hunger without desire to eat, vomiting roundworms after eating, and uncontrollable diarrhea if purged. If Yin qi alone is excessive and Yang qi suddenly perishes, it becomes Yin Du (Yin Toxin). Symptoms include cold limbs, pounding abdominal pain, body feeling like being beaten by a club, deep and rapid pulse, vomiting or diarrhea. Moxibustion below the umbilicus should be performed urgently, followed by acrid-hot medicines to restore Yang qi, resolving through profuse sweating. Ancients said: Acrid and sweet disperse and ascend as Yang, referring to Guizhi Tang (Cinnamon Twig Decoction), Gancao, Ganjiang, Fuzi, etc., which can restore Yang qi. Mildly use acrid-sweet; severely use acrid-bitter. Extreme Yin causes restlessness; Yin syndromes resemble Yang. Students must distinguish them by pulse.

(Question 19) On Yang Syndromes
Taiyang, Yangming, and Shaoyang all belong to Yang syndromes. Taiyang refers to the Bladder meridian: fever, aversion to cold, headache, lower back pain, and floating pulse. Yangming refers to the Stomach meridian: no aversion to cold but aversion to heat, sweating, constipation, tidal fever, and long pulse. Shaoyang refers to the Gallbladder meridian: bitter taste, dry throat, hypochondriac fullness, fever with vomiting, or alternating chills and fever with wiry pulse. Mahuang Tang (Ephedra Decoction) (Zheng 20), Da Qinglong Tang (Major Green Dragon Decoction) (Zheng 35), Guizhi Tang (Cinnamon Twig Decoction) treat Taiyang meridian Wind-Cold damage. Dachaihu Tang (Zheng 30), Xiaochengqi Tang (Minor Order the Qi Decoction) (Zheng 42), Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) (Zheng 43), Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) treat Yangming Shanghan. Xiao Chaihu Tang (Minor Bupleurum Decoction) (Zheng 29) treats Shaoyang Shanghan. Other medicines address post-emesis, purgation, or sweating conditions. ○ If Yang qi alone is excessive and Yin qi suddenly perishes, it becomes Yang Du (Yang Toxin). There will be restlessness, manic running, delirious speech, red face, sore throat, mottled skin rash like brocade, or bloody-yellow diarrhea, with surging-solid or slippery-rapid pulse. Sour-bitter medicines should be used to restore Yin qi, resolving through profuse sweating. Ancients said: Sour and bitter induce vomiting and purging as Yin, referring to Kushen (Sophora Root), Daqing Ye (Isatis Leaf), Tingli Zi (Semen Lepidii), Kujiu (Vinegar), etc. (Za 16), which can restore Yin qi. Mildly use bitter; severely combine sour and bitter to reduce heat and restore Yin. If extreme heat causes Jue (reversal cold), Yang syndromes resemble Yin. Students must distinguish them by pulse.

(Question 20) On cold limbs, pounding abdominal pain, sore throat, vomiting and diarrhea, body feeling like being beaten, cold sweat, vexation/thirst, and fine-almost-absent pulse.
This is named Yin Du (Yin Toxin). In Yin Du disease, initially the hands and feet are cold, the back is stiff, the throat hurts, porridge cannot be swallowed, toxin attacks the heart causing heart/abdominal pain, shortness of breath, limb reversal cold, vomiting/diarrhea, body feeling like beaten. Suitable to take Yindu Gancao Tang (Yin Toxin Licorice Decoction) (Za 7), Baizhu San (Atractylodes Powder) (Za 8), Fuzi San (Aconite Powder) (Za 9), Zhengyang San (Upright Yang Powder) (Za 10), Rougui San (Cinnamon Bark Powder) (Za 11), Huiyang Dan (Return Yang Pill) (Za 12), Fanyin Dan (Reverse Yin Pill) (Za 13), Tianxiong San, Zhengyuan San, Tuiyin San (all Za 14), etc. Selectively use. ○ Generally, Yin Du originates from Kidney Qi deficiency and cold, or spleen injury from cold foods, combined with external Wind-Cold. Internally latent Yin, externally contracted Cold, or external Cold first then internal latent Yin, making both interior and exterior Yin, causing Yang Qi to fail to hold. This leads to headache, heavy waist/abdomen, eye pain, body fatigue, cold limbs, continuous cold sweat on forehead/back of hands, or vexation/thirst, mental trance, feeling lost. Within two to three days, one might walk, feeling not too heavy. Diagnosis shows all six pulses deep, fine, and rapid; Chi position is short/small; Cun position pulse may be large. (If all six pulses are floating-large, or deep-palpated large but not very rapid, it is not a Yin syndrome. Generally, Yang Du Shanghan pulses are wiry and surging-numerous; Yin Du Shanghan pulses are deep-fine and wiry-rapid; this must be known.) If cool medicines are mistakenly taken, thirst increases, restlessness intensifies. With these symptoms, urgent administration of acrid-hot medicine is required; peace returns in one or two days. ○ If Yin Du deepens, symptoms become heavy: cold limbs, worsening abdominal pain, throat obstruction, epigastric fullness/hardness, vexation/thirst, continuous false sweat. (Excess Yang causes body heat without sweat; Excess Yin causes body cold with sweat. Qibo said: Yang excess causes body heat, closed pores, rough breathing, difficulty lying flat, no sweat but heat; Yin excess causes body cold, sweating, constant chilliness, frequent shivering/chills, cold leading to reversal cold) Or muttering delirium, blue-black nails/face, six pulses deep-fine-rapid, seven beats per respiration or more. With these signs, urgently moxa Qihai or Guanyuan points 300-200 units until hands/feet warm. Continue taking Zhengyang San, Rougui San, Huiyang Dan, Fanyin Dan, Tianxiong San, Baizhu San. Internal and external expulsion restores Yang qi, resolving through profuse sweating. (When Yin alone is excessive and Yang qi suddenly perishes, it is Yin Du; if Yang alone is excessive and Yin qi suddenly perishes, it is Yang Du. Generally, separation of Yin and Yang cannot be restored without profuse sweating.) ○ If Yin Du is already deep, disease is critical, six pulses require deep pressure to feel, disappearing on light touch, eight beats per respiration or more, or uncountable. Medicine is difficult to apply here. But use Congyi method (Scallion Ironing) (Za 15) on the umbilicus, or moxa 300-500 units. If hands/feet remain cold, it is incurable. If hands/feet warm, continue previous hot medicines. If Yin disperses and Yang returns, gradually reduce hot medicines and regulate. (When Yang temporarily returns, restlessness often occurs; strictly avoid cool medicines. For severe restlessness, give Fanyin Dan again to settle. Always remember this to avoid error.)

(Question 21) On restlessness, manic running, delirious speech, red face, sore throat, body rash like brocade patterns, or bloody-yellow diarrhea, with surging-solid pulse.
This is named Yang Du (Yang Toxin). In Shanghan, if Yang qi alone is excessive and Yin qi suddenly perishes, there will be restlessness, manic running, delirious speech, red face, sore throat, body rash like brocade, or bloody-yellow diarrhea, surging-solid or slippery-rapid pulse. Use sour-bitter medicines to restore Yin qi, resolving through profuse sweating. Tingli Kujiu Tang (Lepidium Vinegar Decoction) (Za 16), Yangdu Shengma Tang (Yang Toxin Cimicifuga Decoction) (Za 17), Dahuang San (Rhubarb Powder) (Za 18), Zhizi Ren Tang (Gardenia Seed Decoction) (Za 19), Heinu Wan (Black Slave Pill) (Za 20) are selectable. ○ Recently, treating Shanghan with surging-large pulse, internal/external knotted heat, curled/scorched black tongue, nose smelling like soot: soak cloth in water, layer several times, soak in fresh water, wring slightly, place on chest. When heated, soak again in cold water as before. Change fresh water many times daily, dozens of changes. For severe heat, place patient in water until heat subsides. Also a good method.

(Question 22) On patient with tidal fever, talking alone, seeing ghosts, unrecognized during episodes, picking at clothes/air, staring straight, slight panting.
Zhongjing said: After Shanghan emesis or purgation, unresolved, no bowel movement for five-six days up to ten-plus days, tidal fever at dusk, no aversion to cold, talking alone, seeing ghosts. If severe, unrecognized during episodes, picking at clothes/bed, fearful/restless, slight panting, staring straight. Only fever and delirium: Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) governs. If one dose yields relief, stop subsequent doses. Wiry pulse indicates life; choppy pulse indicates death. (Wiry is Yang; Choppy is Yin. Yang syndrome with Yin pulse is death. Patient with Yang syndrome and choppy pulse must not be purged.)

(Question 23) On chest/diaphragm discomfort,痞满 (fullness/obstruction), blue lips, cold hands/feet, deep-fine pulse, low mood, or abdominal pain.
This is named Taiyin. Recently, few recognize Yin syndromes; seeing chest discomfort, they administer digestive aids, which is incorrect treatment. Generally, Yin syndrome results from cold food injuring Spleen/Stomach, affecting Yin meridians. It governs chest/diaphragm fullness, lack of luster in face/lips, cold hands/feet, deep-fine pulse, low mood, not due to desires, but internal injury from cold food or damaging Stomach Qi, forming Yin syndrome. Administering Radix Crotonis (Badou) type drugs worsens chest discomfort, causing vomiting/diarrhea, leading to death in one-two days. Because they do not know Cold attacking Taiyin. Taiyin is the Spleen meridian. ○ Question: If dietary irregularity causes chest discomfort, Cold damaging Yin meridians, how to treat? Answer: Urgently make Lizhong Tang, add Qingju/Chenju (Green/Aged Tangerine Peel) chopped like hemp seeds. Take one-two doses, chest discomfort resolves. Zhishi Lizhong Wan (Immature Bitter Orange Regulate Middle Pill) (Za 81), Wuji San (Five Accumulations Powder) (Za 21) are especially good.

(Question 24) On faint-fine pulse, desire to vomit but nothing comes out, vexation, desire to sleep, spontaneous diarrhea with thirst after five-six days.
This is named Shaoyin. Shaoyin disease presents as desire to vomit but nothing comes out, vexation, desire to sleep. Spontaneous diarrhea with thirst after five-six days indicates deficiency, hence drawing water to save oneself. If urine is white, Shaoyin syndrome characteristics are complete. White urine indicates lower Jiao deficiency-cold, inability to control water, hence white color. Sini Tang (Reverse the Extremities Decoction) (Zheng 75) governs. ○ Shaoyin disease, if dry mouth/tongue with thirst, requires urgent purging, do not delay. Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) governs. If pulse is deep-slow, requires warming; Sini Tang governs. Dry mouth/thirst indicates Heat; deep-slow pulse distinguishes Cold. Shaoyin belongs to Kidney, ancients called it Kidney Shanghan. Kidney Shanghan, dry mouth/tongue/thirst, definitely requires urgent purging. Generally, Kidney Shanghan also lacks interior/exterior heat, only suffering from vexation/depression, silence, extreme exhaustion, dislike for light, occasional abdominal pain, deep-fine pulse. Old usage of Sishun Tang was criticized by ancients as too hot. For Kidney disease with residual heat, Zhongjing's Sini San (Reverse the Extremities Powder) (Zheng 76) can be taken. If over ten days, continuous diarrhea, cold limbs throughout, no heat signs, modify Sishun Tang (Za 119). ○ Shaoyin disease with aversion to cold and [body heat], frequent restlessness, dislike for heavy clothing: use Dachaihu Tang minus Dahuang (Zheng 30). ○ Shaoyin disease at onset, contrary fever, deep pulse: Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) (Zheng 23) induces slight sweating. ○ Shaoyin disease after two-three days, commonly lacking Yang syndrome signs, still requires slight sweating; Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) (Zheng 22) is suitable. Students must know this.

(Question 25) On slight body heat, vexation, red face, deep-micro pulse.
This is named Yin syndrome resembling Yang. Yin causes restlessness/heat/reversal cold; things reverse at extremes. Generally, rely on pulse: numerous indicates Heat, slow indicates Cold, nothing more reliable. Suppose slight body heat, vexation, red face, deep-micro pulse: all are Yin syndromes. Slight heat is due to interior cold. Vexation is due to Yin excess. Face wearing Yang (red face) is due to lower deficiency. If doctor ignores pulse, mistaking floating Yang upper-chest restlessness for Excess Heat, giving cool medicines consumes Qi causing major illness. Waitai Mi Yao says: Yin excess causing restlessness is named Yin Zao (Yin Restlessness), wanting to sit in well, treat with hot medicine. Zhongjing's Shaoyin syndrome with red face: Sini Tang plus Congbai (Scallion White) governs.

(Question 26) On cold limbs, constipation, red urine, or black stool, deep-slippery pulse.
This is named Yang syndrome resembling Yin. Excessive Yang becomes Yin, excessive Yin becomes Yang, change of cold/heat. Suppose cold limbs, constipation, red urine, or black stool, deep-slippery pulse: all are Yang syndromes. Mild case: Baihu Tang (White Tiger Decoction) (Zheng 64). Severe case: Chengqi Tang (Order the Qi Decoction) (Zheng 42). Shanghan missed purgation, blood/qi blocked, causing cold limbs: this is deep latent heat, thus deep reversal cold. Quickly use Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) with increased dosage to purge; sweating brings immediate recovery. (This is what Zhongjing meant by "Reversal cold should be purged.") ○ Heat Jue differs from Yin Jue. Heat Jue: slight reversal cold then fever. Yin Jue: no fever, cold limbs, aversion to cold, deep-fine pulse, loose stools/urine.

(Question 27) On cold body, fine-deep-rapid pulse, vexation without desire to drink.
This is named Yin excess blocking Yang. Shanghan Yin excess blocking Yang: patient cold body, fine-deep-rapid pulse, vexation without desire to drink. Desire to drink is incorrect. No desire to drink: use Pili San (Thunderbolt Powder) (Za 22). Soon restlessness stops, sleep and sweating bring recovery. This medicine disperses cold qi, then hot qi rises, sweating heals. Huoyan San (Flame Powder) (Za 22), Dansha Wan (Cinnabar Pill) (Za 24) also govern.

(Question 28) On cold limbs
This is named Jue (Reversal). Jue means reversal. Yin and Yang do not connect smoothly, causing cold limbs. Yang qi declines, Yin qi exceeds, Yin surpasses Yang, so Yang pulse reverses, not reaching hands/feet, hence cold. Shanghan with more Heat than Jue: disease should heal. More Jue than Heat: disease progresses. ○ However, there is Cold Jue and Heat Jue, must distinguish carefully. ○ Cold Jue: from onset day, limbs cold, deep-micro non-rapid pulse, legs curled/wanting warmth, pulling clothes to cover, no desire to drink, or clear grain diarrhea, or normal stool (normal stool means stool like usual), or frequent urination, exterior signs mostly alert and quiet, pulse deep-solid but slow-weak on pressure indicates Cold Jue. Sini Tang (Zheng 75), Lizhong Tang (Zheng 74), Tongmai Sini Tang (Zheng 81), Danggui Sini Tang (Angelica Reverse Extremities Decoction) (Zheng 78), Danggui Sini Jia Zhuyu Shengjiang Tang (Angelica Reverse Extremities plus Dogwood and Ginger Decoction) (Zheng 80), Botong Zhu Dan Tang (Clear Connect Pig Bile Decoction) (Zheng 98) are selectable. ○ Heat Jue: during epidemic, besides body heat/headache, other Yang signs exist. By day two-three to four-five, Jue appears. Combined Heat Jue: Jue lasts half day then body heats up, because heat is deep, requiring two-three days to cause Jue. If slight Jue then fever, heat is mild. Pulse deep-hidden but slippery on pressure indicates interior Heat. Patient may fear heat, drink water, throw hands/feet, vexation insomnia, constipation, red urine, exterior signs mostly confused: knows as Heat Jue. Baihu Tang (Zheng 64), Chengqi Tang (Zheng 42) used according to syndrome. Zhongjing said: Shanghan day one-four-five Jue, must have fever, previous heat follows with Jue, deep Jue means deep heat, slight Jue means slight heat, Jue should be purged; if wrongly sweated, mouth injuries/redness occur. (Heat Jue should be purged, hence "Jue should be purged"; if wrongly sweated, mouth injuries/redness occur.) Also, full purgation signs with Sini (cold limbs): missed purgation, blood/qi blocked, limbs Jue. Doctor doesn't recognize, suspects Yin Jue, gives hot medicine, disaster follows instantly. Generally Heat Jue requires deep-hidden slippery pulse, sweat on head, hands cold but fingers occasionally warm, must use Chengqi Tang to purge, do not hesitate. (All cold limbs belong to Jueyin, cannot purge/sweat, but some need purge/sweat: if limbs cold but sometimes warm, palms warm, not true Jue reversal, observe carefully.) ○ If patient has cold/heat and Jue, dull complexion, dizziness, sudden absence of pulse in both or one hand: must be correct sweating. Wrap hands/feet in cotton to keep warm, urgently take Wuwei Zi Tang (Schisandra Decoction) (Za 25), or combine Mahuang Xixin Gancao Tang. Upon taking, profuse sweating resolves. ○ Or Shanghan Jue with epigastric palpitations: treat water first, take Fuling Gancao Tang (Poria and Licorice Decoction) (Zheng 53), then treat Jue; otherwise water enters stomach causing diarrhea. ○ Also patient with cold limbs, intermittent knotted pulse: pathogen knotted in chest, epigastric fullness/vexation, hunger unable to eat: disease is in