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Sini Decoction (Four Reversal Decoction) is the principal formula of Zhang Zhongjing for restoring yang and rescuing from collapse. If correctly mastered and applied according to syndrome differentiation, the three herbs—Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), and Gancao (Licorice Root)—can revive the dying. Zheng Qin'an once said: "Zhang Zhongjing deeply understood the subtleties of creation, knowing that Fuzi has the power to replenish the nearly extinguished fire seed of the先天 (innate constitution). Therefore, he used it as the sovereign drug. Fearing that yin pathogens might block the path and prevent direct entry to the root, he assisted with the acrid-warm dispersing nature of Ganjiang as a vanguard to sweep away yin pathogens, welcome yang back to its residence, revitalize the fire seed, and immediately restore life; hence it is called 'restoring yang.' Once yang is restored, without earth to support it, the flame would easily extinguish, and although life might be saved, longevity would not be ensured. Thus, he followed with the sweet nature of Gancao to moderate the righteous qi. 'Moderating' implies 'securing'; when the true fire is secured, it can be reborn. How can this formula be disregarded?" (Yili Zhenchuan / True Transmission of Medical Principles)

Tongmai Sini Decoction (Pulse-Resuscitating Four Reversal Decoction), which was used in this case, is formed by adding double the amount of Ganjiang to Sini Decoction. Ganjiang assisting Fuzi can more effectively eliminate deep-seated cold in the six fu organs, reverse jue (cold extremities) of the three yin channels, rescue the yuan yang of the kidney, and address conditions where pulse qi is about to vanish. Doubling the dosage of Ganjiang particularly increases the acrid-hot property to drive out cold pathogens, taking advantage of the meaning of acrid-warm dispersion, thereby strengthening the effect of sweeping away yin pathogens and welcoming yang back to its residence. After administration, the child suddenly experienced epistaxis. The parents were panicked, believing that the mistaken use of ginger and aconite would certainly lead to death! Little did they know that in the late stage of this disease, yin qi permeated everywhere. Administering bitter-cold heat-clearing agents at this time was like adding frost to ice, causing the qi and blood throughout the body to coagulate. At this juncture, switching to a large dose of Tongmai Sini Decoction to restore yang and return to the origin, vigorously driving out yin cold, warmed and unblocked the ice-frozen and coagulated blood vessels. As the yang-moving drugs circulated, yin pathogens gradually transformed, and blood exited through the upper orifices. This was actually the power of Tongmai Sini Decoction to demolish walls and overturn battlements, showing the first signs of reviving the dying. Why should there be panic? At this critical moment, seizing the turning point and making a decisive decision, the dosage was doubled again on the basis of the original large dose, with both ginger and aconite increased to 500 grams. The coagulated blood streaks and clots were all expelled through warming and unblocking. A new breakthrough occurred in the struggle between righteous qi and pathogens, and the child finally turned from critical to safe.

One might ask: In this case, within half a month, the dosage of Fuzi per prescription ranged from 250 to 500 grams, accumulating to 6500 grams. After thirty years of verification, the prognosis was good. Does the issue of the effective and toxic doses of Fuzi deserve re-examination?

Practice is the sole criterion for testing truth. We believe that how to address the above issues by combining theory and practice, and striving to use modern scientific methods for in-depth research, constitutes an important topic for excavating the great treasure house of traditional Chinese medicine.

Shaoyin Syndrome Lin Disease (Prostatitis)
Zhang X, Male, 57 years old. Director of a film production studio.

[Medical History] In the winter of 1961, while living in a rural area, he fell ill after sleeping on a newly built damp kang (heated brick bed). Initially, one testicle swelled, and sitting, standing, and walking were unbearable due to pain. Because medical attention was not sought in time, the condition worsened day by day. The Affiliated Hospital of XX Medical University diagnosed him with "prostatitis." He was cured after one year of treatment at a certain Traditional Chinese Medicine Research Institute. In the winter of 1974, the old illness relapsed, lingering for about three years. Initially, there was only frequent urination and testicular discomfort; taking several doses of TCM heat-clearing and diuretic agents provided relief. Subsequently, the attacks became frequent and severe. Not only did he experience urgent and frequent urination and burning pain in the urinary tract, but he also often felt coldness and numbness in the genitals. XX Hospital examined and confirmed the diagnosis, still labeling it "prostatitis" (Examination report: Pus cells "B", few lecithin bodies, white blood cells >50 per high-power field, red blood cells >30 per high-power field). From April to August 1977, various Western and Chinese medical treatments were adopted: chemotherapy, ultrasound physiotherapy, hot sitz baths, acupuncture, massage, etc., along with over 150 doses of TCM clearing heat, detoxifying, and draining dampness. However, his subjective symptoms increased rather than decreased, progressing to impotence, general physical collapse, difficulty walking, and ultimately forcing him to take total leave. On August 30, 1977, he came for consultation. Treating according to Shaoyin Yang Deficiency and Yin Excess Syndrome, he recovered after three months of treatment.

[First Visit] Aversion to cold with curling up, flaccid limbs, listlessness, dizziness, insomnia, significantly reduced appetite (only eating one liang per meal). Testicular heaviness extending to the abdomen, often feeling cold, numbness, and pain. Turbid and frequent urination, impotence. Withered yellow and dark complexion, pale tongue body, dense white coating over the entire tongue, pale yellow thick greasy coating at the root, sinking, minute, and fine pulse. This is Shaoyin Yang Deficiency with internal excess of yin cold. The method should be to tonify yang, warm the kidney, dispel cold, and relieve pain. Use Sini Decoction plus Rougui (Cinnamon Bark) as the main treatment.
Prescription:
Chuan Fupian (Prepared Sichuan Aconite Child Root) 120g (decocted for a long time), Ganjiang (Dried Ginger) 120g, Zhigancao (Honey-fried Licorice Root) 60g, Shang Rougui (Top-grade Cinnamon Bark) 15g (ground into powder and taken with decoction).
Three doses.
After taking three consecutive doses, the heaviness and pain in the lower abdomen and testicles decreased, urine color turned clear, and frequency improved. Yang qi gradually recovered. The dosages of Fuzi and Ganjiang in the original prescription were reduced to 60g each; Fuling (Poria) and Chao Baizhu (Stir-fried Atractylodes Macrocephala Rhizome) were added to strengthen the spleen and drain dampness, continuing for thirty doses. Dizziness, insomnia, aversion to cold, fatigue, lower abdominal and testicular heaviness further decreased, and the sensation of coldness and numbness in the genitals was also milder than before.

[Syndrome Differentiation] This disease presents with aversion to cold, cold limbs, listlessness, and curling up, indicating decline of heart and kidney yang, inability to warm and nourish, deficiency of righteous qi, and being trapped by pathogens. Testicular heaviness, often feeling cold, numbness, and pain, indicates decline of kidney qi, inability to warm and nourish tendons and vessels, condensation of yin cold, and stagnation of qi and blood. This shows that the main syndrome of Shaoyin Yang Deficiency transforming into cold is relatively prominent. The internal excess of yin cold in Shaoyin Cold Transformation belongs to yin, interior, deficiency, and cold, representing a systemic deficiency-cold syndrome that inevitably affects the overall function of the person and multiple zang-fu organs. Frequent urination is due to consumption of kidney qi and loss of control; turbid urine is due to qi deficiency and dysfunction, unable to restrain lipid fluids. Impotence is due to depletion of the lower source, decline of Mingmen (Gate of Life) fire, and loss of strength. Yellow complexion indicates cold-dampness; withered yellow belongs to spleen yang depression; combined with black indicates cold and pain; dull and lusterless indicates kidney yang deficiency. Pale tongue body indicates failure of yang qi; white indicates extreme cold of zang-fu organs. Sinking and forceless pulse indicates severe interior deficiency; minute indicates yang decline and inability to push blood circulation; fine indicates insufficient yin-blood and unfull pulse vessels. In summary, all belong to the main syndrome of Shaoyin Cold Transformation, with yang decline and yin excess running through the whole picture. One must grasp the root, making driving out yin and supporting yang the urgent task.

[Second Visit] Aversion to cold, listlessness, coldness/numbness/pain in genitals, etc., further improved. Tongue body slightly appeared reddish, and the thick yellow-white greasy coating had decreased. Only the Shaoyin heart and kidney organs remain; the heart governs blood and fire; the kidney is the organ where water and fire reside together, storing true yin and true yang qi. The patient's systemic deficiency-cold syndrome not only injured kidney yang but also affected kidney yin. The method should continue to warm and tonify kidney yang, attending to yin, and additionally assist with warming the middle and strengthening the spleen. Use Sini Decoction combined with Lizhong Tang (Regulate the Middle Decoction) with modifications as the main treatment.
Prescription:
Chuan Fupian 60g (decocted for a long time), Ganjiang 60g, Zhigancao 60g, Renshen (Codonopsis Root/Panax Ginseng - *Note: Dangshen is Codonopsis*) 30g, Shang Rougui 10g (ground into powder and taken with decoction), Dongchongxiacao (Cordyceps Sinensis) 15g, Gouqi (Goji Berry) 30g, Tusizi (Dodder Seed) 30g, Yunling (Poria) 20g.
After taking more than ten doses, all symptoms continued to improve. Subsequently, based on the condition, modifications were made, reducing ginger and aconite to 30g, and taking another ten-plus doses.

[Third Visit] Examination showed prostatitis was basically cured; simultaneously, low blood pressure, dizziness, insomnia, etc., which had persisted for many years, disappeared; appetite increased sharply, and spirit greatly revived. Afterwards, pills were prepared using agents to tonify yang, benefit the kidney, nourish the heart, and calm the spirit, for slow conditioning to consolidate curative effects.

Prescription:
Chuan Fupian 120g, Shang Rougui 30g, Zhusha (Cinnabar) 15g, Dongchongxiacao 30g, Hupo (Amber) 20g, Shexiang (Musk) 0.3g, Gouqi 30g, Rongrong (Cistanche Stem) 30g, Baiziren (Biota Seed) 30g, Tusizi 30g.
Take twice daily, 1 gram each time.

In early December 1977, he recovered and resumed work. On December 10, 1978, he wrote saying: "Our work often requires climbing mountains and wading through rivers, battling severe cold, scorching heat, heavy snow, fierce winds, blazing sun, and torrential rain... After my illness was cured by Old Fan, I have finished shooting a feature film; currently, I am preparing to meet new challenges."

[Commentary] This case is not a typical Sini Syndrome, so why use Sini Decoction?
Sini Decoction in the *Shanghan Lun* (Treatise on Cold Damage) is the principal formula for restoring yang and rescuing from collapse. However, based on Old Fan's decades of clinical experience, its role is not limited to this. Besides typical Sini Syndrome such as yang deficiency with impending collapse and faint pulse, it can also be widely used for all patients with yang deficiency and yin excess.
From the perspective of Six Channel Syndrome Differentiation in Shanghan, most variant syndromes and deteriorated syndromes among the Three Yang diseases, and deficiency-cold syndromes among the Three Yin diseases, can be appropriately treated with it.
How to accurately and flexibly apply Sini Decoction in clinical practice? The key lies in strictly grasping the basic points of diseases characterized by yang deficiency and yin excess. Apart from the typical Sini Syndrome mentioned above, these points generally include: pale white tongue body, moist coating with fluid; dull and lusterless complexion; mental fatigue, aversion to cold, cold limbs, no thirst, or thirst without desire to drink; or preference for hot drinks; stools not dry, or although difficult to pass, the abdomen feels comfortable, or hard initially then loose, frequent night urination, weak pulse, etc.
Under the premise of accurate syndrome differentiation, strict mastery of herb compatibility and dosage magnitude is also required. The dosage of Fuzi should be appropriate to the condition and must be decocted for more than one and a half hours. Fuzi is not drying without ginger; the dosage of Ganjiang must be flexibly controlled. In cases of yang deficiency and yin excess without reaching Sini Syndrome, if the tongue body is pale but not extremely so, and the coating is white but not thick, Ganjiang can be used sparingly; conversely, it can be increased until equal to the dosage of Fuzi. The dosage of Gancao should not exceed half that of Fuzi, roughly equal to Ganjiang.
It must be pointed out that in individuals with yang deficiency and apparent excess (of cold), upon initial intake of acrid-warm and large-hot substances, there may often be inner restlessness, black blood from the nose, dry throat, dry or red eyes, cough with excessive phlegm, swelling of face/body, abdominal pain and diarrhea, or increased fatigue, etc. This is not a medication error, but a favorable omen of yang drugs circulating, yin departing and yang rising, pathogens eliminating and righteous qi growing, transitioning from yin to yang. A relatively ideal reaction after taking the medicine is warmth throughout the body, and the tongue body and complexion appearing reddish. At this time, small amounts of yin-nourishing substances can be used to secure the restored yang. When yang is secured by yin, it has something to rely on, naturally achieving mutual rooting and assistance between yin and yang, expelling pathogens and stabilizing righteousness.

Shaoyin Syndrome Lin Disease