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Xiao XX, female, 36 years old. A primary school teacher in Guanghan County, Sichuan.
[Medical History] Difficulty in urination for over ten years; in severe cases, urine is yellow and the urge to void is urgent but difficult to initiate. There is a burning pain in the urethra with dribbling and incomplete emptying. After examinations and treatments by various parties, the efficacy was not obvious. She sought medical consultation in August 1960.
[Diagnosis and Treatment] Urination occurs dozens of times per day and night, with extremely small volume, sometimes only a few drops. There is painful and difficult urination, and pain is felt in the lower back and hypogastrium. The external genitalia are eroded with excessive leukorrhea; the four limbs are not warm; the tip and edges of the tongue are red, and the coating is white and slippery. This is Shaoyin Yang depression with Qi mechanism dysfunction. The treatment principle should be to promote the circulation of Qi, transform Yin, and unblock the Fu organs. The main prescription is Sini San (Cinnamon Twig Decoction variant for harmonizing Liver and Spleen and resolving depression) with modifications.
Prescription:
Chai Hu (Bupleuri Radix) 24g, Bai Shao (Paeoniae Radix Alba) 24g, Zhi Shi (Aurantii Fructus Immaturus) 24g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g, Jie Geng (Platycodonis Radix) 30g, Fu Ling (Poria) 30g. Four doses.
Additionally, self-made Jiucheng Dan was applied topically to the affected area of the external genitalia.
After taking the medicine, urination became smooth, and all symptoms resolved. The erosion of the external genitalia improved. Applying a small amount of the pill to the lesion led to recovery after half a month.
[Analysis] The *Shanghan Lun* states: "Shaoyin disease, characterized by cold extremities, where the patient may have cough, palpitations, difficulty in urination, or abdominal pain... Sini San is indicated." In this case, difficulty in urination, cold extremities, and abdominal pain indicate that pathogenic factors have entered the Shaoyin level, and Yang is depressed by Yin cold. Shaoyin serves as the pivot of the three Yin meridians; when pathogenic factors stagnate in the middle, clear and turbid Qi fail to separate. Furthermore, due to the chronic nature of the illness, depression has caused increasingly severe Qi stagnation. Sini San is used to raise the depressed Yang pathogen and unblock the stagnant Qi mechanism. Chai Hu promotes the ascending of Yang Qi and resolves depression; Bai Shao nourishes true Yin and regulates the Liver and Spleen, ensuring harmony between Wood and Earth so that Qi flows smoothly. The combination of Chai Hu and Zhi Shi creates one ascending and one descending action, allowing clear and turbid Qi to separate. Zhang Zhongjing's original formula notes adding Fu Ling for difficulty in urination. However, fearing its effect might be too slow, relying solely on leaching dampness is insufficient to unblock the Qi mechanism. The Lung is the upper source of water, governs respiration, controls the Qi of the whole body, prefers clarity and purity, and follows downward movement. Now, constrained by external pathogens, the water passages are difficult to regulate. Therefore, a heavy dose of Jie Geng is used for its acrid-opening and bitter-descending properties; Fu Ling promotes diuresis, which combines with the lifting action of Jie Geng to form another ascending-descending pair. Once the water pathogen is eliminated, all symptoms naturally subside.
[Commentary] The *Suwen · Linglan Midian Lun* states: "The Bladder is the official of the metropolitan area, storing fluids; it can excrete them through Qi transformation." Thus, although urination is governed by the Bladder, without Qi transformation, how can it be discharged as urine? Therefore, disorders of urination are closely related to the Qi transformation functions of the Kidney, Liver, Spleen, Lung, and Sanjiao. In clinical practice, for various causes of urinary retention or incontinence, consideration is often given comprehensively to the relevant Zang-Fu organs and meridians. Master Fan believes that for symptoms such as frequent and urgent urination, incomplete emptying, obstruction, painful urination; distension, pain, or soreness in the hypogastrium, hypochondrium, or waist; if these symptoms do not need to be fully present, they can all be treated with modified Sini San based on syndrome differentiation.

Shaoyin Syndrome Lin Disease (Dysuria)
Wang XX, female, 67 years old. A resident of Rongcheng County, Shandong Province.
[Medical History] For more than ten years, the patient has frequently experienced urgent urination; in severe cases, there is dribbling, painful urination, and incomplete emptying. Multiple urine tests were normal. She had taken large amounts of antibiotics and diuretics, and was treated with methods to tonify Kidney Qi and drain Damp-Heat, with fluctuating results. Recently, her condition worsened, leading her to seek consultation.
[Diagnosis and Treatment] December 5, 1978. For the past month, she urinates approximately every half hour, with very small volume; the total daily output is only over 300 ml, dark yellow like strong tea. There is burning sensation during urination and a feeling of incomplete emptying; the four limbs are cold, the hypogastrium is full, distended, and painful, causing restlessness day and night. The tongue body is pale red and slightly dark, with a white slippery coating. This indicates pathogenic factors entering Shaoyin, Yang depression preventing extension, and failure of Water Qi to transform. The treatment principle is to promote Qi circulation, transform Yin, and unblock Fu organs. The main prescription is Sini San with modifications.
Prescription:
Chai Hu (Bupleuri Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Jie Geng (Platycodonis Radix) 15g, Fu Ling (Poria) 20g. Four doses.
After taking the medicine, urination became smooth, and the disease was cured.
Follow-up on May 15, 1979: Her daughter reported that after recovery, she returned to her native place in Shandong. A recent letter confirmed no recurrence.
[Commentary] Cases Xiao and Wang both suffered from Shaoyin Syndrome Lin Disease, with similar etiologies, conditions, and courses. Only because Case Wang was over sixty and had milder symptoms were the dosages slightly reduced. Both were treated with Sini San plus Fu Ling and Jie Geng. Both recovered after the first visit.

Shaoyin Syndrome Lin Disease
(Pyelonephritis)
Zhou XX, female, 40 years old. An employee of a factory in Chengdu.
[Medical History] In May 1973, she suffered from lower back pain and difficulty in urination. Examinations at two hospitals showed cloudy urine with a large number of white blood cells, a few red blood cells, a small amount of protein, and elevated white blood cell count in blood tests. Both diagnosed "Pyelonephritis." After taking Chinese and Western medicines for over three months, the condition did not improve. She sought consultation in August of the same year.
[First Visit] August 29, 1973. Over the past month, the condition gradually worsened: short and difficult urination, frequent, yellow, incomplete emptying, stinging pain in drops, radiating to the hypogastrium, with severe lower back pain. Headache, aversion to cold, anhidrosis, cold hands and feet, sallow complexion, pale red tongue with thin yellow coating. This is Lin Disease, belonging to Shaoyin syndrome, complicated by Taiyang Cold Damage pathogen intertwining and accumulating. The treatment principle should start from the Taiyang level, release the exterior and dispel cold, open the pores to drive out pathogens. The main prescription is Gancao Mahuang Tang (Licorice and Ephedra Decoction) with modifications.
Prescription:
Mahuang (Ephedrae Herba) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 30g, Cong Bai (Allii Fistulosi Bulbus) 60g. Two doses.
[Second Visit] Headache and aversion to cold improved significantly, lower back pain decreased, and short, difficult, frequent urination slightly reduced. Other symptoms remained. The thin yellow coating had disappeared, indicating the Taiyang Cold pathogen was resolved. One should seize the Shaoyin pivot, promote Qi circulation, transform Yin, and unblock Fu organs. The main prescription is Sini San with modifications.
Prescription:
Chai Hu (Bupleuri Radix) 10g, Zhi Shi (Aurantii Fructus Immaturus) 12g, Bai Shao (Paeoniae Radix Alba) 12g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Fu Ling (Poria) 30g, Jie Geng (Platycodonis Radix) 30g. Three doses.
After taking three consecutive doses, urination became smooth, urine tests turned negative, and other symptoms subsided. Follow-up in November 1979: She persisted in heavy physical labor for several years with no recurrence.
[Commentary] The *Jingui Yaolue* states: "In Lin disease, urine resembles millet grains, the hypogastrium is tense and acute, pain radiates to the umbilicus." This case's frequent, short, difficult urination, dribbling stinging pain, and腰酸 upon pain are indeed the main clinical features of Lin Disease. Its basic pathology is impaired Qi transformation in the Lower Jiao, belonging to the Shaoyin Sini San syndrome. However, why use Gancao Mahuang Tang first?
Although Shaoyin syndrome has contraindications for sweating, and there is a warning against sweating for patients with Lin disease, this case involves concurrent Taiyang Cold Damage excess syndrome, thus exempt from these prohibitions. The prohibition of sweating in Shaoyin refers to "disease being in the interior": either Shaoyin Cold Transformation with deficient Yang, or Shaoyin Heat Transformation with Yin deficiency and internal heat. This case not only has exterior pathogen constriction blocking Qi mechanism and worsening Qi transformation dysfunction, but although it belongs to Shaoyin, it is neither Sini Tang syndrome nor Heat Transformation syndrome; although the disease has entered the interior, Yang is not deficient. Although it is Lin disease, it is neither Damp-Heat accumulation in the Bladder nor prior deficiency of Bladder fluids. It truly belongs to the Shaoyin Sini San syndrome where Yang is depressed by Yin, causing Qi mechanism dysfunction. Using Gancao Mahuang Tang from the *Jingui Yaolue* first can release the exterior and dispel cold while promoting urination. Heavy use of Gan Cao supports and moderates the action. Adding Cong Bai connects Upper and Lower Yang Qi and smooths the Qi mechanism. Thus, this formula appears harsh but is actually stable, addressing both interior and exterior as a vanguard. Subsequently using modified Sini San leverages the Shaoyin pivot, utilizing the position of pathogens between interior and exterior, advancing and retreating, moving up and down, to harmonize and disperse, leading to cure.

Shaoyin Syndrome Amenorrhea
Hu XX, female, 38 years old. A farmer from Tuanjie Township, Pixian County, Sichuan.
[Medical History] Amenorrhea for four years; treatment was ineffective, progressing to chills, cold limbs, tremors, generalized edema, requiring assistance to walk. She sought consultation in April 1953.
[First Visit] Generalized edema, worse in the lower limbs, pitting upon pressure, slight tremors in muscles throughout the body. Dizziness, aversion to cold, poor appetite, mental fatigue and desire to lie down, cold four limbs, low voice and shortness of breath. Dark bluish complexion lacking luster, pale tongue, fat body with teeth marks, thin white coating, deep pulse. This is Shaoyin Syndrome Amenorrhea with Yang deficiency edema. The treatment principle should be to unblock Yang and leach dampness, warm the Kidney and center. The main prescription is Fuling Sini Tang (Poria and Cinnamon Twig Decoction variant) with modifications.
Prescription:
Fu Ling (Poria) 30g, Lu Dang Shen (Codonopsis Radix) 15g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 30g, Gan Jiang (Zingiberis Rhizoma) 60g, Zhi Fu Pian (Prepared Aconiti Lateralis Radix) 120g (decocted for a long time), Gui Zhi (Cinnamomi Ramulus) 12g, Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 12g.
[Second Visit] After finishing the first dose, urine became clear and copious, swelling slightly reduced, able to eat one liang of rice per meal. After continuing for two more doses, swelling improved significantly, tremors stopped. Advised to take three more doses of the original formula, replacing Gan Jiang with Pao Jiang (Roasted Zingiberis Rhizoma), adding Xue Yu Tan (Carbo Hominis) 30g, to continue at home. Recovered within a month.
Follow-up in July 1979: The patient is now 63 years old. Since recovering twenty-six years ago until menopause, her menstruation has been regular, and her health is good.
[Syndrome Differentiation] The patient is a middle-aged peasant woman, originally robust constitution. After stopping menstruation for a few years, she declined rapidly. At the first visit, the illness was severe. Reasons include: first, years of farming exposed her to wind, frost, rain, and dew, accumulating cold and injuring dampness, leading to Cold coagulation and Blood stasis. As stated in the *Jingui Yaolue*: "Women's diseases, due to deficiency, accumulated cold, and Qi stagnation, result in cessation of menstruation." Second, chronic illness depleted Essence and Qi, compounded by previous intake of mostly blood-breaking and purging Chinese medicines, damaging Spleen and Kidney Yang, causing Kidney Water to flood and Spleen failing to control water, resulting in generalized swelling. The Classics state: "All cold contraction and pulling belong to the Kidney," "All dampness, swelling, and fullness belong to the Spleen." Thus, this syndrome belongs to Spleen and Kidney Yang deficiency with internal accumulation of Yin Cold, primarily dominated by Shaoyin deficiency. Chills, cold limbs, mental fatigue, low voice, shortness of breath, dark bluish complexion, pale tongue, and deep pulse are all clear signs of Shaoyin Cold Transformation. Treatment uses Fuling Sini Tang; Ginger and Aconite restore Yang and expel Yin; Gan Cao moderates the middle; Fu Ling leaches and drains; Dang Shen supports Zheng Qi. Added Bai Zhu tonifies Spleen and dries dampness; added Gui Zhi unblocks Heart Yang and transforms Bladder Qi; replaced Gan Jiang with Pao Jiang to warm meridians and assist Blood flow; added Xue Yu Tan for removing stasis and generating new blood, and promoting diuresis to accelerate elimination of swelling.
[Commentary] In this case, Cold Blood Stasis was mismanaged with purgatives, initially injuring both Yin and Yang, causing amenorrhea and edema, and further leading to Yin-Yang dual deficiency due to lack of proper treatment. Therefore, Fuling Sini Tang was chosen for its efficacy in eliminating Yang deficiency edema while attending to Yin. Added Pao Jiang and Xue Yu Tan to warm meridians, dispel cold, remove stasis, and generate new blood, breaking through the key point of menstrual obstruction, resolving all symptoms.

Shaoyin Syndrome Infertility
Huang XX, female, 34 years old. A cadre in Sichuan Province.
[Medical History] Married for seven years without pregnancy; physiological checks for both husband and wife were normal. Starting from winter 1959, she felt dizzy and fatigued, morning facial edema, afternoon foot edema, and irregular menstruation. In spring 1965, the condition developed severely. She sought consultation on July 20 of the same year.