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The Shaoyin Kidney Meridian is the repository of Water and Fire. When pathogenic factors invade this meridian, they transform according to the patient's deficiency or excess: either transforming into Water (manifesting as Cold) or transforming into Fire (manifesting as Heat). The Yin-Cold pathogen resulting from Water transformation constitutes the Root (Ben); the Yang-Heat pathogen resulting from Fire transformation constitutes the Branch (Biao). The pulse for Yin pathogens is deep, fine, and faint; the pulse for Yang pathogens is deep, fine, and rapid. Their clinical manifestations also differ. Yin pathogens present with a desire to sleep and absence of fever; Yang pathogens, although desiring to sleep, are often accompanied by mental restlessness. Yin pathogens present with aversion to cold in the back and a neutral sensation in the mouth; Yang pathogens present with aversion to cold in the back and dryness in the mouth. Yin pathogens present with sore throat without swelling; Yang pathogens present with sore throat accompanied by swelling. Yin pathogens present with abdominal pain and diarrhea with undigested food; Yang pathogens present with abdominal pain and diarrhea passing clear water or pus and blood. Yin pathogens present with external heat, red complexion, internal cold, free bowel movements, and white urine; Yang pathogens present with external cold, cold extremities, internal heat, constipation, and red urine. These are the pulses and symptoms of Cold and Heat in the Root and Branch of Shaoyin disease. For treatments following the Root (Cold transformation), warming Cold and restoring Yang are appropriate; for treatments following the Branch (Heat transformation), clearing Heat and preserving Yin are appropriate. The timing for restoring Yang and saving Yin is critical; it depends entirely on careful clinical investigation to distinguish between Root/Branch and Cold/Heat, allowing for urgent treatment. Only then can there be hope of success; any delay will render treatment ineffective.

Shaoyin disease is characterized by a faint and fine pulse and a desire to sleep.

[Annotation] The Shaoyin Kidney Meridian is a Zang organ of extreme Yin abundance. When Shaoyin is invaded by pathogens, Yang Qi becomes weak, hence the faint and fine pulse. Wei Qi (Defensive Qi) moves through Yang leading to wakefulness, and through Yin leading to sleep. When Shaoyin is invaded, Yin is abundant, and movement through Yin predominates, hence the desire to sleep. This is the outline of Shaoyin disease; subsequent mentions of "Shaoyin disease" refer to these specific pulses and symptoms.

[Collected Annotations] Fang Youzhi states: The Shaoyin Kidney Meridian is located at the lowest part of the body, and its pulse originates below the little toe. *Ling Shu* states: It governs diseases generated within itself, manifesting as drowsiness and a desire to sleep. Humans mirror Heaven and Earth; when the Qi of Heaven and Earth moves through Yang, it opens to become day; when it moves through Yin, it closes to become night. Thus, when human Qi moves through Yang, one is active and awake; when it moves through Yin, one is quiet and asleep. Patients who only desire to sleep do so because pathogens have lodged in Yin.

Zhang Lu states: This discusses the general pulse and symptom of Shaoyin. Shaoyin belongs to Water and governs stillness. Even if Heat pathogens transmit to this meridian, if the initial pulse was floating and large, it must now change to deep and fine; if the initial symptom was irritability and heat, it must now change to lethargy and drowsiness. One must distinguish: a fine, deep, and rapid pulse with a dry mouth indicates Heat; a deep, faint, and fine pulse with a neutral mouth indicates Cold. With such clear distinction, errors will be avoided.

Cheng Yingmao states: All Yin pulses are deep, differing from the floating pulse of Taiyang, which needs no further explanation. Yangming pulses are large; "faint" is the opposite of large. Shaoyang pulses are wiry; "fine" is the opposite of wiry. A pulse that is both deep and combined with faint and fine confirms a Yin syndrome.

In Shaoyin disease, upon initial onset, if there is contrary fever and a deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) should be administered.

[Annotation] Shaoyin disease refers to the symptom of desiring to sleep. A deep pulse here means the pulse is not faint and fine but specifically deep. Upon initial onset, fever should not be present; the presence of contrary fever indicates Shaoyin interior Cold combined with Taiyang exterior Heat. Therefore, Mahuang Fuzi Xixin Tang is suitable to warm the interior and induce sweating, protecting Yang Qi, thereby resolving the Cold pathogens of both Taiyang and Shaoyin (dual invasion).

[Collected Annotations] Fang Youzhi states: Fever indicates the pathogen is in the exterior; a deep pulse indicates Shaoyin's position in the North and interior. Because it is interior, yet fever exists due to exterior pathogens, it is termed "contrary." Since the pathogen is in the exterior and not the interior, Mahuang is used to disperse it; because the root is Yin and the branch is Cold, Fuzi (Prepared Aconite Root) is used to warm it. Xixin (Asarum) is acrid and warm, connecting to Shaoyin, used as an assistant to guide the main treatment, as it specializes in entering this meridian.

Cheng Zhi states: The method for treating exterior syndromes in the Three Yin meridians differs from the Three Yang. In the Three Yin, warming meridian herbs must be used for exterior release, particularly crucial in Shaoyin. Thus, formulas that disperse pathogens and warm meridians are used, allowing deeply entrenched exterior pathogens to exit while preventing internal Yang from escaping outward.

Cheng Yingmao states: Onset with immediate fever, combined with anhidrosis in a Yin meridian, leads some physicians who count days and match symptoms to use Mahuang (Ephedra) while avoiding Fuzi. They do not realize that a deep pulse occurs because the person's Kidney meridian is inherently cold, and interior Yang cannot coordinate, causing the pulse to be deep rather than floating. A deep pulse belongs to Shaoyin, where sweating is generally contraindicated. However, fever at the very beginning indicates concurrent Taiyang involvement, necessitating sweating. One must use Fuzi...

The above three ingredients: Use ten sheng of water. First boil Mahuang (Ephedra Herb), reducing by two sheng, remove the foam on top, add the remaining herbs, boil to obtain three sheng, strain, and take one sheng warm, three times daily.

In Shaoyin disease, after two or three days, if Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) is used to induce slight sweating: Because there are no interior symptoms after two or three days, slight sweating is indicated.

[Annotation] This elaborates on the previous case where Shaoyin disease persists for two or three days with continued deep pulse and fever. Ma Huang Fu Zi Gan Cao Tang is suitable for slight sweating. If after two or three days there are no signs of vomiting, diarrhea, or interior cold, it indicates the pathogen has weakened. However, since heat remains in the exterior, sweating is still required, but it must not be excessive. Hence, Xixin is replaced by Gancao (Licorice Root), introducing a harmonizing element within the warming and dispersing action. Neither of these cases explicitly mentions anhidrosis; this is not an omission by Zhongjing, but because Yin syndromes do not typically involve sweating, so it need not be stated.

[Collected Annotations] Zhang Lu states: There is no method for inducing sweating in Shaoyin; doing so leads to loss of Yang. Only in this specific case, where there is exterior Taiyang fever and anhidrosis, but no interior vomiting, diarrhea, agitation, irritability, vomiting, or thirst, can one warm the meridians and disperse cold, seeking only a slight perspiration.

Cheng Yingmao states: The use of "because" and "therefore" after stating "slight sweating" emphasizes caution. These two clauses correspond to the Taiyang chapter's case of fever, headache, and deep pulse treated with Sini Tang. In that case, if unresolved after three days, the disease enters the interior, and even with residual Taiyang headache, it is treated according to Shaoyin principles. Here, in early Shaoyin disease (2-3 days), despite lacking headache, it cannot be treated solely as Shaoyin; thus, Taiyang methods are applied concurrently. One approach exits, one enters, akin to legal judgment. If the first clause applies to 2-3 days, and the latter clauses apply to >3 days without resolution, the roles of Sini Tang and Mahuang-based formulas would be interchangeable.

Wang Hu states: The previous clause describes contrary fever and deep pulse as urgent (initial onset); this clause describes it as slower (onset after 2-3 days). A slower disease progression warrants a milder treatment.

Ma Huang Fu Zi Gan Cao Tang Formula
Mahuang (Ephedrae Herba, removed nodes, 2 liang)
Fuzi (Prepared Aconiti Lateralis Radix, peeled, broken into eight pieces, 1 piece)
Gancao (Prepared Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang)

The above three ingredients: Use seven sheng of water. First boil Mahuang for one boiling, remove the foam, add other herbs, boil to obtain three sheng, strain, and take one sheng warm, three times daily.

[Collected Exegesis] Ke Qin states: In the Taiyang case with a contrary deep pulse, Sini Tang is used to urgently rescue the interior, indicating interior Cold and Yin abundance. In this Shaoyin case with a contrary exterior heat, Fuzi is added to the exterior formula to pre-emptively secure Yang, indicating exterior Heat with Yang deficiency. With fever and anhidrosis (Taiyang exterior) and deep pulse/desire to sleep (Shaoyin interior), if Mahuang were used to open pores and Xixin to scatter floating heat without Fuzi to secure primal Yang, the slight Yang of Taiyang would escape. Only with Mahuang and Fuzi together can Cold pathogens be scattered without losing Yang. This interior disease affecting the exterior, requiring sweating due to a deep pulse, is diametrically opposed to exterior diseases requiring sweating due to a floating pulse. If exterior heat is mild, cold invasion is light; thus, Gancao replaces Xixin for slight sweating. Gancao slows/harmonizes, contrasting with Xixin's dispersing nature.

In Shaoyin disease, if the pulse is faint, sweating is contraindicated due to the risk of Yang loss. If Yang is already deficient and the Chi (Cun-Chi) pulse is weak and choppy, purging is also contraindicated.

[Annotation] In Shaoyin disease, a faint pulse, even with fever, represents interior Cold with exterior Heat, distinct from Taiyang fever. Sweating is contraindicated as it causes Yang loss. If Yang is deficient and fluids exhausted, even if symptoms like dry mouth and throat suggest purging is needed, a weak and choppy Chi pulse indicates Yin/Blood deficiency, making purging contraindicated to avoid Yin loss.

[Collected Annotations] Fang Youzhi states: A faint pulse indicates insufficient Yang Qi ("No Yang"), meaning transformation and circulation fail, so sweating is impossible. The Chi position reflects Yin; weak and choppy indicates insufficient Yin Blood, hence purging is also contraindicated. Urgent warming and tonification are indicated.

Cheng Yingmao states: Shaoyin disease often involves spontaneous diarrhea, so physicians rarely use purgatives lightly. However, highlighting "weak and choppy Chi pulse" implies that Shaoyin cases suitable for Dachengqi Tang would present with a strong and slippery Chi pulse, a point foreshadowed here.

If a patient's pulse is tight in all positions (Yin-Yang俱紧) and sweats contrary to expectation, this is Yang loss belonging to Shaoyin. According to protocol, this should present with sore throat, vomiting, and diarrhea.

[Annotation] Tight pulses in all positions with fever and anhidrosis indicate Taiyang Cold Damage; fever with continuous sweating indicates Taiyang Yang loss. Now, tight pulses without fever but with contrary sweating belong to Shaoyin. Shaoyin protocol dictates sore throat, vomiting, and diarrhea. The previous clause (faint pulse, anhidrosis) contraindicated sweating based on the pulse; this clause (sweating, tight pulse) contraindicates sweating based on the symptom. One must carefully distinguish whether to follow the pulse or the symptom.

[Collected Annotations] Cheng Zhi states: Tight pulses in Yin and Yang positions are characteristic of Cold Damage, expecting anhidrosis. Contrary sweating indicates the escape of Taiyang Yang. Mistaking Shaoyin Yang loss for Taiyang Wind Strike is an error. Shaoyin Cold forcing upward causes sore throat and vomiting; forcing downward causes diarrhea.

In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, hands and feet become warm, and the tight pulse disappears, the condition is resolving. Although there is irritability and diarrhea, it will heal spontaneously.

[Annotation] This expands on the previous clause to distinguish Yin/Yang and Cold/Heat. Shaoyin disease with deep, faint, fine pulses indicates Cold; deep, rapid, fine pulses indicate Heat. Tight pulse with sweating indicates Shaoyin Cold-Deficiency; tight pulse without sweating indicates Shaoyin Cold-Excess. After seven to eight days, spontaneous diarrhea occurs. If Cold-Excess resolves, the pulse changes from tight to suddenly faint, and symptoms shift from cold extremities to warmth. This indicates pathogens exiting via diarrhea, signaling resolution. Thus, despite irritability and diarrhea, this represents Yin retreating and Yang returning, ensuring spontaneous healing.

[Collected Annotations] Fang Youzhi states: Tight pulse indicates Cold Pathogen. Spontaneous diarrhea with sudden faintness of pulse indicates internal expulsion of Yin-Cold. Hence, "contrary warmth" of extremities indicates Yang return. Yang return means Yin retreat, so disappearance of tight pulse signals resolution. Just as exterior Heat with rapid pulse resolves with sweating and cooling, interior Cold with tight pulse resolves with diarrhea and warmth; both illustrate the mechanism of Yin-Yang victory and defeat.

Cheng Yingmao states: The pulse changing from tight to faint after diarrhea, and extremities becoming warm, indicates this "faintness" is not the fatal faintness of Yang loss, but the favorable faintness of "tightness gone, peace restored." The prior Cold has exited via diarrhea, allowing Yang to return and resolve. Thus, irritability and diarrhea will self-resolve.

In Shaoyin disease, upon onset of one or two days, if the mouth feels neutral and there is aversion to cold in the back, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) administered.

[Annotation] Aversion to cold in the back can occur in both Yin and Yang syndromes. For example, Yangming disease with no significant fever, dry mouth/thirst, irritability, and slight back aversion to cold is treated with Baihu Jia Renshen Tang. Here, Shaoyin disease with desire to sleep, onset of 2-3 days, neutral mouth (not dry), and back aversion to cold indicates Shaoyin Yang deficiency, not Yangming Heat steaming. Therefore, moxibustion and Fuzi Tang are used to assist Yang and dissipate Yin. "Dry mouth" vs. "Neutral mouth" are definitive differentiators.

[Collected Annotations] Cheng Zhi states: Early onset with neutral mouth (no thirst/dryness) indicates no interior Heat. *Nei Jing* states: The back is Yang; back aversion to cold indicates Yang deficiency and Yin abundance, implying deep Cold. If exterior Wind-Cold caused aversion to cold, the whole body would be cold. Moxibustion assists Yang and dissipates Yin; Fuzi Tang warms meridians and disperses Cold. The text notes Yangming cases with Baihu Jia Renshen Tang involve Heat sinking due to Yin deficiency, distinct from this severe Yin-Cold. Heat entering Yin causes dry mouth/irritability; severe Yin-Cold does not consume fluids, hence neutral mouth.

Zhang Lu states: Severe deficiency of Taiyang Exterior Qi allows pathogens to invade Shaoyin. Thus, early back aversion to cold without fever indicates dual deficiency of Yin and Yang, more severe than dual invasion (both exterior and interior Heat). Dual invasion can still be treated with exterior-releasing and interior-purging methods; this case involves interior-exterior deficiency-Cold with no Heat to attack. Treatment must warm meridians and tonify Yang, supplemented by moxibustion at Guanyuan. Although symptoms seem milder than fever/deep pulse, the danger is greater.

Wang Hu states: Zhongjing does not specify which acupoint to moxa. Chang Qizhi suggests Ge Shu and Guanyuan, third row of Back-Shu points. Guo Yong suggests a textual error, correcting to Ge Shu and Guanyuan. Ge Shu is actually the second row. Chang's "third row" likely refers to Ge Guan. *Tu Jing* states: Ge Guan (2 points) are below the 7th thoracic vertebra, 3 cun lateral, in depressions, where Foot-Taiyang Qi emerges, treating back aversion to cold, stiff spine, and difficulty bending/straightening; 5 moxa cones are applicable. Shaoyin Cold enters via Taiyang, hence these points. Guanyuan (1 point) is 3 cun below the umbilicus on the midline, intersection of Foot-Yin meridians and Ren Mai; 100 moxa cones are applicable. Moxa Ge Guan warms exterior to disperse external pathogens; moxa Guanyuan warms interior to boost primal Qi.

In Shaoyin disease, if there is body pain, cold hands and feet, bone/joint pain, and a deep pulse, Fuzi Tang is administered.

[Annotation] This elaborates on the previous clause's symptoms and treatment. Body pain occurs in both exterior and interior syndromes. Taiyang disease with floating pulse, fever, aversion to cold, body pain, warm hands/feet, and joint pain is exterior Cold, treated with Mahuang Tang to release exterior and disperse Cold. Here, Shaoyin disease with deep pulse, no fever, aversion to cold, body pain, cold hands/feet, and joint pain is interior Cold, treated with Fuzi Tang to warm interior and disperse Cold.

[Collected Annotations] Fang Youzhi states: Shaoyin corresponds to Kidney; Kidney governs bones; Cold invasion causes pain.

Cheng Yingmao states: Body pain, cold extremities, and joint pain are also seen in Taiyang Cold Damage. Differentiation by deep pulse indicates heavy Yin-Cold; excess interior Yin and deficient exterior Yang. Hence, Fuzi Tang is used.

Fuzi Tang Formula
Fuzi (Raw Aconiti Radix, peeled, broken into eight pieces, 2 pieces)
Fuling (Poria, 3 liang)
Renshen (Ginseng Radix, 2 liang)
Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang)
Shaoyao (Paeoniae Radix Alba, 3 liang)

The above five ingredients: Use eight sheng of water, boil to obtain three sheng, strain, and take one sheng warm, three times daily.

[Formula Analysis] Shaoyin is the organ of Cold Water; severe Cold injury often enters Shaoyin, making it prone to fatal cases. Fuzi (2 pieces) is the Sovereign herb for its potent strength. Raw usage strengthens the Minor Fire (Yang) and disperses interior/exterior Cold, stopping body pain, eliminating aversion to cold, and warming extremities. Renshen is the Minister herb to secure the source of Life Qi, providing roots for the Zang-Fu and meridians, raising the pulse from deep, and harmonizing joints. Baizhu supports Earth (Spleen), Shaoyao soothes Wood (Liver), and Fuling drains Water. Draining Water allows Fire to flourish; flourishing Fire dissipates Yin shadows; soothing Wood stabilizes Earth; stable Earth controls Water. Control enables transformation and production. This is a comprehensive strategy. Those who fear using it and delay treatment commit a grave error.

In Shaoyin disease, if the pulse is deep, urgent warming is required, preferably with Sini Tang (Four Reversals Decoction).

[Annotation] Shaoyin disease with desire to sleep and deep pulse, absent of fever or dry mouth, indicates Cold pathogens have entered the Zang organ. Do not hesitate; urgently warm with Sini Tang to eliminate Yin and assist Yang.

[Collected Annotations] Wu Renju states: Deep pulses must be differentiated for deficiency/excess and duration. If chronic and solid/deep, treat differently.

Sini Tang Formula
Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 2 liang)
Ganjiang (Dried Zingiberis Rhizoma, 1.5 liang)
Fuzi (Raw Aconiti Radix, peeled, broken into eight pieces, 1 piece)

The above three ingredients: Use three sheng of water, boil to obtain 1.2 sheng, strain, and divide into two warm doses. Strong individuals may use a large Fuzi (1 piece) and Ganjiang (3 liang).

[Formula Analysis] Named "Four Reversals," it treats Shaoyin interior-exterior Cold and limb reversal (cold extremities). Gancao (sweet/warm) is Sovereign to nourish Yang. Ganjiang and Fuzi (acrid/warm) are Ministers to assist Yang against Cold. Gancao with Jiang/Fuzi stirs Kidney Yang and warms middle Cold (warming Earth in Water). Jiang/Fuzi with Gancao penetrates joints and limbs, driving out Yin and restoring Yang. Stirred Kidney Yang dissipates Cold Yin, allowing Yang to reach the exterior, raising the pulse, and warming extremities.

[Collected Exegesis] Wang Hu states: Shaoyin baseline is faint/fine pulse and desire to sleep. Here, light pressure reveals no faint pulse; heavy pressure barely finds fine pulse, hiding into deepness. This indicates Cold pathogens deeply entrenched, nearing the Zang. Urgent warming is essential. Delay leads to aversion to cold, curling up, vomiting/diarrhea, irritability, inability to sleep, cold extremities, and absent pulse—imminent death. Can the use of Sini Tang be delayed?

In Shaoyin disease with diarrhea, Baitong Tang (White Through Decoction) is administered.

[Annotation] Shaoyin disease with desire to sleep, faint/fine pulse, indicates Yang trapped by Yin. Added diarrhea risks extreme Yin descent and Yang collapse. Congbai (Scallion White) is Sovereign to freely unblock Yang and direct it upward; Ganjiang and Fuzi are Ministers to urgently overcome Yin and slow its descent, recovering non-collapsed Yang.

[Collected Annotations] Fang Youzhi states: Shaoyin with diarrhea involves both Meridian and Zang, indicating severe Cold and Yin abundance. Ganjiang/Fuzi overcome Yin to disperse Cold. Congbai ("White Through") unblocks Yang to dissipate Yin.

Cheng Zhi states: Diarrhea requires unblocking Yang. Shaoyin diarrhea indicates extreme Yin abundance, risking Yang rejection. Jiang/Fuzi eliminate Yin; Congbai raises Yang. "Through" means warming to allow Yang entry and dispersing to allow Yin exit.

Wang Hu states: Kidney deficiency without Fire cannot control Water, causing diarrhea. Baitong Tang warms interior and disperses Cold.

Baitong Tang Formula
Congbai (Scallion Stems, 4 stems)
Ganjiang (Dried Zingiberis Rhizoma, 1 liang)
Fuzi (Raw Aconiti Radix, peeled, broken into eight pieces, 1 piece)

The above three ingredients: Use three sheng of water, boil to obtain one sheng, strain, and divide into two warm doses.

[Collected Exegesis] Wang Hu states: This formula resembles Sini Tang but omits Gancao. To expel Cold quickly, the acrid/pungent nature acts swiftly to reach the Lower Jiao; thus, sweet/harmonizing Gancao is avoided. The emphasis remains on Congbai...