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The disease of Yin-Yang Exchange (Yin Yang Yi) in Shanghan (Cold Damage) presents with a heavy body, shortness of breath, urgency and tension in the lower abdomen, sometimes drawing the genitalia into spasms, heat rushing up to the chest, heaviness of the head making one unwilling to lift it, blurred vision or seeing spots before the eyes, and stiffness and cramping of the knees and calves. It is primarily treated with Shao Kun San (Burned Underwear Powder).

Shao Kun San
Take the part of the woman's undergarment (close-fitting underwear) near the genitals, cut it off, burn it to ash, mix with water, and administer one Fang Cun Bi (a square-inch measure) per dose, three times daily. When urination becomes smooth and the glans penis swells slightly, the patient will recover. If the patient is a woman, take the crotch of the man's undergarment, burn it to ash, and administer.

I once treated a patient whose Shanghan had not yet fully resolved but who engaged in sexual intercourse, leaving them on the verge of death. I used Du Shen Tang (Ginseng Decoction) to mix and administer Shao Kun San. Among those who took more than one liang of Ginseng and recovered, there were three or four cases. This truly demonstrates that medication should not be applied rigidly.

Appendix:
Treating Shanghan after recent recovery where Yin and Yang Qi are not yet harmonized, leading to illness due to sexual intercourse. In men, this causes swelling of the scrotum and colicky pain radiating into the abdomen; in women, it causes urgency in the lower abdomen and pain connecting the waist, hips, and internal abdomen. This condition is named Yin-Yang Exchange. If a man recovers from illness but has not stabilized and engages in intercourse with a woman, contracting the disease, it is called Yang Exchange (Yang Yi); if a woman recovers but has not stabilized and engages in intercourse with a man, contracting the disease, it is called Yin Exchange (Yin Yi). If two men or two women interact, they do not exchange diseases. It is called "Exchange" because Yin and Yang mutually influence each other, and its toxic pathogen attaches to the person like a substitution. The symptoms include fever, heat rushing to the chest, heaviness of the head preventing lifting, blurred vision, stiffness and cramping of the four limbs, colicky pain in the lower abdomen, and curling of the hands and feet into fists, which leads to death. Some do not die immediately; they suffer from urgency in the lower abdomen, heat rushing to the chest, heaviness of the head, separation of joints, slack meridians, deficiency of blood and Qi, exhaustion of bone marrow, mental confusion, weak breathing, decreasing physical strength, inability to move or rise from bed, requiring support from others or being dragged, dying after months. Suitable formulas include Shao Kun San, Shu Fen Tang (Mouse Feces Decoction), Zhu Ru Tang (Bamboo Shavings Decoction), Qing Zhu Ru Tang (Green Bamboo Shavings Decoction), Gan Jiang Tang (Dried Ginger Decoction), and Dang Gui Bai Zhu Tang (Angelica and Atractylodes Macrocephala Decoction). (Haizang stated: For heat patterns, use Shao Kun San or Zhu Pi Tang; for cold patterns, use Shu Fen Tang or Dang Gui Bai Zhu Tang. Regarding the correction of Miao Xiang Wan treating miscellaneous disease Yin-Yang Exchange containing Rhinoceros Horn [substitute], Realgar, Musk, and Bovine Calculus, these treat heat patterns.)

Qing Zhu Ru Tang (Green Bamboo Shavings Decoction)
For women whose illness has not stabilized, causing heat to rush to the chest due to movement, resulting in stiffness and convulsions of the hands and feet resembling stroke. This formula is suitable.

Gua Lou Tang (Trichosanthes Root Decoction)
Gua Lou (Trichosanthes Radix) (1 liang), Qing Zhu Ru (Green Bamboo Shavings) (half sheng, light bamboo is preferred). Boil in two sheng of water to obtain one sheng and two he, remove dregs, and divide into two or three doses.

Miao Xiang Wan (Wonderful Fragrance Pill)
Treats Yin-Yang Exchange that has not healed, with constipation, confused mind, restlessness, and fearfulness.

Chen Sha (Cinnabar) (separately ground fine, water-washed, 3 qian), Bing Pian (Borneol), Ni Fen (Calomel), She Xiang (Musk), Niu Huang (Bovine Calculus) (each 7.5 qian), Jin Bo (Gold Leaf) (5 pieces), Ba Dou Shuang (Croton Seed Frost) (2.5 qian). Grind all into fine powder, add Huang La (Yellow Beeswax) (3 qian) and Mi (Honey) (one small spoon), refine and mix evenly to form pills. Each liang of medicine makes thirty pills. Administer five pills with rice drink; three pills for the weak, seven for the strong. Stop when bowel movement is achieved.

Bai Yi Zhi Fa (Method from Hundred Cures): For relapse due to intercourse causing scrotal swelling or retraction into the abdomen, colicky abdominal pain, or fecal impaction, crush earthworms to extract juice and administer; it is effective.

Haizang said: If Yin-Yang Exchange indeed presents with a Jueyin pulse, use Dang Gui Si Ni Tang (Angelica Decoction for Cold Reversal) to swallow Shao Kun San according to the pattern. If the pulse is at Shaoyin, use Tong Mai Si Ni Tang (Pulse-Restoring Decoction for Cold Reversal) to swallow Shao Kun San. If the pulse is at Taiyin, use Si Shun Li Zhong Wan (Four-Obedience Regulating Middle Pill) to swallow Shao Kun San. Using medicines corresponding to their respective meridians yields rapid effects.

Shu Fen Tang (Mouse Feces Decoction)
Treats Yang Exchange in men after Shanghan.

Jiu Bai Gen (Allium Tuberosum White Root) (one handful), Shu Fen (Mouse Feces) (14 grains, those pointed at both ends). Boil these two ingredients in five sheng of water to obtain half a sheng, remove dregs, boil again for three boils, and take warm. If effective but no sweat, administer again. It also treats various types of Lao Fu (relapse due to overexertion).

Dang Gui Bai Zhu Tang (Angelica and Atractylodes Macrocephala Decoction)
Treats women whose illness has not stabilized, causing urgency and pain in the lower abdomen, inability to move the waist, hips, and limbs, weakness, and fever due to movement.

Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Gui Zhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Praeparata - Raw), Gan Cao (Glycyrrhizae Radix et Rhizoma), Shao Yao (Paeoniae Radix), Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix) (each 2.5 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (half liang). Cut into pieces, decoct in water, take after meals, then take again, cover warmly to induce slight sweating, and the illness will resolve.

Li Liangzuo's son presented with Taiyang syndrome, with floating and rapid pulses at both cun and chi positions, but empty upon pressure. I observed internal Yin deficiency and cured him with Shen Shu Jia Gan Jiang Tang (Atractylodes Formula with Added Dried Ginger). Later, he fell ill again. I saw him looking depressed, hanging his head, and unwilling to speak, suspecting sexual excess. I asked if he had engaged in intercourse, and he admitted it. I administered Da Jian Zhong Tang (Major Construct the Middle Decoction) three or four doses. The external Yang retreated inward, the pulse returned to deep and small, revealing Yin signs. I then administered pills containing Han Jiang (Cold Reversal), Shao Yao, and Hui Xiang, five or six doses. Within three days, he consumed about six or seven hundred pills, and his pulse revived. I continued with Da Jian Zhong Tang, leading to profuse sweating and resolution.

Shan Shi treated Yin syndrome Shanghan caused by female lust by frying Chen Pi (Citri Reticulatae Pericarpium) in a hot pan until charred, cooking it with wine, filtering the wine, and drinking it.

Jiu Gen San (Leek Root Powder)
Treats Yin-Yang Exchange after Shanghan, characterized by heavy head, joint pain, weak qi, inability to rise from bed, severe cases with curled hands and feet, swollen and painful scrotum.

Jiu Gen (Allii Tuberosi Radix), Gua Lou Gen (Trichosanthes Radix) (each 2 liang), Qing Zhu Ru (Green Bamboo Shavings), Gan Jiang (Zingiberis Rhizoma) (prepared, each half liang). Finely chop and mix evenly, divide into eight doses. Each dose uses one large cup of water, boiled down to two-fifths, remove dregs, add one zi of powdered mouse feces, stir well, and take at any time. Sheng Ji Fang grinds and sifts five qian bi, boils in one and a half cups of water to one cup, removes dregs, and takes warm before meals. Also known as Feng Ben Tang.

Gan Jiang San (Dried Ginger Powder)
Treats women suffering from Shanghan who, although recovered, engage in intercourse within 100 days, causing Yin-Yang Exchange. Symptoms inevitably include body stiffness, curled hands and feet approaching death. In men, it is called Yin Exchange; in women, Yang Exchange. Prompt sweating can cure it. After four days, it is untreatable. Patients should take this medicine. Symptoms include heavy body, urgent lower abdomen, heat rushing to the chest, heavy head unable to lift, blurred vision, and stiff knees and calves. Use Gan Jiang (Dried Ginger) (4 liang ground to powder), mixed with boiling water, taken continuously. Cover with blankets to induce sweating for relief, extending hands and feet to recover.

Er Hui San (Two Ashes Powder)
Treats Yin-Yang Exchange in Shanghan.

Shou Zu Jia Zhi (Fingernails and Toenails) (20 pieces, use female nails for male patients, male nails for female patients), Zhong Yi Dang (Crotch of Undergarment) (one piece near the genitals, use female garment for male patients, male garment for female patients). Burn all to ash, grind finely, divide into three doses. Take at any time, mixed with warm wine or rice soup.

Yi Lin states: Li Jing Mai (Departure Pulse) appearing mostly indicates death. Excessive is called "Zhi," three beats per exhalation is "Zhi"; insufficient is called "Sun," one beat per exhalation is "Sun." Only Yin-Yang Exchange presents with such pulses.

Zhang stated: Suppose a woman has recently recovered but not stabilized, and a man engages in intercourse with her, suddenly falling ill due to external pathogens. This is actually not transmission of residual pathogens. Doctors seeing the rapid onset call it Yin Exchange. How to distinguish this medically? Exchange patients possess the symptoms seen in the previous article; how is this comparable to external contraction? If it were external Wind-Cold, there should be exterior signs. How could there be lower abdominal urgency drawing the genitalia into spasms? Or again: Suppose a man recovers but has not stabilized, forces intercourse, and falls ill himself, still presenting with lower abdominal urgency and genital spasms, identical to Exchange symptoms. Investigating the principle, why does he not infect others but relapse himself? Examining the treatment, can it be the same? Although the disease is self-relapse, it is similar to Exchange, so Shao Kun San is also used to guide and calm the Zheng Qi (Upright Qi). Exchange disease involves stimulating residual pathogens through intercourse, and since the person's Zheng Qi is originally deficient, they become infected. Otherwise, how could they receive the pathogen? Now, self-relapse occurs because Zheng Qi is still weak, and residual pathogens are activated by movement, entirely unlike external contraction. Thus, it is similar to Exchange, and Shao Kun San is used to stabilize Zheng Qi. Once Zheng Qi is stable, residual pathogens naturally subside.