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It treats cases where vomiting and diarrhea have ceased, yet sweating occurs accompanied by cold limbs (limbs cold to the touch), tetanic stiffness of the four limbs, and a faint pulse nearly imperceptible. This decoction is indicated.

To the original formula of Tongmai Sini Decoction (Pulse-Reviving Cold-Limb Decoction), add pig bile (4 he). After decocting Tongmai Sini Decoction, incorporate the pig bile. Divide into two doses and take warm. The pulse will then emerge.

The song states: One raw Fuzi (Aconiti Lateralis Radix Praeparata) weighing three liang, two liang of Ganjiang (Zingiberis Rhizoma), two liang of Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) [This follows the Song edition of *Jinkui Yufan Jing*; commercial editions of *Shanghan Lun* state three liang of Gancao roasted with honey]. A faint pulse indicates internal exhaustion [Vomiting and diarrhea ceasing means fluids are exhausted internally; tetanic stiffness means fluids are exhausted internally and cannot nourish the exterior]. Rely on the true fluid [The text mentions "fluid" as only half a he; here referring to pig bile].

Commentary by Wei: The Treatise says "vomiting and diarrhea cease," meaning both Yin and Yang, Qi and Blood are deficient, and water and grain essences are exhausted, so there is nothing left to vomit or purge naturally. It says "sweating and cold limbs with a faint pulse nearly imperceptible," indicating a lack of Yang Qi to govern and secure. It says "tetanic stiffness of the four limbs," indicating a lack of Jin-Ye (Body Fluids) to nourish. At this critical juncture, if one uses the warming properties of Ganjiang and Fuzi in Sini Decoction (Cold-Limb Decoction), it might not fail to restore Yang. If one doubles the sweet nature of Gancao, it might not fail to nourish Yin. However, there is still fear that the action would be too slow to be effective. If one uses Tongmai Sini Decoction, doubling the potency of Ganjiang, it seems capable of retrieving primal Yang. Yet, there remains concern that after severe vomiting and diarrhea, suddenly administering large amounts of acrid-hot substances would cause internal fluids to dry up further and external sinews and vessels to spasm more intensely, leading to death within moments. The Master sought a path to life amidst ten thousand deaths, taking Tongmai Sini Decoction to reverse cold limbs and stop sweating, assisted by pig bile mixed raw. Taking advantage of its vital energy, the bitter taste enters the Heart first to restore the pulse, and the fluid replenishes the middle Jiao's fluids, irrigating the sinews so stiffness resolves. Acrid-sweet and bitter-sweet mutually assist each other, harmonizing Yin and Yang Qi within moments. This is essentially the intent of Sini Jia Renshen Tang (Sini Decoction plus Ginseng Decoction). However, Renshen (Ginseng Radix) is merely an insensate root, unlike pig bile which belongs to a different species and possesses vital energy. Mixed raw to obtain its vital energy, its efficacy is doubly miraculous. Various schools, constrained by the precedent of Baitong Jia Zhuyedan Tang (Baitong Decoction plus Pig Bile and Human Urine Decoction), claim that due to Yang repulsion preventing entry, bitter-cold is borrowed for counter-treatment (antidotal therapy). This is laughable. According to ancient texts, only bile is added, without human urine. Zhang Yinan's commentary includes human urine, likely based on some source. Reading his commentary reveals profound insight. Zhang Yinan stated: This section repeats the statement to conclude the meaning of the previous two sections. The previous two sections both primarily used Sini Decoction. Here, mentioning "internal exhaustion," the so-called "faint pulse nearly imperceptible" remains unchanged. This indicates deficiency of Yin, Yang, Blood, and Qi, making Tongmai Sini Jia Zhuyedan Tang the appropriate treatment. The explanation of Tongmai Sini Decoction is found in the Shaoyin Chapter. Adding the gallbladder of the Water Element animal (pig), which is the Jia Gallbladder, initiates the essence fluid of the Kidney to nourish the Blood of the Heart Master. Additionally, adding human urine draws the fluid from the Bladder back into the Stomach, aiming for internal nourishment by essence fluid and harmony of Blood and Qi. Generally, pathogens of wind, rain, cold, and heat directly entering the Middle Jiao all result in Huoluan (Cholera-like disease). If vomiting and purging are excessive, damaging vital Qi internally, causing cold hands and feet and a faint pulse nearly imperceptible, Sini Decoction should be used regardless of whether the pathogen is cold or heat. Why? Because when Zheng Qi (Upright Qi) is injured, one need only rescue Zheng Qi, and the illness will heal. Even Yin-Yang Tang or Huangtu Tang can treat it. If Huoluan involves interior deficiency, the ancient sages established only two formulas, Sini Tang and Lizhong Tang, as methods for emergency rescue of Zheng Qi. Some say Huoxiang Zhengqi San (Agastache Powder to Regulate the Qi and Rectify the Middle) treats summerheat Huoluan; this is incorrect. I often see patients dying of Huoluan in summer with cold limbs and no pulse. Huoxiang Zhengqi San is merely a formula to broaden the chest and release the exterior; how can it treat this? Moreover, in summer, Yuan Qi (Primal Qi) dissipates outward, leaving the Middle Qi greatly deficient. When external pathogens strike suddenly, rescuing Zheng Qi is already late enough, let alone using dispersing agents. When pathogens and Zheng Qi contend, there are distinctions among wind, rain, cold, and heat. When Zheng Qi is injured by pathogens, one only discusses the deficiency or excess of Zheng Qi. Entering the Zang organs constitutes an untreatable fatal syndrome; it is not that wind and summerheat are Yang while cold and rain are Yin. This is the general principle of Huoluan. Students should keep it firmly in mind and not lose it. Gao Zi said: In Huoluan, the use of pig bile and human urine implies that since Jin-Ye are exhausted and Yin Blood is simultaneously deficient, one should not merely assist Yang but also nourish and benefit Yin. I often see cases of summer Huoluan with cold limbs and a faint pulse nearly imperceptible. Administering Lizhong Tang or Sini Tang fails to produce results, whereas administering a small amount of Mingfan (Alumen) mixed with cool water cures them immediately. This aligns with the intent of pig bile and human urine. The legislation of the sages was indeed comprehensive and detailed.