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Treat Shaoyin disease presenting with diarrhea of undigested food. Internal cold and external heat. Cold extremities (Ji Ni). Pulse is faint and nearly imperceptible. The body does not feel aversion to cold. The person's face appears red. Or accompanied by dry retching. Or accompanied by sore throat. Or where diarrhea has stopped but the pulse remains unobtainable. This formula (Tongmai Sini Tang, Pulse-Reviving Four Reversal Decoction) is indicated for these symptoms.
Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) (3 liang), Ganjiang (Dried Ginger, *Zingiberis Rhizoma*) (3 liang, 4 liang for robust individuals), Fuzi (Prepared Aconite Root Lateralis, *Aconiti Lateralis Radix Praeparata*) (1 piece, used raw).
Take the above three ingredients. Add 3 sheng of water. Boil to obtain 1.2 sheng of liquid. Strain off the dregs. Divide into two doses and take warm. If the pulse returns, the patient will recover. For those with a red face, add 9 stalks of Congbai (Scallion White, *Allii Fistulosi Bulbus*).
For those whose pulse does not return, remove Jiegeng (Platycodon Root, *Platycodonis Radix*) and add Renshen (Ginseng Root, *Panacis Quinquefolii Radix* or *Panacis Ginseng Radix*) 2 liang.
Song says: One raw Fuzi, 3 liang Gancao, 3 liang Ganjiang. To recruit lost Yang, this serves as the guide. External heat, internal cold, red face, and cold extremities. Explore the method within Tongmai therapy. (Another version mentions: Gancao)
Modification Song says: Red face, add 9 stalks of Congbai. Abdominal pain, removing Congbai is truly effective. Remove Congbai, add 2 liang Shaoyao (Peony Root, *Paeoniae Radix Alba*). For vomiting, add Shengjiang (Fresh Ginger, *Zingiberis Rhizoma Recens*). For sore throat, remove Shaoyao and must add Jiegeng. Jiegeng 1 liang follows the meridian. If the pulse does not appear, add 2 liang Renshen. Discard Jiegeng without hesitation.
Commentaries by various physicians: When Yang Qi cannot circulate and operate, Sini Tang (Four Reversal Decoction) is suitable. When Yuan Yang (Primal Yang) is severely deficient, Fuzi Tang (Aconite Decoction) is suitable. When Yin excess at the lower jiao repels Yang to the upper jiao, Baitong Tang (White Passage Decoction) is suitable. How can one hastily disperse Yang to make it return? Therefore, double the amount of Ganjiang. The reason Gancao is not reduced is to fear that after the dispersion, the body cannot withstand the fierce nature of Ganjiang and Fuzi. It still relies on Gancao to complete the therapeutic effect. If the face is red, it is floating deficient Yang ascending. Add Congbai to guide Yang Qi downward. For abdominal pain, it is disharmony of the Spleen collaterals. Remove Congbai and add Shaoyao to unblock the Spleen collaterals. For vomiting, it is rebellious Stomach Qi. Add Shengjiang to disseminate rebellious Qi. For sore throat, it is Shaoyin meridian Qi rebelling upward. Remove the bitter-draining property of Shaoyao; add the lifting property of Jiegeng. For diarrhea stopping but pulse not appearing, it is deficiency of Grain Qi internally, so the pulse lacks foundation. Remove Jiegeng and add Renshen to generate the pulse.

Treat Shaoyin disease with cold extremities (Ji Ni). Among these patients, some have cough. Some have palpitations. Some have difficulty urinating. Some have abdominal pain. Some have diarrhea with a sensation of heaviness in the rectum. These are primarily treated with this formula (Sini San, Four Reversal Powder).
Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*), Zhishi (Immature Bitter Orange Fruit, *Citri Reticulatae Fructus Immaturus*), Chaihu (Bupleurum Root, *Bupleuri Radix*), Shaoyao (Peony Root, *Paeoniae Radix Alba*).
Take the above four ingredients. Each in equal parts (10 fen). Pound and sieve. Mix with white rice decoction (Baiyin). Take one cun bi (a square-inch measure) per dose. Take three times daily. For cough, add Wuweizi (Schisandra Berry, *Schisandrae Chinensis Fructus*) and Ganjiang (Dried Ginger, *Zingiberis Rhizoma*) each 5 fen. Also treats diarrhea. For palpitations, add Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) 5 fen. For difficulty urinating, add Fuling (Poria, *Polyporus Umbellatus*) 5 fen. For abdominal pain, add Fuzi (Prepared Aconite Root Lateralis, *Aconiti Lateralis Radix Praeparata*) 1 piece, processed until cracked. For diarrhea with rectal heaviness, divide into two warm doses.
Song says: Zhishi, Gancao, Chaihu, Shaoyao in equal numbers. Heat Ji Ni can be reversed by investigating the cause. Mix evenly with Baiyin, one cun bi. Using this is divine for connecting Yin and Yang smoothly.
Modification Song says: For cough, add Wuweizi and Ganjiang. Equal 5 fen is the correct path. For diarrhea diseases, modify according to this. Acrid-warm and sour-astringent should attend to each other.
Methodology: For abdominal pain. Use 3 sheng of water. Remove Xiebai (Macrostemon Bulb, *Allii Macrostemis Bulbus*) and add the powder in quantities of one cun bi. Boil again until 1.5 sheng remains. Dividing into two warm doses illustrates the method.
Zhanglingshao said: All cases of Shaoyin disease with Ji Ni belong to deficiency-cold of Yang Qi. However, there are also cases where Yang Qi is internally constrained and cannot reach the exterior, causing Ji Ni. In such cases, Sini San (Four Reversal Powder) is indicated. Zhishi is round and fragrant, a suitable item for the Stomach. Thus, it can disseminate and unblock the Stomach collaterals. Shaoyao drains and disperses blood vessels in the collaterals. Gancao regulates the Middle Jiao. Chaihu initiates and guides Yang Qi outward. When Yang Qi flows freely, the four limbs become warm. For cough, it is Lung cold with rebellious Qi. Use Wuweizi and Ganjiang to warm and astringe Lung Qi. To treat diarrhea simultaneously, use warm herbs to scatter cold and sour herbs to astringe. For palpitations, it is Heart Qi deficiency. Add Guizhi to protect Heart Qi. For difficulty urinating, it is obstruction of the Water pathways. Add Fuling to promote water metabolism. For abdominal pain, it is interior cold. Add Fuzi to warm and dispel cold. For diarrhea with rectal heaviness, it is Yang Qi constrained in the lower jiao. Use Xiebai to unblock Yang Qi.