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Haizang said: Cholera accompanied by headache and fever, the pathogenic factor originates from wind-cold. The middle jiao is the dividing line where cold and heat are equally divided; if the pathogen resides slightly higher in the yang aspect, it manifests as a heat syndrome. If there is excessive drinking of water, Wuling San (Five-Ingredient Powder with Poria) is used to dissipate it. If the pathogen resides slightly lower in the yin aspect, it manifests as a cold syndrome. If there is no desire for water, Lizhong Wan (Regulate the Middle Pill) is used to warm the interior. Thus, similar to Shaoyin disease entering the interior, if it connects with the hand meridians transforming into heat, Dachengqi Tang (Major Order the Qi Decoction) is used to purge; if it connects with the foot meridians transforming into cold, Sini Tang (Frigid Extremities Decoction) is used to warm.

Haizang said: The Yin pulse chapters in Zhang Zhongjing's work were arranged according to Wang Shuhe's order, and the herbs are all found under the relevant clauses in Zhang Zhongjing's original classic.
Pressing feels present but vanishes upon lifting, Qi fills the three jiao while zang organs are deficient, cold qi fails to regulate causing stagnation in the three positions, only by unblocking the intestines and establishing the stomach can it be eliminated. This is the deep pulse on the right side.
The choppy pulse at the guan position indicates concurrent stomach Qi deficiency; at the middle position, blood scatters and cannot stay; if seen at the chi position, it meets with counter-cold, body coldness, and rumbling below the navel. This is the choppy pulse on the right side.
The weak pulse at the cun position indicates deficiency of the Yang pathway; if present at the guan position, Qi is often dispersed; if in the chi position, Yin Qi is exhausted, leading to soreness and pain radiating to the upper skin. This is the weak pulse on the right side.
The cun position pulse is tight and wiry like a single string, chest urgency and pain feel like rope pulling; if wiry at the guan position, cold is in the stomach, stagnant water fills the lower jiao and Dantian. This is the wiry pulse on the right side.
The faint pulse at the cun position indicates Qi invading upwards; at the middle position, depression and stagnation of Qi affect the heart; if seen at the chi position, accumulation occurs below the navel, body coldness leads to groaning after drinking water. This is the faint pulse on the right side.
Yin Toxic Cold Damage causes heavy body, stiff back, unbearable eye pain, urgent lower abdominal pain, blue-black lips, toxic vapors rushing to the heart making it uncontrollable, cold extremities with desire to vomit, throat discomfort, fine and deep pulse. If moxa is applied quickly below the navel ring, joy may be seen after six days.
The five acupoints below the navel are detailed under the section on indications for moxibustion.

Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes. Taiyin is the spleen; Shaoyin is the kidney; Jueyin is the liver.
What is the Taiyin syndrome? The Taiyin spleen meridian governs chest and diaphragm distension. The *Jiayi Jing* states: Pathogens arising from Yang are contracted from wind, rain, cold, and summer heat; pathogens striking Yin are contracted from diet, dwelling, and emotions. It also says: Rogue winds and empty pathogens are received by Yang; irregular diet and improper living habits are received by Yin. Received by Yang enters the fu organs; received by Yin enters the zang organs. Entering the six fu organs causes fever, inability to lie down regularly, and wheezing/calling out; entering the five zang organs causes fullness and obstruction, lower part presents as undigested diarrhea, prolonged becomes intestinal dysentery.
What is the Shaoyin syndrome? The Shaoyin kidney meridian governs fine and minute pulse, vexation but desire to sleep, or spontaneous diarrhea with thirst. The classic asks: Why does Shaoyin disease appear on day one or two? It means that during an epidemic, when pores are cold, pathogens enter the Yin meridians without passing through the Three Yang meridians.
Although Cold Damage involves Three Yin and Three Yang, generally manifesting in Yang is Taiyang disease, manifesting in Yin is Shaoyin disease. These two meridians are exterior-interior pairs and are most commonly affected. Yangming and Taiyin are less frequently affected. Shaoyang and Jueyin, being liver and gallbladder meridians, are even rarer. For any illness from one to twelve or thirteen days, if Taiyang syndrome persists, treat only Taiyang. If Shaoyin syndrome appears immediately upon onset, attack Shaoyin directly, without needing to transmit sequentially from Juyang (Taiyang).
Cold qi entering Taiyang causes fever and aversion to cold; entering Yin meridians causes only aversion to cold without fever. In Three Yin cold damage, mild cases use Lizhong Tang; slightly cold extremities or cold-damage diarrhea use Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction).
Slight coldness of finger and toe tips is called "Qing" (cold), which has not yet reached the severity for Sini Tang because the disease is light; only Lizhong or Dried Ginger type medicines should be taken.
For severe cases, use Sini Tang; for absent pulse, use Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction).
What is Jueyin? The Jueyin liver meridian governs excessive thirst, Qi rushing up to the heart causing pain and heat, hunger but no desire to eat, vomiting roundworms after eating, and unremitting diarrhea if purged. If Yin Qi alone is excessive and Yang Qi suddenly perishes, it becomes Yin Toxic. Symptoms include cold extremities, pounding pain in umbilical/abdominal region, body feeling like beaten by a staff, deep and rapid pulse, or vomiting/diarrhea. Emergency treatment is required: moxa below the navel and administer pungent-hot medicines to restore Yang Qi, resolving via profuse sweating. Ancients said: Pungent and sweet disperse and are Yang, referring to Guizhi Tang (Cinnamon Twig Decoction), Gancao, Ganjiang, Fuzi, etc., which can restore Yang Qi. Mild cases use pungent-sweet; severe cases use pungent-bitter-hot. Extreme Yin causes restlessness, a Yin syndrome resembling Yang. Scholars must distinguish by pulse.
Question: Cold extremities, pounding abdominal pain, sore throat, vomiting/diarrhea, body like beaten, or cold sweat/vexation/thirst, fine pulse nearly vanished—what is this?
This is named Yin Toxic. Yin Toxic disease begins with cold extremities, stiff back, sore throat, inability to swallow porridge, toxic vapors attacking the heart, heart/abdominal pain, shortness of breath, cold extremities, vomiting/diarrhea, body like beaten. Suitable formulas include Yindu Gancao Tang (Yin Toxic Licorice Decoction), Baizhu San (Atractylodes Powder), Fuzi San (Aconite Powder), Zhengyang San (Correct Yang Powder), Rougui San (Cinnamon Bark Powder), Huiyang Dan (Return Yang Pill), Fanyin Dan (Reverse Yin Pill), Tianxiong San (Heavenly Male Aconite Powder), Zhengyuan San (Correct Origin Powder), Tuiyin San (Push Away Yin Powder), etc., select as appropriate. Generally, Yin Toxic stems from kidney Qi deficiency and cold, or cold food injuring spleen, external wind-cold, internal latent Yin plus external cold, or external cold first then internal latent Yin. Both interior and exterior are Yin, so Yang Qi cannot guard, leading to headache, heavy waist, abdominal pain, eye pain, body fatigue, cold extremities, cold sweat on forehead/back of hands, or vexation/thirst, mental confusion as if lost. Within 2-3 days, one might walk, not feeling very heavy. Diagnosis shows six pulses all deep, fine, and rapid, chi position short/small, cun position possibly large.
Yang syndrome pulses are all floating and large, or deep-palpated large but not very rapid; this is not Yin syndrome. Generally, Yang Toxic Cold Damage pulses are wiry, surging, and rapid; Yin Toxic Cold Damage pulses are deep, fine, wiry, and rapid; this must be known.
If cool medicines are mistakenly taken, thirst increases, restlessness intensifies. For such symptoms, urgently take pungent-hot medicines; peace returns in one or two days.
If Yin Toxic deepens, symptoms become heavy, cold extremities, worsening abdominal pain, throat discomfort, epigastric fullness/hardness, vexation/thirst, continuous cold sweat.
Regarding the previous point where cool medicines caused increased vexation/thirst, hot medicines should be administered.
Yang excess causes hot body without sweat; Yin excess causes cold body with sweat. Qibo said: Yang excess causes hot body, closed pores, rough breathing, tossing about, no sweat but heat; Yin excess causes cold body, sweating, constant chilliness, frequent restlessness and cold, cold leads to cold extremities. (Chill means cold.)
The above passage explains the origin of Yin restlessness according to Qibo.
Occasional confused speech, blue-black nails and complexion, six pulses deep, fine, and rapid, seven beats per respiration or more. For such symptoms, quickly moxa Qihai or Guanyuan acupoints 300-200 times, aiming for warm extremities, concurrently take Zhengyang San, Huiyang Dan, Tianxiong San, Baizhu San. Interior-exterior connect, Yang Qi restores, resolving via profuse sweating.
Excessive Yin Toxic and sudden Yang Qi perishing constitutes Yin Toxic; excessive Yang and sudden Yin Qi perishing constitutes Yang Toxic. Generally, separation of Yin and Yang cannot restore righteous Qi without profuse sweating.
Yin and Yang are like husband and wife; each attaining balance brings harmony. If biased, each takes power to the extreme, leading to separation! Medicines attack pathogens; once pathogens leave, righteous Qi returns. This is like whipping to teach while wanting to coexist.
If Yin Toxic is deep, disease is critical, six pulses felt only pressing to bone, vanish upon lifting, eight beats per respiration or more, or uncountable. At this stage, medicines are difficult to use! Use onion-warming method on the navel, or moxa 300-500 times. If extremities do not warm, it is incurable. If extremities warm, take more hot medicines to assist. If Yin/Yang Qi returns, gradually reduce hot medicines and regulate.
If Yang Qi temporarily recovers, restlessness often appears. Do not administer cool medicines. For severe restlessness, give Fanyin Dan again to settle. Always remember this, do not err.
Question: Chest/diaphragm discomfort, fullness/obstruction, blue lips, cold extremities, deep/fine pulse, low mood, or abdominal pain—what is this?
This is Taiyin. Modern people often do not recognize Yin syndromes; seeing chest discomfort, they administer digestive aids, which is incorrect treatment. Generally, Yin syndrome results from cold food injuring spleen/stomach, affecting Yin meridians, governing chest/diaphragm fullness. Face and lips lack luster, cold extremities, deep/fine pulse, low mood, not due to desires, but internal injury from cold food or damaging stomach Qi, forming Yin syndrome. Administering Radix Crotonis Seed (Baidu) again worsens chest discomfort, causes vomiting/diarrhea, leading to death within 1-2 days, due to ignorance of cold invading Taiyin spleen meridian.
Right-side chest discomfort: Do not use digestive aids; purging leads to glomus.
Haizang said: Yin syndrome chest discomfort has no pathological form; administering Radix Crotonis Seed creates pathological form. Mildly turns to glomus, severely to consumptive disease, critically leads to death in 1-2 days. Thus, *Qin Ren Shu* states: Pills containing Radix Crotonis Seed only attack food stagnation!
Question: What if irregular diet causes chest discomfort, cold invading Yin meridians, how to treat?
Answer: Urgently use Lizhong Tang added with Qingpi and Chenpi, cut small like hemp seeds, take 1-2 doses, chest discomfort resolves. Zhishi Lizhong Wan (Immature Bitter Orange Regulate the Middle Pill) and Wuji San (Five Accumulations Powder) are especially good.
Wuji San addresses exterior syndrome simultaneously. If no exterior syndrome, or transmission from interior to highest exterior, this medicine is suitable. Without exterior, this is inappropriate; using Lizhong method is sufficient.
Question: Fine/minute pulse, desire to vomit but unable, vexation but desire to sleep, spontaneous diarrhea with thirst after 6-7 days—what is this?
This is Shaoyin. Shaoyin disease features desire to vomit but unable, vexation but desire to sleep, spontaneous diarrhea with thirst after 6-7 days. This is deficiency, hence drawing water to save oneself. If urine is white, Shaoyin disease signs are complete. White urine indicates lower jiao deficiency with cold, inability to control water, hence color is white. Sini Tang is primary.
Comparing Yang syndrome and Shaoyin syndrome: Dry mouth/tongue with thirst requires urgent purging, do not delay, use Dachengqi Tang. If pulse is deep and slow, require warming, use Sini Tang. Dry mouth/tongue/thirst indicates heat; deep/slow pulse distinguishes cold.
Shaoyin disease belongs to kidney, ancients called it Kidney Cold Damage. Kidney Cold Damage with dry mouth/tongue/thirst should be purged urgently. Generally, Kidney Cold Damage often lacks interior/exterior heat. If extremely vexed/silent, avoiding light, occasional abdominal pain, deep/fine pulse, traditionally use Sini Tang. Ancients feared heat and did not use it hastily, saying if kidney disease with residual heat, Huanglian Longgu Tang (Coptis and Dragon Bone Decoction) can be taken. If over 10 days, diarrhea stops, slight cold extremities, no heat signs, Zengsun Sishun San (Modified Four-Gentle Smooth Powder) can be taken.
Regarding the previous point "kidney disease with residual heat," observe duration; do not assume heat just because it appears. Not using Sini Tang but Huanglian, or using Sishun when extremities are cold, is not entirely accurate.
Comparing Yang syndrome and Shaoyin disease: If aversion to cold, fatigue, frequent self-vexation, dislike thick clothing, Da Chaihu Tang purges. Shaoyin disease, initially presenting with fever and deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) induces slight sweating. Shaoyin disease, 2-3 days in, usually lacking Yang syndrome signs, still requires slight sweating, use Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction). Scholars must know this.
Question: Slight body heat, restlessness, red face, deep/micro pulse—what is this?
This is Yin syndrome resembling Yang. Yin causes restlessness, heat causes cold extremities, extremes reverse. Generally, distinguish by pulse: rapid numbers indicate heat, slow numbers indicate cold; this is most reliable.
The above sentence serves as a standard for the world.
Suppose slight body heat, restlessness, red face, deep/micro pulse—all are Yin syndromes. Slight heat is due to interior cold; restlessness is due to Yin excess; red face (floating Yang) is due to lower deficiency. Treators ignoring pulse mistake vacuous Yang restlessness for excess heat, giving cool medicines, depleting Qi and causing major disease. *Waitai Miyao* says: Yin excess causing restlessness, desiring to sit in wells, treat with hot medicines. Zhang Zhongjing's Shaoyin syndrome with red face uses Sini Tang adding Congbai (Green Onion Bulb).
Above: Exterior heat, interior cold, restlessness, do not use cool/hot indiscriminately.
Question: Cold body, fine/deep/rapid pulse, restlessness without desire to drink—what is this?
This is Yin Excess Repelling Yang. Cold Damage Yin Excess Repelling Yang: patient cold body, fine/deep/rapid pulse, restlessness without desire to drink. If desiring to drink, it is not this. Without desire to drink, use Pili San (Thunderbolt Powder). Restlessness stops shortly, sleep follows, sweating ensues, recovery occurs. This medicine disperses cold Qi, then hot Qi rises, sweating resolves disease. Huoyan San (Flame Powder), Dansha Wan (Cinnabar Pill) also treat it.
Question: Heavy body, shortness of Qi, Yin swelling entering interior, abdominal cramping pain, heat rushing to chest, heavy head unwilling to lift, flowers before eyes, women have urgency in interior, waist/hips connecting to abdominal pain—what is this?
This is Yin-Yang Exchange. After recovery from Cold Damage, Yin-Yang Qi not harmonized, sexual intercourse causes Yin swelling, abdominal cramping pain, women have urgency, waist/hip/abdominal pain, named Yin-Yang Exchange. If man newly recovered, not fully restored, woman joins him and gets sick, it is Yang Exchange; if woman newly recovered, not fully restored, man joins her and gets sick, it is Yin Exchange. Two men or two women do not exchange. Called Exchange because Yin-Yang move each other intensely, pestilential toxin attaches to person like swapping. Symptoms: heat rushing to chest, heavy head unable to lift, flowers before eyes, limb spasms, lower abdominal cramping, clenched fists lead to death. Some do not die immediately. If lower abdominal urgency, heat rushing to chest, heavy head, joints separating, meridians slack, Qi/Blood deficient, marrow exhausted, strength diminishes, lying in bed unable to move, needs assistance to rise. If surviving months/years, Shao Kun San (Burnt Underwear Powder), Shu Fen Tang (Mouse Dropping Decoction), Zhupi Tang (Bamboo Peel Decoction), Ganjiang Tang (Dried Ginger Decoction), Qingzhuru Tang (Green Bamboo Sap Decoction), Danggui Baizhu Tang (Angelica and Atractylodes Decoction) can be selected. *Sun Zhao Koujue* treats Yin Excess Repelling Yang: Cold Damage patient restless/hot, no desire to drink, use Pili San.
One piece of Fuzi (Prepared Aconite Root), burned to ash retaining nature, ground to powder, mixed with honey water, taken as one dose for cure. This forces dispersion of cold Qi, then hot Qi rises, sweating resolves disease.