The main manifestation of Shaoyin disease is: the pulse is faint and fine, and the patient has a strong desire to sleep.

Among the Three Yang meridians, Shaoyang serves as the pivot; among the Three Yin meridians, Shaoyin serves as the pivot. The Xian (bowstring) pulse represents the image of Wood. A pulse that is floating, Xian, and fine indicates the nascent stage of Yang (Yang Shao). The Wei (faint) pulse represents the image of Water. A pulse that is deep, Wei, and fine indicates the nascent stage of Yin (Yin Shao).

Wei Qi (Defensive Qi) circulates in the Yang aspect resulting in wakefulness, and circulates in the Yin aspect resulting in sleep. Wei Qi circulates twenty-five cycles daily, usually starting from between the Foot-Shaoyin Kidney meridian, and distributing separately to the Zang-Fu organs. Now, in Shaoyin disease, Wei Qi enters the Yang aspect more frequently, hence the desire to sleep. "Desire to sleep" refers to the patient's subjective feeling of drowsiness, not actual deep sleep. The outline syndrome of Shaoyang disease is described with exquisite subtlety.

In Shaoyin disease, if there is a desire to vomit but inability to do so, mental restlessness, and a desire to sleep, and after five or six days spontaneous diarrhea accompanied by thirst occurs, it belongs to Shaoyin disease. Due to internal deficiency and cold, the patient draws water for self-rescue. If the urine is clear and white, the manifestations of Shaoyin disease are fully present. The reason for clear white urine is deficiency-cold in the Lower Jiao (Lower Burner), which fails to control water metabolism.

A desire to vomit without ability to do so results from pivot pathology causing dysfunction of opening and closing, similar to the frequent vomiting seen in Shaoyang disease. The Shaoyang meridian descends through the chest, causing chest irritability, indicating the disease is at the interior of the exterior (half-exterior/half-interior). The Shaoyin meridian connects with the Heart, causing mental distress, indicating the disease is at the interior of the interior (deep interior).

Desire to vomit without ability, and desire to sleep without ability, are images of Shaoyin pivot dysfunction. At five or six days, this is precisely the period when Shaoyin disease manifests. Taiyin disease transforms according to Dampness, hence spontaneous diarrhea without thirst; Shaoyin disease transforms according to Fire, hence spontaneous diarrhea with thirst. Shaoyin governs the Lower Jiao, responsible for transporting fluids and storing essence. When the Lower Jiao is deficient, the Yang within Kan (Kidney Yang) cannot guide water upward to Li (Heart), resulting in mental distress and thirst. If the gate is not closed, spontaneous diarrhea occurs. Inability to control fire stems ultimately from inability to control water. However, one must examine the urine, because Shaoyin governs Water: heat causes yellow/red urine, while cold causes clear/white urine. If one does not investigate this carefully, treating only the excess-heat of the Upper Jiao while ignoring the deficiency-cold of the Lower Jiao will result in the heat pathogen remaining while diarrhea persists.

Note: Spontaneous diarrhea without thirst belongs to Taiyin disease, whereas thirst indicates Shaoyin disease.

In Shaoyin disease, if the pulse is deep, fine, and rapid, the disease is in the interior, and sweating methods should not be used.

The previous clause detailed the symptoms, and this clause details the pulse. A floating pulse indicates the disease is in the exterior, yet sometimes there are interior syndromes, such as a floating and large pulse with hardness below the heart and heat belonging to the Zang organs. A deep pulse indicates the disease is in the interior, yet sometimes there are exterior syndromes, such as Shaoyin disease presenting with fever. When the Shaoyin pulse is deep, warming is indicated; however, if the pulse is rapid, it indicates heat, and warming is contraindicated. Rapid pulse indicates involvement of the Zang organs, i.e., interior location, making sweating strictly contraindicated. Must one not examine meticulously and distinguish accurately?

In Shaoyin disease, if the pulse is faint, sweating is contraindicated because it leads to collapse of Yang. If Yang is already deficient and the Chi (cun kou) pulse is weak and choppy, purgation is also contraindicated.

Shaoyin disease is contraindicated for both sweating and purgation, similar to Shaoyang disease. However, due to abnormal fever, Ma Huang Tang (Ephedra Decoction) is used for mild sweating; due to severe interior heat, Cheng Qi Tang (Order the Qi Decoction) variants are used for urgent purgation. This disease reverses its root, so the treatment also reverses its root. Faint pulse indicates absence of Yang; choppy pulse indicates scant blood. Sweating causes loss of Yang; purgation causes loss of Yin. Since those with Yang deficiency cannot sweat, they certainly cannot be purged; the character "fu" (again/furthermore) clarifies this. Those with weak and choppy Chi pulses cannot be purged, nor can they be sweated. To say that absence of Yang implies evil-Yin and thus should be purged is a grave error.

If the patient's pulse is tight in all three positions (Cun, Guan, Chi), yet sweating occurs abnormally, this is collapse of Yang. This belongs to Shaoyin disease, and according to the method, sore throat accompanied by vomiting and diarrhea should occur.

Taiyang and Shaoyin have different Yang qualities; sometimes pulses are same but syndromes differ, sometimes pulses and syndromes are identical. Deciding whether to follow the pulse or the syndrome requires careful examination. Deep pulse with fever is a similar syndrome for Taiyang and Shaoyin, as stated by predecessors. Tight pulse in all three positions is a similar pulse for Taiyang and Shaoyin, though few know this. Tight pulse indicates Cold and should belong to Shaoyin. However, disease originating from Yin should not have sweating; if sweating occurs abnormally, it is extreme Yin resembling Yang. Generally, Taiyang governs the exterior; Yang deficiency prevents sweat production, hence fever without sweating. Shaoyin governs the interior; Yin deficiency generates interior heat, hence no body heat but abnormal sweating. Collapse of Yang means deficient Yang fails to return; pathogens arise from Shaoyin failing to store. Thus, the Upper Jiao transforms into Fire causing sore throat and vomiting, while the Lower Jiao, due to Yin deficiency, causes persistent diarrhea. Ba Wei Shen Qi Wan (Eight-Ingredient Rehmannia Pill) should be used.

If the pulse is tight in all three positions, with breath exiting the mouth, dry lips and mouth, nasal discharge, cold feet while lying down, and a slippery coating on the tongue, do not treat rashly. After seven days, if the patient has slight fever and warm hands and feet, this indicates impending resolution. Or, if after eight days there is sudden high fever, this is difficult to treat. If chills are present, vomiting will likely occur; if abdominal pain is present, diarrhea will likely occur.

This is the canonical text of Shaoyin disease, consistent with the context. Wang Shuhe's *Mai Jing* omitted the words "Shaoyin". The Shaoyin meridian connects to the Lung, which governs the nose, hence nasal discharge; Shaoyin meridian connects to the root of the tongue, hence slippery tongue coating; Shaoyin major collaterals inject into various collaterals to warm the calves, hence cold feet. These symptoms resemble collapse of Yang, but are not named so because there is no external sweating or internal vomiting/diarrhea. Breath exiting mouth, dry lips/mouth, nasal discharge indicate interior Heat. Tight pulse in all positions, slippery tongue coating, cold feet indicate interior Cold. Because Shaoyin is the pivot, cold and heat contend. Although the disease originates from Yin, the semi-exterior/semi-interior nature of the mouth, tongue, lips, and nose corresponds exactly to the semi-exterior/semi-interior nature of the mouth, throat, and eyes in Shaoyang. Treatment differs from Shaoyang; one must understand spiritually. Methods of sweating, vomiting, purging, warming, clearing, and tonifying should not be used rashly. Better to remain calm and wait. If after seven days, Yang returns slightly, with slight fever and warm extremities, Yin resolves by gaining Yang support, Yin and Yang harmonize, and the tight pulse disappears. If slight fever persists and after eight days high fever appears, this is late onset. One must fear excessive accumulated heat, potentially leading to carbuncles/pus or bloody stools, making it difficult to treat. If after seven days the patient cannot generate fever, and with tight pulses in all positions, chills worsen, Cold is severe in the exterior, affecting the Upper Jiao, leading to vomiting. If abdominal pain worsens, Cold is severe in the interior, affecting the Middle Jiao, leading to diarrhea.

When the pulse is tight in all three positions, progressing to vomiting and diarrhea, if the pulse alone does not resolve, but the tightness disappears and the person feels comfortable, this indicates impending resolution.

With tight pulses in all positions progressing to vomiting and diarrhea, if the tight pulse remains, this is collapse of Yang. If the tightness disappears, vomiting and diarrhea stop naturally, and the person becomes safe. This is the method of syndrome differentiation based on pulse.

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, this indicates impending resolution. Although there is irritability and diarrhea, recovery will surely occur.

The previous clause describes collapse of Yang pulse and syndrome; this clause describes returning Yang pulse and syndrome. The "fan" (reverse/opposite) in the previous clause denotes rebellion; here it denotes restoration. Observing "fan wen" (reverse warmth), we know extremities were previously cold. Faint is the original Shaoyin pulse; irritability and diarrhea are original Shaoyin syndromes. At seven or eight days, Yin ends and Yang returns; tightness goes and faintness appears, known as the arrival of Grain Qi, slow and harmonious. Irritability means Yang has returned to the Center; warmth means Yang has spread to the four extremities. With Yin balanced and Yang secured, irritability and diarrhea cease spontaneously.

In Shaoyin Wind Strike, if the Yang position (Cun) pulse is faint and the Yin position (Chi) pulse is floating, recovery is imminent.

Faint Yang position pulse restores the original substance of Shaoyin; floating Yin position pulse indicates the return of Yang within Kan. Faint means not tight; floating means not deep, referring to the sudden faintness and disappearance of tightness mentioned earlier. Pathogens coming from outside exit from inside, hence recovery.

The time when Shaoyin disease tends to resolve is from Zi hour to Yin hour.

Heaven generates Water with One, opening at Zi hour; thus Shaoyin governs Zi hour.

In Shaoyin disease, if diarrhea stops spontaneously, the patient is averse to cold and curls up, but hands and feet are warm, the condition is treatable.

In Shaoyin disease, if the patient is averse to cold, curls up, has diarrhea, and hands and feet are cold (reversal cold), the condition is untreatable.

Shanghan (Cold Damage) prioritizes Yang. Not only do Yin syndromes showing Yang pulses indicate life, but Yin diseases showing Yang signs are treatable. The back is Yang, the abdomen is Yin. Excess Yang causes restlessness; Excess Yin causes curling up. If diarrhea occurs but hands remain warm, Yang has returned, hence treatable. If diarrhea persists and hands/feet are reversal cold, it is Pure Yin without Yang. As stated, when Qi of the Six Fu organs perishes externally, hands and feet are cold; when Qi of the Five Zang organs perishes internally, diarrhea is uncontrollable.

In Shaoyin disease, if averse to cold, curling up, occasionally irritable, and desiring to remove clothing/blankets, the condition is treatable.

In Shaoyin disease, if extremities are reversal cold, averse to cold, curling up, pulse is absent, and there is irritability without distress, death ensues.

Excess Yang causes irritability (Fan); Extreme Yin causes restlessness/agitation (Zao). Fan belongs to Qi; Zao belongs to Form. Fan arises internally; Zao manifests externally; form follows Qi movement. Occasional irritability indicates gradual return of Yang; irritability without distress indicates Qi has perished first, leaving only form.

In Shaoyin disease with vomiting and diarrhea, if hands and feet are not reversal cold, but fever occurs, death does not ensue; if the pulse is absent, moxa should be applied to the Shaoyin meridian seven times (zhuang).

In Shaoyin disease with vomiting, diarrhea, irritability, and reversal cold, death ensues.

Upper vomiting and lower diarrhea indicate Stomach Yang about to collapse; hands and feet not reversal cold indicate the root of all Yang remains; presence of fever indicates Defensive Yang still exists. Urgent moxibustion on Shaoyin allows pulse recovery and cessation of vomiting/diarrhea. If vomiting/diarrhea accompany irritability and reversal cold, it is Pure Yin without Yang, irrecoverable.

The Shaoyin arterial pulse is at Taixi (KI3), symbolizing uninterrupted flow. The acupoint is located in the depression above the posterior malleolus where the artery beats; it treats reversal cold of hands/feet and cold reaching joints. It is the Yuan-Source point of Shaoyin. If this pulse perishes, death occurs. Located two cun above the posterior malleolus in the arterial depression is the Jing-River point of Shaoyin; moxibustion here can restore the major pulse.

In Shaoyin disease, if the pulse is faint and choppy, with vomiting and sweating, and frequent bowel movements with small amounts of stool, one should warm the upper part using moxibustion.

In Shaoyin disease, if the pulse is deep, faint, and fine, with desire to sleep, sweating, no irritability, and spontaneous desire to vomit; upon reaching five or six days, if spontaneous diarrhea occurs accompanied by irritability and inability to sleep, death ensues.

Faint and choppy pulse, vomiting, and sweating indicate Yang has collapsed. Frequent but small-volume stools without diarrhea indicate Lower Jiao Yang still exists. Urgently moxa Baihui (GV20) to warm the upper part, then Yang may recover. Deep, faint, fine pulse is the original Shaoyin pulse; desire to sleep and vomit are original Shaoyin syndromes. One should feel irritable but instead feels no irritability; heart is not irritable but instead sweats; signs of Yang collapse appeared from the beginning. Spontaneous diarrhea at five or six days, accompanied by irritability and inability to sleep, indicates fading Yang nearing extinction, with no hope of life. Similarly, averse to cold and curling up: if diarrhea stops and extremities warm, treatable; if diarrhea persists and extremities reversal cold, untreatable. Occasionally irritable, desiring to remove clothes: treatable; not irritable but agitated, reversal cold, absent pulse: death. Same vomiting/diarrhea: if extremities not reversal cold but feverish, no death; if irritable and reversal cold, death. Same vomiting/sweating: if bowel movements are infrequent/small volume, treatable; if spontaneous diarrhea with irritability and inability to sleep, death. Yin and Yang are roots of each other; Yin containing Yang leads to life; without Yang, death; solitary Yin cannot generate life. Therefore, among the Six Meridians, Shaoyin is the pivot.

In Shaoyin disease, if diarrhea stops but dizziness occurs, with periodic sensations of being overwhelmed/blinded, death ensues.

Patients with dizziness who sweat spontaneously recover. Now, with dizziness and periodic overwhelming sensations, Clear Yang Qi has detached. This is not Yang returning stopping diarrhea, but exhaustion of food/water, with nothing left to move.

In Shaoyin disease, after six or seven days, if respiration is high (superficial/shallow), death ensues.

Respiration is the moving Qi between the Kidneys, the root of Zang-Fu, the root of meridians, the stem of breathing, and the source of generating Qi in the San Jiao. High respiration means air exits Heart and Lung but cannot enter Liver and Kidney; generating Qi has perished internally. Among the Six Meridians, only Shaoyin lists death syndromes explicitly; other meridians only mention difficult-to-treat cases. Thus, Shaoyin disease is the pass of life and death.

After six or seven days of illness, if pulses at hand and foot (three positions) are all present, with great irritability, locked jaw unable to speak, and agitation, resolution is certain. If the pulse is harmonious, and the patient is greatly irritable, with yellow color on the inner margin of the eyelids, this also indicates impending resolution.

Pulse originates in Kidney, convenes in Lung; if Kidney Qi perishes, pulse is absent. Presence of pulses in all three hand and foot positions indicates patent pulse channels, rooted and fundamental, not sudden emergence. Great irritability and agitation indicate Yin emerging into Yang, not extreme Yin flare-up. Locked jaw unable to speak is due to initial pulse recovery, unregulated Ying-Blood, and Spleen stagnation failing to transport. If the arriving pulse is harmonious, even with unresolved great irritability, there is little cause for concern. Observe the inner margin of the eyelids, belonging to Spleen; if yellow without mixed colors of other Zang organs, Zhi Yin (Extreme Yin/Spleen) is not deficient, and locked jaw is not concerning. This relies on Spleen as mother of Five Zang organs, and Earth Qi supporting below Water level.