(Throat pain, vomiting, vomiting and diarrhea, diarrhea, desire to sleep/drowsiness, dry mouth and throat)

The characteristic of Shaoyin disease is the desire to sleep. The patient feels like vomiting but cannot, experiences irritability, and desires to sleep. After five or six days, spontaneous diarrhea accompanied by thirst indicates a pattern suitable for Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction). Although Yin patterns generally do not utilize Ephedrae Herba (Mahuang), if Shaoyin disease begins with contrary fever and a deep pulse, Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) may be used. Among the Six Channels, Shaoyin patterns are particularly difficult to differentiate. The classic text states only that the pulse is deep and fine, there is drowsiness, and frequent urination; however, if there is aversion to cold in the back and cold extremities, this can be recognized without extensive inquiry. Alternatively, although severe aversion to cold exists, the patient may not perceive it as cold; or they may prefer thick clothing and proximity to fire, often nodding off, yet deny feeling cold when asked. It should be understood that preferring thick clothing manifests as aversion to cold, and nodding off manifests as "desire to sleep." The pulse may be faint and fine or deep and choppy. In cases where both Yin and Yang pulses are tight, this is often due to pre-existing internal heat combined with external invasion by cold pathogens. Therefore, one must primarily observe the external manifestations and use warm herbs to expel the pathogen. If Yang pathogens transmit inward, or if Shaoyin itself develops heat patterns requiring purgation, emesis, or harmonization, these are common. Although Zhang Zhongjing did not explicitly list slippery, full, deep, or rapid pulses as indications for purgation, such indications can be inferred from the clinical presentation. Pulse and symptoms must correspond. Although sometimes a deep, faint, fine, or slow pulse contradicts the need for purgation, cooling herbs to nourish Yin and subdue Yang may lead to recovery. If recovery does not occur, purgation should only be considered once the pulse becomes forceful. If symptoms indicate urgent purgation but the pulse does not match the condition, mild purgation is appropriate. While heavy purgation is avoided, delay is also inadvisable. The art of adapting to changing conditions lies in spiritual comprehension, known only to skilled physicians and not to mediocre practitioners. The treatment principles for the Six Channels share similarities, except that Shaoyin transmission resembles Taiyang. For instance, Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction), Sini San (Frigid Extrements Powder), and Zhenwu Tang (True Warrior Decoction) all have modification formulas for accompanying symptoms, similar to Xiao Qinglong Tang (Minor Green Dragon Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction) in Taiyang, yet few understand these subtleties.

Treatment methods for the Shaoyin meridian include sweating, purging, inducing vomiting, warming, harmonizing, resolving, moxibustion, and acupuncture.
Sweating methods: Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction); Mahuang Fuzi Gancao Tang (Ephedra, Prepared Aconite, and Licorice Decoction).
Purgative methods: Dachengqi Tang (Major Order the Qi Decoction); Didang Tang (Defend Against Stasis Decoction).
Emetic method: Gouti San (Melon Spore Powder).
Warming methods: Sini Tang (Frigid Extremities Decoction); Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction); Fuzi Tang (Prepared Aconite Decoction); Taohua Tang (Peach Blossom Decoction); Wuzhuyu Tang (Evodia Decoction); Baitong Tang (White Onion Decoction); Baitong Jia Zhuyedan Tang (White Onion Decoction with Pig Bile); Zhenwu Tang (True Warrior Decoction); Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction).
Harmonizing/Resolving methods: Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction); Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction); Zhufu Tang (Pig Skin Decoction); Gancao Tang (Licorice Decoction); Jiegeng Tang (Platycodon Decoction); Kujiu Tang (Bitter Wine Decoction); Banxia San (Pinellia Powder); Zhuling Tang (Polyporus Decoction); Sini Tang (Frigid Extremities Decoction).
Moxibustion: Moxibustion on Shaoyin meridians.

The Classic states: When both Cun and Chi pulses are deep, Shaoyin is affected. Because the Shaoyin meridian connects the Kidney, links to the Lung system, and reaches the root of the tongue, symptoms include dry mouth, dry tongue, and thirst. The hallmark of Shaoyin disease is a faint, fine pulse and drowsiness. Shaoyin disease presenting with desire to vomit without success, irritability, and drowsiness, followed by spontaneous diarrhea and thirst after five or six days, belongs to Shaoyin. Due to deficiency, the patient seeks water to self-rescue. If urine is colorless, the Shaoyin pattern is fully established. Colorless urine results from lower Jiao deficiency-cold failing to control fluids. If a patient has tight Yin and Yang pulses but sweats spontaneously, this indicates collapse of Yang. This belongs to Shaoyin disease; clinically, it should present with throat pain, vomiting, and diarrhea. If Shaoyin disease begins with contrary fever and a deep pulse, Mahuang Fuzi Xixin Tang is indicated. (Zhang's commentary: Some argue this describes transmitted pathogenic factors moving from the Three Yang to Taiyin, then to Shaoyin. Why does it say "just acquired" instead of "transmitted"? Transmission reflects the ancient masters' intent to clarify principles and establish laws; one should not interpret it rigidly. While Yang diseases often transmit sequentially from Taiyang to Jueyin, Yin diseases can also begin with spontaneous non-thirsty diarrhea via Taiyin. Here, Shaoyin disease begins with fever, indicating direct entry into Shaoyin, hence "just acquired." Since Shaoyin typically lacks body heat, its presence is termed "contrary fever," meaning heat appearing where it shouldn't. As the pathogen is superficial initially, Mahuang Fuzi Xixin Tang is used to disperse it.)

If Shaoyin disease presents with a fine, deep, and rapid pulse, the pathology is interior, and sweating is contraindicated. (Cheng Wuji's commentary: If Shaoyin disease begins with fever and a deep pulse, the pathogen is in the meridian, and sweating is permissible. However, a fine, deep, rapid pulse indicates interior pathology, making sweating contraindicated. Note: Yin pulses are deep and fine; the addition of rapidity might mislead one to suspect heat. This is presented to warn against such error. The "rapid" here refers to the rapidity within a deep/fine context, akin to the Classic's statement that "rapid indicates deficiency," not the rapidity associated with heat-induced irritability. Cheng's explanation lacks clarity on this point.)

If Shaoyin disease presents with a faint pulse, sweating is contraindicated as it leads to Yang collapse. If Yang is already deficient and the Chi pulse is weak and choppy, purgation is also contraindicated. (A faint pulse indicates Yang collapse and exterior deficiency, prohibiting sweating; a weak and choppy pulse indicates Yin collapse and interior deficiency, prohibiting purgation.)

If Shaoyin disease is acquired two to three days prior, Mahuang Fuzi Gancao Tang is used for mild sweating because there are no interior syndromes at this stage. (This means that in the first few days, Shaoyin signs appear; since the pathogen is not deep, sweating is required. However, lacking Yang-excess signs, only mild sweating is applied.)

Mahuang Fuzi Gancao Tang Formula:
Ephedrae Herba (Mahuang, removed nodes), Zizyphi Fructus (Gancao, honey-fried, 2 liang each), Prepared Aconiti Lateralis Radix (Fuzi, one piece, fried, skin removed, broken into eight pieces). Boil these three ingredients in seven sheng of water. First boil Mahuang until boiling once or twice, remove the scum. Add other herbs and boil to obtain three sheng. Strain and take one sheng warm, three times daily. (The sweetness of Mahuang and Gancao disperses exterior cold; the pungency of Fuzi warms internal cold.)

Pang Anshi's commentary: Regarding Shaoyin disease with a deep pulse, one must determine the nature of the depth. If deep and tight, sweating disturbs the meridians. Fine, deep, and rapid pulses indicate interior pathology, contraindicating sweating. Examining this pulse, it may be deep with wheezing, or deep and faint, not significantly small. This indicates exterior cold with unresolved interior qi, causing fever in the exterior while the pulse reflects the interior. Thus, mildly pungent herbs are used to warm and disperse, inducing slight sweating.

If Shaoyin disease is acquired one or two days prior, and the mouth feels normal but there is aversion to cold in the back, moxibustion should be applied, and Fuzi Tang is indicated. (The back is the mansion of the chest; Yang Qi originates in the chest and circulates through the back. The Inner Canon states: The back is Yang, the abdomen is Yin. Insufficiency of Yin and Yang Qi with excess Yin-cold causes aversion to cold in the back. If wind-cold is in the exterior, whole-body cold occurs. Isolated back aversion to cold indicates Yin-cold excess, as seen here. Alternatively, if Yin Qi is insufficient and Yang Qi sinks internally into Yin, leaving the exterior Yang newly deficient, there may be slight back aversion to cold. This corresponds to the Classic's description of "cold damage with no significant heat, dry mouth/thirst, irritability, slight back aversion to cold," treated with Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction). One case is Yin-cold excess; the other is Yang sinking. Differentiation relies on oral moisture: Yin-cold preserves fluids (normal mouth), while Yang sinking consumes fluids (dry mouth/thirst). Distinguishing Yin/Yang and cold/heat requires careful examination of oral dryness/moisture.)

Fuzi Tang Formula:
Prepared Aconiti Lateralis Radix (Fuzi, two pieces, fried, skin removed, broken into eight pieces), Atractylodis Macrocephalae Rhizoma (Baizhu, 4 liang), Poria (Fuling), Paeoniae Radix (Shaoyao, 3 liang each), Ginseng Radix et Rhizoma (Renshen, 2 liang). Boil these five ingredients in eight sheng of water to obtain three sheng. Strain and take one sheng warm, three times daily. (Pungency disperses; Fuzi's pungency dispels cold. Sweetness moderates; Fuling, Renshen, and Baizhu's sweetness tonifies Yang. Sourness astringes; Shaoyao's sourness supports Yin. This balance prevents deviation toward extreme Yin or Yang, ensuring fluid equilibrium without dominance.)

If Shaoyin disease persists beyond two to three days, with heart vexation and inability to sleep, Huanglian Ejiao Tang is indicated. (Formula see "Inability to Sleep"). If Shaoyin disease lasts six to seven days with abdominal distension and constipation, urgent purgation is required using Dachengqi Tang.

If Shaoyin disease presents with cold extremities, and the patient has cough, palpitations, dysuria, abdominal pain, or sensation of heaviness in defecation, Sini San is indicated.

Sini San Formula:
Zizyphi Fructus (Gancao, honey-fried), Aurantii Fructus Immaturus (Zhishi, broken, soaked in water, fried dry), Bupleuri Radix (Chaihu), Paeoniae Radix (Shaoyao, equal parts). Pulverize these four ingredients (ten parts each). Mix with rice water (Baiyin) and take one fangcun bi, three times daily. For cough, add Schisandrae Fructus (Wuweizi) and Zingiberis Rhizoma (Ganjiang), half part each, also treating diarrhea. For palpitations, add Cinnamomi Ramulus (Guizhi), half part. For dysuria, add Poria (Fuling), half part. For abdominal pain, add Prepared Aconiti Lateralis Radix (Fuzi), one piece, fried and split. For sensation of heaviness in defecation, first boil Allii Macrostemonis Bulbus (Xiebai) in five sheng of water with three sheng of water to reduce to three sheng, strain, then add three fangcun bi of Sini San to the decoction, boil to one and a half sheng, divide into two warm doses.

For Shaoyin disease with cold extremities and post-diarrhea heaviness, use Sini San plus Xiebai. If diarrhea leads to absent pulse, use Tongmai Sini Tang or Baitong Jia Zhuyedan Tang. (Formulas discussed under Diarrhea). If body and bone joints ache with a deep pulse, Fuzi Tang is suitable. If Shaoyin disease presents with a deep pulse, urgent warming with Sini Tang is indicated. (Formula see Diarrhea). If Shaoyin disease presents with body pain, cold extremities, joint pain, and deep pulse, Fuzi Tang is indicated. If Shaoyin disease presents with deep pulse and fever, Mahuang Fuzi Xixin Tang is suitable.

Shaoyin disease resolves between Zi (11 PM-1 AM) and Yin (3 AM-5 AM) hours.
Shaoyin disease with aversion to cold, curling up, spontaneous vexation, and desire to remove clothing/blankets is treatable.
Shaoyin disease where diarrhea stops but vertigo and occasional dizziness occur are fatal.
Shaoyin wind-stroke with faint Yang pulse and floating Yin pulse indicates impending recovery.
Shaoyin disease with faint, fine, deep pulse, desire to sleep, sweating without vexation, and desire to vomit, progressing to spontaneous diarrhea, restlessness, and insomnia after five to six days, is fatal.
Shaoyin disease with high-pitched respiration after six to seven days is fatal.
Shaoyin disease with tight pulse, progressing to spontaneous diarrhea on day seven or eight, where the tight pulse suddenly becomes faint and hands/feet warm, indicates impending resolution. (Discussion see Diarrhea).
Shaoyin disease persisting eight to nine days with whole-body and hand/foot heat indicates heat in the Bladder, likely leading to hematochezia.
Shaoyin disease with cold extremities and no sweat, forcibly induced sweating will disturb blood, causing hemorrhage from mouth, nose, or eyes, termed Lower Jue and Upper Exhaustion, which is extremely difficult to treat.
Shaoyin disease with cold extremities, aversion to cold, curling up, absent pulse, no vexation but agitation, is fatal.
Shaoyin disease with aversion to cold, curling up, diarrhea, and cold extremities is untreatable.

Dai Yuanli's commentary: Symptoms like dizziness with desire to vomit, irritability, preference for sleep, spontaneous diarrhea with dry mouth/thirst, or normal mouth with back aversion to cold belong to the Shaoyin meridian. Medication for Shaoyin differs by Yin/Yang. Spontaneous diarrhea with thirst suggests Yang-heat transmitting to the Kidney; since the Shaoyin meridian connects to the tongue root, this causes diarrhea, dry mouth, and thirst. Zhuling Tang drains heat from the Kidney. If ineffective, purgation via stool is needed, traditionally using Dachengqi Tang. If Dachengqi Tang is unsuitable, Xiaochengqi Tang (Minor Order the Qi Decoction) or Baitouweng Tang (Pulsatilla Decoction) may be used. These are "Yang contained within Yin" formulas.
For heaviness in defecation with cold extremities, first decoct Scallion White (Congbai) in water, strain, then decoct Sini San. Modify as follows: Cough adds Wuweizi and Ganjiang; Palpitations add Guizhi; Dysuria adds Fuling; Abdominal pain adds Shu Fuzi (Prepared Aconite). If diagnosed as diarrhea with undigested food and cold extremities, with flushed face, abdominal pain, dry retching, or throat pain, use Sini Tang with doubled Ganjiang. Flushed face adds Congbai; Abdominal pain adds Shaoyao; Vomiting adds Shengjiang (Fresh Ginger); Throat pain adds Jiegeng. If mouth is normal with back aversion to cold, use standard Sini Tang without modifications. Sini San and Sini Tang both treat Shaoyin diarrhea, cold extremities, and heaviness in defecation, differing from diarrhea with undigested food by being cooling vs. warming, and Yin vs. Yang distinct. If Shaoyin signs appear immediately upon onset, with fever, aversion to cold, body pain, but no headache, Mahuang Xixin Fuzi Tang is used for mild sweating. Alternatively, Wuji San (Five Accumulations Powder) with Shu Fuzi, or Wuji San combined with Yishun Yuan San may be used.