典藏书目

[Tongmai Sini Decoction Formula]
Zhi Gancao (Prepared Licorice Root) 2 liang, Ganjiang (Dried Ginger) 3 liang (for robust individuals, may increase to 4 liang), Fuzi (Prepared Aconite Root Lateralis) 1 large piece (used raw, skin removed, broken into eight pieces).
The above three ingredients are decocted with 3 sheng of water until reduced to 1.2 sheng. The dregs are strained out, and the liquid is divided into two doses taken warm. If the pulse reappears after administration, the patient will recover.
If the face appears red, add 9 stalks of Congbai (Scallion White); if there is abdominal pain, remove the scallion and add Shaoyao (White Peony Root) 2 liang; if there is vomiting, add Shengjiang (Fresh Ginger) 2 liang; if there is sore throat, remove Shaoyao and add Jiegeng (Platycodon Root) 1 liang; if diarrhea stops but the pulse does not appear, remove Jiegeng and add Renshen (Ginseng Root) 2 liang. Administer only when the condition corresponds to the formula's indications.

[Formula Analysis]
Among the formulas discussed for supporting Yang and suppressing Yin: when internal cold causes Yang Qi to be weak and unable to reach the exterior, Sini Tang (Four Reversal Decoction) is the primary choice; when both interior and exterior are cold and Yang Qi is extremely deficient, Fuzi Tang (Aconite Decoction) is used; when Yin Cold is excessive in the lower jiao and repels Yang Qi to the upper jiao, Bitong Tang (White Connect Decoction) is used; when Yin Cold is excessive internally and repels Yang Qi to the exterior, Tongmai Sini Tang (Pulse-Connecting Four Reversal Decoction) is used. From this, it can be known that Sini Tang circulates Yang Qi, Fuzi Tang warms and tonifies Yang Qi, Bitong Tang unblocks Yang Qi between the upper and lower parts, and Tongmai Sini Tang connects Yang Qi between the interior and exterior. Currently, the pulse is faint and on the verge of disappearing, with internal cold and external heat. This indicates excessive Yin Cold in the Kidney repelling Yang Qi to the exterior; therefore, this formula is indicated. By doubling the amount of Ganjiang (Dried Ginger) and adding Gancao (Licorice Root) to assist Fuzi (Aconite Root), and renaming it Tongmai Sini Tang, it is because the formula greatly strengthens the Primordial Yang, governs the interior and exterior, and collectively attracts the external heat back into the interior. At this time, vital Qi has already dispersed, and death is imminent. If soft and slow-acting Gancao were used as the sovereign herb, how could it swiftly call back the external Yang? Therefore, Ganjiang is substituted as the sovereign herb. However, Gancao must be added in an equal proportion to Ganjiang, lest the fierce nature of Ganjiang and Fuzi fail to nourish the scattered Yuan Qi. This is what is meant by "an army with discipline." If the face is red, Congbai (Scallion White) is added to unblock the Yang repelled to the upper part; if there is abdominal pain, Shaoyao (White Peony Root) is added to harmonize the Yin within; if there is vomiting and counterflow qi, Shengjiang (Fresh Ginger) is added to stop vomiting; if there is a sore throat, Jiegeng (Platycodon Root) is added to benefit the throat. If diarrhea stops, the pulse does not appear, and Qi is deficient, Ren Shen (Ginseng Root) is doubled to generate primordial Qi and restore the pulse.

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In Shaoyin Disease, characterized by vomiting and diarrhea, if the hands and feet are not cold and instead there is fever, the prognosis is favorable (not fatal). If the pulse cannot be felt, moxibustion should be applied to the Shaoyin meridian seven times (seven moxa cones).

[Annotation]
Shaoyin Disease with vomiting and diarrhea typically presents with cold extremities. The fact that they are not cold and instead there is fever indicates that Yang Qi has not yet exhausted, hence it is stated that death will not occur. However, if the pulse is imperceptible, despite the presence of external heat, it may be false heat. One must guard against Yang collapse. Urgent moxibustion on the Shaoyin meridian is required to rapidly unblock its Yang Qi, so that the pulse may recover.

[Collected Annotations]
Cheng Zhi said: The previous clause regarding Tongmai Sini Tang describes internal cold with external heat, cold extremities, and an imperceptible pulse. This clause, using moxibustion, describes internal cold with external heat, non-cold extremities, and an imperceptible pulse. The arterial pulse of the Shaoyin meridian is located at the medial malleolus of the foot.
Yu Chang said: In the previous case of aversion to cold on the back, Fuzi Tang was used after moxibustion because Yin Cold coagulated internally, which one session of moxibustion could not overcome. In this case, the extremities are warm, indicating Yin inside and Yang outside; thus, only the home meridian is moxibusted to guide the Yang inward, without needing further warming herbs.
Wang Hu said: The classics state that the Source point of the Kidney is Taixi (KI3). Moxibustion on the Shaoyin meridian seven times should target Taixi. These points are located in the depression behind the medial malleolus where the posterior tibial artery beats.

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In Shaoyin Disease, characterized by vomiting and diarrhea, cold extremities, and severe restlessness bordering on death, Wuzhuyu Tang (Evodia Decoction) is the primary treatment.

[Annotation]
Although named Shaoyin Disease, the primary use of Jueyin disease medication is because Shaoyin and Jueyin often present as combined diseases. The symptoms are similar but the pathogenesis differs, leading to different treatments. Shaoyin Disease involves vomiting and diarrhea, as does Jueyin Disease; Shaoyin Disease involves cold extremities, as does Jueyin Disease; Shaoyin Disease involves irritability, as does Jueyin Disease. This represents combined disease with identical symptoms. However, Shaoyin cold extremities vary in severity, while Jueyin cold extremities vary in cold or heat nature; Shaoyin irritability tends toward physical restlessness (zao), while Jueyin irritability tends toward mental vexation (fan). Generally, Shaoyin disease involves Yin excess repelling Yang, treated with Sini Tang (Ginger and Aconite) to drive out Yin and return Yang. Jueyin disease involves Yin excess stifling Yang, treated with the pungent and fierce nature of Wuzhuyu (Evodia Fruit) to rapidly disperse and unblock Yang. This illustrates different pathogenesis requiring different treatments. Currently, there is vomiting without regurgitation of roundworms, and cold extremities, so it is named Shaoyin Disease. However, since the cold extremities do not extend beyond the elbows and knees, and there is significant vexation and restlessness bordering on death, it belongs to the domain of Jueyin Disease treatment. Therefore, Sini Tang is not used, but Wuzhuyu Tang is employed.

[Collected Annotations]
Cheng Zhi said: Vomiting and diarrhea indicate Yin pathogens in the interior affecting the Spleen and Stomach upward; cold extremities indicate Yang failing to warm the four limbs; irritability and restlessness indicate extreme Yin excess causing exposed Yang to become chaotic and unsettled. When the condition reaches this stage, it is nearly critical. Without the pungent-warm nature of Zhuyu (Evodia Fruit), the counterflow of Yin Qi cannot be descended; without the sweet-warm nature of Renshen (Ginseng Root), Shengjiang (Fresh Ginger), and Dazao (Jujube Fruit), the Middle Earth (Spleen/Stomach) cannot be fortified to control the Kidney pathogen. There is a distinction between Zao Fan (Restless Vexation) and Fan Zao (Vexatious Restlessness): Zao is Yin-induced restlessness, Fan is Yang-induced vexation. Zao Fan implies progressing from restlessness to vexation, indicating Yin pathogens forcing their way outward; Fan Zao implies progressing from vexation to restlessness, indicating Yang Qi still struggling internally. Scholars should carefully examine these differences in severity and depth.
Cheng Yingmao said: The warming method is originally established for Yin-Cold patterns; thus, true cold patterns often present with false heat. All cases of Yin excess repelling Yang or Yin patterns resembling Yang are traps set by Shaoyin disease to confuse the senses. One must discern the truth from the falsehood to avoid being constrained by them. For instance, vomiting and diarrhea accompanied by cold extremities indicate declining Stomach Yang and the merging of Kidney Yin. Who would not recognize this as a cold pattern? Yet, it deceptively presents with severe irritability and restlessness bordering on death. This occurs because Yang is rejected by Yin and has nowhere to reside, creating this appearance. Wuzhuyu Tang utilizes the power of Wood to augment Fire, thereby warming the Earth (Spleen/Stomach) and driving away the Water-Cold.