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Shang Han Lun · Treatise on Cold Damage
11. Shaoyin Illness · Pulses, Signs and Treatment
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281. Shaoyin illness has a faint, fine pulse and a wish only to sleep.
282. In Shaoyin illness there is an urge to vomit without vomiting, vexation and a wish only to sleep. Spontaneous diarrhea and thirst by the fifth or sixth day belong to Shaoyin: deficiency makes the person draw in water to rescue themselves. If urine is white, the Shaoyin form is fully present. White urine occurs because the lower burner is deficient and cold and cannot restrain water.
283. Tight pulses in both yin and yang, with unexpected sweating, mean loss of yang and belong to Shaoyin. Throat pain followed by vomiting and diarrhea should occur.
284. In Shaoyin illness, cough, diarrhea and delirious speech result from coercion by fire qi. Urination must be difficult, because sweating has been forcibly demanded from Shaoyin.
285. In Shaoyin illness with a fine, deep, rapid pulse, the illness is in the interior. Sweating must not be induced.
286. In Shaoyin illness with a faint pulse, sweating must not be induced because it causes loss of yang. If yang is already deficient and the chi pulse weak and rough, purging is also forbidden.
287. In Shaoyin illness with a tight pulse, spontaneous diarrhea on the seventh or eighth day, a suddenly faint pulse, unexpectedly warm hands and feet, and departure of the tight quality indicate approaching resolution. Even with agitation and diarrhea, spontaneous recovery must follow.
288. In Shaoyin illness with diarrhea, if the diarrhea stops spontaneously and the person lies curled up with aversion to cold but warm hands and feet, the condition is treatable.
289. In Shaoyin illness with aversion to cold and a curled posture, intermittent spontaneous agitation and a wish to remove clothing and covers indicate a treatable condition.
290. In Shaoyin wind-strike, a faint yang pulse and floating yin pulse indicate approaching recovery.
291. The time when Shaoyin illness tends to resolve runs from the zi period through the beginning of yin.
292. In Shaoyin illness with vomiting and diarrhea, if the hands and feet are not reversely cold and fever appears instead, the person does not die. If the pulse fails to arrive, apply seven zhuang of moxibustion to Shaoyin. No more specific point is named in this passage.
293. On the eighth or ninth day of Shaoyin illness, heat throughout the body, hands and feet means heat is in the Bladder, and blood must be passed during elimination.
294. In Shaoyin illness with reversal cold alone and no sweat, forcibly inducing sweat must stir the blood. Its exit route is uncertain: it may emerge from the mouth and nose or from the eyes. This is called reversal below and exhaustion above, and is difficult to treat.
295. Shaoyin illness with aversion to cold, a curled body, diarrhea and reversal cold of the hands and feet is untreatable.
296. Shaoyin illness with vomiting, diarrhea, restlessness, agitation and reversal of all four limbs means death.
297. In Shaoyin illness, cessation of diarrhea followed by dizziness and intermittent clouded oppression means death.
298. Shaoyin illness with reversal of all four limbs, aversion to cold, a curled body, a pulse that does not arrive, and restlessness without agitation means death.
299. On the sixth or seventh day of Shaoyin illness, high breathing means death.
300. Shaoyin illness has a faint, fine, deep pulse, a wish only to lie down, sweating without agitation and a spontaneous urge to vomit. If by the fifth or sixth day spontaneous diarrhea is joined by agitation and restlessness preventing lying down or sleeping, death follows.
301. At the beginning of Shaoyin illness, unexpected fever with a deep pulse is governed by Mahuang Xixin Fuzi Tang.
Mahuang Xixin Fuzi Tang formula:
Mahuang, two liang, nodes removed; Xixin, two liang; Fuzi, one piece, roasted, peeled and broken into eight pieces.
For these three ingredients, first boil Mahuang in one dou of water until the volume has decreased by two sheng. Skim off the foam, add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm, three times daily.
302. On the second or third day of Shaoyin illness, use Mahuang Fuzi Gancao Tang to induce slight sweating. Slight sweating is used because no further presentation has appeared over these two or three days.
Mahuang Fuzi Gancao Tang formula:
Mahuang, two liang, nodes removed; Gancao, two liang, roasted; Fuzi, one piece, roasted, peeled and broken into eight pieces.
For these three ingredients, first boil Mahuang in seven sheng of water for one or two boils and skim off the foam. Add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm, three times daily.
303. After two or three days or more of Shaoyin illness, vexation in the Heart region and inability to lie down are governed by Huanglian Ejiao Tang.
Huanglian Ejiao Tang formula:
Huanglian, four liang; Huangqin, two liang; Shaoyao, two liang; egg yolks, two; Ejiao, three liang—one account gives three ting.
For these five ingredients, first boil the three plant ingredients in six sheng of water until two sheng remain. Remove the dregs and melt the Ejiao into the liquid. Let it cool slightly, add the egg yolks and stir until combined. Take seven he warm, three times daily.
304. On the first or second day of Shaoyin illness, if the mouth is normal but the back is averse to cold, moxibustion should be applied. Fuzi Tang governs.
Fuzi Tang formula:
Fuzi, two pieces, roasted, peeled and each broken into eight pieces; Fuling, three liang; Renshen, two liang; Baizhu, four liang; Shaoyao, three liang.
Boil these five ingredients in eight sheng of water until three sheng remain. Remove the dregs and take one sheng warm, three times daily.
305. Shaoyin illness with bodily pain, cold hands and feet, aching bones and joints, and a deep pulse is governed by Fuzi Tang.
306. Shaoyin illness with diarrhea and passage of pus and blood is governed by Taohua Tang.
Taohua Tang formula:
Chishizhi, one jin, half used whole and half sifted into powder; Ganjiang, one liang; Jingmi rice, one sheng.
For these three ingredients, use seven sheng of water and boil until the rice is cooked. Remove the dregs. To seven he of warm liquid add one fangcunbi of Chishizhi powder, and take three times daily. If one dose brings recovery, do not take the remainder.
307. From the second or third through the fourth or fifth day of Shaoyin illness, abdominal pain, difficult urination, unceasing diarrhea and passage of pus and blood are governed by Taohua Tang.
308. In Shaoyin illness with diarrhea and passage of pus and blood, needling may be used.
309. In Shaoyin illness with vomiting, diarrhea, reversal cold of the hands and feet, and agitation and restlessness as if about to die, Wu Zhuyu Tang governs.
310. Shaoyin illness with diarrhea, throat pain, chest fullness and vexation is governed by Zhufu Tang.
Zhufu Tang formula:
Pig skin, one jin.
Boil this single ingredient in one dou of water until five sheng remain. Remove the dregs, add one sheng of white honey and five he of white powder, heated until fragrant, and mix thoroughly. Divide and take warm in six doses. The note identifies white powder as rice flour.
311. On the second or third day of Shaoyin illness, throat pain may be treated with Gancao Tang. If it does not improve, give Jiegeng Tang.
Gancao Tang formula:
Gancao, two liang.
Boil this single ingredient in three sheng of water until one and a half sheng remain. Remove the dregs and take seven he warm, twice daily.
Jiegeng Tang formula:
Jiegeng, one liang; Gancao, two liang.
Boil these two ingredients in three sheng of water until one sheng remains. Remove the dregs, divide, and take warm in two doses.
312. In Shaoyin illness with injury and sores in the throat, inability to speak and failure of the voice to emerge, Kujiu Tang governs.
Kujiu Tang formula:
Banxia, fourteen pieces, washed and broken to the size of jujube stones; one egg, yolk removed, with bitter wine or vinegar put into the shell.
For these two ingredients, put Banxia into the bitter wine or vinegar. Place the eggshell in the ring of a knife handle and set over fire, bringing it to three boils. Remove the dregs and hold and swallow the liquid little by little. If there is no recovery, prepare three further batches. No volume for the bitter wine or vinegar is supplied.
313. For throat pain in Shaoyin illness, Banxia Powder and Decoction govern.
Banxia Powder and Decoction formula:
Banxia, washed; Guizhi, outer bark removed; Gancao, roasted.
Take equal parts of these three ingredients, pound and sift them separately, then combine. Mix one fangcunbi with plain rice drink and take three times daily. If the powder cannot be taken, boil one sheng of water to seven boils, add two fangcunbi of powder and boil three more times. Remove from the fire, cool slightly and swallow little by little. The final supplied comment warns that Banxia is poisonous and should not be taken as powder; this is retained alongside the preceding powder method.
314. For diarrhea in Shaoyin illness, Baitong Tang governs.
Baitong Tang formula:
Congbai, four stalks; Ganjiang, one liang; Fuzi, one piece, raw, peeled and broken into eight pieces.
Boil these three ingredients in three sheng of water until one sheng remains. Remove the dregs, divide, and take warm in two doses.
315. In Shaoyin illness with diarrhea and a faint pulse, give Baitong Tang. If diarrhea does not stop and there are reversal counterflow, no pulse, dry retching and agitation, Baitong Jia Zhudanzhi Tang governs. After the decoction, a pulse that suddenly emerges means death; one that resumes faintly and continuously means life.
Baitong Jia Zhudanzhi Tang formula:
Congbai, four stalks; Ganjiang, one liang; Fuzi, one piece, raw, peeled and broken into eight pieces; human urine, five he; pig gall liquid, one he.
For these five ingredients, use three sheng of water and boil until one sheng remains. Remove the dregs, add the gall liquid and human urine, mix thoroughly, divide, and take warm in two doses. If gall is unavailable, the preparation may still be used. These are the ingredients and procedures reported by the historical text.
316. Shaoyin illness does not cease after two or three days. By the fourth or fifth day, abdominal pain, difficult urination, heavy painful limbs and spontaneous diarrhea indicate water qi. There may be cough, free urination, diarrhea or vomiting. Zhenwu Tang governs.
Zhenwu Tang formula, with modifications:
Fuling, three liang; Shaoyao, three liang; Baizhu, two liang; Shengjiang, three liang, sliced; Fuzi, one piece, roasted, peeled and broken into eight pieces.
Boil these five ingredients in eight sheng of water until three sheng remain. Remove the dregs and take seven he warm, three times daily. For distressing cough, add half a sheng of Wuweizi and one liang each of Xixin and Ganjiang. For free urination, remove Fuling. For diarrhea, remove Shaoyao and add two liang of Ganjiang. For vomiting, remove Fuzi and increase Shengjiang, including the original amount, to half a jin.
317. In Shaoyin illness with diarrhea containing undigested grain, interior cold and exterior heat, reversal of the hands and feet, a faint pulse on the verge of expiring, and unexpected absence of bodily aversion to cold, the face may be red. There may be abdominal pain, dry retching, throat pain, or cessation of diarrhea without return of the pulse. Tongmai Sini Tang governs.
Tongmai Sini Tang formula:
Gancao, two liang, roasted; Fuzi, one large piece, used raw, peeled and broken into eight pieces; Ganjiang, three liang, or four liang for a robust person.
Boil these three ingredients in three sheng of water until one sheng and two he remain. Remove the dregs, divide, and take warm in two doses. Prompt return of the pulse means recovery. For a red face, add nine stalks of Cong. For abdominal pain, remove Cong and add two liang of Shaoyao. For vomiting, add two liang of Shengjiang. For throat pain, remove Shaoyao and add one liang of Jiegeng. If diarrhea stops but the pulse does not emerge, remove Jiegeng and add two liang of Renshen. Take the preparation only when the illness corresponds to its formula.
318. In Shaoyin illness with reversal of all four limbs, there may be cough, palpitations, difficult urination, abdominal pain, or diarrhea with downward heaviness. Sini San governs.
Sini San formula:
Gancao, roasted; Zhishi, broken up, soaked in water and roasted dry; Chaihu; Shaoyao.
Use ten fen each of these four ingredients, pound and sift, and take one fangcunbi mixed with plain rice drink three times daily. For cough, add five fen each of Wuweizi and Ganjiang; this also governs diarrhea. For palpitations, add five fen of Guizhi. For difficult urination, add five fen of Fuling. For abdominal pain, add one Fuzi, roasted until it cracks. For diarrhea with downward heaviness, first boil three sheng of Xiebai in five sheng of water until three sheng remain and remove the dregs. Add three fangcunbi of the powder to this liquid and boil until one and a half sheng remain. Divide and take warm in two doses.
319. On the sixth or seventh day of Shaoyin illness with diarrhea, cough, vomiting, thirst and vexation preventing sleep, Zhuling Tang governs.
320. On the second or third day of Shaoyin illness, dry mouth and dry throat call for urgent purging. Da Chengqi Tang is appropriate.
321. In Shaoyin illness, spontaneous diarrhea of clear water that is entirely blue-green, with pain that must be present below the Heart and dryness of the mouth, may be purged. Da Chengqi Tang is appropriate.
322. On the sixth or seventh day of Shaoyin illness, abdominal distention and no bowel movement call for urgent purging. Da Chengqi Tang is appropriate.
323. In Shaoyin illness with a deep pulse, warm urgently. Sini Tang is appropriate.
324. In Shaoyin illness, food and drink are vomited as soon as they enter the mouth. There is wenwen uneasiness in the Heart region and an urge to vomit, yet inability to vomit further. If the illness has just begun, with cold hands and feet and a wiry, slow pulse, this is repletion in the chest: purging is forbidden and vomiting should be induced. But if cold retained fluids above the diaphragm cause dry retching, vomiting must not be induced. Warming is required; Sini Tang is appropriate.
325. In Shaoyin illness with diarrhea, a faint, rough pulse, vomiting and sweating, bowel movements should be frequent. If they are instead scant, warm the upper region and apply moxibustion. No specific point is supplied.
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