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Chapter 19 of 29
伤寒杂病论
Holistic Paraphrase
This chapter focuses exclusively on the pulse manifestations, signs, and treatment methods of Shaoyin disease(one of the six-channel pattern differentiation, localized in the heart and kidneys, characterized by systemic deficiency and debilitation).
Shaoyin Disease Outline: The pulse is fine and faint (extremely thin and weak, barely perceptible), the spirit is listless, and there is a constant desire to close the eyes and sleep — this is a typical manifestation of heart-kidney yang depletion and deficiency of both qi and blood. 🌿
Differentiating Shaoyin Disease with Diarrhea and Thirst: The patient feels nauseous but cannot vomit, is vexed, and only wishes to sleep. By the fifth to sixth day, diarrhea with thirst appears — this is the primary presentation of Shaoyin disease. Because lower burner yang qi is deficient, fluids cannot be transported upward, so thirst arises as the body attempts to self-rescue by drinking water. If the urine is clear and copious, the characteristics of Shaoyin disease are fully present, since lower burner deficiency-cold fails to transform fluids, resulting in clear urine.
Yang Collapse with Sweating: When all three positions (cun, guan, chi) of the pulse are tight, yet the patient is sweating, this is a sign of yang collapse (yang qi escaping externally), belonging to Shaoyin disease. There should logically be sore throat, along with vomiting and diarrhea.
Fire Therapy Damaging Fluids: In Shaoyin disease with cough, diarrhea, and delirious speech, the condition has been mistreated by fire methods (ancient techniques using heated needles, moxibustion, etc., to induce sweating). Urination is certain to be difficult, because the forced sweating has damaged Shaoyin fluids. 🔥
Sweating and Purgation Prohibited: In Shaoyin disease, when the pulse is fine, deep, and rapid, the disease location is interior, and sweating must not be induced. In Shaoyin disease with a faint pulse, sweating must not be induced because yang qi is already deficient; if the chi pulse is weak and rough, purgation is even more forbidden.
Signs of Spontaneous Recovery: In Shaoyin disease with a tight pulse, when natural diarrhea occurs by the seventh to eighth day, the pulse suddenly becomes faint, the hands and feet instead turn warm, and the tight pulse disappears — this is a sign that pathogenic qi is departing, righteous qi is recovering, and the disease is about to resolve. Although there may be vexation and diarrhea, spontaneous recovery will occur.
Treatable Conditions: In Shaoyin disease with diarrhea, if the diarrhea ceases on its own, and although the patient fears cold and curls up, the hands and feet remain warm — this is treatable. In Shaoyin disease with fear of cold and curling up, but with periodic vexation and a desire to throw off the blankets, this indicates yang qi is still present — treatable.
Pulse Indicating Impending Recovery: In Shaoyin wind stroke, when the cun pulse is faint and the chi pulse is floating, this indicates impending recovery. The time period during which Shaoyin disease tends to resolve is between zi and yin hours (from 11 PM to 5 AM).
Emergency Moxibustion: In vomiting and diarrhea with warm hands and feet and paradoxical fever, death will not occur; if the pulse cannot be palpated, moxa seven zhuang on the Shaoyin channel points to restore yang.
Blood in Urine Pattern: In Shaoyin disease of eight to nine days' duration, with heat in the body and extremities — heat is in the bladder, and blood will inevitably appear in the urine.
Lower Reversal with Upper Exhaustion: In Shaoyin disease with cold extremities and anhidrosis, if sweating is forcibly induced, this will compel blood to move recklessly, and blood will emerge from unknown places — from the mouth, nose, or ears. This is called "lower reversal with upper exhaustion" (lower burner yang depletion causing cold extremities, upper burner yin blood exhaustion), and it is difficult to treat.
Fatal Patterns:
Formula Section:
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, Asarum Decoction): When Shaoyin disease begins with paradoxical fever and a deep pulse — use this formula to warm yang and release the exterior. Formula: Mahuang (ephedra) 2 liang, Fuzi (aconite) 1 piece (processed), Xixin (asarum) 2 liang. 🌿
Mahuang Fuzi Gancao Tang (Ephedra, Aconite, Licorice Decoction): In Shaoyin disease of two to three days' duration, this formula induces mild sweating. Since the course is short and there is no interior pattern, mild sweating is sufficient.
Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction): In Shaoyin disease lasting more than two to three days, with vexing heat in the heart and inability to sleep — this is yin deficiency with blazing fire, and this formula nourishes yin and clears fire.
Fuzi Tang (Aconite Decoction): In Shaoyin disease of one to two days' duration, without thirst or dryness in the mouth, but with cold in the back — use this formula to warm yang and disperse cold, combined with moxibustion.
Danggui Sini Tang (Tangkuei Counterflow Cold Decoction): In Shaoyin disease with a faint and weak pulse and body pain like pulling/cramping — this is due to disharmony between nutritive and defensive qi, and this formula warms and unblocks the blood vessels.
Taohua Tang (Peach Blossom Decoction): In Shaoyin disease with diarrhea and bloody purulent stool — use this formula to warm, secure, and stop leakage.
Wuzhuyu Tang (Evodia Decoction): In Shaoyin disease with vomiting, diarrhea, counterflow cold in hands and feet, and vexation approaching death — use this formula to warm and descend turbid yin.
Zhufu Tang (Pork Skin Decoction): In Shaoyin disease with diarrhea, sore throat, chest oppression, and vexation — use this formula to moisten the lungs and nourish the kidneys.
Gancao Tang / Jiegeng Tang (Licorice Decoction / Platycodon Decoction): In Shaoyin disease with sore throat, first administer Gancao Tang; if not resolved, administer Jiegeng Tang.
Kujiu Tang (Vinegar Decoction): In Shaoyin disease where the throat is damaged with sores, pain radiating to the sides of the throat, and inability to speak aloud — use this formula to disperse accumulations and reduce swelling.
Banxia San ji Tang (Pinellia Powder and Decoction): In Shaoyin disease with sore throat and a paradoxical floating pulse — use this formula to disperse cold and unblock the throat.
Baitong Tang (White Penetrating Decoction): In Shaoyin disease with diarrhea — use this formula to unblock yang and disperse cold.
Baitong Jia Zhudan Zhi Tang (White Penetrating Decoction Plus Pig Bile): In diarrhea that does not stop, with counterflow cold, absent pulse, dry retching, and vexation — use this formula to unblock yang and rescue from collapse, with adjuvant cold-bitter flavor. After administration, if the pulse suddenly surges forth, death results; if the pulse is faint and gradually resumes, survival follows.
Zhenwu Tang (True Warrior Decoction): In Shaoyin disease of two to three days' duration that does not resolve, progressing to four to five days with abdominal pain, difficult urination, heavy painful limbs, and spontaneous diarrhea — there is internal water qi, and this formula warms yang and promotes urination. Modifications are appended below. 💨
Tongmai Sini Tang (Unblocking the Pulse Counterflow Cold Decoction): In Shaoyin disease with diarrhea of undigested food, interior cold with exterior heat, counterflow cold in hands and feet, faint pulse on the verge of expiration, paradoxical absence of chills with flushed red face, or with abdominal pain, dry retching, sore throat, diarrhea ceasing with the pulse not emerging — use this formula to break yin and restore yang, unblock the pulse, and rescue from collapse.
Sini San (Counterflow Cold Powder): In Shaoyin disease with counterflow cold in the four limbs, or with cough, palpitations, difficult urination, abdominal pain, or diarrhea with rectal heaviness — use this formula to regulate qi movement. ⚠️ (Note: The composition of this formula differs from the commonly circulated edition; see explanation below.)
Zhuling Tang (Polyporus Decoction): In Shaoyin disease with diarrhea for six to seven days, accompanied by cough, vomiting, thirst, vexation, and inability to sleep — use this formula to promote diuresis and nourish yin.
Dachengqi Tang (Major Purgative Decoction): In Shaoyin disease of two to three days' duration, with dry mouth and throat — urgently apply the purgative method. In Shaoyin disease with spontaneous passage of clear water that is pure green in color, pain below the heart, and dry mouth — purgation may be applied. In Shaoyin disease of six to seven days' duration, with abdominal distension and no bowel movement — urgently apply the purgative method. This is the method of "urgent purgation to preserve yin." 🔥
Sini Tang (Counterflow Cold Decoction): In Shaoyin disease with a deep pulse, urgently apply the warming method. In Shaoyin disease where food enters the mouth and is immediately vomited, or where there is nausea in the heart with the desire to vomit but inability to do so, with cold hands and feet and a wiry, slow pulse at the onset — there is solid pathogenic qi in the chest, and the emetic method should be applied; if there is cold rheum above the diaphragm causing dry retching, emetics must not be used, and the warming method should be applied.
Moxibustion: In Shaoyin disease with diarrhea, faint and rough pulse, vomiting, sweating, and frequent urination in small amounts — one should warm the upper portion, using moxibustion.
Shaoyin disease represents one of the most severe stages in the six-channel pattern differentiation system. The core pathology lies in heart-kidney yang qi decline, or true yin depletion. This chapter reveals several key medical principles:
1. Shaoyin as the Pivot — A Matter of Life and Death Shaoyin governs the heart and kidneys; the heart governs blood vessels and the spirit, while the kidneys store primordial yin and yang. The Shaoyin channel represents the very root of the body's yin and yang. When disease enters Shaoyin, it signifies that systemic energy metabolism and circulatory function have reached profound deficiency. The fine, faint pulse and somnolence are external reflections of heart yang debility and kidney essence exhaustion. This explains why this chapter devotes extensive discussion to differentiating fatal versus treatable patterns — Shaoyin disease stands at the threshold of life and death.
2. Dynamic Differentiation of Yin-Yang Waxing and Waning Throughout this chapter, warmth or coldness of the extremities, pulse changes, and presence or absence of vexation are used repeatedly to assess prognosis: warm hands and feet indicate survival; counterflow cold indicates danger; a gradually resuming pulse indicates survival; a suddenly surging pulse indicates death; vexation that resolves on its own leads to recovery; restlessness preventing sleep leads to death. The core principle: whether yang qi returns is the key determinant of Shaoyin disease outcome. "Yang returning means life; yang collapsing means death."
3. The Three-tier Treatment Framework for Shaoyin Disease
4. The Exquisite Use of Counteractive Adjuvants In Baitong Jia Zhudan Zhi Tang, the addition of pig bile and human urine to a formula dominated by acrid-hot herbs exemplifies the classic "counteractive cold-heat adjuvants" approach — when yin and yang are mutually repelling, the exclusive use of hot medicinals may be rejected and vomited out; adding a small amount of cold-cooling substance guides the hot medicinals into the yin, akin to "using cold to attract heat." This represents ancient physicians' profound insight into complex pathology.
Modern Mapping of "Shaoyin Disease": The symptom cluster described — fine faint pulse, somnolence, counterflow cold in the extremities, diarrhea of undigested food, pulse on the verge of expiration — corresponds considerably to modern medical shock, severe dehydration, acute heart failure, and late-stage severe infection. Counterflow cold limbs correlate with microcirculatory failure, diarrhea of undigested food with loss of gastrointestinal function, and labored breathing with respiratory failure.
"Yang Collapse" and Circulatory Failure: Both yin and yang pulses tight with paradoxical sweating is judged as "yang collapse" — yang qi about to escape. This shares similar logic with early shock in modern medicine (peripheral vasoconstriction, cold sweats, abnormal pulse). The ancients' ability to judge critical conditions through the contradictory relationship between pulse and sweating reflects exceptional clinical observational skill.
Scientific Validity of Prognostic Indicators: Using warmth or coldness of hands and feet as a prognostic criterion is essentially observation of peripheral circulation — a very reasonable approach. Modern emergency medicine likewise uses extremity temperature as an important reference for circulatory status. "Sudden pulse surge indicates death; gradual resumption indicates survival" bears some relation to the modern concept that "rapid arrhythmia upon rhythm return carries poor prognosis, while slow stable recovery carries better prognosis."
Historical Limitations: Some formulas employ human urine and pig bile, reflecting ancient rescue concepts under extreme conditions (such as supplementing electrolytes, or using bitter-cold counteractive agents), but their specific components and mechanisms require cautious evaluation through modern research. Some fatal pattern determinations appear overly absolute by today's standards, but ancient medicine lacked modern rescue measures, and these judgments were based on the therapeutic capabilities of that era.
Protect yang qi; be cautious against cold pathogens: Shaoyin disease most often arises from deep invasion of cold and depletion of yang qi. In daily life, maintain warmth, especially the lower back, abdomen, and feet. Minimize excessive work and staying up late at night, because Shaoyin governs midnight; the zi through yin hours are precisely when yang qi begins to be generated — deep sleep during this time supports yang qi's hidden storage and recovery. 🌙
Eat with moderation; avoid excess raw and cold foods: Shaoyin disease involves considerable discussion of "diarrhea," directly related to damage of spleen-stomach yang qi. Daily diet should avoid excessive raw, cold, or iced items, especially during cold seasons or in states of deficiency. Raw and cold foods entering the stomach deplete middle burner yang, which can subsequently affect kidney yang.
Excessive rumination depletes essence; be cautious about overthinking: Shaoyin corresponds to heart and kidney — the heart stores the spirit, the kidney stores essence. Prolonged anxiety and excessive rumination silently consume heart-kidney essence-qi, potentially producing the "desire to sleep" type of mental listlessness coexisting with physical fatigue. Consciously regulate emotions, avoid prolonged high-stress states, and give the heart and kidneys space to recover.
Be alert to the fatigue signal of "desire to sleep": If there is persistent excessive daytime sleepiness with difficulty rousing the spirit, accompanied by cold intolerance and cold hands and feet — this is a signal of insufficient yang qi in the body. Adjust rest patterns promptly and, if necessary, seek professional Traditional Chinese Medicine consultation rather than self-diagnosing.
Associated Concepts:
Further Reading:
This content is based on classical Chinese medical texts and is provided for traditional cultural study and research only. It does not constitute any medical diagnosis, medication advice, or treatment recommendations. If you feel unwell, please seek medical attention promptly.