Survey of Classical Texts Long Fall 2011
I.
A General introduction to the book “Shanghan Lun”
A. The book and its author
“Shanghan Lun,” originally named “Shanghan Zabing Lun” (Treatise on
Febrile Diseases Caused by Pathogenic Cold and Other Miscellaneous
Diseases), was compiled around 200-210 A.D. As its name implies, the book includes two parts: febrile diseases and miscellaneous diseases, altogether 16 chapters.
Dr. Zhang Zhongjing (150-219 A.D), the author of the book, succeeded and further developed the ancient medical knowledge passed down by Neijing and Nanjing etc., summarized his and others’ clinical experience, and completed the great work.
Later, the book became broken during the war. Some physicians kept it as their own secret. So there was no complete edition of the book. In the Jing dynasty (about 50 years later), Dr. Wang Shuhe, also the author of “Mai
Jing” (the Classics of Pulse Diagnosis) collected the segments of the first part of book, the Febrile Diseases, and entitled it “Shanghan Lun”. Another
300 years later, Dr. Sun Simiao in the Tang Dynasty rearranged it and collected it in his book “Qian Jin Yi Fang.” In the Song Dynasty, the government set up a publishing house for medical literature, and the book was examined again and reedited into 10 chapters and 397 verses with 112 formulas. Nowadays, the current edition of “Shanghan Lun” is the edition from the Ming Dynasty published by Zhao Kaimei based on the Song
Dynasty’s edition.
As to the second part of the book, the miscellaneous diseases, it was recompiled by Lin Yi in the Song dynasty, and named “Jin Gui Yao Nue”
(the Prescriptions in Golden Cabinet).
B. The academic accomplishment of Shanghan Lun
Shanghan is the first book on external diseases. It puts forward the principle of determining the treatment based on differentiation of the disease. If we say Neijing establishes the theoretic systems of Chinese medicine, then we can also regard the Shanghan Lun as creating a clinical system of Chinese medicine. The book best demonstrates how to apply TCM theories to clinical practice, how to link theory, treatment principle, formula and herbs in a chain.

Survey of Classical Texts Long Fall 2011
The greatest contribution of Shanghan Lun is that Dr. Zhang Zhongjing developed a sophisticated differentiation system-Liu Jing Bian Zhen.
Because of its high academic and clinical value, Shanghan Lun is always a textbook for medical students and its author Dr. Zhang Zhongjing is worshiped by the medical circle as a medical sage.
II. Two important concepts
A. The concept of Shanghan
Shanghan Lun is named after the Chinese word "Shanghan." Thus it is necessary for you to understand the concept of "Shanghan.” Generally speaking "Shanghan" has two meanings: a broad and a narrow sense.
1.
The narrow sense
In Chinese, "Shanghan" literally means injury from exogenous cold. So in its narrow sense "Shanghan" refers to external diseases caused by wind and cold. Why Dr. Zhang Zhongjing focused his discussion on cold injury diseases might be explained by historical reasons. First, people at that time lacked warm clothing and housing due to poor productive level. Secondly, the meteorological record shows the temperature 1800 years ago was 4 degree centigrade lower than currently. Thus people were more susceptible to cold injury, and diseases caused by cold became life threatening.
2. The broad sense
In its broad sense "cold" should be understood as not only cold itself but also six exogenous pathogenic factors: wind, cold, heat, dampness, dryness and fire. Shanghan is also a general term for various external diseases caused by six exogenous pathogenic factors.
Conclusion: Shanghan Lun is a book that illustrates external diseases with an emphasis on those caused by pathogenic cold.
B. The Concept of Liujing
Literally, Liujing refers to Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin, the six channels. However they are also six systems or networks consisting of Zang-fu organs and their corresponding channels and collaterals in Shanghan Lun. They are quite different from channels and collaterals we often talk about, since they mainly refer to physiological functions and pathological changes of Qi and blood in Zang-fu organs and channels and collaterals rather than their meridian structure.

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Liujing, as the principle for differentiation rather than the structural concept in Shanghan Lun, is derived from the Neijing but is much more sophisticated than Neijing.
Table 1 : Differences between Neijing’s Liujing and Shanghan’s Liujing
Neijing Shanghan
Structure
Disease
: Six channels
: heat and excess
Transmission : in order go through all channels
in 6 days
Treatment : Qing and Xie
Six systems or networks heat and cold, excess and deficiency in order ( Xun jing) jumping in ( Yue jing ) direct attack (Zhi Zhong) combination ( He Bing) overlapped (Bin Bing)
Ba Fa
III. Liujing Bianzhen Lun Zhi
(determining treatments based on differentiation of the disease according to the six channels)
A. Physiology of Liujing
1. Taiyang refers to the urinary bladder channel of foot-Taiyang and its Fu organ urinary bladder. Located in the lower Jiao, urinary bladder stores body fluid. Of the body fluid stored in the urinary bladder, the clear fluid is steamed up by the kidney Yang and produces a kind of Qi just like fog. This kind of Qi is called the Qi of Taiyang when it reaches the body surface. The
Qi of Taiyang circulates on the body surface and functions to warm up the body surface and to safeguard the body against exogenous pathogenic factors and to control the opening and closing of the skin pores. Thus, this kind of Qi is also called "Weiqi"(defensive Qi). Two questions arise here. a) Where does the defensive Qi come from? There are three different opinions about it: 1) from the upper Jiao, 2) middle Jiao and 3) lower Jiao respectively, because different scholars viewed this matter from various angles and based it on their own clinical experiences. If all of these opinions are put together, we will have a perfect explanation on the matter. The
Defensive Qi is produced by the kidney Yang steaming up clear fluid from urinary bladder, so the defensive Qi is considered generated from kidney and coming from the lower Jiao. After being produced, the defensive Qi must be

Survey of Classical Texts Long Fall 2011 replenished and nourished by the food essence digested and absorbed by the spleen and the stomach, so the defensive Qi is regarded growing in the middle Jiao. Moving outside the vessels and between muscles and skin, the defensive Qi depends upon the dispersing function of the lung, so the defensive Qi is also considered being distributed by the lung and coming from the upper Jiao. b) What dominates the body surface? We know that lung dominates the body surface. In Shanghan Lun, it says that Taiyang dominates the body surface. Are they contradictory? They sound contradictory but they are not.
Both the lung and Taiyang are closely related to defensive Qi. When we say that the lung dominates the body surface, we focus on distribution of the defensive Qi, i.e., the defensive Qi spreading over the body surface like misting through the dispersive function of the lung. When we say the
Taiyang dominates the body surface, our attention is on the origin of defensive Qi, i.e., defensive Qi arising from the lower Jiao and circulating on the surface. In addition, urinary bladder channel of Foot-Taiyang is the largest and longest among all channels. Along with Du channel, Taiyang channel takes its course on the back of the human body and crosses with Du channel at the points of Baihui, Fengmen and Dazhui. In light of the theory of Yin and Yang, the back of the human body belongs to Yang and the abdomen to Yin. Pathogenic cold pertains to Yin and is most likely to attack and injure Yang. Taiyang dominates the body surface and is located on the outmost of the human body. Thus, pathogenic cold is apt to invade Taiyang and give rise to Taiyang disease.
2. Yangming refers to the stomach channel of Foot-Yangming and the large intestine channel of Hand-Yangming as well as their associated Fu organs.
Yangming channel is more replete with Qi and blood than any other channel and has the brightest Yang Qi. In regards to the Zang-fu organ, the stomach and the large intestine belong to the six Fu organs. The main functions of the six Fu organs are transportation and transformation. And the Fu organs like to be open and dislike to be blocked. The stomach and the large intestine are optimal when their Qi descends and moves smoothly. Only in doing so can the food be continuously taken into the stomach and the waste be discharged from the large intestine. Through the normal function of the stomach and the intestines, the human body can produce sufficient body fluid and Yang Qi which are vital to all physiological activities. Energetically, Yangming belongs to dry metal. It has a tendency to develop into dry-heat under pathological influences.

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3. Shaoyang refers to the gallbladder channel of Foot-Shaoyang and the San
Jiao channel of Hand-Shaoyang as well as their associated Fu organs.
Both gallbladder and San Jiao contain Xianghuo (ministerial fire), a kind of physiological fire which, along with the Junhuo (emperor fire), warm up the
Zang-Fu organs and motivate their functional activities. It is believed that ministerial fire originates from the Mingmen (life gate) and is stored in the liver, gallbladder and San Jiao.
Gallbladder attaches to the liver and collects and stores Jingzhi (bile) secreted from the liver, therefore it is closely related to the liver's Shu Xie
(dredging and draining) function. San Jiao is a big cavity throughout the whole body serving as the passage for water, Yuan Qi (original Qi) and
Xiang Huo. Both need to be free of obstruction and stagnation.
Located in the middle between the Biao and Li, Shaoyang operates as the pivot for Qi movement. The following points expound the half-exterior and half-interior position of the Shaoyang. a) Shaoyang dominates membranes, which make up the body cavity and are located in the middle layer between the skin and muscles, body surface and internal organs. b) Gallbladder channel of Foot-Shaoyang is located between urinary bladder channel of
Foot-Taiyang and stomach channel of Foot-Yangming. In comparison, the
Yang Qi of Shaoyang is not as strong as Taiyang and Yangming, ( Taiyang has outer power of Yang Qi whereas Yangming the inner power of Yang Qi) and therefore its strength to fight against exogenous pathogens is relatively weaker than Taiyang and Yangming. c) Shaoyang is a transit area, a midway station between the exterior and interior, Yin and Yang. Among the three
Yang channels, Taiyang energy circulates on the exterior of the body,
Yangming energy in the interior of the body and Shaoyang energy a halfexterior and half-interior of the body. Between the three Yang and three Yin,
Shaoyang is located in a place where Yang channels connect with Yin channels and vise versa, and pathogens enter and exit from Yang to Yin. It is just like the hinge of a door controlling opening and closing.
4. Taiyin only refers to spleen channel of Foot-Taiyin and the associated organ. Located in the middle Jiao and abdomen, the spleen exteriorly opens into the mouth and dominates muscles and extremities, and interiorly governs transportation and transformation of food to produce Qi and blood.
Taiyin is the first layer of the three Yin channels. As a Yin organ, Taiyin needs Yang energy to warm it up. It likes dryness and hates dampness.

Survey of Classical Texts Long Fall 2011
5. Shaoyin includes the heart channel of Hand-Shaoyin and the kidney channel of Foot-Shaoyin and their associated organs. According to the theory of five elements, heart pertains to fire and dominates blood and vessels and houses the mind, while the kidney pertains to water and stores essence and source Qi. Thus, the heart and kidney work together to govern fire and water, Yin and Yang in the human body. However, they must mutually support and restrain one another so as to achieve a state of harmony. In general, Shaoyin takes the kidney as its root and fire as foundation of its functional activities.
6. Jueyin literally means that Yin is on verge of extinction and the Yang initiates. Jueyin includes pericardium channel of Hand-Jueyin and liver channel of Foot-Jueyin and their associated organs. Liver stores blood and
Xianghuo. Liver prefers to stretch up and maintain the free flow of Qi, which is crucial to the digestive function of the spleen and stomach.
Pericardium is a membrane surrounding the heart and protecting the heart.
Also Pericardium can preside over other Zang-Fu organs on behalf of the heart. Using San Jiao as a pathway, the Xianghuo of the pericardium descends to warm kidney, in turn, the kidney water ascends to cool the heart, and at the same time nourishes the liver (water nourishes wood). Thus the fire in the upper Jiao will not flame up and the water in the lower Jiao will not become icy cold, hence a healthy body.
B. The pathology of Liu Jing
Under the influences of the exogenous pathogenic factor, pathological changes take place in the human body and certain symptoms and signs will present. Based on the understanding of the physiology of the Liu Jing, we are able to overall analyze those symptoms and signs and attribute them to certain channels. Thus the specific disease (patterns) are established and the treatment is determined accordingly.
1. Taiyang disease
Taiyang disease is mostly seen in the early stage of exopathic diseases
Location of Taiyang disease: on the surface
Nature of Taiyang disease: excess
Pathology of Taiyang disease: Exogenous pathogenic cold and wind attack the first layer of the body, causing disharmony between the nutrient Qi and the defensive Qi, and hinder Qi circulation in the urinary bladder channel.
Clinical characteristics of Taiyang disease: Chills (aversion to cold) headache, stiff neck, superficial pulse.

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This is what is called the outline of Taiyang disease. It is a basis for us to identify Taiyang disease. Among these symptoms and signs, chills are the key symptoms.
*Note well the difference between aversion to cold and intolerance of cold.
Bian Zheng Lun Zhi
General treatment principle: relieve the surface syndrome with pungent and warm herbs and harmonize the nutritive Qi and the defensive Qi.
According to the differences in the strength of Zheng Qi and the intensity of
Xie Qi, there are three sub-disease: a. Taiyang Zhong Feng : fever and chills, aversion to wind, already sweating, floating and soft pulse. Formula for this is Guizhi Tang. In case of secondary symptoms present, Guizhi Tang plus Houpo, Xinren for cough and asthma; Guizhi Tang plus Gegen for stiff neck; Guizhi Tang plus Fuzi for profuse sweating due to Yang deficiency, etc. b. Taiyang Shanghan : aversion to cold, no sweating, floating and tight pulse. Formula for this is Mahuang Tang. In case of secondary symptoms present, Dr Zhang Zhongjing used the Mahuang Tang as a basic one to develop some other formulas, such as Da Qinglong Tang for cold wrapping fire, Xiao Qinglong Tang for cold stirring up watery phlegm, Gegen Tang for cold coagulating in the Taiyang channel, Gegen Jia Banxia Tang for cold affecting the stomach and intestines, etc. c. Biao Yu Qing Zheng : mild case of surface syndrome due to delayed diaphoresis with chief symptoms of paroxysmal fevers and chills. Formula for this is Guizhi Mahuang Ge Ban Tang.
Prognosis of Taiyang disease: normally easily cured if it is treated in a timely manner. For many reasons Taiyang disease may further progress.
There are basically two ways of transmission: in case of severe damage of
Yin fluid, it may advance to Yangming and Shaoyang or other complications characterized with heat. In case of severe damage of Yang Qi, it may sink into the three Yin channels and turns to deficient cold disease.
2. Yangming disease
Yangming disease is seen at the critical stage of exopathic diseases including Shanghan and Wen Bing (epidemic febrile diseases). At this stage, there is a fierce fight between Zheng Qi and Xie Qi, and heat comes to its climax.
Location of Yangming disease: Yangming disease belongs to interior

Survey of Classical Texts Long Fall 2011 syndrome and it locates in the stomach and the large intestines.
Nature of Yangming disease: excessive heat.
Pathology of Yangming disease: Since Yangming is ample with Qi and blood, and has a dry metal energy, it is likely that the pathogens turn to a excessive heat in the stomach and the large intestines, and present a totally excessive syndrome when they enter the Yangming territory. “Yangming is always a kind of excess,” this is the outline of Yangming disease.
Clinical characteristic of Yangming disease: excessive heat, aversion to heat instead of cold.
Bian Zheng Lun Zhi
General treatment principle: clear heat and purge dry stools to protect Yin fluid.
Yangming disease is divided into two types: Yangming Re (or Jing) syndrome and Yangming Shi (or Fu) syndrome. a. Yangming Jing syndrome : heat dispersing along the Yangming channels and the muscles with “four bigs”: big fever, big thirst and big restlessness, big sweat, and big pulse. Clearing heat method is used with Baihu Tang. If excessive heat damages both Qi and Yin, Baihu Jia Renshen Tang is recommended. If restlessness becomes predominant, Zhizi Chi Tang is a good choice. b. Yangming Fu syndrome: dry heat mixes with feces in the large intestine with symptoms and signs of fullness and bloating of the abdomen, constipation with dry stools, tidal fever, delirium, deep but forceful pulse and red tongue with yellow dry coating or brown thorny coating. Purging method is used with three Cheng Qi Tang.
Jaundice and bleeding are two possible complications of Yangming disease.
Prognosis of Yangming disease: Yangming disease looks very severe but is never life threatening, as the Zheng Qi is rather strong, so it usually has a favorable prognosis.
3. Shaoyang Disease
Shaoyang disease appears when the patient's Yang Qi is in a state of relative weakness. It may result from a.) direct attack of Shaoyang channel by the exogenous pathogens b.) advance from Taiyang c.) lingering Yang disease.
Location of Shaoyang disease: half-exterior and half-interior of the body.
Nature of Shaoyang disease: Yang, heat, excess
Pathology of Shaoyang disease: Exogenous pathogenic factors invade
Shaoyang leading to a conflict between anti-pathogenic Qi and exogenous

Survey of Classical Texts Long Fall 2011 pathogenic factors, giving rise to the stagnation of Qi and body fluid in the
Sanjiao and flaring up of the gallbladder fire, and possibly affecting the spleen and the stomach in transportation and transformation.
Clinical characteristics of Shaoyang disease: Since exogenous pathogenic factors lodge between the exterior and interior of the human body, Shaoyang disease is actually an intermediate disease. Its main clinical characteristics are alternate chills and fever, fullness and discomfort in the intercostal and hypochondriac regions, anorexia, restlessness, vomiting, a bitter taste in the mouth, dryness of the throat, blurry vision and a wiry pulse. Among these symptoms and signs, a bitter taste in the mouth, dryness of the throat and blurry vision are regarded as the outline of Shaoyang disease.
Bian Zheng Lun Zhi
Treatment principle: Harmonize Shaoyang
Chief Formula: Xiao Chaihu Tang
Because of its location Shaoyang disease can either exit or enter, affecting the Taiyang and Yangming and giving rise to a wide variety of symptoms and signs. In Shanghan Lun it mentions many “Huo Ran
Zheng” (possibly symptoms and signs, such as thirst, abdominal pain, hardness under the ribs, palpitation, difficult urination, cough, etc.).
Shanghan Lun also points out that Shaoyang disease can be identified when one of the chief symptoms presents, hence it is not necessary to see the whole set of symptoms and signs. The “harmonize” approach means multiple-treatment combined in a package: clearing and warming, tonifying and reducing, ascending and descending. The vigorous treatments which simply attack the pathogens cannot cope with the complicated conditions of Shaoyang syndrome, thus they are prohibited.
Traditionally, there are three treatment contraindications for Shaoyang disease. They are:
 contraindication in diaphoresis-------because Shaoyang disease is not located on the exterior of the human body.
 contraindication in purgation-------because Shaoyang disease is not located in the interior of the human body.
 contraindication in emetic therapy-------because there is no phlegm in the upper Jiao.
Because of its location Shaoyang disease is commonly to have many complications. For instance:
Shaoyang disease complicated with Taiyang syndrome-Chaihu Guizhi Tang.
Shaoyang disease complicated with Yangming syndrome-Da Chaihu Tang.
Shaoyang disease complicated with retention of watery phlegm-Chaihu
Guizhi Ganjiang Tang.

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Shaoyang syndromes complicated with Shen disturbance- Chaihu Jia
Longgu Muli Tang.
Prognosis of Shaoyang disease: general speaking it has a fair prognosis.
There are three ways for its changes: resolved at the Shaoyang stage through harmonizing treatment, progressing to Yangming when Yang Qi is strong, transmitting to three Yin when Yang Qi is weak.
4. Taiyin disease
Taiyin disease is a early stage of three Yin disease of Liujing diseases in
Shanghan Lun. In clinic, Taiyin disease is mainly caused by overeating raw or cold food and misuse of clearing and purging treatments that injure the spleen Yang. Therefore, the study of Taiyin disease is of practical value for miscellaneous diseases as well as exopathic diseases.
Location of Taiyin disease: located in the interior of the human body, particularly the spleen in the middle Jiao.
Nature of Taiyin disease: deficiency and cold
Pathology of Taiyin disease: invasion of the middle Jiao by pathogenic cold and dampness based on deficiency of the spleen Yang leads to dysfunction of the spleen in transportation and transformation.
Clinical characteristics of the Taiyin disease: the main clinical manifestations are abdominal distention, vomiting, poor appetite, diarrhea, occasional abdominal pain which is alleviated by warmth or pressure, absence of thirst, a pale tongue with a white coating and a slow or deep slow pulse. Except absence of thirst, and manifestations of the tongue and pulse, the others are regarded as the outline of Taiyin disease.
Bian Zheng Lun Zhi:
General treatment principle: warm up the middle Jiao, invigorate the function of the spleen, and disperse cold and dry up dampness.
Chief Formula: Li Zhong Tang (mild)
Si Ni Tang (severe)
The symptoms, such as abdominal pain, bloating in the stomach, vomiting and loss of appetite, may present in either Yangming or Taiyin diseases. But they are opposite in nature. This is just what Neijing Chapter 29 says: “Yang
Dao Shi, Yin Dao Xu.”
Taiyin disease has fewer complications compared to the other channels.
Prognosis of Taiyin disease: Although Taiyin disease is deficient and cold in nature, it is the first layer of the three Yin diseases with relatively simple pathology and clinical pattern. Therefore it has fair prognosis if a proper and timely treatment is employed.

Survey of Classical Texts Long Fall 2011
There are a few possibilities for transmission: a.) sudden restlessness and diarrhea might be the good sign of recovery, b.) transformation into
Yangming syndrome when Yang Qi gets stronger or cold-dampness has been resolved, in which stools become dry, c.) long standing retention of cold-dampness leads to Yin Huang, and d.) further development into
Shaoyin or even Jueyin diseases due to incorrect treatment or deterioration.
5. Shaoyin disease
Shaoyin disease is a critical stage of the developing process of Liujing diseases in Shanghan Lun. At this stage, the ability of the human body to resist diseases is remarkably weakened. Thus, the deficiency and cold symptoms and signs are presented. Shaoyin disease may result from transmission from the other channels, esp. from the Taiyin as son affecting mother, or from a direct attack by the pathogenic cold penetrating Taiyang into Shaoyin when the Yang Qi is extremely weak.
Location of Shaoyin disease: Shaoyin disease involves two Zang organs, namely, heart and kidney. They are interior syndromes.
Nature of Shaoyin disease: Deficiency of either fire or water, imbalance between Yin and Yang.
Pathology of Shaoyin disease:
In general, Shaoyin disease includes weakness of the kidney and heart, and deficiency of Yin or Yang. Therefore its outline is: “faint pulse and lethargic stupor.” Due to the diversity of patients’ body constitutions, pathogenic cold may transform into either a cold or heat condition.
Clinically Shaoyin diseases can be subdivided into two small diseases, namely cold syndrome and heat syndrome of Shaoyin. The former is major accounting for over 80%, while the latter is minor.
a. Cold syndrome of Shaoyin
Clinical characteristics of cold syndrome of Shaoyin: intolerance of cold, lying in a curled up position, listlessness, lethargic stupor, cold limbs, diarrhea with undigested food, absence of thirst or preference to hot drinks, a pale tongue with white coating and a faint (deep, feeble and thready) pulse.
Among these symptoms and signs, faint pulse and lethargic stupor are the outline of Shaoyin cold syndrome.
Treatment Principle: Support weak Yang and suppress excessive Yin.
Emphasis of treatment should be placed on warming and tonifying the kidney Yang. Why not warm and tonify the heart Yang? Because the heart
Yang is rooted in Mingmen fire.
Chief Formula: Si Ni Tang

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Complications:
If the Yin is too much and Yang is too little, the weak Yang may be excluded outside, the syndrome of so called “Yin Sheng Ge Yang.” That will cause false heat and true cold with the symptoms and signs of a flushed face, restlessness, thirst, etc. The treatment should break the Yin and bring back the Yang by using the formulas such Bai Tong Tang, Bai Tong Jia
Zhudanzhi Tang and Tong Mai Si Ni Tang.
If the Yang is too weak to steam up water, that will cause retention of water in the lower Jiao or even overflow of water to the upper Jiao, the syndrome of so called “Yang Xu Shui Fan.” The treatment should warm up Yang Qi, drain dampness and disperse cold by using the formulas like Fuzi Tang or
Zheng Wu Tang.
If the Yang is too weak to protect the body, the pathogenic cold may directly attack the Shaoyin, penetrating Taiyang to its paired channel. This is called
“Shaoyin Zhi Zhong.” The treatment should warm up the channel and relieve the surface by using the formula Mahuang Fuzi Xixin Tang. b. Heat Syndrome of Shaoyin
Pathology of Heat Syndrome of Shaoyin: The fire of the heart is overactive in the upper Jiao when the Yin of the kidney is insufficient and fails to rise up to nourish the Yin of the heart, leading to disharmony between the heart and the kidney.
Clinical characteristics of Heat Syndrome of Shaoyin: Mental restlessness, insomnia, thirst, sore throat, red tongue with little coating, thready and rapid pulse. All show kidney Yin deficiency and flaming of heart fire.
Treatment Principle: nourish the Yin of the heart and the kidney and clear off heat in the heart.
Chief Formula: Huanglian Ejiao Tang
Complication: Yin deficiency complicated with water retention. Zhuling
Tang is indicated.
Prognosis of the Shaoyin disease: in general the prognosis of Shaoyin disease is poor. Regarding the cold syndrome of Shaoyin, the prognosis depends on the recovery of Yang Qi. Many Shaoyin diseases die due to exhaustion of Yang Qi. With the heat syndrome of Shaoyin, the prognosis should depend on the existence of Yin fluid, as Wen Bing school emphasized later.

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6. Jueyin Disease
Jueyin disease is mostly seen in the final stage of Liujing diseases in
Shanghan Lun. Its condition is very complicated and critical. Jueyin disease is mainly resultant from transmission and development from the other channels, esp. the Shaoyang, its paired channel.
Location of Jueyin Disease: Liver and pericardium are two Zang organs involving in Jueyin disease. They are interior syndromes.
Nature of Jueyin disease: mixture of heat and cold, deficiency and excess
Pathology of Jueyin Disease: When the pathogens get into the Jueyin, a final battle arises. Since Jueyin is the last and deepest layer of the Liujing and the turning point of Yin and Yang, diseases in Jueyin tend to develop towards the two poles: extreme Yin or extreme Yang, extreme hot or extreme cold, extreme up to the vertex and throat or extreme down to the lower orifices and the feet, and possibly a mixture of the two extremes.
Bian Zheng Lun Zhi a. Shang Re Xia Han ( heat in the upper and cold in the lower)
When the pathogens enter the Jueyin, the liver is contracted. Liver Qi stagnation will easily affect the spleen in its function of transportation and transformation giving rise to many digestive symptoms and signs. There is a mixture of heat in the upper and cold in the lower, or heat in the liver and gallbladder, and cold in the spleen and stomach.
Clinical manifestations: Its main symptoms and signs are thirst, feeling of a gust of Qi rushing to the chest, heartburn, hunger with no desire to eat, cold limbs, diarrhea, and vomiting or vomiting of round worms. Among these symptoms and signs, thirst, the feeling of a gust of Qi rushing to the chest, heart burn, and hunger with no desire to eat are regarded as the outline of this pattern of Jueyin Disease.
Treatment Principle: harmonize the wood and the earth, clear heat above and warm up cold below.
Chief Formula: Wumei Wan b. Jue Re Sheng Fu : (cold extremities and feverish sensation prevails alternately)
Jueyin is the end of three Yin and the beginning of Shaoyang, therefore it calls for the smooth transition or hand-over. Pathologically, the failure of smooth transit leads to extreme Yin or extreme Yang, which manifest themselves with Jue (syncope, cold extremities, adverse-rising Qi rushing to the thorax from the lower abdomen) and feverish sensation. There are a few types of Jue syndromes discussed as follows:

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1) Re Jue
: “ Re Sheng Jue Yi Sheng”- clear heat and disperse depressed heat, Bai Hu Tang.
2) Han Jue: due to excessive Yin and weak Yang- warm up the channels and disperse cold, Si Ni Tang.
Cold extremities due to blood deficiency and cold coagulation in the liver channel-nourish blood, disperse cold, warm up the channel, Danggui Si Ni
Tang.
3) Qi Jue: cold extremities due to liver Qi stagnation and hindrance of Yang
Qi from dispersing to the outermost- course liver and disperse Yang, Si Ni
San.
Prognosis of Jueyin disease: prognosis depends on result of the battle between the Zheng Qi and Xie Qi. Jue and Re reflect the battling. Jue or coldness suggests preponderance of Yin and exhaustion of Yang, indicating a poor prognosis; while Re or feverish sensation implies restoring of Yang which Qi indicates a favorable prognosis.

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Jin Gui, an abbreviation of Jin Gue Yao Lue or Jin Gui Yao Lue Fang Lun
(Synopsis of the Golden Chamber), was also written by Dr. Zhang
Zhongjing. As a matter of fact, the book is a part of Shanghan Zabing Lun.
Around 200 A.D, Zhang Zhongjing completed his great works Shanghan
Zabing Lun (Treatise on Febrile Diseases Caused by Pathogenic Cold and
Other Miscellaneous Disease). As its name implies, the book contains two parts: febrile diseases and miscellaneous diseases, altogether 16 chapters, 10 on febrile diseases and 6 on miscellaneous diseases.
Not long after the compilation, the book was lost during the war. Later, Dr.
Wang Shuhe collected and reedited the scattered materials and made it the
Shanghan Lun with only the first part on febrile diseases omitting the part of miscellaneous diseases. Until the Northern Song Dynasty the lost part was found out by accident in the national library. Based on this version a group of scholars led by Ling Yi worked on it and finally compiled it, and titled it
Jin Gui Yao Lue Fang Lun. Since then this book has been passed down from generation to generation available as the same version today.
The book is made up of 25 chapters. The first chapter serves as the general outline of the whole book. Chapter 2 through 17 are on diseases of internal medicine. Chapter 18 is on external diseases. Chapter 19 collects some diseases that are hard to be put into any categories. Chapter 20 through 22 are on gynecology and obstetrics. Chapter 23 is on folk remedies. Chapter
24-25 are on food contraindications. The first 22 chapters contain 398 verses involving over 40 diseases and disease, 155 herbs, and 205 formulas. In addition to the herbal medicine, acupuncture and dietary therapy are also discussed in the book.
Jin Gue and Shanghan originally are two parts of one book written by the same author. So basically they are the same in academic ideas and just different in content.

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Table 1: Differences and similarities of Shanghan and Jin Gui
Shanghan Jin Gui
Similarities : both of them demonstrate how to determine the treatment
Differences : based on the differentiation of disease and how to link the Li, Fa, Fang, Yao in a chain(process).
Focus :
Differentiation febrile diseases
: six channels
Influence : on epidemic diseases miscellaneous diseases
Zang-fu organs internal medicine
The book is of high clinical value and some physicians keep it as their own secret. It has a profound impact on the development of clinical medicine.
The name of the book “Jin Gui” means that such a highly valuable book deserves a golden chamber or cabinet to keep it forever.