Both guan wiry (I assume the dong on the guan has some tension). You’ve been treating with a FZ formula and you have subcostal pain (that comes & goes), headache and dizziness that hasn’t resolved with shao yin/water treatment, making shao yang most likely.You also have diarrhoea and urinary incontinence that has not resolved with shao yin treatment, and SNS is one of the primary formulas to regulate bowels and urination.Now with the subcostal pain, headache & dizziness, one could consider harmonising with a CHT, but then do you want HQin, as there is a cold bladder? In that case SNS, along with the GZFLW indicated on the R chi gives you BS+MDP, which is the interior of HQin, and doesn’t cool the bladder further. Then with the dong on the L guan, that not only implies tension, but also some slight increased size/bulge, that with the R guan not being big gives you more licence to use CH at 24, giving you CH24 +BS&MDP, so a lot like a CHT structure.Then add the tight R 1st and you have ZWT, which allows you to warm the lower and the middle while regulating it with the SNS structure so the newly warmed ministerial fire can descend unhindered.
