鄭論：按緩脈，乃太陰之本象，此以為當發黃，吾甚不解。夫緩為胃氣，不主於病，取其兼見，方可論病。又曰：小便利者不發黃，全未見有胃家遏鬱病情，而獨曰小便利者不發黃，皆非正論。即謂太陰轉屬陽明，其脈必不得以緩論，即見大便鞭，當下之證，定有一翻先數日脈緩，後忽見實、大、洪、數之脈，乃為合法。
【闡釋】自此以下三節，皆言陽明假實之證，亦即邪從三陰傳入陽明之證也。太陰病濕盛陽微，不能溫運，若寒濕瘀滯，身當發黃；如小便通利，濕從下泄，便不能發黃。但小便自利過多，則腸中水分漸幹，積至七八日而大便鞭者，則太陰轉成陽明證矣。如此解釋，則鄭氏之疑可以不疑矣。
附：少陰轉陽明一證（據舒本校補）
七、少陰病，六七日，腹脹（滿）〔不大便〕者急下之，宜大承氣湯。原文322
鄭論：按此病必是少陰協火而動之候，前數日所現定是滿盤少陰證形，迨延至六七日，積陰生內熱，邪遂從熱化矣。熱甚以致腹脹不大便，則邪已轉入陽明，若不急下之，則真陰有立亡之勢，故下之宜急也。
【闡釋】鄭氏曰：“積陰生內熱，邪遂從熱化矣。熱甚以致腹脹，不大便，則邪已轉入陽明”。腹脹不大便者，必兼見舌苔乾燥，惡熱飲冷，方為實證。實則此乃少陰化熱太過，火傷中土之證也。急下以救中土，土壞則生機立竭矣。非用大承氣急下，安能救其危哉!
附：厥陰轉陽明一證（據舒本校補）
八、下利譫語者，有（躁）〔燥〕屎〔也〕，宜小承氣湯。原文374
鄭論：按譫語多緣內有（躁）〔燥〕屎，茲何又稱下利譫語？若下利而譫語，必非實證，必非下證。然譫語亦有似是而非處，學者務當細求，苟下利而譫語，其人有神，脈大而實，口渴、舌幹、飲冷，此為協熱而下利，皆在可下之例；若其人下利譫語，身重無神，舌潤不渴，脈微，又當溫腎扶陽，不得以譫語而盡為熱證，亦不得盡為可下之證也。
又按此條，大約為裏虛夾（躁）〔燥〕，而有（躁）〔燥〕屎結於中者言之也。余意當于溫補劑中，加大黃逐之，庶為妥切。
【闡釋】下利而譫語，有陽虛、陰虛之別，陽證者為協熱而下利，治以小承氣湯。若陰證下利譫語，無神不渴，脈微，法當溫腎扶陽，治以附子理中湯加補腎藥味。故鄭氏曰：“不得以譫語而盡為熱證，亦不得盡為可下之證也”，自當辨證施治，方為恰當。又按此條，大約為裏虛夾燥，鄭氏于溫補劑中，加大黃逐之，法可遵從。
傷寒恒論卷七
少陽篇計二十一法（據舒本校補）
一、傷寒五六日，中風，往來寒熱①，胸脅苦滿②，默默不欲飲食③，心煩喜嘔④，或胸中煩而不嘔、或渴、或腹中痛、或脅下痞鞕、或心下悸、小便不利、或不渴、身有微熱，或咳者，小柴胡湯主之。原文96
①往來寒熱：惡寒時不知熱，當熱時不知寒，寒和熱間代出現，即所謂間歇型熱。
②胸脅苦滿：謂胸脅部有苦悶的感覺。因少陽脈循胸脅，邪入其經，所以胸滿。
③默默：靜默不言也。
④喜嘔：即是時常作嘔。
鄭論：按少陽當陰陽交會之中，出與陽爭則熱生，入與陰爭則寒作，故有寒熱往來也。胸脅滿，默默不欲食者，肝邪實而上克其土，土畏木克，故不欲食。心煩喜嘔者，肝喜發洩也。甚至或煩、或咳、或渴、或腹痛、或心下悸、或小便不利，種種病情，皆係肝木不舒所致也。故以小柴胡主之，專舒木氣，木氣一舒，樞機複運，而諸證自釋矣。
【闡釋】往來寒熱，胸脅苦滿，默默不欲飲食，心煩喜嘔，這是小柴胡湯的主要證候，以下的或然證，並不是用小柴胡湯的主要目標。鄭氏所按已詳盡矣，無庸贅述。
小柴胡湯方（校補）
柴胡半斤黃芩三兩人參三兩半夏半升（洗）甘草（炙）生薑各三兩（切）大棗十二枚（擘）上七味，以水一鬥二升，煮取六升，去渣，再煎取三升，溫服一升，日三服。若胸中煩而不嘔者，去半夏人參，加栝蔞實一枚。若渴，去半夏，加人參合前成四兩半，栝蔞根四兩。
若腹中痛者去黃芩，加芍藥三兩。若脅下痞鞕，去大棗，加牡蠣四兩。若心下悸，小便不利者，去黃芩，加茯苓四兩。若不渴，外有微熱者，去人參，加桂枝三兩，溫複微汗愈。若咳者，去人參、大棗、生薑，加五味子半升，乾薑二兩。
【方解及其應用範圍】小柴胡湯乃表裏兩解法，亦轉輸調和之方。柴胡乃少陽主藥，可升陽達表，力能輸肝木之滯機，宣暢氣血，使半表半裏之邪得從外宣。黃芩苦寒，能清胸腹之熱，使半表半裏之邪得從內徹。《本經》稱柴胡推陳致新，黃芩主治諸熱，柴、芩合用，能解半表半裏之邪，半夏、生薑調理胃氣以止嘔，人參、棗、草益氣和中以養正。本方寒熱並用，攻補兼施，有疏利三焦氣機，調達上下升降，宣通內外，運行氣血之功，八法中列入和劑。關於此方除用治少陽經症外，鄭氏在《醫法圓通》中說：“治發熱、口苦、耳聾，其脈弦者，又治太陽、陽明二經發熱不退，寒熱往來。隨即舉出其圓通應用六條：（1）治兩脅脹痛；（2）治頭響，兩側脹；（3）治兩耳紅腫痛甚；（4）治瘧疾；（5）治吐酸不食；（6）治婦女熱入血室，譫語。筆者用以治肝咳，其由於肝陽不足者，用小柴胡湯去參、棗、生薑，加乾薑、五味、桂枝以溫肝利肺而咳愈；如因肝陰不足，肝火上逆，治當滋肝、降火、潤肺，用小柴胡湯去參、薑、棗、加貝母、知母、石膏治之。又曾治胃脘脹痛，其症狀為口苦、目眩、胸脅滿悶，脘腹時作脹痛，稍多食則大便溏，日四五次，舌質淡紅，苔膩，脈弦細，治以小柴胡湯加公丁香，吳茱萸，二劑而痊癒。現代用以治療具有本方主症的多種疾病，如感冒、扁桃腺炎、流行性腮腺炎、各型肝炎、膽囊炎、胸膜炎、腎炎及產後發熱、長期潮熱等，只要加減適宜，均能收到良效。更有用本方以通小便、止泄瀉的，可能與原文所謂“上焦得通，津液得下，胃氣因和”的作用有關，足見其制方之精當與應用之廣泛了”。
鄭論：按少陽稟風火之髒，口苦咽幹者，膽有熱也，膽液乃目之精，今為熱擾，精氣不榮，故見眩也。
【闡釋】諸家注傷寒者，大多以口苦、咽幹、目眩為少陽病之提綱。鄭氏僅釋三者之成因而不說是少陽病之提綱。舒馳遠亦僅謂此少陽之腑證也。口苦、咽幹、目眩，少陽病自然可以見到，但就不得為提綱。如陽明上篇16條的：“陽明中風，口苦咽幹”。同篇17條雲：“陽明病，脈浮而緊，咽燥口苦”。太陽中篇49條雲：“氣上沖胸，起則頭眩”。太陽上篇21條亦雲：“心下悸，頭眩身瞤動”。這說明口苦、咽幹、目眩等證，太陽病、陽明病都有，把它作為提綱看，在臨床沒有多大價值。相反把本篇第一條：“寒熱往來，胸脅苦滿，默默不欲飲食，心煩喜嘔”的小柴胡證作為少陽病提綱，還全面得多。在臨證時，應把兩條結合起來，這樣就全面了。
三、傷寒脈弦細，頭痛發熱者，屬少陽。少陽不可發汗，發汗則譫語，此屬胃，胃和則愈，胃不和，（則躁）〔煩〕而悸。原文265
鄭論：按少陽證，本宜和解，原不在發汗之例，強發其汗，血液被奪，則胃必（躁）〔燥〕，胃（躁）〔燥〕而譫語生，此條可謂少陽轉陽明，立論方可。
又按燥與悸，本係兩證，燥為熱邪，悸為水邪，此以籠統言之，大非少陽立法。
【闡釋】三陽證均有頭痛發熱，但在部位上有區別，太陽痛在腦後，陽明痛在前額，少陽痛在兩側。今頭痛發熱而脈弦細，正是少陽的主脈，與太陽頭痛發熱脈必浮，陽明頭痛發熱脈必大，亦有明顯的不同。少陽病邪不在表，是以禁汗。鄭氏曰：“強發其汗，血液被奪，則胃必燥，胃燥而譫語生”。所論甚是。
胃和則愈可有兩種情況，一是胃氣自和而愈，一是治療得當而愈，可用調胃承氣湯治之。
四、少陽中風①，兩耳無所聞，目赤，胸中滿而煩（躁）者，不可吐、下，吐、下則悸而驚。原文264
①中風：此處當解作外邪的總稱，包括傷寒在內。
鄭論：按少陽屬相火，今得中風，風火相煽，壅於上竅則耳聾目赤，壅於胸中則滿而煩躁，當此時也，正當小柴胡加開鬱清火去風之品，切切不可吐下。前條原有當下、當吐、與不當下、不當吐之禁，若妄施之，則驚悸立作矣，可不慎歟？
【闡釋】此條合前條是治療少陽病的三禁，不問其為傷寒或中風，只要病在少陽，均當禁用汗、吐、下三法。因少陽病邪不在表，所以禁用發汗；病不在裏，腸胃沒有燥屎結實，所以禁用攻下；雖有胸滿而煩，卻非胸中邪實，所以禁用吐法。鄭氏釋耳聾、目赤、胸中滿而煩為風火相煽，亦是正確的。若誤吐下，則誅伐無過，反致損氣耗液，而引起心悸、驚惕等變證。
五、傷寒三日，三陽為盡，三陰當受邪，其人反能食〔而〕不嘔，此為三陰不受邪也。原文270
鄭論：按三陰、三陽，各有界限，當三日後，應歸三陰，而其人反能食不嘔，可知太陰氣旺，旺不受邪，理勢然也。
【闡釋】診斷病邪傳變，應當以現有證狀為依據，方可決定其傳與不傳。鄭氏說：“能食不嘔，可知太陰氣旺，旺不受邪，理勢然也”。正足以說明不能為傳經規律所拘。
六、傷寒三日，少陽脈小者，欲已也。原文271
鄭論：按少陽當三日而脈小者，邪已衰也，故斷其欲已。
【闡釋】根據傳經規律，傷寒三日，應為少陽受病，脈當弦緊，今脈小者，邪氣微而病退，為欲愈的徵象。亦即鄭氏所說“邪已衰也，故斷其欲已”，筆者認為不能單憑脈以定證，必須證狀見減的，庶為欲愈。如脈小而證狀加劇，則為正衰邪盛，非欲愈之征。
七、少陽病欲解時，從寅至辰上。原文272
鄭論：按六經各有旺時，邪氣衰者，每于旺時自解，正所謂正旺而邪自退也。
【闡釋】本條指出少陽病欲解的時間，其精神與太陽病，陽明病欲解時同一意義。寅至辰上即每日上午三點至九點之間。
八、傷寒六七日，無大熱，其人（煩躁）〔躁煩〕者，此〔為〕陽去入陰故也①。原文269
①陽去入陰：就是去表入裏的意思。
鄭論：按身無大熱者，表邪將盡也，其人煩躁者，邪入陽明之驗也，又並無三陰證據，何言陽去入陰，於理法不合，姑錄之，以俟高明。
【闡釋】鄭氏雲：“無三陰證據，何言陽去入陰，於理法不合”。此應解“陽去入陰”為由表證“陽”入裏證“陰”之謂也。陰者指裏而言，非指三陰也。
九、傷寒四五日，身熱惡風，（頭）〔頸〕項強，脅下滿，手足溫而渴者，小柴胡湯主之。原文99
鄭論：按項強、身熱惡風者，太陽之表證也。口渴而手足溫者，胃中有熱也。脅下滿者，少陽氣機為寒束也。法宜桂枝湯加粉葛、柴胡、花粉之類，於此病庶為合法，若專主小柴胡湯，似未盡善。
【闡釋】本條有太陽表證，複有陽明裏證，更有少陽證，即脅下滿者，少陽氣機為寒束也。據“傷寒中風，有柴胡證，但見一證便是，不必悉具”之義，則可用小柴胡治之。鄭氏則認為專主小柴胡湯未盡善，而主桂枝湯加粉葛、柴胡、花粉之類，是三陽症狀兼顧，更為全面，理法可從。
十、傷寒陽脈澀，陰脈弦，法當（溫）〔腹〕中急痛（者），先與小建中湯，不差者，（與）小柴胡湯主之。原文100
鄭論：按陽脈澀者，陽虛也，陰脈弦者，陰盛也，法宜扶陽祛陰。若腹中急痛，則為陰寒阻滯，小建中湯力弱，恐不能勝其任。余意當以吳萸四逆湯，小柴胡湯更不能也。
【闡釋】腹中急痛，多屬虛寒證，所以金匱有虛勞裏急，腹中痛的記載，都用小建中湯建立中氣。但鄭氏認為小建中湯力弱，主用吳萸四逆湯，一舉祛邪外出。其實本條為少陽病兼裏虛寒證，脾胃之陽氣不能流暢，故腹中急痛，與小建中湯調和氣血，建中止痛，自屬正治。服後腹痛止，而少陽證不差者，再用小柴胡湯以和解少陽。
十一、傷寒五六日，已發汗而複下之，胸（腹）〔脅〕滿微結，小便不利，渴而不嘔，但頭汗出，往來寒熱，心煩者，此為未解也，柴胡桂枝乾薑湯〔主之〕。原文147
鄭論：按少陽證，法當和解，汗、下皆在所禁之例，今既汗、下之，而胸（腹）〔脅〕滿微結者，是下之傷中，濁陰得以上僭也。汗之而太陽傷，以致氣化失運，小便所以不利也。又見寒熱往來，少陽證仍在，主小柴胡湯加桂枝、乾薑，三陽並治，實為妥切。
【闡釋】太陽病汗、下後，則邪當解。今不解而見胸脅滿微結，小便不利，又見寒熱往來等證，是邪陷少陽，複有太陽之表，陽明之裏，此三陽並病。故鄭氏曰：“主小柴胡湯加桂枝、乾薑，三陽並治，實為妥切”。
柴胡半斤桂枝三兩（去皮）乾薑二兩黃芩三兩栝蔞根四兩牡蠣二兩（熬）甘草二兩（炙）上七味，以水一鬥二升，煮取六升，去渣，再煎取三升，溫服一升，日三服，初服微煩，複服汗出便愈。
[Zheng's Commentary]: Regarding the slow pulse (Huan Mai), it is the intrinsic pulse image of the Taiyin syndrome. To claim that jaundice should occur here is something I greatly fail to understand. The slow pulse represents Stomach Qi (Wei Qi) and does not indicate disease on its own; only by considering accompanying pulses can one discuss pathology. Furthermore, stating that "if urination is free, jaundice will not develop" completely fails to recognize the pathological condition of gastric stagnation and depression. To single out "free urination prevents jaundice" without evidence of such stagnation is not a correct argument. Even if one argues that Taiyin has transferred to Yangming, the pulse certainly cannot be described as slow. Even if hard stools appear, indicating a need for purgation, there must first be several days of a slow pulse, followed suddenly by solid, large, surging, or rapid pulses, which would be logically consistent.
[Explanation]: The following three sections all discuss the "false excess" syndromes of Yangming, which are essentially pathogens transmitting from the Three Yin meridians into Yangming. In Taiyin disease, dampness is abundant while Yang energy is weak, failing to warm and transport. If cold-dampness stasis occurs, jaundice should develop in the body. However, if urination is free, dampness drains downward, and jaundice cannot develop. Yet, if free urination persists excessively, fluids in the intestines gradually dry up. After accumulating for seven or eight days leading to hard stools, Taiyin transforms into a Yangming syndrome. With this explanation, Zheng’s doubts can be resolved.
Appendix: One Case of Shaoyin Transferring to Yangming (Supplemented according to Shu's edition)
Seven. In Shaoyin disease, after six or seven days, if abdominal fullness and inability to pass stool occur, urgent purgation is required; Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Original Text 322
[Zheng's Commentary]: This illness must be a manifestation of Shaoyin ministerial fire moving recklessly. The symptoms presented in the preceding days were undoubtedly a complete picture of Shaoyin syndrome. By the sixth or seventh day, accumulated yin generates internal heat, and the pathogen transforms into heat. Severe heat leads to abdominal distension and constipation, indicating the pathogen has entered Yangming. If urgent purgation is not performed, true Yin faces imminent depletion; therefore, purgation must be urgent.
[Explanation]: Zheng stated: "Accumulated yin generates internal heat, and the pathogen transforms into heat. Severe heat causes abdominal distension and constipation, indicating the pathogen has entered Yangming." Abdominal distension with constipation must be accompanied by a dry tongue coating, aversion to heat, and preference for cold drinks to constitute an excess syndrome. This is actually a case where Shaoyin transforms into excessive heat, damaging the central Earth (Spleen/Stomach) with fire. Urgent purgation aims to rescue the central Earth; if the central Earth collapses, vital energy will instantly exhaust. Without using Da Cheng Qi Tang for urgent purgation, how can this crisis be saved?
Appendix: One Case of Jueyin Transferring to Yangming (Supplemented according to Shu's edition)
Eight. Diarrhea accompanied by delirious speech indicates the presence of dry fecal matter; Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is indicated. Original Text 374
[Zheng's Commentary]: Delirious speech usually arises from dry fecal matter within. Why, then, is diarrhea mentioned alongside delirium? If diarrhea accompanies delirium, it is certainly not an excess syndrome, nor is it suitable for purgation. However, delirium can sometimes be deceptive; scholars must investigate carefully. If diarrhea is accompanied by delirium, but the patient retains spirit, has a large and forceful pulse, thirst, dry tongue, and preference for cold drinks, this is diarrhea due to協熱 (collateral heat) and falls under the category of purgation. Conversely, if the patient has diarrhea and delirium, but presents with heavy body, lack of spirit, moist tongue, no thirst, and a faint pulse, warming the Kidney and supporting Yang is required. One must not assume all delirium is due to heat, nor that all cases are suitable for purgation.
Furthermore, regarding this clause, it likely refers to interior deficiency mixed with dryness, where dry fecal matter is knotted in the middle. My opinion is that Rhubarb (Da Huang) should be added to warming and tonifying formulas to expel the dryness, which would be more appropriate.
[Explanation]: Diarrhea with delirium differs between Yang deficiency and Yin deficiency. For Yang syndromes, it is collateral heat causing diarrhea, treated with Xiao Cheng Qi Tang. For Yin syndromes with diarrhea and delirium, lacking spirit and thirst, with a faint pulse, the method is to warm the Kidney and support Yang, treating with Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) plus Kidney-tonifying herbs. Thus, Zheng said: "One must not assume all delirium is heat, nor that all cases are suitable for purgation." One must treat based on syndrome differentiation. Additionally, regarding this clause referring to interior deficiency with dryness, Zheng’s suggestion to add Rhubarb to warming/tonifying formulas is a method worth following.
Shanghan Heng Lun, Volume 7
Shaoyao Chapter: Total of Twenty-One Methods (Supplemented according to Shu's edition)
One. In Shanghan (Cold Damage) after five or six days, or Wind Strike, presenting with alternating chills and fever①, bitter fullness in the chest and hypochondrium②, silence with loss of appetite③, irritability and tendency to vomit④, or alternatively, irritability in the chest without vomiting, thirst, abdominal pain, hardness/fullness below the hypochondrium, palpitations, difficulty urinating, no thirst, slight fever on the body, or cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. Original Text 96
① Alternating chills and fever: Feeling cold without feeling hot, and feeling hot without feeling cold, with cold and heat appearing alternately, i.e., intermittent fever.
② Bitter fullness in chest and hypochondrium: A sensation of distress and fullness in the chest and hypochondriac region. Since the Shaoyao meridian traverses this area, pathogen invasion causes fullness.
③ Silence: Quiet and unwilling to speak.
④ Tendency to vomit: Frequent nausea/vomiting.
[Zheng's Commentary]: Shaoyao exists at the intersection of Yin and Yang. When emerging to contend with Yang, heat is generated; when entering to contend with Yin, cold is produced, hence the alternating chills and fever. Chest/hypochondriac fullness and silence with anorexia result from Liver pathogen excess attacking Spleen Earth; Earth fears Wood control, hence the anorexia. Irritability and vomiting occur because Liver Qi likes to vent. Even if symptoms vary—irritability, cough, thirst, abdominal pain, palpitations, urinary difficulty—the root cause is the unsoothing of Liver Wood Qi. Therefore, Xiao Chai Hu Tang is used to specifically soothe Wood Qi. Once Wood Qi is soothed, the pivot mechanism recovers operation, and all symptoms resolve.
[Explanation]: Alternating chills and fever, bitter fullness in chest/hypochondrium, silence with anorexia, and irritability with vomiting are the main syndromes for Xiao Chai Hu Tang. The alternative symptoms listed below are not the primary targets for this formula. Zheng’s analysis is thorough, requiring no further elaboration.
Xiao Chai Hu Tang Formula (Corrected/Supplemented)
Chai Hu (Bupleuri Radix) half jin, Huang Qin (Scutellariae Radix) three liang, Ren Shen (Ginseng Radix) three liang, Ban Xia (Pinelliae Rhizoma) half sheng (washed), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) each three liang (sliced), Da Zao (Jujubae Fructus) twelve pieces (torn). These seven ingredients are boiled in one dou two sheng of water, reduced to six sheng, dregs removed, then decocted again to three sheng. Take one sheng warm, three times daily.
If irritability in the chest without vomiting: remove Ban Xia and Ren Shen, add Gua Lou Shi (Trichosanthis Fructus) one piece.
If thirsty: remove Ban Xia, increase Ren Shen to total four liang half, add Gua Lou Gen (Trichosanthis Radix) four liang.
If abdominal pain: remove Huang Qin, add Bai Shao (Paeoniae Radix Alba) three liang.
If hardness/fullness below hypochondrium: remove Da Zao, add Mu Li (Ostreae Concha) four liang.
If palpitations and difficulty urinating: remove Huang Qin, add Fu Ling (Poria) four liang.
If no thirst and slight external fever: remove Ren Shen, add Gui Zhi (Cinnamomi Ramulus) three liang; cover warmly to induce slight sweating for recovery.
If coughing: remove Ren Shen, Da Zao, Sheng Jiang; add Wu Wei Zi (Schisandrae Fructus) half sheng, Gan Jiang (Zingiberis Rhizoma) two liang.
[Formula Analysis and Scope of Application]: Xiao Chai Hu Tang is a method of resolving both exterior and interior, and a formula for transmission and harmonization. Chai Hu is the chief herb for Shaoyao, capable of raising Yang to the exterior, relieving Liver Wood stagnation, promoting Qi and Blood circulation, allowing half-exterior/half-interior pathogens to dissipate outward. Huang Qin is bitter and cold, clearing chest/abdominal heat, allowing half-exterior/half-interior pathogens to penetrate inward. The *Shennong Bencao Jing* states Chai Hu pushes out the old and brings forth the new, while Huang Qin treats various heats. Together, they resolve half-exterior/half-interior pathogens. Ban Xia and Sheng Jiang regulate Stomach Qi to stop vomiting; Ren Shen, Zao, and Cao tonify Qi and harmonize the middle to nourish righteousness. This formula uses cold and heat together, attack and tonification simultaneously, possessing the function of smoothing Sanjiao Qi mechanism, regulating upper/lower ascent/descent, communicating interior/exterior, and moving Qi/Blood. It is classified as a Harmonizing Agent among the Eight Methods. Besides treating Shaoyao meridian syndromes, Zheng stated in *Yifa Yuantong*: "It treats fever, bitter taste, deafness with wiry pulse; also treats persistent fever in Taiyang/Yangming with alternating chills/fever. He listed six versatile applications: (1) Hypochondriac distension/pain; (2) Head ringing, lateral distension; (3) Red/swollen/painful ears; (4) Malaria; (5) Acid regurgitation/anorexia; (6) Women’s Heat Entering Blood Chamber with delirium. I have used it for Liver Cough due to insufficient Liver Yang, modifying Xiao Chai Hu Tang by removing Ren Shen, Zao, Sheng Jiang, adding Gan Jiang, Wu Wei Zi, Gui Zhi to warm Liver and benefit Lungs. For Liver Yin deficiency with flaming Liver Fire, I modify it by removing Ren Shen, Jiang, Zao, adding Bei Mu, Zhi Mu, Shi Gao to nourish Liver, descend fire, and moisten Lungs. I once treated epigastric distension/pain with bitter taste, vertigo, chest/hypochondriac fullness, intermittent epigastric/abdominal pain, loose stools after eating, pale red tongue with greasy coating, and wiry-thin pulse. Using Xiao Chai Hu Tang plus Gong Ding Xiang and Wu Zhu Yu cured it in two doses. Modernly, it treats various diseases with these main symptoms, such as common cold, tonsillitis, mumps, hepatitis, cholecystitis, pleurisy, nephritis, postpartum fever, long-term tidal fever, etc. With appropriate modifications, good effects are achieved. It is even used to promote urination and stop diarrhea, possibly related to the original text’s 'Upper Jiao opens, fluids descend, Stomach Qi harmonizes,' demonstrating the formula’s precision and broad application."
Two. What defines Shaoyao disease is bitter taste in the mouth, dry throat, and vertigo. Original Text 263
[Zheng's Commentary]: Shaoyao inherits the nature of Wind-Fire organs. Bitter taste and dry throat indicate Gallbladder heat. Gallbladder fluid is the essence of the eyes; now disturbed by heat, the essence fails to nourish, resulting in vertigo.
[Explanation]: Most commentators consider bitter taste, dry throat, and vertigo as the outline of Shaoyao disease. Zheng only explains their causes, not calling them the outline. Shu Chi Yuan also merely calls this the Shaoyao Fu syndrome. While these symptoms naturally appear in Shaoyao disease, they should not serve as the sole outline. For instance, Yangming Upper Chapter Clause 16 says: "Yangming Wind Strike, bitter taste and dry throat." Clause 17 says: "Yangming disease, floating-tight pulse, dry throat, bitter taste." Taiyang Middle Chapter Clause 49 says: "Qi rushing to chest, vertigo upon rising." Taiyang Upper Chapter Clause 21 says: "Palpitations, vertigo, tremors." This shows these symptoms occur in Taiyang and Yangming too. Using them as the outline has limited clinical value. Instead, using the first clause’s Xiao Chai Hu syndrome ("alternating chills/fever, chest/hypochondriac fullness, silence/anorexia, irritability/vomiting") as the Shaoyao outline is much more comprehensive. Clinically, combining both clauses provides a complete picture.
Three. In Shanghan, wiry-thin pulse with headache and fever belongs to Shaoyao. Shaoyao prohibits sweating; sweating causes delirium, which belongs to the Stomach. If Stomach harmonizes, recovery ensues; if not, irritability and palpitations occur. Original Text 265
[Zheng's Commentary]: Shaoyao syndromes require harmonization, not sweating. Forcing sweat depletes blood, causing the Stomach to become dry, leading to delirium. This clause effectively describes Shaoyao transferring to Yangming.
Furthermore, dryness and palpitations are distinct: dryness is heat pathogen, palpitations are water pathogen. Grouping them loosely contradicts Shaoyao legislative principles.
[Explanation]: All Three Yang syndromes present with headache and fever, but locations differ: Taiyang pain is in the back of the head, Yangming in the forehead, Shaoyao on the sides. Headache/fever with wiry-thin pulse is indeed the principal Shaoyao pulse, distinct from Taiyang’s floating pulse or Yangming’s large pulse. Since Shaoyao pathogen is not in the exterior, sweating is prohibited. Zheng said: "Forcing sweat depletes blood, causing Stomach dryness and delirium." This is correct.
"Stomach harmonizes, recovery ensues" implies two scenarios: spontaneous Stomach Qi harmony or successful treatment using Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).
Four. Shaoyao Wind Strike, hearing loss in both ears, red eyes, chest fullness with irritability, prohibits emesis and purgation; emesis/purgation causes palpitations and fright. Original Text 264
① Wind Strike: Here refers to external pathogens generally, including Shanghan.
[Zheng's Commentary]: Shaoyao relates to Ministerial Fire. With Wind Strike, wind and fire fan each other, blocking upper orifices (deafness/red eyes) and chest (fullness/irritability). At this time, Xiao Chai Hu Tang plus herbs to open depression, clear fire, and dispel wind is appropriate. Emesis/purgation must absolutely be avoided. Previous clauses listed prohibitions against improper emesis/purgation; reckless use causes immediate palpitations/fright. Caution is essential!
[Explanation]: These two clauses constitute the Three Prohibitions for treating Shaoyao disease. Regardless of Shanghan or Wind Strike, if the disease is in Shaoyao, sweating, emesis, and purgation are prohibited. Pathogen is not in the exterior (no sweating); not in the interior without dry feces (no purgation); chest fullness/irritability is not excess phlegm/fluid in the chest (no emesis). Zheng’s explanation of deafness/red eyes/chest fullness/irritability as wind-fire fanning is correct. Mistaken emesis/purgation damages healthy Qi and fluids, causing palpitations/fright complications.
Five. In Shanghan after three days, Three Yang are exhausted, and Three Yin should receive the pathogen. If the person can eat and does not vomit, this means Three Yin do not receive the pathogen. Original Text 270
[Zheng's Commentary]: Three Yin and Three Yang have boundaries. After three days, the pathogen should enter Three Yin. However, the ability to eat and absence of vomiting indicates strong Taiyin Qi. Strong Qi resists pathogen; this is logical.
[Explanation]: Diagnosing pathogen transmission requires basing decisions on current symptoms. Zheng said: "Ability to eat/no vomiting indicates strong Taiyin Qi, which resists pathogen." This proves one should not be bound rigidly by transmission rules.
Six. In Shanghan after three days, if the Shaoyao pulse is small, the disease is about to resolve. Original Text 271
[Zheng's Commentary]: If the Shaoyao pulse is small on the third day, the pathogen has weakened, so I judge it as resolving.
[Explanation]: According to transmission rules, Day 3 corresponds to Shaoyao, expecting wiry-tight pulse. A small pulse indicates weak pathogen and recovering disease, a sign of resolution. As Zheng said, "pathogen weakened, thus resolving." However, pulse alone is insufficient; symptom reduction is necessary. If pulse is small but symptoms worsen, it indicates healthy Qi decline and pathogen excess, not resolution.
Seven. Shaoyao disease resolves from Yin hour to Chen hour. Original Text 272
[Zheng's Commentary]: Each of the Six Meridians has a peak time. When pathogen weakens, it often resolves during the peak time, meaning strong Healthy Qi drives out pathogen.
[Explanation]: This clause specifies the resolution time for Shaoyao disease, sharing the same principle as Taiyang and Yangming resolution times. Yin to Chen hours correspond to 3:00 AM to 9:00 AM daily.
Eight. In Shanghan after six or seven days, no significant fever, but the person is irritable/restless, this is because Yang departs and enters Yin①. Original Text 269
① Yang departs enters Yin: Means departing the exterior and entering the interior.
[Zheng's Commentary]: No significant fever indicates exterior pathogen is nearly exhausted. Irritability/restlessness indicates pathogen entering Yangming. Without evidence of Three Yin, claiming "Yang departs enters Yin" contradicts theory/method. I record it tentatively for experts to evaluate.
[Explanation]: Zheng questioned: "No Three Yin evidence, how can we say Yang enters Yin?" This should be interpreted as transitioning from Exterior Syndrome ("Yang") to Interior Syndrome ("Yin"). "Yin" here refers to the Interior, not specifically the Three Yin meridians.
Nine. In Shanghan after four or five days, body heat, aversion to wind, stiff neck, fullness below hypochondrium, warm hands/feet, and thirst, Xiao Chai Hu Tang is indicated. Original Text 99
[Zheng's Commentary]: Stiff neck, body heat, aversion to wind are Taiyang exterior signs. Thirst and warm extremities indicate Stomach heat. Hypochondriac fullness indicates Shaoyao Qi mechanism constrained by cold. The method should be Gui Zhi Tang (Cinnamon Twig Decoction) plus Ge Gen (Puerariae Lobatae Radix), Chai Hu, and Hua Fen (Trichosanthis Radix). This is more appropriate than solely using Xiao Chai Hu Tang.
[Explanation]: This clause involves Taiyang exterior, Yangming interior, and Shaoyao syndromes (hypochondriac fullness due to cold constraint). Based on the principle "In Shanghan/Wind Strike, if Chai Hu syndrome is present, seeing one symptom suffices," Xiao Chai Hu Tang could be used. Zheng argued that relying solely on Xiao Chai Hu Tang is incomplete; proposing Gui Zhi Tang plus Ge Gen, Chai Hu, Hua Fen covers all Three Yang symptoms comprehensively, which is theoretically sound.
Ten. In Shanghan, superficial pulse is choppy, deep pulse is wiry; methodologically, acute abdominal pain should occur. First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if ineffective, Xiao Chai Hu Tang is indicated. Original Text 100
[Zheng's Commentary]: Choppy superficial pulse indicates Yang deficiency; wiry deep pulse indicates Yin excess. Method dictates supporting Yang and dispelling Yin. Acute abdominal pain indicates Yin-cold obstruction. Xiao Jian Zhong Tang is too weak; I suggest Wu Zhu Yu Si Ni Tang (Evodia Four Reversals Decoction) instead. Xiao Chai Hu Tang is inadequate.
[Explanation]: Acute abdominal pain often indicates deficiency-cold. *Jin Gui Yao Lue* records using Xiao Jian Zhong Tang for deficiency consumptive conditions with acute abdominal pain to establish Middle Qi. Zheng considered Xiao Jian Zhong Tang too weak, preferring Wu Zhu Yu Si Ni Tang to expel pathogen. However, this clause represents Shaoyao disease combined with interior deficiency-cold. Spleen/Stomach Yang fails to flow smoothly, causing acute pain. Xiao Jian Zhong Tang harmonizes Qi/Blood and builds Middle to stop pain, which is correct treatment. If pain stops but Shaoyao symptoms persist, then use Xiao Chai Hu Tang to harmonize Shaoyao.
Eleven. In Shanghan after five or six days, after sweating and then purging, chest/hypochondriac fullness with slight knotting, difficulty urinating, thirst without vomiting, only head sweating, alternating chills/fever, and irritability, this is unresolved; Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is indicated. Original Text 147
[Zheng's Commentary]: Shaoyao syndromes require harmonization; sweating/purgation are prohibited. Having already sweated and purged, chest/hypochondriac fullness/knotting results from purgation injuring the Middle, allowing turbid Yin to rebel upward. Sweating injured Taiyang, causing Qi transformation failure and urinary difficulty. Alternating chills/fever shows Shaoyao syndrome persists. Using Xiao Chai Hu Tang plus Gui Zhi and Gan Jiang treats all Three Yang simultaneously, which is appropriate.
[Explanation]: After Taiyang sweating/purgation, pathogen should resolve. Failure to resolve, presenting with chest/hypochondriac fullness/knotting, urinary difficulty, and alternating chills/fever, indicates pathogen sinking into Shaoyao with residual Taiyang exterior and Yangming interior involvement—a Three Yang concurrent disease. Zheng said: "Using Xiao Chai Hu Tang plus Gui Zhi/Gan Jiang treats all Three Yang simultaneously, which is appropriate."
Chai Hu Gui Zhi Gan Jiang Tang Formula (Corrected/Supplemented)
Chai Hu half jin, Gui Zhi three liang (bark removed), Gan Jiang two liang, Huang Qin three liang, Gua Lou Gen four liang, Mu Li two liang (roasted), Zhi Gan Cao two liang. These seven ingredients are boiled in one dou two sheng of water, reduced to six sheng, dregs removed, then decocted again to three sheng. Take one sheng warm, three times daily. Initial dose may cause slight irritability; subsequent doses induce sweating and cure.