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Without sound but with phlegm is not cough. Cough, without sound but with phlegm, is called "ke". Cough is the upward reversal of Lung Qi. The Lung is the zang organ that governs Qi, controlling respiration and circulating Wei Qi (Defensive Qi). If Qi reverses upward, tonification is inappropriate. Therefore, the sweet properties of Ren Shen (Ginseng Radix) and Da Zao (Jujube Fruit) are removed.

Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) need not be removed. The addition of Wu Wei Zi (Schisandrae Fructus) and Gan Jiang (Zingiberis Rhizoma, Dried Ginger) follows the formulation principle of Xiao Qing Long Tang (Minor Blue Dragon Decoction). Xiao Qing Long Tang is used because cold-water injury damages the Lung; thus, it uses these herbs to astringe the upward-reversing Lung Qi. The rationale for using them in this formula is identical. However, this combination is suitable for cases of Cold-Phlegm in the Lung with Qi reversal; it should not be added in cases of Lung Heat with excess.

The term "half sheng" does not refer to the modern unit of measurement "sheng". Adding half a sheng of Wu Wei Zi would startle readers, who might find it hard to believe that such an astringent herb could be used in such a large quantity. It is unknown to many that the ancient "sheng" was roughly the size of a "fang cun bi" (square-inch spoon), made of copper, with a square top one inch on each side, a bottom six fen deep, and a depth of only eight fen. It resembled a small, square iron. I have seen such old vessels, but people did not recognize them, suspecting them to be incense burner accessories, unaware that they were actually ancient measuring vessels for herbs. This description matches the dimensions and shape recorded by Tao Hongjing in *Ming Yi Bie Lu* (Classification of Famous Physicians' Records), except for the handle, which was likely added for convenience. Using half of this ancient sheng as one dose, divided into three servings, is reasonable and not surprising. This measure has long been abandoned, so people are unaware of its existence, mistaking it for the modern sheng. Consequently, they are startled by the perceived impropriety of ancient prescriptions, claiming that ancient formulas cannot treat modern diseases—a conclusion that is understandable given this misunderstanding.

[Correction of Errors] Ke Yunbo (*Tiao Bian*) and Yu Jiayan (*Shang Lun*) both transcribed the text as "Shang Han (Cold Damage) five or six days, Zhong Feng (Wind Strike) alternating chills and fever." Cheng Wuji's annotated version reads "Shang Han Zhong Feng five or six days." In his annotation, Cheng cites the *Yu Han Jing* (Jade Chamber Classic): "Zhong Feng five or six days, Shang Han alternating chills and fever." He interprets this to mean either Zhong Feng or Shang Han, not Shang Han followed by Zhong Feng, nor Zhong Feng followed by Shang Han. This aligns with Zhang Zhongjing’s statement: "In Shang Han or Zhong Feng, if there are Chai Hu syndrome signs, observing just one symptom is sufficient." This refers to either Zhong Feng or Shang Han. This interpretation is logical and should be adopted. Fang Youzhi states that the *Mai Jing* (Pulse Classic) reads "Zhong Feng alternating chills and fever, after five or six days of Shang Han," and "Xin Fan" (heart vexation) as "Fan Xin," "Xin Xia" (epigastrium) as "Xin Zhong," and "Shen You" (body has) as "Wai You." Although transmission variations exist, the meaning remains the same.

"In Shang Han or Zhong Feng, if there are Chai Hu syndrome signs, observing just one symptom is sufficient; all symptoms need not be present."

The previous two clauses detailed various manifestations of Shaoyang channel pathology, yet not all symptoms necessarily appear. To prevent later practitioners from assuming that only the presence of all symptoms constitutes Shaoyang disease, this clause was established to clarify the "either-or" nature of symptoms mentioned earlier, such as "vexation in the chest," "thirst," or "abdominal pain." "Shang Han Zhong Feng" means either Shang Han or Zhong Feng. It implies that within the context of Shang Han or Zhong Feng, any appearance of Shaoyang symptoms indicates a Chai Hu Tang syndrome. Even observing just one symptom confirms that pathogenic factors have entered the Shaoyang stage, without requiring all symptoms to be present as described previously. If only Shaoyang channel-specific symptoms are present, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used primarily. If there are concurrent symptoms from other channels, Xiao Chai Hu Tang should still be the primary formula, supplemented by herbs targeting the other channels. For instance, if Chai Hu syndrome signs are present but Taiyang exterior symptoms persist, Xiao Chai Hu Tang plus Gui Zhi Tang (Cinnamon Twig Decoction) should be used. If Shaoyang disease is unresolved but Yangming interior pathogens are urgent, Da Chai Hu Tang (Major Bupleurum Decoction) is formed by removing Ren Shen and Gan Cao from Xiao Chai Hu Tang and adding Da Huang (Rhei Radix et Rhizoma) to resolve both exterior and interior simultaneously. Furthermore, if Shaoyang disease becomes a "ruined disease" due to mis-treatment, formulas such as Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction plus Mirabilite), Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction), and Chai Hu Long Gu Mu Li Tang (Bupleurum, Dragon Bone, and Oyster Shell Decoction) may be employed. These are all modifications of Xiao Chai Hu Tang. Since observing any single Shaoyang symptom warrants treatment with Xiao Chai Hu Tang, these conditions are termed "Chai Hu syndromes." In older editions, various modified Chai Hu Tang formulas were mixed into the Taiyang chapter. Now, they are collected in the Shaoyang chapter, governed by Xiao Chai Hu Tang as the principal formula, with modified versions listed beneath it, allowing students to follow the sequence for treatment. This approach may help approximate Zhang Zhongjing’s intent, perhaps grasping even a fraction of his wisdom.

After four or five days of Shang Han, if the patient presents with body heat, aversion to wind, stiffness in the neck and occiput, fullness under the costal margin, warm hands and feet, and thirst, Xiao Chai Hu Tang should be administered.

Four or five days mark the completion of transmission through the Three Yang channels. Body heat, aversion to wind, and neck stiffness are Taiyang exterior symptoms. Fullness under the costal margin indicates pathogenic factors entering Shaoyang. Warm hands and feet and thirst indicate that the pathogen has not entered the Yin channels. From the perspective of Taiyang exterior syndrome, sweating therapy might seem appropriate. However, since fullness under the costal margin is already present, the pathogen has entered Shaoyang. As Zhang Zhongjing stated, "In Shang Han or Zhong Feng, if there are Chai Hu syndrome signs, observing just one symptom is sufficient; all symptoms need not be present." Therefore, despite the persistence of Taiyang exterior symptoms, inducing sweat would violate contraindications. Thus, Xiao Chai Hu Tang remains the primary treatment. However, it must be used according to modification principles. If Taiyang exterior symptoms persist, Ren Shen should be removed and Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) added. For fullness under the costal margin, Mu Li (Ostrea Concha, Oyster Shell) should be added. For thirst, Ban Xia (Pinelliae Rhizoma, Pinellia Tuber) should be removed and Gua Lou Gen (Trichosanthis Radix, Trichosanthes Root) added.

In Shang Han, if the Yang pulse is choppy (Se) and the Yin pulse is wiry (Xian), abdominal cramping pain is expected. Treat first with Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). If ineffective, administer Xiao Chai Hu Tang.

Yang pulses relate to the exterior, and Yin pulses relate to the interior. A wiry pulse indicates Liver pathogenic factors causing tension and urgency. A choppy pulse indicates stagnation of Ying Blood (Nutritive Blood). Thus, wiry relates to Liver pathogenic factors, and choppy relates to Yin. When cold is at the semi-exterior/semi-interior boundary, Wei Qi fails to circulate, and Ying Blood does not flow smoothly, resulting in a choppy pulse. When pathogens enter Shaoyang, Liver Wood qi becomes hyperactive, causing a wiry pulse. A choppy Yang pulse indicates taking the superficial floating position lightly. A wiry Yin pulse indicates pressing the deep沉 position heavily. A choppy Yang pulse reveals disharmony between Ying and Wei, stagnation of Qi and Blood, and pathogens at the semi-exterior. A wiry Yin pulse indicates pathogens partially entering the interior, with Wood overacting on Earth, affecting the Taiyin Spleen. The Taiyin Spleen Earth is invaded by Liver pathogenic factors, causing abdominal cramping pain. The abdomen is the territory of the Foot-Taiyin Spleen meridian, which originates at the tip of the great toe, ascends along the medial anterior aspect of the knee and thigh, enters the abdomen, connects with the Spleen, and links with the Stomach. Hence, the abdomen is the domain of Taiyin. Cramping pain results from the severe Yin pathogenic factors of Jueyin Liver Wood injuring the Spleen. The *Su Wen: Zang Qi Fa Shi Lun* states: "The Liver suffers from tension; urgently use sweet flavors to relax it." It also states: "The Spleen desires relaxation; urgently use sweet flavors to relax it." Therefore, Xiao Jian Zhong Tang is used first for its sweet property to relieve the tension of the Liver and Spleen and establish Middle Qi. Once Middle Qi is robust, Liver pathogenic factors will recede. If symptoms persist, Shaoyang pathogens remain unresolved, and Xiao Chai Hu Tang should be used to harmonize and resolve them. Given the abdominal cramping, Middle Qi deficiency-cold is likely. Besides Cheng Wuji’s removal of Huang Qin (Scutellariae Radix, Skullcap Root) and addition of Shao Yao (Paeoniae Radix Alba, White Peony Root), Sheng Jiang and Gui Zhi could also be added.

After five or six days of Shang Han, if there is sweating only on the head, slight aversion to cold, cold hands and feet, epigastric fullness, desire to eat nothing, hard stools, and a fine pulse, this is termed "Yang Micro-Constriction." There must be both exterior and interior involvement. A deep pulse also indicates interior involvement. Sweating indicates Yang micro-deficiency. If it were pure Yin constriction, there would be no exterior symptoms; all pathogens would be interior. This represents pathogens half in the interior and half in the exterior. Even if the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease. Why? Because Yin syndromes should not present with sweating. The presence of head sweating indicates it is not Shaoyin. Xiao Chai Hu Tang may be administered. If the condition remains unrelieved ("liao liao bu liao"), resolution occurs through defecation.

This clause not only differentiates suspected Shaoyang and Shaoyin syndromes but, extended further, embodies the essence of distinguishing Yin and Yang across the Six Channels. Five or six days indicate pathogens entering the interior. Head sweating indicates pathogens in Yang channels. Aversion to cold is a fundamental symptom of Three Yin, but Taiyang exterior symptoms also include aversion to cold. Epigastric fullness occurs in Shaoyang (chest fullness) and Shaoyin syndromes. Cold hands and feet are characteristic of Shaoyin, but Jueyin presents with "deeper cold, deeper heat." Both Shaoyang and Jueyin present with "silent desire not to speak/eat." Only hard stools distinguish this from Three Yin syndromes. With mixed symptoms and confusing Yin-Yang patterns, careful pulse diagnosis is required. If the pulse is merely fine without being deep and slow, the pathogen remains in Shaoyang, with weak Yang and excess Yin. Yin pathogens constricting the interior cause cold extremities, epigastric fullness, and anorexia, while head sweating remains a Yang sign. Thus, this is "Yang Micro-Constriction," indicating pathogens involving both exterior and interior. A deep pulse confirms interior involvement. Although cold extremities and anorexia suggest interior Yin pathogens, head sweating remains a Yang sign, albeit weak. Why? Pure Yin constriction would lack exterior signs like head sweating, with all pathogens interior. The presence of Yang channel exterior signs means pathogens are half interior, half exterior, hence "exterior and interior." Thus, even with a deep-tight pulse, it is not Shaoyin. Yin channel pathogens do not typically cause sweating; in Shaoyin, sweating is "counterflow" and indicates collapse of Yang. Head sweating occurs because Yang channels ascend to the head, while Yin channels stop at the neck. Therefore, it is not Shaoyin. Pathogens remain at the semi-exterior/semi-interior, i.e., Shaoyang. Xiao Chai Hu Tang should be used to harmonize. If "liao liao bu liao" (unclear/unresolved vision) persists, it implies the pathogen has moved from Shaoyang to Yangming interior, akin to the Yangming chapter's description of "unclear vision, unstable pupils, no exterior/interior symptoms, difficult defecation, indicating excess, requiring urgent purgation." Hence, the method of "attacking Earth stagnation" (purging bowels) is indicated, leading to resolution via stool. If vision is not yet unclear, pathogens remain in Shaoyang, and purgation is contraindicated.

[Correction of Errors] Yu Jiayan (*Shang Lun*) interprets "Yang Micro-Constriction" as mild constriction of Yang pathogens, not fully dispersed. Interpreting it as Yang Qi collapse leading to pathogen constriction is a significant error. If true, head sweating would indicate Yang collapse, not semi-exterior/semi-interior status. Similarly, "Yin Constriction" would imply Yin Qi collapse. I argue that interpreting "Yang Micro-Constriction" as mild Yang pathogen constriction links "micro" and "constriction." Thus, interpreting it as Yang Qi collapse is incorrect. However, how should "Yang micro" in "sweating indicates Yang micro" be interpreted? If head sweating is Yang collapse, then cases in the Taiyang chapter ("head sweating only, no other sweat, stopping at the neck") and Yangming chapter ("head sweating only, body no sweat, stopping at the neck, dry urine, likely jaundice") would all be Yang collapse. Interpreting Yin Constriction as Yin Qi collapse is similarly absurd. Zhang Zhongjing’s intent was that Shang Han normally causes no sweat. Due to weakened Wei Yang and insecure Yang Qi, head sweating and slight aversion to cold occur. "Sweating indicates Yang micro" shows that despite Yin-cold interior symptoms (cold extremities, epigastric fullness, anorexia), the presence of sweating and aversion to cold indicates residual Yang pathogens in the exterior, not pure Yin constriction. Pure Yin constriction would lack exterior signs and be entirely interior. Since Yang is weak but Yang signs persist, it is half interior, half exterior. This clearly indicates Yang Qi weakness with internal Yin pathogen constriction. One cannot force interpretations, mistakenly labeling sweating as Yang collapse or Yin constriction as Yin Qi collapse. Regarding "unclear vision," the Yangming chapter provides clear guidance. How can Da Chai Hu Tang be considered a harmonizing method here?

In Shang Han, if there is abdominal fullness and delirious speech, and the Cun Kou (radial artery at the wrist) pulse is floating and tight, this is Liver Wood overacting on Spleen Earth, termed "Zong" (Vertical/Unrestrained). Treat by puncturing Qi Men.

These two clauses demonstrate that diseases and treatments have no fixed rules, offering new perspectives amidst difficulty, similar to the *Nei Jing*’s concept of "evaluating the extraordinary." Abdominal fullness is a Foot-Taiyin Spleen disease. Delirious speech is a Foot-Yangming Stomach excess condition. Abdominal fullness suggests Spleen Cold, warranting warming. Delirious speech suggests Stomach Heat, warranting purgation. Cun Kou, or Qi Kou, is the pulse point of the Hand-Taiyin Lung meridian. The Lung governs Qi, and Ying-Wei Qi reconverges here after fifty cycles. Thus, it reflects Stomach Qi. The Stomach is the Sea of Water and Grain, the source of the Five Zang and Six Fu organs. Flavors enter the stomach and intestines to nourish the Zang organs, manifesting at Qi Kou. Here, the Qi Kou pulse is floating and tight. Floating indicates Wind; Tight indicates Cold. These are exterior pathogen pulses. However, the symptoms (fullness, delirium) suggest pathogens are not exterior. The pulse suggests pathogens are not interior. In the Taiyin chapter, abdominal fullness has no sweating indication. In the Yangming chapter, abdominal fullness with floating-tight pulses has no purgation indication. Pulse and symptoms contradict, making treatment difficult. Deep analysis reveals that if pathogens were truly exterior, only Cun Kou would not be floating and tight alone. If pulse remained floating-tight, pathogens would be exterior, yet abdominal fullness and delirium would not occur. Zhang Zhongjing recognized that pathogens invade the Middle Jiao, manifesting uniquely at Qi Kou. Hence, he named it "Liver overacting on Spleen." "Overacting" means attacking what it controls. Wood naturally controls Earth, following the normal cycle of Five Elements generation and restriction. This is logical and direct, hence termed "Zong" (Vertical/Unrestrained), implying smooth texture. With no sweating or purgation methods available, and knowing Liver Wood controls Spleen Earth, treatment focuses on draining the Liver. Qi Men is the Front-Mu point of the Foot-Jueyin Liver meridian. The meridian starts at Da Dun on the big toe and ends at Qi Men, located 4.5 cun lateral to Ju Que below the nipple. From here, it enters to connect with the Liver and Gallbladder. Puncturing it drains excess, following the principle of "draining based on excess," thereby calming Qi and resolving pathogens.

In Shang Han, if there is fever, slight aversion to cold, extreme thirst desiring water, and abdominal fullness, but spontaneous sweating and free urination occur, the disease will resolve. This is Liver Wood overacting on Lung Metal, termed "Heng" (Horizontal/Rebellious). Treat by puncturing Qi Men.

Shang Han fever refers to established fever in Shang Han. Slight aversion to cold indicates Wind pathogens in the exterior. Extreme thirst desiring water was discussed in the Shang Han section regarding Wind Strike: fever for six or seven days unresolved with vexation and exterior-interior symptoms leads to thirst. This is thirst caused by pathogens invading the Taiyang interior. Also, after excessive sweating in Taiyang disease, stomach dryness causes thirst. Thirst from combined Wind-Cold invasion and Yangming chapter cases of thirst with dry mouth/tongue are treated with Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction). These involve no exterior symptoms, with Heat pathogens entering the Stomach. Here, fever and slight aversion to cold indicate pathogens still in the exterior. Extreme thirst indicates pathogens in the interior. While exterior pathogens can coexist with interior symptoms, such severe interior symptoms with persistent exterior signs are unusual. Why? Although presenting as Shang Han fever with slight aversion to cold, this is actually Ying-Wei disharmony. The Lung governs skin/hair and circulates Ying-Wei. Lung pathogen invasion causes loose skin pores, leading to slight aversion to cold. Commentators attribute extreme thirst to Wood excess generating intense Heat, which is incorrect. Abdominal fullness does not result solely from drinking water. Abdominal fullness is a Spleen disease. The *Jing Mai Bie Lun* states: "Water enters the stomach, essence floats up, transports to the Spleen, Spleen scatters essence, returns to the Lung, regulates water passages, descends to the Bladder, water essence distributes four directions, flows through five meridians." Where does extreme thirst fit? This occurs because Liver Wood overacts on Spleen Earth, causing abdominal fullness. Spleen disease fails to scatter essence and transport it to the Lung, weakening Lung Qi. Weak Lung Qi cannot govern the hundred vessels and transmit essence to skin/hair, causing slight aversion to cold and extreme thirst to moisten dryness. This is Liver overacting on Lung. Lung is Metal, controlled by Wood. How can it be overacted upon? It is because strong Liver Wood, having conquered Earth, borrows strength to insult weak Lung Metal. This is irregular, hence termed "Heng" (Horizontal/Rebellious). If Lung strengthens itself, it will not be insulted. Its Qi will circulate Ying-Wei, open skin/hair, induce sweating, resolve fever/aversion to cold, regulate water passages, promote urination, and reduce abdominal fullness. Thus, the disease resolves. If unresolved, puncture Qi Men to drain excess Liver Qi, relieving the siege on Spleen and Lung.