诸外实者不可下。下之则发微热。亡脉厥者。当脐握热。
诸外实者。为表热里寒。下之则表邪内陷。客于下焦。故脉伏不至四肢厥逆。但当脐一片掣引。而烦热不宁也。
诸虚者不可下。下之则大渴求水者易愈。恶水者剧。
诸虚下之为重虚内竭津液。故令大渴求水者。阳气未竭故易愈也。
脉数者不可下。下之则必烦。利不出。
阳明之脉必浮大。若兼之以数为邪气方炽。下之则热邪乘虚入里。故内烦而协热利也。
以上宿病禁下
少阳证统而言之。邪居表里之半。析而言之。亦有在经在腑之分。然其治总不越小柴胡随证加减为权衡。谓其能于
本经中鼓舞胃气。上载其邪于上也。盖少阳为枢职司开阖而转运其枢者。全赖胃气充满。则开阖有权。其邪不敢内犯。
胃气不振则关钥废弛。邪得出入无禁矣。是少阳所主宁不重在胃气乎。
少阳之为病。口苦咽干目眩也。
少阳热炽。故口苦咽干。热聚于胸也。目眩者。木盛生风也。
伤寒脉弦细。头痛发热者。属少阳。少阳不可发汗。发汗则谵语此属胃。胃和则愈。胃不和则烦而悸。
少阳中风。两耳无所闻。目赤胸中满而烦者。不可吐下。吐下则悸而惊。
少阳伤寒禁发汗。少阳中风禁吐下。二义互举其旨益严。盖伤寒之头痛发热宜于发汗者。尚不可汗。则中风之不可
汗不待言矣。伤寒之胸满而烦痰饮上逆。似可吐下者尚不可吐下。则伤寒之不可吐下更不待言矣。头痛发热。为太阳伤
寒之候。以其脉不浮紧而弦细。故知邪入少阳之界矣○脉弦细者邪欲入里。其在胃中之津液必为热耗重复发汗而驱其津
液外出。安得不谵语乎。胃和者。邪散而津回也。不和者津枯而饮结。所以烦而悸也。胸满而烦。无形之风与有质之饮
结于胸际。故非吐下所能出徒取烦悸而已○少阳上治全重在阳明。故云此属胃。胃和则愈。乃少阳一经之要领也。
伤寒三日。三阳为尽。三阴当受邪。其人反能食而不呕。此为三阴不受邪也。
伤寒三日。少阳脉小者欲已也。
能食不呕与胃和则愈互义脉不弦大。邪微欲解之先征。
伤寒四五日。身热恶风颈项强胁下满。手足温而渴者。小柴胡汤主之。
身热恶风太阳证也。颈项强。太阳兼阳明证也。胁下满少阳证也。本当从三阳合并病之例而用表法但其手足温而加
渴。外邪辐凑于小阳而向里之机已着倘更用辛甘发散之法是重增其热而大耗其津也。故从小柴胡之和法。则阳邪自罢。
而阴津不伤。一举而两得之矣。
伤寒阳脉涩。阴脉弦。法当腹中急痛。先与小建中汤不瘥者。与小柴胡汤主之。
阳脉涩阴脉弦。浑似在里之阴寒。所以腹中急痛。腹中急痛则阴阳乖于中。而脾气不建矣。故以小建中之缓而和其
急腹痛止而脉不弦涩矣。若不瘥则弦为少阳之本脉。而涩乃汗出不彻。腹痛乃邪传太阴之候。则用小柴胡以和阴阳而升
举。其阴分之邪为的当无疑矣。
伤寒五六日中风。往来寒热。胸胁苦满。默默不欲饮食心烦喜呕。或胸中烦而不呕。或渴或腹中痛。或胁下痞硬。
或心下悸。小便不利或不渴。身有微热。或咳者。与小柴胡汤主之。
少阳主半表半里之间。其邪入而并于阴。则寒出而并于阳则热。往来寒热无常期也。风寒之外邪挟身中有形之痰。
结聚于少阳之本位所以胸胁满也。胸胁既满。胃中之水谷亦不消。所以默默不欲食。即昏昏之意。非静默也。心烦者。
邪在胸胁逼处心间也。或呕或不呕。或渴或不渴。诸多见证。各随人之气体不尽同也。然总以小柴胡和法为主治。而各
随见证以加减之耳。本方以柴胡为少阳一经之向导。专主往来寒热。谓其能升提风木之气也。黄芩苦而不沉。黄中带青
有去风热之专功谓其能解风木之邪也。半夏力能涤饮。胆为清净之府。病则不能行清净之令致寒饮沃于内。热邪淫于外。
非此迅扫涎沫。则胆终不温。表终不解也。其用人参甘草补中者。以少阳气血皆薄全赖上膏资养。则水气始得发荣。即
是胃和则愈之意用姜枣和胃者。不得使半表之邪。仍从肌表而散也。独怪后世用小柴胡。一概除去人参。加入耗气之药。
此岂仲景立方本意哉。
伤寒中风有柴胡证但见一证便是不必悉具若胸中烦而不呕。去人参半夏加栝蒌实一枚。若渴者去半夏加人参。合前
成四两半。栝蒌根四两。若腹中痛者去黄芩。加芍药三两。若胁下痞硬。去大枣加牡蛎四两。若心下悸小便不利者去黄
芩。加茯苓四两。若不渴外有微热者去人参。加桂三两温覆取微汗愈。若咳者。去人参大枣生姜。加五味子半升。干姜
二两。
胸为阳分。烦为阳邪。以阳邪留薄于胸中。故去半夏人参之助阳而加栝蒌。实以涤饮除烦也。渴为津液受伤。故去
半夏之辛燥。而用栝蒌根之清润加用人参之甘以益津也。腹中痛者为阳邪攻阴以黄芩能伤胃中清阳之气。故去之芍药。
专主阳邪传阴。为阴中伐木之要药。故滞下亦咸用之设阴寒腹痛自利。又为切禁也。胁下痞硬为饮结。
少阳部分。故去大枣之甘壅而加牡蛎以软坚逐邪为务也。心下悸而小便不利。为水停心下。故去黄芩之苦寒。助阴
而加茯苓以淡渗利水也。故不渴外有微热者。知热邪未入于里。故去人参而加桂枝。温覆取微汗以解表也。若咳者为肺
气受邪。故用大枣之益气。生姜之上气。而加干姜之辛散兼五味之酸辛。以散邪敛肺也。
凡柴胡汤病证而下之。若柴胡证不罢者。复与柴胡汤。必蒸蒸而振。却发热汗出而解。
下之而证不罢复与柴胡以升举之使邪不致陷入阴分也。设见腹痛烦燥等证。必当从去黄芩加芍药法矣。
本发汗而复下之。此为逆也若先发汗治不为逆。本先下之而反汗之为逆若先下之治不为逆。
本表证而用表药。汗不透故未愈当再与轻表则立解矣。医见热不除疑为前药不当。反与下药则误矣然虽误下。以其
先曾用过表剂邪势已杀矣故不为逆。但未尽表邪。因下药。引入半里所以从少阳例治也。邪气已入于腑。与里药下之矣。
其下未尽。故热不去。当更与里药则已。医见下之不愈。疑前药未当。反与表药则误矣以其先前曾用过下药里邪少杀。
故不为逆但未尽余热。因表药提出半表。所以亦从少阳治例也。
伤寒五六日。头汗出。微恶寒。手足冷心下满。口不欲食大便难。脉细者。此为阳微结。必有表复有里也。脉沉亦
有里也。汗出为阳微假令纯阴结。不得复有外证悉入在里。此为半在里半在外也。脉虽沉紧不得为少阴病所以然者。阴
不得有汗。今头汗出。故知非少阴也。可与小柴胡汤。设不了了者。得屎而解。
阳微结者。阳分之邪。微微结聚不能传出于表也。注作阳气衰微。故阳气结聚大差。果尔则头汗出为亡阳之证。非
半表半里之证矣。果尔则阴结。又是阴气衰微矣。既本文假令纯阴结等语谓阳邪若不微结。纯是阴邪内结。则不得复有
外证。其义甚明。得屎而解。即前证过经十余日。用大柴胡分提使传之法也。
妇人中风发热恶寒。经水适来得之七八日。热除而脉迟身凉。胸胁下满而结胸状。谵语者。此为热入血室。当刺期
门。随其实而泻之。
中风七八日。热邪传里之时。因经水适来。邪气乘虚而入血室。却不入于胃腑也。经水适来。而即止必有瘀结。此
为实证。故宜刺期门以泻之。
妇人中风七八日。续得寒热发作有时。经水适断者。此为热入血室。其血必结故使如疟状。发作有时。小柴胡汤主
之。
中风七八日。表证已罢经水不应断而适断复见寒热如疟。必经行未尽而有结血。然经既行而适断。此为虚证。故不
可泻宜小柴胡和之。
妇人伤寒发热经水适来昼日明了暮则谵语。如见鬼状者。此为热入血室。无犯胃气。及上二焦。必自愈。
伤寒热邪在表。故经水来而不断。虽为热入血室。以气分不受邪。故昼日明了但夜则谵语。候经尽热随血散自愈。
不可刺期门。妄犯胃气。及用柴胡犯上二焦也。
血弱气尽腠理开邪气因入与正气相搏结于胁下正邪相争。往来寒热。休作有时。默默不欲饮食脏腑相连其痛必然邪
高痛下故使呕也。小柴胡汤主之。
申明上二焦热入血室之由。尚恐如结胸状四字。邪有不尽。故以脏腑相连。邪高痛下。畅发病情。盖血室者冲任也。
下居腹内厥阴肝之所主也。而少阳之胆与肝相连腑邪在上。脏邪在下胃口逼处二邪之间。所以默默不欲食。而但喜呕也。
太阳病十日已去脉浮细而嗜卧者。外已解也。设胸满胁痛者。与小柴胡汤。脉但浮者。与麻黄汤。
太阳病十日已去。脉浮细嗜卧。外证已去。其证有两。一为邪入少阴。阳邪传里之候。一为表邪解散不传之候。故
见胸满胁痛。证属少阳。当用小柴胡无疑。倘脉尚见浮紧。虽证显少阳。仍当用麻黄汤开发腠理。使太阳之邪。仍从营
分而散也。
以上少阳经证。
本太阳病不解。转入少阳者。胁下硬满干呕不能食往来寒热。尚未吐下。脉沉紧者。与小柴胡汤。若已吐下发汗温
针谵语。柴胡汤证罢。此为坏病。知犯何逆以法治之。
尚未吐下。虽脉沉紧者犹当与小柴胡汤。言表邪初陷于里。未变为实。犹可提其邪气外出而解。若已吐下发汗温针。
是为坏病。邪气已全入里。正气内伤不可用小柴胡也。然必柴胡证罢。乃为少阳里病。不可与太阳坏病例世也。
伤寒八九日下之。胸满烦惊。小便不利。谵语一身尽重不可转侧者。柴胡加龙骨牡蛎汤主之。
此系少阳之里证。诸家注作心经病误也。盖少阳有三禁不可妄犯。虽八九日过经下之。尚且邪气内犯胃土受伤胆木。
夫荣痰聚膈土。故胸满烦惊。惊者。胆不宁。非心虚也。小便不利谵语者。胃中津液竭也。一身尽重者。邪气结聚。痰
饮于胁中。故令不可转侧主以小柴胡和解内外。逐饮通津。加龙骨牡蛎以镇肝胆之惊。即是虚劳失精之人。感冒用桂枝
汤。加龙骨牡蛎同意。
太阳病过经十余日。反二三下之。后四五日柴胡证仍在者。先与小柴胡汤。呕不止者。心下急。郁郁微烦为未解也。
与大柴胡汤下之则愈。
过经十余日。不知少阳证未罢。反二三下之。因而致变多矣。后四五日。柴胡证仍在。未有他变。本当两解表里。
但其人之邪屡。因误下而深入。不能传散。故必先用小柴胡。提其邪出半表然后用大柴胡为合法也。
伤寒十三日不解。胸胁满而呕。日晡所发潮热。已而微利。此本柴胡证。下之而不得利。今反利者。知医以丸药。
下之非其治也。潮热者实也。先宜小柴胡汤以解外。后以柴胡加芒硝汤主之。
过经不解者。言三阳俱已传过故其法在半表半里之间。胸胁满而呕。邪在少阳也。发潮热里可攻也。微下利。便不
硬也。以大柴胡不解。表邪荡涤里热则邪去而微利。亦自止也。若误用丸药则徒引热邪内陷。而下利表里俱不解也。故
先用小柴胡分提以解外邪。加芒硝以荡涤胃中之虚热也。
以上少阳腑证。
服柴胡汤已渴者属阳明也。此法治之。
风寒之邪。从阳明而传少阳。起先不渴。里证未具及服小柴胡汤。已重加口渴则邪还阳明。当调胃以存津液矣。然
不曰攻下。而曰以法治之。其意无穷盖少阳之寒热往来。明有渴证。倘少阳未罢而恣言攻下不自犯少阳之禁乎。所以少
阳重解阳明之证。但云以法治之。
上条少阳转阳明证。
伤寒七八日无大热。其人躁烦者。此为阳去入阴故也。
邪气传里。则躁烦不传里则安静也。
上条少阳经将传太阴证。
少阳病欲解。时从寅至辰上。
上条少阳经证自解候。
For all exterior excess conditions, purgation is contraindicated. If purgation is mistakenly used, slight fever will develop; in cases where the pulse vanishes and cold extremities occur, the patient will experience a pulling heat sensation around the navel.
"Exterior excess" refers to heat on the exterior and cold in the interior. Mistaken purgation causes exterior pathogens to sink inward and lodge in the lower jiao. Consequently, the pulse becomes hidden (fú) and extremities become cold and inverted. However, the patient will only feel pulling pain and restlessness with heat around the navel.
For all deficiency conditions, purgation is contraindicated. If mistakenly used, leading to severe deficiency and exhaustion of internal fluids, those who thirst greatly for water are easy to cure because yang qi has not yet exhausted; those who dislike water will suffer aggravation.
"Mistaken purgation in deficiency" causes severe deficiency and exhaustion of internal fluids. Thus, those who thirst greatly for water recover easily due to unexhausted yang qi.
In cases of rapid pulse (shu), purgation is contraindicated. If mistakenly used, it will inevitably cause inner vexation and diarrhea that does not stop or flows poorly.
The Yangming channel pulse should be floating and large; if accompanied by a rapid pulse, it indicates vigorous pathogenic factors. Mistaken purgation allows heat pathogens to enter the interior vacuously, causing inner vexation and diarrhea accompanying heat.
These are discussions on the prohibition of purgation for chronic diseases.
Shaoyang syndrome, generally speaking, involves pathogens residing halfway between the exterior and interior; specifically analyzed, there are distinctions between involvement of the meridian and the fu-organ. However, treatment always revolves around Xiao Chai Hu Tang (Minor Bupleurum Decoction) with modifications based on symptoms. This is because Xiao Chai Hu Tang can stimulate stomach qi within its own channel, carrying pathogens upward for expulsion. Shaoyang serves as the pivot, governing opening and closing; the key to transporting this pivot relies entirely on abundant stomach qi. When stomach qi is abundant, opening and closing have authority, preventing pathogens from invading internally; when stomach qi is weak, the lock relaxes, allowing unrestricted entry and exit of pathogens. Therefore, treating Shaoyang must emphasize stomach qi.
The hallmark symptoms of Shaoyang disease are bitter taste in the mouth, dry throat, and dizziness.
Intense Shaoyang heat causes bitter taste and dry throat; heat gathers in the chest. Dizziness arises from excessive wood generating wind.
In Shanghan (Cold Damage) with wiry-thin pulse, headache, and fever, the condition belongs to Shaoyang. Shaoyang is contraindicated for sweating therapy; sweating leads to delirium, which belongs to the Stomach. If stomach qi harmonizes, recovery occurs; if not, vexation and palpitations arise.
In Shaoyang Wind Strike, with bilateral deafness, red eyes, chest fullness, and vexation, emesis and purgation are contraindicated. Mistaken use leads to palpitations and fright.
Shaoyang Cold Damage prohibits sweating; Shaoyang Wind Strike prohibits emesis and purgation. These two prohibitions reinforce each other strictly. Headache and fever suitable for sweating in Taiyang Cold Damage cannot be sweated in Shaoyang, so Wind Strike certainly cannot. Chest fullness and vexation with phlegm-fluid rising might seem suitable for emesis/purgation, but these are also prohibited, making the prohibition even clearer. Headache and fever are Taiyang signs; since the pulse is wiry-thin rather than floating-tight, we know the pathogen has entered the Shaoyang boundary. ○ Wiry-thin pulse indicates pathogen entering interior; stomach fluids are consumed by heat. Repeated sweating drives fluids out, inevitably causing delirium. "Stomach harmonizes" means pathogen disperses and fluids return; "not harmonized" means fluid depletion and fluid retention, causing vexation and palpitations. Chest fullness and vexation result from formless wind and substantial fluid binding in the chest, which emesis/purgation cannot remove, merely causing vexation and palpitations. ○ Shaoyang treatment focuses heavily on Yangming, hence "this belongs to the Stomach." Stomach harmony leads to recovery, the essence of Shaoyang treatment.
After three days of Shanghan, the three Yang channels are exhausted, and the three Yin channels should receive pathogens. If the patient can eat without vomiting, it indicates the three Yin channels do not receive pathogens.
After three days of Shanghan, if the Shaoyang pulse becomes small, the disease is about to resolve.
Ability to eat without vomiting shares meaning with "stomach harmony leads to recovery." A non-wiry-large pulse is an early sign of weak pathogens and impending resolution.
On the fourth or fifth day of Shanghan, with body heat, aversion to wind, stiff neck, hypochondriac fullness, warm hands/feet, and thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Body heat and aversion to wind are Taiyang signs; stiff neck is Taiyang combined with Yangming; hypochondriac fullness is Shaoyang. Although one might consider treating combined Three Yang disorders with exterior-releasing methods, warm hands/feet and thirst indicate external pathogens gathering at Shaoyang with a trend toward the interior. Using acrid-sweet dispersing methods would increase heat and consume fluids. Thus, using the harmonizing method of Xiao Chai Hu Tang allows yang pathogens to cease while preserving yin fluids, achieving two benefits with one action.
In Shanghan, if the exterior pulse is choppy and interior pulse is wiry, abdominal cramping pain is expected according to the law. First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if ineffective, then give Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Choppy exterior and wiry interior pulses resemble interior yin-cold, causing abdominal cramping pain. This disrupts yin-yang balance in the middle jiao and impairs spleen function. Xiao Jian Zhong Tang relieves the urgency. If pain stops and pulse is no longer wiry-choppy, treatment succeeds. If ineffective, the wiry pulse is the root pulse of Shaoyang, and choppy pulse results from incomplete sweating; abdominal pain indicates transmission to Taiyin. Then Xiao Chai Hu Tang harmonizes yin-yang and raises clear yang, appropriately addressing yin-pathogens.
On the fifth or sixth day of Shanghan with Wind Strike, alternating chills and fever, hypochondriac distress, silent desire not to eat, heart vexation, and frequent vomiting are present. Or chest vexation without vomiting, thirst, abdominal pain, hypochondriac hardness, epigastric palpitations, difficult urination, absence of thirst, slight body heat, or cough. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Shaoyang governs the half-exterior half-interior space. Pathogens entering and merging with yin produce chills; merging with yang produce fever. Alternating chills and fever occur irregularly. External wind-cold pathogens bind with internal phlegm-fluids at the Shaoyang locus, causing hypochondriac fullness. With fullness, stomach food digestion fails, causing silence and lack of appetite ("silent" implies lethargy, not quietness). Heart vexation occurs because pathogens press near the heart. Vomiting/thirst variations depend on individual constitution. The primary treatment is the harmonizing method of Xiao Chai Hu Tang, modified by symptoms. Chai Hu guides Shaoyang, resolving alternating chills/fever by lifting wind-wood qi. Huang Qin clears wind-heat. Ban Xia eliminates phlegm-fluids. Dan (Gallbladder) is a pure organ; disease prevents pure function, allowing cold-fluids inside and heat outside. Without Ban Xia clearing saliva/phlegm, Gallbladder remains unwarmed and exterior unresolved. Ren Shen and Gan Cao tonify middle qi because Shaoyang blood/qi are thin, relying on upper jiao nourishment for fluid flourishing ("stomach harmony"). Jiang and Zao harmonize stomach, preventing half-exterior pathogens from escaping via skin. Later generations removing Ren Shen and adding qi-consuming herbs contradicts Zhong Jing's original intent.
Shanghan/Wind Strike with Chai Hu syndrome: seeing one symptom suffices; all need not be present.
- If chest vexation without vomiting: remove Ren Shen, Ban Xia; add Gua Lou Shi (Trichosanthes Fruit) one piece.
- If thirsty: remove Ban Xia; add Ren Shen, total four taels half liang; add Gua Lou Gen (Trichosanthes Root) four taels.
- If abdominal pain: remove Huang Qin; add Shao Yao (Peony) three taels.
- If hypochondriac hardness: remove Da Zao (Jujube); add Mu Li (Oyster Shell) four taels.
- If epigastric palpitations/difficult urination: remove Huang Qin; add Fu Ling (Poria) four taels.
- If not thirsty with slight exterior heat: remove Ren Shen; add Gui Zhi (Cinnamon Twig) three taels; cover warmly for slight sweat.
- If coughing: remove Ren Shen, Da Zao, Sheng Jiang (Fresh Ginger); add Wu Wei Zi (Schisandra) half sheng, Gan Jiang (Dried Ginger) two taels.
Chest is yang division; vexation is yang pathogen. Yang pathogen lingering in chest requires removing Yang-assisting Ren Shen/Ban Xia, adding Gua Lou Shi to clear fluids/vexation. Thirst indicates fluid injury; remove drying Ban Xia, add moistening Gua Lou Gen and sweet Ren Shen to benefit fluids. Abdominal pain involves yang attacking yin; Huang Qin damages stomach clear yang, so remove it. Shao Yao targets yang transmitting to yin, essential for subduing wood in yin, also used for dysentery. Contraindicated for yin-cold abdominal pain with spontaneous diarrhea. Hypochondriac hardness is fluid binding in Shaoyang region; remove cloying Da Zao, add Mu Li to soften hardness/expel pathogens. Epigastric palpitations/difficult urination indicate water stopping in epigastrium; remove bitter-cold Huang Qin to avoid aiding yin, add Fu Ling to leach water. Non-thirst with slight exterior heat indicates heat not yet in interior; remove Ren Shen, add Gui Zhi to warm/cover for slight sweat. Cough indicates lung qi affected; use Da Zao for qi, Sheng Jiang for ascending qi, Gan Jiang for pungent dispersion, and Wu Wei Zi for sour-astringency to disperse pathogens/astringe lung.
If Chai Hu syndrome is treated with purgation and Chai Hu signs persist, administer Chai Hu Tang again. The patient will likely experience shaking chills followed by fever and sweating for resolution.
Mistaken purgation with persistent signs requires Chai Hu to lift pathogens, preventing sinking into yin. If abdominal pain/vexation arise, follow the rule of removing Huang Qin and adding Shao Yao.
Originally indicating sweating but using purgation is adverse; originally indicating purgation but using sweating is adverse. However, prior correct treatment mitigates error.
Treating exterior signs with exterior medicine without sufficient sweating requires light exterior release. Misdiagnosing persistent heat as prior failure leads to mistaken purgation. Though erroneous, prior exterior treatment weakened pathogens, so it is not fully adverse. Unresolved exterior pathogens drawn inward by purgation require Shaoyang-style treatment. If pathogens entered fu-organs and purgation was insufficient, heat persists; more interior medicine is needed. Misdiagnosing purgation failure as prior error leads to mistaken sweating. Prior purgation reduced interior pathogens slightly, so not fully adverse. Residual heat raised to half-exterior by sweating requires Shaoyang-style treatment.
On the fifth/sixth day of Shanghan, with head sweating, slight aversion to cold, cold hands/feet, epigastric fullness, unwillingness to eat, difficult defecation, and thin pulse, this is "Yang Micro-Binding." There is both exterior and interior signs. Deep pulse also indicates interior. Sweating is a false sign of mild yang. Pure Yin Binding would have no exterior signs, all interior. This is half-interior half-exterior. Even deep-tight pulse is not Shaoyin disease because yin conditions do not sweat; head sweating confirms it is not Shaoyin. Give Xiao Chai Hu Tang. If unresolved after bowel movement, resolution follows.
Yang Micro-Binding refers to slight accumulation of yang pathogens unable to exit via exterior. Some interpret as yang decline, which is incorrect; head sweating would then be yang collapse, not half-exterior/half-interior. Pure Yin Binding implies yin decline. The text states if yang pathogens do not micro-bind but are purely yin binding, no exterior signs exist, clarifying the meaning. Resolution via stool relates to previous over-stage treatments using Da Chai Hu Tang.
In women with Wind Strike fever/aversion to cold, menstruation begins. After seven/eight days, heat subsides, pulse slows, body cools, hypochondriac fullness resembles Jie Xiong (Chest Binding), and delirium occurs. This is Heat Entering Blood Chamber. Puncture Qi Men (LR14) to drain excess.
During Wind Strike days 7-8, heat enters interior. Menstruation provides vacancy for pathogens to enter Blood Chamber, not Stomach. Sudden cessation of menstruation implies blood stasis, an excess condition. Puncture Qi Men to drain.
In women with Wind Strike days 7-8, subsequent intermittent chills/fever coinciding with menstruation cessation. This is Heat Entering Blood Chamber. Blood binds, causing malaria-like episodes. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Days 7-8 of Wind Strike, exterior resolved, menstruation unexpectedly stops with malaria-like chills/fever. Incomplete menstruation with bound blood. Since menstruation stopped prematurely, this is deficiency. Do not drain; harmonize with Xiao Chai Hu Tang.
In women with Shanghan fever during menstruation, clarity during day, delirium like seeing ghosts at night. This is Heat Entering Blood Chamber. Do not violate stomach qi or upper/middle jiao; it will self-resolve.
Shanghan heat in exterior keeps menstruation flowing. Heat enters Blood Chamber but qi layer unaffected, so day clarity, night delirium. Resolve after menstruation ends as heat scatters with blood. Do not puncture Qi Men or violate stomach qi/upper jiao with Chai Hu.
Weak blood/qi, open pores allow pathogen entry, binding at hypochondrium. Zheng/pathogen struggle causes alternating chills/fever. Silence/lack of appetite results from connected organs; high pathogen pain low causes vomiting. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Explains Heat Entering Blood Chamber in upper/middle jiao. "Resembling Chest Binding" may imply incomplete pathogens. Connected organs, high pathogen/low pain explain pathology. Blood Chamber is Chong/Ren meridians, lower abdomen, governed by Jueyin Liver. Shaoyang Gallbladder connects to Liver; fu-pathogen high, zang-pathogen low, stomach located between them, causing silence/lack of appetite and preference for vomiting.
After ten days of Taiyang disease, floating-thin pulse and desire to lie down indicate exterior resolution. If chest fullness/hypochondriac pain occur, give Xiao Chai Hu Tang (Minor Bupleurum Decoction). If only floating pulse, give Ma Huang Tang (Ephedra Decoction).
Ten days post-Taiyang, floating-thin pulse/lethargy indicate resolved exterior. Two possibilities: pathogen entering Shaoyin (yang transmitting interior) or exterior resolving without transmission. Chest fullness/hypochondriac pain indicate Shaoyang; Xiao Chai Hu Tang is certain. If floating-tight pulse persists despite Shaoyang signs, use Ma Huang Tang to open pores, scattering Taiyang pathogens via Ying level.
Above are Shaoyang Meridian Syndromes.
Original Taiyang unresolved transferring to Shaoyang presents with hard/full hypochondrium, dry retching, inability to eat, alternating chills/fever. If not yet vomited/purged, with deep-tight pulse, give Xiao Chai Hu Tang (Minor Bupleurum Decoction). If already vomited/purged/sweated/warm-needled with delirium, Chai Hu signs cease; this is a damaged disease. Treat according to the deviation.
Not yet vomited/purged, even with deep-tight pulse, Xiao Chai Hu Tang is appropriate. Initial interior sinking without solidification allows lifting pathogens outward. Vomiting/purging/sweating/warm-needling constitutes damaged disease; pathogens fully interior, right qi injured, Xiao Chai Hu Tang contraindicated. Chai Hu signs ceasing defines Shaoyang interior disease, distinct from Taiyang damage.
After eight/nine days of Shanghan with purgation, chest fullness, vexation/fright, difficult urination, delirium, whole-body heaviness immovable. Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) is indicated.
This is Shaoyang interior syndrome, misinterpreted by some as Heart disease. Shaoyang has three prohibitions. Even after stage progression, purgation harms Stomach earth and Gallbladder wood. Phlegm-fluids gather at diaphragm, causing chest fullness/vexation/fright. Fright stems from Gallbladder unrest, not Heart deficiency. Difficult urination/delirium indicate stomach fluid exhaustion. Whole-body heaviness results from pathogen/phlegm binding in hypochondrium. Xiao Chai Hu Tang harmonizes interior/exterior, moves fluids, restores fluids. Long Gu and Mu Li calm Gallbladder/Liver fright, similar to Gui Zhi Tang plus Long Gu/Mu Li for deficiency loss of essence.
Over-stage Taiyang (>10 days) with repeated purgation, Chai Hu signs persist after 4-5 days. First give Xiao Chai Hu Tang (Minor Bupleurum Decoction). If vomiting persists, epigastric urgency, subtle vexation unresolved, give Da Chai Hu Tang (Major Bupleurum Decoction) to purge.
Repeated purgation after stage progression causes changes. Persistent Chai Hu signs without other changes suggest dual exterior/interior resolution. However, pathogens deeply lodged by error cannot scatter. First use Xiao Chai Hu Tang to lift pathogens to half-exterior, then Da Chai Hu Tang is correct.
Thirteen days of Shanghan unresolved, chest/hypochondriac fullness, vomiting, tidal fever at dusk, slight diarrhea. Originally Chai Hu syndrome, purgation failed to induce diarrhea, now diarrhea occurred. Physician used pill-purgative incorrectly. Tidal fever indicates excess. First give Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve exterior, then Chai Hu Jia Mang Xiao Tang (Bupleurum Plus Niter Decoction).
Unresolved over-stage means Three Yang transmitted; treatment lies in half-exterior/half-interior. Chest/hypochondriac fullness/vomiting indicate Shaoyang. Tidal fever suggests interior attack possible. Slight diarrhea means stool not hard. Da Chai Hu Tang resolves exterior, sweeps interior heat, stopping diarrhea. Pill-purgatives draw heat inward, causing diarrhea/unresolved exterior. First Xiao Chai Hu Tang lifts/resolves exterior; Mang Xiao sweeps stomach empty heat.
Above are Shaoyang Fu-Organ Syndromes.
Thirst after taking Chai Hu Tang indicates Yangming syndrome. Treat accordingly.
Wind-cold transmits Yangming to Shaoyang; initially no thirst, interior signs absent. Post-Chai Hu Tang, intense thirst indicates pathogen returning to Yangming. Regulate stomach to preserve fluids. Not called "purge" but "treat accordingly," implying infinite meaning. Shaoyang alternating chills/fever clearly shows thirst; if Shaoyang unresolved, blindly purging violates Shaoyang prohibitions. Hence, resolving Yangming signs in Shaoyang simply says "treat accordingly."
Previous clause: Shaoyang transforming to Yangming.
Seven/eight days of Shanghan, no major heat, restlessness/vexation. This is yang leaving to enter yin.
Pathogen transmitting interior causes restlessness; not transmitting interior results in calmness.
Previous clause: Shaoyang meridian about to transmit to Taiyin.
Shaoyang disease resolves between Yin (3-5 AM) and Chen (7-9 AM) hours.
Previous clause: Shaoyang meridian self-resolution timing.