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If there is vexation in the chest without vomiting, remove Banxia (Pinelliae Rhizoma) and Renshen (Ginseng Radix), and add one Gualou Shi (Trichosanthis Fructus). (Vexation refers to a sensation of heat-induced oppression. Renshen is removed because heat accumulation causes oppression, making it inappropriate to tonify Qi further. The absence of vomiting indicates no pathological fluid retention with upward rebellion, so Banxia is removed. Since there is no fluid retention requiring dispersal, acrid-dispersing herbs are unnecessary. Gualou Shi is cold in nature to drain heat and bitter in flavor to dissipate fullness.)

If thirst occurs, remove Banxia, increase the dosage of Renshen to total four taels and half, and add Gualou Gen (Trichosanthis Radix) four taels. (Thirst indicates insufficient body fluids. Banxia is drying and damages fluids, hence it is removed. Renshen generates fluids and relieves thirst; Gualou Gen clears heat and benefits fluids, hence they are added.)

If abdominal pain occurs, remove Huangqin (Scutellariae Radix) and add Shaoyao (Paeoniae Radix) three taels. (Abdominal pain results from blood stasis and internal cold. Huangqin is bitter and cold, potentially damaging middle Jiao Yang, so it is removed. Shaoyao promotes circulation and relieves pain, so it is added.)

If there is epigastric or hypochondriac stuffiness and hardness, remove Dazao (Ziziphi Jujubae Fructus) and add Muli (Ostreae Concha) four taels. (Hypochondriac stuffiness and hardness result from the binding of pathogenic heat and retained fluids forming an excess pattern. Dazao is sweet and can cause Qi stagnation leading to middle Jiao fullness, so it is removed. Muli is salty and can soften hardness and resolve cold-heat patterns, so it is added.)

If there is palpitations and difficulty urinating, remove Huangqin and add Fuling (Poria) four taels. (Palpitations refer to heart restlessness. Fluid retention in the heart region causes palpitations and difficulty urinating. The Kidney governs water. Huangqin’s bitter-cold nature tends to firm the Kidney; if the Kidney becomes too firm, water retention worsens, so Huangqin is removed. Fuling promotes diuresis; once the orifices are unblocked, water drains away, so Fuling is added.)

If there is no thirst but slight external fever, remove Renshen and add Guizhi (Cinnamomi Ramulus) three taels. Cover warmly to induce a slight sweat for resolution. (No thirst indicates intact body fluids, so Renshen for moistening is unnecessary. Slight external fever indicates the exterior syndrome has not fully resolved, so Guizhi is added to release the muscle layer.)

If cough occurs, remove Renshen, Dazao, and Shengjiang (Zingiberis Rhizoma Recens); add Wuweizi (Schisandrae Fructus) half sheng and Ganjiang (Zingiberis Rhizoma) two taels. (Cough is due to rebellious Qi causing spasmodic cough. Renshen and Dazao are removed because their sweetness tonifies Qi and may promote dampness. Cold-fluid obstruction causes cough; although Banxia in the formula dries dampness, cold requires heat to disperse. Thus, Ganjiang replaces Shengjiang for its stronger warming property to disperse cold. Cough relates to the Lung, which desires consolidation; Wuweizi is added for its sour astringent property to consolidate Lung Qi. In the Taiyang channel, the distinction lies primarily in Ying and Wei levels, hence Wind-Cold are treated differently. The Yangming channel, though close to Taiyang and involving meridians and organs, maintains strict differentiation between Wind and Cold due to proximity of Ying-Wei pathways. The Shaoyang channel, beyond Yangming and distant from Taiyang, lacks direct Ying-Wei interaction, involving only meridians and organs. Since meridians and organs do not differ significantly, Wind and Cold treatments converge. The text mentions “Cold damage for five to six days, Wind strike, alternating chills and fever,” interwoven to illustrate that at this stage, Wind and Cold converge into a single treatment principle. The subtlety of this medical Dao lies herein.)

(61) In Cold Damage or Wind Strike, if Chaihu Syndrome presents, observing even one symptom suffices; it is not necessary for all symptoms to be present.
This follows the previous clause to elaborate on the general principle of identifying Shaoyang channel diseases.

(62) After taking Chaihu Tang, if thirst develops, it belongs to Yangming. Treat according to Yangming methods.
"Yi" (already/completed) means the course of medication is finished. Thirst can be an optional symptom of Chaihu Syndrome, but usually does not occur unless there is fluid deficiency or fluid retention with rebellion. It may also be temporary thirst during alternating chills and fever. Now, since thirst appears only after completing the Chaihu Tang regimen, it is not temporary. It indicates heat has entered the Stomach, consuming fluids, thus belonging to Yangming.

(63) If a Chaihu Syndrome patient is mistakenly purged, and the Chaihu Syndrome persists, administer Chaihu Tang again. The patient will inevitably experience vigorous shaking followed by fever and sweating, leading to resolution.
"Chaihu Zheng bu ba" means the disease remains unresolved but has not transformed into another pattern. Therefore, harmonizing treatment should be repeated, hence "administer Chaihu Tang again." "Zhengzheng er zhen" describes a battle-sweat reaction. Resolution requires this process because the interior is deficient following purgation. This corresponds with Clause 55 in the Middle Section.

(64) A woman suffering from Wind Strike with fever and aversion to cold, whose menstruation coincides with the onset, after seven to eight days, presents with disappearance of fever, slow pulse, cool body, hypochondriac fullness resembling Jie Xiong (chest binding), and delirium. This is Re Ru Xue Shi (Heat Entering the Blood Chamber). Pricking Qimen (Liv 14) to drain excess is indicated.
Fever and aversion to cold correspond to subsequent alternating chills and fever. Menstruation coinciding with illness: women are governed by blood. Regardless of regularity, internal郁 (depression) of pathogenic heat forces blood to move recklessly, often resulting in coincidental menstruation. Seven to eight days is when pathogens typically enter the interior; thus, external heat disappears, pulse slows, and body cools as the exterior resolves. "Ru" means resembling. Hypochondriac fullness resembles Jie Xiong caused by Yang pathogen sinking inward after improper purgation, accompanied by delirium. Although no purgation was performed, the coincidental menstruation creates a void allowing pathogen entry, similar to the effect of purgation. "Xue Shi" (Blood Chamber) is where Ying-Blood gathers and meridians converge, identified as the Chong Mai (Penetrating Vessel), also known as the Sea of Blood. Its vessel originates at Qichong (ST 30), runs alongside the Shaoyin channel up the umbilicus to the chest, and disperses. Heat entering here causes these symptoms. Qimen (Liv 14) is located 1.5 cun lateral to Burong (ST 19), the Front-Mu point of the Liver. The Liver stores blood; pricking Qimen drains excess heat from the blood level.

(65) A woman with Wind Strike, after seven to eight days, develops subsequent alternating chills and fever occurring at specific times, while her menstruation abruptly stops. This is Heat Entering the Blood Chamber. The blood must congeal, causing malaria-like paroxysms at set times. Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
The previous clause discussed coincidental menstruation; this discusses abrupt cessation, providing detailed reciprocal analysis. "Xu" means subsequently occurring. "Han Re" refers to alternating chills and fever, consistent with the previous clause's fever and aversion to cold. "Shi Duan" means menstruation started and then suddenly stopped. While both clauses involve Heat Entering the Blood Chamber, the mechanisms differ. In the "coincidental start" case, heat forces blood out, carrying heat with it. In the "abrupt stop" case, heat enters while blood is present, binding with blood and preventing exit, hence "blood must congeal." "Malaria-like" explains the paroxysmal nature of chills and fever. The previous clause used acupuncture; this uses Xiao Chaihu Tang; both illuminate each other.

(66) When blood is weak and Qi exhausted, pores open, and pathogenic Qi enters, contending with healthy Qi, knotting below the hypochondrium. Healthy and pathogenic Qi contend, causing alternating chills and fever occurring intermittently, silent mood, and loss of appetite. Organs are connected; pathology descends. Pathogen is high, pathology is low, causing vomiting. Xiao Chaihu Tang is the primary treatment.
"Tong" (pain) here should be read as "Bing" (disease/condition). This summarizes the previous two clauses to clarify the indication for Xiao Chaihu Tang.
"Blood weak and Qi exhausted" refers to the menstrual changes mentioned above. "Pores open, pathogen enters" refers to Wind Strike heat entering the Blood Chamber. The hypochondrium is the domain of the Shaoyang channel. When pathogen transmits to Shaoyang, heat enters the Blood Chamber but cannot exit, knotting in the hypochondrium, explaining the "resembling Jie Xiong" in the previous clause. The contention of healthy and pathogenic Qi causes alternating chills and fever; separation leads to retreat, explaining the "malaria-like" symptoms. "Silent mood and loss of appetite" is an optional Shaoyang symptom, also indicating Spleen-Stomach injury.
Regarding organ connection: Heart-Lung pair with Large Intestine-Small Intestine (upper-lower distance); Kidney pairs with Bladder (front-back difference); Spleen-Stomach pair centrally but remain distinct. Only Liver-Gallbladder are intimately connected. The Liver nature attaches to the Gallbladder (wife follows husband); thus, Yang-heat pathogen descends into Yin Blood Chamber. Yin receives, accepting heat and facilitating transmission, hence "Bi" (necessarily). "Bi" implies certainty.
"Pathogen high, pathology low": Pathogen is Yang, floating high; pathology is in Blood Chamber, Yin, situated low. Upward movement of pathology and downward movement of pathogen affect the central Spleen-Stomach, causing vomiting despite no direct disease there.
Xiao Chaihu Tang treats ascending-descending and alternating chills-fever. Heat Entering Blood Chamber presents similar heat patterns but differs in location. Why use this formula? Because both involve Shaoyang governing alternating chills and fever. For Shaoyang pathogen, releasing exterior is ineffective as there is no exterior syndrome; attacking interior is contraindicated for the Stomach. Treating Blood Chamber directly misses the hypochondriac knot. Liver and Gallbladder share treatment principles. Following the Shaoyang Xiao Chaihu Tang resolves Jueyin Blood Chamber issues, harmonizing the couple relationship, ensuring recovery from tidal fever. Thus, Xiao Chaihu Tang is decisively chosen for Heat Entering Blood Chamber without hesitation. This correlates with the final clause of the Middle Section. Women's Wind-Cold treatment differs from men's primarily due to blood-Qi distinctions. Following meridian principles remains consistent. Observing that Heat Entering Blood Chamber relies solely on Xiao Chaihu Tang allows inference for other cases. The text repeats details to instruct students to master this principle. Ah, how profound!