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Ge Gen Tang (Kudzu Decoction) original formula plus Ban Xia (Pinelliae Rhizoma, 半夏) half sheng (washed). The decoction and administration method are the same as the previous clause.

Taiyang (Sunshine Meridian) and Yangming (Yang Brightness Meridian) simultaneous disease, without diarrhea. From the previous clause, we knew it was Taiyang-Yangming simultaneous disease because of the diarrhea; now that there is no diarrhea, how do we know it is a simultaneous disease? We must examine the primary symptoms of both meridians one by one. Even without diarrhea, it can be determined as a simultaneous disease. However, if there is vomiting, Ge Gen Jia Ban Xia Tang (Kudzu Decoction with Pinellia) should be used. In the previous clause, Taiyang disease caused diarrhea due to improper purgative treatment, so Huang Qin (Scutellariae Radix, 黄芩) and Lian Zi (Coptidis Rhizoma, 黄连) were used to treat the diarrhea. Because the patient originally had a Gui Zhi Tang (Cinnamon Twig Decoction) pattern and a rapid pulse, only Ge Gen (Puerariae Lobatae Radix, 葛根) was added to resolve the pathogen newly entering Yangming. This clause involves Taiyang-Yangming simultaneous disease, so the full Ge Gen Tang is used. Since there is only vomiting, Ban Xia is added to stop vomiting. Formulas are prescribed according to the disease, each with its own principles.

For fever accompanied by vomiting, this formula works like magic.

Chai Hu (Bupleuri Radix, 柴胡) (half jin), Huang Qin (Scutellariae Radix, 黄芩), Ren Shen (Ginseng Radix, 人参), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草) (roasted), Sheng Jiang (Zingiberis Rhizoma Recens, 生姜) (sliced, three liang each), Ban Xia (Pinelliae Rhizoma, 半夏) (half jin), Da Zao (Jujubae Fructus, 大枣) (twelve pieces). The above seven ingredients are boiled in one dou two sheng of water, reduced to six sheng, dregs removed, and then decocted again. This is another method. Take three sheng, warm and take one sheng, three times a day. Excluding Da Zao, this formula totals twenty-eight liang, which converts to slightly over five liang six qian in modern weights. Although divided into three doses, it is still a heavy dose. This is likely because Shaoyang (Lesser Yang Meridian) is situated between two Yang meridians and must attend to all three meridians, so the dosage should not be light. Removing dregs and decocting again is because this formula is a harmonizing agent; decocting again harmonizes the medicinal properties, allowing meridian qi to blend, preventing alternating entry and exit. Ancient sages not only excelled in medication but also in decoction methods, which hold profound meaning.

If there is chest irritability without vomiting, remove Ban Xia and Ren Shen. No vomiting means Ban Xia is unnecessary; irritability means Ren Shen should not be used. Add one Gua Lou Shi (Trichosanthis Fructus, 瓜蒌实). Gua Lou Shi treats chest bi (obstruction), which is the method of Xiao Xian Xiong Tang (Minor Intra-thoracic Obstruction Decoction). If there is thirst, remove Ban Xia. Ban Xia clears phlegm-dampness but consumes body fluids. Add Ren Shen to generate body fluids. Combined with the previous amount, it becomes four liang and half, plus Gua Lou Gen (Trichosanthis Radix, 瓜蒌根) four liang. Treats xiao ke (wasting-thirst). If there is abdominal pain, remove Huang Qin due to its bitter cold nature. Add Bai Shao (Paeoniae Radix Alba, 白芍) three liang to relieve abdominal pain. If there is hypochondriac fullness and hardness, remove Da Zao because it tonifies spleen and stomach. Add Mu Li (Ostreae Concha, 牡蛎) four liang. *Shen Nong Ben Cao Jing* states: treats hypochondriac fullness-heat. If there is palpitation under the heart and difficult urination, remove Huang Qin and add Fu Ling (Poria, 茯苓) four liang to promote urination. If there is no thirst but slight external heat, remove Ren Shen because no thirst indicates sufficient body fluids. Add Gui Zhi (Cinnamomi Ramulus, 桂枝) three liang. Slight heat indicates pathogen remaining in Taiyang. Cover with blankets to induce slight sweating for cure. If there is cough, remove Ren Shen and Da Zao as they are not suitable for cough. Ginger: since Gan Jiang (Zingiberis Rhizoma, 干姜) is added, Sheng Jiang is removed. Add Wu Wei Zi (Schisandrae Fructus, 五味子) half sheng and Gan Jiang two liang. Ancient formulas for cough always use Wu Wei Zi and Gan Jiang together; one disperses cold pathogen, the other consolidates healthy qi. There is never a method of using Wu Wei Zi alone for cough. Later generations who do not know they must be used together may cause harm. Moreover, fire-cough from heat or labor differs greatly from cold-fluid invading the lung in this context. Using Wu Wei Zi alone to consolidate wind-fire-phlegm-saliva allows it to penetrate deeply into the lungs, making it incurable!

Note: Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Gui Zhi Tang have extensive applications. Deeply understanding their principles leads to flexibility in usage.

In the *Treatise*, any universally applicable formula must have modification methods.

Cold damage on the fifth or sixth day is the period when the disease transmits to Shaoyang. Wind-stroke presents with alternating chills and fever. Taiyang chills and fever involve heat during chills and chills during heat. Alternating means after chills comes heat, and after heat comes chills.

Distending fullness in the chest and hypochondrium, as the chest and hypochondrium are the location of Shaoyang. Silent desire not to eat, wood pathogen attacking earth. Mental irritability and frequent vomiting, wood qi reversing upward. Or chest irritability without vomiting, or thirst, indicating Shaoyang fire pathogen. Or abdominal pain, wood overcoming earth. Or hypochondriac fullness and hardness, wood qi stagnation. Or palpitation under the heart, indicating phlegm-fluid retention. Difficult urination, or no thirst, indicating fluid retention. Slight body heat, Taiyang pathogen not yet exhausted. Or cough, indicating phlegm-fluid in the lungs. Use Xiao Chai Hu Tang as the main treatment. Shaoyang presents many symptoms, and the symptoms treated by Chai Hu Tang are not uniform; modification methods are recorded at the end of the formula.

Weak blood and exhausted qi, opening of couli (pores), pathogen enters due to this, combats with healthy qi, knots in the hypochondrium. Healthy and pathogenic qi struggle, causing alternating chills and fever, occurring at specific times, silent desire not to eat. Zang-fu organs are connected, pain must be lower. Pathogen high, pain low, thus causing vomiting. This clause explains the reasons for alternating chills and fever, desire not to eat, lower pain and upper vomiting, all caused by weak healthy qi and invading pathogen, with zang-fu organs pulling each other. Thus, the intent of the formula can be deduced. Use Xiao Chai Hu Tang.

After taking Chai Hu Tang, if thirsty, it belongs to Yangming, treat according to the method. This must have first shown Shaoyang symptoms, hence Chai Hu Tang was used. After taking it, thirst indicates transmission to Yangming.

Cold damage on the fourth or fifth day, body heat and aversion to wind, neck stiffness, these are common to Taiyang. Hypochondriac fullness is unique to Shaoyang. Warm hands and feet with thirst: the thirst in the previous clause belonged to Yangming; this case, due to hypochondriac fullness, although resembling Yangming, is not treated as Yangming. Use Xiao Chai Hu Tang.

Cold damage, yang pulse choppy, yin pulse string-like, law dictates abdominal urgent pain. First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if not cured, use Xiao Chai Hu Tang. See details in Gui Zhi category.

Cold damage or wind-stroke, having Chai Hu syndrome, seeing just one symptom is sufficient, no need for all to be present. Shaoyang interacts with Taiyang and Yangming; one symptom serves as evidence, and even with other symptoms, they can be treated concurrently. For Chai Hu Tang indications improperly treated with purgatives, if Chai Hu syndrome persists, give Chai Hu Tang again. For any improper treatment where the primary syndrome remains, use the formula for the primary syndrome; this applies to all meridians, not just Chai Hu syndrome. There will be steaming fever and shaking, followed by fever and sweating for resolution. Pathogen has sunk downward, hence shaking is necessary to reach the exterior. *Bian Mai Fa Chapter* says: shaking and sweating indicates the person was originally deficient. Thus, shaking, fever, and sweating allow pathogen to exit via Shaoyang.

Cold damage unresolved for thirteen days, passing through two periods. Chest and hypochondriac fullness with vomiting, this is a definite Shaoyang symptom. Tidal fever at dusk, resembling Yangming. Subsequently slight diarrhea, showing interior syndrome. Chaotic medication leads to chaotic symptoms. This was originally a Chai Hu syndrome; purging did not cause diarrhea, but now there is diarrhea. We know the doctor used pill-based purgatives, which is incorrect treatment. Using liquid medicine for purging would not work; using pills again causes severe injury. Tidal fever indicates excess. First use Xiao Chai Hu Tang to resolve the exterior. Although tidal fever, it fundamentally belongs to Shaoyang pathogen, so still use Chai Hu to resolve the exterior. Then use Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Mirabilite). Resolution follows with Mang Xiao added.

Cold damage on the fifth or sixth day, head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, no desire to eat, hard stool, fine pulse: this is Yang mild knotting. Yang qi cannot disperse along the meridians, thus stagnating and uncomfortable. Not due to medication error, but prolongation. It is a mild form of damaged syndrome. There must be both exterior and interior signs. The above symptoms show both exterior and interior; Chai Hu Tang treats both. Pulse deep is also interior. Fine pulse implies deep. Sweating is Yang mild, indicated by sweat. If it were pure Yin knotting, there would be no exterior signs, all entering the interior. Yin has no sweat. This is half interior, half exterior. Deep pulse is interior, sweating is exterior. Although pulse is deep and tight, fine implies tightness. Cannot be Shaoyin disease. Why? Yin cannot have sweat; this is the key point. Now with head sweating, we know it is not Shaoyin. Can give Xiao Chai Hu Tang. If still uneasy after taking the soup, resolution comes with stool passage. If still uneasy after taking the soup, it is because of interior syndrome, hard stool. Must unblock the stool for cure. The method to unblock stool is adding Mang Xiao, or formulas like Da Chai Hu Tang.

Yangming disease, tidal fever, loose stool, normal urination, persistent hypochondriac fullness: give Xiao Chai Hu Tang. Yangming tidal fever is a sign for purging, but with normal stool and urine, interior syndrome is not complete. Plus persistent hypochondriac fullness indicates pathogen lingering in Shaoyang. Use this formula to harmonize.

Yangming disease, hypochondriac hardness, a Shaoyang symptom. Constipation, purging is possible. Vomiting, also a Shaoyang symptom. White coating on tongue, pathogen not knotted in Yangming, hence white coating. Although constipated, purging is contraindicated. This is a key point. Can give Xiao Chai Hu Tang. Upper jiao opens, fluids descend, stomach qi harmonizes, body sweats naturally and resolves. These four sentences explain the efficacy of Xiao Chai Hu Tang, thus all symptoms are cured by it.

Note: Outside Shaoyang is Taiyang, inside is Yangming, and Shaoyang resides between them. Thus, Shaoyang symptoms may combine with Taiyang or Yangming. Seeing one Shaoyang symptom allows use of Xiao Chai Hu Tang, achieving dual benefit. This is why Zhang Zhongjing highly values this formula.

Yangming wind-stroke, pulse string-like, floating, and large. String-like belongs to Shaoyang, floating-large belongs to Yangming. Shortness of breath, abdominal fullness, hypochondriac and heart pain, these are Shaoyang symptoms. Pressing long reveals qi obstruction. Dry nose, inability to sweat, lethargy, these resemble Shaoyin. Whole body and eyes yellow, difficult urination, these two resemble Taiyin. Tidal fever, resembles Yangming. Swelling around ears. Acupuncture brings slight relief. Exterior unresolved. Disease past ten days, pulse continues to float: give Xiao Chai Hu Tang. Floating pulse with interior signs suggests pathogen still wants to exit. Floating pulse alone without other signs: give Ma Huang Tang (Ephedra Decoction). Only floating without other signs means no interior signs, must resolve via sweating, hence Ma Huang Tang.

These two clauses clarify Yangming wind-stroke symptoms: with interior pathogen use Xiao Chai Hu Tang, without interior pathogen use Ma Huang Tang. Always rely on pulse and symptoms, no fixed method. If unable to urinate, bladder qi exhausted. Abdominal fullness with hiccups: incurable. *Treatise* Yangming chapter says: Yangming disease, inability to eat, attacking heat causes hiccups. Why? Stomach deficiency-cold. "Deficiency-cold" clearly indicates declining Yang qi. Also says: severe vomiting and purging, sweating with oppression, giving water to induce sweating causes hiccups. *Ling Shu* says: true and pathogenic qi attack each other, qi reverses, causing hiccups. Hiccups. *Su Wen* says: deep disease manifests as hiccups. Caused by separation of Lung and Stomach qi, combined with abdominal fullness, hence incurable.

Original Taiyang disease unresolved, transmitting to Shaoyang, this is transmitted pathogen. Hypochondriac hardness, dry retching, inability to eat, alternating chills and fever, all are primary Shaoyang symptoms. Not yet vomited or purged, pulse deep and tight. Not vomited or purged means no iatrogenic error. Shaoyang gradually entering interior, hence not floating but deep and tight, extreme string-like, also a primary Shaoyang pulse. Give Xiao Chai Hu Tang.

Vomiting with fever: Xiao Chai Hu Tang is the main treatment. Fever without alternating chills and fever is similar to Taiyang and Yangming, but vomiting is unique to Shaoyang, hence this formula is used.

Taiyang disease, ten days passed, pulse floating and fine, desire to lie down: exterior resolved. If chest fullness and hypochondriac pain: give Xiao Chai Hu Tang. Pulse only floating: give Ma Huang Tang. Explanation seen in Ma Huang Tang.

After cold damage recovery, subsequent fever: Xiao Chai Hu Tang is the main treatment. This is recurrence, not labor recurrence, not sexual activity recurrence, but insufficient healthy qi, residual pathogen not exhausted, remaining between semi-exterior and semi-interior, hence Xiao Chai Hu Tang is used. Treatment for recurrence is clarified here; later discussions vary, none being correct. Floating pulse: resolve with sweating. Deep-solid pulse: resolve with purging. In recurrence, examine these two pulses. If floating, pathogen remains in Taiyang, use sweating method. If deep-solid, interior pathogen not exhausted, use purging method. But sweating/purging without specifying formula names? Because methods vary. Physicians choose among Ma Huang, Gui Zhi, Cheng Qi, Da Chai Hu, etc., based on severity, ensuring effectiveness.

Woman with wind-stroke, seven or eight days, subsequent chills and fever, occurring at times, this is what follows as malaria-like. Menstruation just stopped: this is heat entering blood chamber, blood must knot, blood knots due to heat, becoming stasis. Hence malaria-like symptoms, occurring at times. Xiao Chai Hu Tang is the main treatment. Treat malaria method accordingly.

Also says: Woman with wind-stroke, fever and aversion to cold, menstruation just started. Previous said stopped, this says started. Seven or eight days later, heat gone, pulse slow, body cool, external pathogen internalized. Hypochondriac fullness, like chest binding, delirium: this is heat entering blood chamber. Blood chamber is gathering place of Ying qi in middle jiao. Liver stores blood, Heart governs blood. Ying-blood stagnation causes Liver qi and Heart meridian qi to condense, hence hypochondriac fullness and mental confusion/delirium. Should puncture Qi Men (Liv-14), draining excess. Qi Men is below nipple, second rib end, about four cun from nipple, Liver Mu point. Meeting of Jueyin and Yin Wei meridians. Insert four fen. Blood knotting forms tangible symptoms, decoctions difficult to effect quickly. Puncturing Qi Men drains Jueyin excess heat, most appropriate and easy to dissipate.

Also says: Woman with cold damage fever, menstruation just started. Clear during day, delirious at night, seeing ghosts: this is heat entering blood chamber. Day clear, night dim. Do not violate Stomach qi and upper two jiaos, will self-resolve. This is middle jiao Ying qi disease, sweating and purging methods are inappropriate. Xiao Chai Hu Tang: puncturing Qi Men is the treatment.

Note: Heat entering blood chamber conditions are most detailed in these two clauses. Women with cold damage have this symptom most often. Previous clause symptoms slightly lighter, latter two clauses symptoms heavier. Men also have it.