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[Outline] Zhang Zhongjing stated: In Taiyang disease, after the pathogen has passed through the meridians for more than ten days, if it is mistakenly treated with purgatives two or three times, and after another four to five days, the Chaihu syndrome (Bupleurum Syndrome) still persists, one should first administer Xiao Chaihu Tang (Minor Bupleurum Decoction). If there is incessant vomiting, epigastric urgency, and slight depression and vexation, the disease has not yet resolved; Da Chaihu Tang (Major Bupleurum Decoction) should be administered, leading to recovery.

[Commentary] Li stated: In Shanghan (Cold Damage), transmission through the meridians is completed in six days, and resolution should occur on the seventh day. If it remains unresolved beyond the thirteenth day, it is termed "Guojing" (Passing the Meridian Stage). Due to inappropriate sweating or purging, the pathogenic factor lingers, causing mental confusion, delirium, chest fullness, and tidal fever. Treatment should be adjusted according to the presenting exterior or interior symptoms. One may resort to mild re-sweating or re-purging. However, if the pulse is chaotic, restlessness is present, and the Cun and Chi pulses are sunken, the condition is critical. If the pulse is slow and the patient sleeps peacefully, but the pathogen remains, this indicates that the Zheng Qi (Upright Qi) has not yet recovered. Can Hu Shao Yao Tang (Ginseng, Bupleurum, and Peony Decoction) can be used for regulation. In cases of diarrhea with a harmonious pulse, other physicians may have used pill-based purgatives, leaving residual heat. Generally, when Guojing occurs with Qi deficiency, or when mixed with other pathogenic factors, external symptoms must be considered comprehensively.

Yu Chang stated: "Guojing bujie" (Unresolved after passing the meridian stage) refers to the period from after the seventh or eighth day up to after the thirteenth day, spanning one or two "Hou" (five-day periods), without recovery. Since the pathogen has remained in the body for a long time, it inevitably clusters in the Three Yang meridians, most commonly in Taiyang, followed by Shaoyang, and then Yangming. Once it enters the Three Yin meridians, life and death hang in the balance, unlike the prolonged nature of this condition.

Cheng Jiaoqian stated: After more than ten days of Guojing, if one fails to recognize that the Taiyang syndrome has not ceased, and mistakenly applies purgatives two or three times, many variations arise. Four to five days later, if the Chaihu syndrome persists without other changes, Da Chaihu Tang should theoretically be used to resolve both exterior and interior simultaneously. However, since the pathogen has deeply penetrated due to repeated erroneous purging, the purgative method of Da Chaihu Tang is no longer directly applicable. Therefore, Xiao Chaihu Tang must first be used to draw the pathogen out from the half-exterior/half-interior level, followed by Da Chaihu Tang, which conforms to the correct therapeutic principle.

[Outline] Zhang Zhongjing stated: In Taiyang disease, after passing the meridian stage for more than ten days, if there is nausea with a desire to vomit, chest pain, loose stools, slight abdominal fullness, and slight depression and vexation, and if prior to these symptoms the patient had undergone extreme emesis or purging, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction) should be given. If such extreme emesis or purging did not occur, this formula is contraindicated. Symptoms limited to a desire to vomit, chest pain, and slightly loose stools do not constitute Chaihu syndrome; the vomiting indicates prior extreme emesis or purging.

[Commentary] Yu Chang stated: This passage requires two distinctions. If the patient previously underwent severe emesis and purging, the pathogen was resolved via emesis and entered the interior; thus, the method of Tiao Wei Cheng Qi Tang can be used. If no emesis or purging occurred, and there is only a desire to vomit, chest pain, and slight loose stools, the chest pain is not caused by emesis damage, nor is the loose stool caused by purging damage; therefore, the method of Tiao Wei Cheng Qi Tang is inapplicable. Not only is Tiao Wei Cheng Qi Tang inapplicable, but Xiao Chaihu Tang is also contraindicated, as the pathogen remains at the high position of the Taiyang meridian. Treating only Yangming and Shaoyang will not resolve the pathogen. Zhang Zhongjing has already detailed how to resolve Taiyang pathogens, so here he merely indicates the principle. If the patient can vomit, it indicates injury from emesis/purging, and the focus is no longer on the Taiyang meridian.

[Outline] Zhang Zhongjing stated: In Shanghan, after thirteen days without resolution, if there is chest and hypochondriac fullness with vomiting, tidal fever occurring in the late afternoon (You hour), followed by slight diarrhea, this originally presented as Chaihu syndrome. It was erroneously treated with purgatives, resulting in no initial diarrhea. Now, diarrhea has occurred; knowing that the physician used pill-based purgatives, this was an incorrect treatment. If the diarrhea were spontaneous, the pulse would be faint and cold (Jue); however, the pulse is now harmonious, indicating internal excess (Nei Shi). Tiao Wei Cheng Qi Tang should be the primary treatment.

[Commentary] Yu Chang stated: Both passages present symptoms of slight diarrhea, making it difficult to distinguish between internal deficiency and internal excess. In the first passage, chest and hypochondriac fullness with vomiting indicate the pathogen gathering at the exterior of Shaoyang; thus, purging is indicated, and using Chaihu Tang is correct. Using other purgatives causes the exterior pathogen to sink inward, resulting in internal deficiency. In the second passage, there was originally no exterior syndrome; despite erroneous purging with pills, the pulse remains harmonious, indicating internal excess. According to Zhang Zhongjing’s methods, pill-based purgatives are frequently cautioned against. The only exception is the use of Ma Ren Wan (Hemp Seed Pill) for Taiyang Pi Yue (Spleen Constraint), because the patient typically suffers from dry intestines and depleted fluids. Waiting until the pathogen enters Yangming for purging might fail to preserve fluids. Thus, even while the pathogen is in Taiyang, the mild laxative and moistening action of the pill is used to lubricate the intestines, preventing the exterior pathogen from sinking inward due to harsh attack. These points require cross-reference. Furthermore, in Shanghan, seven days constitute one "Hou." If unresolved after two or three Hou, the pathogen often lingers in the Three Yang meridians. Transmission is not necessarily complete in seven days; even after thirteen or twenty-plus days, transmission may continue. Without differentiating symptoms, merely counting meridians and Hou periods leads to errors in sweating and purging, causing Zheng Qi deficiency and pathogen accumulation, making treatment increasingly difficult over time. Therefore, in Guojing bujie, one must identify which meridian the pathogen resides in and treat accordingly. Zhang Zhongjing stated: Taiyang headache resolving after seven days occurs because the meridian circulation is complete, consistent with the Nei Jing’s principle that Taiyang disease declines and headache improves after seven days. For Taiyang, if it persists beyond seven days and one wishes to prevent further transmission, acupuncture of the Foot-Yangming meridian can stop transmission and promote recovery. Because Taiyang lingers for many days, Yangming and Shaoyang may also linger, extending the unresolved period indefinitely. Thus, early intervention at the Yangming Central Earth is necessary to intercept transmission; this is a swift method. To claim that after all Six Meridians are transmitted, the pathogen returns to Taiyang is illogical. This is a trap set by Cheng Wuji for later scholars. How could Jueyin, where two Yins meet and exhaust in the interior, re-enter Taiyang from the skin and hair? Please dispel this great confusion.