络先后论篇。问曰。病有急当救里救表者。何谓也。师曰。病医下之。续得下利。清谷不止。身体疼痛者。急
当救里。后身体疼痛。清便自调者。急当救表也。明是示当知缓急先后之序也。
活人书曰。两感者。表里俱病也。仲景无治法。但云两
感病俱作。治有先后。发表攻里。本自不同。寻至第三卷中。言伤寒下之云云。遂以意寻比仿效。治两感有先
后。宜先救里。若阳气内正。即可医也。内才正。急当救表。盖内尤为急。才温内则急救表。亦不可缓也。
病发热头痛。脉反沉。若不瘥。身体疼痛。当救其里。宜四逆汤。（玉函。疼上。有更字。）
〔柯〕此太阳麻黄汤证。病为在表。脉当浮而反沉。此为逆也。若汗之不瘥。即身体疼痛不罢。当凭其脉
之沉。而为在里矣。阳证见阴脉。是阳消阴长之兆也。热虽发于表。为虚阳。寒反据于里。是真阴矣。必有里
证。伏而未见。藉其表阳之尚存。乘其阴之未发。迎而夺之。庶无吐利厥逆之患。里和而表自解矣。邪之所凑。
其气必虚。故脉有余。而证不足。则从证。证有余。而脉不足。则从脉。有余可假。而不足为真。此仲景心法。
〔周〕身体疼痛。并不及恶寒微厥。则四逆何敢漫投。而仲景明言当救其里。因脉本沉。中则阳素虚。复投汗
药。则阳气外亡。阴寒内存。至此则发热变为身疼。敢不回阳。则身痛必如被杖。阴燥因致厥逆。势所必至。
然曰。当救者。可想而知也。〔程〕此条。乃太阳中之少阴。麻黄附子细辛汤条。乃少阴中之太阳。究竟二证。
皆是发于阳。而病在阴。故皆阳病见阴脉。
案金鉴曰。身体疼痛之下。当有下利清谷四字。方合当温其里之文。果如其说。则与前条无别。似剩义矣。
程本金鉴。改救作温字。非也。
太阳病。先下而不愈。因复发汗。以此表里俱虚。其人因致冒。冒家汗出自愈。所以然者。汗出表和故也。
里未和。然后复下之。（先下下。成本有之字。玉函。脉经。无以此二字。家下。有当字。里未和。脉经。作
表和。成本。作得里和。）
〔程〕先下之而不愈。阴液先亡矣。因复发汗。营从卫泄。阳津亦耗。以此表里两虚。虽无邪气扰乱。而
虚阳戴上。无津液之升以和之。所以怫郁而致冒。冒者。清阳不彻。昏蔽及头目也。必得汗出津液到。而怫郁
始去。所以然者。汗出表和故也。汗者。阳气之所酿。汗出。知阳气复于表。故愈。则非用发表之剂。而和表
之剂可知。而里未和者。阳气虽返于内。阴气尚未滋而复。得字宜玩。迟久之辞。盖大便由溏而燥。由燥而硬。
至此不得不斟酌下之。以助津液矣。和表药。桂枝加附子汤。或大建中汤类也。〔锡〕然后者。缓词也。如无
里证。可不必下也。〔鉴〕下之。宜调胃承气汤和之。〔张〕冒为发汗过多。胃中清阳气伤。宜小建中汤加参
。若更加熟附子。昏冒耳聋。非大剂温补。不能取效也。
案此条症。汪氏。和表。用桂枝汤。小建中汤。黄 建中汤。和里。用桂枝大黄汤。而驳常器之和表用小
柴胡汤。和里用调胃承气汤。并似乖于经旨焉。
太阳病未解。脉阴阳俱停。（【原注】一作微。）必先振栗。汗出而解。但阳脉微者。先汗出而解。但阴
脉微（【原注】一作尺脉实。）者。下之而解。若欲下之。宜调胃承气汤。（【原注】一云用大柴胡汤○玉函。
作阴微者。先下之而解。汗之宜桂枝汤。下之宜承气汤。千金翼同。脉经。与本经同。唯调胃承气汤。作大柴
胡汤。玉函。脉经。无阳脉之脉。后汗出。作汗之。）
〔程〕太阳病不解。脉阴阳俱停止。而不见者。是阴极而阳欲复也。三部既无偏胜。解之兆也。然必先振栗。
汗出而解者。郁极而欲复。邪正必交争。而阴阳乃退耳。若见停止之脉。而仍不解者。必阴阳有偏胜处也。但
于三部停止中。而阳脉微见者。即于阳微处。知阳部之邪实盛。故此处欲停之。而不能停也。先汗出以解其表
邪则愈。于三部停止中。而阴脉微见者。即于阴微处。知其阴部之邪实盛。故此处欲
停之。而不能停也。下之以解其里邪则愈。〔汪〕脉微二字。当活看。此非微弱之微。乃邪滞而脉道细伏之义。
邪滞于经。则表气不得条达。故阳脉微。邪滞于腑。则里气不能通畅。故阴脉微。先汗出而解。仲景无方。千
金云。宜桂枝汤。
伤寒类方曰。脉法无停字。疑似沉滞不起。即下微字之义。寸为阳。尺为阴。微字即上停字之意。与微弱
不同。微弱则不当复汗下也。
案停脉。成氏为均调之义。方喻张柯魏汪并同。程钱二氏及金鉴。为停止之谓。然据下文阴脉微阳脉微
推之。宋版注。一作微者。极为允当。况停脉。素灵难经。及本经中。他无所见。必是讹谬。且本条文意。与
他条不同。诸注亦未明切。但程注稍似可通。故姑取之云。
太阳病。发热汗出者。此为营弱卫强。故使汗出。欲救邪风者。宜桂枝汤。（此条。玉函。脉经。千金
翼。在太阳上编桂枝汤方后。玉函。救。作解。）
〔鉴〕此释上条阳浮阴弱之义也。经曰。邪气盛则实。精气夺则虚。卫为风入。则发热。邪风因之而实。
故为卫强。是卫中之邪气强也。营受邪蒸。则汗出。精气因之而虚。故为营弱。是营中之阴气弱也。所以使发
热汗出也。欲救邪风者。宜桂枝汤。〔喻〕邪风。即风邪。勿凿看。〔方〕救者。解救救护之谓。
案方氏曰。不曰风邪。而曰邪风者。以本体言也。喻盖非之。
伤寒五六日中风。往来寒热。胸胁苦满。嘿嘿不欲饮食。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。小柴胡汤主之。（玉函。作中风五六日。伤
寒往来寒热。脉经。作中风往来寒热。伤寒五六日
以后。全书。钱本。作伤寒中风五六日。脉经。心烦。作烦心。玉函。脉经。硬。作坚。心下悸。作心中悸。
身。作外。外台。作心下卒悸。成本。嘿嘿。作默默。下同。小柴胡上。有与字。）
〔方〕此少阳之初证。叔和以无少阳明文。故犹类此。伤寒五六日中风往来寒热。互文也。言伤寒与中风。
当五六日之时。皆有此往来寒热已下之证也。五六日。大约言也。往来寒热者。邪入躯壳之里。脏腑之外。两
夹界之隙地。所谓半表半里。少阳所主之部位。故入而并于阴则寒。出而并于阳则热。出入无常。所以寒热间
作也。胸胁苦满者。少阳之脉。循胸络胁。邪凑其经。伏饮搏聚也。默。静也。胸胁既满。谷不化消。所以静
默不言。不需饮食也。心烦喜呕者。邪热伏饮。搏胸胁者。涌而上溢也。或为诸证者。邪之出入不常。所以变
动不一也。〔成〕五六日。邪气自表传里之时。中风者。或伤寒至五六日也。玉函曰。中风五六日伤寒。即是
或中风或伤寒。非是伤寒再中风。中风复伤寒也。经云。伤寒中风。有柴胡证。但见一证便是。不必悉具者。
正是谓也。〔钱〕往来寒热者。或作或止。或早或晏。非若疟之休作有时也。〔程〕少阳脉循胁肋。在腹阳背
阴两岐间。在表之邪欲入里。为里气所拒。故寒往而热来。表里相拒。而留于岐分。故胸胁苦满。神识以拒而
昏困。故嘿嘿。木受邪则妨土。故不欲食。胆为阳木。而居清道。为邪所郁。火无从泄。逼炎心分。故心烦。
清气郁而为浊。则成痰滞。故喜呕。此则少阳定有之证。〔鉴〕伤寒中风。见口苦咽干目眩之证。与弦细之脉。
更见往来寒热云云证。知邪已传少阳矣。〔魏〕或为诸证者。因其人平素气血偏胜。各有所兼挟。以为病也。
明理论曰。伤寒邪气在表者。必渍形以为汗。邪气在里者。必荡涤以为利。其于不外不内。半表半里。既非发汗之
所宜。又非吐下之所对。是当和解则可矣。小柴胡为和解表里之剂也。
医史吕沧洲传云。淅东运使曲出。道过鄞。病卧涵虚驿。召翁往视。翁察色切脉。则面戴阳。气口皆长而
弦。盖伤寒三阳合病也。以方涉海。为风涛所惊。遂血菀而神慑。为热所搏。遂吐血一升许。且胁痛烦渴谵语。
适是年岁运。左尺当不足。其辅行京医。以为肾已绝。泣告其左右曰。监司脉病皆逆。不禄在旦夕。家人皆惶
惑无措。翁曰。此天和脉。无忧也。为投小柴胡汤。减参。加生地黄半剂。后俟其胃实。以承气下之。得利愈。
丹溪医案。治一人。旧有下疳疮。忽头疼发热。自汗。众作伤寒治。尺剧。脉弦甚七至。重则涩。丹溪曰。
此病在厥阴。而与证不对。以小柴胡汤。加草龙胆胡黄连热服。四帖而安。
小柴胡汤方
柴胡（半斤○千金翼。作八两） 黄芩（三两） 人参（三两） 半夏（半升洗） 大枣（十二枚擘○全
书。十三枚。） 甘草（炙） 生姜（各三两切）
上七味。以水一斗二升。煮取六升。去滓再煎取三升。温服一升。日三服。若胸中烦而不呕者。去半夏人
参。加栝蒌实一枚。若渴。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。加桂枝三两。温覆微汗愈。若咳者。去人参大枣生姜。加五味子半升。干姜二两。（玉函。七味下。有
咀字。再煎。作再煮。无三服之服。若渴下。有者字。成本亦有。千金翼。无栝蒌根四两五字。玉函。千金
翼。硬。作坚。下有者字。牡蛎四两。千金翼。外台。作六两。成本。玉函。千金翼。缺桂枝之枝。钱氏不见
宋版。故有为桂枝无疑
之说。）
〔鉴〕邪传太阳阳明。曰汗。曰吐。曰下。邪传少阳。惟宜和解。汗吐下三法。皆在所禁。以其邪在半表
半里。而角于躯壳之内界。在半表者。是客邪为病也。在半里者。是主气受病也。邪正在两界之间。各无进退
而相持。故立和解一法。既以柴胡解少阳在经之表寒。黄芩解少阳在腑之里热。犹恐在里之太阴。正气一虚。
在经之少阳。邪气乘之。故以姜枣人参。和中而预壮里气。使里不受邪而和。还表以作解也。世俗不审邪之所
据。果在半表半里之间。与所以应否和解之宜。及阴阳疑似之辨。总以小柴胡为套剂。医家幸其自处无过。病
者喜其药味平和。殊不知因循误人。实为不浅。故凡治病者。当识其未然。图机于早也。〔程〕至若烦而不呕
者。火气燥实逼胸也。故去人参半夏。加栝蒌实也。渴者。燥已耗液逼肺也。故去半夏。加栝蒌根也。腹中痛
者。木气散入土中。胃肠受困。故去黄芩以安土。加芍药以戢木也。胁下痞硬者。邪既留则木气实。故去大枣
之甘而缓。加牡蛎之咸而软也。心下悸。小便不利者。水邪侵乎心。故去黄芩之苦寒。加茯苓之淡渗也。不渴
身有微热者。半表之寒。尚滞于肌。故去人参。加桂枝以解之也。咳者。半表之寒。凑入于肺。故去参枣。加
五味子。易生姜为干姜。以温之。虽肺寒不减黄芩。恐干姜助热也。又腹痛为太阴证。少阳有此。由邪气自表
之里。里气不利所致。〔钱〕柴胡汤而有大小之分者。非柴胡有大小之异也。盖以其用之轻重。力之大小而言
也。牡蛎。名医别录云。治心胁下痞热。加五味子干姜者。以水寒伤肺。故以此收肺气之逆。即小青龙汤之制
也。肺热气盛者。未可加也。
古方选注曰。去滓再煎。恐刚柔不相济。有碍于和也。
七味主治在中。不及下焦。故称之曰小。
伤寒类方曰。此汤除大枣。共二十八两。较今秤亦五两六钱零。虽分三服。已为重剂。盖少阳介于两阳
之间。须兼顾三经。故药不宜轻。去渣再煎者。此方乃和解之剂。再煎则药性和合。能使经气相融。不复往来
出入。古圣不但用药之妙。其煎法俱有精义。古方治嗽。五味干姜必同用。一以散寒邪。一以敛正气。从无单
用五味治嗽之法。后人不知。用必有害。况伤热劳怯火呛。与此处寒饮犯肺之症不同。乃独用五味。收敛风火
痰涎。深入肺脏。永难救疗。
案钱氏曰。五味子半升者。非今升斗之升也。古之所谓升者。其大如方寸匕。以铜为之。上口方各一寸。
下底各六分。深仅八分。状如小熨斗而方形。尝于旧器中见之。而人疑其为香炉中之器用。而不知即古人用药
之升也。与陶隐居名医别录之形像分寸皆同。但多一柄。想亦所以便用耳。如以此升之半作一剂。而分三次服
之。亦理之所有。无足怪也。考本草序例。凡方云半夏一升者。秤五两为正。所谓一升。岂方一寸者哉。半夏
之半升。与五味之半升。其升必同。钱说难从。
苏沈良方曰。此药。伤寒论。虽主数十证。大要其间有五证。最的当。服之必愈。一者。身热心中逆。
或呕吐者。可服。若因渴饮水而呕者。不可服。身体不温热者。不可服。二旨。寒热往来者。可服。三者。发
潮热者可服。四者。心烦胁下满。或渴或不渴。皆可服。五者。伤寒已瘥后。更发热者。可服。此五证。但有
Chapter on Differentiating Pulse, Syndrome, and Treatment of Taiyang Disease (Part 2). In the *Lingshu* chapter "Discussion on Collaterals: Priority of Interior and Exterior", it is asked: "In diseases, there are cases where one must urgently treat the interior or the exterior. What does this mean?" The Master said: "If a disease is treated with purgatives by a physician, and subsequently diarrhea with undigested food occurs continuously, while body pain persists, one must urgently treat the interior. Later, if body pain persists but bowel movements and urination are normal and harmonious, one must urgently treat the exterior." This clearly indicates that one should understand the order of priority between urgency and delay.
The *Huoren Shu* (Book of Vitality) states: "Lianggan" (Double Exposure) disease involves both exterior and interior pathology. Zhang Zhongjing did not provide specific treatment methods, merely stating that when Lianggan disease occurs simultaneously, treatment has a sequence; releasing the exterior and attacking the interior are fundamentally different approaches. Searching through Volume 3, regarding the mistreatment of cold damage with purgatives, I have inferred and imitated based on my understanding, believing that treating Lianggan disease requires a sequence, prioritizing the rescue of the interior. If the internal yang qi recovers its upright state, treatment can proceed. Once the interior is rectified, one must urgently treat the exterior. Since the interior condition is particularly urgent, once the interior is warmed, the exterior must be urgently resolved; delay is not permissible.
When a patient presents with fever, headache, and a pulse that is unexpectedly deep (Chen), if the condition does not improve and body pain persists, one should rescue the interior, preferably using Sini Tang (Four Reversal Decoction). (*Yuhan Jing* adds the character 'Geng' [more] after 'pain'.)
[Ke Qin] This is a Shaoyang-Mahuang Tang syndrome. The pathogen is in the exterior, so the pulse should be floating but is instead deep, which is an adverse sign. If sweating fails to resolve it, the body pain will not cease. One must rely on the deep pulse to diagnose the pathology as being in the interior. An Yang syndrome presenting with a Yin pulse is a sign of Yang declining and Yin growing. Although heat manifests in the exterior, it is deficient Yang; conversely, cold occupies the interior, representing true Yin. There must be latent interior symptoms that have not yet appeared. Relying on the remaining exterior Yang, and taking advantage before the Yin pathogen fully develops, one should intercept and defeat it, thereby avoiding complications such as vomiting, diarrhea, and cold limbs. Once the interior harmonizes, the exterior resolves spontaneously. Where pathogens gather, Qi must be deficient. Therefore, if the pulse indicates excess but symptoms indicate deficiency, follow the symptoms; if symptoms indicate excess but the pulse indicates deficiency, follow the pulse. Excess may be false, while deficiency is true. This is Zhang Zhongjing's core methodology.
[Zhou Yangjun] Body pain without mention of aversion to cold or slight cold limbs—how dare one casually administer Sini Tang? Yet Zhang Zhongjing explicitly states to rescue the interior because the pulse is inherently deep, indicating inherent deficiency of Middle Jiao Yang. Subsequent use of diaphoretics caused Yang Qi to escape outward, leaving Yin-Cold inside. At this stage, fever transforms into body pain. If one does not restore Yang, the pain will feel like being beaten with a staff. Yin-cold stagnation leading to cold limbs is inevitable. However, the phrase "should rescue" implies profound reasoning.
[Cheng Zhi] This clause describes a Shaoyin pattern within Taiyang disease. The Mahuang Fuzi Xixin Tang clause describes a Taiyang pattern within Shaoyin disease. Ultimately, both patterns originate from Yang (disease starting in Yang meridians) but involve Yin (pathology affecting Yin organs/meridians); thus, both present Yang diseases with Yin pulses.
Commentary: Jin Jian states that the characters "diarrhea with undigested food" should appear after "body pain" to align with the text regarding warming the interior. If this were true, it would be identical to the previous clause, rendering it redundant. Cheng Zhi and Jin Jian changing "rescue" to "warm" is incorrect.
In Taiyang disease, if initial purgation fails and subsequent sweating is employed, this results in deficiency of both exterior and interior. Consequently, the patient experiences "Mao" (vertigo/dizziness/clouded consciousness). Patients with Mao syndrome recover spontaneously upon sweating. The reason is that sweating harmonizes the exterior. If the interior is not yet harmonized, then purgation may be applied subsequently. (*Chengben* includes the characters "Xian Xia Xia"; *Yuhan Jing* and *Maijing* omit "Yi Ci". *Chengben* adds "Dang" after "Jia". *Maijing* reads "Biao He" for "Li Wei He"; *Chengben* reads "De Li He".)
[Cheng Zhi] Initial purgation failed, depleting Yin fluids first. Subsequent sweating caused Ying Qi to leak with Wei Qi, consuming Yang fluids. This leads to dual deficiency of exterior and interior. Even without pathogenic disturbance, deficient Yang floats upward, lacking fluids to harmonize it, causing oppression and resulting in Mao. Mao refers to clear Yang failing to penetrate, causing cloudiness in the head and eyes. Recovery requires sweating and fluid arrival to dispel oppression. Hence, sweating harmonizes the exterior. Sweat is brewed by Yang Qi; its emergence indicates Yang Qi returning to the exterior, signaling recovery. Thus, harmonizing exterior agents (not dispersing agents) are indicated. Regarding unharmonized interior, although Yang returns internally, Yin has not yet nourished and recovered. The character "De" (obtain) suggests a prolonged timeframe. Stool transitions from loose to dry, then hard; at this point, cautious purgation is necessary to assist fluids. Harmonizing exterior formulas include Guizhi Jia Fuzi Tang or Dajianzhong Tang.
[Shen Mingzong] "Ranhou" (then/subsequently) is a缓和 term. If no interior signs exist, purgation is unnecessary.
[Jin Jian] For purgation, Tiaowei Chengqi Tang is suitable for harmonization.
[Zhang Lu] Mao results from excessive sweating injuring clear Yang Qi in the Stomach. Xiao Jianzhong Tang plus Ren Shen is appropriate. For severe dizziness and deafness, large doses of warming tonics are required for efficacy.
Commentary: Regarding this clause, Wang advocates Guizhi Tang, Xiao Jianzhong Tang, and Huangqi Jianzhong Tang for harmonizing the exterior, and Guizhi Dahuang Tang for harmonizing the interior. He refutes Chang Qizi’s proposal of Xiaochaihu Tang for exterior harmony and Tiaowei Chengqi Tang for interior harmony, arguing these deviate from the classic intent.
When Taiyang disease remains unresolved, and the pulse at Cun, Guan, and Chi positions appears to stop (Note 1: alternatively described as faint), the patient must first experience chills and trembling, followed by sweating and resolution. If only the Yang pulse (Cun) is faintly visible, resolution occurs via sweating. If only the Yin pulse (Chi) is faintly visible (Note 1: alternatively described as Chi pulse solid), resolution occurs via purgation. If purgation is desired, Tiaowei Chengqi Tang is appropriate. (Note 1: Alternatively, Dachaihu Tang. *Yuhan Jing*: If Yin pulse is faint, resolve via purgation; sweating uses Guizhi Tang; purgation uses Chengqi Tang. *Qianjin Yi* agrees. *Maijing* matches this text, except substituting Dachaihu Tang for Tiaowei Chengqi Tang. *Yuhan Jing* and *Maijing* omit the character "Mai" in "Yang Mai"; later "Hanchu" is written as "Han Zhi".)
[Cheng Zhi] When Taiyang disease is unresolved and the pulse at Yin and Yang positions stops/disappears, this indicates extreme Yin with impending Yang recovery. With no bias among the three positions, it signals resolution. However, chills and sweating precede resolution because extreme stagnation seeks recovery, causing struggle between pathogen and righteous Qi, allowing Yin and Yang to retreat. If the stopped pulse persists without resolution, there is bias in Yin or Yang. If the Yang pulse faintly appears among the stopped pulses, it indicates excess pathogen in the Yang sector, preventing the pulse from truly stopping. Sweating resolves exterior pathogens. If the Yin pulse faintly appears among the stopped pulses, it indicates excess pathogen in the Yin sector. Purgation resolves interior pathogens.
[Wang Hu] The term "Mai Wei" (pulse faint) should be interpreted flexibly. It does not mean weak/faint, but rather pathogenic stagnation causing the pulse channel to become fine and hidden. Pathogen stagnating in meridians prevents smooth flow of exterior Qi, hence Yang pulse is faint. Pathogen stagnating in fu-organs prevents smooth flow of interior Qi, hence Yin pulse is faint. For resolving via sweating, Zhang Zhongjing provided no formula; *Qianjin Fang* suggests Guizhi Tang.
*Shanghan Leifang* states: The pulse methodology lacks the character "Ting" (stop). It likely refers to sinking/stagnant pulse not rising, encompassing the meaning of "Wei" (faint/micro). Cun is Yang, Chi is Yin. "Wei" here means the same as "Ting" above, distinct from "Ruoxiao" (weak/faint). If weak/faint, sweating/purgation would be contraindicated.
Commentary: Cheng Wuji interprets "Ting Mai" as balanced/harmonious, a view shared by Fang Youzhi, Yu Jiayan, Zhang Luyu, Ke Qin, Wei Litong, and Wang Hu. Cheng Zhi, Qian Huang, and Jin Jian interpret it as "stopping". However, inferring from the subsequent text "Yin Mai Wei" and "Yang Mai Wei", Song edition note "alternatively Wei" is highly appropriate. Moreover, "Ting Mai" appears nowhere in *Suwen*, *Lingshu*, *Nanjing*, or other chapters of this text, suggesting an error. The textual logic differs from other clauses, and previous annotations lack clarity. Cheng’s annotation is slightly more coherent, so it is tentatively adopted.
In Taiyang disease, fever and sweating indicate weak Ying and strong Wei, causing sweating. To rescue from evil wind, Guizhi Tang is appropriate. (This clause appears after the Guizhi Tang formula in *Yuhan Jing*, *Maijing*, and *Qianjin Yi*. *Yuhan Jing* writes "Jie" [resolve] instead of "Jiu" [rescue].)
[Jin Jian] This explains the meaning of "Yang Floating, Yin Weak" from the previous clause. The Classic states: "Excess of pathogen constitutes Shi (Excess); depletion of essence constitutes Xu (Deficiency)." When Wei is invaded by wind, fever occurs; the pathogen becomes strong, hence "Wei Qiang" (Strong Wei), referring to strong pathogen in Wei. When Ying is steamed by pathogen, sweating occurs; essence becomes depleted, hence "Ying Ruo" (Weak Ying), referring to weak Yin in Ying. This causes fever and sweating. To rescue from evil wind, Guizhi Tang is indicated.
[Yu Jiayan] "Xie Feng" (Evil Wind) simply means Wind Pathogen; do not interpret rigidly.
[Fang Youzhi] "Jiu" means to rescue or relieve.
Commentary: Fang states that saying "Xie Feng" rather than "Feng Xie" emphasizes the nature of the pathogen itself. Yu Jiayan refutes this; I disagree with Yu.
After five or six days of Shanghan or Zhongfeng, presenting with alternating chills and fever, fullness and distress in the chest and hypochondrium, silent desire not to eat, irritability, and frequent vomiting. Or, irritability in the chest without vomiting; thirst; abdominal pain; hardness/fullness under the hypochondrium; palpitations in the epigastrium; dysuria; absence of thirst with slight external heat; or cough. Xiaochaihu Tang is the primary prescription. (*Yuhan Jing*: Zhongfeng 5-6 days, Shanghan alternating chills/fever. *Maijing*: Zhongfeng alternating chills/fever, Shanghan 5-6 days onwards. Complete Works/Qian Edition: Shanghan Zhongfeng 5-6 days. *Maijing*: "Xin Fan" instead of "Fan Xin". *Yuhan Jing/Maijing*: "Jian" instead of "Ying". *Yuhan Jing/Maijing*: "Xin Xia Ji" instead of "Xia Ji". *Waitai*: "Xin Xia Cu Ji". *Chengben*: "Mo Mo" instead of "Hei Hei". Character "Yu" added before Xiaochaihu Tang.)
[Fang Youzhi] This is the initial syndrome of Shaoyang. She He classified it here due to lack of explicit Shaoyang headings. "Shanghan 5-6 days Zhongfeng alternating chills/fever" is a rhetorical device (huwen), meaning both Shanghan and Zhongfeng at day 5-6 present with alternating chills/fever etc. Day 5-6 is approximate. Alternating chills and fever occur when pathogen enters the space between the shell (exterior) and viscera (interior), known as Half-Exterior Half-Interior, governed by Shaoyang. Entering Yin causes chills; emerging Yang causes fever. Irregular entry/exit causes alternating chills/fever. Chest/hypochondriac fullness/distress occurs because Shaoyang meridians traverse chest/ribs; pathogen gathers in meridians, causing fluid retention and aggregation. "Mo" means quiet. Fullness prevents digestion, leading to silence and lack of appetite. Irritability and vomiting occur because pathogenic heat and retained fluid surge upward. Variable symptoms arise because pathogen movement is irregular.
[Cheng Wuji] Days 5-6 mark the transmission of pathogen from exterior to interior. "Zhongfeng" refers to Shanghan progressing to day 5-6. *Yuhan Jing* clarifies: "Zhongfeng 5-6 days Shanghan" means either Zhongfeng or Shanghan, not Shanghan followed by Zhongfeng. The Classic states: "In Shanghan or Zhongfeng, if Chaihu signs are present, even one sign suffices; all need not be present." This applies here.
[Qian Huang] Alternating chills and fever vary in onset and cessation, unlike malaria which has fixed intervals.
[Cheng Zhi] Shaoyang meridians run along costal regions, between anterior Yang and posterior Yin. Exterior pathogen attempting to enter is rejected by interior Qi, causing chills then fever. Rejection keeps pathogen in the boundary, causing chest/hypochondriac fullness. Mental confusion from rejection causes silence. Wood pathogen affects Earth, causing anorexia. Gallbladder is Yang Wood, residing in clear pathways; pathogen depression traps Fire, forcing it toward Heart, causing irritability. Clear Qi stagnates becoming turbid Phlegm, causing vomiting. These are definitive Shaoyang signs.
[Jin Jian] Presence of bitter taste, dry throat, vertigo, wiry-thin pulse, plus alternating chills/fever indicates transmission to Shaoyang.
[Wei Litong] Variable symptoms occur because individuals have inherent Qi/Blood biases and accompanying pathogenic factors.
*Ming Lilun* states: Pathogen in exterior requires sweating; pathogen in interior requires purgation. Pathogen in Half-Exterior Half-Interior is unsuitable for sweating, vomiting, or purgation; harmonization is required. Xiaochaihu Tang is the harmonizing formula.
*Medical History: Biography of Lv Cangzhou*: Qu Chu, Transport Commissioner of Zhedong, fell ill at Hanxu Post Station. Lv examined his face and pulse: facial flushing (Dai Yang), long and wiry Qi Kou pulse. This was Triple Yang Combined Disease. Sea travel caused fright, leading to blood stasis and spirit fear, combined with heat, causing hematemesis (~1 sheng), hypochondriac pain, irritability, thirst, and delirium. Annual luck suggested deficiency in Left Chi. Attending physicians claimed Kidney exhaustion, predicting imminent death. Family panicked. Lv stated: "This is Tianhe Pulse, no worry." Prescribed Xiaochaihu Tang, reducing Ren Shen, adding Sheng Di Huang half dose. Later, upon stomach solidity, used Chengqi Tang for purgation. Recovery ensued.
*Dandan Medical Cases*: Treated a man with chronic genital ulcer who suddenly developed headache, fever, and spontaneous sweating. Others treated as Shanghan. Chi pulse rapid, very wiry (7 beats per breath), coarse pressure revealed choppy quality. Dandan said: "Pathology is in Jueyin, inconsistent with symptoms." Prescribed Xiaochaihu Tang plus Cao Longdan and Huhuanglian, taken hot. Recovered after 4 doses.
**Xiaochaihu Tang Formula**
Chai Hu (8 liang / *Qianjin Yi*)
Huang Qin (3 liang)
Ren Shen (3 liang)
Ban Xia (0.5 sheng, washed)
Da Zao (12 pieces / Complete Works: 13)
Gan Cao (roasted)
Sheng Jiang (3 liang each, sliced)
Seven ingredients. Boil in 12 sheng water, reduce to 6 sheng. Remove dregs, decoct again to 3 sheng. Warm dose: 1 sheng, three times daily.
Modifications:
- Chest irritability without vomiting: Remove Ban Xia, Ren Shen; add Gua Lou Shi (1 piece).
- Thirst: Remove Ban Xia; increase Ren Shen to total 4.5 liang; add Gua Lou Gen (4 liang).
- Abdominal pain: Remove Huang Qin; add Bai Shao (3 liang).
- Hypochondriac hardness: Remove Da Zao; add Mu Li (4 liang).
- Epigastric palpitations with dysuria: Remove Huang Qin; add Fu Ling (4 liang).
- No thirst with slight external heat: Remove Ren Shen; add Gui Zhi (3 liang); cover for mild sweating.
- Cough: Remove Ren Shen, Da Zao, Sheng Jiang; add Wu Wei Zi (0.5 sheng), Gan Jiang (2 liang).
(*Yuhan Jing*: Adds "Ju" [chew] after 7 ingredients. "Zai Jian" as "Zai Zhu". Omits "Fu" in "San Fu". *Chengben* adds "Zhe" after "Ruo Ke". *Qianjin Yi* omits "Gua Lou Gen 4 liang". *Yuhan/Qianjin Yi*: "Jian" for "Ying". Adds "Zhe" below. *Qianjin/Waitai*: Mu Li 6 liang. *Chengben/Yuhan/Qianjin Yi*: Omit "Zhi" in Gui Zhi. Qian edition missing Song version led to debate.)
[Jin Jian] Transmission to Taiyang/Yangming uses sweating, vomiting, purgation. Transmission to Shaoyang requires only harmonization; sweating, vomiting, purgation are forbidden. Pathogen is in Half-Exterior Half-Interior. Exterior aspect involves guest pathogen; interior aspect involves host Qi. Pathogen and Righteous Qi stand still between boundaries, necessitating harmonization. Chai Hu resolves exterior cold in Shaoyang meridians; Huang Qin resolves interior heat in Shaoyang fu-organs. Ginger, Jujube, Ren Shen harmonize Middle and strengthen interior Qi preemptively, preventing interior invasion and facilitating exterior resolution. Laypeople indiscriminately use Xiaochaihu Tang as a panacea without discerning Half-Exterior Half-Interior status or Yin-Yang differentiation. Physicians seek safety, patients prefer mild herbs, but this negligence causes harm. Physicians must anticipate pathology and act early.
[Cheng Zhi] Irritability without vomiting indicates dry heat oppressive to chest; remove Ren Shen/Ban Xia, add Gua Lou Shi. Thirst indicates dryness consuming fluids oppressing Lung; remove Ban Xia, add Gua Lou Gen. Abdominal pain indicates Wood scattering into Earth, confining Stomach/Intestines; remove Huang Qin to calm Earth, add Bai Shao to restrain Wood. Hypochondriac hardness indicates pathogen retention strengthening Wood; remove sweet/slow Da Zao, add salty/softening Mu Li. Epigastric palpitations/dysuria indicate Water invading Heart; remove bitter/cold Huang Qin, add bland/drainage Fu Ling. No thirst/slight heat indicates exterior cold lingering in muscle; remove Ren Shen, add Gui Zhi to resolve. Cough indicates exterior cold entering Lung; remove Ren Shen/Da Zao, add Wu Wei Zi, replace Sheng Jiang with Gan Jiang to warm. Do not remove Huang Qin despite Lung cold, fearing Gan Jiang aids heat. Abdominal pain is Taiyang pattern; Shaoyang presents this due to pathogen moving from exterior to interior, causing interior Qi obstruction.
[Qian Huang] Size variations in Chaihu Tang refer to dosage strength, not herb difference. Mu Li treats heart/hypochondriac heat. Adding Wu Wei Zi/Gan Jiang addresses Water-Cold injuring Lung, reversing Lung Qi, mirroring Xiao Qinglong Tang logic. Not for Lung Heat/Fire.
*Gu Fang Xuan Zhu* states: Removing dregs and re-decocting ensures balance between rigid and soft properties, aiding harmonization.
Seven ingredients target the Middle Jiao, not Lower Jiao, hence "Small" Chaihu Tang.
*Shanghan Leifang* states: Excluding Da Zao, total weight is 28 liang (~5.6 qian modern). Divided into three doses, it is a heavy formula. Shaoyang lies between two Yangs, requiring coverage of three meridians; herbs must not be light. Re-decoction harmonizes properties, integrating meridian Qi, stopping fluctuation. Ancient sages valued decoction methods as much as prescriptions. Ancient cough treatments always paired Wu Wei Zi and Gan Jiang: one disperses cold, one consolidates Zheng Qi. Single use of Wu Wei Zi for cough is erroneous and harmful. Heat/Labor consumption cough differs from Cold-Fluid invading Lung; single Wu Wei Zi收敛s wind/fire/phlegm into Lung, making cure impossible.
Commentary: Qian states: "Half sheng" of Wu Wei Zi is not modern measure. Ancient "Sheng" was square bronze vessel, 1 cun top/bottom, 6 fen base, 8 fen deep, like small iron. Found in old vessels, mistaken for incense burner. Matches Tao Hongjing's description. Has handle for convenience. Half sheng per dose, divided thrice, is logical. *Bencao Xuli* states Ban Xia 1 sheng = 5 liang. Thus Ban Xia 0.5 sheng and Wu Wei Zi 0.5 sheng use same measure. Qian’s view is difficult to accept.
*Su Shen Liang Fang* states: Although *Shanghan Lun* lists many indications, five are most accurate:
1. Fever with reverse Qi or vomiting (exclude if vomiting due to thirst/drinking; exclude if body not warm).
2. Alternating chills and fever.
3. Tide-like fever.
4. Irritability, hypochondriac fullness, with or without thirst.
5. Recurrent fever after recovery from Shanghan.
These five signs...