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。（此条系太阳病传入少阳之证。但
其脉似少阴。医人所当审也。伤寒五六日。成注云。邪当传里之时。头汗出。微恶寒。手足冷者。此在表之邪未解也。
心下满。口不能食。此在里之邪方结也。大便硬者。此本阳明府证。只因脉细。有似乎阴邪入结于里。故云大便硬而脉
细者。此为阳邪微结。成注云。大便硬为阳结。此邪热虽传于里。然以外带表邪。则热结犹浅。故曰阳微结必有表。指
头汗出云云言。复有里。指心下满云云言。故言有表复有里也。又脉不细而沉者。亦为阳邪微结于里。何也。以头汗出。
故云阳微结。盖诸阳之经。皆上于头也。假令纯阴结。纯者。真也。诸阴之经皆至颈胸中而还。不得复有头汗出之外证。
其真阴之邪。悉当入于里矣。此为阳微结。邪当在半表半里。间也。又脉虽沉而且紧者。终不得为少阴寒证。所以然者。
云云。是重言以申明。头汗出为阳微之义。可与小柴胡汤者。乃和解半表半里之邪也。设不了了者。言服汤后而病。犹
未愈也。得屎而解者。言少阳之表邪既除。大便仍硬。须用药以微利之。则愈按此条论。仲景于小柴胡汤之外。别无利
大便之药。补亡论郭白云云。实者大柴胡虚者蜜煎导之。其说甚是。上三条证俱自太阳下编移附于此）
阳明病发潮热。大便溏。小便自可。胸胁满。不去者。小柴胡汤主之。（此条系阳明病传入少阳之证。阳明病发潮热。
若似乎胃家实矣。但胃实者。大便必硬。小便赤涩。今则大便溏。小便自可。是热虽潮。邪犹在经。非入府之证也。更
加胸胁满不去者。已传入少阳也。故与小柴胡汤。以和解半表半里之邪。）
阳明病胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。上焦得通。津液得下。胃气因和。身 然而汗出解也。
（此条阳明病实少阳之证居多。故从少阳例治。胁下硬满而呕者。此皆少阳证也。惟不大便。为阳明病。兼之舌上白苔。
成注云。为邪未入府。在表里之间。故与小柴胡汤以和解之。上焦得通者。硬满去而呕止也。津液得下者。大便自行也。
胃气和。则阴阳升降而里邪平。身汗出。则内外通达而表邪散。故云。解也。）
阳明中风。脉弦浮大而短气。腹部满胁下及心痛。久按之。气不通。鼻干不得汗嗜卧。一身及面目悉黄。小便难。
有潮热时时哕。耳前后肿。刺之小瘥。外不解。病过十日。脉续浮者。与小柴胡汤。脉但浮。无余证者。与麻黄汤。若
不尿。腹满加哕者。不治。（此条病。虽云阳明中风。观其脉弦。胁下痛。时时哕。耳前后肿。少阳之证偏重。故从柴胡
例治。其用麻黄汤者。虽除太阳之邪而非专证也。少阳脉弦。太阳脉浮。阳明脉大。三阳之脉齐见。而先曰弦者。少阳
之邪居多也。短气者风热甚而气壅逆也。气逆壅甚。故虽以手按抑之。而气愈不能通也。腹满鼻干嗜卧。一身及面目悉
黄潮热者。阳明风热甚也。惟小便难为太阳府证。胁下及心痛者。以本胁痛。而连及于心胸之分。此为少阳经主病。兼
之时时哕者。哕即气逆而呕。呕亦少阳之兼证。耳前后肿者。少阳之脉上耳后。其支者。从耳后。人耳中。出走耳前。
当其既肿之时。愚以纵有阳明风热。已传入少阳之经矣。条辩注耳前后肿。为三阳见证。殊不知太阳当脑后肿。阳明当
面肿。此耳前后肿。当是少阳经证无疑。刺之小瘥者。谓以针刺其肿处。而肿少愈也。外不解者。谓短气胁痛等证未除
也。邪传少阳。浮脉当去。今者病过十日而脉续浮。脉续浮者。谓弦脉本在而仍得浮脉也。脉虽续浮。以过十日。则邪
不在表。当从少阳例治。故与小柴胡汤。以和解表里之邪。若脉但浮无余证者。谓脉不弦而但浮。且无短气胁痛等证。
此邪气欲出而还于表也。故与麻黄汤以汗之。否则少阳证不可汗。岂有更用麻黄汤之理。若不尿云云。是承上短气胁痛
等证而言。不尿则比之小便难更甚。腹满加哕。则比之腹部满时时哕。亦更甚矣。真气已衰。邪气又盛。谓非不治之证
而何。或云。不尿者。宜五苓散。腹满者。宜大柴胡汤。独不思经云。病深者其声哕。虽治之复何益哉。上三条证俱自
阳明篇移附于此）
呕而发热者。小柴胡汤主之。（成注引经云。呕而发热者。柴胡证具愚以其呕。必兼口苦也。此条病自厥阴篇移附于
此）（见后例）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。（少阳病有三禁。医若不知
而妄行吐。下发汗更加温针。损耗津液胃中干燥。以故谵语成注云。此木邪干胃也。最前条云。若柴胡证不罢者。复与
柴胡汤。今柴胡证罢。此为坏病。正文与注见后第十二卷救逆法中）
三阳合病脉浮大。上关上。但欲眠睡。目合则汗（此条虽系合病。实则少阳之邪居多。故从少阳篇例。成注云。关
脉以候少阳之气。太阳之脉浮。阳明之脉大。脉浮大上关上。则知太阳阳明之邪。将并归于少阳经矣。经热。则胆亦热。
故多眠睡。目合则汗者月合目。则欲寐。寐属阴。寐则卫气行于里。邪在半表半里。故目暂合。而汗即出也。按此条论。
仲景无治法。补亡论常器之云。可柴胡桂枝汤。庞安时云。脉不言弦者。隐于浮大也。）
伤寒六七日。无大热。其人躁烦者。此为阳去入阴故也。（此条病。乃少阳之邪欲传入阴经也。伤寒六七日。为邪退
正复之时。其人身无热而安静者。此为欲愈也。今者。身无大热。是热未尽退也。反加躁。扰烦乱。以邪去阳经而入于
阴。故躁烦也。成注云。表为阳。里为阴。少阳之邪。居半表半里之间。邪去少阳。则入三阴经矣。医者可不于六七日
之间。而预为调治。以截其入阴之路乎。）
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。（此承上条之病而言。乃少阳之邪自解。
不传入于阴经也。伤寒三日者。即素问相传日数。上条言六七日。此止言三日可见日数不可拘也。邪在少阳。原呕而不
能食。今反能食而不呕。可征里气之和。而少阳之邪自解也。既里和而少阳邪解。则其不传三阴。断断可必。故云。三
阴不受邪也。此条注本。武陵陈亮斯语）
伤寒三日。少阳脉小者。欲已也。（此条以脉辩少阳病。欲已之法也。少阳伤寒。以脉弦大为病进。今者。脉不弦而
且小。乃邪气已退。正气将复也。故云其病欲已。已。止也。）
少阳病欲解时。从寅至辰上。（注已见前第三卷太阳病欲解注中。）
（附例）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。心下急郁郁微烦者。
为未解也。与大柴胡汤下之。则愈。（此条系太阳病。传入少阳。复入于胃之证。太阳病过经十余日。知其时已传入少阳
矣。故以二三下之为反也。下之而四五日后。更无他变。前此之柴胡证仍在者。其时纵有可下之证。须先与小柴胡汤。
以和解半表半里之邪。如和解之。而呕止者。表里气和。为已解也。若呕不止。兼之心下急。郁郁微烦。心下者。正当
胃府之中。急则满闷已极。郁烦为热结于里。此为未解也。后与大柴胡汤。以下其里热。则愈。上条证并下汤自太阳中
篇移附于此）
However, Yin syndromes typically do not present with sweating. The fact that the patient has sweat only on the head indicates that this is not a Shaoyin syndrome. Xiaochaihu Tang (Minor Bupleurum Decoction) may be administered. If the patient remains uncomfortable after taking the medicine, relief will occur upon defecation. (This clause discusses a syndrome where Taiyang disease transmits to Shaoyang. Although the pulse resembles that of Shaoyin, physicians must examine it carefully. During the fifth or sixth day of Cold Damage, Cheng Wuji's commentary states: This is the time when pathogenic factors should transmit inward. Head sweating, slight aversion to cold, and cold hands and feet indicate that exterior pathogenic factors have not yet been resolved; fullness in the epigastrium and inability to eat indicate that interior pathogenic factors are beginning to knot; hard stool suggests originally a Yangming Fu-organ syndrome. However, because the pulse is fine, it appears as if Yin pathogenic factors have entered and knotted inward. Thus, hard stool with a fine pulse indicates slight knotting of Yang pathogenic factors. Cheng Wuji comments: Hard stool belongs to Yang knotting. Although heat pathogenic factors have transmitted inward, because they are accompanied by exterior pathogenic factors, the heat knotting is still shallow. Therefore, "Yang slight knotting must have an exterior" refers to symptoms such as head sweating; "and also an interior" refers to symptoms such as epigastric fullness. Hence, it is said that there is both an exterior and an interior. Furthermore, if the pulse is not fine but deep, it is also slight knotting of Yang pathogenic factors in the interior. Why? Because of head sweating, it is called Yang slight knotting. All Yang meridians ascend to the head. If it were pure Yin knotting, meaning true Yin knotting, all Yin meridians reach the neck and chest and return, so there would be no external sign of head sweating. True Yin pathogenic factors would all enter the interior. This is Yang slight knotting, where pathogenic factors reside between the exterior and interior. Additionally, even if the pulse is deep and tight, it ultimately cannot be diagnosed as a Shaoyin cold syndrome. The reason for this repeated emphasis is to clarify that head sweating signifies Yang slight knotting. Administering Xiaochaihu Tang aims to harmonize pathogenic factors between the exterior and interior. "If the patient remains uncomfortable" means the illness persists after taking the decoction. "Relief upon defecation" means that once the exterior pathogenic factors of Shaoyang are removed, if the stool remains hard, mild purgation using medication will bring recovery. According to this discussion, Zhang Zhongjing provides no other bowel-relieving formulas besides Xiaochaihu Tang. Guo Baiyun in the *Supplement to Lost Classics* states: For excess conditions, use Daxiehu Tang (Major Bupleurum Decoction); for deficiency conditions, use honey suppositories. This view is very correct. The above three clauses regarding these syndromes were transferred from the Taiyang chapter and attached here.)
In Yangming disease, tidal fever occurs, the stool is loose, urination is normal, and chest and hypochondriac fullness persist without relief. Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment. (This clause discusses a syndrome where Yangming disease transmits to Shaoyang. Tidal fever in Yangming disease seems to suggest Stomach Excess (Gastrointestinal Dryness and Excess). However, in Stomach Excess, the stool must be hard and urination red and scanty. Here, the stool is loose and urination is normal, indicating that although the fever is tidal, the pathogen remains in the meridians, not having entered the Fu organs. With the addition of persistent chest and hypochondriac fullness, it has transmitted to Shaoyang. Therefore, Xiao Chaihu Tang is given to harmonize pathogenic factors between the exterior and interior.)
In Yangming disease, hardness and fullness below the ribs, constipation, vomiting, and a white coating on the tongue indicate that Xiaochaihu Tang (Minor Bupleurum Decoction) may be administered. Once the Upper Jiao (Upper Burner) is unblocked, body fluids descend, the Stomach Qi harmonizes, and the body naturally sweats, leading to resolution. (Most cases in this Yangming clause belong to Shaoyang syndromes, so they are treated according to Shaoyang principles. Hardness/fullness below the ribs and vomiting are Shaoyang symptoms. Constipation alone characterizes Yangming disease. Combined with a white tongue coating, Cheng Wuji comments: This indicates the pathogen has not entered the Fu organs but resides between the exterior and interior, hence Xiaochaihu Tang is used to harmonize. "Upper Jiao unblocked" means the hardness/fullness resolves and vomiting stops. "Body fluids descend" means stool passes spontaneously. When Stomach Qi harmonizes, Yin and Yang rise and fall, calming interior pathogens. Sweating allows internal and external communication, dispersing exterior pathogens. Thus, it is said to resolve.)
Yangming Wind Strike presents with a string-taut, floating, and large pulse, shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of Qi flow even with prolonged pressing, dry nose with inability to sweat, lethargy, generalized jaundice affecting the whole body and face, difficult urination, tidal fever, occasional hiccups, and swelling around the ears and temples. Acupuncture provides slight relief, but the exterior syndrome remains unresolved. If the disease lasts more than ten days and the pulse continues to float, administer Xiaochaihu Tang (Minor Bupleurum Decoction). If the pulse is merely floating without other symptoms, administer Mahuang Tang (Ephedra Decoction). If the patient cannot urinate, abdominal fullness increases, and hiccups worsen, it is an untreatable condition. (Although termed Yangming Wind Strike, the string-taut pulse, hypochondriac pain, frequent hiccups, and ear/temporal swelling indicate a predominance of Shaoyang symptoms, so it is treated following the Chaihu protocol. The use of Mahuang Tang addresses Taiyang pathogens but is not the specific indication. Shaoyang pulse is string-taut, Taiyang is floating, Yangming is large. When all three Yang pulses appear, the string-taut pulse is mentioned first because Shaoyang pathogens predominate. Shortness of breath results from severe wind-heat causing Qi stagnation and rebellion. Severe Qi rebellion makes pressing ineffective. Abdominal fullness, dry nose, lethargy, jaundice, and tidal fever indicate severe Yangming wind-heat. Difficult urination relates to the Taiyang Fu organ. Hypochondriac and heart pain stem from hypochondriac pain radiating to the chest, a principal Shaoyang meridian disease. Hiccups represent Qi rebellion and vomiting, also a Shaoyang accompanying symptom. Swelling around the ears and temples corresponds to the Shaoyang meridian pathway. Even if Yangming wind-heat exists, it has transmitted to the Shaoyang meridian. While *Tiaobian Zhu* considers ear swelling a Three Yang sign, Taiyang swelling occurs at the back of the head, Yangming at the face; thus, ear swelling is undoubtedly a Shaoyang meridian sign. "Slight relief after acupuncture" means swelling subsides slightly via needling. "Exterior unresolved" means shortness of breath and hypochondriac pain persist. Pathogens transmitting to Shaoyang should eliminate the floating pulse. If the pulse remains floating after ten days, it means the string-taut pulse persists alongside a floating pulse. Despite the floating pulse, after ten days, the pathogen is no longer in the exterior, so it is treated as Shaoyang with Xiaochaihu Tang to harmonize interior and exterior. If the pulse is merely floating without other symptoms, it means the pulse is not string-taut but only floating, lacking shortness of breath or pain, indicating pathogens returning to the exterior. Thus, Mahuang Tang is used to induce sweating. Otherwise, Shaoyang syndromes contraindicate sweating, making Mahuang Tang inappropriate. "Cannot urinate" etc., follows the previous discussion of shortness of breath and pain. Inability to urinate is worse than difficulty; increased abdominal fullness and hiccups are worse than before. With depleted healthy Qi and flourishing pathogenic factors, it is indeed untreatable. Some suggest Wuling San (Five-Ling Powder) for inability to urinate and Daxiehu Tang for abdominal fullness, ignoring the classic saying: "Deep disease manifests as hiccups." Treatment would be futile. The above three clauses were transferred from the Yangming chapter and attached here.)
Vomiting accompanied by fever is primarily treated with Xiaochaihu Tang (Minor Bupleurum Decoction). (Cheng Wuji cites the classics: Vomiting and fever indicate the presence of Chaihu symptoms. I believe vomiting must be accompanied by a bitter taste in the mouth. This clause was transferred from the Jueyin chapter and attached here.) (See subsequent examples.) If emesis, purgation, sweating, or warm needle therapy have already been applied, resulting in delirious speech, and the Chaihu syndrome has ceased, this is termed a Ruined Disease (Bad Condition). One must determine what error was committed and treat accordingly based on the new presentation. (Shaoyang disease has three prohibitions. If physicians ignorantly apply emesis, purgation, sweating, or warm needles, they deplete body fluids, causing dryness in the Stomach and leading to delirium. Cheng Wuji comments: This is Wood pathogen invading the Stomach. The earlier clause states: If Chaihu symptoms persist, repeat Xiaochaihu Tang. Now that Chaihu symptoms have ceased, it is a Ruined Disease. See Volume 12, Rescue Methods section for text and notes.)
Three Yang Combined Disease presents with a floating and large pulse, prominent at the Guan position, somnolence, and sweating upon closing the eyes. (Although this is a combined disease, Shaoyang pathogens predominate, so it follows Shaoyang protocols. Cheng Wuji comments: The Guan pulse monitors Shaoyang Qi. Taiyang pulse is floating, Yangming is large. A floating and large pulse at the Guan position indicates Taiyang and Yangming pathogens converging on the Shaoyang meridian. Meridian heat causes Gallbladder heat, leading to excessive sleep. Closing eyes induces sleep, which belongs to Yin. During sleep, Wei Qi moves inward. With pathogens between exterior and interior, brief eye closure triggers sweating. Zhang Zhongjing provides no treatment method for this clause. Chang Qizhi in *Supplement to Lost Classics* suggests Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction). Pang Anshi notes: The pulse does not mention string-taut because it is hidden within the floating and large qualities.)
After six or seven days of Cold Damage, with no significant fever, restlessness and irritability indicate that Yang Qi has retreated and pathogens have entered Yin. (This condition involves Shaoyang pathogens intending to transmit to Yin meridians. Days six or seven mark the time for pathogen decline and healthy Qi recovery. Absence of fever and calmness indicate impending recovery. Lack of significant fever means heat has not fully subsided. Restlessness and irritability arise because pathogens leave Yang meridians and enter Yin. Cheng Wuji comments: Exterior is Yang, Interior is Yin. Shaoyang pathogens reside between exterior and interior. Leaving Shaoyang leads to the Three Yin meridians. Should physicians not intervene during these six to seven days to block transmission to Yin?)
After three days of Cold Damage, the Three Yang meridians' pathogens are exhausted, and the Three Yin meridians should receive pathogens. If the patient can eat and does not vomit, it indicates the Three Yin meridians are not receiving pathogens. (This follows the previous clause, indicating Shaoyang pathogens resolving spontaneously without transmitting to Yin. "Three days" refers to the transmission days in *Suwen*. The previous clause mentions six to seven days, this one three, showing days are not rigid. Shaoyang pathogens typically cause vomiting and anorexia. Ability to eat without vomiting verifies harmonized Interior Qi and spontaneous resolution of Shaoyang pathogens. With Interior harmony and Shaoyang resolution, transmission to Three Yin is impossible. Hence, "Three Yin does not receive pathogens." This note is attributed to Chen Liangsi of Wuling.)
After three days of Cold Damage, if the Shaoyang pulse is small, the disease is about to resolve. (This clause uses pulse diagnosis to identify Shaoyang recovery. In Shaoyang Cold Damage, a string-taut and large pulse indicates disease progression. A non-string-taut, small pulse indicates pathogen retreat and healthy Qi recovery, signaling imminent resolution. "Resolve" means stop.)
The optimal time for Shaoyang disease to resolve is from Yin hour to Chen hour. (Note previously seen in Volume 3, Taiyang Disease Resolution Note.)
(Attached Example) Taiyang disease lasting over ten days, mistakenly subjected to two or three purgations. Five or four days later, if Chaihu symptoms persist, first administer Xiaochaihu Tang (Minor Bupleurum Decoction). If vomiting persists, epigastric urgency, and depression with slight irritability occur, the disease is unresolved. Administer Daxiehu Tang (Major Bupleurum Decoction) to purge, and the patient will recover. (This clause describes Taiyang disease transmitting to Shaoyang and then to the Stomach. Over ten days implies transmission to Shaoyang, making purgation incorrect. After purgation, if five days pass without change and Chaihu symptoms persist, even if purgation indications exist, Xiaochaihu Tang must be used first to harmonize exterior-interior. If vomiting stops after harmonization, exterior-interior Qi is balanced, and the disease resolves. Persistent vomiting with epigastric urgency and depression/irritability indicates unresolved heat knotting in the interior (epigastrium is the Stomach location; urgency implies extreme fullness; depression/irritability implies heat knotting). Subsequently, Daxiehu Tang is used to purge interior heat, leading to recovery. These syndromes and formulas were transferred from the Taiyang chapter and attached here.)