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For those cases where the disease is in the interior and the pulse is deep and fine, regardless of whether it is caused by wind-cold or summer-heat-dampness, or when neither exterior nor interior symptoms are obvious, or when injured by various internal and external pathogenic factors, whether with or without sweating, presenting with heart and abdominal pain and fullness, delirium and irritability, and excessive accumulation of heat within, as long as the pulse is deep, all should be treated with Chengqi Tang (Cathartic Decoction) combined with Jiedu Tang (Detoxification Decoction) to purge.

If self-sweating occurs due to summer-heat, use Baihu Tang (White Tiger Decoction) to resolve the heat. After the heat is resolved by Baihu Tang, regulate with Wuling San (Five-Ingredient Powder with Poria) combined with Tianshui San (Heavenly Water Powder); taking several doses more is harmless.

If there is abdominal distension and fullness with a deep pulse, mild purging should also be performed using Chengqi Tang combined with Jiedu Tang.

If after inducing sweating the heat does not resolve and the pulse remains floating, use Baizhu Jia Cangzhu Tang (White Tiger Decoction with Atractylodes Rhizome) to resolve the condition again.

If interior heat is abundant and yang reversal is extremely deep, this results from failing to purge when indicated, leading to cold body, faint pulse, and stupor approaching death. Do not use cold medicines to purge; doing so will cause death. Some incompetent physicians mistakenly diagnose this as yin reversal and attempt to administer warm agents such as Xuanwu Tang or Sini Tang (Frigid Extremities Decoction); ingestion will surely lead to death. They do not realize that this syndrome involves exhaustion of yin and depletion of yang. Extreme weakness of yin is called "hao" (exhaustion), and extreme depth of yang reversal is called "jie" (depletion). This is a state where accumulated heat is stifled and about to cease. At this juncture, neither cold nor hot agents should be administered. One should only advance Liangge San (Cooling the Chest Powder) and Jiedu Tang to nourish yin and retreat yang, dissipate the accumulated heat, allow the pulse qi to gradually regenerate, and achieve recovery through profuse sweating; some recover without sweating but with harmonious qi. If not recovered, use Jiedu Tang combined with Chengqi Tang to purge. Subsequently, combine Jiedu Tang, Liangge San, and Tianshui San into one formula to harmonize yin and yang, cleanse the zang-fu organs, so that other residual syndromes will naturally not arise. In cases where heat persists after severe purging, and repeated purging increases the heat, if purging fails to cure and the pulse is faint with qi deficiency and physical weakness, there is no principle for survival according to standard methods. If purging is stopped, the pathogenic heat becomes extremely abundant while yin qi becomes extremely deficient, the pulse gradually ceases, and rescue is impossible. Such cases result in death whether purged or not. Physicians facing this situation determine life or death in an instant; few can remain composed. (The rhyme states: After sweating in shaoyang disease, if sweating does not resolve or fails to occur and the pulse remains floating, use Baizhu Jia Cangzhu Tang to resolve again. Also referring to my discussion: After purging in shaoyang disease, if spontaneous sweating and deficiency-heat persist, use Baizhu Jia Cangzhu Tang with Ren Shen (Ginseng Radix et Rhizoma), which works miraculously after one dose, stopping sweating and cooling the body; this is a transcendent wonderful method. Thus, for heat persisting after sweating or purging, regardless of sweating presence, Baizhu Jia Cangzhu Tang is suitable for resolution, adding Chao Ren Shen (Stir-fried Ginseng Radix et Rhizoma), along with Liangge San and Jiedu Tang for regulation.)

The Classic states: Those whose heat does not resolve after three purgations will die. Later practitioners have survived after four or five purgations, or even ten or twenty times; these were accidental errors. For every one saved, hundreds or thousands died. Students must not take this as a method. Instead, follow the previous method using Jiedu Tang combined with Liangge San to regulate, allowing yang-heat to recede and yin pulse to gradually emerge, thereby preserving life.

If injury from fluid retention fails to disperse, forming Jie Xiong (Chest Binding) syndrome, select Da Xianxiong Tang/Wan (Major Cathartic Pill for Chest Binding) or Xiao Xianxiong Tang/Wan (Minor Cathartic Pill for Chest Binding) for repeated purging. If the pulse is floating, do not purge, as the exterior syndrome has not exited; use Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Xiao Xianxiong Tang. If the pulse is floating but heat is extremely intense, slowly unblock and drain using Chengqi Tang.

If there is excessive retained fluid generating internal damp-heat, causing continuous spontaneous diarrhea with unresolved heat, treat with Jiedu Tang. For Yang Du (Yang Toxin) with macules, use Liangge San with Dang Gui (Angelicae Sinensis Radix). For stifled heat abundant at the exterior, dry without sweat, and damp-heat trapped inside unable to vent externally, struggling together to cause jaundice, use Yinchen Hao Tang (Artemisiae Scopariae and Sophorae Flavescens Decoction) regulated with Wuling San. Severe cases use Yinchen Hao Tang combined with Chengqi Tang to purge.

1. For mental restlessness and inability to lie down, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).

Yinchen Hao Tang
Shan Yin Chen (Artemisiae Scopariae Herba, 1 liang)
Da Huang (Rhei Radix et Rhizoma, 5 qian)
Zhi Zi (Gardeniae Fructus, 10 pieces)
Finely cut, decoct in 2 zhan of water until 1 zhan remains, take warm; stop when bowel movement is achieved.

Zhizi Chi Tang (Formula seen previously.)

1. For premature purging leading to chest binding and deficiency bloating, use Liangge San with Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix).

1. For Gang Jing (Yang Spasm) and Rou Jing (Yin Spasm), presenting with delirium and mania, climbing walls, or jumping into wells, all caused by extreme abundance of yang-heat, use Chengqi Tang combined with Jiedu Tang to purge.

1. For thirst and desire for water after sweating and purging, select Liangge San, Jian Gui Wuling San (Wuling San without Cinnamon Twig), Ganlu Yin (Sweet Dew Drink), or Yiyuan San (Primordial Element Powder) as appropriate.

Ganlu Yin
Fu Ling (Poria, 2 liang)
Ze Xie (Alismatis Rhizoma, 2 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang)
Shi Gao (Gypsum Fibrosum, 2 liang)
Han Shui Shi (Halloysit Rubrum, 2 liang)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 5 qian)
Gui Zhi (Cinnamomi Ramulus, 5 qian)
Zhu Ling (Polyporus, 5 qian)
Hua Shi (Talcum, 4 liang)
Grind into powder; take 3 qian per dose, mixed with boiling water or fresh well water; taking with ginger soup is especially excellent.

1. For urinary obstruction, use Wuling San to drain. For fecal impaction, use Chengqi Tang to purge. For additional exterior symptoms, adjust medications within the Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) formula according to the syndrome; this ensures success.

1. Women's treatments are the same, except pregnant women in the third/fourth months and seventh/eighth months should avoid Xiao Yao (Mangxiao/Metastone) and Da Huang (Rhubarb); usage is safe in other months.

1. Children should take reduced doses.

This contains the secret wonders of ancient treatments for shaoyang disease; later students should carefully treasure them.

My commentary: The shaoyang treatment methods from Hejian and earlier are suitable for spring months and warm diseases/summer-heat transmitting meridians around Summer Solstice. Following these methods ensures safety.

(Danxi Flexible Methods)
For any shaoyang disease transmitting meridians, initially acquiring Taiyang meridian disease with aversion to cold, fever, stiff neck and back, lumbar and spinal pain, and anhidrosis, urgently use Dongyuan Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) to release the exterior and achieve cure. If all pains disappear and aversion to cold ceases, but fever persists or slight sweating occurs, this indicates accompanying deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) as the main formula. For sweating cases, add Guizhi (Cinnamomi Ramulus) and Shaoyao (Paeoniae Radix Alba). If sweat is not penetrating and pulse is still floating and tight, add Qianghuo (Notopterygii Rhizoma et Radix), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), Gegen (Puerariae Lobatae Radix), and double Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix). For chest oppression, remove Huang Qi (Astragali Radix) and Ren Shen (Ginseng Radix et Rhizoma). If headache persists, add Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Bohe (Menthae Haplocalycis Herba), Jingjie (Schizonepetae Spica), Xixin (Asari Radix et Rhizoma), Gegen. For thirst, add Wuweizi (Schisandrae Chinensis Fructus), Maidong (Ophiopogonis Radix), Tianhuafen (Trichosanthis Radix). On days 3-4, do not use previous herbs; instead verify and adjust with Xiao Chaihu Tang. If chills and fever, hypochondriac pain, and all Shaoyang exterior symptoms are present, use the base formula alone. If accompanied by abdominal fullness and spontaneous diarrhea, indicating Taiyang syndrome while Shaoyang symptoms remain, add Wuling San to the base formula, named Chai Ling Tang (Bupleurum and Poria Decoction). For intense heat, remove Guizhi and double Huang Qin (Scutellariae Radix). For severe thirst, remove Banxia (Pinelliae Rhizoma) from the base formula and add Wuweizi and Tianhuafen. On days 5-6 with constipation, tidal fever, and desire for drinks, remove Ren Shen and Gan Cao from the base formula, add Shaoyao, Zhi Ke, Houpo (Magnoliae Officinalis Cortex), and Da Huang; for severe cases, add Mangxiao (Natrii Sulfas), or use Hejian Sanyi Chengqi Tang (Three-One Cathartic Decoction). On days 7-8, if past the meridian stage and heat persists, select Huanglian Jiedu Tang (Coptis Detoxification Decoction) or Liangge San, or continue regulating with Xiao Chaihu Tang based on symptoms. If fever recurs due to overwork after recovery, use Buzhong Yiqi Tang again; multiple doses will bring peace. Even if recurrence is due to dietary indiscretion, never lightly use Da Huang or Mangxiao to purge, as qi and blood are greatly deficient post-illness; further purging will cause death. Be extremely cautious!

Additionally, for delirium after purging in shaoyang disease, initially able to recognize people, but after 3-5 days speaking incessantly and irrationally, this is spirit failing to reside in its house; do not purge again. Pulse is often deep and fine, with cold feet and shortness of breath, cyanotic-brown complexion, and dry mouth; use Buzhong Yiqi Tang with doubled Ren Shen and 20-30 leaves of Zhuye (Bambusae Folium). For internal and external weakness becoming severely deficient after sweating/purging, with fine-rapid pulse, burning heat, and shortness of breath, use Ren Shen, Dang Gui, Bai Zhu, Huang Qi, Gan Cao, Wuweizi, and Zhi Mu (Anemarrhenae Rhizoma), plus a few leaves of Zhuye, decocted with Tongbian (Boy's Urine); 2-3 doses bring peace. For critical illness collapse due to yin deficiency, moxa Dantian (CV-8) to tonify yang, as yang generation promotes yin growth. Do not use Fuzi (Aconiti Lateralis Radix Praeparata); only use Renshen and Huangqi, taken in large amounts is best. After mistaken sweating/vomiting/purging in shaoyang disease, with sanjiao heat, surging-rapid pulse, delirium ignoring bodily form, day-night panting, epistaxis with unresolved heat, yellow eyes and body, screaming and running, continue Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction) for 3-4 doses to cure. For frail individuals infected with cold-dampness, presenting with fever, anorexia, unconsciousness, erratic speech, coma, cyanotic face, black teeth after several days—considered fatal—with deep fine pulse, if Xiao Chaihu Tang fails, urgently use Sijunzi Tang (Four-Gentlemen Decoction) with a few slices of Fuzi. Decoct, place the bowl in a basin of water briefly to reduce heat properties, then take slightly warm; pulse and consciousness return, then use other medicines. This is called Yin Syndrome Shaoyang Disease. For shaoyang disease with stifled stagnation unresolved, where Three Yang merge into Three Yin, causing organ dryness, red face, thirst, palpitations, delirium, more internal than external heat, use Er Yi Chengqi Tang (Two-One Cathartic Decoction), or send down 30-50 Muxiang Binglang Wan (Costus and Areca Seed Pills) with this medicine to purge dry stool and achieve peace. If heat persists after sweating/purging, use Zhizi Douchi Tang (Gardenia and Fermented Soybean Decoction) or Dongyuan Modified Liangge San to decoct and drink, eliminating pathogens to cure.

For any shaoyang disease with body pain, aversion to wind and cold, preference for warmth, floating-rapid pulse, requiring profuse sweating for cure regardless of days, use Liutong Shenjie San (Six-Penetration Divine Release Powder) decocted. For delirium and restless spirit, indicating heat entering the interior incompletely resolved, add Ren Shen and Huang Qin to the base formula for peace. If previous medicine does not induce sufficient sweat, add Zi Su Ye (Perillae Folium), Gegen, Baizhi, etc., to assist; profuse sweating will sweep away the disease. This is Zhang Zairen's method; though mild, it possesses divine efficacy, do not neglect it. For shaoyang disease with macules, red face, stupor, delirium, surging-empty pulse, weak on pressure, or absent, use 5 qian each of Ren Shen and Sheng Di Huang (Rehmanniae Radix), 1 qian Pao Fuzi (Prepared Aconite Lateralis Radix), and 2.5 qian Da Huang; taking it causes mild diarrhea, acceptable in summer. For shaoyang disease with macules and heat, use cucumber root juice (Cucumber refers to small melons growing on walls, yellow clusters, appearing in April) mixed with Fulonggan (Vitreum) to take; removing red spots is excellent. Macules resembling shaoyang disease are actually phlegm-heat manifesting externally; induce slight sweating to disperse, use Tongsheng San cautiously.

(Medical Cases)
Dongyang Du Shiliang's elder brother contracted shaoyang disease in March, with aversion to cold, fever, dysuria, and constipation. Initially, small blood clots like dates emerged from the urethra. Physicians attributed this to sexual activity, treating it as deficiency with Buzhong Yiqi Tang. After 7-8 days, heat intensified, with extreme thirst, gastric fullness, and confused speech. Upon examination, all six pulses were rapid and strong; right three positions were long, deep, and slippery; left hand was slightly level but also deep, solid, and long. I stated: This is a major excess and fullness syndrome belonging to Yangming Meridian; use Da Chengqi Tang (Major Cathartic Decoction). Everyone was shocked, saying: Sir is mistaken. I did not listen, prepared a large dose, administered two doses consecutively; after severe diarrhea, heat subsided and qi harmonized. Ten days after recovery, due to excessive duck consumption, fever recurred. I advised burning duck meat to ash, mixing with raw leek juice, taking 6-7 qian; passage of one bowl of black stool brought peace.

Dongyang Qi, aged 18, contracted shaoyang disease in April, with aversion to cold, high fever, thirst, and white tongue coating. Three days prior, whole body and spine joints ached. By the fourth day, only hypochondriac pain, vomiting, and spontaneous diarrhea remained. Summoned on the sixth day, pulse was string-long, deep, solid, and very rapid in both hands. I stated: Originally a combination of Three Yang syndromes; Taiyang has ceased, but Shaoyang and Yangming remain. Administered Xiao Chaihu Tang combined with Huanglian Jiedu Tang; after three doses, hypochondriac pain and vomiting ceased, but heat persisted. By the ninth day, breathing became noisy with phlegm, sounding like sawing wood; after profuse sweating, body heat increased further, indicating fatal prognosis. However, his face had a clean red hue without evil qi, speech was clear with occasional unclear delirium. I continued treatment, using Liangge San with doubled Da Huang; two doses resulted in similar output as before, clearing watery stool, phlegm noise continued. Administered Da Chengqi Tang combined with Huanglian Jiedu Tang; two doses yielded similar results. I stated: This is likely heat knotting without dry stool expulsion. Subsequently alternating the two formulas, 3-4 times daily, each medicine taken for five doses, finally expelled over ten hard stools like soap pods; phlegm noise gradually calmed, heat decreased, recovering on the fifteenth day with heat subsided and qi harmonized. A knowledgeable physician asked: Shanghan Lun states purging should not be repeated after initial purging; why did daily harsh purging succeed? I replied: As long as dry stool remains and pulse is solid, why not purge again? Therefore, physicians must not be rigid.