难而谵语，宜下之。又阳明中寒，不能食，小便不利，手足 然汗出，此欲作痼瘕。二者俱手足汗出，一则大
便初硬后溏，胃中冷，水谷不别，故不可下；一则大便难，谵语，为阳明证具，故宜下也。（《证治准绳》）
大便秘结
大便秘结，杂证门有实秘、虚秘、风秘、冷秘、热秘、气秘、血枯之分；外感门，审其表邪之解与未解，
里热之结与不结，汗之多与不多，身之热与不热，下证之急与不急，屎之硬与不硬，津液之干与不干，脐腹之
痛与不痛，脉之数与不数，以别可下、不可下，微下、急下，俟之、导之之法也。（《伤寒大白》）
寒热往来
太阳之身寒，在未发热时，如已发热，虽恶寒而身不再寒。阳明之身寒，恶寒只在初得之一日至二日，
则恶寒自罢，便发热而反恶热。惟少阳之寒热，有往而复来之义，寒来便身寒恶寒而不恶热，热来便身热恶热
而不恶寒，与太阳之如疟，发热恶寒而不恶热，阳明之如疟，潮热恶热而不恶寒者不相侔也。然寒为欲去之寒，
热为新炽之热，寒热非实，故小柴胡汤只治热而不治寒，预备其虚而不攻其实也。小柴胡为半表设，而其证皆
属于里，盖表证既去其半，则病机偏于向里也。惟寒热往来一证，尚为表邪未去，故独以柴胡一味主之，其他
悉用里药。凡里证，属阳者多实热，属阴者多虚寒，而少阳为半里，偏于阳，偏于热，虽有虚有实，不尽属于
虚也。仲景深以里虚为虑，故于半表未解时便用人参以固里。（柯韵伯）
寒热如疟与往来寒热，似是而实非。如疟者，止作有时，正与邪争则作，分则止；往来寒热，则止作无时，
或往或来，日三、五发或十数发，此其与疟异也。（成无己）
目眩口苦
问曰∶目眩、口苦，何以是半表半里证？答曰∶目者，肝之窍也。胆附于肝。今少阳胆病，故目眩。苦者，
胆之汁也。热泄胆汁，故口苦。凡目眩、口苦，俱是少阳半表半里证，当和解之。（《伤寒五法》）
耳聋
伤寒耳聋有二证∶其一未持脉时，令其咳而不咳者，此必耳聋无闻也。此为重发汗虚故也，治以黄 建中
汤。其一少阳中风而耳无闻，邪在半表半里也，治以小柴胡汤。（《伤寒类证》）
胁满痛
胁居一身之半，故胁为少阳之枢。岐伯曰∶中于胁则下少阳。此指少阳自病。然太阳之邪欲转属少阳，少
阳之邪欲归迸阳明，皆从胁转。如伤寒四、五日，身热恶风，头项强，胁下满者，是太阳少阳并病，将转属少
阳之机也；以小柴胡汤与之，所以断太阳之来路。如阳明病，发潮热，大便溏，小便自可，胸胁满而不去者，
是少阳阳明并病，此转属阳明之始也；以小柴胡汤与之，所以开阳明之出路。（柯韵伯）
呕吐
问曰∶ 呕吐何以是半表半里证？答曰∶邪将入里，里气上冲，邪正分争，故呕吐。《论》云∶伤寒三日，
三阳为尽，三阴当受邪，其人反能食而不呕者，此为三阴不受邪也。由此观之，是知呕吐者，邪欲入阴之机。
然犹在将入未入之间，故和解可愈也。亦有胃热而呕者，有胃寒而呕者，有停饮而呕者，有食积而呕者。病患
口燥渴，呕吐黄水者，胃热也；呕吐清涎沫，口鼻气冷，手足厥冷者，胃寒也；渴饮水而复呕，咳引胁下痛者，停饮也；呕
吐饮食，胸膈胀痛，吞酸嗳腐者，食积也。以此为别。（程钟龄）
盗汗
盗汗者，谓睡而汗出也。杂病盗汗，责其阴虚；伤寒盗汗，由邪在半表半里使然也。《论》曰∶太阳病，
脉浮而动数，头痛发热，微盗汗出，反恶寒者，表未解也。又阳明里实而脉浮者，必盗汗。又三阳合病，目合
则汗。是知盗汗邪在半表半里之间，而悉属和解明矣。（《证治准绳》）
头汗
头汗出有数种∶如发黄，头汗出者，热不得越而上泄也；背强恶寒，头汗出者，寒湿客搏经络也；下血谵
语，头汗出者，热入血室也；虚烦懊 ，头汗出者，邪客胸中，熏发于上也；水结胸，头汗出者，水气停蓄不
得外行也；阳微结，与往来寒热，头汗出者，邪在半表半里也；发黄，鼻衄，小便难，头汗出者，邪风火热熏
灼上炎也。外有二证，又为头汗出之逆。《经》云∶关格不通，不得尿，头无汗者生，有汗者死。又湿家下之，
头上汗出微喘，小便利者死，下利不止者亦死。以阳气上脱故也。（赵以德）
腹满痛
太阴病腹满证有三∶有次第传经之邪；有直入本经之邪；有下后内陷之邪。不可不辨也。如腹满咽干者，
此传经之阳邪也，法当下之；腹满而吐，食不下，自利益甚，时腹自痛，若下之必胸下结硬者，此直入本经之
阴邪也，法当温之；如太阳病医反下之，因而腹满时痛者，此误下内陷之邪也，法当用桂枝加芍药汤，大实痛
者，桂枝加大黄汤。（赵以德）
自利
自利者，不经攻下，自然注泄也。伤寒自利多种，有表邪传里，里虚协热而利；有不应下而下，内虚协热
而利。又三阳合病，皆有自利。太阳阳明合病自利者，为邪在表也，故与葛根汤汗之；太阳少阳合病自利者，
为邪在半表半里也，故与黄芩汤和之；阳
明少阳合病自利者，为邪入腑也，故与承气汤下之。是三者所以异也。下利何以明其寒热耶？盖自利不渴者，
属太阴，以其脏有寒故也；下利欲饮水者，以有热故也。大便溏，小便自可者，此为有热；自利，小便色白者，
此为有寒。恶寒脉微，自利清谷，此为有寒；发热后重，泄色黄赤，此为有热。又自利以身凉脉小为顺，身热
脉大为逆。少阴病脉紧，下利脉暴微，手足反温，脉紧反去者，此为欲解。下利脉大者为未止，脉微弱数者为
欲止，虽发热不死。又自利有可温者，理中、白通诸四逆辈。又有利在下焦，温剂不应者，《经》曰理中者，
理中焦。此利在下焦，宜石脂余粮汤；复不止者，当利其小便。又少阴病，自利清水，色纯青，心下必痛，口
干燥与下利，三部脉皆平，按之心下硬，或脉沉而滑，或不欲食而谵语，或瘥后至年月日复发。凡此数者，
皆肠胃有积结，而须攻泄。《经》曰通因通用者是也。又下利虽有表证，不可发汗，以下利为邪气内攻，走泄
津液而胃虚。《经》曰下利不可攻表，汗出必胀满者是也。大抵五夺之中，下利为甚。《经》曰∶下利日十余
行，脉反实者死；发热，下利，厥不止者死；直视，谵语，下利者死；下利，手足厥冷，无脉，灸之不温，脉
不还者死；少阴病自利，烦躁，不得卧者死。凡此数者，皆邪夺正气而下脱也。（黄仲理）
三阴俱有下利证∶自利不渴者，属太阴，是脏有寒也；自利渴者，属少阴，以下焦虚寒，津液不升，故引
水自救也；惟厥阴下利属于热，以厥阴主肝而司相火，肝旺则气上撞心，火郁则热利下重，《经》云暴注下迫
者是矣。（柯韵伯）
咽痛
太阳、阳明，咽痛各一，悉属阳证。少阴咽痛有六∶阳热四证，治以猪肤汤、甘草汤、桔梗汤、苦酒汤；
阴寒二证，治以桂枝干姜汤、真武汤、四逆汤。厥阴咽痛者一，亦阳证也，治以桔梗汤。夫咽痛皆是阳证，少
阴内有二证属寒者，一以汗多亡阳，一以阴
盛格阳也。成氏云∶甘草汤，主治少阴热壅咽痛者；桔梗汤，主治少阴寒热相搏咽痛者；半夏散，主治少阴客
寒挟痰咽痛者。吴氏云∶凡阴证咽痛，用以上诸法。若阳证咽痛，当用甘露饮、元参汤。按∶三阴里证咽痛
者多，三阳表证咽痛者少。然太阳表寒外束里热，少阳里有郁热外冒表邪，阳明胃有积热外冒表邪，皆有咽痛。
若无汗恶寒、脉浮紧者，太阳表证为重，宜先散表，羌活冲和汤加甘、桔；阳明里热者，用清胃汤加甘、桔；
少阳里热者，用柴胡清肝饮。（《伤寒大白》）
伤寒他经，皆不言咽痛，惟少阴有咽痛之证，因少阴之脉循喉咙故也。非大热，则为大寒，治之一误，死
生立判，不可概为风热而混治之。（郑重光）
目不明
问曰∶目不明何以是里证？答曰∶目为五脏精华之所系，五脏属阴，阴居于里，故言在里。况瞳子属肾，
内热燔灼，则肾水枯涸，致目不能照物，当急下之以救肾水。（陈养晦）
烦躁
烦为烦扰而烦，躁为愤怒而躁。烦为阳，心病也；躁为阴，肾病也。烦字从火，躁字从足，其理可见。
烦则热轻，躁则热重。所谓烦躁者，先烦后躁也。其不烦而躁者，阴躁也。有邪气在表而烦躁者，有邪气在里
而烦躁者，有因火劫而烦躁者，有阳虚而烦躁者，有阴盛格阳而烦躁者，须审证而治之。（郑重光）
躁烦与烦躁有别，躁者阴躁，烦者阳烦。躁烦者，言自躁而烦，是阴邪已外逼也；烦躁者，言自烦而躁，
是阳气犹内争也。其轻重浅深宜审。（程郊倩）
六经皆有烦躁，而少阴更甚者，以真阴之虚也。盖阳甚则烦，阴极则躁，烦气属，躁属形。烦发于内，
躁见于外，是形从气动也；先躁后烦，是气为形役也。不躁而烦，是阳和渐回，故可治；不烦而躁，是五脏之
阳已竭，惟魄独居，故死。故少阴以烦为生
机，躁为死兆。○烦躁虽六经俱有，而多见于太阳、少阴者，太阳为真阴之标，少阴为真阴之本也。阴阳之标
本，皆从烦躁见；烦躁之虚实，又从阴阳分。如未经汗下而烦躁，属太阳，是烦为阳盛，躁为阴虚矣；汗下后
烦躁，属少阴，是烦为阳虚，躁为阴竭矣。（柯韵伯）
少阴、厥阴俱有烦躁。少阴之躁，由龙火不归，故用姜、附以回阳；厥阴之躁，惟雷火上逆，若用姜、附，
是益其震烈耳，故厥阴之躁证多死。（王又原）
有汗之烦躁，里证也，宜清热；无汗之烦躁，表证也，宜散表；脉浮之烦躁，表证也，宜散表；脉伏之
烦躁，伏邪也，宜升提；沉数之烦躁，里热也，宜清热；沉迟之烦躁，里寒也，宜温经。（《伤寒大白》）
不能言及言语难出
不能言及言语难出，其证有二∶一则太阳风湿；一则少阴咽伤生疮。皆传经之邪，热气壅闭所致。（黄仲理）
厥逆
《论》言四逆与厥非一，或曰四逆，或曰厥，或曰厥逆、厥冷、厥寒，或曰手足逆冷、手足厥逆、手足
厥冷，俱是言寒冷耳。故厥、逆二字，每每互言。然四肢与手足却有所分，以四字加逆字之上者，是通指手、
足、臂、胫言也；以手足字加厥逆、厥冷等上及无手足字者，是独指手足言也。虽厥、逆俱为寒冷，却有阴阳
之殊。热极而成厥逆，阳极似阴也，仲景以四逆散治之，寒极而成厥逆，独阴无阳也，仲景虽无四逆汤治四逆
之条，但四逆汤之名，由四肢之冷而立，岂非逆、厥之不异乎？成氏既谓四逆为热，至少阴死证二条又谓四
逆为寒，不自悖乎？是知四逆亦犹厥之有寒有热，但四肢通冷，比之手足独冷，则有间耳。故少阴病三条，二
为死者，以四逆言；一为可治者，以厥冷言。可见四逆重于厥冷矣。成氏谓厥甚于逆，岂不谬哉？（王安道）
凡伤寒病，初起发热，煎熬津液，鼻干，口渴，便闭，渐至发厥者，不问知其为热也。若阳证忽变阴厥者，
万中无一，从古至今无一也。盖阴厥得之阴证，一起便直中阴经，唇青面白，遍身冷汗，便利不渴，身倦多睡，
醒则人事了了，与伤寒传经之热邪转入转深，人事昏愦者，万万不同。诸书类载阴阳二厥为一门，即明者犹为
所混，况昧者乎？（《寓意草》）
按∶阳厥、阴厥，其辨如前，此先哲之大法也。然愚则犹有所辨，如阴厥一证，既无阳证阳脉，而病寒若
此，明是阴证，知此者无难，惟阳厥一证，有不得不辨者。夫厥由三阳所传，是为阳厥，此固然矣。即以传
经者言之，又岂尽无阴证乎？故凡病真阳不足者，即阳中之阴厥也；脉弱无神者，即阳中之阴厥也；攻伐清凉
太过者，即阳中之阴厥也。四肢为诸阳之本，使非有热结、烦渴、胀实等证，而见厥逆者，皆由阳气不足也。
成无己曰∶大抵厥逆为阴，主寒者多。又曰∶厥为阴之盛也。故凡属夹虚伤寒，虽自阳经传入，亦伤中之阴厥，
勿谓其先有头痛、发热，自三阳传至，便为阳厥。为害不小。（张景岳）
脏厥蛔厥
厥有脏与蛔之别，脏厥者，肾脏之阳不行也；蛔厥者，胃腑之阳不行也。蛔厥者，蛔动则烦，而有静时，
非若脏厥之躁，而无暂安时也。故厥同而证异。（程知）
舌卷囊缩
问曰∶舌卷囊缩，何以是传经厥阴证？答曰∶肝主筋，热邪内灼，则津液枯不能荣养于筋，故舌卷而囊缩，
宜急下之。又问曰∶直中证，亦舌卷囊缩何也？答曰∶直中于寒，阳气衰微而敛缩，此冬令万物闭藏之象也。
今内热消烁，此夏令津液干枯之象也。然直中证，脉必沉迟，或兼见下利清谷、口鼻气冷诸寒证；若邪传厥阴，
必烦满消渴，或唇焦口燥、身如枯柴，形情不同。且直中证，舌虽短缩而润泽；邪传厥阴，则舌敛束如荔枝焦
燥，毫无
津液。又问曰∶妇人之诊如何？答曰∶妇人乳缩，男人囊缩，先验其舌，已自明白。（程钟龄）
脏结
结胸，是阳邪下陷，尚有证见于外，故有可下之理。脏结，是积渐凝结而为阴，五脏之阳已竭，外无烦躁
Difficult defecation accompanied by delirium indicates the suitability of purgation. Additionally, in Yangming cold-dampness syndrome where food intake is impaired, urination is obstructed, and there is persistent sweating on the hands and feet, this suggests the impending formation of a *Gu Zha* (chronic abdominal mass). Both conditions present with sweating on the hands and feet; however, in the former case, stool is initially hard then loose due to cold in the stomach causing failure to separate water and grain, thus purgation is contraindicated; in the latter case, difficult defecation with delirium signifies complete Yangming syndrome, making purgation appropriate. (*Zheng Zhi Zhun Sheng*)
**Constipation**
Constipation in miscellaneous diseases is categorized into excess constipation, deficiency constipation, wind constipation, cold constipation, heat constipation, qi stagnation constipation, and blood depletion constipation. In external contraction diseases, one must assess whether the exterior pathogen has resolved, whether interior heat is accumulated, the degree of sweating, presence or absence of fever, urgency of purgation, hardness of stool, dryness of body fluids, presence or absence of umbilical/abdominal pain, pulse frequency, etc., to distinguish between suitable and unsuitable purgation, mild versus urgent purgation, waiting versus guiding methods. (*Shang Han Da Bai*)
**Alternating Chills and Fever**
Chills in Taiyang disease occur before fever develops; once fever appears, although aversion to cold persists, the body no longer feels cold. Chills in Yangming disease are limited to the first one or two days of onset, after which chills cease, followed by fever and aversion to heat. Only Shaoyang disease features alternating chills and fever: when chills come, the body is cold with aversion to cold but not heat; when heat comes, the body is hot with aversion to heat but not cold. This differs from Taiyang malaria-like symptoms (fever and chills without aversion to heat) and Yangming tidal fever (heat without aversion to cold). Here, chills represent departing pathogens and heat represents newly intense pathogens; since neither is substantial, Xiao Chai Hu Tang treats only the heat while protecting against deficiency rather than attacking excess. Xiao Chai Hu Tang is designed for half-exterior/half-interior conditions, yet its symptoms belong to the interior because as half the exterior resolves, the pathological mechanism shifts inward. Only alternating chills and fever indicates lingering exterior pathogens, hence Chai Hu is used exclusively as the primary herb, with other herbs targeting the interior. Interior syndromes belonging to Yang are mostly excess-heat, while those belonging to Yin are mostly deficiency-cold. Shaoyang, being half-interior, leans toward Yang and heat; though it may have deficiency aspects, it is not purely deficient. Zhang Zhongjing deeply worried about interior deficiency, thus using Ren Shen to secure the interior even when the half-exterior is unresolved. (Ke Yunbo)
Alternating chills and fever resembling malaria are similar in appearance but different in essence. Malaria-like episodes occur at fixed times, arising when righteous Qi conflicts with pathogens and ceasing when they separate. Alternating chills and fever occur irregularly, happening three to five times or more daily, distinguishing it from malaria. (Cheng Wuji)
**Dizziness and Bitter Taste**
Q: Why are dizziness and bitter taste considered half-exterior/half-interior syndromes? A: The eyes are the orifices of the Liver. The Gallbladder attaches to the Liver. When Shaoyang Gallbladder is diseased, dizziness occurs. Bitterness is the taste of bile. Heat forces bile leakage, causing a bitter taste. Dizziness and bitter taste together indicate Shaoyang half-exterior/half-interior syndrome, requiring harmonization treatment. (*Shang Han Wu Fa*)
**Deafness**
There are two types of deafness in Shanghan: First, if a patient cannot cough when prompted before pulse diagnosis, they likely suffer from deafness due to excessive sweating causing deficiency; treat with Huang Qi Jian Zhong Tang. Second, deafness caused by Shaoyang wind-strike, where pathogens are in the half-exterior/half-interior; treat with Xiao Chai Hu Tang. (*Shang Han Lei Zheng*)
**Hypochondriac Fullness and Pain**
The hypochondrium lies at the midpoint of the body, serving as the pivot of Shaoyang. Qibo stated: "Pathogens striking the hypochondrium enter Shaoyang," referring to primary Shaoyang disease. However, Taiyang pathogens transferring to Shaoyang, or Shaoyang pathogens merging into Yangming, both pass through the hypochondrium. For instance, four to five days into Shanghan, with fever, aversion to wind, stiff neck, and hypochondriac fullness, this is a concurrent Taiyang-Shaoyang condition transitioning to Shaoyang; administering Xiao Chai Hu Tang blocks the incoming Taiyang pathogen. If Yangming disease presents with tidal fever, loose stool, normal urination, and persistent chest/hypochondriac fullness, this is a concurrent Shaoyang-Yangming condition beginning to transition to Yangming; administering Xiao Chai Hu Tang opens the exit for Yangming pathogens. (Ke Yunbo)
**Vomiting**
Q: Why is vomiting a half-exterior/half-interior syndrome? A: As pathogens move inward, interior Qi rebels upward, causing conflict between pathogens and righteous Qi, resulting in vomiting. The Treatise states: "On the third day of Shanghan, after the Three Yang meridians are exhausted, the Three Yin should be affected. If the patient can eat and does not vomit, it means the Three Yin are unaffected." Thus, vomiting indicates pathogens attempting to enter the Yin stage but remaining in the transitional phase, resolvable via harmonization. Other causes include stomach heat, stomach cold, fluid retention, and food stagnation. Dry mouth/thirst with yellow vomit indicates stomach heat; clear saliva vomit with cold breath/extremities indicates stomach cold; thirst-drinking-vomit cycle with coughing pulling hypochondriac pain indicates fluid retention; vomiting food with chest/diaphragm distension, acid regurgitation, and foul belching indicates food stagnation. (Cheng Zhongling)
**Night Sweats**
Night sweats refer to sweating during sleep. In miscellaneous diseases, night sweats are attributed to Yin deficiency; in Shanghan, they result from pathogens in the half-exterior/half-interior. The Treatise states: "Taiyang disease with floating/agitated-numerous pulse, headache, fever, slight night sweats, and aversion to cold indicates unresolved exterior." Also, Yangming interior excess with floating pulse causes night sweats. San Yang combined disease causes sweating upon closing eyes. Thus, night sweats indicate pathogens in the half-exterior/half-interior, clearly requiring harmonization. (*Zheng Zhi Zhun Sheng*)
**Head Sweating**
Head sweating arises from various causes: Jaundice with head sweating indicates heat unable to vent, rising instead; back stiffness/chills with head sweating indicates cold-dampness blocking collaterals; bloody stool/delirium with head sweating indicates heat entering the Blood Chamber; vexation/regret with head sweating indicates pathogens in the chest steaming upward; water accumulation in the chest with head sweating indicates stagnant water failing to circulate externally; Yang micro-aggregation with alternating chills/fever and head sweating indicates pathogens in the half-exterior/half-interior; jaundice/epistaxis/difficult urination with head sweating indicates wind-fire heat scorching upward. Two additional conditions represent adverse head sweating. The Classic states: "When Guan-Ge obstruction prevents urination, survival depends on absence of head sweat; death follows if head sweat appears." Furthermore, dampness patients treated incorrectly with purgation showing head sweat, slight panting, and free urination die, as do those with unceasing diarrhea, due to Yang Qi escaping upward. (Zhao Yi De)
**Abdominal Fullness and Pain**
Taiyang abdominal fullness has three origins: sequentially transmitted pathogens, directly invading pathogens, and pathogens sinking inward after incorrect purgation. Abdominal fullness with dry throat indicates transmitted Yang pathogens, requiring purgation. Abdominal fullness with vomiting, inability to eat, worsening diarrhea, and intermittent pain, where purgation causes epigastric hardness, indicates direct Yin pathogens invading the meridian, requiring warming. Abdominal fullness/pain following incorrect purgation of Taiyang disease indicates sunken pathogens, treated with Gui Zhi Jia Shao Yao Tang; severe cases use Gui Zhi Jia Da Huang Tang. (Zhao Yi De)
**Spontaneous Diarrhea**
Spontaneous diarrhea occurs without prior purgation. Causes include exterior pathogens transmitting inward with interior deficiency and協熱 (collaborating heat); improper purgation causing interior deficiency and協熱 diarrhea. San Yang combined diseases also cause spontaneous diarrhea. Taiyang-Yangming combined with diarrhea indicates exterior pathogens, treated with Ge Gen Tang to induce sweating. Taiyang-Shaoyang combined with diarrhea indicates half-exterior/half-interior pathogens, treated with Huang Qin Tang to harmonize. Yangming-Shaoyang combined with diarrhea indicates pathogens entering the Fu organs, treated with Cheng Qi Tang to purge. Cold vs. heat differentiation: Non-thirsty diarrhea belongs to Taiyin (interior cold); thirsty diarrhea indicates heat. Loose stool with normal urine indicates heat; white urine indicates cold. Chills/micro-pulse/clear undigested stool indicates cold; fever/tenesmus/yellow-red stool indicates heat. Smooth prognosis involves cool body/small pulse; adverse prognosis involves fever/large pulse. Shaoyin disease with tight pulse becoming suddenly weak, warm extremities, and disappearing tightness indicates recovery. Large pulse indicates ongoing illness; weak-numerous pulse indicates cessation, even with fever. Treatments include warming formulas like Li Zhong Tang, Bai Tong Tang, and Si Ni Tang variants. Lower Jiao diarrhea resistant to warming requires Shi Zhi Yu Liang Tang or promoting diuresis. Pure green watery diarrhea with epigastric pain/dry mouth/plaintive pulse/hard epigastrium/constipation/delirium/recurrence indicates intestinal accumulation requiring purgation ("Tong Yin Yong Tong" - treating obstruction with draining). Diarrhea with exterior signs contraindicates sweating due to fluid loss and stomach weakness ("Do not attack the exterior in diarrhea; sweating causes distension"). Diarrhea is among the Five Exhaustions. Fatal signs include frequent diarrhea with strong pulse, fever/diarrhea/unrelenting cold limbs, staring/delirium/diarrhea, cold limbs/no pulse/unresponsive to moxibustion, and Shaoyin diarrhea with restlessness/inability to lie down. These indicate pathogenic exhaustion of righteous Qi. (Huang Zhongli)
All Three Yin meridians exhibit diarrhea: Non-thirsty diarrhea belongs to Taiyin (organ cold); thirsty diarrhea belongs to Shaoyin (lower Jiao deficiency cold preventing fluid ascent, prompting self-hydration); Jueyin diarrhea is heat-related (Liver governs Xiang Fire; Liver excess causes Qi rushing to heart, Fire stagnation causes heat diarrhea with tenesmus, described as "violent sudden discharge with urgency"). (Ke Yunbo)
**Sore Throat**
Taiyang and Yangming each have one sore throat type, all Yang syndromes. Shaoyin has six types: Four heat syndromes treated with Zhu Fu Tang, Gan Cao Tang, Jie Geng Tang, Ku Jiu Tang; Two cold syndromes treated with Gui Zhi Gan Jiang Tang, Zhen Wu Tang, Si Ni Tang. Jueyin has one sore throat type, also Yang, treated with Jie Geng Tang. Generally, sore throats are Yang syndromes; Shaoyin cold types arise from excessive sweating depleting Yang or Yin excess repelling Yang. Cheng Wuji notes: Gan Cao Tang treats Shaoyin heat congestion; Jie Geng Tang treats Shaoyin cold-heat conflict; Ban Xia San treats Shaoyin external cold with phlegm. Wu氏 notes: Use above methods for Yin sore throats; use Gan Lu Yin or Yuan Shen Tang for Yang sore throats. Note: Interior sore throats (Three Yin) are common; exterior sore throats (Three Yang) are rare. However, Taiyang exterior cold/internal heat, Shaoyang internal郁 heat/external pathogen, and Yangming stomach heat/external pathogen all cause sore throats. No sweat/chills/floating-tight pulse indicates dominant Taiyang exterior, treat first with Qiang Huo Chong He Tang plus Gan Cao/Jie Geng. Yangming interior heat uses Qing Wei Tang plus Gan Cao/Jie Geng. Shaoyang interior heat uses Chai Hu Qing Gan Yin. (*Shang Han Da Bai*)
Other Shanghan meridians rarely mention sore throat; only Shaoyin does, due to its meridian pathway along the throat. It is either extreme heat or extreme cold; misdiagnosis leads immediately to life or death. Do not indiscriminately treat as wind-heat. (Zheng Zhongguang)
**Visual Impairment**
Q: Why is visual impairment an interior syndrome? A: Eyes connect to the essence of the Five Zang organs. Zang organs belong to Yin, residing in the interior. Pupil relates to Kidney. Internal heat blazing depletes Kidney Water, impairing vision; urgent purgation is needed to save Kidney Water. (Chen Yanghui)
**Vexation and Restlessness**
Vexation (Fan) is mental agitation; Restlessness (Zao) is physical irritability. Fan is Yang/Heart disease; Zao is Yin/Kidney disease. Fan contains the radical for fire; Zao contains the radical for foot, illustrating their nature. Fan indicates lighter heat; Zao indicates heavier heat. True "Fan-Zao" implies Fan precedes Zao. Absence of Fan with Zao alone indicates Yin restlessness. Causes include exterior pathogens, interior pathogens, fire coercion, Yang deficiency, and Yin excess repelling Yang. Diagnosis must guide treatment. (Zheng Zhongguang)
Zao-Fan differs from Fan-Zao. Zao-Fan (restlessness turning to vexation) indicates Yin pathogens forcing outward; Fan-Zao (vexation turning to restlessness) indicates Yang Qi still contending internally. Severity and depth require careful assessment. (Cheng Jiaoqian)
All Six Meridians exhibit Fan-Zao, most severely in Shaoyin due to True Yin deficiency. Extreme Yang causes Fan; extreme Yin causes Zao. Fan relates to Qi/Spirit; Zao relates to Form. Fan originates internally, Zao manifests externally (Form follows Qi movement). Zao preceding Fan indicates Qi enslaved by Form. Fan without Zao indicates returning Yang harmony (treatable); Zao without Fan indicates exhaustion of Five Zang Yang, leaving only Po (dead). Thus, in Shaoyin, Fan signals life, Zao signals death. Fan-Zao appears frequently in Taiyang and Shaoyin because Taiyang is the mark of True Yin, and Shaoyin is the root. Mark and Root manifest in Fan-Zao; Excess/Deficiency distinguishes Yin/Yang. Un-treated Fan-Zao belongs to Taiyang (Fan=Yang excess, Zao=Yin deficiency); Post-sweat/purge Fan-Zao belongs to Shaoyin (Fan=Yang deficiency, Zao=Yin exhaustion). (Ke Yunbo)
Shaoyin and Jueyin both have Fan-Zao. Shaoyin restlessness stems from Dragon Fire failing to return, treated with Jiang/Fu to restore Yang. Jueyin restlessness stems from Thunder Fire rebelling upward; using Jiang/Fu exacerbates violence, leading to high mortality. (Wang Youyuan)
Sweating Fan-Zao is interior, requiring clearing heat. Non-sweating Fan-Zao is exterior, requiring releasing exterior. Floating pulse Fan-Zao is exterior, requiring releasing exterior. Hidden pulse Fan-Zao is hidden pathogen, requiring lifting. Deep-numerous pulse Fan-Zao is interior heat, requiring clearing heat. Deep-slow pulse Fan-Zao is interior cold, requiring warming meridians. (*Shang Han Da Bai*)
**Inability to Speak/Difficulty Speaking**
Two types: Taiyang Wind-Dampness, and Shaoyin throat injury with sores. Both result from transmitted pathogens causing heat congestion/blockage. (Huang Zhongli)
**Cold Extremities (Jue Ni)**
The Treatise distinguishes Si Ni (Four Cold) and Jue (Extremity Cold), using terms like Jue Ni, Jue Leng, Jue Han, Shou Zu Ni Leng, etc., all indicating cold. Jue and Ni are often interchangeable. However, "Si" refers generally to arms/legs, while "Shou Zu" specifies hands/feet. Though both imply cold, they differ in Yin/Yang nature. Extreme heat causing Jue Ni (Yang excess mimicking Yin) is treated with Si Ni San. Extreme cold causing Jue Ni (Yin excess without Yang) is associated with Si Ni Tang, named for limb coldness. Cheng Wuji claims Si Ni is heat, then later calls it cold in Shaoyin death cases, appearing contradictory. Si Ni, like Jue, has cold/heat variations; general limb cold differs from isolated hand/foot cold. In Shaoyin disease, two fatal cases use "Si Ni," one treatable case uses "Jue Leng," indicating Si Ni is more severe than Jue Leng. Cheng's claim that Jue is worse than Ni is erroneous. (Wang Andao)
Initial Shanghan fever boiling fluids causes dry nose/thirst/constipation progressing to cold extremities, clearly indicating heat. Sudden transformation of Yang syndrome to Yin cold extremities is virtually non-existent historically. Yin cold extremities arise from direct invasion of Yin meridians, presenting with blue lips/pale face/cold sweat/free urination/non-thirst/lethargy/clarity upon waking, distinct from deepening heat transmission causing confusion. Grouping Yin/Yang cold extremities together confuses even experts. (*Yu Yi Cao*)
Note: Differentiation of Yang/Yin cold extremities is established. However, I argue: Yin cold extremities lack Yang signs/pulses, clearly Yin. Yang cold extremities require distinction. Transmitted from Three Yang constitutes Yang cold extremities, but even transmitted cases may involve Yin deficiency. True Yang insufficiency constitutes Yin within Yang cold extremities. Weak/pulseless constitution indicates Yin within Yang. Overuse of cooling/purging drugs induces Yin within Yang. Limbs are the root of Yang; without heat accumulation/thirst/distension, cold extremities stem from Yang insufficiency. Cheng Wuji states Jue Ni is mostly Yin/Cold. Thus, mixed-deficiency Shanghan, even if transmitted from Yang meridians, involves Yin cold extremities damaging the center. Do not assume prior headache/fever from Three Yang makes it Yang cold extremities. Harm is significant. (Zhang Jingyue)
**Zang Jue vs. Hui Jue**
Jue divides into Zang Jue and Hui Jue. Zang Jue results from Kidney Yang failure. Hui Jue results from Stomach Yang failure. In Hui Jue, Ascaris movement causes vexation with quiet periods, unlike Zang Jue's constant restlessness. Same Jue, different syndromes. (Cheng Zhi)
**Tongue Curling and Scrotal Contraction**
Q: Why is tongue curling/scrotal contraction a transmitted Jueyin syndrome? A: Liver governs sinews. Internal heat burns fluids, failing to nourish sinews, causing tongue curling/scrotal contraction. Urgent purgation is required. Q: Why does direct strike cold also cause this? A: Direct cold causes Yang deficiency and contraction, mirroring winter closure. Internal heat consumption mirrors summer fluid drying. Direct cold shows deep-slow pulse, clear undigested stool, cold breath/nose. Jueyin transmission shows vexation/fullness/thirst, scorched lips/mouth, emaciation. Direct cold tongue is short but moist; Jueyin tongue is shriveled like dried lychee, devoid of fluids. Female diagnosis: breast retraction parallels male scrotal contraction; tongue examination clarifies. (Cheng Zhongling)
**Zang Jie (Organ Knotting)**
Jie Xiong (Chest Binding) results from Yang pathogens sinking, with external manifestations allowing purgation. Zang Jie results from gradual Yin condensation, exhaustion of Five Zang Yang, and absence of external vexation/restlessness...