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Excessive sweating leads to intensified heat, while scanty sweating results in difficult defecation. This is the latter part of pulse diagnosis theory, deducing the reason why purgation should be employed. It means that after taking medicine, if sweating occurs and the couli (pores) are opened, and if there is still a slight sensation of sweating within two or three days, the pathogenic factor will be subdued, the heat eliminated, and the disease will not transmit to the interior. If sweating occurs but the couli close immediately afterward, the heat pathogen will not be expelled but will transmit to the interior. Once the heat transmits to the interior, body fluids must be consumed, leading to difficult defecation; therefore, purgation is appropriate to preserve body fluids. The text later states "pulse is slow, purgation is not yet suitable," warning against mistaken purgation to avoid severely damaging body fluids. It must be understood that these three phrases generally pertain to fu-organ syndromes, aiming to prevent frequent urination, serving as an annotation for the purgation of Yangming disease. (Yu Jiayan)

In cold damage, if the yang pulse is choppy and the yin pulse is string-taut, according to medical principles, acute abdominal pain should occur. First, use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if it does not improve, treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction).

Someone asked: For abdominal pain, first Xiao Jian Zhong was used for warming, then Xiao Chai Hu for cooling. Was Zhang Zhongjing merely testing? The answer is: No. "Not improving" means not fully healed, not that the condition has worsened. First, Jian Zhong resolves the muscle layer and releases the exterior; pain relief relies on Shaoyao (Paeoniae Radix Alba). Subsequently, Chai Hu Tonifies the middle and expels pathogens; pain relief relies on Renshen (Panacis Ginseng Radix). According to the modification rules of Chai Hu Tang, for abdominal pain, Huangqin (Scutellariae Radix) is removed and Shaoyao is added, doubling its efficacy compared to Jian Zhong. How can there be a difference between warm and cool properties? Since the yang pulse remains choppy, Renshen is used to assist Guizhi (Cinnamomi Ramulus); since the yin pulse remains string-taut, Chaihu (Bupleuri Radix) is used to assist Shaoyao. If one dose cures it, why would Renshen's warm tonification and Chaihu's ascending-descending actions be needed? Zhang Zhongjing has cases using two formulas for one syndrome, such as using Mahuang Tang (Ephedra Decoction) for sweating resolution, and if vexation returns half a day later, using Guizhi Tang (Cinnamon Twig Decoction) again, which is the same method. However, these are methods to manage disease, not absolute certainties. First Mahuang, then Guizhi, is a method from exterior to interior; first Jian Zhong, then Chai Hu, is a method from interior to exterior. (Ke Yunbo)

When blood is weak and qi is exhausted, the couli open, allowing pathogenic factors to enter and contend with healthy qi, knotting at the hypochondrium. Healthy qi and pathogens struggle, causing alternating chills and fever occurring at intervals, silence, and loss of appetite. Because zang and fu organs are connected, pain must extend downward; the pathogen is high, pain is low, thus causing vomiting. Treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction).

Question: Regarding the section "blood weak, qi exhausted," mentioning "zang and fu connected, pain extends downward, pathogen high, pain low, thus causing vomiting." Does "high" refer to the exterior? Does "low" refer to the hypochondrium? Answer: "High" does not refer to the exterior, "low" does not refer to the hypochondrium. Understand that this refers to women whose menstruation has just started or stopped. After menstruation stops, is it not blood weakness and qi exhaustion? Because Shaoyang heat pathogen enters the Blood Chamber, forcing menstrual blood to flow recklessly, forming this syndrome. The Shaoyang Gallbladder is housed within the Jueyin Liver leaf; zang and fu are connected. Unlike Taiyang and Yangming, which form separate zones, Shaoyang is distinct from Shaoyin and Taiyin. Thus, Taiyang and Yangming fu pathogens cannot invade the zang, but Shaoyang fu pathogens connect with the zang without clear boundaries. Heat pathogens in the hypochondrium force blood to flow recklessly, causing pain connecting to the abdomen. Although menstrual blood stops, abdominal pain persists. Here, "high" refers to the hypochondrium, "low" refers to the abdomen. Pathogens in both hypochondria force fluid upward; pain in the abdomen causes turbid qi to harass upward. Thus, vomiting and reflux are severe. Do not mistake abdominal pain for a Jueyin syndrome and mistakenly use Wuzhuyu Tang (Evodia Decoction) for vomiting or Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) for pain. Still use Xiao Chai Hu Tang to treat the fu organ, not the zang organ. This is a crucial admonition; implicitly, treating zang and fu together will lead to fu pathogens entering the zang. Zhang Zhongjing could not express everything, relying only on "Xiao Chai Hu Tang Zhu Zhi" to turn the tide. (Yu Jiayan)

Xiao Chai Hu Tang Formula: Remove dregs and decoct again.

Question: Why must Xiao Chai Hu Tang be filtered and decocted again? Answer: Using Xiao Chai Hu Tang requires filtering and decocting again; this is a method within Zhang Zhongjing's methods, containing profound meaning. Shaoyang channel medications have three prohibitions: sweating, vomiting, and purgation. Therefore, only Xiao Chai Hu Tang is used to harmonize. However, within one prescription, Chaihu seeks to release the exterior, Huangqin seeks to enter the interior, and Banxia seeks to drive out phlegm; they move chaotically, lacking harmony greatly. Thus, removing dregs and decocting again merges their medicinal properties into one, ensuring they do not fail. Furthermore, harmonization is neither in the exterior nor in the interior, but in the middle jiao. It must be decocted thoroughly so medicinal qi settles in the stomach, then spreads to the exterior and interior with stomach qi, quietly eliminating pathogens. Hence, besides Renshen and Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) are added,不厌其烦 (without tiring of repetition), relying entirely on the innate qi of the stomach for mediation, like a strong person carrying it away. Consider Zhang Zhongjing verifying Zhang Zhongjing: in San Huang Fuzi Tang (Three Yellows and Aconite Decoction), because yang pathogen enters yin with intense heat, only San Huang can remove heat; because true yang is internally weak and yin is abundant, only Fuzi (Aconiti Lateralis Radix Preparata) can restore yang. Yet each must be decocted separately to perform its function, then decocted together to act jointly; is this not obvious? (Yu Jiayan)

Three-yang combined disease: pulse is floating and large, prominent above the Guan position; desire to sleep, sweating when eyes are closed.

Some say: This syndrome belongs in the Shaoyang chapter; can Xiao Chai Hu Tang be used? Answer: Yes. In three-yang combined disease, pathogens manifest in the pulse: floating indicates Taiyang; large indicates Yangming; prominent above Guan indicates Shaoyang. Desire to sleep and sweating upon closing eyes indicate gallbladder heat, matching pulse and syndrome, hence appearing in the Shaoyang chapter. Generally, a floating pulse without corresponding symptoms prohibits sweating; a large pulse without corresponding symptoms prohibits purgation. Floating and large pulses at the Guan position indicate three-yang combined disease with heat in the gallbladder. The gallbladder resides semi-exterior semi-interior; using Xiao Chai Hu Tang is appropriate. (Zhang Jianshan)

Shaoyin disease: at onset, with contrary fever and deep pulse, treat with Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction).

Question: Discussing transmitted pathogens, from three-yang to Taiyin, Taiyin to Shaoyin; here it does not mention transmission, but says "at onset," why? Answer: Transmission reflects the ancients' intent to clarify principles and establish laws; how can one argue rigidly? Three-yang cold damage often starts from Taiyang and transmits sequentially to Jueyin. Three-yin cold damage also exists, starting from Taiyin with diarrhea and no thirst. Now, Shaoyin disease at onset with contrary fever is due to direct invasion, hence "at onset." Since Shaoyin normally has no body heat, current heat is called "contrary fever" because it should not be present. Because the pathogen is shallow initially, Ma Huang Fu Zi Xi Xin Tang is given to disperse it. Note: Among the six channels, Shaoyin syndrome is hardest to identify. Look at the word "contrary" here. Although yin syndromes generally do not use Mahuang, now that it is at onset, with contrary fever and deep pulse, Ma Huang Fu Zi Xi Xin Tang is used for warm dispersion. (Zhang Jianshan)

Shaoyin disease with diarrhea and faint pulse: give Bai Hu Tang (White Tiger Decoction); if diarrhea continues, with cold limbs, absent pulse, dry retching, and vexation, treat with Bai Tong Jia Zhu Dan Jiang Tang (Baitong Plus Pig Bile Decoction).

Question: Bai Tong Tang, Bai Tong Plus Pig Bile Decoction, Zhen Wu Tang, and Tong Mai Si Ni Tang are all set for Shaoyin diarrhea. Aside from Ginger and Aconite being the same, other herbs differ. Why? Answer: Different diseases require different medicines. Shaoyin diarrhea involves severe cold, requiring Ginger and Aconite. The principle of diarrhea is similar, but accompanying syndromes vary, so medication must suit each case. Bai Tong Tang uses Ginger and Aconite to scatter cold and stop diarrhea, adding Congbai (Allii Fistulosi Bulbus) to regulate yang qi. If diarrhea includes dry retching and vexation, cold is too severe, causing internal rejection; Ginger and Aconite are unsuitable for vexation, likely causing vomiting and refusal to take medicine. Thus, Ren Nao (Human Urine) and Zhu Dan Jiang (Pig Bile), salty-bitter and cold-natured, are added, taken warm or cold, to ensure acceptance without obstruction; upon reaching the disease site, the cold nature dissipates, and the hot nature activates. Similarly, Zhen Wu Tang treats Shaoyin disease persisting for 2-3 days, progressing to 4-5 days with abdominal fullness, difficult urination, heavy painful limbs, and spontaneous diarrhea, indicating water qi. Water qi is cold-dampness, governed by the Kidney. Kidney disease fails to control water, leading to water retention. The Classic states: Spleen dislikes dampness; sweet flavors enter the Spleen first. Poria and Atractylodes Macrocephala (Atractylodis Macrocephalae Rhizoma) are sweet to benefit the spleen and drain water. Cold-dampness dominance is balanced with pungent-hot; dampness excess is assisted with sour-pungent. Thus, Aconite, Shaoyao, and Shengjiang are used for their sour-pungent nature to warm meridians and scatter dampness. Tong Mai Si Ni Tang treats Shaoyin diarrhea with undigested food, interior cold and exterior heat; cold limbs and faint pulse indicate interior cold; body heat, aversion to cold, and red face indicate exterior heat. This is yin abundance internally rejecting yang externally, blocking communication. Tong Mai Si Ni Tang is given to scatter yin and unblock yang. All four syndromes mention diarrhea, but accompanying symptoms vary, so medications are largely similar but slightly different. (Zhang Jianshan)

Shaoyin disease, after 2-3 days, with dry mouth and throat: urgently purge, suitable for Da Cheng Qi Tang (Major Order the Conveyance Decoction). ○ Shaoyin disease, spontaneous watery diarrhea, pure green color,必 (must) have epigastric pain, and dry mouth: urgently purge, suitable for Da Cheng Qi Tang. ○ Shaoyin disease, after 6-7 days, with abdominal distension and constipation: urgently purge, suitable for Da Cheng Qi Tang.

Question: The word "urgent" suggests no delay. The syndrome is merely dry mouth, and it is Shaoyin disease, only 2-3 days, not the massive fullness and solidity of 10+ days. Is it right to use Chengqi Tang? Answer: Shaoyin disease, after 2-3 days, presenting with dry mouth and throat, indicates the patient's kidney water was originally depleted. Urgent purgation is needed to save kidney water; any delay means the jar is empty and the cup dry, making rescue impossible. Thus, Yangming has three urgent purgation methods to save body fluids, and Shaoyin has three urgent purgation methods to save kidney water. Both concern life and death, like saving a burning head; what room is there for deliberation or waiting? This is vastly different from massive fullness/solidity cases, requiring early differentiation. (Yu Jiayan)

Question: Chengqi Tang is suitable for Yangming purgation syndromes; why use it for Shaoyin disease? Answer: The Stomach is the sea of water and grain, nourishing the four peripheries; diseases in the peripheries can transmit inward. Dry stomach earth dries kidney water. Dry mouth and throat within 2-3 days indicate deep heat and rapid transmission, so urgent purgation preserves kidney water. When earth is solid, water is clear. Spontaneous watery diarrhea and dry mouth result from dry-heat in stomach earth. Diarrhea with green color: Green corresponds to Liver, indicating Liver transmitting to Kidney. Since the Kidney meridian exits the Lung, connects to the Heart, and pours into the chest, epigastric pain occurs. Thus, urgent purgation removes stomach heat and drives out kidney pathogens. Abdominal distension and constipation after 6-7 days indicate severe obstruction of pathogens entering the fu; victorious stomach earth depletes kidney water, so urgent purgation removes stomach heat and nourishes kidney water. Both Yangming and Shaoyin have urgent purgation clauses; although syndromes differ, the principle of pathogens entering the fu is identical. (Zhang Jianshan)

Taiyang disease resolves from Si to Wei hours. ○ Yangming disease resolves from Shen to Xu hours. ○ Shaoyang disease resolves from Yin to Chen hours. ○ Taiyin disease resolves from Hai to Chou hours. ○ Shaoyin disease resolves from Zi to Yin hours. ○ Jueyin disease resolves from Chou to Mao hours.

Question: Yang diseases resolve from Yin to Xu, yin diseases from Hai to Yin; this is yang resolving by yang, yin by yin. But some say yang resolves at midnight, yin at noon. Why? Answer: Yang resolving by yang, yin by yin, follows the prosperity of channel qi. Shaoyang prospers at Yin-Mao-Chen; Taiyang at Si-Wu-Wei; Yangming at Shen-You-Xu; Taiyin at Hai-Zi-Chou; Shaoyin at Zi-Chou-Yin; Jueyin at Chou-Yin-Mao. Each channel follows its prosperous time. Shaoyin alone follows its generation time. Shaoyin Kidney contains True Yang; at Zi hour, one yang is born (reed tube ash flies, spring returns). At Chou hour, two yangs; at Yin hour, three yangs. As yang advances, yin retreats; as yang grows, yin declines. Also, Heaven generates one water; Zi water generates Earth, which is the prosperous place. Thus, Shaoyin resolves uniquely at this time. However, three-yang resolution begins at Yin-Mao; three-yin resolution ends at Yin-Mao. Yin is the beginning of human life; Mao is the gate of heaven and earth, reflecting the cyclical nature of yin and yang. The prosperous times of three-yang are nine, not overlapping; the prosperous times of three-yin are five, consecutive. This shows yang moves vigorously, its path long, so it does not overlap; yin moves sluggishly, its path short, so it follows closely. From this, we see Zhang Zhongjing's precise analysis. Regarding yang resolving at midnight and yin at noon, the Inner Classic's intent is the harmony of yang meeting yin and yin meeting yang. Do not the former and latter sages share the same principle? (Yu Jiayan)