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Episodes occur at regular intervals, the patient is taciturn and has no desire to eat. The zang and fu organs are interconnected, so the pain must manifest in the lower part (hypochondrium). Since the pathogenic factor is high and the pain is low, vomiting ensues; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.

[Annotation] This passage elaborates on the preceding three clauses. In women suffering from Wind-stroke or Cold-injury, if menstruation occurs simultaneously with excessive bleeding, it leads to blood deficiency and qi exhaustion, causing the interstices (cou li) to become lax. Pathogenic heat then enters the Blood Chamber (Xue Shi) through the deficiency. The pathogen and healthy qi contend with each other, knotting at the boundary of Shaoyang (Lesser Yang), thus causing the pathogen to knot in the hypochondrium. When the pathogen and healthy qi contend, contention in the Yang aspect results in fever, while contention in the Yin aspect results in chills, hence the alternating chills and fever. After the contention ceases, the healthy qi necessarily weakens, and the symptoms stop, hence the episodes occur at regular intervals. Shaoyang disease has entered the semi-interior and approaches Jueyin (Terminal Yin), hence the taciturnity and lack of appetite. Shaoyang Gallbladder and Jueyin Liver are exterior-interior partners, hence it is said that the zang and fu organs are connected. The Shaoyang meridian descends through the chest and follows the lateral aspect of the hypochondrium; the Jueyin meridian reaches the lower abdomen and follows the medial aspect of the hypochondrium, hence the pain inevitably extends to the hypochondrium. The Shaoyang pathogen moves from the chest down to the hypochondrium; because the chest is diseased, it affects the hypochondrium, hence it is said "the pathogen is high, the pain is low." The pathogen enters the interior from the chest along the hypochondrium, and the interior qi resists upward, causing vomiting. Zhang Zhongjing repeats this clause and still prescribes Xiao Chai Hu Tang (Minor Bupleurum Decoction) to indicate that the therapeutic principle remains within Shaoyang, and there is no need to seek treatment specifically from the Jueyin Blood Chamber.

[Collected Annotations] Yu Chang stated: These four clauses employ mutual textual references to reveal their meanings. One version says menstruation just arrived; another says it just ceased. One version says after seven or eight days the heat subsides, pulse becomes slow, and body temperature normalizes; another says after seven or eight days, chills and fever recur, occurring at regular intervals. One version says fullness below the chest and hypochondrium; another says the pathogen enters internally and knots with healthy qi in the hypochondrium. One version says resembling Chest Binding (Jie Xiong); another says "pathogen high, pain low." One version says delirium; another says clear consciousness during the day but delirium resembling seeing ghosts at night. One version says resembling Malaria; another says alternating chills and fever, occurring at regular intervals. One version says puncture Qi Men (Liv 14); another says use Xiao Chai Hu Tang (Minor Bupleurum Decoction). One version says do not damage Stomach Qi and the Upper Two Jiaos. All these are mutual texts clarifying the main idea, serving as their own annotations. The phrase "resembling Chest Binding" was deemed by Zhang Zhongjing insufficiently descriptive, so he added "zang and fu connected, pathogen high, pain low" to fully elucidate the pathology. The Blood Chamber is the Chong Mai (Penetrating Vessel), located in the lower abdomen, governed by Jueyin Liver. Shaoyang Gallbladder connects with the Liver; Fu pathogens are above, Zang pathogens are below, and the Stomach opening lies at the boundary of these two pathogens. Hence, the patient is taciturn, lacks appetite, and prefers vomiting. Qi Men (Liv 14) is the Front-Mu point of the Liver; draining according to excess drains Liver excess, which serves as the annotation for puncturing Qi Men. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the standard treatment for Shaoyang disease. If one does not damage Stomach Qi and the Upper Two Jiaos, then apart from Qi Men and Xiao Chai Hu Tang (Minor Bupleurum Decoction), there are no other methods.

Vomiting accompanied by fever is treated primarily with Xiao Chai Hu Tang (Minor Bupleurum Decoction). (This is a spurious addition, already appearing in the Taiyang chapter under the Ban Xia Xie Xin Tang clause). Shaoyang disease tends to resolve from Yin hour to Chen hour.

[Annotation] Yin, Mao, and Chen hours are times when Wood energy is prosperous. The Classics state: The Shaoyang within Yang corresponds to the Qi of Spring. Therefore, Shaoyang diseases often resolve when the corresponding Qi is at its peak. This is consistent with the principle of meridian qi recovery.

[Collected Annotations] Wei Litong said: If the disease is in Shaoyang, and one treats it according to the proper method during its time of peak healthy qi, what illness would not be cured?