少阳阳明者。发汗利小便已。胃中燥烦实。大便难是也。
此言少阳入阳明之由也。少阳阳明之证。有阳明之经邪传入少阳者。有少阳之经邪归入阳明胃腑者。
皆可称少阳阳明。虽两经之兼证。然论中已有明训曰。伤寒中风。有柴胡证。但见一证便是。不必悉具。
又申之以禁例曰。少阳不可发汗。不可吐下。若此。则凡见少阳一症。汗吐下三法。皆在所禁矣。若以
少阳证而发其汗。且利其小便。令胃中之津液干燥而烦。是少阳之邪。并归于胃。故曰燥烦实。实则大
便难也。盖以少阳胆经。内藏精汁。不出不纳。无本经里证。既不内入三阴。故复归阳明中土而大便难。
既归阳明。则邪气已离少阳。而汗下之禁已弛。其治当与太阳阳明之脾约不远矣。仲景虽不言治法。
而但曰胃中燥烦实。大便难。则是与前太阳阳明之亡津液。胃中干燥。大便难之证无异。其和胃之法。
从可推矣。
服柴胡汤已。渴者。属阳明也。以法治之。
此亦邪自少阳入阳明也。服柴胡汤者。邪在少阳故也。无论他经传入。或本经自感。但见少阳证。
即当用之以和解
半表半里之邪。无他法也。服已而渴。非复少阳证之或渴或不渴矣。夫少阳之渴。热犹在经而未入里。
故虽渴不甚。但以小柴胡加栝蒌根治之而已。至服汤之后。当邪解而渴止矣。乃服已而渴。知邪已入胃。
胃中津液枯燥。即前渴欲饮水之渴。故曰属阳明也。但云以法治之而不言法者。盖法无定法也。倘虽
属阳明。而少阳证尚有未罢。犹未可轻犯少阳之禁。若竟归阳明。即当以治阳明法治之。不必更拘少
阳法也。邪热既以归胃。当审其虚实而治之可也。假令无形之热邪在胃。烁其津液。则有白虎汤之法
以解之。若津竭胃虚。又有白虎加人参之法以救之。若有形之实邪。则有小承气及调胃承气汤和胃之法。
若大实满而潮热谵语。大便硬者。则有大承气攻下之法。若胃气已实而身热未除者。则有大柴胡汤两
解之法。若此之类。机变无穷。当随时应变。因证便宜耳。岂有一定之法可立。又岂因久远遗亡之所
致哉。
辨误 夫邪之入少阳也。或从太阳与阳明传来。或本经自受。盖太阳主外而居表。邪气由此假途而入。
在所不免。然未必一定从阳明传入也。虽云太阳总营卫而主第一层。阳明主肌肉而为第二层。少阳主
躯壳之里而为第三层。而其经脉。则太阳之脉行身之背。阳明之脉行身之前。少阳之脉行身之侧。虽各
有支别。行度而不乱。然其交互盘错。则有不能必相离异者。故其受邪必不能按次循序。先后不紊。
若云必由太阳而传阳明。阳明而传少阳。挨次轮传。则太少有所间隔。何谓两阳合明乎。且合病并病条中。
不当有太少合并之病矣。更曷为有柴胡桂枝汤之太少两解。及柴胡桂枝干姜汤乎。注家谓风寒皆从阳
明而传少阳。此又云少阳重转阳明。则邪还阳明。岂知阳明传少阳者。乃在表之经邪也。故谓之传经。
少阳属阳明者。乃入胃之腑邪也。为自经入里。非惟三阳之邪自经归里。皆
必入胃。胃实而后可下。即三阴证中如太阴症之腹满时痛至大实痛者。即以桂枝大黄汤主之。及腐秽当
去之类。又如少阴症中之承气汤急下三条。厥阴证中之下利谵语。有燥屎者以小承气汤。皆邪气入胃。
所谓阳明中土。万物所归。无所复传之地也。惟此三阴下证。然后可称重转阳明。邪还阳明。以既入三阴。
理难再返。故曰重转。若在三阳。不过邪气入里。谓之转属阳明而已。岂宜胶固其层次之说。而又茫
然混称其为重转阳明也哉。
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。
此阳明兼少阳之证也。邪在阳明而发潮热。为胃实可下之候矣。而大便反溏。则知邪虽入而胃未实也。
小便自可。尤知热邪未深。故气化无乖而经邪尚未尽入也。胸胁满者。邪在少阳之经也。少阳之脉循胁里。
其支者合缺盆。下胸中。胸胁之满未去。其邪犹在半表半里之间。故为少阳阳明。然既曰阳明病。而独以
少阳法治之者。盖阳明虽属主病。而仲景已云伤寒中风。有柴胡证。但见一证便是。不必悉具。故凡见少阳
一证。便不可汗下。惟宜以小柴胡汤和解之也。
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。
此亦阳明兼少阳之证也。上文虽潮热而大便反溏。小便自可。此虽不大便而未见潮热。皆为阳明热邪未实于胃
之证。前云胸胁满未去。此云胁下硬满而呕。皆为少阳见证。而似瘥有轻重。以致后人有少阳为多之解。然仲
景之意。不过互相发明。初无少异。但训人以见证虽有不同。其理本无二致也。言证见阳明而又胁下硬满。此证兼少阳
也。少阳之脉行身之侧。循胁里。邪气入经。故硬满也。不大便为阳明里热。然呕则又少阳证也。少阳
之支脉。合缺盆。下胸中。邪在胸中。故呕也。舌苔之状。虽各有不同。而寒热虚实。及邪之浅深。
证之表里。无不毕现。智者明睿所照。自是纤毫无爽。若热邪实于胃。则舌苔非黄即黑。或干硬。或芒
刺矣。舌上白苔。为舌苔之初现。若夫邪初在表。舌尚无苔。既有白苔。邪虽未必全在于表。然犹未尽
入于里。故仍为半表半里之证。邪在半里。则不可汗。邪在半表。则不可下。故可与小柴胡汤以和解之。
少阳之经邪得解。则胸邪去而其呕自止。胁邪平而硬满自消。无邪气间隔于中。则上焦之气得以通行无
滞。故胃中之津液得以下流。而大便自通。胃气因此而和。遂得表里畅达。通身 然汗出而解矣。
上焦得通。津液得下。胃气因和三句。成氏未悟其旨。故不能解。方氏已知津液得下为大便行矣。
喻氏因之。故曰既云津液得下。则大便自行。亦可知矣。而犹未知上焦得通。胃气因和之义。故有风寒
之邪。协津液而上聚膈中之说。又多一篇泛论。盖小柴胡非上焦之药。因少阳之脉络循胸胁。邪入其
经。故胁硬满而呕。胸胁如此。所以上下不通。既得和解。而少阳之经脉流通。硬满已消。一无障碍。故
上焦之气得以通行。而胃中之津液。亦随气下走。燥去而大便通矣。胃气因和者。因大便通而胃气得和也。
即前太阳阳明证中小承气和胃之义也。前以汗吐下后。又利其小便。虽无大热。奈胃中之津液枯涸。故成
脾约。胃中既无津液。无以流通。故不得已而以小承气和胃。及麻仁丸润燥。令胃和则愈。此以未经汗下。
津液无损。故不必小承气而后和。但得和解而气通津下。大便自通。胃气自和矣。仲景之文。虽未显言。
然推其词气。已无余蕴矣。若但举其所知而遗其所不知。是终未得其全旨。恐于后学。终无益也。
少阳阳明病，是指经过发汗和利小便治疗后，导致胃中干燥、烦闷、实热，大便困难的情况。
这是说明少阳病转入阳明病的原因。少阳阳明病证，有阳明经的邪气传入少阳的，也有少阳经的邪气归入阳明胃腑的。都可以称为少阳阳明。虽然这是两经的兼夹证候，但在《伤寒论》中已有明确教导说：患伤寒或中风，出现柴胡汤证（少阳病主方），只要见到其中一个症状即可，不必所有症状都具备。又补充了禁忌条例说：少阳病不可发汗，不可催吐或泻下。像这样，凡是见到少阳的一个症状，汗、吐、下三种治法都在禁忌之列。如果对少阳证使用发汗法，并且通利小便，致使胃中的津液干燥而产生烦热，这就是少阳的邪气一并归于胃中，所以称为“燥、烦、实”。实热则导致大便困难。因为少阳胆经内藏精汁（胆汁），既不出也不纳，没有本经的里证，既然不向内传入三阴经，所以又回归到阳明中土（脾胃）而导致大便困难。既然邪气已归入阳明，那么邪气已经离开少阳，而之前对少阳的发汗和下法的禁忌也就解除了。其治疗方法应当与太阳阳明病的脾约证（因津液亏损导致的便秘）相差不远。张仲景虽然没有直接说明治法，但只说“胃中燥烦实，大便难”，这与前面太阳阳明病中因亡失津液、胃中干燥、大便困难的证候没有不同。其调和胃气的方法，就可以由此推知了。
服用柴胡汤后，出现口渴症状的，属于阳明病。按照治疗阳明病的方法处理。
这也是邪气从少阳转入阳明的情况。服用柴胡汤，是因为邪气在少阳的缘故。无论是其他经传入，还是本经直接感受外邪，只要见到少阳证，就应当使用柴胡汤来和解半表半里的邪气，没有其他治法。服药后出现口渴，就不再是少阳病那种有时渴有时不渴的情况了。少阳病的口渴，是因为热邪还在经络而未入里，所以虽然口渴但并不严重，只需用小柴胡汤加栝蒌根（天花粉）治疗即可。到了服药之后，应当邪气解除而口渴停止。现在服药后反而口渴，知道邪气已经入胃，胃中津液枯燥，就是前面提到的想喝水的那种口渴，所以说属于阳明病。这里只说“按法治之”而没有具体说明方法，是因为治法没有固定不变的模式。倘若虽然属于阳明病，但少阳证还有未消除的，仍然不可以轻易触犯少阳的禁忌。如果完全归属于阳明，就应当用治疗阳明病的方法来治疗，不必再拘泥于少阳的治法。邪热既然已经归入胃中，应当审查其虚实来进行治疗。假如是无形的热邪在胃中，灼烧津液，就有白虎汤的方法来解除它；如果是津液枯竭、胃气虚弱，又有白虎加人参汤的方法来救治它；如果是有形的实邪，就有小承气汤及调胃承气汤来调和胃气的方法；如果是大实大满且伴有潮热、谵语、大便干结的，就有大承气汤攻下的方法；如果是胃气已实但身体发热仍未除去的，就有大柴胡汤表里双解的方法。像这一类情况，机变无穷，应当随时应变，根据证候灵活处理罢了。难道有一定固定的法则可以设立吗？这难道是因为久远年代遗失造成的吗？
【辨误】
邪气侵入少阳，有的是从太阳和阳明传来，有的是本经直接受邪。太阳主表居外，邪气由此借道而入，在所难免。然而未必一定从阳明传入。虽然说太阳统摄营卫而居第一层，阳明主肌肉而为第二层，少阳主躯壳之里而为第三层，但其经脉方面，太阳的脉行于身背，阳明的脉行于身前，少阳的脉行于身侧。虽然各有分支，运行有序不乱，但它们交互盘错，则有不能完全分离不同的地方。所以它们受邪必然不能按照次序循序渐进，先后不紊乱。如果说必须由太阳传到阳明，再由阳明传到少阳，挨次轮传，那么太阳和少阳之间就有间隔了，怎么能叫“两阳合明”呢？而且在合病并病的条文中，就不应当有太阳和少阳合并的病证了。又怎么会有柴胡桂枝汤这种太少两解的方子，以及柴胡桂枝干姜汤呢？注家认为风寒都从阳明传到少阳，这里又说少阳转属阳明，说是邪气还归阳明。哪里知道阳明传少阳的，是在表的经邪，所以称之为传经；少阳属阳明的，是入胃的腑邪，是自经入里。不仅三阳的邪气自经归里，都必须入胃，胃实之后才可以攻下，即使是三阴证中如太阴证的腹满时痛甚至大实痛，就用桂枝大黄汤主治，以及腐秽当去之类；又如少阴证中的承气汤急下三条，厥阴证中的下利谵语、有燥屎的用小承气汤，都是邪气入胃，所谓的“阳明中土，万物所归，无所复传”的地方。只有这三种阴经的下证，然后可以称为重转阳明、邪还阳明，因为既然进入三阴，按理难以再返回，所以叫重转。如果在三阳，不过是邪气入里，称之为转属阳明而已。哪里应该固执于层次的说法，而又茫然地混称其为重转阳明呢？
阳明病，出现定时发热（潮热），大便稀溏，小便正常，胸胁部胀满感持续不消的，用小柴胡汤主治。
这是阳明兼少阳的证候。邪气在阳明而出现潮热，是胃实可下的征候了。但大便反而稀溏，就知道邪气虽然入里但胃尚未实。小便正常，尤其知道热邪不深，所以气化功能没有失常，经邪还没有完全入里。胸胁胀满，是邪气在少阳的经络。少阳的脉循行于胁肋内部，其支脉会合于缺盆，下行至胸中。胸胁部的胀满感没有消退，说明邪气仍在半表半里之间，所以称为少阳阳明。既然称为阳明病，却单独用少阳法治之，是因为张仲景曾说：伤寒中风，有柴胡证，只要见到一个症状即可，不必全部具备。所以凡是见到少阳的一个症状，便不可发汗或泻下，只宜用小柴胡汤来和解。
阳明病，胁下硬满，不大便且呕吐，舌上有白苔的，可以给予小柴胡汤。上焦通畅，津液得以输布下行，胃气因而调和，全身微微出汗而病愈。
这也是阳明兼少阳的证候。上文虽然提到潮热但大便反稀溏，小便正常；这里虽然提到不大便但没有出现潮热，都是阳明热邪未在胃中成实的证候。前文说胸胁满未去，这里说胁下硬满且呕吐，都是少阳的见证，只是病情有轻重之分，以致后人解释为少阳证居多。然而张仲景的本意，不过是互相阐明，原本没有多少差异，只是教导人们见证虽有不同，其道理本无二致。言证见阳明而又胁下硬满，此证兼有少阳。少阳的脉行于身侧，循行于胁肋内部，邪气入经，所以硬满。不大便是阳明里热，但呕吐又是少阳证。少阳的支脉，会合于缺盆，下行至胸中，邪气在胸中，所以呕吐。舌苔的状态，虽然各不相同，但寒热虚实，以及邪气的浅深，证候的表里，无不显现出来。智者明察秋毫，自然纤毫无爽。如果热邪实于胃，则舌苔非黄即黑，或干燥坚硬，或有芒刺。舌上白苔，是舌苔初现的表现。如果邪气初在表，舌上尚无苔；既有白苔，说明邪气虽未必全在于表，但也未尽入于里，所以仍为半表半里的证候。邪在半里，则不可发汗；邪在半表，则不可泻下。所以可以给予小柴胡汤来和解。少阳的经邪得到解除，则胸中的邪气去除而呕吐自然停止，胁肋的邪气平息而硬满自然消除。没有邪气阻隔在中焦，则上焦的气得以通行无阻，所以胃中的津液得以下流，大便自然通畅，胃气因此调和，于是表里畅达，全身微微出汗而病解。
关于“上焦得通，津液得下，胃气因和”这三句，成无己未能领悟其旨意，所以无法解释。方有执只知道“津液得下”意味着大便通行，喻嘉言沿袭了他的观点，所以说既然讲津液得下，那么大便自行通畅也就知道了。但仍然不明白“上焦得通，胃气因和”的含义，所以提出风寒之邪协同津液上聚膈中之说，又多了一篇泛泛而谈的文章。其实小柴胡汤并非专门针对上焦的药物，而是因为少阳的脉络循行于胸胁，邪气侵入其经，所以胁下硬满且呕吐。胸胁如此，导致上下不通。既然得到和解，少阳的经脉流通，硬满已消，一无障碍，所以上焦之气得以通行，而胃中的津液，也随着气机下行，燥热去除而大便通畅。所谓“胃气因和”，是因为大便通畅而胃气得以调和。这就如同前面太阳阳明证中小承气汤调和胃气的意义一样。前面因为发汗、催吐、泻下后又利小便，虽然没有大热，无奈胃中津液枯涸，所以形成脾约。胃中既无津液，无法流通，所以不得已用小承气汤调和胃气，以及麻仁丸润燥，令胃气和则痊愈。这里是因为未经过汗下治疗，津液未受损，所以不必用小承气汤后再调和，只要得到和解而气通津下，大便自然通畅，胃气自然调和。张仲景的文字，虽然没有显明说出，但推敲其词语气息，已经没有剩余的内涵了。如果只列举自己所知道的而遗漏自己所不知道的，终究未能得其全貌，恐怕对后学之人，终究没有益处。
Shaoyang-Yangming disease refers to the condition where, after undergoing sweating and diuresis treatments, the stomach becomes dry, irritable, and full of excess heat, resulting in difficult defecation.
This explains the mechanism by which Shaoyang disease transitions into Yangming disease. The syndrome of Shaoyang-Yangming includes cases where pathogenic factors from the Yangming channel transmit to Shaoyang, as well as cases where pathogenic factors from the Shaoyang channel enter the Yangming Stomach organ. Both can be termed Shaoyang-Yangming. Although this is a combined syndrome of two channels, the *Shanghan Lun* (Treatise on Cold Damage) explicitly states: In cases of cold damage or wind strike, if there are Chaihu Syndrome (the main formula syndrome for Shaoyang disease) signs, observing just one symptom is sufficient; it is not necessary for all symptoms to be present. Furthermore, contraindications are reiterated: Shaoyang disease should not be treated with sweating, emesis, or purging. Thus, whenever even one sign of Shaoyang is observed, the three methods of sweating, emesis, and purging are all prohibited. If sweating is applied to a Shaoyang syndrome, along with promoting urination, the body fluids in the stomach will dry up, causing irritability and heat. This means the Shaoyang pathogen has converged into the stomach, hence described as "dryness, irritability, and excess." Excess leads to difficult defecation. Since the Gallbladder channel of Shaoyang stores essence juice (bile) and neither excretes nor absorbs internally, lacking interior syndromes of its own channel, and since it does not transmit inward to the Three Yin channels, it returns to the Yangming Earth (Spleen and Stomach), causing difficult defecation. Once the pathogen has entered Yangming, it has left Shaoyang, and the previous prohibitions against sweating and purging for Shaoyang are lifted. The treatment method should not differ significantly from the Pi Yue (Spleen Restriction) syndrome of Taiyang-Yangming (constipation due to fluid depletion). Although Zhang Zhongjing did not explicitly state the treatment, merely saying "stomach dryness, irritability, excess, and difficult defecation," this is identical to the earlier Taiyang-Yangming syndrome characterized by loss of body fluids, dry stomach, and difficult defecation. The method of harmonizing the stomach can thus be inferred.
If thirst occurs after taking Chaihu Tang, it belongs to Yangming disease. Treat according to the methods for Yangming disease.
This also represents the transmission of pathogen from Shaoyang to Yangming. Taking Chaihu Tang indicates the pathogen was in Shaoyang. Whether transmitted from other channels or directly contracted by the channel itself, whenever Shaoyang signs appear, Chaihu Tang should be used to harmonize and resolve pathogens in the half-exterior, half-interior; there is no other method. Thirst appearing after medication is no longer the intermittent thirst characteristic of Shaoyang disease. In Shaoyang disease, thirst arises because heat remains in the channel without entering the interior; thus, although thirsty, the sensation is mild, and it can be treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Gualou Gen (Trichosanthes Root). After taking the decoction, the pathogen should resolve and thirst cease. Now, if thirst persists or appears after taking the medicine, it indicates the pathogen has entered the stomach, drying the stomach fluids. This is the same thirst desiring water mentioned previously, hence stated as belonging to Yangming. The text says "treat according to the method" without specifying it because there is no fixed method. If, although belonging to Yangming, Shaoyang signs have not yet resolved, one must still avoid violating Shaoyang contraindications. If it completely belongs to Yangming, then Yangming treatment methods should be used, without being constrained by Shaoyang methods. Since the pathogenic heat has returned to the stomach, one must examine its deficiency or excess to treat accordingly. If formless heat exists in the stomach, scorching fluids, Bai Hu Tang (White Tiger Decoction) can be used to resolve it. If fluids are exhausted and Stomach Qi is deficient, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is used to rescue. If there is substantial excess pathogen, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) or Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) are used to harmonize the stomach. If there is severe fullness and hardness accompanied by tidal fever, delirium, and hard stool, Da Cheng Qi Tang (Major Order the Qi Decoction) is used for purging. If Stomach Qi is excessive but external fever remains, Da Chai Hu Tang (Major Bupleurum Decoction) is used for simultaneous exterior-interior resolution. Such variations are infinite; one must adapt to changes according to circumstances and adjust flexibly based on the syndrome. Is there a fixed rule? Is this due to loss over long ages?
[Correction of Misunderstandings]
When pathogens enter Shaoyang, they may come from Taiyang and Yangming, or be directly contracted by the channel itself. Taiyang governs the exterior and resides on the surface; pathogens borrowing this route to enter are inevitable. However, they do not necessarily transmit from Yangming. Although it is said that Taiyang governs Ying and Wei and occupies the first layer, Yangming governs muscles and occupies the second layer, and Shaoyang governs the interior of the body shell occupying the third layer, regarding their meridians: Taiyang meridians run along the back, Yangming along the front, and Shaoyang along the sides. Although each has branches running orderly, they interweave and cannot always be strictly separated. Therefore, contracting pathogens does not necessarily follow a sequential order without deviation. If one claims transmission must go from Taiyang to Yangming, then to Shaoyang, sequentially, there would be a gap between Taiyang and Shaoyang, contradicting the concept of "Two Yangs Combining to Brighten." Moreover, in sections on Combined Diseases and Concurrent Diseases, there would be no mention of Taiyang-Shaoyang concurrent diseases, nor the existence of formulas like Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) for resolving both Taiyang and Shaoyang, or Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). Commentators claim wind-cold transmits from Yangming to Shaoyang, and here it says Shaoyang turns to Yangming, calling it "pathogen returning to Yangming." They fail to realize that Yangming transmitting to Shaoyang involves exterior channel pathogens, termed "transmission." Shaoyang belonging to Yangming involves interior organ pathogens entering the stomach, termed "entering from channel to interior." Not only do Three Yang pathogens entering from channels to interior must enter the stomach before purging can occur, but even in Three Yin syndromes, such as Taiyin syndrome with abdominal fullness and pain ranging to severe pain, Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) is used, or for eliminating foul matter; similarly, the three urgent purging indications using Cheng Qi Tang in Shaoyin syndrome, and dysentery with delirium and dry feces in Jueyin syndrome treated with Xiao Cheng Qi Tang, all indicate pathogens entering the stomach—the so-called "Yangming Central Earth, where all things return, having nowhere else to transmit." Only these Three Yin purging indications can be called "re-turning to Yangming" or "pathogen returning to Yangming," because once entering Three Yin, it is theoretically difficult to return, hence "re-turning." In the Three Yang, it is merely pathogen entering the interior, termed "turning to belong to Yangming." One should not rigidly adhere to hierarchical layers and vaguely confuse them with "re-turning to Yangming."
In Yangming disease, if there is tidal fever, loose stools, normal urination, and persistent chest-hypochondriac fullness, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
This is a Yangming syndrome combined with Shaoyang. Pathogen in Yangming causing tidal fever suggests stomach excess suitable for purging. However, stools are loose, indicating that although the pathogen has entered, the stomach is not yet solid. Normal urination further indicates shallow heat, unimpaired Qi transformation, and that channel pathogens have not fully entered the interior. Chest-hypochondriac fullness indicates pathogen in the Shaoyang channel. Shaoyang meridians circulate through the hypochondrium; branch meridians converge at the Clavicle (Quepen) and descend into the chest. Persistent chest-hypochondriac fullness indicates the pathogen remains in the half-exterior, half-interior, hence termed Shaoyang-Yangming. Although termed Yangming disease, treating solely with Shaoyang methods is because Zhang Zhongjing stated: in cold damage or wind strike, if Chaihu signs exist, observing one is sufficient. Thus, whenever one Shaoyang sign appears, sweating and purging are prohibited; only Xiao Chai Hu Tang should be used to harmonize.
In Yangming disease, if there is hardness and fullness under the hypochondrium, constipation, vomiting, and a white coating on the tongue, Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given. When the Upper Jiao becomes free, body fluids descend, Stomach Qi harmonizes, and the patient sweats slightly, the disease resolves.
This is also a Yangming syndrome combined with Shaoyang. Previously, tidal fever with loose stools and normal urination indicated Yangming heat not yet solid in the stomach. Here, constipation without tidal fever also indicates Yangming heat not solid in the stomach. Previous chest-hypochondriac fullness and current hypochondriac hardness with vomiting are both Shaoyang signs, differing only in severity, leading some later commentators to believe Shaoyang signs predominate. However, Zhang Zhongjing's intent was mutual clarification, with no fundamental difference, teaching that while signs vary, the principle is consistent. Yangming signs with hypochondriac hardness indicate combined Shaoyang. Shaoyang meridians run along the side and hypochondrium; pathogen entering the channel causes hardness. Constipation indicates Yangming interior heat, but vomiting is a Shaoyang sign. Shaoyang branch meridians converge at Quepen and descend into the chest; pathogen in the chest causes vomiting. Tongue coating varies, revealing cold-heat, deficiency-excess, pathogen depth, and exterior-interior status. A wise observer sees clearly. If heat is solid in the stomach, the coating is yellow or black, dry/hard, or prickly. A white coating is an initial manifestation. If pathogen is initially in the exterior, there is no coating; presence of white coating means pathogen is not entirely in the exterior nor fully in the interior, remaining half-exterior, half-interior. Pathogen in half-interior prohibits sweating; pathogen in half-exterior prohibits purging. Thus, Xiao Chai Hu Tang is used to harmonize. Resolution of Shaoyang channel pathogens removes chest pathogens (stopping vomiting) and calms hypochondriac pathogens (resolving hardness). With no pathogen obstructing the middle, Upper Jiao Qi flows freely, allowing stomach fluids to descend and bowels to open naturally. Stomach Qi harmonizes, interior-exterior flow is smooth, slight sweating occurs, and the disease resolves.
Regarding the phrases "Upper Jiao becomes free, body fluids descend, Stomach Qi harmonizes," Cheng Wuji failed to grasp the meaning and could not explain. Fang Youzhi understood "body fluids descend" implies bowel movement, and Yu Jiayan followed him, stating that if fluids descend, bowel movement follows. However, they missed the meaning of "Upper Jiao becomes free, Stomach Qi harmonizes," proposing instead that wind-cold pathogens combine with fluids gathering in the Diaphragm, adding unnecessary generalizations. Xiao Chai Hu Tang is not specifically an Upper Jiao drug; rather, Shaoyang meridians traverse the chest and hypochondrium. Pathogen entering the channel causes hypochondriac hardness and vomiting. Obstruction in chest-hypochondrium blocks upper-lower communication. Upon harmonization, Shaoyang meridians flow freely, hardness resolves, and obstacles clear. Thus, Upper Jiao Qi flows, and stomach fluids follow the Qi downward. Dryness clears, bowels open. "Stomach Qi harmonizes" means Stomach Qi harmonizes due to opened bowels. This aligns with the harmonizing stomach meaning of Xiao Cheng Qi Tang in earlier Taiyang-Yangming cases. Previously, after sweating, emesis, purging, and diuresis, despite lack of major heat, stomach fluids were depleted, forming Pi Yue. With no fluids to circulate, Xiao Cheng Qi Tang and Ma Ren Wan (Hemp Seed Pill) were used to moisten dryness and harmonize the stomach. Here, without prior sweating/purging, fluids are intact, so Xiao Cheng Qi Tang is unnecessary. Harmonization allows Qi flow and fluid descent, naturally opening bowels and harmonizing Stomach Qi. Although Zhang Zhongjing did not explicitly state this, analyzing his wording reveals complete meaning. Listing only what is known while omitting the unknown fails to capture the full intent, ultimately offering little benefit to future students.