然者。阴不得有汗今头汗出。故知非少阴也。可与小柴胡汤。设不了了者。得屎而解。（此条系太阳病传入少阳之证。但
其脉似少阴。医人所当审也。伤寒五六日。成注云。邪当传里之时。头汗出。微恶寒。手足冷者。此在表之邪未解也。
心下满。口不能食。此在里之邪方结也。大便硬者。此本阳明府证。只因脉细。有似乎阴邪入结于里。故云大便硬而脉
细者。此为阳邪微结。成注云。大便硬为阳结。此邪热虽传于里。然以外带表邪。则热结犹浅。故曰阳微结必有表。指
头汗出云云言。复有里。指心下满云云言。故言有表复有里也。又脉不细而沉者。亦为阳邪微结于里。何也。以头汗出。
故云阳微结。盖诸阳之经。皆上于头也。假令纯阴结。纯者。真也。诸阴之经皆至颈胸中而还。不得复有头汗出之外证。
其真阴之邪。悉当入于里矣。此为阳微结。邪当在半表半里。间也。又脉虽沉而且紧者。终不得为少阴寒证。所以然者。
云云。是重言以申明。头汗出为阳微之义。可与小柴胡汤者。乃和解半表半里之邪也。设不了了者。言服汤后而病。犹
未愈也。得屎而解者。言少阳之表邪既除。大便仍硬。须用药以微利之。则愈按此条论。仲景于小柴胡汤之外。别无利
大便之药。补亡论郭白云云。实者大柴胡虚者蜜煎导之。其说甚是。上三条证俱自太阳下编移附于此）
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。（此条系阳明病传入少阳之证。阳明病发潮热。
若似乎胃家实矣。但胃实者。大便必硬。小便赤涩。今则大便溏。小便自可。是热虽潮。邪犹在经。非入府之证也。更
加胸胁满不去者。已传入少阳也。故与小柴胡汤。以和解半表半里之邪。）
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。
（此条阳明病实少阳之证居多。故从少阳例治。胁下硬满而呕者。此皆少阳证也。惟不大便。为阳明病。兼之舌上白苔。
成注云。为邪未入府。在表里之间。故与小柴胡汤以和解之。上焦得通者。硬满去而呕止也。津液得下者。大便自行也。
胃气和。则阴阳升降而里邪平。身汗出。则内外通达而表邪散。故云。解也。）
阳明中风。脉弦浮大而短气。腹部满胁下及心痛。久按之。气不通。鼻干不得汗嗜卧。一身及面目悉黄。小便难。
有潮热时时哕。耳前后肿。刺之小瘥。外不解。病过十日。脉续浮者。与小柴胡汤。脉但浮。无余证者。与麻黄汤。若
不尿。腹满加哕者。不治。（此条病。虽云阳明中风。观其脉弦。胁下痛。时时哕。耳前后肿。少阳之证偏重。故从柴胡
例治。其用麻黄汤者。虽除太阳之邪而非专证也。少阳脉弦。太阳脉浮。阳明脉大。三阳之脉齐见。而先曰弦者。少阳
之邪居多也。短气者风热甚而气壅逆也。气逆壅甚。故虽以手按抑之。而气愈不能通也。腹满鼻干嗜卧。一身及面目悉
黄潮热者。阳明风热甚也。惟小便难为太阳府证。胁下及心痛者。以本胁痛。而连及于心胸之分。此为少阳经主病。兼
之时时哕者。哕即气逆而呕。呕亦少阳之兼证。耳前后肿者。少阳之脉上耳后。其支者。从耳后。人耳中。出走耳前。
当其既肿之时。愚以纵有阳明风热。已传入少阳之经矣。条辩注耳前后肿。为三阳见证。殊不知太阳当脑后肿。阳明当
面肿。此耳前后肿。当是少阳经证无疑。刺之小瘥者。谓以针刺其肿处。而肿少愈也。外不解者。谓短气胁痛等证未除
也。邪传少阳。浮脉当去。今者病过十日而脉续浮。脉续浮者。谓弦脉本在而仍得浮脉也。脉虽续浮。以过十日。则邪
不在表。当从少阳例治。故与小柴胡汤。以和解表里之邪。若脉但浮无余证者。谓脉不弦而但浮。且无短气胁痛等证。
此邪气欲出而还于表也。故与麻黄汤以汗之。否则少阳证不可汗。岂有更用麻黄汤之理。若不尿云云。是承上短气胁痛
等证而言。不尿则比之小便难更甚。腹满加哕。则比之腹部满时时哕。亦更甚矣。真气已衰。邪气又盛。谓非不治之证
而何。或云。不尿者。宜五苓散。腹满者。宜大柴胡汤。独不思经云。病深者其声哕。虽治之复何益哉。上三条证俱自
阳明篇移附于此）
呕而发热者。小柴胡汤主之。（成注引经云。呕而发热者。柴胡证具愚以其呕。必兼口苦也。此条病自厥阴篇移附于
此）（见后例）若已吐下。发汗温针。谵语。柴胡汤证罢。此为坏病。知犯何逆。以法治之。（少阳病有三禁。医若不知
而妄行吐。下发汗更加温针。损耗津液胃中干燥。以故谵语成注云。此木邪干胃也。最前条云。若柴胡证不罢者。复与
柴胡汤。今柴胡证罢。此为坏病。正文与注见后第十二卷救逆法中）
三阳合病脉浮大。上关上。但欲眠睡。目合则汗（此条虽系合病。实则少阳之邪居多。故从少阳篇例。成注云。关
脉以候少阳之气。太阳之脉浮。阳明之脉大。脉浮大上关上。则知太阳阳明之邪。将并归于少阳经矣。经热。则胆亦热。
故多眠睡。目合则汗者月合目。则欲寐。寐属阴。寐则卫气行于里。邪在半表半里。故目暂合。而汗即出也。按此条论。
仲景无治法。补亡论常器之云。可柴胡桂枝汤。庞安时云。脉不言弦者。隐于浮大也。）
伤寒六七日。无大热。其人躁烦者。此为阳去入阴故也。（此条病。乃少阳之邪欲传入阴经也。伤寒六七日。为邪退
正复之时。其人身无热而安静者。此为欲愈也。今者。身无大热。是热未尽退也。反加躁。扰烦乱。以邪去阳经而入于
阴。故躁烦也。成注云。表为阳。里为阴。少阳之邪。居半表半里之间。邪去少阳。则入三阴经矣。医者可不于六七日
之间。而预为调治。以截其入阴之路乎。）
伤寒三日。三阳为尽。三阴当受邪。其人反能食而不呕。此为三阴不受邪也。（此承上条之病而言。乃少阳之邪自解。
不传入于阴经也。伤寒三日者。即素问相传日数。上条言六七日。此止言三日可见日数不可拘也。邪在少阳。原呕而不
能食。今反能食而不呕。可征里气之和。而少阳之邪自解也。既里和而少阳邪解。则其不传三阴。断断可必。故云。三
阴不受邪也。此条注本。武陵陈亮斯语）
伤寒三日。少阳脉小者。欲已也。（此条以脉辩少阳病。欲已之法也。少阳伤寒。以脉弦大为病进。今者。脉不弦而
且小。乃邪气已退。正气将复也。故云其病欲已。已。止也。）
少阳病欲解时。从寅至辰上。（注已见前第三卷太阳病欲解注中。）
（附例）太阳病。过经十余日。反二三下之后。四五日柴胡证仍在者。先与小柴胡汤。呕不止。心下急郁郁微烦者。
为未解也。与大柴胡汤下之。则愈。（此条系太阳病。传入少阳。复入于胃之证。太阳病过经十余日。知其时已传入少阳
矣。故以二三下之为反也。下之而四五日后。更无他变。前此之柴胡证仍在者。其时纵有可下之证。须先与小柴胡汤。
以和解半表半里之邪。如和解之。而呕止者。表里气和。为已解也。若呕不止。兼之心下急。郁郁微烦。心下者。正当
胃府之中。急则满闷已极。郁烦为热结于里。此为未解也。后与大柴胡汤。以下其里热。则愈。上条证并下汤自太阳中
篇移附于此）
然而，阴证通常不应有汗，现在患者只有头部出汗，因此知道这不是少阴病。可以给予小柴胡汤治疗。如果服药后病情仍然不舒畅，通过排便即可痊愈。（这一条论述的是太阳病传入少阳的证候。虽然其脉象类似少阴，但医生应当仔细审察。伤寒五六日时，成无己注解说：这是邪气应当传里的时期。头部出汗、轻微恶寒、手脚发冷，说明在表的邪气尚未解除；心下胀满、口不能进食，说明在里的邪气正在结聚；大便干硬，这本来是阳明腑实证，只因为脉象细，看起来像阴邪入里结聚，所以说大便硬而脉细，这是阳邪微结。成无己注解说：大便硬属于阳结。虽然邪热已传入里，但因为兼带有表邪，所以热结尚浅。因此说“阳微结必有表”，指的是头部出汗等情况；“复有里”，指的是心下胀满等情况。所以说既有表证又有里证。另外，脉象如果不细而是沉的，也是阳邪微结于里。为什么呢？因为头部出汗，所以说是阳微结。因为所有阳经都上行至头部。假如是纯阴结，所谓“纯”就是真。所有阴经都到达颈胸部就返回了，不可能再有头部出汗的外在表现。真正的阴邪，全都应当入里了。这是阳微结，邪气应当在半表半里之间。另外，脉象虽然沉而且紧，终究不能诊断为少阴寒证。之所以这样，是因为反复强调以申明头部出汗是阳微结的意义。可以给予小柴胡汤，是为了和解半表半里的邪气。如果说服药后病情仍不舒畅，意思是服药后病仍未愈。通过排便而解，意思是少阳的表邪既然已经去除，大便仍然干硬，需要用药物轻微通利，病就好了。按此条论述，张仲景在小柴胡汤之外，没有其他的通便药。《补亡论》中郭白云说：实证用大柴胡汤，虚证用蜜煎导法，这种说法非常正确。以上三条证候都是从太阳篇移编附于此处的。）
阳明病出现定时发热（潮热），大便稀溏，小便正常，胸胁部胀满持续不缓解的，以小柴胡汤为主治方剂。（这一条论述的是阳明病传入少阳的证候。阳明病出现潮热，似乎像是胃家实（胃肠燥实）了。但是胃家实证，大便必定干硬，小便赤涩。现在是大便稀溏，小便正常，这说明虽然发热如潮，但邪气仍在经络，不是入腑的证候。再加上胸胁部胀满持续不缓解，说明已经传入少阳。因此给予小柴胡汤，以和解半表半里的邪气。）
阳明病出现胁下硬满，不大便且呕吐，舌上有白苔的，可以给予小柴胡汤。上焦得到通畅，津液得以下行，胃气因而调和，身体自然出汗而病解。（这一条阳明病的证候中，属于少阳证的居多，所以按照少阳的法则治疗。胁下硬满且呕吐，这些都是少阳证。只有不大便，才是阳明病。兼有舌上白苔，成无己注解说：这是因为邪气未入腑，处于表里之间，所以给予小柴胡汤以和解之。上焦得通，是指硬满消除且呕吐停止；津液得下，是指大便自行排出；胃气和，则阴阳升降而里邪平息；身体出汗，则内外通达而表邪消散。所以说病解了。）
阳明中风，脉象弦、浮、大且短气，腹部胀满，胁下及心前区疼痛，长时间按压，气机不通畅，鼻干不得汗出，嗜睡，全身及面目都发黄，小便困难，有潮热，不时呃逆，耳前后肿胀，针刺后稍有好转，但表证未解，病程超过十天，脉象依然浮的，给予小柴胡汤。脉象仅浮，没有其他证候的，给予麻黄汤。如果出现不排尿，腹部胀满加重并伴有呃逆的，属于不治之症。（这一条病证，虽然称为阳明中风，但看其脉弦、胁下痛、时时呃逆、耳前后肿，少阳的证候偏重，所以从柴胡例治疗。使用麻黄汤的情况，虽然是去除太阳的邪气，但不是专证。少阳脉弦，太阳脉浮，阳明脉大。三阳脉象同时出现，先说弦脉，是因为少阳的邪气居多。短气，是因为风热严重导致气机壅逆。气逆壅滞严重，所以即使用手按压抑制，气更加不能通畅。腹部胀满、鼻干、嗜睡、全身及面目悉黄、潮热，是阳明风热严重。只有小便困难属于太阳腑证。胁下及心前区疼痛，是因为原本胁痛，牵连到心胸部位，这是少阳经的主病。兼有时时呃逆，呃逆即气逆而呕，呕吐也是少阳的兼证。耳前后肿胀，是因为少阳经脉上行至耳后，其支脉从耳后进入耳中，走出耳前。当它肿胀的时候，我认为即使有阳明风热，也已经传入少阳经了。《条辩注》认为耳前后肿是三阳见证，殊不知太阳病应当在脑后肿，阳明病应当面部肿，这里耳前后肿，应当是少阳经证无疑。针刺后稍有好转，是说用针刺其肿胀处，肿胀稍微减轻。外不解，是说短气、胁痛等证候未除。邪气传入少阳，浮脉应当消失。现在病程超过十天而脉象依然浮，脉续浮，是说弦脉本来存在而又见到浮脉。脉象虽然依然浮，但因为过了十天，邪气不在表，应当从少阳例治疗，所以给予小柴胡汤，以和解表里之邪。如果脉象仅浮而没有其他证候，是说脉不弦而仅浮，且没有短气、胁痛等证候，这是邪气欲出而还于表。所以给予麻黄汤以发汗。否则少阳证不可发汗，难道还有再用麻黄汤的道理吗？如果不排尿等情况，是承接上面的短气、胁痛等证候而言。不排尿比小便困难更严重。腹部胀满加上呃逆，比腹部胀满、时时呃逆也更严重了。真气已经衰弱，邪气又盛，如果不是不治之症又是什么呢？有人说，不排尿的，宜用五苓散；腹部胀满的，宜用大柴胡汤。只是没考虑到经文说：病深者其声哕（呃逆）。即使治疗又有什么益处呢？以上三条证候都是从阳明篇移附于此处的。）
呕吐且发热的，以小柴胡汤为主治方剂。（成无己引用经文说：呕吐且发热，是柴胡证具备。我认为呕吐必然兼有口苦。这一条病证是从厥阴篇移附于此处的。）（见后例）如果已经经过吐法、下法、发汗、温针治疗，出现谵语，柴胡汤证已罢，这称为坏病。要知道犯了什么逆治错误，根据具体情况依法治疗。（少阳病有三禁，医生如果不知道而妄行吐、下、发汗，再加上温针，损耗津液，导致胃中干燥，因此形成谵语。成无己注解说：这是木邪干犯胃也。最前面的条文说：如果柴胡证不罢，再给予柴胡汤。现在柴胡证已罢，这称为坏病。正文与注释见后第十二卷救逆法中。）
三阳合病，脉象浮大，关脉部位明显，只想睡觉，闭上眼睛就出汗（这一条虽然是合病，但实际上少阳的邪气居多，所以从少阳篇的法则处理。成无己注解说：关脉用来候察少阳之气。太阳脉浮，阳明脉大。脉浮大且见于关脉，就知道太阳、阳明的邪气，将要并归于少阳经了。经热，则胆也热，所以多眠睡。目合则汗，是指闭上眼睛就想睡觉，睡眠属阴，睡着时卫气行于体内，邪气在半表半里，所以眼睛暂时闭合，汗就出来了。按此条论述，张仲景没有给出治法。《补亡论》中常器之说：可用柴胡桂枝汤。庞安时说：脉象不说弦，是因为隐伏在浮大中。）
伤寒六七日，身上没有大热，其人躁扰烦乱的，这是阳气退去、邪气入阴的缘故。（这一条病证，是少阳的邪气欲传入阴经。伤寒六七日，是邪气衰退、正气恢复的时候。如果病人身上无热而安静，这是想要痊愈的表现。现在是身上没有大热，说明热势未尽退。反而加上躁扰烦乱，是因为邪气离开阳经而进入阴经，所以躁烦。成无己注解说：表为阳，里为阴。少阳的邪气，居于半表半里之间。邪气离开少阳，就会进入三阴经。医生可不可以在六七日之间，预先调治，以截断邪气入阴的路径呢？）
伤寒三日，三阳经的病邪已尽，三阴经应当受邪。如果病人反而能吃饭且不呕吐，这是三阴经不受邪的表现。（这一条是承接上一条的病证而言，是少阳的邪气自行解除，不传入阴经。伤寒三日，即《素问》中相传的天数。上一条说六七日，这里只说三日，可见天数不可拘泥。邪气在少阳，原应呕吐而不能进食。现在反而能进食且不呕吐，可以验证里气调和，而少阳的邪气自行解除。既然里气调和且少阳邪气解除，那么它不传入三阴，是完全可以肯定的。所以说三阴不受邪。这一条的注释来源于武陵陈亮斯的话。）
伤寒三日，少阳脉象小的，是病将要痊愈的表现。（这一条是通过脉象辨别少阳病欲愈的方法。少阳伤寒，以脉弦大为病进。现在脉不弦而且小，是邪气已退，正气将复。所以说病欲已。“已”，就是停止的意思。）
少阳病欲解的时间，从寅时到辰时。（注释已见前第三卷太阳病欲解注中。）
（附例）太阳病，病程超过十余日，反而被误用了二三次攻下法。四五日后，柴胡证仍在的，先给予小柴胡汤。如果呕吐不止，心下急迫，心中郁郁微烦的，说明病未解。给予大柴胡汤攻下，病就好了。（这一条是太阳病传入少阳，又入于胃的证候。太阳病病程超过十余日，知道此时已传入少阳了。所以说误用二三次攻下法是反治。攻下后四五日，如果没有其他变化，之前的柴胡证仍在，此时即使有可下的证候，也必须先给予小柴胡汤，以和解半表半里的邪气。如果和解之后，呕吐停止，说明表里气机调和，病已解。如果呕吐不止，兼有心下急迫，心中郁郁微烦。心下，正当胃腑之中。急迫则是满闷已极。郁烦则是热结于里。这属于病未解。后来给予大柴胡汤，以攻下里热，病就好了。以上证候及方剂都是从太阳篇移附于此处的。）
However, Yin syndromes typically do not present with sweating. The fact that the patient has sweat only on the head indicates that this is not a Shaoyin syndrome. Xiaochaihu Tang (Minor Bupleurum Decoction) may be administered. If the patient remains uncomfortable after taking the medicine, relief will occur upon defecation. (This clause discusses a syndrome where Taiyang disease transmits to Shaoyang. Although the pulse resembles that of Shaoyin, physicians must examine it carefully. During the fifth or sixth day of Cold Damage, Cheng Wuji's commentary states: This is the time when pathogenic factors should transmit inward. Head sweating, slight aversion to cold, and cold hands and feet indicate that exterior pathogenic factors have not yet been resolved; fullness in the epigastrium and inability to eat indicate that interior pathogenic factors are beginning to knot; hard stool suggests originally a Yangming Fu-organ syndrome. However, because the pulse is fine, it appears as if Yin pathogenic factors have entered and knotted inward. Thus, hard stool with a fine pulse indicates slight knotting of Yang pathogenic factors. Cheng Wuji comments: Hard stool belongs to Yang knotting. Although heat pathogenic factors have transmitted inward, because they are accompanied by exterior pathogenic factors, the heat knotting is still shallow. Therefore, "Yang slight knotting must have an exterior" refers to symptoms such as head sweating; "and also an interior" refers to symptoms such as epigastric fullness. Hence, it is said that there is both an exterior and an interior. Furthermore, if the pulse is not fine but deep, it is also slight knotting of Yang pathogenic factors in the interior. Why? Because of head sweating, it is called Yang slight knotting. All Yang meridians ascend to the head. If it were pure Yin knotting, meaning true Yin knotting, all Yin meridians reach the neck and chest and return, so there would be no external sign of head sweating. True Yin pathogenic factors would all enter the interior. This is Yang slight knotting, where pathogenic factors reside between the exterior and interior. Additionally, even if the pulse is deep and tight, it ultimately cannot be diagnosed as a Shaoyin cold syndrome. The reason for this repeated emphasis is to clarify that head sweating signifies Yang slight knotting. Administering Xiaochaihu Tang aims to harmonize pathogenic factors between the exterior and interior. "If the patient remains uncomfortable" means the illness persists after taking the decoction. "Relief upon defecation" means that once the exterior pathogenic factors of Shaoyang are removed, if the stool remains hard, mild purgation using medication will bring recovery. According to this discussion, Zhang Zhongjing provides no other bowel-relieving formulas besides Xiaochaihu Tang. Guo Baiyun in the *Supplement to Lost Classics* states: For excess conditions, use Daxiehu Tang (Major Bupleurum Decoction); for deficiency conditions, use honey suppositories. This view is very correct. The above three clauses regarding these syndromes were transferred from the Taiyang chapter and attached here.)
In Yangming disease, tidal fever occurs, the stool is loose, urination is normal, and chest and hypochondriac fullness persist without relief. Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment. (This clause discusses a syndrome where Yangming disease transmits to Shaoyang. Tidal fever in Yangming disease seems to suggest Stomach Excess (Gastrointestinal Dryness and Excess). However, in Stomach Excess, the stool must be hard and urination red and scanty. Here, the stool is loose and urination is normal, indicating that although the fever is tidal, the pathogen remains in the meridians, not having entered the Fu organs. With the addition of persistent chest and hypochondriac fullness, it has transmitted to Shaoyang. Therefore, Xiao Chaihu Tang is given to harmonize pathogenic factors between the exterior and interior.)
In Yangming disease, hardness and fullness below the ribs, constipation, vomiting, and a white coating on the tongue indicate that Xiaochaihu Tang (Minor Bupleurum Decoction) may be administered. Once the Upper Jiao (Upper Burner) is unblocked, body fluids descend, the Stomach Qi harmonizes, and the body naturally sweats, leading to resolution. (Most cases in this Yangming clause belong to Shaoyang syndromes, so they are treated according to Shaoyang principles. Hardness/fullness below the ribs and vomiting are Shaoyang symptoms. Constipation alone characterizes Yangming disease. Combined with a white tongue coating, Cheng Wuji comments: This indicates the pathogen has not entered the Fu organs but resides between the exterior and interior, hence Xiaochaihu Tang is used to harmonize. "Upper Jiao unblocked" means the hardness/fullness resolves and vomiting stops. "Body fluids descend" means stool passes spontaneously. When Stomach Qi harmonizes, Yin and Yang rise and fall, calming interior pathogens. Sweating allows internal and external communication, dispersing exterior pathogens. Thus, it is said to resolve.)
Yangming Wind Strike presents with a string-taut, floating, and large pulse, shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of Qi flow even with prolonged pressing, dry nose with inability to sweat, lethargy, generalized jaundice affecting the whole body and face, difficult urination, tidal fever, occasional hiccups, and swelling around the ears and temples. Acupuncture provides slight relief, but the exterior syndrome remains unresolved. If the disease lasts more than ten days and the pulse continues to float, administer Xiaochaihu Tang (Minor Bupleurum Decoction). If the pulse is merely floating without other symptoms, administer Mahuang Tang (Ephedra Decoction). If the patient cannot urinate, abdominal fullness increases, and hiccups worsen, it is an untreatable condition. (Although termed Yangming Wind Strike, the string-taut pulse, hypochondriac pain, frequent hiccups, and ear/temporal swelling indicate a predominance of Shaoyang symptoms, so it is treated following the Chaihu protocol. The use of Mahuang Tang addresses Taiyang pathogens but is not the specific indication. Shaoyang pulse is string-taut, Taiyang is floating, Yangming is large. When all three Yang pulses appear, the string-taut pulse is mentioned first because Shaoyang pathogens predominate. Shortness of breath results from severe wind-heat causing Qi stagnation and rebellion. Severe Qi rebellion makes pressing ineffective. Abdominal fullness, dry nose, lethargy, jaundice, and tidal fever indicate severe Yangming wind-heat. Difficult urination relates to the Taiyang Fu organ. Hypochondriac and heart pain stem from hypochondriac pain radiating to the chest, a principal Shaoyang meridian disease. Hiccups represent Qi rebellion and vomiting, also a Shaoyang accompanying symptom. Swelling around the ears and temples corresponds to the Shaoyang meridian pathway. Even if Yangming wind-heat exists, it has transmitted to the Shaoyang meridian. While *Tiaobian Zhu* considers ear swelling a Three Yang sign, Taiyang swelling occurs at the back of the head, Yangming at the face; thus, ear swelling is undoubtedly a Shaoyang meridian sign. "Slight relief after acupuncture" means swelling subsides slightly via needling. "Exterior unresolved" means shortness of breath and hypochondriac pain persist. Pathogens transmitting to Shaoyang should eliminate the floating pulse. If the pulse remains floating after ten days, it means the string-taut pulse persists alongside a floating pulse. Despite the floating pulse, after ten days, the pathogen is no longer in the exterior, so it is treated as Shaoyang with Xiaochaihu Tang to harmonize interior and exterior. If the pulse is merely floating without other symptoms, it means the pulse is not string-taut but only floating, lacking shortness of breath or pain, indicating pathogens returning to the exterior. Thus, Mahuang Tang is used to induce sweating. Otherwise, Shaoyang syndromes contraindicate sweating, making Mahuang Tang inappropriate. "Cannot urinate" etc., follows the previous discussion of shortness of breath and pain. Inability to urinate is worse than difficulty; increased abdominal fullness and hiccups are worse than before. With depleted healthy Qi and flourishing pathogenic factors, it is indeed untreatable. Some suggest Wuling San (Five-Ling Powder) for inability to urinate and Daxiehu Tang for abdominal fullness, ignoring the classic saying: "Deep disease manifests as hiccups." Treatment would be futile. The above three clauses were transferred from the Yangming chapter and attached here.)
Vomiting accompanied by fever is primarily treated with Xiaochaihu Tang (Minor Bupleurum Decoction). (Cheng Wuji cites the classics: Vomiting and fever indicate the presence of Chaihu symptoms. I believe vomiting must be accompanied by a bitter taste in the mouth. This clause was transferred from the Jueyin chapter and attached here.) (See subsequent examples.) If emesis, purgation, sweating, or warm needle therapy have already been applied, resulting in delirious speech, and the Chaihu syndrome has ceased, this is termed a Ruined Disease (Bad Condition). One must determine what error was committed and treat accordingly based on the new presentation. (Shaoyang disease has three prohibitions. If physicians ignorantly apply emesis, purgation, sweating, or warm needles, they deplete body fluids, causing dryness in the Stomach and leading to delirium. Cheng Wuji comments: This is Wood pathogen invading the Stomach. The earlier clause states: If Chaihu symptoms persist, repeat Xiaochaihu Tang. Now that Chaihu symptoms have ceased, it is a Ruined Disease. See Volume 12, Rescue Methods section for text and notes.)
Three Yang Combined Disease presents with a floating and large pulse, prominent at the Guan position, somnolence, and sweating upon closing the eyes. (Although this is a combined disease, Shaoyang pathogens predominate, so it follows Shaoyang protocols. Cheng Wuji comments: The Guan pulse monitors Shaoyang Qi. Taiyang pulse is floating, Yangming is large. A floating and large pulse at the Guan position indicates Taiyang and Yangming pathogens converging on the Shaoyang meridian. Meridian heat causes Gallbladder heat, leading to excessive sleep. Closing eyes induces sleep, which belongs to Yin. During sleep, Wei Qi moves inward. With pathogens between exterior and interior, brief eye closure triggers sweating. Zhang Zhongjing provides no treatment method for this clause. Chang Qizhi in *Supplement to Lost Classics* suggests Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction). Pang Anshi notes: The pulse does not mention string-taut because it is hidden within the floating and large qualities.)
After six or seven days of Cold Damage, with no significant fever, restlessness and irritability indicate that Yang Qi has retreated and pathogens have entered Yin. (This condition involves Shaoyang pathogens intending to transmit to Yin meridians. Days six or seven mark the time for pathogen decline and healthy Qi recovery. Absence of fever and calmness indicate impending recovery. Lack of significant fever means heat has not fully subsided. Restlessness and irritability arise because pathogens leave Yang meridians and enter Yin. Cheng Wuji comments: Exterior is Yang, Interior is Yin. Shaoyang pathogens reside between exterior and interior. Leaving Shaoyang leads to the Three Yin meridians. Should physicians not intervene during these six to seven days to block transmission to Yin?)
After three days of Cold Damage, the Three Yang meridians' pathogens are exhausted, and the Three Yin meridians should receive pathogens. If the patient can eat and does not vomit, it indicates the Three Yin meridians are not receiving pathogens. (This follows the previous clause, indicating Shaoyang pathogens resolving spontaneously without transmitting to Yin. "Three days" refers to the transmission days in *Suwen*. The previous clause mentions six to seven days, this one three, showing days are not rigid. Shaoyang pathogens typically cause vomiting and anorexia. Ability to eat without vomiting verifies harmonized Interior Qi and spontaneous resolution of Shaoyang pathogens. With Interior harmony and Shaoyang resolution, transmission to Three Yin is impossible. Hence, "Three Yin does not receive pathogens." This note is attributed to Chen Liangsi of Wuling.)
After three days of Cold Damage, if the Shaoyang pulse is small, the disease is about to resolve. (This clause uses pulse diagnosis to identify Shaoyang recovery. In Shaoyang Cold Damage, a string-taut and large pulse indicates disease progression. A non-string-taut, small pulse indicates pathogen retreat and healthy Qi recovery, signaling imminent resolution. "Resolve" means stop.)
The optimal time for Shaoyang disease to resolve is from Yin hour to Chen hour. (Note previously seen in Volume 3, Taiyang Disease Resolution Note.)
(Attached Example) Taiyang disease lasting over ten days, mistakenly subjected to two or three purgations. Five or four days later, if Chaihu symptoms persist, first administer Xiaochaihu Tang (Minor Bupleurum Decoction). If vomiting persists, epigastric urgency, and depression with slight irritability occur, the disease is unresolved. Administer Daxiehu Tang (Major Bupleurum Decoction) to purge, and the patient will recover. (This clause describes Taiyang disease transmitting to Shaoyang and then to the Stomach. Over ten days implies transmission to Shaoyang, making purgation incorrect. After purgation, if five days pass without change and Chaihu symptoms persist, even if purgation indications exist, Xiaochaihu Tang must be used first to harmonize exterior-interior. If vomiting stops after harmonization, exterior-interior Qi is balanced, and the disease resolves. Persistent vomiting with epigastric urgency and depression/irritability indicates unresolved heat knotting in the interior (epigastrium is the Stomach location; urgency implies extreme fullness; depression/irritability implies heat knotting). Subsequently, Daxiehu Tang is used to purge interior heat, leading to recovery. These syndromes and formulas were transferred from the Taiyang chapter and attached here.)