汗多则热愈，汗少则便难，乃脉法后段，推原所以当下之故，谓服药得汗，腠理既开，两三日内，仍觉 微
汗，则邪服而热除，不传里矣。若汗才得而腠理随闭，则热邪不服而传里，热既传里，津液必耗而便难，故宜
攻下，以存津液。观下文复云脉迟尚未可攻，又戒其勿误攻，以重伤津液也。要知此三语总顶属府者，不令
溲数，而为阳明病下注脚耳。（喻嘉言）
伤寒，阳脉涩，阴脉弦，法当腹中急痛，先用小建中汤；不瘥者，小柴胡汤主之。
或问∶腹痛，前以小建中温之，后以小柴胡凉之，仲景岂姑试之乎？曰∶非也。不瘥者，但未愈，非更
甚也。先以建中解肌而发表，止痛在芍药；继以柴胡补中而达邪，止痛在人参。按柴胡
汤加减法，腹中痛者，去黄芩加芍药，其功倍于建中，岂有温凉之异乎？阳脉仍涩，故用人参以助桂枝；阴
脉仍弦，故用柴胡以助芍药。若一服瘥，又何必更用人参之温补、柴胡之升降乎？仲景有一证用两方者，如用
麻黄汗解，半日复烦，用桂枝更汗同法。然皆设法御病，非必然也。先麻黄，继桂枝，是从外之内法；先建中，
继柴胡，是从内之外法。（柯韵伯）
血弱气尽，腠理开，邪气因入，与正气相搏，结于胁下。正邪分争，往来寒热，休作有时，默默不欲饮食，
脏腑相连，其痛必下，邪高痛下，故使呕也，小柴胡汤主之。
问∶血弱气尽一节，有脏腑相连，其痛必下，邪高痛下，故使呕也。高指表耶？下指胁耶？答∶高不
指表，下不指胁。要知此乃为妇人经水适来适断之词，经水适断之后，岂非血弱气尽乎？因少阳热邪尽入血室，
逼其经血妄行，致成此证。盖少阳胆藏于厥阴肝叶之内，脏腑相连，与太阳、阳明两阳各为一区，不与少
阴、太阴相连者迥殊。所以太阳、阳明之腑邪，不能袭入于脏，而少阳之腑邪与脏相连，漫无界限，其热邪之
在胁者，迫血妄行，必痛连腹中，见经血虽止，而腹痛犹不止耳。高指胁也，下指腹也。邪在两胁，已搏饮上
逆；痛在腹中，又浊气上干。所以其证呕逆特甚，但不可因其痛在腹中，遂指为厥阴见证，误用吴茱萸等汤治
呕，桂枝大黄等汤治痛，仍用小柴胡汤治其腑，不治其脏。此是吃紧叮咛，言外见脏腑，同治必领腑邪入脏矣。
仲景不能尽所欲言，但以小柴胡汤主之一语，砥柱狂澜也。（喻嘉言）
小柴胡汤方去滓复煎。
问∶小柴胡汤去滓复煎，必有其义。答∶用小柴胡汤必去滓复煎，此仲景法中之法，原有奥义。盖少阳
经用药，有汗、吐、下三禁，故但取小柴胡汤以和之。然一药之中，柴胡欲出表，黄芩欲入里，半夏欲驱痰，
纷纭而动，不和甚矣。故去滓复煎，使其药性合而为一，漫无异同，俾其不至偾事耳。又，和非和于表，
亦非和于里，乃和于中也。是必煎至最熟，令药气并停胃中，少顷随胃气以敷布表里，而表里之邪不觉潜消默
夺。所以方中既用人参、甘草，复加生姜、大枣，不厌其复，全藉胃中天真之气为斡旋，所谓大力者负之而走
耳。试即以仲景印仲景，三黄附子汤中，以其人阳邪入阴而热炽，非三黄不能除热；其人复真阳内微而阴盛，
非附子不能回阳。然必各煎后，乃得以各行其事，而复煎以共行其事之义，不亦彰彰乎？（喻嘉言）
三阳合病，脉浮大，上关上，但欲眠睡，目合则汗。
或谓∶此证属《少阳篇》中，亦可用小柴胡否？答曰∶可用。夫三阳合病，其邪发见于脉∶浮者太阳也，
大者阳明也，上关上者少阳也。但欲眠睡，目合则汗，此胆有热，脉证相符，故出于《少阳篇》中。盖浮脉
无证不可汗，大脉无证不可下，浮大之脉，具上关，知三阳合病，热在胆也。胆居半表半里，用小柴胡亦当。（张兼善）
少阴病，始得之，反发热，脉沉者，麻黄附子细辛汤主之。
或问∶论传经之邪，自三阳传至太阴，太阴则传少阴；此不言传经，而言始得之，何也？答曰∶传经者，
古人明理立法之意如此，安可执一而论哉！夫三阳伤寒，多自太阳入，次第而传至厥阴者，固有也。其三阴伤
寒，亦有自利不渴，始自太阴而入者。今少阴病始得之，反发热，正由自入，故云始得之。缘少阴无身热，今
身有热，故言反发热，以不当发热而热也。为初病邪浅，故与麻黄附子细辛汤以发散之。按∶六经中，但少阴
证难辨，此条要看一反字，是以阴证虽云不用麻黄，今既始得之，反发热，脉沉，所以用麻黄附子细辛汤温散
之耳。（张兼善）
少阴病，下利，脉微者，与白虎汤；利不止，厥逆无脉，干呕烦者，白通加猪胆汁汤主之。
或问∶白通汤及白通加猪胆汁汤，真武汤与通脉四逆汤，皆为少阴下利而设，除用姜、附相同，余药各
异，何也？答曰。病
殊则药异。少阴下利，寒气已甚，非姜、附不能治。此下利之理无殊，至兼证不一，则用药当各从其宜。如白
通汤用姜、附以散寒止利，则加葱白以通调阳气。若利而干呕烦者，寒气太甚，内为格拒，而姜、附非烦者之
所宜，必呕而不纳，故加人尿、猪胆汁咸苦性寒之物，并候温冷服之，自纳而不阻；至其病所，则冷体既消，
热性便发。又真武汤治少阴病，二三日不已，至四五日，腹满，小便不利，四肢沉重疼痛，自下利者，为有水
气。夫水气者，即寒湿也，肾主之。肾病不能制水，水饮停蓄为水气。《经》曰∶脾恶湿，甘先入脾；茯苓、
白术之甘，以益脾逐水。寒湿所胜，平以辛热；湿淫所胜，佐以酸辛；故用附子、芍药、生姜之酸辛，以温经
散湿。通脉四逆，治少阴下利清谷，里寒外热；手足厥逆，脉微欲绝者为里寒；身热恶寒，面色赤者，为外
热；此阴盛于内，格阳于外，而不相通，与通脉四逆汤，以散阴通阳。四证具云下利，而兼有或为之证不一，
是以用药大同而小异也。（张兼善）
少阴病，得之二三日，口燥咽干者，急下之，宜大承气汤。○少阴病，自利清水，色纯青，心下必痛，口干燥
者，急下之，宜大承气汤。○少阴病，六七日，腹胀不大便者，急下之，宜大承气汤。
问∶观急字似不宜缓，其证不过口干燥，而且病为少阴，少阴又不过二三日，非十余日之大满大实，有
此神见，而便用承气耶？答∶少阴病，得之二三日，即口燥咽干，其人肾水素竭可知。故宜急下以救肾水，少
缓须臾，瓮干杯罄，救无及矣。所以阳明有急下三法以救津液，少阴有急下三法以救肾水。皆动关性命，如救
头燃，何商量等待之有耶？此与大满大实之条，天渊悬绝，所当辨之于早矣。（喻嘉言）
或问∶承气汤，阳明当下之证宜用，今少阴病亦用之，何也？盖胃为水谷之海，主养四旁；四旁有病，皆
能传入。胃土燥则肾
水干，以二三日即口燥咽干，是热之深、传之速也，故急下以全肾水。夫土实则水清，故自利清水而口干燥，
此胃土燥热而然；下利色青。青，肝也，乃肝传肾，缘肾之经脉从肺出络心，注胸中，由是而心下痛，故急下
以去胃热，逐肾邪。其六七日腹胀不大便，以入腑之邪壅甚，胃土胜则肾水涸，故急下以逐胃热，滋肾水。盖
阳明与少阴皆有急下之条，证虽不同，其入腑之理则一也。（张兼善）
太阳病，欲解时，从巳至未上。○阳明病，欲解时，从申至戌上。○少阳病，欲解时，从寅至辰上。○太阴病，
欲解时，从亥至丑上。○少阴病，欲解时，从子至寅上。○厥阴病，欲解时，从丑至卯上。
问∶阳病从寅而解于戌，阴病从亥而解于寅，是阳得阳解、阴得阴解。而有曰阳病解于夜半，阴病解于
日中，何也？答∶阳得阳解、阴得阴解者，此从其经气之旺也。如少阳旺于寅卯辰，太阳旺于巳午未，阳明旺
于申酉戌，太阴旺于亥予丑，少阴旺于子丑寅，厥阴旺于丑寅卯是也。各经皆从其旺，少阴独从其生者，少阴
肾中内藏真阳，子时一阳生，葭管飞灰，早已春回 谷。丑时二阳，寅时三阳，阳进阴必退，阳长阴必消也。
且天一生水，子水生地，即是旺地，故少阴欲解独从之也。然三阳之解，从寅卯而始；三阴之解，从寅卯而终。
寅为生人之首，卯为天地之门户，亦阴阳如环之理也。但三阳之旺时九，各不相袭；三阴之旺时五，逐位相连。可
见阳行健，其道长，故不相及；阴行钝，其道促，故皆相蹑也。于此见仲景析义之精矣。至阳病解于夜半，
阴病解于日中者，《内经》之旨，取阳见阴、阴见阳，两相和协之义。先圣后圣，岂非一揆也哉！（喻嘉言）
汗出过多则热势更盛，汗出少则大便干结难下。这是脉法后段的论述，推究之所以应当使用攻下法的缘故。意思是服药后若能出汗，腠理（皮肤毛孔）既然已经开泄，两三日内仍感觉微微出汗，那么邪气已服从而热邪消除，病邪就不会传入里部了。如果汗刚出来而腠理随即闭合，那么热邪就不能被驱除反而传入里部，热邪既已传入里部，津液必然耗损而导致大便干结，所以适宜用攻下法，以保存津液。看下文又说“脉迟尚未可攻”，又是告诫不要误用攻下法，以免重伤津液。要知道这三句话总归是属于腑证的范畴，是为了防止小便频数，作为对阳明病应当攻下的注解。（喻嘉言）
伤寒病，阳脉涩滞，阴脉弦紧，按照医理应当出现腹中急痛的症状，先用小建中汤治疗；如果不痊愈的，用小柴胡汤主治。
有人问：腹痛，先前用小建中汤温补，后来用小柴胡汤清解，张仲景难道是随意试探吗？回答说：不是这样。“不愈”是指没有完全好，并不是病情加重了。先使用建中汤解除肌表之邪并发表，止痛主要靠芍药的作用；接着使用柴胡汤补益中气并透达邪气，止痛主要靠人参的作用。根据柴胡汤的加减法，腹中痛的，去掉黄芩加上芍药，其功效比建中汤加倍，哪里有温性和凉性的区别呢？阳脉仍然涩滞，所以用人参来辅助桂枝；阴脉仍然弦紧，所以用柴胡来辅助芍药。如果吃一剂药就好了，又何必再用人参的温补、柴胡的升降作用呢？张仲景有一证使用两方剂的例子，比如用麻黄汤发汗解表，半天后又出现烦躁，再用桂枝汤发汗，是同样的道理。然而这都是设法应对疾病，并非必然如此。先用麻黄，后用桂枝，是从外向内的治法；先使用建中，后使用柴胡，是从内向外的治法。（柯韵伯）
血气虚弱，正气耗尽，腠理开泄，邪气乘虚而入，与正气相搏结，郁结在胁下。正邪分争，出现寒热往来，发作有定时，神情沉默不想饮食。脏腑相连，疼痛必然向下延伸，邪气位置高而疼痛位置低，所以导致呕吐，用小柴胡汤主治。
问：关于“血弱气尽”这一节，提到“脏腑相连，其痛必下，邪高痛下，故使呕也”。这里的“高”是指表证吗？“下”是指胁下吗？回答：“高”不指表，“下”不指胁。要知道这是针对妇女月经适来或适断的情况而言的，月经刚断之后，难道不是血弱气尽吗？因为少阳的热邪全部进入血室，逼迫经血妄行，从而形成这种证候。大概少阳胆藏于厥阴肝叶之内，脏腑相连，与太阳、阳明这两阳各自为一区不同，不与少阴、太阴相连有着显著的区别。所以太阳、阳明的腑邪，不能侵袭入脏，而少阳的腑邪与脏相连，漫无界限，其中的热邪在胁部，逼迫血液妄行，必然疼痛牵连腹部，见到经血虽然停止，但腹痛仍然不止。这里的“高”指胁部，“下”指腹部。邪气在两胁，已经迫饮上逆；疼痛在腹部，又有浊气上干。所以这个证候呕吐逆气特别严重，只是不要因为疼痛在腹部，就把它当作厥阴见证，误用吴茱萸汤等治疗呕吐，用桂枝大黄汤等治疗疼痛，仍然应该用小柴胡汤治疗其腑证，而不治疗其脏证。这是关键的叮咛，言外之意是见脏腑同治，必定会导致腑邪入脏。张仲景不能完全表达他的意思，只用“小柴胡汤主之”一句话，起到力挽狂澜的作用。（喻嘉言）
小柴胡汤方：去渣后再煎煮。
问：小柴胡汤去渣后再煎煮，一定有其中的深意。回答：使用小柴胡汤必须去渣再煎，这是张仲景法度中的法度，原本就有奥妙的义理。大概少阳经用药，有汗、吐、下三禁，所以只取小柴胡汤来和解它。然而在一副药中，柴胡想要透达表邪，黄芩想要清解里热，半夏想要驱除痰饮，纷纭而动，不和的程度非常厉害。所以去渣再煎，使药性合而为一，弥漫无异，让它们不至于败坏事情。另外，和解不是和解于表，也不是和解于里，而是和解于中焦。这必须煎至最熟，让药气并停于胃中，片刻之后随着胃气敷布于表里，而表里的邪气不知不觉地潜消默夺。所以方中既然用了人参、甘草，又加上生姜、大枣，不厌其烦地重复煎煮，全赖胃中的天真之气为斡旋，所谓大力者背负着它行走一样。试着用张仲景印证张仲景，在三黄附子汤中，因为其人阳邪入阴而热势炽盛，非三黄不能除热；其人又真阳内微而阴寒盛，非附子不能回阳。然而必须各药分别煎煮后，才能各自发挥其作用，然后再合并煎煮以共同发挥作用，这个道理不是很明显吗？（喻嘉言）
三阳合病，脉象浮大，关部以上明显，只想睡觉闭目，眼睛一闭就出汗。
有人说：这个证候属于《少阳篇》中，也可以用小柴胡汤吗？回答说：可以用。三阳合病，其邪气发见于脉象：浮的是太阳病，大的是阳明病，关部以上明显的是少阳病。只想睡觉闭目，眼睛一闭就出汗，这是胆有热，脉证相符，所以出自《少阳篇》中。大概浮脉如果没有相应的症状不可发汗，大脉如果没有相应的症状不可攻下，浮大之脉，具备在关部以上，可知是三阳合病，热在胆腑。胆居半表半里，使用小柴胡汤也是恰当的。（张兼善）
少阴病，刚开始得病，反而发热，脉沉的，用麻黄附子细辛汤主治。
有人问：论及传经之邪，从三阳传到太阴，太阴则传到少阴；这里不说传经，而说“始得之”，为什么呢？回答说：传经，是古人阐明医理立法的意图如此，怎么能拘泥于一端来讨论呢！三阳伤寒，多从太阳传入，依次传到厥阴的，固然有这种情况。其三阴伤寒，也有自利不渴，开始从太阴而入的。现在少阴病刚开始得病，反而发热，正是由邪气直接侵入所致，所以说“始得之”。因为少阴病本不应身热，现在身体有热，所以说“反发热”，是因为不应当发热却发热了。由于初病邪气浅，所以给予麻黄附子细辛汤来发散它。按：六经中，只有少阴证难以辨别，这一条要看一个“反”字，是以阴证虽然说不用麻黄，现在既然刚开始得病，反而发热，脉沉，所以用麻黄附子细辛汤温散它。（张兼善）
少阴病，下利，脉微弱的，给白虎汤；如果下利不止，四肢厥冷无脉，干呕心烦的，用白通加猪胆汁汤主治。
有人问：白通汤及白通加猪胆汁汤，真武汤与通脉四逆汤，都是为少阴下利而设的，除了使用姜、附相同，其余药物各不相同，为什么呢？回答说：病不同则药不同。少阴下利，寒气已经很甚，非姜、附不能治疗。这个下利的道理没有不同，至于兼夹证不一，则用药应当各从其宜。如白通汤用姜、附来散寒止利，则加葱白来通调阳气。如果下利且干呕心烦，寒气太甚，内部格拒，而姜、附不适合心烦者，必然呕吐而不纳药，所以加入人尿、猪胆汁咸苦性寒之物，并且等候温冷服用，自然能纳入而不阻碍；到了病所，则冷体既消，热性便发。又如真武汤治疗少阴病，二三日不好，到四五日，腹部胀满，小便不利，四肢沉重疼痛，自下利的，是为有水气。所谓水气，就是寒湿，由肾主管。肾病不能制约水，水饮停蓄成为水气。《内经》说：脾恶湿，甘味先入脾；茯苓、白术的甘味，用来益脾逐水。寒湿所胜，用辛热平之；湿淫所胜，佐以酸辛；所以用附子、芍药、生姜的酸辛，来温经散湿。通脉四逆汤，治疗少阴下利清谷，里寒外热；手足厥冷，脉微欲绝的是里寒；身热恶寒，面色赤的是外热；这是阴盛于内，格阳于外，而不相通，给予通脉四逆汤，以散阴通阳。四个证候都说是下利，而兼有的或然证不一，所以用药大同而小异。（张兼善）
少阴病，得病二三天，口燥咽干的，紧急攻下，宜用大承气汤。○少阴病，自利清水，颜色纯青，心下必然疼痛，口干燥的，紧急攻下，宜用大承气汤。○少阴病，六七天，腹胀不大便的，紧急攻下，宜用大承气汤。
问：看“急”字似乎不宜缓，这个证候不过是口干燥，而且病属少阴，少阴也不过二三天，不是十余日的大满大实，有此神见，就用承气汤吗？回答：少阴病，得病二三天，就口燥咽干，可知此人肾水素来枯竭。所以宜紧急攻下以救肾水，稍微迟缓片刻，就像瓮干杯罄一样，就来不及救治了。所以阳明有急下三法以救津液，少阴有急下三法以救肾水。都关系到性命，如同救火燃头，哪里还有商量等待的呢？这与大满大实的条文，天渊悬殊，应当在早期辨别清楚。（喻嘉言）
有人问：承气汤，是阳明病应当攻下的证候宜用，现在少阴病也用，为什么呢？大概胃是水谷之海，主养四周；四周有病，都能传入。胃土燥热则肾水干枯，以二三天即口燥咽干，说明热邪深重、传变迅速，所以紧急攻下以保全肾水。土实则水清，所以自利清水而口干燥，这是胃土燥热所致；下利颜色青。青色属肝，乃肝传肾，因为肾的经脉从肺出络心，注胸中，由此而心下痛，所以紧急攻下去除胃热，驱逐肾邪。那六七天腹胀不大便，是因为入腑的邪气壅塞严重，胃土胜则肾水涸，所以紧急攻下去除胃热，滋补肾水。大概阳明与少阴都有急下的条文，证候虽然不同，其入腑的道理是一致的。（张兼善）
太阳病，想要缓解的时候，从巳时到未时之前。○阳明病，想要缓解的时候，从申时到戌时之前。○少阳病，想要缓解的时候，从寅时到辰时之前。○太阴病，想要缓解的时候，从亥时到丑时之前。○少阴病，想要缓解的时候，从子时到寅时之前。○厥阴病，想要缓解的时候，从丑时到卯时之前。
问：阳病从寅时开始缓解于戌时，阴病从亥时开始缓解于寅时，这是阳得阳解、阴得阴解。但有说法说阳病解于夜半，阴病解于日中，为什么呢？回答：阳得阳解、阴得阴解，这是顺应经气旺盛的时候。如少阳旺于寅卯辰，太阳旺于巳午未，阳明旺于申酉戌，太阴旺于亥子丑，少阴旺于子丑寅，厥阴旺于丑寅卯。各经都顺应其旺盛之时，唯独少阴顺应其生发之时，少阴肾中内藏真阳，子时一阳生，葭管飞灰，早已春回大地。丑时二阳，寅时三阳，阳进阴必退，阳长阴必消。而且天一生水，子水生地，即是旺地，所以少阴欲解独从此时。然而三阳的缓解，从寅卯开始；三阴的缓解，从寅卯结束。寅是生人之首，卯是天地之门户，也是阴阳如环的道理。只是三阳的旺时九，互不重叠；三阴的旺时五，逐位相连。可见阳行健，其道长远，所以不相及；阴行钝，其道短促，所以皆相蹑。从这里可以看出张仲景分析义理的精细。至于阳病解于夜半，阴病解于日中，《内经》的宗旨，取阳见阴、阴见阳，两相和协的意义。先圣后圣，难道不是一致吗！（喻嘉言）
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)