少阳之为病。口苦咽干目眩也。（成本。无为字。）
〔成〕足少阳。胆经也。内经曰。有病口苦者。名曰胆瘅。甲乙经曰。胆者。中精之腑。五脏取决于胆。
咽为之使。少阳之脉。起于目锐 。少阳受邪。故口苦咽干目眩。〔鉴〕口苦者。热蒸胆气上溢也。咽干者。热
耗其津液也。目眩者。热熏眼发黑也。此揭中风伤寒。邪传少阳之总纲。凡篇中称
少阳中风伤寒者。即具此证之谓也。〔柯〕太阳主表。头项强痛为提纲。阳明主里。胃家实为提纲。少阳居半
表半里之位。仲景特揭口苦咽干目眩为提纲。盖口咽目三者。不可谓之表。又不可谓之里。是表之入里。里之
出表处。所谓半表半里也。苦干眩者。人所不知。惟病患独知。诊家所以不可无问法。〔程〕少阳在六经中。
典开阖之枢机。出则阳。入则阴。凡客邪侵到其界。里气辄从而中起。故云半表半里之邪。半表者。指经中所
到之风寒而言。所云往来寒热。胸胁苦满等。是也。半里者。指胆腑而言。所云口苦咽干目眩。是也。表为寒。
里为热。寒热互拒。所以有和解一法。观其首条所揭口苦咽干目眩之证。终篇总不一露。要知终篇无一条不具
有此条之证也。有此条之证。而兼一二表证。小柴胡汤方可用。无此条之证。而只据往来寒热等。及或有之证。
用及小柴胡。腑热未具。而里气预被寒侵。是为开门揖盗矣。余目击世人之以小柴胡汤杀人者不少。非其认证
不真。盖亦得半而止耳。（入里不解。则成骨蒸痨疟。入阴渐深。则为厥逆亡阳。）
少阳中风。两耳无所闻。目赤。胸中满而烦者。不可吐下。吐下则悸而惊。
〔鉴〕少阳。即首条口苦咽干目眩之谓也。中风。谓此少阳病。是从中风之邪传来也。少阳之脉。起目
锐。从耳后。入耳中。其支者。会缺盆。下胸中循胁。表邪传其经。故耳聋目赤。胸中满而烦也。然此少阳
半表半里之胸满而烦。非太阳证具之邪陷。胸满而烦者比。故不可吐下。若吐下。则虚其中。神志虚怯。则悸
而惊也。〔汪〕补亡论。庞安时云。可小柴胡汤。吐下悸而惊者。郭白云云。当服柴胡加龙骨牡蛎汤。
伤寒脉弦细。头痛发热者。属少阳。少阳不可发汗。发
汗则谵语。此属胃。胃和则愈。胃不和。烦而悸。（【原注】一云躁○烦上。成本。玉函。有则字。）
〔鉴〕脉弦细。少阳之脉也。上条不言脉。此言脉者。补言之也。头痛发热无汗。伤寒之证也。又兼见口
苦咽干目眩。少阳之证。故曰属少阳也。盖少阳之病。已属半里。故不可发汗。若发汗。则益伤其津。而助其
热。必发谵语。既发谵语。则是转属胃矣。若其人津液素充。胃能自和。则或可愈。否则津干热结。胃不能和。
不但谵语。且更烦而悸矣。〔王〕凡头痛发热。俱为在表。惟此头痛发热。为少阳者。何也。以其脉弦细。故
知邪入少阳之界也。〔钱〕以小承气和胃。令大便微溏。胃和则愈也。胃不和者。以阳气虚损之胃。邪热陷入。
而胃虚邪实。所以烦闷而筑筑然悸动。此少阳误汗之变证也。可不慎哉。
案不可发汗。盖此属柴胡桂枝汤证。程氏云。烦而悸。当是小建中汤。汪氏云。和胃之药。成注云。与
调胃承气汤。愚以须用大柴胡汤。未知的当否。
伤寒选录曰。少阳。小柴胡加姜桂。阳明。调胃承气汤。
本太阳病不解。转入少阳者。胁下硬满。干呕不能食。往来寒热。尚未吐下。脉沉紧者。与小柴胡汤。
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。（若已吐下以下。原本。别为二条。
今据玉函。及千金翼。合为一条。喻本。张本。柯本。钱本。魏本。并以两条。合为一条。玉函。千金翼。无
本字。食下。有饮字。巢源。无谵语二字。）
〔鉴〕脉沉紧。当是脉沉弦。若是沉紧。是寒实在胸。当吐之诊也。惟脉沉弦。始与上文之义相属。故
可与小柴胡汤。〔沈〕太阳不解。而传少阳。当与小柴胡和解。乃为定法。反
以吐下发汗温针。以犯少阳之戒。而邪热陷入阳明。故发谵
语。已为坏证。要知谵语。乃阳明受病。即当知犯阳明之逆而治之。若无谵语。而见他经坏证。须证书凭脉。
另以活法治之也。〔程〕此条云。知犯何逆。以法治之。桂枝坏病条亦云。观其脉证。知犯何逆。随证治之。
只此一观字。一知字。已是仲景见病知源地位。
三阳合病。脉浮大上关上。但欲眠睡。目合则汗。（眠睡。玉函。千金翼。作寐一字。吴本。与阳明篇第
四十一条三阳合病腹满身重云云白虎汤条。合为一条。）
〔钱〕关上者。指关脉而言也。仲景辨脉篇中。称尺脉曰尺中。关脉曰关上。寸脉曰寸口。〔程〕大为
阳明主脉。太阳以其脉合。故浮大上关上。从关部连上寸口也。少阳以其证合。故但欲眠睡。目合则汗。但欲
眠。为胆热。盗汗为半表里也。当是有汗则主白虎汤。无汗则主小柴胡汤也。〔吴〕上关上。热势弥漫之象也。
〔鉴〕但欲眠睡。非少阴也。乃阳盛神昏之睡也。
汪氏云。常器之云。可柴胡桂枝汤。庞安时云。脉不言弦者。隐于浮大也。○案此说未知是否。姑附存于斯。
伤寒六七日。无大热。其人躁烦者。此为阳去入阴故也。（玉函。无故字。）
〔成〕表为阳。里为阴。邪在表则外有热。六七日。邪气入里之时。外无大热。内有躁烦者。表邪传里也。
故曰阳去入阴。〔印〕无大热者。邪不在表矣。其人躁烦者。邪入于里阴矣。此为去表之阳而入于里之阴也。
〔张〕邪气传里则躁烦。不传里则安静也。
方氏云。去。往也。言表邪往而入于里。○案此说未稳。又案汪氏金鉴。以阳去入阴。为三阳传经之热邪。
入于三阴之义。恐不然也。表邪入于里阴。而躁烦者。盖此阳明胃家
实而已。钱氏注与汪氏同。
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。
〔汪〕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。此注。本武陵陈亮斯语。〔印〕以上二章。与太阳篇之第三章同义。
伤寒三日。少阳脉小者。欲已也。（玉函。此条无。）
〔成〕内经曰。大则邪至。小则平。伤寒三日。邪传少阳。脉当弦紧。今脉小者。邪气微而欲已也。
案此语。内经中无所考。脉要精微云。大则病进。
少阳病欲解时。从寅至辰上。
〔成〕内经曰。阳中之少阳。通于春气。寅卯辰。少阳木王之时。〔柯〕辰上者。卯之尽。辰之始也。
少阳病的提纲证是：口苦、咽干、眼睛昏花眩晕。（成本本作无“为”字。）
〔成无己注〕足少阳经属于胆经。《内经》说：患有口苦病的人，名叫胆瘅（胆热病）。《甲乙经》说：胆是中精之腑，五脏的决断取决于胆，咽喉作为胆气的通道。少阳经脉起于目外角，少阳经受邪，所以出现口苦、咽干、眼睛昏花眩晕的症状。〔尤在泾注〕口苦，是因为热蒸腾胆气上溢所致；咽干，是因为热耗伤津液所致；眼睛昏花眩晕，是因为热熏蒸眼部导致视物发黑。这是揭示中风或伤寒邪气传入少阳病的总纲。凡是篇中提到的少阳中风、少阳伤寒，就是指具备这些症状的情况。〔柯琴注〕太阳主表，以头项强痛为提纲；阳明主里，以胃家实为提纲。少阳居于半表半里的位置，张仲景特意提出口苦、咽干、目眩作为提纲。因为口、咽、目这三个部位，不能称之为表，也不能称之为里，这是由表入里、由里出表的过渡地带，也就是所谓的半表半里。口苦、咽干、目眩这些感觉，外人不知，只有患者自己清楚，所以医生诊断时不可不进行问诊。〔程应旄注〕少阳在六经中，掌管开阖的枢机，外出则属阳，内入则属阴。凡是外邪侵犯到它的界限，体内的正气就会随之从中而起抗争，所以说它是半表半里的邪气。所谓“半表”，是指经络中所感受的风寒，如往来寒热、胸胁苦满等就是；所谓“半里”，是指胆腑，如口苦、咽干、目眩就是。表受寒，里有热，寒热互相抗拒，所以有和解这一治疗方法。看首条所提出的口苦、咽干、目眩的症状，直到全书结束都没有单独再次列出，要知道全书没有哪一条不具备这些症状。有了这些症状，并且兼有一两个表证，才可以用小柴胡汤。如果没有这些症状，仅仅依据往来寒热等，或者偶尔出现的其他症状，就使用小柴胡汤，此时胆腑的热象尚未完全具备，而体内的正气预先受到寒邪侵袭，这等于开门揖盗（引狼入室）了。我亲眼目睹世人因误用或少用（得半而止）小柴胡汤而杀人的情况不少，这不仅仅是辨证不真，也是因为用药不得其法，只取了一半功效罢了。（如果邪气入里不解，就会形成骨蒸痨疟；如果深入阴分，就会变成厥逆亡阳。）
少阳中风，表现为两耳听不见声音，眼睛发红，心中胀满且烦躁，这种情况下不可使用催吐或泻下的方法。如果误用吐下法，会导致心悸和惊恐。
〔尤在泾注〕少阳，即指首条所说的口苦、咽干、目眩。中风，是指这种少阳病是由中风之邪传变而来的。少阳经脉，起于目外角，从耳后进入耳中，其支脉，会合于缺盆，下行经过胸中沿着胁肋。表邪传入这条经脉，所以出现耳聋、目赤、胸中胀满且烦躁。然而，这种少阳半表半里引起的胸中胀满和烦躁，不同于太阳病邪气内陷导致的胸满而烦，所以不可使用吐下法。如果误用吐下，会使中焦空虚，神志虚弱怯懦，就会出现心悸和惊恐。〔汪昂补注〕《补亡论》记载庞安时说：可以用小柴胡汤。对于误用吐下导致心悸惊恐者，郭白云说：应当服用柴胡加龙骨牡蛎汤。
伤寒脉象弦细，伴有头痛、发热，属于少阳病。少阳病不可发汗，如果误发汗，会出现谵语（说胡话），这属于转属胃的问题。如果胃气调和就会痊愈，如果胃气不和，就会出现烦躁和心悸。（【原注】一说作躁○在“烦”字之上，成本、玉函本有“则”字。）
〔尤在泾注〕脉象弦细，是少阳病的脉象。上一条没有讲脉象，这里讲脉象，是为了补充说明。头痛、发热、无汗，是伤寒的症状。又兼见口苦、咽干、目眩，是少阳病的症状，所以说属于少阳病。大概少阳病已经属于半里，所以不可发汗。如果发汗，就会进一步损伤津液并助长热势，必然导致谵语。既然出现了谵语，那就是转属胃了。如果此人津液素来充足，胃能自我调和，或许可以痊愈；否则津液干枯、热邪结聚，胃不能调和，不但谵语，而且更加烦躁和心悸。〔王晋三注〕凡是头痛发热，都认为是病在表，唯独这个头痛发热属于少阳，为什么呢？因为脉象弦细，所以知道邪气进入了少阳的界限。〔钱潢注〕用小承气汤调和胃气，使大便微微溏泄，胃气调和就会痊愈。如果胃气不和，是因为阳气虚损的胃，邪热陷入，导致胃虚邪实，所以感到烦闷且心脏筑筑然悸动。这是少阳病误用汗法后的变证，能不谨慎吗？
按语：不可发汗，大概这属于柴胡桂枝汤的证候。程氏说：烦躁和心悸，应当用小建中汤。汪氏说：调和胃的药物。成无己注说：给予调胃承气汤。我认为应该用大柴胡汤，不知道是否恰当。
《伤寒选录》说：少阳病，用小柴胡汤加生姜、桂枝；阳明病，用调胃承气汤。
原本患太阳病未解，转入少阳的，表现为胁下硬满，干呕不能进食，往来寒热，还没有经过催吐、泻下治疗，脉象沉紧的，给予小柴胡汤。
如果已经经过催吐、发汗、温针治疗，出现谵语，且柴胡汤证已消失，这叫坏病。要弄清楚犯了什么错误，根据具体情况进行治疗。（如果已经催吐、泻下以下这段文字，原本分为两条，现在根据《玉函经》及《千金翼方》，合并为一条。喻嘉言本、张卿子本、柯琴本、钱潢本、魏荔彤本，也都将两条合并为一条。《玉函经》、《千金翼方》中没有“本”字，“食”下有“饮”字，《诸病源候论》中没有“谵语”二字。）
〔尤在泾注〕脉象沉紧，应当是脉象沉弦。如果是沉紧，那是寒邪实在胸中，应当用催吐法的诊断。只有脉象沉弦，才与上文的意义相衔接，所以可以给予小柴胡汤。〔沈明宗注〕太阳病未解，而传变到少阳，应当用小柴胡汤进行和解，这才是定法。反而用催吐、发汗、温针，违反了少阳病的禁忌，导致邪热陷入阳明，所以发生谵语。已经成为坏证，要知道谵语是阳明受病，就应当知道犯了阳明的错误而治疗它。如果没有谵语，而出现其他经络的坏证，必须结合症状和脉象，另外用灵活的方法治疗。〔程应旄注〕这一条说：“知犯何逆，以法治之。”桂枝汤坏病条也说：“观其脉证，知犯何逆，随证治之。”只有一个“观”字，一个“知”字，已经是张仲景见病知源的境界了。
三阳合病，脉象浮大且关部明显，只想睡觉，闭上眼睛就出汗。（想睡觉，《玉函经》、《千金翼方》写作“寐”一个字。吴谦本，与阳明篇第四十一条“三阳合病，腹满身重……”白虎汤条合并为一条。）
〔钱潢注〕关上，指的是关脉。张仲景《辨脉篇》中，称尺脉为尺中，关脉为关上，寸脉为寸口。〔程应旄注〕大为阳明的主脉。太阳以其脉合，所以脉浮大且上至关部，从关部连上寸口。少阳以其证合，所以只想睡觉，闭上眼睛就出汗。只想睡觉，是因为胆热；盗汗是因为在半表半里之间。应当是有汗则主治用白虎汤，无汗则主治用小柴胡汤。〔吴谦注〕上关上，是热势弥漫的现象。〔尤在泾注〕只想睡觉，不是少阴病，而是阳盛神志昏蒙的睡眠。
汪氏说：常器之说：可用柴胡桂枝汤。庞安时说：脉象不说弦，是因为隐伏在浮大之中。○按语：这种说法不知道是否正确，暂且附存于此。
伤寒六七天，体表没有明显的大热，但病人躁动烦乱，这是因为阳邪去表入里（入阴）的缘故。（《玉函经》无“无”字。）
〔成无己注〕表为阳，里为阴。邪气在表则体表有热。六七天，是邪气入里的时间。体表没有大热，体内有躁烦，是表邪传入了里，所以说阳去入阴。〔印鉴注〕没有大热，说明邪气不在表了。病人躁烦，说明邪气进入了里阴。这是离开表之阳而进入里之阴。〔张路玉注〕邪气传里就会躁烦，不传里就会安静。
方有执说：去，往也。意思是表邪前往而入于里。○按语：这种说法不太稳妥。又按语：汪氏《金鉴》认为“阳去入阴”是指三阳传经的热邪，进入三阴的意思，恐怕不对吧。表邪进入里阴而出现躁烦的，大概只是阳明胃家实而已。钱氏注与汪氏相同。
伤寒三天，三阳经的病邪已经尽除，三阴经应当受邪。如果病人反而能吃饭且不呕吐，这说明三阴经不受邪。
〔汪昂注〕伤寒三天，即《素问》相传的天数。上一条说六七天，这里只说三天，可见天数不可拘泥。邪气在少阳，本来应该呕吐而不能进食，现在反而能进食且不呕吐，可以证明里气调和，而少阳的邪气自然解除。既然里气调和，少阳邪气解除，那么它不传三阴，完全可以肯定，所以说三阴不受邪。这个注释，源自武陵陈亮斯的话。〔印鉴注〕以上两章，与太阳篇第三章意义相同。
伤寒三天，少阳脉象变小的，是病情将要痊愈的表现。（《玉函经》此条不存在。）
〔成无己注〕《内经》说：脉大则邪气至，脉小则平和。伤寒三天，邪气传入少阳，脉象应当弦紧，现在脉象变小，说明邪气微弱，病情将要痊愈。
按语：这句话在《内经》中无法考证。《脉要精微论》说：脉大则病进。
少阳病欲解的时间，是从寅时到辰时这段时间。
〔成无己注〕《内经》说：阳中之少阳，通应于春气。寅、卯、辰时，是少阳木气旺盛的时候。〔柯琴注〕辰上，是指卯时的结束，辰时的开始。
The guideline syndrome of Shaoyang disease is: bitter taste in the mouth, dryness of the throat, and dizziness/blurred vision. (Cheng Ben edition omits the character "wei".)
[Cheng Wuji's Commentary] The Foot-Shaoyang meridian belongs to the Gallbladder meridian. The *Neijing* states: Those suffering from bitter taste in the mouth are named Dan-Dan (Gallbladder Heat Disease). The *Jiayi Jing* states: The Gallbladder is the Middle-Jing Fu organ; the decisions of the Five Zang organs depend on the Gallbladder, and the pharynx serves as its conduit. The Shaoyang meridian originates at the outer canthus. When the Shaoyang meridian is invaded by pathogenic factors, symptoms such as bitter taste in the mouth, dryness of the throat, and dizziness/blurred vision occur. [You Yuyuan's Commentary] Bitter taste in the mouth is caused by heat steaming and overflowing gallbladder qi upwards; dryness of the throat is caused by heat consuming body fluids; dizziness/blurred vision is caused by heat steaming the eyes leading to darkened vision. This reveals the general outline for wind-stroke or cold damage pathogens transmitting into the Shaoyang stage. Whenever the text mentions Shaoyang wind-stroke or Shaoyang cold damage, it refers to cases possessing these symptoms. [Ke Qin's Commentary] Taiyang governs the exterior, with stiffness and pain of the head and neck as its guideline; Yangming governs the interior, with "stomach house excess" (fullness and hardness in the epigastrium/abdomen due to accumulation) as its guideline. Shaoyang resides in the half-exterior half-interior position. Zhang Zhongjing specifically highlights bitter taste in the mouth, dryness of the throat, and dizziness/blurred vision as the guideline. Because the mouth, pharynx, and eyes cannot be strictly classified as exterior nor interior, they represent the transition zone from exterior to interior and from interior to exterior, known as the half-exterior half-interior. These sensations—bitter taste, dryness, dizziness—are unknown to others but clear only to the patient; therefore, physicians must not neglect inquiry during diagnosis. [Cheng Yingmao's Commentary] In the Six Stages, Shaoyang governs the pivot of opening and closing; emerging implies Yang, entering implies Yin. When external pathogens invade its boundary, the internal righteous Qi rises from within to resist, hence it is called a half-exterior half-interior pathogen. The term "half-exterior" refers to the wind-cold affecting the meridians, such as alternating chills and fever, chest and hypochondriac fullness and discomfort; "half-interior" refers to the Gallbladder Fu organ, such as bitter taste in the mouth, dryness of the throat, and dizziness/blurred vision. The exterior is affected by cold, while the interior generates heat; cold and heat repel each other, thus necessitating the harmonizing method. Observing that the symptoms of bitter taste, dryness, and dizziness highlighted in the first clause are never listed individually throughout the rest of the book, one must understand that no case lacks these symptoms. If these symptoms are present along with one or two exterior signs, Xiao Chai Hu Tang may be used. If these symptoms are absent, and only alternating chills and fever or occasional other signs are present, using Xiao Chai Hu Tang when the Gallbladder heat is not fully established, while the internal Qi is prematurely invaded by cold, is akin to inviting thieves through an open door. I have witnessed many deaths caused by the misuse or incomplete application of Xiao Chai Hu Tang by practitioners; this is not merely due to inaccurate differentiation, but also because treatment stops halfway (incomplete efficacy). (If pathogens enter the interior and do not resolve, bone-stealing tuberculosis and malaria may develop; if they penetrate deeper into the Yin levels, Jue-ni and collapse of Yang may ensue.)
Shaoyang wind-stroke presents with bilateral deafness, redness of the eyes, chest fullness with irritability. In such cases, emesis and purgation are contraindicated. If emesis or purgation is mistakenly applied, palpitations and fright will result.
[You Yuyuan's Commentary] Shaoyang here refers to the bitter taste, dry throat, and dizziness mentioned in the first clause. Wind-stroke indicates that this Shaoyang disease has been transmitted from a wind-stroke pathogen. The Shaoyang meridian originates at the outer canthus, passes behind the ear, and enters the ear; its branch meets at the clavicular fossa (Quepen), descends through the chest, and follows the ribs. When exterior pathogens transmit into this meridian, deafness, red eyes, and chest fullness with irritability occur. However, this chest fullness and irritability arising from the half-exterior half-interior nature of Shaoyang differs from that caused by pathogen sinking into the chest due to Taiyang syndrome; thus, emesis and purgation are contraindicated. If mistakenly used, the middle Jiao becomes deficient, leading to timidity of the Shen (Spirit), resulting in palpitations and fright. [Wang Ang's Supplementary Commentary] *Bu Wang Lun* records Pang Anshi saying: Xiao Chai Hu Tang may be used. For cases where emesis/purgation leads to palpitations and fright, Guo Baiyun says: Chai Hu Jia Long Gu Mu Li Tang should be administered.
In cold damage, if the pulse is wiry-thin (Xian-Xi) accompanied by headache and fever, it belongs to Shaoyang. Shaoyang disease is contraindicated for sweating therapy. If sweating is mistakenly induced, delirium occurs, indicating transmission to the Stomach. If the Stomach harmonizes, recovery ensues; if the Stomach does not harmonize, irritability and palpitations arise. ([Original Note] One version reads "Zao" instead. Above "Fan", Cheng Ben and Yu Han editions include the character "Ze".)
[You Yuyuan's Commentary] A wiry-thin pulse is characteristic of Shaoyang. The previous clause did not mention the pulse; this clause adds it for completeness. Headache, fever, and absence of sweat are signs of cold damage. Combined with bitter taste, dry throat, and dizziness, these are Shaoyang signs; hence, it is said to belong to Shaoyang. Generally, Shaoyang disease already involves the semi-interior level, so sweating is contraindicated. If sweating is forced, body fluids are further damaged and heat is exacerbated, inevitably leading to delirium. Once delirium appears, the condition has transferred to the Stomach. If the patient's fluids were originally abundant and the Stomach can self-harmonize, recovery might occur; otherwise, fluid depletion and heat binding prevent Stomach harmony, causing not only delirium but also increased irritability and palpitations. [Wang Jinshan's Commentary] Headache and fever generally indicate exterior involvement. Why is this specific headache and fever attributed to Shaoyang? Because the pulse is wiry-thin, indicating the pathogen has entered the Shaoyang boundary. [Qian Huang's Commentary] Use Xiao Cheng Qi Tang to harmonize the Stomach, allowing slight loose stools; once the Stomach harmonizes, recovery ensues. If the Stomach does not harmonize, it is due to deficiency of Yang Qi in the Stomach combined with pathogenic heat sinking in, creating a state of Stomach deficiency and pathogen excess, leading to oppression and palpitations. This is a complication of mistaken sweating in Shaoyang disease; caution is essential.
Note: Sweating is contraindicated; this likely falls under the indication for Chai Hu Gui Zhi Tang. Cheng says: For irritability and palpitations, Xiao Jian Zhong Tang should be used. Wang says: Medicines to harmonize the Stomach. Cheng Wuji notes: Give Tiao Wei Cheng Qi Tang. I believe Da Chai Hu Tang is required, though I am unsure if this is accurate.
*Shanghan Xuanlu* states: For Shaoyang, use Xiao Chai Hu Tang plus Sheng Jiang and Gui Zhi; for Yangming, use Tiao Wei Cheng Qi Tang.
If a pre-existing Taiyang disease fails to resolve and transmits into Shaoyang, presenting with hardness and fullness below the costal margin, dry retching, inability to eat, alternating chills and fever, and without prior emesis, purgation, with a deep-tight pulse, administer Xiao Chai Hu Tang.
If emesis, purgation, sweating, or warm needle therapy have already been applied, resulting in delirium, and the Chai Hu syndrome has ceased, this is termed a "Bad Disease" (Complication). Determine what error was made and treat according to the current presentation. ([Regarding the section starting "If emesis...": Originally two clauses; now merged into one based on *Yu Han Jing* and *Qianjin Yi Fang*. Editions by Yu, Zhang, Ke, Qian, and Wei also merge them. *Yu Han* and *Qianjin Yi Fang* omit "Ben"; add "Yin" after "Shi"; *Bing Yuan* omits "Zhan Yu".])
[You Yuyuan's Commentary] A deep-tight pulse should actually be a deep-wiry pulse. A deep-tight pulse indicates cold stagnation in the chest, requiring emesis. Only a deep-wiry pulse aligns with the preceding context, justifying the use of Xiao Chai Hu Tang. [Shen Mingzong's Commentary] When Taiyang fails to resolve and transmits to Shaoyang, harmonizing with Xiao Chai Hu Tang is the standard method. Mistakenly applying emesis, sweating, or warm needles violates Shaoyang precautions, causing pathogenic heat to sink into Yangming, resulting in delirium. This constitutes a Bad Disease. Note that delirium indicates Yangming involvement; thus, treat the Yangming error. If there is no delirium but other meridian complications exist, differentiate based on symptoms and pulse, and apply flexible treatments. [Cheng Yingmao's Commentary] This clause states: "Know what deviation occurred, and treat accordingly." The Gui Zhi Bad Disease clause also states: "Observe pulse and symptoms, know the deviation, and treat following the syndrome." The words "observe" and "know" demonstrate Zhang Zhongjing's principle of tracing the origin of disease from its manifestations.
In San-Yang (Three Yang) combined disease, the pulse is floating-large and prominent at the Guan position. The patient desires sleep, and sweats upon closing the eyes. ("Desires sleep" is written as "Mei" in *Yu Han* and *Qianjin Yi Fang*. Wu Qian's edition merges this with Clause 41 of the Yangming chapter regarding San-Yang combined disease treated with Bai Hu Tang.)
[Qian Huang's Commentary] "Guan Shang" refers to the Guan pulse position. In Zhang Zhongjing's *Bian Mai Pian*, Chi pulse is called "Chi Zhong", Guan pulse "Guan Shang", and Cun pulse "Cun Kou". [Cheng Yingmao's Commentary] Large is the main pulse of Yangming. Taiyang combines with its pulse, making it floating-large extending up to the Guan position, connecting to Cun Kou. Shaoyang combines with its symptoms, causing desire for sleep and sweating upon eye closure. Desire for sleep indicates Gallbladder heat; night sweats indicate half-exterior half-interior status. Typically, with sweat, Bai Hu Tang is indicated; without sweat, Xiao Chai Hu Tang is indicated. [Wu Qian's Commentary] "Extending up to Guan" reflects the diffusion of heat. [You Yuyuan's Commentary] Desire for sleep is not Shaoyin disease, but sleepiness due to Yang excess confusing the Spirit.
Wang Ang notes: Chang Qizhi says: Chai Hu Gui Zhi Tang may be used. Pang Anshi says: The pulse does not mention wiry because it is hidden within the floating-large quality. ○ Note: Uncertain if correct; recorded tentatively here.
In cold damage lasting six to seven days, with no significant exterior heat but restlessness and irritability, this indicates the pathogen leaving the Yang (exterior) and entering the Yin (interior). (*Yu Han Jing* omits "Wu" [no].)
[Cheng Wuji's Commentary] Exterior is Yang, Interior is Yin. Pathogens in the exterior cause external heat. At six to seven days, it is the time for pathogens to enter the interior. Lack of significant external heat combined with internal restlessness/irritability indicates transmission of exterior pathogens to the interior; hence, "Yang leaves, entering Yin". [Yin Jian's Commentary] No significant heat means the pathogen is no longer in the exterior. Restlessness/irritability means the pathogen has entered the interior Yin. This signifies leaving the exterior Yang to enter the interior Yin. [Zhang Luoyu's Commentary] Pathogens transmitting to the interior cause restlessness/irritability; if they do not transmit, the patient remains quiet.
Fang Youzhi says: "Qu" means "go". It means exterior pathogens go and enter the interior. ○ Note: This explanation is unstable. Another note: Wang Shi's *Jin Jian* interprets "Yang leaves, entering Yin" as heat pathogens transferring from the Three Yang to the Three Yin, which is likely incorrect. Restlessness/irritability from exterior pathogens entering interior Yin is essentially Yangming "Stomach House Excess". Qian's commentary agrees with Wang.
On the third day of cold damage, the Three Yang stages are exhausted, and the Three Yin stages should receive the pathogen. If the patient can eat and does not vomit, this indicates the Three Yin stages are not receiving the pathogen.
[Wang Ang's Commentary] "Third day" refers to the days mentioned in *Suwen*. The previous clause mentioned six to seven days, this one only three, showing that days should not be rigidly adhered to. Pathogens in Shaoyang typically cause vomiting and inability to eat. Now, the ability to eat without vomiting proves the interior Qi is harmonious and the Shaoyang pathogen is resolving. With interior harmony and Shaoyang resolution, transmission to the Three Yin is impossible; hence, "Three Yin does not receive pathogen". This annotation originates from Chen Liangsi of Wuling. [Yin Jian's Commentary] These two clauses share the same meaning as Clause 3 of the Taiyang chapter.
In cold damage on the third day, if the Shaoyang pulse becomes small, the disease is about to resolve. (*Yu Han Jing* omits this clause.)
[Cheng Wuji's Commentary] The *Neijing* states: Large pulse indicates pathogen presence; small pulse indicates peace/recovery. On the third day of cold damage, when pathogens transmit to Shaoyang, the pulse should be wiry-tight. A small pulse now indicates weak pathogens and impending resolution.
Note: This statement cannot be verified in the *Neijing*. *Mai Yao Jing Wei Lun* states: Large pulse indicates disease progression.
Shaoyang disease tends to resolve between Yin and Chen hours (03:00–07:00).
[Cheng Wuji's Commentary] The *Neijing* states: Shaoyang among Yang corresponds to Spring Qi. Yin, Mao, and Chen hours are when Shaoyang Wood Qi is prosperous. [Ke Qin's Commentary] "Chen Shang" means the end of Mao hour and the beginning of Chen hour.