胸烦不呕去参夏,加蒌若渴半易根,腹痛去芩加芍药,心悸尿秘苓易芩,胁下痞硬
枣易蛎,不渴微热桂易参,咳去参枣加干味,小柴临证要当斟。
【注】少阳经主证,宜小柴胡汤主治也。其或有之证,务要临证斟酌加减可也。若胸
中烦而不呕,去半夏、人参,加栝萎实。若渴者,以半夏易栝萎根。若腹中痛,去黄芩
加白芍,若心下悸,小便不利者,加茯苓去黄芩。若胁下痞硬,加牡蛎去大枣。若不渴
外有微热者,去人参加桂枝微汗之。若咳者,去人参、大枣,加干姜、五味子。义详少阳
篇小柴胡汤下。
少阳三禁要详明,汗谵吐下悸而惊,甚则吐下利不止,水浆不入命难生。
【注】三禁,谓少阳禁吐、禁汗、禁下也。若误发汗,则生谵语,若误吐下,则心悸而
惊。少阳经,即有心下硬,不可下,下之甚,则下利不止。即有胸中满,不可吐,吐之甚,
则水浆不入,变成危候,命难生也。详少阳篇。
胸满热烦栀子豉,痞硬冲喉瓜蒂平,发热恶寒肢烦痛,微呕支结柴桂宁。郁郁微烦
呕不止,心下痛硬大柴攻,误下柴胡证仍在,复与柴胡振汗生。
【注】上言其禁,恐失宜也;此言其可,
贵变通也,胸满烦热,太阳少阳轻邪也,宜栀子豉汤涌之。胸满痞硬,气上冲喉不得息
者,太阳、少阳重邪也,宜瓜蒂散吐之。发热恶寒,四肢烦疼微呕,心下支结,太阳、少
阳表证也,宜柴胡桂枝汤,微汗两解之。郁郁微烦,呕不止,心下痛硬,少阳、阳明表
里证也,宜大柴胡汤缓攻两解之。误下不致变逆,柴胡证仍在者,复与柴胡汤以和解之,
若解则必蒸蒸振汗出而解,以下后虚故也。详太阳、少阳篇。
胸中烦闷但不呕吐,去掉人参、半夏,加入栝楼;若口渴,将半夏改为栝楼根;腹部疼痛,去掉黄芩加入芍药;心悸且小便不通畅,将茯苓改为黄芩(注:此处原文逻辑似有误,通常悸加苓去芩,但依原文直译);胁下痞塞坚硬,将大枣改为牡蛎;不渴且体表有微热,将人参改为桂枝;咳嗽,去掉人参、大枣,加入干姜、五味子。使用小柴胡汤时临证必须仔细斟酌。
【注】少阳经的主证,适宜用小柴胡汤主治。如果伴有其他症状,务必根据临床情况斟酌加减。如果胸中烦闷但不呕吐,去掉半夏、人参,加入栝楼实。如果有口渴症状,用半夏替换栝楼根。如果腹中疼痛,去掉黄芩加入白芍。如果心下悸动,小便不利,加入茯苓去掉黄芩。如果胁下痞塞坚硬,加入牡蛎去掉大枣。如果不渴且体表有微热,去掉人参加入桂枝以微微发汗。如果咳嗽,去掉人参、大枣,加入干姜、五味子。义理详见少阳篇小柴胡汤之下。
少阳病的“三禁”需要详细明了,误汗则谵语,误吐误下则心悸而惊,甚至出现上吐下泻不止,水浆不进,性命难保。
【注】“三禁”,指少阳病禁止催吐、禁止发汗、禁止攻下。如果误用发汗法,就会产生谵语;如果误用吐法或下法,就会导致心悸和惊恐。少阳经病症,即使有心下硬满,也不可用下法,若强行攻下严重了,会导致下利不止。即使有胸中满闷,也不可用吐法,若强行催吐严重了,会导致水浆不入,变成危重证候,性命难保。详见少阳篇。
胸满烦热用栀子豉汤,痞硬气冲喉部用瓜蒂散平息,发热恶寒肢体烦痛微呕,心下支结用柴胡桂枝汤和解。郁郁微烦、呕吐不止、心下痛硬,用大柴胡汤缓攻两解。误用下法后柴胡证仍在,再次给予柴胡汤会出现战栗出汗而解。
【注】上文讲的是禁忌,是担心治疗不当;这里讲的是可以用的方法,贵在灵活变通。胸满烦热,是太阳、少阳的轻浅邪气,适宜用栀子豉汤涌吐。胸满痞硬,气上冲喉导致呼吸不畅的,是太阳、少阳的重邪,适宜用瓜蒂散催吐。发热恶寒,四肢烦疼微呕,心下支结,是太阳、少阳的表证,适宜用柴胡桂枝汤,通过微微发汗来两解。郁郁微烦,呕吐不止,心下痛硬,是少阳、阳明的表里同病,适宜用大柴胡汤缓攻两解。误用下法没有导致变逆,柴胡证仍在的,再次给予柴胡汤以和解,如果病情解除,必定会蒸蒸然战栗出汗而痊愈,这是因为下法之后正气虚弱所致。详见太阳、少阳篇。
Chest fullness with vexation but no vomiting: remove Ren Shen (Ginseng Radix) and Ban Xia (Pinelliae Rhizoma), add Gua Lou (Trichosanthis Fructus). If thirst is present, replace Ban Xia with Gua Lou Gen (Trichosanthis Radix). Abdominal pain: remove Huang Qin (Scutellariae Radix), add Shao Yao (Paeoniae Radix). Palpitations with urinary difficulty: replace Fu Ling (Poria) with Huang Qin (note: original text logic appears inverted compared to standard practice, translated literally). Hypochondriac fullness and hardness: replace Da Zao (Jujubae Fructus) with Mu Li (Ostreae Concha). No thirst with slight exterior heat: replace Ren Shen with Gui Zhi (Cinnamomi Ramulus). Cough: remove Ren Shen and Da Zao, add Gan Jiang (Zingiberis Rhizoma) and Wu Wei Zi (Schisandrae Fructus). When using Xiao Chai Hu Tang (Minor Bupleurum Decoction), clinical judgment must be exercised carefully.
[Note] The main syndrome of the Shaoyang (Lesser Yang) meridian is primarily treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). If accompanying symptoms exist, modifications must be considered based on clinical presentation. If there is chest vexation without vomiting, remove Ban Xia and Ren Shen, and add Gua Lou Shi (Trichosanthis Fructus). If thirst is present, substitute Gua Lou Gen for Ban Xia. If abdominal pain occurs, remove Huang Qin and add Bai Shao (White Peony Root). If palpitations occur with difficult urination, add Fu Ling and remove Huang Qin. If hypochondriac fullness and hardness are present, add Mu Li and remove Da Zao. If there is no thirst but slight exterior heat, remove Ren Shen and add Gui Zhi to induce slight sweating. If coughing occurs, remove Ren Shen and Da Zao, and add Gan Jiang and Wu Wei Zi. The rationale is detailed under Xiao Chai Hu Tang in the Shaoyang chapter.
The "Three Prohibitions" of Shaoyang disease must be clearly understood: misapplied sweating leads to delirious speech; misapplied vomiting or purging leads to palpitations and fright. Severe cases may result in unceasing vomiting and diarrhea, inability to take food or fluids, leading to a critical condition where life is hard to save.
[Note] The "Three Prohibitions" refer to the prohibitions against vomiting, sweating, and purging in Shaoyang disease. If sweating is mistakenly induced, delirium ensues. If vomiting or purging is mistakenly applied, palpitations and fright occur. In Shaoyang disorders, even if there is epigastric hardness, purging is contraindicated; severe purging leads to unceasing diarrhea. Even if there is chest fullness, vomiting is contraindicated; severe vomiting leads to the inability to ingest food or fluids, resulting in a critical state where life is endangered. Refer to the Shaoyang chapter for details.
For chest fullness and vexation with heat, use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce emesis. For fullness, hardness, and qi rushing to the throat causing breathing difficulty, use Gua Di San (Melon Seed Powder) to induce emesis. For fever, aversion to cold, limb vexation and pain, slight vomiting, and subcostal binding (Zhi Jie), use Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) to resolve both Taiyang and Shaoyang through slight sweating. For depression with slight vexation, incessant vomiting, and painful hardness in the epigastrium, use Da Chai Hu Tang (Major Bupleurum Decoction) for gentle attack and dual resolution. If purging was mistakenly applied but the Chai Hu syndrome remains, re-administer Chai Hu Tang for harmonization; resolution will likely manifest as shivering followed by sweating due to post-purging deficiency. Refer to the Taiyang and Shaoyang chapters.
[Note] The preceding text discusses prohibitions to prevent inappropriate treatment; this section discusses permissible methods, emphasizing flexibility. Chest fullness and vexation with heat indicate light pathogenic factors affecting both Taiyang and Shaoyang, suitable for Zhi Zi Chi Tang to induce emesis. Chest fullness, hardness, and qi rushing to the throat causing respiratory distress indicate heavy pathogenic factors affecting both Taiyang and Shaoyang, suitable for Gua Di San to induce emesis. Fever, aversion to cold, limb vexation and pain, slight vomiting, and subcostal binding represent exterior syndromes of Taiyang and Shaoyang, suitable for Chai Hu Gui Zhi Tang to resolve both via slight sweating. Depression with slight vexation, incessant vomiting, and painful hardness in the epigastrium represent interior-exterior syndromes of Shaoyang and Yangming, suitable for Da Chai Hu Tang for gentle dual resolution. If purging was mistakenly applied without causing adverse transformations, and the Chai Hu syndrome persists, re-administer Chai Hu Tang for harmonization. Resolution typically presents as shivering and sweating due to the deficiency following purging. Refer to the Taiyang and Shaoyang chapters.