（少阳主半表半里。）
何谓少阳经症。曰。口苦。咽干。目眩。是也。有虚火实火二症之辨。
寒热往来于外。胸胁苦满。默默不欲食。心烦喜呕。为虚火症。宜小柴胡汤。
寒热往来于外。心中痞硬。郁郁微烦。呕不止。为实火症。宜大柴胡汤。
何谓少阳腑症。曰。少阳主寒热。属于半表则为经。属于半里则为腑。其症虽无寒热往来于外。而有寒热
相搏于中。有痞痛利呕四症之辨。
因呕而痞。不痛者。半夏泻心汤。
胸中有热而欲呕。胃中有邪气。而腹中痛。宜黄连汤。
邪已入里。则胆火下攻于脾而自利。宜黄芩汤。
胆火上逆于胃而为呕。宜黄芩加半夏生姜汤。
以上四方。寒热攻补并用。仍不离少阳和解法。
经云。少阳之上。相火治之。所谓本也。本之下。中之见也。见之下。气之标也。又曰。少阳从本。又曰。少阳
为枢。又热病论曰。三日少阳受之。少阳主胆。其脉循胁络于耳。故胸胁痛而耳聋。其经脉出耳前后。下循胸胁。
故为胁痛耳聋等症。
伤寒论云。少阳之为病。口苦。苦从火化。咽干。火胜则干。目眩。风火相煽。则眩也。此节为少阳证之提纲。主
少阳之气化而言也。柯韵伯云。口咽目三者。不可谓之表。亦不可谓之里。是表之入里。里之出表处。所谓
半表半里是也。三者能开能阖。恰合枢机之象。苦干眩三者。皆相火上走空窍而为病也。此病自内之外。
人所不知。惟病患自知。诊家所以不可无问法。三证为少阳病机。兼风火杂病而言。
少阳标阳本火。标本不异。故从本经云。少阳为甲木。主风火之为病。论中止十节。第一节言口苦咽干
目眩。为少阳之总纲。皆就气化而言也。以下补言经脉。第二节云少阳中风两耳无所闻者。以少阳之
脉。从耳后入耳中。出走耳前也。目赤者。以少阳之脉。起于目锐 也。胸中满而烦者。以枢不运则满。相
火合于君火则烦也。不可吐下者。恐伤上下二焦之气也。吐下则悸而惊者。以手少阳三焦合于手厥
阴心包。足少阳胆合于足厥阴肝。吐则伤心包而为悸。下则伤肝而为惊也。此少阳自受之风邪。戒其
不可吐下。从总纲中分出一纲也。第三节云伤寒脉弦细者。以弦为少阳之本脉。而细则为寒邪伤经
之脉也。头痛发热属少阳者。以少阳之脉。上头角而为痛。少阳之火。发于外而为热。此属少阳自受之
寒邪也。不可发汗。发汗则谵语者。以少阳主枢而不主表。若发表汗。则耗伤其津液。以致胃不和而谵
语。故特申之曰。此属胃。言所以运此枢者胃也。胃和则愈。胃不和则烦而悸者。言胃和则能转枢而病
愈。胃不和则手少阳三焦之火气上逆而为烦。足少阳胆气失职而为悸也。此少阳自受之寒邪。戒其
不可发汗。从总纲中又分出一纲也。但二者为少阳自受之风寒。而更有少阳转属之风寒。又从总纲
中续分出一纲。第四节云本太阳病不解。转入少阳者。转入即转属。言少阳病自受外而又有转属之
证也。胁下硬满者。以少阳之脉。其直者。从缺盆下腋。循胸。过季胁也。干呕不能食者。以木火相通。而胆
喜犯胃也。往来寒热者。以少阳居表里之间。进而就阴则寒。退而从阳则热也。此三句为少阳病大略。
尚未吐下者。以未经吐下。犹幸中气之未伤也。脉沉紧者。以邪气向内则沉。太阳伤寒其本寒。与少阳
火热相搏。则脉紧。言外可悟太阳中风。其标阳与少阳相合则脉缓。既入少阳。无论伤寒中风皆为枢。
逆于内不得外达。均宜小柴胡汤达之。故曰。与小柴胡汤。见汗吐下皆非所宜。惟此汤为对证之的剂
也。然而汗吐下三禁外。又有温针为尤忌。第五节云。若已吐下。发汗温针。谵语。柴胡汤证罢。此为坏病
者。承上节尚未吐下句而言。庸医误行吐下。且更发汗温针。大伤中气。竭其胃液而谵语。其胁下硬满。
干呕不能食。往来寒热之柴胡汤证反罢。胃坏全无枢象。正与第三节所言属胃。胃和则愈之旨相反。
故特儆之曰。此为坏病也。知犯何逆。以法治之者。言病无枢象。断不可用小柴胡之枢药。当知所犯何
逆而救治之也。且也自受转属误治证。各节既详其义。而合病之脉证。不可不明。传经之同异。不可不
讲。欲已欲解之日时。不可不知。曷言合病。第六节云。三阳合病。脉浮大上关上。但欲眠寐者。以太阳之
浮。阳明之大。二脉俱上于少阳之关上。则二阳之气。不得少阳枢转而俱行于阴。故但欲眠寐也。目合
则汗者。以开目为阳。合目为阴。阳气乘目合之顷内行于阴。则外失所卫而汗出也。曷言传经。第七节
云。伤寒六七日。无大热。其人烦躁者。此为阳去入阴故也。盖以七日来复于太阳。太阳与少阴。一腑一
脏。雌雄相应之道也。若少阳病当太阳主气之期。枢有权则外转而出。枢失职则内入而深。去太阳则
身无大热。入少阴则其人烦躁。此表里相传之义也。第八节云。伤寒三日。三阳为尽。三阴当受邪。其人
反能食而不呕者。此为三阴不受邪也。盖以三日为三阳之终。太阴为三阴之首。能食不呕。太阴不受
邪。便知三阴俱不受邪。此以次第相传之义也。曷言欲已之日。第九节云。伤寒三日。少阳脉小者。为欲
愈也。言少阳本弦之脉。转而为小。小则病退。其病欲已。不但三阴不受邪也。曷言欲解之时。第十节云。
少阳病欲解时。从寅至辰上。盖以少阳之气旺于寅卯。至辰时上。其气已化。阳气大旺。正可胜邪故也。
少阳全篇止此十节。而病之源流分合。无有弗备。治之经权常变。无有弗该。熟读而玩味之。方知其妙。
门人问曰。少阳篇止十节。夫子逐节引其原文。析其疑义。与各家之妄逞臆见。及画蛇添足者不同。第
有论无方。学人无从摸索。本篇中止于第四节云。本太阳病不解转入少阳者。与小柴胡汤一方。其实
此方详于太阳篇中。与阳明篇及各篇亦有之。未可谓为少阳之专方。然则治少阳病。将何从下手乎。
曰。太阳篇伤寒五六日中风。往来寒热。胸胁苦满。默默不欲食。心烦喜呕。以此数证。为小柴胡之的证。
其余兼证尚在或然或不然无定之间。统以小柴胡汤主之。论中谓有柴胡证。但见一证便是。不必悉
具。即此意也。以下凡十五节。皆论柴胡汤之证治。不可谓为少阳之正方。然少阳主风火之气。而所重
在枢。柴胡为转枢之药。故后人取之以为和解之方。汗下俱在所禁也。然和解中亦兼及汗下。时贤谓
为权变法。大抵证兼太阳之表。则宜兼汗。证兼阳明之里。则宜兼下。如柴胡加桂枝汤。柴胡加芒硝汤。
大柴胡汤。柴胡桂枝汤等方是也。然寒热游行于外。则有柴胡等法。而寒热互搏于中。则为痞呕。又有
诸泻心汤。黄连汤。黄芩汤等法。柯韵伯论翼已详言之。至于少阳为枢。而所以运此枢者胃也。小柴胡
汤中之参枣。是补胃中之正气以转枢。柴胡龙骨牡蛎汤是驱胃中之邪气以转枢。补正即所以驱邪。
驱邪即所以补正。一而二之。二而一之。不可姑待其枢折而救治无及也。且也黄 一味。得初阳之气。
初阳者少阳也。手少阳三焦之气。上逆则为烦。足少阳胆气。失职则为悸。凡少阳枢折之坏症。必重用
此药以救之也。少阳寒热往来。病形见于外。苦喜不欲。病情得于内。有苦喜欲三字。非真呕真满真不
能饮食也。看往来二字。即见有不寒热时。往来寒热。胸胁苦满。是无形之表。心烦喜呕。默默不欲食。是
无形之里。其或胸中烦而不呕。或渴。或腹中痛。或胁下痞硬。或心下悸小便不利。或咳者。此七证皆偏
于里。惟微热为在表。皆属于无形。惟胁痛痞硬为有形。皆风寒通证。惟胁下痞硬属少阳。总是气分为
病。非有实热可据。故从半表半里之治法。
少阳为游部。其气游行三焦。循两胁输腠理。是先天真元之正气。正气虚。不足以固腠理。邪因其开。得
入其部。少阳主胆。为中正之官。不容邪气内犯。必与之相搏。搏而不胜。所以邪结胁下也。邪正相争。即
往来寒热。更实更虚。所以休作有时。邪实正虚。所以默默不欲饮食。仲景于表证不用人参。此因邪正
分争。正不胜邪。故用之扶元气。强主以逐寇也。若外有微热而不往来寒热。是风寒之表未解。不可谓
之半表。当小发汗。故去参加桂。心烦与咳。虽逆气有余。而正气未虚。故去人参。如太阳汗后身痛而脉
沉迟。与下后协热利而心下硬。是太阳之半表里证也。表虽不解。里气已虚。故参桂并用。是知仲景用
参。皆是预保元气。更有脉证不合柴胡者。仍是柴胡证。本论云。伤寒五六日。头汗出。微恶寒。手足冷。心
下满。口不欲食。大便硬。脉细者。此为阳微结。半在里半在表也。脉虽沉紧。不得为少阴病者。阴不得有
汗。今头汗出。故知非少阴也。可与小柴胡汤。此阳微结之治法也。夫阴不得有汗。亦须活看。然亡阳与
阴结。其别在大便。亡阳则咽痛吐利。阴结则不能食而大便反硬也。亡阳与阳结。其别在汗。亡阳者卫
气不固。汗出必遍身。阳结者邪热闭结郁。汗止在头也。且阳微结者。谓少阳阳微。故不能食而大便硬
为的证。非若纯阳结为阳明阳盛。以能食而大便硬为的证。则阳结阳微结之辨又在食也。故少阳之
阳微结证。欲与小柴胡汤。必究其病在半表。然微恶寒。亦可属少阴。但头汗出。始可属少阳。故反复讲
明头汗之义。可与小柴胡而无疑也。所以然者。少阳为枢。少阴亦为枢。故见证多相似。必于阴阳表里。
辨之真而审之确。始可以一剂而瘳。此少阳少阴之疑似证。又柴胡证之变局也。
胁居一身之半。故胁为少阳之枢。岐伯曰。中于胁则下少阳。此指少阳自病。然太阳之邪。欲转属少阳。
少阳之邪。欲归迸阳明。皆从胁转。如伤寒四五日。身热恶风。头项强。胁下满者。是太阳少阳并病。将转
属少阳之机也。以小柴胡汤与之。所以断太阳之来路。如阳明病。发潮热。大便溏。小便自可。胸胁满而
不去者。是少阳阳明并病。此转属阳明之始也。以小柴胡汤与之。所以开阳明之出路。若据此次第传
经之说。必阳明而始传少阳。则当大便硬而不当大便溏。当曰胸胁始满。不当曰满而不去矣。又阳明
病胁下硬满。大便硬而呕。舌上白苔者。此虽已属阳明。而少阳之证未罢也。盖少阳之气游行三焦。因
胁下之阻隔。合上节之治节不行。水精不能四布。故舌上有白苔而呕。与小柴胡汤转少阳之枢。则上
焦气化始通。津液得下。胃不实而大便自输矣。身 然而汗出解者。是上焦津液所化。故能开发腠理。
熏肤充身泽毛。若雾露之溉。与胃中邪热症不同。故以小柴胡汤主之。所谓枢机之象。宜熟玩者也。
什么是少阳经的症状？回答说：口苦、咽干、目眩，就是这些症状。这里需要辨别虚火和实火两种证候。
在体表出现寒热往来，胸胁部感觉苦于胀满，神情沉默不想进食，心烦且喜欢呕吐，这是虚火证。适宜用小柴胡汤。
在体表出现寒热往来，心中痞塞坚硬，情绪抑郁微烦，呕吐不止，这是实火证。适宜用大柴胡汤。
什么是少阳腑的症状？回答说：少阳主管寒热，邪气属于半表则为经病，属于半里则为腑病。其症状虽然没有体表的寒热往来，但有寒热在中焦相互搏结。这里有痞、痛、利、呕四种症状的辨别。
邪气已经入里，胆火向下攻伐脾土导致自发性腹泻的，适宜用黄芩汤。
《内经》说：“少阳之上，相火治之。”这就是所谓的“本”。本的下面，是“中”所显现的征象；征象的下面，是气的“标”。又说：“少阳从本化”，又说：“少阳为枢”。《热病论》说：“第三天少阳受邪。”少阳主胆，其经脉循行胁肋并联络耳朵，所以会出现胁痛和耳聋。其经脉出于耳前后，向下循行胸胁，所以会出现胁痛、耳聋等症状。
《伤寒论》说：“少阳病的表现是口苦、咽干、目眩。”口苦是因为火化所致，咽干是因为火盛伤津则干，目眩是因为风火相煽则眩晕。这一节是少阳证的提纲，主要论述少阳的气化功能。柯韵伯说：口、咽、目三者，不能称为表，也不能称为里，这是由表入里、由里出表的地方，也就是所谓的半表半里。这三者能开能阖，恰好符合枢机的形象。口苦、咽干、目眩这三种症状，都是相火上走空窍而致病。这种病是从内向外发展的，外人不知道，只有患者自己知道，所以医生诊察时不可没有问诊法。这三个症状反映了少阳的病机，兼有风火杂病的情况。
少阳标阳本火，标本一致，所以经文说“少阳从本”。经文又说：“少阳为甲木，主风火之为病。”《伤寒论》中关于少阳的条文共十节。第一节讲口苦、咽干、目眩，是少阳的总纲，都是从气化角度而言的。以下补充论述经脉。第二节说少阳中风两耳听不见，是因为少阳经脉从耳后进入耳中，走出耳前。眼睛发红，是因为少阳经脉起于目锐眦。胸中满闷而烦躁，是因为枢机不运则满，相火合于君火则烦。不可使用吐法和下法，因为恐怕会损伤上下二焦的气机。吐下之后出现心悸和惊惕，是因为手少阳三焦与手厥阴心包相合，足少阳胆与足厥阴肝相合。吐法伤心包而为悸，下法伤肝而为惊。这是少阳自受的风邪，告诫不可使用吐下法，是从总纲中分出的一个纲领。第三节说伤寒脉弦细，是因为弦脉是少阳的本脉，而细脉是寒邪伤及经脉的脉象。头痛发热属于少阳的，是因为少阳经脉上行头角而致痛，少阳之火发于外而致热。这属于少阳自受的寒邪。不可发汗，如果发汗导致谵语，是因为少阳主枢而不主表，若强行发表发汗，就会耗伤津液，导致胃不和而出现谵语。所以特别申明说：“此属胃”，意思是运转这个枢机的关键在于胃。胃和则病愈，胃不和则烦而悸，是说胃和则能转枢而病愈，胃不和则手少阳三焦的火气上逆而为烦，足少阳胆气失职而为悸。这是少阳自受的寒邪，告诫不可发汗，是从总纲中又分出的一个纲领。但是这两者是少阳自受的风寒，还有少阳转属的风寒，又从总纲中续分出第三个纲领。第四节说原本太阳病未解，转入少阳的，“转入”即“转属”，意思是少阳病除了自受之外，又有转属的证候。胁下硬满，是因为少阳经脉直行者，从缺盆下行腋下，循行胸中，经过季胁。干呕不能进食，是因为木火相通，胆易侵犯胃。往来寒热，是因为少阳居于表里之间，进而在阴分则寒，退而从阳分则热。这三句是少阳病的大略情况。尚未被误用吐下法的，是因为未经吐下，尚幸中气未受伤。脉沉紧，是因为邪气向内则脉沉，太阳伤寒其本为寒，与少阳火热相搏，则脉紧。言外之意可以领悟到太阳中风，其标阳与少阳相合则脉缓。既然进入少阳，无论伤寒中风都成为枢机之病，逆于内不得外达，都适宜用小柴胡汤通达它。所以说：“与小柴胡汤”，表明汗、吐、下都不是适宜的，只有这个汤是对证的特效药。然而除了汗、吐、下三禁之外，又有温针是尤为忌讳的。第五节说：如果已经用了吐法、下法、发汗、温针，出现谵语，柴胡汤证已罢，这叫坏病。这是承接上一节“尚未吐下”这句话来说的。庸医误用吐下，并且更用发汗温针，大伤中气，竭尽胃液而导致谵语。其胁下硬满、干呕不能食、往来寒热的柴胡汤证反而消失。胃气败坏全无枢机之象，正与第三节所说的“属胃，胃和则愈”的宗旨相反。所以特别警示说：“此为坏病也。”“知犯何逆，以法治之”的意思是，病无枢机之象，断不可用小柴胡这类枢药，应当知道犯了什么错误而进行救治。况且自受、转属、误治各节的证义既已详细阐述，那么合病的脉证不可不明白，传经的同异不可不讲求，欲愈、欲解的日期时间不可不知道。什么叫合病？第六节说：三阳合病，脉浮大上关上，只想睡觉。这是因为太阳的浮脉、阳明的大脉，两脉都上至于少阳的关部，则二阳之气，得不到少阳枢机的转运而俱行于阴分，所以只想睡觉。闭眼则出汗的，是因为睁眼为阳，闭眼为阴，阳气乘闭眼的瞬间内行于阴分，则体表失去卫护而汗出。什么叫传经？第七节说：伤寒六七天，没有大热，其人烦躁，这是阳去入阴的缘故。大概因为七日来复于太阳，太阳与少阴，一腑一脏，是雌雄相应的关系。如果少阳病当太阳主气的时期，枢机有权则向外转出，枢机失职则向内深入。离开太阳则身无大热，进入少阴则其人烦躁。这是表里相传的道理。第八节说：伤寒三日，三阳经气已尽，三阴经应当受邪，其人反而能吃饭且不呕吐的，这是三阴经不受邪。大概因为三日是三阳经的终结，太阴是三阴经之首，能吃饭不呕吐，说明太阴不受邪，便知道三阴经都不受邪。这是按次第相传的道理。什么叫欲愈的日期？第九节说：伤寒三日，少阳脉变小的，是病欲愈的意思。说少阳本应弦的脉，转变为小脉，小则病退，其病欲愈。不仅三阴不受邪。什么叫欲解的时间？第十节说：少阳病欲解的时间，从寅时至辰时。大概因为少阳之气旺于寅卯，到了辰时，其气已化，阳气大旺，正气可胜邪气故也。少阳全篇仅此十节，而病的源流分合，无不具备；治疗的经权常变，无不包括。熟读并玩味它，才知道其中的奥妙。
门人问：少阳篇仅十节，老师逐节引用原文，分析疑难，与各家妄逞臆见及画蛇添足者不同。只是有论无方，学人无从摸索。本篇中仅在第四节说：“本太阳病不解转入少阳者，与小柴胡汤一方。”其实此方在太阳篇中详述，与阳明篇及各篇也有，不能说它是少阳的专方。那么治疗少阳病，将从何下手呢？
回答说：太阳篇中说伤寒五六日中风，往来寒热，胸胁苦满，默默不欲食，心烦喜呕，以这几个症状作为小柴胡汤的确切指征。其余兼证尚在或然或不然的不定状态中，统以小柴胡汤主治。论中说有柴胡证，但见一证便是，不必悉具，就是这个意思。以下凡十五节，都是论述柴胡汤的证治，不能说它是少阳的正方。然而少阳主风火之气，而所重在枢机。柴胡是转枢的药物，所以后人取它作为和解的方剂，汗法和下法都在禁忌之列。然而和解中也兼及汗下，当代贤人称之为权变法。大体上证兼太阳之表，则宜兼用汗法；证兼阳明之里，则宜兼用下法。如柴胡加桂枝汤、柴胡加芒硝汤、大柴胡汤、柴胡桂枝汤等方剂就是如此。然而寒热游行于体表，则有柴胡等法；而寒热互搏于体内，则为痞证和呕吐，又有诸泻心汤、黄连汤、黄芩汤等法。柯韵伯在《论翼》中已详细论述。至于少阳为枢，而所以运转这个枢机的是胃。小柴胡汤中的人参、大枣，是补益胃中的正气以转枢；柴胡龙骨牡蛎汤是驱除胃中的邪气以转枢。补正即所以驱邪，驱邪即所以补正，一分为二，二合为一，不可姑且等待其枢机折断而救治不及。况且黄芩一味药，得初阳之气。初阳就是少阳。手少阳三焦之气上逆则为烦，足少阳胆气失职则为悸。凡是少阳枢机折断的坏症，必须重用此药来救治。少阳寒热往来，病形见于外表；苦、喜、不欲，病情得于内部。有苦、喜、欲三个字，并非真正的呕吐、真正的胀满、真正的不能饮食。看“往来”二字，即见到有不寒不热的时候。往来寒热、胸胁苦满，是无形的表证；心烦喜呕、默默不欲食，是无形的里证。其中或者胸中烦而不呕，或者渴，或者腹中痛，或者胁下痞硬，或者心下悸小便不利，或者咳嗽的，这七个证候都偏于里，只有微热是在表，都属于无形。只有胁痛痞硬是有形的，都是风寒的通证，只有胁下痞硬属于少阳。总是气分为病，没有实热可依据，所以遵循半表半里的治法。
少阳为游部，其气游行三焦，循行两胁，输布腠理。这是先天真元的正气。正气虚，不足以固护腠理，邪气趁其开泄而入其部位。少阳主胆，为中正之官，不容邪气内犯，必与之相搏结。搏结而不胜，所以邪气结于胁下。邪正相争，即往来寒热，虚实更替，所以发作有时。邪实正虚，所以神情沉默不想饮食。仲景在表证中不用人参，这是因为邪正分争，正不胜邪，所以用人参扶助元气，强主以逐寇。如果外表有微热而不往来寒热，是风寒之表未解，不可称为半表，应当小发其汗，所以在方中去掉人参加上桂枝。心烦与咳嗽，虽然逆气有余，而正气未虚，所以去掉人参。如太阳病发汗后身痛而脉沉迟，与下后协热利而心下硬，是太阳的半表里证。表虽未解，里气已虚，所以人参、桂枝并用。由此可知仲景用人参，都是预先保护元气。更有脉证不合柴胡汤常规的，仍是柴胡证。本论说：伤寒五六日，头汗出，微恶寒，手足冷，心下满，口不欲食，大便硬，脉细的，这是阳微结，半在里半在表。脉虽沉紧，不能诊断为少阴病，因为阴证不得有汗，现在头汗出，所以知道不是少阴病。可与小柴胡汤。这是阳微结的治法。夫阴不得有汗，也必须活看。然而亡阳与阴结，区别在大便。亡阳则咽痛吐利，阴结则不能食而大便反硬。亡阳与阳结，区别在汗。亡阳者卫气不固，汗出必遍身；阳结者邪热闭结郁滞，汗止在头部。且阳微结，谓少阳阳微，故不能食而大便硬为确切指征，不像纯阳结为阳明阳盛，以能食而大便硬为确切指征，则阳结与阳微结的区别又在饮食方面。所以少阳的阳微结证，想用小柴胡汤，必须究明其病在半表。然而微恶寒，也可属少阴，只有头汗出，才可属少阳。所以反复讲明头汗的意义，可与小柴胡汤而无疑了。之所以这样，是因为少阳为枢，少阴亦为枢，所以见证多相似。必须在阴阳表里之间，辨之真而审之确，始可以用一剂而痊愈。这是少阳与少阴的疑似证，又是柴胡证的变局。
胁居一身之半，所以胁为少阳之枢。岐伯说：“中于胁则下少阳。”这是指少阳自病。然而太阳的邪气，欲转属少阳，少阳的邪气，欲归并入阳明，都从胁部转变。如伤寒四五日，身热恶风，头项强，胁下满的，是太阳少阳并病，是将转属少阳的机转。用小柴胡汤给予它，所以阻断太阳的来路。如阳明病，发潮热，大便溏，小便正常，胸胁满而不去的，是少阳阳明并病，这是转属阳明的开始。用小柴胡汤给予它，所以开通阳明的出路。如果依据此次第传经的说法，必定阳明而后传少阳，则应当大便硬而不应当大便溏，应当说胸胁始满，不应当说满而不去。又阳明病胁下硬满，大便硬而呕，舌上白苔的，这虽然已属阳明，而少阳的证候未罢。盖少阳之气游行三焦，因胁下的阻隔，合上节所述治节不行，水精不能四布，所以舌上有白苔而呕。与小柴胡汤转少阳之枢，则上焦气化始通，津液得以下行，胃不实而大便自然通畅。身体濈然而汗出而解的，是上焦津液所化，所以能开发腠理，熏肤充身泽毛，若雾露之溉。这与胃中邪热症不同，所以以小柴胡汤主治。所谓枢机之象，应当熟读玩味。
(Shaoyang governs the half-exterior and half-interior location.)
What are the symptoms of the Shaoyang channel? It is said: bitter taste in the mouth, dryness of the throat, and dizziness. These are the symptoms. There is a distinction between deficiency-fire and excess-fire syndromes.
Chills and fever alternating on the exterior, chest and hypochondriac distress (fullness), silent desire not to eat, mental irritability, and propensity to vomit constitute the deficiency-fire syndrome. Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
Chills and fever alternating on the exterior, epigastric痞 (stuffiness/hardness), mild depression and vexation, incessant vomiting constitute the excess-fire syndrome. Daxiaohu Tang (Major Bupleurum Decoction) is indicated.
What are the symptoms of the Shaoyang fu-organ? It is said: Shaoyang governs chills and fever. When the pathogen belongs to the half-exterior, it is a channel disease; when it belongs to the half-interior, it is a fu-organ disease. Although there are no chills and fever alternating on the exterior, there is a struggle between cold and heat within. There is a distinction among four symptoms:痞 (stuffiness), pain, diarrhea, and vomiting.
Vomiting leading to stuffiness without pain: Banxia Xiexin Tang (Pinellia Heart-Mending Decoction).
Heat in the chest with desire to vomit, and pathogenic qi in the stomach causing abdominal pain: Huanglian Tang (Coptis Decoction).
Pathogen has entered the interior, with gallbladder fire attacking the spleen causing spontaneous diarrhea: Huangqin Tang (Scutellaria Decoction).
Gallbladder fire reversing upward into the stomach causing vomiting: Huangqin Jia Banxia Shengjiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger).
The above four formulas combine cold and heat, attack and tonification, still adhering to the Shaoyang harmonizing method.
The Classic says: "Above Shaoyang, Ministerial Fire governs." This is what is called the Root (Ben). Below the Root is the Manifestation (Jian) of the Middle. Below the Manifestation is the Mark (Biao) of the Qi. It also says: "Shaoyang follows the Root," and "Shaoyang acts as the Pivot." The Treatise on Heat Diseases says: "On the third day, Shaoyang receives the pathogen." Shaoyang governs the Gallbladder, its meridian circulates along the hypochondrium and connects to the ear. Therefore, hypochondriac pain and deafness occur. Its meridian emerges from before and behind the ear, descends along the chest and hypochondrium, thus causing symptoms such as hypochondriac pain and deafness.
The Treatise on Cold Damage says: "The manifestation of Shaoyang disease is bitter taste in the mouth, dryness of the throat, and dizziness." Bitter taste arises from fire transformation; dryness of the throat occurs because fire excess consumes fluids; dizziness results from wind and fire stirring each other. This section serves as the outline for Shaoyang syndromes, primarily discussing the Qi transformation of Shaoyang. Ke Yunbo stated: Mouth, throat, and eyes cannot be classified as exterior or interior; they are the place where exterior enters interior and interior exits to exterior, known as the half-exterior and half-interior. These three can open and close, perfectly matching the image of the pivot. Bitter taste, dryness, and dizziness are all diseases caused by Ministerial Fire ascending to the empty orifices. This disease develops from inside out; outsiders do not know, only the patient knows. Hence, physicians must employ inquiry methods. These three symptoms reflect the pathogenesis of Shaoyang disease, involving mixed wind and fire conditions.
Shaoyang's mark is Yang, its root is Fire; root and mark are identical, hence the text says "Shaoyang follows the root." The text also states: "Shaoyang is Jia Wood, governing diseases of wind and fire." The Treatise contains ten sections on Shaoyang. The first section discusses bitter taste, dry throat, and dizziness as the general outline of Shaoyang, all from the perspective of Qi transformation. The following supplements the discussion on meridians. The second section states that Shaoyang wind-stroke causes bilateral hearing loss because the Shaoyang meridian enters the ear from behind, passes through the ear, and emerges in front. Red eyes occur because the Shaoyang meridian originates at the outer canthus. Chest fullness and vexation occur because pivot dysfunction leads to fullness, and Ministerial Fire combines with Sovereign Fire to cause vexation. Vomiting and purging are contraindicated to avoid damaging the Qi of the Upper and Lower Jiao. Vomiting damages the Pericardium (Heart Protector) causing palpitations; purging damages the Liver causing fright. This refers to wind pathogens self-received by Shaoyang, warning against vomiting and purging, dividing a guideline from the general outline. The third section states that in cold damage, a wiry-thin pulse indicates the wiry pulse is the root pulse of Shaoyang, while thinness indicates cold pathogen injuring the meridian. Headache and fever belonging to Shaoyang occur because the Shaoyang meridian ascends to the head corner causing pain, and Shaoyang fire emerging externally causes fever. This is cold pathogen self-received by Shaoyang. Sweating is contraindicated; if sweating leads to delirious speech, it is because Shaoyang governs the pivot, not the exterior. Forcing sweating consumes body fluids, leading to stomach disharmony and delirium. Thus, it is emphasized: "This belongs to the Stomach," meaning the Stomach operates this pivot. If the Stomach harmonizes, the disease resolves; if not, vexation and palpitations arise due to rebellious Sanjiao fire and dysfunctional Gallbladder Qi. This warns against sweating for self-received cold pathogen, dividing another guideline from the outline. However, besides self-received wind-cold, there is transferred wind-cold, dividing a third guideline. The fourth section states that unresolved Taiyang disease transferring to Shaoyang ("transferring" means "attributing") implies Shaoyang disease has both self-received and attributed patterns. Hardness and fullness under the hypochondrium occur because the straight branch of the Shaoyang meridian descends from the supraclavicular fossa to the axilla, circulates the chest, and passes the costal margin. Dry heaving and inability to eat occur because Wood and Fire connect, and Gallbladder easily invades the Stomach. Alternating chills and fever occur because Shaoyang resides between exterior and interior; advancing into Yin causes chills, retreating to Yang causes fever. These three sentences summarize Shaoyang disease. For those not yet subjected to vomiting or purging, the middle Qi remains intact. A deep-tight pulse indicates pathogen moving inward (deep) and cold-heat struggle (tight). Externally, Taiyang wind-stroke combining with Shaoyang yields a slow pulse. Once in Shaoyang, regardless of cold or wind, it becomes a pivot disorder obstructed internally, requiring Xiaochaihu Tang to unblock. Thus, "administer Xiaochaihu Tang," indicating sweating, vomiting, and purging are unsuitable; this decoction is the specific remedy. Besides the three prohibitions, warm needle therapy is especially taboo. The fifth section states: If vomiting, purging, sweating, or warm needles have been used, leading to delirium and cessation of Xiaochaihu signs, this is a damaged disease (Huai Bing). This follows the previous section's mention of "not yet subjected to vomiting/purging." Quack doctors mistakenly use these therapies, severely damaging middle Qi and exhausting stomach fluids, causing delirium. The original Xiaochaihu signs (hypochondriac hardness, dry heaving, alternating chills/fever) disappear. The Stomach is ruined, lacking pivot imagery, contradicting the principle that "Stomach harmony leads to recovery." Thus, it warns: "This is a damaged disease." "Know what deviation occurred and treat accordingly" means one must not use pivot drugs like Xiaochaihu when pivot function is lost but identify the error and treat it. Having detailed self-received, transferred, and mistreated cases, one must understand combined disease pulses/symptoms, transmission differences, and timing of resolution. What is combined disease? The sixth section states: Three-Yang combined disease presents with floating-large pulse rising to the Guan position, and somnolence. Taiyang floating and Yangming large pulses converge at Shaoyang Guan, preventing Two-Yang Qi from rotating via the Shaoyang pivot into Yin, causing somnolence. Sweating upon closing eyes occurs because opening is Yang, closing is Yin; Yang Qi enters Yin during eye closure, losing external defense and causing sweat. What is disease transmission? The seventh section states: Cold damage after six-seven days, without high fever, but with restlessness, indicates Yang departing to enter Yin. Seven days marks return to Taiyang; Taiyang and Shaoyin are paired Fu-Zang. If Shaoyang disease occurs during Taiyang's ruling period, pivot function allows outward exit; failure allows inward depth. Leaving Taiyang removes high fever; entering Shaoyin causes restlessness. This is the meaning of interior-exterior transmission. The eighth section states: On the third day of cold damage, Three-Yang energy ends, Three-Yin should receive pathogen. If the patient can eat and does not vomit, Three-Yin is unaffected. Three days end Three-Yang; Taiyin is head of Three-Yin. Eating without vomiting proves Taiyin unaffected, implying all Three-Yin unaffected. This follows sequential transmission. What is the time of desired resolution? The ninth section states: On the third day, if Shaoyang pulse becomes small, recovery is desired. The normally wiry Shaoyang pulse becoming small indicates disease retreat. Not only are Three-Yin unaffected. What is the time of desired relief? The tenth section states: Shaoyang disease relieves from Yin to Chen hours. Shaoyang Qi peaks at Yin/Mao; by Chen, Qi transforms, Yang Qi is strong, overcoming pathogens. The entire Shaoyang chapter has only ten sections, covering disease origins, flow, division, combination, and treatment principles comprehensively. Studying them reveals their subtleties.
Disciple asks: The Shaoyang chapter has only ten sections. You quote and analyze them, unlike others who speculate. Yet there are theories but no formulas, leaving students confused. Only in the fourth section is Xiaochaihu Tang mentioned for Taiyang transferring to Shaoyang. But this formula appears in Taiyang, Yangming, etc., so it is not exclusive to Shaoyang. How then to treat Shaoyang disease?
Answer: In the Taiyang chapter, cold damage/wind-stroke after five-six days presenting alternating chills/fever, hypochondriac fullness, silence/anorexia, vexation/vomiting constitutes the specific indication for Xiaochaihu Tang. Other accompanying symptoms are variable. Generally, Xiaochaihu Tang is used. The text says if Xiaochaihu signs exist, seeing one sign suffices, not all need be present. The following fifteen sections discuss Xiaochaihu indications and treatments. Though not exclusively a Shaoyang formula, Shaoyang governs Wind-Fire Qi, focusing on the Pivot. Chai Hu (Bupleuri Radix) turns the pivot, making it the basis for harmonizing formulas, prohibiting sweating/purging. However, harmonizing may include sweating/purging as flexible methods. If combined with Taiyang exterior, add sweating agents; if combined with Yangming interior, add purging agents. Examples include Chaihu Jia Guizhi Tang, Chaihu Jia Mangxiao Tang, Daxiaohu Tang, Chaihu Guizhi Tang. For external wandering chills/fever, use Chai Hu methods; for internal clashing chills/fever causing stuffiness/vomiting, use Xiexin Decoctions, Huanglian Tang, Huangqin Tang, etc., as detailed by Ke Yunbo. Since Shaoyang is the pivot operated by the Stomach, Ginseng and Jujube in Xiaochaihu Tang tonify Stomach Zheng Qi to turn the pivot; Chaihu Longgu Muli Tang expels Stomach Xie Qi to turn the pivot. Tonifying Zheng expels Xie; expelling Xie tonifies Zheng. They are two aspects of one reality. Do not wait for pivot collapse. Huang Qin (Scutellariae Radix) obtains initial Yang Qi (Shaoyang). Rebellious Sanjiao Qi causes vexation; dysfunctional Gallbladder Qi causes palpitations. Severe pivot-collapse cases require heavy use of Huang Qin. Shaoyang alternating chills/fever manifests externally; bitterness, propensity, anorexia manifest internally. These terms do not imply true severe vomiting/fullness/inability to eat. "Alternating" implies periods without chills/fever. Alternating chills/fever and hypochondriac fullness are formless exterior; vexation/vomiting/anorexia are formless interior. Variations like chest vexation without vomiting, thirst, abdominal pain, hypochondriac hardness, palpitations/dysuria, or cough are interior-predominant formless conditions. Only slight heat is exterior formless. Hypochondriac pain/hardness is formless. These are common wind-cold Qi-level disorders, not solid heat. Thus, treat via half-exterior/half-interior methods.
Shaoyang is a roaming department, Qi travels through Sanjiao, along hypochondria, distributing to interstices. This is primordial Righteous Qi. Deficiency fails to secure interstices; pathogens enter. Shaoyang governs Gallbladder, the Official of Justice, rejecting pathogens. Struggle ensues; defeat leads to pathogen knotting in hypochondria. Pathogen-Righteous struggle causes alternating chills/fever (fluctuating deficiency/excess), hence periodic attacks. Pathogen excess/Righteous deficiency causes silence/anorexia. Zhongjing avoids Ren Shen (Ginseng Radix) in exterior syndromes because Righteous Qi loses to Pathogen; here, Ren Shen supports Yuan Qi to strengthen the host against invaders. If slight heat exists without alternation, exterior wind-cold is unresolved, not half-exterior; mild sweating is needed, removing Ren Shen adding Guizhi (Cinnamon Twig). Vexation/cough indicate rebellious Qi but intact Righteous Qi, so remove Ren Shen. Post-sweating body ache/deep-slow pulse or post-purging febrile diarrhea/epigastric hardness are Taiyang half-exterior/interior syndromes. Exterior unresolved, Interior deficient; use Ren Shen and Guizhi together. Zhongjing uses Ren Shen to protect Yuan Qi. Some pulses/symptoms don't match standard Xiaochaihu but remain Xiaochaihu indications. Text: Cold damage 5-6 days, head sweating, slight aversion to cold, cold limbs, epigastric fullness, anorexia, hard stool, thin pulse = Yang Mild Knotting, half-interior/half-exterior. Deep-tight pulse doesn't mean Shaoyin because Yin syndromes shouldn't sweat; head sweating confirms non-Shaoyin. Administer Xiaochaihu Tang. This treats Yang Mild Knotting. "Yin shouldn't sweat" requires flexible interpretation. Wang Yang vs. Yin Knotting differs in stool: Wang Yang has sore throat/diarrhea; Yin Knotting has anorexia/hard stool. Wang Yang vs. Yang Knotting differs in sweat: Wang Yang has generalized sweat (Wei Qi insecurity); Yang Knotting has head-only sweat (pathogenic heat closure). Yang Mild Knotting implies weak Shaoyang Yang, causing anorexia/hard stool as definitive signs, unlike Yangming Strong Yang (anorexia absent, hard stool present). Distinction lies in eating. For Shaoyang Yang Mild Knotting, using Xiaochaihu Tang requires confirming half-exterior nature. Slight aversion to cold could be Shaoyin, but head sweating confirms Shaoyang. Clarifying head sweating validates Xiaochaihu use. Shaoyang and Shaoyin are both pivots, hence similar signs. Differentiate Yin/Yang, exterior/interior precisely for effective single-dose cure. These are differential diagnoses between Shaoyang and Shaoyin, and variations of Xiaochaihu syndromes.
Hypochondrium is halfway on the body, thus the Shaoyang pivot. Qibo said: "Strike hypochondrium, descend to Shaoyang," referring to self-disease. However, Taiyang pathogens transferring to Shaoyang, or Shaoyang pathogens merging into Yangming, all shift via hypochondrium. E.g., Day 4-5 cold damage, fever/aversion to wind, stiff neck, hypochondriac fullness = Taiyang-Shaoyang concurrent disease, shifting to Shaoyang. Use Xiaochaihu Tang to block Taiyang entry. E.g., Yangming disease, tidal fever, loose stool, normal urination, persistent hypochondriac fullness = Shaoyang-Yangming concurrent disease, starting transfer to Yangming. Use Xiaochaihu Tang to open Yangming exit. Sequential transmission theory suggests Yangming precedes Shaoyang, implying hard stool and new fullness, not loose stool and persistent fullness. Another case: Yangming disease, hypochondriac hardness, hard stool, vomiting, white tongue coating. Though Yangming, Shaoyang signs persist. Shaoyang Qi travels Sanjiao; hypochondriac obstruction stops regulation, preventing fluid distribution, causing white coating/vomiting. Xiaochaihu Tang rotates Shaoyang pivot, restoring Upper Jiao Qi transformation, allowing fluids to descend, softening stool. Profuse sweating resolving the condition comes from Upper Jiao fluids transforming, opening interstices, nourishing skin/hair like mist/dew. This differs from Stomach heat syndromes; thus, Xiaochaihu Tang is indicated. The image of the pivot deserves careful study.