寒热者，寒已又热，热已又寒，或一日二三度发。若每日一发，先寒后热，发作有定期者，
又名似疟而非寒热矣。寒热之症，太阳经居多，有时邪热内伏则寒，有时邪热外发则热。表
邪多，则寒多热少而无汗，羌活柴胡汤散表。里热多则热多寒少而有汗，以小柴胡汤和解。
若寒多脉浮大者，倍用柴胡；若手足常冷，恶寒汗少，再加发表之药。汗多脉沉数者，方用
黄芩；若汗多口渴脉数，再加清里之药。表寒多，用发散忌以清凉，里热多，用清凉兼发
散；若汗多有寒有热之症，不得不用发散清凉，寒热杂合之剂，以和解表里，是以仲景小柴
胡汤，和解少阳经时寒时热之症。以柴胡一味，升散在表之邪，使恶寒自已。以黄芩一味，
清解在里之热，使发热自除。再加人参、广皮、甘草，以和胃气，使胃阳敷布，得专和解之
权。推而比例，则症之兼见太阳者，羌活冲和汤，症见阳明者，干葛石膏汤；若三阳经俱见
症者，用羌活、葛根、柴胡三味散表，以治恶寒，黄芩、石膏、知母三味清凉，以治里热，
广皮、甘草，以和中气，则三阳寒热汗多，一和解而尽之矣。《准绳》书以此治夏秋三阳寒热
之疟，深中此旨。
伤寒病，至十余日，外热结在里，复往来寒热，宜大柴胡汤。
十余日，外热结在里，已为可下。今因往来寒热，少阳症，但可用柴胡汤散表邪，略加大
黄一味，以去里热。
伤寒六七日中风，往来寒热，胸胁苦满，默默不欲饮食，心烦喜呕，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，或不渴，身有微热，或咳者，小柴胡汤主之。
此条详注呕吐门。
本太阳病，不解，转入少阳，胁满干呕，往来寒热，尚未吐下，脉沉紧者，小柴胡汤。
太阳病传入少阳，胁满干呕，往来寒热，症见沉紧弦脉，症脉皆是少阳，故用小柴胡汤。
伤寒五六日，已汗下，胸胁微结，小便不利，渴而不呕，但头汗出，往来寒热心烦者，未解
也，宜柴胡桂枝干姜汤。
五六日已汗下，胸胁微结，小便不利，渴而不呕，但头汗，往来寒热，又心烦，此太阳表
症未罢，少阳诸症又急，故用柴胡、桂枝合治。因汗下后，略加干姜和中。
小柴胡汤
柴胡 黄芩 人参 熟半夏 广皮 甘草
此仲景和解少阳表里寒热之方。若太阳兼症，加羌活；若阳明兼症，加葛根、升麻；无
汗，加防风；口渴，去半夏，加天花粉；大便秘结，腹中胀痛，下症急者，加大黄；小便
不利，加木通；大便滑泄，加赤茯苓，名柴苓汤。头角痛，加川芎。
羌活冲和汤 见发热。
此方和解太阳寒热之症。加减详发热门。
干葛石膏汤
干葛 柴胡 黄芩 石膏 广皮 甘草
此方以柴葛解肌汤、干葛石膏汤、小柴胡汤三方合一，双解阳明少阳表里者。
大柴胡汤
柴胡 黄芩 广皮 甘草 大黄
此方小柴胡，去人参，加大黄，名大柴胡汤。治少阳表症未罢，下症已急，故以此汤双解表里。
柴胡桂枝干姜汤
柴胡 桂枝 黄芩 广皮 甘草 人参 芍药 干姜 半夏
此即小柴胡合桂枝汤，治太阳中风，兼少阳寒热者。广而推之，仲景治项强症，有桂枝加
葛根汤，麻黄加葛根汤，同此法也。
时寒时热症，世俗皆以小柴胡和解少阳，然未见效。余今进求精切，因知发热恶寒，皆太
阳表症，时寒者，表邪欲发未伸也。时热者，邪热临时外现也。时寒时热者，邪热欲发未
能，邪正分争，表邪未越，表汗未彻也；岂小柴胡和解一法得以治之！夫似疟症，每发必
汗出身凉，专务散邪主治，忌用寒凉抑遏，恐明日至其时，尚有恶寒表症耳，况寒热不凉
者乎！理肺发表汤、平胃发表汤，治时寒时热最效。方见身痛。
寒热交替的症状，是指发冷之后又发热，发热之后又发冷，或者一天发作两三次。如果每天只发作一次，先冷后热，且发作时间有规律，这叫做“似疟”，而不是普通的寒热交替。
寒热交替的病症，多属于太阳经病变。有时是因为外感邪气中的热邪内伏，所以表现为发冷；有时是因为外感邪气中的热邪向外发散，所以表现为发热。如果表邪较重，则发冷多而发热少，且无汗，可用羌活柴胡汤来疏散表邪。如果里热较重，则发热多而发冷少，且有汗，可用小柴胡汤来和解表里。
如果发冷较多且脉象浮大，应加倍使用柴胡；如果手足经常发冷，怕冷且汗少，再加用发表的药物。如果出汗多且脉象沉数，方剂中才使用黄芩；如果出汗多、口渴且脉数，再加用清解里热的药物。表寒多时，应用发散法，忌用清凉药；里热多时，应用清凉法兼用发散法；如果出汗多，既有寒症又有热症，不得不使用发散与清凉混合的方剂，以和解表里，这就是张仲景用小柴胡汤治疗少阳经受邪所致忽冷忽热症状的原因。方中以柴胡一味药，升散在表的邪气，使怕冷自然消除；以黄芩一味药，清解在里的热邪，使发热自然去除。再加入人参、广皮（陈皮）、甘草，来调和胃气，使胃阳敷布全身，从而专门掌握和解的权柄。推演其例，若症状兼见太阳经者，用羌活冲和汤；症状见阳明经者，用干葛石膏汤；若三阳经症状俱见者，用羌活、葛根、柴胡三味药疏散表邪，以治疗怕冷；用黄芩、石膏、知母三味药清热，以治疗里热；用广皮、甘草来调和中气，这样三阳经的寒热、汗多等症状，通过一个和解之法就能全部治愈。《准绳》一书记载此方治疗夏秋季节三阳经寒热交替的疟疾，深得此旨意。
伤寒病，到了十多天，体外的热邪结聚在体内，再次出现往来寒热的症状，宜用大柴胡汤。
过了十多天，体外的热邪结聚在体内，已经属于可以攻下的情况。现在因为出现往来寒热，这是少阳经的症状，只能使用柴胡汤来疏散表邪，略微加大黄一味药，以去除里热。
伤寒六七天，或中风，出现往来寒热，胸胁部苦闷胀满，沉默不想饮食，心烦喜呕，或者心中烦闷但不呕吐，或者口渴，或者腹中痛，或者胁下痞硬，或者心下悸动，小便不利，或者不渴，身体有微热，或者咳嗽的，以小柴胡汤为主治方剂。
此条详细注释参见呕吐门。
原本患太阳病，未得解除，转入少阳经，出现胁部胀满、干呕、往来寒热，尚未进行过催吐或泻下治疗，脉象沉紧的，用小柴胡汤。
太阳病传入少阳经，出现胁部胀满、干呕、往来寒热，症状呈现沉紧弦脉，症状和脉象都符合少阳经特征，故用小柴胡汤。
伤寒五六天，已经经过发汗或泻下治疗，胸胁部轻微结滞，小便不利，口渴但不呕吐，仅头部出汗，往来寒热且心烦的，病仍未解除，宜用柴胡桂枝干姜汤。
过了五六天，已经发汗或泻下，胸胁部轻微结滞，小便不利，口渴但不呕吐，仅头部出汗，往来寒热，又心烦，这是太阳表证未罢，少阳诸证又急迫，故用柴胡、桂枝合治。因发汗泻下后，略加干姜以调和中焦。
小柴胡汤
组成：柴胡、黄芩、人参、熟半夏、广皮、甘草。
这是张仲景和解少阳经表里寒热的方剂。若兼有太阳经症状，加羌活；若兼有阳明经症状，加葛根、升麻；无汗，加防风；口渴，去掉半夏，加天花粉；大便秘结，腹中胀痛，里实证急迫的，加大黄；小便不利，加木通；大便滑泄，加赤茯苓，名为柴苓汤。头角疼痛，加川芎。
羌活冲和汤 见于发热章节。
此方用于和解太阳经寒热交替的症状。加减方法详见发热门。
干葛石膏汤
组成：干葛、柴胡、黄芩、石膏、广皮、甘草。
此方将柴葛解肌汤、干葛石膏汤、小柴胡汤三方合一，双解阳明经和少阳经的表里之邪。
大柴胡汤
组成：柴胡、黄芩、广皮、甘草、大黄。
此方由小柴胡汤去掉人参，加大黄，名为大柴胡汤。治疗少阳经表证未罢，里实证已急迫的情况，故以此汤双解表里。
柴胡桂枝干姜汤
组成：柴胡、桂枝、黄芩、广皮、甘草、人参、芍药、干姜、半夏。
此方即小柴胡汤合桂枝汤，治疗太阳中风，兼有少阳经寒热交替的症状。推广而言，张仲景治疗项强症状，有桂枝加葛根汤、麻黄加葛根汤，与此法相同。
对于忽冷忽热的症状，世俗人都用小柴胡汤和解少阳经，然而往往不见效。我如今进一步探究以求精准切中病情，因而知道发热恶寒，都是太阳经的表证。所谓“时寒”，是表邪想要发散却未能伸展；所谓“时热”，是邪热暂时显露于外。所谓“时寒时热”，是邪热想要发散却未能成功，邪气与正气分争，表邪未越出，表汗未透彻！哪里是小柴胡汤和解一法所能治疗的！那种类似疟疾的症状，每次发作必定出汗后身凉，专门致力于发散邪气主治，忌用寒凉药抑制遏阻，恐怕到明天这个时候，还有恶寒的表证存在，何况那些寒热交替且不凉爽的呢！理肺发表汤、平胃发表汤，治疗时寒时热最为有效。方剂见身痛章节。
The symptom of alternating chills and fever refers to a condition where, after chills subside, fever arises, and after fever subsides, chills return, or it may occur two or three times a day. If it occurs only once daily, starting with chills followed by fever, and the onset is regular in timing, it is called "simulating malaria" (Simulating Malaria), rather than ordinary alternating chills and fever.
Symptoms of alternating chills and fever mostly belong to disorders of the Taiyang Channel (Taiyang Channel Disorder). Sometimes, chills occur because pathogenic heat from external pathogens is latent internally; sometimes, fever occurs because pathogenic heat from external pathogens is emerging externally. If exterior pathogenic factors are predominant, chills will be more frequent than fever, accompanied by anhidrosis (absence of sweating); Qianghuo Chaihu Tang (Notopterygium and Bupleurum Decoction) should be used to disperse exterior pathogens. If interior heat is predominant, fever will be more frequent than chills, accompanied by hyperhidrosis (excessive sweating); Xiao Chaihu Tang (Minor Bupleurum Decoction) should be used to harmonize the exterior and interior.
If chills are predominant and the pulse is floating and large, the dosage of Chai Hu (Bupleuri Radix) should be doubled. If the hands and feet are constantly cold, with aversion to cold and scanty sweating, additional diaphoretic agents should be added. If sweating is profuse and the pulse is deep and rapid, Huang Qin (Scutellariae Radix) should be included in the formula; if sweating is profuse, accompanied by thirst and a rapid pulse, additional interior-clearing agents should be added. When exterior cold is predominant, dispersing methods should be used, avoiding cooling agents; when interior heat is predominant, cooling methods should be used combined with dispersing methods. If there is profuse sweating with both cold and heat symptoms, it becomes necessary to use a compound formula combining dispersing and cooling properties to harmonize the exterior and interior. This is why Zhang Zhongjing used Xiao Chaihu Tang to treat alternating chills and fever caused by pathogens affecting the Shaoyang Channel (Shaoyang Channel Disorder). In this formula, Chai Hu (Bupleuri Radix) alone lifts and disperses exterior pathogens, resolving aversion to cold naturally; Huang Qin (Scutellariae Radix) alone clears and resolves interior heat, eliminating fever naturally. Additionally, Ren Shen (Ginseng Radix et Rhizoma), Guang Pi (Citri Reticulatae Pericarpium), and Gan Cao (Glycyrrhizae Radix et Rhizoma) are added to harmonize Stomach Qi (Stomach Energy), allowing Stomach Yang (Stomach Heat/Energy) to distribute throughout the body, thereby mastering the authority of harmonization. By analogy, if symptoms involve the Taiyang Channel, Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) is used; if symptoms involve the Yangming Channel (Yangming Channel Disorder), Gange Shigao Tang (Pueraria and Gypsum Decoction) is used; if symptoms of all three Yang channels are present, Qiang Huo (Notopterygii Rhizoma et Radix), Ge Gen (Puerariae Lobatae Radix), and Chai Hu (Bupleuri Radix) are used to disperse exterior pathogens and treat aversion to cold; Huang Qin (Scutellariae Radix), Shi Gao (Gypsum Fibrosum), and Zhi Mu (Anemarrhenae Rhizoma) are used to clear heat and treat interior heat; Guang Pi (Citri Reticulatae Pericarpium) and Gan Cao (Glycyrrhizae Radix et Rhizoma) are used to harmonize Middle Jiao Qi (Middle Burner Energy). Thus, the alternating chills and fever, along with profuse sweating, involving the three Yang channels can be completely resolved through one method of harmonization. The book *Zhunsheng* records that this formula treats malaria with alternating chills and fever of the three Yang channels during summer and autumn, deeply grasping this principle.
In Shanghan disease (Cold Damage Disease), after more than ten days, if exterior heat condenses into the interior and recurrent alternating chills and fever reappear, Da Chaihu Tang (Major Bupleurum Decoction) is indicated.
After more than ten days, if exterior heat has condensed into the interior, purgation is already indicated. However, due to the presence of recurrent alternating chills and fever, which are Shaoyang Channel symptoms, one should only use Chaihu Tang to disperse exterior pathogens, adding just one ingredient, Da Huang (Rhei Radix et Rhizoma), to remove interior heat.
In Shanghan disease lasting six or seven days, or following Wind Strike (Wind Attack), if there are recurrent alternating chills and fever, bitter fullness in the chest and hypochondrium, silence with loss of appetite, irritability and a tendency to vomit, or alternatively, irritability in the chest without vomiting, thirst, abdominal pain, hardness and stuffiness under the hypochondrium, palpitations in the epigastrium, difficulty in urination, absence of thirst, slight fever on the body, or cough, Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
This clause is detailed in the Vomiting Section.
If a original Taiyang disease (Taiyang Disease) does not resolve and transitions into the Shaoyang channel, presenting with hypochondriac fullness, dry retching, and recurrent alternating chills and fever, without prior emesis or purgation, and with a deep and tight pulse, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used.
When Taiyang disease transmits to the Shaoyang channel, presenting with hypochondriac fullness, dry retching, and recurrent alternating chills and fever, with a deep, tight, and wiry pulse, both the symptoms and pulse correspond to the Shaoyang channel; therefore, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used.
In Shanghan disease lasting five or six days, after having undergone sweating or purging treatments, if there is slight knotting in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, recurrent alternating chills and fever, and irritability, the disease has not yet resolved; Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is appropriate.
After five or six days, following sweating and purging, if there is slight knotting in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, recurrent alternating chills and fever, and irritability, this indicates that the Taiyang exterior syndrome has not ceased, while the Shaoyang symptoms are urgent. Therefore, Chai Hu (Bupleuri Radix) and Gui Zhi (Cinnamomi Ramulus) are used in combination. Due to the post-sweating and purging state, Gan Jiang (Zingiberis Rhizoma) is slightly added to harmonize the Middle Jiao (Middle Burner).
Xiao Chaihu Tang (Minor Bupleurum Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Shu Ban Xia (Prepared Pinelliae Tuber), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma).
This is Zhang Zhongjing's formula for harmonizing the exterior and interior, and treating alternating chills and fever in the Shaoyang channel. If accompanied by Taiyang symptoms, add Qiang Huo (Notopterygii Rhizoma et Radix); if accompanied by Yangming symptoms, add Ge Gen (Puerariae Lobatae Radix) and Sheng Ma (Cimicifugae Rhizoma); if there is no sweat, add Fang Feng (Saposhnikoviae Radix); if thirsty, remove Ban Xia (Pinelliae Tuber) and add Tian Hua Fen (Trichosanthis Radix); if constipation with abdominal distension and pain, indicating urgent interior excess, add Da Huang (Rhei Radix et Rhizoma); if difficulty in urination, add Mu Tong (Akebiae Caulis); if loose stools, add Chi Fu Ling (Polyporus with Hostwood), named Chai Ling Tang (Bupleurum and Polyporus Decoction). For pain at the temples, add Chuan Xiong (Ligustici Chuanxiong Rhizoma).
Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) - See Fever section.
This formula harmonizes alternating chills and fever of the Taiyang channel. Modifications are detailed in the Fever section.
Gange Shigao Tang (Pueraria and Gypsum Decoction)
Ingredients: Ge Gen (Puerariae Lobatae Radix), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Shi Gao (Gypsum Fibrosum), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma).
This formula combines Sanfang (three formulas): Chaige Jieli Tang (Bupleurum and Pueraria Decoction to Release the Muscle Layer), Gange Shigao Tang (Pueraria and Gypsum Decoction), and Xiao Chaihu Tang (Minor Bupleurum Decoction), to simultaneously resolve the exterior and interior of the Yangming and Shaoyang channels.
Da Chaihu Tang (Major Bupleurum Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Da Huang (Rhei Radix et Rhizoma).
This formula is derived from Xiao Chaihu Tang (Minor Bupleurum Decoction) by removing Ren Shen (Ginseng Radix et Rhizoma) and adding Da Huang (Rhei Radix et Rhizoma), named Da Chaihu Tang (Major Bupleurum Decoction). It treats cases where the Shaoyang exterior syndrome has not ceased, but the interior excess syndrome is urgent, thus using this decoction to simultaneously resolve the exterior and interior.
Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Gui Zhi (Cinnamomi Ramulus), Huang Qin (Scutellariae Radix), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Shao Yao (Paeoniae Radix), Gan Jiang (Zingiberis Rhizoma), Ban Xia (Pinelliae Tuber).
This is essentially the combination of Xiao Chaihu Tang (Minor Bupleurum Decoction) and Guizhi Tang (Cinnamon Twig Decoction), treating Wind Strike of the Taiyang channel complicated by alternating chills and fever of the Shaoyang channel. Extending this logic, Zhang Zhongjing treated stiff neck symptoms with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria) and Mahuang Jia Gegen Tang (Ephedra Decoction plus Puerara), following the same principle.
For symptoms of intermittent chills and fever, laypeople commonly use Xiao Chaihu Tang (Minor Bupleurum Decoction) to harmonize the Shaoyang channel, yet often see no effect. I now advance to seek precision in diagnosis and treatment, realizing that fever and aversion to cold are both Taiyang exterior syndromes. "Intermittent chills" indicate that exterior pathogens desire to emerge but cannot extend fully; "intermittent fever" indicates that pathogenic heat temporarily manifests externally. "Intermittent chills and fever" means pathogenic heat desires to emerge but fails to do so, leading to a struggle between pathogenic factors and healthy Qi, where exterior pathogens have not transcended the surface and perspiration is not thorough. How can the single method of harmonization via Xiao Chaihu Tang (Minor Bupleurum Decoction) treat this! For symptoms simulating malaria, each episode must end with sweating and cooling of the body; the treatment focuses exclusively on dispersing pathogens, avoiding cold-cooling agents that might suppress them, lest aversion-to-cold exterior symptoms persist until the next cycle. How much less applicable is this to cases of alternating chills and fever without cooling! Lifei Fabiao Tang (Lung-Regulating Exterior-Dispersing Decoction) and Pingwei Fabiao Tang (Spleen-Pacifying Exterior-Dispersing Decoction) are most effective for treating intermittent chills and fever. Formulas are found in the Body Pain section.