论云。少阳之为病。口苦咽干目眩也。此皆胆火内盛。上走空窍而然。不拘伤寒杂症。以少阳相
火治之。柴芩、栀子、丹皮之类。
邵评∶此症是胆火上升。不拘伤寒杂病。皆当清其相火。
眩。头旋目花也。在少阳。为木火上炎。凡钩藤、天麻、池菊等。均属熄风妙品。宜加入之。
汗吐下后。属虚无疑。
少阳中风。则耳聋无闻。厥阴荣卫不通。耳聋囊缩者死。凡伤寒温疫。耳聋为常
例。然以此可察病之重轻。其耳渐醒。其病渐退。其聋渐甚。其病渐进。
按金鉴云。目眩耳聋。少阳本病。病退自复。若三法后。目眩兼神昏语乱者。乃神散
气脱之候。不治。若误发湿温之汗。以致耳聋不能言语者。名重 。死证也。
邵评∶以耳聋察病之轻重。验其精气之伤与不伤也。惟瘟疫耳聋。不关少阳。治不同例。
少阳有往来寒热。寒已而热作。热已而寒起。相因不已是也。为少阳主证。小柴胡汤。
邵评∶邪与阳争则寒。与阴争则热。在半表半里。则往来寒热。少阳在半表半里。故为主症。
太阳有如疟寒热。寒热无休止之常。日三五发。谓之如疟。此太阳未尽之表邪也。
无汗。宜麻桂各半汤。有汗。宜桂枝二麻黄一汤。热多寒少。宜桂枝二越婢一汤。
若寒热有作止之常。一日一次。或间日一次。谓之疟。不得概以小柴胡治之。（参金鉴）
邵评∶太阳表邪未尽。不可不汗。故用此三方。然亦不可过汗。故用此二方微汗之。
按往来寒热。虽为少阳本病。而所因有三。如少阳自受寒邪。阴气郁遏。初则不能
发热恶寒。至五六日。郁热内发。与寒邪相争。则为往来寒热。一也。或太阳受寒。过
五六日。余邪转属少阳。而为往来寒热。二也。或少阳自受风邪。即为往来寒热。三
也。不得执定从太阳传来。其胸胁苦满。默默不欲饮食。心烦喜呕。此皆少阳本病
也。或烦而不呕。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。此皆少阳或
有之证也。总以小柴胡汤主之。其或有之证。治法悉在本方加减内。须细阅之。（参来苏集）
邵评∶少阳在半表半里。为枢机之经。偏寒偏热。本无一定。故多或然之症。
《伤寒论》论述说：少阳病的主要表现是口苦、咽干、头晕目眩。这些都是因为胆火内盛，向上熏蒸头面空窍所致。无论是伤寒还是杂病，只要属于少阳相火为患，都应当用柴胡、黄芩、栀子、丹皮等药物来治疗。
邵评注：这种症状是胆火上升引起的。无论是伤寒还是杂病，都应当清泄相火。
“眩”，是指头晕眼花。在少阳病中，这是由于木火上炎所致。凡是钩藤、天麻、池菊（菊花）等，都属于熄风止晕的妙药，适宜加入方剂中使用。如果经过发汗、催吐或泻下治疗后出现此症，则属于虚证，这是毫无疑问的。
少阳经受中风邪气，会导致耳聋听不见声音。如果是厥阴经营卫不通，出现耳聋且睾丸收缩的，属于死证。凡是伤寒或温疫，耳聋是常见症状。然而可以通过耳聋的程度来判断病情的轻重：耳朵逐渐恢复听力，说明病情逐渐好转；耳聋逐渐加重，说明病情逐渐恶化。
按语引用《医宗金鉴》的观点：目眩和耳聋是少阳病的本证，病愈后自然会恢复。如果在发汗、催吐、泻下三法之后，除了目眩还伴有神志昏迷、胡言乱语的情况，这是神气涣散、元气脱失的征候，属于不治之症。如果误用发汗法治疗湿温病，导致耳聋且不能言语的，称为“重暍”（zhòng yè），属于死证。
邵评注：通过耳聋来判断病情的轻重，以此验证精气是否受损。只有瘟疫引起的耳聋，与少阳经无关，治疗方法不同。
少阳病有往来寒热的症状，即寒冷过后发热发作，热退之后又起寒冷，交替出现不止。这是少阳病的主证，用小柴胡汤治疗。
邵评注：邪气与阳气相争则恶寒，与阴气相争则发热。病位在半表半里之间，所以表现为往来寒热。少阳经位于半表半里，因此这是其主要症状。
太阳病也有类似疟疾的寒热症状，其特点是寒热发作没有固定的规律，一天发作三五次，称为“如疟”。这是太阳经未尽的表邪。如果没有汗，适宜用麻桂各半汤；如果有汗，适宜用桂枝二麻黄一汤；如果热多寒少，适宜用桂枝二越婢一汤。
如果寒热发作有固定的规律，一天一次，或者隔日一次，这称为疟疾，不能一概用小柴胡汤治疗。（参考《医宗金鉴》）
邵评注：太阳经表邪未尽，不可不发汗，所以使用这三个方剂。但也不可过度发汗，所以使用其中两个方剂以微汗解表。
按语指出：往来寒热虽然是少阳病的本证，但其成因有三种情况：一是少阳经直接感受寒邪，阴气被郁遏，起初不能发热恶寒，到了五六天，郁热在内爆发，与寒邪相争，从而出现往来寒热，这是一；二是太阳经受寒，过了五六天，余邪转入少阳经，而出现往来寒热，这是二；三是少阳经直接感受风邪，随即出现往来寒热，这是三。不能固执地认为一定是从太阳经传变而来。此外，胸胁部胀满不适、神情沉默不欲饮食、心烦喜呕，这些都是少阳病的本证。或者有心烦但不呕吐，或者有口渴，或者有腹痛，或者有胁下痞块硬结，或者有心中悸动、小便不利，或者不渴而身体微热，或者有咳嗽等症状，这些都属于少阳病可能出现的兼证。总体上都以小柴胡汤为主治方剂。对于上述可能出现的兼证，治疗方法都在本方的加减变化之中，需要仔细阅读掌握。（参考《伤寒来苏集》）
The *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: The defining characteristics of Shaoyang disease are bitter taste in the mouth, dryness of the throat, and vertigo. These manifestations result from excessive Fire of the Gallbladder ascending to affect the orifices. Regardless of whether it is a cold damage disorder or an miscellaneous disease, if the pathology involves the Ministerial Fire of Shaoyang, formulas containing Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Danpi (Moutan Cortex) should be employed.
Shaoyang's Commentary: This syndrome is caused by the rising of Gallbladder Fire. Whether in cold damage or miscellaneous diseases, the Ministerial Fire must be cleared.
"Vertigo" refers to dizziness and blurred vision. In Shaoyang disease, this is due to the flaming upward of Wood-Fire. Herbs such as Gouteng (Uncariae Ramulus cum Uncis), Tianma (Gastrodiae Rhizoma), and Chiju (Chrysanthemi Flos) are excellent for extinguishing wind and stopping dizziness, and should be added to prescriptions. If these symptoms appear after diaphoresis, emesis, or purgation, they undoubtedly indicate deficiency.
When Shaoyang channel is struck by Wind pathogen, deafness and inability to hear occur. If Jueyin channel has unblocked Ying and Wei, presenting with deafness and retraction of the testicles, it is a fatal condition. Deafness is a common symptom in cold damage and warm epidemics. However, the degree of deafness can indicate the severity of the disease: gradual recovery of hearing indicates the disease is receding; worsening deafness indicates the disease is progressing.
According to the *Yizong Jinjian* (Golden Mirror of Medical Tradition): Vertigo and deafness are intrinsic to Shaoyang disease and will resolve spontaneously upon recovery. However, if after the three methods (diaphoresis, emesis, purgation), the patient presents with vertigo accompanied by coma and delirious speech, this indicates the dispersion of Spirit and collapse of Qi, which is incurable. If damp-warmth is mistakenly treated with diaphoresis, leading to deafness and aphasia, it is termed "Zhong Ye" (severe heat stroke/toxicity), a fatal syndrome.
Shaoyang's Commentary: Assessing the severity of the disease through deafness verifies whether the Essence and Qi are damaged. Only deafness caused by warm epidemics is unrelated to Shaoyang, and its treatment differs.
Shaoyang disease features alternating chills and fever, where chills cease and fever arises, and fever subsides while chills return, continuing indefinitely. This is the principal syndrome of Shaoyang, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Shaoyang's Commentary: When pathogen contends with Yang, chills occur; when it contends with Yin, fever arises. Located between the exterior and interior, the contention manifests as alternating chills and fever. Since Shaoyang resides at the half-exterior half-interior level, this is its principal symptom.
Taiyang disease also presents with malaria-like chills and fever, characterized by irregular episodes occurring three to five times a day, termed "like malaria." This represents residual exterior pathogen in Taiyang. If there is no sweating, Ma Gui Ge Ban Tang (Half-Mahuang Half-Guizhi Decoction) is indicated. If there is sweating, Gui Zhi Er Ma Huang Yi Tang (Guizhi-Two-Mahuang-One Decoction) is indicated. If heat predominates over cold, Gui Zhi Yue Bi Yi Tang (Guizhi-Two-Yuebi-One Decoction) is indicated.
If chills and fever have a regular rhythm, occurring once daily or every other day, it is classified as Malaria, and cannot be uniformly treated with Xiao Chai Hu Tang. (Refer to *Yizong Jinjian*)
Shaoyang's Commentary: Residual exterior pathogen in Taiyang requires diaphoresis, hence the use of these three formulas. However, excessive sweating must be avoided, hence the use of the latter two formulas to induce mild sweating.
Note: Although alternating chills and fever is the intrinsic syndrome of Shaoyang, there are three etiologies: First, Shaoyang directly receives Cold pathogen, suppressing Yin Qi; initially unable to generate fever or aversion to cold, but by the fifth or sixth day, constrained Heat erupts internally and contends with Cold, causing alternating chills and fever. Second, Taiyang receives Cold, and after five or six days, residual pathogen transfers to Shaoyang, causing alternating chills and fever. Third, Shaoyang directly receives Wind pathogen, immediately resulting in alternating chills and fever. One must not rigidly assume transmission solely from Taiyang. Additionally, fullness and discomfort in the chest and hypochondrium, taciturnity with loss of appetite, irritability, and a tendency to vomit are intrinsic Shaoyang syndromes. Other possible symptoms include irritability without vomiting, thirst, abdominal pain, hardness and fullness under the ribs, palpitations with dysuria, absence of thirst with slight body heat, or coughing. These are all possible accompanying syndromes of Shaoyang disease. Generally, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary formula. Treatment for these possible accompanying syndromes is found within the modifications of this base formula, which must be studied carefully. (Refer to *Shanghan Laisu Ji*)
Shaoyang's Commentary: Shaoyang is located at the half-exterior half-interior level and serves as the pivot mechanism of the channels. It lacks fixed patterns of cold or heat, thus often presenting with variable or contingent symptoms.