柴胡(半斤) 黄芩(半斤洗) 半夏(半斤洗) 人参(三两) 甘草(三两) 生姜(三两) 大枣(十二枚)
上七味以水一斗二升煮取六升去滓再煎取三升温服一升日三服 若胸中烦而不呕去半夏人参加栝蒌实一枚(栝蒌实
涤淤而清烦)若渴者去半夏加人参合前成四两半栝蒌根四两(人参栝蒌根益气而生津清金而止渴)若腹痛者去黄芩加芍
药三两(芍药泄甲木而清相火息风燥而止腹痛)若胁下痞硬去大枣加牡蛎四两(牡蛎软坚而消痞硬)若心下悸小便不利
者去黄芩加茯苓四两(茯苓泄水而去湿湿去则木达风息悸动自安)若不渴外有微热者去人参加桂三两温覆取微似汗愈(桂
枝解太阳之表邪)若咳者去人参大枣生姜加五味子半斤干姜二两(五味子干姜降逆气而止咳)
血弱气尽腠理开邪气因入与正气相搏结于胁下正邪分争往来寒热休作有时默默不欲饮食脏腑相连其痛必下邪高痛下
故使呕也小柴胡汤主之
少阳之病缘太阳阳明之经外感风寒经气郁勃逼侵少阳少阳之经因于二阳之侵血弱气尽腠理开泄二阳经邪因而内入与
本经正气两相搏战经气郁迫结滞胁下少阳之经自头走足脉循胁肋病则经气不降横塞胁肋此胸胁苦满胁下痞硬之故也正气
病则正亦为邪阴郁而为寒是为阴邪阳郁而为热是为阳邪邪正分争休作有时此往来寒热之故也分争之久正气困乏精神衰倦
静默无言饮食不思此默默不欲饮食之故也脾脏胃腑以膜相连一被木邪则胃气上逆脾气下陷脾气既陷则肝气抑遏而克脾土
其痛必在下部此腹中作痛之故也胃土既逆则上脘填塞君火不降浊气涌翻于是心烦而喜呕吐胃土逆则邪高脾下陷则痛下痛
下而邪高此心烦喜呕之故也是皆小柴胡证宜以主之 邪气入内者正气病而成邪是即邪气之内传非必风寒之里入也
柴胡(半斤) 黄芩(半斤,洗净) 半夏(半斤,洗净) 人参(三两) 甘草(三两) 生姜(三两) 大枣(十二枚)
以上七味药,用水一斗二升,煎煮至六升,滤去药渣,再次煎煮浓缩至三升,每次温服一升,每日服用三次。
如果胸中烦闷但不呕吐的,去掉半夏,加入一枚栝蒌实(栝蒌实能涤除瘀滞并清除烦热)。
如果口渴的,去掉半夏,让人参的量增加到四两半,加入栝蒌根四两(人参和栝蒌根能益气生津,清肺金以止渴)。
如果腹痛的,去掉黄芩,加入芍药三两(芍药能疏泄甲木之气,清泻相火,平息风燥以止腹痛)。
如果胁下痞塞硬满的,去掉大枣,加入牡蛎四两(牡蛎能软坚散结以消除痞硬)。
如果心下悸动、小便不利的,去掉黄芩,加入茯苓四两(茯苓能利水渗湿,湿气去除则肝木之气通达,风息则悸动自安)。
如果不口渴且体表有轻微发热的,去掉人参,加入桂枝三两,覆盖衣被使其微微出汗即可痊愈(桂枝能解除太阳经的表邪)。
如果咳嗽的,去掉人参、大枣、生姜,加入五味子半斤、干姜二两(五味子和干姜能降逆气以止咳)。
血气虚弱,正气耗尽,腠理(皮肤纹理及汗孔)开泄,邪气趁机侵入,与正气相互搏结,郁结于胁下。正邪分争,表现为寒热往来,发作有时;神情默默不欲饮食。脏腑相连,疼痛必然向下转移,因为邪气位置高而疼痛位置低,所以导致呕吐。小柴胡汤主治此证。
少阳病是因为太阳、阳明经感受风寒,经气郁勃,逼迫侵扰少阳。少阳经因受二阳之侵,血弱气尽,腠理开泄,二阳经的邪气因而内入,与本经正气相互搏战。经气郁迫结滞于胁下,少阳经脉从头走足,循行经过胁肋,发病时经气不降,横塞于胁肋,这就是胸胁苦满、胁下痞硬的原因。正气生病,则阳气被邪气郁遏而为寒,这是阴邪;阳气郁遏而为热,这是阳邪。正邪分争,休作有时,这就是寒热往来的原因。分争日久,正气困乏,精神衰倦,静默无言,不思饮食,这就是默默不欲饮食的原因。脾脏与胃腑以膜相连,一旦受到木邪(肝胆之邪)侵犯,则胃气上逆,脾气下陷。脾气既已下陷,则肝气抑遏而克制脾土,其疼痛必然在下部,这就是腹中作痛的原因。胃土既已上逆,则上脘填塞,君火不降,浊气涌翻,于是心烦而喜呕吐。胃土逆则邪气位置高,脾下陷则疼痛位置低,痛在下而邪在高,这就是心烦喜呕吐的原因。这些都是小柴胡证的指征,应当以小柴胡汤为主治。邪气内传,是正气生病而转化为邪的表现,这即是邪气的内传,并非一定是风寒之邪直接入里。
Chai Hu (Radix Bupleuri, half jin) Huang Qin (Radix Scutellariae, half jin, washed) Ban Xia (Rhizoma Pinelliae, half jin, washed) Ren Shen (Radix Ginseng, three liang) Gan Cao (Radix Glycyrrhizae, three liang) Sheng Jiang (Rhizoma Zingiberis Recens, three liang) Da Zao (Fructus Jujubae, twelve pieces)
Take the above seven ingredients, boil with one dou and two sheng of water, reduce to six sheng, remove the dregs, and decoct again to obtain three sheng. Take one sheng warm each time, three times a day.
If there is irritability in the chest without vomiting, remove Ban Xia and add one fruit of Gua Lou Shi (Trichosanthis Fructus, which clears turbidity and relieves irritability).
If there is thirst, remove Ban Xia, increase the dosage of Ren Shen to four liang and half, and add Gua Lou Gen (Radix Trichosanthis, four liang; Ren Shen and Gua Lou Gen benefit qi, generate fluids, clear the Metal element, and stop thirst).
If there is abdominal pain, remove Huang Qin and add Shao Yao (Radix Paeoniae Alba, three liang; Shao Yao drains the Wood of Jia, clears ministerial fire, extinguishes wind-dryness, and stops abdominal pain).
If there is fullness and hardness under the hypochondrium, remove Da Zao and add Mu Li (Concha Ostreae, four liang; Mu Li softens hardness and dissipates fullness).
If there is palpitation of the heart and difficulty in urination, remove Huang Qin and add Fu Ling (Poria, four liang; Fu Ling drains water and removes dampness; once dampness is removed, Wood Qi flows freely, wind is extinguished, and palpitations settle naturally).
If there is no thirst but a slight fever on the exterior, remove Ren Shen and add Gui Zhi (Ramulus Cinnamomi, three liang); cover with blankets to induce a slight sweat for recovery (Gui Zhi releases exterior pathogens of the Tai Yang channel).
If there is cough, remove Ren Shen, Da Zao, and Sheng Jiang, and add Wu Wei Zi (Fructus Schisandrae, half jin) and Gan Jiang (Rhizoma Zingiberis Secatus, two liang; Wu Wei Zi and Gan Jiang descend rebellious Qi and stop cough).
When blood is weak and qi is exhausted, the couli (pores and skin texture) open, allowing pathogenic factors to enter. They contend with healthy qi and knot at the hypochondrium. The struggle between healthy qi and pathogenic factors results in alternating chills and fever occurring intermittently, silence, and lack of desire to eat. Since the zang and fu organs are connected, pain must shift downward. Because the pathogen is high and the pain is low, vomiting occurs. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Shaoyang disease arises because external contraction of wind-cold by the Taiyang and Yangming channels causes their qi to become stagnant and oppressive, invading the Shaoyang. Due to this invasion from the two yang channels, blood becomes weak and qi exhausted, causing the couli to open. The pathogens from the Taiyang and Yangming channels then enter internally, contending with the healthy qi of the Shaoyang channel itself. This stagnation and obstruction of channel qi knots at the hypochondrium. The Shaoyang channel runs from head to foot along the hypochondrium; when diseased, its qi fails to descend and blocks horizontally at the hypochondrium, causing bitter fullness in the chest and hypochondrium and hardness under the hypochondrium. When healthy qi is compromised, yang is constrained by pathogenic yin, manifesting as cold (yin pathogen); yang is constrained and manifests as heat (yang pathogen). The intermittent struggle between these forces causes alternating chills and fever. Prolonged struggle exhausts healthy qi, leading to mental fatigue, silence, and anorexia. The spleen and stomach are connected by membranes; invaded by wood-pathogens (liver/gallbladder), stomach qi rebels upward while spleen qi sinks. Sinking spleen qi suppresses liver qi, which attacks spleen earth, causing pain in the lower abdomen. Rebellious stomach qi fills the upper epigastrium, preventing descending junfire and causing turbid qi to surge, resulting in irritability and vomiting. Stomach rebellion places the pathogen high; spleen sinking places pain low; thus irritability and vomiting occur. These are indications of Xiao Chai Hu syndrome, treated primarily with Xiao Chai Hu Tang. Internal transmission of pathogens signifies that healthy qi has become pathological; this is internal transmission, not necessarily direct interior contraction of wind-cold.