伤寒四五日身热恶寒颈项强胁下满手足温而渴者小柴胡汤主之
颈项强是太阳之病而肝胆主司筋脉相火旺则筋脉燥急少阳之经自头下行而循颈项故亦有颈项强证胁下满者少阳之病
手足温者阳明之病四肢秉气于胃胃阳盛旺则手足温而手少阳自手走头足少阳自头走足故亦有手足温证是宜小柴胡汤也
呕而发热者小柴胡汤主之
少阳经气不舒侵迫阳明胃腑胃气上逆必作呕吐相火郁蒸是以发热少阳之经往来寒热此但云发热而不言寒是半表之阳
盛而将传于阳明者是宜小柴胡汤泄其表热也
伤寒六七日发热微恶寒肢节烦疼微呕心下支结外证未去者柴胡桂枝汤主之
太阳病发热恶寒骨节疼痛此发热恶寒肢节烦痛者以太阳之外证未去而相火旺于半表故恶寒不甚甲木侵克戊土土主四
肢故痛在四肢素问太阴阳明论四肢皆秉气于胃胃与四肢气脉流通则疼痛不作胃病而气不四达四肢经络壅滞不行是以痛生
节者四肢之溪谷经气郁遏溪谷填塞故痛在骨节相火郁发是以烦生也少阳经自胃口旁下胁肋故心下支结（支结者旁支偏结
也）经病多而腑少故微呕不甚此皆少阳之病而微见恶寒则太阳之外证未去也宜柴胡合桂枝双解太少之经邪也 小柴胡加
减外有微热者加桂枝此微恶寒即外有微热之互文少阳以相火化气寒往则纯是发热若但热无寒则发热更剧无发热而兼恶寒
者微有恶寒或外热轻微便是太阳外证未去故与桂枝汤合用伤寒而不用麻黄者以其恶寒之微也
伤寒或中风，出现柴胡证，只要见到其中一个症状即可，不必所有症状都具备。
这是总结前两章关于柴胡汤证的论述。
伤寒发病四五日，身体发热、怕冷、颈项强直、胁下胀满、手足温暖且口渴的，用小柴胡汤主治。
颈项强直是太阳经的病证，而肝胆主管筋脉，相火旺盛则筋脉干燥急迫；少阳经脉从头向下行走并循行于颈项，所以也有颈项强直的症状。胁下胀满是少阳经的病证。手足温暖是阳明经的病证，四肢的气血禀受于胃，胃阳旺盛则手足温暖；手少阳经从手走向头，足少阳经从头走向足，所以也有手足温暖的证候。这种情况适宜使用小柴胡汤。
呕吐且发热的，用小柴胡汤主治。
少阳经气机不舒畅，侵扰逼迫阳明胃腑，导致胃气上逆必然发生呕吐；相火郁结蒸腾因此发热。少阳经的病证往来寒热，这里只说发热而不说恶寒，是因为半表之阳气盛旺，即将传入阳明经。这种情况适宜用小柴胡汤来宣泄表热。
伤寒六七日，发热轻微怕冷，肢体关节烦痛，轻微呕吐，心下部有支撑感结聚，外部证候尚未消除的，用柴胡桂枝汤主治。
太阳病表现为发热、怕冷、骨节疼痛。这里的发热、怕冷、肢体关节烦痛，是因为太阳经的外部证候尚未消除，同时相火在半表部位旺盛，所以怕冷并不严重。甲木（胆）侵犯克制戊土（胃），脾主四肢，所以疼痛在四肢。《素问·太阴阳明论》指出四肢都禀受胃气，胃与四肢的气脉流通则疼痛不发生；胃病导致气机不能通达四肢，四肢经络壅滞不通，所以产生疼痛。关节是四肢的溪谷，经气郁结遏制，溪谷填塞，所以疼痛在骨节。相火郁结发作所以产生烦闷。少阳经从胃口旁边向下经过胁肋，所以心下部有支撑感结聚（支结是指旁支偏侧结聚）。少阳经病多涉及经脉而腑病较少，所以呕吐轻微不严重。这些都是少阳经的病证，而轻微怕冷说明太阳经的外部证候尚未消除。适宜用柴胡汤合桂枝汤双解太阳和少阳两经的邪气。小柴胡汤加减法中有“如果有轻微发热加桂枝”，这里的轻微怕冷就是“外部有轻微发热”的互文说法。少阳以相火化生气化，寒气往则纯是发热；如果只有发热没有恶寒，则发热更剧烈；如果没有发热而兼有怕冷，则是轻微怕冷或者外部热象轻微，这就是太阳经外部证候尚未消除，所以与桂枝汤合用。伤寒不用麻黄汤，是因为怕冷很轻微。
Taiyang disease or wind-stroke presenting with Shaoyang (Lesser Yang) syndrome symptoms: if even one of the Chaihu (Bupleurum) syndrome manifestations is observed, it suffices; there is no need for all symptoms to be present.
This summarizes the discussions on various Chaihu syndrome presentations from the preceding two chapters.
In Taiyang disease occurring four or five days after onset, if the patient presents with body heat, aversion to cold, stiffness in the neck and nape, fullness below the costal margin, warmth of the hands and feet, and thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Stiffness in the neck and nape is a symptom of the Taiyang (Greater Yang) channel. The Liver and Gallbladder govern the sinews; when Ministerial Fire (Xiang Huo) is hyperactive, the sinews become dry and tense. The Shaoyang channel descends from the head and follows the neck and nape, hence this symptom also appears in Shaoyang disorders. Fullness below the costal margin is a disorder of the Shaoyang channel. Warmth of the hands and feet is a manifestation of the Yangming (Yang Brightness) channel. The four limbs derive their Qi from the Stomach; when Stomach Yang is vigorous, the hands and feet are warm. The Hand-Shaoyang channel travels from the hand to the head, and the Foot-Shaoyang channel travels from the head to the foot, hence warmth of the hands and feet can also occur. In such cases, Xiao Chai Hu Tang is appropriate.
Vomiting accompanied by fever: Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
When Shaoyang channel Qi fails to circulate freely, it invades and pressures the Yangming Stomach organ, causing Stomach Qi to rebel upward, resulting in vomiting. Ministerial Fire stagnates and steams, leading to fever. Shaoyang channel disorders typically present with alternating chills and fever. Here, only fever is mentioned without chills because the Yang qi at the half-exterior level is abundant and about to transmit into the Yangming stage. It is appropriate to use Xiao Chai Hu Tang to vent the exterior heat.
In Taiyang disease lasting six or seven days, if there is slight fever, mild aversion to cold, vexing pain in the joints and limbs, slight vomiting, subcardiac support and knotting (a sensation of fullness or obstruction under the heart), and the exterior syndrome has not yet resolved, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is the primary treatment.
Taiyang disease presents with fever, aversion to cold, and bone and joint pain. The presence of fever, aversion to cold, and vexing limb/joint pain here indicates that the Taiyang exterior syndrome has not yet resolved, while Ministerial Fire is hyperactive at the half-exterior level, so the aversion to cold is not severe. Jia Wood (Gallbladder) invades and overacts upon Wu Earth (Stomach/Spleen). The Spleen governs the four limbs, hence pain manifests in the limbs. The *Su Wen: Taiyin Yangming Lun* states that the four limbs all derive Qi from the Stomach. If the Qi and vessels of the Stomach and limbs flow smoothly, pain does not arise. If Stomach disease causes Qi to fail to reach the four limbs, the meridians and collaterals of the limbs become obstructed and stagnant, thus generating pain. The joints are the "streams and valleys" (Xi Gu) of the limbs. When channel Qi is depressed and constrained, and the Xi Gu are filled, pain occurs in the bones and joints. The depression and eruption of Ministerial Fire generate vexation. The Shaoyang channel descends laterally from the stomach opening through the hypochondrium, hence there is subcardiac support and knotting (Zhi Jie refers to lateral branch knotting). Shaoyang disorders more often involve the channels than the fu organs, hence vomiting is slight and not severe. These are all Shaoyang disorders. The presence of mild aversion to cold indicates that the Taiyang exterior syndrome has not yet resolved. It is appropriate to combine Chai Hu Tang with Gui Zhi Tang to simultaneously resolve the pathogenic factors of both the Taiyang and Shaoyang channels. In the modification rules for Xiao Chai Hu Tang, "if there is slight heat, add Gui Zhi." The mention of "mild aversion to cold" here is a textual variation corresponding to "slight heat at the exterior." Shaoyang transforms via Ministerial Fire; when cold recedes, it is purely fever. If there is only fever without chills, the fever is more intense. If there is no fever but accompanied by aversion to cold, it indicates mild aversion to cold or slight external heat, signifying that the Taiyang exterior syndrome has not yet resolved; therefore, it is combined with Gui Zhi Tang. Ma Huang Tang (Ephedra Decoction) is not used in Taiyang disease because the aversion to cold is mild.