葛根汤原方加半夏半升（洗）。煎服法同。
太阳与阳明合病，不下利，前条因下利而知太阳，阳明合病，今既不下利，则合病何从而知？必须从两经
本症，一一对勘，即不下利，而亦可定为合病矣。但呕者，葛根加半夏汤主之。前条太阳误下而成利，则
用芩连治利，因其本属桂枝症而脉促，故止加葛根一味，以解阳明初入之邪。此条乃太阳、阳明合病，故
用葛根汤全方，因其但呕，加半夏一味以止呕，随病立方，各有法度。
发热而呕者如神。
柴胡（半斤） 黄芩 人参 甘草（炙） 生姜（切，各三两） 半夏（半斤） 大枣（十二枚） 上七味，以水
一斗二升，煮取六升，去渣，再煎，此又一法。取三升，温服一升，日三服。此汤除大枣，共廿八两，较今秤亦
五两六钱零，虽分三服，已为重剂，盖少阳介于两阳之间，须兼顾三经，故药不宜轻。去渣再煎者，此方
乃和解之剂，再煎则药性和合，能使经气相融，不复往来出入。古圣不但用药之妙，其煎法俱有精义。
若胸中烦而不呕者，去半夏、人参，不呕，不必用半夏；烦，不可用人参。加栝蒌实一枚。栝蒌实除
胸痹，此小陷胸之法也。若渴者，去半夏。半夏能涤痰湿，即能耗津液。加人参，生津液。合前成四两
半，栝蒌根四两。治消渴。若腹中痛者，去黄芩，苦寒。加芍药三两，除腹痛。若胁下痞硬，去大枣，以其能
补脾胃。加牡蛎四两。《别录》云∶治胁下痞热。若心下悸，小便不利者，去黄芩，加茯苓四两。利小便。若
不渴，外有微热者，去人参，不渴，则津液自足。加桂枝三两。微热则邪留太阳。温覆取微似汗愈。若咳
者，去人参、大枣，二味与嗽非宜。生姜，加干姜故去生姜。加五味子半升，干姜二两，古方治嗽，五味、干
姜必同用，一以散寒邪，一以敛正气，从无单用五味治嗽之法。后人不知用必有害，况伤热、劳祛。火呛，
与此处寒饮犯肺之症又大不同，乃独用五味，收敛风火痰涎，深入肺脏，永难救疗矣！
又按∶小柴胡与桂枝二方，用处极多，能深求其义，则变化心生矣。
论中凡可通用之方，必有加减法。
伤寒五、六日，正当传少阳之期。中风往来寒热。太阳之寒热，寒时亦热，热时亦寒。往来者，寒已而
热，热已而寒也。
胸胁苦满，胸胁为少阳之位。默默不欲饮食，木邪干土。心烦喜呕，木气上逆。或胸中烦而不呕，或渴，
少阳火邪。或腹中痛，木克土。或胁下痞硬，木气填
郁。或心下悸，有痰饮。小便不利，或不渴，有蓄饮。身有微热，太阳未尽。或咳者，肺有皆饮。小柴胡汤
主之。少阳所现之症甚多，柴胡汤所治之症亦不一，加减法具载方末。
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。此条申明所以往来寒热，及不欲食，下痛上呕之故，皆
因正衰邪入，脏腑相牵所致，则立方之意，可推而知矣。小柴胡汤主之。
服柴胡汤已渴者，属阳明也，以法治之。此必先见少阳之症，故用柴胡汤，服后而渴，则转属阳明矣。
伤寒四、五日，身热恶风，颈项强，此是太阳所同。胁下满，此则少阳所独。手足温而渴者，前条之
渴者属阳明，此因胁下满，则虽似阳明，不作阳明治矣。小柴胡汤主之。
伤寒阳脉涩，阴脉弦，法当腹中急痛。先与小建中汤，不瘥者，与小柴胡汤主之。详见桂枝类中。
伤寒、中风，有柴胡证，但见一证便是，不必悉具。少阳与太阳、阳明，相为出入，一证可据，虽有
他证，可兼治矣。凡柴胡汤病证而下之，误治。若柴
胡证不罢者，复与柴胡汤。凡误治而本证未罢，仍用本证之方，他经尽同，不独柴胡证也。必蒸蒸而振，却
复发热汗出而解。邪已陷下，故必振动，而后能达于外。《辨脉法篇》云∶战而汗出者，其人本虚。是以
发战发热汗出，邪仍从少阳而出。
伤寒十三日不解，过经二候。胸胁满而呕，此少阳的症。日晡所，发潮热，此似阳明。已而微利，又现
里症，药乱则症亦乱。此本柴胡症，下之而不得利，今反利者，知医以丸药下之，非其治也。以汤剂利之，不
应；复以丸药利之，是谓重伤。潮热者，实也，先宜小柴胡汤以解外，虽潮热，本属少阳之邪，故仍以柴胡
解外。后以柴胡加芒硝主之。解在后加芒硝汤下。
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。阳气不能
随经而散，故郁结不舒，非药误，即迁延所致。亦坏症之轻者。必有表，复有里也，以上诸症，有表有里，
柴胡汤兼治表里。脉沉亦在里也。脉细者必沉。汗出为阳微，以汗为征。假令纯阴结，不得复有外证，悉入
在里。阴则无汗。此为半在里，半在表也。脉沉为里，汗出为表。脉虽沉紧，细即有紧象。不得为少
阴病，所以然者，阴不得有汗，此为要诀。今头汗出，
故知非少阴也，可与小柴胡汤。设不了了者，得屎而解。得汤而不了了者，以有里症，故大便硬，必通其
大便，而后其病可愈。其通便之法，即加芒硝，及大柴胡等方是也。
阳明病，发潮热，大便溏，小便自可，胸胁满而不去者，与小柴胡汤。阳明潮热乃当下之症，因大
便、小便自可，则里症未具。又胸胁尝满，则邪留少阳无疑，用此汤和解之。
阳明病，胁下硬满，少阳症。不大便，可下。而呕，亦少阳症。舌上白苔者，邪未结于阳明，故舌苔
白，虽不大便，不可下。此要诀也。可与小柴胡汤。上焦得通，津液得下，胃气因和，身 然汗出而解也。
此四句，申明小柴胡之功效如此，所以诸症得之皆愈也。
按∶少阳之外为太阳，里为阳明，而少阳居其间。故少阳之症，有兼太阳者，有兼阳明者，内中见少阳
一症，即可用小柴胡汤，必能两顾得效。仲景所以独重此方也。
阳明中风，脉弦浮大，弦属少阳，浮大属阳明。而短气，腹都满，胁下及心痛，此少阳症。久按之气不
通，鼻干不得汗，嗜卧，此症又似少阴。一身面目悉
黄，小便难，此二症又似太阴。有潮热，此似阳明。耳前后肿。刺之小瘥。外不解。病过十日，脉续浮者，
与小柴胡汤。脉浮虽有里症，邪仍欲外出。脉但浮，无余证者，与麻黄汤。但浮无余症，则里症全无，必从
汗解，故用麻黄汤。
此二条，明阳明中风之症，有里邪用小柴胡，无里邪则用麻黄，总以脉症为凭，无一定法也。若不尿，膀
胱气绝。腹满加哕者，不治。论中阳明篇云∶阳明病，不能食，攻其热必哕。所以然者？胃中虚冷故也。“虚
冷”二字尤明，盖阳微欲尽也。又云∶大吐大下，汗出怫郁，复与之水以发其汗，因得哕。《灵枢》云∶真邪
相攻，气并相逆，故为哕。即呃逆也。《素问》云∶病深者，其声哕。乃肺胃之气隔绝所致，兼以腹满，故不
治。
本太阳病不解，转入少阳者，此为传经之邪也。胁下硬满干呕不能食，往来寒热，以上皆少阳本症。尚未
吐下，脉沉紧者，未吐下，不经误治也，少阳已渐入里，故不浮而沉紧，则弦之甚者，亦少阳本脉。与小柴胡
汤。
呕而发热者，小柴胡汤主之。但发热而非往来寒热，则与太阳、阳明同，惟呕则少阳所独，故亦用此汤。
太阳病，十日以去，脉浮细而嗜卧者，外已解也，设胸满胁痛者，与小柴胡汤，脉但浮者，与麻黄汤。解
见麻黄汤。
伤寒瘥以后，更发热者，小柴胡汤主之。此复症也，非劳复，非女劳复，乃正气不充，余邪未尽，留
在半表半里之间，故亦用小柴胡。复病治法，明着于此，后世议论不一，皆非正治。脉浮者，以汗解之，脉
沉实者，以下解之。复症之中，更当考此二脉。如果脉见浮象，则邪留太阳，当用汗法，如脉见沉实，则
里邪未尽，当用下法。但汗下不着方名者？因汗下之法不一，医者于麻黄、桂枝，及承气、大柴胡等方，对
症之轻重，择而用之，则无不中病矣。
妇人中风，七八日，续得寒热，发作有时，此即下文所谓如疟也。经水适断者，此为热入血室，其血
必结，血因热结，而成瘀矣。故使如疟状，发作有时，小柴胡汤主之。即以治疟之法治之。
又云∶妇人中风，发热恶寒，经水适来，彼云断，此云来。得之七八日，热除而脉迟身凉，外邪内伏。胸
胁下满，如结胸状，谵语者，此为热入血室也。血室为中焦营气之所聚。肝藏血，心主血，营血结滞，则
肝气与心经之气亦凝，故胁满而神昏谵语。当刺期门，
随其实而泻之。期门在乳下第二肋端，去乳头约四寸，肝募也。厥阴、阴维之会，刺入四分，血结则为有形
之症，汤剂一时难效。刺期门以泻厥阴有余之热，则尤亲切而易散。
又云∶妇人伤寒发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室。昼清而夜昏者。血
室属阴，病在阴经也。无犯胃气，及上二焦，必自愈。此为中焦营气之疾，汗下二法，皆非所宜，小柴胡汤∶
刺期门，则其治也。
按∶热入血室之状，此二条为最详，妇人伤寒，此症最多，前条症稍轻，后二条症尤重。男子亦有之。
葛根汤原方中加入半夏半升（洗净）。煎煮和服用方法与前条相同。
太阳经与阳明经同时发病，若没有腹泻，从前一条因腹泻而判断为太阳、阳明合病；现在既然没有腹泻，那么如何得知是两经合病呢？必须根据这两经的本证，逐一对照检查，即使没有腹泻，也可以确定为合病了。但如果出现呕吐症状，就用葛根加半夏汤主治。前一条中太阳病误用下法导致腹泻，所以用黄芩、黄连治疗腹泻，因为患者原本属于桂枝汤证且脉象急促，因此只加入葛根一味药，以解除刚刚侵入阳明的邪气。这一条则是太阳、阳明合病，所以使用葛根汤全方，因为仅有呕吐症状，加入半夏一味药来止呕，随病情变化制定方剂，各有法度。
柴胡（半斤） 黄芩 人参 甘草（炙烤） 生姜（切片，各三两） 半夏（半斤） 大枣（十二枚） 以上七味药，用水一斗二升，煮取六升，去掉药渣，再次煎煮，这是另一种煎法。取三升药液，温服一升，每天三次。此汤除去大枣，共重二十八两，换算成现在的秤也是五两六钱多一点，虽然分三次服用，但已经是重剂，大概是因为少阳经介于两阳之间，必须兼顾三经，所以药量不宜轻。去掉药渣再煎煮的原因在于，此方是和解的药剂，再次煎煮能使药性调和，使经络之气融合，不再往来出入。古代圣人不仅在用药上有妙处，其煎煮方法也都有精深的含义。
如果胸中烦闷但不呕吐的，去掉半夏、人参，不呕吐就不必用半夏；烦闷，不可用人参。加入栝蒌实一枚。栝蒌实能治疗胸痹，这是小陷胸汤的方法。如果有口渴症状的，去掉半夏。半夏能涤除痰湿，即会消耗津液。加入人参，生津液。加上之前的分量共四两半，栝蒌根四两。治疗消渴症。如果腹中疼痛的，去掉黄芩，因其苦寒。加入芍药三两，消除腹痛。如果胁下痞塞硬满的，去掉大枣，因为它能补脾胃。加入牡蛎四两。《神农本草经》记载：治疗胁下痞热。如果心下悸动，小便不利的，去掉黄芩，加入茯苓四两。利小便。如果不渴，体表有轻微发热的，去掉人参，不渴则津液自足。加入桂枝三两。微热说明邪气留在太阳经。盖被保暖使其微微出汗即可痊愈。如果咳嗽的，去掉人参、大枣，这两味药对咳嗽不利。生姜，因为加了干姜所以去掉生姜。加入五味子半升，干姜二两。古方治疗咳嗽，五味子和干姜必须同用，一味用来散寒邪，一味用来敛正气，从来没有单独使用五味子治疗咳嗽的方法。后人不知道必须配合使用会有害处，何况是伤热、劳倦引起的火呛，与此处寒饮犯肺的症状又大不相同，乃至于单独使用五味子，收敛风火痰涎，深入肺脏，永远难以救治了！
又按：小柴胡汤与桂枝汤两个方子，用途极多，能深入研究其义理，就能产生变化之心了。
《伤寒论》中凡是通用的方剂，必定有加减法。
伤寒五六日，正是传变到少阳的时期。中风表现为往来寒热。太阳病的寒热，冷的时候也热，热的时候也冷。往来的意思是，冷过之后热，热过之后冷。
胸胁部苦于胀满，胸胁是少阳经的位置。神情沉默不想饮食，木邪侵犯土。心烦喜欢呕吐，木气上逆。或者胸中烦闷但不呕吐，或者口渴，这是少阳火邪。或者腹中疼痛，木克土。或者胁下痞塞硬满，木气郁结。或者心下悸动，有痰饮。小便不利，或者不渴，有蓄水。身体有轻微发热，太阳经邪气未尽。或者咳嗽的，肺中有痰饮。用小柴胡汤主治。少阳经表现出的症状很多，柴胡汤所治疗的病症也不一，加减法都记载在方剂末尾。
血弱气尽，腠理开泄，邪气趁机进入，与正气相搏结，结聚在胁下。正邪分争，往来寒热，发作有定时，神情沉默不想饮食。脏腑相连，疼痛必然向下。邪气位置高而疼痛位置低，所以引起呕吐。这一条说明了之所以往来寒热，以及不欲食、下痛上呕的原因，都是因为正气衰弱邪气入侵，脏腑相互牵制所致，那么立方剂的用意，可以推知了。用小柴胡汤主治。
服用柴胡汤后感到口渴的，属于阳明病，按照法治之。这一定是先出现少阳的症状，所以用柴胡汤，服药后而口渴，则转属阳明了。
伤寒四五天，身体发热恶风，颈项强直，这是太阳经共同有的症状。胁下满，这是少阳经独有的症状。手足温暖而口渴的，前一条的口渴者属阳明，这一条因为胁下满，所以虽然像阳明病，不按阳明病治疗。用小柴胡汤主治。
伤寒脉象阳部涩，阴部弦，法当腹中急痛。先给予小建中汤，不愈的，用小柴胡汤主治。详见桂枝类方中。
伤寒、中风，有柴胡证，只要见到一个证候就可以，不必全部具备。少阳与太阳、阳明，互相出入，有一个证候可以作为依据，虽然有其它证候，可以兼治。凡是柴胡汤病证误用下法的，若是柴胡证未罢的，再次给予柴胡汤。凡是误治而本证未罢的，仍用本证的方剂，其他经都一样，不只是柴胡证如此。必定会出现蒸蒸发热并战栗，随后又发热汗出而解。邪气已经陷入下部，所以必定振动，然后才能达于体表。《辨脉法篇》说：战栗而汗出的，其人本来虚弱。所以发战发热汗出，邪气仍然从少阳而出。
伤寒十三天未解，超过了一个经的病程。胸胁满而呕，这是少阳的确切症状。下午申时左右，发潮热，这类似阳明病。不久轻微腹泻，又现里证，用药混乱则症状也混乱。这本来是柴胡证，误下而没有得到腹泻，现在反而腹泻的，知道医生用了丸药攻下，这不是正确的治法。如果用汤剂攻下，不应效；再用丸药攻下，这叫重伤。潮热者是实证，先宜用小柴胡汤以解外，虽然潮热，本属少阳之邪，所以仍以柴胡解外。后用柴胡加芒硝汤主治。解表在后，加芒硝汤下。
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，这叫阳微结。阳气不能随经脉而发散，所以郁结不舒，不是药物误治，就是迁延所致。也是坏证中的轻者。一定既有表证，又有里证。以上诸症，有表有里，柴胡汤兼治表里。脉沉也在里。脉细的必定沉。汗出为阳微，以汗为征象。假如是纯阴结，不得再有外证，全都入在里。阴证则无汗。这是半在里，半在表。脉沉为里，汗出为表。脉虽沉紧，细即有紧象。不能诊断为少阴病，之所以这样，是因为阴证不得有汗，这是关键要点。现在头汗出，所以知道不是少阴病，可以给予小柴胡汤。如果服药后仍感觉不爽快，得大便通下而解。得汤后仍不爽快的，因为有里证，所以大便硬，必须通其大便，而后病可愈。其通便的方法，就是加芒硝，及大柴胡等方剂。
阳明病，发潮热，大便溏，小便正常，胸胁满而不去的，与小柴胡汤。阳明潮热本是应当攻下的症状，因为大便、小便正常，则里证未具。又胸胁常满，则邪留少阳无疑，用此汤和解。
阳明病，胁下硬满，这是少阳症。不大便，可下。而呕，也是少阳症。舌上白苔的，邪未结于阳明，所以舌苔白，虽然不大便，不可下。这是关键要点。可与小柴胡汤。上焦通畅，津液下行，胃气因而调和，身体自然汗出而解。这四句，阐明了小柴胡的功效如此，所以各种病症得了它都能痊愈。
按：少阳之外是太阳，里是阳明，而少阳居其间。所以少阳的病证，有兼太阳的，有兼阳明的，内中见到少阳一个症状，即可用小柴胡汤，一定能两顾得效。张仲景所以独重此方的原因。
阳明中风，脉弦浮大，弦属少阳，浮大属阳明。而短气，腹部都满，胁下及心痛，这是少阳症。久按之气不通，鼻干不得汗，嗜卧，这症状又像少阴。一身面目悉黄，小便难，这两个症状又像太阴。有潮热，这像阳明。耳前后肿。针刺后稍好。表证未解。病过十天，脉续浮的，与小柴胡汤。脉浮虽有里证，邪气仍欲外出。脉但浮，无余证的，与麻黄汤。但浮无余症，则里症全无，必从汗解，故用麻黄汤。
这两条，阐明阳明中风的病证，有里邪用小柴胡，无里邪则用麻黄，总以脉症为依据，没有一定之法。若不排尿，膀胱气绝。腹满加哕的，不治。《伤寒论》阳明篇说：阳明病，不能食，攻其热必哕。之所以这样？是因为胃中虚冷。“虚冷”二字尤其明确，大概是阳气微弱欲尽了。又说：大吐大下，汗出怫郁，复与之水以发其汗，因得哕。《灵枢》说：真邪相攻，气并相逆，故为哕。即呃逆也。《素问》说：病深者，其声哕。乃肺胃之气隔绝所致，兼以腹满，故不治。
本太阳病不解，转入少阳的，此为传经之邪。胁下硬满干呕不能食，往来寒热，以上皆少阳本症。尚未吐下，脉沉紧的，未吐下，不经误治也，少阳已渐入里，故不浮而沉紧，则弦之甚者，亦少阳本脉。与小柴胡汤。
呕而发热者，小柴胡汤主治。但发热而非往来寒热，则与太阳、阳明同，惟呕则少阳所独，故亦用此汤。
太阳病，十日以上，脉浮细而嗜卧的，外已解也，设胸满胁痛的，与小柴胡汤，脉但浮的，与麻黄汤。解见麻黄汤。
伤寒病愈以后，更发热的，小柴胡汤主治。这是复症，非劳复，非女劳复，乃正气不充，余邪未尽，留在半表半里之间，故亦用小柴胡。复病治法，明着于此，后世议论不一，皆非正治。脉浮的，以汗解之，脉沉实的，以下解之。复症之中，更当考此二脉。如果脉见浮象，则邪留太阳，当用汗法，如脉见沉实，则里邪未尽，当用下法。但汗下不着方名者？因汗下之法不一，医者于麻黄、桂枝，及承气、大柴胡等方，对症之轻重，择而用之，则无不中病矣。
妇人中风，七八日，续得寒热，发作有时，这就是下文所谓如疟。月经刚断的，此为热入血室，其血必结，血因热结，而成瘀矣。所以使如疟状，发作有时，小柴胡汤主治。即以治疟之法治之。
又说：妇人中风，发热恶寒，月经适来，彼云断，此云来。得之七八日，热除而脉迟身凉，外邪内伏。胸胁下满，如结胸状，谵语的，此为热入血室。血室为中焦营气之所聚。肝藏血，心主血，营血结滞，则肝气与心经之气亦凝，故胁满而神昏谵语。当刺期门，随其实而泻之。期门在乳下第二肋端，去乳头约四寸，肝募也。厥阴、阴维之会，刺入四分，血结则为有形之症，汤剂一时难效。刺期门以泻厥阴有余之热，则尤亲切而易散。
又说：妇人伤寒发热，月经适来，昼日明了，暮则谵语，如见鬼状的，此为热入血室。昼清而夜昏的。无犯胃气，及上二焦，必自愈。此为中焦营气之疾，汗下二法，皆非所宜，小柴胡汤：刺期门，则其治也。
Ge Gen Tang (Kudzu Decoction) original formula plus Ban Xia (Pinelliae Rhizoma, 半夏) half sheng (washed). The decoction and administration method are the same as the previous clause.
Taiyang (Sunshine Meridian) and Yangming (Yang Brightness Meridian) simultaneous disease, without diarrhea. From the previous clause, we knew it was Taiyang-Yangming simultaneous disease because of the diarrhea; now that there is no diarrhea, how do we know it is a simultaneous disease? We must examine the primary symptoms of both meridians one by one. Even without diarrhea, it can be determined as a simultaneous disease. However, if there is vomiting, Ge Gen Jia Ban Xia Tang (Kudzu Decoction with Pinellia) should be used. In the previous clause, Taiyang disease caused diarrhea due to improper purgative treatment, so Huang Qin (Scutellariae Radix, 黄芩) and Lian Zi (Coptidis Rhizoma, 黄连) were used to treat the diarrhea. Because the patient originally had a Gui Zhi Tang (Cinnamon Twig Decoction) pattern and a rapid pulse, only Ge Gen (Puerariae Lobatae Radix, 葛根) was added to resolve the pathogen newly entering Yangming. This clause involves Taiyang-Yangming simultaneous disease, so the full Ge Gen Tang is used. Since there is only vomiting, Ban Xia is added to stop vomiting. Formulas are prescribed according to the disease, each with its own principles.
For fever accompanied by vomiting, this formula works like magic.
Chai Hu (Bupleuri Radix, 柴胡) (half jin), Huang Qin (Scutellariae Radix, 黄芩), Ren Shen (Ginseng Radix, 人参), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草) (roasted), Sheng Jiang (Zingiberis Rhizoma Recens, 生姜) (sliced, three liang each), Ban Xia (Pinelliae Rhizoma, 半夏) (half jin), Da Zao (Jujubae Fructus, 大枣) (twelve pieces). The above seven ingredients are boiled in one dou two sheng of water, reduced to six sheng, dregs removed, and then decocted again. This is another method. Take three sheng, warm and take one sheng, three times a day. Excluding Da Zao, this formula totals twenty-eight liang, which converts to slightly over five liang six qian in modern weights. Although divided into three doses, it is still a heavy dose. This is likely because Shaoyang (Lesser Yang Meridian) is situated between two Yang meridians and must attend to all three meridians, so the dosage should not be light. Removing dregs and decocting again is because this formula is a harmonizing agent; decocting again harmonizes the medicinal properties, allowing meridian qi to blend, preventing alternating entry and exit. Ancient sages not only excelled in medication but also in decoction methods, which hold profound meaning.
If there is chest irritability without vomiting, remove Ban Xia and Ren Shen. No vomiting means Ban Xia is unnecessary; irritability means Ren Shen should not be used. Add one Gua Lou Shi (Trichosanthis Fructus, 瓜蒌实). Gua Lou Shi treats chest bi (obstruction), which is the method of Xiao Xian Xiong Tang (Minor Intra-thoracic Obstruction Decoction). If there is thirst, remove Ban Xia. Ban Xia clears phlegm-dampness but consumes body fluids. Add Ren Shen to generate body fluids. Combined with the previous amount, it becomes four liang and half, plus Gua Lou Gen (Trichosanthis Radix, 瓜蒌根) four liang. Treats xiao ke (wasting-thirst). If there is abdominal pain, remove Huang Qin due to its bitter cold nature. Add Bai Shao (Paeoniae Radix Alba, 白芍) three liang to relieve abdominal pain. If there is hypochondriac fullness and hardness, remove Da Zao because it tonifies spleen and stomach. Add Mu Li (Ostreae Concha, 牡蛎) four liang. *Shen Nong Ben Cao Jing* states: treats hypochondriac fullness-heat. If there is palpitation under the heart and difficult urination, remove Huang Qin and add Fu Ling (Poria, 茯苓) four liang to promote urination. If there is no thirst but slight external heat, remove Ren Shen because no thirst indicates sufficient body fluids. Add Gui Zhi (Cinnamomi Ramulus, 桂枝) three liang. Slight heat indicates pathogen remaining in Taiyang. Cover with blankets to induce slight sweating for cure. If there is cough, remove Ren Shen and Da Zao as they are not suitable for cough. Ginger: since Gan Jiang (Zingiberis Rhizoma, 干姜) is added, Sheng Jiang is removed. Add Wu Wei Zi (Schisandrae Fructus, 五味子) half sheng and Gan Jiang two liang. Ancient formulas for cough always use Wu Wei Zi and Gan Jiang together; one disperses cold pathogen, the other consolidates healthy qi. There is never a method of using Wu Wei Zi alone for cough. Later generations who do not know they must be used together may cause harm. Moreover, fire-cough from heat or labor differs greatly from cold-fluid invading the lung in this context. Using Wu Wei Zi alone to consolidate wind-fire-phlegm-saliva allows it to penetrate deeply into the lungs, making it incurable!
Note: Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Gui Zhi Tang have extensive applications. Deeply understanding their principles leads to flexibility in usage.
In the *Treatise*, any universally applicable formula must have modification methods.
Cold damage on the fifth or sixth day is the period when the disease transmits to Shaoyang. Wind-stroke presents with alternating chills and fever. Taiyang chills and fever involve heat during chills and chills during heat. Alternating means after chills comes heat, and after heat comes chills.
Distending fullness in the chest and hypochondrium, as the chest and hypochondrium are the location of Shaoyang. Silent desire not to eat, wood pathogen attacking earth. Mental irritability and frequent vomiting, wood qi reversing upward. Or chest irritability without vomiting, or thirst, indicating Shaoyang fire pathogen. Or abdominal pain, wood overcoming earth. Or hypochondriac fullness and hardness, wood qi stagnation. Or palpitation under the heart, indicating phlegm-fluid retention. Difficult urination, or no thirst, indicating fluid retention. Slight body heat, Taiyang pathogen not yet exhausted. Or cough, indicating phlegm-fluid in the lungs. Use Xiao Chai Hu Tang as the main treatment. Shaoyang presents many symptoms, and the symptoms treated by Chai Hu Tang are not uniform; modification methods are recorded at the end of the formula.
Weak blood and exhausted qi, opening of couli (pores), pathogen enters due to this, combats with healthy qi, knots in the hypochondrium. Healthy and pathogenic qi struggle, causing alternating chills and fever, occurring at specific times, silent desire not to eat. Zang-fu organs are connected, pain must be lower. Pathogen high, pain low, thus causing vomiting. This clause explains the reasons for alternating chills and fever, desire not to eat, lower pain and upper vomiting, all caused by weak healthy qi and invading pathogen, with zang-fu organs pulling each other. Thus, the intent of the formula can be deduced. Use Xiao Chai Hu Tang.
After taking Chai Hu Tang, if thirsty, it belongs to Yangming, treat according to the method. This must have first shown Shaoyang symptoms, hence Chai Hu Tang was used. After taking it, thirst indicates transmission to Yangming.
Cold damage on the fourth or fifth day, body heat and aversion to wind, neck stiffness, these are common to Taiyang. Hypochondriac fullness is unique to Shaoyang. Warm hands and feet with thirst: the thirst in the previous clause belonged to Yangming; this case, due to hypochondriac fullness, although resembling Yangming, is not treated as Yangming. Use Xiao Chai Hu Tang.
Cold damage, yang pulse choppy, yin pulse string-like, law dictates abdominal urgent pain. First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if not cured, use Xiao Chai Hu Tang. See details in Gui Zhi category.
Cold damage or wind-stroke, having Chai Hu syndrome, seeing just one symptom is sufficient, no need for all to be present. Shaoyang interacts with Taiyang and Yangming; one symptom serves as evidence, and even with other symptoms, they can be treated concurrently. For Chai Hu Tang indications improperly treated with purgatives, if Chai Hu syndrome persists, give Chai Hu Tang again. For any improper treatment where the primary syndrome remains, use the formula for the primary syndrome; this applies to all meridians, not just Chai Hu syndrome. There will be steaming fever and shaking, followed by fever and sweating for resolution. Pathogen has sunk downward, hence shaking is necessary to reach the exterior. *Bian Mai Fa Chapter* says: shaking and sweating indicates the person was originally deficient. Thus, shaking, fever, and sweating allow pathogen to exit via Shaoyang.
Cold damage unresolved for thirteen days, passing through two periods. Chest and hypochondriac fullness with vomiting, this is a definite Shaoyang symptom. Tidal fever at dusk, resembling Yangming. Subsequently slight diarrhea, showing interior syndrome. Chaotic medication leads to chaotic symptoms. This was originally a Chai Hu syndrome; purging did not cause diarrhea, but now there is diarrhea. We know the doctor used pill-based purgatives, which is incorrect treatment. Using liquid medicine for purging would not work; using pills again causes severe injury. Tidal fever indicates excess. First use Xiao Chai Hu Tang to resolve the exterior. Although tidal fever, it fundamentally belongs to Shaoyang pathogen, so still use Chai Hu to resolve the exterior. Then use Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Mirabilite). Resolution follows with Mang Xiao added.
Cold damage on the fifth or sixth day, head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, no desire to eat, hard stool, fine pulse: this is Yang mild knotting. Yang qi cannot disperse along the meridians, thus stagnating and uncomfortable. Not due to medication error, but prolongation. It is a mild form of damaged syndrome. There must be both exterior and interior signs. The above symptoms show both exterior and interior; Chai Hu Tang treats both. Pulse deep is also interior. Fine pulse implies deep. Sweating is Yang mild, indicated by sweat. If it were pure Yin knotting, there would be no exterior signs, all entering the interior. Yin has no sweat. This is half interior, half exterior. Deep pulse is interior, sweating is exterior. Although pulse is deep and tight, fine implies tightness. Cannot be Shaoyin disease. Why? Yin cannot have sweat; this is the key point. Now with head sweating, we know it is not Shaoyin. Can give Xiao Chai Hu Tang. If still uneasy after taking the soup, resolution comes with stool passage. If still uneasy after taking the soup, it is because of interior syndrome, hard stool. Must unblock the stool for cure. The method to unblock stool is adding Mang Xiao, or formulas like Da Chai Hu Tang.
Yangming disease, tidal fever, loose stool, normal urination, persistent hypochondriac fullness: give Xiao Chai Hu Tang. Yangming tidal fever is a sign for purging, but with normal stool and urine, interior syndrome is not complete. Plus persistent hypochondriac fullness indicates pathogen lingering in Shaoyang. Use this formula to harmonize.
Yangming disease, hypochondriac hardness, a Shaoyang symptom. Constipation, purging is possible. Vomiting, also a Shaoyang symptom. White coating on tongue, pathogen not knotted in Yangming, hence white coating. Although constipated, purging is contraindicated. This is a key point. Can give Xiao Chai Hu Tang. Upper jiao opens, fluids descend, stomach qi harmonizes, body sweats naturally and resolves. These four sentences explain the efficacy of Xiao Chai Hu Tang, thus all symptoms are cured by it.
Note: Outside Shaoyang is Taiyang, inside is Yangming, and Shaoyang resides between them. Thus, Shaoyang symptoms may combine with Taiyang or Yangming. Seeing one Shaoyang symptom allows use of Xiao Chai Hu Tang, achieving dual benefit. This is why Zhang Zhongjing highly values this formula.
Yangming wind-stroke, pulse string-like, floating, and large. String-like belongs to Shaoyang, floating-large belongs to Yangming. Shortness of breath, abdominal fullness, hypochondriac and heart pain, these are Shaoyang symptoms. Pressing long reveals qi obstruction. Dry nose, inability to sweat, lethargy, these resemble Shaoyin. Whole body and eyes yellow, difficult urination, these two resemble Taiyin. Tidal fever, resembles Yangming. Swelling around ears. Acupuncture brings slight relief. Exterior unresolved. Disease past ten days, pulse continues to float: give Xiao Chai Hu Tang. Floating pulse with interior signs suggests pathogen still wants to exit. Floating pulse alone without other signs: give Ma Huang Tang (Ephedra Decoction). Only floating without other signs means no interior signs, must resolve via sweating, hence Ma Huang Tang.
These two clauses clarify Yangming wind-stroke symptoms: with interior pathogen use Xiao Chai Hu Tang, without interior pathogen use Ma Huang Tang. Always rely on pulse and symptoms, no fixed method. If unable to urinate, bladder qi exhausted. Abdominal fullness with hiccups: incurable. *Treatise* Yangming chapter says: Yangming disease, inability to eat, attacking heat causes hiccups. Why? Stomach deficiency-cold. "Deficiency-cold" clearly indicates declining Yang qi. Also says: severe vomiting and purging, sweating with oppression, giving water to induce sweating causes hiccups. *Ling Shu* says: true and pathogenic qi attack each other, qi reverses, causing hiccups. Hiccups. *Su Wen* says: deep disease manifests as hiccups. Caused by separation of Lung and Stomach qi, combined with abdominal fullness, hence incurable.
Original Taiyang disease unresolved, transmitting to Shaoyang, this is transmitted pathogen. Hypochondriac hardness, dry retching, inability to eat, alternating chills and fever, all are primary Shaoyang symptoms. Not yet vomited or purged, pulse deep and tight. Not vomited or purged means no iatrogenic error. Shaoyang gradually entering interior, hence not floating but deep and tight, extreme string-like, also a primary Shaoyang pulse. Give Xiao Chai Hu Tang.
Vomiting with fever: Xiao Chai Hu Tang is the main treatment. Fever without alternating chills and fever is similar to Taiyang and Yangming, but vomiting is unique to Shaoyang, hence this formula is used.
Taiyang disease, ten days passed, pulse floating and fine, desire to lie down: exterior resolved. If chest fullness and hypochondriac pain: give Xiao Chai Hu Tang. Pulse only floating: give Ma Huang Tang. Explanation seen in Ma Huang Tang.
After cold damage recovery, subsequent fever: Xiao Chai Hu Tang is the main treatment. This is recurrence, not labor recurrence, not sexual activity recurrence, but insufficient healthy qi, residual pathogen not exhausted, remaining between semi-exterior and semi-interior, hence Xiao Chai Hu Tang is used. Treatment for recurrence is clarified here; later discussions vary, none being correct. Floating pulse: resolve with sweating. Deep-solid pulse: resolve with purging. In recurrence, examine these two pulses. If floating, pathogen remains in Taiyang, use sweating method. If deep-solid, interior pathogen not exhausted, use purging method. But sweating/purging without specifying formula names? Because methods vary. Physicians choose among Ma Huang, Gui Zhi, Cheng Qi, Da Chai Hu, etc., based on severity, ensuring effectiveness.
Woman with wind-stroke, seven or eight days, subsequent chills and fever, occurring at times, this is what follows as malaria-like. Menstruation just stopped: this is heat entering blood chamber, blood must knot, blood knots due to heat, becoming stasis. Hence malaria-like symptoms, occurring at times. Xiao Chai Hu Tang is the main treatment. Treat malaria method accordingly.
Also says: Woman with wind-stroke, fever and aversion to cold, menstruation just started. Previous said stopped, this says started. Seven or eight days later, heat gone, pulse slow, body cool, external pathogen internalized. Hypochondriac fullness, like chest binding, delirium: this is heat entering blood chamber. Blood chamber is gathering place of Ying qi in middle jiao. Liver stores blood, Heart governs blood. Ying-blood stagnation causes Liver qi and Heart meridian qi to condense, hence hypochondriac fullness and mental confusion/delirium. Should puncture Qi Men (Liv-14), draining excess. Qi Men is below nipple, second rib end, about four cun from nipple, Liver Mu point. Meeting of Jueyin and Yin Wei meridians. Insert four fen. Blood knotting forms tangible symptoms, decoctions difficult to effect quickly. Puncturing Qi Men drains Jueyin excess heat, most appropriate and easy to dissipate.
Also says: Woman with cold damage fever, menstruation just started. Clear during day, delirious at night, seeing ghosts: this is heat entering blood chamber. Day clear, night dim. Do not violate Stomach qi and upper two jiaos, will self-resolve. This is middle jiao Ying qi disease, sweating and purging methods are inappropriate. Xiao Chai Hu Tang: puncturing Qi Men is the treatment.
Note: Heat entering blood chamber conditions are most detailed in these two clauses. Women with cold damage have this symptom most often. Previous clause symptoms slightly lighter, latter two clauses symptoms heavier. Men also have it.