典藏书目

Treat patients with heat accumulation internally, urgency and intractable vomiting in the epigastrium (heart below), mild depression and irritability, while the Shaoyang syndrome (Shaoyang disease pattern) still persists, by administering Dahuang Huangqi Tang (Major Rhubarb and Bupleurum Decoction) to purge.

Dahuang Huangqi Tang Formula: Chaihu (Bupleuri Radix) half jin, Huangqin (Scutellariae Radix) three liang, Banxia (Pinelliae Rhizoma Preparatum) half sheng, Shaoyao (Paeoniae Radix Alba) three liang, Zhishi (Aurantii Fructus Immaturus) four pieces, Dahuang (Rhei Radix et Rhizoma) two liang, Shengjiang (Zingiberis Rhizoma Recens) five liang, Dazao (Jujubae Fructus) twelve pieces (torn open). The above eight herbs, with water one dou and two sheng, decoct to obtain six sheng, remove the dregs and decoct again, take one sheng warm each time, three times a day.

[Note] Since the Shaoyang syndrome persists and there is additionally an interior excess condition, the method of resolving both exterior and interior for Shaoyang disease is established. Using Xiaochaihu Tang (Minor Bupleurum Decoction) plus Zhishi and Shaoyao continues to resolve the exterior pathogen and harmonize the interior. Removing Renshen (Ginseng Radix et Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) is because the interior is not deficient. Slightly increasing the dose of Dahuang is to purge the accumulated heat. Doubling the amount of Shengjiang is due to intractable vomiting. In this formula, Chaihu combined with doubled Shengjiang rapidly resolves the half-exterior pathogen; Zhishi and Shaoyao combined with a small amount of Dahuang slowly attack the half-interior pathogen. Although termed a "purging method," it is also a harmonizing agent within purging methods.

After six or seven days of Shanghan (Cold Damage), presenting with fever, slight aversion to cold, vexing pain in the limbs and joints, slight vomiting, and a sensation of support and stagnation in the epigastrium, this is a concurrent disease of Taiyang (Greater Yang) and Shaoyang, which should be treated with Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).

Chaihu Guizhi Tang Formula: Chaihu (Bupleuri Radix) four liang, Guizhi (Cinnamomi Ramulus) one liang and half, Renshen (Ginseng Radix et Rhizoma) one liang and half, Gancao (Glycyrrhizae Radix et Rhizoma) one liang, Banxia (Pinelliae Rhizoma Preparatum, washed) two he and half, Huangqin (Scutellariae Radix) one liang and half, Shaoyao (Paeoniae Radix Alba) one liang and half, Dazao (Jujubae Fructus, torn open) six pieces, Shengjiang (Zingiberis Rhizoma Recens, sliced) one liang and half. The above nine herbs, with water seven sheng, decoct to obtain three sheng, remove the dregs, and divide into warm doses.

[Collected Notes] Ke Qin stated: Among Zhang Zhongjing's writings, the two most important formulas are Chaihu Tang and Guizhi Tang. Guizhi Tang resolves the muscle-surface pathogen of Taiyang and can also regulate the muscle-surface of various meridians; Xiaochaihu Tang resolves the half-exterior/half-interior pathogen of Shaoyang and can also harmonize the half-exterior/half-interior of the Three Yang meridians. Therefore, outside the classification of the Six Meridians diseases, there are exclusively terms like "Guizhi Syndrome" and "Chaihu Syndrome," indicating that these two formulas have significant roles and are not confined to specific meridians. For instance, the clause "Yang floating and Yin weak" is Zhang Zhongjing's own annotation for Guizhi Syndrome; the clause "Blood deficiency and Qi exhaustion" is his own annotation for Chaihu Syndrome. Guizhi Syndrome cases can deteriorate into Huabing (mismanaged diseases), and Chaihu Syndrome cases can also become Huabing; Guizhi Syndrome has suspected/ambiguous patterns, and Chaihu Syndrome also has ambiguous patterns. Conditions resembling Guizhi Syndrome but actually being different include leg cramping and chest fullness with hardness. Conditions resembling Chaihu Syndrome but actually being different include thirst with vomiting after drinking or eating, and only wanting to vomit with chest pain and slight diarrhea. This clause describes the period of six or seven days in Shanghan, when chills and fever should normally recede, yet exterior symptoms like fever and aversion to cold appear, along with interior symptoms like epigastric support and stagnation. Since neither exterior nor interior pathogens are resolved, the legal treatment requires simultaneous resolution of both. However, since aversion to cold is slight and fever is also slight, it can be inferred that limb joint pain indicates no severe bone and joint pain throughout the body; slight vomiting implies only slight epigastric stagnation, hence termed "supportive stagnation." Although the exterior syndrome remains, it has lightened; although the interior syndrome appears, it is not severe. Therefore, half the dose of Guizhi Tang is used to disperse the remaining Taiyang pathogen; half the dose of Xiaochaihu Tang is used to resolve the slight Shaoyang stagnation. When there is no thirst and slight body heat, Renshen should legally be removed; however, after six or seven days, although the pathogen is unresolved, the healthy Qi is already deficient, so Renshen is retained. Although external symptoms persist, the disease mechanism manifests in the interior; thus, the formula name places Chaihu before Guizhi, serving as a light agent to simultaneously resolve the Two Yangs (Taiyang and Shaoyang).