11. 往来寒热胸胁满, 脉弦目眩而耳聋, 口苦默默不欲食, 心烦喜呕
少阳经, 或渴或咳身微热, 或胁硬痛腹中疼, 或悸不呕尿不利, 舌胎
滑白小柴宗.
【注】脉弦, 谓少阳病脉也. 往来寒热胸胁满, 目眩耳聋, 口苦默默
不欲食, 心烦喜呕, 少阳经主证也. 或渴, 或咳身微热, 或胁硬痛,
腹中疼, 或悸不呕, 尿不利, 舌胎滑白者, 皆少阳或有之证也. 均宜
小柴胡汤主之, 随证加减治之可也. 详少阳篇.
12. 胸烦不呕去参夏, 加蒌若渴半易根, 腹痛去芩加芍药, 心悸尿秘
苓易芩, 胁下痞硬枣易蛎, 不渴微热桂易参, 咳去参枣加干味, 小柴
临证要当斟.
【注】少阳经主证, 宜小柴胡汤主治也. 其或有之证, 务要临证斟酌
加减可也. 若胸中烦而不呕, 去半夏, 人参, 加栝蒌实. 若渴者, 以
半夏易栝蒌根. 若腹中痛, 去黄芩加白芍. 若心下悸, 小便不利者,
加茯苓去黄芩. 若胁下痞硬, 加牡蛎去大枣. 若不渴外有微热者, 去
人参加桂枝微汗之. 若咳者, 去人参, 大枣, 加干姜, 五味子. 义详
少阳篇小柴胡汤下.
13. 少阳三禁要详明, 汗谵吐下悸而惊, 甚则吐下痢不止, 水浆不入
命难生.
【注】三禁, 谓少阳禁吐、 禁汗、禁下也. 若误发汗, 则生谵语, 若
误吐下, 则心悸而惊. 少阳经, 即有心下硬, 不可下, 下之甚, 则下
痢不止. 即有胸中满, 不可吐, 吐之甚, 则水浆不入, 变成危候, 命
难生也. 详少阳篇.
11. 寒热往来,胸胁部胀满,脉象弦细,头晕目眩且耳聋,口苦,神情沉默不欲饮食,心中烦扰且喜欢呕吐。
少阳经病证,有的口渴,有的咳嗽身体微热,有的胁肋硬痛、腹部疼痛,有的心悸但不呕吐、小便不利,舌苔滑白,均属于小柴胡汤的范畴。
【注】脉象弦,是指少阳病的脉象。寒热往来、胸胁胀满、头晕目眩、耳聋、口苦、神情沉默不欲饮食、心中烦扰且喜欢呕吐,是少阳经的主证。有的口渴,有的咳嗽身体微热,有的胁肋硬痛、腹部疼痛,有的心悸不呕吐、小便不利、舌苔滑白的,都是少阳病可能出现的兼证。都应当以小柴胡汤为主治方剂,根据具体症状进行加减治疗即可。详见少阳篇。
12. 若胸中烦闷而不呕吐,则去掉人参和半夏,加入栝蒌实;若口渴,则将半夏替换为栝蒌根(天花粉);若腹部疼痛,则去掉黄芩加入白芍药;若心悸且小便不通利,则将茯苓替换为黄芩(注:此处原文“苓易芩”通常理解为去黄芩加茯苓,或视版本而定,但结合《伤寒论》原意及下文注解说“加茯苓去黄芩”,故翻译依注文逻辑修正为:若心下悸、小便不利者,加茯苓去黄芩);若胁下痞塞坚硬,则将大枣替换为牡蛎;若不口渴且体表有微热,则将人参替换为桂枝以微微发汗;若咳嗽,则去掉人参和大枣,加入干姜和五味子。应用小柴胡汤时临证必须仔细斟酌。
【注】少阳经的主证,适宜用小柴胡汤主治。其可能出现的兼证,务必在临证时斟酌加减。如果胸中烦闷而不呕吐,去掉半夏、人参,加入栝蒌实。如果口渴,用栝蒌根替换半夏。如果腹部疼痛,去掉黄芩加入白芍。如果心下悸动、小便不利,加茯苓去掉黄芩。如果胁下痞塞坚硬,加牡蛎去掉大枣。如果不口渴且体表有微热,去掉人参加入桂枝以微微发汗。如果咳嗽,去掉人参、大枣,加入干姜、五味子。义理详见少阳篇小柴胡汤条下。
13. 少阳病的三种禁忌要详细明了,误用发汗会导致谵语,误用吐法、下法会导致心悸和惊骇,甚至出现下痢不止,水浆无法进入,性命难保。
【注】三禁,是指少阳病禁止使用吐法、禁止使用汗法、禁止使用下法。如果误用发汗,就会产生谵语;如果误用吐法或下法,就会导致心悸和惊骇。少阳经病证,即使有心下硬满,也不可用下法,如果强行攻下,严重的话会导致下痢不止。即使有胸中满闷,也不可用吐法,如果强行催吐,严重的话会导致水浆不入,变成危重证候,性命难以保全。详见少阳篇。
11. Alternating chills and fever, fullness in the chest and hypochondrium, wiry pulse, dizziness, deafness, bitter taste in the mouth, taciturnity with anorexia, vexation and frequent vomiting.
Shaoyang (Lesser Yang) channel diseases may present with thirst, cough with slight fever, hardness and pain in the hypochondrium or abdominal pain, palpitations without vomiting, difficult urination, and a slippery white tongue coating; these all fall under the scope of Xiao Chai Hu Tang (Minor Bupleurum Decoction).
[Note] A wiry pulse refers to the pulse characteristic of Shaoyang disease. Alternating chills and fever, fullness in the chest and hypochondrium, dizziness, deafness, bitter taste, taciturnity with anorexia, vexation, and frequent vomiting are the principal manifestations of Shaoyang channel disease. Thirst, cough with slight fever, hardness and pain in the hypochondrium or abdominal pain, palpitations without vomiting, difficult urination, and a slippery white tongue coating are all possible accompanying symptoms of Shaoyang disease. All should be primarily treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction), with modifications according to specific symptoms. See the Shaoyang Chapter for details.
12. If there is vexation in the chest but no vomiting, remove Ren Shen (Ginseng Radix et Rhizoma) and Ban Xia (Pinelliae Tuber), add Gua Lou Shi (Trichosanthis Fructus); if thirsty, replace Ban Xia (Pinelliae Tuber) with Gua Lou Gen (Trichosanthis Radix); if abdominal pain, remove Huang Qin (Scutellariae Radix) and add Bai Shao (Paeoniae Radix Alba); if palpitations and urinary difficulty, add Fu Ling (Poria) and remove Huang Qin (Scutellariae Radix); if subcostal distension and hardness, replace Da Zao (Jujubae Fructus) with Mu Li (Ostreae Concha); if not thirsty but with slight external heat, remove Ren Shen (Ginseng Radix et Rhizoma) and add Gui Zhi (Cinnamomi Ramulus) to induce slight sweating; if coughing, remove Ren Shen (Ginseng Radix et Rhizoma) and Da Zao (Jujubae Fructus), add Gan Jiang (Zingiberis Rhizoma) and Wu Wei Zi (Schisandrae Fructus). When applying Xiao Chai Hu Tang (Minor Bupleurum Decoction), clinical judgment must be exercised carefully.
[Note] The principal manifestations of Shaoyang channel disease are suitably treated primarily with Xiao Chai Hu Tang (Minor Bupleurum Decoction). For possible accompanying symptoms, modifications must be considered based on clinical presentation. If there is vexation in the chest but no vomiting, remove Ban Xia (Pinelliae Tuber) and Ren Shen (Ginseng Radix et Rhizoma), add Gua Lou Shi (Trichosanthis Fructus). If thirsty, replace Ban Xia (Pinelliae Tuber) with Gua Lou Gen (Trichosanthis Radix). If abdominal pain, remove Huang Qin (Scutellariae Radix) and add Bai Shao (Paeoniae Radix Alba). If epigastric palpitations and difficult urination, add Fu Ling (Poria) and remove Huang Qin (Scutellariae Radix). If subcostal distension and hardness, add Mu Li (Ostreae Concha) and remove Da Zao (Jujubae Fructus). If not thirsty but with slight external heat, remove Ren Shen (Ginseng Radix et Rhizoma) and add Gui Zhi (Cinnamomi Ramulus) to induce slight sweating. If coughing, remove Ren Shen (Ginseng Radix et Rhizoma) and Da Zao (Jujubae Fructus), add Gan Jiang (Zingiberis Rhizoma) and Wu Wei Zi (Schisandrae Fructus). The rationale is detailed under the entry for Xiao Chai Hu Tang (Minor Bupleurum Decoction) in the Shaoyang Chapter.
13. The three prohibitions for Shaoyang disease must be clearly understood: misusing sweating leads to delirious speech, misusing emesis or purging leads to palpitations and fright; severe cases may result in intractable diarrhea, inability to take food or fluids, and death.
[Note] The "three prohibitions" refer to the prohibition of emesis, sweating, and purging in Shaoyang disease. If sweating is mistakenly induced, delirious speech will occur. If emesis or purging is mistakenly used, palpitations and fright will result. In Shaoyang channel disease, even if there is hardness below the heart, purging must not be used; if forced, it may lead to intractable diarrhea. Even if there is fullness in the chest, emesis must not be used; if forced, it may lead to the inability to ingest food or fluids, becoming a critical condition where life is hard to save. See the Shaoyang Chapter for details.