黄连三两 甘草（炙）三两 干姜三两 人参二两 桂枝三两 半夏（洗）半升 大
枣（擘）十二枚
右七味，以水一斗，煮取六升，去滓，温服，昼三夜二。
【方解】
伤寒邪气入里，因人藏气素有之寒热而化病。如阳明病，□满不大便而呕，舌上白苔
者，以小柴胡汤，及太阳病下之里虚懊□，舌上如苔者，以栀子豉汤之类，是随胸中
有寒，丹田有热化者也。此则随胃中有寒，胸中有热而化，腹中痛欲呕吐，故以是方
主之。君黄连以清胃中之热，臣干姜以温胃中之寒，半夏降逆，佐黄连呕吐可止，人
参补中，佐干姜腹痛可除，桂枝所以安外，大枣所以培中也。然此汤寒温不一，甘苦
并投，故必加甘草协和诸药。此为阴阳相格，寒热并施之治法也。
@@@
太阳病，十日以去，脉浮细而嗜卧者，外已解也。设胸满□痛者，与小柴胡汤；脉但
浮者，与麻黄汤。
【注】
太阳病十日以上无他证，脉浮细而嗜卧者，外邪已解，不须药也。设有胸满□痛等证
，则知少阳之外邪未解，故与小柴胡汤和之。若脉但浮不细，而有头痛发热恶寒无汗
等证，则仍是太阳之外邪未解，当与麻黄汤汗之。
【按】
论中脉浮细，太阳少阳脉也；脉弦细，少阳脉也；脉沉细，少阴脉也。脉浮细，身热
嗜卧者，阳也；脉沉细，身无热嗜卧者，阴也；脉缓细，身和嗜卧者已解也。是皆不
可不察也。
【集注】
王肯堂曰：此条当是太阳、少阳合病。胸满虽同，而脉浮细嗜卧，则为表邪已解，□
痛为少阳有邪，故与小柴胡汤。若脉但浮者，又当先治太阳也，故与麻黄汤。此是设
为变通之言，非为服柴胡而脉浮也。
@@@
伤寒发热，汗出不解，心中痞□，呕吐而下利者，大柴胡汤主之。
【按】
下利之「下」字，当是「不」字，若是「下」字，岂有上吐下利，而以大柴胡汤下之
之理乎？
【注】
伤寒发热汗出不解，表尚未已也；心中痞□大便不利，里病又急矣。呕吐，少阳、阳
明兼有之证也。少阳、阳明两急，心中热结成痞，故以大柴胡汤，外解少阳发热未尽
之表，内攻阳明成实痞□之里也。
【按】
太阳病发热汗出不解，心下痞□，下利不呕吐者，此表里俱虚，桂枝人参汤证也。若
呕吐不利者，此表里俱实，大柴胡汤证也。彼则脉微弱，此则脉必有力也。
@@@
太阳病，过经十余日，反二、三下之，后四、五日，柴胡证仍在者，先与小柴胡汤。
呕不止，心下急，郁郁微烦者，为未解也，与大柴胡汤下之则愈。
【注】
太阳病传过三阳之经十余日，医不随经施治，反二、三下之，未致变逆，后四、五日
，惟见少阳寒热往来之柴胡证仍在者，宜先与小柴胡汤解表和里。如或不愈，其呕不
止，心下满急，郁郁微烦，此为少阳表里均未解也，与大柴胡汤下之，攻里和表，自
可愈也。
【集注】
方有执曰：过经与坏病同，不知何逆，而二、三下之，适所以致逆，故曰：反也。下
而又下，阳明虽未伤，而少阳亦未除，故曰：柴胡证仍在也。呕不止，郁郁微烦，乃
邪扰二阳，故曰：未解也。
程知曰：此言过经误下，有用大小柴胡两解法也。盖其人之邪，因屡下而深入，若表
证未罢，必先用小柴胡和其半表，而后可兼攻其里也。
程应旄曰：此条与阳明经呕多，虽有阳明证不可下之条，细细酌量，阳明证呕在上，
而邪亦在膈之上，未入府，故不可下；此条呕不止，心下急，乃邪在膈之下，已属胃
，乃可下也。可下不可下，此等处最不容误也。
林澜曰：呕不止，则半表里证犹在，然心下急，郁郁微烦，必中有燥屎也，非下除之
不可，故以大柴胡兼而行之。
【方解】
伤寒邪气侵入体内，是因为人体脏腑之气原本就有寒热错杂的情况，从而转化为疾病。例如阳明病，出现胸中烦闷、大便不通且呕吐，舌苔白腻的症状，使用小柴胡汤；以及太阳病经过误下导致里虚，心中懊恼不适，舌面像有苔藓覆盖的症状，使用栀子豉汤等方剂，这些都是随着胸中有寒、丹田（下焦）有热而转化的病证。此方则是随着胃中有寒、胸中有热而转化的病证，表现为腹中疼痛、想要呕吐，所以用这个方子来主治。以黄连为君药，清除胃中的热邪；以干姜为臣药，温煦胃中的寒邪；半夏降逆气，辅助黄连使呕吐得以停止；人参补益中气，辅助干姜使腹痛得以消除；桂枝用来安定体表，大枣用来培补中焦脾胃。然而这个汤剂寒热性质不一，甘味和苦味药物并用，所以必须加入甘草来协调各种药物。这是针对阴阳相互格拒、寒热并用的治疗方法。
@@@
太阳病，病程超过十天，脉象浮而细弱，且病人喜欢躺卧的，说明体表的邪气已经解除。如果伴有胸部胀满和疼痛的症状，给予小柴胡汤；如果脉象仅仅浮起，给予麻黄汤。
【注】
太阳病十日以上没有其他症状，脉象浮而细弱，且病人喜欢躺卧的，说明外邪已经解除，不需要用药。如果伴有胸部胀满和疼痛等症状，就知道少阳经的外邪尚未解除，所以用小柴胡汤来和解。如果脉象仅浮而不细，且伴有头痛、发热、恶寒、无汗等症状，则仍然是太阳经的外邪未解，应当用麻黄汤发汗治疗。
【按】
论述中提到脉浮细，是太阳和少阳的脉象；脉弦细，是少阳的脉象；脉沉细，是少阴的脉象。脉浮细，身体发热且喜欢躺卧的，属于阳证；脉沉细，身体无发热且喜欢躺卧的，属于阴证；脉缓细，身体平和且喜欢躺卧的，说明病已解除。这些情况都是不可不仔细辨察的。
【集注】
王肯堂说：这一条应当是太阳和少阳合病。胸部胀满虽然相同，但脉浮细且喜欢躺卧，说明表邪已解，胸痛是因为少阳有邪气，所以给予小柴胡汤。如果脉象仅浮起，又应当先治疗太阳经，所以给予麻黄汤。这是假设性的变通说法，并非指服用柴胡汤后脉象才变浮。
@@@
伤寒发热，出汗后热势不解，心中痞塞不适，呕吐且腹泻的，以大柴胡汤主治。
【按】
“下利”的“下”字，应当是“不”字，如果是“下”字，哪有上吐下泻，却还用大柴胡汤攻下的道理呢？
【注】
伤寒发热，出汗后热势不解，说明表证尚未完全解除；心中痞塞不适且大便不通，里证又很急迫了。呕吐，是少阳和阳明两经兼有的症状。少阳和阳明两经病情都急迫，心中热邪结聚形成痞块，所以用大柴胡汤，向外解除少阳发热未尽的表证，向内攻伐阳明成实的痞塞里证。
【按】
太阳病发热出汗后热势不解，心下痞塞不适，腹泻但不呕吐的，这是表里俱虚，属于桂枝人参汤的证候。如果呕吐且不利（此处依前文逻辑修正为不利或结合语境理解为实证表现，原文注疏对比指出彼为虚为此实），这是表里俱实，属于大柴胡汤的证候。前者脉象微弱，后者脉象必然有力。
@@@
太阳病，病程已过十余日，反而被医生用了二三次攻下法，之后过了四五天，柴胡证仍然存在的，先给予小柴胡汤。如果呕吐不止，心下拘急难受，情绪抑郁且轻微烦躁的，说明病邪未解，给予大柴胡汤攻下即可痊愈。
【注】
太阳病传变经过三阳经十余日，医生不随经施治，反而用了二三次攻下法，未导致严重的变证，之后四五天，只见少阳寒热往来的柴胡证仍然存在，适宜先给予小柴胡汤解表和里。如果不愈，呕吐不止，心下满闷拘急，情绪抑郁且轻微烦躁，这是少阳表里均未解除，给予大柴胡汤攻下，攻里和表，自然可以痊愈。
【集注】
方有执说：过经与坏病类似，不知道是什么逆乱，反而用了二三次攻下法，恰好导致了逆乱，所以说“反”。下了又下，阳明虽未受伤，但少阳邪气也未清除，所以说“柴胡证仍在”。呕吐不止，情绪抑郁且轻微烦躁，是邪气扰乱二阳，所以说“未解”。
程知说：这说明过经误用下法，有用大小柴胡汤两解的方法。大概因为病人的邪气，因为多次攻下而深入，如果表证未罢，必须先用小柴胡汤调和半表，然后才可以兼攻其里。
程应旄说：这一条与阳明经篇中“呕多，虽有阳明证不可下之”的条文，细细斟酌，阳明证的呕吐在上部，邪气也在膈膜之上，未入腑，所以不可下；这一条呕吐不止，心下急迫，是邪气在膈膜之下，已属胃腑，才可以下。可下与不可下，这些地方最不容许出错。
林澜说：呕吐不止，说明半表半里的证候依然存在，然而心下急迫，情绪抑郁且轻微烦躁，其中必有燥屎，非攻下除去不可，所以用大柴胡汤兼而行之。
[Formula Analysis]
Shaoyang (Lesser Yang) pathogenic factors have entered the interior, transforming into disease due to the pre-existing cold-heat complexity in the Zang-Fu organs. For instance, in Yangming disease, with symptoms of chest fullness, constipation, and vomiting, accompanied by a white coating on the tongue, Xiaochaihu Tang (Minor Bupleurum Decoction) is used; similarly, for Taiyang disease where internal deficiency follows improper purgation, leading to vexation and a moss-like coating on the tongue, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) or similar formulas are employed. These cases transform based on cold in the chest and heat in the Dantian (lower Jiao). This formula, however, transforms based on cold in the stomach and heat in the chest, manifesting as abdominal pain and nausea/vomiting; thus, this formula is indicated. Huanglian (Coptidis Rhizoma) serves as the Sovereign herb to clear heat in the stomach; Ganjiang (Zingiberis Rhizoma) serves as the Minister herb to warm cold in the stomach; Banxia (Pinelliae Tuber) descends rebellious Qi, assisting Huanglian to stop vomiting; Renshen (Ginseng Radix et Rhizoma) tonifies the Middle Jiao, assisting Ganjiang to relieve abdominal pain; Guizhi (Cinnamomi Ramulus) stabilizes the exterior; and Dazao (Jujubae Fructus) nourishes the Middle Jiao. Since this decoction contains both cold and warm properties, and sweet and bitter flavors are combined, Gancao (Glycyrrhizae Radix et Rhizoma) must be added to harmonize the various herbs. This represents a treatment method for Yin-Yang mutual rejection and simultaneous application of cold and warm therapies.
@@@
In Taiyang disease, if ten days have passed, the pulse is floating and fine, and the patient prefers lying down, it indicates that the exterior pathogens have resolved. If there is chest fullness and pain, administer Xiaochaihu Tang (Minor Bupleurum Decoction); if the pulse is merely floating, administer Mahuang Tang (Ephedra Decoction).
[Annotation]
If more than ten days have passed in Taiyang disease without other symptoms, and the pulse is floating and fine with the patient preferring rest, the external pathogens have resolved, and no medication is required. If symptoms such as chest fullness and pain are present, it indicates that the Shaoyang (Lesser Yang) exterior pathogens have not yet resolved; therefore, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to harmonize. If the pulse is only floating and not fine, accompanied by headache, fever, aversion to cold, and anhidrosis, the Taiyang exterior pathogens remain unresolved, and Mahuang Tang (Ephedra Decoction) should be used to induce sweating.
[Commentary]
The text mentions that a floating and fine pulse corresponds to Taiyang and Shaoyang; a wiry and fine pulse corresponds to Shaoyang; and a deep and fine pulse corresponds to Shaoyin. A floating and fine pulse with fever and preference for rest indicates a Yang pattern; a deep and fine pulse with no fever and preference for rest indicates a Yin pattern; a slow and fine pulse with a normal body state and preference for rest indicates resolution. All these patterns require careful differentiation.
[Collected Annotations]
Wang Kentang stated: This clause likely refers to a combined Taiyang and Shaoyang disease. Although chest fullness is common, a floating and fine pulse with preference for rest indicates that the exterior pathogens have resolved, while chest pain indicates Shaoyang pathogens; hence, Xiaochaihu Tang (Minor Bupleurum Decoction) is given. If the pulse is merely floating, the Taiyang channel should be treated first, hence Mahuang Tang (Ephedra Decoction) is given. This is a hypothetical statement regarding flexibility, not implying that the pulse becomes floating after taking Chaihu.
@@@
In Shanghan (Cold Damage) with fever, where sweating does not resolve the condition, accompanied by epigastric痞 (stuffiness/oppression), vomiting, and diarrhea, Da Chaihu Tang (Major Bupleurum Decoction) is the primary treatment.
[Commentary]
The character "Xia" (down/below) in "Xiali" (diarrhea) should likely be "Bu" (not). If it were "Xia," it would make no sense to use Da Chaihu Tang (Major Bupleurum Decoction), which has purgative properties, for a case of simultaneous vomiting and diarrhea.
[Annotation]
Shanghan fever with sweating that does not resolve indicates the exterior syndrome is not yet fully resolved; epigastric stuffiness and constipation indicate the interior syndrome is urgent. Vomiting is a symptom involving both Shaoyang (Lesser Yang) and Yangming. With both Shaoyang and Yangming syndromes being urgent, heat accumulates in the heart/epigastrium forming stuffiness; therefore, Da Chaihu Tang (Major Bupleurum Decoction) is used to release the remaining exterior heat of Shaoyang externally and attack the solidified interior stuffiness of Yangming internally.
[Commentary]
In Taiyang disease, if fever persists despite sweating, with epigastric stuffiness but without vomiting, it is a case of deficiency in both exterior and interior, corresponding to Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction). If there is vomiting and constipation/stuffiness, it is a case of excess in both exterior and interior, corresponding to Da Chaihu Tang (Major Bupleurum Decoction). The former presents with a weak pulse, while the latter presents with a forceful pulse.
@@@
In Taiyang disease, after passing through the meridians for more than ten days, if the physician incorrectly applied purgation two or three times, and four or five days later, the Chaihu (Bupleurum) syndrome persists, administer Xiaochaihu Tang (Minor Bupleurum Decoction) first. If vomiting continues incessantly, with epigastric urgency, depression, and slight irritability, indicating the disease has not resolved, administer Da Chaihu Tang (Major Bupleurum Decoction) to purge, and recovery will follow.
[Annotation]
After Taiyang disease has transmitted through the Three Yang meridians for over ten days, if the physician fails to treat according to the meridian progression and instead uses purgation two or three times, causing no severe adverse reactions, and four or five days later, only the Shaoyang alternating chills and fever (Chaihu syndrome) remains, one should first administer Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize the exterior and interior. If it does not resolve, and symptoms include incessant vomiting, epigastric fullness and urgency, depression, and slight irritability, it indicates that both the exterior and interior of Shaoyang are unresolved; administering Da Chaihu Tang (Major Bupleurum Decoction) to purge the interior and harmonize the exterior will lead to recovery.
[Collected Annotations]
Fang Youzhi said: Passing the meridian stage is similar to a damaged disease. Without knowing the specific deviation, applying purgation two or three times causes deviation, hence the term "fan" (contrary/reverse). Repeated purgation injures neither Yangming nor clears Shaoyang, hence "Chaihu syndrome remains." Incessant vomiting, depression, and slight irritability indicate pathogenic disturbance of the Two Yangs, hence "unresolved."
Cheng Zhi said: This illustrates that after passing the meridian stage and incorrect purgation, a dual-resolution method using both Xiao and Da Chaihu Tang may be applicable. Generally, because the pathogen has penetrated deeply due to repeated purgation, if the exterior syndrome is not resolved, one must first use Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize the half-exterior before addressing the interior.
Cheng Yingmao said: Comparing this clause with the Yangming chapter's statement "frequent vomiting, even with Yangming symptoms, prohibits purgation," careful consideration reveals that Yangming vomiting occurs above, with pathogens in the upper diaphragm, not entering the Fu organs, so purgation is prohibited. In this clause, incessant vomiting and epigastric urgency indicate pathogens below the diaphragm, having entered the Stomach, so purgation is permissible. The distinction between permissible and impermissible purgation is critical here.
Lin Lan said: Incessant vomiting indicates the half-exterior/half-interior syndrome persists. However, epigastric urgency, depression, and slight irritability suggest the presence of dry fecal matter, which requires purgation to remove; thus, Da Chaihu Tang (Major Bupleurum Decoction) is used to address both aspects simultaneously.