少气者，热伤气也，加甘草以益气；呕者，热烦而气逆也，加生姜以散气。少气，则气为热搏散而不
收者，甘以补之可也；呕，则气为热搏逆而不散者，辛以散之可也。
发汗、若下之而烦热，胸中窒者，栀子豉汤主之。
阳受气于胸中，发汗若下，使阳气不足，邪热客于胸中，结而不散，故烦热而胸中窒塞，与栀子豉汤以
吐胸中之邪。
伤寒五六日，大下之后，身热不去，心中结痛者，未欲解也，栀子豉汤主之。
伤寒五六日，邪气在里之时，若大下后，身热去，心胸空者，为欲解。若大下后，身热去而心结痛者，结胸
也；身热不去，心中结痛者，虚烦也。结胸为热结（医统本作“客”）胸中，为实，是热气已收敛于内，则外身
热去；虚烦为热客胸中，未结为实，散漫为烦，是以身热不去。六七日为欲解之时，以热为虚烦，
故云未欲解也。与栀子豉汤以吐除之。
伤寒下后，心烦、腹满、卧起不安者，栀子浓朴汤主之。
下后，但腹满而不心烦，即邪气入里为里实；但心烦而不腹满，即邪气在胸中为虚烦。既烦且满，则邪
气壅于胸腹之间也。满则不能坐，烦则不能卧，故（医统本有“令”字）卧起不安。与栀子浓朴汤，吐烦泄满。
栀子浓朴汤方∶
栀子（十四枚，赵本作个，擘。味苦寒） 浓朴（四两，姜炙。赵本作炙，去皮，苦温） 枳实（四枚，
水浸，去穣，炒。，赵本作“炙令黄”，味苦寒）
酸苦涌泄。栀子之苦，以涌虚烦；浓朴枳实之苦，以泄腹满。
以上（赵本作“右”）三味，以水三升半，煮取一升半，去滓，分二服。温进一服，得吐者，止后服。
伤寒，医以丸药大下之，身热不去，微烦者，栀子
干姜汤主之。
丸药不能除热，但损正气。邪气乘虚留于胸中而未入深者，则身热不去而微烦，与栀子干姜汤，吐烦益正气。
栀子干姜汤方∶
栀子（十四枚，赵本作“个”擘。味苦寒） 干姜（二两。味辛热）
苦以涌之，栀子之苦以吐烦。辛以润之，干姜之辛以益气。
上二味，以水三升半，煮取一升半，去滓，分二服。温进一服，得吐者，止后服。
凡用栀子汤，病患旧微溏者，不可与服之。
病患旧微溏者，里虚而寒在下也，虽烦则非蕴热，故不可与栀子汤。《内经》曰∶先泄而后生他病者，
治其本，必且调之，后乃治其他病。
太阳病发汗，汗出不解，其人仍发热，心下悸，头眩，身 动，振振欲擗（赵本注∶“一作僻”）地者，真
武汤主之。（赵本有“真武汤方”详见本书卷六）
发汗不解仍发热，邪气未解也；心下悸、头眩、身 动、振振欲擗地者，汗出亡阳也。里虚为悸，上虚为
眩，经虚为身 振振摇，与真武汤主之，温经复阳。
咽喉干燥者，不可发汗。
津液不足也。
淋家不可发汗，发汗必便血。
膀胱里热则淋，反以汤药发汗，亡耗津液，增益（医统本作“损”）客热，膀胱虚燥，必小便血。
疮家虽身疼痛，不可发汗，发汗则 。（赵本作“汗出则 ”）
表虚聚热，则生疮，疮家身疼如伤寒，不可发汗，发汗则表气愈虚，热势愈甚，生风，故变 也。
衄家不可发汗，汗出必额上陷，脉急紧，直视不能 ，不得眠。
衄者，上焦亡血也。若发汗，则上焦津液枯竭，经络干涩，故额上陷，脉急紧。诸脉者，皆属于目。筋
脉紧急则牵引其目，故直视不能 。 瞬合目也。《针经》曰∶阴气虚则目不
瞑，亡血为阴虚，是以不得眠也。
亡血家，不可发汗，发汗则寒栗而振。
《针经》曰∶夺血者无汗，夺汗者无血。亡血发汗，则阴阳俱虚，故寒栗而振摇。
汗家重发汗，必恍惚心乱，小便已，阴疼，与禹余粮丸，阙。（赵本注∶“方本阙”）
汗者心之液，汗家重发汗，则心虚恍惚心乱；夺汗则无水，故小便已，阴中疼。
病患有寒，复发汗，胃中冷，必吐蛔。（赵本注∶“一作逆”）
病患有寒，则当温散，反发汗，损阳气，胃中冷，必吐蛔也。
本发汗而复下之，此为逆也；若先发汗，治不为逆。本先下之，而反汗之为逆；若先下之，治不为逆。
病在表者，汗之为宜，下之为逆；病在里者，下之为宜，汗之为逆。经曰∶阳盛阴虚，汗之则死，下之
则愈，阳虚阴盛，汗之则愈，下之则死。
伤寒医下之，续得下利，清谷不止，身疼痛者，急当救里；后身疼痛，清便自调者，急当救表。救里宜四
逆汤；救表宜桂枝汤。
伤寒下之，续得下利清谷不止，身疼痛者，急当救里者，以里气不足，必先救之，急与四逆汤。得清便
自调，知里气已和，然后急与桂枝汤以救表，身疼者，表邪也。《内经》曰∶病
发而不足，标而本之，先治其标，后治其本。此以寒为本也。
病发热，头痛，脉反沉，若不瘥，身体疼痛，当救其里，宜四逆汤。（赵本有“四逆汤方”详见本书卷二）
发热头痛，表病也。脉反沉者，里脉也。经曰∶表有病者，脉当浮大；今脉反沉迟，故知愈也。见表病
而得里脉则当瘥，若不瘥，为内虚寒甚也，与四逆汤救其里。
太阳病，先下之（赵本无“之”字）而不愈，因复发汗，以此表里俱虚，其人因致冒，冒家汗出自愈。
所以然者，汗出表和故也。得（赵本无“得”字）里未和，然后复下之。
冒者，郁也，下之则里虚而亡血；汗之则表虚而亡阳。表里俱虚，寒气拂（医统本作“怫”）郁，其人
因致冒。《金匮要略》曰∶亡血复汗，寒多，故令郁冒，汗出则拂（医统本作“怫”）郁之邪得解，则
冒愈。《金匮要略》曰∶冒家欲解，必大汗出。汗出表和而里未和者，然后复下之。
太阳病未解，脉阴阳俱停，（赵本注∶“一作微”）必先振栗，汗出而解。但阳脉微者，先汗出而解；
但阴脉微（赵本注∶“一作尺脉实”）者，下之而解。若欲下之，宜调胃承气汤主之。（赵本无“主之”二
字，又赵本注∶“一云，用大柴胡汤”）
脉阴阳俱停无偏胜者，阴阳气和也。经曰∶寸口、关上、尺中三处，大小浮沉迟数同等，此脉阴阳为
和平，虽剧当愈。今（医统本有“脉”字）阴阳既和，必先振栗汗出而解。但阳脉微者，阳
不足而阴有余也，经曰∶阳虚阴盛，汗之则愈。阴脉微者，阴
不足而阳有余也，经曰∶阳盛阴虚，下之则愈。
太阳病，发热汗出者，此为荣弱卫强，故使汗出，欲救邪风者，宜桂枝汤。
太阳中风，风并于卫，则卫实而荣虚。荣者阴也，卫者阳也。发热汗出，阴弱阳强也。《内经》曰∶阴
虚者阳必凑之，故少气时热而汗出，与桂枝汤解散风邪，调和荣卫。
伤寒五六日，中风，往来寒热，胸胁苦满，默默（赵本作“嘿嘿”）不欲饮食，心烦喜呕，或胸中
烦而不呕，或渴，或腹中痛，或胁下痞硬，或心下悸，小便不利，或不渴，身有微热，或咳者，与小柴胡
汤主之。（赵本无“与”字）
病有在表者，有在里者，有在表里之间者。此邪气在表里之间，谓之半表半里证。五六日，邪气自表传
里之时。中风者，或伤寒至五六日也。《玉函》曰∶中风五六日，伤寒，往来寒热，即是。或中风，或伤寒，
非是伤寒再中风，中风复伤寒也。经曰∶伤寒中风，有柴胡证，但见一证，便是，不必悉具者正是。谓或
中风、或伤寒也。邪在表则寒，邪在里则热。今邪在半表半里之间，未有定处，是以寒热往来也。邪在表，则心
腹不满，邪在里，则心腹胀满。今止言胸胁苦满，知邪气在表里之间，未至于心腹满，言胸胁苦满，知邪气
在表里也。默默，静也。邪在表，则呻吟不安，邪在里，则烦闷乱。《内经》曰∶阳入之阴则静。默默者，
邪方自表之里，在表里之间也。邪在表则能食，邪在里则不能食，不欲食者，邪在表里之间，未至于
必不能食也。邪在表，则不烦不呕，邪在里，则烦满而呕，（医统本有“心”字）烦喜呕者，邪在表方传
里也。邪初入里，未有定处，则所传不一，故有或为之证。有柴胡证，但见一证便是，即是此或为之证。
小柴胡汤方∶
柴胡（半斤。味苦，微寒） 黄芩（三两。味苦寒） 人参（三两。味甘温） 甘草（三两，赵本有“
炙”字。味甘平） 半夏（半升，洗。味辛温） 生姜（三两，切。味辛温） 大枣（十三，赵本医统本并作
“二”，枚，擘。味甘温）
《内经》曰∶热淫于内，以苦发之。柴胡、黄芩之苦，以发传邪之热。里不足者，以甘缓之。人参、甘
草之甘，以缓中和之气。邪半入里则里气逆，辛以散之，半夏以除烦呕；邪半在表，则荣卫争之，辛甘
解之，姜枣以和荣卫。
上七味，以水一斗二升，煮取六升，去滓，再煎，取三升，温服一升，日三服。
后加减法∶（赵本无此四字）
若胸中烦而不呕，（赵本有“者”字）去半夏、人参，加栝蒌实一枚。
胸中烦而不呕，热聚而气不逆也。甘者令人中满，方热聚，无用人参之补；辛散逆气，既不呕，无用半
夏之辛温。热宜寒疗，聚宜苦，栝蒌实苦寒，以泄胸中蕴热。
若渴者，（赵本无“者”字）去半夏，加人参，合前成四两半，栝蒌根四两。
半夏燥津液，非渴者所宜。人参甘而润，栝蒌根苦而凉，彻热生津，二物为当。
若腹中痛者，去黄芩，加芍药三两。
去黄芩恶寒中，加芍药以通壅。
若胁下痞硬，去大枣，加牡蛎四两。
甘，令人中满痞者，去大枣之甘。咸以软之，痞硬者，加牡蛎之咸。
若心下悸，小便不利者，去黄芩，加茯苓四两。
饮而水蓄不行为悸，小便不利。《内经》曰∶肾欲坚。急食苦以坚肾，则水益坚，故去黄芩。淡味渗泄
为阳，茯苓甘淡以泄伏水。
若不渴，外有微热者，去人参，加桂（赵本有“枝”字）三两，温覆取（赵本无“取”字）微汗愈。
不渴者，里和也，故去人参。外有微热，表未解也，加桂以发汗。
若咳者，去人参、大枣、生姜，加五味子半升，干姜二两。
咳者，气逆也。甘则壅气，故去人参、大枣。《内经》曰∶肺欲收，急食酸以收之。五味子之酸，以收
逆气。肺寒则咳，散以辛热，故易生姜以干姜之热也。
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（赵本作“
嘿嘿”）不欲饮食。脏腑相连，其痛必下，邪高痛下，故使呕也。（赵本注∶“一云脏腑相违，其病必下，胁
膈中痛”）小柴胡汤主之。
人之气血随时盛衰，当月郭空之时，则为血弱气尽，腠理开疏之时也。邪气乘虚，伤人则深。《针经》曰∶
月郭空，则海水东盛，人血气虚，卫气去，形独居，肌肉减，皮肤缓，腠理开，毛发残，瞧理薄，（医统本有“
烟”字）垢落，当是时遇贼风，则其入深者是矣。邪因正虚，自表之里，而结于胁下，与正分争，作往来
寒热。默默不欲饮食，此为自外之内。经络与脏腑相连，气随经必传于里，故曰其痛下。痛，一作病。邪在
上焦为邪高，邪渐传里为痛下，里气与邪气相搏，逆而上行，故使呕也。与小柴胡汤，以解半表半里之邪。
服柴胡汤已，渴者，属阳明也，（赵本无“也”字）以法治之。
服小柴胡汤，表邪已而渴，里邪传于阳明也，以阳明治之。
得病六七日，脉迟浮弱，恶风寒，手足温，医二三下之，不能食，而胁下满痛，面目及身黄，颈项强，小便
难者，与柴胡汤。后必下重，本渴，而饮水（赵本作“饮水而呕者”）呕者，柴胡汤不中与也。食谷者哕。
得病六七日，脉迟浮弱，恶风寒，手足温，则邪气在半表半里，未为实，反二三下之，虚其胃气，损其
津液，邪蕴于里，故不能食而胁下满痛。胃虚为热蒸之，熏发于外，面目及身悉黄也。颈项强者，表仍未解
也。小便难者，内亡津液。虽本柴胡汤证，然以里虚，下焦气涩而小便难，若与柴胡汤，又走津液，
后必下重也。不因饮水而呕者，柴胡汤证。若本因饮而呕者，水停心下也。《金匮要略》曰∶先渴却呕者，
为水停心下，此属饮家。饮水者，水停而呕；食谷者，物聚而哕，皆非小柴胡汤所
宜，二者皆柴胡汤之戒，不可不识也。
伤寒四五日，身热恶风，颈项强，胁下满，手足温而渴者，小柴胡汤主之。
身热恶风，颈项强者，表未解也；胁下满而渴者，里不和也。邪在表则手足通热，邪在里则手足厥寒；
今手足温者，知邪在表里之间也。与小柴胡汤以解表里之邪。
伤寒，阳脉涩，阴脉弦，法当腹中急痛者，（赵本无“者”字）先与小建中汤；不瘥者，与小柴胡汤主之。
脉阳涩、阴弦，而腹中急痛者，当作里有虚寒治之，与小建中汤，温中散寒；若不瘥者，非里寒也，必
由邪气自表之里，里气不利所致，与小柴胡汤，去黄芩加芍药，以除传里之邪。
小建中汤方∶
桂枝（三两，去皮。味辛热） 甘草（三赵本作“二”两，炙。味甘平） 大枣（十二枚，擘。味甘
温） 芍药（六两。味酸微寒） 生姜（三两，切。味辛温） 胶饴（一升。味甘温）
少气（气息微弱），是因为热邪损伤了正气，所以加入甘草来补益正气；呕吐，是因为热扰心神导致烦躁且胃气上逆，所以加入生姜来宣散郁结之气。如果少气，说明正气被热邪搏击而耗散不收，用甘味药来补益是合适的；如果呕吐，说明气机被热邪搏击而上逆未散，用辛味药来宣散是合适的。
经过发汗或攻下治疗后，仍然出现烦热、胸中窒塞感的，主治方剂为栀子豉汤（Gardenia and Fermented Soybean Decoction）。
阳气在胸中生成，发汗或攻下后，导致阳气不足，邪热乘虚客居于胸中，郁结不散，所以出现烦热和胸中窒塞感，给予栀子豉汤以涌吐胸中的邪气。
伤寒病五六天，经过猛烈攻下之后，身体发热不退，心中结滞疼痛的，这是病邪尚未解除，主治方剂为栀子豉汤。
伤寒病五六天，是邪气由表入里的时期，如果经过猛烈攻下后，身体发热消退，心胸空虚无不适，这是病情将要解除的表现。如果猛烈攻下后，身体发热不退，心中结滞疼痛，这是结胸证（Jie Xiong Syndrome）；如果身体发热不退，心中结滞疼痛，这是虚烦证（Xu Fan Syndrome）。结胸证是热邪结聚于胸中，属于实证，此时热气已经收敛于内，所以体表发热会消退；虚烦证是热邪客居胸中，尚未结聚成实，热邪散漫导致烦躁，所以体表发热不退。第六七天本是病情欲解的时候，但因为现在是虚烦证，所以说“未欲解”（尚未解除）。给予栀子豉汤以涌吐清除邪气。
伤寒攻下后，出现心烦、腹部胀满、坐卧不安的，主治方剂为栀子厚朴汤（Gardenia, Magnolia Bark, and Immature Bitter Orange Decoction）。
攻下后，如果只是腹部胀满而没有心烦，说明邪气入里形成了里实证；如果只是心烦而没有腹部胀满，说明邪气仍在胸中形成虚烦证。现在既心烦又腹满，说明邪气壅滞于胸腹之间。腹满则不能安坐，心烦则不能安卧，所以坐卧不安。给予栀子厚朴汤，以涌吐除烦，泄下消满。
栀子厚朴汤方：
栀子（十四枚，赵本注作“个”，掰开。性味苦寒） 厚朴（四两，姜汁炙。赵本注作“炙”，去皮，性味苦温） 枳实（四枚，水浸，去瓤，炒。赵本注作“炙令黄”，性味苦寒）
酸苦之性能涌泄。栀子的苦味，用来涌吐虚烦；厚朴、枳实的苦味，用来泄除腹满。
以上三味药，用水三升半，煮取一升半，去渣，分两次服用。温服一次，如果服药后呕吐，停止服用剩下的药。
伤寒病，医生用丸药猛烈攻下，身体发热不退，轻微心烦的，主治方剂为栀子干姜汤（Gardenia and Dried Ginger Decoction）。
丸药不能清除热邪，只会损伤正气。邪气乘虚留滞于胸中而未深入，所以身体发热不退且轻微心烦，给予栀子干姜汤，以涌吐除烦并补益正气。
栀子干姜汤方：
栀子（十四枚，赵本注作“个”，掰开。性味苦寒） 干姜（二两。性味辛热）
苦味能涌泄，栀子的苦味用来涌吐烦热。辛味能润燥益气，干姜的辛味用来补益正气。
以上两味药，用水三升半，煮取一升半，去渣，分两次服用。温服一次，如果服药后呕吐，停止服用剩下的药。
凡是使用栀子汤，如果病人平时大便稀溏的，不可服用。
病人平时大便稀溏，说明里虚且下部有寒，虽然有心烦也不是蕴热所致，所以不可与栀子汤。《内经》说：先腹泻而后发生其他疾病的，治疗其根本，必须先调理脾胃，然后再治疗其他疾病。
太阳病发汗后，汗出后病仍未解，病人仍然发热，心下悸动，头晕目眩，身体震颤动摇，站立不稳像要倒地似的，主治方剂为真武汤（Zhenwu Decoction）。（赵本中有“真武汤方”，详见本书卷六）
发汗后病未解仍发热，说明邪气未解；心下悸、头晕、身体震颤动摇、站立不稳像要倒地，这是汗出过多导致亡阳（Yang Collapse）。里虚导致心悸，上部虚导致眩晕，经络虚导致身体震颤摇动，给予真武汤主治，以温通经脉、恢复阳气。
患有淋证（Lin Syndrome，指小便频数短涩、滴沥刺痛）的人，不可发汗，发汗必然导致尿血。
膀胱里有热则患淋证，反而用汤药发汗，会耗伤津液，增加客居的热邪，导致膀胱虚燥，必然出现小便出血。
患有疮疡（Chuang Yang，指皮肤化脓性感染）的人，即使身体疼痛，也不可发汗，发汗就会导致痉病（Jing Bing，指项背强直、角弓反张等痉挛症状）。（赵本注：“汗出则生痉”）
表虚聚热，就会生疮，疮家身体疼痛如同伤寒，不可发汗，发汗则表气更虚，热势更盛，生风，所以变成痉病。
患有鼻衄（Nu Jue，指经常流鼻血）的人，不可发汗，发汗必然导致额部凹陷，脉象急紧，两眼直视不能闭合，无法入睡。
鼻衄，是上焦失血。如果发汗，则上焦津液枯竭，经络干涩，所以额部凹陷，脉象急紧。所有的脉络都连属于眼睛。筋脉紧急就会牵引眼球，所以两眼直视不能闭合。瞬，指眨眼合目。《针经》说：阴气虚则眼睛不能闭合，失血导致阴虚，所以无法入睡。
亡血（Wang Xue，指失血）的人，不可发汗，发汗会导致寒战颤抖。
《针经》说：夺血者无汗，夺汗者无血。亡血之人再发汗，则阴阳俱虚，所以寒战颤抖。
多汗的人，如果再发汗，必然导致神志恍惚、心中乱，小便结束后，前阴疼痛，给予禹余粮丸（Yuyuliang Pill），但此方已缺。（赵本注：“方本阙”）
汗是心的体液，多汗的人如果再发汗，则心虚导致神志恍惚、心中乱；夺汗则无水，所以小便结束后，阴中疼痛。
病人素有寒疾，又再次发汗，胃中寒冷，必然吐出蛔虫。（赵本注：“一作逆”）
病人素有寒疾，应当温散，反而发汗，损伤阳气，导致胃中寒冷，必然吐出蛔虫。
本来应该发汗却反而攻下，这叫逆治；如果先发汗，治疗就不算逆。本来应该先攻下却反而发汗，这叫逆治；如果先攻下，治疗就不算逆。
病在表，发汗适宜，攻下为逆；病在里，攻下适宜，发汗为逆。经文说：阳盛阴虚，发汗则死，攻下则愈；阳虚阴盛，发汗则愈，攻下则死。
伤寒医生攻下后，接着出现下利清谷（Qing Gu，指泻下不消化的食物）不止，身体疼痛的，应当紧急救里；后来身体疼痛，大小便正常的，应当紧急救表。救里宜用四逆汤（Sini Decoction）；救表宜用桂枝汤（Guizhi Decoction）。
伤寒攻下后，接着出现下利清谷不止，身体疼痛的，应当紧急救里，因为里气不足，必须先救里，紧急给予四逆汤。等到大小便正常，知道里气已调和，然后紧急给予桂枝汤以救表，身体疼痛是表邪所致。《内经》说：病发而正气不足，先治标后治本，先治标，后治本。这里以寒为本。
病人发热，头痛，脉象反而沉，如果病不好转，身体疼痛，应当救其里，宜用四逆汤。（赵本中有“四逆汤方”，详见本书卷二）
发热头痛，是表病。脉象反而沉，是里脉。经文说：表有病，脉应当浮大；现在脉象反而沉迟，所以知道病情变化。见到表病却得到里脉，按理应当好转，如果不好转，说明内虚寒甚，给予四逆汤救其里。
太阳病，先攻下而不愈，因此又发汗，这样表里俱虚，病人因此出现头昏目眩（Mao，指头重如裹、视物模糊的昏蒙状态），冒家出汗后自然痊愈。
之所以这样，是因为出汗后表气调和的缘故。如果里气尚未调和，然后再攻下。
冒，是郁结的意思，攻下则里虚而亡血；发汗则表虚而亡阳。表里俱虚，寒气拂郁，病人因此出现头昏目眩。《金匮要略》说：亡血后又发汗，寒邪多，所以导致郁冒，出汗则拂郁之邪得解，则冒自愈。《金匮要略》说：冒家想要解除，必定是大汗出。出汗后表气和而里未和，然后再攻下。
太阳病未解，脉象寸关尺三部皆隐伏不见（Pulse Yin Yang Ju Ting，指脉搏暂时摸不到），必定先出现寒战，然后出汗而解。如果只有阳脉（寸脉）微，先出汗而解；如果只有阴脉（尺脉）微，攻下而解。如果要攻下，宜用调胃承气汤（Tiaowei Chengqi Decoction）主治。（赵本无“主之”二字，又赵本注：“一云，用大柴胡汤”）
脉象寸关尺三部无偏胜，说明阴阳气和。经文说：寸口、关上、尺中三处，脉的大小浮沉迟数同等，这是脉象阴阳和平，虽然病重也会痊愈。现在阴阳既和，必定先寒战出汗而解。只有阳脉微，是阳不足而阴有余，经文说：阳虚阴盛，发汗则愈。阴脉微，是阴不足而阳有余，经文说：阳盛阴虚，攻下则愈。
太阳病，发热汗出的，这是营弱卫强（Ying Ruo Wei Qiang，指营阴不足而卫阳亢盛），所以导致汗出，想要救治邪风的，宜用桂枝汤。
太阳中风，风邪并入卫分，则卫实而营虚。营属阴，卫属阳。发热汗出，是阴弱阳强。《内经》说：阴虚者阳必凑之，所以少气、时热而汗出，给予桂枝汤解散风邪，调和营卫。
伤寒五六天，中风，往来寒热（Wang Lai Han Re，指恶寒与发热交替出现），胸胁苦满（Xiong Xie Ku Man，指胸胁部胀满不适），默默不欲饮食（Mo Mo Bu Yu Yin Shi，指神情沉默、不想吃东西），心烦喜呕（Xin Fan Xi Ou，指心中烦闷、喜欢呕吐），或者胸中烦而不呕，或者口渴，或者腹中痛，或者胁下痞硬，或者心下悸，小便不利，或者不渴，身体有微热，或者咳嗽的，与小柴胡汤（Xiao Chaihu Tang）主治。（赵本无“与”字）
病有的在表，有的在里，有的在表里之间。这是邪气在表里之间，称为半表半里证（Ban Biao Ban Li Zheng）。五六天，是邪气从表传里的时期。中风，或者是伤寒到了五六天。《玉函》说：中风五六天，伤寒，往来寒热，就是这种情况。或者是中风，或者是伤寒，不是伤寒再中风，中风复伤寒。经文说：伤寒中风，有柴胡证，但见一证便是，不必悉具，正是这个意思。谓或者是中风、或者是伤寒。邪在表则恶寒，邪在里则发热。现在邪在半表半里之间，没有定处，所以寒热往来。邪在表，则心腹不满；邪在里，则心腹胀满。现在只说胸胁苦满，知道邪气在表里之间，未到心腹满的程度。说胸胁苦满，知道邪气在表里之间。默默，是安静的意思。邪在表，则呻吟不安；邪在里，则烦闷乱。《内经》说：阳入之阴则静。默默，是邪气刚从表入里，处于表里之间。邪在表则能食，邪在里则不能食，不欲食，是邪在表里之间，还未到完全不能食的地步。邪在表，则不烦不呕；邪在里，则烦满而呕，心烦喜呕，是邪气从表刚传入里。邪初入里，没有定处，所以传变不一，因此有各种或然证。有柴胡证，但见一证便是，就是指这些或然证。
小柴胡汤方：
柴胡（半斤。性味苦，微寒） 黄芩（三两。性味苦寒） 人参（三两。性味甘温） 甘草（三两，赵本有“炙”字。性味甘平） 半夏（半升，洗。性味辛温） 生姜（三两，切。性味辛温） 大枣（十三枚，赵本医统本并作“二”，掰开。性味甘温）
《内经》说：热淫于内，以苦发之。柴胡、黄芩的苦味，用来发散传入之邪热。里不足者，以甘缓之。人参、甘草的甘味，用来缓和中和之气。邪气半入里则里气逆，辛以散之，半夏用来除烦呕；邪气半在表，则营卫争之，辛甘解之，姜枣用来调和营卫。
以上七味药，用水一斗二升，煮取六升，去渣，再煎，取三升，温服一升，每日三次。
后加减法：（赵本无此四字）
如果胸中烦而不呕，（赵本有“者”字）去掉半夏、人参，加栝蒌实一枚。
胸中烦而不呕，是热聚而气不逆。甘味药令人中满，现在热聚，无用参之补；辛散逆气，既然不呕，无用半夏之辛温。热宜寒疗，聚宜苦泄，栝蒌实苦寒，用来泄除胸中蕴热。
如果口渴，（赵本无“者”字）去掉半夏，加人参，合前成四两半，加栝蒌根四两。
半夏燥津液，不适合口渴者。人参甘而润，栝蒌根苦而凉，彻热生津，这两样药合适。
如果腹中痛，去掉黄芩，加芍药三两。
去掉黄芩以免恶寒伤中，加芍药以通壅滞。
如果胁下痞硬，去掉大枣，加牡蛎四两。
甘味令人中满痞，去掉大枣之甘。咸以软之，痞硬者，加牡蛎之咸。
如果心下悸，小便不利，去掉黄芩，加茯苓四两。
饮停水蓄不行为悸，小便不利。《内经》说：肾欲坚。急食苦以坚肾，则水益坚，所以去掉黄芩。淡味渗泄为阳，茯苓甘淡以泄伏水。
如果不渴，外有微热，去掉人参，加桂枝三两，温覆取微汗愈。（赵本有“枝”字，赵本无“取”字）
不渴，说明里和，所以去掉人参。外有微热，说明表未解，加桂枝以发汗。
如果咳嗽，去掉人参、大枣、生姜，加五味子半升，干姜二两。
咳嗽，是气逆。甘则壅气，所以去掉人参、大枣。《内经》说：肺欲收，急食酸以收之。五味子的酸味，用来收敛逆气。肺寒则咳，散以辛热，所以换生姜为干姜之热。
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。（赵本注：“一云脏腑相违，其病必下，胁膈中痛”）小柴胡汤主之。
人的气血随时间盛衰，当月郭空之时，就是血弱气尽，腠理开疏的时候。邪气乘虚伤人则深。《针经》说：月郭空，则海水东盛，人血气虚，卫气去，形独居，肌肉减，皮肤缓，腠理开，毛发残，腠理薄，垢落，当是时遇贼风，则其入深者是矣。邪因正虚，自表之里，而结于胁下，与正分争，作往来寒热。默默不欲饮食，此为自外之内。经络与脏腑相连，气随经必传于里，故曰其痛下。痛，一作病。邪在上焦为邪高，邪渐传里为痛下，里气与邪气相搏，逆而上行，故使呕也。与小柴胡汤，以解半表半里之邪。
服柴胡汤已，渴者，属阳明也，（赵本无“也”字）以法治之。
服小柴胡汤，表邪已解而渴，是里邪传于阳明，以阳明法治之。
得病六七日，脉迟浮弱，恶风寒，手足温，医二三下之，不能食，而胁下满痛，面目及身黄，颈项强，小便难者，与柴胡汤。后必下重，本渴，而饮水（赵本作“饮水而呕者”）呕者，柴胡汤不中与也。食谷者哕。
得病六七日，脉迟浮弱，恶风寒，手足温，则邪气在半表半里，未为实，反二三下之，虚其胃气，损其津液，邪蕴于里，故不能食而胁下满痛。胃虚为热蒸之，熏发于外，面目及身悉黄也。颈项强者，表仍未解也。小便难者，内亡津液。虽本柴胡汤证，然以里虚，下焦气涩而小便难，若与柴胡汤，又走津液，后必下重也。不因饮水而呕者，柴胡汤证。若本因饮而呕者，水停心下也。《金匮要略》说：先渴却呕者，为水停心下，此属饮家。饮水者，水停而呕；食谷者，物聚而哕，皆非小柴胡汤所宜，二者皆柴胡汤之戒，不可不识也。
伤寒四五日，身热恶风，颈项强，胁下满，手足温而渴者，小柴胡汤主之。
身热恶风，颈项强者，表未解也；胁下满而渴者，里不和也。邪在表则手足通热，邪在里则手足厥寒；今手足温者，知邪在表里之间也。与小柴胡汤以解表里之邪。
伤寒，阳脉涩，阴脉弦，法当腹中急痛者，（赵本无“者”字）先与小建中汤；不瘥者，与小柴胡汤主之。
脉阳涩、阴弦，而腹中急痛者，当作里有虚寒治之，与小建中汤，温中散寒；若不瘥者，非里寒也，必由邪气自表之里，里气不利所致，与小柴胡汤，去黄芩加芍药，以除传里之邪。
小建中汤方：
桂枝（三两，去皮。性味辛热） 甘草（三两，赵本作“二”两，炙。性味甘平） 大枣（十二枚，掰开。性味甘温） 芍药（六两。性味酸微寒） 生姜（三两，切。性味辛温） 胶饴（一升。性味甘温）
Shortness of breath (Qi deficiency) is caused by heat damaging the righteous Qi; therefore, Licorice Root (Gancao, Glycyrrhizae Radix) is added to tonify Qi. Vomiting is caused by heat disturbing the mind leading to irritability and rebellious Stomach Qi; therefore, Fresh Ginger Shengjiang (Shengjiang, Zingiberis Rhizoma Recens) is added to disperse stagnant Qi. If there is shortness of breath, it indicates that righteous Qi has been combated by heat, scattered, and unable to gather; using sweet herbs to tonify is appropriate. If there is vomiting, it indicates that Qi has been combated by heat, rebellious, and not yet dispersed; using pungent herbs to disperse is appropriate.
After sweating or purging therapies, if irritability, heat sensation, and a sensation of obstruction in the chest persist, Gardenia and Fermented Soybean Decoction (Zhizi Chi Tang) is the primary formula.
Yang Qi originates in the chest. Sweating or purging therapies may deplete Yang Qi, allowing pathogenic heat to lodge in the chest, knotting and failing to disperse. This results in irritability, heat sensation, and chest obstruction. Gardenia and Fermented Soybean Decoction is administered to induce vomiting and expel the pathogen from the chest.
In Cold Damage disease, after five or six days, if severe purging is performed and body heat persists accompanied by a knotted pain in the heart region, the disease is not yet resolved. Gardenia and Fermented Soybean Decoction (Zhizi Chi Tang) is the primary formula.
During the fifth or sixth day of Cold Damage, when pathogens are transitioning from the exterior to the interior, if severe purging causes body heat to cease and the chest feels empty, resolution is imminent. However, if severe purging leaves body heat present along with knotted pain in the heart region, this constitutes Chest Binding (Jie Xiong). If body heat persists with knotted pain in the heart region without the characteristics of binding, it is Deficient Irritability (Xu Fan). Chest Binding involves heat knotting in the chest, constituting an Excess condition where heat has converged internally, causing external body heat to subside. Deficient Irritability involves heat lodging in the chest without forming excess knots; the diffuse nature of the heat causes irritability, hence external body heat persists. Although the sixth or seventh day is typically a time for resolution, because this case involves Deficient Irritability, it is stated as "not yet resolved." Gardenia and Fermented Soybean Decoction is given to purge and remove the pathogen.
Following purging in Cold Damage, if irritability, abdominal fullness, and restlessness (inability to lie down or sit comfortably) occur, Gardenia, Magnolia Bark, and Immature Bitter Orange Decoction (Zhizi Houpo Tang) is the primary formula.
After purging, if only abdominal fullness exists without irritability, the pathogen has entered the interior forming an Interior Excess pattern. If only irritability exists without abdominal fullness, the pathogen remains in the chest forming Deficient Irritability. The presence of both irritability and fullness indicates pathogenic qi stagnating between the chest and abdomen. Fullness prevents sitting; irritability prevents lying down; thus, restlessness ensues. Gardenia, Magnolia Bark, and Immature Bitter Orange Decoction is administered to purge irritability and drain fullness.
**Gardenia, Magnolia Bark, and Immature Bitter Orange Decoction Formula:**
Gardenia Fruit (Zhizi, Gardeniae Fructus), fourteen seeds, split (A.Zhao edition notes "ge", bitter and cold in nature).
Magnolia Bark (Houpo, Magnoliae Officinalis Cortex), four liang, ginger-fried (A.Zhao edition notes fried, peeled, bitter and warm in nature).
Immature Bitter Orange (Zhishi, Aurantii Fructus Immaturus), four pieces, soaked in water, pith removed, stir-fried (A.Zhao edition notes "fried until yellow", bitter and cold in nature).
The sour and bitter flavors promote upward expulsion and downward drainage. The bitterness of Gardenia promotes the expulsion of deficient irritability; the bitterness of Magnolia Bark and Immature Bitter Orange drains abdominal fullness.
The above three ingredients are boiled in three and a half sheng of water to yield one and a half sheng. The dregs are removed, and the decoction is divided into two doses. Take one dose warm. If vomiting occurs, stop taking the remaining dose.
In Cold Damage, if a physician uses pill-based purgatives causing severe purging, resulting in persistent body heat and slight irritability, Gardenia and Dried Ginger Decoction (Zhizi Ganjiang Tang) is the primary formula.
Pill-based purgatives fail to clear heat and instead damage righteous Qi. When pathogens take advantage of this deficiency to remain in the chest without penetrating deeply, body heat persists and slight irritability occurs. Gardenia and Dried Ginger Decoction is administered to expel irritability and support righteous Qi.
**Gardenia and Dried Ginger Decoction Formula:**
Gardenia Fruit (Zhizi, Gardeniae Fructus), fourteen seeds, split (A.Zhao edition notes "ge", bitter and cold in nature).
Dried Ginger (Ganjiang, Zingiberis Rhizoma), two liang (pungent and hot in nature).
Bitterness promotes expulsion; the bitterness of Gardenia expels irritability. Pungency moistens and supports; the pungency of Dried Ginger tonifies Qi.
The above two ingredients are boiled in three and a half sheng of water to yield one and a half sheng. The dregs are removed, and the decoction is divided into two doses. Take one dose warm. If vomiting occurs, stop taking the remaining dose.
Generally, when using Gardenia formulas, if the patient has a history of loose stools, they should not be administered.
Patients with a history of loose stools have Interior deficiency and Cold in the lower jiao. Although they may experience irritability, it is not due to accumulated heat; therefore, Gardenia formulas are contraindicated. *Neijing* states: "If diarrhea precedes other diseases, treat the root cause; one must regulate first, then treat other diseases."
In Taiyang disease, if sweating fails to resolve the condition, and the patient still exhibits fever, palpitations in the epigastrium, dizziness, tremors of the body, and a trembling sensation as if about to fall to the ground, True Warrior Decoction (Zhenwu Tang) is the primary formula. (A.Zhao edition contains the "Zhenwu Tang Formula," see Volume 6 of this book.)
Failure to resolve after sweating with persistent fever indicates unresolved pathogens. Palpitations, dizziness, body tremors, and instability indicate Yang collapse due to excessive sweating. Interior deficiency causes palpitations; upper deficiency causes dizziness; channel deficiency causes body tremors. True Warrior Decoction is administered to warm the channels and restore Yang.
If the throat is dry, sweating therapy is contraindicated.
This indicates insufficient body fluids (Jin Ye).
Patients suffering from Strangury (Lin Syndrome, characterized by painful/difficult urination) must not undergo sweating therapy; doing so will inevitably lead to hematuria.
Strangury is caused by Heat in the Bladder. Using herbal decoctions to induce sweating consumes fluids and aggravates exogenous Heat, leading to Bladder deficiency and dryness, inevitably resulting in blood in the urine.
Patients suffering from Sores and Ulcers (Chuang Jia), even if experiencing body pain, must not undergo sweating therapy. Doing so will lead to Wind-Stroke spasms (Jing Bing).
Exterior deficiency with accumulated Heat generates sores. Patients with sores may experience body pain resembling Cold Damage, but sweating is contraindicated. Sweating further depletes Exterior Qi, intensifies Heat, generates Wind, and transforms into spasms.
Patients prone to Epistaxis (Nu Jia) must not undergo sweating therapy. Sweating will cause depression of the supraorbital ridges, tight and rapid pulse, fixed staring gaze inability to blink, and insomnia.
Epistaxis indicates Blood loss in the Upper Jiao. Sweating depletes Upper Jiao fluids, drying the collaterals, causing supraorbital depression and tight pulses. All vessels connect to the eyes. Tight tendons pull the eyes, causing fixed staring and inability to blink. "Shun" refers to blinking. *Zhenjing* states: "Yin deficiency leads to inability to close the eyes." Blood loss causes Yin deficiency, hence insomnia.
Patients with Blood Loss (Wang Xue) must not undergo sweating therapy. Doing so will cause chills and tremors.
*Zhenjing* states: "Those who lose Blood cannot sweat; those who lose Sweat cannot lose Blood." In patients with Blood loss, inducing sweating depletes both Yin and Yang, causing chills and tremors.
Patients prone to sweating, if subjected to repeated sweating, will suffer from mental confusion and palpitations. After urination, they will experience genital pain. Yu Yuliang Pill (Yuyuliang Wan) should be administered, but the formula is missing. (A.Zhao edition note: "Formula originally missing").
Sweat is the fluid of the Heart. Repeated sweating in patients prone to sweating depletes Heart Qi, causing mental confusion. Depletion of fluids leads to post-urinary genital pain.
If a patient with existing Cold conditions undergoes sweating, the Stomach becomes cold, potentially leading to the expulsion of roundworms. (A.Zhao edition note: "One version says 'rebellious'").
Patients with Cold should be treated with warming dispersal. Inducing sweating damages Yang Qi, causing Stomach Cold and potential expulsion of roundworms.
If a condition requiring sweating is mistakenly treated with purging, this is a therapeutic error (Ni). If sweating is performed first, it is not an error. If a condition requiring purging is mistakenly treated with sweating, this is an error. If purging is performed first, it is not an error.
When pathogens are in the Exterior, sweating is appropriate and purging is erroneous. When pathogens are in the Interior, purging is appropriate and sweating is erroneous. The Classics state: "In cases of Excess Yang and Deficient Yin, sweating leads to death, purging leads to recovery. In cases of Deficient Yang and Excess Yin, sweating leads to recovery, purging leads to death."
In Cold Damage, if a physician purges the patient, leading to continuous diarrhea with undigested food (Qing Gu) and persistent body pain, urgent treatment of the Interior is required. Later, if body pain persists but bowel movements normalize, urgent treatment of the Exterior is required. To rescue the Interior, Sini Decoction (Sini Tang) is indicated; to rescue the Exterior, Guizhi Decoction (Guizhi Tang) is indicated.
Following purging in Cold Damage, if continuous diarrhea with undigested food and body pain occur, the Interior must be urgently rescued because Interior Qi is insufficient. Sini Decoction is urgently administered. Once bowel movements normalize, indicating Interior harmony, Guizhi Decoction is urgently administered to rescue the Exterior. Body pain indicates Exterior pathogens. *Neijing* states: "When disease arises with deficiency, treat the branch first, then the root." Here, Cold is the root.
If a patient presents with fever, headache, and a contrary deep pulse (Chen Mai), and symptoms do not improve, accompanied by body pain, the Interior must be rescued using Sini Decoction. (A.Zhao edition contains the "Sini Tang Formula," see Volume 2 of this book.)
Fever and headache indicate Exterior disease. A deep pulse is an Interior pulse. The Classics state: "In Exterior disease, the pulse should be floating and large." A contrary deep and slow pulse suggests a change. While seeing Exterior signs with an Interior pulse might suggest improvement, lack of improvement indicates severe Internal Cold Deficiency. Sini Decoction is given to rescue the Interior.
In Taiyang disease, if initial purging fails and subsequent sweating is attempted, both Exterior and Interior become deficient. The patient may develop Mao syndrome (a state of dizziness/heaviness like being wrapped). Resolution occurs through spontaneous sweating.
This occurs because sweating harmonizes the Exterior. If the Interior is not yet harmonized, purging may be considered subsequently.
"Mao" refers to stagnation. Purging causes Interior deficiency and Blood loss; sweating causes Exterior deficiency and Yang loss. With both Exterior and Interior deficient, Cold Qi stagnates, causing Mao syndrome. *Jingui Yaolue* states: "Blood loss followed by sweating with abundant Cold leads to stagnation and dizziness. Sweating resolves the stagnation, curing Mao." *Jingui Yaolue* also states: "For Mao syndrome to resolve, profuse sweating must occur." Once the Exterior is harmonized by sweating but the Interior remains unharmonized, purging may follow.
In unresolved Taiyang disease, if the pulse at the Cun, Guan, and Chi positions (Yin and Yang) all disappear (Ting Mai), the patient will first experience chills and tremors, followed by sweating and resolution. If only the Exterior pulse (Cun) is slightly visible, sweating resolves it. If only the Interior pulse (Chi) is slightly visible, purging resolves it. For purging, Tiaowei Chengqi Decoction (Tiaowei Chengqi Tang) is indicated. (A.Zhao edition lacks "zhu zhi"; note: "One version says use Dachaihu Tang").
When Yin and Yang pulses are balanced without bias, Harmonious Qi prevails. The Classics state: "When Cun, Guan, and Chi pulses are equal in size, floating/sinking, and speed, Yin and Yang are peaceful; even severe illness will resolve." Now that Yin and Yang are harmonized, chills and sweating precede resolution. A slight Exterior pulse indicates Yang deficiency and Yin excess; the Classics state: "Yang deficiency with Yin excess resolves with sweating." A slight Interior pulse indicates Yin deficiency and Yang excess; the Classics state: "Yang excess with Yin deficiency resolves with purging."
In Taiyang disease, fever and sweating indicate Ying Weakness and Wei Strength (Ying Ruo Wei Qiang). Sweating results from this imbalance. To address pathogenic Wind, Guizhi Decoction (Guizhi Tang) is indicated.
In Taiyang Wind Strike, Wind merges with Wei, making Wei Excess and Ying Deficient. Ying is Yin; Wei is Yang. Fever and sweating indicate Yin weakness and Yang strength. *Neijing* states: "Where Yin is deficient, Yang converges." This causes shortness of breath, intermittent fever, and sweating. Guizhi Decoction is given to dissipate Wind and harmonize Ying and Wei.
In Cold Damage or Wind Strike lasting five to six days, presenting with alternating chills and fever (Wang Lai Han Re), fullness and discomfort in the chest and hypochondrium (Xiong Xie Ku Man), silent desire not to eat (Mo Mo Bu Yu Yin Shi), irritability and frequent vomiting (Xin Fan Xi Ou), or alternatively chest irritability without vomiting, thirst, abdominal pain, hardness under the hypochondrium, palpitations, difficult urination, absence of thirst with slight external heat, or cough, Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary formula. (A.Zhao edition lacks "yu").
Diseases may be in the Exterior, Interior, or between Exterior and Interior. This represents pathogens in the semi-Exterior semi-Interior (Ban Biao Ban Li). Days five to six mark the transition from Exterior to Interior. Whether Wind Strike or Cold Damage, if Chai Hu patterns are present, observing any single symptom suffices; all need not be present. Pathogens in the Exterior cause chills; in the Interior, heat. Between Exterior and Interior, without fixed location, chills and fever alternate. Exterior pathogens do not cause abdominal fullness; Interior pathogens do. Fullness limited to chest/hypochondrium confirms semi-Exterior semi-Interior status. "Mo mo" implies quietness. Exterior pathogens cause groaning; Interior pathogens cause agitation. *Neijing* states: "When Yang enters Yin, there is quietness." Silence indicates pathogens moving from Exterior to Interior. Exterior pathogens allow eating; Interior pathogens prevent it. Lack of appetite indicates semi-Exterior semi-Interior status, not total inability to eat. Exterior pathogens cause no irritability/vomiting; Interior pathogens cause irritability/fullness/vomiting. Irritability and vomiting indicate pathogens just entering the Interior. Early Interior invasion lacks fixed location, causing varied symptoms ("huo" symptoms). Observing one Chai Hu symptom confirms the diagnosis.
**Xiao Chaihu Tang Formula:**
Bupleurum Root (Chaihu, Bupleuri Radix), half jin (bitter, slightly cold).
Scutellaria Root (Huangqin, Scutellariae Radix), three liang (bitter, cold).
Ginseng Root (Renshen, Panacis Ginseng Radix), three liang (sweet, warm).
Licorice Root (Gancao, Glycyrrhizae Radix), three liang, roasted (sweet, neutral).
Pinellia Tuber (Banxia, Pinelliae Rhizoma), half sheng, washed (pungent, warm).
Fresh Ginger (Shengjiang, Zingiberis Rhizoma Recens), three liang, sliced (pungent, warm).
Jujube Fruit (Dazao, Zizyphi Fructus), thirteen pieces, split (sweet, warm).
*Neijing* states: "For heat rampant within, use bitter to release." The bitterness of Chaihu and Huangqin releases transmitted heat. "For Interior insufficiency, use sweet to moderate." The sweetness of Renshen and Gancao moderates Middle Qi. When pathogens enter halfway to the Interior, Interior Qi rebels; pungency disperses, Banxia removes irritability/vomiting. When pathogens remain halfway in the Exterior, Ying and Wei contend; pungent-sweet combinations resolve, Jiang and Zao harmonize Ying and Wei.
The above seven ingredients are boiled in twelve sheng of water to yield six sheng. Dregs are removed, decoction is reheated to yield three sheng. Take one sheng warm, three times daily.
**Modifications:**
If chest irritability without vomiting: Remove Banxia and Renshen; add Trichosanthes Fruit (Gualou Shi), one piece.
Chest irritability without vomiting indicates Heat aggregation without Qi rebellion. Sweet herbs cause fullness; unnecessary for Heat aggregation. Pungent herbs disperse rebellious Qi; unnecessary without vomiting. Trichosanthes Fruit is bitter-cold, draining chest Heat.
If thirst: Remove Banxia; increase Renshen to total four and a half liang; add Trichosanthes Root (Gualou Gen), four liang.
Banxia dries fluids, unsuitable for thirst. Renshen is sweet-moistening; Gualou Gen is bitter-cooling, clearing heat and generating fluids.
If abdominal pain: Remove Huangqin; add White Peony Root (Shaoyao), three liang.
Remove Huangqin to avoid harming Middle Qi with cold; add Shaoyao to unblock stagnation.
If hardness under hypochondrium: Remove Dazao; add Oyster Shell (Muli), four liang.
Sweet herbs cause fullness; remove Dazao. Salty herbs soften hardness; add Muli.
If palpitations and difficult urination: Remove Huangqin; add Poria (Fuling), four liang.
Fluid retention causes palpitations and difficult urination. *Neijing* states: "Kidney desires firmness." Bitter herbs firm the Kidney, retaining water; thus remove Huangqin. Fuling is sweet-bland, draining retained water.
If no thirst with slight external heat: Remove Renshen; add Cinnamon Twig (Guizhi), three liang. Cover warmly to induce slight sweating for resolution.
No thirst indicates Interior harmony; remove Renshen. External heat indicates unresolved Exterior; add Guizhi to induce sweating.
If cough: Remove Renshen, Dazao, Shengjiang; add Schisandra Berry (Wuweizi), half sheng; add Dried Ginger (Ganjiang), two liang.
Cough indicates rebellious Qi. Sweet herbs obstruct Qi; remove Renshen and Dazao. *Neijing* states: "Lungs desire consolidation." Wuweizi is sour, consolidating rebellious Qi. Lung Cold causes cough; pungent-hot herbs disperse cold; replace Shengjiang with Ganjiang.
When Blood is weak and Qi exhausted, pores open, allowing pathogens to enter and combat righteous Qi, knotting in the hypochondrium. Righteous and pathogenic Qi struggle, causing alternating chills and fever at intervals, silence, and anorexia. Zang-Fu organs are connected; pain radiates downward. High pathology (pathogen in upper jiao) causing low pain (radiating down) leads to vomiting. Xiao Chaihu Tang is the primary formula.
Human Qi and Blood fluctuate with time. During the new moon, Blood is weak and Qi exhausted, pores are open. Pathogens penetrate deeply. *Zhenjing* states: "When the moon is dark, sea waters rise eastward; human Qi and Blood are deficient, Wei Qi departs, form stands alone, muscles reduce, skin relaxes, pores open... meeting wind at this time leads to deep penetration." Pathogens exploit deficiency, moving from Exterior to Interior, knotting in the hypochondrium, struggling with righteous Qi, causing alternating chills/fever and anorexia. This is movement from Outside to Inside. Channels connect to Zang-Fu; Qi transmits via channels to the Interior, hence "pain radiates down." Pathogen in Upper Jiao is "high"; transmission to Interior is "low." Interior Qi combats pathogen, reversing upward, causing vomiting. Xiao Chaihu Tang resolves semi-Exterior semi-Interior pathogens.
After taking Chaihu Tang, if thirst develops, the pattern belongs to Yangming; treat according to Yangming principles.
Thirst after Xiao Chaihu Tang indicates Exterior pathogens have resolved and Interior pathogens have transmitted to Yangming.
If, after six or seven days of disease, the pulse is slow, floating, and weak, with aversion to wind/cold and warm hands/feet, and the physician purges two or three times, leading to inability to eat, hypochondriac fullness/pain, jaundice of face/body, stiff neck, and difficult urination, Chaihu Tang is initially given. However, this will likely lead to tenesmus. If the patient was thirsty and vomited after drinking water, Chaihu Tang is contraindicated. If food intake causes hiccups...
Six to seven days into disease, with slow-floating-weak pulse, aversion to wind/cold, and warm extremities, pathogens are in the semi-Exterior semi-Interior, not yet Excess. Repeated purging damages Stomach Qi and fluids, trapping pathogens in the Interior, causing anorexia and hypochondriac fullness. Stomach deficiency allows Heat to steam outward, causing jaundice. Stiff neck indicates unresolved Exterior. Difficult urination indicates internal fluid depletion. Although this resembles a Chaihu Tang pattern, Interior deficiency and Lower Jiao Qi stagnation causing difficult urination make Chaihu Tang risky, as it may further deplete fluids, leading to tenesmus. Vomiting not triggered by drinking water fits Chaihu Tang. Vomiting triggered by drinking water indicates Water retention in the Heart/Stomach. *Jingui Yaolue* states: "Thirst followed by vomiting indicates Water retention in the Heart/Stomach, belonging to Phlegm-Fluid disorders." Drinking water causing vomiting or food causing hiccups are not suitable for Xiao Chaihu Tang. These are contraindications for Chaihu Tang and must be recognized.
In Cold Damage, four to five days in, with body heat, aversion to wind, stiff neck, hypochondriac fullness, warm hands/feet, and thirst, Xiao Chaihu Tang is the primary formula.
Body heat and aversion to wind with stiff neck indicate unresolved Exterior. Hypochondriac fullness and thirst indicate Interior disharmony. Exterior pathogens cause hot extremities; Interior pathogens cause cold extremities. Warm extremities confirm semi-Exterior semi-Interior status. Xiao Chaihu Tang resolves pathogens in both layers.
In Cold Damage, if the Exterior pulse (Yang) is choppy and the Interior pulse (Yin) is string-taut, abdominal cramping pain is expected. First administer Jianzhong Tang (Build the Middle Decoction); if ineffective, Xiao Chaihu Tang is the primary formula.
Choppy Yang and string-taut Yin pulses with abdominal pain indicate Interior Deficient Cold. Jianzhong Tang warms the Middle and dispels Cold. If ineffective, it is not Interior Cold but rather pathogens transmitting from Exterior to Interior causing Interior Qi stagnation. Xiao Chaihu Tang, removing Huangqin and adding Shaoyao, clears transmitted Interior pathogens.
**Jianzhong Tang Formula:**
Cinnamon Twig (Guizhi, Ramulus Cinnamomi), three liang, bark removed (pungent, hot).
Licorice Root (Gancao, Glycyrrhizae Radix), two or three liang, roasted (sweet, neutral).
Jujube Fruit (Dazao, Zizyphi Fructus), twelve pieces, split (sweet, warm).
White Peony Root (Shaoyao, Paeoniae Radix Alba), six liang (sour, slightly cold).
Fresh Ginger (Shengjiang, Zingiberis Rhizoma Recens), three liang, sliced (pungent, warm).
Malt Sugar (Jiangyi, Saccharum Officialis), one sheng (sweet, warm).