治伤寒中风,少阳病口苦咽干,目眩耳聋,往来寒热,胸胁苦满,默默不欲饮食,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,或汗后余热不解,或疟发寒热,妇人伤寒,热入血室,暮则 语;并治伤寒
阳微结,头汗肢寒,脉细便坚,亦半表里也。
柴胡(半斤) 黄芩 人参 炙草 生姜(各三两) 半夏(半升) 大枣(十二枚) 以
水一斗二升,煮取六升,去滓再煎,(此方为和解之剂。去滓再煎,则药性和合,不相捍格
矣。)取三升,分温三服。
治阳明病潮热,大便溏,小便利,胸胁满而不去。先服小柴胡一剂乃进。
柴胡(二两十六铢) 黄芩 炙草 人参 生姜(各一两) 半夏(二十铢) 大枣(四
枚) 芒硝(二两) 水四升,煮取二升,去滓,纳芒硝,更煮微沸,分温再服。不解,更
作服。 小柴胡汤和解供,(少阳为半表半里,汗、吐、下皆在所禁,法当和解,此方主
之。)半夏人参甘草从,更用黄芩与姜枣,少阳百病此为宗。(此和解少阳之主方。柴胡升阳
达表,黄芩退热和阴,半夏和胃而通阴阳,参、甘、姜、枣补中气,调营卫,经言“交阴阳
者,必和其中”是也。)往来寒热(太阳之寒热,寒时亦热,热时亦寒;少阳之寒热,寒已
而热,热已而寒,故曰“往来”;若阳明则但热不寒,以此为别。)胸胁满,(少阳行身之侧,
故胸胁苦满。)喜呕心烦(木火上逆,故烦而呕;呕则木火两舒,故喜之也。)或眩聋,(少
阳清气不升,故目眩耳聋。)或咳或悸或腹痛,(木邪干肺则咳,犯心则悸,侮脾则腹痛,可
见少阳有病,三焦皆不得宁。盖少阳在人身为游部,凡表里经络之罅,皆能随其虚而见之,
故有或然之证。)咽干口苦(耳聋目眩,口苦咽干,贴切少阳枢机病象。)白胎浓。(舌上白
胎,邪在半表半里;若全入里,则焦黄矣。)诸证不必皆全具,杂病风寒俱可庸。(《伤寒论·太
阳篇》云
表,(合病一
明,而少阳居其
柴胡以和之,邪
小柴胡汤潮热不
入血室如疟状,
成瘀,则肝气与
刺期门法,(期门
血结为有形之证,
桃仁海蛤攻。(按∶
热,颇有奇功,因附
暮则谵语,此证最多
辨莫通融,便坚脉细
曰“纯阴结”。此
热虽结而不甚也
同)头汗知非少
阴阳俱紧,反
亡阳之汗,大有
细,不得谓阴证
沉为里,头汗为
与小柴胡而不疑
气上越之候,若
则不忌。)
治疗伤寒或中风引起的少阳病,症状包括口苦、咽干、目眩、耳聋,寒热往来,胸胁部胀满不适,神情沉默、不想饮食,心烦、喜欢呕吐;或者胸中烦闷但不呕吐,或者口渴,或者腹部疼痛,或者胁下痞塞坚硬,或者心下悸动、小便不利,或者不渴但身体有轻微发热,或者咳嗽,或者发汗后余热未解,或者疟疾发作时的寒热交替,妇女患伤寒,热邪侵入血室,傍晚出现胡言乱语;同时也治疗伤寒导致的阳气微结,表现为头部出汗、四肢发凉、脉象细弱、大便干硬,这也属于半表半里的证候。
柴胡(半斤) 黄芩 人参 炙甘草 生姜(各三两) 半夏(半升) 大枣(十二枚)。用水一斗二升,煮取六升药液,滤去药渣,再次煎煮,(此方是和解剂。滤去药渣再次煎煮,能使药性调和,互不抵触。)最终取三升药液,分三次温服。
治疗阳明病的潮热,大便溏薄,小便通畅,胸胁部胀满持续不去。先服用一剂小柴胡汤,然后再进其他药物。
柴胡(二两十六铢) 黄芩 炙甘草 人参 生姜(各一两) 半夏(二十铢) 大枣(四枚) 芒硝(二两)。用水四升,煮取二升药液,滤去药渣,加入芒硝,再稍微煮沸,分两次温服。如果病不解,继续服用。
小柴胡汤用于和解少阳,(少阳位于半表半里之间,汗法、吐法、下法都在禁忌之列,治法应当和解,此方为主治方。)方中包含半夏、人参、甘草,再加上黄芩与生姜、大枣,少阳经的各种疾病都以此方为宗。(这是和解少阳的主方。柴胡升发阳气达于体表,黄芩清除热邪并调和阴气,半夏和胃并沟通阴阳,人参、甘草、生姜、大枣补益中气,调和营卫,经文说“要交合阴阳,必须调和其中焦”就是这个道理。)
关于“寒热往来”,(太阳病的寒热,寒冷时体内也热,发热时体内也寒;少阳病的寒热,冷过后才热,热过后才冷,所以称为“往来”;若阳明病则是只热不寒,以此作为区别。)
“胸胁满”,(少阳经脉行于身体侧面,所以胸胁部感到胀满。)
“喜呕心烦”,(木火之气上逆,所以心烦且呕吐;呕吐后木火之气得以舒展,所以患者感觉舒适而“喜”之。)
“或见眩晕耳聋”,(少阳清气不能上升,所以出现目眩耳聋。)
“或咳嗽或心悸或腹痛”,(木邪侵犯肺脏则咳嗽,侵犯心脏则心悸,克制脾土则腹痛,可见少阳有病,三焦都不能安宁。因为少阳在人体中游走不定,凡是表里经络的缝隙,都能随其虚弱之处而显现病症,所以有这些或然性的症状。)
“咽干口苦”,(耳聋目眩,口苦咽干,贴切地描述了少阳枢机病的病象。)
“舌苔白厚腻”。(舌上出现白色厚腻苔,说明邪气在半表半里之间;如果完全入里,舌苔就会变成焦黄色。)
以上诸证不必全部具备,杂病及风寒感冒均可使用。(《伤寒论·太阳篇》云:……)
表证,(合病一……明,而少阳居其……柴胡以和之,邪……小柴胡汤潮热不……入血室如疟状,……成瘀,则肝气与……刺期门法,(期门……血结为有形之证,……桃仁海蛤攻。(按:……热,颇有奇功,因附……暮则谵语,此证最多……辨莫通融,便坚脉细……曰“纯阴结”。此……热虽结而不甚也……同)头汗知非少……阴阳俱紧,反……亡阳之汗,大有……细,不得谓阴证……沉为里,头汗为……与小柴胡而不疑……气上越之候,若……则不忌。)
Treats Shaoyang disease (Shaoyang syndrome) caused by cold damage or wind strike, with symptoms including bitter taste in the mouth, dry throat, vertigo, deafness, alternating chills and fever, fullness and distress in the chest and hypochondrium, silence with loss of appetite, irritability, and frequent vomiting; or irritability in the chest without vomiting, or thirst, or abdominal pain, or hardness and stuffiness under the ribs, or palpitations in the epigastrium with difficult urination, or no thirst but slight body heat, or cough, or residual heat remaining after sweating, or alternating chills and fever during malaria attacks, or women suffering from cold damage where heat enters the blood chamber causing delirium at dusk; also treats Yangming disease characterized by yang qi slight binding, head sweating, cold limbs, fine pulse, and hard stool, which also belongs to the half-exterior half-interior syndrome.
Chai Hu (Caulis Bupleuri) (8 liang), Huang Qin (Radix Scutellariae), Ren Shen (Radix Ginseng), Zhi Gan Cao (Prepared Radix Glycyrrhizae), Sheng Jiang (Rhizoma Zingiberis Recens) (each 3 liang), Ban Xia (Rhizoma Pinelliae Preparatum) (0.5 sheng), Da Zao (Fructus Jujubae) (12 pieces). Boil in 12 dou of water, reduce to 6 sheng, remove dregs, and decoct again. (This formula is a harmonizing agent. Removing dregs and decocting again allows the medicinal properties to blend harmoniously without conflict.) Reduce to 3 sheng, divide into three warm doses.
Treats Yangming disease with tidal fever, loose stools, free urination, and persistent fullness in the chest and hypochondrium. First administer one dose of Xiao Chai Hu Tang (Minor Bupleurum Decoction), then proceed with other treatments.
Chai Hu (Caulis Bupleuri) (2 liang 16 zhu), Huang Qin (Radix Scutellariae), Zhi Gan Cao (Prepared Radix Glycyrrhizae), Ren Shen (Radix Ginseng), Sheng Jiang (Rhizoma Zingiberis Recens) (each 1 liang), Ban Xia (Rhizoma Pinelliae Preparatum) (20 zhu), Da Zao (Fructus Jujubae) (4 pieces), Mang Xiao (Natrii Sulfas) (2 liang). Boil in 4 sheng of water, reduce to 2 sheng, remove dregs, add Mang Xiao, boil slightly until simmering, divide into two warm doses. If not resolved, continue administration.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used for harmonization. (Shaoyang is located between the exterior and interior; sweating, emesis, and purgation are all contraindicated; the treatment method should be harmonization, and this formula is primary.) It contains Ban Xia, Ren Shen, and Gan Cao, along with Huang Qin, Sheng Jiang, and Da Zao; it serves as the master formula for various Shaoyang diseases. (This is the main formula for harmonizing Shaoyang. Chai Hu ascends yang qi to reach the exterior, Huang Qin clears heat and harmonizes yin, Ban Xia harmonizes the stomach and connects yin and yang, while Ren Shen, Gan Cao, Sheng Jiang, and Da Zao tonify middle qi and regulate Ying and Wei. The classic text states "to interact yin and yang, one must harmonize the middle," which is the principle here.)
Regarding "alternating chills and fever": In Taiyang disease, chills and fever occur simultaneously; in Shaoyang disease, fever follows chills and vice versa, hence termed "alternating"; whereas Yangming disease presents with fever only, distinguishing it.
"Fullness in chest and hypochondrium": Since the Shaoyang meridian runs along the side of the body, there is distress and fullness in the chest and hypochondrium.
"Frequent vomiting and irritability": Due to rebellious Wood and Fire qi, leading to irritability and vomiting; vomiting releases the Wood and Fire qi, bringing relief.
"Vertigo and deafness": Occurs when clear Qi of Shaoyang fails to ascend.
"Cough, palpitations, or abdominal pain": Wood pathogen invading the Lung causes cough, invading the Heart causes palpitations, and overacting on the Spleen causes abdominal pain. This shows that when Shaoyang is diseased, the San Jiao cannot remain tranquil. As Shaoyang is a wandering part of the body, it manifests symptoms wherever there are gaps in the exterior-interior meridians due to deficiency, resulting in these optional symptoms.
"Bitter mouth and dry throat": These symptoms accurately reflect the pathology of the Shaoyang pivot mechanism.
"White thick tongue coating": A white thick coating indicates pathogenic factors in the half-exterior half-interior region; if fully entering the interior, the coating would turn scorched yellow.
These symptoms need not all be present; it can be used for miscellaneous diseases and wind-cold patterns. (As stated in the *Shanghan Lun* · Taiyang Chapter: ...)
Exterior syndrome... (Combined syndromes... Yangming, while Shaoyang resides... Chai Hu harmonizes it, pathogen... Xiao Chai Hu Tang for tidal fever does not... Enter blood chamber resembling malaria... Formation of stasis, then Liver qi with... Puncture Qimen method, (Qimen... Blood stasis becomes a tangible condition... Tao Ren and Hai Ge attack. [Note:... Heat, has remarkable efficacy, thus attached... Delirium at dusk, this pattern is common... Differentiation requires flexibility, hard stool and fine pulse... Said "pure Yin binding". This... Heat binds but is not severe... Same) Head sweat indicates not Shaoyang... Yin and Yang both tight, conversely... Yang collapse sweating, greatly... Fine, cannot be called Yin syndrome... Deep indicates interior, head sweat is... Administer Xiao Chai Hu Tang without doubt... Qi ascending upward sign, if... Then no contraindication.)