治伤寒十三日不解。胸胁满而呕。日晡所发潮热。已而微利。此本柴胡证。
下之而不得利。今反利者。知医以丸药下之。非其治也。潮热者实也。先宜小柴胡以解
外。
柴胡（二两十六铢） 半夏（二十铢） 黄芩（一两） 甘草（一两） 生姜（一两） 人
上八味。以水四升。煮去二升。去滓。内芒硝。更煮微沸。分温再服。（此药剂之最轻
者。
歌曰 小柴分两照原方。二两芒硝后入良。误下热来日晡所。补兼荡涤有奇长。（此歌
照内
蔚按。小柴胡汤使太阳之气从枢外出。解见原方。兹云十三日。经尽一周。既来复于太
阳。
满而呕者。阳明之阖不得少阳之枢以外出也。日晡所者。申酉戌之际也。阳明旺于申酉戌。
故应其时而发潮热。热已微利者。阳明之气虽实。其奈为丸药所攻而下陷。陷者举之。用小
柴胡汤以解外。解寓升发之义。即所以举其陷而止其利也。又加芒硝者。取芒硝之咸寒以直
通地道
其义深矣。
治太阳病不解。热结膀胱。其人如狂。血自下者愈。其外不解者。尚未可攻。
当先解外。外已解。但小腹急结者。乃可攻之。宜此方主之。
桃仁（五十个） 大黄（四两） 甘草（二两 生。） 桂枝（二两） 芒硝（二两）
上五味。以水七升。煮取二升半。去滓。内芒硝。更上火微沸。下火。先食。温服五合。
日
歌曰 五十桃仁四两黄。桂硝二两草同行。膀胱热结如狂证。外解方攻用此汤。
蔚按。张令韶谓太阳有气有经。其气从胸而出入。其经挟脊入循膂而内络膀胱。如病邪
从
则为桃仁承气汤证。太阳之腑曰膀胱。在小腹之间。为血海之所。膀胱有津液而无血。
而与
当
其仁微苦而涌泄。为行血之缓药。得大黄以推陈致新。得芒硝以清热消瘀。得甘草以主持于
中。俾诸药遂其左宜右有之势。桂枝用至二两者。注家以为兼解外邪。而不知辛能行气。气
行而血乃行也。（男蔚按。内经曰。血在上喜忘。血在下如狂。）
治疗伤寒病程十三天仍未痊愈。出现胸胁部胀满且伴有呕吐，每日下午申酉戌时（约15:00-21:00）定时发作潮热（发热如潮水般定时涨落），随后出现轻微腹泻。这原本是小柴胡汤证（少阳病的主方证候）。
经过攻下治疗后并未导致腹泻，如今反而出现腹泻，可知是医生使用了丸药进行攻下，这不是正确的治疗方法。出现潮热说明体内有实邪。应当先用小柴胡汤（和解少阳的代表方剂）来解除表邪。
柴胡（二两十六铢） 半夏（二十铢） 黄芩（一两） 甘草（一两） 生姜（一两） 人参（一两） 大枣（十二枚，擘开） 芒硝（二两）
以上八味药，用水四升，煎煮至剩余二升，去渣，加入芒硝，再稍微煮沸，分两次温服。（这是药剂中最轻的一剂。）
歌诀曰：小柴胡汤的分量依照原方，二两芒硝在后方入为好。误用攻下导致热邪在日晡时发作，补益兼有荡涤积滞的功效奇妙而特长。（此歌诀依据内文编写）
陈蔚按语：小柴胡汤能使太阳经之气通过枢机向外透达，解释详见原方条文。这里说病程十三天，是经气运行一周完毕，既然后来复归于太阳经。
胸胁胀满且呕吐，是因为阳明经的阖降功能不得少阳枢机的协助而外达。日晡时，是指申、酉、戌三个时辰之间。阳明经气旺盛于申、酉、戌时，所以在这个时间发作潮热。热邪伴随轻微腹泻，是因为阳明之气虽然实盛，但被丸药攻伐而下陷。下陷的病证应当提升，使用小柴胡汤来解除表邪，解表之中寓含升发之意，这就是提升下陷之气并止住腹泻的方法。又加入芒硝，是取芒硝咸寒之性以直通大便之道。其中的义理非常深远。
治疗太阳病未解，热邪结聚于膀胱。患者神志如狂。如果瘀血自行排出则病愈。如果表证未解，尚不可攻里。
应当先解表。表证已解，仅见小腹急迫结痛者，才可以攻里。适宜用本方主治。
桃仁（五十个） 大黄（四两） 甘草（二两，生用） 桂枝（二两） 芒硝（二两）
以上五味药，用水七升，煎煮至剩余二升半，去渣，加入芒硝，再次上火微沸，离火。饭前温服五合。
歌诀曰：五十个桃仁配四两大黄，桂枝芒硝各二两甘草同行。膀胱热结导致如狂证候，表解之后方可攻里使用此汤。
陈蔚按语：张令韶认为太阳经既有气又有经，其气从胸部出入，其经挟脊深入循行于膂肉内部并联络膀胱。如果病邪从……（此处原文似有缺漏或断句问题，依上下文推断为邪气入腑）……则为桃仁承气汤证。太阳的腑称为膀胱，位于小腹之间，是血海所在之处。膀胱只有津液而没有血。
当……（此处原文逻辑跳跃，结合下文应为论述瘀血与膀胱关系）……
桃仁味微苦而具有涌泄作用，是行血的缓药。得到大黄可以推陈致新，得到芒硝可以清热消瘀，得到甘草可以在中焦主持调和，使各种药物发挥各自适宜的作用。桂枝用到二两的量，注家认为是为了兼解外邪，却不知道辛味能行气，气行则血乃行。（男蔚按：《内经》说：血在上容易健忘，血在下则如狂。）
Treats Taiyang disease (Disease of the Taiyang channel) persisting for thirteen days without resolution. The patient presents with fullness and distension in the chest and hypochondrium accompanied by vomiting, tidal fever (fever that rises like a tide at specific times) occurring during the Shen, You, and Xu hours (approximately 3 PM to 9 PM), followed by slight diarrhea. This was originally a Xiao Chai Hu Tang syndrome (Syndrome treated by Minor Bupleurum Decoction).
After purgative treatment, diarrhea did not occur; now, conversely, diarrhea has occurred. It is known that the physician used pill-based purgatives, which was not the correct treatment. The presence of tidal fever indicates excess pathogenic factors within. One should first use Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve the exterior.
Chai Hu (Bupleuri Radix) [2 liang 16 zhu], Ban Xia (Pinelliae Rhizoma Praeparatum cum Ginger et Alumine) [20 zhu], Huang Qin (Scutellariae Radix) [1 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma) [1 liang], Sheng Jiang (Zingiberis Rhizoma Recens) [1 liang], Ren Shen (Ginseng Radix et Rhizoma) [1 liang], Da Zao (Jujubae Fructus) [12 pieces, split], Mang Xiao (Natrii Sulfas) [2 liang].
Take the above eight ingredients, add four sheng of water, decoct until two sheng remain, remove the dregs, add Mang Xiao, boil slightly again, divide into two warm doses. (This is the lightest dosage among these formulas.)
Song verse: Follow the original proportions for Xiao Chai Hu Tang; adding two liang of Mang Xiao later is good. Heat arising from mistaken purgation occurs at dusk; tonifying while simultaneously cleansing accumulation yields extraordinary efficacy. (This verse follows the internal text.)
Commentary by Chen Wei: Xiao Chai Hu Tang enables the Qi of the Taiyang channel to exit outward through the pivot mechanism. See the explanation in the original formula section. Here, it states that after thirteen days, the cycle of the channels is complete, and the pathogen returns to the Taiyang channel.
Fullness and vomiting occur because the closing function of the Yangming channel cannot exit outward without the assistance of the Shaoyang pivot. The "Shen, You, Xu" hours refer to the period between 3 PM and 9 PM. Yangming Qi is prosperous during these hours, hence the tidal fever occurs at this time. The slight diarrhea accompanying heat is because although Yangming Qi is excessive, it has been driven downward and sunk by the pill purgatives. For conditions of sinking, one must lift them; using Xiao Chai Hu Tang to resolve the exterior contains the meaning of lifting and raising, which thereby lifts the sinking Qi and stops the diarrhea. Furthermore, adding Mang Xiao utilizes its salty and cold nature to directly unblock the bowel pathway. The rationale here is profound.
Treats Taiyang disease unresolved, where heat binds in the Bladder (Bladder organ). The person appears manic. If blood discharges spontaneously, the disease will heal. If the exterior is not yet resolved, attack is not yet permissible.
One must first resolve the exterior. Once the exterior is resolved, if there is only urgency and binding pain in the lower abdomen, then attack is permissible. This formula is suitable for treating this condition.
Tao Ren (Persicae Semen) [50 pieces], Da Huang (Rhei Radix et Rhizoma) [4 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma, raw) [2 liang], Gui Zhi (Cinnamomi Ramulus) [2 liang], Mang Xiao (Natrii Sulfas) [2 liang].
Take the above five ingredients, add seven sheng of water, decoct until two and a half sheng remain, remove the dregs, add Mang Xiao, boil slightly on fire, remove from fire. Take warm, five he, before meals.
Song verse: Fifty Tao Ren and four liang Da Huang, Gui Zhi and Mang Xiao two liang each, Gan Cao accompanies. Bladder heat binding causes manic symptoms; only after resolving the exterior should this decoction be used to attack.
Commentary by Chen Wei: Zhang Lingshao stated that the Taiyang channel has both Qi and vessels. Its Qi emerges from and enters the chest; its vessels run along the spine, penetrate the back muscles, and internally connect to the Bladder. If the pathogen... [text implies entry into the fu organ] ...it becomes a Tao Ren Cheng Qi Tang syndrome. The Fu organ of Taiyang is called the Bladder, located in the lower abdomen, which is the seat of the Blood Sea. The Bladder contains Jin Ye (Body Fluids) but no Xue (Blood).
[Text fragment regarding interaction] ...
Tao Ren is slightly bitter and has an upward-pushing and draining action; it is a mild herb for moving blood. With Da Huang, it pushes out the old and generates the new; with Mang Xiao, it clears heat and dissipates stasis; with Gan Cao, it presides over the middle, allowing the various herbs to exert their appropriate influences. The use of Gui Zhi up to two liang is considered by commentators as primarily for resolving exterior pathogens, but they do not realize that pungent flavors can move Qi; when Qi moves, Blood then moves. (Commentary by Chen Wei's son: The Nei Jing states: Blood stagnating above leads to forgetfulness; Blood stagnating below leads to mania.)