口苦咽干。目眩。耳聋。往来寒热。胸胁满痛呕。
按少阳属半表半里。故仲景以口苦。咽干目眩。为一经主病。盖胆属木。而少阳为相火。此皆木火上
炎之证。已该伤寒杂症而言。阅少阳篇内。或言伤寒。或言中风。或言并病。或言转属。本无一定。
若执定从太阳阳明传入。不啻痴人说梦矣。
凡遇伤寒初起头痛发热。而脉弦细者。此少阳初感寒邪。故头痛发热与太阳同。
而脉则现少阳本象也。少阳少血多火。虽有表邪。不可发汗。当以小柴胡汤和之。
若发热耳聋。目赤胸满而烦者。此少阳中风也。盖少阳属木火。风中其经。亦同气相感。风动火炎。
故见症如此。耳目为表之里。胸中为里之表。亦当用小柴胡汤和之。
若头痛胸满。口苦咽干。或往来寒热。脉浮而弦。自下利者。此太阳少阳合病也。缘热邪入少阳之里。
胆移热于脾。故下利。黄芩汤主之。其邪不在半表。而在半里。故不用柴胡而主黄芩。呕加半夏、生
姜。治痰饮也。
伤寒汗出不解。十余日。结热在里。心下痞硬。呕吐下利。复往来寒热者。大柴胡汤主之。此热邪从
少阳而结于阳明。故合治之。
伤寒四五日。身热恶风。头项强。（桂枝症）胁下满。（柴胡症）手足温而渴者。小柴胡汤主之。
按此是太阳少阳并病。当用小柴胡。去参夏。加桂枝、栝蒌根两解之。
阳明病发潮热。（阳明）大便溏。小便自可。（胃未实）胸胁满者。（少阳）小柴胡汤主之。按
此阳明少阳合病。因胃家未实。故从少阳胸胁满一症。即用小柴胡和之。使热邪
从少阳而解。不复入阳明矣。
阳明病。不大便。胸下硬满而呕。（尚在少阳部位）舌上白苔者。可与小柴胡汤。按白苔。属
痰饮溢于上焦。与小柴胡。则痰饮化而津液行。胃气一和。则上焦仍得汗出而解矣。
邵评∶若痰饮溢于上中焦。症见少阳阳明。可用柴胡温胆汤。
伤寒阳脉涩。阴脉弦。法当腹中急痛。先用小建中汤。不瘥者。小柴胡汤主之。按尺寸俱弦。为少阳受病。
今阳涩阴弦。是寒邪伤于厥阴也。腹中为厥阴部位。故急痛。先用小建中。所以平肝散寒也。未瘥。
仍用柴胡者。使邪引出少阳而解也。
伤寒胸中有热。胃中有邪气。腹中痛。欲呕吐者。黄连汤主之。此寒热相持于内。故用姜连以和里。胃
中寒邪尚可外达。故用桂枝以和表。此仍不离少阳之和法。亦可兼治厥阴寒热呕逆。
邵评∶因上热下寒。格拒中宫。故腹痛而呕吐。用黄连汤开痞而和上下也。且黄连汤与小柴胡汤。
俱是枢机之剂。而为和法。小柴胡和其表里。黄连汤和其上下。同一和法。而有横直之不同也。
Bitter taste in the mouth, dryness of the throat, vertigo (dizziness), deafness, alternating chills and fever, distending pain in the chest and hypochondrium accompanied by vomiting.
Note: The Shaoyang (Lesser Yang) channel belongs to the half-exterior and half-interior level. Therefore, Zhang Zhongjing regarded bitter taste in the mouth, dryness of the throat, and vertigo as the principal manifestations of the Shaoyyang disease. This is because the Gallbladder belongs to Wood, while Shaoyang represents Ministerial Fire; these are all syndromes of Wood-Fire flaming upward. This covers both Shanghan (Cold Damage) and miscellaneous diseases. In reading the Shaoyang chapter, some passages mention Shanghan, some mention Wind Strike, some mention concurrent diseases (Bingbing), and some mention transformation and attachment (Zhuan shu); there is no fixed rule. If one rigidly insists that the disease must have transmitted from the Taiyang or Yangming stage, it is nothing but nonsense spoken by a fool.
Whenever one encounters the initial stage of Shanghan with headache and fever, and the pulse is wiry and fine (Xian Xi), this indicates that Shaoyang has initially contracted cold pathogenic factors. Thus, the headache and fever are similar to those of Taiyang disease, but the pulse reveals the characteristic image of Shaoyang. Shaoyang has little blood and abundant fire. Although there is an exterior pathogen, sweating methods should not be used. Instead, Chaihu Tang (Bupleurum Decoction) should be employed to harmonize.
If fever, deafness, red eyes, chest fullness, and irritability occur, this is Shaoyang Wind Strike. Since Shaoyang belongs to Wood and Fire, when Wind pathogen invades its channel, it follows the principle of like attracting like. Wind stirring causes Fire to flare up, resulting in such symptoms. The ears and eyes are interior to the exterior, and the chest is exterior to the interior; in either case, Chaihu Tang should be used to harmonize.
If headache, chest fullness, bitter taste in the mouth, dryness of the throat, or alternating chills and fever occur, along with a floating and wiry pulse and spontaneous diarrhea, this is a concurrent disease of Taiyang and Shaoyang. The cause is that heat pathogen enters the interior of Shaoyang, and Gallbladder heat transfers to the Spleen, causing diarrhea. Huangqin Tang (Scutellaria Decoction) is the primary treatment. Because the pathogen is not at the half-exterior but at the half-interior, Chaihu is not used, and Huangqin (Scutellariae Radix) is prioritized. If vomiting is present, Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) are added to treat phlegm-fluid retention.
In Shanghan, if sweating fails to resolve the condition, and after more than ten days, heat pathogen becomes knotted in the interior, causing epigastric stiffness and fullness (Pi Ying), vomiting, diarrhea, and recurring alternating chills and fever, Dachaihu Tang (Major Bupleurum Decoction) is the primary treatment. This occurs when heat pathogen from Shaoyang knots into Yangming, requiring combined treatment of both channels.
In Shanghan lasting four to five days, if there is body heat, aversion to wind, stiffness of the head and neck (Gui Zhi Tang syndrome), fullness under the costal margin (Chaihu Tang syndrome), warm hands and feet, and thirst, Chaihu Tang is the primary treatment.
Note: This is a concurrent disease of Taiyang and Shaoyang. Chaihu Tang should be used, with Renshen (Ginseng Radix et Rhizoma) and Banxia removed, and Guizhi (Cinnamomi Ramulus) and Gualougen (Trichosanthis Radix) added to resolve both conditions simultaneously.
In Yangming disease, if tidal fever (Chao Re) occurs, the stool is loose, urination is normal (indicating the Stomach is not yet solid/excess), and there is chest and hypochondriac fullness, Chaihu Tang is the primary treatment.
Note: This is a concurrent disease of Yangming and Shaoyang. Because the Stomach house is not yet solidified, based on the symptom of Shaoyang chest and hypochondriac fullness, Chaihu Tang is immediately used to harmonize, allowing the heat pathogen to resolve via Shaoyang without further entering Yangming.
In Yangming disease, if there is constipation, hardness and fullness below the chest, vomiting, and a white coating on the tongue, Chaihu Tang may be administered.
Note: A white coating indicates phlegm-fluid overflowing into the Upper Jiao. Administering Chaihu Tang resolves the phlegm-fluid and promotes the flow of body fluids. Once the Stomach Qi is harmonized, the Upper Jiao can still resolve through sweating.
Commentary by Shao: If phlegm-fluid overflows into the Upper and Middle Jiao, presenting with symptoms involving Shaoyang and Yangming, Chaihu Wendan Tang (Bupleurum and Phlegm-Resolving Decoction) can be used.
In Shanghan, if the Yang pulse is choppy (Se) and the Yin pulse is wiry (Xian), according to medical principles, there should be acute abdominal pain. First, use Xiao Jianzhong Tang (Minor Construct the Middle Decoction). If ineffective, then use Chaihu Tang as the primary treatment.
Note: A wiry pulse in all three positions (Cun, Guan, Chi) indicates Shaoyang disease. Now, with a choppy Yang pulse and wiry Yin pulse, it indicates Cold pathogen injuring Jueyin. The abdomen is the region of Jueyin, hence the acute pain. Xiao Jianzhong Tang is used first to soothe the Liver and dispel Cold. If the condition does not improve, using Chaihu agents again serves to draw the pathogen out to Shaoyang for resolution.
In Shanghan, if there is heat in the chest, pathogenic factors in the Stomach, abdominal pain, and a desire to vomit, Huanglian Tang (Coptis Decoction) is the primary treatment. This is due to the mutual standoff of Cold and Heat within. Therefore, Ganjiang (Zingiberis Rhizoma) and Huanglian (Coptidis Rhizoma) are used to harmonize the interior. The Cold pathogen in the Stomach can still reach the exterior, so Guizhi is used to harmonize the exterior. This still adheres to the harmonizing method of Shaoyang and can also concurrently treat Jueyin Cold-Heat vomiting and reversal.
Commentary by Shao: Due to upper Heat and lower Cold obstructing the Middle Palace, abdominal pain and vomiting occur. Huanglian Tang opens the obstruction and harmonizes the upper and lower. Both Huanglian Tang and Chaihu Tang are pivot-formulas belonging to the harmonizing method. Chaihu Tang harmonizes the exterior and interior, while Huanglian Tang harmonizes the upper and lower. They share the same harmonizing nature but differ in their directional action (horizontal vs. vertical).