【纲】仲景曰。伤寒脉弦细。头痛。发热者。属少阳。少阳不可发汗。发汗则谵语。此属胃。
胃和则愈。胃不和。则烦而躁。
【目】李杲曰。假令少阳症。头痛。往来寒热。脉浮弦。此三症但有一者。是为表也。口失滋
味。腹中不和。大小便或秘而不通。或泄而不调。但有一者。是为里也。如无上下表里症。余者皆
虚热也。
韩祗和曰。少阳初受寒邪。病全在表。故头痛发热。与太阳同。
【纲】仲景曰。伤寒五六日。头痛。汗出。微恶寒。手足冷。心下满。口不欲食。大便硬。脉
沉细者。此为阳微结。必有表复有里也。脉沉亦在里也。
【目】陶华曰。头痛属三阳。乃邪气上攻也。太阳专主头痛。阳明少阳亦有之。少阳头痛脉弦。
发热。小柴胡汤。
鳌按。旧本于此条。有云头痛汗出者。有无痛字。云头汗出者。但此条原属太阳阳明二阳合病。
但见少阳细脉。因从少阳为治者。如此则头痛汗出微恶寒手足冷四项。乃是太阳表症。心下满口
不欲食心下硬三项。乃是阳阴里症。所以谓之有表复有里也。前四项既属太阳。太阳主头痛。其见
头痛之症无疑。不得曰头汗出也。
【纲】仲景曰。伤寒四五日。身热恶风。头项强。胁下满。手足温而渴者。小柴胡汤主之。
【目】喻昌曰。身热恶风。太阳症也。头项强。太阳兼阳明病也。胁下满。少阳症也。本当从
三阳合并病之列。而用表法。但手足温而加渴。外邪辐凑于少阳。而向里之机已着。倘更用辛甘发
散。是重增其热。而大耗其津也。故从小柴胡和法。则阳邪自罢。而阴津以生。一举而两得矣。此
用小柴胡汤。当从加减法。不呕而渴。去半夏加栝蒌根为是。
魏荔彤曰。三阳俱见病。仍寻少阳。作驱邪之出路。太阳在表之邪。可附少阳之清气。上升而
透于表。阳明在里之邪。
可附少阳之浊气。下降而泄于下。主以小柴胡。策励半表之清气。逐太阳之表邪。役使半里之浊气。
驱阳明之里邪。是藉少阳半表半里之正气。而治表里之邪。犹之用兵。各因其势而致之。易为力
也。
【纲】仲景曰。太阳与少阳并病。脉弦。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大
椎第一间肺俞肝俞。慎不可发汗。发汗则谵语。若谵语不止。当刺期门。
【目】柯琴曰。是经脉之为眚汗吐下之法。非少阳所宜。若不明刺法。不足以奏功。
[General Principle] Zhang Zhongjing stated: In cold damage disease, if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang disease. Shaoyang disease should not be treated with diaphoresis (sweating method). If diaphoresis is mistakenly used, it leads to delirious speech (Zhenyu), which indicates stomach disharmony. If the stomach qi harmonizes, the disease will heal; if the stomach qi does not harmonize, the patient will experience vexation and restlessness.
[Detailed Discussion] Li Gao said: Suppose there are Shaoyang syndrome symptoms, such as headache, alternating chills and fever (Wanglai Hanre), and a floating-wiry pulse. If any one of these three symptoms exists, it is considered a Exterior Syndrome (Biao). If there is loss of normal taste in the mouth, abdominal discomfort, or constipation/diarrhea that is irregular, and any one of these exists, it is considered an Interior Syndrome (Li). If there are no such exterior or interior symptoms above and below, the remaining conditions belong to Deficiency-Heat.
Han Zhihe said: When Shaoyang disease initially receives cold pathogenic factors, the pathology is entirely at the exterior. Therefore, headache and fever occur, which is the same as Taiyang disease.
[General Principle] Zhang Zhongjing stated: In cold damage disease, after five or six days, if there is headache, sweating, slight aversion to cold, cold hands and feet, fullness in the epigastrium, lack of desire to eat, hard stools, and a deep-fine pulse, this is called "Yang Mild Binding" (Yang Wei Jie) (mild stagnation of Yang Qi). This condition must have both an exterior and an interior component. A deep pulse also indicates the pathology is in the interior.
[Detailed Discussion] Tao Hua said: Headache belongs to the Three Yang meridians (Taiyang, Yangming, Shaoyang); it is caused by pathogenic factors attacking upwards. Taiyang meridian specifically governs headache, but Yangming and Shaoyang meridians also present with it. Shaoyang headache presents with a wiry pulse and fever, and Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.
Shen Jin'ao's commentary: In older editions of this text, some versions read "headache and sweating," while others omit the word "pain" (implying only head sweating without headache). I believe this clause originally belongs to a combined disease of Taiyang and Yangming. However, since only the fine pulse of Shaoyang is seen, treatment proceeds from the perspective of Shaoyang. Thus, the four items—headache, sweating, slight aversion to cold, and cold hands and feet—are Taiyang exterior symptoms. The three items—epigastric fullness, lack of desire to eat, and epigastric hardness—are Yangming interior symptoms. Hence, it is called "having both exterior and interior." Since the first four items belong to Taiyang, and Taiyang governs headache, the presence of headache is undeniable; it cannot be described merely as head sweating.
[General Principle] Zhang Zhongjing stated: In cold damage disease, after four or five days, if there is body heat, aversion to wind, stiffness and rigidity of the head and nape, fullness in the hypochondrium, warm hands and feet, and thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
[Detailed Discussion] Yu Chang said: Body heat and aversion to wind are Taiyang symptoms. Stiffness and rigidity of the head and nape indicate Taiyang combined with Yangming disease. Fullness in the hypochondrium is a Shaoyang symptom. Originally, this should be categorized under combined diseases of the Three Yang and treated with exterior-releasing methods. However, because the hands and feet are warm and thirst is added, it indicates that external pathogens are gathering at Shaoyang, and the tendency toward the interior is already established. If辛甘 (acrid-sweet) dispersing agents are still used, it will further increase heat and severely consume Yin fluids. Therefore, using the harmonizing method of Xiao Chai Hu Tang (Minor Bupleurum Decoction) allows Yang pathogens to subside naturally and Yin fluids to regenerate, achieving two benefits with one action. When using Xiao Chai Hu Tang (Minor Bupleurum Decoction) here, modifications according to the addition/subtraction rules should be applied: if there is no vomiting but there is thirst, remove Banxia (Pinellia Rhizome) and add Gualougen (Trichosanthes Root) for correctness.
Wei Litong said: When symptoms of all Three Yang meridians appear, one should still seek Shaoyang as the exit route for expelling pathogens. Pathogens in the exterior of Taiyang can attach to the clear Qi of Shaoyang, ascending and penetrating to the exterior; pathogens in the interior of Yangming can attach to the turbid Qi of Shaoyang, descending and draining downward. The primary use of Xiao Chai Hu Tang (Minor Bupleurum Decoction) stimulates the clear Qi of the half-exterior/half-interior to drive out Taiyang exterior pathogens; it employs the turbid Qi of the half-exterior/half-interior to drive out Yangming interior pathogens. This utilizes the righteous Qi of Shaoyang at the half-exterior/half-interior level to treat pathogens in both the exterior and interior, similar to military strategy where one acts according to the situation, making it easier to succeed.
[General Principle] Zhang Zhongjing stated: When Taiyang and Shaoyang diseases occur simultaneously (Bingbing), with a wiry pulse, stiffness and pain in the head and nape, or dizziness and vertigo, sometimes feeling like Jie Xiong (Chest Binding) (stiffness and pain in the chest and epigastrium), and epigastric stuffiness and hardness, one should puncture the first interspace of the Dazhui (GV14) acupoint, Feishu (BL13), and Ganshu (BL18). Diaphoresis must be strictly avoided. If diaphoresis causes delirious speech, and the delirium does not cease, one should puncture the Qimen (LR14) acupoint.
[Detailed Discussion] Ke Qin said: This scripture discusses meridian pathologies; the methods of sweating, vomiting, and purgation are not suitable for Shaoyang. Without understanding acupuncture methods, therapeutic efficacy cannot be achieved.