【纲】仲景曰。少阳之为病。口苦咽干目眩也。
【目】成无己曰。咽干口燥舌涩。俱为热症。但有微甚耳。惟太阳中寒桂枝附子汤症。由误汗
咽干。作甘草干姜汤。以复其阳者。随其逆治坏病者也。非治其本寒也。然咽干之由。由汗下后而
得者。有不由汗下而得者。其间治法。或和解。或微汗。或急下。或微下。当察兼有之症。而施轻
重之治。然其为热。则一也。盖经谓咽喉干燥。亦不可汗。以其多有里症故也。实无寒病。善治者。
尤宜互参渴门。乃获全功焉。
王肯堂曰。凡伤寒头眩者。莫不因汗吐下。虚其上焦元气之所致。眩者。目无常主。头眩者。
俗谓头旋眼花是也。眩冒者。昏冒是也。少阳口苦咽干目眩者。少阳居表里之间。以表邪渐入于里。
表中阳虚。故目眩也。太阳少阳并病或眩者。责其虚也。伤寒有起则头眩与眩冒者。皆汗吐下后
所致。是知其阳虚也。故针经曰。上虚则眩。下虚则厥。眩虽为虚。又阳明中风。但头眩不恶寒者。
此又风主眩也。凡此皆水逆候。及其诸逆发汗。剧者言乱目眩。则死矣。
治少阳目眩。小柴胡汤加天麻、川芎。
张兼善曰。凡口唇焦干为脾热。焦而红者吉。焦而黑者凶。唇口俱赤肿者。热甚也。唇口俱青
黑者。冷极也。口中苦者。胆热也。口中甜者。脾热也。口燥咽干者。肾热也。舌干口燥而欲饮水
者。阳明热也。口噤难言者。痉风也。凡上唇有疮为狐。虫蚀其脏。下唇有疮为惑。虫蚀其肛。若
唇青舌卷。唇吻反青。环口黧黑。口张气直。口如鱼口。及口唇颤摇不止。气出不返。皆不治也。
柯琴曰。此为少阳病之提纲也。口咽目三者。不可谓表。不可谓里。是表之入里。里之出表处。
所谓半表里也。
三症为少阳经病机。兼风寒杂病而言。但见一症即是。不必悉具。
【纲】仲景曰。少阳中风。两耳无所闻。目赤。胸中满而烦者。不可吐下。吐下则悸而惊。
【目】魏荔彤曰。凡伤寒。原兼伤风而言。风寒之邪。从类而投太阳营卫。在肌肤之表而已。
感之者浅。故曰伤。所以日久不治。渐入渐深。有经尽而解者。有过经而传者。皆有一定之道路。
此伤寒所以有传经。无传经则非伤寒病矣。若夫中风中寒。则直突而来。并无次第。然风必中于三
阳之少阳。寒必中于三阴之少阴。仍是各从其类。又寓从少不从老之理。其邪较太阳营卫之伤甚深
且速。故曰中。所以卒遇即病。有立尽者。此与伤寒传经之病大不同也。
[Outline] Zhang Zhongjing stated: The defining symptoms of Shaoyang disease are bitter taste in the mouth, dryness of the throat, and vertigo (dizziness).
[Mu] Cheng Wuji stated: Dryness of the throat, thirst in the mouth, and a dry tongue are all manifestations of Heat syndromes, differing only in severity. Only in cases of Taiyang Cold injury treated with Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), where misapplied sweating leads to dryness of the throat, should Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) be used to restore Yang Qi. This is treating the complicated disease resulting from mismanagement according to the deviation, not treating the original fundamental Cold. However, the causes of dry throat include those arising after sweating or purging, and those not arising from these methods. The treatment methods involved may include harmonizing, mild sweating, urgent purging, or mild purging. One must observe accompanying symptoms to apply treatments of appropriate intensity. Although the underlying nature is Heat, this remains consistent. As the classics state, those with dry throat should not be subjected to sweating, as interior syndromes are often present. For patients truly lacking Cold pathogenic factors, skilled practitioners should cross-reference chapters on thirst to achieve comprehensive success.
Wang Kentang stated: In all cases of Shanghan (Cold Damage) presenting with vertigo, it is invariably caused by prior sweating, emesis, or purging, which has depleted the Yuan Qi (Primordial Qi) of the Upper Jiao (Upper Burner). "Xuan" refers to the inability of the eyes to focus steadily; "Tou Xuan" is the common term for dizziness and blurred vision. "Xuan Mao" refers to dizziness accompanied by confusion. In Shaoyang disease, characterized by bitter taste, dry throat, and vertigo, Shaoyang resides between the exterior and interior. As exterior pathogens gradually move inward, deficiency of Yang Qi at the exterior level results in vertigo. When Taiyang and Shaoyang diseases occur simultaneously with vertigo, the root cause is deficiency. In Shanghan, dizziness upon rising or severe dizziness/confusion are all caused by post-sweating, post-emetic, or post-purging states, indicating Yang deficiency. Thus, the *Zhen Jing* (Classic of Acupuncture) states: Deficiency above leads to vertigo; deficiency below leads to cold extremities. Although vertigo is generally a sign of deficiency, there are cases of Yangming Wind strike presenting solely with vertigo and no aversion to cold; this indicates that Wind is the primary cause of vertigo. All such scenarios belong to the pattern of Water Counterflow. If various counterflow conditions are mistakenly treated with sweating, severe cases will result in disordered speech and vertigo, leading to death.
To treat vertigo caused by Shaoyang disease, use Xiaochaihu Tang (Minor Bupleurum Decoction) supplemented with Tianma (Gastrodia Rhizome) and Chuanxiong (Ligusticum Rhizome).
Zhang Jianshan stated: Scorched and dry lips indicate Spleen Heat; if scorched but red, it is auspicious; if scorched and black, it is ominous. Redness and swelling of both lips and mouth indicate extreme Heat. Cyanosis and blackness of both lips and mouth indicate extreme Cold. Bitter taste in the mouth indicates Gallbladder Heat. Sweet taste in the mouth indicates Spleen Heat. Dry mouth and throat indicate Kidney Heat. Dry tongue, oral dryness, and desire to drink water indicate Yangming Heat. Trismus (lockjaw) and difficulty speaking indicate Spasm or Wind disease. Sores on the upper lip are termed "Hu" (Fox), indicating parasites eroding the internal organs; sores on the lower lip are termed "Huo" (Confusion), indicating parasites eroding the anus. If the lips are cyanotic and the tongue is curled, if the corners of the mouth turn cyanotic, if the area around the mouth is dark/black, if the mouth is open with straight airflow, if the mouth resembles a fish's mouth, or if the lips tremble continuously with breath failing to return, these are all untreatable conditions.
Ke Qin stated: This is the outline syndrome of Shaoyang disease. The symptoms involving the mouth, throat, and eyes cannot be classified strictly as Exterior or Interior; they represent the transition from Exterior to Interior and from Interior to Exterior, known as the Half-Exterior Half-Interior stage. These three symptoms reflect the pathogenesis of the Shaoyang meridian, applicable to wind-cold and miscellaneous diseases. The presence of any one symptom is sufficient for diagnosis; it is not necessary for all to be present.
[Outline] Zhang Zhongjing stated: In Shaoyang Wind strike, the patient experiences bilateral hearing loss, redness of the eyes, fullness in the chest, and irritability. Emesis and purging methods must not be used. Misapplication of emesis or purging will lead to palpitations and fright.
[Mu] Wei Litong stated: Shanghan inherently includes aspects of Wind strike. Wind-Cold pathogens, following the principle of similarity, invade the Ying and Wei (Nutritive and Defensive) Qi of the Taiyang meridian, remaining only at the surface of the skin and muscles. The invasion is shallow, hence termed "Shang" (Injury). Therefore, if left untreated for a long time, the pathogen gradually deepens. It may resolve after traversing one meridian or transmit after passing through one meridian, following a fixed pathway. This is why Shanghan involves "meridian transmission"; without transmission, it would not be considered Shanghan disease. In contrast, Zhongfeng (Wind Strike) and Zhonghan (Cold Strike) arrive suddenly without sequential order. However, Wind pathogens inevitably strike the Shaoyang meridian among the Three Yang meridians, and Cold pathogens inevitably strike the Shaoyin meridian among the Three Yin meridians, adhering to the principle of affinity. This also embodies the logic of "following the young rather than the old." These pathogens are deeper and faster than those affecting Taiyang Ying and Wei, hence termed "Zhong" (Strike). Consequently, illness occurs immediately upon exposure, sometimes leading to instant death. This differs significantly from Shanghan diseases transmitted via meridians.