（此方自原论中第三卷移附于此）
柴胡（半斤） 黄芩 人参 甘草（各三两） 半夏（半升洗） 生姜（三两切） 大枣（十二枚擘）
上七味。以水一斗二升。煮取六升。去滓。再煎取三升。温服一升。日三服。
成氏明理论云。伤寒邪气在表者。必渍形以为汗。邪气在里者。必荡涤以为利。其于不外不内。半表半里。既非
发汗之所宜。又非吐下之所对。是当和解则可矣。小柴胡为和解表里之剂也。柴胡味苦平微寒。黄芩味苦寒。内经曰。
热淫于内。以苦发之。邪在半表半里。则半成热矣。热气内传变不可测。须迎而夺之。必先散热。是以苦寒为主。故以
柴胡为君。黄芩为臣。以成彻热发表之剂。人参味甘温。甘草味甘平。邪气传里。则里气不治。甘以缓之。是以甘物为
之助。故用人参甘草为佐。以扶正气而复之也。半夏味辛微温。邪初入里。则里气逆。辛以散之。是以辛物为之助。故
用半夏为佐。以顺逆气而散邪也。里气平正。则邪气不得深入。是以三味佐柴胡以和里。生姜味辛温。大枣味甘温。内
经曰辛甘发散为阳。表邪未已。迤逦内传。既未作实。宜当两解。其在外者。必以辛甘之物发散。故生姜大枣为使。辅
柴胡以和表。七物相合。两解之剂当矣。
后加减法（明理论又云。邪气自表。未敛为实乘虚而凑。则所传不一。故有增损以御之。）
若胸中烦而不呕。去半夏人参。加栝蒌实一枚。（烦者。热也。呕者。气逆也。胸中烦而不呕。则热聚而气不逆。邪
气欲渐成实也。人参味甘为补剂。去之使不助热也。半夏味辛为散剂。去之以无逆气也。栝蒌实味苦寒。除热必以寒。
泄热必以苦。加栝蒌实以通胸中郁热。）若渴者。去半夏。加人参合前成四两半。栝蒌根四两。（津液不足则渴。半夏味
辛性燥。渗津液物也。去之则津液易复。人参味甘而润栝蒌根。味苦而坚。坚润相合。津液生而渴自已。愚以胃实热甚
而渴者。人参恐不宜用。加药法不可执也。）
若腹中痛者。去黄芩。加芍药。三两（宜通而塞为痛。邪气入里。里气不足。寒气壅之。则腹中痛。黄芩味苦寒性
坚而寒中。去之则中气易和。芍药味酸苦微寒。酸性泄而利中。加之则塞气得通而痛自已。愚以此必是里寒血滞。而腹
中痛。以故去黄芩。加芍药。若邪热实结而腹中痛。恐黄芩不宜去。芍药不宜加也。又上云芍药性泄而利中。亦非正解。）
若胁下痞硬。去大枣。加牡蛎四两（内经曰。甘者令人中满。大枣味甘温去之则痞者。消。咸以软之。牡蛎味酸咸寒。
加之而硬者软。）若心下悸。小便不利者。去黄芩。加茯苓四两。（心下悸。小便不利。水蓄而不行也。内经曰。肾欲坚。
急食苦以坚之。坚肾则水益。黄芩味苦寒。去之则蓄水浸行。内经曰。淡味渗泄为阳。茯苓味甘淡。加之则津液通流。
愚以津液通流。则蓄水自行矣。）若不渴。外有微热者。去人参。加桂三两。温覆取微汗愈（不渴则津液足。去人参。以
人参为主内之物也。外有微热。则表证多。加桂以取汗。发散表邪也。愚以此邪必自太阳经传来者。）若咳者。去人参大
枣生姜。加五味子半升。干姜二两（肺气逆则咳。甘补中。则肺气愈逆。故去人参大枣之甘。五味子。酸温。肺欲收。
急食酸以收之。气逆不收。故加五味子之酸。生姜干姜一物也。生者。温而干者热。寒气内淫。则散以辛热。盖诸咳皆
本于寒。故去生姜。加干姜。是相假以正温热之功。愚以如肺有邪热而作咳。恐五味子太敛。干姜又太热不宜加也。成
氏又云。识诸此者。小小变通。触类而长。则知以上加减法。不可拘也。）
琥按上柴胡汤方。专治少阳经往来寒热。头角痛。耳聋口苦。胁痛脉弦者。倘其病初伤本经。或初自太阳阳明二经
传来。邪气方盛。人参一味断不可用。若其病过经不解。或本经中有留邪未尽。正气已虚。人参一味。方可加之也。
琥又按加减法。不但原方后所传云云。外有师传加减者。内台金镜云。如发热小便不利者。和五苓散。呕恶者。加
橘红。胸中痞结者。加枳实。咳逆而发热者。加丁香柿蒂。呕吐者。加竹茹。据上师传加减法云。咳逆发热。咳逆当是
呃逆。呃逆候。未必尽由于胃寒。其加丁香。不无所误。
（附例）伤寒五六日中风。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。或咳者。小柴胡汤主之。（此条系太阳风寒传入少阳之证。既曰伤
寒。复曰中风者。成注引玉函云。中风五六日。伤寒往来寒热。此即是或中风。或伤寒。于五六日时。太阳风寒之邪。
传于少阳。皆有此往来寒热之证。非是既伤于寒。复中于风也。胸胁者。少阳经所行之部分。邪传少阳之经。则胸胁苦
满也。胸胁既满。则胃中之水谷亦不消。以故默默不欲饮食也。默默者。尚论篇云。即昏昏之意。邪热甚而神思不清也。
邪在胸膈。上逼于心。则烦。犯于胃。则呕心烦喜呕者。成注云。邪在表。方传里也。邪初入里。未有定处。则所传不
一。故有或渴或痞等证。总以小柴胡汤加减主之。或胸中烦云云。注已见上加减法中。兹不复赘。）
血弱气尽。腠理开。邪气因入。与正气相搏。结于胁下。正邪分争。往来寒热。休作有时。默默不欲饮食。脏腑相
连。其痛必下。邪高痛下故使呕也。小柴胡汤主之。（此条病。乃承上条中风。所以往来寒热之故。而申言之也。少阳本
少血之经故云。血弱。中风者。风伤气至五六日之时。则正气渐消。故云。气尽。血弱气尽。则营中之阴既虚。卫外之
阳不固。以故腠理开疏。风邪之气。因入于里。与正气相搏击而结于胁下。正当少阳之部分也。正邪分争者。正气与邪
气互相并争。是以往来寒热也。休作有时者。此发明往来之意。盖言寒休则热作。热休则寒作。往来有时而不能止也。
默默不欲饮食。注见上条。五脏惟肝与胆府相连。位近于下。此即脉经云肾肝居沉之义。故其痛亦必在胁之下。也痛虽
在下。而病邪之气。必挟肝胆之火。上而犯胃。故使呕也。高字作上字解。脏腑相连。脏从腑治。故与小柴胡汤。以和
解半表半里之邪。愚以汤中人参宜加用。以此条病。本血弱气尽故也。）
服柴胡汤已。渴者。属阳明也。以法治之。（未服柴胡汤而渴。渴亦柴胡汤兼主之候。今者。服汤已而渴。则邪传阳
明。热已入胃。以法治之者。盖言白虎承气。各随其宜而用之耳。）
得病六七日。脉迟浮弱。恶风寒。手足温。医二三下之。不能食而胁下满痛。面目及身黄。颈项强。小便难者。与
柴胡汤。后必下重。本渴而饮水。呕者。柴胡汤不中与也。食谷者。哕。（此条系太阳阳明证居多。医人不可以其胁下满
痛而呕。全以为少阳之证。而轻用柴胡汤也。得病六七日。而脉迟者。当是阳明受病手足温者。系在太阴。故医家认以
为可下之证。殊不知脉虽迟而兼浮弱。手足虽温而恶风寒。纵六七日。其邪犹在太阳之经。未入于府。为不可下。医反
二三下之为误也。误下之则损其胃气。故不能食。热邪传里。搏于少阳。故胁下满痛。面目及身黄者。胃气损。为热所
蒸。故发黄色也。颈项强者。太阳阳明之证犹在也。小便难者。内亡津液。膀胱之气燥热。故小水涩也。若此者。医人
不可以其胁下满痛。而与小柴胡汤。以柴胡汤中有半夏。乃解肌兼燥津液之剂。如误与之。则大便后。必燥。涩而下重
也。本渴而饮水呕者。水停心下也。此非少阳证喜呕之比。故云。柴胡不中与也。食谷而哕者亦然。哕者。食入气逆而
呕也。凡此者。皆轻用柴胡汤之所当禁也。愚按此条论。本太阳中篇移附于此。曰脉浮弱曰恶风寒。曰项强。皆系太阳
病。医人不识。以六七日。为可下而误下之。邪入少阳。又不专在少阳。故柴胡在所当禁。本渴饮水而呕者。补亡论常
器之云。宜五苓散。愚以身黄未退者。加茵陈颈项强者。还宜以葛根汤加减增入用之。）
伤寒四五日。身热恶风。颈项强胁下满。手足温而渴者。小柴胡汤主之。（此条系三阳经齐病。当是少阳之邪居多。
太阳伤寒。已至四五日之时。不曰发热恶风。止曰身热者。此太阳之邪渐衰也。其兼阳明证。不曰鼻干不得卧。而止曰
颈项强者。此阳明之邪亦将衰也。惟胁下满。为少阳经之专证。况兼手足温而又渴。此为邪将传里之机。成注云。手足
温者。知邪在表里之间也。故与小柴胡汤。以和解表里之邪。尚论篇云。此用小柴胡汤。当从加减法。去半夏。加栝蒌
根为是。）
伤寒阳脉涩。阴脉弦。法当腹中急痛者。先与小建中汤。不瘥者。与小柴胡汤。（此条乃。少阳病兼挟里虚之证。伤
寒脉弦者。弦本少阳之脉。宜与小柴胡汤。兹但阴脉弦。而阳脉则涩。此阴阳以浮沉言。脉浮。取之则涩。而不流利。
沉取之又弦而不和缓。涩主气血虚少弦又主痛。法当腹中急痛。与建中汤者以温中补虚。缓其痛而兼散其邪也。先温补
矣。而弦脉不除。痛犹未止者。为不瘥。此为少阳经有留邪也。后与小柴胡汤。去黄芩。加芍药以和解之。盖腹中痛。
亦柴胡证中之一候也。愚以先补后解。乃仲景神妙之法。然亦必少阳经气虚无郁热者宜之。小建中汤方见前第四卷太阳
篇中）
伤寒中风。有柴胡证。但见一证便是不必悉具（伤寒中风者。谓或伤寒。或中风不必拘也。柴胡证者。谓邪入少阳。
在半表半里之间也。但见一证。谓或口苦。或咽干目眩。或耳聋无闻。或胁下硬满。或呕不能食。往来寒热等。便宜与
柴胡汤治之。不必待其证候全具也。愚按此条系用柴胡汤之法。兼总上文以申明之。）
凡柴胡汤病证而下之。若柴胡证不罢者。复与柴胡汤。必蒸蒸而振。却发热汗出而解。（凡柴胡汤病证而下之者。误
下之也。若柴胡证不罢。以无变证。故其病犹在也。当复与柴胡汤。以和解之。得汤必蒸蒸而振。振者。战也。战而后
发热。故云。蒸蒸互辞以见义也。正气与邪气相争。正气胜。则邪气还表。故汗出而解。愚以柴胡非发汗之药。然邪气
不因下而陷入于里。原因在里之正气胜。藉药力而祛邪欲出之表。故必自汗出而解也。上八条证俱自太阳中篇移附于此）
妇人中风。七八日。续得寒热。发作有时。经水适断者。此为热入血室。其血必结。故使如疟状。发作有时。小柴
胡汤主之。（妇人中风与男子同。惟热入血室之证。必从少阳主治。故于此条复附及之成注云。中风七八日。乃邪气传里
之时。发作有时者。此言往来之状也。以其初无寒热。故云。续得寒热。经水适断者。此值经水正来。适遇邪热。壅其
经而不行。故云。断也。此其病名为热入血室。其血必结以下文。此申明经断所以寒热之义。与小柴胡汤。以解邪热。
则所结之血。必自行而愈矣。愚按血室者。即血海。人身中冲脉是也。经云。冲脉者。经脉之海。言受纳诸经之灌注。
营血于。此而蓄藏。故谓之海。亦谓之室也。或问云。经云。冲脉者。为十二经之海。当是血脉之所会聚。男子妇人皆
有之。何以热入血室之证。仲景但指妇人。不指男子也。余答云。然。男女皆有此冲脉也。但妇人阴类。血亦属阴。经
脉流通。惟妇人易盈。盈则必聚于冲脉之中。故有热入血室之证。乃邪热内入。与血相结。瘀而不行。此为血有余而邪
实也。其治以小柴胡汤者。保命集云。妇人天癸既行。皆从厥阴。厥阴与少阳相为表里。故下条治法云。无犯胃气。及
上二焦。以胆经有三禁。故止宜用小柴胡汤也。又刺法。热入血室者。当刺期门。随其实而泻之。期门者。肝之募。厥
阴之经也。其不用小柴胡汤。即刺期门者。二经可相通而治故也。）
妇人伤寒发热。经水适来。昼日明了。暮则谵语如见鬼状者。此为热入血室。无犯胃气。及上二焦。必自愈。（此条
言妇人伤寒者。可见风寒之邪。皆有热入血室证也。发热者。寒郁而成热也。经水适来者。盖言经水适当其时而来。过
多不止。则血室空虚。邪热乘虚而入也。昼日明了云云者。昼属阳。阳主气。暮属阴。阴主血。今则热邪入血室而为病。
以故昼日明了。而病轻。暮则谵语。如见鬼状。而病剧也。谵语者。系胃家实。医人用下药者多。此非胃家实。故云。
无犯胃气。言不可下也。上二焦者。营卫之所出也。汗伤营血。吐伤卫气。此言三法。皆不可用也。必也。与小柴胡汤
以和解邪热。斯不调其经。而经血调谵语等证。可不治而自愈。按此条论。仲景不言用小柴胡。补亡论郭白云。云如不
愈者。服小柴胡汤。则知其汤与证甚相对。可无疑矣。）
伤寒五六日。头汗出微恶寒。手足冷。心下满口不欲食。大便硬。脉细者。此为阳微结必有表。复有里也。脉沉。
亦在里也。汗出为阳微。假令纯阴结。不得复有外证。悉入在里。此为半在里半在外也。脉虽沉紧。不得为少阴病所以
(This formula was transferred from Volume 3 of the original treatise and attached here.)
Chai Hu (Bupleuri Radix) (half jin), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) (each three liang), Ban Xia (Pinelliae Tuber) (half sheng, washed), Sheng Jiang (Zingiberis Rhizoma Recens) (three liang, sliced), Da Zao (Jujubae Fructus) (twelve pieces, torn open).
The above seven ingredients. Use one dou two sheng of water. Boil to obtain six sheng. Remove the dregs. Decoct again to obtain three sheng. Take one sheng warm. Administer three times daily.
Cheng Wuji stated in *Ming Li Lun* (Theory of Clarification): When pathogenic factors of Shang Han (Cold Damage) are on the exterior, they must be expelled by inducing sweating through soaking the body; when they are on the interior, they must be purged via bowel movements. When pathogens are neither strictly on the exterior nor the interior, but in the half-exterior half-interior stage, this is neither suitable for sweating nor for vomiting or purging methods; it should be treated with harmonizing methods. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is a formula for harmonizing the exterior and interior. Chai Hu (Bupleuri Radix) is bitter, neutral, and slightly cold; Huang Qin (Scutellariae Radix) is bitter and cold. The *Nei Jing* (Inner Canon) states: "When heat floods within, use bitter substances to disperse it." When pathogens are in the half-exterior half-interior stage, heat has already formed to some extent. If heat qi transmits inward, changes are unpredictable; one must intercept and eliminate it, first dissipating heat. Therefore, bitter-cold herbs are used as the main component. Thus, Chai Hu (Bupleuri Radix) is used as the Sovereign herb, and Huang Qin (Scutellariae Radix) as the Minister herb, to form a formula that thoroughly clears heat and releases the exterior. Ren Shen (Ginseng Radix) is sweet and warm; Gan Cao (Glycyrrhizae Radix et Rhizoma) is sweet and neutral. When pathogens transmit to the interior, the interior qi becomes disordered. Sweet substances can moderate this, so sweet herbs are used as assistants. Therefore, Ren Shen (Ginseng Radix) and Gan Cao (Glycyrrhizae Radix et Rhizoma) are used as Assistant herbs to support healthy qi and restore it. Ban Xia (Pinelliae Tuber) is acrid and slightly warm. When pathogens initially enter the interior, interior qi rebels upward; acrid substances can scatter this, so acrid herbs are used as assistants. Thus, Ban Xia (Pinelliae Tuber) is used as an Assistant herb to direct rebellious qi downward and scatter pathogens. When interior qi is peaceful and upright, pathogens cannot penetrate deeply. These three assistant herbs combine with Chai Hu (Bupleuri Radix) to harmonize the interior. Sheng Jiang (Zingiberis Rhizoma Recens) is acrid and warm; Da Zao (Jujubae Fructus) is sweet and warm. The *Nei Jing* states: "Acrid and sweet substances that disperse belong to Yang." Since exterior pathogens remain and gradually transmit inward without yet forming excess conditions, both aspects should be addressed. Those on the outside must be dispersed using acrid-sweet substances; thus, Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) are used as Envoy herbs to assist Chai Hu (Bupleuri Radix) in harmonizing the exterior. The combination of these seven ingredients forms an appropriate dual-resolving formula.
Subsequent modifications (as *Ming Li Lun* further states: Pathogens coming from the exterior do not immediately consolidate into excess; they invade due to deficiency, leading to varied transmission patterns. Therefore, additions and subtractions are made to address them.)
If there is vexation in the chest without vomiting, remove Ban Xia (Pinelliae Tuber) and Ren Shen (Ginseng Radix), and add one Gua Lou Shi (Trichosanthis Fructus). (Vexation indicates heat; vomiting indicates rebellious qi. Vexation in the chest without vomiting means heat is concentrated but qi does not rebel, and pathogens are tending toward consolidation. Ren Shen (Ginseng Radix) is sweet and tonifying; removing it prevents aiding heat. Ban Xia (Pinelliae Tuber) is acrid and dispersing; removing it is unnecessary as there is no rebellious qi. Gua Lou Shi (Trichosanthis Fructus) is bitter and cold; clearing heat requires cold substances, and draining heat requires bitter substances. Adding Gua Lou Shi (Trichosanthis Fructus) unblocks depressed heat in the chest.) If there is thirst, remove Ban Xia (Pinelliae Tuber), increase Ren Shen (Ginseng Radix) to total four liang and half, and add Gua Lou Gen (Trichosanthis Radix) four liang. (Insufficiency of body fluids causes thirst. Ban Xia (Pinelliae Tuber) is acrid and drying, promoting fluid excretion. Removing it allows fluids to recover. Ren Shen (Ginseng Radix) is sweet and moistening; Gua Lou Gen (Trichosanthis Radix) is bitter and firm/astringent. Firmness and moisture combined generate fluids, stopping thirst. I believe if thirst is caused by severe stomach excess-heat, Ren Shen (Ginseng Radix) might not be suitable; the method of adding herbs should not be rigidly applied.)
If there is abdominal pain, remove Huang Qin (Scutellariae Radix) and add Bai Shao (Paeoniae Radix Alba) three liang. (Pain results from obstruction where flow is desired. Pathogens entering the interior deplete interior qi; cold qi stagnation causes abdominal pain. Huang Qin (Scutellariae Radix) is bitter and cold, hard in nature and chilling the middle; removing it allows middle qi to harmonize. Bai Shao (Paeoniae Radix Alba) is sour, bitter, and slightly cold; its sourness drains and benefits the middle. Adding it unblocks obstruction and stops pain. I consider this must be interior cold with blood stasis causing abdominal pain, hence removing Huang Qin (Scutellariae Radix) and adding Bai Shao (Paeoniae Radix Alba). If abdominal pain is due to excess-heat consolidation, Huang Qin (Scutellariae Radix) probably should not be removed, nor Bai Shao (Paeoniae Radix Alba) added. Furthermore, the previous statement that Bai Shao (Paeoniae Radix Alba) is draining and beneficial to the middle is not entirely accurate.)
If there is fullness and hardness under the costal margin, remove Da Zao (Jujubae Fructus) and add Mu Li (Ostreae Concha) four liang. (*Nei Jing* states: "Sweet substances cause fullness in the center." Da Zao (Jujubae Fructus) is sweet and warm; removing it resolves fullness. Salty substances soften hardness. Mu Li (Ostreae Concha) is sour, salty, and cold; adding it softens hardness.) If there is palpitation below the heart and difficult urination, remove Huang Qin (Scutellariae Radix) and add Fu Ling (Poria) four liang. (Palpitation below the heart and difficult urination indicate water retention without movement. *Nei Jing* states: "The Kidney desires firmness; urgently eat bitter substances to firm it." Firming the kidney increases water control. Huang Qin (Scutellariae Radix) is bitter and cold; removing it allows retained water to move. *Nei Jing* states: "Light/damp flavors promote permeability and drainage, belonging to Yang." Fu Ling (Poria) is sweet and light/damp; adding it promotes fluid circulation. I believe once fluids circulate, retained water moves naturally.) If there is no thirst but slight external fever, remove Ren Shen (Ginseng Radix) and add Gui Zhi (Cinnamomi Ramulus) three liang, cover warmly to induce slight sweating for cure. (No thirst indicates sufficient fluids; remove Ren Shen (Ginseng Radix) as it primarily acts internally. Slight external fever indicates many exterior symptoms; add Gui Zhi (Cinnamomi Ramulus) to induce sweating and disperse exterior pathogens. I believe this pathogen likely transmitted from the Taiyang channel.) If there is coughing, remove Ren Shen (Ginseng Radix), Da Zao (Jujubae Fructus), and Sheng Jiang (Zingiberis Rhizoma Recens); add Wu Wei Zi (Schisandrae Fructus) half sheng and Gan Jiang (Zingiberis Rhizoma) two liang. (Rebellious lung qi causes coughing; sweet substances tonify the middle, making lung qi more rebellious. Hence remove the sweetness of Ren Shen (Ginseng Radix) and Da Zao (Jujubae Fructus). Wu Wei Zi (Schisandrae Fructus) is sour and warm; the Lung desires contraction; urgently eat sour substances to contract it. Qi is rebellious and not contracting, so add the sourness of Wu Wei Zi (Schisandrae Fructus). Sheng Jiang (Zingiberis Rhizoma Recens) and Gan Jiang (Zingiberis Rhizoma) are the same plant; fresh is warm, dried is hot. Internal invasion of cold qi requires scattering with acrid-hot substances. Generally, all coughs originate from cold. Hence remove Sheng Jiang (Zingiberis Rhizoma Recens) and add Gan Jiang (Zingiberis Rhizoma) to correct the warming effect. I believe if cough is due to lung excess-heat, Wu Wei Zi (Schisandrae Fructus) is too astringent, and Gan Jiang (Zingiberis Rhizoma) is too hot, so they should not be added. Cheng Wuji also said: Understanding these principles allows for minor adjustments and analogical extension, knowing that the above modification methods should not be rigidly applied.)
Hu notes regarding the above Chai Hu Tang formula: It specifically treats Shaoyang channel symptoms such as alternating chills and fever, pain at the temples, deafness, bitter taste in the mouth, hypochondriac pain, and wiry pulse. If the disease initially injures this channel, or initially transmits from the Taiyang or Yangming channels while pathogens are vigorous, Ren Shen (Ginseng Radix) absolutely should not be used. If the disease persists beyond the expected period, or residual pathogens remain in this channel while healthy qi is deficient, then Ren Shen (Ginseng Radix) may be added.
Hu further notes regarding modification methods: Besides those transmitted after the original formula, there are teacher-transmitted modifications. *Nei Tai Jin Jing* states: For fever with difficult urination, combine with Wu Ling San (Five-Ingredient Powder with Poria); for nausea and vomiting, add Ju Hong (Citri Reticulatae Pericarpium Rubrum); for chest fullness and knotting, add Zhi Shi (Aurantii Fructus Immaturus); for hiccups with fever, add Ding Xiang (Caryophylli Flos) and Shi Di (Diospyri Fructus); for vomiting, add Zhu Ru (Bambusae Caulis in Taenia). According to these teacher-transmitted modifications, "hiccups" likely refers to hiccuping (E Ni). Hiccuping does not necessarily stem solely from stomach cold; adding Ding Xiang (Caryophylli Flos) may be erroneous.
(Attached Example) In Shang Han or Feng Zhong (Wind Strike) after five to six days, with alternating chills and fever, oppression and fullness in the chest and hypochondrium, silence and lack of desire for food, irritability and frequent vomiting, or chest vexation without vomiting, or thirst, or abdominal pain, or fullness and hardness under the costal margin, or palpitation below the heart with difficult urination, or no thirst with slight body fever, or coughing, Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs. (This clause describes the syndrome of Taiyang wind-cold transmitting to Shaoyang. Although called Shang Han and Feng Zhong, Cheng's commentary cites *Yu Han Jing*: "Feng Zhong after five to six days, Shang Han with alternating chills and fever" implies either Feng Zhong or Shang Han. At five to six days, Taiyang wind-cold pathogens transmit to Shaoyang, presenting with alternating chills and fever. This is not simultaneous injury by cold and strike by wind. The chest and hypochondrium are areas traversed by the Shaoyang channel; when pathogens transmit to this channel, there is oppression and fullness. With chest/hypochondriac fullness, stomach water and grain fail to digest, causing silence and lack of appetite. "Silence" refers to mental confusion due to intense pathogenic heat affecting the mind. Pathogens in the chest/diaphragm press upward on the Heart causing vexation; invading the Stomach causes vomiting. "Irritability and frequent vomiting": Cheng's note says pathogens are on the exterior, about to transmit inward. Newly entered into the interior without fixed location leads to varied transmissions, hence thirst, fullness, etc. Total treatment uses modified Xiao Chai Hu Tang (Minor Bupleurum Decoction). References to chest vexation etc. are noted in the modification section above, omitted here.)
When blood is weak and qi exhausted, pores open, pathogens enter, struggle with healthy qi, knotting under the hypochondrium, healthy and pathogenic qi contend, alternating chills and fever occurring at intervals, silence and lack of desire for food. Organs and fu-viscera are connected; pain must occur below. Pathogens are high, pain is low, thus causing vomiting. Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs. (This condition follows the previous Feng Zhong clause, explaining the cause of alternating chills and fever. Shaoyang is a channel with little blood and much qi, hence "blood weak." In Feng Zhong, wind injures qi; by five to six days, healthy qi declines, hence "qi exhausted." Blood weakness and qi exhaustion mean Ying-nutritive yin is deficient, and Wei-defensive yang is insecure. Thus pores open, wind-pathogens enter the interior, struggle with healthy qi, and knot under the hypochondrium, precisely the Shaoyang area. Contention of healthy and pathogenic qi causes alternating chills and fever. "Occurring at intervals" explains alternation: when chills cease, fever arises; when fever ceases, chills arise, continuing indefinitely. Silence/lack of appetite noted previously. Only Liver and Gallbladder are closely connected, located lower, consistent with *Mai Jing* stating Liver/Kidney pulses are deep; thus pain occurs under the hypochondrium. Though pain is below, pathogenic qi carries Liver/Gallbladder fire upward to invade the Stomach, causing vomiting. "High" refers to upper. Connected organs/fu-viscera imply treating zang via fu; hence Xiao Chai Hu Tang (Minor Bupleurum Decoction) harmonizes half-exterior half-interior pathogens. I believe Ren Shen (Ginseng Radix) should be added in the decoction because this condition stems from blood weakness and qi exhaustion.)
After taking Chai Hu Tang (Bupleurum Decoction), if thirst develops, it belongs to Yangming; treat according to the method. (Thirst before taking Chai Hu Tang (Bupleurum Decoction) is also a symptom managed by it. Thirst developing after taking it indicates transmission to Yangming, with heat entering the Stomach. "Treat according to method" refers to using Bai Hu Tang (White Tiger Decoction) or Cheng Qi Tang (Order the Qi Decoction) as appropriate.)
Six or seven days after contracting disease, with slow, floating, weak pulse, aversion to wind and cold, warm hands and feet. If the physician purges two or three times, leading to inability to eat, fullness and pain under the hypochondrium, yellow face/eyes/body, stiff neck, and difficult urination: giving Chai Hu Tang (Bupleurum Decoction) will later cause heaviness in the rectum. If originally thirsty and vomiting after drinking water: Chai Hu Tang (Bupleurum Decoction) is contraindicated. Eating grain causes hiccups. (This clause involves mostly Taiyang-Yangming syndromes. Physicians should not attribute hypochondriac fullness/pain and vomiting solely to Shaoyang and lightly use Chai Hu Tang (Bupleurum Decoction). Six to seven days with slow pulse suggests Yangming involvement. Warm hands/feet suggest Taiyin. Physicians mistake this as purgable. However, slow pulse with floating/weakness, warm limbs with aversion to wind/cold, even after six/seven days, means pathogens remain in Taiyang channel, not Fu-organs, making purging inadvisable. Purging twice/thrice is error. Error damages Stomach qi, causing inability to eat. Heat transmits inward, contending with Shaoyang, causing hypochondriac fullness/pain. Yellow complexion is due to damaged Stomach qi steamed by heat. Stiff neck indicates remaining Taiyang-Yangming signs. Difficult urination results from internal fluid loss and dry-heat in Bladder qi. In such cases, physicians should not give Xiao Chai Hu Tang (Minor Bupleurum Decoction) based on hypochondriac fullness. Ban Xia (Pinelliae Tuber) in the formula resolves muscle layer and dries fluids; misuse causes dry, heavy stool. Original thirst with vomiting after drinking indicates water retention in the epigastrium, distinct from Shaoyang vomiting; thus Chai Hu Tang (Bupleurum Decoction) is contraindicated. Hiccups upon eating are similar. All these prohibit light use of Chai Hu Tang (Bupleurum Decoction). I note this clause was moved from Taiyang chapter. Floating/weak pulse, aversion to wind/cold, stiff neck are Taiyang signs. Physicians missed this, purging wrongly at six/seven days. Pathogens entered Shaoyang but did not stay exclusively there; thus Chai Hu Tang (Bupleurum Decoction) is prohibited. For thirst/vomiting water, Chang Qizi in *Bu Wang Lun* suggests Wu Ling San (Five-Ingredient Powder with Poria). I suggest adding Yin Chen (Artemisiae Scopariae Herba) for unresolved jaundice; for stiff neck, Ge Gen Tang (Kudzu Decoction) modifications are appropriate.)
Four or five days after Shang Han, with body heat, aversion to wind, stiff neck, hypochondriac fullness, warm hands/feet, and thirst: Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs. (This clause involves simultaneous disease of Three Yang channels, predominantly Shaoyang pathogens. Taiyang Shang Han at four/five days shows only "body heat" rather than fever/aversion to wind, indicating declining Taiyang pathogens. Accompanying Yangming signs show only "stiff neck" rather than nasal dryness/restlessness, indicating declining Yangming pathogens. Hypochondriac fullness is specific to Shaoyang. Combined with warm limbs and thirst, this signals impending transmission inward. Cheng's note: Warm limbs indicate pathogens between exterior and interior. Hence Xiao Chai Hu Tang (Minor Bupleurum Decoction) harmonizes exterior/interior. *Shang Lun Pian* states: Using Xiao Chai Hu Tang (Minor Bupleurum Decoction) here should follow modification rules: remove Ban Xia (Pinelliae Tuber), add Gua Lou Gen (Trichosanthis Radix).)
In Shang Han, if Yang pulse is choppy and Yin pulse is wiry, law dictates urgent abdominal pain: First give Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). If not cured, give Xiao Chai Hu Tang (Minor Bupleurum Decoction). (This clause is Shaoyang disease complicated by interior deficiency. Wiry pulse in Shang Han is Shaoyang pulse, suitable for Xiao Chai Hu Tang (Minor Bupleurum Decoction). Here only Yin pulse is wiry, Yang pulse is choppy. Yin/Yang refer to deep/superficial. Superficial pulse is choppy/unsmooth; deep pulse is wiry/unrelaxed. Choppy indicates qi/blood deficiency; wiry indicates pain. Law dictates urgent abdominal pain. Giving Jian Zhong Tang warms middle, tonifies deficiency, moderates pain, and scatters pathogens. After warming/tonifying, if wiry pulse persists and pain continues (not cured), it indicates residual Shaoyang pathogens. Then give Xiao Chai Hu Tang (Minor Bupleurum Decoction), removing Huang Qin (Scutellariae Radix), adding Bai Shao (Paeoniae Radix Alba) to harmonize. Abdominal pain is one of the Chai Hu symptoms. I consider tonifying first then resolving is Zhang Zhongjing's divine method, suitable only when Shaoyang qi is deficient without stagnant heat. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) formula is in Volume 4, Taiyang chapter.)
In Shang Han or Feng Zhong, if there are Chai Hu symptoms, seeing just one symptom is sufficient; it is not necessary for all to be present. ("Shang Han/Feng Zhong" means either condition applies. "Chai Hu symptoms" mean pathogens entered Shaoyang, in half-exterior half-interior. "Seeing one symptom" means any of: bitter taste, dry throat/dizzy eyes, deafness, hypochondriac hardness/fullness, vomiting/inability to eat, alternating chills/fever, etc. Immediately give Chai Hu Tang (Bupleurum Decoction); do not wait for all symptoms to appear. I note this clause explains the method of using Chai Hu Tang (Bupleurum Decoction), summarizing previous text.)
Whenever Chai Hu Tang (Bupleurum Decoction) indications are treated with purging, and if Chai Hu symptoms persist, re-administer Chai Hu Tang (Bupleurum Decoction); there will surely be shivering and trembling, followed by fever and sweating for resolution. (Treating Chai Hu indications with purging is error. If Chai Hu symptoms persist without transformation, disease remains. Re-give Chai Hu Tang (Bupleurum Decoction) to harmonize. After taking it, shivering/trembling occurs. Trembling means battle. Battle followed by fever means "zheng zheng" describes mutual meaning. Healthy and pathogenic qi contend; healthy qi wins, pathogens return to exterior, thus sweating resolves. I believe Chai Hu is not a diaphoretic drug, but since pathogens did not sink inward due to purging, and internal healthy qi is strong,借助药力 (relying on medicinal power) to expel pathogens outward, sweating naturally occurs. The above eight clauses were moved from Taiyang chapter.)
In women with Feng Zhong, after seven to eight days, continuous onset of chills and fever occurring at intervals, with menstruation suddenly stopping: This is Heat Entering the Blood Chamber. Blood must knot, causing malaria-like symptoms occurring at intervals. Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs. (Women's Feng Zhong is same as men's, except Heat Entering Blood Chamber must be treated via Shaoyang. Cheng's note: Seven/eight days post-Feng Zhong is time for pathogens to transmit inward. "Occurring at intervals" describes alternation. Initially no chills/fever, hence "continuous onset." Menstruation suddenly stopping means menses arrived, met by pathogenic heat blocking flow, hence "stopped." Disease named Heat Entering Blood Chamber. "Blood must knot" explains why cessation causes chills/fever. Give Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve pathogenic heat; knotted blood will move and heal. I note Blood Chamber is Blood Sea, Chong Mai (Penetrating Vessel). Classics state Chong Mai is Sea of Channels, receiving infusion from all channels, storing Ying-blood. Hence Sea/Chamber. Question: Classics say Chong Mai is Sea of Twelve Channels, common to men/women. Why does Zhang Zhongjing specify women for Heat Entering Blood Chamber? Answer: Both have Chong Mai. Women are Yin type, blood is Yin. Menstrual flow is easy to fill; filling gathers in Chong Mai, causing Heat Entering Blood Chamber. Pathogenic heat enters, knots with blood, stagnates. This is blood excess with pathogenic excess. Treatment with Xiao Chai Hu Tang (Minor Bupleurum Decoction): *Bao Ming Ji* states: After Tian Gui (menstruation) begins, diseases follow Jueyin. Jueyin and Shaoyang are exterior-interior pairs. Next clause says: Do not harm Stomach qi and Upper/Middle Jiao, because Gallbladder channel has three prohibitions, so only Xiao Chai Hu Tang (Minor Bupleurum Decoction) is suitable. Acupuncture method: For Heat Entering Blood Chamber, puncture Qi Men (Liv-14) to drain excess. Qi Men is Liver Front-Mu point, Jueyin channel. Not using Xiao Chai Hu Tang (Minor Bupleurum Decoction) but puncturing Qi Men works because the two channels communicate.)
In women with Shang Han fever, with menstruation arriving, clear during day, delirium at night seeing ghosts: This is Heat Entering the Blood Chamber. Do not harm Stomach qi or Upper/Middle Jiao; it will self-heal. (This clause shows wind-cold pathogens can cause Heat Entering Blood Chamber in women. Fever is cold stagnation turning to heat. Menstruation arriving means menses came on time. If excessive/prolonged, Blood Chamber empties, pathogenic heat enters via deficiency. Day clear/night delirium: Day is Yang/Qi, Night is Yin/Blood. Heat enters Blood Chamber (Yin), so day symptoms are mild, night delirium is severe. Delirium usually indicates Stomach excess; physicians often use purgatives. This is not Stomach excess, hence "Do not harm Stomach qi" means no purging. Upper/Middle Jiao are sources of Ying/Wei. Sweating injures Ying-blood, vomiting injures Wei-qi. These three methods are forbidden. Must give Xiao Chai Hu Tang (Minor Bupleurum Decoction) to harmonize pathogenic heat. Without directly regulating menses, menses regulate, and delirium etc. heal spontaneously. Note: Zhang Zhongjing does not explicitly state using Xiao Chai Hu Tang (Minor Bupleurum Decoction) here. Guo Baiyun in *Bu Wang Lun* says: If not cured, take Xiao Chai Hu Tang (Minor Bupleurum Decoction), proving the formula matches the syndrome perfectly.)
Shang Han five to six days, head sweating, slight aversion to cold, cold hands/feet, epigastric fullness, no desire to eat, hard stool, fine pulse: This is Yang Micro-Consolidation. There must be exterior, and also interior. Deep pulse also indicates interior. Sweating indicates Yang micro. Suppose pure Yin Consolidation, there cannot be exterior signs; all enter interior. This is half-interior half-exterior. Even if pulse is deep and tight, it cannot be Shaoyin disease because