少阳之为病。口苦。咽干。目眩也。
足少阳、胆也。胆盛精汁三合。而其味苦。胆受邪而热。其气上溢。故口苦。咽门者。肝胆之候
。目锐 者。胆脉之所起。故咽干目眩也。
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。与小柴胡汤主之。
伤寒五六日中风者。言或伤寒五六日。传至少阳。或少阳本经。自中风邪。非既伤寒五六日。
而又中于风也。往来寒热者。少阳居表里之间。进而就阴则寒。退而从阳则热也。胸胁苦满者。少
阳之脉。其直者。从缺盆下腋循胸过季胁故也。默默不欲饮食。心烦喜呕者。木火相通。而胆喜犯胃
也。或者。未定之辞。以少阳为半表半里。其气有乍进乍退之机。故其病有或然或不然之异。而少
阳之病。但见有往来寒热。胸胁苦满之证。盒饭以小柴胡和解表里为主。所谓伤寒中风。有柴胡证
。但见一证便是。不必悉具是也。此条自太阳篇移入。
小柴胡汤方
柴胡（半斤） 黄芩（三两） 人参（三两） 甘草（三两） 生姜（三两） 半夏（半升洗
）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。
加减法
若胸中烦而不呕。去半夏、人参。加栝蒌实一枚。
胸中烦而不呕者。邪聚于膈而不上逆也。热聚则不得以甘补。不逆则不必以辛散。故去人参、
半夏。而加栝蒌实之寒。以除热而荡实也。
若渴者。去半夏。加人参合前成四两半。栝蒌根四两。
渴者。木火内烦。而津虚气燥也。故去半夏之温燥。而加人参之甘润。栝蒌根之凉苦。以彻热
而生津也。
若腹中痛者。去黄芩。加芍药三两。
腹中痛者。木邪伤土也。黄芩苦寒。不利脾阳。芍药酸寒。能于土中泻木。去邪气止腹痛也。
若胁下痞硬。去大枣。加牡蛎四两。
胁下痞硬者。邪聚少阳之募。大枣甘能增满。牡蛎咸能软坚。好古云、牡蛎以柴胡引之。能去
胁下痞也。
若心下悸。小便不利者。去黄芩。加茯苓四两。
心下悸。小便不利者。水饮蓄而不行也。水饮得冷则停。得淡则利。故去黄芩。加茯苓。
若不渴。外有微热者。去人参。加桂三两。温覆取微汗愈。
不渴外有微热者。里和而表未解也。故不取人参之补里。而用桂枝之解外也。
若咳者。去人参、大枣、生姜。加五味子半升。干姜二两。
咳者。肺寒而气逆也。经曰、肺苦气上逆。急食酸以收之。又曰、形寒饮冷则伤肺。故加五味
之酸。以收逆气。干姜之温。以却肺寒。参、枣、甘壅。不利于逆。生姜之辛。亦恶其散耳。
血弱气尽。腠理开。邪气因入。与正气相抟。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。服柴胡汤已。渴者。
属阳明也。以法治之。
血弱气尽。腠理开。谓亡血新产劳力之人。气血不足。腠理疏豁。而邪气乘之也。邪入必与
正相抟。而结于胁下。胁下者。少阴之募。而少阴者。阴阳之交也。邪气居之。阴出而与邪争则寒。
阳入而与邪争则热。阴阳出入。各有其时。故寒热往来。休作有时也。默默不欲饮食。义如上条。
脏腑相连四句。是原所以邪气入结之故。谓胆寄于肝。地逼气通。是以其邪必从腑而入脏。所谓其
痛必下也。邪高、谓病所来处。痛下、谓病所结处。邪欲入而正拒之。则必上逆而呕也。至其治法
。亦不出小柴胡和解表里之法。服后邪解气和。口必不渴。若渴者。是少阳邪气复还阳明也。以法
治之者。谓当从阳明之法。而不可复从少阳之法矣。此亦从太阳篇移入。
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。
此条类似太阳与少阳并病。以太阳不得有胁下满。少阳不得有颈项强。且手足温而渴。知其邪
不独在表。而亦在里也。欲合表里而并解。则非小柴胡不可耳。亦太阳篇移入。
伤寒中风。有柴胡证。但见一证便是。不必悉具。
柴胡证。如前条所谓往来寒热。胸胁苦满等证是也。伤寒中风者。谓无论伤寒中风。有柴胡证
者。但见一证。盒饭以小柴胡和解之。不可谓其不具。而以他药发之也。前条云、身热恶风。颈项
强。胁下满者。与小柴胡不与桂枝。即此意。亦太阳篇移入。
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。
柴胡证不应下而反下之。于法为逆。若柴胡证不罢者。仍宜柴胡汤和解。所谓此虽已下。不为
逆也。蒸蒸而振者。气从内达。邪从外出。有战胜之义焉。是以发热汗出而解也。亦太阳篇移入。
伤寒阳脉涩。阴脉弦。法当腹中急痛者。先与小建中汤。不瘥者。与小柴胡汤主之。
阳脉涩。阳气少也。阴脉弦。阴有邪也。阳不足而阴乘之。法当腹中急痛。故以小建中汤温里
益虚散阴气。若不瘥。知非虚寒在里。而是风邪内干也。故当以小柴胡汤散邪气止腹痛。亦太阳篇
移入。
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。所以然者。阴不得有汗。今头汗出。故知非少阴也
。可与小柴胡汤。设不了了者。得屎而解。头汗出。微恶寒。为表证。手足冷。心下满。口不欲食
。大便硬。脉细。为里证。阳微结者。阳邪微结。未纯在里。亦不纯在表。故曰必有表。复有里也
。伤寒阴邪中于阴者。脉沉。阳邪结于里者。脉亦沉。合之于证。无外
证者。为纯在里。有外证者。为半在表也。无阳证者。沉为在阴。有阳证者。沉为在里也。夫头
为阳之会。而阴不得有汗。今脉沉紧而头汗出。知其病不在少阴。亦并不纯在表。故可与小柴胡汤
。合外内而并治之耳。设不了了者。必表解而里未和也。故曰得屎而解。
本太阳病。不解。转入少阳者。胁下硬痛。干呕不能食。往来寒热。尚未吐下。脉沉紧者。与小
柴胡汤。若已吐下。发汗。温针。谵语。柴胡汤证罢。此为坏病。知犯何逆。以法治之。
本太阳脉浮头痛恶寒之证。而转为胁下硬满。干呕不能食。往来寒热者。太阳不解。而传入
少阳也。尚未吐下。不经药坏者。脉虽沉紧。可与小柴胡以和之。以证见少阳。舍脉而从证也。或
云脉沉紧。连上未吐下看。言尚未经吐下。与脉未至沉紧者。知其邪犹在经。可与小柴胡以和之。
或云沉当作浮。前阳明篇第四十七条云、病过十日。脉续浮者。与小柴胡汤是也。并通。若已吐下发
汗温针。叠伤津液。胃燥谵语。而胁下硬满干呕等证反罢者。此众法尽投。正已大伤。而邪犹不解
。谓之坏病。非小柴胡所得而治者。须审其因犯何逆。随证以法治之。
The manifestation of Shaoyang disease (Daiyang Disease) is: bitter taste in the mouth, dryness of the throat, and dizziness/blurred vision.
The Foot-Shaoyang channel corresponds to the Gallbladder (Dan). The Gallbladder stores three he of essence fluid, which has a bitter taste. When the Gallbladder is invaded by pathogenic factors and generates heat, its Qi overflows upward, resulting in a bitter taste in the mouth. The pharynx is the indicator of the Liver and Gallbladder; the outer canthus of the eye is where the Gallbladder channel originates. Therefore, dryness of the throat and dizziness occur.
After five or six days of contracting Cold Damage (Shanghan) or Wind Strike (Zhongfeng), symptoms such as alternating chills and fever (Wanglai Hanre), fullness and distension in the chest and hypochondrium (Xiong Xie Ku Man), silence with loss of appetite (Momo Bu Yu Yinshi), irritability with frequent vomiting (Xin Fan Xi Ou) may appear. Alternatively, there may be irritability in the chest without vomiting, thirst, abdominal pain, hardness and stuffiness under the hypochondrium, palpitations in the epigastrium, difficulty in urination, absence of thirst with slight fever on the body, or coughing. The primary formula for treatment is Xiaochaihu Tang (Minor Bupleurum Decoction).
"Contracting Cold Damage or Wind Strike after five or six days" refers to either the transmission of Cold Damage to the Shaoyang channel after five or six days, or the direct invasion of Wind pathogens into the Shaoyang channel itself. It does not mean that one contracts Cold Damage for five or six days and then subsequently contracts Wind. "Alternating chills and fever" occurs because Shaoyang resides between the exterior and interior; when the pathogen advances into the Yin aspect, chills occur, and when it retreats to the Yang aspect, fever occurs. "Fullness and distension in the chest and hypochondrium" occurs because the straight branch of the Shaoyang channel descends from the supraclavicular fossa to the axilla, passing through the chest and reaching the costal region. "Silence with loss of appetite, irritability with frequent vomiting" results from the mutual connection of Wood and Fire, where Gallbladder Qi easily invades the Stomach. The term "or" indicates uncertainty. Because Shaoyang is located at the half-exterior and half-interior level, its Qi mechanism fluctuates between advancing and retreating, leading to variations in symptoms. However, if Shaoyang disease presents with either "alternating chills and fever" or "fullness and distension in the chest and hypochondrium," Xiaochaihu Tang should be used primarily to harmonize the exterior and interior. This is what is meant by "In cases of Cold Damage or Wind Strike presenting with Chaihu syndrome, the presence of even one symptom is sufficient; it is not necessary for all symptoms to be present." This clause was transferred from the Taiyang chapter.
Formula for Xiaochaihu Tang (Minor Bupleurum Decoction):
Chai Hu (Bupleuri Radix) - 8 liang
Huang Qin (Scutellariae Radix) - 3 liang
Ren Shen (Ginseng Radix) - 3 liang
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 3 liang
Sheng Jiang (Zingiberis Rhizoma Recens) - 3 liang
Ban Xia (Pinelliae Tuber) - 0.5 sheng, washed
Da Zao (Jujubae Fructus) - 12 pieces, split
Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove the dregs, and decoct again to obtain 3 sheng. Take 1 sheng warm, three times a day.
Modifications:
If there is irritability in the chest without vomiting, remove Ban Xia and Ren Shen, and add one Gua Lou Shi (Trichosanthis Fructus).
Irritability in the chest without vomiting indicates that pathogenic factors are gathered in the diaphragm without counterflow upward. Heat accumulation precludes the use of sweet tonification, and lack of counterflow precludes the need for pungent dispersal. Therefore, Ren Shen and Ban Xia are removed, and cold-natured Gua Lou Shi is added to clear heat and purge accumulation.
If there is thirst, remove Ban Xia, increase Ren Shen to 4.5 liang (combined with previous amount), and add Gua Lou Gen (Trichosanthis Radix) 4 liang.
Thirst is caused by internal irritation from Wood-Fire and deficiency of fluids with dry Qi. Therefore, the warm-drying Ban Xia is removed, and sweet-moistening Ren Shen and cool-bitter Gua Lou Gen are added to penetrate heat and generate fluids.
If there is abdominal pain, remove Huang Qin, and add Shao Yao (Paeoniae Radix Alba) 3 liang.
Abdominal pain is caused by Wood pathogen injuring Earth (Spleen/Stomach). Huang Qin is bitter and cold, which is unfavorable for Spleen-Yang; Shao Yao is sour and cold, capable of draining Wood within Earth, removing pathogenic factors and stopping abdominal pain.
If there is hardness and stuffiness under the hypochondrium, remove Da Zao, and add Mu Li (Ostreae Concha) 4 liang.
Hardness and stuffiness under the hypochondrium indicate pathogenic factors gathering at the Front-Mu point of Shaoyang. Da Zao is sweet and can increase fullness; Mu Li is salty and can soften hardness. Li Haogou stated that Mu Li, guided by Chai Hu, can remove subcostal stuffiness.
If there are palpitations in the epigastrium and difficulty in urination, remove Huang Qin, and add Fu Ling (Poria) 4 liang.
Palpitations in the epigastrium and difficulty in urination indicate retention of fluid-drink. Fluid-drink stagnates when cold and is promoted by bland leaching agents. Therefore, Huang Qin is removed, and Fu Ling is added.
If there is no thirst but slight fever on the exterior, remove Ren Shen, and add Gui Zhi (Cinnamomi Ramulus) 3 liang. Cover with blankets to induce slight sweating for recovery.
Absence of thirst with slight exterior fever indicates that the interior is harmonized but the exterior pathogen remains unresolved. Therefore, Ren Shen's interior tonification is avoided, and Gui Zhi's exterior resolution is utilized.
If there is coughing, remove Ren Shen, Da Zao, and Sheng Jiang, and add Wu Wei Zi (Schisandrae Fructus) 0.5 sheng and Gan Jiang (Zingiberis Rhizoma) 2 liang.
Coughing is due to Lung cold and rebellious Qi. The Classics state: "The Lung dislikes rebellious Qi; urgently consume sour substances to gather it." Also: "External cold and cold drinks injure the Lung." Therefore, sour Wu Wei Zi is added to gather rebellious Qi, and warm Gan Jiang is added to dispel Lung cold. Ren Shen and Da Zao are sweet and cloying, unfavorable for rebellion; Sheng Jiang is pungent, and its dispersing nature is also disliked in this context.
When blood is weak and Qi is exhausted, the interstices (Cou Li) open, allowing pathogenic factors to enter and contend with healthy Qi, knotting at the hypochondrium. The struggle between healthy and pathogenic Qi manifests as alternating chills and fever, occurring at specific times, along with silence and loss of appetite. The Zang and Fu organs are connected; pain necessarily radiates downward. The pathogen is high (source), while pain is low (site), causing vomiting. The primary formula is Xiaochaihu Tang. If thirst develops after taking Xiaochaihu Tang, the condition belongs to Yangming; treat according to Yangming methods.
"Blood is weak and Qi is exhausted, interstices open" refers to individuals who have lost blood, are postpartum, or are overworked, having insufficient Qi and Blood, making the interstices loose so pathogens take advantage. Pathogens entering must contend with healthy Qi and knot at the hypochondrium. The hypochondrium is the location of the Shaoyang Front-Mu point, and Shaoyang is the intersection of Yin and Yang. When pathogens reside here, Yin emerging to contend causes chills, and Yang entering to contend causes fever. Yin and Yang emerge and enter at specific times, hence alternating chills and fever occurring at regular intervals. "Silence and loss of appetite" has the same meaning as in the previous clause. The four sentences regarding connected Zang and Fu explain the cause of pathogen knotting: the Gallbladder is attached to the Liver, adjacent in location and connected in Qi, so pathogens enter from the Fu organ to the Zang organ, meaning "pain radiates downward." "Pathogen high" refers to the source of the disease; "pain low" refers to the site of knotting. As pathogens attempt to enter and healthy Qi resists, Qi rebels upward causing vomiting. The treatment method does not exceed the principle of Xiaochaihu Tang harmonizing the exterior and interior. After the medicine takes effect, pathogen resolves and Qi harmonizes, so the mouth will not be bitter. If thirst develops, it indicates Shaoyang pathogen returning to Yangming. "Treat according to method" means following Yangming protocols rather than Shaoyang protocols. This clause was also transferred from the Taiyang chapter.
After four or five days of Cold Damage or Wind Strike, if there is body heat, aversion to wind, stiffness in the neck and nape, fullness under the hypochondrium, warm hands and feet, and thirst, the primary formula is Xiaochaihu Tang.
This clause resembles concurrent Taiyang and Shaoyang disease. Taiyang disease should not present with subcostal fullness, and Shaoyang disease should not present with neck stiffness. Additionally, warm hands/feet and thirst indicate the pathogen is not solely in the exterior but also in the interior. To resolve both exterior and interior simultaneously, Xiaochaihu Tang is indispensable. This clause was also transferred from the Taiyang chapter.
In cases of Cold Damage or Wind Strike presenting with Chaihu syndrome, the presence of even one symptom is sufficient; it is not necessary for all symptoms to be present.
Chaihu syndrome refers to symptoms such as alternating chills and fever and subcostal fullness mentioned earlier. Whether Cold Damage or Wind Strike, if Chaihu syndrome is present, observing even one symptom warrants the use of Xiaochaihu Tang to harmonize. One should not assume that because other symptoms are absent, other diaphoretic drugs should be used. The previous clause mentions body heat, aversion to wind, neck stiffness, and subcostal fullness treated with Xiaochaihu Tang instead of Guizhi Tang, illustrating this principle. This clause was also transferred from the Taiyang chapter.
For any Chaihu syndrome treated incorrectly with purgatives, if the Chaihu syndrome persists, administering Xiaochaihu Tang again will likely result in intense heat followed by shivering, then fever and sweating leading to resolution.
Administering purgatives for Chaihu syndrome is contrary to proper method. If the Chaihu syndrome persists, Xiaochaihu Tang should still be used for harmonization. This means that although purgation was performed, it is not considered a deviation. Intense heat and shivering indicate healthy Qi reaching outward and pathogen exiting, signifying victory over the pathogen. Thus, fever and sweating lead to resolution. This clause was also transferred from the Taiyang chapter.
In Cold Damage, if the Yang pulse is choppy (Se) and the Yin pulse is taut (Xian), abdominal cramping pain is expected according to principles. First administer Xiaojianzhong Tang (Minor Construct the Middle Decoction). If ineffective, then administer Xiaochaihu Tang.
A choppy Yang pulse indicates deficient Yang Qi. A taut Yin pulse indicates Yin pathogen. Deficient Yang allows Yin to invade, leading to abdominal cramping pain. Thus, Xiaojianzhong Tang is first used to warm the interior, tonify deficiency, and dissipate Yin Qi. If ineffective, it is known that the cause is not interior deficiency-cold but internal disturbance by Wind pathogen. Therefore, Xiaochaihu Tang is used to disperse pathogen and stop pain. This clause was also transferred from the Taiyang chapter.
After five or six days of Cold Damage, if there is sweating only on the head, slight aversion to cold, cold hands and feet, fullness in the epigastrium, desire not to eat, hard stools, and a fine pulse, this is called Minor Yang Knotting (Yang Wei Jie). There must be an exterior component and an interior component. A deep pulse indicates interior involvement. Head sweating indicates Minor Yang Knotting. If it were Pure Yin Knotting, there would be no exterior signs, and all symptoms would be interior. This represents being half-interior and half-exterior. Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease. Why? Because Yin conditions should not have sweating. Since there is head sweating, it is known not to be Shaoyin. Xiaochaihu Tang may be given. If the patient still feels unwell afterward, resolution will come with defecation. Head sweating and slight aversion to cold are exterior signs; cold hands/feet, epigastric fullness, anorexia, hard stools, and fine pulse are interior signs. Minor Yang Knotting refers to mild knotting of Yang pathogen, not purely interior nor purely exterior. Hence, "must have exterior, also has interior." In Cold Damage, Yin pathogens attacking Yin channels cause deep pulses; Yang pathogens knotting in the interior also cause deep pulses. Correlating with symptoms: no exterior signs indicate pure interior; exterior signs indicate half-exterior. No Yang signs with deep pulse indicate Yin channel; Yang signs with deep pulse indicate interior. The head is the meeting place of Yang; Yin conditions should not sweat. With deep-tight pulse and head sweating, the disease is not Shaoyin, nor purely exterior. Thus, Xiaochaihu Tang can be given to treat both exterior and interior. If unwell afterward, it implies exterior resolved but interior not harmonized, so defecation leads to resolution.
If original Taiyang disease does not resolve and transfers to Shaoyang, presenting with hardness and pain under the hypochondrium, dry retching, inability to eat, and alternating chills and fever, and if emesis or purgation has not yet been used, and the pulse is deep and tight, administer Xiaochaihu Tang. If emesis, purgation, sweating, or moxibustion have already been used, leading to delirium, and the Chaihu syndrome has ceased, this is called a Ruined Condition (Huai Bing). Determine what error was made and treat according to the specific presentation.
Original Taiyang symptoms of floating pulse, headache, and aversion to cold transforming into subcostal hardness/fullness, dry retching, inability to eat, and alternating chills and fever indicate Taiyang unresolved and transmitting to Shaoyang. If no medicinal errors like emesis or purgation have occurred, even with a deep-tight pulse, Xiaochaihu Tang can be used for harmonization, prioritizing syndrome over pulse since signs point to Shaoyang. Some argue "deep-tight pulse" connects to "not yet emesis/purgation," meaning the pulse hasn't become deep-tight yet, indicating pathogen still in the channel, suitable for Xiaochaihu Tang. Others suggest "deep" should be "floating," referencing Clause 47 of the Yangming chapter ("Disease lasting over ten days, pulse continues to float, give Xiaochaihu Tang"); both interpretations are valid. If emesis, purgation, sweating, and moxibustion have been stacked, damaging fluids repeatedly, causing stomach dryness and delirium, while subcostal hardness and dry retching cease, this is a Ruined Condition where various treatments have injured healthy Qi significantly while pathogen remains. This is beyond the scope of Xiaochaihu Tang. One must examine the specific errors committed and treat accordingly based on the current syndrome.