伤寒六七日。发热微恶寒。肢节烦疼。微呕。心下支结。外证未去者。柴胡桂枝汤主之。
发热微恶寒。肢节烦疼。邪在肌表。所谓外证未去也。伤寒邪欲入里。而正不容则呕。微呕者
。邪入未多也。支结者。偏结一处。不正中也。与心下硬满不同。此虽表解。犹不可攻。况外证未
去者耶。故以柴胡、桂枝合剂。外解表邪。内除支结。乃七表三里之法也。
柴胡桂枝汤方
柴胡（半两） 桂枝（半两） 甘草（一两炙） 黄芩（半两） 人参（半两） 半夏（二合
半） 白芍（半两） 生姜（一两半） 大枣（六枚擘）
上九味。以水七升。煮取三升。去滓。温服。
伤寒五六日。已发汗而复下之。胸胁满。微结。小便不利。渴而不呕。但头汗出。往来寒热。
心烦者。此为未解也。柴胡桂枝干姜汤主之。
王叔和本在太阳篇中。今移置此。
汗下之后。胸胁满微结者。邪聚于上也。小便不利。渴而不呕者。热胜于内也。伤寒汗出。周身
。人静不烦者。为已解。但头汗出而身无汗。往来寒热。心烦者。为未欲解。夫邪聚于上。热胜于
内。而表复不解。是必合表里以为治。柴胡、桂枝。以解在外之邪。干姜、牡蛎。以散胸中之结。
栝蒌根、黄芩。除心烦而解热渴。炙甘草佐柴胡、桂枝以发散。合芩、栝蒌、姜、蛎以和里。为三表七里
之法也。
柴胡桂枝干姜汤方
柴胡（半斤） 桂枝（三两） 干姜（二两） 黄芩（三两） 栝蒌根（四两） 牡蛎（三两
熬） 甘草（二两炙）
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。初服微烦。
复服汗出愈。
After six or seven days of Taiyang cold damage (Shanghan, a disease caused by cold pathogenic factors), the patient presents with fever and slight aversion to cold, vexatious pain in the limbs and joints, slight vomiting, and a sensation of support and stagnation under the heart (epigastric region). If the exterior syndrome has not yet resolved, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is indicated.
Fever, slight aversion to cold, and vexatious pain in the limbs and joints indicate that the pathogen remains in the muscle and surface layers, which is referred to as "the exterior syndrome has not yet resolved." When the cold pathogen attempts to penetrate inward but is resisted by the healthy qi, vomiting occurs. Slight vomiting suggests that the pathogen has not entered deeply. "Zhi jie" (supporting knot) refers to stagnation localized to one side rather than the center, which differs from hardness and fullness under the heart. Although the exterior may be considered resolved in some contexts, purgative methods should still be avoided; how much more so when the exterior syndrome persists? Therefore, combining Chaihu (Radix Bupleuri) and Guizhi (Ramulus Cinnamomi) addresses both the exterior pathogen and the internal stagnation. This represents a method of treating seven parts exterior and three parts interior.
Chaihu Guizhi Tang Formula
Radix Bupleuri (Banliang) Ramulus Cinnamomi (Banliang) Radix Glycyrrhizae Preparata (Liang, honey-fried) Radix Scutellariae (Banliang) Radix Ginseng (Banliang) Rhizoma Pinelliae (Erhe Ban) Radix Paeoniae Alba (Banliang) Rhizoma Zingiberis Recens (Liang Ban) Fructus Jujubae (Six pieces, split)
The above nine ingredients are decocted in seven sheng of water until three sheng remain. The dregs are removed, and the liquid is taken warm.
Five or six days into cold damage, after sweating therapy has been administered followed by purgation, the patient experiences fullness in the chest and hypochondrium, slight binding, difficulty in urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and irritability. This indicates that the pathogen has not yet resolved. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is indicated.
Wang Shuhe originally placed this clause in the Taiyang chapter but has moved it here.
Following sweating and purgation, fullness in the chest and hypochondrium with slight binding indicates pathogen accumulation in the upper jiao. Difficulty in urination, thirst, and absence of vomiting indicate predominant heat within. In cold damage, if the whole body sweats and the person is quiet without irritability, the disease is resolved. However, if there is sweating only on the head, no sweat on the body, alternating chills and fever, and irritability, the disease is not yet resolving. With pathogen accumulation in the upper jiao, predominant internal heat, and unresolved exterior symptoms, treatment must address both the exterior and interior simultaneously. Chaihu and Guizhi resolve the external pathogen; Ganjiang (Rhizoma Zingiberis) and Muli (Concha Ostreae) dissipate the binding in the chest; Gualougen (Radix Trichosanthis) and Huangqin (Radix Scutellariae) clear irritability and resolve heat and thirst; Zhi Gancao (Prepared Radix Glycyrrhizae) assists Chaihu and Guizhi in dispersal, while coordinating with Huangqin, Gualougen, Ganjiang, and Muli to harmonize the interior. This represents a method of treating three parts exterior and seven parts interior.
Chaihu Guizhi Ganjiang Tang Formula
Radix Bupleuri (Banjin) Ramulus Cinnamomi (Sanliang) Rhizoma Zingiberis (Liang Er) Radix Scutellariae (Sanliang) Radix Trichosanthis (Si liang) Concha Ostreae (Sanliang, calcined) Radix Glycyrrhizae Preparata (Liang Er, honey-fried)
The above seven ingredients are decocted in twelve dou of water until six sheng remain. The dregs are removed, and the liquid is further concentrated until three sheng remain. Take one sheng warm, three times daily. Mild irritability may occur after the first dose; upon subsequent doses, sweating will occur and the disease will be cured.