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[Da Chai Hu Tang Formula]
Chai Hu (Bupleuri Radix) half a jin, Huang Qin (Scutellariae Radix) three liang, Ban Xia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine) (washed) half sheng, Shao Yao (Paeoniae Radix Alba) three liang, Zhi Shi (Aurantii Fructus Immaturus) (roasted) four pieces, Da Huang (Rhei Radix et Rhizoma) two liang, Sheng Jiang (Zingiberis Rhizoma Recens) (sliced) five liang, Da Zao (Jujubae Fructus) (broken open) twelve pieces.
The above eight herbs are boiled in one dou and two sheng of water, reduced to six sheng, the dregs are strained out, and it is decocted again. Take one sheng warm each time, three times a day.

[Commentary]
Xu Shuwei said: In the Da Chai Hu Tang formula, some versions do not contain Da Huang, while others do. This formula uses Da Huang because Da Huang has the function of sweeping away accumulated heat, making it an important herb for treating Shang Han (Cold Damage). Wang Shuhe said: If Da Huang is not used, it probably cannot be called Da Chai Hu Tang. Moreover, the classic text explicitly states that "purging will lead to cure." Without Da Huang, what would be used to purge the urgency and fullness in the epigastrium? Therefore, Wang Shuhe's view should be considered correct.

[Formula Analysis]
Since the Chai Hu syndrome (Shaoyang disease pattern) persists and there is also a interior syndrome, a method to resolve both Shaoyang and Yangming is established. Using Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Zhi Shi and Shao Yao is to release the exterior and harmonize the interior. Ginseng and Licorice are removed because the interior is not deficient; a slight increase in Da Huang is to purge the knotted heat; doubling the amount of Sheng Jiang is due to persistent vomiting.

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In Tai Yang disease (disease of the Tai Yang channel), after more than ten days, the patient feels nauseous with a desire to vomit, experiences pain in the chest, has loose stools instead of constipation, mild abdominal fullness, and is slightly irritable with a depressed mood. If prior to this time, the patient had undergone severe emesis or purgation, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Powder) may be given; otherwise, it should not be given. If there is only a desire to vomit, chest pain, and loose stools, this is not a Chai Hu syndrome. The presence of vomiting indicates that this was caused by previous severe emesis or purgation.

[Commentary]
Wang Kentang stated that "Wen Wen" should be "Wa Wa" (describing nausea and the urge to vomit). He also added that there might be missing text after "because of vomiting."

[Annotation]
In Tai Yang disease persisting for over ten days, unresolved after emesis or purgation: Severe emesis damages the chest qi, allowing pathogenic heat to enter the chest vacuously, causing nausea and chest pain. Severe purgation damages the interior qi, allowing pathogenic heat to enter the interior vacuously, resulting in loose stools, mild abdominal fullness, and slight irritability/depression. Upon inquiry, if it is confirmed that severe emesis or purgation occurred previously, the pathogenic heat originally on the exterior has sunk into the chest and abdomen, presenting as unharmonized interior syndromes. Thus, Tiao Wei Cheng Qi Tang is appropriate to purge and harmonize. If this is not the case—meaning these symptoms did not arise from severe emesis or purgation—this formula should not be used. A mere desire to vomit belongs to Shaoyang; chest pain belongs to Tai Yang; loose stools belong to the diarrhea of combined Tai Yang and Shaoyang diseases. Since there are no symptoms like nausea, depression, abdominal fullness, or feverish sensation, Cheng Qi Tangs are certainly contraindicated. However, this is also not a Chai Hu syndrome, so Chai Hu Tang is also contraindicated. One should consider combined Tai Yang and Shaoyang disease with diarrhea and vomiting, and use Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction with Added Pinellia and Fresh Ginger).

[Collected Notes]
Fang Youzhi said: Chest pain indicates the pathogen is in the diaphragm. If severe emesis had occurred, there should be a sensation of nausea in the epigastrium. Why? Because the stomach opening has been injured by emesis, and pathogenic heat struggles upward in the diaphragm, causing the desire to vomit without success. Mild abdominal fullness and slight irritability indicate the pathogen is in the stomach. If severe purgation had occurred, stools should be loose. Why? Because purgation weakens the stomach; although pathogens are excess in the stomach, the stools cannot become dry. Thus, it says: "If severe emesis or purgation occurred prior to this time," give Tiao Wei Cheng Qi Tang. This means to sweep away heat and harmonize the stomach. "Otherwise" means no severe emesis or purgation occurred. From "mere desire to vomit" to the end, reiterates the preceding meaning.

Yu Chang said: In Tai Yang disease persisting for over ten days, with nausea, desire to vomit but inability to do so, chest pain, loose stools, mild abdominal fullness, and slight irritability, there are two distinctions: If there was prior severe emesis or purgation, the exterior pathogen resolved via emesis and entered the interior; Tiao Wei Cheng Qi Tang method can be used. If there was no severe emesis or purgation, and there is merely a desire to vomit without actual vomiting, chest pain, and loose stools, then the pain is not caused by emesis, and the looseness is not caused by purgation; the Tiao Wei method is not applicable.

Cheng Zhi said: "Passing the stage" refers to illness lasting beyond seven to thirteen days, where the channel qi has circulated once but remains unresolved. It may even last twenty-plus days. Generally, if unresolved after passing the stage, the pathogen lingers in the Yang channels; if in Yin channels, how could it persist so long? If it cannot persist, how can recovery be expected?

Cheng Yingmao said: Loose stools imply qi descending, so the abdomen should not be full, nor should irritability be depressed. The current mild fullness and depressed irritability suggest gastric obstruction, and purgation failed to bring relief. Although belonging to Yangming syndrome, typical Yangming signs are absent, leaving only Shaoyang signs. There must have been mismanagement. Thus, one must trace the cause of these symptoms to correctly identify the disease based on the presentation.

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Shang Han (Cold Damage) persisting for thirteen days without resolution, accompanied by chest fullness and vomiting, tidal fever in the late afternoon, followed by mild diarrhea. This was originally a Da Chai Hu Tang syndrome, which should have responded to purgation with bowel movement. Now, however, there is diarrhea, indicating the physician used pill-based purgatives, which was incorrect treatment. Tidal fever indicates excess; first, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve the exterior, then treat with Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Added Niter).

[Annotation]
Generally, when Shang Han persists past its stage and heat transfers to the Stomach Fu, purgation is indicated. Here, Shang Han persists for thirteen days, having passed the stage, with chest fullness, vomiting, tidal fever in the late afternoon, and subsequent mild diarrhea. This was originally a Da Chai Hu Tang syndrome. Purgation failed to produce bowel movements, yet now there is diarrhea. Inquiry reveals the physician used rapid-acting pill purgatives, which was inappropriate. Rapid purgation removes fluid but leaves dryness intact. Perhaps the physician mistook the post-purgation diarrhea for deficiency, hence the clarification: tidal fever indicates excess, warranting further purgation. However, since the pathogen in the chest remains, first use Xiao Chai Hu Tang to resolve the Shaoyang exterior, then use Xiao Chai Hu Tang with added Mang Xiao (Natrii Sulfas) to purge the Shaoyang interior. Da Huang is omitted and Mang Xiao added because the interior condition is not urgent and rapid purgation has already occurred; the goal is merely to soften hardness and moisten dryness. This reflects a combination of purgation and harmonization.

[Collected Notes]
*Nei Tai Fang Yi* discusses: Tidal fever indicates excess. Why not use Da Chai Hu Tang or Da/Xiao Cheng Qi Tang for purgation, but instead use Mang Xiao? Although tidal fever is excess, the prior use of pills has damaged the Zang-Fu organs. Using Da Huang again would damage Spleen qi and create a critical condition. Only Mang Xiao is needed to moisten dryness and induce mild purgation.

Fang Youzhi said: Thirteen days indicates passing the stage. Lack of resolution indicates a corrupted syndrome, implying incorrect prior treatment. The preceding text traces the corruption to medical error. The following text to the end describes the corrective treatment.