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Chai Hu (Bupleuri Radix) 4 liang, Gui Zhi (Cinnamomi Ramulus) 1.5 liang, Ren Shen (Ginseng Radix et Rhizoma) 1.5 liang, Gan Cao (Licorice Radix et Rhizoma, prepared with honey) 1 liang, Ban Xia (Pinelliae Tuber) 2.5 he, Huang Qin (Scutellariae Radix) 1.5 liang, Shao Yao (Paeoniae Radix) 1.5 liang, Da Zao (Zizyphi Fructus, broken open) 6 pieces, Sheng Jiang (Zingiberis Rhizoma Recens, sliced) 1.5 liang.

The above nine ingredients are decocted in seven sheng of water, reduced to three sheng, the dregs are removed, and one sheng is taken warm.

[Collected Explanations]
Ke Qin stated: Among Zhang Zhongjing's writings, the two formulas most valued are Chai Hu Tang (Bupleurum Decoction) and Gui Zhi Tang (Cinnamon Twig Decoction). Gui Zhi Tang resolves the exterior of the Tai Yang (Greater Yang) channel and can also harmonize the exterior of various channels; Xiao Chai Hu Tang (Minor Bupleurum Decoction) resolves the half-exterior/half-interior of the Shao Yang (Lesser Yang) channel and can also harmonize the half-exterior/half-interior of the Three Yang channels. Therefore, beyond the six-channel diseases, there are unique designations for "Gui Zhi Syndrome" and "Chai Hu Syndrome," indicating that these two formulas have significant roles and are not restricted to a single channel. For instance, the clause on "floating yang and deficient yin" is Zhang Zhongjing's own annotation for Gui Zhi Syndrome; the clause on "deficient blood and exhausted qi" is his own annotation for Chai Hu Syndrome. Gui Zhi Syndrome cases may develop into complicated diseases due to mistreatment, as do Chai Hu Syndrome cases; Gui Zhi Syndrome has ambiguous presentations, as does Chai Hu Syndrome. For example, when the disease resembles Gui Zhi Syndrome but presents with spasmodic cramping of the legs and epigastric fullness/obstruction, or when it resembles Chai Hu Syndrome but involves initial thirst followed by vomiting upon drinking water, or merely retching with chest pain, these are such cases. This clause states that in Shang Han (Cold Damage) at six or seven days, when chills and fever should subside, instead, exterior symptoms such as fever and aversion to cold appear, along with interior symptoms like support-like binding beneath the heart. Since neither the exterior nor the interior is resolved, the treatment method should be simultaneous resolution of both. However, since the aversion to cold is mild, the fever is also mild; thus, the vexation and pain in the joints imply that the whole body's bone and joint areas are not painful; similarly, mild retching implies only slight binding in the epigastrium, hence termed "support-like binding." This indicates that although the exterior syndrome persists, it has lightened, and although the interior syndrome has appeared, it is not severe. Therefore, half the dose of Gui Zhi Tang is used to disperse the lingering pathogenic factors of Tai Yang, and half the dose of Chai Hu Tang is used to resolve the slight binding of Shao Yang. In cases where there is no thirst and a slight fever on the body, Ren Shen should theoretically be omitted; however, because at six or seven days the pathogen remains unresolved while the healthy qi is already deficient, Ren Shen is retained. Although external symptoms persist, the disease mechanism is manifest in the interior; thus, the formula places Chai Hu before Gui Zhi, serving as a mild agent to simultaneously resolve the Two Yangs (Tai Yang and Shao Yang).

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In Shang Han at five or six days, after sweating has been induced and purgation has been applied again, resulting in chest and hypochondriac fullness with slight binding, difficulty in urination, thirst without vomiting, only sweating on the head, alternating chills and fever, and mental restlessness, this indicates the pathogen has not yet resolved; Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is the primary treatment.

[Annotation]

In Shang Han at five or six days, after sweating was induced, if the exterior remained unresolved and purgation was subsequently applied, if the pathogen sank into the interior of Yang Ming (Yang Brightness), it would inevitably lead to syndromes such as Jie Xiong (chest binding), Pi Qing (epigastric fullness/obstruction), and Xie Re Xia Li (diarrhea with accompanying heat). Now, since the pathogen has sunk into the interior of Shao Yang, it causes chest and hypochondriac fullness with slight binding. Difficulty in urination, thirst, and absence of vomiting are not due to fluid retention, but rather due to the damage of body fluids caused by sweating and purgation. The treatise mentions cases of no sweating on the body, only sweating on the head, fever without aversion to cold, and mental restlessness; these are head sweats caused by Yang Ming exterior heat being constrained and unable to vent outward. Now, with only head sweating, accompanied by alternating chills and fever and mental restlessness, and lacking Yang Ming symptoms, it is known to be Shao Yang exterior heat, constrained and disharmonious, steaming upward to cause head sweating. This is a syndrome of Shao Yang exterior and interior unresolved; therefore, Chai Hu Gui Zhi Gan Jiang Tang is prescribed to specifically resolve the half-exterior pathogen and simultaneously dissipate the half-interior binding.

[Collected Notes]

Lin Lan stated: By the fifth or sixth day, after sweating and purgation, the pathogen should have resolved. Now, with chest and hypochondriac fullness, slight binding, chills, fever, and mental restlessness, the pathogen remains between the half-exterior and half-interior. Difficulty in urination and thirst result from the loss of body fluids and internal dryness following sweating and purgation. If there were heat from fluid retention, vomiting would necessarily occur; now, with thirst but no vomiting, it is known not to be due to fluid retention with heat. In Shang Han, sweating usually leads to harmony; now, with only head sweating and no sweating elsewhere, it indicates insufficient body fluids and lack of harmony. Chai Hu Gui Zhi Gan Jiang Tang is given to resolve the exterior and interior and restore body fluids.

Wang Hu stated: Head sweating in Shang Han is due to Yang Qi being constrained at the exterior, not due to Yang deficiency in the upper part.