少阳主春，其气半出地外，半在地中，人身之气亦如之，故主半表半里也。半表者，
谓在外之太阳也；半里者，谓在内之太阴也。邪入其间，阴阳相移，寒热交作，邪正
相持，进退互拒，此际汗、吐、下三法俱在所禁，故立小柴胡汤和解法，加减施治。
然小柴胡加减法中，又有：口不渴身有微热者，加桂枝以取汗，及下后胸□满微结，
小便不利，渴而不呕，头汗出往来寒热者，用柴胡桂枝干姜汤汗之。又有柴胡证具，
而反下之，心下满而□痛者，此为结胸也，大陷胸汤主之；及柴胡证仍在者，先与小
柴胡汤；呕不止心下急，郁郁微烦者，为未解也，与大柴胡汤下之。更有本柴胡证，
医以丸药，下之微利，胸□满而呕，日晡潮热者，小柴胡加芒硝汤下之等法。是仲景
亦有汗、下之法，惟在临证详察，因病施治，不可执一也。
@@@
少阳之为病，口苦，咽干，目眩也。
【注】
少阳者，胆经也。其脉起于目锐眦，从耳后入耳中，挟咽出颐颔中。邪伤其经，故口
苦、咽干、目眩也。口苦者，热蒸胆气上溢也；咽干者，热耗其津液也；目眩者，热
薰眼发黑也。此揭中风、伤寒邪传少阳之总纲，凡篇中称少阳中风、伤寒者，即具此
证之谓也。
【集注】
林澜曰：论中言少阳病，胸□痛耳聋，往来寒热，心烦喜呕，胸□痞□，半表半里之
证详矣。此何以曰：口苦咽干目眩也？大抵病于经络者，此篇诸条已悉之矣，若胆热
府自病，则又必有此证也。
沈明宗曰：此虽少阳总证，然偏里矣。少阳主胆，其脉循□络于耳，故胸□痛而耳聋
。仲景另出手眼，以补口苦、咽干、目眩之里证，乃括少阳风伤卫、寒伤荣，风寒两
伤而言也。
吴人驹曰：少阳者，一阳也。少阳之上，相火主之。若从火化，火盛则干，故口苦咽
干也。少阳属木，木主肝，肝主目，故病则目眩也。
魏荔彤曰：胆府与少阳经为表里，而非半表半里之谓。半表者，对太阳之全表言；半
里者，对太阴之全里言，故少阳在半表半里之间，总以经络之界为言。又曰：经中所
谓不必悉具者，指或中余证，而少阳经胆府之主病，未有不悉具而遽可指为少阳病成
者。
@@@
少阳中风，两耳无所闻，目赤，胸中满而烦者，不可吐下，吐下则悸而惊。
【注】
少阳，即首条口苦、咽干、目眩之谓也。中风，谓此少阳病，是从中风之邪传来也。
少阳之脉，起目锐眦，从耳后入耳中；其支者、会缺盆，下胸中，循□。表邪传其经
，故目赤耳聋，胸中满而烦也。然此乃少阳半表半里之胸满而烦，非太阳证具之邪陷
胸满而烦者比，故不可吐、下，若吐、下则虚其中，神志虚怯，则悸而惊也。此揭中
风邪传少阳之大纲也。
【集注】
程知曰：少阳惟宜和解，若吐之则虚其阳而悸，下之则虚其阴而惊。
汪琥曰：少阳有吐下之禁，只因烦满，故误行吐下之法。成注谓：吐则伤气，气虚者
悸；下则亡血，血虚者惊、。不知惊悸，皆主于心，误吐且下，则津液衰耗，神志虚
怯，故悸而惊也。
沈明宗曰：胸中烦满似乎可吐，但在少阳，其邪已下胸循□，吐之徒伤胸中之气，使
邪内并逼迫神明，则悸而惊也。
魏荔彤曰：此条论仲景不出方。小柴胡条中有心烦心下悸之证，想可无事他求也。汗
、吐、下三法既不可行，则当和解之。小柴胡为少阳对证之药，斯用之宜决耳！
伤寒，脉弦细，头痛发热者，属少阳，少阳不可发汗，发汗则□语，此属胃，胃和则
愈，胃不和，则烦而悸。
【注】
不曰少阳伤寒，而曰伤寒，略言之也。谓此少阳病是从伤寒之邪传来也。脉弦细，少
阳之脉也。上条不言脉，此言脉者，补言之也。头痛发热无汗，伤寒之证也，又兼见
口苦、咽干、目眩少阳之证，故曰属少阳也。盖少阳之病已属半里，故不可发汗，若
发汗，则益伤其津，而助其热，必发□语，既发□语，则是转属胃矣。若其人津液素
充，胃能自和，则或可愈。否则津干热结，胃不能和，不但□语，且更烦而悸矣。此
揭伤寒邪传少阳之大纲也。
【集注】
王肯堂曰：凡头痛、发热俱为在表，惟此头痛、发热为少阳者何也？以其脉胘细，故
知邪入少阳之界也。
喻昌曰：少阳伤寒禁发汗，少阳中风禁吐、下，二义互举，其旨益严。盖伤寒之头痛
发热，宜于发汗者，尚不可汗，则伤风之不可汗，更不待言矣。伤风之胸满而烦，似
可吐、下者，尚不可吐、下，则伤寒之不可吐，下，更不待言矣。脉弦细者，邪欲入
里，其在胃之津液已为热耗，重复发汗，而驱其津液外出，安得不谵语乎？
汪琥曰：误发其汗，□语者，夺其津液而胃干，故言乱也。此少阳之邪，已转属胃，
胃和则愈者，言当用药以下胃中之热，而使之和平也。胃不和，不但□语，更加烦扰
忪悸，此言胃热上犯于心，故藏神不自宁也。
@@@
伤寒五、六日，中风，往来寒热，胸□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□下痞□，或心下悸，小便不利，或不渴，身有微热，
或咳者，小柴胡汤主之。
【注】
此承上三条，互详其证，以明其治也。伤寒中风三、四日，见口苦、咽干、目眩之证
，与弦细之脉，知邪已传少阳矣。若兼见耳聋目赤，胸满而烦者，则知是从中风传来
也；若兼见头痛发热无汗者，则知是从伤寒传来也。今五、六日，更见往来寒热，胸
□苦满，默默不欲饮食，心烦喜呕，则知是中风、伤寒兼见俱有之证也。少阳之邪，
进可传太阴之里，退可还太阳之表，中处于半表半里之间，其邪：外并于表，半表不
解则作寒；内并于里，半里不和则作热，或表或里无常，故往来寒热不定也。少阳之
脉，下胸循□，邪凑其经，故胸□苦满也；少阳邪近乎阴，故默默也；少阳木邪病则
妨土，故不欲饮食也；邪在胸□，火无从泄，上逼于心，故心烦也。邪欲入里，里气
外拒，故呕，呕则木气舒，故喜之也，此皆柴胡应有之证也。其余诸证，时或有之，
总宜以小柴胡汤主之，各随见证以加减治之可耳。然既分中风、伤寒之传，而不分其
治者何也？盖以太阳有荣卫之分，故风寒之辨宜严，及传阳明少阳则无荣卫之分，且
其邪皆化热，故同归一致也。
【集注】
成无己曰：邪在表里之间，谓之半表半里。伤寒中风者，是或伤寒或中风，非伤寒再
中风，中风复伤寒也。五、六日，邪自表传里之时，邪在表则寒，在里则热，今在半
表半里之间，未有定处，故往来寒热也。邪在表心腹不满，邪在里则心腹胀满，今言
胸□苦满，亦是在表里之间也。邪在表呻吟不安，邪在里则内烦。经云：阳入之阴，
则静默默，由邪方自表之里，在表里之间也。邪在表则能食，邪在里不能食，不欲食
者，未至于必不能食，故亦为在表里之间也。邪在表则不烦、不呕，邪在里则烦满而
呕，烦而喜呕者，邪在表方传里也·邪初入里，未有定处，所传不一，故有或见之证
也。
方有执曰：五、六日，大约言也。往来寒热者，邪入躯壳之里，藏府之外，两界之隙
地，所谓半表半里，乃少阳所主之部位也。故入而并于阴则寒，出而并于阳则热，出
入无常，故寒热间作也。太阳一经，有荣卫之不同，所以风寒异治；阳明切近太阳，
荣卫之道在迩，风寒之辨尚严，少阳一经，越阳明去太阳远矣，风寒无异治。经以伤
寒、中风五、六日，往来寒热，交互为文者，发明风寒至此，同归于一致也 。
Shaoyang corresponds to spring. Its Qi mechanism is half outside the body surface and half within the interior; human Qi operates similarly, thus Shaoyang governs the semi-exterior semi-interior location. "Semi-exterior" refers to the Taiyang (Greater Yang) meridian located externally; "semi-interior" refers to the Taiyin (Lesser Yin) meridian located internally. When pathogenic factors invade this space, Yin and Yang Qi shift mutually, causing alternating chills and fever. Pathogenic factors and healthy Qi stand in stalemate, resisting advance or retreat. At this juncture, the three methods of sweating (Han Fa), vomiting (Tu Fa), and purging (Xia Fa) are all contraindicated. Therefore, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is established as the representative formula for the harmonizing method (He Jie Fa), with modifications applied according to the condition. However, within the modification rules of Xiao Chai Hu Tang, there are further specifications: if the mouth is not dry and there is slight fever on the body, Gui Zhi (Cinnamon Twig) is added to induce sweating; and after a purgative treatment, if chest fullness with slight binding occurs, urination is difficult, thirst is present without vomiting, head sweating occurs alongside alternating chills and fever, Chai Hu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is used to release the exterior via sweating. Furthermore, if Chai Hu Syndrome (Bupleurum Pattern) is present but purgatives were mistakenly administered, resulting in epigastric fullness and pain, this is Jie Xiong (Chest Binding), treated with Da Xian Xiong Tang (Major Intra-abdominal Binding Decoction); if Chai Hu Syndrome persists, Xiao Chai Hu Tang is given first; if vomiting is incessant, epigastric urgency is felt, and there is a sense of depression and slight irritability, indicating the disease has not resolved, Da Chai Hu Tang (Major Bupleurum Decoction) is used for purging. Additionally, if the original presentation was Chai Hu Syndrome, but the physician mistakenly used pill-based purgatives leading to mild diarrhea, followed by chest fullness, vomiting, and tidal fever in the late afternoon, Xiao Chai Hu Tang plus Mangxiao (Natrii Sulfas) is used for purging. This demonstrates that Zhang Zhongjing also employed sweating and purging methods; the key lies in careful clinical observation and treating according to the specific disease, avoiding rigid adherence to a single approach.
@@@
The general outline of Shaoyang disease includes: bitter taste in the mouth, dry throat, and vertigo/dizziness.
[Annotation]
Shaoyang refers to the Gallbladder Meridian of Foot-Shaoyang. The meridian originates at the outer canthus, enters the ear from behind it, runs along the throat, and emerges at the jaw. When pathogenic factors damage this meridian, bitter taste, dry throat, and vertigo occur. Bitter taste results from heat steaming and overflowing gallbladder Qi upward; dry throat results from heat consuming body fluids; vertigo results from heat steaming the eyes, causing darkened vision. This outlines the general pattern for wind-stroke or cold-pathogen transmitting to Shaoyang. Any mention of Shaoyang wind-stroke or cold in this chapter refers to cases presenting these symptoms.
[Collected Annotations]
Lin Lan stated: The text describes Shaoyang disease with symptoms such as chest pain, deafness, alternating chills and fever, irritability, frequent vomiting, and chest/hypochondriac stuffiness, detailing the semi-exterior semi-interior patterns extensively. Why then is it stated as bitter taste, dry throat, and vertigo? Generally, pathology in the meridians is covered in other sections of this chapter; however, if the Gallbladder Fu-organ itself is diseased, these symptoms must necessarily appear.
Shen Mingzong stated: Although this is the general pattern of Shaoyang, it leans towards interior pathology. Shaoyang governs the Gallbladder, whose meridian circulates and connects to the ear, hence chest pain and deafness may occur. Zhang Zhongjing adopts a distinct perspective to supplement these interior symptoms of bitter taste, dry throat, and vertigo, encompassing wind damaging the Wei (Defensive) level and cold damaging the Ying (Nutritive) level in Shaoyang, as well as combined wind-cold injury.
Wu Renju stated: Shaoyang is the One-Yang meridian. Above Shaoyang, Ministerial Fire (Xiang Huo) dominates. If the disease transforms into fire, excessive fire causes dryness, leading to bitter taste and dry throat. Shaoyang belongs to Wood, which corresponds to the Liver; the Liver opens into the eyes. Thus, when diseased, vertigo occurs.
Wei Litong stated: The Gallbladder Fu-organ and the Shaoyang meridian are exterior-interior partners, not referring to semi-exterior semi-interior. "Semi-exterior" is relative to the complete exterior of Taiyang; "semi-interior" is relative to the complete interior of Taiyin. Thus, Shaoyang lies between semi-exterior and semi-interior, defined primarily by meridian boundaries. He further stated: When the text says symptoms need not be fully present, it refers to miscellaneous accompanying signs. The primary diseases of the Shaoyang meridian and Gallbladder Fu-organ cannot be diagnosed as established Shaoyang disease without their presence.
@@@
In Shaoyang wind-stroke, if both ears become deaf, eyes turn red, and there is chest fullness with irritability, vomiting and purging are contraindicated. Mistaken use of vomiting or purging will lead to palpitations and fright.
[Annotation]
"Shaoyang" here refers to the symptoms of bitter taste, dry throat, and vertigo mentioned in the first clause. "Wind-stroke" indicates this Shaoyang disease originated from the transmission of wind-stroke pathogens. The Shaoyang meridian originates at the outer canthus and enters the ear from behind; its branch meets at the Clavicular Fossa (Quepen), descends through the chest, and follows the hypochondrium. Exterior pathogens transmitting into this meridian cause red eyes, deafness, chest fullness, and irritability. However, this chest fullness and irritability belong to the semi-exterior semi-interior pattern of Shaoyang, differing from the chest fullness and irritability caused by pathogen sinking into the chest due to complete Taiyang syndrome. Therefore, vomiting and purging are prohibited. If mistakenly used, they will weaken the Middle Jiao, causing the Shen (Spirit) to become deficient and timid, resulting in palpitations and fright. This outlines the major principle of wind-stroke pathogens transmitting to Shaoyang.
[Collected Annotations]
Cheng Zhi stated: Shaoyang disease is only suitable for harmonization. Vomiting will weaken Yang Qi, causing palpitations; purging will weaken Yin Blood, causing fright.
Wang Hu stated: Shaoyang has contraindications against vomiting and purging. Because of irritability and fullness, physicians might mistakenly apply these methods. Cheng Wuji noted: Vomiting damages Qi, and Qi deficiency causes palpitations; purging loses Blood, and Blood deficiency causes fright. Ignoring that both fright and palpitations are governed by the Heart, mistaken vomiting and purging deplete body fluids, making the Shen weak and timid, hence palpitations and fright occur.
Shen Mingzong stated: Chest irritability and fullness might seem treatable with vomiting, but in Shaoyang, the pathogen has descended into the chest and along the hypochondrium. Vomiting would merely damage Qi in the chest, allowing the pathogen to merge inward and oppress the Spirit, leading to palpitations and fright.
Wei Litong stated: This clause discusses Zhang Zhongjing not prescribing a formula. In the Xiao Chai Hu Tang section, symptoms of heart irritability and epigastric palpitations are mentioned, suggesting no other formula is needed. Since sweating, vomiting, and purging are impossible, harmonization should be used. Xiao Chai Hu Tang is the correct formula for Shaoyang; its use is decisive!
Cold-pathogen invasion presenting with wiry-thin pulse, headache, and fever belongs to Shaoyang. Shaoyang disease prohibits sweating; if sweat is induced, delirium (Chan Yu) occurs. This shifts to the Stomach; if the Stomach harmonizes, recovery ensues; if not, irritability and palpitations follow.
[Annotation]
It does not say "Shaoyang Cold," but simply "Cold," implying brevity. It means this Shaoyang disease resulted from the transmission of cold pathogens. A wiry-thin pulse is characteristic of Shaoyang. The previous clause omitted the pulse; this one adds it for completeness. Headache, fever, and anhidrosis are signs of cold-pathogen invasion. Combined with Shaoyang signs like bitter taste, dry throat, and vertigo, it is classified as belonging to Shaoyang. Since Shaoyang disease is already semi-interior, sweating is prohibited. Sweating would further damage fluids and assist heat, inevitably causing delirium. Once delirium occurs, the condition transfers to the Stomach. If the patient's fluids are naturally abundant and the Stomach can self-harmonize, recovery may occur. Otherwise, fluid depletion and heat binding prevent Stomach harmony, leading not only to delirium but also to irritability and palpitations. This outlines the major principle of cold-pathogen transmission to Shaoyang.
[Collected Annotations]
Wang Kentang stated: Headache and fever generally indicate exterior conditions. Why do these belong to Shaoyang? Because the wiry-thin pulse indicates the pathogen has entered the Shaoyang boundary.
Yu Chang stated: Shaoyang cold prohibits sweating; Shaoyang wind-stroke prohibits vomiting and purging. These two points reinforce each other, making the principles stricter. Even for cold-induced headache and fever, which are suitable for sweating, it is forbidden; thus, wind-stroke cases are even more strictly forbidden. For wind-stroke chest fullness and irritability, which might seem suitable for vomiting/purging, it is forbidden; thus, cold-induced cases are even more strictly forbidden. A wiry-thin pulse suggests the pathogen desires to enter the interior, and fluids in the Stomach are already consumed by heat. Repeated sweating drives fluids out, inevitably causing delirium.
Wang Hu stated: Mistaken sweating leads to delirium because fluids are depleted, drying the Stomach and causing disordered speech. The Shaoyang pathogen has transferred to the Stomach. "Stomach harmonizes" implies using medication to purge Stomach heat and restore balance. If the Stomach does not harmonize, delirium is accompanied by irritability and palpitations, indicating Stomach heat attacking the Heart, disturbing the Shen.
@@@
After five or six days of cold-pathogen or wind-stroke invasion, if there are alternating chills and fever, bitter fullness in the chest and hypochondrium, silent desirelessness for food, irritability, and frequent vomiting; or alternatively, chest irritability without vomiting, thirst, abdominal pain, hypochondriac stiffness, epigastric palpitations, difficult urination, absence of thirst with slight body fever, or coughing, Xiao Chai Hu Tang is the primary treatment.
[Annotation]
This continues the previous three clauses, detailing symptoms to clarify treatment. After three or four days of cold or wind invasion, if bitter taste, dry throat, vertigo, and wiry-thin pulse appear, the pathogen has transmitted to Shaoyang. If accompanied by deafness, red eyes, chest fullness, and irritability, it indicates transmission from wind-stroke; if accompanied by headache, fever, and anhidrosis, it indicates transmission from cold. Now, at five or six days, the appearance of alternating chills and fever, bitter fullness in chest/hypochondrium, silence, anorexia, irritability, and frequent vomiting indicates combined wind-cold transmission. Shaoyang pathogen can advance to Taiyin interior or retreat to Taiyang exterior, residing in the semi-exterior semi-interior space. If the pathogen merges outward to the exterior and semi-exterior remains unresolved, chills occur; if it merges inward to the interior and semi-interior is disharmonious, fever occurs. Since location varies, alternating chills and fever are irregular. The Shaoyang meridian descends through the chest and along the hypochondrium; pathogen accumulation causes bitter fullness. Shaoyang pathogen is close to Yin, causing silence. Shaoyang Wood pathogen damages Earth (Spleen/Stomach), causing anorexia. Pathogen in the chest/hypochondrium traps Fire, which presses upward on the Heart, causing irritability. Pathogen desiring to enter the interior meets resistance from Interior Qi, causing vomiting; vomiting releases Wood Qi stagnation, hence the preference for vomiting. These are typical indications for Chai Hu. Other symptoms may occasionally appear; overall, Xiao Chai Hu Tang is indicated, modified according to specific signs. Why distinguish wind/cold transmission but not treatment? Taiyang has Ying/Wei distinctions, requiring strict differentiation of wind/cold. Upon transmission to Yangming and Shaoyang, Ying/Wei distinctions vanish, and pathogens transform into heat, unifying the treatment approach.
[Collected Annotations]
Cheng Wuji stated: Pathogen between exterior and interior is called semi-exterior semi-interior. Cold or wind means either cold or wind, not sequential infection. Five to six days is the time for pathogen transmission from exterior to interior. Exterior pathogen causes chills; interior causes heat. Residing in semi-exterior semi-interior without fixed position causes alternating chills and fever. Exterior pathogen causes no abdominal fullness; interior causes distension. Chest/hypochondriac bitter fullness indicates intermediate location. Exterior pathogen causes groaning; interior causes internal irritability. Text states: Yang entering Yin becomes quiet/silent, as pathogen moves from exterior to interior. Exterior allows eating; interior prevents eating. Desirelessness for food, yet not total inability, indicates intermediate status. Exterior has no irritability/vomiting; interior has irritability/fullness/vomiting. Irritability with preference for vomiting indicates pathogen moving from exterior to interior. Initial interior entry lacks fixed position, causing varied symptoms.
Fang Youzhi stated: Five to six days is approximate. Alternating chills and fever indicate pathogen in the space between the body shell and viscera, the semi-exterior semi-interior domain of Shaoyang. Entering Yin causes chills; emerging to Yang causes heat. Irregular movement causes alternating chills and fever. Taiyang has Ying/Wei differences, requiring different treatments for wind/cold. Yangming is close to Taiyang, so distinctions remain strict. Shaoyang is far from Taiyang beyond Yangming, so wind/cold require identical treatment. The text interweaves cold/wind and five-six days with alternating chills/fever to illustrate that wind and cold converge into unity at this stage.