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Fifteen syndromes, corresponding to seven prescriptions.

When blood is deficient and qi is exhausted, the couli (pores and interstices of skin and muscle) open, allowing pathogenic factors to enter due to this deficiency. The pathogen contends with healthy qi, lodging in the hypochondrium. As healthy qi and pathogenic factors struggle against each other, alternating chills and fever occur, with episodes happening at regular intervals. The patient presents with a silent demeanor and lack of desire for food and drink. Because the zang-fu organs are connected, pain must manifest below; since the pathogen is high (in the hypochondrium) but pain is low, vomiting ensues. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. If thirst occurs after taking Chai Hu (Bupleuri Radix), this indicates involvement of the Yangming channel, which should be treated according to its specific methods.

After six or seven days of illness, if the pulse is slow, floating, and weak, accompanied by aversion to wind and cold, and warmth of the hands and feet, but the physician repeatedly applies purgative methods, leading to an inability to eat, hypochondriac fullness and pain, yellowing of the face, eyes, and body, stiffness of the neck, and difficulty urinating: administering Chai Hu Tang at this stage will likely result in a sensation of heaviness in the rectum (tenesmus). If the patient was originally vomiting due to drinking water because of thirst, Chai Hu Tang is also contraindicated; consuming grain may lead to hiccups.

In Shaoyang disease occurring four or five days after contraction of cold damage, where the body is hot and sensitive to wind, the neck is stiff, there is hypochondriac fullness, the hands and feet are warm, and there is thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. In cold damage, if the yang pulse is choppy and the yin pulse is wiry, abdominal cramping pain is expected by law; first administer Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if there is no improvement, then administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) (see Xiao Jian Zhong Tang in the Miscellaneous Treatment section).

In cold damage or wind strike, if there are Chai Hu syndrome manifestations, observing even one symptom is sufficient for diagnosis; it is not necessary for all symptoms to be present. If a Chai Hu syndrome is mistakenly treated with purgatives, and the Chai Hu syndrome persists, re-administering Chai Hu Tang (Minor Bupleurum Decoction) will lead to resolution, characterized by a feeling of heat rising from within followed by shivering, and subsequently sweating and recovery. In cold damage lasting five or six days, or wind strike, presenting with alternating chills and fever, bitter taste and fullness in the chest and hypochondrium, a silent demeanor with loss of appetite, irritability, and frequent vomiting, or alternatively chest irritability without vomiting, thirst, abdominal pain, hardness in the hypochondrium, palpitations under the heart, difficult urination, absence of thirst, slight external heat, or cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.

Chai Hu (Bupleuri Radix) (8 liang), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted), Sheng Jiang (Zingiberis Rhizoma Recens) (each 3 liang, sliced), Ban Xia (Pinelliae Rhizoma) (0.5 sheng, washed), Da Zao (Jujubae Fructus) (12 pieces, broken apart).

Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove the dregs, and decoct again. Take 1 sheng warm, three times daily. If there is chest irritability without vomiting, remove Ban Xia and Ren Shen, and add one Gua Lou Shi (Trichosanthis Fructus). If thirsty, remove Ban Xia, and increase Ren Shen to a total of 4.5 liang. If there is abdominal pain, remove Huang Qin, and add Shao Yao (Paeoniae Radix Alba) 3 liang. If there is hardness in the hypochondrium, remove Da Zao, and add Mu Li (Ostreae Concha) 6 liang. If there are palpitations under the heart and difficult urination, remove Huang Qin, and add Fu Ling (Poria) 4 liang. If not thirsty but with slight external heat, remove Ren Shen, add Gui Zhi (Cinnamomi Ramulus) 3 liang, cover with blankets to induce slight sweating. If coughing, remove Ren Shen, Da Zao, and Sheng Jiang, add Wu Wei Zi (Schisandrae Chinensis Fructus) 0.5 sheng, and Gan Jiang (Zingiberis Rhizoma) 2 liang.

In cold damage lasting five or six days, if there is sweating only on the head, slight aversion to cold, cold hands and feet, fullness under the heart, lack of desire to eat, hard stools, and a fine pulse, this is termed "Yang mild binding" (Yang wei jie). There is both exterior and interior involvement. A sinking pulse indicates the disease is in the interior. Sweating also indicates mild Yang involvement. If it were pure Yin binding, there would be no exterior signs, and all pathology would be internal. This condition is half exterior and half interior. Although the pulse may be sinking and tight, it cannot be diagnosed as Shaoyin disease. The reason is that Yin patterns do not typically present with sweating; however, here there is significant head sweating, therefore...

If cold damage remains unresolved for thirteen days, with hypochondriac fullness and vomiting, tidal fever occurring at dusk (Shen hour), and slight diarrhea: this case originally required purgation via Chai Hu Tang. Since diarrhea did not occur initially but now does, we know the physician used pill-based purgatives, which was incorrect treatment. Tidal fever indicates excess. First, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) twice to resolve the exterior, then treat with Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Natrii Sulfas). Prescription:

Chai Hu (Bupleuri Radix) (2 liang 16 zhu), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted), Sheng Jiang (Zingiberis Rhizoma Recens) (each 1 liang, sliced), Ban Xia (Pinelliae Rhizoma) (1 he, washed), Da Zao (Jujubae Fructus) (4 pieces, broken apart), Mang Xiao (Natrii Sulfas) (2 liang).

Take these seven ingredients, add 4 sheng of water, decoct to obtain 2 sheng, remove dregs, and take warm in two divided doses to resolve the exterior. If unresolved, prepare another dose.

Chai Hu Jia Da Huang Mang Xiao Sang Piao Xiao Tang (Bupleurum Decoction with Rheum, Natrii Sulfas, and Mantidis Oötheca) Prescription:
Take the previous seven ingredients, add 7 sheng of water, then add Mang Xiao (Natrii Sulfas) 3 he, Da Huang (Rhei Radix et Rhizoma) 4 fen, and Sang Piao Xiao (Mantidis Oötheca) 5 pieces. Decoct to obtain 1.5 sheng, remove dregs, and take 5 he warm. Mild purgation leads to cure. The original note states: Administer Chai Hu Tang twice to resolve the exterior; take the remaining 2 sheng, adding Mang Xiao, Da Huang, and Sang Piao Xiao.

In cold damage lasting eight or nine days, if mistakenly purged, resulting in chest fullness, irritability and fright, difficult urination, delirious speech, and body rigidity preventing turning over, use Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell). Prescription:

Chai Hu (Bupleuri Radix) (4 liang), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) (sliced), Long Gu (Fossilia Ossis Mastodi et Mammutis), Mu Li (Ostreae Concha) (calcined), Gui Zhi (Cinnamomi Ramulus), Fu Ling (Poria), Qian Dan (Lithargyrum) (each 1.5 liang).

Take these twelve ingredients, add 8 sheng of water, decoct to obtain 4 sheng. Add Da Huang (Rhei Radix et Rhizoma), cut into chess-piece sized chunks, boil for one or two more boils, remove dregs, and take 1 sheng warm. The original note states: This is Chai Hu Tang with added Long Gu and others.

In cold damage lasting six or seven days, if there is fever, slight aversion to cold, painful joints, slight vomiting, subcostal binding ("zhi jie"), and exterior signs persisting, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate. If excessive sweating leads to Yang collapse and delirium, purgation is contraindicated; instead, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) can be given to harmonize Ying and Wei, promote fluid circulation, leading to spontaneous recovery. Prescription:

Chai Hu (Bupleuri Radix) (4 liang), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) (sliced), Gui Zhi (Cinnamomi Ramulus), Shao Yao (Paeoniae Radix Alba) (each 1.5 liang), Ban Xia (Pinelliae Rhizoma) (2.5 he, washed), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 liang, roasted), Da Zao (Jujubae Fructus) (6 pieces, broken apart).

Take these nine ingredients, add 6 sheng of water, decoct to obtain 2 sheng, remove dregs, and take 1 sheng warm. The original note states: Originally, Ren Shen Tang was prepared like Gui Zhi Tang, with added Chai Hu and Huang Qin; following Chai Hu method, using Ren Shen, prepared as half a dose.

In cold damage lasting five or six days, if the patient has already sweated and then been mistakenly purged, resulting in slight binding in the chest and hypochondrium, difficult urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and irritability, the disease is unresolved. Use Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). Prescription:

Chai Hu (Bupleuri Radix) (8 liang), Gui Zhi (Cinnamomi Ramulus) (3 liang), Gan Jiang (Zingiberis Rhizoma) (2 liang), Gua Lou Gen (Trichosanthis Radix) (4 liang), Huang Qin (Scutellariae Radix) (3 liang), Mu Li (Ostreae Concha) (2 liang, calcined).

Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove dregs, and decoct again. Take 1 sheng warm, twice daily. Initial administration may cause slight irritability, followed by sweating and cure.

In Taiyang disease, after more than ten days, if mistakenly purged repeatedly, and four or five days later Chai Hu signs persist, first administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If vomiting stops and the patient feels slightly relieved but remains郁 (depressed/slightly irritable), the disease is unresolved; administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge.

In cold damage lasting ten-plus days, if pathogenic factors bind in the interior and there is a recurrence of alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) should be given.

In cold damage with fever, sweating that does not resolve the condition, epigastric hardness/fullness, vomiting, and diarrhea, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated. If a patient has no typical exterior-interior signs but has had fever for seven or eight days, and although the pulse is floating and rapid, purgation is still applicable, Da Chai Hu Tang (Major Bupleurum Decoction) is suitable. Prescription:

Chai Hu (Bupleuri Radix) (8 liang), Zhi Shi (Aurantii Fructus Immaturus) (4 pieces, roasted), Sheng Jiang (Zingiberis Rhizoma Recens) (5 liang, sliced), Huang Qin (Scutellariae Radix) (3 liang), Shao Yao (Paeoniae Radix Alba) (3 liang), Ban Xia (Pinelliae Rhizoma) (0.5 sheng, washed), Da Zao (Jujubae Fructus) (12 pieces, broken apart).

Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove dregs, and decoct again. Take 1 sheng warm, three times daily. Another version adds Da Huang (Rhei Radix et Rhizoma) 2 liang; without it, it may not properly be called Da Chai Hu Tang (Major Bupleurum Decoction).