桂枝（三两去皮味辛温） 甘草（三两炙味甘平） 大枣（十二枚擘味甘温） 芍
药（六两味酸微寒） 生姜（三两切味辛温） 胶饴（一升味甘温）
上六味。以水七升。煮取三升。去滓、内胶饴。更上微火消解。温服一升。日三服。
呕家不可用建中汤。以甜故也。
建中者。建脾也。内经曰。脾欲缓。急食甘以缓之。胶饴大枣甘草之甘。以缓中也。
辛、润也。散也。荣卫不足。润而散之。桂枝生姜之辛。以行荣卫。酸、收也。泄
也。正气虚弱。收而行之。芍药之酸。以收正气。
成氏云。或谓桂枝汤解表而芍药数少。建中汤温里而芍药数多。何也。皮肤为近。则
制小其服。心腹为远。则制大其服。此所以为不同也。
伤寒中风。有柴胡证。但见一证便是。不必悉具。
柴胡证。是邪气在表里之间也。或胸中烦而不呕。或渴。或腹中痛。或胁下痞硬。
或心下悸。小便不利。或不渴。身有微热。或咳。但见一证。便宜与柴胡汤治之。不必
待其证候全具也。
凡柴胡汤病证而下之。若柴胡证不罢者。复与柴胡汤。必蒸蒸而振。却发热汗出而解。
邪在半表半里之间。为柴胡证。即未作里实。医便以药下之。若柴胡证仍在者。
虽下之。不为逆。可复与柴胡汤。以和解之。得汤。邪气还表者。外作蒸蒸而热。先经下。
里虚。邪气欲出。内则振振然也。正气胜。阳气生。却复发热。汗出而解也。
伤寒二三日。心中悸而烦者。小建中汤主之。
前条心下悸而烦。皆与柴胡汤。此条悸而烦。建中主之何也。前条悸而烦。以往来寒
热默默不食。自表传里之悸烦也。此条悸而烦。以邪气在表里。头疼发热之时而悸烦。
此里虚血气不胜其邪之故也。故与建中汤以温里。如此可悟。凡治悸烦之例也。
伤寒二三日。邪气在表。未当传里之时。心中悸而烦。是非邪气搏所致。心悸者。
气虚也。烦者。血虚也。以气血内虚。与小建中汤。先建其里。
太阳病。过经十余日。反二三下之。后四五日。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。则愈。
日数过多。累经攻下。而柴胡证不罢者。亦须先与小柴胡汤。以解其表。经曰。凡
柴胡汤疾证而下之。若柴胡证不罢者。复与柴胡者是也。呕止者。表里和也。若呕不止。
郁郁微烦者。里热已甚。结于胃中也。与大柴胡汤。下其里寒则愈。
Cinnamon Twig (Guizhi, *Ramulus Cinnamomi*, three liang, bark removed, pungent and warm) Licorice Root (Gancao, *Radix Glycyrrhizae*, three liang, honey-fried, sweet and neutral) Jujube (Dazao, *Fructus Ziziphi Jujubae*, twelve pieces, broken open, sweet and warm) Peony Root (Shaoyao, *Radix Paeoniae Alba*, six liang, sour and slightly cold) Fresh Ginger (Shengjiang, *Rhizoma Zingiberis Recens*, three liang, sliced, pungent and warm) Maltose (Jiaoyi, *Saccharum*, one sheng, sweet and warm)
The above six ingredients. Use seven sheng of water. Decoct to obtain three sheng of liquid. Remove the dregs, add the maltose. Heat gently over a low fire until dissolved. Take one sheng warm. Three times daily.
Patients with vomiting should not use Jianzhong Tang (Middle-Building Decoction). This is because the sweet flavor may exacerbate vomiting.
"Jianzhong" refers to establishing the Middle Qi (Spleen and Stomach Qi). The *Neijing* states: "The Spleen desires relaxation; urgently use sweet substances to relax it." The sweetness of Jiaoyi, Dazao, and Gancao serves to relax the Middle Jiao. Pungent flavors have moistening and dispersing properties. When Ying and Wei Qi are insufficient, they are regulated through moistening and dispersing. The pungency of Guizhi and Shengjiang facilitates the circulation of Ying and Wei Qi. Sour flavors have astringent and draining properties. When Zheng Qi (Upright Qi) is weak, it is regulated through astringing and guiding. The sourness of Shaoyao serves to astringe Zheng Qi.
Cheng Wuji stated: Some ask why Guizhi Tang uses less Shaoyao for releasing the exterior, while Jianzhong Tang uses more Shaoyao for warming the interior. The reason is that the skin is superficial, so the dosage is smaller; the heart and abdomen are deep, so the dosage is larger. This is the difference between them.
In Shanghan or Zhongfeng diseases, if Chaihu Syndrome (Shaoyang Syndrome) appears, it is sufficient to observe just one symptom; it is not necessary for all symptoms to be present.
Chaihu Syndrome indicates pathogenic factors located between the exterior and interior. Symptoms may include vexation in the chest without vomiting, thirst, abdominal pain, fullness and hardness in the hypochondrium, palpitations with difficult urination, absence of thirst with slight fever on the body, or cough. If any one of these symptoms is observed, it is appropriate to administer Chaihu Tang (Bupleurum Decoction). There is no need to wait for the complete syndrome to manifest.
If a patient with Chaihu Tang indications undergoes purgative treatment erroneously, and the Chaihu Syndrome persists, administering Chaihu Tang again will likely result in intense heat sensation followed by chills, then fever and sweating, leading to resolution.
Pathogenic factors located between the exterior and interior constitute Chaihu Syndrome. At this stage, interior excess has not yet formed. If the physician erroneously applies purgatives, but the Chaihu Syndrome remains, this is not considered a counter-indication (Ni Zheng). Chaihu Tang can be administered again to harmonize the Shaoyang. After taking the decoction, as pathogenic factors return to the exterior, intense heat sensation occurs externally. Previously, purgatives caused interior deficiency; as pathogenic factors attempt to exit, internal chills occur. When Zheng Qi prevails and Yang Qi generates, fever and sweating ensue, resulting in recovery.
In Shanghan disease, two to three days after onset, if there are palpitations and vexation, Xiao Jianzhong Tang (Minor Middle-Building Decoction) is the primary treatment.
In the previous clause, palpitations and vexation were treated with Chaihu Tang. Why is Jianzhong Tang used here? In the previous case, the palpitations and vexation resulted from alternating chills and fever, silent desire to eat, and transmission of pathogenic factors from the exterior to the interior. In this case, the palpitations and vexation occur during headache and fever, when pathogenic factors are between the exterior and interior. This is due to interior deficiency where Blood and Qi cannot resist the pathogen. Therefore, Jianzhong Tang is given to warm and tonify the interior. From this, one can understand the general principle for treating palpitations and vexation.
Two to three days into Shanghan, when pathogenic factors are still at the exterior and have not yet transmitted to the interior, if there are palpitations and vexation, this is not caused by pathogenic collision. Palpitations indicate Qi deficiency; vexation indicates Blood deficiency. Due to interior deficiency of Qi and Blood, Xiao Jianzhong Tang is administered to first establish the interior.
In Taiyang Disease, after more than ten days, if the patient was erroneously subjected to purgative treatment two or three times, and four to five days later the Chaihu Syndrome persists, first administer Xiao Chaihu Tang (Minor Bupleurum Decoction). If vomiting persists, there is urgency and discomfort in the epigastrium, and mild depression/vexation, indicating the disease has not resolved. Administer Da Chaihu Tang (Major Bupleurum Decoction) to purge the interior excess, which will lead to cure.
If the duration of the disease is prolonged and multiple purgative treatments have been applied, yet the Chaihu Syndrome persists, one must first administer Xiao Chaihu Tang to resolve the exterior/interior conflict. As stated in the classics: "For diseases requiring Chaihu Tang, if purgatives are used erroneously and the Chaihu Syndrome does not cease, re-administer Chaihu Tang." If vomiting ceases, it indicates harmony between the exterior and interior. If vomiting persists along with depression and vexation, it indicates severe interior heat accumulating in the Stomach. Da Chaihu Tang should be administered to purge the interior heat excess, leading to recovery.