【纲】仲景曰。伤寒脉弦细。头痛。发热者。属少阳。少阳不可发汗。发汗则谵语。此属胃。
胃和则愈。胃不和。则烦而躁。
【目】李杲曰。假令少阳症。头痛。往来寒热。脉浮弦。此三症但有一者。是为表也。口失滋
味。腹中不和。大小便或秘而不通。或泄而不调。但有一者。是为里也。如无上下表里症。余者皆
虚热也。
韩祗和曰。少阳初受寒邪。病全在表。故头痛发热。与太阳同。
【纲】仲景曰。伤寒五六日。头痛。汗出。微恶寒。手足冷。心下满。口不欲食。大便硬。脉
沉细者。此为阳微结。必有表复有里也。脉沉亦在里也。
【目】陶华曰。头痛属三阳。乃邪气上攻也。太阳专主头痛。阳明少阳亦有之。少阳头痛脉弦。
发热。小柴胡汤。
鳌按。旧本于此条。有云头痛汗出者。有无痛字。云头汗出者。但此条原属太阳阳明二阳合病。
但见少阳细脉。因从少阳为治者。如此则头痛汗出微恶寒手足冷四项。乃是太阳表症。心下满口
不欲食心下硬三项。乃是阳阴里症。所以谓之有表复有里也。前四项既属太阳。太阳主头痛。其见
头痛之症无疑。不得曰头汗出也。
【纲】仲景曰。伤寒四五日。身热恶风。头项强。胁下满。手足温而渴者。小柴胡汤主之。
【目】喻昌曰。身热恶风。太阳症也。头项强。太阳兼阳明病也。胁下满。少阳症也。本当从
三阳合并病之列。而用表法。但手足温而加渴。外邪辐凑于少阳。而向里之机已着。倘更用辛甘发
散。是重增其热。而大耗其津也。故从小柴胡和法。则阳邪自罢。而阴津以生。一举而两得矣。此
用小柴胡汤。当从加减法。不呕而渴。去半夏加栝蒌根为是。
魏荔彤曰。三阳俱见病。仍寻少阳。作驱邪之出路。太阳在表之邪。可附少阳之清气。上升而
透于表。阳明在里之邪。
可附少阳之浊气。下降而泄于下。主以小柴胡。策励半表之清气。逐太阳之表邪。役使半里之浊气。
驱阳明之里邪。是藉少阳半表半里之正气。而治表里之邪。犹之用兵。各因其势而致之。易为力
也。
【纲】仲景曰。太阳与少阳并病。脉弦。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大
椎第一间肺俞肝俞。慎不可发汗。发汗则谵语。若谵语不止。当刺期门。
【目】柯琴曰。是经脉之为眚汗吐下之法。非少阳所宜。若不明刺法。不足以奏功。
【纲】张仲景说：伤寒病，脉象弦细，伴有头痛、发热的，属于少阳病。少阳病不可使用发汗法治疗。如果误用发汗法，会导致胡言乱语（谵语），这属于胃气不和。如果胃气调和，病就会痊愈；如果胃气不调和，患者就会出现心烦且躁动不安的症状。
【目】李杲说：假如出现少阳病的症状，如头痛、忽冷忽热（往来寒热）、脉象浮弦。这三种症状中只要有一种存在，就属于表证。口中失去正常滋味、腹部不适、大小便或者秘结不通、或者泄泻而不规律。这些症状中只要有一种存在，就属于里证。如果没有上述上下表里的症状，其余的情况都属于虚热证。
韩祗和说：少阳病在初期感受寒邪时，病邪完全在体表，所以会出现头痛、发热，这与太阳病相同。
【纲】张仲景说：伤寒病经过五六天，出现头痛、出汗、轻微怕冷、手脚冰凉、心下部胀满、嘴里不想吃东西、大便干硬、脉象沉细的，这叫做“阳微结”（阳气轻微郁结）。这种情况必定既有表证又有里证。脉象沉也说明病位在里。
【目】陶华说：头痛归属于三阳经（太阳、阳明、少阳），这是邪气向上攻冲所致。太阳经专门主管头痛，阳明经和少阳经也会出现头痛。少阳头痛表现为脉弦、发热，应用小柴胡汤治疗。
沈金鳌按语：旧版本在此条文中，有的写“头痛汗出”，有的写“头无痛字”（即无头痛，只有头汗出）。我认为此条文原本属于太阳病和阳明病合病，但只见少阳病的细脉，因此从少阳病来治疗。像这样，头痛、出汗、轻微怕冷、手脚冰凉这四项，是太阳病的表证；心下胀满、嘴里不想吃东西、心下部硬满这三项，是阳明病的里证。所以称之为“有表复有里”。前四项既然属于太阳病，太阳经主管头痛，出现头痛症状是毫无疑问的，不能说是头汗出。
【纲】张仲景说：伤寒病经过四五天，身体发热、怕风、头项强直不舒、胁下胀满、手脚温暖且口渴的，主治用小柴胡汤。
【目】喻昌说：身体发热、怕风，是太阳病的症状。头项强直，是太阳病兼有阳明病的症状。胁下胀满，是少阳病的症状。本应当列入三阳合并病的范畴，并使用解表的方法治疗。但是手脚温暖且加上口渴，说明外邪聚集于少阳，向里转化的趋势已经明显。如果再使用辛甘发散的药物，会加重体内的热邪并大量耗伤津液。所以采用小柴胡汤的和解法，那么阳热邪气自然消除，阴津得以生成，一举两得。此处使用小柴胡汤，应当根据加减法进行化裁：如果不呕吐而口渴，去掉半夏，加入栝蒌根（天花粉）才是正确的。
魏荔彤说：三阳经的症状都出现了，仍然要寻找少阳经作为驱除邪气的出路。太阳经在体表的邪气，可以依附少阳经的清气，上升而透达于体表；阳明经在里的邪气，可以依附少阳经的浊气，下降而从下焦排泄。主治用小柴胡汤，激励半表半里的清气，驱逐太阳经的表邪；役使半表半里的浊气，驱赶阳明经的里邪。这是借助少阳经半表半里的正气，来治疗表里两方面的邪气，就像用兵打仗一样，顺应形势而引导它，就容易成功了。
【纲】张仲景说：太阳病与少阳病同时发病（并病），脉象弦，头项强痛，或者头晕目眩、昏蒙，有时感觉像结胸证（胸膈痞硬疼痛），心下部痞塞硬满的，应当针刺大椎穴第一间隙、肺俞穴、肝俞穴。千万不可发汗。如果发汗导致胡言乱语，若谵语不止，应当针刺期门穴。
【目】柯琴说：这条经文讲的是经脉病变，汗、吐、下三种治疗方法都不适合少阳病。如果不明白针刺的治疗方法，就不足以取得疗效。
[General Principle] Zhang Zhongjing stated: In cold damage disease, if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang disease. Shaoyang disease should not be treated with diaphoresis (sweating method). If diaphoresis is mistakenly used, it leads to delirious speech (Zhenyu), which indicates stomach disharmony. If the stomach qi harmonizes, the disease will heal; if the stomach qi does not harmonize, the patient will experience vexation and restlessness.
[Detailed Discussion] Li Gao said: Suppose there are Shaoyang syndrome symptoms, such as headache, alternating chills and fever (Wanglai Hanre), and a floating-wiry pulse. If any one of these three symptoms exists, it is considered a Exterior Syndrome (Biao). If there is loss of normal taste in the mouth, abdominal discomfort, or constipation/diarrhea that is irregular, and any one of these exists, it is considered an Interior Syndrome (Li). If there are no such exterior or interior symptoms above and below, the remaining conditions belong to Deficiency-Heat.
Han Zhihe said: When Shaoyang disease initially receives cold pathogenic factors, the pathology is entirely at the exterior. Therefore, headache and fever occur, which is the same as Taiyang disease.
[General Principle] Zhang Zhongjing stated: In cold damage disease, after five or six days, if there is headache, sweating, slight aversion to cold, cold hands and feet, fullness in the epigastrium, lack of desire to eat, hard stools, and a deep-fine pulse, this is called "Yang Mild Binding" (Yang Wei Jie) (mild stagnation of Yang Qi). This condition must have both an exterior and an interior component. A deep pulse also indicates the pathology is in the interior.
[Detailed Discussion] Tao Hua said: Headache belongs to the Three Yang meridians (Taiyang, Yangming, Shaoyang); it is caused by pathogenic factors attacking upwards. Taiyang meridian specifically governs headache, but Yangming and Shaoyang meridians also present with it. Shaoyang headache presents with a wiry pulse and fever, and Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.
Shen Jin'ao's commentary: In older editions of this text, some versions read "headache and sweating," while others omit the word "pain" (implying only head sweating without headache). I believe this clause originally belongs to a combined disease of Taiyang and Yangming. However, since only the fine pulse of Shaoyang is seen, treatment proceeds from the perspective of Shaoyang. Thus, the four items—headache, sweating, slight aversion to cold, and cold hands and feet—are Taiyang exterior symptoms. The three items—epigastric fullness, lack of desire to eat, and epigastric hardness—are Yangming interior symptoms. Hence, it is called "having both exterior and interior." Since the first four items belong to Taiyang, and Taiyang governs headache, the presence of headache is undeniable; it cannot be described merely as head sweating.
[General Principle] Zhang Zhongjing stated: In cold damage disease, after four or five days, if there is body heat, aversion to wind, stiffness and rigidity of the head and nape, fullness in the hypochondrium, warm hands and feet, and thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
[Detailed Discussion] Yu Chang said: Body heat and aversion to wind are Taiyang symptoms. Stiffness and rigidity of the head and nape indicate Taiyang combined with Yangming disease. Fullness in the hypochondrium is a Shaoyang symptom. Originally, this should be categorized under combined diseases of the Three Yang and treated with exterior-releasing methods. However, because the hands and feet are warm and thirst is added, it indicates that external pathogens are gathering at Shaoyang, and the tendency toward the interior is already established. If辛甘 (acrid-sweet) dispersing agents are still used, it will further increase heat and severely consume Yin fluids. Therefore, using the harmonizing method of Xiao Chai Hu Tang (Minor Bupleurum Decoction) allows Yang pathogens to subside naturally and Yin fluids to regenerate, achieving two benefits with one action. When using Xiao Chai Hu Tang (Minor Bupleurum Decoction) here, modifications according to the addition/subtraction rules should be applied: if there is no vomiting but there is thirst, remove Banxia (Pinellia Rhizome) and add Gualougen (Trichosanthes Root) for correctness.
Wei Litong said: When symptoms of all Three Yang meridians appear, one should still seek Shaoyang as the exit route for expelling pathogens. Pathogens in the exterior of Taiyang can attach to the clear Qi of Shaoyang, ascending and penetrating to the exterior; pathogens in the interior of Yangming can attach to the turbid Qi of Shaoyang, descending and draining downward. The primary use of Xiao Chai Hu Tang (Minor Bupleurum Decoction) stimulates the clear Qi of the half-exterior/half-interior to drive out Taiyang exterior pathogens; it employs the turbid Qi of the half-exterior/half-interior to drive out Yangming interior pathogens. This utilizes the righteous Qi of Shaoyang at the half-exterior/half-interior level to treat pathogens in both the exterior and interior, similar to military strategy where one acts according to the situation, making it easier to succeed.
[General Principle] Zhang Zhongjing stated: When Taiyang and Shaoyang diseases occur simultaneously (Bingbing), with a wiry pulse, stiffness and pain in the head and nape, or dizziness and vertigo, sometimes feeling like Jie Xiong (Chest Binding) (stiffness and pain in the chest and epigastrium), and epigastric stuffiness and hardness, one should puncture the first interspace of the Dazhui (GV14) acupoint, Feishu (BL13), and Ganshu (BL18). Diaphoresis must be strictly avoided. If diaphoresis causes delirious speech, and the delirium does not cease, one should puncture the Qimen (LR14) acupoint.
[Detailed Discussion] Ke Qin said: This scripture discusses meridian pathologies; the methods of sweating, vomiting, and purgation are not suitable for Shaoyang. Without understanding acupuncture methods, therapeutic efficacy cannot be achieved.