（此方自原论中第十卷采附于此）
柴胡（四两） 桂枝（去皮） 黄芩 人参（各一两半） 甘草（一两炙） 半夏（二合半洗） 芍药（一两半） 大
枣（六枚擘） 生姜（一两半切）
上九味。以水七升。煮取三升。去滓。温服。
琥按上方乃柴胡合桂枝汤两方相合之复方。其不曰桂枝柴胡汤者。以柴胡为君也。益可见少阳邪甚。太阳邪微矣。
伤寒五六日。已发汗而复下之。胸胁满。微结。小便不利渴而不呕。但头汗出。往来寒热心烦者。此为未解也。柴
胡桂枝干姜汤主之。（此条亦太阳病传入少阳之证。伤寒五六日。已发汗矣。而复下之不无少误。惟误下。以故胸胁满微
结。微结者。言其邪不甚。未入于府。正当表里之间也。小便不利者。此因汗下之后。而津液少也。惟津液少而非停饮。
以故渴而不呕。但头汗出者。此热郁于经不得外越。故但升于头而汗出也。心烦者。即胸烦往来。寒热胸烦者。此为少
阳之邪未解也。故与柴胡桂枝干姜汤。以专解其半表之邪。兼散其半里之结也。上二条证并下汤方俱自太阳下编移附于
此。）
柴胡（半斤） 桂枝（三两去皮） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎（二两熬） 甘草（二两炙）
上七味。以水一斗二升。煮取六升。去滓。再煎取三升。温服一升。日三服。初服微烦复服。汗出便愈。
成注引内经曰。热淫于内。以苦发之。柴胡黄芩之苦。以解传里之邪。辛甘发散为阳。桂枝甘草之辛甘。以散在
表之邪咸以软之。牡蛎之咸。以消胸胁之满。辛以润之。干姜之辛以固阳虚之汗津液不足而为渴。苦以坚之。栝蒌之苦。
以生津液。
琥按上成注云。干姜之辛。以固阳虚之汗。其说甚误。夫头汗出者。乃阳郁于表。非阳虚于上也。如系阳虚。不堪
再汗。岂有方后云。复服使汗出之理。况干姜亦辛热之品。助以桂枝。能散太阳未尽之表邪。若云固汗。吾不信矣。
琥按上方。即小柴胡汤加减方也。据原方加减法云。胸中烦而不呕者。去半夏人参。加栝蒌实。若渴者。去半夏。
兹者。心烦渴而不呕。故去人参半夏。加栝蒌根四两。若胁下痞硬。去大枣。加牡蛎。兹者。胸胁满微结。即痞硬也。
故去大枣。加牡蛎二两。若心悸。小便不利者。去黄芩。加茯苓。兹者。小便不利。心不悸而但烦。是为津液少而躁热。
非水蓄也。故留黄芩。不加茯苓。又云若咳者去人参大枣生姜。加五味子干姜。兹不因咳而以干姜易生姜者。何也。盖
干姜味辛而气热。其用有二。一以辛散胸胁之微结。一以热济黄芩栝蒌根之苦寒。使阴阳和而寒热已焉。
伤寒五六日。呕而发热者。柴胡证具。而以他药下之。柴胡证仍在者。复与柴胡汤。此虽已下之不为逆。必蒸蒸而
振。却发热汗出而解。若心下满而硬痛者。此为结胸也。大陷胸汤主之。但满而不痛者。此为痞。柴胡不中与之宜半夏
泻心汤。（此条系少阳病误下。而成痞结之证。成注云伤寒五六日。邪在半表半里之时。呕而发热邪在半表半里之证。柴
胡证具云云。至汗出而解。注已见前小柴胡汤附例之下。心下满云云。乃复言下后之变以出其治。然心下满。须有阴阳
之分。若下后邪气传里。陷于胸中。成注云胸中为阳受气之分。邪结虽高。而硬痛必下。此为结胸证也。与大陷胸汤以
下其结。若下后邪气传里。留于心下。成注云心下为阴受气之分。痞塞虽下而气逆则高。此为痞证也。宜半夏泻心汤以
通其痞柴胡不中与之者。此言结胸痞气。皆系柴胡证罢。故宜另与陷胸等汤也。愚按此条。可见少阳病误下之。亦有痞
结之证。前第五卷太阳下编云。太阳病误下之。因作结胸太阴病误下之。因作痞气。兹者。少阳病误下。邪在半表半里。
居阴阳之间。故亦有痞结证也。夫人身腹阴。而背阳。少阳行身之侧。居阴阳之间。为半表里。然人身膈以下属阴。膈
以上属阳。少阳居清道。而协乎膈之间。亦为半表里。此可征少阳病误下。邪气乘虚入里。而结胸痞气所由分矣。大陷
胸汤已见前第五卷太阳下编）
（此方从原论第十卷摘录附于此）
柴胡（四两） 桂枝（去皮） 黄芩 人参（各一两半） 甘草（一两，炙） 半夏（二合半，洗） 芍药（一两半） 大枣（六枚，掰开） 生姜（一两半，切）
以上九味药。用水七升。煮取三升。去渣。温服。
琥按：上方是柴胡汤与桂枝汤两个方剂相合而成的复方。之所以不叫“桂枝柴胡汤”，是因为以柴胡为君药。这更可见少阳邪气盛，太阳邪气微了。
伤寒五六天，已经发汗又用下法治疗。出现胸胁满闷，轻微痞结，小便不利，口渴但不呕吐，只有头部出汗，往来寒热，心烦的，这是病未解。用柴胡桂枝干姜汤主治。（这一条也是太阳病传入少阳的证候。伤寒五六天，已经发汗了，却又用下法，不能没有小失误。正因为误用下法，所以胸胁满闷、轻微痞结。“微结”是说邪气不重，未入于腑，正当在表里之间。小便不利，是因为经过汗下之后，津液少了。正因为津液少而不是水饮停聚，所以口渴但不呕吐。只有头部出汗，是因为热郁滞在经脉中不能向外发散，所以只向上蒸腾到头部而出汗。心烦，就是胸中烦闷。往来寒热、胸中烦闷，这是少阳邪气未解。所以给予柴胡桂枝干姜汤，专门解除在半表的邪气，兼散在半里的痞结。以上两条证候及下方剂均从太阳篇下编移附于此。）
柴胡（半斤） 桂枝（三两，去皮） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎（二两，熬） 甘草（二两，炙）
以上七味药。用水一斗二升。煮取六升。去渣。再煎取三升。温服一升。每天服三次。初次服药后微微心烦，再次服药后，出汗便痊愈。
成无己注引《内经》说：“热淫于内，以苦发之。”柴胡、黄芩的苦味，用来解除传入里的邪气。“辛甘发散为阳”，桂枝、甘草的辛甘，用来发散在表的邪气。“咸以软之”，牡蛎的咸味，用来消除胸胁的满闷。“辛以润之”，干姜的辛味，用来固护阳虚导致的汗出。津液不足而口渴，“苦以坚之”，栝蒌根的苦味，用来生津液。
琥按：上面成无己的注释说：“干姜的辛味，用来固护阳虚的汗出。”这种说法非常错误。头汗出，是阳气郁滞在体表，不是阳气虚于上。如果是阳虚，不堪再发汗，怎么会有方后注说“再次服药使汗出”的道理呢？况且干姜也是辛热的药物，配合桂枝，能发散太阳未尽的表邪。如果说能固汗，我不相信。
琥按：上方是小柴胡汤的加减方。根据原方加减法说：胸中烦而不呕的，去掉半夏、人参，加栝蒌实。如果口渴的，去掉半夏。现在心烦、口渴但不呕吐，所以去掉人参、半夏，加栝蒌根四两。如果胁下痞硬，去掉大枣，加牡蛎。现在是胸胁满闷、轻微痞结，也就是痞硬。所以去掉大枣，加牡蛎二两。如果心悸、小便不利的，去掉黄芩，加茯苓。现在是小便不利，心不悸只是心烦，这是津液少而躁热，不是水蓄积。所以保留黄芩，不加茯苓。又说如果咳嗽的，去掉人参、大枣、生姜，加五味子、干姜。现在不是因为咳嗽而以干姜替换生姜，为什么呢？大概干姜味辛而气热，它的用法有两个：一是用辛味疏散胸胁的微结；二是用热性济助黄芩、栝蒌根的苦寒，使阴阳调和而寒热停止。
伤寒五六天，呕吐且发热的，柴胡证具备，却用其他药攻下。柴胡证仍在的，再给柴胡汤。这虽然已经攻下，但不算逆证，必定会蒸蒸而振栗，随后发热出汗而解。如果心下满而且硬痛的，这是结胸证。用大陷胸汤主治。只是满而不痛的，这是痞证。柴胡汤不适合用它，宜用半夏泻心汤。（这一条是少阳病误下，而成痞结的证候。成无己注说：伤寒五六天，邪气在半表半里的时候，呕吐且发热，这是半表半里的证候，柴胡证具备云云。至于出汗而解，注解已见前小柴胡汤附例之下。心下满云云，是再说下法后的变证以出其治法。然而心下满，必须有阴阳之分。如果下后邪气传里，陷于胸中，成无己注说胸中是阳气受气的部位，邪气结聚虽然位置高，但硬痛必然向下，这是结胸证。用大陷胸汤以下其结聚。如果下后邪气传里，留于心下，成无己注说心下是阴气受气的部位，痞塞虽然位置低，但气逆则感觉高，这是痞证。宜用半夏泻心汤以通其痞。说“柴胡不中与之”，这是说结胸和痞气，都是柴胡证罢除后，所以宜另外给予陷胸等汤。愚按：这一条可以看出少阳病误下，也有痞结的证候。前第五卷太阳篇下编说：太阳病误下，因而成为结胸；太阴病误下，因而成为痞气。现在是少阳病误下，邪气在半表半里，居于阴阳之间，所以也有痞结证。人身腹部属阴，背部属阳。少阳行于身侧，居于阴阳之间，为半表里。然而人身膈以下属阴，膈以上属阳。少阳居清道，而协理膈之间，也为半表里。这可以验证少阳病误下，邪气乘虚入里，而结胸与痞气由此区分。大陷胸汤已见前第五卷太阳篇下编）
(This prescription is extracted from Volume 10 of the original treatise and attached here.)
Chai Hu (Bupleuri Radix) [4 liang], Gui Zhi (Cinnamomi Ramulus, peeled), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma) [each 1.5 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) [1 liang], Ban Xia (Pinelliae Tuber, washed) [2.5 he], Shao Yao (Paeoniae Radix Alba) [1.5 liang], Da Zao (Ziziphi Jujubae Fructus, split) [6 pieces], Sheng Jiang (Zingiberis Rhizoma Recens, sliced) [1.5 liang].
The above nine ingredients. Use seven sheng of water. Decoct to obtain three sheng. Remove the dregs. Take warm.
Hu notes: The above formula is a compound formed by combining the Chai Hu Tang (Bupleurum Decoction) and Gui Zhi Tang (Cinnamon Twig Decoction). It is not called "Gui Zhi Chai Hu Tang" because Chai Hu serves as the sovereign drug. This further indicates that the pathogenic factor in Shaoyang (Lesser Yang) is abundant, while that in Taiyang (Greater Yang) is slight.
In Shanghan (Cold Damage) disease, after five or six days, if sweating has already been applied followed by purgation, and symptoms such as fullness and slight binding in the chest and hypochondrium, difficulty in urination, thirst without vomiting, only sweating on the head, alternating chills and fever, and vexation occur, this indicates the disease has not resolved. Treat with Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). (This clause also represents a syndrome where Taiyang disease transmits to Shaoyang. After five or six days of Shanghan, sweating was already performed, yet purgation was again used, which cannot be without minor error. Precisely due to the erroneous use of purgation, there is fullness and slight binding in the chest and hypochondrium. "Slight binding" means the pathogen is not severe and has not entered the Fu organs, but resides exactly between the exterior and interior. Difficulty in urination occurs because fluids are depleted after sweating and purging. Since it is fluid depletion rather than retained fluid retention, there is thirst but no vomiting. Only sweating on the head occurs because heat is constrained within the meridians and cannot diffuse outward, thus rising only to the head to cause sweating. Vexation refers to chest vexation. Alternating chills and fever with chest vexation indicate that the Shaoyang pathogen has not resolved. Therefore, Chai Hu Gui Zhi Gan Jiang Tang is given to specifically resolve the pathogen at half-exterior and simultaneously dissipate the binding at half-interior. The above two clauses regarding syndromes and prescriptions are moved from the lower section of the Taiyang chapter and attached here.)
Chai Hu (Bupleuri Radix) [8 liang], Gui Zhi (Cinnamomi Ramulus, peeled) [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, roasted) [2 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) [2 liang].
The above seven ingredients. Use twelve sheng of water. Decoct to obtain six sheng. Remove the dregs. Re-decoct to obtain three sheng. Take one sheng warm. Administer three times daily. After the initial dose, slight vexation may occur; after subsequent doses, sweating will occur and the patient will recover.
Cheng Wuji's commentary cites the *Neijing*: "When heat dominates internally, release it with bitter flavors." The bitter nature of Chai Hu and Huang Qin resolves the pathogen transmitted inward. "Pungent and sweet disperse for Yang"; the pungent and sweet nature of Gui Zhi and Gan Cao disperses the pathogen remaining at the exterior. "Salty softens hardness"; the salty nature of Mu Li eliminates fullness in the chest and hypochondrium. "Pungent moistens"; the pungent nature of Gan Jiang secures sweat caused by Yang deficiency. Fluid insufficiency causes thirst; "Bitter solidifies"; the bitter nature of Gua Lou Gen generates body fluids.
Hu notes: Cheng Wuji's commentary states, "The pungent nature of Gan Jiang secures sweat caused by Yang deficiency." This explanation is highly erroneous. Sweating on the head results from Yang constraint at the exterior, not Yang deficiency above. If it were Yang deficiency, further sweating would be intolerable; how could the post-prescription instructions say "subsequent doses cause sweating"? Moreover, Gan Jiang is pungent and hot; combined with Gui Zhi, it can disperse residual exterior pathogens of Taiyang. To claim it secures sweat, I do not believe it.
Hu notes: The above formula is a modification of Xiao Chai Hu Tang (Minor Bupleurum Decoction). According to the original modification rules: if there is vexation in the chest without vomiting, remove Ban Xia and Ren Shen, add Gua Lou Shi (Trichosanthis Fructus). If thirsty, remove Ban Xia. Currently, there is vexation, thirst, but no vomiting; therefore, Ren Shen and Ban Xia are removed, and Gua Lou Gen is added (4 liang). If there is stiffness and fullness under the ribs, remove Da Zao, add Mu Li. Currently, there is fullness and slight binding in the chest and hypochondrium, which equates to stiffness and fullness; therefore, Da Zao is removed, and Mu Li is added (2 liang). If there is palpitations and difficulty urinating, remove Huang Qin, add Fu Ling (Poria). Currently, there is difficulty urinating, no palpitations, only vexation; this indicates fluid depletion with restlessness and heat, not water accumulation. Therefore, Huang Qin is retained, and Fu Ling is not added. It also states: if coughing occurs, remove Ren Shen, Da Zao, and Sheng Jiang, add Wu Wei Zi (Schisandrae Fructus) and Gan Jiang. Why is Gan Jiang used instead of Sheng Jiang here despite no cough? Gan Jiang is pungent and hot, with two uses: first, to dissipate slight binding in the chest and hypochondrium via its pungency; second, to balance the bitter-cold nature of Huang Qin and Gua Lou Gen with its heat, harmonizing Yin and Yang to cease cold and heat.
After five or six days of Shanghan, if there is vomiting and fever, the Chai Hu syndrome is complete. If other drugs are used for purgation, and the Chai Hu syndrome persists, administer Chai Hu Tang again. Although purgation has been performed, this is not a counter-indication; the patient will inevitably experience trembling and shaking, followed by fever and sweating, leading to resolution. If there is fullness below the heart with hardness and pain, this is Jie Xiong (Chest Binding); treat with Da Xian Xiong Tang (Major Cathartic for the Chest Decoction). If there is fullness without pain, this is Pi (Stagnant Blockage); Chai Hu Tang is not indicated. Instead, Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) should be used. (This clause involves a Pi-Jie syndrome resulting from erroneous purgation in Shaoyang disease. Cheng Wuji's commentary states: During the fifth or sixth day of Shanghan, when the pathogen is at half-exterior and half-interior, vomiting and fever represent half-exterior and half-interior syndromes, and the Chai Hu syndrome is complete, etc. Regarding resolution through sweating, the annotation is already seen under the appendix examples of Xiao Chai Hu Tang previously. Regarding fullness below the heart, it discusses post-purgation variations to derive treatment methods. However, fullness below the heart must be distinguished by Yin and Yang. If after purgation the pathogen transmits inward and sinks into the chest, Cheng Wuji notes that the chest is the area where Yang Qi receives energy; although the pathogen binds high, hardness and pain necessarily extend downward, constituting Jie Xiong syndrome. Use Da Xian Xiong Tang to purge the binding. If after purgation the pathogen transmits inward and remains below the heart, Cheng Wuji notes that below the heart is the area where Yin Qi receives energy; although blockage is low, Qi rebellion makes it feel high, constituting Pi syndrome. Use Ban Xia Xie Xin Tang to unblock the Pi. Saying "Chai Hu Tang is not suitable for it" means that both Jie Xiong and Pi syndromes arise after the Chai Hu syndrome has ceased, so other formulas like Xian Xiong are appropriate. In my opinion, this clause shows that erroneous purgation in Shaoyang disease can also result in Pi-Jie syndromes. In Volume 5, lower section of Taiyang, it states: Erroneous purgation in Taiyang disease leads to Jie Xiong; erroneous purgation in Taiyin disease leads to Pi. Now, erroneous purgation in Shaoyang disease places the pathogen at half-exterior and half-interior, residing between Yin and Yang, hence also producing Pi-Jie syndromes. The human abdomen is Yin, and the back is Yang. Shaoyang runs along the side of the body, residing between Yin and Yang, constituting half-exterior and half-interior. Furthermore, below the diaphragm is Yin, and above the diaphragm is Yang. Shaoyang resides in the clear pathways and coordinates with the area between the diaphragms, also constituting half-exterior and half-interior. This verifies that in erroneous purgation of Shaoyang disease, the pathogen enters the interior taking advantage of deficiency, distinguishing the origins of Jie Xiong and Pi syndromes. Da Xian Xiong Tang has been seen in Volume 5, lower section of Taiyang.)