治郁怒伤肝，肝血虚少。（抑郁多怒，肝火旺而血虚。）寒热如疟，（必先有微寒，此阳
陷入
故此症最能误也。）五心烦热，鼻燥咽干，（血虚则内热矣。）头晕眼花，两目干涩，（肝伤血
少之本病也。）胁肋作痛，（肝脉布胁肋也。）肢体尽疼，（血不能荣筋也。）嗜卧少食，（子病
及母，故嗜卧，肝木乘胃，故食少。）月水不调，（血热相搏故也。）或小腹重坠，水道涩痛
，或肿痛出脓，（亦有阴中痒者，皆肝火所致，以肝脉绕阴器，抵小腹也。）或遍身瘙痒，赤
白游风，或瘰 结核等症。（肝伤火旺，血燥生风，或 瘩瘙痒，或脓水淋漓，或赤或白，
游行无定，瘰 结核，皮色不变，皆属肝火，血燥而筋挛所致，瘰 则累累如贯珠，多生于
前后胸胁间，结核则如榛如豆，亦有累累如贯珠者，不拘头项肢体皆结也。）
柴胡（能散诸经血结气滞） 薄荷（木不能郁，故用柴、薄之辛以散之，各五钱，此味赵
氏加
，如嫌辛温，些少用之，或生地凉血补阴之品，或另代二地，丹参之属） 乳制白术（木盛则
土衰，术以扶之，如嫌香燥，或另代石斛、米仁、山药之属） 茯苓（木枯则易焚，木火通气
，心必不宁，苓以宁之，愚每兼用麦冬，以清心降火） 甘草（肝为将军之官，火动必猛烈。
丹溪云∶火甚不可骤用寒凉，盖恐扑之而愈焰，以生甘草泻而兼缓，猖狂自定。各一钱）
加丹皮（凉血活血），黑山栀（泻火，各五分），名加味逍遥散。赵氏以山栀屈曲下行泄水，
改用吴茱萸、姜汁炒黄连。吕晚村云∶山栀亦不止治水，但不若黄连之运用，在上能达心
胃之郁耳！愚谓如见吞酸症，用之如神。
此方辛散酸收，甘缓养血，而兼宁心扶脾之剂。乃肝经之要药，女科之神剂也。仓公
传与褚
寒乍热，而如疟状，久则成劳。愚谓大凡女人多郁，郁怒则伤肝，气结血凝，火旺血虚而成
劳。所以前论云∶童子室女，不生欢笑，及寡妇僧尼，易犯此症也。立斋《女科医按》，每
用此方，屡屡见功。又云∶若因郁怒伤肝而寒热，有怔忡不寐少食等症者，参以加味归脾汤
治之。李时珍云∶寇氏乃谓柴胡本草无一字治劳，不分脏腑有热无热，一概摈斥，殊非通论
。东垣则谓诸有热者加之，无热去之。愚谓劳有五劳，病有五脏。柴胡为肝、胆、心包、三
焦引经之药。故劳在肝，而寒热如疟者，正宜用之，若劳在肺肾者，不可用耳！沈氏云∶若
病起于肝，先见胁痛而后咳嗽，乃木挟心相刑金，先治其本，加清金之药，兼治其标，原有
郁甚舒肝之说也。嘉言谓虚劳畏寒发热，禁用小柴胡汤。又谓骨蒸发热，热深在内里，禁用
一切轻扬之剂，恐引热势外出，而增其炽，灼干津液肌肉。正与上言劳在肺肾，不用柴胡之
说相合。此方赵氏极称其用之广，而效之神。凡寒热往来如疟，呕吐吞酸，嘈杂胸痛胁痛，
小腹胀闷，头晕盗汗，黄胆风温，疝气飧泄，一切郁症，皆对症之方，以此加减出入，无不
获效。愚按∶师尼寡妇，欲念一萌，肾中相火必动，动久则水必亏，郁怒伤肝，火旺血虚，
肝木将槁，若非肾水浇灌，则干柴烈火燎原，不可止遏，虽用本方，必兼壮水为主。
治疗因抑郁愤怒损伤肝脏，导致肝血亏虚。（表现为情绪抑郁且易怒，肝火旺盛而血液不足。）出现类似疟疾的寒热交替症状，（必定先有轻微恶寒，这是因为阳气陷入体内所致，因此此症最容易误诊。）五心（手心、脚心和心口）烦热，鼻腔干燥，咽喉干涩，（血液亏虚则产生内热。）头晕眼花，双眼干涩，（这是肝脏受损、血液亏少的根本病症表现。）胁肋部位疼痛，（因为肝经脉络分布于胁肋部。）全身肢体疼痛，（血液不能滋养筋脉所致。）嗜睡且食欲不振，（子病及母，故嗜睡；肝木克制胃土，故食欲减少。）月经失调，（血热相互搏结所致。）或者小腹沉重下坠，小便通道涩痛，或者肿痛流脓，（也有阴道瘙痒的情况，这都是肝火所致，因为肝经脉络环绕阴器，抵达小腹。）或者全身瘙痒，出现赤白游风（一种皮肤红斑游走不定的病症），或者瘰疬结核等病症。（肝脏受损、火气旺盛，血液干燥生风，或者皮肤瘙痒，或者脓水淋漓，颜色或红或白，游走不定；瘰疬累累如串珠，多生于前后胸胁之间；结核状如榛子豆子，也有累累如串珠的，不限于头项肢体都会结聚。这些都属于肝火、血燥导致筋脉拘挛所致。）
柴胡（能够疏散各经络的血结和气滞） 薄荷（如果木气郁结，所以用柴胡、薄荷的辛味来疏散，各五钱，这个味道是赵献可加上的，如果觉得辛温，可以少量使用，或者用地黄凉血补阴的药物，或者另外替代二地，丹参之类的药物） 乳制白术（木气过盛则脾胃虚弱，用白术来扶持，如果觉得香燥，或者另外替代石斛、薏苡仁、山药之类的药物） 茯苓（木枯则容易燃烧，木火通气，心脏必然不安宁，用茯苓来宁心安神，我通常兼用麦冬，以清心降火） 甘草（肝脏被称为将军之官，火动必猛烈。朱丹溪说：火势极旺时不可突然使用寒凉药物，恐怕扑灭后火势更旺，所以用生甘草既泻火又缓和，猖狂的火势自然平息。各一钱） 加入牡丹皮（凉血活血），黑山栀（泻火，各五分），命名为加味逍遥散。赵献可认为山栀屈曲下行泄水，改用吴茱萸、姜汁炒黄连。吕晚村说：山栀也不止治水，但不若黄连的运用，在上焦能通达心胃的郁结！我认为如果遇到吞酸症状，使用它效果如神。
此方具有辛散、酸收、甘缓养血的功效，并且兼具宁心安神、扶助脾脏的作用。这是治疗肝经疾病的重要药物，也是妇科的神奇方剂。仓公（淳于意）传给褚先生，忽冷忽热，像疟疾一样，久了就会变成虚劳。我认为大凡女人多郁结，郁怒会损伤肝脏，气结血凝，火旺血虚从而形成虚劳。所以前面的论述说：童男童女如果不常欢笑，以及寡妇僧尼，容易犯这种病症。薛立斋《女科医案》中，经常使用此方，屡屡见效。又说：如果因为郁怒伤肝而导致寒热，伴有怔忡、失眠、食欲少等症状的，配合加味归脾汤治疗。李时珍说：寇氏却说柴胡的本草书中没有一个字提到治疗虚劳，不分脏腑是否有热，一概排斥，这绝不是通论。李东垣则认为诸种有热的情况加上柴胡，无热的去掉。我认为虚劳有五劳，疾病涉及五脏。柴胡是肝、胆、心包、三焦的引经药。所以虚劳在肝，且出现类似疟疾的寒热症状，正适宜使用，如果虚劳在肺肾，则不可使用！沈氏说：如果病起于肝，先见胁痛而后咳嗽，这是木气挟带心包相火刑克肺金，先治其本，加入清金润肺的药物，兼治其标，原本就有郁结甚重需舒肝的说法。张景岳（嘉言）认为虚劳畏寒发热，禁用小柴胡汤。又认为骨蒸发热，热势深在内里，禁用一切轻扬升散的药剂，恐怕引动热势外出，从而增加炽盛程度，灼干津液肌肉。这与上面所说的虚劳在肺肾，不用柴胡的说法相吻合。此方赵献可极力称赞其应用广泛，疗效神奇。凡是寒热往来如疟疾，呕吐吞酸，嘈杂胸痛胁痛，小腹胀闷，头晕盗汗，黄疸风温，疝气飧泄，一切郁结病症，都是对症的方剂，以此加减出入，没有不获效的。我认为：师尼寡妇，欲望念头刚一萌发，肾中相火必然发动，发动久了则肾水必然亏损，郁怒伤肝，火旺血虚，肝木即将干枯，如果不是肾水浇灌，就像干柴烈火燎原，无法遏制，虽然使用本方，必须兼以壮水为主。
Treatment for Liver Injury Due to Depression and Anger, with Deficiency of Liver Blood. (Manifestations include emotional depression with irritability, hyperactive Liver Fire, and blood deficiency.) Alternating chills and fever resembling malaria. (There must be initial mild aversion to cold; this is due to Yang Qi sinking into the interior, making this syndrome prone to misdiagnosis.) Five-center heat (heat sensation in the palms, soles, and chest), dry nose, and dry throat. (Blood deficiency generates internal heat.) Dizziness, blurred vision, and dry eyes. (These are the fundamental manifestations of Liver injury and blood deficiency.) Pain in the hypochondrium and ribs. (The Liver meridian traverses the hypochondrium and ribs.) Generalized body pain. (Blood fails to nourish the sinews.) Lethargy and poor appetite. (Disease affecting the mother organ leads to lethargy; Liver Wood overacting on Stomach Earth leads to reduced intake.) Irregular menstruation. (Due to the struggle between blood heat.) Or a heavy bearing sensation in the lower abdomen, painful and difficult urination, or swelling, pain, and pus discharge. (Vaginal itching may also occur; all are caused by Liver Fire, as the Liver meridian encircles the genitalia and reaches the lower abdomen.) Or generalized pruritus, red and white wandering wind (a dermatological condition characterized by migrating erythema), or scrofula and lymphatic nodules. (Liver injury with hyperactive fire causes blood dryness generating wind, leading to skin itching, oozing pus, varying colors from red to white, and unpredictable migration. Scrofula appears as beads strung together, mostly occurring between the anterior/posterior chest and ribs; lymphatic nodules resemble hazelnuts or beans, sometimes strung like beads, occurring anywhere on the head, neck, or limbs. These all belong to Liver Fire and blood dryness causing sinew contraction.)
Chai Hu (Bupleuri Radix) (Able to disperse blood stasis and qi stagnation in various meridians). Bo He (Menthae Haplocalycis Herba) (If Wood Qi is depressed, Xin [acrid] flavors of Chai Hu and Bo He are used to disperse it; each 5 qian. This addition was made by Zhao Xianke. If the acrid-warm nature is disliked, use sparingly, or substitute with cooling-blood and yin-nourishing herbs such as Sheng Di Huang [Rehmanniae Radix], or alternatives like Dan Shen [Salviae Miltiorrhizae Radix]). Ru Zhi Bai Zhu (Milky-processed Atractylodis Macrocephalae Rhizoma) (When Wood is excessive, Earth becomes deficient; Bai Zhu supports Earth. If the aromatic-dry nature is disliked, substitute with Shi Hu [Dendrobii Caulis], Yi Yi Ren [Coicis Semen], or Shan Yao [Dioscoreae Rhizoma]). Fu Ling (Poria) (When Wood is withered, it burns easily; Wood and Fire communicate, disturbing the Heart; Fu Ling calms the Spirit. I often combine it with Mai Dong [Ophiopogonis Tuber] to clear Heart heat and descend fire). Gan Cao (Glycyrrhizae Radix et Rhizoma) (The Liver is the General; when Fire moves, it is fierce. Zhu Danxi stated: When Fire is extreme, sudden use of cold-cooling herbs is contraindicated, lest suppression cause rebound flare-up. Raw Gan Cao clears heat while moderating intensity, calming the rampant Fire. Each 1 qian). Add Dan Pi (Moutan Cortex) (Cool blood and invigorate blood), Hei Shan Zhi (Gardeniae Fructus, charred) (Drain fire, each 0.5 fen). Named Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). Zhao Xianke believed Shan Zhi descends water via its curved structure, suggesting substitution with Wu Zhu Yu (Evodiae Fructus) and Huang Lian (Coptidis Rhizoma) stir-fried with ginger juice. Lü Wancun stated: Shan Zhi does not only treat water retention, but Huang Lian is more versatile, reaching the depression of the Heart and Stomach in the upper jiao! I assert that for acid regurgitation, it works miraculously.
This formula combines acrid dispersing, sour astringing, and sweet-slowing blood-nourishing properties, along with calming the Heart and supporting the Spleen. It is a key herb for the Liver channel and a miraculous agent in gynecology. Cang Gong (Chunyu Yi) passed it down to Chu... Alternating chills and fever resembling malaria, which over time develops into consumptive disease (Lao). I believe women are generally prone to depression; anger and depression injure the Liver, causing qi knotting and blood coagulation, leading to hyperactive fire and blood deficiency, resulting in Lao. Thus, the previous discussion states: virgins who do not laugh often, as well as widows, nuns, and monks, are susceptible to this syndrome. Li Jiezi's *Gynecological Medical Cases* frequently uses this formula with repeated success. It further states: For cases where depression and anger injure the Liver causing chills and fever, accompanied by palpitations, insomnia, and poor appetite, combine with Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction). Li Shizhen stated: Kou Zongshi claimed there is not a single word in the Materia Medica about Chai Hu treating Lao, excluding it regardless of whether organs have heat or not, which is not a comprehensive view. Li Dongyuan stated that Chai Hu should be added for conditions with heat and removed for those without. I argue that Lao involves five types of exhaustion and diseases affect five zang organs. Chai Hu is a guiding herb for the Liver, Gallbladder, Pericardium, and Triple Burner. Therefore, if Lao is in the Liver with malaria-like chills and fever, it is appropriate to use; however, if Lao is in the Lung or Kidney, it should not be used. Shen Shi stated: If the disease originates in the Liver, presenting first with hypochondriac pain followed by cough, this is Wood carrying Pericardium Ministerial Fire to punish Metal. Treat the root first by adding herbs that clear the Lung, while addressing the branch, adhering to the principle of soothing the Liver when depression is severe. Zhang Jingyue (Jiayan) stated that for Lao with aversion to cold and fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is contraindicated. He also stated that for bone-steaming fever, where heat is deep within, all light and ascending agents are contraindicated, as they may draw heat outward, increasing its intensity and burning up fluids and muscles. This aligns with the statement above that Chai Hu is not used for Lao in the Lung and Kidney. Zhao Xianke highly praised the wide application and miraculous efficacy of this formula. For all symptoms including alternating chills and fever like malaria, vomiting and acid regurgitation, epigastric discomfort, chest and hypochondriac pain, lower abdominal distension, dizziness, night sweats, jaundice, wind-warmth, hernia, and undigested food diarrhea, as well as all depression syndromes, this is a symptomatic formula; with modifications, it achieves efficacy. I analyze: For nuns and widows, once desire arises, the Ministerial Fire in the Kidney inevitably moves; prolonged movement depletes Kidney Water. Depression and anger injure the Liver, causing hyperactive fire and blood deficiency, leaving Liver Wood withering. Without Kidney Water irrigation, it is like dry wood fueling a raging fire, uncontrollable. Although using this formula, one must primarily strengthen Water (nourish Yin).