少阳之为病，口苦咽干目眩也。（《活人》云∶宜小柴胡汤。）
少阳中风，两耳无所闻，目赤，胸中满而烦者，不可吐下，吐下则悸而惊。（误吐气虚者悸，误下
血虚者惊。）
伤寒脉弦细，头痛发热者，属少阳。少阳不可发汗，发汗则谵语，此属胃家，胃和则愈，胃不和则烦悸。
伤寒三日，少阳脉小者，欲已也。少阳欲解时，从寅至辰上。
阳明病，腹满，脉浮紧，口苦咽干而喘。若其人发热恶寒，误下之，则腹满，小便难。若其人发热不恶寒
反恶热，误下之，则胃空虚，为懊 ；误下之，则谵语；误加烧针，则不得眠。（论见腹满。许学士云∶
宜小柴胡汤。）
眩而口苦舌干者，属少阳。（论见口苦。）眩而心下硬，项强者，属太阳少阳并病，当刺大椎、肺俞。忌
汗下。（论见项强。）
眩而胃实，若能食不恶寒者，中风；若饱则头眩，小便难者，谷疸。皆属阳明。（论见胃实。）
太阳发汗后，仍发热，心悸头眩，身 振振欲擗地者，真武汤主之。（方论见战振。）
动气在左，误汗则头眩，汗不止，筋惕肉 。（方论见动气。《活人》云∶宜小建中汤。）诸逆误汗而言
乱目眩者死。（论见谵语。）头眩脉沉紧，发汗则动经，身为振振摇。（论见战振。）
〔《本》〕太阳病不解，转入少阳者，胁下硬满，干呕不能食，往来寒热，尚未吐下，脉沉紧者，与小柴胡汤。若
已吐下发汗温针，谵语，柴胡症罢，此为坏病，知犯何逆，以法治之。伤寒五六日，中风，往来寒热，胸胁苦
满，默默不欲饮食，心烦喜呕，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，或咳者，小柴胡主之。血虚气尽，腠理开，邪气因入，与正气相搏，结于胁下，正邪分争，
往来寒热，休作有时，默默不欲饮食者，脏腑相连，其病必下，邪高病下，故使呕也，宜小柴胡汤。
柴胡（二两） 黄芩 人参 甘草（各三钱） 半夏（姜制，六钱）
上 咀，每服五钱，生姜五片，枣二枚，同煎温服，日三服。若胸中烦而不呕，去半夏、人参，加栝蒌实
一枚。苦渴者，去半夏，加人参三钱，栝蒌根一两。若腹中痛者，去黄芩，加芍药三分。若胁下痞硬，
去大枣，加牡蛎一两。心下悸，小便不利者，去黄芩，加茯苓一两。若不渴，外有微热者，去人参，加桂三分，
温覆取微汗愈。若咳者，去人参、大枣、生姜，加五味子半两，干姜三分。
凡柴胡病下之不罢者，复与柴胡汤，必蒸蒸而振，却发热汗出而解。伤寒中风，有柴胡症，但见一
症便是，不必悉具。
伤寒十余日，热结在里，复往来寒热者，宜大柴胡汤。（论见结胸。）
大柴胡汤
柴胡（二两） 黄芩 芍药（各半两） 半夏（制，六钱） 生姜（一两） 枳实（半两） 大黄（一两）
上 咀，每服五钱，加大枣三枚，水煎温服，以利为度，未利再服。
〔许〕有人病伤寒，心烦喜呕，往来寒热，医以小柴胡与之，不除。予曰∶脉洪大而实，热结在里，小柴胡
安能去之？仲景云∶伤寒十余日，热结在里，复往来寒热者，与大柴胡汤，三服而病除。盖大黄荡涤
蕴热，伤寒中要药。王叔和云∶若不用大黄，恐不名柴胡，须酒洗生用有力。伤寒五六日，已发汗而复下
之，胸腹满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦，此为未解也。
宜柴胡桂枝干姜汤。
柴胡（二两） 桂枝 干姜（各半两） 栝蒌根 黄芩（各一两） 牡蛎 甘草（炙。各半两）
上 咀，每服五钱，煎温服。微烦，再服，汗出愈。
病患脉微而涩者，此为医所病也，大发其汗，又数大下之，其人亡血，病当恶寒，后乃发热无休止时，夏
月盛热，欲着复衣，冬月盛寒，欲裸其身。所以然者，阳微则恶寒，阴弱则发热，此医发其汗，令阳
气微，又大下之，令阴气弱。五月之时，阳气在表，胃中虚冷，以阳气内微，不能胜冷，故欲着复衣。十一
月之时，阳
气在里，胃中烦热，以阴气内弱，不能胜热，故裸其身。又阴脉迟涩，故知血亡也。
上脉微因大发汗所致，故病当恶寒之时，虽盛夏亦欲着复衣；脉涩因大下所致，故病当恶寒后发
热之时，虽盛冬亦欲裸其体；是皆亡血阳微阴弱，不能胜冷胜热，非是盛夏牵延至盛冬也。
少阳经受邪所致的病证，表现为口苦、咽干、头晕目眩。（《活人书》说：适宜用小柴胡汤。）
少阳经感受风邪，出现双耳听力减退、眼睛发红、胸中胀满且心烦的症状，此时不可使用催吐或泻下的治法，如果误用吐法或下法，会导致心悸和惊恐。（误用吐法导致气虚则心悸，误用下法导致血虚则惊恐。）
伤寒病脉象弦细，伴有头痛发热的，属于少阳病。少阳病禁止使用发汗法，如果误用发汗法，会导致胡言乱语，这是因为病邪传入胃腑，胃气调和则痊愈，胃气不和则会出现心烦和心悸。
伤寒发病三天后，如果少阳脉象变小，说明病情将要好转。少阳病缓解的时间段，从寅时到辰时（凌晨3点至上午9点）。
阳明病，腹部胀满，脉象浮紧，口苦咽干且气喘。如果患者发热恶寒，误用下法，会导致腹部胀满、小便困难。如果患者发热不恶寒反而怕热，误用下法，会导致胃中空虚，产生心中懊恼烦闷；误用下法，会导致胡言乱语；误用温针疗法，会导致失眠。（相关论述见“腹满”条。许叔微说：适宜用小柴胡汤。）
头晕目眩且口苦舌干的，属于少阳病。（相关论述见“口苦”条。）头晕目眩且心下部硬满、颈项强直的，属于太阳病与少阳病合并症，应当针刺大椎穴和肺俞穴。忌用发汗和下法。（相关论述见“项强”条。）
头晕目眩且胃中有实邪，如果能进食且不恶寒的，属于中风；如果饱食后头晕目眩、小便困难的，属于谷疸。这些都属于阳明病。（相关论述见“胃实”条。）
太阳病发汗后，仍然发热，伴有心悸、头晕目眩、身体震颤欲倒地的，用真武汤主治。（方剂论述见“战振”条。）
动气在左侧，误用发汗法会导致头晕目眩，汗出不止，筋肉跳动。（方剂论述见“动气”条。《活人书》说：适宜用小建中汤。）各种逆证误用发汗法而出现神志错乱、头晕目眩的，预后不良致死。（相关论述见“谵语”条。）头晕目眩脉象沉紧，误用发汗法会扰动经脉，导致身体震颤摇晃。（相关论述见“战振”条。）
〔《本草衍义》引〕太阳病未解，转入少阳经的，表现为胁下硬满、干呕不能进食、忽冷忽热，尚未使用吐法、下法，脉象沉紧的，给予小柴胡汤。如果已经使用了吐法、下法、发汗法或温针疗法，出现胡言乱语，柴胡证候已消失，这称为坏病，需查明犯了什么错误，按照相应的法治之。伤寒五六天，或中风，出现忽冷忽热、胸胁部苦于胀满、沉默不想吃东西、心烦喜呕，或者胸中烦闷但不呕吐，或者口渴，或者腹中疼痛，或者胁下痞塞硬满，或者心下悸动、小便不利，或者不渴、身体有轻微发热，或者咳嗽的，用小柴胡汤主治。血虚气弱，腠理开泄，邪气乘虚而入，与正气相搏结，郁结在胁下，正邪分争，导致忽冷忽热，发作有定时，沉默不想吃东西。脏腑相连，病势必然下行，邪气位置高而病症表现低，所以引起呕吐，适宜用小柴胡汤。
柴胡（二两） 黄芩 人参 甘草（各三钱） 半夏（姜制，六钱）
以上药材切碎，每次服用五钱，加生姜五片、大枣二枚，共同煎煮，温服，每日三次。如果胸中烦闷但不呕吐，去掉半夏、人参，加栝蒌实一枚。如果严重口渴，去掉半夏，加人参三钱、栝蒌根一两。如果腹中疼痛，去掉黄芩，加芍药三分。如果胁下痞塞硬满，去掉大枣，加牡蛎一两。如果心下悸动、小便不利，去掉黄芩，加茯苓一两。如果不渴，体表有轻微发热，去掉人参，加桂枝三分，覆盖衣被取微汗即可痊愈。如果咳嗽，去掉人参、大枣、生姜，加五味子半两、干姜三分。
凡是柴胡病误用下法后病未愈的，再次给予柴胡汤，必定会出现全身蒸蒸发热并颤抖，随后发热出汗而病愈。伤寒或中风，有柴胡证候，只要见到其中一个症状即可，不必所有症状都具备。
伤寒十多天，热邪结聚在体内，又出现忽冷忽热的，适宜用大柴胡汤。（相关论述见“结胸”条。）
大柴胡汤
柴胡（二两） 黄芩 芍药（各半两） 半夏（制，六钱） 生姜（一两） 枳实（半两） 大黄（一两）
以上药材切碎，每次服用五钱，加大枣三枚，水煎煮，温服，以大便通畅为度，若未通利再服用。
〔许叔微〕有人患伤寒病，心烦喜呕，忽冷忽热，医生用小柴胡汤给他服用，病未除。我说：脉象洪大而实，热邪结聚在体内，小柴胡汤怎么能去除它？仲景说：伤寒十多天，热邪结聚在体内，又出现忽冷忽热的，给予大柴胡汤，服用三次病就消除了。因为大黄能荡涤蕴积的热邪，是治疗伤寒的重要药物。王叔和说：如果不用大黄，恐怕就不叫柴胡汤了，必须用酒洗过的生大黄，效力更强。伤寒五六天，已经发汗后又误用下法，胸腹部胀满且轻微结聚，小便不利，口渴但不呕吐，只有头部出汗，忽冷忽热，心烦，这是病邪未解。
适宜用柴胡桂枝干姜汤。
柴胡（二两） 桂枝 干姜（各半两） 栝蒌根 黄芩（各一两） 牡蛎 甘草（炙。各半两）
以上药材切碎，每次服用五钱，煎煮后温服。如果仍有轻微心烦，再服用，出汗即愈。
病人脉象微而涩的，这是医生治疗失误造成的，大发其汗，又多次峻下，导致其人亡失血液，病人应当感到恶寒，后来变成发热且无休止，夏季天气极热时，想要穿厚衣服；冬季天气极寒时，想要裸露身体。之所以这样，是因为阳气微弱则恶寒，阴气虚弱则发热。这是医生发汗使阳气微弱，又大下使阴气虚弱。五月的时候，阳气在表，胃中虚冷，因为阳气内里微弱，不能抵御寒冷，所以想要穿厚衣服。十一月的时候，阳气在里，胃中烦热，因为阴气内里虚弱，不能抵御热邪，所以裸露身体。另外阴脉迟涩，所以知道是亡血所致。
上述脉微是因为大发汗所致，所以在应当恶寒的时候，即使是盛夏也想要穿厚衣服；脉涩是因为大下所致，所以在应当恶寒后发热的时候，即使是严冬也想要裸露身体；这都是因为亡血、阳气微弱、阴气虚弱，不能抵御寒冷和热邪，并不是指盛夏拖延到严冬的情况。
Shaoyang disease (Disease of the Shaoyang channel) is characterized by bitter taste in the mouth, dryness of the throat, and dizziness. (The *Ren Shu* states: Xiao Chai Hu Tang [Minor Bupleurum Decoction] is appropriate.)
When Shaoyang is affected by wind pathogen, symptoms include bilateral hearing loss, redness of the eyes, fullness and irritability in the chest. Purging (Purgation) or emesis (Emetic therapy) are contraindicated; if mistakenly used, they will lead to palpitations (Palpitation) and fright. (Mistaken emesis leads to Qi deficiency causing palpitations; mistaken purging leads to Blood deficiency causing fright.)
In cold damage (Shanghan), if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang. Shaoyang disease prohibits sweating therapy (Diaphoresis); if mistakenly induced, it leads to delirious speech (Delirium), indicating the pathogen has entered the Stomach organ (Stomach). If the Stomach harmonizes, recovery occurs; if not, irritability and palpitations ensue.
Three days after the onset of cold damage, if the Shaoyang pulse becomes small, the disease is about to resolve. The time when Shaoyang disease tends to resolve is from Yin hour to Chen hour (03:00–09:00).
Yangming disease presents with abdominal fullness, a floating and tight pulse, bitter taste, dry throat, and wheezing. If the patient has fever and aversion to cold, and is mistakenly purged, abdominal fullness and difficult urination result. If the patient has fever without aversion to cold but rather aversion to heat, and is mistakenly purged, the Stomach becomes empty, leading to vexation (Vexation/Regret); mistaken purging leads to delirious speech; mistaken application of burning needle therapy leads to insomnia. (See discussion on Abdominal Fullness. Xu Xueshi states: Xiao Chai Hu Tang [Minor Bupleurum Decoction] is appropriate.)
Dizziness with bitter taste and dry tongue belongs to Shaoyang. (See discussion on Bitter Taste.) Dizziness with hardness below the heart and neck stiffness belongs to concurrent Taiyang and Shaoyang disease; Da Zhui and Fei Shu acupoints should be needled. Sweating and purging are contraindicated. (See discussion on Neck Stiffness.)
Dizziness with excess in the Stomach, where the patient can eat and has no aversion to cold, indicates wind strike; dizziness after eating and difficult urination indicate Grain Jaundice. Both belong to Yangming. (See discussion on Stomach Excess.)
After sweating therapy for Taiyang disease, if fever persists, accompanied by palpitations, dizziness, and body tremors as if falling to the ground, Zhen Wu Tang [True Warrior Decoction] is the primary treatment. (See discussion on Tremors/Shivering.)
If "moving qi" is on the left, mistaken sweating leads to dizziness and continuous sweating with muscle twitching. (See discussion on Moving Qi. *Ren Shu* states: Xiao Jian Zhong Tang [Minor Construct the Middle Decoction] is appropriate.) In various counterflow conditions, mistaken sweating leading to confused speech and dizziness indicates a fatal prognosis. (See discussion on Delirium.) Dizziness with a deep and tight pulse; mistaken sweating disturbs the channels, leading to body tremors and swaying. (See discussion on Tremors/Shivering.)
[From *Ben Cao Yan Yi*] If Taiyang disease does not resolve and transfers to Shaoyang, presenting with hardness and fullness under the hypochondrium, dry retching, inability to eat, and alternating chills and fever, and if emesis, purging, sweating, or warm needle therapy have not yet been used, and the pulse is deep and wiry, administer Xiao Chai Hu Tang [Minor Bupleurum Decoction]. If emesis, purging, sweating, or warm needle therapy have already been used, leading to delirious speech and the cessation of Chai Hu syndrome, this is termed a damaged disease (Bad Disease). Determine what error was made and treat accordingly.
In cold damage or wind strike lasting five to six days, presenting with alternating chills and fever, oppression and fullness in the chest and hypochondrium, silence with lack of desire for food, irritability, and frequent vomiting, or alternatively, chest vexation without vomiting, thirst, abdominal pain, hypochondriac痞 (stagnation/hardness), subcostal palpitations, difficult urination, absence of thirst with slight external fever, or cough, Xiao Chai Hu Tang [Minor Bupleurum Decoction] is the primary treatment. When Blood is deficient and Qi is exhausted, the pores open, allowing the pathogen to enter and contend with the healthy Qi, knotting at the hypochondrium. The contention between healthy and pathogenic factors causes alternating chills and fever with regular intervals. Silence and lack of desire for food occur because the organs are connected, and the disease inevitably moves downward. The pathogen is high, but the manifestation is low, hence vomiting occurs; Xiao Chai Hu Tang [Minor Bupleurum Decoction] is appropriate.
Chai Hu (2 liang), Huang Qin (Scutellaria Root), Ren Shen (Ginseng Root), Gan Cao (Licorice Root) (each 3 qian), Ban Xia (Pinellia Tuber, processed with ginger) (6 qian).
Crush the herbs. Take 5 qian per dose, add 5 slices of fresh ginger and 2 jujubes, decoct together, and take warm. Three doses daily.
If there is chest vexation without vomiting, remove Ban Xia and Ren Shen, add one Gua Lou Shi (Trichosanthes Fruit).
If severe thirst, remove Ban Xia, add Ren Shen 3 qian and Gua Lou Gen (Trichosanthes Root) 1 liang.
If abdominal pain, remove Huang Qin, add Bai Shao (White Peony Root) 3 fen.
If hypochondriac stagnation/hardness, remove Da Zao (Jujube), add Mu Li (Oyster Shell) 1 liang.
If subcostal palpitations and difficult urination, remove Huang Qin, add Fu Ling (Poria) 1 liang.
If no thirst but slight external fever, remove Ren Shen, add Gui Zhi (Cinnamon Twig) 3 fen, cover with blankets to induce slight sweating for recovery.
If cough, remove Ren Shen, Da Zao, and fresh ginger, add Wu Wei Zi (Schisandra Berry) 0.5 liang and Gan Jiang (Dried Ginger) 3 fen.
For Chai Hu disease that does not resolve after purging, administering Xiao Chai Hu Tang [Minor Bupleurum Decoction] again will likely cause intense internal heat and shivering, followed by fever and sweating, leading to resolution. In cold damage or wind strike, if Chai Hu syndrome is present, the appearance of even one symptom is sufficient; all symptoms need not be present.
In cold damage lasting more than ten days, with heat knotting internally and recurring alternating chills and fever, Da Chai Hu Tang [Major Bupleurum Decoction] is appropriate. (See discussion on Chest Binding.)
Da Chai Hu Tang [Major Bupleurum Decoction]
Chai Hu (2 liang), Huang Qin (Scutellaria Root), Bai Shao (White Peony Root) (each 0.5 liang), Ban Xia (Pinellia Tuber, processed) (6 qian), Sheng Jiang (Fresh Ginger) (1 liang), Zhi Shi (Immature Bitter Orange) (0.5 liang), Da Huang (Rhubarb Root and Rhizome) (1 liang).
Crush the herbs. Take 5 qian per dose, add 3 jujubes, decoct in water, and take warm. Stop when bowel movement is achieved; if not achieved, take again.
[Xu Shumi] A patient suffered from cold damage with irritability, frequent vomiting, and alternating chills and fever. The physician administered Xiao Chai Hu Tang [Minor Bupleurum Decoction], but the illness did not resolve. I said: The pulse is surging and large yet firm, indicating heat knotting internally; how can Xiao Chai Hu Tang eliminate it? Zhang Zhongjing stated: In cold damage lasting more than ten days, with heat knotting internally and recurring alternating chills and fever, administer Da Chai Hu Tang [Major Bupleurum Decoction]. After three doses, the illness resolved. This is because Da Huang (Rhubarb Root and Rhizome) sweeps away accumulated heat and is a crucial herb for treating cold damage. Wang Shuhe stated: Without Da Huang, it cannot be called a Chai Hu formula; it must be raw and wine-washed for efficacy.
In cold damage lasting five to six days, after sweating and mistaken purging, presenting with chest and abdominal fullness with slight knotting, difficult urination, thirst without vomiting, only head sweating, alternating chills and fever, and irritability, the disease is unresolved.
Hu Ge Gui Zhi Gan Jiang Tang [Bupleurum, Cinnamon Twig, and Dried Ginger Decoction] is appropriate.
Hu Ge Gui Zhi Gan Jiang Tang [Bupleurum, Cinnamon Twig, and Dried Ginger Decoction]
Chai Hu (2 liang), Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger) (each 0.5 liang), Gua Lou Gen (Trichosanthes Root), Huang Qin (Scutellaria Root) (each 1 liang), Mu Li (Oyster Shell), Gan Cao (Licorice Root, honey-fried) (each 0.5 liang).
Crush the herbs. Take 5 qian per dose, decoct, and take warm. If slight vexation remains, take again; sweating indicates recovery.
If the patient's pulse is faint and choppy, this is iatrogenic injury caused by excessive sweating and repeated severe purging, leading to blood loss. The patient should feel aversion to cold, which later turns into ceaseless fever. In midsummer heat, they desire thick clothing; in midwinter cold, they desire to be naked. The reason is that faint Yang causes aversion to cold, and weak Yin causes fever. The physician’s sweating depleted Yang Qi, and purging depleted Yin Qi. In May, Yang Qi is on the exterior, and the Stomach is cold due to internal Yang deficiency, unable to overcome cold, hence desiring thick clothing. In November, Yang Qi is interior, and the Stomach is vexed with heat due to internal Yin deficiency, unable to overcome heat, hence desiring to be naked. Additionally, a slow and chopping Yin pulse confirms blood loss.
The faint pulse resulted from excessive sweating; thus, during aversion to cold, even in midsummer, thick clothing is desired. The choppy pulse resulted from severe purging; thus, during fever following aversion to cold, even in midwinter, nakedness is desired. These are due to blood loss, weak Yang, and weak Yin, unable to resist cold or heat, not implying that midsummer extends into midwinter.