一十五证 方七首
血弱气尽，腠理开，邪气因入，与正气相搏，在于胁下，正邪分争，往来寒热，休作有
时，嘿嘿不欲食饮，脏腑相连，其痛必下，邪高痛下，故使其呕，小柴胡汤主之。服柴胡而
渴者，此为属阳明，以法治之。
得病六七日，脉迟浮弱，恶风寒，手足温，医再三下之，不能食，其人胁下满痛，面目
及身黄，颈项强，小便难，与柴胡汤，后必下重；本渴饮水而呕，柴胡复不中与也，食谷者
哕。
伤寒四五日，身体热恶风。颈项强，胁下满，手足温而渴，小柴胡汤主之。伤寒，阳脉
涩，阴脉弦，法当腹中急痛，先与小建中汤；不瘥，与小柴胡汤（小建中汤见杂疗门中）。
伤寒中风，有柴胡证，但见一证便是，不必悉具也。凡柴胡汤证而下之，柴胡证不罢，
复与柴胡汤解者，必蒸蒸而振，却发热汗出而解。伤寒五六日，中风，往来寒热，胸胁苦满，
嘿嘿不欲饮食，心烦喜呕，或胸中烦而不呕，或渴，或腹中痛，或胁下痞坚，或心下悸，小
便不利，或不渴，外有微热，或咳，小柴胡汤主之。
柴胡（八两） 黄芩 人参 甘草（炙） 生姜（各三两，切） 半夏（半升，洗） 大
枣（十
二枚，擘）
上七味，以水一斗二升，煮取六升，去滓再煎，温服一升，日三。若胸中烦不呕者，去
半夏人参，加栝蒌实一枚；渴者，去半夏，加人参合前成四两半；腹中痛者，去黄芩，加芍
药三两；胁下痞坚者，去大枣，加牡蛎六两；心下悸，小便不利者，去黄芩，加茯苓四两；
不渴，外有微热者，去人参，加桂三两，温覆微发其汗；咳者，去人参大枣生姜，加五味子
半升，干姜二两。
伤寒五六日，头汗出，微恶寒，手足冷，心下满，口不欲食，大便坚，其脉细，此为阳
微结，必有表，复有里。沉则为病在里。汗出亦为阳微。假令纯阴结，不得有外证，悉入在
于里；此为半在外半在里，脉虽沉紧，不得为少阴，所以然者，阴不得有汗，今头大汗出，
故
伤寒十三日不解，胸胁满而呕，日晡所发潮热，而微利，此本当柴胡下之，不得利，今
反利者，故知医以丸药下之，非其治也。潮热者，实也。先再服小柴胡汤，以解其外，后以
柴胡加芒硝汤主之，方∶
柴胡（二两十六铢） 黄芩 人参 甘草（炙） 生姜（各一两，切） 半夏（一合，
洗） 大
枣（四枚，擘） 芒硝（二两）
上七味，以水四升煮取二升，去滓，温分再服，以解其外，不解更作。
柴胡加大黄芒硝桑螵蛸汤方∶
上，以前七味，以水七升，下芒硝三合，大黄四分，桑螵蛸五枚，煮取一升半，去滓，
温服五合，微下即愈。本云∶柴胡汤再服以解其外，余二升，加芒硝大黄桑螵蛸也。
伤寒八九日，下之，胸满烦惊，小便不利，谵语，一身不可转侧，柴胡加龙骨牡蛎汤主
之，方∶
柴胡（四两） 黄芩 人参 生姜（切） 龙骨 牡蛎（熬） 桂枝 茯苓 铅丹（各
一两半）
上一十二味，以水八升，煮取四升，纳大黄，切如棋子大，更煮一两沸，去滓，温服一
升。本云∶柴胡汤，今加龙骨等。
伤寒六七日，发热，微恶寒，肢节烦疼，微呕，心下支结，外证未去者，宜柴胡桂枝汤
发汗多，亡阳狂语者，不可下，以为可与柴胡桂枝汤，和其荣卫，以通津液，后自愈方
柴胡（四两） 黄芩 人参 生姜（切） 桂枝 芍药（各一两半） 半夏（二合半，
洗） 甘
草（一两，炙） 大枣（六枚，擘）
上九味，以水六升，煮取二升，去滓，温服一升。本云∶人参汤作如桂枝法，加柴胡黄
芩；复如柴胡法，今用人参，作半剂。
伤寒五六日，其人已发汗，而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，
往来寒热而烦，此为未解，柴胡桂枝干姜汤主之。方∶
柴胡（八两） 桂枝（三两） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎
（二两，熬）
上七味，以水一斗二升，煮取六升，去滓更煎，温服一升，日二服，初服微烦，汗出愈
太阳病，过经十余日，反再三下之，后四五日，柴胡证续在，先与小柴胡汤；呕止，小
安，其人郁郁微烦者，为未解，与大柴胡汤下者止。
伤寒十余日，邪气结在里，欲复往来寒热，当与大柴胡汤。
伤寒发热，汗出不解，心中痞坚，呕吐下利者，大柴胡汤主之。病患表里无证，发热七
八日，虽脉浮数可下之，宜大柴胡汤。方∶
柴胡（八两） 枳实（四枚，炙） 生姜（五两，切） 黄芩（三两） 芍药（三两） 半
夏（半
升，洗） 大枣（十二枚，擘）
上七味，以水一斗二升，煮取六升，去滓，更煎，温服一升，日三服。一方，加大黄二
两，若不加，恐不名大柴胡汤。
十五种证候，对应七个方剂。
血气虚弱，正气耗竭，腠理（皮肤毛孔及肌肉间隙）疏松，邪气乘虚而入，与正气相互搏结，病位位于胁下。正气与邪气分争，表现为寒热往来，发作有定时；神情沉默，不欲饮食。因脏腑相连，疼痛部位往往偏下，即“邪高痛下”，从而导致呕吐，以小柴胡汤主治。服用柴胡汤后出现口渴的，这是病属阳明经，应按阳明病法治之。
患病六七天，脉象迟而浮弱，恶风恶寒，手足温暖。医生反复使用攻下法，导致患者不能进食，胁下胀满疼痛，面目及全身发黄，颈项强直，小便困难。此时若给予柴胡汤，之后必然出现肛门重坠感（下重）；原本因口渴饮水而呕吐的，也不宜再用柴胡汤，进食谷物则会发生呃逆。
伤寒四五日，身体发热，恶风，颈项强直，胁下胀满，手足温暖且口渴，用小柴胡汤主治。伤寒，阳脉涩，阴脉弦，按法应当腹中急痛，先给予小建中汤；若不愈，再给予小柴胡汤（小建中汤见杂疗门中）。
伤寒或中风，只要有柴胡证，但见到一个症状即可确诊，不必所有症状都具备。凡是柴胡汤证误用攻下法后，柴胡证未罢，再次给予柴胡汤而痊愈的，患者必定会出现蒸蒸然振栗，随后发热汗出而解。伤寒五六日，中风，寒热往来，胸胁苦满，神情沉默不欲饮食，心烦喜呕，或者胸中烦闷但不呕吐，或者口渴，或者腹中痛，或者胁下痞硬，或者心下悸动，小便不利，或者不渴，体表有微热，或者咳嗽，均用小柴胡汤主治。
柴胡（八两） 黄芩 人参 甘草（炙） 生姜（各三两，切片） 半夏（半升，洗净） 大枣（十二枚，掰开）
以上七味药，用水一斗二升，煮取六升，去渣滓，再煎煮，温服一升，每日三次。若胸中烦闷但不呕吐的，去掉半夏、人参，加栝蒌实一枚；口渴的，去掉半夏，加人参至共四两半；腹中痛的，去掉黄芩，加芍药三两；胁下痞硬的，去掉大枣，加牡蛎六两；心下悸动、小便不利的，去掉黄芩，加茯苓四两；不渴、体表有微热的，去掉人参，加桂枝三两，覆盖衣被使其微微发汗；咳嗽的，去掉人参、大枣、生姜，加五味子半升，干姜二两。
伤寒五六日，头部出汗，轻微恶寒，手足冷，心下胀满，口不欲食，大便坚硬，脉象细，此为阳微结，既有表证，又有里证。脉沉表示病在里。头汗出也属于阳微。假如是纯阴结，不会有外证，全部病邪都在里；此证一半在外一半在里，脉虽沉紧，也不能诊断为少阴病，之所以这样，是因为阴证不得有汗，现在头部大汗出，所以……
伤寒十三日未解，胸胁满闷而呕吐，日晡时（下午3-5点）发潮热，且轻微腹泻，这本来应当用柴胡汤攻下，结果没有腹泻，现在反而腹泻了，因此知道是医生用了丸药攻下，这不是正确的治法。潮热者，属实证。先再服小柴胡汤，以解除其外证，后用柴胡加芒硝汤主治，方剂如下：
柴胡（二两十六铢） 黄芩 人参 甘草（炙） 生姜（各一两，切片） 半夏（一合，洗净） 大枣（四枚，掰开） 芒硝（二两）
以上七味药，用水四升，煮取二升，去渣滓，分两次温服，以解其外证，若不解再制作服用。
柴胡加大黄芒硝桑螵蛸汤方：
以上，以前七味药，用水七升，加入芒硝三合，大黄四分，桑螵蛸五枚，煮取一升半，去渣滓，温服五合，轻微腹泻即愈。原本说法是：柴胡汤再服以解其外，剩余的二升药液，加入芒硝、大黄、桑螵蛸。
伤寒八九日，误用攻下法，出现胸满、烦躁惊悸、小便不利、谵语、身体沉重不可转侧，用柴胡加龙骨牡蛎汤主治，方剂如下：
柴胡（四两） 黄芩 人参 生姜（切片） 龙骨 牡蛎（熬制） 桂枝 茯苓 铅丹（各一两半）
以上十二味药，用水八升，煮取四升，纳入大黄，切成棋子大小，再煮一两沸，去渣滓，温服一升。原本说法是：柴胡汤，现在加上龙骨等药。
伤寒六七日，发热，轻微恶寒，肢节烦疼，轻微呕吐，心下支撑结聚，外证未去的，适宜用柴胡桂枝汤。发汗过多，亡阳导致谵语的，不可攻下，认为可以给予柴胡桂枝汤，调和营卫，以通津液，之后自愈。方剂如下：
柴胡（四两） 黄芩 人参 生姜（切片） 桂枝 芍药（各一两半） 半夏（二合半，洗净） 甘草（一两，炙） 大枣（六枚，掰开）
以上九味药，用水六升，煮取二升，去渣滓，温服一升。原本说法是：人参汤作如桂枝法，加柴胡、黄芩；又依柴胡法，现用人参，制成半剂。
伤寒五六日，患者已经发汗，而又误用攻下法，胸胁满闷微结，小便不利，口渴但不呕吐，仅头部出汗，寒热往来且烦躁，此为病未解，用柴胡桂枝干姜汤主治。方剂如下：
柴胡（八两） 桂枝（三两） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎（二两，熬制）
以上七味药，用水一斗二升，煮取六升，去渣滓再煎，温服一升，每日二次。初服时轻微烦躁，汗出即愈。
太阳病，经过病程十余日，反而反复使用攻下法，之后四五天，柴胡证仍在，先给予小柴胡汤；呕吐停止，稍感安宁，但其人郁郁微烦的，为病未解，给予大柴胡汤攻下后停止。
伤寒十余日，邪气结在里，想要恢复寒热往来的症状，应当给予大柴胡汤。
伤寒发热，汗出而病不解，心中痞硬，呕吐腹泻的，用大柴胡汤主治。病患表里无典型证候，发热七八日，虽然脉浮数也可攻下，适宜用大柴胡汤。方剂如下：
柴胡（八两） 枳实（四枚，炙） 生姜（五两，切片） 黄芩（三两） 芍药（三两） 半夏（半升，洗净） 大枣（十二枚，掰开）
以上七味药，用水一斗二升，煮取六升，去渣滓，再煎，温服一升，每日三次。另一版本，加大黄二两，如果不加大黄，恐怕不能称为大柴胡汤。
Fifteen syndromes, corresponding to seven prescriptions.
When blood is deficient and qi is exhausted, the couli (pores and interstices of skin and muscle) open, allowing pathogenic factors to enter due to this deficiency. The pathogen contends with healthy qi, lodging in the hypochondrium. As healthy qi and pathogenic factors struggle against each other, alternating chills and fever occur, with episodes happening at regular intervals. The patient presents with a silent demeanor and lack of desire for food and drink. Because the zang-fu organs are connected, pain must manifest below; since the pathogen is high (in the hypochondrium) but pain is low, vomiting ensues. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. If thirst occurs after taking Chai Hu (Bupleuri Radix), this indicates involvement of the Yangming channel, which should be treated according to its specific methods.
After six or seven days of illness, if the pulse is slow, floating, and weak, accompanied by aversion to wind and cold, and warmth of the hands and feet, but the physician repeatedly applies purgative methods, leading to an inability to eat, hypochondriac fullness and pain, yellowing of the face, eyes, and body, stiffness of the neck, and difficulty urinating: administering Chai Hu Tang at this stage will likely result in a sensation of heaviness in the rectum (tenesmus). If the patient was originally vomiting due to drinking water because of thirst, Chai Hu Tang is also contraindicated; consuming grain may lead to hiccups.
In Shaoyang disease occurring four or five days after contraction of cold damage, where the body is hot and sensitive to wind, the neck is stiff, there is hypochondriac fullness, the hands and feet are warm, and there is thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. In cold damage, if the yang pulse is choppy and the yin pulse is wiry, abdominal cramping pain is expected by law; first administer Xiao Jian Zhong Tang (Minor Construct the Middle Decoction); if there is no improvement, then administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) (see Xiao Jian Zhong Tang in the Miscellaneous Treatment section).
In cold damage or wind strike, if there are Chai Hu syndrome manifestations, observing even one symptom is sufficient for diagnosis; it is not necessary for all symptoms to be present. If a Chai Hu syndrome is mistakenly treated with purgatives, and the Chai Hu syndrome persists, re-administering Chai Hu Tang (Minor Bupleurum Decoction) will lead to resolution, characterized by a feeling of heat rising from within followed by shivering, and subsequently sweating and recovery. In cold damage lasting five or six days, or wind strike, presenting with alternating chills and fever, bitter taste and fullness in the chest and hypochondrium, a silent demeanor with loss of appetite, irritability, and frequent vomiting, or alternatively chest irritability without vomiting, thirst, abdominal pain, hardness in the hypochondrium, palpitations under the heart, difficult urination, absence of thirst, slight external heat, or cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Chai Hu (Bupleuri Radix) (8 liang), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted), Sheng Jiang (Zingiberis Rhizoma Recens) (each 3 liang, sliced), Ban Xia (Pinelliae Rhizoma) (0.5 sheng, washed), Da Zao (Jujubae Fructus) (12 pieces, broken apart).
Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove the dregs, and decoct again. Take 1 sheng warm, three times daily. If there is chest irritability without vomiting, remove Ban Xia and Ren Shen, and add one Gua Lou Shi (Trichosanthis Fructus). If thirsty, remove Ban Xia, and increase Ren Shen to a total of 4.5 liang. If there is abdominal pain, remove Huang Qin, and add Shao Yao (Paeoniae Radix Alba) 3 liang. If there is hardness in the hypochondrium, remove Da Zao, and add Mu Li (Ostreae Concha) 6 liang. If there are palpitations under the heart and difficult urination, remove Huang Qin, and add Fu Ling (Poria) 4 liang. If not thirsty but with slight external heat, remove Ren Shen, add Gui Zhi (Cinnamomi Ramulus) 3 liang, cover with blankets to induce slight sweating. If coughing, remove Ren Shen, Da Zao, and Sheng Jiang, add Wu Wei Zi (Schisandrae Chinensis Fructus) 0.5 sheng, and Gan Jiang (Zingiberis Rhizoma) 2 liang.
In cold damage lasting five or six days, if there is sweating only on the head, slight aversion to cold, cold hands and feet, fullness under the heart, lack of desire to eat, hard stools, and a fine pulse, this is termed "Yang mild binding" (Yang wei jie). There is both exterior and interior involvement. A sinking pulse indicates the disease is in the interior. Sweating also indicates mild Yang involvement. If it were pure Yin binding, there would be no exterior signs, and all pathology would be internal. This condition is half exterior and half interior. Although the pulse may be sinking and tight, it cannot be diagnosed as Shaoyin disease. The reason is that Yin patterns do not typically present with sweating; however, here there is significant head sweating, therefore...
If cold damage remains unresolved for thirteen days, with hypochondriac fullness and vomiting, tidal fever occurring at dusk (Shen hour), and slight diarrhea: this case originally required purgation via Chai Hu Tang. Since diarrhea did not occur initially but now does, we know the physician used pill-based purgatives, which was incorrect treatment. Tidal fever indicates excess. First, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) twice to resolve the exterior, then treat with Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Natrii Sulfas). Prescription:
Chai Hu (Bupleuri Radix) (2 liang 16 zhu), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted), Sheng Jiang (Zingiberis Rhizoma Recens) (each 1 liang, sliced), Ban Xia (Pinelliae Rhizoma) (1 he, washed), Da Zao (Jujubae Fructus) (4 pieces, broken apart), Mang Xiao (Natrii Sulfas) (2 liang).
Take these seven ingredients, add 4 sheng of water, decoct to obtain 2 sheng, remove dregs, and take warm in two divided doses to resolve the exterior. If unresolved, prepare another dose.
Chai Hu Jia Da Huang Mang Xiao Sang Piao Xiao Tang (Bupleurum Decoction with Rheum, Natrii Sulfas, and Mantidis Oötheca) Prescription:
Take the previous seven ingredients, add 7 sheng of water, then add Mang Xiao (Natrii Sulfas) 3 he, Da Huang (Rhei Radix et Rhizoma) 4 fen, and Sang Piao Xiao (Mantidis Oötheca) 5 pieces. Decoct to obtain 1.5 sheng, remove dregs, and take 5 he warm. Mild purgation leads to cure. The original note states: Administer Chai Hu Tang twice to resolve the exterior; take the remaining 2 sheng, adding Mang Xiao, Da Huang, and Sang Piao Xiao.
In cold damage lasting eight or nine days, if mistakenly purged, resulting in chest fullness, irritability and fright, difficult urination, delirious speech, and body rigidity preventing turning over, use Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell). Prescription:
Chai Hu (Bupleuri Radix) (4 liang), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) (sliced), Long Gu (Fossilia Ossis Mastodi et Mammutis), Mu Li (Ostreae Concha) (calcined), Gui Zhi (Cinnamomi Ramulus), Fu Ling (Poria), Qian Dan (Lithargyrum) (each 1.5 liang).
Take these twelve ingredients, add 8 sheng of water, decoct to obtain 4 sheng. Add Da Huang (Rhei Radix et Rhizoma), cut into chess-piece sized chunks, boil for one or two more boils, remove dregs, and take 1 sheng warm. The original note states: This is Chai Hu Tang with added Long Gu and others.
In cold damage lasting six or seven days, if there is fever, slight aversion to cold, painful joints, slight vomiting, subcostal binding ("zhi jie"), and exterior signs persisting, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate. If excessive sweating leads to Yang collapse and delirium, purgation is contraindicated; instead, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) can be given to harmonize Ying and Wei, promote fluid circulation, leading to spontaneous recovery. Prescription:
Chai Hu (Bupleuri Radix) (4 liang), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) (sliced), Gui Zhi (Cinnamomi Ramulus), Shao Yao (Paeoniae Radix Alba) (each 1.5 liang), Ban Xia (Pinelliae Rhizoma) (2.5 he, washed), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 liang, roasted), Da Zao (Jujubae Fructus) (6 pieces, broken apart).
Take these nine ingredients, add 6 sheng of water, decoct to obtain 2 sheng, remove dregs, and take 1 sheng warm. The original note states: Originally, Ren Shen Tang was prepared like Gui Zhi Tang, with added Chai Hu and Huang Qin; following Chai Hu method, using Ren Shen, prepared as half a dose.
In cold damage lasting five or six days, if the patient has already sweated and then been mistakenly purged, resulting in slight binding in the chest and hypochondrium, difficult urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and irritability, the disease is unresolved. Use Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). Prescription:
Chai Hu (Bupleuri Radix) (8 liang), Gui Zhi (Cinnamomi Ramulus) (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) (2 liang, calcined).
Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove dregs, and decoct again. Take 1 sheng warm, twice daily. Initial administration may cause slight irritability, followed by sweating and cure.
In Taiyang disease, after more than ten days, if mistakenly purged repeatedly, and four or five days later Chai Hu signs persist, first administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If vomiting stops and the patient feels slightly relieved but remains郁 (depressed/slightly irritable), the disease is unresolved; administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge.
In cold damage lasting ten-plus days, if pathogenic factors bind in the interior and there is a recurrence of alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) should be given.
In cold damage with fever, sweating that does not resolve the condition, epigastric hardness/fullness, vomiting, and diarrhea, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated. If a patient has no typical exterior-interior signs but has had fever for seven or eight days, and although the pulse is floating and rapid, purgation is still applicable, Da Chai Hu Tang (Major Bupleurum Decoction) is suitable. Prescription:
Chai Hu (Bupleuri Radix) (8 liang), Zhi Shi (Aurantii Fructus Immaturus) (4 pieces, roasted), Sheng Jiang (Zingiberis Rhizoma Recens) (5 liang, sliced), Huang Qin (Scutellariae Radix) (3 liang), Shao Yao (Paeoniae Radix Alba) (3 liang), Ban Xia (Pinelliae Rhizoma) (0.5 sheng, washed), Da Zao (Jujubae Fructus) (12 pieces, broken apart).
Take these seven ingredients, add 12 dou of water, decoct to obtain 6 sheng, remove dregs, and decoct again. Take 1 sheng warm, three times daily. Another version adds Da Huang (Rhei Radix et Rhizoma) 2 liang; without it, it may not properly be called Da Chai Hu Tang (Major Bupleurum Decoction).