桂枝（去皮） 黄芩 人参（各一两半） 甘草（一两炙） 半夏（二合半） 芍
药（一两半） 大枣（六枚擘） 生姜（一两半切） 柴胡（四两）
上九味。以水七升。煮取三升。去滓。温服。
娄氏云。病虽属太阳表证。而有里证兼之者。则不言太阳病。但称表不解。外证未
去。其兼心下支结。则此条柴胡桂枝汤是也。
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。
伤寒五六日已经汗下之后。则邪当解。今胸胁满。微结。小便不利。渴而不呕。但
头汗出。往来寒热心烦者。即邪气犹在半表半里之间。为未解也。胸胁满。微结。寒热。
心烦者。邪在半表半里之间也。小便不利而渴者。汗下后。亡津液。内燥也。若热消津
液。令小便不利而渴者。其人必呕。今渴而不呕。知非里热也。伤寒汗出则和。今但头汗
出。而余处无汗者。津液不足。而阳虚于上也。与柴胡桂枝干姜汤。以解表里之邪。复
津液而助阳也。
柴胡（半斤味苦平） 桂枝（三两去皮味辛热） 干姜（三两味辛热） 栝蒌根
（四两味苦寒） 黄芩（三两味苦寒） 牡蛎（三两熬味咸寒） 甘草（二两炙味甘平）
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。
内经曰。热淫于内。以苦发之。柴胡黄芩之苦。以解传表之邪。辛甘发散为阳。桂
枝甘草之辛甘以散在表之邪。咸以 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。
伤寒五六日头汗出。微恶寒。手足冷。心下满。口不欲食。大便硬。脉细者。此为
阳微结。必有表复有里也。脉沉。亦在里也。汗出为阳微。假令纯阴结。不得复有外证。悉
入在里。此为半在里半在外也。脉虽沉紧。不得为少阴病。所以然者。阴不得有汗。今头
汗出。故知非少阴也。可与小柴胡汤。设不了了者。得屎而解。
伤寒五六日。邪当传里之时。头汗出。微恶寒者。表仍未解也。手足冷。心下满。
口不欲食。大便硬。脉细者。邪结于里也。大便硬。为阳结。此邪热虽传于里。然以外
带表邪。则热结犹浅。故曰阳微结。脉沉。虽为在里。若纯阴结。则更无头汗恶寒之表
证。诸阴脉。皆至颈胸中而还。不上循头。今头汗出。知非少阴也。与小柴胡汤。以除
半表半里之邪。服汤已。外证罢而不了了者。为里热未除。与汤。取其微利则愈。故云
得屎而解。
伤寒。五六日。呕而发热者。柴胡汤证具。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。
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。是为柴胡证具。以
他药下之。柴胡证不罢者。不为逆。却与柴胡汤则愈。若下后。邪气传里者。邪在半表
半里则阴阳俱有邪。至于下后。邪气传里。亦有阴阳之异。若下后。阳邪传里者。则结
于胸中。为结胸。以胸中为阳受气之分。与大陷胸汤。以下其结。阴邪传里者。则留于
心下。为痞以心下为阴受气之分。与半夏泻心汤。以通其痞。经曰。病发于阳而反下之。
热入。因作结胸。病发于阴而反下之。因作痞。此之谓也。
【柴胡桂枝汤方第五十四】
桂枝（去皮） 黄芩 人参（各一两半） 甘草（一两，炙） 半夏（二合半） 芍药（一两半） 大枣（六枚，掰开） 生姜（一两半，切） 柴胡（四两）
以上九味药。用水七升。煮取三升。去渣。温服。
娄氏说。病虽然属于太阳表证。但有里证兼夹的。就不称太阳病。只称为表不解。外证未去。如果兼有心下支撑痞结。就是这一条所说的柴胡桂枝汤证。
伤寒五六天。已经发汗又用攻下法。出现胸胁胀满。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。这是邪气未解。用柴胡桂枝干姜汤主治。
伤寒五六天。经过发汗和攻下之后。邪气应当解除。现在胸胁胀满。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。说明邪气仍然在半表半里之间。属于未解。胸胁胀满。轻微痞结。寒热往来。心烦。是邪气在半表半里之间。小便不利而口渴。是因为发汗攻下后。津液耗伤。体内干燥。如果是热邪消耗津液。导致小便不利而口渴的人。一定会呕吐。现在口渴但不呕吐。知道不是里热。伤寒出汗则调和。现在只有头部出汗。而身体其余部位无汗。是津液不足。阳气虚于上。给予柴胡桂枝干姜汤。以解除表里之邪。恢复津液并助阳。
【柴胡桂枝干姜汤方第五十五】
柴胡（半斤，味苦平） 桂枝（三两，去皮，味辛热） 干姜（三两，味辛热） 栝蒌根（四两，味苦寒） 黄芩（三两，味苦寒） 牡蛎（三两，熬制，味咸寒） 甘草（二两，炙，味甘平）
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。每日三次。初服时轻微心烦。再服后。出汗便痊愈。
《内经》说。热邪淫溢于内。用苦味药发散。柴胡、黄芩的苦味。以解除传入表的邪气。辛甘发散为阳。桂枝、甘草的辛甘。以发散在表的邪气。咸味以软坚散结。牡蛎的咸味。以消除胸胁的胀满。辛味以润燥。干姜的辛味。以固护阳气虚导致的汗出。津液不足而口渴。苦味以坚阴。栝蒌根的苦味。以生津液。
伤寒五六天。头部出汗。轻微恶寒。手足冷。心下胀满。口不想吃东西。大便硬。脉细的。这是阳微结。一定有表证又有里证。脉沉。也是在里。出汗为阳气微弱。假如是纯阴结。就不会再有外证。全部入在里。这是半在里半在外。脉虽然沉紧。不能诊断为少阴病。之所以这样。是因为阴证不得有汗。现在头部出汗。所以知道不是少阴病。可以给予小柴胡汤。如果服药后仍感觉不爽快。得大便通畅即可解除。
伤寒五六天。是邪气应当传里的时期。头部出汗。轻微恶寒。说明表证仍未解除。手足冷。心下胀满。口不想吃东西。大便硬。脉细。是邪气结于里。大便硬。为阳结。此邪热虽然传入里。但因为外带表邪。所以热结尚浅。所以叫阳微结。脉沉。虽然在里。如果是纯阴结。就没有头汗、恶寒这些表证。所有阴脉。都到颈胸部就返回。不上行到头。现在头部出汗。知道不是少阴病。给予小柴胡汤。以清除半表半里之邪。服药后。外证消失但仍感觉不爽快的。是里热未除。给予汤药。取其轻微通利即可痊愈。所以说得大便通畅即解。
伤寒。五六天。呕吐且发热的。具备柴胡汤证。却用其他药物攻下。柴胡证仍在的。再次给予柴胡汤。这虽然已经攻下。不算是误治。病人必定会蒸蒸而振栗。随后发热出汗而解。如果心下胀满而且硬痛的。这是结胸证。大陷胸汤主治。只是胀满而不痛的。这是痞证。不能用柴胡汤。宜用半夏泻心汤。
伤寒五六天。邪气在半表半里的时候。呕吐且发热。邪气在半表半里之证。就是柴胡证具备。用其他药物攻下。柴胡证不罢的。不算是误治。再次给予柴胡汤就会痊愈。如果攻下后。邪气传里。邪气在半表半里时阴阳都有邪气。至于攻下后。邪气传里。也有阴阳的区别。如果攻下后。阳邪传里。就结于胸中。成为结胸。因为胸中是阳气受气的部位。给予大陷胸汤。以下其结聚。阴邪传里。就留于心下。成为痞证。因为心下是阴气受气的部位。给予半夏泻心汤。以通其痞塞。经书说。病发于阳而反用攻下法。热邪内入。因而作成结胸。病发于阴而反用攻下法。因而作成痞证。说的就是这个道理。
[Formula 54: Chaihu Guizhi Tang]
Guizhi (Cinnamon Twig, peeled), Huangqin (Scutellaria Root), Renshen (Ginseng Root) [each 1.5 liang], Gancao (Licorice Root, honey-fried) [1 liang], Banxia (Pinellia Tuber) [2.5 he], Shaoyao (Peony Root) [1.5 liang], Dazao (Jujube Fruit) [6 pieces, split], Shengjiang (Fresh Ginger, sliced) [1.5 liang], Chaihu (Bupleurum Root) [4 liang].
The above nine ingredients. Decoct with seven sheng of water. Boil down to three sheng. Remove the dregs. Take warm.
Lou Shi said: Although the disease belongs to Taiyang exterior syndrome, if there is an interior syndrome accompanying it, it is not called Taiyang disease, but referred to as "exterior not resolved" and "exterior signs not gone". If accompanied by a sensation of fullness and binding under the heart (epigastric region), this refers to the Chaihu Guizhi Tang syndrome described in this clause.
In Shanghan (Cold Damage) after five or six days, having already induced sweating and then purged, presenting with fullness in the chest and hypochondrium, slight binding, dysuria, thirst without vomiting, only head sweating, alternating chills and fever, and irritability: this indicates the pathogen has not yet resolved. Treat with Chaihu Guizhi Ganjiang Tang.
After five or six days of Shanghan, following sweating and purging, the pathogen should have resolved. Now, with fullness in the chest and hypochondrium, slight binding, dysuria, thirst without vomiting, only head sweating, alternating chills and fever, and irritability, the pathogen remains between the half-exterior and half-interior, indicating it is unresolved. Fullness in the chest and hypochondrium, slight binding, alternating chills and fever, and irritability indicate the pathogen is between the half-exterior and half-interior. Dysuria and thirst result from fluid depletion due to sweating and purging, leading to internal dryness. If heat consumed fluids causing dysuria and thirst, vomiting would necessarily occur. Since there is thirst without vomiting, it is known not to be interior heat. In Shanghan, sweating harmonizes the body; now, only the head sweats while the rest of the body does not, indicating insufficient fluids and deficient Yang at the upper part. Administer Chaihu Guizhi Ganjiang Tang to resolve the pathogens in both exterior and interior, restore fluids, and assist Yang.
[Formula 55: Chaihu Guizhi Ganjiang Tang]
Chaihu (Bupleurum Root) [8 liang, bitter, neutral], Guizhi (Cinnamon Twig, peeled) [3 liang, acrid, hot], Ganjiang (Dried Ginger) [3 liang, acrid, hot], Gualougen (Trichosanthes Root) [4 liang, bitter, cold], Huangqin (Scutellaria Root) [3 liang, bitter, cold], Muli (Oyster Shell, calcined) [3 liang, salty, cold], Gancao (Licorice Root, honey-fried) [2 liang, sweet, neutral].
The above seven ingredients. Decoct with twelve sheng of water. Boil down to six sheng. Remove the dregs. Decoct again. Obtain three sheng. Take one sheng warm, three times daily. Initially, slight irritability may occur; upon subsequent doses, sweating will lead to recovery.
The Neijing states: "When heat floods internally, use bitter flavors to disperse." The bitterness of Chaihu and Huangqin resolves the pathogen transmitted to the exterior. "Acrid and sweet flavors disperse for Yang." The acridity and sweetness of Guizhi and Gancao disperse the pathogen in the exterior. "Salty flavors soften hardness." The salinity of Muli eliminates fullness in the chest and hypochondrium. "Acrid flavors moisten." The acridity of Ganjiang secures sweating caused by Yang deficiency. Fluid insufficiency causes thirst; "bitter flavors solidify Yin." The bitterness of Gualougen generates fluids.
In Shanghan after five or six days, with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, desire not to eat, hard stools, and a fine pulse: this is "Yang slight binding" (Yang Wei Jie). There must be both exterior and interior signs. A deep pulse also indicates interior involvement. Sweating indicates slight Yang deficiency. If it were pure Yin binding, there would be no exterior signs; everything would be interior. This is half-interior and half-exterior. Even if the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease. The reason is that Yin syndromes do not present with sweating. Since there is head sweating, it is known not to be Shaoyin. Xiao Chaihu Tang may be administered. If the patient still feels unwell after taking the decoction, resolution occurs with bowel movement.
Shanghan after five or six days is when the pathogen should transmit to the interior. Head sweating and slight aversion to cold indicate the exterior has not yet resolved. Cold hands and feet, epigastric fullness, desire not to eat, hard stools, and a fine pulse indicate pathogen binding in the interior. Hard stools constitute Yang binding. Although the pathogenic heat has transmitted to the interior, because it carries exterior pathogen, the heat binding is still shallow; hence, it is called "Yang slight binding." A deep pulse, although indicating interior involvement, if it were pure Yin binding, would lack exterior signs like head sweating and aversion to cold. All Yin meridians return at the neck and chest and do not ascend to the head. Since there is head sweating, it is known not to be Shaoyin. Administer Xiao Chaihu Tang to eliminate the pathogen between the half-exterior and half-interior. After taking the decoction, if exterior signs cease but the patient still feels unwell, it is because interior heat remains. Administer the decoction to induce mild purgation for recovery. Hence, it is said that resolution occurs with bowel movement.
In Shanghan, after five or six days, with vomiting and fever, the Chaihu Tang syndrome is complete. However, if purged with other medicines, and the Chaihu syndrome persists, administer Chaihu Tang again. Although purged, this is not a contraindication (error). The patient will inevitably experience trembling and shaking, followed by fever and sweating, leading to resolution. If the epigastrium is full, hard, and painful, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang. If merely full without pain, this is Pi (Stagnant Blockage). Chaihu Tang is not indicated; Banxia Xiexin Tang is appropriate.
Shanghan after five or six days is when the pathogen is between the half-exterior and half-interior. Vomiting and fever represent the syndrome of the pathogen being between the half-exterior and half-interior, constituting the Chaihu syndrome. If purged with other medicines and the Chaihu syndrome does not cease, it is not an error. Re-administering Chaihu Tang leads to recovery. If, after purging, the pathogen transmits to the interior: when the pathogen was between the half-exterior and half-interior, both Yin and Yang had pathogens. After purging, when the pathogen transmits to the interior, there are differences between Yin and Yang. If Yang pathogen transmits to the interior, it binds in the chest, forming Jie Xiong (Chest Binding), because the chest is the area where Yang Qi receives energy. Da Xianxiong Tang is given to purge the binding. If Yin pathogen transmits to the interior, it remains in the epigastrium, forming Pi (Stagnant Blockage), because the epigastrium is the area where Yin Qi receives energy. Banxia Xiexin Tang is given to unblock the stagnation. The Classics state: "When a disease originates from Yang and is incorrectly purged, heat enters, resulting in Chest Binding. When a disease originates from Yin and is incorrectly purged, it results in Stagnant Blockage." This is what is meant.