作有时，默默不欲饮食，脏腑相连，其痛必下，邪高痛下，故使呕也，（一云∶脏腑相连，其病必下，胁膈中
痛），小柴胡汤主之。
【注】此详申上三条，妇人中风、伤寒，经水适来过多，以致血弱气尽，腠理不密，邪热之气乘虚入于血
室，邪与正相抟，结于少阳之界，故邪结于胁下也。邪正相争，争于阳则热，争于阴则寒，故往来寒热也；争
已必衰，衰则止，故休作有时也；少阳病已入半里，将近厥阴，故默默不欲饮食也；少阳胆与厥阴肝相为表里，
故曰脏腑相连也。少阳之脉，下胸中，循胁表；厥阴之脉，抵少腹，循胁里，故其痛必及于胁下也。少阳之邪，
从胸而下胁，因胸而病及于胁，故曰邪高痛下也。邪从胸循胁入里，里气上拒，故使呕也。仲景重出此条，仍
主之以小柴胡汤者，使知法不外少阳，不必另从厥阴血室中求治也。
【集注】喻昌曰∶四条皆互文见意也。一云∶经水适来，一云∶经水适断。一云∶七八日热除，而脉迟身
凉，一云∶七八日续得寒热，发作有时。一云∶胸胁下满，一云∶邪气因入与正气相抟，结于胁下。一云∶如
结胸状，一云∶邪高痛下。一云∶谵语，一云∶昼日明了，暮则谵语如见鬼状。一云∶如疟状，一云∶往来寒
热休作有时。一云∶刺期门，一云∶用小柴胡汤。一云∶毋犯胃气及上二焦。皆互文以明大意，而自为注脚也。
学人试因此而细绎全书，思过半矣。“如结胸状”四字，仲景尚恐形容不尽，重以脏腑相连，邪高痛下之语，
畅发病情。盖血室者冲脉也，下居腹内，厥阴肝之所主也。而少阳之胆与肝相连，腑邪在上，脏邪在下，胃口
逼处二邪之界，所以默默不欲饮食，而但喜呕耳。期门者，肝之募也，随其实而泻之，泻肝之实也，又刺期门
之注脚也。小柴胡汤，治少阳正法也。毋犯胃气及上二焦，则舍期门、小柴胡汤，更无他法矣。
呕而发热者，小柴胡汤主之。（衍文。已见太阳中篇半夏泻心汤条上）。少阳病，欲解时，从寅至辰上。
【注】寅、卯、辰，木旺之时也。经云∶阳中之少阳，通于春气。故少阳之病，每乘气旺之时而解。经气
之复，理固然也。
【集注】魏荔彤曰∶病在少阳，乘其正旺，如法治之，何病不已。
发作有定时，神情沉默不想吃东西。脏腑相互连接，疼痛必然出现在下部（胁下），病邪位置高而疼痛位置低，因此导致呕吐，用小柴胡汤主治。
【注】这一段详细阐述前面的三条内容。妇女患中风或伤寒，月经恰好来潮且量多，导致血虚气弱，腠理不致密，邪热之气乘虚侵入血室，邪气与正气相互搏结，结聚在少阳的边界，所以邪气结聚在胁下。邪气与正气相争，在阳分相争则发热，在阴分相争则恶寒，所以出现往来寒热；争斗之后正气必然衰减，衰减后症状停止，所以发作有定时；少阳病已经入半里，接近厥阴，所以神情沉默不想吃东西；少阳胆与厥阴肝互为表里，所以说脏腑相连。少阳经脉，下行经过胸中，沿胁肋外侧循行；厥阴经脉，抵达少腹，沿胁肋内侧循行，所以疼痛必然波及胁下。少阳的邪气，从胸中向下至胁下，因为胸部受病而波及胁下，所以说“邪高痛下”。邪气从胸中沿胁肋进入体内，体内的正气向上抗拒，所以导致呕吐。张仲景重复列出这一条，仍然主张用小柴胡汤治疗，是为了让人知道治法不离少阳，不必另外从厥阴血室中去寻求治疗方法。
【集注】喻昌说：这四条内容是互相补充、互文见义的。一说月经恰好来潮，一说月经恰好结束。一说七八天后热退，脉迟身凉，一说七八天后继续出现寒热，发作有定时。一说胸胁下满闷，一说邪气因内入与正气相搏结，结聚在胁下。一说像结胸证的样子，一说邪高痛下。一说谵语，一说白天神志清楚，晚上则谵语如见鬼怪之状。一说像疟疾一样，一说往来寒热，发作有定时。一说针刺期门穴，一说使用小柴胡汤。一说不要损伤胃气及上二焦。这些都是通过互文来阐明大意，并自为注解。“像结胸证的样子”这四个字，张仲景还担心形容得不够详尽，再次用“脏腑相连，邪高痛下”的话语，充分阐发病情的机理。所谓血室就是冲脉，位于腹部内部，由厥阴肝所主。而少阳的胆与肝相连，腑邪在上，脏邪在下，胃口处于这两种邪气的交界之处，所以神情沉默不想吃东西，只是喜欢呕吐。期门穴是肝的募穴，随着其实证而泻之，这是泻肝的实证，也是针刺期门穴的注解。小柴胡汤是治疗少阳病的正法。如果不损伤胃气及上二焦，那么除了期门穴和小柴胡汤之外，就没有其他方法了。
呕吐并且发热的，用小柴胡汤主治。（此为衍文，已在太阳篇中半夏泻心汤条文处见过）。少阳病欲解除的时间，是从寅时到辰时。
【注】寅、卯、辰时，是木气旺盛的时候。经书说：阳中的少阳，通应于春气。所以少阳的病，往往趁着气旺的时候而解除。经气的回复，道理本来就是这样的。
Episodes occur at regular intervals, the patient is taciturn and has no desire to eat. The zang and fu organs are interconnected, so the pain must manifest in the lower part (hypochondrium). Since the pathogenic factor is high and the pain is low, vomiting ensues; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
[Annotation] This passage elaborates on the preceding three clauses. In women suffering from Wind-stroke or Cold-injury, if menstruation occurs simultaneously with excessive bleeding, it leads to blood deficiency and qi exhaustion, causing the interstices (cou li) to become lax. Pathogenic heat then enters the Blood Chamber (Xue Shi) through the deficiency. The pathogen and healthy qi contend with each other, knotting at the boundary of Shaoyang (Lesser Yang), thus causing the pathogen to knot in the hypochondrium. When the pathogen and healthy qi contend, contention in the Yang aspect results in fever, while contention in the Yin aspect results in chills, hence the alternating chills and fever. After the contention ceases, the healthy qi necessarily weakens, and the symptoms stop, hence the episodes occur at regular intervals. Shaoyang disease has entered the semi-interior and approaches Jueyin (Terminal Yin), hence the taciturnity and lack of appetite. Shaoyang Gallbladder and Jueyin Liver are exterior-interior partners, hence it is said that the zang and fu organs are connected. The Shaoyang meridian descends through the chest and follows the lateral aspect of the hypochondrium; the Jueyin meridian reaches the lower abdomen and follows the medial aspect of the hypochondrium, hence the pain inevitably extends to the hypochondrium. The Shaoyang pathogen moves from the chest down to the hypochondrium; because the chest is diseased, it affects the hypochondrium, hence it is said "the pathogen is high, the pain is low." The pathogen enters the interior from the chest along the hypochondrium, and the interior qi resists upward, causing vomiting. Zhang Zhongjing repeats this clause and still prescribes Xiao Chai Hu Tang (Minor Bupleurum Decoction) to indicate that the therapeutic principle remains within Shaoyang, and there is no need to seek treatment specifically from the Jueyin Blood Chamber.
[Collected Annotations] Yu Chang stated: These four clauses employ mutual textual references to reveal their meanings. One version says menstruation just arrived; another says it just ceased. One version says after seven or eight days the heat subsides, pulse becomes slow, and body temperature normalizes; another says after seven or eight days, chills and fever recur, occurring at regular intervals. One version says fullness below the chest and hypochondrium; another says the pathogen enters internally and knots with healthy qi in the hypochondrium. One version says resembling Chest Binding (Jie Xiong); another says "pathogen high, pain low." One version says delirium; another says clear consciousness during the day but delirium resembling seeing ghosts at night. One version says resembling Malaria; another says alternating chills and fever, occurring at regular intervals. One version says puncture Qi Men (Liv 14); another says use Xiao Chai Hu Tang (Minor Bupleurum Decoction). One version says do not damage Stomach Qi and the Upper Two Jiaos. All these are mutual texts clarifying the main idea, serving as their own annotations. The phrase "resembling Chest Binding" was deemed by Zhang Zhongjing insufficiently descriptive, so he added "zang and fu connected, pathogen high, pain low" to fully elucidate the pathology. The Blood Chamber is the Chong Mai (Penetrating Vessel), located in the lower abdomen, governed by Jueyin Liver. Shaoyang Gallbladder connects with the Liver; Fu pathogens are above, Zang pathogens are below, and the Stomach opening lies at the boundary of these two pathogens. Hence, the patient is taciturn, lacks appetite, and prefers vomiting. Qi Men (Liv 14) is the Front-Mu point of the Liver; draining according to excess drains Liver excess, which serves as the annotation for puncturing Qi Men. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the standard treatment for Shaoyang disease. If one does not damage Stomach Qi and the Upper Two Jiaos, then apart from Qi Men and Xiao Chai Hu Tang (Minor Bupleurum Decoction), there are no other methods.
Vomiting accompanied by fever is treated primarily with Xiao Chai Hu Tang (Minor Bupleurum Decoction). (This is a spurious addition, already appearing in the Taiyang chapter under the Ban Xia Xie Xin Tang clause). Shaoyang disease tends to resolve from Yin hour to Chen hour.
[Annotation] Yin, Mao, and Chen hours are times when Wood energy is prosperous. The Classics state: The Shaoyang within Yang corresponds to the Qi of Spring. Therefore, Shaoyang diseases often resolve when the corresponding Qi is at its peak. This is consistent with the principle of meridian qi recovery.
[Collected Annotations] Wei Litong said: If the disease is in Shaoyang, and one treats it according to the proper method during its time of peak healthy qi, what illness would not be cured?