这一条明确提及柴胡证只要具备一条便是，不必都有。This passage clearly states that for Bupleurum syndrome, the presence of only one symptom is enough, not all of them.
也就是半表半里证的四个主证（往来寒热、胸胁苦满、心烦喜呕、嘿嘿不欲饮食）具其一便可认为是柴胡证。That is, among the four main symptoms of the syndrome between the exterior and the interior (alternating chills and fever, fullness and discomfort in the chest and hypochondrium, restlessness with a tendency to vomit, and listlessness with a lack of desire for food), having just one of them can be regarded as Bupleurum syndrome.
其实这四个主证，一证便包含二证，所以不违背《伤寒论》不可单一证论断的学术精神。In fact, each of these four main symptoms contains elements of the other two, so it does not violate the academic spirit of "Treatise on Cold - induced Febrile Diseases" which states that a single symptom alone is not sufficient for diagnosis.
其余诸如咳、腹痛、渴之类的兼证不能作为柴胡证的确证。Other associated symptoms such as cough, abdominal pain, thirst, etc. cannot be used as conclusive evidence for Bupleurum syndrome.
说说我个人运用柴胡汤的经验。Let me talk about my personal experience in using Bupleurum Decoction.
柴胡汤的实质是脾胃虚，只要是脾胃虚引起的虚寒难辨的疑难杂症，在没有显证，找不到合适方子的情况下，都可以考虑用柴胡类方剂来治疗。The essence of Bupleurum Decoction lies in deficiency of the spleen and stomach. As long as the difficult-to-distinguish complex diseases of deficiency - cold are caused by deficiency of the spleen and stomach, and when there are no obvious symptoms and no suitable prescription can be found, Bupleurum-related formulas can be considered for treatment.
在柴胡证的理解上要善于变通的才能治更多的病。时好时坏反复发作的病；或者定时发作的病，如定时的烦躁寒热，或定时醒来就睡不着了；In understanding Bupleurum syndrome, one must be flexible in order to treat more diseases. Diseases that have relapses with alternating good and bad conditions; or diseases that occur at regular intervals, such as regular restlessness, chills and fever, or waking up at a fixed time and then being unable to fall asleep again;
或身体上下左右寒热不均匀；或只是身体的一侧发生某种不常规情况；Or those with uneven distribution of cold and heat in the upper, lower, left or right parts of the body; or those with some abnormal conditions occurring only on one side of the body;
或脉象忽强忽弱忽快忽慢忽阴忽阳，总之不稳定，都可以理解为是广义上的往来寒热的范畴，原理有可能是一样的。Or with a pulse that is erratically strong or weak, fast or slow, yin or yang, in short, unstable. All these can be understood as falling within the category of the broad-sense alternating chills and fever, and the underlying principle may be the same.
此理在治重病和绝症上常有妙用，屡屡于无路处找到路而愈病。This principle is often very useful in treating serious and terminal diseases, often finding a way out when there seems to be no way, and thus curing the diseases.
我举这个例子是要讲一个观念：学伤寒学经方不要死学，要活学，只有弄清楚方证背后人体的原理，才能运用于无穷。I give this example to convey an idea: When learning "Treatise on Cold - induced Febrile Diseases" and classical formulas, one should not learn rigidly, but learn flexibly. Only by understanding the principles of the human body behind the formula - syndrome relationship can these formulas be applied infinitely.
后面说，柴胡汤证误治，用了下药，如果还有柴胡汤证，还是用柴胡汤。中医治病是以当下症状为准的。It is further stated that if the treatment of Bupleurum - syndrome is mismanaged and purgatives are used, and if the Bupleurum - syndrome still persists, Bupleurum Decoction should still be used. In traditional Chinese medicine, treatment is based on the current symptoms.
服了柴胡汤“蒸蒸而振”，体内的能量像蒸气一样出来了，人体感觉得震颤、振奋，然后就“汗出而解”了。After taking Bupleurum Decoction, there is a "steaming and trembling" sensation. The energy in the body emerges like steam, and the body feels tremors and a sense of invigoration, and then there is sweating and the condition is relieved.
很多人争论柴胡汤是不是发汗剂。其实柴胡汤只是建中和疏通半表半里的。Many people debate whether Bupleurum Decoction is a diaphoretic. In fact, Bupleurum Decoction only tonifies the middle jiao and dredges the area between the exterior and the interior.
药物只是在协助人体回到正常的秩序而已，秩序恢复了，该汗自然会汗，不汗也是人体自己的事。The medicine only helps the human body return to its normal order. Once the order is restored, sweating will occur naturally if it should, and if not, it is the body's own decision.
其实严格意义上没有发汗剂，就是麻黄汤也不是喝了必汗，他只是向体表疏散能量。In fact, strictly speaking, there is no real diaphoretic. Even Mahuang Decoction does not necessarily cause sweating after being taken. It just disperses energy towards the body surface.
有的喝了只是小便多，有的喝了只是身体轻松了，有的喝了甚至没什么明显感觉，病好了就行。Some people may have increased urination after taking it, some may just feel their body becoming more relaxed, and some may not have any obvious sensations at all. As long as the disease is cured, that's fine.
后世的医学喜欢将方药和某个具体的病症画等号，这容易误解药物。Later-generation medicine tends to equate a formula with a specific disease symptom, which can easily lead to misunderstandings of the medicine.
102．伤寒二三日，心中悸而烦者，小建中汤主之。In cases of cold - induced febrile diseases that have persisted for two or three days, if there is palpitation in the heart and restlessness, Xiao Jianzhong Decoction is indicated for treatment.
《伤寒论》将小建中汤和柴胡汤穿插来讲是有深意的，因为这两个方子都是以建中为主的。There is a profound significance in the "Treatise on Cold-Damage Diseases" for presenting Xiao Jianzhong Decoction and Bupleurum Decoction in an alternating manner, as both formulas mainly focus on strengthening the middle - jiao.
“悸”和“烦”这两个证在前面小柴胡汤的条文里出现，这里为什么又用小建中来治呢？The symptoms of "palpitation" and "restlessness" appeared in the previous articles about Bupleurum Decoction. Why are they treated with Xiao Jianzhong Decoction here?
首先，此二证不是小柴胡的主证，既然不是主证，那别的方证里也是会有的。这些兼证是最考验辩证功夫的，这就需要综合分析。Firstly, these two symptoms are not the main symptoms of Bupleurum Decoction. Since they are not the main symptoms, they can also appear in other formula-syndromes. These associated symptoms are the most challenging for syndrome differentiation, which requires comprehensive analysis.
这里单就柴胡汤证和小建中汤证来鉴别一下两种不同的悸烦。Here, let's distinguish the different types of palpitation and restlessness in Bupleurum - syndrome and Xiao Jianzhong - syndrome.
柴胡证的悸烦主要因为表里上下痞塞不通引起的，身体失衡的情况比较明白，有上热下寒，中焦痞塞，心烦喜呕，间歇发作之类的症状。The palpitation and restlessness in Bupleurum - syndrome are mainly caused by blockage and inaccessibility between the exterior and interior, as well as up and down in the body. The imbalance in the body is relatively clear, with symptoms such as upper-body heat, lower-body cold, blockage in the middle jiao, restlessness with a tendency to vomit, and intermittent attacks.
小建中的悸烦主要是津血虚引起，是虚寒或虚亢的模式，或肢体酸痛，或虚寒腹痛，或衄，或五心烦热，或盗汗遗精。The palpitation and restlessness in Xiao Jianzhong-syndrome are mainly caused by deficiency of body fluids and blood, following a pattern of deficiency-cold or deficiency-hyperactivity, accompanied by symptoms such as limb soreness, deficiency-cold abdominal pain, epistaxis, restlessness in the five centers (palms, soles, and chest), or night sweats and spermatorrhea.
当然，看主证最好的方法，如果有半表半里证或表证的主证，情况就很清楚了。Of course, the best way to identify the main syndrome is to look for the main symptoms of the syndrome between the exterior and the interior or the exterior - syndrome. If present, the situation will be clear.
103．太阳病，过经十余日，反二三下之。In cases of Taiyang - diseases, after more than ten days, purgatives were used two or three times contrary to the proper treatment.
后四五日，柴胡证仍在者，先与小柴胡。Four or five days later, if the symptoms of Bupleurum - syndrome still remain, first administer Xiao Chaihu Decoction.
呕不止、心下急、郁郁微烦者，为未解也，与大柴胡汤，下之则愈。If there is unceasing vomiting, a feeling of tightness in the epigastric region, and a mild, depressed restlessness, it indicates that the condition has not been resolved. Then, administer Da Chaihu Decoction, and the condition will be cured after purging.
大柴胡汤方 Recipe for Da Chaihu Decoction:
柴胡半斤 黄芩三两 芍药三两 半夏半升(洗) 生姜五两(切) 枳实四枚(炙)大枣十二枚(擘)Bupleurum Root (Chaihu) 8 liang Baikal Skullcap Root (Huangqin) 3 liang Peony Root (Shaoyao) 3 liang Pinellia Tuber (Banxia, washed) half a sheng Fresh Ginger (Shengjiang, sliced) 5 liang Immature Bitter Orange (Zhishi, roasted) 4 pieces Chinese Date (Dazao, broken) 12 pieces Note: “liang” and “sheng” are traditional Chinese measurement units. In modern prescriptions, metric units are usually used.
上七味，以水一斗二升，煮取六升，去滓再煎，温服一升，日三服。一方，加大黄二两；若不加，恐不为大柴胡汤。Take these seven ingredients, decoct them with 1 dou and 2 sheng of water to obtain 6 sheng of decoction. Remove the dregs and decoct again. Take 1 sheng of the warm decoction, three times a day. In one variation, add 2 liang of Rheum officinale. If not added, it may not be considered as Da Chaihu Decoction.
用了下药造成误治，柴胡证仍在的话，先给小柴胡汤。服了小柴胡汤后发生了“呕不止”的情况。呕不止是剧烈的呕吐反应，区别于小柴胡汤的“喜呕”。When purgatives are misused and the Bupleurum - syndrome still persists, first give Xiao Chaihu Decoction. After taking Xiao Chaihu Decoction, "unceasing vomiting" occurs. Unceasing vomiting is a severe vomiting reaction, different from the "frequent vomiting" in Xiao Chaihu Decoction.
且有“心下急”，心下是胃的区域，感觉急结，里面有食物堵住了。And there is a "feeling of tightness in the epigastric region". The epigastric region is the area of the stomach, with a feeling of tightness and fullness as if there is food blocked inside.
这都是因为患者有柴胡证，本来就上下不能交通，同时又有宿食积滞，堵在了胃肠里，于是形成了少阳和阳明的合病，此为大柴胡汤的方义。This is because the patient has Bupleurum-syndrome, with an original inability to communicate between the upper and lower parts of the body. At the same time, there is retained food and stagnation accumulated in the stomach and intestines, thus forming a combined disease of Shaoyang and Yangming. This is the principle of Da Chaihu Decoction.
既然是少阳阳明的合病，阳明如何治呢？Since it is a combined disease of Shaoyang and Yangming, how to treat the Yangming aspect?
在方后的加减法里有提到，大柴胡汤是要加大黄二两的，没有大黄不成其为大柴胡汤。As mentioned in the modifications after the recipe, 2 liang of Rheum officinale should be added to Da Chaihu Decoction. Without Rheum officinale, it cannot be called Da Chaihu Decoction.
枳实加大黄，已经略具承气汤之意了，只是没有厚朴芒硝，用药的量也轻些。Immature bitter orange combined with Rheum officinale already has a somewhat similar effect to Chengqi Decoction, but without Magnolia officinalis and Mirabilite, and the dosage of the medicine is also lighter.
大柴胡证的热是在中下焦，主要表现为便秘或腹泻，所以只是“郁郁微烦”，区别于小柴胡证的上热心烦。The heat in Da Chaihu - syndrome is in the middle and lower jiao, mainly manifested as constipation or diarrhea, so there is only a "mild, depressed restlessness", different from the upper-body heat and restlessness in Xiao Chaihu - syndrome.
大柴胡汤是小柴胡汤去了人参炙甘草，加了芍药、枳实和大黄组成的。Da Chaihu Decoction is composed of removing Ginseng Radix and prepared Licorice Radix from Xiao Chaihu Decoction, and adding Peony Radix, Immature bitter orange, and Rheum officinale.
这是虚和实的区别，小柴胡汤在脾胃问题上是以脾胃弱津液虚为主；大柴胡汤是肠胃实，堵住了。This reflects the difference between deficiency and excess. Xiao Chaihu Decoction mainly addresses the weakness of the spleen and stomach and deficiency of body fluids; while Da Chaihu Decoction is for excess in the stomach and intestines, with blockage.
加芍药是引津血下行，且去腹痛；加枳实、大黄是泻肠胃之实。Adding Peony Radix can lead body fluids and blood downward and relieve abdominal pain; adding Immature bitter orange and Rheum officinale can purge the excess in the stomach and intestines.
去了党参炙甘草是因为肠胃有积滞有热，所以不用这种滋补的东西，只保留大枣和生姜建中。用生姜是因为有呕，当然也是因为胃的功能弱。Ginseng Radix and prepared Licorice Radix are removed because there is accumulation, stagnation, and heat in the stomach and intestines, so tonifying substances are not needed. Only Jujube and fresh ginger are retained to strengthen the middle jiao. Fresh ginger is used because of vomiting, and also because of the weak function of the stomach.
大柴胡汤的积滞不同于承气汤证，大柴胡汤有胃虚，主胃虚不能运化的瘀而生热；The accumulation and stagnation in Da Chaihu-syndrome are different from those in Chengqi-syndrome. In Da Chaihu-syndrome, there is stomach deficiency, with heat generated from stagnation due to the inability of the weak stomach to transport and transform.
承气汤证是真正的实热证的积滞，所以大柴胡汤里可以有生姜。Chengqi-syndrome is a real-heat syndrome with accumulation and stagnation. Therefore, fresh ginger can be included in Da Chaihu Decoction.
在临证上，如果热象明显，或胃口好，生姜也可以去掉，甚至可再加生石膏，只留大枣建中即可；In clinical practice, if the heat symptoms are obvious or the appetite is good, fresh ginger can be removed, and even Gypsum Fibrosum can be added, leaving only Jujube to strengthen the middle jiao.
如果水饮明显，则可以将生姜换成白术；如果肠胃有腐浊，可以将生姜换成藿香佩兰。If there is obvious fluid retention, fresh ginger can be replaced with Atractylodes Macrocephala. If there is putrid turbidity in the stomach and intestines, fresh ginger can be replaced with Agastache rugosa and Eupatorium fortunei.
如果有大柴胡证且寒象明显，是寒积的肠胃积滞，则可以将生姜换成干姜。经方要如此灵活加减才更能效如桴鼓。If there are symptoms of Da Chaihu - syndrome with obvious cold symptoms, which is cold - induced accumulation and stagnation in the stomach and intestines, fresh ginger can be replaced with dried ginger. Only by making such flexible modifications to classical formulas can they achieve remarkable curative effects.
大柴胡之所以能如此广泛的运用，是因为有半表半里证，同时又有下焦瘀滞的局面非常多见。这种下焦瘀滞不仅限于肠胃积滞，也包括瘀血。Da Chaihu Decoction can be widely applied because the situation of having a syndrome between the exterior and the interior along with stagnation in the lower - jiao is very common. This stagnation in the lower - jiao is not limited to accumulation and stagnation in the stomach and intestines, but also includes blood stasis.
经方大家胡希恕很擅于用大柴胡治疗各种疾病，甚至有“大茶壶”（谐音）的外号。Hu Xishu, a master of classical formulas, was very good at using Da Chaihu Decoction to treat various diseases and even had the nickname "big teapot" (homophone).
胡老常用大柴胡治疗哮喘、心血管疾病和肝脏的疾病，因为这些疾病往往伴有瘀血证，大柴胡里的芍药和大黄能下瘀血。Mr. Hu often used Da Chaihu Decoction to treat asthma, cardiovascular diseases, and liver diseases because these diseases are often accompanied by blood - stasis syndrome. Peony Radix and Rheum officinale in Da Chaihu Decoction can remove blood stasis.
当然，可以再加当归、川芎、丹皮、桃仁类去瘀血的药，显效更快。Of course, herbs for removing blood stasis such as Angelica sinensis, Ligusticum chuanxiong, Moutan Cortex, and Persica semen can be added to achieve more rapid effects.
枳实这味药是橘类的幼果，其味香烈而苦辛，是破气药，上能破胸之气满；中能消痞导滞；下能破大肠之气闭气结。Immature bitter orange is the young fruit of citrus. It has a strong, fragrant, bitter, and pungent taste. It is a herb for breaking qi. It can relieve fullness of qi in the chest, resolve distention and guide stagnation in the middle jiao, and break qi-blockage in the large intestine.
和厚朴作用相近似，只不过厚朴温厚，枳实峻烈。Its function is similar to that of Magnolia officinalis, but Magnolia officinalis is warm and mild, while Immature bitter orange is more drastic.
厚朴味苦走下，气厚也走下，在经方中主要用于除腹满；枳实主要用于去胸满。二药常同用。Magnolia officinalis has a bitter taste and acts on the lower part of the body due to its thick qi. In classical formulas, it is mainly used to relieve abdominal fullness. Immature bitter orange is mainly used to relieve chest fullness. These two herbs are often used together.
