柴胡加芒硝汤方 Recipe for Bupleurum and Mirabilite Decoction:
柴胡二两十六铢 黄芩一两 人参一两 甘草一两(炙) 生姜一两(切) 半夏二十铢(本云五枚，洗) 大枣四枚(擘) 芒硝二两
Bupleurum: 2 liang and 16 zhu
Scutellaria baicalensis: 1 liang Ginseng: 1 liang Licorice (prepared): 1 liang Ginger (sliced): 1 liang Pinellia ternata: 20 zhu (originally said to be five pieces, washed) Jujube (broken): 4 pieces Mirabilite: 2 liang
上八味，以水四升，煮取二升，去滓，内芒硝，更煮微沸，分温再服；不解更作。Take these eight ingredients, decoct them with 4 sheng of water to obtain 2 sheng of decoction. Remove the dregs, add mirabilite, and decoct until it slightly boils. Take it warm in two doses. If the condition is not resolved, make the decoction again.
感冒十三天不好，已经到了血弱气耗的时候了。“胸胁满而呕”，呈现出来的是柴胡证。The cold has persisted for thirteen days, and at this time, the blood is weak and qi is consumed. "Fullness in the chest and hypochondrium with vomiting" presents the syndrome suitable for Bupleurum Decoction.
“日哺所发潮热”“潮热者，实也”，这是说有潮热的人是里面有实，有积滞。"Tidal fever occurring around the time of sunset" and "tidal fever indicates interior excess" mean that those with tidal fever have interior excess and stagnation.
有积滞的人到了日哺，也就是黄昏的时候，阴气重了，气血运行能力弱了，瘀滞得会更严重，于是发生这种潮热，像潮水一样定时发作。For those with stagnation, around sunset, when the yin qi is heavy and the ability of qi and blood circulation is weak, the stasis will be more severe, thus resulting in this kind of tidal fever, which occurs regularly like the tide.
有瘀血证的人会睡前烦躁发热，甚至越睡越兴奋也是这个道理，睡前是阴气最重的时候，内有瘀血此时也会瘀滞得更严重，于是淤而生热。The reason why those with blood stasis syndrome feel restless and feverish before going to bed, and even become more excited as they sleep is the same. Before going to bed is the time when the yin qi is the heaviest. With internal blood stasis, the stasis will also be more severe at this time, so stasis generates heat.
“已而微利”，潮热事实上也是人体在亢盛起来调集津液排瘀，所以潮热之后会有微微的腹泻。"Followed by mild diarrhea" actually means that tidal fever is also the body's attempt to mobilize body fluids to expel stasis when it becomes vigorous. Therefore, there will be mild diarrhea after tidal fever.
“此本柴胡证，下之以不得利”，古人行文太简，联系前后文来看应该这样解释："This was originally a syndrome suitable for Bupleurum Decoction. When purging was applied, there should be no diarrhea." The ancients' writing was too concise. Considering the context, it should be explained as follows:
如果是柴胡证的潮热，用大柴胡下之 ，应该就不腹泻了。If it is the tidal fever of Bupleurum syndrome and Major Bupleurum Decoction is used for purging, the diarrhea should stop.
为什么本来有腹泻，用了大黄这样的下药泻药反而还不腹泻了呢？这也是一个临证上要注意的问题。Why does the use of a purgative like rhubarb stop the diarrhea when there was originally diarrhea? This is also a problem that needs attention in clinical practice.
如果是肠胃的积滞造成的偏实热的腹泻，用了大黄反而会止泻；如果是偏实热的便秘，用了大黄就会大便通畅。If the diarrhea is caused by stagnation in the stomach and intestines with relatively excess heat, the use of rhubarb will instead stop the diarrhea. If it is constipation with relatively excess heat, the use of rhubarb will make the stools unobstructed.
所以，说一样药物单纯是止泻或者通便是容易误导人的，用这种理解去治病，时效时不效当是常事。So, simply saying that a medicine is for stopping diarrhea or promoting defecation can be misleading. Using this kind of understanding to treat diseases, it is common that the treatment may or may not be effective.
药物只是一种能量，这种能量只是让人体回到正常秩序和状态，至于腹泻也好止泻也好，是人体自己去协调的事。Medicine is just a kind of energy, which only helps the body return to its normal order and state. Whether it is diarrhea or stopping diarrhea, it is the body's own coordination.
并不是所有的便秘都能用大黄。后世的医家总喜欢用药物直接去通便去清热去消炎，结果病没治好，患者元气大伤，陷入阴证，越发缠绵不愈的比比皆是。Not all cases of constipation can be treated with rhubarb. Later-generation physicians always like to directly use medicine to promote defecation, clear heat, and reduce inflammation. As a result, the disease is not cured, and the patient's vital qi is greatly damaged, falling into a yin syndrome. There are numerous cases where the condition becomes more lingering and difficult to heal.
在这种中医理念被歪曲的时代，做真正的中医很难，现在的人以为便秘就是上火，上火就要泻火，你给他开大柴胡，他一见到生姜大枣立刻就认定你是个庸医了。In an era when the concept of traditional Chinese medicine is distorted, it is very difficult to be a true traditional Chinese medicine doctor. Nowadays, people think that constipation is due to excessive internal heat, and excessive internal heat requires purging fire. If you prescribe Major Bupleurum Decoction for them, as soon as they see ginger and jujube, they will immediately think you are an incompetent doctor.
我治过一个痔疮疼痛出血严重的患者，刻诊脉证偏阴寒，用干姜桂枝，合了一点点大黄， 很快血就止了。I treated a patient with severe hemorrhoids, pain, and bleeding. The pulse and symptoms diagnosed at that time were of yin-cold nature. I used dried ginger and cinnamon twig, combined with a little rhubarb, and the bleeding stopped quickly.
患者之前吃过很多泻火药，不但没好，反而越吃越严重。The patient had taken many heat-clearing medicines before, but not only did it not improve, but the condition became more serious.
所以辩证辩的是证，不能跟病扯在一起，不能说出血就要禁桂枝干姜，就得用止血泻火药，有时候你越用止血泻火药越止不住。So, syndrome differentiation focuses on the syndrome, not the disease. It cannot be said that for bleeding, cinnamon twig and dried ginger should be prohibited, and only hemostatic and heat-clearing medicines should be used. Sometimes, the more you use hemostatic and heat-clearing medicines, the less likely the bleeding will stop.
“今反利者，知医以丸药下之，此非其治也。”"Now, instead, there is diarrhea. It can be known that the doctor used pills to induce purgation, which is an inappropriate treatment."
接着前面的条文说，该吃下药的吃了下药会止泻，如果吃了下药反而腹泻加重了，那就是医师用丸药下了。Continuing from the previous text, if the patient takes a purgative and the diarrhea stops, but if the diarrhea worsens after taking the purgative, it means the doctor used pills for purgation.
何为丸药呢？在古代指类似于巴豆这样的温性烈性的泻下剂。What are pills? In ancient times, they referred to warm and strong purgatives like croton.
大柴胡汤是建中疏通为主，泻下为辅的，用了巴豆竣下当然是误治，腹泻当然会严重。Major Bupleurum Decoction focuses on strengthening the middle jiao and dredging, with purgation as a secondary function. Using croton for drastic purgation is of course a wrong treatment, and the diarrhea will surely be more severe.
下面说解决方法，要先以小柴胡汤解外，再用小柴胡加芒硝汤下之。The following describes the solution. First, use Minor Bupleurum Decoction to relieve the exterior syndrome, and then use Minor Bupleurum and Mirabilite Decoction for purgation.
为什么要分两步治疗呢？因为泻下之后津液脾胃皆虚。Why is the treatment divided into two steps? Because after purgation, both the body fluids, the spleen, and the stomach are deficient.
此时如果又解表又治理，津液如何能兼顾表又兼顾里呢？所以只能治从少阳。At this time, if both relieving the exterior and treating the interior are carried out simultaneously, how can the body fluids take care of both the exterior and the interior? Therefore, the treatment can only start from the Shaoyang aspect.
少阳的治法是以建中救津液为主，然后就是疏通半表半里。津液复了，枢机通了，人体自己就能解决问题。这就是三阳并病治从少阳的原理。The treatment principle of Shaoyang is to strengthen the middle jiao and rescue the body fluids, and then dredge the semi-exterior and semi-interior. When the body fluids are restored and the pivot mechanism is unobstructed, the body can solve the problem on its own. This is the principle of treating the co-existence of the three yang syndromes starting from the Shaoyang aspect.
在这种津液伤了情况下，哪怕里有瘀滞，也只能先治少阳。In the case of damaged body fluids, even if there is internal stasis, only the Shaoyang aspect can be treated first.
小柴胡汤让津液复枢机通，人体自己将外证解了，如果里证还要，这个时候就可以兼顾攻下了。于是要用到小柴胡加芒硝汤。Minor Bupleurum Decoction restores the body fluids and unobstructs the pivot mechanism, allowing the body to relieve the exterior syndrome on its own. If the interior syndrome still exists, at this time, purgation can be considered. Thus, Minor Bupleurum and Mirabilite Decoction is needed.
小柴胡加芒硝汤是用约三分之一剂量的柴胡汤，加上芒硝组成的。Minor Bupleurum and Mirabilite Decoction is composed of about one-third of the dosage of Bupleurum Decoction plus mirabilite.
这个组方也很严谨：之前已经用过柴胡汤，津液已复，外证大致已经解了，所以柴胡汤可以减量。This formula is also very precise: Bupleurum Decoction has been used before, the body fluids have been restored, and the exterior syndrome has been mostly relieved, so the dosage of Bupleurum Decoction can be reduced.
为什么用芒硝而不用大黄呢？因为芒硝虽然也是攻下药，攻下却不是其特长，其性寒咸微酸，更偏向于去潮热散坚结。这里主要是潮热，用芒硝更合适。Why use mirabilite instead of rhubarb? Although mirabilite is also a purgative, purgation is not its main feature. Its nature is cold, salty, and slightly sour, and it is more inclined to dispel tidal fever and resolve hard lumps. Since the main symptom here is tidal fever, mirabilite is more appropriate.
105．伤寒十三日，过经谵语者，以有热也，当以汤下之。When a patient has suffered from cold - induced febrile disease for thirteen days, and after the pathogen has passed through the channel, there is delirium, which is due to the presence of heat. It should be purged with a decoction.
若小便利者，大便当硬，而反下利，脉调和者。知医以丸药下之，非其治也。If the urination is smooth, the feces should be hard. But instead, there is diarrhea, and if the pulse is harmonious. It can be known that the doctor used pills to induce purgation, which is an inappropriate treatment.
若自下利者，脉当微，厥，今反和者，此为内实也，调胃承气汤主之。If there is spontaneous diarrhea, the pulse should be faint, and there should be cold limbs. Now, if the pulse is instead harmonious, this indicates interior excess. Modified Rhubarb Decoction for Purging the Stomach should be used for treatment.
太阳伤寒十三天，已经过了太阳经了，发生谵语，谵语是阳明实热证，这时候应该用汤药下之。After suffering from Taiyang cold - induced febrile disease for thirteen days, the pathogen has passed through the Taiyang channel, and delirium occurs. Delirium is a syndrome of Yangming excess - heat. At this time, it should be purged with a decoction.
阳明实热证如果小便利，也就是小便多的话，大便就应该硬。In Yangming excess - heat syndrome, if urination is smooth, that is, if there is frequent urination, the feces should be hard.
如果患者反而腹泻，而且“脉调（不）和”（这里可能是错误，应该是“脉不和”才通），那应该是医师用了竣下的丸药，这是误治，津液会双重损耗。If the patient instead has diarrhea, and the "pulse is harmonious (not harmonious, there may be a mistake here, it should be 'the pulse is disharmonious' to make sense), it should be that the doctor used drastic purgative pills. This is a wrong treatment, and the body fluids will be doubly depleted.
不能竣下，那应该怎么治呢？用一点缓下的药就好了。If drastic purgation is not allowed, then how should it be treated? Using a mild purgative will be sufficient.
如果患者持续腹泻，脉象就会“微”，并且四肢“厥”冷。如果脉象反而调和，说明这个持续腹泻是因为肠胃有实热，下了脉象反而变好了。If the patient has continuous diarrhea, the pulse will be "faint", and the four limbs will be "cold". If the pulse is instead harmonious, it indicates that this continuous diarrhea is due to excess - heat in the stomach and intestines. After purging, the pulse becomes better instead.
那就可以用调胃承气汤，助人体一把力，将实热下干净，同时兼顾补津液，就不腹泻了。Then Modified Rhubarb Decoction for Purging the Stomach can be used to help the body expel the excess - heat completely, while also taking care to nourish the body fluids, and then the diarrhea will stop.
106．太阳病不解，热结膀胱，其人如狂，血自下，下者愈。When Taiyang disease persists without resolution, heat accumulates in the bladder. The patient appears manic, and there is spontaneous bleeding from the lower part, and the disease will be cured when the bleeding occurs.
其外不解者，尚未可攻，当先解其外；If the exterior syndrome has not been resolved, purging is not advisable yet. First, the exterior syndrome should be resolved.
外解已，但少腹急结者，乃可攻之，宜桃核承气汤。After the exterior syndrome has been resolved, if there is only urgent fullness in the lower abdomen, then purging can be carried out. Persica and Mirabilite Decoction is appropriate.
桃核承气汤方Recipe for Persica and Mirabilite Decoction:
50 peach kernels (with skin and tip removed) 4 liang of rhubarb 2 liang of cinnamon twig (with skin removed) 2 liang of licorice (prepared) 2 liang of mirabilite
上五味，以水七升，煮取二升半，去滓，内芒硝，更上火微沸，下火。先食温服五合，日三服，当微利。Take these five ingredients, decoct them with 7 sheng of water to obtain 2 sheng and a half of decoction. Remove the dregs, add mirabilite, bring it to a gentle boil over the fire again, and then remove from the fire. Take 5 ge of the decoction warm before meals, three times a day. There should be mild diarrhea.
太阳病不解，热结于膀胱。准确地讲是热与瘀血结在膀胱这个区域，也就是腹部下方这个区域。这是实热型的瘀血证。When Taiyang disease persists without resolution, heat accumulates in the bladder. To be precise, heat combines with blood stasis in the bladder area, that is, the area below the abdomen. This is a blood - stasis syndrome of the excess-heat type.
如何鉴别呢？“其人如狂”。下焦有瘀血，人体的自然模式，津血就要汇集于下焦去攻这个瘀血，那头部的津液就缺乏了，这时候头部也要启动自保模式兴奋起来争夺津血；How to identify it? "The patient appears manic." When there is blood stasis in the lower jiao, according to the body's natural pattern, body fluids and blood will gather in the lower jiao to attack this blood stasis. Then, there will be a lack of body fluids in the head. At this time, the head will also activate its self-protection mode and become excited to compete for body fluids and blood.
加之有瘀热不能下，浊火毒素就会上冲，这种兴奋反应就会很强烈，“如狂”了。In addition, because the stasis - heat cannot go downward, turbid fire and toxins will rush upward, and this excited reaction will be very intense, resulting in "manic - like" symptoms.
之前学过阳明实热证有谵语和烦惊的反应，和这个原理一样，都是有瘀滞在下面堵住了，同时有热证。We learned before that in Yangming excess - heat syndrome, there are reactions such as delirium, restlessness, and fright, which follow the same principle. There is stasis blocking below, and at the same time, there is a heat syndrome.
不但热证的瘀血有“如狂”，阴证也会有，只是没那么强烈。我曾经治过一个患者，看上去脾气非常好，非常谦和敦厚的一个人。Not only the blood - stasis syndrome of the heat type has "manic - like" symptoms, but the yin-type syndrome also has them, just not as intense. I once treated a patient who seemed to have a very good temper, being very modest, kind, and honest.
再看脉象，弦尺脉，一派瘀滞阴寒之象。Looking at the pulse, it was a taut and deep-seated pulse, showing a pattern of blood stasis and yin-cold.
我用柴胡桂枝干姜汤合当归川芎牡蛎龙骨，一个星期后患者告诉我，情绪好了，不砸了。I used Bupleurum, Cinnamon Twig, Dried Ginger Decoction combined with Angelica sinensis, Ligusticum chuanxiong, Oyster shell, and Dragon's bone. A week later, the patient told me that his mood had improved and he no longer smashed things.
这就是阴证瘀血的“如狂”。This is the "mania-like" manifestation in the blood-stasis syndrome of the yin type.
当然，阴证瘀血证的“如狂”一般来讲还可以自控，也就是莫名烦躁抑郁、情绪容易起伏、容易悲观而已，因为没有热上冲；。Generally, the "mania-like" state in the blood-stasis syndrome of the yin type can usually be self-controlled. It is merely characterized by inexplicable restlessness, depression, emotional volatility, and a tendency to be pessimistic. This is because there is no upward-surging heat.
热证的“如狂”往往强烈到不能自控In contrast, the "mania-like" state in the blood-stasis syndrome of the heat type is often so intense that it cannot be self - controlled.
如果患者自己又便血的话，瘀血证也就解了，病也好了。If the patient has spontaneous rectal bleeding, the blood-stasis syndrome will be resolved, and the disease will be cured.
如果用药物治疗的话，就需要辩证了。若外证没有解，那就不要管腹中瘀血的问题，按先表后里的原则，要先解外。If using medicine for treatment, syndrome differentiation is needed. If the exterior syndrome has not been resolved, do not worry about the blood stasis in the abdomen. According to the principle of treating the exterior first and then the interior, the exterior syndrome should be resolved first.
外证解了，只有少腹急结了，这就可以攻下了，如果是热证的瘀血，那就用桃核承气汤。After the exterior syndrome has been resolved, if there is only urgent fullness in the lower abdomen, then purging can be carried out. If it is a blood - stasis syndrome of the heat type, Persica and Mirabilite Decoction should be used.
有些医家见桃核承气汤有桂枝，便认为这个方子治的是表里同病。Some physicians, seeing that Persica and Mirabilite Decoction contains cinnamon twig, think that this formula is used to treat both exterior and interior diseases.
其实不能这么理解，因为条文中说得很清楚，外证已解才用桃核承气汤。In fact, this is not the correct understanding, because it is clearly stated in the text that Persica and Mirabilite Decoction is used only after the exterior syndrome has been resolved.
那桂枝在这里起什么作用呢？首先，《伤寒论》理解人体是一个运行着的能量场，这个能量场以压力锅做比方，只有把气放出来，旁边的阀门才会掉下去。So what is the role of cinnamon twig here? First of all, in Treatise on Cold - Induced Febrile Diseases, the human body is understood as a running energy field. Taking a pressure cooker as an example, only when the gas is released can the valve beside it drop.
同理，只要打开向外的通道，下焦的淤阻才更容易向下排。人体的脏腑关系也是这样：Similarly, only by opening the outward passage can the stasis in the lower jiao be more easily discharged downward. The relationship between the zang-fu organs in the human body is also like this:
五脏的经络，比如脾经、肾经、肝经都是从下往上升的；六腑的经络，比如胃经、膀胱经、胆经都是从上往下降的。The meridians of the five zang organs, such as the spleen meridian, kidney meridian, and liver meridian, all ascend from the bottom; the meridians of the six fu organs, such as the stomach meridian, bladder meridian, and gallbladder meridian, all descend from the top.
脏腑相连，脏之气往表往上走，腑之气随之往里往下走，脏不升则腑不降。The zang-fu organs are connected. The qi of the zang organs goes to the surface and upward, and the qi of the fu organs goes inward and downward accordingly. If the zang organs do not ascend, the fu organs will not descend.
所以用桂枝事实上是借用向外的力量来帮助降里下瘀，并不局限于有没有明显的表证。So the use of cinnamon twig actually borrows the outward-going force to help descend the stasis in the interior, not limited to the presence or absence of obvious exterior symptoms.
再者，与后面的抵挡汤对比来看，桃核承气汤之蓄血主要蓄在膀胱这个位置；抵挡汤之蓄血主要蓄在里，也就是以大肠为主的这个里的区域。Furthermore, compared with the later Di - Dang Decoction, the blood stasis in Persica and Mirabilite Decoction mainly accumulates in the bladder area; the blood stasis in Di - Dang Decoction mainly accumulates in the interior, that is, the area mainly including the large intestine.
膀胱经是络表的经络，桂枝走表，气化增加，自然废水的下行之力也会增加，此二力原为一体，自然用桂枝解外也就更能通利膀胱。The bladder meridian is a meridian that connects to the surface. Cinnamon twig acts on the surface, increasing qi-transformation, and naturally, the downward-going force of waste water will also increase. These two forces are originally one, so using cinnamon twig to relieve the exterior can better promote the flow of the bladder.
炙甘草是顾护中气的；大黄、芒硝是攻下的，这都不用再解释了。Prepared licorice protects the middle-qi. Rhubarb and mirabilite are for purging, which needs no further explanation.
这里说说桃仁这味药。桃仁辛厚香苦、辛香行散，味厚郁则能走血，苦则破下，所以主要用于开破瘀血。Let's talk about the herb peach kernel. Peach kernel is pungent, thick - flavored, fragrant, and bitter. Its pungent and fragrant nature can promote circulation and dispersion, and its thick flavor can enter the blood, and its bitterness can break up and purge. So it is mainly used to break up blood stasis.
它没有滋养治性，偏性不强，所以寒热虚实都能用。《金匮》里治肠痈、肺痈也用它。It has no nourishing properties and its bias is not strong, so it can be used in cases of cold, heat, deficiency, or excess. In Synopsis of the Golden Chamber, it is also used to treat intestinal and lung abscesses.
