黄黄连泻心汤。金鉴。主甘草泻心汤。未如钱氏不主一方也。
太阳中风。下利呕逆。表解者。乃可攻之。其人 汗
出。发作有时。头痛。心下痞硬满。引胁下痛。干呕短气。汗出不恶寒者。此表解里未和也。十枣汤主之。
（干呕短气。玉函。作呕即短气。玉函。无汗出不恶寒者六字。玉函。脉经。千金翼。此下。有为字。）
〔柯〕中风下利呕逆。本葛根加半夏症。若表既解。而水气淫溢。不用十枣攻之。胃气大虚。后难为力
矣。然下利呕逆。固为里症。而本于中风。不可不细审其表也。若其人 汗出。似乎表证。然发作有时。则
病不在表矣。头痛是表证。然既不恶寒。又不发热。但心下痞硬而满。胁下牵引而痛。是心下水气泛溢。上攻
于脑。而头痛也。与伤寒不大便六七日而头痛。与承气汤同。干呕汗出。为在表。然而汗出而有时。更不恶寒。
干呕而短气。为里症也明矣。此可以见表之风邪已解。而里之水气不和也。然诸水气为患。或喘或渴。或噎或
悸。或烦。或利而不吐。或吐而不利。或吐利而无汗。此则外走皮毛而汗出。上走咽喉而呕逆。下走肠胃而下
利。浩浩莫御。非得利水之峻剂。以直折之。中气不支矣。此十枣之剂。与五苓青龙泻心等法悬殊矣。
案金鉴云。下利之下。当是不字。发作之作字。当是热字。汪氏云。头痛二字。当在发作有时之上。二说并非也。
十枣汤方
芫花（熬） 甘遂 大戟
上三味等分。各别捣为散。以水一升半。先煮大枣肥者十枚。取八合。去滓。纳药末。强人服一钱匕。
羸人服半钱。温服之。平旦服。若下少。病不除者。明日更服。加半钱。得快下利后。糜粥自养。
〔柯〕头痛短气。心腹胁下。皆痞硬满痛。是水邪尚留结于中。三焦升降之气。拒隔而难通也。表邪已罢。
非汗散所宜。里邪充斥。又非渗泄之品所能治。非选利水之至锐者。
以直折之。中气不支。亡可立待矣。甘遂芫花大戟。皆辛苦气寒。而秉性最毒。并举而任之。气同味合。相须
相济。决渎而大下。一举而水患可平矣。然邪之所凑。其气已虚。而毒药攻邪。脾胃必弱。使无健脾调胃之品。
主宰其间。邪气尽而元气亦随之尽。故选枣之大肥者为君。预培脾土之虚。且制水势之横。又和诸药之毒。既
不使邪气之盛而不制。又不使元气之虚而不支。此仲景立方之尽善也。张子和制浚川禹功神 等方。治水肿痰
饮。而不知君补剂以护本。但知用毒药以攻邪。所以善全者鲜。〔方〕羸。瘦劣也。糜粥。取糜澜过熟。易化
而有能补之意。
吴云。一钱匕者。匕者。匙也。谓钱大之匙也。○千金云。钱匕者。以大钱上全抄之。若云半钱匕者。则是
一钱抄取一边尔。并用五铢钱也。
金匮要略。病悬饮者。此汤主之。又咳家其脉弦。为有水。此汤主之。又有支饮家。咳烦胸中痛者。不卒
死。至一百日。或一岁。宜此汤。
外台秘要。深师朱雀汤。疗久病癖饮。停痰不消。在胸膈上液液。时头眩痛苦挛。眼暗。身体手足十指甲
尽黄。亦疗胁下支满。饮辄引胁下痛。（即本方。用甘遂。芫花。各一分。大戟三分。大枣十二枚。）圣济总
录。三圣散。治久病饮癖停痰。及胁满支饮。辄引胸下痛。（即本方）
汪氏云。陈无择三因方。以十枣汤药为末。用枣肉和丸。以治水气四肢浮肿。上气喘急。大小便不通。
盖善变通者也。
医学纲目。昔杜壬问孙兆曰。十枣汤。毕竟治甚病。孙曰。治太阳中风。表解里未和。杜曰。何以知里
未和。孙曰。头痛心下痞满。胁下痛。干呕汗出。此知里未和也。杜曰。公但言病症。而所以里未和之故。要
紧总未言也。孙曰。某
尝于此未决。愿闻开谕。杜曰。里未和者。盖痰与燥气。壅于中焦。故头痛干呕。短气汗出。是痰膈也。非十
枣汤不治。但此汤不得轻用。恐损人于倏忽。用药者慎之。
宣明论。此汤。兼下水肿腹胀。并酒食积。肠垢积滞。 癖坚积。蓄热暴痛疟气久不已。或表之正气与邪
热。并甚于里。热极似阴。反寒战。表气入里。阳厥极深。脉微而绝。并风热燥甚。结于下焦。大小便不通。
实热腰痛。及小儿热结。乳癖积热。作发风潮搐。斑疹热毒。不能了绝者。○又云。芫花。慢火炒变色。仲景乡
语。云炒作熬。下凡言熬者。皆干炒也。案杨雄方言云。凡以火而干五谷之类。自山而东。齐楚以往。谓之熬。
即其义也。
嘉定县志。唐杲字德明。善医。太仓武指挥妻。起立如常。卧则气绝欲死。杲言是为悬饮。饮在喉间。坐
之则坠。故无害。卧则壅塞诸窍。不得出入。而欲死也。投以十枣汤而平。
医学六要。一人饮茶过度。且多愤懑。腹中常辘辘有声。秋来发热寒似疟。以十枣汤料。黑豆煮。晒干。
研末。枣肉和丸。芥子大。而以枣汤下之。初服五分。不动。又治五分。无何腹痛甚。以大枣汤饮。大便五六
行。皆溏粪无水。时盖晡时也。夜半乃大下数斗积水。而疾平。当其下时。瞑眩特甚。手足厥冷。绝而复苏。
举家号泣。咸咎药峻。嗟乎药可轻哉。
方脉正宗。治五种饮证。芫花。醋煮。大戟。醋煮。甘遂。童便煮。三处煮过。各等分。焙干为末。每
服二钱。大枣十枚。煎汤调下。（出本草汇言。）
直指方。治小瘤方。先用甘草。煎膏。笔蘸妆瘤四围。干而复妆。凡三次。后以大戟芫花甘遂。上等为
细末。米醋调。别笔妆敷其中。不得近着甘草处。次日缩小。又以甘草
膏。妆小晕三次。中间仍用大戟芫花甘遂如前。自然焦缩。
活人书。用此汤。合下不下。令人胀满。通身浮肿。而死。
太阳病。医发汗。遂发热恶寒。因复下之。心下痞。表里俱虚。阴阳气并竭。无阳则阴独。复加烧针。因
胸烦。面色青黄。肤 者难治。今色微黄。手足温者易愈。（心上。玉函。脉经。有则字。 下。有如此二字。
烧。脉经。作火。）
〔成〕太阳病因发汗。遂发热恶寒者。外虚阳气。邪复不除也。因复下之。又虚其里。表中虚邪内陷。传于
心下为痞。发汗表虚为竭阳。下之里虚为竭阴。表证罢为无阳。里有痞为阴独。又加烧针。虚不胜火。火气内
攻。致胸烦也。伤寒之病。以阳为主。其人面色青。肤肉 动者。阳气大虚。故云难治。若面色微黄。手足温
者。阳气得复。故云易愈。
案既云阴阳气并竭。而又云无阳则阴独。义不明切。方氏云。无阳。以俱虚言也。阴独。谓痞也。喻氏云。
虽曰阴阳气并竭。实繇心下无阳。故阴独痞塞也。程氏云。阴阳气并竭。则并陷入之阳邪。亦不成其为阳。而
兼并于阴矣。无阳则阴独。恐发热者。不发热。而单恶寒矣。志聪云。无太阳之表阳。有阴邪之独陷也。锡驹
云。言无阳气于外。则阴血独守于内也。钱氏云。并竭之阴阳者。乃人身之真气也。此所谓无阳者。指胃中之
阳气空虚也。阴独者。谓唯有阴邪痞塞于中也。魏氏云。阴阳之正气虽俱竭。而阴药之性。痞塞于心下之阴分
者。独不散。故曰无阳则阴独。金鉴云。阴阳并竭。已成坏证矣。况无阳则阴不生。阴独则阳不化。而复加烧
针。火气内攻。阴阳皆病。汪氏云。痞证为天气不降。地气不升。气属阳。二气不能交通。故曰无阳。中州之
土闭塞。犹之孟冬之月。则纯阴用事。故曰阴独。以上数说。糊
涂不通。特柯氏于此二句。不敢解释。岂其遵阙如之圣训耶。郭白云云。此为难治之证。须临时更详轻重。痞
甚。先泻心汤。发热恶寒甚。则先小柴胡。火逆甚。则先救逆汤。从所重治之。汪氏云。小柴胡不宜用。发热
恶寒甚。乃太阳表证在也。仲景法。宜更用桂枝汤以解肌。○案医垒元戎。此条证。治以大黄黄连泻心汤。恐不
允矣。钱氏云。手足温。则知阳气犹未败亡。温经复阳之治。尚可施也。锡驹云。予亲遇此证。不啻十百。皆
从温补而愈。二家之言。当切当矣。
宗印曰。本经多有立论而无方者。有借医之汗下。而为说辞者。多意在言外。读论者当活泼泼看去。若
留着于眼。便为糟粕。如补立方剂。何异悬瘤。
心下痞。按之濡。其脉关上浮者。大黄黄连泻心汤主之。（千金翼。濡上。有自字。玉函。浮上。有自字。）
〔汪〕关上浮者。诸阳之脉皆浮也。以手按其痞处虽濡。纯是邪热壅聚。故用此汤。以导其热。而下其
邪也。成注云。虚热者误。夫中气虽虚。邪热则聚。故仲景以实热治之。若系虚热。则不用大黄黄连矣。〔钱〕
心下者。心之下。中脘之上。胃之上脘也。胃居心之下。故曰心下也。其脉关上浮者。浮为阳邪。浮主在上。
关为中焦。寸为上焦。因邪在中焦。故关上浮也。按之濡。乃无形之邪热也。热虽无形。然非苦寒以泄之。不
能去也。故以此汤主之。
柯氏改濡作硬。柯氏方论。又以濡。为汗出湿濡之义。徐灵胎亦为心下濡湿。金鉴。濡上。补不字。并非也。
大黄黄连泻心汤方
大黄（二两） 黄连（一两）
上二味。以麻沸汤二升渍之。须臾绞去滓。分温再服。（【原注】臣亿等看详大黄黄连泻心汤。诸本皆
二味。又后附子泻心汤。用大黄黄连芩附子。
恐是前方中。亦有黄芩。后但加附子也。故后云附子泻心汤。本云加附子也。）
〔汪〕麻沸汤者。熟汤也。汤将熟时。其面沸泡如麻。以故云麻。痞病者。邪热聚于心下。不比结胸之大
实大坚。故用沸汤。渍绞大黄黄连之汁温服。取其气味皆薄。则性缓恋膈。能泄心下痞热之气。此为邪热稍轻
之证。大抵非虚热也。〔钱〕麻沸汤者。言汤沸时泛沫之多。其乱如麻也。全生集。作麻黄沸汤。谬甚。
千金翼注。此方。必有黄芩。医垒元戎。本方。加黄芩。为伊芳尹三黄汤。
金匮要略。心气不足。吐血衄血。泻心汤主之。
于本方。加黄芩一两。以水三升。煮取一升。顿服之。
千金方。巴郡太守奏三黄丸。治男子五劳七伤。消渴不生肌肉。妇人带下。手足寒热。（加减随四时。）
又三黄汤。治下焦结热。不得大便。
于本方。去黄连。加栀子。甘草。若大便秘。加芒硝二两。
外台秘要。集验。疗黄胆身体面目皆黄。大黄散。三味各等分。捣筛为散。先食服方寸匕。日三服。亦可
为九服。（又出千金。）
圣惠方。治热蒸在内。不得宣散。先心腹胀满。气急。然后身面悉黄。名为内黄。（即本方）
和剂局方。三黄丸。治丈夫妇人。三焦积热。上焦有热。攻冲眼目赤肿。头项肿痛。口舌生疮。中焦有热。
心膈烦躁。不美饮食。下焦有热。小便赤涩。大便秘结。五脏俱热。即生HT 疖疮痍。及治五般痔疾。粪门肿痛。
或下鲜血。三味各等分。为细末。炼蜜为丸。如梧桐子大。每服三十丸。熟水吞下。小儿积热。亦宜服之。（案
本出圣惠方热病门。）活人书。泻心
三黄汤。妇人伤寒。六七日。胃中有燥屎。大便难。烦躁谵语。目赤毒瓦斯闭塞。不得通。（即本方）
如目赤睛疼。宜加白茯苓嫩竹叶。泻肝余之气。
拔萃方。犀角地黄汤。治主脉浮。客脉芤。浮芤相合。血积胸中。热之甚血在上焦。此药主之。
于本方加地黄
张氏医通。噤口痢。有积秽太多。恶气熏蒸者。大黄黄连泻心汤。加木香。
心下痞。而复恶寒。汗出者。附子泻心汤主之。（玉函。心上。有若字。）
〔钱〕伤寒郁热之邪。误入而为痞。原非大实。而复见恶寒汗出者。其命门真阳已虚。以致卫气不密。
故玄府不得紧闭而汗出。阳虚不任外气而恶寒也。〔程〕伤寒大下后复发汗。心下痞。恶寒者。表未解也。不可
攻痞。当先解表。表解乃可攻痞。解表宜桂枝汤。攻痞宜大黄黄连泻心汤。与此条宜参看。彼条何以主桂枝解
表。此条何以主附子回阳。缘彼条发汗汗未出。而原来之恶寒不罢。故属之表。此条汗已出。恶寒已罢。而复
恶寒汗出。故属之虚。凡看论中文本。须于异同处。细细参考互勘。方得立法处方之意耳。
附子泻心汤方
大黄（二两） 黄连（一两） 附子（二枚炮去皮破别煮取汁○成本。玉函。千金翼。作一枚。） 黄
芩（一两）
上四味。切三味。以麻沸汤二升渍之。须臾绞去滓。纳附子汁。分温再服。（切。玉函。作 咀二字。）
〔钱〕以热邪痞于心下。则仍以大黄黄连泻之。加附子以扶真阳。助其蒸腾之卫气。则外卫固密矣。因
既有附子之加。并入黄芩。以为彻热之助。而寒热并施。各司其治。而阴阳
之患息。倾痞之功又立矣。〔程〕二证俱用大黄。以条中无自利证。则知从前下后。肠中反成滞涩。闭住阴邪。
势不得不破其结。使阴邪有出路也。此虽曰泻心。而泻热之中。即具回阳之力。故以附子名汤耳。〔鉴〕其妙尤
在以麻沸汤渍三黄。须臾绞去滓。纳附子别煮汁。义在泻痞之意轻。扶阳之意重也。〔舒〕案此汤治上热下寒之
证。确乎有理。三黄略浸。即绞去滓。但取轻清之气。以去上焦之热。附子煮取浓汁。以治下焦之寒。是上用
Huanglian Xiedan Decoction. *Yizong Jinjian* advocates the use of Gancao Xiexin Decoction, which differs from Qian's view of not exclusively adhering to one formula.
In Taiyang Wind-Strike syndrome, presenting with diarrhea and vomiting/retching: if the exterior syndrome has resolved, only then can interior purgation be applied. If the patient sweats, with episodes occurring at specific times, accompanied by headache, epigastric hardness/fullness, pain radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates that the exterior is resolved but the interior is disharmonious. Shizao Tang (Ten Jujube Decoction) is indicated.
("Dry retching and shortness of breath" in *Yuhuan Jing* is written as "retching immediately followed by shortness of breath". *Yuhuan Jing* lacks the six characters "sweating without aversion to cold". *Maijing* and *Qianjin Yi Fang* have the character "wei" (is) below this passage.)
[Ke Qin] Wind-strike causing diarrhea and vomiting/retching should originally be a Gegen Jiuxie Tang (Pueraria and Pinellia Decoction) pattern. If the exterior is resolved but water qi overflows, failing to use Shizao Tang to purge will severely damage Stomach Qi, making subsequent treatment difficult. However, diarrhea and vomiting/retching are interior syndromes, yet originate from wind-strike; thus, the exterior must be carefully examined. Sweating may seem like an exterior sign, but if it occurs at specific times, the disease is not in the exterior. Headache is an exterior sign, yet without aversion to cold or fever, but with epigastric hardness/fullness and hypochondriac traction pain, this indicates water qi overflowing from the heart/stomach region, attacking upward to the brain, causing headache. This is similar to Taiyang disease with constipation for six to seven days and headache, treated with Chengqi Tang. Dry retching and sweating suggest the exterior; however, sweating with timing and no aversion to cold, combined with dry retching and shortness of breath, clearly indicates an interior syndrome. This shows the exterior wind pathogen has resolved, while interior water qi is disharmonious. Various water pathologies present differently: some have panting, thirst, choking, palpitations, irritability, diarrhea without vomiting, vomiting without diarrhea, or vomiting/diarrhea without sweating. This case involves water moving outward to skin/hair pores causing sweating, upward to throat causing vomiting/retching, and downward to intestines/stomach causing diarrhea. The torrential nature cannot be controlled without potent diuretic agents to directly subdue it, otherwise Middle Qi will collapse. Shizao Tang differs significantly from Wuling San (Five-Ling Powder), Xiao Qinglong Tang (Minor Blue Dragon Decoction), and Xiexin Tang (Gallbladder-Draining Decoctions).
Note: *Yizong Jinjian* states that after "diarrhea," there should be the character "bu" (not). After "fabu," the character "zuo" should be "re" (heat). Wang Shi says "headache" should precede "fabu you shi." Both views are incorrect.
Shizao Tang Formula
Yuanhua (Stir-fried) Gansui Daji
These three herbs are equal in dosage, each separately pounded into powder. Use 1.5 sheng of water, first decoct ten large jujubes until reduced to 0.8 sheng, remove dregs, add the herb powders. Strong individuals take one qianbi (a spoonful measured by a coin); weak individuals take half a qianbi. Take warm on an empty stomach in the morning. If defecation is insufficient and disease persists, administer again the next day, increasing by half a qianbi. After obtaining free profuse diarrhea, nourish the body with millet porridge.
[Ke Qin] Headache, shortness of breath, epigastric/abdominal/hypochondriac hardness/fullness/pain indicate water pathogen lingering in the middle, blocking the ascending/descending Qi of the Triple Burner, preventing circulation. Exterior pathogen is gone, so diaphoresis is unsuitable. Interior pathogen abounds, so moistening/diuretic herbs are ineffective. Only sharp diuretics can directly subdue it; otherwise, Middle Qi collapse and death follow. Gansui, Yuanhua, and Daji are pungent, bitter, and cold in nature, extremely toxic. Used together, their Qi and flavor harmonize, assisting each other to open water passages and induce massive purgation, resolving water disaster in one stroke. However, where pathogen gathers, Qi is deficient; toxic drugs attack pathogen but weaken Spleen/Stomach. Without Spleen-nourishing/Stomach-regulating herbs to govern, eliminating pathogen eliminates vital Qi too. Thus, large plump jujubes are used as Sovereign herb to pre-nourish Spleen Earth deficiency, restrain rampant water, and moderate herb toxicity. This prevents unchecked pathogen and unsupported vital Qi, demonstrating Zhang Zhongjing's perfect prescription design. Zhang Zihe's Junchuan, Yugong, Shenyue formulas treat edema/phlegm-fluid but lack sovereign tonic herbs to protect root, relying only on toxic drugs to attack pathogen, hence few recover. [Fang] Lei means emaciated/wretched. Mixi refers to well-cooked, easily digestible porridge with nourishing intent.
Wu Qian notes: One qianbi refers to a spoon the size of a coin. ○ *Qianjin Fang* states: Qianbi means filling a large coin completely with powder. Half-qianbi means filling one side of the coin. Five-zhu coins are used.
*Jingui Yaolue*: For Huan Yin (Suspended Fluid) disease, this decoction is indicated. For chronic coughers with wiry pulse indicating fluid retention, this decoction is indicated. For Zhi Yin (Branch Fluid) patients with cough, irritability, and chest pain who do not die suddenly, even after 100 days or a year, this decoction is appropriate.
*Waitai Miyao*: Shen Shi Zhuque Tang treats long-standing Pi Yin (accumulated fluid), stagnant phlegm-fluid in thoracic/diaphragmatic region causing dizziness, pain, spasms, dim vision, yellowing of nails/skin. Also treats hypochondriac fullness/fluid-induced pain. (Same formula: Gansui, Yuanhua 1 fen each, Daji 3 fen, 12 jujubes.) *Shengji Zonglu*: Sansheng San treats long-standing Pi Yin/stagnant phlegm and hypochondriac/Zhi Yin causing chest pain. (Same formula.)
Wang Shi notes: Chen Wuzhe's *San Yin Fang* uses Shizao Tang powder mixed with jujube paste into pills to treat water qi causing limb edema, upper body panting, urinary/fecal obstruction. This demonstrates adaptability.
*Yixue Gangmu*: Du Ren asked Sun Zhao: What does Shizao Tang treat? Sun: Taiyang Wind-Strike, exterior resolved, interior unharmonized. Du: How do you know interior is unharmonized? Sun: Headache, epigastric fullness, hypochondriac pain, dry retching, sweating indicate interior disharmony. Du: You listed symptoms but not the cause. Sun: I was unsure, please instruct. Du: Interior disharmony is due to phlegm and dry Qi obstructing Middle Jiao, causing headache, retching, shortness of breath, sweating—this is Tan Ge (Phlegm Obstruction). Only Shizao Tang treats it. But this decoction must not be used lightly as it may cause sudden harm; physicians must be cautious.
*Xuanming Lun*: This decoction also treats water edema/abdominal distension, wine/food stagnation, intestinal mucus accumulation, hard Pi masses, accumulated heat/sudden malaria pain persisting long, or exterior righteous Qi merging with interior pathogenic heat causing extreme heat mimicking Yin (chills), Yang reversal (deep cold, faint pulse), wind-heat/dryness binding Lower Jiao causing urinary/fecal obstruction, excess heat lower back pain, pediatric heat accumulation, milk Pi/accumulated heat causing wind/tremors/rash/toxins that cannot resolve. ○ Also: Stir-fry Yuanhua until color changes. Zhongjing's dialect calls stir-frying "ao"; all mentions of "ao" mean dry frying. Yang Xiong's *Fangyan* states: Drying grains with fire from Shandong to Qi/Chu is called "ao."
*Jiading County Annals*: Tang Gao (Zi Deming) was skilled in medicine. Wife of Taicang Military Commander stood normally but suffocated when lying down. Tang diagnosed Huan Yin. Fluid in throat falls when sitting (harmless) but blocks orifices when lying (fatal). Shizao Tang cured her.
*Yixue Liuyao*: A person drank excessive tea and felt resentful, hearing gurgling in abdomen. Autumn brought fever/chills resembling malaria. Treated with Shizao Tang ingredients boiled with black beans, dried, powdered, mixed with jujube paste into mustard-seed-sized pills, taken with jujube decoction. Initial dose 0.5 qian had no effect. Second dose caused severe abdominal pain, relieved by jujube decoction, resulting in 5-6 loose stools without water. By dusk, midnight brought massive evacuation of several dou of accumulated fluid, curing disease. During evacuation, severe adverse reaction occurred: cold limbs, near-death state, then recovery. Family wept, blaming harsh medicine. Alas, how can medicine be underestimated!
*Fangmai Zhengzong*: Treats five types of Yin syndromes. Boil Yuanhua in vinegar, Daji in vinegar, Gansui in child's urine. Dry and powder equally. Take 2 qian with 10 jujubes decocted in water. (From *Bencao Huiyan*.)
*Zhizhi Fang*: Treats small tumors. First, decoct Gancao into paste, paint around tumor four times until dry/reapplied. Then pound Daji, Yuanhua, Gansui into fine powder, mix with rice vinegar, paint inside tumor avoiding Gancao area. Tumor shrinks next day. Reapply Gancao paste three times, repeat herb application. Tumor naturally scabs/shrinks.
*Horen Shu*: Using this decoction when purgation is needed but fails causes abdominal distension, whole-body edema, and death.
Taiyang Disease: Physician induced sweating, leading to fever/aversion to cold. Then applied purgation, causing epigastric痞 (Pi/Fullness). Exterior and interior both deficient, Yin/Yang Qi exhausted. "No Yang means Yin alone," plus moxibustion/cauterization causing chest irritability, bluish-yellow complexion, muscle twitching indicates difficult-to-treat. If complexion is slightly yellow and hands/feet warm, easy to cure. (*Yuhuan Jing*, *Maijing* add "ze" after "Xin Shang"; add "ru ci" after "Run"; *Maijing* writes "Huo" instead of "Shao".)
[Cheng Wuji] Taiyang disease treated with sweating damages exterior Yang Qi, leaving pathogen. Further purgation damages interior, allowing exterior pathogen to sink into Heart/Stomach causing Pi. Sweating exhausts Yang; purgation exhausts Yin. Exterior resolution is "No Yang"; interior Pi is "Yin Alone." Cauterization adds fire, overwhelming deficiency, causing chest irritability. Shaoyang disease prioritizes Yang. Bluish face/muscle twitching indicates severe Yang deficiency (difficult). Slightly yellow face/warm extremities indicate Yang recovery (easy).
Note: "Yin/Yang Qi exhausted" vs. "No Yang means Yin alone" is unclear. Fang Shi: "No Yang" means mutual deficiency; "Yin Alone" refers to Pi. Yu Shi: Though Yin/Yang exhausted, it stems from lack of Yang in Heart region, causing Yin Pi blockage. Cheng Shi: Exhausted Yin/Yang includes sinking Yang pathogen merging with Yin. "No Yang means Yin alone" implies fever stops, leaving only aversion to cold. Zhicong: No Taiyang exterior Yang, only Yin pathogen sinking. Xiju: No exterior Yang, only interior Yin Blood remaining. Qian Shi: Exhausted Yin/Yang is True Qi. "No Yang" refers to empty Stomach Yang; "Yin Alone" is Yin pathogen blocking middle. Wei Shi: Although righteous Yin/Yang exhausted, Yin drug nature blocking Yin portion of Heart remains undispersed. *Jinjian*: Yin/Yang exhaustion creates complex damage. "No Yang generates no Yin; Yin alone transforms no Yang." Cauterization attacks internally, damaging both. Wang Shi: Pi is Heaven Qi not descending, Earth Qi not ascending; Qi is Yang, lack of communication is "No Yang." Middle Earth blocked like early winter pure Yin dominance is "Yin Alone." These explanations are confusing. Ke Qin dared not explain these two sentences, perhaps following the Sage's rule of leaving gaps. Guo Baiyun: Difficult case, assess severity. Severe Pi: start with Xiexin Tang. Severe fever/aversion: start with Xiaochaihu Tang. Severe fire injury: start with Jiuni Tang. Treat according to priority. Wang Shi: Xiaochaihu Tang inappropriate. Severe fever/aversion indicates Taiyang exterior syndrome remains; per Zhongjing, use Guizhi Tang to release muscle layer. ○ Note: *Yilei Yuanrong* treats this with Dahuang Huanglian Xiexin Tang, likely incorrect. Qian Shi: Warm hands indicate Yang not yet destroyed; warming meridians/restoring Yang therapy is applicable. Xiju: Personally encountered this case dozens of times, all cured with warming/tonifying. Their words are accurate.
Zongyin: *Shanghan Lun* often establishes principles without formulas, using physician's sweating/purgation as rhetorical devices, implying meanings beyond text. Readers must interpret flexibly; rigid adherence turns it to dregs. Adding new formulas is like hanging tumors.
Epigastric Pi, soft upon pressure, Guan pulse floating: Dahuaung Huanglian Xiexin Tang is indicated. (*Qianjin Yi Fang* adds "zi" after "Ru"; *Yuhuan Jing* adds "zi" after "Fu".)
[Wang Ang] Guan floating indicates all Yang pulses float. Though soft to touch, it is purely pathogenic heat accumulation. This decoction guides heat downward. Cheng's note calling it "deficient heat" is wrong. Middle Qi may be deficient, but pathogenic heat accumulates; Zhongjing treats it as excess heat. Deficient heat would not use Dahuang/Huanglian. [Qian] "Xin Xia" is below Heart, above Zhongwan, upper Stomach. Stomach is below Heart, hence "Xin Xia." Guan floating indicates Yang pathogen in Upper/Middle Jiao. Soft pressure indicates formless pathogenic heat. Formless heat requires bitter-cold draining to remove. Hence this decoction.
Ke Qin changed "Ru" (soft) to "Ying" (hard). Ke's commentary interprets "Ru" as dampness from sweating. Xu Lingtai also views it as dampness. *Jinjian* adds "Bu" (not) before "Ru," which is incorrect.
Dahuang Huanglian Xiexin Tang Formula
Dahuang (2 liang) Huanglian (1 liang)
Soak these two herbs in 2 sheng of boiling water ("Mafei Tang") for a moment, strain, divide into two warm doses. [Original Note]: Chen Yi et al. note all versions have two herbs. Later Fuzi Xiexin Tang uses Dahuang, Huanglian, Huangqin, Fuzi. Likely Huangqin was in original formula, later just added Fuzi. Hence "Fuzi Xiexin Tang originally meant adding Fuzi."
[Wang Ang] Mafei Tang is boiling water with foam like hemp seeds. Pi disease involves heat gathering in Heart region, less severe than Jie Xiong (Knotted Chest). Boiling water extracts thin Qi/flavor of Dahuang/Huanglian, slowing action to linger in Diaphragm, draining Heart Pi heat. This suits mild heat patterns, generally not deficient heat. [Qian] Mafei Tang describes abundant foam. *Quansheng Ji* writing "Mahuang Fei Tang" is erroneous.
*Qianjin Yi Fang Note*: This formula must contain Huangqin. *Yilei Yuanrong* adds Huangqin, creating Yifangyin Sanhuang Tang.
*Jingui Yaolue*: Heart Qi insufficiency causing hematemesis/epistaxis: Xiexin Tang is indicated.
Add Huangqin (1 liang) to this formula, decoct in 3 sheng water to 1 sheng, take in one dose.
*Qianjin Fang*: Ba Jun Taishou reported Sanhuang Wan treating male five labors/seven injuries, wasting-thirst, female leukorrhea, cold/heat in limbs. (Adjust per seasons.)
Also Sanhuang Tang treats Lower Jiao heat constipation.
Remove Huanglian, add Zhizi/Gancao. If severe constipation, add Mangxiao (2 liang).
*Waitai Miyao*: Jiyan treats jaundice (body/face yellow) with Dahuang San (equal parts powder). Take 1 cunbi before meals, three times daily. Can also make nine doses. (Also from *Qianjin*.)
*Shenghui Fang*: Treats internal heat steaming, causing abdominal distension/breathlessness before general yellowing (Nei Huang). (Same formula.)
*Heji Jufang*: Sanhuang Wan treats San Jiao accumulated heat. Upper: red/swollen eyes/headache. Middle: irritability/poor appetite. Lower: dark/scanty urine/constipation. All organs hot cause boils/sores/hemorrhoids. Equal parts powder, honey pills. Take 30 pills with warm water. Pediatric heat also suitable. (From *Shenghui Fang* Heat Disease section.) *Horen Shu*: Xiexin Sanhuang Tang treats women with Taiyang disease day 6-7, dry stool in Stomach, difficult defecation, irritability/delirium, red eyes/toxic gas blockage. (Same formula.)
For red/painful eyes, add Baifuling/Tender Zhuye to drain Liver residual Qi.
*Bacui Fang*: Xijiao Dihuang Tang treats floating/Kou pulse combination indicating blood stasis in chest, extreme heat in Upper Jiao. Add Dihuang to this formula.
*Zhangshi Yitong*: Jin Kou Li (lockjaw dysentery) with excessive filth/evil qi: Dahuang Huanglian Xiexin Tang + Muxiang.
Epigastric Pi with aversion to cold and sweating: Fuzi Xiexin Tang is indicated. (*Yuhuan Jing* adds "Ruo" after "Xin Shang".)
[Qian] Shaoyang constrained heat entering mistakenly causes Pi, not true excess. Aversion to cold/sweating indicates Mingmen True Yang deficiency, leading to insecure Wei Qi and open pores (sweating). Yang deficiency cannot resist exterior Qi (aversion to cold). [Cheng] After heavy purgation and sweating, Pi with aversion to cold indicates unresolved exterior. Do not attack Pi; resolve exterior first with Guizhi Tang, then attack Pi with Dahuang Huanglian Xiexin Tang. Compare with this case. Why Guizhi here? Because sweating didn't occur, original aversion persists (exterior). Here, sweating occurred, aversion returned (deficiency). Analyzing similarities/differences reveals prescription logic.
Fuzi Xiexin Tang Formula
Dahuang (2 liang) Huanglian (1 liang) Fuzi (2 pieces, processed, peeled, broken, decocted separately for juice ○ *Chengben*, *Yuhuan Jing*, *Qianjin Yi Fang* say 1 piece.) Huangqin (1 liang)
Cut three herbs (Dahuang, Huanglian, Huangqin), soak in 2 sheng boiling water for a moment, strain, add Fuzi juice, divide into two warm doses. (Cut, *Yuhuan Jing* writes "Ju".)
[Qian] Heat Pi in Heart region drained by Dahuang/Huanglian. Add Fuzi to support True Yang and strengthen Wei Qi, securing exterior. Adding Huangqin assists heat clearance. Cold/heat administered together address respective issues, resolving Yin/Yang pathology and Pi. [Cheng] Both cases use Dahuang. No spontaneous diarrhea here suggests prior purgation caused intestinal stagnation trapping Yin pathogen. Breaking stagnation provides exit. Though named Xiexin, it contains Yang-restoring power via Fuzi. [Jian] Brilliance lies in soaking Sanhuang briefly to extract light/clear Qi for Upper Jiao heat, while Fuzi decocted strongly treats Lower Jiao cold. Light extraction removes Upper heat; strong decoction treats Lower cold. Thus, upper...