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。
成注引内经曰。火热受邪。心病生焉。苦入心。寒除热大黄黄连之苦寒。以导泻心下之虚热。但以麻沸汤渍服者。
取其气薄而泄虚热。
琥按麻沸汤者。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。
（附例）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。（伤寒大下后。复发汗。是为汗下颠倒。下之。徒伤太阴之里。邪热陷于心下。故成痞。
汗之。徒虚太阳之经。风寒着于腠理。故恶寒。是为表里之邪。俱不解也。但其时恶寒甚。不可攻痞。当先与桂枝汤以
解表邪。表解。乃与大黄黄连泻心汤。以攻里热。可见表里之治。有缓急先后之分。不可紊也。）
心下痞而复恶寒。汗出者。附子泻心汤主之。（心下痞者。邪热壅聚也。恶寒汗出者。表未解也。仲景法。宜用桂枝
汤以解散之。今者心下痞。则阳盛于里。桂枝不宜用也。因以三黄汤。泻其心下之痞。加附子以散在表之邪。以附子同
一辛热。即经云。发表不远热之义也。且也。心下热痞。纯用苦寒药以泻之。其气反凝聚而不散。加附子。其辛热之性。
兼能行三黄之滞。令痞气豁然。此汤非神于医者。不敢用也。或问前条心下痞。恶寒。当先解表。宜桂枝汤。兹则同是
心下痞。而复恶寒。何以不先用桂枝汤。余答云。前条以恶寒甚。故虽心下痞。不得骤服泻心汤。因先用桂枝汤以解表。
此条以心下痞甚。故虽恶寒。不得仍服桂枝汤。只得用三黄泻心汤。加附子。以两解之也。）
Da Huang (Rhei Radix et Rhizoma, 2 liang) and Huang Lian (Coptidis Rhizoma, 1 liang).
The above two ingredients. Soak them in 2 sheng of boiling water (Mafei Tang, boiling water with surface foam resembling hemp seeds). After a short while, strain off the dregs. Divide into two doses and take warm.
Cheng Wuji's commentary cites the *Neijing*: "When fire-heat pathogen is affected, heart disease arises." Bitter flavor enters the Heart. The bitter-cold nature of Da Huang and Huang Lian is used to guide and drain the deficient heat in the epigastrium. The reason for soaking and taking only with Mafei Tang is to utilize their thin qi to drain deficient heat.
Hu's note: Mafei Tang refers to fully boiled water. When the decoction is about to boil, its surface bubbles resemble hemp seeds, hence the name. Pi syndrome (a condition characterized by fullness and obstruction in the epigastrium) involves evil heat gathering in the epigastrium; it differs from Jie Xiong syndrome (a condition of phlegm-fluid retention and heat binding in the chest causing hardness and pain) which presents with extreme excess and firmness. Therefore, boiling water is used to soak and squeeze out the juice of Da Huang and Huang Lian, taken warm. This utilizes their thin aroma and flavor, making the nature gentle and lingering in the diaphragm, capable of draining the heat qi of epigastric pi. This belongs to a syndrome where evil heat is relatively mild. Generally, it is not truly deficient heat.
(Attached Example): After severe purgation in Shanghan (Cold Damage), followed by recurrence of sweating, if there is epigastric pi and aversion to cold, the exterior has not yet resolved. One must not attack the pi directly; one should first resolve the exterior. Once the exterior is resolved, then one can attack the pi. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable. To attack the pi, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is suitable. (Severe purgation followed by sweating in Shanghan represents an inversion of treatment methods. Purgation vainly injures the Taiyin interior, causing evil heat to sink into the epigastrium, thus forming pi. Sweating vainly weakens the Taiyang channel, allowing wind-cold to adhere to the cou-li (pores/skin texture), thus causing aversion to cold. This indicates that both exterior and interior pathogens remain unresolved. However, if at this time aversion to cold is severe, one must not attack the pi; one should first administer Guizhi Tang to resolve the exterior pathogen. Once the exterior is resolved, then administer Dahuang Huanglian Xiexin Tang to attack the interior heat. This demonstrates that in treating simultaneous exterior and interior conditions, there is a distinction in urgency and sequence; they must not be confused.)
If there is epigastric pi accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) is the primary treatment. (Epigastric pi is caused by the congestion and accumulation of evil heat. Aversion to cold and sweating indicate that the exterior has not yet resolved. According to Zhang Zhongjing's method, Guizhi Tang should be used to disperse it. Now, since there is epigastric pi, yang is excessive inside, so Guizhi Tang is not suitable. Therefore, Sanhuang Tang (Three-Yellow Decoction, referring here to the bitter-cold clearing formula contextually involving Rhubarb, Coptis, and often Scutellaria in related contexts or as interpreted by the commentator for heat clearing) is used to drain the epigastric pi, and Fuzi (Aconiti Lateralis Radix Praeparata) is added to scatter the exterior pathogen. Because Fuzi possesses a pungent-hot nature, it aligns with the classic saying: "To release the exterior, do not avoid heat." Moreover, for pure heat-pi in the epigastrium, using purely bitter-cold drugs to drain it may cause the qi to condense rather than disperse. Adding Fuzi, with its pungent-hot nature, helps move the stagnation of the three yellow herbs, allowing the pi qi to dissipate abruptly. This prescription is one that only highly skilled physicians dare to use. Someone asked: In the previous clause, regarding epigastric pi and aversion to cold, one should first resolve the exterior with Guizhi Tang; in this clause, it is also epigastric pi with aversion to cold, why not use Guizhi Tang first? I answer: In the previous clause, because aversion to cold was severe, even though there was epigastric pi, one could not immediately take the Heart-Draining Decoction, so Guizhi Tang was used first to resolve the exterior. In this clause, because the epigastric pi is severe, even though there is aversion to cold, one cannot continue to use Guizhi Tang; instead, one must use Sanhuang Xiexin Tang plus Fuzi to resolve both simultaneously.)