（此方出古本东垣书第九卷此事难知中）
黄连无分两并无用水煎法
易老随证加减例附后
烦者。加栀子。（烦心烦也。仲景少阴热病。有心烦一条。）
燥者加香豉。（燥。即口燥是也。加香豉者。火郁则发之也。）呕者。加半夏。（呕者。胸有饮也。加半夏以涤饮。）
满者。加甘草。（满。胸满也。加生甘草。引黄连一味。直至满所。以泄实热。）腹痛。加芍药。（少阴热病。有腹中痛一
条仲景加炮附子者。误也。今加芍药。以能和营血。止腹痛。）脉迟。加附子。下焦寒。加干姜。（此二条。与制汤本义
相反。今从删。）大便硬者。加酒浸大黄。此比之大承气为少缓耳。虽下之与脉细小无害。
琥按上方。乃海藏治少阴传经热证。口燥舌干而渴。止因尺寸脉细小。不敢用大承气。而以此汤代之者也。观乎
此。而知昔贤读仲景书。不轻用仲景方。盖慎之至耳。今医。治伤寒。但知证书。而不细察夫脉者。不其大害矣夫。
琥又按仲景辩少阴证。相传为足经。主肾。今海藏反用黄连一味。为泻心汤者。乃知手少阴亦有伤寒病也。
又云。少阴渴逆者。失下也。阴消将尽。阳逆上行。使阴不纳也。或舌挛。言语不正。反昏冒。与咽痛者。少阴也。
速下之。大承气汤。若阳极。脉微将尽者。不宜下。宜泻心汤。凉膈散。去硝清肺亦可。
(This prescription is from the ninth volume of the ancient edition of Li Dongyuan's *Cishi Nan Zhi* [Difficulties in This Matter].)
There is no specified dosage for Huanglian (Rhizoma Coptidis), nor are there instructions for decoction with water.
The examples of modification according to symptoms by Yi Lao (Li Dongyuan, courtesy name Mingzhi, pseudonym Yi Lao) are attached below:
For restlessness (Fanzao, mental agitation and discomfort), add Zhizi (Fructus Gardeniae). (Restlessness refers to mental agitation. In Zhang Zhongjing's *Shanghan Lun* [Treatise on Cold Pathogenic Diseases], there is a section regarding restlessness in Shaoyin heat diseases.)
For dryness (Zao), add Xiangchi (Fermented Soybean). (Dryness refers to dry mouth. Adding Xiangchi is because fire stagnation requires dispersal.)
For vomiting (Ou), add Banxia (Rhizoma Pinelliae). (Vomiting occurs due to fluid retention in the chest. Adding Banxia helps to eliminate fluid retention.)
For fullness (Man), add Gancao (Radix Glycyrrhizae). (Fullness refers to chest distension. Adding raw Gancao guides the single herb Huanglian directly to the site of fullness to drain excess heat.)
For abdominal pain (Futong), add Shaoyao (Radix Paeoniae Alba). (In Zhang Zhongjing's *Shanghan Lun*, there is a section regarding abdominal pain in Shaoyin heat diseases. Previous commentators believed that adding Paofuzi (Prepared Radix Aconiti Lateralis) was an error. Now, Shaoyao is added because it can harmonize Ying and Blood and stop abdominal pain.)
For slow pulse (Machi), add Fuzi (Radix Aconiti Lateralis Preparata). For cold in the Lower Jiao, add Ganjiang (Rhizoma Zingiberis). (These two items contradict the original intent of the formula's preparation and are therefore deleted here.)
For hard stool (Dabian ying), add Jiuhuangda (Rhubarb macerated in wine). This is slightly milder than Dachengqi Tang (Major Order the Qi Decoction). Even if purgation is used, it is harmless for patients with fine and small pulses.
Wang Hu notes: The above prescription was used by Haicang (Zhang Yuansu, pseudonym Haicang) to treat Shaoyin transmitted heat syndromes, characterized by dry mouth, dry tongue, and thirst. Because the pulse at the cun, guan, and chi positions was fine and small, he dared not use Dachengqi Tang and instead substituted this decoction. From this, we can see that past sages, when studying Zhang Zhongjing's works, did not lightly employ his prescriptions; this demonstrates extreme caution. Modern physicians, when treating Shanghan, only rely on symptoms without carefully examining the pulse. Is this not a great harm?
Wang Hu further notes: Zhang Zhongjing's differentiation of Shaoyin syndromes has traditionally been attributed to the Foot Shaoyin Kidney meridian, governing the Kidney. However, Haicang uses only Huanglian as Xiexin Tang (Drain the Epigastrium Decoction), indicating that the Hand Shaoyin Heart meridian also suffers from Shanghan diseases.
It is also stated: Shaoyin disease presenting with thirst and rebellious qi results from failure to purge earlier. Yin fluids are nearly exhausted, and Yang qi rebels upward, preventing Yin from being received. If there is tongue spasm, abnormal speech, sudden dizziness/fainting, or sore throat, it belongs to Shaoyin. Rapid purgation should be employed using Dachengqi Tang. If Yang is at its extreme and the pulse is faint and nearly absent, purgation is contraindicated; instead, Xiexin Tang or Liangge San (Cool the Diaphragm Powder) should be used. Removing Mangxiao (Natrii Sulfas) and Qingfei (Clearing the Lung) is also acceptable.