上杵二味为末，内巴豆于臼中杵之，以白饮合服。强人一钱，羸者减之。病在膈上
必吐，在膈下必利，不利进热粥一杯，利过不止，进冷粥一杯。
【注】是方治寒实痰水结胸，极峻之药也。君以巴豆极辛极烈，攻寒逐水，斩关夺门，所
到之处无不破也。佐以贝母开胸之结，使以桔梗为之舟楫，载巴豆搜逐胸邪。膈上者必
吐，膈下者必利，使其邪悉尽无余矣。然惟知任毒以攻邪，不量强羸，鲜能善其后也，故
羸者减之，不利进热粥，利过进冷粥，盖巴豆性热，得热则行，得冷则止。不用水而用
粥者，藉谷气以保胃也。
大黄黄连泻心汤 治伤寒表解，心下痞，按之不软，其脉关上浮者。
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。
【注】痞硬虚邪而用大黄、黄连，能不起后人之疑耶？仲景使人疑处，正是妙处。盖
因后人未尝细玩，不得其法，皆煎而服之，大悖其旨矣。观乎用气薄之麻沸汤渍大黄、黄
连，须臾去滓，仅得其无形之气，不重其有形之味，是取其气味俱薄，不大泻下。虽曰
攻痞，而攻之之妙义无穷也。
附子泻心汤 治伤寒表解，心下痞，恶寒汗出者。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（炮去皮，别煮汁，一枚）
上四味，切三味，以麻沸汤二升渍之，须臾绞去滓，内附子汁，分温再服。
【注】心下硬痛，结胸也；硬而不痛，心下痞也。恶寒而复汗出，非表不解，乃表阳
虚也。故以大黄、黄连、黄芩泻痞之热，附子温表之阳，合内外而治之。其妙在以麻沸
汤渍三黄，须臾绞去滓，内别煮附子汁，义在泻痞之意轻，扶阳之意重也。
甘草泻心汤 治伤寒中风，医反下之，其人下利，日数十行，谷不化，腹中雷鸣，心
下痞硬而满，干呕心烦不得安。医见心下痞，谓病不尽，复下之，其痞益甚，此非结热，但
以胃中虚客气上逆，故使硬也。
甘草（四两） 黄芩（三两） 黄连（一两） 干姜（三两） 半夏（洗，半升） 大枣（擘，十二枚）
上六味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【注】毋论伤寒、中风，表未解，总不可下，医反下之，因而成痞。其人下利日数十
行，水谷不化，腹中雷鸣者，误下胃中空虚也。心下痞硬而满，干呕心烦不得安者，乘
虚客邪上逆也。医见心下痞硬，谓下之不尽，又复下之，其痞益甚。但此非结热之痞，亦
非寒结之痞，乃乘胃空虚，客气上逆，阳陷阴凝之痞也。方以甘草命名者，取和缓之意。
用甘草、大枣之甘温，补中缓急，治痞之益甚。半夏之辛，破客逆之上从。芩、连泻阳
陷之痞热，干姜散阴凝之痞寒。缓急破逆，泻痞寒热，备乎其治矣。
生姜泻心汤 治伤寒汗出解后，胃中不和，心下痞硬，干噫食臭，胁下有水气，腹
中雷鸣下利者。
甘草（炙，二两） 人参（三两） 干姜（一两） 半夏（洗，半升） 黄芩（三两） 黄连（一两）
生姜（切，四两） 大枣（擘，十二枚）
上八味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【注】伤寒汗出之后，余邪转属阳明，心下痞满硬痛不大便者，此其人胃素燥热，因
而成实，攻之可也。今其人平素胃虚，兼胁下有水气，即不误下，余热乘虚入里，结成
痞硬不痛，胃虚不能消化水谷，则干噫食臭也。胃中寒热不和，则腹中雷鸣下利也。名
生姜泻心汤者，其义重在散水气之痞也。生姜、半夏散胁下之水气，人参、大枣补中州
之土虚，干姜、甘草以温里寒，黄芩、黄连以泻痞热。备乎虚水寒热之治，胃中不和下
利之痞，未有不愈者也。
半夏泻心汤 治伤寒五六日，呕而发热，柴胡证具，而以他药下之，但满不痛，心下
痞者。
半夏（洗，半升） 黄芩（三两） 干姜（三两） 人参（三两） 黄连（一两） 甘草（炙，三两）
大枣（擘，十二枚）
上七味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【集注】王又原曰∶伤寒五六日，柴胡证具，而以他药下之成痞。即用小柴胡汤，以
干姜易生姜，以黄连易柴胡。彼以和表里，此以彻上下。而必推半夏为君者，痞从呕得来，
半夏之辛以破结而止呕也。
旋复代赭石汤 治汗、吐、下解之后，心下痞硬，噫气不除。
旋复花（三两） 人参（二两） 代赭石（一两） 半夏（洗，半升） 生姜（切，五两）
甘草（炙，三两） 大枣（擘，十二枚）
上七味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【集注】罗谦甫曰∶汗、吐、下解后，邪虽去而胃气已亏矣。胃气既亏，三焦因之失
职，清无所归而不升，浊无所纳而不降，是以邪气留滞，伏饮为逆，故心下痞硬，噫气
不除。方中以人参、甘草养正补虚，姜、枣和脾养胃，所以安定中州者至矣。更以代赭
石之重，使之敛浮镇逆，旋复花之辛，用以宣气涤饮，佐人参以归气于下，佐半夏以蠲
饮于上。浊降痞硬可消，清升噫气自除，观仲景治少阴水气上凌，用真武汤镇之；治下
焦滑脱不守，用赤石脂禹余粮固之。此胃虚气失升降，复用此法理之，则胸中转否为泰，
其为归元固下之法，各极其妙如此。
麻黄连轺赤小豆汤 治伤寒表不解，瘀热在里发黄者。
麻黄（二两） 赤小豆（一升） 杏仁（去皮尖，四十枚） 生姜（切，一两） 大枣（擘，十二枚）
甘草（炙，一两） 生梓白皮（一升） 连轺（二两）
以上八味，以潦水一斗，先煮麻黄，再沸，去上沫，内诸药，煮取三升，分温三服，
半日则尽。
【注】湿热发黄无表里证，热盛者清之，小便不利者利之，里实者下之，表实者汗之，
皆无非为病求去路也。用麻黄汤以开其表，使黄从外而散。去桂枝者避其湿热也，佐姜枣
者和其营卫也，加连轺、梓皮以泻其热，赤小豆以利其湿，同成表实发黄之效也。连轺
即连翘根，无梓皮以茵陈代之，成无己曰∶煎以潦水者，取其味薄不助湿热也。
栀子柏皮汤 治伤寒身黄发热，无表里证者。
栀子（擘，十五枚） 甘草（一两） 黄柏（一两）
上三味，以水四升，煮取一升半，去滓，分温再服。
【注】伤寒身黄发热者，若有无汗之表，以麻黄连轺赤小豆汤汗之；若有成实之里，以
茵陈蒿汤下之。今外无可汗表证，内无可下里证，惟有黄热，宜以栀子柏皮汤清之可也。
此方之甘草当是茵陈，传写之误也。
茵陈蒿汤 阳明病发热，但头汗出，身无汗，小便不利，渴饮水浆，此为瘀热在里，
身必发黄，腹微满者，本方主之。
茵陈蒿（六两） 栀子（擘，十四枚） 大黄（二两）
上三味，以水二斗，先煮茵陈，减六升，内二味，煮取三升，去滓，分温三服。小便
当利，如皂角汁状，色正赤，一宿腹减，黄从小便去也。
【集注】柯琴曰∶太阳、阳明俱有发黄证，但头汗出而身无汗，则热不外越。小便不利，
则热不下泄，故瘀热在里。然里有不同，肌肉是太阳之里，当汗而发之，故用麻黄连翘
赤小豆汤为凉散法。心胸是太阳阳明之里，当寒以胜之，用栀子柏皮汤，乃清火法。肠胃
是阳明之里，当泻之于内，故立本方，是逐秽法。茵陈禀北方之气，经冬不调，傲霜凌
雪，偏受大寒之气，故能除热邪留结，率栀子以通水源，大黄以调胃实，令一身内外瘀
热，悉从小便而出，腹满自减，肠胃无伤，乃合引而竭之之法，此阳明利水之圣剂也。又
曰∶仲景治阳明渴饮有四法∶本太阳转属者，五苓散微发汗以散水气∶大烦燥渴小便自利
者，白虎加参清火而生津；脉浮发热小便不利者，猪苓汤滋阴而利水；小便不利腹满者，
茵陈蒿汤以泄满，令黄从小便出，病情治法，胸有成竹矣。每思仲景利小便必用气化之品，
通大便必用承气之品。故小便不利者，必加茯苓，甚者兼用猪苓，因二苓为气化之品，而
小便由于气化也。兹小便不利，不用二苓者何？本论云∶阳明病，汗出多而渴者，不可
与猪苓汤，以汗多胃中燥，猪苓汤复利小便故也。斯知阳明病汗出多而渴者，不可用，则
汗不出而渴者，津液先虚，更不可用明矣。此以推陈致新之茵陈，佐以屈曲下行之栀子，不
用枳、朴以承气，与芒硝之峻利，则大黄但可以润胃燥，而大便之不遽行可知。故必一
宿而腹始减，黄从小便去而不由大肠去，仲景立法神奇，匪夷所思耳。
Pound the first two ingredients into a powder. Place the Crotonis Fructus (Badou, 巴豆) in a mortar and pound it. Mix with rice water and administer orally. For robust individuals, administer one qian; for frail individuals, reduce the dose. If the pathogen is above the diaphragm, vomiting will inevitably occur; if below the diaphragm, purging will inevitably occur. If there is no purging after administration, drink one cup of hot porridge to promote the effect; if purging is excessive and does not stop, drink one cup of cold porridge to arrest it.
[Annotation] This formula treats Cold-Excess Phlegm-Water Chest Binding (Han Shi Tan Shui Jie Xiong), which is an extremely potent medicine. Crotonis Fructus (Badou, 巴豆) serves as the sovereign drug; due to its extreme pungency and烈ness, it attacks cold and expels water, breaking through barriers like a siege engine, destroying everything in its path. Fritillariae Thunbergii Bulbus (Beimu, 贝母) acts as the assistant to open chest congestion, while Platycodonis Radix (Jiegeng, 桔梗) serves as the guide, acting as a vessel to carry Crotonis Fructus to search out and expel pathogens in the chest. Pathogens above the diaphragm cause vomiting; those below cause purging, ensuring all pathogens are completely eliminated. However, knowing only to use toxic drugs to attack pathogens without weighing the patient's strength or weakness rarely leads to good outcomes. Therefore, the dose is reduced for the frail, hot porridge is given if there is no purging (to aid yang and move the medicine), and cold porridge is given if purging is excessive (to inhibit the medicine). This is because Crotonis Fructus (Badou, 巴豆) is hot in nature; its action accelerates with heat and stops with cold. Porridge is used instead of water to leverage the grain qi to protect the stomach qi.
Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium): Treats Shaoyang disease where the exterior syndrome has resolved, resulting in epigastric fullness and stuffiness (Pi), which feels hard upon pressure but is not soft, with a floating pulse at the Guan position.
Dahuang (Rhei Radix et Rhizoma, 大黄) (2 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang)
Take these two ingredients, soak them in two sheng of boiling water (Mafei Tang, 麻沸汤) for a short while, then strain off the dregs. Divide into two doses and take warm.
[Annotation] Using Dahuang (Rhei Radix et Rhizoma, 大黄) and Huanglian (Coptidis Rhizoma, 黄连) for Pi (epigastric fullness/stuffiness) caused by deficiency and evil naturally raises doubts among later generations. The very place where Zhang Zhongjing creates doubt is precisely where the brilliance lies. It is likely that later generations did not study carefully and missed the method, decocting and taking the herbs, which completely contradicts the original intent. Observing the use of Mafei Tang (boiling water), which has thin qi, to soak Dahuang (Rhei Radix et Rhizoma, 大黄) and Huanglian (Coptidis Rhizoma, 黄连), and straining immediately, extracts only their formless qi, not their heavy taste. This aims for thin qi and flavor, avoiding drastic purgation. Although it attacks Pi (epigastric fullness/stuffiness), the subtlety of this attack is infinite.
Fuzi Xiexin Tang (Aconite Decoction to Drain the Epigastrium): Treats Shaoyang disease where the exterior syndrome has resolved, accompanied by epigastric fullness and stuffiness (Pi), aversion to cold, and sweating.
Dahuang (Rhei Radix et Rhizoma, 大黄) (2 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Huangqin (Scutellariae Radix, 黄芩) (1 liang) Fuzi (Prepared Aconiti Lateralis Radix, 附子) (Processed, peeled, decocted separately for juice, 1 piece)
Cut the first three ingredients, soak them in two sheng of Mafei Tang (boiling water) for a short while, strain off the dregs, add the Fuzi (Prepared Aconiti Lateralis Radix, 附子) juice, divide into two doses, and take warm.
[Annotation] Hardness and pain in the epigastrium indicate Chest Binding (Jie Xiong); hardness without pain indicates Epigastric Fullness and Stuffiness (Xia Pi). Aversion to cold combined with sweating indicates not unresolved exterior syndrome, but deficiency of Exterior Yang. Therefore, Dahuang (Rhei Radix et Rhizoma, 大黄), Huanglian (Coptidis Rhizoma, 黄连), and Huangqin (Scutellariae Radix, 黄芩) are used to drain the heat of Pi (epigastric fullness/stuffiness), while Fuzi (Prepared Aconiti Lateralis Radix, 附子) warms the Exterior Yang, treating both interior and exterior. The subtlety lies in soaking the "Three Yellows" (Dahuang, Huanglian, Huangqin) in Mafei Tang (boiling water) and straining immediately, then adding separately decocted Fuzi (Prepared Aconiti Lateralis Radix, 附子) juice. The intent is lighter on draining Pi (epigastric fullness/stuffiness) and heavier on supporting Yang.
Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium): Treats Shaoyang disease or Wind Strike where the physician erroneously used purgatives. The patient suffers from diarrhea dozens of times a day, undigested food, borborygmus (rumbling in the abdomen), epigastric fullness and stuffiness (Pi) with hardness and distension, dry retching, irritability, and restlessness. Seeing the epigastric Pi (fullness/stuffiness), the physician thought the pathogen was not fully expelled and purged again, making the Pi (fullness/stuffiness) worse. This is not Heat Binding, but rather deficiency in the stomach with rebellious Qi rising, causing hardness.
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (4 liang) Huangqin (Scutellariae Radix, 黄芩) (3 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Ganjiang (Zingiberis Rhizoma, 干姜) (3 liang) Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above six ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Annotation] Regardless of Shaoyang disease or Wind Strike, if the exterior syndrome is unresolved, purgatives should never be used. The physician erroneously purged, leading to Pi (epigastric fullness/stuffiness). Diarrhea dozens of times a day with undigested food and borborygmus results from the emptiness of the stomach caused by erroneous purging. Epigastric Pi (fullness/stuffiness) with hardness and distension, dry retching, irritability, and restlessness result from pathogenic factors invading upward due to deficiency. Seeing the epigastric Pi (fullness/stuffiness) and hardness, the physician thought purging was incomplete and purged again, worsening the Pi (fullness/stuffiness). This is neither Heat Binding Pi nor Cold Binding Pi, but Pi caused by pathogenic factors invading upward due to stomach emptiness, with Yang sinking and Yin coagulating. The formula is named after Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) to imply a gentle and moderating approach. Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) and Dazao (Jujubae Fructus, 大枣) use their sweet and warm nature to tonify the middle and relieve urgency, treating the worsening Pi (fullness/stuffiness). Banxia (Pinelliae Rhizoma, 半夏)'s pungency breaks the rebellion of pathogenic Qi. Huangqin (Scutellariae Radix, 黄芩) and Huanglian (Coptidis Rhizoma, 黄连) drain the heat of Yang-sinking Pi (epigastric fullness/stuffiness), while Ganjiang (Zingiberis Rhizoma, 干姜) disperses the cold of Yin-coagulation Pi (epigastric fullness/stuffiness). Relieving urgency, breaking rebellion, draining Pi (epigastric fullness/stuffiness), and treating cold and heat comprehensively completes the treatment.
Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium): Treats Shaoyang disease where sweating resolved the exterior, but the stomach is disharmonious, resulting in epigastric Pi (fullness/stuffiness) with hardness, belching with a smell of fermented food, fluid retention under the flanks, borborygmus, and diarrhea.
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 2 liang) Renshen (Panacis Ginseng Radix, 人参) (3 liang) Ganjiang (Zingiberis Rhizoma, 干姜) (1 liang) Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Huangqin (Scutellariae Radix, 黄芩) (3 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Shengjiang (Zingiberis Rhizoma Recens, 生姜) (Sliced, 4 liang) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above eight ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Annotation] After sweating resolves Shaoyang disease, residual pathogens may transfer to Yangming. If the epigastrium is full, stiff, painful, and constipated, it indicates the person usually has dry-heat in the stomach, leading to excess, which can be attacked. However, this person usually has stomach deficiency and fluid retention under the flanks. Even without erroneous purging, residual heat enters the interior due to deficiency, forming Pi (fullness/stuffiness) that is hard but not painful. Stomach deficiency fails to digest food and fluids, causing belching with a smell of fermented food. Disharmony of cold and heat in the stomach causes borborygmus and diarrhea. Named Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium), the emphasis is on dissipating Pi (fullness/stuffiness) caused by fluid retention. Shengjiang (Zingiberis Rhizoma Recens, 生姜) and Banxia (Pinelliae Rhizoma, 半夏) dissipate fluid retention under the flanks; Renshen (Panacis Ginseng Radix, 人参) and Dazao (Jujubae Fructus, 大枣) tonify the deficiency of the Middle Jiao Earth; Ganjiang (Zingiberis Rhizoma, 干姜) and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) warm the interior cold; Huangqin (Scutellariae Radix, 黄芩) and Huanglian (Coptidis Rhizoma, 黄连) drain Pi (epigastric fullness/stuffiness) heat. This comprehensively treats deficiency, fluid, cold, and heat. Cases of Pi (epigastric fullness/stuffiness) with diarrhea due to stomach disharmony will invariably heal.
Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium): Treats Shaoyang disease after five or six days, with vomiting and fever, presenting Chaihu Syndrome (Bupleuri Syndrome), but the physician erroneously purged with other drugs, resulting in fullness without pain and epigastric Pi (fullness/stuffiness).
Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Huangqin (Scutellariae Radix, 黄芩) (3 liang) Ganjiang (Zingiberis Rhizoma, 干姜) (3 liang) Renshen (Panacis Ginseng Radix, 人参) (3 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 3 liang)
Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above seven ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Collected Annotations] Wang Youyuan said: After five or six days of Shaoyang disease, when Chaihu Syndrome (Bupleuri Syndrome) is present, erroneous purging leads to Pi (epigastric fullness/stuffiness). Even using Xiao Chaihu Tang (Minor Bupleurum Decoction), Ganjiang (Zingiberis Rhizoma, 干姜) replaces Shengjiang (Zingiberis Rhizoma Recens, 生姜), and Huanglian (Coptidis Rhizoma, 黄连) replaces Chaihu (Bupleuri Radix, 柴胡). The former harmonizes interior and exterior; the latter clears upper and lower. Banxia (Pinelliae Rhizoma, 半夏) must be considered the sovereign drug because Pi (epigastric fullness/stuffiness) arises from vomiting, and Banxia (Pinelliae Rhizoma, 半夏)'s pungency breaks stagnation and stops vomiting.
Xuanfu Daizhe Shi Tang (Inula and Hematitum Decoction): Treats epigastric Pi (fullness/stuffiness) with hardness and persistent belching after sweating, vomiting, or purging have resolved the condition.
Xuanfuhua (Inulae Flos, 旋复花) (3 liang) Renshen (Panacis Ginseng Radix, 人参) (2 liang) Daizhishi (Hematitum, 代赭石) (1 liang) Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Shengjiang (Zingiberis Rhizoma Recens, 生姜) (Sliced, 5 liang)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 3 liang) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above seven ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Collected Annotations] Luo Qianfu said: After sweating, vomiting, and purging, although pathogens are gone, stomach qi is depleted. With depleted stomach qi, the Triple Burner loses its function; clear qi has no return and does not ascend, turbid qi has no reception and does not descend. Thus, pathogenic factors linger, and retained fluid rebels, causing epigastric Pi (fullness/stuffiness) with hardness and persistent belching. In the formula, Renshen (Panacis Ginseng Radix, 人参) and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) nourish righteousness and tonify deficiency; ginger and jujube harmonize spleen and nourish stomach, greatly stabilizing the Middle Jiao. Furthermore, the heaviness of Daizhishi (Hematitum, 代赭石) converges floating qi and suppresses rebellion; the pungency of Xuanfuhua (Inulae Flos, 旋复花) promotes qi circulation and eliminates fluid, assisting Renshen (Panacis Ginseng Radix, 人参) to direct qi downward, and assisting Banxia (Pinelliae Rhizoma, 半夏) to eliminate fluid upward. As turbidity descends, Pi (fullness/stuffiness) dissipates; as clarity ascends, belching ceases. Observe Zhang Zhongjing treating Shaoyin Water Qi flooding upward with Zhenwu Tang (True Warrior Decoction) to suppress it; treating Lower Jiao sliding and loss of control with Chishizhi Yuyuliang Tang (Red Stone and Hematite Decoction) to consolidate it. Here, stomach deficiency leads to loss of qi ascending and descending; applying this method again transforms obstruction into smoothness. Their methods of returning to the source and consolidating the lower are each exquisitely subtle.
Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction): Treats Shaoyang disease where the exterior is unresolved, and stasis-heat is trapped inside, causing jaundice.
Mahuang (Ephedrae Herba, 麻黄) (2 liang) Chixiaodou (Phaseoli Semen Rubrum, 赤小豆) (1 sheng) Xingren (Armeniacae Semen Amarum, 杏仁) (Skin and tips removed, 40 pieces) Shengjiang (Zingiberis Rhizoma Recens, 生姜) (Sliced, 1 liang) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 1 liang) Shengzibaipí (Catalpae Cortex Albus Recens, 生梓白皮) (1 sheng) Lianqiao (Forsythiae Fructum, 连轺) (2 liang)
Take the above eight ingredients, boil in one dou of Liaoshui (rainwater or surface runoff) first. Boil Mahuang (Ephedrae Herba, 麻黄), remove the foam on the surface when boiling, add the remaining herbs, boil until three sheng remain. Divide into three warm doses, finish within half a day.
[Annotation] For damp-heat jaundice without distinct exterior or interior syndromes: if heat is excessive, clear it; if urination is difficult, promote diuresis; if interior excess exists, purge it; if exterior excess exists, induce sweating. All aim to provide an exit for the pathogen. Using Mahuang Tang (Ephedra Decoction) to open the exterior allows the yellow color to disperse outward. Guizhi (Cinnamomi Ramulus, 桂枝) is removed to avoid aggravating damp-heat; ginger and jujube are added to harmonize Ying and Wei; Lianqiao (Forsythiae Fructum, 连轺) and Zibai pi (Catalpae Cortex Albus, 梓白皮) drain heat; Chixiaodou (Phaseoli Semen Rubrum, 赤小豆) promotes dampness drainage, jointly achieving the effect of treating exterior-excess jaundice. Lianqiao (Forsythiae Fructum, 连轺) refers to the root of Forsythia suspensa; if Zibai pi (Catalpae Cortex Albus, 梓白皮) is unavailable, Yinchen (Artemisiae Scopariae Herba, 茵陈) can substitute. Cheng Wuji stated: Using Liaoshui (rainwater) for decoction takes advantage of its thin flavor to avoid aiding damp-heat.
Zhizi Baipi Tang (Gardenia and Phellodendron Decoction): Treats Shaoyang disease with body jaundice and fever, without exterior or interior syndromes.
Zhizi (Gardeniae Fructus, 栀子) (Broken open, 15 pieces) Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (1 liang) Huangbai (Phellodendri Cortex, 黄柏) (1 liang)
Take the above three ingredients, boil in four sheng of water until one and a half sheng remain, strain, divide into two warm doses.
[Annotation] For Shaoyang disease with body jaundice and fever: if there is an exterior syndrome of no sweat, use Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) to induce sweating; if there is interior excess, use Yinchen Hao Tang (Artemisia and Yellow Gentian Decoction) to purge. Now, there is no exterior syndrome suitable for sweating externally, nor interior excess suitable for purging internally; there is only jaundice and heat, so Zhizi Baipi Tang (Gardenia and Phellodendron Decoction) should be used to clear it. The Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) in this formula should be Yinchen (Artemisiae Scopariae Herba, 茵陈); this is a transcription error.
Yinchen Hao Tang (Artemisia and Yellow Gentian Decoction): Yangming disease with fever, only head sweating, no body sweating, difficulty urinating, thirst for drinking fluids. This indicates stasis-heat trapped inside, leading to body jaundice and slight abdominal fullness. This formula is indicated.
Yinchen Hao (Artemisiae Scopariae Herba, 茵陈蒿) (6 liang) Zhizi (Gardeniae Fructus, 栀子) (Broken open, 14 pieces) Dahuang (Rhei Radix et Rhizoma, 大黄) (2 liang)
Take the above three ingredients, boil in two dou of water. First boil Yinchen Hao (Artemisiae Scopariae Herba, 茵陈蒿) until the volume reduces by six sheng, then add the other two ingredients, boil until three sheng remain, strain, divide into three warm doses. Urination should become profuse, resembling soy sauce liquid, with a reddish color. After one night, abdominal fullness decreases, and the yellow color exits via urination.
[Collected Annotations] Ke Qin said: Both Taiyang and Yangming diseases have jaundice syndromes. If only the head sweats and the body does not, heat cannot vent outward. If urination is difficult, heat cannot drain downward, so stasis-heat traps inside. However, the interior location differs: Muscles are the interior of Taiyang, requiring sweating to release, hence Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is used as a cooling dispersion method. Heart and chest are the interior of Taiyang and Yangming, requiring cold to overcome heat, hence Zhizi Baipi Tang (Gardenia and Phellodendron Decoction) is used as a fire-clearing method. Intestines and stomach are the interior of Yangming, requiring internal purging, hence this formula is established as a turbidity-expelling method. Yinchen (Artemisiae Scopariae Herba, 茵陈) inherits Northern energy, remains evergreen through winter, braves frost and snow, absorbing great cold energy, thus clearing heat-pathogen accumulation. It leads Zhizi (Gardeniae Fructus, 栀子) to unblock the water source and Dahuang (Rhei Radix et Rhizoma, 大黄) to regulate stomach excess, allowing stasis-heat throughout the body to exit via urination. Abdominal fullness naturally decreases, intestines and stomach are unharmed, fitting the method of "drawing out and exhausting." This is the holy agent for promoting urination in Yangming disease. He also said: Zhang Zhongjing has four methods for treating Yangming thirst and drinking: Transferred from Taiyang, use Wuling San (Five-Ling Powder) to mildly induce sweating and dissipate water qi; Great vexation, thirst, and normal urination, use Baihu Jiasharen Tang (White Tiger plus Ginseng Decoction) to clear fire and generate fluids; Floating pulse, fever, and difficulty urinating, use Zhu Ling Tang (Polyporus Decoction) to nourish yin and promote urination; Difficulty urinating and abdominal fullness, use Yinchen Hao Tang (Artemisia and Yellow Gentian Decoction) to drain fullness, letting yellow exit via urination. The pathology and treatment principles are clear in mind. I often reflect that Zhang Zhongjing uses qi-transforming herbs for promoting urination and Chengqi herbs for unblocking bowels. Thus, for difficulty urinating, Fuling (Poria, 茯苓) is added, and Zhu Ling (Polyporus, 猪苓) is added in severe cases, because these two are qi-transforming herbs, and urination depends on qi transformation. Why are these two not used here? The text states: Yangming disease with excessive sweating and thirst should not receive Zhu Ling Tang (Polyporus Decoction), because excessive sweating causes dryness in the stomach, and Zhu Ling Tang (Polyporus Decoction) further promotes urination. Thus, it is known that Yangming disease with excessive sweating and thirst cannot use it; therefore, non-sweating but thirsty patients, whose fluids are already deficient, certainly cannot use it either. Here, using Yinchen (Artemisiae Scopariae Herba, 茵陈) to push out the old and bring forth the new, assisted by Zhizi (Gardeniae Fructus, 栀子) which bends downward, without using Zhishi (Immature Bitter Orange, 枳实) and Houpo (Magnolia Bark, 厚朴) to form Chengqi Tang (Order the Qi Decoction), nor Mangxiao (Mirabilite, 芒硝) for harsh purging, Dahuang (Rhei Radix et Rhizoma, 大黄) can only moisten stomach dryness, and immediate bowel movement is unlikely. Thus, abdominal fullness only decreases after one night, and yellow exits via urination, not the large intestine. Zhang Zhongjing's legislation is magical and beyond imagination.