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
泻心
大黄（二两） 黄连（一两）
以麻沸汤二升，渍之须臾，绞去滓服之。
心下痞，而复恶寒汗出者，附子泻心汤。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（一枚，别煮取汁。）
以麻沸汤二升，渍三味，须臾，去滓，纳附子汁。
伤寒汗出解之后，胃中不和，心下痞硬，干噫食臭，胁下有水气，腹中雷鸣，下利，生
姜泻
生姜（四两） 甘草 人参（各三两） 干姜（一两） 黄连（一两） 黄芩（三两） 半
夏
（半升） 大枣（十
上八味，以水一斗，煮取六升，分温三服。
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
逆
甘草（四两） 黄芩 干姜（各三两） 半夏（半升） 黄连（一两） 大枣（十二枚）
上六味，以水一斗，煮取六升，去滓，分温三服。
王又原曰∶病发于阴而反下之，因作痞。然亦有汗出解之后而痞者，亦有下后复汗而痞
者，
辛以
而同
五六
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
汗出解之后，已无伤寒矣。胃藏津液，发汗则津液亡，故胃中不
发胃家升腾之气，乃治杂证之标的也。一属少阳，一属汗解，人
正在太阳，无用人参之例。虽下而复下，为胃中虚，不可用也。
和其客气之上逆，温其中气之不调，补其心烦之不安焉耳。心下
痞之诊也。按之濡，关上浮，为痞尚未成，故无用虏荆之六十
此渍以麻沸汤，须臾去滓，仅得其无形之气，不用其有形之味
之症，明系表邪未解；心下痞而复恶寒者，为续见之证，明系
见者，以两汤治之；续见者，以一汤救之。其附子则煮汁者，
重也。然胃居心下，心下痞者，胃痞也。不曰泻胃，而曰泻心
误为传入阳明，以治阳明之法治之也。此仲景之微旨也。
After severe purgation in a Taiyang disease (disease of the Taiyang channel), followed by repeated sweating, if epigastric fullness and stuffiness (Xin Xia Pi) occurs accompanied by aversion to cold, it indicates that the exterior syndrome has not yet resolved. One must not attack the fullness directly; instead, one should first resolve the exterior. Only after the exterior is resolved can the fullness be treated.
Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction for Draining the Epigastrium):
Da Huang (Rhei Radix et Rhizoma, 2 liang); Huang Lian (Coptidis Rhizoma, 1 liang).
Soak in two sheng of boiling water (Ma Fei Tang) for a short while, strain, and take the decoction.
If epigastric fullness and stuffiness is accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium) is indicated.
Da Huang (Rhei Radix et Rhizoma, 2 liang); Huang Lian (Coptidis Rhizoma, 1 liang); Huang Qin (Scutellariae Radix, 1 liang); Fu Zi (Aconiti Lateralis Radix Praeparata, one piece, boiled separately to extract juice).
Soak the three herbs (Da Huang, Huang Lian, Huang Qin) in two sheng of boiling water for a short while, strain, and mix with the juice of the boiled Fu Zi.
After sweating resolves the exterior syndrome in Taiyang disease, if there is disharmony in the Stomach, hardness and fullness in the epigastrium, dry belching with a smell of undigested food, fluid retention under the flanks, borborygmus in the abdomen, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Decoction for Draining the Epigastrium) is indicated.
Sheng Jiang (Zingiberis Rhizoma Recens, 4 liang); Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix, each 3 liang); Gan Jiang (Zingiberis Rhizoma, 1 liang); Huang Lian (Coptidis Rhizoma, 1 liang); Huang Qin (Scutellariae Radix, 3 liang); Ban Xia (Pinelliae Rhizoma, half sheng); Da Zao (Jujubae Fructus, 10 pieces).
Boil these eight ingredients in ten dou of water until six sheng remain, divide into three doses, and take warm.
In Taiyang disease or Zhongfeng (Wind Strike), if the physician erroneously uses purgation, leading to diarrhea occurring dozens of times a day with undigested food, borborygmus, hard and full epigastric stuffiness, and dry vomiting, Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium) is indicated.
Gan Cao (Glycyrrhizae Radix et Rhizoma, 4 liang); Huang Qin (Scutellariae Radix), Gan Jiang (Zingiberis Rhizoma, each 3 liang); Ban Xia (Pinelliae Rhizoma, half sheng); Huang Lian (Coptidis Rhizoma, 1 liang); Da Zao (Jujubae Fructus, 12 pieces).
Boil these six ingredients in ten dou of water until six sheng remain, strain, divide into three doses, and take warm.
Wang Youyuan stated: When a disease originates from the Yin aspect and is erroneously purged, Pi (fullness/stuffiness) results. However, Pi can also remain after sweating resolves the exterior, or arise after purgation followed by sweating... Pungent substances harmonize the interior and exterior, thereby clearing the upper and lower. Ban Xia is elevated as the sovereign herb because Pi arises from vomiting... After sweating resolves the exterior, Taiyang disease is gone. The Stomach stores Jin Ye (Body Fluids); sweating depletes these fluids, causing Stomach disharmony... stimulating the ascending Qi of the Stomach-Fu is the symptomatic treatment for miscellaneous diseases. One case belongs to Shaoyang, another to post-sweating resolution... If the pathogen is still in Taiyang, there is no indication for Ren Shen. Although double purgation causes Stomach deficiency, certain tonics may be contraindicated... Harmonizing the rebellious Qi, warming the middle Jiao, and calming mental restlessness are the goals. The diagnosis of epigastric Pi: palpable softness and floating Guan pulse indicate Pi is not yet fully formed... Soaking in boiling water extracts only the formless Qi, not the solid taste... Symptoms clearly show unresolved exterior pathogens; Pi with aversion to cold appearing subsequently indicates a new development... Two formulas treat simultaneous occurrences; one formula treats subsequent developments. Fu Zi is boiled separately to preserve its potency... The Stomach resides below the heart; thus, epigastric Pi is Stomach Pi. It is called "Draining the Heart" rather than "Draining the Stomach"... Mistakenly treating it as Yangming transmission using Yangming methods misses Zhang Zhongjing's profound intent.