麻子仁（二升） 芍药 枳实（各半斤擘） 大黄（去皮） 浓朴（去皮） 杏仁（各一斤去皮
尖熬别研作脂）
上六味为末。炼蜜为丸。如桐子大。饮服十丸。日三服。渐加。以利为度。趺阳脉浮而涩。
浮则胃气强。涩则小便数。浮涩相搏。大便则难。其脾为约。麻仁丸主之。按经言太阳阳明
者。脾约是也。此与攻胃实不同。故用芍药以益阴。麻杏以润燥。而大黄浓朴分两皆从轻减
。服止十丸。以次渐加。皆示不欲遽下之意。
蜜七合。一味纳铜器中。微火煎之。稍凝饴状。搅之勿令焦着。欲可丸。并手捻作挺。
令头锐
。大如指。长二寸许。当热时急作。冷则硬。以纳谷道中。以手急抱。欲大便时。乃去之。
按汗出矢硬。何殊阳明内实之证。但小便自利。则津液内竭。慎不可攻矣。一切下剂。
皆在
禁例。误投之则重虚其津液。故宜蜜煎导而通之。不从内治而从外治。但使硬矢得下。仍无
伤于胃气也。
大猪胆一枚。泻汁。和醋少许。以灌谷道中。如一食顷。当大便出。此与蜜煎导方同义
。但蜜煎导借其热势以行津液。此则于导滞之中。
兼寓涤热之意。微细有别。土瓜导亦同此法。
生姜（四两切） 甘草（三两炙） 人参（三两） 干姜（一两） 黄芩（三两） 黄连（一两）
半夏（半升洗） 大枣（十二枚擘）
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。
伤寒汗出解之后。胃中不和。心下痞硬。干噫食臭。胁下有水气。腹中雷鸣下利者。生
姜泻
心汤主之。按伤寒成痞。多因误下。此则不因误下而成痞。皆因胃中不和。太阳未尽之余邪
。入而与内饮相搏结。阳邪居胃之上口。故心下痞硬。干噫食臭。水邪居胃之下口。故胁
下有水气。
而腹中雷鸣下利。故君以生姜。两擅散邪逐饮之用。而热之格于上者。用芩连之苦以泻之。
寒之格于下者。用干姜半夏之温以泻之。复以人参甘草大枣和养胃气。使邪不能犯正而痞自
解。以痞在心下。故方以泻心名。此寒热错杂之邪。故以寒热错杂之药治之。而一一对证。
制方之义精矣。
麻子仁（二升） 芍药 枳实（各半斤，掰开） 大黄（去皮） 浓朴（去皮） 杏仁（各一斤，去皮尖，熬制后单独研成脂状）
以上六味药捣碎成末。用炼蜜制成丸剂。大小如梧桐子。温水送服十丸。每日三次。逐渐增加剂量。以大便通畅为度。趺阳脉（足背动脉，反映脾胃状况）浮而涩。浮表示胃气强盛。涩表示小便频数。浮与涩相互搏结。导致大便困难。这就是脾约证（脾阴不足，约束大肠，致便秘）。麻仁丸主治。按《伤寒论》经文所说太阳阳明合病中的脾约证即是此证。这与攻下胃中实热不同。所以用芍药来滋养阴液。用麻子、杏仁来润燥。而大黄、浓朴的用量都从轻减少。每次只服十丸。依次逐渐增加。这都是显示不急于峻下的意思。
蜂蜜七合。将蜂蜜放入铜器中。用微火煎煮。稍微凝固成饴糖状。搅拌它不要让它焦糊粘底。等到可以做成丸剂时。用手捻成条状。让一头尖锐。粗细如手指。长约两寸左右。趁热时赶紧制作。冷了就会变硬。将其纳入肛门中。用手紧紧抱住臀部。想大便时。再取出。按：汗出后大便干硬。这与阳明腑实证有什么不同呢？只是小便自利（正常或偏多）。说明津液在体内枯竭。千万不可攻下。一切泻下剂。都在禁忌之列。误用则会进一步损伤津液。所以适宜用蜜煎导法从外部通便。不从内部治疗而从外部治疗。只要使干硬的大便排出。就不会伤害胃气。
大猪胆一个。取胆汁。加少许醋。灌入肛门中。大约一顿饭的时间。大便应当排出。这与蜜煎导方的原理相同。但蜜煎导是利用其温热之势来运行津液。这里则在通导积滞之中。兼寓清除热邪之意。细微之处有所不同。土瓜根导法也是同样的方法。
生姜（四两，切片） 甘草（三两，炙烤） 人参（三两） 干姜（一两） 黄芩（三两） 黄连（一两） 半夏（半升，洗净） 大枣（十二枚，掰开）
以上八味药。用水一斗。煮取六升。去掉药渣。再次煎煮取三升。温服一升。每日三次。
伤寒发汗后表证已解。但胃中不和。心下部痞塞胀硬。干呕伴有食物腐臭气味。胁下有停饮。肠鸣音亢进并腹泻。生姜泻心汤主治。按：伤寒形成痞证。多因误用下法所致。此处并非因误下而成痞。都是因为胃中不和。太阳经未尽之余邪。进入体内与内在水饮相互搏结。阳邪停留在胃的上口。所以心下部痞塞胀硬。干呕伴有食物腐臭气味。水邪停留在胃的下口。所以胁下有停饮。肠鸣音亢进并腹泻。所以以生姜为君药。兼具疏散邪气、驱逐水饮的功效。对于格拒于上的热邪。用黄芩、黄连的苦寒之性来清泻。对于格拒于下的寒邪。用干姜、半夏的温性来散寒。再用参、草、枣调和养护胃气。使邪气不能侵犯正气而痞证自然解除。因为痞证位于心下。所以方名泻心汤。这是寒热错杂的邪气。所以用寒热错杂的药物来治疗。而且每一味药都对应病症。组方的意义非常精妙。
Hemp Seed (Fructus Cannabis, 2 sheng) Paeonia Root (Radix Paeoniae Rubra or Alba), Schizonepeta Fruit (Fructus Schizonepetae) [Note: Text says Zhi Shi, usually Fructus Aurantii Immaturus], Immature Bitter Orange (Fructus Aurantii Immaturus) (each half jin, broken open) Rhubarb (Radix et Rhizoma Rhei, peeled) Magnolia Bark (Cortex Magnoliae Officinalis, peeled) Apricot Seed (Semen Armeniacae Amarum) (each one jin, peeled and tips removed, roasted and separately ground into paste)
The above six herbs are powdered. Honey is refined to make pills, sized like paulownia seeds. Take ten pills with warm water, three times a day. Gradually increase the dose until bowel movement becomes unobstructed. The Fuyang pulse (pulse at the dorsalis pedis artery, reflecting Spleen and Stomach status) is floating and choppy. Floating indicates strong Stomach Qi. Choppy indicates frequent urination. When floating and choppy interact, difficulty in defecation ensues. This is called Pi Yue Syndrome (Spleen constraint syndrome, where insufficient Spleen Yin constrains the Large Intestine causing constipation). Mahren Wan (Hemp Seed Pill) is the primary formula. According to the classic text, Pi Yue in the context of Taiyang-Yangming disease refers to this condition. This differs from purging excess heat in the Stomach. Therefore, Paeonia is used to nourish Yin. Hemp seed and Apricot seed are used to moisten dryness. The dosages of Rhubarb and Magnolia Bark are reduced. Only ten pills are taken initially, gradually increased. This demonstrates an intention not to purge hastily.
Seven he of honey. Place the honey in a copper vessel. Simmer over low heat until it slightly thickens to the consistency of maltose syrup. Stir constantly to prevent burning or sticking. When it can be molded, roll by hand into cylindrical suppositories. Shape one end to be pointed. Make them as thick as a finger and about two cun long. Form them while hot; they harden when cold. Insert into the anal canal. Hold buttocks tightly together. Remove only when the urge to defecate arises. Commentary: Sweating followed by hard stool resembles Yangming Interior Excess syndrome. However, since urination is normal or frequent, body fluids are depleted internally. Purging must be strictly avoided. All purgative formulas are contraindicated. Misuse would further deplete fluids. Therefore, Mi Jian Dao (Honey Suppository) is appropriate for external evacuation. Treatment proceeds externally rather than internally. As long as hard stool is expelled, Stomach Qi remains undamaged.
One large pig gallbladder. Extract the bile. Mix with a small amount of vinegar. Enema into the anal canal. After approximately one meal's time, defecation should occur. This shares the same principle as Mi Jian Dao. However, Mi Jian Dao utilizes its warmth to promote fluid circulation. Here, besides guiding stagnation, there is an intent to clear heat. The distinction is subtle. Tu Gua Dao (Trichosanthes Radix Suppository) employs a similar method.
Ginger (Sheng Jiang, Fresh Ginger Root, 4 liang, sliced) Licorice (Zhi Gan Cao, Roasted Licorice Root, 3 liang) Ginseng (Ren Shen, 3 liang) Dried Ginger (Gan Jiang, 1 liang) Scutellaria Root (Huang Qin, 3 liang) Coptis Rhizome (Huang Lian, 1 liang) Pinellia Tuber (Ban Xia, 0.5 sheng, washed) Jujube (Da Zao, 12 pieces, broken open)
The above eight herbs are boiled in 10 dou of water until reduced to 6 sheng. Strain the dregs. Decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.
After sweating resolves the exterior syndrome of Shanghan (Cold Damage), disharmony in the Stomach persists. There is epigastric fullness and hardness, dry belching with a smell of food rot, fluid retention under the hypochondrium, borborygmus, and diarrhea. Shengjiang Xiexin Tang (Ginger Decoction that Drains the Epigastrium) is indicated. Commentary: Shanghan resulting in Pi (glomus/fullness) often stems from erroneous purgation. Here, Pi arises not from error but from Stomach disharmony. Residual pathogenic factors from the Taiyang stage enter the interior and bind with internal fluid retention. Yang pathogens lodge at the upper opening of the Stomach, causing epigastric fullness/hardness and dry belching with food odor. Water pathogens lodge at the lower opening, causing hypochondriac fluid retention, borborygmus, and diarrhea. Thus, Ginger is used as the sovereign herb to disperse pathogens and expel fluids. For heat constrained above, the bitter-cold properties of Scutellaria and Coptis are used to drain it. For cold constrained below, the warming properties of Dried Ginger and Pinellia are used to scatter it. Ginseng, Licorice, and Jujube are added to harmonize and nourish Stomach Qi, preventing pathogens from attacking healthy Qi so that Pi resolves naturally. Since Pi is located in the epigastrium (heart region), the formula is named Xiexin (Draining the Heart/Epigastrium). This addresses mixed cold-heat pathogens with mixed cold-heat herbs. Each ingredient corresponds precisely to the pathology. The art of formula composition is exquisite.