桂枝（四两） 人参（三两） 白术（三两） 甘草（三两） 干姜（三两）
上五味以水九升先煮四味取五升内桂更煮取三升温服一升日再夜一服
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方可攻痞解表宜桂枝汤（方在太阳五）攻痞宜大黄
黄连泻心汤
伤寒下后复汗阳亡土败遂成痞证而外见恶寒者表未解也盖阴气外束阳郁不达则见恶寒外见恶寒则内必发热内热痞郁
法应攻之而表未解者不可攻也当先解表表解乃可攻痞解表宜从中风例用桂枝汤病在汗下后是以不用麻黄攻痞宜大黄黄连
泻心汤去其痞郁之上热也 上章用桂枝人参汤双解表里此用桂枝汤解表大黄黄连攻痞者以上则外热而内寒此则外寒而内
热攻补不同也温中解表可以并用攻里发表不可双行故仲景于宜攻之病而有表证皆先表而后下
脉浮而紧而复下之紧反入里则作痞按之自濡但气痞耳心下痞按之濡其脉关上浮者大黄黄连泻心汤主之心下痞而复恶
寒汗出者附子泻心汤主之
脉浮而紧应以汗解而复下之紧反入里浮紧变为沉紧则作痞证痞证阳气格郁必生上热阴气凝塞必生下寒寒热相逼二气
抟结则心下石硬而关脉沉紧是当用诸泻心清上温下之法若按之心下自濡诊之关上脉浮者是下寒未生但是阳气痞塞郁生上
热宜用大黄黄连泻其上热无用温药也若下寒已生则心下不濡而关上不浮其上热逼蒸别无去路是必开其皮毛泄而为汗如是
心下痞硬而复恶寒汗出者是其下寒已动宜附子泻心汤大黄芩连泄其上热附子温其下寒也此以下伤其中气土败胃逆胆心不
降君相二火皆升大黄泄胃而降逆黄连泻其心火黄芩泻其胆火第曰泻心者相火以君火为主也
桂枝（四两） 人参（三两） 白术（三两） 甘草（三两） 干姜（三两）
以上五味药，用九升水，先煎煮前四味药，取五升药液，再加入桂枝，继续煎煮至三升。每次温服一升，每日两次，夜间一次。
伤寒病经过猛烈攻下后，又发汗，出现胃脘部痞塞不适且恶寒的症状，这是表证尚未解除的表现。此时不可直接攻治痞证，应当先解除表证，待表证解除后，方可攻治痞证。解除表证适宜使用桂枝汤（方剂见太阳篇第五条）。攻治痞证适宜使用大黄黄连泻心汤。
伤寒病经过攻下后又发汗，导致阳气亡失、脾胃衰败，从而形成痞证，同时外部表现为恶寒，这说明表证尚未解除。因为阴气在外部束缚，阳气郁结不能通达，所以出现恶寒；外部表现为恶寒，内部必然发热，内热与痞气郁结。按照法则应当攻治，但如果表证未解，则不可攻治。应当先解除表证，待表证解除后才能攻治痞证。解除表证应参照中风病的例子，使用桂枝汤。因为疾病发生在发汗和攻下之后，所以不使用麻黄。攻治痞证适宜使用大黄黄连泻心汤，以去除痞气郁结在上部的热邪。上一章使用桂枝人参汤来双解表里，这里使用桂枝汤解表、大黄黄连攻痞，是因为上一章是外热内寒，而本章是外寒内热，攻补的方法不同。温中解表可以同时进行，但攻里发表不可并行。因此，张仲景对于适宜攻里的病症如果有表证，都是先解表而后攻下。
大黄（二两） 黄连（一两）
以上两味药，用滚开的沸水浸泡，滤去药渣，分两次温服。
脉象浮而紧，本应通过发汗来解表，如果反而误用攻下法，紧脉反而入里，就会形成痞证。用手按压痞块感觉柔软，这仅仅是气机痞塞而已。如果胃脘部痞塞，按压时感觉柔软，且脉象在关部呈现浮象的，适用大黄黄连泻心汤主治。如果胃脘部痞塞，同时又伴有恶寒、出汗症状的，适用附子泻心汤主治。
脉象浮而紧，本应以发汗法解表，如果反而误用攻下法，紧脉反而入里，浮紧变为沉紧，就会形成痞证。痞证是由于阳气格拒郁结，必然产生上部热邪；阴气凝滞闭塞，必然产生下部寒邪。寒热相互逼迫，二气搏结，就会导致胃脘部坚硬如石，且关脉沉紧，这时应当使用各种泻心汤，清上温下的方法。如果按压胃脘部感觉柔软，诊察关脉浮象的，说明下部寒邪尚未产生，只是阳气痞塞郁结而生上部热邪，适宜使用大黄黄连来清泄上部热邪，无需使用温药。如果下部寒邪已经产生，那么胃脘部就不会柔软，关脉也不会浮，上部热邪逼迫蒸腾，别无出路，必须打开皮毛使其发散为汗。像这种胃脘部痞硬，同时又恶寒、出汗的，说明下部寒邪已经发动，适宜使用附子泻心汤。方中大黄、黄芩、黄连清泄上部热邪，附子温补下部寒邪。这是因为误下损伤了中焦之气，导致脾胃衰败、胃气上逆，胆气和心气不降，君火和相火都上升。方名虽称“泻心”，是因为相火以君火为主导。
Guizhi (Cinnamon Twig) (4 liang) Renshen (Ginseng Radix et Rhizoma) (3 liang) Baizhu (Atractylodis Macrocephalae Rhizoma) (3 liang) Gancao (Licorice Root) (3 liang) Ganjiang (Dried Ginger) (3 liang)
Take the above five herbs, add nine sheng of water, and first decoct the first four herbs to obtain five sheng of liquid. Then add Guizhi and continue to decoct until three sheng remain. Take one sheng warm each time, twice a day and once at night.
After severe purgation in Shanghan (Cold Damage Disease), followed by sweating, if there is epigastric fullness and aversion to cold, it indicates that the exterior syndrome has not yet resolved. One must not attack the fullness directly; instead, resolve the exterior first. Only after the exterior is resolved can the fullness be treated. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable (formula found in Taiyang Chapter 5). To treat the fullness, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is suitable.
After purgation and subsequent sweating in Shanghan, yang qi may perish and earth (Spleen/Stomach) may fail, leading to a fullness syndrome with external aversion to cold, indicating that the exterior syndrome remains unresolved. This is because yin qi binds externally, causing yang qi to be depressed and unable to penetrate, resulting in aversion to cold. External aversion to cold implies internal heat; internal heat combined with fullness requires treatment via purging. However, if the exterior is unresolved, purging is contraindicated. One must first resolve the exterior; only then can the fullness be attacked. Resolving the exterior should follow the example for Wind Strike (Zhongfeng), using Guizhi Tang. Since the condition arises after sweating and purgation, Mahuang (Ephedra Herb) is not used. To treat the fullness, Dahuang Huanglian Xiexin Tang is used to clear the upper heat caused by the depression of fullness. The previous chapter used Guizhi Renshen Tang to simultaneously resolve the exterior and interior; this chapter uses Guizhi Tang to resolve the exterior and Dahuang Huanglian to attack the fullness because the former involves external heat and internal cold, whereas this case involves external cold and internal heat. The methods of tonification and purging differ. Warming the middle and resolving the exterior can be done simultaneously, but attacking the interior and releasing the exterior cannot be performed together. Therefore, Zhang Zhongjing always resolves the exterior before purging the interior when treating diseases suitable for purging that present with exterior syndromes.
Dahuang (Rhubarb Root and Rhizome) (2 liang) Huanglian (Coptis Rhizome) (1 liang)
Take the above two herbs, steep them in boiling water (Ma Fei Tang), remove the dregs, and take half warm each time, divided into two doses.
If the pulse is floating and tight, sweating should be indicated. If purgation is mistakenly applied, the tight pulse moves inward, resulting in a fullness syndrome. Palpation reveals softness, indicating merely Qi fullness (Qi Pi). If there is epigastric fullness, palpation reveals softness, and the pulse at the Guan position is floating, Dahuang Huanglian Xiexin Tang is the primary formula. If epigastric fullness is accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) is the primary formula.
A floating and tight pulse indicates sweating as the correct treatment. If purgation is mistakenly applied, the tight pulse moves inward, changing from floating-tight to deep-tight, resulting in a fullness syndrome. In fullness syndrome, yang qi is obstructed and depressed, inevitably generating upper heat; yin qi is condensed and blocked, inevitably generating lower cold. The mutual pressure of cold and heat causes the two energies to knot, resulting in a rock-hard epigastrium and a deep-tight Guan pulse. In such cases, various Xiexin formulas should be used to clear the upper and warm the lower. If palpation of the epigastrium reveals softness and the Guan pulse is floating, it indicates that lower cold has not yet formed; only yang qi obstruction and depression have generated upper heat. Dahuang and Huanglian should be used to clear the upper heat without warming medicines. If lower cold has already formed, the epigastrium will not be soft, and the Guan pulse will not be floating. The upper heat, forced upward, has no other outlet and must be released through the skin as sweat. In cases where epigastric fullness and hardness are accompanied by aversion to cold and sweating, lower cold has moved. Fuzi Xiexin Tang is appropriate: Dahuang, Huangqin (Scutellaria Root), and Huanglian clear the upper heat, while Fuzi (Aconite Lateral Root) warms the lower cold. This occurs because downward purgation damages the Middle Qi, causing Earth failure and Stomach Qi rebellion. Gallbladder and Heart Qi fail to descend, and Minister Fire and Sovereign Fire ascend. Although named "Xiexin" (Heart-Draining), it is because Minister Fire is governed by Sovereign Fire.