大黄 黄连
心下痞。按之濡。其脉关上浮者。此汤主之。 濡者。软也。 结言胸。痞言心下。结
言按之
曰。大热受邪。心病生焉。味苦入心。性寒除热。大黄黄连之苦寒。以泻心下之虚热。但以
麻沸汤渍服者。取其清薄而泻虚热也。
芫花 甘遂 大戟
太阳中风。下利呕逆。表解者。乃可攻之。 汗出。发作有时。头痛。痞满。引胁下
痛。干呕短气。汗出。不恶寒者。此表解。里未和也。此汤主之。 杜壬问孙兆曰。十枣汤治何病
。孙曰。治太阳中风。表解里未和。杜曰。何以知里未和。孙曰。头痛。痞满。胁痛。干呕
。汗出。知里未和也。杜曰。此但言病症。而所以里未和之故。总未言也。孙曰。某实未决
。愿听开论。杜曰。里未和者。痰与燥气壅于中焦。故头痛干呕。短气汗出。是痰隔也。非
十枣汤不能治。但此汤不宜轻用。恐损人于倏忽也。
赤石脂 禹余粮
下利心下痞硬。服泻心已。复以它药下之。利不止。治以理中。利益甚。理中者。理中
焦。此利在下焦。与赤石脂禹余粮汤。复下利。当利小便。
旋复花 甘草 人参 代赭石 生姜 半夏 大枣
汗吐下后。心下痞硬。噫气不除。此汤主之。 噫气。俗名嗳气。饱食息也。 硬则气
坚。咸味可以软之。旋复花之咸。以软痞硬。虚则气浮。重剂可以镇之。代赭石之重。以镇虚逆。
生姜半夏。辛以散虚痞。人参大枣。甘以补胃弱。 痞而下利。生姜泻心汤。痞而不下利。
旋复代赭汤。
心下部痞塞胀满，按压时感觉柔软。脉象在关部呈现浮象的，用此方主治。濡，是指柔软的意思。结胸是指胸部硬满疼痛，痞证是指心下部痞塞不适。所谓“结”，是指按压时有抵抗感或疼痛。
大热之邪受于体内，导致心病产生。苦味药物入心经，寒性药物能清除热邪。大黄和黄连的苦寒之性，用来泻除心下部的虚热。之所以只用滚开的沸水浸泡服用，是取其药气清轻薄透，以泻除虚热。
太阳中风证，出现腹泻、呕吐逆气。表证已经解除后，才可以攻逐里实。汗出，发作有定时，头痛，心下痞满，牵引胁下疼痛，干呕，呼吸短促，汗出，不恶寒的，这是表证已解，里气未和。用此方主治。杜壬问孙兆说：“十枣汤治疗什么病？”孙兆说：“治疗太阳中风，表解而里未和。”杜壬说：“怎么知道里气未和？”孙兆说：“头痛，心下痞满，胁痛，干呕，汗出，就知道里气未和了。”杜壬说：“这只是在陈述病症，而对于里气未和的原因，完全没有说明。”孙兆说：“我确实没有想透彻，愿意听您详细论述。”杜壬说：“里气未和，是因为痰饮与燥气壅滞在中焦，所以出现头痛、干呕、短气、汗出，这是痰饮阻隔所致。非十枣汤不能治疗。但是此方不宜轻易使用，恐怕会在瞬间损伤人体正气。”
腹泻伴有心下部痞塞坚硬。服用泻心汤后，又用其他泻下药攻下，导致腹泻不止。用理中汤治疗，腹泻反而加重。理中汤是调理中焦的，此处的腹泻病位在下焦。给予赤石脂禹余粮汤。如果再次腹泻，应当通利小便。
经过发汗、催吐或泻下治疗后，出现心下部痞塞坚硬，嗳气持续不除的，用此方主治。噫气，俗称嗳气，即饱食后打嗝。坚硬则说明气机坚结，咸味药物可以软化它，旋复花的咸味，用来软化痞硬；虚弱则说明气机上浮，重镇药物可以平抑它，代赭石的沉重之性，用来镇摄虚逆之气。生姜和半夏，辛散以消除虚痞；人参和大枣，甘温以补益胃气虚弱。痞塞并伴有腹泻的，用生姜泻心汤；痞塞但不伴有腹泻的，用旋复代赭汤。
Rhizoma Rhei Preparata (Dahuang), Folium Coptidis (Huanglian)
Epigastric fullness and oppression, soft upon palpation. If the pulse is floating at the Guan position, this decoction is indicated. "Ru" refers to softness. "Jie" (knotting) refers to hardness and pain in the chest, while "Pi" (stagnation) refers to epigastric fullness. "Jie" implies resistance or pain upon pressure.
When pathogenic heat enters the interior, it affects the Heart. Bitter flavors enter the Heart meridian, and cold nature clears heat. The bitter-cold properties of Rhizoma Rhei Preparata and Folium Coptidis are used to drain deficient heat from the epigastrium. It is soaked only in boiling water for administration to utilize its light and thin aromatic quality to drain deficient heat.
Radix Genkwanis (Yuanhua), Radix Kansui (Gansui), Radix Euphorbiae Pekinensis (Daji)
In Taiyang Wind-stroke syndrome, with diarrhea and vomiting/rebellious qi. Only after the exterior syndrome has resolved can one attack the interior. Sweating, occurring at specific times, headache, epigastric fullness, pain radiating to the hypochondrium, dry retching, shortness of breath, sweating, and absence of aversion to cold indicate that the exterior is resolved but the interior is not harmonized. This decoction is indicated. Du Ren asked Sun Zhao: "What disease does Shizao Tang treat?" Sun replied: "It treats Taiyang Wind-stroke where the exterior is resolved but the interior is not harmonized." Du asked: "How do you know the interior is not harmonized?" Sun said: "Headache, epigastric fullness, hypochondriac pain, dry retching, and sweating indicate that the interior is not harmonized." Du said: "You are merely stating the symptoms, but have not explained the cause of the interior disharmony." Sun said: "I have not fully deliberated on this; I wish to hear your exposition." Du said: "The interior disharmony is due to phlegm-fluids and dry qi obstructing the Middle Jiao, causing headache, dry retching, shortness of breath, and sweating. This is obstruction by phlegm-fluids. Only Shizao Tang can treat it. However, this decoction should not be used lightly, as it may damage the person suddenly."
Lapis Kaolinitis Ruber (Chishizhi), Lapis Haematitatis (Yuyuliang)
Diarrhea with epigastric fullness and hardness. After taking Xiexin Tang, if other purgatives are administered, leading to incessant diarrhea, treating with Lizhong Tang will worsen the diarrhea. Lizhong Tang regulates the Middle Jiao; this diarrhea originates from the Lower Jiao. Administer Chishizhi Yuyuliang Tang. If diarrhea persists, promote urination.
Flos Inulae (Xuanfuhua), Radix Glycyrrhizae Preparata (Gancao), Radix Ginseng (Renshen), Os Draconis (Daizheshi), Rhizoma Zingiberis Recens (Shengjiang), Rhizoma Pinelliae Preparata (Banxia), Fructus Jujubae (Dazao)
After sweating, vomiting, or purging, if epigastric fullness and hardness occur with persistent belching, this decoction is indicated. Belching, commonly known as eructation, is the sound of gas escaping after a full meal. Hardness indicates firm qi; salty flavor can soften it. The salinity of Flos Inulae softens the epigastric hardness. Deficiency leads to floating qi; heavy substances can anchor it. The heaviness of Os Draconis anchors rebellious qi due to deficiency. Rhizoma Zingiberis Recens and Rhizoma Pinelliae Preparata use pungency to disperse deficient stagnation; Radix Ginseng and Fructus Jujubae use sweetness to tonify stomach weakness. For fullness accompanied by diarrhea, Shengjiang Xiexin Tang is used. For fullness without diarrhea, Xuanfu Daizhe Tang is used.