（此方出古本东垣书第九卷此事难知中）
黄连无分两并无用水煎法
易老随证加减例附后
烦者。加栀子。（烦心烦也。仲景少阴热病。有心烦一条。）
燥者加香豉。（燥。即口燥是也。加香豉者。火郁则发之也。）呕者。加半夏。（呕者。胸有饮也。加半夏以涤饮。）
满者。加甘草。（满。胸满也。加生甘草。引黄连一味。直至满所。以泄实热。）腹痛。加芍药。（少阴热病。有腹中痛一
条仲景加炮附子者。误也。今加芍药。以能和营血。止腹痛。）脉迟。加附子。下焦寒。加干姜。（此二条。与制汤本义
相反。今从删。）大便硬者。加酒浸大黄。此比之大承气为少缓耳。虽下之与脉细小无害。
琥按上方。乃海藏治少阴传经热证。口燥舌干而渴。止因尺寸脉细小。不敢用大承气。而以此汤代之者也。观乎
此。而知昔贤读仲景书。不轻用仲景方。盖慎之至耳。今医。治伤寒。但知证书。而不细察夫脉者。不其大害矣夫。
琥又按仲景辩少阴证。相传为足经。主肾。今海藏反用黄连一味。为泻心汤者。乃知手少阴亦有伤寒病也。
又云。少阴渴逆者。失下也。阴消将尽。阳逆上行。使阴不纳也。或舌挛。言语不正。反昏冒。与咽痛者。少阴也。
速下之。大承气汤。若阳极。脉微将尽者。不宜下。宜泻心汤。凉膈散。去硝清肺亦可。
（此方出自古本李东垣《此事难知》第九卷）
黄连没有规定分量，也没有注明用水煎煮的方法。
易老（李东垣，字明之，号易老）随证加减的示例附在后面：
心烦的，加栀子。（烦，指心中烦乱。张仲景《伤寒论》少阴热病中，有一条关于心烦的记载。）
口燥的，加香豉。（燥，即口干燥。加入香豉，是因为火郁结需要发散。）
呕吐的，加半夏。（呕吐，是因为胸中有痰饮。加入半夏以涤除痰饮。）
胸满的，加甘草。（满，指胸中胀满。加入生甘草，引导黄连这一味药直达胀满之处，以泄实热。）
腹痛的，加芍药。（张仲景《伤寒论》少阴热病中，有一条关于腹中痛的记载。此前注家认为张仲景加炮附子是错误的。现在加入芍药，因为它能调和营血，止住腹痛。）
脉迟的，加附子。下焦寒的，加干姜。（这两条与制汤的本义相反，现在予以删除。）
大便硬的，加酒浸大黄。这比之大承气汤药力稍缓。即使使用泻下法，对于脉细小的患者也无害。
王琥按：上述方剂，是海藏（张元素，号海藏）治疗少阴传经热证，出现口燥、舌干而渴的症状。仅仅因为寸关尺脉细小，不敢使用大承气汤，而用此汤代替它。由此可知，以前的贤人研读张仲景的书，不轻易使用张仲景的方剂，这是极其谨慎的表现。现在的医生，治疗伤寒，只知道根据症状用药，而不仔细诊察脉象，这不是造成很大的危害吗？
王琥又按：张仲景辨析少阴证，相传认为是足少阴肾经病变，主责于肾。现在海藏反而只用黄连一味药作为泻心汤，这说明手少阴心经也有伤寒病。
又说：少阴病出现口渴、气逆的，是因为失于攻下。阴液消亡将尽，阳气逆乱上行，导致阴气不能收纳。或者出现舌体挛急、言语不正，反而昏冒，以及咽痛的，属于少阴病。应当迅速攻下，使用大承气汤。如果阳极，脉微细将绝的，不宜攻下，宜用泻心汤、凉膈散。去除硝黄，清肺也可以。
(This prescription is from the ninth volume of the ancient edition of Li Dongyuan's *Cishi Nan Zhi* [Difficulties in This Matter].)
There is no specified dosage for Huanglian (Rhizoma Coptidis), nor are there instructions for decoction with water.
The examples of modification according to symptoms by Yi Lao (Li Dongyuan, courtesy name Mingzhi, pseudonym Yi Lao) are attached below:
For restlessness (Fanzao, mental agitation and discomfort), add Zhizi (Fructus Gardeniae). (Restlessness refers to mental agitation. In Zhang Zhongjing's *Shanghan Lun* [Treatise on Cold Pathogenic Diseases], there is a section regarding restlessness in Shaoyin heat diseases.)
For dryness (Zao), add Xiangchi (Fermented Soybean). (Dryness refers to dry mouth. Adding Xiangchi is because fire stagnation requires dispersal.)
For vomiting (Ou), add Banxia (Rhizoma Pinelliae). (Vomiting occurs due to fluid retention in the chest. Adding Banxia helps to eliminate fluid retention.)
For fullness (Man), add Gancao (Radix Glycyrrhizae). (Fullness refers to chest distension. Adding raw Gancao guides the single herb Huanglian directly to the site of fullness to drain excess heat.)
For abdominal pain (Futong), add Shaoyao (Radix Paeoniae Alba). (In Zhang Zhongjing's *Shanghan Lun*, there is a section regarding abdominal pain in Shaoyin heat diseases. Previous commentators believed that adding Paofuzi (Prepared Radix Aconiti Lateralis) was an error. Now, Shaoyao is added because it can harmonize Ying and Blood and stop abdominal pain.)
For slow pulse (Machi), add Fuzi (Radix Aconiti Lateralis Preparata). For cold in the Lower Jiao, add Ganjiang (Rhizoma Zingiberis). (These two items contradict the original intent of the formula's preparation and are therefore deleted here.)
For hard stool (Dabian ying), add Jiuhuangda (Rhubarb macerated in wine). This is slightly milder than Dachengqi Tang (Major Order the Qi Decoction). Even if purgation is used, it is harmless for patients with fine and small pulses.
Wang Hu notes: The above prescription was used by Haicang (Zhang Yuansu, pseudonym Haicang) to treat Shaoyin transmitted heat syndromes, characterized by dry mouth, dry tongue, and thirst. Because the pulse at the cun, guan, and chi positions was fine and small, he dared not use Dachengqi Tang and instead substituted this decoction. From this, we can see that past sages, when studying Zhang Zhongjing's works, did not lightly employ his prescriptions; this demonstrates extreme caution. Modern physicians, when treating Shanghan, only rely on symptoms without carefully examining the pulse. Is this not a great harm?
Wang Hu further notes: Zhang Zhongjing's differentiation of Shaoyin syndromes has traditionally been attributed to the Foot Shaoyin Kidney meridian, governing the Kidney. However, Haicang uses only Huanglian as Xiexin Tang (Drain the Epigastrium Decoction), indicating that the Hand Shaoyin Heart meridian also suffers from Shanghan diseases.
It is also stated: Shaoyin disease presenting with thirst and rebellious qi results from failure to purge earlier. Yin fluids are nearly exhausted, and Yang qi rebels upward, preventing Yin from being received. If there is tongue spasm, abnormal speech, sudden dizziness/fainting, or sore throat, it belongs to Shaoyin. Rapid purgation should be employed using Dachengqi Tang. If Yang is at its extreme and the pulse is faint and nearly absent, purgation is contraindicated; instead, Xiexin Tang or Liangge San (Cool the Diaphragm Powder) should be used. Removing Mangxiao (Natrii Sulfas) and Qingfei (Clearing the Lung) is also acceptable.