后治其内之理也。桂枝加芍药，治阳邪下陷；桂枝更加桂，治阴邪上攻。只在一味中加分两，不于本方外求他
味，不即不离之妙如此。
桂枝去芍药加蜀漆龙骨牡蛎救逆汤∶
伤寒者，寒伤君主之阳也。以火迫劫汗，并亡君主之阴，此为火逆矣。盖太阳伤寒，以发汗为主。用麻黄
发汗，是为扶阳。用火劫汗犹挟天子以令诸侯，权不由主，此汗不由心也。故惊狂而起卧不安，犹芒刺在背之
状矣。心为阳中之阳，太阳之汗，心之液也。凡发热自汗出者，是心液不收，桂枝方用芍药以收之。此因迫汗，
津液既亡，无液可敛。故去芍药加龙骨牡蛎者，是取其咸以补心，重以镇怯，涩以固脱，故曰救逆也。且去芍
药之酸，则肝家得辛甘之补；加龙骨牡蛎之咸，肾家既有既济之力。此虚则补母之法，又五行承制之理矣。
（蜀漆未详。昔云常山之苗则谬。）
桂枝甘草龙骨牡蛎汤∶
火逆又下之，因烧针而烦躁，即惊狂之渐也。急用桂枝、甘草以安神，加龙骨、牡蛎以救逆，比前方简而
切当。近世治伤寒者，无火熨之法，而病伤寒者，多烦躁惊狂之变，大抵用白虎、承气辈，作有余治之。然此
症属实热者固多，而属虚寒者间有，则温补安神之法，不可废也。更有阳盛阴虚而见此症者，当用炙甘草加减，
用枣仁、远志、茯苓、当归等味，又不可不知。
桂枝附子汤∶
桂枝 附子 甘草 生姜 大枣
桂枝附子去桂加白术汤∶
治伤寒八九日，风湿相搏，身体烦疼，不能转侧，不呕不渴，脉浮虚而涩者。若其人大便硬，小便自利，去
桂加白术。按∶桂枝附子汤，即桂枝去芍药加附子汤也。彼治下后脉促胸满而微恶寒，是病在半表，仍当是桂
枝为君，加附子为佐。此风寒湿相合而相搏于表，当从君君臣臣之制，则桂、附并重可知。旧本两方，分两相
同，误亦甚矣。夫脉浮为风，涩为虚，浮而涩，则知寒之不去，而湿之相承也。风寒湿三气合至，合而成痹，
故身体烦疼而不能转侧，病只在表而不在内。桂枝能驱风散寒而胜湿，故重其分两，配附子之辛热，率甘草、
姜、枣以主之，三气自平，营卫以和矣。若其人又兼里气不和，大便反硬，小便反利者，此非胃家实，乃脾家
虚也。盖脾家实，腐秽当自去。此湿流肌肉，因脾土失职，不能制水，故大便反见燥化。不呕不渴，是上焦之
化源清，故小便自利。濡湿之地，风气常存，故风寒相搏而不解耳。病本在脾，法当培土以胜湿，而风寒自解，
故君白术以代桂枝。白术专主健脾。脾虚则湿胜而不运，湿流于内，故使大便不实，湿流于表，更能使大便不
濡。脾健则能制水，水在内，能使下输膀胱而大便实，水在外，能使还入胃中而大便濡。故方末云∶“初服其
人身如痹，三服尽，其人如冒状。”此以术、附并走皮肉，逐水气未得除，故使然耳，法当加桂四两。此本一
方二法，以大便硬，小便自利，去桂也。以大便不硬，小便不利，当加桂。因桂枝治上焦，大便硬小便利，是
中焦不治，故去桂。服汤已，湿反入胃，故大便不硬，小便不利，是上焦不治，故仍须加桂。盖小便由于上焦
之气化，而后膀胱之藏者能出也。《内经》曰∶“风气胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹。”
此身痛而不能转侧，是风少而寒湿胜，必赖附子雄壮之力，以行痹气之着。然附子治在下焦，故必同桂枝，始
能令在表之痹气散；同白术，又能令在表之痹气内行。故桂枝附子汤是上下二焦之表剂，去桂加白术汤是中下
二焦之表剂，附子白术汤仍加桂枝是通行三焦之表剂也。是又一方三法也。世以仲景方、法分两，动称一百一
十三方，三百九十七法，不知从何处而起。
甘草附子汤∶
甘草 附子 白术 桂枝
治风湿相搏，骨节疼痛，不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不欲去衣，或身微肿者。此
即桂枝附子汤加白术去姜、枣者也。前症得之伤寒，有表无里。此症因于中风，故兼见汗出身肿之表，短气小
便不利之里。此《内经》所谓风气胜者，为行痹之症也。然上焦之化源不清，总因在表之风湿相搏，故于前方
仍重用桂枝，而少减术、附。去姜枣者，以其短气，而辛散湿泥之品，非所宜耳。
大陷胸丸∶
大黄 芒硝 杏仁 葶苈 甘遂
大陷胸汤∶
大黄 芒硝 甘遂
病发于阳，而反下之，邪入于胃中与不得为汗之水气，结而不散，心中硬痛，因名结胸。然结胸一症，有
只在太阳部分者，有并病阳明者。此或丸或汤，有轻重缓急之不同也。结在太阳部分者，身无大热，但头汗出，
项亦强如柔 状，寸脉浮，关脉沉，是病在上焦。因气之不行，致水之留结耳。夫胸中者，太阳之都会，宗气
之所主，故名气海。太阳为诸阳主气，气为水母，气清则水精四布，气热则水浊而壅瘀矣。此水结因于气结，
用杏仁之苦温，以开胸中之气，气降则水下矣。气结因于热邪，用葶苈之大寒，以清气分之热，源清而流洁矣。
水结之所，必成窠臼∶甘遂之苦辛，所以直达其窠臼也。然太阳之气化，不行于胸中，则阳明之胃府，亦因热
而成实，必假大黄、芒硝，小其制而为丸，和白蜜以缓之，使留恋于胸中，过一宿乃下，即解心胸之结滞，又保
肠胃之无伤。此太阳里病之下法，是以攻剂为和剂者也。其并病阳明者，因水结于胸，上焦不通，则津液不下，
无以润肠胃。故五六日不大便，因而舌干口渴，日晡潮热，是阳明亦受病矣。心下至小腹硬满而痛不可近，脉沉
紧者，此水邪结于心胸，而热邪实于肠胃。用甘遂以浚太阳之水，硝黄以攻阳明之实，汤以荡之，是为两阳表
里之下法也。二方比大承气更峻，治水肿痢疾之初起者甚捷。然必视其人之壮实者施之，如平素虚弱，或病后不
任攻伐者，当念虚虚之祸。
小陷胸汤∶
黄连 半夏 栝蒌实
热入有浅深，结胸分大小。心腹硬痛，或连小腹不可按者，为大
结胸。此土燥水坚，故脉亦应其象而沉紧。止在心下，不及胸腹，按之知痛不甚硬者，为小结胸。是水与热结，
凝滞成痰，留于膈上，故脉亦应其象而浮滑也。秽物据清阳之位，法当泻心而涤痰，用黄连除心下之痞实，半夏
消心下之痰结，寒温并用，温热之结自平。栝蒌实色赤形圆，中含津液，法象于心，用以为君，助黄连之苦，
且以滋半夏之燥，洵为除烦涤痰开结宽胸之剂。虽同名陷胸，而与攻利水谷之方悬殊矣。
大小青龙攻太阳之表，有水火之分，大小陷胸攻太阳之里，有痰饮之别，不独以轻重论也。
生姜泻心汤∶
人参 甘草 黄连 黄芩 干姜 半夏 生姜 大枣
此小柴胡汤去柴胡加干姜、黄连，又即黄连汤去桂易芩。
伤寒汗出外已解，胃中不和，心下痞硬，干呕食臭，胁下有水气，腹中雷鸣下利者，是阳不足而阴乘之也。
凡外感风寒而阳盛者，汗出不解，多转属阳明而成胃实。此心下痞硬而下利者，病虽在胃，不是转属阳明。
下利不因误下，肠鸣而不满痛，又非转属太阴矣。夫心为阳中太阳，则心下是太阳之宫城，而心下痞是太阳之
里也。君主之火用不宣，汗出不彻，内之水气不得越。水气不得散，所以痞硬；邪热不杀谷，故干呕食臭。胁
下为少阳之位，太阳之阳气不盛，少阳之相火不支，故水气得支。胁下土虚不能制水，水气从胁入胃，泛溢中
州，故腹中雷鸣而下利也。病势已在腹中，病根犹在心下，总因寒热交结于内，以致胃中不和。若用热散寒，
则热势猖獗；用寒攻热，则水势横行。法当寒热并举，攻补兼施，以和胃气。故用芩、连除心下之热，干姜散
心下之痞，生姜、半夏去胁下之水，参、甘、大枣培腹中之虚。因太阳之病为在里，故不从标本，从乎中治也。
且芩、连之苦，必得干姜之辛，始能散痞；人参得甘、枣之甘，协以保心。又君生姜佐半夏，全以辛散甘苦之
枢，而水气始散。名曰泻心，实以安心也。
此与十枣症，皆表解而里不和。见心下痞硬，干呕下利，然后因于中风之阳邪，故外症尚有余热，是痞硬
下利属于热，故可用苦寒峻利之剂以直攻之。此因于伤寒之阴邪，故内症反有郁逆，是痞硬下利属于虚，故当
用寒温兼补之剂以和解之。是治病各求其本也。按∶泻心本名理中黄连人参汤，此以病在上焦，故名泻心耳。
世徒知膀胱为太阳之里，热入膀胱为犯本，不知心下痞硬为犯本，因有传足不传手之谬。
甘草泻心汤∶
甘草 黄连 黄芩 干姜 半夏 大枣
伤寒中风，初无下症，下之，利日数十行，完谷不化，腹中雷鸣，其人胃气素虚可知。则心下痞硬而满，
非有形之结热，以胃中空虚，客气上逆于胃口，故干呕心烦不得安。所云当汗不汗，其人心烦耳。若认为实热
而复下之，则痞益甚矣。本方君甘草者，一以泻心而除烦，一以补胃中之空虚，一以缓客气之上逆也。倍加干
姜者，本以散中宫下药之寒，且以行芩、连之气而消痞硬，佐半夏以除呕，协甘草以和中。是甘草得位而三善
备，干姜任重而四美具矣。中虚而不用人参者，以未经发汗，热不得越，上焦之余邪未散，与用小柴胡汤有胸
中烦者去人参同一例也。干呕而不用生姜者，以上焦之津液已虚，无庸再散耳。此病已在胃，亦不曰理中，
仍名泻心者，以心烦痞硬，病在上焦，犹未离乎太阳也。心烦是太阳里症，即是阳明之表症，故虽胃中空虚，
完谷不化，而不用人参。因心烦是胃实之根，太阳转属阳明之捷路也。凡伤寒中风，下利清谷属于寒，下利完
谷属于热。《内经》所云“暴注下迫属于热”者是也。仲景之去人参，预以防胃家之实欤？
半夏泻心汤∶
半夏 干姜 黄连 黄芩 人参 甘草 大枣
本论云∶“呕而发热者，小柴胡主之。”即所云“伤寒中风有柴胡证，但见一症即是，不必悉具”者是也。
又云∶“呕多虽有阳明证，不可攻之。”可见少阳阳明合病，阖从枢转，故不用阳明之三承气，当从少阳之大柴
胡。上焦得通，则津液得下，故大柴胡为少阳阳明之下药也。若伤寒五六日，呕而发热，是柴胡汤证，而以他
药下之，枢机废弛，变症见矣。少阳居半表半里之位，其症不全发阳，不全发阴。故下后变症偏于半表者，热入
而成结胸；偏于半里者，热结心下而成痞也。结胸与痞，同为硬满之症，当以痛为辨。满而硬痛为结胸热实，大
陷胸下之，则痛随利减。如满而不痛者为虚热痞闷，宜清火散寒而补虚。盖泻心汤方，即小柴胡去柴胡加黄连
干姜汤也。不往来寒热，是无半表症，故不用柴胡。痞因寒热之气互结而成，用黄连、干姜之大寒大热者，为之
两解，且取其苦先入心，辛以散邪耳。此痞本于呕，故君以
半夏。生姜能散水气，干姜善散寒气。凡呕后痞硬，是上焦津液已干，寒气留滞可知，故去生姜而倍干姜。痛
本于心火内郁，故仍用黄芩佐黄连以泻心也。干姜助半夏之辛，黄芩协黄连之苦，痞硬自散。用参、甘、大枣
者，调既伤之脾胃，且以壮少阳之枢也。
《内经》曰∶“腰以上为阳。”故三阳俱有心胸之病。仲景立泻心汤，以分治三阳。在太阳以生姜为君者，
以未经误下而心下成痞，虽汗出表解，水气犹未散，故微寓解肌之义也。在阳明用甘草为君者，以两番妄下，
胃中空虚，其痞益甚，故倍甘草以建中，而缓客邪之上逆，是亦从乎中治之法也。在少阳用半夏为君者，以误
下而成痞，邪已去半表，则柴胡汤不中与之，又未全入里，则黄芩汤亦不中与之矣。未经下而胸胁苦满，是里
之表症，用柴胡汤解表。心下满而胸胁不满，是里之半里症，故制此汤和里，稍变柴胡半表之治，推重少阳半
里之意耳。名曰泻心，实以泻胆也。
大黄黄连泻心汤
附子泻心汤∶
附子 大黄 黄连 黄芩
治心下痞，按之濡，其脉关上浮者，用大黄黄连泻心汤。心下痞而复恶寒汗出者，用附子泻心汤。此皆攻
实之剂，与前三方，名虽同而法不同矣。濡者湿也，此因妄下汗不得出，热不得越，结于心下而成痞。胃火炽
于内，故心下有汗，而按之者，知其濡湿耳。结胸症，因症发于阳，热邪留于上焦，故其寸脉独浮，而但头汗
出，余处无汗。此心下痞，因症发于阴，热邪已蓄于中焦，故其脉独关上浮，而汗但出于心下。心下者，胃口
之气。尺寸不浮而关上独浮，此浮为胃实外见之征，不得责之浮为在表矣。子能令母实，故心下之痞不解，母
实而兼泻其子，是又治太阳阳明并病之一法也。云泻心者，泻其实耳。热有虚实，客邪内陷为实，藏气自病为
虚。黄连苦燥，但能解离宫之虚火，不能除胃家之实邪。非君大黄之勇以荡涤之，则客邪协内实而据心下者，漫
无出路。故用一君一臣，以麻沸汤渍其汁，乘其锐气而急下之，除客邪须急也。夫心下痞而大便硬者，是热结
于中，当不恶寒而反恶寒，当心下有汗，而余处皆无汗。若恶寒已罢，因痞而复恶寒，初无汗，今痞结而反出
这是治疗内部病变的原理。桂枝汤中增加芍药用量，用于治疗阳邪下陷；桂枝汤中再增加桂枝用量，用于治疗阴邪上攻。仅仅在一味药中调整剂量，不在原方之外寻找其他药物，其中的奥妙就在于这种不即不离的关系。
桂枝去芍药加蜀漆龙骨牡蛎救逆汤：
伤寒，是寒邪损伤了君主（心）的阳气。如果用火法强迫发汗，会导致君主之阴也同时亡失，这称为火逆。大概太阳伤寒的治疗以发汗为主。使用麻黄发汗，是为了扶助阳气。用火劫法发汗就像挟持天子来号令诸侯，权力不再由君主掌控，这种汗不是由心主发出的。所以会出现惊狂、起卧不安的症状，就像背上芒刺一样难受。心是阳中之阳，太阳经的汗液是心的津液。凡是发热自汗出的，是心液不能收敛，桂枝汤中使用芍药来收敛它。这里因为火迫发汗，津液已经亡失，没有津液可敛。所以去掉芍药，加入龙骨、牡蛎，是利用它们的咸味来补益心脏，利用重镇之性来镇定惊恐，利用涩味来固脱止汗，所以称为救逆。而且去掉芍药的酸味，肝脏就能得到辛甘味的补益；加入龙骨、牡蛎的咸味，肾脏也就有了水火既济的力量。这是虚则补其母的方法，也是五行承制的道理。（蜀漆不详。以前说是常山的嫩芽，那是错误的。）
桂枝甘草龙骨牡蛎汤：
火逆之后又误用泻下法，再加上烧针治疗导致烦躁，这是惊狂的前兆。急需使用桂枝、甘草来安神，加入龙骨、牡蛎来救逆，比前面的方子简单而恰当。近代治疗伤寒的人，没有火熨这种方法，但患伤寒的人，多有烦躁惊狂的变化，大多使用白虎汤、承气汤类，当作有余（实证）来治疗。然而这个病症属于实热的固然多，但属于虚寒的也有，那么温补安神的方法就不能废弃。更有阳气盛阴虚而出现这种症状的，应当使用炙甘草加减，配合枣仁、远志、茯苓、当归等药物，这也是不可不知道的。
桂枝附子去桂加白术汤：
治疗伤寒八九日，风湿相搏，身体烦疼，不能翻身转动，不呕吐不口渴，脉象浮虚而涩的。如果这个人大便干硬，小便自利，就去掉桂枝加入白术。按语：桂枝附子汤，就是桂枝去芍药加附子汤。那个方子治疗误下后脉促胸满且微恶寒，这是病在半表，仍然应当以桂枝为君药，加入附子为佐药。这里是风寒湿三气相合而在体表相搏，应当遵循君臣佐使的制度，那么桂枝和附子的分量并重就可以知道了。旧版本两个方子的分量相同，错误也很严重了。脉浮表示有风，脉涩表示虚，浮而涩，就知道寒气未去，湿气随之而来。风寒湿三气合至，合而成痹，所以身体烦疼而不能转身，病只在表而不在里。桂枝能驱风散寒而胜湿，所以重用它的分量，配合附子的辛热，率领甘草、姜、枣来主治，三气自然平息，营卫也就调和了。如果这个人又兼有里气不和，大便反而干硬，小便反而通利的，这不是胃家实，而是脾家虚。大概脾家实，腐秽之物自然会去除。这里是湿气流注肌肉，因为脾土失职，不能制水，所以大便反而呈现燥化。不呕吐不口渴，说明上焦的化源清肃，所以小便自利。潮湿之地，风气常存，所以风寒相搏而不解。病本在脾，治法应当培土以胜湿，而风寒自然解除，所以以白术为君药代替桂枝。白术专门主治健脾。脾虚则湿胜而不能运化，湿气流入体内，所以使大便不成形；湿气流于体表，更能使大便不干濡。脾健则能制水，水在体内，能使向下输送到膀胱从而使大便成形；水在体外，能使回流进入胃中从而使大便濡润。所以方末说：“初服后身体像麻木一样，三服药吃完，人好像头昏沉的样子。”这是因为白术、附子并走皮肉，驱逐水气尚未除去，所以才会这样，治法应当加入桂枝四两。这原本是一个方子两种用法，因为大便硬、小便利，所以去掉桂枝。因为大便不硬、小便不利，应当加入桂枝。因为桂枝治上焦，大便硬小便利，是中焦不治，所以去掉桂枝。服药后，湿气反而进入胃中，所以大便不硬、小便不利，是上焦不治，所以仍然需要加入桂枝。大概小便由于上焦的气化，然后膀胱的藏泄功能才能正常排出。《内经》说：“风气胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹。”这种身痛而不能转侧，是风少而寒湿胜，必须依赖附子雄壮的力量，来行散痹气的着滞。然而附子治在下焦，所以必须同桂枝一起，才能使在表的痹气消散；同白术一起，又能使在表的痹气向内运行。所以桂枝附子汤是上下二焦的表剂，去桂加白术汤是中下二焦的表剂，附子白术汤仍加桂枝是通行三焦的表剂。这又是一个方子三种用法。世人把仲景的方子和法度、分量，动不动就称有一百一十三方，三百九十七法，不知道是从哪里开始的。
治疗风湿相搏，骨节疼痛，不能屈伸，靠近则疼痛剧烈，出汗短气，小便不利，怕风不想脱衣，或者身体轻微浮肿的。这就是桂枝附子汤加白术去掉姜、枣的方子。前一种病症得之于伤寒，只有表证没有里证。这种病症得之于中风，所以兼见出汗、身肿的表证，以及短气、小便不利的里证。这就是《内经》所说的风气胜者，为行痹的病症。然而上焦的化源不清，总因在表的风湿相搏，所以在前方中仍然重用桂枝，而稍微减少术、附的分量。去掉姜枣，是因为患者短气，而辛散湿腻的药物，不适合使用罢了。
病发于阳，却反用下法，邪气进入胃中，与不得发汗的水气结合，凝结不散，心中硬痛，因此命名为结胸。然而结胸这一病症，有的只在太阳部分，有的并病阳明。这里或丸或汤，有轻重缓急的不同。结在太阳部分的，身体没有大热，只是头部出汗，项背强直像柔痉的样子，寸脉浮，关脉沉，这是病在上焦。因为气机不行，导致水液留结。胸中是太阳的都会，宗气所主持的地方，所以叫气海。太阳是诸阳的主气，气是水之母，气清则水精四布，气热则水浊而壅瘀。这种水结是由于气结引起的，使用杏仁的苦温，来开胸中之气，气降则水下。气结是由于热邪引起的，使用葶苈的大寒，来清气分之热，源头清则水流洁。水结的地方，必然形成窠臼：甘遂的苦辛，所以能直达其窠臼。然而太阳的气化，不行于胸中，则阳明的胃府，也因热而成实，必须借助大黄、芒硝，减小其制剂做成丸药，和白蜜来缓和它，使其留恋于胸中，过一夜才下行，既解除了心胸的结滞，又保护肠胃不受伤害。这是太阳里病下的方法，是以攻剂作为和剂。那些并病阳明的，因为水结于胸，上焦不通，则津液不下，无法滋润肠胃。所以五六天不大便，因而舌干口渴，日晡潮热，这是阳明也受病了。心下至小腹硬满而痛不可触碰，脉沉紧的，这是水邪结于心胸，而热邪实于肠胃。用甘遂来疏浚太阳之水，硝黄来攻伐阳明的实邪，用汤剂来荡涤，这是两阳表里的下法。这两个方子比大承气汤更峻猛，治疗水肿痢疾的初起非常快捷。然而必须看人的体质强壮者施用，如果平时虚弱，或病后不能承受攻伐的，应当考虑到虚虚（使虚者更虚）的祸害。
热入有浅深，结胸分大小。心腹硬痛，甚至牵连小腹不可按压的，为大结胸。这是土燥水坚，所以脉象也应其象而沉紧。只停在心下，不及胸腹，按压知道疼痛但不甚硬的，为小结胸。这是水与热结，凝滞成痰，留在膈上，所以脉象也应其象而浮滑。秽物占据清阳之位，治法应当泻心而涤痰，用黄连清除心下的痞实，半夏消除心下的痰结，寒温并用，温热之结自然平息。栝蒌实色赤形圆，内含津液，法象于心，用它作为君药，辅助黄连的苦味，并且滋润半夏的燥性，确实是除烦涤痰开结宽胸的药剂。虽然同名陷胸，但与攻利水谷的方子相差悬殊了。
大小青龙汤攻太阳之表，有水火之分；大小陷胸汤攻太阳之里，有痰饮之别，不仅仅以轻重来论断。
这是小柴胡汤去掉柴胡加上干姜、黄连，也就是黄连汤去掉桂枝换成黄芩。
伤寒汗出后外证已解，但胃中不和，心下痞硬，干呕食臭，胁下有水气，腹中雷鸣下利的，这是阳不足而阴乘之。凡是外感风寒而阳盛的，汗出不解，多转属阳明而成胃实。这里心下痞硬而下利的，病虽在胃，但不是转属阳明。下利不是因为误下，肠鸣而不满痛，也不是转属太阴了。心是阳中之太阳，那么心下就是太阳的宫城，而心下痞就是太阳的里证。君主之火用不宣畅，汗出不彻底，内在水气不得发散。水气不得散，所以痞硬；邪热不能消化食物，所以干呕食臭。胁下是少阳之位，太阳的阳气不盛，少阳的相火不支持，所以水气得逞。胁下土虚不能制水，水气从胁入胃，泛溢中州，所以腹中雷鸣而下利。病势已在腹中，病根犹在心下，总因寒热交结于内，以致胃中不和。如果用热药散寒，则热势猖獗；用寒药攻热，则水势横行。治法应当寒热并举，攻补兼施，以和胃气。所以用芩、连清除心下的热，干姜散心下的痞，生姜、半夏去胁下的水，参、甘、大枣培补腹中的虚。因为太阳的病是在里，所以不从标本，而从乎中治。而且芩、连的苦，必须得到干姜的辛，才能散痞；人参得甘、枣的甘，协同以保心。又以生姜为君，半夏为佐，全凭辛散甘苦的中枢，水气才能散。名叫泻心，实际上是安心。
这与十枣汤证，都是表解而里不和。见到心下痞硬，干呕下利，然后因为中风之阳邪，所以外症尚有余热，是痞硬下利属于热，所以可用苦寒峻利之剂直接攻之。这里因为伤寒之阴邪，所以内症反有郁逆，是痞硬下利属于虚，所以当用寒温兼补之剂来和解。这是治病各求其本。按语：泻心本名理中黄连人参汤，这里因为病在上焦，所以名叫泻心。世人只知道膀胱是太阳的里，热入膀胱是犯本，不知道心下痞硬是犯本，因而有传足不传手的谬误。
伤寒中风，起初没有下症的指征，误用下法，一天腹泻几十次，完谷不化，腹中雷鸣，这个人的胃气素虚可以知道了。那么心下痞硬而满，不是有形之结热，因为胃中空虚，客气上逆于胃口，所以干呕心烦不得安。所谓当汗不汗，其人就会心烦。如果认为是实热而复用下法，则痞更严重了。本方以甘草为君，一是泻心而除烦，一是补胃中之空虚，一是缓客气之上逆。倍加干姜，本来是为了散中宫下药之寒，并且行芩、连之气而消痞硬，佐半夏以除呕，协甘草以和中。这样甘草得位而三善具备，干姜任重而四美具矣。中虚而不用人参的，因为未经发汗，热不得越，上焦之余邪未散，与用小柴胡汤有胸中烦者去人参同一例。干呕而不用生姜的，因为上焦之津液已虚，无需再散罢了。这个病已在胃，也不叫理中，仍名泻心的，因为心烦痞硬，病在上焦，还没有离开太阳。心烦是太阳里症，即是阳明之表症，所以虽然胃中空虚，完谷不化，而不用人参。因为心烦是胃实之根，太阳转属阳明的捷路。凡伤寒中风，下利清谷属于寒，下利完谷属于热。《内经》所说的“暴注下迫属于热”就是这个意思。仲景去掉人参，预先防止胃家之实吗？
本论说：“呕而发热者，小柴胡主之。”就是所说的“伤寒中风有柴胡证，但见一症即是，不必悉具”的意思。又说：“呕多虽有阳明证，不可攻之。”可见少阳阳明合病，阖从枢转，所以不用阳明之三承气，当从少阳之大柴胡。上焦得通，则津液得下，所以大柴胡是少阳阳明之下药。如果伤寒五六日，呕而发热，是柴胡汤证，而以他药下之，枢机废弛，变症出现了。少阳居半表半里之位，其症不全发阳，不全发阴。所以下后变症偏于半表的，热入而成结胸；偏于半里的，热结心下而成痞。结胸与痞，同为硬满之症，应当以痛来辨别。满而硬痛为结胸热实，大陷胸汤下之，则痛随利减。如满而不痛者为虚热痞闷，宜清火散寒而补虚。盖泻心汤方，就是小柴胡去柴胡加黄连干姜汤。不往来寒热，是无半表症，所以不用柴胡。痞因寒热之气互结而成，用黄连、干姜的大寒大热者，为之两解，并且取其苦先入心，辛以散邪。这个痞本于呕，所以以半夏为君。生姜能散水气，干姜善散寒气。凡呕后痞硬，是上焦津液已干，寒气留滞可知，所以去生姜而倍干姜。痛本于心火内郁，所以仍用黄芩佐黄连以泻心。干姜助半夏之辛，黄芩协黄连之苦，痞硬自散。用参、甘、大枣的，调既伤之脾胃，且以壮少阳之枢。
《内经》说：“腰以上为阳。”所以三阳都有心胸之病。仲景立泻心汤，以分治三阳。在太阳以生姜为君的，因为未经误下而心下成痞，虽然汗出表解，水气犹未散，所以微寓解肌之义。在阳明用甘草为君的，因为两番妄下，胃中空虚，其痞更甚，所以倍甘草以建中，而缓客邪之上逆，这也是从乎中治的方法。在少阳用半夏为君的，因为误下而成痞，邪已去半表，则柴胡汤不中与之，又未全入里，则黄芩汤亦不中与之。未经下而胸胁苦满，是里之表症，用柴胡汤解表。心下满而胸胁不满，是里之半里症，所以制此汤和里，稍变柴胡半表之治，推重少阳半里之意。名叫泻心，实际上是泻胆。
治疗心下痞，按之软，其脉关上浮的，用大黄黄连泻心汤。心下痞而又恶寒汗出的，用附子泻心汤。这都是攻实的药剂，与前三个方子，名虽同而法不同。濡者湿也，这里因为妄下汗不得出，热不得越，结于心下而成痞。胃火炽于内，所以心下有汗，而按之，知其濡湿。结胸症，因为症发于阳，热邪留于上焦，所以其寸脉独浮，而但头汗出，余处无汗。这个心下痞，因为症发于阴，热邪已蓄于中焦，所以其脉独关上浮，而汗但出于心下。心下，是胃口之气。尺寸不浮而关上独浮，这个浮是胃实外见之征，不能责怪浮为在表。子能令母实，所以心下之痞不解，母实而兼泻其子，这又是治太阳阳明并病的一法。云泻心，是泻其实。热有虚实，客邪内陷为实，藏气自病为虚。黄连苦燥，只能解离宫之虚火，不能除胃家之实邪。非君大黄之勇以荡涤之，则客邪协内实而据心下者，漫无出路。所以用一君一臣，用麻沸汤浸泡取汁，乘其锐气而急下之，除客邪须急。夫心下痞而大便硬的，是热结于中，应当不恶寒而反恶寒，当心下有汗，而余处皆无汗。若恶寒已罢，因痞而复恶寒，初无汗，今痞结而反出
This is the principle of treating internal pathology. Adding Shao Yao (Paeonia lactiflora) to Guizhi Tang (Cinnamon Twig Decoction) treats the sinking of Yang pathogenic factors; adding more Guizhi (Cinnamon Twig) to Guizhi Tang treats the attacking upward of Yin pathogenic factors. The subtlety lies in adjusting the dosage of a single herb without seeking other ingredients outside the original formula, maintaining a relationship that is neither too close nor too distant.
Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction with Shuqi, Dragon Bone, and Oyster Shell for Saving from Reversal):
Shanghan (Cold Damage) refers to cold pathogens injuring the Yang of the Monarch (Heart). Using fire methods to force sweating causes not only the loss of the Monarch's Yin but also its Yang, which is termed Huoni (Fire Reversal). Generally, the treatment for Taiyang Shanghan focuses on inducing sweating. Using Mahuang (Ephedra) to induce sweating aids Yang. Using fire coercion to induce sweating is like holding the Emperor hostage to command the feudal lords; power no longer resides with the Monarch, and this sweat does not originate from the Heart. Consequently, symptoms such as fright, mania, restlessness, and inability to lie still occur, resembling the sensation of thorns in the back. The Heart is Yang within Yang, and the sweat of the Taiyang channel is the fluid of the Heart. In cases of fever with spontaneous sweating, the Heart fluid fails to consolidate; thus, Shaoyao is used in Guizhi Tang to astringe it. However, in this case, due to forced sweating, the body fluids are already depleted, leaving no fluid to astringe. Therefore, Shaoyao is removed, and Longgu (Dragon Bone) and Muli (Oyster Shell) are added. Their salty flavor nourishes the Heart, their heavy nature calms fright, and their astringent property secures against collapse, hence the name "Saving from Reversal." Removing the sourness of Shaoyao allows the Liver to receive the tonifying effects of acrid and sweet flavors; adding the salinity of Longgu and Muli enables the Kidney to achieve the state of Water and Fire interacting. This is the method of tonifying the mother when deficient, following the principle of mutual restraint among the Five Elements. (The identity of Shuqi is uncertain. It was previously claimed to be the sprout of Changshan (Dichroa febrifuga), which is erroneous.)
Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction with Dragon Bone and Oyster Shell):
After Huoni (Fire Reversal), if purgatives are mistakenly administered, followed by burning needle therapy leading to irritability, this is a precursor to fright and mania. Urgently, Guizhi and Gancao (Licorice) should be used to calm the Spirit, and Longgu and Muli added to save from reversal. This formula is simpler and more appropriate than the previous one. In recent times, practitioners treating Shanghan lack the method of hot compresses, yet patients often develop irritability and mania. Most use Baihu Tang (White Tiger Decoction) or Chengqi Tang (Order the Qi Decoctions), treating it as an excess condition. However, while many such cases are excess-heat, some are deficiency-cold; thus, warming and tonifying methods to calm the Spirit must not be abandoned. For those with Yang excess and Yin deficiency presenting these symptoms, modified Zhigancao Tang (Prepared Licorice Decoction) with Suanzaoren (Ziziphus Seed), Yuanzhi (Polygala Root), Fuling (Poria), and Danggui (Angelica Sinensis) should be considered.
Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction):
Ingredients: Guizhi, Fuzi (Aconite Lateralis Radix Praeparata), Gancao, Shengjiang (Fresh Ginger), Dazao (Jujube).
Guizhi Fuzi Qu Gu Jia Baizhu Tang (Cinnamon Twig and Aconite Decoction without Cinnamon Twig plus Atractylodes Macrocephala):
Treats Shanghan after eight or nine days where Wind-Dampness intertwines, causing severe body pain, inability to turn over, no vomiting, no thirst, and a floating, deficient, and choppy pulse. If the patient has hard stools and free urination, remove Guizhi and add Baizhu (Atractylodes Macrocephala). Note: Guizhi Fuzi Tang is essentially Guizhi Qu Shaoyao Jia Fuzi Tang. That formula treats post-purgative rapid pulse, chest fullness, and slight aversion to cold, indicating disease at the half-exterior level, requiring Guizhi as the sovereign herb with Fuzi as an assistant. Here, Wind-Cold-Dampness combine and struggle at the exterior, requiring equal emphasis on Guizhi and Fuzi according to sovereign-minister principles. Old editions listing identical dosages for both formulas are erroneous. A floating pulse indicates Wind, a choppy pulse indicates deficiency; floating and choppy together indicate lingering Cold and accompanying Dampness. The combination of Wind, Cold, and Dampness forms Bi Syndrome (Obstruction Syndrome), causing severe body pain and immobility, located solely at the exterior. Guizhi expels Wind, disperses Cold, and overcomes Dampness; thus, its dosage is increased, combined with the acrid-hot Fuzi, led by Gancao, Shengjiang, and Dazao to pacify the three pathogens and harmonize Ying and Wei. If accompanied by interior disharmony with hard stools and free urination, this is not Stomach Excess but Spleen Deficiency. When the Spleen is solid, turbid matter clears naturally. Here, Dampness flows into muscles because Spleen Earth fails to control Water, causing dryness in stools. No vomiting or thirst indicates clear transformation sources in the Upper Jiao, allowing free urination. Moist places harbor Wind, so Wind-Cold struggle unresolved. The root is in the Spleen; the method is to strengthen Earth to overcome Dampness, resolving Wind-Cold. Thus, Baizhu replaces Guizhi as the sovereign. Baizhu strengthens the Spleen. Spleen deficiency leads to Dampness excess and failure to transport; Dampness inside causes loose stools, while Dampness outside prevents proper moistening. A strong Spleen controls Water: internally, it directs water to the Bladder for formed stools; externally, it returns water to the Stomach for moistened stools. The formula note states: "After the first dose, the body feels numb; after three doses, the person feels dizzy." This occurs because Baizhu and Fuzi move through skin and flesh, failing to fully eliminate water qi. The method requires adding four liang of Guizhi. This is one formula with two methods: remove Guizhi for hard stools/free urination; add Guizhi for soft stools/urinary difficulty. Guizhi treats the Upper Jiao; hard stools/free urination indicate Middle Jiao dysfunction, hence removal. After taking the decoction, if Dampness enters the Stomach causing soft stools/urinary difficulty, it indicates Upper Jiao dysfunction, requiring Guizhi. Urination depends on Upper Jiao Qi transformation enabling Bladder storage and excretion. *Neijing* states: "Wind predominance causes Xing Bi (Wandering Bi); Cold predominance causes Tong Bi (Painful Bi); Dampness predominance causes Zhuo Bi (Fixed Bi)." Immobility with pain indicates less Wind and predominant Cold-Dampness, requiring Fuzi's potent force to move fixed Bi Qi. Fuzi acts on the Lower Jiao; combined with Guizhi, it disperses exterior Bi Qi; combined with Baizhu, it moves exterior Bi Qi inward. Thus, Guizhi Fuzi Tang is a surface formula for Upper and Lower Jiao; Guizhi Fuzi Qu Gu Jia Baizhu Tang is for Middle and Lower Jiao; Fuzi Baizhu Tang with added Guizhi circulates through all three Jiao. This is one formula with three methods. People erroneously claim Zhang Zhongjing had 113 formulas and 397 methods without knowing their origin.
Gancao Fuzi Tang (Licorice and Aconite Decoction):
Ingredients: Gancao, Fuzi, Baizhu, Guizhi.
Treats Wind-Dampness intertwining, causing joint pain, inability to flex or extend, severe pain upon touch, sweating, shortness of breath, urinary difficulty, aversion to wind preferring to keep clothes on, or slight body swelling. This is Guizhi Fuzi Tang plus Baizhu minus Shengjiang and Dazao. The previous condition arose from Shanghan, having exterior signs only. This condition arises from Fengshan (Wind Strike), showing exterior signs like sweating and swelling, and interior signs like shortness of breath and urinary difficulty. This corresponds to *Neijing*'s description of Wind predominance causing Xing Bi. However, unclear transformation sources in the Upper Jiao result from exterior Wind-Dampness struggle. Thus, Guizhi is heavily used in the previous formula, while Baizhu and Fuzi are slightly reduced. Shengjiang and Dazao are removed because they are acrid, dispersing, and damp-nourishing, unsuitable for shortness of breath.
Da Xianxiong Wan (Major Yellow Trap Pill):
Ingredients: Dahuang (Rhubarb), Mangxiao (Mirabilite), Xingren (Apricot Seed), Tingli (Descurainia Seed), Gansui (Kansui Root).
Da Xianxiong Tang (Major Yellow Trap Decoction):
Ingredients: Dahuang, Mangxiao, Gansui.
When disease originates in Yang, but purgatives are wrongly applied, pathogens enter the Stomach and bind with retained water qi that could not be sweated out, causing hardness and pain in the heart region, named Jie Xiong (Knotted Chest). Jie Xiong may occur solely in the Taiyang sector or involve Yangming. Pills or decoctions vary by severity and urgency. Cases confined to Taiyang show little fever, only head sweating, neck stiffness resembling Rou Jing (Soft Spasm), floating Cun pulse, and sinking Guan pulse, indicating Upper Jiao involvement due to Qi stagnation causing water retention. The chest is the hub of Taiyang and the residence of Zong Qi (Gathering Qi), called Qi Hai (Sea of Qi). Taiyang governs all Yang; Qi is the mother of Water. Clear Qi distributes Water essence; Hot Qi makes Water turbid and stagnant. This water binding stems from Qi binding. Xingren's acrid-warm nature opens chest Qi; descending Qi allows Water to flow. Heat pathogens cause Qi binding; Tingli's great cold clears Qi-level heat, clearing the source to purify the stream. Water binding forms pockets; Gansui's acrid-bitter nature reaches these pockets directly. If Taiyang Qi transformation fails in the chest, Yangming Stomach Fu becomes solid due to heat. Dahuang and Mangxiao are used in reduced pill form with honey to linger in the chest overnight before purging, relieving chest constriction while protecting the intestines. This is a purgative method for Taiyang interior disease, using attacking agents as harmonizing ones. Cases involving Yangming feature water binding in the chest blocking Upper Jiao, preventing Jin Ye (Body Fluids) from descending to moisten intestines. After five to six days of constipation, dry tongue, thirst, and afternoon tidal fever, Yangming is affected. Hardness and pain from epigastrium to lower abdomen unyielding to pressure, with deep-tight pulses, indicate Water Evil binding in chest-heart and Heat Evil solidifying in intestines. Gansui drains Taiyang water; Xiaohuang attacks Yangming excess. Decoction sweeps them away, representing a dual exterior-interior purgative for Two Yangs. These formulas are harsher than Da Chengqi Tang, effective for early-stage edema and dysentery, but only for robust patients. Weak patients or those post-illness unable to withstand attack risk "making the deficient more deficient."
Xiao Xianxiong Tang (Minor Yellow Trap Decoction):
Ingredients: Huanglian (Coptis Rhizome), Banxia (Pinellia Tuber), Gualou Shi (Trichosanthes Fruit).
Heat penetration varies in depth; Jie Xiong divides into large and small. Hard, painful heart and abdomen extending to lower abdomen, unpressable, is Large Jie Xiong. Dry earth and firm water reflect in deep-tight pulses. Pain limited to epigastrium, not extending to chest/abdomen, tender but not hard on pressure, is Small Jie Xiong. Water-Heat binding congeals into Phlegm lodging above the diaphragm, reflecting in floating-slippery pulses. Filth occupying pure Yang positions requires draining the Heart and eliminating Phlegm. Huanglian removes epigastric fullness-solidity; Banxia dissolves epigastric Phlegm knots. Cold and heat are used together, resolving heat-warmth knots. Gualou Shi is red, round, contains fluids, symbolizes the Heart, and serves as sovereign. It assists Huanglian's bitterness and moistens Banxia's dryness, truly being a formula for removing vexation, eliminating Phlegm, opening knots, and widening the chest. Though named "Trap Chest," it differs vastly from formulas purging food and water.
Da/Xiao Qinglong Tang attack Taiyang exterior with distinctions between Water and Fire; Da/Xiao Xianxiong Tang attack Taiyang interior with distinctions between Phlegm and Fluids, not merely by severity.
Shengjiang Xiexin Tang (Fresh Ginger Draining Heart Decoction):
Ingredients: Renshen (Ginseng), Gancao, Huanglian, Huangqin (Scutellaria Root), Ganjiang (Dried Ginger), Banxia, Shengjiang, Dazao.
This is Xiao Chaihu Tang minus Chaihu plus Ganjiang and Huanglian, equivalent to Huanglian Tang minus Guizhi replacing it with Huangqin.
After Shanghan sweating resolves exterior signs, but Stomach disharmony persists with epigastric hardness, dry retching with food odor, subcostal water qi, borborygmus, and diarrhea, this is Yang insufficiency allowing Yin invasion. Exterior Wind-Cold with Yang excess usually turns to Yangming Stomach Excess after unresolved sweating. Here, epigastric hardness with diarrhea is not Yangming transition. Diarrhea without mistaken purgation, borborygmus without fullness/pain, is not Taiyin transition. The Heart is Yang within Yang; the epigastrium is Taiyang's palace wall; epigastric fullness is Taiyang interior. Monarch Fire fails to disseminate; incomplete sweating traps interior water qi. Unresolved water qi causes fullness-hardness; pathogenic heat fails to digest food, causing dry retching/food odor. Subcostal area is Shaoyang position; weak Taiyang Yang fails to support Shaoyang Minister Fire, allowing Water Qi dominance. Subcostal Earth deficiency fails to control Water; Water enters Stomach from subcostal area, flooding Central Jiao, causing borborygmus/diarrhea. Disease trend is abdominal, root is epigastric, caused by interior Cold-Heat knotting leading to Stomach disharmony. Heat disperses Cold but exacerbates Heat; Cold attacks Heat but exacerbates Water. Method: simultaneous Cold/Heat, attack/tonification to harmonize Stomach Qi. Huangqin/Huanglian clear epigastric heat; Ganjiang disperses epigastric fullness; Shengjiang/Banxia remove subcostal water; Renshen/Gancao/Dazao tonify abdominal deficiency. Since Taiyang disease is interior, treatment follows the Middle rather than Root/Branch. Bitterness of Qin/Lian requires acridity of Ganjiang to disperse fullness; sweetness of Ren/Gan/Zao protects Heart. With Shengjiang as sovereign and Banxia as assistant, relying on acrid-dispersing/sweet-bitter pivot, Water Qi disperses. Named "Draining Heart," it actually "Calms Heart."
Like Shizao Tang syndrome, this presents interior disharmony after exterior resolution: epigastric hardness, dry retching, diarrhea. Caused by Wind Strike Yang Pathogen, residual exterior heat remains; fullness/diarrhea are Heat-type, allowing bitter-cold drastic purgatives. Here, caused by Cold Damage Yin Pathogen, interior symptoms show depression/rebellion; fullness/diarrhea are Deficiency-type, requiring Cold-Warm tonifying harmonizers. Treating diseases seeks their root. Note: Xiexin was originally named Lizhong Huanglian Renshen Tang; named Xiexin here due to Upper Jiao location. People mistakenly believe Bladder is Taiyang interior and Heat entering Bladder is "attacking the root," ignoring epigastric hardness as attacking the root, leading to the fallacy of "transmitting to Foot channels only, not Hand channels."
Gancao Xiexin Tang (Licorice Draining Heart Decoction):
Ingredients: Gancao, Huanglian, Huangqin, Ganjiang, Banxia, Dazao.
Shanghan/Fengshan initially lacking purgative indications, mistaken purgation causes frequent daily defecation, undigested food, borborygmus, indicating chronic Stomach Qi deficiency. Epigastric fullness-hardness is not有形 (material) Heat knot; empty Stomach allows hostile Qi to rebel upward, causing dry retching/vexation/restlessness. "Should have sweated but didn't, causing vexation." Mistaking this for Excess Heat and purging worsens fullness. Gancao as sovereign: drains Heart/removes vexation, tonifies Stomach emptiness, moderates hostile Qi rebellion. Doubling Ganjiang disperses Cold from mistaken purgatives in Middle Jiao, moves Qin/Lian Qi to resolve fullness, assists Banxia for retching, harmonizes with Gancao. Gancao achieves three virtues; Ganjiang fulfills four beauties. Renshen omitted despite deficiency because no sweating occurred, Heat couldn't vent, Upper Jiao residual pathogen remains, same logic as omitting Renshen in Xiao Chaihu Tang for chest vexation. Shengjiang omitted for dry retching because Upper Jiao fluids are deficient, avoiding further dispersion. Disease in Stomach, not named Lizhong, but Xiexin, because vexation/fullness is Upper Jiao, still within Taiyang. Vexation is Taiyang interior symptom, also Yangming exterior symptom; thus, despite Stomach emptiness/undigested food, Renshen is omitted. Vexation is root of Stomach Excess, quick path for Taiyang turning to Yangming. Shanghan/Fengshan diarrhea with clear undigested food is Cold; diarrhea with undigested food is Heat. *Neijing*: "Violent diarrhea with tenesmus belongs to Heat." Did Zhongjing omit Renshen to prevent Stomach Excess?
Banxia Xiexin Tang (Pinellia Draining Heart Decoction):
Ingredients: Banxia, Ganjiang, Huanglian, Huangqin, Renshen, Gancao, Dazao.
Text states: "Vomiting with fever, Xiao Chaihu Tang governs." Meaning "Shanghan/Fengshan with Chaihu syndrome, seeing one symptom suffices, not all need be present." Also: "Frequent vomiting even with Yangming signs, do not purge." Shows Shaoyang-Yangming combined disease transforms via Pivot; thus, avoid Yangming Three Chengqi formulas, use Shaoyang Da Chaihu Tang. Upper Jiao patent allows Jin Ye descent; Da Chaihu Tang is Shaoyang-Yangming purgative. If Shanghan day five-six presents vomiting/fever (Chaihu indication) but wrongly purged, Pivot mechanism slackens, complications arise. Shaoyang sits half-exterior/half-interior; symptoms neither purely Yang nor Yin. Post-purgation complications leaning half-exterior become Heat entering Jie Xiong; leaning half-interior become Heat knotting epigastrium causing Pi (Fullness). Both Jie Xiong and Pi present hardness/fullness, distinguished by pain. Fullness-hardness-pain is Jie Xiong Heat Excess, treated with Da Xianxiong Tang, pain reduces with purging. Fullness without pain is Deficient Heat Pi stuffiness, treat with clearing Fire, dispersing Cold, tonifying Deficiency. Xiexin Tang is Xiao Chaihu Tang minus Chaihu plus Huanglian/Ganjiang. No alternating chills/fever means no half-exterior sign, hence no Chaihu. Pi forms from Cold-Heat knotting; Huanglian/Ganjiang's extreme Cold/Heat resolve both, utilizing Bitter entering Heart, Acrid dispersing Pathogen. Pi originates from vomiting, so Banxia is sovereign. Shengjiang disperses Water Qi; Ganjiang disperses Cold Qi. Post-vomiting Pi-hardness indicates dried Upper Jiao fluids and lingering Cold, hence remove Shengjiang, double Ganjiang. Pain stems from interiorly depressed Heart Fire, so Huangqin assists Huanglian to drain Heart. Ganjiang assists Banxia's acridity; Huangqin assists Huanglian's bitterness, resolving Pi-hardness. Renshen/Gancao/Dazao repair damaged Spleen/Stomach and strengthen Shaoyang Pivot.
*Neijing*: "Above waist is Yang." All Three Yang channels have chest-heart diseases. Zhongjing established Xiexin Tangs to treat Three Yang separately. In Taiyang, Shengjiang is sovereign because Pi formed without mistaken purgation; though sweating resolved exterior, Water Qi remains, subtly implying muscle-releasing meaning. In Yangming, Gancao is sovereign because double mistaken purgation emptied Stomach, worsening Pi; doubling Gancao builds Middle, moderates hostile Qi rebellion, following Middle treatment. In Shaoyang, Banxia is sovereign because Pi formed after mistaken purgation; pathogen left half-exterior, so Chaihu Tang inappropriate; not fully interior, so Huangqin Tang inappropriate. Pre-purgation subcostal fullness is Interior-Exterior sign, treated with Chaihu Tang. Epigastric fullness without subcostal fullness is Interior-Half-Interior sign, so this formula harmonizes Interior, slightly altering Chaihu's Half-Exterior treatment, emphasizing Shaoyang Half-Interior intent. Named "Draining Heart," actually "Draining Gallbladder."
Dahuang Huanglian Xiexin Tang
Fuzi Xiexin Tang (Aconite Draining Heart Decoction):
Ingredients: Fuzi, Dahuang, Huanglian, Huangqin.
Treats epigastric Pi, soft on pressure, floating Guan pulse, using Dahuang Huanglian Xiexin Tang. Epigastric Pi with aversion to cold and sweating uses Fuzi Xiexin Tang. These are attacking Excess agents, differing in method from previous three formulas though sharing names. "Ru" (soft) indicates Dampness. Here, mistaken purgation prevented sweating, Heat couldn't vent, knotting epigastrium forming Pi. Stomach Fire blazing internally causes epigastric sweating; pressing reveals dampness. Jie Xiong syndrome, originating in Yang, Heat lingering in Upper Jiao, shows isolated floating Cun pulse and head-only sweating, no other sweating. This epigastric Pi, originating in Yin, Heat accumulating in Middle Jiao, shows isolated floating Guan pulse and epigastric-only sweating. Epigastrium represents Stomach Qi. Cun-Chi not floating, only Guan floating, indicates external manifestation of Stomach Excess, not exterior location. Son making Mother Excess: unresolved epigastric Pi implies Mother Excess, draining Son is another method for Taiyang-Yangming combined disease. "Draining Heart" means draining its Excess. Heat has Deficiency/Excess types: invading pathogens causing interior sinking is Excess; Zang organ self-disease is Deficiency. Huanglian's bitter-dryness resolves Li Gong (Heart Palace) Deficient Fire but cannot remove Stomach Excess Pathogen. Without Dahuang's bravery to sweep, invading pathogens combining with internal Excess occupy epigastrium with no exit. Thus, Sovereign-Minister pair uses boiling water infusion to capture sharp energy for rapid purging; removing invading pathogens requires speed. Epigastric Pi with hard stools indicates Heat knotting Middle; should have no aversion to cold but instead has it; epigastric sweating but no other sweating. If aversion to cold ceases then returns due to Pi, initially no sweating now returns with Pi knotting...