主汗吐下后，心烦不得眠，心中懊 。
栀子（十四枚） 香豉（四合，绵裹） 水四升，先煎栀子，取二升半，去滓，纳豉，
煮取一升半，分二服，温进一服，得快吐，止后服。
《经》曰∶高者因而越之，下者引而竭之，中满者泻之于内，其有邪者，渍形以为
汗，其在皮者，汗而发之。治伤寒之妙，虽有变通，终不越此数法也。邪气自表传里，
留于胸中为邪，在高分则可吐之，所吐之症，亦自不同。如不经汗下，邪气蕴郁于
膈，谓之膈实，应以瓜蒂散吐之。若汗吐下后，邪气乘虚留于胸中，谓之虚烦，应以栀
子豉汤吐之。《经》曰∶酸苦涌泄为阴，是以栀子为君，烦为热胜，涌热者，必以苦
胜，热者必以寒，香豉苦寒是以为臣也。
主伤寒下早，心满而不痛者为痞。
半夏（半升，洗） 黄连（一两） 黄芩 干姜 人参 甘草（炙，各三两） 大枣（十二枚
，去核） 水一斗，煮六升，去滓，煎取三升，温服一升，日三服，加甘草一两，即
甘草泻心汤。治痞硬吐痢，加生姜四两，即生姜泻心汤，治痞硬噫气。
成氏曰∶结而不散，壅而不通，为结胸。陷胸汤为直达之剂，塞而不通，否而不
泰为痞，泻心汤为分解之剂，痞与结胸有高下焉。邪结在胸中，故曰陷胸汤。留邪在心
下，故曰泻心汤。泻心者，必以苦，黄连、黄芩皆苦寒，《经》曰∶苦先入心，以苦泄
之，故黄连为君，黄芩为臣，降阳而升阴也。散痞者，必以辛，半夏辛温，干姜辛
热，《经》曰∶辛走气，辛以散之，故半夏、干姜为佐抑阴而行阳也。甘草甘平、参、枣
甘温，阴阳不交为痞，上下不通为满，欲通上下，交阴阳者，必平其中，中者脾胃也。
脾不足者，以甘补之，故参、枣、甘草为使。上下得通，水升火降，则痞热自消矣。
主治经过发汗、催吐或泻下治疗后，出现心中烦乱、无法入睡，胸中闷乱不适的症状。
栀子（十四枚） 香豉（四合，用棉布包裹） 用水四升，先煎煮栀子，取药液二升半，滤去药渣，加入香豉，
继续煎煮至一升半，分两次服用，温服一次，若服药后引起快速呕吐，则停止后续服用。
《黄帝内经》说：病位在高处的，因势利导使其涌越而出；病位在下部的，引导其排泄干净；中焦胀满的，从内部攻泻；体内有邪气的，浸渍形体以发汗；邪气在皮表的，通过发汗来发散。治疗伤寒的精妙之处，虽然有所变通，但终究不超出这几类治法。邪气从体表传入体内，
停留在胸中成为邪气，位置较高时可以采用吐法，所吐出的病症表现也各不相同。如未经过发汗或泻下，邪气郁结在膈间，称为膈实，应当用瓜蒂散进行催吐。如果经过发汗、催吐或泻下后，邪气乘虚滞留于胸中，称为虚烦，应当用栀子豉汤进行催吐。《黄帝内经》说：酸味和苦味具有涌泄作用，属于阴的性质，因此以栀子为君药，心烦是由于热邪亢盛，要涌泄热邪，必须用苦味来制约，热邪必须用寒凉药物来清除，香豉性味苦寒，所以作为臣药。
半夏（半升，洗净） 黄连（一两） 黄芩 干姜 人参 甘草（炙烤，各三两） 大枣（十二枚，去核） 用水一斗，煎煮至六升，滤去药渣，再浓缩煎取三升，每次温服一升，每日服用三次。若增加甘草一两，即为甘草泻心汤。用于治疗痞硬伴有呕吐腹泻症状时，加入生姜四两，即为生姜泻心汤，用于治疗痞硬伴有嗳气症状。
成无己说：气机结聚而不消散，壅滞而不通畅，称为结胸。陷胸汤是直达病所的药剂；气机阻塞而不通，闭塞而不得安泰，称为痞证。泻心汤是分解病邪的药剂，痞证与结胸在病位上有高下之分。邪气结聚在胸中，所以叫陷胸汤。邪气留滞在胃脘部（心下），所以叫泻心汤。治疗痞证，必须用苦味药，黄连、黄芩都是苦寒之品，《黄帝内经》说：苦味先入心，用苦味来泄降邪气，所以黄连为君药，黄芩为臣药，旨在降阳升阴。消散痞结，必须用辛味药，半夏性辛温，干姜性辛热，《黄帝内经》说：辛味能行气，用辛味来散结，所以半夏、干姜作为佐药，旨在抑制阴邪而运行阳气。甘草性甘平，人参、大枣性甘温，阴阳不能相交导致痞证，上下不通导致胀满，想要疏通上下、交通阴阳，必须调和其中焦，中焦即脾胃。脾脏虚弱时，用甘味药来补益，所以人参、大枣、甘草作为使药。上下得以通畅，水气上升、火气下降，那么痞热自然消除。
Indicated for restlessness and insomnia, accompanied by a sense of oppression and discomfort in the chest (Xiongzhong), following sweating, emesis, or purgation therapies.
Gardenia Fruit (Zhizi, 14 seeds) Fermented Soybean (Xiangchi, 4 he, wrapped in silk) Add four sheng of water, first decoct Zhizi, obtain two and a half sheng of liquid, remove dregs, add Xiangchi,
decoct to obtain one and a half sheng, divide into two doses, take one dose warm; if rapid vomiting occurs, stop taking the remaining dose.
The *Classic* states: For pathogens located high, promote their expulsion upwards; for those located low, guide them downwards to exhaust them; for fullness in the middle, purge from within; for pathogens in the body, soak the form to induce sweating; for pathogens in the skin, disperse through sweating. The subtlety of treating Cold Damage (Shanghan) lies in flexibility, yet ultimately does not exceed these few methods. When pathogenic factors transmit from the exterior to the interior,
staying in the chest as evil, if located at a high level, emesis may be used; the symptoms expelled vary. If without prior sweating or purgation, pathogenic factors accumulate and stagnate in the diaphragm, termed Diaphragmatic Excess (Ge Shi), Guadi San (Melon Tendril Powder) should be used to induce emesis. If after sweating, emesis, or purgation, pathogenic factors take advantage of deficiency to remain in the chest, termed Deficient Restlessness (Xu Fan), Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used to induce emesis. The *Classic* states: Sour and bitter flavors have the property of surging and draining, belonging to Yin. Therefore, Zhizi is used as the Sovereign herb. Restlessness is caused by excessive heat; to surge out heat, bitterness must overcome it; heat must be cleared with cold. Xiangchi is bitter and cold, thus serving as the Minister herb.
Indicated for epigastric fullness without pain (Pi syndrome) resulting from premature purgation in Cold Damage.
Pinellia Tuber (Banxia, half sheng, washed) Coptis Rhizome (Huanglian, one liang) Scutellaria Root (Huangqin) Zingiber Rhizome (Ganjiang) Codonopsis Root (Renshen) Licorice Root (Gancao, roasted, three liang each) Jujube (Dazao, twelve pieces, pitted) Add ten dou of water, decoct to six sheng, remove dregs, further concentrate to three sheng, take one sheng warm, three times daily. Adding one liang of Gancao constitutes Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium). For Pi hard with vomiting and diarrhea, add four liang of Shengjiang (Fresh Ginger), constituting Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium), indicated for Pi hard with belching.
Cheng Wuji stated: Knotting without dispersal, obstruction without flow, is Jie Xiong (Chest Binding). Xiongxiao Tang is a direct-acting agent; blockage without passage, stagnation without peace, is Pi (Epigastric Fullness). Xiexin Tang is a resolving agent. There is a distinction in location between Pi and Jie Xiong. Pathogens knotting in the chest are treated with Xiongxiao Tang. Pathogens lingering in the heart region (epigastrium) are treated with Xiexin Tang. To drain the heart (epigastrium), bitter herbs are necessary. Huanglian and Huangqin are both bitter and cold. The *Classic* states: Bitter enters the Heart first; use bitterness to drain, hence Huanglian is the Sovereign, Huangqin is the Minister, descending Yang and ascending Yin. To dissipate Pi, acrid herbs are necessary. Banxia is acrid and warm, Ganjiang is acrid and hot. The *Classic* states: Acrid moves Qi; use acrid to disperse, hence Banxia and Ganjiang are Assistant herbs, suppressing Yin and promoting Yang. Gancao is sweet and neutral; Renshen and Dazao are sweet and warm. When Yin and Yang fail to interact, Pi results; when upper and lower do not connect, fullness results. To connect upper and lower and facilitate interaction between Yin and Yang, the Middle Jiao must be balanced. The Middle Jiao is the Spleen and Stomach. When the Spleen is deficient, tonify with sweet flavor. Thus, Renshen, Dazao, and Gancao serve as Envoy herbs. When upper and lower are connected, Water ascends and Fire descends, and Pi-heat naturally dissipates.