上杵二味为末，内巴豆于臼中杵之，以白饮合服。强人一钱，羸者减之。病在膈上
必吐，在膈下必利，不利进热粥一杯，利过不止，进冷粥一杯。
【注】是方治寒实痰水结胸，极峻之药也。君以巴豆极辛极烈，攻寒逐水，斩关夺门，所
到之处无不破也。佐以贝母开胸之结，使以桔梗为之舟楫，载巴豆搜逐胸邪。膈上者必
吐，膈下者必利，使其邪悉尽无余矣。然惟知任毒以攻邪，不量强羸，鲜能善其后也，故
羸者减之，不利进热粥，利过进冷粥，盖巴豆性热，得热则行，得冷则止。不用水而用
粥者，藉谷气以保胃也。
大黄黄连泻心汤 治伤寒表解，心下痞，按之不软，其脉关上浮者。
大黄（二两） 黄连（一两）
上二味，以麻沸汤二升渍之，须臾绞去滓，分温再服。
【注】痞硬虚邪而用大黄、黄连，能不起后人之疑耶？仲景使人疑处，正是妙处。盖
因后人未尝细玩，不得其法，皆煎而服之，大悖其旨矣。观乎用气薄之麻沸汤渍大黄、黄
连，须臾去滓，仅得其无形之气，不重其有形之味，是取其气味俱薄，不大泻下。虽曰
攻痞，而攻之之妙义无穷也。
附子泻心汤 治伤寒表解，心下痞，恶寒汗出者。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（炮去皮，别煮汁，一枚）
上四味，切三味，以麻沸汤二升渍之，须臾绞去滓，内附子汁，分温再服。
【注】心下硬痛，结胸也；硬而不痛，心下痞也。恶寒而复汗出，非表不解，乃表阳
虚也。故以大黄、黄连、黄芩泻痞之热，附子温表之阳，合内外而治之。其妙在以麻沸
汤渍三黄，须臾绞去滓，内别煮附子汁，义在泻痞之意轻，扶阳之意重也。
甘草泻心汤 治伤寒中风，医反下之，其人下利，日数十行，谷不化，腹中雷鸣，心
下痞硬而满，干呕心烦不得安。医见心下痞，谓病不尽，复下之，其痞益甚，此非结热，但
以胃中虚客气上逆，故使硬也。
甘草（四两） 黄芩（三两） 黄连（一两） 干姜（三两） 半夏（洗，半升） 大枣（擘，十二枚）
上六味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【注】毋论伤寒、中风，表未解，总不可下，医反下之，因而成痞。其人下利日数十
行，水谷不化，腹中雷鸣者，误下胃中空虚也。心下痞硬而满，干呕心烦不得安者，乘
虚客邪上逆也。医见心下痞硬，谓下之不尽，又复下之，其痞益甚。但此非结热之痞，亦
非寒结之痞，乃乘胃空虚，客气上逆，阳陷阴凝之痞也。方以甘草命名者，取和缓之意。
用甘草、大枣之甘温，补中缓急，治痞之益甚。半夏之辛，破客逆之上从。芩、连泻阳
陷之痞热，干姜散阴凝之痞寒。缓急破逆，泻痞寒热，备乎其治矣。
生姜泻心汤 治伤寒汗出解后，胃中不和，心下痞硬，干噫食臭，胁下有水气，腹
中雷鸣下利者。
甘草（炙，二两） 人参（三两） 干姜（一两） 半夏（洗，半升） 黄芩（三两） 黄连（一两）
生姜（切，四两） 大枣（擘，十二枚）
上八味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【注】伤寒汗出之后，余邪转属阳明，心下痞满硬痛不大便者，此其人胃素燥热，因
而成实，攻之可也。今其人平素胃虚，兼胁下有水气，即不误下，余热乘虚入里，结成
痞硬不痛，胃虚不能消化水谷，则干噫食臭也。胃中寒热不和，则腹中雷鸣下利也。名
生姜泻心汤者，其义重在散水气之痞也。生姜、半夏散胁下之水气，人参、大枣补中州
之土虚，干姜、甘草以温里寒，黄芩、黄连以泻痞热。备乎虚水寒热之治，胃中不和下
利之痞，未有不愈者也。
半夏泻心汤 治伤寒五六日，呕而发热，柴胡证具，而以他药下之，但满不痛，心下
痞者。
半夏（洗，半升） 黄芩（三两） 干姜（三两） 人参（三两） 黄连（一两） 甘草（炙，三两）
大枣（擘，十二枚）
上七味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【集注】王又原曰∶伤寒五六日，柴胡证具，而以他药下之成痞。即用小柴胡汤，以
干姜易生姜，以黄连易柴胡。彼以和表里，此以彻上下。而必推半夏为君者，痞从呕得来，
半夏之辛以破结而止呕也。
旋复代赭石汤 治汗、吐、下解之后，心下痞硬，噫气不除。
旋复花（三两） 人参（二两） 代赭石（一两） 半夏（洗，半升） 生姜（切，五两）
甘草（炙，三两） 大枣（擘，十二枚）
上七味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【集注】罗谦甫曰∶汗、吐、下解后，邪虽去而胃气已亏矣。胃气既亏，三焦因之失
职，清无所归而不升，浊无所纳而不降，是以邪气留滞，伏饮为逆，故心下痞硬，噫气
不除。方中以人参、甘草养正补虚，姜、枣和脾养胃，所以安定中州者至矣。更以代赭
石之重，使之敛浮镇逆，旋复花之辛，用以宣气涤饮，佐人参以归气于下，佐半夏以蠲
饮于上。浊降痞硬可消，清升噫气自除，观仲景治少阴水气上凌，用真武汤镇之；治下
焦滑脱不守，用赤石脂禹余粮固之。此胃虚气失升降，复用此法理之，则胸中转否为泰，
其为归元固下之法，各极其妙如此。
麻黄连轺赤小豆汤 治伤寒表不解，瘀热在里发黄者。
麻黄（二两） 赤小豆（一升） 杏仁（去皮尖，四十枚） 生姜（切，一两） 大枣（擘，十二枚）
甘草（炙，一两） 生梓白皮（一升） 连轺（二两）
以上八味，以潦水一斗，先煮麻黄，再沸，去上沫，内诸药，煮取三升，分温三服，
半日则尽。
【注】湿热发黄无表里证，热盛者清之，小便不利者利之，里实者下之，表实者汗之，
皆无非为病求去路也。用麻黄汤以开其表，使黄从外而散。去桂枝者避其湿热也，佐姜枣
者和其营卫也，加连轺、梓皮以泻其热，赤小豆以利其湿，同成表实发黄之效也。连轺
即连翘根，无梓皮以茵陈代之，成无己曰∶煎以潦水者，取其味薄不助湿热也。
栀子柏皮汤 治伤寒身黄发热，无表里证者。
栀子（擘，十五枚） 甘草（一两） 黄柏（一两）
上三味，以水四升，煮取一升半，去滓，分温再服。
【注】伤寒身黄发热者，若有无汗之表，以麻黄连轺赤小豆汤汗之；若有成实之里，以
茵陈蒿汤下之。今外无可汗表证，内无可下里证，惟有黄热，宜以栀子柏皮汤清之可也。
此方之甘草当是茵陈，传写之误也。
茵陈蒿汤 阳明病发热，但头汗出，身无汗，小便不利，渴饮水浆，此为瘀热在里，
身必发黄，腹微满者，本方主之。
茵陈蒿（六两） 栀子（擘，十四枚） 大黄（二两）
上三味，以水二斗，先煮茵陈，减六升，内二味，煮取三升，去滓，分温三服。小便
当利，如皂角汁状，色正赤，一宿腹减，黄从小便去也。
【集注】柯琴曰∶太阳、阳明俱有发黄证，但头汗出而身无汗，则热不外越。小便不利，
则热不下泄，故瘀热在里。然里有不同，肌肉是太阳之里，当汗而发之，故用麻黄连翘
赤小豆汤为凉散法。心胸是太阳阳明之里，当寒以胜之，用栀子柏皮汤，乃清火法。肠胃
是阳明之里，当泻之于内，故立本方，是逐秽法。茵陈禀北方之气，经冬不调，傲霜凌
雪，偏受大寒之气，故能除热邪留结，率栀子以通水源，大黄以调胃实，令一身内外瘀
热，悉从小便而出，腹满自减，肠胃无伤，乃合引而竭之之法，此阳明利水之圣剂也。又
曰∶仲景治阳明渴饮有四法∶本太阳转属者，五苓散微发汗以散水气∶大烦燥渴小便自利
者，白虎加参清火而生津；脉浮发热小便不利者，猪苓汤滋阴而利水；小便不利腹满者，
茵陈蒿汤以泄满，令黄从小便出，病情治法，胸有成竹矣。每思仲景利小便必用气化之品，
通大便必用承气之品。故小便不利者，必加茯苓，甚者兼用猪苓，因二苓为气化之品，而
小便由于气化也。兹小便不利，不用二苓者何？本论云∶阳明病，汗出多而渴者，不可
与猪苓汤，以汗多胃中燥，猪苓汤复利小便故也。斯知阳明病汗出多而渴者，不可用，则
汗不出而渴者，津液先虚，更不可用明矣。此以推陈致新之茵陈，佐以屈曲下行之栀子，不
用枳、朴以承气，与芒硝之峻利，则大黄但可以润胃燥，而大便之不遽行可知。故必一
宿而腹始减，黄从小便去而不由大肠去，仲景立法神奇，匪夷所思耳。
将前两味药捣碎成粉末，把巴豆放入臼中捣烂，用米汤送服。体质强壮者服一钱，体弱者减量。病邪在膈膜以上，必然引起呕吐；病邪在膈膜以下，必然引起腹泻。如果服药后没有腹泻，喝一杯热粥以助药力；如果腹泻不止，喝一杯冷粥以止泻。
【注解】此方用于治疗寒邪与痰水互结于胸部的“寒实结胸”，是极为峻猛的药剂。以巴豆为君药，因其极辛极烈，能攻逐寒邪、驱逐水饮，如斩关夺门般，所到之处无不攻破。以贝母为佐药，开通胸中的郁结；以桔梗为使药，如同舟楫一般，载着巴豆搜逐胸中的邪气。病在膈上者必然呕吐，病在膈下者必然腹泻，从而使邪气彻底清除无余。然而，如果只知道任用毒性药物来攻伐邪气，而不根据患者体质的强弱进行权衡，很少能妥善处理好后续事宜。因此，体弱者要减量，不腹泻的喝热粥（助阳行药），腹泻过度的喝冷粥（抑制药性）。这是因为巴豆性热，遇热则药力行散，遇冷则药力停止。不用水而用粥，是借助谷气来保护胃气。
大黄黄连泻心汤：治疗伤寒表证已解，出现心下部痞塞感，按压时感觉坚硬而不柔软，脉象关部浮起的病症。
大黄（二两） 黄连（一两）
将这两味药，用滚开的麻沸汤二升浸泡片刻，随即绞去药渣，分两次温服。
【注解】对于痞硬这种虚邪，却使用大黄、黄连，怎能不引起后人的疑惑呢？张仲景让人产生疑惑的地方，正是其精妙之处。大概是因为后人未曾仔细研读，不得其法，都将药物煎煮后服用，这完全违背了原方的旨意。观察其用法，用气味轻薄的麻沸汤浸泡大黄、黄连，片刻后去渣，仅取其无形之气，而不重用其有形的味道，这是取其气味俱薄，不至于造成剧烈的泻下作用。虽然说是攻除痞满，但其中攻法的奥妙无穷无尽。
附子泻心汤：治疗伤寒表证已解，心下部痞塞，伴有恶寒、汗出的症状。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（炮制去皮，另煮取汁，一枚）
将前三味药切碎，用麻沸汤二升浸泡，片刻后绞去药渣，加入附子的汁液，分两次温服。
【注解】心下部坚硬且疼痛，是结胸证；坚硬但不疼痛，是心下痞证。恶寒而又汗出，并非表证未解，而是表阳虚损。因此用大黄、黄连、黄芩来清泻痞满之热，用附子来温补表阳，内外同治。其精妙之处在于用麻沸汤浸泡三黄（大黄、黄连、黄芩），片刻后去渣，再加入另煮的附子汁，其义在于清泻痞热的意图较轻，扶助阳气的意图较重。
甘草泻心汤：治疗伤寒或中风，医生反而误用攻下法，导致患者腹泻，每天数十次，食物不消化，腹中肠鸣音如雷，心下部痞塞坚硬且胀满，干呕，心烦不安。医生见心下部痞塞，认为病邪未尽，再次攻下，结果痞满更加严重。这并不是热邪结实，而是因为胃中空虚，客气上逆，所以导致痞硬。
甘草（四两） 黄芩（三两） 黄连（一两） 干姜（三两） 半夏（洗，半升） 大枣（掰开，十二枚）
将以上六味药，用水一斗，煮取六升，去渣后再煎，取三升，每次温服一升，每日三次。
【注解】无论是伤寒还是中风，在表证未解时，总不可用攻下法，医生反而误下，因而形成痞证。患者腹泻每天数十次，水谷不化，腹中雷鸣，这是误下导致胃中空虚所致。心下部痞塞坚硬且胀满，干呕，心烦不安，这是邪气乘虚上逆所致。医生见心下部痞硬，认为下之不尽，又再次攻下，导致痞满更甚。但这并非热结之痞，也非寒结之痞，而是乘胃空虚，客气上逆，阳气下陷、阴气凝滞所形成的痞证。方名以甘草命名，取意于缓和之意。用甘草、大枣的甘温之性，补益中焦、缓解急迫，以治疗日益严重的痞满。半夏的辛味，破除客邪上逆之势。黄芩、黄连清泻阳气下陷之痞热，干姜散除阴气凝滞之痞寒。缓急、破逆、泻痞、寒热并调，治疗方法完备。
生姜泻心汤：治疗伤寒发汗后表证已解，但胃中不和，心下部痞塞坚硬，嗳气带有食物腐臭味，胁下有积水气，腹中肠鸣音如雷并伴有腹泻。
甘草（炙，二两） 人参（三两） 干姜（一两） 半夏（洗，半升） 黄芩（三两） 黄连（一两）
生姜（切片，四两） 大枣（掰开，十二枚）
将以上八味药，用水一斗，煮取六升，去渣后再煎，取三升，每次温服一升，每日三次。
【注解】伤寒发汗之后，余邪转属阳明，若心下部痞满坚硬疼痛且不大便，说明此人平素胃燥热，因而成实，可以攻下。如今此人平素胃虚，兼有胁下水气，即使不误用攻下，余热也会乘虚入里，结成痞硬但不疼痛。胃虚不能消化水谷，所以出现嗳气带有食物腐臭味。胃中寒热不调和，所以腹中肠鸣音如雷并伴有腹泻。命名为生姜泻心汤，其意义重在消散水气导致的痞满。生姜、半夏消散胁下的水气，人参、大枣补益中焦脾胃之虚，干姜、甘草温补里寒，黄芩、黄连清泻痞热。备齐了治疗虚、水、寒、热的方法，对于胃中不和导致的下利痞证，没有不痊愈的。
半夏泻心汤：治疗伤寒五六天，出现呕吐且发热，具备柴胡汤证，但医生用其他药物攻下，导致只觉胀满而不疼痛，心下部痞塞。
半夏（洗，半升） 黄芩（三两） 干姜（三两） 人参（三两） 黄连（一两） 甘草（炙，三两）
大枣（掰开，十二枚）
将以上七味药，用水一斗，煮取六升，去渣后再煎，取三升，每次温服一升，每日三次。
【集注】王又原说：伤寒五六天，具备柴胡证，却用其他药物攻下而形成痞证。此时即使用小柴胡汤，也是用干姜代替生姜，用黄连代替柴胡。前者调和表里，后者彻通上下。而必须推举半夏为君药，是因为痞证源于呕吐，半夏的辛味能破除结滞并止呕。
旋复代赭石汤：治疗经过发汗、催吐、攻下治疗后，心下部痞塞坚硬，嗳气不止。
旋复花（三两） 人参（二两） 代赭石（一两） 半夏（洗，半升） 生姜（切片，五两）
甘草（炙，三两） 大枣（掰开，十二枚）
将以上七味药，用水一斗，煮取六升，去渣后再煎，取三升，每次温服一升，每日三次。
【集注】罗谦甫说：发汗、催吐、攻下之后，邪气虽去但胃气已亏损。胃气既亏，三焦因此失职，清气无所归而不升，浊气无所纳而不降，因此邪气留滞，伏饮上逆，所以心下部痞塞坚硬，嗳气不止。方中用人参、甘草养护正气、补益虚弱，姜、枣调和脾胃、养胃气，安定中焦的作用极大。再用代赭石的沉重之性，收敛浮越、镇降逆气；旋复花的辛味，宣通气机、涤除饮邪，辅助人参使气归于下，辅助半夏在上焦消除饮邪。浊气下降则痞硬可消，清气上升则嗳气自除。看张仲景治疗少阴水气上凌，用真武汤镇压它；治疗下焦滑脱不固，用赤石脂禹余粮汤固涩它。这里是胃虚导致气机升降失常，再次运用这种方法调理，则胸中由否转为泰，其回归本源、固摄下焦的方法，各自精妙至此。
麻黄连轺赤小豆汤：治疗伤寒表证未解，瘀热蕴结在体内导致发黄的病症。
麻黄（二两） 赤小豆（一升） 杏仁（去皮尖，四十枚） 生姜（切片，一两） 大枣（掰开，十二枚）
甘草（炙，一两） 生梓白皮（一升） 连轺（二两）
以上八味药，用潦水（雨水或地面流动的积水）一斗，先煮麻黄，沸腾后去掉表面的泡沫，加入其他药物，煮取三升，分三次温服，半天内服完。
【注解】湿热发黄若无明显的表里证，热盛者清热，小便不利者利湿，里实者攻下，表实者发汗，无非都是为病邪寻找出路。用麻黄汤开泄表邪，使黄色从体表散发。去掉桂枝是为了避开其温热助湿之性，佐以姜枣调和营卫，加连轺、梓皮以泻热，赤小豆以利湿，共同完成治疗表实发黄的疗效。连轺即连翘根，若无梓皮可用茵陈代替。成无己说：用潦水煎煮，是取其味道淡薄，不助长湿热。
栀子柏皮汤：治疗伤寒身体发黄且发热，无表证也无里证的病症。
栀子（掰开，十五枚） 甘草（一两） 黄柏（一两）
以上三味药，用水四升，煮取一升半，去渣，分两次温服。
【注解】伤寒身体发黄发热，若有无汗的表证，用麻黄连轺赤小豆汤发汗；若有成实的里证，用茵陈蒿汤攻下。如今外无可汗的表证，内无可下的里证，只有黄热，宜用栀子柏皮汤清解即可。此方中的甘草应当是茵陈，是传写之误。
茵陈蒿汤：阳明病发热，仅头部出汗，身体无汗，小便不利，口渴想喝水浆，这是瘀热蕴结在体内，身体必然发黄，腹部微满的，本方主治。
茵陈蒿（六两） 栀子（掰开，十四枚） 大黄（二两）
以上三味药，用水二斗，先煮茵陈，水量减少六升，加入另外两味药，煮取三升，去渣，分三次温服。小便应当通利，排出物如皂角汁状，颜色正红，过一夜腹部胀满减轻，黄色从小便排出。
【集注】柯琴说：太阳病、阳明病都有发黄的证候，但若仅头部出汗而身体无汗，则热邪不能向外发散。小便不利，则热邪不能向下排泄，所以瘀热蕴结在体内。然而体内的情况有所不同：肌肉是太阳的里，应当发汗解表，所以用麻黄连翘赤小豆汤作为凉散法。心胸是太阳阳明的里，应当用寒凉胜热，用栀子柏皮汤，乃清火法。肠胃是阳明的里，应当从内部泻下，所以设立本方，是逐秽法。茵陈禀受北方寒气，经冬不凋，傲霜凌雪，偏受大寒之气，所以能清除热邪留结，率领栀子疏通水源，大黄调理胃实，使一身内外的瘀热，全部从小便排出，腹部胀满自然减轻，肠胃不受损伤，符合“引而竭之”的方法，这是阳明病利水的圣剂。又说：张仲景治疗阳明渴饮有四法：由太阳转属而来的，用五苓散微发汗以散水气；大烦渴、小便自利的，用白虎加人参汤清火生津；脉浮发热、小便不利的，用猪苓汤滋阴利水；小便不利、腹部胀满的，用茵陈蒿汤泄满，令黄色从小便排出。病情与治疗法则，心中已有定见。每每想到张仲景利小便必用气化之品，通大便必用承气之品。所以小便不利者，必加茯苓，严重者兼用猪苓，因为二苓是气化之品，而小便的通利依赖于气化。此次小便不利，为何不用二苓？本论云：阳明病，汗出多而口渴者，不可与猪苓汤，因为汗多导致胃中干燥，猪苓汤再次利小便的缘故。由此可知，阳明病汗出多而口渴者不可用，那么不出汗而口渴者，津液先虚，更不可用，这是显而易见的。此处用推陈致新的茵陈，佐以屈曲下行的栀子，不用枳实、厚朴来构成承气汤，也不用芒硝的峻猛泻下，那么大黄只能润燥胃，大便不会立即通行可知。所以必须过一夜腹部才减轻，黄色从小便去而不是从大肠去，张仲景立法神奇，真是匪夷所思。
Pound the first two ingredients into a powder. Place the Crotonis Fructus (Badou, 巴豆) in a mortar and pound it. Mix with rice water and administer orally. For robust individuals, administer one qian; for frail individuals, reduce the dose. If the pathogen is above the diaphragm, vomiting will inevitably occur; if below the diaphragm, purging will inevitably occur. If there is no purging after administration, drink one cup of hot porridge to promote the effect; if purging is excessive and does not stop, drink one cup of cold porridge to arrest it.
[Annotation] This formula treats Cold-Excess Phlegm-Water Chest Binding (Han Shi Tan Shui Jie Xiong), which is an extremely potent medicine. Crotonis Fructus (Badou, 巴豆) serves as the sovereign drug; due to its extreme pungency and烈ness, it attacks cold and expels water, breaking through barriers like a siege engine, destroying everything in its path. Fritillariae Thunbergii Bulbus (Beimu, 贝母) acts as the assistant to open chest congestion, while Platycodonis Radix (Jiegeng, 桔梗) serves as the guide, acting as a vessel to carry Crotonis Fructus to search out and expel pathogens in the chest. Pathogens above the diaphragm cause vomiting; those below cause purging, ensuring all pathogens are completely eliminated. However, knowing only to use toxic drugs to attack pathogens without weighing the patient's strength or weakness rarely leads to good outcomes. Therefore, the dose is reduced for the frail, hot porridge is given if there is no purging (to aid yang and move the medicine), and cold porridge is given if purging is excessive (to inhibit the medicine). This is because Crotonis Fructus (Badou, 巴豆) is hot in nature; its action accelerates with heat and stops with cold. Porridge is used instead of water to leverage the grain qi to protect the stomach qi.
Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium): Treats Shaoyang disease where the exterior syndrome has resolved, resulting in epigastric fullness and stuffiness (Pi), which feels hard upon pressure but is not soft, with a floating pulse at the Guan position.
Dahuang (Rhei Radix et Rhizoma, 大黄) (2 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang)
Take these two ingredients, soak them in two sheng of boiling water (Mafei Tang, 麻沸汤) for a short while, then strain off the dregs. Divide into two doses and take warm.
[Annotation] Using Dahuang (Rhei Radix et Rhizoma, 大黄) and Huanglian (Coptidis Rhizoma, 黄连) for Pi (epigastric fullness/stuffiness) caused by deficiency and evil naturally raises doubts among later generations. The very place where Zhang Zhongjing creates doubt is precisely where the brilliance lies. It is likely that later generations did not study carefully and missed the method, decocting and taking the herbs, which completely contradicts the original intent. Observing the use of Mafei Tang (boiling water), which has thin qi, to soak Dahuang (Rhei Radix et Rhizoma, 大黄) and Huanglian (Coptidis Rhizoma, 黄连), and straining immediately, extracts only their formless qi, not their heavy taste. This aims for thin qi and flavor, avoiding drastic purgation. Although it attacks Pi (epigastric fullness/stuffiness), the subtlety of this attack is infinite.
Fuzi Xiexin Tang (Aconite Decoction to Drain the Epigastrium): Treats Shaoyang disease where the exterior syndrome has resolved, accompanied by epigastric fullness and stuffiness (Pi), aversion to cold, and sweating.
Dahuang (Rhei Radix et Rhizoma, 大黄) (2 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Huangqin (Scutellariae Radix, 黄芩) (1 liang) Fuzi (Prepared Aconiti Lateralis Radix, 附子) (Processed, peeled, decocted separately for juice, 1 piece)
Cut the first three ingredients, soak them in two sheng of Mafei Tang (boiling water) for a short while, strain off the dregs, add the Fuzi (Prepared Aconiti Lateralis Radix, 附子) juice, divide into two doses, and take warm.
[Annotation] Hardness and pain in the epigastrium indicate Chest Binding (Jie Xiong); hardness without pain indicates Epigastric Fullness and Stuffiness (Xia Pi). Aversion to cold combined with sweating indicates not unresolved exterior syndrome, but deficiency of Exterior Yang. Therefore, Dahuang (Rhei Radix et Rhizoma, 大黄), Huanglian (Coptidis Rhizoma, 黄连), and Huangqin (Scutellariae Radix, 黄芩) are used to drain the heat of Pi (epigastric fullness/stuffiness), while Fuzi (Prepared Aconiti Lateralis Radix, 附子) warms the Exterior Yang, treating both interior and exterior. The subtlety lies in soaking the "Three Yellows" (Dahuang, Huanglian, Huangqin) in Mafei Tang (boiling water) and straining immediately, then adding separately decocted Fuzi (Prepared Aconiti Lateralis Radix, 附子) juice. The intent is lighter on draining Pi (epigastric fullness/stuffiness) and heavier on supporting Yang.
Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium): Treats Shaoyang disease or Wind Strike where the physician erroneously used purgatives. The patient suffers from diarrhea dozens of times a day, undigested food, borborygmus (rumbling in the abdomen), epigastric fullness and stuffiness (Pi) with hardness and distension, dry retching, irritability, and restlessness. Seeing the epigastric Pi (fullness/stuffiness), the physician thought the pathogen was not fully expelled and purged again, making the Pi (fullness/stuffiness) worse. This is not Heat Binding, but rather deficiency in the stomach with rebellious Qi rising, causing hardness.
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (4 liang) Huangqin (Scutellariae Radix, 黄芩) (3 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Ganjiang (Zingiberis Rhizoma, 干姜) (3 liang) Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above six ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Annotation] Regardless of Shaoyang disease or Wind Strike, if the exterior syndrome is unresolved, purgatives should never be used. The physician erroneously purged, leading to Pi (epigastric fullness/stuffiness). Diarrhea dozens of times a day with undigested food and borborygmus results from the emptiness of the stomach caused by erroneous purging. Epigastric Pi (fullness/stuffiness) with hardness and distension, dry retching, irritability, and restlessness result from pathogenic factors invading upward due to deficiency. Seeing the epigastric Pi (fullness/stuffiness) and hardness, the physician thought purging was incomplete and purged again, worsening the Pi (fullness/stuffiness). This is neither Heat Binding Pi nor Cold Binding Pi, but Pi caused by pathogenic factors invading upward due to stomach emptiness, with Yang sinking and Yin coagulating. The formula is named after Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) to imply a gentle and moderating approach. Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) and Dazao (Jujubae Fructus, 大枣) use their sweet and warm nature to tonify the middle and relieve urgency, treating the worsening Pi (fullness/stuffiness). Banxia (Pinelliae Rhizoma, 半夏)'s pungency breaks the rebellion of pathogenic Qi. Huangqin (Scutellariae Radix, 黄芩) and Huanglian (Coptidis Rhizoma, 黄连) drain the heat of Yang-sinking Pi (epigastric fullness/stuffiness), while Ganjiang (Zingiberis Rhizoma, 干姜) disperses the cold of Yin-coagulation Pi (epigastric fullness/stuffiness). Relieving urgency, breaking rebellion, draining Pi (epigastric fullness/stuffiness), and treating cold and heat comprehensively completes the treatment.
Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium): Treats Shaoyang disease where sweating resolved the exterior, but the stomach is disharmonious, resulting in epigastric Pi (fullness/stuffiness) with hardness, belching with a smell of fermented food, fluid retention under the flanks, borborygmus, and diarrhea.
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 2 liang) Renshen (Panacis Ginseng Radix, 人参) (3 liang) Ganjiang (Zingiberis Rhizoma, 干姜) (1 liang) Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Huangqin (Scutellariae Radix, 黄芩) (3 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Shengjiang (Zingiberis Rhizoma Recens, 生姜) (Sliced, 4 liang) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above eight ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Annotation] After sweating resolves Shaoyang disease, residual pathogens may transfer to Yangming. If the epigastrium is full, stiff, painful, and constipated, it indicates the person usually has dry-heat in the stomach, leading to excess, which can be attacked. However, this person usually has stomach deficiency and fluid retention under the flanks. Even without erroneous purging, residual heat enters the interior due to deficiency, forming Pi (fullness/stuffiness) that is hard but not painful. Stomach deficiency fails to digest food and fluids, causing belching with a smell of fermented food. Disharmony of cold and heat in the stomach causes borborygmus and diarrhea. Named Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium), the emphasis is on dissipating Pi (fullness/stuffiness) caused by fluid retention. Shengjiang (Zingiberis Rhizoma Recens, 生姜) and Banxia (Pinelliae Rhizoma, 半夏) dissipate fluid retention under the flanks; Renshen (Panacis Ginseng Radix, 人参) and Dazao (Jujubae Fructus, 大枣) tonify the deficiency of the Middle Jiao Earth; Ganjiang (Zingiberis Rhizoma, 干姜) and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) warm the interior cold; Huangqin (Scutellariae Radix, 黄芩) and Huanglian (Coptidis Rhizoma, 黄连) drain Pi (epigastric fullness/stuffiness) heat. This comprehensively treats deficiency, fluid, cold, and heat. Cases of Pi (epigastric fullness/stuffiness) with diarrhea due to stomach disharmony will invariably heal.
Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium): Treats Shaoyang disease after five or six days, with vomiting and fever, presenting Chaihu Syndrome (Bupleuri Syndrome), but the physician erroneously purged with other drugs, resulting in fullness without pain and epigastric Pi (fullness/stuffiness).
Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Huangqin (Scutellariae Radix, 黄芩) (3 liang) Ganjiang (Zingiberis Rhizoma, 干姜) (3 liang) Renshen (Panacis Ginseng Radix, 人参) (3 liang) Huanglian (Coptidis Rhizoma, 黄连) (1 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 3 liang)
Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above seven ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Collected Annotations] Wang Youyuan said: After five or six days of Shaoyang disease, when Chaihu Syndrome (Bupleuri Syndrome) is present, erroneous purging leads to Pi (epigastric fullness/stuffiness). Even using Xiao Chaihu Tang (Minor Bupleurum Decoction), Ganjiang (Zingiberis Rhizoma, 干姜) replaces Shengjiang (Zingiberis Rhizoma Recens, 生姜), and Huanglian (Coptidis Rhizoma, 黄连) replaces Chaihu (Bupleuri Radix, 柴胡). The former harmonizes interior and exterior; the latter clears upper and lower. Banxia (Pinelliae Rhizoma, 半夏) must be considered the sovereign drug because Pi (epigastric fullness/stuffiness) arises from vomiting, and Banxia (Pinelliae Rhizoma, 半夏)'s pungency breaks stagnation and stops vomiting.
Xuanfu Daizhe Shi Tang (Inula and Hematitum Decoction): Treats epigastric Pi (fullness/stuffiness) with hardness and persistent belching after sweating, vomiting, or purging have resolved the condition.
Xuanfuhua (Inulae Flos, 旋复花) (3 liang) Renshen (Panacis Ginseng Radix, 人参) (2 liang) Daizhishi (Hematitum, 代赭石) (1 liang) Banxia (Pinelliae Rhizoma, 半夏) (Washed, 0.5 sheng) Shengjiang (Zingiberis Rhizoma Recens, 生姜) (Sliced, 5 liang)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 3 liang) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Take the above seven ingredients, boil in one dou of water until six sheng remain, strain, decoct again to obtain three sheng. Take one sheng warm, three times a day.
[Collected Annotations] Luo Qianfu said: After sweating, vomiting, and purging, although pathogens are gone, stomach qi is depleted. With depleted stomach qi, the Triple Burner loses its function; clear qi has no return and does not ascend, turbid qi has no reception and does not descend. Thus, pathogenic factors linger, and retained fluid rebels, causing epigastric Pi (fullness/stuffiness) with hardness and persistent belching. In the formula, Renshen (Panacis Ginseng Radix, 人参) and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) nourish righteousness and tonify deficiency; ginger and jujube harmonize spleen and nourish stomach, greatly stabilizing the Middle Jiao. Furthermore, the heaviness of Daizhishi (Hematitum, 代赭石) converges floating qi and suppresses rebellion; the pungency of Xuanfuhua (Inulae Flos, 旋复花) promotes qi circulation and eliminates fluid, assisting Renshen (Panacis Ginseng Radix, 人参) to direct qi downward, and assisting Banxia (Pinelliae Rhizoma, 半夏) to eliminate fluid upward. As turbidity descends, Pi (fullness/stuffiness) dissipates; as clarity ascends, belching ceases. Observe Zhang Zhongjing treating Shaoyin Water Qi flooding upward with Zhenwu Tang (True Warrior Decoction) to suppress it; treating Lower Jiao sliding and loss of control with Chishizhi Yuyuliang Tang (Red Stone and Hematite Decoction) to consolidate it. Here, stomach deficiency leads to loss of qi ascending and descending; applying this method again transforms obstruction into smoothness. Their methods of returning to the source and consolidating the lower are each exquisitely subtle.
Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction): Treats Shaoyang disease where the exterior is unresolved, and stasis-heat is trapped inside, causing jaundice.
Mahuang (Ephedrae Herba, 麻黄) (2 liang) Chixiaodou (Phaseoli Semen Rubrum, 赤小豆) (1 sheng) Xingren (Armeniacae Semen Amarum, 杏仁) (Skin and tips removed, 40 pieces) Shengjiang (Zingiberis Rhizoma Recens, 生姜) (Sliced, 1 liang) Dazao (Jujubae Fructus, 大枣) (Broken open, 12 pieces)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (Roasted, 1 liang) Shengzibaipí (Catalpae Cortex Albus Recens, 生梓白皮) (1 sheng) Lianqiao (Forsythiae Fructum, 连轺) (2 liang)
Take the above eight ingredients, boil in one dou of Liaoshui (rainwater or surface runoff) first. Boil Mahuang (Ephedrae Herba, 麻黄), remove the foam on the surface when boiling, add the remaining herbs, boil until three sheng remain. Divide into three warm doses, finish within half a day.
[Annotation] For damp-heat jaundice without distinct exterior or interior syndromes: if heat is excessive, clear it; if urination is difficult, promote diuresis; if interior excess exists, purge it; if exterior excess exists, induce sweating. All aim to provide an exit for the pathogen. Using Mahuang Tang (Ephedra Decoction) to open the exterior allows the yellow color to disperse outward. Guizhi (Cinnamomi Ramulus, 桂枝) is removed to avoid aggravating damp-heat; ginger and jujube are added to harmonize Ying and Wei; Lianqiao (Forsythiae Fructum, 连轺) and Zibai pi (Catalpae Cortex Albus, 梓白皮) drain heat; Chixiaodou (Phaseoli Semen Rubrum, 赤小豆) promotes dampness drainage, jointly achieving the effect of treating exterior-excess jaundice. Lianqiao (Forsythiae Fructum, 连轺) refers to the root of Forsythia suspensa; if Zibai pi (Catalpae Cortex Albus, 梓白皮) is unavailable, Yinchen (Artemisiae Scopariae Herba, 茵陈) can substitute. Cheng Wuji stated: Using Liaoshui (rainwater) for decoction takes advantage of its thin flavor to avoid aiding damp-heat.
Zhizi Baipi Tang (Gardenia and Phellodendron Decoction): Treats Shaoyang disease with body jaundice and fever, without exterior or interior syndromes.
Zhizi (Gardeniae Fructus, 栀子) (Broken open, 15 pieces) Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (1 liang) Huangbai (Phellodendri Cortex, 黄柏) (1 liang)
Take the above three ingredients, boil in four sheng of water until one and a half sheng remain, strain, divide into two warm doses.
[Annotation] For Shaoyang disease with body jaundice and fever: if there is an exterior syndrome of no sweat, use Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) to induce sweating; if there is interior excess, use Yinchen Hao Tang (Artemisia and Yellow Gentian Decoction) to purge. Now, there is no exterior syndrome suitable for sweating externally, nor interior excess suitable for purging internally; there is only jaundice and heat, so Zhizi Baipi Tang (Gardenia and Phellodendron Decoction) should be used to clear it. The Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) in this formula should be Yinchen (Artemisiae Scopariae Herba, 茵陈); this is a transcription error.
Yinchen Hao Tang (Artemisia and Yellow Gentian Decoction): Yangming disease with fever, only head sweating, no body sweating, difficulty urinating, thirst for drinking fluids. This indicates stasis-heat trapped inside, leading to body jaundice and slight abdominal fullness. This formula is indicated.
Yinchen Hao (Artemisiae Scopariae Herba, 茵陈蒿) (6 liang) Zhizi (Gardeniae Fructus, 栀子) (Broken open, 14 pieces) Dahuang (Rhei Radix et Rhizoma, 大黄) (2 liang)
Take the above three ingredients, boil in two dou of water. First boil Yinchen Hao (Artemisiae Scopariae Herba, 茵陈蒿) until the volume reduces by six sheng, then add the other two ingredients, boil until three sheng remain, strain, divide into three warm doses. Urination should become profuse, resembling soy sauce liquid, with a reddish color. After one night, abdominal fullness decreases, and the yellow color exits via urination.
[Collected Annotations] Ke Qin said: Both Taiyang and Yangming diseases have jaundice syndromes. If only the head sweats and the body does not, heat cannot vent outward. If urination is difficult, heat cannot drain downward, so stasis-heat traps inside. However, the interior location differs: Muscles are the interior of Taiyang, requiring sweating to release, hence Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is used as a cooling dispersion method. Heart and chest are the interior of Taiyang and Yangming, requiring cold to overcome heat, hence Zhizi Baipi Tang (Gardenia and Phellodendron Decoction) is used as a fire-clearing method. Intestines and stomach are the interior of Yangming, requiring internal purging, hence this formula is established as a turbidity-expelling method. Yinchen (Artemisiae Scopariae Herba, 茵陈) inherits Northern energy, remains evergreen through winter, braves frost and snow, absorbing great cold energy, thus clearing heat-pathogen accumulation. It leads Zhizi (Gardeniae Fructus, 栀子) to unblock the water source and Dahuang (Rhei Radix et Rhizoma, 大黄) to regulate stomach excess, allowing stasis-heat throughout the body to exit via urination. Abdominal fullness naturally decreases, intestines and stomach are unharmed, fitting the method of "drawing out and exhausting." This is the holy agent for promoting urination in Yangming disease. He also said: Zhang Zhongjing has four methods for treating Yangming thirst and drinking: Transferred from Taiyang, use Wuling San (Five-Ling Powder) to mildly induce sweating and dissipate water qi; Great vexation, thirst, and normal urination, use Baihu Jiasharen Tang (White Tiger plus Ginseng Decoction) to clear fire and generate fluids; Floating pulse, fever, and difficulty urinating, use Zhu Ling Tang (Polyporus Decoction) to nourish yin and promote urination; Difficulty urinating and abdominal fullness, use Yinchen Hao Tang (Artemisia and Yellow Gentian Decoction) to drain fullness, letting yellow exit via urination. The pathology and treatment principles are clear in mind. I often reflect that Zhang Zhongjing uses qi-transforming herbs for promoting urination and Chengqi herbs for unblocking bowels. Thus, for difficulty urinating, Fuling (Poria, 茯苓) is added, and Zhu Ling (Polyporus, 猪苓) is added in severe cases, because these two are qi-transforming herbs, and urination depends on qi transformation. Why are these two not used here? The text states: Yangming disease with excessive sweating and thirst should not receive Zhu Ling Tang (Polyporus Decoction), because excessive sweating causes dryness in the stomach, and Zhu Ling Tang (Polyporus Decoction) further promotes urination. Thus, it is known that Yangming disease with excessive sweating and thirst cannot use it; therefore, non-sweating but thirsty patients, whose fluids are already deficient, certainly cannot use it either. Here, using Yinchen (Artemisiae Scopariae Herba, 茵陈) to push out the old and bring forth the new, assisted by Zhizi (Gardeniae Fructus, 栀子) which bends downward, without using Zhishi (Immature Bitter Orange, 枳实) and Houpo (Magnolia Bark, 厚朴) to form Chengqi Tang (Order the Qi Decoction), nor Mangxiao (Mirabilite, 芒硝) for harsh purging, Dahuang (Rhei Radix et Rhizoma, 大黄) can only moisten stomach dryness, and immediate bowel movement is unlikely. Thus, abdominal fullness only decreases after one night, and yellow exits via urination, not the large intestine. Zhang Zhongjing's legislation is magical and beyond imagination.