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
右七味，以水一斗，煮取六升，去滓再煮，取三升，温服一升，日三服。
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本以下之，故心下痞，与泻心汤。痞不解，其人渴而口燥烦，小便不利者，五苓散主
之。
【注】
本以下之早，故成心下痞。如绑定热成实之痞，则宜大黄黄连泻心汤，寒攻之法也，
如系外寒内热之痞，则宜附子泻心汤，温攻之法也；如系虚热水气之痞，则宜生姜泻
心汤，散饮之法也；如系虚热而呕之痞，则宜半夏泻心汤，折逆之法也；如系虚热益
甚之痞，则宜甘草泻心汤，缓急之法也。今以诸泻心汤，审证与之，而痞不解，则当
审其人，若渴而口燥心烦，小便不利者，非辨证不明，药力之不及也。盖水饮内蓄，
津液不行，故痞病不解耳。宜五苓散外发内利，汗出小便利则愈，于此可类推矣。
【集注】
方有执曰：泻心汤治痞而痞不解，则非气聚之痞可知。渴而口燥烦，小便不利者，津
液涩而不行，伏饮凝结也。五苓散利水生津，津生而渴烦止，水利而痞自除，所以又
为消痞满之一法也。
程应旄曰：泻心诸方，开结、荡热、益虚可谓备矣。然其治法实在上、中二焦，亦有
痞在上而治在下焦者，斯又不同其法也。若痞之来路虽同，而其人口渴，燥烦，小便
不利，则知下后胃虚，以致水饮内蓄，津液不行，痞无去路，非结热也。以五苓散主
之者，使浊阴出下窍，而清阳之在上焦者，自无阻留矣。况五苓散宜通气化，兼行表
里之邪，使心邪不从心泻，而从膀胱泻，又一法也。
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伤寒服汤药，下利不止，心下痞□，服泻心汤已，复以他药下之，利不止，医以理中
与之，利益甚；理中者，理中焦，此利在下焦，赤石脂禹余粮汤主之，复利不止者，
当利其小便。
【注】
伤寒服汤药，下利不止，心中痞□者，误下之所致也。下利痞□，仍虚痞也，服泻心
汤已合法矣。而痞不愈，复以他药下之，痞虽去而利不止，医与理中汤温之，其利益
甚。不知理中者，理中焦也，此利在下焦，属滑脱也，故用赤石脂禹余粮汤，涩滑固
脱，利可止也。若止而复利，则当审其小便之利与不利。小便若利，当佐以温补之药
以收全功。小便不利，是水无去路，固涩日久，所以复利不止。则又当利其小便，使
水道通而利自止矣。
【集注】
郑重光曰：汤者荡也，即下药也。误下利不止，心下痞□，服泻心汤为合法矣。乃复
以他药下之，误而又误，用理中开痞止利，原不为过，而利益甚者，以屡下伤肾，下
焦失守也。故用石脂禹粮固肠虚而收滑脱，利仍不止，当利其小便。盖膀胱者肾之府
也，肾主二便，开窍于二阴，利小便者，令藏府各司其事，庶水谷分而下利自止也。
半夏（洗净）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
以上七味药，用水一斗，煎煮至六升，滤去药渣后再煎煮，取三升药液，每次温服一升，每日服用三次。
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本因误用攻下法，导致心下痞塞，给予泻心汤治疗。若痞证未解，患者出现口渴、口燥、心烦、小便不利等症状的，以五苓散主治。
【注】
本因过早使用攻下法，故形成心下痞证。如果是热结结实而成的痞证，则适宜用大黄黄连泻心汤，这是寒性攻下的方法；如果是外寒内热形成的痞证，则适宜用附子泻心汤，这是温性攻下的方法；如果是虚热兼水气形成的痞证，则适宜用生姜泻心汤，这是消散水饮的方法；如果是虚热兼呕吐形成的痞证，则适宜用半夏泻心汤，这是降逆止呕的方法；如果是虚热更甚形成的痞证，则适宜用甘草泻心汤，这是缓急和中焦的方法。现在如果用各种泻心汤，仔细辨证后给予治疗，而痞证仍未解除，就应当审视患者的情况，如果口渴、口燥、心烦、小便不利，这并不是辨证不明或药力不足。这是因为水饮内停蓄积，津液运行不畅，所以痞病不能解除。适宜用五苓散外发汗液、内利小便，汗出且小便利则病愈，由此可以类推其他情况。
【集注】
方有执说：泻心汤治疗痞证而痞证不解，这就知道不是单纯气机郁聚的痞证。口渴、口燥、心烦、小便不利，是津液涩滞而不行，伏留的水饮凝结所致。五苓散能利水生津，津液生成则口渴心烦停止，水湿得利则痞满自然消除，这又是消除痞满的一种方法。
程应旄说：各种泻心方剂，开结、荡热、补虚可以说很完备了。然而它们的治疗重点实在上、中二焦，也有痞证在上部却治疗下部焦域的，这又不同于其治疗方法。如果痞证的来路虽然相同，但患者出现口渴、燥烦、小便不利，就知道是攻下后胃气虚弱，导致水饮内停蓄积，津液不行，痞证没有出路，并非结热。用五苓散主治，是使浊阴从下窍排出，而上焦的清阳之气，自然就没有阻碍滞留了。况且五苓散适宜通调气化，兼行表里之邪，使心部的邪气不从心经泻出，而从膀胱泻出，这又是另一种方法。
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伤寒患者服用汤药后，下利不止，心下痞塞，服用泻心汤后，又用其他药物攻下，下利仍不止，医生用理中汤给予治疗，下利反而加重；理中汤是调理中焦的，此下利在下焦，应用赤石脂禹余粮汤主治，如果再次下利不止，应当通利小便。
【注】
伤寒患者服用汤药后，下利不止，心中痞塞，这是误用攻下法导致的。下利伴痞塞，仍是虚性痞塞，服用泻心汤已经符合治法。但痞证未愈，又用其他药物攻下，痞证虽去而下利不止，医生给予理中汤温补，其下利反而加重。不知道理中汤是调理中焦的，此下利在下焦，属于滑脱不禁，所以用赤石脂禹余粮汤，涩肠固脱，下利可止。如果止住后又复利，就应当审视其小便的通利与否。如果小便通利，应当辅助以温补的药物以收全功。如果小便不利，是水液没有出路，固涩日久，所以再次下利不止。这时又应当通利小便，使水道通畅而利自止。
【集注】
郑重光说：汤者荡也，即指下药。误用攻下导致下利不止，心下痞塞，服用泻心汤是合法的治疗。却又用其他药物攻下，误而又误，用理中汤开痞止利，原本不算过错，但下利反而加重的原因，是因为多次攻下损伤肾气，下焦失守。所以用赤石脂、禹余粮固护肠虚而收敛滑脱，如果下利仍不止，应当通利小便。因为膀胱是肾的府邸，肾主管二便，开窍于前后二阴，通利小便，是让脏腑各司其职，这样水谷分离而下利自然停止。
Banxia (washed) half sheng, Huangqin three liang, Ganjiang three liang, Renshen three liang, Huanglian one liang, Gancao (roasted with honey) three liang, Dazao (broken open) twelve pieces.
The above seven herbs, with ten dou of water, decoct to obtain six sheng, remove the dregs and decoct again to obtain three sheng, take one sheng warm each time, three times a day.
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Originally due to premature purgation, epigastric fullness (epigastric stuffiness) resulted, and Xixin Tang (Heart-Draining Decoction) was administered. If the fullness does not resolve, and the patient presents with thirst, dry mouth, vexation, and dysuria, Wuling San (Five-Ingredient Powder with Poria) is indicated.
[Annotation]
It originally became epigastric fullness due to premature purgation. If it is fullness caused by heat accumulation and solidification, Dahuang Huanglian Xixin Tang (Rhubarb and Coptis Heart-Draining Decoction) is suitable; this is a cold purging method. If it is fullness caused by exterior cold and interior heat, Fuzi Xixin Tang (Aconite Heart-Draining Decoction) is suitable; this is a warm purging method. If it is fullness caused by deficiency-heat and water qi, Shengjiang Xixin Tang (Fresh Ginger Heart-Draining Decoction) is suitable; this is a method to dissipate fluid retention. If it is fullness accompanied by vomiting due to deficiency-heat, Banxia Xixin Tang (Pinellia Heart-Draining Decoction) is suitable; this is a method to subvert rebellion (stop vomiting). If it is fullness where deficiency-heat is even more severe, Gancao Xixin Tang (Licorice Heart-Draining Decoction) is suitable; this is a method to moderate urgency. Now, if various Xixin Tangs are used, and after careful syndrome differentiation and administration, the fullness still does not resolve, one must examine the patient. If there is thirst, dry mouth, vexation, and dysuria, it is not due to unclear syndrome differentiation or insufficient medicinal power. It is because internal accumulation of water-fluid impedes the movement of body fluids, so the fullness disease does not resolve. It is appropriate to use Wuling San to induce sweating externally and promote urination internally; when sweat appears and urination becomes smooth, the disease will heal. This can be analogized to other cases.
[Collected Annotations]
Fang Youzhi said: When Xixin Tang treats fullness but the fullness does not resolve, it is evident that this is not fullness caused merely by qi aggregation. Thirst, dry mouth, vexation, and dysuria indicate that body fluids are stagnant and not flowing, with latent fluid retention condensing. Wuling San promotes urination and generates fluids; when fluids are generated, thirst and vexation cease, and when water is promoted, fullness naturally removes. Thus, this is another method for eliminating fullness.
Cheng Yingmao said: Various Xixin formulas, in opening knots, clearing heat, and benefiting deficiency, are quite comprehensive. However, their treatment methods focus on the Upper and Middle Jiao. There are cases where fullness is in the upper part but treated in the Lower Jiao, which differs from these methods. Although the origin of the fullness may be the same, if the patient presents with thirst, dryness, vexation, and dysuria, it indicates that post-purgation stomach deficiency led to internal accumulation of water-fluid and impaired fluid movement, leaving no exit for the fullness, rather than accumulated heat. Using Wuling San as the main treatment causes turbid yin to exit through the lower orifices, allowing clear yang in the Upper Jiao to flow without obstruction. Moreover, Wuling San is suitable for promoting qi transformation and expelling pathogenic factors from both the exterior and interior, causing heart-pathogens to drain via the Bladder rather than the Heart channel. This is yet another method.
@@@
In typhoid fever, after taking herbal decoctions, diarrhea persists incessantly, with epigastric fullness. After taking Xixin Tang, the physician again used other drugs to purge, resulting in persistent diarrhea. The physician then administered Lizhong Tang (Middle-Warming Decoction), but the diarrhea worsened. Lizhong Tang regulates the Middle Jiao, whereas this diarrhea is in the Lower Jiao; Chishizhi Yuyuliang Tang (Red Stone Lip and Hematite Decoction) should be used. If diarrhea persists despite this, diuresis should be promoted.
[Annotation]
In typhoid fever, after taking herbal decoctions, persistent diarrhea and epigastric fullness are caused by erroneous purgation. Diarrhea with fullness remains a deficient fullness. Taking Xixin Tang was already the correct method. However, since the fullness did not heal, and the physician again used other drugs to purge, although the fullness resolved, the diarrhea persisted. The physician gave Lizhong Tang to warm, but the diarrhea worsened. One must understand that Lizhong Tang regulates the Middle Jiao; this diarrhea is in the Lower Jiao and belongs to slipping and loss of control. Therefore, Chishizhi Yuyuliang Tang is used to astringe intestines and secure leakage, stopping the diarrhea. If it stops and then recurs, one must examine whether urination is smooth or difficult. If urination is smooth, warming and tonifying medicines should be assisted to complete the cure. If urination is difficult, it means water has no exit; prolonged astringency causes recurrent persistent diarrhea. In this case, diuresis should be promoted to unblock the water passages, after which the diarrhea will stop spontaneously.
[Collected Annotations]
Zheng Zhongguang said: "Tang" (decoction) implies sweeping away, referring here to purgative drugs. Erroneous purgation caused persistent diarrhea and epigastric fullness; taking Xixin Tang was the legal treatment. Yet, using other drugs to purge again was an error upon error. Using Lizhong Tang to open fullness and stop diarrhea was not originally wrong, but the worsening diarrhea occurred because repeated purgation injured Kidney Qi, leading to Lower Jiao instability. Therefore, Chishizhi and Yuyuliang are used to consolidate intestinal deficiency and arrest slipping. If diarrhea still does not stop, diuresis should be promoted. Since the Bladder is the mansion of the Kidney, and the Kidney governs both excreta, opening apertures at the two yins, promoting urination allows the zang-fu organs to perform their respective duties, thereby separating water and grain, and stopping diarrhea spontaneously.