甘草（炙）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
右六味，以水一斗，煮取六升，去滓，再煎取三升，温服一升，日三服。
【方解】
方以甘草命名者，取和缓之意也。用甘草、大枣之甘，补中之虚，缓中之急；半夏之
辛，降逆止呕，芩连之寒，泻阳陷之痞热；干姜之热，散阴凝之痞寒。缓中降逆，泻
痞除烦，寒热并用也。
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伤寒汗出，解之后，胃中不和，心下痞□，干噫食臭，□下有水气，腹中雷鸣下利者
，生姜泻心汤主之。
【注】
伤寒汗出表解之后，余邪转属阳明，心下痞满□痛不大便者，必其人胃素燥热，因而
成实，攻之可也。今其人平素胃虚，兼□下有水气，即不误下，而余热亦乘虚入里，
以致胃中不和，谷气不化，故心下痞□，干噫食臭也。水气不行，故腹中雷鸣下利也
。主之以生姜泻心汤者，其意重在散水气之虚痞耳。
【集注】
喻昌曰：篇中论结胸及痞之根源，云胃中空虚。此云胃中不和，以其未经误下而致空
虚耳。故但言不和也，然不和已足成痞，胃气所关之钜，固若此哉。
程知曰：此为汗后，未经误下，心中痞□，水饮搏聚者，立治法也。外邪虽解，然必
胃气通和，始得脱然无恙。汗出解后，胃中不和，饮食搏结，故心中痞□。中焦不能
消谷，故干噫食臭。土弱不能制水，故□下有水气旁流。腹中雷鸣者，搏击有声，下
利而清浊不分也。故于泻心汤内，君生姜以散之，法用再煮，取其熟而和胃也。
程应旄曰：汗多亡阳，人皆知之矣。然人身之阳，部分各有所主。有卫外之阳，为周
身荣卫之主，此阳虚，遂有汗漏不止，恶寒身疼痛之证；有肾中之阳，为下焦真元之
主，此阳虚，遂有发热眩悸，身□动，欲擗地之证；有膻中之阳，为上焦心气之主，
此阳虚，遂有叉手冒心、耳聋及奔豚之证；有胃中之阳，为中焦水谷化生之主，此阳
虚，遂有腹胀满，胃中不和，而成心下痞之证。虽皆从发汗后所得，然救误者，须观
其脉证，知犯何逆，以法治之，不得以汗多亡阳一语，混同漫及之也。
甘草（炙）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
以上六味药，用水一斗，煮取六升药液，滤去药渣，再次煎煮至三升，每次温服一升，每日服用三次。
【方解】
本方以“甘草”命名，取其调和缓急之意。使用甘草、大枣的甘味，来补益中焦之虚损，缓解中焦之急迫；利用半夏的辛味，以降逆止呕；借助黄芩、黄连的寒性，来清泻阳气下陷所致的痞塞热邪；配合干姜的热性，来消散阴寒凝滞所致的痞塞寒邪。此方旨在缓和中焦、降逆气、泻痞满、除烦闷，体现了寒热药物并用的配伍原则。
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伤寒病经过发汗治疗后，表证已解，但出现胃中不和，心下部痞塞胀满，嗳气带有食物腐臭味，肠间有水气走动，腹部雷鸣般作响并伴有腹泻者，用生姜泻心汤主治。
【注】
伤寒病发汗后表证解除，若余邪转入阳明经，导致心下部痞塞胀满且疼痛、大便不通的，必定是患者平素胃中燥热，因而形成实邪，此时可以采用攻下法治疗。如今这位患者平素胃气虚弱，兼有肠间水气停滞，即使没有误用下法，余热也会乘虚侵入体内，导致胃中不和，食物难以消化，所以出现心下部痞塞胀满，嗳气带有食物腐臭味。水气运行不畅，所以腹部雷鸣般作响并伴有腹泻。使用生姜泻心汤主治，其用意重在消散因胃虚导致的水气痞塞。
【集注】
喻昌说：书中论述结胸证及痞证的根源时，提到“胃中空虚”。这里说“胃中不和”，是因为患者并未经过误用下法而导致胃气空虚。所以说只是“不和”。然而，“不和”已经足以形成痞证，可见胃气的重要性如此巨大。
程知说：这是针对发汗后、未经误用下法，心中痞塞胀满，水饮搏结聚集的情况，制定的治疗方法。外邪虽然已解，但必须胃气通畅调和，才能完全康复。发汗解表后，胃中不和，饮食相互搏结，所以心中痞塞胀满。中焦不能消化谷物，所以嗳气带有食物腐臭味。土气虚弱不能制约水湿，所以肠间有水气旁流。腹部雷鸣般作响，是水气搏击发出的声音，腹泻导致清浊不分。所以在泻心汤的基础上，重用生姜作为君药以发散水气，煎煮方法采用再煎，取其药性熟和以调和胃气。
程应旄说：出汗过多导致亡阳，人们都知道。然而人体之阳，在不同部位各有主宰。有护卫体表的阳，为周身营卫之主，此阳虚，就会出现汗漏不止、恶寒、身体疼痛的症状；有肾中的阳，为下焦真元之主，此阳虚，就会出现发热、眩晕、心悸、身体颤动、想要扑倒在地上的症状；有膻中的阳，为上焦心气之主，此阳虚，就会出现双手交叉按护心前区、耳聋以及奔豚气的症状；有胃中的阳，为中焦水谷化生之主，此阳虚，就会出现腹胀满、胃中不和，从而形成心下部痞塞的症状。这些症状虽然都发生在发汗之后，但救治误治者，必须观察其脉象和证候，了解犯了什么错误，然后依法治疗，不能仅凭“出汗多导致亡阳”这一句话，就混淆一概而论。
Cistanche Radix Preparata (Zhi Gancao, Prepared Licorice Root) 4 liang, Scutellariae Radix (Huangqin, Baikal Skullcap Root) 3 liang, Coptidis Rhizoma (Huanglian, Goldthread Rhizome) 1 liang, Zingiberis Rhizoma Recens (Ganjiang, Dried Ginger) 3 liang, Pinelliae Rhizoma Preparatum (Banxia, Prepared Pinellia Tuber) half sheng, Jujubae Fructus (Dazao, Chinese Date) twelve pieces.
The above six herbs are boiled in ten dou of water to obtain six sheng of decoction. The dregs are filtered out, and the liquid is further concentrated by boiling until three sheng remain. One sheng is taken warm each time, administered three times daily.
[Formula Analysis]
This formula is named after Gancao (Licorice Root), reflecting its intention to harmonize and relieve urgency. The sweetness of Gancao (Licorice Root) and Dazao (Chinese Date) is used to tonify deficiency in the Middle Jiao and alleviate urgency there; the pungency of Banxia (Prepared Pinellia Tuber) descends rebellious Qi and stops vomiting; the cold nature of Huangqin (Baikal Skullcap Root) and Huanglian (Goldthread Rhizome) clears heat from stagnation caused by sinking of Yang Qi; and the hot nature of Ganjiang (Dried Ginger) disperses cold stagnation causing obstruction. This combination aims to soothe the Middle Jiao, descend rebellious Qi, resolve obstruction, and relieve irritability, demonstrating the principle of using both cold and hot herbs together.
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After a Taiyang disease (Exterior Syndrome of the Taiyang Channel) has been treated with sweating methods and the exterior syndrome is resolved, if disharmony in the Stomach occurs, manifesting as fullness and stuffiness in the epigastrium (Xin Xia Pi), belching with the odor of undigested food, water qi moving in the intestines, borborygmus (rumbling sounds in the abdomen), and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Decoction for Draining the Epigastrium) is indicated.
[Annotation]
After Taiyang disease is treated with sweating and the exterior is resolved, if residual pathogenic factors transfer to the Yangming channel, causing epigastric fullness, pain, and constipation, it indicates that the patient’s Stomach was originally dry and hot, leading to excess accumulation; in such cases, purgative therapy may be applied. However, in this case, the patient has a constitutionally weak Stomach Qi and concurrent water qi retention in the intestines. Even without improper use of purgatives, residual heat can invade the interior due to deficiency, resulting in Stomach disharmony and failure to transform food grains. Consequently, epigastric stuffiness and belching with food odor occur. Impaired movement of water qi leads to borborygmus and diarrhea. Shengjiang Xiexin Tang (Fresh Ginger Decoction for Draining the Epigastrium) is prescribed primarily to dissipate the water-qi-induced epigastric fullness arising from deficiency.
[Collected Annotations]
Yu Chang stated: In the text discussing the root causes of Jie Xiong (Chest Binding) and Pi Zheng (Epigastric Obstruction Syndrome), it mentions "emptiness in the Stomach." Here, it says "disharmony in the Stomach" because the emptiness was not caused by improper purgative therapy. Thus, only "disharmony" is mentioned. Yet, mere disharmony is sufficient to cause obstruction, highlighting the immense importance of Stomach Qi.
Cheng Zhi stated: This addresses the treatment method for post-sweating conditions where no purgative was improperly used, but epigastric obstruction and water-fluid retention have occurred. Although external pathogens are resolved, recovery requires the free flow and harmony of Stomach Qi. After sweating resolves the exterior, Stomach disharmony causes food to bind together, resulting in epigastric obstruction. The Middle Jiao fails to digest grains, causing belching with food odor. Weak Spleen Earth fails to control Water, leading to water qi flowing into the intestines. Borborygmus results from the clash of fluids, and diarrhea reflects the mixing of clear and turbid substances. Therefore, within the Xiexin Tang (Decoction for Draining the Epigastrium), Shengjiang (Fresh Ginger) is used as the sovereign herb to disperse water qi. The decoction is boiled twice to ensure the herbs are thoroughly cooked and harmonizing to the Stomach.
Cheng Yingmao stated: It is well known that excessive sweating leads to the loss of Yang Qi. However, Yang Qi governs different parts of the body. There is Wei Yang (Defensive Yang), which governs the defensive and nutritive systems of the whole body; deficiency here leads to continuous sweating, aversion to cold, and body pain. There is Kidney Yang, which governs the true Yuan Qi of the Lower Jiao; deficiency here leads to fever, vertigo, palpitations, tremors, and a desire to fall prostrate. There is Dan Zhong Yang (Pericardium Yang), which governs Heart Qi in the Upper Jiao; deficiency here leads to covering the heart with hands, deafness, and Ben Tun (Rushing Pig) syndrome. There is Stomach Yang, which governs the transformation of food and drink in the Middle Jiao; deficiency here leads to abdominal distension, Stomach disharmony, and epigastric obstruction. Although all these conditions arise after sweating, treating iatrogenic errors requires observing pulse and symptoms to identify the specific deviation and applying appropriate therapy. One must not indiscriminately attribute all post-sweating complications merely to "loss of Yang from excessive sweating."