（仲景）
治伤寒下之早，胸满而不痛者为痞，身寒而呕，饮食不下，非柴胡证（经曰∶伤寒五六
日，呕血发热，柴胡证具，而以他药下之，柴胡证仍在者，复与柴胡汤；此虽已下之，不为
逆，必蒸蒸而振，却发热汗出而解。若心下满而硬痛者，此为结胸也，大陷胸汤主之；若满
而不痛者，此为痞，柴胡不中与也，宜半夏泻心汤。凡用泻心者，皆属误下之证，非传经热
邪也。
半夏（半升） 黄连（一两） 黄芩 甘草（炙） 人参 干姜（三两） 大枣（十二
枚。）
此手少阴、足太阴药也。成氏曰∶否而不泰为痞。苦先入心，泻心者必以苦，故以黄连
为君
而行
下之后，脾气必虚），则痞热消而大汗以解矣（旧注曰∶此方药味，盖本理中、人参、黄芩
汤方。王海藏曰∶外证全是下证，而脉反细不可下者，泻心汤主之；脉有力者，黄连泻心汤；
脉无力者，半夏泻心汤。喻嘉言曰∶诸泻心汤，原以涤饮，此证因呕，故推半夏为君。程郊
倩曰∶痞虽虚邪，然表气入里，拂郁于心阳之分，寒亦成热矣。寒已成热，则不能外出，而
热非实，秽又不能下行，唯用苦寒从其部而下之，仍虑下焦之阴邪上入，兼辛热以温之，阴
阳两解，不攻痞而痞自散，所以寒热互用。若阴痞不关阳郁，即郁而未成热，只是上下阴阳
部分拒格而成，泻心之法概不可用也。又曰∶人皆曰汗多亡阳，不知下多亦亡阳，以亡阴中
之阳，故曰亡阴耳。下焦之阳骤虚，气必上逆，则上焦之阳反因下而成实，以火气不下行故
也，治多泻上补下，心君得苦寒而安，则反能从阳引之入阴，故芩连栀子泻亦成补；若汗下
相因，有
本方除人参，再加甘草（一两，合前四两），名甘草泻心汤（仲景）∶治伤寒中风，医反
下之，下利谷不化，腹中雷鸣，心下痞硬而满，干呕心烦，医复下之，其痞益甚，此非结热，
但以胃虚客气上逆，故使硬也（为下后里虚胃弱，内损阴气，故加甘草以和中益胃，复真阴，
退虚热。
甄权
伤寒
肠
动
治
至于阴即协寒，其证尤显，所以云阳证下利，误温则发黄出斑而死，此等支
本方加生姜四两，名生姜泻心汤（仲景）∶治汗解后胃中不和，心中痞硬，干噫（嗳同）食
臭，完谷不化，胁下有水气，腹中雷鸣下利（客气上逆，伏饮搏膈，故痞硬；中气不和，故
干嗳；胃虚火盛，邪热不杀谷，故完谷不化；胁下有水气，土弱不能制水，故腹中雷鸣下利，
谓之协热利，为汗后胃虚，外损阳气，故加生姜以散邪涤饮，益胃复阳。刘河间曰∶泻而水
谷变色者为热，不变色而澄沏清冷者为寒。若肛门燥涩，小便黄赤，水谷虽不变，犹为热也，
此由火性急速，食下即出，无容克化，所谓邪热不杀谷也）。本方除黄芩、大枣，加枳实、
浓朴、麦芽、白术、茯苓，蒸饼糊丸，名枳实消痞丸（东垣）。
（张仲景）
治疗伤寒误用攻下法过早，导致胸中胀满但不疼痛的称为痞证，伴有身体发冷和呕吐，饮食无法下咽。这不是柴胡汤证（古籍记载：伤寒五六日，出现呕血、发热，具备柴胡汤证的指征，却用了其他药物攻下，若柴胡汤证仍在，可再次给予柴胡汤；此处虽然已经攻下，但并不为逆乱之证，患者必然会出现战栗振摇，随后发热出汗而病解。如果心下部胀满且坚硬疼痛的，这是结胸证，由大陷胸汤主治；如果胀满但不疼痛的，这是痞证，不可使用柴胡汤，适宜使用半夏泻心汤。凡是使用泻心汤治疗的，都属于误用攻下法导致的证候，并非传经而来的热邪。）
半夏（半升） 黄连（一两） 黄芩 甘草（炙） 人参 干姜（三两） 大枣（十二枚）。
此方属于手少阴心经和足太阴脾经的药物。成无己说：否塞而不通泰即为痞证。苦味先入心，要清泻心火必须用苦味药，所以以黄连为君药。
（在误下之后，脾气必然虚弱），这样痞热消散，通过大汗而病解（旧注解说：这个方的药味，原本取自理中汤、人参黄芩汤。王海藏说：外证完全像可用攻下的实证，但脉象反而细弱不可攻下的，用泻心汤主治；脉象有力的，用黄连泻心汤；脉象无力的，用半夏泻心汤。喻嘉言说：各种泻心汤，原本是用来涤除饮邪的，此证因为呕吐，所以推举半夏为君药。程郊倩说：痞证虽然是虚邪，但是表气陷入里部，拂郁在心阳的分布区域，寒邪也会化热。寒邪已经化为热邪，就不能向外发散，而热邪又不是实热，秽浊之气又不能下行，只能用苦寒药顺着病位向下攻逐，仍然担心下焦的阴邪向上侵入，兼用辛热药来温补它，阴阳两解，不直接攻痞而痞自然消散，所以寒热药互用。如果是阴痞不涉及阳气郁结，即郁结但未化热，只是上下阴阳部位相互格拒形成的，泻心的方法一概不可用。又说：人们都说汗出过多亡失阳气，不知道攻下过多也会亡失阳气，因为亡失了阴中的阳气，所以称为亡阴。下焦的阳气骤然虚弱，气机必然上逆，那么上焦的阳气反而因为下部的虚弱而成实，因为火气不能下行的缘故，治疗多采用泻上补下的方法，心主得到苦寒药而安宁，就能反过来从阳引导进入阴，所以黄芩、黄连、栀子的泻法也变成了补法；如果汗法和下法相继使用，有……）
本方除去人参，再加甘草（一两，合前面的共四两），名为甘草泻心汤（张仲景）：治疗伤寒中风，医生反而误用攻下法，导致腹泻完谷不化，腹中肠鸣如雷，心下部痞硬且胀满，干呕心烦，医生再次误用攻下法，痞证更加严重，这不是结聚的热邪，只是因为胃气虚弱，客气上逆，所以导致痞硬（因为是攻下后里虚胃弱，内损阴气，所以加甘草来调和其中、益养胃气，恢复真阴，退去虚热。甄权……伤寒……肠……动……治……至于阴证即协寒，其症状尤其明显，所以说阳证下利，误用温法则发黄出斑而死，这些支……）
本方加生姜四两，名为生姜泻心汤（张仲景）：治疗汗解后胃中不和，心中痞硬，干噫（嗳气同义）食臭，完谷不化，胁下有停水，腹中雷鸣下利（客气上逆，伏留的饮邪搏结于膈间，所以痞硬；中气不和，所以干嗳；胃虚火盛，邪热不能腐熟水谷，所以完谷不化；胁下有停水，土气虚弱不能制约水湿，所以腹中雷鸣下利，称为协热利，这是因为汗后胃虚，外损阳气，所以加生姜来散邪涤饮，益胃复阳。刘河间说：腹泻且水谷变色的为热证，不变色且清澈寒冷的为寒证。如果肛门干燥涩滞，小便黄赤，水谷虽不变色，仍属热证，这是由于火性急速，食物吃下即排出，没有机会消化，所谓邪热不能杀谷也）。本方除去黄芩、大枣，加枳实、厚朴、麦芽、白术、茯苓，用蒸饼做糊制成丸剂，名为枳实消痞丸（李东垣）。
(Zhang Zhongjing)
Treats the condition where early purgation in Cold Damage (Shanghan) leads to chest fullness without pain, termed Pi syndrome (Pih), accompanied by chills and vomiting, with inability to ingest food. This is not Chaihu Tang syndrome (Classics state: In Cold Damage after five or six days, if hematemesis and fever occur, indicating Chaihu Tang syndrome, but other purgatives are mistakenly used; if Chaihu symptoms persist, Chaihu Tang may be administered again; although purgation has been performed here, it is not a counter-indication, the patient will inevitably experience shivering and trembling, followed by fever and sweating for resolution. If the epigastrium is full, hard, and painful, this is Jie Xiong syndrome (Chest Binding), treated with Da Xian Xiong Tang; if full but not painful, this is Pi syndrome, Chaihu Tang is contraindicated, and Banxia Xiexin Tang is appropriate. All uses of Xiexin Tang belong to conditions caused by erroneous purgation, not heat pathogens transmitted through meridians.)
Banxia (Pinelliae Rhizoma) (half sheng) Huanglian (Coptidis Rhizoma) (one liang) Huangqin (Scutellariae Radix) Gancao (Glycyrrhizae Radix et Rhizoma, prepared) Renshen (Ginseng Radix) Ganjiang (Zingiberis Rhizoma) (three liang) Dazao (Jujubae Fructus) (twelve pieces).
This formula acts on the Hand-Shaoyin Heart Meridian and Foot-Taiyin Spleen Meridian. Cheng Wuji stated: "Pi" refers to obstruction without smooth flow. Bitter flavor enters the Heart first; to drain the Heart, bitter herbs must be used, hence Huanglian serves as the Sovereign herb.
(After erroneous purgation, Spleen Qi must be deficient), thus dissipating the Pi-heat and resolving via profuse sweating (Old commentary notes: The ingredients of this formula are derived from Lizhong Tang and Renshen Huangqin Tang. Wang Haicang said: When external signs resemble excess conditions requiring purgation, but the pulse is fine and weak, precluding purgation, Xiexin Tang is indicated; if the pulse is forceful, Huanglian Xiexin Tang is used; if the pulse is weak, Banxia Xiexin Tang is used. Yu Jiayan said: Various Xiexin Tangs originally aim to clear fluid retention; since this case involves vomiting, Banxia is elevated to Sovereign status. Cheng Jiaoqian said: Although Pi syndrome involves deficiency pathogens, when exterior qi sinks into the interior and stagnates in the distribution of Heart Yang, cold transforms into heat. Once cold has transformed into heat, it cannot disperse outward, yet the heat is not excess, and turbid qi cannot descend downward. Only by using bitter-cold herbs to guide them downward along the pathogen's location, while simultaneously using acrid-hot herbs to warm against the potential ascent of Yin pathogens from the Lower Jiao, can both Yin and Yang be resolved. Without directly attacking Pi, Pi disperses naturally, hence the mutual use of cold and hot herbs. If Yin Pi does not involve Yang stagnation, i.e., stagnation has not yet transformed into heat, but is merely a rejection between upper and lower Yin-Yang sectors, the method of draining the Heart is entirely contraindicated. He further stated: People say excessive sweating causes loss of Yang, but do not know that excessive purgation also causes loss of Yang, specifically the loss of Yang within Yin, hence termed loss of Yin. When Lower Jiao Yang suddenly becomes deficient, Qi must rebel upward, causing Upper Jiao Yang to become excess due to lower deficiency, because Fire Qi fails to descend. Treatment often involves draining the upper and tonifying the lower; when the Heart Monarch is pacified by bitter-cold herbs, it can reverse and guide from Yang into Yin, thus the draining action of Huangqin, Huanglian, and Zhizi becomes tonification; if sweating and purgation follow each other...)
Removing Renshen from this formula and adding Gancao (one liang, totaling four liang with the previous amount) creates Gancao Xiexin Tang (Zhang Zhongjing): Treats Cold Damage or Wind Strike where the physician erroneously purges, leading to diarrhea with undigested food, borborygmus in the abdomen, epigastric hardness and fullness, dry belching, and irritability. If the physician purges again, the Pi worsens. This is not accumulated heat, but rather Stomach deficiency with rebellious hostile Qi causing hardness (Because purgation causes interior deficiency and weak Stomach, damaging Yin Qi internally, Gancao is added to harmonize the middle, benefit Stomach Qi, restore True Yin, and clear deficient heat. Zhen Quan... Cold Damage... Intestine... Movement... Treat... Regarding Yin syndromes, they align with Cold, making symptoms even more apparent; thus it is said that in Yang syndrome diarrhea, mistaken warming leads to jaundice and macules, resulting in death...).
Adding Shengjiang (Zingiberis Rhizoma Recens) four liang to this formula creates Shengjiang Xiexin Tang (Zhang Zhongjing): Treats disharmony in the Stomach after resolution via sweating, epigastric hardness, dry belching with food odor, undigested food in stool, water-fluid retention under the hypochondrium, and borborygmus with diarrhea (Rebellious hostile Qi and latent fluid retention binding at the diaphragm cause hardness; Middle Qi disharmony causes dry belching; Stomach deficiency with flourishing fire and pathogenic heat failing to digest grains causes undigested food; water-fluid retention under the hypochondrium, with Earth deficiency failing to control Water, causes borborygmus and diarrhea, termed Xiere Li [Collateral Heat Diarrhea]. Because sweating damages Stomach Qi and externally injures Yang, Shengjiang is added to disperse pathogens, clear fluids, benefit Stomach, and restore Yang. Liu Hejian said: Diarrhea with discoloration of water and food indicates Heat; unchanged color and clear, cold appearance indicate Cold. If the anus is dry and astringent, and urine is yellow and red, even if food remains unchanged, it is still Heat, due to the rapid nature of Fire, where food exits immediately without digestion, termed pathogenic heat failing to "kill" grains). Removing Huangqin and Dazao from this formula, and adding Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), Maiya (Hordei Fructus Germinatus), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuling (Poria), processed into pills with steamed dough paste, creates Zhishi Xiaopi Wan (Li Dongyuan).