（仲景）
治伤寒心下痞，而复恶寒汗出者（伤寒心下满 而痛者，为结胸，为实；硬满而不痛者，
为痞，
附子
后复
满，
从外
大黄（二两） 黄连 黄芩（一两） 附子（一枚，炮，去皮，破，别煮取汁）
此足太阳、手少阴药也。吴鹤皋曰∶心下痞，故用三黄以泻痞；恶寒汗出，故用附子以
固阳
此邪
汤
以
类
而
表
故
东
因
甚
药
本方去附子，名三黄泻心汤（见前）。再去黄芩，名大黄黄连泻心汤（仲景）∶治伤寒心
下痞，按之濡（音软，）关上脉浮（沉为实热，浮为虚热。经曰∶按之自濡，但气痞耳。周
扬俊曰∶以非痰饮结聚，故无取半夏、生姜也。《活人》云∶结胸与痞，关脉须皆沉∶若关
脉浮而结者，三黄以泻肝。李时珍曰∶仲景治心气不足、吐衄血者，用泻心汤，实泻心包、
肝、脾、胃四经血中之伏火也。又治心下痞满，按之软者，用泻心汤，亦泻脾胃之湿热，非
泻心也。病发于阴而反下之，则痞满，乃寒伤营血，邪结上焦，胃之上脘在心，故曰泻心。
经曰∶太阴所至为痞满。又曰∶浊气在上则生 胀是已。病发于阳而反下之，则结胸，乃邪
热陷入血分，亦在上脘，故大陷胸汤丸皆用大黄，亦泻脾胃血分之邪而散其热也；若结胸在
气分，则用小陷胸汤；痞满在气分，只用半夏泻心汤。按∶发阳发阴，诸解不同，终成疑案。
李氏则以寒伤为阴病，热陷为阳病，然仲景所用皆寒药，未尝有所分也；周扬俊则谓总属下
早致然，似为近
（张仲景）
治疗伤寒导致的心下痞满，并且伴有怕冷、出汗症状的（伤寒病中，心下部胀满且疼痛的，称为结胸，属于实证；坚硬胀满但不疼痛的，称为痞证）。
[方剂组成]
附子（一枚，炮制，去皮，掰开，单独煎煮取汁）
大黄（二两） 黄连 黄芩（各一两）
[方解]
本方是足太阳膀胱经和手少阴心经的药物。吴鹤皋说：心下痞满，所以用三黄（大黄、黄连、黄芩）来泻除痞满；怕冷且出汗，所以用附子来固护阳气。
[加减变化]
本方去掉附子，名为三黄泻心汤（见前文）。再去除黄芩，名为大黄黄连泻心汤（张仲景）：治疗伤寒导致的心下痞满，按压时感觉柔软（音同“软”），关脉浮（沉脉主实热，浮脉主虚热。经典记载：按压自感柔软，只是气机痞塞而已。周扬俊说：因为不是痰饮积聚，所以不需要用半夏、生姜。《活人书》说：结胸与痞证，关脉都应当沉；如果关脉浮而结滞，用三黄来泻肝火。李时珍说：张仲景治疗心气不足、吐血衄血的患者，使用泻心汤，实际上是泻除心包、肝、脾、胃四经血分中的伏火。又治疗心下痞满，按压柔软的，使用泻心汤，也是泻除脾胃的湿热，并非真正泻心。疾病发于阴经却误用攻下法，则导致痞满，这是寒邪损伤营血，邪气结聚在上焦，胃的上脘部位对应心脏，所以称为泻心。经典记载：太阴湿土之气所致病症表现为痞满。又说：浊气停留在上部就会产生胀满，说的就是这个道理。疾病发于阳经却误用攻下法，则导致结胸，这是邪热陷入血分，也在上脘部位，所以大陷胸汤丸都用大黄，也是泻除脾胃血分的邪气并散其热；如果结胸在气分，则用小陷胸汤；痞满在气分，只用半夏泻心汤。按语：关于发阳发阴，各种解释不同，最终成为疑案。李氏认为寒伤为阴病，热陷为阳病，然而张仲景所用的都是寒药，并没有加以区分；周扬俊则认为总归是由于过早攻下导致的，似乎更为接近事理）。
(Zhang Zhongjing)
Treats *Shanghan* (Cold Damage) presenting with epigastric fullness and obstruction (*Xin Xia Pi*), accompanied by aversion to cold and sweating. (In *Shanghan*, epigastric fullness with pain is termed *Jie Xiong* [Chest Binding], which is an excess condition; hardness and fullness without pain is termed *Pi* [Obstruction]).
[Formula Composition]
Fuzi (Aconiti Lateralis Radix Praeparata, one piece, processed, skin removed, broken, decocted separately to extract the juice)
Dahuang (Rhei Radix et Rhizoma, two liang) Huanglian (Coptidis Rhizoma) Huangqin (Scutellariae Radix, each one liang)
[Formula Analysis]
This formula acts on the Foot-Taiyang Bladder Meridian and Hand-Shaoyin Heart Meridian. Wu Hegao stated: For epigastric obstruction, Sanhuang (Three Yellows: Dahuang, Huanglian, Huangqin) is used to drain the obstruction; for aversion to cold and sweating, Fuzi is used to secure Yang Qi.
[Modifications]
Removing Fuzi from this formula yields Sanhuang Xiexin Tang (Three Yellows Decoction to Drain the Epigastrium) (see previous). Removing Huangqin as well yields Dahuang Huanglian Xiexin Tang (Dahuang and Huanglian Decoction to Drain the Epigastrium) (Zhang Zhongjing): Treats *Shanghan* presenting with epigastric obstruction, where palpation reveals softness (pronounced "ruan"), and the Guan pulse is floating (Deep pulse indicates excess heat; Floating pulse indicates deficient heat. The Classics state: If palpation feels naturally soft, it is merely Qi obstruction. Zhou Yangjun said: Since there is no accumulation of phlegm-fluids, Banxia and Shengjiang are not required. *Ren Shu* states: For both Jie Xiong and Pi, the Guan pulse should be deep; if the Guan pulse is floating and knotted, Sanhuang is used to drain Liver fire. Li Shizhen said: Zhang Zhongjing uses Xiexin Tang to treat insufficient Heart Qi causing hematemesis and epistaxis, which actually drains latent fire in the blood of the Pericardium, Liver, Spleen, and Stomach meridians. It also treats epigastric fullness that is soft upon palpation, draining damp-heat from the Spleen and Stomach, rather than truly draining the Heart. When a disease originates in the Yin aspect but is incorrectly treated with purgatives, obstruction and fullness result; this is cold damaging the Ying-Blood, with pathogenic factors binding in the Upper Jiao. The upper part of the Stomach corresponds to the Heart, hence it is called "Draining the Heart." The Classics state: What Taiyin brings about is obstruction and fullness. It also states: When turbid Qi remains in the upper region, distension arises, referring to this situation. When a disease originates in the Yang aspect but is incorrectly treated with purgatives, Jie Xiong results; this is pathogenic heat sinking into the Blood level, also located in the upper Stomach. Therefore, Da Xianxiong Tang and Wan both use Dahuang to drain pathogenic factors from the Spleen and Stomach blood level and dissipate heat; if Jie Xiong is at the Qi level, Xiao Xianxiong Tang is used; if obstruction and fullness are at the Qi level, only Banxia Xiexin Tang is used. Commentary: Regarding "originating in Yang" versus "originating in Yin," various interpretations differ, remaining a doubtful case. Li considers cold damage as Yin disease and heat sinking as Yang disease, yet all medicines used by Zhang Zhongjing are cold-natured, showing no distinction; Zhou Yangjun suggests it is generally due to premature purgation, which seems more plausible).