仲景大黄黄连泻心汤治心下痞按之濡其脉关上浮者或寸沉关浮而有热者
大黄(二两) 黄连(一两)
上锉以麻沸汤二升渍之须臾绞去滓分温再服
按此手少阴经药也出阳明例成无己云大黄黄连以导泻心下之虚热以麻沸汤渍服者取其气
薄而泄虚热也
又按活人云伊芳尹汤液论大黄黄连黄芩汤共三味今监本无黄芩脱落之也又保命集无黄芩却
加甘草(一两)
仲景附子泻心汤治心下痞而复恶寒汗出脉沉迟也
大黄(二两) 黄连 黄芩(各一两) 附子(一枚炮去皮别煮)
上锉以麻沸汤二升渍之须臾绞去滓内附子汁分温再服
半夏泻心汤治汗下后身寒痞满而呕食饮不下脉微
按之不痛非柴胡证
半夏(半升洗) 黄芩 干姜 人参(各三两) 黄连(一两) 大枣(十二枚) 甘草(二两
炙)
上七味以水一斗煮取六升去滓再煮取二升温服一升日三服
生姜泻心汤治汗下后胃中不利干噫食臭自利肠鸣胁下有水气而心下痞满
比半夏泻心汤加生姜(四两) 减干姜作(一两)
甘草泻心汤治下之后腹中雷鸣心下痞硬再下之痞益甚此非结热以胃中虚客气上逆也
比半夏泻心汤无人参加甘草作(四两)
按以上诸泻心汤元戎云手少阴药也以其心下痞故入阳明例况服栀子黄芩黄连黄柏大黄为
上下通经之剂安得不例阳明乎
秘藏大消痞丸治一切心下痞闷及积年久不愈者
黄连(炒) 黄芩(各六钱) 姜黄 白术(各一钱) 炙甘草 砂仁 干生姜
神曲(炒各一钱) 人参(二钱) 枳实(炒五钱) 橘皮(二钱) 泽泻(三钱) 浓朴(炒三
钱) 猪苓(一钱半)半夏(四钱)
上同为细末水浸蒸饼丸桐子大每五十丸至百丸白汤下
枳实消痞丸治右关脉浮弦心下虚痞恶食懒倦开胃进食
枳实 黄连(各五钱) 干生姜(二钱) 半夏曲(三钱) 浓朴(炙四钱) 人参(三钱) 白
术(三钱) 炙甘草(二钱) 茯苓 大麦面(各二钱)
上同为细末水浸蒸饼为丸每三五十丸温水下
按以上二方并半夏泻心汤加减法也内有枳术汤四君子五苓平胃等利湿消痞补虚之药也
张仲景的大黄黄连泻心汤,用于治疗心下痞塞、按之柔软,且脉象关部浮起的病证;或者寸脉沉、关脉浮并伴有热象的情况。
将药材切碎,用滚开的麻沸汤二升浸泡片刻,绞取药汁,去除药渣,分两次温服。
按语:这是手少阴经的药物,出自阳明病的范畴。成无己说,使用大黄和黄连是为了引导泻去心下的虚热,用麻沸汤浸泡服用,是取其气味轻薄以泄除虚热。
又按《活人书》说,《伊尹汤液论》中大黄黄连黄芩汤共有三味药,现在的监本缺少了黄芩,是脱漏所致。而《保命集》中没有黄芩,却加入了甘草(一两)。
张仲景的附子泻心汤,用于治疗心下痞塞,同时伴有恶寒、汗出、脉象沉迟的病证。
大黄(二两) 黄连 黄芩(各一两) 附子(一枚,炮制后去皮,另煎取汁)
将药材切碎,用麻沸汤二升浸泡片刻,绞取药汁,去除药渣,加入附子的药汁,分两次温服。
半夏泻心汤,用于治疗发汗或攻下之后,身体寒冷、痞满、呕吐、饮食难以下咽,脉象微弱,按压不痛,不属于柴胡证的情况。
半夏(半升,洗净) 黄芩 干姜 人参(各三两) 黄连(一两) 大枣(十二枚) 甘草(二两,炙)
以上七味药,用水一斗煮取六升,去除药渣,再煎煮取二升,每次温服一升,每日三次。
生姜泻心汤,用于治疗发汗或攻下之后,胃中不和,干噫食臭,自利,肠鸣,胁下有停饮,且心下痞满的情况。
甘草泻心汤,用于治疗攻下之后,腹中雷鸣,心下痞硬,再次攻下后痞满更加严重。这不是结热,而是因为胃中虚弱,客气上逆所致。
按语:以上各种泻心汤,李东垣在《医学发明》中说属于手少阴经药物,因为有心下痞的症状,所以归入阳明例。况且服用栀子、黄芩、黄连、黄柏、大黄等作为上下通经的药剂,怎么能不归入阳明呢?
黄连(炒) 黄芩(各六钱) 姜黄 白术(各一钱) 炙甘草 砂仁 干生姜 神曲(炒,各一钱) 人参(二钱) 枳实(炒五钱) 橘皮(二钱) 泽泻(三钱) 浓朴(炒三钱) 猪苓(一钱半) 半夏(四钱)
以上药物共同研为细末,用水浸湿蒸饼制成梧桐子大小的丸剂,每次五十丸至一百丸,用白开水送服。
枳实消痞丸,用于治疗右关脉浮弦,心下虚痞,厌恶食物,懒倦乏力,旨在开胃进食。
枳实 黄连(各五钱) 干生姜(二钱) 半夏曲(三钱) 浓朴(炙四钱) 人参(三钱) 白术(三钱) 炙甘草(二钱) 茯苓 大麦面(各二钱)
以上药物共同研为细末,用水浸湿蒸饼制成丸剂,每次三五十丸,用温水送服。
按语:以上两个方子以及半夏泻心汤都是加减法的应用。其中含有枳术汤、四君子汤、五苓散、平胃散等具有利湿、消痞、补虚作用的药物。
Zhang Zhongjing's Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium) is indicated for epigastric fullness and stuffiness that feels soft upon palpation, accompanied by a floating pulse at the Guan position; or when there is a deep pulse at the Cun position, a floating pulse at the Guan position, and signs of heat.
Dahuang (Rhei Radix et Rhizoma, 2 liang) Huanglian (Coptidis Rhizoma, 1 liang)
Crush the herbs, soak them in two sheng of boiling water infused with hemp seeds (Mafei Tang), briefly squeeze out the liquid, discard the dregs, and divide into two doses to be taken warm.
Note: These are herbs belonging to the Hand-Shaoyin meridian, yet they are categorized under Yangming patterns. Cheng Wuji stated that Dahuang and Huanglian are used to guide and drain deficient heat from the heart/epigastrium. Soaking them in Mafei Tang utilizes their light aroma to drain deficient heat.
Furthermore, according to *Ren Shu* (The Man Who Can Do It), *Yi Yin Tang Ye Lun* lists Dahuang Huanglian Huangqin Tang as having three ingredients. The current official edition lacks Huangqin, which is an omission. However, *Baoming Ji* excludes Huangqin but adds Gancao (Licorice Root, 1 liang).
Zhang Zhongjing's Fuzi Xiexin Tang (Aconite Decoction to Drain the Epigastrium) is indicated for epigastric fullness and stuffiness accompanied by aversion to cold, sweating, and a deep, slow pulse.
Dahuang (Rhei Radix et Rhizoma, 2 liang) Huanglian (Coptidis Rhizoma, 1 liang) Huangqin (Scutellariae Radix, 1 liang) Fuzii Preparata Radix (Prepared Aconite Root, 1 piece, processed, peeled, decocted separately)
Crush the herbs, soak them in two sheng of boiling water infused with hemp seeds (Mafei Tang), briefly squeeze out the liquid, discard the dregs, mix in the juice of the separately decocted Fuzi, and divide into two doses to be taken warm.
Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated for symptoms following sweating or purgation, including chills, epigastric fullness and stuffiness, vomiting, inability to swallow food and drink, a faint pulse, and painlessness upon palpation. This is not a Chaihu pattern.
Banxia (Pinelliae Tuber, half sheng, washed) Huangqin (Scutellariae Radix) Ganjiang (Zingiberis Rhizoma) Renshen (Ginseng Radix) (each 3 liang) Huanglian (Coptidis Rhizoma, 1 liang) Dazao (Jujubae Fructus, 12 pieces) Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried)
Take the above seven ingredients, add one dou of water, decoct to obtain six sheng, strain, then decoct again to obtain two sheng. Take one sheng warm per dose, three times daily.
Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium) is indicated for symptoms following sweating or purgation, including stomach disharmony, dry belching with a smell of food, spontaneous diarrhea, borborygmus, fluid retention under the hypochondrium, and epigastric fullness and stuffiness.
Compared to Banxia Xiexin Tang, increase Shengjiang (Zingiberis Recens Rhizoma) to four liang and decrease Ganjiang (Zingiberis Rhizoma) to one liang.
Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium) is indicated for rumbling in the abdomen after purgation, hardness and fullness in the epigastrium, and worsening fullness after further purgation. This is not due to accumulated heat, but rather deficiency in the stomach allowing hostile qi to rebel upward.
Compared to Banxia Xiexin Tang, remove Renshen and increase Gancao (Glycyrrhizae Radix et Rhizoma) to four liang.
Note: Li Dongyuan in *Yixue Mingbian* states that the aforementioned Xiexin Tangs belong to the Hand-Shaoyin meridian because they treat epigastric fullness, thus categorized under Yangming. Moreover, since Zhi Zi, Huangqin, Huanglian, Huangbai, and Dahuang are used as agents to unblock the upper and lower meridians, how can they not be categorized under Yangming?
Mizang Da Xiaopi Wan (Secret Collection Large Pill to Dissolve Fullness) is indicated for all types of epigastric fullness and stuffiness, especially those persisting for years and refractory to treatment.
Huanglian (Coptidis Rhizoma, stir-fried, 6 qian) Huangqin (Scutellariae Radix, stir-fried, 6 qian) Jianghuang (Curcumae Longae Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma) (each 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) Sharen (Amomi Fructus) Ganshengjiang (Zingiberis Rhizoma) Shenqu (Massae Medicatae Fermentatae, stir-fried, each 1 qian) Renshen (Ginseng Radix, 2 qian) Zhishi (Aurantii Fructus Immaturus, stir-fried, 5 qian) Jupi (Citri Reticulatae Pericarpium, 2 qian) Zexie (Alismatis Rhizoma, 3 qian) Houpo (Magnoliae Officinalis Cortex, stir-fried, 3 qian) Zhuling (Polyporus, 1.5 qian) Banxia (Pinelliae Tuber, 4 qian)
Grind all ingredients into a fine powder. Mix with water-soaked steamed dough to form pills the size of paulownia seeds. Take 50 to 100 pills per dose with plain boiled water.
Zhishi Xiaopi Wan (Immature Bitter Orange Pill to Dissolve Fullness) is indicated for a floating and wiry pulse at the right Guan position, empty fullness in the epigastrium, aversion to food, lethargy, aiming to open the stomach and promote appetite.
Zhishi (Aurantii Fructus Immaturus) Huanglian (Coptidis Rhizoma) (each 5 qian) Ganshengjiang (Zingiberis Rhizoma, 2 qian) Banxiaqu (Pinelliae Tuber Fermentatum, 3 qian) Houpo (Magnoliae Officinalis Cortex, honey-fried, 4 qian) Renshen (Ginseng Radix, 3 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 qian) Fuling (Poria) Damaimian (Hordei Fructus Germinatus) (each 2 qian)
Grind all ingredients into a fine powder. Mix with water-soaked steamed dough to form pills. Take 30 to 50 pills per dose with warm water.
Note: The above two formulas, along with Banxia Xiexin Tang, represent modification methods. They contain herbs from Zhizhu Tang, Sijunzi Tang, Wuling San, and Pingwei San, which have functions of promoting diuresis, resolving fullness, and tonifying deficiency.