大黄（二两） 黄连（一两）
上二味。以麻沸汤渍之。须臾绞去滓。分温再服。
脉浮而紧而复下之。紧反入里则作痞。按之自濡。但气痞耳。心下痞。按之濡。其脉关
上
浮者。大黄黄连泻心汤主之。此条柯韵伯谓按之濡。当作按之硬。必有当急下之证。故制比
峻攻
之剂。疑属错简。此说强经就我。转使作圣之灵思巧法。尽行埋没。愚按经文言紧反入里。
里邪
不能再使出表。当从里解。但按之不濡。中挟饮邪。按之自濡。中不挟饮。故曰但气痞也。
若
表邪未罢。脉当尺寸俱浮。今但关上浮。则属中焦痞结。气有上逆之象。既曰气痞。但当顺
其气。本方大黄黄连。分两既轻。渍以沸汤。绞去滓而温服。则但取其气。不取其味。使气
顺而痞自解。况经文本有表未解不可攻痞之条。此之表解而邪入里。攻痞自宜此法。先圣处
方。
妙在能用药而不为药用。观其服法。本非急下之剂。与大陷胸之用大黄。小陷胸之用黄连。
药虽同而制则异矣。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（一枚炮去皮破别煮取汁）
上四味。 咀三味。以麻沸汤二升渍之。绞去滓。纳附子汁。分温再服。心下痞而复恶
寒汗出
者。附子泻心汤主之。此条柯氏于心下痞之下。自添大便硬心烦不得眠八字。谓恶寒者表未
解。不当用大黄。若汗出是胃实。不当用附子。若汗出为亡阳。不当用芩连。当有大便硬心
烦
不得眠句。始与此方相合。愚按此说尤悖。大凡恶寒汗不出者属表实。恶寒汗自出者属表虚
。
若但汗出恶寒。仲景自有芍药甘草附子汤之制今心下痞而复恶寒汗出。则表虚而里实。但固
表则里邪愈壅。但清里则表阳将亡。故以三黄附子合而用之。附子自能固表。三黄自能清
里。且三黄得附子。其苦寒不致留滞阴邪。附子得三黄。其剽悍不致劫
伤津液。此正善用反佐之法。故能以一方而全收复阳驱邪之效。若必加入大便硬心烦不得眠
八字。以求与本方之三黄相合。则本经之用大黄。岂必尽为胃实而设。亦有本自下利而反用
大
黄者。至心烦不得眠。安知非由胃虚客气上逆之证。亦不得概从苦寒直折。且附子雄烈之性
。又安见与大便硬心烦不得眠者相宜。柯氏胶执己见。擅改经文。无论其所言背谬。即使见
果
确凿。亦当存阙疑之例。况一偏之见。泥药求方。使先圣极空灵极神变之活法。而转以死法
求
之。悖甚矣。余历考前贤医案。用附子泻心汤而愈者。不一而足。且余亦尝试验。故敢直辟
柯氏之谬。
以上两味药。用滚开的沸水浸泡它们。片刻后绞去药渣。分两次温服。
脉象浮而紧，如果误用攻下法，紧脉反而入里，就会形成痞证。按压时感觉柔软，这仅仅是气机阻滞形成的痞证。心下部痞满，按压时感觉柔软，且脉象在关部呈现浮象的，用大黄黄连泻心汤主治。这一条柯韵伯认为“按之濡”应当是“按之硬”，必定有急需攻下的证候，所以制定了比较峻猛的攻下剂型。怀疑这是竹简错乱所致。这种说法牵强附会，反而使圣人构思巧妙的法则被埋没。我认为经文说紧脉反入里，里邪不能再透出体表，应当从内部解决。但如果按压不柔软，说明中挟带饮邪；按压自感柔软，说明中不挟带饮邪，所以说仅仅是气痞。如果表邪未解，脉象应当在寸部和尺部都呈现浮象。现在仅仅关部浮，则属于中焦痞结，气机有上逆的迹象。既然称为气痞，就应当顺其气机。本方中大黄、黄连的分量既轻，又用沸水浸泡，绞去药渣后温服，这样只是取其气味，而不取其厚味，使气机顺畅而痞证自然解除。况且经文中本来就有表证未解不可攻痞的条文，这里是表解之后邪气入里，攻治痞证自然适宜用此法。先圣处方，妙在能用药而不被药物所局限。看它的服用方法，本就不是急下之剂。与大陷胸汤使用大黄、小陷胸汤使用黄连相比，虽然药物相同但制法不同。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（一枚，炮制，去皮，破开，另外煮取汁液）
以上四味药。将前三味药切碎，用二升滚开的沸水浸泡它们。绞去药渣。纳入附子的汁液。分两次温服。心下部痞满，同时又恶寒、汗出的，用附子泻心汤主治。这一条柯氏在心下痞之下，自行添加了“大便硬、心烦、不得眠”八个字，认为恶寒是表证未解，不应当用大黄；如果汗出是胃实，不应当用附子；如果汗出是亡阳，不应当用黄芩、黄连。如果有“大便硬、心烦、不得眠”的句子，才与本方相合。我认为这种说法尤其荒谬。大凡恶寒且不出汗的属于表实证；恶寒且自汗出的属于表虚证。如果只是汗出且恶寒，仲景自有芍药甘草附子汤的方制。现在心下部痞满而又恶寒、汗出，则是表虚而里实。如果只固护表阳，则里邪会更加壅滞；如果只清泄里热，则表阳将会消亡。所以将三黄（大黄、黄连、黄芩）与附子合用。附子自然能固护表阳，三黄自然能清泄里热。而且三黄得到附子，其苦寒之性不至于留滞阴邪；附子得到三黄，其剽悍之性不至于劫伤津液。这正是善于运用反佐之法，所以能以一方而完全收回复阳驱邪的功效。如果一定要加入“大便硬、心烦、不得眠”这八个字，来求与本方中的三黄相合，那么本经中使用大黄，难道全是为了胃实证而设的吗？也有原本下利却反而使用大黄的。至于心烦不得眠，怎么知道不是由胃虚客气上逆引起的证候呢？也不能一概从苦寒直折的角度治疗。况且附子雄烈之性，又怎么见得适合大便硬、心烦、不得眠的情况？柯氏固执己见，擅自更改经文，无论他的言论多么背谬，即使见解确实确凿，也应当存疑保留。何况这是一种偏颇的见解，拘泥于药物来寻求方剂，使先圣极其空灵、极其神变的活法，转而用死法去追求，太悖谬了。我历考前代医家的医案，使用附子泻心汤治愈的病例，数不胜数。而且我也曾经试验过，所以敢于直接驳斥柯氏的错误。
Rhubarb (2 liang) Coptis Rhizome (1 liang)
The above two ingredients. Soak them in boiling water (Ma Fei Tang). After a short while, strain off the dregs. Divide into two doses and take warm.
If the pulse is floating and tight, and purgation is mistakenly applied, the tight pulse enters the interior instead, resulting in Pi syndrome (a sensation of fullness and obstruction in the epigastrium). Palpation reveals softness; this is merely Qi stagnation forming a Pi. When there is epigastric fullness, palpation feels soft, and the pulse at the Guan position is floating, Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Heart-Draining Decoction) is indicated. Ke Yunbo commented on this passage, suggesting that "palpation feels soft" should be read as "palpation feels hard," implying there must be symptoms requiring urgent purgation, thus justifying a more峻猛 (harsh) purgative formula. He suspected this was due to bamboo slip dislocation. This argument forces the text to fit preconceived notions, thereby burying the profound and ingenious methods of the Sages. I argue that the text states the tight pulse enters the interior; interior pathogens cannot be expelled through the exterior and must be resolved from within. However, if palpation is not soft, it indicates the presence of fluid retention in the middle jiao; if palpation is soft, it indicates no fluid retention, hence it is called merely Qi Pi. If the exterior pathogen has not resolved, the pulse should be floating at both the Cun and Chi positions. Now, only the Guan position is floating, indicating middle jiao Pi formation with an upward reversal of Qi. Since it is termed Qi Pi, one should facilitate the smooth flow of Qi. The dosages of Rhubarb and Coptis in this formula are light; soaking them in boiling water and taking the strained liquid warm extracts their Qi rather than their heavy flavors, allowing Qi to flow smoothly and resolving the Pi naturally. Moreover, the classic explicitly states that when the exterior is unresolved, one should not attack the Pi. Here, the exterior has resolved, and the pathogen has entered the interior, making this method appropriate for attacking the Pi. The ancients' prescription is subtle in using herbs without being limited by them. Observing the administration method, this is not an urgent purgative. Compared to Da Xian Xiong Tang (Major Chest-Stagnating Decoction) using Rhubarb and Xiao Xian Xiong Tang (Minor Chest-Stagnating Decoction) using Coptis, although the herbs are the same, the preparation differs.
Rhubarb (2 liang) Coptis Rhizome (1 liang) Scutellaria Root (1 liang) Aconite Root (one piece, processed, skin removed, broken apart, decocted separately to extract juice)
The above four ingredients. Chop the first three ingredients. Soak them in two sheng of boiling water. Strain off the dregs. Mix in the Aconite juice. Divide into two doses and take warm. When there is epigastric fullness accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Heart-Draining Decoction) is indicated. In this passage, Ke added the eight characters "hard stool, vexation, and inability to sleep" after "epigastric fullness." He argued that aversion to cold indicates unresolved exterior, so Rhubarb should not be used; sweating indicates stomach excess, so Aconite should not be used; sweating indicates collapse of Yang, so Scutellaria and Coptis should not be used. Only with "hard stool, vexation, and inability to sleep" would this formula be applicable. I consider this view particularly absurd. Generally, aversion to cold without sweating belongs to Exterior Excess; aversion to cold with spontaneous sweating belongs to Exterior Deficiency. If there is merely sweating and aversion to cold, Zhongjing already provided the Shaoyao Gancao Fuzi Tang (Peony and Licorice Aconite Decoction). Now, with epigastric fullness accompanied by aversion to cold and sweating, it represents Exterior Deficiency and Interior Excess. If one only secures the exterior, the interior pathogens will become more congested; if one only clears the interior, the exterior Yang will perish. Therefore, combining the Three Yellows (Rhubarb, Coptis, Scutellaria) with Aconite allows Aconite to secure the exterior and the Three Yellows to clear the interior. Furthermore, the Three Yellows combined with Aconite prevent their bitter-cold nature from retaining Yin pathogens; Aconite combined with the Three Yellows prevents its acrid-hot nature from damaging body fluids. This is a skillful application of counteracting methods (Fan Zuo), enabling the formula to restore Yang and expel pathogens effectively. If one insists on adding "hard stool, vexation, and inability to sleep" to align with the Three Yellows, then does the use of Rhubarb in the classics apply only to stomach excess? There are cases of diarrhea where Rhubarb is paradoxically used. Regarding vexation and inability to sleep, how do we know it is not caused by stomach deficiency and rebellious hostile Qi? One cannot simply treat it with bitter-cold downward-draining methods. Moreover, given the potent and fierce nature of Aconite, how can it be suitable for conditions with hard stool, vexation, and insomnia? Ke adhered rigidly to his own views and arbitrarily altered the classic text. Regardless of how erroneous his statements are, even if his insights were accurate, one should preserve doubts. His biased view, clinging to herbs to seek formulas, turns the Sages' extremely flexible and divine living methods into rigid rules, which is highly aberrant. I have reviewed medical records of past experts, finding numerous cures using Fu Zi Xie Xin Tang. I have also personally tested it. Thus, I dare to directly refute Ke's errors.