伤寒汗出解之后，胃中不和，心下痞硬，干呕食臭，胁下有水气，腹中雷鸣下利者，生姜泻心汤主之。
汗出而解，太阳症已罢矣。胃中不和，是太阳之余邪与阴寒之水气杂处其中故也。阳邪居胃之上口，故心下
痞硬，干呕而食臭；水邪居胃之下口，故腹中雷鸣而下利也。火用不宣则痞硬，水用不宣则干呕，邪热不杀谷则
食臭。胁下即腹中也。土虚不能制水，故肠鸣。此太阳寒水之邪，侵于形躯之表者已罢，而入于形躯之里者未散。故
病虽在胃而不属阳明，仍属太阳寒水之变耳。
生姜泻心汤∶
生姜（四两） 人参 黄芩 甘草（各三两） 半夏（半升） 干姜 黄连（各一两） 大枣（十二枚）
上八味，以水一斗，煮取六升，去滓，再煎至二升，温服一升，日三服。
按∶心下痞是太阳之里症。太阳之上，寒气主之。中见少阴，少阴者心也。心为阳中之太阳。必其人平日
心火不足，胃中虚冷，故太阳寒水得以内侵。虚阳郁而不舒，寒邪凝而不解，寒热交争于心下，变症蜂起，君主
危矣。用热以攻寒，恐不戢而自焚；用寒以胜热，恐召寇而自卫。故用干姜、芩、连之苦入心化痞，人参、甘
草之甘泻心和胃，君以生姜，佐以半夏。倍辛甘之发散，兼苦寒之涌泄，水气有不散者乎？名曰泻心，止戈
为武之意也。
伤寒中风，医反下之。其人下利日数十行，谷不化，腹中雷鸣，心下痞硬而满，干呕，心烦不得安。医见心
下痞，谓病不尽，复下之，其痞益甚。此非结热，但以胃中空虚，客气上逆，故使硬也，甘草泻心汤主之。
上条是汗解后水气下攻症，此条是误下后客气上逆症，总是胃虚而稍有分别矣。上条腹鸣下利，胃中犹寒
热相半，故云不和。此腹鸣而完谷不化，日数十行，则痞为虚痞、硬为虚硬、满为虚满也明矣。上条因水气下趋，
故不烦不满。此虚邪逆上，故心烦而满。盖当汗不汗，其人心烦，故于前方去人参而加甘草。下利清谷，又不
可攻表，故去生姜而加干姜。不曰理中仍名泻心者，以心烦痞硬，病本于心耳。
伤寒中风，是病发于阳。误下热入而其人下利，故不结胸。若心下痞硬干呕心烦，此为病发于阴矣。而复
下之，故痞益甚也。
甘草泻心汤∶
前方去人参、生姜，加甘草（一两），干姜（二两）。余同前法。
伤寒五六日，呕而发热者，柴胡汤症具。而以他药下之，若心下满而硬痛者，此为结胸也，大陷胸汤主之。
但满而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤。
呕而发热者，小柴胡症也。呕多虽有阳明症，不可攻之。若有下
症，亦宜大柴胡。而以他药下之，误矣。误下后有二症者，少阳为半表半里之经，不全发阳，不全发阴，故误下
之变，亦因偏于半表者成结胸，偏于半里者心下痞耳。此条本为半夏泻心而发，故只以痛不痛分结胸与痞，未及
他症。
半夏泻心汤∶
前方加半夏（半斤），干姜（二两），去生姜。余同前法。
泻心汤，即小柴胡去柴胡加黄连干姜汤也。三方分治三阳。在太阳用生姜泻心汤，以未经误下而心下痞硬，
虽汗出表解，水犹未散，故君生姜以散之，仍不离太阳为开之义。在阳明用甘草泻心汤者，以两番误下，胃中空
虚，其痞益甚，故倍甘草以建中，而缓客气之上逆，仍是从乎中治之法也。在少阳用半夏泻心者，以误下而成痞，
邪既不在表，则柴胡汤不中与之，又未全入里，则黄芩汤亦不中与之矣。胸胁苦满与心下痞满，皆半表里症也。
于伤寒五六日，未经下而胸胁苦满者，则柴胡汤解之。伤寒五六日，误下后，心下满而胸胁不满者，则去柴胡、生
姜，加黄连、干姜以和之。此又治少阳半表里之一法也。然倍半夏而去生姜，稍变柴胡半表之治，推重少阳半里
之意耳。君火以明，相火以位，故仍名曰泻心，亦以佐柴胡之所不及。
伤寒吐下后，复发汗，虚烦，脉甚微，八九日，心下痞硬，胁下痛，气上冲咽喉，眩冒，经脉动惕者，久
而成痿。
此以八九日吐下复汗，其脉甚微，看出是虚烦。则心下痞硬、胁下痛、经脉动惕，皆属于虚，气上冲咽喉、
眩冒，皆虚烦也。此亦半夏泻心症，治之失宜，久而成痿矣。若用竹叶石膏汤，大谬。
太阳病，已发汗，仍发热恶寒，复下之，心下痞，表里俱虚，阴阳气并竭，无阳则阴独，复加烧针，因胸
烦，面色青黄肤 者难治。今色微黄手足温者易愈。
此亦半夏泻心症。前条因吐下后复汗，以致虚烦。此因汗下后加烧针，以致虚烦。多汗伤血，故经脉动惕；
烧针伤肉，故面青肤 。色微黄手足温，是胃阳渐回，故愈。
伤寒本自寒下，医复吐下之，寒格。若食入口即吐，干姜黄连黄芩人参汤主之。
治之小误，变症亦轻，故制方用泻心之半。上焦寒格，故用参、姜；心下蓄热，故用芩、连；呕家不喜甘，
故去甘草。不食则不吐，是心下无水气，故不用姜、夏。要知寒热相阻，则为格症；寒热相结，则为痞症。
干姜黄连黄芩人参汤∶
干姜 黄连 黄芩 人参（各二两）
上四味，以水六升，煮取二升，分温再服。
心下痞，按之濡，大便硬而不恶寒反恶热，其脉关上浮者，大黄黄连泻心汤主之。
大黄黄连泻心汤∶
大黄（二两） 黄连（一两）
上二味，以麻沸汤一升渍之，须臾，绞去滓，分温再服。
濡当作硬。按之濡下，当有大便硬不恶寒反恶热句，故立此汤。观泻心汤治痞，是攻补兼施、寒热并驰之剂。
此则尽去温补，独任苦寒下泄之品，且用麻沸汤渍绞浓汁而生用之，利于急下如此，而不言及热结当攻诸症，
谬矣。夫按之濡为气痞，是无形也，则不当下。且结胸症，其脉浮大者，不可下，则心下痞而关上浮者，反可下
乎？小结胸按之痛者，尚不用大黄，何此比陷胸汤更峻？是必有当急下之症，比结胸更甚者，故制此峻攻之剂也。
学人用古方治今病，如据此条脉症而用此方，下咽即死耳。勿以断简残文尊为圣经，而曲护其说，以遗祸后人也。
心下痞，大便硬，心烦不得眠，而复恶寒汗出者，附子泻心汤主之。
附子泻心汤∶
大黄（二两） 黄连 黄芩（各一两） 附子（一枚，别煮取汁）
上三味，以麻沸汤二升渍之，须臾，绞去滓，内附子汁，
分温再服。
心下痞下，当有大便硬、心烦不得眠句，故用此汤。夫心下痞而恶寒者，表未解也，当先解表。宜桂枝加附
子，而反用大黄，谬矣。既加附子，复用芩、连，抑又何也？若汗出是胃实，则不当用附子。若汗出为亡阳，
又乌可用芩、连乎？许学士云∶“但师仲景意，不取仲景方。”盖谓此耳。
伤寒服汤药，下利不止，心下痞硬。服泻心汤已，复以他药下之，利不止。医以理中与之，利益甚。理中者
理中焦。此利在下焦，赤石脂禹余粮汤主之。复利不止者，当利其小便。
服汤药而利不止，是病在胃。复以他药下之而利不止，则病在大肠矣。理中非不善，但迟一着耳。石脂、余粮，
助燥金之令，涩以固脱。庚金之气收；则戊土之湿化。若复利不止者，以肾主下焦，为胃之关也。关门不利，再利
小便，以分消其湿。盖谷道既塞，水道宜通，使有出路。此理下焦之二法也。
赤石脂禹余粮汤∶
赤石脂 禹余粮（各一斤）
上二味，以水六升，煮取二升，去滓，分温三服。
利在下焦，水气为患也。唯土能制水。石者，土之刚也。石脂、禹粮，皆土之精气所结。石脂色赤入丙，
助火以生土；余粮色黄入戊，实胃而涩肠。虽理下焦，实中宫之剂也。且二味皆甘，甘先入脾，能坚固堤防而平
水气之亢，故功胜于甘、术耳。
伤寒发汗，若吐若下，解后，心下痞硬、噫气不除者，旋复代赭石汤主之。
伤寒者，寒伤心也。既发汗复吐下之，心气太虚，表寒乘虚而结于心下。心气不得降而上出于声，君主出亡之
象也。噫者伤痛声。不言声而曰气者，气随声而见于外也。
旋复代赭石汤∶
旋复花 甘草（各三两） 人参（二两） 半夏（半升） 代赭石（一两） 生姜（五两） 大枣（十二枚）
上七味，以水一斗，煮六升，去滓，再煮三升，温服一升，日三服。
此生姜泻心去芩、连、干姜加旋复、代赭石方也。以心虚不可复泻心，故制此剂耳。心主夏，旋复花生于夏
末，咸能补心，能软硬，能消结气。半夏生于夏初，辛能散邪，能消痞，能行结气。代赭禀南方之火色，入通于
心，散痞硬而镇虚热。参、甘、大枣之甘，佐旋复以泻虚火；生姜之辛，佐半夏以散水结。斯痞硬消，噫气自
除矣。若用芩、连以泻心，能保微阳之不灭哉？
伤寒病经过发汗治疗后，表证已解，但胃气不和，出现心下痞塞胀硬、干呕且有食物腐臭味、胁下有停饮、肠鸣腹泻的症状，用生姜泻心汤主治。
出汗后病邪解除，说明太阳表证已经消除。胃中不和，是因为太阳病的余邪与阴寒的水气混杂在胃中。阳热之邪停留在胃的上口，所以心下痞塞胀硬，干呕并伴有食物腐臭；水湿之邪停留在胃的下口，所以腹中肠鸣如雷并发生腹泻。火气不能宣通则导致痞塞胀硬，水气不能宣通则导致干呕，邪热不能腐熟水谷则产生食物腐臭。胁下就是腹部。脾气虚弱不能制约水湿，所以肠鸣。这是太阳寒水之邪，侵袭体表的病邪已经解除，但侵入体内的病邪尚未消散。所以病位虽然在胃，但不属于阳明病，仍然属于太阳寒水之邪的变证。
生姜泻心汤方：
生姜（四两） 人参 黄芩 甘草（各三两） 半夏（半升） 干姜 黄连（各一两） 大枣（十二枚）
以上八味药，用水一斗，煮取六升药液，去渣滓，再煎浓缩至二升，每次温服一升，每日服用三次。
按语：心下痞是太阳病的里证。太阳经之上，由寒气主令。中见少阴经，少阴经对应心脏。心为阳中之太阳。必定是患者平日心火不足，胃中虚冷，所以太阳寒水之邪得以内侵。虚弱的阳气郁结而不能舒展，寒邪凝滞而不能解散，寒热之气在心下交争，变证蜂拥而起，心神危殆。如果用热药来攻伐寒邪，恐怕火势失控而自焚；如果用寒药来克制热邪，恐怕引寇入室而危害自身。所以使用干姜、黄芩、黄连的苦味药物入心以化解痞塞，用人参、甘草的甘味药物泻心火和调胃气，以生姜为君药，半夏为佐药。加倍使用辛甘发散的药物，兼用苦寒涌泄的药物，水气难道还有不散的吗？名为“泻心”，取的是止戈为武的意思。
伤寒或中风病，医生反而使用攻下法。患者腹泻每天几十次，完谷不化，腹中肠鸣如雷，心下痞塞胀硬且满闷，干呕，心烦不安。医生看到心下痞塞，认为病邪未尽，再次使用攻下法，结果痞塞更加严重。这不是实热结聚，而是因为胃中空虚，客气上逆，所以导致痞塞胀硬，用甘草泻心汤主治。
上一条是汗出解表后水气下攻的症状，这一条是误用攻下后客气上逆的症状，都是胃气虚弱，只是稍有区别罢了。上一条是腹鸣腹泻，胃中还是寒热各半，所以说“不和”。这一条是腹鸣且完谷不化，每天几十次，那么痞塞是虚痞、胀硬是虚硬、满闷是虚满，这已经很明白了。上一条因为水气下趋，所以没有心烦和满闷。这一条因为虚邪逆上，所以心烦且满闷。应当发汗而没有发汗，人心烦，所以在前方中去掉人参而加入甘草。腹泻清稀完谷，不可以攻表，所以去掉生姜而加入干姜。不叫理中丸而仍名泻心汤，是因为心烦痞塞胀硬，病本源于心。
伤寒或中风，是病发于阳经。误用攻下，热邪内陷而导致腹泻，所以不形成结胸。如果心下痞塞胀硬、干呕、心烦，这是病发于阴经了。如果再误用攻下法，所以痞塞更加严重。
甘草泻心汤方：
前方去掉人参、生姜，加入甘草（一两），干姜（二两）。其余同前法。
伤寒五六天，呕吐且发热，具备小柴胡汤证。却用其他药物攻下，如果心下满闷且硬痛，这是结胸证，用大陷胸汤主治。
只是满闷而不疼痛的，这是痞证，小柴胡汤不适用，宜用半夏泻心汤。
呕吐且发热，是小柴胡汤证。呕吐多者，即使有阳明病症状，也不可用攻下法。如果有下焦实证，也宜用大柴胡汤。却用其他药物攻下，这是错误的。误用攻下后有两种症状，少阳经是半表半里的经络，不完全发于阳，也不完全发于阴，所以误用攻下后的变证，也是因偏于半表而形成结胸，偏于半里而形成心下痞。这一条原本是为半夏泻心汤而发的，所以只通过疼痛与否来区分结胸与痞证，未涉及其他症状。
半夏泻心汤方：
前方加入半夏（半斤），干姜（二两），去掉生姜。其余同前法。
泻心汤，就是小柴胡汤去掉柴胡，加入黄连、干姜而成的汤剂。三方分别治疗三阳病。在太阳病用生姜泻心汤，是因为未经误下而心下痞塞胀硬，虽然出汗后表证已解，但水气仍未消散，所以以生姜为君药以散水气，仍然不离太阳主开的意义。在阳明病用甘草泻心汤，是因为两次误用攻下，胃中空虚，痞塞更加严重，所以加倍使用甘草以建立中气，缓和客气上逆，仍然是从中治的方法。在少阳病用半夏泻心汤，是因为误用攻下而成痞证，邪气既不在表，则小柴胡汤不适用，又未完全入里，则黄芩汤也不适用。胸胁苦满与心下痞满，都是半表半里证。在伤寒五六天，未经攻下而胸胁苦满的，则用小柴胡汤解表。伤寒五六天，误用攻下后，心下满闷而胸胁不苦的，则去掉柴胡、生姜，加入黄连、干姜以调和。这又是治疗少阳半表半里的一种方法。然而加倍使用半夏而去掉生姜，稍微改变小柴胡汤治疗半表的方法，推重少阳半里的意思罢了。君火清明，相火守位，所以仍命名为泻心，也是为了辅助小柴胡汤所不及之处。
伤寒经过催吐、攻下后，又发汗，出现虚烦，脉象非常微弱，到了第八九天，心下痞塞胀硬，胁下疼痛，气上冲咽喉，眩晕昏冒，经脉跳动惕动，时间久了会发展成痿证。
这是因为八九天内经过吐、下后又发汗，脉象非常微弱，看出是虚烦。那么心下痞塞胀硬、胁下疼痛、经脉跳动惕动，都属于虚证，气上冲咽喉、眩晕昏冒，也都是虚烦所致。这也是半夏泻心汤证，治疗不当，时间久了就会发展成痿证。如果使用竹叶石膏汤，就大错特错了。
太阳病，已经发过汗，仍然发热恶寒，又用攻下法，导致心下痞塞，表里俱虚，阴阳之气都衰竭，无阳则阴独存，如果再加用烧针，导致胸中烦闷，面色青黄、皮肤干燥粗糙的难治。现在面色微黄、手足温暖的容易痊愈。
这也是半夏泻心汤证。前一条因为吐下后复汗，导致虚烦。这一条因为汗下后加用烧针，导致虚烦。多汗伤血，所以经脉跳动惕动；烧针伤肉，所以面青肤燥。面色微黄、手足温暖，是胃阳逐渐恢复，所以痊愈。
伤寒本来就有寒性下利，医生又用催吐、攻下法，导致寒热格拒。如果食物入口即吐，用干姜黄连黄芩人参汤主治。
治疗有小失误，变证也较轻，所以制方只用了一半的泻心汤意。上焦寒邪格拒，所以用人参、干姜；心下蓄积热邪，所以用黄芩、黄连；呕吐的人不喜欢甘味，所以去掉甘草。不吃东西就不会呕吐，说明心下没有水气，所以不用生姜、半夏。要知道寒热相互阻隔，就称为格证；寒热相互结聚，就称为痞证。
干姜黄连黄芩人参汤方：
干姜 黄连 黄芩 人参（各二两）
以上四味药，用水六升，煮取二升，分两次温服。
心下痞塞，按之柔软，大便干硬且不恶寒反而恶热，脉象关部浮大的，用大黄黄连泻心汤主治。
大黄黄连泻心汤方：
大黄（二两） 黄连（一两）
以上两味药，用滚开的水一升浸泡，片刻后，绞去渣滓，分两次温服。
“濡”字应当作“硬”字解。按之濡下面，应当有“大便硬、不恶寒反恶热”几句，所以设立此汤。看泻心汤治疗痞证，是攻补兼施、寒热并用的方剂。此方则完全去掉温补药物，单独使用苦寒下泄的药物，且用麻沸汤浸泡绞取浓汁而生用，利于急下如此，却不提及热结实证当攻下的诸种症状，这是错误的。按之柔软是气痞，是无形的，就不应当攻下。况且结胸证，脉象浮大的，不可攻下，那么心下痞塞而关脉浮大的，反而可以攻下吗？小结胸证按之痛的，尚且不用大黄，为何此方比陷胸汤更峻猛？这必定有应当急下的症状，比结胸更严重的，所以制定此峻猛的攻下剂。学习古人用古方治疗今病，如果根据这条脉症而使用此方，药咽下去就会致死。不要将残缺不全的古文尊为圣经，从而曲意维护其说法，给后人留下祸患。
心下痞塞，大便干硬，心烦不得安眠，而又恶寒汗出的，用附子泻心汤主治。
附子泻心汤方：
大黄（二两） 黄连 黄芩（各一两） 附子（一枚，另煮取汁）
以上三味药，用滚开的水二升浸泡，片刻后，绞去渣滓，纳入附子汁，
分两次温服。
心下痞下面，应当有“大便硬、心烦不得眠”几句，所以用此汤。夫心下痞塞而恶寒的，是表证未解，应当先解表。宜用桂枝加附子汤，反而使用大黄，这是错误的。既然加了附子，又复用黄芩、黄连，这又是为什么呢？如果汗出是胃实，则不应当用附子。如果汗出是亡阳，又怎么可以用黄芩、黄连呢？许学士说：“只师法张仲景的意旨，不照搬张仲景的方剂。”大概说的就是这个意思。
伤寒服用汤药后，腹泻不止，心下痞塞胀硬。服用泻心汤后，又用其他药物攻下，腹泻仍不止。医生用理中丸给予治疗，腹泻更严重。理中丸是调理中焦的。此腹泻在下焦，用赤石脂禹余粮汤主治。如果腹泻仍不止，应当通利小便。
服用汤药而腹泻不止，是病在胃。再用其他药物攻下而腹泻不止，则病在大肠了。理中丸并非不好，只是晚了一步。赤石脂、禹余粮，助燥金之气，涩以固脱。庚金之气收敛，则戊土之湿化解。如果腹泻仍不止，是因为肾主下焦，是胃的关口。关门不利，再通利小便，以分消湿气。盖谷道既堵塞，水道宜通畅，使有出路。这是治疗下焦的两种方法。
赤石脂禹余粮汤方：
赤石脂 禹余粮（各一斤）
以上两味药，用水六升，煮取二升，去渣滓，分三次温服。
腹泻在下焦，是水气为患。只有土能制水。石，是土的刚硬部分。石脂、禹粮，都是土的精气凝结而成。石脂色赤入丙，助火以生土；余粮色黄入戊，实胃而涩肠。虽然是治疗下焦，实际上是调理中宫的方剂。且这两味药皆味甘，甘味先入脾，能坚固堤防而平抑水气的亢盛，所以功效胜过甘草、白术。
伤寒发汗，或者催吐或者攻下，病解后，心下痞塞胀硬、嗳气不止的，用旋复代赭石汤主治。
伤寒，是寒邪伤心。既发汗又催吐攻下，心气太虚，表寒乘虚而结于心下。心气不能下降而上出于声，这是君主外亡的现象。噫是伤痛的声音。不说声音而说气，是因为气随着声音显露于外。
旋复代赭石汤方：
旋复花 甘草（各三两） 人参（二两） 半夏（半升） 代赭石（一两） 生姜（五两） 大枣（十二枚）
以上七味药，用水一斗，煮取六升，去渣滓，再煮取三升，每次温服一升，每日服用三次。
这是生姜泻心汤去掉黄芩、黄连、干姜，加入旋复花、代赭石的方子。因为心虚不可再泻心，所以制定此剂。心主夏，旋复花生于夏末，咸味能补心，能软化坚硬，能消散结气。半夏生于夏初，辛味能散邪，能消痞，能行结气。代赭石禀受南方之火色，入通于心，散痞硬而镇虚热。人参、甘草、大枣的甘味，辅助旋复花以泻虚火；生姜的辛味，辅助半夏以散水结。这样痞塞胀硬消除，嗳气自然停止。如果使用黄芩、黄连来泻心，能保护微弱的阳气不灭吗？
After the exterior syndrome of a cold damage disease is resolved by sweating, the stomach is disharmonious, presenting with epigastric fullness and hardness, dry retching with a smell of food decay, fluid retention under the costal region, borborygmus in the abdomen, and diarrhea. Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium) is the primary treatment.
The resolution of the pathogen through sweating indicates that the Taiyang (Greater Yang) syndrome has ceased. The disharmony in the stomach is due to the residual pathogens of Taiyang mixing with yin-cold fluid retention within it. The yang pathogen resides at the upper opening of the stomach, causing epigastric fullness and hardness, dry retching, and the smell of food decay; the water pathogen resides at the lower opening of the stomach, causing borborygmus like thunder and diarrhea. When the fire function fails to circulate freely, fullness and hardness result; when the water function fails to circulate freely, dry retching occurs; when the pathogenic heat fails to digest food, the smell of food decay arises. "Under the costal region" refers to the abdomen. Spleen deficiency fails to control water, leading to intestinal rumbling. This indicates that the Taiyang cold-water pathogen invading the exterior of the body has been resolved, but the pathogen entering the interior has not yet dispersed. Thus, although the disease is located in the stomach, it does not belong to Yangming (Yang Brightness), but remains a variation of the Taiyang cold-water pathogen.
Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium):
Shengjiang (Fresh Ginger Rhizome, 4 liang), Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), Gancao (Licorice Radix et Rhizoma) (each 3 liang), Banxia (Pinelliae Tuber), Ganjiang (Zingiberis Rhizoma), Huanglian (Coptidis Rhizoma) (each 1 liang), Dazao (Jujubae Fructus) (12 pieces).
Take the above eight ingredients, add one dou of water, decoct to obtain six sheng of liquid, remove the dregs, and decoct again to concentrate to two sheng. Take one sheng warm, three times daily.
Note: Epigastric fullness (Xin Xia Pi) is an interior syndrome of Taiyang. At the upper level of Taiyang, cold qi governs. It corresponds internally to Shaoyin (Lesser Yin), which relates to the Heart. The Heart is the Sun-Yang within the Yang. It must be that the patient normally has insufficient heart-fire and a cold-deficient stomach, allowing the Taiyang cold-water pathogen to invade internally. Deficient yang becomes stagnant and fails to disperse, while cold pathogen coagulates and fails to resolve. Cold and heat contend at the epigastrium, causing myriad variations, endangering the "Sovereign" (Heart). Using hot drugs to attack cold risks uncontrolled burning; using cold drugs to overcome heat risks inviting invaders and harming defense. Therefore, bitter drugs like Ganjiang, Huangqin, and Huanglian enter the heart to resolve fullness; sweet drugs like Renshen and Gancao drain heart-fire and harmonize the stomach. Shengjiang is used as the sovereign drug, and Banxia as the assistant. Doubling the pungent-sweet dispersing drugs and combining them with bitter-cold draining drugs, how could fluid retention remain undispersed? Named "Xiexin" (Draining the Heart), it implies the meaning of "stopping weapons constitutes martial virtue."
In cold damage or wind-strike, if the physician erroneously uses purgation, the patient suffers diarrhea dozens of times a day, with undigested food, borborygmus, epigastric fullness and hardness with distension, dry retching, and vexation preventing rest. Seeing the epigastric fullness, the physician assumes the pathogen is not fully expelled and purges again, making the fullness worse. This is not excess-heat accumulation, but rather emptiness in the stomach with rebellious guest-qi ascending, causing hardness. Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium) is the primary treatment.
The previous clause describes symptoms of water-qi attacking downward after resolution by sweating; this clause describes symptoms of rebellious guest-qi ascending after erroneous purgation. Both involve stomach deficiency, with slight differences. In the previous case, borborygmus and diarrhea indicate the stomach still has half-cold and half-heat, hence described as "disharmonious." In this case, borborygmus with undigested food occurring dozens of times a day clearly shows the fullness is false-fullness, hardness is false-hardness, and distension is false-distension. In the previous case, because water-qi trends downward, there is no vexation or distension. In this case, because deficient pathogen rebels upward, there is vexation and distension. When sweating should have occurred but did not, the person feels vexed; thus, Renshen is removed from the previous formula and Gancao is added. For clear diarrhea with undigested food, exterior attack is contraindicated; thus, Shengjiang is removed and Ganjiang is added. It is not called Lizhong Wan but retains the name Xiexin Tang because the root of the vexation and epigastric fullness/hardness lies in the Heart.
Cold damage and wind-strike originate from Yang channels. Erroneous purgation allows heat to enter, causing diarrhea, so Jie Xiong (Chest Binding) does not form. If there is epigastric fullness/hardness, dry retching, and vexation, this originates from Yin channels. Subsequent erroneous purgation makes the fullness worse.
Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium):
Remove Renshen and Shengjiang from the previous formula, add Gancao (1 liang) and Ganjiang (2 liang). Remainder follows the previous method.
After five to six days of cold damage, vomiting and fever present, indicating Xiao Chaihu Tang (Minor Bupleurum Decoction) syndrome. If other drugs are used to purge, and the epigastrium becomes full, hard, and painful, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang (Major Descending the Chest Decoction).
If it is only full without pain, this is Pi (Fullness/Blockage); Xiao Chaihu Tang is not indicated; Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) is appropriate.
Vomiting with fever is a Xiao Chaihu Tang syndrome. Even with Yangming symptoms, excessive vomiting precludes purgation. If interior excess exists, Da Chaihu Tang (Major Bupleurum Decoction) is suitable. Using other drugs to purge is erroneous. After erroneous purgation, two syndromes may appear. Shaoyang (Lesser Yang) is the half-exterior, half-interior channel; it does not fully manifest as Yang nor fully as Yin. Thus, variations from erroneous purgation also depend on whether the pathogen leans toward the half-exterior, forming Jie Xiong, or the half-interior, forming epigastric Pi. This clause originates for Banxia Xiexin Tang, distinguishing Jie Xiong from Pi solely by pain, omitting other symptoms.
Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium):
Add Banxia (8 liang) and Ganjiang (2 liang) to the previous formula, remove Shengjiang. Remainder follows the previous method.
Xiexin Tangs are derived from Xiao Chaihu Tang by removing Chaihu and adding Huanglian and Ganjiang. The three formulas treat the Three Yang channels respectively. For Taiyang, Shengjiang Xiexin Tang is used because, without erroneous purgation, epigastric fullness/hardness persists despite sweating resolving the exterior; water-qi remains undispersed, so Shengjiang is used as sovereign to disperse it, adhering to Taiyang's principle of opening. For Yangming, Gancao Xiexin Tang is used because double erroneous purgation leaves the stomach empty and fullness worsens; doubling Gancao strengthens the middle and slows rebellious guest-qi, following the method of treating from the center. For Shaoyang, Banxia Xiexin Tang is used because erroneous purgation causes Pi; the pathogen is neither in the exterior (so Xiao Chaihu Tang is unsuitable) nor fully in the interior (so Huangqin Tang is unsuitable). Costal distress and epigastric fullness are both half-exterior, half-interior syndromes. For costal distress without prior purgation, Xiao Chaihu Tang resolves it. For epigastric fullness without costal distress after erroneous purgation, Chaihu and Shengjiang are removed, and Huanglian and Ganjiang are added to harmonize. This is another method for treating Shaoyang half-exterior, half-interior conditions. Doubling Banxia and removing Shengjiang slightly alters the half-exterior treatment of Chaihu, emphasizing the Shaoyang half-interior aspect. With Jun-Huo bright and Xiang-Huo in position, it is still named Xiexin to assist where Chaihu falls short.
After vomiting, purgation, and subsequent sweating in cold damage, deficiency-vexation appears with a very faint pulse. By the eighth or ninth day, epigastric fullness/hardness, hypochondriac pain, qi rushing to the throat, vertigo, and twitching of meridians occur; prolonged, this leads to Wei Syndrome (flaccidity).
Given vomiting, purgation, and sweating over eight to nine days with a very faint pulse, this is identified as deficiency-vexation. Consequently, epigastric fullness/hardness, hypochondriac pain, and meridian twitching all belong to deficiency; qi rushing to the throat and vertigo are also manifestations of deficiency-vexation. This is also a Banxia Xiexin Tang syndrome; improper treatment leads to Wei Syndrome over time. Using Zhuye Shigao Tang (Leafy Bamboo Sheath and Gypsum Decoction) would be a major error.
In Taiyang disease, if sweating is performed but fever and aversion to cold persist, followed by purgation, epigastric Pi results. Exterior and interior are both deficient, and yin and yang qi are exhausted. "No Yang means Yin stands alone." If moxa-burning needles are then applied, chest vexation ensues. A greenish-yellow complexion and dry skin indicate a difficult-to-treat case. A slightly yellow complexion and warm hands and feet indicate easy recovery.
This is also a Banxia Xiexin Tang syndrome. The previous case involved deficiency-vexation from sweating after vomiting/purgation. This case involves deficiency-vexation from moxa-burning after sweating/purgation. Excessive sweating damages blood, causing meridian twitching; moxa-burning damages flesh, causing green face and dry skin. Slightly yellow complexion and warm extremities indicate returning Stomach-Yang, hence recovery.
In cold damage with inherent cold-diarrhea, if the physician erroneously uses vomiting and purgation, cold obstruction (Ge) occurs. If food is vomited immediately upon entry, Ganjiang Lianhua Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction) is the primary treatment.
A minor treatment error leads to mild variations, so the formula uses half the intent of Xiexin Tang. Upper Jiao cold obstruction requires Renshen and Ganjiang; heat accumulation in the epigastrium requires Huangqin and Huanglian; vomiters dislike sweet flavors, so Gancao is removed. No eating means no vomiting, indicating no water-qi in the epigastrium, so Shengjiang and Banxia are omitted. Note: Cold and heat obstructing each other forms Ge (Obstruction); cold and heat knotting together forms Pi (Fullness).
Ganjiang Lianhua Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction):
Ganjiang, Huanglian, Huangqin, Renshen (each 2 liang).
Take the above four ingredients, add six sheng of water, decoct to obtain two sheng, divide into two warm doses.
For epigastric Pi, soft upon pressure, with hard stool, no aversion to cold but aversion to heat, and a floating pulse at the Guan position, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction for Draining the Epigastrium) is the primary treatment.
Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction for Draining the Epigastrium):
Dahuang (Rhei Radix et Rhizoma, 2 liang), Huanglian (1 liang).
Take the above two ingredients, steep in one sheng of boiling water (Mafei Tang) for a moment, strain, and divide into two warm doses.
"Ru" (soft) should be read as "Ying" (hard). Below "soft upon pressure," the phrases "hard stool, no aversion to cold but aversion to heat" should exist, justifying this formula. Observing that Xiexin Tangs for Pi combine tonification and purgation, and cold and heat, this formula removes all warming/tonifying drugs, relying solely on bitter-cold draining agents. Steeping in boiling water and using raw herbs facilitates rapid purgation. However, failing to mention symptoms of heat-excess requiring purgation is erroneous. Softness upon pressure indicates Qi-Pi (formless blockage), which should not be purged. Moreover, if Jie Xiong with a floating-large pulse cannot be purged, how can Pi with a floating Guan pulse be purged? Even Jie Xiong Xiao (Minor Chest Binding) with tenderness does not use Dahuang; why is this formula more severe than Xianxiong Tang? There must be urgent purgation indications more severe than Jie Xiong, hence this harsh purgative formula. Students using ancient formulas for modern diseases who apply this based on these pulse/symptoms will die instantly. Do not revere fragmented texts as sacred scriptures and distort their meanings, bringing disaster to posterity.
For epigastric Pi, hard stool, vexation with insomnia, accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium) is the primary treatment.
Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium):
Dahuang (2 liang), Huanglian, Huangqin (each 1 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, decocted separately for juice).
Take the above three ingredients, steep in two sheng of boiling water for a moment, strain, mix with the Fuzi juice, and divide into two warm doses.
Below "epigastric Pi," the phrases "hard stool, vexation with insomnia" should exist, justifying this formula. Aversion to cold with epigastric Pi indicates unresolved exterior; exterior should be resolved first, preferably with Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). Using Dahuang is erroneous. Why add Fuzi and then use Huangqin/Huanglian? If sweating indicates Stomach-excess, Fuzi is contraindicated. If sweating indicates collapse of Yang, Huangqin/Huanglian are contraindicated. Scholar Xu said, "Learn the intent of Zhang Zhongjing, not his formulas." This likely refers to this situation.
After taking herbal medicine for cold damage, diarrhea persists, with epigastric fullness/hardness. After taking Xiexin Tang, further purgation with other drugs fails to stop diarrhea. The physician administers Lizhong Wan (Regulate the Middle Pill), worsening the diarrhea. Lizhong Wan regulates the Middle Jiao. This diarrhea is in the Lower Jiao; Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction) is the primary treatment. If diarrhea persists, promote urination.
Diarrhea persisting after herbal medicine indicates disease in the Stomach. Further purgation failing to stop diarrhea indicates disease in the Large Intestine. Lizhong Wan is not bad, but it acts too slowly. Chishizhi and Yuyuliang aid Metal Qi, astringing to secure leakage. As Geng-Metal Qi contracts, Wu-Earth dampness transforms. If diarrhea persists, it is because the Kidney governs the Lower Jiao and acts as the gate of the Stomach. If the gate fails to close, promoting urination helps dissipate dampness. Since the anal passage is blocked, the urinary pathway should be open to provide an exit. These are two methods for treating the Lower Jiao.
Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction):
Chishizhi (Halloysitum Rubrum), Yuyuliang (Hematitum) (each 1 jin).
Take the above two ingredients, add six sheng of water, decoct to obtain two sheng, strain, and divide into three warm doses.
Diarrhea in the Lower Jiao is caused by water-qi. Only Earth controls Water. Stone is the rigid part of Earth. Chishizhi and Yuyuliang are結 (condensed) essences of Earth. Chishizhi is red, enters Bing (Fire), aids Fire to generate Earth; Yuyuliang is yellow, enters Wu (Earth), strengthens the Stomach and astringes the Intestines. Although treating the Lower Jiao, it is actually a formula for the Central Palace. Both are sweet; sweet enters the Spleen first, strengthening the dike to calm excessive water-qi, thus surpassing Gancao and Baizhu in efficacy.
After sweating, vomiting, or purgation in cold damage, once resolved, if epigastric fullness/hardness and persistent belching (Yi Qi) remain, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is the primary treatment.
Cold damage harms the Heart. After sweating and subsequent vomiting/purgation, Heart-Qi is severely deficient. Exterior cold invades the deficiency and knots in the epigastrium. Heart-Qi fails to descend and rises outward as sound, resembling the "flight of the Sovereign." Belching is a sound of pain. Speaking of "Qi" rather than "Sound" indicates Qi manifesting externally with the sound.
Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction):
Xuanfuhua (Inulae Flos), Gancao (each 3 liang), Renshen (2 liang), Banxia (0.5 sheng), Daizheshi (Hematitum, 1 liang), Shengjiang (5 liang), Dazao (12 pieces).
Take the above seven ingredients, add one dou of water, decoct to six sheng, strain, decoct again to three sheng. Take one sheng warm, three times daily.
This is Shengjiang Xiexin Tang minus Huangqin, Huanglian, and Ganjiang, plus Xuanfuhua and Daizheshi. Because the Heart is deficient and cannot be drained further, this formula is created. The Heart governs Summer; Xuanfuhua blooms in late summer. Salty flavor tonifies the Heart, softens hardness, and dissipates knotting Qi. Banxia blooms in early summer; pungent flavor disperses pathogen, resolves Pi, and moves knotting Qi. Daizheshi inherits Southern Fire color, connects to the Heart, dissipates Pi/hardness, and calms deficiency-heat. Sweetness of Renshen, Gancao, and Dazao assists Xuanfuhua to drain deficiency-fire; pungency of Shengjiang assists Banxia to disperse water-knotting. Thus, Pi/hardness resolves, and belching ceases. Using Huangqin/Huanglian to drain the Heart, how could minute Yang be preserved?