凉而下用温。上行泻而下行补。泻取轻而补取重。制度之妙。全在神明运用之中。是必阳热结于上。阴寒结于
下。用之乃为的对。若阴气上逆之痞证。不可用也。
本以下之。故心下痞。与泻心汤。痞不解。其人渴而口燥。烦。小便不利者。五苓散主之。一方云。忍之
一日乃愈。（脉经。无烦字。成本。无一方以下九字。而注中释其义。则系于遗脱。）
〔成〕本因下后成痞。当与泻心汤除之。若服之痞不解。其人渴而口燥。烦。小便不利者。为水饮内蓄。
津液不行。非热痞也。与五苓散。发汗散水则愈。一方忍之一日乃愈者。不饮者。外水不入。所停之水得行。
而痞亦愈也。
案口燥烦之烦。诸家不解。特魏氏及金鉴云。渴而口燥心烦。然则烦字。当是一字句。
伤寒汗出解之后。胃中不和。心下痞硬。干噫食臭。胁下有水气。腹中雷鸣下利者。生姜泻心汤主之。（柯
本。噫。作呕。非。玉函。下利。作而利。）
〔方〕解。谓大邪退散也。胃为中土。温润则和。不和者。汗后亡津液。邪乍退散。正未全复。而尚弱也。
痞硬。伏饮搏膈也。噫。饱食息也。食臭。 气也。平人过饱伤食。则噫食臭。病患初瘥。脾胃尚弱。化输未
强。虽无过饱。犹之过饱而然也。水气。亦谓饮也。雷鸣者。脾胃不和。薄动之声也。下利者。水谷不厘清。
所以杂迸而走注也。〔成〕干噫
食臭者。胃虚而不杀谷也。胁下有水气。腹中雷鸣。土弱不能胜水也。〔钱〕伤寒汗出解之后。言表邪俱从汗
出而悉解也。胃中不和以下。皆言里症未除也。
案干噫之干。诸家无注义。程氏解干呕云。干。空也。此原郑玄注礼记。正与此同义。噫有吐出酸苦水者。
今无之。故曰干噫。柯氏改作干呕。大失经旨矣。
生姜泻心汤方
生姜（四两切） 甘草（三两炙） 人参（三两） 干姜（一两） 黄芩（三两） 半夏（半升洗） 黄
连（一两） 大枣（十二枚擘）
上八味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。附子泻心汤。本云。加附子。半
夏泻心汤。甘草泻心汤。同体别名耳。生姜泻心汤。本云理中人参黄芩汤。去桂枝术。加黄连。并泻肝法。（附
子泻心汤以下。玉函。成本。无。）
〔鉴〕名生姜泻心汤者。其义重在散水气之痞也。生姜半夏。散胁下之水气。人参大枣。补中州之虚。干姜
甘草。以温里寒。黄芩黄连。以泻痞热。备乎虚水寒热之治。胃中不和。下利之痞。焉有不愈者乎。
施氏续易简方。生姜泻心汤。治大病新瘥。脾胃尚弱。谷气未复。强食过多。停积不化。心下痞硬。干噫
食臭。胁下有水。腹中雷鸣。下利发热。名曰食复。最宜服之。
伤寒中风。医反下之。其人下利日数十行。谷不化。腹中雷鸣。心中痞硬而满。干呕。心烦不得安。医见
心下痞。谓病不尽。复下之。其痞益甚。此非热结。但以胃中虚。客气上逆。故使硬也。甘草泻心汤主之。（谷
上。外台。有水字。心烦。玉函。脉经。作而烦。不得间。外台。有能字。脉经。千金翼。谓作为。复下。有
重字。使硬。作使之坚。外台并同。玉函。亦有之字。）
〔鉴〕毋论伤寒中风。表未解。总不当下。医反下之。或
成痞。或作利。今其人以误下之故。下利日数十行。水谷不化。腹中雷鸣。是邪乘里虚而利也。心下痞硬而满。
干呕心烦不得安。是邪陷胸虚而上逆也。似此痞利表里兼病。法当用桂枝加人参汤两解之。医惟以心下痞。谓
病不尽复下之。其痞益甚。可见此痞非热结。亦非寒结。乃乘误下中虚。而邪气上逆。阳陷阴凝之痞也。故以
甘草泻心汤。以缓其急。而和其中也。〔志〕挟邪纳入。有乖蒸变。故谷不化。而腹中雷鸣。
案谷不化。喻氏钱氏张氏柯氏。以完谷不化为解。非也。谓胃弱不能转运。故水谷不得化。留滞于腹中。
作响而雷鸣也。
甘草泻心汤方
甘草（四两炙） 黄芩（三两） 干姜（三两○外台。作二两。） 大枣（十二枚擘） 半夏（半升洗○外
台。有去滑二字） 黄连（一两）
上六味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。（【原注】臣亿等谨案上生姜泻
心汤法。本云理中人参黄芩汤。今详泻心以疗痞。痞气因发阴而主。是半夏生姜甘草泻心三方。皆本于理中也。
其方必各有人参。今甘草泻心中无者。脱落之也。又案千金。并外台秘要。治伤寒 食。用此方。皆有人参。
知脱落无疑。○外台云。一方。有人参三两。）
〔鉴〕方以甘草命名者。取和缓之意也。用甘草大枣之甘。补中之虚。缓中之急。半夏之辛。降逆止呕。
芩连之寒。泻阳陷之痞热。干姜之热。散阴凝之痞寒。缓中降逆。泻痞除烦。寒热并用也。
案总病论。本方有人参注云。胃虚故加甘味。医垒元戎。伊芳尹甘草泻心汤。即本方有人参。云伊芳尹汤液。
此汤也七味。今监本。无人参。脱落之也。又案元戎文。医方类聚。引南阳活人书。今所传无求子活人书。无
此文。金匮要略曰。狐
惑之为病。状如伤寒。默默欲眠。目不得闭。卧起不安。蚀于喉为惑。蚀于阴为狐。不欲饮食。恶闻食臭。其
面目乍赤。乍黑乍白。蚀于上部则声喝。甘草泻心汤主之。（即本方。亦用人参三两。）
张氏医通曰。痢不纳食。俗名噤口。如因邪留胃中。胃气伏而不宣。脾气因而滞涩者。香连枳朴橘红茯
苓之属。热毒冲心。头疼心烦。呕而不食。手足温暖者。甘草泻心汤。去大枣。易生姜。此证胃口有热。不可用温药。
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。复不止者。当利其小便。（汤药下。脉经。千金。有而字。
复不止。玉函。脉经。作若不止。复下。成本。有利字。已。千金。作竟。庞氏。末句。改作复利不止。当以
五苓散利小便。）
〔成〕伤寒服汤药下后。利不止。而心下痞硬者。气虚而客气上逆也。与泻心汤攻之则痞也。医复以他
药下之。又虚其里。致利不止也。理中丸。脾胃虚寒。下利者。服之愈。此以下焦虚。故与之其利益甚。圣济
经曰。滑则气脱。欲其收也。如开肠洞泄。便溺遗失。涩剂所以收之。此利由下焦不约。与赤石脂禹余粮汤。
以涩洞泄。下焦主厘清浊。下利者水谷不分也。若服涩剂。而利不止。当利小便。以分其气。〔汪〕利其小便。
仲景无方。补亡论。常器之云。可五苓散。
赤石脂禹余粮汤方
赤石脂（一斤碎） 太一禹余粮（一斤碎○玉函。成本。无太一二字）
上二味。以水六升。煮取二升。去滓。分温三服。（成本。上字。作已上二字。误。脱分温二字。）
〔成〕本草云。涩可去脱。石脂之涩。以收敛之。重可去怯。余粮之重。以镇固之。〔柯〕甘姜参术。
可以补中宫火气
之虚。而不足以固下焦脂膏之脱。此利在下焦。未可以理中之剂收功也。然大肠之不固。仍责在胃。关门之不
紧。仍责在脾。此二味皆土之精气所结。能实胃而涩肠。盖急以治下焦之标者。实以培中宫之本也。要之此证。
是土虚而非火虚。故不宜于姜附。若水不利而湿甚。复利不止者。则又当利其小便矣。凡下焦虚脱者。以二物
为本。参汤调服。最效。
案志聪云。按神农本经。太乙余粮。禹余粮。各为一种。既云太乙禹余粮。此方宜于三味。或相传有误。
此说大误。证类本草。图经云。本草。有太乙余粮。禹余粮。两种。治体犹同。
伤寒吐下后发汗。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。
（脉经。发上。无后字。）
〔成〕伤寒吐下后发汗。则表里之气俱虚。虚烦脉甚微。为正气内虚。邪气独在。至七八日。正气当复。
邪气当罢。而心下痞。胁下痛。气上冲咽喉。眩冒者。正气内虚而不复。邪气留结而不去。经脉动惕者。经络
之气虚极。久则热气还经。必成痿弱。〔锡〕痿者。肢体委废。而不为我用也。久而成痿者。经血不外行于四
末也。〔钱〕如此阴盛阳虚之证。虽或侥幸而不至危殆。若经久不愈。必至阳虚不治。筋弛骨痿。而成废疾矣。
〔魏〕此条证。仍用茯苓桂枝白术甘草汤。或加附子。倍加桂枝为对也。
案成注热气还经。于义未允。汪氏引作表气虚不能充养于身。似是。金鉴云。八九日心下痞硬。胁下痛。
气上冲咽喉。三句。与上下文义不属。必是错简。注家因此三句。皆蔓衍支离。牵强注释。不知此证。总因汗
出过多。大伤津液而成。当用补气补血。益筋壮骨之药。经年始可愈也。未知
此说果是否。姑存俟考。汪氏引补亡论云。可茯苓甘草白术生姜汤。郭白云云。当作茯苓桂枝白术甘草汤。成
痿者。振痿汤。
伤寒发汗。若吐若下。解后。心下痞硬。噫气不除者。旋复代赭汤主之。（玉函。脉经。发汗。作汗出。
复。作覆。成本。玉函。赭下。有石字。）
〔方〕解。谓大邪已散也。心下痞硬。噫气不除者。正气未复。胃气尚弱。而伏饮为逆也。〔汪〕此噫气。
比前生姜泻心汤之干噫不同。是虽噫而不至食臭。故知其为中气虚也。与旋复代赭石汤。以补虚散痞。下逆气。
旋复代赭汤方
旋复花（三两） 人参（二两） 生姜（五两○成本。有切字） 大枣（十二枚擘） 甘草（三两炙）
半夏（半升洗） 代赭（一两○玉函。成本。代赭石）
上七味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。（成本。上下。有件字。）
〔周〕旋复花。能消痰结。软痞。治噫气。代赭石。止反胃。除五脏血脉中热。建脾。乃痞而噫气者用
之。谁曰不宜。于是佐以生姜之辛。可以开结也。半夏。逐饮也。人参。补正也。甘草大枣。益胃也。予每借
之。以治反胃噎食。气逆不降者。靡不神效。
伤寒类方曰。灵枢口问篇云。寒气客于胃。厥逆从下上散。复出于胃。故为噫。俗名嗳气。皆阴阳不和
于中之故。此乃病已向愈。中有留邪。在于心胃之间。与前诸泻心法。大约相近。本草云。旋复治结气胁下满。
代赭治腹中邪毒瓦斯。如此二物。以治噫气。余则散痞补虚之法也。
吴仪洛方论曰。去滓复煎。亦取共行其事之义。与生姜泻心汤等同义。
活人书曰。有旋复代赭石证。其人或咳逆气虚者。先服四逆汤。胃寒者。先服理中丸。次服旋复代赭汤。
为良。喻氏寓意草曰。治一人膈气。粒食不入。始吐清水。次吐绿水。次吐黑水。次吐臭水。呼吸将绝。一昼
夜。先服理中汤六剂。不令其绝。来早转方。一剂而安。金匮有云。噫气不除者。旋复代赭石汤主之。吾于此
病。分别用之者有二道。一者以黑水为胃底之水。此水且出。则胃中之津。久已不存。不敢用半夏。以燥其胃
也。一者以将绝之气。止存一系。以代赭坠之。恐其立断。必先以理中。分理阴阳。使气易于降下。然后代赭
得以建奇奏 。乃用旋复花一味煎汤。调代赭石末二匙。与之。才入口。即觉其转入丹田矣。但困倦之极。服
补药二十剂。将息二月而愈。
下后。不可更行桂枝汤。若汗出而喘。无大热者。可与麻黄杏子甘草石膏汤。（玉函。作大下以后。杏子。
作杏仁。）
〔成〕前第三卷十六证云。发汗后不可更行桂枝汤。汗出而喘。无大热者。为与此证治法同。汗下虽殊。
既不当损正气则一。邪气所传既同。遂用一法治之。经所谓若发汗若下若吐后者。是矣。〔程〕下在用桂枝后。
是从更字上看出。
案志聪锡驹并云。此节重出。下字疑本汗字。非也。
太阳病。外证未除。而数下之。遂KT 热而利。利下不止。心下痞硬。表里不解者。桂枝人参汤主之。（KT 。成
本。作协。玉函。脉经。千金翼。作挟。）
〔程〕太阳病。外证未除。而数下之。表热不去。而里虚作利。是曰协热。利下不止。心下痞硬者。里气
虚。而土来心下也。表里不解者。阳因痞。而被格于外也。桂枝行阳于外以解表。理中助阳于内以止利。阴阳
两治。总是补正。令邪自却。缘此痞无客气上逆。动膈之阳邪。辄防阳欲入阴。
故不但泻心中芩连不可用。并桂枝中芍药不可用也。协热而利。向来俱作阳邪陷入下焦。果尔。安得用理中耶。
利有寒热二证。但表热不罢者。皆为协热利也。
案此条。方氏诸家。并为热邪陷入证。至汪氏则云。此系邪热未解。乃实热之证。非虚寒也。桂枝人参汤。
大都是叔和撰次时。传写之误。此盖以协热之协。为协议之义。而不知与挟同。皆坐不博考之弊也。程氏辨晰
之。极是矣。锡驹以挟热为解。然而未能免陷入之说。殊可惜也。案此心下痞硬。与金匮胸痹心中痞。与人参
汤之证。略同。
桂枝人参汤方
桂枝（四两别切○别切二字。玉函。成本。作去皮） 甘草（四两炙） 白术（三两） 人参（三两）
干姜（三两）
凉药在下部使用温热药。上部用泻法，下部用补法。泻法取轻清之品，补法取厚重之品。炮制制度的精妙之处，全在于神妙的运用之中。这必须是阳热结聚于上，阴寒结聚于下，使用此法才算是对症。如果是阴气上逆导致的痞证，则不可使用。
本是因为误用下法，所以导致心下痞满。给予泻心汤治疗，但痞满未解。如果患者口渴、口干燥、心烦、小便不利，应用五苓散主治。另一版本说，忍耐一天自然痊愈。（《脉经》中没有“烦”字，《成本》中没有“一方云”以下九个字，但在注释中解释其义，说明是原文脱漏。）
〔成无己〕原本因为下法之后形成痞证，应当用泻心汤来消除它。如果服用后痞满未解，患者出现口渴、口干燥、心烦、小便不利的症状，这是水饮内停蓄积，津液不能运行，不是热痞。给予五苓散，发汗散水即可痊愈。另一版本说忍耐一天自然痊愈的，是指不饮水，外来的水不入体内，所停留的水得以运行，痞满也就痊愈了。
按语：关于“口燥烦”中的“烦”字，各家注解不明，只有魏氏及《医宗金鉴》说是“渴而口燥心烦”。那么，“烦”字应当是一个独立的句子。
伤寒病出汗后表证已解，但胃中不和，心下痞硬，干呕伴有食物腐败的气味，胁下有水气，腹中肠鸣如雷并伴有下利，应用生姜泻心汤主治。（柯琴本，“噫”作“呕”，不对。《玉函经》，“下利”作“而下利”。）
〔方有执〕“解”，指大邪退散。胃属中土，温润则调和。所谓“不和”，是因为发汗后亡失津液，邪气刚刚退散，正气尚未完全恢复，尚且虚弱。痞硬，是伏留的水饮搏结于膈间。噫，是饱食后的叹息声。食臭，是气味。普通人过饱伤食，就会打嗝带有食物腐败味。病人初愈，脾胃尚且虚弱，运化输布功能不强，即使没有过饱，也如同过饱一样。水气，也是指水饮。雷鸣，是脾胃不和，相互激荡的声音。下利，是水谷不能分清别浊，所以混杂奔注而出。〔成无己〕干噫食臭，是胃虚不能腐熟水谷。胁下有水气，腹中雷鸣，是土弱不能胜水。〔钱天来〕“伤寒汗出解之后”，是说表邪全部从汗出而完全解除。“胃中不和”以下，都是说里证未除。
按语：关于“干噫”的“干”字，各家没有注解含义。程氏解释为干呕，说“干”即空。这原本出自郑玄对《礼记》的注解，正与此处意义相同。噫气有吐出酸苦水的，现在没有这种情况，所以叫“干噫”。柯氏改为“干呕”，大大违背了经典原意。
生姜泻心汤方
生姜（四两，切） 甘草（三两，炙） 人参（三两） 干姜（一两） 黄芩（三两） 半夏（半升，洗） 黄连（一两） 大枣（十二枚，掰开）
以上八味药，用水一斗，煮取六升，去渣滓，再煎取三升，温服一升，每日三次。附子泻心汤，原本说是加附子。半夏泻心汤、甘草泻心汤，是同体异名罢了。生姜泻心汤，原本说是理中人参黄芩汤，去掉桂枝、白术，加入黄连，兼有泻肝之法。（附子泻心汤以下的内容，《玉函经》和《成本》中没有。）
〔吴谦〕命名为生姜泻心汤，其意义重在消散水气引起的痞证。生姜、半夏，消散胁下的水气；人参、大枣，补益中州的虚弱；干姜、甘草，以温里寒；黄芩、黄连，以泻痞热。具备了治疗虚、水、寒、热的各方面方法。对于胃中不和、下利的痞证，哪有不好的道理呢？
施氏《续易简方》记载，生姜泻心汤，治疗大病刚痊愈，脾胃尚且虚弱，谷气未恢复，勉强进食过多，停滞积聚不消化，心下痞硬，干噫食臭，胁下有水，腹中雷鸣，下利发热，名叫“食复”，最适合服用此方。
伤寒或中风，医生反而误用下法。患者每天腹泻几十次，完谷不化，腹中肠鸣如雷，心中痞硬且胀满，干呕，心烦不安。医生见心下痞，认为病邪未尽，再次误用下法，痞满更加严重。这不是热结，只是因为胃中虚弱，客气上逆，所以导致痞硬。应用甘草泻心汤主治。（“谷”字之上，《外台秘要》有“水”字。“心烦”，《玉函经》、《脉经》作“而下烦”。“不得安”，《外台秘要》有“能”字。《脉经》、《千金翼方》将“谓”作为“复下”。《成本》、《玉函经》在“使硬”处作“使之坚”，《外台秘要》也相同，《玉函经》也有“之”字。）
〔吴谦〕无论伤寒还是中风，表证未解，总不应该下。医生反而误下，或者形成痞证，或者造成下利。现在这个人因为误下的缘故，每天腹泻几十次，水谷不化，腹中雷鸣，这是邪气乘里虚而下利。心下痞硬且胀满，干呕心烦不安，这是邪气陷入胸中虚处而上逆。像这样痞利表里兼病，治法应当用桂枝加人参汤来两解。医生只看到心下痞，认为病邪未尽而再次误下，痞满更加严重。可见这个痞证不是热结，也不是寒结，而是乘误下导致中焦虚弱，邪气上逆，阳气下陷、阴气凝滞的痞证。所以用甘草泻心汤，来缓和急迫，调和其中焦。〔尤在泾〕夹杂邪气纳入，违背了正常的蒸腾变化，所以水谷不化，腹中雷鸣。
按语：关于“谷不化”，喻嘉言、钱天来、张路玉、柯琴等人解释为完谷不化，是不对的。意思是胃弱不能转运，所以水谷不能消化，留滞在腹中，发出声响如雷鸣。
甘草泻心汤方
甘草（四两，炙） 黄芩（三两） 干姜（三两○《外台秘要》作二两。） 大枣（十二枚，掰开） 半夏（半升，洗○《外台秘要》有“去滑”二字） 黄连（一两）
以上六味药，用水一斗，煮取六升，去渣滓，再煎取三升，温服一升，每日三次。（【原注】臣亿等谨慎考察：上面的生姜泻心汤法，原本说是理中人参黄芩汤。现在详细考察，泻心汤用来治疗痞证，痞气因发阴而起，所以半夏、生姜、甘草这三首泻心汤，都基于理中汤。这些方剂必定各有人参，现在甘草泻心汤中没有，是脱落了。又考察《千金方》和《外台秘要》，治疗伤寒饮食停滞，使用此方，都有人参，知道脱落无疑。○《外台秘要》说：一方，有人参三两。）
〔吴谦〕方剂以甘草命名，取中和缓急之意。用甘草、大枣的甘味，补益中气的虚弱，缓和其中的急迫；半夏的辛味，降逆止呕；黄芩、黄连的寒性，泻阳气下陷的痞热；干姜的热性，消散阴气凝滞的痞寒。缓和其中，降逆止呕，泻痞除烦，寒热并用。
按语：《总病论》中，本方有人参的注解，说：“胃虚故加甘味。”《医垒元戎》伊芳尹甘草泻心汤，就是本方有人参，说伊芳尹汤液，此汤有七味。现在监本没有人参，是脱落了。又考察《元戎》一文，《医方类聚》引用《南阳活人书》，现在流传的无求子《活人书》没有这篇文章。《金匮要略》说：狐惑病，症状像伤寒，沉默想睡，眼睛闭不上，卧起不安。侵蚀咽喉为惑，侵蚀阴部为狐。不想饮食，厌恶闻到食物气味，面目时而红，时而黑，时而白。侵蚀在上部则声音嘶哑，应用甘草泻心汤主治。（即本方，也用人参三两。）
《张氏医通》说：痢疾不能进食，俗名“噤口痢”。如果是因为邪气留在胃中，胃气潜伏而不宣通，脾气因而滞涩的，用香连、枳朴、橘红、茯苓之类。如果是热毒冲心，头疼心烦，呕吐而不进食，手足温暖的，用甘草泻心汤，去掉大枣，换生姜。这个证候胃口有热，不能用温药。
伤寒服用汤药后，下利不止，心下痞硬。服用泻心汤后，又用其他药物误下，下利不止。医生用理中汤治疗，下利更严重。理中汤是调理中焦的，这个下利在下焦，应用赤石脂禹余粮汤主治。如果还不停止，应当通利小便。（“汤药下”之后，《脉经》、《千金方》有“而”字。“复不止”，《玉函经》、《脉经》作“若不止”。“复下”，《成本》有“利”字。“已”，《千金方》作“竟”。庞氏，末句，改作“复利不止，当以五苓散利小便”。）
〔成无己〕伤寒服用汤药下后，下利不止，心下痞硬，是气虚而客气上逆。给予泻心汤攻伐，则痞证仍在。医生又用其他药物误下，又损伤里气，导致下利不止。理中丸，适用于脾胃虚寒的下利，服用会痊愈。这是因为下焦虚，所以给它服用，下利反而更严重。《圣济经》说：滑则气脱，想要收敛它。如肠道洞泄，大小便失禁，涩剂所以用来收敛。这个下利由于下焦不固摄，给予赤石脂禹余粮汤，以涩止洞泄。下焦主管分清别浊，下利是水谷不分。如果服用涩剂，下利仍不止，应当通利小便，以分利其气。〔汪昂〕通利小便，仲景没有给出方子。《补亡论》常器之说：可以用五苓散。
赤石脂禹余粮汤方
赤石脂（一斤，捣碎） 太一禹余粮（一斤，捣碎○《玉函经》、《成本》无“太一”二字）
以上两味药，用水六升，煮取二升，去渣滓，分三次温服。（《成本》，“上”字，作“已上”二字，误。脱漏“分温”二字。）
〔成无己〕《本草》说：涩可去脱。石脂的涩性，用来收敛它。重可去怯。余粮的重性，用来镇固它。〔柯琴〕干姜、人参、白术，可以补益中宫火气的虚弱，但不足以固摄下焦脂膏的脱失。这个下利在下焦，不可以用理中剂的方子收功。但是大肠的不固，仍归责于胃；关门的不紧，仍归责于脾。这两味药都是土的精气凝结而成，能充实胃而涩肠。大概是紧急治疗下焦的标症，实际上是为了培补中宫的本源。总之这个证候，是土虚而不是火虚，所以不适合用姜、附。如果水不利而湿甚，再次下利不止，则又应当通利小便了。凡是下焦虚脱的，以这两味药为本，用参汤调服，效果最好。
按语：志聪说：按《神农本草经》，太乙余粮、禹余粮，各是一种。既然说太乙禹余粮，此方应该有三味药。或者是相传有误。这种说法大错。《证类本草》、《图经本草》说：《本草》有太乙余粮、禹余粮两种，治疗功效大体相同。
伤寒吐下后又发汗，出现虚烦，脉象非常微弱。到了第八九天，心下痞硬，胁下痛，气上冲咽喉，眩晕昏冒，经脉跳动震颤的，时间久了会形成痿证。（《脉经》，“发”字上，无“后”字。）
〔成无己〕伤寒吐下后又发汗，则表里之气都虚弱。虚烦脉甚微，是正气内虚，邪气独存。到了七八天，正气应当恢复，邪气应当罢休，但心下痞，胁下痛，气上冲咽喉，眩晕昏冒，是正气内虚而不能恢复，邪气留结而不离去。经脉跳动震颤，是经络之气极度虚弱，时间久了热气返还经络，必然形成痿弱。〔李中梓〕痿，是肢体委顿废弃，不能为我所用。时间久了形成痿证，是经血不外行于四肢末端。〔钱天来〕像这样阴盛阳虚的证候，虽然或许侥幸不至危殆，但如果经久不愈，必然导致阳虚不治，筋弛骨痿，而成为废疾。〔魏荔彤〕这条证的治法，仍用茯苓桂枝白术甘草汤，或者加附子，倍加桂枝才是对症。
按语：成无己注解说“热气还经”，在义理上不妥当。汪昂引用作“表气虚不能充养于身”，比较合理。吴谦说：第八九天心下痞硬，胁下痛，气上冲咽喉，这三句，与上下文义不连贯，必定是错简。注家因此这三句，都蔓衍支离，牵强注释。不知道这个证候，总因出汗过多，大伤津液而成。应当用补气补血、益筋壮骨的药，经过一年才能痊愈。不知道这个说法是否确实，暂且保存以待考证。汪昂引用《补亡论》说：可用茯苓甘草白术生姜汤。郭白云说：应当作茯苓桂枝白术甘草汤。治痿证者，用振痿汤。
伤寒发汗，或者吐，或者下，病解之后，心下痞硬，噫气不除的，应用旋复代赭汤主治。（《玉函经》、《脉经》，“发汗”作“汗出”。“复”作“覆”。《成本》、《玉函经》，“赭”下，有“石”字。）
〔方有执〕“解”，指大邪已经散去。心下痞硬，噫气不除，是正气未恢复，胃气尚且虚弱，而伏留的水饮上逆。〔汪昂〕这个噫气，与前生姜泻心汤的干噫不同，是虽然打嗝但没有食物腐败味，所以知道是中气虚弱。给予旋复代赭石汤，以补虚散痞，降逆气。
旋复代赭汤方
旋复花（三两） 人参（二两） 生姜（五两○《成本》有“切”字） 大枣（十二枚，掰开） 甘草（三两，炙） 半夏（半升，洗） 代赭（一两○《玉函经》、《成本》作“代赭石”）
以上七味药，用水一斗，煮取六升，去渣滓，再煎取三升，温服一升，每日三次。（《成本》，“上”、“下”之间，有“件”字。）
〔周扬俊〕旋复花，能消痰结，软痞，治噫气。代赭石，止反胃，除五脏血脉中的热，健脾，是痞而噫气的人使用的。谁说不可用？于是佐以生姜的辛味，可以开结。半夏，驱逐水饮。人参，补益正气。甘草、大枣，益胃。我每次借用此方，治疗反胃噎食，气逆不降的，无不神效。
《伤寒类方》说：《灵枢·口问篇》说：寒气客居于胃，厥逆之气从下向上散，又出于胃，所以为噫。俗名嗳气，都是阴阳在中焦不和的缘故。这是病已向愈，中有留邪，在于心胃之间，与前诸泻心法，大约相近。《本草》说：旋复治结气胁下满，代赭治腹中邪毒瓦斯。用这两味药来治噫气，其余则是散痞补虚的方法。
吴仪洛《方论》说：去渣滓再煎，也是取共同行使其功效的意思。与生姜泻心汤等同义。
《活人书》说：有旋复代赭石证。其人如果咳嗽气逆气虚的，先服四逆汤。胃寒的，先服理中丸，然后服旋复代赭汤，为好。
喻嘉言《寓意草》说：治疗一人膈气，粒食不入。开始吐清水，接着吐绿水，接着吐黑水，接着吐臭水，呼吸将绝。一昼夜，先服理中汤六剂，不让其断绝。第二天早上转方，一剂而安。《金匮要略》说：噫气不除者，旋复代赭石汤主之。我对此病，分别使用有两种途径。一是以黑水为胃底之水，此水且出，则胃中之津，久已不存在，不敢用半夏，以燥其胃。二是以将绝之气，只存一线，如果用代赭坠之，恐怕其立即断裂。必须先以理中汤，分理阴阳，使气易于降下，然后代赭石得以建功奏效。于是用旋复花一味煎汤，调代赭石末二匙，给他服用。才入口，就觉其转入丹田了。只是困倦至极，服用补药二十剂，调养两个月而痊愈。
下法之后，不可再用桂枝汤。如果汗出而喘，没有大热的，可以与麻黄杏子甘草石膏汤。（《玉函经》，作“大下以后”。“杏子”作“杏仁”。）
〔成无己〕前第三卷十六证说：发汗后不可再用桂枝汤。汗出而喘，没有大热的，与此证治法相同。汗法和下法虽然不同，既然都不应当损伤正气，是一样的。邪气所传既同，遂用同一法治之。经文所谓“若发汗、若下、若吐后”，就是这个意思。〔程知〕下法用在桂枝汤之后，是从“更”字上看出来的。
按语：志聪、锡驹都说：这一节重复出现。“下”字疑本是“汗”字。不对。
太阳病，外证未除，而多次误用下法，遂致协热而利，下利不止，心下痞硬，表里不解的，应用桂枝人参汤主治。（“KT”，《成本》作“协”，《玉函经》、《脉经》、《千金翼方》作“挟”。）
〔程知〕太阳病，外证未除，而多次误用下法，表热不去，而里虚作利，这叫协热。下利不止，心下痞硬，是里气虚，而土气来心下。表里不解，是阳气因痞而被格拒于外。桂枝行阳于外以解表，理中助阳于内以止利。阴阳两治，总是补正，令邪气自退。因为这个痞证没有客气上逆，动膈的阳邪，经常防止阳气欲入阴。
所以不但泻心汤中的黄芩、黄连不可用，就连桂枝汤中的芍药也不可用。协热而利，向来都作阳邪陷入下焦。果真如此，怎么能用理中汤呢？下利有寒热两证。只要表热不罢的，都为协热利。
按语：这一条，方有执诸家，都认为是热邪陷入证。到汪昂则说：这是邪热未解，乃实热之证，非虚寒也。桂枝人参汤，大多是王叔和编撰时，传写之误。这里是以“协热”的“协”，为协议之义，而不知与“挟”同，都是因为没有广泛考证的弊病。程氏辨析得很清楚，非常正确。锡驹以“挟热”为解，然而未能免除陷入的说法，殊为可惜。按语：此心下痞硬，与《金匮要略》胸痹心中痞，与人参汤的证候，大致相同。
桂枝人参汤方
桂枝（四两，另切○“别切”二字，《玉函经》、《成本》作“去皮”） 甘草（四两，炙） 白术（三两） 人参（三两） 干姜（三两）
Cooling drugs are used in the lower part with warming drugs. The upper part uses purgative methods, while the lower part uses tonifying methods. Purgative methods take light and clear substances, while tonifying methods take heavy and substantial substances. The subtlety of processing systems lies entirely within divine application. This must be when Yang-heat is knotted in the upper part and Yin-cold is knotted in the lower part; only then is this method appropriate. If it is a *pi* syndrome (fullness and obstruction in the epigastrium) caused by counterflow of Yin qi, it cannot be used.
Originally, because of mistaken purgation, *pi* fullness in the epigastrium resulted. Given Xie Xin Tang (Drain the Epigastrium Decoction), but the *pi* fullness did not resolve. If the patient is thirsty, has a dry mouth, feels vexed, and has difficult urination, Wu Ling San (Five-Ingredient Powder with Poria) should govern it. Another version says: endure it for one day and it will heal. (*Mai Jing* lacks the character "vexed"; *Cheng Ben* lacks the nine characters from "another version says" onwards, but the annotation explains its meaning, indicating an omission.)
[Cheng] Originally, *pi* formed after purgation; one should use Xie Xin Tang to eliminate it. If after taking it the *pi* does not resolve, and the patient presents with thirst, dry mouth, vexation, and difficult urination, this is water-fluid retention internally, with body fluids failing to circulate; it is not heat-*pi*. Give Wu Ling San; inducing sweating to scatter water will lead to recovery. The other version saying "endure it for one day and it heals" refers to not drinking water; external water does not enter, the retained water moves, and the *pi* resolves.
Note: Regarding the character "vexation" in "dry mouth and vexation," various commentaries do not explain it. Only Wei and *Yi Zong Jin Jian* state "thirst, dry mouth, and mental vexation." Thus, the character "vexation" should form a separate sentence.
After Taiyang disease sweats out and resolves, the stomach interior is disharmonious, resulting in *pi* hardness in the epigastrium, dry belching with a smell of food, water-fluids under the flanks, thunderous rumbling in the abdomen with diarrhea; Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) governs it. (*Ke Ben*: "belching" is written as "vomiting," which is incorrect. *Yu Han Jing*: "diarrhea" is written as "and diarrhea.")
[Fang] "Resolve" means the major pathogen has dispersed. The Stomach belongs to Central Earth; if warm and moist, it harmonizes. "Disharmonious" means that after sweating, body fluids were lost, the pathogen just dispersed, and Zheng Qi (Upright Qi) has not fully recovered and remains weak. *Pi* hardness is latent fluid clashing at the diaphragm. Belching is sighing after a full meal. Smell of food is odor. When a healthy person overeats and injures food, they belch with a smell of food. When a patient first recovers, the Spleen and Stomach are still weak, and transformation/transportation is not strong; even without overeating, it is like overeating. Water-fluids also refer to fluid retention. Thunderous rumbling is the sound of Spleen and Stomach disharmony agitating each other. Diarrhea is the failure to separate clear from turbid, so water and grain rush out mixed. [Cheng] Dry belching with smell of food indicates Stomach deficiency failing to rot and ripen grains. Water-fluids under the flanks and abdominal rumbling indicate Earth weakness failing to overcome Water. [Qian] "After Taiyang disease sweats out and resolves" means all exterior pathogens exited via sweat and completely resolved. "Stomach interior disharmony" onwards describes unremoved interior syndromes.
Note: Regarding the character "dry" in "dry belching," no home provides an annotated meaning. Cheng interprets it as dry vomiting, stating "dry" means empty. This originates from Zheng Xuan's annotation on *Li Ji*, which matches this meaning exactly. Belching sometimes expels sour/bitter water; currently, there is none, hence "dry belching." Ke changing it to "dry vomiting" greatly deviates from the classic intent.
Sheng Jiang Xie Xin Tang Formula
Sheng Jiang (Fresh Ginger, 4 liang, sliced) Gan Cao (Licorice Root, 3 liang, honey-fried) Ren Shen (Ginseng Root, 3 liang) Gan Jiang (Dried Ginger, 1 liang) Huang Qin (Scutellaria Root, 3 liang) Ban Xia (Pinellia Tuber, half sheng, washed) Huang Lian (Coptis Rhizome, 1 liang) Da Zao (Jujube Fruit, 12 pieces, split)
The above eight ingredients: Use 1 dou of water, decoct to obtain 6 sheng, remove dregs, decoct again to obtain 3 sheng. Warm dose 1 sheng, three times daily. Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) originally stated adds Fu Zi (Aconite Lateral Root). Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) and Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction) are aliases of the same body. Sheng Jiang Xie Xin Tang originally stated is Li Zhong Ren Shen Huang Qin Tang (Regulate Middle Ginseng Scutellaria Decoction), removing Gui Zhi (Cinnamon Twig) and Bai Zhu (Atractylodes Macrocephala Rhizome), adding Huang Lian, combining liver-draining methods. (From Fu Zi Xie Xin Tang downwards, *Yu Han Jing* and *Cheng Ben* lack these.)
[Wu] Named Sheng Jiang Xie Xin Tang because its meaning focuses on scattering water-fluids causing *pi*. Sheng Jiang and Ban Xia scatter water-fluids under the flanks; Ren Shen and Da Zao tonify the deficiency of Central Zhou; Gan Jiang and Gan Cao warm interior cold; Huang Qin and Huang Lian drain *pi*-heat. It prepares treatments for deficiency, water, cold, and heat. For *pi* due to Stomach interior disharmony and diarrhea, how could it not heal?
Shi's *Xu Yi Jian Fang* records: Sheng Jiang Xie Xin Tang treats newly recovered major illness where Spleen/Stomach are still weak, Gu Qi (Grain Qi) not yet restored, forcing excessive eating, stagnation not transforming, *pi* hardness in epigastrium, dry belching with food smell, water under flanks, abdominal rumbling, diarrhea with fever, named "Food Relapse," most suitable to take.
Taiyang Shang Han (Cold Damage) or Zhong Feng (Wind Strike), the doctor mistakenly uses purgation. The patient has diarrhea dozens of times daily, undigested food, abdominal thunderous rumbling, epigastric *pi* hardness and fullness, dry retching, mental vexation unable to rest. The doctor sees epigastric *pi*, thinks disease is not exhausted, purges again, making *pi* worse. This is not heat-knotting, but solely due to Stomach interior deficiency, Guest Qi counterflow upward, thus causing hardness. Gan Cao Xie Xin Tang governs it. ("Grain" above, *Wai Tai Mi Yao* has "water". "Mental vexation", *Yu Han Jing*, *Mai Jing* write "and vexation". "Unable to rest", *Wai Tai Mi Yao* has "can". *Mai Jing*, *Qian Jin Yi Fang* treat "wei" as "fu xia". *Cheng Ben*, *Yu Han Jing* treat "shi ying" as "shi zhi jian", *Wai Tai Mi Yao* agrees, *Yu Han Jing* also has "zhi".)
[Wu] Regardless of Taiyang Shang Han or Zhong Feng, if exterior is unresolved, total prohibition of purgation. Doctor mistakenly purges, either forming *pi* or causing diarrhea. Now this person, due to mistaken purgation, has diarrhea dozens of times daily, water/grain undigested, abdominal rumbling; this is pathogen exploiting interior deficiency to cause diarrhea. Epigastric *pi* hardness/fullness, dry retching, mental vexation unable to rest; this is pathogen sinking into chest deficiency and counterflowing upward. In such *pi* and diarrhea with exterior-interior concurrent disease, method should use Gui Zhi Jia Ren Shen Tang (Cinnamon Twig Plus Ginseng Decoction) to resolve both. Doctor only sees epigastric *pi*, thinks pathogen not exhausted, purges again, *pi* worsens. Visible this *pi* is not heat-knotting, nor cold-knotting, but exploiting mistaken purgation middle-deficiency, pathogen counterflowing upward, Yang sinking, Yin coagulating *pi*. Thus use Gan Cao Xie Xin Tang to缓 (slow/relax) urgency and harmonize middle. [You] Pathogen incorporated violates steaming/transformation, thus grain undigested and abdominal rumbling.
Note: Regarding "grain undigested," Yu, Qian, Zhang, Ke interpret as whole undigested grains, which is incorrect. It means Stomach weakness fails to transport, thus water/grain fail to transform,滞留 (stagnate) in abdomen, making noise like rumbling.
Gan Cao Xie Xin Tang Formula
Gan Cao (Licorice Root, 4 liang, honey-fried) Huang Qin (Scutellaria Root, 3 liang) Gan Jiang (Dried Ginger, 3 liang ○ *Wai Tai Mi Yao* writes 2 liang.) Da Zao (Jujube Fruit, 12 pieces, split) Ban Xia (Pinellia Tuber, half sheng, washed ○ *Wai Tai Mi Yao* has "remove slip" two characters) Huang Lian (Coptis Rhizome, 1 liang)
The above six ingredients: Use 1 dou of water, decoct to obtain 6 sheng, remove dregs, decoct again to obtain 3 sheng. Warm dose 1 sheng, three times daily. ([Original Note] Chen Yi et al. carefully examine: The above Sheng Jiang Xie Xin Tang method originally states Li Zhong Ren Shen Huang Qin Tang. Now detailed examination shows Xie Xin Tang treats *pi*; *pi* qi arises from Fa Yin (releasing Yin), so Ban Xia, Sheng Jiang, Gan Cao three Xie Xin formulas all originate from Li Zhong. These formulas must each have Ren Shen; now Gan Cao Xie Xin Tang lacks it, an omission. Also examine *Qian Jin* and *Wai Tai Mi Yao*, treating Shang Han Shi (Cold Damage Food Stagnation) using this formula, all have Ren Shen, knowing omission is certain. ○ *Wai Tai Mi Yao* says: One formula has Ren Shen 3 liang.)
[Wu] Formula named after Gan Cao, taking the meaning of harmony and slowness. Using Gan Cao and Da Zao sweetness to tonify middle deficiency, slow middle urgency; Ban Xia pungency to descend counterflow and stop vomiting; Qin/Lian coldness to drain Yang-sinking *pi*-heat; Gan Jiang heat to scatter Yin-coagulating *pi*-cold. Slowing middle, descending counterflow, draining *pi*, removing vexation, cold and heat used together.
Note: *Zong Bing Lun*, this formula has Ren Shen annotation saying: "Stomach deficiency thus adds sweet flavor." *Yi Lei Yuan Rong* Yi Fang Yin Gan Cao Xie Xin Tang is this formula with Ren Shen, saying Yi Fang Yin Tang Ye, this soup has seven flavors. Now Supervised Edition lacks Ren Shen, an omission. Also examine *Yuan Rong* text, *Yi Fang Lei Ju* cites *Nanyang Huo Ren Shu*, current transmitted Wu Qiu Zi *Huo Ren Shu* lacks this text. *Jin Gui Yao Lue* says: Huo Huo disease, appearance like Shang Han, silent wanting sleep, eyes cannot close, lying/sitting uneasy. Eroding throat is Huo, eroding yin is Hu. No desire to eat, dislike smelling food odor, face suddenly red, suddenly black, suddenly white. Eroding upper part then voice hoarse, Gan Cao Xie Xin Tang governs it. (Is this formula, also uses Ren Shen 3 liang.)
*Zhang Shi Yi Tong* says: Dysentery not accepting food, vulgar name Jin Kou (Clamped Mouth). If due to pathogen staying in Stomach, Stomach Qi latent not spreading, Spleen Qi thus stagnant, use Xiang Lian, Zhi Po, Ju Hong, Fu Ling category. If Heat Toxin rushes Heart, headache/vexation, vomiting not eating, hands/feet warm, Gan Cao Xie Xin Tang, remove Da Zao, replace with Sheng Jiang. This syndrome Stomach aperture has heat, cannot use warm drugs.
Shang Han taking Tang Yao (Soup Medicine), diarrhea not stopping, epigastric *pi* hardness. After taking Xie Xin Tang, again using other drugs to purge, diarrhea not stopping. Doctor gives Li Zhong, diarrhea increases severely. Li Zhong regulates Middle Jiao; this diarrhea is in Lower Jiao, Chi Shi Zhi Yu Yi Liang Tang (Red Halloysite and Yuchalk Decoction) governs it. If still not stopping, should promote urination. ("Tang Yao xia", *Mai Jing*, *Qian Jin* have "er" character. "Fu bu zhi", *Yu Han Jing*, *Mai Jing* write "ruo bu zhi". "Fu xia", *Cheng Ben* has "li" character. "Yi", *Qian Jin* writes "jing". Pang Shi, last sentence, changes to "fu li bu zhi, dang yi Wu Ling San li xiao bian".)
[Cheng] Shang Han taking Tang Yao purging, diarrhea not stopping, epigastric *pi* hardness, Qi deficiency and Guest Qi counterflow upward. Giving Xie Xin Tang attacking makes *pi* persist. Doctor again using other drugs purging, again empties interior, causing diarrhea not stopping. Li Zhong Wan treats Spleen/Stomach deficiency-cold diarrhea, taking it heals. This is due to Lower Jiao deficiency, thus giving it makes diarrhea worse. *Sheng Ji Jing* says: Slip implies Qi escape, desire to gather it. Like opening intestine hole leakage, urine/feces loss, astringent agents therefore gather it. This diarrhea due to Lower Jiao not restraining, give Chi Shi Zhi Yu Yi Liang Tang to astringent hole leakage. Lower Jiao governs separating clear/turbid, diarrhea is water/grain not dividing. If taking astringent agent and diarrhea not stopping, should promote urination to divide its Qi. [Wang] Promoting urination, Zhong Jing has no formula. *Bu Wang Lun* Chang Qi Zhi says: Can use Wu Ling San.
Chi Shi Zhi Yu Yi Liang Tang Formula
Chi Shi Zhi (Halloysitum Rubrum, 1 jin, crushed) Tai Yi Yu Yi Liang (Yuchalk, 1 jin, crushed ○ *Yu Han Jing*, *Cheng Ben* lack "Tai Yi" two characters)
The above two ingredients: Use 6 sheng of water, decoct to obtain 2 sheng, remove dregs, divide into three warm doses. (*Cheng Ben*, "shang" character, writes "yi shang" two characters, error. Omits "fen wen" two characters.)
[Cheng] *Ben Cao* says: Astringent can remove escape. Shi Zhi astringency gathers it. Heavy can remove fear. Yu Liang heaviness stabilizes it. [Ke] Gan/Jiang/Ren/Shen/Zhu can tonify Central Palace Fire Qi deficiency, but insufficient to solidify Lower Jiao fat/wax escape. This diarrhea is in Lower Jiao, cannot use Li Zhong agent to achieve success. But Large Intestine not solid, still blames Stomach; Gate not tight, still blames Spleen. These two flavors are Earth essence condensation, can fill Stomach and astringent Intestine. Basically urgently treating Lower Jiao branch, actually cultivating Central Palace root. Ultimately this syndrome, is Earth deficiency not Fire deficiency, thus unsuitable for Jiang/Fu. If Water not benefiting and dampness severe, again diarrhea not stopping, then again should promote urination. All Lower Jiao deficiency escape, take these two as root, Ren Tang mixing dose, most effective.
Note: Zhi Cong says: Examine *Shen Nong Ben Jing*, Tai Yi Yu Liang, Yu Yi Liang, each is one type. Since saying Tai Yi Yu Yi Liang, this formula should have three flavors. Or passed down with error. This theory is greatly wrong. *Zheng Lei Ben Cao*, *Tu Jing* say: *Ben Cao* has Tai Yi Yu Liang, Yu Yi Liang, two types, treatment bodies still same.
Shang Han vomit/purge then sweat, Xu Fan (Deficiency Vexation), pulse very faint. Eight/Nine days epigastric *pi* hardness, flank pain, Qi rushing up throat, dizziness/caput vertigo, meridians moving/trembling, long time becomes Wei (Flaccidity). (*Mai Jing*, "fa" above, lacks "hou" character.)
[Cheng] Shang Han vomit/purge then sweat, then Exterior/Interior Qi both deficient. Deficiency vexation pulse very faint, is Zheng Qi internal deficiency, Pathogen alone remaining. To 7/8 days, Zheng Qi should recover, Pathogen should cease, but epigastric *pi*, flank pain, Qi rushing up throat, dizziness, is Zheng Qi internal deficiency not recovering, Pathogen lingering knot not leaving. Meridian moving/trembling, is Meridian Qi extremely deficient, long time Heat Qi returns to meridian, must become Wei Ru (Flaccid Weakness). [Xi] Wei is limb委废 (lying waste) not using me. Long time becoming Wei, is Jing Xue (Meridian Blood) not flowing outward to four extremities. [Qian] Such Yin excess Yang deficiency syndrome, although perhaps lucky not to reach danger, if long time not healing, must reach Yang deficiency not treating, tendon relaxing bone萎 (flaccid), becoming disability. [Wei] This clause syndrome, still use Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria Cinnamon Atractylodes Licorice Decoction), or add Fu Zi, double Gui Zhi is correct.
Note: Cheng annotation "Heat Qi returns to meridian" is not compliant with meaning. Wang cites "Exterior Qi deficiency cannot nourish body," seems correct. Jin Jian says: 8/9 days epigastric *pi* hardness, flank pain, Qi rushing up throat, three sentences, do not belong to context meaning, must be Cuojian (misplaced slips). Commentators because of these three sentences, all蔓yan (spreading) fragmented, forced annotation. Do not know this syndrome, total because sweating too much, greatly injuring Jin Ye (Body Fluids) formed. Should use Bu Qi Bu Xue (Tonify Qi Tonify Blood), Yi Jin Zhuang Gu (Benefit Tendon Strengthen Bone) drugs, Jing Nian (Whole year) can heal. Do not know if this theory is true, temporarily keep waiting for verification. Wang cites *Bu Wang Lun* says: Can use Fu Ling Gan Cao Bai Zhu Sheng Jiang Tang. Guo Bai Yun says: Should make Fu Ling Gui Zhi Bai Zhu Gan Cao Tang. Cheng Wei (Become Flaccid)者, Zhen Wei Tang (Shake Flaccidity Decoction).
Shang Han sweating, if vomit if purge, resolving afterwards, epigastric *pi* hardness, Yi Qi (Belching) not removing, Xuan Fu Dai Zhe Tang (Inula Haematodes and Hematitum Decoction) governs it. (*Yu Han Jing*, *Mai Jing*, "fa han" writes "han chu". "Fu" writes "fu". *Cheng Ben*, *Yu Han Jing*, "zhe" below, has "shi" character.)
[Fang] "Resolving" means major pathogen already scattered. Epigastric *pi* hardness, belching not removing, is Zheng Qi not recovering, Stomach Qi still weak, and latent fluid counterflowing. [Wang] This belching, compared to previous Sheng Jiang Xie Xin Tang dry belching is different, is although belching not reaching food smell, thus know it is Zhong Qi (Middle Qi) deficiency. Give Xuan Fu Dai Zhe Shi Tang, to tonify deficiency scatter *pi*, descend counterflow Qi.
Xuan Fu Dai Zhe Tang Formula
Xuan Fu Hua (Inula Flower, 3 liang) Ren Shen (Ginseng Root, 2 liang) Sheng Jiang (Fresh Ginger, 5 liang ○ *Cheng Ben* has "qie" character) Da Zao (Jujube Fruit, 12 pieces, split) Gan Cao (Licorice Root, 3 liang, honey-fried) Ban Xia (Pinellia Tuber, half sheng, washed) Dai Zhe (Hematitum, 1 liang ○ *Yu Han Jing*, *Cheng Ben* Dai Zhe Shi)
The above seven ingredients: Use 1 dou of water, decoct to obtain 6 sheng, remove dregs, decoct again to obtain 3 sheng. Warm dose 1 sheng, three times daily. (*Cheng Ben*, "shang/xia", has "jian" character.)
[Zhou] Xuan Fu Hua, can dissolve Phlegm Knot, soften *pi*, treat belching. Dai Zhe Shi, stops Fan Wei (Reverse Stomach), removes Five Zang Blood Vessel internal heat, builds Spleen, is *pi* and belching person using it. Who says not suitable? Thus assist with Sheng Jiang pungency, can open knot. Ban Xia, drives fluid. Ren Shen, tonifies Zheng. Gan Cao Da Zao, benefits Stomach. I often borrow it, to treat Fan Wei Ye Shi (Reverse Stomach Choking Food), Qi counterflow not descending, no not miraculous effect.
*Shang Han Lei Fang* says: *Ling Shu Kou Wen Pian* says: Cold Qi lodges in Stomach, Jue Ni (Rebellious Counterflow) from below scatters upward, again exits Stomach, thus for Yi (Belching). Vulgar name Ai Qi (Sighing Qi), all Yin Yang not harmonizing in middle. This is disease towards resolving, middle has leftover pathogen, located between Heart/Stomach, with previous various Xie Xin methods, approximately similar. *Ben Cao* says: Xuan Fu treats Jie Qi (Knotted Qi) flank fullness, Dai Zhe treats Fu Zhong Xie Du Wa Si (Abdominal Evil Toxin Gas). Such two items, to treat belching, remainder is scatter *pi* tonify deficiency method.
Wu Yi Luo *Fang Lun* says: Remove dregs re-decoct, also takes Gong Xing Qi Shi (Together Perform Its Affairs) meaning. With Sheng Jiang Xie Xin Tang same meaning.
*Huo Ren Shu* says: Has Xuan Fu Dai Zhe Shi syndrome. The person if cough/rebellious Qi deficiency, first take Si Ni Tang (Four Reversals Decoction). Stomach cold, first take Li Zhong Wan (Regulate Middle Pill), next take Xuan Fu Dai Zhe Tang, is good. Yu Shi *Yu Yi Cao* says: Treat one person Ge Qi (Diaphragmatic Qi), granular food not entering. First spit clear water, next spit green water, next spit black water, next spit stinky water, breathing about to cut off. One day/night, first take Li Zhong Tang six doses, not let it cut off. Next morning turn prescription, one dose and safe. *Jin Gui* says: Yi Qi bu chu zhe, Xuan Fu Dai Zhe Shi Tang zhu zhi. I on this disease, separately use it has two ways. One is black water as Stomach bottom water, this water coming out, then Stomach interior Jin Ye, long time not exist, dare not use Ban Xia, to dry its Stomach. One is about-to-cut off Qi, only exists one thread, with Dai Zhe dropping it, fear it immediately cuts off. Must first with Li Zhong, divide/harmonize Yin/Yang, make Qi easy to descend downward, then Dai Zhe can build miracle奏 (report). Then use Xuan Fu Hua one item decoct soup, mix Dai Zhe Shi mo (powder) two qian, give it. Just enter mouth, immediately feel it turn into Dan Tian. But extremely tired, take Bu Yao (Tonifying Drugs) twenty doses, rest two months and heal.
Xia Hou (After Purging), cannot more perform Gui Zhi Tang. If sweat out and pant, no great heat, can give Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra Apricot Kernel Licorice Gypsum Decoction). (*Yu Han Jing*, writes "Da Xia Yi Hou" (After Great Purge). "Xing Zi" writes "Xing Ren".)
[Cheng] Previous Volume 3 Clause 16 syndrome says: After sweating cannot more perform Gui Zhi Tang. Sweat out and pant, no great heat, is with this syndrome treatment method same. Sweating/Purging although different, since not damaging Zheng Qi is one. Pathogen transmission although same,遂 (then) use one method treating. Classic says "If sweating If purging If vomiting afterwards", is this. [Cheng] Purging uses after Gui Zhi, is from "geng" (more/again) character seeing out.
Note: Zhi Cong Xi Ju both say: This section repeats. "Xia" character suspects original "Han" character. Not correct.
Taiyang Bing (Sunyang Disease), Wai Zheng (Exterior Syndrome) not removing, and multiple purging,遂 (then) Xie Re (Colluding Heat) and Li (Diarrhea), Li Xia Bu Zhi (Diarrhea Down Not Stopping), Xin Xia Pi Ying (Heart Below *Pi* Hard), Biao Li Bu Jie (Exterior Interior Not Resolved), Gui Zhi Ren Shen Tang (Cinnamon Twig Ginseng Decoction) governs it. ("KT", *Cheng Ben*, writes "Xie", *Yu Han Jing*, *Mai Jing*, *Qian Jin Yi Fang*, writes "Jia".)
[Cheng] Taiyang Bing, exterior syndrome not removing, and multiple purging, Exterior Heat not going, and Interior Deficiency makes Li, is called Xie Re (Colluding Heat). Diarrhea down not stopping, epigastric *pi* hard, is Interior Qi deficient, and Earth comes to Heart Below. Exterior Interior not resolved, is Yang because *pi*, being rejected on Exterior. Gui Zhi walks Yang on Exterior to resolve Exterior, Li Zhong assists Yang on Interior to stop Li. Yin Yang two treat, always tonify Zheng,令 (make) Xie (Evil) self retreat. Because this *pi* no Guest Qi counterflow, moving Diaphragm Yang Xie, often prevent Yang want enter Yin.
Thus not only Xie Xin Zhong Qin/Lian cannot use, even Gui Zhi Zhong Shao Yao cannot use. Xie Re Er Li (Colluding Heat And Diarrhea), always all make Yang Xie sink into Lower Jiao. Indeed so, how can use Li Zhong? Li has Cold/Heat two syndromes. Only Exterior Heat not stopping, all are Xie Re Li.
Note: This clause, Fang Shi various families, all for Re Xie Xian Ru (Heat Evil Sink Enter) syndrome. To Wang Shi then says: This is Xie Re not resolved,乃 (then) Shi Re (Solid Heat) syndrome, not Xu Han (Deficiency Cold). Gui Zhi Ren Shen Tang, mostly Shu He Bian Ci (Editing Order) when, Chuan Xie Zhi Wu (Transmission Writing Error). This covers with Xie Re de Xie, for Xie Yi (Agreement Meaning), and not know with Jia same, all sit not Bo Kao (Extensive Verification) bi (fault). Cheng Shi Bian Xi (Differentiate Analyze) zhi, Ji Shi (Very Correct)矣. Xi Ju with Jia Re (Colluding Heat) wei jie, however未能 (Not Yet Able)免 (Avoid) Xian Ru (Sink Enter) zhi shuo (Theory), Shu Ke Xi (Great Pity) ye. Note: This Xin Xia Pi Ying, with *Jin Gui* Xiong Bi (Chest Bi) Xin Zhong Pi, with Ren Shen Tang zhi Zheng (Syndrome), lve tong (Slightly Same).
Gui Zhi Ren Shen Tang Formula
Gui Zhi (Cinnamon Twig, 4 liang bie qie ○ "Bie Qie" two characters, *Yu Han Jing*, *Cheng Ben*, writes "Qu Pi" (Remove Skin)) Gan Cao (Licorice Root, 4 liang, honey-fried) Bai Zhu (Atractylodes Macrocephala Rhizome, 3 liang) Ren Shen (Ginseng Root, 3 liang) Gan Jiang (Dried Ginger, 3 liang)