芫花（熬） 甘遂 大戟 大枣（十枚擘）
以上三味。等分。各别捣为散。以水一升半。先煮大枣肥者十枚。取八合。去滓。内药末。强人服一钱匕。羸人服
半钱。温服之。平旦服。若下少。病不除者。明日更服。加半钱得快下。利后。糜粥自养。
成注云。辛以散之。芫花之辛。以散饮。苦以泄之。甘遂大戟之苦。以泄水。水者。肾所主也。甘者。脾之味也。
大枣之甘。益土而胜水。
琥按李东壁云。十枣汤驱逐里邪。使水气自大小便而泄。乃内经所谓洁净府。去陈 法也。芫花大戟甘遂之性。逐
水泄湿。能直达水饮窠囊隐僻之处。但可徐徐用之。取效因捷。不可过剂。泄人真元也。陈无择三因方。以十枣汤药为
末。用枣肉和丸。以治水气喘急浮肿之证。盖善变通者也。语云。伤寒方可用以治杂证者。其以汤改丸之义欤。
琥又按补亡论郭白云云。十枣汤太峻。后人未易用。当以槟榔汤代之。盖见证未的。此等汤。世医宁莫轻投。郭云。
以槟榔汤代之极是。
太阳病。医发汗。遂发热恶寒。因复下之。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。（太阳病发汗。不宜发热恶寒矣。其仍发热恶寒者。此必是中
风证误用
麻黄汤。徒伤太阳之经而虚其表。因复下之。更伤太阴之藏而虚其里。以故心下作痞。虚其里者。阴气竭也。虚其表者。
阳气竭也。是为表里俱虚。阴阳并竭。无阳则阴独者。谓痞证为天气不降。地气不升。气属阳。二气不能交通故曰无阳。
中州之土闭塞。犹之孟冬之月。则纯阴用事。故曰阴独也。医人复加烧针以强助其阳。病者虚不胜火。火气内攻。故致
胸烦也。面色青黄者。脾受克贼之色也。人身肌肤。脾藏主之。肌肤 动而不宁。则太阴之真气欲脱。故难治也。今则
面色微黄。是无克贼之色。手足温者。脾主四肢。温则藏真之气可回。故曰易愈也。按此条论。仲景无方。补亡论郭白
云云。此为难治之证。须临时更详轻重。痞甚。先泻心汤。发热。恶寒甚。则先小柴胡。火逆甚。则先救逆汤。从所重
治之。愚以小柴胡不宜用。发热恶寒甚。乃太阳表证在也。仲景法。宜更用桂枝汤以解肌。又治痞法。即详下二条证中。）
心下痞。按之濡。其脉关上浮者。大黄黄连泻心汤主之。（此申言痞病非阴寒。并言脉以出其治也。脉关上浮者。诸
阳之脉皆浮也。以手按其痞处虽濡。纯是邪热壅聚。故用大黄黄连泻心汤。以导其热而下其邪也。按成注云。虚热者误。
夫中气虽虚。邪热则聚。故仲景以实热治之。若系虚热。则不用大黄黄连矣。）
芫花（经熬制） 甘遂 大戟 大枣（十枚，掰开）
以上三味药。分量相等。分别捣碎成散剂。用水一升半。先煮肥大者十枚大枣。取药液八合。去渣。加入药末。体质强壮的人服用一钱匕。体质虚弱的人服用半钱。温服。清晨空腹时服用。如果泻下量少，病邪未除，第二天再服。增加半钱，以得快下为度。泻下之后。用米粥自行调养。
成无己注解说：辛味能发散，芫花的辛味，用来发散水饮；苦味能泄降，甘遂、大戟的苦味，用来泄下水气。水，由肾所主。甘味，是脾的味道。大枣的甘味，能补益脾气而克制水邪。
琥按李东壁说：十枣汤驱逐里邪，使水气从大小便排出，这是《内经》所说的“洁净府，去陈莝”的方法。芫花、大戟、甘遂的药性，逐水泄湿，能直达水饮积聚的隐蔽之处。但只能慢慢使用，求效迅速。不可过量，否则会损伤人体真元。陈无择《三因方》中，将十枣汤药制成丸剂，用枣肉和丸，用来治疗水气喘急浮肿的病症。这可以说是善于变通。俗话说：伤寒方可用来治杂证，大概就是把汤剂改为丸剂的用意吧。
琥又按《补亡论》郭白云说：十枣汤药力太峻猛，后人不要轻易使用。应当用槟榔汤替代。因为辨证如果不确切，这类汤剂，世间的医生宁可不要轻率投用。郭云：用槟榔汤替代非常正确。
太阳病，医生发汗后，反而出现发热恶寒。接着又用攻下法，导致心下痞塞。表里都虚，阴阳之气都衰竭。没有阳气则阴气独盛。再加上烧针，导致胸中烦闷。面色青黄，肌肤跳动不安的，难治。现在面色微黄，手足温暖的，容易痊愈。（太阳病发汗，不应当出现发热恶寒。如果仍然发热恶寒，这一定是中风证误用了麻黄汤，徒然损伤太阳经而使其表虚。接着又用攻下法，更伤太阴脏而使其里虚。因此心下作痞。里虚，是阴气竭；表虚，是阳气竭。这就是表里俱虚，阴阳并竭。所谓“无阳则阴独”，是说痞证是因为天气不降，地气不升。气属阳，二气不能交通，所以叫无阳。中州的土气闭塞，就像孟冬之月，纯阴当令，所以叫阴独。医生再加烧针来强助其阳，病人虚不胜火，火气内攻，所以导致胸烦。面色青黄，是脾受克贼的颜色。人身肌肤，由脾脏主宰。肌肤跳动而不宁，说明太阴的真气将要脱失，所以难治。现在面色微黄，是没有克贼之色。手足温暖，是因为脾主四肢，温暖说明脏器的真气可以恢复，所以说容易痊愈。按此条论述，张仲景没有给出方子。《补亡论》郭白云说：这是难治的证候，必须临时详细斟酌轻重。痞证严重的，先用泻心汤。发热、恶寒严重的，先用小柴胡汤。火逆严重的，先用救逆汤。从主要方面治疗。我认为小柴胡汤不宜用。发热恶寒严重，说明太阳表证仍在。张仲景的法度，宜再用桂枝汤来解肌。另外治疗痞证的方法，详见下面两条证候中。）
心下痞塞，按压时柔软，脉象关部浮的，用大黄黄连泻心汤主治。（这是进一步说明痞病不是阴寒，并通过脉象指出治疗方法。脉象关部浮，是诸阳脉皆浮的表现。用手按压痞处虽然柔软，但纯粹是邪热壅聚，所以用大黄黄连泻心汤，来引导热邪下行并祛除邪气。按成无己注解说：认为是虚热是错误的。虽然中气虽虚，但邪热聚集，所以张仲景用实热的方法来治疗。如果是虚热，就不会用大黄和黄连了。）
Radix Kansui (Arisaema cum Bile) (processed), Rhizoma Kolchici, Radix Euphorbiae Lathyridis, Fructus Jujubae (10 pieces, split).
The above three herbs. Equal parts. Each separately pounded into powder. With one sheng and half of water, first decoct ten large Fructus Jujubae. Obtain eight ge of liquid. Remove dregs. Add the herbal powder. For strong individuals, administer one qianbi. For frail individuals, administer half a qianbi. Take warm. Administer at dawn on an empty stomach. If the purgation is slight and the pathogen remains, take again the next day. Increase by half a qianbi until rapid purgation occurs. After purgation, nourish oneself with millet porridge.
Cheng Wuji commented: Pungent flavor disperses; the pungency of Radix Kansui disperses fluid retention. Bitter flavor drains; the bitterness of Rhizoma Kolchici and Radix Euphorbiae Lathyridis drains water. Water is governed by the Kidney. Sweet flavor is the taste of the Spleen. The sweetness of Fructus Jujubae tonifies Earth to overcome Water.
Hu notes Li Dongbi said: Shizao Tang (Ten Jujube Decoction) expels interior pathogens, allowing Qi of Water to drain via urination and defecation. This is what the Neijing refers to as "cleansing the bladder and removing old accumulation." The nature of Radix Kansui, Radix Euphorbiae Lathyridis, and Rhizoma Kolchici drives out water and drains dampness, reaching the hidden places where fluid retention accumulates. However, it should be used gradually for swift effect. Do not overdose, as it damages the body's true Yuan Qi. Chen Wuyue's San Yin Fang uses Shizao Tang powdered and formed into pills with jujube paste to treat edema and asthma due to water qi. This shows adaptability. It is said that Shanghan formulas can treat miscellaneous diseases, perhaps implying the change from decoction to pill form.
Hu further notes Guo Baiyun in Bu Wang Lun said: Shizao Tang is too harsh; later generations should not use it easily. Instead, use Binglang Tang (Areca Nut Decoction). Because if the syndrome differentiation is not accurate, physicians should not lightly prescribe such decoctions. Guo stated that substituting with Binglang Tang is very appropriate.
Taiyang disease, after the physician induced sweating, fever and aversion to cold ensued. Then, purgation was applied, resulting in epigastric fullness and obstruction (Pi syndrome). Both exterior and interior are deficient; both Yin and Yang Qi are exhausted. Absence of Yang leads to dominance of Yin. Adding cauterization caused chest irritability. Cyan-yellow complexion and twitching of skin and muscles indicate a difficult-to-treat condition. Now, with a slightly yellow complexion and warm hands and feet, recovery is easy. (Sweating in Taiyang disease should not cause fever and aversion to cold. Persistent fever and aversion to cold suggest Wind-strike syndrome was mistakenly treated with Mahuang Tang, damaging the Taiyang channel and weakening the exterior. Subsequent purgation damaged the Taiyin organ and weakened the interior, causing epigastric Pi. Interior deficiency implies exhaustion of Yin Qi; exterior deficiency implies exhaustion of Yang Qi. This is simultaneous deficiency of exterior and interior, and exhaustion of Yin and Yang. "Absence of Yang leads to dominance of Yin" means Pi syndrome results from failure of Heaven Qi to descend and Earth Qi to ascend. Qi belongs to Yang; inability of these two Qi to communicate is called absence of Yang. Closure of the Central Earth is like the month of Early Winter, where Pure Yin prevails, hence "dominance of Yin." Cauterization attempted to strengthen Yang, but the deficient patient could not withstand fire, leading to internal attack of Fire Qi and chest irritability. Cyan-yellow complexion indicates Spleen being overcontrolled. Skin and muscles are governed by the Spleen. Twitching suggests impending collapse of Taiyin True Qi, hence difficult to treat. A slightly yellow complexion indicates no overcontrol. Warm hands and feet indicate Spleen governs four limbs; warmth suggests return of Zang True Qi, hence easy recovery. Regarding this clause, Zhang Zhongjing provided no formula. Guo Baiyun in Bu Wang Lun states this is a difficult condition requiring careful assessment of severity. Severe Pi: use Xixin Tang first. Severe fever and aversion to cold: use Xiaochaihu Tang first. Severe fire injury: use Jiuni Tang first. Treat based on the primary aspect. I believe Xiaochaihu Tang is inappropriate. Severe fever and aversion to cold indicate Taiyang exterior syndrome persists. According to Zhang Zhongjing's method, Guizhi Tang should be used again to release the muscle layer. Methods for treating Pi are detailed in the following two clauses.)
Epigastric fullness and obstruction, soft upon palpation, with a floating pulse at the Guan position: Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is indicated. (This elaborates that Pi disease is not Cold-Yin, and uses pulse diagnosis to guide treatment. Floating pulse at Guan indicates all Yang pulses are floating. Although soft to touch, the Pi is purely due to accumulation of Pathogenic Heat. Thus, Dahuang Huanglian Xiexin Tang is used to guide heat downward and expel pathogens. Cheng Wuji commented: considering it Deficient Heat is incorrect. Although Middle Qi is deficient, Pathogenic Heat gathers. Therefore, Zhang Zhongjing treats it as Excess Heat. If it were Deficient Heat, Dahuang and Huanglian would not be used.)