（此方自原论中第十卷采附于此）
甘草（四两） 黄芩（三两） 干姜（三两） 半夏（半升洗） 大枣（十二枚擘） 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。
琥按上汤。即生姜泻心汤内。去生姜人参。倍甘草干姜也。伤寒中风。至一再下之。胃中既虚。脾藏亦受伤矣。
若多用生姜散之。徒耗其中州之元气。骤以人参补之。反助其上逆之客邪。故用炙甘草大枣之甘温。以和中补虚。缓逆
气。黄芩黄连之苦寒。以清中泄热。止呕烦。干姜半夏之辛温。以守中。散痞满。要之痞满散。而硬亦消矣。又合而言
之。凡辛甘温之药。皆助阳也。阳气复。则能下交于阴。苦寒之药。皆助阴也。阴气复。则能上交于阳。阴阳相交。升
降如常。痞乃成泰。复何病之有哉。
内台方议问曰泻心汤中。一加生姜。一加甘草各立其名。何邪。答曰。发汗后。胃虚。外伤阳气。致成痞者。故加
生姜以益阳。太下后。胃虚。内损。阴气。致成痞者。故加甘草以益阴。而缓其中也。愚按上论实本成注之义。
琥又按仲景泻心汤有五。方中皆用黄连。成注云。苦以泻心者。非也。乃泻心下之痞也。海藏老人云。泻心者其实
泻脾。实则泻其子也。所以洁古丹溪皆云。黄连去中焦湿热。夫中焦者。即为中州。足太阴经脾藏主之。仲景云。心下
痞。谓非中焦病邪。所以泻心汤内用黄连。有同大黄共剂者。泻实热之痞。成注云。泻虚热者误也。有同大黄黄芩。复
加附子共剂者。泻寒热交结之痞。内台方议云。泻虚寒者误也。有同黄芩半夏。干生姜大枣人参甘草共剂者。泻湿热不
调。虚实相半之痞也。可见伤寒痞证。与结胸相类而稍轻。皆是实热。无所谓虚寒也。
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。（汤药者。下药也。伤寒误服下药。下利不止。心下
痞硬。此与上条之证略同。服泻心汤已。则心下之痞硬既除。其于中焦脾胃之气。已豁然矣。医复以他药下之。其药直
走大肠。大肠滑而气脱。利复不止。医以理中丸与之者。彼以下药。皆苦寒。大伤脾胃之剂。故用甘温以补之也。利虽
益甚。治不为逆。盖理中者。但理中焦脾胃虚寒。此利在下焦。乃大肠滑脱。圣济经云。滑则气脱。欲其收也。赤石脂
禹余粮汤为涩剂。正所以收之。若服涩剂。复利不止。难经云。下焦者。当膀胱上口。主分别清浊。下利者。水谷不分
也。当利小便以厘清之。则利无余治。而愈可必矣。按此条论云。利其小便。仲景无方。补亡论常器之云。可五苓散。）
（此方从原论第十卷摘录附于此）
甘草（四两） 黄芩（三两） 干姜（三两） 半夏（半升，洗净） 大枣（十二枚，掰开） 黄连（一两）
以上六味药。用水一斗。煮取六升。去渣滓。再次煎煮。取三升。温服一升。每日三次服用。
琥按：上述汤剂，即生姜泻心汤内去掉生姜、人参，加倍使用甘草和干姜而成。伤寒或中风病证，经过一次或多次误用下法后，胃气已经虚弱，脾脏也受到了损伤。
如果多用生姜发散，只会耗损中焦脾胃的元气；骤然用人参补益，反而助长上逆的客邪之气。因此使用炙甘草和大枣的甘温之性，来调和脾胃、补益虚损，缓解上逆之气；黄芩和黄连的苦寒之性，来清泄中焦热邪，止住呕吐和心烦；干姜和半夏的辛温之性，来固守中焦，消散痞满。总之，痞满消散了，硬结也就消除了。综合来看，凡是辛甘温的药物，都是助阳的。阳气恢复，就能下行交于阴；苦寒的药物，都是助阴的。阴气恢复，就能上行交于阳。阴阳相交，升降功能恢复正常，痞塞之证自然转为通泰，还有什么疾病呢？
《内台方议》问道：泻心汤中，一加生姜，一加甘草，各自立名，为什么呢？回答说：发汗后，胃气虚弱，外伤阳气，导致形成痞证的，所以加生姜以益阳；大下之后，胃气虚弱，内损阴气，导致形成痞证的，所以加甘草以益阴，并缓和其中焦之急。愚按：上述论述实际上本源于成无己注解的含义。
琥又按：张仲景的泻心汤有五种，方中都使用了黄连。成无己注解说：“苦以泻心”，这是不对的，其实是泻心下部位的痞满。海藏老人说：所谓“泻心”，其实是在泻脾。根据五行理论，“实则泻其子”（心属火，脾属土，火生土，故脾为心之子）。所以洁古、丹溪都说：黄连能去除中焦湿热。中焦就是中州，由足太阴经脾脏所主。张仲景说“心下痞”，指的并非中焦病邪，所以泻心汤内使用黄连，有的与大黄同用，是泻实热之痞；成注说“泻虚热”是错误的；有的与大黄、黄芩，再加附子同用，是泻寒热错杂之痞；《内台方议》说“泻虚寒”是错误的；有的与黄芩、半夏、干姜、生姜、大枣、人参、甘草同用，是泻湿热不调、虚实夹杂之痞。由此可见，伤寒痞证，与结胸证相似但稍轻，都是实热，无所谓虚寒。
伤寒患者服用汤药后，下利不止，心下痞硬。服用泻心汤后，又用其他药物攻下，导致下利不止。医生用理中汤给予治疗，下利更加严重。理中汤的作用是调理中焦，而此处的下利位于下焦，应用赤石脂禹余粮汤主治。如果仍然下利不止，应当通利小便。（注：汤药指下药。伤寒误服下药，导致下利不止、心下痞硬，这与上一条的证候大致相同。服用泻心汤后，心下的痞硬既已消除，中焦脾胃之气已经通畅。医生再用其他药物攻下，药力直走大肠，大肠滑脱而气机外泄，导致下利再次不止。医生给理中丸，是因为之前的下药多为苦寒之品，大伤脾胃，故用甘温之药补益。虽然下利加重，但这种治法并不违背医理。因为理中汤仅能调理中焦脾胃虚寒，而此处的下利位于下焦，属于大肠滑脱。《圣济经》说：“滑则气脱”，需要用收涩之法。赤石脂禹余粮汤正是收涩之剂，正适合用来收敛固涩。如果服用收涩剂后，下利仍不止，《难经》说：下焦位于膀胱上口，主管分别清浊。下利是因为水谷不分。应当通过利小便来澄清分清，这样下利就没有残余的病邪，痊愈就可以确定了。按：此条经文说“利其小便”，张仲景没有给出具体方剂，《补亡论》常器之说：可用五苓散。）
(This prescription is extracted from Volume 10 of the original treatise and appended here.)
Gancao (Licorice Root, 4 liang) Huangqin (Scutellaria Root, 3 liang) Ganjiang (Dried Ginger, 3 liang) Banxia (Pinellia Tuber, half sheng, washed) Dazao (Jujube Fruit, 12 pieces, split) Huanglian (Coptis Rhizome, 1 liang)
The above six herbs. Boil in ten dou of water. Reduce to six sheng. Remove the dregs. Decoct again. Obtain three sheng. Take one sheng warm. Administer three times daily.
Hu notes: The aforementioned decoction is derived from Shengjiang Xiexin Tang (Ginger Bitter-Heart Decoction) by removing Shengjiang (Fresh Ginger) and Renshen (Ginseng), and doubling the dosage of Gancao (Licorice Root) and Ganjiang (Dried Ginger). In cases of Shanghan (Cold Damage) or Zhongfeng (Wind Strike), after one or multiple erroneous applications of purgative methods, the Stomach Qi has become deficient, and the Spleen Zang organ has also been injured.
If Shengjiang (Fresh Ginger) is used excessively for dispersal, it will merely deplete the Yuan Qi (Original Qi) of the Middle Jiao (Middle Burner). If Renshen (Ginseng) is suddenly used for tonification, it may instead assist the rebellious pathogenic factors moving upward. Therefore, the sweet-warm nature of Zhigancao (Honey-fried Licorice Root) and Dazao (Jujube Fruit) is used to harmonize the Middle Jiao and tonify deficiency, while alleviating rebellious Qi. The bitter-cold nature of Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) is used to clear heat and drain fire from the center, stopping vomiting and irritability. The pungent-warm nature of Ganjiang (Dried Ginger) and Banxia (Pinellia Tuber) is used to secure the Middle Jiao and dissipate fullness and stuffiness. Ultimately, once the fullness and stuffiness are dissipated, the hardness also disappears. Synthesizing these points, all pungent-sweet-warm herbs aid Yang Qi. When Yang Qi recovers, it can descend to interact with Yin. All bitter-cold herbs aid Yin Qi. When Yin Qi recovers, it can ascend to interact with Yang. When Yin and Yang interact, and ascending/descending functions return to normal, the Pi syndrome (Stagnation/Fullness) transforms into Tai (Peace/Harmony). What disease would remain?
Neitai Fangyiwen (Inquiries on Formulas of the Inner Platform) asks: Among Xiexin Tang (Bitter-Heart Decoctions), one adds Shengjiang (Fresh Ginger) and another adds Gancao (Licorice Root), each given a distinct name. Why? The answer states: After sweating, if Stomach deficiency occurs and external injury damages Yang Qi, leading to Pi syndrome (Stagnation/Fullness), Shengjiang (Fresh Ginger) is added to benefit Yang. After severe purging, if Stomach deficiency occurs and internal damage injures Yin Qi, leading to Pi syndrome (Stagnation/Fullness), Gancao (Licorice Root) is added to benefit Yin and缓 (soothe/moderate) the center. This observer notes that the above discussion actually originates from the meaning of Cheng Wuji's commentary.
Hu further notes: Zhang Zhongjing's Xiexin Tang (Bitter-Heart Decoctions) include five types, all using Huanglian (Coptis Rhizome). Cheng Wuji commented: "Bitterness drains the Heart," which is incorrect; it actually drains Pi (Stagnation/Fullness) in the epigastrium. Haizang Laoren (Elder Haizang) stated: What is called "draining the Heart" is actually draining the Spleen. According to the principle of "draining the son when excess exists" (Fire generates Earth, so Spleen is the son of Heart), Jiegu and Danxi both stated that Huanglian (Coptis Rhizome) removes damp-heat from the Middle Jiao (Middle Burner). The Middle Jiao is the Central Plain, governed by the Foot-Taiyin Meridian and the Spleen Zang organ. Zhang Zhongjing stated "Pi at the Xinxia (below the heart/epigastrium)," referring not to a pathogen of the Middle Jiao itself. Thus, Huanglian (Coptis Rhizome) is used in Xiexin Tang (Bitter-Heart Decoctions). In some formulas combined with Dahuang (Rhubarb Root and Rhizome), it drains excess heat-type Pi (Stagnation/Fullness); Cheng's comment that it "drains deficient heat" is wrong. In others combined with Dahuang (Rhubarb Root and Rhizome), Huangqin (Scutellaria Root), and Fuzi (Aconite Lateral Root), it drains Pi (Stagnation/Fullness) caused by intertwined cold and heat; Neitai Fangyi claims it "drains deficient cold" is wrong. In those combined with Huangqin (Scutellaria Root), Banxia (Pinellia Tuber), Ganjiang (Dried Ginger), Shengjiang (Fresh Ginger), Dazao (Jujube Fruit), Renshen (Ginseng), and Gancao (Licorice Root), it drains Pi (Stagnation/Fullness) due to disharmonious damp-heat and mixed deficiency-excess. It can be seen that Shanghan (Cold Damage) Pi syndrome (Stagnation/Fullness) is similar to but slightly milder than JieXiong (Knotted Chest) syndrome. Both involve excess heat, with no such thing as deficient cold.
In Shanghan (Cold Damage), after taking medicinal decoctions, diarrhea persists unceasingly, accompanied by hardness and fullness below the heart. After taking Xiexin Tang (Bitter-Heart Decoction), other purgatives were administered, causing diarrhea to persist unceasingly. The physician administered Lizhong Tang (Regulate the Middle Decoction), yet the diarrhea worsened. Lizhong Tang (Regulate the Middle Decoction) regulates the Middle Jiao (Middle Burner), whereas this diarrhea is located in the Lower Jiao (Lower Burner). Chishizhi Yuyuliang Tang (Red Stone Lipite and Hematite Decoction) should be the primary treatment. If diarrhea still persists unceasingly, one should promote urination. (Note: "Medicinal decoctions" here refer to purgatives. Erroneous use of purgatives in Shanghan (Cold Damage) leads to unceasing diarrhea and epigastric hardness, similar to the syndrome in the previous clause. After taking Xiexin Tang (Bitter-Heart Decoction), the epigastric hardness is resolved, and the Qi of the Middle Jiao (Middle Burner) and Spleen-Stomach becomes clear. The physician then used other purgatives, whose force went directly to the Large Intestine. Due to intestinal slipperiness and Qi collapse, diarrhea recurs. The physician gave Lizhong Wan (Regulate the Middle Pill) because previous purgatives were mostly bitter-cold agents that severely injured the Spleen and Stomach, hence sweet-warm herbs were used to tonify. Although diarrhea worsened, this treatment was not contrary to principles. Since Lizhong Tang (Regulate the Middle Decoction) only regulates deficient-cold of the Middle Jiao (Middle Burner) Spleen-Stomach, and this diarrhea is in the Lower Jiao (Lower Burner) due to Large Intestine slipperiness, Shengji Jing states: "Slipperiness indicates Qi collapse," requiring astringency. Chishizhi Yuyuliang Tang (Red Stone Lipite and Hematite Decoction) is an astringent formula, suitable for consolidation. If diarrhea persists even after taking astringents, Nanjing (Classic of Difficult Issues) states: The Lower Jiao (Lower Burner) is located at the opening of the Bladder and governs the separation of clear and turbid. Diarrhea results from the inability to separate water and grain. One should promote urination to clarify and separate them. Then there will be no residual pathology in the diarrhea, and recovery is assured. Note: This clause mentions "promoting urination," but Zhang Zhongjing did not provide a specific formula. Chang Qizi in Buwang Lun (Supplementing Lost Treatises) suggested: Wuling San (Five-Ingredient Powder with Poria) can be used.)