（此方自原论中第十卷采附于此）
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。
琥按上方。即半夏泻心汤中。减干姜二两。加生姜四两是也。成无己明理论。于此方无注。已于半夏泻心汤方内
言之。余因采其论附此。以发明上方之义。
成氏明理论云。陷胸者。攻结也。泻心者。攻痞也。气结而不散。壅而不通。为结胸。陷胸汤为直达之剂。塞而不
通。痞而不分。为痞。泻心汤为分解之剂。所以谓之泻心者。谓泻心下之邪也。痞与结胸。有高下焉。结胸者。邪结在
胸中。故治结胸。曰陷胸汤。痞者。邪留在心下。故治痞曰泻心汤。黄连黄芩味苦寒。内经曰。苦先入心。以苦泄之泻
心者。必以苦为主。是以黄连为君。黄芩为臣。以降阳而升阴也。半夏味辛温干姜味辛热。内经曰。辛走气。辛以散之。
散痞者。必以辛为助。故以半夏干姜为佐。以分阴而行阳也。甘草味甘平。人参大枣味甘温。阴阳不交曰痞。上下不通
为满。欲通上下。交阴阳。必和其中。所谓中者。脾胃是也。脾不足者。以甘补之。故用人参甘草大枣为使。以补脾而
和中。中气得和。上下得通。阴阳得位。水升火降。则痞消热已。而大汗解矣。
琥又按仲景用半夏泻心汤治伤寒。五六日呕而发热。乃少阳经有半表半里之邪。误下成痞。故用此汤之苦以泄之。
辛以散之。甘以和之。如上成注云。痞消热已。而汗解者。正此谓也。若生姜泻心汤。乃伤寒汗解之后。胃中不和。心
下痞之药。其品味虽相同。而治证则大异。成氏不另作注诚缺文也。
或问半夏泻心汤证。为少阳经半表半里之邪未解。何以不用生姜。而反用干姜。生姜泻心汤证。为太阳经在表之邪
已解。何以既留干姜而反加生姜。余答云。用干姜者。取其辛热之性能助芩连。挟半夏。从中焦以开痞热。使痞热消。
则表自和。解表之用。即在其中也。加生姜者。取其辛温之性。亦能助芩连。挟半夏。上以和胃。中以开痞。横以散胁
下水气。下以平湿热之利。更能同大枣。合参草。内以补脾。且为胃行其津液也。方氏条辩注云。生姜大枣。益胃而健
脾。黄芩黄连。清上而坚下。半夏干姜。蠲饮以散痞人参甘草。益气。而和中。此即上成注云。中气得和。上下得通。
水升火降。则痞消热已。而噎臭下利等证自平。斯言诚可以补成注之缺略云。
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。但以胃中虚。客气上逆。故使硬也。甘草泻心汤主之。
伤寒中风者。是互言以见二证之皆不可下也。成注云。邪气在表。医反下之。虚其肠胃。则邪气内陷。其人下利。
日十数行。谷不化。腹中雷鸣。肠胃里虚可知。心下痞硬而满。干呕。心烦不安。邪热之气。内陷可知。此条痞证硬满。
乃下后中气受伤。而作虚硬虚满。医人不识。犹以为热邪未尽。复误下之。气愈伤。则痞益甚。此非比结胸之实热。但
以胃中虚。内陷之客气上逆。客邪之气聚。亦能使心下硬也。由是见腹中雷鸣。总是虚气。非若前条之有水气也。呕烦
不安。虽有客热。亦是虚烦。非若前条之干噎食臭也。故与泻心汤。以泄痞热。加甘草。以去虚邪。或问心下痞。且硬
且满。何以知是胃中虚。客邪气逆。余答云。其人下利。日数十行。则胃中之物已尽。何由而不为虚。况医复下之而痞
益甚。愈可知其非实证矣。若犹是实证。则仲景。当日。必曰硬而痛。不曰硬而满矣。止此满字。而虚实之证了然。
（此方从原论第十卷摘录并附于此）
生姜（四两，切片） 甘草（三两，蜜炙） 人参（三两） 干姜（一两） 黄芩（三两） 半夏（半升，洗净） 黄连（一两）
大枣（十二枚，掰开）
以上八味药。用水一斗（约十升）。煮取六升药液。滤去药渣。再次煎煮至三升。每次温服一升。每日服用三次。
琥按：上述方剂，即在半夏泻心汤中减去干姜二两，加入生姜四两而成。成无己在《明理论》中对此方没有注释，已在半夏泻心汤方内论述过。我因此采纳他的论述附于此，以阐明上方之义。
成氏《明理论》说：陷胸汤，是攻逐结聚的。泻心汤，是攻逐痞满的。气机结聚而不散，壅塞而不通，称为结胸。陷胸汤是直达病所的药剂。堵塞而不通，痞塞而不分，称为痞。泻心汤是分解病邪的药剂。之所以称为泻心，是指泻除心下的邪气。痞与结胸，有高下之分。结胸，是邪气结聚在胸中，所以治疗结胸用陷胸汤。痞，是邪气留滞在心下，所以治疗痞用泻心汤。黄连、黄芩味苦性寒，《内经》说：苦味先入心，用苦味来泄降。治疗痞证，必须以苦味为主，所以用黄连为君药，黄芩为臣药，以降阳而升阴。半夏味辛性温，干姜味辛性热，《内经》说：辛味走气，用辛味来发散。消散痞满，必须以辛味为辅助，所以用半夏、干姜为佐药，以分阴而行阳。甘草味甘性平，人参、大枣味甘性温。阴阳不交称为痞，上下不通称为胀满。想要通上下，交阴阳，必须调和其中焦。所谓中焦，就是脾胃。脾不足，用甘味来补益，所以用人参、甘草、大枣为使药，以补脾而和中。中气得调和，上下得以通畅，阴阳各归其位，水升火降，则痞消热退，大汗出而病解。
琥又按：仲景用半夏泻心汤治疗伤寒，症见五六日呕吐且发热，这是少阳经有半表半里的邪气，误用下法导致成痞，所以用此汤的苦味以泄之，辛味以散之，甘味以和之，正如成注所说：痞消热退，汗出而解，正是这个意思。至于生姜泻心汤，是伤寒发汗解之后，胃中不和，心下痞塞的药物。虽然药味相同，但治疗的证候则大不相同。成氏不另作注释，确实是缺漏。
有人问：半夏泻心汤证，是少阳经半表半里之邪未解，为什么不用生姜，反而用干姜？生姜泻心汤证，是太阳经在表之邪已解，为什么既保留干姜反而加生姜？我回答说：用干姜，是取其辛热之性，能协助芩、连，挟带半夏，从中焦打开痞热，使痞热消退，则表自和，解表的作用就在其中了。加生姜，是取其辛温之性，也能协助芩、连，挟带半夏，上以和胃，中以开痞，横以疏散胁下水气，下以平复湿热之利。更能同大枣、合参、草，内以补脾，并且为胃运行津液。方有执《条辩》注解说：生姜、大枣，益胃而健脾；黄芩、黄连，清上而坚下；半夏、干姜，蠲除饮邪以散痞；人参、甘草，益气而和中。这就是上面成注所说的：中气得和，上下得通，水升火降，则痞消热退，而噫腐食臭、下利等证自然平复。这话确实可以补充成注的缺略。
伤寒或中风，医生反而用下法，病人出现下利，每天几十次，完谷不化，腹中雷鸣，心下痞硬且满，干呕，心烦，不得安宁。医生见心下痞，认为病邪未尽，再次用下法，其痞更加严重。这不是结热，只是因为胃中虚，客气上逆，所以使心下硬。甘草泻心汤主之。
伤寒或中风，是互文见义，说明这两种证候都不可用下法。成注说：邪气在表，医生反而用下法，使其肠胃虚弱，则邪气内陷。病人下利，每天十几次，完谷不化，腹中雷鸣，可知肠胃里虚。心下痞硬且满，干呕，心烦不安，可知邪热之气内陷。此条痞证的硬满，是下后中气受伤，造成虚硬、虚满。医生不认识，还以为是热邪未尽，再次误用下法，气更伤，则痞更甚。这不像结胸那样的实热，只是因为胃中虚，内陷的客气上逆，客邪之气聚集，也能使心下硬。由此看来，腹中雷鸣，总是虚气，不像前条那样有水气。呕、烦、不安，虽然有客热，也是虚烦，不像前条那样有干噎食臭。所以给予泻心汤，以泄痞热，加甘草，以去除虚邪。有人问：心下痞，又硬又满，怎么知道是胃中虚，客邪气逆？我回答说：病人下利，每天几十次，则胃中之物已尽，怎么能不虚呢？何况医生再次用下法而痞更甚，更可知其不是实证了。如果还是实证，那么仲景当日一定会说“硬而痛”，不会说“硬而满”了。仅凭一个“满”字，虚实之证就一目了然了。
(This prescription is extracted from Volume 10 of the original treatise and attached here.)
Shengjiang (Raw Ginger, 4 liang, sliced) Gancao (Licorice Root, 3 liang, honey-fried) Renshen (Ginseng Radix et Rhizoma, 3 liang) Ganjiang (Dried Ginger, 1 liang) Huangqin (Scutellariae Radix, 3 liang) Banxia (Pinelliae Rhizoma, half sheng, washed) Huanglian (Coptidis Rhizoma, 1 liang)
Dazao (Jujubae Fructus, 12 pieces, split open)
The above eight herbs. Boil with one dou (approx. 10 sheng) of water. Decoct to obtain 6 sheng of liquid. Strain to remove dregs. Re-decoct to obtain 3 sheng. Take 1 sheng warm each time. Administer three times daily.
Hu notes: The above prescription is derived from Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) by reducing Ganjiang (Dried Ginger) by 2 liang and adding Shengjiang (Raw Ginger) by 4 liang. Cheng Wuji did not provide commentary on this prescription in his *Ming Lilun* (Illustrated Theory), having discussed it within the context of Banxia Xiexin Tang. I therefore adopt his discussion and attach it here to elucidate the meaning of the above prescription.
Cheng's *Ming Lilun* states: Xianxiong Tang (Throat-Sinking Decoction) attacks accumulation (jie). Xiexin Tang (Heart-Draining Decoction) attacks stuffiness (pi). Qi accumulation without dispersion, obstruction without flow, constitutes Jie Xiong (Chest Accumulation). Xianxiong Tang is a direct-acting agent. Obstruction without flow, stuffiness without differentiation, constitutes Pi (Epigastric Stuffiness). Xiexin Tang is a resolving agent. It is called "Xiexin" because it drains pathogenic factors from the epigastrium. Pi and Jie Xiong differ in location. Jie Xiong involves pathogenic factors accumulating in the chest; thus, treatment uses Xianxiong Tang. Pi involves pathogenic factors remaining in the epigastrium; thus, treatment uses Xiexin Tang. Huanglian and Huangqin are bitter and cold. The *Neijing* states: Bitter flavor enters the Heart first; use bitter to drain. To treat Pi, bitter must be primary; hence, Huanglian is the Sovereign herb, and Huangqin is the Minister herb, to descend Yang and ascend Yin. Banxia is acrid and warm; Ganjiang is acrid and hot. The *Neijing* states: Acrid flavor moves Qi; use acrid to disperse. To dissipate Pi, acrid must assist; hence, Banxia and Ganjiang are Assistant herbs, to differentiate Yin and move Yang. Gancao is sweet and neutral; Renshen and Dazao are sweet and warm. When Yin and Yang do not intersect, it is called Pi; when upper and lower do not communicate, it is called fullness. To connect upper and lower, and intersect Yin and Yang, one must harmonize the Middle Jiao. The so-called Middle Jiao refers to the Spleen and Stomach. For Spleen deficiency, tonify with sweet; hence, Renshen, Gancao, and Dazao are Envoy herbs, to tonify the Spleen and harmonize the Middle. When the Middle Qi is harmonized, upper and lower become unobstructed, Yin and Yang return to their proper positions, Water ascends and Fire descends, then Pi dissipates and heat resolves, leading to profuse sweating and disease resolution.
Hu further notes: Zhang Zhongjing used Banxia Xiexin Tang to treat Shaoyang syndrome (Lesser Yang disorder) presenting with vomiting and fever after five or six days, indicating half-exterior, half-interior pathogenic factors in the Shaoyang channel. Misapplication of purgation led to Pi; thus, this decoction uses bitter to drain, acrid to disperse, and sweet to harmonize, as Cheng noted: "Pi dissipates, heat resolves, and sweating leads to resolution." In contrast, Shengjiang Xiexin Tang (Raw Ginger Decoction for Draining the Epigastrium) is used after sweating has resolved Taiyang syndrome (Greater Yang disorder), where disharmony in the Stomach causes epigastric Pi. Although the ingredients are similar, the treated conditions differ significantly. Cheng's failure to provide separate commentary is indeed an omission.
A question arises: In Banxia Xiexin Tang syndrome, where half-exterior, half-interior pathogenic factors of the Shaoyang channel remain unresolved, why is Shengjiang not used, but rather Ganjiang? In Shengjiang Xiexin Tang syndrome, where exterior pathogenic factors of the Taiyang channel have resolved, why is Ganjiang retained while Shengjiang is added? My answer is: Ganjiang is used for its acrid-hot nature to assist Huangqin and Huanglian, along with Banxia, to open Pi-heat from the Middle Jiao. Once Pi-heat dissipates, the exterior harmonizes naturally, and the function of releasing the exterior is inherent. Shengjiang is added for its acrid-warm nature, which also assists Huangqin and Huanglian, along with Banxia, to harmonize the Stomach upwards, open Pi in the middle, disperse fluid retention under the ribs laterally, and calm damp-heat diarrhea downwards. Furthermore, combined with Dazao, Renshen, and Gancao, it tonifies the Spleen internally and facilitates the distribution of fluids by the Stomach. Fang Youzhi's commentary in *Tiaobian* states: Shengjiang and Dazao benefit the Stomach and strengthen the Spleen; Huangqin and Huanglian clear the Upper and firm the Lower; Banxia and Ganjiang eliminate phlegm-fluids to dissipate Pi; Renshen and Gancao boost Qi and harmonize the Middle. This aligns with Cheng's note: "When Middle Qi is harmonized, upper and lower become unobstructed, Water ascends and Fire descends, then Pi dissipates, heat resolves, and symptoms such as belching with food odor and diarrhea naturally subside." This statement indeed supplements the omissions in Cheng's commentary.
In Taiyang or Shaoyang disorders, if the physician mistakenly applies purgation, the patient suffers from diarrhea dozens of times daily, undigested food, borborygmus (rumbling in the abdomen), epigastric hardness and fullness, dry retching, irritability, and restlessness. Seeing epigastric Pi, the physician assumes incomplete elimination of pathogens and applies purgation again, worsening the Pi. This is not accumulated heat, but rather Stomach deficiency causing rebellious guest Qi, resulting in hardness. Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium) is indicated.
"Taiyang or Shaoyang disorders" implies that neither condition should be treated with purgation. Cheng's commentary states: Pathogens are in the exterior; mistaken purgation weakens the intestines and stomach, allowing pathogens to sink inward. Diarrhea dozens of times daily with undigested food and borborygmus indicates interior deficiency of the intestines and stomach. Epigastric hardness, fullness, dry retching, and irritability indicate sinking of pathogenic heat. The hardness and fullness in this Pi syndrome result from injury to Middle Qi due to purgation, creating false hardness and fullness. Unaware physicians mistake this for residual heat and purge again, further injuring Qi and worsening Pi. Unlike the excess heat of Jie Xiong, this is due to Stomach deficiency and rebellious sinking guest Qi. Aggregation of guest pathogens can also cause epigastric hardness. Thus, borborygmus indicates deficient Qi, unlike the fluid retention in previous cases. Irritability and restlessness, though involving guest heat, represent false irritability, unlike the belching with food odor in previous cases. Therefore, Xiexin Tang is given to drain Pi-heat, with added Gancao to dispel deficient pathogens. A question arises: How do we know epigastric Pi with hardness and fullness is due to Stomach deficiency and rebellious guest Qi? My answer is: Diarrhea dozens of times daily empties the Stomach contents, inevitably causing deficiency. Moreover, worsening Pi after repeated purgation confirms it is not excess. If it were excess, Zhang Zhongjing would have described it as "hard and painful," not "hard and full." The single character "full" clearly distinguishes deficiency from excess.