（此方自原论中第十卷采附于此）
大黄（二两） 黄连 黄芩（各一两） 附子（一枚泡去皮破别煮取汁）
上四味。切三味。以麻沸汤二升。渍之。须臾。绞去滓。内附子汁。分温再服。
内台方议云。心下痞者。虚热内伏也。又加恶寒汗出者。本为表未解。当用桂枝汤。若脉微弱者加附子。今此有
痞证。故用大黄黄连泻心汤中。加附子去痞以固阳也。
琥按上议。实本成注之意。成注以恶寒汗出。为阳气外虚。故加附子以固阳。要之内伏之热。乃实热。非虚热也。
在表之寒。乃风寒。非真寒也。上汤中加附子者。乃热因热用。从治之法也。
琥又按内台方。附子泻心汤中无黄芩。反云今世本中有黄芩者。乃后人不详其理。而误添之。殊不知附子泻心汤。
本系攻热痞之剂。只因恶寒汗出不得已。而加附子。后人恐其辛热僭上。妙在复添黄芩。使上下之热。得以通彻。则是
附子得黄芩之佐。实相制而和表助里。以成莫大之功。虽起仲景于今日。亦应首肯其加药之精。而议方者反以为非。一
何不思之甚欤。
（重出例）本以下之。故心下痞。（云云至）小便不利者。五苓散主之。（正文与注见前第四卷五苓散方下）
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。（寒伤于表。
表病以汗出而得解者。胃中以汗出而欠和。夫胃为津液之主。汗后。则津液亡故也。胃不和。则脾气困而不运。以故心
下痞硬。痞硬者。湿与热结也。噫饱食息也。食臭。嗳馊酸也。伤寒初解。脾胃尚弱。饮食不化。以故干噎食臭也。胁
下有水气者。中州土虚。不能渗湿散热。以故成水。而旁渗于胁下也。腹中雷鸣者。脾为阴。胃为阳。阴阳不和。因搏
击有声也。夫阴阳不和。则清浊亦不分。湿热下注而为利也。故与泻心汤。以开痞清湿热。兼益脾胃之气。可见痞证。
不皆由误下而成。有汗后津液干。脾胃气虚。阴阳不能升降。而成痞者。医人不可以不察也。）
（此方从原论第十卷摘录附于此）
大黄（二两） 黄连 黄芩（各一两） 附子（一枚，炮制后去皮、破开，另煮取汁液）
以上四味药。将其中三味切碎。用滚开的麻沸汤二升浸泡。片刻之后，绞去药渣。加入附子的汁液。分两次温服。
《内台方议》评论说：心下痞满的症状，是因为虚热内伏所致。如果又加上恶寒、汗出的症状，原本是因为表证未解，应当使用桂枝汤。如果脉象微弱，则加用附子。如今此处有痞证，所以在大黄黄连泻心汤中，加入附子以消除痞满并固护阳气。
琥按：上述评论，实际上是基于成无己注解的意思。成无己认为恶寒汗出，是阳气在外虚弱，所以加附子来固护阳气。然而，内伏的热邪，实际上是实热，并非虚热。在表的寒邪，乃是风寒之邪，并非真寒。在上述汤剂中加入附子，这是“热因热用”的顺从治法。
琥又按：《内台方议》指出，附子泻心汤中没有黄芩，反而说当今版本中有黄芩，是后人不明其理而误添的。殊不知附子泻心汤，原本是攻逐热痞的方剂。只因伴有恶寒汗出，不得已才加入附子。后人担心附子的辛热之性上僭，巧妙地又添加黄芩，使上下的热邪得以通彻清除。这样，附子得到黄芩的佐助，确实相互制约，调和表里，从而成就巨大的功效。即使让张仲景复活于今日，也应当赞同这种加药的精妙，而评论方剂的人反而认为不对，这多么缺乏思考啊。
（重出例）本因误下，导致心下痞。（内容至）小便不利的，用五苓散主治。（正文与注见前第四卷五苓散方下）
伤寒发汗后，表证已解，但胃中不和，心下痞硬，干呕伴有食物腐臭味，胁下有停饮，肠鸣腹泻的，用生姜泻心汤主治。（寒邪伤及体表，表病通过发汗得以解除，但胃中因出汗而失和。胃为津液之主，汗出后，津液耗亡。胃不和，则脾气困顿而不能运化，因此心下痞硬。痞硬，是湿与热互结所致。噫，即饱食后的叹息声。食臭，即嗳气带有酸腐味。伤寒初解，脾胃尚且虚弱，饮食不能消化，因此干呕伴有食物腐臭味。胁下有停饮，是因为中焦脾土虚弱，不能渗湿散热，因此形成水饮，旁渗于胁下。腹中雷鸣，是因为脾属阴，胃属阳，阴阳不和，相互搏击而产生声响。阴阳不和，则清浊不分，湿热下注而导致泄泻。所以给予泻心汤，以开通痞满、清除湿热，兼补益脾胃之气。由此可见，痞证并不都是由误下引起的，也有因汗后津液干燥、脾胃气虚、阴阳不能升降而形成的痞证，医生不可以不仔细考察。）
(This prescription is extracted from Volume 10 of the original treatise and appended here.)
Rhubarb (2 liang) Coptis Rhizome (Huanglian) Scutellaria Root (Huangqin) (each 1 liang) Aconite Lateral Root Preparata (Fuzi) (one piece, processed, skin removed, broken apart, decocted separately to obtain the juice).
The above four herbs. Three of them are cut into pieces. Soak them in two sheng of boiling water (referred to as "Ma Fei Tang" or hemp-boiling water). After a short while, strain off the dregs. Add the juice of the Aconite. Divide into two doses and take warm.
*Neitai Fangyi* comments: The sensation of fullness and obstruction in the epigastrium (Xin Xia Pi) is caused by deficient heat lurking internally. If accompanied by aversion to cold and sweating, it originally indicates that the exterior syndrome has not yet resolved, and Guizhi Tang (Cinnamon Twig Decoction) should be used. If the pulse is faint and weak, Fuzi (Aconite Lateral Root Preparata) should be added. Since there is a Pi syndrome here, Fuzi is added to the Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Decoction for the Epigastrium) to eliminate the fullness and secure the Yang Qi.
Hu notes: The above commentary is actually based on the meaning of Cheng Wuji's annotations. Cheng Wuji considered aversion to cold and sweating as a sign of external deficiency of Yang Qi, hence adding Fuzi to secure the Yang. However, the heat lurking internally is actually excess heat, not deficient heat. The cold at the exterior is wind-cold pathogen, not true cold. Adding Fuzi to the aforementioned decoction is an application of the treatment principle of "treating heat with heat" (Re Yin Re Yong), which is a method of following the disease nature.
Hu further notes: *Neitai Fangyi* states that Fuzi Xiexin Tang (Aconite Decoction for the Epigastrium) does not contain Scutellaria Root (Huangqin), and claims that its presence in current versions is an erroneous addition by later generations who did not understand the rationale. Little do they know that Fuzi Xiexin Tang is originally a formula for attacking heat-induced Pi (fullness/obstruction). Fuzi was added only reluctantly due to the accompanying aversion to cold and sweating. Later generations, fearing that the acrid-hot nature of Fuzi might flare upwards, cleverly added Huangqin to allow the heat in the upper and lower parts to be thoroughly cleared. In this way, Fuzi receives the assistance of Huangqin; they indeed mutually restrain each other, harmonize the interior and exterior, and thereby achieve great efficacy. Even if Zhang Zhongjing were resurrected today, he would likely approve of the precision of this herbal addition, yet commentators on formulas反而 consider it incorrect. How lacking in thought this is!
(Repeated Example) Originally due to inappropriate purgation, leading to epigastric fullness... (content continues)... For cases with difficulty in urination, Wuling San (Five-Ingredient Poria Pill) is the primary treatment. (Main text and annotations see under Wuling San Formula in Volume 4 previously).
After sweating resolves the exterior syndrome in Shanghan (Cold Damage), but the Stomach remains disharmonious, presenting with hard epigastric fullness, dry belching with a smell of fermented food, fluid retention under the flanks, and borborygmus with diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Decoction for the Epigastrium) is the primary treatment. (Cold pathogens injure the exterior. When the exterior syndrome is resolved by sweating, the Stomach becomes disharmonious due to sweat loss. The Stomach is the master of body fluids; after sweating, body fluids are depleted. Disharmonious Stomach leads to Spleen Qi being trapped and unable to transport. Hence, epigastric hard fullness occurs. Hard fullness is the binding of dampness and heat. Belching refers to sighing after eating. Smell of fermented food refers to sour-smelling eructation. After the initial resolution of Cold Damage, the Spleen and Stomach are still weak, and food cannot be digested properly, hence dry belching with fermented food odor. Fluid retention under the flanks occurs because the central Earth (Spleen) is deficient and cannot transform dampness and dissipate heat, leading to fluid formation that infiltrates the flanks. Borborygmus occurs because the Spleen is Yin and the Stomach is Yang; disharmony between Yin and Yang causes friction and sound. Disharmony of Yin and Yang leads to failure in separating clear and turbid, with damp-heat pouring downward causing diarrhea. Therefore, Xiexin Tang is given to open the fullness, clear damp-heat, and simultaneously benefit Spleen and Stomach Qi. This shows that Pi syndrome is not always caused by inappropriate purgation; there are also cases where Pi forms due to dryness of body fluids after sweating, deficiency of Spleen and Stomach Qi, and inability of Yin and Yang to ascend and descend. Physicians must carefully examine these aspects.)