诸陷胸汤、丸及白散之外，又有泻心汤数方，虽曰泻心实亦治
胸中之病，盖陷胸诸方所治者，胸中有形之痰水为病，诸泻心汤所治之病，胸中无形之气化为病也。
《伤寒论》原文∶心下痞，按之濡，其脉关上浮者，大黄黄连泻心汤主之。
【大黄黄连泻心汤方】大黄二两，黄连一两。
上二味，以麻沸汤二升渍之，须臾绞去渣，分温再服。
人之上焦如雾。上焦者膈上也，所谓如雾者，心阳能蒸腾上焦之湿气作云雾而化水，缘三焦脂膜以下达
于膀胱也。乃今因外感之邪气深陷胸中，与心火蒸腾之气抟结于心下而作痞，故用黄连以泻心火，用大黄以
除内陷之外邪，则心下之痞者开，自能还其上焦如雾之常矣。至于大黄、黄连不用汤煮，而俱以麻沸汤渍之
者，是但取其清轻之气以治上，不欲取其重浊之汁以攻下也。
（附∶自拟变通方）
心下痞病，有宜并凉、热之药为一方，而后能治愈者，《伤寒论》附子泻心汤所主之病是也。试再详论之。
《伤寒论》原文∶心下痞，而复恶寒汗出者，附子泻心汤主之。
【附子泻心汤方】大黄二两，黄连、黄芩各一两，附子一枚炮去皮破（别煮取汁）。
上四味，切前三味以麻沸汤二升渍之，须臾绞去滓，纳附子汁，分温再服。
附子泻心汤所主之病，其心下之痞与大黄黄连泻心汤所主之病同，因其复恶寒，且汗出，知其外卫之阳
不能固摄，且知其阳分虚弱不能抗御外寒也。夫太阳之根底在于下焦水府，故于前方中加附子以补助水府之元
阳，且以大黄、黄连治上，但渍以麻沸汤，取其清轻之气易于上行也。以附子治下，则煎取浓汤，欲其
重浊之汁易于下降也。是以如此寒热殊异之药，浑和为剂，而服下热不妨寒，寒不妨热，分途施治，同时
奏功，此不但用药之妙具其精心，即制方之妙亦几令人不可思议也。
附子泻心汤之方虽妙，然为其大寒大热并用，医者恒不敢轻试。而愚对于此方原有变通之法，似较平易易
用。其方无他，即用黄 以代附子也。盖太阳之府原有二，一在膀胱、一在胸中，而胸中所积之大气，实与太
阳外表之卫气有息息密切之关系。气原属阳，胸中大气一虚，不但外卫之气虚不能固摄，其外卫之阳，亦遂
因之衰微而不能御寒，是以汗出而且恶寒也。用黄 以补助其胸中大气，则外卫之气固，而汗可不出，即外
卫之阳亦因之壮旺而不畏寒矣。盖用附子者，所以补助太阳下焦之府；用黄
者所以补助太阳上焦之府，二府之气化原互相流通也。爰审定
其方于下，以备采用。
大黄三钱、黄连二钱、生箭 三钱。
前二味，用麻沸汤渍取清汤多半盅，后一味，煮取浓汤少半盅，浑和作一次温服。
或问∶凡人脏腑有瘀，恒忌服补药，因补之则所瘀者益锢闭也，今此证既心下瘀而作痞，何以复用
黄以易附子乎？答曰∶凡用药开瘀，将药服下必其脏腑之气化能营运其破药之力始能奏效，若但知重用破
药以破瘀，恒有将其气分破伤而瘀转不开者，是以人之有瘀者，固忌服补气之药，而补气之药若与开破之药同
用，则补气之药转能助开破之药，俾所瘀者速消。
除了陷胸汤、丸及白散之外，还有几首泻心汤。虽然名为“泻心”，实际上也是治疗胸中的疾病。大概陷胸类方剂所治疗的，是胸中有形的痰水为患；而诸泻心汤所治疗的，则是胸中无形的气化失常所致之病。
《伤寒论》原文记载：胃脘部痞塞胀满，按之柔软，脉象关部浮的，用大黄黄连泻心汤主治。
【大黄黄连泻心汤方】大黄二两，黄连一两。
将以上两味药，用滚开的沸水二升浸泡，片刻后绞去药渣，分两次温服。
人的上焦如同雾露弥漫。上焦位于膈肌之上，所谓“如雾”，是指心阳能够蒸腾上焦的湿气，化作云雾进而化为津液，通过三焦的脂膜向下通达至膀胱。如今因为外感邪气深陷胸中，与心火蒸腾之气搏结于胃脘部而形成痞证，所以用黄连来清泻心火，用大黄来祛除内陷的外邪，这样胃脘部的痞塞就能消散，自然能恢复上焦如雾的正常生理状态。至于大黄、黄连不用煎煮，而是都用麻沸汤（滚开水）浸泡的原因，是只取它们清轻的气味来治疗上部病变，不想要取它们沉重浑浊的药汁来攻下肠道。
（附：自拟变通方）
治疗胃脘痞塞的病，有的适合将凉药和热药合为一方的，才能治愈，《伤寒论》中附子泻心汤所主治的病就是这种情况。试再详细论述它。
《伤寒论》原文记载：胃脘部痞塞，并且伴有怕冷、出汗症状的，用附子泻心汤主治。
【附子泻心汤方】大黄二两，黄连、黄芩各一两，附子一枚（炮制，去皮，破开，另煎取汁）。
将以上四味药，切碎前三味，用滚开的沸水二升浸泡，片刻后绞去药渣，加入附子的药汁，分两次温服。
附子泻心汤所主治的病，其胃脘部的痞塞与大黄黄连泻心汤所主治的病相同，但因为患者又出现怕冷、出汗的症状，可以推断其体表的卫阳不能固摄，且阳气虚弱不能抵御外寒。太阳经的根本在于下焦的水腑（肾与膀胱），所以在前方中加入附子以补助水腑的元阳，同时用大黄、黄连治疗上部病变，只用麻沸汤浸泡，取其清轻之气易于上行；用附子治疗下部，则煎取浓汤，希望其沉重浑浊的药汁易于下降。因此像这样寒热性质截然不同的药物，混合制成药剂，服用后热药不妨碍寒药，寒药也不妨碍热药，分途施治，同时见效。这不仅是用药的精妙之处，连组方的精妙也几乎令人不可思议。
附子泻心汤的方子虽然精妙，但因其大寒大热并用，医生们往往不敢轻易尝试。而我对此方原本有变通的方法，似乎比较平易易用。这个方子没有别的，就是用黄芪来代替附子。因为太阳的腑原本有两个，一个在膀胱，一个在胸中，而胸中积聚的大气，实在与太阳外表的卫气有着密切的关系。气本属阳，胸中的大气一旦虚弱，不仅体表的卫气虚弱不能固摄，体表的卫阳也随之衰微而不能御寒，所以出现出汗而且怕冷的症状。使用黄芪来补助胸中的大气，那么体表的卫气就会坚固，汗就可以不出，即使体表的卫阳也会因此壮旺而不畏寒了。使用附子，是为了补助太阳下焦的腑；使用黄芪，是为了补助太阳上焦的腑，这两个腑的气化原本是互相流通的。于是审定以下方子，供参考采用。
大黄三钱，黄连二钱，生黄芪三钱。
前两种药，用麻沸汤浸泡取大半盅清汤，后一种药，煮取少半盅浓汤，混合在一起一次温服。
有人问：凡是人体脏腑有瘀滞，通常忌讳服用补药，因为补益会使瘀滞更加闭塞。现在这个证候既然心下有瘀滞而形成痞塞，为什么反而用黄芪来代替附子呢？回答说：凡是用药开破瘀滞，服药之后必须依靠脏腑的气化功能能够营运药物的破瘀之力，才能奏效。如果只知道重用破瘀药来攻破瘀滞，常常会有损伤正气而导致瘀滞反而打不开的情况。所以人有瘀滞的人，固然忌讳单服补气药；但是补气药若与开破药同用，补气药反而能帮助开破药，使瘀滞迅速消除。
In addition to the Xiongxiang Decoctions (Chest-Trap Formulas), Pills, and Baisan (White Powder), there are several Xiexin Decoctions (Heart-Purging Formulas). Although named "Heart-Purging," they actually treat diseases of the chest. Generally speaking, the Xiongxiang formulas treat diseases caused by tangible phlegm-fluids in the chest, whereas the Xiexin formulas treat diseases caused by intangible Qi transformation disorders in the chest.
The original text of *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: "Epigastric fullness and stuffiness, soft upon palpation, with a floating pulse at the Guan position, is primarily treated with Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Purging Decoction)."
[Dahuang Huanglian Xiexin Tang Formula] Rhubarb (Radix et Rhizoma Rhei) two liang, Coptis (Rhizoma Coptidis) one liang.
Take the above two ingredients, soak them in two sheng of boiling water (Mafei Tang), wait for a short while, strain off the dregs, and divide into two doses to be taken warm.
The upper Jiao (Triple Burner) of humans is like mist. The upper Jiao is located above the diaphragm. What is meant by "like mist" is that Heart Yang can vaporize the dampness of the upper Jiao, transforming it into clouds and mist, which then becomes fluids, descending through the fatty membranes of the Triple Jiao to reach the Bladder. However, now due to external pathogenic factors sinking deeply into the chest, they knot together with the Qi steamed by Heart Fire at the epigastrium, causing fullness and stuffiness (Pi syndrome). Therefore, Coptis is used to purge Heart Fire, and Rhubarb is used to eliminate the internally sunk external pathogens. Thus, the epigastric fullness will dissipate, naturally restoring the normal state of the upper Jiao being like mist. As for why Rhubarb and Coptis are not decocted but soaked in Mafei Tang (boiling water), it is solely to extract their clear and light aromatic properties to treat the upper body, without desiring their heavy and turbid juices to attack downward.
(Attached: Self-devised Modified Formula)
For treating epigastric fullness and stuffiness, some cases require combining cooling and warming herbs in one formula to achieve a cure; this is the condition primarily treated by Fuzi Xiexin Tang (Aconite Heart-Purging Decoction) in *Shanghan Lun*. Let us discuss it in further detail.
The original text of *Shanghan Lun* states: "Epigastric fullness and stuffiness, accompanied by aversion to cold and sweating, is primarily treated with Fuzi Xiexin Tang."
[Fuzi Xiexin Tang Formula] Rhubarb two liang, Coptis and Scutellaria (Radix Scutellariae) one liang each, Aconite Root (Radix Aconiti Lateralis Preparata) one piece (processed, skin removed, broken, decocted separately to obtain juice).
Cut the first three ingredients. Soak them in two sheng of boiling water for a short while, strain off the dregs, add the Aconite juice, and divide into two doses to be taken warm.
The condition primarily treated by Fuzi Xiexin Tang involves epigastric fullness identical to that treated by Dahuang Huanglian Xiexin Tang. However, because there is also aversion to cold and sweating, it indicates that the defensive Yang on the exterior cannot consolidate, and the Yang aspect is weak, unable to resist external cold. The root foundation of the Taiyang (Greater Yang) channel lies in the lower Jiao Water Mansion (Kidneys and Bladder). Therefore, Aconite is added to the previous formula to supplement the Primordial Yang of the Water Mansion. Meanwhile, Rhubarb and Coptis treat the upper part, soaked only in Mafei Tang to take advantage of their clear and light Qi ascending easily. Aconite treats the lower part, decocted into a strong soup, intending for its heavy and turbid juice to descend easily. Thus, drugs with such different cold and hot natures are mixed into one preparation. Upon ingestion, the hot nature does not hinder the cold nature, nor does the cold hinder the hot. They act along separate paths but achieve efficacy simultaneously. This demonstrates not only the ingenuity of medication but also the almost inconceivable brilliance of formula formulation.
Although the Fuzi Xiexin Tang formula is brilliant, because it combines major cold and major heat herbs, physicians often dare not try it lightly. I originally had a modified method for this formula, which seems more accessible and easy to use. The formula has no other secret; it simply uses Astragalus (Radix Astragali) to replace Aconite. The Taiyang Fu organs originally include two: one in the Bladder and one in the Chest. The Great Qi accumulated in the chest has an intimate relationship with the Defensive Qi on the exterior of Taiyang. Qi belongs to Yang. When the Great Qi in the chest is deficient, not only is the exterior Defensive Qi deficient and unable to consolidate, but the exterior Defensive Yang also becomes weak and unable to ward off cold, resulting in sweating and aversion to cold. Using Astragalus to supplement the Great Qi in the chest will solidify the exterior Defensive Qi, stopping sweating, and strengthen the exterior Defensive Yang, eliminating aversion to cold. Using Aconite supplements the Taiyang lower Jiao Fu organ; using Astragalus supplements the Taiyang upper Jiao Fu organ. The Qi transformations of these two Fu organs originally circulate mutually. Therefore, I have finalized the following formula for reference.
Rhubarb 3 qian, Coptis 2 qian, Raw Astragalus 3 qian.
Soak the first two ingredients in Mafei Tang to obtain most of a cup of clear decoction. Decoct the third ingredient to obtain a small amount of concentrated decoction. Mix them together and take once warm.
One might ask: Whenever there is blood stasis in the Zang-Fu organs, tonifying medicines are generally contraindicated because tonification may further obstruct the stasis. In this case, since there is stasis in the epigastrium causing fullness, why use Astragalus to replace Aconite? The answer is: When using medicine to resolve stasis, after administration, the Qi transformation of the Zang-Fu organs must be able to transport and utilize the breaking power of the medicine for it to be effective. If one merely relies on heavily using breaking medicines to break stasis, it often happens that the Qi aspect is damaged, and the stasis remains unresolved. Therefore, those with stasis should indeed avoid taking Qi-tonifying medicines alone. However, if Qi-tonifying medicines are used together with breaking/opening medicines, the Qi-tonifying medicines can assist the breaking medicines, enabling the stasis to dissipate rapidly.