厚朴八两 大黄四两 枳实五枚
右三味，以水一斗二升，先煮二味，取五升，内大黄，煮取三升，温服一升，以利为
度。
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其脉数而紧，乃弦，状如弓弦，按之不移。脉弦数者，当下其寒。脉紧大而迟者，必
心下坚。脉大而紧者，阳中有阴，可下之。
【按】
「其脉数而紧乃弦，状如弓弦，按之不移，脉弦数者」之十九字，当是衍文，阅『伤
寒论·辨脉法』自知。「当下其寒」之四字，当在「必心下坚」之下，文义始属。
【注】
脉紧大而迟者，必心下坚□，乃寒实也，当下其寒。脉大而紧者，阳中有阴也，大者
阳实，紧者阴实也，故可下之。
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□下偏痛，发热，其脉紧弦，此寒也，宜温药下之，以大黄附子汤。
【按】
□下偏痛之「偏」字，当是「满」字，必是传写之□。
【注】
腹满而痛，脾实邪也；□下满痛，肝实邪也。发热若脉数大，胃热实邪也。今脉紧弦
，脾寒实邪也，当以温药下之，故以大黄附子汤下其寒实。方中佐细辛者，以散其肝
邪，此下肝脾寒实之法也。
【集注】
尤怡曰：□中满痛而脉紧弦，阴寒成聚也，虽有发热，亦有阳气被郁所致。是以非温
不能已其寒，非下不能去其结，故曰：宜以温药下之。
厚朴八两，大黄四两，枳实五枚。
以上三味药，用水一斗二升，先煎煮前两种药（厚朴、枳实），取药液五升，加入大黄，再煎煮取药液三升，每次温服一升，以大便通畅为度。
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脉象数而紧，即为弦脉，形状像弓弦一样，重按不移。脉象弦数的，应当攻下其寒邪。脉象紧大而迟的，必定心下坚硬。脉象大而紧的，是阳中有阴，可以攻下。
【按语】
“其脉数而紧乃弦，状如弓弦，按之不移，脉弦数者”这十九个字，应该是衍文（多余的文字），查阅《伤寒论·辨脉法》即可知晓。“当下其寒”这四个字，应该放在“必心下坚”的下面，文义才通顺。
【注释】
脉象紧大而迟的，必定心下坚硬，这是寒实证，应当攻下其寒邪。脉象大而紧的，是阳中有阴。大脉代表阳实，紧脉代表阴实，所以可以攻下。
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腹部一侧疼痛，发热，脉象紧弦，这是寒邪，适宜用温性药物攻下，方用大黄附子汤。
【按语】
“□下偏痛”中的“偏”字，应该是“满”字，必然是传抄过程中的错误。
【注释】
腹满而痛，是脾脏实邪；腹部胀满疼痛，是肝脏实邪。如果发热且脉象数大，是胃热实邪。现在脉象紧弦，是脾寒实邪，应当用温性药物攻下，所以用大黄附子汤来攻下寒实。方中佐以细辛，是为了疏散肝邪，这是治疗肝脾寒实证的方法。
【集注】
尤怡说：腹部胀满疼痛且脉象紧弦，是阴寒凝聚所致，虽然有发热，也是阳气被郁遏所致。因此，不用温药不能消除寒邪，不用攻下药不能去除结滞，所以说：适宜用温性药物攻下。
Houpo 8 liang, Dahuang 4 liang, Zhishi 5 pieces.
The above three herbs are decocted with 12 sheng of water. First, boil the first two herbs (Houpo and Zhishi) to obtain 5 sheng of liquid. Then add Dahuang and continue boiling to obtain 3 sheng of liquid. Take 1 sheng warm each time, stopping when bowel movement is unobstructed.
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A pulse that is rapid and tight constitutes a Wiry Pulse (Xian Mai), resembling the string of a bow, firm upon heavy pressure. In cases of a wiry and rapid pulse, one should purge the cold pathogen. If the pulse is tight, large, and slow, there must be hardness in the epigastrium. If the pulse is large and tight, it indicates Yang containing Yin, and purgation is indicated.
[Commentary]
The nineteen characters "its pulse is rapid and tight, thus wiry, resembling the string of a bow, firm upon heavy pressure, [and] the wiry and rapid pulse" are likely interpolations (extraneous text); this can be verified by consulting the *Shanghan Lun: Differentiation of Pulses*. The four characters "one should purge the cold" should follow "there must be hardness in the epigastrium" for the meaning to be coherent.
[Annotation]
When the pulse is tight, large, and slow, there is necessarily hardness in the epigastrium; this is a Cold Excess syndrome, and one should purge the cold. A large and tight pulse indicates Yang containing Yin. A large pulse signifies Yang excess, and a tight pulse signifies Yin excess; therefore, purgation is applicable.
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Pain on one side of the abdomen accompanied by fever, with a tight and wiry pulse, indicates Cold pathogen; it is appropriate to use warm purgatives, specifically the Dahuang Fuzi Tang (Rhubarb and Aconite Decoction).
[Commentary]
The character "pian" (one-sided) in "pain on one side of the abdomen" should likely be "man" (fullness/distension), which was probably a transcription error.
[Annotation]
Abdominal fullness and pain indicate Spleen excess pathogen; abdominal distension and pain indicate Liver excess pathogen. Fever accompanied by a rapid and large pulse indicates Stomach Heat excess pathogen. Currently, the tight and wiry pulse indicates Spleen Cold excess pathogen; thus, warm purgatives should be used. Therefore, Dahuang Fuzi Tang (Rhubarb and Aconite Decoction) is employed to purge the cold excess. The addition of Xixin (Asarum Herba) in the formula serves to disperse the Liver pathogen; this is the method for treating Cold excess of the Liver and Spleen.
[Collected Annotations]
You Yi stated: Abdominal distension and pain with a tight and wiry pulse indicate the accumulation of Yin-Cold. Although fever is present, it is caused by the constraint of Yang Qi. Therefore, only warm medicine can dispel the cold, and only purgative medicine can remove the accumulation; hence, it is stated that warm purgatives are appropriate.