大黄二两 黄连一两
右二味，以麻沸汤二升渍之，须臾绞去滓，分温再服。
【方解】
痞□虚邪，而用大黄、黄连，能不起后人之疑耶？然仲景使人疑处，正是使人解处。
盖因后人未能细玩，不得其法，竟煎而服之，大悖其旨矣。观其以滚沸如麻之汤，渍
大黄、黄连，须臾绞去滓，仅得其无形之气，不重其有形之味，是取其气味俱薄，不
大泻下。虽曰攻痞，而用攻之妙，不可思议也。
@@@
脉浮而紧，而复下之，紧反入里，则作痞，按之自濡，但气痞耳。
【注】
伤寒脉浮紧，不汗而下之，浮紧之脉，变为沉紧，是为寒邪内陷作痞之诊也。按之自
濡者，谓不□不痛，但气痞不快耳。此甘草泻心汤证也。
【集注】
程应旄曰：误下成痞，既误在证，尤误在脉，则救之之法，仍当兼凭夫脉与证而定治
矣。紧反入里，则浮紧变为沉紧，表邪陷入而不散，徙怫郁于心下，故作痞。
@@@
心下痞，按之濡，其脉关上浮者，大黄黄连泻心汤主之。
【按】
濡字上当有「不」字。若按之濡，乃虚痞也，补之不暇，岂有用大黄泻之之理乎？
【注】
此承上条以互明之也。按之自濡者，但气痞耳！若心下痞，按之不濡，此为可攻之热
痞也。然其脉，关上不沉紧而浮，则是所结之热亦浅，未可峻攻也，故以大黄黄连泻
心汤主之。
@@@
心下痞，而复恶寒汗出者，附子泻心汤主之。
【注】
心下□痛，结胸也。□而不痛，心下痞也。心下痞而复恶寒汗出者，非表不解，乃表
阳虚也。故以大黄、黄连、黄芩泻痞之热，附子温表之阳，合外寒内热而兼治之，其
妙尤在以麻沸汤渍三黄，须臾绞去滓，内附子别煮汁。义在泻痞之意轻，扶阳之意重
也。
【集注】
方有执曰：痞本阴邪内伏而虚热上凝，复恶寒汗出，则表虚而阳不为护卫可知矣。泻
心汤固所以为清热倾痞之用，加附子者，盖欲敛其汗，而固其阳也。黄芩因附子而更
加表里两解具见矣。
李中梓曰：以三黄之苦寒，清中济阴，以附子之辛热，温经固阳。寒热互用，攻补并
施而不悖，此仲景之妙用入神也。
程应旄曰：此条宜与伤寒大下后，复发汗，心下痞，恶寒者，表未解也，不可攻痞，
当先解表，表解乃可攻痞，解表宜桂枝汤，攻痞宜大黄黄连泻心汤合看。彼条用桂枝
者，缘发汗汗未出，而初时之恶寒不罢，故属表未和；此条加附子者，缘汗已出，恶
寒已罢，而复恶寒汗出，故属之表阳虚，须于异同处细细参看。
大黄二两，黄连一两。
以上两味药，用滚开的沸水二升浸泡它们，片刻后绞取药汁并去除药渣，分两次温服。
【方解】
痞证属于虚邪，却使用大黄、黄连，难道不会引起后人的疑惑吗？然而张仲景在让人疑惑的地方，正是让人理解的关键所在。
大概是因为后人未能仔细研读，没有掌握其方法，竟然将药物煎煮后服用，这完全违背了原意。看他用像麻子一样滚烫的开水，浸泡大黄、黄连，片刻后绞去药渣，只获取药物无形的气（指轻清之气），而不重视其有形的味（指厚重之味），这是取其气味都轻薄，不至于造成剧烈的泻下作用。虽然说是攻逐痞结，但其中运用的攻法之妙，真是不可思议。
@@@
脉象浮而紧，如果误用攻下法，紧脉反而入里，就会形成痞证，按压时感觉柔软不硬，这只是气机阻滞形成的痞证罢了。
【注】
伤寒病脉象浮紧，本应发汗却误用攻下法，导致浮紧的脉象变为沉紧，这是寒邪内陷形成痞证的诊断依据。所谓“按之自濡”，是指按压时不坚硬也不疼痛，只是感觉气机阻滞而不畅快。这是甘草泻心汤的适应证。
【集注】
程应旄说：误用攻下法导致痞证，既错误在于证候判断，更错误在于脉象辨识，所以救治的方法，仍然应当结合脉象与证候来制定治疗方案。紧脉反入里，意味着浮紧脉变为沉紧脉，表邪陷入体内而不能消散，郁结在心下部位，从而形成痞证。
@@@
心下部痞塞胀满，按压时感觉不坚硬，且关部脉象浮的，用大黄黄连泻心汤主治。
【按】
“濡”字上面应当有一个“不”字。如果按压时感觉柔软，那是虚性痞证，补益尚且来不及，哪里有用大黄来泻下的道理呢？
【注】
这是承接上一条文义以互相阐明。前条说“按之自濡”，是指仅仅是气机阻滞的痞证；如果心下痞塞，按压时不柔软（即有抵抗感或硬痛），这才是可以攻逐的热性痞证。然而其脉象，关部不是沉紧而是浮，说明所结聚的热邪也较浅，不可以峻猛攻下，所以用大黄黄连泻心汤主治。
@@@
心下部痞塞胀满，并且又出现恶寒、出汗症状的，用附子泻心汤主治。
【注】
心下部疼痛，是结胸证。不疼痛，才是心下痞证。心下痞塞并且又出现恶寒、出汗，这不是表证未解，而是表阳虚损。所以用大黄、黄连、黄芩来泻除痞结之热，用附子来温补表阳，同时治疗外寒内热，其精妙之处在于用滚开水浸泡三黄（大黄、黄连、黄芩），片刻后绞去药渣，另将附子单独煮取汁液。其含义在于泻除痞热的意图较轻，扶助阳气的意图较重。
【集注】
方有执说：痞证本是阴邪内伏而虚热上凝，再加上恶寒出汗，说明表虚而阳气不能护卫体表可知。泻心汤固然用于清热倾泻痞结，加入附子，是想收敛汗液，巩固阳气。黄芩因附子的加入，使得表里双解的功效更加完备。
李中梓说：用三黄的苦寒之性，清中焦济护阴液；用附子的辛热之性，温经脉固护阳气。寒热药互用，攻补法并施而不相悖，这是张仲景运用药物出神入化的妙处。
程应旄说：这一条应当与“伤寒大下之后，再次发汗，心下痞，恶寒者，表证未解，不可攻痞，应当先解表，表解后方可攻痞，解表宜用桂枝汤，攻痞宜用大黄黄连泻心汤”这条条文对照阅读。那条条文用桂枝，是因为发汗后汗未出，起初的恶寒未止，所以属于表未调和；这一条加附子，是因为汗已出，恶寒曾止，却又出现恶寒出汗，所以属于表阳虚，需要在异同之处细细参详。
Rhizoma Rhei Preparata (Dahuang) 2 liang, Rhizoma Coptidis (Huanglian) 1 liang.
The above two herbs are soaked in 2 sheng of boiling water (Mafei Tang). After a short while, the liquid is squeezed out and the dregs discarded. The decoction is divided into two doses and taken warm.
[Fangjie - Analysis of the Formula]
Pi syndrome (epigastric fullness and obstruction) is caused by deficient pathogenic factors, yet Dahuang and Huanglian are used. Would this not arouse suspicion among later practitioners? However, Zhang Zhongjing's points of potential confusion are precisely where understanding lies.
This is likely because later generations failed to study carefully and did not grasp the method, actually decocting and administering the herbs, which completely contradicts the original intent. Observe that he uses boiling water like hemp seeds to soak Dahuang and Huanglian, squeezing out the liquid after a brief moment and discarding the dregs. This extracts only the formless Qi (light and clear energetic properties) of the herbs, not their substantial flavor (heavy and thick taste), thereby utilizing their light aroma and flavor to avoid severe purgation. Although it is said to attack Pi, the subtlety of this attacking method is inconceivable.
@@@
If the pulse is floating and tight, and a purgative method is mistakenly applied, the tightness moves inward, resulting in Pi syndrome. Palpation reveals softness without hardness; this is merely Qi Pi (Qi-type stagnation).
[Annotation]
In Taiyang disease, if the pulse is floating and tight, sweating should be induced. If purgatives are mistakenly used, the floating-tight pulse transforms into a sinking-tight pulse. This indicates cold pathogenic factors sinking inward to form Pi, which is the diagnostic sign. "Soft upon palpation" means there is no hardness or pain, only a sensation of Qi stagnation and discomfort. This is the indication for Gancao Xiexin Tang.
[Jizhu - Collected Annotations]
Cheng Yingmao stated: Mistaken purgation leading to Pi involves errors in both syndrome differentiation and pulse diagnosis. Therefore, the rescue method must still be determined by combining pulse and syndrome analysis. When the tightness moves inward, the floating-tight pulse becomes sinking-tight. The exterior pathogen sinks inward and fails to disperse, lodging in the epigastrium and causing Pi.
@@@
When there is epigastric fullness and obstruction, palpation reveals no hardness, and the Guan position pulse is floating, Dahuang Huanglian Xiexin Tang is the primary treatment.
[Commentary]
There should be a "not" character before "soft". If palpation reveals softness, it is a deficient Pi syndrome. In such cases, tonification is insufficiently addressed, let alone using Dahuang for purgation.
[Annotation]
This clarifies the previous clause. "Soft upon palpation" refers merely to Qi Pi. However, if there is epigastric Pi and palpation reveals it is NOT soft (indicating resistance or hardness), this is a Heat Pi suitable for attack. Yet, since the Guan pulse is floating rather than sinking-tight, the accumulated heat is shallow, and harsh purgation is not appropriate. Thus, Dahuang Huanglian Xiexin Tang is used.
@@@
When there is epigastric fullness and obstruction, accompanied by aversion to cold and sweating, Fuzi Xiexin Tang is the primary treatment.
[Annotation]
Epigastric pain indicates Jie Xiong (chest binding). Absence of pain indicates Xin Xia Pi (epigastric Pi). Epigastric Pi accompanied by aversion to cold and sweating is not due to unresolved exterior syndrome, but rather deficiency of Exterior Yang. Therefore, Dahuang, Huanglian, and Huangqin are used to clear the heat of Pi, while Fuzi warms the Exterior Yang. This treats both external cold and internal heat simultaneously. The brilliance lies in soaking the three yellows (Sanhuang) in boiling water, squeezing out the liquid quickly, and separately decocting Fuzi. The principle emphasizes light clearing of Pi heat and heavy support of Yang.
[Jizhu - Collected Annotations]
Fang Youzhi stated: Pi originates from Yin pathogens lurking internally with deficient heat congealing upward. Aversion to cold and sweating indicate exterior deficiency and Yang failing to protect the surface. Xiexin Tang clears heat and dissipates Pi; adding Fuzi consolidates Yang and stops sweating. With Huangqin and Fuzi combined, the dual resolution of interior and exterior is fully manifested.
Li Zhongzi stated: The bitter-cold nature of the three yellows clears the middle and nourishes Yin; the acrid-hot nature of Fuzi warms the meridians and consolidates Yang. The mutual use of cold and hot, and simultaneous application of attack and tonification without contradiction, demonstrates Zhang Zhongjing's divine mastery.
Cheng Yingmao stated: This clause should be read alongside: "After severe purgation in Taiyang disease, followed by repeated sweating, if there is epigastric Pi and aversion to cold, the exterior is unresolved. Do not attack Pi; first resolve the exterior. Once the exterior is resolved, then attack Pi. Resolve the exterior with Guizhi Tang; attack Pi with Dahuang Huanglian Xiexin Tang." In that case, Guizhi Tang is used because sweating was incomplete and initial aversion to cold persisted, indicating unharmonized exterior. Here, Fuzi is added because sweating has occurred, initial aversion to cold ceased, but aversion to cold and sweating have returned, indicating deficiency of Exterior Yang. Careful comparison of similarities and differences is required.