甘草（炙）三两 人参三两 干姜一两 半夏（洗）半升 黄芩三两 黄连一两 生
姜（切）四两 大枣（擘）十二枚
右八味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【方解】
名生姜泻心汤者，其义重在散水气之痞也。生姜、半夏散□下之水气，人参、大枣补
中州之土虚，干姜、甘草以温里寒，黄芩、黄连以泻痞热，备乎虚水寒热之治，胃中
不和下利之痞，焉有不愈者乎？
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伤寒五、六日，呕而发热者，柴胡汤证具，而以他药下之，柴胡证仍在者，复与柴胡
汤，此虽已下之不为逆，必蒸蒸而振，却产热汗出而解。若心下满而□痛者，此为结
胸也，大陷胸汤主之。但满而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤。
【注】
结胸兼阳明里实者，大陷胸汤证也；兼阳明不成实者，小陷胸汤证也。痞□兼少阳里
实证者，大柴胡汤证也；兼少阳里不成实者，半夏泻心汤证也。今伤寒五、六日，呕
而发热者，是邪传少阳之病也。既柴胡证具，乃不以柴胡和之，而以他药下之，误矣
。若柴胡证仍在者，此虽已下，尚未成逆，则当复与柴胡汤，必蒸蒸而振战，然后发
热汗出而解矣。盖以下后虚中、作解之状皆如是也。若下后心下满而□痛者，此为结
胸，大陷胸汤固所宜也。若但满而不痛，此为虚热气逆之痞，即有呕而发热之少阳证
，柴胡汤亦不中与之。法当治痞也，宜半夏泻心汤主之。
【集注】
成无己曰：若下后阳邪传里者，则结于胸中为结胸，以胸中为阳受气之分也。阴邪传
里者，则留于心下为痞，以心下为阴受气之分也。
程应旄曰：泻心虽同，而证中具呕，则功专涤饮，故以半夏名汤也，曰泻心者，言满
在心下清阳之位，热邪挟饮，尚未成实，故清热涤饮，使心下之气得通，上下自无阻
留，阴阳自然交互矣。然枢机全在于胃，故复补胃家之虚，以为之斡旋，与实热入胃
而泻其蓄满者，大相迳庭矣。痞虽虚邪，乃表气入里，寒成热矣。寒虽成热，而热非
实，故用苦寒以泻其热，兼佐辛甘以补其虚，不必攻痞而痞自散。所以一方之中，寒
热互用，若阴痞不关阳郁，即郁而亦未成热，泻心之法概可用也。
汪琥曰：少阳病误下，邪在半表半里，居阴阳之间，故有痞结证。夫人身、膈以下属
阴，膈以上属阳，少阳居清道而介乎膈之间，亦为半表半里。此可征少阳病误下，邪
气乘虚入里，而结胸痞气所由分也。
甘草（蜜炙）三两，人参三两，干姜一两，半夏（水洗）半升，黄芩三两，黄连一两，生姜（切片）四两，大枣（掰开）十二枚。
以上八味药，用水一斗，煎煮至剩余六升，滤去药渣，再次煎煮浓缩至三升，每次温服一升，每日服用三次。
【方解】
命名为“生姜泻心汤”，其含义重在消散水气所致的心下痞满。生姜和半夏能疏散停滞于胃脘部的水气，人参和大枣能补益中焦脾胃的虚弱，干姜和甘草用来温煦体内的寒邪，黄芩和黄连用来清泻痞结之热，全面兼顾了虚证、水饮、寒邪、热邪的治疗，对于胃气不和导致的下利及痞满症状，哪有不能治愈的呢？
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伤寒病经过五到六天，出现呕吐且发热的症状，这是小柴胡汤证的典型表现，但如果误用其他药物进行攻下治疗，而小柴胡汤证依然存在，应当再次给予小柴胡汤。这种情况虽然已经经过攻下，但并未造成逆证，服药后患者必然会出现蒸蒸汗出并伴有战栗的现象，随后通过发热出汗而病愈。如果患者感到心下（胃脘部）胀满且疼痛，这属于结胸证，应使用大陷胸汤主治。如果只是胀满而不疼痛，这属于痞证，不适合使用小柴胡汤，适宜使用半夏泻心汤。
【注】
结胸证兼有阳明腑实证的，是大陷胸汤证；兼有阳明证但未形成腑实证的，是小陷胸汤证。痞证兼有少阳腑实证的，是大柴胡汤证；兼有少阳证但未形成腑实证的，是半夏泻心汤证。如今伤寒病五到六天，出现呕吐且发热，这是邪气传入少阳的病证。既然小柴胡证已具备，却不使用柴胡剂来和解，反而用其他药物攻下，这是错误的。如果小柴胡证仍然存在，虽然已经经过攻下，但尚未形成逆证，则应当再次给予小柴胡汤，患者必然会出现蒸蒸汗出并伴有战栗，然后发热出汗而痊愈。这是因为攻下后导致中气虚弱，以及疾病解除时的反应都是这样的。如果攻下后心下胀满且疼痛，这属于结胸证，使用大陷胸汤是适宜的。如果只是胀满而不疼痛，这属于因虚热气逆导致的痞证，即使伴有呕吐发热的少阳证，也不适合使用小柴胡汤。治疗方法应当针对痞证，适宜使用半夏泻心汤主治。
【集注】
成无己说：如果攻下后阳邪传入体内，就会结聚在胸中形成结胸，因为胸中是阳气受气的部位。阴邪传入体内，就会停留于心下形成痞证，因为心下是阴气受气的部位。
程应旄说：虽然都称为泻心汤，但此证中伴有呕吐，功效专在于涤除痰饮，所以以半夏命名方剂。称为“泻心”，是指满闷位于心下这一清阳之气所在之位，热邪挟带痰饮，尚未形成实证，因此清热涤饮，使心下的气机得以通畅，上下自然没有阻滞留滞，阴阳自然交互调和。然而，枢机的运转全在于胃，所以还要补益胃家的虚弱，以此来斡旋气机，这与实热入胃而泻其蓄积满实的治法，截然不同。痞证虽然是虚邪，却是表气入里，由寒转化为热。虽然寒已化热，但热并非实热，所以用苦寒药来清泻其热，同时佐以辛甘药来补益其虚，不必专门攻破痞结，痞结自然消散。因此一方之中，寒热药物互用，如果是阴痞不涉及阳气郁结，或者虽有郁结但未化热，泻心汤的方法都可以使用。
汪琥说：少阳病误用攻下，邪气在半表半里之间，处于阴阳交界之处，所以会出现痞结证。人体膈以下属阴，膈以上属阳，少阳位居清道，介于膈膜之间，也属于半表半里。由此可以推知，少阳病误用攻下，邪气乘虚入里，从而区分出结胸和痞气形成的原因。
Licorice Root (Honey-fried) [Gancao] 3 liang, Ginseng Root [Renshen] 3 liang, Dried Ginger [Ganjiang] 1 liang, Pinellia Tuber (Washed) [Banxia] half sheng, Scutellaria Root [Huangqin] 3 liang, Coptis Rhizome [Huanglian] 1 liang, Fresh Ginger [Shengjiang] (sliced) 4 liang, Jujube Fruit (Broken open) [Dazao] 12 pieces.
The above eight herbs are decocted with one dou of water until six sheng remain. The dregs are filtered out, and the liquid is further concentrated by boiling until three sheng remain. Take one sheng warm per dose, three times a day.
[Formula Analysis]
Named "Shengjiang Xiexin Tang" (Fresh Ginger Decoction to Drain the Epigastrium), its significance lies primarily in dissipating the epigastric fullness caused by fluid retention. Shengjiang (Fresh Ginger) and Banxia (Pinellia Tuber) disperse the fluid qi stagnating below; Renshen (Ginseng Root) and Dazao (Jujube Fruit) tonify the deficiency of the Middle Jiao Earth; Ganjiang (Dried Ginger) and Gancao (Licorice Root) warm the interior cold; Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) drain the heat of the palpable fullness. This formula comprehensively addresses treatments for deficiency, fluid, cold, and heat. For epigastric disharmony leading to diarrhea and palpable fullness, how could it fail to heal?
@@@
In Taiyang disease (Cold Damage syndrome), after five or six days, if there is vomiting accompanied by fever, the Chaihu Tang (Bupleurum Decoction) pattern is complete. If mistakenly treated with purgatives from other formulas, and the Chaihu pattern persists, administer Chaihu Tang again. Although purgation has been performed, this is not yet a reversal condition. The patient will inevitably experience a sensation of rising heat followed by chills, and subsequently resolve through sweating and fever. If there is epigastric fullness accompanied by pain, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang (Major Intractable Chest Decoction). If there is fullness without pain, this is Pi (Palpable Fullness/Blockage); Chaihu Tang is not indicated, and Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is appropriate.
[Annotation]
Jie Xiong (Chest Binding) combined with Yangming Interior Excess is the Da Xianxiong Tang pattern; combined with Yangming but not forming excess is the Xiao Xianxiong Tang (Minor Intractable Chest Decoction) pattern. Pi (Palpable Fullness) combined with Shaoyang Interior Excess is the Da Chaihu Tang (Major Bupleurum Decoction) pattern; combined with Shaoyang but not forming excess is the Banxia Xiexin Tang pattern. Currently, in Taiyang disease after five or six days, vomiting with fever indicates pathogenic factors transmitting to the Shaoyang (Lesser Yang) channel. Since the Chaihu pattern is present, failing to harmonize with Chaihu and instead using purgatives is an error. If the Chaihu pattern remains, although purgation has occurred, it has not yet become a reversal condition; thus, Chaihu Tang should be administered again. The patient will inevitably experience rising heat and chills, followed by resolution through fever and sweating. This is because post-purgation middle deficiency and the manifestations of resolving illness are all like this. If post-purgation results in epigastric fullness and pain, this is Jie Xiong (Chest Binding), and Da Xianxiong Tang is indeed appropriate. If there is only fullness without pain, this is Pi (Palpable Fullness) due to deficient heat and rebellious qi. Even with Shaoyang symptoms such as vomiting and fever, Chaihu Tang is not suitable. The method should treat Pi (Palpable Fullness); Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated.
[Collected Annotations]
Cheng Wuji stated: If after purgation, Yang pathogenic factors transmit inward, they bind in the chest to form Jie Xiong (Chest Binding), because the chest is the region where Yang Qi receives energy. If Yin pathogenic factors transmit inward, they remain at the epigastrium to form Pi (Palpable Fullness), because the epigastrium is the region where Yin Qi receives energy.
Cheng Yingmao stated: Although both are called Xiexin Tang (Decoctions to Drain the Epigastrium), since this pattern features vomiting, its function specializes in draining phlegm-fluids, hence named after Banxia (Pinellia Tuber). To call it "Draining the Epigastrium" means that the fullness is located at the epigastrium, the seat of clear Yang Qi. Heat pathogens carrying phlegm-fluids have not yet formed solid excess. Therefore, clearing heat and draining fluids allows the Qi at the epigastrium to flow freely, eliminating obstruction above and below, allowing Yin and Yang to interact naturally. However, the pivot mechanism relies entirely on the Stomach; thus, tonifying the deficiency of the Stomach family is necessary to facilitate rotation. This is vastly different from treating solid heat entering the Stomach by draining accumulated fullness. Pi (Palpable Fullness) is a deficient pathogen, resulting from exterior Qi entering the interior and transforming from cold to heat. Although cold transforms into heat, the heat is not solid. Therefore, bitter-cold herbs are used to drain the heat, assisted by pungent-sweet herbs to tonify deficiency. There is no need to attack the Pi (Palpable Fullness) directly; it will dissipate on its own. Thus, within one formula, cold and heat herbs are used together. If it is Yin Pi (Deficient Cold Palpable Fullness) unrelated to Yang depression, or if depression has not yet transformed into heat, the method of Xiexin Tang (Draining the Epigastrium) can generally be applied.
Wang Hu stated: When Shaoyang (Lesser Yang) disease is mistakenly purged, the pathogen remains between the exterior and interior, situated between Yin and Yang, thus presenting with Pi (Palpable Fullness) binding patterns. Below the diaphragm belongs to Yin, above the diaphragm belongs to Yang. Shaoyang resides in the clear pathways, interposed between the diaphragms, also belonging to the half-exterior half-interior. This demonstrates that when Shaoyang disease is mistakenly purged, pathogens enter the interior taking advantage of deficiency, explaining the differentiation between Jie Xiong (Chest Binding) and Pi (Palpable Fullness).