（仲景） 治伤寒心下痞，而复恶寒汗出者。（伤寒心下满硬而痛者为结胸，硬满而不
痛者为痞。经曰∶心下痞，按之濡，关上浮者，大黄黄连泻心汤。心下痞，而复恶寒汗
附子泻心汤。大抵诸痞皆热，故攻之多寒剂。此加附子，恐三黄重损其阳，非补虚也
后复汗，或下后阳虚，故恶寒汗出。诸泻心汤，皆治伤寒痞满，满在心胸，不在胃也
病痞满，有寒热虚热之不同。保命集云∶脾不能行气于四脏，结而不散则为痞。伤寒之
为寒郁内热，宜苦泄。杂病之痞，为气不涤畅，宜辛散。）
大黄（二两） 黄连 黄芩（一两） 附子（一枚。炮去皮脐。别煮取汁。）
吴鹤皋曰∶心下痞，故用三黄以泻痞。恶寒汗出，故用附子以回阳。非三黄不能去痞热，
无
之
二
下
者
类
解
渴
作
痞
中
关上
活人
足吐
心汤
胃之
发于
分之
阳发
当有
（仲景） 治伤寒下之早，胸满而不痛者为痞，身寒而呕，饮食不下，非柴胡证。
（经曰∶伤寒五六日，呕而发热，柴胡证具。而以他药下之，柴胡证仍在者，复与柴胡汤。
此难已下之，不为逆，必蒸蒸而振，欲发热汗出而解。若心下满而硬痛者，此为结胸也，大
陷胸汤主之。若满而不痛者，此为痞，柴胡不中与也，宜半夏泻心汤。凡用泻心者，皆属误
下之证，非传经热邪也。）
半夏（半升） 黄连（一两） 黄芩 甘草（炙） 人参 干姜（三两） 大枣（十二
枚）
成氏曰∶否而不泰为痞，苦先入心，泻心者必以苦。故以黄连为君，黄芩为臣，以降阳
而升
者，
而大
证，
嘉言
怫
寒
寒热
不可
阳骤
得苦
犹恐
除人参再加甘草，（一两，合前四两。）名甘草泻心汤。（仲景）治伤寒中风，医反下之，
下利
胃虚
退
并云甘草能除满，以脾健运则满除也。观仲景用以消痞，岂非取其散满哉？又按此乃伤寒之
下利肠鸣也。杂证肠鸣，亦多属脾胃虚。经云∶脾胃虚则肠鸣腹满。又云∶中气不足，肠为
之苦鸣，宜参术补剂加甘草芩连枳实干姜等。丹溪曰∶腹中水鸣，乃火激动其水也，宜二陈
汤加芩连栀子。）加生姜四两，名生姜泻心汤。（仲景）治汗解后，胃中不和，心下痞硬，干
噫（嗳同），食臭，完谷不化，胁下有水气，腹中雷鸣下利。（客气上逆，伏饮搏膈，故痞硬。
中气不和，故干嗳。胃虚火盛，邪热不杀谷，故完谷不化。胁下有水气，土弱不能制水，
故腹中雷鸣下利，谓之协热利。为汗后胃虚，外损阳气，故加生姜以散邪涤饮，益胃复阳。
刘河间曰∶泻而水谷变色者为热，不变色而澄彻清冷者为寒。若肛门燥涩，小便黄赤，水谷
虽不变，犹为热也。此因火性急速，食下即出，不及克化，所谓邪热不杀谷也。）
（张仲景）治疗伤寒导致的心下痞满，同时伴有恶寒和汗出的症状。（注：伤寒引起的心下部位胀满坚硬且疼痛的称为结胸；若仅硬满而不疼痛的则称为痞。经典记载说：心下痞满，按压时柔软，脉象关部浮起的，适用大黄黄连泻心汤。若心下痞满，又兼有恶寒汗出，则用附子泻心汤。大抵各种痞证多属热证，所以常用寒凉药物攻治。此处加入附子，是担心三黄（大黄、黄连、黄芩）药性过重损伤阳气，并非为了补虚。这是因为发汗后或误用攻下法后导致阳气虚弱，所以出现恶寒汗出。所有的泻心汤，都是治疗伤寒引起的痞满，病位在心胸，不在胃中。）
关于痞满的病机，有寒热虚实之不同。《保命集》说：脾不能将气输送到四肢脏腑，气机郁结不散就形成痞证。伤寒引起的痞，是因为寒邪郁闭导致内热，适宜用苦味药泄热；杂病引起的痞，是因为气机不畅，适宜用辛味药发散。）
大黄（二两） 黄连 黄芩（一两） 附子（一枚。炮制，去皮去脐。另煎取汁。）
吴鹤皋说：心下痞满，所以用三黄来泻除痞热。恶寒汗出，所以用附子来回阳救逆。没有三黄不能去除痞热，没有附子不能挽回阳气。
（张仲景）治疗伤寒因过早使用攻下法，导致胸中胀满但不疼痛的痞证，身体发冷且呕吐，饮食难进，这不是柴胡汤证。（经典记载说：伤寒五六天，出现呕吐且发热，这是柴胡汤证的典型表现。如果此时误用其他药物攻下，而柴胡证仍在的，应再给予柴胡汤。此条所述为已经误下，并未造成坏病，患者必定会感到蒸蒸然振栗，想要发热出汗而病解。如果心下胀满且坚硬疼痛的，这是结胸证，应用大陷胸汤主治。如果胀满但不疼痛的，这是痞证，不可用柴胡汤，适宜用半夏泻心汤。凡是使用泻心汤治疗的，都属于误下后的证候，并非传经的热邪。）
半夏（半升） 黄连（一两） 黄芩 甘草（炙） 人参 干姜（三两） 大枣（十二枚）
成无己说：否塞不通、阴阳不交称为痞。苦味先入心，要泻心火必须用苦味药。所以以黄连为君药，黄芩为臣药，以降阳气而升阴气……（原文此处有残缺/错乱，依义理推断为调和阴阳之意）。
若去掉人参再加甘草（一两，合前四两），名为甘草泻心汤。（张仲景）治疗伤寒中风，医生反而误用攻下法，导致下利肠鸣。胃气虚弱……（原文此处有残缺/错乱）。并说甘草能消除胀满，因为脾气健运则胀满自除。观察张仲景用它来消除痞满，难道不是取其消散胀满的作用吗？另外按此乃伤寒误下导致的下利肠鸣。杂病中的肠鸣，也多属于脾胃虚弱。经典说：脾胃虚弱则肠鸣腹满。又说：中气不足，肠道为之鸣响，适宜用参术等补剂加上甘草、黄芩、黄连、枳实、干姜等。朱丹溪说：腹中水鸣声，是火热扰动津液所致，适宜用二陈汤加上黄芩、黄连、栀子。）再加入生姜四两，名为生姜泻心汤。（张仲景）治疗发汗解表后，胃中不和，心下痞硬，干呕（嗳气同义），食物腐臭气味，完谷不化，胁下有停饮，腹中雷鸣般作响且下利。（客气上逆，伏留的饮邪搏结于膈间，所以心下痞硬。中气不和，所以干呕。胃虚火盛，邪热不能消化食物，所以完谷不化。胁下有停饮，土弱不能制水，所以腹中雷鸣下利，这称为协热利。因为是发汗后胃气虚弱，外损阳气，所以加生姜以散邪涤饮，益胃复阳。刘河间说：腹泻且水谷颜色变异的属于热证；不变色且清澈寒冷的属于寒证。如果肛门干燥涩滞，小便黄赤，即使水谷颜色未变，仍属热证。这是因为火性急速，食物吃下即排出，来不及消化，所谓邪热不能杀谷也。）
(Zhang Zhongjing) Treats Heart-Bind (Xin Xia Pi) resulting from Cold Damage (Shang Han), accompanied by aversion to cold and sweating. (Note: In Cold Damage, if the epigastric region is full, hard, and painful, it is termed Jie Xiong [Knot-Chest]; if it is full and hard but not painful, it is termed Pi [Bind]. The Classics state: For Heart-Bind that is soft upon palpation with a floating pulse at the Guan position, Da Huang Huang Lian Xie Xin Tang [Rhubarb and Coptis Decoction to Drain the Epigastrium] is indicated. If Heart-Bind is accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang [Aconite Decoction to Drain the Epigastrium] is used. Generally, various forms of Pi are heat-patterns, so they are often treated with cold-natured drugs. Here, Fu Zi [Radix Aconiti Lateralis Preparata] is added because it is feared that the heavy use of San Huang [Da Huang, Huang Lian, Huang Qin] might excessively damage Yang Qi; this is not for tonifying deficiency. This occurs due to Yang deficiency after excessive sweating or erroneous purgation, leading to aversion to cold and sweating. All Xie Xin Tang formulas treat Pi and fullness caused by Cold Damage; the pathology is in the chest and heart, not in the Stomach.)
Regarding the pathogenesis of Pi and fullness, there are differences between cold, heat, deficiency, and excess. *Bao Ming Ji* states: When the Spleen fails to transport Qi to the four Zang organs, Qi stagnates and does not disperse, forming Pi. Pi caused by Cold Damage arises from external cold constraint generating internal heat, suitable for bitter-draining methods. Pi arising from miscellaneous diseases stems from stagnant Qi, suitable for acrid-dispersing methods.)
Da Huang (2 liang) Huang Lian Huang Qin (1 liang) Fu Zi (1 piece. Prepared, skin and umbilicus removed. Decocted separately to extract juice.)
Wu Hegao said: Heart-Bind requires San Huang to drain the bind-heat. Aversion to cold and sweating require Fu Zi to restore Yang. Without San Huang, bind-heat cannot be removed; without Fu Zi, Yang cannot be restored.
(Zhang Zhongjing) Treats Pi characterized by chest fullness without pain, occurring after premature purgation in Cold Damage, accompanied by body coldness, vomiting, and inability to eat. This is not Chai Hu syndrome. (The Classics state: In Cold Damage, on the fifth or sixth day, if vomiting and fever occur, Chai Hu syndrome signs are present. If purged erroneously with other drugs while Chai Hu signs remain, administer Chai Hu Tang again. In the case described here, although purged erroneously, it has not become a adverse transformation; the patient will likely experience shivering and chills, followed by fever and sweating as the disease resolves. If the epigastrium is full, hard, and painful, this is Jie Xiong [Knot-Chest], treated with Da Xian Xue Tang [Major Draining Chest Decoction]. If it is full but not painful, this is Pi, Chai Hu Tang is contraindicated, and Ban Xia Xie Xin Tang [Pinellia Decoction to Drain the Epigastrium] is appropriate. All cases treated with Xie Xin Tang result from erroneous purgation, not from transmitted heat pathogens.)
Ban Xia (0.5 sheng) Huang Lian (1 liang) Huang Qin Gan Cao (Honey-fried) Ren Shen Gan Jiang (3 liang) Da Zao (12 pieces)
Cheng Wuji said: "Pi" refers to blockage without harmony. Bitter flavors enter the Heart first; to drain the Heart, one must use bitter substances. Thus, Huang Lian is the Sovereign herb, and Huang Qin is the Minister herb, to descend Yang and ascend Yin... (Text fragmentary).
If Ren Shen is removed and Gan Cao is increased (to 1 liang, totaling 4 liang with previous amounts), it is named Gan Cao Xie Xin Tang [Licorice Decoction to Drain the Epigastrium]. (Zhang Zhongjing) treats Cold Damage Wind-Strike where the physician erroneously purges, leading to diarrhea and intestinal borborygmus. Stomach Qi deficiency... (Text fragmentary). It is also stated that Gan Cao can relieve fullness because when Spleen Qi functions well, fullness dissipates. Observing Zhang Zhongjing's use of it to eliminate Pi, is it not to utilize its ability to scatter fullness? Furthermore, this refers to diarrhea and intestinal borborygmus caused by erroneous purgation in Cold Damage. Intestinal borborygmus in miscellaneous diseases often belongs to Spleen and Stomach deficiency. The Classics state: Spleen and Stomach deficiency leads to intestinal borborygmus and abdominal fullness. Also: Insufficiency of Middle Qi causes the intestines to resonate. Suitable treatments include tonics like Ren Shen and Bai Zhu, plus Gan Cao, Huang Qin, Huang Lian, Zhi Shi, and Gan Jiang. Zhu Danxi said: Water-sounding noises in the abdomen are caused by Fire agitating fluids; Er Chen Tang [Two-Cured Decoction] plus Huang Qin, Huang Lian, and Zhi Zi is appropriate.) Add Sheng Jiang (4 liang), and it is named Sheng Jiang Xie Xin Tang [Fresh Ginger Decoction to Drain the Epigastrium]. (Zhang Zhongjing) treats post-sweating disharmony in the Stomach, characterized by epigastric hardness and fullness, dry belching (same as eructation), putrid food odor, undigested food in stool, fluid retention under the hypochondrium, and loud intestinal borborygmus with diarrhea. (Rebellious Qi ascends, latent fluid retention struggles against the diaphragm, causing epigastric hardness and fullness. Disharmony of Middle Qi causes dry belching. Stomach deficiency with abundant fire, and pathogenic heat failing to digest food, leads to undigested food in stool. Fluid retention under the hypochondrium, with weak Earth failing to control Water, results in loud intestinal borborygmus and diarrhea, termed Xie Re Li [Collaborating Heat Diarrhea]. Because sweating damaged Stomach Qi and externally injured Yang Qi, Sheng Jiang is added to dispel pathogens and resolve fluid retention, benefiting the Stomach and restoring Yang. Liu Hejian said: Diarrhea with altered color of water and grain indicates heat; unchanged color and clear, cold discharge indicate cold. If the anus is dry and astringent, and urine is yellow and red, even if the stool color is unchanged, it is still heat. This is because Fire nature is rapid; food exits immediately after ingestion, insufficient time for digestion, known as pathogenic heat failing to "kill" (digest) the grain.)