治脾约，大便难，小便数，关脉浮涩者。此润肠之主方。
大麻仁（二升） 杏仁（一斤去皮尖） 白芍（半斤） 大黄（一斤） 浓朴（一尺炙）
枳实（半斤）为末，炼蜜丸如桐子大，饮服十丸，日二服。渐加，以利为度。
麻仁丸方治脾约，枳朴大黄麻杏芍。土燥津亡大便难，养液通幽蜜丸嚼。（脾约为脾土
过燥、胃液日亡，故以麻、杏润脾燥，白芍安脾阴，而后以枳、朴、大黄承气法胜之，则下
不亡阴。法中用丸渐加者，脾燥宜用缓法，滋柔润下，以遂脾欲，非比胃实当急下也。）
治心下痞，按之濡，大便硬，不恶寒，反恶热，脉关上数者；心火亢盛，吐衄不止，甚
良。
大黄（二两） 黄连（一两） 以麻沸汤二升，渍之须臾，绞去滓，分温服。（此法之
最奇者，
治心下痞，大便硬，心烦不得眠，而复恶寒汗出者。
大黄（二两酒浸） 黄连（炒） 黄芩（各一两炒） 附子（一枚去皮别煮取汁） 以
麻沸汤二升，渍三黄须臾，绞去滓，纳附子汁，分温再服。（此法更精。附子用煎，三味用
泡，扶阳欲其
治胁下偏痛，脉弦，大便难，发热恶寒。
大黄（三两） 附子（三枚） 细辛（二两） 水五升，煮二升，分温三服。
大黄黄连泻心汤，心痞恶热乃堪尝，（若心下痞恶寒者，表未解也，不可攻痞，当先解
表，表解乃可攻痞。）按之自濡为虚痞，数（脉）在关上君火强，泻火通阴痞自化，（痞有不
因误下而成者。关上脉数，系心火亢盛，不得下交于阴，而中宫受其燔灼，气失升降而为痞。
按之自濡，是无形者也，故独任苦寒，便可泄却，如大黄泻营分之热，黄连泄气分之热，且
大黄有攻坚破结之能，其泄痞之功，即寓于泻热之内。以麻沸汤渍绞其汁，取其气不取其味，
治虚痞不伤正气也。）火炎吐衄最为良。（按∶吐衄之证，世医率用寒凉止血，不知血得寒则
凝，血止之后，必有瘀凝胃络，或为胸胁疼痛，或至夜微热不除，而贻余患者多矣。审其果
为实火迫血妄行，不若竟用此方，泻火通阴，行瘀止血之为美备也。）更加黄芩与附子，附
子泻心汤法彰，恶寒汗出亡阳兆，（故用附子）便硬心烦痞热殃，（故用三黄）痞乃热邪寒药
治，（伤寒痞满，从外之内，满在胸而不在胃，多属热邪，故宜苦寒泻之；若杂病之痞，从
内之外，则又宜辛散也。）阳虚加附始相当。（附子非泻心之药。心下痞而复恶寒汗出，阳气
外撤矣。若但以苦寒泻痞，恐其虚寒骤脱，故用三黄撤三焦而泻热，即用附子彻上下以温经。
三黄用麻沸汤渍，附子别煮汁，是取三黄之气轻，附子之力重，其义仍在乎救亡阳也。）大
黄附子汤同意，温药下之妙异常，主治胁疼脉弦紧，便难寒热互参详。（按《金匮要略·腹
满寒疝宿食篇》云∶“胁下偏痛，发热，其脉紧弦，此寒也，以温药下之，宜大黄附子汤。”
又云∶“趺阳脉微弦，法当腹满；不满者，必便难，两胁疼痛，此虚寒从下上也，当以温药
服之。”又曰∶“寸口脉弦者，即胁下拘急而痛，其人啬啬恶寒也。”合三条观之，见胁下偏
痛，脉弦紧，为阴寒成聚；大便难，发热恶寒，为阳气被郁。故以附子破阴寒，细辛散浮热
，大黄通便难，共成温下之功。夫附子泻心汤用芩、连佐大黄，以祛膈上之热痞，即兼附子
之温以散之；大黄附子汤用细辛佐附子，以攻胁下之寒结，即兼大黄之寒，导而下之。）寒
则宜温积宜下，后人效法好商量。（许学士温脾汤，治寒积腹痛泄泻，即效仲景温药下之之
法也。）
治疗脾约证，表现为大便困难、小便频数、关脉浮涩者。这是润肠通便的主要方剂。
火麻仁（二升） 杏仁（一斤，去皮尖） 白芍（半斤） 大黄（一斤） 厚朴（一尺，炙）
枳实（半斤），研为细末，用炼蜜制成梧桐子大小的丸药，每次服用十丸，每日两次。逐渐增加剂量，以大便通畅为度。
【歌诀】麻仁丸主治脾约，枳实、厚朴、大黄、火麻仁、杏仁、白芍。土燥津液枯竭导致大便困难，滋养阴液、通利幽隐，制成蜜丸咀嚼服用。（脾约是指脾土过燥、胃中津液日渐耗亡，因此用火麻仁、杏仁滋润脾燥，白芍安抚脾阴，然后用枳实、厚朴、大黄的承气汤法来攻下，这样泻下而不伤阴液。方中使用丸剂并逐渐加量，是因为脾燥适宜用缓和方法，通过滋柔润下的方式顺应脾的生理需求，不像胃实证那样需要急下。）
治疗心下部痞塞感，按之柔软，大便干硬，不恶寒，反而怕热，脉象关部数者；若是心火亢盛导致的吐血、鼻衄不止，此方效果极佳。
大黄（二两） 黄连（一两），用滚开的沸水二升，浸泡片刻，绞取汁液去渣，分次温服。（这种用法最为奇特，
治疗心下部痞塞感，大便干硬，心烦失眠，同时又伴有恶寒、出汗者。
大黄（二两，酒浸） 黄连（炒） 黄芩（各一两，炒） 附子（一枚，去皮，另煮取汁），用滚开的沸水二升，浸泡三黄片刻，绞取汁液去渣，加入附子汁，分次温服。（这种用法更加精妙。附子单独煎煮，三味清热药仅浸泡，扶阳需要其力持久，
治疗胁下偏侧疼痛，脉弦，大便困难，发热恶寒。
大黄（三两） 附子（三枚） 细辛（二两），加水五升，煮取二升，分三次温服。
【歌诀】大黄黄连泻心汤，治疗心下痞塞且怕热者方可使用，（若心下痞塞且恶寒，说明表证未解，不可攻逐痞结，应当先解表，表解之后才可攻痞。）按之柔软属于虚痞，关脉数表示君火强盛，清泻火热、通达阴气则痞结自消，（痞证并非都由误下引起。关脉数，是心火亢盛，不能下行交于阴，导致中焦受其燔灼，气机升降失常而形成痞证。按之柔软，说明是无形的邪气，所以单用苦寒药即可泄除，如大黄清泻营分之热，黄连清泻气分之热，且大黄有攻坚破结的能力，其消除痞结的功效，就蕴含在清泻火热之中。用沸水浸泡绞取其汁，是取其气味轻清而非厚重，治疗虚痞而不损伤正气也。）火热上炎导致的吐血鼻衄疗效最好。（按：对于吐血鼻衄的病症，世医通常使用寒凉药物止血，不知道血遇寒则凝滞，血止之后，必然会在胃络形成瘀凝，或者出现胸胁疼痛，或者夜间低热不退，从而遗留许多病患。如果确认为实火逼迫血液妄行，不如直接使用此方，清泻火热、通达阴气、行瘀止血，才算完美。）再加上黄芩与附子，附子泻心汤的法度彰显，恶寒出汗是亡阳的先兆，（所以用附子）大便干硬心烦是痞热之殃，（所以用三黄）痞证乃热邪用寒药治疗，（伤寒引起的痞满，病势从外入内，满闷在胸而不在胃，多属热邪，所以宜用苦寒药泻之；如果是杂病引起的痞证，病势从内出外，则又宜用辛散法。）阳气虚弱加上附子才恰当。（附子并非泻心汤的主药。心下痞塞又兼恶寒出汗，说明阳气外脱。如果只用苦寒药泻痞，恐怕会导致虚寒骤然脱失，所以用三黄清撤三焦之热，同时用附子彻上下以温经。三黄用沸水浸泡，附子另煮取汁，是取三黄之气轻清，附子之力厚重，其用意仍在挽救亡阳。）大黄附子汤意旨相同，用温药攻下的妙处异常，主治胁痛脉弦紧，大便难伴寒热需仔细参详。（按《金匮要略·腹满寒疝宿食篇》说：“胁下偏侧疼痛，发热，脉象紧弦，这是寒证，应用温药攻下，宜用大黄附子汤。”又说：“趺阳脉微弦，法当腹部胀满；若不胀满，必定大便困难，两胁疼痛，这是虚寒从下向上侵犯，应当用温药服用。”又说：“寸口脉弦，即胁下拘急而痛，其人啬啬恶寒。”综合这三条来看，见胁下偏侧疼痛，脉弦紧，是阴寒凝聚；大便困难，发热恶寒，是阳气被郁遏。所以用附子破除阴寒，细辛发散浮热，大黄通便困难，共同成就温下之功。附子泻心汤用黄芩、黄连佐助大黄，以祛除膈上的热痞，同时兼用附子的温性以散之；大黄附子汤用细辛佐助附子，以攻逐胁下的寒结，同时兼用大黄的寒性，引导而下。）寒积适宜用温法攻下，后人效法值得商榷讨论。（许叔微的温脾汤，治疗寒积腹痛泄泻，就是效法仲景温药攻下的方法。）
Treats Pi Yue (Spleen Restraint), characterized by difficult defecation, frequent urination, and a floating and choppy pulse at the Guan position. This is the principal formula for moistening the intestines.
Hemp Seed (Cannabis Fructus, 2 Sheng)
Apricot Kernel (Armeniacae Semen Amarum, 1 Jin, remove skin and tips)
White Peony Root (Paeoniae Radix Alba, 0.5 Jin)
Rhubarb Root (Rhei Radix et Rhizoma, 1 Jin)
Magnolia Bark (Magnoliae Officinalis Cortex, 1 Chi, processed with heat)
Immature Bitter Orange (Aurantii Fructus Immaturus, 0.5 Jin)
Grind into fine powder, mix with refined honey to make pills the size of Chinese quince seeds. Take 10 pills with water, twice daily. Gradually increase the dose until bowel movement is unobstructed.
[Verse] Ma Ren Wan treats Pi Yue; Zhi Shi, Hou Po, Da Huang, Ma Ren, Xing Ren, Bai Shao. When earth is dry and fluids are depleted, causing difficult defecation, nourish fluids and open the orifices; take as honey pills chewed. (Pi Yue refers to excessive dryness of Spleen Earth and daily depletion of Stomach fluids. Therefore, Hemp Seed and Apricot Kernel moisten Spleen dryness, White Peony Root calms Spleen Yin, followed by the Cheng Qi method using Zhi Shi, Hou Po, and Da Huang to purge. Thus, purging does not deplete Yin. The use of pills and gradual dosage increase in this method indicates that Spleen dryness requires a slow approach: nourishing, softening, and moistening downward to accommodate the Spleen's desire, unlike Stomach excess which requires urgent purgation.)
Treats Xin Xia Pi (Epigastric fullness/oppression), where palpation reveals softness, hard stool, aversion to cold is absent but aversion to heat is present, and the pulse is rapid at the Guan position. It is also highly effective for excessive Heart Fire causing persistent hematemesis or epistaxis.
Rhubarb Root (2 Liang)
Coptis Rhizome (Coptidis Rhizoma, 1 Liang)
Steep in two Sheng of boiling water for a moment, strain to remove dregs, and take warm in divided doses. (This method is most unique,
Treats Epigastric oppression, hard stool, irritability and insomnia, accompanied by aversion to cold and sweating.
Rhubarb Root (2 Liang, soaked in wine)
Coptis Rhizome (stir-fried)
Scutellaria Root (Scutellariae Radix, each 1 Liang, stir-fried)
Aconite Root (Aconiti Lateralis Radix Praeparata, one piece, peeled and decocted separately to extract juice)
Steep the three yellow herbs (San Huang) in two Sheng of boiling water for a moment, strain to remove dregs, add the Aconite juice, and take warm in divided doses. (This method is even more exquisite. Aconite is decocted separately while the other three are steeped; supporting Yang requires its potency to be sustained,
Treats unilateral pain under the hypochondrium, wiry pulse, difficult defecation, fever, and aversion to cold.
Rhubarb Root (3 Liang)
Aconite Root (3 pieces)
Asarum Root (Asari Radix et Rhizoma, 2 Liang)
Add five Sheng of water, decoct to obtain two Sheng, and take warm in three divided doses.
[Verse] Da Huang Huang Lian Xie Xin Tang is suitable for epigastric oppression with aversion to heat. (If there is epigastric oppression with aversion to cold, the exterior syndrome has not resolved; do not attack the oppression, first resolve the exterior. Only after the exterior is resolved can the oppression be attacked.) Palpable softness indicates empty oppression; rapid pulse at the Guan position signifies strong Ministerial/Heart Fire. Clearing fire and unblocking Yin resolves the oppression spontaneously. (Oppression does not always result from mistaken purgation. Rapid pulse at the Guan indicates excessive Heart Fire failing to descend and interact with Yin, scorching the Middle Jiao, leading to loss of Qi ascending and descending, forming oppression. Softness upon palpation indicates it is formless; thus, bitter-cold herbs alone can drain it. For example, Rhubarb drains Ying-level heat, Coptis drains Qi-level heat. Moreover, Rhubarb has the ability to break hardness and knots; its function in resolving oppression is inherent in its heat-draining property. Steeping in boiling water and extracting the juice utilizes their light aroma rather than heavy taste, treating empty oppression without damaging healthy Qi.) It is best for hematemesis and epistaxis caused by flaming fire. (Note: For hematemesis and epistaxis, physicians usually use cold-cooling hemostatics, unaware that blood congeals when exposed to cold. After bleeding stops, blood stasis may remain in the stomach collaterals, causing chest/hypochondriac pain or lingering low-grade fever at night, resulting in many residual cases. If confirmed as real fire forcing blood to move recklessly, it is better to use this formula directly to clear fire, unblock Yin, move stasis, and stop bleeding, achieving perfection.) Add Scutellaria and Aconite, revealing the method of Fu Zi Xie Xin Tang. Aversion to cold and sweating are signs of Yang collapse (thus use Aconite); hard stool and irritability are consequences of oppression-heat (thus use the Three Yellows). Oppression caused by heat pathogens is treated with cold medicines. (In Shang Han, fullness/oppression moves from exterior to interior, located in the chest not the Stomach, mostly due to heat pathogens, so bitter-cold purgation is appropriate; for miscellaneous disease oppression moving from interior to exterior, acrid-dispersing methods are appropriate.) Adding Aconite matches Yang deficiency. (Aconite is not a primary herb for Xie Xin Tang. Epigastric oppression with aversion to cold and sweating indicates external withdrawal of Yang. If only bitter-cold herbs are used to drain oppression, sudden collapse of deficiency-cold is feared. Thus, the Three Yellows withdraw heat from the San Jiao, while Aconite warms the meridians throughout the body. Steeping the Three Yellows in boiling water and decocting Aconite separately takes advantage of the light Qi of the former and the heavy power of the latter; the intent remains rescuing collapsing Yang.) The intention aligns with Da Huang Fu Zi Tang; the wonder of using warm medicines to purge is extraordinary. It mainly treats hypochondriac pain with wiry-tight pulse; difficult defecation with alternating chills and fever requires careful analysis. (According to "Jin Gui Yao Lue · Abdominal Fullness, Cold Cramps, and Retained Food Chapter": "Unilateral pain under the hypochondrium with fever and tight-wiry pulse indicates cold; treat with warm purgatives, Da Huang Fu Zi Tang is indicated." Also: "Fu Yang pulse slightly wiry suggests abdominal fullness; if no fullness, there must be difficult defecation and bilateral hypochondriac pain, indicating deficiency-cold rising from below; treat with warm medicines." Also: "Wiry pulse at Cun position indicates constrained and painful hypochondrium with aversion to cold." Observing these three clauses together: unilateral hypochondriac pain with tight-wiry pulse indicates Yin-cold accumulation; difficult defecation with fever and aversion to cold indicates Yang Qi being depressed. Thus, Aconite breaks Yin-cold, Asarum disperses floating heat, and Rhubarb relieves difficult defecation, jointly achieving warm purgation. Fu Zi Xie Xin Tang uses Scutellaria and Coptis to assist Rhubarb in dispelling upper diaphragm heat-oppression, combined with Aconite's warmth to disperse it; Da Huang Fu Zi Tang uses Asarum to assist Aconite in attacking lower hypochondriac cold-stagnation, combined with Rhubarb's coldness to guide downward.) Cold accumulation should be warmed and purged; later generations' emulation warrants discussion. (Xu Xueshi's Wen Pi Tang, treating cold accumulation abdominal pain and diarrhea, effectively follows Zhong Jing's method of warm purgation.)