Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Dahuang Huanglian Xiexin Tang is the smallest formula in this family and, in a sense, the root of it: add aconite and it becomes Fuzi Xiexin Tang. The classical instruction is unusual — the two ingredients are steeped briefly in boiling water (麻沸汤) and strained, rather than decocted at length. Classical commentators have long connected that instruction with a real chemical observation: rhubarb contains both anthraquinone glycosides, which are strongly laxative, and condensed tannins, which are astringent, and prolonged boiling extracts proportionally more of the tannin fraction. That is the traditional explanation and it is recorded here as such; it is a commentarial rationale, not a demonstrated clinical difference, and it is certainly not a preparation instruction.
The indication line is 心下痞，按之濡, 其脉关上浮: fullness below the heart that is soft when pressed, with a floating pulse at the guan position. Two things about that sentence are worth saying plainly. First, the classical texts themselves distinguish 痞 that is soft from 痞 that is hard and full — the same word, different palpation, and in this library that difference is what separates this formula from the others in the group. In practice, however, an epigastric mass, guarding or rigidity, fullness with persistent vomiting, or tenderness that wakes someone from sleep are reasons to be examined, not reasons to sort a sensation into a category. Second, the pulse description belongs to the classical examination and is recorded as part of the text; a pulse is not used here to reach any conclusion about any person.
The more important thing to say about this formula is a naming problem, because it is the kind of problem that injures people. The Shanghan Lun formula for 心下痞 is not the same entity as the 泻心汤 of the Jingui Yaolüe, which is recorded with rhubarb, scutellaria and coptis for 吐血 and 衄血 — vomiting blood and nosebleed. Similar names, different texts, different recorded indications. And bleeding is where this library stops rather than continues: haematemesis and melaena are presentations of upper gastrointestinal bleeding, which includes peptic ulcer, varices, Mallory-Weiss tears, and malignancy, and which is managed with resuscitation, risk stratification and endoscopy, not with a decoction. Nosebleed is usually trivial and occasionally is not — posterior epistaxis, anticoagulation, a bleeding disorder, or hypertension-associated bleeding are all reasons for it to be dealt with directly. Nothing in this entry is offered for bleeding of any kind.
The two ingredients each carry documented cautions. 大黄 is an anthraquinone stimulant laxative. Chronic use is associated with melanosis coli, a benign and reversible brown pigmentation of the colonic mucosa that is noticed at colonoscopy; with potassium loss and the dependence that follows from long-term use; and stimulant laxatives are conventionally avoided in pregnancy and breastfeeding and are not used where intestinal obstruction, inflammatory bowel disease or undiagnosed abdominal pain is a possibility. Hypokalaemia from laxative use interacts with digoxin and with diuretics in the direction that matters most. 大黄 is Rheum, admitted from several species in the Pharmacopoeia, and it is not 土大黄, the Rumex docks that are sometimes supplied in its place. 黄连 is Coptis and its principal alkaloid is berberine, a documented inhibitor of CYP enzymes and P-glycoprotein, with case reports of raised cyclosporine and tacrolimus concentrations in transplant patients; berberine displaces bilirubin from albumin, which is why Coptis preparations are regarded as unsuitable for jaundiced newborns and are avoided in pregnancy and breastfeeding. 黄连 is not 胡黄连 (Picrorhiza). Where an edition adds 黄芩, that is Scutellaria baicalensis, which is not American skullcap; skullcap-labelled supplements have been reported in liver-injury case series often complicated by adulteration or misidentification, so a label is not a guarantee of the plant inside.
This entry is a record of what a classical text said about one kind of epigastric fullness, and of a textual disagreement that is still open. It is not a way of deciding that epigastric symptoms are benign, and it offers nothing for bleeding.
大黄黄连泻心汤是这一族里最小的一方，某种意义上也是这一族的根：加上附子，就成了附子泻心汤。古典条文里有一处不寻常的交代 —— 两味药以**麻沸汤**（滚水）**短时浸泡、绞去滓**，而不是久煎。后世注家很早就把这条交代与一个确实存在的化学事实联系起来：大黄既含**蒽醌苷**（泻下作用强），又含**缩合鞣质**（具收敛作用），久煎会相对更多地提出鞣质部分。本库将其作为**传统解释**记录 —— **它是注释性的理由，不是已被证明的临床差别，更不是制法说明**。
主治条文是**心下痞，按之濡，其脉关上浮**。这句话有两点该说清楚。第一，**古典文献自己区分了「痞」之软与痞之硬满** —— 同一个字，按诊不同；在本库里，正是这个差别把本方与同族各方分开。但在实际中，**上腹部包块、腹肌紧张或板样强直、痞满伴持续呕吐、或痛至夜间醒来的压痛**，都是需要被当面检查的理由，而不是把一种感觉归进某一类的理由。第二，脉象描述属于古典诊法的一部分，作为文本记录在此；**切脉在此不用于对任何人作出任何结论**。
关于本方更该说的是一个**命名问题**，因为它正是会伤到人的那类问题。《伤寒论》治**心下痞**的这一方，与《金匮要略》以大黄、黄芩、黄连治**吐血、衄血**的**泻心汤**并非同一实体。**名字相近，文本不同，所记主治不同。** 而出血这件事，本库在这里是**停下来**而不是继续：**呕血与黑便是上消化道出血的表现**，其成因包括消化性溃疡、静脉曲张、Mallory-Weiss 撕裂与恶性肿瘤，处理靠复苏、危险分层与内镜，**不是靠一碗汤剂**。鼻出血多数无碍，有时不是 —— **后鼻道出血、正在抗凝、存在凝血障碍或与高血压相关的出血**，都需要当场处理。本条**不为任何形式的出血提供任何方案**。
两味药各有被记载的注意事项：**大黄**是蒽醌类刺激性泻药。长期使用与**结肠黑变病**（结肠黏膜良性、可逆的褐色色素沉着，结肠镜下发现）、**失钾**以及长期使用后的**依赖**相关；刺激性泻药在孕期与哺乳期按惯例回避，在**肠梗阻、炎症性肠病或未诊断的腹痛**可能存在的情形下不使用。泻药所致低钾与地高辛、与利尿剂的相互作用，正落在最要紧的方向上。大黄是 Rheum，药典收数个种；**它不是土大黄**（酸模属，偶被充替）。**黄连**是 Coptis，主要生物碱为**小檗碱** —— 已被证实的 CYP 酶与 P-糖蛋白抑制剂，有移植受者环孢素、他克莫司浓度升高的病例报告；小檗碱置换胆红素，故含黄连的制剂**对黄疸新生儿视为不宜**，孕期与哺乳期回避；且**黄连不是胡黄连**（Picrorhiza）。若某一版本加黄芩，那是 Scutellaria baicalensis，**不是美黄芩**；标称黄芩属的补充剂出现在肝损伤病例系列中，常牵涉掺伪或误判 —— **瓶签不等于瓶中之物**。
本条是「一部古典文献对一种上腹痞闷说了什么」的记录，也是对一个**至今开放**的文本分歧的记录。它不能用来判定上腹症状是良性的；它对出血不提供任何东西。