Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Fuzi Xiexin Tang is Dahuang Huanglian Xiexin Tang with aconite added. One ingredient separates them, and it is the most consequential one in this library: a hot, cardiotoxic root is placed into a formula otherwise built from three bitter cold ones. That is the classical idea of 寒热并用, cold and hot used together, and reading it is only useful if the toxicity of the hot half is stated without softening.
The classical text also specifies two different extraction methods in a single formula: the aconite is simmered on its own, while the rhubarb, coptis and scutellaria are steeped briefly in boiling water and strained rather than boiled. This is a genuine and unusual feature of the source. It is recorded here as a textual fact, not as a preparation instruction, and not as a way of managing the risk: prolonged heating hydrolyses the toxic diester alkaloids of aconite into far less toxic ones, and traditional processing does the same, but both reduce the hazard rather than remove it.
The indication line is short: 心下痞, 而复恶寒汗出 — epigastric fullness, and on top of it chilliness and sweating. That pairing deserves to be read as a warning rather than as a pattern to be matched. Epigastric discomfort accompanied by sweating and a sensation of cold is a recognised way for acute coronary syndromes to present, especially in older people, women, and people with diabetes, who are precisely the groups most likely to describe the event as indigestion. The same combination is produced by sepsis, which in older people may present with hypothermia rather than fever; by gastrointestinal bleeding and hypovolaemia; by a perforated peptic ulcer; and by hypoglycaemia. All of these are reasons to be assessed in person and none of them is self-managed.
Aconite needs the full statement. 附子 is the processed daughter root of Aconitum carmichaelii; 川乌 is the mother root of the same plant and 草乌 comes from other Aconitum species. The whole genus carries aconitine-type diester alkaloids, which hold voltage-gated sodium channels open. Poisoning produces tingling and numbness of the mouth and limbs, nausea, vomiting, dizziness, ventricular tachyarrhythmias and fibrillation, and asystole. Poisoning clusters following improperly processed or excessive aconite have been reported from China, Hong Kong and elsewhere, including fatal cases; there is no specific antidote and management is supportive with control of the arrhythmia. Because aconite belongs to the 乌头 group that the classical incompatibility lists set against 半夏, 瓜蒌, 贝母, 白蔹 and 白及, it is worth noticing that these four formulas each keep those two sides apart — the ones that contain Pinellia do not contain aconite, and the one that contains aconite does not contain Pinellia.
The cold half carries its own cautions. 大黄 is an anthraquinone stimulant laxative; chronic use is associated with melanosis coli (a benign, reversible pigmentation seen at colonoscopy), potassium loss, and dependence, and stimulant laxatives are conventionally avoided in pregnancy and breastfeeding and are not used when intestinal obstruction or undiagnosed abdominal pain is a possibility. 大黄 is Rheum, and it is not 土大黄, the Rumex docks that are sometimes substituted. 黄连 supplies berberine, a documented inhibitor of CYP enzymes and P-glycoprotein with case reports of raised immunosuppressant concentrations; berberine also displaces bilirubin, which is why Coptis preparations are regarded as unsuitable for jaundiced newborns and are avoided in pregnancy and breastfeeding. 黄连 is Coptis, not 胡黄连. 黄芩 is Scutellaria baicalensis, not American skullcap; skullcap-labelled supplements have been reported in liver-injury case series frequently complicated by adulteration or misidentification.
This entry records a formula whose entire interest lies in putting two opposite things in one bowl. It is not a way of deciding that epigastric fullness with sweating is something to wait out.
附子泻心汤就是大黄黄连泻心汤加了一味附子。**一味之差，而这一味是本库里分量最重的一味**：在一张原本由三味苦寒药构成的方子里，放进一味辛热而**有心脏毒性**的根。这就是古典所谓**寒热并用**；但要读懂它，前提是辛热那一半的毒性被不含糊地写清楚。
古典条文还规定了**同一方内两种不同的提取法**：附子另煮取汁，大黄、黄连、黄芩三味则以「麻沸汤」短时浸泡、绞去滓而不煎煮。这是原文献里一个确实存在且不同寻常的特征。本库把它作为**文献事实**记录，**不是制法说明，更不是风险管理的方法**：长时间加热会把附子中的双酯型生物碱水解为毒性低得多的产物，传统炮制也是同理，但两者都是**降低**危险，而不是**消除**危险。
主治条文很短：**心下痞，而复恶寒汗出** —— 上腹痞闷，再加上怕冷与出汗。这一组应当被读作**警示**，而不是一个可以对照归类的证。**上腹不适伴出汗与畏寒**，是急性冠脉综合征已被承认的一种起病方式，在老年人、女性与糖尿病患者中尤其如此 —— 而这些人恰恰最可能把这回事描述成「消化不良」。同样的组合还由以下情况造成：**脓毒症**（老年人可表现为低体温而非发热）、**消化道出血与低血容量**、**消化性溃疡穿孔**、**低血糖**。这些都需要当面评估，没有一种是可以自行处理的。
附子需要写完整。**附子**是乌头（Aconitum carmichaelii）子根的加工品；**川乌**是同一植物的母根，**草乌**来自乌头属的另一些种。乌头属全株含**乌头碱型双酯型生物碱**，使电压门控钠通道持续开放。中毒表现为口舌与四肢麻木刺痛、恶心呕吐、头晕、**室性心动过速与室颤、心搏骤停**。因炮制不当或过量而中毒的聚集性病例在中国大陆、中国香港及其它地区均有公开报道，含致死病例；**无特异解毒剂**，处理以支持治疗与控制心律失常为主。因为附子属于十八反中与**半夏、瓜蒌、贝母、白蔹、白及**相对的乌头类，值得注意这四首方各自都把这两边分开 —— 含半夏的不含附子，含附子的不含半夏。
苦寒那一半也有它自己的注意事项：**大黄**是蒽醌类刺激性泻药，长期使用与**结肠黑变病**（结肠镜下所见、良性且可逆）、**失钾**与**依赖**相关；刺激性泻药在孕期与哺乳期按惯例回避，在**疑似肠梗阻或未诊断的腹痛**存在时亦不使用。大黄是 Rheum，**不是土大黄**（酸模属，偶见误替）。**黄连**提供小檗碱 —— 已被证实的 CYP 酶与 P-糖蛋白抑制剂，有升高免疫抑制剂浓度的病例报告；小檗碱还置换胆红素，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**。**黄芩**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。
本条记录的是一张把两种相反的东西放进同一碗里的方子。它不能用来判定「上腹痞闷加出汗」是可以等着看的事。