Zhang Zhongjing’s Five Xie Xin Decoctions for Various Mouth Sores
11. Zhang Zhongjing’s Five Xie Xin Decoctions for Various Mouth Sores
Oral ulcers are called mouth sores in TCM. The spleen opens into the mouth, and the heart opens into the tongue; mouth sores, though localized, have their pathomechanism in the middle jiao. The five Xie Xin Tang from the Shanghan Lun (Banxia Xie Xin Tang, Gancao Xie Xin Tang, Shengjiang Xie Xin Tang, Dahuang-Huanglian Xie Xin Tang, and Fuzi Xie Xin Tang) all use the principle of draining the heart and resolving stagnation to treat mouth sores by regulating spleen-stomach qi. The five formulas have similar ingredients but each has its own emphasis; clinical selection requires clear differentiation of cold-heat and excess-deficiency.
Zhang Zhongjing, revered as the Sage of Medicine, had all five Xie Xin Tang originally from the Taiyang chapter of the Shanghan Lun, primarily treating epigastric stagnation. Later generations extended its pathomechanism to mouth sores, huoxue disease, and other mucosal lesions, making it a core formula group for TCM treatment of oral ulcers.
Pathomechanism of Mouth Sores
| Pattern Type | Key Pathomechanism | Pattern Features |
|---|---|---|
| Cold-heat mixture | Middle jiao qi stagnation, cold and heat mutually binding in the epigastrium, damp-heat steaming upward to the oral orifices | Recurrent mouth sores with epigastric fullness, nausea, vomiting, borborygmus, and diarrhea; red tongue with alternating yellow-white coating |
| Severe spleen-stomach deficiency | Severely deficient stomach qi, counterflowing guest qi, non-consolidation of central qi leading to non-healing mucosal ulceration | Deep, large, or multiple mouth sores, lingering, with undigested food in stools, mental restlessness, or vulvar ulcers |
| Fluid retention with food stagnation | Stomach deficiency with water retention, undigested food causing belching, water qi and old food mutually binding and rising upward | Mouth sores with sour foul belching, water sounds in the hypochondrium, borborygmus, diarrhea, poor appetite |
| Excessive stomach fire | Formless pathogenic heat congesting in the stomach, heat damaging the flesh, scorching upward to the oral orifices | Red, swollen, burning mouth sores, flushed face and thirst, mental restlessness and constipation, red tongue with yellow coating, forceful pulse |
| Upper heat and lower cold | Pathogenic heat congesting above, yang deficiency below, upper scorching and lower cold | Recurrent mouth sores with chills and sweating, cold limbs, loose stools, pale tongue with thin yellow coating, deep weak pulse |
The Five Xie Xin Tang
1. Banxia Xie Xin Tang - Cold-heat mixture type mouth sores
Composition: Processed Banxia 12g, Scutellaria 9g, Coptis 3g, Dried Ginger 9g, Codonopsis 12g (originally ginseng), Honey-processed Licorice 9g, 4 jujubes
Efficacy: Pungent opening, bitter descending, harmonizing the intestines and stomach, resolving stagnation and relieving vexation
Indications: Recurrent mouth sores with epigastric fullness, nausea, vomiting, borborygmus, and diarrhea
This formula uses the principle of pungent opening and bitter descending: Banxia and Dried Ginger are pungent-warm, dispersing cold and descending counterflow; Scutellaria and Coptis are bitter-cold, clearing heat and drying dampness; the two groups’ pairings make cold and heat resolve separately. Codonopsis, Honey-processed Licorice, and jujube are sweet-warm, tonifying the center, supporting the already-damaged spleen and stomach. The whole formula uses cold and heat together, combining tonifying and draining; after restoring the middle jiao’s ascending-descending function, the damp-heat rising to the oral orifices naturally descends. For mouth sores with pronounced gastrointestinal symptoms, this formula is the most precisely matching.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Pungent opening, dissipating nodules | Processed Banxia 12g, Dried Ginger 9g | Pungent-warm opening and dissipation, warming the spleen to dispel cold, descending counterflow to stop vomiting |
| Bitter descending, draining heat | Scutellaria 9g, Coptis 3g | Bitter-cold clearing heat and drying dampness, draining epigastric stagnation heat |
| Sweet-warm tonifying the center | Codonopsis 12g, Honey-processed Licorice 9g, 4 jujubes | Tonifying spleen and qi, calming the center, supporting healthy qi |
2. Gancao Xie Xin Tang - Severe spleen-stomach deficiency type mouth sores
Composition: Honey-processed Licorice 15g (originally 4 liang; severe cases up to 30g), Processed Banxia 12g, Scutellaria 9g, Coptis 3g, Dried Ginger 9g, Codonopsis 12g, 4 jujubes
Efficacy: Tonifying the center and relieving urgency, clearing heat and resolving stagnation, promoting tissue growth and converging sores
Indications: Deep, large, or multiple mouth sores lingering and not healing, with undigested food in stools, mental restlessness, or vulvar ulcers (huoxue disease)
This formula is Banxia Xie Xin Tang with increased Honey-processed Licorice. In the original formula, Licorice was increased to 4 liang, using its sweet-relentant quality to tonify the center, benefit qi, and relieve urgency and pain. Those with recurrent, non-healing mouth sores often have severe spleen-stomach deficiency; with non-consolidation of central qi, mucosal repair is weak. Heavy Licorice both tonifies deficiency and consolidates the center, clears heat and detoxifies; it also has a corticosteroid-like anti-inflammatory effect, significantly effective for recurrent oral ulcers and huoxue disease (Behcet’s disease). The Jinkui Yaolue states, In huoxue disease… eroding the throat is huo, eroding the yin area is hu, Gancao Xie Xin Tang governs it - a classic record for treating mucosal ulcers.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Sweet-relentant tonifying the center | Honey-processed Licorice 15g, Codonopsis 12g, 4 jujubes | Heavy Licorice to tonify the center and relieve urgency, combined with Codonopsis and jujube to benefit qi and consolidate the center, promoting mucosal repair |
| Pungent opening, bitter descending | Processed Banxia 12g, Dried Ginger 9g, Scutellaria 9g, Coptis 3g | Cold and heat used together, pungent dispersion and bitter drainage, resolving stagnation and relieving vexation |
3. Shengjiang Xie Xin Tang - Fluid retention with food stagnation type mouth sores
Composition: Fresh Ginger 12g, Processed Banxia 12g, Scutellaria 9g, Coptis 3g, Dried Ginger 3g, Codonopsis 12g, Honey-processed Licorice 9g, 4 jujubes
Efficacy: Harmonizing the stomach and dispersing water, resolving stagnation and dissipating accumulation, descending counterflow to stop vomiting
Indications: Mouth sores with sour foul belching, water sounds in the hypochondrium, borborygmus, diarrhea, poor appetite
This formula is Banxia Xie Xin Tang with reduced Dried Ginger and increased Fresh Ginger. Fresh Ginger up to 4 liang, using its stomach-harmonizing, water-dispersing power. For mouth sores with indigestion and water retention in the stomach, simply clearing heat will not remove the water retention; simply tonifying deficiency will make water qi stagnation worse. Fresh Ginger combined with Banxia disperses water qi in the hypochondrium; Dried Ginger dosage reduced to prevent excessive warm-drying. When the formula disperses water qi and dissipates food stagnation, spleen-stomach ascending-descending returns to normal, and damp-heat rising to the oral orifices naturally subsides.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Water dispersion, stomach harmonizing | Fresh Ginger 12g, Processed Banxia 12g | Heavy Fresh Ginger to disperse gastric water qi, combined with Banxia to descend counterflow and stop vomiting |
| Pungent opening, bitter descending | Dried Ginger 3g, Scutellaria 9g, Coptis 3g | Reduced Dried Ginger for mild warming; Scutellaria and Coptis clear heat and resolve stagnation |
| Sweet-warm tonifying the center | Codonopsis 12g, Honey-processed Licorice 9g, 4 jujubes | Tonifying spleen and qi, calming the center, supporting healthy qi |
4. Dahuang-Huanglian Xie Xin Tang - Excessive stomach fire type mouth sores
Composition: Rhubarb 6g, Coptis 3g, Scutellaria 3g (originally 1 liang)
Decoction Method: Soak with boiling water, briefly wring out the residue, take warm in divided doses
Efficacy: Draining fire to resolve stagnation, clearing heat to detoxify
Indications: Red, swollen, burning mouth sores, flushed face and thirst, mental restlessness and constipation, red tongue with yellow coating, forceful pulse
This formula has only three herbs, pure bitter-cold direct draining, specifically treating mouth sores from excessive stomach heat. Rhubarb drains heat and unblocks the viscera, Coptis clears heart-stomach fire, Scutellaria clears lung-gallbladder heat; the three herbs together drain upward-rising fire downward. The decoction method uses boiling-water soaking rather than prolonged decoction, taking the light-clear qi to clear upper jiao formless pathogenic heat, avoiding bitter-cold damaging the stomach from prolonged decoction. Mouth sores with constipation, foul breath, and mental restlessness are the most precisely matching. If accompanied by middle jiao cold-deficiency, this formula is not suitable.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Unblocking viscera, draining heat | Rhubarb 6g | Drains heat and unblocks bowels, guiding upward-rising fire downward |
| Bitter-cold clearing heat | Coptis 3g, Scutellaria 3g | Coptis clears heart-stomach fire; Scutellaria clears lung-gallbladder heat, directly draining pathogenic heat |
5. Fuzi Xie Xin Tang - Upper heat, lower cold type mouth sores
Composition: Rhubarb 6g, Coptis 3g, Scutellaria 3g, Processed Aconite 6g (pre-decocted)
Decoction Method: Soak the three yellows with boiling water to obtain light-clear qi; separately decoct Aconite to obtain thick juice, mix and take
Efficacy: Draining heat to resolve stagnation, warming yang to consolidate the exterior
Indications: Recurrent mouth sores with chills and sweating, cold limbs, loose stools, pale tongue with thin yellow coating
This formula adds Processed Aconite to Dahuang-Huanglian Xie Xin Tang, treating upper-heat, lower-cold mouth sores. Mouth sores belong to upper jiao excessive heat, but patients simultaneously have lower-cold manifestations such as yang-deficiency chills, cold limbs, and loose stools; simply using bitter-cold heat clearing would further damage yang qi. Aconite warms the meridians and supports yang; the three yellows clear heat and resolve stagnation; cold and heat proceed in parallel. In the decoction method, the three yellows are soaked in boiling water to obtain light-rising qi for clearing upper heat; Aconite is separately decocted to obtain thick juice for warming lower cold; the exquisite method lies in separately extracting drug properties, each following its own path.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Warming yang, consolidating below | Processed Aconite 6g (pre-decocted) | Warming meridians and supporting yang, dispelling lower jiao yin-cold, separately decocted for thick juice to heavily consolidate and tonify |
| Clearing heat, resolving stagnation | Rhubarb 6g, Coptis 3g, Scutellaria 3g | Clearing upper jiao pathogenic heat, resolving epigastric stagnation |
Five-Formula Comparison and Formula Selection Points
All five formulas treat epigastric stagnation, with Scutellaria and Coptis as the common foundation, but each has its own emphasis in combination structure. In clinical formula selection, first determine the cold-heat, excess-deficiency proportion of mouth sore patients: pure excess-heat without deficiency uses Dahuang-Huanglian Xie Xin Tang; upper heat, lower cold adds Aconite; middle deficiency cold-heat mixture uses Banxia Xie Xin Tang; severe deficiency heavily uses Licorice; fluid retention with food stagnation adds Fresh Ginger.
| Comparison Dimension | Banxia Xie Xin Tang | Gancao Xie Xin Tang | Shengjiang Xie Xin Tang |
|---|---|---|---|
| Core combination | Scutellaria and Coptis bitter-descending, Ginger and Banxia pungent-opening, Codonopsis, Licorice, and jujube tonifying the center | Same as Banxia Xie Xin Tang, increasing Honey-processed Licorice to 4 liang | Same as Banxia Xie Xin Tang, reducing Dried Ginger and increasing Fresh Ginger |
| Emphasized pathomechanism | Cold-heat mixture, middle jiao qi stagnation | Severe stomach deficiency, counterflow of guest qi, non-healing mucosa | Stomach deficiency water retention, food stagnation |
| Suitable pattern | Mouth sores with simultaneous stagnation, vomiting, and diarrhea | Deep, large, non-healing mouth sores, or vulvar ulcers | Mouth sores with foul belching, water sounds, and borborygmus |
| Differentiation point | Cold and heat each half, excess and deficiency equally weighted | Deficiency more than cold, strongest central tonification power | Water retention most pronounced, strongest water-dispersion power |
| Comparison Dimension | Dahuang-Huanglian Xie Xin Tang | Fuzi Xie Xin Tang |
|---|---|---|
| Core combination | Rhubarb, Coptis, Scutellaria, pure bitter-cold direct draining | Same three yellows, adding Processed Aconite to warm yang |
| Emphasized pathomechanism | Formless pathogenic heat congesting in the stomach, pure excess-heat | Upper jiao excessive heat with lower jiao yang deficiency, upper heat and lower cold |
| Suitable pattern | Red, swollen, burning mouth sores with constipation, forceful pulse | Mouth sores with chills and sweating, cold limbs, and loose stools |
| Differentiation point | No deficiency, no cold, purely clearing excess heat | Both heat and cold, clearing upper and warming lower in parallel |
VI. Summary
The five Xie Xin Tang for treating mouth sores have their core in clearly differentiating cold-heat and excess-deficiency. Banxia Xie Xin Tang treats cold-heat mixture, Gancao Xie Xin Tang treats severe deficiency with non-convergence, Shengjiang Xie Xin Tang treats fluid retention with food stagnation, Dahuang-Huanglian Xie Xin Tang treats excessive stomach fire, and Fuzi Xie Xin Tang treats upper heat and lower cold. The five formulas use Scutellaria and Coptis as the common foundation; through sovereign herb changes and combination adjustments, they cover the major patterns of mouth sores. Clinically, gastrointestinal symptoms are the key to differentiation - when stagnation, vomiting, and diarrhea coexist, use Banxia; for severe deficiency with non-convergence, use Licorice; for water-food stagnation, use Fresh Ginger; for pure heat without deficiency, use Dahuang-Huanglian; for both heat and cold, use Aconite.
References:
[1] Zhang Zhongjing. Shanghan Lun [M]. Beijing: People’s Medical Publishing House, 2005.
[2] Zhang Zhongjing. Jinkui Yaolue [M]. Beijing: People’s Medical Publishing House, 2005.
[3] Liu Zhilong. Xie Xin Tang Formulas in Classical Formulas [J]. Haodaifu Online, 2019.
[4] Wei Wei. Clinical Experience in Treating Mouth Sores from Spleen-Stomach Theory [J]. Chinese Journal of Integrated Traditional and Western Medicine Digestion, 2018.
[5] Zhang Zhi. Banxia Xie Xin Tang for Treating Recalcitrant Oral Ulcers [N]. Medical and Pharmaceutical News, 2024-11-26.
11. 張仲景五首瀉心湯—治各種口腔潰瘍
口腔潰瘍，中醫稱”口瘡”。脾開竅於口，心開竅於舌，口瘡雖發於局部，病機卻在中焦。《傷寒論》五首瀉心湯——半夏瀉心湯、甘草瀉心湯、生薑瀉心湯、大黃黃連瀉心湯、附子瀉心湯，均以”瀉心消痞”為法，通過調和脾胃氣機治療不同證型的口瘡。五方藥味相近，立法各有側重，臨床選方須辨明寒熱虛實。
張仲景後世尊為”醫聖”。五首瀉心湯均出自《傷寒論》太陽病篇，原治”心下痞”證，後世將其病機推廣應用於口瘡、狐惑病等黏膜病變，成為中醫治療口腔潰瘍的核心方劑群。
口瘡病機
| 證型 | 病機要點 | 證候特徵 |
|---|---|---|
| 寒熱錯雜 | 中焦氣機壅滯，寒熱互結於心下，溼熱上蒸口竅 | 口瘡反覆發作，伴胃脘痞滿、噁心嘔吐、腸鳴下利，舌紅苔黃白相間 |
| 脾胃虛甚 | 胃氣重虛，客氣上逆，中氣不固則黏膜潰爛不斂 | 口瘡深大或多發，遷延不愈，伴下利完谷不化、心煩不安，或見外陰潰瘍 |
| 水飲食滯 | 胃虛水停，谷不化而幹噫食臭，水氣與宿食搏結上泛 | 口瘡伴噯氣酸腐、脅下有水聲、腸鳴下利、食慾不振 |
| 胃火熾盛 | 無形邪熱壅聚胃脘，熱盛肉腐，上灼口竅 | 口瘡紅腫灼痛，面赤口渴、心煩便秘、舌紅苔黃燥、脈實有力 |
| 上熱下寒 | 邪熱壅於上而陽氣虛於下，上灼下寒，寒熱錯雜 | 口瘡反覆伴畏寒汗出、四肢不溫、大便稀溏，舌淡苔薄黃，脈沉弱 |
五個瀉心湯：
1. 半夏瀉心湯——寒熱錯雜型口瘡
組成：法半夏 12g，黃芩 9g，黃連 3g，乾薑 9g，黨參 12g（原方人參），炙甘草 9g，大棗 4枚
功效：辛開苦降，調和腸胃，消痞除煩
主治：口瘡反覆發作，伴胃脘痞滿、噁心嘔吐、腸鳴下利
本方以辛開苦降立法，半夏、乾薑辛溫散寒降逆，黃芩、黃連苦寒清熱燥溼，兩組配伍使寒熱分消。黨參、炙甘草、大棗甘溫補中，扶助已傷之脾胃。全方寒熱並用、補瀉兼施，恢復中焦升降功能後，上炎口竅之溼熱自降。口瘡伴胃腸症狀明顯者，此方最為對證。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 辛開散結 | 法半夏 12g、乾薑 9g | 辛溫開結，溫脾散寒，降逆止嘔 |
| 苦降洩熱 | 黃芩 9g、黃連 3g | 苦寒清熱燥溼，瀉心下痞熱 |
| 甘溫補中 | 黨參 12g、炙甘草 9g、大棗 4枚 | 補脾益氣，和中安胃，防苦寒傷正 |
2. 甘草瀉心湯——脾胃虛甚型口瘡
組成：炙甘草 15g（原方四兩，重症可用至30g），法半夏 12g，黃芩 9g，黃連 3g，乾薑 9g，黨參 12g，大棗 4枚
功效：補中緩急，清熱消痞，生肌斂瘡
主治：口瘡深大或多發遷延不愈，伴下利完谷不化、心煩不安，或合併外陰潰瘍（狐惑病）
本方即半夏瀉心湯重用炙甘草。炙甘草在原方基礎上加至四兩，取其甘緩之性，補中益氣、緩急止痛。口瘡反覆不愈者，多有脾胃虛甚，中氣不固則黏膜修復力弱。重用甘草既能補虛固中，又能清熱解毒，尚有類皮質激素樣抗炎作用，對反覆發作的口腔潰瘍及狐惑病（白塞病）效果顯著。《金匱要略》載”狐惑之為病……蝕於喉為惑，蝕於陰為狐，甘草瀉心湯主之”，是治療黏膜潰瘍的經典記載。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 甘緩補中 | 炙甘草 15g、黨參 12g、大棗 4枚 | 重用甘草補中緩急，合參棗益氣固中，促進黏膜修復 |
| 辛開苦降 | 法半夏 12g、乾薑 9g、黃芩 9g、黃連 3g | 寒熱並用，辛散苦洩，消痞除煩 |
3. 生薑瀉心湯——水飲食滯型口瘡
組成：生薑 12g，法半夏 12g，黃芩 9g，黃連 3g，乾薑 3g，黨參 12g，炙甘草 9g，大棗 4枚
功效：和胃散水，消痞化滯，降逆止嘔
主治：口瘡伴噯氣酸腐、脅下有水聲、腸鳴下利、食慾不振
本方即半夏瀉心湯減乾薑用量、重加生薑。生薑用至四兩，取其和胃散水之力。口瘡伴消化不良、胃中水飲停聚者，單純清熱則水飲不去，單純補虛則水氣更滯。生薑配半夏散脅下之水氣，減乾薑量以防溫燥太過。方中水氣得散，谷滯得消，脾胃升降復常，上泛口竅之溼熱自平。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 散水和胃 | 生薑 12g、法半夏 12g | 生薑重用散胃中水氣，合半夏降逆止嘔 |
| 辛開苦降 | 乾薑 3g、黃芩 9g、黃連 3g | 乾薑減量溫脾，芩連清熱消痞 |
| 甘溫補中 | 黨參 12g、炙甘草 9g、大棗 4枚 | 補脾益氣，安中扶正 |
4. 大黃黃連瀉心湯——胃火熾盛型口瘡
組成：大黃 6g，黃連 3g，黃芩 3g（原方一兩）
煎法：以麻沸湯（沸水）漬之，須臾絞去滓，分溫再服
功效：瀉火消痞，清熱解毒
主治：口瘡紅腫灼痛，面赤口渴、心煩便秘、舌紅苔黃、脈實有力
本方僅三味藥，純苦寒直折，專治胃中邪熱壅盛之口瘡。大黃洩熱通腑，黃連清心胃之火，黃芩清肺膽之熱，三藥合用使上炎之火從下而洩。煎服法取麻沸湯漬泡而非久煎，取其氣之輕清以清上焦無形邪熱，避免久煎後苦寒敗胃。口瘡伴便秘、口臭、心煩者最為對證。若兼中焦虛寒則非本方所宜。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 通腑洩熱 | 大黃 6g | 洩熱通便，導上炎之火從下而出 |
| 苦寒清熱 | 黃連 3g、黃芩 3g | 黃連清心胃之火，黃芩清肺膽之熱，直折邪熱 |
5. 附子瀉心湯——上熱下寒型口瘡
組成：大黃 6g，黃連 3g，黃芩 3g，炮附子 6g（先煎）
煎法：三黃以麻沸湯漬之取清輕之氣，附子另煎取濃汁，合服
功效：瀉熱消痞，溫陽固表
主治：口瘡反覆伴畏寒汗出、四肢不溫、大便稀溏、舌淡苔薄黃
本方在大黃黃連瀉心湯基礎上加炮附子，治上熱下寒之口瘡。口瘡屬上焦熱盛，但患者同時有陽虛畏寒、四肢不溫、便溏等下寒表現，單純苦寒清熱則更傷陽氣。附子溫經扶陽，三黃清熱消痞，寒熱並行。煎服法上三黃沸水漬泡取氣輕揚以清上熱，附子另煎取汁醇厚以溫下寒，制度之妙在於藥性分取，各行其道。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 溫陽固下 | 炮附子 6g（先煎） | 溫經扶陽，散下焦陰寒，另煎取濃汁以重鎮溫補 |
| 清熱消痞 | 大黃 6g、黃連 3g、黃芩 3g | 清上焦邪熱，消心下痞 |
五方對比與選方要點
五方同治”心下痞”，藥物以芩、連為共同基礎，但配伍結構各有側重。臨床選方時，首先判斷口瘡患者的寒熱虛實比例：純實熱無虛者用大黃黃連瀉心湯，上熱下寒者加附子，中虛寒熱錯雜者用半夏瀉心湯，虛甚者重用甘草，水飲食滯者加生薑。
| 對比維度 | 半夏瀉心湯 | 甘草瀉心湯 | 生薑瀉心湯 |
|---|---|---|---|
| 核心配伍 | 芩、連苦降，姜、夏辛開，參、草、棗補中 | 同半夏瀉心湯，重用炙甘草至四兩 | 同半夏瀉心湯，減乾薑、重加生薑 |
| 側重病機 | 寒熱錯雜，中焦氣機壅滯 | 胃虛甚，客氣上逆，黏膜不斂 | 胃虛水停，食滯不化 |
| 適用證型 | 口瘡伴痞滿、嘔、利並見 | 口瘡深大不愈，或合併外陰潰瘍 | 口瘡伴噯腐、水聲、腸鳴 |
| 鑑別要點 | 寒熱各半，虛實並重 | 虛多於寒，補中力最強 | 水飲突出，散水力最強 |
| 對比維度 | 大黃黃連瀉心湯 | 附子瀉心湯 |
|---|---|---|
| 核心配伍 | 大黃、黃連、黃芩，純苦寒直折 | 同三黃，加炮附子溫陽 |
| 側重病機 | 無形邪熱壅聚胃脘，純實熱證 | 上焦熱盛兼下焦陽虛，上熱下寒 |
| 適用證型 | 口瘡紅腫灼痛、便秘、脈實有力 | 口瘡伴畏寒汗出、四肢不溫、便溏 |
| 鑑別要點 | 無虛無寒，純清實熱 | 有熱有寒，清上溫下並行 |
六小結
五首瀉心湯治口瘡，核心在於辨明寒熱虛實。半夏瀉心湯治寒熱錯雜，甘草瀉心湯治虛甚不斂，生薑瀉心湯治水飲食滯，大黃黃連瀉心湯治胃火熾盛，附子瀉心湯治上熱下寒。五方以芩、連為共同底藥，通過君藥變換和配伍調整，覆蓋口瘡的主要證型。臨床以胃腸症狀為辨證眼目——痞、嘔、利並見者用半夏，虛甚不斂者用甘草，水食停滯者用生薑，純熱無虛者用大黃黃連，熱寒並見者用附子。
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