在腑不寒专发热。咽干作呕心烦渴。发狂谵语大肠坚。大小三承汤可啜。
按不恶寒者，邪不在表也。咽干烦渴，并作呕者。皆胃热甚也。胃火上冲。故心神失守
。谵语狂言。大便坚燥。皆里症也。急宜下之。陶节 曰。伤寒邪热传里。须看气势浅深用
药。若三焦俱伤。则痞满燥实坚全见。宜大承气汤。邪在中焦。只有燥实坚三症。宜调胃承气
汤加甘草和中。去枳实者。恐伤上焦氤氲之气也。邪在上焦。则痞而满。宜小承气汤去芒硝
者。恐伤下焦真阴也。若表症未除。里症又急。不得不下者。则用大柴胡汤通表里而缓治之
。大承气最紧。小承气次之。调胃又次之。大柴胡又次之。盖恐硝性急燥。不可轻用也。
大承气汤用朴硝。大黄等分不须饶。浓朴倍加并枳实。通肠利便有功劳。小承气汤
三件药。枳实大黄并浓朴。结胸谵语大肠坚。每服五钱功易觉。
大黄 浓朴 枳实 名浓朴三物汤 又浓朴大黄两味治太阳病腹痛而闭。
调胃承气有硝黄。甘草同加用最良。腹满便坚兼口渴。心烦谵语总相当。大柴胡汤用大
半夏枳实共为良。更有黄芩与芍药。姜枣同煎利大肠。瓜蒂散中赤小豆。二味匀平有传授。
豆豉一合水同煎。膈上停痰须此吐。栀子豉汤栀子先。更加豆豉水同煎。病后虚烦眠不得
。心中懊恼吐之痊。
When the pathogen enters the Fu organs, it manifests as fever without aversion to cold. Symptoms include dryness of the throat, vomiting, mental restlessness, and thirst. If there is mania, delirium (delusional speech), and hardness of the large intestine, one of the three Chengqi Decoctions (Chengqi Formulas) may be used.
Note: The absence of aversion to cold indicates that the pathogen is not in the exterior. Dryness of the throat, mental restlessness, thirst, and vomiting together indicate severe Stomach heat. The upward rushing of Stomach fire causes the loss of control over the Spirit (Shen). Delirium, manic speech, and hard, dry stools are all interior syndromes. Immediate purgation is required. Tao Jie'an stated: When the pathogenic heat of Shanghan (Cold Damage) transmits inward, medication must be chosen based on the depth of the pathogen's influence. If the Upper, Middle, and Lower Jiao are all injured, presenting with fullness, distension, dryness, excess, and hardness simultaneously, Da Chengqi Tang (Major Order the Qi Decoction) is appropriate. If the pathogen is in the Middle Jiao, presenting only with dryness, excess, and hardness, Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) with added Gancao (Licorice Root) to harmonize the Middle Jiao should be used; Zhi Shi (Immature Bitter Orange) is omitted to avoid damaging the ethereal Qi of the Upper Jiao. If the pathogen is in the Upper Jiao, presenting with fullness and distension, Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate; Mangxiao (Mirabilite) is omitted to avoid damaging the True Yin of the Lower Jiao. If the exterior syndrome has not yet been resolved but the interior syndrome is urgent, requiring purgation, Dachaihu Tang (Major Bupleurum Decoction) should be used to unblock both the exterior and interior for a milder treatment. Da Chengqi Tang is the most potent, followed by Xiao Chengqi Tang, then Tiaowei Chengqi Tang, and finally Dachaihu Tang. This caution exists because Mangxiao has an urgent and drying nature and should not be used lightly.
Da Chengqi Tang uses Puxiao (Mirabilite) and Dahuang (Rhubarb Rhizome) in equal proportions, without excess. Houpo (Magnolia Bark) is doubled and combined with Zhishi (Immature Bitter Orange); this combination excels at unblocking the intestines and promoting bowel movements. Xiao Chengqi Tang consists of three herbs: Zhishi (Immature Bitter Orange), Dahuang (Rhubarb Rhizome), and Houpo (Magnolia Bark). For treating Jie Xiong (Chest Binding), delirium, and hardness of the large intestine, each dose of five qian demonstrates its efficacy readily.
Dahuang (Rhubarb Rhizome), Houpo (Magnolia Bark), and Zhishi (Immature Bitter Orange) constitute Nongpu Sanwu Tang (Three-Ingredient Magnolia Bark Decoction). Additionally, the two-herb combination of Houpo (Magnolia Bark) and Dahuang (Rhubarb Rhizome) treats abdominal pain and constipation associated with Taiyang disease (Taiyang Syndrome).
Tiaowei Chengqi Tang contains Mangxiao (Mirabilite) and Dahuang (Rhubarb Rhizome); adding Gancao (Licorice Root) yields the best results. It is suitable for abdominal fullness, hard stools accompanied by thirst, mental restlessness, and delirium. Dachaihu Tang (Major Bupleurum Decoction) utilizes Dahuang (Rhubarb Rhizome), Banxia (Pinellia Tuber), and Zhishi (Immature Bitter Orange) for excellent effect. Huangqin (Scutellaria Root) and Shaoyao (Peony Root) are also included; decocting with Shengjiang (Fresh Ginger) and Dazao (Jujube Fruit) benefits the large intestine. Gouti San (Gourd Tip Powder) contains Chixiaodou (Adzuki Bean); these two ingredients are used in equal proportions, a method passed down through tradition. Douchi (Prepared Soybean) combined with water is decocted; this formula induces vomiting to expel phlegm retained above the diaphragm. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) involves decocting Zhizi (Gardenia Fruit) first, then adding Douchi (Prepared Soybean) and water. For post-illness deficiency heat causing restlessness and insomnia, with a feeling of stifling discomfort in the chest, inducing vomiting with this formula leads to recovery.