大黄（四两清酒浸） 甘草（二两炙） 芒硝（半升）
上三味 咀。以水三升煮取一升。去滓。纳芒硝更上火微煮令沸。少少温服之。
承气者。用以制亢极之气使之承顺而下也。伤寒秘要曰。王海藏论云。仲景承气汤有大小调胃之殊。今人以三一承
气不分上下缓急用之。岂不失仲景本意。大热大实。用大承气。小热小实。用小承气。实热尚在胃中，用调胃承气以甘
草缓其下行而祛胃热也若病大用小。则邪气不伏。病小用大则过伤正气。病在上而用急下之剂。则上热不除岂可一概混
治哉节庵论小承气曰。上焦受伤。去芒硝恐伤下焦血分之真阴。论调胃承气曰邪在中焦不用枳实浓朴以伤上焦虚无氤氲
之元气然此汤独可用芒硝以伤下焦乎。吾未闻承气汤有主上焦者。未闻调胃承气之证。至于坚而燥也。仲景调胃承气汤
证。八方中并无干燥。不过曰胃气不和。曰胃实。曰腹满。则知此汤专主表邪悉罢初入腑而欲结之证也。故仲景以调胃
承气收入太阳阳明。而大黄注曰酒浸。是太阳阳明去表未远其病在上。不当攻下。故宜缓剂以调和之。及至正阳阳明。
则皆曰急下之。而大承气汤大黄注曰。酒洗是洗轻于浸微升其走下之性以和其中。至于少阳阳明。则去正阳而逼太阴。
其分在下。故用小承气大黄不用酒制也。
Rhei Radix et Rhizoma (Four liang, soaked in clear wine) Glycyrrhizae Radix et Rhizoma Preparata (Two liang, honey-fried) Natrii Sulfas (Half sheng)
The above three ingredients are coarsely crushed. Boil with three sheng of water to obtain one sheng of decoction. Remove the dregs. Add Natrii Sulfus and boil gently over fire until it boils. Take warm medicine in small amounts frequently.
"Chengqi" refers to using agents to restrain excessive Qi and make it descend smoothly. *Shanghan Miyao* states: Wang Haicang discussed that Zhang Zhongjing's Chengqi Decoctions differ into Da Chengqi Tang, Xiao Chengqi Tang, and Tiaowei Chengqi Tang. Nowadays, people use San-Yi Chengqi Tang indiscriminately for upper/lower or slow/urgent conditions, which surely deviates from Zhang Zhongjing's original intent. For severe heat and excess, use Da Chengqi Tang; for mild heat and excess, use Xiao Chengqi Tang; when excess-heat remains in the Stomach, use Tiaowei Chengqi Tang. The sweetness of Glycyrrhizae Radix slows its downward action to dispel Stomach heat. If a severe disease is treated with a mild formula, the pathogenic factor will not be subdued; if a mild disease is treated with a strong formula, healthy Qi will be excessively damaged. If an urgent purgative is used for a disease located in the upper jiao, the upper heat will not be eliminated. How can all cases be treated uniformly? Jie'an discussed Xiao Chengqi Tang, stating that removing Natrii Sulfus prevents damage to the true Yin of the blood in the lower jiao when the upper jiao is injured. He discussed Tiaowei Chengqi Tang, stating that avoiding Zhi Shi and Hou Po protects the ethereal Yuan Qi of the upper jiao from injury by the middle-jiao pathogen. However, does this formula alone, containing Natrii Sulfus, not harm the lower jiao? I have never heard of Chengqi Tang treating the upper jiao, nor have I heard of indications for Tiaowei Chengqi Tang involving hard, dry stool. In Zhang Zhongjing's descriptions of Tiaowei Chengqi Tang indications across eight clauses, there is no mention of dryness, only "Stomach Qi disharmony," "Stomach excess," and "abdominal fullness." Thus, we know this decoction specifically treats conditions where exterior pathogens have completely resolved, just entering the fu-organs and beginning to bind. Therefore, Zhang Zhongjing included Tiaowei Chengqi Tang in the Taiyang-Yangming chapter and noted that Rhei Radix should be wine-soaked. This is because Taiyang-Yangming pathology is still close to the exterior, with the disease location higher up, so direct purgation is inappropriate; thus, a mild harmonizing formula is suitable. When reaching Zhengyang Yangming, urgent purgation is indicated, and the Rhei Radix in Da Chengqi Tang is noted as wine-washed. Washing is milder than soaking, slightly enhancing its descending property to harmonize the middle jiao. As for Shaoyang-Yangming, it moves away from Zhengyang and approaches Taiyin, with the pathology located lower down; therefore, Xiao Chengqi Tang is used, and the Rhei Radix therein is not processed with wine.