大承气去芒硝。浓朴，枳实亦减。
大黄（四两，酒洗） 枳实（三枚大者，炙） 浓朴（二两，炙去皮） 上三味，以水四升，煮取一升二合，去
渣，分温二服。初服汤，当更衣，不尔者，尽饮之。若更衣者，勿服之。
阳明病，脉迟，虽汗出，不恶寒者，凡汗出者皆恶寒。其身必重，短气腹满而喘，有潮热者，以上皆内
实之症。此外欲解，不恶寒。可攻里也。手足 然汗出者，此大便已硬也，四肢为诸阳之本， 然汗出，阳
气已盛于土中矣。以此验大便之硬。又一法。大承气汤主之。若汗多，微发热、恶寒者，外未解也，其
热未潮，未可与承气汤。若腹大满不通者，可与小承气汤，微和胃气，勿令大泄下。腹满不通，虽外未
解，亦可用小承气，此方乃和胃之品，非大下之峻剂故也。
阳明病，潮热，大便微硬者，可与大承气汤，不硬者，不可与之。潮热而便不硬，亦禁下。若不大便，六、
七日，恐有燥屎，欲知之法，少与小承气汤，汤入腹中，转失气者，此有燥屎也，此以药探之。又一
法。乃可攻之。若不转失气者，以但初头硬，后必溏，不可攻之，攻之必胀满，不能食也；邪气因正虚而陷入。
欲饮水者，与水则哕；寒热相争则哕。其后发热者，必大便复硬而少也，重伤津液。以小承气汤和之，仍
用小承气，以大便硬故也。不转失气者，慎不可攻也。又再申前戒，圣人之慎下如此。
阳明病，其人多汗，以津液外出，胃中燥，大便必硬，硬则谵语。谵语由便硬；便硬由胃燥；胃燥由
汗出、津液少，层层相因。病情显著。大承气汤主之。若一服谵语止，更莫复服。
阳明病，谵语，发潮热，脉滑而疾者，小承气汤主之。因滑疾则易下，故止用小承气。因与小承气汤
一升，腹中转失气者，更服一升，若不转失气，勿更与之，明日不大便，脉反微涩者，里虚也，为难治，攻
之不应，是为难治。不可更与承气汤也。
太阳病，若吐、若下、若发汗后，过治。微烦，小便数，大便因硬者，因字当着眼，大便之硬，由小便
数之所致。盖吐、下、汗已伤津液，而又小便太多，故
尔微硬，非实邪也。与小承气汤，和之愈。
下利谵语者，有燥屎也。利而仍谵语，邪火不因利而息，则必有燥屎，盖燥屎不因下利而去也。后医
见利则不复下，岂知燥屎之不能自出乎？！宜小承气汤。
Da Chengqi Tang (Major Order the Qi Decoction) with Mangxiao (Natrii Sulfas, 芒硝) removed. The dosages of Houpo (Magnoliae Officinalis Cortex, 厚朴) and Zhishi (Immature Bitter Orange, 枳实) are also reduced.
Dahuang (Rhei Radix et Rhizoma, 大黄) (4 liang, washed with wine), Zhishi (Immature Bitter Orange, 枳实) (3 large pieces, roasted), Houpo (Magnoliae Officinalis Cortex, 厚朴) (2 liang, roasted and skin removed). These three ingredients are decocted in 4 sheng of water until 1.2 sheng remains. Strain the dregs, and divide into two warm doses. After the first dose, defecation should occur; if not, consume the remaining liquid. If defecation has occurred, do not take the rest.
In Yangming disease, with a slow pulse, although sweating occurs, there is no aversion to cold. Generally, those who sweat should have an aversion to cold. The body must feel heavy, there is shortness of breath, abdominal fullness, and wheezing. If tidal fever is present, these are all symptoms of internal excess accumulation. Furthermore, since the exterior syndrome is resolved and there is no aversion to cold, it indicates that purging the interior is permissible. Continuous sweating on the hands and feet indicates that the stool has already hardened. The four limbs are the root of all yang meridians; continuous sweating suggests that yang qi is abundant in the spleen and stomach (earth element). This serves as another method to verify the hardness of the stool. The treatment principle is Da Chengqi Tang (Major Order the Qi Decoction). If there is excessive sweating with slight fever and aversion to cold, the exterior is not yet resolved, and the heat has not reached the stage of tidal fever; thus, Chengqi Tangs should not be used. If there is significant abdominal fullness and obstruction, Xiao Chengqi Tang (Minor Order the Qi Decoction) may be used to mildly harmonize the stomach qi, avoiding severe purgation. Even if the exterior is not fully resolved, Xiao Chengqi Tang can be used for abdominal fullness and obstruction because this formula belongs to agents that harmonize the stomach, not harsh purgatives.
In Yangming disease, with tidal fever and slightly hard stool, Da Chengqi Tang (Major Order the Qi Decoction) may be used; if the stool is not hard, it should not be used. Tidal fever without hard stool also contraindicates purgation. If there is no bowel movement for six or seven days, suspecting dry feces, the method to confirm is to administer a small amount of Xiao Chengqi Tang (Minor Order the Qi Decoction). If passing gas after taking the medicine indicates the presence of dry feces, this is a diagnostic probe using medication, which is another method. Only then can aggressive purgation be considered. If there is no passing of gas, it implies that only the initial part of the stool is hard while the rest is loose; purgation is contraindicated as it will cause abdominal fullness and loss of appetite, causing pathogenic factors to sink due to deficiency of healthy qi. If the patient desires water but develops hiccups upon drinking, it indicates a struggle between cold and heat causing hiccups. Subsequent fever indicates that the stool will become hard again but in smaller quantity due to severe injury of body fluids. Use Xiao Chengqi Tang (Minor Order the Qi Decoction) to harmonize, continuing its use due to the hardness of the stool. If there is no passing of gas, absolutely avoid purgation. This reiterates the previous warning, demonstrating the sage's caution regarding purgation.
In Yangming disease, excessive sweating leads to the loss of body fluids, resulting in dryness of the stomach and hardening of the stool, which causes delirium (verbal confusion). Delirium results from hard stool; hard stool results from stomach dryness; stomach dryness results from sweating and depletion of body fluids, forming a chain of causality. The condition is evident. Treat with Da Chengqi Tang (Major Order the Qi Decoction). If delirium stops after one dose, do not administer further doses.
In Yangming disease, presenting with delirium, tidal fever, and a slippery and rapid pulse, treat with Xiao Chengqi Tang (Minor Order the Qi Decoction). Because the slippery and rapid pulse indicates ease of downward movement, only Xiao Chengqi Tang is used. Administer one sheng of Xiao Chengqi Tang (Minor Order the Qi Decoction); if passing gas occurs, administer another sheng. If no gas passes, do not give more. If the next day there is still no bowel movement and the pulse becomes faint and choppy, it indicates interior deficiency, making it difficult to treat. If purgation fails to respond, it is deemed difficult to treat. Do not administer Chengqi Tangs again.
In Taiyang disease, after improper use of emesis, purgation, or sweating therapies (over-treatment), mild irritability, frequent urination, and consequently hard stool may occur. The character "consequently" is key; the hardness of the stool is caused by frequent urination. Since emesis, purgation, and sweating have already damaged body fluids, and excessive urination follows, the stool becomes slightly hard, not due to excess pathogens. Treat with Xiao Chengqi Tang (Minor Order the Qi Decoction) to harmonize and cure.
Diarrhea accompanied by delirium indicates the presence of dry feces. Diarrhea persisting with delirium means the pathogenic fire does not subside with diarrhea, implying dry feces remain because they cannot be expelled by diarrhea. Later physicians see diarrhea and refrain from purgation, failing to realize that dry feces cannot exit spontaneously. Treat with Xiao Chengqi Tang (Minor Order the Qi Decoction).