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Treating Yangming Fu-organ disease, presenting with tidal fever (Tidal Fever), delirium (Delirium), constipation (Constipation), and hard pain around the navel (Hard pain around the navel), indicates the presence of dry feces (Dry feces). This heat is accumulated and condensed. Use Da Huang (Rhei Radix et Rhizoma, 3 qian), Mang Xiao (Natrii Sulfas, 2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 5 fen), decocted in water and taken orally.

Removing Gan Cao from this formula and adding Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex), it is named Da Cheng Qi Tang (Major Order the Qi Decoction).

My commentary: Zhi Shi eliminates epigastric fullness and stuffiness (Pi), Hou Po removes abdominal distension (Man), Mang Xiao moistens dryness (Zao), and Da Huang purges excess (Shi). It can only be used when all four symptoms—epigaastrium stuffiness (Epigastric stuffiness), abdominal distension (Abdominal distension), dryness (Dryness), and excess (Excess)—are present simultaneously. If there is epigastric stuffiness and abdominal distension but no dryness or excess, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be used without Mang Xiao, to avoid damaging the Yin blood of the Lower Jiao (Lower Jiao). If there is dryness and excess but no epigastric stuffiness or abdominal distension, use this formula (Tiao Wei Cheng Qi Tang - Regulate the Stomach Order the Qi Decoction) without Zhi Shi and Hou Po, to avoid damaging the Yang Qi of the Upper Jiao (Upper Jiao).

Eight contraindications for using Cheng Qi Tang are discussed:
1. If the exterior syndrome is not resolved and aversion to cold (Aversion to cold) persists, and urination is clear and profuse, it is known that the pathogen is still at the exterior level, not the interior. The treatment method should be diaphoresis (Diaphoresis) to resolve the exterior.
2. Hardness and fullness in the epigastrium (Epigastric hardness and fullness). Fullness in the epigastrium indicates the pathogen is still shallow; if mistakenly treated with purgation, diarrhea will persist incessantly, potentially leading to the collapse of healthy Qi downward.
3. Flushed face (Flushed face). A flushed face indicates the pathogen is at the exterior, with floating fire gathering above but not condensing below, so purgation is not yet appropriate. Furthermore, a flushed face may indicate Dai Yang syndrome (Floating Yang syndrome), which requires careful differentiation.
4. Small food intake normally, or ability to eat during illness. Small food intake normally indicates deficiency of Stomach Qi (Stomach Qi), so purgation is inappropriate. However, if dry feces are present, one usually cannot eat; if one can eat despite illness, it means there are no dry feces, only hard stool, so purgation is also inappropriate.
5. Frequent vomiting (Frequent vomiting). Vomiting belongs to Shaoyang syndrome (Shaoyang syndrome); the pathogen is in the Upper Jiao, so purgation is inappropriate.
6. Slow pulse (Slow pulse). A slow pulse indicates Cold (Cold); purgation will lead to hiccups (Hiccups).
7. Exhaustion of body fluids internally. The patient sweats spontaneously, and urination is normal/profuse. This indicates exhaustion of body fluids internally (Exhaustion of body fluids internally); purgation is inappropriate. Instead, honey suppositories (Honey suppository) should be used to promote bowel movement.
8. Scanty urination. Normally, the patient urinates three or four times a day; today only twice. This indicates that stool will soon enter the Large Intestine (Large Intestine); it is advisable to wait temporarily and not to blindly purge.

Question: Why does tidal fever belong to Yangming Fu-organ syndrome? Answer: Tidal fever occurs like the tide, on time. Today fever occurs in the afternoon, and tomorrow fever also occurs in the afternoon, hence the name tidal fever. If fever lasts all day until evening, it is simply fever, not tidal fever. If alternating chills and fever occur, it is alternating chills and fever (Alternating chills and fever). Zhang Zhongjing said: "If the heat is not tidal, do not administer Cheng Qi Tang." This shows that tidal fever is suitable for Cheng Qi Tang. Another question: Tidal fever certainly warrants purgation; what if there are concurrent exterior symptoms? Answer: If tidal fever is accompanied by an exterior syndrome, the exterior must first be resolved, then the interior attacked. If the interior condition is very urgent, the method of Da Chai Hu Tang (Major Bupleurum Decoction) can be used to treat both the exterior and interior simultaneously.