麻仁二升 芍药半筋 枳实半筋 大黄（去皮）一筋 厚朴（去皮）一筋 杏仁（去
皮、尖，熬，别作脂）一升
右六味，蜜合丸，如桐子大。饮服十丸，日三服，渐加、以和为度。
【集解】
方有执曰：麻子、杏仁能润干燥之坚，枳实、厚朴能导固结之滞，芍药敛液以辅润，
大黄推陈以致新，脾虽为约，此能疏之。
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伤寒吐后，腹胀满者，与调胃承气汤。
【注】
伤寒吐后，胸不胀满而腹胀满者，是表邪已尽，胃中壅热故也。宜与调胃承气汤，下
其热而和之。以无□痛，故不用大小承气也。
【集注】
程知曰：言吐后腹胀满宜调胃也。热在上焦则吐，吐后腹胀满，则邪不在胸，其为里
实可知。然胀满而不□痛，自不宜用急下之法，但与调胃承气，和其胃热可耳！『内
经』云：诸胀腹大，皆属于热也。
程应旄曰：吐伤津液，燥气不能下达，遂成土郁，是以腹胀满，用调胃承气，一夺其
郁可耳！
大黄（去皮，酒浸）四两 甘草（炙）二两 芒硝半升
右三味，以水三升，煮取一升，去滓，内芒硝，更煮两沸，少少温服之。
【方解】
方名调胃承气者，有调和承顺胃气之义，非若大小承气专攻下也。经曰：热淫于内，
治以咸寒；火淫于内，治以苦寒。君大黄之苦寒，臣芒硝之咸寒，二味并举，攻热泻
火之力备矣。恐其速下，故佐甘草之缓；又恐其过下，故少少温服之，其意在不峻而
和也。
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阳明病，不吐不下，心烦者，可与调胃承气汤。
【注】
阳明病，谓已传阳明，不吐、不下，心烦者，谓未经吐、下而心烦也，其为热盛实烦
可知。故与调胃承气汤泻热，而烦自除也。
【集注】
成无己曰：吐后心烦谓之内烦，下后心烦谓之虚烦，今阳明病不吐不下心烦，则是胃
有郁热也，与调胃承气汤以下其郁热。
喻昌曰：胃气及津液，既不由吐、下而伤，则心烦明系胃中热炽，故可与调胃承气汤
。
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阳明发热汗多者，急下之，宜大承气汤。
【注】
阳明病，不大便，发热汗多不止者，虽无内实，亦当急下之。盖因阳气大蒸于内，恐
致阴液暴亡于外，故以全津液为急务也，宜大承气汤下之。
【集注】
喻昌曰：汗多则津液外渗，加以发热，则津液尽随热势，蒸蒸腾达于外，更无他法以
止其汗，惟有急下一法，引热势从大肠而出，庶津液不致尽越于外耳。
程应旄曰：此等之下，皆为救阴而设，不在夺实，夺实之下可缓，救阴之下不可缓。
沈明宗曰：阳明里实，以潮热微汗为正。兹见发热汗多，乃里热炽盛之极，蒸腾胃中
津液，尽越于外，非亟夺其邪以救津液不可，故宜大承气汤急下也。
Hemp Seed (Cannabis Fructus) 2 sheng, Peony Root (Paeoniae Radix Alba) half jin, Immature Bitter Orange (Aurantii Fructus Immaturus) half jin, Rhubarb (Rhei Radix et Rhizoma) (peeled) 1 jin, Magnolia Bark (Magnoliae Officinalis Cortex) (peeled) 1 jin, Apricot Seed (Armeniacae Semen Amarum) (peeled and tipped, roasted, ground separately into paste) 1 sheng.
The above six herbs are combined with honey to form pills, sized like wu-tong seeds. Take ten pills at a time with warm water, three times daily. Gradually increase the dosage until bowel movements become harmonious.
[Ji Jie - Collected Commentary]
Fang Youzhi stated: Hemp seed and apricot seed can moisten dryness and soften hardness; immature bitter orange and magnolia bark can guide and resolve stagnation of solid accumulation; peony root collects fluids to assist in moistening; rhubarb eliminates the old to bring forth the new. Although the Spleen is constrained (referring to Pi Yue syndrome), this formula can relieve it.
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In Taiyang Cold Damage disease, if abdominal fullness occurs after emesis, administer Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction).
[Note]
In Taiyang Cold Damage disease, if the chest is not full but the abdomen is full after emesis, it indicates that the exterior pathogenic factor has been completely exhausted, and there is obstructing heat in the Stomach. It is appropriate to administer Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) to purge the heat and harmonize the stomach. Since there is no abdominal pain, Da Cheng Qi Tang (Major Order the Qi Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) are not used.
[Ji Zhu - Collected Annotations]
Cheng Zhi said: This discusses that abdominal fullness after emesis requires regulating the Stomach. Heat in the Upper Jiao causes emesis; if abdominal fullness follows emesis, the pathogen is not in the chest, indicating interior excess. However, since there is fullness without pain, urgent purging is inappropriate. One should only use Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) to harmonize the Stomach heat! The *Neijing* states: All cases of abdominal distension and enlargement belong to heat.
Cheng Yingmao said: Emesis damages body fluids, preventing dry qi from descending, leading to Earth qi stagnation, resulting in abdominal fullness. Using Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) can resolve this stagnation.
Rhubarb (Rhei Radix et Rhizoma) (peeled, soaked in wine) 4 liang, Licorice Root (Glycyrrhizae Radix et Rhizoma) (roasted) 2 liang, Mirabilite (Natrii Sulfas) 0.5 sheng.
The above three herbs are boiled in 3 sheng of water to obtain 1 sheng of decoction. Strain out the dregs, add Mirabilite (Natrii Sulfas), boil for two more boils, and take small amounts warm.
[Fang Jie - Formula Explanation]
The name "Tiao Wei Cheng Qi" implies harmonizing and accommodating Stomach Qi, unlike Da Cheng Qi Tang (Major Order the Qi Decoction) and Xiao Cheng Qi Tang (Minor Order the Qi Decoction) which specialize in purging. The Classics state: For heat flooding within, treat with salty-cold substances; for fire flooding within, treat with bitter-cold substances. Using Rhubarb (Rhei Radix et Rhizoma) as the sovereign herb for its bitter-cold nature, and Mirabilite (Natrii Sulfas) as the minister herb for its salty-cold nature, these two together provide sufficient power to attack heat and drain fire. To prevent rapid purging, Licorice Root (Glycyrrhizae Radix et Rhizoma) is added as an assistant to moderate the action; to prevent excessive purging, it is taken in small amounts warm. The intent is to be non-violent and harmonizing.
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In Yangming disease, if there is mental restlessness (fan) without prior emesis or purgation, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) may be given.
[Note]
Yangming disease refers to the transmission of the pathogen to the Yangming channel. Mental restlessness (fan) occurring without prior emesis or purgation indicates heat excess causing real mental restlessness. Therefore, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) is given to purge heat, and the mental restlessness will naturally resolve.
[Ji Zhu - Collected Annotations]
Cheng Wuji said: Mental restlessness after emesis is called internal mental restlessness; mental restlessness after purgation is called deficient mental restlessness. Now, in Yangming disease, mental restlessness without emesis or purgation indicates stagnant heat in the Stomach. Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) is given to purge this stagnant heat.
Yu Chang said: Since Stomach Qi and body fluids are not damaged by emesis or purgation, the mental restlessness is clearly due to blazing heat in the Stomach. Thus, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) can be given.
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In Yangming disease, if there is fever and profuse sweating, urgent purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable.
[Note]
In Yangming disease, if there is constipation, fever, and continuous profuse sweating, even without typical interior excess accumulation, urgent purgation is necessary. This is because Yang Qi is vigorously steaming internally, risking sudden exhaustion of Yin fluids externally. Preserving body fluids is the urgent priority, so Da Cheng Qi Tang (Major Order the Qi Decoction) should be used for purgation.
[Ji Zhu - Collected Annotations]
Yu Chang said: Profuse sweating causes body fluids to leak outward; combined with fever, all body fluids follow the heat trend, steaming and reaching outward. There is no other method to stop the sweating except urgent purgation, which guides the heat trend out through the Large Intestine, preventing body fluids from being entirely lost outward.
Cheng Yingmao said: Purgation in such cases is designed to save Yin, not to seize excess. Purgation to seize excess can be slow; purgation to save Yin cannot be delayed.
Shen Mingzong said: In Yangming interior excess, tidal fever and slight sweating are typical signs. Seeing fever and profuse sweating now indicates extreme blazing interior heat, steaming Stomach fluids and causing them to overflow outward. It is imperative to urgently seize the pathogen to save body fluids, hence Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable for urgent purgation.