大黄四两 浓朴二两 枳实三枚（麸炒）
此治邪在中、上两焦之正法也。注中但有谵语潮热、喘满等症，而无腹胀坚满之象，故
减去芒硝，不使伐无病之地以劫阴。略一加减，必有精义，规矩方圆之至也。
大黄（酒浸） 芒硝一两 甘草（炙）五钱
少少温服。
此治邪在中下焦之正法也。注中“恶热口渴、腹满，中焦燥实”数语，最宜着眼。可见
病在脾胃，全与上焦无涉，若杂入枳、朴以犯上焦，则下焦之浊气必随感而上，反致喘逆者
有之矣！去枳、朴，加甘草，使之专入脾胃，而又缓芒、黄善走之烈，谨慎周详，毫发无憾。
大黄二两 芒硝一升 甘遂一钱（为末）
先煮大黄去滓，内芒硝，煮一、二沸，内甘遂末，温服。
伤寒下之早，则反为结胸。盖缘邪尚未入阳明，若先下之，则邪未去而徒伤胃气，邪反
得乘虚入胃，而为结胸。或热胜、寒胜、痰胜、湿胜，诸泻心汤参酌用之，最为妥善。此症
仲景用泻心、承气诸法，而用大陷胸汤者，因三焦俱实，而又有水气，故不得不改用此方。
观
胃
至前后两条，有云∶“或重汗而复下之，不大便，五六日，舌上燥渴”，此则津液大伤，近
于阳结。又云∶“或无大热，但头微汗出，脉沉”，为水结胸，则近于阴结。此二条，似不
堪此峻剂矣！丹溪亦微有不满之意，后人自当以慎重为宜。
Rhubarb (Da Huang) 4 liang, Magnolia Bark (Hou Po) 2 liang, Immature Bitter Orange (Zhi Shi) 3 pieces (stir-fried with bran)
This is the standard treatment for pathogenic factors located in the Middle and Upper Jiao. The commentary notes symptoms such as delirium (Chan Yu), tidal fever (Chao Re), and distension/fullness with panting, but lacks the sign of abdominal distension, hardness, and fullness. Therefore, Mirabilite (Mang Xiao) is omitted to prevent attacking healthy areas and depleting Yin fluids. A slight modification necessarily contains profound principles, representing the utmost adherence to rules and standards.
Rhubarb (Da Huang) (soaked in wine), Mirabilite (Mang Xiao) 1 liang, Licorice Root (Gan Cao) (roasted) 5 qian
Take small amounts, warmed.
This is the standard treatment for pathogenic factors located in the Middle and Lower Jiao. The phrases "aversion to heat, thirst, abdominal fullness, and dryness-excess in the Middle Jiao" in the commentary deserve special attention. This indicates that the disease is in the Spleen and Stomach, completely unrelated to the Upper Jiao. If Zhi Shi and Hou Po were added to invade the Upper Jiao, turbid Qi from the Lower Jiao would likely ascend due to stimulation, potentially causing adverse effects such as panting and rebellion! By removing Zhi Shi and Hou Po and adding Gan Cao, the medicinal action is directed specifically to the Spleen and Stomach, while simultaneously moderating the aggressive and moving nature of Mang Xiao and Da Huang. This approach is cautious, detailed, and flawless.
Rhubarb (Da Huang) 2 liang, Mirabilite (Mang Xiao) 1 sheng, Kansui Root (Gan Sui) 1 qian (ground into powder)
First decoct Da Huang, remove the dregs, add Mang Xiao, boil for one or two boils, then add the Gan Sui powder, and take warm.
If purgation is used too early in Taiyang Cold Damage (Shang Han), it may result in Chest Binding (Jie Xiong). This is because the pathogen has not yet entered the Yangming stage; if purgation is applied first, the pathogen remains while the Stomach Qi is unnecessarily damaged, allowing the pathogen to take advantage of the deficiency and enter the Stomach, forming Chest Binding. Alternatively, depending on whether Heat, Cold, Phlegm, or Dampness predominates, various Xi Xin Tang formulas should be considered and selected appropriately, which is the most prudent approach. For this condition, although Zhang Zhongjing could have employed methods such as Xi Xin Tang or Cheng Qi Tang, he used Da Xian Xiong Tang because there was excess in all three Jiaos accompanied by fluid retention (Water Qi), necessitating the use of this formula.
Observing the preceding and following clauses regarding the stomach area: one states, "Or after heavy sweating followed by purgation, no bowel movement for five or six days, dry tongue and thirst," indicating severe injury to body fluids, approaching Yang Binding (Yang Jie). Another states, "Or no significant heat, only slight sweating on the head, deep pulse," indicating Water Binding in the Chest (Shui Jie Xiong), approaching Yin Binding (Yin Jie). These two conditions seem unsuitable for such harsh remedies! Zhu Danxi also expressed slight dissatisfaction, and later practitioners should naturally prioritize caution.