瓜蒂散 治表证罢，邪热入里，结于胸中，烦满而饥不能食，微厥而脉乍紧者，宜以吐之。
大柴胡汤 诸服小柴胡汤证后，病不解，表里热势更甚而心下急郁微烦，或
发热汗出不解，下心痞硬，呕吐下利（以上属太阳）；或阳明病，多汗；或少阴病，
下利清水，心下痛而口干；或太阴病，腹满而痛；或无表里证，但发热七、八日，虽脉浮而数，
或脉在肌肉，实数而滑者；及两感诸证，可微下者，双除表里三热者，并宜此剂。
大承气汤 治大、小二柴胡证后，表里俱热，病势更甚者；或阳明脉迟、汗出、不恶寒。
阳明主肌肉，热甚，自汗多，故脉不能数而反迟也。里热更甚，故不恶寒而反恶热也。
身重短气，腹满而喘，有时潮热，
恶寒为表热，当汗而不可下；发热为里热，当下而不可汗。
或手足心 然汗出者。（ ，阻立切，和也。）
今言，唯手心足心气似和，然而汗出也。
此大便已硬也；或吐下后不解，不大便五、六日至十余日，日晡潮热，不恶
寒，独语如见鬼状，剧者发则不识人，循衣摸床，惕然而安，微喘，此阳明里热极甚也。
足阳明胃经外为肌肉十二经之长；内为五脏之本，六腑之大源。故阳明
胃病虽为腑病，其脉沉数而实者，皆当下之也。然肠胃热甚则大便自黄赤变褐以至于黑者，难治也。
凡潮热谵语，不能食者，肠中已有燥粪，能食者但硬耳。旧云胸中有燥粪，是寄手阳明证在足阳明也。
燥粪实非在于胸耳。
或阳明病，下之后，心胸燥热而懊 烦躁者（亡液故也）；或烦热，汗出则解，
复如疟状，日晡发热而脉沉实者，宜以下也。
脉浮虚者，桂枝汤主之。
或六、七日不大便，目不了了，睛不和，无表里证，大便难，身微热者；或
小便不利，大便乍难乍易，时发微热，喘冒不能卧者，有燥粪也；或三部脉皆
平，心下硬；或脉大而紧者；或下利、脉滑而数者；或下利，脉迟而滑者。
迟由热泄不止而致之，实非寒也。
或少阳病，二、三日，口燥咽干者；或自利清水，色纯青，心下痞痛，口燥者。
皆湿相搏于肠胃之内而或下利也。然热则郁结，湿则痞闭，故水液不结
及浸润于外，则肠胃之外，燥热太甚，而烦渴不止，肠胃之内湿热泻也，本因热郁而留饮以成湿也。
或诸腹满实痛，烦渴谵妄，脉实数而沉者，无问日数，并宜大承气下之。或里热燥甚，肠胃怫郁，
留饮不散，烦渴不止，胸腹高起痛不可忍，但呕冷液，大渴反不能饮饮亦不能止其渴，喘急闷乱但欲死
者，热服下咽立止其渴有若无病之人，须臾大汗而愈，至此往往多未利而汗出，亦有药力但随汗
之宣通，则不利而愈者也。
小承气汤 治伤寒日深，恐有燥屎，欲知之法，少服小承气汤，腹中转矢气（谓动转失
泄之气也），有燥屎也，乃可攻之；不转矢气者，必初硬后溏，未可攻之，攻之则腹满不能食也。欲
饮水而哕，其后发热者，大便复硬而少也，宜小承气和之。若腹大满不通与小承气汤微和胃气，勿
大泄也。或阳明多汗，津液外出，肠
胃燥热，大便必硬而谵语也。或谵语、脉滑疾，或发汗、吐、下后，微烦，小便、大便因硬者；或下
利谵语者，多复有燥屎也，通宜小承气汤下之。或得病二、三日，脉弱，无太阳柴胡证，烦躁，心下
硬，至四、五日，虽能食，少少与小承气汤和之，令小安。
调胃承气汤 治诸发汗、和解、吐后，不恶寒，但发热而或蒸蒸然者；或日
深，心下温温欲吐而胸中满痛，大便反溏，腹微满，郁郁微烦，先此时，自极吐下者（先，苏佃切）。
先此时者，先此时之前，已曾自极吐、下而复此证也。
或日深，里热、谵语，法当承气下之。误以银粉、巴豆燥热大毒丸药下之，以致真阴损虚，则邪热
转甚（甚者为邪，衰者为正），因而协热下利不止，脉反调和也（协，胡劫切，和也，合也）。
今言病本为热，而又与辛热大毒丸药下之，则两热协和相合而热甚，下利不止也。下利脉
当微厥，而其热药攻之，故脉反适当其调和也。言有热，利不止而脉反平，或滑、实、大而紧者也。
及或表病里和，而下之太早，表热乘虚入里，而或不成结胸，但为热利不
止，心下满硬或痛，烦渴咽干，脉滑数而或实者，或诸腹满实痛者，或烦渴谵妄
者，小便赤涩，大便或硬，或热泄，脉滑实而紧甚也，并宜调胃承气汤下之。
三一承气汤 通治大、小、调胃，三承气汤证。
大法表证罢，热传于里则宜下之，热除即愈，宜调胃承气也；此失下，热极则危而死矣。表
病里和，则当汗之，热泄身凉即愈；若反下之，则表热乘虚入里而成结胸之类诸病也。或表热
半传于里，半尚在表，则不可汗、下，宜小柴胡之类和解之也。或表里两证热势俱甚，而和解不能已
者，虽邪热半在里、半在表，法当寒热往来，以其表里热势俱甚，故亦不恶寒而俱恶热也，宜大柴胡汤
微下之，通除表里之热也。或误用调胃承气，则只能攻里不能除其表热；或用小承气，多攻里、少除
表，则表热乘虚入里，皆能为害也。其大柴胡证，势更甚者，宜大承气下之。设未全愈，而或有表之微
浅邪热入之于里，以其浓朴、枳实之类，善开结滞，而不能成其结胸之类诸病也。故《活人书》言∶
攻里之药，调胃承气最紧，小承气次之，大承气又次之，大柴胡最缓慢。故表证未罢而为里热已甚，
须可缓下者，先大柴胡，次大承气，亦可通也。若论善开郁结，怫热峻疾得利，而效至大，设未痊除而
亦难再郁结者，大承气也。故《活人书》复言大承气最紧，小承气次之，调胃
承气又次之，大柴胡最慢也。是以可急下之者，宜大承气也，故虽大柴亦可
通用，而复无急下之证也。或可微下及微和胃气者，小承气汤、调胃承气为后、先之次。由是观之，
而缓下、急下，善开发而难郁结，可通用者，大承气汤最为妙也。故今加甘草名曰三一承气汤，
通治三承气汤证于效甚速而无加害也。然以其甘草味能缓其急结，温中润燥而又善以和合诸药而能成功，
故《本草》云国老子也。是以大承气汤得其甘草则尤妙也。然此一方，是三承气等汤也。
或无问伤寒、杂病、内外一切所伤，日数远近，但以腹满、咽干、烦渴、谵妄、心下按之硬
痛，或热甚喘咳、闷乱、惊悸、癫狂、目疾、口疮、舌肿、喉痹、痈肿、疮疡，或伤寒、阳明胸热、
发斑、脉沉，须可下者；及小儿惊风、热极潮搐，涎喘、昏塞，并斑疹。痘疮、热极黑陷、小便不
通、腹满喘急、将欲死者，或斑疹后热毒不退，久不作痂者（痂，音茄，疮痂也），或作斑痈、疮
癣，久不已者；或怫热内成 癖坚积，腹满而喘，黄瘦潮热，惊风热积，及大人小儿久新疟
疾，暴卒心痛，风痰酒膈，肠垢积滞，久壅风暴，伤酒食，烦心闷乱，脉数沉实，或肾水阴虚，阳
热暴甚，而僵仆卒中，或一切暴喑不语，失喑；或蓄热内甚，阳厥极深，脉反沉细而欲绝者；或表之
冲和正气与邪气并之于里，则里热亢甚而阳极似阴，反为寒战，脉微欲绝者；或风热燥甚，客于下
焦而大、小便涩滞
或不通者；
风木能胜湿土，火热能耗水液，因而成燥。燥则紧敛、坚结、滞不通，故风热燥甚于下焦，
则燥粪结硬，腹又紧敛者，其燥粪不能相离，并膀胱燥郁不能渗泄，故不通也。慎不可用银粉、巴
豆大毒燥热丸药下之，反生燥热而耗其阴液也。故伤寒下热，古皆禁之。最宜三一承气汤兼用下取法。
或产妇胎死不下者；
风热燥湿紧敛，则产户不得自然开通也。其证逆，脉弦数而涩，面赤，或青，或变五色，腹
满急痛，喘闭，胎已不动者，是也。手足温而脉滑者止为难产，但宜滑胎催生，慎不可下也。
及两感，表里热甚，欲可下者，并宜三一承气（大承气加甘草是也）。或下食积及
急攻结滞者，调下轻粉一字。滞下、目疾、口疮、咽喉疮疡，斑疹，加凉膈散。下死胎加益元散。
十枣汤 治太阳中风，下痢呕逆，表证罢，干呕短气，不恶寒， 汗出，
发作有时，头痛、心下痞、硬满，引胁下痛者，兼下水肿、腹胀，并酒积、食积一切肠垢积滞、
癖坚积，或蓄热心腹暴痛，或疟气久不已者，或表之正气与邪热并甚于里，热极似阴而反寒战，
表气入里而阳厥极深，故脉微而欲绝也。并风
热燥甚，结于下焦，大便不通，或实热腰痛者，及小儿热结，乳癖积热作发，惊
风潮搐，斑疹热毒不能了绝者，宜以下之。
瓜蒂散 治疗表证已解，邪热内传入里，结聚于胸中，出现烦闷胀满且感到饥饿却无法进食，手足轻微厥冷而脉搏突然变紧的情况，适宜采用涌吐法治疗。
大柴胡汤 适用于服用小柴胡汤后，病情仍未解除，表里热势更加严重，且心下（胃脘部）拘急郁结、微有烦闷，或者发热汗出而病不解，导致心下痞塞坚硬，呕吐并伴有腹泻（以上属于太阳病范畴）；或者是阳明病，多汗；或者是少阴病，腹泻排出清水样便，心下疼痛且口干；或者是太阴病，腹部胀满且疼痛；或者是没有明显的表证或里证，仅仅发热七八天，虽然脉搏浮而数，或者脉搏位于肌肉层之间，脉象实、数而滑的；以及两感病等各种证候，适合轻微攻下的，能够同时清除表里三经热邪的，都适宜使用此方。
大承气汤 治疗经过大、小柴胡汤证治疗后，表里俱热，病情更加严重的；或者是阳明病见脉迟、出汗、不恶寒。阳明经主司肌肉，热势极盛，自汗多，所以脉搏不能表现为数脉反而呈现迟脉。里热更加严重，所以不恶寒反而恶热。身体沉重、气短，腹部胀满且喘息，有时出现潮热。恶寒属于表热，应当发汗而不可攻下；发热属于里热，应当攻下而不可发汗。或者手心脚心持续不断地出汗。（“濈然”，读音为阻立切，意为连续不断的样子。）现在的意思是，只有手心脚心的气机似乎调和，然而却持续出汗。这说明大便已经干硬了；或者在呕吐、攻下之后病情仍未解除，五六天到十几天不大便，每天下午定时发热（日晡潮热），不恶寒，独自说话如同看见鬼怪一样，严重的发作时不认识人，手循摸衣被和床沿，惊恐不安，轻微气喘，这是阳明里热极度亢盛的表现。足阳明胃经外部是十二经脉之长，主管肌肉；内部是五脏的根本，六腑的大源头。所以阳明胃病虽然是腑病，但如果脉象沉、数而实，都应当攻下。然而如果肠胃热势极盛，导致大便颜色由黄赤变为褐色甚至黑色，这就难以治疗了。凡是出现潮热、谵语、不能进食的，说明肠中已有燥屎；能进食的，仅仅是大便干硬罢了。旧说认为胸中有燥屎，这是将手阳明大肠的证候寄附在足阳明胃经上了。燥屎实际上并不在胸中。或者是阳明病，攻下之后，心胸燥热且懊恼烦躁的（这是因为津液耗亡的缘故）；或者是烦热，出汗后暂时缓解，但随后又像疟疾一样，每天下午发热且脉象沉实的，适宜攻下。脉象浮而虚弱的，用桂枝汤主治。或者是六七天不大便，眼睛视物不清，眼球转动不灵活，没有明显的表里证，大便困难，身体微热的；或者是小便不利，大便时而难时而易，偶尔发热，气喘头晕不能平卧的，说明有燥屎；或者是寸关尺三部脉象都平和，但心下痞硬的；或者是脉大而紧的；或者是腹泻、脉滑而数的；或者是腹泻、脉迟而滑的。脉迟是因为热性腹泻不止导致的，实际上并非寒证。或者是少阳病，二三天，口干燥咽干的；或者是自行腹泻清水，颜色纯青，心下痞塞疼痛，口干燥的。这都是湿热相搏结于肠胃内部而导致腹泻。然而热则郁结，湿则痞闭，所以水液不能凝结及浸润于体表之外，导致肠胃之外燥热太甚，烦渴不止；肠胃之内则是湿热下泻，这原本是因为热邪郁结而停留的水饮形成了湿邪。或者是各种腹部胀满、实证疼痛，烦渴、谵语妄言，脉象实、数而沉的，不论患病天数多少，都适宜用大承气汤攻下。或者是里热燥热极甚，肠胃郁结，停留的水饮不散，烦渴不止，胸腹部高高隆起疼痛无法忍受，只呕吐冷涎，极度口渴反而不能饮水，即使饮水也不能止渴，气喘急促、胸闷烦乱痛苦欲死的，热服药液咽下后立即止渴，好像没病的人一样，一会儿大汗出而痊愈，到了这种地步往往大便不通利而先出汗，也有药力随着汗液的宣通而发挥作用，从而在大便不通利的情况下痊愈的。
小承气汤 治疗伤寒病程加深，担心有燥屎，想要确认的方法，少量服用小承气汤，如果腹中转动排气（所谓动转失泄之气，即放屁），说明有燥屎，才可以攻下；如果不排气的，一定是初头硬后稀溏，不可以攻下，攻下就会导致腹部胀满不能进食。想要喝水却发生呃逆，后来发热的，大便再次变硬但量少，适宜用小承气汤调和。如果腹部大满不通，给予小承气汤轻微调和胃气，不要剧烈攻下。或者是阳明病多汗，津液外泄，肠胃燥热，大便必然干硬且出现谵语。或者是谵语、脉滑疾，或者是发汗、催吐、攻下之后，轻微烦闷，小便、大便因此干硬的；或者是腹泻伴谵语的，大多还有燥屎，通用小承气汤攻下。或者是得病二三天，脉弱，没有太阳病或少阳病的证候，烦躁，心下痞硬，到了四五天，虽然能进食，少量给予小承气汤调和，使其稍微安宁。
调胃承气汤 治疗各种发汗、和解、催吐之后，不恶寒，只是发热而且蒸蒸然汗出的；或者是病程加深，心下温温欲吐且胸中满痛，大便反而稀溏，腹部轻微胀满，郁郁微烦，在此之前，曾经自己过度使用催吐或攻下法（“先”，读音为苏佃切）。所谓“先此时”，是指在当时之前，已经曾自己过度使用催吐、攻下法而又出现这些证候。或者是病程加深，里热、谵语，依法应当用承气汤攻下。误用银粉、巴豆等燥热大毒的丸药攻下，导致真阴受损虚弱，那么邪热反而更甚（盛者为邪，衰者为正），因而协热下利不止，脉象反而调和（“协”，读音为胡劫切，意为和、合）。现在的意思是，病本为热，又给予辛热大毒的丸药攻下，那么两热协和相合而热势更甚，下利不止。下利脉象应当微弱或厥冷，但因为热药攻伐，所以脉象反而显得调和。说有热，下利不止而脉象反而平和，或者是滑、实、大而紧的。以及或者是表病里和，但攻下过早，表热乘虚入里，而可能不成结胸，只是热利不止，心下满硬或疼痛，烦渴咽干，脉滑数或实的，或者是各种腹部胀满实证疼痛的，或者是烦渴谵妄的，小便赤涩，大便或干硬，或热泄，脉滑实而紧甚的，都适宜用调胃承气汤攻下。
三一承气汤 通用治疗大、小、调胃，三承气汤的证候。大法则是：表证已解，热邪传于里则适宜攻下，热除即愈，适宜用调胃承气汤；这是失于攻下，热极则危险而死。表病里和，则应当发汗，热泄身凉即愈；如果反而攻下，则表热乘虚入里而成结胸之类诸病。或者是表热一半传于里，一半还在表，则不可发汗、攻下，适宜用小柴胡汤之类和解。或者是表里两证热势都严重，而和解不能消除的，虽然邪热一半在里、一半在表，依法应当寒热往来，因为表里热势都严重，所以也不恶寒而都恶热，适宜用大柴胡汤轻微攻下，通用清除表里之热。或者是误用调胃承气汤，则只能攻里不能清除表热；或者用小承气汤，多攻里、少除表，则表热乘虚入里，都能造成危害。其大柴胡汤证，病势更严重的，适宜用大承气汤攻下。假设未完全痊愈，而有轻微的浅表邪热入里，因为厚朴、枳实之类，善于开通结滞，而不能形成结胸之类诸病。所以《活人书》说：攻里的药物，调胃承气最紧急，小承气次之，大承气又次之，大柴胡最缓慢。所以表证未罢而为里热已甚，需要可以缓下的，先用大柴胡，再用大承气，也可以通用。如果论善于开郁结，怫热峻疾得利，而效果极大，假设未痊愈而也难以再郁结的，是大承气汤。所以《活人书》又说大承气最紧急，小承气次之，调胃承气又次之，大柴胡最慢。因此可以急下的，适宜用大承气汤，所以虽然大柴胡也可通用，但没有急下的证候。或者是可以微下及微和胃气的，小承气汤、调胃承气汤作为先后次序。由此看来，缓下、急下，善于开发而难郁结，可通用的，大承气汤最为奇妙。所以现在加入甘草，命名为三一承气汤，通用治疗三承气汤证，疗效迅速且不增加危害。然而因为甘草的味道能缓和急结，温中润燥而又善于调和诸药而能成功，所以《本草》称其为国老。因此大承气汤得到甘草则尤其奇妙。然而这一方，是三承气等汤的合并。或者是无论伤寒、杂病、内外一切所伤，不论日数远近，只要以腹部胀满、咽干、烦渴、谵妄、心下按压硬痛，或者热甚喘咳、闷乱、惊悸、癫狂、眼疾、口疮、舌肿、喉痹、痈肿、疮疡，或者是伤寒、阳明胸热、发斑、脉沉，需要可下的；以及小儿惊风、热极潮搐、痰喘、昏塞，并斑疹痘疮、热极黑陷、小便不通、腹部胀满喘急、将要死亡的，或者是斑疹后热毒不退，久久不结痂的（“痂”，音茄，疮痂也），或者是形成斑痈、疮癣，久久不愈的；或者是怫热内成癖坚积，腹部胀满而喘，黄瘦潮热，惊风热积，以及大人小儿久新疟疾，暴卒心痛，风痰酒膈，肠垢积滞，久壅风暴，伤酒食，烦心闷乱，脉数沉实，或者是肾水阴虚，阳热暴甚，而僵仆卒中，或者是所有暴喑不语、失喑；或者是蓄热内甚，阳厥极深，脉反沉细而欲绝的；或者是表的冲和正气与邪气并之于里，则里热亢甚而阳极似阴，反而寒战，脉微欲绝的；或者是风热燥甚，客于下焦而大、小便涩滞或不通的；风木能胜湿土，火热能耗水液，因而成燥。燥则紧敛、坚结、滞不通，所以风热燥甚于下焦，则燥粪结硬，腹部又紧敛的，其燥粪不能相离，并膀胱燥郁不能渗泄，所以不通。千万不要用银粉、巴豆等大毒燥热丸药攻下，反而生燥热而耗损阴液。所以伤寒下热，古人都禁止这样做。最适宜三一承气汤兼用下取法。或者是产妇胎死不下的；风热燥湿紧敛，则产户不得自然开通。其证逆，脉弦数而涩，面赤，或青，或变五色，腹部满急痛，喘闭，胎已不动的，就是这种情况。手足温而脉滑的，仅为难产，只适宜滑胎催生，千万不要攻下。以及两感病，表里热甚，需要可下的，都适宜三一承气汤（即大承气加甘草）。或者是下食积及急攻结滞的，调下轻粉一字。滞下、眼疾、口疮、咽喉疮疡，斑疹，加凉膈散。下死胎加益元散。
十枣汤 治疗太阳中风，下痢呕逆，表证已解，干呕短气，不恶寒，漐漐汗出，发作有时，头痛、心下痞、硬满，牵引胁下疼痛的，兼下水肿、腹胀，并酒积、食积一切肠垢积滞、癖坚积，或者是蓄热心腹暴痛，或者是疟气久久不愈的，或者是表的正气与邪热并甚于里，热极似阴而反寒战，表气入里而阳厥极深，所以脉微而欲绝的。并风热燥甚，结于下焦，大便不通，或者是实热腰痛者，以及小儿热结，乳癖积热发作，惊风潮搐，斑疹热毒不能彻底清除的，适宜攻下。
Guadi San (Melon Seed Powder) treats cases where the exterior syndrome has resolved, pathogenic heat has entered the interior, and is knotted in the chest. Symptoms include irritability, fullness, hunger but inability to eat, slight coldness of the extremities, and a pulse that suddenly becomes tight. In such cases, emesis (inducing vomiting) is appropriate.
Da Chaihu Tang (Major Bupleurum Decoction) is indicated after taking Xiao Chaihu Tang (Minor Bupleurum Decoction), when the disease remains unresolved, the heat intensity in both the exterior and interior increases, and there is urgency and oppression in the epigastrium with slight irritability, or fever and sweating without relief, leading to epigastric stiffness and hardness, vomiting, and diarrhea (these belong to Taiyang disease); or Yangming disease with profuse sweating; or Shaoyin disease with diarrhea of clear water, pain in the epigastrium, and dry mouth; or Taiyin disease with abdominal fullness and pain; or when there are no obvious exterior or interior syndromes, but only fever for seven or eight days, with a floating and rapid pulse, or a pulse located in the muscle layer, being solid, rapid, and slippery; as well as various syndromes of Lianggan (simultaneous contraction of two meridians). For those suitable for mild purgation, capable of simultaneously clearing heat from the three layers of exterior and interior, this formula is appropriate.
Dachengqi Tang (Major Order the Qi Decoction) treats cases following Da and Xiao Chaihu syndrome, where both exterior and interior are hot, and the disease condition is more severe; or Yangming disease presenting with a slow pulse, sweating, and aversion to cold. The Yangming meridian governs the muscles. When heat is extreme and spontaneous sweating is profuse, the pulse cannot be rapid but instead appears slow. Since interior heat is more severe, there is aversion to cold replaced by aversion to heat. Symptoms include heavy body, shortness of breath, abdominal fullness, wheezing, and occasional tidal fever. Aversion to cold indicates exterior heat, which should be treated with sweating, not purgation; fever indicates interior heat, which should be treated with purgation, not sweating. Or if there is continuous sweating from the palms and soles ("Ji ran", pronounced zu li qie, meaning continuous/uninterrupted). This implies that the qi in the palms and soles seems harmonious, yet sweating occurs. This indicates that the feces have already become hard. Or if, after vomiting or purgation, the condition remains unresolved, with no bowel movement for five to ten days, accompanied by tidal fever in the late afternoon, aversion to cold absent, muttering as if seeing ghosts, and in severe cases, loss of recognition, grasping at clothes and bedrails, sudden fright, slight wheezing—this represents extreme excess heat in the Yangming interior. The Foot-Yangming Stomach meridian is the leader of the twelve meridians externally, governing muscles; internally, it is the root of the five zang organs and the great source of the six fu organs. Thus, although Yangming stomach disease is a fu organ disease, if the pulse is deep, rapid, and solid, purgation is indicated. However, if intestinal and gastric heat is extreme, causing stool color to change from yellow-red to brown and then black, it is difficult to treat. Whenever there is tidal fever, delirium, and inability to eat, there is dry feces in the intestines; if eating is possible, the stool is merely hard. Old texts claim dry feces are in the chest, attributing Hand-Yangming Large Intestine symptoms to the Foot-Yangming Stomach. Dry feces are actually not in the chest. Or after purgation of Yangming disease, if there is燥热 (dry-heat) and ao nao (restlessness/regret) in the heart and chest (due to fluid depletion); or if there is irritability and heat, resolving with sweat, but recurring like malaria with afternoon fever and a deep, solid pulse, purgation is indicated. If the pulse is floating and deficient, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment. Or if there is no bowel movement for six or seven days, unclear vision, unresponsive eyes, no obvious exterior or interior syndromes, difficulty defecating, and slight body heat; or if urination is obstructed, stool alternates between difficult and easy, with occasional slight fever, wheezing, dizziness, and inability to lie down, this indicates dry feces. Or if the pulses at the cun, guan, and chi positions are all normal, but the epigastrium is stiff; or if the pulse is large and tight; or if there is diarrhea with a slippery and rapid pulse; or if there is diarrhea with a slow and slippery pulse. The slowness is caused by persistent heat-induced diarrhea, not cold. Or if Shaoyang disease presents on the second or third day with dry mouth and throat; or spontaneous diarrhea of clear water, pure green in color, epigastric obstruction and pain, and dry mouth. These result from dampness and heat fighting within the intestines and stomach, leading to diarrhea. Heat causes stagnation, dampness causes obstruction, so fluids do not condense or moisten the exterior, leading to extreme dry-heat outside the intestines and stomach, causing incessant irritability and thirst; inside, there is damp-heat diarrhea. This originates from heat stagnation retaining fluids to form dampness. Or for any abdominal fullness, solid pain, irritability, thirst, delirium, and madness, with a solid, rapid, and deep pulse, regardless of the number of days, Dachengqi Tang is appropriate for purgation. Or if interior dry-heat is extreme, intestinal and gastric qi is stagnant, retained fluids do not disperse, irritability and thirst are incessant, chest and abdomen are distended and painfully rigid, only cold saliva is vomited, extreme thirst cannot be quenched even by drinking, wheezing is urgent, chest stuffiness and confusion make one wish to die—taking the medicine warm stops thirst immediately, making the patient seem healthy, followed by profuse sweating and recovery. Often, before this, there is no bowel movement but sweating occurs; sometimes the medicinal power acts through the dispersion of sweat, curing without bowel movement.
Xiao Chengqi Tang (Minor Order the Qi Decoction) treats deepening Shanghan (Cold Damage) where dry feces are suspected. To confirm, administer a small dose of Xiao Chengqi Tang. If flatus passes (gas moving and exiting), dry feces are present, and attack (purgation) can proceed. If no flatus passes, the stool is likely hard initially and loose later; do not attack, as this will cause abdominal fullness and anorexia. If there is a desire to drink but hiccups occur, followed by fever, the stool becomes hard again but in small amounts; Xiao Chengqi Tang is appropriate to harmonize. If there is significant abdominal fullness and obstruction, give Xiao Chengqi Tang to mildly harmonize stomach qi, avoiding drastic purgation. Or if Yangming disease involves profuse sweating, fluid loss, intestinal and gastric dry-heat, leading to hard stool and delirium. Or if there is delirium with a slippery and rapid pulse, or slight irritability after sweating, vomiting, or purgation, with hard urine and stool; or diarrhea with delirium, often indicating remaining dry feces; Xiao Chengqi Tang is generally used for purgation. Or if, two to three days into illness, the pulse is weak, with no Taiyang or Chaihu syndromes, but irritability and epigastric stiffness; by the fourth or fifth day, even if the patient can eat, give a small amount of Xiao Chengqi Tang to harmonize and bring slight relief.
Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) treats cases after sweating, harmonizing, or vomiting, where there is no aversion to cold, only fever, possibly with steaming sweat; or as the disease deepens, warmth in the epigastrium with urge to vomit, chest fullness and pain, loose stool, slight abdominal fullness, and slight depression/irritability. "Prior to this" (xian, su dian qie) refers to having previously subjected oneself to extreme vomiting or purgation, leading to these symptoms. Or if the disease deepens with interior heat and delirium, requiring Chengqi purgation. Mistaken use of silver powder or croton seed (badou) pills, which are extremely hot and toxic, damages true yin, causing pathogenic heat to worsen (excess is pathogen, deficiency is healthy qi), leading to persistent協热下利 (collateral heat diarrhea) with a seemingly harmonious pulse (xie, hu jie qie, meaning harmony/combination). The original disease was heat, but hot toxic pills were given, combining two heats to worsen heat and cause persistent diarrhea. Diarrhea usually presents with a faint or cold pulse, but due to hot medicine, the pulse appears harmonious. It states that with heat and persistent diarrhea, the pulse may appear flat, or slippery, solid, large, and tight. Or if exterior disease with interior harmony is purged too early, exterior heat enters the interior due to deficiency, potentially failing to form Jie Xiong (chest binding) but causing persistent heat diarrhea, epigastric fullness/stiffness/pain, irritability, thirst, dry throat, and slippery/rapid/solid pulse. Or for any abdominal fullness and solid pain, irritability, thirst, delirium, red/astringent urine, hard stool, or heat diarrhea with a slippery, solid, and very tight pulse, Tiaowei Chengqi Tang is appropriate for purgation.
Sanyi Chengqi Tang (Three-One Order the Qi Decoction) universally treats syndromes of Da, Xiao, and Tiaowei Chengqi Tangs. The general principle: when exterior syndrome resolves and heat transmits to the interior, purgation is indicated; once heat is removed, recovery ensues, favoring Tiaowei Chengqi Tang. Failure to purge leads to extreme heat, danger, and death. If exterior disease exists with interior harmony, sweating is indicated; heat dissipates, body cools, and recovery ensues. Purging in this case allows exterior heat to enter the interior, forming Jie Xiong and other diseases. If half the exterior heat transmits to the interior while half remains exterior, neither sweating nor purging is appropriate; harmonizing with Xiao Chaihu Tang is indicated. If both exterior and interior heat are severe and harmonizing fails, although pathogenic heat is half interior/half exterior (typically presenting with alternating chills and fever), the severity means aversion to cold is absent and aversion to heat prevails; Da Chaihu Tang is used for mild purgation to clear exterior and interior heat. Mistaken use of Tiaowei Chengqi Tang attacks interior but fails to clear exterior heat; using Xiao Chengqi Tang mostly attacks interior with little exterior clearance, allowing exterior heat to enter the interior and cause harm. For more severe Da Chaihu syndromes, Dachengqi Tang is indicated. If not fully recovered, slight superficial pathogenic heat entering the interior is handled by Houpo (Magnolia Bark) and Zhishi (Immature Bitter Orange), which open stagnation but do not form Jie Xiong. Thus, *Huoren Shu* states: among purgatives, Tiaowei Chengqi is most urgent, Xiao Chengqi next, Dachengqi next, and Da Chaihu is slowest. Therefore, if exterior syndrome is unresolved but interior heat is severe, requiring slow purgation, start with Da Chaihu, then Dachengqi. Regarding opening stagnation and relieving fierce heat quickly for effective purgation, Dachengqi is best. *Huoren Shu* also states Dachengqi is most urgent, Xiao Chengqi next, Tiaowei Chengqi next, and Da Chaihu slowest. Thus, for urgent purgation, Dachengqi is indicated, though Da Chaihu can be used generally without urgent indications. For mild purgation or mild stomach harmonization, Xiao Chengqi and Tiaowei Chengqi are used in sequence. Thus, for slow or urgent purgation, opening stagnation effectively, Dachengqi is the most versatile and excellent. Hence, Gancao (Licorice Root) is added to create Sanyi Chengqi Tang, treating all three Chengqi syndromes rapidly without adding harm. Gancao's flavor moderates acute stagnation, warms the middle, moistens dryness, and harmonizes herbs, earning it the title "Guolao" (State Elder) in materia medica. Adding Gancao to Dachengqi Tang makes it even better. This formula combines the three Chengqi decoctions. Regardless of Shanghan, miscellaneous diseases, internal/external injuries, or duration, if symptoms include abdominal fullness, dry throat, irritability/thirst, delirium, epigastric tenderness/stiffness, severe heat with wheezing/cough, confusion, palpitations, mania, eye diseases, mouth ulcers, tongue swelling, throat bi, carbuncles, sores, Yangming chest heat with macules, deep pulse requiring purgation; pediatric convulsions, extreme heat tidal spasms, phlegm-wheezing, coma, macules/rashes, smallpox with extreme heat/black sinking, urinary obstruction, abdominal fullness/wheezing imminent death; post-macule/rash persistent heat-toxin, failure to scab (jia, jia sound, scab); chronic macule/carbuncle/psoriasis; internal fierce heat forming masses/lumps, abdominal fullness/wheezing, sallow thinness/tidal fever, pediatric convulsions/heat accumulation, adult/pediatric old/new malaria, sudden heart pain, wind-phlegm/alcohol obstruction, intestinal mucus/stagnation, long-term wind-storm obstruction, alcohol/food injury, irritability/confusion, rapid/deep/solid pulse; Kidney water yin deficiency with sudden extreme yang heat causing collapse/stroke; sudden aphasia/loss of voice; intense internal heat retention with deep yang reversal, pulse deep/fine/near extinction; conflict between harmonious righteous qi and pathogenic qi in the interior, causing extreme interior heat, yang extreme resembling yin, chills, faint/near-extinction pulse; wind-heat dryness in lower jiao causing urinary/fecal obstruction; wind wood overcomes damp earth, fire heat consumes water fluids, leading to dryness. Dryness causes tightening, hard knotting, and obstruction. Wind-heat dryness in lower jiao leads to hard dry feces and tight abdomen, preventing separation from bladder dryness/stagnation, causing obstruction. Do not use silver powder or croton seed toxic hot pills, as they generate more dry-heat and consume yin fluids. Ancient texts forbid purging heat in Shanghan. Sanyi Chengqi Tang is most suitable, combined with purgative methods. For postpartum retained dead fetus: wind-heat/dampness dryness/tightness prevents natural opening of the birth canal. Symptoms are adverse, pulse string-like/rapid/astringent, red/blue/changing face color, abdominal fullness/urgent pain, wheezing/obstruction, fetal movement stopped. Warm hands/feet with slippery pulse indicate difficult labor, requiring slipperiness-inducing delivery aids, not purgation. For Lianggan with severe exterior/interior heat requiring purgation, Sanyi Chengqi Tang (Dachengqi plus Gancao) is indicated. For food stagnation or urgent stagnation attack, mix with 1 zi (unit) of Qinfen (Calomel). For dysentery, eye disease, mouth/throat sores, macules/rashes, add Liangge San (Cool the Diaphragm Powder). For dead fetus, add Yiyuan San.
Shizao Tang (Ten Date Decoction) treats Taiyang wind-strike with diarrhea, vomiting/reversal, resolved exterior syndrome, dry retching, shortness of breath, no aversion to cold, dripping sweat, paroxysmal onset, headache, epigastric obstruction/stiffness/fullness, pain radiating to hypochondriums. It also treats edema, abdominal distension, alcohol/food stagnation, intestinal mucus/stagnation, mass/lump accumulation, sudden heat-toxin pain in heart/abdomen, chronic malaria, conflict of righteous qi and pathogenic heat in interior causing extreme heat resembling yin with chills, exterior qi entering interior causing deep yang reversal with faint/near-extinction pulse. It treats wind-heat dryness knotted in lower jiao causing constipation, solid heat lower back pain, pediatric heat knot, milk mass/accumulated heat eruption, pediatric convulsions/tidal spasms, macules/rash heat-toxin unable to resolve. Purgation is indicated.