潮热者若潮汛之来不失其时一日一发按时而发者谓之潮热若日三五发者是即发热非潮热也潮热属阳明阳明旺于未
申必于日晡时发乃为潮热
太阳 病重发汗而复下之不大便五六日舌上燥而渴日晡小有潮热从心下至少腹硬满而痛不可近者大陷胸汤主之（成
重发汗而复下之则内外重亡津液而热内结致不大便五六日舌上燥而渴也日晡潮热者属胃此日晡小有潮热非但在胃从心
下至少腹硬满而痛不可近者是一腹之中上下邪气俱甚者也宜陷胸汤以下其邪 丹 谨按太阳病已重发汗表则虚矣而复
下之里又虚矣不大便五六日可见津液之耗矣非若前章之未曾发汗而但下之伤于早尔今虽有硬痛而可以迅攻之乎若曰潮
热于申酉系阳明属调胃承气证既又曰小有潮热犹可疑待之间将无他法以缓取之乎 潮热本属阳明也太阳潮热惟此一证
耳杂病太阳潮热则在己午更玩一小字则知邪太阳为多阳明为少）
阳明 病潮热大便微硬可与大承气汤不硬者不与之若不大便六七日恐有燥粪欲愈之可少与小承气汤入腹中转失气
者此有燥粪须当攻之若不转失气者此但初头硬后必溏不可攻之攻之必胀满不能食也欲饮水者与之则哕其后发热者必大
便复硬而少也以小承气汤和之不转失气者慎不可攻也 阳明病脉迟虽汗出不恶寒者其身必重短气腹满而喘有潮热者此
外欲解可攻里也手足 然汗出者此大便已硬也大承气汤主之若汗多微发热恶寒者外未解也其热不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 阳明病谵语有潮热反不能食者胃中必有燥屎五六枚也若能食者但硬尔
宜大承气汤下之（胃热当消谷引食反不能食者胃中有燥屎而实也若能食者胃中虚热虽硬不得为有燥屎玩但字则末句恐当
在若能食者之上燥屎在大肠而曰胃中者伤寒传胃不传大肠治病必求其本故仲景从本言之况承气能下燥大肠同为燥金
也）二阳并病太阳证罢但发潮热手足 汗出大便难而谵语者下之则愈宜大承气汤（成 本太阳并病于阳明名曰并病太
阳证罢是无表证但发潮热是属阳明一身汗出为热越今手足 汗出是热聚于胃也必大便难而谵语经曰手足 然而汗出
者必大便已硬也与大承气汤以下胃中实热）阳明病谵语发潮热脉滑而疾者小承气汤主之与汤一升腹中转失气者更服一升
不转失气勿更与之明日不大便脉反微涩者里虚也最为难治不可更与承气汤（成 阳明病谵语发潮热若脉沉实者内实也则
可下若脉滑疾为里热未实则未可下先与小承气汤和之汤入腹中转失气者中有燥屎可更与小承气汤一升以除之若不转失
气者是无燥屎不可更与小承气汤至明日邪气传时脉得沉实紧牢之类是里实也反得微涩者里气大虚也若大便利后脉微涩
者止为里虚而犹可此不曾大便脉反微涩是正气内衰为邪胜也故曰难治）
大承气汤方（海藏云浓朴去痞枳实泄满芒硝软坚大黄泄实必痞满燥实四证全者方可用之）
大黄（四两酒洗） 浓朴（炙去粗皮半斤） 枳实（五枚炙） 芒硝（七钱半）上四味以水一斗先煮二物取五升去
滓纳大黄煮取二升去滓纳芒硝更上火微煎一二沸分温再服得下余勿服
成 承顺也伤寒邪入胃者谓之入腑腑之为言聚也胃为水谷之海荣卫之原水谷会聚于胃变化为荣卫邪气入胃胃气郁
滞糟粕秘结壅而为实是正气不得舒顺也本草云通可去滞泄可去闭塞而不利闭而不通以汤荡涤使塞者利而闭者通正气得
以舒顺故曰承气也王冰曰宜下必以苦宜补必以酸溃坚破结苦寒为主是以枳实为君内经曰燥淫于内治以苦温泄满除燥苦
温为辅是以浓朴为臣内经曰热淫于内治以咸寒人伤于寒则为病热热气聚于胃则谓之实咸寒之物以消实热故以芒硝咸寒
为佐内经曰燥淫所胜以苦下之热气内胜则津液消而肠胃燥苦寒之物以荡涤其燥热故以大黄为使是以大黄有将军之号也
承气汤下药也用之尤宜审如大满大实有燥屎乃可投也如非大满则生寒证而结胸痞气之属由是而生矣
小承气汤方（海藏云大黄泄实浓朴去痞必痞实全者可用）
大黄（四两） 浓朴（炙去粗皮二两） 枳实（三枚大者炙） 以上三味以水四升煮取一升二合去滓分温二服初服
汤当更衣不尔者尽饮之若更衣者勿再服（大热结实者与大承气汤小热微结与小承气汤热不大甚故大承气去芒硝结不至坚
故不减朴枳也）
吴 或问承气汤仲景有大小调胃之名何也然伤寒邪热传变入里谓之入腑腑者聚也盖邪热与糟粕蕴而为实也实则潮
热谵语手心 汗出此燥屎所为也如人壮大热大实者宜大承气汤下之小热小实者与小承气汤下之又热结不坚满者故减
去浓朴枳实加甘草而和缓之故曰调胃承气也若病大而以小承气攻之则邪气不伏病小而以大承气攻之则过伤正气耳不及
还可再攻过则不能复救可不谨哉仲景曰凡欲行大承气先与小承气一钟服之腹中转失气乃有燥屎也可以大承气攻之若不
转失气慎不可攻攻之则腹胀不能食而难治又曰服承气汤得利慎勿再服此谆谆告诫也凡用攻法必须妙算料量合宜则应手
而效若不料量孟浪攻之必且杀人
伤寒若吐若下后不解不大便五六日上至十余日日晡所发潮热不恶寒独语如见鬼状若剧者发则不识人循衣摸床惕而
不安微喘直视脉弦者生涩者死但发热谵语者大承气汤主之一服利止后服（详循衣摸床）
阳明病发潮热大便溏小便自利胸胁满不去者小柴胡汤主之（阳明为病胃实是也今便溏而言阳明病者谓阳明外证身热
汗出不恶寒反恶热之病也）阳明中风脉弦浮大短气腹满胁下及心痛鼻干不得汗嗜卧身黄小便难时时哕而潮热者小柴胡加
茯苓主之伤寒十三日不解胸胁满而呕日晡所发潮热已而微利此本柴胡证下之而不得利今反利者知医以丸药下之非其治
也潮热者实也先宜小柴胡汤以解外后以柴胡加芒硝汤主之
柴胡加芒硝汤方
柴胡（一两） 黄芩 人参 甘草（炙） 生姜（各五钱） 半夏（汤浸三个） 大枣（三枚） 芒硝（一两） 每
服五钱水一盏半煎至八分去滓纳芒硝更微沸温服
阳明病脉浮而紧必潮热发作有时但浮者必盗汗出（成 脉浮在经紧者里实脉浮紧者表热里实也必发潮热发作有时若
脉但浮而不紧者止是表热也必盗汗出盗汗者睡而汗出也阳明病里热者自汗表热者盗汗）
活人书冬月阳明潮热脉浮而紧者发作有时但脉浮者必盗汗黄芩汤主之（方见下利）
潮热，就像潮汐涨落一样有固定的时间。如果一天发作一次，按时发作的，称为潮热；如果一天发作三到五次，那就是普通的发热，不是潮热。潮热属于阳明病。阳明经气旺盛于未时和申时（下午13点至17点），所以必须在日晡时（下午3点至5点）发作，才算是潮热。
太阳病：经过重度发汗后又误用攻下法，导致五六天不大便，舌面干燥且口渴，日晡时分出现轻微的潮热，从心窝部一直到小腹部硬满疼痛，甚至不能触碰的，用大陷胸汤主治。（成无己注：重度发汗又攻下，会导致内外津液严重耗损，热邪内结，从而造成五六天不大便、舌燥口渴。日晡时潮热属于胃家实，这里说“轻微”潮热，说明病邪不仅局限于胃，而是从心下到小腹，上下邪气都很盛。应当用陷胸汤来泻下邪气。丹波元坚按：太阳病已经重发汗，表证已虚，又攻下，里证也虚了。五六天不大便，可见津液耗伤，不像前章那样未曾发汗而直接攻下那样过早伤正。现在虽然有硬痛，可以迅速攻下吗？如果说潮热在申酉时属于阳明，是调胃承气汤证，但又说“轻微”潮热，这就值得怀疑等待了。难道没有其他缓和取效的方法吗？潮热本属阳明，太阳病出现潮热只有这一例。杂病中太阳病出现潮热则在巳午时。再玩味一个“小”字，可知邪气在太阳多，在阳明少。）
阳明病：出现潮热，大便微硬，可以用大承气汤；如果不硬，则不能用。如果六七天不大便，担心有燥屎，想试探是否可攻，可以先少量给予小承气汤。服药后腹中转出矢气的，这是有燥屎，必须攻下；如果不转矢气，这只是开头大便硬，后面一定是溏便，不可攻下。如果攻下，必然导致胀满、不能进食。如果想喝水，给水喝则会打嗝。之后如果出现发热，大便一定会再次变硬但量少，应用小承气汤调和。不转矢气的，千万不可攻下。
阳明病脉迟，虽然出汗但不恶寒，身体必定沉重，短气，腹满而喘，有潮热的，这是表证将解，可以攻里的征象。手足濈然汗出的，这说明大便已经硬结，用大承气汤主治。如果汗多，微发热恶寒的，表证未解，热不呈潮热状，不可用承气汤。如果腹部大满不通，可用小承气汤轻微调和胃气，不要令其剧烈泄下。
阳明病谵语，有潮热，反而不能食的，胃中一定有燥屎五六枚。如果能食的，只是大便硬罢了，宜用大承气汤攻下。（成无己注：胃热应当消谷引食，反而不能食，是因为胃中有燥屎而实证。如果能食，是胃中虚热，虽然大便硬，但不能算作有燥屎。玩味“但”字，末句恐怕应当在“若能食者”之上。燥屎在大肠，却说“胃中”，是因为伤寒传胃不传大肠，治病必求其本，所以仲景从本言之。况且承气汤能下燥屎，大肠与胃同为燥金之腑。）
二阳并病：太阳证已罢，只发潮热，手足濈然汗出，大便难而谵语的，攻下则愈，宜用大承气汤。（成无己注：本是太阳并病转入阳明，名叫并病。太阳证罢，说明没有表证。只发潮热，属于阳明。一身汗出是热向外越，现在手足汗出，是热聚于胃。必然大便难而谵语。经曰：手足濈然而汗出者，必大便已硬。与大承气汤以泻胃中实热。）
阳明病谵语，发潮热，脉滑而疾的，用小承气汤主治。服用一升药汤，腹中转出矢气的，再服一升；不转矢气的，不要再给。第二天如果不大便，脉反见微涩的，是里虚，最为难治，不可再给承气汤。（成无己注：阳明病谵语发潮热，如果脉沉实，是内实，则可下。如果脉滑疾，是里热未实，则不可下。先与小承气汤调和。汤入腹中转矢气，说明中有燥屎，可再给小承气汤一升以去除它。如果不转矢气，说明无燥屎，不可再给。到了第二天，邪气传变之时，脉得沉实紧牢之类，是里实；反得微涩，是里气大虚。如果是大便通利后脉微涩，只是里虚还可以救治；这里不曾大便，脉反微涩，是正气内衰被邪气所胜，所以说难治。）
大承气汤方：（张元素云：浓朴去痞，枳实泄满，芒硝软坚，大黄泄实。必须痞、满、燥、实四证俱全者方可使用。）
大黄（四两，酒洗） 浓朴（炙，去粗皮，半斤） 枳实（五枚，炙） 芒硝（七钱半）。以上四味，用水一斗，先煮浓朴、枳实，取五升，去滓，纳大黄，煮取二升，去滓，纳芒硝，更上火微煎一二沸，分温两次服。得下，余勿服。
成无己注：承顺的意思。伤寒邪气入胃，叫做入腑。腑的意思是聚。胃是水谷之海，荣卫之源。水谷会聚于胃，变化为荣卫。邪气入胃，胃气郁滞，糟粕秘结，壅塞而成实，这是正气不得舒顺。本草云：通可去滞，泄可去闭。不利闭而不通，用汤剂荡涤，使塞者利而闭者通，正气得以舒顺，所以叫承气。王冰曰：宜下必以苦，宜补必以酸。溃坚破结，以苦寒为主，所以用枳实为君。内经曰：燥淫于内，治以苦温，泄满除燥，以苦温为辅，所以用浓朴为臣。内经曰：热淫于内，治以咸寒。人伤于寒则为病热，热气聚于胃则谓之实。咸寒之物以消实热，所以用芒硝咸寒为佐。内经曰：燥淫所胜，以苦下之。热气内胜则津液消而肠胃燥。苦寒之物以荡涤其燥热，所以用大黄为使。因此大黄有将军的称号。承气汤是下药，使用尤其要审慎。如大满大实有燥屎，才可投用。如果不是大满，就会产生寒证以及结胸、痞气等病由此而生。
小承气汤方：（张元素云：大黄泄实，浓朴去痞。必须痞、实全者可用。）
大黄（四两） 浓朴（炙，去粗皮，二两） 枳实（三枚，大的，炙）。以上三味，用水四升，煮取一升二合，去滓，分温两次服。初服汤后应当排便，如果不排便，就喝完剩下的。如果排便了，就不要再次服用。（大热结实者与大承气汤，小热微结与小承气汤。热不大甚，所以大承气汤去掉芒硝；结不至坚，所以不减朴、枳。）
吴崑问：承气汤仲景有大、小、调胃之名，为什么呢？然而伤寒邪热传变入里，叫做入腑。腑者，聚也。盖邪热与糟粕蕴结而为实。实则潮热、谵语、手心汗出，这是燥屎造成的。如人体壮热大实者，宜用大承气汤攻下；小热小实者，用小承气汤攻下。又有热结不坚满者，所以减去浓朴、枳实，加入甘草来调和缓和，所以叫调胃承气。如果病大而用小承气攻之，则邪气不伏；病小而用大承气攻之，则过伤正气。不及还可以再攻，过了就不能复救，可不谨慎吗？仲景说：凡欲行大承气，先与小承气一钟服之，腹中转矢气，乃有燥屎，才可以大承气攻之。若不转矢气，慎不可攻。攻之则腹胀不能食而难治。又说：服承气汤得利，慎勿再服。这是谆谆告诫。凡用攻法，必须妙算料量合宜，则应手而效。如果不料量孟浪攻之，必杀人。
伤寒如果吐或下后不解，不大便五六天，上至十余天，日晡时发潮热，不恶寒，独语如见鬼状。如果病情加重，发作时不认识人，循衣摸床，惊恐不安，微喘直视，脉弦的生存，脉涩的死。只是发热谵语的，大承气汤主治。一服利，止后服。（详细参见“循衣摸床”条）
阳明病发潮热，大便溏，小便自利，胸胁满不去的，小柴胡汤主治。（阳明为病，胃实是也。今便溏而言阳明病者，是指阳明外证身热、汗出、不恶寒、反恶热的病。）
阳明中风，脉弦浮大，短气，腹满，胁下及心痛，鼻干不得汗，嗜卧，身黄，小便难，时时哕而潮热的，小柴胡加茯苓主治。
伤寒十三日不解，胸胁满而呕，日晡所发潮热，已而微利。此本柴胡证，下之而不得利，今反利者，知医以丸药下之，非其治也。潮热者，实也。先宜小柴胡汤以解外，后以柴胡加芒硝汤主治。
柴胡加芒硝汤方：
柴胡（一两） 黄芩 人参 甘草（炙） 生姜（各五钱） 半夏（汤浸三个） 大枣（三枚） 芒硝（一两）。每服五钱，水一盏半，煎至八分，去滓，纳芒硝，更微沸，温服。
阳明病脉浮而紧，必潮热，发作有时。但浮者，必盗汗出。（成无己注：脉浮在经，紧者里实。脉浮紧者，表热里实也，必发潮热，发作有时。若脉但浮而不紧者，止是表热也，必盗汗出。盗汗者，睡而汗出也。阳明病里热者自汗，表热者盗汗。）
Tidal fever (Chao Re) is like the coming and going of tides, occurring at regular times. If it occurs once a day at a fixed time, it is called tidal fever; if it occurs three to five times a day, it is ordinary fever, not tidal fever. Tidal fever belongs to Yangming disease. The Qi of the Yangming channel is vigorous during Wei (13:00–15:00) and Shen (15:00–17:00) hours; therefore, it must occur during Ribu (15:00–17:00) to be considered tidal fever.
Taiyang Disease: After severe sweating followed by erroneous purgation, leading to constipation for five to six days, dryness and thirst on the tongue, slight tidal fever at Ribu, hardness, fullness, and pain from the epigastrium down to the lower abdomen that cannot be touched, Da Xian Xiong Tang (Great Trapdoor Decoction) is indicated. (Cheng Wuji notes: Severe sweating and purgation cause severe depletion of fluids inside and outside, with heat binding internally, causing constipation for five to six days and dry tongue/thirst. Tidal fever at Ribu indicates Stomach excess. The term "slight" suggests the pathogen is not limited to the Stomach but affects the entire abdomen from epigastrium to hypogastrium, where both upper and lower pathogens are severe. One should use Xian Xiong Tang to purge the pathogen. Danbo Yuanjian observes: Taiyang disease after severe sweating has deficient exterior; subsequent purgation makes the interior also deficient. Constipation for five to six days shows fluid consumption, unlike previous chapters where purgation was done prematurely without prior sweating. Although there is hardness and pain now, can one rapidly attack? If tidal fever at Shen/You hours belongs to Yangming and is a Tiao Wei Cheng Qi Tang syndrome, yet it says "slight" tidal fever, this is doubtful and warrants waiting. Are there no other methods to achieve effect gently? Tidal fever inherently belongs to Yangming; this is the only case of tidal fever in Taiyang. In miscellaneous diseases, Taiyang tidal fever occurs during Si/Wu hours. Observing the word "slight" implies more pathogen in Taiyang than Yangming.)
Yangming Disease: With tidal fever and slightly hard stool, Da Cheng Qi Tang (Great Order the Qi Decoction) may be used; if not hard, do not use it. If there is constipation for six or seven days and concern about dry feces, to test if purgation is suitable, first give a small amount of Xiao Cheng Qi Tang (Minor Order the Qi Decoction). If flatus passes after ingestion, there are dry feces, and purgation is necessary; if no flatus passes, the stool is merely hard at the beginning and likely loose later, so do not purge. Purging will cause abdominal fullness and inability to eat. Thirst for water may lead to hiccups. Subsequent fever may cause stool to become hard again but scanty; use Xiao Cheng Qi Tang to harmonize. If no flatus passes, absolutely do not purge.
In Yangming disease, if the pulse is slow, sweating occurs without aversion to cold, the body feels heavy, there is shortness of breath, abdominal fullness, wheezing, and tidal fever, this indicates the exterior syndrome is resolving and the interior can be attacked. Sweating on the hands and feet (Ji Ran Han Chu) indicates the stool has hardened; Da Cheng Qi Tang is indicated. If there is profuse sweating, slight fever, and aversion to cold, the exterior is not resolved, the fever is not tidal, and Cheng Qi Tang should not be used. If there is significant abdominal fullness and obstruction, Xiao Cheng Qi Tang may be used to mildly harmonize the Stomach Qi, avoiding drastic purgation.
In Yangming disease, delirium (Man Yu) with tidal fever and inability to eat indicates dry feces (Zao Shi) in the stomach; if able to eat, the stool is merely hard. Da Cheng Qi Tang is indicated for purging. (Cheng Wuji notes: Stomach heat usually promotes digestion; inability to eat indicates excess due to dry feces. Ability to eat suggests deficient heat in the Stomach; although hard, it is not dry feces. Dry feces are in the Large Intestine, but Zhang Zhongjing refers to the Stomach because Shaoyang disease transmits to the Stomach, not directly to the Large Intestine; treating the root is essential. Moreover, Cheng Qi Tang acts on dry feces, and the Large Intestine shares the same Dry Metal nature with the Stomach.)
Two Yangs Concurrent Disease: When Taiyang symptoms cease and only tidal fever, sweating on hands and feet, difficult defecation, and delirium remain, purgation leads to recovery; Da Cheng Qi Tang is indicated. (Cheng Wuji notes: This is Taiyang disease transmitting to Yangming. Cessation of Taiyang symptoms means no exterior syndrome. Tidal fever alone indicates Yangming. General sweating allows heat to vent outward; hand and foot sweating indicates heat gathering in the Stomach. This causes difficult defecation and delirium. The Classic states: Hand and foot sweating indicates hardened stool. Use Da Cheng Qi Tang to purge Stomach excess heat.)
In Yangming disease, delirium with tidal fever and a slippery, rapid pulse is treated with Xiao Cheng Qi Tang. Administer one sheng; if flatus passes, administer another sheng. If no flatus passes, do not administer further. If the next day there is still no bowel movement and the pulse becomes faint and choppy, this indicates interior deficiency, which is difficult to treat; do not give Cheng Qi Tang again. (Cheng Wuji notes: Delirium and tidal fever with a deep, solid pulse indicate interior excess suitable for purgation. A slippery, rapid pulse indicates interior heat not yet solidified, so purgation is premature. First, harmonize with Xiao Cheng Qi Tang. Flatus indicates dry feces present, allowing further administration. No flatus means no dry feces. On the second day, if the pulse becomes deep, solid, tight, or firm, it indicates interior excess. A faint, choppy pulse indicates severe interior deficiency. If this occurs after diarrhea, it is manageable; here, without prior diarrhea, a faint/choppy pulse indicates internal decline of righteous Qi overcome by pathogenic factors, hence difficult to treat.)
Da Cheng Qi Tang Formula: (Zhang Yuansu notes: Hou Po removes distension, Zhi Shi relieves fullness, Mang Xiao softens hardness, Da Huang drains excess. It is only suitable when all four syndromes—distension, fullness, dryness, and excess—are present.)
Da Huang (4 liang, washed with wine), Hou Po (half jin, roasted, coarse bark removed), Zhi Shi (5 pieces, roasted), Mang Xiao (7 qian half). Boil the first two herbs in 1 dou of water to obtain 5 sheng, strain, add Da Huang, boil to obtain 2 sheng, strain, add Mang Xiao, simmer briefly. Divide into two warm doses. If bowel movement occurs, stop remaining dose.
Cheng Wuji notes: "Cheng" means to obey or smooth. When Shaoyin/Yangming pathogen enters the Stomach, it is called entering the Fu organs. Fu means accumulation. The Stomach is the sea of water and grain, the source of Ying and Wei. Water and grain accumulate in the Stomach to transform into Ying and Wei. Pathogen entering the Stomach causes Qi stagnation, fecal retention, and excess accumulation, preventing the smooth flow of righteous Qi. Materia Medica states: Unblocking removes stagnation; draining removes blockage. Using decoctions to cleanse restores smooth flow, hence "Cheng Qi." Wang Bing states: Purging requires bitter flavors; tonifying requires sour flavors. To break hardness and resolve knots, bitter-cold is primary, so Zhi Shi is the sovereign herb. The Classic states: For dryness invading internally, treat with bitter-warm to relieve fullness and remove dryness; thus Hou Po is the minister herb. For heat invading internally, treat with salty-cold. Cold injury transforms into heat; heat gathering in the Stomach is excess. Salty-cold substances clear excess heat, so Mang Xiao is the assistant herb. For excessive dryness, treat with bitter-purgatives. Internal heat consumes fluids, causing intestinal dryness. Bitter-cold substances cleanse dryness-heat, so Da Huang is the envoy. Hence Da Huang is called the General. Cheng Qi Tang is a purgative formula; its use must be cautious. Only use for major fullness and excess with dry feces. Otherwise, cold syndromes, Jie Xiong (Chest Binding), or Pi Qi (Epigastric Fullness) may arise.
Xiao Cheng Qi Tang Formula: (Zhang Yuansu notes: Da Huang drains excess, Hou Po removes distension. Suitable when distension and excess are present.)
Da Huang (4 liang), Hou Po (2 liang, roasted, coarse bark removed), Zhi Shi (3 large pieces, roasted). Boil these three in 4 sheng of water to obtain 1.2 sheng, strain, divide into two warm doses. If defecation occurs after the first dose, do not take the rest. If no defecation, consume the remainder. (For major heat and solidification, use Da Cheng Qi Tang; for minor heat and slight binding, use Xiao Cheng Qi Tang. Heat is not severe enough to require Mang Xiao; binding is not hard enough to reduce Hou Po and Zhi Shi.)
Wu Kun asks: Why does Zhang Zhongjing name Cheng Qi Tang as Major, Minor, and Harmonizing Stomach? When Shaoyang/Yangming pathogenic heat transmits inward, it is called entering the Fu. Fu means accumulation. Pathogenic heat and feces bind to form excess. Excess causes tidal fever, delirium, and palmar sweating due to dry feces. For major heat and excess, use Da Cheng Qi Tang. For minor heat and excess, use Xiao Cheng Qi Tang. For heat binding without significant fullness, Hou Po and Zhi Shi are removed, and Gan Cao is added to harmonize and mildify, hence "Harmonizing Stomach Cheng Qi." Attacking a major disease with a minor formula fails to subdue the pathogen; attacking a minor disease with a major formula damages righteous Qi excessively. Failure to act allows recurrence; over-action is irreparable. Be cautious. Zhang Zhongjing states: Before using Da Cheng Qi Tang, first give Xiao Cheng Qi Tang. If flatus passes, dry feces are present, and Da Cheng Qi Tang can be used. If no flatus, do not purge. Purging causes abdominal fullness and anorexia, making treatment difficult. Also: If purgation occurs after taking Cheng Qi Tang, do not repeat. This is earnest warning. Purgative methods require precise calculation. Improper use kills.
After vomiting or purgation in Shaoyin/Yangming disease, if unresolved, with constipation for five to ten days, tidal fever at Ribu, no aversion to cold, talking alone as if seeing ghosts: If severe, with confusion, grasping at clothes, bed sheets, fearfulness, slight wheezing, and staring eyes, a string-like pulse indicates survival, a choppy pulse indicates death. If only fever and delirium, Da Cheng Qi Tang is indicated. Stop subsequent doses after beneficial purgation.
In Yangming disease, tidal fever with loose stool, free urination, and persistent chest/hypochondriac fullness is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). (Yangming disease usually implies Stomach excess. Loose stool here refers to the external Yangming syndrome: fever, sweating, no aversion to cold, aversion to heat.)
Yangming Wind Strike: String-taut, floating, large pulse; shortness of breath, abdominal fullness, hypochondriac and heart pain, nasal dryness, inability to sweat, lethargy, jaundice, difficult urination, frequent hiccups, and tidal fever are treated with Xiao Chai Hu Tang plus Fu Ling.
Shaoyin/Yangming disease unresolved for thirteen days, with chest/hypochondriac fullness, vomiting, tidal fever at Ribu, followed by slight diarrhea: This was originally a Chai Hu syndrome. Purging should not have caused diarrhea. The physician erroneously used pill-based purgatives. Tidal fever indicates excess. First, use Xiao Chai Hu Tang to resolve the exterior, then use Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction plus Mang Xiao).
Chai Hu Jia Mang Xiao Tang Formula:
Chai Hu (1 liang), Huang Qin, Ren Shen, Gan Cao (roasted), Sheng Jiang (each 5 qian), Ban Xia (soaked in boiling water, 3 pieces), Da Zao (3 pieces), Mang Xiao (1 liang). Take 5 qian per dose, boil in 1.5 cups of water until reduced to 0.8 cup, strain, add Mang Xiao, simmer briefly, take warm.
In Yangming disease, a floating and tight pulse indicates tidal fever occurring at specific times. If only floating, night sweats (Dao Han) occur. (Cheng Wuji notes: Floating pulse indicates exterior; tight indicates interior excess. Floating and tight indicate exterior heat and interior excess, causing tidal fever at set times. Only floating indicates exterior heat, causing night sweats. Night sweats occur during sleep. Interior heat Yangming causes spontaneous sweating; exterior heat causes night sweats.)
*Qiu Ren Shu*: In winter, Yangming tidal fever with floating and tight pulse occurs at specific times. If only floating, night sweats occur. Huang Qin Tang is indicated. (Formula see under Diarrhea section.)