大承气汤 治阳明病，潮热，手足 然汗出，谚语汗出多，胃燥独语，如见鬼状，喘
冒不能卧，腹满痛，脉滑实。又目中不了了，睛不和。又少阴病初得之，口燥咽干者。自
利清水，色纯青，心下痛，口燥舌干者。六七日，腹胀不大便者。
大黄（酒洗，四两） 浓朴（半斤） 枳实（炙，五枚） 芒硝（三合）
上四味，以水一斗，先煮二物，取五升，内大黄，煮取二升，去滓；内芒硝，再上火
微煮一二沸，分温再服。得下即停后服。
小承气汤
大黄（四两） 浓朴（炙，去皮，二两） 枳实（三枚）
上三味，以水四升，煮取一升二合，去滓，分温三服。初服汤当大便，不尔再服，以
利为度。得便即止服。
【集注】柯琴曰∶诸病皆因于气，秽物之不去，由于气之不顺也。故攻积之剂，必用
气分之药，因以承气名汤。方分大、小者，有二义焉∶浓朴倍大黄，是气药为君，名大承
气；大黄倍浓朴，是气药为臣，名小承气。味多性猛，制大其服，欲令大泄下也，因名曰
大，味寡性缓，制小其服，欲微和胃气也，因名曰小。且煎法更有妙义，大承气用水一斗，
煮积朴，取五升，去滓，内大黄，再煮取二升，内芒硝，何哉？盖生者气锐而先行，熟
者气纯而和缓，仲景欲使芒硝先化燥屎，大黄继通地道，而后积、朴除其痞满。若小承
气以三味同煎，不分次第，同一大黄，而煎法不同，此可见仲景微和之意也。
喻昌曰∶《金匮》治痉为病，胸满口噤，卧不着席，脚挛急必龄齿，可与大承气汤，乃
死中求生之法也。《灵枢》谓热而痉者死，腰折、螈 、齿龄也。兹所云卧不着席，即腰
折之变文。脚挛急，即螈 之变文。且断齿加以胸满口禁，上、中、下三焦热邪充斥，死
不旋踵矣。在伤寒证腹满可下，胸满则不可下，然投是汤者，须知所谓胸满，谓其邪尚
在表，故不可下。此证入里之热，极深极重，匪可比伦，况阳热深极，阴血立至消亡，即
小小下之，尚不足以胜其阳救其阴。故取此汤以承领其一线之阴气，阴气不尽为阳热所
劫，因而得生者多矣。“可与”二字甚活，临证酌而用之，初非定法也。既有下之重伤其
阴之大戒，复有下之急救其阴之活法，学人欲为深造，端在此矣。
谓胃承气汤 治表解有汗，里热不除，胃因不和，而不作解者。
大黄（酒洗，四两） 甘草（炙，二两） 芒硝（半斤）
上三味，以水三升，先煮二味，取一升，去滓，内芒硝，微煮令沸，少少温服之。
【注】三承气汤之立名，而曰大者，制大其服，欲急下其邪也；小者，制小其服，欲
缓下其邪也。曰调胃者，则有调和承顺胃气之义，非若大、小专攻下也。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。更佐甘草之缓，调停于大黄、芒硝之间，又少少温服之，使其力不峻，则
不能速下而和也。
更衣丸 治津液不足，肠胃干燥，大便不通。
朱砂（研如飞面，五钱） 芦荟（研细，生用，七钱）
滴好酒少许，和丸。每服一钱二分，好酒下。
【集注】柯琴曰∶胃为后天之本，不及固病，太过亦病。然太过复有阳盛阴虚之别焉。
两阳合明而胃家实，仲景制三承气汤以下之；三阳燥结而津液亡，前贤又制更衣丸以润之。
古人入厕必更衣，故以此命名也。朱砂以汞为体，性寒重坠下达；芦荟以液为质，味苦
膏润下滋。兼以大寒大苦之性味，能润燥结，从上导下而胃关开矣。合以为丸，两者相须，
得效最宏，奏功甚捷，诚匪夷所思矣。
麻仁丸（又名脾约丸） 治肠胃燥热，大便秘结，小便数多。
麻子（二升） 芍药（半斤） 枳实（半斤） 大黄（去皮，一斤） 浓朴（去皮，一斤）
杏仁（去皮煎熬，碾脂，一升）
上六味为末，炼蜜为丸，桐子大，饮服十丸，日三服；渐加，以利为度。
【集注】成无己曰∶约者，约结之约，又约束也。经曰∶饮入于胃，游溢精气，上输
于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。今胃强脾弱，
约束津液，不得四布，但输膀胱，小便数而大便硬，故曰脾约。麻仁甘平而润，杏仁甘
温而润。经曰∶脾欲缓，急食甘以缓之。本草曰∶润可去燥。是以麻仁为君，杏仁为臣。
枳实破结，浓朴泻满，故以为佐。芍药调中，大黄通下，故以为使。
朱震亨曰∶既云脾约，血枯火燔津竭，理宜滋阴降火，津液自生，何秘之有？此方惟
热甚而禀实者可用，热微而虚者，愈致燥涸之苦矣。
桃仁承气汤 治血结胸中，手不可近，或中焦蓄血，寒热胸满，漱水不欲咽，善忘，昏
迷如狂者。此方治败血留经，通月事。
桃仁（去皮尖，五十个） 桂枝（三两） 大黄（四两） 芒硝（二两） 甘草（二两）
上五味，以水七升，煮取二升半，去滓；内芒硝，更上火微沸；下火先食，温服五合；
日三服，当微利。
抵当汤并丸 治伤寒蓄血，并治 瘕，追虫攻毒甚佳。
水蛭（熬，三十个） 虻虫（熬，去头足，三十个） 大黄（三两） 桃仁（去皮尖，三十个）
上四味为散，以水五升，煮三升，去滓，温服一升。不下再服，利为度。
水蛭（熬，二十个） 虻虫（熬，去翅，二十五个） 桃仁（去皮尖，二十个） 大黄（三两）
上四味杵，分为四丸，以水一升，煮一九，取七合服。 时当下血，若不下更服。
【集注】柯琴曰∶膀胱为水府，血本无所容蓄者也。少腹者，膀胱之室也，热结硬满，
当小便不利，而反利者，是病不在膀胱内而在少腹内也。可知其随经之营血，因瘀热而
结于少腹之里，而非膀胱之里也。故小便虽利，而硬满急结，蓄血仍瘀于少腹也。热淫
于内，神魂不安，故发狂。血瘀不行，则营不运，故脉微而沉，营不运，则气不宣，故
沉而结也。营气不周于身，则身黄。消谷善饥者，胃火炽盛也。大便反易者，血之濡也，
色黑者，蓄血渗入也。善忘者，血不荣、智不明也。此皆瘀血之征兆，非至峻之剂，不
足以抵其巢穴而当此重任，故立抵当汤。蛭，虫之善饮血者，而利于水。虻，虫之善吮血
者、而猛于陆。并取水陆之善取血者以攻之，同气相求，更佐桃仁之苦甘，推陈致新，大
黄之苦寒，荡涤邪热，故名抵当也。若热虽盛而未狂，少腹满而未硬，宜小其制，为丸
以缓治之。若外证已解，少腹急结，其人如狂，是转属阳明，用调胃承气加桃仁、桂枝
之行血者于其中，以微利之，胃和则愈矣。此桃仁承气为治之缓也。
栀子豉汤（附∶加减诸汤） 治阳明病，脉浮而
紧，咽燥口苦，腹满而喘，发热汗出，不恶寒、反恶热，身重烦躁，心中愦愦，怵惕懊
，目疼鼻干，不得卧。
栀子（擘，十四枚） 香豉（绵裹，四合）
上二味，以水四升，先煮栀子，得二升半；内豉，煮取一升半，去滓，分二服。温
进一服，得吐止后服。
若少气者，加甘草二两。若呕者，加生姜三两。若下后心烦腹满、起卧不安者，去
香豉加浓朴四两、枳实四枚。若医以丸药下之，身热不去，心中结痛，去香豉加干姜二
两。若身热发黄者，去香豉加甘草一两、黄柏二两。
【集注】柯琴曰∶太阳以心腹为里，阳明以心腹为表。盖阳明之里是胃实，不特发热
恶热、目痛鼻干、汗出身重谓之表。一切虚烦虚热，咽燥口苦舌苔，腹满烦躁不得卧，消
渴而小便不利，凡在胃之外者，悉是阳明之表也。仲景制汗剂，是开太阳表邪之出路，制
吐剂是引阳明表邪之出路。所以太阳之表宜汗不宜吐，阳明之表当吐不当汗。太阳当汗
而反吐之，便见自汗出不恶寒，饥不能食，朝食暮吐，欲食冷食，不欲近衣等证，此太阳
转属阳明之表法，当栀子豉汤吐之。阳明当吐而不吐，反行汗下，温针等法，以致心中
愦愦，怵惕懊 ，烦躁舌苔等证，然仍在阳明之表，仍当栀子豉汤主之。栀子苦能涌泄，
寒能胜热，其形象心，又赤色通心，故主治心中上、下一切证。豆形象肾，又黑色入肾，
制而为豉，轻浮上行，能使心腹之浊邪上出于口，一吐而心腹得舒，表里之烦热悉解矣。
所以然者，急除胃外之热，不致胃家之实，即此栀豉汤为阳明解表之圣剂矣。热伤气者少
气，加甘草以益气。虚热相抟者多呕，加生姜以散邪。若下后而心腹满，起卧不安，是
热已入胃，便不当吐，故去香豉。屎未燥硬，不宜复下，故只用栀子以除烦，佐枳朴以泄
满，此两解心腹之妙，又小承气之轻剂也。若以丸药下之，身热不去，知表未解也，心中
结痛，知寒留于中也。表热里寒，故任栀子之苦以除热，倍干姜之辛以逐寒，而表热自
解，里寒自除。然非吐不能达表，故用此以探吐之。此又寒热并用，为和中解表之剂矣。
内外热炽，肌肉发黄，必须苦甘之剂以调之，柏皮、甘草色黄而润，助栀子以除内烦而解
外热。形色之病，无假形色以通之。此皆用栀豉加减以御阳明表证之变幻也。夫栀子之
性，能屈曲下行，不是上涌之剂，惟豉之腐气上蒸心肺，能令人吐耳。观瓜蒂散必用豉
汁和服，是吐在豉而不在栀也。栀子干姜汤去豉用姜，是取其横开。栀子浓朴汤，以积
朴易豉，是取其下泄。似皆不欲上越之义，虽苦亦能作涌，然非探吐不能吐也。病患旧微
溏者不可与，则栀子之性自明矣。
瓜蒂散 治胸中痞硬痰饮，一切实邪，及气冲咽不得息者，用此吐之。
瓜蒂（熬黄，一分） 赤小豆（一分）
上二味，各别捣筛，为散已，合治之。取一钱匕，以香豉一合，热汤七合，煮作稀糜，
去滓，取汁和散，温，顿服之。不吐者，少少加服，得快吐乃止。
【注】胸中者，清阳之府，诸邪入胸，皆阻阳气不得宣达，以致胸满痞硬，热气上冲，
燥渴心烦，温温欲吐，脉数促者，热郁结也。胸满痞硬，气上冲咽喉不得息，手足寒冷，欲
吐不能吐，脉迟紧者，寒郁结也。凡胸中寒热与气与饮郁结为病，谅非汗下之法所能治，
必得酸苦涌泻之品，因而越之，上焦得通，阳气得复，痞硬可消，胸中可和也。瓜蒂极苦，
赤豆味酸，相须相益，能除胸胃中实邪，为吐剂中第一品也。而佐香豉粥汁合服者，藉
谷气以保胃气也。服之不吐，少少加服，得快吐而即止者，恐伤胃中元气也。此方奏功
之捷，胜于汗下。所以三法鼎立，今人不知岐伯、仲景之精义，置之不用，可胜惜哉！
小陷胸汤 治心下痞，按之则痛，脉浮
滑者。
黄连（一两） 半夏（半升） 栝蒌实（大者，一个）
上三味，以水六升，先煮栝蒌实，取三升，去滓，内诸药，煮取二升，分温三服。
【集注】程知曰∶此热结未深者，在心下，不似大结胸之高在心上。按之痛，比手不可
近为轻。脉之浮滑又缓于沉紧，但痰饮素盛，挟热邪而内结，所以脉见浮滑也。以半夏之
辛散之，黄连之苦泻之，栝蒌之苦润涤之，皆所以除热散结于胸中也。先煮栝蒌，分温三
服，皆以缓治上之法。
程应旄曰∶黄连涤热，半夏导饮，栝蒌润燥，合之以开结气，亦名曰陷胸者，攻虽
不峻，而一皆直泻，其胸里之实邪，亦从此夺矣。
大陷胸汤丸 主治伤寒发热，不发汗而反下之，表热乘虚入于胸中，与不得为汗之
水气结而不散，令心下至少腹硬满而痛不可近，其人身无大热，但头汗出，或潮热燥渴，
脉沉紧者。如水肿、肠 ，初起形气俱实者，亦可用。
大黄（六两） 芒硝 苦葶苈子 杏仁（去皮，各半升） 甘遂（为末，一钱）
上五味，以水先煮大黄、杏、苈，去滓，内芒硝，煮一二沸，内甘遂末，温服，得快利止后
服。如未剧者，加白蜜二合，作丸如弹子大，水煮一丸，服过宿乃下，如不下更服。
【集注】柯琴曰∶胸中者，宗气之所出，故名气海。气为阳，故属太阳之部。气为水
母，气清则水精四布，气热则水浊而壅结矣。水结于胸，则津液不下，无以润肠胃，故大
便必燥，不下输膀胱，故水道不通。大黄、芒硝善涤肠胃之热实，此病在胸中而亦用以为
君者，热淫于内，当治以苦寒，且以润阳明之燥，是实则泻子之法，补膀胱之寒，亦制之以
其所畏也。任甘遂之苦辛，所以直攻其水结。然水结因于气结，必佐杏仁之苦温，以开其水
中之气，气行而水自利矣。水结又因于气热，必佐葶苈之大寒，以清其气分之热，源清而流
自洁矣。若胸中水结而未及中焦者，当小其制，而复以白蜜之甘以缓之，使留恋于胸中，
过宿乃下，但解胸心之结滞，而保肠胃之无伤，是又以香剂为和剂也。是方为利水攻积之
剂，故治水肿、痢疾之初起者甚捷，然必视其人壮实，可以一战成功，如平昔素虚弱与病久
而不任攻伐者，当念虚虚之戒矣。
三物白散方 治伤寒，寒实结胸无热证者，及胸膈寒实痰水内结等证。
桔梗（三分） 贝母（三分） 巴豆（去皮，熬黑，研如泥，一分）
大承气汤 治疗阳明病，表现为潮热（定时发热），手足濈然汗出（手脚持续出汗），谵语（神志不清说胡话）且出汗多，胃中干燥而独自说话，像看见鬼怪一样的幻觉，气喘、头晕目眩不能平卧，腹部胀满疼痛，脉象滑而实。又有眼睛视物不清，眼球转动不灵活的情况。又有少阴病初起时，出现口燥咽干的。自利清水，颜色纯青，心下疼痛，口燥舌干的情况。病程六七天，腹胀不大便的情况。
大黄（用酒洗，四两） 浓朴（半斤） 枳实（炙烤，五枚） 芒硝（三合）
以上四味药，用水一斗，先煮枳实和浓朴，取汁五升，加入大黄，煮取二升，去渣；再加入芒硝，再次上火微煮一二沸，分两次温服。大便通下后即停止后服。
小承气汤
大黄（四两） 浓朴（炙烤，去皮，二两） 枳实（三枚）
以上三味药，用水四升，煮取一升二合，去渣，分三次温服。初次服药后应当排便，如果不排便则再服，以大便通畅为度。大便通畅即停止服用。
【集注】柯琴说：各种疾病都因气机失调引起，秽浊之物排不出去，是由于气机不顺。所以攻积导滞的药剂，必须使用调理气分的药物，因此以“承气”命名方剂。方剂分为大、小两种，有两层含义：浓朴用量倍于大黄，是以理气药为主药，名叫大承气汤；大黄用量倍于浓朴，是以理气药为辅药，名叫小承气汤。药味多且药性猛烈，加大剂量，想要使其大泻下，因此命名为大；药味少且药性缓和，减小剂量，想要轻微调和胃气，因此命名为小。而且煎法更有妙义，大承气汤用水一斗，先煮枳实、浓朴，取汁五升，去渣，加入大黄，再煮取二升，加入芒硝，为什么呢？因为生药气味锐利而先行，熟药气味纯正而和缓，张仲景想要让芒硝先化解燥屎，大黄接着疏通肠道，然后枳实、浓朴消除痞满。如果小承气汤将三味药同煎，不分先后次序，同样是使用大黄，但煎法不同，这可见张仲景轻微调和的意图。
喻昌说：《金匮要略》治疗痉病，胸满口噤（牙关紧闭），卧床时背部挺直接触不到席子，脚挛急并伴有磨牙，可以用大承气汤，这是死里求生的方法。《灵枢》说热盛发痉者死，表现为腰背反折、抽搐、磨牙。这里所说的卧床背部挺直接触不到席子，就是腰背反折的另一种说法。脚挛急，就是抽搐的另一种说法。况且磨牙加上胸满口禁，上、中、下三焦热邪充斥，死亡就在眨眼之间了。在伤寒证中，腹满可以攻下，胸满则不可攻下，然而投用此汤的人，需知所谓的胸满，是指邪气尚在表，所以不可攻下。此证是入里的热邪，极深极重，不可相提并论，何况阳热极盛，阴血立刻就会消亡，即使轻微攻下，还不足以战胜阳热救助阴液。所以取此汤来承接引领一线之阴气，阴气不被阳热所劫夺，因而得以生存的人很多。“可与”二字非常灵活，临证时斟酌使用，并非固定不变的方法。既有攻下重伤阴液的巨大禁忌，又有攻下急救阴液的灵活方法，学者想要达到高深造诣，关键在于此。
调胃承气汤 治疗表证已解且有汗出，里热未除，胃气不和，病情不得缓解的情况。
以上三味药，用水三升，先煮大黄和甘草，取汁一升，去渣，加入芒硝，微煮令沸，少量多次温服。
【注】三个承气汤的命名，称为大的，是加大剂量，想要紧急攻下邪气；称为小的，是减小剂量，想要缓慢攻下邪气。称为调胃的，则有调和顺承胃气的含义，不像大、小承气汤专门攻下。经文说：热邪淫溢于内，用咸寒药物治疗；火邪淫溢于内，用苦寒药物治疗。君药使用大黄的苦寒，臣药使用芒硝的咸寒，两味药并用，攻热泻火的力量具备了。更佐以甘草的缓急作用，在大黄、芒硝之间进行调和，又采用少量多次温服的方法，使药力不峻猛，从而不能迅速攻下而是起到调和作用。
滴入少许好酒，和药制成丸剂。每次服用一钱二分，用好酒送服。
【集注】柯琴说：胃是后天之本，功能不及固然生病，太过也会生病。然而太过又有阳盛阴虚的区别。两阳合明而导致胃家实证，张仲景制定三个承气汤来攻下它；三阳燥结导致津液亡失，前贤又制定更衣丸来润燥。古人上厕所必换衣服，所以以此命名。朱砂以汞为体，性寒重坠下达；芦荟以液为质，味苦膏润下滋。兼以大寒大苦的性味，能润燥结，从上引导向下从而使胃关开启。合起来制成丸剂，两者相互辅助，取得效果最宏大，奏效甚快，确实匪夷所思。
麻子（二升） 芍药（半斤） 枳实（半斤） 大黄（去皮，一斤） 浓朴（去皮，一斤） 杏仁（去皮煎熬，碾成脂状，一升）
以上六味药研为末，炼蜜为丸，梧桐子大小，饮服十丸，每日三次；逐渐增加剂量，以大便通畅为度。
【集注】成无己说：约，是约束的意思。经文说：水饮进入胃中，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五脏经脉并行。现在胃强脾弱，约束津液，使其不能四布，只输送到膀胱，导致小便频数而大便坚硬，所以叫脾约。麻仁甘平而润，杏仁甘温而润。经文说：脾欲缓，急食甘以缓之。本草说：润可去燥。所以以麻仁为君药，杏仁为臣药。枳实破结，浓朴泻满，所以作为佐药。芍药调中，大黄通下，所以作为使药。
朱震亨说：既然叫脾约，血枯火燔津液枯竭，按理应该滋阴降火，津液自然生成，哪里有秘结的道理？此方只有热盛且体质结实的人可用，热微而虚的人，会更加导致燥涸的痛苦。
桃仁承气汤 治疗血结胸中，手不可触碰，或者中焦蓄血，寒热交替胸满，漱水不欲咽，健忘，昏迷如狂的情况。此方治疗败血留滞经络，通调月经。
桃仁（去皮尖，五十个） 桂枝（三两） 大黄（四两） 芒硝（二两） 甘草（二两）
以上五味药，用水七升，煮取二升半，去渣；加入芒硝，再次上火微沸；饭前温服五合；每日三次，应当轻微腹泻。
抵当汤并丸 治疗伤寒蓄血，并治疗癥瘕（腹内结块），驱虫攻毒效果很好。
水蛭（熬制，三十个） 虻虫（熬制，去头足，三十个） 大黄（三两） 桃仁（去皮尖，三十个）
以上四味药研为散，用水五升，煮取三升，去渣，温服一升。不服药不下行则再服，以大便通利为度。
水蛭（熬制，二十个） 虻虫（熬制，去翅，二十五个） 桃仁（去皮尖，二十个） 大黄（三两）
以上四味药捣碎，分为四丸，用水一升，煮一丸，取汁七合服用。此时应当下血，如果不下则再服。
【集注】柯琴说：膀胱是水府，血液本来没有地方蓄积。少腹是膀胱的居室，热结硬满，应当小便不利，反而小便通利的，说明病不在膀胱内而在少腹内。可知随经运行的营血，因瘀热而结于少腹之里，而非膀胱之里。所以小便虽然通利，但硬满急结，蓄血仍瘀于少腹。热邪淫溢于内，神魂不安，所以发狂。血瘀不行，则营血不运，所以脉微而沉，营血不运，则气机不宣，所以脉沉而结。营气不周流于身，则身体发黄。消谷善饥，是胃火炽盛。大便反而容易，是血的濡润，颜色黑，是蓄血渗入。健忘，是血不荣养、智力不明。这些都是瘀血的征兆，非至峻猛的药剂，不足以抵挡其巢穴并承担此重任，所以创立抵当汤。水蛭，是善于吸血的水虫，利于在水中活动。虻，是善于吮血的气虫，猛烈于陆地。同时选取水陆善于取血的虫类来攻逐它们，同气相求，更佐以桃仁的苦甘，推陈致新，大黄之苦寒，荡涤邪热，所以名叫抵当。如果热虽盛但未发狂，少腹满而未硬，宜减小剂量，制成丸剂以缓治之。如果外证已解，少腹急结，其人如狂，是转属阳明，用调胃承气汤加桃仁、桂枝等行血药在其中，以轻微通利，胃气和则痊愈。这是桃仁承气汤治疗较缓的方法。
栀子豉汤（附：加减诸汤） 治疗阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒、反恶热，身重烦躁，心中愦愦（烦乱不适），怵惕懊憹（恐惧悔恨），目疼鼻干，不得卧。
以上两味药，用水四升，先煮栀子，得二升半；加入香豉，煮取一升半，去渣，分两次服用。温服一次，如果呕吐则停止后服。
如果少气的，加甘草二两。如果呕吐的，加生姜三两。如果下后心烦腹满、起卧不安的，去掉香豉加浓朴四两、枳实四枚。如果医生用丸药攻下，身热不去，心中结痛，去掉香豉加干姜二两。如果身热发黄的，去掉香豉加甘草一两、黄柏二两。
【集注】柯琴说：太阳以心腹为里，阳明以心腹为表。所谓阳明之里是胃实，不仅发热恶热、目痛鼻干、汗出身重叫做表。一切虚烦虚热，咽燥口苦舌苔，腹满烦躁不得卧，消渴而小便不利，凡在胃之外的，都是阳明之表。张仲景制定汗剂，是开通太阳表邪的出路，制定吐剂是引导阳明表邪的出路。所以太阳之表宜汗不宜吐，阳明之表当吐不当汗。太阳应当汗而反吐之，就会出现自汗出不恶寒，饥不能食，朝食暮吐，想吃冷食，不想靠近衣物等症状，这是太阳转属阳明之表的方法，应当用栀子豉汤吐之。阳明应当吐而不吐，反而行汗下、温针等方法，以致心中愦愦，怵惕懊憹，烦躁舌苔等症状，然而仍在阳明之表，仍当用栀子豉汤主治。栀子苦能涌泄，寒能胜热，其形象心，又赤色通心，所以主治心中上下的一切证候。豆形象肾，又黑色入肾，制成豉后，轻浮上行，能使心腹的浊邪上出于口，一吐而心腹得舒，表里的烦热悉解。之所以这样，是因为急除胃外的热，不致使胃家成实，这个栀豉汤就是阳明解表的圣剂。热伤气则少气，加甘草以益气。虚热相搏则多呕，加生姜以散邪。如果下后而心腹满，起卧不安，是热已入胃，便不应当吐，所以去掉香豉。屎未燥硬，不应当再下，所以只用栀子以除烦，佐枳朴以泄满，这是两解心腹的妙法，又是小承气汤的轻剂。如果用丸药攻下，身热不去，知道表未解，心中结痛，知道寒留于中。表热里寒，所以任栀子之苦以除热，倍干姜之辛以逐寒，而表热自解，里寒自除。然而不吐不能达表，所以用此方以探吐。这又是寒热并用，为和中解表的剂型。内外热炽，肌肉发黄，必须用苦甘之剂来调和，柏皮、甘草色黄而润，助栀子以除内烦而解外热。形色之病，无假形色以通之。这都是用栀豉加减来应对阳明表证的变幻。夫栀子的性质，能屈曲下行，不是上涌的剂型，只有豉的腐气上蒸心肺，能令人吐。看瓜蒂散必用豉汁和服，是吐在豉而不在栀。栀子干姜汤去豉用姜，是取其横开。栀子浓朴汤，以枳朴易豉，是取其下泄。似乎都不欲上越的意思，虽然苦也能作涌，然而不探吐不能吐。病患旧有轻微溏泄的不可以给予，则栀子的性质自然明了。
瓜蒂散 治疗胸中痞硬痰饮，一切实邪，以及气冲咽喉不得呼吸的，用此方吐之。
以上两味药，分别捣筛，成为散剂后，混合在一起。取一钱匕，用香豉一合，热汤七合，煮成稀糜，去渣，取汁和散，温，顿服之。不吐的，少量多次增加剂量，得快吐乃止。
【注】胸中是清阳之府，各种邪气进入胸中，都阻碍阳气不得宣达，以致胸满痞硬，热气上冲，燥渴心烦，温温欲吐，脉数促的，是热郁结。胸满痞硬，气上冲咽喉不得呼吸，手足寒冷，欲吐不能吐，脉迟紧的，是寒郁结。凡是胸中寒热与气与饮郁结为病，想必不是汗下之法所能治疗，必须得到酸苦涌泻的药物，因而越之，上焦得通，阳气得复，痞硬可消，胸中可和。瓜蒂极苦，赤豆味酸，相互辅助，能除胸胃中实邪，为吐剂中的第一品。而佐以香豉粥汁合服的，是借谷气以保胃气。服之不吐，少量多次增加剂量，得快吐而即止的，是恐伤胃中元气。此方奏效之快，胜于汗下。所以三法鼎立，今人不知岐伯、仲景的精义，置之不用，可惜啊！
以上三味药，用水六升，先煮栝蒌实，取三升，去渣，加入诸药，煮取二升，分三次温服。
【集注】程知说：这是热结未深的，在心下，不像大结胸的高在心上。按之痛，比手不可近为轻。脉之浮滑又缓于沉紧，只是痰饮素盛，挟热邪而内结，所以脉见浮滑。用半夏之辛散之，黄连之苦泻之，栝蒌之苦润涤之，都是为了除热散结于胸中。先煮栝蒌，分温三服，都是以缓治上的方法。
程应旄说：黄连涤热，半夏导饮，栝蒌润燥，合之以开结气，也名叫陷胸，攻虽不峻，而一皆直泻，其胸里的实邪，也从此被夺走。
大陷胸汤丸 主治伤寒发热，不发汗而反下之，表热乘虚入于胸中，与不得为汗之水气结而不散，令心下至少腹硬满而痛不可近，其人身无大热，但头汗出，或潮热燥渴，脉沉紧的。如水肿、肠澼（痢疾），初起形气俱实的，也可用。
大黄（六两） 芒硝 苦葶苈子 杏仁（去皮，各半升） 甘遂（为末，一钱）
以上五味药，用水先煮大黄、杏、苈，去渣，加入芒硝，煮一二沸，加入甘遂末，温服，得快利止后服。如未剧烈的，加白蜜二合，作丸如弹子大，水煮一丸，服过宿乃下，如果不下再服。
【集注】柯琴说：胸中是宗气之所出，所以名气海。气为阳，所以属太阳之部。气为水母，气清则水精四布，气热则水浊而壅结。水结于胸，则津液不下，无以润肠胃，所以大便必燥，不下输膀胱，所以水道不通。大黄、芒硝善涤肠胃之热实，此病在胸中而亦用以为君，是热淫于内，当治以苦寒，且以润阳明之燥，是实则泻子之法，补膀胱之寒，也是制之以其所畏。任甘遂之苦辛，所以直攻其水结。然而水结因于气结，必佐杏仁之苦温，以开水中之气，气行而水自利。水结又因于气热，必佐葶苈之大寒，以清气分之热，源清而流自洁。如果胸中水结而未及中焦，当小其制，而复以白蜜之甘以缓之，使留恋于胸中，过宿乃下，但解胸心之结滞，而保肠胃之无伤，这又是以香剂为和剂。此方为利水攻积之剂，所以治水肿、痢疾之初起者甚捷，然而必须视其人壮实，可以一战成功，如果平昔素虚弱与病久而不任攻伐者，应当念虚虚之戒。
Da Cheng Qi Tang (Major Order the Qi Decoction) treats Yangming disease, characterized by tidal fever (fever that occurs at a specific time), continuous sweating of the hands and feet, delirium with excessive sweating, dryness in the stomach leading to muttering to oneself, hallucinations as if seeing ghosts, panting, dizziness, inability to lie down, abdominal fullness and pain, and a slippery and solid pulse. It also treats cases where vision is unclear and the eyes are unresponsive. Additionally, it treats Shaoyin disease in its early stage presenting with dry mouth and throat. It treats spontaneous diarrhea of clear water, purely green in color, pain in the epigastrium, dry mouth and tongue. It treats conditions lasting six or seven days with abdominal distension and constipation.
Rhubarb (washed with wine, 4 liang)
Stemma Polygalae (half jin)
Immature Bitter Orange (roasted, 5 pieces)
Mirabilite (3 he)
The above four ingredients are boiled in 10 dou of water. First, boil Stemma Polygalae and Immature Bitter Orange until 5 sheng of liquid remains. Remove the dregs, add Rhubarb, and boil until 2 sheng remains. Remove the dregs again, add Mirabilite, heat briefly for one or two boils, and divide into two warm doses. Stop subsequent doses once bowel movement occurs.
Xiao Cheng Qi Tang (Minor Order the Qi Decoction)
Rhubarb (4 liang)
Stemma Polygalae (roasted, peeled, 2 liang)
Immature Bitter Orange (3 pieces)
The above three ingredients are boiled in 4 sheng of water until 1.2 sheng remains. Remove the dregs and divide into three warm doses. Bowel movement should occur after the first dose; if not, administer the next dose. Stop when bowel movement is achieved.
[Collected Annotations] Ke Qin stated: All diseases arise from qi dysfunction; the retention of turbid matter is due to the obstruction of qi flow. Therefore, purgative agents must use herbs that regulate the qi aspect, hence the name "Cheng Qi" (Order the Qi). The distinction between Major and Minor lies in two aspects: When Stemma Polygalae is used in double the amount of Rhubarb, the qi-regulating herb is the sovereign, named Da Cheng Qi Tang. When Rhubarb is used in double the amount of Stemma Polygalae, the qi-regulating herb is the minister, named Xiao Cheng Qi Tang. With many ingredients and potent properties, larger dosages are used to induce strong purgation, hence "Major." With fewer ingredients and milder properties, smaller dosages are used to gently harmonize the Stomach Qi, hence "Minor." Furthermore, the decoction method holds profound meaning. Da Cheng Qi Tang uses 10 dou of water, boiling Immature Bitter Orange and Stemma Polygalae first to obtain 5 sheng, removing dregs, adding Rhubarb, boiling to 2 sheng, then adding Mirabilite. Why? Raw herbs have sharp qi and act quickly, while cooked herbs have pure qi and act slowly. Zhang Zhongjing intended for Mirabilite to first dissolve dry feces, followed by Rhubarb to unblock the intestinal tract, and finally Immature Bitter Orange and Stemma Polygalae to eliminate fullness and stagnation. In contrast, Xiao Cheng Qi Tang boils all three ingredients together without sequence. Although using the same Rhubarb, the different decoction methods reveal Zhang Zhongjing's intent to gently harmonize.
Yu Chang stated: *Jin Gui Yao Lue* treats spasm disease with chest fullness, locked jaw, inability to lie flat (back stiff against the bed), leg cramps, and teeth grinding, recommending Da Cheng Qi Tang as a method of seeking life amidst death. *Ling Shu* states that heat-induced spasm leads to death, manifesting as opisthotonos, convulsions, and teeth grinding. The described inability to lie flat is a variation of opisthotonos. Leg cramps are a variation of convulsions. Coupled with teeth grinding, chest fullness, and locked jaw, heat pathogens fill the Upper, Middle, and Lower Jiao, leading to imminent death. In Taiyang syndrome, abdominal fullness can be purged, but chest fullness cannot. However, those administering this formula must understand that "chest fullness" here refers to pathogenic factors still in the exterior, thus contraindicating purgation. This case involves interior heat that is extremely deep and severe, incomparable to simple exterior patterns. Moreover, extreme yang heat rapidly consumes yin blood. Even mild purgation may not suffice to overcome yang heat and rescue yin. Thus, this formula is used to receive and guide the remaining thread of yin qi. If yin qi is not hijacked by yang heat, survival is likely. The phrase "may be given" implies flexibility in clinical application, not a rigid rule. There is a major prohibition against purging which severely injures yin, yet also a flexible method of purging to urgently rescue yin. Scholars aiming for profound mastery must focus on this.
Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) treats cases where the exterior has resolved with sweating, but interior heat persists, causing disharmony in the Stomach and failure to recover.
Rhubarb (washed with wine, 4 liang)
Licorice (roasted, 2 liang)
Mirabilite (half jin)
The above three ingredients are boiled in 3 sheng of water. First, boil Licorice and Rhubarb to obtain 1 sheng. Remove dregs, add Mirabilite, boil briefly, and take small amounts warm.
[Note] The naming of the three Cheng Qi formulas reflects dosage strategy: "Major" indicates large dosage for urgent purgation; "Minor" indicates small dosage for slow purgation. "Regulate the Stomach" implies harmonizing and smoothing Stomach Qi, unlike the specific purgative action of the Major and Minor forms. The Classic states: For heat flooding internally, treat with salty-cold; for fire flooding internally, treat with bitter-cold. Rhubarb (bitter-cold) is the sovereign, Mirabilite (salty-cold) is the minister. Their combined power to attack heat and drain fire is complete. Licorice (mild) is added to moderate between Rhubarb and Mirabilite. Taking small amounts warm prevents harsh action, allowing for gradual harmonization rather than rapid purgation.
Geng Yi Wan (Changing Clothes Pill) treats insufficient body fluids, dry intestines and stomach, and constipation.
Cinnabar (ground fine, 5 qian)
Aloe (ground fine, raw, 7 qian)
Mix with a little good wine to form pills. Take 1.2 qian per dose, washed down with good wine.
[Collected Annotations] Ke Qin stated: The Stomach is the root of post-heaven existence. Deficiency causes disease, and excess also causes disease. Excess differs in yang-excess with yin-deficiency. When two yangs combine to brighten, resulting in Stomach excess, Zhang Zhongjing created the three Cheng Qi formulas to purge it. When the three yangs become dry and bound with fluid depletion, earlier sages created Geng Yi Wan to moisten it. Ancients changed clothes before entering the toilet, hence the name. Cinnabar, based on mercury, is cold, heavy, and descending. Aloe, based on resin, is bitter, pasty, moistening, and descending. Combined with their great cold and bitter nature, they moisten dryness and binding, guiding downward from above to open the Stomach gate. As pills, they assist each other, yielding magnificent and rapid effects, truly beyond imagination.
Ma Ren Wan (Hemp Seed Pill, also known as Pi Yue Wan / Spleen Constrained Pill) treats intestinal and stomach dry-heat, constipation, and frequent urination.
Hemp Seed (2 sheng)
Paeonia Root (half jin)
Immature Bitter Orange (half jin)
Rhubarb (peeled, 1 jin)
Stemma Polygalae (peeled, 1 jin)
Apricot Kernel (peeled, boiled, ground to paste, 1 sheng)
Grind the above six ingredients into powder, mix with refined honey to form pills the size of tung seeds. Take 10 pills with water, three times daily; gradually increase dosage until bowel movement is achieved.
[Collected Annotations] Cheng Wuji stated: "Yue" means constraint. The Classic states: Drink enters the Stomach, essence floats up, transports to the Spleen, Spleen scatters essence, returns to the Lung, regulates water passages, transports to the Bladder, fluids distribute everywhere, and the five meridians run together. Now, Stomach is strong but Spleen is weak, constraining fluids so they cannot distribute widely, only transporting to the Bladder, causing frequent urination and hard stool, hence "Spleen Constraint." Hemp Seed is sweet, neutral, and moistening; Apricot Kernel is sweet, warm, and moistening. The Classic states: The Spleen desires relaxation; urgently eat sweet to relax it. Materia Medica states: Moistening removes dryness. Thus, Hemp Seed is sovereign, Apricot Kernel is minister. Immature Bitter Orange breaks stagnation, Stemma Polygalae drains fullness, serving as assistants. Paeonia harmonizes the middle, Rhubarb unblocks downward, serving as envoys.
Zhu Zhenheng stated: Since it is called Spleen Constraint, with blood deficiency, fire blazing, and fluid exhaustion, one should nourish yin and descend fire, generating fluids naturally, avoiding constipation. This formula is suitable only for those with intense heat and robust constitution; those with mild heat and deficiency will suffer further dryness.
Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) treats blood stasis in the chest, intolerable to touch, or blood accumulation in the middle jiao with alternating chills and fever, chest fullness, rinsing mouth without swallowing, forgetfulness, confusion, and mania-like behavior. This formula treats retained bad blood in the meridians and regulates menstruation.
Peach Kernel (peeled and tip removed, 50 pieces)
Cinnamon Twig (3 liang)
Rhubarb (4 liang)
Mirabilite (2 liang)
Licorice (2 liang)
Boil the above five ingredients in 7 sheng of water to obtain 2.5 sheng. Remove dregs, add Mirabilite, boil briefly. Take 0.5 sheng warm before meals, three times daily. Mild purgation should occur.
Di Dang Tang and Wan (Resist Water Decoction and Pill) treats Taiyang blood accumulation and zhang masses (abdominal masses); excellent for expelling parasites and attacking toxins.
Leech (roasted, 30 pieces)
Blue Bottle Fly (roasted, head and feet removed, 30 pieces)
Rhubarb (3 liang)
Peach Kernel (peeled and tip removed, 30 pieces)
Grind the above four ingredients into powder. Boil in 5 sheng of water to obtain 3 sheng. Remove dregs, take 1 sheng warm. If no effect, repeat. Stop when purged.
Leech (roasted, 20 pieces)
Blue Bottle Fly (roasted, wings removed, 25 pieces)
Peach Kernel (peeled and tip removed, 20 pieces)
Rhubarb (3 liang)
Pound the above four ingredients, divide into four pills. Boil one pill in 1 sheng of water to obtain 0.7 sheng. Take. Blood should pass; if not, take again.
[Collected Annotations] Ke Qin stated: The Bladder is the residence of water; blood has no place to accumulate. The lower abdomen is the chamber of the Bladder. Heat binding causes hardness and fullness; urine should be difficult, but if it flows freely, the disease is not in the Bladder interior but in the lower abdomen interior. Thus, circulating nutritive blood, due to stasis-heat, binds in the lower abdomen, not the Bladder interior. Hence, even with free urination, hardness, fullness, and urgency persist, with blood stasis remaining in the lower abdomen. Heat flooding internally disturbs the soul and spirit, causing madness. Blood stasis prevents circulation, so nutritive qi does not move, resulting in faint and deep pulses. Nutritive qi stagnation prevents qi dissemination, causing deep and knotted pulses. Nutritive qi failing to circulate the body causes yellowing. Eating well and hunger indicate blazing Stomach fire. Stool being easy to pass is due to blood lubrication; black color indicates blood infiltration. Forgetfulness indicates blood failing to nourish and intellect dimming. These are signs of blood stasis. Only the most峻猛 (harsh/potent) agents can reach the nest and bear this responsibility, hence Di Dang Tang was established. Leeches are aquatic insects skilled at drinking blood. Blue Bottle Flies are aerial insects skilled at sucking blood. Using both aquatic and aerial blood-suckers seeks resonance. Assisted by Peach Kernel (bitter-sweet) to push out the old and generate the new, and Rhubarb (bitter-cold) to cleanse evil heat, it is named "Di Dang" (Resist/Withstand). If heat is intense but not manic, and lower abdomen is full but not hard, reduce the dosage and use pills for slow treatment. If exterior symptoms resolve, lower abdomen is urgent and knotted, and the patient is mania-like, it has transferred to Yangming. Use Tiao Wei Cheng Qi Tang plus Peach Kernel and Cinnamon Twig to move blood, inducing mild purgation. Harmonized Stomach leads to recovery. This is the slower treatment of Tao Ren Cheng Qi Tang.
Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction, with Attached Modified Formulas) treats Yangming disease with floating and tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to cold absent but aversion to heat present, heaviness, irritability, mental restlessness, fear, regret, eye pain, nasal dryness, and insomnia.
Gardenia Fruit (broken, 14 pieces)
Prepared Fermented Soybean (wrapped in cloth, 4 he)
Boil the above two ingredients in 4 sheng of water. First boil Gardenia to 2.5 sheng. Add Fermented Soybean, boil to 1.5 sheng. Remove dregs, divide into two doses. Take warm. Stop subsequent doses if vomiting occurs.
If short of qi, add Licorice (2 liang). If vomiting, add Fresh Ginger (3 liang). If after purgation there is irritability, abdominal fullness, and restlessness, remove Fermented Soybean, add Stemma Polygalae (4 liang) and Immature Bitter Orange (4 pieces). If treated with pill purgatives, fever persists, and there is knotting pain in the heart, remove Fermented Soybean, add Dried Ginger (2 liang). If fever with jaundice appears, remove Fermented Soybean, add Licorice (1 liang) and Phellodendron Bark (2 liang).
[Collected Annotations] Ke Qin stated: For Taiyang, the heart and abdomen are interior; for Yangming, the heart and abdomen are exterior. Yangming interior is Stomach excess. Not only fever, aversion to heat, eye pain, nasal dryness, sweating, and heaviness are considered exterior. All empty irritability, empty heat, dry throat, bitter taste, tongue coating, abdominal fullness, irritability, insomnia, thirst with difficult urination, anything outside the Stomach, is Yangming exterior. Zhang Zhongjing's diaphoretic agents open the exit for Taiyang exterior pathogens; emetic agents guide Yangming exterior pathogens out. Thus, Taiyang exterior should be diaphoresed, not vomited; Yangming exterior should be vomited, not diaphoresed. If Taiyang requires diaphoresis but vomiting is used, spontaneous sweating, aversion to cold absent, hunger without appetite, morning food evening vomiting, desire for cold food, aversion to clothing appear. This is Taiyang transferring to Yangming exterior, treated with Zhi Zi Chi Tang to induce vomiting. If Yangming requires vomiting but is not, and instead diaphoresis, purgation, or moxibustion are used, leading to mental restlessness, fear, regret, irritability, and tongue coating, yet still in Yangming exterior, Zhi Zi Chi Tang is still indicated. Gardenia is bitter (promotes vomiting/drains) and cold (overcomes heat); its shape resembles the heart, and red color connects to the heart, treating all heart-related disorders. Soybean resembles the kidney, black color enters the kidney. Processed into fermented soybean, it becomes light and ascending, guiding turbid pathogens from heart and abdomen upward through the mouth. One vomit relieves heart and abdomen, resolving exterior-interior irritability and heat. This works by urgently clearing heat outside the Stomach, preventing Stomach excess, making Zhi Zi Chi Tang the holy agent for resolving Yangming exterior. Heat injuring qi causes shortness of breath; add Licorice to tonify qi. Empty heat combing causes vomiting; add Ginger to scatter pathogens. After purgation, if heart/abdomen fullness and restlessness occur, heat has entered the Stomach; vomiting is inappropriate. Remove Fermented Soybean. If stool is not dry/hard, further purgation is inappropriate. Use only Gardenia to relieve irritability, assisted by Immature Bitter Orange and Stemma Polygalae to drain fullness. This cleverly resolves heart and abdomen, acting as a mild Xiao Cheng Qi Tang. If pill purgatives were used, persistent fever indicates unresolved exterior; knotting pain in the heart indicates cold滞留 (retention) in the middle. Exterior heat, interior cold. Use Gardenia's bitterness to clear heat, double Dried Ginger's pungency to drive out cold. Exterior heat resolves, interior cold clears. However, vomiting is needed to reach the exterior, so this formula probes for vomiting. This is a harmonizing and exterior-resolving formula using cold and heat together. Intense internal and external heat causing muscle jaundice requires bitter-sweet harmonizing agents. Phellodendron and Licorice are yellow and moistening, assisting Gardenia to clear internal irritability and resolve external heat. Diseases of form and color require agents of form and color to penetrate. These modifications of Zhi Zi Chi Tang handle Yangming exterior variations. Gardenia's nature descends curvingly, not an emetic. Only Fermented Soybean's fermented vapor steams upward to the heart and lungs, causing vomiting. Guan Di San uses soybean juice to mix, indicating vomiting comes from Soybean, not Gardenia. Zhi Zi Gan Jiang Tang removes Soybean, adds Ginger, taking its horizontal opening. Zhi Zi Hou Po Tang replaces Soybean with Immature Bitter Orange and Stemma Polygalae, taking its downward draining. These seem to avoid upward emergence. Though bitter can induce vomiting, probing for vomiting is required. Patients with chronic loose stools should not receive it, clarifying Gardenia's nature.
Gua Di San (Melon Peduncle Powder) treats chest oppression, hardness, phlegm-fluid, all excess pathogens, and qi rushing to the throat causing dyspnea. Induce vomiting with this formula.
Melon Peduncle (roasted yellow, 1 fen)
Adzuki Bean (1 fen)
Grind each separately into powder, then mix. Take 1 qian bi. Mix with 1 he of Fermented Soybean and 0.7 sheng of hot water, boil into thin porridge. Remove dregs, mix juice with powder. Take warm in one dose. If no vomiting, increase slightly. Stop when vigorous vomiting occurs.
[Note] The chest is the mansion of clear yang. Pathogens entering the chest block yang qi from dispersing, causing chest fullness, oppression, hardness, rising heat, dryness, thirst, irritability, nausea, and rapid, intermittent pulse (heat constraint). Chest fullness, oppression, hardness, qi rushing to throat causing dyspnea, cold limbs, desire to vomit but unable, with slow, tight pulse (cold constraint). Diseases caused by constraint of cold, heat, qi, and fluid in the chest cannot be treated by diaphoresis or purgation. Sour-bitter emetic-draining agents are needed to induce upward emergence. Upper jiao opens, yang qi recovers, oppression/hardness dissipates, chest harmonizes. Melon Peduncle is extremely bitter; Adzuki Bean is sour. They assist each other to remove excess pathogens in chest/stomach, being the premier emetic. Adding Fermented Soybean porridge juice preserves Stomach qi via grain qi. Increasing dose slightly if no vomiting, stopping after vigorous vomiting, prevents injury to Stomach yuan qi. This formula acts faster than diaphoresis or purgation. Thus, the three methods stand equal. Moderns ignore the essence of Qibo and Zhang Zhongjing, discarding these formulas, which is lamentable.
Xiao Xian Xiong Tang (Minor Trap the Chest Decoction) treats epigastric oppression, pain upon pressure, and floating-slippery pulse.
Coptis Rhizome (1 liang)
Pinellia Tuber (half sheng)
Trichosanthes Fruit (large, 1 piece)
Boil the above three ingredients in 6 sheng of water. First boil Trichosanthes Fruit to 3 sheng. Remove dregs, add other herbs, boil to 2 sheng. Divide into three warm doses.
[Collected Annotations] Cheng Zhi stated: This is heat binding not yet deep, located in the epigastrium, unlike Da Xian Xiong Tang which is high in the chest. Pain on pressure is lighter than intolerance to touch. Floating-slippery pulse is slower than deep-tight. It arises from abundant phlegm-fluid combining with heat to bind internally, hence the floating-slippery pulse. Pinellia's pungency disperses, Coptis' bitterness drains, Trichosanthes' bitterness-moisture cleanses. All remove heat and dissipate binding in the chest. Boiling Trichosanthes first and dividing into three warm doses employs the method of treating the upper jiao slowly.
Cheng Yingmao stated: Coptis clears heat, Pinellia guides fluid, Trichosanthes moistens dryness. Combined to open constrained qi. Also named "Trap the Chest," though not harsh, it directly attacks and evacuates excess pathogens in the chest interior.
Da Xian Xiong Tang and Wan (Major Trap the Chest Decoction and Pill) mainly treats Taiyang fever where lack of diaphoresis leads to incorrect purgation. Exterior heat enters the chest via deficiency, binding with fluid that cannot transform into sweat, causing hardness, fullness, and pain from epigastrium to lower abdomen, intolerable to touch. Body has no significant heat, only head sweating, or tidal fever, dryness, thirst, and deep-tight pulse. Also treats early-stage edema and dysentery (chang pi) in robust individuals with sufficient qi and form.
Rhubarb (6 liang)
Mirabilite
Semen Lepidii (Bitter Teasel Seed)
Apricot Kernel (peeled, half sheng each)
Kansui Root (powder, 1 qian)
Boil Rhubarb, Apricot Kernel, and Semen Lepidii in water first. Remove dregs, add Mirabilite, boil 1-2 boils. Add Kansui powder. Take warm. Stop subsequent doses when brisk purgation occurs. If not severe, add White Honey (2 he), form pills like bullet sizes. Boil one pill in water. Effect occurs overnight. If no effect, take again.
[Collected Annotations] Ke Qin stated: The chest is where Zong Qi (Gathering Qi) originates, hence named Qi Sea. Qi is yang, belonging to the Taiyang sector. Qi is the mother of water. Clear qi allows fluid distribution; hot qi makes turbid water bind. Water binding in the chest prevents fluids from descending to moisten intestines, causing dry stool. Failure to transport to Bladder blocks water passages. Rhubarb and Mirabilite cleanse gastrointestinal heat-excess. Used as sovereign here because heat flooding internally requires bitter-cold treatment, and to moisten Yangming dryness. This is "draining the son when excess" method, and restraining Bladder cold with what it fears. Kansui's bitter-pungency directly attacks water binding. Since water binding stems from qi binding, assist with Apricot Kernel's bitter-warm to open qi within water; moving qi moves water. Since water binding stems from qi heat, assist with Semen Lepidii's great cold to clear qi-heat; clearing source cleanses flow. If chest water binding hasn't reached middle jiao, reduce dosage and add White Honey's sweetness to缓 (slow/moderate), retaining it in the chest, acting overnight to resolve chest-heart stagnation while protecting intestines/stomach. This uses aromatic agents as harmonizing agents. This formula promotes water and attacks accumulation, effective for early edema/dysentery. Must ensure patient is robust for single success. Weak patients or long-term illness unsuitable for attack must heed the warning against "deficiency inducing deficiency."
San Wu Bai San Formula (Three-Ingredient White Powder) treats Taiyang cold-real constraint chest without heat signs, and cold-real phlegm-fluid binding in chest/diaphragm.
Platycodon Root (3 fen)
Fritillaria Bulb (3 fen)
Croton Seed (peeled, roasted black, ground to paste, 1 fen)