伤寒下后，心烦腹满，卧起不安者，栀子浓朴汤主之。伤寒，医以丸药大下之，身热不去，微烦者，栀
子干姜汤主之。发汗，若下之而烦热胸中窒者，栀子豉汤主之。发汗吐下后，虚烦不得眠，若剧者，必反复
颠倒，心中懊 者，栀子豉汤主之，若少气者，栀子甘草豉汤主之。若呕者，栀子生姜豉汤主之。
凡用栀子汤，病患旧微溏者，不可与之。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，若发汗则躁，心愦愦反谵语，若加烧针，必怵惕烦躁不得眠。若下之，则胃中空虚，客气
动膈，心中懊 ，舌上苔者，栀子豉汤主之。阳明病，下之，其外有热，手足温，不结胸，心中懊 ，饥不
能食，但头汗出者，栀子豉汤主之。下利后，更烦，按之心下濡者，为虚烦也，宜栀子豉汤。病如桂枝证
，头不痛，项不强，寸脉微浮胸中痞硬，气上冲咽喉，不得息，此为胸中有寒也。当吐之，宜瓜蒂散。诸亡
血家，不可与。病患手足厥冷，脉乍紧者，邪结在胸中，心下满而烦，饥不能食者，病在胸中，当须吐之。宜
瓜蒂散。太阳病不解，热结膀胱，其人如狂，血自下，下者愈。其外不解者，尚未可攻，当先解外，外解已
，但小腹急结者，乃可攻之。宜桃核承气汤。太阳病，六
七日，表证犹存，脉微而沉，反不结胸，其人如狂者，以热在下焦，少腹当硬满，小便自利者，下血乃愈。
所以然者，以太阳随经，瘀热在腹里故也。抵当汤主之。太阳病，身黄，脉沉结，小腹硬，小便不利者，
为无血也，小便自利，其人如狂，血证谛也。抵当汤主之。阳明病，其人喜忘者，必有蓄血。所以然者，必
有久瘀血，故令喜忘，屎虽硬，大便反易，其色必黑。宜抵当汤下之。病患无表里证，发热七八日，虽脉浮
数者，可下之。假令已下，脉数不解，合热则消谷善饥。至六七日不大便者，有瘀血也，宜抵当汤。若脉不
解，而下利不止，必协热而便脓血也。伤寒有热，少腹满，应小便不利，今反利者，为有血也，当下之，
不可余药，宜抵当丸。太阳病，脉浮而动数，浮则为风，数则为热，动则为痛，数则为虚，头痛发热，微盗
汗出，而反恶寒者，表未解也，医反下之，动数变迟，膈内拒痛，胃中空虚，客气动膈，短气烦躁，心中懊
，阳气内陷，心下因硬，则为结胸。大陷胸汤主之。伤寒六七日，结胸热实，脉沉而紧，心下痛，按之石硬者，大陷胸
汤主之。太阳症重发汗而复下之，不大便五六日，舌上燥而渴，日晡时小有潮热，从心下至少腹硬满而痛不可
近者，大陷胸汤主之。伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。但结胸无大热者，此谓水结在胸
胁也。但头微汗出者，大陷胸汤主之。伤寒五六日，呕而发热者，柴胡证具，而以他药下之，柴胡证仍在者
，复与柴胡，此虽已下之，不为逆。必蒸蒸而振，却发热汗出而解。若心下满而硬痛者，此为结胸也。大陷胸
汤主之。结胸者，项亦强，如柔痉状，下之则和。宜大陷胸丸。小结胸病，正在心下，按之则痛，脉浮滑者，
小陷胸汤主之。伤寒大下后，复发汗，心下痞，恶寒者，表未解也。不可攻痞，当先解表，表解方可攻痞。
宜大黄黄连泻
心汤。脉浮而紧，而复下之，紧反入里，则作痞，按之自濡，但气痞耳。心下痞，按之濡，其脉关上浮
者，大黄黄连泻心汤主之。心下痞，而复恶寒汗出者，附子泻心汤主之。太阳中风，下利呕逆，表解者，
乃可攻之。其人 汗出，发作有时，头痛，心下痞硬满，引胁下痛，干呕短气，汗出不恶寒者，此表
解里未和也。十枣汤主之。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。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，与小承气汤，少
少与，微和之，令小安。至六日，与承气汤一升，若不大便，六七日小便少者，虽不能食但初头硬，后必溏，
未定成硬，攻之必溏。须小便利，屎定硬，乃可攻之，宜大承气汤。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，脉眩者生，涩者死，微者但发热谵语耳，大承气汤主之，若一服利，止后服。汗出谵语者，以有燥屎
在胃中，此为风也，须下之。过经乃可下之，下之若早，语言必乱，以表虚里实故也。下之则愈，宜大承气
汤。阳明病，下之，心中懊 而烦，胃中有燥屎者可攻。腹微满，初头硬，后必溏，不可攻之。若有燥屎
者，宜大承气汤。阳明病，谵语有潮热，反不能食者，胃中必有燥屎五六枚也，宜大承气汤下之。若能食者，
但硬耳。病患小便不利，大便乍难乍易，时有微热，喘冒不得卧者，有燥屎也。宜大承气汤。病患不大便五
六日，绕脐痛，烦躁，发作有时者，此有燥屎，故使不大便也。大下后，六七日不大便，烦不解，腹满痛者
，此有躁屎也。所以然者，本有宿食故也。宜大承气汤。阳明少阳合病，必下利，其脉不负者顺也，负者失
也。互相克贼，名为负也。脉滑而数者，有宿食也，当下之。宜大
承气汤。发汗不解，腹满痛者，急下之。宜大承气汤。阳明病，发热汗多者，急下之。宜大承气汤。伤寒六
七日，目中不能了了，睛不和，无表里证，大便难，身微热者，此为实也，急下之。宜大承气汤。少阴病，
得之二三日，口燥咽干者，急下之。宜大承气汤。少阴病，自利清水，色纯青，心下必痛，目干燥者，急下
之。宜大承气汤。少阴病，六七日，腹胀不大便者，急下之，宜大承气汤。
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 然而汗出者，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。太阳病，若吐、若下、若发汗，微烦，小便数，大便因硬者，与小承气汤和
之愈。阳明病，潮热，大便微硬者，可与大承气汤。不硬者，不可与之。若不大便六七日，恐有燥屎，欲知之
法，少与小承气汤，汤入腹中，转失气者，此有燥屎，乃可攻之。若不转失气，此但初头硬，后必溏，攻之
必胀满不能食也。欲饮水者，与水则哕。其后发热者，必大便复硬而少也。以小承气和之，不转失气者，慎不
可攻也。阳明病，谵语发潮热，脉滑而疾者，小承气汤主之。因与承气一升，腹中转失气，更服一升。若不转
失气，勿更与之。明日不大便，脉反微涩者，里虚也，为难治，不可更与承气汤也。下利谵语者，有燥屎也。
宜小承气汤。太阳病未解，脉阴阳俱停，必先振栗汗出而解。但阳脉微者，先汗出而解。但阴脉微者，下之而
解。若欲下之，宜调胃承气汤。发汗后恶寒者，虚故也。不恶寒，反恶热者，实也。当和胃气，与调胃承气
汤。伤寒，若胃气不和谵语者，少与调胃承气汤。太阳病，三日发汗不解，蒸蒸发热者，属胃也。调胃承气汤
主之。阳明病不吐、不下，心烦者，可与调胃承气汤。伤寒十三日不解，过经谵语
者，以有热也，当以汤药下之。小便利者，大盒饭硬，而反下利，胃脉调和者，知医以丸药下之，非其治也
。若自下利者，脉当微厥，今反和者，此为内实也。调胃承气汤主之。太阳病，过经十余日，心中温温欲吐
，而胸中痛，大便反溏，腹微满，郁郁微烦。先此时自极吐下者。与调胃承气汤。若不尔者，不可与。伤寒
吐后腹胀满者，与调胃承气汤。趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，其脾为约，
麻仁丸主之。
按以上诸证，或实邪在上，而用吐法。或实邪在下，而用攻法。或为痰，或为血，或为水，或为食，均属
实邪在里也。故以里实证统之。
栀子浓朴汤
栀子（五六枚） 浓朴（四钱姜炙） 枳实（二钱） 水煎服。按实邪在上，故用浓朴
、枳实泄满而降逆，栀子吐浊瘀而除烦也。
栀子干姜汤
栀子（五枚） 干姜（二钱五分） 水煎服，得吐止，后服。按下伤中气，浊阴上逆，
故用干姜降逆而温中，栀子吐瘀而降烦也。
栀子豉汤
栀子（五七枚） 香豉（四钱） 先煮栀子，后入香豉，煮服，得吐，止后服。按汗下败
其中气，胃土上逆，胸中窒塞，故用香豉调中气而开窒塞，栀子吐浊瘀而除烦热也。
栀子甘草豉汤
栀子（五七枚） 香豉（四钱） 甘草（二钱炙） 煎法同上。按此方加甘草以益气也。
栀子生姜豉汤
栀子（五七枚） 香豉（四钱） 生姜（五钱） 煎法同上。按此方加生姜以止逆也。
瓜蒂散
瓜蒂 赤小豆 上各等分为末，取二钱，以香豉一撮，用热汤煮作稀糜、和药散服之，不吐者
，少少加，得快吐乃止。诸亡血家，不可与之。按胸有寒痰，阻塞肺窍，故用香
豉行其滞，小豆泄其湿，瓜蒂涌其寒痰也。
桃核承气汤
桃仁（十六粒去皮尖） 大黄（四钱） 甘草（二钱） 桂枝（二钱） 芒硝（二钱）
水煎去滓，入芒硝，煎微沸温服。按瘀血内结小腹，故用枝桂、桃仁通经而破血，大黄、芒硝下瘀而泄湿，甘
草保其中气也。
抵当汤
虻虫（十二个） 水蛭（十二个熬） 大黄（三钱） 桃仁（七个） 熬制照方，水一杯半
，煎七分温服，不下再服。活人云∶水蛭必用锻石炒过再熬，方不害人。按热结血分，故用水蛭、虻虫、桃仁
、大黄破瘀而泄热也。
抵当丸
水蛭（七个熬） 虻虫七个（去翅足） 大黄（三钱酒洗） 桃仁（十二枚去皮尖） 研末为
丸，水一杯，煮取七分服， 时当下血，不下血，再服。按变汤为丸，是缓攻法也。
大陷胸汤
大黄（二钱） 芒硝 甘遂（三分末） 水一杯，先煮大黄至六分，去滓，入芒硝，煮一
二沸，纳甘遂末服，得快利，勿再服。按结胸证，乃肺金郁遏，雾气淫蒸，津液淤浊，化生痰涎，故用硝黄清
其郁热，甘遂决其痰饮，胸中邪热推荡无余矣。
大陷胸丸
大黄（四钱） 芒硝（一钱五分） 杏仁（一钱五分） 葶苈子（一钱五分） 捣为丸，如
弹子大，每用一丸，入甘遂末三分，白蜜半匙，水一杯，煮半杯，温服，一宿乃下。如不下，更服，以下为
度。按胸膈痞塞，湿热熏冲，故用硝黄荡其结热，杏仁破其滞气，葶苈泄其水饮，变汤为丸，取其缓也。
小陷胸汤
黄连（一钱） 半夏（二钱） 栝蒌实（三钱） 水二杯，先煮栝蒌实至一杯余，入二味再煮
至七分服，微下黄涎，止后服。 按小结胸证，亦属内热蓄饮，故用黄连泄热，半夏降逆而涤饮，栝蒌清金而去
垢也。
大黄黄连泻心汤
大黄（二钱） 黄连（一钱） 以麻沸汤渍
之，须臾绞去滓，温服。按内热痞郁，故用大黄、黄连泻其痞郁之上热也。
附子泻心汤
大黄（二钱酒浸） 黄芩（一钱炒） 黄连（一钱炒） 附子（一钱另煮取汁） 以麻沸
汤渍三黄，须臾去滓，取汁，纳附子汁合和、温服。按痞证而动下寒，故用大黄，芩、连泄其上热，而用附
子温其下寒也。
十枣汤
芫花（熬） 甘遂 大戟（各等分） 异筛秤末，合和之。水二杯，先煮大枣十枚，至七分去
渣滓，纳药末，强人服八九分，羸人服五六分，平旦温服。若下少，病不除，明日更服，加三分，利后糜粥自
养。按内有水饮郁格，故用大枣保其脾精，芫、遂、大戟泄其水饮也。
大承气汤
芒硝（二钱） 大黄（二钱酒洗） 枳实（三钱五分） 浓朴（四钱） 水三杯，先煮枳实
、浓朴至一杯半，去滓，纳大黄，煎取一杯，去滓，纳硝，更上微火一两沸，温服，得下勿再服。按大承气证
，胃腑烁热，闭塞不通，故用芒硝、大黄泄其燥热，用枳、朴开其闭结也。
小承气汤
大黄（四钱） 浓朴（二钱） 枳实（二钱） 水二杯，煎八分温服。按小承气去芒硝，取
其缓攻也。
调胃承气汤
大黄（四钱酒洗） 甘草（三钱炙） 芒硝（三钱） 水二杯，先煮大黄、甘草，取一杯
，去滓，纳芒硝，更上微火煮令沸，少少温服之。按调胃承气用大黄、芒硝荡热而去瘀，用甘草补中而生津也。
麻仁丸
麻仁（二两） 芍药（五钱） 枳实（五钱） 大黄（一两） 浓朴（一两） 杏仁（一
两） 炼蜜丸如桐子大，饮服十丸，渐加，以知为度。按脉浮涩相合，乃土燥水枯，大便则难，其脾气约滞，
而粪粒坚小。故用麻仁、杏仁润燥而滑肠，芍药、大黄清风而泄热、浓朴、枳实行滞而开结者也。
伤寒病经过泻下治疗后，出现心中烦乱、腹部胀满、坐卧不宁的症状，应当用栀子厚朴汤主治。伤寒病，医生用丸药猛烈泻下，导致身体发热不退、轻微心烦的，应当用栀子干姜汤主治。经过发汗或泻下后，出现烦热、胸中窒塞感的，应当用栀子豉汤主治。经过发汗、催吐、泻下之后，出现虚烦、无法入睡，如果病情严重的，必定会翻来覆去、心中懊恼（烦闷特甚），应当用栀子豉汤主治；如果伴有气短症状的，应当用栀子甘草豉汤主治；如果伴有呕吐症状的，应当用栀子生姜豉汤主治。
凡是使用栀子汤类方剂，如果病人平时大便稀溏的，不可给予服用。阳明病，脉象浮而紧，咽喉干燥口苦，腹部胀满且气喘，发热出汗，不怕冷反而怕热，身体沉重，如果误用发汗法，会出现躁扰不安、神志昏乱甚至说胡话；如果误加用烧针疗法，必定会出现惊恐、烦躁、无法入睡。如果误用泻下法，会导致胃中空虚，外邪乘虚扰动膈间，出现心中懊恼、舌苔厚的症状，应当用栀子豉汤主治。阳明病，经过泻下后，体表仍有热感，手足温暖，没有形成结胸证，心中懊恼，感觉饥饿却无法进食，只有头部出汗的，应当用栀子豉汤主治。腹泻停止后，烦躁加重，按压心下部柔软无抵抗感的，属于虚烦，适宜用栀子豉汤。病症类似桂枝汤证，但头不痛、项不强，寸脉微浮，胸中痞塞硬满，气向上冲至咽喉，呼吸不畅，这是胸中有寒饮所致。应当用吐法治疗，适宜用瓜蒂散。凡是失血患者，不可服用此方。病人手足厥冷，脉象突然变紧的，是邪气结聚在胸中，心下部胀满且心烦，感觉饥饿却无法进食，病位在胸中，应当用吐法治疗，适宜用瓜蒂散。
太阳病未解，热邪结聚于膀胱，病人神情如狂，瘀血自行排出，排出后病愈。如果表证仍未解除，尚不可攻里，应当先解表，表证解除后，仅剩下小腹急迫拘结的，才可以攻里。适宜用桃核承气汤。太阳病，病程六七天，表证依然存在，脉象微而沉，反而没有形成结胸，病人神情如狂的，是因为热邪在下焦，少腹部应当硬满，小便自利的，排出瘀血后病愈。之所以这样，是因为太阳经邪气随经入里，瘀热结聚在腹里的缘故。应当用抵当汤主治。太阳病，身体发黄，脉象沉结，小腹硬，小便不利的，是无瘀血的表现；如果小便自利，病人神情如狂，则是瘀血的确凿证据。应当用抵当汤主治。阳明病，病人容易健忘的，必定有蓄血。之所以这样，是因为必有久存的瘀血，所以导致健忘，大便虽然坚硬，排便却反而容易，颜色必定发黑。适宜用抵当汤攻下。病人没有表证和里实证的典型表现，发热七八天，即使脉象浮数，也可以攻下。假如已经攻下，脉数不解，合并在热邪消谷善饥。到了六七天不大便的，是有瘀血，适宜用抵当汤。如果脉数不解，反而腹泻不止，必定是协热利导致便脓血。伤寒有热症，小腹胀满，应该小便不利，现在反而小便通利的，是有瘀血，应当攻下，不可用其他药物，适宜用抵当丸。
太阳病，脉象浮而动数，浮脉主风，数脉主热，动脉主痛，数脉也主虚，头痛发热，微微盗汗，反而恶寒的，说明表证未解，医生反而误用泻下法，导致动数之脉变为迟脉，膈内拒按疼痛，胃中空虚，外邪扰动膈间，气短烦躁，心中懊恼，阳气内陷，心下部因此硬满，这就形成了结胸证。应当用大陷胸汤主治。伤寒六七天，结胸热实证，脉象沉而紧，心下部疼痛，按压像石头一样硬的，应当用大陷胸汤主治。太阳病证候重，发汗后又误用泻下法，五六天不大便，舌上干燥口渴，傍晚时分有轻微潮热，从心部下至少腹部硬满且疼痛不可触碰的，应当用大陷胸汤主治。伤寒十多天，热邪结聚在里，又出现往来寒热的，应当用大柴胡汤。如果是结胸证而没有大热表现的，这叫水饮结聚在胸胁，只有头部微微出汗的，应当用大陷胸汤主治。伤寒五六天，呕吐且发热的，具备柴胡汤证，如果用其他药物误下，柴胡汤证仍在的，再次给予柴胡汤，这虽然已经误下，但不为逆证。必定会蒸蒸然振栗，随后发热出汗而解。如果心下部胀满且硬痛的，这是结胸证。应当用大陷胸汤主治。结胸证，颈部也强直，像柔痉的样子，用泻下法可以使病情缓和。适宜用大陷胸丸。小结胸病，病位正在心下部，按压才疼痛，脉象浮滑的，应当用小陷胸汤主治。伤寒大病后，又发汗，出现心下部痞塞，恶寒的，说明表证未解。不可攻痞，应当先解表，表解后方可攻痞。适宜用大黄黄连泻心汤。脉象浮而紧，又误用泻下法，紧脉反陷入里，则形成痞证，按压自己感觉柔软，这只是气痞而已。心下部痞塞，按压柔软，脉象关部浮的，应当用大黄黄连泻心汤主治。心下部痞塞，又伴有恶寒出汗的，应当用附子泻心汤主治。太阳中风，出现下利呕逆，表证解除的，才可以攻里。病人濈濈然汗出，发作有时，头痛，心下部痞塞硬满，牵引胁下疼痛，干呕气短，出汗不怕冷的，这是表解里未和。应当用十枣汤主治。二阳并病，太阳证已罢，只出现潮热，手足濈濈然汗出，大便困难且说胡话的，用泻下法可以痊愈。适宜用大承气汤。得病二三天，脉弱，没有太阳病和柴胡汤证，烦躁心下部硬。到了四五天，虽然能进食，给予小承气汤，少量多次服用，轻微调和胃气，让病人稍安。到了第六天，给承气汤一升，如果不大便，六七天小便少的，虽然不能进食，但大便初头硬，后面必定稀溏，尚未完全成形坚硬，攻下必定导致腹泻。必须等到小便通利，大便确定坚硬，才可以攻下，适宜用大承气汤。伤寒如果经过催吐或泻下后病不解，五六天到十余天不大便，傍晚时发潮热，不怕冷，独自说话像看见鬼怪一样的，如果病情严重，发作时不认识人，循衣摸床，惊恐不安，轻微喘息直视，脉象圆滑者生，涩者死，轻的只是发热说胡话而已，应当用大承气汤主治，如果服一次大便通利，停服后面的药。出汗说胡话的，是因为胃中有燥屎，这是风邪所致，必须攻下。必须过了经期才可以攻下，攻下如果过早，语言必定错乱，因为表虚里实的缘故。攻下后痊愈，适宜用大承气汤。阳明病，经过泻下，心中懊恼而烦，胃中有燥屎的可以攻下。腹部微满，初头硬，后面必溏，不可攻下。如果有燥屎的，适宜用大承气汤。阳明病，说胡话有潮热，反而不能进食的，胃中必定有燥屎五六枚，适宜用大承气汤攻下。如果能进食的，只是大便硬罢了。病人小便不利，大便乍难乍易，时有轻微发热，喘促头晕不能躺卧的，是有燥屎。适宜用大承气汤。病人五六天不大便，绕脐疼痛，烦躁，发作有定时的，这是有燥屎，所以导致不大便。大病泻下后，六七天不大便，烦躁不解，腹部胀满疼痛的，这是有燥屎。之所以这样，是因为本来就有宿食。适宜用大承气汤。阳明少阳合病，必定下利，脉象不负（即脉象与病机相符）的是顺证，负（即脉象与病机相克）的是逆证。互相克贼，称为负。脉象滑而数的，有宿食，应当攻下。适宜用大承气汤。发汗后病不解，腹部胀满疼痛的，紧急攻下。适宜用大承气汤。阳明病，发热汗多的，紧急攻下。适宜用大承气汤。伤寒六七天，眼睛视物不清，眼球转动不灵活，没有表里证，大便困难，身体微热的，这是实证，紧急攻下。适宜用大承气汤。少阴病，得病二三天，口燥咽干的，紧急攻下。适宜用大承气汤。少阴病，自利清水，颜色纯青，心下部必定疼痛，眼睛干燥的，紧急攻下。适宜用大承气汤。少阴病，六七天，腹部胀满不大便的，紧急攻下，适宜用大承气汤。
阳明病，脉迟，虽然出汗不怕冷，身体必定沉重，气短，腹部胀满且气喘，有潮热的，这是表证欲解，可以攻里。手足濈濈然汗出的，这说明大便已经坚硬。应当用大承气汤主治。如果汗多，轻微发热恶寒的，表证未解。其热不潮，不可给予承气汤。如果腹部大满不通的，可以给予小承气汤，轻微调和胃气，不要让它剧烈泻下。太阳病，如果经过催吐、泻下、发汗，出现轻微心烦，小便频数，大便因此坚硬的，给予小承气汤调和即可痊愈。阳明病，潮热，大便微硬的，可以给予大承气汤。不硬的，不可给予。如果六七天不大便，担心有燥屎，想知道的方法，少量给予小承气汤，汤药进入腹中，转放屁的，这是有燥屎，才可以攻下。如果不转放屁，这只是初头硬，后面必溏，攻下必定导致胀满不能进食。想喝水的，给水则发生呃逆。其后发热的，必定大便再次变硬且量少。用小承气汤调和，不转放屁的，千万不要攻下。阳明病，说胡话发潮热，脉象滑而疾速的，应当用小承气汤主治。因此给予承气汤一升，腹中转放屁的，再服一升。如果不转放屁，不要再给。明天不大便，脉象反而微涩的，是里虚，难以治疗，不可再给承气汤。下利说胡话的，是有燥屎。适宜用小承气汤。太阳病未解，脉阴阳俱停，必定先振栗出汗而解。但阳脉微的，先出汗而解。但阴脉微的，攻下而解。如果要攻下，适宜用调胃承气汤。发汗后恶寒的，是虚证。不恶寒，反而恶热的，是实证。应当调和胃气，给予调胃承气汤。伤寒，如果胃气不和说胡话的，少量给予调胃承气汤。太阳病，三天发汗后病不解，蒸蒸发热的，属胃家实。应当用调胃承气汤主治。阳明病，没有经过催吐、泻下，心烦的，可以给予调胃承气汤。伤寒十三天病不解，过经说胡话的，是因为有热，应当用汤药攻下。小便利的，大便应当硬，反而下利，胃脉调和的，知道是医生用了丸药攻下，这不是正确的治法。如果是自然下利，脉应当微厥，现在反而调和，这是内实。应当用调胃承气汤主治。太阳病，过经十多天，心中温温欲吐，而胸中痛，大便反溏，腹部微满，郁郁微烦。在此之前曾经用过极端的吐下法。给予调胃承气汤。如果不是这样，不可给予。伤寒吐后腹胀满的，给予调胃承气汤。趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，脾为约，应当用麻仁丸主治。
以上各种证候，有的是实邪在上，用吐法；有的是实邪在下，用攻法。或者是痰，或者是血，或者是水，或者是食，都属于实邪在里。所以以里实证统括。
栀子厚朴汤
栀子（五六枚） 厚朴（四钱姜炙） 枳实（二钱） 水煎服。按实邪在上，故用厚朴、枳实泄满而降逆，栀子吐浊瘀而除烦。
栀子干姜汤
栀子（五枚） 干姜（二钱五分） 水煎服，得吐止，后服。按下伤中气，浊阴上逆，故用干姜降逆而温中，栀子吐瘀而降烦。
栀子豉汤
栀子（五七枚） 香豉（四钱） 先煮栀子，后入香豉，煮服，得吐，止后服。按汗下败其中气，胃土上逆，胸中窒塞，故用香豉调中气而开窒塞，栀子吐浊瘀而除烦热。
栀子甘草豉汤
栀子（五七枚） 香豉（四钱） 甘草（二钱炙） 煎法同上。按此方加甘草以益气。
栀子生姜豉汤
栀子（五七枚） 香豉（四钱） 生姜（五钱） 煎法同上。按此方加生姜以止逆。
瓜蒂散
瓜蒂 赤小豆 上等分为末，取二钱，用香豉一撮，用热汤煮作稀糜，和药散服之，不吐者，少量增加，得快吐乃止。诸亡血家，不可与之。按胸有寒痰，阻塞肺窍，故用香豉行其滞，小豆泄其湿，瓜蒂涌其寒痰。
桃核承气汤
桃仁（十六粒去皮尖） 大黄（四钱） 甘草（二钱） 桂枝（二钱） 芒硝（二钱） 水煎去滓，入芒硝，煎微沸温服。按瘀血内结小腹，故用桂枝、桃仁通经而破血，大黄、芒硝下瘀而泄湿，甘草保其中气。
抵当汤
虻虫（十二个） 水蛭（十二个熬） 大黄（三钱） 桃仁（七个） 熬制照方，水一杯半，煎七分温服，不下再服。活人云：水蛭必用煅石炒过再熬，方不害人。按热结血分，故用水蛭、虻虫、桃仁、大黄破瘀而泄热。
抵当丸
水蛭（七个熬） 虻虫七个（去翅足） 大黄（三钱酒洗） 桃仁（十二枚去皮尖） 研末为丸，水一杯，煮取七分服，须臾当下血，不下血，再服。按变汤为丸，是缓攻法。
大陷胸汤
大黄（二钱） 芒硝 甘遂（三分末） 水一杯，先煮大黄至六分，去滓，入芒硝，煮一二沸，纳甘遂末服，得快利，勿再服。按结胸证，乃肺金郁遏，雾气淫蒸，津液淤浊，化生痰涎，故用硝黄清其郁热，甘遂决其痰饮，胸中邪热推荡无余矣。
大陷胸丸
大黄（四钱） 芒硝（一钱五分） 杏仁（一钱五分） 葶苈子（一钱五分） 捣为丸，如弹子大，每用一丸，入甘遂末三分，白蜜半匙，水一杯，煮半杯，温服，一宿乃下。如不下，更服，以下为度。按胸膈痞塞，湿热熏冲，故用硝黄荡其结热，杏仁破其滞气，葶苈泄其水饮，变汤为丸，取其缓也。
小陷胸汤
黄连（一钱） 半夏（二钱） 栝蒌实（三钱） 水二杯，先煮栝蒌实至一杯余，入二味再煮至七分服，微下黄涎，止后服。按小结胸证，亦属内热蓄饮，故用黄连泄热，半夏降逆而涤饮，栝蒌清金而去垢也。
大黄黄连泻心汤
大黄（二钱） 黄连（一钱） 以麻沸汤渍之，须臾绞去滓，温服。按内热痞郁，故用大黄、黄连泻其痞郁之上热也。
附子泻心汤
大黄（二钱酒浸） 黄芩（一钱炒） 黄连（一钱炒） 附子（一钱另煮取汁） 以麻沸汤渍三黄，须臾去滓，取汁，纳附子汁合和、温服。按痞证而动下寒，故用大黄，芩、连泄其上热，而用附子温其下寒也。
十枣汤
芫花（熬） 甘遂 大戟（各等分） 异筛秤末，合和之。水二杯，先煮大枣十枚，至七分去渣滓，纳药末，强人服八九分，羸人服五六分，平旦温服。若下少，病不除，明日更服，加三分，利后糜粥自养。按内有水饮郁格，故用大枣保其脾精，芫、遂、大戟泄其水饮也。
大承气汤
芒硝（二钱） 大黄（二钱酒洗） 枳实（三钱五分） 厚朴（四钱） 水三杯，先煮枳实、厚朴至一杯半，去滓，纳大黄，煎取一杯，去滓，纳硝，更上微火一两沸，温服，得下勿再服。按大承气证，胃腑烁热，闭塞不通，故用芒硝、大黄泄其燥热，用枳、朴开其闭结也。
小承气汤
大黄（四钱） 厚朴（二钱） 枳实（二钱） 水二杯，煎八分温服。按小承气去芒硝，取其缓攻也。
调胃承气汤
大黄（四钱酒洗） 甘草（三钱炙） 芒硝（三钱） 水二杯，先煮大黄、甘草，取一杯，去滓，纳芒硝，更上微火煮令沸，少少温服之。按调胃承气用大黄、芒硝荡热而去瘀，用甘草补中而生津也。
麻仁丸
麻仁（二两） 芍药（五钱） 枳实（五钱） 大黄（一两） 厚朴（一两） 杏仁（一两） 炼蜜丸如桐子大，饮服十丸，渐加，以知为度。按脉浮涩相合，乃土燥水枯，大便则难，其脾气约滞，而粪粒坚小。故用麻仁、杏仁润燥而滑肠，芍药、大黄清风而泄热、厚朴、枳实行滞而开结者也。
After purgation in Taiyang disease (Taiyang disease), if the patient presents with vexation, abdominal fullness, and restlessness (unable to lie down or sit still), Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) is indicated. In Shaoyang disease (Shaoyang disease), if a physician used pill-based purgatives causing severe downward purging, resulting in persistent body heat and slight vexation, Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) is indicated. After sweating or purgation, if vexation-heat and chest oppression occur, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. After sweating, vomiting, or purgation, if deficiency-vexation and insomnia occur, or in severe cases, tossing and turning with extreme mental depression (Ao Nao), Zhi Zi Chi Tang is indicated; if accompanied by shortness of breath, Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is indicated; if accompanied by vomiting, Zhi Zi Sheng Jiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction) is indicated.
Whenever using Gardenia decoctions, they should not be given to patients who have a history of loose stools. In Yangming disease (Yangming disease), if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to cold being absent but aversion to heat present, and heaviness of the body, erroneous sweating may lead to irritability, mental confusion, and delirium; erroneous application of burning needle therapy will certainly cause fright, restlessness, and insomnia. Erroneous purgation will hollow out the stomach, allowing pathogenic qi to disturb the diaphragm, causing mental depression, thick tongue coating, for which Zhi Zi Chi Tang is indicated. In Yangming disease, after purgation, if there is external heat, warm hands and feet, no Jie Xiong (Chest Binding), mental depression, hunger but inability to eat, and only sweating on the head, Zhi Zi Chi Tang is indicated. After diarrhea, if vexation increases and pressing the epigastrium reveals softness, it is deficiency-vexation, suitable for Zhi Zi Chi Tang. If symptoms resemble Gui Zhi Tang (Cinnamon Twig Decoction) syndrome but without headache or stiff neck, with a slightly floating cun pulse, chest obstruction and hardness, Qi rushing to the throat causing dyspnea, this indicates cold-phlegm in the chest. Emesis is required, suitable for Gua Di San (Melon Pedicle Powder). It is contraindicated in patients with blood loss. If a patient has cold extremities and a suddenly tight pulse, with epigastric fullness, vexation, hunger but inability to eat, the pathogen is bound in the chest, requiring emesis, suitable for Gua Di San.
If Taiyang disease does not resolve, heat binds in the Bladder, causing manic behavior; if blood passes spontaneously, the disease resolves. If exterior symptoms persist, interior attack is premature; resolve the exterior first. Once the exterior is resolved, if only urgency and binding in the lower abdomen remain, attack is permitted, suitable for Tao He Cheng Qi Tang (Peach Kernel and Decoction for Receiving Qi). In Taiyang disease, after six or seven days, if exterior signs persist, pulse is faint and sinking, no Chest Binding occurs, but the patient is manic due to heat in the Lower Jiao (Lower Burner), with hard/full lower abdomen and free urination, passing blood resolves the disease. This is because Taiyang pathogen followed the meridians into the interior, where stasis-heat resides. Dang Dang Tang (Mustard Seed and Leech Decoction) is indicated. In Taiyang disease, if jaundice, deep/knotted pulse, hard lower abdomen, and dysuria occur, there is no blood stasis; if urination is free and the patient is manic, blood stasis is confirmed. Dang Dang Tang is indicated. In Yangming disease, frequent forgetting indicates blood accumulation due to long-standing stasis; although stool is hard, defecation is easy and black. Dang Dang Tang is indicated. If a patient lacks typical exterior/interior signs but has fever for seven-eight days, even with floating-numerous pulse, purgation may be considered. If purged and pulse remains numerous with excessive hunger, and after six-seven days constipation persists, blood stasis is present; Dang Dang Tang is indicated. If pulse remains numerous with uncontrolled diarrhea, it is heat-collateral pus-blood. In cold damage with heat, full lower abdomen, and free urination (instead of dysuria), blood stasis exists; purge it with Dang Dang Wan (Mustard Seed and Leech Pill).
In Taiyang disease, if pulse is floating, moving, and numerous (floating-wind, numerous-heat, moving-pain, numerous-deficiency), with headache, fever, slight night sweats, yet aversion to cold, the exterior is unresolved. Erroneous purgation changes the pulse to slow, causing diaphragmatic pain, hollow stomach, pathogenic qi disturbing the diaphragm, shortness of breath, vexation, mental depression, internal sunken Yang, and hard epigastrium, forming Jie Xiong (Chest Binding). Da Xian Xiong Tang (Major Decoction for Draining the Chest) is indicated. In cold damage after six-seven days, if heat-real Jie Xiong presents with deep-tight pulse, epigastric pain, and stone-hard palpation, Da Xian Xiong Tang is indicated. If Taiyang syndrome was heavy, treated with sweating then purgation, leading to five-six days of constipation, dry thirsty tongue, evening tidal fever, and hard/full painful abdomen from epigastrium to lower abdomen, Da Xian Xiong Tang is indicated. In cold damage after ten-plus days, with interior heat and alternating chills/fever, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated. If Jie Xiong has no significant heat, it is water-binding in chest/hypochondrium, with slight head sweat; Da Xian Xiong Tang is indicated. In cold damage after five-six days, with vomiting and fever (Chai Hu syndrome), if erroneously purged but Chai Hu signs persist, re-administer Chai Hu Tang. Although purged, it is not adverse; shaking chills followed by fever/sweating will resolve it. If epigastric fullness/pain occurs, it is Jie Xiong; Da Xian Xiong Tang is indicated. If Jie Xiong includes stiff neck resembling Rou Ji (Soft Spasm), purgation harmonizes it; Da Xian Xiong Wan (Major Decoction for Draining the Chest Pill) is indicated. For minor Jie Xiong, located at epigastrium, tender on pressure, with floating-slippery pulse, Xiao Xian Xiong Tang (Minor Decoction for Draining the Chest) is indicated.
After major purgation and sweating in cold damage, if epigastric pi (blockage) and aversion to cold occur, the exterior is unresolved. Do not attack pi; resolve exterior first, then attack pi. Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction for Draining the Heart) is indicated. If floating-tight pulse follows purgation, tightness enters the interior forming pi, which is soft on pressure (Qi pi). If epigastric pi is soft with floating guan pulse, Da Huang Huang Lian Xie Xin Tang is indicated. If epigastric pi accompanies aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Decoction for Draining the Heart) is indicated. In Taiyang wind-strike, with diarrhea/vomiting, if exterior is resolved, attack interior. If sweating occurs intermittently, headache, hard/full epigastric pi radiating to hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this is exterior resolved, interior unharmonized. Shi Zao Tang (Ten Jujube Decoction) is indicated. In two-Yang concurrent disease, if Taiyang signs cease, only tidal fever, hand-foot sweating, difficult defecation, and delirium remain, purgation cures it; Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. If illness lasts two-three days with weak pulse, no Taiyang/Chai Hu signs, but vexation/hard epigastrium, by day four-five, if eating is possible, give Xiao Cheng Qi Tang (Minor Order the Qi Decoction) sparingly to harmonize. By day six, one sheng of Cheng Qi Tang. If no bowel movement by day six-seven with little urine, though unable to eat, initial stool is hard, later loose, do not purge. Wait for free urination and hard stool, then use Da Cheng Qi Tang.
If cold damage persists after vomiting/purgation, with five-six to ten-plus days of constipation, evening tidal fever, no aversion to cold, muttering as if seeing ghosts, severe cases involve unconsciousness, grasping clothes, bed-touching, fright, restlessness, slight panting, fixed gaze. Round pulse indicates life, choppy pulse indicates death; mild cases have only fever/delirium. Da Cheng Qi Tang is indicated; stop after one dose if bowels move. Sweating with delirium indicates dry feces in stomach (wind); purge after the meridian passes. Early purgation causes speech disorder due to exterior deficiency/interior excess. Da Cheng Qi Tang is indicated. In Yangming disease, after purgation, if Ao Nao/vexation occurs with dry feces in stomach, purge. If abdomen is slightly full with hard initial/loose later stool, do not purge. If dry feces exist, Da Cheng Qi Tang is indicated. In Yangming disease, delirium with tidal fever and inability to eat indicates five-six dry feces; Da Cheng Qi Tang is indicated. If able to eat, stool is merely hard. If dysuria, alternating hard/loose stool, slight fever, panting/dizziness preventing lying down, dry feces exist; Da Cheng Qi Tang is indicated. If five-six days of constipation with periumbilical pain, vexation, periodic onset, dry feces exist; Da Cheng Qi Tang is indicated. After major purgation, if six-seven days of constipation with unresolved vexation/abdominal pain, dry feces exist due to retained food; Da Cheng Qi Tang is indicated. In Yangming-Shaoyang combined disease with diarrhea, favorable pulse matches pathology, unfavorable indicates conflict. Slippery-numerous pulse indicates retained food; purge with Da Cheng Qi Tang. If sweating fails to resolve abdominal fullness/pain, urgently purge with Da Cheng Qi Tang. In Yangming disease with fever/excessive sweating, urgently purge with Da Cheng Qi Tang. In cold damage after six-seven days, unclear vision, eye stiffness, no exterior/interior signs, difficult defecation, slight fever, this is excess; urgently purge with Da Cheng Qi Tang. In Shaoyin disease, day two-three with dry mouth/throat, urgently purge with Da Cheng Qi Tang. In Shaoyin disease, clear watery diarrhea, pure green color, epigastric pain, dry eyes, urgently purge with Da Cheng Qi Tang. In Shaoyin disease, day six-seven with abdominal fullness/constipation, urgently purge with Da Cheng Qi Tang.
In Yangming disease, slow pulse, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness/wheezing, tidal fever indicate exterior resolving, interior attackable. Hand-foot sweating indicates hard stool; Da Cheng Qi Tang is indicated. If excessive sweating with slight fever/aversion to cold, exterior unresolved. Without tidal fever, do not give Cheng Qi Tang. If major abdominal fullness/obstruction, give Xiao Cheng Qi Tang to mildly harmonize stomach Qi, avoiding drastic purgation. In Taiyang disease, after vomiting/purgation/sweating, if slight vexation, frequent urination, and hard stool occur, Xiao Cheng Qi Tang harmonizes and cures. In Yangming disease, tidal fever with slightly hard stool allows Da Cheng Qi Tang; if not hard, do not give. If six-seven days of constipation suspecting dry feces, test with small Xiao Cheng Qi Tang; passing gas indicates dry feces, allowing attack. No gas indicates hard initial/loose later stool; attacking causes bloating/anorexia. Thirst with water induces hiccups. Subsequent fever indicates recurrent hard/scant stool; harmonize with Xiao Cheng Qi Tang. No gas means caution against purgation. In Yangming disease, delirium/tidal fever with slippery-rapid pulse, Xiao Cheng Qi Tang is indicated. Give one sheng; if gas passes, give another. If no gas, stop. Next day, if no bowel movement and pulse becomes faint/choppy, interior deficiency makes it difficult; do not give Cheng Qi Tang. Diarrhea with delirium indicates dry feces; Xiao Cheng Qi Tang is indicated. In Taiyang disease unresolved, if Yin-Yang pulses stop, shaking chills/sweating resolve it. If Yang pulse is faint, sweating resolves it. If Yin pulse is faint, purgation resolves it; Tiao Wei Cheng Qi Tang (Regulate Stomach Order the Qi Decoction) is indicated. Post-sweating aversion to cold indicates deficiency; aversion to heat indicates excess. Harmonize stomach with Tiao Wei Cheng Qi Tang. In cold damage, if stomach disharmony causes delirium, give small amount of Tiao Wei Cheng Qi Tang. In Taiyang disease, three days post-sweating with steaming fever, stomach excess, Tiao Wei Cheng Qi Tang is indicated. In Yangming disease,心烦 (vexation) without vomiting/purgation allows Tiao Wei Cheng Qi Tang. In cold damage thirteen days unresolved, over-meridian delirium indicates heat; purge with decoction. Free urination suggests hard stool, but diarrhea occurs; if stomach pulse is harmonious, physician used pill purgative incorrectly. Natural diarrhea should have faint/cold pulse; harmonious pulse indicates interior excess. Tiao Wei Cheng Qi Tang is indicated. In Taiyang disease, over-meridian ten-plus days with warm nausea, chest pain, loose stool, slight abdominal fullness, depressed slight vexation, following extreme vomiting/purgation, Tiao Wei Cheng Qi Tang is indicated. If not so, do not give. Post-emesis abdominal fullness in cold damage allows Tiao Wei Cheng Qi Tang. Foot-Yang pulse floating-slippery: floating-strong stomach Qi, slippy-frequent urination, combined causing difficult defecation, spleen constrained; Ma Ren Wan (Hemp Seed Pill) is indicated.
Regarding the above syndromes, some are excess pathogens above, treated with emesis; some are below, treated with purgation. Whether phlegm, blood, water, or food, all are interior excess pathogens, categorized here as Interior Excess Syndromes.
Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction): Gardenia (5-6 pods), Hou Po (Magnolia Bark, 4 qian ginger-fried), Zhi Shi (Immature Bitter Orange, 2 qian). Decoct in water. Rationale: Pathogen above uses Hou Po/Zhi Shi to drain fullness and direct Qi downward; Gardenia expels turbid stasis and relieves vexation.
Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction): Gardenia (5 pods), Gan Jiang (Dried Ginger, 2.5 qian). Decoct in water; stop after vomiting. Rationale: Lower injury damages middle Qi, turbid Yin rebels upward; Gan Jiang directs Qi downward and warms middle; Gardenia expels stasis and relieves vexation.
Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction): Gardenia (5-7 pods), Xiang Chi (Fermented Soybean, 4 qian). Boil Gardenia first, add Chi, decoct and take; stop after vomiting. Rationale: Sweating/purgation damages middle Qi, Stomach Earth rebels upward causing chest oppression; Xiang Chi regulates middle Qi and opens obstruction; Gardenia expels turbid stasis and relieves heat-vexation.
Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction): Gardenia (5-7 pods), Xiang Chi (4 qian), Gan Cao (Licorice, 2 qian honey-fried). Same preparation. Rationale: Adds Licorice to tonify Qi.
Zhi Zi Sheng Jiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction): Gardenia (5-7 pods), Xiang Chi (4 qian), Sheng Jiang (Fresh Ginger, 5 qian). Same preparation. Rationale: Adds Fresh Ginger to stop rebellion/vomiting.
Gua Di San (Melon Pedicle Powder): Gua Di (Melon Pedicle), Chi Xiao Dou (Red Adzuki Bean). Equal parts powder, take 2 qian with Xiang Chi (1 pinch) boiled in hot water to porridge consistency, mix and take. Increase slightly if no emesis; stop when vigorous vomiting occurs. Contraindicated in blood-loss patients. Rationale: Cold-phlegm in chest blocks lung orifices; Xiang Chi moves stagnation, Red Bean drains dampness, Gua Di induces emesis of cold-phlegm.
Tao He Cheng Qi Tang (Peach Kernel and Decoction for Receiving Qi): Tao Ren (Peach Kernel, 16 pieces peeled/cored), Da Huang (Rhubarb, 4 qian), Gan Cao (Licorice, 2 qian), Gui Zhi (Cinnamon Twig, 2 qian), Mang Xiao (Mirabilite, 2 qian). Decoct, strain, add Mang Xiao, boil briefly, take warm. Rationale: Blood stasis binds lower abdomen; Gui Zhi/Tao Ren unblock meridians and break stasis; Da Huang/Mang Xiao purge stasis and drain dampness; Gan Cao protects middle Qi.
Dang Dang Tang (Mustard Seed and Leech Decoction): Meng Chong (Blue Bottle Fly, 12), Shui Zhi (Leech, 12 fried), Da Huang (Rhubarb, 3 qian), Tao Ren (Peach Kernel, 7). Prepare as directed, decoct in 1.5 cups water to 0.7 cups, take warm. Repeat if ineffective. Note: Leeches must be fried with calcined stone to reduce toxicity. Rationale: Heat binds blood aspect; Leech/Fly/Peach Kernel/Rhubarb break stasis and drain heat.
Dang Dang Wan (Mustard Seed and Leech Pill): Shui Zhi (Leech, 7 fried), Meng Chong (Fly, 7 wings/legs removed), Da Huang (Rhubarb, 3 qian wine-washed), Tao Ren (Peach Kernel, 12 peeled/cored). Powder, form pills. Decoct in 1 cup water to 0.7 cups. Blood should pass shortly; repeat if not. Rationale: Changing decoction to pill is a slow purgation method.
Da Xian Xiong Tang (Major Decoction for Draining the Chest): Da Huang (Rhubarb, 2 qian), Mang Xiao (Mirabilite), Gan Sui (Kansui Root, 0.3 qian powder). Decoct Da Huang in 1 cup water to 0.6 cups, strain, add Mang Xiao, boil 1-2 times, add Kansui powder. Stop after effective purgation. Rationale: Chest Binding involves Lung Metal suppression, misty vapor steaming, turbid fluids transforming to phlegm-saliva; Mirabilite/Rhubarb clear suppressed heat, Kansui resolves phlegm-fluids, driving out pathogenic heat from chest.
Da Xian Xiong Wan (Major Decoction for Draining the Chest Pill): Da Huang (4 qian), Mang Xiao (1.5 qian), Xing Ren (Apricot Kernel, 1.5 qian), Ting Li Zi (Periplocas Seed, 1.5 qian). Pound into pills size of弹子 (bullet). Take one pill with 0.3 qian Kansui powder, half spoon white honey, 1 cup water, boil to 0.5 cup, take warm. Bowels move overnight; repeat if needed. Rationale: Chest/diaphragm blockage with damp-heat steaming; Mirabilite/Rhubarb sweep binding heat, Apricot Kernel breaks stagnant Qi, Periplocas drains fluid-water; pill form ensures slow action.
Xiao Xian Xiong Tang (Minor Decoction for Draining the Chest): Huang Lian (Coptis, 1 qian), Ban Xia (Pinellia, 2 qian), Gua Lou Shi (Trichosanthes Fruit, 3 qian). Decoct Trichosanthes in 2 cups water to >1 cup, add other two, boil to 0.7 cups. Mild yellow phlegm discharge; stop after. Rationale: Minor Chest Binding involves interior heat retaining fluid; Coptis drains heat, Pinellia directs Qi downward and washes fluid, Trichosanthes clears Metal and removes filth.
Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction for Draining the Heart): Da Huang (2 qian), Huang Lian (1 qian). Steep in boiling water (Ma Fei Tang), squeeze quickly, strain, take warm. Rationale: Interior heat/pi stagnation; Rhubarb/Coptis drain upper heat of pi stagnation.
Fu Zi Xie Xin Tang (Aconite Decoction for Draining the Heart): Da Huang (2 qian wine-soaked), Huang Qin (Scutellaria, 1 qian fried), Huang Lian (1 qian fried), Fu Zi (Aconite, 1 qian decocted separately for juice). Steep "Three Yellows" in boiling water, strain quickly, mix with Aconite juice, take warm. Rationale: Pi syndrome with lower cold; Rhubarb/Scutellaria/Coptis drain upper heat, Aconite warms lower cold.
Shi Zao Tang (Ten Jujube Decoction): Yuan Hua (Genkwa Flower, fried), Gan Sui (Kansui Root), Da Ji (Euphorbia, equal parts). Sieve/weigh powder, mix. Decoct 10 Da Zao (Jujubes) in 2 cups water to 0.7 cups, strain, add powder. Strong persons take 0.8-0.9 fen, weak persons 0.5-0.6 fen, warm on empty stomach. If insufficient effect, increase 0.3 fen next day; nourish with millet porridge after purgation. Rationale: Interior water-fluid retention; Jujube protects Spleen essence, Genkwa/Kansui/Euphorbia drain water-fluids.
Da Cheng Qi Tang (Major Order the Qi Decoction): Mang Xiao (2 qian), Da Huang (2 qian wine-washed), Zhi Shi (Immature Bitter Orange, 3.5 qian), Hou Po (Magnolia Bark, 4 qian). Decoct Zhi Shi/Hou Po in 3 cups water to 1.5 cups, strain, add Da Huang, boil to 1 cup, strain, add Mang Xiao, boil briefly on low fire, take warm. Stop after bowel movement. Rationale: Major Cheng Qi syndrome involves stomach blazing heat, blockage; Mirabilite/Rhubarb drain dry-heat, Immature Bitter Orange/Magnolia Bark open closure.
Xiao Cheng Qi Tang (Minor Order the Qi Decoction): Da Huang (4 qian), Hou Po (2 qian), Zhi Shi (2 qian). Decoct in 2 cups water to 0.8 cups, take warm. Rationale: Removes Mirabilite for slower purgation.
Tiao Wei Cheng Qi Tang (Regulate Stomach Order the Qi Decoction): Da Huang (4 qian wine-washed), Gan Cao (3 qian honey-fried), Mang Xiao (3 qian). Decoct Rhubarb/Licorice in 2 cups water to 1 cup, strain, add Mang Xiao, boil briefly on low fire, take small amounts warm. Rationale: Rhubarb/Mirabilite sweep heat/remove stasis, Licorice tonifies middle/generates fluids.
Ma Ren Wan (Hemp Seed Pill): Ma Ren (Hemp Seed, 2 liang), Shao Yao (Peony, 5 qian), Zhi Shi (5 qian), Da Huang (1 liang), Hou Po (1 liang), Xing Ren (Apricot Kernel, 1 liang). Honey pills size of Wisteria seeds. Take 10 pills with water, increase gradually until effective. Rationale: Floating-slippery pulse indicates dry earth/depleted water causing difficult defecation, spleen constraint with hard/small stool. Hemp/Apricot kernels moisten dryness/lubricate intestines; Peony/Rhubarb clear wind/drains heat; Magnolia/Immature Bitter Orange move stagnation/open closure.