伤寒阳邪入里，三焦大热，痞满燥实，四症俱全，发热谵语，脉沉实者。
枳实（五枚） 浓朴（半斤） 芒硝（三合） 大黄（四两，酒洗） 王海藏曰∶邪气居高，非
酒不到，大黄若用生者，则遗高分之邪热，病愈后变生目赤，喉痹头肿膈上热疾也。水
一斗，先煮枳、朴，取五升，去渣，纳大黄，煮取二升，去滓，纳芒硝，微火一二
沸，温服得利则止。
承，顺也。邪入胃者，郁滞糟粕，秘结壅实，气不得顺也。通可去滞，泄可去闭，
气得以顺，故曰∶承气，大满大实有燥屎，乃可投也。如非大满，则生寒症而为结胸痞
气之属矣。仲景曰∶欲行大承气，先与小承气，复中转失气者，有燥屎也，可以大承气
汤攻之，不转失气，慎不可攻！
治伤寒阳明症，谵语便硬，潮热而喘，及杂病上焦，痞满不通。
大黄（四两） 浓朴（二两，姜炒） 枳实（三枚，麸炒） 锉如麻豆大，分作二服，水
一盏，姜三片，煎至半盏，绞汁服，未利再服。
治伤寒腹满，呕干烦渴，谵妄，心下按之硬痛，大小便秘，阳明胃热，发斑脉沉可下者。
大黄（锦纹者） 芒硝 浓朴 枳实（各五钱） 甘草（半两） 每服一两，姜水煎至一
钟，入芒硝一沸，通口服。
治诸发热和解，不恶寒但发热蒸蒸然，心下满硬，或痛，烦渴咽干，滑数而实，诸
腹满实痛，烦渴谵妄，小便赤，大便硬，脉滑实紧者。
大黄（酒浸） 芒硝（一两） 甘草（炙，五钱） 每服斟酌多少，先煮二味，熟去
渣，下硝，再煮二三沸，顿服之，以利为度，未利再服。
伤寒病中，阳热邪气深入体内，导致三焦（上、中、下三焦）出现严重热象，具备痞（心下堵闷）、满（腹部胀满）、燥（肠中干燥）、实（腑实积滞）四大症状，同时伴有发热、说胡话（谵语），脉象沉而有力。
枳实（五枚） 厚朴（半斤） 芒硝（三合） 大黄（四两，用酒清洗） 王海藏说：邪气位置较高，不用酒引导药力无法到达；如果大黄使用生品，则会遗漏高位的热邪，病愈后可能引发眼睛发红、咽喉闭塞、头部肿胀以及膈膜以上的热性疾病。用水一斗，先煮枳实和厚朴，取药液五升，去掉药渣，加入大黄，煮取二升，去掉药渣，再加入芒硝，用小火煮一二沸，温服，大便通畅即停止服用。
“承”，意为顺接。邪气进入胃腑，郁结阻滞糟粕，秘结壅塞且坚实，气机不能顺畅下行。通利可以去除停滞，泄下可以解除闭结，使气机得以顺接，所以称为“承气”。只有当大满大实且有燥屎时，才可投用此方。如果不是大满之证，则会产生寒症，属于结胸、痞气之类的病症。张仲景说：想要使用大承气汤，应先给予小承气汤，如果服药后转放屁（失气），说明有燥屎，可以用大承气汤攻下；如果不转放屁，千万不可攻下！
治疗伤寒阳明经病症，表现为说胡话、大便干硬、潮热（定时发热）且气喘，以及杂病中上焦部位，痞闷胀满不通畅。
大黄（四两） 厚朴（二两，用姜炒） 枳实（三枚，用麸皮炒） 锉碎如麻豆大小，分两次服用，用水一盏，生姜三片，煎至半盏，滤出汁液服用，若未通便可再服。
治疗伤寒引起的腹部胀满，干呕烦躁口渴，神志不清胡言乱语，心窝部按压坚硬疼痛，大小便不通，属阳明胃热，身体发斑且脉象沉实可下者。
大黄（选用锦纹大黄） 芒硝 厚朴 枳实（各五钱） 甘草（半两） 每次服用一两量药材，用姜水煎至一钟，加入芒硝煮一二沸，一次性口服。
治疗各种发热经和解法治疗后，不恶寒只发热且蒸蒸然（高热貌），心下部胀满坚硬或疼痛，烦躁口渴咽干，脉象滑数而实，各种腹部胀满实痛，烦躁口渴胡言乱语，小便色赤，大便干硬，脉象滑实紧者。
大黄（用酒浸泡） 芒硝（一两） 甘草（炙过，五钱） 每次根据病情斟酌用量，先煮前两种药材，煮熟去渣，加入芒硝，再煮二三沸，一次性顿服，以大便通畅为度，若未通便可再服。
When pathogenic Yang-heat enters the interior in Taiyang cold damage, causing severe heat in the Sanjiao (Triple Burner), accompanied by the four cardinal symptoms of Pi (epigastric fullness/stuffiness), Man (abdominal distension), Zao (intestinal dryness), and Shi (fu-organ excess/accumulation), along with fever, delirium, and a deep, forceful pulse.
Zhi Shi (Immature Bitter Orange, 5 pieces) Hou Po (Magnolia Bark, half jin) Mang Xiao (Mirabilite, three he) Da Huang (Rhubarb Root and Rhizome, four liang, washed with wine). Wang Haicang stated: "When pathogenic factors reside in high positions, only wine can guide the medicinal efficacy there; if raw Da Huang is used, it will fail to clear the heat from the upper regions, potentially leading to sequelae such as red eyes, throat obstruction, head swelling, and heat diseases above the diaphragm after recovery." Use one dou of water, first decoct Zhi Shi and Hou Po until five sheng remain, discard the dregs, add Da Huang, decoct until two sheng remain, discard the dregs, then add Mang Xiao, simmer over low heat for one or two boils, take warm orally, and stop once bowel movement occurs.
"Cheng" means to follow or smooth out. When pathogens enter the stomach, they stagnate fecal matter, causing constipation, blockage, and excess, preventing the Qi mechanism from descending smoothly. Unblocking removes stagnation, purging resolves closure, allowing Qi to flow freely; hence it is named "Cheng Qi". It should only be administered when there is significant fullness and excess with dry stool. If these conditions are not met, it may induce cold syndromes belonging to Jie Xiong (Chest Binding) or Pi Qi (Pi Syndrome). Zhang Zhongjing said: "To use Da Cheng Qi Tang, first administer Xiao Cheng Qi Tang. If flatus follows, dry stool is present, and Da Cheng Qi Tang can be used to purge; if no flatus occurs, do not purge!"
Treat Yangming syndrome in cold damage characterized by delirium, hard stools, tidal fever, and wheezing, as well as miscellaneous diseases involving upper Jiao obstruction with stuffiness and fullness.
Da Huang (Rhubarb Root and Rhizome, four liang) Hou Po (Magnolia Bark, two liang, stir-fried with ginger) Zhi Shi (Immature Bitter Orange, three pieces, bran-fried). Cut into sizes similar to hemp seeds, divide into two doses. Use one zhan of water and three slices of ginger, decoct until half a zhan remains, strain and drink. If unrelieved, administer again.
Treat cold damage presenting with abdominal fullness, dry retching, irritability, thirst, delirium, hardness and pain upon pressing the epigastrium, constipation of both urine and stool, Yangming stomach heat, skin eruptions, and a deep pulse indicating suitability for purgation.
Da Huang (Jin Wen variety preferred) Mang Xiao (Mirabilite) Hou Po (Magnolia Bark) Zhi Shi (Immature Bitter Orange) (each five qian) Gan Cao (Licorice Root, half liang). For each dose using one liang of herbs, decoct with ginger-water until one zhong remains, add Mang Xiao, boil for one round, and take orally in one go.
Treat various febrile conditions where harmonizing methods have failed, presenting with aversion to cold absent but persistent steaming fever, epigastric fullness/hardness or pain, irritability, thirst, dry throat, slippery-rapid-forceful pulse, general abdominal fullness/excess/pain, irritability, thirst, delirium, red urine, hard stools, and slippery-excessive-tight pulse.
Da Huang (Rhubarb Root and Rhizome, soaked in wine) Mang Xiao (Mirabilite, one liang) Gan Cao (Licorice Root, honey-fried, five qian). Adjust dosage according to condition. First decoct the former two ingredients, remove dregs when cooked, add Mang Xiao, boil for two or three rounds, take all at once. Stop when bowel movement occurs; if unrelieved, administer again.