麻仁二升 芍药半筋 枳实半筋 大黄（去皮）一筋 厚朴（去皮）一筋 杏仁（去
皮、尖，熬，别作脂）一升
右六味，蜜合丸，如桐子大。饮服十丸，日三服，渐加、以和为度。
【集解】
方有执曰：麻子、杏仁能润干燥之坚，枳实、厚朴能导固结之滞，芍药敛液以辅润，
大黄推陈以致新，脾虽为约，此能疏之。
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伤寒吐后，腹胀满者，与调胃承气汤。
【注】
伤寒吐后，胸不胀满而腹胀满者，是表邪已尽，胃中壅热故也。宜与调胃承气汤，下
其热而和之。以无□痛，故不用大小承气也。
【集注】
程知曰：言吐后腹胀满宜调胃也。热在上焦则吐，吐后腹胀满，则邪不在胸，其为里
实可知。然胀满而不□痛，自不宜用急下之法，但与调胃承气，和其胃热可耳！『内
经』云：诸胀腹大，皆属于热也。
程应旄曰：吐伤津液，燥气不能下达，遂成土郁，是以腹胀满，用调胃承气，一夺其
郁可耳！
大黄（去皮，酒浸）四两 甘草（炙）二两 芒硝半升
右三味，以水三升，煮取一升，去滓，内芒硝，更煮两沸，少少温服之。
【方解】
方名调胃承气者，有调和承顺胃气之义，非若大小承气专攻下也。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。恐其速下，故佐甘草之缓；又恐其过下，故少少温服之，其意在不峻而
和也。
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阳明病，不吐不下，心烦者，可与调胃承气汤。
【注】
阳明病，谓已传阳明，不吐、不下，心烦者，谓未经吐、下而心烦也，其为热盛实烦
可知。故与调胃承气汤泻热，而烦自除也。
【集注】
成无己曰：吐后心烦谓之内烦，下后心烦谓之虚烦，今阳明病不吐不下心烦，则是胃
有郁热也，与调胃承气汤以下其郁热。
喻昌曰：胃气及津液，既不由吐、下而伤，则心烦明系胃中热炽，故可与调胃承气汤
。
@@@
阳明发热汗多者，急下之，宜大承气汤。
【注】
阳明病，不大便，发热汗多不止者，虽无内实，亦当急下之。盖因阳气大蒸于内，恐
致阴液暴亡于外，故以全津液为急务也，宜大承气汤下之。
【集注】
喻昌曰：汗多则津液外渗，加以发热，则津液尽随热势，蒸蒸腾达于外，更无他法以
止其汗，惟有急下一法，引热势从大肠而出，庶津液不致尽越于外耳。
程应旄曰：此等之下，皆为救阴而设，不在夺实，夺实之下可缓，救阴之下不可缓。
沈明宗曰：阳明里实，以潮热微汗为正。兹见发热汗多，乃里热炽盛之极，蒸腾胃中
津液，尽越于外，非亟夺其邪以救津液不可，故宜大承气汤急下也。
麻仁二升，芍药半筋，枳实半筋，大黄（去皮）一筋，厚朴（去皮）一筋，杏仁（去皮、尖，炒制，另研成脂状）一升。
以上六味药，用蜂蜜调和制成丸剂，大小如梧桐子。每次用温水送服十丸，每日三次，逐渐增加剂量，以大便调和为度。
【集解】
方有执说：麻子、杏仁能够润燥软化坚结，枳实、厚朴能够疏导固结的气滞，芍药收敛津液以辅助润燥，大黄推陈出新，虽然脾脏被约束（指脾约证），此方能疏解它。
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伤寒病经过催吐后，出现腹部胀满的，给予调胃承气汤。
【注】
伤寒病经过催吐后，胸部不胀满而腹部胀满的，说明表邪已经完全解除，是胃中有壅滞的热邪所致。适宜给予调胃承气汤，泻下热邪并调和胃气。因为没有腹痛的症状，所以不使用大承气汤或小承气汤。
【集注】
程知说：这里讲的是吐后腹胀满应当调理胃气。热邪在上焦则引起呕吐，吐后出现腹胀满，说明邪气不在胸中，可以知道这是里实证。然而只是胀满而没有疼痛，自然不宜使用急下之法，只需给予调胃承气汤，调和胃中的热邪即可！《内经》说：各种腹部胀大，都属于热证。
程应旄说：催吐损伤了津液，燥气不能下达，于是形成土气郁结，导致腹部胀满，使用调胃承气汤，一旦解除这种郁结就可以了！
大黄（去皮，酒浸）四两，甘草（炙）二两，芒硝半升。
以上三味药，用水三升，煮取一升，滤去药渣，加入芒硝，再煮沸两次，少量多次温服。
【方解】
方名“调胃承气”，含有调和、承顺胃气的意义，不像大承气汤和小承气汤那样专门攻下。经书说：热邪淫溢于内，用咸寒之品治疗；火邪淫溢于内，用苦寒之品治疗。以大黄之苦寒为君药，芒硝之咸寒为臣药，两药并用，攻热泻火的功效具备了。担心其泻下过快，所以佐以甘草来缓和药性；又担心其泻下过度，所以采用少量多次温服的方法，其用意在于不峻猛而求调和。
@@@
阳明病，未经过催吐或泻下，出现心烦的，可以给予调胃承气汤。
【注】
阳明病，是指病邪已经传入阳明经，未经过催吐或泻下而出现心烦的，说明没有经过吐、下法治疗而心烦，可知这是热盛导致的实性心烦。因此给予调胃承气汤泻热，心烦自然消除。
【集注】
成无己说：吐后心烦称为内烦，下后心烦称为虚烦，现在阳明病未经过吐、下而心烦，则是胃中有郁积的热邪，给予调胃承气汤以泻下其郁热。
喻昌说：胃气和津液，既然不是由催吐或泻下所损伤，那么心烦明确是由于胃中热势炽盛，所以可以给予调胃承气汤。
@@@
阳明病，发热且汗出多的，应当紧急攻下，适宜用大承气汤。
【注】
阳明病，大便不通，发热且汗出不止的，即使没有典型的里实结聚，也应当紧急攻下。这是因为阳气在体内大量蒸腾，恐怕导致阴液在体外突然亡失，所以保全津液是当务之急，适宜用大承气汤攻下。
【集注】
喻昌说：汗多则津液外渗，加上发热，津液会全部随着热势，蒸蒸腾腾地发散到体外，没有其他方法可以止汗，只有紧急攻下一法，引导热势从大肠排出，这样津液才不至于完全耗散于体外。
程应旄说：这类情况下的攻下，都是为了救阴而设，不在于攻夺实邪，攻夺实邪的攻下可以稍缓，救阴的攻下不可迟缓。
沈明宗说：阳明里实证，以潮热微汗为正证。现在见到发热汗多，乃是里热炽盛到了极点，蒸腾胃中的津液，全部越出于体外，不急需攻夺邪气以救津液是不行的，所以适宜用大承气汤紧急攻下。
Hemp Seed (Cannabis Fructus) 2 sheng, Peony Root (Paeoniae Radix Alba) half jin, Immature Bitter Orange (Aurantii Fructus Immaturus) half jin, Rhubarb (Rhei Radix et Rhizoma) (peeled) 1 jin, Magnolia Bark (Magnoliae Officinalis Cortex) (peeled) 1 jin, Apricot Seed (Armeniacae Semen Amarum) (peeled and tipped, roasted, ground separately into paste) 1 sheng.
The above six herbs are combined with honey to form pills, sized like wu-tong seeds. Take ten pills at a time with warm water, three times daily. Gradually increase the dosage until bowel movements become harmonious.
[Ji Jie - Collected Commentary]
Fang Youzhi stated: Hemp seed and apricot seed can moisten dryness and soften hardness; immature bitter orange and magnolia bark can guide and resolve stagnation of solid accumulation; peony root collects fluids to assist in moistening; rhubarb eliminates the old to bring forth the new. Although the Spleen is constrained (referring to Pi Yue syndrome), this formula can relieve it.
@@@
In Taiyang Cold Damage disease, if abdominal fullness occurs after emesis, administer Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction).
[Note]
In Taiyang Cold Damage disease, if the chest is not full but the abdomen is full after emesis, it indicates that the exterior pathogenic factor has been completely exhausted, and there is obstructing heat in the Stomach. It is appropriate to administer Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) to purge the heat and harmonize the stomach. Since there is no abdominal pain, Da Cheng Qi Tang (Major Order the Qi Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) are not used.
[Ji Zhu - Collected Annotations]
Cheng Zhi said: This discusses that abdominal fullness after emesis requires regulating the Stomach. Heat in the Upper Jiao causes emesis; if abdominal fullness follows emesis, the pathogen is not in the chest, indicating interior excess. However, since there is fullness without pain, urgent purging is inappropriate. One should only use Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) to harmonize the Stomach heat! The *Neijing* states: All cases of abdominal distension and enlargement belong to heat.
Cheng Yingmao said: Emesis damages body fluids, preventing dry qi from descending, leading to Earth qi stagnation, resulting in abdominal fullness. Using Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) can resolve this stagnation.
Rhubarb (Rhei Radix et Rhizoma) (peeled, soaked in wine) 4 liang, Licorice Root (Glycyrrhizae Radix et Rhizoma) (roasted) 2 liang, Mirabilite (Natrii Sulfas) 0.5 sheng.
The above three herbs are boiled in 3 sheng of water to obtain 1 sheng of decoction. Strain out the dregs, add Mirabilite (Natrii Sulfas), boil for two more boils, and take small amounts warm.
[Fang Jie - Formula Explanation]
The name "Tiao Wei Cheng Qi" implies harmonizing and accommodating Stomach Qi, unlike Da Cheng Qi Tang (Major Order the Qi Decoction) and Xiao Cheng Qi Tang (Minor Order the Qi Decoction) which specialize in purging. The Classics state: For heat flooding within, treat with salty-cold substances; for fire flooding within, treat with bitter-cold substances. Using Rhubarb (Rhei Radix et Rhizoma) as the sovereign herb for its bitter-cold nature, and Mirabilite (Natrii Sulfas) as the minister herb for its salty-cold nature, these two together provide sufficient power to attack heat and drain fire. To prevent rapid purging, Licorice Root (Glycyrrhizae Radix et Rhizoma) is added as an assistant to moderate the action; to prevent excessive purging, it is taken in small amounts warm. The intent is to be non-violent and harmonizing.
@@@
In Yangming disease, if there is mental restlessness (fan) without prior emesis or purgation, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) may be given.
[Note]
Yangming disease refers to the transmission of the pathogen to the Yangming channel. Mental restlessness (fan) occurring without prior emesis or purgation indicates heat excess causing real mental restlessness. Therefore, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) is given to purge heat, and the mental restlessness will naturally resolve.
[Ji Zhu - Collected Annotations]
Cheng Wuji said: Mental restlessness after emesis is called internal mental restlessness; mental restlessness after purgation is called deficient mental restlessness. Now, in Yangming disease, mental restlessness without emesis or purgation indicates stagnant heat in the Stomach. Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) is given to purge this stagnant heat.
Yu Chang said: Since Stomach Qi and body fluids are not damaged by emesis or purgation, the mental restlessness is clearly due to blazing heat in the Stomach. Thus, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Inherit Qi Decoction) can be given.
@@@
In Yangming disease, if there is fever and profuse sweating, urgent purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable.
[Note]
In Yangming disease, if there is constipation, fever, and continuous profuse sweating, even without typical interior excess accumulation, urgent purgation is necessary. This is because Yang Qi is vigorously steaming internally, risking sudden exhaustion of Yin fluids externally. Preserving body fluids is the urgent priority, so Da Cheng Qi Tang (Major Order the Qi Decoction) should be used for purgation.
[Ji Zhu - Collected Annotations]
Yu Chang said: Profuse sweating causes body fluids to leak outward; combined with fever, all body fluids follow the heat trend, steaming and reaching outward. There is no other method to stop the sweating except urgent purgation, which guides the heat trend out through the Large Intestine, preventing body fluids from being entirely lost outward.
Cheng Yingmao said: Purgation in such cases is designed to save Yin, not to seize excess. Purgation to seize excess can be slow; purgation to save Yin cannot be delayed.
Shen Mingzong said: In Yangming interior excess, tidal fever and slight sweating are typical signs. Seeing fever and profuse sweating now indicates extreme blazing interior heat, steaming Stomach fluids and causing them to overflow outward. It is imperative to urgently seize the pathogen to save body fluids, hence Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable for urgent purgation.