（仲景）
治伤寒阳明证，不恶寒，反恶热，口渴，便秘，谵语，腹满。中焦燥实，及伤寒吐后腹
胀满者（邪在表，则身热、汗出而恶寒；邪已入里，则表证罢，故不恶寒、身热汗出而反恶
热也。汗多亡津，热又入里，故渴、便秘。无水以制火，内有燥屎，故见妄言谵语。吐后不
解，腹胀满者，热入胃也，然满而不痛，不宜急下，少与调胃和之，阳明病不吐不下而心烦
者吐后烦为内烦，下后烦为虚烦，不吐不下心烦者，胃有郁热也）；亦治渴证中消，善食而
溲。
大黄（酒浸） 芒硝（一两） 甘草（炙五钱，）少少温服。
此足太阳、阳明药也（东垣曰∶正阳阳明药）。大黄苦寒，除热荡实；芒硝咸寒，润燥
软坚；二物下行甚速，故用甘草甘平以缓之，不致伤胃，故曰调胃承气。去枳朴者，不欲其
犯上焦气分也（《准绳》曰∶阳明一证，分为太阳、正阳、少阳三等。按∶本草大黄酒浸入
太阳经，酒洗入阳明经，浸久于洗，故能引于至高之分。仲景以调胃承气收入太阳门，而大
黄注曰酒浸，汤后曰少少温服、曰当和胃气。又本汤治不吐不下心烦者及发汗不解、蒸蒸发
热者，吐后腹胀满者，是太阳阳明去表未远，其病在上，不当攻下，故宜缓剂调和之也。至
正阳阳明，则曰急下之，而大承气汤大黄下注曰酒洗，洗轻于浸，是微升其走下之性，以治
其中也；至少阳阳明，则去正阳而逼太阴，其分为下，故小承气汤大黄不用酒制，少阳不宜
下，故去
本方加当归，姜、枣煎，名当归承气汤（河间）∶治里热火郁，或皮肤枯燥，或咽燥鼻
干，或便溺秘结，或瘀血发狂（加当归，入血分以润燥调营，亦与桃仁承气同意。加姜枣，
引入胃也）。本方除芒硝，名大黄甘草汤∶《金匮》用治食已即吐；《外台》用治吐水（《准绳》
曰∶仲景云，欲吐者不可下，又以大黄、甘草治食已即吐何也。曰∶欲吐者，其病在上，因
而越之可也，而逆之使下，（则必抑塞愦乱而益甚；若已吐不止，有升无降，则当逆而折之，
引令下行，无速于大黄者矣，故不禁；丹溪泥之。而曰凡呕吐切不可下，固矣夫）。本方用
大黄二两半、芒硝、甘草各二两，又名破棺丹∶治多汗大渴，便闭谵语，阳结之证，及诸疮
肿热。
（张仲景）治疗伤寒阳明证，表现为不恶寒，反而恶热，口渴，便秘，说胡话，腹部胀满。以及中焦燥实，和伤寒呕吐后出现腹胀满的情况。（邪气在表时，身体发热、出汗且怕冷；邪气已入里，则表证消失，所以不怕冷，身体发热出汗却反而怕热。汗多导致津液亏损，热邪又深入体内，所以口渴、便秘。体内无水以制约火邪，里面有干燥的粪便，所以出现胡言乱语。呕吐后症状未解，腹胀满的，是热邪进入胃腑，然而只是胀满而不疼痛，不宜急于攻下，少量给予调胃承气汤来调和它。阳明病没有经过吐法或下法而出现心烦的，呕吐后心烦属于内烦，下法后心烦属于虚烦，没有经过吐下而心烦的，是胃中有郁热）；也治疗消渴病中的中消证，食欲旺盛但小便频多。
大黄（用酒浸泡）一两，芒硝一两，甘草（炙制五钱）。少量多次温服。
这是足太阳、足阳明的药物。（李东垣说：这是正阳阳明的药物）。大黄味苦性寒，能清除热邪、荡涤实邪；芒硝味咸性寒，能润燥、软化坚硬；这两味药下行速度很快，所以使用味甘性平的甘草来缓和药性，以免损伤胃气，因此称为“调胃承气”。去掉枳实、厚朴的原因，是不想让它们侵犯上焦的气分。（《准绳》说：阳明一证，分为太阳、正阳、少阳三个等级。按：本草记载大黄酒浸入太阳经，酒洗入阳明经，浸泡比清洗时间久，所以能引药到达最高的部位。张仲景将调胃承气汤归入太阳门，并在大黄下注明酒浸，汤剂服用说明中提到少量温服、说要调和胃气。另外本方治疗没有经过吐下而心烦的，以及发汗后不解、蒸蒸发热的，呕吐后腹胀满的，这些情况太阳表证尚未完全解除，病位偏上，不应当攻下，所以适宜用缓剂来调和。至于正阳阳明，就说要急下，而大承气汤中大黄注解说酒洗，清洗比浸泡轻，这是稍微提升其走下的药性，以治疗中焦的病；至于少阳阳明，则是远离正阳而逼近太阴，病位在下，所以小承气汤中大黄不用酒制，少阳不宜攻下，所以去掉……）
本方加入当归，用生姜、大枣煎煮，名为当归承气汤（刘河间）：治疗里热火郁，或者皮肤干枯粗糙，或者咽喉干燥鼻子干，或者大小便闭塞不通，或者瘀血导致发狂（加入当归，进入血分以润燥调理营血，也与桃仁承气汤用意相同。加入姜枣，引入胃腑）。本方除去芒硝，名为大黄甘草汤：《金匮要略》用它治疗吃完东西就吐；《外台秘要》用它治疗呕吐清水（《准绳》说：张仲景说，想吐的人不可以用下法，为什么又用大黄、甘草治疗吃完东西就吐呢？回答说：想吐的人，病位在上，顺势向上涌吐是可以的，如果逆势使其向下，（就会必然导致气机阻滞混乱而更加严重；如果已经呕吐不止，只有升没有降，那么就应当逆折其势，引导其下行，没有比大黄更快的了，所以不禁用；朱丹溪拘泥于此，说凡是呕吐切不可用下法，这固然正确啊）。本方使用大黄二两半、芒硝、甘草各二两，又名破棺丹：治疗多汗大渴，大便闭塞说胡话，阳结的证候，以及各种疮肿热毒。
(Zhang Zhongjing) Treats Yangming syndrome of Cold Damage (Shanghan), characterized by aversion to cold being absent, but aversion to heat present, thirst, constipation, delirium, and abdominal fullness. It also treats dryness-excess in the Middle Jiao, and abdominal fullness following vomiting in Cold Damage. (When pathogenic factors are at the Exterior, there is fever, sweating, and aversion to cold; when pathogenic factors have entered the Interior, the Exterior syndrome resolves, hence no aversion to cold, but fever with sweating and an actual aversion to heat. Excessive sweating depletes Body Fluids, and Heat enters the Interior, causing thirst and constipation. Without Water to control Fire, and with dry feces inside, delirious speech occurs. If symptoms persist after vomiting with abdominal fullness, it indicates Heat entering the Stomach; however, since there is fullness without pain, urgent purgation is not suitable. A small amount of Tiaowei Chengqi Tang should be given to harmonize it. In Yangming disease, if irritability occurs without prior emesis or purgation, irritability after emesis is considered internal irritability, irritability after purgation is deficiency irritability, and irritability without emesis or purgation indicates stagnant Heat in the Stomach.) It also treats Zhongxiao (Middle Xiao/Intermediate Diabetes) in Xiao Ke (Wasting-Thirst Syndrome), characterized by excessive hunger with frequent urination.
Dahuang (Rhubarb Root and Rhizome, soaked in wine) 1 liang, Mangxiao (Mirabilite) 1 liang, Gancao (Licorice Root, honey-fried) 5 qian. Take warm, in small amounts frequently.
This acts on the Foot-Taiyang and Foot-Yangming meridians. (Li Dongyuan stated: This is a medicine for Zhengyang Yangming). Dahuang is bitter and cold, clearing Heat and sweeping away excess; Mangxiao is salty and cold, moistening dryness and softening hardness; these two substances descend rapidly, so sweet and neutral Gancao is used to moderate their action, preventing damage to the Stomach Qi, thus named "Tiaowei Chengqi" (Regulate the Stomach and Inherit the Qi). Zhi Shi (Immature Bitter Orange) and Houpo (Magnolia Bark) are omitted to avoid offending the Qi aspect of the Upper Jiao. (Zhuansheng states: The Yangming syndrome is divided into three grades: Taiyang, Zhengyang, and Shaoyang. According to Materia Medica, Dahuang soaked in wine enters the Taiyang meridian, while Dahuang washed in wine enters the Yangming meridian. Soaking takes longer than washing, thus guiding the drug to the highest parts. Zhang Zhongjing included Tiaowei Chengqi Tang in the Taiyang chapter, noting Dahuang was soaked in wine, and instructed to take it warm in small amounts to harmonize Stomach Qi. Furthermore, this formula treats irritability without emesis/purgation, persistent steaming fever after sweating, and abdominal fullness after vomiting. These cases indicate that the Taiyang Exterior has not completely resolved, the pathology is upper, and aggressive purgation is inappropriate; thus, a mild formula for harmonization is suitable. Regarding Zhengyang Yangming, urgent purgation is indicated, and in Da Chengqi Tang, Dahuang is noted as washed in wine. Washing is lighter than soaking, slightly enhancing its descending nature to treat the Middle Jiao; regarding Shaoyang Yangming, it moves away from Zhengyang towards Taiyin, with pathology lower down, so in Xiao Chengqi Tang, Dahuang is not wine-processed, as Shaoyang is unsuitable for purgation, hence [Zhi Shi and Houpo are removed]...)
Adding Danggui (Angelica Sinensis Root) and decocting with Shengjiang (Fresh Ginger) and Dazao (Jujube Fruit) creates Danggui Chengqi Tang (Liu Wansu): Treats interior Heat and Fire stagnation, dry and rough skin, dry throat and nose, constipation of stool and urine, or mania due to Blood stasis. (Adding Danggui enters the Blood aspect to moisten dryness and regulate Ying, consistent with the intent of Tao Ren Chengqi Tang. Adding Jiang and Zao guides the formula to the Stomach.) Removing Mangxiao from this formula creates Dahuang Gancao Tang: Used in Jin Gui Yao Lue to treat vomiting immediately after eating; used in Waitai Miyao to treat vomiting clear water. (Zhuansheng notes: Zhang Zhongjing said those wanting to vomit should not be purged, yet why use Dahuang and Gancao to treat vomiting immediately after eating? The answer is: For those wanting to vomit, the pathology is upper, and inducing upward expulsion is appropriate. Opposing this by forcing downward movement would cause obstruction and confusion, worsening the condition. However, if vomiting persists uncontrollably, with only ascending and no descending, one must counteract this trend and guide it downward. Nothing acts faster than Dahuang for this purpose, hence it is not prohibited. Zhu Danxi rigidly adhered to the view that vomiting must never be treated with purgatives, which is indeed correct in many contexts.) Using 2.5 liang of Dahuang, 2 liang of Mangxiao, and 2 liang of Gancao, this variant is also known as Po Guan Dan: Treats profuse sweating and extreme thirst, constipation with delirium, Yang-Jie syndrome, and various sores and swellings with Heat.