论曰凡伤寒邪入于阴。其病在里，法当下之，诸腹满不大便，或口燥舌干而渴，或潮热
谵语，皆为可下之证，诸诊得脉沉而实。即为可下之脉，但脉证已具，不必拘以日数，急宜
攻里，若病虽过经而里证未备者，未可下也，故经曰阳盛阴虚，下之则愈，其法谓此。
阳明病不吐不下心烦者，可与调胃承气汤，太阳病三日，发汗不解，蒸蒸热者。可与调
胃承气汤，伤寒吐后腹胀满者。可与调胃承气汤方
甘草（炙二两） 大黄（以清酒洗四两）
上二味。 咀，每服五钱匕，水一盏半，煎至一盏，去滓入芒硝一钱匕，更煎一二沸温
服。
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 然汗出者。此大便已硬也，与大承气汤，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，勿令至大泄下。大承气
汤方
大黄（酒洗四两） 浓朴（去粗皮炙半斤） 枳实（麸炒五枚）
上三味。 咀，每服五钱匕，水一盏半，煎至一盏，去滓入芒硝一钱匕，更煎一二沸温
服。
阳明病其人多汗，以津液外出，胃中燥，大便必硬，硬则谵语，小承气汤主之。若一服
谵语止者，勿再服。小承气汤方
大黄（四两） 浓朴（去粗皮炙二两） 枳实（麸炒大者三枚）
上三味， 咀，每服五钱匕，水一盏半，煎至一盏，去滓温服，初服汤当更衣，不尔者
尽饮之，若更衣者勿服。
治伤寒四日以后，烦热不解，大小肠涩。柴胡汤方
柴胡（去苗） 黄芩（去黑心各一两） 犀角（镑） 芍药（各三分） 山栀子仁（半
两） 大黄
（细
上八味。粗捣筛，每服五钱匕，水一盏半，入竹叶三片，同煎至一盏，去滓腹空服，大
小肠通为度，如未通再服。
治伤寒十余日，热结在里，往来寒热者。与大柴胡汤方
柴胡（去苗半斤） 枳实（麸炒四枚） 黄芩（去黑心） 芍药（各三两） 半夏（二
两半汤洗
七遍去滑） 大黄（二两）
上六味。 咀，每服五钱匕，水一盏半，入生姜十片，枣三枚，去核，同煎至一盏，去
滓温服。
治伤寒四日以后，腹胀满痛，喘粗壮热。四味承气汤方
大黄（细锉醋炒二两） 枳壳（去瓤麸炒一两半） 朴硝（二两） 甘草（炙锉三分）
上四味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓空腹温服。
治伤寒五日，口干头痛大便涩。黄芩汤方
黄芩（去黑心） 山栀子仁 大黄（锉醋炒各一两） 陈橘皮（汤浸去白焙一分）
上五味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓温服。
治伤寒发汗不解，蒸蒸发热者。调胃承气加橘皮汤方
陈橘皮（汤浸去白焙半两） 大黄（锉醋炒一两） 甘草（炙半两）
上三味，细锉，每服四钱匕，水一盏半，煎至一盏去滓，入芒硝一钱匕，搅令匀，更煎
三两沸温服。
治伤寒日数过多，心中气闷，或发疼痛，狂言不定，烦躁不得眠，大小便不通，柴胡大
黄汤方
柴胡（去苗） 大黄（湿纸裹煨） 朴硝 枳壳（去瓤麸炒各一两） 甘草（炙锉半两）
上五味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓温服，日二服，不可过多，
若大小肠通，则汗自出。
治伤寒脉大，潮躁伏热。宣毒散方
大黄（锉炒） 甘草（炙锉各半两） 朴硝（研一分） 牵牛子（一两半生半两）
上四味，捣罗为散，每服二钱匕，用龙脑腻粉蜜水调下，一方炼蜜为丸，如梧桐子大，
每服十五丸，用龙脑腻粉水下。
治伤寒八九日，大便不通，心神闷乱。小黄芩汤方
黄芩（去黑心一两） 大黄（锉炒二两） 枳壳（去瓤麸炒） 大腹（锉醋炒各一两）
上四味，粗捣筛，每服三钱匕，水一盏，煎至七分去滓，不计时候温服，如人行三五里，
未通再服，以通为度。
治阳盛发狂有斑，大小便秘涩，大青散方
大青 知母 黄芩（去黑心） 大黄（煨） 山栀子仁 升麻 黄连（去须各一两） 甘
草
（炙锉半两）
上八味，捣罗为散，每服三钱匕，入朴硝一钱匕，用蜜水调下。
治伤寒时气温热病，大便不通。承气丸方
大黄（锉炒三分） 郁李仁（汤浸去皮研） 枳实（去瓤麸炒） 朴硝（研各一两）
上四味，捣研为末，和匀炼蜜，丸如梧桐子大，每服二十丸，生姜汤下，未利再服，不
计时候。
论述说：大凡伤寒邪气侵入阴经，病位在里，治法应当使用下法。凡是出现腹部胀满、大便不通，或者口燥舌干而口渴，或者潮热、胡言乱语的症状，都属于可以使用下法的证候；凡是诊察到脉象沉而有力（实），就属于可以使用下法的脉象。只要脉象和症状已经具备，不必拘泥于患病的天数，应当紧急攻逐里实。如果病虽然已经传变过一经，但里证尚未完全具备，则不可以使用下法。所以医经说：“阳盛阴虚，使用下法即可痊愈”，其治法就是指这种情况。
阳明病，未经吐法或下法治疗而出现心烦的，可以给予调胃承气汤。太阳病经过三天，发汗后病仍未解除，出现蒸蒸发热的，可以给予调胃承气汤。伤寒呕吐之后出现腹胀满的，可以给予调胃承气汤。
调胃承气汤方：
甘草（炙制，二两） 大黄（用清酒清洗，四两）
以上两味药，切碎，每次服用五钱匕，加水一盏半，煎煮至一盏，滤去药渣，加入芒硝一钱匕，再煮沸一两次，温服。
阳明病，脉象迟缓，虽然出汗但不恶寒的，身体必定沉重，短气、腹部胀满且喘息，如果有潮热的，这是表证将要解除，可以攻逐里实。如果手足濈然汗出，这说明大便已经坚硬，给予大承气汤。如果出汗多、轻微发热且恶寒的，说明表证未解，且热势不呈潮热状，不可给予承气汤。如果腹部显著胀满且大便不通的，可以给予小承气汤，微微调和胃气，不要让它导致严重的泄泻。
大承气汤方：
大黄（酒洗，四两） 厚朴（去除粗皮，炙制，半斤） 枳实（麸炒，五枚）
以上三味药，切碎，每次服用五钱匕，加水一盏半，煎煮至一盏，滤去药渣，加入芒硝一钱匕，再煮沸一两次，温服。
阳明病，患者多汗，因为津液外泄，导致胃中干燥，大便必然坚硬，大便硬则会出现胡言乱语，以小承气汤为主治方。如果服用一次后谵语停止，不要再服用。
小承气汤方：
大黄（四两） 厚朴（去除粗皮，炙制，二两） 枳实（麸炒，大的三枚）
以上三味药，切碎，每次服用五钱匕，加水一盏半，煎煮至一盏，滤去药渣，温服。初次服药后应当排便，如果不排便，则将药液全部喝完；如果已经排便，则停止服用。
治疗伤寒四天以后，烦热不解，大小肠涩滞不通。柴胡汤方：
柴胡（去苗） 黄芩（去黑心，各一两） 犀角（镑片） 芍药（各三分） 山栀子仁（半两） 大黄（细锉）
以上八味药，粗捣筛，每次服用五钱匕，加水一盏半，放入竹叶三片，同煎至一盏，滤去药渣，空腹服用，以大小肠通畅为度，如未通畅可再次服用。
治疗伤寒十余日，热邪结聚在里，出现往来寒热的症状。给予大柴胡汤方：
柴胡（去苗，半斤） 枳实（麸炒，四枚） 黄芩（去黑心） 芍药（各三两） 半夏（二两半，汤洗七遍去滑） 大黄（二两）
以上六味药，切碎，每次服用五钱匕，加水一盏半，放入生姜十片、去核大枣三枚，同煎至一盏，滤去药渣，温服。
治疗伤寒四天以后，腹部胀满疼痛，气喘、体壮、身热。四味承气汤方：
大黄（细锉，醋炒，二两） 枳壳（去瓤，麸炒，一两半） 朴硝（二两） 甘草（炙制，锉碎，三分）
以上四味药，粗捣筛，每次服用五钱匕，加水一盏半，煎煮至一盏，滤去药渣，空腹温服。
治疗伤寒五天，口干、头痛、大便涩滞。黄芩汤方：
黄芩（去黑心） 山栀子仁 大黄（锉碎，醋炒，各一两） 陈橘皮（汤浸，去白，焙干，一分）
以上五味药，粗捣筛，每次服用五钱匕，加水一盏半，煎煮至一盏，滤去药渣，温服。
治疗伤寒发汗后病仍未解除，出现蒸蒸发热的。调胃承气加橘皮汤方：
陈橘皮（汤浸，去白，焙干，半两） 大黄（锉碎，醋炒，一两） 甘草（炙制，半两）
以上三味药，细锉，每次服用四钱匕，加水一盏半，煎煮至一盏，滤去药渣，加入芒硝一钱匕，搅拌令均匀，再煮沸两三滚，温服。
治疗伤寒天数过多，心中气闷，或者发生疼痛，胡言乱语不定，烦躁不得睡眠，大小便不通。柴胡大黄汤方：
柴胡（去苗） 大黄（湿纸包裹煨制） 朴硝 枳壳（去瓤，麸炒，各一两） 甘草（炙制，锉碎，半两）
以上五味药，粗捣筛，每次服用五钱匕，加水一盏半，煎煮至一盏，滤去药渣，温服，每日两次，不可过量。如果大小肠通畅，则汗自出。
治疗伤寒脉大，潮热躁动，伏热内蕴。宣毒散方：
大黄（锉碎，炒制） 甘草（炙制，锉碎，各半两） 朴硝（研细，一分） 牵牛子（一两半，生用一两，炒用半两）
以上四味药，捣罗成散剂，每次服用二钱匕，用龙脑、腻粉、蜜水调服。另一法是用炼蜜制成丸药，如梧桐子大，每次服用十五丸，用龙脑、腻粉的水送服。
治疗伤寒八九日，大便不通，心神烦闷扰乱。小黄芩汤方：
黄芩（去黑心，一两） 大黄（锉碎，炒制，二两） 枳壳（去瓤，麸炒） 大腹（锉碎，醋炒，各一两）
以上四味药，粗捣筛，每次服用三钱匕，加水一盏，煎煮至七分，滤去药渣，不限时候温服。如果行走三五里路后仍不通畅，可再次服用，以通畅为度。
治疗阳盛发狂伴有斑疹，大小便秘涩。大青散方：
大青 知母 黄芩（去黑心） 大黄（煨制） 山栀子仁 升麻 黄连（去须，各一两） 甘草（炙制，锉碎，半两）
以上八味药，捣罗成散剂，每次服用三钱匕，加入朴硝一钱匕，用蜜水调服。
治疗伤寒时气温热病，大便不通。承气丸方：
大黄（锉碎，炒制，三分） 郁李仁（汤浸，去皮，研碎） 枳实（去瓤，麸炒） 朴硝（研细，各一两）
以上四味药，捣研成末，混合均匀，用炼蜜制成丸药，如梧桐子大，每次服用二十丸，生姜汤送服，未通便可再次服用，不限时候。
Commentary states: Generally, when the pathogenic factor of Cold Damage (Shanghan) invades the Yin meridians, the disease location is in the interior. The treatment method should be purgation. Any presentation of abdominal fullness and constipation, or dry mouth and tongue with thirst, or tidal fever and delirium, are all indications for the use of purgation. Any pulse diagnosis revealing a deep and forceful (Shi) pulse constitutes an indication for purgation. Once the pulse and symptoms are established, one need not adhere strictly to the number of days since onset; urgent attack on the interior excess is required. However, if the disease has passed through a meridian stage but the interior syndrome is not yet fully developed, purgation should not be used. Thus, the classic text states: "When Yang is excessive and Yin is deficient, purgation leads to recovery." This refers to this specific therapeutic principle.
In Yangming disease, if there is mental irritability without prior emesis or purgation, Tiaowei Chengqi Tang (Stomach-Regulating Purging Decoction) may be administered. In Taiyang disease, if after three days and sweating therapy the condition remains unresolved with a sensation of steaming heat, Tiaowei Chengqi Tang may be administered. If abdominal fullness occurs after vomiting in Cold Damage, Tiaowei Chengqi Tang may be administered.
Formula for Tiaowei Chengqi Tang (Stomach-Regulating Purging Decoction):
Gancao (Zhi, Prepared Licorice Root, 2 liang) Dahuang (Qingjiu Xi, Rhubarb washed with clear wine, 4 liang)
The above two ingredients are cut into pieces. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain the decoction, add Mangxiao (1 qianbi), boil for one or two more boils, and take warm.
In Yangming disease, if the pulse is slow, sweating occurs without aversion to cold, the body must feel heavy, there is shortness of breath, abdominal fullness, and wheezing. If tidal fever is present, this indicates the exterior is about to resolve, and interior attack is permissible. If sweat oozes continuously from the hands and feet, this indicates the feces have already hardened; Da Chengqi Tang (Major Purging Decoction) should be given. If there is profuse sweating, slight fever, and aversion to cold, the exterior has not yet resolved, and the heat is not tidal; Chengqi Tang should not be given. If the abdomen is significantly full and obstructed, Xiao Chengqi Tang (Minor Purging Decoction) may be given to gently harmonize the Stomach Qi, avoiding severe diarrhea.
Formula for Da Chengqi Tang (Major Purging Decoction):
Dahuang (Jiu Xi, Rhubarb wine-washed, 4 liang) Houpo (Qu Cupi Zhi, Magnolia Bark peeled and processed, 0.5 jin) Zhishi (Fuchao, Immature Bitter Orange bran-fried, 5 pieces)
The above three ingredients are cut into pieces. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain the decoction, add Mangxiao (1 qianbi), boil for one or two more boils, and take warm.
In Yangming disease, if the patient sweats excessively, causing fluids to escape externally, the Stomach becomes dry, and the feces inevitably harden. Hard feces lead to delirium; this is primarily treated with Xiao Chengqi Tang (Minor Purging Decoction). If delirium ceases after one dose, do not administer further doses.
Formula for Xiao Chengqi Tang (Minor Purging Decoction):
Dahuang (Rhubarb, 4 liang) Houpo (Magnolia Bark peeled and processed, 2 liang) Zhishi (Immature Bitter Orange, large ones, bran-fried, 3 pieces)
The above three ingredients are cut into pieces. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain the decoction and take warm. After the first dose, defecation should occur. If it does not, consume the entire dose. If defecation has occurred, stop administration.
For Cold Damage persisting beyond four days with unresolved vexation and heat, and obstruction in the Large and Small Intestines, Chaihu Tang (Bupleurum Decoction) is indicated.
Chaihu (Qu Miao, Bupleurum Root de-rooted) Huangqin (Qu Heixin, Scutellaria Root de-blackened, each 1 liang) Xijiao (Pounded, Rhino Horn) Shaoyao (Peony Root, each 3 fen) Shanzhizi Ren (Gardenia Seed, 0.5 liang) Dahuang (Finely cut)
The above eight ingredients are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with three leaves of Zhuye (Bamboo Leaf) until reduced to 1 sheng. Strain and take on an empty stomach. Continue until the Large and Small Intestines are unobstructed; if still obstructed, administer again.
For Cold Damage lasting over ten days with heat binding in the interior and alternating chills and fever, Da Chaihu Tang (Major Bupleurum Decoction) is indicated.
Chaihu (Qu Miao, Bupleurum Root de-rooted, 0.5 jin) Zhishi (Immature Bitter Orange, bran-fried, 4 pieces) Huangqin (Scutellaria Root de-blackened) Shaoyao (Peony Root, each 3 liang) Banxia (Pinellia Tuber, 2.5 liang, washed seven times in hot water to remove slipperiness) Dahuang (Rhubarb, 2 liang)
The above six ingredients are cut into pieces. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with ten slices of Shengjiang (Fresh Ginger) and three pitted Zao (Jujube) until reduced to 1 sheng. Strain and take warm.
For Cold Damage persisting beyond four days with abdominal fullness and pain, wheezing, robust constitution, and high fever, Siwei Chengqi Tang (Four-Ingredient Purging Decoction) is indicated.
Dahuang (Finely cut, vinegar-fried, 2 liang) Zhiqiao (Aurantii Fructus, pulp removed, bran-fried, 1.5 liang) Puxiao (Mirabilite, 2 liang) Gancao (Licorice Root, roasted and cut, 3 fen)
The above four ingredients are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain and take warm on an empty stomach.
For Cold Damage on the fifth day with dry mouth, headache, and constipation, Huangqin Tang (Scutellaria Decoction) is indicated.
Huangqin (Scutellaria Root de-blackened) Shanzhizi Ren (Gardenia Seed) Dahuang (Rhubarb, finely cut, vinegar-fried, each 1 liang) Chenju Pi (Tangerine Peel, soaked in water, white pith removed, dried, 1 fen)
The above five ingredients are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain and take warm.
For Cold Damage where sweating fails to resolve the condition and steaming heat occurs, Tiaowei Chengqi Jia Ju Pi Tang (Stomach-Regulating Purging Decoction with Tangerine Peel) is indicated.
Chenju Pi (Tangerine Peel, soaked in water, white pith removed, dried, 0.5 liang) Dahuang (Rhubarb, finely cut, vinegar-fried, 1 liang) Gancao (Licorice Root, roasted, 0.5 liang)
The above three ingredients are finely cut. Each dose consists of 4 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain, add Mangxiao (1 qianbi), stir to dissolve, boil for two or three more boils, and take warm.
For prolonged Cold Damage causing chest oppression, pain, incessant delirious speech, restlessness, insomnia, and obstruction of urination and defecation, Chaihu Dahuang Tang (Bupleurum and Rhubarb Decoction) is indicated.
Chaihu (Bupleurum Root de-rooted) Dahuang (Rhubarb, wrapped in wet paper and baked) Puxiao (Mirabilite) Zhiqiao (Aurantii Fructus, pulp removed, bran-fried, each 1 liang) Gancao (Licorice Root, roasted and cut, 0.5 liang)
The above five ingredients are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain and take warm. Administer twice daily; do not overdose. If the Large and Small Intestines become unobstructed, sweat will naturally appear.
For Cold Damage with a large pulse, tidal fever, agitation, and latent heat, Xuandu San (Toxin-Releasing Powder) is indicated.
Dahuang (Rhubarb, finely cut and fried) Gancao (Licorice Root, roasted and cut, each 0.5 liang) Puxiao (Mirabilite, ground, 1 fen) Qianniuzi (Pharbitis Seed, 1.5 liang, half raw and half fried)
The above four ingredients are pounded and sieved into a powder. Each dose consists of 2 qianbi, taken with Longnao (Borneol), Nifen (Calomel), and honey-water. Alternatively, form pills with refined honey, size of Wutongzi (Chinese Honeylocust seed), taking 15 pills per dose with Longnao and Nifen water.
For Cold Damage lasting eight or nine days with constipation and mental confusion, Xiao Huangqin Tang (Minor Scutellaria Decoction) is indicated.
Huangqin (Scutellaria Root de-blackened, 1 liang) Dahuang (Rhubarb, finely cut and fried, 2 liang) Zhiqiao (Aurantii Fructus, pulp removed, bran-fried) Dafu (Areca Seed, finely cut, vinegar-fried, each 1 liang)
The above four ingredients are coarsely crushed and sifted. Each dose consists of 3 qianbi, boiled in 1 sheng of water until reduced to 0.7 sheng. Strain and take warm at any time. If unobstructed after walking for three to five li, administer again. Continue until unobstructed.
For Yang excess causing mania with macules, and constipation of urine and feces, Daqing San (Great Indigo Powder) is indicated.
Daqing (Indigo Naturalis) Zhimu (Anemarrhenae Rhizoma) Huangqin (Scutellaria Root de-blackened) Dahuang (Rhubarb, baked) Shanzhizi Ren (Gardenia Seed) Shengma (Cimicifugae Rhizoma) Huanglian (Coptidis Rhizoma, de-whiskered, each 1 liang) Gancao (Licorice Root, roasted and cut, 0.5 liang)
The above eight ingredients are pounded and sieved into a powder. Each dose consists of 3 qianbi, mixed with Puxiao (1 qianbi), and taken with honey-water.
For Cold Damage seasonal warmth-heat diseases with constipation, Chengqi Wan (Purging Pill) is indicated.
Dahuang (Rhubarb, finely cut and fried, 3 fen) Yuliren (Prunus Semen, soaked in water, skin removed, ground) Zhishi (Immature Bitter Orange, pulp removed, bran-fried) Puxiao (Mirabilite, ground, each 1 liang)
The above four ingredients are pounded and ground into powder, mixed evenly, and formed into pills with refined honey, size of Wutongzi (Chinese Honeylocust seed). Take 20 pills per dose with Ginger Water. If no laxative effect occurs, administer again at any time.