治少阳阳明府证。
大黄(四钱。生用。) 浓朴(六钱。) 枳实(三枚。炙。)
初服汤当更衣。不尔者。尽饮之。若更衣。勿服之。经云。亢则害。承乃制。专取大黄以制亢极之害也。
承气汤证有三。太阳之邪初传阳明之府。用调胃承气。藉甘草之缓。款留硝、黄。以祛胃中方张之邪。
邪热亢极于胃。用大承气之硝、黄、枳、朴并攻全盛之邪。故无庸于甘缓也。邪气 欲犯少阳之界。
斯时热已向衰。但须枳、朴助大黄。以击惰归之邪。故无取于芒硝之峻锐也。其桃核承气。则又
主太阳犯本之证。以桃仁、桂枝血药引调胃承气三味以破膀胱蓄血。与阳明之府。略无交涉。
调胃承气汤(玉函) 治太阳阳明府证。
小承气汤去浓朴、枳实。方中大黄酒浸。加芒硝三合。甘草二钱。
大承气汤(玉函) 治正阳阳明府证。
小承气汤本方大黄。酒洗倍用。浓朴半两。枳实五枚。加芒硝三合。
桃核承气汤(玉函。即桃仁承气汤。)治热结膀胱如狂。
小承气汤去浓朴、枳实加芒硝、甘草、桃仁、桂枝。
浓朴大黄汤(金匮) 治支饮胸满。
小承气汤倍大黄。
浓朴三物汤(金匮) 治腹满痛闭。
小承气汤倍浓朴用枳实五枚。
浓朴七物汤(金匮) 治腹满发热。饮食如故。
小承气汤加甘草、桂枝、姜、枣。此本小承气合桂枝汤。中间裁去白芍之酸收。不致引邪入
犯营血。虽同用桂枝、甘草。与桂枝汤泾渭攸分。其浓朴独倍他药。正以泄气之浊逆耳。
大黄甘遂汤(金匮) 治妇人血结。少腹如敦。
小承气汤去枳实、浓朴。本方大黄用四钱。加甘遂阿胶各二钱。顿服之。
大黄甘草汤(金匮) 治食已即吐。
小承气去枳实、浓朴。用大黄一两。加甘草三钱。
大黄牡丹汤(金匮 肘后名瓜子汤。) 治大肠痈。
小承气汤去枳实、浓朴。加芒硝、桃仁、牡丹皮、甜瓜子。
大黄附子汤(金匮)治胁下寒饮偏痛。
小承气汤去枳实、浓朴。本方用大黄一两。加附子六钱。细辛二钱。水煎。分温三服。如人行
四五里进一服。按此即泻心汤去芩、连之苦燥泻里。加细辛之辛温走表。以治胁下寒积。两不移
易之定法也。
黄龙汤 治失下循衣撮空。虚极热盛。不下必死者。
小承气汤本方用大黄三钱。浓朴钱半。枳实一钱加芒硝二钱。甘草一钱。人参较大黄减半。
当归二钱。生姜五片。大枣一枚。如肠鸣。去芒硝加半夏、茯苓。血秘。去甘草加桃仁泥、生地黄汁。
气秘。去当归加木香。风秘。去大枣加羌活。年老气虚。去芒硝。汤取黄龙命名。专攻中央燥土。土
既燥竭。虽三承气萃集一方。不得参、归鼓舞胃气。乌能兴云致雨。或者以为因虚用参。殊不
知参在群行剂中。则迅扫之威愈猛。安望其有补益之力欤。千金又以小柴胡易名黄龙汤。意在培
土以安风木。殊非此方寓补于泻之义。
三化汤 治类中风。外无六经形证。内有便溺阻隔。
小承气汤加羌活。
羌活导滞汤 治大便风秘。
小承气汤去浓朴。加羌活、独活、防己、当归、甘草。此方较三化汤。药味稍异而功用不殊。
与枳实导滞丸。则泾渭各别。彼虽亦本承气。而兼枳、术、三黄。因隶之伤饮食门。此不复列。
紫草承气汤 治痘疮干紫。便秘喘满。
小承气汤加紫草。
治疗少阳与阳明腑证。
大黄(四钱,生用。) 浓朴(六钱。) 枳实(三枚,炙过。)
初次服用汤药后应当排便。如果不排便,就全部喝完。如果已经排便,就不要继续服用。经书说:“亢盛则有害,顺承才能制约。”专门选取大黄来制约亢极的危害。
承气汤的证候有三种:太阳之邪初传至阳明之腑,使用调胃承气汤,借助甘草的缓和作用,延缓硝石、大黄的泻下之力,以祛除胃中正盛的邪气。
邪热在胃中极度亢盛,使用大承气汤中的硝石、大黄、枳实、浓朴同时攻伐全盛的邪气,所以不需要甘缓的药物。邪气想要侵犯少阳的界限,此时热势已经衰退,只需要枳实、浓朴辅助大黄,以打击懈怠归顺的邪气,所以不需要芒硝的峻烈锐利。至于桃核承气汤,则是主治太阳病侵犯本经(膀胱)的证候,用桃仁、桂枝等血分药物引导调胃承气汤的三味药来破除膀胱蓄血,这与阳明腑证几乎没有关系。
调胃承气汤(玉函) 治疗太阳阳明腑证。
小承气汤去掉浓朴、枳实。方中大黄用酒浸,加芒硝三合,甘草二钱。
大承气汤(玉函) 治疗正阳阳明腑证。
小承气汤原方中的大黄,用酒洗并加倍用量,浓朴半两,枳实五枚,加芒硝三合。
桃核承气汤(玉函。即桃仁承气汤。)治疗热结膀胱导致的神志如狂。
小承气汤去掉浓朴、枳实,加芒硝、甘草、桃仁、桂枝。
浓朴大黄汤(金匮要略) 治疗支饮导致的胸满。
小承气汤加倍大黄用量。
浓朴三物汤(金匮要略) 治疗腹部胀满疼痛且闭塞不通。
小承气汤加倍浓朴用量,使用枳实五枚。
浓朴七物汤(金匮要略) 治疗腹部胀满发热,饮食正常。
小承气汤加甘草、桂枝、生姜、大枣。这原本是小承气汤合桂枝汤,中间裁去白芍的酸收之性,以免引邪深入侵犯营血。虽然同样使用桂枝、甘草,但与桂枝汤截然不同。其中浓朴独独比其他药物加倍,正是为了泄除浊逆之气。
大黄甘遂汤(金匮要略) 治疗妇人血结,少腹坚硬如敦(古代的一种容器)。
小承气汤去掉枳实、浓朴。本方大黄用四钱,加甘遂、阿胶各二钱,一次性服下。
大黄甘草汤(金匮要略) 治疗进食后立即呕吐。
小承气汤去掉枳实、浓朴,用大黄一两,加甘草三钱。
大黄牡丹汤(金匮要略,《肘后备急方》名为瓜子汤。) 治疗大肠痈。
小承气汤去掉枳实、浓朴,加芒硝、桃仁、牡丹皮、甜瓜子。
大黄附子汤(金匮要略)治疗胁下寒饮引起的偏侧疼痛。
小承气汤去掉枳实、浓朴。本方用大黄一两,加附子六钱,细辛二钱,水煎煮,分三次温服。如人行走四五里的时间服用一次。按:此方即泻心汤去掉黄芩、黄连的苦燥泻里之性,加上细辛的辛温走表之性,用来治疗胁下的寒积,这是不可更改的定法。
黄龙汤 治疗因失于攻下导致循衣摸空,正气极度虚弱而热势盛大,不攻下必死的情况。
小承气汤原方用大黄三钱,浓朴钱半,枳实一钱,加芒硝二钱,甘草一钱,人参用量比大黄减半,当归二钱,生姜五片,大枣一枚。如果肠鸣,去掉芒硝,加半夏、茯苓。如果是血秘,去掉甘草,加桃仁泥、生地黄汁。如果是气秘,去掉当归,加木香。如果是风秘,去掉大枣,加羌活。年老体虚气弱者,去掉芒硝。汤剂取名为黄龙,专门攻伐中央燥土。土既已干燥枯竭,即使集合了三承气汤的药力,如果没有人参、当归鼓舞胃气,怎能兴云致雨呢?有人认为是因为虚损而用人参,殊不知人参在群行(攻下)药剂中,会使迅扫的威力更加猛烈,哪里还能指望它有补益的作用呢?《千金方》又用小柴胡汤改名为黄龙汤,意在培土以安风木,这完全不是本方寓补于泻的本义。
三化汤 治疗类似中风,外无六经形证,内有大小便阻隔。
小承气汤加羌活。
羌活导滞汤 治疗大便风秘。
小承气汤去掉浓朴,加羌活、独活、防己、当归、甘草。此方较三化汤药味稍异但功用相同。与枳实导滞丸则截然不同,后者虽然也基于承气汤,但兼有枳实、白术、三黄,因此归类于伤食门,此处不再列出。
Treat Shaoyang and Yangming Fu-organ syndromes.
Rhubarb (Da Huang) (4 qian, used raw.) Pinellia Stem with Magnolia Bark (Nong Po) (6 qian.) Immature Bitter Orange (Zhi Shi) (3 pieces, roasted.)
Upon the first dose of the decoction, bowel movement should occur. If not, drink the entire amount. If bowel movement has already occurred, do not take more. The Classics state: "Excess leads to harm; subordination brings control." Rhubarb is specifically selected to control the harm of extreme excess.
There are three types of Chengqi Tang syndromes: When pathogenic factors from Taiyang initially transmit to the Yangming Fu-organ, Tiaowei Chengqi Tang is used. It relies on the moderating effect of Licorice Root (Gan Cao) to delay the purgative action of Mirabilite (Xiao Shuang) and Rhubarb, thereby dispelling the flourishing pathogenic factors in the Stomach.
When pathogenic heat is extremely excessive in the Stomach, Dachengqi Tang uses Mirabilite, Rhubarb, Immature Bitter Orange, and Pinellia Stem with Magnolia Bark to simultaneously attack the fully developed pathogenic factors, so there is no need for sweet moderation. When pathogenic factors intend to invade the boundary of Shaoyang, the heat has already declined at this time. Only Immature Bitter Orange and Pinellia Stem with Magnolia Bark assisting Rhubarb are needed to strike the sluggish and retreating pathogens, so the harsh and sharp nature of Mirabilite is not required. As for Taohao Chengqi Tang, it primarily treats syndromes where Taiyang pathogenic factors invade the root organ (Bladder). Using Peach Kernel (Tao Ren) and Cinnamon Twig (Gui Zhi), blood-invigorating herbs guide the three ingredients of Tiaowei Chengqi Tang to break up blood stasis in the Bladder, which has little to do with Yangming Fu-organ syndromes.
Tiaowei Chengqi Tang (from Yuhan) Treats Taiyang-Yangming Fu-organ syndrome.
Remove Pinellia Stem with Magnolia Bark and Immature Bitter Orange from Xiaochengqi Tang. In the formula, use Rhubarb soaked in wine, add Mirabilite 3 he, and Licorice Root 2 qian.
Dachengqi Tang (from Yuhan) Treats Zhengyang Yangming Fu-organ syndrome.
In the original Xiaochengqi Tang formula, double the amount of Rhubarb washed in wine, use Pinellia Stem with Magnolia Bark 0.5 liang, Immature Bitter Orange 5 pieces, and add Mirabilite 3 he.
Taohao Chengqi Tang (from Yuhan. Also known as Tao Ren Chengqi Tang.) Treats heat binding in the Bladder causing manic behavior.
Remove Pinellia Stem with Magnolia Bark and Immature Bitter Orange from Xiaochengqi Tang, add Mirabilite, Licorice Root, Peach Kernel, and Cinnamon Twig.
Nongpo Dahuang Tang (from Jin Gui Yao Lue) Treats chest fullness caused by fluid retention (Zhi Yin).
Double the amount of Rhubarb in Xiaochengqi Tang.
Nongpo Sanwu Tang (from Jin Gui Yao Lue) Treats abdominal fullness, pain, and obstruction.
Double the amount of Pinellia Stem with Magnolia Bark in Xiaochengqi Tang, using 5 pieces of Immature Bitter Orange.
Nongpo Qiwu Tang (from Jin Gui Yao Lue) Treats abdominal fullness and fever, with normal diet.
Add Licorice Root, Cinnamon Twig, Ginger, and Jujube to Xiaochengqi Tang. This is originally a combination of Xiaochengqi Tang and Guizhi Tang. White Peony Root (Bai Shao)'s sour astringent property is removed to prevent drawing pathogens into the Ying and Blood levels. Although Cinnamon Twig and Licorice Root are used, it is distinct from Guizhi Tang. Pinellia Stem with Magnolia Bark is uniquely doubled compared to other herbs precisely to drain turbid rebellious Qi.
Dahuang Gusu Tang (from Jin Gui Yao Lue) Treats blood binding in women, with the lower abdomen hard like a Dun (ancient vessel).
Remove Immature Bitter Orange and Pinellia Stem with Magnolia Bark from Xiaochengqi Tang. Use Rhubarb 4 qian in this formula, add Kansui Root (Gan Sui) and Donkey-Hide Gelatin (E Jiao) each 2 qian, and take in one dose.
Dahuang Gancao Tang (from Jin Gui Yao Lue) Treats vomiting immediately after eating.
Remove Immature Bitter Orange and Pinellia Stem with Magnolia Bark from Xiaochengqi Tang, use Rhubarb 1 liang, and add Licorice Root 3 qian.
Dahuang Mudan Tang (from Jin Gui Yao Lue; named Gua Zi Tang in Zhou Hou Bei Ji Fang) Treats intestinal abscess (Da Chang Yong).
Remove Immature Bitter Orange and Pinellia Stem with Magnolia Bark from Xiaochengqi Tang, add Mirabilite, Peach Kernel, Moutan Cortex (Mu Dan Pi), and Sweet Melon Seed (Tian Gua Zi).
Dahuang Fuzi Tang (from Jin Gui Yao Lue) Treats unilateral pain under the hypochondrium caused by cold-fluid retention.
Remove Immature Bitter Orange and Pinellia Stem with Magnolia Bark from Xiaochengqi Tang. Use Rhubarb 1 liang in this formula, add Aconite Root (Fu Zi) 6 qian and Asarum (Xi Xin) 2 qian. Decoct in water, divide into three warm doses. Administer one dose every four to five li of walking. Note: This formula is derived from Xie Xin Tang by removing the bitter-dry properties of Scutellaria Root (Huang Qin) and Coptis Rhizome (Huang Lian) that purge interior heat, and adding Asarum's acrid-warm property that moves outward, to treat cold accumulation under the hypochondrium. This is an unchangeable established method.
Huanglong Tang Treats cases of wandering fingers and picking at bedclothes due to failure to purge earlier, with extreme deficiency and intense heat. Without purging, death is inevitable.
Use Rhubarb 3 qian, Pinellia Stem with Magnolia Bark 0.5 qian, and Immature Bitter Orange 1 qian from the original Xiaochengqi Tang formula. Add Mirabilite 2 qian, Licorice Root 1 qian, Ginseng Root (Ren Shen) half the amount of Rhubarb, Angelica Sinensis Root (Dang Gui) 2 qian, Ginger 5 slices, and Jujube 1 piece. If borborygmus occurs, remove Mirabilite and add Pinellia Tuber (Ban Xia) and Poria (Fu Ling). For blood constipation, remove Licorice Root and add Peach Kernel paste and Rehmannia Root juice (Sheng Di Huang Zhi). For Qi constipation, remove Angelica Sinensis Root and add Aucklandia Root (Mu Xiang). For Wind constipation, remove Jujube and add Notopterygium Rhizome (Qiang Huo). For elderly patients with Qi deficiency, remove Mirabilite. The decoction is named Huanglong (Yellow Dragon) to specifically attack the dry Earth of the Center. Since the Earth is dried up, even if the three Chengqi formulas are combined, without Ginseng and Angelica Sinensis Root to encourage Stomach Qi, how can clouds be raised and rain brought? Some believe Ginseng is used for deficiency, not realizing that within a group of purgative agents, Ginseng intensifies the swift sweeping power, let alone expecting it to have tonifying effects. Qian Jin Fang also renames Xiao Chaihu Tang as Huanglong Tang, intending to nourish Earth to calm Liver Wood, which completely contradicts the meaning of this formula, which embeds tonification within purgation.
Sanhua Tang Treats stroke-like conditions with no exterior Six Meridian signs/symptoms, but internal obstruction of stool and urine.
Add Notopterygium Rhizome (Qiang Huo) to Xiaochengqi Tang.
Qiang Huo Daozhi Tang Treats wind constipation.
Remove Pinellia Stem with Magnolia Bark from Xiaochengqi Tang, add Notopterygium Rhizome (Qiang Huo), Saposhnikovia Root (Du Huo), Stephania Root (Fang Ji), Angelica Sinensis Root (Dang Gui), and Licorice Root. This formula differs slightly in ingredients from Sanhua Tang but has similar efficacy. It is distinct from Zhishi Daozhi Wan. Although the latter is also based on Chengqi Tang, it includes Immature Bitter Orange, Atractylodes Macrocephala Rhizome (Bai Zhu), and the Three Yellows (San Huang), so it is classified under Food Retention categories and is not listed here.
Zicao Chengqi Tang Treats dry purple acne/pox, constipation, wheezing, and fullness.
Add Arnebia Root/Licorice Root (Zi Cao) to Xiaochengqi Tang.