潮热者若潮汛之来不失其时一日一发按时而发者谓之潮热若日三五发者是即发热非潮热也潮热属阳明阳明旺于未
申必于日晡时发乃为潮热
太阳 病重发汗而复下之不大便五六日舌上燥而渴日晡小有潮热从心下至少腹硬满而痛不可近者大陷胸汤主之（成
重发汗而复下之则内外重亡津液而热内结致不大便五六日舌上燥而渴也日晡潮热者属胃此日晡小有潮热非但在胃从心
下至少腹硬满而痛不可近者是一腹之中上下邪气俱甚者也宜陷胸汤以下其邪 丹 谨按太阳病已重发汗表则虚矣而复
下之里又虚矣不大便五六日可见津液之耗矣非若前章之未曾发汗而但下之伤于早尔今虽有硬痛而可以迅攻之乎若曰潮
热于申酉系阳明属调胃承气证既又曰小有潮热犹可疑待之间将无他法以缓取之乎 潮热本属阳明也太阳潮热惟此一证
耳杂病太阳潮热则在己午更玩一小字则知邪太阳为多阳明为少）
阳明 病潮热大便微硬可与大承气汤不硬者不与之若不大便六七日恐有燥粪欲愈之可少与小承气汤入腹中转失气
者此有燥粪须当攻之若不转失气者此但初头硬后必溏不可攻之攻之必胀满不能食也欲饮水者与之则哕其后发热者必大
便复硬而少也以小承气汤和之不转失气者慎不可攻也 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大承气汤主之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大泄下 阳明病谵语有潮热反不能食者胃中必有燥屎五六枚也若能食者但硬尔
宜大承气汤下之（胃热当消谷引食反不能食者胃中有燥屎而实也若能食者胃中虚热虽硬不得为有燥屎玩但字则末句恐当
在若能食者之上燥屎在大肠而曰胃中者伤寒传胃不传大肠治病必求其本故仲景从本言之况承气能下燥大肠同为燥金
也）二阳并病太阳证罢但发潮热手足 汗出大便难而谵语者下之则愈宜大承气汤（成 本太阳并病于阳明名曰并病太
阳证罢是无表证但发潮热是属阳明一身汗出为热越今手足 汗出是热聚于胃也必大便难而谵语经曰手足 然而汗出
者必大便已硬也与大承气汤以下胃中实热）阳明病谵语发潮热脉滑而疾者小承气汤主之与汤一升腹中转失气者更服一升
不转失气勿更与之明日不大便脉反微涩者里虚也最为难治不可更与承气汤（成 阳明病谵语发潮热若脉沉实者内实也则
可下若脉滑疾为里热未实则未可下先与小承气汤和之汤入腹中转失气者中有燥屎可更与小承气汤一升以除之若不转失
气者是无燥屎不可更与小承气汤至明日邪气传时脉得沉实紧牢之类是里实也反得微涩者里气大虚也若大便利后脉微涩
者止为里虚而犹可此不曾大便脉反微涩是正气内衰为邪胜也故曰难治）
大承气汤方（海藏云浓朴去痞枳实泄满芒硝软坚大黄泄实必痞满燥实四证全者方可用之）
大黄（四两酒洗） 浓朴（炙去粗皮半斤） 枳实（五枚炙） 芒硝（七钱半）上四味以水一斗先煮二物取五升去
滓纳大黄煮取二升去滓纳芒硝更上火微煎一二沸分温再服得下余勿服
成 承顺也伤寒邪入胃者谓之入腑腑之为言聚也胃为水谷之海荣卫之原水谷会聚于胃变化为荣卫邪气入胃胃气
郁
滞糟粕秘结壅而为实是正气不得舒顺也本草云通可去滞泄可去闭塞而不利闭而不通以汤荡涤使塞者利而闭者通正气得
以舒顺故曰承气也王冰曰宜下必以苦宜补必以酸溃坚破结苦寒为主是以枳实为君内经曰燥淫于内治以苦温泄满除燥苦
温为辅是以浓朴为臣内经曰热淫于内治以咸寒人伤于寒则为病热热气聚于胃则谓之实咸寒之物以消实热故以芒硝咸寒
为佐内经曰燥淫所胜以苦下之热气内胜则津液消而肠胃燥苦寒之物以荡涤其燥热故以大黄为使是以大黄有将军之号也
承气汤下药也用之尤宜审如大满大实有燥屎乃可投也如非大满则生寒证而结胸痞气之属由是而生矣
小承气汤方（海藏云大黄泄实浓朴去痞必痞实全者可用）
大黄（四两） 浓朴（炙去粗皮二两） 枳实（三枚大者炙） 以上三味以水四升煮取一升二合去滓分温二服初服
汤当更衣不尔者尽饮之若更衣者勿再服（大热结实者与大承气汤小热微结与小承气汤热不大甚故大承气去芒硝结不至坚
故不减朴枳也）
吴 或问承气汤仲景有大小调胃之名何也然伤寒邪热传变入里谓之入腑腑者聚也盖邪热与糟粕蕴而为实也实则
潮
热谵语手心 汗出此燥屎所为也如人壮大热大实者宜大承气汤下之小热小实者与小承气汤下之又热结不坚满者故减
去浓朴枳实加甘草而和缓之故曰调胃承气也若病大而以小承气攻之则邪气不伏病小而以大承气攻之则过伤正气耳不及
还可再攻过则不能复救可不谨哉仲景曰凡欲行大承气先与小承气一钟服之腹中转失气乃有燥屎也可以大承气攻之若不
转失气慎不可攻攻之则腹胀不能食而难治又曰服承气汤得利慎勿再服此谆谆告诫也凡用攻法必须妙算料量合宜则应手
而效若不料量孟浪攻之必且杀人
伤寒若吐若下后不解不大便五六日上至十余日日晡所发潮热不恶寒独语如见鬼状若剧者发则不识人循衣摸床惕而
不安微喘直视脉弦者生涩者死但发热谵语者大承气汤主之一服利止后服（详循衣摸床）
阳明病发潮热大便溏小便自利胸胁满不去者小柴胡汤主之（阳明为病胃实是也今便溏而言阳明病者谓阳明外证身热
汗出不恶寒反恶热之病也）阳明中风脉弦浮大短气腹满胁下及心痛鼻干不得汗嗜卧身黄小便难时时哕而潮热者小柴胡加
茯苓主之伤寒十三日不解胸胁满而呕日晡所发潮热已而微利此本柴胡证下之而不得利今反利者知医以丸药下之非其治
也潮热者实也先宜小柴胡汤以解外后以柴胡加芒硝汤主之
柴胡加芒硝汤方
柴胡（一两） 黄芩 人参 甘草（炙） 生姜（各五钱） 半夏（汤浸三个） 大枣（三枚） 芒硝（一两） 每
服五钱水一盏半煎至八分去滓纳芒硝更微沸温服
阳明病脉浮而紧必潮热发作有时但浮者必盗汗出（成 脉浮在经紧者里实脉浮紧者表热里实也必发潮热发作有时若
脉但浮而不紧者止是表热也必盗汗出盗汗者睡而汗出也阳明病里热者自汗表热者盗汗）
活人书冬月阳明潮热脉浮而紧者发作有时但脉浮者必盗汗黄芩汤主之（方见下利）
潮热，就像潮汐的涨落一样有固定的时间。如果一天发作一次，按时发作的，称为潮热；如果一天发作三到五次，那就是普通的发热，而不是潮热。潮热归属于阳明经，阳明经的气血在未时和申时（下午1点至5点）最旺盛，所以必然在日晡时（下午3点至5点）发作，这才是真正的潮热。
太阳病经过重度发汗后又误用攻下法，导致五六天不大便，舌面干燥且口渴，下午3点至5点左右出现轻微的潮热，从心窝部一直到小腹部坚硬胀满，疼痛剧烈到不能触碰，这种情况应当使用大陷胸汤治疗。（成无己注：重度发汗后又攻下，会导致内外津液严重耗损，热邪内结，从而造成五六天不大便、舌燥口渴。日晡时出现的潮热属于胃家实，但此处仅是“轻微”潮热，说明病邪不仅局限于胃，而是从心下到小腹，上下邪气都很盛，因此需要用陷胸汤来泻下邪气。丹波元简按语：太阳病已经重发汗，表证已虚，又攻下，里证也虚，五六天不大便可见津液耗伤，不像前章那样未曾发汗而直接攻下那样过早伤正。现在虽然有硬痛，可以迅速攻下吗？如果说潮热在申酉时属于阳明，是调胃承气汤的适应证，但又说“轻微”潮热，这就值得怀疑了。难道没有别的方法可以缓和地取效吗？潮热本属阳明，太阳病出现潮热只有这一个案例。杂病中太阳病的潮热则在巳午时，再玩味一个“小”字，可知邪气多在太阳，少在阳明。）
阳明病出现潮热，大便微硬，可以给予大承气汤；如果不硬，则不可给予。如果六七天不大便，担心有燥屎，想验证是否可攻，可以先少量给予小承气汤。服药后如果在腹中能转矢气（放屁），说明有燥屎，必须攻下；如果不能转矢气，说明只是开头硬后面稀溏，不可攻下。如果攻下，必然导致腹胀满、不能进食。如果想喝水，给水喝则会打嗝（哕）。之后如果出现发热，大便又会变硬但量少，应用小承气汤调和。如果不能转矢气，千万不可攻下。
阳明病脉迟，虽然出汗但不恶寒，身体必然沉重，短气，腹满而喘，伴有潮热，这说明表证已解，可以攻里。如果手足濈然汗出，说明大便已经硬结，应当使用大承气汤。如果出汗多，微发热恶寒，说明表证未解，热势不呈潮热状，不可给予承气汤。如果腹部大大胀满不通，可以给予小承气汤，轻微调和胃气，不要令其过度泄下。
阳明病谵语，伴有潮热，反而不能进食，说明胃中有燥屎五六枚。如果能进食，说明大便只是硬而已，适宜用大承气汤攻下。（成无己注：胃热应当消谷引食，反而不能进食，是因为胃中有燥屎而实证。如果能进食，说明胃中是虚热，虽然大便硬，但不能算作有燥屎。玩味“但”字，末句恐怕应当在“若能食者”之上。燥屎在大肠，却说“胃中”，是因为伤寒传胃不传大肠，治病必求其本，所以仲景从本言之。况且承气汤能下燥屎，大肠与胃同为燥金之腑。）
二阳并病，太阳证已罢，只出现潮热、手足濈然汗出、大便难且谵语，攻下后即可痊愈，适宜使用大承气汤。（成无己注：原本是太阳并病于阳明，名叫并病。太阳证罢，说明无表证。只发潮热，说明属阳明。一身汗出为热越散，如今手足汗出，说明热聚于胃。必然大便难且谵语。经曰：手足濈然而汗出者，必大便已硬。与大承气汤以泻胃中实热。）
阳明病谵语，发潮热，脉滑而疾，用小承气汤主治。服用一升药汤，如果腹中转矢气，再服一升；如果不转矢气，不要再给。第二天如果仍不大便，脉象反而变为微涩，这是里虚，最为难治，不可再给予承气汤。（成无己注：阳明病谵语发潮热，如果脉沉实，是内实，则可下。如果脉滑疾，是里热未实，则不可下。先与小承气汤调和。汤入腹中转矢气，说明中有燥屎，可再给小承气汤一升以去除。如果不转矢气，说明无燥屎，不可再给。到了第二天，邪气传变之时，脉得沉实紧牢之类，是里实。反而得到微涩脉，是里气大虚。如果大便通利后脉微涩，只是里虚还可以治。这里不曾大便，脉反微涩，是正气内衰被邪气所胜，所以说难治。）
大承气汤方（张元素云：浓朴去痞，枳实泄满，芒硝软坚，大黄泄实。必须痞、满、燥、实四证俱全者方可使用。）
大黄（四两，酒洗） 浓朴（炙，去粗皮，半斤） 枳实（五枚，炙） 芒硝（七钱半）
以上四味，用水一斗，先煮浓朴、枳实，取五升，去渣，纳大黄，煮取二升，去渣，纳芒硝，再上火微煎一二沸，分两次温服。得下后，余药勿服。
成无己注：承顺的意思。伤寒邪气入胃，叫做入腑。腑的意思是聚。胃是水谷之海，荣卫之源。水谷会聚于胃，变化为荣卫。邪气入胃，胃气郁滞，糟粕秘结，壅塞而成实，使得正气不得舒顺。本草云：通可去滞，泄可去闭。不利闭而不通，用汤剂荡涤，使塞者利而闭者通，正气得以舒顺，所以叫承气。王冰曰：宜下必以苦，宜补必以酸。溃坚破结以苦寒为主，所以用枳实为君。内经曰：燥淫于内，治以苦温，泄满除燥，苦温为辅，所以用浓朴为臣。内经曰：热淫于内，治以咸寒。人伤于寒则为病热，热气聚于胃则谓之实。咸寒之物以消实热，故以芒硝咸寒为佐。内经曰：燥淫所胜，以苦下之。热气内胜则津液消而肠胃燥。苦寒之物以荡涤其燥热，故以大黄为使。所以大黄有将军的称号。承气汤是下药，使用尤其要审慎。如大满大实有燥屎，才可投用。如果不是大满，则会产生寒证以及结胸、痞气等病症。
小承气汤方（张元素云：大黄泄实，浓朴去痞。必须痞、实全者可用。）
大黄（四两） 浓朴（炙，去粗皮，二两） 枳实（三枚大的，炙）
以上三味，用水四升，煮取一升二合，去渣，分两次温服。初次服药应当排便，如果不排便，就喝完剩下的药。如果排便了，就不要再次服用。（大热结实者与大承气汤，小热微结与小承气汤。热势不大甚，所以大承气汤去掉芒硝；结不至坚，所以不减朴、枳。）
吴崑问：承气汤，仲景有大、小、调胃之名，为什么呢？然而伤寒邪热传变入里，叫做入腑。腑者聚也。盖邪热与糟粕蕴结而为实。实则潮热、谵语、手心汗出，这是燥屎造成的。如人体壮热大实者，宜用大承气汤攻下。小热小实者，与小承气汤攻下。又有热结不坚满者，所以减去浓朴、枳实，加入甘草而使其和缓，所以叫调胃承气。如果病大而用小承气攻之，则邪气不伏；病小而用大承气攻之，则过伤正气。不及还可再攻，过了则不能复救，可不谨慎吗？仲景说：凡欲行大承气，先与小承气一钟服之，腹中转矢气乃有燥屎，可以用大承气攻之。若不转矢气，慎不可攻。攻之则腹胀不能食而难治。又说：服承气汤得利，慎勿再服。这是谆谆告诫。凡用攻法，必须妙算料量合宜，则应手而效。如果不料量孟浪攻之，必且杀人。
伤寒如果经过吐法或下法后，病不解，五六天甚至十余天不大便，日晡时发潮热，不恶寒，独自说话像看见鬼怪一样。如果病情加重，发作时不认识人，循衣摸床，惊恐不安，微喘直视，脉弦者生，脉涩者死。如果只是发热谵语，大承气汤主治。服用一次，如果大便通利，停止后服。（详细见循衣摸床条）
阳明病发潮热，大便溏，小便自利，胸胁满不去者，小柴胡汤主治。（阳明为病，胃实是也。今便溏而言阳明病者，谓阳明外证身热、汗出、不恶寒、反恶热之病也。）
阳明中风，脉弦浮大，短气，腹满，胁下及心痛，鼻干不得汗，嗜卧，身黄，小便难，时时哕而潮热者，小柴胡加茯苓主之。
伤寒十三日不解，胸胁满而呕，日晡所发潮热，已而微利。此本柴胡证，下之而不得利，今反利者，知医以丸药下之，非其治也。潮热者，实也。先宜小柴胡汤以解外，后以柴胡加芒硝汤主之。
柴胡加芒硝汤方
柴胡（一两） 黄芩 人参 甘草（炙） 生姜（各五钱） 半夏（汤浸三个） 大枣（三枚） 芒硝（一两）
每服五钱，水一盏半，煎至八分，去渣，纳芒硝，更微沸，温服。
阳明病脉浮而紧，必潮热，发作有时。但浮者，必盗汗出。（成无己注：脉浮在经，紧者里实。脉浮紧者，表热里实也，必发潮热，发作有时。若脉但浮而不紧者，止是表热也，必盗汗出。盗汗者，睡而汗出也。阳明病里热者自汗，表热者盗汗。）
Tidal fever (Chao Re) arrives like the tide, without missing its time. If it occurs once a day at a fixed time, it is called tidal fever; if it occurs three to five times a day, it is merely fever (Fa Re), not tidal fever. Tidal fever belongs to the Yangming (Yangming Jing) channel. The Qi of Yangming is most vigorous during the Wei (13:00-15:00) and Shen (15:00-17:00) hours; therefore, it must occur during the Ribu period (15:00-17:00) to be considered true tidal fever.
In Taiyang disease (Taiyang Bing), after severe sweating followed by mistaken purgation, if there is no bowel movement for five or six days, dryness on the tongue with thirst, and slight tidal fever occurring around Ribu time, accompanied by hardness, fullness, and pain from the epigastrium down to the lower abdomen that cannot be tolerated to touch, Da Xian Xiong Tang (Major Chest-Trapping Decoction) should be administered. (Cheng Wuji notes: Severe sweating followed by purgation causes a heavy loss of fluids inside and outside, leading to internal heat binding, resulting in no bowel movement for five or six days, dry tongue, and thirst. Tidal fever at Ribu belongs to Stomach excess; however, "slight" tidal fever here indicates that the pathogen is not only in the Stomach but extends from the epigastrium to the lower abdomen, where both upper and lower pathogens are severe. Thus, Xian Xiong Tang is needed to purge the pathogen. Danbo Yuanjian comments: Taiyang disease has already undergone severe sweating, so the exterior is deficient; subsequent purgation makes the interior deficient. No bowel movement for five or six days shows fluid consumption, unlike the previous chapter where purgation was done early without prior sweating. Although there is hardness and pain now, can rapid purgation be used? If tidal fever at Shen and You hours belongs to Yangming and fits Tiao Wei Cheng Qi Tang, but it says "slight" tidal fever, this is suspicious. Is there another method for a milder approach? Tidal fever inherently belongs to Yangming; this is the only case of Taiyang tidal fever. In miscellaneous diseases, Taiyang tidal fever occurs at Si and Wu hours. Observing the word "slight" suggests the pathogen is mostly in Taiyang and less in Yangming.)
In Yangming disease, if there is tidal fever and slightly hard stool, Da Cheng Qi Tang (Major Order the Qi Decoction) may be given; if not hard, do not give it. If there is no bowel movement for six or seven days and one fears dry feces, to verify if purgation is suitable, first give a small amount of Xiao Cheng Qi Tang (Minor Order the Qi Decoction). If gas passes after ingestion, this indicates dry feces, and purgation is necessary. If gas does not pass, the stool is likely hard at the beginning and loose later; do not purge. Purging will cause abdominal fullness and inability to eat. If the patient desires water, giving water will cause hiccups (Yue). Subsequent fever will cause the stool to become hard again but scanty; use Xiao Cheng Qi Tang to harmonize. If gas does not pass, absolutely do not purge.
In Yangming disease, if the pulse is slow, sweating occurs without aversion to cold, the body feels heavy, there is shortness of breath, abdominal fullness, wheezing, and tidal fever, this indicates the exterior syndrome has resolved, and the interior can be attacked. If sweat oozes continuously from the hands and feet, the stool is already hard; Da Cheng Qi Tang is indicated. If there is much sweating, slight fever, and aversion to cold, the exterior is not resolved, the heat is not tidal, and Cheng Qi Tang should not be given. If the abdomen is greatly full and obstructed, Xiao Cheng Qi Tang may be given to mildly harmonize the Stomach Qi, avoiding excessive purgation.
In Yangming disease, if there is delirium (Man Yu), tidal fever, and paradoxically an inability to eat, there must be dry feces (Zao Shi) in the stomach/intestines. If the patient can eat, the stool is merely hard; Da Cheng Qi Tang is suitable for purgation. (Cheng Wuji notes: Stomach heat should digest food and stimulate appetite; inability to eat indicates dry feces causing excess. If able to eat, it indicates deficient heat in the Stomach; although hard, it is not dry feces. Note the word "merely," suggesting the last sentence might belong under "if able to eat." Dry feces are in the Large Intestine, but referred to as "Stomach" because Sha Jing transmits to the Stomach, not the Large Intestine; treating disease requires seeking the root, so Zhongjing speaks from the root. Moreover, Cheng Qi Tang purges dry feces; the Large Intestine and Stomach both belong to Dry Metal.)
When two Yang channels are involved simultaneously (Er Yang Bing Bing), and the Taiyang syndrome has ceased, presenting only with tidal fever, continuous sweating from hands and feet, difficulty in defecation, and delirium, purgation will cure it; Da Cheng Qi Tang is suitable. (Cheng Wuji notes: Originally Taiyang concurrent with Yangming, named concurrent disease. Cessation of Taiyang symptoms means no exterior syndrome. Only tidal fever indicates Yangming involvement. Whole-body sweating indicates heat dispersing; now hand/foot sweating indicates heat gathering in the Stomach. Defecation difficulty and delirium follow. The Classic states: continuous sweating from hands and feet implies hard stool. Give Da Cheng Qi Tang to purge Stomach excess heat.)
In Yangming disease, if there is delirium, tidal fever, and a slippery and rapid pulse, Xiao Cheng Qi Tang is the primary treatment. Administer one sheng of decoction. If gas passes in the abdomen, administer another sheng. If no gas passes, do not give more. If the next day there is still no bowel movement and the pulse becomes faint and choppy, this indicates interior deficiency, which is very difficult to treat; do not give Cheng Qi Tang again. (Cheng Wuji notes: Yangming delirium and tidal fever with a deep and solid pulse indicate interior excess, allowing purgation. A slippery and rapid pulse indicates interior heat not yet solid, so purgation is premature. First give Xiao Cheng Qi Tang to harmonize. Gas passage indicates dry feces, allowing another dose. No gas passage means no dry feces, so do not give more. By the next day, when pathogens transmit, a deep, solid, tight, or firm pulse indicates interior excess. A faint and choppy pulse indicates severe interior deficiency. If pulse is faint/choppy after diarrhea, it is just interior deficiency and still treatable. Here, no bowel movement yet, but pulse is faint/choppy, indicating internal decline of healthy Qi overcome by pathogens, hence difficult to treat.)
Da Cheng Qi Tang Formula (Zhang Yuansu states: Hou Po removes distension, Zhi Shi relieves fullness, Mang Xiao softens hardness, Da Huang purges excess. It can only be used when all four syndromes of distension, fullness, dryness, and excess are present.)
Da Huang (4 liang, washed with wine) Hou Po (roasted, coarse bark removed, 8 liang) Zhi Shi (5 pieces, roasted) Mang Xiao (7.5 qian)
These four ingredients are boiled in 1 dou of water. First boil Hou Po and Zhi Shi to obtain 5 sheng, remove dregs, add Da Huang, boil to obtain 2 sheng, remove dregs, add Mang Xiao, boil briefly over fire for 1-2 boils. Divide into two warm doses. If bowel movement occurs, stop taking the remainder.
Cheng Wuji notes: "Cheng" means to obey or smooth. When Sha Jing pathogens enter the Stomach, it is called entering the Fu organs. "Fu" means gathering. The Stomach is the sea of water and grain, the source of Ying and Wei. Water and grain gather in the Stomach and transform into Ying and Wei. Pathogens entering the Stomach cause Stomach Qi stagnation, fecal retention, blockage, and excess, preventing healthy Qi from flowing smoothly. Materia Medica states: "Unblocking removes stagnation, purging removes closure." Using decoctions to cleanse prevents blockage, allowing the blocked to open and the obstructed to flow, enabling healthy Qi to smooth out, hence "Cheng Qi." Wang Bing states: Purging requires bitter flavors; tonifying requires sour flavors. Softening hardness and breaking knots relies mainly on bitter-cold, so Zhi Shi is the sovereign herb. The Inner Canon states: "For dryness invading internally, treat with bitter-warm to relieve fullness and remove dryness." Bitter-warm serves as the minister, so Hou Po is the minister. The Inner Canon states: "For heat invading internally, treat with salty-cold." Injury by cold leads to heat disease; heat gathering in the Stomach is called excess. Salty-cold substances eliminate excess heat, so Mang Xiao is the assistant. The Inner Canon states: "For excess dryness, purge with bitter." Internal heat victory consumes fluids, causing intestinal dryness. Bitter-cold substances cleanse dryness and heat, so Da Huang is the envoy. Hence Da Huang is called the General. Cheng Qi Tangs are purgatives; their use requires extreme caution. They are for major fullness and excess with dry feces. If not major fullness, cold syndromes, chest trapping, or palpitations may arise.
Xiao Cheng Qi Tang Formula (Zhang Yuansu states: Da Huang purges excess, Hou Po removes distension. Suitable when distension and excess are present.)
Da Huang (4 liang) Hou Po (roasted, coarse bark removed, 2 liang) Zhi Shi (3 large pieces, roasted)
These three ingredients are boiled in 4 sheng of water to obtain 1.2 sheng, remove dregs, divide into two warm doses. After the first dose, if defecation occurs, stop; if not, drink the rest. If defecation occurs, do not take again. (Major heat and solid excess use Da Cheng Qi Tang; minor heat and slight binding use Xiao Cheng Qi Tang. Heat is not severe, so Mang Xiao is omitted from Da Cheng Qi Tang; binding is not hard, so Hou Po and Zhi Shi are not reduced.)
Wu Kun asks: Why does Zhongjing have names like Major, Minor, and Harmonizing Stomach for Cheng Qi Tang? When Sha Jing pathogenic heat transmits inward, it is called entering the Fu organ. Fu means gathering. Pathogenic heat and fecal matter accumulate to form excess. Excess manifests as tidal fever, delirium, and palm sweating, caused by dry feces. For robust patients with major heat and excess, Da Cheng Qi Tang is used for purgation. For minor heat and excess, Xiao Cheng Qi Tang is used. For heat binding without significant fullness, Hou Po and Zhi Shi are removed, and Gan Cao is added to make it mild, hence "Harmonizing Stomach Cheng Qi." If a major disease is treated with Xiao Cheng Qi Tang, pathogens remain unconquered; if a minor disease is treated with Da Cheng Qi Tang, healthy Qi is overly damaged. If insufficient, it can be repeated; if excessive, it cannot be rescued. Must one not be cautious? Zhongjing said: Before using Da Cheng Qi Tang, first give Xiao Cheng Qi Tang. If gas passes, there are dry feces, and Da Cheng Qi Tang can be used. If no gas passes, absolutely do not purge. Purging causes abdominal fullness, inability to eat, and difficulty. Also: If Cheng Qi Tang produces diarrhea, do not take again. This is earnest warning. Any purgative method requires precise calculation and appropriateness for immediate effect. Reckless purgation without calculation will kill.
After Sha Jing vomiting or purgation, if the disease persists, no bowel movement for five or six days up to ten-plus days, tidal fever at Ribu time, no aversion to cold, talking alone as if seeing ghosts. If severe, episodes of not recognizing people, grasping at clothes and bedrails, fright, restlessness, slight wheezing, and staring straight ahead. If the pulse is string-like, survival; if choppy, death. If merely fever and delirium, Da Cheng Qi Tang is the main treatment. One dose, if bowel movement occurs, stop subsequent doses. (See detailed entry on grasping at clothes/bedrails.)
In Yangming disease, if there is tidal fever, loose stool, free urination, and persistent fullness in the chest and hypochondrium, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the main treatment. (Yangming disease refers to Stomach excess. Mentioning Yangming with loose stool refers to the Yangming exterior syndrome: body heat, sweating, no aversion to cold, but aversion to heat.)
In Yangming wind-strike, if the pulse is string-like, floating, and large, with shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, dry nose, inability to sweat, lethargy, jaundice, difficult urination, frequent hiccups, and tidal fever, Xiao Chai Hu Tang plus Fu Ling is the main treatment.
If Sha Jing remains unresolved after thirteen days, with chest/hypochondriac fullness and vomiting, tidal fever at Ribu time, followed by slight diarrhea: this was originally a Chai Hu syndrome. Purgation should not have caused diarrhea. Now that diarrhea occurred, we know the physician used pill-based purgatives, which was incorrect. Tidal fever indicates excess. First, use Xiao Chai Hu Tang to resolve the exterior, then use Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction plus Sodium Sulfate).
Chai Hu Jia Mang Xiao Tang Formula
Chai Hu (1 liang) Huang Qin Ren Shen Gan Cao (roasted) Sheng Jiang (each 5 qian) Ban Xia (soaked in boiling water, 3 pieces) Da Zao (3 pieces) Mang Xiao (1 liang)
Take 5 qian per dose, boil in 1.5 cups of water until 0.8 cup remains, remove dregs, add Mang Xiao, boil briefly, and take warm.
In Yangming disease, if the pulse is floating and tight, there must be tidal fever occurring at specific times. If the pulse is only floating, there must be night sweats (Dao Han). (Cheng Wuji notes: Floating pulse indicates exterior; tight indicates interior excess. Floating and tight indicates exterior heat and interior excess, causing tidal fever at specific times. If only floating and not tight, it is merely exterior heat, causing night sweats. Night sweats mean sweating during sleep. Yangming interior heat causes spontaneous sweating; exterior heat causes night sweats.)
*Huojren Shu* (Book of Vitality): In winter, Yangming tidal fever with a floating and tight pulse occurs at specific times. If the pulse is only floating, there must be night sweats. Huang Qin Tang (Scutellaria Decoction) is the main treatment. (Formula see entry on Diarrhea.)