治伤寒阳明腑证，谵言，便硬，潮热，上中二焦痞满不通。
大黄（四两） 浓朴（二两姜炒） 枳实（三枚麸炒） 水四升，煮取一升二合，分温
服。小承气汤朴实黄，胸腹痞硬上中强。（大承气汤通治三焦，小承气汤不犯下焦，调胃承
气汤不犯上焦。）犯治胃实故曰“小”，（大承气汤破中焦竟犯下焦，故称曰“大”；小承气汤
独
胃
利而去，仍为胃实。医见下利，遂不复敢议下，岂未读仲景书乎？）又有初硬后溏者，（若
腹不满，不转矢气，此但初头硬，后必溏，不可攻之；攻之必胀满，不能食也。）宜否之间
好审量。（一则下利谵语，仍宜攻下；一则便硬腹不满，戒不可攻。仲景立法，详审如此。）
益以羌活名三化，（《机要》加羌活，名三化汤。）中风闭实可消详。（用承气通二便，加羌活
散风邪，中风体实者可偶用，虚者不可轻投。）
治热邪结胃，胸痛心烦，口渴便秘，谵语。
大黄（四两酒浸） 甘草（二两炙） 芒硝（半升） 水三升，煮一升，纳芒硝化服。
〔附〕当归承气汤（刘完素《素问病机气宜保命集》 治里热火郁，或皮肤干燥，或咽
燥鼻干，或便溺秘结，或瘀血发狂。
当归 大黄（各一两） 甘草（半两） 芒硝（九钱） 姜、枣煎。
治疗伤寒阳明腑实证，症见胡言乱语（谵言），大便干硬，潮热，上焦和中焦气机痞塞胀满不通。
大黄（四两） 厚朴（二两，姜汁炒） 枳实（三枚，麸皮炒） 用水四升，煎煮至一升二合，分两次温服。小承气汤由厚朴、枳实、大黄组成，主治胸腹部痞塞坚硬，病位集中在上中二焦。（大承气汤通治上、中、下三焦；小承气汤不侵犯下焦；调胃承气汤不侵犯上焦。）因为主要治疗胃家实热证，所以称为“小”。（大承气汤攻破中焦后进而波及下焦，所以称为“大”；小承气汤仅针对胃实，药力较轻而去势较缓。医生见到患者有下利症状，便不敢再议用攻下法，这难道是没有读过张仲景的著作吗？）又有初头大便干硬而后溏泄的情况。（如果腹部没有胀满感，也没有转矢气，这只是大便开头硬，后面必然稀溏，不可使用攻下法；若误用攻下法，必然导致腹胀满、不能进食。）此时宜与不宜之间，需要仔细审度权衡。（一种情况是虽有下利和谵语，但仍适宜攻下；另一种情况是大便干硬但腹部不胀满，严禁攻下。张仲景制定的法则，如此详尽审慎。）另外加入羌活则名为三化汤。（《兰室秘藏》等书中记载加入羌活，命名为三化汤。）中风闭证实证者可详细斟酌使用。（用承气汤疏通二便，加羌活疏散风邪，体质壮实的中风闭实证患者可偶尔使用，虚证患者不可轻易投用。）
大黄（四两，酒浸） 甘草（二两，蜜炙） 芒硝（半升） 用水三升，煎煮至一升，纳入芒硝使其溶化后服用。
〔附〕当归承气汤（出自刘完素《素问病机气宜保命集》，治疗里热火郁，或皮肤干燥，或咽喉干燥鼻窍干涩，或大小便闭塞不通，或瘀血导致发狂。
当归 大黄（各一两） 甘草（半两） 芒硝（九钱） 加生姜、大枣煎服。）
Treats Yangming Fu-organ syndrome (syndrome of the Yangming fu organs) in cold damage, characterized by delirium (谵言), hard stool, tidal fever, and qi stagnation with fullness and obstruction in the upper and middle jiao (upper and middle energy centers).
Da Huang (Rhei Radix et Rhizoma, 4 liang) Hou Po (Magnoliae Officinalis Cortex, 2 liang, stir-fried with ginger juice) Zhi Shi (Aurantii Fructus Immaturus, 3 pieces, stir-fried with bran). Boil in 4 sheng of water until reduced to 1.2 sheng; divide into two doses and take warm. Xiao Chengqi Tang (Minor Order the Conveyance Decoction) consists of Hou Po, Zhi Shi, and Da Huang. It treats chest and abdominal fullness and hardness, targeting the upper and middle jiao. (Da Chengqi Tang treats all three jiao; Xiao Chengqi Tang does not affect the lower jiao; Tiaowei Chengqi Tang does not affect the upper jiao.) It is called "Minor" because it primarily treats excess heat in the stomach. (Da Chengqi Tang breaks through the middle jiao and affects the lower jiao, hence "Major"; Xiao Chengqi Tang targets only stomach excess and has a milder action. Physicians see diarrhea and dare not discuss purgation; have they not read Zhang Zhongjing's works?) There are cases where stool is initially hard but later loose. (If the abdomen is not full and there is no passing of flatus, this indicates only the initial part of the stool is hard, and the rest will be loose; do not use purgation. Purgation will cause abdominal fullness and inability to eat.) One must carefully weigh whether to purge or not. (In one case, despite diarrhea and delirium, purgation is still appropriate; in another, with hard stool but no abdominal fullness, purgation is forbidden. Zhang Zhongjing's laws are so detailed and prudent.) Adding Qiang Huo creates Sanhua Tang. (Adding Qiang Huo as recorded in texts like *Jiyao* names it Sanhua Tang.) For wind-stroke with closure and excess, this can be considered carefully. (Using Chengqi Tang to unblock the bowels and bladder, plus Qiang Huo to disperse wind pathogens, may be used occasionally for patients with wind-stroke who are physically strong and have excess patterns, but should not be lightly administered to those with deficiency patterns.)
Treats heat pathogen knotting in the stomach, presenting with chest pain, vexation, thirst, constipation, and delirium.
Da Huang (Rhei Radix et Rhizoma, 4 liang, soaked in wine) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-roasted) Mang Xiao (Natrii Sulfas, half sheng). Boil in 3 sheng of water until reduced to 1 sheng; add Mang Xiao, dissolve, and take.
[Appendix] Danggui Chengqi Tang (From Liu Wansu's *Suwen Bingji Qi Yi Baoming Ji*, treating interior heat and fire stagnation, or dry skin, or dry throat and nose, or constipation of urine and feces, or mania due to blood stasis.
Dang Gui (Angelicae Sinensis Radix) Da Huang (Rhei Radix et Rhizoma) (each 1 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma) (0.5 liang) Mang Xiao (Natrii Sulfas) (9 qian). Decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).