治伤寒脉结代。心动悸者主之。
甘草（四两 炙。） 桂枝（三两） 生姜（三两） 人参（二两） 阿胶（二两） 大
枣（
上九味。以清酒七升。水八升。先煮八味。取三升。去滓。内胶烊消尽。温服一升。日
三服
歌曰 结代脉须四两甘。枣枚三十桂姜三。半升麻麦一斤地。二两参胶酒水涵。
蔚按。周禹载云。本条不言外证。寒热已罢可知。不言内证。二便自调可知。第以病久
正气
阿胶、麦冬、大枣、麻仁。皆柔润之品以养阴。必得桂枝、生姜之辛以行阳气。而结代之脉
乃复。尤重在炙甘草一味。主持胃气以资脉之本原。佐以清酒。使其捷行于脉道也。其煮法
用酒七升
结代者用此方以复之。非谓脉脱者以此方救之也。学人切不可泥其方名。致误危证。推之孙
真人制生脉散。亦因其命名太夸。庸医相沿。贻害岂浅鲜哉。
男元犀按。此证必缘发汗过多所致。汗为心液。心液伤则血虚不能养心。故心动悸。心
液
治阳明病大实大满。大便不通。腹痛大热。其脉沉实者。此方主之。（此内台方
与伤寒论大同小异。）
芒硝（三合 内台方。三两） 大黄（四两 酒洗。） 枳实（五枚 炙。） 浓朴（半
斤去
上四味。以水一斗。先煮枳、朴。取五升。去滓。内大黄。煮取二升。去滓内芒硝。更
上微
歌曰 大黄四两朴半斤。枳五硝三急下云。朴枳先熬黄后入。去渣硝入火微熏。
蔚按。承气汤有起死回生之功。惟善读仲景书者方知其妙。俗医以滋润之脂麻油、当归、
火
真阴不复。往往死于粪出之后。于是咸相戒曰。润肠之品。且能杀人。而大承气汤。更无论
矣。甚矣哉。大承气汤之功用。尽为那庸耳俗目所掩也。
张隐庵曰。伤寒六经。止阳明少阴有急下证。盖阳明秉悍热之气。少阴为君火之化。在
阳明
在
鲜有能生之。且予尝闻之曰。痞满燥实坚五证皆备。然后可下。噫。当下者。全不在此五证
治疗伤寒病中出现脉象结代、心中悸动不安的病症，以本方为主治。
甘草（四两，炙用）、桂枝（三两）、生姜（三两）、人参（二两）、阿胶（二两）、大枣（擘开，十二枚）。
以上九味药，用清酒七升、水八升，先煎煮前八味药，取汁三升，滤去药渣，加入阿胶，加热使其完全溶化。每次温服一升，每日服用三次。
歌诀云：结代脉须用四两甘草，三十枚大枣、三两桂枝和生姜。半升麻子、一斤麦冬、一斤地黄。二两人参和阿胶，用水和酒来涵育。
蔚按语：周禹载说，本条文中没有提及外在证候，可知寒热症状已经消退；没有提及内在证候，可知大小便自然调畅。只是因为病程日久，正气虚弱，所以使用阿胶、麦冬、大枣、火麻仁这些柔润的药物来滋养阴液。必须借助桂枝、生姜的辛散之性来运行阳气，这样结代之脉才能恢复。尤其重在炙甘草这一味药，主持胃气以资助脉道的根本。佐以清酒，使药力能迅速通行于脉道之中。其煎煮方法是用酒七升、水八升。
结代脉用此方来使之恢复，并不是说脉绝脱失者可以用此方来救治。学习中医的人切不可拘泥于方名，以致延误危重证候的治疗。推及孙思邈真人创制的生脉散，也是因为它命名太过夸大，庸医沿袭旧习，造成的危害难道不深吗？
男元犀按语：此证必定是因为发汗过多所致。汗为心之液，心液受伤则血虚不能养心，所以出现心动悸。心液...（原文此处中断）
治疗阳明病出现大实大满、大便不通、腹痛伴有大热、脉象沉实的病症，以本方为主治。（此方与《内台方议》所载大同小异。）
芒硝（三合，《内台方》作三两）、大黄（四两，酒洗）、枳实（五枚，炙）、厚朴（半斤，去皮）。
以上四味药，用水一斗，先煎煮枳实和厚朴，取汁五升，滤去药渣，加入大黄，再煎取汁二升，滤去药渣，加入芒硝，稍微煮沸即可。
歌诀云：大黄四两、厚朴半斤，枳实五枚、芒硝三合，急下之症需谨记。厚朴枳实先煎，大黄后入，去渣后加入芒硝，微火稍煮。
蔚按语：承气汤有起死回生的功效，只有善于研读张仲景著作的人才能知道其中的奥妙。世俗医生认为滋润的药如芝麻油、当归等是安全的，而将峻下剂视为禁忌。结果导致真阴无法恢复，往往在粪便排出后死亡。于是大家都互相告诫说：润肠的药物尚且能杀人，至于大承气汤，更不用提了。大承气汤的功效，完全被那些平庸浅陋的医生所掩盖。
张隐庵说：伤寒六经中，只有阳明经和少阴经有急下证。这是因为阳明经禀受悍热之气，少阴经为君火所化...（原文此处中断）
...很少有能救活的。况且我曾听说过：痞、满、燥、实、坚五种证候都具备，然后才可以攻下。唉，该用下法的时候，完全不仅仅看这五种证候...（原文此处中断）
Treats the condition of Taiyang disease (Disease of the Taiyang channel) presenting with a knotted and intermittent pulse (Jiedai Mai, a pulse with irregular rhythm and pauses) and palpitations (Xin Dong Ji), for which this formula is indicated.
Gancao (Radix Glycyrrhizae Preparata, 4 liang, prepared by honey-frying), Guizhi (Ramulus Cinnamomi, 3 liang), Shengjiang (Rhizoma Zingiberis Recens, 3 liang), Renshen (Radix Ginseng, 2 liang), Ejiao (Colla Corii Asini, 2 liang), Dazao (Fructus Jujubae, 12 pieces, split).
Take the above nine ingredients. Add 7 sheng of clear wine and 8 sheng of water. First decoct the first eight ingredients to obtain 3 sheng of liquid. Strain to remove the dregs. Add Ejiao and heat until completely dissolved. Take 1 sheng warm, three times a day.
The rhyme states: For a knotted and intermittent pulse, use four liang of Gancao; thirty Dazao, three liang each of Guizhi and Shengjiang. Half a sheng of Huma Ren, one jin of Maidong, one jin of Dihuang. Two liang each of Renshen and Ejiao, nurtured by water and wine.
Commentary by Wei: Zhou Yuzai stated that since the text does not mention external signs, it can be inferred that exterior cold-heat symptoms have resolved. Since it does not mention internal signs, it can be inferred that bowel and bladder functions are normal. The condition arises from prolonged illness depleting righteous Qi (Zheng Qi). Therefore, soft and moistening herbs such as Ejiao, Maidong (Radix Ophiopogonis), Dazao, and Huma Ren (Semen Cannabis) are used to nourish Yin fluids. It is necessary to employ the acrid nature of Guizhi and Shengjiang to circulate Yang Qi, so that the knotted and intermittent pulse may recover. Particularly important is the single herb Zhi Gancao, which supports Stomach Qi to nourish the root of the pulse. Clear wine is added as an assistant to facilitate rapid circulation through the pulse channels. The decoction method uses seven sheng of wine and eight sheng of water.
This formula is used to restore the knotted and intermittent pulse; it is not intended to treat cases of pulse disappearance or collapse. Students must not rigidly adhere to the name of the formula, lest they mismanage critical conditions. By extension, Sun Simiao’s Shengmai San (Life-Preserving Powder) was also created because its name was perhaps too grandiose; vulgar physicians followed suit, causing significant harm.
Note by Yuanxi: This condition is certainly caused by excessive sweating. Sweat is the fluid of the Heart. When Heart fluids are damaged, blood deficiency fails to nourish the Heart, resulting in palpitations. Heart fluid... [Text cuts off]
Treats Yangming disease (Disease of the Yangming channel) characterized by severe excess and fullness, constipation, abdominal pain with high fever, and a deep, forceful pulse, for which this formula is indicated. (This formula is largely similar to that in Neitai Fangyi.)
Mangxiao (Natrii Sulfas, 3 he; Neitai Fangyi records 3 liang), Dahuang (Radix et Rhizoma Rhei, 4 liang, washed with wine), Zhishi (Fructus Aurantii Immaturus, 5 pieces, prepared by honey-frying), Houpo (Cortex Magnoliae Officinalis, half a jin, bark removed).
Take the above four ingredients. Add one dou of water. First decoct Zhishi and Houpo to obtain five sheng of liquid. Strain to remove dregs. Add Dahuang and decoct to obtain two sheng of liquid. Strain to remove dregs. Add Mangxiao and boil slightly.
The rhyme states: Four liang of Dahuang, half a jin of Houpo; five Zhishi, three he of Mangxiao, urgent purgation is said. Decoct Houpo and Zhishi first, add Dahuang later. Remove dregs, add Mangxiao, and simmer slightly over fire.
Commentary by Wei: Chengqi Tang has the power to revive the dying. Only those who skillfully study Zhang Zhongjing’s works can appreciate its subtleties. Vulgar physicians consider lubricating agents like Sesame Oil and Danggui (Radix Angelicae Sinensis) safe, while regarding harsh purgatives as taboo. Consequently, True Yin fails to recover, and patients often die after stool evacuation. Thus, everyone warns each other: "Lubricating intestinal agents can even kill people, let alone Da Chengqi Tang." The efficacy of Da Chengqi Tang is entirely obscured by mediocre and unrefined physicians.
Zhang Yin'an stated: Among the Six Channels of Shanghan, only Yangming and Shaoyin have urgent purgation indications. This is because Yangming possesses fierce and hot Qi, and Shaoyin transforms via Ministerial Fire... [Text cuts off]
...there are few who can survive. Moreover, I have heard it said: One should only purge when all five syndromes—Pi (stuffiness), Man (fullness), Zao (dryness), Shi (excess), and Jian (hardness)—are present. Alas, when purgation is indicated, it depends entirely on more than just these five syndromes... [Text cuts off]