Discussion on Chengqi Tang Syndrome 1977.8.3

Discussion on Chengqi Tang Syndrome 1977.8.3

The three Chengqi Tang formulas—Dachengqi Tang, Xiaochengqi Tang, and Tiaowei Chengqi Tang—are renowned prescriptions from the "Shanghan Lun." Dachengqi Tang addresses痞 (distention), 满 (fullness), 燥 (dryness), and 实 (solidity); Xiaochengqi Tang focuses on痞, 满, and 实; while Tiaowei Chengqi Tang targets 燥 and 实. The key components are: Dahuang (for 实), Mangxiao (for 燥), Zhishi (for痞), and Houpu (for 满). These principles summarize the indications for the three Chengqi Tang formulas. Article 203 of the "Shanghan Lun" states: "In Yangming disease, patients normally sweat spontaneously; however, if physicians further induce sweating, even after the illness has improved, and the patient still feels slightly uncomfortable and confused, this is due to hard stools. This occurs because body fluids have been depleted, leaving the stomach dry and causing constipation. One should inquire about the frequency of urination: if the patient normally urinates three times a day but now only once, it indicates that the stool has remained hard for a long time. Since urine output is low, indicating that body fluids are still retained in the stomach, it suggests that bowel movement will occur soon." This passage emphasizes the importance of observing whether urination is frequent or not when dealing with hard stools. If urination is frequent, it indicates stagnation, and purgation is necessary; if urination is infrequent, it means body fluids are still retained in the stomach, suggesting that bowel movement will occur shortly. This temporary dryness can be distinguished from persistent dryness by assessing urine volume. If urine output remains high, Dachengqi Tang can be used; if urine output is low, Dachengqi Tang is not indicated. Article 215 of the "Shanghan Lun" states: "In Yangming disease, if a patient experiences delirium, tidal fever, and refusal to eat, it indicates that there are five or six hardened fecal masses in the stomach. If the patient can eat, it merely signifies dry stools, and Dachengqi Tang should be administered." This article clarifies that patients with hardened stools who can eat should not be purged, whereas those who cannot eat likely have solidified stools, making Dachengqi Tang appropriate. Here, the ability to eat serves as a criterion for distinguishing between temporary and persistent dryness. Article 208 of the "Shanghan Lun" states: "In Yangming disease, if the pulse is slow, sweating occurs, and there is no aversion to cold, the body feels heavy. Shortness of breath, abdominal distension, and tidal fever suggest that the condition is worsening, and aggressive treatment is warranted. If the hands and feet are profusely sweating, it indicates that the stools have already hardened, and Dachengqi Tang should be prescribed. However, if excessive sweating and mild fever with chills persist, it implies that the exterior has not yet been resolved, and the heat is not tidal, so Chengqi Tang should not be used. If the abdomen is severely distended and obstructed, Xiaochengqi Tang can be administered to gently regulate stomach qi without causing severe diarrhea." The key point here is that patients with tidal fever can be treated with Chengqi Tang, while those with profuse sweating can also receive treatment; however, patients with exterior symptoms or non-tidal heat should not be treated with Chengqi Tang. The presence or absence of tidal fever determines whether Chengqi Tang can be used. Article 254 of the "Shanghan Lun" states: "If sweating does not relieve the condition and diarrhea persists, immediate purgation with Dachengqi Tang is required." This passage highlights that painful diarrhea is an indication for purgation. Article 256 of the "Shanghan Lun" states: "In cases where Yangming and Shaoyang diseases coexist and diarrhea occurs, if the pulse is not weak, it indicates harmony; if the pulse is weak, it suggests disharmony and mutual conflict, which is considered negative. A slippery and rapid pulse indicates accumulated food, and purgation with Dachengqi Tang is recommended." This article discusses heat accumulation and its associated complications, advocating the use of Dachengqi Tang as a general therapeutic approach. The indications for Dachengqi Tang include constipation and abdominal distension, but when these symptoms are present, one must also consider: ① patients with poor appetite can be purged; ② patients with painful diarrhea can be purged; ③ patients with tidal fever can be purged; ④ patients with abundant urination can be purged; ⑤ patients with delirium can be purged; ⑥ patients with agitation can be purged; ⑦ patients with associated complications can be purged.