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Cinnamon Twig (Guizhi, 2 liang, bark removed) Rhubarb (Dahuang, 1 liang) Peony Root (Shaoyao, 6 liang) Fresh Ginger (Shengjiang, 2 liang, sliced) Prepared Licorice Root (Gancao, 1 liang, honey-fried) Jujube (Dazao, 12 pieces)

These six ingredients. Decoct with seven sheng of water. Boil to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm. Administer three times daily.

Commentary: The "severe real pain" (Da Shi Tong) mentioned in this clause is not comparable to "abdominal fullness and intermittent pain" (Fu Man Shi Tong). "Abdominal fullness and intermittent pain" arises from spleen yin being disturbed by deficient yang; whereas "severe real pain" indicates that both spleen qi and yang qi are in a state of excess. In cases of severe excess and fullness, it might seem appropriate to urgently purge. However, the pathogenic yang ultimately descended from the Taiyang channel into the Taiyin channel, which differs from the excess condition of the Yangming stomach. Therefore, it is still suitable to use Guizhi Tang (Cinnamon Twig Decoction) to lead out the exterior pathogenic yang, merely adding Dahuang (Rhubarb) to slightly guide away the stagnation. Thus, both exterior and interior pathogens have their respective paths of exit. Cheng Jiaoqian stated: Although these two conditions belong to Taiyin disease, their origin indeed comes from the Taiyang channel; therefore, the pulse must still retain a floating quality.

Further Commentary: Ke Yunbo asserted that "abdominal fullness and intermittent pain" represents a concurrent disease of Taiyang and Taiyin; if it is "severe real pain," it represents a concurrent disease of Taiyang and Yangming. Abdominal fullness with intermittent pain is a sign of impending diarrhea; severe real pain with pain is a sign of dry stool accumulation. Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root) is a trial of the Jianzhong (Establish the Middle) formula's efficacy; Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) subtly demonstrates the function of Tiaowei (Regulate the Stomach) [Chengqi] action. Wang Jinthree also followed this theory. However, the phrase "severe real pain" in the classic text directly follows the preceding context without any mention of transmission to Yangming. Moreover, Zhang Zhongjing included clauses in the Taiyin disease section where Dahuang and Shaoyao should be used. If it were truly a Yangming stomach excess, "severe real pain" would be an indication for urgent attack by Chengqi Tang (Major Order the Qi Decoction). Guizhi Jia Dahuang Tang, essentially, belongs to harmonizing methods, not to drastic purgative agents. It is feared that Ke's statement is somewhat forced and far-fetched.

Cinnamon Twig (Guizhi, 3 liang, bark removed) Prepared Licorice Root (Gancao, 2 liang, honey-fried) Fresh Ginger (Shengjiang, 3 liang, sliced) Jujube (Dazao, 12 pieces, broken open) Pyrite Fern Rhizome (Shuqi, 2 liang, washed to remove root base) Dragon Bone (Longgu, 4 liang) Oyster Shell (Muli, 5 liang, calcined)

Grind the above ingredients into coarse powder. Use twelve dou of water. First decoct Shuqi (Pyrite Fern Rhizome), reducing the volume by two dou. Then add the remaining herbs. Decoct to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm. The Classic states: In cold damage, if the pulse is floating, and the physician uses fire methods to force sweating leading to loss of yang, there will inevitably be fright, mania, restlessness lying down and rising up. This formula governs such cases. Commentary: "Loss of yang" has two meanings. When excessive sweating leads to cold limbs, twitching of tendons and flesh, resulting in loss of yang, this is the loss of yang within yin; thus, Zhenwu Tang (True Warrior Decoction) or similar formulas are used to rescue it. In this case, changes caused by fire coercion leading to fright, mania, restlessness, and loss of yang represent the loss of yang within yang. Therefore, there is no need to rely on Shaoyao (Peony Root) to astringe yin; instead, heavy sedatives entering the Heart should be added in greater dosage to urgently retrieve the flying away yang spirit. If this condition lingers even for a moment, even divine pills cannot save it; hence the addition of the characters "Rescue from Peril." Yu Jiayan said: Removing Shaoyao from Guizhi Tang is not due to aversion to its sour astringent nature. Rather, because the yang spirit is scattered, one must seek resolution through yang. Guizhi Tang is a yang formula, but one must remove the heavy yin nature of Shaoyao to allow rapid arrival at the yang position. Once reaching the yang position, the fright and mania of the spirit are difficult to stabilize. Adding Shuqi as the primary unifying agent allows the spirit to rely on it for stability. This is because Shuqi has the most urgent nature; Danxi stated it can "fly and tonify." Additionally, Longgu (Dragon Bone) and Muli (Oyster Shell), being tangible bone substances, serve as vessels to carry the spirit back to its residence. Beyond heavy sedation for fearfulness and astringency for collapse prevention, they exert their subtle effects. Only in this way can the Heavenly Lord (Heart/Mind) be restored, akin to the good strategy of chasing Duke Chong'er of Jin and King Goujian of Yue to return to their states.