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Hemp Seed (Fructus Cannabis, 2 sheng) Paeonia Root (Radix Paeoniae Rubra or Alba), Schizonepeta Fruit (Fructus Schizonepetae) [Note: Text says Zhi Shi, usually Fructus Aurantii Immaturus], Immature Bitter Orange (Fructus Aurantii Immaturus) (each half jin, broken open) Rhubarb (Radix et Rhizoma Rhei, peeled) Magnolia Bark (Cortex Magnoliae Officinalis, peeled) Apricot Seed (Semen Armeniacae Amarum) (each one jin, peeled and tips removed, roasted and separately ground into paste)

The above six herbs are powdered. Honey is refined to make pills, sized like paulownia seeds. Take ten pills with warm water, three times a day. Gradually increase the dose until bowel movement becomes unobstructed. The Fuyang pulse (pulse at the dorsalis pedis artery, reflecting Spleen and Stomach status) is floating and choppy. Floating indicates strong Stomach Qi. Choppy indicates frequent urination. When floating and choppy interact, difficulty in defecation ensues. This is called Pi Yue Syndrome (Spleen constraint syndrome, where insufficient Spleen Yin constrains the Large Intestine causing constipation). Mahren Wan (Hemp Seed Pill) is the primary formula. According to the classic text, Pi Yue in the context of Taiyang-Yangming disease refers to this condition. This differs from purging excess heat in the Stomach. Therefore, Paeonia is used to nourish Yin. Hemp seed and Apricot seed are used to moisten dryness. The dosages of Rhubarb and Magnolia Bark are reduced. Only ten pills are taken initially, gradually increased. This demonstrates an intention not to purge hastily.

Seven he of honey. Place the honey in a copper vessel. Simmer over low heat until it slightly thickens to the consistency of maltose syrup. Stir constantly to prevent burning or sticking. When it can be molded, roll by hand into cylindrical suppositories. Shape one end to be pointed. Make them as thick as a finger and about two cun long. Form them while hot; they harden when cold. Insert into the anal canal. Hold buttocks tightly together. Remove only when the urge to defecate arises. Commentary: Sweating followed by hard stool resembles Yangming Interior Excess syndrome. However, since urination is normal or frequent, body fluids are depleted internally. Purging must be strictly avoided. All purgative formulas are contraindicated. Misuse would further deplete fluids. Therefore, Mi Jian Dao (Honey Suppository) is appropriate for external evacuation. Treatment proceeds externally rather than internally. As long as hard stool is expelled, Stomach Qi remains undamaged.

One large pig gallbladder. Extract the bile. Mix with a small amount of vinegar. Enema into the anal canal. After approximately one meal's time, defecation should occur. This shares the same principle as Mi Jian Dao. However, Mi Jian Dao utilizes its warmth to promote fluid circulation. Here, besides guiding stagnation, there is an intent to clear heat. The distinction is subtle. Tu Gua Dao (Trichosanthes Radix Suppository) employs a similar method.

Ginger (Sheng Jiang, Fresh Ginger Root, 4 liang, sliced) Licorice (Zhi Gan Cao, Roasted Licorice Root, 3 liang) Ginseng (Ren Shen, 3 liang) Dried Ginger (Gan Jiang, 1 liang) Scutellaria Root (Huang Qin, 3 liang) Coptis Rhizome (Huang Lian, 1 liang) Pinellia Tuber (Ban Xia, 0.5 sheng, washed) Jujube (Da Zao, 12 pieces, broken open)

The above eight herbs are boiled in 10 dou of water until reduced to 6 sheng. Strain the dregs. Decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.

After sweating resolves the exterior syndrome of Shanghan (Cold Damage), disharmony in the Stomach persists. There is epigastric fullness and hardness, dry belching with a smell of food rot, fluid retention under the hypochondrium, borborygmus, and diarrhea. Shengjiang Xiexin Tang (Ginger Decoction that Drains the Epigastrium) is indicated. Commentary: Shanghan resulting in Pi (glomus/fullness) often stems from erroneous purgation. Here, Pi arises not from error but from Stomach disharmony. Residual pathogenic factors from the Taiyang stage enter the interior and bind with internal fluid retention. Yang pathogens lodge at the upper opening of the Stomach, causing epigastric fullness/hardness and dry belching with food odor. Water pathogens lodge at the lower opening, causing hypochondriac fluid retention, borborygmus, and diarrhea. Thus, Ginger is used as the sovereign herb to disperse pathogens and expel fluids. For heat constrained above, the bitter-cold properties of Scutellaria and Coptis are used to drain it. For cold constrained below, the warming properties of Dried Ginger and Pinellia are used to scatter it. Ginseng, Licorice, and Jujube are added to harmonize and nourish Stomach Qi, preventing pathogens from attacking healthy Qi so that Pi resolves naturally. Since Pi is located in the epigastrium (heart region), the formula is named Xiexin (Draining the Heart/Epigastrium). This addresses mixed cold-heat pathogens with mixed cold-heat herbs. Each ingredient corresponds precisely to the pathology. The art of formula composition is exquisite.