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Guizhi (Cinnamon Twig) (4 liang) Renshen (Ginseng Radix et Rhizoma) (3 liang) Baizhu (Atractylodis Macrocephalae Rhizoma) (3 liang) Gancao (Licorice Root) (3 liang) Ganjiang (Dried Ginger) (3 liang)
Take the above five herbs, add nine sheng of water, and first decoct the first four herbs to obtain five sheng of liquid. Then add Guizhi and continue to decoct until three sheng remain. Take one sheng warm each time, twice a day and once at night.

After severe purgation in Shanghan (Cold Damage Disease), followed by sweating, if there is epigastric fullness and aversion to cold, it indicates that the exterior syndrome has not yet resolved. One must not attack the fullness directly; instead, resolve the exterior first. Only after the exterior is resolved can the fullness be treated. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable (formula found in Taiyang Chapter 5). To treat the fullness, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) is suitable.

After purgation and subsequent sweating in Shanghan, yang qi may perish and earth (Spleen/Stomach) may fail, leading to a fullness syndrome with external aversion to cold, indicating that the exterior syndrome remains unresolved. This is because yin qi binds externally, causing yang qi to be depressed and unable to penetrate, resulting in aversion to cold. External aversion to cold implies internal heat; internal heat combined with fullness requires treatment via purging. However, if the exterior is unresolved, purging is contraindicated. One must first resolve the exterior; only then can the fullness be attacked. Resolving the exterior should follow the example for Wind Strike (Zhongfeng), using Guizhi Tang. Since the condition arises after sweating and purgation, Mahuang (Ephedra Herb) is not used. To treat the fullness, Dahuang Huanglian Xiexin Tang is used to clear the upper heat caused by the depression of fullness. The previous chapter used Guizhi Renshen Tang to simultaneously resolve the exterior and interior; this chapter uses Guizhi Tang to resolve the exterior and Dahuang Huanglian to attack the fullness because the former involves external heat and internal cold, whereas this case involves external cold and internal heat. The methods of tonification and purging differ. Warming the middle and resolving the exterior can be done simultaneously, but attacking the interior and releasing the exterior cannot be performed together. Therefore, Zhang Zhongjing always resolves the exterior before purging the interior when treating diseases suitable for purging that present with exterior syndromes.

Dahuang (Rhubarb Root and Rhizome) (2 liang) Huanglian (Coptis Rhizome) (1 liang)
Take the above two herbs, steep them in boiling water (Ma Fei Tang), remove the dregs, and take half warm each time, divided into two doses.

If the pulse is floating and tight, sweating should be indicated. If purgation is mistakenly applied, the tight pulse moves inward, resulting in a fullness syndrome. Palpation reveals softness, indicating merely Qi fullness (Qi Pi). If there is epigastric fullness, palpation reveals softness, and the pulse at the Guan position is floating, Dahuang Huanglian Xiexin Tang is the primary formula. If epigastric fullness is accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) is the primary formula.

A floating and tight pulse indicates sweating as the correct treatment. If purgation is mistakenly applied, the tight pulse moves inward, changing from floating-tight to deep-tight, resulting in a fullness syndrome. In fullness syndrome, yang qi is obstructed and depressed, inevitably generating upper heat; yin qi is condensed and blocked, inevitably generating lower cold. The mutual pressure of cold and heat causes the two energies to knot, resulting in a rock-hard epigastrium and a deep-tight Guan pulse. In such cases, various Xiexin formulas should be used to clear the upper and warm the lower. If palpation of the epigastrium reveals softness and the Guan pulse is floating, it indicates that lower cold has not yet formed; only yang qi obstruction and depression have generated upper heat. Dahuang and Huanglian should be used to clear the upper heat without warming medicines. If lower cold has already formed, the epigastrium will not be soft, and the Guan pulse will not be floating. The upper heat, forced upward, has no other outlet and must be released through the skin as sweat. In cases where epigastric fullness and hardness are accompanied by aversion to cold and sweating, lower cold has moved. Fuzi Xiexin Tang is appropriate: Dahuang, Huangqin (Scutellaria Root), and Huanglian clear the upper heat, while Fuzi (Aconite Lateral Root) warms the lower cold. This occurs because downward purgation damages the Middle Qi, causing Earth failure and Stomach Qi rebellion. Gallbladder and Heart Qi fail to descend, and Minister Fire and Sovereign Fire ascend. Although named "Xiexin" (Heart-Draining), it is because Minister Fire is governed by Sovereign Fire.