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Hemp Seed (Er Sheng) / Paeonia Root (Ban Jin) / Apricot Seed (Yi Sheng, processed separately into paste) / Rhubarb (Yi Jin, peeled) / Magnolia Bark (Yi Jin) / Immature Bitter Orange (Ban Jin, stir-fried)

The above six herbs are ground into powder, mixed with refined honey to form pills the size of a tung tree seed. Take ten pills per dose, three times daily. Gradually increase the dosage until bowel movements become harmonious.

Two or three days after onset of disease, if the pulse is weak and there are no Shaoyang Hu Tang (Bupleurum Decoction) signs characteristic of Taiyang disease (diseases caused by pathogenic invasion of the Taiyang channel), but rather irritability and hardness in the epigastrium: By the fourth or fifth day, even if the patient can still eat, administer Xiao Chengqi Tang (Minor Order the Yang Decoction) in small amounts frequently to mildly harmonize the interior and provide slight relief. By the sixth day, when pathogenic factors are substantial, administer one sheng of Chengqi Tang (Order the Yang Decoction) to promote bowel movement, thereby draining fu-organ heat. If there is no bowel movement for six or seven days, yet urine output is scanty, even if the patient cannot eat, it indicates that only the beginning of the stool is hard while the rest will be loose. Premature purgation will inevitably cause diarrhea. One must wait until urination becomes smooth, indicating fluid depletion and dryness of the spleen-earth, resulting in completely hardened feces, before proceeding with purgation; Da Chengqi Tang (Major Order the Yang Decoction) is indicated.

Two or three days after onset of disease, if the pulse is weak and there are no exterior signs of Taiyang disease or Shaoyang disease (diseases caused by pathogenic invasion of the Shaoyang channel), yet irritability and fullness/hardness in the epigastrium appear, this is not a Shaoyang syndrome but a Yangming disease (diseases caused by pathogenic invasion of the Yangming channel). The meridians of the Gallbladder and Stomach run from the head to the feet, passing through the stomach opening. In Shaoyang disease, Jia Wood (Gallbladder) forces Wu Earth (Stomach); in Yangming disease, Wu Earth (Stomach) obstructs Jia Wood (Gallbladder). When meridian qi fails to descend and stagnates at the stomach opening, both present with hardness/fullness in the epigastrium. However, since this case lacks Shaoyang exterior signs and presents with irritability, it is definitively a Yangming condition, unrelated to Shaoyang. By the fourth or fifth day, although the patient can still eat, the fu-organ pathogen has formed; administering small amounts of Xiao Chengqi Tang (Minor Order the Yang Decoction) can harmonize the interior and alleviate irritability slightly. By the sixth day, when pathogens are substantial, administering one sheng of Chengqi Tang (Order the Yang Decoction) promotes drainage, clearing fu-organ heat. If there is no bowel movement for six or seven days, suggesting the timing is suitable for purgation, but urine is scanty, the stool will certainly not be hard. Hard stool with intestinal binding and stomach heat failing to drain downward causes turbid qi to rush upward, leading to an inability to eat. Although the patient cannot eat due to this obstruction, the stomach is not dry; rather, the initial hardening of the stool blocks the path of turbid qi descent. Subsequent stools will be loose. Purging prematurely before complete hardening will result in diarrhea. Only after urination is smooth, fluids are depleted, earth is dry, and feces are fully hardened should purgation be employed, using Da Chengqi Tang (Major Order the Yang Decoction).

In Yangming disease, if there is tidal fever (periodic fever) and slightly hard stool, Da Chengqi Tang (Major Order the Yang Decoction) may be given; if the stool is not hard, it must not be given. If there is no bowel movement for six or seven days and one suspects dry feces (desiccated feces), the method to verify is to administer a small amount of Xiao Chengqi Tang (Minor Order the Yang Decoction). If, after the decoction enters the abdomen, flatus (passing gas) occurs, this indicates the presence of dry feces, and purgation may proceed. If there is no flatus, it merely indicates hard stool at the beginning and loose stool at the end; purgation will inevitably cause abdominal distension and an inability to eat. A patient desiring water who drinks water may experience hiccups. If fever develops subsequently, the stool will become hard again but scanty. Harmonize with Xiao Chengqi Tang (Minor Order the Yang Decoction); do not purge cases without flatus.

Dry feces often obstruct and cause stagnation of qi. Xiao Chengqi Tang (Minor Order the Yang Decoction) drains congestion, allowing the intestinal tunnel to open slightly, thus causing the passage of foul-smelling flatus. This situation requires purgation with Da Chengqi Tang (Major Order the Yang Decoction). If there is no flatus, it indicates no dry feces in the stomach; purgation will damage middle qi, inevitably causing distension and an inability to eat. Drinking water causes hiccups and further refusal to drink. Even if yang returns and fever develops later, with hard stool, the fecal volume will be small because the patient cannot eat. Therefore, only Xiao Chengqi Tang (Minor Order the Yang Decoction) should be used to harmonize, not to purge.