Library

Banxia (Pinelliae Rhizoma) is acrid and can dissipate stagnation. Its slippery nature can unblock the diaphragm. Therefore, it is used as the sovereign drug. The slippery property of Banxia is discussed in the commentary on Xiaoxianxiong Tang (Minor Inward-Draining Decoction). Ganjiang (Dried Zingiberis Rhizoma) is warm, warms the middle jiao, eliminates yin-cold, and removes stagnation. Renshen (Ginseng Radix et Rhizoma) and Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) greatly tonify middle qi to benefit the deficiency caused by erroneous purgation. These three ingredients, when tonifying, make qi vigorous; when warm, they promote circulation. Thus, they are used as minister drugs. Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) follow the principle of "using cold for heat" and "bitterness to open," as seen in the previous Gancao Xiexin Tang (Licorice Heart-Draining Decoction). Therefore, Huanglian is used only in one-third of the dosage as a counter-agent (antidote). Dazao (Ziziphi Jujubae Fructus) harmonizes the middle and moistens, assisting in resolving the stagnation.

After a taiyang disease (disease of the taiyang channel) has been resolved by sweating, if there is disharmony in the stomach, fullness and hardness in the epigastrium (xin xia), belching with the smell of food, fluid retention under the flanks, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction) should be administered.

"After taiyang disease is resolved by sweating" means that all exterior pathogens have been expelled through sweat. The phrase "disharmony in the stomach" onwards describes the persistence of interior syndromes. This case is not caused by erroneous purgation but by the transmission of pathogenic factors to the taiyin (taiyin spleen-stomach system). However, it mentions "disharmony in the stomach" without explicitly referring to the taiyin spleen earth, because the *Suwen* (Basic Questions) chapter on Taiyin and Yangming states: "The spleen and stomach are connected by membranes. The foot-taiyin meridian passes through the stomach, belongs to the spleen, and connects to the throat, forming an exterior-interior relationship with the foot-yangming meridian." When stomach yang is weak and qi fails to circulate, yin-cold blocks the pathway, resulting in epigastric fullness and hardness. Cold in the stomach prevents the rotting and ripening of food, and weakness of the spleen impairs its transportation function, leading to belching with a food odor. "Yi" (belching) refers to the emission of food odors. Due to stomach cold and failure to digest, retained food ferments, causing sour and foul belching. The *Lingshu* (Spiritual Pivot) chapter on Kouwen states: "When cold qi lodges in the stomach, rebellious qi rises from below, disperses, and re-emerges from the stomach, causing belching." The *Suwen* chapter on Maijie states: "What taiyin calls 'distension' moving upward to the heart causes belching; this is due to excess yin moving upward to yangming." Stagnation in the middle jiao prevents the spleen from transporting fluids for the stomach, disrupting transformation and transportation. Fluids fail to flow, gathering as water qi under the flanks. Qi stagnation prevents normal circulation, causing borborygmus. Middle qi fails to maintain control, clear yang fails to ascend, spleen qi sinks, and water and grain are not separated, leading to diarrhea. Hence, Shengjiang Xiexin Tang is indicated.

Shengjiang Xiexin Tang Formula
Shengjiang (Fresh Zingiberis Rhizoma, 4 liang, sliced) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma, 3 liang) Renshen (Ginseng Radix et Rhizoma, 3 liang) Ganjiang (Dried Zingiberis Rhizoma, 1 liang) Banxia (Pinelliae Rhizoma, half sheng, washed) Huangqin (Scutellariae Radix, 3 liang) Huanglian (Coptidis Rhizoma, 1 liang) Dazao (Ziziphi Jujubae Fructus, 12 pieces, split)

Take these eight ingredients, add ten dou of water, decoct to obtain six sheng, remove the dregs, and decoct again to obtain three sheng. Take one sheng warm, three times daily.

Shengjiang Xiexin Tang is derived from Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) by adding Shengjiang. Banxia Xiexin Tang is originally used to treat deficiency-type stagnation characterized by fullness without pain. In this case, after sweating, the exterior pathogen is resolved. Although not caused by erroneous purgation, the middle qi is deficient and cold, yang harmony is not distributed, the three jiao cannot disseminate and transform, and fluids do not circulate. This condition is more severe than simple fullness without pain, so Shengjiang is added to disseminate. Xu Zhicai stated: "Dispersing can remove obstruction, such as with Shengjiang and Jupe (Citri Reticulatae Pericarpium)." Li Dongyuan said: "When external six-excess pathogens attempt to transmit inward, the san-yin channels are solid and reject them. The pathogens rebel in the chest, affecting both qi and blood levels, causing blockage. This may manifest as hiccups or vomiting, which is termed 'obstruction.' San-yin refers to the spleen. Therefore, qi-breaking herbs must be used to drain the obstruction." Li Shizhen said: "Obstruction means blockage; dispersing means spreading and scattering. Diseases of stagnation, neither ascending nor descending, with disrupted transformation, require herbs that spread and scatter, akin to the concept of conveying flow and disseminating transformation." Generally, Shengjiang is acrid and dispersing, warm and moving, serving as the primary agent for dissemination and development. It circulates stagnant yin-turbid qi and stimulates the mechanism of transformation and transport. One might ask: Since there is water qi under the flanks, why not use Shizao Tang (Ten Date Decoction)? The answer is: Shizao Tang syndrome occurs when shaoyang wind-pathogens enter the interior, presenting with diarrhea, vomiting, headache, epigastric fullness and hardness, pain radiating to the flanks, dry retching, shortness of breath, until sweating occurs without aversion to cold. At this point, the exterior pathogen is resolved, and the interior pathogen is excess, so it is used to drain fluid and harmonize the interior. This case involves spleen-stomach deficiency-cold and deficiency-stagnation of the taiyin channel. Therefore, Ganjiang and Banxia to warm the middle and drain fluid suffice. The dosage of Ganjiang is reduced to one liang because four liang of Shengjiang are used. Renshen and Zhigancao are added to support righteous qi, making qi vigorous and circulating, thereby enabling dissemination. The uses of Huangqin, Huanglian, and Dazao are identical to those in Banxia Xiexin Tang. Observing Zhang Zhongjing's five Heart-Draining Decoctions, their advances and retreats in attack and tonification, yin and yang, excess and deficiency, fully embody their principles. How profound is their supportive and coordinating role!

If taiyang disease presents with fever, and sweating does not resolve the condition, accompanied by epigastric fullness and hardness, vomiting, and diarrhea, Da Chaihu Tang (Greater Bupleurum Decoction) should be administered.

This case is also not caused by erroneous purgation but is a stagnation syndrome transmitted from the exterior to the interior. When cold injures the ying (nutritive) level, symptoms include headache, fever, aversion to cold, and anhidrosis. Sweating should resolve these. If sweating fails to resolve them, it is either due to insufficient sweating or heavy pathogens. The pathogens then transmit inward, causing epigastric fullness and hardness. Because the invading pathogen is trapped in the interior and cannot vent outward, it causes upper vomiting and lower diarrhea. This represents severe reversal, necessitating attack. However, some pathogens remain at the semi-exterior/semi-interior level. If only purgation is used, there is a risk of pathogens sinking deeper. Therefore, Da Chaihu Tang combines half of Xiao Chaihu Tang (Lesser Bupleurum Decoction) with Chengqi (Purgative) principles to resolve both exterior and interior. This allows exterior pathogens to be resolved and interior pathogens to be drained, achieving the effect of initial obstruction followed by relief. Xiao Chaihu Tang omits Renshen and Zhigancao because the pathogen is in the interior. Shaoyao (Paeoniae Radix Alba) is added to astringe yin qi due to diarrhea after sweating. Dahuang (Rhei Radix et Rhizoma) is used despite diarrhea because "treating obstruction with unblocking methods" applies when there is excess. This clarifies the Da Chaihu Tang section on Jie Xiong (Chest Binding), showing that stagnation entering from the exterior is essentially similar to heat-entering Jie Xiong, differing only in name, with comparable etiologies and treatments.

After taiyang disease is treated with sweating, emesis, or purgation, and the exterior and interior are resolved, if epigastric fullness and hardness persist along with incessant belching, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) should be administered.

This refers to cases where taiyang symptoms (headache, fever, aversion to cold, anhidrosis) have been treated with sweating, or further with emesis or purgation. After the exterior and interior are resolved, if epigastric fullness and hardness and incessant belching remain, it is because although pathogens are gone, stomach yang is deficient, yin-cold causes stagnation, and yang qi cannot circulate. Spleen weakness impairs transportation, causing rebellious qi and belching. Compared to the previous Shengjiang Xiexin Tang case (post-sweating resolution), this lacks stomach disharmony, fluid retention under flanks, borborygmus, and diarrhea, indicating a milder condition. Thus, the formula is modified from Shengjiang Xiexin Tang to Xuanfu Daizhe Shi Tang.

Correction of Misinterpretations Previous commentaries attributed the rebellion to latent fluid retention, using Xuanfu and Banxia to drain fluid. They failed to recognize that when yin-pathogens cause stagnation and stomach qi fails to move, any fluid entering the stomach can accumulate into phlegm-fluid. Why cling to such rigid views? If stomach qi moves freely, essential fluids will circulate everywhere. Commentators argued that stomach qi rebels upward, never descending, having ascent without descent, citing Suwen: "When strings break, the sound is hoarse; when earth fails, the sound is hiccup." This is erroneous. According to *Suwen: Baoming Quanxing Lun*, the Yellow Emperor asked: "Kings and commoners alike wish to preserve their bodies. Yet diseases of the form are unknown in their details, lingering and deepening, attaching to the marrow. I worry privately. I wish to cure these diseases with needles." Qibo replied: "Salt tastes salty; its vapor causes moisture to seep from vessels. When a string breaks, its sound becomes hoarse and broken. When trees flourish, leaves sprout (*Suhui Ji* notes *Tai Su* reads 'when trees decay, leaves fall'). When disease is deep, the voice hiccups. Having these three signs indicates damaged fu organs. Poisonous drugs cannot treat them, and short needles cannot access them. This damages skin and flesh, causing blood and qi to contend and turn black." This passage discusses the emperor's desire to cure the deepest diseases, while Qibo explains that deeply failing diseases cannot be fully cured. If pathogens linger and attach to the marrow, like salt penetrating even hard ceramic vessels to exude brine, it illustrates pathogens infiltrating sinews, bones, zang, and fu organs, making them difficult to eradicate. The kidney is the organ of descending, salty water. If lower leakage is uncontrolled, kidney yuan-yang essence fails. Like a breaking string producing broken sounds, it illustrates liver qi failing when the pulse is taut and about to snap. Unlike flourishing trees that sprout leaves, deep diseases involve stomach qi failure and spleen extinction, manifesting as hiccups. "Damaged fu organs" refers to the body shell housing the zang-fu like containers. *Lingshu: Zhang Lun* states: "Zang-fu in the chest and abdomen are like boxes containing precious items." Damage to three zang organs constitutes damaged fu organs. Even poisonous drugs cannot treat them, and short needles cannot reach them. Using them merely damages skin and flesh without benefit. Why? At this stage, qi is disordered, blood dies, and blood-qii contention turns black, rendering it incurable. How can commentators cite scriptures of inevitable death to prove the mild, non-lethal stagnation in Zhang Zhongjing's text, distorting the meaning of both classics? Moreover, since Wang Bing (Wang Taipu) in the Tang dynasty, no one has successfully interpreted this scripture. How can it be cited as proof? Alas! Although *Suwen* is an ancient classic with profound meanings, its intent need not remain obscure. The *I Ching* says: "Books cannot fully express words, and words cannot fully express intent." Can the sages' intent remain forever hidden? If future generations can interpret it, what then?

Xuanfu Daizhe Shi Tang Formula
Xuanfuhua (Inulae Flos, 3 liang) Renshen (Ginseng Radix et Rhizoma, 2 liang) Shengjiang (Fresh Zingiberis Rhizoma, 5 liang, sliced) Banxia (Pinelliae Rhizoma, half sheng) Daizhe Shi (Hematitum, 1 liang) Dazao (Ziziphi Jujubae Fructus, 12 pieces, split) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma, 3 liang)

Take these seven ingredients, add ten dou of water, decoct to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm, three times daily.

The Seven-Ingredient Xuanfu Daizhe Shi Tang mentioned in *Jinkui Yaolue* is derived from Shengjiang Xiexin Tang by modification. Due to differences in severity, the formula is adjusted. Shengjiang Xiexin Tang treats fluid retention under flanks, borborygmus, and diarrhea due to excessive yin qi. Shengjiang's dispersing action combined with Ganjiang's acrid-warmth opens yin stagnation. To prevent cold rejection, Huangqin and Huanglian are used as counter-agents. This case involves only deficiency-stagnation in the epigastrium and incessant belching. Ganjiang is removed, eliminating the need for cold counter-agents. Instead, one extra liang of Shengjiang replaces Ganjiang to enhance acrid-warmth and dispersing power, aiding Renshen and Gancao in warming, tonifying, and opening. Xuanfuhua, according to *Shennong Bencao Jing*, treats qi-knots and flank fullness, draining fluid and directing qi downward, thus serving as the sovereign drug. Li Shizhen noted: Daizhe Shi acts on the jueyin channels. Its heavy nature suppresses upward-rebellious belching. Compared to the five Heart-Draining Decoctions, this formula is a gentle, orthodox treatment, lacking extraordinary measures or harsh tactics, representing a balanced, impartial approach.

If taiyang disease patients take herbal medicine and suffer continuous diarrhea with epigastric fullness and hardness, and after taking Xiexin Tang, another purgative is administered causing persistent diarrhea, and the physician prescribes Lizhong Wan (Middle-Regulating Pill), worsening the diarrhea: Lizhong Wan regulates the middle jiao, but this diarrhea originates in the lower jiao. Chishizhi Yuyuliang Tang (Red Halloysite and Metastone Decoction) should be used. If diarrhea persists, promote urination.

"Tangyao" refers to cleansing herbs. "Ta Yao" refers to other purgatives. This section, from taking medicine to persistent diarrhea, follows the theme of stagnation caused by erroneous purgation. The part about the physician using Lizhong Wan serves to illustrate that diseases vary and treatments must adapt. One must assess the situation and change strategies accordingly, not adhere rigidly to one method for all conditions. The previous five Xiexin Tang formulas address pathogens in the middle jiao via various methods (cold, heat, attack, tonification). However, they do not account for qi-sinking diarrhea originating in the lower jiao. Lizhong Wan only treats middle-jiao deficiency-cold and has no effect on the lower jiao. Mismatched pathology and treatment worsen the diarrhea. "Worsening" means the medicine is inappropriate, not that Lizhong Wan harms. Comparing it to "flooding a neighbor's state" is an exaggeration. Since the pathology is in the lower jiao with intestinal sliding and prolapse, heavy and astringent herbs are needed to reach the lower jiao and secure closure. Hence, Chishizhi Yuyuliang Tang is used. However, this is rhetorical elaboration, not the core emphasis. The crucial point is "if diarrhea persists, promote urination." If primordial qi is not exhausted and it is merely intestinal sliding, astringents suffice. But if repeated purgation depletes true qi, leaving lower jiao fireless and true yang unable to perform steaming and transforming functions, clear and turbid fail to separate, and water/grain are not differentiated. Diarrhea persists beyond the reach of astringents. Treatment requires restoring lower jiao fire and promoting qi transformation. The reason no formula is provided for "promoting urination" is that theories on three-jiao and bladder qi transformation are complex and cannot be summarized briefly. Scholars confident in their understanding need not add赘述. As Zhang Zhongjing wrote in his preface: "Modern physicians do not study classics to expand knowledge, relying instead on family techniques and old methods. In diagnosing, they rely on eloquence rather than insight, making it difficult to distinguish life from death." Bladder qi transformation theory is detailed in the Wuling San commentary.

Chishizhi Yuyuliang Tang Formula
Chishizhi (Halloysitum Rubrum, 1 jin, ground) Yuyuliang (Metastone, 1 jin, ground)

Take these two ingredients, add six sheng of water, decoct to obtain two sheng, remove dregs, and divide into three doses.

Xu Zhicai stated: "Astringency removes slipping/prolapse, such as with Muli (Ostreae Concha) and Longgu (Fossilia Ossis Mastodi)." Li Shizhen listed Muli, Longgu, Haopiaoxiao (Sepiae Endoconcha), Wubeizi (Terminalia Chebulae Fructus), Wuweizi (Schisandrae Chinensis Fructus), Wumei (Mume Fructus), Liupi (Granati Cortex), Hezi (Chebulae Fructus), Shuke (Arecae Semen), Lianfang (Nelumbinis Plumula), Zonghui (Ziziphus Spinosae Ramulus Cinis), and Shizhi as astringents. Chishizhi and Yuyuliang act on the hand-foot yangming channels. Chishizhi is warm, heavy, and astringent; its heaviness and astringency stop dampness and secure the lower jiao. Its sweetness and warmth tonify qi and regulate the middle (intestines/stomach/muscles). Yuyuliang is astringent and targets the lower jiao. Li Xianzhi's poem states: "Lower jiao ailments are hard to comprehend, requiring Yuliang and Chishizhi." Li Shizhen added: "Slipping syndromes include qi, blood, essence, and spirit slipping. Slipping implies scattering without retention, requiring sour-astringent, warm, and neutral herbs to gather dispersion. Since qi commands blood, qi-slipping requires qi-tonics, and blood-slipping requires blood-tonics and qi-tonics. Thus, Taohua Tang (Peach Kernel Decoction) differs in its application."

Originally, due to erroneous purgation, epigastric stagnation occurred. Xiexin Tang was given, but stagnation did not resolve. The patient presents with thirst, dry mouth, irritability, and dysuria. Wuling San (Five-Ling Powder) should be administered.

This refers to stagnation in the epigastrium caused by erroneous purgation driving pathogens inward, initially warranting Xiexin Tang. However, Xiexin Tang applications vary: there is stagnation from cold pathogens entering after purgation (tight pulse entering interior); stagnation from stomach deficiency after purgation; and stagnation from yin pathogens knotting internally after sweating resolution. Treatments range from purging heat-excess to warming meridians, dispelling stagnation, and tonifying/opening. Treatments differ based on syndrome. This specific stagnation is taiyang exterior pathogens transmitting inward. The bladder is the fu organ of taiyang. Although stagnation is in the epigastrium, the pathogen has entered the interior, affecting the bladder. Using Xiexin Tang alone will not resolve the stagnation and may exacerbate thirst, dry mouth, irritability, and dysuria. The foot-taiyang bladder is the repository of fluids, dependent on three-jiao qi transformation for movement. Qi transformation involves lower jiao qi ascending, allowing upper jiao qi to descend. Ascending qi transforms fluids into saliva/nasal discharge; descending qi directs fluids to urine/feces. Pathogens invading the bladder prevent lower jiao qi from ascending, stopping fluid ascent. This causes thirst and dryness/irritability. With lower qi failing to ascend, upper qi cannot descend, causing dysuria. Hence, Wuling San is indicated (see Wuling San commentary). Thirst, dry mouth, and irritability here share the same meaning as floating-pulse, rapid-pulse, irritability, and thirst in the first taiyang mis-sweating clause. Despite different causes (mis-sweating vs. mis-purgation), the underlying lower-jiao deficiency-cold and lack of fire are identical. By identifying meridians and analyzing pulses clearly, hesitation is unnecessary. Clinical doubt and hesitant prescribing stem from weak faith in the dao and insufficient practice, not from ancient secrecy.

In taiyang wind-stroke, with diarrhea and vomiting, if the exterior is resolved, attack may proceed. If the patient has continuous sweating occurring at intervals, headache, epigastric fullness and hardness, fullness radiating pain to the flanks, dry retching, shortness of breath, sweating without aversion to cold, this indicates resolved exterior and unresolved interior. Shizao Tang (Ten Date Decoction) should be administered.

Old interpretations claimed wind injuring wei (defensive) layer with erroneous purgation leads to Jie Xiong, while cold injuring ying (nutritive) layer leads to Pi (Stagnation). This explains Zhang Zhongjing's "manifesting on yang" vs. "manifesting on yin." Previously, we saw Jie Xiong Heat-Excess after six days and Jie Xiong without significant heat after ten days. In the Banxia Xiexin Tang section, taiyang presented with both Jie Xiong and Pi. Here, taiyang wind-stroke presents with epigastric fullness and hardness. Thus, Zhang Zhongjing's distinction lies in yin/yang channels, not wind/cold patterns. This section omits exterior symptoms, stating diarrhea and vomiting indicate heat pathogens attacking intestines/stomach, suggesting interior excess suitable for purgation. However, even if pathogens enter the interior, attack is only permissible if the exterior is fully resolved. If exterior signs persist, attack is contraindicated. "Jiran" refers to slight sweating. Intermittent sweating and fever suggest yangming transmission with spontaneous sweating and tidal fever. Headache is not exclusive to exterior syndromes; it can result from interior pathogen knotting and yang-pathogen oppression upward. Epigastric fullness/hardness radiating to flanks indicates interior pathogen blocking middle jiao. Pure qi-stagnation would not cause hardness or radiating pain. Interior pathogens impair stomach fluid transport, causing fluid retention, epigastric hardness, qi restriction, and flank pain. This aligns with Shengjiang Xiexin Tang's "fluid retention under flanks" and "water knotting in chest/flanks." Pathogens in the stomach cause rebellious qi (dry retching). Middle jiao blockage causes fullness and shortness of breath. These are indications for attack. Sweating without aversion to cold confirms complete exterior resolution and yangming entry, leaving only interior disharmony. Interior disharmony means stomach is constrained by pathogens, failing to circulate fluids, accumulating in chest/flanks. This differs from Jie Xiong Heat-Excess (painful epigastrium, stone-hard on pressure). Jie Xiong Heat-Excess uses Daxiexiong Tang (Major Inward-Draining Decoction) with Dahuang and Mangxiao as sovereigns. This is a solid stagnation case but less severe than Jie Xiong Heat-Excess. Therefore, draining water-dampness-phlegm-fluid is required to harmonize the stomach and restore qi flow. Shizao Tang is indicated.

Shizao Tang Formula
Yuanhua (Genkwa Flos, processed) Gansui (Euphorbiae Kansui Radix) Daji (Euphorbiae Pekinensis Radix) Dazao (Ziziphi Jujubae Fructus, 10 pieces, split)