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Guadi San (Melon Seed Powder) treats cases where the exterior syndrome has resolved, pathogenic heat has entered the interior, and is knotted in the chest. Symptoms include irritability, fullness, hunger but inability to eat, slight coldness of the extremities, and a pulse that suddenly becomes tight. In such cases, emesis (inducing vomiting) is appropriate.

Da Chaihu Tang (Major Bupleurum Decoction) is indicated after taking Xiao Chaihu Tang (Minor Bupleurum Decoction), when the disease remains unresolved, the heat intensity in both the exterior and interior increases, and there is urgency and oppression in the epigastrium with slight irritability, or fever and sweating without relief, leading to epigastric stiffness and hardness, vomiting, and diarrhea (these belong to Taiyang disease); or Yangming disease with profuse sweating; or Shaoyin disease with diarrhea of clear water, pain in the epigastrium, and dry mouth; or Taiyin disease with abdominal fullness and pain; or when there are no obvious exterior or interior syndromes, but only fever for seven or eight days, with a floating and rapid pulse, or a pulse located in the muscle layer, being solid, rapid, and slippery; as well as various syndromes of Lianggan (simultaneous contraction of two meridians). For those suitable for mild purgation, capable of simultaneously clearing heat from the three layers of exterior and interior, this formula is appropriate.

Dachengqi Tang (Major Order the Qi Decoction) treats cases following Da and Xiao Chaihu syndrome, where both exterior and interior are hot, and the disease condition is more severe; or Yangming disease presenting with a slow pulse, sweating, and aversion to cold. The Yangming meridian governs the muscles. When heat is extreme and spontaneous sweating is profuse, the pulse cannot be rapid but instead appears slow. Since interior heat is more severe, there is aversion to cold replaced by aversion to heat. Symptoms include heavy body, shortness of breath, abdominal fullness, wheezing, and occasional tidal fever. Aversion to cold indicates exterior heat, which should be treated with sweating, not purgation; fever indicates interior heat, which should be treated with purgation, not sweating. Or if there is continuous sweating from the palms and soles ("Ji ran", pronounced zu li qie, meaning continuous/uninterrupted). This implies that the qi in the palms and soles seems harmonious, yet sweating occurs. This indicates that the feces have already become hard. Or if, after vomiting or purgation, the condition remains unresolved, with no bowel movement for five to ten days, accompanied by tidal fever in the late afternoon, aversion to cold absent, muttering as if seeing ghosts, and in severe cases, loss of recognition, grasping at clothes and bedrails, sudden fright, slight wheezing—this represents extreme excess heat in the Yangming interior. The Foot-Yangming Stomach meridian is the leader of the twelve meridians externally, governing muscles; internally, it is the root of the five zang organs and the great source of the six fu organs. Thus, although Yangming stomach disease is a fu organ disease, if the pulse is deep, rapid, and solid, purgation is indicated. However, if intestinal and gastric heat is extreme, causing stool color to change from yellow-red to brown and then black, it is difficult to treat. Whenever there is tidal fever, delirium, and inability to eat, there is dry feces in the intestines; if eating is possible, the stool is merely hard. Old texts claim dry feces are in the chest, attributing Hand-Yangming Large Intestine symptoms to the Foot-Yangming Stomach. Dry feces are actually not in the chest. Or after purgation of Yangming disease, if there is燥热 (dry-heat) and ao nao (restlessness/regret) in the heart and chest (due to fluid depletion); or if there is irritability and heat, resolving with sweat, but recurring like malaria with afternoon fever and a deep, solid pulse, purgation is indicated. If the pulse is floating and deficient, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment. Or if there is no bowel movement for six or seven days, unclear vision, unresponsive eyes, no obvious exterior or interior syndromes, difficulty defecating, and slight body heat; or if urination is obstructed, stool alternates between difficult and easy, with occasional slight fever, wheezing, dizziness, and inability to lie down, this indicates dry feces. Or if the pulses at the cun, guan, and chi positions are all normal, but the epigastrium is stiff; or if the pulse is large and tight; or if there is diarrhea with a slippery and rapid pulse; or if there is diarrhea with a slow and slippery pulse. The slowness is caused by persistent heat-induced diarrhea, not cold. Or if Shaoyang disease presents on the second or third day with dry mouth and throat; or spontaneous diarrhea of clear water, pure green in color, epigastric obstruction and pain, and dry mouth. These result from dampness and heat fighting within the intestines and stomach, leading to diarrhea. Heat causes stagnation, dampness causes obstruction, so fluids do not condense or moisten the exterior, leading to extreme dry-heat outside the intestines and stomach, causing incessant irritability and thirst; inside, there is damp-heat diarrhea. This originates from heat stagnation retaining fluids to form dampness. Or for any abdominal fullness, solid pain, irritability, thirst, delirium, and madness, with a solid, rapid, and deep pulse, regardless of the number of days, Dachengqi Tang is appropriate for purgation. Or if interior dry-heat is extreme, intestinal and gastric qi is stagnant, retained fluids do not disperse, irritability and thirst are incessant, chest and abdomen are distended and painfully rigid, only cold saliva is vomited, extreme thirst cannot be quenched even by drinking, wheezing is urgent, chest stuffiness and confusion make one wish to die—taking the medicine warm stops thirst immediately, making the patient seem healthy, followed by profuse sweating and recovery. Often, before this, there is no bowel movement but sweating occurs; sometimes the medicinal power acts through the dispersion of sweat, curing without bowel movement.

Xiao Chengqi Tang (Minor Order the Qi Decoction) treats deepening Shanghan (Cold Damage) where dry feces are suspected. To confirm, administer a small dose of Xiao Chengqi Tang. If flatus passes (gas moving and exiting), dry feces are present, and attack (purgation) can proceed. If no flatus passes, the stool is likely hard initially and loose later; do not attack, as this will cause abdominal fullness and anorexia. If there is a desire to drink but hiccups occur, followed by fever, the stool becomes hard again but in small amounts; Xiao Chengqi Tang is appropriate to harmonize. If there is significant abdominal fullness and obstruction, give Xiao Chengqi Tang to mildly harmonize stomach qi, avoiding drastic purgation. Or if Yangming disease involves profuse sweating, fluid loss, intestinal and gastric dry-heat, leading to hard stool and delirium. Or if there is delirium with a slippery and rapid pulse, or slight irritability after sweating, vomiting, or purgation, with hard urine and stool; or diarrhea with delirium, often indicating remaining dry feces; Xiao Chengqi Tang is generally used for purgation. Or if, two to three days into illness, the pulse is weak, with no Taiyang or Chaihu syndromes, but irritability and epigastric stiffness; by the fourth or fifth day, even if the patient can eat, give a small amount of Xiao Chengqi Tang to harmonize and bring slight relief.

Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) treats cases after sweating, harmonizing, or vomiting, where there is no aversion to cold, only fever, possibly with steaming sweat; or as the disease deepens, warmth in the epigastrium with urge to vomit, chest fullness and pain, loose stool, slight abdominal fullness, and slight depression/irritability. "Prior to this" (xian, su dian qie) refers to having previously subjected oneself to extreme vomiting or purgation, leading to these symptoms. Or if the disease deepens with interior heat and delirium, requiring Chengqi purgation. Mistaken use of silver powder or croton seed (badou) pills, which are extremely hot and toxic, damages true yin, causing pathogenic heat to worsen (excess is pathogen, deficiency is healthy qi), leading to persistent協热下利 (collateral heat diarrhea) with a seemingly harmonious pulse (xie, hu jie qie, meaning harmony/combination). The original disease was heat, but hot toxic pills were given, combining two heats to worsen heat and cause persistent diarrhea. Diarrhea usually presents with a faint or cold pulse, but due to hot medicine, the pulse appears harmonious. It states that with heat and persistent diarrhea, the pulse may appear flat, or slippery, solid, large, and tight. Or if exterior disease with interior harmony is purged too early, exterior heat enters the interior due to deficiency, potentially failing to form Jie Xiong (chest binding) but causing persistent heat diarrhea, epigastric fullness/stiffness/pain, irritability, thirst, dry throat, and slippery/rapid/solid pulse. Or for any abdominal fullness and solid pain, irritability, thirst, delirium, red/astringent urine, hard stool, or heat diarrhea with a slippery, solid, and very tight pulse, Tiaowei Chengqi Tang is appropriate for purgation.

Sanyi Chengqi Tang (Three-One Order the Qi Decoction) universally treats syndromes of Da, Xiao, and Tiaowei Chengqi Tangs. The general principle: when exterior syndrome resolves and heat transmits to the interior, purgation is indicated; once heat is removed, recovery ensues, favoring Tiaowei Chengqi Tang. Failure to purge leads to extreme heat, danger, and death. If exterior disease exists with interior harmony, sweating is indicated; heat dissipates, body cools, and recovery ensues. Purging in this case allows exterior heat to enter the interior, forming Jie Xiong and other diseases. If half the exterior heat transmits to the interior while half remains exterior, neither sweating nor purging is appropriate; harmonizing with Xiao Chaihu Tang is indicated. If both exterior and interior heat are severe and harmonizing fails, although pathogenic heat is half interior/half exterior (typically presenting with alternating chills and fever), the severity means aversion to cold is absent and aversion to heat prevails; Da Chaihu Tang is used for mild purgation to clear exterior and interior heat. Mistaken use of Tiaowei Chengqi Tang attacks interior but fails to clear exterior heat; using Xiao Chengqi Tang mostly attacks interior with little exterior clearance, allowing exterior heat to enter the interior and cause harm. For more severe Da Chaihu syndromes, Dachengqi Tang is indicated. If not fully recovered, slight superficial pathogenic heat entering the interior is handled by Houpo (Magnolia Bark) and Zhishi (Immature Bitter Orange), which open stagnation but do not form Jie Xiong. Thus, *Huoren Shu* states: among purgatives, Tiaowei Chengqi is most urgent, Xiao Chengqi next, Dachengqi next, and Da Chaihu is slowest. Therefore, if exterior syndrome is unresolved but interior heat is severe, requiring slow purgation, start with Da Chaihu, then Dachengqi. Regarding opening stagnation and relieving fierce heat quickly for effective purgation, Dachengqi is best. *Huoren Shu* also states Dachengqi is most urgent, Xiao Chengqi next, Tiaowei Chengqi next, and Da Chaihu slowest. Thus, for urgent purgation, Dachengqi is indicated, though Da Chaihu can be used generally without urgent indications. For mild purgation or mild stomach harmonization, Xiao Chengqi and Tiaowei Chengqi are used in sequence. Thus, for slow or urgent purgation, opening stagnation effectively, Dachengqi is the most versatile and excellent. Hence, Gancao (Licorice Root) is added to create Sanyi Chengqi Tang, treating all three Chengqi syndromes rapidly without adding harm. Gancao's flavor moderates acute stagnation, warms the middle, moistens dryness, and harmonizes herbs, earning it the title "Guolao" (State Elder) in materia medica. Adding Gancao to Dachengqi Tang makes it even better. This formula combines the three Chengqi decoctions. Regardless of Shanghan, miscellaneous diseases, internal/external injuries, or duration, if symptoms include abdominal fullness, dry throat, irritability/thirst, delirium, epigastric tenderness/stiffness, severe heat with wheezing/cough, confusion, palpitations, mania, eye diseases, mouth ulcers, tongue swelling, throat bi, carbuncles, sores, Yangming chest heat with macules, deep pulse requiring purgation; pediatric convulsions, extreme heat tidal spasms, phlegm-wheezing, coma, macules/rashes, smallpox with extreme heat/black sinking, urinary obstruction, abdominal fullness/wheezing imminent death; post-macule/rash persistent heat-toxin, failure to scab (jia, jia sound, scab); chronic macule/carbuncle/psoriasis; internal fierce heat forming masses/lumps, abdominal fullness/wheezing, sallow thinness/tidal fever, pediatric convulsions/heat accumulation, adult/pediatric old/new malaria, sudden heart pain, wind-phlegm/alcohol obstruction, intestinal mucus/stagnation, long-term wind-storm obstruction, alcohol/food injury, irritability/confusion, rapid/deep/solid pulse; Kidney water yin deficiency with sudden extreme yang heat causing collapse/stroke; sudden aphasia/loss of voice; intense internal heat retention with deep yang reversal, pulse deep/fine/near extinction; conflict between harmonious righteous qi and pathogenic qi in the interior, causing extreme interior heat, yang extreme resembling yin, chills, faint/near-extinction pulse; wind-heat dryness in lower jiao causing urinary/fecal obstruction; wind wood overcomes damp earth, fire heat consumes water fluids, leading to dryness. Dryness causes tightening, hard knotting, and obstruction. Wind-heat dryness in lower jiao leads to hard dry feces and tight abdomen, preventing separation from bladder dryness/stagnation, causing obstruction. Do not use silver powder or croton seed toxic hot pills, as they generate more dry-heat and consume yin fluids. Ancient texts forbid purging heat in Shanghan. Sanyi Chengqi Tang is most suitable, combined with purgative methods. For postpartum retained dead fetus: wind-heat/dampness dryness/tightness prevents natural opening of the birth canal. Symptoms are adverse, pulse string-like/rapid/astringent, red/blue/changing face color, abdominal fullness/urgent pain, wheezing/obstruction, fetal movement stopped. Warm hands/feet with slippery pulse indicate difficult labor, requiring slipperiness-inducing delivery aids, not purgation. For Lianggan with severe exterior/interior heat requiring purgation, Sanyi Chengqi Tang (Dachengqi plus Gancao) is indicated. For food stagnation or urgent stagnation attack, mix with 1 zi (unit) of Qinfen (Calomel). For dysentery, eye disease, mouth/throat sores, macules/rashes, add Liangge San (Cool the Diaphragm Powder). For dead fetus, add Yiyuan San.

Shizao Tang (Ten Date Decoction) treats Taiyang wind-strike with diarrhea, vomiting/reversal, resolved exterior syndrome, dry retching, shortness of breath, no aversion to cold, dripping sweat, paroxysmal onset, headache, epigastric obstruction/stiffness/fullness, pain radiating to hypochondriums. It also treats edema, abdominal distension, alcohol/food stagnation, intestinal mucus/stagnation, mass/lump accumulation, sudden heat-toxin pain in heart/abdomen, chronic malaria, conflict of righteous qi and pathogenic heat in interior causing extreme heat resembling yin with chills, exterior qi entering interior causing deep yang reversal with faint/near-extinction pulse. It treats wind-heat dryness knotted in lower jiao causing constipation, solid heat lower back pain, pediatric heat knot, milk mass/accumulated heat eruption, pediatric convulsions/tidal spasms, macules/rash heat-toxin unable to resolve. Purgation is indicated.