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After the exterior syndrome of a cold damage disease is resolved by sweating, the stomach is disharmonious, presenting with epigastric fullness and hardness, dry retching with a smell of food decay, fluid retention under the costal region, borborygmus in the abdomen, and diarrhea. Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium) is the primary treatment.

The resolution of the pathogen through sweating indicates that the Taiyang (Greater Yang) syndrome has ceased. The disharmony in the stomach is due to the residual pathogens of Taiyang mixing with yin-cold fluid retention within it. The yang pathogen resides at the upper opening of the stomach, causing epigastric fullness and hardness, dry retching, and the smell of food decay; the water pathogen resides at the lower opening of the stomach, causing borborygmus like thunder and diarrhea. When the fire function fails to circulate freely, fullness and hardness result; when the water function fails to circulate freely, dry retching occurs; when the pathogenic heat fails to digest food, the smell of food decay arises. "Under the costal region" refers to the abdomen. Spleen deficiency fails to control water, leading to intestinal rumbling. This indicates that the Taiyang cold-water pathogen invading the exterior of the body has been resolved, but the pathogen entering the interior has not yet dispersed. Thus, although the disease is located in the stomach, it does not belong to Yangming (Yang Brightness), but remains a variation of the Taiyang cold-water pathogen.

Shengjiang Xiexin Tang (Ginger Decoction for Draining the Epigastrium):
Shengjiang (Fresh Ginger Rhizome, 4 liang), Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), Gancao (Licorice Radix et Rhizoma) (each 3 liang), Banxia (Pinelliae Tuber), Ganjiang (Zingiberis Rhizoma), Huanglian (Coptidis Rhizoma) (each 1 liang), Dazao (Jujubae Fructus) (12 pieces).
Take the above eight ingredients, add one dou of water, decoct to obtain six sheng of liquid, remove the dregs, and decoct again to concentrate to two sheng. Take one sheng warm, three times daily.

Note: Epigastric fullness (Xin Xia Pi) is an interior syndrome of Taiyang. At the upper level of Taiyang, cold qi governs. It corresponds internally to Shaoyin (Lesser Yin), which relates to the Heart. The Heart is the Sun-Yang within the Yang. It must be that the patient normally has insufficient heart-fire and a cold-deficient stomach, allowing the Taiyang cold-water pathogen to invade internally. Deficient yang becomes stagnant and fails to disperse, while cold pathogen coagulates and fails to resolve. Cold and heat contend at the epigastrium, causing myriad variations, endangering the "Sovereign" (Heart). Using hot drugs to attack cold risks uncontrolled burning; using cold drugs to overcome heat risks inviting invaders and harming defense. Therefore, bitter drugs like Ganjiang, Huangqin, and Huanglian enter the heart to resolve fullness; sweet drugs like Renshen and Gancao drain heart-fire and harmonize the stomach. Shengjiang is used as the sovereign drug, and Banxia as the assistant. Doubling the pungent-sweet dispersing drugs and combining them with bitter-cold draining drugs, how could fluid retention remain undispersed? Named "Xiexin" (Draining the Heart), it implies the meaning of "stopping weapons constitutes martial virtue."

In cold damage or wind-strike, if the physician erroneously uses purgation, the patient suffers diarrhea dozens of times a day, with undigested food, borborygmus, epigastric fullness and hardness with distension, dry retching, and vexation preventing rest. Seeing the epigastric fullness, the physician assumes the pathogen is not fully expelled and purges again, making the fullness worse. This is not excess-heat accumulation, but rather emptiness in the stomach with rebellious guest-qi ascending, causing hardness. Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium) is the primary treatment.

The previous clause describes symptoms of water-qi attacking downward after resolution by sweating; this clause describes symptoms of rebellious guest-qi ascending after erroneous purgation. Both involve stomach deficiency, with slight differences. In the previous case, borborygmus and diarrhea indicate the stomach still has half-cold and half-heat, hence described as "disharmonious." In this case, borborygmus with undigested food occurring dozens of times a day clearly shows the fullness is false-fullness, hardness is false-hardness, and distension is false-distension. In the previous case, because water-qi trends downward, there is no vexation or distension. In this case, because deficient pathogen rebels upward, there is vexation and distension. When sweating should have occurred but did not, the person feels vexed; thus, Renshen is removed from the previous formula and Gancao is added. For clear diarrhea with undigested food, exterior attack is contraindicated; thus, Shengjiang is removed and Ganjiang is added. It is not called Lizhong Wan but retains the name Xiexin Tang because the root of the vexation and epigastric fullness/hardness lies in the Heart.

Cold damage and wind-strike originate from Yang channels. Erroneous purgation allows heat to enter, causing diarrhea, so Jie Xiong (Chest Binding) does not form. If there is epigastric fullness/hardness, dry retching, and vexation, this originates from Yin channels. Subsequent erroneous purgation makes the fullness worse.

Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium):
Remove Renshen and Shengjiang from the previous formula, add Gancao (1 liang) and Ganjiang (2 liang). Remainder follows the previous method.

After five to six days of cold damage, vomiting and fever present, indicating Xiao Chaihu Tang (Minor Bupleurum Decoction) syndrome. If other drugs are used to purge, and the epigastrium becomes full, hard, and painful, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang (Major Descending the Chest Decoction).
If it is only full without pain, this is Pi (Fullness/Blockage); Xiao Chaihu Tang is not indicated; Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) is appropriate.

Vomiting with fever is a Xiao Chaihu Tang syndrome. Even with Yangming symptoms, excessive vomiting precludes purgation. If interior excess exists, Da Chaihu Tang (Major Bupleurum Decoction) is suitable. Using other drugs to purge is erroneous. After erroneous purgation, two syndromes may appear. Shaoyang (Lesser Yang) is the half-exterior, half-interior channel; it does not fully manifest as Yang nor fully as Yin. Thus, variations from erroneous purgation also depend on whether the pathogen leans toward the half-exterior, forming Jie Xiong, or the half-interior, forming epigastric Pi. This clause originates for Banxia Xiexin Tang, distinguishing Jie Xiong from Pi solely by pain, omitting other symptoms.

Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium):
Add Banxia (8 liang) and Ganjiang (2 liang) to the previous formula, remove Shengjiang. Remainder follows the previous method.

Xiexin Tangs are derived from Xiao Chaihu Tang by removing Chaihu and adding Huanglian and Ganjiang. The three formulas treat the Three Yang channels respectively. For Taiyang, Shengjiang Xiexin Tang is used because, without erroneous purgation, epigastric fullness/hardness persists despite sweating resolving the exterior; water-qi remains undispersed, so Shengjiang is used as sovereign to disperse it, adhering to Taiyang's principle of opening. For Yangming, Gancao Xiexin Tang is used because double erroneous purgation leaves the stomach empty and fullness worsens; doubling Gancao strengthens the middle and slows rebellious guest-qi, following the method of treating from the center. For Shaoyang, Banxia Xiexin Tang is used because erroneous purgation causes Pi; the pathogen is neither in the exterior (so Xiao Chaihu Tang is unsuitable) nor fully in the interior (so Huangqin Tang is unsuitable). Costal distress and epigastric fullness are both half-exterior, half-interior syndromes. For costal distress without prior purgation, Xiao Chaihu Tang resolves it. For epigastric fullness without costal distress after erroneous purgation, Chaihu and Shengjiang are removed, and Huanglian and Ganjiang are added to harmonize. This is another method for treating Shaoyang half-exterior, half-interior conditions. Doubling Banxia and removing Shengjiang slightly alters the half-exterior treatment of Chaihu, emphasizing the Shaoyang half-interior aspect. With Jun-Huo bright and Xiang-Huo in position, it is still named Xiexin to assist where Chaihu falls short.

After vomiting, purgation, and subsequent sweating in cold damage, deficiency-vexation appears with a very faint pulse. By the eighth or ninth day, epigastric fullness/hardness, hypochondriac pain, qi rushing to the throat, vertigo, and twitching of meridians occur; prolonged, this leads to Wei Syndrome (flaccidity).

Given vomiting, purgation, and sweating over eight to nine days with a very faint pulse, this is identified as deficiency-vexation. Consequently, epigastric fullness/hardness, hypochondriac pain, and meridian twitching all belong to deficiency; qi rushing to the throat and vertigo are also manifestations of deficiency-vexation. This is also a Banxia Xiexin Tang syndrome; improper treatment leads to Wei Syndrome over time. Using Zhuye Shigao Tang (Leafy Bamboo Sheath and Gypsum Decoction) would be a major error.

In Taiyang disease, if sweating is performed but fever and aversion to cold persist, followed by purgation, epigastric Pi results. Exterior and interior are both deficient, and yin and yang qi are exhausted. "No Yang means Yin stands alone." If moxa-burning needles are then applied, chest vexation ensues. A greenish-yellow complexion and dry skin indicate a difficult-to-treat case. A slightly yellow complexion and warm hands and feet indicate easy recovery.

This is also a Banxia Xiexin Tang syndrome. The previous case involved deficiency-vexation from sweating after vomiting/purgation. This case involves deficiency-vexation from moxa-burning after sweating/purgation. Excessive sweating damages blood, causing meridian twitching; moxa-burning damages flesh, causing green face and dry skin. Slightly yellow complexion and warm extremities indicate returning Stomach-Yang, hence recovery.

In cold damage with inherent cold-diarrhea, if the physician erroneously uses vomiting and purgation, cold obstruction (Ge) occurs. If food is vomited immediately upon entry, Ganjiang Lianhua Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction) is the primary treatment.

A minor treatment error leads to mild variations, so the formula uses half the intent of Xiexin Tang. Upper Jiao cold obstruction requires Renshen and Ganjiang; heat accumulation in the epigastrium requires Huangqin and Huanglian; vomiters dislike sweet flavors, so Gancao is removed. No eating means no vomiting, indicating no water-qi in the epigastrium, so Shengjiang and Banxia are omitted. Note: Cold and heat obstructing each other forms Ge (Obstruction); cold and heat knotting together forms Pi (Fullness).

Ganjiang Lianhua Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction):
Ganjiang, Huanglian, Huangqin, Renshen (each 2 liang).
Take the above four ingredients, add six sheng of water, decoct to obtain two sheng, divide into two warm doses.

For epigastric Pi, soft upon pressure, with hard stool, no aversion to cold but aversion to heat, and a floating pulse at the Guan position, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction for Draining the Epigastrium) is the primary treatment.

Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction for Draining the Epigastrium):
Dahuang (Rhei Radix et Rhizoma, 2 liang), Huanglian (1 liang).
Take the above two ingredients, steep in one sheng of boiling water (Mafei Tang) for a moment, strain, and divide into two warm doses.

"Ru" (soft) should be read as "Ying" (hard). Below "soft upon pressure," the phrases "hard stool, no aversion to cold but aversion to heat" should exist, justifying this formula. Observing that Xiexin Tangs for Pi combine tonification and purgation, and cold and heat, this formula removes all warming/tonifying drugs, relying solely on bitter-cold draining agents. Steeping in boiling water and using raw herbs facilitates rapid purgation. However, failing to mention symptoms of heat-excess requiring purgation is erroneous. Softness upon pressure indicates Qi-Pi (formless blockage), which should not be purged. Moreover, if Jie Xiong with a floating-large pulse cannot be purged, how can Pi with a floating Guan pulse be purged? Even Jie Xiong Xiao (Minor Chest Binding) with tenderness does not use Dahuang; why is this formula more severe than Xianxiong Tang? There must be urgent purgation indications more severe than Jie Xiong, hence this harsh purgative formula. Students using ancient formulas for modern diseases who apply this based on these pulse/symptoms will die instantly. Do not revere fragmented texts as sacred scriptures and distort their meanings, bringing disaster to posterity.

For epigastric Pi, hard stool, vexation with insomnia, accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium) is the primary treatment.

Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium):
Dahuang (2 liang), Huanglian, Huangqin (each 1 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, decocted separately for juice).
Take the above three ingredients, steep in two sheng of boiling water for a moment, strain, mix with the Fuzi juice, and divide into two warm doses.

Below "epigastric Pi," the phrases "hard stool, vexation with insomnia" should exist, justifying this formula. Aversion to cold with epigastric Pi indicates unresolved exterior; exterior should be resolved first, preferably with Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). Using Dahuang is erroneous. Why add Fuzi and then use Huangqin/Huanglian? If sweating indicates Stomach-excess, Fuzi is contraindicated. If sweating indicates collapse of Yang, Huangqin/Huanglian are contraindicated. Scholar Xu said, "Learn the intent of Zhang Zhongjing, not his formulas." This likely refers to this situation.

After taking herbal medicine for cold damage, diarrhea persists, with epigastric fullness/hardness. After taking Xiexin Tang, further purgation with other drugs fails to stop diarrhea. The physician administers Lizhong Wan (Regulate the Middle Pill), worsening the diarrhea. Lizhong Wan regulates the Middle Jiao. This diarrhea is in the Lower Jiao; Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction) is the primary treatment. If diarrhea persists, promote urination.

Diarrhea persisting after herbal medicine indicates disease in the Stomach. Further purgation failing to stop diarrhea indicates disease in the Large Intestine. Lizhong Wan is not bad, but it acts too slowly. Chishizhi and Yuyuliang aid Metal Qi, astringing to secure leakage. As Geng-Metal Qi contracts, Wu-Earth dampness transforms. If diarrhea persists, it is because the Kidney governs the Lower Jiao and acts as the gate of the Stomach. If the gate fails to close, promoting urination helps dissipate dampness. Since the anal passage is blocked, the urinary pathway should be open to provide an exit. These are two methods for treating the Lower Jiao.

Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction):
Chishizhi (Halloysitum Rubrum), Yuyuliang (Hematitum) (each 1 jin).
Take the above two ingredients, add six sheng of water, decoct to obtain two sheng, strain, and divide into three warm doses.

Diarrhea in the Lower Jiao is caused by water-qi. Only Earth controls Water. Stone is the rigid part of Earth. Chishizhi and Yuyuliang are結 (condensed) essences of Earth. Chishizhi is red, enters Bing (Fire), aids Fire to generate Earth; Yuyuliang is yellow, enters Wu (Earth), strengthens the Stomach and astringes the Intestines. Although treating the Lower Jiao, it is actually a formula for the Central Palace. Both are sweet; sweet enters the Spleen first, strengthening the dike to calm excessive water-qi, thus surpassing Gancao and Baizhu in efficacy.

After sweating, vomiting, or purgation in cold damage, once resolved, if epigastric fullness/hardness and persistent belching (Yi Qi) remain, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is the primary treatment.

Cold damage harms the Heart. After sweating and subsequent vomiting/purgation, Heart-Qi is severely deficient. Exterior cold invades the deficiency and knots in the epigastrium. Heart-Qi fails to descend and rises outward as sound, resembling the "flight of the Sovereign." Belching is a sound of pain. Speaking of "Qi" rather than "Sound" indicates Qi manifesting externally with the sound.

Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction):
Xuanfuhua (Inulae Flos), Gancao (each 3 liang), Renshen (2 liang), Banxia (0.5 sheng), Daizheshi (Hematitum, 1 liang), Shengjiang (5 liang), Dazao (12 pieces).
Take the above seven ingredients, add one dou of water, decoct to six sheng, strain, decoct again to three sheng. Take one sheng warm, three times daily.

This is Shengjiang Xiexin Tang minus Huangqin, Huanglian, and Ganjiang, plus Xuanfuhua and Daizheshi. Because the Heart is deficient and cannot be drained further, this formula is created. The Heart governs Summer; Xuanfuhua blooms in late summer. Salty flavor tonifies the Heart, softens hardness, and dissipates knotting Qi. Banxia blooms in early summer; pungent flavor disperses pathogen, resolves Pi, and moves knotting Qi. Daizheshi inherits Southern Fire color, connects to the Heart, dissipates Pi/hardness, and calms deficiency-heat. Sweetness of Renshen, Gancao, and Dazao assists Xuanfuhua to drain deficiency-fire; pungency of Shengjiang assists Banxia to disperse water-knotting. Thus, Pi/hardness resolves, and belching ceases. Using Huangqin/Huanglian to drain the Heart, how could minute Yang be preserved?