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Liu Hejian added two qian of Gancao (Licorice Root) to this formula and named it Sanyi Chengqi Tang (Three-One Descending Qi Decoction).

Dahuang (Rhubarb Radix et Rhizoma, four liang, washed with wine), Nongpo (Magnoliae Officinalis Cortex, half jin, roasted and skin removed), Zhishi (Immature Bitter Orange, five pieces, roasted). The above four ingredients are decocted in one dou of water. First, boil Nongpo and Zhishi until the liquid reduces to five sheng, then remove the dregs. Add Dahuang and boil further until the liquid reduces to two sheng, then remove the dregs again. Add Mangxiao (Mirabilite) and boil gently for one or two boils. Divide into two doses and take warm. If bowel movement occurs, stop taking the remaining medicine.

After a Taiyang disease (disease of the Taiyang channel) has been treated with emesis or purgation, if the condition remains unresolved, it is considered a "ruined syndrome" (bad outcome due to improper treatment). If there is no bowel movement for five or six days, extending up to ten or more days, and tidal fever (fever that worsens in the late afternoon) occurs daily without aversion to cold, accompanied by talking to oneself as if seeing ghosts, these are critical symptoms of Yangming disease (disease of the Yangming channel/stomach-intestine system). In severe cases, the patient may not recognize others during episodes, clutch at clothing and bedrails, feel terrified and restless, have slight shortness of breath, and fixed staring eyes. These are all critical Yangming symptoms caused by the depletion of middle qi and exhaustion of body fluids after emesis or purgation, leaving isolated yang, dryness in the stomach, and potentially dry feces. A wiry pulse indicates survival potential, while a choppy pulse indicates death. A wiry pulse suggests that yin qi still exists and can restrain the excess in the stomach. A choppy pulse indicates that qi and blood are exhausted. Although a wiry pulse suggests a possibility of survival, it does not guarantee it; a choppy pulse implies certain death. Milder cases present only with fever, tidal fever, and delirium (confused speech), without the aforementioned critical symptoms. The main treatment is Dachengqi Tang (Major Order the Qi Decoction). If one dose results in relief, stop subsequent doses. Stop medication once the illness is addressed.

In Yangming disease, if delirium and tidal fever occur but the patient cannot eat, it indicates exogenous heat failing to digest food. There must be five or six pieces of dry feces in the stomach. If the patient can eat, the stool is merely hard. "Can eat" does not mean true appetite, but rather that porridge or drinks can still be swallowed. Inability to eat means grain qi cannot approach at all due to extreme fullness in the intestines and stomach. Dachengqi Tang should be used to purge. Purging is indicated when the stool is hard.

Note: Dry feces should be in the intestines, yet the text says "stomach." Why? When pathogenic factors bind with waste products before descending, they are in the stomach; when preparing to descend, they are in the intestines. Once bound, they are called dry feces. Mentioning the stomach implies the intestines are included.

Sweating accompanied by delirium indicates dry feces in the stomach, caused by wind pathogen. Yangming disease naturally involves sweating, but some cases do not sweat. Here, sweating indicates wind pathogen, meaning exterior pathogenic factors remain. Lack of sweating indicates internal binding of fire pathogen. Purging is permissible only after the pathogen has passed through the meridians. This defines the timing for purging. If purging is done too early, speech will become chaotic, worse than simple delirium, because the exterior is deficient and the interior is excessive. Premature purging draws exterior pathogens inward, causing exterior deficiency and interior excess. Purging will cure the condition; Dachengqi Tang is appropriate. Even if purging was previously mistaken, if delirium and other symptoms persist, purging should be repeated; a previous mistake does not preclude future purging.

When two yang channels are involved simultaneously, it is called combined disease (Hebing); when one channel's disease is not resolved and another channel becomes diseased, it is called concurrent disease (Bingbing). If Taiyang symptoms have ceased, presenting only with tidal fever, sweating on hands and feet, difficult defecation, and delirium, these are current Yangming symptoms. Purging will cure the condition; Dachengqi Tang is appropriate.

After purging Yangming disease, if the patient feels heart vexation and restlessness (Aonao), it indicates incomplete purging, resulting in real vexation. If there are dry feces in the stomach, purging is indicated. Dry feces in the stomach must present with other specific symptoms. If the abdomen is slightly full, and stool is hard at the beginning but loose later, purging is contraindicated. Slight fullness alone indicates no dry feces, so purging is contraindicated. If dry feces are present, Dachengqi Tang is appropriate.

If a patient suffers from vexation and heat, which resolves with sweating, but resembles malaria with evening fever, it belongs to Yangming. A solid pulse indicates purging is suitable; a floating and deficient pulse indicates sweating is suitable. For purging, use Dachengqi Tang; for sweating, use Guizhi Tang (Cinnamon Twig Decoction). See the detailed explanation of Guizhi Tang earlier.

After severe purging, if there is no bowel movement for six or seven days, persistent vexation, and abdominal fullness and pain, this indicates dry feces. The reason is pre-existing retained food. Because of retained food, even after severe purging, dry feces may not be fully expelled. Dachengqi Tang is appropriate.

If a patient has not had a bowel movement for five or six days, experiences periumbilical pain (the location of dry feces), and has vexation that comes and goes at specific times, this indicates dry feces causing constipation.

If a patient has difficulty urinating, intermittent difficulty and ease in defecation, occasional slight fever, and shortness of breath with vertigo preventing lying down, this indicates dry feces. Shortness of breath, vertigo, and inability to lie down are signs of dry feces. Ideally, defecation should be difficult without ease. The intermittent ease is due to difficulty urinating; dry feces do not pass easily with loose stool. Dachengqi Tang is appropriate. The above three clauses describe methods for diagnosing dry feces in Yangming disease.

On the second or third day of illness, if the pulse is weak, with no Taiyang or Chaihu (Bupleurum) symptoms, but with vexation and hardness below the heart, indicating pathogenic heat entering the interior. By the fourth or fifth day (two days later), even if the patient can eat, administer Xiaochengqi Tang (Minor Order the Qi Decoction) in small amounts to gently harmonize the stomach qi, without using the full formula. This is a method of medication to provide slight relief. By the sixth day (one day later), if the illness persists, administer one sheng of Dachengqi Tang, also possibly not the full formula. Ancient physicians, despite clear symptoms, would test with mild formulas cautiously. If there is no bowel movement for six or seven days and urine output is low, even if the patient cannot eat, if the stool is hard at the beginning but loose later, and it is not confirmed to be hard, and urine is insufficient, meaning water and grain are not fully separated and stool is still damp, purging will cause loose stool. One must wait for free urination and confirmed hard stool before purging. Whether to purge depends on the sufficiency of urination. This is another method. Dachengqi Tang is appropriate.

On the sixth or seventh day of Shanghan (Cold Damage), if the eyes appear unclear and pupils are unresponsive, these are signs of excessive yang. With no exterior or interior symptoms, the pathogen is bound in the interior. Difficulty in defecation and slight body heat indicate an excess condition. Pathogen binding creates excess. Urgent purging is required; Dachengqi Tang is appropriate.

"Yangming disease" encompasses various Yangming symptoms. If there is fever and profuse sweating, urgent purging is required. The emphasis is on profuse sweating, fearing that intense internal heat will force yang outward, leading to yang collapse. Dachengqi Tang is appropriate.

If sweating fails to resolve the condition, and abdominal fullness and pain occur, "unresolved" implies accompanying Yangming symptoms. Added abdominal fullness and pain confirm excess pathogen. Urgent purging is required; Dachengqi Tang is appropriate.

Abdominal fullness that does not decrease, or decreases insignificantly, requires purging. Although slight reduction occurs, fullness remains. Purging is required; Dachengqi Tang is appropriate. The above clauses list one or two symptoms requiring purging. However, other symptoms must be consulted to ensure appropriateness.

In combined Yangming and Shaoyang disease, diarrhea is inevitable. A pulse that does not show "defeat" (negative indication) is favorable; a "defeated" pulse is unfavorable. Shaoyang corresponds to Wood, with a wiry-tight pulse; Yangming corresponds to Earth, with a surging-slow pulse. If Shaoyang pulse dominates, it is defeat; if Yangming pulse dominates, it is non-defeat. The Jueyin chapter states: "Shaoyin defeating Zuyang is favorable." Shaoyin corresponds to Water, Zuyang to Earth; Earth overcoming Water indicates strong stomach qi, hence favorable. This principle applies here, though Shaoyin involves cold limbs and diarrhea, whereas this case involves Shaoyang. Mutual overcoming is called defeat. A slippery and rapid pulse indicates retained food. Slippery-rapid represents the Yangming pulse appearing exclusively and excessively, indicating excess pathogen and retained food. Purging is required; Dachengqi Tang is appropriate.

Question: How to distinguish retained food in patients? Master said: If the Cun-kou pulse is floating and large, but feels choppy upon pressure, and the Chi position is also faint and choppy, this indicates qi stagnation and blockage due to food retention. Thus, retained food is confirmed, and purging is required; Dachengqi Tang is appropriate.

In Shaoyin disease, on the second or third day, as yang pathogen initially transfers to yin, dry mouth and throat indicate urgent purging. As yang pathogen transfers to yin, kidney water is about to dry up, so the pathogen must be urgently removed to preserve body fluids. Dachengqi Tang is appropriate.

In Shaoyin disease, spontaneous diarrhea of clear water, purely green in color, indicates liver pathogen entering the kidney, not cold pathogen. The Nan Jing states: "Coming from the source is excess pathogen." Pain below the heart and dry mouth confirm it is not cold pathogen. Urgent purging is required; Dachengqi Tang is appropriate. Both clauses emphasize dry mouth, confirming heat pathogen.

In Shaoyin disease, on the sixth or seventh day, abdominal fullness and constipation require urgent purging. Constipation with fullness lasting long necessitates purging. Dachengqi Tang is appropriate.

In diarrhea, if the pulses in all three positions are level and there are no exterior symptoms, but pressing reveals hardness below the heart, this indicates tangible excess pathogen. Urgent purging is required; Dachengqi Tang is appropriate.

In diarrhea, if the pulse is slow and slippery, it indicates internal excess. Diarrhea has not stopped; purging is required; Dachengqi Tang is appropriate.

In diarrhea, if there is loss of appetite, it is due to retained food. Food injury and aversion to food. Even "closed-mouth" diarrhea is caused by retained food. Purging is indicated; Dachengqi Tang is appropriate.

If diarrhea recurs in the same year, month, or day after recovery, it is because the illness was not fully resolved. Purging is required; Dachengqi Tang is appropriate.

In diarrhea, if the pulse is unexpectedly slippery, there is something to eliminate. A slippery pulse indicates excess pathogen does not remain. Purging leads to recovery; Dachengqi Tang is appropriate.

Abdominal fullness and pain indicate excess. Purging is required; Dachengqi Tang is appropriate.

A double-wiry and slow pulse indicates hardness below the heart, with wood pathogen attacking earth. A large and tight pulse indicates yang containing yin. Large is yang, tight is yin. Purging is permissible; Dachengqi Tang is appropriate.

Note: The above seven clauses appear in the "Purgative Clauses" of the Shanghan Lun. They seem to refer to purgative methods for miscellaneous diseases, not strictly within the Six Channels treatment framework.