Library

[General Principle] Zhang Zhongjing stated: In cold damage (Shanghan) with fever, if sweating does not resolve the condition, accompanied by epigastric fullness and hardness, vomiting, and diarrhea, Da Chai Hu Tang (Major Bupleurum Decoction) is the primary treatment.

[Detailed Discussion] Zhu Gong said: Generally speaking, both Jie Xiong (Chest Binding) and Pi Syndrome (Epigastatic Fullness) are suitable for purgative methods. However, if the exterior syndrome has not resolved, attacking internally is contraindicated. Zhang Zhongjing stated: One should first resolve the exterior; only after the exterior is resolved can one attack the Pi syndrome. To resolve the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate; to attack the Pi syndrome, Da Huang Huang Lian Xie Xin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction) is appropriate. If sweating occurs and the exterior resolves, but the stomach interior is disharmonious, presenting with epigastric fullness and hardness, dry belching with a smell of food rot, fluid retention in the hypochondrium, and rumbling diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Heart-Draining Decoction) should be used. If there are dozens of bowel movements per day with undigested food, rumbling in the abdomen, and epigastric fullness, hardness, and distension, this is caused by the physician's erroneous use of purgatives. If purgatives are used again, the Pi syndrome will worsen; in such cases, Gan Cao Xie Xin Tang (Licorice Heart-Draining Decoction) should be used. This is not due to accumulated heat, but rather because of deficiency in the stomach allowing hostile Qi to rebel upward, causing hardness. If there is diarrhea with epigastric Pi, and after taking Sheng Jiang Xie Xin Tang or Gan Cao Xie Xin Tang the diarrhea persists, one should treat the Lower Jiao (Lower Burner) with Chi Shi Zhi Yu Liang Tang (Red Halloysite and Hematite Decoction). The previous two Heart-Draining Decoctions treat the Middle Jiao (Middle Burner); since this diarrhea originates from the Lower Jiao, treating only the Middle Jiao will exacerbate the diarrhea. If the Chi Shi Zhi Tang still fails to stop the diarrhea, one should promote urination using Wu Ling San (Five-Ingredient Powder with Poria). If the Tai Yang (Greater Yang) syndrome remains unresoved yet multiple purgations have been performed, leading to diarrhea with accompanying heat that does not cease, accompanied by epigastric fullness and hardness, and unresolved exterior and interior conditions, Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) is the main treatment. As for Shi Zao Tang (Ten Jujubes Decoction) and Da Chai Hu Tang, they also treat epigastric Pi, but this formula is particularly difficult to apply. It is indicated only when the exterior syndrome has ceased, there is no aversion to cold, the body is cool, the patient sweats at specific times, has headaches, epigastric fullness, hardness, and distension radiating pain to the hypochondrium, dry retching, and shortness of breath. Only then can Shi Zao Tang be administered. If the exterior is not resolved, it must strictly not be used. Da Chai Hu Tang treats cold damage with fever, where sweating does not resolve the condition, accompanied by epigastric fullness and hardness, vomiting, and diarrhea; in such cases, Da Chai Hu Tang is indispensable. After sweating, emesis, or purgation, if epigastric fullness and hardness occur with persistent belching, Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) is used. This primarily treats epigastric Pi following the resolution of the exterior.

[General Principle] Zhang Zhongjing stated: In cold damage on the fifth or sixth day, if there is vomiting without fever, indicating the presence of Xiao Chai Hu Tang (Minor Bupleurum Decoction) syndrome, but other drugs were used to purge it. If the epigastrium becomes full and painful with hardness, this is Jie Xiong (Chest Binding), treated primarily with Da Xian Xiong Tang (Major Thorax-Purgating Decoction). If it is merely full without pain, it is Pi syndrome (Epigastatic Fullness); Xiao Chai Hu Tang is not indicated, and Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction) is appropriate.

[Detailed Discussion] Ke Qin said: This is a deteriorated state of the Xiao Chai Hu Tang syndrome; therefore, a Heart-Draining decoction is used instead of Xiao Chai Hu Tang.

[General Principle] Zhang Zhongjing stated: In Shaoyang (Lesser Yang) wind strike, with hearing loss in both ears, red eyes, chest fullness, and irritability, emesis and purgation are contraindicated. Emesis and purgation will lead to palpitations and fright.

[Detailed Discussion] Ke Qin said: The chest is the exterior of the interior. Fullness is caused by deficient wind.

[General Principle] Zhang Zhongjing stated: When Tai Yang (Greater Yang) and Shaoyang (Lesser Yang) syndromes occur together, with a wiry pulse, stiffness and pain in the head and neck, occasional dizziness or vertigo, symptoms resembling Jie Xiong (Chest Binding), and epigastric fullness and hardness, one should needle the first interspace of the Dazhui (GV14) acupoint, as well as Feishu (BL13) and Ganshu (BL18). Sweating must be strictly avoided; inducing sweating will lead to delirious speech. If delirium persists, Qimen (LR14) should be needled.

[Detailed Discussion] Zhu Gong said: Epigastric fullness without pain is named Pi syndrome (Epigastatic Fullness). Cold damage inherently does not present with Pi; the body should be cold. If the physician erroneously purges, Pi forms. Zhi Shi Li Zhong Wan (Immature Bitter Orange and Spleen-Nourishing Pill) is most effective. Among Zhang Zhongjing’s various decoctions for Pi Qi (Pi Syndrome), the two Heart-Draining Decoctions involving Sheng Jiang (Fresh Ginger) and Ban Xia (Pinellia) are mild and gentle, making them suitable for use. Ban Xia Xie Xin Tang treats Pi characterized by fullness without pain. This decoction is likely derived from the Li Zhong Ren Shen Huang Qin Tang (Spleen-Nourishing, Ginseng, and Scutellaria Decoction). Once Pi is confirmed, using Jie Geng Zhi Ke Tang (Platycodon and Aurantium Decoction) first is excellent, as these herbs move Qi and descend through the diaphragm; their prior use is invariably effective. For both Jie Xiong and Pi, the Guan (Cun) pulse must be deep. If the Guan pulse is floating, Da Huang Huang Lian Huang Qin Xie Xin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction) is used, because a floating Guan pulse indicates accumulated heat, and the three yellows can clear Liver fire. If there is additionally aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Heart-Draining Decoction) is used. If the patient has epigastric Pi that does not resolve with Heart-Draining Decoctions, accompanied by thirst, dry mouth, and dysuria, Wu Ling San (Five-Ingredient Powder with Poria) is indicated.

[General Principle] Zhang Zhongjing stated: In Tai Yang-Shaoyang combined syndrome, if purgation is erroneously applied, resulting in Jie Xiong (Chest Binding), epigastric hardness, incessant diarrhea, inability to take fluids, and mental restlessness. In Tai Yang-Shaoyang combined syndrome, with epigastric hardness, neck stiffness, and dizziness, one should needle Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Purging must strictly be avoided.

[Detailed Discussion] Tao Hua said: Pi syndrome arises from Tai Yang syndrome, where Ma Huang Tang (Ephedra Decoction) should have been taken, but Cheng Qi Tang (Ordering the Qi Decoction) was mistakenly used for purgation, leading to Pi and fullness. This is due to the stagnation of deficient pathogenic factors. If purgation is desired, one must wait until the exterior syndrome has resolved before proceeding. Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Jie Geng (Platycodon) and Zhi Ke (Aurantium) is appropriate.

[General Principle] Zhang Zhongjing stated: In cold damage lasting eight or nine days, after purgation, if there is chest fullness, fright, dysuria, delirium, heaviness of the entire body, and inability to turn over, Chai Hu Long Gu Mu Li Tang (Bupleurum, Dragon Bone, and Oyster Shell Decoction) is the main treatment.

[Detailed Discussion] Shen Jin'ao noted: This results from reckless purgation, causing heat pathogens to invade inward, leading to a transformation of Yin exhaustion.

[General Principle] Zhang Zhongjing stated: In Tai Yang disease, after passing beyond the meridian for more than ten days, if purgation is erroneously applied two or three times, and four or five days later the Xiao Chai Hu Tang (Minor Bupleurum Decoction) syndrome persists, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) first. If vomiting persists, there is epigastric urgency, and slight depression with vexation, the condition has not resolved; administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge, and the patient will recover.

[Detailed Discussion] Lou Ying said: This is due to repeated reckless purgation over a long period, yet the Xiao Chai Hu Tang syndrome persists. Because the patient's healthy Qi is not deficient, the pivot mechanism remains intact, preventing the formation of a deteriorated disease. Administering Xiao Chai Hu Tang harmonizes the condition. Although the exterior syndrome may have resolved, the interior remains unrelieved. The previously used purgatives could only remove tangible accumulations in the intestines and stomach but failed to drain the accumulated heat in the Qi aspect of the chest. "Urgency" refers to fullness; mere fullness without pain constitutes Pi syndrome (Epigastatic Fullness).