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Perspiration therapy, when misapplied, causes the yin pathogenic factor of cold damage to fail to dissipate, while the heat pathogenic factors of the two yang (referring to the Taiyang and Yangming channels) fail to expand. They contend with each other at the epigastrium, forming a *pi* syndrome (fullness and obstruction). The treatment principle should involve assisting with *Fuzi* (Prepared Aconite Root), which is processed and decocted separately to warm and disperse the accumulated cold; the other three herbs are used raw to extract their juice. This approach aims to urgently clear the heat by preparing the cold and hot medicines separately and then mixing them for administration. This represents a clever method of counter-assistance (*fan zuo*) employed within an even-numbered formula. If the knotted heat is not rapidly eliminated, it will inevitably develop into dry excess in the stomach (*wei jia zao shi*); if the epigastric fullness does not dissipate, it will inevitably transform into a major *jie xiong* syndrome (chest binding). Is this the meaning behind using boiling water (*ma fei tang*) to soak these two formulas?

Zhang Zhongjing has no fixed method for treating *xie xin* (draining the heart/epigastrium). If healthy qi is depleted, it becomes deficiency-type *pi*; various sweet-tonifying, acrid-dispersing, bitter-draining, and cold-warming herbs are mixed to harmonize it. If pathogenic qi is abundant, it becomes excess-type *pi*; strongly cold, strongly hot, strongly bitter, and strongly acrid flavors are used to purge it. Harmonization has degrees of lightness and heaviness, while purging has distinctions of cold and heat. Although both are named "draining the heart," the composition and dosage differ so greatly. However, among these five *xie xin* formulas, the types and dosages of various herbs have their own advances and reductions, except for *Huanglian* (Coptis Rhizome), which remains fixed. This is because the bitter flavor enters the heart first; *Huanglian* is hollow inside and firm outside, capable of unblocking the cold and heat properties of other herbs, thus serving as the chief agent for draining the heart.

*Xuanfu Daizhe Tang* (Inula and Hematitum Decoction):
Ingredients: *Xuanfuhua* (Inula Flower), *Daizheshi* (Hematitum), *Renshen* (Ginseng Radix), *Gancao* (Licorice Root), *Banxia* (Pinellia Tuber), *Shengjiang* (Fresh Ginger Rhizome), *Dazao* (Jujube Fruit).
After cold damage is treated with perspiration, vomiting, or purgation, once the exterior syndrome resolves, but epigastric hardness and persistent belching occur, this is due to severe deficiency of heart qi, with residual pathogenic factors knotting at the epigastrium, preventing heart qi from descending.
The Heart is the Sovereign Lord; cold is a thief pathogen. Although the exterior cold has resolved, the fire of the Heart loses its proper position, causing blockage and resulting in epigastric hardness; because the Sovereign Lord is unsettled, belching persists. This formula is a variation of the *Xie Xin* formulas. Since heart qi is deficient and cannot be directly drained again, the bitter-cold and acrid-hot herbs like *Qinh* (Scutellaria Root), *Lian* (Coptis Rhizome), and *Ganjiang* (Dried Ginger Rhizome) are removed. The Heart corresponds to the Taiyang channel and connects with the Qi of Summer. *Xuanfuhua* blooms in summer; its salty flavor can tonify the heart and soften hardness. *Banxia* matures in summer; its acrid flavor can disperse knotting qi and stop belching. These two herbs fully acquire the Qi of Summer, so they are used to unblock heart qi. The Heart naturally tends toward relaxation, but after injury by the thief pathogen, it becomes tense; therefore, *Gancao* is added to relax it. The Heart naturally tends toward contraction, but now, due to residual pathogenic retention, it needs dispersion; therefore, *Shengjiang* is doubled to disperse it. For ascending rebellious deficient qi, unless heavy minerals are used to suppress and descend it, the hardness cannot be quickly eliminated, nor can belching be instantly stopped. *Daizheshi* (Hematitum) possesses the red color of the South, enters and communicates with the Heart; its hardness removes fullness, and its weight removes belching. Used as an assistant herb, it addresses the branch symptoms urgently. *Renshen* and *Dazao* tonify deficiency while residual pathogens remain, addressing the root preemptively. Supporting righteous qi to drive out pathogens allows the spirit to settle. If *Qinh* and *Lian* were used to drain the heart, how could the faint yang be protected from extinction? Decocting *Xuanfuhua* and *Banxia*, and mixing with powdered *Daizheshi*, is best for treating stubborn phlegm knotted in the chest and diaphragm, or surging saliva. Adding *Renshen* is very effective for cases with deficiency.

*Ganjiang Huanglian Huangqin Renshen Tang* (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction):
Indicated for vomiting immediately after food intake following cold damage treated with vomiting or purgation. This is caused by cold pathogenic factors repelling heat into the upper jiao. Although there is no epigastric hardness, the root of the disease lies in the heart, hence half the dose of the *Xie Xin* formula is used. *Ganjiang* disperses cold in the upper jiao; *Huangqin* and *Huanglian* clear heat in the epigastrium; *Renshen* unblocks rebellious qi, thereby harmonizing cold and heat to achieve balance. *Shengjiang* and *Banxia* are removed because the deficient stomach cannot tolerate acrid dispersion; *Gancao* and *Dazao* are omitted because vomiting is unfavorable to sweet flavors. For patients with vomiting accompanied by heat, fragrant and aromatic formulas containing *Sha* (Amomum), *Ju* (Citrus Peel), *Jiegeng* (Platycodon Root), and *Banxia* are unsuitable; taking this formula results in comfort. After erroneous perspiration, if water and medicine cannot enter the mouth, it is called *shui ni* (water rebellion); after erroneous vomiting or purgation, if food is vomited immediately upon entry, it is called *shi ge* (food gridlock). This distinguishes injury to lung qi from injury to stomach qi. Immediate vomiting without retention indicates the image of fire flaming upward, so bitter-cold herbs outweigh acrid-hot ones. It is not named *Xie Xin Tang* because that formula is specifically for epigastric hardness. One must understand that cold and heat knotting at the epigastrium forms *pi* (fullness); cold and heat obstructing at the epigastrium forms *ge ni* (rebellion). The source is the same, but the manifestations differ.

*Chishizhi Yuyuliang Tang* (Red Halloysite and Metastone Decoction):
Following purgation, if diarrhea persists, and administering *Lizhong Tang* (Regulate the Middle Decoction) worsens the dysentery, this indicates the gate of the stomach is insecure, and there is collapse of the lower jiao. Gan, Jiang, Ren, and Zhu (Licorice, Ginger, Ginseng, Atractylodes) can tonify the deficiency of the central qi, but are insufficient to secure the leakage of the large intestine's fatty tissue. Therefore, for diarrhea located in the lower jiao, the principles of *Lizhong* cannot achieve success. The insecurity of the large intestine is still attributed to the stomach; the failure of the gate to close is still attributed to the spleen. Earth deficiency failing to control water requires tonifying earth. However, aromatic herbs inherit the transformation of Jia and Yi (Wood), which earth fears. One must select herbs inheriting the transformation of Wu Earth to cultivate earth and control water to succeed. Stones are the rigid aspect of earth. Both stones are結ings of earth's essence and qi; their sweet taste returns to the spleen, their qi is mild, and their nature is stable. They are used to reinforce the dam and calm earth and water, surpassing the efficacy of herbs. Moreover, *Chishizhi* (Red Halloysite) is red, entering Bing Fire, assisting fire to generate earth; *Yuyuliang* (Metastone) is yellow, entering Wu Earth, solidifying the stomach and astringing the intestines. Used to treat the branch of the lower jiao, it actually cultivates the root of the central palace. This syndrome involves earth deficiency without fire deficiency, so *Ganjiang* and *Fuzi* are unsuitable. The original text states: "If diarrhea continues, promote urination." This shows it differs from *Taohua Tang* (Peach Kernel Decoction). For lower jiao collapse, using these two substances as the base, taken with *Renshen* decoction, is most effective.

*Didang Tang/Wan* (Resist Directly Decoction/Pill):
Ingredients: *Shuizhi* (Leech), *Dahuang* (Rhubarb Root), *Mengchong* (Blue Bottle Fly Larva), *Taoren* (Peach Seed).
In Taiyang disease lasting six or seven days, if exterior symptoms persist, the intensity of yang qi is evident. The pulse should be large but is instead minute; it should be floating but is instead deep. Deep indicates interior location; one would expect *jie xiong* (chest binding) symptoms, yet there is none, indicating the disease is not in the upper jiao. Minute pulses indicate absence of yang, yet the patient goes mad, indicating the disease is not in the qi level. Generally, yang diseases ascend to the extreme and then descend, indicating heat is in the lower jiao. Untreated lower jiao pathology leads to hardness and fullness in the hypogastrium, indicating heat knotting in the bladder, which should cause urinary retention (*long bi*). Yet urine flows freely. This indicates the qi transformation of the lung in the upper jiao is functioning, but nutritive qi in the meridians is obstructed. People know internal heat causes urinary obstruction; here, heat knots in the bladder, yet urine is free, indicating urination depends on lung qi. When yang is excessive, yin must be deficient; when qi prevails, blood must be diseased. Stagnant heat knotted internally in the bladder causes nutritive blood to overflow externally into the meridians. Injury to nutritive qi results in minute and deep pulses; accumulation of stagnant blood results in hypogastric hardness. Blood stasis prevents flow; the heart cannot govern, the liver has nowhere to store, and the soul and spirit become restless, leading to madness, jaundice, or deep, knotted pulses. All result from stagnation of nutritive qi. Judging by free urination, we confirm the disease is in the blood level without error.
If stagnant blood is not removed, new blood cannot be generated; if nutritive qi does not flow, the five zang organs become blocked, and death follows swiftly. Qibo said: "If blood is clear and qi is sluggish, rapid purging exhausts qi; if blood is turbid and qi is sluggish, rapid purging unblocks the meridians." Only the most potent agents can reach the nest and shoulder this responsibility. *Shuizhi* (Leech) is skilled at drinking blood among insects; *Mengchong* (Blue Bottle Fly Larva) is fierce at sucking blood among flying insects. Here, land and water creatures skilled at removing blood are used to attack the stasis, utilizing similar qi attraction. Assisted by *Taoren* to push out the old and generate the new, and *Dahuang*'s bitter cold to cleanse pathogenic heat, it is named *Didang* (Resist Directly), meaning striking directly at the target. If there is heat but no madness, and abdominal fullness but no hardness, the dosage should be reduced and made into pills for slow treatment. If exterior symptoms resolve, but the hypogastrium is knotted, urgent, and full, and the person resembles madness, this has transferred to the Yangming stage. Use *Taoren* and *Guizhi* in *Tiaowei Chengqi Tang* (Regulate the Stomach and Order Qi Decoction) to mildly purge; when the stomach harmonizes, recovery occurs.
A question arises: Blood moves with heat, why does it knot here? Bladder heat causes urinary obstruction, why is it free here? The answer: The Chong Mai (Penetrating Vessel) is the Sea of Blood, located above the lower abdomen; the bladder is at the bottom. If bladder heat is present with abundant blood, blood flows down and does not accumulate; if bladder heat is present with scant blood, blood coagulates and knots in the lower abdomen. Water enters the stomach, is transported up to the spleen and lungs, and down to the bladder. The bladder is the official of the reservoir, relying entirely on spleen and lung qi transformation for fluid excretion. With heat in the lower jiao, if upper and middle jiao qi transformation is unaffected, urine flows freely. Obstruction of the bladder is *long*, due to Taiyin insecurity; incontinence is due to Taiyin failure to hold. Zhang Zhongjing formulated *Da Qinglong Tang*, *Da Chaihu Tang*, and *Baihu Tang* to treat formless heat knotting in the three yang stages. The heat-excess treated by the three *Chengqi* formulas involves fecal matter; the solid knotting treated by *Taoren* and *Didang* involves blood stasis. Within the tangible, there is a distinction between qi and blood. Whenever Zhang Zhongjing uses *Xiaoshi* (Niter) and *Dahuang*, it is to cleanse heat and remove filth, not to remove blood. Later generations exclusively contrasted qi and blood levels, mistaking feces for blood, and erroneously promoted *Dahuang* as a blood-level herb. They did not know *Dahuang*'s aroma opens spleen qi and removes decay, hence the name *Chengqi* (Ordering Qi). Without *Taoren*, how can blood be broken? Without leech and fly larvae, how can hardness be attacked? Thus, blood-resolving formulas have degrees of potency. Any mass (*jia*) that does not dissipate and eventually takes shape is caused by blood stasis. Today's practitioners, failing to identify the cause, use qi-level herbs like *Sanleng* (Sparganium Rhizome), severely damaging primordial qi. As primordial qi declines, pathogenic qi easily knots. Feces are removed by qi movement; blood stasis becomes harder when qi is injured. Understanding this, using *Didang Wan* yields effects in treating masses, expelling parasites, and attacking toxins.
Note: *Shuizhi* is physically soft but inherently dangerous, secretly stealing human blood unnoticed. If swallowed accidentally with water, it lingers in the stomach, consuming blood, causing abdominal pain or not, leading to emaciation and death. Observing cattle rumens containing this worm reveals they are always thin, allowing inference for others. *Mengchong* flies high and far, specifically sucking cow blood, more ferocious than houseflies. Houseflies cause painful bites; if ingested, immediate abdominal pain occurs until expelled. Flying insects belong to yang, specifically targeting nutritive blood, refusing to stay in the stomach, differing from the yin toxicity of crawling insects. Zhang Zhongjing combines *Meng* and *Zhi* so that *Zhi* does not linger in the stomach, aided by *Dahuang* to cleanse. Toxins and blood stasis are both expelled without lingering harm. However, these two drugs attack toxin with toxin; they should not be used lightly unless pathogenic factors are firmly knotted and primordial qi is not deficient.
Above are forty-six formulas in total. Those such as *Guizhi Jia Gegen Tang* and *Gegen Jia Banxia Tang* are easiest to understand, so they are not discussed in detail. Formulas such as *Sini Tang* and *Zhenwu Tang* are borrowed by Taiyang; their discussions belong to their respective positions, and the classic texts are listed subsequently.