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Da Cheng Qi Tang (Major Order the Qi Decoction) treats Yangming disease, characterized by tidal fever (fever that occurs at a specific time), continuous sweating of the hands and feet, delirium with excessive sweating, dryness in the stomach leading to muttering to oneself, hallucinations as if seeing ghosts, panting, dizziness, inability to lie down, abdominal fullness and pain, and a slippery and solid pulse. It also treats cases where vision is unclear and the eyes are unresponsive. Additionally, it treats Shaoyin disease in its early stage presenting with dry mouth and throat. It treats spontaneous diarrhea of clear water, purely green in color, pain in the epigastrium, dry mouth and tongue. It treats conditions lasting six or seven days with abdominal distension and constipation.

Rhubarb (washed with wine, 4 liang)
Stemma Polygalae (half jin)
Immature Bitter Orange (roasted, 5 pieces)
Mirabilite (3 he)

The above four ingredients are boiled in 10 dou of water. First, boil Stemma Polygalae and Immature Bitter Orange until 5 sheng of liquid remains. Remove the dregs, add Rhubarb, and boil until 2 sheng remains. Remove the dregs again, add Mirabilite, heat briefly for one or two boils, and divide into two warm doses. Stop subsequent doses once bowel movement occurs.

Xiao Cheng Qi Tang (Minor Order the Qi Decoction)
Rhubarb (4 liang)
Stemma Polygalae (roasted, peeled, 2 liang)
Immature Bitter Orange (3 pieces)

The above three ingredients are boiled in 4 sheng of water until 1.2 sheng remains. Remove the dregs and divide into three warm doses. Bowel movement should occur after the first dose; if not, administer the next dose. Stop when bowel movement is achieved.

[Collected Annotations] Ke Qin stated: All diseases arise from qi dysfunction; the retention of turbid matter is due to the obstruction of qi flow. Therefore, purgative agents must use herbs that regulate the qi aspect, hence the name "Cheng Qi" (Order the Qi). The distinction between Major and Minor lies in two aspects: When Stemma Polygalae is used in double the amount of Rhubarb, the qi-regulating herb is the sovereign, named Da Cheng Qi Tang. When Rhubarb is used in double the amount of Stemma Polygalae, the qi-regulating herb is the minister, named Xiao Cheng Qi Tang. With many ingredients and potent properties, larger dosages are used to induce strong purgation, hence "Major." With fewer ingredients and milder properties, smaller dosages are used to gently harmonize the Stomach Qi, hence "Minor." Furthermore, the decoction method holds profound meaning. Da Cheng Qi Tang uses 10 dou of water, boiling Immature Bitter Orange and Stemma Polygalae first to obtain 5 sheng, removing dregs, adding Rhubarb, boiling to 2 sheng, then adding Mirabilite. Why? Raw herbs have sharp qi and act quickly, while cooked herbs have pure qi and act slowly. Zhang Zhongjing intended for Mirabilite to first dissolve dry feces, followed by Rhubarb to unblock the intestinal tract, and finally Immature Bitter Orange and Stemma Polygalae to eliminate fullness and stagnation. In contrast, Xiao Cheng Qi Tang boils all three ingredients together without sequence. Although using the same Rhubarb, the different decoction methods reveal Zhang Zhongjing's intent to gently harmonize.

Yu Chang stated: *Jin Gui Yao Lue* treats spasm disease with chest fullness, locked jaw, inability to lie flat (back stiff against the bed), leg cramps, and teeth grinding, recommending Da Cheng Qi Tang as a method of seeking life amidst death. *Ling Shu* states that heat-induced spasm leads to death, manifesting as opisthotonos, convulsions, and teeth grinding. The described inability to lie flat is a variation of opisthotonos. Leg cramps are a variation of convulsions. Coupled with teeth grinding, chest fullness, and locked jaw, heat pathogens fill the Upper, Middle, and Lower Jiao, leading to imminent death. In Taiyang syndrome, abdominal fullness can be purged, but chest fullness cannot. However, those administering this formula must understand that "chest fullness" here refers to pathogenic factors still in the exterior, thus contraindicating purgation. This case involves interior heat that is extremely deep and severe, incomparable to simple exterior patterns. Moreover, extreme yang heat rapidly consumes yin blood. Even mild purgation may not suffice to overcome yang heat and rescue yin. Thus, this formula is used to receive and guide the remaining thread of yin qi. If yin qi is not hijacked by yang heat, survival is likely. The phrase "may be given" implies flexibility in clinical application, not a rigid rule. There is a major prohibition against purging which severely injures yin, yet also a flexible method of purging to urgently rescue yin. Scholars aiming for profound mastery must focus on this.

Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) treats cases where the exterior has resolved with sweating, but interior heat persists, causing disharmony in the Stomach and failure to recover.

Rhubarb (washed with wine, 4 liang)
Licorice (roasted, 2 liang)
Mirabilite (half jin)

The above three ingredients are boiled in 3 sheng of water. First, boil Licorice and Rhubarb to obtain 1 sheng. Remove dregs, add Mirabilite, boil briefly, and take small amounts warm.

[Note] The naming of the three Cheng Qi formulas reflects dosage strategy: "Major" indicates large dosage for urgent purgation; "Minor" indicates small dosage for slow purgation. "Regulate the Stomach" implies harmonizing and smoothing Stomach Qi, unlike the specific purgative action of the Major and Minor forms. The Classic states: For heat flooding internally, treat with salty-cold; for fire flooding internally, treat with bitter-cold. Rhubarb (bitter-cold) is the sovereign, Mirabilite (salty-cold) is the minister. Their combined power to attack heat and drain fire is complete. Licorice (mild) is added to moderate between Rhubarb and Mirabilite. Taking small amounts warm prevents harsh action, allowing for gradual harmonization rather than rapid purgation.

Geng Yi Wan (Changing Clothes Pill) treats insufficient body fluids, dry intestines and stomach, and constipation.

Cinnabar (ground fine, 5 qian)
Aloe (ground fine, raw, 7 qian)

Mix with a little good wine to form pills. Take 1.2 qian per dose, washed down with good wine.

[Collected Annotations] Ke Qin stated: The Stomach is the root of post-heaven existence. Deficiency causes disease, and excess also causes disease. Excess differs in yang-excess with yin-deficiency. When two yangs combine to brighten, resulting in Stomach excess, Zhang Zhongjing created the three Cheng Qi formulas to purge it. When the three yangs become dry and bound with fluid depletion, earlier sages created Geng Yi Wan to moisten it. Ancients changed clothes before entering the toilet, hence the name. Cinnabar, based on mercury, is cold, heavy, and descending. Aloe, based on resin, is bitter, pasty, moistening, and descending. Combined with their great cold and bitter nature, they moisten dryness and binding, guiding downward from above to open the Stomach gate. As pills, they assist each other, yielding magnificent and rapid effects, truly beyond imagination.

Ma Ren Wan (Hemp Seed Pill, also known as Pi Yue Wan / Spleen Constrained Pill) treats intestinal and stomach dry-heat, constipation, and frequent urination.

Hemp Seed (2 sheng)
Paeonia Root (half jin)
Immature Bitter Orange (half jin)
Rhubarb (peeled, 1 jin)
Stemma Polygalae (peeled, 1 jin)
Apricot Kernel (peeled, boiled, ground to paste, 1 sheng)

Grind the above six ingredients into powder, mix with refined honey to form pills the size of tung seeds. Take 10 pills with water, three times daily; gradually increase dosage until bowel movement is achieved.

[Collected Annotations] Cheng Wuji stated: "Yue" means constraint. The Classic states: Drink enters the Stomach, essence floats up, transports to the Spleen, Spleen scatters essence, returns to the Lung, regulates water passages, transports to the Bladder, fluids distribute everywhere, and the five meridians run together. Now, Stomach is strong but Spleen is weak, constraining fluids so they cannot distribute widely, only transporting to the Bladder, causing frequent urination and hard stool, hence "Spleen Constraint." Hemp Seed is sweet, neutral, and moistening; Apricot Kernel is sweet, warm, and moistening. The Classic states: The Spleen desires relaxation; urgently eat sweet to relax it. Materia Medica states: Moistening removes dryness. Thus, Hemp Seed is sovereign, Apricot Kernel is minister. Immature Bitter Orange breaks stagnation, Stemma Polygalae drains fullness, serving as assistants. Paeonia harmonizes the middle, Rhubarb unblocks downward, serving as envoys.

Zhu Zhenheng stated: Since it is called Spleen Constraint, with blood deficiency, fire blazing, and fluid exhaustion, one should nourish yin and descend fire, generating fluids naturally, avoiding constipation. This formula is suitable only for those with intense heat and robust constitution; those with mild heat and deficiency will suffer further dryness.

Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) treats blood stasis in the chest, intolerable to touch, or blood accumulation in the middle jiao with alternating chills and fever, chest fullness, rinsing mouth without swallowing, forgetfulness, confusion, and mania-like behavior. This formula treats retained bad blood in the meridians and regulates menstruation.

Peach Kernel (peeled and tip removed, 50 pieces)
Cinnamon Twig (3 liang)
Rhubarb (4 liang)
Mirabilite (2 liang)
Licorice (2 liang)

Boil the above five ingredients in 7 sheng of water to obtain 2.5 sheng. Remove dregs, add Mirabilite, boil briefly. Take 0.5 sheng warm before meals, three times daily. Mild purgation should occur.

Di Dang Tang and Wan (Resist Water Decoction and Pill) treats Taiyang blood accumulation and zhang masses (abdominal masses); excellent for expelling parasites and attacking toxins.

Leech (roasted, 30 pieces)
Blue Bottle Fly (roasted, head and feet removed, 30 pieces)
Rhubarb (3 liang)
Peach Kernel (peeled and tip removed, 30 pieces)

Grind the above four ingredients into powder. Boil in 5 sheng of water to obtain 3 sheng. Remove dregs, take 1 sheng warm. If no effect, repeat. Stop when purged.

Leech (roasted, 20 pieces)
Blue Bottle Fly (roasted, wings removed, 25 pieces)
Peach Kernel (peeled and tip removed, 20 pieces)
Rhubarb (3 liang)

Pound the above four ingredients, divide into four pills. Boil one pill in 1 sheng of water to obtain 0.7 sheng. Take. Blood should pass; if not, take again.

[Collected Annotations] Ke Qin stated: The Bladder is the residence of water; blood has no place to accumulate. The lower abdomen is the chamber of the Bladder. Heat binding causes hardness and fullness; urine should be difficult, but if it flows freely, the disease is not in the Bladder interior but in the lower abdomen interior. Thus, circulating nutritive blood, due to stasis-heat, binds in the lower abdomen, not the Bladder interior. Hence, even with free urination, hardness, fullness, and urgency persist, with blood stasis remaining in the lower abdomen. Heat flooding internally disturbs the soul and spirit, causing madness. Blood stasis prevents circulation, so nutritive qi does not move, resulting in faint and deep pulses. Nutritive qi stagnation prevents qi dissemination, causing deep and knotted pulses. Nutritive qi failing to circulate the body causes yellowing. Eating well and hunger indicate blazing Stomach fire. Stool being easy to pass is due to blood lubrication; black color indicates blood infiltration. Forgetfulness indicates blood failing to nourish and intellect dimming. These are signs of blood stasis. Only the most峻猛 (harsh/potent) agents can reach the nest and bear this responsibility, hence Di Dang Tang was established. Leeches are aquatic insects skilled at drinking blood. Blue Bottle Flies are aerial insects skilled at sucking blood. Using both aquatic and aerial blood-suckers seeks resonance. Assisted by Peach Kernel (bitter-sweet) to push out the old and generate the new, and Rhubarb (bitter-cold) to cleanse evil heat, it is named "Di Dang" (Resist/Withstand). If heat is intense but not manic, and lower abdomen is full but not hard, reduce the dosage and use pills for slow treatment. If exterior symptoms resolve, lower abdomen is urgent and knotted, and the patient is mania-like, it has transferred to Yangming. Use Tiao Wei Cheng Qi Tang plus Peach Kernel and Cinnamon Twig to move blood, inducing mild purgation. Harmonized Stomach leads to recovery. This is the slower treatment of Tao Ren Cheng Qi Tang.

Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction, with Attached Modified Formulas) treats Yangming disease with floating and tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to cold absent but aversion to heat present, heaviness, irritability, mental restlessness, fear, regret, eye pain, nasal dryness, and insomnia.

Gardenia Fruit (broken, 14 pieces)
Prepared Fermented Soybean (wrapped in cloth, 4 he)

Boil the above two ingredients in 4 sheng of water. First boil Gardenia to 2.5 sheng. Add Fermented Soybean, boil to 1.5 sheng. Remove dregs, divide into two doses. Take warm. Stop subsequent doses if vomiting occurs.

If short of qi, add Licorice (2 liang). If vomiting, add Fresh Ginger (3 liang). If after purgation there is irritability, abdominal fullness, and restlessness, remove Fermented Soybean, add Stemma Polygalae (4 liang) and Immature Bitter Orange (4 pieces). If treated with pill purgatives, fever persists, and there is knotting pain in the heart, remove Fermented Soybean, add Dried Ginger (2 liang). If fever with jaundice appears, remove Fermented Soybean, add Licorice (1 liang) and Phellodendron Bark (2 liang).

[Collected Annotations] Ke Qin stated: For Taiyang, the heart and abdomen are interior; for Yangming, the heart and abdomen are exterior. Yangming interior is Stomach excess. Not only fever, aversion to heat, eye pain, nasal dryness, sweating, and heaviness are considered exterior. All empty irritability, empty heat, dry throat, bitter taste, tongue coating, abdominal fullness, irritability, insomnia, thirst with difficult urination, anything outside the Stomach, is Yangming exterior. Zhang Zhongjing's diaphoretic agents open the exit for Taiyang exterior pathogens; emetic agents guide Yangming exterior pathogens out. Thus, Taiyang exterior should be diaphoresed, not vomited; Yangming exterior should be vomited, not diaphoresed. If Taiyang requires diaphoresis but vomiting is used, spontaneous sweating, aversion to cold absent, hunger without appetite, morning food evening vomiting, desire for cold food, aversion to clothing appear. This is Taiyang transferring to Yangming exterior, treated with Zhi Zi Chi Tang to induce vomiting. If Yangming requires vomiting but is not, and instead diaphoresis, purgation, or moxibustion are used, leading to mental restlessness, fear, regret, irritability, and tongue coating, yet still in Yangming exterior, Zhi Zi Chi Tang is still indicated. Gardenia is bitter (promotes vomiting/drains) and cold (overcomes heat); its shape resembles the heart, and red color connects to the heart, treating all heart-related disorders. Soybean resembles the kidney, black color enters the kidney. Processed into fermented soybean, it becomes light and ascending, guiding turbid pathogens from heart and abdomen upward through the mouth. One vomit relieves heart and abdomen, resolving exterior-interior irritability and heat. This works by urgently clearing heat outside the Stomach, preventing Stomach excess, making Zhi Zi Chi Tang the holy agent for resolving Yangming exterior. Heat injuring qi causes shortness of breath; add Licorice to tonify qi. Empty heat combing causes vomiting; add Ginger to scatter pathogens. After purgation, if heart/abdomen fullness and restlessness occur, heat has entered the Stomach; vomiting is inappropriate. Remove Fermented Soybean. If stool is not dry/hard, further purgation is inappropriate. Use only Gardenia to relieve irritability, assisted by Immature Bitter Orange and Stemma Polygalae to drain fullness. This cleverly resolves heart and abdomen, acting as a mild Xiao Cheng Qi Tang. If pill purgatives were used, persistent fever indicates unresolved exterior; knotting pain in the heart indicates cold滞留 (retention) in the middle. Exterior heat, interior cold. Use Gardenia's bitterness to clear heat, double Dried Ginger's pungency to drive out cold. Exterior heat resolves, interior cold clears. However, vomiting is needed to reach the exterior, so this formula probes for vomiting. This is a harmonizing and exterior-resolving formula using cold and heat together. Intense internal and external heat causing muscle jaundice requires bitter-sweet harmonizing agents. Phellodendron and Licorice are yellow and moistening, assisting Gardenia to clear internal irritability and resolve external heat. Diseases of form and color require agents of form and color to penetrate. These modifications of Zhi Zi Chi Tang handle Yangming exterior variations. Gardenia's nature descends curvingly, not an emetic. Only Fermented Soybean's fermented vapor steams upward to the heart and lungs, causing vomiting. Guan Di San uses soybean juice to mix, indicating vomiting comes from Soybean, not Gardenia. Zhi Zi Gan Jiang Tang removes Soybean, adds Ginger, taking its horizontal opening. Zhi Zi Hou Po Tang replaces Soybean with Immature Bitter Orange and Stemma Polygalae, taking its downward draining. These seem to avoid upward emergence. Though bitter can induce vomiting, probing for vomiting is required. Patients with chronic loose stools should not receive it, clarifying Gardenia's nature.

Gua Di San (Melon Peduncle Powder) treats chest oppression, hardness, phlegm-fluid, all excess pathogens, and qi rushing to the throat causing dyspnea. Induce vomiting with this formula.

Melon Peduncle (roasted yellow, 1 fen)
Adzuki Bean (1 fen)

Grind each separately into powder, then mix. Take 1 qian bi. Mix with 1 he of Fermented Soybean and 0.7 sheng of hot water, boil into thin porridge. Remove dregs, mix juice with powder. Take warm in one dose. If no vomiting, increase slightly. Stop when vigorous vomiting occurs.

[Note] The chest is the mansion of clear yang. Pathogens entering the chest block yang qi from dispersing, causing chest fullness, oppression, hardness, rising heat, dryness, thirst, irritability, nausea, and rapid, intermittent pulse (heat constraint). Chest fullness, oppression, hardness, qi rushing to throat causing dyspnea, cold limbs, desire to vomit but unable, with slow, tight pulse (cold constraint). Diseases caused by constraint of cold, heat, qi, and fluid in the chest cannot be treated by diaphoresis or purgation. Sour-bitter emetic-draining agents are needed to induce upward emergence. Upper jiao opens, yang qi recovers, oppression/hardness dissipates, chest harmonizes. Melon Peduncle is extremely bitter; Adzuki Bean is sour. They assist each other to remove excess pathogens in chest/stomach, being the premier emetic. Adding Fermented Soybean porridge juice preserves Stomach qi via grain qi. Increasing dose slightly if no vomiting, stopping after vigorous vomiting, prevents injury to Stomach yuan qi. This formula acts faster than diaphoresis or purgation. Thus, the three methods stand equal. Moderns ignore the essence of Qibo and Zhang Zhongjing, discarding these formulas, which is lamentable.

Xiao Xian Xiong Tang (Minor Trap the Chest Decoction) treats epigastric oppression, pain upon pressure, and floating-slippery pulse.

Coptis Rhizome (1 liang)
Pinellia Tuber (half sheng)
Trichosanthes Fruit (large, 1 piece)

Boil the above three ingredients in 6 sheng of water. First boil Trichosanthes Fruit to 3 sheng. Remove dregs, add other herbs, boil to 2 sheng. Divide into three warm doses.

[Collected Annotations] Cheng Zhi stated: This is heat binding not yet deep, located in the epigastrium, unlike Da Xian Xiong Tang which is high in the chest. Pain on pressure is lighter than intolerance to touch. Floating-slippery pulse is slower than deep-tight. It arises from abundant phlegm-fluid combining with heat to bind internally, hence the floating-slippery pulse. Pinellia's pungency disperses, Coptis' bitterness drains, Trichosanthes' bitterness-moisture cleanses. All remove heat and dissipate binding in the chest. Boiling Trichosanthes first and dividing into three warm doses employs the method of treating the upper jiao slowly.

Cheng Yingmao stated: Coptis clears heat, Pinellia guides fluid, Trichosanthes moistens dryness. Combined to open constrained qi. Also named "Trap the Chest," though not harsh, it directly attacks and evacuates excess pathogens in the chest interior.

Da Xian Xiong Tang and Wan (Major Trap the Chest Decoction and Pill) mainly treats Taiyang fever where lack of diaphoresis leads to incorrect purgation. Exterior heat enters the chest via deficiency, binding with fluid that cannot transform into sweat, causing hardness, fullness, and pain from epigastrium to lower abdomen, intolerable to touch. Body has no significant heat, only head sweating, or tidal fever, dryness, thirst, and deep-tight pulse. Also treats early-stage edema and dysentery (chang pi) in robust individuals with sufficient qi and form.

Rhubarb (6 liang)
Mirabilite
Semen Lepidii (Bitter Teasel Seed)
Apricot Kernel (peeled, half sheng each)
Kansui Root (powder, 1 qian)

Boil Rhubarb, Apricot Kernel, and Semen Lepidii in water first. Remove dregs, add Mirabilite, boil 1-2 boils. Add Kansui powder. Take warm. Stop subsequent doses when brisk purgation occurs. If not severe, add White Honey (2 he), form pills like bullet sizes. Boil one pill in water. Effect occurs overnight. If no effect, take again.

[Collected Annotations] Ke Qin stated: The chest is where Zong Qi (Gathering Qi) originates, hence named Qi Sea. Qi is yang, belonging to the Taiyang sector. Qi is the mother of water. Clear qi allows fluid distribution; hot qi makes turbid water bind. Water binding in the chest prevents fluids from descending to moisten intestines, causing dry stool. Failure to transport to Bladder blocks water passages. Rhubarb and Mirabilite cleanse gastrointestinal heat-excess. Used as sovereign here because heat flooding internally requires bitter-cold treatment, and to moisten Yangming dryness. This is "draining the son when excess" method, and restraining Bladder cold with what it fears. Kansui's bitter-pungency directly attacks water binding. Since water binding stems from qi binding, assist with Apricot Kernel's bitter-warm to open qi within water; moving qi moves water. Since water binding stems from qi heat, assist with Semen Lepidii's great cold to clear qi-heat; clearing source cleanses flow. If chest water binding hasn't reached middle jiao, reduce dosage and add White Honey's sweetness to缓 (slow/moderate), retaining it in the chest, acting overnight to resolve chest-heart stagnation while protecting intestines/stomach. This uses aromatic agents as harmonizing agents. This formula promotes water and attacks accumulation, effective for early edema/dysentery. Must ensure patient is robust for single success. Weak patients or long-term illness unsuitable for attack must heed the warning against "deficiency inducing deficiency."

San Wu Bai San Formula (Three-Ingredient White Powder) treats Taiyang cold-real constraint chest without heat signs, and cold-real phlegm-fluid binding in chest/diaphragm.

Platycodon Root (3 fen)
Fritillaria Bulb (3 fen)
Croton Seed (peeled, roasted black, ground to paste, 1 fen)