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[From *Huoren Shu* (Book of Vitality)] In cold damage diseases, there is originally no "Pi" (stagnation/fullness) syndrome. The correct treatment should be sweating; if the physician mistakenly uses purgation, Pi syndrome ensues. Zhishi Lizhong Wan (Aurantium Fructus and Poria Decoction) is the best choice. Once Pi syndrome is confirmed, using Jiegeng Zhike Tang (Platycodon and Bitter Orange Decoction) first is particularly effective.
This is because Jiegeng (Platycodon Root) and Zhike (Bitter Orange Fruit) regulate Qi; using them first proves invariably effective.
Jiegeng Zhike Tang treats Pi qi (Qi stagnation in the chest) caused by cold damage, characterized by chest fullness feeling as if it were about to sever.
Ingredients: Jiegeng (Platycodon Root), Zhike (Bitter Orange Fruit, bran-fried, pith removed; each 2 liang).
Preparation: Coarsely crush the herbs. Add two zhan (approx. 400ml) of water, decoct until one zhan remains. Strain and divide into two doses.

After sweating, vomiting, or purging, deficiency-heat vexation occurs with insomnia. If severe, the patient tosses and turns, experiencing internal restlessness and regret (Ao Gu), treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If accompanied by shortness of breath, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is used. If accompanied by vomiting, Zhizi Shengjiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is used. In Yangming disease, after purgation, if exterior heat persists, hands and feet are warm, and no Jie Xiong (chest binding) has formed, but there is internal restlessness in the epigastrium, hunger without desire to eat, and only head sweating, Zhizi Chi Tang is indicated. In Yangming disease, if the pulse is floating and tight, and purgation was mistakenly applied, leaving the stomach empty and allowing pathogenic Qi to disturb the diaphragm, resulting in internal restlessness and a white tongue coating, Zhizi Chi Tang is appropriate. (Discussion see Self-Sweating section.)
After diarrhea ceases, if vexation appears and the epigastrium is soft upon palpation, it is deficiency-vexation, treated with Zhizi Chi Tang.
Ingredients: Fei Zhizi (Large Gardenia Fruit, four pieces, broken), Xiang Chi (Fermented Soybean, half liang).
Preparation: Add two zhan of water. First decoct Zhizi until one zhan remains, then add Xiang Chi and decoct together until seven-tenths remain. Strain and take warm. If rapid vomiting occurs, stop subsequent doses.
Zhizi Gancao Chi Tang: Add half liang of Gancao (Licorice Root) to Zhizi Chi Tang. Follow previous methods; stop if vomiting occurs.
Zhizi Shengjiang Chi Tang: Add 1.2 qian of Shengjiang (Fresh Ginger) to Zhizi Chi Tang. Follow previous methods; stop subsequent doses if vomiting occurs.
In cold damage, if a physician uses pill-based strong purgatives, body heat persists, and there is slight vexation, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is indicated.
Ingredients: Zhizi (Gardenia Fruit, 4 liang, broken), Ganjiang (Dried Ginger, half liang).
Preparation: Add one and a half zhan of water to these two ingredients. Decoct until eight-tenths remain. Strain and take warm. Stop subsequent doses if vomiting occurs.
After sweating, vomiting, or purging, if there is internal restlessness and vexation, and there is no dry stool with normal bowel movements, this indicates the indication for Zhizi Chi Tang and similar formulas; if there is dry stool and constipation, refer to the Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) formula later.
In Taiyang disease, if emesis, purgation, or sweating leads to slight vexation, frequent urination, and consequent hard stools, Xiaochengqi Tang is given to harmonize and cure.
In Yangming disease, after purgation, if there is internal restlessness in the epigastrium and vexation, and dry stool exists in the stomach, attack may proceed. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, do not attack. If dry stool exists, Dachengqi Tang (Major Order the Yellow Dragon Decoction) is appropriate. (Formula see Yangming Tidal Fever section.) For gastric excess causing constipation and vexation, if following emesis or purgation, use Dachengqi Tang or Xiaochengqi Tang; if not following emesis/purgation, use Wei Chengqi Tang (Stomach-Harmonizing Order the Yellow Dragon Decoction).
[Xu Shumi] A patient suffered from cold damage for eight or nine days, with body heat, no sweat, occasional delirium, and constipation for three days due to prior mistaken purgation. There was neither agitation nor vexation, neither aversion to cold nor pain. The patient could not lie down all night, feeling an indescribable discomfort in the heart/mind, occasionally emitting a sigh-like sound. The physician did not know the syndrome. I diagnosed it as simultaneous occurrence of Ao Gu (internal restlessness) and Fu Yu (depressed Qi). With dry stool in the stomach, administering Chengqi Tang expelled twenty pieces of dry stool, leading to recovery through bowel movement. Zhang Zhongjing stated: In Yangming disease after purgation, if there is internal restlessness and slight vexation with dry stool in the stomach, attack is possible. He also said: If there is difficulty in urination, alternating difficulty and ease in defecation, slight fever, and depressed Qi preventing sleep, there is dry stool, treated with Chengqi Tang. *Suwen* states: When the Stomach is disharmonious, sleep is uneasy; thus the inability to sleep at night. Zhang Zhongjing stated: Dryness in the Stomach with hard stools causes delirium; hence the occasional delirium. The absence of vexation/agitation/cold/pain explains the internal restlessness. The sigh-like sound represents external Qi depression. Once dry stool is removed and bowel movements normalize, Stomach harmony is restored, and the disease resolves.
Inability to sleep with vexation. (Discussion see Insomnia section.)
Chest fullness with vexation: If not preceded by sweating, accompanied by alternating chills and fever, use Xiaochaihu Tang (Minor Bupleurum Decoction). (Formula discussion see Alternating Chills and Fever section.) If accompanied by diarrhea and sore throat, use Zhufu Tang (Pig Skin Decoction). (Formula discussion see Diarrhea section.) If following sweating or purgation, with alternating chills and fever, use Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). (Formula discussion see Alternating Chills and Fever section.) If accompanied by heavy body and inability to turn, use Chaihu Longgu Muli Tang (Bupleurum, Dragon Bone, and Oyster Shell Decoction). (Formula discussion see Palpitations/Fright section.)
After sweating or purgation, if there is vexing heat and chest obstruction, Zhizi Chi Tang is indicated.
Epigastric hardness and fullness with vexation: If full but not painful, with borborygmus and diarrhea, use Ganxiao Xiexin Tang (Licorice, Pinellia, and Scutellaria Decoction modified). Pain in the hypochondrium with Qi rushing to the throat and dizziness may lead to flaccidity syndromes. (Formula discussion see Pi Syndrome section.)
If full, painful, with incessant diarrhea and inability to swallow fluids, it is a combined disease. (Formula discussion see Pi Syndrome section.) After cold damage purgation, if there is vexation, abdominal fullness, and restlessness in lying down or sitting up, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is appropriate.
Ingredients: Zhizi (Gardenia Fruit, shelled, 4 liang), Houpo (Magnolia Bark, ginger-processed, 1 liang), Zhishi (Immature Bitter Orange, sliced, 1 piece).
Preparation: Add one and a half zhan of water to these three ingredients. Decoct until eight-tenths remain. Strain and take warm. Stop subsequent doses if vomiting occurs.
Abdominal fullness with vexation: If dry stool exists, it is the Dachengqi Tang syndrome mentioned earlier; if stools are loose, chest pain with urge to vomit, following recent violent emesis/purgation, it is Wei Chengqi Tang. (Discussion see Vomiting section.)
In Taiyang disease, after emesis, although Taiyang disease typically presents with aversion to cold, now there is no aversion to cold and a dislike for clothing; this is internal vexation caused by emesis. The pulse is slightly rapid; moxibustion is contraindicated as it will cause vexing rebellion. (Discussion see General Principles section.)
During vomiting, if there is depressed slight vexation, and Xiaochaihu Tang fails to stop vomiting, use Dachaihu Tang (Major Bupleurum Decoction); if following violent emesis/purgation, with chest fullness, loose stools, and abdominal pain, use Wei Chengqi Tang.
When a disease is about to resolve, there must first be vexation, followed by sweating and resolution. (Discussion see General Principles section.) In Taiyang disease, if initial administration of Guizhi Tang (Cinnamon Twig Decoction) results in unresolved vexation, first puncture Fengchi (GB20) and Fengfu (GV16), then administer Guizhi Tang for cure. In cold damage, if fever resolves via sweating but returns with vexation after half a day, and the pulse is floating and rapid, repeat sweating with Guizhi Tang.
If the patient's pulse has normalized but there is slight evening vexation, it is because the disease has just healed, people force feeding, and the Spleen/Stomach Qi is still weak, unable to digest food, causing slight heat and vexation; reducing food intake leads to recovery. After emesis, diarrhea, or sweating, if the pulse is calm but there is slight vexation, it is due to Stomach deficiency being unable to handle grain Qi. (Discussion see Emesis/Diarrhea section.)
Palpitations with vexation: If following Shaoyang sweating, with delirium and Stomach disharmony causing vexation and palpitations, *Huoren Shu* recommends Wei Chengqi Tang. (Discussion see Bitter Taste section.) If within two to three days there are palpitations and vexation in the heart, use Xiaojianzhong Tang (Minor Construct the Middle Decoction). (Discussion see Palpitations section.) Vexation with thirst. (Formula discussion see Thirst section.)
In Shaoyin disease, if there is desire to sleep with vexation, spontaneous diarrhea with thirst, and white urine, *Huoren Shu* uses Sini Tang (Frigid Extremities Decoction). (Discussion see Desire to Sleep section.) If after Baicong Tang (White Onion Decoction), diarrhea continues, extremities are cold, pulse is absent, and there is dry heaving, use Baicong Tang plus Pig Bile. If there is aversion to cold, fatigue, and frequent vexation with desire to remove clothes, the condition is treatable. (Discussion see Desire to Sleep section.)
Cold extremities with vexation: If the pulse is intermittently knotted or tight, with epigastric fullness, hunger but inability to eat, use Gouti San (Melon Seed Powder) to induce vomiting. If the pulse is tight, and after seven to eight days spontaneous diarrhea occurs, with the tight pulse suddenly becoming faint and extremities warming, resolution is desired. (Formulas/Discussion see Diarrhea section.) If diarrhea occurs with absent pulse and dry heaving, use Baicong Tang plus Pig Bile. (Discussion see Diarrhea section.)