Library

Distension and fullness in the hypochondrium, dry retching, and alternating chills and fever indicate Shaoyang disease. (For the formula discussion, see "Alternating Chills and Fever".)

In cold damage disease, after four or five days, if there is body heat, aversion to wind, stiffness of the neck and nape, fullness below the costal margin, warm hands and feet, and thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Banxia (Pinelliae Rhizoma) removed, and Renshen (Ginseng Radix et Rhizoma) and Gualougen (Trichosanthis Radix) added should be used as the primary treatment. If, after six or seven days of illness, the pulse is floating, sinking, and weak, accompanied by aversion to cold and wind, warm hands and feet, and the physician has performed purgation two or three times, leading to inability to eat, fullness and pain below the costal margin, yellowing of the face and body, stiffness of the neck and nape, and difficulty in urination, administering Chai Hu Tang (Bupleurum Decoction) will certainly cause a sensation of heaviness in the anus during defecation.

[From *Bencao*] If there is thirst, desire to drink water, but vomiting after drinking, Chai Hu Tang should not be administered; eating grain will induce hiccups. (Wang Bing's commentary states: Vomiting without desire to drink water belongs to the Chai Hu syndrome; if vomiting is caused by water retention, it is due to water stagnating in the epigastrium.) Fullness in the hypochondrium combined with Shi Wei (Stomach Excess/Heat), or vomiting with a white coating on the tongue, or a pulse that is wiry, floating, and large, with jaundice, difficulty in urination, and heat, all belong to Yangming syndrome, for which Xiao Chai Hu Tang (Minor Bupleurum Decoction) is suitable. (For the formula discussion, see "Stomach Excess".) Fullness in the hypochondrium with tidal fever and loose stools should be treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). (For the formula discussion, see "Tidal Fever"). If vomiting occurs due to mild diarrhea induced by improper purgation, first use Chai Hu Tang (Bupleurum Decoction) to resolve the exterior, then treat with Xiao Chai Hu Jia Mangxiao Tang (Minor Bupleurum Decoction plus Natrii Sulfas). (For the formula discussion, see "Tidal Fever".) In Taiyang disease, if ten days have passed and the pulse is floating and fine, and the patient prefers lying down, the exterior pathogen has been resolved. If there is chest fullness and hypochondriac pain, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If the pulse is floating, administer Ma Huang Tang (Ephedra Decoction). In Taiyang Wind Strike syndrome, with diarrhea and vomiting/reversal of qi, once the exterior is resolved, one may proceed to attack the interior. If the patient sweats, with attacks occurring at regular times, headache, epigastric stuffiness, fullness, hardness, pain radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is disharmonious. Shizao Tang (Ten Dates Decoction) is appropriate.

Yuanhua (Genkwa Flos, stir-fried until black) Gansui (Kansui Radix) Daji (Euphorbiae Pekinensis Radix) (equal parts)

Grind the above herbs into a fine powder, mix well, and pound in a mortar two or three hundred times. First, boil ten large dates in one sheng of water, reduce to approximately half a sheng, remove the dregs, and add the herbal powder. For strong individuals, take one qian; for weak individuals, take half a qian. Take alone with the date decoction in the morning before dawn. If the purgation is insufficient and the disease persists, administer again the next day, increasing the dose by five fen. After purgation, nourish the body with rice congee. If purgation is indicated but does not occur, it will lead to abdominal distension and generalized edema. Previously, Du Ren asked Sun Zhao: "What disease does Shizao Tang (Ten Dates Decoction) ultimately treat?" Sun replied: "It treats Taiyang Wind Strike where the exterior is resolved but the interior is disharmonious." Du asked: "How do you know the interior is disharmonious?" Sun said: "Headache, epigastric stuffiness and fullness, hypochondriac pain, dry retching, and sweating indicate interior disharmony." Du said: "You only listed the symptoms, but you have not stated the crucial reason why the interior is disharmonious." Sun said: "I was uncertain about this and wish to hear your enlightenment." Du said: "Interior disharmony here is due to phlegm and dry qi obstructing the middle jiao, causing headache, dry retching, shortness of breath, and sweating; this is Phlegm Obstruction (Tan Ge), which cannot be cured except by Shizao Tang (Ten Dates Decoction). However, this decoction must not be used lightly, as it may harm the patient suddenly. Physicians must exercise caution."

When a woman suffers from fever and aversion to cold, and her menses happen to begin, followed by the cessation of fever, slow pulse, cool body, hypochondriac fullness resembling Jie Xiong (Chest Binding) syndrome, and delirium, puncture Qimen (Liv14). (For the discussion, see "Delirium".)

After emesis, purgation, and diaphoresis, if the pulse is faint, there is epigastric stuffiness, hypochondriac pain, qi rushing up to the throat, vertigo, and pulsating tremors, Wei Syndrome (Flaccidity Syndrome) will develop. (For the discussion, see "Stuffiness".) After purgation, if the pulse is wiry, there will inevitably be tension and tightness in both hypochondria. (For the discussion, see "General Principles of Cold Damage".)