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The retention of water qi (pathogenic moisture and energy) in the epigastrium can cause dry retching, coughing, and wheezing. However, this water qi remains formless and does not lead to a sensation of fullness and hardness. In cases of Cold Damage (Shanghan), or when the healthy qi of the middle jiao is damaged by sweating, vomiting, or purging, the Chong Qi (Penetrating Vessel Qi) and Liver Qi may ascend due to the deficiency of Middle Qi, pressing and clashing in the epigastrium to cause a sensation of fullness and hardness. Furthermore, if exhaled air must be released through belching, this condition cannot be treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). Instead, it must be treated with Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction).

Original text from *Shanghan Lun* (Treatise on Cold Damage): After sweating, vomiting, or purging for Cold Damage, if the pathogen is resolved but there remains a sensation of fullness and hardness in the epigastrium accompanied by persistent belching, Xuan Fu Dai Zhe Shi Tang should be administered.

[Xuan Fu Dai Zhe Shi Tang Formula] Xuan Fu Hua (Inula Flower) 3 liang, Ren Shen (Ginseng Root) 2 liang, Sheng Jiang (Fresh Ginger Rhizome) 5 liang sliced, Dai Zhe Shi (Hematite) 1 liang, Da Zao (Jujube Fruit) 12 pieces split open, Gan Cao (Licorice Root) 3 liang honey-fried, Ban Xia (Pinellia Tuber) half sheng washed.

Take the above seven ingredients, boil in one dou (approx. 10 liters) of water until reduced to six sheng (approx. 6 liters), remove the dregs, and boil again until reduced to three sheng (approx. 3 liters). Take one sheng (approx. 300ml) warm at a time, three times daily.

The most critical responsibility of Stomach Qi is the transportation of food and drink; thus, its smooth downward movement is the norm. In this syndrome, damage to Stomach Qi by sweating, vomiting, or purging prevents downward movement, causing it to rebel upward. The Chong Mai (Penetrating Vessel) of the lower jiao, which originally ascends to connect with the Yangming Stomach channel, is drawn upward by the rebellious Stomach Qi, further exacerbating the upward rebellion. Additionally, while Liver Qi normally assists the Stomach in digestion, it too rebels upward in this state, clustering in the epigastrium to cause fullness and hardness. This obstructs respiratory Qi from ascending, resulting in persistent belching. Belching is the sound of forcibly exhaling air. Phlegm-fluids and Qi stagnate together within. Therefore, Xuan Fu Hua is used to expel phlegm-fluids and relieve hypochondriac fullness, descending Stomach Qi and soothing the Liver. It is assisted by Dai Zhe Shi and Ban Xia to descend Stomach Qi and calm the Chong Qi. Ren Shen, Gan Cao, Da Zao, and Sheng Jiang are added to tonify the deficiency of Stomach Qi. Assisting these descending, liver-soothing, and Chong-calming agents, therapeutic efficacy is readily achieved.

Dai Zhe Shi is most effective in soothing the Liver, descending Stomach Qi, and calming the Chong Qi, acting as a key general in this formula. However, the original prescription uses only 1 liang (approx. 3 qian modern weight). If calculated as one-third, a single dose contains only 1 qian. Such a light dosage is unlikely to be effective. Therefore, I use this formula with a light dosage of 6 qian or a heavy dosage of 1 liang. Using such larger amounts not only aids Xuan Fu Hua and Ban Xia in soothing the Liver, descending Stomach Qi, and calming the Chong Qi, but also assists Ren Shen in supporting healthy Qi. Although Ren Shen is excellent for tonifying Qi, its nature tends to ascend and float. Only by borrowing the heavy, descending property of Dai Zhe Shi to neutralize this ascent can the tonifying power of Ren Shen reach down to the Yongquan point (KI-1). Otherwise, merely using Ren Shen to tonify Qi allows its ascending nature to support rebellious Qi rather than healthy Qi, rendering its use ineffective. Thus, based on repeated experience, I know that in this formula, even in small doses, Dai Zhe Shi should be used in three times the amount of Ren Shen.

*Xun Fu Hua* (Inula Flower), according to *Shennong Bencao Jing* (Divine Farmer's Materia Medica), has a salty taste and treats constrained Qi, hypochondriac fullness, palpitations, and removes water. Due to its salty taste, resembling Po Xiao (Mirabilite), it possesses the function of softening hardness and promoting downward movement, thereby achieving the aforementioned effects. The *Xuan Fu Hua* produced in Wudi Taiwu, my hometown (Yanshan), has a salty and pungent taste. It is indeed highly effective in soothing the Liver, descending Stomach Qi, resolving phlegm, and promoting Qi flow.

A boy surnamed Wang, aged twelve or thirteen, suddenly suffered paralysis of the left side of his body upon waking in the morning. I determined this was due to phlegm and blood stasis blocking the collaterals, preventing the free flow of Qi and Blood. At that time, I had some self-made Ban Xia and collected *Xuan Fu Hua* from Wudi Taiwu. I first gave him the self-made Ban Xia, ground into powder to be taken slowly. After consuming 6 liang, his weakness decreased by half. Subsequently, I gave him the Wudi Taiwu *Xuan Fu Hua*, instructing him to take 2.5 qian per dose, decocted in water, twice daily. He recovered completely after ten days. This is likely because its salty and pungent taste enhances its ability to resolve phlegm and unblock stasis, yielding rapid results. *Xuan Fu Hua* with a salty and pungent taste is a rare and superior quality. Those with a slightly salty and not very bitter taste, possibly found in pharmacies, can also be effective. If even this type is unavailable, when using this formula, reduce the dosage of *Xuan Fu Hua* by half and add several qian more of Dai Zhe Shi. Such modification can also yield temporary effectiveness.

Someone asked: Respiration occurs only in the Lungs. In the syndrome of Xuan Fu Dai Zhe Shi Tang, the fullness and hardness are located in the epigastrium. How does this interfere with respiration to the extent of causing persistent belching? I answer: The Lungs are the organ initiating respiration. However, the reach of respiratory Qi extends beyond the Lungs. The Lung tubes have branches connecting downward to the Heart, then penetrating the diaphragm to connect with the Liver, and further connecting via the Liver to the fatty membrane surrounding the Kidneys, leading to the Bao Shi (Uterus/Womb, present in both sexes). For instance, when a woman is pregnant, the umbilical cord connects to the Bao Shi, allowing the fetus to inhale and exhale along with the mother. Is this not clear evidence that Qi can descend? From this, we understand that the Qi blocked by epigastric fullness and hardness, although related to respiration, is actually the Qi descending from the branches of the Lung tubes.