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38. In Yang syndromes (diseases characterized by excess heat or hyperactivity), Pi-hardness (a sensation of fullness and hardness in the epigastrium) belongs to Heat Pi, which can be settled with Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction). If accompanied by sweating, aversion to cold, and a mix of cold and heat, Fuzi Xiexin Tang (Aconite Heart-Draining Decoction) achieves success by addressing both aspects. If Shaoyang syndrome (syndrome of the Gallbladder and Triple Burner channels) results from premature purgation, presenting with fever and vomiting, Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) can resolve the epigastric fullness. For Pi syndrome complicated by deficiency, heat, and water qi, manifesting as dysentery, irritability, dry retching, and borborygmus, Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is indicated; for urgent Pi with rebellious Qi, Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is effective. Guizhi Tang (Cinnamon Twig Decoction) should be used to resolve the exterior before attacking Pi; Wuling San (Five-Ingredient Powder with Poria) is used for irritability, thirst, and promoting urination.

[Note] Premature purgation in Shanghan (Cold Damage) leads to Pi-hardness, while premature purgation in Fengshang (Wind Strike) leads to Jiechong (Knotted Chest), which is the general rule. However, the Treatise mentions that premature purgation in Wind Strike does not preclude Pi-hardness, nor does premature purgation in Cold Damage preclude Jiechong. Generally, transformations from deficiency tend toward Pi-hardness, while transformations from excess tend toward Jiechong. Epigastric Pi-hardness in Yang syndromes is Heat Pi, suitable for Dahuang Huanglian Xiexin Tang. If Yang syndrome presents with sweating and aversion to cold, it is Cold-Heat Pi, suitable for Fuzi Xiexin Tang. Misguided purgation leading to Shaoyang fever and vomiting, with epigastric fullness, constitutes Vomiting-Rebellious Qi Pi, suitable for Banxia Xiexin Tang. Yang syndrome mismanaged with purgation, resulting in epigastric Pi-hardness, dysentery, irritability, dry retching, borborygmus, subcostal water accumulation, and difficulty in urination, constitutes Deficient-Heat Water-Qi Pi, suitable for Shengjiang Xiexin Tang. If these symptoms are present but without subcostal water accumulation, and the Pi is urgent and severe, it constitutes Rebellious Qi Pi due to deficient heat, suitable for Gancao Xiexin Tang. For any Pi syndrome, if there is an exterior syndrome of no sweating and aversion to cold, one must first use Guizhi Tang to resolve the exterior; only after the exterior is resolved can Dahuang Huanglian Xiexin Tang be used to attack the Pi. If Pi persists despite taking Xiexin Decoctions, accompanied by irritability, thirst, and difficulty in urination, one should first use Wuling San; once urination becomes free, various Xiexin Decoctions can then be used to treat the Pi.

39. Damp-Heat Jaundice manifests as head sweating, difficulty in urination, and thirst, involving the Yangming channel. Individuals with pre-existing cold-dampness, after sweating therapy, may develop jaundice transforming from Yin, involving the Taiyin channel. Yang Jaundice has a bright color, while Yin Jaundice has a dark color; Sunyang Blood Accumulation may also cause jaundice, often accompanied by mania. For exterior excess with no sweating and jaundice, Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) is indicated; for interior excess with constipation, Yinchen Hao Tang (Artemisia Capillaris Seed Decoction) clears heat; Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) clears excessive heat. Yin Jaundice is primarily treated with Yinchen Sini Tang (Artemisia Capillaris and Counterflow Decoction); for loose stools and urinary retention, Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Powder with Poria) is used. Blackening around the mouth with soft sweat indicates a fatal condition; a body dry and rough like soot signifies the extinction of Yang Qi.

[Note] Yangming syndrome should present with generalized sweating, termed "Releasing Heat" (heat escaping via sweat). Currently, only the head sweats while the body does not, indicating heat cannot escape. Thirst with desire to drink and difficulty in urination indicate water retention. Heat and dampness stagnate and transform through the Earth element (Spleen/Stomach), affecting the muscles externally, known as Damp-Heat Jaundice. Alternatively, if a person has pre-existing cold-dampness, suppressed by exterior pathogens, or already has jaundice and undergoes sweating therapy, transmitting to the Taiyin channel, transforming from Yin, it is called Cold-Damp Jaundice. Yangming belongs to Yang, hence its color is bright. Taiyin belongs to Yin, hence its color is dull. Sunyang Blood Accumulation can also cause jaundice, often co-occurring with mania; treatment should follow the principles for Blood Accumulation. For exterior excess with no sweating and jaundice, Ma Huang Lian Qiao Chi Xiao Dou Tang is indicated to induce sweating. For interior excess with constipation, Yinchen Hao Tang is indicated to purge. Without exterior or interior signs but with excessive heat, Zhizi Bopi Tang is indicated to clear. For Yin syndrome jaundice, Yinchen Sini Tang is indicated to warm. For loose stools, urinary obstruction, and jaundice, Yinchen Wuling San is indicated to promote diuresis. Blackening around the mouth with soft sweat (cold sweat) is a fatal sign of Yin Jaundice. A body dry and rough like soot is a fatal sign of Yang Jaundice.