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Ephedrae Herba (Mahuang, 麻黄) [removed nodes] 2.5 liang, Cimicifugae Rhizoma (Shengma, 升麻) 1.1 liang, Angelicae Sinensis Radix (Danggui, 当归) 1.1 liang, Anemarrhenae Rhizoma (Zhimu, 知母) 18 zhu, Scutellariae Radix (Huangqin, 黄芩) 18 zhu, Polygonati Odorati Rhizoma (Weirui, 萎蕤) 18 zhu, Gypsum Fibrosum (Shigao, 石膏) [crushed and wrapped in cotton] 6 zhu, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) 6 zhu, Zingiberis Rhizoma Recens (Ganjiang, 干姜) 6 zhu, Paeoniae Radix Alba (Shaoyao, 芍药) 6 zhu, Asparagi Radix (Tian dong, 天冬) [core removed] 6 zhu, Cinnamomi Ramulus (Guizhi, 桂枝) 6 zhu, Poria (Fuling, 茯苓) 6 zhu, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [honey-fried] 6 zhu.

The above fourteen ingredients are decocted with one dou of water. First, boil Ephedrae Herba for one or two boils, remove the foam on the surface, then add the remaining herbs. Decoct until three sheng of liquid remain, filter out the dregs, and divide into three warm doses. The interval between doses should be approximately the time it takes to cook three sheng of rice. Take all the medicine. Recovery occurs when sweating ensues.

[Fangjie - Formula Analysis]
If the condition presents as cold below and heat above without exterior syndrome, the method of Huanglian Tang (Coptis Decoction) should be adopted. Since an exterior syndrome is present now, this formula is established separately to demonstrate the beginning of flexible treatment based on symptom changes. Cimicifugae Rhizoma, Polygonati Odorati Rhizoma, Scutellariae Radix, Gypsum Fibrosum, Anemarrhenae Rhizoma, and Asparagi Radix are herbs that ascend and clear heat; they are used to avoid the cold below and nourish the upper part. Ephedrae Herba, Cinnamomi Ramulus, Zingiberis Rhizoma Recens, Angelicae Sinensis Radix, Paeoniae Radix Alba, Atractylodis Macrocephalae Rhizoma, Poria, and Glycyrrhizae Radix et Rhizoma are acrid-sweet herbs that move outward and disperse warmth; they are used to distance from the heat above and harmonize the interior. Dividing into three warm doses ensures complete intake; the intention is to expel pathogens gently without damaging healthy qi, thoroughly eliminating the pathogen. Although the pulse is deep and slow at the Cun position and absent at the Chi position; although symptoms include cold extremities and continuous diarrhea; fundamentally, it is not a pure yin-cold pathogen. Therefore, there are concurrent symptoms of sore throat and expectoration of pus and blood. This is a disease of confused cold and heat, mixed yin and yang, resulting from severe purgation damaging the middle jiao. Thus, Zhang Zhongjing uses this decoction primarily to expel pathogens; once pathogens are expelled, healthy qi naturally settles.

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In Taiyang Cold Damage (Shanghan), after eight or nine days, if purgation is mistakenly applied, resulting in chest fullness, irritability, fright, difficulty in urination, delirious speech, heaviness of the entire body, and inability to turn over, Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is indicated.

[Zhu - Annotation]
After eight or nine days of Taiyang Cold Damage, if the pathogen is unresolved and the exterior syndrome is not cleared, purgation should not be used. If purgation is mistakenly applied, the pathogen will sink inward due to deficiency. In the upper part, mild cases present with chest fullness, while severe cases present with Jie Xiong (chest binding); chest fullness is caused by heat entering the chest and qi stagnation. In the middle part, mild cases present with irritability and fright, while severe cases present with coma and mania; irritability, fright, and delirious speech are caused by heat affecting the Heart, leading to restless Shen (spirit). In the lower part, mild cases present with difficulty in urination, while severe cases present with hypogastric fullness and pain; difficulty in urination is caused by heat lodging in the Lower Jiao, obstructing the water passages. Pathogenic factors stagnating in the San Jiao (Triple Burner) prevent the smooth flow of Ying (Nutritive) and Wei (Defensive) Qi. With no outlet for water, it seeps externally into the muscles and skin, causing heaviness of the entire body and inability to turn over. Chaihu Jia Longgu Muli Tang is used; its main principle is to harmonize and sedate, combining attack and tonification.

[An - Commentary]
This clause describes body heaviness due to damp-heat in the Yang meridians. It would be erroneous to attribute it to fluid depletion and blood stasis preventing the dissemination of Yang Qi, which would characterize body heaviness due to damp-cold in the Yin meridians. For body heaviness due to cold-damp, Zhenwu Tang (True Warrior Decoction) and Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) are used because there is no thirst and no internal heat. For body heaviness due to heat-damp, Baihu Tang (White Tiger Decoction) and Chaihu Jia Longgu Muli Tang are used because there is irritability/thirst and stomach heat. Body heaviness due to Wind-Damp or Wind-Warmth also involves combinations of cold or heat; thus, this formula uses Poria, Pinelliae Rhizoma, and Rhei Radix et Rhizoma as assistants.

[Jizhu - Collected Annotations]
Fang Youzhi stated: Chest fullness results from interior deficiency after purgation, allowing external heat to enter the interior and carry phlegm-fluid upward to the diaphragm, causing irritability. Fright injures the Heart; the Heart houses the Shen and resides below the diaphragm. When healthy qi is deficient and pathogenic factors prevail, the Shen becomes restless. Heaviness of the entire body and inability to turn over occur because Taiyang Cold Damage originally causes whole-body pain. Depletion of body fluids leads to blood stasis and obstruction, transforming into sinking stagnation and increased heaviness.

Cheng Zhi stated: Irritability and abdominal fullness after purgation are treated with Gardeniae Fructus and Magnoliae Officinalis Cortex because the pathogen has entered the abdomen. Chest fullness, irritability, and fright after purgation are treated with Dragon Bone and Oyster Shell because the pathogen has entered the Heart. Irritability and fright caused by fire therapy are treated with Guizhi Jia Longgu Muli Tang to rescue the outwardly floating Heart Yang. Irritability and fright caused by purgation are treated with Chaihu Jia Longgu Muli Tang to resolve the internal blockage of Heart Yang. Xiaoxianxiong Tang (Minor Intra-thoracic Binding Decoction) and Daxianxiong Tang (Major Intra-thoracic Binding Decoction) are distinguished by high/low location and urgency/xiety. Various Xiexin Tang (Drain the Epigastrium Decoctions) are differentiated by cold/heat and deficiency/excess. Pinelliae Rhizoma and Poria treat phlegm; Scutellariae Radix and Scutellariae Barbatae? No, Huanglian (Coptidis Rhizoma) directs rebellious qi downward; Gardeniae Fructus and Sojae Preparata (Zhi Chi) induce vomiting for empty irritability; Ginseng Radix and Aconiti Lateralis Radix Praeparata restore Yang in deficiency. The major principles of treatment after purgation are fully contained herein.

Yu Chang stated: Purging after passing eight or nine days seems cautious! Who knew that incomplete external pathogens would sink inward due to deficiency? While the pathogen is still between the exterior and interior, the affliction has already reached the Shen (Spirit). To remedy this situation, is it easy?

Zhang Lu stated: This belongs to the interior syndrome of Shaoyang (Lesser Yang). Previous annotations incorrectly classified it as a Heart Meridian disease. Shaoyang has three prohibitions and must not be violated arbitrarily. Even after eight or nine days, mistaken purgation causes the pathogen to invade internally, injuring Stomach Earth and depriving Gallbladder Wood of nourishment. Phlegm accumulates above the diaphragm, causing such transformations. Therefore, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to harmonize the interior and exterior, expel fluid retention, and unblock fluids, supplemented with Dragon Bone and Oyster Shell to calm the fright of the Liver and Gallbladder.