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Gardenia (Shanzhi, 14 seeds, stir-fried) Fermented Soybean (Xiangchi, 4 he)

After the treatment of sweating, vomiting, or purging in Cold Damage (Shanghan), if deficiency vexation occurs with insomnia and a feeling of stifling discomfort in the heart, this formula is indicated.

Following sweating, vomiting, or purging, the healthy qi is insufficient, and pathogenic factors take advantage of the deficiency to knot in the chest. Therefore, vexation-heat and stifling discomfort arise. Vexation-heat refers to mental restlessness accompanied by heat; stifling discomfort refers to a feeling of mental frustration and depression. Gardenia has a bitter taste and can induce vomiting to expel pathogenic heat; Fermented Soybean has a putrid odor and can restrain the heat potential. This is what is meant by "bitterness overcomes heat, and putridity overcomes scorching."

This formula is only suitable for inducing vomiting to treat formless deficiency vexation; if used to eliminate substantial pathogens, it is not within the capacity of Gardenia to disperse them. To disperse substantial pathogens, the following Gengti San (Melon Peduncle Powder) is indicated.

Melon Peduncle (Gualougen, slightly stir-fried) Red Adzuki Bean (Chixiaodou, each 5 fen)

In Cold Damage, if there is excessive phlegm-fluid in the chest accompanied by headache, this formula treats it by inducing vomiting.

Excessive phlegm-fluid in the chest constitutes a substantial pattern, which differs from deficiency vexation; the interaction and overflow of phlegm-heat cause headache. The Classics state: "Bitterness can induce vomiting and purgation." Melon Peduncle is a bitter substance, so when used in the upper body, it induces vomiting of substantial phlegm in the chest. Tao Hongjing said: "Dryness can remove dampness, such as Red Adzuki Bean." Here it is used as an assistant herb, also intending to dry damp-phlegm. This formula effectively and swiftly removes phlegm by vomiting; however, it is contraindicated in cases of blood loss or deficiency patterns. For if vomiting is applied after blood loss, qi will also be depleted; if vomiting is applied in deficiency patterns, yin will be damaged.

Clam Shell (Wenge, ground into powder, 1 cun-bi measure)

When the disease is in the Yang aspect, water-cold therapy is wrongly applied. Heat is attacked internally, while cold becomes more solid. The patient desires to drink water, but giving water is inappropriate, hence it is called "wrongly applying water." Although heat attacks internally, because the cold-water stagnates and does not dissipate, the patient desires to drink but does not feel thirsty. This indicates the presence of retained water, so Wenge (Clam Shell) with its salty taste is used to moisten downward and break water retention.

Poria (Fuling) Polyporus (Zhu Ling) Atractylodes Macrocephala Rhizome (Baizhu, each 18 zhu) Alisma Rhizome (Zexie, 1 liang 6 zhu) Cinnamon Twig (Guizhi, 0.5 liang)

In Cold Damage, if there is difficulty in urination accompanied by thirst, this formula is indicated.

The water passages are blocked by heat, causing difficulty in urination; due to difficulty in urination, fluid metabolism cannot occur, leading to thirst. Water does not belong to any of the five flavors, so bland herbs are used to treat water retention. Poria, Polyporus, Alisma Rhizome, and Atractylodes Macrocephala Rhizome, although differing in being either moistening or drying, all possess a bland nature, thus all are sufficient to promote diuresis. Cinnamon Twig is acrid and warm; acrid and warm properties can transform qi. The Classics state: "The Bladder is the official of the capital, where fluids are stored; only through qi transformation can they be excreted." This is the rationale for using Cinnamon Twig here. Since Cinnamon Twig has the function of transforming qi, the formula is collectively named Wu Ling San (Five-Poria Powder). Once turbid yin exits through the lower orifice, clear yang naturally exits through the upper orifices; furthermore, heat is discharged with urine, so thirst can resolve spontaneously without specific treatment. Nevertheless, difficulty in urination can also result from the depletion of body fluids after sweating and purging. In such cases, one must not forcibly use Wu Ling San to promote diuresis; forcing diuresis would cause further fluid depletion and exacerbate yin deficiency. Thus it is stated: "After severe purging followed by sweating, if difficulty in urination occurs, it is due to fluid depletion; do not treat it directly. When urination becomes normal, it will heal itself." The Master also said: "Pathogens from the Taiyang channel traveling along the meridian reach the Bladder directly, causing difficulty in urination and symptoms resembling madness. This is because the Taiyang pathogen did not transmit to other channels but entered its fu-organ directly. Wu Ling San is indicated, which serves to discharge the yang pathogen via urine. Refer to the Huoluan (Huo Luan) section for cross-reference."