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(Zhang Zhongjing)
Treats cases where the exterior syndrome of Shanghan (Cold Damage) is not resolved, with heat accumulating in the Bladder meridian, causing fullness and distension in the lower abdomen, black stools, free urination, restlessness, thirst, delirium, fever due to blood stasis, and manic behavior;
as well as stomach pain, abdominal pain, and hypochondriac pain caused by blood stasis; nocturnal onset of excess-heat type malaria; dysentery; and acute pain due to blood stasis. (Note: Heat pathogen fails to resolve from the Taiyang meridian, transmits to the Bladder meridian, and contends with blood. If blood discharges spontaneously, heat exits with the blood and the disease resolves; if it does not discharge, blood accumulates in the Lower Jiao, hence the urgent distension of the lower abdomen and visible cyanotic veins on the skin; black stools indicate blood stasis; free urination indicates pathology in the Blood level while the Qi level remains unaffected; free urination combined with persistent lower abdominal urgency confirms blood accumulation. The Heart governs the blood vessels; when evil heat harasses the upper body, the Heart Spirit becomes unsettled, resulting in restlessness, delirium, and manic behavior; when blood stasis gathers in the Yangming meridian, it causes stomach pain; in the Taiyin meridian, abdominal pain; in the Jueyin meridian, hypochondriac pain. Nocturnal onset of malaria indicates heat entering the Blood level. The *Liu Ren Shu* states: If sweating is indicated but not performed, or conversely, if sweating is performed when inappropriate, fluids are depleted. Extreme agitation of Yang invades Yin, causing dry blood to accumulate in the chest. Li Shizhen states: Taiyang syndromes present with manic-like behavior; Yangming syndromes present with forgetfulness; Shaoyang syndromes present with alternating chills and fever resembling malaria. In Shanghan, if Da Chengqi Tang is ineffective and the patient presents with hard stools and good appetite, this is due to blood stasis. Fullness in the chest or epigastrium is due to Qi stagnation; fullness in the abdomen may be due to dry feces or retained food; fullness in the lower abdomen may be due to urine retention or blood accumulation. Clear Yang emerges from the upper orifices, so upper fullness is due to Qi rather than tangible matter; turbid Yin emerges from the lower orifices, so lower fullness is due to tangible matter rather than Qi. These are mostly heat diseases; only cold binding in the Bladder with lower abdominal fullness accompanied by cold limbs belongs to cold patterns.)

Taoren (Peach Kernel, 50 seeds, remove skin and tips, grind) Dahuang (Rhubarb Root and Rhizome, 4 liang) Mangxiao (Mirabilite) Gancao (Licorice Root) Guizhi (Cinnamon Twig, 2 liang)

This formula acts on the Foot-Taiyang meridian. Dahuang and Mangxiao purge heat and eliminate excess; Gancao harmonizes the Stomach and moderates the middle. This constitutes the base of Tiaowei Chengqi Tang. When heat is severe and contends with blood, blood aggregates to form stasis... (Text fragment follows)... (*Qunshu Zhengzhi* states: Guizhi is light, ascending, and dispersing; here it should refer to the twig rather than just the bark. Yu Jiayan states: Taoren is used to reach the blood level, and Guizhi is added to release exterior pathogens, similar to using Chaihu in Da Chaihu Tang to release the exterior. This further proves that pathogens following the meridian into the interior in Taiyang cannot be resolved without Guizhi. Wang Ang notes: Shanghan differs from miscellaneous diseases; Zhang Zhongjing's works are specifically for Shanghan, thus Guizhi should be used. Cheng Jiaoqian states: Wuling San and Taoren Chengqi Tang both treat Taiyang pathogen invading the Fu organs; one promotes urination targeting the Qi level, the other promotes bowel movement targeting the Blood level, with different treatments. Yingningsheng states: For conditions such as bleeding or abnormal blood flow due to accumulation, initially use agents like Taoren and Dahuang to move blood and break stasis to curb their sharpness, then differentiate treatment. Question: How can deficiency withstand purgation after hemorrhage? Su Yifangju answers: Since blood has wandered and lost its proper course, if accumulated blood and stasis are not removed and guided out, wandering will become the norm, and how can it be controlled? Moreover, what is removed goes away, and what is generated arises naturally; why would there be deficiency?)

Adding Qingpi (Bitter Orange Peel), Zhishi (Immature Bitter Orange Fruit), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Sumu juice (Sappan Wood Juice), and Chaihu (Bupleurum Root) to this formula creates Tao Ren Cheng Qi Yin Zi. (Jie'an added Qingpi and Zhishi because breaking blood requires moving Qi; adding Danggui and Shaoyao removes stasis and generates new blood; Chaihu soothes the Liver, raises clear Yang, and disperses exterior heat; Sumu assists Taoren and Guixin...)