Library

(Zhang Zhongjing)
Treats *Shanghan* (Cold Damage) presenting with epigastric fullness and obstruction (*Xin Xia Pi*), accompanied by aversion to cold and sweating. (In *Shanghan*, epigastric fullness with pain is termed *Jie Xiong* [Chest Binding], which is an excess condition; hardness and fullness without pain is termed *Pi* [Obstruction]).

[Formula Composition]
Fuzi (Aconiti Lateralis Radix Praeparata, one piece, processed, skin removed, broken, decocted separately to extract the juice)
Dahuang (Rhei Radix et Rhizoma, two liang) Huanglian (Coptidis Rhizoma) Huangqin (Scutellariae Radix, each one liang)

[Formula Analysis]
This formula acts on the Foot-Taiyang Bladder Meridian and Hand-Shaoyin Heart Meridian. Wu Hegao stated: For epigastric obstruction, Sanhuang (Three Yellows: Dahuang, Huanglian, Huangqin) is used to drain the obstruction; for aversion to cold and sweating, Fuzi is used to secure Yang Qi.

[Modifications]
Removing Fuzi from this formula yields Sanhuang Xiexin Tang (Three Yellows Decoction to Drain the Epigastrium) (see previous). Removing Huangqin as well yields Dahuang Huanglian Xiexin Tang (Dahuang and Huanglian Decoction to Drain the Epigastrium) (Zhang Zhongjing): Treats *Shanghan* presenting with epigastric obstruction, where palpation reveals softness (pronounced "ruan"), and the Guan pulse is floating (Deep pulse indicates excess heat; Floating pulse indicates deficient heat. The Classics state: If palpation feels naturally soft, it is merely Qi obstruction. Zhou Yangjun said: Since there is no accumulation of phlegm-fluids, Banxia and Shengjiang are not required. *Ren Shu* states: For both Jie Xiong and Pi, the Guan pulse should be deep; if the Guan pulse is floating and knotted, Sanhuang is used to drain Liver fire. Li Shizhen said: Zhang Zhongjing uses Xiexin Tang to treat insufficient Heart Qi causing hematemesis and epistaxis, which actually drains latent fire in the blood of the Pericardium, Liver, Spleen, and Stomach meridians. It also treats epigastric fullness that is soft upon palpation, draining damp-heat from the Spleen and Stomach, rather than truly draining the Heart. When a disease originates in the Yin aspect but is incorrectly treated with purgatives, obstruction and fullness result; this is cold damaging the Ying-Blood, with pathogenic factors binding in the Upper Jiao. The upper part of the Stomach corresponds to the Heart, hence it is called "Draining the Heart." The Classics state: What Taiyin brings about is obstruction and fullness. It also states: When turbid Qi remains in the upper region, distension arises, referring to this situation. When a disease originates in the Yang aspect but is incorrectly treated with purgatives, Jie Xiong results; this is pathogenic heat sinking into the Blood level, also located in the upper Stomach. Therefore, Da Xianxiong Tang and Wan both use Dahuang to drain pathogenic factors from the Spleen and Stomach blood level and dissipate heat; if Jie Xiong is at the Qi level, Xiao Xianxiong Tang is used; if obstruction and fullness are at the Qi level, only Banxia Xiexin Tang is used. Commentary: Regarding "originating in Yang" versus "originating in Yin," various interpretations differ, remaining a doubtful case. Li considers cold damage as Yin disease and heat sinking as Yang disease, yet all medicines used by Zhang Zhongjing are cold-natured, showing no distinction; Zhou Yangjun suggests it is generally due to premature purgation, which seems more plausible).