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Yu Chang said, Huanglian Tang (Coptis Decoction) is a formula used by Zhang Zhongjing to treat Shanghan (Cold Damage). When Shanghan involves heat in the chest and pathogenic qi in the stomach, accompanied by abdominal pain and a desire to vomit, Huanglian Tang should be administered. This is because pathogenic qi in the stomach obstructs the mechanism of ascending and descending of Yin and Yang, preventing them from interacting in the Middle Jiao. Consequently, Yin cannot ascend and acts exclusively in the lower part, causing Lower Cold, manifested as abdominal pain. Yang cannot descend and acts exclusively in the upper part, causing Heat in the Chest and a desire to vomit. Using this decoction to regulate the ascending and descending of Yin and Yang is indeed appropriate.

However, why is this same formula used for patients with Dampness diseases who have been incorrectly treated with purgatives, resulting in a tongue coating resembling fetal membrane, with Heat in the Dantian and Cold in the chest? Later generations have forced interpretations, failing to grasp the essence of formula formulation; how then can they properly select and apply this formula?

Generally, the treatment of Shanghan is divided into methods for the Exterior, Interior, and Middle. When both Exterior and Interior pathogens are abundant, harmonization from the Middle is employed. Thus, Xiaochaihu Tang (Minor Bupleurum Decoction) utilizes the Harmonizing method. Based on Renshen (Ginseng Radix), Gancao (Licorice Root), Banxia (Pinellia Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus) to support Stomach Qi, only one herb, Chaihu (Bupleuri Radix), is added to penetrate the Exterior, and one herb, Huangqin (Scutellariae Radix), to penetrate the Interior. Fearing that the sharp edges of these herbs might hinder harmonization, the dregs are removed and the liquid is boiled again, blending the properties so that differences are indistinguishable. Upon entering the Stomach, the portion of the liquid carried upward by Stomach Qi brings Chaihu out to the Exterior; the portion carried downward brings Huangqin into the Interior. One act of harmonization eliminates both Exterior and Interior pathogens. Any remaining pathogens can then be addressed further without mutual rejection.

Regarding pathogens in the Dantian and Chest, they reside in the Upper and Lower positions rather than the Exterior and Interior. Therefore, Xiaochaihu Tang is transformed into Huanglian Tang to harmonize the Upper and Lower. Guizhi (Cinnamon Twig) replaces Chaihu, Huanglian (Coptidis Rhizoma) replaces Huangqin, and Ganjiang (Zingiberis Rhizoma) replaces Shengjiang. Upon entering the Stomach, the liquid is allowed to distribute upward and downward by Stomach Qi. Thus, whether there is Upper Heat and Lower Cold, or Upper Cold and Lower Heat, it can be treated.

For Exterior-Interior pathogens, Chaihu and Huangqin are used; for Upper-Lower pathogens, Guizhi and Huanglian are used. For Exterior-Interior pathogens, the pungency of Shengjiang is used to disperse; for Upper-Lower pathogens, the acridity of Ganjiang is used to open. Zhang Zhongjing’s sage methods are clearly evident. I wish to modify and adjust the methods for regulating Upper and Lower Qi. What technique do I employ to advance and retreat? As discussed previously, one seeks balance in the Middle, grasps the pivot to operate, and gradually penetrates to the Upper and Lower. Once Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) are smoothly flowing forward, advancement and retreat can be executed. However, this is difficult to explain. If rejection leads to vomiting and regurgitation, advancing with this formula is suitable.

Since the Taiyang (Greater Yang) channel governs opening, if Taiyang does not open, obstruction occurs in the chest, leading to inability to eat or immediate regurgitation after eating. Because Guizhi is a herb of the Taiyang channel, it harmonizes Ying and Wei Qi and promotes the flow of Yang Dao, thus capable of opening obstructions. However, when Fire generated by the Five Emotions (Wu Zhi) and Jue Yang (Jueyin Yang) ascends, Guizhi must not be used. Using it would be adding fire to fire, causing sweating on the head and collapse of Yang, resulting in Guan Ge (Obstruction and Rejection) where urination is impossible.

The method of retreat involves penetrating into the Yin aspect through Stomach Qi; in such cases, Guizhi is also excluded. However, if the "gate" of the Stomach opens, and Shaoyin (Lesser Yin) governs closing, if Shaoyin Qi does not ascend, the Stomach's gate will certainly not open. I am particularly concerned that the Shaoyin pulse being deep and sluggish, and the Duyang pulse being hidden and choppy, are both worrisome conditions. The *Neijing* frequently mentions these: "Kidney Qi sinks alone," and "Kidney Qi is unbalanced." True Qi residing in the Kidneys acts like a counterweight and beam; with both weight and balance, the gate opens and closes intermittently. With weight but no balance, the gate only closes and never opens. How then can urine exit? Therefore, Shenqi Wan (Kidney Qi Pill) is also a consideration within the method of retreat. When Kidney Qi interacts with the Stomach, the gate opens; when it interacts with the Heart, Jue Yang Fire descends and settles. There are times when its use is indispensable. The sequence of advancement and retreat within a single formula is so profound; how could an ordinary person discern it?

[Four Medical Laws]
1. In treating Guan Ge disease, if one does not know to use guiding and draining methods to break the rejection, but merely hopes to stop vomiting and urinary difficulty, hastily treating the symptoms while exhausting one's skills and strength, causing harm instead of benefit, is the physician's fault.
2. In treating Guan Ge disease, if one fails to examine the pulses at Renying, Duyang, and Taichong points, relying solely on the Cun Kou (Radial artery) pulse, this is negligence. If one is also ignorant of distinguishing Yin and Yang at the Cun Kou, this is even greater fault.
3. In treating Guan Ge disease, if one does not differentiate between Pulse Deficiency and Excess of Yang and Yin to determine therapeutic advancement or retreat, it is like a blind person walking without knowing east from west; this is the physician's fault.
4. In treating Guan Ge disease, if one abandons the "Kingly Way" (gentle and principled treatment) and resorts to "Hegemonic Methods" (harsh and aggressive tactics), displaying personal prowess and hastening death, this is the physician's fault.