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When the *Neijing* (Classic of Internal Medicine) was transmitted to the Three Yin meridians, it only stated that purgation could be used. From Zhang Zhongjing onwards, the terminology changed, establishing the Da Chengqi Tang (Major Order the Stomach Decoction), Xiao Chengqi Tang (Minor Order the Stomach Decoction), and Tiaowei Chengqi Tang (Regulate the Stomach Order the Stomach Decoction).

Later generations followed and used these formulas. Often, after administering a sweating treatment, they would hastily proceed to purgation, causing many people to suffer premature death. This is because they did not understand that Zhang Zhongjing distinguished between pi (glomus/fullness), man (distension), zao (dryness), shi (excess), and jian (hardness), noting the differences among the Upper, Middle, and Lower Jiao regarding qi, blood, fluids, and food residues. Without meticulously seeking the underlying principles, the methods cannot be applied.

Why is this so? The Upper Jiao is the realm of qi. Its primary function is reception without discharge. When diseased, it loses its ability to receive properly, leading to pi (glomus sensation). For pathogens located in the upper region, one should use the method of "causing them to ascend and vomit" (yin er yue zhi). However, there are cases suitable for emesis and those unsuitable. In cases where symptoms persist after vomiting, herbs such as Zhi Ke (Aurantii Fructus), Jie Geng (Platycodonis Radix), and Chen Pi (Citri Reticulatae Pericarpium) are required to vent the qi of the Upper Jiao, which will achieve the desired effect.

The Middle Jiao is primarily responsible for the rotting and ripening of food and drink. When diseased, it loses this function, leading to man (distension). The intestines and stomach are like a market, accepting all things; treatment should vary according to the specific pathogen received, using methods to dissolve and grind away the stagnation. Combined with bitter-warm herbs, this constitutes the method for draining the Middle Jiao.

The Lower Jiao belongs to the yin aspect. Its primary function is discharge without reception. When diseased, it fails to discharge properly, resulting in zao (dryness), shi (excess), and jian (hardness) accumulations. After prolonged retention of heat, body fluids must be depleted, and the transmission of waste is impaired. One must use drastic purgative agents to cleanse and purge, thereby achieving recovery.

From this perspective, the Upper, Middle, and Lower Jiao naturally have a sequence of depth. There are instances where treating the Upper Jiao leads to rapid resolution in the Middle Jiao, or treating the Middle Jiao leads to unblocking the Lower Jiao. It is inconceivable that one would skip draining the Upper and Middle Jiao and hastily use Chengqi formulas to purge the Lower Jiao.

Consider his statement: "When pathogenic factors are in the Middle Jiao, if Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) are not used, it is feared that the yuan qi (original qi) of the Upper Jiao will be damaged; therefore, Gan Cao (Licorice Root) is used to harmonize the stomach, hence the name Tiaowei Chengqi Tang." Do Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) not damage the yuan qi? Can a single herb of Gan Cao truly regulate it?

Consider his statement: "If the Upper Jiao is injured, pi becomes solid; Mang Xiao is removed, naming it Xiao Chengqi Tang," claiming this avoids damaging the true yin of the Lower Jiao. Do Zhi Shi, Hou Po, and Da Huang truly fail to undermine the root?

Consider his further statement: "When all three Jiao are injured, and pi, man, zao, shi, and jian are all present, Da Chengqi Tang is used." Does this imply no damage to the yuan qi above and no undermining of true yin below? Can such formulas be indiscriminately administered? One must palpate the patient; only if there is indeed hardness from the chest to the lower abdomen, which is intolerable to touch, should these be used reluctantly.

Nevertheless, profound principles exist within. What humans rely on for life is the Mingmen (Gate of Life). What receives destiny and operates throughout the body is the Sanjiao (Triple Burner). Mingmen is the source of generating qi, also known as the Spirit that Guards against Pathogens. The Sanjiao emits qi to warm the muscles and fill the skin. Therefore, when cold pathogens invade, one relies solely on this fire to resist them, preventing deep penetration into the flesh and skin; if they penetrate, high fever ensues. The functions of reception/discharge and rotting/ripening then cannot function as in a healthy person. Thus, in Shanghan (Cold Damage), one strictly should not eat, and even if one does, digestion fails; this refers to the concept that pathogenic heat cannot "kill grain" (digest food). It is appropriate to use sweet, bitter, and warm herbs to assist this fire. Why instead use bitter-cold herbs to attack the generating qi? Otherwise, if this fire declines, cold pathogens directly invade, resulting in a Pure Yin syndrome, from which fever cannot arise.

Note: One day I read Li Dongyuan's *Pi Wei Lun* (Treatise on the Spleen and Stomach). His explanation of Huang Qin (Scutellariae Radix) states it is a holy medicine for removing irritability, heat, and muscle heat. It also says it warms the muscular layer, benefits the skin and hair, consolidates the cou li (pores), thereby benefiting yuan qi and tonifying the Sanjiao. It seems that fatigue-induced fever also originates from the Sanjiao. Thus, attributing Shanghan fever to the Sanjiao is well-founded. However, why can internal injury patients who cannot eat eventually eat, while Shanghan patients strictly cannot eat? One is a disease of the proper qi itself, requiring tonification; the other is an invasion by exogenous pathogens, requiring purgation.

Appendix: Li Shizhen's Differentiation of the Sanjiao
Li Shizhen said: The Sanjiao is the envoy of Yuan Qi; the Mingmen is the origin of the Sanjiao. They share one origin and one branch. The Mingmen refers to the residence, named as the organ storing essence and connecting to the uterus. The Sanjiao refers to the regions of governance, named as the department of reception/discharge and rotting/ripening. One is named by form, the other by function. Its form is neither fat nor flesh, but a white membrane wrapping around, located beside the seventh thoracic vertebra, between the two kidneys. Two ligaments attach to the spine, connecting downward to the two kidneys, upward to the heart and lungs, and penetrating to the brain. It is the origin of life, the master of Ministerial Fire, and the mansion of essence and qi. All humans and animals possess it; human birth and biological generation all emerge from here. Walnut kernels resemble it significantly; their outer skin and juice are dark green-black, entering the North, communicating with the Mingmen, and benefiting the Sanjiao. I observe that this is actually pancreatic fat. It connects the zang-fu organs and circulates throughout the body, relying on this substance.

Prescriptions

Wei Chengqi Tang (Stomach-Ordering Purgative Decoction)
Da Huang (6 qian, washed with wine), Mang Xiao (4 qian), Gan Cao (1 qian).
Decoct in water.

Xiao Chengqi Tang (Minor Order the Stomach Decoction)
Da Huang (4 qian), Hou Po (2 qian, stir-fried), Zhi Shi (1 qian, stir-fried).
Decoct in water.

Da Chengqi Tang (Major Order the Stomach Decoction)
Da Huang (5 qian), Hou Po (2 qian, stir-fried), Zhi Shi (1 qian, stir-fried), Mang Xiao (4 qian).
Decoct in water.