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(Decoction for Modification of Zhizi Chi Tang)

Treats Yangming disease characterized by a floating and tight pulse, dryness of the throat, bitter taste in the mouth, abdominal fullness with panting, fever, sweating, aversion to cold absent but aversion to heat present, heaviness of the body, and irritability/restlessness.

Zhizi (Gardeniae Fructus, 14 pieces) Xiangchi (Fermented Soybean, 4 he, wrapped in silk gauze)

Take the above two ingredients, add four sheng of water, first decoct Zhizi until half remains (2.5 sheng), then add Xiangchi, and continue decocting until one and a half sheng remains. Strain off the dregs, divide into two doses, and take warm. After taking one dose, if vomiting occurs, stop; if the patient feels at ease, proceed as directed.

Ke Yunbo stated: In Taiyang disease, the heart and abdomen are considered the interior; in Yangming disease, the heart and abdomen are considered the exterior. The "interior" of Yangming refers to gastric excess, manifesting not only with fever, aversion to cold, eye pain, and restlessness during sleep.

If after purgation there is abdominal fullness and restlessness in sitting or lying down, it indicates that heat has entered the stomach; in this case, emesis is inappropriate, so Xiangchi is removed. If the stool is not yet dry and hard, further purgation is not suitable, so only Zhizi is used to relieve vexation, assisted by Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) to drain fullness. This is a subtle method to resolve both cardiac and abdominal issues, serving as a mild formula of Xiaochengqi Tang.

If purgation was performed using pill preparations, resulting in slight mental vexation without profound regret/irritability (ao nao), it indicates that cold pathogen remains in the middle jiao while heat lingers in the upper jiao. Therefore, Zhizi is employed to clear vexation, and Ganjiang (Dried Ginger) is doubled to expel internal cold, allowing the exterior heat to resolve spontaneously. This represents the concurrent use of cold and hot properties, forming a formula that harmonizes the middle and releases the exterior.

When internal and external heat are blazing, causing yellowing of the muscles/skin, a bitter-sweet formula must be used to regulate. Baipi (Phellodendri Cortex) and Gancao (Licorice Root) are yellow and moistening; they assist Zhizi in clearing internal vexation and resolving external heat. For diseases manifesting in color and form, one still utilizes agents with corresponding colors and forms to facilitate communication/resolution. These are all modifications of Zhizi Chi Tang to manage the variations of Yangming exterior syndromes.

The nature of Zhizi allows it to descend curvingly; it is not an emetic agent. It is only the fermented odor of Xiangchi that steams upward to the heart and lungs, capable of inducing vomiting! Observing that Gouti San (Melon Seed Powder) must be taken mixed with Xiangchi juice, it is evident that the emetic effect lies in Xiangchi, not Zhizi. (This meaning... Xiangchi... Chen...)