Library

[Background Information]
Book: Chengfang Qieyong (Essential Use of Prescribed Formulas)
Author: Wu Yiluo
Dynasty: Qing
Chapter: Snuffing Method / ... / Dachengqi Tang (Total 5 Sections)
Category: Formula

[English Translation]

Patients with dampness disorders presenting with nasal congestion and headache, or pain in the forehead and bilateral Taiyang regions, are suitable for this method.
Take an unspecified amount of Gualadi Duan (Bitter Melon Stalk), grind it into powder. Instruct the patient to hold a mouthful of water, then blow one "yi" (approximately 1.5 fen or 0.45g) of the powder into the nose.
Headache in patients with dampness is caused by turbid pathogens interfering with the distribution of clear Yang qi. The nose is the orifice of Qi, connecting upwards to the brain and downwards to the Lung. Turbid pathogens interfere here, causing obstruction of the clear orifices.

This treats Chanhou Ji Bi (acute throat constriction and bi-syndrome) and trismus (lockjaw).
Use Zaojiao (Gleditsiae Fructus, peeled and string-removed, stir-fried), Baifan (Alumen), Xionghuang (Realgar), and Lilu (Veratrum nigrum). Grind into powder and administer via snuffing.

To induce vomiting of deficient phlegm. (For patients who are weak with dry phlegm that cannot be expectorated, this formula is miraculous; although it induces vomiting, it absolutely does not damage Qi and Blood.)
Danggui (Angelicae Sinensis Radix, 5 qian), Gancao Tou (Radix Glycyrrhizae Ulnatae, 1 qian), Shenlu (Rhizoma Ginseng, 1 qian). Decoct with reverse-flowing water.

(Generally, treating Qi stagnation involves attacking its accumulation, which can be dispersed. Treating Blood stasis involves breaking up the stasis, which can be unblocked. Treating accumulations involves attacking hardness. For diseases located in the Zang organs, methods of breaking down and promoting movement are used.
In excess patterns, there is a specific pathogenic factor acting as a thief, covering the origin. The situation is most urgent, requiring treatment targeting the root.)

(Zhang Zhongjing) Treats Yangming Fu syndrome of Shanghan (Cold Damage), where Yang pathogens have entered the interior. Symptoms include stomach excess, constipation, fever, delirium, spontaneous sweating, aversion to cold absent.
When Pi (stuffiness), Man (fullness), Zao (dryness), Shi (excess), and Jian (hardness) are all present, or in miscellaneous diseases presenting with severe heat in the Sanjiao and a deep, excess pulse. (The exterior syndrome of Yangming is characterized by body heat, sweating, absence of aversion to cold, and aversion to heat. This indicates the disease is in the channels, and sweating should still be used to disperse it.
If heat pathogens have entered the Stomach Fu, and Pi, Man, Zao, Re (heat), and Jian are all present, purgation is indicated. Excess patterns manifest as delirium (disordered speech without sequence). Deficient patterns manifest as Zhengsheng (repetitive speech). Yangming has abundant Qi and Blood, so spontaneous sweating is normal. Excessive sweating leads to fluid loss; without water to control fire, dry feces accumulate in the intestines and stomach, leading to hallucinations and delirium.
The Classics state: Why does Yangming disease occur? Answer: After Taiyang disease, if sweating, purgation, or diuresis were used excessively, fluids are lost, the Stomach becomes dry, and it transforms into Yangming disease. "Stomach excess" refers to difficulty in defecation. It also states: In early Taiyang disease, if sweating was induced but was incomplete, it transforms into Yangming disease.
In Yangming syndromes, the ability to eat indicates Windstroke (Wind-Yang pathogen, which digests grain); inability to eat indicates Coldstroke (Cold-Yin pathogen, which fails to digest grain). This is the basis for differentiation. Chest stuffiness with anorexia is Pi; chest and abdominal distension is Man. Dry and scant stools is Zao; abdominal fullness, pain, and constipation is Shi; hardness upon palpation like stone is Jian. This also treats Yangming Gangjing (Yangming rigid spasm).
(This is a Taiyang-Yangming combined syndrome. Symptoms include abdominal fullness, trismus, inability to lie flat on the back, opisthotonos [arching back], teeth grinding, and anhidrosis. This is called Gangjing, and purgation is indicated. Because Yangming moistens the Zongjin (major sinews), when Wind-Cold-Damp-Heat damages the Yangming Stomach, Jin-Ye (body fluids) fail to circulate, and sinews lose nourishment. Thus, this decoction is used to purge damp-heat and promote fluid circulation.
Yu Jiayan said: In Shanghan, abdominal fullness can be purged, but chest fullness cannot, because the heat pathogen is still at the exterior. In this syndrome, the interior heat is extremely deep and severe. When Yang heat reaches its peak, Yin blood is immediately threatened with depletion. Mild purgation is insufficient. Strong purgation is necessary to preserve the last thread of Yin. If Yin is not completely robbed by Yang, many patients will survive. There is both a major prohibition against excessive purgation leading to Yin collapse, and a vital method of urgent purgation to save Yin. For students seeking deep understanding, this is key.
The Classics state: Yangming resides in the center, belongs to Earth, and is the destination of all things, with no further transmission. Since the Stomach is the Sea of Water and Grain, diseases from the four directions all transmit to the Stomach. Once entering the Stomach Fu, it no longer transmits to other channels.)

Dahuang (Rhei Radix et Rhizoma, 4 liang, washed with wine). Wang Haicang said: Pathogens located high require wine to reach them. If raw Dahuang is used, high-level heat pathogens may be missed. After the illness resolves...
First decoct Puxiao (Natrii Sulfas), then add Dahuang. Boil again, add Mangxiao (Natrii Sulfas), boil slightly over low heat until boiling. Take warm, one sheng. Stop taking after defecation occurs.
Danshi (Sojae Semen Preparatum) plays a minor role.
When heat invades the interior, treat with salty-cold substances. To soften firm Qi, use salty flavors. To eliminate intense heat, use cold properties. Therefore, Mangxiao's salty-cold nature is used to moisten dryness and soften hardness.
Accumulation is overcome.
Zhishi (Aurantii Fructus Immaturus)
Da (Great/Large)
Qi (Energy/Qi)
Da (Great/Large)
Bing (Disease)

If sweating leads to recovery, Mahuang Tang (Ephedra Decoction) is appropriate. This cuts off the path of the pathogen entering Yangming, resolving it from the exterior, preventing internal attack. It also states: In Yangming disease, sweating is indicated. If the physician incorrectly uses purgation, this is a major error. This reflects Zhang Zhongjing's caution regarding purgation. Yu Jiayan said: Yangming disease centers on Stomach excess, making purgation the standard treatment.
The pathogen in Yangming comes from Taiyang. If Yangming symptoms are 80-90% present but Taiyang symptoms remain 10-20%, treat from Taiyang, not Yangming; sweating is allowed, purgation is forbidden.
Its exit route trends toward Shaoyang. If Yangming symptoms are 80-90% present but Shaoyang symptoms appear slightly (10-20%), treat from Shaoyang, not Yangming; neither sweating nor purgation is applicable.
Only when Wind-Cold pathogens have left Taiyang but not yet reached Shaoyang, residing precisely within Yangming, is urgent purgation required. This prevents transmission to other channels, preserving both Jin-Ye and Yuan-Qi.
Mediocre and ignorant practitioners wait seven days for transmission to complete before daring to discuss purgation. They do not know that Taiyang disease can persist for over ten days without resolution. If meridians are not differentiated and only days are counted, misapplied purgation may still target Taiyang. By the second or third day of Yangming, purgative signs often appear.

Ancient practitioners cured chills and tremors using Dachengqi Tang to purge dryness. This occurred when Yang pathogens entered the interior, heat knotted inside, and the exterior was empty of Yang, causing chills and tremors.
This is Yang excess repelling Yin, a heat disease, not a cold pattern. Administering hot medicines would be fatal.)

Add Gancao (Licorice Root) in equal parts, named Sanyi Chengqi Tang (Three-One Resolving Decoction). Treats Dachengqi Tang syndrome (abdominal fullness and solid pain), Tiaowei Chengqi Tang syndrome (delirium with diarrhea), and Xiaochengqi Tang syndrome (internal heat).
Chengqi (Resolving Decoction)
Zhang Zhongjing
With Zhang
Enter
Six
Cao (Grass/Licorice)
(
Doctor
Shao (Peony)
Stool
Up
Ride/Attack
Enter

It was never stated that Spleen Qi is weak. Yu Jiayan said: If Spleen Qi were weak, tonification would be indicated. Why use Dahuang, Houpo, and Zhishi? This is due to excessive dryness of Spleen Earth, causing dehydration of the intestines and stomach, leading to middle-xiao (middle burning consumption) and difficult defecation. If the Spleen were truly weak, stools would be loose or diarrheal; how could it restrict food intake in the Stomach?
In Yangming syndromes suitable for purgation, one fears the pathogen has not yet entered the Stomach and stools are not hard. One also fears initial hardness followed by looseness, prohibiting reckless purgation. Thus, Xiaochengqi Tang is given first to test for flatus (turning loss of gas). Only then is purgation applied. This considers the potential weakness of Spleen Qi.
If this is Pi Yue Syndrome (Spleen Restriction), it should have been purged during Taiyang stage. Why wait for Yangming? Zhu Danxi said: This results from prolonged illness, following massive sweating or purgation, leading to exhaustion of Yin and Blood, blazing internal fire, damaging Yuan-Qi, and injuring the Spleen.
Lung Metal is controlled by Fire, losing its ability to govern Qi. Kidney is the child of Lung; Lung consumption leads to fluid deficiency. Metal consumption means Wood lacks restraint. Can Earth remain uninjured? Impossible.
Lung loses its transport function, Spleen loses its transformation and transportation function. Hence, constipation and frequent urination. Theoretically, one should nourish Yin and Blood, extinguish fire, allow Metal to transform, restrain Wood, and calm Spleen Earth. Then Jin-Ye can enter the intestines and stomach, moistening and unblocking them.
This formula is safe for patients with excess heat and robust Qi. For those with excess heat and deficient Blood, do not apply it rigidly.)

Indications for Immediate Purgation (Patterns):
(Sweating fails to resolve the condition, accompanied by abdominal fullness and pain: immediate purgation. Diarrhea with smooth pulses in all three positions, hardness upon pressing the epigastrium: immediate purgation.
Pulse slippery
Large
Exterior-Interior syndromes
Unclear,
Internal dryness
Dryness, this
Heat pathogens enter
Middle dryness
Syndrome.
Si Ni (Four Reversals)
Zongjin
Chengqi
Shaoyin
Empty
Touching bed
And recovered

Contraindications for Purgation:
Taiyang disease, exterior syndrome unresolved: do not purge. Pulse floating and large indicates exterior location: do not purge. Aversion to cold indicates pathogen at exterior: do not purge.
Cannot
Stomach pathogen
Heat pathogen
Can purge