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(Zhang Zhongjing) Treats Heart-Bind (Xin Xia Pi) resulting from Cold Damage (Shang Han), accompanied by aversion to cold and sweating. (Note: In Cold Damage, if the epigastric region is full, hard, and painful, it is termed Jie Xiong [Knot-Chest]; if it is full and hard but not painful, it is termed Pi [Bind]. The Classics state: For Heart-Bind that is soft upon palpation with a floating pulse at the Guan position, Da Huang Huang Lian Xie Xin Tang [Rhubarb and Coptis Decoction to Drain the Epigastrium] is indicated. If Heart-Bind is accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang [Aconite Decoction to Drain the Epigastrium] is used. Generally, various forms of Pi are heat-patterns, so they are often treated with cold-natured drugs. Here, Fu Zi [Radix Aconiti Lateralis Preparata] is added because it is feared that the heavy use of San Huang [Da Huang, Huang Lian, Huang Qin] might excessively damage Yang Qi; this is not for tonifying deficiency. This occurs due to Yang deficiency after excessive sweating or erroneous purgation, leading to aversion to cold and sweating. All Xie Xin Tang formulas treat Pi and fullness caused by Cold Damage; the pathology is in the chest and heart, not in the Stomach.)

Regarding the pathogenesis of Pi and fullness, there are differences between cold, heat, deficiency, and excess. *Bao Ming Ji* states: When the Spleen fails to transport Qi to the four Zang organs, Qi stagnates and does not disperse, forming Pi. Pi caused by Cold Damage arises from external cold constraint generating internal heat, suitable for bitter-draining methods. Pi arising from miscellaneous diseases stems from stagnant Qi, suitable for acrid-dispersing methods.)

Da Huang (2 liang) Huang Lian Huang Qin (1 liang) Fu Zi (1 piece. Prepared, skin and umbilicus removed. Decocted separately to extract juice.)

Wu Hegao said: Heart-Bind requires San Huang to drain the bind-heat. Aversion to cold and sweating require Fu Zi to restore Yang. Without San Huang, bind-heat cannot be removed; without Fu Zi, Yang cannot be restored.

(Zhang Zhongjing) Treats Pi characterized by chest fullness without pain, occurring after premature purgation in Cold Damage, accompanied by body coldness, vomiting, and inability to eat. This is not Chai Hu syndrome. (The Classics state: In Cold Damage, on the fifth or sixth day, if vomiting and fever occur, Chai Hu syndrome signs are present. If purged erroneously with other drugs while Chai Hu signs remain, administer Chai Hu Tang again. In the case described here, although purged erroneously, it has not become a adverse transformation; the patient will likely experience shivering and chills, followed by fever and sweating as the disease resolves. If the epigastrium is full, hard, and painful, this is Jie Xiong [Knot-Chest], treated with Da Xian Xue Tang [Major Draining Chest Decoction]. If it is full but not painful, this is Pi, Chai Hu Tang is contraindicated, and Ban Xia Xie Xin Tang [Pinellia Decoction to Drain the Epigastrium] is appropriate. All cases treated with Xie Xin Tang result from erroneous purgation, not from transmitted heat pathogens.)

Ban Xia (0.5 sheng) Huang Lian (1 liang) Huang Qin Gan Cao (Honey-fried) Ren Shen Gan Jiang (3 liang) Da Zao (12 pieces)

Cheng Wuji said: "Pi" refers to blockage without harmony. Bitter flavors enter the Heart first; to drain the Heart, one must use bitter substances. Thus, Huang Lian is the Sovereign herb, and Huang Qin is the Minister herb, to descend Yang and ascend Yin... (Text fragmentary).

If Ren Shen is removed and Gan Cao is increased (to 1 liang, totaling 4 liang with previous amounts), it is named Gan Cao Xie Xin Tang [Licorice Decoction to Drain the Epigastrium]. (Zhang Zhongjing) treats Cold Damage Wind-Strike where the physician erroneously purges, leading to diarrhea and intestinal borborygmus. Stomach Qi deficiency... (Text fragmentary). It is also stated that Gan Cao can relieve fullness because when Spleen Qi functions well, fullness dissipates. Observing Zhang Zhongjing's use of it to eliminate Pi, is it not to utilize its ability to scatter fullness? Furthermore, this refers to diarrhea and intestinal borborygmus caused by erroneous purgation in Cold Damage. Intestinal borborygmus in miscellaneous diseases often belongs to Spleen and Stomach deficiency. The Classics state: Spleen and Stomach deficiency leads to intestinal borborygmus and abdominal fullness. Also: Insufficiency of Middle Qi causes the intestines to resonate. Suitable treatments include tonics like Ren Shen and Bai Zhu, plus Gan Cao, Huang Qin, Huang Lian, Zhi Shi, and Gan Jiang. Zhu Danxi said: Water-sounding noises in the abdomen are caused by Fire agitating fluids; Er Chen Tang [Two-Cured Decoction] plus Huang Qin, Huang Lian, and Zhi Zi is appropriate.) Add Sheng Jiang (4 liang), and it is named Sheng Jiang Xie Xin Tang [Fresh Ginger Decoction to Drain the Epigastrium]. (Zhang Zhongjing) treats post-sweating disharmony in the Stomach, characterized by epigastric hardness and fullness, dry belching (same as eructation), putrid food odor, undigested food in stool, fluid retention under the hypochondrium, and loud intestinal borborygmus with diarrhea. (Rebellious Qi ascends, latent fluid retention struggles against the diaphragm, causing epigastric hardness and fullness. Disharmony of Middle Qi causes dry belching. Stomach deficiency with abundant fire, and pathogenic heat failing to digest food, leads to undigested food in stool. Fluid retention under the hypochondrium, with weak Earth failing to control Water, results in loud intestinal borborygmus and diarrhea, termed Xie Re Li [Collaborating Heat Diarrhea]. Because sweating damaged Stomach Qi and externally injured Yang Qi, Sheng Jiang is added to dispel pathogens and resolve fluid retention, benefiting the Stomach and restoring Yang. Liu Hejian said: Diarrhea with altered color of water and grain indicates heat; unchanged color and clear, cold discharge indicate cold. If the anus is dry and astringent, and urine is yellow and red, even if the stool color is unchanged, it is still heat. This is because Fire nature is rapid; food exits immediately after ingestion, insufficient time for digestion, known as pathogenic heat failing to "kill" (digest) the grain.)