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The tongue appears yellow and dry with a rough texture. If the coating presents with septal partitions (geographic tongue-like fissures), it indicates that heat has entered the Stomach (Wei, stomach) and the pathogenic toxin is deep-seated. The patient suffers from Heart fire (Xin huo, hyperactivity of heart fire) causing irritability and thirst; urgent administration of Da Chengqi Tang (Cinnamon Twig and Rhubarb Decoction) for purgation is required. If jaundice (huang, yellowing of skin and eyes) manifests, use Yinchen Hao Tang (Artemisia Capillaris and Rhubarb Decoction). For hematochezia (xia xue, bleeding from the rectum), use Didang Tang (Didang Decoction). For fluid retention in the hypochondrium (shui zai xie nei, water accumulating within the ribs), use Shizao Tang (Ten Jujube Decoction). For severe chest binding (jie xiong shen zhe, severe phlegm-fluid and heat binding in the chest), use Daxiexiong Tang (Major Chest-Binding Decoction). For fullness obstruction (pi, epigastric fullness without pain), use Dahuang Xiexin Tang (Rhubarb Heart-Draining Decoction).

[Commentary by Jie] Yellow coating with septal partitions signifies extreme excess heat in the Zang-Fu organs. This may result from warm or summerheat pathogens scorching Stomach fluids, or from the erroneous administration of warm-drying herbs that deplete fluids, leading to steaming by toxic heat. Externally, there must be high fever, intense thirst, red face, and red lips; severely, delirium (shen hun, loss of consciousness) and coma may occur. Treatment should employ Da Chengqi Tang to urgently purge and preserve fluids. Regarding jaundice, there is a distinction between damp-heat and blood stasis. If Yangming heat excess combined with dampness causes jaundice, external signs include absence of sweat over the body, sweating only on the head, difficulty urinating, and desire to drink water. This is due to heat unable to vent outward, stagnating and steaming into jaundice. Treatment requires Yinchen Hao Tang, using bitter-cold properties to unblock and drain, allowing internal stagnant heat to descend, so jaundice resolves via the stool. If jaundice presents with clear urine or easy bowel movements, and the pulse is deep, fine, and knotted, this is jaundice caused by blood stasis (xu xue). Treatment requires Didang Tang to eliminate stasis and resolve jaundice. Furthermore, there is the disease of hanging fluid (xuan yin, pleural effusion), where the pulse is deep, wiry, and fine. Due to fluid retention condensing and hanging between the chest and hypochondrium, coughing draws internal pain. Based on these symptoms, it must not be mistaken for chest binding. Treatment requires Shizao Tang to reach the disease site directly, causing fluid to descend without binding pain. There is also the syndrome of chest binding (jie xiong), which occurs when a disease begins in the Taiyang channel, but the physician fails to release the exterior and erroneously uses purgation. Pathogenic heat enters the interior and binds with accumulated fluids in the chest. The pulse is deep and tight, pain exists below the heart (xin xia, epigastrium) and feels hard like stone upon pressure. This is chest binding caused by heat excess. Treatment requires Daxiexiong Tang to soften hardness, break accumulation, and guide out pathogenic heat. When a disease in the Yang channels is treated with purgation, heat enters and forms chest binding; this pathology and treatment have been described. However, one must also know that when a disease in the Yin channels is treated with purgation, it can lead to pi (fullness obstruction). Although both pi and chest binding present with hardness and fullness, they are distinguished by pain: if full, hard, and painful, it is chest binding; if full but not painful, it is pi-fullness. In treating cold damage, after severe purgation followed by sweating, righteous qi becomes deficient and pathogens enter, forming pi in the epigastrium. External signs such as aversion to cold and body heat require initial treatment with exterior-releasing formulas. After the exterior is resolved, administer Dahuang Xiexin Tang to attack pi and clear heat. Thus, while a pure yellow septal tongue warrants the strong purgation of Da Chengqi Tang, careful examination of symptoms and diagnosis is essential. Otherwise, distinctions such as damp-heat versus blood stasis in jaundice, or hanging fluid versus chest binding, may be confused. Erroneous use of Chengqi formulas could lead to complications of chest binding or pi-fullness.

Da Chengqi Tang
Houpo (Magnolia Bark, ginger-processed, 3 qian)
Zhishi (Immature Bitter Orange, bran-fried, 2 qian)
Dahuang (Rhubarb Root, 2 qian)
Mangxiao (Mirabilite, 2 qian)
Take 1 liang per dose. Use 1.5 zhong of water. First decoct Zhishi. Once boiling, add Dahuang. Boil a few more times, then add Mangxiao. Boil for three to five boils, strain, and take hot.

[Commentary by Jie] The function of Da Chengqi Tang lies in its meaning of urgent purgation. It applies to Yangming syndrome with delirium and tidal fever, or two-Yang combined disease causing tidal fever, or post-purgation Yangming syndrome with mental restlessness, abdominal fullness and pain, and existing food retention. It also applies to Shaoyin syndrome with dry mouth and tongue, or spontaneous diarrhea of clear water with pure green color. These are all caused by extreme heat in the Stomach and dry feces. Therefore, the bitter-cold Dahuang is used to cleanse filth and clear toxic heat. Mangxiao, bitter and salty, softens dry feces. Zhishi and Houpo eliminate stagnant Qi. The Large Intestine is the official of transmission and transformation. Thus, Da Chengqi Tang unblocks and drains the Large Intestine to control heat in the Stomach.

Yinchen Hao Tang
Yinchen (Artemisiae Scopariae Herba, 5 qian)
Dahuang (Rhubarb Root, 3 qian)
Shanzhizi (Gardeniae Fructus, 7 pieces)
Take 1 liang per dose. Use 1.5 zhong of water. First decoct Yinchen until half-cooked, then add the other two herbs. Decoct further, strain, and take hot orally.

[Commentary by Jie] Ke Yunbo stated: Yinchen inherits the Qi of the North, does not wither in winter, braves frost and snow, and absorbs great cold. Thus, it can remove lingering heat pathogens. Guided by Zhizi to open the water source, and assisted by Dahuang to regulate Stomach excess, it allows internal and external stagnant heat to exit via urination. Abdominal fullness decreases naturally, and the intestines remain undamaged. This aligns with the method of "drawing out and exhausting." It is the sacred formula for draining water in Yangming syndrome.

Didang Tang
Shuizhi (Leech, fried with glutinous rice, 7 pieces)
Mengchong (Dragonfly Larva, fried, wings and feet removed, 7 pieces)
Dahuang (Rhubarb Root, 3 qian)
Prepare as one dose. Use 1.5 zhong of water, decoct to 1 zhong, strain, and take orally.

[Commentary by Jie] Zhang Zhongjing's original Didang Tang included Taoren (Peach Kernel). Its absence here is likely due to omission in the original text. Regarding the formula's rationale, Ke Yunbo explained it clearly: Leeches are good at drinking blood and thrive in water; dragonfly larvae suck blood and are fierce on land. Using these aquatic and terrestrial blood-suckers attacks the pathogen through sympathetic resonance. Assisted by Taoren's bitter-sweetness to push out the old and generate the new, and Dahuang's bitter-coldness to scour pathogenic heat, it is named Didang. If heat is severe but without mania, and lower abdomen is full but not hard, reduce the dosage and make pills for slow treatment.

Shizao Tang
Yuanhua (Genkwa Flos, vinegar-soaked and fried)
Daji (Euphorbiae Pekinensis Radix)
Gansui (Kansui Radix, roasted, equal parts)
Take 2 qian per dose (half for weak persons). Use 1.5 zhong of water and 10 large jujubes (dazao), split and crushed. Decoct to obtain 0.8 zhong, strain, and take orally.

[Commentary by Jie] Ke Yunbo stated: Gansui, Yuanhua, and Daji are all pungent-bitter, cold in nature, and highly toxic. Used together, their flavors combine and mutually assist, allowing them to attack the pathogen's nest, open the waterways, and extinguish water disaster in one stroke. However, where water accumulates, righteous Qi is already deficient. Toxic drugs attacking pathogens weaken the Spleen and Stomach further. Without Spleen-tonifying and Stomach-regulating agents as masters, eliminating pathogens would also kill the patient. Therefore, ten large, plump jujubes are chosen as the sovereign herb to tonify deficient Spleen Earth, restrain rampant Water Qi, and detoxify the harsh herbs. One ingredient achieves three benefits: controlling excess pathogens without damaging deficient righteous Qi. This is the perfection of Zhang Zhongjing's legislation. Ignorant people, confused by the saying "sweetness causes fullness," dare not use it, failing to understand the principle of restraint and control.

Daxiexiong Tang
Dahuang (Rhubarb Root, 7 qian)
Mangxiao (Mirabilite, 3 qian)
Gansui Mo (Kansui Radix Powder, 4 fen)
Use 2 zhong of water. First decoct Dahuang to 1 zhong, strain. Add Mangxiao, boil for three to five boils. Add Gansui powder, take warm to induce evacuation.

[Commentary by Jie] Dahuang and Mangxiao are excellent at cleansing excess heat in the intestines and stomach. Although the disease is in the chest, they serve as sovereign herbs because heat invading the interior is treated with bitter-cold substances to cleanse chest heat. Combined with Gansui's pungent-bitterness to directly attack fluid pathogens in the chest, it no longer solely targets gastric filth. This is a specialized formula for chest binding caused by pathogen retention in the chest affecting the Stomach, resulting in simultaneous disease of the chest and Stomach.

Dahuang Xiexin Tang
Dahuang (Rhubarb Root, 5 qian)
Huanglian (Coptidis Rhizoma, 2.5 qian)
Huangqin (Scutellariae Radix, 2.5 qian)
Prepare as one dose. Use 2 zhong of water, decoct to 1 zhong, strain, and take orally. If there is food retention or phlegm-fluid, add Banxia Qu (Pinellia Fermented Paste, 2 qian).

[Commentary by Jie] Epigastric pi feels soft upon pressure and is not hard. This is internalized pathogens combining with formless Qi, stagnating to form heat-pi. Therefore, bitter-cold descending herbs are used to drain formless heat. Zhishi and Houpo are not used because this is not a formula for scouring excess heat. If complicated by food retention or phlegm-fluid, Banxia Qu is added to open pi and dispel fluid.