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When Yin pathogens transmit inward, they remain in the epigastrium forming a *Pi* syndrome (fullness and obstruction without pain), because the epigastrium is the region where Yin Qi receives.

Cheng Yingmao stated: Although all utilize Xie Xin Tang (Drain the Epigastrium Decoction), if vomiting is present among the symptoms, the efficacy specializes in draining fluid retention; hence, Banxia is used to name the formula. The term "Xie Xin" (Draining the Heart/Epigastrium) refers to the fullness located in the position of clear Yang Qi in the epigastrium. Heat pathogens carrying fluid retention have not yet formed solid excrement. Therefore, clearing heat and draining fluid allows the Qi in the epigastrium to flow freely, eliminating upper and lower stagnation, allowing Yin and Yang to interact naturally. However, the pivot mechanism relies entirely on the Stomach; thus, tonifying the deficiency of the Stomach Qi serves as a mediator. This differs significantly from treating excess heat entering the Stomach by purging accumulated fullness. Pi syndrome, though a deficiency pathogen, results from exterior Qi entering the interior, transforming cold into heat. Although cold transforms into heat, this heat is not excess; therefore, bitter-cold herbs are used to drain the heat, accompanied by acrid-sweet herbs to tonify deficiency. There is no need to directly attack the Pi mass for it to dissipate spontaneously. Hence, within one formula, cold and hot herbs are used together. If it is a Yin Pi not involving Yang depression, or if there is depression but no heat formation, the method of Xie Xin can generally be applied.

Wang Hu stated: When Shaoyang disease is incorrectly treated with purgatives, the pathogen remains at the half-exterior half-interior level, situated between Yin and Yang, resulting in Pi knotting. In the human body, below the diaphragm belongs to Yin, and above the diaphragm belongs to Yang. Shaoyang resides in the clear pathways between the diaphragms, also representing the half-exterior half-interior. This confirms that after incorrect purgative treatment of Shaoyang disease, pathogens enter the interior due to deficiency, distinguishing the origins of Jie Xiong (Chest Binding) and Pi Qi.

**Banxia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) Formula**
Banxia (washed, half sheng) Huangqin (three liang) Ganjiang (dried ginger, three liang) Renshen (three liang) Huanglian (one liang) Gancao (honey-fried, three liang) Dazao (broken open, twelve pieces)

The above seven ingredients are boiled in ten dou of water to obtain six sheng. Remove the dregs and boil again to obtain three sheng. Take one sheng warm, three times daily.

Originally, premature use of purgatives caused epigastric Pi. Xie Xin Tang was administered. If the Pi does not resolve, and the patient presents with thirst, dry mouth, irritability, and dysuria, Wuling San (Five-Ingredient Powder with Poria) should be used as the primary treatment.

[Note] Premature purgative treatment led to epigastric Pi. If the Pi resembles binding heat forming solid excrement, Dahuang Huanglian Xie Xin Tang (Rhubarb and Coptis Drain the Epigastrium Decoction) is appropriate, employing a cold purgative method. If the Pi involves exterior cold and interior heat, Fuzi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) is appropriate, employing a warm purgative method. If the Pi involves deficiency-heat and fluid-water, Shengjiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is appropriate, employing a method to disperse fluid retention. If the Pi involves deficiency-heat with vomiting, Banxia Xie Xin Tang is appropriate, employing a method to subvert rebellious Qi. If the Pi involves severe deficiency-heat, Gancao Xie Xin Tang (Licorice Drain the Epigastrium Decoction) is appropriate, employing a method to relieve urgency. Now, having examined the various Xie Xin Tang formulas based on syndrome differentiation, if the Pi does not resolve, one must examine the patient. If there is thirst, dry mouth, irritability, and dysuria, this is not due to unclear syndrome differentiation or insufficient medicinal power. Rather, internal accumulation of fluid-water and non-flowing Jin-Ye (body fluids) cause the Pi to persist. Wuling San should be used to induce sweating externally and promote urination internally. Recovery occurs when sweat appears and urination becomes smooth; other cases can be inferred similarly.

[Collected Notes] Fang Youzhi stated: If Xie Xin Tang fails to resolve Pi, it indicates the Pi is not formed by Qi aggregation. Thirst, dry mouth, irritability, and dysuria indicate stagnant and non-flowing Jin-Ye with condensed hidden fluid retention. Wuling San promotes urination and generates Jin-Ye; once Jin-Ye is generated, thirst and irritability cease; once urination flows, Pi dissipates. Thus, this is another method for eliminating Pi fullness.

Cheng Yingmao stated: Various Xie Xin formulas adequately address opening knots, sweeping heat, and tonifying deficiency. However, their therapeutic methods focus on the Upper and Middle Jiao. There are cases where Pi is in the upper part but treated via the Lower Jiao, which differs from previous methods. If the origin of Pi is similar, but the patient exhibits thirst, restlessness, and dysuria, it indicates that post-purgative Stomach deficiency led to internal fluid-water accumulation and non-flowing Jin-Ye, leaving Pi with no exit route; this is not clustered heat. Using Wuling San causes turbid Yin to exit from the lower orifices, allowing clear Yang in the Upper Jiao to flow without obstruction. Moreover, Wuling San promotes Qi transformation and expels pathogens from both exterior and interior, causing Heart pathogens to drain via the Bladder rather than the Heart channel, representing yet another method.

In Shanghan (Cold Damage), after taking herbal decoctions, persistent diarrhea and hard epigastric Pi occur. After taking Xie Xin Tang, if other purgatives are administered and diarrhea persists, and the physician prescribes Lizhong Tang (Regulate the Middle Decoction), the diarrhea worsens. Lizhong Tang regulates the Middle Jiao. This diarrhea is in the Lower Jiao; Chishizhi Yuyuliang Tang (Red Halloysite and Hematitum Decoction) should be used. If diarrhea persists despite this, promoting urination is indicated.

[Note] In Shanghan, taking herbal decoctions leading to persistent diarrhea and epigastric hardness is caused by incorrect purgative treatment. Diarrhea with Pi hardness constitutes deficiency Pi; taking Xie Xin Tang was correct. However, if Pi does not heal and further purgatives are used, although Pi may resolve, diarrhea persists. If the physician administers Lizhong Tang for warmth, diarrhea worsens. One must understand that Lizhong Tang regulates the Middle Jiao; this diarrhea is in the Lower Jiao, belonging to sliding collapse (incontinence). Therefore, Chishizhi Yuyuliang Tang is used to astringe intestines and secure collapse, stopping diarrhea. If diarrhea stops and recurs, one must assess urination. If urination is smooth, tonifying and warming herbs should be added to complete the cure. If urination is unsmooth, it indicates water has no exit route; prolonged astringency causes recurrent diarrhea. In this case, promoting urination is necessary so that the water pathway opens and diarrhea stops spontaneously.

[Collected Notes] Zheng Zhongguang stated: "Tang" (decoction) implies sweeping, i.e., purgatives. Incorrect purgative treatment caused persistent diarrhea and hard epigastric Pi; taking Xie Xin Tang was correct. Yet, using other purgatives compounded the error. Using Lizhong Tang to open Pi and stop diarrhea was not wrong, but worsening diarrhea occurred because repeated purgation damaged Kidney Qi, causing Lower Jiao instability. Thus, Chishizhi and Yuyuliang are used to secure intestinal deficiency and arrest sliding collapse. If diarrhea persists, promoting urination is required. The Bladder is the Fu organ of the Kidney. The Kidney governs the two lower orifices and opens into them. Promoting urination allows Zang-Fu organs to perform their functions, separating water and grain so diarrhea stops.

**Chishizhi Yuyuliang Tang (Red Halloysite and Hematitum Decoction) Formula**
Chishizhi (crushed, one jin) Taiyi Yuyuliang (crushed, one jin)

The above two ingredients are boiled in six sheng of water to obtain two sheng. Remove dregs and take warm in three doses.

[Formula Analysis] Ke Qin stated: Gan, Jiang, Renshen, and Zhu can tonify the deficiency of Yuan Qi in the Middle Palace but cannot secure the sliding collapse of lipid essence in the Lower Jiao. Since this diarrhea is in the Lower Jiao, Lizhong agents cannot achieve the cure. However, large intestine insecurity is attributed to the Stomach; loose closure is attributed to the Spleen. These two ingredients are結 (condensed) essences of Earth, capable of firming the Stomach and astringing intestines. Urgently treating the branch symptom in the Lower Jiao actually cultivates the root in the Middle Palace. Essentially, this syndrome involves Earth deficiency, not Fire deficiency; thus, Jiang (Ginger) and Fu (Aconite) are unsuitable. If water is unsmooth and dampness is severe, causing persistent diarrhea, promoting urination is again indicated.

After Shanghan is treated with sweating, vomiting, or purgation, and resolves, if epigastric hardness and persistent belching remain, Xuanshu Daizhe Shi Tang (Inula and Hematitum Decoction) should be used.

[Note] After Shanghan is treated with sweating, vomiting, or purgation, if exterior and interior are cleared, natural recovery follows with harmonized Stomach Qi and appetite. Now, although pathogens are resolved, epigastric hardness indicates Stomach deficiency with knotting. Persistent belching indicates rebellious Stomach Qi. Methods for treating Pi do not exceed various Xie Xin Tangs. Therefore, in the Shengjiang Xie Xin Tang formula, Huangqin, Huanglian, and Ganjiang are removed because, post-resolution, there are no cold or heat pathogens. Xuanshu and Daizhe Shi are added to tonify deficiency, circulate Qi, drain fluid, and suppress rebellion.

[Collected Notes] Fang Youzhi stated: Resolution means major pathogens have dispersed. Epigastric hardness and persistent belching indicate unrecovered righteous Qi, weak Stomach Qi, and rebellious hidden fluid retention. Thus, Xuanshu Daizhe Shi Tang is used to nourish righteousness and scatter residual pathogens.

Yu Chang stated: The emphasis lies on "persistent belching." With epigastric hardness and persistent belching, Stomach Qi rebels upward, failing to descend, rising only without descending. As the saying goes: when strings break, the sound is hoarse; when Earth fails, the sound is hiccups. Thus, Daizhe Shi leads Renshen downward to calm rebellious Qi.

Wang Hu stated: This belching differs from the dry belching in Shengjiang Xie Xin Tang; here, belching occurs without food odor, indicating Middle Qi deficiency.

Shen Mingzong stated: Incorrect purgation causes Pi; observing this case, resolution after sweating can also cause Pi. Sweating, vomiting, and purgation all damage internal Qi. Wherever there is greatest deficiency, pathogens reside. Thus, minor pathogens sink inward through deficiency, turbid Yin rebels upward striking the Heart, causing epigastric hardness and persistent belching.

**Xuanshu Daizhe Shi Tang (Inula and Hematitum Decoction) Formula**
Xuanfuhua (three liang) Renshen (two liang) Shengjiang (cut, five liang) Daizhe Shi (one liang) Banxia (washed, half sheng) Gancao (honey-fried, three liang) Dazao (broken open, twelve pieces)

The above seven ingredients are boiled in one sheng of water to obtain six sheng. Remove dregs and simmer again to obtain three sheng. Take one sheng warm, three times daily.

[Formula Analysis] Luo Tianyi stated: After resolution via sweating, vomiting, or purgation, pathogens are gone but Stomach Qi is depleted. Depleted Stomach Qi causes San Jiao dysfunction: clear Qi has no return and fails to ascend; turbid Qi has no reception and fails to descend. Thus, pathogens linger, hidden fluid rebels, causing epigastric hardness and persistent belching. In the formula, Renshen and Gancao nourish righteousness and tonify deficiency; Shengjiang and Dazao harmonize Spleen and nourish Stomach, stabilizing the Middle Region profoundly. Daizhe Shi's heaviness gathers floating Qi and suppresses rebellion; Xuanfuhua's acridity circulates Qi and drains fluid. Assisted by Renshen, Qi returns downward; assisted by Banxia, fluid is eliminated upward. Turbidity descends, resolving hardness; clarity ascends, removing belching. Observe Zhang Zhongjing treating Shaoyin fluid-water flooding upward with Zhenwu Tang to suppress it; treating Lower Jiao sliding collapse with Chishizhi Yuyuliang Tang to secure it; here, Stomach deficiency with disrupted Qi ascent/descent uses this method to regulate, turning obstruction into harmony. Their methods of returning to the root and securing the lower are each exquisitely effective.

After excessive vomiting and purgation in Shanghan, extreme deficiency occurs. If excessive sweating follows, because the patient's exterior Qi is constrained (Fu Yu), and water is given to induce sweating, hiccups (Yue) result. The reason is cold in the Stomach.

[Note] After excessive vomiting and purgation in Shanghan, Jin-Ye is extremely deficient. The patient has a red face, exterior Qi is constrained, desires to drink, and is given soup/water to aid sweating, resulting in hiccups. The reason is that excessive vomiting/purgation weakened the interior, and sweating caused Yang to escape outward, hence "Stomach deficiency and cold." Wu Zhu Yu Tang (Evodia Decoction) should be used to warm the middle and subvert rebellion.

[Commentary] The Stomach governs reception, connecting downward to the earthy pathway. If Stomach disease causes dysfunction, contents do not transmit to the large and small intestines; instead of receiving, they vomit. Ejection of matter without sound is called Tu (vomiting); ejection of matter and sound is called Ou (retching); sound without matter is called Gan Ou (dry retching). Gan Ou is Yue (hiccups/belching), named for its "Yue Yue" sound. The Treatise considers Ou mild and Yue severe. Because Stomach contains matter, matter and Qi rebel together, causing lighter injury; empty Stomach, only Qi rebels, causing heavier injury. Yue accompanying Three Yin syndromes indicates deficiency and cold; Yue accompanying Three Yang syndromes indicates excess and heat. For deficiency-cold, use Sini Tang, Lizhong Tang, Wu Zhu Yu Tang, etc.; for excess-heat, use Tiaowei Chengqi Tang, Dachengqi Tang, etc. Choose appropriately; do not assume Yue indicates Stomach failure precluding purgation. The Treatise states: "In Shanghan, Yue with abdominal fullness, observe anterior and posterior orifices, identify which is obstructed, unblock it, and it heals." Also, worldly terms calling Yue "E Ni" (hiccup), "Chi Ni," or "Yi Qi" are incorrect. Yue's sound/Qi comes from Stomach to mouth, loud and urgent. E Ni's sound arises from below the navel rushing up, making "ge" sounds at the anus, scattered and discontinuous. "E Ni" corresponds to "Chi Chi" in the Ping Mai Pian chapter, meaning Qi blockage with sound. Observing E Ni patients, drinking cold water immediately triggers "ge" sounds, unlike Yue. Chi Ni and Yi Qi refer to modern "belching." Chi Ni occurs immediately after eating too fast, without food odor. Yi Qi occurs later after overeating, with food odor. Yue, Chi Chi, Ai, and Yi all involve sound without matter, all being upward Qi rebellion, yet differing in deficiency/excess, cold/heat, severity, and duration. Confusing Ke Ni (coughing against) with E Ni is erroneous; Ke Ni is modern asthma/cough. Mixing them is an investigative failure with significant consequences. Distinction is crucial. Gan Ou is Yue; Ke Ni is asthma/cough. Detailed in *Jingui Yaolue*.

[Collected Notes] Cheng Yingmao stated: Yue syndrome has deficiency and excess types. Deficiency arises from Stomach cold, following excessive vomiting/purgation where Yin deficiency leaves Yang unattached, causing red face and constrained exterior Qi due to inability to sweat. Physicians mistaking red face for heat constraint give water to induce heavy sweating, unaware that Yang escapes outward weakening Stomach, and water attacks internally blocking pathogens, weakening Stomach Qi, inevitably causing Yue!

Wang Hu stated: After excessive vomiting/purgation in Shanghan, extreme deficiency exists! Why induce excessive sweating? Because the patient's exterior Qi is constrained; facial Qi resembles external pathogens constrained at the exterior. This is extreme deficiency of the Yangming Stomach Fu, with floating heat rising to the face. Physicians mistake this for extreme Stomach heat/dryness preventing sweating, giving water to aid sweating, resulting in Yue.