【纲】仲景曰。太阳病。十日已去。脉浮细而嗜卧者。外已解也。设胸满胁痛者。与小柴胡汤。
脉但浮者。与麻黄汤。
【目】黄仲理曰。本节乃太少二阳合病耳。故胸满胁痛嗜卧。非少阳之气不得上升乎。故和以
柴胡汤。脉但浮。则仍属太阳之脉。故与麻黄以发之也。
韩祗和曰。胸满者。胸膈间气满闷也。非心下满。胁满者。胁肋下气填胀满也。非腹中满。盖
邪自表传里。必先胸胁以至心腹入胃。是以胸满多带表症。宜发汗。惟胁满或痛。多带半表半里。
小柴胡加枳实和之。至于胸中痰实者涌之。如胸中邪结而为实。燥渴大便闭者。大陷胸汤主之。
【纲】仲景曰。下后。脉促。胸满者。桂枝去芍药汤主之。太阳与阳明合病。喘而胸满者。不
可下。宜麻黄汤。
【目】成无己曰。此二条是胸满属表而须发汗者也。盖胸中至表犹近。及胁则不言发汗。但和
解而已。大抵胸胁满。以邪气初入里未停留。而湿气郁积而不行。致生满也。和解可矣。若邪气留
胸中。聚而为实者。非涌吐不可已。故华佗曰。四日在胸。吐之则愈。是邪气已收敛而不散漫者。
则可吐之也。
韩祗和曰。喘而胸痛。犹带表症。不可下。与麻黄汤。或麻黄杏子甘草石膏汤。脉促胸满而与
桂枝去芍药汤者。病在于胃。芍药入营。故去之也。
鳌按。胸满本阳症。但下后满而不喘。则是寒邪内结。将作结胸矣。故知胸满不但阳盛。即阳
虚者亦然也。
【纲】仲景曰。伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。发汗。则动经。
身为振振摇者。茯苓桂枝白术甘草汤主之。
【目】柯琴曰。伤寒初起。正宜发表。吐下非法也。然吐下后不转属太阴。而心下逆满。气上
冲胸。阳气内扰也。
【纲】仲景曰。发汗。若下之。而发烦热。胸中窒者。栀子豉汤主之。
病如桂枝症。头不疼。项不强。寸脉微浮。胸中痞硬。气上冲咽喉不得息者。此为胸有寒也。
当吐之。宜瓜蒂散。
【目】成无己曰。二者均是吐利。栀子豉汤吐胸中虚烦客热。瓜蒂散吐胸中痰实宿寒。
鳌按。此二条本阳明症。以欲明胸满之当吐。故附此。
【纲】仲景曰。太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。发作有时。心下痞。
硬满。引胁下痛。干呕短气。汗出不恶寒。此表解里未和也。十枣汤主之。
【目】鳌按。此条心下硬满。牵引胁满。是由心下水气泛溢不和也。
【纲】仲景曰。服桂枝汤。或下之。仍头项强痛。翕翕发热。无汗。心下满微痛。小便不利者。
桂枝去桂加茯苓白术汤主之。小便利则愈。
【目】鳌按。此水结中焦。只可利而不可散也。因汗不彻而遽下之。致水气结于心下。然病根
虽在心下。而病机仍在膀胱。今小便不利。则是太阳本病。实非桂枝症未罢也。故用本方以散邪行
水。
【纲】仲景曰。发汗后。腹胀满者。浓朴生姜甘草半夏人参汤主之。
【目】韩祗和曰。腹满者。邪入太阴脾土也。常痛为里实。须下之。承气汤。时减者为里虚。
当温之。理中汤。若表解内不消。非大满犹生寒热。是邪未全入里。亦未可下。若大满大实。兼
有燥屎。是邪已入腑。虽得之四五日。亦可下。大抵阳邪为热。则腹满而咽干。阴邪为寒。则腹满
而吐利。食不下。若已经吐下后而腹满者。治法又各不同。是又不可不知也。
柯琴曰。此条不是妄汗。人本虚也。汗后反见有余症。邪气盛则实。故用姜、朴、夏散邪以除
腹满。正气虚。故用参、甘补中而益气。
【纲】仲景曰。本太阳病。医反下之。因而腹满时痛者。属太阴也。桂枝加芍药汤主之。大实
痛者。桂枝加大黄汤主之。
【目】陶华曰。阳明发热。腹满微喘。口苦咽干。或不大便谵语。并小柴胡汤。哕而小便难。
加茯苓。三阳合病。腹满身重。难以转侧。谵语。口中不仁。小柴胡汤。有汗白虎汤。太阴腹满。
吐食不下。枳桔理中丸。少阴病六七日。腹胀满。不大便。急下之。大承气汤。腹满痛者。脾不胜
水。水与气搏皮肉之间。腹中漉漉有声。小半夏茯苓汤加桂枝。下利腹满身疼痛。先温其里。四逆
汤。后攻其表。桂枝汤。发汗后腹满。当温。浓朴半夏生姜人参汤。吐后腹满。当下。少与调胃承
气汤。下后腹满。宜栀子浓朴汤。
腹胀满者。阴阳不和也。桔梗半夏汤。
柯琴曰。腹满时痛。因于下后。是阳邪转属。非太阴本病。表症未罢。故仍用桂枝解外。腹痛
既见。故倍加芍药以和里。此病本于阳。故用阴以和阳。若因下而腹大实痛。是太阳转属阳明而胃
实。尚未离乎太阳。此之谓有表里症。仍用桂枝加大黄以除实痛。此双解表里法也。凡妄下必伤胃
气。胃气虚则阳邪袭阴。故转属太阴。胃气实则两阳相抟。故转属阳明。太阴则满痛不实。阴道虚也。
阳明则大实而痛。阳道实也。满而时痛。下利之兆。大实而痛。燥屎之征。桂枝加芍药。即建中
之方。桂枝加大黄。即调胃之剂。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），病程已过十天，如果脉象浮细且患者喜欢静卧，说明表邪已经解除。假如出现胸部胀满、胁肋疼痛的症状，应给予小柴胡汤（和解少阳的代表方剂）。如果脉象仅见浮象，则给予麻黄汤（发汗解表的代表方剂）。
【目】黄仲理说：这一节讲的是太阳与少阳两经合病的情况。所以出现胸满、胁痛、嗜睡，是因为少阳之气不能上升所致。因此用柴胡汤来调和。如果脉象仅见浮象，则仍然属于太阳病的脉象，所以用麻黄汤来发散邪气。
韩祗和说：胸满是胸膈间气机壅滞闷塞的感觉，不是心下（胃脘部）的胀满；胁满是胁肋下方气机填塞胀满的感觉，不是腹中的胀满。大概邪气从体表传入体内，必定先经过胸胁，然后进入心腹乃至胃腑。因此胸满多带有表证，适宜发汗；只有胁满或疼痛，多带有半表半里的特征。可用小柴胡汤加枳实来调和它。至于胸中有痰饮实邪阻滞的，应当用涌吐法治疗。如果胸中邪气结聚而成实证，伴有燥渴、大便闭塞的，以大陷胸汤为主治方剂。
【纲】张仲景说：经过泻下治疗后，脉象急促，胸部胀满的，以桂枝去芍药汤为主治方剂。太阳病与阳明病合病，出现气喘且胸部胀满的，不可使用泻下法，适宜用麻黄汤。
【目】成无己说：这两条条文所述的都是胸满属于表证而需要发汗的情况。大概胸中距离体表较近，到了胁部就不再说发汗，只是进行和解罢了。大抵胸胁胀满，是因为邪气初入里尚未停留，湿气郁积而不运行，从而导致胀满。此时和解即可。如果邪气留滞在胸中，聚结成为实证，非涌吐法不能治愈。所以华佗说：“病邪在第四天位于胸中，用吐法可以治愈。”这是指邪气已经收敛而不散漫的情况，才可以采用吐法。
韩祗和说：气喘且胸痛，仍带有表证，不可使用泻下法，给予麻黄汤，或者麻黄杏子甘草石膏汤。脉象急促且胸满而给予桂枝去芍药汤的，病位在胃。因为芍药入营分，所以去掉它。
沈金鳌按语：胸满本属阳证，但如果经过泻下后出现胀满但不气喘，则是寒邪内结，将要形成结胸证。由此可知，胸满不仅见于阳气盛者，阳气虚者也会出现。
【纲】张仲景说：伤寒病，如果用吐法或下法治疗后，出现心下（胃脘部）逆觉胀满，气向上冲撞至胸部，起身时头晕目眩，脉象沉紧，如果再发汗，就会扰动经脉，导致身体震颤摇晃的，以茯苓桂枝白术甘草汤为主治方剂。
【目】柯琴说：伤寒初起，正宜发表，使用吐法和下法是非法的治疗。然而在吐下之后，病证没有转属太阴，反而出现心下逆满、气上冲胸，这是阳气在内受到干扰。
【纲】张仲景说：经过发汗，或者经过泻下治疗后，出现心中烦热、胸部窒塞感的，以栀子豉汤为主治方剂。
病症类似桂枝汤证，但头不疼，项不强，寸脉微浮，胸部痞塞硬满，气向上冲撞咽喉导致呼吸不畅的，这是因为胸中有寒饮。应当用涌吐法，适宜用瓜蒂散。
【目】成无己说：这两种情况都涉及吐法。栀子豉汤用于吐出胸中的虚烦客热，瓜蒂散用于吐出胸中的痰饮实邪和宿寒。
沈金鳌按语：这两条条文原本属于阳明病范畴，是为了阐明胸满应当用吐法的情况，所以附在此处。
【纲】张仲景说：太阳中风证，伴有下利、呕逆。表证已解的，才可以攻逐里实。如果患者汗出，发作有定时，心下痞塞，硬满，牵引胁下疼痛，干呕，短气，汗出且不恶寒，这是表证已解而里气未和，以十枣汤为主治方剂。
【目】沈金鳌按语：这一条中心下硬满，牵引胁肋胀满，是由于心下水气泛溢不和所致。
【纲】张仲景说：服用桂枝汤，或者经过泻下治疗后，仍然头项强痛，发热如翕翕然（形容发热轻微），无汗，心下胀满微痛，小便不利的，以桂枝去桂加茯苓白术汤为主治方剂。小便通利则病愈。
【目】沈金鳌按语：这是水湿结聚在中焦，只能利水而不能发散。因为发汗不彻底就急于使用下法，导致水气结聚在心下。虽然病根在心下，但病机仍在膀胱。现在小便不利，这实际上是太阳经的本病，并非桂枝汤证未罢。所以用本方来疏散邪气并行水利尿。
【纲】张仲景说：发汗后，出现腹部胀满的，以浓朴生姜甘草半夏人参汤为主治方剂。
【目】韩祗和说：腹满是邪气侵入太阴脾土所致。经常疼痛的是里实证，必须使用泻下法，如承气汤；时轻时重的是里虚证，应当温补，如理中汤。如果表证已解而内部积滞未消，如果不是大满证，还会产生寒热，说明邪气未完全入里，也不可使用下法。如果是大满大实，兼有燥屎，说明邪气已进入腑，即使得病四五天，也可以使用下法。大抵阳邪致病为热，则腹满且咽干；阴邪致病为寒，则腹满且吐利、饮食不下。如果已经经过吐下治疗后出现腹满，治疗方法又各不相同，这也是不可忽视的。
柯琴说：这一条不是误汗，而是人体本虚。发汗后反而出现有余之症，是邪气盛则实，所以用生姜、厚朴、半夏来散邪以消除腹满；正气虚，所以用人参、甘草来补中益气。
【纲】张仲景说：原本是太阳病，医生反而使用下法，因而导致腹部胀满、时时疼痛的，属于太阴病，以桂枝加芍药汤为主治方剂。如果大实痛（剧烈疼痛且拒按），以桂枝加大黄汤为主治方剂。
【目】陶华说：阳明病发热，腹满微喘，口苦咽干，或者不大便、谵语，用小柴胡汤。呃逆且小便困难的，加茯苓。三阳合病，腹满身重，难以翻身侧卧，谵语，口中感觉迟钝麻木，用小柴胡汤。有汗出的用白虎汤。太阴病腹满，呕吐食物不下，用枳桔理中丸。少阴病六七天，腹胀满，不大便，急用下法，用大承气汤。腹满痛者，因脾不胜水湿，水气与气搏结于皮肉之间，腹中漉漉有声，用小半夏茯苓汤加桂枝。下利伴腹满身疼痛，先温其里，用四逆汤，后攻其表，用桂枝汤。发汗后腹满，应当温补，用浓朴半夏生姜人参汤。吐后腹满，当下，少量给予调胃承气汤。下后腹满，宜用栀子浓朴汤。
柯琴说：腹满时痛，是因为误下所致，是阳邪转属太阴，并非太阴的本病。表证未罢，所以仍用桂枝汤解外；腹痛既然出现，所以加倍使用芍药来调和里气。此病本源于阳，所以用阴药来调和阳。如果因误下而导致腹大实痛，是太阳转属阳明而胃实，但尚未脱离太阳，这叫做有表里同病。仍用桂枝加大黄汤来消除实痛，这是双解表里的方法。凡是妄用下法必伤胃气，胃气虚则阳邪侵袭阴分，所以转属太阴；胃气实则两阳相搏结，所以转属阳明。太阴病则满痛但不坚实，因为阴道虚；阳明病则大实而痛，因为阳道实。满而时痛，是下利的征兆；大实而痛，是燥屎的征象。桂枝加芍药汤即是建中汤的变方，桂枝加大黄汤即是调胃承气汤的变方。
[Outline] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), if ten days have passed and the pulse is floating and fine, and the patient desires to lie still, it indicates that the exterior pathogens have been resolved. If chest fullness and hypochondriac pain occur, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be administered. If the pulse is merely floating, Ma Huang Tang (Ephedra Decoction) should be given.
[Commentary] Huang Zhongli stated: This section describes a combined disease of Taiyang and Shaoyang (Lesser Yang). Therefore, chest fullness, hypochondriac pain, and somnolence occur because the Qi of Shaoyang cannot ascend. Thus, Chai Hu Tang (Bupleurum Decoction) is used to harmonize. If the pulse is merely floating, it still belongs to the pulse pattern of Taiyang; therefore, Ma Huang Tang is used to disperse the pathogen.
Han Zhihe stated: Chest fullness refers to a sensation of Qi stagnation and oppression in the chest and diaphragm, not fullness in the epigastrium (Xin Xia). Hypochondriac fullness refers to a sensation of Qi filling and distension below the ribs, not fullness in the abdomen. Generally, when pathogens transmit from the exterior to the interior, they must first pass through the chest and hypochondrium before entering the heart, abdomen, and stomach. Therefore, chest fullness often carries exterior symptoms and is suitable for sweating therapy. Only hypochondriac fullness or pain often carries half-exterior, half-interior characteristics. It can be harmonized with Xiao Chai Hu Tang added with Zhi Shi (Aurantii Fructus). For phlegm-fluid retention causing excess patterns in the chest, emesis should be induced. If pathogenic factors condense in the chest forming an excess pattern, accompanied by dry thirst and constipation, Da Xian Xiong Tang (Major Draining the Chest Decoction) is the primary treatment.
[Outline] Zhang Zhongjing stated: After purgation, if the pulse is hurried and there is chest fullness, Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction without Paeonia) is the primary treatment. In a combined disease of Taiyang and Yangming, if wheezing and chest fullness occur, purgation is contraindicated; Ma Huang Tang is suitable.
[Commentary] Cheng Wuji stated: These two clauses describe cases where chest fullness belongs to the exterior and requires sweating therapy. The chest is relatively close to the exterior. When the condition reaches the hypochondrium, sweating is no longer mentioned, but only harmonization is performed. Generally, chest and hypochondriac fullness occurs because pathogens have just entered the interior without settling, causing dampness to stagnate and fail to circulate, leading to fullness. Harmonization is sufficient. If pathogens remain in the chest and condense into an excess pattern, only emesis can cure it. Thus, Hua Tuo said, "On the fourth day, when the pathogen is in the chest, emesis leads to recovery." This applies when pathogens have condensed and are no longer diffuse, allowing for emesis.
Han Zhihe stated: Wheezing with chest pain still carries exterior symptoms and purgation is contraindicated; administer Ma Huang Tang, or Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). For hurried pulse and chest fullness treated with Gui Zhi Qu Shao Yao Tang, the disease is located in the Stomach. Since Shao Yao (Paeoniae Radix Alba) enters the Ying (Nutritive) level, it is removed.
Shen Jin'ao's Note: Chest fullness originally belongs to Yang syndromes. However, if fullness occurs after purgation without wheezing, it indicates cold pathogens binding internally, potentially developing into Jie Xiong (Chest Binding). Thus, chest fullness occurs not only in cases of Yang excess but also in cases of Yang deficiency.
[Outline] Zhang Zhongjing stated: In Shang Han (Cold Damage), if vomiting or purgation is used, resulting in rebellious fullness in the epigastrium, Qi rushing up to the chest, dizziness upon rising, and a deep, tight pulse, further sweating will disturb the meridians, causing tremors and shaking of the body. Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is the primary treatment.
[Commentary] Ke Qin stated: At the onset of Shang Han, releasing the exterior is appropriate; vomiting and purgation are illegal treatments. However, after these methods, if the disease does not transfer to Taiyin but instead presents with rebellious epigastric fullness and Qi rushing to the chest, this indicates internal disturbance of Yang Qi.
[Outline] Zhang Zhongjing stated: After sweating or purgation, if irritability and heat appear in the chest with a sensation of obstruction, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
If symptoms resemble Gui Zhi Tang syndrome, but there is no headache or neck stiffness, and the Cun (Inch) pulse is slightly floating, with chest痞 (Pi, stuffiness/hardness) and hardness, and Qi rushing up to the throat causing breathing difficulty, this is due to cold-fluid in the chest. Emesis should be induced using Gua Di San (Thistle Powder).
[Commentary] Cheng Wuji stated: Both involve emesis. Zhi Zi Chi Tang expels empty irritability and guest-heat from the chest; Gua Di San expels phlegm-fluid excess and old-cold from the chest.
Shen Jin'ao's Note: These two clauses originally belong to Yangming syndromes, attached here to clarify that chest fullness may require emesis.
[Outline] Zhang Zhongjing stated: In Taiyang Wind Strike syndrome, with diarrhea and retching/vomiting, once the exterior is resolved, one may attack the interior. If the patient sweats, with episodes occurring at specific times, epigastric Pi (stuffiness), hardness, fullness pulling into the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. Shi Zao Tang (Ten Jujubes Decoction) is the primary treatment.
[Commentary] Shen Jin'ao's Note: In this clause, epigastric hardness/fullness pulling into hypochondriac fullness is caused by water-Qi overflowing and failing to harmonize in the heart/epigastrium.
[Outline] Zhang Zhongjing stated: After taking Gui Zhi Tang, or after purgation, if head and neck stiffness/pain persist, fever feels like covering (Xi Xi Fa Re - mild fever), there is no sweat, epigastric fullness with slight pain, and urination is difficult, Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala) is the primary treatment. Recovery occurs when urination becomes free.
[Commentary] Shen Jin'ao's Note: This is water-dampness knotting in the Middle Jiao (Middle Burner); it can only be drained, not dispersed. Because sweating was incomplete and purgation was hastily applied, water-Qi knotted in the epigastrium. Although the root is in the epigastrium, the pathology remains in the Bladder. Now, with difficult urination, this is essentially a Taiyang disease, not merely unresolved Gui Zhi syndrome. Thus, this formula is used to disperse pathogens and promote urination.
[Outline] Zhang Zhongjing stated: After sweating, if abdominal fullness occurs, Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is the primary treatment.
[Commentary] Han Zhihe stated: Abdominal fullness indicates pathogens entering the Taiyin Spleen Earth. Constant pain indicates Interior Excess, requiring purgation such as Cheng Qi Tang (Order the Qi Decoction). Intermittent reduction indicates Interior Deficiency, requiring warming such as Li Zhong Tang (Regulate the Middle Decoction). If the exterior is resolved but internal accumulation persists, unless it is a major fullness, chills and fever may still occur, indicating pathogens have not fully entered the interior, so purgation is not yet appropriate. If there is major fullness and excess, accompanied by dry feces, pathogens have entered the Fu organs; even if four or five days have passed, purgation can be used. Generally, Yang pathogens causing heat lead to abdominal fullness and dry throat; Yin pathogens causing cold lead to abdominal fullness, vomiting/diarrhea, and inability to eat. If abdominal fullness occurs after vomiting or purgation, treatment methods differ, which must be known.
Ke Qin stated: This clause is not due to erroneous sweating, but pre-existing deficiency. Post-sweating excess symptoms indicate pathogen excess becoming solid; thus, Sheng Jiang (Fresh Ginger), Hou Po (Magnolia Bark), and Ban Xia (Pinellia) are used to disperse pathogens and remove fullness. Righteous Qi is deficient, so Ren Shen (Ginseng) and Gan Cao (Licorice) are used to tonify the Middle and boost Qi.
[Outline] Zhang Zhongjing stated: Originally a Taiyang disease, if the physician erroneously uses purgation, resulting in abdominal fullness and intermittent pain, it belongs to Taiyin. Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction increased with Paeonia) is the primary treatment. For severe excess pain, Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction increased with Rhubarb) is the primary treatment.
[Commentary] Tao Hua stated: Yangming fever, abdominal fullness, slight wheezing, bitter taste, dry throat, or constipation with delirium: use Xiao Chai Hu Tang. Hiccups with difficult urination: add Fu Ling (Poria). Combined disease of Three Yangs, abdominal fullness, heaviness, difficulty turning, delirium, insensitivity in the mouth: use Xiao Chai Hu Tang. With sweating: use Bai Hu Tang (White Tiger Decoction). Taiyin abdominal fullness, vomiting food, inability to eat: use Ji Ju Li Zhong Wan (Aurantium and Isatis Pill regulating the Middle). Shaoying disease for six to seven days, abdominal fullness, constipation: urgent purgation with Da Cheng Qi Tang (Major Order the Qi Decoction). Abdominal fullness and pain due to Spleen failing to control water, water and Qi fighting between skin and flesh, rumbling sounds in abdomen: use Xiao Ban Xia Fu Ling Tang plus Gui Zhi (Cinnamon Twig). Diarrhea with abdominal fullness and body pain: first warm the interior with Si Ni Tang (Frigid Extremities Decoction), then attack the exterior with Gui Zhi Tang. Abdominal fullness after sweating: should be warmed with Hou Po Ban Xia Sheng Jiang Ren Shen Tang. Fullness after vomiting: should be purged with small doses of Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction). Fullness after purgation: use Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction).
Abdominal fullness is due to disharmony of Yin and Yang; use Jie Geng Ban Xia Tang (Platycodon and Pinellia Decoction).
Ke Qin stated: Abdominal fullness with intermittent pain results from erroneous purgation, where Yang pathogens transfer to Taiyin, not a primary Taiyin disease. Since exterior symptoms persist, Gui Zhi Tang is still used to release the exterior. Since abdominal pain appears, Shao Yao (Paeonia) is doubled to harmonize the interior. This disease originates from Yang, so Yin herbs are used to harmonize Yang. If erroneous purgation leads to severe excess pain, Taiyang has transferred to Yangming with Stomach excess, yet has not left Taiyang; this is called having both exterior and interior symptoms. Gui Zhi Jia Da Huang Tang is still used to remove excess pain; this is a method of simultaneously resolving exterior and interior. Erroneous purgation inevitably damages Stomach Qi. If Stomach Qi is deficient, Yang pathogens invade Yin, transferring to Taiyin; if Stomach Qi is solid, two Yangs contend, transferring to Yangming. Taiyin presents with fullness and pain but not solidity, because the Yin pathway is deficient. Yangming presents with severe excess and pain, because the Yang pathway is solid. Fullness with intermittent pain is a sign of impending diarrhea; severe excess and pain is a sign of dry feces. Gui Zhi Jia Shao Yao Tang is a variation of Jian Zhong (Establish the Middle) formulas; Gui Zhi Jia Da Huang Tang is a variation of Tiao Wei Cheng Qi Tang.