典藏书目

Houpo Banjin (Magnolia Bark Half Jin), Shengjiang Banjin (Fresh Ginger Half Jin), Banxia Banjin (Pinellia Tuber Half Jin), Renshen Liang (Ginseng Root 1 Liang), Gancao Zhi Sanliang (Prepared Licorice Root 3 Liang).
The above five herbs are boiled in one dou of water, reduced to three sheng of liquid, the dregs are removed, and one sheng is taken warm each time, three times a day.

Abdominal fullness that does not decrease, or decreases insignificantly, requires purgation; Dachengqi Tang (Major Order the Qi Decoction) is appropriate.
[Annotation]
Abdominal fullness that comes and goes intermittently is deficiency-type fullness; abdominal fullness that is constant and solid is excess-type fullness. "Abdominal fullness does not decrease, or decreases insignificantly" means that the abdominal fullness shows no significant relief; even if there is some reduction, it is slight and insufficient to be called a decrease. Deficiency-type fullness should be treated with warming methods, while excess-type fullness should be treated with purgation. Therefore, Dachengqi Tang (Major Order the Qi Decoction) is suitable for purging, which is the method for treating excess-type fullness.
[Collected Annotations]
You Yi stated: "Decreases insignificantly" means that although there is some reduction, it is not worth mentioning, thereby describing the severity of the fullness. Hence, vigorous purgation is appropriate. This refers to the principle that "for fullness in the center, drain from within."
Dachengqi Tang (Major Order the Qi Decoction) formula (see previous section on Spasm Disease).

When a patient presents with abdominal fullness, non-tenderness upon palpation indicates deficiency, while tenderness indicates excess, and purgation may be used. If the tongue coating is yellow and purgation has not yet been administered, the yellow coating will disappear after purgation.
[Annotation]
The previous clause distinguished between deficiency and excess in abdominal fullness based on whether it decreased intermittently or not; this clause distinguishes between surplus and insufficiency based on tenderness versus non-tenderness. Abdominal fullness that is non-tender upon palpation indicates deficiency, specifically Spleen deficiency, which should be treated with warming methods, such as using Houpao Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction). Tenderness upon palpation indicates excess, specifically Stomach excess, which should be treated with purgation, such as using Dachengqi Tang (Major Order the Qi Decoction). In cases of Stomach excess, the tongue coating must be yellow; if purgation has not yet been performed, the yellow coating will naturally clear after purgation.
[Collected Annotations]
Zhao Liang stated: Abdominal fullness can also be due to excess conditions, which clearly are not deficiency-cold. How can they all be treated with warming medicines? Thus, there is a trial method: distinguishing between tenderness and non-tenderness makes the difference between excess and deficiency obvious. Generally, Stomach excess involves heat; heat steaming leads to a yellow tongue coating. After purging the excess heat, would the yellow coating not clear itself? With this differentiation, the assessment of deficiency becomes more rigorous.
Wei Litong stated: When formless deficient qi causes stagnation and blockage, palpation reveals no solid mass, so why would there be pain? However, if there are tangible pathogenic factors causing issues, such as retained food in the Stomach or hernias in the lower abdomen, palpation reveals obstructions beside the zang-fu organs. Would there be no pain? This is the method of determining excess and deficiency by assessing tenderness upon palpation.

If a patient presents with sallow complexion, restlessness without thirst, cold-excess in the chest/epigastrium, and unceasing diarrhea, the prognosis is fatal.
[Commentary]
"Restlessness without thirst" should likely be "dryness without thirst" for the text to make sense. "Cold-excess in the chest" should likely be "cold-excess in the Stomach"; if it were cold-excess in the chest, how could it lead to death via unceasing diarrhea? These are errors or missing characters in transcription.
[Annotation]
A sallow complexion in a patient, if accompanied by dry mouth and thirst, indicates heat-excess; however, sallow complexion with dry mouth but no thirst indicates cold-excess. Cold-excess typically does not cause diarrhea; if diarrhea occurs, it indicates cold-deficiency. Unceasing diarrhea here signifies the collapse of Stomach qi due to cold-deficiency, hence the fatal prognosis.
[Collected Annotations]
Cheng Lin stated: Sallow complexion indicates Spleen and Stomach disease. Thirst indicates heat, while lack of thirst indicates cold. If a patient has sallow complexion combined with uncontrollable diarrhea, the Spleen qi is exhausted, leading to a fatal outcome.
Li [Name Missing] stated: Diarrhea with dryness and thirst indicates heat, where yang qi is still present and treatable. Now, dryness without thirst indicates severe cold pathogen in the Stomach. If diarrhea is unceasing, yin is excessive and yang is declining, with qi collapsing downward, hence the fatal outcome.

In thin individuals, periumbilical pain indicates wind-cold, obstructing the movement of grain qi. If purgation is mistakenly applied, qi will rush upward; if it does not rush upward, epigastric stuffiness (pi syndrome) will occur.
[Annotation]
This clause follows up on the previous point regarding the error of using cold purgatives for cold-excess syndromes. Thin individuals have weak constitution and qi, making them vulnerable to external pathogens. Periumbilical pain suggests wind-cold injuring the Stomach, obstructing the movement of grain qi. Although periumbilical pain appears to be an excess condition, when caused by wind-cold, it is cold-excess. The physician should use warming methods to promote movement. Mistakenly using cold purgatives now causes the wind-cold pathogen: if the upper part is deficient, qi rushes upward; if the middle part is deficient, pi syndrome forms in the epigastrium. This is the logical consequence.
[Collected Annotations]
You Yi stated: Thin individuals have deficient internal qi and weak viscera, allowing wind-cold to easily enter. Once entered, grain qi stagnates and fails to move, causing periumbilical pain. It resembles interior excess but is actually deficiency-cold, requiring warming medicines to assist Spleen function. Mistaken purgation expels grain qi but leaves the wind-cold pathogen behind, further weakening the body and leaving the pathogen unchecked. Consequently, qi will inevitably rush upward; if it does not rush upward, pi syndrome will form in the epigastrium.

At the Cun Kou pulse position, a wiry pulse indicates tightness and pain in the hypochondrium, accompanied by aversion to cold.
[Annotation]
This clause elaborates on the first clause, explaining that pain in both hypochondria belongs to cold. A wiry pulse at Cun Kou corresponds to the wiry pulse mentioned in the first clause. Tightness and pain in the hypochondrium correspond to the pain in both hypochondria mentioned in the first clause. How do we know it is cold? The patient must exhibit signs of yang deficiency and aversion to cold (se se e han) to confirm liver-cold pain. Even if abdominal fullness is present, warming treatment is appropriate.
[Collected Annotations]
Cheng Lin stated: Wiry pulse is the Liver pulse, belonging to yin. The Liver meridian runs through the hypochondrium. Cold governs contraction and drawing inward, causing tightness and pain in the hypochondrium. Because cold dominates internally, yang qi cannot circulate externally, resulting in external aversion to cold.

Individuals prone to intermediate cold often yawn. If they have clear nasal discharge, fever, and normal facial color, they sneeze frequently.
[Annotation]
"Intermediate cold family" refers to those who chronically suffer from intermediate cold. Previously, intermittent reduction was used to distinguish intermediate cold in abdominal fullness, and aversion to cold was used to distinguish intermediate cold in hypochondriac pain. Here, yawning and clear nasal discharge are used to distinguish intermediate cold in the chest and heart region. Yawning (qian) is a sigh or yawn. When one is sleepy and yawns, it is yin drawing yang inward; when waking and yawning, it is yang drawing yin outward. Now, yawning due to intermediate cold indicates yin excess drawing yang. Clear nasal discharge in the elderly indicates yang deficiency; in those exposed to cold, it indicates cold excess. Clear nasal discharge in intermediate cold indicates yang deficiency and cold. If there is fever with normal facial color, it is not intermediate cold, but rather external cold attacking. Even with clear nasal discharge, it results from frequent sneezing.

In intermediate cold, if the patient has diarrhea due to interior deficiency, and desires to sneeze but cannot, this indicates cold in the abdomen (or pain).
[Annotation]
The previous clause distinguished intermediate cold in the chest using yawning and spontaneous clear nasal discharge; this clause distinguishes cold in the abdomen using diarrhea and the inability to sneeze despite the urge. Diarrhea indicates chronic interior qi deficiency. Why does the inability to sneeze indicate abdominal cold? Sneezing represents the movement of Lei qi (thunder qi); when internal yang and external yin-yang qi strive forth, sneezing occurs. Now, the desire to sneeze but inability to do so indicates yang qi attempting to exit but being retained, signifying yin excess. Thus, abdominal cold is confirmed.
[Collected Annotations]
Shen Mingzong stated: This is the manifestation of Cold invading the Spleen Meridian. Cold enters Taiyin, causing excessive yin-cold and dampness. Yang deficiency fails to secure, leading to diarrhea, mostly due to insufficiency, hence interior deficiency. Harmonious yang leads to sneezing; the inability to sneeze indicates yin-cold stagnating internally, causing abdominal pathology.

For cold qi in the abdomen causing rumbling sounds and cutting pain, with reverse fullness in the chest/hypochondrium and vomiting, Fuzi Jingmi Tang (Aconite and Rice Decoction) is the primary treatment.
[Annotation]
Cutting pain in the abdomen is due to cold; rumbling sounds are due to qi. Cold qi in the abdomen causes rumbling and cutting pain. Reverse fullness in the chest/hypochondrium is caused by cold qi outside the intestines and stomach. Abdominal pain, rumbling, and vomiting are caused by cold qi inside the intestines and stomach. Fuzi Jingmi Tang (Aconite and Rice Decoction) is used to overcome cold qi and harmonize the interior and exterior. This is the method for treating cold in the abdomen.