典藏书目

Rhizoma Rhei (Dahuang) 2 liang, Rhizoma Coptidis (Huanglian) 1 liang, Cortex Scutellariae (Huangqin) 1 liang, Radix Aconiti Lateralis Preparata (Fuzi, processed, skin removed, broken apart, decocted separately to extract the juice) 1 piece.
Take the above four ingredients. Chop three of them, soak them in two sheng of boiling water (referred to as "Ma Fei Tang"), wait for a short while, then strain out the dregs; add the extracted juice of Fuzi, and take half warm, divided into two doses.

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In cases of Shanghan (Cold Damage) or Zhongfeng (Wind Strike), if the physician erroneously applies purgation, the patient may suffer from diarrhea, occurring dozens of times a day, with undigested food, borborygmus in the abdomen, epigastric stuffiness and fullness, dry retching, restlessness, and inability to find peace. If the physician observes epigastric stuffiness and assumes the pathogenic factor is not fully eliminated, applying purgation again will exacerbate the stuffiness. This is not due to heat accumulation, but rather to deficiency in the Stomach and rebellious flow of hostile Qi, thus causing stuffiness. Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium) is indicated.

[Annotation]
Regardless of whether it is Shanghan or Zhongfeng, if the exterior syndrome has not been resolved, purgation should generally not be used. Erroneous purgation may lead to Pi (stuffiness) or Li (diarrhea). In this case, due to erroneous purgation, the patient suffers from diarrhea dozens of times daily, with undigested food and borborygmus, indicating that pathogens have taken advantage of interior deficiency to cause diarrhea. Epigastric stuffiness and fullness, dry retching, and restlessness indicate that pathogens have sunk into the deficiency of the chest and are rebelling upwards. In such cases where Pi and Li coexist involving both interior and exterior, the appropriate method is to use Guizhi Jiarenshen Tang (Cinnamon Twig Decoction plus Ginseng) to resolve both. The physician, seeing only epigastric stuffiness and assuming incomplete elimination of disease, applied purgation again, worsening the stuffiness. This demonstrates that the stuffiness is neither due to heat accumulation nor cold accumulation, but results from middle-jiao deficiency caused by erroneous purgation, leading to rebellious pathogenic Qi, sinking of Yang, and congealing of Yin. Therefore, Gancao Xiexin Tang is used to alleviate urgency and harmonize the middle jiao.

[Collected Annotations]
Shen Liangchen stated: Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) and Gancao Xiexin Tang are both caused by Qi damage following purgation. Shengjiang Xiexin Tang (Fresh Ginger Decoction for Draining the Epigastrium) arises from dietary stagnation; Dahuang Xiexin Tang (Rhubarb Decoction for Draining the Epigastrium) arises from internal heat; Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium) arises from external cold. Since the syndromes differ, the prescriptions vary accordingly.
Yu Chang stated: Diarrhea with undigested food, borborygmus, vomiting, and restlessness are all consequences of gastric emptiness due to erroneous purgation. If one fails to understand this principle and mistakenly believes it is heat accumulation, applying purgation again will inevitably worsen the stuffiness. Thus, the text reiterates gastric deficiency and rebellious hostile Qi to clarify the etiology.
Cheng Yingmao stated: Zhang Zhongjing feared that heat accumulation might be difficult to distinguish clearly, so he specifically highlighted gastric emptiness and rebellious hostile Qi to clarify that it is not heat accumulation. Therefore, acrid-warm herbs are used to regulate Yang and restrain hostile Qi from rebelling upwards; bitter-cold herbs are used to clear and purge, removing hostile heat to prevent obstruction. In this way, neither aspect hinders the other, Yin and Yang harmonize, and adversity turns into prosperity.
Wang Hu stated: If the patient suffers from diarrhea dozens of times a day, the contents of the Stomach must be exhausted, how could it not be deficient? Moreover, after the physician applied purgation again and the stuffiness worsened, it becomes even clearer that this is not an excess syndrome. If it were an excess syndrome, it would certainly be described as "stuffiness and pain," not merely "stuffiness and fullness." The single character "fullness" makes the distinction between excess and deficiency evident.
Wei Litong stated: In the previous clause, due to aversion to cold and sweating, Yang follows sweat to the exterior, fearing Yang collapse on the outside, so Fuzi is used to restore Yang; this clause emphasizes gastric deficiency, with weak Yang in the middle, so Gancao and Ganjiang (Dried Ginger) are used to benefit Yang; this is also an urgent matter of treating exterior and interior separately. However, the principle of consolidating Yang as the foundation for expelling pathogens remains consistent.