典藏书目

Any formula capable of descending qi, resolving phlegm, guiding stagnation, expelling water, unblocking blood stasis, reducing jaundice, eliminating distension, or driving out parasites is referred to as the "Attacking Interior Method" (Gong Li Fa). The Attacking Interior Method aims to resolve the knotted pathogenic factors within the interior. Knotted pathogenic factors causing disease are of great significance; diseases manifesting as palpitations (Pi), fullness (Man), wheezing (Chuan), edema (Zhong), chest oppression (Men), obstruction (Bi), pain (Tong), and distension (Zhang) all involve knotting. As stated in the *Neijing* (Inner Canon): knotting of Yin leads to hematochezia; knotting of Yang leads to swelling; knotting of one Yin and one Yang is called throat bi (Hou Bi); knotting of two Yangs is called Xiao Ke (wasting and thirsting); knotting of three Yangs is called Ge Shi (dysphagia/obstruction). Furthermore, in the *Shanghan Lun* (Treatise on Cold Damage), there are minor Jie Xiong (knotted chest) located at the epigastrium, painful upon pressure; major Jie Xiong with epigastric pain hard as stone upon pressure; central Jie Tong (knotted pain); sub-epigastric support-type knotting; acute knotting in the lower abdomen; heat knotting in the interior; heat knotting in the Bladder; heat entering the Blood Chamber where blood must knot; as well as food Jie Xiong, water Jie Xiong, blood Jie Xiong, cold-solid Jie Xiong, and heat-solid Jie Xiong, among many others. Therefore, the treatment of interior diseases generally focuses on resolving knots; once the knot is resolved, the disease will inevitably disappear. Is it only for the four conditions of fecal impaction, large intestine gelatinous obstruction, diarrhea with fever (Xie Re Xia Li), and heat knotting with purging flow (Re Jie Pang Liu) that pathogenic knots in the interior require attacking methods to resolve? Let us describe the formulas for attacking the interior, listed as follows:

Warm-heat knotted pathogenic factors generally belong to latent fire, so the correct treatment should naturally be bitter-cold draining of fire. San Huang Xie Xin Tang (Coptis, Scutellaria, and Rhubarb Decoction to Drain the Heart, from *Shanghan Lun*) is the primary formula, while Xu's Da Huang Tang (Rhubarb Decoction by Xu, from *Waitai Mi Yao*) is particularly effective. However, one must distinguish whether it is toxic fire requiring urgent purgation, such as Zi Cao Cheng Qi Tang (Arnebia and Rhubarb Decoction), Qing Liang Gong Du San (Cooling and Detoxifying Powder), Fei's Bi Sheng Tang (Fei's Invincible Decoction), Qing Huo Jie Du Tang (Clearing Fire and Resolving Toxicity Decoction, from *Jiu Pian Suo Yan*), Chen's Si Hu Yin (Chen's Four Tigers Drink, from *Yi Sha Cao*), Shi Quan Ku Han Jiu Bu Tang (Ten Complete Bitter-Cold Rescue and Tonification Decoction, from *She Jian Bian Zheng*), Ba Cui Xi Jiao Di Huang Tang (Extract of Rhinoceros Horn and Rehmannia Decoction) added with Jin Zhi (Gold Juice) and Yuan Ming Fen (Mirabilite), or similar formulas, used according to symptoms. For wind-fire, dispersing and purging is suitable, such as Ju Fang Liang Ge San (Regulatory Bureau Cooling Chest Powder), Jia Wei Liang Ge San (Modified Cooling Chest Powder, from *Han Wen Tiao Bian*), and Qing Xin Tang (Clearing Heart Decoction, from *Dan Xi Xin Fa*). For damp-fire, slow purging is suitable, such as Yin Chen Hao Tang (Artemisiae Scopariae Decoction, from *Jin Gui Yao Lue*), Jia Wei Xiao Xian Xiong Tang (Modified Minor Incongruity Chest Decoction, from *Yi Yuan*), Xiao Xian Xiong Tang combined with Pu Huang Wan (Minor Incongruity Chest Decoction combined with Rhubarb and Magnolia Pill, from Cheng Guopeng's *Yi Xue Xin Wu*), San Huang Zhi Zhu Wan (Three Yellows and Immature Bitter Orange Pill, from Dongyuan's *Pi Wei Lun*), Shen Xiong Dao Shui Wan, etc. For dry-fire, moistening purging is suitable, such as Qian Jin Sheng Di Huang Tang (Thousand Gold Raw Rehmannia Decoction, from Sun Simiao's *Qian Jin Yao Fang*), Yang Rong Cheng Qi Tang (Nourishing Glory and Rhubarb Decoction, from Wu Youke's *Wen Yi Lun*), Dang Gui Cheng Qi Tang, Si Shun Yin Zi (Four Smooth Infusion, from Hejian's *Liu Shu*), Dongyuan Run Chang Wan (Dongyuan Moistening Intestine Pill), Wu Ren Wan (Five Seeds Pill, from You Zaijing's *Jin Kui Yi*), Xue Geng Jia Wei Jian (Snow and Fish Soup Modified Decoction, Fan Shi's Verified Formula), etc. For phlegm-fire, descending and purging is suitable, such as Xiao Xian Xiong combined with Jia Wei Ban Xia Xie Xin Tang (Modified Minor Incongruity Chest combined with Modified Pinellia Draining Heart Decoction, from *Yi Yuan*), Cheng Qi Xian Xiong Tang (Rhubarb and Incongruity Chest Decoction, from *Wen Bing Tiao Bian*), Lou Lu Ju Pi Tang (Rhizoma Leuzeae and Tangerine Peel Decoction, from *Waitai*), Niu Huang San (Calculus Bovis Powder, from *Liu Shu*) added with Xue Geng (from *Gu Fang Xuan Zhu*), Jia Wei Zao Jiao Wan (Modified Gleditsia Sinensis Pill, from *Jin Kui Yi*), Liang Ge San added with Ting Li Zi, Gan Sui, Bai Jie Zi, Ginger Juice, and Bamboo Sap (from *Yi Tong*), etc. For food accumulation transforming into fire, clearing and purging is suitable, such as Zhi Shi Dao Zhi Tang (Immature Bitter Orange Guiding Stagnation Decoction, Nie Shi's Verified Formula), Zhi Shi Dao Zhi Wan (Immature Bitter Orange Guiding Stagnation Pill, from *Pi Wei Lun*), Pu Huang Wan (Rhubarb and Magnolia Pill, from *Yi Xue Xin Wu*), Lu Shi Run Zi Wan (Lu's Moistening Character Pill, from Lu Yangyu's *San Shi Yi Yan*), etc. For blood stasis transforming into fire, unblocking and purging is suitable, such as Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction), Xia Yu Xue Tang (Eliminating Blood Stasis Decoction, Zhang Zhongjing's Formula), Jia Wei Da Chai Hu Tang (Modified Major Bupleurum Decoction, Ye Tianshi's *Wen Bing Lun* formula), Wu Shi Tao Ren Cheng Qi Tang (Wu's Peach Kernel and Rhubarb Decoction, from *Wen Yi Lun*), Dai Di Dang Wan (Substitute Dandang Pill, from *Han Wen Tiao Bian*), Wu Ji Wan (Limitless Pill, from Li Shizhen's *Ben Cao Gang Mu*), Hui Sheng Zhi Bao Dan (Life-Restoring Precious Pill, Hua Shi's Gynecology Verified Formula), Tao Ren Cheng Qi Tang combined with Xiao Yao San modified, etc. For water-fire mutual knotting, guiding and purging is suitable, such as Da Xian Xiong Tang (Major Incongruity Chest Decoction, from *Shanghan Lun*), Kong Xian Dan (Controlling Phlegm Pill, from *He Ji Ju Fang*). If water-fire mutual knotting is accompanied by parasites, guiding and purging combined with killing parasites is suitable, such as Jia Wei Kong Xian Dan (Modified Controlling Phlegm Pill, from Tanbo Lianfu's *Guan Ju Fang Yao Bu*), Xiong Huang Jie Du Wan (Realgar Detoxifying Pill, from *Hou Ke Mi Zhi*), etc. Additionally, for those with weak constitution and chronic illness, or after repeated sweating, clearing, and purging, even if indications for purging exist, they cannot tolerate harsh attacking methods. For qi deficiency leading to failure to purge, moistening purging combined with tonifying qi is suitable, such as Huang [Tang] (likely Huang Long Tang variant, from *Jin Kui Yi*), Bu Zhong Yi Qi Tang added with Mirabilite and White Honey (Gao Gufeng's *Ji Ren Bian*), etc. For blood deficiency leading to failure to purge, moistening purging combined with nourishing blood is suitable, such as Yu Zhu San (Jade Candle Powder, from *Yi Zong Jin Jian* Gynecology), Yi Xue Run Chang Wan (Benefiting Blood Moistening Intestine Pill, from *Jin Kui Yi*), etc. For dual qi and blood deficiency yet requiring purging, dual tonification of qi and blood combined with purging is suitable, treating both pathogen and righteous qi simultaneously. Tao Shi Huang Long Tang (Tao's Yellow Dragon Decoction, from *Wen Yi Lun*) is primary; San Yi Cheng Qi Tang added with Ginseng (from *Yi Tong*) is also indicated. For yang deficiency leading to failure to purge, warm-moistening method replaces purging; Cong Rong Run Chang Wan (Cistanche Moistening Intestine Pill, from *Jin Kui Yi*) is most appropriate; Ban Liu Wan (Half Sulfur Pill, from *He Ji Ju Fang*) can also be temporarily used. For yin deficiency leading to failure to purge, moistening-nourishing method replaces purging; Cong Mi Di Huang Tang (Cistanche, Honey, and Rehmannia Decoction, from *Yan Fang Xin Bian*) is most stable; Qian Jin Sheng Di Huang Jian (Thousand Gold Raw Rehmannia Decoction, from *Qian Jin Yao Fang*) is also effective.

Secondly, one must distinguish the location within the Triple Burner (San Jiao). If knotted pathogenic factors are in the chest and lungs, the method should treat lung and intestines together, urgently descending qi to purge downward. For example, Pi Pa Ye Yin Zi (Loquat Leaf Infusion, from *Waitai*) with heavy use of Gua Lou Pi (Trichosanthes Peel) 3 qian to soothe lungs and widen chest, and Chuan Bei Mu (Fritillaria Bulb) 8 qian to 1 liang to resolve knots and descend qi; this is invariably effective. Next is Su Zi Jiang Qi Tang added with Zhi Xing Tang (Perilla Seed Descending Qi Decoction added with Immature Bitter Orange and Apricot Kernel Decoction); for severe cases, Liu Mo Yin Zi (Six Grinding Infusion, from *Jin Kui Yi*) or Ye Shi Wan Xing Tang (Ye's Asthma-Almond Decoction: Zi Wan 8 qian, Guang Xing Ren 3 qian, Gua Lou Ren 5 qian, Guang Yu Jin 3 qian, Xiao Zhi Shi 1.5 qian, Ku Jie Geng 1 qian), which are also very rapid in effect. If knotted pathogenic factors are in the chest and heart, the method should treat heart and stomach together, cooling and unblocking blood to purge downward. Examples include Qian Jin Sheng Di Huang Tang, Qian Jin Qing Xin Tang, Ba Cui Xi Jiao Di Huang Tang (from *Wen Du Bing Lun*), Xi Lian Cheng Qi Tang (Xi Jiao and Scutellaria Rhubarb Decoction, from *Shanghan Xun Yuan*), possibly added with Zi Xue (Purple Snow) or Niu Huang Wan (Calculus Bovis Pill). If knotted pathogenic factors are in the chest-diaphragm, opening the chest-diaphragm to purge downward is suitable; for mild cases, Jia Wei Xiao Xian Xiong Tang; for severe cases, Cheng Qi Xian Xiong Tang. If knotted pathogenic factors are in the chest-hypochondrium extending to the right hypochondrium involving liver and gallbladder, reaching the membrane source to purge downward is suitable, such as Da Chai Hu Tang (Major Bupleurum Decoction, from *Shanghan Lun*), Da Chai Hu Tang combined with San Yi Cheng Qi Tang (from *Liu Shu*), Qian Jin Xie Gan Tang (Thousand Gold Draining Liver Decoction, from *Qian Jin Yao Fang*); or unblocking collaterals to purge downward, such as Si Shun Yin Zi, Youke Tao Ren Cheng Qi Tang, Fei Shi Qing Huo Jie Du Tang. If knotted pathogenic factors are in the chest-epigastrium extending to the left hypochondrium involving spleen, soothing qi to purge downward is suitable, such as Qian Jin Qing Pi Yin, Zhi Shi Dao Zhi Wan, San Huang Zhi Zhu Wan. If knotted pathogenic factors are above the navel in the epigastrium, harmonizing the middle to purge downward is suitable, such as Tiao Wei Cheng Qi Tang (Regulating Stomach and Rhubarb Decoction, from *Shanghan Lun*), San Yi Cheng Qi Tang (from *Liu Shu*). If knotted pathogenic factors are at the navel and below in the small intestine, widening intestines to purge downward is suitable, such as Xiao Cheng Qi Tang (Minor Rhubarb Decoction, from *Shanghan Lun*), Xiao Cheng Qi Tang added with Huang Lian (from *Gan Zheng Bao Fa*). If knotted pathogenic factors are in the chest-diaphragm and large abdomen, with all three burners knotted, presenting complete Pi, Man, Zao, Shi, and Jian, urgent attacking of the three burners to purge downward is suitable, such as Da Cheng Qi Tang (Major Rhubarb Decoction, from *Shanghan Lun*), Xian Xiong Cheng Qi Tang, Chen Shi Si Hu Yin, Shi Quan Ku Han Jiu Bu Tang. If knotted pathogenic factors are in the lower abdomen extending to the kidneys in both loins, urgently clearing the kidneys to purge downward is suitable, such as Qian Jin Qing Shen Tang, Zhi Chi added with Shu Shi Da Huang Tang (Thousand Gold Decoction, from *Qian Jin Yao Fang*), Jia Wei Ba Zheng San (Modified Eight Correct Powders, from *Liu Shu*). These are the general principles of various attacking interior methods. External treatments: such as Honey Suppository Method, Pig Gallbladder Suppository Method, Enema Method, are sufficient to supplement the inadequacies of decoctions, pills, and powders. Regarding the severity and urgency of the attacking interior method, it is always based on the presenting symptoms, detailed as follows:

Indications for Urgent Purging in Warm-Heat Diseases: Fever with profuse sweating, nose appearing like coal smoke, dry tongue, rolled tongue, short tongue, black scorched dry tongue, thorny tongue coating, dry teeth and bleeding gums, chest and abdominal fullness and pain, delirium and mania, even coma, cold body and hiccups, constipation, scanty and astringent urination, even anuria, spasms of hands and feet.

Indications for Purging in Warm-Heat Diseases: Headache and distending pain, irritability, delirium, excessive talking, amnesia, yellow dry tongue coating, diarrhea with fever, or heat knotting with purging flow, scanty red urine.

Indications for Slow Purging in Warm-Heat Diseases: Tidal fever and thirst, dry teeth, axillary sweating, intense heat in chest and abdomen, yellow coarse tongue coating, large intestine gelatinous obstruction, foul flatus, yellow-red urine.

If the above symptoms requiring slow purging are not treated with slow purging, they will gradually worsen into symptoms requiring purging; if symptoms requiring purging are treated with slow purging, they will worsen into symptoms requiring urgent purging; if symptoms requiring urgent purging fail to be purged, even multiple purgations will not result in passage, and knotted heat will reverse upward from below, distension filling up to the epigastrium, penetrating upward through the diaphragm, causing chest fullness hard as stone, sawing sounds in the throat, eyes staring straight and white, or blindness and dilated pupils, deafness, obstruction of the nine orifices; even with divine medicines, rescue is impossible.

Indications of Internal Excess Wind-Fire in Warm-Heat Diseases: High fever without sweat, red eyes and dizziness, red face and scorched lips, mouth ulcers and cracked lips, yellow dry tongue coating, constipation of both bowels and bladder, even nasal hemorrhage and hematemesis, spasms of hands and feet, eruption of macules and mania, coma and delirium.

Indications of Dry-Fire Scorching Lungs in Warm-Heat Diseases: Reverse coughing without sputum; if sputum exists, it is sticky and difficult to expectorate, dry nostrils, even sore throat and hoarseness, tinnitus like deafness, chest-diaphragm oppression.

Indications of Phlegm-Fire Obstructing Lungs in Warm-Heat Diseases (i.e., Modified Liang Ge San Syndrome): Copious sputum and cough, croaking sound in throat like a water fowl, flaring and swollen nostrils, hot breath in and out, chest-diaphragm palpitation and fullness, wheezing distension and chaotic oppression, thorny tongue coating, constipation, even chest and abdomen hard as iron stone, death by distension and oppression.

Indications of Damp-Fire Accompanying Food Accumulation Knotting in Stomach and Intestines: Fever and spontaneous sweating, chest palpitation and abdominal fullness, burning sensation upon pressure, large intestine gelatinous obstruction, extremely foul flatus, or passage of small amounts of yellow-black thick sticky stool不爽利, scanty and astringent yellow-red urine, yellow greasy coarse tongue coating.

Indications of Toxic Fire Scorching Upper, Middle, and Lower Triple Burners: Redness of face and eyes, thirst preferring cold drinks, intense heat in chest and abdomen, hardness and fullness with refusal to press, constipation, red astringent urination, coma and cold limbs, even whole-body cold limbs, old yellow tongue coating, or scorched black thorny coating, or scorched black petal-like coating bottom, open mouth blowing air, foul odor spraying, even whole-body stench, coma like a corpse, rolled tongue and retracted scrotum, or locked jaw and clenched teeth, limb spasms, inability to lie flat with back touching the bed.

Indications of Water-Fire Mutual Knotting in Warm-Heat Diseases (i.e., Water Retention with Fecal Knotting): Dry mouth but no thirst, hardness, fullness, and pain from epigastrium to lower abdomen unpressable, gurgling sound upon rubbing, intense heat in chest and abdomen, only head sweating, slight surface heat, heat knotting with purging flow of stool, small amount and不畅利, or diarrhea with fever though heavy and difficult to pass, difficult urination, even strangury, thick yellow greasy tongue coating.

Indications of Blood Stasis Retention Transforming into Fire in Warm-Heat Diseases: Dry mouth and tongue, rinsing mouth but not swallowing, chest bi-pain, lower abdomen hardness and fullness, even distending pain, heavy body, binding constraint of abdomen and back making movement difficult, irritability like mania, delirium and amnesia, free urination; although stool is hard, defecation is surprisingly easy and black in color, or only bloody water passes, seeing stool indicates life, not seeing stool indicates death; purple-dark moist tongue color.

Summary: Among the above warm-heat interior syndromes, those complicated by phlegm and food accumulation are the most common; water retention and blood stasis follow; toxic fire and dry fire are the most urgent and dangerous; wind fire follows; damp fire is next.