Cold-damage disease, with heat, slight abdominal distension and fullness, should have difficulty in urination, but now it is the opposite, indicating the presence of blood, and purgation is appropriate, suitable for Resistant and Withstanding Pill.

bubble_chart Note

• This follows from the previous section to discuss the milder symptoms, to mutually elucidate their meanings and consider their treatment.
• Cold-damage disease, a disease of the nutrient aspect, with persistent heat, hidden in the nutrient aspect, the blood does not recklessly travel through the channels causing nosebleeds, then it must accumulate in the bladder through the channels, the lower abdomen is the chamber of the bladder, hence slight abdominal distension and fullness.
• If there is difficulty in urination, then the disease is in the defense aspect, with stagnant water; now the opposite is true, then the disease is in the nutrient aspect, with static blood, the method should be purgation, suitable for Resistant and Withstanding Decoction. Made into pills in a smaller dose, for gentle laxation, one should not overuse Resistant and Withstanding Decoction.

bubble_chart Collected Annotations

• Fang You-zhi said: "The formula from the previous section, changed from a decoction to pills. Although named as pills, it is still boiled like a decoction. Decoctions are for purging, pills are for gentleness, changing from decoction to pills yet not departing from the decoction, it captures the intention of wanting gentleness without gentleness, not purging yet purging."
• Cheng Ying-gao said: "Fullness due to the pattern of heat invading the qi aspect, and accumulation involving body fluids, should have difficulty in urination, now the opposite is true, then it is known that what is accumulated is not body fluids, but blood. Blood becomes full and congealed due to heat, hence Resistant and Withstanding Decoction is used, altered into pills, boiled and taken with the dregs, to directly reach the blood, to purge old heat, completely eliminate new stasis, and eradicate the root!"

bubble_chart Formula

Resistant and Withstanding Pill Formula
Leech twenty pieces (roasted) Gadfly twenty pieces (roasted, wings and legs removed) Peach kernel twenty-five pieces (peeled, tips removed) Rhubarb Rhizoma three taels
The above four ingredients, pounded and sieved into four pills, with one sheng of water, boil one pill, take seven ge, and consume it. Within a day and night, blood should be purged, if not, take more.

bubble_chart Collected Explanations

• Ke Qin said: "The bladder is the water mansion, and blood originally has no place to accumulate. The lower abdomen is the chamber of the bladder. When heat accumulates and causes hardness and fullness, there should be difficulty in urination, but if urination is instead smooth, it indicates that the disease is not within the bladder but within the lower abdomen. The nourishing blood that follows the meridians becomes stagnant due to heat accumulation in the interior of the lower abdomen, not within the bladder. Therefore, although urination is smooth, the hardness, fullness, and acute binding remain as before, indicating blood stasis in the lower abdomen. When heat overwhelms the interior, the spirit becomes restless, hence mania occurs; when blood stasis does not move, the nourishing function does not circulate, hence the pulse is faint and deep; when the nourishing function does not circulate, the qi does not disperse, hence the pulse is deep and knotted. When the nourishing qi does not circulate throughout the body, the body becomes jaundiced. Rapid digestion and frequent hunger indicate intense stomach fire; easy bowel movements indicate the moistening effect of blood; black color indicates the transformation of stagnant blood; forgetfulness indicates that blood does not nourish the intellect, hence clarity is lost. These are all signs of static blood, and only the most potent formulas are sufficient to reach its lair and bear this heavy responsibility, hence the Resistant and Withstanding Decoction was established. Leeches are good at drinking blood and are beneficial for water; gadflies are good at sucking blood and are fierce on land. Both are used to attack the blood stasis, as like seeks like; additionally, the bitter and warm peach kernel is used to expel the old and bring forth the new, and the bitter and cold Rhubarb Rhizoma is used to purge pathogenic heat, hence the name 'Resistant and Withstanding.' If the heat is severe but not to the point of mania, and there is slight abdominal distension and fullness but not hardness, then it is appropriate to reduce the formula to pills for a gentler treatment. If the external symptoms have resolved, but there is acute binding in the lower abdomen and the person is manic, this indicates a transition to a Yangming pattern, and the Stomach-Regulating Qi-Coordinating Decoction with peach kernel and Cinnamon Twig, which promote blood circulation, should be used to gently purge, so that when the stomach is harmonized, recovery will follow. This is why the Peach Kernel Qi-Coordinating Decoction is used for a gentler treatment."