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Formulas for cooling heat in the qi aspect are applicable for heat in the yangming in cold damage syndromes or heat in the qi aspect in the warm diseases. Other than excessive heat in the qi aspect, which damages the body fluid with the symptoms of strong fever, vexation and thirst, great sweating, aversion to heat, surging and powerful pulse, the symptoms such as generalized heat with profuse sweating, vexation and oppression in the heart and chest, dry mouth and red tongue caused by heat remaining in the qi aspect, and both damage to qi and body fluid are identifiable in clinic. Due to the perfusion of evil heat in the qi aspect, the diseased region is always characterized by formless evil heat in the qi aspect though it refers to the lung, the chest and the diaphragm, the stomach and intestine, and the liver and gallbladder. Formulas for cooling heat in the qi aspect are mainly composed of acrid and cold or bitter and cold medicinals for clearing heat and draining fire, shí gāo (Gypsum Fibrosum), zhī mŭ (Rhizoma Anemarrhenae), zhú yè (Herba Lophatheri), zhī zĭ (Fructus Gardeniae) or huáng qín (Radix Scutellariae), and huáng lián (Rhizoma Coptidi), etc. are often used. According to the difference in the degree of the heat syndrome and the combined evil qi, the combination involves the following aspects:
For example, mài dōng (Radix Ophiopogonis), xuán shēn (Radix Scrophulariae), shēng dì (Radix Rehmanniae), lú gēn (Rhizoma Phragmitis). Fire is a yang pathogen and its nature is to cause flaming heat, therefore it can burn yin fluid and often forces body fluid to leak from the exterior. Therefore, excessive heat in the qi aspect is often combined with consumption and damage of yin body fluid to various degrees. Alternatively, deficient yin fluids lead to and increase heat, which aggravates further the excessive heat in the qi aspect. Wu Tang indicated that: “ Warmth and heat are yang pathogen, and predominant yang can damage yin of the human body ” (温热阳邪也，阳盛伤人之阴也); “ excessive heat will certainly damage yin ” (热之所过，其阴必伤), cited from Systematic Differentiation of Warm Pathogen Diseases . Zhang Bing-cheng also emphasized that: “ Summer-heat burning and steaming qi will always cause damage to the lung; lung damage requires assistance from the stomach leading to exhaustion of stomach fluid ”(凡暑热炎蒸之气，无不有伤于肺，肺伤必求救于胃，于是胃汁被耗), cited from Convenient Reader of Established Formulas . This shows profound revelations about the characteristics of the pathomechanisms that excessive heat in the qi aspect will damage body fluid and shows that medicinals for nourishing yin and engendering body fluid are the important compatible methods in formulas for cooling heat in the qi aspect. For example, Bái Hŭ Tāng (White Tiger Decoction)recorded in the Discussion on Cold Damage is for treating excessive heat syndromes of the yangming in the qi aspect. In addition to the heavy amount of shí gāo (Gypsum Fibrosum)used as the chief medicinal for clearing excess heat in the yangming of the qi aspect, bitter, cold, and moist zhī mŭ (Rhizoma Anemarrhenae)is used for clearing heat as well as nourishing yin and engendering body fluid and is used as the deputy medicinal in combination with jīng mĭ (Semen Oryza Sativa). Gān căo (Radix et Rhizoma Glycyrrhizae) is used to supplement the stomach and preserve body fluid as the assistant medicinal. This formula has become famous as the “ supreme formula for draining stomach fire and engendering body fluid ” (泻胃火、生津液之上剂), cited from Formula Discussions by Famous Physicians from the Past and Present. Zhú Yè Shí Gāo Tāng (Lophatherum and Gypsum Decoction) recorded in the Discussion on Cold Damage is formulated for the syndromes of advanced stage warm-heat disease, residual heat, and damage to both qi and yin. The formulation deletes zhī mŭ (Rhizoma Anemarrhenae) from Bái Hŭ Tāng (White Tiger Decoction) and then adds rén shēn (Radix et Rhizoma Ginseng), mài dōng (Radix Ophiopogonis), zhú yè (Herba Lophatheri), and bàn xià (Rhizoma Pinelliae), namely “ the great cold formula is changed into a formula for clearing and supplementing ”, cited from Golden Mirror of the Medical Tradition - Discussions of Selected Formulas from Eminent Physician. The combination of mài dōng (Radix Ophiopogonis) and jīng mĭ (Semen Oryza Sativa) for nourishing yin and engendering body fluid in this formula also belongs to this kind of compatible method. Experts in warm disease in later generations emphasized that gaining one percent of body fluid means gaining one percent of survival in the treatment of warm disease, and paid close attention to the combination of medicinals for nourishing yin and engendering body fluid. Take Dōng Dì Sān Huáng Tāng (Ophiopogon and Raw Rehmannia Three Yellows Decoction, 冬地三黄汤) recorded in the Systematic Discussion on Warm Pathogen Diseases as an example, while bitter and cold huáng lián (Rhizoma Coptidis), huáng qín (Radix Scutellariae), and huáng băi (Cortex Phellodendri Chinensis) are used in this formula for clearing heat and draining fire, freeing and removing heat nodes from the small intestine; a large group of sweet and cold medicinals for nourishing yin and engendering body fluid such as shēng dì (Radix Rehmanniae), xuán shēn (Radix Scrophulariae), mài dōng (Radix Ophiopogonis), yín huā lù (银花露, Lonicerae Distillatum Floris), and lú gēn (Rhizoma Phragmitis) are used in a large dosage. This formula is mainly indicated for warm disease in the yangming with damaged yin by evil heat and inhibited urination. Regarding the combination essence of “ the combination of sweet and bitter ” (甘苦合化) and sweet and cold medicinals larger than those bitter and cold, Wu Tang indicated that: “ The warm disease is dry and heating in property. To relieve the dryness of warm disease, the dryness should be moistened first without the mere application of bitter and cold medicinals, which will aggravate the dryness. …I have seen many patients with warm disease die from the exhaustion of body fluid caused by the abuse of bitter and cold medicinals. …Take Dōng Dì Sān Huáng Tāng(Ophiopogon and Raw Rehmannia Three Yellows Decoction) as an example, medicinals sweet and cold constitute eighty or ninety percent of it, while bitter and cold medicinals take merely ten or twenty percent ” (温病燥热，欲解其燥，先滋其干，不可纯用苦寒也，服之反燥甚。……吾见温病而恣用苦寒，津液干涸不救者甚多. ……冬地三黄汤，甘寒十之八、九，苦寒仅十之一、二耳), cited from Systematic Discussion on Warm Pathogen Diseases . Many of the formulas for cooling heat in the qi aspect formulated by experts on warm disease in the Qing Dynasty have such compatible characteristics.
Regarding the selection of medicinals for clearing heat in formulas for cooling heat in the qi aspect, acrid and cold or bitter and cold medicinals, moist in texture and with concurrent effects of clearing heat and nourishing yin, such as shí gāo (Gypsum Fibrosum), and zhī mŭ (Rhizoma Anemarrhenae), which are both first-rate medicinals for clearing heat and engendering body fluid, and thus often chosen as the first choice. As is shown by the result of the experimental study through the observation of the fever reducing effect of each component in Bái Hŭ Tāng (White Tiger Decoction)in a family rabbit pharmacological model, both the zhī mŭ (Rhizoma Anemarrhenae) group and shí gāo (Gypsum Fibrosum) group lowered the body temperature by 0.7℃, the combined group of shí gāo (Gypsum Fibrosum) and zhī mŭ (Rhizoma Anemarrhenae) by 1.2℃ and the complete formula by 1.3℃ (Chinese Pharmacological Journal, 1981, 3:61). From this it can be seen that shí gāo (Gypsum Fibrosum) and zhī mŭ (Rhizoma Anemarrhenae)used as the first choice not only embody the compatible method of medicinals in mutual promotion, but also have the experimental evidence for strengthening the effect of clearing heat and draining fire. When bitter and cold medicinals for clearing heat are used as the main components, large amounts of sweet and cold medicinals for engendering body fluid are generally used in balance. Wu Tang stated accordingly that: “ Since the Tang and Song Dynasty, the warm disease is …always treated with incorrect use of bitter and cold medicinals, for example, groups of huáng qín (Radix Scutellariae), huáng lián (Rhizoma Coptidis), zhī mŭ (Rhizoma Anemarrhenae), and huáng băi (Cortex Phellodendri Chinensis), which leads to more dryness. When applying the formulas composed of huáng qín (Radix Scutellariae) and huáng lián (Rhizoma Coptidis), groups of sweet and cold medicinals should definitely be used for supervision, to achieve the effect of clearing heat and transforming yin without producing dryness ” (唐、宋以来，治温热病者……则恣用苦寒，大队芩、连、知、柏，愈服愈燥.于应用芩、连方内，必大队甘寒以监之，但令清热化阴，不令化燥), cited from Systematic Discussion on Warm Pathogen Diseases ; a statement based on experience.
Regarding the selection of medicinals for nourishing yin and engendering body fluid in formulas for clearing the qi aspect, firstly, medicinals for clearing heat and engendering body fluid are recommended such as shēng dì (Radix Rehmanniae), xuán shēn (Radix Scrophulariae), mài dōng (Radix Ophiopogonis), lú gēn (Rhizoma Phragmitis), etc., for they are the most suitable for syndromes of damage to the body fluid due to excessive heat, because of their effects of nourishing yin and engendering body fluid, combined with concurrent good effects of clearing and resolving the heat evil; secondly, medicinals for supplementing qi and engendering body fluid are recommended such as xī yáng shēn (西洋参, Radix Panacis Quinquefolii), rén shēn (Radix et Rhizoma Ginseng), etc. Evil heat causes the damage of yin and forces the leakage of body fluid combined with qi desertion; or summer-heat damages qi and qi leakage in turn causes perspiration, thus causing the syndromes of damage in both the qi and body fluid. Xī yáng shēn (Radix Panacis Quinquefolii) and rén shēn (Radix et Rhizoma Ginseng) are often used in combination for treating syndromes of damage in both qi and body fluid caused by exuberant heat in the qi aspect or residual heat, because of their effects of greatly nourishing original qi and also boosting qi and engendering body fluid; thirdly, medicinals for boosting the stomach and preserving body fluid are recommended such as jīng mĭ (Semen Oryza Sativa). Medicinals very cold for clearing heat are liable to injure the stomach qi, and transform and engender the source of yin fluid which is the spleen and stomach. “ Jīng mĭ (Semen Oryza Sativa), mild in smell and flavor, can support digestion of food, it can keep away the worry of the damage to the spleen and stomach by ying and cold medicinals, when combined with the two medicinals (shí gāo - Gypsum Fibrosum and zhī mŭ - Rhizoma Anemarrhenae) as an assistant medicinal ” (粳米气味温和，禀容平之德，作甘稼穑，得二味（石膏、知母）为佐，阴寒之物庶务伤损脾胃之虑也), cited from Formula Discussions by Famous Physicians from the Past and Present. It was also recorded in the Essays on Medicine Esteeming the Chinese and Respecting the Western that “ The reason of using jīng mĭ (Semen Oryza Sativa) is that its thick juice can balance shí gāo (Gypsum Fibrosum), a mineral medicinal, and bring it into harmony with the stomach ” (用粳米者，取其汁浆浓郁，能调石膏金石之药，使之与胃相宜也). All types of the medicinals above can be selected for application, with discretion, in clinic.
For example, dòu chĭ (Semen Sojae Praeparatum), bò he (Herba Menthae), chán yī (Periostracum Cicadae), jú huā (Flos Chrysanthemi), etc. Generally speaking, when pathogenic heat has recently entered the qi aspect, with syndromes in the defensive aspect still not being resolved, or depressed heat remaining in the chest and diaphragm with the diseased region close to the upper and middle jiao ; or for insubstantial evil heat in the qi aspect penetrating from the exterior and unresolved, then formulas for cooling heat in the qi aspect are often combined with acrid and cool medicinals that can release the exterior, for relieving external pathogen in the defensive aspect, or dispersing depressed heat in the chest and diaphragm, or clearing and dispersing pathogenic heat in the qi aspect, to attain the effects of dispelling pathogens to the exterior, in addition to the effect of clearing interior heat, thus improving the curative effects. For this combination, Wu Kun-an held that: “ For syndromes with heat pathogen still being retained in the qi aspect and unexhausted body fluid, chái hú (Radix Bupleuri), gé gēn(Radix Puerariae Lobatae), huáng qín (Radix Scutellariae), lián qiào (Fructus Forsythiae), or zhī zĭ (Fructus Gardeniae), dòu chĭ (Fermented Soybean), lián qiào (Fructus Forsythiae), bò he (Herba Menthae), which are light in nature, can be used to clear heat and disperse the exterior and then pathogen may be dispelled to the muscle layer and can be resolved ” (热邪尚在气分，津液未亡，不妨用柴、葛、芩、翘，或栀、豉、翘、薄之类，轻清泄热透表，邪亦可外达肌分而解也), cited from Thorough Understanding of Cold Damage ( Shāng Hán Zhĭ Zhăng , 伤寒指掌). Zhang Xi-chun indicated:“ A large group of cold or cool medicinals combined with light medicinals for clearing and diffusing, can dispel internal heat from the striae and interstitial space to the skin and hair and then be expelled ” (大队寒凉之品与清轻宣散之品相并，自能排逐内蕴之热，息息自腠理达于皮毛以透出也), cited from Essays on Medicine Esteeming the Chinese and Respecting the Western . Zhī Zĭ Chĭ Tāng (Gardenia and Fermented Soybean Decoction, 栀子豉汤)recorded in the Discussion on Cold Damage is originally for treating symptoms of generalized fever, anguish, vacuity, vexation, and insomnia, caused by blockage in the qi aspect with residual heat in the chest and diaphragm, in cold damage, though excess pathogen is eliminated after the perspiration, emesis, and purgation. Bitter and cold zhī zĭ (Fructus Gardeniae) is applied in this formula for draining fire, and removing heat and eliminating vexation; and acrid and cool dòu chĭ (Semen Sojae Praeparatum) is used for diffusing and dispersing, expelling pathogen and smoothing the middle. The combination of the two medicinals combines the effect of clearing in expelling, thus achieving the joint effect of clearing and diffusing the depressed heat from the chest and diaphragm. Hán Jiĕ Tāng (Cold-Resolving Decoction, 寒解汤) recorded in Essays on Medicine Esteeming the Chinese and Respecting the Western is mainly for treating symptoms of generalized strong fever, heat vexation in the heart with thirst or constant headache and general sense of constriction, etc. , caused by pathogen entering the qi aspect of the yangming while also with “ unresolved external evil in the taiyang ” (太阳之表，犹未尽罢) in cold damage and warm disease. This formula imitated the concept of Bái Hŭ Tāng (White Tiger Decoction), it is composed of shí gāo (Gypsum Fibrosum), and zhī mŭ (Rhizoma Anemarrhenae) as the main components for clearing heat in the qi aspect and yangming , and was combined with acrid and cool chán yī (Periostracum Cicadae), lián qiào (Fructus Forsythiae) for releasing the exterior to cause heat in the yangming to return to the taiyang and be resolved through perspiration, thus it was an effective formula for clearing heat by using cold and cool medicinals, resolving the exterior and expelling pathogens. The other examples such as the combination with bò he (Herba Menthae), shēng má (Rhizoma Cimicifugae), and chái hú (Radix Bupleuri) in Pŭ Jì Xiāo Dú Yĭn (Universal Salvation Toxin-Dispersing Beverage, 普济消毒饮), from the Dong Yuan Tried and True Prescriptions ( Dōng Yuán Shì Xiào Fāng , 东垣试效方); the combination with chán tuì (Periostracum Cicadae) and jiāng cán (Bombyx Batryticatus) in Xiăo Qīng Liáng Săn (Minor Cooling Powder, 小清凉散), from the Systematic Differentiation of Cold Damage and Warm Epidemics ( Shāng Hán Wēn Yì Tiáo Biàn , 伤寒温疫条辨); the combination with bò he (Herba Menthae), hé yè (荷叶, Folium Nelumbinis), and zhú yè (Herba Lophatheri)in Xīn Jiā Bái Hŭ Tāng (Newly Amended White Tiger Decoction, 新加白虎汤), from the Popular Guide to the Discussion on Cold Damage ; and the combination with bò he (Herba Menthae), lián qiào (Fructus Forsythiae), and jú huā (Flos Chrysanthemi) in Shàng Qīng Wán (Upper-Body-Clearing Pill, 上清丸) in the Pharmacopaeia of the People’s Republic of China (中国药典, Zhōng Guó Yào Diăn ), all of these belong to this kind of compatible method.
Aside from this there were many formulas for clearing heat which could also achieve the effect of clearing and diffusing the pathogenic heat by the combination of acrid and warm medicinals for resolving the exterior before the Ming and Qing Dynasties. The two reasons are as follow: First, the influence of the habitual application of acrid and warm medicinals for resolving the exterior in the Han and Tang Dynasty; and second, these kind of formulas are mostly composed of a large group or amount of cold and cool medicinals for clearing heat with the combination of a small amount of acrid and warm medicinals for resolving the exterior. With the interaction after the combination of the two kinds of medicinals, the acrid and warm is eliminated while the effect of dispersing and expelling evils is retained, thus achieving the effect of clearing internal heat. For example, Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) recorded in the Discussion on Cold Damage consists of acrid and cold shí gāo (Gypsum Fibrosum) for clearing heat at a dosage that is double that of the acrid and warm má huáng (Herba Ephedrae)for resolving the exterior; it became the most famous formula for diffusing and draining with the acrid and cool, and clearing the lung and calming panting. Medical experts later often changed the compatible proportion between shí gāo (Gypsum Fibrosum) and má huáng (Herba Ephedrae) in the original formula, holding that shí gāo (Gypsum Fibrosum) should be several times or even ten times more than má huáng (Herba Ephedrae) in dosage. Zhang Xi-chun had the unique view on that by claiming that: “ The original formula should be modified according to syndromes for application. Therefore when I use this formula, shí gāo (Gypsum Fibrosum) is always ten times more than má huáng (Herba Ephedrae) in dosage, namely má huáng (Herba Ephedrae) one qian and shí gāo (Gypsum Fibrosum) one liang; or má huáng (Herba Ephedrae) one and half qian and shí gāo(Gypsum Fibrosum) one and half… Shí gāo(Gypsum Fibrosum) can be applied heavier in dosage for severe heat syndromes. I once used má huáng (Herba Ephedrae) in one qian and two liang of shí gāo (Gypsum Fibrosum) for treating diphtheria syndromes and scarlet fever syndromes, though throat diseases prohibit the use of má huáng (Herba Ephedrae), but the large quantity of shí gāo (Gypsum Fibrosum) applied as assistant to make use of the force of má huáng(Herba Ephedrae) achieves miraculous effects ”(用此方时，原宜因证为之变通. 是以愚用此方时，石膏之分量恒为麻黄之十倍，或麻黄一钱，石膏一两；或麻黄钱半，石膏两半……若遇热重者，石膏又可多用. 曾治白喉证及烂喉痧证，麻黄用一钱，石膏恒重至二两，喉症最忌麻黄，而能多用石膏以辅弼之，则不惟不忌，转能借麻黄之力而见奇功也), cited from Essays on Medicine Esteeming the Chinese and Respecting the Western . This is a statement based on experience. In the application of this formula in the modern clinic, the ratio of dosage between shí gāo (Gypsum Fibrosum) and má huáng (Herba Ephedrae) is 5:1 for treating heat congestion in the lung with perspiration and panting, and 3:1 for treating heat block in the lun g without perspiration but with panting. This method with a modified dosage according to the pathogenic condition is more relevant to clinical practice. Another example is Shí Gāo Tāng (Gypsum Decoction, 石膏汤)quoted by the Arcane Essentials from the Imperial Library from the Profound Formulas from a Master ( Shēn Shī Fāng , 深师方), where shí gāo (Gypsum Fibrosum), huáng lián (Rhizoma Coptidis), huáng qín (Radix Scutellariae), huáng băi (Cortex Phellodendri Chinensis), and zhī zĭ (Fructus Gardeniae) are applied in large dosages for draining fire and resolving toxicity, má huáng (Herba Ephedrae)and xiāng dòu chĭ (香豆豉, Semen Sojae Praeparatum) are combined for promoting sweating and resolving the exterior, thus it is an effective formula for treating heat in both the exterior and the interior with exuberant fire in the san jiao . To sum up, it is easy to find that the combination of acrid and cool medicinals for releasing the exterior or the acrid and warm for resolving the exterior in formulas for clearing heat is a consideration from different compatible perspectives. The aim of the former is to complement each other, and the latter to oppose each other but also complement each other, reflecting the character of compatible methods in formulas for clearing heat in different periods of the disease process with the idea of attaining the same effect by a different treatment.
For example, dà huáng (Radix et Rhizoma Rhei). For symptoms of excessive heat in the qi aspect of upper and middle jiao with concurrent dyspepsia, or dry stool mutually binding in the stomach and intestine, merely clearing heat lacks the necessary power to attain effective treatment. Therefore, one often must address intense evil heat on the basis of position and aspect as well as the complex of internal heat and its seriousness and the degree of urgency. Thus, it is necessary to consider the direction of treatment and the compatibility of medicines using cold purgating medicinals so as to rake the firewood from beneath the cauldron to augment the heat clearing action. Zhang Bingcheng once stated that: “ Fire pathogen flaming up to the upper and middle jiao and dyspepsia in the stomach binding without dissipating. …fire dissipates and overflows from the interior to the exterior and can be cleared and dissipated for recovery. If they are pressed and have form they cannot be dissipated, the disease cannot be cured until one gets rid of the binds ”(火邪至于上、中二焦，与胃中宿食渣滓之物结而不散. ……若火之散漫者，或在里，或在表，皆可清之、散之而愈，如夹有形之物结而不散者，非去其结，则病终不痊), cited from Convenient Reader of Established Formulas . Therefore, the combination with purgating medicinals in formulas for clearing heat has clinical significance for clearing the origin. For example, Dà Huáng Huáng Lián Xiè Xīn Tāng (Rhubarb and Coptis Heart-Draining Decoction, 大黄黄连泻心汤) recorded in the Discussion on Cold Damage and Xiè Xīn Tāng (Heart-Draining Decoction) in the Essentials from the Golden Cabinet both contain bitter and cold huáng lián (Rhizoma Coptidis) and huáng qín (Radix Scutellariae) for clearing heat, draining fire, and resolving toxicity, in combination with dà huáng (Radix et Rhizoma Rhei) for freeing the bowels and opening binds to reinforce the effect of clearing heat and draining fire, and are regarded as the representative formulas with simultaneous application of clearing and purgating therapy applied by later doctors. Liáng Gé Săn (Diaphragm-Cooling Powder) recorded in the Formulary of the Bureau of Medicines of the Taiping Era is mainly for treating syndromes of excessive evil heat in the upper and middle jiao . While zhī zĭ (Fructus Gardeniae), huáng qín (Radix Scutellariae), lián qiào (Fructus Forsythiae), zhú yè (Herba Lophatheri), and bò he (Herba Menthae) are applied for clearing heat and cooling the diaphragm, simultaneously dà huáng (Radix et Rhizoma Rhei) and máng xiāo (Natrii Sulfas) are combined for draining heat to free the bowels and conduct the heat downward. The combination of these two kinds of medicinals address the upper and middle jiao heat, free excess, clear the upper, drain the lower, and diaphragm heat should clear spontaneously eliminating various diseases. This formula is not exclusive for attacking to loosen the bowels, though is composed of medicinals for draining and freeing the fu organs. It is formulated for clearing and draining the chest and diaphragm fire-heat, even though there is not constipation and yet there is scorching heat in the chest and diaphragm, if there is burning it can also be employed. This shows the original intention of the name of this formula as “Diaphragm-Cooling”(凉膈). In Systematic Differentiation of Cold Damage and Warm Epidemics , Yang Li-shan in the Qing Dynasty recorded fifteen famous formulas for treating warm disease, nine of which i. e. Shēng Jiàng Săn (Ascending and Descending Powder, 升降散), Qīng Huà Tāng (Clearing and Transforming Decoction, 清化汤), Zēng Sŭn Sān Huáng Shí Gāo Tāng (Modified Three Yellows and Gypsum Decoction, 增损三黄石膏汤), Zēng Sŭn Dà Chái Hú Tāng (Modified Major Bupleurum Decoction, 增损大柴胡汤), Zēng Sŭn Shuāng Jiĕ Săn (Modified Double Resolution Powder, 增损双解散), Jiā Wèi Liáng Gé Săn (Supplemented Diaphragm-Cooling Powder, 加味凉膈散), Jiā Wèi Liù Yī Shùn Qì Tāng (Supplemented Six-To-One Qi-Normalizing Decoction, 加味六一顺气汤), Zēng Sŭn Pŭ Jì Xiāo Dú Yĭn (Modified Universal Salvation Toxin-Dispersing Beverage, 增损普济消毒饮), Jiĕ Dú Chéng Qì Tāng (Toxin-Resolving Qi-Coordinating Decoction, 解毒承气汤) all contain dà huáng (Radix et Rhizoma Rhei) and máng xiāo (Natrii Sulfas). This indicates the universality of the combination with cool purgating medicinals in the formulas for clearing heat. Modern study in pharmacology has indicated that purgating medicinals can regulate the gastric function and strengthen enterokinesia, improve blood circulation, and decrease the capillary permeability, thus having the effect of relieving fever and acting as an antiinflammatory. In recent years, the experimental study on Qīng Yí Tāng (Pancreas-Clearing Decoction) showed that the simple application of pú gōng yīng (Herba Taraxaci) or zĭ huā dì dīng (紫花地丁, Herba Violae) in this formula could increase the peristaltic format of the intestinal tract, without causing diarrhea. When combined with dà huáng (Radix et Rhizoma Rhei) and máng xiāo (Natrii Sulfas), its purgating effect can be achieved by strengthening rhythmic peristalsis of the intestinal tract, thus biliary tract inflammation and pancreatitis can be relieved by promoting the draining of the bile and pancreatic juices into the intestinal tract, recored in Compiled Medical Materials ( Yī Xué Zī Liào Huì Biān , 医学资料汇编, 1982, 86). It can be seen that the combination of formulas for clearing heat with purgating medicinals can really improve the effect of clearing heat.
It should be noted that the decocting or other preparation methods of the medicinals should be emphasized besides selecting those cold purgating medicinals with the combined effects of draining and clearing heat such as dà huáng (Radix et Rhizoma Rhei) and máng xiāo (Natrii Sulfas) as the best choice in the combination of purgating medicinals in formulas for clearing heat. Firstly, the purgating medicinals are mostly decocted with medicinals for clearing heat, which is different from the method of “decocting later” (后下) of the purgating medicinals in purgating formulas. Although the purgating function of those purgating medicinals will be reduced after the long simultaneous decoction with formulas for clearing heat, the effect of clearing heat will not be weakened, which meets the requirement of reinforcing the effect of clearing heat by the combination with purgating medicinals in formulas for clearing heat. This is shown by the rare notation of later decoction by doctors, in prescribing formulas for clearing heat comprised of combined purgating medicinals. Secondly, the heavy and turbid flavor of these medicinals should be avoided to promote the function of clearing insubstantial evil heat. As for Dà huáng Huáng Lián Xiè Xīn Tāng (Rhubarb and Coptis Heart-Draining Decoction) recorded in the Discussion on Cold Damage , “ soak in two liters of Má Fèi Tāng (Boiled Water Decoction, 麻沸汤) for a while and then filter to remove the residual. Warm it and then take in several doses ” (以麻沸汤二升渍之，须臾，绞去滓，分温再服). Wang Hu believed that “ because of the thin smell and flavor, it is slow in property and retains in the diaphragm, and can drain glomus and heat qi under the heart ” (取其气味皆薄，则性缓恋膈，能泻心下痞热之气), cited from Extensive Annotations to the Differentiation of Patterns in the Discussion on Cold Damage ( Shāng Hán Lùn Biàn Zhèng Guăng Zhù , 伤寒论辨证广注). Xu Da-chun indicated that:“ The most miraculous point of this method is the soaking method instead of decoction, to achieve the effect of flushing the evil in the upper jiao with its light and clearing property ”(此又法之最奇者，不取煎而取泡，欲其轻扬清淡，以涤上焦之邪), cited from Categorization of Formulas from the Discussion on Cold Damage . In the analytical comparison between Dà Huáng Huáng Lián Xiè Xīn Tāng (Rhubarb and Coptis Heart-Draining Decoction) recorded in the Discussion on Cold Damage and Xiè Xīn Tāng (Heart-Draining Decoction) in the Essentials from the Golden Cabinet , the former takes the boiling water for soakage to drain heat and eliminate glomus for treating formless heat evil accummulation forming heat glomus below the heart; the latter takes the simultaneous decoction in water emphasizing downbearing fire and stopping bleeding, for treating intense fire-heat forcing the blood to move frenetically with blood ejection and spontaneous external bleeding. It is not difficult to see that the difference between various decocting methods of formulas for clearing heat combined with purgating medicinals directly influences the efficacy in treating illness and disease syndromes.
In clinic, the compatible proportion of the purgating medicinals can be increased properly for syndromes of intense heat in the qi aspect with concurrent severe fu excess and heat accumulation. For example, both Xuān Bái Chéng Qì Tāng (White-Diffusing Coordinating Decoction) recorded in the Systematic Differentiation of Warm Pathogen Diseases and Bái Hŭ Chéng Qì Tāng (White Tiger Coordinating Decoction)in the Popular Guide to the Discussion on Cold Damage consists of dà huáng (Radix et Rhizoma Rhei) and máng xiāo (Natrii Sulfas)in large dosages for draining heat accumulation, making it a formula that puts equal emphasis on both clearing heat and purgating. Regarding the proportion of purgating medicinals in the formulas for clearing heat, it usually depends on the degree of fu excess and heat accumulation. If fu excess and heat accumulation are the main symptoms, the combination of the purgating medicinals should be emphasized. So the category of this formula has changed to the field of the compatible methods in purgating formulas.
For example, líng yáng jiăo (羚羊角, Cornu Saigae Tataricae), gōu téng (钩藤, Ramulus Uncariae Cum Uncis), jú huā (Flos Chrysanthemi), jiāng cán (Bombyx Batryticatus), tiān má (天麻, Rhizoma Gastrodiae), etc. Intense heat in the yangming can burn body fluid and damage yin, leading to the loss of nutrition of the sinews and vessels; or intense heat in the qi aspect, latent evil liver wind, often causes high fever, tetany leading to coma. Intense heat in the yangming and qi aspect is the root of stirred wind, it is necessary to clear heat completely; but because liver wind is stirred, the therapy of extinguishing wind and checking tetany should also be taken into consideration. Zhao Shao-qin, a contemporary doctor, suggested that: “ Intense heat in the qi aspect can stir the liver wind. The pathogenesis is of the qi aspect, thus the treatment should focus on treating qi… Moreover, heat in the qi aspect can invade the liver, liver wind is stirred, therefore líng yáng jiăo (Cornu Saigae Tataricae), gōu téng (Ramulus Uncariae Cum Uncis), jú huā(Flos Chrysanthemi), jiāng cán (Bombyx Batryticatus) should be combined as the assistant medicinals for cooling the liver and clearing heat, calming the liver and extinguishing wind ”(气分热炽，引动肝风，其病变之由，在于气分，故治当以气分为主. ……又因气分之热，淫及于肝，肝风已动，故须同时佐以羚羊角、钩藤、菊花、僵蚕之类药物，以凉肝清热，平肝熄风), cited from the Comprehensive Discussion on Warm Diseases . Therefore, medicinals for extinguishing wind and checking tetany are often combined in formulas for clearing heat in the qi aspect in clinical therapy for syndromes of intense heat stirring wind, in this way, one can achieve a more effective therapy by simultaneously considering the root and branch. For example, Xī Líng Bái Hŭ Tāng (Rhinoceros Horn and Antelope White Tiger Decoction, 犀羚白虎汤), from the Revised and Expanded Discussion on Warm-Heat Pathogen Diseases ( Chóng Dìng Guăng Wēn Rè Lùn , 重订广温热论), combines shuĭ niú jiăo (Cornu Bubali), líng yáng jiăo (Cornu Saigae Tataricae) and gōu téng (Ramulus Uncariae Cum Uncis) for clearing heat and cooling the liver, extinguishing wind and checking tetany, based on Bái Hŭ Tāng (White Tiger Decoction) for clearing heat and draining fire, eliminating anxiety and checking thirst, thus becoming the typical formula for clearing heat and extinguishing wind. Líng Má Bái Hŭ Tāng (Antelope and Gastrodia White Tiger Decoction, 羚麻白虎汤) recorded in the Treatment Strategies and Formulas in Chinese Medicine ( Zhōng Yī Zhì Fă Yŭ Fāng Jì , 中医治法与方剂), also comprised Bái Hŭ Tāng (White Tiger Decoction)and was combined with líng yáng jiăo (Cornu Saigae Tataricae), tiān má (Rhizoma Gastrodiae)for extinguishing wind and checking tetany, with guā lóu rén (Semen Trichosanthis), and chuān bèi (川贝, Bulbus Fritillariae Cirrhosae) for clearing heat and transforming phlegm, thus it is appropriate for syndromes of stirred wind due to intense heat with concurrent phlegm-heat.
According to the close causality between intense heat and the liver wind, medicinals with the function of extinguishing wind and checking tetany, with concurrent effects of clearing heat are recommended, such as líng yáng jiăo (Cornu Saigae Tataricae), gōu téng (Ramulus Uncariae Cum Uncis), and so on, in combination in formulas for clearing heat in the qi aspect. The primary and secondary considerations in the clinic when treating intense heat and liver wind should be: Clearing heat as the focus combined with extinguishing wind and checking tetany; or extinguishing wind and checking tetany as the focus, with clearing heat. For the latter therapy, the compatible methods in formulas for treating wind can be referred to for comparison, for comprehensive analysis.