胸满者，胸膈间气塞闭也，非心下满。胁满者，胁肋下气填胀满也，非腹中
满。盖邪自表传里，必先自胸胁以至心腹而入胃，是以胸满多带表证，宜发汗。胁满者，多在半表
半里之间，宜和解。至于邪结胸中而为实者，又须涌吐之也。
太阳病，下后脉促，胸满，桂枝去芍药汤。病在于胃气，芍药入荣，故去之。
阳明病，喘而胸满，犹带表证，不可下，与麻黄汤、麻黄杏仁甘草石膏汤。
胸胁俱满，或胁下硬痛，或呕吐，舌上白苔，或不大便，并属小柴胡汤。
伤寒五七日，往来寒热，胸胁若满，默默不饮食，心烦喜呕，或胁下痞硬，柴胡加牡蛎汤。
伤寒七八日，下之，胸满烦惊，小便不利，谵语，一身尽痛，不可转侧，柴胡加龙骨牡蛎汤；
胸中痰实，瓜蒂散吐之。胸膈不快，填满闭塞，唇青手冷，脉细沉，少情绪，或腹痛，此名太阴。
经曰∶病发于阳而反下之，热入因作结胸。注曰∶发热恶寒者，发于阳也。外
证项强，心下满硬而痛是也。此为实邪在里，法当下之。若脉浮大，若表证，若水气填，不可下。亦
有不因下而心下硬满者。经曰∶病患手足厥，脉乍紧，邪结胸中，心满而烦，饥不欲食；当吐之。
是则病在胸中也。经曰∶阳明病，心下硬满，不可下，下之，利不止而死。是则邪气自表传里，留
于心下，未全为实，法当吐之，故有此戒。其或结胸证具而烦躁者，不治。
结胸，寸脉浮，关尺皆沉紧，宜下。若脉浮大，或有表证，先用小柴胡汤，表已解，下之。大
结胸，不按而痛连脐腹，痛硬不可近，大陷胸汤；或太峻，用丸。
小结胸，按之而痛，心下硬，小陷胸汤。热实结胸，懊 烦渴，心下痛，少与大陷胸汤。寒实
结胸，无热证，三物白散、枳实理中丸。
For severe heat and extreme thirst, use Heinu Wan (Black Slave Pill). For heatstroke causing thirst, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).
"Fullness in the chest" refers to the obstruction and closure of Qi in the chest and diaphragm region, not fullness below the heart (epigastrium). "Fullness in the hypochondrium" refers to the filling and distension of Qi under the ribs, not fullness in the abdomen. This is because pathogenic factors transmitting from the exterior to the interior must first pass through the chest and hypochondrium before entering the epigastrium and stomach. Therefore, chest fullness is often accompanied by exterior syndromes and should be treated with sweating methods. Hypochondriac fullness usually occurs between the exterior and interior and should be treated with harmonizing methods. As for cases where pathogenic factors knot in the chest forming excess syndromes, emetic methods must be used.
In Taiyang Disease (Taiyang Disease), if pulse acceleration and chest fullness occur after purgation, use Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia). The pathology lies in the disturbance of Stomach Qi; since Shaoyao (Paeonia Root) enters the Ying (Nutritive) level, it is removed.
In Yangming Disease (Yangming Disease), if panting and chest fullness occur while still carrying an exterior syndrome, purgation is contraindicated. Administer Mahuang Tang (Ephedra Decoction) or Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction).
If both the chest and hypochondrium are full, or there is hardness and pain under the hypochondrium, vomiting, a white coating on the tongue, or constipation, these all fall under the indication for Xiaochaihu Tang (Minor Bupleurum Decoction).
In Cold Damage disease lasting five to seven days, if there are alternating chills and fever, chest and hypochondriac fullness, silent demeanor with loss of appetite, irritability and frequent vomiting, or hardness beneath the hypochondrium, use Chaihu Jia Muli Tang (Bupleurum with Oyster Shell Decoction).
In Cold Damage disease lasting seven to eight days, if purgation was performed leading to chest fullness, irritability and fright, difficulty in urination, delirious speech, generalized body pain, and inability to turn the body, use Chaihu Jia Longgu Muli Tang (Bupleurum with Dragon Bone and Oyster Shell Decoction); if there is phlegm-excess in the chest, use Goudi San (Melon Stalk Powder) to induce vomiting. If the chest and diaphragm feel uncomfortable, filled and blocked, with blue lips, cold hands, fine and deep pulse, low mood, or abdominal pain, this is named Taiyin Disease (Taiyin Disease).
The Classics state: When a disease originating in the Yang stage is mistakenly treated with purgation, heat enters and causes Jie Xiong (Knotting Chest Syndrome). The commentary notes: Fever and aversion to cold indicate origin in the Yang stage. External signs include stiffness of the neck and fullness, hardness, and pain below the heart. This represents excess pathogens in the interior, and according to the method, purgation should be used. However, if the pulse is floating and large, if there are still exterior signs, or if there is fluid retention, purgation is contraindicated. There are also cases of hardness and fullness below the heart not caused by mistaken purgation. The Classics state: When patients have cold extremities, sudden tightness of the pulse, pathogens knotted in the chest, mental fullness and vexation, hunger but no desire to eat, emesis should be induced. This indicates the pathology is in the chest. The Classics state: In Yangming Disease, hardness and fullness below the heart are contraindications for purgation; if purged, diarrhea will persist until death. This indicates that pathogens transmitted from the exterior remain below the heart and have not fully formed excess; thus, emesis is indicated, hence this warning. Cases where Jie Xiong symptoms are complete but accompanied by restlessness are considered incurable.
For Jie Xiong, the cun pulse is floating, while guan and chi pulses are sunken and tight; purgation is appropriate. If the pulse is floating and large, or if there are exterior signs, first use Xiaochaihu Tang (Minor Bupleurum Decoction); once the exterior is resolved, proceed with purgation. For Major Jie Xiong (Major Knotting Chest Syndrome), pain radiates to the umbilicus and abdomen even without pressure, and the area is painful, hard, and intolerant to touch; use Daxiexiong Tang (Major Downward Draining Decoction for the Chest). If this is too harsh, use pills.
For Minor Jie Xiong (Minor Knotting Chest Syndrome), pain occurs only upon pressure, with hardness below the heart; use Xiaoxiexiong Tang (Minor Downward Draining Decoction for the Chest). For Heat-Excess Jie Xiong, characterized by profound stifling sensation, vexation, thirst, and pain below the heart, administer small doses of Daxiexiong Tang (Major Downward Draining Decoction for the Chest). For Cold-Excess Jie Xiong, with no heat signs, use Sanwu Baisan (Three-Ingredient White Powder) or Zhishi Lizhong Wan (Aurantium and Immature Bitter Orange Pill to Regulate the Middle).